m- “Lr
: “-3
a 5,

.‘v

if

#éz'éa': 6'

€753?“

v. 3‘
_~.
A;

In. .
Fifi". a
), x, g.

. 5:33

n ‘1 . I ‘ ‘ ~

I .. A ' ‘{

9‘? HIE"; “' :5 ‘

1:41. *4
. r

x

n '
r . ' 4""
n}. . ”33."

 

 

Jr z-z‘f.‘ .

a 353,179???“
has JN- :u:
h. ’

 

STATE UNIVERSITY LIBRARI ISE

IIIIIIIIIIIIII IIII II IIII II IIIII

3 1293 01399 4516

THESIS LlBRARY
é: __ Michigan State
< , University

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This is to certify that the

dissertation entitled

The Implications of Separation-Individuation
Difficulties and Parent Eating Preoccupation
for Disordered Eating in Late Adolescent Women

presented by

Susan Marie Jackson—Walker

has been accepted towards fulfillment
of the requirements for

Ph.D. degreein Psychology

 

 

Date law/49;] 99

MS U is an Affirmative Action/Equal Opportunity Institution 0-12771

PLACE ll RETURN BOX to remove thle checkom horn your record.
To AVOID FINES return on or before dete due.

DATE DUE DATE DUE DATE DUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

::I
—_II | I

 

 

MSU Ie An Afflrmetive AotloNEmel Opponmlty Inetltwon
mm:

THE IMPLICATIONS OF SEPARATION-INDIVIDUATION
DIFFICULTIES AND PARENT EATING PREOCCUPATION
FOR DISORDERED EATING IN LATE ADOLESCENT WOMEN

By
Susan Marie J ackson-Walker

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Psycholog
1994

ABSTRACT

THE IMPLICATIONS OF SEPARATION -INDIVIDUATION
DIFFICULTIES AND PARENT EATING PREOCCUPATION
FOR DISORDERED EATING IN LATE ADOLESCENT WOMEN

By
Susan Marie J ackson-Walker

The present investigation sought to determine whether difficulties in
the separation-individuation process in relation to mothers and fathers are
associated with disordered eating specifically, and adjustment problems
more generally, in late adolescent women. In addition, it explored whether
adolescents' perceptions of their parents' eating and weight preoccupation
increase the risk for disordered eating, in the context of problems with
separation-individuation. Specifically, this research measured a number
of aspects of autonomy versus dependency in relationships with parents in
college women through a semi-structured interview and several self-report
questionnaires. In addition, participants' reports of eating and adjustment
problems were assessed using self-report questionnaires, and a new
measure (Parent Eating Attitudes Scale) was developed to assess
perceptions of their parents' preoccupation with eating, food, and weight.
Participants were 79 women ages 17 to 22; 40 received scores at or above the
clinical cutofi' on a measure of eating patholog (disordered eating group),
and 39 received scores that are not indicative of eating problems
(comparison group).

Results indicated that perceptions of both mother's and father's
preoccupation with their own and their daughter's eating and weight were
direct predictors of daughter's eating pathology. However, the results

regarding autonomy from mothers versus fathers were somewhat
difl'erent. Separation-individuation dificulties in relation to fathers
appeared to be more pathognomic for disordered eating than similar
dificulties with mothers. In the relationship with mothers, low levels of
autonomy were predictive of adjustment problems, rather than eating
disturbance. Several interaction efi‘ects were also found, and indicated that
at least some types of autonomy may be associated with both risks and
benefits for late adolescent women. The findings suggest that, although
often overlooked, fathers play an important role in the development of
disordered eating in late adolescent women, both with regard to their
attitudes about eating and weight, and in the level of autonomy daughters

experience in their relationships with their fathers.

ACKNOWLEDGMENTS

First, my thanks go to Susan Frank, my chairperson and mentor, for
her guidance, constant encouragement, and invaluable assistance. She
has challenged me, been available to me, and through her energy and
enthusiasm, has intensified my interest in research. I would also like to
thank the other members of my dissertation committee, Ellen Strommen,
Elaine Donelson, and Jacqueline Lerner, who have been inspirational
through their own interests and work in female and adolescent
development.

I would like to express my sincere appreciation to Carla Monestere
and Lisa Crandell, without whose help and contributions I could not have
completed this project. The assistance of Jackie Dean, Audrey Duncan,
Allison Pollen, Tonya Walaskay, and Jodi Wildrom was also invaluable;
their reliability and competence assured the smooth operation of this
project. I am also very grateful to the women who parficipamd in this study
and shared their experiences so willingly and openly.

Finally, I would like to acknowledge all of my family members for
their unwavering confidence and encouragement. I wish to express my
deepest appreciation to my husband, J ohnWalker, for his constant support,
caring, and faith in me, for being someone I can count on, and for always
being there, through even the most dificult times. My infinite thanks go to
my parents for all they have given me, but especially for giving me both

"roots" and "wings".

iv

TABLE OF CONTENTS

Em

LIST OF TABLES ....................................................................... vii
LIST or FIGURES ............................................................ ' ........ viii
INTRODUCTION ........................................................................ 1
Distinctions between Anorexia Nervosa and Bulimia .............. 3
Sociocultural Influences ...................................................... 5
Psychoanalytic Theories ....................................................... 8
Family Influences .............................................................. 12
Father-Daughter Relationships ............................................ 14
Evidence for Psychoanalytic and Family Systems Theories ...... 16
Separation-Individuation and Adiustment ............................ 23
Parent Eating Preoccupation ............................................... 23
Hypotheses ........................................................................ 33
METHOD ................................................................................ :5
Participants ....................................................................... 35
Measures .......................................................................... 37
Eating Attitudes and Behaviors ................................... I3

Autonomy ................................................................. 40
Adjustment .............................................................. 46

Procedure .......................................................................... 48
RESULTS ................................................................................ 52
Preliminary Analyses ......................................................... 62

Comparisons between disordered and non-disordered eaters . . . 54

Eating Behavior ......................................................... 54

Adjustment .............................................................. 5
Comparisons between three groups ...................................... 5
Factor Analyses ................................................................. 56

Parent Eating Attitudes Scale .......... 56

Autonomy Scales ....................................................... 57
Regression Analyses ........................................................... Q

DISCUSSION .............................................................................. 73
Methodological Considerations ............................................ 84
APPENDICES
A Informed Consent (Phase One and Phase Two) ............. 87

Recontact Form ......................................................... 9)
C Personal Background Questionnaire ................... 91
D Parent Eating Attitudes Scale ..................................... %
E Eating Attitudes Test ............................................... 100
F Emotional Autonomy Scale ....................................... 102
G. Parental Relationship Inventory ............................... 106
H Psychological Separation Inventory-Conflictual '

Independence Scale ................................................. 114
I Familial Insecurity Scale ......................................... 117
J Ofi‘er Self-Image Questionnaire ................................. 123
K Health History ......................................................... 129
L Young Adult/Parent Relationship Interview and

Coding Manual ....................................................... 142

LIST OF REFERENCES .............................................................. 174

vi

LIST OF TABLES

Page

Table 1 Demographic Characteristics of Participants in

Sample 2 .......... $
Table 2 Internal Reliability for Self-Report Measures .................... 41
Table 3 Interrater Reliability for the Young AdulUParent

Relationship Interview ................................................... 45
Table 4 Predicted Factors for the Autonomy Scales ........................ 47
Table 5 Means (and Standard Deviations) on Autonomy and

Eating Preoccupation Scales for Mothers and Fathers ........ 53
Table 6 Factor Loadings for Autonomy Scales on the Three

Factors Obtained for Relationship with Mothers ................ 58
Table 7 Factor Loadings for Autonomy Scales on the Three

Factors Obtained for Relationship with Fathers ................. 59
Table 8 Correlations among PEATS Scales ................................... 63
Table 9 Correlations among Eating and Adjustment Problems,

Parents' Eating Preoccupation, and Experiences of

Autonomy ..................................................................... 6
Table 10 Regression Analyses for Relationship with Mothers .......... 6'7
Table 11' Regression Analyses for Relationship with Fathers ........... 7O

vii

LIST OF FIGURES
Baa

Figure 1 Interaction between Disengagement and Mother
Eating Moccupation in Pmdicting Eating Pathology ......... 68

Figure 2 Interaction between Autonomy with Overt Conflict
and Father Eating Preoccupation in Predicting
Self-Concept Problems .................................................... 71

Figure 3 Interaction between Autonomy with Overt Conflict

and Father Eating Preoccupation in Predicting
Depressive Symptoms ..................................................... 71

viii

Introduction

Problematic eating behavior, excessive weight concerns, body
dissatisfaction, and even full-blown eating disorders have become
increasingly serious problems in college populations within the last few
decades. In fact, researchers have noted that dieting and disturbed eating
behaviors are so common among college women that they are actually the
norm, rather than the exception (Mintz 8: Betz, 1988; Polivy & Herman,
1987; Thompson 81. Schwartz, 1982). Many theorists have ofl‘ered
sociocultural explanations for the prevalence of dieting and weight
concerns among adolescent females, and societal factors no doubt "set the
stage" for body and weight preoccupation. However, theories that include
variables at an individual or family level of analysis are needed in order to
understand which women actually develop eating disorders in the context
of a social environment that places a high value on thinness and
attractiveness for females.

Psychoanalytic and family systems theorists typically focus on f
parent-child and family relationships in etiological discussions of eating
disorders. A common theme that joins most of these theories is the
primary role played by separation-individuation issues (Amdur, Tucker,
Detre & Markhus, 1969; Bruch, 1973; Minuchin, Rosman, & Baker, 1978).
Although the pictures that are painted of anorexic families as opposed to
bulimic families differ in potentially important ways (difi'erences that may
account for the distinctive disturbed eating patterns), both family
environments appear to contribute to the failure of the eating disordered

2
daughter to become truly independent from her family and gain a sense of

autonomy.

There is some empirical evidence that autonomy from parents may
be as important in subclinical populations as it is in clinical populations.
However, because eating symptomatology in college women is not always
pathognomic, and may in fact be quite transitory (Thelen, Farmer, Mann 8:
Pruitt, 1990), it is important to identify factors that predict severity and
chronicity as well as prevalence of eating problems in subclinical
populations. Frank & J ackson-Walker (in press) reported that risk for
severe eating pathology in college women (defined as the association
between eating symptoms and specific forms of personality dysfunction) is
greater among women reporting higher levels of dependency on their
parents. Yet, dependency on parents has been associated with a number of
other problems for college women in addition to eating disorders, so that
separation-individuation problems may be indicative of broader dificulties
in adjustment. Hence, it is also important to determine which factors, in
the context of separation dificulties, lead a woman to develop an eating
disorder rather than a difl‘erent symptom or type of pathology.

As it appears that both family and sociocultural factors are
implicated in eating problems, it is likely that the interplay between the two
is critical. When the family strongly endorses society's attitudes about
thinness in women, or family members (especially parents) are themselves
caught up in struggles surrounding weight, dieting, and food, it is
conceivable that the risk of developing an eating disorder as a response to
family dysfunction is increased.

The purpose of the current study is to investigate these issues
empirically in order to determine the impact of problems in separation-

3
individuation in the parent-adolescent relationship, as well as the family's

"attitudes about weight and dieting, on the development of disordered eating
in late adolescent women. Specifically, this research measured
experiences of autonomy versus dependency in relation to parents in college
women (N =80) through a semi-structured interview and several self-report
questionnaires. Forty of the women received scores at or above the clinical
cutofl‘ on a measure of eating pathology (disordered eating group), and 40
received scores that are not indicative of eating problems (comparison
group). In addition, participants' reports of adjustment problems and
perceptions of their parents' attitudes about eating, food, and weight were

assessed using self-report questionnaires.

 

At this point, it is necessary to distinguish between the two primary
types of eating disorders that occur in adolescent and young adult women.
Anorexia nervosa and bulimia are defined in the Diagnostic and Statistical
Manual of Mental Disorders-Third edition-Revised (DSM-III-R) as separate
and distinct categories. Diagnostic criteria for anorexia nervosa are as
follows: . refusal to maintain body weight over a minimal normal weight for
age and height (15% below expected body weight); intense fear of gaining
weight or becoming fat, even though underweight; distorted body image;
and amenorrhea in females. The essential features of bulimia include:
recurrent episodes of binge eating (minimum of two binge eating episodes a
week for at least three months); feeling of lack of control over eating
behavior during hinges; self-induced vomiting, use of laxatives or diuretics,
strict dieting or fasting, or vigorous exercise in order to prevent weight

4
gain; and persistent overconcern with body shape and weight (American

Psychiatric Association, 1987).

It is important to note and keep in mind that, although bulimia and
anorexia nervosa are separate diagnostic categories, bulimic and anorexic
symptomatology are not mutually exclusive. Often, symptoms of both
disorders are expressed, and many times, females who initially exhibit
bulimic symptomatology become anorexic or those who initially exhibit
anorexic symptoms later become bulimic. For this reason, the term
"bulimic-anorexic" has been used to refer to women who exhibit aspects of
both disorders, i.e. those who have bulimic symptoms but have also lost the
amount of weight required for a diagnosis of anorexia (15% of body weight).
Although there appear to be many similarities between anorexics and
bulimics, particularly with regard to underlying weight concerns and body
dissatisfaction, important difi'erences have been found at the individual,
interpersonal, and family levels. A number of studies comparing anorexic,
bulimic, and bulimic-anorexic groups have indicated that bulimic-anorexic
women are more similar to normal-weight bulimics than to restricting
anorexics, in personality style and family functioning (Garner, Garfinkel &
O'Shaughnessy, 1985; Shisslak, McKeon & Crago, 1990; Strober, 1981).

In non-clinical populations, these distinctions are less clear and
there may be even more overlap between types of eating disorders. Mintz &
Betz (1988), in a study of college women, provide some evidence that there is
a continuum of eating pathology, ranging fi-om normal eating, to
subthreshold or atypical eating disorders, to anorexia or bulimia. Probably
for these reasons, studies of eating problems in college student samples

commonly explore the severity of more generalized ”eating disturbance”

5
and other characteristics associated with eating disorders, rather than

maln’ng distinctions between anorexia and bulimia.

A variety of theories have addressed risk factors and etiological
contributions to eating disorders, and to anorexia and bulimia specifically.
Perhaps the first issue to address, in providing a theoretical framework for
understanding factors that increase the risk of developing these disorders,
is the pervasiveness of eating problems and weight concerns in young

women.

SocimltumLInfluenm

Because eating disorders occur almost exclusively among adolescent
and young adult females, and they have been increasing in prevalence over
the past several decades, it is important to explore the contribution of
sociocultural factors to the development of these disorders. Societal
attitudes towards women and the female body provide a backdrop for
pervasive overconcern with body image and weight in girls and women.
Throughout history, women's bodies have been viewed as objects of beauty,
and there has been pressure on women to strive toward the ideal body
image of the period (Orbach, 1986; Striegel-Moore, Silberstein & Rodin,
1986). In the more recent past, the ideal body image for women and the
models held up for women to emulate, have become increasingly thinner.
However, while society and the media have provided encouragement for
women to reduce their weight, the average weight for a young woman has
actually been increasing (Garner, Garfinkel, Schwartz 8; Thompson, 1980),
moving women even farther from society's ideal. These sociocultural
factors no doubt play a major role in the pervasiveness of dieting and body
dissatisfaction in adolescent girls and collegeoage women, and it is likely

6
that these factors are especially influential for women who develop full-

fledged eating disorders.

Some empirical evidence for the contention that societal factors play a
role in the development of eating disorders is provided by Garner &
Garfinkel (1980), who found that women who experienwd greater demands
for thinness and dieting by virtue of their career choice (dance or
modelling) were at higher risk for anorexia and subclinical types of
anorexia than were normal controls. In addition, several studies
demonstrated that bulimics endorsed societal beliefs about female thinness
and attractiveness to a higher degree than did other college women,
including those reporting subclinical levels of eating symptomatology
(Mintz & Betz, 1988; Striegel-Moore et al., 1986). Similarly, in a non-clinical
sample of college females, Timko, Striegel-Moore, Silberstein 8: Rodin (1987)
found that level of eating symptomatology was associated with the
importance the participants placed on appearance. Steiner-Adair (1990)
interviewed high school girls regarding their perceptions of societal and
their own ideal images of women. One pattern that emerged from these
interviews was labeled the ”Super Woman pattern", in which the societal
ideal image of women included being autonomous and successful, as well
as thin and beautiful. The girls who described this pattern and identified it
as their an ideal image were more likely to report disordered eating than
girls who rejected these societal ideal images for themselves.

Feminist theories also point to societal and sex-role linked pressures
as central to the development and increasing prevalence of eating disorders
among females. Orbach (1986) discussed two major societal demands for
women that can be linked to eating disorders. She suggested that,

consistent with society's dictates, women's identities and feelings of self-

7
worth are equated with their image of their bodies. Consequently, in this

society, a positive self-image is dependent on the extent to which women
perceive themselves as attractive and thin. The resulting body insecurity
and instability in self-image are, in turn, reinforced by society, media, and
the weight control industry (Striegel-Moore et a1, 1986). Compounding the
demands regarding their bodies are demands regarding women's roles in
society. As mothers and "nurturers", women are expected to meet others'
needs, and deny their own. Food is one medium through which this
dynamic is clearly expressed. In fact, food has been so central to the role of
”nurturer” that it has become women's special domain (Orbach, 1986). A
woman is expected to cook for and nurture others, but not be nmd or
"fed” herself. Anorexia can thus be thought of as an extreme expression of
the feminine role: strict adherence to society's demands for thinness, and
the ultimate denial and repression of one's own most basic needs (i.e. food
and nurturance). On the other hand, however, anorexia can also be viewed
as a contradiction and repudiation of the feminine role, as the anorexic
”defeminizes” her body (e.g. through amenorrhea, and loss of body fat),
thereby avoiding the pressures that accompany adult female status.
Indeed, many analytic and neoanalytic theorists discuss the "fear of
maturity" as a major component of the disorder (Crisp, 1965; Selvini-
Palazzoli, 1978).

Although societal pressures and demands create a context in which
eating disorders are likely to flourish, sociocultural theories do not provide
adequate information about the factors that place some women at higher
risk for deve10ping eating disorders than others. For this reason, it is
essential to look beyond societal influences in order to gain a more complete
understanding of eating disordered women.

E l l |° I] .
Several major classes of theories have focused on family
relationships as central to the pathology of both bulimia and anorexia.
Psychoanalytic conceptualizations of eating disorders typically point
specifically to the mother-daughter relationship as the locus of the
difliculty. Based on her extensive clinical observations, Bruch (1971; 1973;
1978; 1980) postulated that early mother-infant interactions, particularly
surrounding feeding, are significantly disturbed in girls who later develop
anorexia nervosa. She contended that these mothers are poorly attuned to
their infant's needs and desires, and their responses to the child are based
on their own needs or on misinterpretations of the child's needs. For
example, with regard to the feeding process, the mother will provide food
for the child at a specified time, or when she herself is hungry, as opposed
to when the child gives a signal indicating that she is hungry. The lack of
appropriate responses to the child's cues disrupts the normal interactive
process through which the child learns to recognize and difi‘erentiate her
own feelings, sensations, and internal bodily states, as well as develop a
basic sense of security and trust. The confusion in perceptual awareness
(interoceptive confusion), in turn, provokes a sense of ineffectiveness, a
feeling of not being in control of one's body and behavior, and deficits in the
development of a separate and individual identity. These dificulties in early
separation-individuation are reawakened during the second individuation
process of adolescence (Blos, 1967), when demands for autonomy become
stronger, and these girls' deficits become more apparent. Bruch (1973)
suggested that the eating disorder is essentially a struggle for control, self-
eficacy, and an individual identity, and the eating concerns and weight

9
loss are symptomatic expressions of the underlying personality

disturbance.

Similarly, self-psychologists point to problems in a specific
component of the mother-child relationship, that is, ”empathic mirroring",
in mothers with an eating-disordered child (Atkins, 1989). Empathic
mirroring involves an ongoing interaction between mother and infant, in
which the child provides cues indicating the existence of a need, the mother
accurately interprets and responds to, or ”mirrors" the child's cues, and
the child gradually learns to distinguish his/her individual needs and
feelings. When the mother is deficient in empathy and mirroring skills,
and fails to accurately read the child's cues, the child has dificulty
learning to difl‘erentiate his/her needs and subsequently feels
misunderstood and dependent on others (Atkins, 1989).

Schwartz (1988) theorized that bulimics, like anorexics, act out
conflicts surrounding separation-individuation, which are first
experienced early in life and are reactivated during adolescence. Failure to
separate from the mother in the first years of life leads to disturbances in
self-other difl'erentiation, which is particularly problematic during
adolescence. Krueger (1989) suggested that the developmental task of the
first separation-individuation process is to develop a distinct sense of self
(what is inside), other (what is outside), and boundaries between the two.
The primary dificulties in the mother-infant relationship, which prevent
the bulimic from mastering this developmental task, lie in the mother's
empathic unavailability, overintrusiveness, and inconsistency of response
to her infant. Because the bulimic fails to develop a separate sense of self, .
she later uses food to create an experience of self. Food, in essence,

represents the mother; it stimulates the body and is temporarily able to

l 0
regulate afi'ective states. The bulimic symptomatolog is the bulimic's

attempt to satisfy her unmet needs; however, the hinge is not genuinely
soothing, and the bulimic does not receive the nurturance and empathy she
craves, nor does she learn to be self-nurturant (Krueger, 1989).

Humphrey & Stern (1988) integrated psychoanalytic and family
systems theories in their conceptualization of bulimic etiology. Similar to
other theories about eating disorders, they note deficits in nurturance,
soothing, and empathy in the early mother-chfld relationship, which lead
to problems for the child in separating fi'om the mother and developing a
stable sense of self. In particular, the mother is unable to adequately adjust
her responses to the infant's alternating needs for autonomy and
dependence. However, while theories about anorexics have contended that
the parents respond negatively to the child's attempts to separate and more
positively to dependent behavior, Humphrey & Stern contended that the
bulimic's parents generally respond negatively to both types of behavior.
The child's attempts to separate from the parents are invalidated, and the
child is threatened with abandonment or punishment. However,
dependent behavior is not rewarded either, because it places undesired
demands on the parent. The parent's support is given only when the child
meets the parent's needs. The authors hypothesized that this occurs
because in bulimic families, parents as well as children experience a sense
of emotional deprivation and neediness. Parents repeat the cycle that has
been played out in their own families: For example, just as the bulimic
child is expected to nurture and meet the needs of her mother, the bulimic's
mother has had to nurture her own mother. Moreover, the whole family
uses food as an attempt to satisfy their emotional needs. The bulimic
symptomatology, then, can be viewed as a metaphor for the family. The

1 l
binge represents the attempt to satisfy overwhelming cravings for

nurturance and soothing. The purge, on the other hand. is an attempt to
expel the results of the over-indulgence, as well as the ”bad” and inadequate
parts of the self.

Beattie (1988) ofi‘ers an explanation for the gender-specificity of eating
disorders, based on theories of separation-individuation and the notion that
dimculties in this process play a major role in the development of both
bulimia and anorexia. Chodorow (1978) contends that separation-
individuation fi'om the mother is a much more dificult and protracted
process for girls than it is for boys. Whereas mothers tend to create distinct
boundaries between themselves and their sons, they are more likely to
identify with their daughters, and have more blurred boundaries in their
relationships with their daughters. As a result, mother-daughter
relationships are typically more intense and ambivalent than mother-son
relationships. Although both girls and boys are required to separate and
develop distinct identities from their mothers, boys are able to identify with
their fathers in order to accomplish this task, while girls must
simultaneously separate fi-om and identify with their mothers. This leads
to a good deal of ambivalence in the struggle for individuation for girls,
which, in combination with gender-linked societal factors previously
discussed, may greatly increase females' risk for developing eating
disorders (Beattie, 1988).

In light of the postulation that girls typically have more dificulty
with separation-individuation than boys, it is conceivable that girls who
have even more dificulty with this task than other girls may be at
particularly high risk for adjustment problems or eating disorders. In fact,
Lopez, Campbell & Watkins (1986) found that for girls, too little separation

1 2
from parents was associated with poor adjustment, whereas for boys, too

much separation was associated with poor adjustment.

EamilLInflnancas

Although psychoanalytic theorists focus heavily on mother-child
relationships, they have also addressed the broader family backgrounds
and environments of girls and women with eating disorders. Clinical
observations of families of anorexics were summed up by Bruch (1973) as
follows: Typically they were upper middle class, successful, perfectionistic,
and achievement-oriented. Anorexic daughters were compliant,
submissive, and perfectionistic as well. Amdur et a1. (1969) added that
these families were very rational, expressed little warmth or emotion, and
were overly concerned with outward appearances. The parents reported
stable marriages, and presented a picture of ”normality”, generally
denying any problems within the family. However, treatment fi-equently
revealed underlying tension and marital or family conflict (Bruch, 1971;
Crisp, Hsu, Harding 8: Hartshorn, 1980). In a review of family issues
involved in anorexia, Yager (1982) reported that families of anorexics are
consistently described as presenting a pleasant and untroubled facade,
appearing "superficially" healthy.

Family systems theorists, most notably Minuchin and colleagues
(Minuchin, Baker, Rosman, Liebman, Milman & Todd, 1975; Minuchin et
al., 1978), have delineated a number of family interaction patterns they
believed to be characteristic of anorexic families. These patterns include
enmeshment, overprotectiveness, rigidity, lack of conflict resolution, and
triangulation of the child in marital conflict. Enmeshment within the
family is characterized by intrusiveness into other family members' lives,

l 3
poor differentiation between sense of self and other, and poor boundaries

between family members and family subsystems. These families are also
overly concerned with one another's welfare, and attempt to take over
functions which could be performed by the individual. For a child, this
prevents the development of a sense of competence and individual
autonomy. Rigidity involves the refusal to alter family patterns and modes
of interaction in response to demands for change or growth. This is
particularly troublesome during the child's transition to adolescence, when
the family needs to adapt to the adolescent's increasing autonomy-
strivings. These families refuse to negotiate changes in decision-making
power or independence for the adolescent. They have a low threshold for
conflict, so they either avoid or suppress conflict or refuse to negotiate
disagreements, leading to a lack of conflict resolution. Finally, the child is
triangulated in marital conflict, typically making it possible for parents to
avoid conflict. Each of these interaction patterns contributes to a family
style that does not allow individuality and prevents the child from becoming
a difi'erentiated and autonomous individual.

Although some theorists suggest that the interaction patterns
discussed by Minuchin are also characteristic of bulimic families
(Schwartz, Barrett, & Soba, 1985), Humphrey & Stern (1988) suggest that
bulimic families difi'er in noteworthy ways. Similar to anorexic families,
bulimic families attempt to present a facade of well-being, and rely heavily
on idealization of family members. However, their facade is less
convincing; they outwardly appear more dysfunctional and negative, and
their deficits in nurturance and empathy are easily apparent.
Nevertheless, and in spite of apparent difl'erences between bulimic and

1 4
anorexic families, both family systems are believed to stifle the development

of autonomy in their daughters.

