Applied Research in Quality of Life

, Volume 9, Issue 2, pp 309–324 | Cite as

Quality of Family Relationships as Protective Factors of Eating Disorders: An Investigation Amongst Italian Teenagers



The study here presented aims to investigate the links between quality of family relationships and some prodromes in eating disorders. A sample of 1,083 subjects took part in the study by filling PBI, FACES and EDI questionnaires. In order to clarify the role played by family relationships in the onset of EDs, two subgroups (high risklow risk) were individuated by using the EDI cut-offs as discriminator factors and tested separately from the main sample. The results revealed some significant relationships between the analysed dimensions. It was shown that by increasing the values from the parents’ caring style scale and the real family’s cohesiveness scale the probability for subjects to fall into the high risk group decreases. Also, by increasing the family adaptability’s values, an increase of the probability for subjects to fall into the high risk group occurs. These results support the implementation of preventive and therapeutic plans to promote health and quality of life of adolescence.


Quality of family relationships Risk of eating disorder Health promotion Prevention 


  1. Abbate Daga, G., Gramaglia, C., Malfi, G., & Fassino, P. (2007). Eating problems and personality traits. An Italian pilot study among 992 high school students. European Eating Disorders Review, 15(6), 471–478.CrossRefGoogle Scholar
  2. Benninghoven, D., Tetsch, N., Kunzendorf, S., & Jantschek, G. (2007). Body image in patients with eating disorders and their mothers, and the role of family functioning comprehensive. Psychiatry, 48, 118–123.Google Scholar
  3. Bruch, H. (1974). Eating disorders: obesity, anorexia nervosa and the person within. New York: Basic Books.Google Scholar
  4. Calam, R., Waller, G., Slade, P., & Newton, T. (1990). Eating disorders and perceived relationships with parents. International Journal of Eating Disorders, 9, 79–85.CrossRefGoogle Scholar
  5. Canetti, L., Kanyas, K., Lerer, B., Latzer, Y., & Bachar, E. (2008). Anorexia nervosa and parental bonding: the contribution of parent–grandparent relationships to eating disorder psychopathology. Journal of Clinical Psychology, 64(6), 703–716.CrossRefGoogle Scholar
  6. Claes, L., Vandereycken, W., & Vertommen, H. (2004). Family environment of eating disordered patients with and without self-injurious behaviours. European Psychiatry, 19, 494–498.CrossRefGoogle Scholar
  7. Crisp, A. H., Gowers, S., Joughin, N., McClelland, L., Rooney, B., Nielsen, S., et al. (2006). Anorexia nervosa in males: similarities and differences to anorexia nervosa in females. European Eating Disorders Review, 14, 163–167.CrossRefGoogle Scholar
  8. Crow, S. J., Peterson, C. B., Swanson, S. A., Raymond, N. C., Specker, S., Eckert, E. D., et al. (2009). Increased mortality in Bulimia Nervosa and other eating disorders. Source American Journal of Psychiatry, 166, 1342–1346.CrossRefGoogle Scholar
  9. Cuffe, S. P., Mckeown, R. E., Addy, C. L., & Garrison, C. Z. (2005). Family and psychosocial risk factors in a longitudinal epidemiological study of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 121–129.CrossRefGoogle Scholar
  10. Day, J., Schmidt, U., Collier, D., Perkins, S., Van den Eynde, F., Treasure, J., Yi, I., Winn, S., Robinson, P., Murphy, R., Keville, S., Johnson-Sabine, E., Jenkins, M., Frost, S., Dodge, L., Berelowitz, M., & Eisler, I. (2011). Risk factors, correlates, and markers in early-onset bulimia nervosa and EDNOS. International Journal of Eating Disorders, 44(4), 287–294.CrossRefGoogle Scholar
  11. Eisler, I. (2005). The empirical and theoretical base of family therapy and multiple family day therapy for adolescent anorexia nervosa. Journal of Family Therapy, 27, 104–131.CrossRefGoogle Scholar
  12. Eisler, I., Dare, C., Russell, G., Szmukler, G., le Grange, D., & Dodge, E. (1997). A five-year follow up of a controlled trial of family therapy in severe eating disorders. Archives of General Psychiatry, 54, 1025–1030.CrossRefGoogle Scholar
  13. Eisler, I., Dare, C., Hodes, M., Russell, G., Dodge, E., & Le Grange, D. (2000). Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. Journal of Child Psychology and Psychiatry, 41(6), 727–736.CrossRefGoogle Scholar
  14. Eisler, I., Simic, M., Russell, G. F., & Dare, C. (2007). A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. Journal of Child Psychology and Psychiatry, 48, 552–560.CrossRefGoogle Scholar
