Breaking the Cycle of Risk: Intervention for Mothers with Eating Disorders

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DESCRIPTION (provided by applicant): Although eating disorders, particularly anorexia nervosa, can affect fertility, many women with eating disorders and eating disorder histories are becoming mothers. Many of these women have difficulty achieving adequate nutrition during pregnancy, initiating and maintaining breastfeeding, adequately nourishing their children, modulating expectations regarding eating in their children, and judging what is normative and what is pathological in their children. These mothers are highly motivated to seek guidance to help reduce their children's risk of eating disorders. This proposed Exploratory Research Grant (R34) aims to develop a parenting intervention for mothers with current or past eating disorders called NURTURE (Networking, Uniting, and Reaching out To Upgrade Relationships and Eating). Our intervention is based on preliminary information from focus groups with mothers with eating disorders and extant research. We will systematically develop a manualized intervention for mothers with histories of threshold and subthreshold eating disorders who have children between the ages of 0-2. The specific aims of this R34 are: 1) to develop and standardize a modular manualized intervention for mothers with eating disorders to facilitate therapist training and treatment dissemination; 2) to implement NURTURE in a small, randomized, delayed entry controlled trial to determine feasibility and acceptability; 2) to evaluate whether immediate treatment with NURTURE is superior to a delayed entry control for improving targeted outcomes, and 4) to identify potential moderators and mediators of treatment. Our primary outcome will be observer ratings of videotaped maternal-child mealtime interactions and secondary outcomes will include measures of general parenting self-efficacy and maternal behaviors that enhance the social and emotional growth of their children. This trial will be designed explicitly to gather preliminary outcome data to inform sample size and power calculations for a subsequent larger randomized controlled trial. Results of this investigation have the potential to develop an effective and acceptable intervention that will improve both feeding-related and general parenting efficacy in mothers with eating disorders. Extensions of the intervention will include developmentally appropriate modules for mothers of children of various ages as well as web-based variants to optimize dissemination of the intervention.