caretaking, separation from parents, and the development of eating disorders

JOURNAL OF COUNSEL ING & DEVELOPMENT • SPR ING 1998 • VOLUME 7 6166

Caretaking, Separation From Parents, and theDevelopment of Eating Disorders

Dinah F. Meyer and Richard K. Russell

Dinah F. Meyer is an assistant professor in the Department of Psychology at Ohio State University, Marion Campus. Richard K. Russell is an associateprofessor in the Department of Psychology at Ohio State University. Portions of this article were presented at the 103rd Annual Convention of the AmericanPsychological Association, New York. Correspondence regarding this article should be sent to Dinah F. Meyer, The Ohio State University, 1465 Mt. VernonAvenue, Marion, OH 43302-5695 (e-mail: [email protected]).

The authors investigated the relationship between the cognitive and behavioral indicators of eating disorders and characteristicsof codependency, including exaggerated caretaking and constricted emotion. In addition, the role of family environment wasinvestigated through an assessment of separation from parents. College women who displayed more codependent characteris-tics evidenced higher levels of eating disordered behavior and conflictual separation from parents. The findings suggest thatcodependency may serve as an additional variable in the relationship between eating disorders and separation/individuationdifficulties. Implications for counseling with college women are discussed.

Over the last few decades, the incidence ofeating disordered behavior in the UnitedStates has increased in epidemic proportions,particularly among college women(Klemchuk, Hutchinson, & Frank, 1990;

Whitaker & Davis, 1989). Recent estimates postulate thatup to 65% of women in their first year of college displaysome behavioral and psychological characteristics of dis-turbed eating (Mintz & Betz, 1988). Furthermore, the rec-ognition of a broad continuum of eating disorders serves toinclude those women with serious eating disorder symp-toms, but not serious enough to meet the Diagnostic andStatistical Manual of Mental Disorders (DSM-IV; AmericanPsychiatric Association, 1994) criteria (Rodin, Silberstein,& Striegel-Moore, 1985; Scarno & Kalodner-Martin, 1994).In response to this phenomenon, a plethora of theory andresearch has attempted to identify the biological, familial,and psychosocial correlates of disordered eating.

In the last 10 years, a major focus of attention has beenon the separation–individuation model as providing a richformulation for understanding the etiology and course ofeating disorders (Armstrong & Roth, 1989; Friedlander &Siegel, 1990; Heesacker & Neimeyer, 1990). Stemming frompsychodynamic, family systems, and object relations theory,this theory proposes a link between the cognitions and be-haviors indicative of eating disorders and a woman’s diffi-culty with separating from her parents to acquire personalindependence and a separate identity (Strober & Humphrey,1987). Drawing on Bowlby’s attachment theory, separation-individuation theory posits that the separation process goesawry when caregivers inconsistently respond to children’s

needs and cues. Research supporting separation–individuationtheory has shown that for some anorexic women a relianceon weight loss and dieting is a desperate attempt to estab-lish a sense of personal efficacy and control in those inter-personal situations they see as tenuous (Armstrong & Roth,1989). Similarly, bulimic women who binge may be seek-ing a readily available method of self-soothing because theyhave learned to expect others to be unavailable or insensi-tive to their needs (Smolak & Levine, 1993).

Empirical research suggests that problems in the separa-tion-individuation process largely result from pervasive dis-turbances in family dynamics, role conflict, and suppressedaffective expression among family members (Friedlander& Siegel, 1990; Strober & Humphrey, 1987). Families ofanorexic women have been characterized as enmeshed,overprotective, conflict avoiding, and unresponsive to thedaughter’s self-expressions (Garner, Garfinkel, & Bemis,1982). In such families in which interpersonal boundariesare violated and independence is discouraged, young womenfeel personally deficient, inadequate, and overly dependenton their parents. Upon facing developmental tasks requir-ing individuation, women may focus on eating and weightto grasp a sense of control and personal power. Similarly,separation conflicts were also noted by Friedlander andSiegel (1990), who found higher parental dependency con-flicts and poor self–other differentiation to be associatedwith eating disorder characteristics. Furthermore, eating dis-order symptoms have been linked to insecure attachment,social incompetence (Heesacker & Neimeyer, 1990), andover-responsibility in relation to parents (Smolak & Levine,1993).

