The Behavioral Traits and Dyadic Relationship Between Mother and Child as Predictors of Anorexia Nervosa 

Author’s Note

This literature review holds deep significance for me as a survivor of anorexia nervosa. By the time I received my diagnosis in 2016, I was already entrenched in a relentless cycle of restriction, self-judgment, and unattainable goals. I believed that losing weight would bring a sense of control and fulfillment, yet any intake of food felt like a failure. While anorexia nervosa perpetuated my dissatisfaction and distorted my self-worth, its impact ultimately shaped my path toward recovery and resilience. 

Through a combination of sharing my personal journey and extensive research, my goal has been to contribute to the academic discussion on the psychological and sociocultural factors influencing anorexia nervosa. Specifically, this review examines the dyadic mother-child relationship and challenges treatment models that focus primarily on the individual. Instead, I advocate for a more comprehensive, family-centered approach that recognizes the influence of maternal behaviors and attitudes. This perspective underscores the need for tailored interventions that address both the individual and the family unit in the treatment and prevention of anorexia nervosa.

Introduction 

The enigma surrounding the development of eating disorders, particularly anorexia nervosa (AN), has been the center of attention for researchers and clinical psychologists. Eating disorders are defined by a disturbance in eating habits that are either excessive or insufficient.             

The root cause is believed to arise from the interaction of multiple etiologies, including biological, psychological, and sociocultural. The tightly woven network of these multiple factors make the study of AN strenuous. Furthermore, adolescence represents a relevant developmental stage during which important changes in self-concept, body image perception, peer influence, and emotional-regulation occur. For these characteristics, researchers indicate adolescence as a developmental phase that is at risk for the onset of eating disorders (Erriu, Cimino, & Cerniglia, 2020). There has also been a growing consensus among researchers and clinicians implicating family-related factors in the emergence of disordered eating in adolescence (Keel, Heatherton, Harnden, & Hornig, 1997). As a result, researchers are increasingly shifting their attention to the dyadic relationship between individuals with AN and their mothers. More recently, studies such as those by Cerniglia et al. (2017) and Martini et al. (2023) have examined the role of family interactions, particularly mother-child dynamics, in the development of AN.

AN is inherently self-deceptive because patients often believe that achieving their desired weight loss or a "perfect" body will resolve their problems. Theorists offer different explanations for the development of AN; however, when comparing these perspectives, several common factors emerge. These include a lack of open and honest communication within the family, the need to protect certain family members, often through distorted perceptions of reality, and the resulting lack of trust in relationships (Dalzel, 2000). Generally, patients with AN are treated without taking a look at their parental environment. However, we can discover and create preventative treatments based on the research found linking behavioral traits and the dyadic relationship between mother and child as predictors of anorexia nervosa. 

Anorexia Nervosa 

As defined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013), AN is a common eating disorder characterized by patterns of serious diet restriction and a phobia of weight gain, paired with a constant attempt to maintain body weight below minimally normal weight (85%) or body mass index <17.5 for age and height. This deadly disease affects people of all ages, sexes, and walks of life, and can be categorized under two subtypes known as the restricting type and the binge eating/ purging type. 

Anorexia Nervosa Subtypes 

As noted by the American Psychiatric Association (n.d.), individuals with the restricting subtype avoid caloric intake, while those with the binge-eating/purging subtype also engage in starvation periods but intermittently compensate through binge eating and purging behaviors (e.g., self-induced vomiting, laxative abuse, diuretic misuse, excessive exercise). A study by Casper et al. (1980) found that approximately 53% of individuals with AN were classified as having the restricting subtype, while 47% fell under the binge-eating/purging subtype. Similarly, Reas and Rø (2018) reported that 54.9% of their sample met the criteria for the restricting type, whereas 45.1% were categorized under the binge-eating/purging type. All in all, both subtypes are not only detrimental to one’s mental and physical health but can also be fatal. 

Physical, Psychological, and Behavioral Symptoms 

The National Eating Disorder Association (NEDA, n.d.) states that the symptoms and warning signs of AN can be categorized into three groups: physical, psychological, and behavioral. 

