Copyright 1991 by the American Psychological Association, Inc. 0021-843X/91/S3.00
Journal of Abnormal Psychology 1991, Vol. 100, No. 2, 198-204
Mothers, Daughters, and Disordered Eating Kathleen M. Pike and Judith Rodin
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Yale University We examined features of 77 mothers' attitudes and behavior that relate to disordered eating among their adolescent daughters. Mothers whose daughters reported a level of disordered eating comparable with clinical samples of bulimic patients were compared with mothers whose daughters reported a low level of eating disturbances. As hypothesized, mothers of daughters with disordered eating were more dissatisfied with the general functioning of the family system. Also, mothers whose daughters were eating disordered were themselves more eating disordered and differed in their dieting history compared with mothers of the girls who were not eating disordered. Furthermore, mothers of girls with disordered eating thought their daughters should lose more weight than mothers of girls who were not eating disordered. They also thought that their daughters were less attractive than the girls judged themselves.
To put this study of the mother-daughter relationship in its proper context requires an assessment of the unique social system to which this dyad belongs, namely the family. In this regard, converging evidence has indicated that families of girls with both subtypes of bulimia (i.e., anorexic and normal weight) experience a range of problems in the general functioning of their family systems. As compared with persons from control families, those with bulimic anorexia and normal weight bulimia nervosa report that their families are more conflictual, disorganized, critical, and walled-off and are less cohesive, helpful, trusting, and nurturing (Humphrey, 1986a, 1987; Johnson & Flach, 1985; Kog & Vandereycken, 1985; Kog, Vertommen, & DeGroote, 1986; Ordman & Kirschenbaum, 1986; Strober, 1981; Strober & Humphrey, 1987). Reports from parents of girls with bulimic anorexia and normal weight bulimia, as well as from mothers of compulsive eaters, have noted similar problems with the family system (Attie & Brooks-Gunn, 1989; Humphrey, 1986b). Furthermore, these subjective reports have been corroborated by observational studies of anorexic, bulimic, and normal families (Humphrey, 1987,1988). In addition to general problems in the functioning of the family system, several investigations have attempted to determine whether disordered eating and a preoccupation with weight and appearance by other family members is associated with bulimia in adolescent girls. Although girls with eating disorders commonly report weight problems and dieting concern among other family members (Carroll & Leon, 1981; Fairburn & Cooper, 1982; Pyle, Mitchell, & Eckert, 1981), controlled studies are not entirely consistent on this issue. In the case of anorexia nervosa, Halmi, Struss, and Goldberg (1978) found no significant weight differences between the parents of adolescent girls with anorexia nervosa and control parents. It has also been reported that parents of anorexic girls do not differ in their own level of disordered eating, level of restraint, overvaluation of thinness, or related attitudes (Garfinkel et al., 1983). However, other investigations have found significantly higher rates of eating disorders among family members of persons diagnosed with anorexia nervosa than in relatives of control subjects (Gershon et al., 1983; Strober, Morrell, Burroughs, Salkin, & Jacobs, 1985).
The highest incidence of disordered eating occurs among women during adolescence and young adulthood (Candour, 1984; Levine, 1987). Although it is commonly agreed that the family system is powerfully influential during this developmental phase, the specific ways in which the family is involved in the onset and maintenance of disordered eating have yet to be fully explicated. The aim of this study was to focus on the motherdaughter relationship and the features of mothers' attitudes and behavior that relate to disordered eating among their adolescent daughters. From a sociocultural perspective it has been argued that there is mounting pressure on women in our society to achieve a body weight and size through dieting that is both unrealistic and unhealthy (Garner, Garfinkel, Schwartz, & Thompson, 1980; Johnson & Pure, 1986; Rodin, Silberstein, & Striegel-Moore, 1984; Wooley & Wooley, 1979). In fact, it has been argued that societal concern with dieting and weight is so widespread that a moderate degree of concern is normative among women (Striegel-Moore, Silberstein, & Rodin, 1986). Accordingly, rather than being a discrete group with unique concerns, women who develop eating disorders are thought to be those who fall at the extreme end of the continuum of eating and weight concerns. This theoretical perspective raises several interesting questions with regard to mothers and daughters. First, to what extent do mothers and daughters, both female and both subject to intense social pressures, share similar attitudes and behaviors about diet and weight? Second, to what extent do mothers serve as role models for their daughters in terms of concerns with appearance and dieting? Finally, is it possible that the mothers of girls who become eating disordered operate as society's messengers, directly pressuring their daughters to achieve the cultural ideal of thinness and attractiveness? This investigation was designed to address these questions of how the motherdaughter relationship may relate to the manifestation of disordered eating among adolescent girls. Correspondence concerning this article should be addressed to Judith Rodin, P.O. Box 11A, Yale Station, New Haven, Connecticut 06520.