  15. Emanuelli, F., Ostuzzi, R., Cuzzolaro, M., Baggio, F., Lask, B., & Waller, G. (2004). Family functioning in adolescent anorexia nervosa: a comparison of family members’ perceptions. Eating and Weight Disorders, 9(1), 1–6.CrossRefGoogle Scholar
  16. Erola, A., Yazicib, F., & Toprakc, G. (2007). Family functioning of patients with an eating disorder compared with that of patients with obsessive compulsive disorder. Comprehensive Psychiatry, 48, 47–50.CrossRefGoogle Scholar
  17. Fitzgerald, J., & Lane, R. C. (2000). The role of the father in anorexia. Journal of Contemporary Psychotherapy, 30(1), 71–84.CrossRefGoogle Scholar
  18. Fosse, G. K., & Holen, A. (2006). Childhood maltreatment in adult female psychiatric outpatients with eating disorders. Eating Behaviours, 7(4), 404–409.CrossRefGoogle Scholar
  19. Furnham, A., & Adam-Saib, S. (2001). Abnormal eating attitudes and behaviours and perceived parental control. Social Psychiatry and Psychiatric Epidemiology, 6, 462–470.CrossRefGoogle Scholar
  20. Garner, D. M. (1991). Eating disorder inventory-2. Professional manual. Odessa, Florida: Psychological Assessment Resources.Google Scholar
  21. Gowen, L. K., Hayward, C., Killen, J. D., Robinson, T. N., & Taylor, C. B. (1999). Acculturation and eating disorder symptom in adolescent girls. Journal of Research on Adolescence, 9(1), 67–83.CrossRefGoogle Scholar
  22. Gowers, S., & North, C. (1999). Difficulties in family functioning and adolescent anorexia nervosa. The British Journal of Psychiatry, 174, 63–66.CrossRefGoogle Scholar
  23. Gutzwiller-Jurman, K. L. (2000). Relationship between eating disorder symptomatology and perceptions of closeness-caregiving and intrusiveness in the mother-daughter and father-daughter relationship. Dissertation Abstracts International: The Sciences and Engineering, 60(8-B), 4223.Google Scholar
  24. Haworth-Hoeppner, S. (2000). The critical shapes of body image: the role of culture and family in the production of eating disorders. Journal of Marriage and the Family, 62, 212–227.CrossRefGoogle Scholar
  25. Hsiu-Lan, C., & Mallinckrodt, B. (2009). Parental bonds, anxious attachment, media internalization, and body image dissatisfaction: exploring a mediation mode. Journal of Counselling Psychology, 56(3), 365–375.CrossRefGoogle Scholar
  26. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348–358.CrossRefGoogle Scholar
  27. Kagan, D. M, & Squires, R. L. (2006). Family cohesion, family adaptability, and eating behaviors among college students. International Journal of Eating Disorders, 4, 267–279.Google Scholar
  28. Keel, P. K., & Klump, K. L. (2003). Are eating disorders culture-bound syndromes? Implications for conceptualizing their etiology. Psychological Bulletin, 129(5), 747–769.CrossRefGoogle Scholar
  29. Kluck, A. S. (2008). Family factors in the development of disordered eating: integrating dynamic and behavioral explanations. Eating Behaviors, 9, 471–483.CrossRefGoogle Scholar
  30. Kyle, S. G., Harper, J. M., Larson, H. J., Barrett, M. E., & Hardman, R. K. (2009). Implicit family process rules in eating-disordered and non-eating-disordered families. Journal of Marital and Family Therapy, 35(2), 159–174.CrossRefGoogle Scholar
  31. Laliberté, M., Boland, F. J., & Leichner, P. (1999). Family climates: family factors specific to disturbed eating and bulimia nervosa. Journal of Clinical Psychology, 55, 1021–1040.CrossRefGoogle Scholar
  32. Latzer, Y., Hochdorf, Z., Bachar, E., & Canetti, L. (2002). Attachment style and family functioning as discriminating factors. Eating Disorders, Contemporary Family Therapy, 24, 581–599.CrossRefGoogle Scholar
  33. Le Grange, D., Lock, J., Loeb, K., & Nicholls, D. (2010). Academy for eating disorders position paper: the role of the family in eating disorders. International Journal of Eating Disorders, 43, 1–5.Google Scholar
  34. Lee, D. V., Kim, S., & Cho, D. Y. (2012). Obesity-related quality of life and distortive self body image in adults. Applied Research in Quality of Life. doi:10.1007/s11482-012-9174-x.Google Scholar
  35. Miller, M. N., & Pumariega, A. J. (2001). Culture and eating disorders: a historical and cross-cultural review. Psychiatry, 64, 93–110.Google Scholar
  36. Minuchin, S., Rosman, L., & Baker, L. (1980). Famiglie psicosomatiche: l’anoressia mentale nel contesto familiare. Roma: Astrolabio.Google Scholar
  37. Olson, D. H., Portner, J., & Bell, R. Q. (1982). FACES II: family adaptability and cohesion evaluation scales. Minnesota: Family Social Science, University of Minnesota.Google Scholar