Ell -D ll Bll' l'

The focus in the theoretical literature on eating disorders has almost
exclusively been on mother-daughter relationships, whereas father-
daughter relationships have commonly been overlooked. This is also the
case with the literature on separation-individuation, particularly when
referring to early separation-individuation processes, because in general
the mother has always been considered the primary caretaker. However,
the father-daughter relationship likely also has important implications for
adolescent autonomy development, adjustment, and even disordered
eating. Girls have been found to be more dependent on and emotionally
involved with their mothers, perhaps partially explaining the continued
focus on mother-daughter relationships throughout adolescence. However,
it has been suggested that while mothers typically provide a foundation of
security and attachment for adolescents, fathers encourage independence
and individuation (Campbell, Adams & Dobson, 1984). It appears that
fathers may be particularly instrumental in helping their daughters to
differentiate from their mothers. Chodorow (1978) contends that when girls
become involved in the process of individuation, they view their fathers as
symbols of autonomy, and their relationships with their fathers provide a
way to separate from their mothers and gain a sense of independence.
Hence, difi'erentiation may be particularly problematic for the daughter
when the father is unable to help in this process, Mcause he is either
emotionally or physically absent, rejecting, or is himself smashed with the
daughter.

l 5
Through her clinical work, Maine (1991) has explored the

relationship between fathers, daughters, and eating disorders, and
postulates that a major problem for girls who develop disordered eating is
that their fathers are unavailable to them. A possible explanation Maine
ofi‘ers for this phenomenon is that with the onset of puberty, fathers may
become uncomfortable with their daughter's emerging sexuality and may
try to distance themselves from her. On the other hand, it may be simply a
consequence of society's dictates and role expectations that fathers are more
unavailable to their children than are mothers. Regardless of the cause of
fathers' unavailability, Maine suggests that it is very threatening for girls
to separate fiom their mothers when their fathers are not there to provide
assistance. Eichenbaum & Orbach (1983), too, suggest that fathers are
commonly uninvolved with childrearing in early life (during the first
separation-individuation process) or during adolescence (during the second
individuation process), and therefore cannot help with the troublesome
aspects of mother-daughter separation.

Alternatively, as our society has evolved and more and more fathers
are becoming involved with their children, it may he that the opposite
pattern leads to similar difiiculties. Indeed, family systems
conceptualizations of families with an eating disordered daughter suggest
that the whole family (including the father) may be characterized as
enmeshed and overinvolved. If the daughter is overly dependent on or
smashed with her father, he will clearly not be able to help her to
differentiate fipm her mother.

There is some empirical evidence that in addition to relationships
with mothers, relationships with fathers are problematic for eating
disordered women. Engel & Stienen (1988) found that fathers of anorexics

1 6
were more likely than fathers of controls to be either negative and rejecting

or overprotective and overly close to their daughters. Humphrey 8: Stern
(1988) also suggested that fathers of bulimics may have dificulty in
establishing boundaries between themselves and their daughters. They
repomd that father-daughter relationships in bulimic families were
typically very close, but these relationships appeared to meet the fathers'
needs, rather than the daughters'. The authors also suggested that often,
fathers were very close to their bulimic daughters before puberty, then
became more emotionally distant, perhaps out of guilt over inappropriate
impulses towards their daughters, or discomfort with their daughter's
sexuality. This shift in the relationship may be troublesome in and of itself
for the daughter, but may also hinder the process of separating from her

mother, because she may fear losing both parents.

 

A large body of literature empirically exploring the theories
discussed above has provided somewhat mixed support for the role of
specific family characteristics in the development of eating disorders.
However, support for the role of separation-individuation dificulties and
family discouragement of autonomy is much more consistent. One group
of studies using clinical populations to examine family characteristics
provides support for the notions that bulimic family environments are
negative and conflictual, and family members demonstrate little closeness
or empathy for one another, and that anorexic family environments are
characterized by denial and avoidance of conflict, and appear on the surface
to be ”healthy”. Other studies find the families of women with anorexic
versus bulimic symptomatology to be more similar. Taking first the studies

l 7
that report difi'erences, Garner et al. (1985) found that bulimic-anorexics

and normal-weight bulimics reported more family conflict than did
restricting anorexics. The researchers suggested that the restricting
anorexics' descriptions of their family environments as essentially
"normal" is likely indicative of substantial denial and idealization of their
families. In addition, Humphrey (1989) found that although bulimics' and
their parents' reported experiences of their family relationships were
consistent with observational data, anorexics and their families denied
problems, and reported that their relationships were much more positive
and adaptive than observational data indicated.

Results of a number of self-report studies comparing bulimics to
controls (but not to anorexics) concurred that bulimics described less
closeness and supportiveness, less open expression of feelings, and more
conflict in their families (Dolan, Lieverman, Evans 8: Lacey, 1990; Johnson
8: Flach, 1985; Shisslak et al., 1990). Moreover, Humphrey (1986a) found
that mothers and fathers (as well as bulimic daughters) described their
families as less supportive, more conflictual and detached, and more
chaotic and disorganimd than controls. In an observational study,
Humphrey, Apple & Kirschenhaum (1986) found that families of bulimic-
anorexics had more disturbed interactions] styles than control families;
that is, they used negative (e.g. belittling and ignoring) and contradictory
styles of communication more frequently, and were less likely to use
positive communication styles (e.g. nurturing, helping, and trusting). In
addition, Pole, Waller, Stewart & Parkin-Feigenbaum (1988) reported that
bulimics perceived their mothers to be less caring and empathic than did

non-eatingodisordered women.

1 8
Several researchers reported that bulimics were more likely than

controls to experience their families as discouraging strivings for
autonomy (Johnson & Flach, 1985; Shisslak et al., 1990), and as having poor
boundaries among family members (Humphrey, 1986a). In an
observational study, in which parents and their bulimic-anorexic daughter
took part in a family discussion, Humphrey (1986b) found that parents
provided contradictory messages regarding autonomy for their daughters,
by both ofi'ering autonomy and simultaneously taking control. Daughters,
in turn, responded ambivalently, and alternated between attempting to
assert their autonomy and resentftu submitting to their parents. The
confusing interactions undermined the daughter's autonomy-strivings, as
these struggles typically ended with parents controlling and daughters
submitting.

In contrast to the studies that found difl'erences between bulimic and
anorexic families, another group of studies compared these populations,
and found few or no difi'erences between the family environments among
eating disorder subtypes. In a self-report questionnaire study, Stern,
Dixon, Jones, Lake, Menzer & Sansone (1989) compared two bulimic groups
(bulimicranorexic and normal-weight), a restricting anorexic group, and a
non-eating-disordered control group. All eating disorder groups reported
that their families were less encouraging of open expression of feelings
than the control group. Both bulimic groups also reported that there was
less closeness among family members than controls, and parents of
hulimic-anorexics reported more conflict in their families than parents of
controls. However, there were no significant difi'erences between eating
disorder groups on these variables, although the bulimic-anorexic group
generally reported the most dysfunction.

l 9
Calam, Waller, Slade & Newton (1990) found that both bulimic and

anorexic women perceived their mothers and fathers as less caring than
did controls (although normal-weight bulimics reported the least care from
their parents overall), and their fathers as more intrusive and
overprotective. Steiger, Van der Feen, Goldstein & Leichner (1989) found
that anorexics and bulimics repormd receiving less caring and empathy
from their fathers than controls, while Rhodes & Kroger (1992) reported
that eating disordered women experienced their anthem as less caring and
more rejecting, as well as more intrusive than controls.

Again, eating disordered women (both bulimic and anorexic)
reported more difliculties and anxieties over separation-individuation than
non-eating disordered women (Armstrong & Roth, 1989; Rhodes & Kroger,
1992). Likewise, Strauss & Ryan (1987) reported that both anorexics and
bulimic-anorexia had more poorly-difi'erentiated concepts of self than
normal controls. Kenny & Hart (1992) found that women with eating
disorders (primarily bulimics) reported that their parents were less
encouraging of their autonomy-strivings than college student controls.
Williams, Chamove & Millar (1990) found that bulimics and anorexics felt
they had little personal control over their lives or their emotions, had
dificulty asserting themselves, and described a family environment which
was not encouraging of independence. However, although the researchers
found significant difi'erences on these variables fi-om both normal controls
and women who frequently dieted, only family discouragement of
independence distinguished eating disordered women from psychiatric
controls.

In a series of observational studies, Humphrey found both
similarities and differences between bulimics and anorexics. She reported

2 0
that both bulimics and anorexics perceived their parents as rejecting,

neglectful, and blaming. However, bulimics perceived their parents, and
especially their fathers, as significantly lacln'ng in nurturance and
empathy, as compared to anorexics (Humphrey, 1986). Humphrey also
reported that parents of anorexics gave confusing messages of nurturance,
on one hand, and neglect of their daughter's need to express her true
feelings, on the other hand. The combination of overconcern along with
invalidation of the anorexic's needs and feelings worked together to keep
the anorexic dependent and prevent her from separating from her parents.
In contrast, bulimics appeared to be more ”hostilely enmeshed" with their
parents; that is, little afi'ection was expressed, and family members were
mutually blaming, belittling, and appeasing. The bulimic's attempts at
separation and self-assertion were met with hostility, keeping her
dependent on her parents as well (Humphrey, 1989). In sum, although all
of these studies of clinical populations taken together suggest that there are
both similarities and differences between bulimic and anorexic families,
one consistent finding is that the parent-adolescent relationship is marked
by dificulties surrounding separation-individuation.

In attempts to identify factors that pmdict severe eating problems in
college women, it is important to determine whether mum
populations describe family patterns similar to those found in clinical
populations. Again, findings regarding specific family characteristics
appear to be somewhat inconsistent. For example, in a college student
sample, Kent & Clopton (1992) compared a group of women meeting DSM-
III-R criteria for bulimia, a group of women who could be described as
subclinical bulimics, and a control group of women without eating
problems. Although bulimics reported that their families were less

2 l
expressive of feelings than the other two groups, there were no difi‘erences

among groups in either perceived family conflict or perceived parental
caring. However, although most participants overall reported that they
were closer to their mothers than their fathers, both the bulimics and the
subclinical bulimics were more likely than controls to report that they were
closer to their fathers. Similarly, Scalf-Mclver & Thompson (1989) found
that family conflict was not associamd with severity of bulimic problems in
a college population. However, both lack of family closeness and parental
inconsistency of afi'ection were related to bulimic behavior, with mother's
inconsistency being the best predictor. McNamara 8r Loveman (1990) found
that college women meeting DSM-III-R criteria for bulimia repomd that
their families were more enmeshed and overinvolved than other families.
At the same time, they were more emotionally disengamd and had poor
communication and problem-solving skills. Finally, Reeves 8; Johnson
(1992) found that among college sorority members, reports of family
problems, such as the inability to express feelings and needs, lack of
empathy, and poor conflict resolution, were relawd to aspects of personality
disturbance found to discriminate eating disordered fi'om non-eating
disordered women.

A number of studies provided evidence that women with subclinical
eating problems, like women with clinically significant eating pathology,
have difficulties with separation-individuation and perceive their families
as discouraging autonomy. Friedlander & Siegel (1990) found that women
reporting high levels of eating pathology, as defined by a variety of eating
symptoms and other characteristics associated with eating disorders, were
less difi'erentiated from their fathers and rede a high level of
resentment and anger in relation to their fathers. The pattern of results

2 2
found in relation to mothers was somewhat more complex. Those women

reporting high levels of bulimic symptoms and a number of problematic
personality characteristics also reported being less differentiated fi-om their
mothers. Those who reported a strong desire to be thinner (but did not
report other personality disturbances) were more dependent on their
mothers for help in making decisions as well as for providing emotional
support. Smolak & Levine (1993) found that college women exhibiting both
anorexic-like and bulimic-like symptoms reported more feelings of guilt
and resentment regarding separation from their parents than women
without eating symptomatology. However, the women with bulimic-like

symptoms reported being less dependent on their parents in determining
their attitudes and values than controls and anorexic-er women. This
may reflect the alienation bulimics reportedly experience with regard to
their parents, as greater attitudinal independence has been associated with
lower personal adjustment in college students (Hofinan, 1984).

Zakin (1989) found that eating symptomatology in a college population
was associated with lack of emotional separation from parents, and
especially from mother. Other researchers found that, among college
students, women with more severe eating problems had more insecure and
anxious attachments to their parents, and were more fearful of
abandonment and rejection and of losing their sense of self in a close
relationship (Heesacker & Neimeyer, 1990; Steiger 8: Houle, 1991). In
another college student sample, Schupak-Neuberg & Nemerofi' (1993) found
that women exhibiting bulimic symptomatology perceived their identities as
being enmeshed with others, and desired more separation fi'om their
mothers than did controls. In addition, Frank & J ackson-Walker (in press)

reported that risk for severe eating pathology in college women was higher

2 3
among those who continued to idealize and depend excessively on their

parents.

The above review of the literature indicates that problems with
autonomy are consistently associawd with eating disturbance. However,
the operational definitions of "autonomy problems" are numerous and vary
widely across studies. Kenny & Hart (1992) argue that we need a better
understanding of the specific aspects of separation that are associated with
eating disorders, and which are associated with psychological distress
more generally. Hence, a more in-depth exploration of the process of
separation-individuation throughout adolescence, and its relationship to

emotional adjustment, is warranted.

S I' 41.1 l' 151° | |

Although theorists have referred to early adolescence as the second
individuation process (e.g. Blos, 1967), it has become clear that adolescents
continue to grapple with separation-individuation issues throughout late
adolescence and even into early adulthood (hank, Avery & Laman, 1988).
As a result, researchers have begun to explore the implications of
autonomy for college student adjustment. During the first few years of
college in particular, separation-individuation issues are reawakened,
because it is often the first time adolescents have lived away from home.
Living away from home provides an opportunity for late adolescents to
successfully negotiate challenges and make gains in autonomy. However,
if their coping skills are not suficient to handle the new environment and
its accompanying demands, it can be a time of stress and anxiety, and can
lead to problems in adjustment

2 4
Recently, there has been an ongoing debate in the literature

regarding the positive vs. negative implications of autonomy for adolescent
adjustment. One dificulty in deciding this debate is that difi‘erent
definitions of autonomy currently exist in the literature. Analytic and
neoanalytic theorists have argued that autonomy involves ”individuation”,
in which adolescents become increasingly more self-governing, relinquish
idealized perceptions of and identifications with parents, and loosen close
ties with them (Blos, 1967; J osselson, 1980). Others have argued that
autonomy is defined by "mutuality", which involves parental
encouragement of increased adolescent independence, respect for the
adolescent's individual decisions and opinions, as well as reciprocal
respect on the part of the adolescent for the parent (Grotevant & Cooper,
1986; Kenny, 1987). These theorists have suggested that mutuality occurs in
the context of close, connected parent-adolescent relationships, which are
supportive of autonomy. These difl'erent definitions, or perhaps difi'erent
types of autonomy are likely to have unique implications for adjustment. A
number of researchers have begun to explore this question, focusing on one
or the other type of autonomy.

Ryan & Lynch (1989), based on findings with early and middle
adolescents, suggest that individuation, which in their work was defined by
a measure of ”emotional autonomy” (Steinberg & Silverberg, 1986), has
negative implications for adjustment and may be better described as
detachment, because it is associated with insecurity and feelings of
rejection in relation to parents. In response to this contention, Lamborn &
Steinberg (1990) suggested that the implications of emotional autonomy for
adolescent adjustment may be afi'ected by the emotional climate of the
parent-adolescent relationship. And in fact, they found such differences for

2 5
adolescents (ninth through twelflzh grades) who experienced secure as

opposed to insecure (anxious or avoidant) relationships with their mothers.
Those adolescents who reported insecure relationships with their mothers
were most well-adjusted when they reported moderate to high levels of
emotional autonomy, whereas those who reported secure relationships
were most well-adjusmd when they reported moderate to low levels of
emotional autonomy. The authors suggested that among secure
adolescents, emotional autonomy, as Ryan & Lynch have suggested, may be
indicative of detachment and lead to negative outcomes. In contrast, for
insecure adolescents, emotional autonomy may represent an adaptive level
of separation from parents and lead to more positive outcomes. In this
group, rebellion and separation fiom parents may allow the adolescent to
gain emotional distance in order to rework negative relationships with
parents. Similarly, Frank & Poorman ( 1992) found that emotional
disengagement from parents was more strongly linked to insecurity about
separation among late adolescents who perceived their parents as having a
more (as compared to less) well-functioning parenting partnership.

The age or developmental level of the adolescent or young adult in
question is clearly an important factor that must be taken into account in
understanding the implications of autonomy. There is some evidence
indicating that although individuation has more negative implications for
younger adolescents, it has increasingly more positive implications for
older adolescents. Whereas Ryan & Lynch (1989) reported that emotional
autonomy was associated with insecurity among fifth through twelfth
grade adolescents, Frank & colleagues have suggested that individuation is
a more ”mixed bag“ for late adolescents, and is associated with both
opportunities and pitfalls. Using a number of college student samples, they

2 6
found that higher levels of individuation in college students were related to

more positive self-concepts, less identity foreclosure, and fewer dificulties
in intimate relationships, but also to more alcohol and drug problems
(Frank, Pirsch & Wright, 1990; Frank & Burke, 1992).

Hofl'man (1984), based on psychoanalytic descriptions of the early
separation-individuation process (Mahler, 1968; Blos, 1967). separated the
construct of individuation into four distinct aspects of adolescent
independence in order to determine whether particular aspects of
autonomy would be more or less associated with difi'erent aspects of
adjustment (i.e. personal adjustment, academic adjustment, and
adjustment in romantic relationships). The four aspects of individuation
were measured by the Psychological Separation Inventory (PSI), and
included functional independence (ability to make decisions and run one's
life without depending on parents), emotional independence (not needing
an excessive amount of approval and emotional support fi'om parents),
attitudinal independence (ability to determine one's own values and beliefs),
and conflictual independence (freedom fi-om guilt, resentment, and other
negative feelings regarding parents). He found, generally, that greater
conflictual independence was related to fewer problems in romantic
relationships for both college men and women, and to personal adjustment
in women. Lopez, Campbell, & Watkins (1988) found a similar relationship
between conflictual independence and personal adjustment in both college
men and women. In addition, in Hofinan's study, greater emotional
independence was associated with fewer academic problems, but greater
attitudinal independence was associated with less personal adjustment for

both men and women, and to more problems in romantic relationships for

2 7
men. Functional independence was not significantly associated with any of

the adjustment measures (Hofinan, 1984).

Frank & J ackson-Walker (in press) explored both individuation and
mutuality, as they related to eating pathology. They found that
individuation and mutuality were negatively correlated, but hath were
related to less personality dysfunction. In addition, individuation
moderated the relationship between eating symptomatology and personality
disturbance associated with severe eating disorders, such that eating
symptoms were more strongly linked to personality dysfunction among less
individuated as compared to more individuated women. However,
mutuality did not moderate this relationship.

' Other researchers have explored another aspect of autonomy
development that appears to be relawd to mutuality, but which may in fact
be a separate dimension. In particular, researchers have examined
"anxieties about separation from parents", and have consistently found
positive relationships between this factor and adjustment problems. For
example, Holmbeck 8r Wandrei (1993) found that college females' reports of
anxieties surrounding separation and difficulties regulating distance in
interpersonal relationships were associated with depression and physical
symptoms. Similarly, Kenny & Donaldson (1991) reported that late f
adolescents' perceptions of their families' anxieties about separation were
associated with psychological symptoms and lower social competence in the
late adolescents.

Rice, Cole & Lapsley (1990) factor analyzed a number of difl'erent
autonomy measures and obtained two factors: The first factor was similar
to what has been referred to here as ”individuation”, and was labeled
"independence from parents”. It was defined by functional, emotional, and

2 8
attitudinal independence (as measured by the PSI). The second factor was

labeled "positive separation feelings” and was defined by positive outlooks
toward separation experiences, lack of anxieties about separation, and
conflictual independence (from the PSI). Interestingly, although
conflictual independence was conceptually developed as a part of
individuation, it appears to be associated with other measures of the
afl'ective experience regarding separation, and also has relatively
consistent positive relationships with adjustment. In this study,
independence fi'om parents and positive separation feelings were positively
correlated; however, the researchers found that it was positive feelings
about separation, rather than actual independence, that was relawd to
positive adjustment.

In sum, individuation, mutuality, and feelings about separation all
appear to have notable, although somewhat difl’erent, implications for
adolescent adjustment. In addition, it appears that a positive affective
experience regarding separation is most consistently associated with
psychological adjustment in late adolescents, or conversely, that anxieties
about separation are associated with various types of emotional distress.
An important task is to determine whether a specific aspect of autonomy
development is more predictive of eating disorders than others, and
whether any of the different aspects or types of autonomy are specifically
predictive of disordered eating rather than adjustment problems more
generally.

E | E |° E I'
Although lack of autonomy appears to be a major issue for women
with eating disorders, it is as yet unclear why their dysfunction is

2 9
expressed through an eating problem. Returning to Bruch's discussion of

the etiology of eating disorders, she contends that feeding is a particular
trouble spot in mother-infant interactions for girls who develop eating
disorders. Moreover, the resulting difficulties in recognizing their own
feelings, sensations, and internal bodily states could clearly lead to
problems in regulating eating behavior, as a response to distress.

However, moving beyond the mother-dauflrter relationship, I
suggested earlier that the interplay between family and sociocultural
factors may also be relevant in predicting risk for eating disorders. Again,
sociocultural theories do not explain why some women are more
susceptible to societal pressures than others. It may be that when the
my endorses or mirrors sociocultural attitudes about thinness in
women or models unhealthy or maladaptive eating attitudes or behaviors,
the daughters are more likely to internalize these attitudes themselves, and
hence, are more likely to express dysfunction through an eating problem.
In a review of the literature, Yager (1982) summarized the ”typical”
anorexic family as one that has excessive concerns with weight, thinness,
and exercise, as well as a strong investment in maintaining
"appearances". However, he pointed out the need to move beyond
descriptive data, and argued for more substantial empirical evidence for
these claims.

Several theorists and researchers have, in fact, explored whether
weight problems within the family, the family's preoccupation with food or
weight, or dysfunctional attitudes toward dieting or eating are pathognomic
for the development of eating disorders in daughters (Scalf-McIver &
Thompson, 1989; Crisp et al, 1980). A number of uncontrolled studies of
anorexic patients and their families suggested that a relatively high

3 0
number of parents of anorexics had weight problems themselves, being

either overweight, underweight, or even anorexic (Crisp et al., 1980;
Kalucy, Crisp, & Harding, 1977). In contrast, a controlled study found no
difi‘erences in current weight between parents of anorexic daughters and
control parents (Halmi, Struss & Goldberg, 1978). Garfinkel,lGarner, Rose,
Darby, Brandes, O'Hanlon, & Walsh (1983) also found no difi'erences
between parents of anorexics and parents of controls on measures of
weight, dietary restraint, or eating pathology. In addition, they reported
that parents of anorexics were not overly concerned with dieting or weight
loss. A more recent study examining parents of bulimic daughters found
that although bulimics' fathers' weight histories did not difi‘er from fathers
of normal controls, mothers of bulimics currently weighed more
(controlling for height), and had higher lifetime-maximum weights than
mothers of controls (Y ates, 1992).

Rather than focusing on actual weight problems in the family, other
investigators have explored relationships between the family's overconcern
with food, eating, or weight and daughter's eating problems. Again,
clinical observations of anorexics and their families suggested that parents
were unusually preoccupied with weight, dieting, and physical appearance
(Amdur et al., 1969; Beattie, 1988; Bruch, 1978), leading some researchers to
suggest that the eating disordered dauglter mirrors her parents'
preoccupation with their own weight and appearance (Stoltz, 1985).
Similarly, Schwartz et al. (1985) noted that bulimic families seemed to be
very conscious of appearances and often attached a special meaning to food
and eating.

There has been some empirical support for these claims. Kent &
Clopton (1992) found that both bulimics and subclinical bulimics were more

3 I
likely to report maladaptive eating patterns and weight concerns in their

family members than were controls. They suggested that the association
could be attributed to genetic influences, simple behavioral modeling, or
modeling of a family style in which food is used as a means of getting
nurturance or of coping with emotional dificulty. '

Pike 82. Rodin (1991) suggested that mothers in particular may
"operate as society's messengers”, and directly pressure their daughters to
diet and lose weight. On the other hand, daughters may simply model their
mothers' attitudes or concerns about weight and attractiveness. In a study
exploring this issue in high school girls and their mothers, the authors
found that mothers of daughters with high levels of eating pathology had
more disordered eating behaviors themselves, and their attitudes regarding
their daughters difi'ered from those of other mothers. These mothers
thought their daughters should lose more weight than did mothers of
daughters with no eating pathology, even after accounting for weight
difi'erences among the girls. Moreover, they rated their daughters as
significantly less attractive than the daughters rated themselves, while this
difi'erence was not evident in the other mother-daughter pairs. The
researchers concluded that mothers likely model unhealthy eating
attitudes and behaviors as well as modeling the use of these maladaptive
behaviors as styles of coping with difiiculty. Moreover, they appear to hold
very critical opinions of their daughters' appearances. These attitudes may
create a context in which separation dificulties are expressed as eating
pathology. 2‘

Again, the father's influence on the daughter's eating problems has
Men largely ignored. However, in a study of normal children and
adolescents, Striegel-Moore & Kearney-Cooke (1994) found a strong

3 2
relationship between parent dieting and parent encouragement of the child

to diet in hath mothers-and fathers. In addition, contrary to their
expectations, they found that mothers were more likely to praise their
children's appearance than were fathers, pointing out the possibility that
fathers' lack of praise, or even criticism of children's appearance, may be a
very relevant factor in children's body image development.

In addition to parents' weight preoccupations and concerns about
their daughter's weight and eating, the use of food as a means of getting or
providing nurturance has been suggested as an important theme in eating
disordered families (Kent & Clopton, 1992). Humphrey (1986b) found that
bulimics experience deficits in parental nurturance and empathy, and are
also deficient in self-nurturance and self-acceptance. She suggested that
for this reason, bulimics turn to food as a substitute for the empathy and
nurturance they crave. Lehman & Rodin (1989) provided some empirical
support for their contentions that bulimics utilize food as their primary
means of self-nurturance, have dificulty gaining gratification from
sources other than food, and are unable to be comforting or accepting of
themselves. However, although the researchers also suggesmd, as did
Stoltz (1985), that other members of bulimic families may similarly use food
as a means of nurturance and soothing, this hypothesis was not supported
in Lehman & Rodin's sample.

Despite evidence that family concerns with weight and food, as well
as using food as nurturance, may be associated with eating disorders, most
researchers point out that family weight and food concerns alone are not
likely to lead to eating disorders. Rather, within the context of a
dysfunctional family environment, these concerns are likely to increase
risk. For example, Strober & Humphrey (1987) suggested that personal

3 3
deficits produced by an adverse family environment, in the context of

pressures to diet and be slim, is likely to be especially pathognomic for
eating disorders. Likewise, Johnson & Flach (1985) and Pike & Rodin (1991)
point out that although family relationships and interactions are probably
central to the pathology of eating disorders, the family's preoccupation with
food and weight may be responsible for the specific expression of the
disorder.

