UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Anorexia nervosa and social network Buch, Wes 1988

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1988_A8 B82.pdf [ 7.63MB ]
Metadata
JSON: 831-1.0053743.json
JSON-LD: 831-1.0053743-ld.json
RDF/XML (Pretty): 831-1.0053743-rdf.xml
RDF/JSON: 831-1.0053743-rdf.json
Turtle: 831-1.0053743-turtle.txt
N-Triples: 831-1.0053743-rdf-ntriples.txt
Original Record: 831-1.0053743-source.json
Full Text
831-1.0053743-fulltext.txt
Citation
831-1.0053743.ris

Full Text

ANOREXIA NERVOSA AND SOCIAL NETWORK By M. WESLEY BUCH B.A., U n i v e r s i t y of B r i t i s h Columbia, 1976 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Counselling Psychology) We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA July 1988 © M. Wesley Buch, 1988 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department The University of British Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date Q-pk^i^ T. DE-6(3/81) i i ABSTRACT Aspects of the s o c i a l networks of anorexic (N=34) and non-a n o r e x i c (N=35) women were examined a c c o r d i n g to h y p o t h e s e s de r i v e d from s o c i a l network t h e o r y and r e s e a r c h and from the l i t e r a t u r e p e r t a i n i n g to anorexia nervosa. The nature of the s o c i a l network was d i s c u s s e d from the p e r s p e c t i v e of P a t t i s o n ' s (1977a) psychodynamic p s y c h o s o c i a l systems theory. S u b j e c t s were compared on s e l e c t e d s o c i a l network v a r i a b l e s using the P a t t i s o n P s y c h o s o c i a l I n v e n t o r y ( P P I ) . The C a l i f o r n i a P s y c h o l o g i c a l Inventory (CPI) and the Family Environment Scale (FES) were used to i n v e s t i g a t e the c o n t r i b u t i o n of c e r t a i n p e r s o n a l i t y and environmental v a r i a b l e s to s o c i a l network v a r i a t i o n . S t a t i s t i c a l a n a l y s e s of the d i f f e r e n c e between means were t e s t e d using the H o t e l l i n g ' s T2 p r o c e d u r e f o l l o w e d by u n i v a r i a t e t - t e s t s . A n a l y s e s of p r o p o r t i o n s were performed u s i n g z - t e s t s . The B o n f e r r o n i i n e q u a l i t y was employed i n o r d e r to r e d u c e the p r o b a b i l i t y of Type I e r r o r when d e t e r m i n i n g the s t a t i s t i c a l s i g n i f i c a n c e of the u n i v a r i a t e t - t e s t s and z - t e s t s . The n u l l h y p o thesis was accepted f o r the m a j o r i t y of the r e s u l t s . Only one s o c i a l network v a r i a b l e , t o t a l network s i z e , s i g n i f i c a n t l y d i f f e r e n t i a t e d a n o r e x i c and c o n t r o l s u b j e c t s , a l t h o u g h s e v e r a l o t h e r v a r i a b l e s were approaching s t a t i s t i c a l s i g n i f i c a n c e . Various c o n t r a s t i n g e x p l a n a t i o n s of the r e s u l t s were d i s c u s s e d . For example, i t i s p o s s i b l e t h a t a n o r e x i a nervosa i s not a homogeneous or s i n g u l a r n o s o l o g i c a l e n t i t y and does not i n e v i t a b l y r e s u l t i n p r e d i c t a b l e and l a r g e l y i n v a r i a n t i i i s o c i a l impairment. I t was proposed t h a t r e c e n t t y p o l o g i e s of anorexia nervosa may y i e l d s i g n i f i c a n t between-group v a r i a t i o n i n s o c i a l network v a r i a b l e s . Furthermore, s o c i a l networks may vary w i t h the degree of s e v e r i t y and/or c h r o n i c i t y of the anorexic c o n d i t i o n . The c o r r e l a t i o n a l a n a l y s e s produced s e v e r a l s t a t i s t i c a l l y s i g n i f i c a n t r e s u l t s . Regarding environmental (FES) v a r i a b l e s , both c o h e s i o n and independence were p o s i t i v e l y c o r r e l a t e d with support from f a m i l y network members. C o n t r a r y to h y p o t h e s e s , however, i n t e r p e r s o n a l e f f e c t i v e n e s s (CPI) achieved only weak and n o n - s i g n i f i c a n t c o r r e l a t i o n s w i t h s o c i a l network s i z e and support. i v TABLE OF CONTENTS .ABSTRACT . . i i LIST OF TABLES v i i LIST OF FIGURES . . . v i i i ACKNOWLEDGEMENTS i x CHAPTER 1 - INTRODUCTION 1 D e f i n i t i o n s 2 E t i o l o g y 3 A psychodynamic p s y c h o s o c i a l systems p e r s p e c t i v e . . 4 NATURE OF THE PROBLEM 6 E a r l y i m p r e s s i o n i s t i c r e s e a r c h . 6 Recent e m p i r i c a l r e s e a r c h . 8 A l i m i t a t i o n of c u r r e n t e m p i r i c a l r e s e a r c h 11 S o c i a l network a n a l y s i s . . 12 CHAPTER 2 - REVIEW OF THE LITERATURE 14 The s o c i a l context and p s y c h i a t r i c d i s t r e s s . . . 15 The s o c i a l network paradigm 16 S o c i a l network as s o c i a l context . 18 S o c i a l network: o b j e c t i v e and s u b j e c t i v e p e r s p e c t i v e s . . . . 18 The per s o n a l s o c i a l network 20 The per s o n a l s o c i a l network as zones of intimacy 21 The i n t i m a t e p s y c h o s o c i a l network . . . . 22 C h a r a c t e r i s t i c s of the p s y c h o s o c i a l network 24 V S o c i a l networks: p e r s o n a l and environmental determinants . . . 31 Normative s o c i a l networks 35 S o c i a l networks and mental h e a l t h 38 S o c i a l networks and p s y c h i a t r i c d i s t r e s s 40 Studies of p s y c h i a t r i c p o p u l a t i o n s 41 Comparative s t u d i e s of non-psychotic ( n e u r o t i c ) p s y c h i a t r i c p o p u l a t i o n s and t h e i r s o c i a l networks 44 Comparative s t u d i e s of ano r e x i c women and t h e i r s o c i a l networks 53 R e c a p i t u l a t i o n of the problem 58 Hypotheses and a summary of t h e i r t h e o r e t i c a l r a t i o n a l e 59 CHAPTER 3 - METHODOLOGY 68 Purpose of the Study 68 Sample 68 Data C o l l e c t i o n Procedure 70 Instrumentation 70 The P a t t i s o n P s y c h o s o c i a l Inventory 70 The C a l i f o r n i a P s y c h o l o g i c a l Inventory 74 The Family Environment Scale 77 Method of A n a l y s i s 78 CHAPTER 4 - RESULTS 80 Demographic Data A n a l y s i s 80 R e s u l t s of Primary Data A n a l y s i s by Hypothesis 82 Summary of R e s u l t s 98 v i CHAPTER 5 - DISCUSSION 100 E v a l u a t i o n of R e s u l t s of Demographic Analyses . . . . . 100 E v a l u a t i o n of R e s u l t s of Primary Data Analyses . . . . 103 L i m i t a t i o n s of the Study 116 I m p l i c a t i o n s f o r S o c i a l Network, Theory, Therapy, and Research . 117 I m p l i c a t i o n s f o r Anorexia Research 120 Conc l u s i o n 121 FOOTNOTES 123 BIBLIOGRAPHY . . . . . . . 124 v i i LIST OF TABLES Table 1. Types of S o c i a l Networks 19 Table 2. Comparisons of the S o c i a l Network S i z e of Anorexic and C o n t r o l Subjects 83 Table 3. Comparisons of I d e n t i f i c a t i o n of S p e c i f i c Network Members by Anorexic and C o n t r o l Subjects 84 Table 4. Comparisons of Frequency of Contact i n the S o c i a l Networks of Anorexic and C o n t r o l Subjects 85 Table 5. Comparisons of High Contact Frequency R e l a t i o n s i n the S o c i a l Networks of Anorexic and C o n t r o l Subjects 87 Table 6. Comparisons of Ambivalent or Negative R e l a t i o n s i n the S o c i a l Networks of Anorexic and C o n t r o l Subjects . 89 Table 7. Comparisons of the I n t e r a c t i o n a l and F u n c t i o n a l Ratings of Parents i n the S o c i a l Networks of Anorexic and C o n t r o l Subjects 90 Table 8. Comparisons of the High Frequency of Support R e l a t i o n s among the S o c i a l Networks of Anorexic and C o n t r o l Subjects 93 Table 9. Comparisons of the High Frequency of R e c i p r o c a l Support R e l a t i o n s among the S o c i a l Networks of Anorexic and C o n t r o l Subjects 94 Table 10. C r o s s - c o r r e l a t i o n s between 13 S o c i a l Network V a r i a b l e s and 3 T r a i t V a r i a b l e s (Anorexic Subjects Only) 97 Table 11. Comparisons of the S o c i a l Networks of A b s t a i n i n g and B u l i m i c Anorexic Subjects 110 v i i i LIST OF FIGURES Fig u r e 1. Zones of S u b j e c t i v e S o c i a l Network 21 i x ACKNOWLEDGEMENTS In a t h e s i s about s o c i a l networks, i t i s p a r t i c u l a r l y f i t t i n g t h a t I express my deep a p p r e c i a t i o n to the members of my own s o c i a l network who have been so h e l p f u l over the course of t h i s study. These people are as f o l l o w s . PAULA BUCH - my wife and c l o s e s t companion: Thank you f o r ' p u t t i n g me t h r o u g h s c h o o l ' a nd f o r y o u r w i l l i n g n e s s to p r o o f r e a d and c r i t i q u e the s e v e r a l d r a f t s of t h i s t h e s i s . Thank you most of a l l f o r your g e n t l e p a t i e n c e , u n d e r s t a n d i n g , and f l e x i b i l i t y , e s p e c i a l l y during those times when I was most obsessed with my r e s e a r c h . REV. MARK & HILDA BUCH - my parents: Thank you f o r your encouragement and s u p p o r t i v e n e s s from the ve r y beginning of t h i s r e s e a r c h p r o j e c t . DR. JOHN FRIESEN - t h e c h a i r m a n o f my ' t h e s i s committee: Thank you f o r your d i r e c t i o n at each stage of my r e s e a r c h , and most of a l l f o r 'sowing seeds' i n my l i f e that have captured my i m a g i n a t i o n . DR. LORETTE WOOLSEY - a member of my t h e s i s committee: Thank you f o r your w i l l i n g n e s s to p a r t i c i p a t e as a c o m m i t t e e member d u r i n g a s e a s o n when .you were p a r t i c u l a r l y pressed f o r time. DR. RALPH HAKSTIAN - c o n s u l t i n g s t a t i s t i c i a n : Thank you f o r the p a t i e n t e x p l a n a t i o n s and humour t h a t d i d much to r e l i e v e my i n i t i a l ' s t a t s - p h o b i a . ' JAMIE & NANCY RICHARDSON - my f r i e n d s : Thank you f o r your e m o t i o n a l and p r a c t i c a l s u p p o r t , and t h o s e marvelous d i s t r a c t i o n s , p a r t i c u l a r l y our s a i l i n g t r i p s t o g e t h e r . PADDY DUCKLOW - my t h e r a p y s u p e r v i s o r and f r i e n d : Thank you f o r being the f i r s t to see p o t e n t i a l i n me as a t h e r a p i s t and r e s e a r c h e r , and f o r h e l p i n g to develop that p o t e n t i a l . THE CONGREGATION OF RICHMOND CHRISTIAN FELLOWSHIP-Thank you f o r the g i f t of a paid month-long s a b b a t i c a l f o r r e s e a r c h purposes. 1 CHAPTER 1 INTRODUCTION A Canadian p e d i a t r i c i a n says anorexia nervosa i s r e a c h i n g epidemic l e v e l s among Canadian teen-agers and i t i s s t a r t i n g to a f f e c t a d o l e s c e n t s as young as twelve. Dr. Sujatha Lena says that the i n c i d e n c e of anorexia nervosa among teenage g i r l s i n t h i s country has doubled i n the l a s t ten years and now a f f e c t s one i n a hundred (News Item, Sept. 10, 1986, Radio S t a t i o n CJOR) There i s mounting evidence that the i n c i d e n c e and prevalence of anorexia nervosa i s i n c r e a s i n g (Bemis, 1978; L e i c h n e r , 1985; Leichner et a l . , 1984; M i t c h e l l & E c k e r t , 1987; R u s s e l l , 1985b; Szmukler et a l , 1986).! For example, Herzog & Copeland (1985) r e p o r t that the i n c i d e n c e of anor e x i a nervosa has doubled over the past two decades. P i k t e l (1986) suggests that the prevalence of severe cases of anorexia nervosa may be as high as 1/200 among school g i r l s , and 1/100 among g i r l s over 16 years of age. There i s some evidence of a trend towards e a r l i e r o n s e t of a n o r e x i a nervosa (eg., Lena et a l , 1985; Irwin, 1984), and R u s s e l l (1985a) has r e c e n t l y d i s c u s s e d p r e m e n a r c h a l a n o r e x i a nervosa and i t s sequelae. Feldman et a l (1988), i n a recent review of c h i l d r e n ' s a t t i t u d e s toward t h i n n e s s and f a t n e s s , found t h a t g i r l s a c q u i r e p r e v a i l i n g c u l t u r a l values of beauty and t h i n n e s s c o n s i d e r a b l y before puberty; indeed, "even nonobese g i r l s as young as 5 or 6 years of age may be concerned about t h e i r body image and have 2 r e a d i l y expressed t h e i r f e a r s of g a i n i n g weight" (pp. 190-191)! U n f o r t u n a t e l y , i n s p i t e of t h e g r o w i n g a w a r e n e s s of a n o r e x i a n e r v o s a among mental h e a l t h p r o f e s s i o n a l s and t h e g e n e r a l p u b l i c , the a n o r e x i c syndrome continues to be l e t h a l . For example, s e v e r a l s t u d i e s by Hsu and h i s a s s o c i a t e s (1979, 1980) show t h a t the m o r t a l i t y r a t e f o r a n o r e x i a n e r v o s a i s between 14% and 21%. Herzog & Copeland (1985) c l a i m t h a t morbidity and m o r t a l i t y r a t e s i n anorexia nervosa are among the hig h e s t recorded f o r p s y c h i a t r i c d i s o r d e r s , and p o i n t to l i f e -t h r e a t e n i n g medical c o m p l i c a t i o n s r e l a t e d to s t a r v a t i o n . I t i s hard l y s u r p r i s i n g t h e r e f o r e t h a t a n o r e x i a n e r v o s a has been a major p u b l i c h e a l t h concern and the su b j e c t of ex t e n s i v e r e s e a r c h during the past decade. D e f i n i t i o n s . Anorexia nervosa has been c o n c e p t u a l i z e d as a d i s c r e t e syndrome (eg., Bruch, 1973; C r i s p , 1970, 1977; G a r f i n k e l & Garner, 1982), a continuum of behaviors (eg., Nylander, 1971; Vandereycken & Meermann, 1984), a spectrum of e a t i n g d i s o r d e r s (Andersen, 1983), and a v a r i a n t of other p s y c h i a t r i c d i s o r d e r s , such as mood d i s o r d e r s ( C a n t w e l l et a l , 1977), and o b s e s s i v e -compulsive d i s o r d e r (Rothenberg, 1986). E f f o r t s continue among re s e a r c h e r s to p r e c i s e l y d e f i n e anorexia nervosa with s u b s t a n t i a l r e l i a b i l i t y and v a l i d i t y . One i m p o r t a n t development i n t h i s endeavour has been the p u b l i c a t i o n of the DSM