Annette S. Kluck

Family factors in the development of disordered eating: Integrating dynamic and behavioral explanations

Previous studies exploring the dynamic (e.g., enmeshment, disengagement, rigidity, communication difficulties, overprotectiveness) and behavioral (e.g., parental modeling of eating behavior and attitudes toward weight, parental criticism and teasing, parental encouragement to diet) influences of the family on disordered eating behaviors have yielded mixed results. However, past research explored these different aspects of the family environment in isolation. The present study extended previous research by testing a prediction model in which the effects of family dynamics on the development of eating disorders operate through family food-related experiences. A total of 268 single college women completed the Eating Attitudes Test - Revised, Bulimia Test - Revised, Parental Bonding Instrument - II, Family Adaptability and Cohesion Scales - II, Parent Adolescent Communication Scale - Adolescent Form, Family Influence Scale, and Family Experiences Related to Food Questionnaire. Structural Equation Modeling revealed that both family dysfunction and negative family food-related experiences were associated with increased disordered eating. Results indicated that negative family food-related experiences mediated the relationship between family dysfunction and disordered eating. Discussion focuses on implications for the assessment and treatment of eating disorders.

Reality television and the muscular male ideal

Although researchers have examined the negative effects of viewing reality television (RTV) on womens body image, this research has not been extended to men. Exploring the extent to which RTV depicts men who embody the muscular ideal may enhance our understanding of the potential influence of this media genre. We explored the extent to which RTV depicted men who embodied the muscular ideal using a quantitative content analysis. Based on binomial tests, the primary male cast members of programs airing on networks popular among young adult men during the Fall 2009 broadcast season were more muscular, with lower levels of body fat, than average U.S. men. The chest-to-waist and shoulder-to-waist ratios of these cast members did not differ as a function of program type (i.e., reality drama, endurance, and romance). Young men who view RTV programs included in the present study would be exposed to an unrepresentative muscular ideal.

Appearance commentary from romantic partners: evaluation of an adapted measure.

The purpose of this study was to evaluate the psychometric properties of the Verbal Commentary on Physical Appearance Scale (VCOPAS; Herbozo & Thompson, 2006b) after modifying it to capture appearance feedback given by romantic partners (VCOPAS-P). Women participants (N=248) completed the VCOPAS-P, as well as measures of disordered eating, body image dissatisfaction, relationship quality, and socially desirable responding. Exploratory factor analysis identified the best factor structure for the VCOPAS-P, which contained three factors similar to the VCOPAS. Correlations between the VCOPAS-P subscales and measures of disordered eating, body image dissatisfaction, relationship quality, and social desirability responding demonstrated convergent and discriminant validity of the VCOPAS-P. There was a significant positive correlation between the negative comments subscale of the VCOPAS-P and the measures of body dissatisfaction and weight concern (measured by the EDE-Q). Additionally, VCOPAS-P subscales reflecting positive comments about appearance and weight were associated with greater relationship satisfaction.

Confidentiality, ethics, and informed consent.

In Fisher’s (January 2008) excellent and much-needed article, she rightly implied that when discussing ethical dilemmas, psychologists may find themselves saying “consult an attorney” almost as often as they find themselves saying, “consult a fellow psychologist.” Fisher’s article was meant to turn the ship so to speak, by providing psychologists with a foundation for thinking clearly about confidentiality issues—a foundation that does not use legal arguments as primary building blocks. The above being said, we offer comments about four issues that we hope will add to the fine ideas expressed by Fisher (2008). First, we believe that Fisher’s careful analysis of this area has opened a somewhat clearer view of a problem that many psychologists have when they write about client consent. Client consent really means two very different things (as Fisher implied but which we wish to emphasize). Psychologists can obtain client “consent” to disclose information, such as having the client consent to the release of records to another psychologist. Presumably under such circumstances, the client really does consent. In contrast, psychologists can also obtain “consent” when they ask clients to sign a statement acknowledging that confidentiality may be broken under certain circumstances. We believe that using the same word to describe both situations is confusing because in everyday language “consent” denotes voluntary or even proactive agreement. Obviously, Fisher did not create this problem, but her article throws it into relief, especially in Sections II, III, and IV of the model. Thus, when one reads the word “consent” in Fisher’s model (Table 2, p. 7), it is not always clear whether the usage refers to true consent or to acknowledgement of the limits of confidentiality. Perhaps the term “client consent” should be used only to refer to situations in which clients really do endorse a psychologist’s action, and a somewhat different phrase should be chosen to describe the process whereby psychologists are to provide complete information about the limits of confidentiality (e.g., “acknowledgement of guidelines that will be followed in psychotherapy” or “client acknowledgement of exceptions to confidentiality”). A second point is related somewhat to our discussion above. In her narrative, Fisher apparently endorsed Behnke’s (2004) “doors” model, including the door that allows disclosure when legally permitted for a valid purpose. Yet, Fisher’s (2008) choice of wording in Section III (“Obtain Truly Informed Consent to Disclose Voluntarily,” p. 7) of her model seems slightly confusing for two reasons. First, Rule A under Section III says: “Respect the rule: Disclose without client consent only if legally unavoidable” (p. 7). This seems somewhat different from the American Psychological Association (APA) Ethical Standard 4.05(b), which says that one can disclose confidential information without client consent “where permitted by law for a valid purpose” (APA, 2002, p. 1066). It also seems different from Behnke’s and even Fisher’s narrative to some extent. Thus, the question arises as to whether Fisher believes that confidential information can be disclosed for a valid purpose or that it can be disclosed only if legally unavoidable. Second, it seems a little inconsistent for Fisher to criticize using legal arguments as the foundation for thinking about confidentiality yet then to suggest (Section III, Rule A, p. 7) that the only way one should break confidentiality without consent is if the legal system demands it. If psychologists wish to redeem confidentiality from the clutches of the legal system, as we think about a legitimate basis for breaking confidentiality and highlight relevant legal issues, shouldn’t we at least give equal weight to principled arguments about potentially higher ethical commitments (perhaps, for example, saving the lives of many people)? Third, although Fisher (2008) analyzed to some extent the words of the current Ethics Code, reviewed the wording of several older versions of the Ethics Code, and implicitly criticized some of these versions, it is still not completely clear where Fisher stands regarding the current relationship between the Ethics Code and confidentiality. Another way of saying this is that there is little in the article to tell us whether Fisher believes that the current APA Ethics Code is just fine the way it is or should be changed in order to shore up the (presumably) eroding foundation of confidentiality. We do understand that Fisher’s central point here is not to critique the current code but rather primarily to use it as a part of discussing confidentiality. Still, we would have liked to hear her ideas on this matter. Thus, when she says on p. 6, “Underneath all the legally imposed exceptions, the familiar old ethical rule is still there. The rule is simple enough,” one wonders how “simple” it can be given the earlier careful distinctions Fisher drew between various versions of the Ethics Code. Fourth, we believe that Fisher’s (2008) article would have been strengthened by some consideration of multicultural and cross-cultural issues. Although there are many practice settings in which psychologists’ commitment to confidentiality may not be significantly and often altered by cultural influences, it is obvious that there are cultural issues bound up in confidentiality (e.g., Meer & VandeCreek, 2002; Pettifor & Sawchuk, 2006). Thus, Fisher’s model would be strengthened if one or more sections of it were to explicitly remind psychologists that culture plays a role in how we understand the construct of confidentiality and how we carry out our commitments. We appreciate the contribution of this article to the literature on confidentiality;

Family Relations and Psychopathology: Examining Depressive and Bulimic Symptomatology

Despite early theories suggesting that family dysfunction (FD) may cause disordered eating, FD has been linked with other disorders and is a non-specific risk factor for disordered eating. We examined one potential model of the way FD relates to disordered eating, drawing on research that identified depression as a risk factor for bulimia. We examined whether depression symptoms (DEPs) partially mediated the relationship between family cohesion (as a measure of FD) and bulimic symptoms (BNs) using a sample of 215 never-married college women under age 20. Perceptions that one’s family was less cohesive (or more disengaged) was associated with increased DEPs and BNs. Moreover, DEPs partially mediated the influence of cohesion on BNs through a significant indirect effect. Both family systems in general and treatment of mood difficulties may be important considerations in the prevention of disordered eating, and prevention efforts that include family relationships should be experimentally explored.

Sexual functioning and disordered eating: A new perspective

Carefully listening to the patient is of paramount importance for psychoanalysis and psychoanalytic psychotherapy. The present study explored whether patient vocalization as well as the gender of the analyst play significant roles in clinical listening. Fifty-one psychoanalysts and psychoanalytic therapists were randomly assigned to listen to one of two dramatized psychoanalytic sessions. The content of the sessions was the same for both versions, but the sessions were dramatized differently. Some differences emerged between the versions, especially on ratings of reality testing, impulse control, pressured speech, patient was confusing, and awareness of imagery. Furthermore, differences emerged between male and female analysts in terms of ratings of intervention strategies and countertransference reactions to the patient material. Session version and gender affect different ratings. Implications of the findings are discussed as is the utility of using more ecologically valid material in conducting empirical research into clinical judgment.