Eating Behaviors 7 (2006) 37 – 45

Is comorbidity in the eating disorders related to perceptions

of parenting? Criterion validity of the revised
Young Parenting Inventory
Alexandra Sheffield a,T, Glenn Waller b, Francesca Emanuelli c, James Murray d
a
Central and North West London Mental Health NHS Trust, Vincent Square Clinic, Hopkinson House, Osbert Street,
London SW1P 2QU, United Kingdom
b
South West London and St. George’s Mental Health NHS Trust, United Kingdom
c
Department of Clinical Psychology, University of East London, United Kingdom
d
Department of Clinical Psychology, University of Surrey, United Kingdom
Received 29 March 2005; accepted 26 May 2005

Abstract

Background: Recent studies support the reliability and validity of the Young Parenting Inventory-Revised (YPI-R)
and its use in investigating the role of parenting in the aetiology and maintenance of eating pathology. However,
criterion validity has yet to be fully established. To investigate one aspect of criterion validity, this study examines
the association between parenting and comorbid problems in the eating disorders (including general
psychopathology and impulsivity).
Method: The participants were 124 women with eating disorders. They completed the YPI-R and the Brief
Symptom Inventory (BSI; a measure of general psychopathology). They were also interviewed about their use of a
number of impulsive behaviours.
Results: YPI-R scales were significant predictors of one of the nine BSI scales, and distinguished those patients
who did or did not use specific impulsive behaviours.

T Corresponding author. Tel.: +44 20 8237 2104; fax: +44 20 8237 2280.
E-mail address: asheffield@nhs.net (A. Sheffield).

1471-0153/$ - see front matter D 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.eatbeh.2005.05.009
38 A. Sheffield et al. / Eating Behaviors 7 (2006) 37–45

Discussion: The criterion validity of the YPI-R is partially supported with regards to general psychopathology and
impulsivity. The findings highlight the specificity of the parenting styles measured by the YPI-R, and the need for
further research using this tool.
D 2005 Elsevier Ltd. All rights reserved.

Keywords: Parenting styles; Eating disorders; Impulsive behaviours; Psychopathology

Existing measures of family functioning consistently differentiate eating-disordered women from non-
eating-disordered women, with poorer levels of family functioning found in eating-disordered groups
(e.g., Hodges, Cochrane, & Brewerton, 1998; Leung, Thomas, & Waller, 2000; Waller, Calam, & Slade,
1988; Waller, Slade, & Calam, 1990). However, the specificity of existing measures is poor. First, levels
of family functioning often fail to predict the severity of eating disorders (e.g., Calam & Slade, 1987;
Scalf-McIver & Thompson, 1989; Waller, 1994; Williams, Chamove, & Millar, 1990). Second, the
measures used in different studies address different constructs, potentially explaining why those studies
do not yield consistent results. Finally, although eating-disordered patients report higher levels of
adverse parenting experiences, this is also the case for subjects with other psychiatric conditions. This
finding suggests that family functioning has poor specificity for eating pathology, and limits
investigation into the pathways by which family functioning might influence the development and
maintenance of eating disorders.
A clinically useful measure of perceived parenting in the eating disorders is likely to be one that
addresses the cognitive structures that underpin those problems and that can account for comorbidity in
such cases. Recent clinical and research evidence suggests that negative core beliefs play a critical role in
the development and maintenance of eating disorders (Cooper, 1997; Leung, Waller, & Thomas, 1999),
indicating that this aspect of cognitive content merits further attention. Negative core beliefs are
unconditional beliefs about the self, the world or others. The Young Parenting Inventory (YPI; Young,
1999) is a measure of perceived parenting, designed to identify the potential origins of those negative core
beliefs, suggesting that it might be a more informative measure than other indices of family function.
Factor analysis of the YPI has led to the development of a shorter version of the scale-the YPI-R
(Sheffield, Waller, Emanuelli, Murray, & Meyer, in press). The YPI-R consists of 37 of the original 72
items of the YPI, making up nine scales reflecting perceived parenting. Each scale is rated separately
for mothers and fathers. At this preliminary stage in validation, the YPI-R scales demonstrate good
test–retest reliability and adequate internal consistency (Sheffield et al., in press). Significant and
clinically meaningful correlations between some YPI-R scales and some negative core beliefs also
support the construct validity of the YPI-R (Sheffield et al., in press). Further support for construct
validity is demonstrated in a study by Emanuelli, Sheffield, Waller, Meyer, and Lacey (in preparation),
which found that YPI-R scales predicted levels of eating pathology and that this relationship was
mediated by core beliefs.
To summarise, preliminary validation studies on non-clinical and eating-disordered samples support
the reliability and validity of the YPI-R. However, studies to date have only used non-clinical samples,
and criterion and discriminant validity have yet to be established. In particular, it is not known whether
parenting is relevant to comorbid behaviours (e.g., impulsivity) or to more general psychopathology
(e.g., anxiety and depression) in the eating disorders. This is clearly an area for investigation, given the
evidence that negative core beliefs might also play an integral role in depression (e.g., Riso et al., 2003;
 A. Sheffield et al. / Eating Behaviors 7 (2006) 37–45 39