198
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
MOTHERS, DAUGHTERS, AND DISORDERED EATING
With regard to the relation between parental weight problems and the manifestation of bulimia, researchers have reported from controlled studies a consistent, but frequently insignificant, trend for the incidence of parental obesity to be greater for bulimic anorexics and normal weight bulimics than for restrictive anorexics. In a study by Garfinkel, Moldofsky, and Garner (1980), mothers of bulimic anorexics reported a significantly higher incidence of obesity than did mothers of restrictive anorexics. Also, in the Strober et al. study (1985), the incidence of eating disorders among family members was especially significant in the bulimic anorexic probands. However, in another study by Strober (1981), a trend for maternal obesity among eating disorder patients was reported, but the difference between groups was not significant. Also, differences between the rates of paternal obesity for girls with eating disorders and for control subjects have not been significant (Garfinkel et al., 1983; Strober, 1981). Only Attie and Brooks-Gunn (1989) examined factors other than parental weight per se—in their case, mothers' concern with weight and bodily issues. These attitudes did not contribute significantly to the regression model for compulsive eating among their daughters. The goal of our study was to explore further how mothers' attitudes and behaviors relate to their daughters' disordered eating. Consistent with the findings we have just discussed, it was hypothesized first of all that mothers of eating disorder girls would report significantly more problems in the general functioning of the family system than would mothers of girls without disordered eating. Mothers were asked to evaluate the general functioning of the family system; in addition to measuring current family functioning, we gathered data from mothers about how their ideal family system would function. In this way, it was possible to compare current versus ideal functioning to ascertain mothers' level of satisfaction with various aspects of their families. It was expected that such a measure of satisfaction would provide additional information about how families differ in their general functioning and would offer further insight into the relation of family dynamics to disordered eating. Second, given the contradictory findings that have related family weight concerns to the incidence of eating disorders, we wished to test a range of measures of weight, diet, and appearance to address the particular question of how mothers' concerns in this domain may be related to disordered eating among their daughters. Clinical case reports and family systems theory suggest that parents may influence their children's eating behavior directly through the process of modeling particular attitudes and behaviors surrounding eating and weight issues (Ausubel, Montemayor, & Svajian, 1977; Boskind-White & White, 1983; Carroll & Leon, 1981; Costanzo & Woody, 1985; Douvan & Gold, 1966). Thus, in this study it was hypothesized that mothers' attitudes and behaviors about weight and appearance would influence their daughters' attitudes in these areas. Serving as role models for their daughters, mothers who are highly concerned with thinness, dieting, and appearance may be more likely to have daughters who are disordered in their eating. Mothers' attitudes about their daughters' weight and appearance were also assessed to test whether, in addition to more passive modeling, there were more active ways in which mothers' concerns with weight and dieting were associated with disordered eating among daughters. It was hypothesized that
199
mothers of girls with disordered eating would not only be highly self-critical about their own weight and appearance but that they would apply the same standards to their daughters, placing more pressure on their daughters to achieve ideals of thinness and attractiveness that wpuld put them at risk for becoming eating disordered. Method This study was conducted as an adjunct to a protocol (Pike, 1989) in which approximately 350 high school girls were studied to determine family system, peer, and personality variables predictive of disordered eating. For the present study two subgroups of girls were identified based on their level of disordered eating. The measure of disordered eating was constructed by summing three subscales, Drive for Thinness, Bulimia, and Body Dissatisfaction, of the Eating Disorders Inventory (EDI). These three subscales of the EDI were used to establish an index of disordered eating because they measure those specific aspects of weight preoccupation and diet concern that are primary to disordered eating and bulimia. Thus, consistent with the diagnostic criteria used to diagnose bulimia, the Disordered Eating Index is a composite score that includes both the behavioral measure of bulimia as well as the attitudinal components of body dissatisfaction and drive for thinness. This procedure permitted us to consider the relevance to the mother-daughter relationship of the five more general subscales of the EDI separate from the primary measure of disordered eating. In both the disordered eating group and the comparison group, the mean age of the girls was 16, and the girls were approximately evenly distributed among the 9th through 12th grades. The disordered eating group was composed of girls in the larger study who scored in the 75th percentile or higher on the Disordered Eating Index. The mean scores of the disordered eating group on all eight subscales of the EDI were comparable to the scores of clinic patients diagnosed with bulimia nervosa (Pike & Rodin, 1991) according to the Diagnostic and Statistical Manual of Mental Disorders (rev. 3rd ed.; American Psychiatric Association, 1987). Girls selected for the comparison group were all those who scored in the 10th-35th percentiles on the Disordered Eating Index. It was decided a priori to exclude girls in the lowest 1 Oth percentile of the EDI index from the comparison group because, as discussed earlier, a moderate degree of concern with weight and appearance is so normative that these girls may actually be aberrant in some way that would preclude their providing a useful comparison. The mean scores on the eight EDI subscales as well as the composite score of disordered eating for the two groups of girls are presented in Table 1.