  38. Onnis, L. (2004). Il tempo sospeso. Anoressia e bulimia tra individuo, famiglia e società. Milano: Franco Angeli.Google Scholar
  39. Onnis, L. (2010). Family and individual in adolescent mental anorexia: an experience of “suspended time”. Human Systems, 3, 41–59.Google Scholar
  40. Onnis, L., Di Gennaro, A., Cespa, G., Agostini, B., Chouhy, A., Dentale, R. C., & Quinzi, P. (1994). Sculpting present and future: a systemic intervention model applied to psychosomatic families. Family Process, 33(3), 341–355.CrossRefGoogle Scholar
  41. Onnis, L., Bernardini, M., Emili, E., Giambartolomei, A., Granese, C., Leonelli, A., & Zammataro, D. (2008). Problemi metodologici della ricerca in psicoterapia sistemica. Il modello di una indagine complessa sui DCA dell’adolescenza. Psicobiettivo, 28(1), 52–73.Google Scholar
  42. Onnis, L., Barbara, E., Bernardini, M., Di Giacomo, S., Giambartolomei, A., Leonelli, A., & Mulè, A.M., et al. (2011). Family relationships and eating diosorders. The effectiveness of an integrated approach in the treatment of adolescent anorexia and bulimia: results of a controlled systemic research. Eating and Weigh Disorders.Google Scholar
  43. Panfilis, C. D., Rabbaglio, P., Rossi, C., Zita, G., & Maggini, C. (2003). Body image disturbance, parental bonding and alexithymia in patients with eating disorders. Psychopathology, 36, 239–246.CrossRefGoogle Scholar
  44. Parker, G., Tupling, H., & Brown, L. B. (1979). A parental bonding instrument. The British Journal of Medical Psychology, 52, 1–10.CrossRefGoogle Scholar
  45. Polivy, J., & Herman, P. (2002). Causes of eating disorders. Annual Reviews Psychology, 53, 187–223.Google Scholar
  46. Rorty, M., Yager, J., Rossotto, E., & Buckwalter, G. (2000). Parental intrusiveness in adolescence recalled by women with a history of bulimia nervosa and comparison women. International Journal of Eating Disorders, 28, 202–208.CrossRefGoogle Scholar
  47. Selvini Palazzoli, M. (1997). Ragazze anoressiche e bulimiche: la terapia familiare. Milano: Cortina.Google Scholar
  48. Selvini Palazzoli, M. (2006). L’anoressia mentale: dalla terapia individuale alla terapia familiare. Milano: Cortina.Google Scholar
  49. Sim, L. A., Homme, J. H., Lteif, A. N., Vande Voort, J. L., Schak, K. M., & Ellingson, J. (2009). Family functioning and maternal distress in adolescent girls with anorexia nervosa. International Journal of Eating Disorders, 42(6), 531–539.CrossRefGoogle Scholar
  50. Soenens, B., Vansteenkiste, M., Vandereycken, W., Luyten, P., Sierens, E., & Goossens, L. (2008). Perceived parental psychological control and eating-disordered symptoms: maladaptive perfectionism as a possible intervening variable. The Journal of Nervous and Mental Disease, 196(2), 144–152.CrossRefGoogle Scholar
  51. Stice, E., Ng, J., & Shaw, H. (2010). Risk factors and prodromal eating pathology. Journal of Child Psychology and Psychiatry, 51(4), 518–525.CrossRefGoogle Scholar
  52. Striegel-Moore, R. H., & Bulik, C. M. (2007). Risk factors for eating disorders. American Psychologist, 62, 181–198.CrossRefGoogle Scholar
  53. Swanson, H., Power, K., Collin, P., Deas, S., Paterson, G., Grierson, D., et al. (2010a). The relationship between parental bonding, social problem solving and eating pathology in an anorexic inpatient sample. European Eating Disorders Review, 18, 22–32.CrossRefGoogle Scholar
  54. Swanson, H., Power, K., Collin, P., Deas, S., Paterson, G., Grierson, D., Yellowlees, A., Park, K., & Taylor, L. (2010b). The relationship between parental bonding, social problem solving and eating pathology in an anorexic inpatient sample. European Eating Disorders Review, 18, 22–32.CrossRefGoogle Scholar
  55. Turner, H., Rose, K., & Cooper, M. (2005). Schema and parental bonding in overweight and nonoverweight female adolescents. International Journal of Obesity, 29(4), 381–387.CrossRefGoogle Scholar
  56. WHO (2007). Global database on body mass index (online database). From
  57. Wisotsky, W., Dancyger, I., Fornari, V., Katz, J., Wisotsky, W. I., & Swencionis, C. (2003). The relationship between eating pathology and perceived family functioning in eating disorder patients in a day treatment program. Eating Disorders, 11, 89–99.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht and The International Society for Quality-of-Life Studies (ISQOLS) 2013

Authors and Affiliations

  • Jessica Lampis
    • 1
  • Mirian Agus
    • 1
  • Barbara Cacciarru
    • 1
  1. 1.Department of Pedagogy, Psychology, PhilosophyUniversity of CagliariCagliariItaly

Personalised recommendations