I I I (1980). The d i a g n o s t i c c r i t e r i a f o r anor e x i a nervosa proposed by the DSM I I I , and used i n t h i s study, are as f o l l o w s : 3 A. Intense f e a r of becoming obese, which does not d i m i n i s h as weight l o s s p r o g r e s s e s . B. Disturbance of body image, e.g., c l a i m i n g to " f e e l f a t " even when emaciated. C. Weight l o s s of at l e a s t 25% of o r i g i n a l body weight or, i f under 18 years of age, weight l o s s from o r i g i n a l body weight plus p r o j e c t e d weight gain expected from growth c h a r t s may be combined to make the 25%. D. R e f u s a l to maintain body weight oyer a minimal weight f o r age and h e i g h t . E. No known p h y s i c a l i l l n e s s that would account f o r the weight l o s s (p. 69). C r i t i c i s m s of the DSM I I I d i a g n o s t i c c r i t e r i a f o r a n o r e x i a nervosa have been reviewed elsewhere (Powers & Fernandez, 1984). The DSM I I I has been r e c e n t l y r e v i s e d (DSM III-R, 1987), although the o n l y s i g n i f i c a n t change to the d i a g n o s t i c c r i t e r i a f o r a n o r e x i a n e r v o s a i s t h e a d d i t i o n o f p r i m a r y or s e c o n d a r y amenorrhea. E t i o l o g y . A n o r e x i a nervosa has been s t u d i e d from v a r i o u s b i o l o g i c a l , p s y c h o l o g i c a l and s o c i o c u l t u r a l p e r s p e c t i v e s , and a v a r i e t y of e t i o l o g i c a l f a c t o r s have been p r o p o s e d , such as g e n e t i c p r e d i s p o s i t i o n , o n s e t of p u b e r t a l hormonal a c t i v i t y , v u l n e r a b l e p e r s o n a l i t y , f a m i l y o r g a n i z a t i o n and i n t e r a c t i o n a l p a t t e r n s , major l i f e change, upper m i d d l e c l a s s s t a t u s , and s o c i e t a l pressure f o r extreme t h i n n e s s (Andersen, 1985). Given t h e number and d i v e r s i t y of t h e s e p r o p o s a l s , i t i s h a r d l y s u r p r i s i n g t h a t some r e s e a r c h e r s h a v e e s p o u s e d a m u l t i d i m e n s i o n a l approach to the e t i o l o g y and treatment of the 4 anorexic syndrome (eg., Bemis, 1978; G a r f i n k e l & G a r n e r , 1982; Katz, 1985; P i a z z a et a l , 1980; Vandereycken & Meermann, 1984). A m u l t i d i m e n s i o n a l approach a f f i r m s a r e c o g n i t i o n of c o n s i d e r a b l e c u r r e n c y among r e s e a r c h e r s s i n c e the very beginning of medical i n t e r e s t i n anor e x i a nervosa: the e x p r e s s i o n of the a n o r e x i c syndrome has i t s r o o t s , i n p a r t , i n the s o c i a l m i l i e u of the i n d i v i d u a l ( G r i g g , 1986; N o r r i s & J o n e s , 1979; Sheppy, 1984). What i s c l e a r l y needed, however, i s an ov e r - a r c h i n g theory that l i n k s s o c i a l and i n d i v i d u a l dimensions of a n o r e x i a n e r v o s a and p o s i t s mechanisms whereby s o c i a l v a r i a b l e s can be t r a n s l a t e d i n t o the s p e c i f i c f e a t u r e s of the anorexic syndrome. A psychodynamic p s y c h o s o c i a l systems p e r s p e c t i v e . Of p a r t i c u l a r i n t e r e s t t o t h i s s t u d y i s t h e p s y c h o d y n a m i c p s y c h o s o c i a l systems p e r s p e c t i v e espoused by P a t t i s o n and h i s c o l l e a g u e s i n t h e i r e f f o r t to e m p i r i c a l l y d e f i n e the p e r s o n a l p s y c h o s o c i a l network ( d i s c u s s e d i n Chapter 2 ) . P a t t i s o n (1977a) views human behaviour as the product of an i n t e r a c t i o n between i n d i v i d u a l psychology and the s o c i a l c o n t e x t , and hence uses the term p s y c h o s o c i a l to l a b e l the system of b e h a v i o u r . He has attempted to e m p i r i c a l l y d e f i n e the s o c i a l context i n terms of those people who are r e l a t e d to the i n d i v i d u a l on the b a s i s of both i n t e r a c t i o n and valued importance. Such people comprise the i n t i m a t e p s y c h o s o c i a l network, the psychodynamic s o c i a l system that r e p r e s e n t s the primary s o c i a l matrix of the i n d i v i d u a l and the primary s o c i a l u n i t f o r s o c i a l behaviour. P a t t i s o n f u r t h e r 5 suggests that the p s y c h o s o c i a l network, c o n s i s t i n g of f i v e to s i x people i n each subgroup of f a m i l y , r e l a t i v e s , f r i e n d s , neighbors, and w o r k - s o c i a l c o n t a c t s , i s the f u n c t i o n a l k i n s h i p group of the i n d i v i d u a l , the modern replacement of the b l o o d - k i n group and a concept t h a t has i m p l i c a t i o n s f o r who to t r e a t i n therapy. Psychodynamic p s y c h o s o c i a l systems t h e o r y has s e v e r a l i m p o r t a n t f e a t u r e s . F i r s t , i t i s r o o t e d i n a v e n e r a b l e t h e o r e t i c a l t r a d i t i o n ( p s y c h o d y n a m i c p s y c h o l o g y ) t h a t has accumulated a s u b s t a n t i a l l i t e r a t u r e concerning anorexia nervosa. S e c o n d , i t a f f i r m s t h e i n d i v i d u a l as a s o c i a l a c t o r , a t h e o r e t i c a l i s s u e that continues to be debated i n the l i t e r a t u r e of f a m i l y systems theory ( N i c h o l s , 1987; N o r r i s & Jones, 1979). T h i r d , i t i m p l i e s t h a t i n t e r a c t i o n a l p a t t e r n s p l a y a c o -d e t e r m i n i n g r o l e i n the e t i o l o g y and maintenance of e a t i n g d i s o r d e r s , as does f a m i l y systems t h e o r y , but a l s o o f f e r s a v a r i e t y of mechanisms ( i n t r a p s y c h i c ) whereby these i n t e r a c t i o n a l p a t t e r n s a r e t r a n s l a t e d i n t o the s p e c i f i c f e a t u r e s of the anorexic syndrome, such as a l t e r e d s e l f - p e r c e p t i o n s , d e s i r e f o r t h i n n e s s , and amenorrhea. Recent o b j e c t r e l a t i o n s f o r m u l a t i o n s of a n o r e x i a nervosa are an e s p e c i a l l y noteworthy source i n t h i s r e g a r d ( e g . , B r u c h , 1973, 1977; M a s t e r s o n , 1977; Ross, 1977; S e l v i n i - P a l a z z o l i , 1974; Sours, 1974, 1980). 6 NATURE OF THE PROBLEM The e a r l y l i t e r a t u r e c o n c e r n i n g a n o r e x i a n e r v o s a has y i e l d e d such a c o n s i s t e n t p r o f i l e of the s o c i a l context of the a n o r e x i c p a t i e n t as to become s t e r e o t y p i c . However, t h i s p r o f i l e i s l a r g e l y based upon c l i n i c a l - i m p r e s s i o n i s t i c data, and, as i s o f t e n the case i n the p r o g r e s s i o n of s c i e n c e i n any knowledge f r o n t i e r , has been c h a l l e n g e d by r e c e n t e m p i r i c a l s t u d i e s p a r t i c u l a r l y from f a m i l y i n t e r a c t i o n a l r e s e a r c h . E a r l y i m p r e s s i o n i s t i c r e s e a r c h . The e a r l y l i t e r a t u r e concerning a n o r e x i a nervosa p r o v i d e s a g e n e r a l p r o f i l e of the immediate s o c i a l m i l i e u of the anorexic p a t i e n t d e r i v e d l a r g e l y from psychodynamic and f a m i l y therapy r e s e a r c h . T h i s r e s e a r c h i s l a r g e l y l i m i t e d to c l i n i c a l impressions of the anorexic and her f a m i l y . P s y c h o d y n a m i c r e s e a r c h commonly d e p i c t s t h e f a m i l y r e l a t i o n s h i p s of the anorexic p a t i e n t as comprised of an o v e r -c o n t r o l l i n g , i n t r u s i v e , and domineering mother, and a p a s s i v e , i n e f f e c t u a l f a t h e r ( f o r a review, see Bemis, 1978; G a r f i n k e l & Garner, 1982). The f a m i l y i s u s u a l l y d e s c r i b e d as o v e r l y c l o s e and o v e r l y i n v o l v e d i n one another's l i v e s , w i t h the a n o r e x i c showing a dependent and immature attachment to her parents which i s thought to i n t e r f e r e w i t h the development of a d o l e s c e n t i d e n t i t y and autonomy ( e g . , K a l u c y et a l , 1977; Mintz, 1980; N o r r i s & Jones, 1979). A s i m i l a r f a m i l y p r o f i l e has emerged from e a r l y f a m i l y systems r e s e a r c h . For example, M i n u c h i n et a l 7 (1978) suggest that f a m i l i e s with a c h i l d who has psychosomatic symptomatology show a f a m i l y o r g a n i z a t i o n p a t t e r n based upon four c h a r a c t e r i s t i c s : enmeshment, r i g i d i t y , o v e r - p r o t e c t i v e n e s s , and l a c k of c o n f l i c t r e s o l u t i o n . The tendency toward unusually c l o s e i n t r a f a m i l i a l dependency has a l s o been found i n a number of demographic s t u d i e s of a n o r e x i c p o p u l a t i o n s (Kog, P i e r l o o t , & Vandereycken, 1983). F u r t h e r m o r e , the anorexic i s t y p i c a l l y d e s c r i b e d as being s o c i a l l y i s o l a t e d (eg_., C r i s p , 1980; D a l l y & Gomez, 1979; G a r f i n k e l & Garner, 1982; Jones, 1981; Neuman & Halvorson, 1983), o f t e n having only one short-term f r i e n d at a time (Bruch, 1977). For example, G a r f i n k e l & Garner (1982) suggest that most anorexic g i r l s l o s e i n t e r e s t i n t h e i r f r i e n d s e a r l y i n t h e i r d i e t i n g a c t i v i t i e s with the f o l l o w i n g r e s u l t s : By the time the weight l o s s has progressed to the p o i n t of medical i n t e r v e n t i o n , the a norexic may be t o t a l l y i s o l a t e d . T h i s i s o l a t i o n r e s u l t s i n l o n e l i n e s s and a sense of s o c i a l inadequacy (p. 8 ) . T h i s p r o f i l e of peer r e l a t i o n s has been found to be e s p e c i a l l y c h a r a c t e r i s t i c o f r e s t r i c t i n g a n o r e x i c s ; t h u s i n t h e i r r e t r o s p e c t i v e s t u d y of 193 b u l i m i c and r e s t r i c t i n g a n o r e x i c p a t i e n t s , G a r f i n k e l & Garner (1982) found t h a t l e s s than one-f i f t h of the r e s t r i c t i n g a n o r e x i c s were i n v o l v e d i n s o c i a l r e l a t i o n s h i p s and found them s a t i s f y i n g . With time, s o c i a l s k i l l d e f i c i t s may become profound, r e s u l t i n g i n a s u b s t a n t i a l l a g i n s o c i a l development (Andersen, 1985). F i n a l l y , G a r f i n k e l & Garner (1982) s u g g e s t that a norexic p a t i e n t s l o s e a l l sexual i n t e r e s t 8 and a v o i d e n c o u n t e r s w i t h t h e o p p o s i t e s e x . I f s e x u a l experiences do occur, they are u s u a l l y not enjoyed. The p r o f i l e of the a n o r e x i c ' s immediate s o c i a l m i l i e u emerging from t h i s e a r l y i m p r e s s i o n i s t i c r e s e a r c h may be b r i e f l y c h a r a c t e r i z e d as c o n s t r i c t e d , s o c i a l l y i s o l a t e d , and dominated  by n u c l e a r f a m i l y r e l a t i o n s h i p s that are e x c l u s i v e , enmeshed and  c o v e r t l y c o n f l i c t e d . T h i s p r o f i l e , however, may be c r i t i c i z e d as a s t e r e o t y p e d o v e r - g e n e r a 1 i z a t i o n b a s e d upon c l i n i c a l -i m p r e s s i o n i s t i c data evoked i n a psychotherapeutic context. Such a p r o f i l e has a tendency to become p r o c r u s t e a n ( G a r f i n k e l & G a r n e r , 1982), even though i t may w e l l be an a r t i f a c t of a l i m i t e d or flawed methodology (ej>. , Bemis, 1978; Kog, P i e r l o o t & Vandereycken, 1983). For example, common c r i t i c i s m s of t h i s e a r l y i m p r e s s i o n i s t i c r e s e a r c h i n c l u d e the i n f r e q u e n t use of v a l i d a t e d measures, the v i r t u a l absence of c o n t r o l g r o u p s , and the assumption of c a u s a l i t y i n the absence of d i r e c t e m p i r i c a l support ( S t r o b e r , 1986). N e v e r t h e l e s s , t h i s s o c i a l p r o f i l e bears a s t r i k i n g resemblance to the c o n s t r i c t e d , family-dominant s o c i a l network found r e p e a t e d l y over the p a s t two decades i n c r o s s -s e c t i o n a l s t u d i e s of v a r i o u s p s y c h i a t r i c p o p u l a t i o n s (reviewed i n Chapter 2). Recent empirical research. The s o c i a l p r o f i l e generated by e a r l y i m p r e s s i o n i s t i c r e s e a r c h has been chal l e n g e d by a growing body of f a m i l y i n t e r a c t i o n a l s t u d i e s ( f o r r e v i e w s , see Bemis, 1978; G r i g g , 1986; Jacob, 1975; Kog & Vandereycken, 1985; Sheppy, 9 1984; Strober & Humphrey, 1987). These s t u d i e s have employed a more r i g o r o u s methodology ( e j * . , c o n t r o l groups, o b s e r v a t i o n a l m e a s u r e s , s e l f - r e p o r t m e a s u r e s w i t h b e t t e r p s y c h o m e t r i c q u a l i t i e s ) , and t h e i r r e s u l t s o f t e n p o i n t t o a s t r i k i n g v a r i a b i l i t y among the f a m i l i e s of a n o r e x i c s ( G r i g g , 1986; Harding & Lachenmeyer, 1986; Humphrey, 1986; Humphrey et a l . , 1986; Kog et a l , 1985; Yager, 1982). For example, Kog et a l (1985), i n a p i l o t study of ten f a m i l i e s w i t h an a n o r e x i a / b u l i m i a nervosa p a t i e n t , employed a s e r i e s of st a n d a r d i z e d i n t e r a c t i o n tasks i n an attempt to v e r i f y Minuchin's psychosomatic f a m i l y model (1975, 1978). They summarized the r e s u l t s of t h e i r study as f o l l o w s : The p r e l i m i n a r y r e s u l t s appear to support the hypothesis that Minuchin's r a t h e r s t a t i c f a m i l y typology should be r e p l a c e d by a more dimensional and dynamic approach to f a m i l y f u n c t i o n i n g (Kog et a l , 1985, 525-538). G r i g g (1986) r e c e n t l y found t h r e e d i s t i n c t l y separate f a m i l y t r a n s a c t i o n a l p a t t e r n s r e l a t e d e x c l u s i v e l y to the a n o r e x i c syndrome! Humphrey et a l . (1986) found four types of parent-daughter i n t e r a c t i o n s t h a t s u c c e s s f u l l y d i s c r i m i