{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:11:20Z","timestamp":1781007080297,"version":"3.54.1"},"reference-count":52,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,4,24]],"date-time":"2022-04-24T00:00:00Z","timestamp":1650758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Anorexia nervosa (AN) patients and their family-members share alexithymia, anxiety, depression, and other psychological symptoms, in the context of altered attachment. These domains have been individually studied in the context of eating disorders; few attempts have been made to study their interaction, especially including family members. In this study, alexithymia, parental-bonding, and psychopathology were assessed in 32 Italian families consisting of an adolescent AN patient, a sibling, and their parents. We aimed to (a) describe a sample of Italian families with a child affected by AN, notably including siblings; (b) investigate interactions between assessed constructs in patients and their siblings; and (c) investigate possible intergenerational effects. Results showed high alexithymia and psychopathological symptoms in patients but not in siblings, although the latter reported high obsession\u2013compulsion and paranoid ideation scores. Patients\u2019 and siblings\u2019 alexithymia correlated with psychopathology. Parents reported generally low alexithymia. Perceived parental bonding was found to be suboptimal in most participants, yet no clear relationship was found between specific parenting styles and other measured traits, nor did we find any other relevant intergenerational effect. Anorexia nervosa implies psychological difficulties for all family members. Siblings\u2019 psychopathological traits are especially concerning and currently understudied. Implications for future research and clinical interventions are discussed.<\/jats:p>","DOI":"10.3390\/bs12050123","type":"journal-article","created":{"date-parts":[[2022,4,24]],"date-time":"2022-04-24T02:22:02Z","timestamp":1650766922000},"page":"123","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Parental-Bonding and Alexithymia in Adolescents with Anorexia Nervosa, Their Parents, and Siblings"],"prefix":"10.3390","volume":"12","author":[{"given":"Stefania","family":"Mannarini","sequence":"first","affiliation":[{"name":"Interdepartmental Center for Family Research (CIRF), University of Padova, Via Venezia, 14-35131 Padova, PD, Italy"},{"name":"Section of Applied Psychology, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Via Venezia, 14-35131 Padova, PD, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1256-2089","authenticated-orcid":false,"given":"Johann Roland","family":"Kleinbub","sequence":"additional","affiliation":[{"name":"Interdepartmental Center for Family Research (CIRF), University of Padova, Via Venezia, 14-35131 Padova, PD, Italy"},{"name":"Section of Applied Psychology, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Via Venezia, 14-35131 Padova, PD, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1007\/s11920-012-0282-y","article-title":"Epidemiology of eating disorders: Incidence, prevalence and mortality rates","volume":"14","author":"Smink","year":"2012","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1001\/archgenpsychiatry.2011.74","article-title":"Mortality rates in patients with anorexia nervosa and other eating disorders: A meta-analysis of 36 studies","volume":"68","author":"Arcelus","year":"2011","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1176\/appi.ajp.2009.09020247","article-title":"Increased mortality in bulimia nervosa and other eating disorders","volume":"166","author":"Crow","year":"2009","journal-title":"Am. J. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/S0140-6736(03)12378-1","article-title":"Eating disorders","volume":"361","author":"Fairburn","year":"2003","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1002\/eat.22103","article-title":"A systematic review of evidence for psychological treatments in eating disorders: 2005\u20132012","volume":"46","author":"Hay","year":"2013","journal-title":"Int. J. Eat. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.neubiorev.2021.11.035","article-title":"Social cognition in female adults with Anorexia Nervosa: A systematic review","volume":"132","author":"Tauro","year":"2022","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.ijnurstu.2016.10.006","article-title":"The lived experience of anorexia nervosa in adolescence, comparison of the points of view of adolescents, parents, and professionals: A metasynthesis","volume":"65","author":"Sibeoni","year":"2017","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1080\/10640266.2019.1642036","article-title":"Emotion regulation and emotional eating in anorexia nervosa and bulimia nervosa","volume":"29","author":"Meule","year":"2021","journal-title":"Eat. Disord."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1002\/eat.23451","article-title":"How the unconscious mind controls body movements: Body schema distortion in anorexia nervosa","volume":"54","author":"Beckmann","year":"2021","journal-title":"Int. J. Eat. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.clinthera.2020.11.006","article-title":"Current therapeutic approaches to anorexia nervosa: State of the art","volume":"43","author":"Muratore","year":"2021","journal-title":"Clin. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1007\/s40519-019-00644-5","article-title":"Evaluation of the reliability and validity of the Italian version of the schema mode inventory for eating disorders: Short form for adults with dysfunctional eating behaviors","volume":"25","author":"Pietrabissa","year":"2020","journal-title":"Eat. Weight Disord."