Skip to main content
SpringerLink
Log in

Maternal Anxiety, Overprotection and Anxious Personality as Risk Factors for Eating Disorder: A Sister Pair Study

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

Using a sister-pair design, we aimed to investigate the role of maternal anxiety in pregnancy and parental overprotection as risk factors for anorexia nervosa (AN) and bulimia nervosa (BN). We were also interested in investigating anxious personality traits in patients with AN and BN compared to their healthy sisters, and their possible association to overprotection. One-hundred-and-fifty-seven females (AN = 94; BN = 63) and their healthy sisters from four European centres were recruited. Data on temperament and childhood characteristics were obtained from cases and their sisters using the Temperament and Character Interview Revised (TCI-R) and the Oxford Risk Factor Interview (ORFI); maternal anxiety and overprotection were obtained from retrospective parental report. Both AN and BN women displayed significantly higher levels of separation anxiety in childhood in comparison to their sisters, but only women with AN showed anxious temperamental traits. Mothers of women with AN reported higher levels of anxiety during the index pregnancy (p < .01), compared to when pregnant with the healthy daughter. The age in months at which women with AN were first left with another adult for a night was also higher compared to their sisters (respectively medians: 12 (range 1–120), 9 (range 1–96), p < .05). This was not the case for women with BN. Maternal overprotection was not associated with index daughter temperament. This finding is suggestive of an association between AN and maternal stress and anxiety in utero and later overprotective care, whilst BN was not associated with maternal anxiety or overprotection.

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

  • Adambegan, M., Wagner, G., Nader, I. W., Fernandez-Aranda, F., Treasure, J., & Karwautz, A. (2012). Internalizing and externalizing behaviour problems in childhood contribute to the development of anorexia and bulimia nervosa—A study comparing sister pairs. European Eating Disorder Review, 20(2), 116–120.

    Article  Google Scholar 

  • Amianto, F., Abbate-Daga, G., Morando, S., Sobrero, C., & Fassino, S. (2011). Personality development characteristics of women with anorexia nervosa, their healthy siblings and healthy controls: What prevents and what relates to psychopathology? Psychiatry Research, 187(3), 401–408.

    Article  PubMed  Google Scholar 

  • Anderluh, M., Tchanturia, K., Rabe-Hesketh, S., Collier, D., & Treasure, J. (2009). Lifetime course of eating disorders: Design and validity testing of a new strategy to define the eating disorders phenotype. Psychological Medicine, 39(1), 105–114.

    Article  PubMed  CAS  Google Scholar 

  • APA. (2000). Diagnostic and statstical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.

  • Blair, M. M., Glynn, L. M., Sandman, C. A., & Davis, E. P. (2011). Prenatal maternal anxiety and early childhood temperament. Stress, 14(6), 644–651. doi:10.3109/10253890.2011.594121.

    Google Scholar 

  • Bulik, C. M., Sullivan, P. F., Fear, J. L., & Joyce, P. R. (1997). Eating disorders and antecedent anxiety disorders: A controlled study. Acta Psychiatrica Scandinavica, 96(2), 101–107.

    Article  PubMed  CAS  Google Scholar 

  • Caspi, A., Roberts, B. W., & Shiner, R. L. (2005). Personality development: Stability and change. Annual Review of Psychology, 56, 453–484.

    Article  PubMed  Google Scholar 

  • Cassin, S. E., & von Ranson, K. M. (2005). Personality and eating disorders: A decade in review. Clinical Psychology Review, 25(7), 895–916. doi:10.1016/j.cpr.2005.04.012.

    Article  PubMed  Google Scholar 

  • Cloninger, C. R. (1987). A systematic method for clinical description and classification of personality variants—A proposal. Archives of General Psychiatry, 44(6), 573–588.

    Article  PubMed  CAS  Google Scholar 

  • Cloninger, C. R. (1999). The temperament and character inventory-revised. St. Louis, MO: Washington University, Center for Psychobiology of Personality. (Available from C. R. Cloninger, Washington University School of Medicine, Department of Psychiatry, P.O. Box 8134, St. Louis, MO 63110.).

  • Cloninger, C. R., Svrakic, D. M., & Przybeck, T. R. (1993). A psychobiological model of temperament and character. Archives of General Psychiatry, 50(12), 975–990.

    Article  PubMed  CAS  Google Scholar 

  • Cloninger, C. R., Zohar, A. H., Hirschmann, S., & Dahan, D. (2012). The psychological costs and benefits of being highly persistent: Personality profiles distinguish mood disorders from anxiety disorders. Journal of Affective Disorders, 136(3), 758–766.

    Article  PubMed  Google Scholar 

  • Corfield, F., Micali, N., Treasure J. (submitted). A meta-analysis of the Parental Bonding Instrument in eating disorders.