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C a r e t a k i n g , S e p a r a t i o n F r o m P a r e n t s , a n d t h e D e v e l o p m e n t o f E a t i n g D i s o r d e r s

In contrast, the families of some bulimic women have beencharacterized by hostile enmeshment, non-nurturance, andemotional unresponsiveness (Humphrey, 1989). Bulimicsymptoms may then develop because food is used as a self-soothing mechanism and purging becomes a way to relieveunpleasant affect in the most expedient manner (Humphrey,1989). Bulimic behaviors have been associated with women’sreports of conflictual dependence on parents, evidenced byexcessive guilt, mistrust, and resentment (Scalf-McIver &Thompson, 1989) as well as greater overseparation of be-liefs and values from parents (Smolak & Levine, 1993). Al-though such research strongly suggests the precipitating roleof family environment in developing eating disorders, it isdifficult to determine from existing research the mechanismby which familial factors may spur disordered eating.

One answer to this question may lie in the contributionof individual coping styles as a link between family envi-ronment and eating disorders. In examining the literature,it can be seen that many of the cognitions and behaviorscharacteristic of the separation–individuation model of eat-ing disorders are strikingly parallel to those associated withthe concept of codependency. A term emerging from theaddictions treatment literature in the 1970s, codependency,was intended to describe people whose lives had becomeunmanageable as a result of being involved with someonewho was chemically dependent (Beattie, 1987). Recently,the term codependent has expanded well beyond its origi-nal boundaries, and now describes an individual who hasbeen significantly affected by current or past involvementin an alcoholic or other stressful family environment(O’Brien & Gaborit, 1992; Potter-Efron & Potter-Efron,1989). Typically, codependents begin with good motives inthat they express worry and concern about another person.Unfortunately, these feelings come to take priority over theirown needs, and codependents become obsessed with man-aging another person’s behavior.

Despite the sizable amount of anecdotal literature on thistopic, codependency has remained an ambiguous concept.Clearly, a precise definition is hindered by a lack of empiricalresearch. One of the earliest studies sought to empiricallyvalidate the typical codependent characteristics describedby clinical observations (Wright & Wright, 1990). Womenwho were deemed to be codependent due to their involve-ment with an alcoholic partner scored significantly differ-ently from those in a noncodependent control group onthe following relationship dimensions: less emotional ex-pression, higher control needs, greater feelings of responsi-bility, and a higher tendency to evaluate personal self-worthon the basis of her partner’s opinion.

The use of the term codependent is unfortunate, particu-larly in light of the confusion over its definition. As Tavris(1992) asserted, labels can both liberate and oppress indi-viduals. In many Western cultures, women are socialized tobe nurturing, caring, and dependent on others. Yet, thesesame women are caught in a bind by a society that labelsthem as “sick” and “codependent” for having the very quali-ties they were raised to possess (Tavris, 1992).

In light of this critique, recent research has sought to de-termine the parameters and psychological correlates of thecodependency construct. The first attempt to generate anoperational, empirically testable definition resulted in adescription of codependency as “an extreme focus outsideof self, lack of open expression of feelings, and attempts toderive a sense of purpose through relationships” (Spann &Fischer, 1990, p. 27). This definition evolved from the re-searchers’ review of the clinical and anecdotal literature oncodependency, and involved a collapse of 18 overlappingcharacteristics into three areas. Using this working defini-tion, Cowan and Warren (1994) demonstrated significantrelationships in undergraduates between codependency andboth overresponsiveness to the needs of others and exces-sive control of others. Similarly, a study using a codepen-dency measure based on Spann and Fischer’s (1990) defi-nition suggested that codependency and loss of self(operationalized as self-sacrifice and suppression of feel-ings) are significantly related, both empirically and concep-tually (Cowan, Bommersbach, & Curtis, 1995). Given thefindings of the most recent empirical investigations, the useof Spann and Fischer’s (1990) definition of codependencyin the current study seems warranted.