Hypotheses
The purpose of the present investigation is to determine whether

dificulties in the separation-individuation process in relation to mothers
and fathers are associated with disordered eating specifically, and
adjustment problems more generally, in a nonclinical population of late
adolescent women. An additional goal is to gain more clarity with regard
to the particular aspects of autonomy, if any, that lead to eating versus
general adjustment problems. A final question to be addressed is whether
adolescents' perceptions of their parents' eating and weight preoccupation
increase the risk for disordered eating, in the context of problems with
separation-individuation. In order to address these questions, I measured
a variety of aspects of autonomy, intended to assess both individuation and
mutuality (as well as its opposite, anxieties about separation) and then
tested the following hypotheses:

1) It is hypothesized that low levels of autonomy in relation to mothers
and fathers will be associated with eating pathology in college women. In
particular, it is predicted that college women who experience anxieties
about separating fi'om their mothers and their fathers, and who report low

3 4
levels of mutuality and individuation from both their mothers and their

fathers will be more likely to be disordered eaters.

2) It is predicted that low levels of autonomy (i.e. anxieties about
separation, lack of individuation, and lack of mutuality) from both mothers
and fathers will also be predictive of general adjustment problems in

college women.

3) It is hypothesized that separation-individuation dificulties will
moderate the relationship between daughters' perceptions of parents'
preoccupation with weight and eating and daughters' eating pathology.
That is, there will be a stronger relationship between eating pathology and
daughters' reports of parent eating preoccupation (i.e. parents' concerns
with weight and eating, concerns with their daughter's weight and eating
patterns, and use of food as a means of providing nurturance) among
women who describe problems with autonomy in relation to their parents

than among women who describe higher levels of autonomy.

4) Itis predicted that dificulties with autonomy will not moderate the
relationship between perceptions of parent eating preoccupation and
adjustment problems. That is, parent eating concerns, within the context
of separation-individuation dificulties, will be a mm; risk factor for
eating pathology, but not adjustment problems.

Method

B l' . | ‘

Two samples were used in this study: the first sample was used to
develop and conduct a factor analysis on a measure of parent eating
preoccupation (the Parent Eating Attitudes Scale), and the second sample
was used to test the hypotheses presented here.

The first sample consismd of 272 female undergraduates fi‘om intact
families. Participants ranged in age from 17 to 22 (M=19.2); 43.4% were
freshmen, 32.4% were sophomores, 20.6% were juniors, and 3.7% were
seniors. The large majority (90%) were Caucasian, and most were fi'om
middle to upper middle class backgrounds.

The second sample initially consisted of 80 female undergraduates
from intact families. Only participants fi-om intact families were selected
in order to be able to equally assess current relationships with both parents.
In addition, because parental divorce is likely to have an independent efi'ect
on adolescent autonomy, I controlled for this factor. Forty women who
received scores at or above the clinical cutoff on a measure of eating
pathology were selected (disordered eating group), and 40 who received
scores not indicative of eating problems were selected (comparison group).
One comparison subject did not complete a large number of the
questionnaires, reducing the number of participants to 79.

Table 1 presents demographic data for Sample 2. Participants
ranged in age from 17 to 22 (M=18.9); 53.2% were fieshmen, 30.4% were

sophomores, 15.2% were juniors, and 1.3% were seniors. They were

35

 

Freshman
Sophomore

Junior

Senior

Race
Caucasian
Asian-American

African-American

“59$

74

53.2
30.4
15.2
1.3

93.7
5.1
1.3

3 7
predominantly Caucasian (93.7%), but a small number were Asian-

American (5.1%) or Afiican-American (1.3%). They were from primarily
middle to upper middle class backgrounds: approximately 87% of their
fathers and 79% of their mothers had had at least some college education,
and 82% of their fathers and 67% of the mothers were in middle to high
status occupations (ranging from secretaries and semiprofessionals to
major professionals and higher executives). Comparisons were similar to
disordered eaters in age and socioeconomic status, and there were no

difi'erences between groups on any of the other demographic variables.

Measures
Sample 1:

Participants were administered a demographics questionnaire and
the W (Frank, J ackson-Walker, & Monestere,
1992; unpublished measure). The PEATS was developed in order to provide
a measure of respondents' perceptions of their parents' preoccupation with
eating and weight, while the respondent was growing up. It assesses
perceptions of parents' concerns about their own weight and dieting (”My
mother was always worried about gaining weight or being too fat"), their
parents' concerns about their daughter's weight and eating patterns ("My
father thought it was very important for me to be thin"), and their parents'
use of food as a means of providing nurturance ("When I was upset, my
mother gave me food to comfort me”). It also assesses parents' attitudes
about drinking and drug use, although these items were not included in the
analyses here. The PEATS is completed separately for each parent, and
has 32 items which are answered on a 4-point Likert scale, ranging from
"very true” to ”very false”. Some of the items from this scale were based on

3 8
items from the Somatopsychological Difi'erentiation Scale (Chatoor, Atkins,

Bernard, & Rohrbeck, 1988).

Sample 2:

Participants were administered an interview assessing. autonomy in
their relationships with their parents, and a number of questionnaires
measuring autonomy, adjustment/self-concept, and eating attitudes and
behaviors (both their own and their perceptions of their parents'). In
addition, they provided personal and family background information
through a demographics questionnaire and a health history questionnaire.

EI' Ell'li lBl .

The Healthflim (adapted fi'om Johnson, 1985) was used to obtain
information about weight and height, eating patterns, binging and purging
behaviors, and exercise habits. In addition, it assesses depressive '
symptoms (e.g. depression, crying episodes, difliculties sleeping) and
psychiatric history. This measure was based on the Diagnostic Survey for
Eating Disorders (DSED), a standardiwd interview developed to obtain
intake information for women with anorexia nervosa or bulimia. It has
been used both in interview and in self-report formats (Johnson, 1985), and
was administered in the current study as a self-report questionnaire.
Although the validity of height and weight estimates obtained through self-
reports has been questioned, Yates (1992) found that actual body mass index
(BMI) correlated highly with BMI calculawd through bulimic (r=.84) and
control subjects' (r=.90) estimates of their heights and weights.

The W (EAT) (Garner & Garfinkel, 1979) assesses
a range of maladaptive eating attitudes and behaviors (e.g. ”I am terrified

3 9
of being overweight"; "I weigh myself several times a day"). The 40 items

are answered on a 6-point Likert-type scale, ranging from "always" to
"never". Scores above the "clinical cutofl" (of 30) on the EAT are viewed as
symptomatic of an eating disorder, although they are not considered to be
diagnostic. The EAT is widely used in studies of disordemd eating, and in
addition to assessing clinical populations, has been used to identify
disturbed eating behavior among college students (Garner, Olmstead, &
Polivy, 1983).

Although the EAT was initially developed to measure symptoms of
anorexia nervosa, it appears to reflect bulimic symptomatology as well. A
factor analysis of the EAT resulted in a "Dieting" factor and a "Bulimia and
Food Preoccupation" factor (Garner, Olmsted, Bohr, 8r Garfinkel, 1982).
Another widely-used measure, the Eating Disorders Inventory (EDI), was
developed to assess a broad range of characteristics associated with both
anorexia and bulimia, including cognitive and psychological aspects
(Garner et al., 1983). In one samfle in a series of validational studies for
the EDI, the EAT "Dieting" factor correlated highly with the EDI Drive for
Thinness scale (r=.80), and the EAT "Bulimia and Food Preoccupation"
factor correlated highly with the EDI Bulimia scale (r=.85). In other
samples, the authors found that the EDI Drive for Thinness scale
correlated highly with the total EAT score (r=.88), and there were no
differences between bulimics and anorexics on the Drive for Thinness scale
(Garner et al., 1983).

The EAT has been reported to have good discriminant and predictive
validity, and appears to be sensitive to recovery (Garner & Garfinkel, 1979).
Internal consistency for a sample of anorexic subjects was .79 and for a
sample including both anorexics and normal controls was .94. Internal

4 0
reliability for the current sample, as measured by Cronbach's alpha, was

.91 (See Table 2 for internal reliability data on all scales in this study).

The W (Frank, J ackson-Walker, &
Monestere, 1992; unpublished measure) already described for Sample 1 was
administered to obtain participants' perceptions of their parents'
preoccupation with eating and weight. I

Autumn:
Participants completed four questionnaire measures and an

interview designed to assess the three aspects of autonomy discussed
previously: individuation, mutuality, and anxieties about separation.

' The 5-item Deidealization subscale from the W
Scale (Steinberg & Silverberg, 1986) was used to assess the adolescent's
level of awareness of parental fallibility. It is measumd by items such as
"Even when my mother and I disagree, my mother is always right"
(negatively scored), and "My father hardly ever makes mistakes"
(negatively scored). This scale was completed separately for mother and for
father, and items were answered on a 4-point Likert scale ranging fi'om
strongly. disagree to strongly agree. The Emotional Autonomy Scale has
been used in a number of studies with early and middle adolescents
(Lamborn & Steinberg, 1990; Ryan & Lynch, 1989; Steinberg 8r Silverberg,
1986) and late adolescents (Frank, Pirsch & Wright, 1990; Frank & J ackson-
Walker, in press), and the Deidealization subscale has been found to
correlate with various aspects of adjustment in the late adolescent samples.
Internal reliability for the current sample was .69 for relationships with
fathers and .62 for relationships with mothers.

Table 2. WWW

I l' '1 IE I] l S 1
Eating Pathology
Self-Concept Problems
Depressive Symptoms

W
Deidealization
Autonomy

Mutuality

Respect for Boundaries
Conflictual Dependence

Insecurity

E |° E l' S 1
Eating Preocc.-Self

Eating Preocc.-Child

Food as Nurturance

.91
.92

.77
.71

388

.79

83233

2'82

.78
.91
.79

.79
.55

4 2
Three scales fi'om Stutman & Lich's (1985) William

Ingentm: were used to assess various aspects of autonomy. The 14—item
Autonomy subscale measures self-governance or self-directedness (e.g. "I
run my own life without nwding my father's direction"). The 5—item
Mutuality scale assesses the extent to which the respondent perceives the
parent as recognizing her new adult status ("My mother doesn't seem to
recognize that I have grown up") (negatively scored). The 9—item Respect
for Intergenerational Boundaries scale assesses the extent to which the
respondent perceives the parent as respecting her opinions, desires for
autonomy, and need for separateness ("It's alright with my father if I
disagree with him"). The items on the Parental Relationship Inventory
were answered on a 4-point Likert scale ranging from strongly disagree to
strongly agree. It was completed separately with regard to mother and to
father. This measure has been used with both young adults and late
adolescents, and associations have been found between its subscales and
several measures of psychological health and personality dysfunction
(Frank & Jackson-Walker, in press; Frank et al., 1990; Stutman & Lich,
1985). Internal consistencies for the current sample were as follows:
Autonomy, .86 for relationships with fathers and .77 for relationships with
mothers; Mutuality, .67 (fathers) and .71 (mothers); and Respect for
Intergenerational Boundaries was .78 (fathers) and .85 (mothers).

The 50-item Conflictual Independence scale fi'om the Euchglggjgal
W (PSI) (Homnan, 1984) was used to assess negative
afi'ect regarding separation from parents. Because items are worded to
reflect lack of independence, this scale will be referred to in this study as
Conflictual Dependence. The scale measures feelings of guilt, resentment,
and anger in relation to parents, and conflicts and anxieties about

4 3
separation (e.g. "I feel uncomfortable keeping things from my mother";

"When I don't write my father often enough I feel guilty"). The measure is
answered on a 5—point Likert scale, ranging from "Not at all true of me" to
"Very true of me". Half of the items on this scale refer to mother and half to
father, yielding separate conflictual dependence scores for each. This scale
has been used in many studies using college student samples, and
conflictual independence has been found to be positively associated with
various measures of adjustment (Friedlander 8r Siegel, 1990; Homnan,
1984; Rice et al., 1990). Alphas in this sample were .91 for dependence on
fathers and .94 for dependence on mothers.

. Ainsworth and Ainsworth's (1958) W
assessed insecurity in the parent-adolescent relationship. This 12-item
scale measures feelings of failure and inferiority, oversensitivity to parents'
disapproval, and lack of self-confidence regarding separation fi-om parents
(e.g. "It makes me feel uneasy to think of being completely on my own"; "I
sometimes worry about the future as a time when I will not get as much
help from my parents as I do now"). This scale was completed separately
for relationships with mother and father, and although the original
measure used a true/false format, participants here responded to the items
on a 4-point Likert scale, ranging from very false (or somewhat false) to
very true (or somewhat true). This 4-point response format has been used
successfully in a number of other studies, and relationships have been
found between insecurity and other measures of attachment with parents
(Bank at al., 1990; Frank & Poorman, 1993). Coeficient alphas in this
study for relationships with both fathers and mothers were .79.

The W (Frank. Avery. &
Laman, 1988) is a 1 1/2 hour semi-structured interview, completed

4 4
separately with regard to each parent. Five difl'erent dimensions

measuring aspects of autonomy (decision making, independence, self-
assertion, personal control, and self-other responsibility) are scored from
the interviews, on a scale ranging from 1, indicating low autonomy, to 5,
indicating high autonomy. (See Appendix L for interview and full
description of the criteria for rating each level.)

The Decision Making dimension assesses the respondent's capacity
to make her own decisions and choices and determine her own values,
without depending on the parent to do so. The Independence scale
measures the respondent's feelings of competence, and beliefs that she can
cope with life dificulties without relying excessively on the parent. The Self-
Other Responsibility scale refers to the adolescent's ability to resolve
conflicts surrounding the parent's needs versus her own needs, as well as
the ability to develop attachments and investments outside of the parent-
adolescent relationship. The Personal Control scale refers to the
adolescent's ability to control her behavior and regulate her feelings
(particularly negative feelings) in the relationship with the parent. The
Self-Assertion scale assesses the extent to which the respondent is
uninhibited by feelings of shame or guilt in the relationship with the
parent, and relies on her own standards or expectations of behavior, rather
than evaluating her behavior based on the parent's standards.

This interview was developed on a young adult sample, ages 22-33,
but has also been used in other studies with college students (Frank, Avery
& Laman, 1988; Wright, 1992; Pirsch, 1993). Interrater reliabilities for this
sample are reported in Table 3; they ranged from .75 (Self-Other
Responsibility) to .90 (Decision Making), with a mean of .82. The following
autonomy subscales described above were expected to measure aspects of

 

Decision Making
Independence
Self-Assertion

Personal Control
Self-Other Responsibility

.81
.78
.87
.75

4 6
indmidaafian: deidealization, autonomy, decision making, and

independence. Mutuality, respect for intergenerational boundaries, and
self-other responsibility were expected to assess aspects of mutuality.
Finally, conflictual dependence, insecurity, personal control, and self-
assertion were intended to measure W (see Table 4
for summary chart).

Adjustment

The W (Ofi'er, Ostrov, 8: Howard, 1989)
measures various aspects of psychological health. Three scales (34 items)
were combined to provide a measure of emotional adjustment, or more
specifically, self-concept: emotional tone, mastery of the external world,
and absence of psychopathology. The measure reportedly has adequate
concurrent validity and discriminates between normal and disturbed
adolescents (Offer et al., 1989). Internal consistency for the combined scales
for this sample was .92.

A number of items from the Haalthjfistau questionnaire (described
above in the Eating Attitudes and Behavior section) were used to assess
depressive symptoms, in order to provide another measure of emotional
adjustment. Respondents were asked to indicate how fiequently they
experience several symptoms of depression (depression, anxiety, dificulty
getting up in the morning, crying episodes, irritability, fatigue, and
difliculty falling asleep) on a 5-point scale ranging from "Never" to
"Always". Factor analysis of these items resulmd in one "depressive
symptoms" factor. Internal consistency for this sample was .85.

47

Table 4. WW

I 1' .1 |°
Deidealization
Autonomy
Decision-Making
Independence

Mutuality

Mutuality

Respect for Boundaries
Self-Other Responsibility

5 . |° l | S |°
Conflictual Dependence

Insecurity
Personal Control
Self-Assertion

Measure
Emotional Autonomy Scale

Parental Relationship Inventory
YAPR
YAPR

Parental Relationship Inventory
Parental Relationship Inventory
YAPR

Psychological Separation Inventory
Familial Insecurity Scale

YAPR

YAPR

Note: YAPkYoung Adult/Parent Relationship Interview

48
Procedure

Participants were recruiwd fi-om the introductory psychology subject
pool at a large midwestern university, and were given research credit for
their psychology course in exchange for their participation. Participants
were part of a larger group of students who completed a battery of
questionnaires, administered in random order, during group testing
sessions lasting approximately one to two hours. They were told that the
purpose of the research was to study the relationship between the family
environment and various health attitudes and behaviors. During the
testing sessions, students were requested to complete a Recontact form if
they wished to be considered for participation in the second phase of the
study. On the moontact form, they were asked to provide a code name by
which they would be identified, along with their phone number. They were
told they would receive additional research credits if chosen to continue.
They were also told that only a small percentage of the total group would be
recontacted, and that even if they signed the form, they were not obligated to
participate in the second phase.1

The majority of students participating in phase one completed the
Recontact form (74%), and the present sample was chosen from this group.
Of women meeting the criteria for the eating disorder group (those who had
scores of 30 or above on the EAT), 79% agreed to be recontacted (as opposed
to 72% of the women who did not meet criteria for the eating disorder

1 The procedure for Samples 1 and 2 was virtually identical, with the only
exception being that Sample 1 was administered all of the questionnaires
but the Health History in the group testing session. Sample 1 was given the
option of participating in Phase 2 of the study, in order to test the success of
using this method to recruit subjects for the interview phase. Although the
primary goal was collecting questionnaire data for Sample 1, 10 subjects
were also administered the interview and included in Sample 2. Hence, 10
subjects were included in both Samples 1 and 2.

4 9
group), indicating that women with disordered eating were no less likely to

agree to be recontacted than other women. Students who met the criteria
for the comparison group (had scores of 20 or less on the EAT) were
matched to an eating disorder subject based on age and socioeconomic
status. Women meeting the criteria for the disordered eating or
comparison groups were recontacted by an interviewer, identified only by
the code name they had provided, and were requeswd to take part in the
interview phase. Unfortunately, statistics on the women who declined to
participate further in the study at this point were not kept. However, the
primary reason for not continuing was having already received the
maximum number of required and extra credit research credits, and this
generally occurred only towards the end of the semester.

Participants who amed to complete the second phase of the study
were administered the interview in either one 3 hour session or two 1 1/2
hour sessions, depending on participant preference. The order in which
mother and father interviews were administered was alternated.
Participants were also given additional questionnaires to fill out at home
prior to the interview. The first 10 participants completed all but one of the
questionnaires (the Health History) in the initial testing session. The
remaining 70 were given half of the questionnaires in the initial session
and half as part of the interview phase of the study. One participant did not
complete the additional questionnaires, reducing the total number of
participants to 79. '

Two primary interviewers (who together complemd 80% of the
interviews) and four secondary interviewers (who administemd 20% of the
interviews) were trained to administer the Young Adult/Parent
Relationship Interview by its author (Susan Frank). Interviewers were all

5 0
female; five were clinical psychology graduate students and one was a

senior psychology student. In the large majority of cases, interviewers
were blind to the status of the participant (i.e. disordered eating group or
comparison group); however, in a few cases, the primary investigator was
aware of the status of the interviewee. .

Two clinical psychology graduate students (the primary investigator
and a secondary interviewer), who had prior experience in coding the
YAPR, coded the autonomy scales using detailed manuals developed by
Susan Frank. The manuals provided criteria for scoring each dimension
on a 5-point scale. The primary investigator "blocked" the interviews by
printing only the responses that pertained to each autonomy dimension on
separate sheets of paper, so that coders were only reading items that
specifically addressed the dimension they were coding. Although there
was still some overlap in content, this process maximized the likelihood
that each autonomy dimension would be scored without information about
other dimensions. Coders were blind to the status (i.e. disordemd eater or
comparison) of the participant, as protocols were identified only by subject
numbers.

Coders practiced scoring the autonomy dimensions using interview
protocols from prior studies by Susan Frank and colleagues. The coders'
interrater reliability was measured using a sample of 20 protocols fi-om a
prior study with college students. Scores for the reliability sample were
established by Susan Frank and a secondary investigator (who had attained
adequate reliability on other protocols); both coders independently scored
the protocols, then discussed them and resolved any difi'erences. The
resulting scores were used as the standard to which the coders' scores in

5 1
this study were compared. Once reliability was established, the coders

scored the protocols fi'om the current study.

Results

E 1' . E 1

Participants ranged in weight from 95 to 180 pounds (Me129.6,
SD=15.86), and ranged in height from 60 to 71 inches (M: 65.49, 812:2.57).
The mean weight of the disordered eating group was 133.35 pounds and the
mean height was 65.92 inches, while the mean weight of the comparison
group was 126.22 pounds, and mean height was 65.22 inches. Analyses of
variance revealed that although there were not significant group
difi'erences on height, disordered eaters weighed significantly more than
controls, F(1,74)=3.97, p<.05. However, a calculation of body mass index
(BMI) (weight in kilograms/height in metersz) revealed no differences
between disordered eaters and controls. Participants' scores on the Eating
Attitudes Test ranged from 6 to 78.

The mean scores for this sample on the scales completed separately
with regard to mothers and fathers are presented in Table 5. Paired t-tests
indicated that in a number of cases, there were significant difi'erences
between daughters' experiences of their relationships with mothers versus
fathers. Where differences existed on measures of separation-
individuation, daughters generally experienced higher levels of autonomy
from fathers than from mothers. In particular, daughters had higher
scores with regard to fathers on the autonomy, t(77)=2.83, p<.01, decision-
making, t(77)=2.00, p<.05, and self-other responsibility scales, t(77)=6.58,
p<.001. However, they reported higher levels of mutuality in relationships
with their mothers, t(77)=3.52, p<.001. On the parent eating preoccupation

52

 

Deidealization
Autonomy

Mutuality

Respect for Boundaries
Conflictual Dependence
Insecurity

Decision Making
Independence
Self-Assertion

Personal Control
Self-Other Responsibility
E I' E I' S 1
Eating Preocc.-Self
Eating Preocc.-Child
Food as Nurturance

‘1 p<.05. b p<.01. ° p<.001.

2.86 (.47)
2.36 (.39)
3.11 (.56)
2.97 (.54)
1.92 (.70)
2.05 (.55)

2.33 (1.18)
2.37 (1.06)
2.20 (1.22)
3.43 (1.18)
1.97 (1.03)

1.84 (.77)
1.61 (.69)
2.00 (.66)

2.85 (.49)
2.50 (.49)
2.89 (.59)
2.97 (.47)
1.80 (.62)
2.08 (.56)

2.65 (1.25)
2.49 (1.15)
2.00 (1.02)
3.41 (1.19)
2.99 (1.22)

1.50 (.64)
1.29 (.59)
1.60 (.54)

.10

2s3b
3.52c
.13
1.76
59
2.00
1.01
1.33

6.58°

3.33c

3.91°
5.59°

5 4
scales, the adolescents perceived their mothers as being more preoccupied

with both their own weight and eating. t(78)=3.33, p<.001, as well as their
daughter's, t(78)=3.91, p<.001. Mothers were also perceived as being more
likely to use food as a means of providing nurturance, t(78)=5.59, p<.001.

 

Preliminary analyses were conducted in order to determine whether
disordered eaters (as defined by scores on the EAT) were significantly
difi‘erent from comparisons on eating-related variables (fi'om the Health
History). Results of chi square analyses conducted on the two groups
indicamd, as would be expected, that disordered eaters were more likely
than comparisons to report having dieted, x2(1, N=78)=12.71, p<.001.
Analyses of variance indicated that disordered eaters also began dieting at
a younger age (M=14.28 vs. 16.64 years), F(1,51)=18.68, p<.001, and started
more diets in their first year of dieting (M=4.34) than did comparisons
(M=2.18), F(1,51)=10.32, p<.002. Disordered eaters were more likely to report
having hinged, x2(1, N=78)=20.86, p<.001, and having vomited after eating in
order to get rid of the food eaten, x2(1, N=78)=11.76, p<.001. Of the women
who reported binging, disordered eaters felt more out of control during
hinges, F(1, 44)=10.38, p<.002. felt more miserable or annoyed after hinges,
F(1, 44)=16.95, p<.001, were more likely to binge eat in private, F(1, 44)=7.92,
p<.007, and were more uncomfortable with their binge eating, F(1, 39)=4.91,
p<.03. However, differences were not found on reports of eating rapidly
during hinges, consuming large amounts of food during hinges, or eating
until feeling physically ill. The two groups did not difi‘er significantly on
whether they had used laxatives to control weight or "get rid of food".

5 5
However, the fact that this relationship was not significant is likely due to

the very low rate of endorsement of this item (only 9 participants endorsed
this item, 8 of whom were disordered eaters).

Adjustment

Analyses of variance indicated that disordered eaters reported more
depressive symptoms, F(1,70)=5.01, P<.03, and poorer self-concepts,
F(1,69)=13.11, P<.001, than comparisons. In addition, disordered eaters
were more likely to have been involved in outpatient mental health
treatment, x20, N=78)=5.01, p<.03. The groups did not difl'er on reports of
attempted suicide, or attempts to physically hurt oneself. They also did not
differ on history of hospitalization for eating or emotional problems or
history of taking psychiatric medication, although, again, this was probably
due to the low Muency with which these variables were endorsed: Only
two participants had been hospitalized, both of whom were disordered
eaters, and five had taken psychiatric medication, including 4 disordered
eaters and 1 comparison subject.

Cemefisonebetmnlhmeflrmms

Participants were also separated into three groups, based on their
EAT scores, which were defined as "no or mild eating pathology" (score
<30), "moderate eating pathology" (score 2 30 and < 40) and "severe eating
pathology" (score 2 40), in order to determine whether difi'erences existed
based on extent or severity of eating pathology. For the most part, results of
comparisons between the three groups were~ similar to the comparisons
between two groups, in that women with both moderate and severe eating
pathology reported more disturbed eating patterns and poorer emotional
adjustment than those with little to no eating pathology. However, there

5 6
were several difi'erences between the women with moderate and severe

eating pathology. Although there were no difl'erences in body mass between
disordemd eaters and comparisons, women with madamta eating
pathology had higher body mass index scores than both women with no
eating pathology and women with severe eating pathology, F(2,75)=3.51,
P<.04. In addition, women with severe eating pathology reported
significantly more depressive symptoms, F(2,70)=4.85, P<.01, and were
more likely to have been hospitalized for eating or emotional problems than
those with no or moderate pathology, x2(2, N=78)=5.95, p<.05.

W

E |E|° lll'll S]

A factor analysis of the Parent Eating Attitudes Scale was conducted,
using Sample 1 (N =272). First, I discarded very low fiequency items, i.e.,
items to which 90% or more of the sample responded "very false". This
resulted in discarding one item for the "mother" scale and four items for
the "father" scale. I then factor analyzed the scales using the remaining
items pertaining to eating and weight. Five factors were obtained for
perceptions of mother and six were obtained for perceptions of father (the
sixth was a single item); the solutions were very similar for mothers and
fathers, except that for fathers the third and fourth factors were reversed.
For perceptions of mothers' eating attitudes, 48% of the variance was
explained by the first three factors, and for perceptions of fathers, 53% of the
variance was explained by the first four factors. Because the three primary
factors were very similar for perceptions of mothers and fathers, I used the
"mother" solution as the standard in computing three scales, by averaging
scores for PEATS items with loadings greater than .45 on each of the

5 7
factors. Factor 1 described daughters' reports of parents' preoccupation

with their own (the parents') weight and eating, Factor 2 described
daughters' perceptions of parents' preoccupation with the daughter's
weight and eating, and Factor 3 described daughters' perceptions of
parents' use of food as a source of nurturance or reinforcement. These

three scales were then compuwd for Sample 2.

