(PS7-68) Parental Self-efficacy and Symptom Accommodation in Family-based Treatment for Anorexia Nervosa

Background: Anorexia nervosa (AN) is one of the most lethal psychiatric disorders and continues to rise in prevalence, particularly among adolescents. Family Based Treatment (FBT) is the first line treatment for AN in adolescents and involves empowering parents to take charge of their adolescent’s renourishment. A critical mechanism underlying FBT is parental self-efficacy in their ability to facilitate their child’s recovery and parent-facilitated exposure during meals. Greater parental self-efficacy predicts greater weight gain for adolescents who receive FBT. A small body of research indicates that greater parental symptom accommodation is associated with poorer treatment outcomes. Due to the impact parental self-efficacy and symptom accommodation can have on treatment outcomes, this study sought to identify whether or not parental self-efficacy and accommodation differed by adolescent sex or age. We hypothesized that parents would have reduced self-efficacy for older adolescents and be more likely to accommodate female as opposed to male adolescents.

Methods: We conducted post-hoc analyses using data from two randomized clinical trials where all participants (N = 149) underwent FBT for AN. At baseline, adolescents had a mean age of 14.8 years (SD = 1.8) and the sample comprised 131 (88%) adolescents assigned female at birth and 18 (12%) assigned male at birth. We collected data on parental self-efficacy and accommodation of symptoms from mothers (n =145) and fathers (n = 139) at baseline and then again at end of treatment.  

Results: Baseline maternal and paternal self-efficacy did not differ based on adolescent sex assigned at birth (sex) (all ps > .05). Maternal accommodation of symptoms did not differ based on adolescent sex; however, paternal accommodation did. Fathers endorsed greater accommodation of symptoms (z = 3.178, p < .001) for girls (M=43.64) than for boys (M=25.76). In order to explore whether or not baseline self-efficacy and accommodation varied by age of the child, we grouped adolescents by age: 11-13 (n = 43), 14-15 (n = 60), and 16-18 (n=46). ANOVAs revealed no difference in parental self-efficacy or accommodation across age groups for either mothers or fathers (all ps > .05). We also explored whether or not there was a change in self-efficacy and symptom accommodation over the course of treatment; using a mixed ANOVA (within variable self-efficacy or accommodation, between variable adolescent sex or age). We found an interaction for maternal self-efficacy wherein self-efficacy increased over treatment when the adolescent was female and decreased when the adolescent was male (p < .05) the same pattern held true for paternal report of self-efficacy (p < .05 ). Accommodation reduced for both parents (p < .05) regardless of adolescent sex. When considering the age group of the adolescent, we found a significant improvement in both maternal and paternal self-efficacy and accommodation of symptoms (all ps < .05) but no significant interaction.

Conclusion:  Parents experience a reduction in accommodation of symptoms over the course of FBT regardless of adolescent age or sex. Parental self-efficacy increased for parents of female adolescents but not males. Implications for treatment delivery will be discussed.