Although empirical research on the codependency con-struct is in the earliest stages, several of the concept’s de-fining characteristics seem to be quite similar to the sepa-ration–individuation difficulties often displayed by womenwith eating disorders. Prominent characteristics of bothcodependents and women with eating disorders who haveseparation–individuation difficulties include a high need forcontrol, distorted self–other boundaries, and the displace-ment of repressed feelings by way of self-destructive be-haviors. In the only study to date that has tested the linkbetween codependency and separation–individuation,Fischer and Crawford (1992) reported higher codependencyscores among women whose fathers were perceived as au-thoritarian (a parental style characterized by high controland low support). The authors speculated that adolescentsmay develop codependency from their parents as they learnthat controlling others is important in relationships. How-ever, the lack of warmth and support from the parent maylead the adolescent to feel emotional insecurity in interper-sonal relationships. Thus, individuals essentially learn acodependent model for relationships and carry this schemainto other interpersonal situations.

One criticism of the concept of codependency, however,is that it does not discriminate between normal caretakingand healthy selflessness and excessive, self-destructive be-haviors (Tavris, 1992). Thus, perhaps moderate codependentcharacteristics are relatively typical and healthy yet becomeharmful and destructive when excessive. In this study, weexamined the codependency construct and its relation toeating disordered behavior and parental separation. We hy-pothesized that women who were assessed as exhibitingstrong codependent behaviors would (a) score higher on aset of cognitive and behavioral variables indicative of eatingdisorders and (b) evidence less mature parental separation,

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compared with women who are not assessed withcodependent behaviors. In addition, we hypothesized thatsignificant inverse relationships would exist between eatingdisorder symptoms and separation from parents, with separa-tion from parents predicting eating disorder characteristics.

METHOD

Participants

Participants were 95 undergraduate women at a large,midwestern university. The mean age of the participantswas 20.3 years, with a range of 18 to 32 years. Of the par-ticipants, 71 were in their first or second year of college.Seventy-six (80%) of the women were Caucasian, 10 (11%)were Asian American, 6 (6%) were African American, andthe remaining 3 (3%) identified themselves as “biracial.” Allwere volunteers who participated for course credit.

Variables

Codependency assessment. The 34-item Codependency As-sessment (CA; Potter-Efron & Potter-Efron, 1989) was usedas a categorical measure of codependency versus non-codependency. This instrument was derived from our clini-cal observations and is being tested as a research tool (Pot-ter-Efron & Potter-Efron, 1989). Stemming from Friel’s(1985) Codependency Assessment Inventory, the CA com-prises eight subscales considered diagnostic forcodependency: Fear, Shame/Guilt, Prolonged Despair, Rage,Denial, Rigidity, Impaired Identity Development, and Con-fusion. Each subscale contains between three and six ques-tions, to which the respondent answers “yes” or “no”. Atleast two questions in each subscale must be endorsed forthat subscale to be considered positive for codependency,and five of eight subscales must be positive for the indi-vidual to obtain a positive assessment for codependency.This scoring method, yielding an assessment of codepen-dency or noncodependency, was derived to obtain the mostconservative assessment of codependency (Potter-Efron &Potter-Efron, 1989). McGlone (1992) reported significanttest–retest reliabilities for each subscale, ranging from .53to .86 over a 5-week interval for a female undergraduatesample. Cronbach’s coefficient alpha for the CA was .97,indicating a high degree of internal consistency reliability(McGlone, 1992). Evidence of concurrent validity of the CAhas been demonstrated by significant associations betweenthe CA and the Differentiation of Self Scale (DSS; Olver,Aries, & Batgos, 1989). The DSS is a measure of self–otherdifferentiation, assessing such characteristics as deferenceto others’ wishes and relying on others for criteria of worth.Individuals designated as codependent by the CA signifi-cantly differed from noncodependents (p < .001) on theDSS, whereby codependent participants retained lower lev-els of self–other boundaries (Meyer, 1995).

Psychological separation. Hoffman’s (1984) PsychologicalSeparation Inventory (PSI) was used to assess parental sepa-ration/individuation. This 138-item inventory contains four

subscales that theoretically reflect a psychodynamic modelof psychological separation. The Functional Independencescale (e.g., “My mother helps me to make my budget”) tapsthe ability to manage personal affairs without parental as-sistance, and the Attitudinal Independence scale (e.g., “Myvalues regarding honesty are similar to my father’s”) assessesthe degree to which one’s values and attitudes differ fromthose of the parents. The Emotional Independence scale(e.g., “Being away from my mother makes me feel lonely”)reflects freedom from an excessive need for parental ap-proval and emotional closeness, and the Conflictual Inde-pendence scale (e.g., “I often have to make decisions for myfather”) measures freedom from excessive guilt, responsi-bility, and distrust toward parents. Participants respond to a5-point scale from not at all true of me (1) to very much trueof me (5), with half of the items pertaining to the motherand the other half to the father.

