Bulimia Nervosa and Parental Interference

Reprinted from Eating Disorders Review
January/February 2001 Volume 12, Number 1
©2001 Gürze Books

The combination of a jealous or competitive mother who invades her adolescent daughter’s privacy, and a seductive father may contribute to their daughter developing bulimia nervosa (BN). Maternal and paternal over-concern with their daughters’ eating, weight, and shape may also propel daughters to binge-eat and purge.

Dr. Marcia Rorty, Pasadena, CA, and colleagues used the Parental Intrusiveness Rating Scale (PIRS) to evaluate 86 women with a lifetime history of BN and 573 comparison subjects (Int J Eat Disord 2000;28:202). The PIRS Scale is a 40-item scale that uses a 5-point Likert-type response format ranging from 1 (never) to 5 (always). The PIRS was developed in 1997, and was based on in-person interviews with active and remitted bulimic women.

More than any other factor, these women cited problematic interactions with their parents as a cause of their bulimia. They described their parents not as over-involved or globally under-involved with them, but as intrusive in specific areas where they sought personal privacy and autonomy (such as personal appearance, private space, and weight and shape).

As they developed the PIRS, Dr. Rorty and colleagues found that women with a lifetime of BN reported higher levels of intrusion by parents and less clearly defined boundaries during adolescence than did comparison women. Specifically, the women with BN reported that their mothers were more likely to invade their personal privacy, relate to them in a jealous and/or competitive manner, and show over-concern about their daughters’ eating, weight, and shape. And the fathers also played a role: bulimic women reported higher levels of seductive or sexualized interactions from their fathers and greater paternal concern with the daughters’ eating behavior. However, the fathers of BN patients were not more likely to intrude upon their privacy than fathers of comparison subjects.

A pattern across ethnic backgrounds

The study included 239 Caucasians, 177 Asian Americans, 83 Latinas, 34 African-Americans, and 23 who identified themselves as “Other,” and were mainly Middle Eastern. In the current study, ethnicity apparently did not play a part—women from varied ethnic groups reported relatively similar patterns of parental behavior. One exception was that Caucasian women reported significantly higher levels of jealous and competitive behavior by their mothers than did Asian American/Pacific Islander subjects.

‘What Caused Your Eating Disorder?’

When women described what they felt had caused their eating disorder, many pointed to cruel teasing by parents and siblings, family competitions to see who could lose the most weight, and fathers or brothers reacting to the daughters’ changing adolescent bodies by labeling the girls as “fat,” or using other derogatory terms. Others reported pressure to be thin to maintain family appearances and even modeling their binge-eating and purging behavior after their mothers’ behaviors.

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