Distress Tolerance and Family Accommodation: Associations in Parents of Young People with Eating Disorder Behaviours

Abstract

Abstract Purpose. Family accommodation has been identified as a maintaining factor for eating disorders, with families often caught up in behaviours that characterise the illness. Given that parents often accommodate symptoms of their child’s eating disorder to reduce family conflict and the young person’s distress, levels of parents’ distress tolerance may help explain the variability seen in accommodation. This study aimed to investigate the relationship between parental distress tolerance (specifically tolerance of negative emotions [TNE] and intolerance of uncertainty [IU]) and family accommodation, assess the role of illness severity, caregiver burden, and parents’ mental health on this association, and understand the findings in the context of the COVID-19 pandemic. Methods. Parents or carers (N = 84) of young people (aged < 18) with a suspected or diagnosed eating disorder completed an online survey comprising of screening questions, demographic and clinical information, validated questionnaires, and questions about the impact of the COVID-19 pandemic. Results. TNE but not IU, was significantly associated with family accommodation. Multiple regression analyses revealed when other significant correlates of accommodating behaviour were entered into the model (caregiver mental health and caregiver burden), only caregiver burden remained significantly associated with family accommodation. Bootstrapped mediation analysis indicated the association between TNE and family accommodation is fully mediated by caregiver burden. Conclusion. There is an association between parents’ TNE and accommodation behaviours, however this association was fully mediated by caregiver burden. Clinical implications include additional psychoeducation and therapeutic support for parents to reduce burden. Level of Evidence. Level V: Cross-sectional descriptive study.