Shah & Waller, 2000; Waller, Shah, Ohanian, & Elliott, 2001), anxiety disorders (e.g., Wells &
Hackmann, 1993), and impulsive behaviours such as suicidality and substance use (e.g., Brotchie,
Meyer, Copello, Kidney, & Waller, 2004; Mohandie & Hatcher, 1999). Therefore, the aim of this study
is to assess the criterion validity of the YPI-R (with regards to comorbidity) in an eating-disordered
group. This will be tested by examining the relationship of the YPI-R scales with a measure of general
psychopathology (the Brief Symptom Inventory; Derogatis & Lazarus, 1994) and with the presence of
impulsive behaviours (binge-eating, self-cutting, other forms of self-harm, suicide attempts, alcohol
abuse, overdoses, and engaging in risky sexual activities).

1. Method

1.1. Participants

The initial sample consisted of 127 eating-disordered clients. Only two were male, and one’s gender
was not recorded (due to an administrative error). These three participants were excluded, leaving the
final sample of 124 female participants. All participants met diagnostic criteria for an eating disorder.
Diagnoses were made by experienced clinicians, via a semi-structured interview, using DSM-IV criteria
(American Psychiatric Association, 1994). Participants fell into the following diagnostic categories:
anorexia nervosa, restrictive subtype (N = 24; mean BMI = 15.9, SD = 1.88); anorexia nervosa, bingeing/
purging subtype (N = 17; mean BMI = 16.0, SD = 1.42); bulimia nervosa, purging subtype (N = 37; mean
BMI = 24.5, SD = 9.02); bulimia nervosa, non-purging subtype (N = 4; mean BMI = 23.6, SD = 4.18);
eating disorder not otherwise specified—purging (EDNOS-p) (N = 12; mean BMI = 24.5, SD = 8.17);
EDNOS-r (restrictive) (N = 20; mean BMI = 19.4, SD = 1.40); and binge eating disorder (BED) (N = 10;
mean BMI = 40.5, SD = 13.98).
The mean age of the sample was 27.6 years (SD = 7.76, range = 17–53). The mean Body Mass index
(BMI = weight [kg] / height [m]2) of the sample was 21.8 (SD = 9.05, range = 12.8–60.5). Ninety-seven
participants (77%) stated their ethnic background to be White British, ten (7.9%) stated dWhite otherT,
and three (2.4%) dWhite IrishT. There was also one participant in each of the following categories:
dWhite and AsianT, dBlack CaribbeanT, and dAsian PakistaniT. Ten participants (7.9%) did not state their
ethnic background.

1.2. Measures

Each woman completed a semi-structured interview, and self-report measures of psychopathology and
perceived parenting.
Semi-structured interview. This interview was used to assess eating behaviours, diagnosis and
comorbid impulsive behaviours. DSM-IV criteria (American Psychiatric Association, 1994) were used
to determine eating disorder diagnoses. Each participant was asked whether they were currently (in the
past 3 months) engaging in any of the following impulsive behaviours—binge-eating; self-cutting; other
forms of self-harm; taking overdoses; attempting suicide; bingeing on alcohol; abusing illicit drugs; or
engaging in risky sexual behaviour. Objective weight and height were measured during this interview.
Young Parenting Inventory-revised (YPI-R; Sheffield et al., in press). The YPI-R was developed from
a validation of the original YPI (Young, 1999). The YPI is a self-report questionnaire, designed on the
40 A. Sheffield et al. / Eating Behaviors 7 (2006) 37–45

