Skip to main content
SpringerLink
Log in

Caring for Sons with Anorexia: The Perspective of Mothers

  • Original Paper
  • Published:
Journal of Child and Family Studies Aims and scope Submit manuscript

Abstract

Little is known about the experience of caring for a son with anorexia nervosa (AN). Prior research with parents of primarily daughters with AN indicate that they experience significant distress. Ten mothers participated in semi-structured interviews regarding their experiences taking care of a son (between the ages of 11 and 18) who had inpatient treatment for AN within 2 years of the interview and was residing at home. Consensual qualitative research methods were used to analyze the data. Mothers reported challenges accessing and navigating treatment, noting that front-line providers missed their sons’ AN because of their gender. Once their sons were diagnosed, mothers continued to experience distress and described negative changes in family relationships, including increased conflict with the diagnosed son, strained sibling relationships, and marital stress. The gender-atypical nature of AN negatively impacted perceived social support. Despite these negative findings, living with AN also offered an opportunity for growth, with some mothers reporting increased closeness with the diagnosed son, greater family unification, and strengthening of the marital bond. Based on these findings, it is recommended that treatment professionals provide greater psychological support and resources to mothers, who often assume primary caregiver responsibilities, and make treatment settings and approaches more gender inclusive.

Highlights

  • Mothers experienced psychological distress, shame, guilt, isolation, self-doubt, and felt blamed by others.

  • Obtaining an accurate diagnosis and appropriate treatment were perceived to be more difficult, due to their son’s gender.

  • Mothers described receiving less social support, which they ascribed to their sons’ gender-atypical illness.

  • Mothers reported challenges with healthcare professionals, including pediatricians, who minimized and dismissed their concerns.

  • Validating mothers’ concerns and helping them find support may enhance their functioning as caregivers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.

  • American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060–1073.

    Article  Google Scholar 

  • Anastasiadou, D., Sepulveda, A. R., Sánchez, J. C., Parks, M., Álvarez, T., & Graell, M. (2016). Family functioning and quality of life among families in eating disorders: a comparison with substance-related disorders and healthy controls. European Eating Disorders Review, 24(4), 294–303. https://doi.org/10.1002/erv.2440.

    Article  PubMed  Google Scholar 

  • Andersen, A. (2014). A brief history of eating disorders in males. In L. Cohn & R. Lemberg (Eds), Current findings on males with eating disorders (pp. 4–10). Routledge.

  • Barry, S. (2013). Dying to be perfect: a mother’s story of her son’s battle with anorexia. KCM Publishing.

  • Bunkley, D. T., Robinson, J. D., Bennett, N. E., & Gordon, S. (2000). Breast cancer in men: emasculation by association? Journal of Clinical Psychology in Medical Settings, 7, 91–97.

    Article  Google Scholar 

  • Bunnell, D. W., & Maine, M. (2014). Understanding and treating males with eating disorders. In L. Cohn & R. Lemberg (Eds), Current findings on males with eating disorders (pp. 168–182). Routledge.

  • Cohn, L., & Lemberg, R. (Eds.). (2014). Current findings on males with eating disorders. Routledge.

  • Domine, F., Berchtold, A., Akre, C., Michaud, P. A., & Suris, J. C. (2009). Disordered eating behaviors: what about boys. Journal of Adolescent Health, 44, 111–117. https://doi.org/10.1016/j.jadohealth.2008.07.019.

    Article  Google Scholar 

  • Eisler, I. (2009). Anorexia nervosa and the family. In J. H. Bray & M. Stanton (Eds.), The Wiley-Blackwell handbook of family psychology (pp. 551–563). John Wiley & Sons.

  • Fox, J. R. E., Dean, M., & Whittlesea, A. (2017). The experience of caring for or living with an individual with an eating disorder: a meta‐synthesis of qualitative studies. Clinical Psychology & Psychotherapy, 24(1), 103–125. https://doi.org/10.1002/cpp.1984.

    Article  Google Scholar 

  • Goodier, G. H. G., McCormack, J., Egan, S. J., Watson, H. J., Hoiles, K. J., Todd, G., & Treasure, J. L. (2014). Parent skills training treatment for parents of children and adolescents with eating disorders: a qualitative study. International Journal of Eating Disorders, 47(4), 368–375. https://doi.org/10.1002/eat.22224.

    Article  PubMed  Google Scholar 

  • Gorrell, S., & Murray, S. B. (2019). Eating disorders in males. Child and Adolescent Psychiatric Clinics of North America, 28(4), 641–651. https://doi.org/10.1016/j.chc.2019.05.012.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gueguen, J., Godart, N., Chambry, J., Brun-Eberentz, A., Foulon, C., Divac, S. M., & Huas, C. (2012). Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality. International Journal of Eating Disorders, 45, 537–545. https://doi.org/10.1002/eat.20987.

