Skip to main content Accessibility help
Hostname: page-component-7ccbd9845f-dxj8b Total loading time: 0.43 Render date: 2023-01-28T20:21:39.400Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Parental bonding and eating psychopathology in bulimia nervosa: personality traits as possible mediators

Published online by Cambridge University Press:  11 April 2011

Secondo Fassino*
Regional Pilot Centre for Eating Disorder of Neuroscience Department, Psychiatry Section, University of Torino, Torino (Italy)
Federico Amianto
Regional Pilot Centre for Eating Disorder of Neuroscience Department, Psychiatry Section, University of Torino, Torino (Italy)
Giuseppe Rocca
Neurosciences Department, Psychiatry Section, University of Torino, Torino (Italy)
Giovanni Abbate Daga
Regional Pilot Centre for Eating Disorder of Neuroscience Department, Psychiatry Section, University of Torino, Torino (Italy)
Address for correspondence: Professor S. fassino, Service for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Torino, Via Cherasco 11, 10126, Torino (Italy). Fax: ++39–011–673473 E-mail:


Aims – The relationship between eating disorders, attachment, personality traits and eating psychopathology remains unexplored. This study tested the mediating role of temperament and character between parental bonding and psy-chopathology in bulimic women. Methods – 154 bulimic subjects and 154 healthy controls were compared using Parental Bonding Instrument (PBI), Temperament and Character Inventory (TCI), Eating Disorder Inventory-2 (EDI-2), and Beck Depression Inventory (BDI). Multiple regression analysis tested the mediation of personality traits between parenting and eating psy-chopathology. Results – Bulimic subjects displayed low maternal and paternal care and low self-directedness, and high novelty seeking and eating psychopathology. Maternal care was negatively related to social insecurity, inadequacy and impulsiveness. Paternal care predicted novelty seeking, self-directedness, interoceptive awareness, impulsiveness, and asceticism. The mediation effect of self-directedness between paternal care and psychopathology was significant, not the one of novelty seeking. Conclusions – Parental care is lower in bulimic than in control women even when controlled for possible confounding variables. Some eating psychopathology traits are related to maternal and paternal care, but not the bulimia subscale. Paternal care is also related to temperament and character traits which are related to eating psychopathology. Self-directedness mediates with different degrees between parenting and eating psychopathology. Clinical implications are discussed.

Declaration of Interest: The first author received financing from Compagnia di San Paolo Foundation for the research on eating disorders (3989 IT/FA 2005.1797). The National Eating Disorder Association (NEDA) awarded a Charron Family Grant to the second author to sustain research about the families of subjects affected by eating disorders. The third author received a grant from “Regione Piemonte” for research on Eating Disorders for the years 2008 and 2009. The authors have not received any other financing for the present research, including pharmaceutical company support or any honoraria for consultancies for interventions during the last two years. The authors are not involved in any conflict of interest in connection to the submitted article.