basis of clinical experience, intended to identify the potential origins of seventeen negative core beliefs.
However, recent validation studies (Emanuelli et al., in preparation; Sheffield et al., in press) indicate
that a shorter version, consisting of nine scales, provides a more reliable and valid measure of perceived
parenting. The shorter YPI-R consists of 37 statements regarding one’s parents (e.g., bmade me feel
unloved or rejectedQ). Each statement reflects one of nine perceived parenting styles: Emotionally
depriving parenting reflects a pattern of parenting that deprives the child of emotional nurturing;
Overprotective parenting reflects a pattern of parenting that denies the child of developmental
opportunities; Belittling parenting reflects behaviour in the parent that criticises the child, leaving the
child feeling defective; Perfectionist parenting reflects the parents’ high expectations for themselves as
well as for their child; Pessimistic/fearful parenting reflects anxious, fearful traits in the parent;
Controlling parenting reflects a pattern of parenting that controls or inhibits the child’s independence;
Emotionally inhibited parenting reflects the parent’s poor ability to share their feelings with their child;
Punitive parenting reflects a pattern of parenting that is hostile to the child’s mistakes; and Conditional/
narcissistic parenting reflects behaviour by the parent that implies that positive regard for the child is
conditional on the child’s success.
Each item is rated on two 6-point Likert scales—one for perceptions of maternal behaviours and one
for perceptions of paternal behaviours. Scores on each scale are mean of the items in that scale. Higher
scores indicate a stronger perception of the particular unhealthy parenting style, and lower scores
indicate that the participant did not perceive their parent in that way.
Brief Symptom Inventory (BSI; Derogatis & Lazarus, 1994). The BSI is a 53-item self-report measure
of current psychiatric symptomatology. The scale is divided into nine primary symptom dimensions:
somatisation (perceptions of bodily dysfunction); obsessive compulsiveness (obsessions and compul-
sions that are experienced as uncontrollable plus general cognitive deficits); interpersonal sensitivity
(feelings of inferiority and sensitivity); depression (symptoms of depression including low mood,
motivation and loss of interest); anxiety (symptoms of anxiety such as feelings of fear and panic);
hostility (thoughts, feelings and behaviours related to anger); phobic anxiety (symptoms related to
specific fears); paranoid ideation (feelings of suspiciousness and grandiosity); and psychoticism
(including symptoms of thought control and feelings of isolation). Each item is rated on a 5-point Likert
scale. Higher scores indicate a greater experience of the symptom.

1.3. Procedure

The relevant ethics boards approved the study. Consecutive referrals to a specialist eating disorders
service (May 2002 until October 2003) were routinely asked to complete a battery of questionnaires as
part of a comprehensive assessment package. That battery included the questionnaires required by this
study (YPI-R and BSI). Diagnoses and information regarding impulsive behaviours were also obtained
as part of the semi-structured assessment. Information sheets were provided and written consent was
obtained.

1.4. Data analysis

Multiple regression analyses were conducted to examine the relationship between perceived parenting
(measured by the YPI-R) and general psychopathology (measured by the BSI). To examine the
relationship between perceived parenting (measured by the YPI-R) and each impulsive behaviour, the
 A. Sheffield et al. / Eating Behaviors 7 (2006) 37–45 41

sample were divided into two groups (behaviour absent versus behaviour present), and t-tests were used
to compare the two groups on their mean YPI-R subscale scores. The t-tests were corrected for unequal
variances where appropriate.

2. Results

2.1. Descriptive statistics

Mean scores and standard deviations on each YPI-R scale were as follows: Emotionally depriving
mothers mean = 3.21 (SD = 1.44); Emotionally depriving fathers mean = 3.57 (SD = 1.53); Overprotective
mothers mean = 2.83 (SD = 1.40); Overprotective fathers mean = 2.25 (SD = 1.02); Belittling mothers
mean = 2.23 (SD = 1.33); Belittling fathers mean = 2.34 (SD = 1.44); Perfectionist mothers mean = 3.48
(SD = 1.35); Perfectionist fathers mean = 3.80 (SD = 1.48); Pessimistic/fearful mothers mean = 2.98
(SD = 1.38); Pessimistic/fearful fathers mean = 2.67 (SD = 1.18); Controlling mothers mean = 2.60
(SD = 1.56); Controlling fathers mean = 2.22 (SD = 1.30); Emotionally inhibited mothers mean = 3.47
(SD = 1.60); Emotionally inhibited fathers mean = 4.31 (SD = 1.46); Punitive mothers mean = 2.84
(SD = 1.41); Punitive fathers mean = 3.06 (SD = 1.61); Conditional/narcissistic mothers mean = 3.10
(SD = 1.27); and Conditional/narcissistic fathers mean = 3.18 (SD = 1.40). Mean scores and standard
deviations on the BSI scales were as follows: Somatisation mean = 10.9 (SD = 6.30); Obsessive-
compulsiveness mean = 12.0 (SD = 5.73); Interpersonal sensitivity mean = 10.0 (SD = 4.75); Depression
mean = 13.6 (SD = 6.01); Anxiety mean = 11.8 (SD = 6.14); Hostility mean = 6.36 (SD = 4.09); Phobic
anxiety mean = 6.41 (SD = 5.10); Paranoid ideation mean = 7.35 (SD = 4.64); and Psychoticism
mean = 9.09 (SD = 4.89).