n a t e d between s i x t e e n f a m i l i e s w i t h a b u l i m i c - a n o r e x i c daughter and twenty-four c o n t r o l f a m i l i e s . T h i s study i s e s p e c i a l l y noteworthy i n t h a t i t employed o b s e r v a t i o n a l d a t a . F u r t h e r m o r e , Humphrey (1986) has a l s o found f a m i l y i n t e r a c t i o n s t h a t a p p e a r t o d i s c r i m i n a t e among b u l i m i c - a n o r e x i c s , c l a s s i c a l a b s t a i n i n g a n o r e x i c s and women w i t h o u t an e a t i n g d i s o r d e r . H a r d i n g & L a c h e n m e y e r ( 1 9 8 6 ) , h o w e v e r , f a i l e d t o f i n d s i g n i f i c a n t d i f f e r e n c e s on any of the f a m i l y v a r i a b l e s c e n t r a l to Minuchin's 10 f a m i l y systems theory of anorexia nervosa (eg_. , o v e r p r o t e c t i o n , enmeshment, and r i g i d i t y ) i n t h e i r s t u d y of t h i r t y f e m a l e a n o r e x i c s and t h i r t y f emale c o l l e g e s t u d e n t c o n t r o l s . Such e m p i r i c a l s t u d i e s u n d e r l i n e Y a g e r ' s (1982) c a u t i o n a g a i n s t d e v e l o p i n g s t e r e o t y p e s of the c h a r a c t e r i s t i c s of a n o r e x i c f a m i l i e s . S e v e r a l recent e m p i r i c a l s t u d i e s have ch a l l e n g e d the common c l i n i c a l r e p o r t of over-involvement i n the f a m i l i e s of anorexic and a n o r e x i c - b u l i m i c p a t i e n t s ( B e r k o w i t z , 1983; H a r d i n g & Lachenmeyer, 1986; Kagan & S q u i r e s , 1985; Sheppy, 1984). These s t u d i e s found that an unusual degree of cohesion (or enmeshment) d i d not s u c c e s s f u l l y d i s c r i m i n a t e between such f a m i l i e s . Such f i n d i n g s are q u i t e c o n s i s t e n t with other e m p i r i c a l r e s e a r c h (ej>. , Str o b e r , 1981; Strober et a l . , 1981; Garner et a l . , 1983), but a r e c o n t r a r y to p r e d i c t i o n s based on e a r l y i m p r e s s i o n i s t i c r e s e a r c h (eg.., Bruch, 1973; S e l v i n i - P a l a z z o l i , 1974; Minuchin et a l . , 1978). F i n a l l y , two e m p i r i c a l s t u d i e s have r e c e n t l y c h a l l e n g e d c l i n i c a l r e p o r t s o f s o c i a l i s o l a t i o n and m a l a d j u s t m e n t i n anor e x i c p a t i e n t s . Herzog et a l (1985), i n an i n v e s t i g a t i o n of s o c i a l maladjustment among female medical stud e n t s , found t h a t students with a previous h i s t o r y of an o r e x i a nervosa (as d e f i n e d by the DSM I I I ) f e l l w i t h i n the norm on s o c i a l adjustment s c a l e s measuring performance i n s c h o o l , s o c i a l and l e i s u r e a c t i v i t i e s , f a m i l y r e l a t i o n s h i p s , and economic independence. Sheppy (1984), u s i n g an e c o l o g i c a l r e s e a r c h s t r a t e g y and a matched c o n t r o l 11 group, d i d not f i n d any s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n the s i z e or q u a l i t y of the s o c i a l networks of anorexic females and t h e i r f a m i l i e s . Taken together, these examples of recent e m p i r i c a l r e s e a r c h s u g g e s t t h a t the s o c i a l c o r r e l a t e s of a n o r e x i a n e r v o s a a r e d i v e r s e and c o m p l e x r a t h e r than i n v a r i a n t . T h i s r e s e a r c h supports G a r f i n k e l & Garner's (1982) p r e d i c t i o n that a v a r i e t y of f a m i l i a l i n t e r r e l a t i o n s h i p s , not a s i n g l e f a m i l y c o n s t e l l a t i o n , w i l l be a s s o c i a t e d with an o r e x i a nervosa, and dampens enthusiasm f o r anorexogenic s o c i a l f a c t o r s of any k i n d . A l i m i t a t i o n of c u r r e n t e m p i r i c a l r e s e a r c h . Recent e m p i r i c a l r e s e a r c h has provided a p r o f i l e of the s o c i a l context of a n o r e x i c p a t i e n t s t h a t i s almost e x c l u s i v e l y c o n f i n e d to a  d e s c r i p t i o n of t h e i r f a m i l y environment and f a m i l y r e l a t i o n s h i p s , d e s p i t e r e c o m m e n d a t i o n s i n t h e l i t e r a t u r e f o r a b r o a d e r e c o l o g i c a l focus (eg., Bronfenbrenner, 1977, 1979; Conger, 1981; Jackson, 1967; Powell, 1979; Sheppy, 1984; Wi l k i n s o n & O'Connor, 1982). L i t t l e r e s e a r c h has been done to e m p i r i c a l l y v e r i f y e t i o l o g i c a l hypotheses that i m p l i c a t e a b r o a d e r s o c i a l m i l i e u than the f a m i l y i n the development and maintenance of anor e x i a nervosa. One p o s s i b l e reason f o r t h i s narrow l o c u s of r e s e a r c h a c t i v i t y may be the g r e a t e r t h e o r e t i c a l s a l i e n c e of i n t r a p s y c h i c and f a m i l i a l dynamics among c u r r e n t r e s e a r c h p a r a d i g m s . For example, the psychodynamic and f a m i l y systems paradigms both tend to give t h e i r g r e a t e s t t h e o r e t i c a l and c l i n i c a l a t t e n t i o n to the 12 f a m i l y r e l a t i o n s h i p s of the a n o r e x i c , though f o r very d i f f e r e n t reasons. Another p o s s i b i l i t y may be the l a c k of a t h e o r y - d r i v e n e m p i r i c a l methodology that can adequately measure a s o c i a l f i e l d which i s l a r g e r than the f a m i l y and of t h e o r e t i c a l s i g n i f i c a n c e to the development and maintenance of i n d i v i d u a l psychopathology. S o c i a l network analysis. T h i s r e s e a r c h s t r a t e g y (reviewed i n C h a p t e r 2) shows c o n s i d e r a b l e promise i n c l a r i f y i n g the s t r u c t u r e , q u a l i t y of i n t e r a c t i o n , and f u n c t i o n of a b r o a d e r c r o s s - s e c t i o n of the a n o r e x i c ' s s o c i a l c o n t e x t than has been attempted by r e c e n t e m p i r i c a l f a m i l y r e s e a r c h . F u r t h e r m o r e , s o c i a l n e t w o r k a n a l y s i s h o l d s g r e a t p r o m i s e f o r c l i n i c a l i n t e g r a t i o n and i n n o v a t i o n i n the treatment of anor e x i a nervosa. However, s o c i a l network r e s e a r c h of anorexic p o p u l a t i o n s i s s t i l l i n i t s i n f a n c y : only one study c o u l d be found by the a u t h o r (Sheppy, 1984). Another study (Berkowitz, 1983) i n v e s t i g a t e d the a n o r e x i c ' s p e r c e p t i o n of her f a m i l y as a s o u r c e o f s o c i a l support, but was not a s o c i a l n e t w o r k ' a n a l y s i s . Together, these two s t u d i e s suggest that there are no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s i n the s o c i a l networks of anorexic and non-anorexic f a m i l i e s with regard to network s i z e , p e r c e i v e d f a m i l y s u p p o r t and r e c i p r o c i t y of o v e r a l l network s u p p o r t , a f i n d i n g t h a t c o n t r a d i c t s a p r e v a i l i n g s o c i a l network p r o f i l e found i n c r o s s -s e c t i o n a l s t u d i e s of n o n - p s y c h o t i c p s y c h i a t r i c p o p u l a t i o n s (reviewed i n Chapter 2). Sheppy (1984) comments that her r e s u l t s a r e s u r p r i s i n g i n view of her l i t e r a t u r e r e v i e w , and a f t e r 13 o f f e r i n g s e v e r a l e x p l a n a t i o n s f o r the f a i l u r e of her network data to a t t a i n s i g n i f i c a n c e she i n v i t e s a more d e t a i l e d a n a l y s i s of t h i s data. Her i n v i t a t i o n prompted t h i s study. The present study does not attempt to f i n d an anorexogenic s o c i a l network. Such an attempt would l i k e l y prove as e l u s i v e as the search f o r an anorexogenic f a m i l y i n t e r a c t i o n a l p a t t e r n or p a r e n t - c h i l d r e l a t i o n s h i p . What i s attempted by t h i s study i s an e x p l o r a t i o n of s o c i a l network c o r r e l a t e s of a n o r e x i a n e r v o s a a n t i c i p a t e d by e a r l y i m p r e s s i o n i s t i c r e s e a r c h concerning the s o c i a l context of the an o r e x i c p a t i e n t and r e p e a t e d l y found i n s o c i a l network analyses of non-psychotic p s y c h i a t r i c p o p u l a t i o n s . The c o n t r i b u t i o n of c e r t a i n p e r s o n a l i t y and f a m i l y v a r i a b l e s to s o c i a l network v a r i a t i o n w i l l a l s o be e x p l o r e d . The r e s u l t s of t h i s study may w e l l be suggestive of a c o - d e t e r m i n i n g r o l e of c e r t a i n s o c i a l network c o r r e l a t e s i n the development and/or maintenance of a n o r e x i a n e r v o s a , a l t h o u g h a more d e f i n i t i v e e t i o l o g i c a l p o s i t i o n i n t h i s r e g a r d would a w a i t p r o s p e c t i v e s t u d i e s . However, the author recommends the p o s i t i o n of Hurd et a l (1981b) who encourage a view of s o c i a l networks as n e i t h e r the s o u r c e o f a l l p a t i e n t p r o b l e m s n o r t h e s o u r c e of t h e i r r e s o l u t i o n , but r a t h e r as a dynamic f e a t u r e of the p a t i e n t ' s l i f e which should not be overlooked i n treatment i n t e r v e n t i o n s . 14 CHAPTER 2 REVIEW OF THE LITERATURE S o c i a l f a c t o r s are an i m p o r t a n t c o n s i d e r a t i o n t o many t h e o r i e s of the e t i o l o g y , maintenance, and r e s o l u t i o n of anorexia nervosa. For example, s o c i a l f a c t o r s r e l a t e d to the s t r u c t u r e and f u n c t i o n of the a n o r e x i c ' s s o c i a l r e l a t i o n s h i p s are of s p e c i a l i n t e r e s t to f a m i l y systems and s o c i a l network t h e o r i e s ( M i l l e r , 1984; Rosman et a l , 1977), whereas s o c i a l f a c t o r s r e l a t e d to c u l t u r a l norms concerning body weight and shape are of s p e c i a l i n t e r e s t to s o c i o c u l t u r a l t h e o r i e s ( A n d e r s e n , 1985; G a r f i n k e l & Garner, 1982; Schwartz et a l , 1985). What t h e s e t h e o r i e s s h a r e i n common, however, i s an a p p r e c i a t i o n f o r the s o c i a l context of a n o r e x i a nervosa. In the l i t e r a t u r e review that f o l l o w s , the concept of s o c i a l c o n t e x t i s e x p l o r e d from a s o c i a l network p e r s p e c t i v e . Of p a r t i c u l a r i n t e r e s t i s the s e m i n a l work of P a t t i s o n and h i s c o l l e a g u e s concerning the p s y c h o s o c i a l network and i t s morphology among v a r i o u s p s y c h i a t r i c p o p u l a t i o n s . Based upon a r e v i e w of t h e s o c i a l n e t w o r k and s o c i a l s u p p o r t l i t e r a t u r e , and the l i t e r a t u r e a l r e a d y reviewed (Chapter 1) p e r t a i n i n g to the s o c i a l c o n t e x t of a n o r e x i a nervosa, hypotheses are advanced concerning s p e c i f i c s t r u c t u r a l , i n t e r a c t i o n a l and f u n c t i o n a l aspects of the p s y c h o s o c i a l networks of a n o r e x i c women, and the c o r r e l a t i o n of t h e i r networks w i t h s p e c i f i c p e r s o n a l i t y and e n v i r o n m e n t a l v a r i a b l e s . 15 The s o c i a l context and psychiatric d i s t r e s s . The t w e n t i e t h century has w i t n e s s e d a growing r e c o g n i t i o n t h a t p s y c h i a t r i c d i s t r e s s , i n p a r t , has i t s r o o t s i n the s o c i a l m i l i e u of the i n d i v i d u a l . On the one hand, there i s a l a r g e l i t e r a t u r e from p s y c h i a t r i c e p i d e m i o l o g y t h a t l i n k s the s i g n i f i c a n c e of the s o c i a l m i l i e u to the maintenance of i n d i v i d u a l w e l l - b e i n g and a d a p t i v e s o c i a l f u n c t i o n i n g ; on the other hand, i t i s evident from the c l i n i c a l l i t e r a t u r e t h a t t h e r e has been a g r a d u a l e x p a n s i o n of treatment focus from the i n d i v i d u a l to the l a r g e r and more complex s o c i a l systems w i t h i n which the i n d i v i d u a l i s embedded ( H u r d e t a l , 1980; f o r a r e v i e w of the c l i n i c a l l i t e r a t u r e i n t h i s r e g a r d , see P a t t i s o n , 1973, 1976). These e f f o r t s , though commendable, share a common problem, however. P s y c h i a t r i c epidemiology has f a i l e d to provide an adequate, e m p i r i c a l methodology with which to assess the s o c i a l context of the i n d i v i d u a l , whereas treatment i n n o v a t i o n s have evolved i n an ad hoc f a s h i o n without w e l l d e f i n e d l i n k a g e s to s c i e n t i f i c theory or experimental r e s e a r c h (Hurd et a l , 1980). P a t t i s o n (1981) summarizes t h i s s t a t e of a f f a i r s as a " c u r i o u s combination of b o t h b a s i c s o c i a l s c i e n c e r e s e a r c h and i n t r i g u i n g c l i n i c a l i n n o v a t i o n " (p. 242). These two streams of development have l a r g e l y f o l l o w e d independent pathways, with l i t t l e i n t e r a c t i o n between the two. For example, E r i c k s o n (1975) notes t h a t even though B o t t ' s (1971) stud y i s o f t e n c i t e d i n t h e c l i n i c a l l i t e r a t u r e , r e f e r e n c e s to her c e n t r a l hypothesis r e l a t i n g network connectedness and c o n j u g a l r e l a t i o n s h i p s are r a r e . C l e a r l y what 16 i s n e e d e d i s a t h e o r y o r m e t a t h e o r y t h a t w o u l d s e r v e a s a h e u r i s t i c f o r a c a r e f u l i n t e g r a t i o n o f t h e c o n c e p t u a l a n d t h e o r e t i c a l b i t s a n d p i e c e s f o u n d t h r o u g h o u t t h e p e r t i n e n t r e s e a r c h and c l i n i c a l l i t e r a t u r e s . A m a j o r c o n t r i b u t i o n i n t h i s r e g a r d h a s com e f r o m t h e a p p l i c a t i o n o f s y s t e m s t h e o r y ( B e r t a l a n f f y , 1 9 6 8 ) t o human s o c i a l s y s t e m s , p a r t i c u l a r l y t h e f a m i l y s y s t e m ( H o f f m a n , 1 9 8 1 ) . E s p e c i a l l y n o t e w o r t h y h a s b