{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T14:17:44Z","timestamp":1775571464700,"version":"3.50.1"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":36,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Eat Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Carers are crucial to the recovery process of people with eating disorders (EDs). The Caregiver Skills (CASK) scale was developed to assess key caregiving skills among carers of individuals with EDs. While psychometric evaluations of the English, German and Spanish versions have supported the original six-factor model, no validated Dutch version exists to date. This study aimed to examine the psychometric properties of a Dutch translation of the CASK. Validated caregiving outcome measures can assist in exploring coping skills in clinical practice and support research evaluating both caregiving interventions and ED treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 248 carers (139 female, 109 male; mean age\u2009=\u200948.3 years) completed the CASK prior to assessment at a specialized ED treatment center in the Netherlands. The internal consistency of the total scale and six subscales was assessed using McDonald\u2019s omega. Confirmatory factor analysis (CFA) was used to test the original six-factor structure. Gender differences in subscale and total scores were explored using linear mixed-effects models (LMM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The original six-factor structure could not be confirmed in CFA, and model fit remained suboptimal after post hoc modifications. However, CFA results for the six subscales separately showed good to acceptable fit, and internal consistency was satisfactory. No gender differences were found in total CASK scores, though male carers reported higher skills on \u2018Self-Care\u2019 and \u2018Insight and Acceptance\u2019, and female carers reported higher skills on \u2018Frustration Tolerance\u2019 and \u2018Emotional Intelligence\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Dutch version of the CASK did not replicate the original six-factor structure at the full-scale level. Nonetheless, the six subscales demonstrated adequate psychometric properties and appear particularly suitable for use at the group level, making the instrument relevant for research and care improvement policies. Further studies are needed to determine whether the CASK can also provide added value at the individual level, for example to guide individualized treatment content, and to evaluate its applicability in more diagnostically and culturally diverse samples. While male and female carers reported comparable overall skills, differences in specific subscale scores highlight the importance of considering gender in the context of skill development and support for carers of individuals with EDs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40337-026-01561-6","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T08:15:19Z","timestamp":1772439319000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Validation of the caregiver skills (CASK) scale in a Dutch sample of carers for adolescents with eating disorders"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1599-512X","authenticated-orcid":false,"given":"C. M. T.","family":"Schilder","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7038-5717","authenticated-orcid":false,"given":"U. N.","family":"Danner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4463-2555","authenticated-orcid":false,"given":"D. J.","family":"Hessen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8745-4763","authenticated-orcid":false,"given":"A. A.","family":"van Elburg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8916-9977","authenticated-orcid":false,"given":"L. C.","family":"Sternheim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,2]]},"reference":[{"issue":"6","key":"1561_CR1","doi-asserted-by":"publisher","first-page":"1953","DOI":"10.1007\/s40519-021-01338-7","volume":"27","author":"L Hannah","year":"2022","unstructured":"Hannah L, Cross M, Baily H, Grimwade K, Clarke T, Allan SM. A systematic review of the impact of carer interventions on outcomes for patients with eating disorders. Eat Weight Disord. 2022;27(6):1953\u201362.","journal-title":"Eat Weight Disord"},{"issue":"1","key":"1561_CR2","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1002\/cpp.1984","volume":"24","author":"JR Fox","year":"2017","unstructured":"Fox JR, Dean M, Whittlesea A. The experience of caring for or living with an individual with an eating disorder: A meta-synthesis of qualitative studies. Clin Psychol Psychother. 