Factors Associated with Caregivers’ Responses to Individuals Affected by Eating Disorders

Rothwell, Emily and Sellwood, Bill and Wilson, Hannah (2023) Factors Associated with Caregivers’ Responses to Individuals Affected by Eating Disorders. PhD thesis, Lancaster University.

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Abstract

Eating disorders can impact the whole family. Caregivers may engage in certain behaviours, termed accommodation and enabling behaviours, as an attempt to reduce conflict. Whilst understandable, the cognitive interpersonal maintenance model suggests that engaging in these behaviours may inadvertently maintain the eating disorder. This can become a vicious cycle. The emotional climate of families can be measured by the construct of expressed emotion (EE). High familial EE is associated with poorer treatment outcomes, as well as increased caregiver distress. It is therefore important to understand factors which are associated with accommodation and enabling behaviours, and EE, in families affected by eating disorders. Section One of this thesis is comprised of a systematic literature review, which explores the factors associated with/correlates of accommodation and enabling behaviours in caregivers of individuals affected by an eating disorder. Factors associated with both the caregiver and the person affected were identified, which can be used to identify caregivers who may be more vulnerable to engaging in accommodation. This provides valuable information regarding the targeting of support to relevant caregivers. Section Two reports an empirical study investigating the relationship between guilt, shame, blame, EE and self-compassion, in caregivers of those affected by eating disorders. It also examines whether self-compassion moderates the relationship between guilt/shame/blame and EE. Emotional overinvolvement (EOI), one component of EE, was positively associated with guilt and shame, and negatively associated with self-compassion. Guilt predicted EOI once other variables had been accounted for. Critical comments, a second component of EE, had a significant positive association with guilt, shame and blame. Blame was the only significant predictor of criticism when other factors had been accounted for. There were no significant moderating effects of self-compassion. Section Three considers the implications of these findings, and the importance of language when discussing these themes.