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. 2025 Dec;58(12):2366-2377.
doi: 10.1002/eat.24551. Epub 2025 Sep 18.

Parenting Stress in Adolescent Anorexia Nervosa: Differential Stress in Mothers and Fathers During Inpatient Treatment

V Stonawski  1 , J Kutzner  1 , S Büscher  2 , A Hoyer  2 , O Kratz  1 , S Horndasch  1   3
Affiliations

Parenting Stress in Adolescent Anorexia Nervosa: Differential Stress in Mothers and Fathers During Inpatient Treatment

V Stonawski et al. Int J Eat Disord. 2025 Dec.

Abstract

Objective: Anorexia nervosa (AN) is a severe psychiatric disorder that impacts both the adolescents themselves and their parents. Parenting stress is associated with impaired mental health of parents and poorer treatment outcomes for their children. Understanding the course of parenting stress during inpatient treatment and differences between mothers and fathers is important to improve AN treatment and (long term) outcome.

Method: Within a longitudinal controlled design, parents of adolescents with AN are compared to healthy children (HC) at three time points during and after their daughters' inpatient treatment (T1 = admission, T2 = discharge/+4 months, T3 = 6-month follow-up) regarding parenting stress. Mothers (T1: AN n = 29, HC n = 25; T3 (after dropout): AN n = 11, HC n = 18) and fathers (T1: AN n = 25, HC n = 22; T3 (after dropout): AN n = 9, HC n = 13) rated their parenting stress via the German version of the Parenting Stress Index (PSI) and their own psychological symptoms via the Brief Symptom Inventory (BSI). Diverse individual, adolescent, AN- and treatment-associated characteristics were assessed and related to parenting stress.

Results: Within the AN group, particularly at admission, parenting stress of mothers was higher compared to fathers. Mothers of adolescents with AN had higher, while fathers of adolescents with AN had lower parenting stress scores compared to those of HC at inpatient admission. During inpatient treatment, parenting stress decreased in mothers and increased in fathers of adolescents with AN, resulting in no differences after inpatient treatment. Comparing mothers and fathers directly showed higher scores in mothers compared to fathers in the AN group. Parental psychological symptoms predicted parenting stress, as opposed to child or treatment associated factors.

Discussion: Parenting stress and the own psychological symptoms of parents should be considered explicitly in inpatient treatment of adolescents with AN. Furthermore, differences between mothers and fathers should be considered in future research and parent-focused interventions.

Keywords: adolescence; anorexia nervosa; fathers; mothers; parenting stress.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Parental stress (PSI) at admission (T1), separated for the AN and HC groups and for mothers and fathers. Mean and standard error (SE) are depicted.
FIGURE 2
FIGURE 2
The estimated group‐specific, parent‐specific, and time‐specific intercept parameters of the main linear mixed regression model of parenting stress in the child domain (PSI) from admission (T1) to discharge (T2) and 6‐month follow‐up (T3), separated for the AN and HC groups and for mothers and fathers. Estimated coefficients and their standard deviation (SD) are depicted.
See this image and copyright information in PMC

References

    1. Abidin, R. R. 1995. Parenting Stress Index. Psychological Assessment Resources.
    1. Altdorf, S. , Dempfle A., Heider K., Seitz J., Herpertz‐Dahlmann B., and Dahmen B.. 2022. “Parents as Co‐Therapists in Home Treatment for Adolescents With Anorexia Nervosa—Factors and Mechanisms.” Praxis Der Kinderpsychologie und Kinderpsychiatrie 71, no. 5: 467–486. (Eltern als Ko‐Therapeuten im Home Treatment Bei Adoleszenter Anorexia Nervosa–Wirkfaktoren und Mechanismen). 10.13109/prkk.2022.71.5.467. - DOI - PubMed
    1. Anastasiadou, D. , Medina‐Pradas C., Sepulveda A. R., and Treasure J.. 2014. “A Systematic Review of Family Caregiving in Eating Disorders.” Eating Behaviors 15, no. 3: 464–477. 10.1016/j.eatbeh.2014.06.001. - DOI - PubMed
    1. Barroso, N. E. , Mendez L., Graziano P. A., and Bagner D. M.. 2018. “Parenting Stress Through the Lens of Different Clinical Groups: A Systematic Review and Meta‐Analysis.” Journal of Abnormal Child Psychology 46, no. 3: 449–461. 10.1007/s10802-017-0313-6. - DOI - PMC - PubMed
    1. Bates, D. , Mächler M., Bolker B., and Walker S.. 2015. “Fitting Linear Mixed‐Effects Models Using lme4.” Journal of Statistical Software 67, no. 1: 1–48. 10.18637/jss.v067.i01. - DOI