2.2. Parenting and general psychopathology

Multiple regression analyses were conducted in order to examine the relationship between the
subscales of the YPI-R and the BSI scales. Due to the number of analyses, a more robust alpha level was
adopted ( P b 0.01) to reduce the risk of Type 1 errors. As shown in Table 1, YPI-R scales were
significantly associated with only one BSI scale-Somatisation. The significant YPI-R correlates of
Somatisation were high scale scores on Punitive fathers and Controlling mothers, and low scores on
Pessimistic fathers and Controlling fathers. There were no significant predictors of Obsessive
Compulsive features, Paranoid Ideation, Psychoticism, Interpersonal Sensitivity, Depression, Anxiety,
Hostility and Phobic Anxiety.

Table 1
Multiple regression analyses predicting psychopathology (BSI scales) from parenting (YPI-R scales)
Dependent Overall P Variance Significant independent t B P
variable F explained predictor variables
Somatisation 2.43 0.01 30.6% Punitive fathers 3.228 0.754 0.002
Pessimistic fathers 2.876 0.431 0.006
Controlling fathers 3.093 0.782 0.004
Controlling mothers 2.635 0.763 0.012
42 A. Sheffield et al. / Eating Behaviors 7 (2006) 37–45

Table 2
Relationship of YPI-R scales to current impulsive behaviours
Impulsive behaviour Significant YPI-R scales Impulsive behaviour Impulsive behaviour t-test
absent present
M (SD) M (SD) t P
Other self-harm (N a = 14) Pessimistic mothers 2.67 (1.20) 4.11 (1.70) 3.06 0.004
Overdoses (N a = 11) Controlling mothers 2.26 (1.43) 3.90 (1.32) 3.48 0.0005
Emotionally inhibited mothers 3.10 (1.50) 4.30 (1.61) 2.51 0.01
Suicide attempts (N a = 11) Overprotective fathers 2.06 (0.98) 2.97 (1.05) 2.78 0.003
Controlling fathers 1.89 (1.14) 3.23 (1.48) 3.45 0.0005
Emotionally inhibited mothers 3.05 (1.48) 4.79 (1.32) 3.75 0.0001
Conditional/narcissistic fathers 2.87 (1.40) 4.39 (1.59) 3.10 0.002
Risky sex (N a = 5) Overprotective mothers 2.58 (1.26) 5.17 (1.30) 3.49 0.0005
Controlling mothers 2.35 (1.44) 4.56 (1.95) 2.60 0.01
Perfectionist mothers 2.79 (1.31) 4.25 (1.77) 2.39 0.01
Punitive mothers 2.69 (1.45) 4.67 (1.00) 3.08 0.002
a
Number displaying the behaviour in the past 3 months (out of a total N = 124 in each case).

2.3. Parenting and impulsive behaviours

T-tests were conducted to examine the relationship between the YPI-R scales and the presence of
impulsive behaviours. Due to the number of t-tests used, a more robust alpha level was adopted ( P b.01)
to reduce the risk of Type 1 errors. As shown in Table 2, there were differences in YPI-R scale scores for
four of the eight impulsive behaviours. In each case, the presence of the impulsive behaviour was
associated with higher scores on the YPI-R scale. Self-harm (other than cutting) was associated with
mothers who were rated as more Pessimistic. Overdoses were associated with greater levels of
Controlling and Emotionally Inhibited maternal behaviours. Suicide attempts were found in those who
rated their fathers as Overprotective, Controlling and Conditional/narcissistic and their mothers as
Emotionally inhibited. Finally, Risky sexual behaviour was associated with mothers being rated as
Overprotective, Controlling, Perfectionist and Punitive.

