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Family Functioning and Family Stage Associated with Patterns of Disordered

Eating in Adult Females

Article in The Australian Educational and Developmental Psychologist · June 2011

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Family Functioning and Family Stage
Associated with Patterns of Disordered
Eating in Adult Females
Terry Bowles,1 Martine Kurlender2 and Bridie Hellings3
1
University of Melbourne, Australia
2
Australian Catholic University, Australia
3
The Priory Hospital, North London, United Kingdom

This study investigated family functioning, family stage and eating disorder risk.
A sample of 140 females (aged 18–59) completed a family functioning
questionnaire (ICPS) and the Eating Disorder Risk scale (EDI-3). Consistent with
previous research, cluster analysis identified two profiles of family functioning: an
authoritative style (high intimacy and high democratic parenting, with low
conflict) and an authoritarian cluster (elevated conflict scores and significantly
lower intimacy and democratic parenting). The second independent variable of
family stage comprised two groups: females living in their family of origin and
those living in their family of choice. The ANOVA showed no interaction involving
family functioning cluster and family stage. A main effect showed that
participants in the authoritarian cluster experienced significantly more drive for
thinness, bulimic symptoms, body dissatisfaction and eating disorder risk. There
was no difference in eating disorder risk between females living at home or those
in the family of choice. The findings have implications for therapists in
demonstrating that independence from the family of origin does not prompt
natural recovery from eating disorder tendencies. The findings provide some
further evidence of the association between specific elements of family
functioning (intimacy, conflict and democratic parenting) with eating disorder risk.

❚ Keywords: family functioning, eating disorder risk, conflict, intimacy, democratic

parenting, family of origin, family of choice

The incidence of eating disorders is ever increasing and while more research is being
dedicated to this area there is no consensus as to the aetiology of eating disorders
(Phelps & Bajorek, 1991). There is also some disagreement in the literature about the
role of families in the development of patterns of disordered eating (e.g., Le Grange,
Lock, Loeb, & Nicholls, 2010). Despite this, there is considerable literature indicating
that there are common patterns of functioning within families of diagnosed sufferers
of eating disorders (clinical families) that are distinct from the patterns of family
functioning in nonclinical families (Casper & Zachery, 1984; Laliberte, Boland, &
Leichner, 1999; Lattimore, Wagner, & Gowers, 2000; Stern, Dixon, Jones, Lake,

Address for correspondence: Terry Bowles, Postgraduate School of Education, University of

Melbourne, Victoria 3010. E-mail: tbowles@ballarat.edu.au

The Australian Educational and Developmental Psychologist ❚ 47

Volume 28 | Issue 1 | 2011 | pp. 47–60 | DOI 10.1375/aedp.28.1.47
 Terry Bowles, Martine Kurlender and Bridie Hellings

Nemzer, & Sansone, 1989). Family functioning has been identified as one factor
associated with the risk in causing an eating disorder (French, Story, Neumark-
Sztainer, Downes, Resnick, & Blum, 1996; Phelps & Bajorek, 1991; Pole, Waller,
Stewart, & Parkin-Feigenbaum, 1988; Soh, Touyz, & Surgenor, 2006; Tata, Fox, &
Cooper, 2001). By contrast, little research has focused on the role of the family of
choice as a facilitator of change in patterns of eating-disordered behaviour. This
research compares whether those living with their family of origin experience greater
risk of an eating disorder than a comparison group who were living in an
environment of their choice or making.
Previous research has identified two distinct styles of parenting described as
controlling and democratic parenting, sometimes labelled authoritarian and
authoritative parenting respectively. Tata et al. (2001) found a direct relationship
between controlling parenting and disordered eating behaviours. Parents engaging in
this parenting style are believed to expect obedience from their child and hold little or
no regard for the child’s autonomy (Baumrind, 1966). This approach to parenting is
widely recognised as ineffective and inappropriate, and implies a superior/inferior
relationship that fails to produce responsible children (Baumrind, 1966). An
authoritative or democratic parenting style is believed to be the most beneficial in
rearing well-adjusted children who are emotionally and socially stable (Baumrind,
1966; Oltmanns & Emery, 2004). Parents engaging in this parenting style uphold
discipline and express this discipline in a democratic manner that respects the child’s
autonomy. In this style of parenting the focus shifts from the strict adherence to rules,
characteristic of a controlling style, to explaining the rules and promoting
understanding (Kaufmann, Gesten, Lucia, Salcedo, Rendina-Gobioff, & Gadd, 2000).
Each style of parenting evokes a patterned response from children, thus the dynamic
influences how families function.
Two other aspects of family functioning and the dynamic between parenting style
and the reactions of children that are associated with authoritarian/autocratic families
are conflict and intimacy. Conflict in the family has been shown to negatively
influence both parent’s and children’s general wellbeing (Rinaldi & Howe, 2003).
Marital conflict has also been found to promote a myriad of serious problems for
children including poor health, depression, anxiety and low self-esteem (Cummings &
Davies, 2002, Davies, Sturge-Apple, Winter, Cummings, & Farrel, 2006; Katz &
Gottman, 1997; Katz & Woodin, 2002). Intimacy is also a well-documented concept
described as the struggle to achieve a healthy balance between closeness and
independence (Guttmann & Rosenberg, 2003). It is also thought to play a crucial role
in family functioning and eating behaviour. For example, lack of intimacy between
family members has been implicated in the development of disordered eating patterns
(May, Kim, McHale ,& Crouter, 2006; Stern et al., 1989).
The three factors of family functioning — intimacy, conflict, and democratic
parenting — emerged from the exploratory analysis of items from five scales of family
functioning resulting in the Intimacy, Conflict and Parenting Style questionnaire (ICPS;
Noller, 1988; Noller, Seth-Smith, Bouma, & Schweitzer, 1992). A direct link has been
found in numerous studies between these three aspects of family functioning and
disordered-eating behaviour (May et al., 2006; Stern et al., 1989; Tata et al., 2001). The
findings suggest that people reared through a controlling parenting style with conflict
and a lack of intimacy in the home may tend to display more patterns of disordered
eating than those reared through a democratic style of parenting. The patterns of

