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Eating Disorders From
Parent to Child:
Mothers’ Perceptions of
Transgenerational
Effect.
PhD Thesis
September 2017
Submitted to the University of
Hertfordshire in partial fulfilment of the
requirements of the degree of PhD.
Sarah Barnett
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Acknowledgements
Due to illness, this thesis has had many suspensions and has therefore taken
longer than most. During this time, my overwhelming gratitude goes to my
supervisor Julia Buckroyd. Without her steadfast belief in me this thesis would
never have been completed. She has not only supported and guided me
through the academic twists and turns, she has constantly given me the
strength to pick up the threads and return after each bout of illness. She has
unstintingly and unselfishly given of her knowledge and her time and for that I
will be eternally grateful.
My thanks goes to Kathy Lee for supporting me through my many
suspensions and helping me negotiate the University’s administration.
My husband David has been there with his unwavering strength throughout
the many low periods. His ability to find words and correct spellings when my
facility failed me undoubtedly enabled me to complete this thesis. To my
children and grandchildren for without them who would I be?
To the participants of this study who gave me access to their lives and
allowed me to publish their stories.
With thanks to both funders for their enthusiasm and faith in this project.
Without their funding, this project would never have been able to be
contemplated.
Funding
Pilot Study
M.A. Submission
£5,000 Funded by the Hertfordshire Early Years Development and Childcare
Partnership.
Main Study
PhD Submission
£75,415 Funded by HertNet.
(Hertfordshire Network of Primary Care Trusts a subsidiary of the NHS.)
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List of Contents
List of Figures…………………………………………12
Abstract…………………………………………………13
Chapter 1
1.0 Introduction……………………………………………….15
1.1 Funding………….……………………………….…20
Chapter 2
2.0 Literature Search………………………………..23
2.1 Eating Disorders…………………………………….26
2.2 Risk Factors…………………………………………26
2.3 Heritability …………………………………………..27
2.4 Psychological & Familial …….…………………….30
2.5 Attachment……………….………………………….33
2.6 Separation……….………………………………..…42
2.7 Mothers with an ED…………………………………47
2.8 Family Pathology and the Mother/Child
Relationship…………………….……………………55
2.9 Body Image……….………….…………………….…60
2.10 The Use of Groups …….…………..………………63
2.11 Eating Disorders & Groups ………………..……….67
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2.12 Research into Group Interventions………………...69
2.13 Prevention Programmes.……………………………85
2.14 Prevention Programmes involving Parents………..87
2.15 Psycho-Social Effects………………………………..95
2.16 Outcome & Recovery……………..…….……………96
2.17 Using Mixed EDs…………………………………….101
2.18 Case Study and EDs………………………………..103
Chapter 3
3.0 Methodology & Methods……………….….…..105
3.1 Qualitative/Quantitative Methodology..….105
3.2 Research Strategy - Case Study ………..106
3.3 Generalizability………………….….…..….107
3.4 Multiple Sources of Evidence…………….108
3.5 The Small-N (n=1) Approach...…………..113
3.6 The Research Question ……………….…114
3.7 Analysis and Coding………………….......115
3.8 Themes…………………………………..…117
3.9 Limitations, Reflexivity & Validity..............119
3.10 Methods…….…………..…………………………122
3.10.1 Recruitment………......…….…..122
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3.10.2 Participants………………......123
3.10.3 Ethics.....................................124
3.10.4 Initial Meeting………………...125
3.10.5 Interviews……….…………….126
3.10.6 Phone Calls……………………130
3.10.7 Inclusion Criteria……………..130
3.10.8 Exclusion Criteria…………….130
3.10.9 The Group…………………….131
3.10.10 Therapeutic Approach……….131
3.10.11 Protocol of the Group ……….132
Chapter 4
4.0 Quantitative Results………………………….…134
4.1 Interpretation of Data………………………………134
4.2 The Eating Disorders Inventory (Graph)……..…..136
4.3 The Eating Disorders Inventory (Table)…….…....137
4.4 Clinical Outcomes in Routine Evaluation………...138
4.5 Clinical Outcomes in Routine Evaluation (Graph).139
4.6 Clinical Outcomes in Routine Evaluation (Table) .140
4.7 Weight and Body Mass Index……………………...141
4.8 Body Mass Index (Table)……………………….…..142