AutonmSealee
Separate factor analyses of the autonomy scales using a varimax

solution resulted in three somewhat difl'erent factors for autonomy fi-om
mothers and autonomy from fathersl. The factor solutions for autonomy
from mothers and fathers are shown in Tables 6 and 7, respectively (factor
loadings greater than .50 are in boldface). Taking relationships with
mothers first, it can be seen that the first two factors obtained were similar
to the predicted factors. The first factor included aspects of both the
predicted Mutuality and Anxieties about Separation factors. Scores for five
subscales loaded on this factor: conflictual dependence (positive), respect
for boundaries (negative), insecurity (positive), mutuality (negative), and
personal control (negative). This factor appears to describe Anxjatjaamht
Wan because it indicates negative afi'ect regarding separation, a
perceived lack of respect by the mother for the adolescent's independence
strivings, and a lack of control over negative emotions in the relationship
with mother.

The second factor describes Indiyidnatjan, and is very similar to the
predicted individuation factor. It consists of deidealization, autonomy,

1 One participant was not used in the analyses regarding relationship with
fathers because she was missing too many variables.

 

Table 6.

Qll' lfl Bll° l' 'IlMll
Anxiety about

Autonmfieale

Conflictual Dependence .90 .11 -.02
Respect for Boundaries -.88 «.12 -.06
Insecurity .87 .21 -.12
Mutuality -.78 -.12 -.37
Personal Control -.64 .23 .01
Decision-Making .15 .75 .29
Independence .10 .71 .28
Self-Assertion -.24 .71 -.40
Deidealization .35 .67 03
Autonomy -.22 .55 .50

Self-Other Responsibility .06 .17 .86

 

Autonomufieele
Respect for Boundaries

Conflictual Dependence
Insecurity
Mutuality

Autonomy

Self-Other Responsibility
Deidealization

Personal Control

Independence
Decision-Making
Self-Assertion

.81

-.78

Autonomy with
W Indenendmee

.25
.16
-.02
-.23

3832

-.03

.14

-.11
-.01
-.13
-.19

3'8

.14

.76
.71

6 0
independence, decision-making, and self-assertion, and most clearly

reflects a healthy form of autonomy. It describes self-governing behavior,
feelings of competence, and an ability to independently evaluate one's own
self-worth. In addition, it reflects a recognition on the adolescent's part of
her mother's fallibility. as opposed to continuing to hold to highly idealized
views of her, and a willingness to assert one's standards, even if they difi'er
from mother's.

The strongest variable loading on the third factor was self-other
responsibility; however, it is important to note that self-assertion as well as
autonomy also had sizeable loadings, with self-assertion in a nagatjya
direction. This factor appears to reflect a defensive type of autonomy that is
often associated with intrapsychic conflict. Although a high score on this
dimension suggests that the daughter has made investments and
attachments outside of the mother-daughter relationship and also
experiences a certain degree of behavioral autonomy from her mother, she
may be unable to assert herself in their relationship, be inhibited by feelings
of shame and guilt, and continue to need her mother's approval in order to
feel good about herself. Because of its associations with intrapsychic (but
not overt) conflict, this factor is labeled Diaangagamant. Factors were
computed by averaging scores for scales with loadings greater than .50 on
each of the factors.

The first factor obtained for relationship with fathers was similar to
that found for relationship with mothers. It included resmct for
boundaries, mutuality, conflictual dependence, and insecurity, and was
also labeled Anxiatiaaahautfiaaamfian. However, the second and third
factors were difi'erent from those regarding relationship with mothers. The
second factor consisted of autonomy, self-other responsibility,

6 l
deidealization, and personal control. Personal control had approximately

equivalent loadings on the first and second factors, but was included on the
second factor because its loading was slightly stronger. Notably, personal
control had a nagatjya loading on factor two, which deserves some
comment. The fact that high levels of autonomy (as defined on this factor)
are associated with low levels of personal control suggests that factor two
describes autonomy which is achieved in the context of a conflicted
relationship with father. It indicates self-governance, a recognition of
father's weaknesses and fallibilities, and an ability to distinguish between
one's own and one's father's needs. However, it also suggests a degree of
alienation from father, as it indicates a lack of emotional control, and an
inability to regulate one's negative feelings in the relationship with father;
therefore, it is labeled Aamnmithflyaztflanfliat. Although this factor
is similar in some ways to the Disengagement factor found for relationship
with mothers, the conflict with fathers is overt, rather than intrapsychic.

The third factor found for relationship with fathers consists of
independence, decision-making, and self-assertion. It describes behavioral
or functional independence and feelings of competence, and appears to best
reflect healthy autonomy in relation to fathers. This factor was labeled
Indaaandange. Again, factors were computed by averaging scores for
scales with loadings greater than .50, with the exception of personal
control, which had high loadings on both factors one and two (.54 and .56
respectively). It was only included on factor ‘two, in order to maintain the
independence of the factors.

6 2
BeneesienAnalxses

Multiple regression analyses assessed whether separation-
individuation dificulties and perceptions of parent eating preoccupation
would predict eating pathology and adjustment problems (poor self-concept
and depressive symptoms), and also whether separation-individuation
experiences would moderate the relationships between parent eating
preoccupation and disordered eating or problems in adjustment. Separate
analyses tested main and interaction effects for relationships with mothers
and relationships with fathers.

In order to reduce the number of variables in the analyses, I
combined the three parent eating preoccupation scales (parent's
preoccupation with own weight and eating, parent's preoccupation with
daughter's weight and eating, and use of food as nurturance) for mothers
and for fathers, creating global mother eating pmoccupation and father
eating preoccupation variables. Correlations among the eating
preoccupation scales for each parent were, for the most part, relatively high
(see Table 8), although fathers' use of food as nurturance was unrelated to
fathers' preoccupation with their own eating, and mothers' use of food as
nurturance was unrelated to mothers' preoccupation with their daughters'
eating. The pattern of results for the regression analyses were very shilar
whether the parent eating preoccupation variables were combined or
entered separately, although efi‘ect sizes were slightly weaker for the
combined scores.

I first regressed eating pathology (defined by EAT scores) on parent
eating pmoccupation and each of the autonomy variables (Anxieties about
Separation, Individuation, and Disengagement for relationships with

6 3
Table 8. WW

1 2 3 4 5 6
1 F. SelfPre. 1.00
2 F. Child Pre. sec 1.00
3 F. Food/Nurt. .08 .27a 100
4 M. Self Pre. .228 .25a .14 1.00
5 M. Child Pro. .12 .37c .10 29b 1.00
6 M. Food/Nurt. .13 .19 .43c .41c .08 1.00

‘ p<.05. b p<.01. ° p<.001.
F.=Father; M.=Mother; Self-Pre.=Preoccupation with own eating; Child
Pre.=Preoccupation with daughter's eating; Food/Nurt.=Using food as

nurturance.

6 4
mothers, and Anxieties about Separation, Independence, and Autonomy

with Overt Conflict for relationships with fathers); I then used a stepwise
procedure to test for possible interactions, which were computed as cross-
products, between parent eating preoccupation and each of the autonomy
factors. For the analyses predicting self-concept problems and depressive
symptoms, I first entered daughter's eating pathology, in order to partial
out the effect of disordered eating on adjustment problems; this was
because there were strong relationships between poor adjustment and
disordered eating. I then regressed each of the adjustment variables
(negative self-concept and depressive symptoms) on the autonomy variables
and parent eating preoccupation, and used a stepwise procedure to test the
interactions between parent eating preoccupation and each of the autonomy
factors.

Table 9 shows correlations among the variables in the analyses. As
can be seen, there were strong correlations among the measures of
individual pathology (eating pathology, self-concept problems, and
depressive symptoms), with r's from .40 to .67. There were also relatively
strong and significant correlations between each of the individual pathology
variables and a) perceptions of mothers' and fathers' eating preoccupation
(r's fi'om .33 to .46), as well as b) reports of anxiety about separation fi-Om
both mothers and fathers (r's from .23 to .56). In addition, perceptions of
mothers' eating preoccupation were associated with anxieties about
separation from mothers (r=.52, p<.001), and perceptions of fathers' eating
preoccupation were associated with anxieties about separation from fathers
(r=.43, p<.001). Although reports of individuation from mothers were
correlated with reports of disengagement in the relationship with mothers

65

38880 figOuOO ”mafiahufi uuofiozu.2
.sevs. 8.x... 8&-

88 e8. 8. 8. 8. 8. e8. e8. 8.. as. 8. senesaomrosg .m a
8.8 8.. 8. 8.. 8. 8. e8. c8. s8. s8. sonataomaccei .2 a

8.8 .8. s8. s3. 8. 8.. 8.. 8.- 8.- 003 aassess-e. .e o.
8.8 8. n8. 8.- 8.- 8.- 8. 8. ssoaomsmsoefi .2 m

8.8 one. 8.- 8.- 8. 8.- 8. concessions .m -

88 8.- 8.- 8.- 8.- 8.- essences—5 .2 m

8.8 8. .8. s8. 8. 888888 manna .m n
8.“ n8. 8. e8. carcasses-am manor .2 8.

SA o5. e3.- mafinfimm eczema-Eon m
84 one. mac—noun ammo—305$ N
8.” 833.com mouse 8

3 3 m m N. w w v m N A

3%

...u .n . ._..,n a...“ u....v ....u 4..n...u .....uu..cn-vt. .
...¢ . r.... I... .c . B .. .c . GO~£¢B

6 6
(r=.31, p<.01), and reports of autonomy with overt conflict in relationships

with fathers were correlated with reports of independence fi'orn fathers
(p.45, p<.001), none of these measures of autonomy were associated with
measures of individual pathology, parents' eating preoccupation, or
anxieties about separation.

Beta coemcients derived from the regression analyses for
relationships with mothers are shown in Table 10. As can be seen,
adolescents' perceptions of mothers' eating preoccupation was the
strongest predictor of daughters' eating pathology, accounting for 25% of
the variance. Contrary to predictions, separation-individuation dimculties
in the relationship with mother were nat significantly associated with
disordered eating. However, one autonomy variable, disengagement, did
moderate the relationship between mothers' eating preoccupation and
eating pathology (See Figure 1). That is, among adolescents reporting high
levels of disengagement in the relationship with their mothers, perceptions
of mothers' weight and eating preoccupations were more strongly related to
daughter's eating pathology than among adolescents reporting low levels of
disengagement.

In contrast to the results for eating pathology, separation-
individuation difliculties in the relationship with mothers predicted
emotional maladjustment. In particular, adolescents' reports of anxieties
about separation from mothers and lack of individuation from mothers
accounted for an additional 27% of the variance in self-concept problems,
after controlling for daughter's eating pathology. Similarly, adolescents'
anxieties about separation and low levels of disengagement in the

 

EATING PATHOLOGY r h 112

Stan].

Eating Preocc- .46° .48c 25" .
Shana

Eating Preocc- x Disengagement .24a .06‘l
SELF-CONCEPT PROBLEMS

Steel

Eating Pathology .43° .43° .18°
Steal

Anxieties about Separation .56c .51° .27c
Individuation -.17 -.24b
DEPRESSIVE SYMPTOMS

Steel

Eating Pathology .40c .40c .16c
$29.2

Anxieties about Separation .52c .55c .25c
Disengagement -.12 -.23‘1

a p<.05. b p<.01- c p<.001.

Eating Pathology

 

Disengagement

 

 

  
  

High Disangagnent

  
 

R

Low Disengagement

 

l I 1
-1.000 0.000 1.000
Mother Eating Preoccupation

 

6 9
relationship with mothers accounted for 25% of the variance in predicting

depressive symptoms. As expecwd, none of the interactions between
separation-individuation difliculties and mothers' eating preoccupation
were significant.

Results regarding relationships with fathers were somewhat
different than those found for mothers. Beta coefiicients fi'om the analyses
for relationships with fathers are shown in Table 11. Like the results for
relationships with mothers, adolescents' perceptions of fathers' eating
preoccupation was a direct predictor of adolescents' eating problems.
However, unlike the results for mothers, both reports of anxieties about
separation from fathers and low levels of autonomy with overt conflict in
the relationship with fathers also accounted for significant variance in
adolescents' eating pathology, with the three variables together accounting
for 28% of the variance. None of the interactions between separation-
individuation and father eating preoccupation were significant.

With regard to adjustment, the results were essentially the same for
poor self-concept and depressive symptoms. As predicted, after controlling
for the effects of daughter's eating pathology, anxieties about separation
fi'om fathers accounted for significant additional variance in adjustment
problems (14% for self-concept problems and 13% for depressive symptoms).
However, the interaction between autonomy with overt conflict and father
eating preoccupation was also significant for both measures of adjustment
problems (see Figures 2 and 3). That is, among adolescents describing high
levels of autonomy with overt conflict in their relationships with their
fathers, degree of self-concept problems or depressive symptoms was

increased when daughters reported that their fathers were highly

Table 11. ’

EATING PATHOLOGY I
Steal

Eating Preoccupation .43c
Aut. w/OC -.12
Anxieties about Separation .36c
SELF-CONCEPT PROBLEMS
Stanl-

Eating Pathology .43°
8139.2

Anxieties about Separation .44"
Stauii

Eating Preocc- by Ant. w/OC

DEPRESSIVE SYMPTOMS

Steel
Eating Pathology .40c

Steuz
Anxieties about Separation .46c

Slant-i
Eating Preocc- by Aut. w/OC

' p<.05. b p<.01- ° p<.001.
Aut. w/OC=Autonomy with Overt Conflict.

.43c

.40c

.36b

 

.18°

.14b

.059

.16c

.13a

Self-Concept Problems

Depressive Symptoms

 

Autonomy w/ Overt Conflict

 

 

   
 

 

 

 

1.0

0.8 '4

0.6 -

0 4: High Autonomy w/OC

° - X

0.2 r

0.0 4 fl
.02 q Lo A tonom IOC
-0.4 -' w u y w
-0.6 -
-0.8 -:
-l.0 1 v r v I

-1.000 0.000 1.000
Father Eating Preoccupation

 

Autonomy w/ Overt Conflict

 

1.0
0.8 -
0.6 4
0.4 1

0.2-:-

0.0 -
-0.2 -
-0.4 -
-0.6 -
-0.8 7-

 

High Autonomy w/OC

Low Autonomy w/OC

 

-1.0

I I I
-1.000 0.000 1.000
Father Eating Preoccupation

 

 

7 2
preoccupied with eating and weight. On the other hand, among

adolescents describing law levels of autonomy with overt conflict in their
relationships with their fathers, there was little to no relationship between
daughters' adjustment problems and reports of fathers' eating

preoccupation.

Discussion

Overall, these results strongly demonstrate the importance of
separation-individuation processes and parent eating preoccupation in the
development of eating pathology in late adolescent women. Interestingly,
the results regarding relationships with mothers versus fathers were quite
different, and they indicated that, despite the fact that fathers have
frequently been overlooked in the eating disorders literature as well as the
literature on adolescent female autonomy development, hath parents have a
substantial impact on daughters' adjustment.

A factor analysis of a variety of asmcts of autonomy resulted in quite
different factors for relationships with mothers versus fathers, suggesting
that daughters may become increasingly autonomous from their parents in
unique ways. First, in relation to both mothers and fathers, an "anxieties
about separation" factor was obtained. The affective experience regarding
separating from parents appears to be a salient component of the
separation-individuation process, and negative feelings about the process
have consistently been found to have negative implications for late
adolescent adjustment (Holmbeck & Wandrei, 1993; Kenny & Donaldson,
1991; Rice et al., 1990). In this study, anxiety about separation was defined
by feelings of insecurity, guilt, shame, and resentment related to
separating from parents, as well as an inability to control these negative
feelings. It also described a perceived lack of mutuality in the relationship
with the parent, including feeling that the parent does not respect the late

73

7 4
adolescent's status as an adult, or her need to become independent and

make her own decisions.

What appeared to be a "healthy autonomy" factor was also obtained
in relation to both parents. However, this factor was somewhat difl'erent for
mothers and fathers, and they were therefore given difl'erent labels
(Individuation and Independence, respectively). The decision making,
independence, and self-assertion scales loaded on both healthy autonomy
factors, indicating that the ability to make one's own decisions, to cope with
life dimculties, and to rely on one's own standards of behavior are
important in becoming independent from mothers and fathers. However,
deidealization and autonomy, often referred to as aspects of "individuation"
in the psychoanalytic literature, also loaded with these scales on the factor
for relationships with mothers. This indicates that, in addition to being
behaviorally independent fiiom mothers, late adolescent women scoring
high on "individuation" were able to see their mothers as fallible and had
given up childish notions of her omnipotence.

For relationships with fathers, deidealization and autonomy loaded
on a third factor along with self-other responsibility and low personal
control. .This suggests that there is an element of conflict and negativity
involved in deidealizing and separating fi'om fathers. Adolescents scoring
high on this variable (autonomy with overt conflict) were able to see their
fathers' weaknesses, distinguish between their own needs and their
fathers' needs, and develop new investments outside of this relationship.
However, they also experienwd overt conflict in the relationship, and had
dificulty controlling their negative feelings regarding fathers. Without
longitudinal data, it is impossible to know if daughters begin to deidealize
and separate fi'om fathers W the conflict in their relationship, or

7 5
whether separating from fathers and relinquishing idealized notions of

them leads to overt conflict.

Women who received high scores on the third factor obtained for
relationships with mothers, disengagement, appeared to have defensively
developed a level of behavioral autonomy and separateness, in order to
compensate for an inability to assert themselves in the mother-daughter
relationship. Unlike the third factor obtained with regard to fathers, the
conflict that appears to exist in the mother-daughter relationship is
intrapsychic rather than overt. In order to gain a better understanding of
this construct, it is helpful to look at self-other responsibility, the variable
with the strongest loading on this factor, more closely. Self-other
responsibility appears to be a more dimcult aspect of autonomy to attain in
the mother-daughter relationship, for late adolescent women. Late
adolescents in this sample averaged a lower score on this variable than on
any of the other interview variables, and it was the only interview variable
on which they scored significantly lower than they did within the father-
daughter relationship. On average, these women fell at level 2, which is
defined by clear overinvolvement by the parent in the child's life. At this
level, late adolescents may make weak, inefi'ective attempts to deinvest in
the parent-chfld relationship, or may resist pressures to deinvest in it. This
suggests that lack of separateness in the mother-daughter relationship is
relatively normative among late adolescents, at least in this sample of
college women. This finding is not altogether unexpected, as others have
found that relationships between mothers and adolescent or young adult
daughters are characterized by less distinct boundaries and higher levels of
emotional intensity than other parent-child dyads (Chodorow, 1978; Frank,
et al., 1988). However, this makes it important to identify the correlates and

7 6
issues involved for women who experience high levels of self-other

responsibility.

The major thrust of this research was to explore factors which place
late adolescent females at risk for developing disordered eating, and to
distinguish between factors which lead to eating disorders versus other
problems of adjustment. First, it is important to point out that women with
eating pathology described more individual dysfunction than women who
did not exhibit dismd eating patterns. As would be expected, disordered
eaters reported earlier histories of concern over weight (i.e., they began
dieting earlier and more frequently), and they repomd more severely
maladaptive eating patterns, including binging and purging. Although
some women in the comparison group repomd binge eating, disordered
eaters experienced their binge eating as more troublesome and out of
control. In addition to differences in eating behavior, the disordered eaters
also had more negative self-concepts and reported more depressive
symptoms than women without eating problems. Moreover, severity of
eating pathology was related to the severity of depression.

The correlational data revealed, like a number of other studies of
college student populations, that anxieties about separation from parents
were strongly correlated with measures of individual dysfunction,
including eating pathology, poor self-concept, and depressive symptoms.
In addition, daughters' perceptions of parent eating preoccupation were
associated with each of the individual pathology variables, and perceptions
of parent eating preoccupation were strongly associated with anxieties
about separation in relation to mothers and fathers. It is conceivable that
when parents are preoccupied with their own and their daughter's eating
and weight, the daughter perceives her parents as being critical of both

7 7
themselves and of her, leading to feelings of insecurity, anger and

resentment. The following excerpt from an interview of a woman in the
disordered eating group exemplifies this concept. Madison states: "She'll
make a suggestion and she doesn't think she's doing anything - but it
hurts. When your mom's always saying something like 'Shouldn't you lose
a few pounds? Don't you want to get down a pants size?‘ Finally I'm like
'Mom, quit telling me! I know I'm fatl' And in retaliation to that I get mad
at her. And then my fiiends come over and say 'You're so mean to your
Mom' and I feel terrible."

Another possible explanation for the relationship between
perceptions of parent eating preoccupation, anxieties about separation, and
individual pathology goes back to the discussion of early separation-
individuation processes. It is easy to imagine that parents who are caught
up in issues surrounding eating and food will be unable to respond
appropriately to their infant's cues regarding hunger and feeding, causing
disruptions for the child in the development of trust, interoceptive
awareness, and separateness. These characteristics, in turn, may lead to
anxieties about separation and eating pathology. In addition, if parents'
preoccupations with food and weight are attributable to their own struggles
with interoceptive confusion and insecurity, they are likely to transmit
these messages across generations through their responses to their
children.

The regression analyses ofi'ered rich, and somewhat unexpected,
findings. For example, the notion that parent eating preoccupation would
be a significant factor in the development of disordered eating in late
adolescents was strongly supported by these data. However, it turned out
that perceptions of parent eating preoccupation were far more important

7 8
than was expected. Although it was predicted that perceptions of parent

eating preoccupation would have relevance for disordered eating only in the
context of problems with separation-individuation, perceptions of both
mother's and father's eating preoccupation were actually dim predictors
of daughter's eating pathology. The results regarding perceptions of
fathers' eating preoccupation are especially noteworthy, as fathers have
typically been neglected in explorations of influences on daughters' body
image and eating pathology.

Contrary to predictions, parent eating preoccupation superseded the
role of separation-individuation problems in eating pathology, in the
relationship with mothers. That is, although perceptions of mothers'
eating preoccupation had a direct efl‘ect on daughters' eating pathology,
none of the autonomy constructs were significant predictors of disordemd
eating. However, there was a significant interaction, in the opposite
direction of that expected, between mothers' eating preoccupation and
disengagement in predicting eating pathology. In particular, among late
adolescents reporting high levels of disengagement fi-om mothers,
perceptions of mothers' weight and eating preoccupation were more
strongly. related to daughters' eating pathology than among late adolescents
reporting low levels of disengagement. It appears that the defensive aspect
involved in disengagement fi'om mothers may be responsible for the
increased association between perceptions of mothers' eating preoccupation
and daughters' disordemd eating. In addition, the intrapsychic conflict
that was associated with disengagement may help to explain this
relationship. When daughters have defensively adopted a level of
separateness fium their mothers, but are not able to assert themselves in
the relationship and need their mothers' approval to feel good about

7 9
themselves, they are more likely to be susceptible to mothers' pressures and

criticisms surrounding weight.

It was predicted that autonomy problems would moderate the
relationship between perceptions of parent eating preoccupation and
daughter's eating pathology, but not between perceptions of parent eating
preoccupation and adjustment problems. In relation to mothers,
perceptions of parent eating preoccupation did not directly predict
adjustment problems (either negative self-concept or depressive symptoms),
nor was the relationship between mother eating preoccupation and
adjustment moderated by autonomy problems. This suggests that mother's
preoccupation with her own and her daughter's weight and eating was a
specific risk factor for eating pathology.

Somewhat surprisingly, problems with autonomy in relation to
mothers were more likely to lead to general adjustment problems than to
disordered eating. Unlike the results for eating pathology, anxieties about
separation fi'om mothers predicted both negative self-concept and
depressive symptoms. In addition, lack of individuation from mothers led
to problems with self-concept, and low levels of disengagement were
predictive of depressive symptoms. These findings suggest that
disengagement is somewhat of a "double-edged sword". Although high
levels of disengagement increased risk for eating pathology when mothers
were perceived as being preoccupied with their own and their daughters'
weight and eating, low levels were associated with increased depression.
Again, it is plausible that the defensive component of disengagment
increased daughters' vulnerability to mothers' weight preoccupation, while
the lack of difi'erentiation fi'om mother and inability to develop a life
separate fi'om her led to depression.

8 0
Taken together, these results provide evidence that late adolescent

women who are overly dependent on their mothers (as defined by each of
the aspects of autonomy measured here) are more likely to have problems
in adjustment than women who are more autonomous from their mothers.
These findings run counter to contentions (e.g. Ryan 8: Lynch, 1989) that
individuation reflects detachment and alienation, and is associamd with
negative outcomes for adolescents. It is particularly noteworthy that
separation-individuation problems in the relationship with mother led to
general maladjustment, rather than to eating disorders.

The findings were quite difi‘erent for relationships with fathers.
Again, perceptions of parent eating preoccupation was a dimct predictor of
daughters' eating pathology. However, unlike results for mothers,
anxieties about separation and inabith to disengage fi'orn fathers (along
with low levels of conflict) made independent contributions to eating
pathology, suggesting that separation-individuation problems with fathers
are more relevant for disturbed eating than with mothers. Looking next at
adjustment problems, after controlling for eating pathology, anxieties about
separation also predicted both poor self-concept and depressive symptoms.
Independence (which appeared to describe "healthy" autonomy) was not
related to either eating pathology or adjustment problems. This raises the
question of whether functional or behavioral autonomy is, in fact, a
"healthy" type of autonomy. However, this type of autonomy has been found
to correlate with ather measures of adjustment, including more mature
identity statuses and success in intimate relationships (Frank et al., 1990).

Although none of the interactions between experiences of autonomy
and perceptions of father eating preoccupation were significant in
predicting eating pathology, a significant interaction was found between

8 l
perceptions of father eating preoccupation and autonomy with overt conflict

in predicting adjustment problems. That is, there was a stronger
association between perceptions of father's eating preoccupation and
daughter's self-concept problems or depressive symptoms, among late
adolescents who experienced high levels of separateness and conflict in the
relationship with father.

Like disengagement fi-om mothers, autonomy with overt conflict in
the father-daughter relationship appears to have both pros and cons.
However, the direction of the efi'ect is the exact appaeite for fathers, and it is
not altogether clear why this is the case. The results suggest that in the
relationship with fathers, autonomy with overt conflict has a bufl'ering
efi'ect for eating pathology; that is, women who experience high levels of
separateness, even at the expense of a conflicted relationship with father,
are less likely to have eating problems than those who experience low levels
of separateness. However, this same type of autonomy appears to lead to
problems in self-concept and depression, when fathers are perceived as
being preoccupied with their own and their daughter's weight. It is
conjectured that the daughter's perception of her father as being critical of
her my be the most relevant component of father eating preoccupation in
explaining the link between adjustment problems and perceptions of father
eating preoccupation. In particular, daufllters experiencing high levels of
separateness and conflict in the father-daughter relationship are more
vulnerable to poor selfoconcept or depression when they perceive their
fathers as being critical of them than daughters who experience low levels
of separateness and conflict. There is some sense that late adolescents who
score high on the autonomy with overt conflict variable are "battling it out"
with their fathers, rather than succombing to a lack of separateness or

8 2
differentiation. This may protect them fi'om an eating disorder, but the

high levels of separation and conflict may lead to feelings of depression or
low self-esteem.

