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. 2025 Jun 6;19(1):66.
doi: 10.1186/s13034-025-00929-x.

Parental psychopathology and expressed emotion in children with avoidant/restrictive food intake disorder

Hannah Lea Klüber  1 , Annick Martin  2 , Franziska Schlensog-Schuster  2   3 , Andreas Hiemisch  4   5 , Wieland Kiess  4   5   6 , Anja Hilbert  7   6 , Ricarda Schmidt  7   6
Affiliations

Parental psychopathology and expressed emotion in children with avoidant/restrictive food intake disorder

Hannah Lea Klüber et al. Child Adolesc Psychiatry Ment Health. .

Abstract

Background: Family factors like parental psychopathology and parental expressed emotion, referring to the emotional atmosphere within a family, play a significant role in the maintenance and treatment outcome of anorexia nervosa. However, nothing is known about these parental characteristics in avoidant/restrictive food intake disorder (ARFID).

Objective: This study aimed to determine the proportion of parents exceeding clinical cutoffs for depression, eating disorder psychopathology, and expressed emotion, specifically criticism and emotional overinvolvement, in ARFID, anorexia nervosa (AN), and healthy controls (HC), and to evaluate group differences. Associations between parental characteristics and child illness characteristics were analyzed.

Method: Treatment-seeking children and adolescents (0–17 years) with ARFID (n = 42) were compared to those with AN (n = 25) and HC (n = 42) in parental eating disorder psychopathology (Eating Disorder Examination-Questionnaire 8), parental depression (Patient Health Questionnaire-9), and parental expressed emotion (Family Questionnaire).

Results: When comparing ARFID with AN and HC, the proportions of parents exceeding clinical cutoffs for depression (26% vs. 20% vs. 14%), eating disorder psychopathology (7% vs. 12% vs. 9%), and criticism (26% vs. 32% vs. 29%) did not differ significantly. For emotional overinvolvement (41% vs. 52% vs. 0%), differences emerged between ARFID and HC, but not AN. Dimensionally, levels of parental depressive symptoms and emotional overinvolvement were higher in those with ARFID versus HC only. More parental depressive symptoms, criticism, and emotional overinvolvement were significantly related to greater children’s restrictive eating behaviors, lower standardized body-mass-index, and lower number of accepted foods.

Conclusion: ARFID and anorexia nervosa were found to share similar distributions in parental psychopathology and parental expressed emotion. Future studies may focus on the role of those family factors in development and outcome of ARFID.

Supplementary Information: The online version contains supplementary material available at 10.1186/s13034-025-00929-x.

Keywords: ARFID; Eating disorders; Expressed emotion; Family factors; Parents.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the Medical Faculty of the University of Leipzig (Reg. No. 264-10-19042010). Written informed assent and consent was obtained from all participants involved in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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