e e n t h e r e c e n t e f f o r t by L ' A b a t e ( 1 9 8 5 ) t o c o l l a t e r e s e a r c h f r o m a v a r i e t y o f s o c i a l s c i e n c e d i s c i p l i n e s p e r t i n e n t t o t h e r e l a t i o n s h i p o f t h e i n d i v i d u a l t o t h e f a m i l y . E r i c k s o n ( 1 9 8 4 ) , h o w e v e r , h a s c r i t i c i z e d t h e c o n c e p t o f a c y b e r n e t i c n e t w o r k and i t s i n h e r e n t s y s t e m i c e p i s t e m o l o g y a s c o n t r i b u t i n g t o t h e d i s a p p e a r a n c e o f t h e s u b j e c t a s a s o c i a l a c t o r , an i s s u e t h a t h a s been r e c e n t l y a d d r e s s e d by N i c h o l s ( 1 9 8 7 ) . A n o t h e r c o n t r i b u t i o n h a s come f r o m t h e s o c i a l n e t w o r k l i t e r a t u r e . Of c e n t r a l i n t e r e s t t o t h i s s t u d y i s t h e s e m i n a l work o f P a t t i s o n a n d h i s c o l l e a g u e s ( P a t t i s o n , 1 9 7 6 , 1 9 7 7 a ; P a t t i s o n , 1 9 8 0 ) i n d e f i n i n g a n d m e a s u r i n g t h e i n t i m a t e p s y c h o s o c i a l n e t w o r k , a m i d - r a n g e c o n c e p t , g r o u n d e d i n a n i n t e r d i s c i p l i n a r y t h e o r y b a s e and an e m p i r i c a l m e t h o d o l o g y , t h a t l i n k s m a c r o s o c i a l a n d i n d i v i d u a l p r o c e s s e s w i t h i n a p s y c h o d y n a m i c f r a m e w o r k . The s o c i a l network paradigm. The s o c i a l n e t w o r k p a r a d i g m emerged f r o m s o c i a l a n t h r o p o l o g y a s a c o n s t r u c t f o r t h e a n a l y s i s o f s o c i a l r e l a t i o n s h i p s . B a r n e s ( 1 9 5 4 ) was a p p a r e n t l y t h e f i r s t 17 to use the concept as a mode of a n a l y s i s i n a study of a small community i n Norway. B o t t (1971) d e v e l o p e d the i d e a i n her seminal work, Family and s o c i a l network, and subsequently, there have been s i g n i f i c a n t a d v a n c e s i n t h e t h e o r y , method and re s e a r c h connected with network a n a l y s i s (eg., Anderson & C a r l o s , 1976; Berkowitz, 1982; B u r t , 1980; 1981, 1982; B u r t & M i nor, 1982; Dunn, 1983; F i s c h e r , 1982; Granovetter, 1973, 1983; Holland & L e i n h a r d t , 1979; L e i n h a r d t , 1977; Mardsen & L i n , 1982; P r i c e , 1981; Rogers & K i n c a i d , 1981; Shulman, 19876; Wellman, 1981, 1983). The h i s t o r i c a l development of the s o c i a l network paradigm has not been l i m i t e d to one d i s c i p l i n e , however. Indeed, i t has become a concept of c o n s i d e r a b l e currency among s o c i a l s c i e n c e r e s e a r c h e r s and c l i n i c i a n s , and i t s h i s t o r i c a l development may be t r a c e d through developments i n s e v e r a l d i s c i p l i n e s that have only r e c e n t l y begun t o c o a l e s c e . T h e s e d i s c i p l i n e s have been di s c u s s e d elsewhere i n r e l a t i o n s h i p to s o c i a l network theory and p r a c t i c e by P a t t i s o n and h i s a s s o c i a t e s as f o l l o w s : s o c i a l anthropology ( P a t t i s o n , 1977a), f a m i l y s o c i o l o g y ( P a t t i s o n et a l , 1975; P a t t i s o n , 1977), f a m i l y t h e r a p y ( P a t t i s o n et a l , 1975; P a t t i s o n , 1976, 1977a, 1977b), community mental h e a l t h ( P a t t i s o n , 1973, 1977b), community p s y c h i a t r y ( P a t t i s o n , 1977a, 1977b; Llamas, 1981; f o r a s o c i a l network a p p r o a c h to the s t r e s s -i l l n e s s r e l a t i o n s h i p , see P a t t i s o n et a l , 1979), p s y c h i a t r i c epidemiology (Llamas et a l , 1981), group psychotherapy ( P a t t i s o n , 1 9 7 0 ) , and s o c i a l p s y c h o l o g y ( P a t t i s o n , 1976; P o l l s t e r & P a t t i s o n , 1979, 1980). 18 S o c i a l network as s o c i a l context. The concept of s o c i a l network suggests that people do not e x i s t i n vague and amorphous r e l a t i o n to t h e i r s o c i a l c ontext. Based on the work of s o c i a l a n t h r o p o l o g i s t s and s o c i o l o g i s t s from Europe and America ( e g . , B a r n e s , 1972; B o i s s e v a i n , 1974; B o i s s e v a i n & M i t c h e l l , 1973; M c C a l l i s t e r & F i s c h e r , 1978; M i t c h e l l , 1969, 1974; W h i t t e n & Wolfe, 1969), the s o c i a l network concept has provided a way f o r s o c i a l s c i e n t i s t s to d e f i n e more p r e c i s e l y the s o c i a l context of the i n d i v i d u a l . Llamas et a l (1981) e x p l a i n s : By i d e n t i f y i n g the a c t u a l set of l i n k s w i t h i n which a p e r s o n may be embedded and by d e l i n e a t i n g t h e i r i n t e r c o n n e c t i o n s , or r e l a t i o n s h i p s , a l e v e l o f a b s t r a c t i o n i s achieved which goes beyond t r a d i t i o n a l c a t e g o r i c a l and person/group dichotomies to encompass an a n a l y s i s of t h e s t r u c t u r a l and i n t e r a c t i o n a l c h a r a c t e r i s t i c s of the s o c i a l m i l i e u . The importance of t h i s a p p r o a c h i s t h a t i t has a l l o w e d f o r the examination of r e l a t i o n s h i p s among a s p e c i f i c number of p e o p l e i n a v a r i e t y of normative contexts along more t h a n one d i m e n s i o n . . . I n s h o r t , i t p r o v i d e s an o p e r a t i o n a l d e f i n i t i o n of a f u n c t i o n a l s o c i a l system of  r e l a t i o n s h i p s (p. 182). S o c i a l network; o b j e c t i v e and s u b j e c t i v e perspectives. S o c i a l networks have been s t u d i e d f r o m two p e r s p e c t i v e s : o b j e c t i v e and s u b j e c t i v e . From an o b j e c t i v e p e r s p e c t i v e , a s o c i a l network may be viewed as an i n t e r - c o n n e c t e d c h a i n or s y s t e m a r b i t r a r i l y d e f i n e d by the s p e c i f i c c r i t e r i o n t h a t motivates the a n a l y s i s ( P a t t i s o n , 1977b). Any given person may be p a r t of many i n t e r l o c k i n g s o c i a l networks, depending on the c r i t e r i o n used. For example, there are s e v e r a l s e t s t h a t can act as c r i t e r i a , such as p e r s o n a l , c a t e g o r i c a l , a c t i o n , r o l e - s y s t e m 19 and f i e l d s e t s (see Table 1). TABLE 1 TYPES OF SOCIAL NETWORKS* L i m i t e d Network ( s e t ) Any e x t r a c t of the t o t a l network based on some c r i t e r i o n a p p l i c a b l e throughout the whole network. U n l i m i t e d Network Personal C a t e g o r i c a l A c t i o n Set Set Set Set l i m i t e d to the l i n k s of one person Set l i m i t e d Set to l i n k s l i m i t e d i n v o l v i n g persons of a c e r t a i n type or category to l i n k s purpose-f u l l y used f o r s p e c i f i c end Role-System F i e l d Set Set Set l i m i t e d Set to l i n k s l i m i t e d i n v o l v e d i n to l i n k s an organized with a r o l e system c e r t a i n or group content (eco-nomic , p o l i t i c a l e t c . ) The s o c i a l network conceived without a p p l i -c a t i o n of l i m i t i n g c r i t e r i a * Adapted from Whitten & Wolfe (1969) by Pattison (1977b). Of p a r t i c u l a r i n t e r e s t to t h i s study i s the p e r s o n a l s e t which d e f i n e s an e x t r a c t of the t o t a l network l i m i t e d to the l i n k s of one person, or the p e r s o n a l ( e g o c e n t r i c ) s o c i a l network ( t o be d i s c u s s e d b e l o w ) . Depending on the c r i t e r i o n or s e t used, t h e r e f o r e , a web of s o c i a l r e l a t i o n s may be i d e n t i f i e d , such as f a m i l y , work, f r i e n d s h i p , rumour, i n f o r m a t i o n , r e c r e a t i o n , a s s i s t a n c e , or worship networks (Hurd et a l , 1981). The n o t i o n of s e t as a c r i t e r i o n f o r the d e l i n e a t i o n of s p e c i f i c types of s o c i a l networks has important treatment i m p l i c a t i o n s i n that i t c l a r i f i e s the q u e s t i o n of where to begin i n c o n s t r u c t i n g a s o c i a l 20 system f o r i n t e r v e n t i o n ( P a t t i s o n , 1977a). C o n v e r s e l y , from a su-b.1ect.ive p e r s p e c t i v e a s o c i a l network may be defi n e d i n terms of t h e s o c i a l u n i t s ( i n d i v i d u a l s or gro u p s ) w i t h whom an i n d i v i d u a l or group has c o n t a c t (Llamas et a l , 1981). T h i s i s t h e p h e n o m e n o l o g i c w o r l d o f r e l a t i o n s h i p s d e f i n e d by the i n d i v i d u a l or group, the former r e f e r r e d to as the pers o n a l or  e g o c e n t r i c network, and the l a t t e r as the s o c i o c e n t r i c network. The personal s o c i a l network. E r i c k s o n (1975) d e f i n e s a p e r s o n a l s o c i a l network as "a f l e x i b l y bounded g r o u p i n g o f i n d i v i d u a l s c o m p r i s i n g a t l e a s t a f o c a l person, everyone the f o c a l person knows or i n t e r a c t s with, the set of r e l a t i o n s h i p s between those i n d i v i d u a l s and the f o c a l person, and the set of r e l a t i o n s h i p s t hat e x i s t s independently of the f o c a l person" (p. 492). There i s l i t t l e i n f o r m a t i o n concerning the extent of the perso n a l s o c i a l networks of i n d i v i d u a l s . Llamas et a l (1981) r e p o r t a n t h r o p o l o g i c a l d a t a suggesting that a person may have over 1500 people with whom he or she has pe r s o n a l i n t e r a c t i o n s ; h o w e v e r , s u c h a - p e r s o n i s n o t u n i f o r m l y r e l a t e d to t h i s p o p u l a t i o n , s i n c e i t may be a r r a n g e d i n t o zones of i n t i m a c y , importance, and i n t e r a c t i o n (See F i g u r e 1). 21 FIGURE 1 ZONES OF SUBJECTIVE SOCIAL NETWORK* * Adapted from Boissevain (1974) by Pattison (1977b). The p e r s o n a l s o c i a l network as zones of i n t i m a c y . B o i s s e v a i n (1974) suggests that persons are arranged i n a roughly g e o m e t r i c space of v a r y i n g p s y c h o s o c i a l d i s t a n c e from ego, r e s u l t i n g i n f i v e zones of r e l a t i o n s h i p s . P a t t i s o n & P a t t i s o n (1981) summarizes these zones as f o l l o w s : 1. The p e r s o n a l zone: persons with whom one l i v e s and has high investment. 2. The i n t i m a t e z o n e : p e r s o n s of h i g h p s y c h o s o c i a l importance with whom one i n t e r a c t s f r e q u e n t l y . 3. The e f f e c t i v e zone: people with whom one i n t e r a c t s but who a r e l e s s i m p o r t a n t ; or i m p o r t a n t p e o p l e w i t h l e s s i n t e r a c t i o n . 22 4. The n o m i n a l z o n e : p e o p l e known, bu t o f l e s s e r importance and i n t e r a c t i o n . 5. The extended zone: people known about or l i n k e d through s i g n i f i c a n t others (pp. 135-136). The i n t i m a t e p s y c h o s o c i a l network. P a t t i s o n and h i s a s s o c i a t e s have c o n f i n e d t h e i r work to a subset of the personal s o c i a l network, the i n t i m a t e p s y c h o s o c i a l network ( a l s o c a l l e d the p s y c h o s o c i a l k i n s h i p network, or s i m p l y , the p s y c h o s o c i a l n e t w o r k ) , which encompasses the f i r s t two zones of i n t i m a c y d i s c u s s e d above. P a t t i s o n uses the term " p s y c h o s o c i a l " because t h e r e l a t i o n s o f t h i s n e t w o r k a r e d e f i n e d i n t e r m s of p s y c h o l o g i c a l meaning to ego, and there i s an observable s o c i a l i n t e r a c t i o n that can be measured between ego and important others ( P a t t i s o n & P a t t i s o n , 1981). The r a t i o n a l e f o r t h i s narrow focus d e r i v e s from both the t h e o r e t i c a l and c l i n i c a l s i g n i f i c a n c e of the p s y c h o s o c i a l network. With r e g a r d to t h e o r e t i c a l s i g n i f i c a n c e , P a t t i s o n (1981) contends that the p s y c h o s o c i a l network "r e p r e s e n t s a fundamental s o c i a l u n i t of e x i s t e n c e " (p. 136). N o t i n g the h i s t o r i c a l importance of k i n s h i p systems as a major determinant of a f f e c t i v e and i n s t r u m e n t a l r e l a t i o n s h i p s , he argues that the n u c l e a r f a m i l y may not be the b a s i c s o c i a l system i n modern s o c i e t y , but r a t h e r an extended p s y c h o s o c i a l k i n s h i p system, comprised of nuclear f a m i l y , some blood r e l a t i v e s , r e l a t i v e s by m a r r i a g e , f r i e n d s , n e i g h b o r s , and c l o s e a s s o c i a t e s f r o m c h u r c h , work, or r e c r e a t i o n a l a c t i v i t i e s ( P a t t i s o n e t a l , 1975). I t i s t h i s 23 c o l l a g e of r e l a t i o n s h i p s , then, that comprises the f u n c t i o n a l p r i m a r y p s y c h o s o c i a l group of the i n d i v i d u a l . Llamas et a l (1981) h i g h l i g h t s the p o t e n t i a l l y s u p p o r t i v e a s p e c t s of t h i s p s y c h o s o c i a l n e t w o r k , s u g g e s t i n g t h a t i t i s h e r e "where i n d i v i d u a l s e x i s t i n h i g h l y interdependent r e l a t i o n s h i p s , t h a t the necessary " p s y c h o s o c i a l s u p p l i e s " s u s t a i n i n g a person's day-to-day e x i s t e n c e are seen as r e s i d i n g " (p. 184). As such, the p s y c h o s o c i a l network may provide the f o u n d a t i o n a l s t r u c t u r e f o r i n d i v i d u a l growth and a d a p t a t i o n , and thus i s u l t i m a t e l y r e l a t e d to the p h y s i c a l and p s y c h o l o g i c a l w e l l - b e i n g of persons (Llamas et a l , 1981). The c l i n i c a l s i g n i f i c a n c e of the p s y c h o s o c i a l network has been summarized by P a t t i s o n et a l (1975) as f o l l o w s : (1) the p s y c h o s o c i a l system does e x i s t ; (2) i t e x e r t s both p o s i t i v e and negative s a n c t i o n s and supports on the nuclear f a m i l y and the i n d