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"600","DOI":"10.3389\/fpsyg.2018.00600","article-title":"Factorial Structure and Preliminary Validation of the Schema Mode Inventory for Eating Disorders (SMI-ED)","volume":"9","author":"Simpson","year":"2018","journal-title":"Front. Psychol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/sjop.12300","article-title":"Alexithymia and psychosocial problems among Italian preadolescents. A latent class analysis approach","volume":"57","author":"Mannarini","year":"2016","journal-title":"Scand. J. Psychol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1037\/0022-0167.49.1.86","article-title":"Association between childhood physical and emotional abuse and disordered eating behaviors in female undergraduates: An investigation of the mediating role of alexithymia and depression","volume":"49","author":"Mazzeo","year":"2002","journal-title":"J. Couns. Psychol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1159\/000075537","article-title":"New trends in alexithymia research","volume":"73","author":"Taylor","year":"2004","journal-title":"Psychother. Psychosom."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/2050-2974-1-21","article-title":"Alexithymia and eating disorders: A critical review of the literature","volume":"1","author":"Nowakowski","year":"2013","journal-title":"J. Eat. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.jpsychores.2017.06.007","article-title":"Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale","volume":"99","author":"Westwood","year":"2017","journal-title":"J. Psychosom. Res."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Erriu, M., Cimino, S., and Cerniglia, L. (2020). The role of family relationships in eating disorders in adolescents: A narrative review. Behav. Sci., 10.","DOI":"10.3390\/bs10040071"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1080\/10640266.2019.1573046","article-title":"\u201cDo I exist in this world, really, or is it just her?\u201d Youths\u2019 perspectives of living with a sibling with anorexia nervosa","volume":"28","author":"Fjermestad","year":"2020","journal-title":"Eat. Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.3389\/fpsyg.2016.02046","article-title":"Triadic Interactions in Families of Adolescents with Anorexia Nervosa and Families of Adolescents with Internalizing Disorders","volume":"7","author":"Balottin","year":"2017","journal-title":"Front. Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1002\/erv.2553","article-title":"The Science Behind the Academy for Eating Disorders\u2019 Nine Truths About Eating Disorders","volume":"25","author":"Schaumberg","year":"2017","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1002\/cpp.2314","article-title":"Are family relations connected to the quality of the outcome in adolescent anorexia nervosa? An observational study with the Lausanne Trilogue Play","volume":"25","author":"Balottin","year":"2018","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_23","first-page":"13","article-title":"The lack of a \u201cNormative Male Alexithymia\u201d in parents of daughters with anorexia nervosa: A pilot study by using the Reading the Mind in the Eyes test (RME) and the Toronto Alexithymia Scale TAS-20","volume":"26","author":"Chinello","year":"2020","journal-title":"Psicoter. Cogn. E Comport."},{"key":"ref_24","first-page":"1941","article-title":"Alexithymia in parents and adolescent anorexic daughters: Comparing the responses to TSIA and TAS-20 scales","volume":"10","author":"Balottin","year":"2014","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/cp.12098","article-title":"Familial factors relating to alexithymic traits in adolescents with psychiatric disorders","volume":"21","author":"Gatta","year":"2017","journal-title":"Clin. Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.2044-8341.1979.tb02487.x","article-title":"Parental bonding instrument (PBI)","volume":"52","author":"Parker","year":"1979","journal-title":"Br. J. Med. Psychol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.3389\/fpsyg.2018.01493","article-title":"Emotion regulation and parental bonding in families of adolescents with internalizing and externalizing symptoms","volume":"9","author":"Mannarini","year":"2018","journal-title":"Front. Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.copsyc.2018.03.003","article-title":"Attachment and eating disorders: A research update","volume":"25","author":"Tasca","year":"2019","journal-title":"Curr. Opin. Psychol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"319","DOI":"10.2147\/NDT.S128418","article-title":"The parental bonding in families of adolescents with anorexia: Attachment representations between parents and offspring","volume":"13","author":"Balottin","year":"2017","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/BF03325079","article-title":"Eating disturbances in siblings of patients with eating disorders","volume":"9","author":"Wunderlich","year":"2004","journal-title":"Eat. Weight Disord.\u2014Stud. Anorexia Bulim. Obes."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1080\/10640266.2018.1453632","article-title":"\u201cThey don\u2019t really get heard\u201d: A qualitative study of sibling involvement across two forms of family-based treatment for adolescent anorexia nervosa","volume":"26","author":"Duncan","year":"2018","journal-title":"Eat. Disord."