Abstract
BACKGROUND: Eating disorders are an emerging global health crisis, with significant implications for both physical and psychological well-being. Disordered eating behaviors in childhood can serve as precursors to more severe eating disorders if left untreated. Previous literature evidences a strong association between perfectionism, as well as parental control and eating disorders, highlighting perfectionism as a significant factor in the development and maintenance of ED symptoms. Early intervention during this critical developmental period is essential to address these risks, prevent the progression to clinical eating disorders, and support healthier long-term outcomes for children. This study aimed to assess the mediating role of parental psychological distress in the association between perfectionism in parents and disordered eating in children. As a secondary objective, the study intended to validate the Arabic version of the Eating Disorders Examination Questionnaire-Short Parent Version (EDE-QS-P). METHODS: A diverse sample of Lebanese parents of children aged 6-11 years (N = 502; mean age of 36.24 ± 8.29 years, 74.5% of mothers) were recruited from schools, community centers, and healthcare facilities into this cross-sectional study. One parent per child completed all the questionnaires, which assessed disordered eating in children, parental perfectionism, and psychological distress. The instruments used included the Eating Disorder Examination Questionnaire-Short Parent Version (EDE-QS-P) for disordered eating, the Big Three Perfectionism Scale - Short Form (BTPS-SF) for parental perfectionism, and the Depression, Anxiety, and Stress Scale-8 Items (DASS-8) for parental psychological distress. The SPSS software v.25 was used for statistical analysis. To examine the factor structure of the EDE-QS-P, we conducted a Confirmatory Factor Analysis (CFA) using SPSS AMOS v.28 software. The mediation analysis was conducted using PROCESS MACRO v.3.4 model 4. RESULTS: The Arabic EDE-QS-P showed a unidimensional factor structure, strong internal consistency reliability and high convergent validity. Higher child's disordered eating scores were reported by fathers compared to mothers (8.32 ± 9.12 vs. 5.62 ± 7.69, t (500) = 3.01, p = 0.003). Parental distress mediated the association between parental perfectionism and child's disordered eating (indirect effect: Beta = 0.14; Boot SE = 0.02; Boot CI 0.11; 0.18). More parental perfectionism was significantly associated with more parental distress, and higher parental distress was significantly associated with more child's disordered eating. Higher parental perfectionism was significantly and directly associated with more child's disordered eating. CONCLUSION: This study successfully validated the Arabic version of the EDE-QS-P in Lebanon, confirming its validity and reliability for assessing parental-reported disordered eating in children in Arab contexts. Elevated parental perfectionism correlates with increased child disordered eating, mediated by parental distress. This suggests that healthcare providers should be alert to signs of perfectionism and psychological distress in parents and provide appropriate interventions, such as cognitive-behavioral therapy or stress management techniques, to alleviate these issues and lower the risk of eating disorders in children.