Scales are scored by adding the ratings for each scale andsubtracting this number from the total number possible foreach scale. Higher subscale scores reflect a developmen-tally mature psychological separation and are calculatedseparately for mother and father. Test–retest reliabilities overa 3-week interval ranged from .70 to .96 for female partici-pants, and internal consistency reliabilities of .84 to .92 havebeen reported with a college student sample (Hoffman,1984; Rice, Cole, & Lapsley, 1990). Palladino Schultheissand Blustein (1994) reported internal consistency estimatesof .90 for the Conflictual Independence subscale and .88for the Attitudinal Independence subscale, also with anundergraduate sample. Evidence for construct validity comesfrom several studies ascertaining that greater psychologicalseparation of young women from their parents is associ-ated with better personal and academic adjustment(Hoffman, 1984; Hoffman & Weiss, 1987; Lapsley, Rice, &Shadid, 1989; Lopez, Campbell, & Watkins, 1986).

Eating disorders. The Eating Disorder Inventory-2 (EDI-2; Garner, 1991) is a 91-item inventory designed to assessthe behaviors and psychological features associated witheating disorders. The EDI-2 consists of eight subscales in-cluded in the original version of the EDI (Garner, Olmsted,& Polivy, 1983): Drive for Thinness, Body Dissatisfaction, Bu-limia, Ineffectiveness, Perfectionism, Interpersonal Distrust,Interoceptive Awareness, and Maturity Fears. In addition, theEDI-2 contains three new provisional subscales. The Asceti-cism scale measures self-denial, the Impulse Regulation scaleassesses impulsivity and self-destructiveness, and the So-cial Insecurity scale measures the belief that social relation-ships are disappointing and conflictual. Higher scores indi-cate greater disturbance on each subscale.

Test–retest reliability of the original EDI with nonclinicalparticipants over a 3-week interval ranged from .65 to .97(Wear & Pratz, 1987). Internal consistency measures rangedfrom .86 to .93 for eating disorder samples, and coefficientalphas of .80 or higher were reported for samples using col-lege women (Garner & Olmsted, 1984). For the three pro-visional subscales, internal consistency estimates ranged from.70 to .80 for eating disorder samples, and .44 to .80 for



nonpatient samples (Garner, 1991). Evidence for constructvalidity of the EDI-2 has been established by demonstratingconvergent and discriminant validity with other psychomet-ric instruments of eating disorder behaviors and attitudes(Garner, 1991; Garner & Olmsted, 1984). Criterion-relatedvalidity has also been shown through differences in EDI-2scores between eating disorder samples and nonpatientsamples (Garner, 1991; Garner et al., 1983). Finally, evi-dence for concurrent validity of the EDI includes establishedrelationships between EDI scores and clinicians’ ratings ofeating disordered clients (Garner & Olmsted, 1984).

Procedure

The initial screening involved administering theCodependency Assessment to 177 women enrolled in anintroductory psychology course, and all received coursecredit for participating. From this sample, participants wereclustered into groups on the basis of CA scores. After thescoring procedure for the CA (Potter-Efron & Potter-Efron,1989), participants were designated as codependent (n =50) if they endorsed at least five of eight subscales on theCA. Participants were designated as noncodependent (n =45) if they endorsed two or fewer subscales of the CA.Eighty-two participants endorsed three or four subscalesof the CA. To allow for a more accurate comparison be-tween codependents and noncodependents, the 82 partici-pants scoring in the midrange of the CA (endorsing threeor four subscales) were eliminated. Thus, 95 participantswere included in the final analyses.

