Living with someone with an eating disorder: factors affecting the caregivers’ burden

  • Maria Cristina StefaniniEmail author
  • Maria Rita Troiani
  • Michela Caselli
  • Paolo Dirindelli
  • Stefano Lucarelli
  • Saverio Caini
  • Maria Grazia Martinetti
Original Article


We focused on carers of subjects suffering from eating disorders (ED), and studied the characteristics that mostly expose them to high levels of stress, anxiety, depression and expressed emotion, favoring the accommodation of the family system to the cared person. We administered the accommodation and enabling scale for eating disorders (AESED) questionnaire, the family questionnaire (FQ) and the depression, anxiety and stress scale (DASS-21) questionnaire to 97 carers of 62 ED patients, and investigated the carer’s characteristics associated with the scores in the three questionnaires. A personal history of ED, being the primary carer, and caring for a person with a diagnosis of anorexia nervosa are the characteristics that contribute most to aggravate the carers’ burden in terms of stress, anxiety, depression, accommodation and enabling. Our findings may help doctors to provide effective support to caregivers and eventually improve the treatment of subjects with ED.


Caregiver burden Eating disorder Burden aggravating factors Maintenance factors 


Compliance with ethical standards

Conflict of interest

All Authors declare they have no conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in this study.


  1. 1.
    Anastasiadou D, Medina-Pradas C, Sepulveda AR, Treasure J (2014) A systematic review of family caregiving in eating disorders. Eat Behav 15(3):464–477. CrossRefPubMedGoogle Scholar
  2. 2.
    Goddard E, Macdonald P, Sepulveda AR, Naumann U, Landau S, Schmidt U, Treasure J (2011) Cognitive interpersonal maintenance model of eating disorders: intervention for carers. Br J Psychiatry 199:225–231. CrossRefPubMedGoogle Scholar
  3. 3.
    Treasure J, Schmidt U (2013) The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord 1:13. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    NICE, National Collaborating Centre for Mental Health (2014) Eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Number CG9. The British Psychological Society LondonGoogle Scholar
  5. 5.
    Hay P, Chinn D et al (2014) Royal Australian and New Zealand college of psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry 48(11):1–62. DOICrossRefGoogle Scholar
  6. 6.
    Sepúlveda AR, Graell M, Berbel E, Anastasiadou D, Botella J, Carrobles JA et al (2012) Factors associated with emotional well-being in primary and secondary caregivers of patients with eating disorders. Eur Eat Disord Rev 20(l):e78–84. CrossRefPubMedGoogle Scholar
  7. 7.
    Vall E, Wade TD (2015) Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. Int J Eat Disord 7:946–971. CrossRefGoogle Scholar
  8. 8.
    Schmidt U, Treasure J (2006) Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. Br J Clin Psychol 45:343–366CrossRefGoogle Scholar
  9. 9.
    Treasure J, Sepulveda AR, Macdonald P, Lopez C, Zabala MJ, Kyriacou O et al (2008) Interpersonal maintaining factors in eating disorder: skill sharing interventions for carers. Int J Child Adolesc Health l(4):33 l-8Google Scholar
  10. 10.
    Treasure J, Rhind C, Macdonald P, Todd G (2015) Collaborative care: the new maudsley model. Eat Disord 23:366–376. CrossRefPubMedGoogle Scholar
  11. 11.
    Treasure J et al (2015) Collaborative care: the new maudsley model. Eat Disord 1–11.
  12. 12.
    Zabala MJ, Macdonald P, Treasure J (2009) Appraisal of caregiving burden expressed emotion and psychological distress in families of people with eating disorders: a systematic review. Eur Eat Disord Rev 17(5):338–349. CrossRefPubMedGoogle Scholar
  13. 13.
    Treasure J, Palazzo Nazar B (2016) Interventions for carers of patients with eating disorders. Curr Psychiatry Rep 18:16. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Sepulveda AR, Kyriacou O, Treasure J (2009) Development and validation of the accommodation and enabling scale for eating disorders (AESED) for caregivers in eating disorders. BMC Health Serv Res 9:171. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Wiedemann et al (2002) The Family Questionnaire: development and validation of a new self-report scale for assessing expressed emotion. Psychiatry Res 109(3):265–279CrossRefGoogle Scholar
  16. 16.
    Lovibond SH, Lovibond PF (1995) Manual for the depression anxiety stress scales (DASS). Psychology Foundation MonographGoogle Scholar
  17. 17.
    Bottesi G, Ghisi M, Altoè G, Conforti E, Melli G, Sica C (2015) The Italian version of the depression anxiety stress scale-21: factor structure and psychometric properties on community and clinical samples. Compr Psychiatry 60:170–181. CrossRefPubMedGoogle Scholar
  18. 18.
    Macdonald P, Rhind C, Hibbs R, Goddard E, Raenker S, Todd G, Schmidt U, Treasure J (2014) Carers’ assessment, skills and information sharing (CASIS) trial: a qualitative study of the experiential perspective of caregivers and patients. J Eur Eat Disord Rev 22:430–438. CrossRefGoogle Scholar
  19. 19.
    Gonzalez N, Padierna A et al (2012) Predictors of change in perceived burden among caregivers of patients with eating disorders. J Affective Disorders 139(3) 273–282. CrossRefGoogle Scholar
  20. 20.
    Treasure J, Smith G, Crane A (2017) Skills-based caring for a loved one with an eating disorder, RoutledgeGoogle Scholar
  21. 21.
    Graap H, Bleich S, Herbst F, Trostmann Y, Wancata J, de Zwaan M (2008) The needs of carers of patients with anorexìa and bulimia nervosa. Europ Eat Disord Rev 16:21–29. CrossRefGoogle Scholar
  22. 22.
    Hibbs R, Rhind C, Leppanen J, Treasure J (2014) Interventions for caregivers of someone with an eating disorder: a meta-analysis. Int I Eating Disord. CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Maria Cristina Stefanini
    • 1
    Email author
  • Maria Rita Troiani
    • 1
  • Michela Caselli
    • 1
  • Paolo Dirindelli
    • 2
  • Stefano Lucarelli
    • 2
  • Saverio Caini
    • 3
  • Maria Grazia Martinetti
    • 1
  1. 1.Neurofarba Department, Children’s Hospital MeyerUniversity of FlorenceFlorenceItaly
  2. 2.Mental Health ServiceToscana CentroItaly
  3. 3.Unit of Cancer Risk Factors and Lifestyle EpidemiologyCancer Research and Prevention Institute (ISPO)FlorenceItaly

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