Michela Criscuolo

Background: Coparenting, defined as the ability of mothers and fathers to coordinate and provide mutual support in parenting, plays a key role in children’s social, emotional, and behavioral adjustment. While previous research has highlighted its influence on internalizing and externalizing problems, comparatively less is known about how children contribute to and respond to coparenting at a relational level. Objective: This study investigates coparenting behaviors in families of adolescents with restrictive eating disorders and examines their association with the patients’ interactive styles during the Lausanne Trilogue Play. We also explore potential correlations of coalition patterns with age, BMI, and clinical diagnosis. Methods: Seventy-seven adolescents with restrictive Eating Disorders (DSM-5) and their parents participated. Most families (81%) were intact. Coparenting coordination was assessed using the Coparenting and Family Rating System, while children’s interactive styles were coded using the Lausanne Trilogue Play reading grid adapted for preadolescents and adolescents. Results: Distinct coalition patterns emerged linking coparenting behaviors and adolescent interactive styles. Functional coparenting was associated with engaged child responses, whereas dysfunctional patterns corresponded to overinvolved responses. No significant correlations were found between coalition patterns and Body Mass Index, age, or specific Eating Disorders diagnosis, suggesting that these relational dynamics do not reflect current clinical status and needed more investigations. Conclusion: Identifying coalition patterns between coparenting and adolescent interactive styles provides valuable insights for family-based interventions in restrictive Eating Disorders. Such patterns allow clinicians to recognize both challenges and resources within the family system, informing psychoeducational and therapeutic strategies that integrate parental support with clinical and nutritional care.

Purpose While the impact of Covid-19 lockdowns on family dynamics and eating behaviors has been widely studied, there is limited and conflicting evidence regarding families of children and adolescents with restrictive eating disorders (EDs). This study examines differences in eating psychopathology and perceptions of family functioning in pediatric patients with anorexia nervosa (AN; restrictive and atypical) and avoidant/restrictive food intake disorder (ARFID) before and after the pandemic. Methods A total of 640 children and adolescents with restrictive EDs and their parents, assessed from January 2018 to December 2022, were grouped into pre-Covid-19, Covid-19, and post-Covid-19 periods. Measures included the Family Assessment Device, the Eating Disorders Inventory-III, and the Eating Disorders Questionnaire in Childhood. Data were analyzed using ANOVA (p < .05). Results Children and adolescents with AN showed greater difficulties compared to children and adolescents with ARFID both in family functioning and eating psychopathology. In particular, children with AN in the COVID-19 group exhibited higher scores in Affective and Mood Disorders, Obsessive–Compulsive Disorder, Pica, and Selective Eating compared to the pre-Covid-19 group. Adolescents with AN reported worse eating psychopathology in Post-COVID-19 group compared to others. Conclusions Patients with restrictive EDs show more dysfunctional family functioning and greater eating psychopathology after the pandemic compared to preceding periods but results varied by age and diagnosis. These findings highlight the need for diagnosis-specific, tailored interventions to address the evolving clinical and family dynamics in pediatric ED populations. Level of evidence: Level V Evidence obtained from a cross-sectional descriptive study.

Family functioning is a risk and maintaining factor for anorexia nervosa (AN). This study aims to identify specific areas of family functioning according to adolescents and parental perspectives associated with eating and general psychological symptoms in people with AN. Four‐hundred‐forty‐five adolescents with AN or atypical AN and their parents were enrolled. Adolescents completed the Eating Disorder Inventory‐3, the Youth Self‐Report questionnaire, and the Family Assessment Device (FAD). Their parents filled in the FAD. A network analysis was conducted including all subscales. The bridge function analysis was applied to identify the bridge nodes connecting each community constituted of family functioning perception with the communities of adolescents' eating and general psychological symptoms. Family communication was the node most strongly connecting fathers and mothers' perception of family functioning and adolescents' eating symptoms. Problem solving was the node with the highest bridge expected influence between mothers' family functioning and adolescents' general psychopathology. General functioning and problem solving were the bridge nodes between adolescents' view of family functioning and eating and general psychopathology. Maturity fear, interpersonal insecurity, and interpersonal alienation were the bridge nodes between adolescents' eating symptoms and mothers, fathers, and adolescents' family functioning communities respectively. Family members must be involved in the therapeutic process to improve family communication and problem solving diverting their attention toward emotional needs and interpersonal difficulties of adolescents with AN. Developing autonomy and independence from parents and building trustworthy relationships with peers may be favored by improving familiar dynamics and may contribute to prevent the maintenance of AN.

Eating disorders are considered one of the psychiatric disorders with a higher risk of death. Food addiction, related to some food addictive-like behaviours, is often in comorbidity with eating disorders and is associated with worse psychopathology. The present study aims to outline the food addiction profile, investigated using the Yale Food Addiction Scale 2.0 (YFAS 2.0), in 122 adolescents (median age: 15.6 years) suffering from eating disorders and to investigate its association with psychopathology. Patients filled out the Youth Self Report, the Multidimensional Anxiety Scale for Children 2, The Children Depression Inventory 2, and the Eating Disorder Inventory 3 (EDI-3). Pearson’s chi-square test and multiple correspondence analysis were used to identify profiles. The mean symptom count was 2.8 ± 2.7. The “withdrawal” symptom was the most frequent (51%) and the most associated with clinical scores. The diagnosis of bulimia nervosa and the EDI-3 bulimia scale resulted to be the only variables to be associated with positive YFAS 2.0 symptoms. Conversely, anorexia nervosa, restrictive and atypical, was not associated with YFAS 2.0 symptoms. In conclusion, outlining the food addiction profile of eating disorders may give information about a patient’s phenotype and could help to identify specific treatment models.