3. Discussion

The aim of this study was to assess the criterion validity of the YPI-R with regards to comorbidity in
an eating-disordered group. This was achieved through examining the relationship of the YPI-R scales
with a measure of general psychopathology and with the reported presence of impulsive behaviours.
Some YPI-R subscales were significant correlates of one aspect of general comorbid psychopathology
(somatisation). The individual predictors of Somatisation were perceptions of high levels of punitiveness
by fathers and control by mothers, but low levels of pessimism and control by fathers. A preliminary
hypothesis could be that when parents are perceived in this way, the child learns that it is not safe to
express emotions, or that emotions should be controlled. Over time, this might contribute to a difficulty
in being able to identify and express emotions (alexithymia), leading to a tendency to express oneself
through more concrete concerns (e.g., somatic concerns and illness). The fact that that the relationships
between perceived parenting and Somatisation were not always in the expected direction appears
 A. Sheffield et al. / Eating Behaviors 7 (2006) 37–45 43

counterintuitive, considering previous evidence linking adverse parenting experiences to later

psychopathology. However, this study focuses on the effects of parenting not on psychopathology per
se, but comorbid psychopathology in the context of individuals with eating disorders. Therefore, it could
be hypothesised that some adverse parenting experiences (along with a range of other risk factors) raise
individual’s vulnerability in the direction of the development of eating pathology, rather than other forms
of psychopathology.
The finding that both negative and positive parenting can be related to poorer psychological health
extends on the previous literature, which has stressed the role of negative parenting only (e.g.,
Gittleman, Klein, Smider, & Essex, 1998). Given that Somatisation was the only BSI scale
significantly associated with YPI-R scales, it could be argued that, the YPI-R might be a better
predictor of underlying comorbid pathology (e.g., somatisation) than of more discrete/overt comorbid
diagnostic states (e.g., anxiety, depression). This is in contrast with other measures of perceived
parental behaviour, which have found associations between perceived parenting and overt pathologies
such as depression (e.g., Shah & Waller, 2000), and anxiety (e.g., Silove, Parker, Hadzi-Pavlovic,
Manicavasagar, & Blaszczynski, 1991). Therefore, the perceived parenting styles measured by the
YPI-R might be more specific to the development and maintenance of eating pathology and its
underlying psychological substrates, rather than predicting comorbidity with more specific, overt
psychopathological conditions.
The YPI-R scores also distinguished impulsive versus non-impulsive groups, with current impulsive
behaviours being associated with poor parental behaviours. The impulsive behaviours concerned were:
risky sex; suicide attempts; taking overdoses; and use of self-harming behaviours (other than cutting).
Given the consistently negative nature of the parental behaviours in such cases, these links are likely to
be accounted for through the use of impulsive behaviours to reduce emotional arousal (e.g., Lacey,
1986). However, further research is needed to explain why the YPI-R scales were not related to the other
affect-regulation behaviours measured (i.e., taking illicit drugs, self-cutting, bingeing, and drinking
alcohol excessively). It could be that the YPI-R does not measure the particular perceptions of parenting
that might be related to these impulsive behaviours, or it could be that parenting experiences are not a
relevant factor here. Explanations of the positive findings regarding impulsivity in this study also need to
be able to account for the negative findings.
Overall, mixed findings regarding the relationship of YPI-R scales to measures of general
psychopathology and impulsivity indicate partial support for the criterion validity of the YPI-R.
Previous studies support the reliability and validity of the YPI-R scales in investigating the role of
parenting in the development and maintenance of eating pathology. This study indicates that perceived
parenting is also related to some aspects of comorbidity (particularly some impulsive behaviours and
underlying aspects of psychopathology) found in the eating disorders. The YPI-R is likely to be a useful
measure in investigating these associations further.
Given that there are likely to be complex interactions between actual parenting behaviour, perceived
parenting behaviour and the later psychopathology, it is unlikely that perceptions always provide an
accurate measure of actual parenting behaviour. There will also be effects of recall bias. However,
although it would be incorrect to make direct assumptions about causality, it can still be argued that
perceptions should be the focus of investigation, because they contribute most to the development and
maintenance of psychological disorders (Parker, 1983, 1989).
This study requires replication and extension. For example, the proposed explanation for the link
between perceived parenting and Somatisation needs to be tested empirically. This study utilised a
44 A. Sheffield et al. / Eating Behaviors 7 (2006) 37–45

highly selected, all female client group referred to a specialist eating disorders service. It will be
necessary to test the utility of the YPI-R among less highly selected samples of eating disorder clients, as
well as other clinical groups where family function has been hypothesised to be relevant to the aetiology
and maintenance of the disorder or related behaviours and symptoms, such as depression (Parker, 1983)
and the personality disorders (Young, Klosko, & Weishaar, 2003). In addition, the YPI-R should be
compared with other measures of family function, to determine if its specificity means that it has greater
concurrent and predictive validity than other measures.

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