Family functioning, parenting stress, and nutritional severity in adolescents hospitalized for anorexia nervosa: the role of the fathers

Family functioning and parenting distress may influence the clinical course of anorexia nervosa (AN), although the role of fathers remains poorly understood. This study investigated the associations between adolescents’ perceptions of family functioning, maternal and paternal parenting distress, and nutritional severity in adolescents hospitalized for AN. A cross-sectional study included 64 female adolescents hospitalized for AN. Nutritional status was assessed using BMI and BMI z-score. Adolescents completed the Family Assessment Device (FAD), whereas mothers and fathers independently completed the Parenting Stress Index–Short Form (PSI-SF). Correlation and multivariable logistic regression analyses were performed. Overall family functioning was not associated with the clinical severity presentation which required hospitalization. Higher paternal Parental Distress and Parent–Child Dysfunctional Interaction scores were significantly associated with lower BMI z-scores. Clinically elevated paternal Parental Distress was independently associated with severe/extreme AN according to DSM-5 severity categories (aOR = 17.72, p < 0.001). Maternal parenting distress was not associated with nutritional severity. Paternal parenting distress, rather than adolescents’ perceived family functioning or maternal distress, was associated with greater nutritional impairment in adolescents hospitalized for AN. These findings support the systematic inclusion of fathers in the assessment and family-based management of severe AN.