48 ❚ The Australian Educational and Developmental Psychologist

 Family Functioning and Family Stage

disordered eating can be described as involving a high drive for thinness, the presence of
bulimic symptoms and high body dissatisfaction (Oltmanns & Emery, 2004).
More particularly, research has explored the role of intimacy and conflict within
the family in the development of disordered eating. May et al. (2006) investigated the
development of weight concerns over three years with adolescent participants who
were asked to report their weight concerns, and their intimacy and conflict with
parents. Decreases in intimacy and increases in conflict over time were significant
predictors of weight concern. These results support the hypothesis that persistent
negative conflict in the family can lead to pathological eating patterns (Casper &
Zachery, 1984). In addition to finding a link between conflict and eating disorders,
intimacy — as measured by the level of family cohesion and expressiveness — has also
been shown to share a direct association with disordered eating (Stern et al., 1989). In
Stern et al.’s study clinical families were found to be significantly more conflictual as well
as less cohesive and expressive, and thus less intimate, than the control group families.
Laliberte et al. (1999) also found that family climate was able to distinguish eating-
disordered sufferers from healthy controls. The clinical group reported significantly
higher levels of dysfunctional communication within their families than the control
group. This and subsequent research has led to the conclusion that the participant’s
disordered eating was a result of their family’s dysfunctional patterns of interaction and
communication (Kent & Clopton, 1992; Shisslak, McKeon, & Crago, 1990).
Lower levels of intimacy between family members, as measured by family cohesion,
have been related to eating disorders (Vidovic, Juresa, Begovac, Mahnik, & Tocilj,
2005). The results indicated that the females with eating disorder symptoms perceived
their families to be less cohesive and less adaptable than the control group. Females
with bulimia nervosa (BN) perceived their families to be even less cohesive and less
adaptable than those with symptoms of anorexia nervosa (AN). This supports the
literature that BN sufferers have more troubled communication and less cohesion and
adaptability within the family environment than AN sufferers (Minuchin, 1977).
Support for this explanation was provided by McDermott, Batik, Roberts and Gibbon
(2002) in a study showing that those with BN perceived their families as being
significantly less cohesive with higher levels of family conflict than those suffering
from AN.
Families described as conflictual in functioning have been associated with
disordered patterns of eating. For example, female sufferers with AN and their
mothers participated in a low conflict and high conflict structured discussion task, as
did a comparison group of psychiatric sufferers and their mothers (Lattimore et al.,
2000). The AN dyads were observed to show more destructive conflictual
communication than the comparison group. As the control group comprised
psychiatric sufferers whose families were no doubt distressed, the results lend support
in discrediting the theory that high conflict, low cohesion, and low expressiveness is
typical of distressed families (Laliberte et al., 1999). Despite these findings indicating
that BN sufferers have more family dysfunctions that AN sufferers, both eating
disorders are thought to develop from negative family environments. Explanations of
how the pathological underpinnings of the family environment actually ‘cause’ people
to develop patterns of disordered eating primarily focus on the overprotective nature
of the parent(s) (Oltmanns & Emery, 2004). Children or adolescents who are
extremely restricted by their parents can feel like they have no control over any aspects
of their life, leading to feelings of being trapped, frustrated and angry. In order to