In sum, anxieties about separation with regard to both mothers and
fathers most consistently predicted dificulty for daughters. However, it is
important to note that low scores on autonomy, regardless of how it was
defined (with the exception of "independence" in relationships with
fathers), were associated with some type of problem for daughters, whether
it was disordered eating, problems with self-concept, or depressive
symptoms. In the relationship with fathers, the risks of lack of
separateness (along with lack of conflict) appeared to be specific to eating
pathology, while anxiety about separation was predictive of both eating and
adjustment problems. In the relationship with mothers, separation-
individuation dificulties were predictive of general adjustment problems,
rather than disordered eating.

Most researchers who have considered parent attitudes about eating
and weight as influential in the development of daughters' eating pathology
have suggested that this variable would have an efi'ect only in the context of
significant family problems (Johnson & Flach, 1985; Pike & Rodin, 1991;
Strober & Humphrey, 1987). In the current study, however, perceptions of
parent eating preoccupation made an independent contribution to
disordered eating, indicating that parents' attitudes about their own and
their daughter's eating may be more important than was previously
thought. In addition, neither perceptions of mother nor father eating
preoccupation had an effect on adjustment problems, suggesting that it
may be a specific risk factor for disordered eating. However, the significant
interactions found between perceptions of father eating preoccupation and

8 3
autonomy in relation to fathers in predicting adjustment problems,

suggests a somewhat more complex relationship. Although the
physiological aspects of eating disorders were not the focus of this research,
it is important to acknowledge the potential impact of biological and genetic
factors. Particularly in attempting to understand the relationship between
parents' eating preoccupation and daughter's eating pathology, it is
essential to recognize the interaction between physiological and
psychological factors.

An intriguing and significant result of this research is the impact of
fathers on the development of disordered eating in late adolescent women,
both with regard to fathers' attitudes towards eating and weight, and in the
level of autonomy daughters experience in their relationships with their
fathers. The findings regarding autonomy were consistent with
Minuchin's family systems theory, in that the dificulty for daughters with
eating pathology appears to lie in a lack of separation and an inability to
disengage fi-om fathers. This research did not support Maine's (1991)
contentions that the problem for eating disordered girls is that their fathers
are uninvolved and unavailable to them. Separation-individuation
dificulties in relation to fathers appear to be even more pathognomic for
eating disorders than similar dificulties with mothers, which seem to be
more predictive of general adjustment problems. In light of this, the fact
that daughters were somewhat more autonomous fi'om fathers than -
mothers in certain areas lends support to the notion that fathers are
instrumental in helping daughters separate from mothers. It appeared to
be somewhat normative for late adolescent daughters to experience a lack of
separateness from their mothers; however, when daughters were unable to
difi'erentiate from their fathers, they appeared to be at particular risk for

8 4
developing disordemd eating. This suggests that fathers may play a key

role in helping daughters to gain a sense of personal autonomy and self-

governance.

MI] I] . IC .1 |°
It is important to keep in mind the characteristics of this sample in
interpreting these results. First, this is a predominantly Caucasian group
of women fi'om intact families, who are from middle to upper middle class
backgrounds, which limits the generalizability of the findings to other
populations. In particular, the findings regarding relationships with
fathers might be very difi'erent for women fi'om divorced families. In
addition, although some women had severe levels of eating pathology, and
had mceived treatment or even been hospitalized for their eating disorders,
many others had more mild forms of disordered eating. These women
were all enrolled in college, indicating that their eating disturbance was
not so severe as to interfere significantly with daily functioning. This may
partly account for the strong efi'ect of perceptions of parent eating
preoccupation on eating pathology. Perhaps in a sample of women with
more severe eating disorders, separation-individuation problems would be
the primary contributor, and perceptions of parent eating preoccupation
would play a lesser, or moderating, role in the development of eating
pathology. Nevertheless, these findings have major implications for
understanding the potential effects of parent attitudes on the development of
disordered eating. Moreover, they speak to the utility of the Parent Eating
Attitudes Scale with eating disordemd populations. Of course, the measure
awaits further validation and replication of the results with larger
samples. In addition, it will be important in future research to have

8 5
parents complete the questionnaire, in order to determine whether

daughters' perceptions of parents' eating preoccupation are similar to
parents' own perceptions of their eating preoccupation.

More generally, the inherent problems of using self-report
measures are acknowledged. However, regarding autonomy, the interview
measure provides some additional validation of the questionnaire
measures, in that adolescents' perceptions of their experiences within the
family are reflected in reported behavior. On the interview, the respondent
must provide evidence for her perceptions of her independence. Unlike on
questionnaire measures, stating ”I am very independent from my mother"
does not guarantee a high score; scores are based on the coders' clinical
judgments regarding autonomy versus dependence and require examples
or "proof'. Nevertheless, a combination of observational and self-report
measures (assessing both the adolescents' and parents' perceptions) would
clearly provide a more complete test of the hypotheses.

Finally, longitudinal data would be helpful in gaining a better
understanding of how daughters actually progress through the separation-
individuation process, and become autonomous from each of their parents.
For example, it is unclear if the negative feelings involved in some types of
autonomy (i.e. autonomy with overt conflict from fathers and
disengagement fi-om mothers) are a result or by-product of gaining
independence fiom parents, or whether the negative feelings allow
separation to take place. An additional issue that must be addressed in
longitudinal research, in order to better understand the implications of
various factors for nonclinical versus clinical levels of eating disturbance,
is whether in fact there is a continuum of disordered eating, such that less
severe eating problems can become full-blown eating disorders, and what

8 6
factors account for the progression to more severe levels of eating pathology.

However, despite these caveats, this research provides compelling evidence
that parents' preoccupation with their own and their daughter's eating and
weight, as well as dificulties in the separation-individuation process (at

least with regard to fathers) have major implications for eating disturbance

in late adolescent women.

APPENDICES

APPENDDI A

8 7
APPENDIX A

INFORMED CONSENT
HEALTH A'I'I‘ITUDES AND FAMILY ENVIRONMENT
(PHASE I)

1. Iunderstand thatthis studyispartofalargerprojectexamining
development and behaviors during late adolescence and early adulthood,
including patterns of alcohol use, eating habits, and different aspects of
one's family environment.

2. My participation in this study will involve approximately one hour. I
will attend one session at which time I will be asked to complete a series of
questionnaires. At the end of my participation, I will be more fully
debriefed about the purpose of this study. In exchange for my participation,
I will receive 2 research credits.

3. . Additionally, I have been told that I will be asked to disclose fairly
personal information, for example, information about my own and my
parents' alcohol use and health behaviors and attitudes. However, I also
understand that I will at no time be asked to reveal my name and that my
research records will be identified by code number only in order to protect
my confidentiality and anonymity.

4. I understand that my participation is completely voluntary and I may
withdraw fiom the study at any time. I also know that I have the right not
to answer any item on any questionnaire that I do not wish to answer.
However, I have been informed that all of my answers are valuable to this
study and that my decision to omit various items may make it dificult or
impossible to use the information I do provide.

5. I understand that I will not mceive feedback on my individual
responses but that I can obtain group results of this study, when they are
available, upon request.

6. If I have any questions or concerns arising from my participation in
this study, I know that I am encouraged to contact Dr. Susan Frank at 355-
9561 in the Department of Psychology to discuss these concerns.

INFORMED CONSENT
HEALTH A'I'I‘ITUDES AND FAMILY ENVIRONMENT
(PHASE II)

1. I understand that I was chosen based on a number of my
questionnaire responses fiom a larger number of volunteers who also
participated in the first phase of this research.

2. I understand that the purpose of this phase of the study is to gain a
more indepth understanding of adolescents' and young adults' feelings
about their parents and to examine possible differences in feelings about
mothers versus fathers. I also understand that this information will be
relawd to other information on my personal adjustment and health
attitudes and behaviors that I reported in the first phase of this study.

3. My participation in this study will involve completing, at my
convenience, a packet of questionnaires that takes approximately one and
one-half hours to complete. In addition, I will complete an interview that
will take approximately three hours. I have been told that these
questionnaires and this interview session ask for information about my
perceptions of and my relationship with one or both of my parents, my
perception of my relationships with my peers, my feelings about intimate
relationships, my health history, and my behaviors and my views of myself
in a variety of different life areas. At the end of my participation, I will be
more fully debriefed about the purpose of this study. In exchange for my
participation, I will receive 8 research credits (in addition to the credit I
received from Phase D.

4. I understand that the investigators will contact me using the code
name I provided during the first phase of this study. I also understand that
my real name will not be associated with my responses and that my
responses to both the questionnaires and interview will be identified by code
number only.

5. My participation is completely voluntary and I may withdraw from the
study at any time. However, I will only receive credit for this stage of the
study if I complete all questionnaires and the interview. I also know that I
have the right not to answer any question on the questionnaires or during
the interview that I do not wish to answer. I understand, however, that all
of my answers are valuable to this study and that my decision to omit
particular items may make it dificult or impossible to use the information
I do provide.

6. I understand that I will not receive feedback on my individual
responses but that I can obtain group results of this study, when they are
available, upon request.

89

7. If I have any questions or concerns arising fi-om my participation in
this study, I know that I am encouraged to contact Dr. Susan Frank at 355-
9561 in the Department of Psychology to discuss these concerns.

APPENDIX B

90
APPENDIX B

RECONTACT FORM

I wish to be considered for participation in Phase II of this research study
on health attitudes and family environment. When you contact me, please
ask for the code name indicated below. I understand that I may not be
contacted, but if I am, I may decide at that time not to participate without
any penalty. I am aware that in exchange for my participation in Phase II
I will receive additional research credits beyond those I received for
participating in Phase I. I have read the informed consent agreement for
Phase II and understand its content.

The name I wish to be identified by is

 

The code number from my questionnaire packet in Phase I is

My daytime phone number is

 

In the evenings I can be reached at

 

Please let your roommates know that we may be calling and asking for
someone with your code name.

APPENDIX C

9 1
APPENDIX C

PERSONAL BACKGROUND QUESTIONNAIRE

 

 

 

 

D I . I E |° .

1) What is your sex? male female

2) Class: Freshman Sophmore _ Junior
Senior 5th Year Senior

 

 

3) What is your age?

4) What is your major?

 

5). What are your future career plans?

 

6) What is your GPA?
7) What was your high school GPA?
8) Are you: Black: _ White: Hispanic:

 

 

Asian: Native American: Other:

 

9) What is your religion?

Protestant (please specify denomination)

 

Roman Catholic Greek Orthodox Jewish
None Other (please specify)

 

 

 

 

10) Are you currently married? yes no

11) Were you ever married? yes no

 

 

12) How many children do you have? none one
two three more than three _
13) Were you adopted? yes no

 

 

 

 

 

9 2
14) Are your biological (or adoptive) parents:

a) married to each other? yes no

b) separated from each other? yes no

 

 

 

 

If yes, how old were you?
What was the month and year they separated? month—
year

c) divorced from each other? yes no

 

 

 

 

If yes, how old were you?
What was the month and year they divorced? month__
year

 

15a) What is your father's occupation? (Be as specific as possible; e.g. what
sort of responsibilities are included with his job?)

 

15b) What was your father's highest level of education?

a) less than high school d) 4 year college deme
b) high school degree 9) Masters degree
c) some college i) Ph.D., J.D., M.D., D.D.S., etc.

16a) What is your mother's occupation? (Be as specific as possible; e.g.
what sort of responsibilities are included with her job?)

 

1%) What was your mother's highest level of education?

a) less than high school (I) 4 year college deme
b) high school degree e) Masters degree
c) some college 0 Ph.D., J .D., M.D., D.D.S., etc

17) If your mother works, has she worked full time (35 hours per week)
since you entered elementary school?

 

 

yes no (if yes, skip to # 18)

My mother worked part time when I was between the ages of
1) __ and __ years old

2) __ and __ years old

3) _ and _ years old

9 3
My mother worked full time when I was between the ages of

 

1) and _ years old
2) __ and __ years old
3) _ and __ years old

18) List your siblings (including step—siblings):

PPS99PP°E°H

5.5.55

14.

L 421 W

 

 

19a) Do you live at home during summers and vacations?

yes no

 

 

19b) Do you live at home during the school year?

 

 

yes no (if yes, skip to #21)

20) What is the average number of phone contacts you have with your
parents each month?

With biological (or adoptive) mother:
With biological (or adoptive) father:

94

What 1: the average number of visits you have with your parents each
month.

With biological (or adoptive) mother: __

With biological (or adoptive) father:

 

21) How many miles away fi-om MSU do your parents live?

years old.

22) My father is years old. My mother is

 

 

23) If there are any additional situations in your family which are
pertinent, please explain them here (and on the back of this sheet):

APPENDDC D

9 5
APPENDIX D

PARENT EATING ATI‘ITUDES SCALE - FATHER

The following questions refer to your father's attitudes about health and
eating while you were growing up. For each of the statements please
indicate whether they are very true (4), somewhat true (3), somewhat false
(2), or very false (1). Circle the number which corresponds to the answer
which is most correct for you.

When I was growing up... Very Somewhat Somewhat Very
True True False False

1. My father thought it was very 4 3 2 1
important for me to be thin.

2. My father nagged me to lose weight. 4 3 2 1

3. My father exercised vigorously 4 3 2 1

' to stay thin.

4. My father greatly discouraged 4 3 2 1
me from drinking alcohol.

5. My father was hurt if I did not 4 3 2 1
like the food that he made.

6. My father rewarded me with food. 4 3 2 1

7. My father put the food on my plate 4 3 2 1
at meals; I did not serve myself.

8. My father thinks fat people are 4 3 2 1
disgusting.

9. My father often drank too much. 4 3 2 1

10. My father took diet pills. 4 3 2 1

11. My father was always worried about 4 3 2 1
gaining weight or being too fat.

12. My father thought it was very 4 3 2 1
important for me to be attractive.

13. My father felt that it was okay if I 4 3 2 I
drank alcohol.

14. My father dieted constantly. 4 3 2 1

15.

16.

17.

31.

96

When I was upset, my father gave
me food to comfort me.

My father sln'pped meals to lose
weight.

My father got upset if I used
marijuana.

My father was considerably
underweight.

My father was very overweight.

My father got upset when I drank
too much.

. My father sometimes ate too much

and then threw up.

My father put me on diets to control
my weight.

My father was a problem drinker.

My father criticized me for being
overweight.

My father often complained about
my mother's weight.

My father was always gaining
and losing weight.

I often felt that my father was
watching everything that I ate.

My father felt that it was okay if I
used marijuana.

My father smoked cigarettes.

My father tried out a number of
fad diets.

Dieting was one of my father's
favorite topics of conversation.

97

32. My father sometimes used drugs
to cheer him up.

9 8
PARENT EATING ATTITUDES SCALE - MOTHER

The following questions refer to your mother's attitudes about health and
eating while you were growing up. For each of the statements please
indicate whether they are very true (4), somewhat true (3), somewhat false
(2), or very false (1). (fircle the number which corresponds to the answer
which is most correct for you.

When I was growing up... Very Somewhat Somewhat Very
. True True False False
1. My mother thought it was very 4 3 2 1
important for me to be thin.
2. My mother nagged me to lose weight. 4 3 2 1
3. My mother exercised vigorously 4 3 2 1
to stay thin.
4. My mother greatly discouraged 4 3 2 1
. me from drinking alcohol.
5. My mother was hurt if I did not 4 3 2 1
like the food that she made.
6. My mother rewarded me with food. 4 3 2 1
7. My mother put the food on my plate 4 3 2 1
at meals; I did not serve myself.
8. My mother thinks fat people are 4 3 2 1
disgusting.
9. My mother often drank too much. 4 3 2 1
10. My‘mother took diet pills. 4 3 2 1
11. My mother was always worried about 4 3 2 1
gaining weight or being too fat.
12. My mother thought it was very 4 3 2 1
important for me to be attractive.
13. My mother felt that it was okay if I 4 3 2 1
drank alcohol.
14. My mother dieted constantly. 4 3 2 1
15. When I was upset, my mother gave 4 3 2 1

me food to comfort me.

16.

17.

18.

£8

31.

99

My mother skipped meals to lose
weight.

My mother got upset if I used
marijuana.

My mother was considerably
underweight.

My mother was very overweight.

My mother got upset when I drank
too much.

. My mother sometimes ate too much

and then threw up.

My mother put me on diets to control
my weight.

My mother was a problem drinker.

My mother criticized me for being
overweight.

My mother often complained about
my father's weight.

My mother was always gaining
and losing weight.

I often felt that my mother was
watching everything that I ate.

My mother felt that it was okay if I
used marijuana.

My mother smoked cigarettes.

My mother tried out a number of
fad diets.

Dieting was one of my mother's
favorite topics of conversation.

My mother sometimes used drugs
to cheer her up.

APPENDIX E

l 0 0
APPENDIX E

EATING A'I'I‘ITUDES TEST
On the line beside each item, please write the number which applies best to
each of the numbemd statements. All of the results will be strictly
confidential. Most of the questions directly relate to food or eating, although
other types of questions have Men included. Please answer each question
carefully. Thank you.

2 3 4 5 6
Very Often Often Sometimes Rarely Never

Like eating with other people

Prepare foods for others, but do not eat what I cook
Become anxious prior to eating

Am terrified about being overweight

Avoid eating when I am hungry

Find myself preoccupied with food

$999.99.”?

Have gone on eating hinges where I feel that I may not be able
to stop

9"

Cut my food into small pieces
9. Am aware of the calorie content of foods that I eat

10. Particularly avoid foods with a high carbohydrate content (e. g.
bread, potatoes, rice, etc)

11. Feel bloated after meals

12. Feel that others would prefer if I ate more
13. Vomit after I have eaten

14. Feel extremely guilty after eating

15. Am preoccupied with a desire to be thinner

16. Exercise strenuously to burn 03 calories

HH/l/ HI Illllllg.

17. Weigh myself several times a day

III/II/IIIIIII I I I l I I I II

18.
19.
20.
21.
22.
23.

25.
26.
27.
28.
29.
30.
31.
32.
33.
. Give too much time and thought to food
35.
36.
37.
38.
39.
40.

101

Like my clothes to fit tightly

Enjoy eating meat

Wake up early in the morning

Eat the same foods day after day

Think about burning up calories when I exercise.
Have regular menstrual periods

Other people think that I am too thin

Am preoccupied with the thought of having fat on my body
Take longer than others to eat my meal

Enjoy eating at restaurants

Take laxatives

Avoid foods with sugar in them

Eat diet foods

Feel that food controls my life

Display self control around food

Feel that others pressure me to eat

Suffer from constipation

Feel uncomfortable after eating sweets
Engage in dieting behavior

Like my stomach to be empty

Enjoy trying new rich foods

Have the impulse to vomit after meals

APPENDIX F

1 0 2
APPENDIX F

EMOTIONAL AUTONOMY SCALE - FATHER

Please read the following statements and decide if you strongly disagree,
disagree, agree, or strongly agree. Circle the appropriate number.

1 =Stlvnslydisagree

2=Drsagree

3 =Agree

4=Suvnslyasree
Strongly Disagree Acme Strongly
Drsagree Agree

1. My father and I agree on everything. 1 2 3 4
2. I go to my father for help before trying 1 2 3 4
to solve a problem myself.
3. I have often wondered how my father 1 2 3 4
acts when I'm not around.
4- Even when my father and I disagree, 1 2 3 4
my father is always right.
5- It's better for kids to go to their best 1 2 3 4
friend than to their father for advice
on some things.
6- When I've done something wrong, I 1 2 3 4
depend on my father to straighten
things out for me.
7- Therearesomethingsaboutmethat 1 2 3 4
my father doesn't know.
8- My father acts differently when he is 1 2 3 4
with his parents from the way he
does at home.
9- My father knows everything there is 1 2 3 4
to know about me.
10. Imighthesurprisedtoseehowmy 1 2 3 4

father acts at a party.

11.

14.

16.

17.

I;

.5

.3

103

Itrytohavethesameopinionsasmy 1
father.

When he is at work, my father acts 1
pretty much the same way he does
when he is at home.

If I was having a problem with one of 1
my fi'iends, I would discuss it with my
Ether before deciding what to do about
it.

My father would be surprised to know 1
what I'm like when I'm not with him.

WhenIbecomeaparent,I'mgoingto 1
treatmychildreninexactlythesame
way that my Ether has treated me.

My father probably talks about difi- 1
erent things when I am around from
what he talks about when I'm not.

There are things that I will do difll 1
erently from my Ether when I become
a parent.

My Ether hardly ever makes mis- 1
takes.

I wish my Ether would understand 1
who I really am.

MyEtheractsprettymuchthe same 1
way when he is with his friends as he
does when he is at home with me.

l 0 4
EMOTIONAL AUTONOMY SCALE - MOTHER

Please read the following statements and decide if you strongly disagree,
disagree, agree, or strongly agree. Circle the appropriate number.

1 = Strongly disagree

2
3
4

10.

11.

 

Drsagree
Agree
Stronglyasree .
Strongly Dwasree Agree Strongly
Drsagree Agree
My mother and I agree on everything. 1 2 3 4
I go to my mother for help before 1 2 3 4
trying to solve a problem myself.
I have often wondemd how my mother 1 2 3 4
acts when I'm not around.
Even when my mother and I disagree, 1 2 3 4
my mother is always right.
It's better for kids to go to their best 1 2 3 4
friend than to their mother for advice
on some things.
When I‘ve done something wrong, I 1 2 3 4
depend on my mother to straighten
things out for me.
There are some things about me that 1 2 3 4

my mother doesn't know.

My mother acts differently when she I 2 3 4
is with her parents from the way she
does at home.

My mother knows everything there is 1 2 3 4
to know about me.

Imightbesurprisedtoseehowmy 1 2 3 4
mother acts at a party.

Itrytohavethesameopinionsasmy 1 2 3 4

mother.

14.

15.

16.

17.

105

When she is at work, my mother acts 1

pretty much the same way she does
when she is at home.

If I was having a problem with one of 1
my friends, I would discuss it with my
mother before deciding what to do

about it.

My mother would be surprised to 1
know what I'm like when I'm not
with her.

When I become a parent, I'm going to 1
treatmychildreninexactlythe same
way that my mother has treated me.

My mother probably talks about difii 1
erent things when I am around from
what she talks about when I'm not.

Therearetbingsthathflldodifi-
erently from my mother when I
become a parent.

My mother hardly ever makes mis- 1
takes.

I wish my mother would understand 1
who I really am.

H

My mother acts pretty much the same 1
way when she is with her friends as
she does when she is at home with me.

APPENDIX G

1 0 6
APPENDIX G

PARENTAL RELATIONSHIP INVENTORY - FATHER

Instructions:

The following questions refer to your current relationship with
your father. If you were not reared by your natural Ether, please respond
in terms of the person who primarily raised you until you were 18 in the
role of a Ether. If your father is no longer living, answer in terms of how
you remember the relationship to have been as well as how you imagine the
relationship would be today if your father was living.

Please circle the number which best describes your agreement or
disagreement with each statement.

Strongly Agree Disame Strongly
Agree Drsagree

1. It is fun to be with my Ether. 4 3 2 1

2. I can still feel good about myself, 4 3 2 1
even when my father is upset
with me.

3. My Ether treats me as if I were 4 3 2 1
the most important person in his
life.

4. WhenI'mtr-yingtoreachagoal, 4 3 2 1
I can't depend on my Ether for
encouragement.

5. My Ether doesn't wem to recognize 4 3 2 1
that I've grown up.

6. If I were in financial trouble, I would 4 3 2 1

feel comfortable asking my father to
lend me money.

7. Myfatherneedsmetokeephimfrom 4 3 2 1
being lonely.

8. Many times when something happens 4 3 2 1
to my father, I feel like it's happening
to me.

10.

11.

14.

15.

16.

17.

107

I generally consult my Ether before
making important decisions.

My Ether respects my desire to be an
independent person.

My Ether does not need me to make
him feel proud of his own life.

When I'm having trouble making
a decision, it really helps to have
my Ether provide direction for me.

My Ether frequently lets me know
that his generation knows best.

My Ether accepts my need for
privacy.

I feel that my father tries to make
me responsible for his happiness.

My Ether wants to know all my
thoughts.

Iamable toputmyownneeds
before my Ether's.

In my relationship with my Ether,
I don't feel like an "orphan".

I don't feel it's my job to make my
Ether happy.

I avoid asking my Ether for his
emotional support.

. I rim my own life without needing

my father's direction.

When I am feeling had, my Ether
shows little interest in my feelings.

My Ether doesn't try to influence the
decisions I make.

It's hard not to feel like a child when
I'm with my father.

31.

l 0 8
It is alright with my father if I
disagree with him.
My Ether and I feel like strangers
to one another.

I feel happy when I'm with my
er.

My father feels most useful when
he is in the ”Ether” role.

When I'm ill, I avoid asking my
Ether for sympathy.

I often don't do things my way
because it would upset my Ether.

WhenI'mfeelingbad, Icancount
on my Ether to remind me ofmy
worth.

I feel uncomfortable keeping secrets
from my Ether.

My Ether can only feel successful
if I am doing well.

The relationship I have with my
Ether feels like a relationship
between equals.

It is important to me that my Ether

approves of the way I am handling
my life.

If I needed practical help, I would
prefer not to go to my father for it.

Ifeeltensewhenlamaroundmy
Ether.

My Ether doesn't try to tell me how
to run my life.

I can't rely on emotional support
fi'om my Ether.

41.

47.

109

My father relies more on others for
companionship than he does on me.

I don't need to tell my Ether all
about what is happening in my life.

When my Ether gives me things
there are generally ”strings
attached".

MyEtberis abletotalktome as
one adult to another.

I feel that my Ether tries to interfere
with my personal business.

I feel comfortable having difi‘erent
beliefs and values than my Ether.

If my Ether feels sad or disappointed
about something, it's hard for me

to enjoy myself.

My Ether and I don't seem to have
“thy much in common with each
0 er.

I find it hard to go against my
Ether's advice.

My Ether often insists on making
me see things his way.

I feel very warm towards my father.

l 10
PARENTAL RELATIONSHIP INVENTORY - MOTHER

Instructions:

The following questions refer to your current relationship with
your mother. If you were not reared by your natural mother, please
respond in terms of the person who primarily raised you until you were 18
in the role of a mother. If your mother rs no longer living, answer in terms
of how you remember the relationship to have been as well as how you
imagine the relationship would be today if your mother was living.

Please circle the number which best describes your agreement or
disagreement with each statement.

Strongly Agree Disagree Strongly
Agree Drsagree

1. It is fun to be with my mother. 4 3 2 1

2. Icanstillfeelgoodabout myself, 4 3 2 1
even when my mother is upset
with me.

3. My mother treats me as if I were 4 3 2 1

ltihfe most important person in her
e.