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.jad.2011.06.009","article-title":"Perception of emotion and bilateral advantage in women with eating disorders, their healthy sisters, and nonrelated healthy controls","volume":"134","author":"Rozenstein","year":"2011","journal-title":"J. Affect. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"664517","DOI":"10.3389\/fpsyt.2021.664517","article-title":"\u201cWe Thought We Were Alone\u201d: The Subjective Experience of the Siblings of Anorexic Adolescent Patients","volume":"12","author":"Persico","year":"2021","journal-title":"Front. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/s40337-021-00440-6","article-title":"\u201cPutting your own oxygen mask on first\u201d: A qualitative study of siblings of adults with anorexia or bulimia","volume":"9","author":"Karlstad","year":"2021","journal-title":"J. Eat. Disord."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/S2352-4642(18)30022-1","article-title":"The age of adolescence","volume":"2","author":"Sawyer","year":"2018","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/0022-3999(94)90006-X","article-title":"The Twenty-item Toronto Alexithymia Scale\u2014II. Convergent, discriminant, and concurrent validity","volume":"38","author":"Bagby","year":"1994","journal-title":"J. Psychosom. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/S0022-3999(96)00228-0","article-title":"Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: An Italian multicenter study","volume":"41","author":"Bressi","year":"1996","journal-title":"J. Psychosom. Res."},{"key":"ref_38","unstructured":"Parker, G. (1983). Parental Overprotection: A Risk Factor in Psychosocial Development, Grune & Stratton."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1002\/1097-4679(200101)57:1<119::AID-JCLP12>3.0.CO;2-2","article-title":"Further results on the reliability of the Parental Bonding Instrument (PBI) in an Italian sample of schizophrenic patients and their parents","volume":"57","author":"Favaretto","year":"2001","journal-title":"J. Clin. Psychol."},{"key":"ref_40","unstructured":"Derogatis, L.R. (1994). SCL-90-R: Administration, Scoring and Procedures Manual, National Computer Systems Inc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.eurpsy.2010.12.006","article-title":"Psychometric properties of the Italian version of the SCL-90-R: A study on a large community sample","volume":"27","author":"Prunas","year":"2012","journal-title":"Eur. Psychiatry"},{"key":"ref_42","unstructured":"R Core Team (2020). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_43","unstructured":"Hollingshead, A.A. (1975). Four-Factor Index of Social Status, Yale University."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"109940","DOI":"10.1016\/j.jpsychores.2020.109940","article-title":"Twenty-five years with the 20-item Toronto Alexithymia Scale","volume":"131","author":"Bagby","year":"2020","journal-title":"J. Psychosom. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"263","DOI":"10.2466\/pr0.2000.86.1.263","article-title":"Assessing clinically significant change: Application to the SCL-90-R","volume":"86","author":"Schmitz","year":"2000","journal-title":"Psychol. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s40337-019-0271-1","article-title":"Alexithymia predicts maladaptive but not adaptive emotion regulation strategies in adolescent girls with anorexia nervosa or depression","volume":"7","author":"Dehning","year":"2019","journal-title":"J. Eat. Disord."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"991","DOI":"10.3389\/fpsyt.2019.00991","article-title":"Alexithymia and Treatment Outcome in Anorexia Nervosa: A Scoping Review of the Literature","volume":"10","author":"Gramaglia","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1192\/bjp.161.2.240","article-title":"Alexithymia in women with anorexia nervosa. A preliminary investigation","volume":"161","author":"Bourke","year":"1992","journal-title":"Br. J. Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1002\/(SICI)1098-108X(199804)23:3<277::AID-EAT5>3.0.CO;2-G","article-title":"The relationship between alexithymia, depression, and axis II psychopathology in eating disorder inpatients","volume":"23","author":"Sexton","year":"1998","journal-title":"Int. J. Eat. Disord."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.apnu.2015.01.003","article-title":"Caring for an adolescent with anorexia nervosa: Parent\u2019s views and experiences","volume":"29","author":"McCormack","year":"2015","journal-title":"Arch. Psychiatr. Nurs."},{"key":"ref_51","first-page":"221","article-title":"Maternal Symptoms of Depression and Paranoid Ideation can be Predictive of the Onset of Eating Disorders in Early Adolescents Offspring: A Nine-year Longitudinal Study","volume":"18","author":"Cimino","year":"2018","journal-title":"Int. J. Psychol. Psychol. Ther."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"S456","DOI":"10.1080\/15374416.2017.1390756","article-title":"The Participation of Mothers, Fathers, and Siblings in Family-Based Treatment for Adolescent Anorexia Nervosa","volume":"47","author":"Hughes","year":"2018","journal-title":"J. Clin. Child Adolesc. Psychol."}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/12\/5\/123\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:59:37Z","timestamp":1760137177000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/12\/5\/123"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,24]]},"references-count":52,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["bs12050123"],"URL":"https:\/\/doi.org\/10.3390\/bs12050123","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,24]]}}}