Subjects The subjects were 77 mothers who were solicited on the basis of their adolescent daughters' classification into one of the two groups in terms of disordered eating. The subjects were unaware of the criteria for recruitment. All subjects were white, middle-class urban and suburban women. The mean age of the mothers whose daughters were in the comparison group was 44, and the mean age of the mothers whose daughters were in the disordered eating group was 42. This age difference was not statistically significant.
Measures Family Adaptability and Cohesion Evaluation Scale III (FACES-HI: Olson, Partner, & Lavee, 1985). The FACES -III is a 20-item, self-report measure that results in two subscales, Family Cohesion and Family Adaptability. Family Cohesion measures the emotional bonding that family members have toward one another. Family Adaptability measures the extent to which the family system is able to change its power
200
KATHLEEN M. PIKE AND JUDITH RODIN
Table 1 Daughters' Scores on the Eating Disorders Inventory (EDI)
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Disordered eaters
Comparison group
EDI scale
M
SD
M
SD
F(l,76)
Bulimia Body Dissatisfaction Drive for Thinness Interoceptive Awareness Ineffectiveness Maturity Fears Perfectionism Interpersonal Sensitivity
8.31 23.82 15.59 9.67 10.97 6.41 6.44 5.82
5.07 4.56 3.35 6.14 7.21 5.05 4.64 5.26
1.03 7.03 1.58 3.00 2.66 3.53 3.97 3.11
1.52 4.61 2.43 3.62 3.06 2.37 3.79 3.04
71.98 258.22 439.53 33.47 43.01 10.20 6.49 7.65
.001 .001 .001 .001 .001 .002 .013 .007
47.72
7.72
9.63
5.36
629.04
.001
Disordered eating
Note. Disordered eating is a composite score based on the summation of Bulimia, Body Dissatisfaction, and Drive for Thinness. Overall test of significance for Wilks's lambda, F(8, 68) = 87.62, p < .001. structure and role relationships on the basis of situational and developmental demands. The scale is administered twice—once to measure how the subject perceives the current family system and once to measure how the subject would ideally like the family system to be. The difference between the current and ideal family situations results in two measures, Satisfaction With Family Cohesion and Satisfaction With Family Adaptability. Items are scored on a 5-point scale from almost never (1) to almost always (5). Documentation provided by Olson et al. (1985) indicates that the FACES-III is a valid, reliable measure with good construct validity and clinical utility. The FACES-III has been used successfully to distinguish a wide range of family systems with problems such as alcoholism, delinquency, and schizophrenia and differentiates between clinical and normal groups (fora review, see Olson et al., 1985). The correlation between the Cohesion and Adaptability scales is .03, which demonstrates good discriminant validity. The internal consistency reliability is .77 for the Cohesion scale and .68 for the Adaptability scale; and the test-retest reliability of the 50item version is .84. Eating Disorders Inventory (Garner, Olmstead, & Polivy, 1983). The EDI is a 64-item, self-report, multiscale measure, with high reliability and validity, that assesses psychological and behavioral traits common to anorexia nervosa and bulimia (Garner et al., 1983; Raciti & Norcross, 1987; Wear & Pratz, 1987). It includes three subscales that measure attitudes and behaviors related to disordered eating, Drive for Thinness, Bulimia, and Body Dissatisfaction. The EDI also includes five subscales that measure psychological constructs related to the psychopathology of eating disorders: Ineffectiveness, Perfectionism, Interpersonal Distrust, Lack of Interoceptive Awareness, and Maturity Fears. Weight, diet, and appearance. Questions with regard to weight and dieting history as well as ratings of attractiveness were included. The mothers were asked their current height in inches, current weight in pounds, ideal weight in pounds, age at first diet, and maximum number of pounds lost from dieting at one time. This data was collected in a self-report questionnaire because studies indicate that actual and selfreported weights are highly correlated (Charney, Goodman, McBride, Lyon, & Pratt, 1976; Coates, Jeffrey, & Wing, 1978) and that there is no systematic error in body measurements due to weight preoccupation (Radke-Sharpe, Whitney-Saltiel, & Rodin, 1990). The mothers were also asked to compare themselves with women their same age in terms of attractiveness on a scale of a great deal less attractive (1) to a great deal more attractive (5). This measure of attractiveness has had a testretest reliability of .89 in a sample of 664 subjects.