4. WhenI'mtryingtoreachagoal, 4 3 2 1
I can't depend on my mother for
encouragement.

5. My mother doesn't seem to recognize 4 3 2 1
that I've grown up.

6. If I were in financial trouble, I would 4 3 2 I
feel comfortable asking my mother to
lend me money.

7. Mymother needsmetokeep her from 4 3 2 1
being lonely.

8. Many times when something happens 4 3 2 1
to my mother, I feel like it's happening
to me.

9. I generally consult my mother before 4 3 2 1

making important decisions.

10. Mymotherrespectsmydesiretobean4 3 2 1
independent person.

11.

14.

16.

17.

111

My mother does not need me to make
her feel proud of her own life.

When I'm having trouble making
a decision, it really helps to have
my mother provide direction for me.

My mother frequently lets me know
that her generation knows best.

My mother accepts my need for
privacy.

I feel that my mother tries to make
me responsible for her happiness.

My mother wants to know all my
thoughts.

Iamabletoputmyownneeds
before my mother's.

In my relationship with my mother,
I don't feel like an "orphan”.

I don't feel it's my job to make my
mother happy.

I avoid asking my mother for her
emotional support.

. I run my own life without needing

my mother's direction.

When I am feeling had, my mother
shows little interest in my feelings.

My mother doesn't try to influence
the decisions I make.

It's hard not to feel like a child when
I'm with my mother.

It is alright with my mother if I
disagree with her.

My mother and I feel like strangers
to one another.

31.

41.

112

I feel happy when I'm with my
mother.

My mother feels most useful when
she is in the "mother" role.

When I'm ill, I avoid asking my
mother for sympathy.

I often don't do things my way
because it would upset my mother.

When I'm feeling bad, I can count
on my mother to remind me of my
worth.

I feel uncomfortable keeping secrets
from my mother.

My mother can only feel successful
if I am doing well.

The relationship I have with my
mother feels like a relationship
between equals.

It is important to me that my mother

approves of the way I am handling
my life.

If I needed practical help, I would
prefer not to go to my mother for it.

Ifeeltensewhenlamaroundmy
mother.

My mother doesn't try to tell me how
to rim my life.

I can't rely on emotional support
from my mother.

My mother relies more on others for
companionship than she does on me.

I don't need to tell my mother all
about what is happening in my life.

47.

113

When my mother gives me things 4
there are generally ”strings
attached".

My mother is able to talk to me as 4
one adult to another.

I feel that my mother tries to interfere 4
with my personal business.

I feel comfortable having difi'erent 4
beliefs and values than my mother.

If my mother feels sad or disappointed 4
about something, it's hard for me

to enjoy myself.

My mother and I don't seem to have 4
vary much in common with each
0 er.

Ifindithardtogoagainstmy 4
mother's advice.

My mother often insists on making 4
me see things her way.

I feel very warm towards my mother. 4

* APPENDIX II

114
APPENDDI H

PSYCHOLOGICAL SEPARATION INVENTORY
CONFLICTUAL INDEPENDENCE SCALE

Instructions: The following list of statements describes different aspects of
students' relationships with both their mother and father. Imagine a scale
ranging fiom 1 to 5 that tells how well each statement applies to you. In the
space next to the statement, please enter a number from "1" (Not at all true
of me) to "5" (Very true of me). If the statement does not apply, enter ”1".
Please be completely honest. Your answers are entirely confidential and
will be useful only if they accurately describe you.

1.

PFflPP‘PS‘F’

H
O

11.
12.
13.
14.
15.
16.

Sometimes my mother is a burden to me.
I feel like I am constantly at war with my mother.
I blame my mother for many of the problems I have.
I wish I could trust my mother more.
I have to be careful not to hurt my mother's feelings.
I sometimes feel like I'm being punished by my mother.
I wish my mother wasn't so overprotective.
I wish my mother wouldn't try to manipulate me.
I wish my mother wouldn't try to make fun of me.

. I feel that I have obligations to my mother that I wish I didn't

have.

My mother expects too much from me.

I wish I could stop lying to my mother.

I often wish that my mother would treat me more like an adult.
I am often angry at my mother.

I hate it when my mother makes suggestions about what I do.

Even whenmymotherhas agoodideal refusetolistentoit
because she made it.

17.
18.
19.
20.
21.
22.
23.

25.
26.
27.
28.
29.
30.
31.
32.
33.
. I wish my Ether wouldn't try to make fun of me.
35.

36.
37.
38.
39.
40.

1 15
I wish my mother wouldn't try to get me to take sides with her.

I argue with my mother over little things.

My mother is sometimes a source of embarassment to me.
I am sometimes ashamed of my mother.

I get angry when my mother criticizes me.

When I don't write my mother often enough I feel guilty.
I feel uncomfortable keeping things from my mother.

. I often have to make decisions for my mother.

I sometimes resent it when my mother tells me what to do.
Sometimes my Ether is a burden to me.

I feel like I am constantly at war with my Ether.

I blame my Ether for many of the problems I have.

I wish I could trust my father more.

I have to be careful not to hurt my Ether's feelings.

I sometimes feel like I'm being punished by my Ether.

I wish my Ether wasn't so overprotective.

I wish my Ether wouldn't try to manipulate me.

I feel that I have obligations to my Ether that I wish I didn't
have.

My father expects too much from me.

I wish I could stop lying to my Ether.

I often wish that my Ether would treat me more like an adult.
I am often angry at my Ether.

I hate it when my Ether makes suggestions about what I do.

41.

42.
43.

45.
46.
47.
48.
49.
50.

116

Even when my Ether has a good idea I refuse to listen to it
because he made it.

I wish my father wouldn't try to get me to take sides with him.
I argue with my father over little things.

. My Ether is sometimes a source of embarassment to me.

I am sometimes ashamed of my Ether.

I get angry when my Ether criticizes me.

When I don't write my Ether often enough I feel guilty.
I feel uncomfortable keeping things from my father.

I often have to make decisions for my father.

I sometimes resent it when my father tells me what to do.

APPENDIX I

1 17
APPENDIX I

FAMILIAL INSECURITY SCALE - FATHER

Read the following statements and dedde whether they are true or false for
you. Under column A, circle T for true or F for Else.

1. Although I value the afi'ection my Ether T F
holds for me, I feel that I do not need it
to make me feel confident in myself

2. I feel on very good terms with my Ether, T F
despite the fact that I no longer rely on
him for help or advice.

3. Ifeel soclosetomyfather thatIfeel T F
that he will always be my closest fiiend.

4. The nagging I get from my father some- T F
times irritates me very much.

5. I enjoy the comfortable feeling that I can T F
handle any problem that might come my
way without help from my Ether.

6. I feel very much at home with my father, T F
more so than with anyone else I have ever
met.

7. I am concerned that my relationship with T F
my father is not all that it might be.

8. I often feel very regretful that I have not T F
fulfilled my obligations to my Ether.

9. When the going gets tough I often wish that T F
I were back in the happy days of my
childhood.

10. Although I get on very well with my Ether, T F
I do not feel that loss or separation would
make any great difi‘erence to my life in
general.

11. Itisagreatcomforttometorealizethatlcan T F

14.

16.

17.

19.

21.

118

always count on my Ether to get me out of a
Jam.

I often get a troubling feeling from wondering
if my Ether might disapprove of what I am '
doing.

My father is very kind to me, but I am sorry
that I do not have a real warm relationship
with him.

It is a great comfort to me that my Ether helps
me to make up my mind.

I feel comfortably fine to make my own
arrangements with my friends without talking
it over with my Ether.

Ifeel discouragedthatitissodificultto
live up to what my father expects of me.

Itmakesmefeeluneasytothinkofbeing
completely on my own.

It is a great comfort to have my Ether help
me such a lot.

Iamhappytofallbackonmyfathertodothe
many little things for me that tend to make life
more comfortable.

I often feel a sense of regret that I have not
Iliadl as happy a Emily life as other people have
a .

One of the most important Ectors in helping
me decide on something is whether or not it
will please my Ether.

It bothers me that my Ether does not allow
metobemore onmyown.

It discourages me that my father interferes
so much in my life.

I sometimes worry about the future as a time
I will not get as much help from my Ether

as I do now.

119

25. I would feel guilty ifI felt that I were letting my T F
father down in any way.

26. I would feel very hesitant to embark on a course T F
of action which my father might consider ‘
wrong.

27. One ofthe reasons thatIgetalongwith my T F
Ether is that I never feel held in by his

disapproval.

Now re-read each statement and decide hm true or false each is for you.

If you circled True, decide whether the statement is Very True or
Somewhat True for you.

If you circled False, indicate whether the statement is Very False or
Somewhat False for you.

Indicate your response by writing under column B:

For items to which you previously responded true, either
' VT (Very True) or
ST (Somewhat True)

For items to which you previously responded false, either
VF (Very False) or
SF (Somewhat False)

l 20
FAMILIAL IN SECURITY SCALE - MOTHER

Read the following statements and decide whether they are true or false for
you. Under column A, circle T for true or F for false.

1. Although I value the afl‘ection my mother T F
holds for me, I feel that I do not need it
to make me feel confident in myself.

2. I feel on very good terms with my mother, T F
despite the fact that I no longer rely on
her for help or advice.

3. Ifeelsoclosetomymotherthatlfeel T F
that she will always be my closest friend.

4. The nagging I get fi'om my mother some- T F
times irritates me very much.

5. I enjoy the comfortable feeling that I can T F
handle any problem that might come my
way without help from my mother.

6. I feel very much at home with my mother, T F
more so than with anyone else I have ever
met.

7. I am concerned that my relationship with T F
my mother is not all that it might be.

8. I often feel very regretful that I have not T F
fulfilled my obligations to my mother.

9. WhenthegoinggetstoughIofienwishthat T F
I were back in the happy days of my
childhood.

10. Although I get on very well with my mother, T F
I do not feel that loss or separation would
make any great difi'erence to my life in
general.

11. Itisagreatcomforttometorealizethatlcan T F
always count on my mother to get me out of a
jam.

13.

14.

16.

17.

21.

121

I often get a troubling feeling from wondering
if my mother might disapprove of what I am
doing.

Mymotherisvery kindtome,butl amsorry ‘
that I do not have a real warm relationship
with her.

It is a great comfort to me that my mother helps
me to make up my mind.

I feel comfortably free to make my own
arrangements with my fiiends without talking
it over with my mother.

Ifeeldiscouragedthatitissodificultto
live up to what my mother expects of me.

Itmakesmefeeluneasytothinkofbeing
completely on my own.

It is a great comfort to have my mother help
me such a lot.

IamhappytoEllbackonmymothertodothe
many little things for me that tend to make life
more comfortable.

Iotten feel a sense ofregretthatlhavenot
flag as happy a Emrl' y life as other people have
a .

One of the most important Ectors in helping
me decide on something is whether or not it
will please my mother.

It bothers me that my mother does not allow
me to be more on my own.

It discourages me that my mother interferes
so much in my life.

I sometimes worry about the future as a time
I will not get as much help from my mother
as I do now.

I would feel guilty if I felt that I were letting my
mother down in any way.

122

26. I would feel very hesitant to embark on a course T F
of action which my mother might consider
wrong.

27. OneofthereasonsthatIgetalongwithmy ‘ T F
mother is that I never feel held in by her
disapproval.

Now re-read each statement and decide hm true or false each is for you.

If you circled True, decide whether the statement is Very True or
Somewhat True for you.

If you circled False, indicate whether the statement is Very False or
Somewhat False for you.

Indicate your response by writing under column B:

For items to which you previously responded true, either
VT (Very True) or
ST (Somewhat True)

For items to which you previously responded false, either
VF (Very False) or
SF (Somewhat False)

APPENDIX J

1 2 3
APPENDIX J

OFFER SELF-IMAGE QUESTIONNAIRE

 

1- Describes me very well 4-Does not quite describe me

2- Describes me well 5-Does not really describe me

3- Describes me fairly well 6-Does not describe me at all

_ 1. I carry many grudges.

__ 2. 22:: I am with people I am afi'aid that someone will make frm

_ 3. Most of the time I think that the world is an exciting place to live
1 .

_ 4. I would not hurt someone just for the "heck of it".

__ 5. The recent changes in my body have given me some satisfaction.

__ 6. I am going to devote my life to helping others.

__ 7. I ”lose my head” easily.

__ 8. Theoppositesexfindsmeabore.

__ 9. IfIwouldbeseparated fromallthepeoplelknowaeel thatI
would not be able to make a go of it.

__ 10. I feel tense most of the time.

_ 11. I usually feel out of place at picnics and parties.

_ 12. I feel that working is too much responsibility for me.

_ 13. Itisveryhardforateenagertoknowhowtohandlesexina
right way.

_ 14. At times I have fits of crying and/or laughing that I seem unable
to control.

__ 15. Iamgoingtodevotemylifetomakingasmuchmoneyaslcan.

__ 16. If I put my mind to it, I can learn almost anything.

17. Only stupid people work.

18.
19.
20.
21.
22.
23.

25.
26.
27.

28.

29111.

124
I am confused most of the time.

I feel inferior to most people I know.

I donotlike to putthingsinorderandmake sense ofthem.
In the past year I have been very worried about my health.
Dirty jokes are fun at times.

I often blame myself even when I am not at fault.

I would not stop at anything if I felt I was done wrong.

The size of my sex organs is normal.

Most of the time I am happy.

I am going to devote myself to making the world a better place to
live in.

I can take criticism without resentment.

(for males only)

My work, in general, is at least as good as the work of the guy
next to me.

__ 29f. (for females ,only)

30.

31.
32.
33.

35.

36.
37.

My work, in general, is at least as good as the work of the girl
next to me.

Sometimes I feel so ashamed ofmyselfthat Ijust want to hide in
a corner and cry.

I am sure that I will be proud about my future profession.
My feelings are easily hurt.

When a tragedy occurs to one of my fiiends, I feel sad too.
I blame others even when I know that I am at Eult too.

When I want something, I just sit around wishing I could have
it.

The picture I have of myselfin the future satisfies me.

I am a superior student in school.

38.
39.
40.
41.

42.
43.

45.
46.
47.

48m.

48f.

49.
50.
51.
52.
53.
54.
55.
56.
57.

58.
59.

1 2 5
I feel relaxed under normal circumstances.

I feel empty emotionally most of the time.
I would rather sit around and loaf than whrk.

Even if it were dangerous, I would help someone who is in
trouble.

Telling the truth means nothing to me.

Our society is a competitive one and I am not afraid of it.
I get violent if I don't get my way.

I think that other people just do not like me.

I find it very diEcult to establish new fiiendships.

I am so very anxious.

(for males only)
Working closely with another fellow never gives me pleasure.

(for females only)
Working closely with another girl never gives me pleasure.

I am proud of my body.
At times I think about what kind of work I will do in the future.
Even under pressure I manage to remain calm.

I often feel that I would rather die than go on living.

I find it extremely hard to make friends.

I would rather be supported for the rest of my life than work.
Ido notmindbeingcorrected, since Icanlearnfi‘omit.

I feel so very lonely.

I do not care how my actions afi‘ect others as long as I gain
something.

I enjoy life.
I keep an even temper most of the time.

61.
62.

65m.

65f.

67.

69.
70.

71.
72.

73.
74.
75.

76.
77.
78.

126

A job well done gives me pleasure.
I seem to be forced to imitate the people I like.

For me good sportsmanship in school is as important as
winning a game.

I prefer being alone than with Eds my age.
When I decide to do something, I do it.

(for males only)
I think that girls find me attractive.

(for females only)
I think that boys find me attractive.

Other people are not alter me to take advantage of me.

I feel that there is plenty I can learn from others.

I do not attend sexy shows.

I fear something constantly.
reeryottenlthinkthatIamnotatallthepersoanouldliketo

I like to help a friend whenever I can.

IfIknowthathillhavetoEceanewsituation,Iwilltryin
advance to find out as much as is possible about it.

If others disapprove of me I get terribly uspset.
Being together with other people gives me a good feeling.

WheneverIEilinsomething,Itrytofindoutwhatlcandoin
order to avoid another failure.

I frequently feel ugly and unattractive.
Sexually I am way behind.
If you confide in others you ask for trouble.

79.

80.

81.
82.
83.
84.
85.
86.
87.

88.

89.
90.

91.
92.
93.
94.

95.
96.
97.
98.
99.

127

Even though I am continuously on the go, I seem unable to get
things done.

When others look at me they must think that I am poorly
developed. ‘

I believe I can tell the real from the fantastic.

Thinking or talking about sex fiightens me.
I am against giving so much money to the poor.

'I feel strong and healthy.

EvenwhenI amsad Icanenjoyagoodjoke.
There is nothing wrong with putting oneself before others.

I firhrd life an endless series of problems-without solution in
sig t.

At times I feel like a leader and feel that other Eds can learn
something from me.

IfeelthatIamabletomakedecisions.

I am certain that I will not be able to assume responsibilities for
myself in the future.

When I enter a new room I have a strange and funny feeling.
I feel that I have no talent whatsoever.
I do not rehearse how I might deal with a real coming event.

When I am with people I am bothered by hearing strange
noises.

I do not have a particularly dificult time in making fiiends.

I do not enjoy solving dificult problems.

School and studying mean very little to me.

Eye for an eye and tooth for a tooth does not apply for our society.

Sexual experiences give me pleasure.

128

100m. (for males only)

Having a girlfriend is important to me.

100f. (for females only)

101.

102.

103.
104.
105.
106.
107.
108.
109.
110.
111.

Having a boyfriend is important to me.

I would not like to be associated with those Eds who ”hit below
the belt”.

1Vlfeorrying a little about one's future helps to make it work out
tter.

I often think about sex.

Usually I control myself.

I enjoy most parties I go to.

Dealing with new intellectual subjects is a challenge for me.
I do not have many fears which I cannot understand.

No one can harm me just by not liking me.

I am fearful of growing up.

I repeat things continuously to be sure that I am right.

I frequently feel sad.

APPENDDI K

1 2 9
APPENDIX K

HEALTH HISTORY
I ll . I | H' |
Current Weight _lbs. Current Height _in. Desired Weight _lbs.
Adult Years:
Highest weight since age 18 _lbs. at age _
Lowest weight since age 18 _ at age __
How long did you remain at your highest adult weight?
_days _months __years
How long did you remain at your lowest adult weight?
_days _months __years
Adolescent Years:
Highest weight between ages 12 and 18 _lbs. at age _
Lowest weight between ages 12 and 18 _lbs. at age __
Have you ever been on a diet? Yes _ No
Ifno, sEp to section III.

At what age did you begin to restrict your food intake due to concern over

your body size?

_years old

In your first year of dieting how many times did you start a diet?

_ # of times

Over the last year how often have you begun a diet?

__ # of times

Please rank fi'om 1-9 your preferred way of dieting (1=most preferred,

9=least preferred).

130

sEp meals _ _ _ reduce portions _ _ -
totalEst ___ goonfaddiets ___
restrict carbohydrates _ _ _ reduce calories _ - _
restrict sweets _ _ __ other _ _ _
restrict fats ‘

Ifyou have ever been encouraged to diet, please rank from 1-10 the people
that encouraged you to diet the most (1=most encouraged, 10=least

encouraged).

boyfiiends __ _ sister __-
girlfriends _ _ _ employer .. - _.
mother __ _ teacher/coach __ _
father _ _ _ other relative _ _ _
brother ___ other (specify) __ _

III B. E |° B l .

Have you ever had an episode of eating a large amount of food in a short
space of time (an eating binge)?

Yes No

If you answered no, sEp to section IV.
Please circle on the scales below, how characteristic the following are of

your binge eating.
I consume a large amount of food during a hinge.
1 2 3 4 5
Never Rarely Sometimes Often Always
I eat very rapidly.
1 2 3 4 5
Never Rarely Sometimes Often Always
I feel out of control when I eat.
1 2 3 4 5

Never Rarely Sometimes Often Always

13 1
I feel miserable or annoyed after a hinge.

1 2 3 4 5
Never Rarely Sometimes Ofien . Always
I get uncontrollable urges to eat and eat until I feel physically ill.

1 2 3 4 5
Never Rarely Sometimes Often Always
I binge eat in private.
1 2 3 4 5

Never Rarely Sometimes Often Always
How long does a hinge usually last?
Less than one hour _ 1-2 hours _ More than 2 hours _
Please rank 1-9 the times of day that you are most likely to binge (1=most
likely, 9=1east likely)

8am-10am ___ 6pm-8pm __..

loam-12pm ___ 8pm-10pm ___

12pm-2pm ___ 10pm-12am _

2pm-4pm ___ afier midnight ___

4 pm - 6 pm __ _

Please rank 1-6 the places where you are most likely to binge (1=most likely,
6=least likely).

Home _ Work _ Restaurant _ Car _
Party _ Other (specify)

Please rank from 1-5 how likely you are to binge eat in the presence ofthe
following people (1=most likely, 5=least likely).
Parents _ Children Alone

Friends

Spouse/significant other _

How old were you when you began binge eating?
years old

1 3 2
How long have you had a problem with binge eating?

_days _months __years
What is the longest period you have had without binge eating since the
onset of the problem?

_days _months __years

What were the circumstances that helped you to not binge eat for that
period of time? (If more than one event is applicable, please rank order the

importance of the event with 1=most important).

began dieting __ _ _ started exercising .. - _
sought professional help ___ began romantic relationship ___
developed illness _ _ _ left romantic relationship _ _ __
hit home _ _ _ divorce - _. ._
marriage _ _ _ pregnancy _ - _
work vacation

Please rank from 1-7 the foods that you are most likely to hinge on (1=most
likely, 7=least likely).

bread/cereal/pasta ___ cheese/milk/yog'urt -- -
fruit ___ meat/fish/poultry/eggs ___
salty snack foods _ _ _ sweets _ _ ..
vegetables __ _

Please rank from 1-7 the foods that you are most likely to eat when you are
not binging (1=most likely, 7=least likely).

bread/cereal/pasta __ _ cheese/milk/yogurt _- -
fruit _ _ _ meat/fish/poultry/eggs _ _ _
salty snack foods _ _ _ sweets ._ .. _
vegetables ___

Were there any particular events in your life, either positive or negative,
which preceded or coincided with the onset of your binge eating (Check as

many as applicable).

death of significant other leaving home

133

illness or injury to self __ _ failure at school or work _ _ _
dificult sexual experience _ _ _ family problems _ .. _
problems with romantic illness or injury to Emily

relationship _ _ _ member or significant other _ _ _
teasing about appearance _ _ _ prolonged periods of dieting _ _ _
marriage _ _ _ pregnancy _ _ _
work transition _ __ _ other (specify) .. _ _

Using the scale below, please select the number which indicates the
intensity of each of the following feelings BEFORE a hinge.

1 - 2 3 4 5

Extremely Very Moderately Slightly Not at all

Intense Intense Intense Intense Intense
Calm __ _ Bored __ _
Empty ___ Frustrated ___
Confused ___ Panicked ___
Excited ___ Relieved ___
Angry --.. Guilty ..-_
Spaced Out _ _ _ Depressed _ _ _
Inadequate ___ Nervous ___
Disgusted ___ Other (specify) ___
Lonely ___

Using the scale below, please select the number which indicates the
intensity of each of the following feelings AFTER a hinge.

1 2 3 4 5

Extremely Very Moderately Slightly Not at all

Intense Intense Intense Intense Intense
Calm ___ Bored ___ _
Empty ___ Frustrated __ _
Confused ___ Panicked __ _
ExciEd __ _ Relieved __ _
Angry -.._ Guilty -_-
Spawd Out _ _ _ Depressed _ _ _
Inadequate ___ Nervous __ _
Disgusted ___ Other (specify) _. _
Lonely ___

Have you noticed a relationship between the frequency of your binge eating
and your menstrual cycle?
Yes No

l 3 4
If yes, please indicate when during your cycle you feel most vulnerable to

binge eating.

During menstruation _
11—14 days prior to menstruation
7- 10 days prior to menstruation
3—6 days prior to menstruation
1-2 days prior to menstruation
After menstruation

How uncomfortable are you with your binge eating behavior?

1 2 3 4 5
Extremely Very Uncomfortable Somewhat Not at all
Uncomfortable Uncomfortable Uncomfortable Uncomfortable

How willing would you be to gain 10 pounds in exchange for not binge
eating anymore?

1 2 3 4 5
Extremely Very Moderately Somewhat Not at all
DZ 2 . B I .

Have you ever vomited or spit out food after eating in order to get rid of the
food eaten?

Yes _ No _

How old were you when you induced vomiting for the first time?

__years old

How long have you been using self-induced vomiting?

_days _months __years

Have you ever used laxatives to control your weight or "get rid of food"?
Yes __ No _

How old were you when you first took laxatives for weight control?
years old

l 3 5
How long have you been using laxatives for weight control?
_days _months _years
How often are you now able to eat a "normal" meal without "binge eating"

and without vomiting?

Never _ _ _ Several meals a week _ _ _
Lessthanonemealaweek ___ Onemealaday _
Aboutonemealaweek ___ Morethanonemealaday ___

How soon after eating do you induce vomiting?

0-15 minutes

16-30 minutes
31-45 minutes
46-60 minutes

One hour or longer

Which of the behaviors, "binge eating" or vomiting after meals came first?

Binge eating came first. _ _ _ Vomiting came first. __ _
They both occumd at the Neither came first, I have never
same time. __ __ had binge eating or vomiting
Neither came first. I have only episodes. _ _ _
binge eating episodes. _ _ _

Neither came first. I have only

vomiting episodes. _ _ _

During the entire last month, what is the average fi'equency that you have
engaged in the following behaviors? (Check one for each behavior.)
(0=Never; 1=Once a month or less; 2=Several times a month; 3=Once a
week; 4=Several times a week; 5=Once a day; 6=More than once a day)

Bingeeating ___- _-_ -_- --.. -_- -..- _-_
Vomiting
Laxativeuse
Useofdietpills ___ ___ __- ___ ___ ._.._ ___
Useofwaterpills ___ ___ --_ __- ___- -__ -__
Use ofenemas' ___ ___ _.__ _._- ___ _-- _--
Exercisetocontrol

weight ___ ___ ___ ___ ___ --_ -_._

136

Fasting(SEpping
mealsforaday) ___ ___ ___ ___ ___ ___ ___.

Using the scale below, please select the number which indicates the
intensity of each of the following feelings BEFORE a purge.

1 2 3 4 5

Extremely Very Moderately Slightly Not at all

Intense Intense Intense Intense Intense
Calm _ _ _ Bored _ _ _
Empty _ _ _ FrustratOd _ _ _
Confused __ _ Panicked ___
Excited __ _ Relieved -- ..
Angry ___ Guilty ___
Spaced Out __ _ Depressed ___
Inadequate _ _ _ Nervous - .. _
Disgusted __ _ Other (specify) ___
Lonely _.__

Using the scale below, please select the number which indicates the
intensity of each of the following feelings AFTER a purge.

1 2 3 4 5

Extremely Very Moderately Slightly Not at all

Intense Intense Intense Intense Intense
Calm __ _ Bored ___
Empty _ _ _ Frustrated _ _ _
Confused __ _ Panicked ___
ExciEd _ _ _ Relieved _ _ _
Angry -_.. Guilty ___...
Spawd Out _ _ _ Depressed _ _ _
Inadequate ___ Nervous ___
Disgusted _ _ _ Other (specify) _ _ _
Lonely -..._
II E . 1 Q I] B I .