i v i d u a l ; (3) i t i s a fundamental s o c i a l matrix that may prove to be e i t h e r p a t h o l o g i c a l or h e l p f u l and t h e r a p e u t i c (p. 1248) . The c l i n i c a l i m p l i c a t i o n here i s t h a t t r e a t m e n t f o c u s must expand from the i n d i v i d u a l or f a m i l y to the l a r g e r context of the p s y c h o s o c i a l network. In summary, P a t t i s o n i s i n t e r e s t e d i n a s u b s e t of the p e r s o n a l s o c i a l network, the p s y c h o s o c i a l network, which he c o n t e n d s i s t h e p r i m a r y s o c i a l m a t r i x of the i n d i v i d u a l . P a t t i s o n a p p r o a c h e s h i s s t u d y o f t h i s n e t w o r k w i t h a psychodynamic o r i e n t a t i o n , t h a t i s , he i s i n t e r e s t e d i n the way t h i s matrix i s r e l a t e d to the i n d i v i d u a l i n terms of i n t e r a c t i o n and valued importance; hence, he views the r e l a t i o n s h i p s i n t h i s 24 matrix as being determined by s o c i a l and p s y c h o l o g i c a l v a r i a b l e s , or the s o c i a l psychology of i n t e r p e r s o n a l r e l a t i o n s h i p s . C h a r a c t e r i s t i c s of the psychosocial network. As a concept, s o c i a l n e t w o r k p e r t a i n s to t h e l i n k a g e between p e o p l e i n r e l a t i o n to a s p e c i f i c i n t e r a c t i o n a l f u n c t i o n (Hurd e t a l , 1981b). For example, there may be s i n g l e i n s t r u m e n t a l l i n k s to o t h e rs (gas s t a t i o n a t t e n d a n t ) , s i n g l e a f f e c t i v e l i n k s to others (a t e n n i s p a r t n e r ) , m u l t i p l e i n s t r u m e n t a l l i n k s to others (a coworker who a l s o p r o v i d e s c a r r e p a i r s e r v i c e s a f t e r work hours), m u l t i p l e a f f e c t i v e l i n k s to others (a t e n n i s p a r t n e r who i s a l s o best f r i e n d ) , and mixed a f f e c t i v e - i n s t r u m e n t a l l i n k s to o t h e r (a c l e r g y m a n who i s a l s o a f r i e n d ) . S o c i a l network a n a l y s i s may t h e r e f o r e be v i e w e d as a d e s c r i p t i o n o f t h e s t r u c t u r a l , i n t e r a c t i o n a l , and f u n c t i o n a l c h a r a c t e r i s t i c s of the s o c i a l l i n k s of a s p e c i f i c s o c i a l o r g a n i z a t i o n (see F i s c h e r et a l , 1977; G r a n o v e t t e r , 1973; H e l l e r & Swindle, 1983; I s r a e l , 1982; Laumann, 1973; M i t c h e l l , 1969; Wellman, 1979; Wood, 1984), i n t h i s study, the p s y c h o s o c i a l network (see Hurd et a l , 1980, 1981b). The s o c i a l network and s o c i a l s u p p o r t l i t e r a t u r e s suggest that these c h a r a c t e r i s t i c s vary with age, gender, race, and s o c i a l c l a s s ( A n t o n u c c i & Depner, 1982; G r i f f i t h , 1985; P a t t i s o n , 1977a; S c h u l z & Rau, 1985; S t o k e s & L e v i n , 1986; Warheit et a l , 1982). Hurd et a l (1980) d e f i n e s the s t r u c t u r a l c h a r a c t e r i s t i c s of a s o c i a l network as "the r e l a t i o n s h i p or p a t t e r n i n g of the l i n k s 25 i n the network with r e s p e c t to one another" (p. 6 ) . S t r u c t u r a l c h a r a c t e r i s t i c s may i n c l u d e the f o l l o w i n g v a r i a b l e s . S i z e ( r a n g e ) : the number of people i n a network. There has been a "bigger i s b e t t e r " m e n t a l i t y i n the s o c i a l network l i t e r a t u r e r e g a r d i n g s i z e . Whereas i t may be true that l a r g e r networks have g r e a t e r p o t e n t i a l f o r g i v i n g s u p p o r t , l a r g e r networks may a l s o b r i n g i n c r e a s e d d e m a n d s and i n c r e a s e d p o t e n t i a l f o r u n p l e a s a n t i n t e r a c t i o n s ( S t o k e s , 1983). P o l i t s e r (1980) suggests a c u r v i l i n e a r r e l a t i o n between the s i z e of a network and i t s a b i l i t y to s a t i s f y one's needs. Indeed, t h e r e i s r e s e a r c h e v i d e n c e f o r a t h r e s h o l d e f f e c t concerning s i z e : Brown et a l (1975) found that women with a c l o s e , c o n f i d i n g r e l a t i o n s h i p were almost 10 t i m e s l e s s l i k e l y to become d e p r e s s e d a f t e r a se v e r e l y s t r e s s f u l l i f e event than women without such a c o n f i d a n t . Conversely, i f , as P e a r l i n (1985) argues, s u p p o r t i s drawn from d i f f e r e n t network sources f o r d i f f e r e n t p r oblems, a l a r g e r s o c i a l n e t w o r k w i t h c o n s i d e r a b l e v a r i a t i o n i n i t s c o m p o s i t i o n i s p r e f e r a b l e . 2. C o m p o s i t i o n ( c o n t e n t ) : the number and kind of r e l a t i o n s contained w i t h i n the network. T h i s v a r i a b l e has been f u r t h e r c h a r a c t e r i z e d as e i t h e r s i n g l e - p l e x (a l i n k d e f i n e d by only one type of r e l a t i o n ) or m u l t i p l e x (a l i n k which c o n s i s t s of m u l t i p l e types of r e l a t i o n s ) (Hurd et a l , 1981a). Vaux & H a r r i s o n (1985) have d e m o n s t r a t e d t h a t c o m p o s i t i o n i s r e l a t e d t o s a t i s f a c t i o n with network support. 3. D e n s i t y : the e x t e n t to which network members c o n t a c t each other independently of the f o c a l person, and i s computed as the p r o p o r t i o n of people who could know one another ( l i n k s that could e x i s t ) to the people who a c t u a l l y do know one another ( l i n k s t h a t do e x i s t ) ( M i t c h e l l , 1969; s e e a l s o F r e e m a n , 1977, 1979, concerning c e n t r a l i t y ) . Hammer et a l (1978) r e p o r t s that the interconnectedness of c l o s e r e l a t i o n s h i p s i n a network i s a d i r e c t f u n c t i o n of the mean d u r a t i o n of the t i e . Hurd et a l (1981b) p o i n t s to the s i g n i f i c a n c e of d e n s i t y to c o l l e c t i v e network b e h a v i o u r . F o r example, a weakly i n t e r c o n n e c t e d network would have d i f f i c u l t y f u n c t i o n i n g c o l l e c t i v e l y t o m o b i l i z e s u p p o r t r e s o u r c e s during c r i s i s ; however, a p o t e n t i a l l i a b i l i t y of t h i s kind of network may be the g r e a t e r p r e s s u r e to conform b e h a v i o r a l l y to network norms. Stokes (1983) has r e v i e w e d s t u d i e s which i n d i c a t e a complex r e l a t i o n s h i p between d e n s i t y and s a t i s f a c t i o n with network s u p p o r t . H i r s c h (1979, 1980) s u g g e s t s 26 that dense networks provide more, but l e s s s a t i s f y i n g , support. 4. D e g r e e of c o n n e c t i o n : the average number of r e l a t i o n s h i p s that each member has with other network members. 5. F l o w : t h e p a t t e r n o f s e r i a l or p a r a l l e l a c t i v a t i o n s of l i n k s (Hurd et a l , 1981b). 6. Geographic prox i m i t y ( d i s p e r s i o n ) : the extent to which network members l i v e near the f o c a l person. 7. Homogeneity: the degree to which network members have s i m i l a r s o c i a l a t t r i b u t e s , such as e d u c a t i o n l e v e l , income l e v e l , and r e l i g i o u s a f f i l i a t i o n . H u r d e t a l ( 1 9 8 0 ) s u g g e s t t h a t s t r u c t u r a l n e t w o r k c h a r a c t e r i s t i c s may be c o n c e i v e d as " s t a t e m e n t s a b o u t t h e t h e o r e t i c a l p o s s i b i l i t y of a person to t r a n s a c t w i t h i n a network" (p. 6 ) . Furthermore, Granovetter (1973, 1983) has d i s c u s s e d the s i g n i f i c a n t i n f l u e n c e that even d i s t a n t network members may have on each other. Indeed, Hurd et a l (1981b) has e l a b o r a t e d on the c l i n i c a l i m p l i c a t i ons of the p o s s i b i l i t y that network members may i n f l u e n c e and be i n f l u e n c e d by other members i n the absence of any d i r e c t l i n k . F i n a l l y , d i f f e r e n c e s i n network s t r u c t u r e are a s s o c i a t e d w i t h v a r i a t i o n s i n network f u n c t i o n , such as i n d i v i d u a l s o c i a l s u p p o r t e x p e r i e n c e s ( C u t r o n a , 1986b; E l l , 1984). The i n t e r a c t i o n a l c h a r a c t e r i s t i c s of s o c i a l networks r e f e r to the nature of the l i n k s , and may be viewed as i n d i c a t o r s of the p o s s i b l e i m p o r t a n c e of t h o s e l i n k s (Hurd et a l , 1980). I n t e r a c t i o n a l c h a r a c t e r i s t i c s may i n c l u d e the f o l l o w i n g . 27 1. D i r e c t e d n e s s : the nature of the r e c i p r o c i t y i n a r e l a t i o n s h i p , t h a t i s , the extent to which a f f e c t i v e and i n s t r u m e n t a l h e l p i s g i v e n and r e c e i v e d f r o m network members. 2. D u r a b i l i t y : the degree of s t a b i l i t y of a person's l i n k s with network members, as i n d i c a t e d by the l e n g t h of time network members have been known and the extent to which network r e l a t i o n s h i p s are changing. S o c i a l networks, i n c l u d i n g the p s y c h o s o c i a l network, a r e not s t a t i c but dynamic, s h i f t i n g and changing over time as i n a k a l e i d o s c o p e due to d i s r u p t i v e l i f e events, such as g e o g r a p h i c a l moves, major l i f e c y c l e t r a n s i t i o n s (Hays & Oxley, 1986; S a u l n i e r , 1982), d i v o r c e ( M i l a r d o , 1987), and death (Walker et a l , 1977), or changing a t t i t u d e s toward network members. B o i s s e v a i n & M i t c h e l l (1973) r e p o r t that i n a f i v e year p e r i o d , 50 percent of the p e o p l e i n t h e i n t i m a t e p s y c h o s o c i a l n e t w o r k changed. P a t t i s o n (1977a) t h e r e f o r e s u g g e s t s t h a t network a n a l y s i s i s "not a search f o r a f i x e d s o c i a l u n i t , but r a t h e r the d e f i n i t i o n of a f u n c t i o n a l s o c i a l system of r e l a t i o n s h i p s " (p. 226). A l s o , as mentioned a b o v e , d u r a b i l i t y h a s i m p l i c a t i o n s f o r t h e connectedness of network l i n k s . 3. I n t e n s i t y ; the degree of e m o t i o n a l c l o s e n e s s b e t w e e n t h e f o c a l p e r s o n and n e t w o r k members. Granovetter (1973) has r e f e r r e d to i n t e n s i t y as the " s t r e n g t h of t i e s , " and def i n e d i t as a "combination of the amount of t i m e , the e m o t i o n a l i n t e n s i t y , t h e i n t i m a c y , a n d t h e r e c i p r o c a l s e r v i c e s w h i c h c h a r a c t e r i z e the t i e " (p. 1361). 4. Frequency: the amount of con t a c t between the f o c a l person and networks. R e s e a r c h of t h e f u n c t i o n a l c h a r a c t e r i s t i c s of s o c i a l networks has tended to focus on t h e i r s u p p o r t i v e f u n c t i o n s (eg., i n s t r u m e n t a l , a f f e c t i v e ) . T h i s emphasis i s l i k e l y r e l a t e d to the meteoric r i s e of i n t e r e s t i n the concept of s o c i a l support as a m e d i a t i n g v a r i a b l e i n the s t r e s s f u l l i f e e v e n t s and i l l n e s s r e l a t i o n s h i p . S o c i a l network r e s e a r c h e r s have responded to t h i s development i n two important ways. 28 F i r s t , there are a number of r e s e a r c h e r s who have s t a t e d s p e c i f i c a l l y that network a n a l y s i s ' s h o u l d e i t h e r be the c e n t r a l focus of the concept of s o c i a l support or serve as a s u b s t i t u t e c o n c e p t ( H a l l & Wellman, 1985; Hammer, 1981; I s r a e l , 1982; M u e l l e r , 1980; Wellman, 1981; Wellman & H i s c o t t , 1985). In support of t h i s c o n t e n t i o n , I s r a e l (1982) marshals the f o l l o w i n g advantages of network a n a l y s i s : (1) a n e u t r a l approach t h a t leaves the r o l e of s o c i a l support (the extent and c o n d i t i o n s under which t i e s are s u p p o r t i v e ) open f o r i n v e s t i g a t i o n ; ( 2 ) t h e e x a m i n a t i o n o f n u m e r o u s ne t w o r k c h a r a c t e r i s t i c s , i n a d d i t i o n to s u p p o r t , and t h e i r r e l a t i o n s h i p to h e a l t h s t a t u s ; (3) the i n v e s t i g a t i o n of the context of i n t e r p e r s o n a l t i e s , t h a t i s , the d i f f e r e n t t y p e s of s u p p o r t t h a t might be provided by d i f f e r e n t types of r e l a t i o n s h i p s ; (4) the e x a m i n a t i o n of i n t e r p e r s o n a l r e l a t i o n s h i p s o t h e r than t h o s e t h a t o c c u r i n groups ( i e . , work, church) or s p e c i f i c s o c i a l c a t e g o r i e s ( i e . , k i n ) ; (5) the study of how o v e r a l l network s t r u c t u r e and component l i n k a g e s a f f e c t the flow of s o c i a l support; (6) l i n k i n g the i n v e s t i g a t i o n of s o c i a l t i e s to the study of the b r o a d e r e n v i r o n m e n t a l d e t e r m i n a n t s of w e l l - b e i n g ; and ( 7 ) t h e d e l i n e a t i o n of n e t w o r k c h a r a c t e r i s t i c s important f o r i n t e r v e n t i o n s aimed at enhancing h e a l t h s t a t u s (p. 66). Brugha (1984), however, has c h a l l e n g e d the idea of using s o c i a l network v a r i a b l e s as measures of s o c i a l s u p p o r t . He c o n t e n d s that such an approach to the a n a l y s i s of s o c i a l support i s based on an u n d e r l y i n g assumption that s o c i a l s u p p o r t i s p o s i t i v e l y r e l a t e d to the number, the d i v e r s i t y , and the q u a l i t y of a person's s o c i a l r e l a t i o n s h i p s w i t h o t h e r s , an a s s u m p t i o n t h a t 29 obscures the c o n t r i b u t i o n of p e r s o n a l i t y c h a r a c t e r i s t i c s and s o c i a l context to the q u a n t i t y and q u a l i t y of s o c i a l support. Second, s e v e r a l r e s e a r c h e r s have questioned whether s o c i a l networks are n e c e s s a r i l y s