Prevalence 

Estimating the prevalence of AN remains a challenge. Keski-Rahkonen et al. (2007) conducted an epidemiological study assessing the prevalence, incidence, and recovery patterns of AN in the general population. Analyzing data from a cohort of Finnish women born between 1975 and 1979, they estimated that, “At any given point in time between 0.3-0.4% of young women and 0.1% of young men will suffer from anorexia nervosa.” Their findings also revealed a high prevalence of undiagnosed cases, highlighting the need for improved identification and intervention strategies. Expanding on these findings, Smink et al. (2012) conducted a meta-analysis of multiple epidemiological studies that emphasized variability in AN prevalence rates. In particular, the study concluded that the average point prevalence of AN in young females is approximately 0.29%, with estimates ranging from 0% to 0.9%, depending on assessment methods and population characteristics (Smink et al., 2012). This suggests that differences in diagnostic criteria and study design can influence reported estimates, making it difficult to determine the true scope of the disorder.

Behavioral Traits In Child 

There have been numerous studies examining the role of mother-child dynamics in the development of AN. Clinical Psychologists have deduced that the frequency and intensity of these relational patterns can serve as predictors of AN onset. Children with AN often report feeling overwhelmed by parental expectations, particularly when parents attempt to impose their attitudes toward weight and food onto their children. Franzen and Gerlinghoff (1997) suggest that these individuals also experience feelings of inadequacy, damaged self-esteem, aggression, and emotional problems. Further supporting this claim, Laghi et al. (2017) assessed family functioning from multiple family members’ perspectives during treatment for adolescent AN and found that adolescents reported greater impairment in family functioning than their mother’s reported. This was evident when they examined areas in communication, rigidity, and problem-solving, suggesting that adolescents with AN are less satisfied with their familial environment.  In a similar study, Erriu et al. (2020) gathered qualitative evidence indicating that AN patients tend to describe their family as more dysfunctional than their mothers do. Additionally, the study found that dysfunctional family relationships and inadequate parenting, including undemocratic parenting, lack of interest in the child’s life, restricted autonomy, and limited emotional involvement, can contribute to adolescent body dissatisfaction. This, in turn, increases the risk of problematic eating behaviors. 

Psychological Complaints 

Individuals with anorexia nervosa had a large number of psychological complaints. In a survey-based study that investigated psychological experiences and perceived causes of AN, Noordenbos et al. (2002) found that nearly all the respondents reported low self-esteem (90%), perfectionistic traits (88%), and a discrepancy between rationality and emotions (88%). They also had a negative body image and were obsessed with food (83%). About half of the women also had suicidal thoughts (43%). Beyond these psychological complaints, Noordenbos et al. (2002) also found that many individuals with AN attributed their emotional distress to difficulties in their early life. The majority reported persistent emotional struggles (70%), while others described strained maternal relationships (45%), family dysfunction (38%), and social isolation (28%). These findings suggest that both intrapersonal struggles and dysfunctional family dynamics play a role in AN development. Furthermore, Dalzell (2000) explored the role of interoceptive awareness in AN, emphasizing that habitual compliance to external expectations can become so ingrained that individuals lose the ability to recognize internal cues of hunger and satiety. This disruption in interoceptive skills further exacerbates psychological distress, as individuals become increasingly disconnected from their own emotional and psychological needs.

Perfectionism, a history of anxiety, and body dysmorphia frequently co-occur in individuals with AN (Jacobs et al., 2009). While these traits contribute to the psychological distress experienced by those with AN, research suggests that maternal behaviors, particularly emotional overinvolvement, may influence clinical outcomes. For instance, in a study investigating the role of high maternal emotional-involvement (EOI), Duclos et al. (2016) found that maternal behaviors, particularly EOI, can play a positive role in the recovery process. His findings highlight the need to examine the behavioral traits in mothers that may contribute to both the development and treatment of AN. 

Behavioral Traits In Mother 

There is a significant relationship between maternal expressed emotion and treatment outcome among anorexic adolescents, as well as its impact on family functioning. Women with eating disorders typically have parents who are preoccupied with weight and eating, and who use external standards to evaluate self-worth. The perfect storm of traits when examining the parent of AN patients includes patterns of control, claims of self-sacrifice, overprotective behavior, and displays of intense emotion (Duclos, Cook-Darzens, Curt, Faucher, & Berthoz, 2016). Mothers in these dyadic relationships are often characterized by the behavioral trait of overprotectiveness. Dalzell (2000) claims that the source of this overprotective behavior is often related to a family secret that is not directly addressed due to the family's relational dynamics. 