In addition to reporting on their own weight and attractiveness, each mother was asked to report her adolescent daughter's current height in inches, current weight in pounds, and ideal weight in pounds. Each mother was also asked to compare her daughter with other girls her daughter's age on the same attractiveness scale given previously. Finally, a measure of body mass (Body Mass Index; BMI) was calculated according to the following formula provided by the Statistical Bulletin ("Measurement of Overweight," 1984): BMI = Weight (kg) + Height1 (m2). Procedure
A cover letter requesting participation accompanied the questionnaires (FACES-III, EDI, and the weight, diet, and appearance questionnaire). The measures were mailed to the mothers of the girls in the two subgroups. Two mailings were conducted and were followed by postcards to encourage participation. The questionnaires were sent to a total of 140 mothers and were returned by 80, which represents an overall 57% return rate. More specifically, 59% (39 of 66) of the comparison mothers and 55% (41 of 74) of the mothers with daughters in the disordered-eating group returned the questionnaire. Because of missing data, three questionnaires were not usable, which left a total of 39 mothers whose daughters were in the disordered-eating group and 38 mothers whose daughters were in the comparison group of nondisordered eaters. Within each group, the girls whose mothers participated did not differ significantly in terms of disordered eating, age, grade, or family systems variables from the girls whose mothers did not participate. Mother and daughter identification numbers were matched in order to conduct analyses that required specific mother-daughter comparisons.
Results
Family Systems Variables A multivariate analysis of variance (MANOVA) of the four subscales on the FACES-III indicated that the two groups did not differ significantly in terms of current family cohesion, current family adaptability, ideal family cohesion, or ideal family adaptability. However, a significant difference did emerge when ratings of satisfaction were compared. The two groups of mothers differed significantly in terms of their satisfaction with
MOTHERS, DAUGHTERS, AND DISORDERED EATING
201
Table 2 Subjects' Scores on the Family Adaptability and Cohesion Evaluation Scale III Comparison group Mothers
Daughters
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Disordered-eating group Daughters
Mothers
Subscale
M
SD
M
SD
M
SD
M
SD
Family Cohesion Family Adaptability Ideal Cohesion Ideal Adaptability Satisfaction With Family Cohesion8 Satisfaction With Family Adaptability
36.03 26.29 39.78 29.69 -3.94 -5.89
6.73 3.63 4.24 5.35 5.18 5.42
32.97 25.05 37.65 32.70 -4.68 -7.65
8.58 7.61 6.49 7.04 6.85 7.53
33.66 24.66 40.97 30.65 -7.22 -5.78
6.44 6.80 4.91 6.49 7.39 6.16
29.21 25.23 38.18 36.39 -8.97 -11.15
9.28 6.71 7.43 5.49 8.26 8.00
Note. In each of the groups of mothers, 2 women did not complete the Ideal version of the questionnaire. Therefore, the satisfaction scores for mothers are slightly different from the differences between the means reported in the table. " For the Satisfaction With Family Cohesion subscale, the two groups of mothers differed significantly ( p < .05), as did the two groups of daughters (p
Journal of Abnormal Psychology 1991, Vol. 100, No. 2, 198-204
Mothers, Daughters, and Disordered Eating Kathleen M. Pike and Judith Rodin
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Yale University We examined features of 77 mothers' attitudes and behavior that relate to disordered eating among their adolescent daughters. Mothers whose daughters reported a level of disordered eating comparable with clinical samples of bulimic patients were compared with mothers whose daughters reported a low level of eating disturbances. As hypothesized, mothers of daughters with disordered eating were more dissatisfied with the general functioning of the family system. Also, mothers whose daughters were eating disordered were themselves more eating disordered and differed in their dieting history compared with mothers of the girls who were not eating disordered. Furthermore, mothers of girls with disordered eating thought their daughters should lose more weight than mothers of girls who were not eating disordered. They also thought that their daughters were less attractive than the girls judged themselves.