After the initial screening, the 95 participants selectedfor inclusion were asked to participate in the second half ofthe study. Participants were informed that the study in-volved dieting, personality, and family relationships, and all95 agreed to participate for additional course credit. Par-ticipants completed the EDI-2, the PSI, and a second CAapproximately 3 weeks later. All measures were counter-balanced to reduce the likelihood of a response set. Aftercompleting the instruments, participants were debriefedthrough a handout that listed information and support re-sources for eating disorders.

Seven participants completed the PSI for only one par-ent, indicating that the other parent was deceased. Data forthese participants were retained in the data set, and theirPSI scores were analyzed for the parent that was indicated.

RESULTS

To compare participants designated as codependent versusnoncodependent on the eating disorder and parental sepa-ration variables, two multivariate analyses of variance(MANOVAs) were performed. The MANOVA indicatedsignificant differences between codependents’ andnoncodependents’ eating disorder symptoms, F(11, 83) =5.28, p < .001. Follow-up univariate tests (see Table 1) wereconducted to further explore the significant multivariateeffect. To control for Type I error, the alpha level was ad-

justed to .004 using a Bonferroni correction. Codependentssignificantly differed from noncodependents on 10 of the11 EDI-2 subscales. Only the Perfectionism subscale wasnot significant, F(1, 93) = 1.02, p = .3153.

Results of a MANOVA were also supportive of the pre-dicted relationship between codependency and parentalseparation, F(8, 79) = 3.63, p < .001. For the follow-upunivariate tests, alpha levels were adjusted to .006 using aBonferroni correction. As shown in Table 1, participantsassessed as codependent evidenced lower levels of paternalconflictual independence, F(1, 86) = 11.73, p = .0009, andmaternal conflictual independence, F(1, 86) = 12.71, p =.0006. There were no significant differences, however, be-tween the two groups on the Emotional, Attitudinal, andFunctional Independence subscales.

To assess the relations between cognitive and behavioralindicators of eating disorders and the parental separationindices, intercorrelations were computed between variables.Alpha was set at .004 using a Bonferroni correction. As pre-sented in Table 2, the intercorrelations showed significantinverse associations between 10 of the 11 EDI-2 subscalesand conflictual parental separation. The results of the cor-relational analyses point to conflictual independence fromparents as the only psychological separation variable asso-ciated with eating disorder characteristics. Participants whoexperienced lower levels of conflictual freedom from theirmother and father scored higher on 10 of the 11 EDI-2variables.

To test the hypothesis that parental separation predictedeating disorder characteristics, simultaneous multiple re-gression analyses were performed. Examination of the cor-relations among the parental separation (predictor) variablesshowed that multicollinearity seemed to be a problem.Specifically, the correlation between maternal emotionalindependence and maternal functional independence was.72, and the correlation between paternal emotional inde-pendence and paternal functional independence was .82.To deal with this, some researchers have suggested droppingthe scale(s) that may produce the greatest redundancy(Cohen & Cohen, 1983). Therefore, the functional inde-pendence scales were dropped from the regression analy-ses. This decision was based primarily on theory (e.g., Bruch,1973; Minuchin, Rosman, & Baker, 1978) and research(Rhodes & Kroger, 1992; Strober & Humphrey, 1987), sug-gesting the importance of emotional overdependence on par-ents in the development of eating disorders.

For the regression analyses, alpha was adjusted to .004using a Bonferroni correction. The overall regression re-vealed that parental separation significantly predicted 4 ofthe 11 eating disorder subscales, including InteroceptiveAwareness, R2 = .24, F(6,87) = 4.17 p = .001; Impulse Regu-lation, R2 = .28, F(6, 87) = 5.25, p = .0001; Social Insecu-rity, R2 = .23, F(6, 87) = 4.01, p = .002; and Asceticism, R2

= .23, F(6, 87) = 3.63, p = .003). An examination of thesignificant individual predictors showed that InteroceptiveAwareness was predicted by maternal conflictual indepen-dence (β = –.26), t(87) = –2.18, p < .05, and maternal emo-



tional independence (β = –.28), t(87) = –2.12, p < .05. Im-pulse Regulation was predicted by maternal conflictual in-dependence (β = –.26), t(87) = –2.25, p < .05, and paternalconflictual independence (β = -.25), t(87) = –2.15, p < .05.Social Insecurity was significantly related to maternalconflictual independence (β = -.28), t(87) = –2.43, p < .025.Finally, Asceticism was predicted by paternal conflictualindependence (β = –.31), t(87) = –2.45, p < .025. Thesefindings then, suggest that most of the variance in eatingdisorder symptoms accounted for by parental separation isdue to a lack of conflictual independence from parents,particularly the mother.