    Article  PubMed  Google Scholar 

  • Haigh, R., & Treasure, J. (2003). Investigating the needs of the carers in the area of eating disorders: development of the carers’ needs assessment measure (CaNAM). European Eating Disorders Review, 11, 125–141. https://doi.org/10.1002/erv.487.

    Article  Google Scholar 

  • Hill, C. E. (Ed.). (2011). Consensual qualitative research: a practical resource for investigating social science phenomena. American Psychological Association.

  • Hill, C. E., & Knox, S. (2021). Essentials of consensual qualitative research. American Psychological Association. http://dx.doi.org.liblink.uncw.edu/10.1037/0000215-000.

  • Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., & Ladaney, N. (2005). Consensual qualitative research: an update. Journal of Counseling Psychology, 52, 196–205. https://doi.org/10.1037/0022-0167.52.2.196.

    Article  Google Scholar 

  • Karp, S., Keitel, S., Houtz, J., & Jackson, M. (2016). Hidden biases of psychological clinicians against mothers of daughters with anorexia nervosa. Poster, American Psychological Association, Denver.

  • Keitel, M. A., Parisi, M., Whitney, J. L., & Stack, L. F. (2010). Salient stressors for mothers of children and adolescents with anorexia nervosa. Eating Disorders: The Journal of Treatment & Prevention, 18, 435–444. https://doi.org/10.1080/10640266.2010.511937.

    Article  Google Scholar 

  • Kyriacou, O., Treasure, J., & Schmidt, U. (2008). Understanding how parents cope with living with someone with anorexia nervosa: modeling the factors that are associated with carer distress. International Journal of Eating Disorders, 41, 233–242. https://doi.org/10.1002/eat.20488.

    Article  PubMed  Google Scholar 

  • 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. https://doi.org/10.1002/eat.20751.

    Article  PubMed  Google Scholar 

  • Matthews, A., Lenz, K. R., Peugh, J., Copps, E. C., & Peterson, C. M. (2018). Caregiver burden and illness perceptions in caregivers of medically hospitalized youth with anorexia nervosa. Eating Behaviors, 29, 14–18.

    Article  PubMed  Google Scholar 

  • Murray, S. B., Nagata, J. M., Griffiths, S., Calzo, J. P., Brown, T. A., Mitchison, D., Blashill, A. J., & Mond, J. M. (2017). The enigma of male eating disorders: a critical review and synthesis. Clinical Psychology Review, 57, 1–11. https://doi.org/10.1016/j.cpr.2017.08.001.

    Article  PubMed  Google Scholar 

  • Murray, S. B., & Touyz, S. W. (2013). How do clinicians in the field conceptualize muscle dysmorphia? Advances in Eating Disorders: Theory, Research, and Practice, 1, 207–212.

    Article  Google Scholar 

  • Nagata, J. M., Brown, T. A., Lavender, J. M., & Murray, S. B. (2021). Eating disorders in boys and men. Springer.

  • Pasold, T. L., Boateng, B. A., & Portilla, M. G. (2010). The use of a parent support group in the outpatient treatment of children and adolescents with eating disorders. Eating Disorders: The Journal of Treatment & Prevention, 18(4), 318–332. https://doi.org/10.1080/10640266.2010.490121.

    Article  Google Scholar 

  • Quadflieg, N., Strobel, C., Naab, S., Voderholzer, U., & Fichter, M. M. (2019). Mortality in males for an eating disorder: a large prospective study. International Journal of Eating Disorders, 52, 1365–1369.

    Article  PubMed  Google Scholar 

  • Richardson, C., & Paslakis, G. (2020). Men’s experiences of eating disorder treatment: a qualitative systematic review of men-only studies. Journal of Psychiatric and Mental Health Nursing, 28, 237–250.

    Article  PubMed  Google Scholar 

  • Ridout, S. (2016). Update: teenage boys with EDs have higher psychiatric burden. Eating Disorders Review, 27. Retrieved from http://eatingdisordersreview.com/teenage-boys-with-eds-have-a-high-psychiatric-burden/.

  • Rosen, D. S. (2010). Identification and management of eating disorders in children and adolescents. Pediatrics, 126, 1240–1253. https://doi.org/10.1542/peds.2010-2821.

    Article  PubMed  Google Scholar 

  • Sabel, A. L., Rosen, E., & Mehler, P. S. (2014). Severe anorexia nervosa in males: clinical presentations and medical treatment. Eating Disorders: The Journal of Treatment and Prevention, 22, 209–220. https://doi.org/10.1080/10640266.2014.890459.

    Article  Google Scholar 

  • 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, 531–747. https://doi.org/10.1002/eat.20654.

    Article  PubMed  Google Scholar 

  • Sangha, S., Oliffe, J. L., Kelly, M. T., & McCuaig, F. (2019). Eating disorders in males: how primary care providers can improve recognition, diagnosis, and treatment. American Journal of Men’s Health, 13(3). https://doi.org/10.1177/1557988319857424.