The Australian Educational and Developmental Psychologist ❚ 49

 Terry Bowles, Martine Kurlender and Bridie Hellings

overcome this, these individuals may take control of the one aspect of their life where
they have the opportunity of control — in their eating behaviour.
From this, some theorists have suggested that eating disorders, particularly AN,
develop out of a desperate pursuit for control (Oltmanns & Emery, 2004). Such
psychological pressure is absent from families where authoritative parents allow a
more democratic approach to the exploration and expression of feelings, thoughts
and behaviours when potential conflicts arise. In such families, eating disorders have
been shown to be less prevalent and have fewer constraining rules and more
facilitative rules than are present in families with eating disorders (Gillett, Harper,
Larson, Berrett, & Hardman, 2009). Capturing the interplay of the three factors of
Intimacy, Conflict, and Democratic Parenting has been achieved through clustering
respondents on the basis of the three factors (Fallon & Bowles, 2001). Using the three
factors of family functioning in a clustering procedure has the advantage of
accounting for the multiple scores provided by each respondent conjointly, to develop
profiles of functionality that have previously resulted in two distinct groups. The
profiles show that the groups differ significantly on two of the three factors (Fallon &
Bowles, 2001). One cluster was defined as the low conflict and high democratic group
(authoritative). The second cluster was described as the high conflict and low
democratic or controlling group (authoritarian). It is anticipated that two profiles of
family functioning will be found in this research in relation to eating-disorder risk,
following the profiles found from previous research.
The issue of the residual nature of the effects of family of origin have, as yet, not
been sufficiently explored in the research. While there is a clear demonstration of the
association between eating disorders and eating disorder risk within families, less is
known about the effect of family of origin and whether habitual patterns of eating
behaviour, established in the family of origin, continue to influence the family of
choice. Some research does indicate that there is a strong residual effect of family of
origin. Research into marital interaction has shown that family of origin hostility was
a strong predictor of marital interaction behaviours and reduced positive engagement
(Whitton, Waldinger, Schulz, Allen, Crowell, & Hauser, 2008). For men, higher family
cohesion was related to healthier eating attitudes and better regulation of eating, with
poor parental management associated with the onset of obesity and disturbed eating
attitudes (Johnson, Brownell, St. Jeur, Brunner, & Worby, 1997).
There has been little, if any, research into the prospect of natural recovery or the
recuperative nature of family of choice or living arrangements of choice once the
family of origin has been left. While some of the family research is retrospective we
intend to compare reports of eating behaviour and family functioning of females
living in their family of origin and females living in the family of choice. In this
research, family of choice refers to living arrangements that are made after leaving
home, when a young adult has the opportunity to make their own choices regarding
all of their the living arrangements. From a developmental perspective, organising a
family of choice is considered a major developmental task and transitional milestone
to adulthood (Holohan, Valentiner, & Moos, 1994; Seiffge-Krenke, 2009). This stage is
typically associated, in western culture, with greater independence from family of
origin (Arnett, 2000; Nelson & Barry, 2005). Early explanations of the stage proposed
that, on leaving home, young adults should develop a stable partnership, establish an
independent household, a family and a career, as well as integrate into social and civic
roles and responsibilities (Havinghurst, 1953). Few would argue today that all of the

50 ❚ The Australian Educational and Developmental Psychologist

 Family Functioning and Family Stage

characteristics proposed by Havinghurst are important in completing the transition

however; making family and relationship arrangements based on personal choice and
relatively free of the influence of family of origin is likely to be a marker of at least the
beginning of this transition. Given this greater personal choice, it is possible that
females will improve their attitudes, behaviours and the eating symptomatology
associated with the family of origin, on leaving home. This may be especially true as
the living arrangements based on choice would, potentially, be free of the conflicts
associated with family of origin that are linked to disordered eating and provide an
opportunity for natural improvement or natural recovery (Klingemann & Sobell,
2007). This second potential explanation is in contrast to the anticipated residual
influence of family of origin. The aim was to investigate eating disorder risk.
It was hypothesised that:
• Three aspects of family functioning comprising intimacy, conflict, and democratic
parenting style would cluster in two groups describing one profile with
authoritarian tendencies and a second with an authoritative family functioning
profile.
• Females from highly authoritarian families would have a pattern of significantly
more disordered eating behaviours than females from environments with
authoritative parents and family functioning.
• Females in family of choice would show significantly less disordered eating
behaviour than female respondents who were still living in their family of origin.

Method
PARTICIPANTS
The participants were a convenience sample of 140 female adults, ranging in age from
18–59 (M = 27.02; SD = 10.33). Of these respondents 49.3% (n = 69) were living in a
family of origin and one was living with their immediate and extended family. The
remaining 50.7% (n = 71) constituted the family of choice group. These females were
living with their partner (11.4%; n = 16), partner and children (11.4%; n = 16),
children (7%; n = 11), unrelated people (20.0%; n = 28), alone (6.4%; n = 9), or with
extended family (0.7%; n = 1). Twenty-four (17.1%) respondents were married,
partnered (11.4%; n = 16), or in de facto relationships (3.6%; n = 5). Seven (5.0%)
were divorced and 16 (11.4%) were in other relationships, while the majority were
single (51.4%; n = 72). One hundred and thirty-seven respondents were working. Of
these, 39 respondents were in sales work (27.9%), 31 were involved in professional
work (22.2%), 9 (6.4%) were involved in clerical roles and the remainder were in
various other forms of work.
Participants’ height ranged from 130–183cm (M = 166.15; SD = 7.64) and weight
ranged from 47–150 kg (M = 65.89; SD = 15.04). The mean body mass index (BMI) of
the group was 24 (SD = 5.96). Based on World Health Organization (WHO; 1995,
2002) calculations (not accounting for gender, nationality or age) there were 8% of
participants who were underweight, 61% within the normal range, 22% who were
overweight and 9% who were obese.
Participants completed a demographics questionnaire providing information
regarding their age, height, weight, education level, occupation, marital status and
living arrangements.

