Using the common-sense model to understand parents’ illness representations of their child with an eating disorder

Abstract

BACKGROUND: Previous research has highlighted the significance of parental distress in the context of caring for a child with an eating disorder (ED). Such distress may contribute to accommodating the child's eating behaviours and lead to poorer treatment outcomes. However, several challenges exist in understanding this parental distress. For instance, the factors that contribute to this distress are not fully understood, and the associations have been examined without a theoretical model. As a result, it is challenging to comprehend and interpret the findings and apply them to clinical practice. Therefore, in this doctorate, the theoretical framework of the Common-Sense Model (CSM) will be used to address this gap and clarify the relationship between parental illness representations, coping strategies, and psychological distress. The CSM is recommended for understanding how parents perceive and respond to their child's illness, including psychological distress. Through the CSM, this research project aims to better understand parental illness representations, and how these affect coping strategies and ultimately influence health outcomes.

OBJECTIVES: The research project has two main aims: first, to conduct a systematic review of the qualitative literature on parental illness representations when caring for a child with anorexia nervosa, in order to gain insight into their cognitive and emotional profile. Second, to undertake an empirical study that applies the full CSM model to re-examine the profile of parental illness perceptions when caring for a child with ED, and investigate whether these illness perceptions impact their psychological distress and coping strategies.

METHODS: The systematic review included 26 relevant studies from the psychINFO, MEDLINE, and EMBASE databases, and used a "best fit" framework analysis to synthesise the qualitative themes. For the empirical study, a cross-sectional design was used to gather data from parents caring for a child with ED. Parental illness representation profiles were examined using descriptive statistics, while a content analysis was used to understand the attributions parents made to their child's ED. Partial correlations were then employed to investigate whether parental illness representations were associated with coping strategies and psychological distress.

RESULTS AND DISCUSSION: The systematic review found that parents of children with anorexia nervosa tended to blame themselves for causing the disorder and had threatening cognitive and emotional representations of their child's illness according to the CSM. Specifically, they perceived anorexia nervosa as uncontrollable, incomprehensible, chronic, associated with serious negative consequences and negative emotions. Conversely, the results of the empirical study indicated that parents generally tended to attribute the causes of their child’s ED to external factors (e.g., school, covid-19, social media). Additionally, parents generally perceived their child's ED as a threatening illness with serious consequences, chronicity, severe symptoms, and negative emotions, but also had a positive view towards the efficacy of treatment and their own capability to manage and comprehend the illness. A threatening emotional illness representation was linked to psychological distress, whereas a positive view of treatment was associated with dysfunctional coping and depression. A better understanding of ED was linked to depression and stress. Therefore, tailored psychoeducation and evidence-based psychological therapies should be considered for parents of children with ED, given the specific illness representations reported in this study. These therapies should focus on managing the emotional and cognitive aspects of caring for a child with ED, such as addressing parents' perceptions of their child's treatment and understanding of ED. Such interventions may prove beneficial in reducing parental psychological distress and, indirectly, improving their child's recovery. Further research is necessary to explore these findings in greater depth.