Double trouble? Associations of parental substance use and eating behaviors with pediatric disordered eating
Introduction
Parents’ personal eating-related psychopathology confers risk for eating psychopathology in their children. Across studies, children of parents with eating disorders have more physical and psychological health problems, including greater incidence of eating disorders (ED; Watson, O'Brien, & Sadeh-Sharvit, 2018). Family weight and eating concerns are associated with heightened risk for binge-eating disorder, bulimia nervosa, and anorexia nervosa (Hilbert et al., 2014). Recent work has shown that parental eating disorders are associated with child eating-related psychopathology (Lydecker and Grilo, 2016a, Lydecker and Grilo, 2016b). Moreover, parental binge eating, to a greater extent than parental weight status, is associated with binge-eating behavior in their children (Lydecker & Grilo, 2017).
In parallel, parents’ personal substance use is related to increased risk for negative outcomes in their children. Parental substance use disorder (SUD) is prospectively associated with SUD in their children (Clark et al., 2004, McLaughlin et al., 2012). Indeed, parental SUD is associated with broadly-defined child impairment, including increased rates of psychological and medical health problems (Smith, Wilson, & Committee on Substance Use and Prevention, 2016).
There is substantial comorbidity between SUD and ED in adults (Bahji et al., 2019). This overlap is likely due to shared neurobiological, psychological, and social factors. One such factor is impulsivity, a multidimensional construct that reflects a tendency towards reward-seeking behavior (Dawe & Loxton, 2004). The mesocorticolimbic dopamine system underlies reward-related and impulsive behavior; this system is related to both substance and eating-related conditions (Bari and Robbins, 2013, Volkow et al., 2013) and is influenced by heritable factors (Bezdjian et al., 2011, Elam et al., 2016, Rapuano et al., 2017). Compared to adults with ED only, adults with comorbid eating and impulse-control difficulties report heightened impulsivity (Boswell & Grilo, 2020). Accordingly, heightened impulsivity may be a common transdiagnostic risk factor that underlies ED, SUD, and comorbidity between these conditions.
In addition to impulsivity, severity of parent psychopathology may be associated with heightened risk for psychopathology in their children. Comorbidity between eating disorders and substance-related problems indicates more severe psychopathology in adults (Bahji et al., 2019, Becker and Grilo, 2015, Boswell and Grilo, 2020, Claudat et al., 2020, Waxman, 2009) and adolescents (Castro-Fornieles et al., 2010). Moreover, severity of parental depression is associated with elevated risk of child psychopathology, including depression and SUD (Lieb, Isensee, Höfler, Pfister, & Wittchen, 2002). Thus, heightened parental clinical severity, reflected in parental comorbidity, may broadly increase risk to their children.
To date, a limited literature has examined whether SUD or ED in parents is related to increased eating psychopathology in children, but no studies have examined their co-occurrence in parents. In a large nationally-representative sample, family history of alcoholism was associated with greater risk for pediatric obesity (Grucza et al., 2010). In a multi-site study examining risk factors for ED, parental SUD was associated with increased risk for binge-eating disorder, bulimia nervosa, and anorexia nervosa (Hilbert et al., 2014). Consistent with the conceptualization that impulsivity has a transdiagnostic association with both SUD and eating-related problems, parental substance use is associated with greater reward-driven eating behaviors in children (Cummings et al., 2020) and greater sensitivity in brain regions implicated in monetary and food reward in adolescents (Stice & Yokum, 2014).
Identifying factors associated with pediatric eating-disorder psychopathology is important for identifying intervention targets for prevention and treatment programs. However, no prior work has examined whether co-occurring parental eating and substance use problems are associated with greater eating-disorder psychopathology in their children. To address this gap in the literature, we investigated whether greater parental SUD behaviors, parental ED behaviors, and/or the interaction of parental SUD and ED behaviors (SUDxED) were associated with increased severity of eating and weight problems in their children. We hypothesized that children of parents with greater combined SUDxED behaviors would have more severe eating-related psychopathology and higher weight, independent of other parental comorbidity (i.e., depression, impulsivity). Additionally, we hypothesized that children of parents with ED behaviors, moreso than parents with SUD behaviors, would have greater eating-related psychopathology and higher weight.
Section snippets
Procedures
Survey respondents (N = 435) were recruited from Amazon Mechanical Turk (MTurk). Individuals responded to an advertisement to complete an online survey on “parents’ opinions about weight and eating” and they were eligible if they were adults, in the United States, proficient in English, and the primary caregiver (i.e., child lives in the home more than half the time) of a child between the ages of 5 and 15 years. Participants were included in the current study if they answered questions about
Child OBEs
There was a significant interaction between parent SUD and ED behaviors, which reflected that parents with greater SUD and greater ED behaviors reported more child binge eating (SUDxED: β = 0.21, p < .001; Fig. 1A). Parent ED behaviors alone were significantly associated with greater child OBEs (β = 0.19, p < .001), but parent SUD behaviors alone were not (β = 0.004, p = .06; Table 1). Child age (β = 0.13, p = .01) and parent depression (β = 0.16, p = .002) were also associated with greater
Discussion
In past work, co-occurring substance use and eating disorders were associated with greater psychopathology in adults. Additionally, parent substance use and parent eating disorders have each been associated with child psychopathology. Our study filled an important gap in the literature by examining whether the severity of co-occurring substance use and eating disorder behaviors in parents was associated with greater child eating and weight problems. The severity of comorbid parent substance use
Contributions
RGB and JAL conceptualized this work. JAL acquired funding and collected and managed these data as part of a larger study. RGB planned and completed statistical analyses and wrote the first draft of the manuscript. JAL and RGB revised and edited the manuscript. Both authors contributed to and approved the final manuscript.
Author Agreement
All authors have been and approved the final version of this manuscript before submission. This submission is the original work of the authors. This work has not been previously published and is not under consideration for publication elsewhere.
Author Disclosures
Role of Funding Sources: This research was supported, in part, by National Institutes of Health grants K24 DK70052 (Dr. Grilo) and K23 DK115893 (Dr. Lydecker). This publication was made possible by CTSA Grant Number UL1 TR001863 from the National Center for Advancing Translational Science (NCATS), components of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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