{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T12:50:17Z","timestamp":1775739017957,"version":"3.50.1"},"reference-count":44,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,28]],"date-time":"2023-01-28T00:00:00Z","timestamp":1674864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health (Ricerca Corrente)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>The quality of family interactions may be a critical factor for restrictive eating disorders (REDs). Adolescent patients with RED have interpersonal problems that can be inferred by observing their behaviours during family interactions. To date, the assessment of the association among RED severity, interpersonal problems, and patients\u2019 interactive behaviours in the family is partially explored. This cross-sectional study aimed to explore how adolescent patients\u2019 interactive behaviours observed during the Lausanne Trilogue Play\u2014clinical version (LTPc) were associated with both RED severity and interpersonal problems. Sixty adolescent patients completed the EDI-3 questionnaire to assess RED severity using the Eating Disorder Risk Composite (EDRC) and Interpersonal Problems Composite (IPC) subscales. Moreover, patients and their parents took part in the LTPc, and patients\u2019 interactive behaviours were coded as participation, organization, focal attention, and affective contact in all the LTPc four phases. A significant association emerged between patients\u2019 interactive behaviours during the LTPc triadic phase and both EDRC and IPC. Better patients\u2019 organization and affective contact significantly correlated with lower RED severity and fewer interpersonal problems. These findings suggest that investigating the quality of family relationships and patients\u2019 interactive behaviours may contribute to better identifying adolescent patients at risk for more severe conditions.<\/jats:p>","DOI":"10.3390\/children10020237","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T03:56:27Z","timestamp":1675050987000},"page":"237","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Family Caregiving Environment Associates with Adolescent Patients\u2019 Severity of Eating Disorder and Interpersonal Problems: A Cross-Sectional Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3178-6830","authenticated-orcid":false,"given":"Giorgia","family":"Baradel","sequence":"first","affiliation":[{"name":"Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7424-8744","authenticated-orcid":false,"given":"Livio","family":"Provenzi","sequence":"additional","affiliation":[{"name":"Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy"},{"name":"Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2682-5006","authenticated-orcid":false,"given":"Matteo","family":"Chiappedi","sequence":"additional","affiliation":[{"name":"Vigevano Child Neurology and Psychiatry Unit, ASST Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2783-5262","authenticated-orcid":false,"given":"Marika","family":"Orlandi","sequence":"additional","affiliation":[{"name":"Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arianna","family":"Vecchio","sequence":"additional","affiliation":[{"name":"Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renato","family":"Borgatti","sequence":"additional","affiliation":[{"name":"Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy"},{"name":"Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9583-0554","authenticated-orcid":false,"given":"Martina Maria","family":"Mensi","sequence":"additional","affiliation":[{"name":"Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy"},{"name":"Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"653047","DOI":"10.3389\/fpsyt.2021.653047","article-title":"Assessing Family Functioning Before and After an Integrated Multidisciplinary Family Treatment for Adolescents With Restrictive Eating Disorders","volume":"12","author":"Mensi","year":"2021","journal-title":"Front. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1097\/YCO.0000000000000278","article-title":"Epidemiology of Eating Disorders in Europe: Prevalence, Incidence, Comorbidity, Course, Consequences, and Risk Factors","volume":"29","author":"Mustelin","year":"2016","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref_3","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_4","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/S0140-6736(09)61748-7","article-title":"Eating Disorders","volume":"375","author":"Treasure","year":"2010","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1002\/erv.2776","article-title":"Drive for Thinness Provides an Alternative, More Meaningful, Severity Indicator than the DSM-5 Severity Indices for Eating Disorders","volume":"29","author":"Krug","year":"2021","journal-title":"Eur. Eat. Disord. Rev. J. Eat. Disord. Assoc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","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_7","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.cpr.2013.10.005","article-title":"A Systematic Review of the Literature on Family Functioning across All Eating Disorder Diagnoses in Comparison to Control Families","volume":"34","author":"Allan","year":"2014","journal-title":"Clin. Psychol. Rev."},{"key":"ref_8","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_9","first-page":"399","article-title":"Predictors of Eating Disorder Risk In Anorexia Nervosa Adolescents","volume":"57","author":"Batista","year":"2018","journal-title":"Acta Clin. Croat."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.cpr.2012.10.009","article-title":"The Role of Interpersonal Functioning in the Maintenance of Eating Psychopathology: A Systematic Review and Testable Model","volume":"33","author":"Arcelus","year":"2013","journal-title":"Clin. Psychol. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e129","DOI":"10.1002\/erv.2161","article-title":"Understanding the Association of Impulsivity, Obsessions, and Compulsions with Binge Eating and Purging Behaviours in Anorexia Nervosa","volume":"20","author":"Hoffman","year":"2012","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1002\/eat.20427","article-title":"Poor Social Comparison and the Tendency to Submissive Behavior in Anorexia Nervosa","volume":"40","author":"Connan","year":"2007","journal-title":"Int. J. Eat. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1038\/sj.ejcn.1601884","article-title":"Epidemiological Study of the Influence of Family and Socioeconomic Status in Disorders of Eating Behaviour","volume":"58","year":"2004","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_14","unstructured":"Fivaz-Depeursinge, E., and Corboz-Warnery, A. (1999). The Primary Triangle: A Developmental Systems View of Mothers, Fathers and Infants, Basic Books."},{"key":"ref_15","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_16","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.1111\/jpc.16070","article-title":"Family-Based Treatment for Adolescents with Anorexia Nervosa: A Long-Term Psychological Follow-Up","volume":"58","author":"Springall","year":"2022","journal-title":"J. Paediatr. Child Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1002\/eat.23710","article-title":"Family Functioning and Eating Disorders Treatment in a Partial Hospitalization Program in Adolescent Females with Eating Disorders","volume":"55","author":"Liu","year":"2022","journal-title":"Int. J. Eat. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Harris, B.A., Scharff, A., Smith, M., Brooks, G., Thompson-Brenner, H., and Boswell, J.F. (2022). Trajectories of Interpersonal Problems in Residential Eating Disorder Treatment: Exploring the Influence of Primary Diagnosis. Clin. Psychol. Psychother., 29.","DOI":"10.1002\/cpp.2795"},{"key":"ref_19","unstructured":"Malagoli Togliatti, M., and Mazzoni, S. (2006). Osservare, Valutare, e Sostenere La Relazione Genitori-Figli. Il Lausanne Trilogue Play Clinico [Observe, Evaluate, and Support the Parent-Child Relationship. The Clinical Lausanne Trilogue Play], Raffaello Cortina Editore."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"112968","DOI":"10.1016\/j.psychres.2020.112968","article-title":"Focus on Family Functioning in Anorexia Nervosa: New Perspectives Using the Lausanne Trilogue Play","volume":"288","author":"Mensi","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/S0022-3999(96)00224-3","article-title":"Relationships between Alexithymia and Psychological Characteristics Associated with Eating Disorders","volume":"41","author":"Taylor","year":"1996","journal-title":"J. Psychosom. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.psychres.2013.11.012","article-title":"Heart Rate Variability in Adolescents with Functional Hypothalamic Amenorrhea and Anorexia Nervosa","volume":"215","author":"Bomba","year":"2014","journal-title":"Psychiatry Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.comppsych.2013.10.002","article-title":"Expressed Emotion in Anorexia Nervosa: What Is inside the \u201cBlack Box\u201d?","volume":"55","author":"Duclos","year":"2014","journal-title":"Compr. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_25","unstructured":"Kaufman, J., Birmaher, B., Axelson, D., Pereplitchikova, F., Brent, D., and Ryan, N. (2016). Schedule for Affective Disorders and Schizophrenia for School-Aged Children: Present and Lifetime Version (K-SADS-PL) DSM-5, Child and Adolescent Research and Education."},{"key":"ref_26","unstructured":"Kaufman, J., Birmaher, B., Rao, U., Ryan, N., di Sogos, C., Di Noia, S.P., Fioriello, F., and Picchiotti, G. (2019). K-SADS-PL DSM-5. Intervista Diagnostica per La Valutazione Dei Disturbi Psicopatologici in Bambini e Adolescenti. [Schedule for Affective Disorders and Schizophrenia for School-Aged Children: Present and Lifetime Version (K-SADS-PL) DSM-5], Erickson."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Wechsler, D. (2003). Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), Giunti Organizzazioni Speciali.","DOI":"10.1037\/t15174-000"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wechsler, D. (2008). Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), Giunti Organizzazioni Speciali.","DOI":"10.1037\/t15169-000"},{"key":"ref_29","unstructured":"First, M.B., Williams, J.B.W., Janet, S.B., and Spitzer, R.L. (2017). Structured Clinical Interview for DSM-5. Personality Disorders (SCID-5-PD), American Psychiatric Association."},{"key":"ref_30","unstructured":"Mensi, M.M. (2022, December 22). Available online: http:\/\/doi.org\/20211006_REDs_LTP-EDI_MMM_01."},{"key":"ref_31","first-page":"478","article-title":"Eating Disorder Inventory-3 (EDI-3)","volume":"35","author":"Garner","year":"2004","journal-title":"Int. J. Eat. Disord."},{"key":"ref_32","unstructured":"Giannini, M., Pannocchia, L., Dalle Grave, R., Muratori, F., and Viglione, V. (2008). EDI-3 Eating Disorder Inventory-3. Manuale. Adattamento Italiano, Giunti OS\u2014Organizzazioni Speciali."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1002\/eat.20763","article-title":"Body Dissatisfaction Moderates Weight Curves in the Inpatient Treatment of Anorexia Nervosa","volume":"43","author":"Vansteelandt","year":"2010","journal-title":"Int. J. Eat. Disord."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1002\/1098-108X(199303)13:2<171::AID-EAT2260130205>3.0.CO;2-L","article-title":"Anorexia Nervosa \u201cRestricters\u201d Who Purge: Implications for Subtyping Anorexia Nervosa","volume":"13","author":"Garner","year":"1993","journal-title":"Int. J. Eat. Disord."},{"key":"ref_35","unstructured":"IBM Corp (2020). IBM SPSS Statistics for Windows, IBM."},{"key":"ref_36","unstructured":"R Core (2022). Team R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.eatbeh.2013.08.009","article-title":"Family Functioning and Risk Factors for Disordered Eating","volume":"14","author":"Lyke","year":"2013","journal-title":"Eat. Behav."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.eatbeh.2014.06.001","article-title":"A Systematic Review of Family Caregiving in Eating Disorders","volume":"15","author":"Anastasiadou","year":"2014","journal-title":"Eat. Behav."},{"key":"ref_39","first-page":"821","article-title":"The Relationship of Gender and Family Environment to Eating Disorder Risk in Adolescents","volume":"29","author":"Felker","year":"1994","journal-title":"Adolescence"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1111\/fare.12611","article-title":"Perceived and Observed Family Functioning in Adolescents Affected by Restrictive Eating Disorders","volume":"71","author":"Mensi","year":"2022","journal-title":"Fam. Relat."},{"key":"ref_41","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_42","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_43","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1159\/000075542","article-title":"Childhood Adversities as Risk Factors for Alexithymia and Other Aspects of Affect Dysregulation in Adulthood","volume":"73","author":"Kooiman","year":"2004","journal-title":"Psychother. Psychosom."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.jaac.2015.01.018","article-title":"Practice Parameter for the Assessment and Treatment of Children and Adolescents with Eating Disorders","volume":"54","author":"Lock","year":"2015","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/2\/237\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:18:39Z","timestamp":1760120319000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/2\/237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,28]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["children10020237"],"URL":"https:\/\/doi.org\/10.3390\/children10020237","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,28]]}}}