To put this study of the mother-daughter relationship in its proper context requires an assessment of the unique social system to which this dyad belongs, namely the family. In this regard, converging evidence has indicated that families of girls with both subtypes of bulimia (i.e., anorexic and normal weight) experience a range of problems in the general functioning of their family systems. As compared with persons from control families, those with bulimic anorexia and normal weight bulimia nervosa report that their families are more conflictual, disorganized, critical, and walled-off and are less cohesive, helpful, trusting, and nurturing (Humphrey, 1986a, 1987; Johnson & Flach, 1985; Kog & Vandereycken, 1985; Kog, Vertommen, & DeGroote, 1986; Ordman & Kirschenbaum, 1986; Strober, 1981; Strober & Humphrey, 1987). Reports from parents of girls with bulimic anorexia and normal weight bulimia, as well as from mothers of compulsive eaters, have noted similar problems with the family system (Attie & Brooks-Gunn, 1989; Humphrey, 1986b). Furthermore, these subjective reports have been corroborated by observational studies of anorexic, bulimic, and normal families (Humphrey, 1987,1988). In addition to general problems in the functioning of the family system, several investigations have attempted to determine whether disordered eating and a preoccupation with weight and appearance by other family members is associated with bulimia in adolescent girls. Although girls with eating disorders commonly report weight problems and dieting concern among other family members (Carroll & Leon, 1981; Fairburn & Cooper, 1982; Pyle, Mitchell, & Eckert, 1981), controlled studies are not entirely consistent on this issue. In the case of anorexia nervosa, Halmi, Struss, and Goldberg (1978) found no significant weight differences between the parents of adolescent girls with anorexia nervosa and control parents. It has also been reported that parents of anorexic girls do not differ in their own level of disordered eating, level of restraint, overvaluation of thinness, or related attitudes (Garfinkel et al., 1983). However, other investigations have found significantly higher rates of eating disorders among family members of persons diagnosed with anorexia nervosa than in relatives of control subjects (Gershon et al., 1983; Strober, Morrell, Burroughs, Salkin, & Jacobs, 1985).
The highest incidence of disordered eating occurs among women during adolescence and young adulthood (Candour, 1984; Levine, 1987). Although it is commonly agreed that the family system is powerfully influential during this developmental phase, the specific ways in which the family is involved in the onset and maintenance of disordered eating have yet to be fully explicated. The aim of this study was to focus on the motherdaughter relationship and the features of mothers' attitudes and behavior that relate to disordered eating among their adolescent daughters. From a sociocultural perspective it has been argued that there is mounting pressure on women in our society to achieve a body weight and size through dieting that is both unrealistic and unhealthy (Garner, Garfinkel, Schwartz, & Thompson, 1980; Johnson & Pure, 1986; Rodin, Silberstein, & Striegel-Moore, 1984; Wooley & Wooley, 1979). In fact, it has been argued that societal concern with dieting and weight is so widespread that a moderate degree of concern is normative among women (Striegel-Moore, Silberstein, & Rodin, 1986). Accordingly, rather than being a discrete group with unique concerns, women who develop eating disorders are thought to be those who fall at the extreme end of the continuum of eating and weight concerns. This theoretical perspective raises several interesting questions with regard to mothers and daughters. First, to what extent do mothers and daughters, both female and both subject to intense social pressures, share similar attitudes and behaviors about diet and weight? Second, to what extent do mothers serve as role models for their daughters in terms of concerns with appearance and dieting? Finally, is it possible that the mothers of girls who become eating disordered operate as society's messengers, directly pressuring their daughters to achieve the cultural ideal of thinness and attractiveness? This investigation was designed to address these questions of how the motherdaughter relationship may relate to the manifestation of disordered eating among adolescent girls. Correspondence concerning this article should be addressed to Judith Rodin, P.O. Box 11A, Yale Station, New Haven, Connecticut 06520.
