Feeding styles and responsiveness in mothers with eating disorders

Eating disorders such as anorexia nervosa and bulimia nervosa represent a significant public health problem for young women in particular, affecting an estimated 2.4% of women of childbearing age in the United States. The children of mothers with eating disorder histories appear to be at especially high-risk for developing eating problems themselves. Yet, little research has investigated how mothers with such histories interact with their young children in the feeding environment. The objective of this project was to provide a comprehensive view of maternal responsiveness in mothers with histories of eating disorders across observational, self-report, and physiologic domains. A case-control pilot study was conducted of 25 mothers with histories of eating disorders with children ages 6--36 months and 25 healthy control mothers matched for child age and child sex. No significant differences were detected between mothers with histories of eating disorders and controls on observed responsiveness to child receptiveness cues during feeding, responsiveness to child fullness cues during feeding or maternal sensitivity during play. Mothers with histories of eating disorders reported less restrictive feeding styles than control mothers (t(47)= -2.08, p<0.05) and scored highest on responsive feeding out of all feeding styles. No significant differences were detected in child diet composition between mothers with histories of eating disorders and controls, but mothers with histories of eating disorders were more likely to report taking a special approach to feeding involving restriction of certain food types or components, such as limiting processed foods (88% mothers with histories of eating disorders and 60% control mothers; OR= 4.89, 95%CI=1.15--20.79). Lastly, mothers with histories of eating disorders reported greater parenting stress (t(47)= 2.15, p<0.04) and displayed a blunted stress response (decreased vagal reactivity) during interactions with their children (F(1,43)= 7.18, p<0.02). These findings indicate that greater attention should be given to the influence of stress on parenting in general and the feeding environment specifically for mothers with histories of eating disorders. Future studies of mothers with histories of eating disorders should include larger more diverse samples and should continue to evaluate responsive feeding behavior as children grow older and the feeding environment becomes more complex.