2017;24(1):103\u201325.","journal-title":"Clin Psychol Psychother"},{"issue":"8","key":"1561_CR3","doi-asserted-by":"publisher","first-page":"1188","DOI":"10.1002\/eat.23260","volume":"53","author":"S Wetzler","year":"2020","unstructured":"Wetzler S, Hackmann C, Peryer G, Clayman K, Friedman D, Saffran K, et al. A framework to conceptualize personal recovery from eating disorders: A systematic review and qualitative meta-synthesis of perspectives from individuals with lived experience. Int J Eat Disord. 2020;53(8):1188\u2013203.","journal-title":"Int J Eat Disord"},{"issue":"3","key":"1561_CR4","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1002\/erv.3059","volume":"32","author":"MJ Pehlivan","year":"2024","unstructured":"Pehlivan MJ, Rodgers B, Schlage J, Maguire S, Miskovic-Wheatley J. Characteristics, correlates of burden and support service use of a help-seeking carers of loved ones with an eating disorder. Eur Eat Disord Rev. 2024;32(3):458\u201375.","journal-title":"Eur Eat Disord Rev"},{"issue":"10","key":"1561_CR5","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1007\/s00127-008-0364-7","volume":"43","author":"H Graap","year":"2008","unstructured":"Graap H, Bleich S, Herbst F, Scherzinger C, Trostmann Y, Wancata J, et al. The needs of carers: a comparison between eating disorders and schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2008;43(10):800\u20137.","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"4","key":"1561_CR6","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1080\/10640260591005236","volume":"13","author":"SM de la Rie","year":"2005","unstructured":"de la Rie SM, van Furth EF, De Koning A, Noordenbos G, Donker MC. The quality of life of family caregivers of eating disorder patients. Eat Disord. 2005;13(4):345\u201351.","journal-title":"Eat Disord"},{"issue":"3","key":"1561_CR7","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1192\/bjp.bp.110.088401","volume":"199","author":"E Goddard","year":"2011","unstructured":"Goddard E, Macdonald P, Sepulveda AR, Naumann U, Landau S, Schmidt U, et al. Cognitive interpersonal maintenance model of eating disorders: intervention for carers. Br J Psychiatry. 2011;199(3):225\u201331.","journal-title":"Br J Psychiatry"},{"key":"1561_CR8","unstructured":"(NICE) NIfHaCE. Eating disorders: recognition and treatment.; 2017."},{"issue":"1","key":"1561_CR9","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1002\/eat.22042","volume":"46","author":"J Couturier","year":"2013","unstructured":"Couturier J, Kimber M, Szatmari P. Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2013;46(1):3\u201311.","journal-title":"Int J Eat Disord"},{"issue":"1","key":"1561_CR10","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s40337-020-00338-9","volume":"8","author":"J Baudinet","year":"2020","unstructured":"Baudinet J, Simic M, Griffiths H, Donnelly C, Stewart C, Goddard E. Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series. J Eat Disord. 2020;8(1):68.","journal-title":"J Eat Disord"},{"issue":"1","key":"1561_CR11","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s40337-022-00585-y","volume":"10","author":"RD Rienecke","year":"2022","unstructured":"Rienecke RD, Le Grange D. The five tenets of family-based treatment for adolescent eating disorders. J Eat Disord. 2022;10(1):60.","journal-title":"J Eat Disord"},{"key":"1561_CR12","unstructured":"Lock JLG. D. Treatment manual for anorexia nervosa: A family-based approach. 2 ed. Guilford Press; 2012."},{"key":"1561_CR13","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/2050-2974-1-13","volume":"1","author":"J Treasure","year":"2013","unstructured":"Treasure J, Schmidt U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord. 2013;1:13.","journal-title":"J Eat Disord"},{"issue":"1","key":"1561_CR14","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1080\/10640266.2016.1255111","volume":"25","author":"AA Moskovich","year":"2017","unstructured":"Moskovich AA, Timko CA, Honeycutt LK, Zucker NL, Merwin RM. Change in expressed emotion and treatment outcome in adolescent anorexia nervosa. Eat Disord. 2017;25(1):80\u201391.","journal-title":"Eat Disord"},{"issue":"4","key":"1561_CR15","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1002\/eat.22298","volume":"48","author":"R Hibbs","year":"2015","unstructured":"Hibbs R, Rhind C, Leppanen J, Treasure J. Interventions for caregivers of someone with an eating disorder: a meta-analysis. Int J Eat Disord. 