Maternal Eating Concerns 

Controlled studies of mothers of disordered eating probands have produced consistent evidence that has increased maternal eating concerns. Studies such as Pike and Rodin (1991) found that mothers of eating-disordered adolescents exhibited higher levels of disordered eating and dieting behaviors compared to mothers of adolescents without eating disorders. These mothers also rated their daughters as less attractive and in greater need of losing weight. These findings reinforce the idea that maternal attitudes and behaviors regarding food and weight may contribute to the onset of disordered eating patterns in their children. Additionally, daughters may be pressured into extreme dieting by their mothers’ criticism of their weight and may learn disordered eating patterns by modeling their mothers’ behaviors. In another study, mothers and daughters have been shown to share similar attitudes about diet and weight (Keel et al., 1997). Even mothers with a history of an eating disorder who have been symptom-free for an extended period remain at high risk of relapse when stressed. As far as the children are concerned, building on the knowledge that they are at risk of developing disturbed behavior patterns, interventions should aim to develop alternative coping strategies and a new repertoire of behavior patterns (Franzen et al., 1997). 

Maternal Attitudes and Behavior Assessments 

Researchers have used Expressed Emotion (EE) measures to assess maternal attitudes and behaviors toward an ill family member in five dimensions: hostility, emotional overinvolvement, positive remarks, warmth, and critical comments. One key finding from these studies is that maternal hostility significantly influences treatment outcomes for adolescents with AN. 

This relationship is also evident in the research conducted by Rienecke et al. (2016), which identified a significant interaction between maternal hostility and treatment effectiveness. Specifically, adolescents whose mothers exhibited higher levels of hostility reached a higher percentage of their expected body weight (EBW) in adolescent-focused therapy (AFT) compared to family-based treatment (FBT). In this context, EBW refers to a weight range deemed appropriate for an adolescent’s age, height, and developmental state. A higher percentage of EBW indicates a greater weight restoration, which is a key marker of recovery. 

Biological Influences 

The behavioral traits surrounding anorexia nervosa are heritable and may co-occur in multiple family members. These behavioral traits include perfectionism, obsessionality, anxiety, and harm avoidance. Researchers were able to narrow it down and discover the chromosomes that are correlated with each different trait. Jacob (2006) illuminated the fact that mothers of individuals with anorexia display evidence of higher levels of perfectionism and a drive for thinness relative to gender and age-matched controls.

The Interaction Between Mother and Child 

Mothers play such a significant role in the life of a child that even from an earlier age, children can succumb to eating disorder tendencies that continue to affect them throughout their lifespan. A four-year-old boy who had repeatedly witnessed his mother’s binge vomit attacks was also able to effortlessly make himself sick. The therapists observed that during the shared meals, there was a tense and cool atmosphere between mothers and their children. The mothers of daughters were concerned that they, too, might develop an eating disorder. One daughter refused to eat in the presence of strangers (Franzen et al., 1997). From this, it is evident that the quality of family functioning and the parent–child relationship deserve to be taken into account in relation to the offspring’s adaptive development (Erriu et al., 2020). Several recent studies have also shown an association between eating disorders in female adolescents, maternal psychopathology and/or psychopathological risk, anxious and depressive symptoms, eating disorders, and problematic family functioning, poor quality of relationships between family members. 

Maternal Psychopathology 

An important aspect to underline is that research in developmental psychopathology has identified maternal psychopathology as a significant risk factor for the development of emotional-behavioral problems in children (Bould et al., 2015). For instance, recent studies have found that poor maternal emotional regulation can lead to problems in family functioning due to distancing or excessive responsiveness (Lafrance Robsinson et al., 2015; Zachrisson & Skårderud, 2010). In particular, difficulties in maternal emotional regulation in families with adolescents could lead to increased risk of disordered eating behaviors for children in this particular stage of development. Moreover, a recent study has pointed out that difficulties between parents and children involve negative psychological consequences for adolescents (Erriu et al., 2020). A study in a published article conducted by Jacobs, Roesch, Wonderlich, Crosby, Thornton, and Wilfey (2009), identified patterns of behavioral traits in an Anorexia Nervosa trio consisting of a proband along with two biological parents. Latent profile analysis and Analysis of Variance (ANOVA) were utilized to pinpoint eating disorder symptoms, anxiety, perfectionism, and temperament (Canetti, Lerer, Latzer, & Bachar, 2008). In this study, ANOVA was employed to identify significant differences in eating disorder symptoms, anxiety, perfectionism, and temperament among the study participants. Results displayed that the mothers’ and probands’ drive for thinness, body dissatisfaction, perfectionism, neuroticism, trait anxiety, and harm avoidance were evident and could be separated into three different classes. The results with fathers displayed no significant differences and could not be separated into classes, which infers that the results were not wide enough of a range in numbers (Jacobs, et al., 2009). This suggests that the genetic link between mother and daughter traits is much stronger when it comes to AN.