Original Articles
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



Avagianou, P. A. & Zafiropoulou, M. (2008). Parental bonding and depression: personality as a mediating factor. International Journal of Adolescence Medicine and Health 20, 261269.Google ScholarPubMed
Baron, R. M. & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 11731182.CrossRefGoogle ScholarPubMed
Beck, A. T., Rial, W. Y. & Rickets, K. (1974). Short form of Depression Inventory: cross-validation. Psychological Reports 34, 11841186.Google ScholarPubMed
Bloks, H., Hoek, H. W., Callewaert, I. & van Furth, E. (2004). Stability of personality traits in patients who received intensive treatment for a severe eating disorder. Journal of Nervous and Mental Disease 192, 129–38.CrossRefGoogle ScholarPubMed
Bulik, C. M., Sullivan, P. F., Fear, J. L. & Pickering, A. (2000). Outcome of anorexia nervosa: eating attitudes, personality, and parental bonding. International Journal of Eating Disorders 28, 139147.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Bulik, C. M., Tozzi, F., Anderson, C., Mazzeo, S. E., Aggen, S. & Sullivan, P. F. (2003). The relation between eating disorders and components of perfectionism. American Journal of Psychiatry 160, 366368.CrossRefGoogle ScholarPubMed
Cloninger, C. R., Svrakic, D. M. & Przybeck, T. R. (1993). A psychobio-logical model of temperament and character. Archives of General Psychiatry 50, 975989.CrossRefGoogle ScholarPubMed
Day, J., Ternouth, A. & Collier, D. A. (2009). Eating disorders and obesity: two sides of the same coin? Epidemiologia e Psichiatria Sociale 18, 96100.Google ScholarPubMed
De Panfilis, C., Rabbaglio, P., Rossi, C., Zita, G. & Maggini, C. (2003). Body image disturbance, parental bonding and alexithymia in patients with eating disorders. Psychopathology 36, 239246.CrossRefGoogle ScholarPubMed
Di Pentima, L., Magnani, M., Tortolani, D., Montecchi, F., Ardovini, C. & Caputo, G. (1998). Use of the Parental Bonding Instrument to compare interpretations of the parental bond by adolescent girls with restricting and binge/purging anorexia nervosa. Eating and Weight Disorders 3, 2531.CrossRefGoogle ScholarPubMed
Eggert, J., Levendosky, A. & Klump, K. (2007). Relationships among attachment styles, personality characteristics, and disordered eating. International Journal of Eating Disorders 40(2), 149155.CrossRefGoogle ScholarPubMed
Enns, M. W., Cox, B. J. & Larsen, D. K. (2000). Perceptions of parental bonding and symptom severity in adults with depression: mediation by personality dimensions. Canadian Journal of Psychiatry 45, 263268.CrossRefGoogle ScholarPubMed
Fassino, S., Abbate Daga, G., Amianto, F., Leombruni, P., Boggio, S. & Rovera, G. G. (2002). Temperament and character profile of eating disorders: a controlled study with TCI. International Journal of Eating Disorders 32, 412425.CrossRefGoogle Scholar
Fassino, S., Abbate Daga, G., Amianto, F. & Rovera, G. G. (2003a). Psicopatologia Alimentare e personalità nei disturbi del comportamento alimentare. Epidemiologia e Psichiatria Sociale 12, 293300.CrossRefGoogle Scholar
Fassino, S., Amianto, F., Daga, G. A., Leombruni, P., Garzaro, L., Levi, M. & Rovera, G. G. (2003b). Bulimic family dynamics: role of parents’ personality – a controlled study with the Temperament and Character Inventory. Comprehensive Psychiatry 44, 7077.CrossRefGoogle ScholarPubMed
Fassino, S., Abbate-Daga, G., Pierò, A., Leombruni, P. & Rovera, G. G. (2003c). Dropout from brief psychotherapy within a combination treatment in bulimia nervosa: role of personality and anger. Psychotherapy and Psychosomatics 72, 203210.CrossRefGoogle ScholarPubMed
Fassino, S., Pierò, A., Gramaglia, C. & Abbate-Daga, G. (2004). Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity. Psychopathology 37, 168174.CrossRefGoogle ScholarPubMed
Fassino, S., Amianto, F., Gastaldi, F., Abbate-Daga, G., Brambilla, F. & Leombruni, P. (2009). Personality trait interactions in borderline families: a controlled study using the Temperament and Character Inventory. Psychiatry Research 165, 128136.CrossRefGoogle ScholarPubMed