  • Deep, A. L., Nagy, L. M., Weltzin, T. E., Rao, R., & Kaye, W. H. (1995). Premorbid onset of psychopathology in long-term recovered anorexia nervosa. International Journal of Eating Disorders, 17(3), 291–297.

    PubMed  CAS  Google Scholar 

  • Degnan, K. A., Almas, A. N., & Fox, N. A. (2010). Temperament and the environment in the etiology of childhood anxiety. Journal of Child Psychology and Psychiatry, 51(4), 497–517.

    Article  PubMed  Google Scholar 

  • Fairburn, C. G., & Cooper, Z. (1993). The eating disorder examination. In: C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment and treatment (12th ed., pp. 317–360).

  • Fairburn, C. G., Doll, H. A., Welch, S. L., Hay, P. J., Davies, B. A., & O’Connor, M. E. (1998). Risk factors for binge eating disorder: A community-based, case-control study. Archives of General Psychiatry, 55(5), 425–432.

    Article  PubMed  CAS  Google Scholar 

  • Fairburn, C. G., Welch, S. L., Doll, H. A., Davies, B. A., & O’Connor, M. E. (1997). Risk factors for bulimia nervosa. A community-based case-control study. Archives of General Psychiatry, 54(6), 509–517.

    Article  PubMed  CAS  Google Scholar 

  • Fassino, S., Abbate-Daga, G., Amianto, F., Leombruni, P., Boggio, S., & Rovera, G. G. (2002). Temperament and character profile of eating disorders: A controlled study with the temperament and character inventory. International Journal of Eating Disorders, 32(4), 412–425.

    Article  PubMed  Google Scholar 

  • Fassino, S., Amianto, F., & Abbate-Daga, G. (2009). The dynamic relationship of parental personality traits with the personality and psychopathology traits of anorectic and bulimic daughters. Comprehensive Psychiatry, 50(3), 232–239. doi:10.1016/j.comppsych.2008.07.010.

    Article  PubMed  Google Scholar 

  • Fassino, S., Amianto, F., Rocca, G., & Daga, G. A. (2010). Parental bonding and eating psychopathology in bulimia nervosa: Personality traits as possible mediators. Epidemiologia e Psichiatria Sociale, 19(3), 214–222.

    PubMed  Google Scholar 

  • Glover, V., & Hill, J. (2012). Sex differences in the programming effects of prenatal stress on psychopathology and stress responses: An evolutionary perspective. Physiology & Behavior, 106(5), 736–740.

    Google Scholar 

  • Godart, N., Berthoz, S., Perdereau, F., & Jeammet, P. (2006). Comorbidity of anxiety with eating disorders and OCD. American Journal of Psychiatry, 163(2), 326; author reply 327–329. doi:10.1176/appi.ajp.163.2.326.

    Google Scholar 

  • Godart, N. T., Flament, M. F., Perdereau, F., & Jeammet, P. (2002). Comorbidity between eating disorders and anxiety disorders: A review. International Journal of Eating Disorders, 32(3), 253–270. doi:10.1002/eat.10096.

    Article  PubMed  CAS  Google Scholar 

  • Halmi, K. A., Eckert, E., Marchi, P., Sampugnaro, V., Apple, R., & Cohen, J. (1991). Comorbidity of psychiatric diagnoses in anorexia nervosa. Archives of General Psychiatry, 48(8), 712–718.

    Article  PubMed  CAS  Google Scholar 

  • Halmi, K. A., Sunday, S. R., Klump, K. L., Strober, M., Leckman, J. F., Fichter, M., et al. (2003). Obsessions and compulsions in anorexia nervosa subtypes. International Journal of Eating Disorders, 33(3), 308–319. doi:10.1002/eat.10138.

    Article  PubMed  Google Scholar 

  • Halmi, K. A., Tozzi, F., Thornton, L. M., Crow, S., Fichter, M. M., Kaplan, A. S., et al. (2005). The relation among perfectionism, obsessive-compulsive personality disorder and obsessive-compulsive disorder in individuals with eating disorders. International Journal of Eating Disorders, 38(4), 371–374. doi:10.1002/eat.20190.

    Article  PubMed  Google Scholar 

  • Haycraft, E., Farrow, C., Meyer, C., Powell, F., & Blissett, J. (2011). Relationships between temperament and eating behaviours in young children. Appetite, 56(3), 689–692. doi:10.1016/j.appet.2011.02.005.

    Article  PubMed  Google Scholar 

  • Hildebrandt, T., Bacow, T., Markella, M., & Loeb, K. L. (2012). Anxiety in anorexia nervosa and its management using family-based treatment. European Eating Disorder Review, 20(1), e1–e16.