High Maternal Emotional Over-Involvement 

In another study, Duclos et al. (2018) examined sixty adolescent females diagnosed with AN, assessing both the baseline and eighteen months later. Duclos and colleagues defined maternal emotional over-involvement (EOI) as behaviors characterized by overprotection, self-sacrifice, heightened emotional displays (e.g., crying), excessive detail about the past, and extreme expressions of love or willingness to do anything for the child. EOI was assessed using the Five-Minute Speech Sample (FMSS), in which parents spoke about their child for five minutes. The researchers concluded that high maternal EOI at baseline was associated with improved clinical state, including higher nutritional status, lower eating disorder severity, and fewer re-hospitalizations eighteen months later, thus highlighting the significance of high maternal EOI and the positive role it plays in treatment outcomes. Therefore, awareness of high maternal EOI is crucial when considering intervention strategies.

Shared Characteristics Between Mother and Child 

An article published in the Trends in Psychology and Psychotherapy presents a study that examines groups of family members of patients with eating disorders (Campos & Sampaio, 2012). Their results strengthened the belief that there are common characteristics in the mother and daughter cases of Anorexia Nervosa. The theme of mutual control, the contention between omnipotence and impotence, and the concept of devotion, passion, and destruction between mother and child are all aspects that form the basis of Anorexia Nervosa; thus, directly influencing the severity of each case and even treatment success. 

Kinship Studies 

With the attention on kinship studies, this article written by Bulik, Reba, Siega-Riz, and Reichborn-Kjennerud (2005) utilizes family and twin studies to emphasize the interaction between genetic and environmental influences and how that particular interaction ultimately leads to the risk of developing anorexia nervosa. It explains that some offspring are unfortunately exposed to a “double disadvantage” because not only are they inheriting the genes that influence

risk for anorexia, but they are also experiencing inappropriate mealtime behaviors that later on result in childhood feeding issues and future eating disorders (Bulik, et al., 2005). The interaction between genetic dispositions and environmental factors pertaining to mother and child is a dangerous combination that allows anorexia to ultimately thrive. 

Generational Trauma 

Gwen, a young woman suffering from Anorexia Nervosa, indicated that their mother was vain and self-absorbed. As a result, her experience of herself is dominated by a shapeless sense of failure, shame, and self-disgust. Gwen stated that it was very clear that she had been the object of her mother’s disappointment and disgust. Distraught, Gwen opens up to the researcher interviewing her and explains that her mother was the reason she has become just as bad as a mother to her daughter, Lucy, who then has become a subpar mother to her own daughter. (Austin, 2009). Gwen’s focus and account of her mother’s behavior and treatment provided a firsthand look into how one’s maternal figure can ultimately influence the mental and physical health of a child, especially when it pertains to a child who is suffering from anorexia.

Based on Gwen’s interactions and perspective of her mother’s treatment, one can gather that her mother only caused more pain and did nothing to alleviate nor support her through Gwen’s eating disorder. Through her distress and guilt, Gwen was able to pinpoint the issue that all began with her own mother leading up to the dissatisfactory childhood and treatment of her own granddaughter. It provides the perspective that poor parenting can lead to a snowball effect, impacting the future generations to come. Her story offers insight into the destructive impact of AN and the complex mother-daughter dynamics that contribute to the disorder.

Conclusion 

Understanding the role of family dynamics in eating disorders is essential for developing targeted intervention programs. According to Family Systems Theory, each individual within the family assumes a defined role that influences and is influenced by other members, shaping the family’s overall functioning (Minuchin, 1974). These roles and patterns of interaction establish implicit rules governing communication, emotional support, and access to resources. In families where rigid roles, high parental expectations, or enmeshment dominate, adolescents may struggle with autonomy and emotional regulation, both of which have been linked to the development of AN (Minuchin et al., 1978).

Expanding on this perspective, the systemic approach shifts the focus from the individual to the dyadic mother-child relationship. While family dynamics as a whole play a critical role, studies like Bould et al. (2015) suggests that the quality of maternal involvement is particularly significant in shaping a child’s psychological development and vulnerability to eating disorders. Rather than attributing AN solely to individual traits or behavior tendencies, research highlights the importance of the interaction between mother and child in either fostering resilience or exacerbating risk factors (Erriu et al., 2020). In many cases, maternal influence can be reinforced through dysfunctional relational patterns, such as enmeshment or over-involvement, which blur the boundaries between mother and child. These blurred boundaries can create an environment where the child struggles to develop a sense of independence, reinforcing disordered eating behaviors as a maladaptive means of control (Rowa, Kerig, & Geller, 2001). 