The Australian Educational and Developmental Psychologist ❚ 51

 Terry Bowles, Martine Kurlender and Bridie Hellings

MEASURES
Intimacy, conflict, and parenting style. Participants completed the 30-item ICPS
Family Functioning scale that measured parenting style (controlling or democratic),
intimacy and conflict (Noller, 1988). Parenting style was assessed using eight items
measuring the extent to which family members are encouraged to be autonomous and
independent and whether they have a say in the family’s rules and decisions. Intimacy
was assessed using 12-items that explored the level of closeness, sharing, expressiveness
and openness in communication found within the family. Ten questions investigated
the level of conflict, assessing the extent of misunderstanding, perceived parental
interference and any difficulties in solving problems and making family plans. All
items were measured on a 6-point, Likert-type scale ranging from 1 = totally disagree,
to 6 = totally agree. The scale had a moderate to strong validity for the three constructs
(Noller, 1988; Noller, Seth-Smith, Bouma, & Schweitzer, 1992).
Eating Disorder Inventory-3 (EDI-3). Participants also completed the Eating Disorder
Risk scale from the EDI-3, which is designed to assess a person’s risk of developing an
eating disorder (Garner, 2004). The scale measures eating disorder risk by
investigating the presence and intensity of psychological traits or symptoms relevant
to the development and maintenance of eating disorders. This scale has 25 items from
the EDI-3. Participants were required to indicate whether each item was true for them
always (A), usually (U), often (O), sometimes (S), rarely (R), or never (N). These
responses were subsequently recoded into a scale ranging from 0 to 4. Never and rarely
were given a value of 0, sometimes was recoded as 1, often was given the value of 2,
usually was recoded as 3, and always was recoded as 4. There were six reverse-scored
items. There were three subscales within the Eating Disorder Risk scale. These include
the seven-item drive for thinness scale, the eight-item bulimia scale and the ten-item
body dissatisfaction scale. High scores on all the subscales indicate an increased risk of
developing an eating disorder. The Eating Disorder Risk scale has a strong reliability
with alpha coefficients of .94 for the eating disorder risk composite and a range of
from .87 to .92 for the three eating disorder risk subscales. Test–retest coefficient
values of .98 for the composite scale and .95 for the three subscales have also been
reported (Garner, 2004).

Results
The data were screened in order to evaluate their integrity. A small number of missing
values were identified and were subsequently replaced using a mean substitution
procedure. After assessment of each participant’s responses on the EDI-3 it was
determined that no participant’s scores reached a clinical level. The internal reliability of
all factors was satisfactory (Table 1). A bivariate correlation was run in order to evaluate
the strength of association between the family functioning factors and the eating
disorder risk factors (see Table 1).
All family functioning factors were significantly associated with the eating disorder
risk factors. The results indicated that higher levels of familial intimacy were associated
with decreased levels of conflict. A democratic style of parenting was associated with
high levels of intimacy and low levels of conflict. A controlling or authoritarian
parenting style was associated with low levels of intimacy and high levels of conflict. The
three Eating Disorder Risk subscales shared a moderate to strong, positive relationship.
The moderate positive relationship between conflict and the eating disorder risk scales

52 ❚ The Australian Educational and Developmental Psychologist

 Family Functioning and Family Stage

TABLE 1
Correlations, Means and Standard Deviations for Family Functioning and Eating Disorder Risk Subscales
1. 2. 3. 4. 5. 6. 7. 8.
1. Intimacy -.61** .68** -.27* -.29** -.31** -.34** .05
2. Conflict -.56** .32** .39** .37** .42** -.04
3. Parenting Style -.18* -.24** -.23** -.25** .11
4. Drive for Thinness .63** .67** .89** -.06
5. Bulimia .49** .75** -.03
6. Body Dissatisfaction .90** -.08
7. ED Risk Composite -.07
8. Age
Total 57.24 29.88 37.89 8.66 4.68 19.43 32.76 27.02
Standard Deviation 10.35 8.53 6.89 7.14 4.78 10.39 19.39 10.33
Cronbach’s Alpha .91 .77 .87 .89 .79 .91 .94

Note: *Correlation is significant at the .05 level (one-tailed); **Correlation is significant at the .01 level (two-tailed).

signified that they increase concurrently. In contrast, intimacy shared a low to moderate
negative relationship with the eating disorder risk scales and composite score, indicating
that as intimacy in the family increased, eating disorder risk decreased. Conflict had a
stronger association with eating disorder risk than did intimacy, and intimacy shared a
stronger association with eating disorder risk than did parenting style.
A cluster analysis was performed to investigate whether two distinct groups would be
classified based on characteristics of family functioning: parenting style, intimacy, and
conflict. Initial analyses involved a hierarchical cluster utilising the Ward’s method as
measured by the squared Euclidean distance. This allowed for graphical representation
of possible cluster memberships. Inspection of the dendogram and the agglomeration
schedule revealed that a two-factor solution would be most suitable. Subsequent
analyses involved a two-group k-means cluster procedure, which confirmed the two-
cluster solution shown in Table 2.
The ANOVA analysis revealed that the two clusters were distinct, differing
significantly on the three family functioning variables. Ratings from the authoritarian
group were significantly lower on intimacy, higher on conflict and lower on democratic
parenting than those in the authoritarian cluster. Correspondingly, cluster 2, named
authoritative, rated intimacy, democratic parenting higher and conflict lower than the
authoritarian group. These results are presented graphically in Figure 1.

TABLE 2
Mean and Standard Deviation of ICPS Responses Based on a Two-Cluster Membership of Family
Functioning
Family Functioning Measures Cluster Effect
Authoritariana Authoritativeb Fc p η2

Intimacy 47.01 63.16 182.68 .001 .57

Conflict 36.86 25.39 102.34 .001 .43
Parenting Style 32.21 41.14 98.54 .001 .39

Note: a n = 53; b n = 87; cdf = 1, 138, n = 140.