Fosse, G. K. & Holen, A. (2006). Childhood maltreatment in adult female psychiatric outpatients with eating disorders. Eating Behaviors 7, 404409.CrossRefGoogle ScholarPubMed
Furnham, A. & Adam-Saib, S. (2001). Abnormal eating attitudes and behaviours and perceived parental control: a study of white British and British-Asian school girls. Social Psychiatry and Psychiatric Epidemiology 36, 462470.CrossRefGoogle ScholarPubMed
Garner, D. M. (1993). Eating Disorder Inventory 2: Professional Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Hedlund, S., Fichter, M. M., Quadflieg, N. & Brandl, C. (2003). Expressed emotion, family environment, and parental bonding in bulimia nervosa: a 6-year investigation. Eating and Weight Disorders 8, 2635.CrossRefGoogle ScholarPubMed
Heru, A. M. (2006). Family psychiatry: from research to practice. American Journal of Psychiatry 163, 962968.CrossRefGoogle ScholarPubMed
Holliday, J., Uher, R., Landau, S., Collier, D. & Treasure, J. (2006). Personality pathology among individuals with a lifetime history of anorexia nervosa. Journal of Personality Disorders 20, 417430.CrossRefGoogle ScholarPubMed
Kent, J. S. & Clopton, J. R. (1992). Bulimic women's perceptions of their family relationships. Journal of Clinical Psychology 48, 281292.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Laliberte, M., Boland, F. J. & Leichner, P. (1999). Family climates: family factors specific to disturbed eating and bulimia nervosa. Journal of Clinical Psychology 55, 10211040.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Laporte, L., Marcoux, V. & Guttman, H. A. (2001). Characteristics of families of women with restricting anorexia nervosa compared with families of normal probands. Encephale 27, 109119.Google ScholarPubMed
Lawson, R., Emanuelli, F., Sines, J. & Waller, G. (2008). Emotional awareness and core beliefs among women with eating disorders. European Eating Disorders Review 16, 155159.CrossRefGoogle ScholarPubMed
Leung, N., Thomas, G. & Waller, G. (2000). The relationship between parental bonding and core beliefs in anorexic and bulimic women. British Journal of Clinical Psychology 39, 205213.CrossRefGoogle ScholarPubMed
Magliano, L., Orrico, A., Fiorillo, A., Del Vecchio, H., Castiello, G., Malangone, C., De Rosa, C., Capuano, V., Maj, M.; IMDS Working Group, Torchio, E., Franzoi, V., Pingani, L., Curti, C., Spanarello, S., Scattina, M., Fuchs, H., Test, G. R., Ferrigno, J., Minciotti, E., Innocente, P., Bardicchia, F., Galli, A., La Rovere, R., Maroncelli, M., Iapichino, S., Pannozzo, M., Nuccetelli, F., Di Nunzio, R., Armellino, R., Palladino, C., Delcuratolo, V., Cadoni, M., Cannas, A., Caniglia, A. & Cudia, M. (2009). Family burden in bipolar disorders: results from the Italian Mood Disorders Study (IMDS). Epidemiologia e Psichiatria Sociale 18, 137146.Google Scholar
McEwen, C. & Flouri, E. (2009). Fathers’ parenting, adverse life events, and adolescents’ emotional and eating disorder symptoms: the role of emotion regulation. European Child & Adolescent Psychiatry 18, 206216.CrossRefGoogle ScholarPubMed
Meyer, C. & Gillings, K. (2004). Parental bonding and bulimic psy-chopathology: the mediating role of mistrust/abuse beliefs. International Journal of Eating Disorders 35, 229233.CrossRefGoogle ScholarPubMed
Miotto, P., De Coppi, M., Frezza, M., Rossi, M. & Preti, A. (2002). Social desirability and eating disorders. A community study of an Italian school-aged sample. Acta Psychiatrica Scandinavica 105, 372377.CrossRefGoogle ScholarPubMed
Mujtaba, T. & Furnham, A. (2001). A cross-cultural study of parental conflict and eating disorders in a non-clinical sample. International Journal of Social Psychiatry 47, 2435.CrossRefGoogle Scholar
Otani, K., Suzuki, A., Oshino, S., Ishii, G. & Matsumoto, Y. (2009). Effects of the “affectionless control” parenting style on personality traits in healthy subjects. Psychiatry Research 165, 181186.CrossRefGoogle ScholarPubMed