    Article  Google Scholar 

  • Hoffman, E. R., Gagne, D. A., Thornton, L. M., Klump, K. L., Brandt, H., Crawford, S., et al. (2012). Understanding the association of impulsivity, obsessions, and compulsions with binge eating and purging behaviours in anorexia nervosa. European Eating Disorder Review, 20(3), e129–e136.

    Article  Google Scholar 

  • Hudson, J. L., & Rapee, R. M. (2001). Parent-child interactions and anxiety disorders: An observational study. Behavior Research and Therapy, 39(12), 1411–1427.

    Google Scholar 

  • Jacobs, M. J., Roesch, S., Wonderlich, S. A., Crosby, R., Thornton, L., Wilfley, D. E., et al. (2009). Anorexia nervosa trios: Behavioral profiles of individuals with anorexia nervosa and their parents. Psychological Medicine, 39(3), 451–461.

    Article  PubMed  CAS  Google Scholar 

  • Karwautz, A., Collier, D., & Treasure, J. L. (2002). Pre-morbid psychiatric morbidity, comorbidity and personality in patients with anorexia nervosa compared to their healthy sisters. European Eating Disorder Review, 10(4), 255–270.

    Article  Google Scholar 

  • Karwautz, A., Wagner, G., Waldherr, K., Nader, W., Fernandez-Aranda, F., Estivill, X., et al. (2011). Gene–environment interaction in anorexia nervosa: Relevance of non-shared environment and the serotonin transporter gene. Molecular Psychiatry, 16, 590–592.

    Article  PubMed  CAS  Google Scholar 

  • Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., & Masters, K. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161(12), 2215–2221. doi:10.1176/appi.ajp.161.12.2215.

    Article  PubMed  Google Scholar 

  • Kaye, W. H., Lilenfeld, L. R., Berrettini, W. H., Strober, M., Devlin, B., Klump, K. L., et al. (2000). A search for susceptibility loci for anorexia nervosa: Methods and sample description. Biological Psychiatry, 47(9), 794–803.

    Article  PubMed  CAS  Google Scholar 

  • Keller, M. B., Lavori, P. W., Friedman, B., Nielsen, E., Endicott, J., McDonald-Scott, P., et al. (1987). The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 8(9), 540–548.

    Article  Google Scholar 

  • Lilenfeld, L. R., Wonderlich, S., Riso, L. P., Crosby, R., & Mitchell, J. (2006). Eating disorders and personality: A methodological and empirical review. Clinical Psychology Review, 26(3), 299–320.

    Article  PubMed  Google Scholar 

  • Martin, G. C., Wertheim, E. H., Prior, M., Smart, D., Sanson, A., & Oberklaid, F. (2000). A longitudinal study of the role of childhood temperament in the later development of eating concerns. International Journal of Eating Disorders, 27(2), 150–162.

    Article  PubMed  CAS  Google Scholar 

  • Matsunaga, H., Kiriike, N., Iwasaki, Y., Miyata, A., Yamagami, S., & Kaye, W. H. (1999). Clinical characteristics in patients with anorexia nervosa and obsessive-compulsive disorder. Psychological Medicine, 29(2), 407–414.

    Article  PubMed  CAS  Google Scholar 

  • Mazzeo, S. E., & Bulik, C. M. (2009). Environmental and genetic risk factors for eating disorders: What the clinician needs to know. Child and Adolescent Psychiatric Clinics of North America, 18(1), 67–82.

    Google Scholar 

  • Micali, N., Hilton, K., Natatani, E., Heyman, I., Turner, C., & Mataix-Cols, D. (2011). Is childhood OCD a risk factor for eating disorders later in life? A longitudinal study. Psychological Medicine, 1–7. doi:10.1017/S003329171100078X.

  • Micali, N., Holliday, J., Karwautz, A., Haidvogl, M., Wagner, G., Fernandez-Aranda, F., et al. (2007). Childhood eating and weight in eating disorders: A multi-centre European study of affected women and their unaffected sisters. Psychotherapy and Psychosomatics, 76(4), 234–241.

    PubMed  CAS  Google Scholar 

  • Monneyron, F., Southgate, L., Corcos, M., & Treasure, J. (in preparation). Eating and personality assessment of mother/child dyads both with a history of an eating disorder.

  • O'Connor, T. G., Heron, J., Golding, J., Beveridge, M., & Glover, V. (2002). Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children. Journal of Child Psychology and Psychiatry, 180, 502–508.

    Google Scholar 

  • Pollice, C., Kaye, W. H., Greeno, C. G., & Weltzin, T. E. (1997). Relationship of depression, anxiety, and obsessionality to state of illness in anorexia nervosa. International Journal of Eating Disorders, 21(4), 367–376.

    Article  PubMed  CAS  Google Scholar 

  • Rastam, M., Gillberg, I. C., & Gillberg, C. (1995). Anorexia nervosa 6 years after onset: Part II. Comorbid psychiatric problems. Comprehensive Psychiatry, 36(1), 70–76.

    Article  PubMed  CAS  Google Scholar 

  • Shoebridge, P. J., & Gowers, S. G. (2000). Parental high concern and adolescent-onset anorexia nervosa: A case–control study to investigate direction of causality. The British Journal of Psychiatry, 176(2), 132–137. doi:10.1192/bjp.176.2.132.

    Article  PubMed  CAS  Google Scholar 

  • Silberg, J. L., & Bulik, C. M. (2005). The developmental association between eating disorders symptoms and symptoms of depression and anxiety in juvenile twin girls. Journal of Child Psychology and Psychiatry, 46(12), 1317–1326.

    Article  PubMed  Google Scholar 

  • Swinbourne, J., Hunt, C., Abbott, M., Russell, J., St Clare, T., & Touyz, S. (2012). The comorbidity between eating disorders and anxiety disorders: Prevalence in an eating disorder sample and anxiety disorder sample. Australian and New Zealand Journal of Psychiatry, 46(2), 118–131.

    Article  PubMed  Google Scholar 

  • Swinbourne, J. M., & Touyz, S. W. (2007). The co-morbidity of eating disorders and anxiety disorders: A review. European Eating Disorder Review, 15(4), 253–274.

    Article  Google Scholar 

  • Talge, N. M., Neal, C., & Glover, V. (2007). Antenatal maternal stress and long-term effects on child neurodevelopment: How and why? Journal of Child Psychology and Psychiatry, 48(3–4), 245–261.

    Article  PubMed  Google Scholar 

  • Treasure, J., Murphy, T., Szmukler, G., Todd, G., Gavan, K., & Joyce, J. (2001). The experience of caregiving for severe mental illness: A comparison between anorexia nervosa and psychosis. Social Psychiatry and Psychiatric Epidemiology, 36(7), 343–347.

    Article  PubMed  CAS  Google Scholar 

  • Troisi, A., Di Lorenzo, G., Alcini, S., Nanni, R. C., Di Pasquale, C., & Siracusano, A. (2006). Body dissatisfaction in women with eating disorders: Relationship to early separation anxiety and insecure attachment. Psychosomatic Medicine, 68(3), 449–453.

    Article  PubMed  Google Scholar 

  • Van den Bergh, B. R., Mulder, E. J., Mennes, M., & Glover, V. (2005). Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: Links and possible mechanisms. A review. Neuroscience and Biobehavioral, 29(2), 237–258.

    Article  Google Scholar 

Download references

Acknowledgments

This study was supported by the European Commission Framework V programme (QLK1-1999-916), a grant from the PPP foundation (1206/87) to J.L.T. and D.C., and partially by FIS (G3/184). Dr. Krug was supported by a Marie-Curie Intra European Fellowship within the 7th European Community Framework Programme, as No. 254774 (call reference: FP7-PEOPLE-2009-IEF). Financial support was received from Fondo de Investigación Sanitaria (PI11/210) and AGAUR (2009SGR1554). CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn) is an initiative of ISCIII.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Behavioural and Brain Sciences Unit, UCL Institute of Child Health, 4th Floor, 30 Guilford Street, London, WC1N 1EH, UK

    E. Taborelli & N. Micali

  2. Eating Disorders Research Unit, King’s College London, London, UK

    I. Krug & J. L. Treasure

  3. Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria

    A. Karwautz, G. Wagner & M. Haidvogl

  4. Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBER Fisiología Obesidad y Nutrición (CIBEROBN), Barcelona, Spain

    F. Fernandez-Aranda, R. Castro & S. Jiménez-Murcia

  5. Child Psychiatry Unit, University Children’s Hospital, University Medical Centre Ljubliana, Ljubljana, Slovenia

    M. Anderluh

  6. Social, Genetic and Developmental Psychiatry Centre (SGDP), Institute of Psychiatry, King’s College London, London, UK

    D. Collier

Authors
  1. E. Taborelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Krug
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Karwautz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Haidvogl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Fernandez-Aranda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Jiménez-Murcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Anderluh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. D. Collier
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. J. L. Treasure
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. N. Micali
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Taborelli.

Additional information

This work is produced by Dr. Nadia Micali under the terms of a Clinician Scientist Award issued by the NIHR. The views and opinions expressed in this publication are those of the authors and do not necessarily reflect those of the National Health Service (NHS), NIHR or the DH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Taborelli, E., Krug, I., Karwautz, A. et al. Maternal Anxiety, Overprotection and Anxious Personality as Risk Factors for Eating Disorder: A Sister Pair Study. Cogn Ther Res 37, 820–828 (2013). https://doi.org/10.1007/s10608-012-9518-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-012-9518-8

Keywords

Search

Navigation