The Australian Educational and Developmental Psychologist ❚ 53

 Terry Bowles, Martine Kurlender and Bridie Hellings

0.8

0.4

0 Authoritarian*
Authoritative
-0.4

-0.8

-1.2
Intimacy Conflict Democratic
Parenting
FIGURE 1
Family functioning scores based on a two group cluster membership.
Note: * Standardised scores were provided in the figure to allow for accurate visual comparison

In order to investigate the potential interaction between the main effects of family
functioning, cluster (authoritarian/authoritative) and family stage (family of origin/
family of choice), an ANOVA with the three Eating Disorder Risk subscales and the
composite score as dependent variables was analysed. A validity check of a chi-squared
analysis was completed to ensure that there were approximately equivalent numbers
of respondents in each of the two by two level of the independent variables. The
analysis showed that there was no association between the independent variables
based on the number of respondents represented in each cell, χ2(1, N = 140) = 76, p =
.86. To control for the potential confound of age of respondent, age was included in
the ANOVA as a covariate.
There was no significant interaction involving drive for thinness, F(1,135) = 1.64, p
= .20, bulimia, F(1,135) = 1.31, p = .25, body dissatisfaction, F(1,135) = 56.67, p = .42,
or the eating disorder risk composite, F(1,135) = 1.51, p = .22. The main effects
analysis involving the independent variable of family functioning showed that all
three of the eating disorder risk scales and the composite were in the anticipated
direction, with all four scales reaching significantly different levels based on cluster
membership (Table 3). Members of the authoritarian cluster indicated a stronger
disposition towards eating disorder risk than the members of the authoritative cluster.
The strongest difference between clusters and the individual scales was shown for
body dissatisfaction, indicating that participants in the high authoritarian cluster were
significantly more dissatisfied with their bodies than participants in the high
intimate/democratic cluster (η2 = .07), although all of the significant differences were
within the low to moderate effect range for the four scales.
The analysis investigating whether females living in the family of their choice
would show significantly less disordered eating behaviour than female respondents
who were still living in their family of origin showed that there was no significant

54 ❚ The Australian Educational and Developmental Psychologist

 Family Functioning and Family Stage

TABLE 3
Eating Disorder Risk Factors Based on Cluster Membership of Family Functioning
Eating Disorder Cluster Effect
Risk Scale Authoritariana Authoritativeb
Mean SD Mean SD Fc p η2

Drive for Thinness 11.06 8.27 8.45 6.25 4.66 .03 .03
Bulimia 6.07 5.48 3.82 4.10 8.01 .01 .06
Body Dissatisfaction 26.17 8.67 21.11 9.68 10.24 .01 .07
Risk Composite 43.30 20.03 33.39 16.66 10.58 .01 .07

Note: a Eating Disorder Risk Composite; b df = 1, 135, n = 140.

difference between those living at home in comparison with those in their family of
choice on either of the three scales or the risk composite (Table 4).

Discussion
The present study was concerned with the family functioning of females and their
associated patterns of eating disorder risk. Of particular interest in the current
investigation was the relationship between intimacy, conflict and parenting style
shared with eating disorder risk as assessed by scales of the EDI-3 of drive for
thinness, bulimia, body dissatisfaction and the eating disorder risk composite. The
hypothesis that the family functioning measures would cluster into two groups based
on the ratings of intimacy, democratic parenting and conflict in families was found.
The two profiles of authoritative and authoritarian family functioning provided
evidence of two different ways that families related. The hypothesis that the two
profiles would be associated with significantly different ratings on the eating disorder
risk scales and composite score was supported. The hypothesis that females raised in a
highly conflicted environment lacking in intimacy with a controlling style of
parenting would display more disordered eating patterns than females raised in
environments with greater intimacy, less conflict and a more democratic style of
parenting was also supported. This hypothesis was supported in regards to each of the
eating disorder composites. These results suggest that family environments rich in
intimacy, involving low levels of negative conflict and with democratic parenting are
associated with a child’s wellbeing, specifically in regards to eating patterns. The third

TABLE 4
Eating Disorder Risk Factors Based on Family Stage
Eating Disorder Family stage Effect
Risk Scale Origina Choiceb
Mean SD Mean SD Fc p η2

Drive for thinness 9.06 6.80 9.81 7.55 1.89 .17 .01
Bulimia 4.32 4.54 5.01 5.01 2.21 .14 .02
Body dissatisfaction 22.24 9.48 23.79 9.72 3.02 .08 .02
Risk compositea 35.62 17.70 38.62 19.40 3.37 .07 .02

Note: a Eating Disorder Risk Composite; b df = 1, 135, n = 140.