Parker, G., Tupling, H. & Brown, L. B. (1979). A Parental Bonding Instrument. British Journal of Medical Psychology 52, 110.CrossRefGoogle Scholar
Picot, A. K. & Lilenfeld, L. R. (2003). The relationship among binge severity, personality psychopathology, and body mass index. International Journal of Eating Disorders 34, 98107.CrossRefGoogle ScholarPubMed
Raffi, A. R., Rondini, M., Grandi, S. & Fava, G. A. (2000). Life events and prodromal symptoms in bulimia nervosa. Psychological Medicine 30, 727731.CrossRefGoogle ScholarPubMed
Romans, S. E., Gendall, K. A., Martin, J. L. & Mullen, P. E. (2001). Child sexual abuse and later disordered eating: a New Zealand epidemio-logical study. International Journal of Eating Disorders 29, 380392.CrossRefGoogle Scholar
Russell, J. D., Kopec-Schrader, E., Rey, J. M. & Beumont, P. J. (1992). The Parental Bonding Instrument in adolescent patients with anorexia nervosa. Acta Psychiatrica Scandinavica 86, 236239.CrossRefGoogle ScholarPubMed
Soenens, B., Luyckx, K., Vansteenkiste, M., Luyten, P., Duriez, B. & Goossens, L. (2008). Maladaptive perfectionism as an intervening variable between psychological control and adolescent depressive symptoms: a three-wave longitudinal study. Journal of Family Psychology 22, 465474.CrossRefGoogle ScholarPubMed
Sordelli, A., Fossati, A., Devoti, R. M. & La Viola, S. (1996). Perceived parental bonding in anorectic and bulimic patients. Psychopathology 29, 6470.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Williams, J. B. & First, M. (1990). Structured Clinical Interview for DSMIII-R. American Psychiatry Press: Washington, DC.Google Scholar
Sullivan, P. F., Bulik, C. M., Carter, F. A. & Joyce, P. R. (1996). Correlates of severity in bulimia nervosa. International Journal of Eating Disorders 20, 239–-251.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Svrakic, D. M., Stanic, S., Fassino, S. & Cloninger, C. R. (2003). Classification of personality disorders: implications for treatment and research; part I; Psychobiology of temperament and character. In Handbook of Medical Psychiatry (ed. Soares, J. C. and Gomes, S.). Marcel Dekker: New York.Google Scholar
Tereno, S., Soares, I., Martins, C., Celani, M. & Sampaio, D. (2008). Attachment styles, memories of parental rearing and therapeutic bond: a study with eating disordered patients, their parents and therapists. European Eating Disorders Review 16, 4958.CrossRefGoogle ScholarPubMed
Turner, H. M., Rose, K. S. & Cooper, M. J. (2005). Parental bonding and eating disorder symptoms in adolescents: the meditating role of core beliefs. Eating Behaviors 6, 113118.CrossRefGoogle ScholarPubMed
Wade, T. D., Treloar, S. A. & Martin, N. G. (2001). A comparison of family functioning, temperament, and childhood conditions in monozy-gotic twin pairs discordant for lifetime bulimia nervosa. American Journal of Psychiatry 158, 11551157.CrossRefGoogle ScholarPubMed
Wonderlich, S. A. & Swift, W. J. (1990). Perceptions of parental relationships in the eating disorders: the relevance of depressed mood. Journal of Abnormal Psychology 99, 353360.CrossRefGoogle ScholarPubMed
Yamaguchi, N., Kobayashi, J., Tachikawa, H., Sato, S., Hori, M., Suzuki, T. & Shiraishi, H. (2000). Parental representation in eating disorder patients with suicide. Journal of Psychosomatic Research 49, 131136.CrossRefGoogle ScholarPubMed
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Parental bonding and eating psychopathology in bulimia nervosa: personality traits as possible mediators
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Parental bonding and eating psychopathology in bulimia nervosa: personality traits as possible mediators
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Parental bonding and eating psychopathology in bulimia nervosa: personality traits as possible mediators
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *