Attachment and perceived parental treatment reported by siblings discordant for eating disorder pathology

Abstract

THESIS :- Title - Attachment and perceived parental treatment reported by sisters discordant for eating disorder pathology Hypotheses - The study tested theoretical predictions that attachment status would differ between siblings discordant for eating disorder (ED) pathology. Differences in perceptions of parental treatment, sibling interaction and parental construing were expected to reflect differential attachment processes as follows: 1. It was predicted that higher levels of insecure attachment would be reported by ED than non-ED sisters. 2. It was expected that ED siblings would report lower levels of parental affection and higher levels of parental control during childhood compared to non-ED sisters. 3. It was expected that ED siblings would report higher levels of sibling jealousy toward their sisters than non-ED siblings. 4. It was predicted that differences would be found in parental construing of daughters. Non-ED daughters were expected to be more positively construed prior to and following development of the ED. Design - A cross-sectional case control design was employed. Patients (cases) were assigned to the ED sister group and sisters (controls) were assigned to the non-ED sister group. Additional investigation of parental perceptions was undertaken where possible. Setting - Participants were recruited from two neighbouring community NHS Eating Disorder Services based within the Home Counties. Both services were similar in terms of patient eligibility (e. g. 18 years and above; out-patient), staffing (multidisciplinary) and provision of treatments for a wide range of eating disorder pathology. Participants - Participants included all female patients currently being offered outpatient treatment for eating disorder pathology (i. e. Anorexia Nervosa, Bulimia Nervosa and EDNOS) with a sister meeting the following eligibility criteria: aged 16 years and above, without a history or current presentation of ED pathology of clinical severity. Non-ED sisters were also required to be of nearest age and to have lived in the family home for at least eight years. Biological parents who had lived in the family home up until and / or following the onset of the eating disorder were also included. Measures - The Stirling Eating Disorder Scales (SEDS; Williams et al., 1994) and the Hospital Anxiety and Depression Scale (HADS; Zigmond & Smith, 1983) were used to screen for eating disorder pathology and additional co-morbid symptomatology. The Reciprocal Attachment Questionnaire (RAQ; West & Sheldon, 1984) and Sibling Inventory of Differential Experience (SIDE; Plomin & Daniels, 1984) were used to compare attachment behaviours and perceptions of differential parental treatment and sibling relationships between sister groups. The Repertory Grid Technique (RGT) was used to explore and compare parental construing of daughters prior to and post development of an eating disorder. Method - 52 siblings (26 sister pairs discordant for eating disorder pathology) were sent questionnaires by post with a stamped addressed envelope. Parents were interviewed separately in the family home. Main findings - As predicted, differences were found in the attachment profiles of sister groups, with ED sisters reporting higher levels of insecurity across all attachment dimensions. However, no significant differences were found in sister groups' perceptions of parental treatment during childhood, failing to support proposed hypotheses regarding differential attachment and parental treatment. ED sisters reported higher levels of jealousy directed toward non-ED sisters as expected. Parents were found to retrospectively construe daughters as similar and equally positively as children. ED daughters became significantly less positively construed in adulthood (i. e. post development of ED) compared to non-ED sisters. Whilst conclusions regarding the role of insecure attachment in the aetiology of ED pathology cannot be drawn (i. e. whether ED pathology is a cause or a result of insecure attachment), the study has furthered the investigation into the role of attachment and eating disorder pathology by combining a number of theoretical and empirical lines of enquiry. Results highlight a number of theoretical areas for further investigation and implications for clinical practice. Recommendations for future research are also discussed.