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 Terry Bowles, Martine Kurlender and Bridie Hellings

hypothesis that females in their family of choice would demonstrate less disordered
eating than those in a family of origin was not found. The tendency was the reverse.
The cluster analysis was designed to explore the possibility of an underlying profile
of family functioning. The cluster procedure used to group the participants based on
the ICPS measures was first used by Fallon and Bowles (2001) and similar cluster
profiles were evident: an authoritative cluster defined as having low conflict and a
high rating of democratic parenting and intimacy, and a second authoritarian cluster
was characterised by high conflict, low democratic and low intimacy ratings. The
difference between the two groups was significantly different on all of the three family
functioning factors and validates previous findings using the same procedure (Fallon
& Bowles, 2001).
Despite being significant there was an absence of very strong correlations between
family functioning factors and drive for thinness. This could be explained by previous
research that has demonstrated BN sufferers report significantly higher levels of
family dysfunction than AN sufferers (McDermott et al., 2002; Vidovic et al., 2005).
That is, AN appears to have a weaker link with family dysfunction than BN. As drive
for thinness is specifically symptomatic of AN, the results obtained in the current
study reinforce this notion. Second, the research involved patterns of nondiagnosed
disordered eating. Had data being gathered on a group with diagnosed eating
disorders their responses would most probably have been more extreme, and more
associated family dysfunction and eating disorders.
The association between disordered eating and the family’s dysfunctional
environment, as suggested by Laliberte et al. (1999), was supported by the current
study’s results. In line with these results, May et al. (2006) found increases in conflict
and decreases in intimacy to be significant predictors of weight concern. The findings
are also consistent with Tata et al. (2001), who found a link between parental
overprotection and disordered eating patterns and body dissatisfaction. The current
study also found a controlling parenting style to be related to significantly higher
eating disorder risk and increased body dissatisfaction. Females reared in
environments lacking in intimacy and with elevated levels of conflict displayed an
increased risk of eating-disordered behaviour. In particular, they reported more
bulimic symptoms and higher levels of dissatisfaction with their body.
The link between high levels of conflict, low levels of intimacy and eating disorder
risk, as demonstrated in the literature and the current study, provides some evidence
of the role of family functioning and its association with eating disorders. It also helps
in strengthening support for the second hypothesis, that participants raised in highly
conflictual environments lacking in intimacy would display increased levels of
disordered eating. An authoritarian profile of family functioning is associated with
patterns of disordered eating. The findings from this research are consistent with the
theory that pathological eating is related to poor conflict resolution, as proposed by
Casper and Zachery (1984). High levels of conflict were significantly associated with
an increased risk of eating-disordered behaviour and, more specifically, with increased
bulimic symptoms and body dissatisfaction. These results are consistent with the
findings from previous studies (Lattimore et al., 2000; Stern et al., 1989).
In the current study, reduced intimacy and parenting style were also shown to have
an association with disordered eating, as found by Stern et al. (1989). Their results
showed that, in addition to conflict, females brought up in less intimate environments
displayed more disordered eating behaviours. In the current study the authoritarian

56 ❚ The Australian Educational and Developmental Psychologist

 Family Functioning and Family Stage

cluster also had higher levels of disordered eating patterns. These findings are
consistent with previous research linking family functioning to BN (Kent & Clopton,
1992; Pole et al., 1988; Shisslak et al., 1990). The results from these studies indicated
that BN clinical and subclinical participants perceived their families as being more
conflictual, less intimate and more controlling than the nonclinical participants. This
is line with the current study’s results. Evidence for this theory has been reported by
Vidovic et al. (2005) and McDermott, Batik, Roberts and Gibbon (2002) who found
that BN sufferers perceived their families as being less intimate and more conflictual
than those with AN.
The interaction involving family functioning and family stage indicated that there
was no association with eating disorder risk. Further, women who had chosen their
family showed no significant decline in their disordered eating behaviour compared
with those within their family of origin. This demonstrated the consistency of eating
disorder risk over time and points to the power of habituated eating patterns in
transferring from, and not altering from, family of origin to family of choice. Such a
finding was contrary to the logic that family of choice would be recuperative or
reparatory of maladaptive behaviours, attitudes and values emanating from the family
dynamic of the family of origin (Klingemann, & Sobell, 2007). The absence of an
effect associated with family of choice indicates that the alternative explanation
remains plausible; that is, that some habits, beliefs and attitudes from family of origin
may recur throughout life and the presence of parents and family to varying degrees,
for some females and males, may remain physically and psychologically present, to a
substantial and influential degree, beyond the advent of a new family situation.
There are several possible limitations to the research reported here. The research
was based on self-report questionnaires about complex relationships. The concern is
that participants may be biased in their responses, particularly when the topics
researched are of a sensitive nature. An investigation into the consistency of self-
reports of the family environment between parents and adolescents showed that a
discrepancy exists (Noller & Callan, 1988; Soh et al., 2006). Parents tended to portray
their family functioning in a positive light while adolescents were more negative in
their responses. However, there is support for the idea that it is the parents who are
biased in their responses due to their greater personal investment in the quality of the
lives of their families (Lerner & Knapp, 1975; Niemi, 1974).
Another limitation is the use of a subclinical sample. As one of the key areas under
investigation is clinical in nature (namely eating disorders) it is likely that this aspect
would be best assessed using a clinical sample, representative of the corresponding
population, so that generalisations can be made. Perhaps the best method would be to
include nonclinical, subclinical, and clinical participants in order to represent the
population entirely. Despite the support of Fallon and Bowles’ (2001) results, the
robustness of the cluster analysis used in the research to define the participants based
on the ICPS measures is worthy of further investigation.
The findings from this research are important as they can be applied to inform
preventative interventions and treatment strategies for those at risk of developing an
eating disorder. Therapy may need to include a corrective parenting experience where
there is a more appropriate balance of intimacy, control and consequent conflict.
Furthermore, education regarding the use of democratic control, rather than
autocratic control, could be given to people from conflictual families of origin. The
whole family could be offered a psychoeducational intervention on how to use conflict