Results of the regression analyses revealed that seven ofthe eating disorder variables were not related to parentalseparation. Parental separation did not predict Drive forThinness, R2 = .17, F(6, 87) = 2.78, p = .02; Bulimia, R2 =.14, F(6, 87) = 1.66, p = .05; Body Dissatisfaction, R2 = .17,F(6, 87) = 2.30, p = .01; Ineffectiveness, R2 = .17, F(6, 87) =2.81, p = .01; Perfectionism, R2 = .17, F(6, 87) = 2.87, p = .01;Interpersonal Distrust, R2 = .15, F(6, 87) = 2.35, p = .04; andMaturity Fears, R2 = .17, F(6, 87) = 2.78, p = .02). Thus, de-spite significant correlations between 10 of the eating disor-der variables and conflictual parental separation, parental

separation variables accounted for an insignificant amountof variance in most of the eating disorder symptoms.

DISCUSSION

The differences found in this study between women as-sessed as codependent versus noncodependent suggest thatcodependency is associated with greater amounts of eatingdisorder symptomatology. In addition, the results of thisstudy suggest that codependency is associated with lowerlevels of conflictual freedom from parents. These findingsrepresent an attempt to further extend the sparse researchon codependency and add to existing knowledge about thecharacteristics associated with eating disordered behavior.

As hypothesized, participants designated as codependentscored higher than noncodependents on 10 of 11 eatingdisorder variables. Although the relationship betweencodependency and eating disorders has never been directlyinvestigated, these results seem to be compatible with re-search that links eating disorders and the personal charac-teristics that Spann and Fischer (1990) included in theirdefinition of codependency. For example, previous studieshave shown an association between eating disorders and a

TABLE 1

Differences in Eating Disorders and Psychological Separation in Women Designatedas Codependent Versus Noncodependent

Variable

Codependent Noncodependent

F pSDSD MM

Eating disorder scalesa

Drive for ThinnessBulimiaBody DissatisfactionIneffectivenessPerfectionismInterpersonal DistrustInteroceptive AwarenessMaturity FearsAsceticismImpulse RegulationSocial Insecurity

Psychological separation scalesb

Conflictual IndependenceMaternalPaternal

Attitudinal IndependenceMaternalPaternal

Emotional IndependenceMaternalPaternal

Functional IndependenceMaternalPaternal

8.13.4

15.66.27.04.66.04.36.45.85.7

66.168.9

27.833.4

35.040.0

29.637.7

5.75.38.66.24.84.35.31.84.95.54.5

18.121.1

13.214.9

14.617.4

12.712.6

3.80.88.90.66.11.11.02.03.31.21.4

81.582.3

26.130.3

41.245.7

32.037.3

5.21.16.71.13.32.21.92.21.81.91.8

16.714.6

11.014.0

13.215.0

10.711.1

14.809.67

17.4334.65

1.0224.2134.2612.4215.3827.5935.30

12.7111.73

0.141.01

5.542.68

0.410.02

.0002

.0025

.0001

.0001

.3153

.0001

.0001

.0007

.0002

.0001

.0001

.0006

.0009

.7112

.3174

.0208

.1055

.5222

.8879

Note. For the psychological separation scales, higher scores reflect a more mature separation.aFor eating disorder scales, df(1, 93). bFor psychological separation scales, df(1, 86).



lack of autonomy in relationships (Becker, Bell, & Billington,1987; Friedlander & Siegel, 1990; Rogers & Petrie, 1996).Furthermore, the results of this study suggest that womenare more likely to display eating disorder symptoms if theytend to deny or refrain from expressing their feelings, acharacteristic of codependency that may represent an at-tempt to please others in relationships (Cowan et al., 1995;Spann & Fischer, 1990). This finding is comparable to pastresearch (e.g., Strober & Humphrey, 1987) and theory(Bruch, 1973), which has suggested that many women witheating disorders have significant difficulties regulating af-fect. Although the finding of an association betweencodependency and eating disorders does not imply causal-ity, the current study seems to support Cowan and Warren’s(1994) postulation that codependency is not synonymouswith healthy caretaking or nurturance but rather with de-nial of needs and feelings.

We also obtained support for the hypothesized relationshipbetween codependency and psychological separation. Partici-pants assessed as codependent evidenced lower levels of ma-ture conflictual separation (as indicated by lower scores onthe PSI). The suggestion that conflictual independence isthe critical parental variable in codependency is in agree-ment with Fischer and Crawford’s (1992) finding thatcodependency was associated with a parenting style charac-terized by high control and low nurturing support (authori-tarian style). It seems plausible that an authoritarianparenting style is associated with feelings of anger and hos-tility in children, potentially leading to some degree ofconflictual dependence on the parents. However, system-atic research is needed before a relationship between parentingstyle, separation, and codependency can be asserted.

The importance of conflictual independence is furtherhighlighted when examining the correlations between pa-

rental separation and eating disorders. Specifically, conflictualseparation from both mother and father was negatively asso-ciated with the Ineffectiveness, Impulse Regulation, SocialInsecurity, and Asceticism subscales of the EDI-2. However,the EDI-2 subscales considered to be behavioral manifesta-tions of eating disorders (Drive for Thinness, Bulimia, andBody Dissatisfaction; Garner, 1991) were associated onlywith lower paternal conflictual independence. Furthermore,the Interpersonal Distrust, Interoceptive Awareness, andMaturity Fears scales were correlated exclusively with ma-ternal conflictual independence. These findings are consis-tent with those of Friedlander and Siegel (1990), who foundthe strongest relationships between eating disorders andconflictual separation from parents.

As shown by the regression analyses, parental separationpredicted several of the psychological traits thought to beclinically relevant to eating disorders (i.e., lack of intero-ceptive awareness, social insecurity), but did not predictthe three EDI-2 subscales considered to be cognitive andbehavioral symptoms of eating disorders (Drive for Thin-ness, Bulimia, Body Dissatisfaction). These nonsignificantfindings were unexpected and inconsistent with past re-search (Friedlander & Siegel, 1990). However, because anonclinical sample was used in this study, it may be thatthe level of eating pathology was not high enough to seeclear predictive relationships.

The regressions also indicate that maternal and paternalconflictual separation seemed to be the most importantparental separation predictors of eating disorders. The re-search literature has long shown a link between maternalseparation and eating disorders (Beattie, 1988; Humphrey,1989; Rhodes & Kroger, 1992), but somewhat inconsistentrelationships have been found between paternal separationand eating disorders (Rhodes & Kroger, 1992; Steiger, Van

TABLE 2

Correlations Between Eating Disorder and Parental Separation Variables

Eating Disorder Scale

Parental Separation Variables

Conflictual Independence Functional Independence Emotional Independence Attitudinal Independence

MT PT PT PT PTMT MT MT

Drive for ThinnessBulimiaBody DissatisfactionIneffectivenessPerfectionismInterpersonal DistrustInteroceptive AwarenessMaturity FearsImpulse RegulationSocial InsecurityAsceticism

.17–.21–.23–.39*–.22–.34*–.35*–.33*–.40*–.45*–.31*

–.32*–.33*–.35*–.33*–.26–.24–.27–.19–.43*–.36*–.41*

–.22–.14–.07

.12–.09

.22–.05

.15

.06

.10–.07

.02

.05

.11

.13–.14

.05

.00–.06

.20

.08–.07

–.24–.22–.15–.02–.11

.00–.24–.04–.11–.06–.15

–.04.00

–.05–.04–.17–.08–.20–.11

.02–.08–.03

–.08–.07

.10

.09–.23

.20

.11

.18

.18

.15–.05

.12

.05

.18

.10–.19

.10

.07

.11

.21

.13–.02

Note. MT = Maternal, PT = Paternal, N = 95.*p < .004



der Feen, Goldstein, & Leichner, 1989). Further examina-tion is needed to ascertain the specific dynamics of father–daughter separation that may contribute to the developmentof an eating disorder.