2015;48(4):349\u201361.","journal-title":"Int J Eat Disord"},{"issue":"3","key":"1561_CR16","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1002\/eat.22362","volume":"48","author":"R Hibbs","year":"2015","unstructured":"Hibbs R, Rhind C, Salerno L, Lo Coco G, Goddard E, Schmidt U, et al. Development and validation of a scale to measure caregiver skills in eating disorders. Int J Eat Disord. 2015;48(3):290\u20137.","journal-title":"Int J Eat Disord"},{"key":"1561_CR17","doi-asserted-by":"crossref","unstructured":"Truttmann S, Philipp J, Zeiler M, Franta C, Wittek T, Merl E et al. Long-Term Efficacy of the Workshop Vs. Online SUCCEAT (Supporting Carers of Children and Adolescents with Eating Disorders) Intervention for Parents: A Quasi-Randomised Feasibility Trial. J Clin Med. 2020;9(6).","DOI":"10.3390\/jcm9061912"},{"issue":"1","key":"1561_CR18","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s40519-023-01597-6","volume":"28","author":"M Zeiler","year":"2023","unstructured":"Zeiler M, Philipp J, Truttmann S, Wittek T, Kopp K, Schofbeck G, et al. Fathers in the spotlight: parental burden and the effectiveness of a parental skills training for anorexia nervosa in mother-father dyads. Eat Weight Disord. 2023;28(1):65.","journal-title":"Eat Weight Disord"},{"key":"1561_CR19","doi-asserted-by":"crossref","unstructured":"Bijsterbosch JM, Schnitzler AME, Harrison A, Treasure JL, Sternheim LC. The Effectiveness and Feasibility of the New Maudsley Collaborative Care Approach Skills-Based Training for Carers of Individuals With an Eating Disorder in the Netherlands. Eur Eat Disord Rev. 2025.","DOI":"10.1002\/erv.3193"},{"key":"1561_CR20","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/j.jad.2015.11.016","volume":"191","author":"L Salerno","year":"2016","unstructured":"Salerno L, Rhind C, Hibbs R, Micali N, Schmidt U, Gowers S, et al. An examination of the impact of care giving styles (accommodation and skilful communication and support) on the one year outcome of adolescent anorexia nervosa: Testing the assumptions of the cognitive interpersonal model in anorexia nervosa. J Affect Disord. 2016;191:230\u20136.","journal-title":"J Affect Disord"},{"issue":"5","key":"1561_CR21","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1002\/erv.2939","volume":"30","author":"A Harrison","year":"2022","unstructured":"Harrison A, Folk R, Proud F, Webb J, Oyeleye O, Clark Bryan D, et al. A description of virtual skills workshops for supporters of loved ones with eating disorders: Indicators of benefit and acceptability, clinical reflections and consideration of neurodiversity. Eur Eat Disord Rev. 2022;30(5):648\u201363.","journal-title":"Eur Eat Disord Rev"},{"issue":"6","key":"1561_CR22","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1002\/erv.2540","volume":"25","author":"J Hodsoll","year":"2017","unstructured":"Hodsoll J, Rhind C, Micali N, Hibbs R, Goddard E, Nazar BP, et al. A Pilot, Multicentre Pragmatic Randomised Trial to Explore the Impact of Carer Skills Training on Carer and Patient Behaviours: Testing the Cognitive Interpersonal Model in Adolescent Anorexia Nervosa. Eur Eat Disord Rev. 2017;25(6):551\u201361.","journal-title":"Eur Eat Disord Rev"},{"issue":"1","key":"1561_CR23","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1002\/cpp.2119","volume":"25","author":"PE Jenkins","year":"2018","unstructured":"Jenkins PE, Bues S, Cottrell J, Hawkins J, Pinder L, Price S, et al. A collaborative care skills workshop for carers: Can it be delivered in 1\u00a0day? Clin Psychol Psychother. 2018;25(1):130\u20137.","journal-title":"Clin Psychol Psychother"},{"issue":"2","key":"1561_CR24","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1002\/erv.2817","volume":"29","author":"M Zeiler","year":"2021","unstructured":"Zeiler M, Philipp J, Truttmann S, Wittek T, Franta C, Imgart H, et al. A German version of the Caregiver Skills scale for caregivers of patients with anorexia nervosa. Eur Eat Disord Rev. 2021;29(2):257\u201368.","journal-title":"Eur Eat Disord Rev"},{"issue":"6","key":"1561_CR25","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1016\/S2352-4642(18)30136-6","volume":"2","author":"J Treasure","year":"2018","unstructured":"Treasure J. Inclusion of fathers in the treatment of eating disorders. Lancet Child Adolesc Health. 2018;2(6):385\u20137.","journal-title":"Lancet Child Adolesc Health"},{"issue":"12","key":"1561_CR26","doi-asserted-by":"publisher","first-page":"2366","DOI":"10.1002\/eat.24551","volume":"58","author":"V Stonawski","year":"2025","unstructured":"Stonawski V, Kutzner J, Buscher S, Hoyer A, Kratz O, Horndasch S. Parenting Stress in Adolescent Anorexia Nervosa: Differential Stress in Mothers and Fathers During Inpatient Treatment. Int J Eat Disord. 