A crucial component in the treatment of AN is the establishment of clear boundaries within the mother-child relationship. A common finding across the studies reviewed is that whenever there are blurred boundaries, over-involvement and unhealthy relational dynamics become prevalent. For instance, Rowa et al. (2001) found that individuals with AN report significantly more parent-child boundary problems than those without the disorder. Given these findings, clinical guidance is imperative in helping parents recognize their role in shaping their child’s attitudes toward food, body weight, and self-perception. One of the most effective approaches in this area is the Maudsley Approach, which directly involves parents in the recovery process. Lock and Le Grange (2002) emphasize that increasing parental awareness of their own attitudes and behaviors can serve as a huge predictor in the recovery of AN, encouraging healthier relational patterns that support a child's psychological well-being. The study also suggests that when parents actively participate in their child’s treatment (e.g., promoting structured meal support, reducing controlling behaviors, and developing emotional responsiveness), long-term recovery outcomes improve significantly.

As research continues to underscore the complex interplay between the mother-child dyad and the emergence and persistence of  AN, it becomes evident that treatment must go beyond the individual and incorporate the family system as a whole. By promoting affective relationships (e.g., warmth, empathy, trust) and fostering healthy, communicative, and boundary-respecting family environments, interventions can more effectively enhance lasting psychological well-being for not only the individual but also the family unit. 

References 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

American Psychiatric Association. (n.d.). What are eating disorders? Retrieved June 15, 2023, from Psychiatry.org - What are Eating Disorders?

Austin, S. (2009). A perspective on the patterns of loss, lack, disappointment, and shame encountered in the treatment of six women with severe and chronic anorexia nervosa. Journal of Analytical Psychology, 54(1), 61–80. https://doi.org/10.1111/j.1468-5922.2008.01757.x

Bould, H., Sovio, U., Koupil, I., Dalman, C., Micali, N., Lewis, G., & Magnusson, C. (2015). Do eating disorders in parents predict eating disorders in children? Evidence from a Swedish cohort. Acta psychiatrica Scandinavica, 132(1), 51–59. https://doi.org/10.1111/acps.12389

Bulik, C. M., Reba, L., Siega-Riz, A., & Reichborn-Kjennerud, T. (2005). Anorexia nervosa: Definition, epidemiology, and cycle of risk. International Journal of Eating Disorders, 37(S2), S2–S9. https://doi.org/10.1002/eat.20107

Campos, L. K. S., Sampaio, A. B. R. F., Junior, C. G., Junior, R. M., de Magalhães Battistoni, M. M., & Turato, E. R. (2012). Psychological characteristics of mothers of patients with anorexia nervosa: Implications for treatment and prognosis. Trends in Psychiatry and Psychotherapy, 34(1), 13–18. https://doi.org/10.1590/S2237-60892012000100004

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. https://doi.org/10.1002/jclp.20482

Casper, R. C., Eckert, E. D., Halmi, K. A., Goldberg, S. C., & Davis, J. M. (1980). Bulimia: Its incidence and clinical importance in patients with anorexia nervosa. Archives of General Psychiatry, 37, 1030–1035. https://doi.org/10.1001/archpsyc.1980.01780220068007

Cerniglia, L., Cimino, S., Tafà, M., Marzilli, E., Ballarotto, G., & Bracaglia, F. (2017). Family profiles in eating disorders: Family functioning and psychopathology. Psychology Research and Behavior Management, 10, 305–312. https://doi.org/10.2147/PRBM.S145463

Cooper, M., Galbraith, M., & Drinkwater, J. (2001). Assumptions and beliefs in adolescents with anorexia nervosa and their mothers. Eating Disorders, 9(3), 217–223. https://doi.org/10.1080/10640260127549

Dalzell, H. J. (2000). Whispers: The role of family secrets in eating disorders. Eating Disorders, 8(1), 43–61. https://doi.org/10.1080/10640260008251211

Erriu, M., Cimino, S., & Cerniglia, L. (2020). The role of family relationships in eating disorders in adolescents: A narrative review. Behavioral Sciences, 10(4), 71. https://doi.org/10.3390/bs10040071

Franzen, U., & Gerlinghoff, M. (1997). Parenting by patients with eating disorders: Experiences with a mother-child group. Eating Disorders, 5(1), 5–14. https://doi.org/10.1080/10640269708249199