u p p o r t i v e at a l l (Hammer, 1981b; Hurd et a l , 1981b; Wellman, 1981). For example, F i s c h e r (1982) p o i n t s to "the double-edged nature of p e r s o n a l r e l a t i o n s " (p. 137), an i d e a that has an important i m p l i c a t i o n f o r t h i s i n v e s t i g a t i o n of p s y c h o s o c i a l networks; t h a t i s , the p s y c h o s o c i a l network only t h e o r e t i c a l l y and p o t e n t i a l l y c o m p r i s e s the e x i s t i n g v i a b l e s o c i a l support system of the f o c a l person. Hurd et a l (1981b) e x p l a i n s : ...we must s t r e s s t h a t a s o c i a l n e t w o r k i s n o t n e c e s s a r i l y a s o c i a l support system. We c o n s i d e r such an assumption to be a major c o n c e p t u a l f l a w i n most c l i n i c a l r e p o r t s about s o c i a l network i n t e r v e n t i o n . S o c i a l networks are j u s t t h a t . They may be s u p p o r t i v e , d e s t r u c t i v e , i n s i g n i f i c a n t , or merely innocuous. Or more p r e c i s e l y , s o c i a l networks may be c o m p r i s e d of s o c i a l i n t e r - a c t i o n s most of which are s u p p o r t i v e , or mostly d e s t r u c t i v e , or an a d m i x t u r e of a range from b e n e f i c e n t to noxious i n t e r a c t i o n s (p. 248). Hammer (1981b) p o i n t s to such a s p e c t s of s o c i a l networks as r e s t r a i n t , o p p o s i t i o n , demandingness, mere presence, and range of a ccess. Research concerning the negative e f f e c t s of s o c i a l networks i s comparatively recent (eg,, Coyne & DeLongis, 1986; F i o r e et a l , 1983; K e s s l e r et a l , 1985; L e f f l e r et a l , 1986; Pagel et a l , 1987; R i l e y & Eckenrode, 1986; Rook, 1984; Sandler & B a r r e r a , 1984). T h i s r e s e a r c h has i m p l i c a t i o n s f o r the s o c i a l networks of a n o r e x i c s , i n t h a t , an o b s e s s i o n w i t h f o o d and s l i m n e s s accompanied by a f i g h t to r e s i s t demands to e a t , as w e l l as 30 concomitant dysphoria i s l i k e l y to produce a m b i v a l e n t or even h o s t i l e network i n t e r a c t i o n s . The f u n c t i o n a l c h a r a c t e r i s t i c s of s o c i a l networks i n c l u d e the f o l l o w i n g (Berkman, 1984; I s r a e l , 1982). 1. A f f e c t i v e support; the p r o v i s i o n of moral support, c a r i n g , and l o v e . 2. I n s t r u m e n t a l support; the p r o v i s i o n of t a n g i b l e a i d and s e r v i c e s , such as f i n a n c i a l help, or help with c h i l d c a r e . 3. C o g n i t i v e support: access to d i v e r s e i n f o r m a t i o n , new knowledge, advice, and feedback. 4. R e c i p r o c i t y : t h e q u a l i t y and i n t e n s i t y o f o b l i g a t i o n i n c u r r e d or a c q u i r e d i n g i v i n g or r e c e i v i n g of i n s t r u m e n t a l or a f f e c t i v e exchange (Hurd e t a l , 1981b). 5. Maintenance of s o c i a l i d e n t i t y : v a l i d a t i o n of a shared world view. 6. S o c i a l o u t r e a c h : a c c e s s to s o c i a l c o n t a c t s and s o c i a l r o l e s . 7. S t r e s s m e d i a t i o n : the s t r e s s g e n e r a t i n g , s t r e s s m a i n t a i n i n g , s t r e s s reducing or b u f f e r i n g f u n c t i o n s of s o c i a l networks. S e v e r a l t y p o l o g i e s of network f u n c t i o n and i n f o r m a l h e l p i n g processes are a v a i l a b l e (eg,, B a r r e r a & A i n l a y , 1983; Rook, 1985; B r e i e r & S t r a u s s , 1984; G o t t l i e b , 1979, 1983; House, 1981; M i t c h e l l & T r i c k e t t , 1980; Schaefer et a l , 1981; Walker et a l , 1977; Weiss, 1974; W i l l s , 1985). There a l s o s t u d i e s i n the s o c i a l s u p p o r t l i t e r a t u r e o f t h e s p e c i f i c b e h a v i o r a l m a n i f e s t a t i o n s of the s u p p o r t i v e f u n c t i o n of s o c i a l networks ( B a r r e r a , 1981; Cutrona, 1986a; G o t t l i e b , 1978; Vaux et a l , 1987; Stokes & Wilson, 1984). 31 S o c i a l networks; personal and environmental determinants. The p e r s o n a l and environmental determinants of s o c i a l networks, e s p e c i a l l y network s u p p o r t i v e n e s s , have been d i s c u s s e d elsewhere (eg., A r g y l e , 1980; Brugha, 1984; Bruhn & P h i l i p s , 1987; Cauce, 1986; D u n k e l - S c h e t t e r et a l , 1987; F l a h e r t y & Richman, 1986; H e l l e r & Swindle, 1983; Henderson, 1982; Lazarus & Folkman, 1984; M i t c h e l l , 1982; M i t c h e l l & T r i c k e t t , 1980; Moos, 1976; Nadler, 1986; Parkes, 1986; Sarason et a l , 1985, 1986; S t a r k e r , 1986; T i e t j e n , 1985). For example, Henderson & Byrne (1977) suggest that a f f i l i a t i v e and attachment needs are l i k e l y to vary between i n d i v i d u a l s and s i t u a t i o n s . F u r t h e r m o r e , the i d e a t h a t the i n d i v i d u a l i s not a p a s s i v e agent w i t h i n a web of network t i e s was h i g h l i g h t e d by H i r s c h (1981) when he proposed t h a t v a r y i n g network p a t t e r n s may r e f l e c t d i f f e r e n c e s i n i n d i v i d u a l s ' c h o i c e s about how to s t r u c t u r e t h e i r s o c i a l worlds. H e l l e r & Swindle (1983) have p r o v i d e d a t i m e l y r e m i n d e r t h a t s o c i a l s u p p o r t networks do not simply a f f e c t i n d i v i d u a l s u n i d i r e c t i o n a l l y , but that persons play an a c t i v e r o l e i n d e t e r m i n i n g t h e i r network f r i e n d s and a s s o c i a t e s , and the amount and type of network support they r e c e i v e : The i n d i v i d u a l i s an a c t i v e " t r a n s a c t i n g " agent i n the development and use of a network...The a s s e t s and s k i l l s necessary to enter many networks are perhaps as i m p o r t a n t i n u n d e r s t a n d i n g t h e " p o t e n c y " o f t h a t network as are the network's a c t i v i t i e s and f u n c t i o n s (p. 91). F i n a l l y , c o r r e l a t i o n a l s t u d i e s , s u c h as t h i s one, t h a t h y p o t h e s i z e a s t a t i s t i c a l l y s i g n i f i c a n t c o r r e l a t i o n between s o c i a l network and some i n d e p e n d e n t v a r i a b l e ( e g . , a n o r e x i a 32 nervosa) are su b j e c t to a s e r i o u s u n c o n t r o l l e d r i v a l h y p o t h e s i s , that i s , the independent or i n t e r a c t i o n a l e f f e c t s of p e r s o n a l i t y and environmental v a r i a b l e s . For example, H e l l e r (1979) has s u g g e s t e d t h a t competent persons are more l i k e l y to have w e l l d e v e l o p e d s o c i a l networks as a d i r e c t r e s u l t of t h e i r more gene r a l s o c i a l competence. R e s e a r c h i n t e r e s t i n t h i s a r e a among s o c i a l network r e s e a r c h e r s has been sparse and r e c e n t , however. For example, Sta r k e r (1986), on the b a s i s of h i s l i t e r a t u r e review, concluded, The l i t e r a t u r e g l a r i n g l y f a i l s to address the i s s u e of i n d i v i d u a l d i f f e r e n c e s i n n e e d s f o r s u p p o r t — p e r s o n a l i t y v a r i a b l e s , c o p i n g s k i l l s , and s o c i a l competence are r a r e l y c o nsidered (p. 487). M i t c h e l l (1982) noted t h a t , While the e f f e c t s of s o c i a l network p a t t e r n s are being d o c u m e n t e d , v e r y l i t t l e i s known a b o u t t h e i r determinants" (p. 388). Perhaps t h i s s t a t e of a f f a i r s i s a t t r i b u t a b l e to the paramount concern, r e f l e c t e d i n the s o c i a l network l i t e r a t u r e as a whole, to e m p i r i c a l l y e s t a b l i s h s o c i a l network c o r r e l a t e s of v a r i o u s forms of p s y c h o l o g i c a l d i s t r e s s i n g e n e r a l and p s y c h i a t r i c p o p u l a t i o n s as an i n i t i a l r e s e a r c h agenda. N e v e r t h e l e s s , there has been an awareness of the need to examine the i n d i v i d u a l and e n v i r o n m e n t a l p r o c e s s e s t h a t shape and are shaped by s o c i a l network p a t t e r n s . For example, T o l s d o r f (1976) i n t r o d u c e d the concept of network o r i e n t a t i o n , a set of b e l i e f s , a t t i t u d e s , and e x p e c t a t i o n s c o n c e r n i n g the p o t e n t i a l u s e f u l n e s s of network members i n h e l p i n g the f o c a l person cope with a l i f e problem. A n e g a t i v e network o r i e n t a t i o n , c h a r a c t e r i s t i c of p s y c h i a t r i c 33 p a t i e n t s , i n v o l v e s "a set of e x p e c t a t i o n s or b e l i e f s that i t i s i n a d v i s a b l e , i m p o s s i b l e , u s e l e s s , or p o t e n t i a l l y dangerous to draw on network r e s o u r c e s " (p. 413). The i n d i v i d u a l w i t h a n e g a t i v e network o r i e n t a t i o n may t h e r e f o r e s u f f e r , not from a l a c k of support r e s o u r c e s , but from an u n w i l l i n g n e s s to maintain, n u r t u r e , and u t i l i z e the network resources a v a i l a b l e ( C o l l e t t a , 1987; Vaux et a l , 1986). Of s p e c i a l i n t e r e s t to t h i s study i s the d i s c o v e r y by Hurd e t a l ( 1 9 8 1 a ) of t h r e e model p a t t e r n s of s o c i a l network p a r t i c i p a t i o n on the b a s i s of f a c t o r analyses of s o c i a l network d a t a g a t h e r e d f r o m a g e n e r a l p o p u l a t i o n : n u c l e a r f a m i l y dominant, extended k i n dominant, and balanced. He d e f i n e s these n e t w o r k p a r t i c i p a t i o n s t y l e s as r e f l e c t i n g a s u b j e c t ' s p r e f e r e n c e f o r c e r t a i n t y p e s of r e l a t i o n s h i p s and modes o f i n t e r a c t i o n , s p e c i f i c a l l y , s o c i a l l y a s c r i b e d ( i e , role-bounded), i n v o l u n t a r y r e l a t i o n s h i p s ( n u c l e a r f a m i l y dominant), non-ascribed ( i e , . n o n - r o l e bounded), v o l u n t a r y r e l a t i o n s h i p s (extended k i n d o m i n a n t ) , or as a m i x t u r e of b o t h t y p e s o f r e l a t i o n s h i p ( b a l a n c e d ) . Two u n d e r l y i n g theses here are that s o c i a l network a c t i v i t y i s an o p e r a t i o n a l component o f an i n d i v i d u a l ' s b e h a v i o r a l r e p e r t o i r e and a p u r p o s e f u l a c t i v i t y . Hurd et a l (1981a) s u g g e s t t h a t network p a r t i c i p a t i o n s t y l e may have i m p o r t a n t i m p l i c a t i o n s f o r a s u b j e c t ' s p e r c e p t i o n of support exchange, frequency of i n t e r a c t i o n and the o v e r a l l number of a l t e r s r e p o r t e d . For example, i f i t i s assumed that people share an e q u a l o p p o r t u n i t y to e s t a b l i s h s o c i a l r e l a t i o n s h i p s , the 34 s m a l l e r s i z e s of n u c l e a r f a m i l y dominant networks may be a consequence of a d i s i n t e r e s t i n r e l a t i o n s h i p s which l a c k the p r e f e r r e d degree of s o c i a l a s c r i p t i o n or role-boundedness d e s i r e d by the s u b j e c t (Hurd et a l , 1981a). Also of s p e c i a l i n t e r e s t to t h i s study i s the c o m p a r a t i v e r e s e a r c h of M i t c h e l l ( 1 9 8 2 ) i n e x a m i n i n g i n d i v i d u a l and environmental v a r i a b l e s that are r e l a t e d to the s o c i a l network c h a r a c t e r i s t i c s of p s y c h i a t r i c c l i e n t s . M i t c h e l l obtained a sample of 35 p s y c h i a t r i c o u t p a t i e n t s , the m a j o r i t y of whom had a d i a g n o s i s of s c h i z o p h r e n i a , and 35 f a m i l y members of t h e s e i n d i v i d u a l s . In h i s s t u d y , he examined the e x t e n t to which i n d i v i d u a l d i f f e r e n c e s i n i n t e r p e r s o n a l problem-solving s t y l e and f a m i l y d i f f e r e n c e s i n f a m i l y c l i m a t e and f a m i l y s o c i a l resources were a s s o c i a t e d with the s o c i a l network dimensions of s i z e and support of h i s p s y c h i a t r i c s u b j e c t s . R e s u l t s i n d i c a t e d t h a t t h e s e i n d i v i d u a l and e n v i r o n m e n t a l v a r i a b l e s were s i g n i f i c a n t c o r r e l a t e s o f s o c i a l n e t w o r k d i m e n s i o n s : f o r e x a m p l e , i n t e r p e r s o n a l p r o b l e m - s o l v i n g s t y l e was p o s i t i v e l y r e l a t e d to network s i z e ; the l e v e l of independence i n f a m i l y c l i m a t e was p o s i t i v e l y r e l a t e d to the o v e r a l l amount of s u p p o r t c l i e n t s r e p o r t e d r e c e i v i n g , e s p e c i a l l y from t h e i r p e e r s ; and f a m i l y cohesion was p o s i t i v e l y r e l a t e d to support from f a m i l y members, but n e g a t i v e l y r e l a t e d to the number of i n t i m a t e r e l a t i o n s h i p s c i t e d by the respondent ( i e , the more cohesive the f a m i l y , the fewer i n t i m a t e r e l a t i o n s h i p s c i t e d ) . M i t c h e l l c o n c l u d e d t h a t f u r t h e r r e s e a r c h was needed to "examine the i n d i v i d u a l and e n v i r o n m e n t a l p r o c e s s e s t h a t network p a t t e r n s " (p. 387). shape and are shaped by 35 s o c i a l Normative s o c i a l networks. M u e l l e r (1980) suggests that primary or immediate s o c i a l networks ( i n t h i s study, p s y c h o s o c i a l n e t w o r k s ) a p p e a r t o have a f a i r l y c o n s i s t e n t p a t t e r n of s t r u c t u r a l c h a r a c t e r i s t i c s i n the gene r a l p o p u l a t i o n , although p r e c i s i o n i s hampered by d i v e r s e methodologies. For example, Jones & F i s c h e r (1978) found a core network of about 17 people i n a sample of community r e s i d e n t s , whereas Boussevain (1974) found an average of 30 people i n the i n t i m a t e s o c i a l network. Hammer et a l (1978) compared t h e i r data of urban, suburban, and r u r a l networks