The Australian Educational and Developmental Psychologist ❚ 57

 Terry Bowles, Martine Kurlender and Bridie Hellings

constructively rather than destructively. Intimacy and positive engagement among

family members should also be encouraged.
Several other limitations are also present. The convenience sample meant that there
was a variety of the families of choice. Future research could more closely define the
types of family of choice and compare whether family type within choice provides
greater natural recovery from issues associated with family of origin. Further, this
research was empirically grounded and, in line with the previous research, anticipates
that family functioning predates and prompts the reactions of children within the
family. However, it is possible that the eating disorder actually prompts or exacerbates
the conflict in the family. Thus, the direction of the association found in this research
requires further investigation.
In order to come to a more concrete conclusion regarding the link between family
environment and eating disorders, future research would need to include large-scale,
longitudinal analyses including diagnosed as well as undiagnosed participants. Such
research could be designed to establish whether participants belonging to the
authoritarian cluster actually develop more clinically diagnosed eating disorders than
those in the authoritative cluster. Further, research could also investigate the buffering
influence of family intimacy and its role in recovery from eating disorders.
Investigation of the changes that may occur, but were not observed in this study, when
people move from their family of origin to the family of their choice, is also deserving
of further research attention.
This study is important because it found that there is no change, evidencing the
possibility of a natural recovery or improvement, in eating disorder risk as a result of
leaving home to establish one’s own family. These findings are in contrast to the
growing literature that shows that for some psychological problems change in the
form of natural recovery is possible (Klingemann & Sobell, 2007). Thus, interventions
designed to improve eating behaviour need to be targeted and strategic and take
account of the need to attend to family functioning patterns in designing remedies.

Acknowledgment
As the author is the Editor of the AEDP, the editorial management and double-blind
review process of the manuscript was completed by one of the serving Editorial Board
Members of the AEDP.

References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.).
Arlington, VA: Author.
Arnett, J.J. (2000). Emerging adulthood. A theory of development from the late teens through the
twenties. American Psychologist, 55, 469–480.
Baumrind, D. (1966). Effects of authoritative parental control on child behaviour. Child Development,
38(2), 291–328.
Casper, D., & Zachery, D. (1984). The eating disorder as a maladaptive conflict resolution. Individual
Psychology: The Journal of Adlerian Theory, Research and Practice, 40(4), 445–453.
Cummings, E., & Davies, P. (2002). Effects of marital conflict on children: Recent advances and emerging
themes in process-oriented research. Journal of Child Psychology and Psychiatry, 43(1), 31–63.
Davies, P., Sturge-Apple, M., Winter, M., Cummings, E., & Farrel, D. (2006). Child adaptational
development in contexts of interparental conflict over time. Child Development, 72, 218–233.
Fallon, B., & Bowles, T. (2001). Family functioning and adolescent help-seeking behaviour. Family
Relations, 50(3), 239–245.