How many minutes a day do you currently exercise (including going on
walks, riding bicycle, etc. )?

___minutes

Have you ever competed in any of the following physical activities? (Check

as many as are applicable.)

137

Distance running ___ Weightlifling __-
Dancing _ _ _ Gymnastics _ _ _
Wrestling _ _ _ Tennis .. _ _
Swimming _ _ _ Other (Specify) _ _ _
Have you ever made a suicide attempt?

Yes No

Have you ever tried to physically hurt yourself (i.e. cut yourself, hit yourself
with intent to hurt, burn yourself with cigarettes)?
Yes No

Since the onset of any eating problem, have you been involved in stealing?
Yes No

W
Have you ever engaged in sexual intercourse? Yes _ No

If your answer is yes, at what age did you first engage in sexual

intercourse?
Age _
Please indicate on the line below your interest in sex before the onset of any
eating problem:
1 2 3 4 5
No interest Somewhat Interested Very Extremely
Interested Interested Interested

Please indicate on the scale below whether there has been a change in your
sexual interest since the onset of any eating problem:

1 2 3 4 5
Much less Somewhat less Equally Somewhat more Much more
Interested Interested Interested Interested Interested

Please check your sexual preference:

Exclusively heterosexual _ _ _ Primarily heterosexual, some
Bisexual ___ homosexual ___
Primarily homosexual, some Autosexual (prefer masturbation
heterosexual to sex with others) _ _ __

Exclusively homosexual Asexual (no sexual pref.)

1 3 8
How satisfied are you with the quality of your sexual activity?

1 2 3 4 5
Extremely Very Satisfied Moderately Not at all
Satisfied Satisfied Satisfied Satisfied
WW

Age at onset of menses (if you have never gotten your period, please mark 0)
___years

Since you began dieting, purging, or binge eating, how many times have
you stopped menstruating for 3 months or more (which were unrelated to
pregnancy)?

_# of times

Before you began dieting, purging, or binge eating, how many times have
you stopped menstruating for 3 months or more (which were unrelated to
Pregnancy)?

_# of times

Since you began dieting, purging, or binge eating, what is the total number
of months that you have not menstruated (months unrelated to pregnancy?)
___months

Before you began dieting, purging, or binge eating, what is the total number
of months that you have not menstruated (months unrelated to pregnancy)?
_ months

Approximate regularity of the cycles before onset of any eating dificulties
(Check one).

Fairly regular (Same number of days +3)

Somewhat irregular (Variation 4-10 days)
Very irregular (Variation greater than 10 days) __ _
Never menstruated

1 3 9
How many times in the past have you had episodes of loss of menstrual

periods lasting 3 months or more associated with significant weight loss
when you were not "binge eating” or pregnant?

_ # of times

ran M1] 12 I°|° H°|

Have you ever had any serious medical dificulties?

Yes No

If yes, please explain:

Please indicate any prior hospitalizations for eating or emotional problems.
Most Recent Second Prior Third Prior Fourth Prior
Date Admitted
Date Discharged
Duration
Age
Primary reason
for admission“
" Use number code: 1=bulimia; 2=anorexia nervosa; 3=chemical
dependency; 4=depression; 5=psychiatric problem other than depression;
6=other
Prior outpatient treatment for eating or emotional problems (i.e., a logically
continuous series of treatments).
Most Recent Second Prior Third Prior Fourth Prior
Date Admitted
Date Discharged
Duration

Age

140
Primary reason

for admission“

"‘ Use number code: 1=bulimia; 2=anorexia nervosa; t3=chemical
dependency; 4=depression; 5=psychiatric problem other than depression;
6=other

Please indicate the types of treatment" you have been involved with:

Most Recent Second Prior Third Prior Fourth Prior

"' Use number code: 1=individual psychotherapy; 2=group psychotherapy;
3=psychiatric medication

Are you currently on any medication?

Yes _ No _

If yes, please identify:
What physical problems have you had since the onset of any eating

 

problems? (If more than one response is applicable please rank order your

answers with 1=most troublesome, 8=least troublesome).

sore throat _ _ _ sores or calluses on fingers
weakness or tiredness _ _ _ due to induction of vomiting _ _ _
seizures _ _ _ dental problems _ _ _
feeling bloawd _ _ _ other _ - ._
stomach pains - _. _

Have you ever taken any psychiatric medication?
Yes No

If yes, please identify:
Please circle on the scale below how fi-equently you experience the following

 

symptoms:

Depression
Anxiety

Difficulty setting
up in the morning
Crying episodes
Irritability
Fatigue

Dificulty falling
asleep

Never

HHHH

141
Rarely

2

NNNN

Sometimes Often

““03“

Ibhrhuh

Always

OIO'IOIOI

APPENDIX L

l 4 2
APPENDIX L

YOUNG ADULT/PARENT RELATIONSHIP INTERVIEW

General Rating Instructions for Coding the Young Adult! Parent
Relationship Dimensions

This manual describes the criteria for rating protocols describing a
dimension of the young adult's relationship with his or her parent on a 5
point rating scale. There are one or more criteria listed under each of the 5
points on the scale (referred to in the manual as "LEVELS" that will guide
you in determining the appropriate rating for each protocol. In some cases,
only one criterion listed under a particular level will fit a particular
protocol and will determine the rating for that protocol. More often several
of the criteria listed under a level will fit the protocol you are rating.
Regardless, it is only necessary to have a clear fit on one criterion to rate a
protocol at a particular level. The diflicult decisions are when criteria at
two different levels seem to apply. To rate the protocol you will have to make
a weighted judgment as to which level best describes the protocol. If several
criteria at one level apply but only one criterion at the other level applies the
protocol is probably best rated at the level at which it meets the largest
number of criteria. This is not a hard and fast rule; you may have to make
a judgment call.

The coding manual cannot cover every case. It is important to
understand the conceptual distinctions between each level so that when a
protocol is not addressed directly by the stated criteria, it is possible to make
a clinical judgment as to the best level. In a sense, the rater should
imagine adding another instance to a particular level that at a more

l 4 3
abstract level gets at the same issues raised by the other examples, albeit

with somewhat difi'erent content. It is also helpful to remember that a scale
consists of a range from low to high. A protocol may be "between" a lower
and a higher level (e.g. it seems like a 4 because there is "more” than what
is at level 3 and "less” than what is described at level 5) even though it does
notmeetthe specific criteria ofthe levelinthe middle. Thisis avalid
criterion for rating a protocol, but should only be used after considering the
specific criteria contained in the manual.

144
W

Introduction: WE TALKED A LI'I'I‘LE ABOUT THIS ON THE PHONE...
WHAT KINDS OF CONTACTS DO YOU HAVE WITH YOUR PARENTS
NOW, SUCH AS VISITS, WRITING LE'I'I‘ERS, TELEPHONE CALLS AND
SUCH. LET'S START WITH YOUR MOTHER/FATHER.

1.

What kinds of contacts do you have with your mother/Ether? (List
below) FOR EACH ONE MENTIONED, ASK: About how often do you
do this?

IF THE YOUNG ADULT IS LIVING IN THE PARENTAL HOME,
ASK: About how much time do you spend with your mother/father?
What kinds of things do you do when you're together with your
mother/father?

What do you enjoy about your contacts with your mother/father?
What does your mother/Ether enjoy about these contacts?

Of course, there's usually something we don't enjoy about others...
what might these things be about your mother/father?

What do you think might not he so enjoyable about these contacts for
your mother/father?

Who initiates the contacts between you and your mother/father? (Can
you give me an example?)

Do you wish you had more or less contact with your mother/father?
IF MORE OR LESS: Why would you prefer (more/less) contact?

IF SAME: What makes it seem about right?

In general, how much does your mother/Ether talk about his/her
personal concerns with you? What kinds of things does she discuss?
(How do you feel about that?)

10.

11a.

11b.

13a.

13c.
14.

16a.
16b.
16c.

17.

1 4 5
And how much do you talk about your personal concerns with

her/him? What kinds of things do you discuss? (How do you feel
about that?

Are there things that you avoid talEng about with your
mother/Ether? What kinds of things?

What do you think makes you avoid these topics? (Can you give me
one or two examples? How do you feel about that?)

In what ways do you feel close to your mother/Ether? What kinds of
things bring you together? And how do you and your mother/Ether
express closeness?

Are there any feelings of tenseness when you and your mother/father
are together?

How often does that occur?

What do you think that feeling of tenseness is about?

In what ways would you like to be closer to your mother/father? (Can
you give me an example?)

What gets in the way of closeness between you and your
mother/father?

At what point were you closest to your mother/father?

At what point were you most distant Earn your mother/Ether?
TAKE THE LATEST REFERENT POINT, OR AGE, WHETHER
CLOSE OR DISTANT AND ASK: Your relationship has changed
since (age... or time...). How do you account for the difference?

In what ways are you like your mother/Ether? (What does that tell
you about yourself?)

In what ways are you difi'erent from your mother/Ether? (What does
that tell you about yourself?)

19a.

21.

22c.

l 4 6
In what ways does your mother/Ether show concern for your needs

or welfare? (Can you give me a few examples? How do you feel about
this?)

Do you think s/he should be more or less responsive to your needs?
(How would that afl‘ect your relationship?)

In what ways do you show concern for your mother/Ether's needs or
welfare? Do you think s/he gets the message? IF NO: What makes
you say that? Do you wish it were difl'erent? IF YES: How do you
know?

Can you think of a time recently when you felt conflicted about your
mother/father's needs and your needs? What was that about? (How
did you handle it? How did you feel about the way it was handled?)
Which parent do you feel closer to? (PROBE: Lots of people Eel closer
to one parent than the other. IF SAYS NEITHER: What makes this
so?)

In what ways are you closer to than to ?

How do you think it came about (that you are closer to ?)

To change to focus somewhat... Can you think ofa time that you
talked over an important decision with your mother/father? IF SAYS
NEVER: Imagine what would happen if you did... what might
happen? IF SAYS CANT IMAGINE: What makes that impossible

 

 

 

to imagine?

What other kinds of decisions do you discuss with your
mother/father... for example, your financial afl'airs, personal
relationships, work or career choices?

Can you think of a time that you and your mother/father disagreed
about something very important? Tell me about that. (How did you

25a.

25b.
25c.

31.

l 4 7
handle that? How did you feel about your response? How did it get

resolved? Is that how disagreements usually get resolved between
you and your mother/father?)

In what ways are your values difi'erent from those of your
mother/father?

In what ways are your values similar to those of your mother/father?
We've talked about things that you discuss with your mother/father.
Besides advice, what other kinds of things does she help you with?
(Do you ask for help or does slhe ofi'er?-Who initiates?-How do you
think she feels about doing that for you? How do you feel?)

What happens when your mother/Ether is not available. (IF SAYS
NOTHING, ASK: Imagine...)

Are there ways in which you wish you could rely more on your
mother/Ether... or maybe less? (How do you expect that to come
about?)

What are some of your mother/father's weaknesses? What do you
think makes her/him that way?

In what ways would you like her/him to change? Do you think slhe
ever will? (How will that come about?) IF SAYS, I DON‘T KNOW:
What do you think s/he might do to change?) IF SAYS NO: What
might prevent her/him from changing?

In what ways has s/he let you down?

What kinds of things about your mother/Ether make you feel proud?
What are some of her/his strengths?

l 4 8
DECISION MAKING

DEFINITION: This definition has to do with the young adult's ability to
make important decisions and life choices without undue influence fi'om
the parent. This includes the young adult's ability to make decisions in
accordance with his or her own values and preferences as well as the

ability to make decisions as to the m of those values and preferences.

Note 1: Young adults who are generally able to make their own decisions
may occasionally seek advice from the parent; these young adults should be
rated as high on decision making if a) the parent's input does not appear to
be essential (e.g. the young adult indicates that he or she often makes
decisions without consulting the parent) and b) the parent's advice is
viewed as input for self-determined decisions rather than as the final word
as to what the young adult ought or ought not to do. These distinctions are
made more explicit in the descriptions of the criteria for rating the various
points on the scale.

Note 2: If the young adult does not consult the parent because of negative
feelings towards the parent or because of a lack of respect for the parent and
the young adult makes his or her decisions without relying on the parent's
standards he or she should probably be coded as high on decision making.
The negative feelings about the parent are coded elsewhere and should not
be confused with the decision making dimension.

1 4 9
Note 3: Some young adults rely on a spouse, close friend, etc. rather than

the parent in making decisions. This should no], afi‘ect the rating. Only
rate how much the young adult relies on and is influenced by the parent.

Wild
The young adult's decision making abilities in relation to the parent
arecodedona5pointscalewith1referringto'low" decisionmaking
abilities and 5 referring to "high" decision making abilities. The criteria
for rating a protocol as 1, 2, 3, 4, or 5 on the Decision MaEng Scale are
described below.

W:

a) The young adult generally relies on the parent in making
decisions or in deciding on his or her values; if there are any difl‘erences at
all, the young adult is extremely susceptible to the parent's pressures to
conform to the parent's beliefs and/or he or she feels very uncertain about
his or her own views.

b) If and when the young adult makes decisions that are difl‘erent
from what the parent wants or thinks the young adult should do, the young
adult feels guilty, ashamed, afraid, etc.

c) The young adult feels guilty, afraid, hurt, abandoned, etc. if the
parent does not agree with and/or support the young adult's decision.

W2:
a) There is some evidence that the young adult is at least trying to
make his or her own decisions, but he or she has relatively little success or

l 5 0
he or she is still heavily influenced by the parent and continues to

experience self-doubts about his or her own decisions.

b) The young adult seems to feel like he or shemakes his or her own
decisions, but these claims are largely unsubstantiated and there is clear
evidence to the contrary.

c) The young adult is very reliant on the parent for help in making
decisions in some important areas of his or her life, but there are at least a
few areas where they do not seek or feel that they need the parent's advice.

d) At this level there is little or only minimal evidence that the young
adult's decisions are based on self- chosen values, standards, or

preferences.

W:

a) The young adult clearly makes his or her own decisions in some
important areas of his or her life, but is still clearly influenwd by the parent
in others.

b) There is clear evidence that the young adult is attempting to make
his or her own decisions, but at the same time he or she is susceptible to
and at times swayed by the parent's influence; this experience is viewed
negatively by the young adult and sometimes leads him or her to act against
his or her own wishes.

c) The young adult tries to avoid discussing his or her decisions with
the parent in order not to be swayed, influenced, or coerced into taking the
parent's point of view.

d) The young adult attempts to make his or her own decisions, but
generally relies on the parent as a sounding board in thinEng out what to

15 1
do; the parent acts as a frequent counselor and advisor who bolsters the

young adult's confidence in his or her final decision.

W:

a) The young adult clearly makes his or her own decisions in life but
his or her values (or what he or she values) are less clearly difi‘erentiated
from those of the parent than at Level 5. For example, the young adult
identifies with (and there is little or no evidence of having questioned) the
parent's values, but he or she may implement these values in a difl‘erent
way.

b) The young adult's values are clearly difl'erentiated fi'om those of
theparentbuthe or she tendsto consulttbe parentonawiderrange of
issues than at level 5.

W:

a) The young adult has a clear sense of conviction about what he or
she believes, values, etc; these stamlards or preferences are at least in part
differentiated fi'om those of the parent, and he or she uses these self-
determined criteria to make his or her own decisions. At this level, the
young adult has identified areas where decisions difl'er Earn the parent and
is satisfied with these difl‘erences. In addition, he or she is able to evaluate
and choose whether or not to accept the parent's advice.

1 5 2
INDEPENDENCE

DEFINITION: This dimension focuses on the young adult's experience of ‘
competence in the relationship with the parent, and on his or her belief that
he or she can cope with the challenges and setbacks in his or her life
without having to rely on the parent.

Note: If the young adult does not rely on the parent because of negative
feelingstowardstheparentorbecause ofalackofrespectfortheparenthe
or she probably should be coded as high ifit is clear that he or she is able to
cope with his or her own life without fear of repeating the parent's
perceived failures. Those negative feelings about the parent that do not
directly afl‘ect the young adult's perception of his or her coping abilities
should not be confounded with the rating for this dimension; these feelings
will be coded elsewhere.

W
The young adult's independence from and competence in the

relationship with the parent is coded on a 5 point scale with 1 referring to
"low" independence and 5 referring to "high” independence. The criteria
for rating a protocol as 1, 2, 3, 4, or 5 on the Independence Scale are
described below.

W:

a) The young adult generally relies on the parent to cope with
challenges and dificulties in his or her own life. Young adults at this level
often experience themselves as helpless and unable to cope without the

l 5 3
parent's support and may feel frustrated or angry when the parent is

unable to help.

b) The young adult may realize and feel badly about his or her
dependency but in spite of desires or wishful thinEng about being more
self-reliant he or she is unable or unwilling to give up this dependency and
face the world on his or her own.

c) The young adult feels inferior to or like a failure in the parent's
eyes and either accepts or feels conflicted about that definition. The young
adult may have dificulty accepting the parent's help without feeling
inferior, ashamed, angry or resentful.

W:

a) The young adult provides some minimal evidence of competence,
for example, he or she at times feels able to cope with the world, but these
feelings are often transitory, are based on thin denials of insecurities,
and/or are accompanied by clear examples of strong dependencies on the
parent. The young adult may vacillate between feelings of competence and
inferiority or may express serious conflicts and self-doubts in spite of some
minimal acknowledgment of his or her competence.

b) Theyoungadulthassomesensethatheorshecanbeofhelptothe
parent, but retains strong doubts about his or her ability to cope with life in
the world outside the Emily.

c) The young adult indicates some competencies that are not being
md because of strong and pervasive dependencies on the parent.

d) The young adult makes some weak attempts to be more
independent but is inhibited by strong ambivalences and fears of feeling
helpless or deprived if the parent's help were not available.

 

l 5 4
W14}:

a) There are clearly some important areas in the young adult's own
life in which he or she feels able to cope without the parent's assistance, but
there are just as clearly other areas in which they feel insecure and unable
to cope without relying on the parent for advice and guidance.

b) The young adult feels like he or she is in a student relationship
with the parent/teacher, although he or she has some abilities or expertise
to offer the parent. The young adult sees the parent as a positive role model
and is worEng towards but has not yet achieved that ideal.

c) The young adult describes some feelings of inferiority but these
feelings are not all-pervasive or overwhelming; there is a definite sense that
the young adult is moving towards becoming more independent, and in
some areas may even feel that he or she has strengths the parent does not
have.

W:

a) The young adult clearly feels he or she can cope without the
parent's help but this sense of competence is not as pronounced as in Level
5; there is greater emphasis on m dependent than on active goal-
oriented coping.

b) _ There is no clear evidence that the young adult is especially proud
of his or her abilities nor direct evidence that he or she is seen by the parent
as especially capable.

c) In spite of an overall sense of competence the young adult reveals
some isolated but obvious areas of concern or self-doubt that may be of

relatively minimal importance to their daily or overall functioning.

1 5 5
W:

a) The young adult feels at least on an equal par with the parent in
evaluating his or her ability to cope and deal efi'ectively with challenges and
dificulties in his or her life. The young adult may identify with the
parent's strengths and/or sees difl'erences in a positive light and feels able
to pick and choose in ernulating the parent's qualities.

b) Theyoungadulthasastrongsenseofconfidenceinhisorher
ability to cope, a perception they often feel is shared by the parent (or an
evaluation that clearly is unshaken in spite of the parent's skepticism).

c) The young adult can maintain a sense of competence even when
accepting help from the parent and is able to draw on other sources when
the parent is not available.

(1) Wan to being able to function independently the young
adultdescribes areasinwhichhisorherexpertiseishelpfultotheparent.

l 5 6
PERSONAL CONTROL

DEFINITION: This dimension refers to the young adult's ability to control
his or her behavior and feelings in the relationship with the parent.

Note: This dimension does not refer to and should not be confounded with
how much the young adult likes or does not like the parent (although the
two may be correlated). The key issue rated in this dimension is how the
young adult handles his or her needs and feelings (including negative
feelings) in the relationship with the parent. - If the young adult is
overwhelmed by or has little control over his or her needs or feelings they
would be identified as low in personal control; however, a young adult who
has some negative feelings about a parent but who is undistressed by, has
some psychological distance born, and is able to keep those feelings fi-om
spilling into inappropriate behaviors could conceivably be raEd as high on
personal control.

W
The young adult's degree of personal control in the relationship with
the parent is coded on a 5 point scale with 1 referring to "low” personal
control and 5 referring to "high" personal control. The criteria for rating a
protocol as 1, 2, 3, 4, or 5 on the Personal Control Scale are described below.

W:

a) The young adult hghms in very inappropriate ways (e.g. yells,
flees the scene, loses his or her temper, argues incessantly, says very
hostile things to the parent that may be regretted later, cries uncontrollably,

l 5 7
etc.) in the relationship with the parent because he or she is unable to

control intense feelings of anger, frustration, or shame.

W:

a) The young adult is overwhelmed by and/or has to be constantly on
guard against intense feelings of unresolved ambivalence, hatred, rage,
shame, or guilt that are often distressful to the young adult.

b) The young adult expresses highly intense feelings of rage,
dependency, shame, etc.; although the young adult appears to be
unashamed or untroubled by these feelings, their intensity indicates a lack
of control and/or constricted rage that is serious enough to be coded at Level
2.

c) The young adult appears to have very little tolerance for
frustration in the relationship with the parent. For example, the young
adult acknowledges extreme dependency needs that are inappropriate in
adulthood; although the parent may be meeting these needs, the young
adult indicates that if his or her needs were not met by the parent this
would result in feelings of anger, deprivation, or extreme frustration.

W:

a) The young adult is irritated by often seemingly minor conflicts or
behaviors on the part of the parent.

b) The young adult occasionally gets into mild arguments with, is
sarcastic towards, or feels mildly ashamed or guilty in the relationship
with the parent; these negative feelings toward the parent and the ways in
which they are expressed are less intense and more controlled than at the

previous levels.

15 8
c) The young adult is disturbed or ashamed by the parent's

weaknesses, relationships, or behaviors even when these do not directly
afl‘ect the young adult.

d) The young adult acknowledges mild ambivalence toward the
parent that creates conflict for the young adult, but is (potentially)
resolvable or at least suficiently under control so as not to be overly

distressing.

W:

a) The young adult experiences minor irritation or discomfort in the
relationship with the parent; although these feelings are mostly under
control or of relatively little importance to the young adult, they are notable
because they indicate that the young adult has not altogether resolved
parent/child issues. For example, these feelings may be stimulaEd by
situations that would not result in conflicts if the other person involved
were not a parent (e.g. the young adult feels inEntilized when the parent
attempts to give advice that probably would be well received from someone

else).

W:

a) The young adult experiences little or no tension, distress, anger,
etc. in the relationship with the parent; in some cases the relationship is
described in a positive way and may be characterized by mutual enjoyment
and pleasure.

b) The young adult has developed efl'ective coping strategies for
dealing with potentially tense interactions or negative feelings; these ways
of coping allow the young adult to master negative perceptions of the parent

l 5 9
or to deal successfully with dificult situations that might otherwise create

discomfort in the relationship.

1 6 0
SELF-ASSERTION

DEFINITION: This dimension refers to the extent to which the young
adult's behavior in the relationship with the parent is inhibited by feelings
of shame or guilt. At the low end of the scale young adults implicitly or
explicitly use the parent as a superego or ego ideal; these young adults'
standards for evaluating and monitoring their behaviors vis a via the
parent are insuficiently differentiated or confused with perceived parental
expectations. At the high end of the scale young adults are uninhibited by
feelings ofshame orguilt,areabletorelyontheirownstandardsin
relating to the parent, and are able to assert themselves in the relationship
when Eilure to do would compromise these standards.

W
The young adult's self assertion in the relationship with the parent is
coded on a 5 point scale with 1 referring to "low" self-assertion and 5
referring to "high" self-assertion. The criteria for rating a protocol as 1, 2,
3, 4, or 5 on the Self-Assertion Scale are described below.

W:

a) The young adult is clearly inhibited by Eelings ofshame and guilt
in the relationship with the parent and/or monitors his or her behavior in
order to avoid the parent's negative evaluation, disapproval, contempt,
anger, or retribution. If the use of the parent as an ego ideal or superego
figure is mostly ego syntonic, the young adults' excessive self-abnegation
may be relatively untroublesome to the young adult even though it is
painfully evident from the perspective of an outsider.

l 6 l
b) The young adult's self-abnegation in the relationship with the

parent is so glaring that even minimal attempts at self-assertion appear
futile or inefi‘ective in view of the larger context of the relationship.

W

a) The young adult, as in Level 1, is constrained in the relationship
by feelings of shame or guilt, perceives the parent as an appropriate
evaluator of his or her behavior and/or is inhibited by the parent's judgment
or disapproval of his or her actions; however, there is some evidence that
the young adult is beginning to assert him or herself in the relationship
with the parent and is questioning or reevaluating his or her perceptions of
the parent's power or authority.

b) The young adult is able to assert him or herself in a few isolated
areas in the relationship with the parent, although overall the young adult
is still inhibited by shame or guilt and/or uses the parent to evaluate and
monitor his or her behavior.

c) The young adult projects his or her own discomfort about being
him or herself onto the parent (e.g. "he can not take it when I let him know
who I really am") and/or denies or does not acknowledge that he or she is
concerned about or fears the parent's disapproval; however, this denial is
dificult to believe in the face of obvious clues to the contrary. For example,
the young adult has tremendous tension or anxiety about opening up with
the parent or is still emotionally involved with the experiences of guilt or
shame in response to memories of past conflicts. Alternatively, the young
adult may be constrained in the relationship because he or she is intensely
ashamed of or embarrassed by the parent; the parent functions as a
negative ego ideal, detracting from and constraining the young adult's

l 6 2
ability to be him or herself in the relationship with the parent and implicitly

or explicitly diminishing the young adult's own feelings of self-worth.

W:

a) In some areas the young adult appears to be uninhibited by shame
or guilt in the relationship with the parent (e.g., he or she can discuss
potentially shameful experiences or assert and maintain his or her own
standards when these difl'er from those of the parent); however, in other
important areas the young adult appears to be constrained in the
relationship by feelings of shame or guilt (be it shame about his or her own
or the parent's characteristics) and these areas compromise the young
adult's feelings of self-worth.

b) In some significant areas the young adult implicitly or explicitly
uses the parent to set standards for his or her behavior in the relationship
and/or indicates that he or she continues to need the parent's approval; in
other areas, however, he or she is more able to be a self-evaluator.

W:

a) The young adult generally is uninhibited by feelings of shame and
uses his or her own standards to monitor his or her behavior in the
relationship with the parent. However, there is a Eirly isolated area in
which he or she continues to be inhibited and implicitly or explicitly seeks
or desires the parent's approval.

b) Although the young adult generally is comfortable being him or
herself in the relationship with the parent he or she admits to an important
but isolawd area in the relationship in which he or she is unable to be him
or herself. Although the constraints are mostly outside of the young adult's

l 6 3
control the tensions in some way detract from the young adult's feelings of

self-worth; implicitly if not explicitly, the young adult appears to need the
parent's acknowledgment or approval to alleviate feelings of self-doubt,
rejection, etc. Alternatively, the young adult may be ashamed of the parent
and while these feelings are relatively isolated they detract in some way
from the young adult's feeling of self-worth and from a generally high level
of self-assertion in the relationship with the parent.

c) While it is evident that the young adult has developed his or her
own standards and is not inhibited by guilt or shame in the relationship
with the parent, repeated statements about not, needing the parent's
approval suggest that his or her sense of being a self-evaluator is not on as
firm ground as at Level 5.