  • Stein, R. E. K., & Jessop, D. J. (2003). The impact on Family Scale revisited: further psychometric data. Journal of Development and Behavioral Pediatrics, 24, 9–16. https://doi.org/10.1097/00004703-200302000-00004.

    Article  Google Scholar 

  • Stillar, A., Strahan, E., Nash, P., Files, N., Scarborough, J., Mayman, S., Henderson, K., Gusella, J., Connors, L., Orr, E. S., Marchand, P., Dolhanty, J., & Lafrance Robinson, A. (2016). The influence of carer fear and self-blame when supporting a loved one with an eating disorder. Eating Disorders, 24(2), 173–185. https://doi.org/10.1080/10640266.2015.1133210.

    Article  PubMed  Google Scholar 

  • Tierney, S. (2005). The treatment of adolescent anorexia nervosa: a qualitative study of the views of parents. Eating Disorders: The Journal of Treatment and Prevention, 13, 369–379. https://doi.org/10.1080/10640260591005254.

    Article  Google Scholar 

  • Tuval-Mashiach, R., Hasson-Ohayon, I., & Ilan, A. (2014). Attacks on linking: stressors and identity challenges for mothers of daughters with long lasting anorexia nervosa. Psychology & Health, 29, 613–631. https://doi.org/10.1080/08870446.2013.879135.

    Article  Google Scholar 

  • Vo, M., Lau, J., & Rubinstein, M. (2016). Eating disorders in adolescent and young adult males: presenting characteristics. Journal of Adolescent Health, 59, 397–400.

    Article  Google Scholar 

  • Whitney, J. L. (2015). Caring for a son with anorexia: the psychosocial impact on mothers. ETD Collection for Fordham University. AAI3713964. https://research.library.fordham.edu/dissertations/AAI3713964.

  • Whitney, J., Haigh, R., Weinman, J., & Treasure, J. (2007). Caring for people with eating disorders: factors associated with psychological distress and negative caregiving appraisals in carers of people with eating disorders. British Journal of Clinical Psychology, 46, 413–428. https://doi.org/10.1348/014466507X173781.

    Article  PubMed  Google Scholar 

  • Williams, E. P., Russell-Mayhew, S., Moules, N. J., & Dimitropoulos, G. (2020). “My whole world fell apart”: Parents discovering their child has anorexia nervosa. Qualitative Health Research, 30(12), 1821–1832. https://doi.org/10.1177/1049732320939508.

    Article  PubMed  Google Scholar 

  • Wooldridge, T., & Lyte, P. (2012). An overview of anorexia nervosa in males. Eating Disorders: The Journal of Treatment and Prevention, 20, 268–278. https://doi.org/10.1080/10640266.2012.715515.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of North Carolina, Wilmington, 601 S. College Road, Wilmington, NC, 28403, USA

    Jessica Lennon Whitney

  2. Fordham University at Lincoln Center, Graduate School of Education, 113 West 60th Street, New York, NY, 10023, USA

    Merle A. Keitel, Joseph G. Ponterotto & Erin Ott

  3. Holy Family University, Graduate Counseling Psychology Department, One Campus Drive, Newtown, PA, 18940, USA

    Melinda Parisi Cummings

Authors
  1. Jessica Lennon Whitney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Merle A. Keitel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melinda Parisi Cummings
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph G. Ponterotto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erin Ott
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to writing or editing of the manuscript.

Corresponding author

Correspondence to Merle A. Keitel.

Ethics declarations

Conflict of Interest

This manuscript is based on an IRB-approved nonfunded qualitative study and presents no conflict of interest. This manuscript is based on the dissertation of the first author that was supervised by the second author as mentor and the third and fourth authors as readers. The fifth author was a member of the research team. All authors contributed to writing or editing of the manuscript.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Interview Protocol

  • What do you think is most important for me to know about your experience?

  • What was it that first alerted you to the fact that your son was struggling with his eating, body image, and/or weight?

  • When your son received a diagnosis of AN, could you describe how you felt?

  • How, if at all, were your relationships affected during this time, including with your son?

  • What did you do to cope throughout diagnosis and treatment?

  • Please describe the process of accessing services and working with medical and mental health professionals.

  • What challenges, if any, do you believe were exacerbated by the fact that you were dealing with a son, rather than a daughter, with AN?

  • Overall, how would you say this experience has affected you?

  • If you had to summarize the most stressful aspects (top 2–3) of this experience, what would they be?

  • Overall, how was your marriage affected by your son’s AN?

  • Overall, how, if at all, were the relationships among your family members affected?

  • What do you believe were the contributing factors to your son’s illness?

  • Is there anything we haven’t talked about that you think is important for me to know about your experience?

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Whitney, J.L., Keitel, M.A., Cummings, M.P. et al. Caring for Sons with Anorexia: The Perspective of Mothers. J Child Fam Stud 32, 2637–2651 (2023). https://doi.org/10.1007/s10826-022-02525-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-022-02525-5

Keywords

Search

Navigation