58 ❚ The Australian Educational and Developmental Psychologist

 Family Functioning and Family Stage

French, S., Story, M., Neumark-Sztainer, D., Downes, B., Resnick, M., & Blum, R. (1996). Ethnic differences
in psychosocial and health behaviour correlates of dieting, purging, and binge eating in a population-
based sample of adolescent females. International Journal of Eating Disorders, 22, 315–322.
Garner, D.M. (2004). Eating Disorder Inventory-3: Professional manual. Lutz, Fl: Psychological
Assessment Resources, Inc.
Gillett, K.S., Harper, J.M., Larson, J.L., Berrett, M.E., & Hardman, R.K. (2009). Implicit family process
rules in eating-disordered and non-eating-disordered families. Journal of Marital and Family Therapy,
35, 159–174.
Guttmann, J., & Rosenberg, M. (2003). Emotional intimacy and children’s adjustment: A comparison
between single-parent divorced and intact families. Educational Psychology, 23(4), 457–471.
Havinghurst, R.J. (1953). Developmental tasks and education. New York: Longmans, Green & Co.
Holohan, C.J., Valentiner, D.P., & Moos, R.H. (1994). Parental support and psychological adjustment
during the transition to young adulthood in a college sample. Journal of Family Psychology, 8, 215–223.
Johnson, B., Brownell, K.D., St. Jeur, S.T., Brunner, R.L., & Worby, M. (1997). Adult obesity and
functioning in the family of origin. International Journal of Eating Disorders, 22, 213–218.
Katz, L., & Gottman, S. (1997). Buffering children from marital conflict dissolution. Journal of Clinical
Child Psychology, 26(2), 157–171.
Katz, L., & Woodin, E. (2002). Hospitality, hostile detachment, and conflict engagement in marriages:
Effects on child and family functioning. Child Development, 73(2), 636–652.
Kaufmann, D., Gesten, E., Lucia, R., Salcedo, O., Rendina-Gobioff, G., & Gadd, R. (2000). The
relationship between parenting style and children’s adjustment: The parent’s perspective. Journal of
Child and Family Studies, 9(2), 231–245.
Kent, J., & Clopton, J. (1992). Bulimic women’s perceptions of their family relationships. Journal of
Clinical Psychology, 48(3), 281–292.
Klingemann, H., & Sobell, L. C. (2007). Promoting self-change from addictive behaviors: Practical
implications for policy, prevention, and treatment. New York, NY: Springer.
Laliberte, M., Boland, F., & Leichner, P. (1999). Family climates: Family factors specific to disturbed
eating and bulimia nervosa. Journal of Clinical Psychology, 55, 1021–1040.
Lattimore, P., Wagner, H., & Gowers, S. (2000). Conflict avoidance in anorexia nervosa: An observational
study of mothers and daughters. European Eating Disorders Review, 8(5), 355–368.
Le Grange, D., Lock, J., Loeb, K., & Nicholls, D. (2010). Academy for eating disorders position paper: The
role of the family in eating disorders. International Journal of Eating Disorders, 43, 1–5.
Lerner, R., & Knapp, J. (1975). Actual and perceived intrafamiliar attitudes of late adolescents and their
parents. Journal of Youth and Adolescence, 4, 17–36.
May, A., Kim, J., McHale, S., & Crouter, A. (2006). Parent-adolescent relationships and the development of
weight concerns from early to late adolescence. International Journal of Eating Disorders, 39, 729–740.
Mallinckrodt, B., McCreary, B.A., & Robertson, A.K. (1995). Co-occurrence of eating disorders and
incest: The role of attachment, family environment, and social competencies. Journal of Counseling
Psychology, 42, 178–186.
McDermott, B., Batik, M., Roberts, L., & Gibbon, P. (2002). Parent and child report of family
functioning in a clinical child and adolescent eating disorders sample. Australian and New Zealand
Journal of Psychiatry, 36, 509–514.
Minuchin, S. (1977). Families and family therapy. London: Routledge.
Nelson, L., & Barry, M.C. (2005). Distinguishing features of emerging adulthood. Journal of Adolescent
Research, 20, 242–262.
Niemi, R. (1974). How family members perceive each other: Political and social attitudes in two generations.
New Haven: Yale University.
Noller, P. (1988). ICPS family functioning scales. Unpublished manuscript, University of Queensland,
Australia.
Noller, P., & Callan, V. (1988). Understanding parent-adolescent interactions: Perceptions of family
members and outsiders. Developmental Psychology, 24, 707–714.

The Australian Educational and Developmental Psychologist ❚ 59

 Terry Bowles, Martine Kurlender and Bridie Hellings

Noller, P., Seth-Smith, M., Bouma, R., & Schweitzer, R. (1992). Parent and adolescent perceptions of
family functioning: A comparison of clinic and non-clinic families. Journal of Adolescence, 15, 101–
114.
Oltmanns, T., & Emery, R. (2004). Abnormal psychology (4th ed.). Upper Saddle River, NJ: Prentice Hall.
Phelps, L., & Bajorek, E. (1991). Eating disorders of the adolescent: Current issues in etiology,
assessment, and treatment. School Psychology Review, 20(1), 9–14.
Pole, R., Waller, D., Stewert, S., & Parkin-Feigenbaum, L. (1988). Parental caring versus overprotection in
bulimia. International Journal of Eating Disorders, 7, 601–606.
Rinaldi, C., & Howe, N. (2003). Perceptions of constructive and destructive conflict within and across
family subsystems. Infant and Child Development, 12, 441–459.
Seiffge-Krenke, I. (2009). Leaving-home patterns in emerging adults: The impact of earlier parental
support and developmental task progression. European Psychologist, 14(3), 238–248.
Shisslak, C., McKeon, R., & Crago, M. (1990). Family dysfunction in normal weight bulimic and bulimic
anorexic families. Journal of Clinical Psychology, 46(2), 185–190.
Soh, N., Touyz, S., & Surgeon, L. (2006). Eating and body image disturbances across cultures: A review.
European Eating Disorders Review, 14, 54–65.
Stern, S., Dixon, K., Jones, D., Lake, M., Nemzer, E., & Sansone, R. (1989). Family environment in
anorexia nervosa and bulimia. International Journal of Eating Disorders, 8(1), 25–31.
Tata, P., Fox, J., & Cooper, J. (2001). An investigation into the influence of gender and parenting styles on
excessive exercise. European Eating Disorders Review, 9, 194–206.
Vidovic, V., Juresa, V., Begovac, I., Mahnik, M., & Tocilj, G. (2005). Perceived family cohesion,
adaptability and communication in eating disorders. European Eating Disorders Review, 13, 19–28.
Whitton, S.W., Waldinger, R.J., Schulz, M.S., Allen, J.P., Crowell, J.A., & Hauser, S.T. (2008). Prospective
associations from family-of-origin interactions to adult marital interactions and relationships
adjustment. Journal of Family Psychology, 22, 274–286.
World Health Organization. (1995). Physical status: the use and interpretation of anthropometry. Report
of a WHO Expert Committee (WHO Technical Report Series 854). Geneva: Author.
World Health Organization. (2000). Obesity: preventing and managing the global epidemic. Report of a
WHO Consultation (WHO Technical Report Series 894). Geneva: Author.

60 ❚ The Australian Educational and Developmental Psychologist

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