Empirical examination of the interpersonal maintenance model of anorexia nervosa.
OBJECTIVE
A cognitive interpersonal maintenance model of anorexia nervosa (AN) was first proposed in 2006 and updated in 2013 (Schmidt and Treasure, J Br J Clin Psychol, 45, 343-366, 2006; Treasure and Schmidt, J Eat Disorders, in press.). The aim of this study was to test the interpersonal component of this model in people with AN requiring intensive hospital treatment (inpatient/day patient).


METHODS
On admission to hospital women with AN or eating disorder not otherwise specified (AN subtype; n = 152; P) and their primary carers (n = 152; C) completed questionnaires on eating symptoms (P), depression and anxiety (P, C), accommodation and enabling (C), and psychological control (C). Structural equation modeling was used to examine relationships among these components.


RESULTS
Carers' expressed emotion and level of psychological control were significantly related to carers' distress, which in turn, was related to patients' distress. This pathway significantly predicted eating symptoms in patients.


CONCLUSIONS
The cognitive interpersonal maintenance model of eating disorders (EDs) was confirmed in part and suggests that interventions targeting interpersonal maintaining factors such as carer distress might impact on patient outcomes.
Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, United Kingdom.
E
E
Goddard
L
L
Salerno
R
R
Hibbs
S
S
Raenker
U
U
Naumann
J
J
Arcelus
A
A
Ayton
N
N
Boughton
F
F
Connan
K
K
Goss
H
H
Lacey
B
B
Laszlo
J
J
Morgan
K
K
Moore
D
D
Robertson
C
C
Schreiber-Kounine
S
S
Sharma
L
L
Whitehead
U
U
Schmidt
J
J
Treasure
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000523:psychology*; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D015986:Confounding Factors, Epidemiologic; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011594:Psychometrics; D012927:Social Control, Informal; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
anorexia nervosa; carers; eating disorders; expressed emotion; family; inpatients; maintenance model