Emotional availability (EA) is a complex construct describing the emotional bond between parents and child, and it refers to support, sensitivity, warmth and closeness. Few studies have investigated the perception of parental EA and its association with dysfunctional eating pattern. The aim of the study is to explore the perception of mothers’ and fathers’ EA of adolescents with anorexia nervosa (AN) and any differences between the two subtypes of binge–purge (B/P) or restrictive (R) AN. Furthermore, it investigates the association of parental EA with AN symptomatology and with patients’ perception of family functioning, which is identified as a maintenance factor for AN. A total of 60 adolescents between 12 and 18 years and their parents (n = 120) were recruited in two eating disorder (ED) specialized care centers. Patients completed the LEAP and the FACES IV questionnaires evaluating parental EA and family functioning, respectively. Results showed no difference between AN subtypes, but a greater perception of mother when compared to father EA was found. Moreover, the EA construct was found not to be associated with ED symptomatology but with a greater positive family functioning. Our study is the first that explores EA in AN, and results suggest the importance of considering parents’ emotional engagement as part of the treatment core, together with the eating symptomatology management.

Studies about family functioning in adolescent anorexia nervosa (AN) are conflicting and often do not consider the possible differences between the restricting and binge/purging subtypes (AN-R and AN-B/P). Moreover, an underestimated element is the quality of the coparenting relationship, that is, the level of coordination and agreement between parents, as well as the methods of managing parental conflict. The study aims to explore family functioning, coparenting and conflict management in a sample of 60 adolescents with AN-R and AN-B/P and their relations with AN severity in terms of body mass index (BMI). Patients and parents completed the following questionnaires: Family Adaptability and Cohesion Evaluation Scales, Coparenting Scale-Revised, and Conflict Management Questionnaire. No differences are found in general family functioning between the two groups, but mothers in the AN-R group show a higher coparental conflict and a tendency to use negative-passive ways of conflict management than mothers of the AN-B/P group. Moreover, the presence of a coparental conflict is associated to lower BMI and to more dysfunctional family functioning. These findings underline the importance of increasing knowledge on specific aspects of general family functioning. In particular, it seems that the way parents manage conflict between themselves as partners can have a role in the maintenance of AN. Clinical implications of these results are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Research in patients with Eating Disorders (EDs) showed high rates of Food Addiction (FA) even in restrictive subtypes. The majority of studies were conducted on adult population. The present work aimed to describe and compared FA in adolescents diagnosed for different EDs and to evaluate its association with patients’ psychopathology. Patients aged 12–18 y were included in the analysis. FA was assessed using the Yale Food Addiction Scale 2.0. The rate of FA was of 49.4% in the whole sample (n = 87, F = 90.8%) and of 53.7% in patients diagnosed with restrictive anorexia nervosa. No difference in FA frequency was detected between EDs. A worse psychopathological picture was found in patients diagnosed with FA. Higher age, higher score to the Eating Attitudes Test–26 and to the Eating Disorder Inventory-3′s Interoceptive Deficits scale have been detected as the major predictors of FA in our sample. FA may be considered a transnosographic construct, not linked to the subtype of ED but to patients’ personal characteristics and, in particular, to age and interoceptive deficits. A worse psychopathology might be considered a risk factor for the presence of FA in EDs.

Objective: Research evidence suggests the need to identify treatments based on a more precise characterization of psychopathology and psychiatric comorbidity in anorexia nervosa. Network analysis provides a new method to conceptualize psychopathology. We use this approach to investigate the relationships between eating disorder and general psychiatric symptoms in adolescents with anorexia nervosa.Methods: Four‐hundred and five adolescents with anorexia nervosa and illness duration less than 3 years were consecutively recruited from those admitted to inpatient treatment. They completed the following questionnaires: the Eating Disorder Inventory‐3, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, and the Youth Self Report. A network analysis was conducted, including eating psychopathology measures, anxiety and depressive symptoms, and obsessive–compulsive and post‐traumatic stress problems. We employ a novel approach, the bridge function, to identify symptom clusters.Results: Depression symptoms and personal alienation were the nodes with the highest centrality in the network, followed by asceticism, post‐traumatic stress problems, drive to thinness, low self‐esteem, and anxiety physical symptoms. Three symptom clusters (relative to eating disorder psychopathology, self‐esteem problems, and internalizing difficulties) were identified. Depression symptoms, personal alienation, low self‐esteem, and interoceptive deficits showed the highest bridge centrality. Besides eating disorder core symptoms, negative affect and internalizing symptoms seem to contribute to anorexia nervosa psychopathology independently from illness duration effects.Discussion: These findings suggest that anorexia nervosa is characterized by a broad psychopathological spectrum rather than the mere eating disorder core symptoms, confirm the need to re‐conceptualize psychiatric comorbidity in this disorder, and provide intriguing diagnostic and therapeutic implications.