Jacobs, M. J. (2006). Temperament patterns in families of individuals with anorexia nervosa (Publication No. 3208601) [Doctoral dissertation, University of California]. ProQuest Dissertations & Theses Global. https://www.proquest.com/dissertations-theses/temperament-patterns-families-individuals-with/docview/304955257/se-2

Jacobs, M. J., Roesch, S., Wonderlich, S. A., Crosby, R., Thornton, L., Wilfley, D. E., & Bulik, C. M. (2009). Anorexia nervosa trios: Behavioral profiles of individuals with anorexia nervosa and their parents. Psychological Medicine, 39(3), 451–461. https://doi.org/10.1017/S0033291708003826

Keel, P. K., Heatherton, T. F., Harnden, J. L., & Hornig, C. D. (1997). Mothers, fathers, and daughters: Dieting and disordered eating. Eating Disorders, 5(3), 216–228. https://doi.org/10.1080/10640269708249227

Keski-Rahkonen, A., Hoek, H. W., Susser, E. S., Linna, M. S., Sihvola, E., Raevuori, A., & Rissanen, A. (2007). Epidemiology and course of anorexia nervosa in the community. American Journal of Psychiatry, 164(8), 1259–1265. https://doi.org/10.1176/appi.ajp.2007.06081388

Laghi, F., Pompili, S., Zanna, V., Tafà, M., Parisi, R., Bianchi, D., & Baiocco, R. (2017). How adolescents with anorexia nervosa and their parents perceive family functioning? Journal of Health Psychology, 22(2), 197–207. https://doi.org/10.1177/1359105315597055

Lock, J., & Le Grange, D. (2001). Treatment manual for anorexia nervosa: A family-based approach. Guilford Press.

Martini, M. G., Taborelli, E., Easter, A., Bye, A., Eisler, I., Schmidt, U., & Micali, N. (2023). Effect of maternal eating disorders on mother-infant quality of interaction, bonding, and child temperament: A longitudinal study. European Eating Disorders Review, 31(2), 335–348. https://doi.org/10.1002/erv.2960

Minuchin, S. (1974). Families and family therapy. Harvard University Press.

Minuchin, S., Rosman, B. L., & Baker, L. (1978). Psychosomatic families: Anorexia nervosa in context. Harvard University Press.

National Eating Disorders Association. (2018, August 3). Risk factors. National Eating Disorders Association. Retrieved September 7, 2022, from Eating Disorder Risk Factors

National Eating Disorders Association. (n.d.). Warning signs and symptoms of an eating disorder. Retrieved September 7, 2022, from Warning Signs and Symptoms

Noordenbos, G., Oldenhave, A., Muschter, J., & Terpstra, N. (2002). Characteristics and treatment of patients with chronic eating disorders. Eating Disorders, 10(1), 15–29. https://doi.org/10.1080/106402602753573531

Pike, K. M., & Rodin, J. (1991). Mothers, daughters, and disordered eating. Journal of Abnormal Psychology, 100(2), 198–204. https://doi.org/10.1037/0021-843X.100.2.198

Reas, D. L., & Rø, Ø. (2018). Less symptomatic, but equally impaired: Clinical impairment in restricting versus binge-eating/purging subtype of anorexia nervosa. Eating Behaviors, 28, 32–37. https://doi.org/10.1016/j.eatbeh.2017.12.004

Rienecke, R. D., Accurso, E. C., Lock, J., & Le Grange, D. (2016). Expressed emotion, family functioning, and treatment outcome for adolescents with anorexia nervosa. European Eating Disorders Review, 24(1), 43–51. https://doi.org/10.1002/erv.2389

Robinson, A. L., Dolhanty, J., & Greenberg, L. (2015). Emotion-focused family therapy for eating disorders in children and adolescents. Clinical psychology & psychotherapy, 22(1), 75–82. https://doi.org/10.1002/cpp.1861

Rowa, K., Kerig, P. K., & Geller, J. (2001). The family and anorexia nervosa: Examining parent–child boundary problems. European Eating Disorders Review, 9(2), 97–114.

Smink, F. R., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence, and mortality rates. Current Psychiatry Reports, 14(4), 406–414. https://doi.org/10.1007/s11920-012-0282-y

Zachrisson, H. D., & Skårderud, F. (2010). Feelings of insecurity: review of attachment and eating disorders. European eating disorders review : the journal of the Eating Disorders Association, 18(2), 97–106. https://doi.org/10.1002/erv.999