2025;58(12):2366\u201377.","journal-title":"Int J Eat Disord"},{"issue":"4","key":"1561_CR27","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1002\/erv.2604","volume":"26","author":"C Vintro-Alcaraz","year":"2018","unstructured":"Vintro-Alcaraz C, Mestre-Bach G, Steward T, Lozano-Madrid M, Aguera Z, Jimenez-Murcia S, et al. Validation of the Caregiver Skills (CASK) scale in Catalonia: Concordance between caregivers in attitudes and behaviours. Eur Eat Disord Rev. 2018;26(4):329\u201336.","journal-title":"Eur Eat Disord Rev"},{"issue":"1","key":"1561_CR28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705519909540118","volume":"6","author":"LB Hu","year":"1999","unstructured":"Hu LB. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equation Modeling: Multidisciplinary J. 1999;6(1):1\u201355.","journal-title":"Struct Equation Modeling: Multidisciplinary J"},{"issue":"3","key":"1561_CR29","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1037\/met0000144","volume":"23","author":"D McNeish","year":"2018","unstructured":"McNeish D. Thanks coefficient alpha, we\u2019ll take it from here. Psychol Methods. 2018;23(3):412\u201333.","journal-title":"Psychol Methods"},{"issue":"3","key":"1561_CR30","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1177\/0049124114543236","volume":"44","author":"DA Kenny","year":"2015","unstructured":"Kenny DA, Kaniskan B, McCoach DB. The performance of RMSEA in models with small degrees of freedom. Sociol Methods Res. 2015;44(3):486\u2013507.","journal-title":"Sociol Methods Res"},{"key":"1561_CR31","volume-title":"The Standards for Educational and \u200bPsychological Testing","author":"AERA A, NCME","year":"2014","unstructured":"AERA A, NCME. The Standards for Educational and \u200bPsychological Testing. Washington D.C.: American Educational Research Association; 2014."},{"issue":"3","key":"1561_CR32","doi-asserted-by":"publisher","first-page":"e70033","DOI":"10.1002\/mpr.70033","volume":"34","author":"R Fasolato","year":"2025","unstructured":"Fasolato R, Bonora F, Barbui C, Boifava E, Bonetto C, Castellazzi M, et al. Italian Validation of the Accommodation and Enabling Scale for Eating Disorders and Caregiver Skills Scale for Caregivers of Patients With Eating Disorders. Int J Methods Psychiatr Res. 2025;34(3):e70033.","journal-title":"Int J Methods Psychiatr Res"},{"key":"1561_CR33","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1192\/bjp.187.5.444","volume":"187","author":"J Whitney","year":"2005","unstructured":"Whitney J, Murray J, Gavan K, Todd G, Whitaker W, Treasure J. Experience of caring for someone with anorexia nervosa: qualitative study. Br J Psychiatry. 2005;187:444\u20139.","journal-title":"Br J Psychiatry"},{"key":"1561_CR34","doi-asserted-by":"publisher","first-page":"771","DOI":"10.3389\/fpsyg.2020.00771","volume":"11","author":"L Lavorgna","year":"2020","unstructured":"Lavorgna L, Di Tella M, Miele G, De Mercanti SF, Streito LM, Perutelli V, et al. Online Validation of a Battery of Questionnaires for the Assessment of Family Functioning and Related Factors. Front Psychol. 2020;11:771.","journal-title":"Front Psychol"}],"container-title":["Journal of Eating Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40337-026-01561-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40337-026-01561-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40337-026-01561-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T13:37:12Z","timestamp":1775569032000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40337-026-01561-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,2]]},"references-count":34,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1561"],"URL":"https:\/\/doi.org\/10.1186\/s40337-026-01561-6","relation":{},"ISSN":["2050-2974"],"issn-type":[{"value":"2050-2974","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,2]]},"assertion":[{"value":"10 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was reviewed by the Medical Research Ethics Committee of the University Medical Center Utrecht, which concluded that the research did not fall under the scope of the Medical Research Involving Human Subjects Act (WMO), meaning further ethical approval was waived. The study was subsequently approved by the Institutional Review Board of Altrecht Mental Health Institute.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"All participating carers received an information letter detailing the study\u2019s purpose and procedures. Written informed consent was obtained from all carers who agreed to the use of their completed questionnaires for the study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"77"}}