i n m e t r o p o l i t a n New York, Vermont, and London w i t h s o c i a l network data gathered by other r e s e a r c h e r s from B r i t a i n on both working c l a s s and middle c l a s s i n d i v i d u a l s , from Malta, and A f r i c a , and found s u r p r i s i n g c o n s i s t e n c y i n network s t r u c t u r e , d e s p i t e c u l t u r a l v a r i a t i o n s -and d i f f e r e n c e s i n the techniques of e l i c i t i n g network d a t a . S p e c i f i c a l l y , an immediate s o c i a l network t y p i c a l l y c o n s i s t e d of approximately 6 to 10 i n t i m a t e l y known members, most of whom knew each o t h e r , and perhaps an a d d i t i o n a l 30 network members who were a l s o seen r e g u l a r l y by the f o c a l i n d i v i d u a l , f o r a t o t a l of about 40 network members. Of t h i s s e t of 40 network members, 20 p e r c e n t of the p o s s i b l e c o n n e c t i o n s t e n d e d a c t u a l l y to o c c u r , but w i t h a d i s t i n c t s t r u c t u r a l form, t h a t i s , 5 or 6 c l u s t e r s of 6 or 7 h i g h l y connected i n d i v i d u a l s i n each, with a lower degree of connection 36 across c l u s t e r s (see a l s o Hammer, 1980). P a t t i s o n et a l (1975), using the P a t t i s o n P s y c h o s o c i a l Inventory, c o l l e c t e d network data from a normative urban p o p u l a t i o n of 200 s u b j e c t s , and found a " n o r m a l " p s y c h o s o c i a l network to be comprised of 22-25 people considered important to the respondent, with 5 or 6 belonging to each of the f o l l o w i n g c l u s t e r s : n u c l e a r f a m i l y , other r e l a t i v e s , f r i e n d s and neighbors, and s o c i a l and work a s s o c i a t e s . About h a l f to two-thirds of these people had s o c i a l r e l a t i o n s h i p s with each o t h e r (a s o c i a l c o n n e c t e d n e s s - u n c o n n e c t e d n e s s r a t i o of 60:40). Nuclear f a m i l y and f r i e n d s were the most valued network members, being most o f t e n sought f o r a f f e c t i v e and i n s t r u m e n t a l a s s i s t a n c e ; h o w e v e r , s i g n i f i c a n t r e l a t i o n s h i p s e x i s t e d i n m u l t i p l e areas of l i f e i n t e r a c t i o n , and the s o c i a l m a t r i x was semiopen to o t h e r p e o p l e . Hurd et a l (1980), using the same instrument as P a t t i s o n et a l (1975) above, c o l l e c t e d network data drawn from a convenience sample of 93 "normal" i n d i v i d u a l s l i v i n g i n Southern C a l i f o r n i a , Chicago, and s e m i - r u r a l upstate New York areas. The s t r u c t u r a l a n a l y s i s r e v e a l e d the e x i s t e n c e of three d i s t i n c t types of s o c i a l network p a t t e r n s that were i d e n t i f i e d by the r a t i o of n u c l e a r f a m i l y to extended f a m i l y : n u c l e a r f a m i l y dominant, extended f a m i l y dominant and balanced. Each of these t h r e e s u b p o p u l a t i o n s v a r i e d s i g n i f i c a n t l y both i n network s i z e and c o m p o s i t i o n . N u c l e a r f a m i l y d o m i n a n t n e t w o r k s were s i g n i f i c a n t l y s m a l l e r o v e r a l l (18 network members), and were c o m p r i s e d of p r i m a r i l y n u c l e a r f a m i l y members (7 members), f r i e n d s (5 members) and co-workers (4 members). Extended f a m i l y 37 dominant networks had an average of 24 network members, p r i m a r i l y composed of extended f a m i l y (9 members), f r i e n d s (6 members), and coworkers (5 members). Balanced networks had an average of 22 network members, w i t h 5 or 6 members i n each of four network s e c t o r s : n u c l e a r f a m i l y , extended f a m i l y , f r i e n d s , and coworkers. P a t t i s o n et a l (1979) found the f o l l o w i n g i n t e r a c t i o n a l and  f u n c t i o n a l c h a r a c t e r i s t i c s of normal p s y c h o s o c i a l networks: ( 1 ) t h e r e a r e f r e q u e n t c o n t a c t s w i t h most of the network members, marked by p o s i t i v e and i n t e n s e emotional investment; (2) t h e r e i s a r e c i p r o c a l exchange of emotional and i n s t r u m e n t a l support; (3) the network i s r e l a t i v e l y c o n f l i c t - f r e e and tends to be s t r e s s - r e d u c i n g , as opposed to s t r e s s - i n d u c i n g or s t r e s s - m a i n t a i n i n g ; and (4) the network prov i d e s a r e l a t i v e l y c o n s i s t e n t set of norms and s o c i a l e x p e c t a t i o n s f o r the management of i n t e r c u r r e n t s t r e s s . In t h e i r i n t e r a c t i o n a l a n a l y s i s , Hurd et a l (1980) found that r e s p o n d e n t s had c o n t a c t w i t h over 50% of a l l t h e i r network members w i t h i n one month; however, the c o n t a c t p a t t e r n s of n u c l e a r f a m i l y d o m i n a n t networks were u n i q u e , r e v e a l i n g a p r e f e r e n c e f o r high c o n t a c t frequency r e l a t i o n s w i t h i n n u c l e a r f a m i l y and f r i e n d s h i p c l u s t e r s , and an abandonment of low c o n t a c t r e l a t i o n s from other network s e c t o r s . A l l respondents i n d i c a t e d that they provided more support than they r e c e i v e d , and t h a t the amount of support exchanged was g r e a t e s t i n the n u c l e a r f a m i l y and f r i e n d s s e c t o r s . Hurd et a l (1980) view the n u c l e a r f a m i l y dominant network as being p a r t i c u l a r l y v u l n e r a b l e , however, due to a network p a r t i c i p a t i o n s t y l e that f o s t e r s almost e x c l u s i v e 38 r e l i a n c e on a s i n g l e s e c t o r , the n u c l e a r f a m i l y c l u s t e r , embedded i n a c o m p a r a t i v e l y s m a l l e r s e t of n e t w o r k r e l a t i o n s f o r p r o v i s i o n s of support: Because the l o s s of a member, e s p e c i a l l y someone seen f r e q u e n t l y , i s c r i t i c a l to amount of p s y c h o - s o c i a l s u p p l i e s a v a i l a b l e , t h e s e n e t w o r k t y p e s a r e t h e o r e t i c a l l y more at r i s k than the o t h e r s u b t y p e s . T h i s would appear p a r t i c u l a r l y to be the case i f a change or d i s r u p t i o n i mpacted the f a m i l y . Because these network types do not r e l y on t h e i r extended k i n and b e c a u s e t h e r e i s e v i d e n c e o f d i s r u p t i o n or d i s p a r i t y i n t h e i r r e l a t i o n s h i p s w i t h f r i e n d s these network types appear as being the most v u l n e r a b l e i n circumstances of s t r e s s f u l l i f e events (p. 31). S o c i a l networks and mental health. The s o c i a l s c i e n c e s have had a l o n g s t a n d i n g i n t e r e s t i n the r e l a t i o n s h i p between mental h e a l t h a n d v a r i o u s e l e m e n t s of s o c i a l s t r u c t u r e . The p s y c h o s o c i a l network may be v i e w e d as a m e d i a t i n g s o c i a l s t r u c t u r e b e t w e e n g l o b a l s t r u c t u r a l f a c t o r s , s u c h as m o d e r n i z a t i o n , u r b a n i z a t i o n and s o c i a l c l a s s , and i n d i v i d u a l m ental h e a l t h . F o l l o w i n g Kadushin (1983), the s o c i a l network ( i n c l u d i n g the p s y c h o s o c i a l network) i s presumed to a f f e c t mental h e a l t h i n at l e a s t the f o l l o w i n g three ways: (1) i t can c r e a t e s i t u a t i o n s that are more or l e s s s t r e s s f u l ; (2) i t can mandate p r a c t i c e s that immunize the i n d i v i d u a l a g a i n s t or s e n s i t i z e him to s t r e s s o r s i n t h e e n v i r o n m e n t ; and ( 3 ) i t c a n p r o d u c e s t r u c t u r e s t h a t a l l e v i a t e or e x a c e r b a t e e x i s t i n g p s y c h i a t r i c d i s o r d e r s . 39 The r e s e a r c h i n v e s t i g a t i n g the r e l a t i o n s h i p between s o c i a l networks and mental h e a l t h may be assigned to four general areas ( M a r s e l l a & Snyder, 1981). 1. S o c i a l networks as the l o c a t i o n of re s o u r c e s and support that enhance mental h e a l t h ( e g . , B i l l i n g s & Moos, 1982; F i n l a y s o n , 1976; Henderson et a l , 1978, 1979, 1980; Litwak & S z e l e n y i , 1969; L i n & Dean, 1984; Moos, 1984; T o l s d o r f , 1976; Walker et a l , 1977). There i s now a r i c h body of r e s e a r c h c o n c e r n i n g s o c i a l networks, p a r t i c u l a r l y t h e i r s u p p o r t i v e a s p e c t s , as a mediating v a r i a b l e i n the s t r e s s f u l l i f e e v e n t s and p s y c h o l o g i c a l w e l l - b e i n g or p s y c h i a t r i c d i s t r e s s r e l a t i o n s h i p ( f o r reviews, see A l l o w a y & B e b b i n g t o n , 1987; B a r r e r a , 1986; Broadhead et a l , 1983; Cohen & Syme, 1985; Cohen & W i l l s , 1985; D o h r e n w e n d & Dohrenwend, 1978; G o t t l i e b , 1983a; H e l l e r , 1979; H e l l e r & Swindle, 1983; Henderson, 1984; House & Kahn, 1985; Jung, 1984; K e s s l e r et a l , 1985; K i e s l e r , 1985; M i t c h e l l et a l , 1982; P e a r s o n , 1986; S c h r a d l e & Dougher, 1985; Shumaker & B r o w n e l l , 1984; S t a r k e r , 1986; T h o i t s , 1982a, 1982b; Turner et a l , 1983; Wortman & Dunkel-Shetter, 1987). 2. S o c i a l networks and t h e i r r e l a t i o n s h i p to h e l p -seeking behaviour and u t i l i z a t i o n of s e r v i c e s ( e g . , B i r k e l & Reppucci, 1983; Gourash, 1978; Horwitz, 1977, 1978; McKinlay, 1973; P e r r u c c i & Targ, 1982; Salloway, 1973). 3. S o c i a l networks as a t h e r a p e u t i c approach (eg., At t n e a v e , 1976; B i s h o p , 1984; Cohen & A d l e r , 1986; E r i c k s o n , 1975, 1984; G a r r i s o n , 1981; G o t t l i e b , 1983; Hurd et a l , 1981b; Jacobson, 1986; Kliman & T r i m b l e , 1983; P a t t i s o n , 1973, 1976, 1977a, 1977b; P a t t i s o n et a l , 1975; P o r r i t t , 1979; S c h o e n f e l d , 1986; S p e c k , 1967; Wortman & Lehman, 1985). 4. T h e o r e t i c a l and c o n c e p t u a l a s p e c t s o f s o c i a l networks and t h e i r r e l a t i o n to p s y c h o l o g i c a l w e l l - b e i n g or d i s t r e s s ( e g . , Anderson, 1982; A n t o n u c c i , 1985; B e e l s , 1978; D ' A u g e l l i , 1983; H a l l & Wellman, 1985; Hammer, 1963, 1981, 1983; Hammer et a l , 1978; Henderson et a l , 1978, 1979; H i r s c h , 1985; H i r s c h & J o l l y , 1982; House & Kahn, 1985; M a r s e l l a & Snyder, 1981; Moos, 1984; P i l i s u k & F r o l a n d , 1978; Q u e v i l l o n & Tr e n e r r y , 1983; Wolfe, 1981). 40 S o c i a l networks and p s y c h i a t r i c d i s t r e s s . The f o l l o w i n g i s a b r i e f review of s t u d i e s i n v e s t i g a t i n g the r e l a t i o n s h i p between s o c i a l network c h a r a c t e r i s t i c s and p s y c h i a t r i c d i s t r e s s i n p s y c h i a t r i c p o p u l a t i o n s . In a d d i t i o n , d e t a i l e d a t t e n t i o n w i l l be given to s e v e r a l comparative s t u d i e s of non-psychotic p s y c h i a t r i c p o p u l a t i o n s , s i n c e i t i s i n t o t h i s general p s y c h i a t r i c category that anorexic p a t i e n t s may be a s s i g n e d . Although s t u d i e s of s o c i a l support and the s t r e s s - d i s t r e s s r e l a t i o n s h i p have been i n c l u d e d where a p p r o p r i a t e , most s t u d i e s from t h i s enormous l i t e r a t u r e have used c a t e g o r i c a l measures i n d i c a t i v e o f s o c i a l s u p p o r t , such as s o c i a l i n t e g r a t i o n , marriage, presence of a c o n f i d a n t , r a t h e r than d i r e c t measures of t h e s t r u c t u r a l and i n t e r a c t i o n a l c h a r a c t e r i s t i c s of s o c i a l networks per se, and t h e r e f o r e are not d i r e c t l y r e l e v a n t to t h i s study. I t i s noted here t h a t the s o c i a l network and s o c i a l support l i t e r a t u r e s r e p o r t g e n d e r ( G r i f f i t h , 1985; L e a v y , 1983; P h i l l i p s , 1981) and e t h n i c ( G r i f f i t h , 1985; Warheit et a l , 1982) d i f f e r e n c e s i n s t u d i e s of s o c i a l network v a r i a b l e s and i n d i c e s of p s y c h o l o g i c a l w e l l - b e i n g or p s y c h i a t r i c d i s t r e s s . There are s e v e r a l e t i o l o g i c a l models of the r e l a t i o n s h i p of s o c i a l network v a r i a b l e s t o p s y c h i a t r i c d i s t r e s s , and t h e s e o f t e n i n c l u d e r e f e r e n c e s to s t r e s s or s t r e s s f u l l i f e events (eg., Dohrenwend & Dohrenwend, 198.1; F i o r e et a l , 1983; G o t t l i e b , 1983; H a l l & Wellman, 1985; Hammer, 1983; H e l l e r & S w i n d l e , 1983; I s r a e l , 1982; K l e i n e r , 1984; K l e i n e r & Parker, 1976; Richman & 41 F l a h e r t y , 1985). Cohen et a l (1986) suggest t h a t s o c i a l network r e s e a r c h e r s have g e n e r a l l y espoused one of two hypotheses which ar e t hought to e x p l a i n the e f f e c t s o f s o c i a l n e t w o r k s on p s y c h o p a t h o l o g i c a l symptoms: one h y pothesis proposes t h a t s o c i a l networks have a d i r e c t e f f e c t on the l e v e l of p s y c h o l o g i c a l symptoms, whereas the o t h e r p o s i t s a b u f f e r i n g e x p l a n a t i o n i n which s o c i a l networks exert t h e i r g r e a t e s t e f f e c t on symptoms as the l e v e l of s t r e s s o r s i n c r e a s e s . According to Cohen et a l , then, s o c i a l network r e s e a r c h e r s have g e n e r a l l y belonged to one of two camps: those whose analyses imply t h a t s o c i a l networks e x e r t o n l y a d i r e c t e f f e c t on symptomatology, and t h o s e who a s s e r t that s o c i a l networks exert an i n d i r e c t , b u f f e r i n g e f f e c t as w e l l . Studies of p s y c h i a t r i c p o pulations. There are s e v e r a l reviews of s t u d i e s which i n v e s t i g a t e s o c i a