198
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
MOTHERS, DAUGHTERS, AND DISORDERED EATING
With regard to the relation between parental weight problems and the manifestation of bulimia, researchers have reported from controlled studies a consistent, but frequently insignificant, trend for the incidence of parental obesity to be greater for bulimic anorexics and normal weight bulimics than for restrictive anorexics. In a study by Garfinkel, Moldofsky, and Garner (1980), mothers of bulimic anorexics reported a significantly higher incidence of obesity than did mothers of restrictive anorexics. Also, in the Strober et al. study (1985), the incidence of eating disorders among family members was especially significant in the bulimic anorexic probands. However, in another study by Strober (1981), a trend for maternal obesity among eating disorder patients was reported, but the difference between groups was not significant. Also, differences between the rates of paternal obesity for girls with eating disorders and for control subjects have not been significant (Garfinkel et al., 1983; Strober, 1981). Only Attie and Brooks-Gunn (1989) examined factors other than parental weight per se—in their case, mothers' concern with weight and bodily issues. These attitudes did not contribute significantly to the regression model for compulsive eating among their daughters. The goal of our study was to explore further how mothers' attitudes and behaviors relate to their daughters' disordered eating. Consistent with the findings we have just discussed, it was hypothesized first of all that mothers of eating disorder girls would report significantly more problems in the general functioning of the family system than would mothers of girls without disordered eating. Mothers were asked to evaluate the general functioning of the family system; in addition to measuring current family functioning, we gathered data from mothers about how their ideal family system would function. In this way, it was possible to compare current versus ideal functioning to ascertain mothers' level of satisfaction with various aspects of their families. It was expected that such a measure of satisfaction would provide additional information about how families differ in their general functioning and would offer further insight into the relation of family dynamics to disordered eating. Second, given the contradictory findings that have related family weight concerns to the incidence of eating disorders, we wished to test a range of measures of weight, diet, and appearance to address the particular question of how mothers' concerns in this domain may be related to disordered eating among their daughters. Clinical case reports and family systems theory suggest that parents may influence their children's eating behavior directly through the process of modeling particular attitudes and behaviors surrounding eating and weight issues (Ausubel, Montemayor, & Svajian, 1977; Boskind-White & White, 1983; Carroll & Leon, 1981; Costanzo & Woody, 1985; Douvan & Gold, 1966). Thus, in this study it was hypothesized that mothers' attitudes and behaviors about weight and appearance would influence their daughters' attitudes in these areas. Serving as role models for their daughters, mothers who are highly concerned with thinness, dieting, and appearance may be more likely to have daughters who are disordered in their eating. Mothers' attitudes about their daughters' weight and appearance were also assessed to test whether, in addition to more passive modeling, there were more active ways in which mothers' concerns with weight and dieting were associated with disordered eating among daughters. It was hypothesized that
199
mothers of girls with disordered eating would not only be highly self-critical about their own weight and appearance but that they would apply the same standards to their daughters, placing more pressure on their daughters to achieve ideals of thinness and attractiveness that wpuld put them at risk for becoming eating disordered. Method This study was conducted as an adjunct to a protocol (Pike, 1989) in which approximately 350 high school girls were studied to determine family system, peer, and personality variables predictive of disordered eating. For the present study two subgroups of girls were identified based on their level of disordered eating. The measure of disordered eating was constructed by summing three subscales, Drive for Thinness, Bulimia, and Body Dissatisfaction, of the Eating Disorders Inventory (EDI). These three subscales of the EDI were used to establish an index of disordered eating because they measure those specific aspects of weight preoccupation and diet concern that are primary to disordered eating and bulimia. Thus, consistent with the diagnostic criteria used to diagnose bulimia, the Disordered Eating Index is a composite score that includes both the behavioral measure of bulimia as well as the attitudinal components of body dissatisfaction and drive for thinness. This procedure permitted us to consider the relevance to the mother-daughter relationship of the five more general subscales of the EDI separate from the primary measure of disordered eating. In both the disordered eating group and the comparison group, the mean age of the girls was 16, and the girls were approximately evenly distributed among the 9th through 12th grades. The disordered eating group was composed of girls in the larger study who scored in the 75th percentile or higher on the Disordered Eating Index. The mean scores of the disordered eating group on all eight subscales of the EDI were comparable to the scores of clinic patients diagnosed with bulimia nervosa (Pike & Rodin, 1991) according to the Diagnostic and Statistical Manual of Mental Disorders (rev. 3rd ed.; American Psychiatric Association, 1987). Girls selected for the comparison group were all those who scored in the 10th-35th percentiles on the Disordered Eating Index. It was decided a priori to exclude girls in the lowest 1 Oth percentile of the EDI index from the comparison group because, as discussed earlier, a moderate degree of concern with weight and appearance is so normative that these girls may actually be aberrant in some way that would preclude their providing a useful comparison. The mean scores on the eight EDI subscales as well as the composite score of disordered eating for the two groups of girls are presented in Table 1.