Future research should address some methodological limi-tations inherent in this study. Regarding instrumentation,additional studies that ascertain validation and normativeinformation are needed for the Codependency Assessment.Furthermore, assessment of a concept as complex ascodependency may call for a more refined instrument thatcaptures its many dimensions. For example, theCodependency Assessment is a categorical measure ofcodependency; respondents are classified either ascodependent or noncodependent. It is possible, however, thatcodependency is better conceptualized as a continuous vari-able, indicating a need for more sensitive instrumentation.In addition, our sample consisted primarily of first-yearcollege students who volunteered to participate in this study,and the results may not be generalizable to all women. How-ever, given our focus on separation–individuation issues,beginning college students may be the most appropriatebecause they are presumed to be experiencing this conflictfor the first time (Hoffman, 1984). Samples drawn fromother grade levels or clinical populations could be used toinvestigate whether adjustment to parental separation af-fects the codependency–eating disorder relationship.

The results of this study have several implications forfuture research. First, our findings highlight the need tofurther assess the contribution of codependent characteris-tics to the development of eating disorder symptoms. Thisresearch may serve to delineate the specific, detrimentalaspects of codependency that are associated with particu-lar eating disorder characteristics. Similarly, this study didnot entail diagnosing clinical eating disorders but looked atthe cognitions and behaviors underlying the pathology. Thus,research investigating differences in parental separation andcodependency between groups with eating disorders andthose without eating disorders could add to the understand-ing of this phenomenon. Finally, the discovery of signifi-cant correlations between the behavioral manifestations ofeating disorders (Drive for Thinness, Bulimia, Body Dissat-isfaction) and paternal separation suggests that father–daughter separation issues seem to be underinvestigated.Although these relationships were not significant in theregression analyses, this relatively unexplored area meritsfurther investigation.

IMPLICATIONS FOR COUNSELING PRACTICE

This investigation has numerous implications for counsel-ing practice. Despite the controversy and criticism surround-ing the concept, codependency will likely continue to beused as a self-descriptor by many individuals who presentfor counseling (Cowan & Warren, 1994; Kaminer, 1990).Women, in particular, are virtually inundated with infor-mation about codependency from the popular media. Inlight of this, counselors should carefully explore what

codependency means to their clients, and, labels aside, workto promote the change of problematic behaviors.

With the identification of codependent characteristics aspossible variables in the relationship between family envi-ronment and eating disorders, an important interventionwould involve helping clients develop appropriate inter-personal boundaries. Drawing on feminist therapy (Mitchell,1992), interventions that address the need to feel good aboutoneself apart from the role of caretaker could diminish theextent that codependent behaviors are expressed in harm-ful ways. Likewise, many women with eating disorders tendto stifle or deny their legitimate needs and feelings, oftenconsidering them to be unimportant or selfish (Mitchell,1992). Counselors may not only help their clients to recog-nize, accept, and articulate these needs and feelings but alsocome to believe in their validity. Collectively, these stepswill allow women to see themselves as nurturing and lov-ing while believing that it is also acceptable to take care ofthemselves.

Clearly, counselors need to address the client’s level ofseparation from parents. Particularly with clients who haveeating disorders, the current study suggests that it may becritical to explore the various modes of psychological sepa-ration from parents. For example, a client may be function-ally independent from her parents yet also harbor guilt andanger toward them (representing a lack of conflictual inde-pendence). Indeed, this study suggests that, especially foreating disorder issues, addressing conflictual independenceis a critical step in assisting a healthy identity formation. Inparticular, the results of this study point to the importanceof mother–daughter separation in the development of eat-ing disorders. Traditionally, the mother has been the keyfigure in the separation–individuation model of eating dis-orders (Beattie, 1988), and the current study substantiatesthis relationship. However, the discovery of significant as-sociations between paternal conflictual separation and eat-ing disordered symptomatology also calls for counselors topay close attention to the client’s relationship with her fa-ther to assess potential separation difficulties.

Although supporting research on codependency is in theearliest stages, this study points to several clear differencesbetween women who display high and low amounts ofcodependent characteristics. The results revealed significantrelationships among codependency, eating disorder symp-tomatology, and conflictual parental separation, suggestingseveral avenues that could be explored through future research.

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caretaking, separation from parents, and the development of eating disorders

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