Reviewer ’s report  
 
Title: Eating behavior and psychological profile: associations between daughters with distinct  
eating disorders and their mothers  
 
Version: 1 Date: 09 Mar 2017  
 
Reviewer: Renee Rienecke Hoste  
 
Reviewer's report:  
 
This study examined eating disorder symptoms and other psychological symptoms among 
patients with AN, BN, BED, and no ED, and their mothers.   
 
 
Introduction: Pg. 3. "This makes it difficult to dissect the influence of the mother in each specific 
disorder since most studies treat all eating disorders as one entity, analyzing AN, BN and BED in 
the same group."  This sentence should have a reference, as the authors just got done reviewing 
studies that analyzed AN, BN, and BED separately.  In addition, the design of the current study 
does not allow for any examination of the influence of the mother on the development or 
maintenance of an eating disorder.   
 
 
Method: Pg. 4. Rather than writing "AN daughters" or "BN daughters", please use more patient -
friendly language, i.e., "daughters with AN" or "daughters with BN".   
 
 
Method: Pg. 5 -6. "The same battery of psychological tests was applied to both mothers and  
daughters, guarding the confidentiality thereof, separately both mothers and daughters was 
applied, and the BMI was obtained for the mothers."  This sentence is confusing; please clarify.   
 
 
Discussion: Pg. 11. "The inverse correlations between mother and  daughter with AN 
corroborated the fact that in anorexia nervosa, the conflict lies in the poor identification with the 
mother or in the rebellion of the daughter against being like her mother."  The results do not 
support this conclusion.  
 
 
"While processe s of imitation, internalization and identification are completely consistent with 
normal development, in anorexia nervosa the eating disorder is probably the only means that 
allows the daughter to initiate this individualization process which has been barr ed for her (24 -
26)."  Two of these references are quite old, and again, this statement is not supported by the 
results.   
 
 
"The fact that the lower the BMI of the daughter, the higher the symptoms of depression in the 
mother, maybe attributable to the grav ity of the illness of the daughter determining the 
depression of the mother, as some authors have demonstrated (27)…"  The study referenced here 
did not demonstrate that the daughter's illness affected mothers' depression.  Likewise, reference 
28 suggested  that mothers' depression may predate and influence the development of AN but did 
not demonstrate it in the referenced study.   
 
 
Pg. 12. "The few correlations between this dyad may be explained by the fact that it has been 
established that the greatest inf luence in BN patients comes from the paternal figure or from 
peers."  This is a bold statement and not one that I'm sure is supported by the references listed.  
Further elaboration on this statement would be helpful.   
 
 
Pg. 13. "Despite the fact that it wa s not the purpose of the study, mothers of this group had 
higher BMI than the rest of the groups."  Were the groups compared statistically?  
 
 
Pg. 13. "It was interesting to corroborate that mothers of our comparison group were also 
healthier than the mother s in the other groups."  This is not clear from the data presented.  How 
was it determined that these mothers were healthier?   
 
 
Pg. 13. "It is possible that the mothers of this group have a positive influence on their 
daughters…"  This cannot be determine d from the design of the current study.   
 
 
Pg. 14. "According to our results, studying each ED separately appears to be indispensable for 
the specific understanding of each of the different ED and this also suggest that including the 
mothers in ED treatmen t of their daughters is key since acknowledging that they are part of the 
solution and not only part of the problem."  Again, this statement is not supported by the results.  
The results do not suggest that including mothers in ED treatment is helpful.  In  addition, this 
statement takes a somewhat blaming view of mothers by saying they are part of the problem.  
The results do not suggest this, and this view of blaming parents for causing the development of 
an eating disorder is somewhat outdated (Le Grange,  Lock, Loeb, & Nicholls, 2010).   
 
 
Could the authors please discuss what, if any, clinical implications this study has?  
 
 
Table 1. "Values in bold mean high scores".  Could the authors include the cutoff scores in the 
descriptions of each measure?  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being pub lished  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary f rom an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has ap plied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I receive consulting fees from the Training Institute for Child and Adolescent Eating Disorders, 
LLC.  
 
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