Subjects The subjects were 77 mothers who were solicited on the basis of their adolescent daughters' classification into one of the two groups in terms of disordered eating. The subjects were unaware of the criteria for recruitment. All subjects were white, middle-class urban and suburban women. The mean age of the mothers whose daughters were in the comparison group was 44, and the mean age of the mothers whose daughters were in the disordered eating group was 42. This age difference was not statistically significant.
Measures Family Adaptability and Cohesion Evaluation Scale III (FACES-HI: Olson, Partner, & Lavee, 1985). The FACES -III is a 20-item, self-report measure that results in two subscales, Family Cohesion and Family Adaptability. Family Cohesion measures the emotional bonding that family members have toward one another. Family Adaptability measures the extent to which the family system is able to change its power
200
KATHLEEN M. PIKE AND JUDITH RODIN
Table 1 Daughters' Scores on the Eating Disorders Inventory (EDI)
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Disordered eaters
Comparison group
EDI scale
M
SD
M
SD
F(l,76)
Bulimia Body Dissatisfaction Drive for Thinness Interoceptive Awareness Ineffectiveness Maturity Fears Perfectionism Interpersonal Sensitivity
8.31 23.82 15.59 9.67 10.97 6.41 6.44 5.82
5.07 4.56 3.35 6.14 7.21 5.05 4.64 5.26
1.03 7.03 1.58 3.00 2.66 3.53 3.97 3.11
1.52 4.61 2.43 3.62 3.06 2.37 3.79 3.04
71.98 258.22 439.53 33.47 43.01 10.20 6.49 7.65
.001 .001 .001 .001 .001 .002 .013 .007
47.72
7.72
9.63
5.36
629.04
.001
Disordered eating
Note. Disordered eating is a composite score based on the summation of Bulimia, Body Dissatisfaction, and Drive for Thinness. Overall test of significance for Wilks's lambda, F(8, 68) = 87.62, p < .001. structure and role relationships on the basis of situational and developmental demands. The scale is administered twice—once to measure how the subject perceives the current family system and once to measure how the subject would ideally like the family system to be. The difference between the current and ideal family situations results in two measures, Satisfaction With Family Cohesion and Satisfaction With Family Adaptability. Items are scored on a 5-point scale from almost never (1) to almost always (5). Documentation provided by Olson et al. (1985) indicates that the FACES-III is a valid, reliable measure with good construct validity and clinical utility. The FACES-III has been used successfully to distinguish a wide range of family systems with problems such as alcoholism, delinquency, and schizophrenia and differentiates between clinical and normal groups (fora review, see Olson et al., 1985). The correlation between the Cohesion and Adaptability scales is .03, which demonstrates good discriminant validity. The internal consistency reliability is .77 for the Cohesion scale and .68 for the Adaptability scale; and the test-retest reliability of the 50item version is .84. Eating Disorders Inventory (Garner, Olmstead, & Polivy, 1983). The EDI is a 64-item, self-report, multiscale measure, with high reliability and validity, that assesses psychological and behavioral traits common to anorexia nervosa and bulimia (Garner et al., 1983; Raciti & Norcross, 1987; Wear & Pratz, 1987). It includes three subscales that measure attitudes and behaviors related to disordered eating, Drive for Thinness, Bulimia, and Body Dissatisfaction. The EDI also includes five subscales that measure psychological constructs related to the psychopathology of eating disorders: Ineffectiveness, Perfectionism, Interpersonal Distrust, Lack of Interoceptive Awareness, and Maturity Fears. Weight, diet, and appearance. Questions with regard to weight and dieting history as well as ratings of attractiveness were included. The mothers were asked their current height in inches, current weight in pounds, ideal weight in pounds, age at first diet, and maximum number of pounds lost from dieting at one time. This data was collected in a self-report questionnaire because studies indicate that actual and selfreported weights are highly correlated (Charney, Goodman, McBride, Lyon, & Pratt, 1976; Coates, Jeffrey, & Wing, 1978) and that there is no systematic error in body measurements due to weight preoccupation (Radke-Sharpe, Whitney-Saltiel, & Rodin, 1990). The mothers were also asked to compare themselves with women their same age in terms of attractiveness on a scale of a great deal less attractive (1) to a great deal more attractive (5). This measure of attractiveness has had a testretest reliability of .89 in a sample of 664 subjects.
In addition to reporting on their own weight and attractiveness, each mother was asked to report her adolescent daughter's current height in inches, current weight in pounds, and ideal weight in pounds. Each mother was also asked to compare her daughter with other girls her daughter's age on the same attractiveness scale given previously. Finally, a measure of body mass (Body Mass Index; BMI) was calculated according to the following formula provided by the Statistical Bulletin ("Measurement of Overweight," 1984): BMI = Weight (kg) + Height1 (m2). Procedure
A cover letter requesting participation accompanied the questionnaires (FACES-III, EDI, and the weight, diet, and appearance questionnaire). The measures were mailed to the mothers of the girls in the two subgroups. Two mailings were conducted and were followed by postcards to encourage participation. The questionnaires were sent to a total of 140 mothers and were returned by 80, which represents an overall 57% return rate. More specifically, 59% (39 of 66) of the comparison mothers and 55% (41 of 74) of the mothers with daughters in the disordered-eating group returned the questionnaire. Because of missing data, three questionnaires were not usable, which left a total of 39 mothers whose daughters were in the disordered-eating group and 38 mothers whose daughters were in the comparison group of nondisordered eaters. Within each group, the girls whose mothers participated did not differ significantly in terms of disordered eating, age, grade, or family systems variables from the girls whose mothers did not participate. Mother and daughter identification numbers were matched in order to conduct analyses that required specific mother-daughter comparisons.
Results
Family Systems Variables A multivariate analysis of variance (MANOVA) of the four subscales on the FACES-III indicated that the two groups did not differ significantly in terms of current family cohesion, current family adaptability, ideal family cohesion, or ideal family adaptability. However, a significant difference did emerge when ratings of satisfaction were compared. The two groups of mothers differed significantly in terms of their satisfaction with
MOTHERS, DAUGHTERS, AND DISORDERED EATING
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Table 2 Subjects' Scores on the Family Adaptability and Cohesion Evaluation Scale III Comparison group Mothers
Daughters
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Disordered-eating group Daughters
Mothers
Subscale
M
SD
M
SD
M
SD
M
SD
Family Cohesion Family Adaptability Ideal Cohesion Ideal Adaptability Satisfaction With Family Cohesion8 Satisfaction With Family Adaptability
36.03 26.29 39.78 29.69 -3.94 -5.89
6.73 3.63 4.24 5.35 5.18 5.42
32.97 25.05 37.65 32.70 -4.68 -7.65
8.58 7.61 6.49 7.04 6.85 7.53
33.66 24.66 40.97 30.65 -7.22 -5.78
6.44 6.80 4.91 6.49 7.39 6.16
29.21 25.23 38.18 36.39 -8.97 -11.15
9.28 6.71 7.43 5.49 8.26 8.00
Note. In each of the groups of mothers, 2 women did not complete the Ideal version of the questionnaire. Therefore, the satisfaction scores for mothers are slightly different from the differences between the means reported in the table. " For the Satisfaction With Family Cohesion subscale, the two groups of mothers differed significantly ( p < .05), as did the two groups of daughters (p
