Caregivers in anorexia nervosa: is grief underlying parental burden?
Authors: Duclos Jeanne , Piva Giulia , Riquin Élise , Lalanne Christophe , Meilleur Dominique , Blondin Soline ,   EVHAN Group, Berthoz Sylvie , Duclos Jeanne , Mattar Lama , Roux Hélène , Thiébaud Marie-Raphaële , Vibert Sarah , Hubert Tamara , Courty Annaig , Ringuenet Damien , Benoit Jean-Pierre , Blanchet Corinne , Moro Marie-Rose , Bignami Laura , Nordon Clémentine , Rouillon Frédéric , Cook Solange , Doyen Catherine , Mouren Marie-Christine , Gerardin Priscille , Lebecq Sylvie , Podlipski Marc-Antoine , Gayet Claire , Lasfar Malaika , Delorme Marc , Pommereau Xavier , Bioulac Stéphanie , Bouvard Manuel , Carrere Jennifer , Doncieux Karine , Faucher Sophie , Fayollet Catherine , Prexl Amélie , Billard Stéphane , Lang François , Mourier-Soleillant Virginie , Greiner Régine , Gay Aurélia , Carrot Guy , Lambert Sylvain , Rousselet Morgane , Placé Ludovic , Venisse Jean-Luc , Bronnec Marie , Falissard Bruno , Genolini Christophe , Hassler Christine , Tréluyer Jean-Marc , Chacornac Olivier , Delattre Maryline , Moulopo Nellie , Turuban Christelle , Auger Christelle , Cook-Darzens Solange , Godart Nathalie 
Published: February 2023

Abstract
Purpose
Anorexia Nervosa (AN) is a severe chronic disorder and parents’ experience of caregiving is usually marked by emotional distress and burden. Severe chronic psychiatric disorders are known to be linked with the concept of grief. Grief has not been investigated in AN. The aim of this study was to explore parents’ and adolescents’ characteristics that may be related to parental burden and grief in AN, and the link between these two dimensions.

Methods
Eighty mothers, 55 fathers and their adolescents (N  =  84) hospitalized for AN participated in this study. Evaluations of clinical characteristics of the adolescent’s illness were completed, as well as self-evaluations of adolescent and parental emotional distress (anxiety, depression, alexithymia). Levels of parental burden were evaluated with the Experience of Caregiving Inventory and levels of parental grief with the Mental Illness Version of the Texas Revised Inventory of Grief.

Results
Main findings indicated that the burden was higher in parents of adolescents with a more severe AN; fathers’ burden was also significantly and positively related to their own level of anxiety. Parental grief was higher when adolescents’ clinical state was more severe. Paternal grief was related to higher anxiety and depression, while maternal grief was correlated to higher alexithymia and depression. Paternal burden was explained by the father’s anxiety and grief, maternal burden by the mother’s grief and her child’s clinical state.

Conclusion
Parents of adolescents suffering from AN showed high levels of burden, emotional distress and grief. These inter-related experiences should be specific targets for intervention aimed at supporting parents. Our results support the extensive literature on the need to assist fathers and mothers in their caregiving role. This in turn may improve both their mental health and their abilities as caregivers of their suffering child.

Level of evidence
Level III: Evidence obtained from cohort or case-control analytic studies.