W:

a) The young adult is able to assert him or herself and express his or
her needs, values and interests in the relationship with the parent even
when these needs or values clash with those of the parent. The young adult
gives no evidence that he or she views the parent as an authority figure or
as an appropriate judge of the young adult's self-worth or behavior.

b) The young adult clearly has his or her own standards for
evaluating his or her behavior and these can be clearly distinguished from
those of the parent. The young adult does not sacrifice these standards in
the relationship with the parent although at times he or she may avoid
certain issues that might lead to unnecessary tensions. At Level 5, not
bringing up these issues does not in any way detract from the young adult's
feelings of self-worth and is rather an indication that he or she does not
need the parent's approval.

l 6 4
c) The young adult's relationship with the parent is limited more by

the parent's conflicts, inhibitions, etc. than by the young adult's lack of
assertiveness. Although the young adult may openly confront the parent in
an attempt to change the relationship, be or she is able to acknowledge and
accept that, given the parent's limitations, he or she will "never" be him or
herself with the parent. This knowledge does not compromise the young
adult's standards nor detract from his or her feelings of self-worth.

l 6 5
SELF/OTHER RESPONSIBILITY

DEFINITION: This dimension describes how the young adult resolves
conflicts and pulls between obligations and needs created by his or her own
life circumstances and the needs of and the obligations to the parents.
Conflicts about where and with whom to spend holidays and vacations often
provide information on this dimension. Selflother responsibility is similar
to what other theorists have described as the parent's ability to allow the
child to develop relationships and interests outside of the parent/child dyad;
however, here it is coded from the young adult's perspective and describes
his or her ability to make attachments and investments outside of the
relationship with the parent.

Note: Most young adults who are high on this dimension should be able to
make new investments without totally denying the needs of or breaEng
contact with the parent. However, a young adult may have a very negative
relationship with the parent and still score high on selflother responsibility
if he or she has developed new sources outside of the parent/young adult
relationship for finding love and afl‘ection, fulfillment, stimulation,
eficacy, etc. A young adult who continues to rely heavily on the parent for
these psychological resources or who Eils to make psychological
investments outside of the dyad Mcause he or she continues to be embroiled
in unresolved conflicts with the parent would be raEd as low on selflother
responsibility. The quality of the parent/young adult relationship that to a
greater or lesser extent is left behind is irrelevant in coding this dimension
and will be rated elsewhere.

166
WEB

The young adult's selflother responsibility in the relationship with
the parent is coded on a 5 point scale with 1 referring. to "low" selflother
responsibility and 5 referring to "high" selflother responsibility. The
criteria for rating a protocol as 1, 2, 3, 4, or 5 on the SelflOther
Responsibility Scale are described below.

W:

a) The young adult is unable to leave home in the psychological
sense. The young adult has not transferred his or her loyalties and
investments to new sources of afl‘ection, stimulation, fulfillment, etc.:
rather, he or she relies heavily on the relationship with the parent for
stimulation, afi‘ection, fulfillment, etc. and feels lonely or abandoned
without constant contact.

b) The parent is involved in the minute details of the young adult's
life. The young adult may have excessive responsibility for or involvement
in the parent's life or concerns and/or is responsible for involving the
parent in his or her own life concerns.

c) The young adult is often triangulated in the parent's marital or
family relationships and/or is unable to keep the parent from interfering in
his or her own relationships or efi‘orts to make an independent life for him
or herself.

W:
a) As in Level 1, there are clear indications that the parent is
overinvolved in significant areas of the young adult's life and vice versa, but

the enmeshment is not as intense, emotionally compelling, or all-pervasive

l 6 7
as in a Level 1 protocol. The young adult may view the enmeshment

positively, may not exert any efi‘ort to separate, or else might make weak but
mostly inefi'ective attempts to deinvest in the dyad.

b) The young adult resists pressures to deinvest in the dyad or yearns
to increase his or her involvements at the expense of separation even
though these efl'orts may be resisted by the parent.

W:

a) The young adult makes clear attempts to resist the parent's
intrusiveness, but constantly has to be on guard against inner pulls (e.g.,
guilt or dependency needs) and/or parental pressures that may interfere
with or encroach on involvements and relationships outside of the dyad or
Emily of origin.

h) The young adult's overinvolvement in the dyadic relationship with
the parent and/or inner pulls towards excessive involvement are moderated
by investments in other important areas (e.g., other close relationships,
career, etc.); these other investments are relevant for rating selfl'other
responsibility if they serve as alternate sources of support, afi'ection,
fulfillment, etc. and help to deintensify involvements with the parent.

W:

a) The young adult describes minor instances of overinvolvement or
minimal conflicts about separating from the parent, but for the most part
the young adult has make satisfying or fulfilling investments outside of the
parent/young adult relationship.

1 6 8
b) Although the parent attempts to triangulate or remain excessively

involved in the young adult's life, the young adult for the most part actively
and successfully Ends 03 these attempts by the parent.

c) There is some evidence that the young adult has in some ways
given in to his or her own or to the parent's desires for triangulation,
overinvolvement, etc., but these compromises only minimally afl‘ect the
young adult's generally successful attempts to make satisfying investments
outside of the dyadic relationship.

W

a) The young adult clearly has made satisfying, stable, and fulfilling
investments outside of the dyadic relationship with the parent and is able to
regulate the relationship so that contacts with the parent do not intrude on
his or her relationships outside of the dyad.

b) The young adult is able to share in the parent's life or to share
their life with the parent (if this is viewed as desirable) without fear of
triangulation, overinvolvement or enmeshment.

c) If the young adult does not directly address the issue of selflother
responsibility but there is no indication of overinvolvement, triangulation,
or enmeshment, code the protocol as a 5.

 

17. In what ways are you like your mother/father? (What does that tell
you about yourself?)

18. In what ways are you difl'erent from your mother/Ether? (What does
that tell you about yourself?)

23a. Canyouthinkofatimethatyoutalkedoveranimportantdecision
with your mother/Ether? IF SAYS NEVER: Imagine what would
happen if you did... what might happen? IF SAYS CAN'T
IMAGINE: What makes that impossible to imagine?

23b. What other kinds of decisions do you discuss with your
mother/father... for example, your financial afl‘airs, personal
relationships, work or career choices?

24. Can you think of a time that you and your mother/father disagreed
about something very important? Tell me about that. (How did you
handle that? How did you feel about your response? How did it get
resolved? Is that how disagreements usually get resolved between
you and your mother/father?)

25a. In what ways are your values difi‘erent fi'om those of your
mother/father?

25b. In what ways are your values similar to those of your mother/Ether?

Independence:

9. In general, how much does your mother/Ether talk about his/her
personal concerns with you? What kinds of things does s/he discuss?
(How do you feel about that?)

1 7 0
10. And how much do you talk about your personal concerns with

her/him? What kinds of things do you discuss? (How do you feel

about that?

17. In what ways are you like your mother/father? (What does that tell
you about yourself?)

18. In what ways are you difl'erent from your mother/Ether? (What does
that tell you about yourself?)

19a. In what ways does your mother/father show concern for your needs
or welfare? (Can you give me a few examples? How do you feel about
this?)

19b. Do you think she should be more or less responsive to your needs?
(How would that afl‘ect your relationship?)

20. In what ways do you show concern for your mother/Ether's needs or
welfare? Do you think she gets the message? IF NO: What makes
you say that? Do you wish it were difl‘erent? IF YES: How do you
know?

25c. We've talked about things that you discuss with your mother/father.
Besides advice, what other kinds of things does she help you with?
(Do you ask for help or does she ofl‘er?-Who initiates9—How do you
think slhe feels about doing that for you? How do you feel?)

26. What happens when your mother/Ether is not available. (IF SAYS
NOTHING, ASK: Imagine...)

27 . Are there ways in which you wish you could rely more on your
mother/Ether... or maybe less? (How do you expect that to come
about?)

Eersanalficntml:

3. What do you enjoy about your contacts with your mother/father?

 

17 1
4. What does your mother/father enjoy about these contacts?

5. Of course, there's usually something we don't enjoy about others...
what might these things be about your mother/Ether?

6. What do you think might not be so enjoyable about these contacts for
your mother/father?

11a. Are there things that you avoid talEng about with your
mother/father? What kinds of things?

11b. What do you think makes you avoid these topics? (Can you give me
one or two examples? How do you feel about that?)

13a. Are there any feelings of tenseness when you and your mother/father
are together?

13b. How often does that occur?

13c. What do you think that feeling of tenseness is about?

24. Can you think of a time that you and your mother/father disagreed
about something very important? Tell me about that. (How did you
handle that? How did you feel about your response? How did it get
resolved? Is that how disagreements usually get resolved between
you and your mother/Ether?)

28. What are some of your mother/father's weaknesses? What do you
think makes her/him that way?

29. In what ways would you like her/him to change? Do you think s/he
ever will? (How will that come about?) IF SAYS, I DON‘T KNOW:
What do you think s/he might do to change?) IF SAYS NO: What
might prevent her/him from changing?

30. In what ways has s/he let you down?

31. What kinds of things about your mother/Ether make you Eel proud?
What are some of her/his strengths?

172

SelfiAssertion:

9.

10.

11a.

11b.

13a.

13b.

13c.

1.68.

16b.

16c.

17.

18.

In general, how much does your mother/father talk about his/her
personal concerns with you? What kinds of things does s/he discuss?
(How do you feel about that?)

And how much do you talk about your personal concerns with
her/him? What kinds of things do you discuss? (How do you feel
about that?

Are there things that you avoid talking about with your
mother/father? What kinds of things?

What do you think makes you avoid these topics? (Can you give me
one or two examples? How do you feel about that?)

Are there any feelings of tenseness when you and your mother/father
are together?

How often does that occur?

What do you think that feeling oftenseness is about?

At what point were you closest to your mother/Ether?

At what point were you most distant from your mother/father?
TAKE THE LATEST REFERENT POINT, OR AGE, WHETHER
CLOSE OR DISTANT AND ASK: Your relationship has changed
since (age... or time...) How do you account for the difl‘erence?

In what ways are you like your mother/father? (What does that tell
you about yourself?)

In what ways are you difl‘erent fi'om your mother/Ether? (What does
that tell you about yourself?)

Can you think of a time that you and your mother/father disagreed
about something very important? Tell me about that. (How did you
handle that? How did you feel about your response? How did it get

l 7 3
resolved? Is that how disagreements usually get resolved between

you and your mother/father?)

SIEQH B 111.

16a.
18).
16c.

21.

What kinds of contacts do you have with your mother/father? (List
below) FOR EACH ONE MENTIONED, ASK: About how often do you
do this?

IF THE YOUNG ADULT IS LIVING IN THE PARENTAL HOME,
ASK: About how much time do you spend with your mother/Ether?
Who initiates the contacts between you and your mother/father? (Can
you give me an example?)

Do you wish you had more or less contact with your mother/father?
IF MORE OR LESS: Why would you prefer (more/less) contact?

IF SAME: What makes it seem about right?

At what point were you closest to your mother/Ether?

At what point were you most distant from your mother/Ether?

TAKE THE LATEST REFERENT POINT, OR AGE, WHE'I'HER
CLOSE OR DISTANT AND ASK: Your relationship has changed
since (age... or time...). How do you account for the difference?

Can you think of a time recently when you felt conflicted about your
mother/father's needs and your needs? What was that about? (How
did you handle it? How did you feel about the way it was handled?)

LIST OF REFERENCES

 

LIST OF REFERENCES

Ainsworth M &Ainsworth L (1958) WWW
Adjustment. Toronto. University of Toronto Press.

Amdur, M., Tucker, G., Detre, T. & Markhus, K. (1969). Anorexia nervosa:

An interactienal study W
559-566.

American Psychiatric Association (1987). Wed
_ . ' f. ' .13., Washington,

 

DC: American Psychiatric Association.

Armstrong, J. & Roth, D. (1989). Attachment and separation dificulties ln
eating disorders: A preliminary investigation. International
W 141-155

AtEns, D. (1989). Treating anorexia nervosa: Di agnostic dilemmas and
therapeutic challenges. In M. Roberts 8; C. Walker (eds) Casebook
(pp. 404-424). New York: The
Guilford Press.

Beattie, H. (1988). Eating disorders and the mother-daughter relationship.
Intemafignal Jamal of Eamg' Disorders, 1, 453-460.

Blos, P. (1967). The second individuation process of adolescence.

W2. 162- 196

Bruch, H. (1971). Family transactions in eating disorders. Win
W2. 238-248

Bruch, H. (1973) : ' ° '
W New York: Basic Books.

Bruch, H. (1978). = - '
Cambridge: Harvard University Press.

Bruch, H. (1980). Preconditions for the development of anorexia nervosa.
Ammimicumalnfifisxchmamim 169-172.

Calam, R., Waller, G., Slade, P. & Newton, T. (1990). Eating disorders and
perceived relationships with parents Intemalinnalicumalaf
W 479- 485

 

 

174

175

Campbell, E., Adams, G. & Dobson, W. (1984). Familial correlates of
identity formation in late adolescence: A study of the predictive
utility of connectedness and individuality in Emily relations.
WW 509-525.

Chatoor,I., Atkins, D., Bernard, P. &Rohrbeck, C. (1988). Measuring
1 Paperpresented at the International

 

Dexelnnmenthfucale
Conference on Eating Disorders, New York.

Chodorow, N. ( 197 8) Mothering, object-relations, and the female oedipal
configuration. W 137- 158

Crisp, A. (1965). Some aspects of the evolution, presentation, and follow-up
ofanorexia nervosa. :nw ... .a . -. . -..
814-820.

Crisp, A., Hsu, L., Harding, B. 8: Hartshorn, J. (1980). Clinical features of
anorexia nervosa. W 179-191

Dolan, B. Lieverman, S., Evans, C. & Lacey, J. (1990). Family features
associated with normal body weight bulimia.

WW7.

Eichenbaum, L. & Orbach, S. (1983).
W New York: Coward-McCann, Inc.

Engel, K. & Stienen, M. (1988). Father types of anorexia nervosa patients:
The 'bonding', the 'brutal', the 'weak' and the 'absent' Ether.

We. 145-152.

Frank, S., Avery, C. 8: Laman, M. (1988). Young adults' perceptions of
their relationships with their parents: Individual difl'erences in
connectedness, competence, and emotional autonomy.

W91“ 729-737 .

Frank. S &Burke..L. (1992). Deideallzaunnandantonmlate.
. . . . . . . .. . ‘ .. Paper

. resented at the Bi-annual Meeting of the Society for on
Adolescence, Washington, DC.

Frank, S. & J ackson-Walker, S. (in press). Family experiences as
moderators of the relationship between eating symptoms and
personality disturbance. WWW-

Frank, S., J ackson-Walker, S. & Monestere, C. (1992). W
W Unpublished measure

 

 

l 7 6
Frank, S., Pirsch, L. & Wright, V. (1990). Late adolescents' perceptions of
their relationships with their parents: Relationships among
deidealization, autonomy, relatedness, and insecurity and
implications for adolescent adjustment and ego identity status.

MW 571-588
Frank's. &Poorman,M. (1993). WWW

messes. Paper presented at the Society for Research m Child
Development, New Orleans, LA.

Friedlander, M. & Siegel, S. (1990). Separation-individuation dificulties
and cognitive-behavioral indicators of eating disorders among college

women. MW 74-78

Garfinke1,P., Garner, D. Rose, J., Darby, P, Brandes, J., O'Hanlon, J. &
Walsh, N. (1983). A comparison of characteristics in the Emilies of
patients with anorexia nervosa and normal controls. hydrological

MedicineJfl. 821-828

Garner, D. & Garfinkel, P. (1979). The Eating Attitudes Test: An index of
the aymotoma of anorexia nervosa. W9. 647-

 

Garner, D. 8: Garfinkel, P. (1980). Sociocultural Ectors rn the development
of anorexia nervosa. W19. 647-656

Garner, D., Garfinkel, P. 8: O'Shaughnessy, M. (1985). Validity of the
distinction between bulimia with and without anorexia nervosa.

W142. 581-587.

Garner, D., Garfinkel, P., Schwartz, D. 8: Thompson, M. (1980). Cultural
expectations ofthinness m women. W 483-

Garner,D., Olmsted, M., Bohr, Y. &Garfinkel, P. (1982). The eating
attitudes test: Psychometric features and clinical correlates.

NW 871-878

Garner, D. Olmsted, M. & Polivy, J. (1983). Development and validation of
a multidimensional eating disorder inventory for anorexia nervosa

and bulimia. W. 15-34

Grotevant, H. 8; Cooper, C. (1986). Individuation in Emily relationships: A
perspective on individual difl’erences in the development of identity
and role—taEng in adolescence. MW 82-100.

l 7 7
Halmi, K., Struss, A. & Goldberg, S. (197 8) An investigation of weights 1n
the parents of anorexia nervosa patients. MW
W195. 358-361

Heesacker, R. 8; N ermeyer, G. (1990). Assessing object relations and social
cognitive correlates of eating disorder. W

M 419-426

Hofi'man, J. (1984). Psychological separation of late adolescents hear their
parents lonmalnfflnrmselinglimhnlnudl. 170-178.

Holmbeck, G. & Wandrei, M. (1993). Individual and relational predictors of
adjustment' in first-year college students. MW
magma. 73-78.

Humphrey, L. (1986a). Family relations ln bulimic-anorexic and

nondistressed families WW
5. 223-232.

Humphrey, L. (1986b). Structural analysis of parent-child relationships in
eating disorders. Janmalnmhnnnnallmhnlcufli. 395402.

Humphrey, L. (1989). Observed Emily interactions among subtypes of
eating disorders using structural analysis of social behavior.

Jonmalniflcnmflfinaandflinicallsxcholnujl. 206-214

Humphrey, L., Apple, R. & Kirschenbaum, D. (1986). Difl'erentiating
ulimic-anorexic from normal Emilies using interpersonal and

behavioral observational systems Jonmalafflonsldfinaand.
W 54. 190-195.

Humphrey, L. 8: Stem, S. (1988). Object relations and the Emily system m
bulimia: A theoretical integration JmlmaLnfMaritalandEarnilx

W 337-350

Johnson, C. (1985). Initial consultation for patients with bulimia and

anorexia nervosa. In D. Garner & P. Garfinkel (eds. ). Handhmknf.
.. . (pp. 19.51). New

 

York: The Guilford Press ‘

Johnson, C. & Flach, A. (1985). Family characteristics of 105 patients with
bulimia WW2 1321-1324

J osselson, R. (1980). Ego development in adolescence. In J. Adelson (ed.),
HandhmkafAdnlescenLEuchclnu (pp. 188.210). New York: Wiley-

Kalucy, R., Crisp, A. & Harding, B. (1977). A study of 56 Emilies with
anorexia nervosa. 381-395.

 

 

178

Kenny, M. (1987 ). The extent and function of parental attachment among

first-year college students. dismaliilnnthandAdnlescenmJfi. 17 -
27 .

Kenny, M. 8: Donaldson, G. (1991). Contributions of parental attachment
and family structure to the social and psychological functioning of
first-year college students Jaumalnffinunsehnsfiuchnlnunai.
479486.

Kenny, M. & Hart, K. (1992). Relationship between parental attachment
and eating disorders m an inpatient and a college sample. Journal

Walla. 4. 521-526

Kent, J. 8: Clopton, J. (1992). Bulimic women's perceptions of their Emily
relationships MW 281-292.

Krueger, D. (1989). = . ° -.
thlcaLIntesminnnflhsnrderufithLSelf New York:

Brunner/Mazel.

Lamborn, s. & Steinberg, L. (1990). Wins
W. Paper presented at the Biennial Conference of the
Society for Research on Adolescence, Atlanta, GA.

Lehman, A. & Rodin, J. (1989). Styles of self-nurturance and disordered
eating Jaimilnflflnnndinsandflinicalflxchdmjl. 117-122

Lopez, F., Campbell, V. & WatEns, C. (1986). Depression, psychological
separation, and college adjustment: An investigation of sex

difierences MW 52-56.

Lopez, F., Campbell, V. & WatEns, C. (1988). Family structure,
psychological separation, and college adjustment: A canonical

analysis and cross-validation. WWW

 

Mahler,M. (1968). 9n ' ° ° ° -.
Indiyidnatjgn. New York: International Universities Press.

Maine. M. (1991). W Carlsbad.
CA: Gurze Books.

McNamara, K. & Loveman,C ..(1990) Differences rn Emily functioning
among bulimics, repeat dieters, and nondieters. W

W 518-523.

Mintz, L. & Betz, N. (1988). Prevalence and correlates of eating disordered

behaviors among undergraduate women. W
M 463-471

 

179

Minuchin, S, Baker, L. Rosman, B., Liebman, R, Milman, L. 8: Todd, T.
(1975). A conceptual model of psychosomatic illness in children.
WW2 1031-1038

Minuchin, S., Rosman, B. & Baker, L. (1978). W:
Annmaflemsnrnfiontext. Cambridge. MA: Harvard University
Press.

Ofi'er, D., Ostrov, E. 8; Howard, K. (1989). WW
QliesimnmfnnAdnlasnsnts Chicago: Michael Reese Hospital

 

Orbach, S. (1986). - V . -.
W- New York: W. W. Norton & Company.

Pike, K. & Rodin, J. (1991). Mothers, daughters, and disordered eating.
WWW 198204.

Prrsch,‘ L. (1993). ' ' ' ‘ '
' ° . Unpublished doctoral dissertation.

Pole, R. ,Waller, D. ,Stewart, S. 8: Parkin-Feigenbaum, L. (1988). Parental
canns versus overprotection in bulimia Intsmninnalimlmalhfi

EainsDisnnlersJ. 601-606

Polivy, J. & Herman, C. (1987). Diagnosis and treatment of normal eating.
JaimathCnnsnlinLandClinicalhychclnufi. 635-644.

moves, P. 8: Johnson, M. (1992). Relationship between family-of-origin
functioning and self-perceived correlates of eating disorders among
female college students. JanmalafiCnllmStidentDenhmmenifla.
44-49.

Rhodes, B. & Kroger, J. (1992). Parental bonding and separation-
individuation dificulties among late adolescent eating disordered

women. Child W12 249-263

Rice, K., Cole, D. & Lapsley, D. (1990). Separation-individuation, Emily
cohesion, and adjustment to college: Measurement validation and

tent of a theoretical model. loumalhfilenselinsPsxchclnuJL
195-202.

Ryan, R. & Lynch, J. (1989). Emotional autonomy versus detachment:
Revisiting the vicissitudes of adolescence and young adulthood.

WW

Scalf-McIver, L. & Thompson, J. (1989). Family correlates of bulimic

characteristics m college females Winnings.
45, 467-472.

180

Schupak-Neuberg, E. & Nemerofi', C. (1993). Disturbances ln identity and
self-regulation ln bulimia nervosa: Implications for a metaphorical

 

Madison, Conn: International Universities Press. ‘

Schwartz, R, Barrett, M. & Saba, G. (1985). Family therapy for bulimia. In
D. Garner & P. Garfinkel (eds. ),

Handbiokflmhntheranm
Anorexiahlerrllsaandfiulimia (pp 280-307). New York: Guilford
Press.

Selvini-Palazzoli, M. (1978). 89199181191191:- New York: Aronson.

Shisslak, C, McKeon, R. & Crago, M. (1990). Family dysfunction rn
normal weight bulimic and bulimic anorexic Emilies. W

ChmcalEucholcuadi. 185-189

Smolak, L. & Levine, M. (1993). Separation-individuation dificulties and
the distinction between bulimia nervosa and anorexia nervosa in

college women. Intsrnaionalinnmnlhffiainanlsnrdersnld. 1. 33-
41.

Steiger, H. & Houle, L. (1991). Defense styles and object-relations
disturbances among university women displaying varying degrees of
InEmainnalJoimalnfEainaDisnrdem.

”symptomatic" eating.
19. 145-153.

Steiger, H, Van der Feen, J, Goldstein, C. & Leichner, P. (1989). Defense
styles and parental bonding m eating-disordered women.
IntemainnalimrmalnfEainsDisnrdemfl. 131-140

Steinberg, L. & Silverberg, S. (1986). The vicissitudes of autonomy in early
adolescence ChildDuclnmnnltJL 841-851.

Steiner-Adair, C. (1990). The body politic: Normal female adolescent
development and the development of eating disorders. In C.

Gilligan, N. Lyons & T. Hanmer (eds). MakinLCnnnecions (pp. 162-
182). Cambridge, MA: Harvard University Press.

Stern, S, Dixon, K., Jones, D. ,Lake, M., Nemzer, E. & Sansone, R (1989).
Family environment in anorexia nervosa and bulimia.

W9 25-31.

Stoltz, S. (1985). Beware of boundary issues. Wis.
JnnmaLJE. 37 -41-

 

181

Strauss, J. & Ryan, R. (1987). Autonomy disturbances in subtypes of
anorexia nervosa. WWW 254-258.

Sh'iegel-Moore, R. & Kearney-Cooke, A. (1994). Exploring parents' attitudes
and behaviors about their children' s physical appearance.

WWW 4. 377-385

Shiegel-Moore, R., Silberstein, L. & Rodin, J. (1986). Toward an

understanding of risk factors for bulimia. W
41, 246-263.

Strober, M. (1981). The significance of bulimia 1n juvenile anorexia
nervosa: An exploration of possible etiologic factors. W
Wardens 28-43.

Strober, M. & Humphrey, L. (1987). Familial contributions to the etiology
and course of anorexia nervosa and bulimia. MW

W95. 654-659.
Stutman, S. & Lich, S: (1985).
Professional Psychology.

Thelen, M. Farmer, J., Mann, L. & Pruitt, J. (1990). Bulimia and
interpersonal relationships: A longitudinal study. W
Qannsding Emhdmjl. 85-90.

Timko, C., Striegel-Moore, R... Silberstein, L. & Rodin, J. (1987).
Femininity/masculinity and disordered eating in women: How are

they relawd? WW9 701-712

Thompson, M. 8: Schwartz, D. (1982). Life adjustment of women with
anorexia nervosa and anorexic-like behavior. W

W 47-60

Williams, G., Chamove, A. 8: Millar, H. (1990). Eating disorders, perceived
control assertiveness and hostility BntishJanmalpLCJininal

W 327-335
Wright, V. (1992).

. Los Angeles: California School of

  

doctoral dissertahon. I '

Yager, J. (1982). Family 1881108 in the pathogenesis of anorexia nervosa.
W 43-58.

Yates,W (.1992) Weight factors 1n normal weight bulimia nervosa: A
controlled family study.
11, 227- 234.

182

Zaln'n, D. (1989). Eating disturbance, emotional separation, and body
image. WW9 411-416.

"lilil'flljlfilillllllflr