l network v a r i a b l e s and p s y c h i a t r i c d i s t r e s s ( D ' A u g e l l i , 1983; E l l , 1984; G r e e n b l a t t et a l , 1982; Hurd et a l , 1980; Leavy, 1983; M u e l l e r , 1980). These r e v i e w s have encompassed some 15 comparative s t u d i e s of e i t h e r mixed p s y c h i a t r i c p o p u l a t i o n s (Cohen & Sokolovsky, 1978; Froland et a l , 1979; Henderson et a l , 1978a, 1978b; P a t t i s o n et a l , 1979; P e r r u c c i & T a r g , 1982; P o s t , 1962; R a t c l i f f e & Azim, 1975; S i l b e r f e l d , 1978;), or s p e c i f i c c l i n i c a l p o p u l a t i o n s , p r i m a r i l y s c h i z o p h r e n i c s ( C l a r k & C u l l e n , 1974; G a r r i s o n , 1978; P a t t i s o n & P a t t i s o n , 1981; Sokolovsky et a l , 1978; T o l s d o r f , 1976; Turner, 1979), and have t y p i c a l l y found d i s t o r t i o n s i n network s t r u c t u r e 42 and i n t e r a c t i o n p a t t e r n s , d e f i c i t s i n network s u p p o r t , and d i s r u p t i o n s i n network r e l a t i o n s h i p s as s i g n i f i c a n t l y a s s o c i a t e d with p s y c h i a t r i c d i s o r d e r ( M u e l l e r , 1980). S t r u c t u r a l l y , people with p s y c h i a t r i c d i s o r d e r s t y p i c a l l y have p e r s o n a l networks that a r e s m a l l e r i n t o t a l s i z e , s m a l l e r by network c l u s t e r ( i e . , f a m i l y , r e l a t i v e s , f r i e n d s , coworkers), and c o m p r i s e d of fewer i n t i m a t e r e l a t i o n s than n o n - p s y c h i a t r i c a l l y i l l persons; indeed, the s m a l l e r the s i z e , the gr e a t e r appears t o be the degree of p s y c h i a t r i c impairment. In some cases, network c l u s t e r s appear to be l e s s i n t e r c o n n e c t e d , although r e s u l t s with regard to network de n s i t y and inte r c o n n e c t e d n e s s are u n c l e a r . There i s a l s o some evidence of a skewedness with r e s p e c t to the network composition of p s y c h i a t r i c p a t i e n t s . For example, the p r o p o r t i o n of network members t h a t a r e k i n t e n d s t o be h i g h e r f o r p s y c h o t i c s ( e s p e c i a l l y s c h i z o p h r e n i c s ) , and c h a r a c t e r i z e d by a high degree of d e n s i t y , whereas the n o n - k i n p o r t i o n of the p s y c h o t i c s ' networks may be l e s s dense or i n t e r c o n n e c t e d . In some cases, there i s a l s o some evidence of a higher p r o p o r t i o n of network members who themselves manifest p s y c h i a t r i c symptomatology. With r e g a r d t o q u a l i t y o f i n t e r a c t i o n , t h e r e i s g e n e r a l l y l e s s s u p p o r t i v e i n t e r a c t i o n (eg., l e s s a f f e c t i v e exchange), and there i s data to suggest t h a t the l e s s the support, the more severe the psychopathology (Hurd et a l , 1980). I n t e r a c t i o n s w i t h network members tend to be predominantly one-way (dependent), e s p e c i a l l y f o r p s y c h o t i c p o p u l a t i o n s , r a t h e r than r e c i p r o c a l . Blackman & G o l d s t e i n ( 1 9 6 7 ) , i n a s t u d y o f r e c i p r o c i t y networks and 43 p s y c h i a t r i c symptoms, found a s i g n i f i c a n t r e l a t i o n s h i p between network r e c i p r o c i t y and p s y c h o l o g i c a l symptomatology: the l e s s p a r t i c i p a t i o n i n a mutual o b l i g a t i o n network, the more manifest symptomatology of the respondent, as p e r c e i v e d by other network members (Hurd et a l , 1980). These g e n e r a l f i n d i n g s have been r e p l i c a t e d i n o t h e r c u l t u r a l s e t t i n g s ( F a m u y i w a , 1984; Westermeyer & P a t t i s o n , 1981). The a n a l y s i s thus f a r has been of a g l o b a l nature, and the s t u d i e s reviewed have been marked by s e v e r e l i m i t a t i o n s , not l e a s t of which i s the c o r r e l a t i o n a l nature of the data; as a consequence, i t i s i m p o s s i b l e to c l a r i f y the i s s u e of whether t h e s e d i f f e r e n c e s emerged a f t e r the onset of a d i s o r d e r (and hence may have developed as a r e s u l t of the d i s o r d e r ) or e x i s t e d p r i o r to onset (and perhaps played an e t i o l o g i c a l r o l e i n o n s e t ) . Furthermore, the nature of the network v a r i a b l e s , the means to measure them, and the d i a g n o s t i c c r i t e r i a vary w i d e l y . F i n a l l y , the network v a r i a b l e s are not s p e c i f i c a l l y l i n k e d to a s p e c i f i c stage i n the n a t u r a l course of a d i s o r d e r , nor to graded l e v e l s of symptom s e v e r i t y . As the p s y c h i a t r i c p o p u l a t i o n of i n t e r e s t to t h i s study i s a non-rpsychotic one, those s t u d i e s i n v e s t i g a t i n g the network v a r i a b l e s of non-psychotic or n e u r o t i c p o p u l a t i o n s w i l l be reviewed i n g r e a t e r d e t a i l . 44 Comparative studies of non-psychotic (neurotic) psychiatric  populations and t h e i r s o c i a l networks. Although the f o l l o w i n g comparative s t u d i e s have shared the common purpose of a n a l y z i n g the s o c i a l network c h a r a c t e r i s t i c s of non-psychotic, p s y c h i a t r i c p o p u l a t i o n s , they have accomplished t h i s purpose using d i f f e r e n t methods of a s s e s s m e n t . N e v e r t h e l e s s , they have a l l focussed, more or l e s s , on some permutation of the p s y c h o s o c i a l network, comprised of n u c l e a r f a m i l y , extended f a m i l y , f r i e n d s , neighbors, and c l o s e a s s o c i a t e s from work, church, r e c r e a t i o n and the l i k e , and v a r i o u s l y r e f e r r e d to i n t h e s e s t u d i e s as the " e f f e c t i v e network," the " p r i m a r y g r o u p , " t h e " p s y c h o s o c i a l s u p p o r t network," and the "core network" (Llamas et a l , 1981). 1* Pattison et a l (1975, 1979). The work of P a t t i s o n and h i s c o l l e a g u e s i s of s p e c i a l r e l e v a n c e to t h i s study because they have p u b l i s h e d data concerning the p s y c h o s o c i a l network of general and p s y c h i a t r i c p o p u l a t i o n s u s i n g the instrument employed i n t h i s s t u d y , the P a t t i s o n P s y c h o s o c i a l I n v e n t o r y . T h e s e r e s e a r c h e r s examined the p s y c h o s o c i a l networks of a normative urban sample of 200 s u b j e c t s and s m a l l e r samples of n e u r o t i c and p s y c h o t i c s u b j e c t s . The p s y c h o s o c i a l networks of n e u r o t i c s u b j e c t s , as c o m p a r e d t o c o n t r o l s , were s m a l l e r i n s i z e ( t y p i c a l l y 15 network members), o f t e n i n c l u d i n g s i g n i f i c a n t people who were dead or l i v e d f a r away, w i t h fewer r e l a t i v e s , f r i e n d s , and c o - w o r k e r s , and a h i g h e r r e l i a n c e on i n v o l u n t a r y t i e s i n the n u c l e a r f a m i l y . These networks had a lower d e n s i t y 45 or i n t e r c o n n e c t e d n e s s r a t i o (30:70), approximately h a l f t h a t of the c o n t r o l group, and thus had no r e l i a b l e set of s o c i a l norms and e x p e c t a t i o n s e i t h e r t o g u i d e b e h a v i o u r o r t o c o r r e c t d i s t o r t e d b e h a v i o r a l r e s p o n s e s . F u r t h e r m o r e , r a t i n g s on the i n t e r a c t i o n a l v a r i a b l e s were much lower i n c o m p a r i s o n to the n o r m a t i v e sample. For example, t h e r e was l e s s f r e q u e n c y of c o n t a c t , and more f r e q u e n c y of n e g a t i v e and weak e m o t i o n a l i n t e r a c t i o n s . R e l a t i o n s h i p s were c h a r a c t e r i z e d by asymmetrical r e c i p r o c i t y , thereby c r e a t i n g a sense of burden and o b l i g a t i o n toward the n e u r o t i c respondent. P a t t i s o n et a l (1979) summarized t h e i r f i n d i n g s of the p s y c h o s o c i a l network of the n e u r o t i c s u b j e c t as f o l l o w s : In metaphoric terras, the n e u r o t i c s u b j e c t i s at the hub of a wagon wheel, with i n d i v i d u a l r e l a t i o n s h i p spokes s t i c k i n g o u t and w i t h a broken r i m t h a t f a i l s to connect the spokes...Simply put, the n e u r o t i c i n t e r a c t s w i t h a l i m i t e d s e t of s p a r s e l y connected i n d i v i d u a l s and r e c e i v e s l i t t l e c o r r e c t i v e group f e e d b a c k . The s o c i a l network of p e r s o n s w i t h n e u r o t i c b e h a v i o r s , consequently, i s l i k e l y both to induce s t r e s s and to maintain or augment s t r e s s . Thus i t i s more l i k e l y to c a t a l y z e the t r a n s f o r m a t i o n of s t r e s s i n t o a n xiety and then i n t o neurotic-symptom behaviors (p. 66). 2. R a t c l i f f e & Azim (1975). These r e s e a r c h e r s compared the s o c i a l networks of p s y c h i a t r i c p a t i e n t s from two h o s p i t a l s with a c o n t r o l sample drawn from households i n the same community. Two p a i r e d samples were drawn from the s u b j e c t pool i n order to c o n t r o l f o r m a r i t a l s t a t u s , age and sex. Subjects were asked to l i s t s i g n i f i c a n t others who were depended upon to meet c e r t a i n i n t e r p e r s o n a l needs (eg., spending f r e e time with, t a l k i n g with 46 when t r o u b l e d , seeking a d v i c e from) and r a t e t h e i r degree of s a t i s f a c t i o n w i t h t h e s e s i g n i f i c a n t network members. R e s u l t s i n d i c a t e d t hat both married and s i n g l e p a t i e n t s , when compared to the c o n t r o l group, were s i g n i f i c a n t l y l e s s s a t i s f i e d with t h e i r p e rsonal network r e l a t i o n s , and re p o r t e d fewer network members who c o u l d be depended upon. Network comp o s i t i o n r e f l e c t e d a predominance of i n v o l u n t a r y r e l a t i o n s with k i n and p r o f e s s i o n a l h e l p e r s , and a l a c k o f v o l u n t a r y f r i e n d s h i p r e l a t i o n s . S i m i l a r l y , m a r r i e d p a t i e n t s , when compared w i t h the m a r r i e d c o n t r o l group, r e p o r t e d a lower r e l i a n c e on t h e i r s p o u s e s . R a t c l i f f e & Azim, i n e x p l a i n i n g these r e s u l t s , suggested that a h i s t o r y of symptomatic b e h a v i o u r r e s u l t s i n a d i s r u p t i o n of r e l a t i o n s h i p s with s i g n i f i c a n t network r e l a t i o n s , l e a d i n g to l e s s r e l i a n c e on r e l a t i v e s and f r i e n d s and more r e l i a n c e on p r o f e s s i o n a l s . 3. Henderson et a l (1978b). The " p r i m a r y group" ( o r p s y c h o s o c i a l network) of 50 non-psychotic p s y c h i a t r i c p a t i e n t s was compared with that of 50 matched c o n t r o l s . A l t h o u g h both groups spent a p p r o x i m a t e l y the same amount of time with t h e i r r e s p e c t i v e network members and d i d not d i f f e r s i g n i f i c a n t l y i n the number of k i n a v a i l a b l e or p r e s e n t i n the community, the p s y c h i a t r i c group c i t e d s i g n i f i c a n t l y fewer good f r i e n d s and atta c h m e n t f i g u r e s , r e p o r t e d fewer s o c i a l c o n t a c t s with people o u t s i d e the household during the previous week, and spent more t i m e i n n e g a t i v e , u n p l e a s a n t c o n v e r s a t i o n and l e s s time i n 47 a f f e c t i v e l y n e u t r a l c o n v e r s a t i o n w i t h p e o p l e , compared to the c o n t r o l group. Furthermore, only 36% of the p s y c h i a t r i c group, as compared to 94% of the c o n t r o l group, c o n s i d e r e d t h a t the support they obtained from attachment f i g u r e s or persons to whom they f e l t af f e c t i o n a l l y c l o s e was s u f f i c i e n t . I n summary, Henderson and h i s c o l l e a g u e s (1978b) found that the primary group of non-psychotic p s y c h i a t r i c s u b j e c t s was d e f i c i e n t i n both s i z e and a f f e c t i v e q u a l i t y , and did not appear to meet the s u b j e c t ' s requirements f o r s o c i a l i n t e r a c t i o n . T h i s study was r e p l i c a t e d by Brugha et a l (1982) i n D u b l i n where the same design, sampling procedures and instruments were used. Remarkably s i m i l a r network d e f i c i e n c i e s were found i n the non-psychotic p s y c h i a t r i c group; however, i t was a l s o found that s i g n i f i c a n t d e f i c i e n c i e s i n the numbers of s o c i a l c o n t a c t s and i n the amount of s o c i a l i n t e r a c t i o n o u t s i d e the household were not r e p o r t e d by p a t i e n t s with more severe non-psychotic d e p r e s s i v e d i s o r d e r s . Brugha et a l t h e r e f o r e concluded that the f i n d i n g s of Henderson e t a l (1978b) c o u l d o n l y be c l e a r l y c o n f i r m e d i n p a t i e n t s with minor or n e u r o t i c forms of depression but not i n the more severe r e t a r d e d d e p r e s s i v e s . Brugha et a l (1982, 1984) a l s o r e p o r t e d t h a t d e p r e s s e d o u t p a t i e n t s had d e f i c i e n c i e s i n t h e i r p e r s o n a l networks which appeared to be l o n g - s t a n d i n g , c o n s i d e r a b l y a n t e d a t i n g t h e i r symptoms. 48 4. S i l b e r f e l d (1978). T h i s r e s e a r c h e r compared the s o c i a l n e t w o r k s of a c o n v e n i e n c e sample of 50 f e m a l e p s y c h i a t r i c o u t p a t i e n t s of mixed d i a g n o s i s with those of a matched c o n t r o l group of 50 female g e n e r a l p r a c t i c e p a t i e n t s , u s i n g as h i s network measure a survey method f o r r e c o n s t r u c t i n g an economy of time spent i n i n t e r p e r s o n a l r e l a t i o n s h i p s . S i l b e r f e l d found that p s y c h i a t r i c p a t i e n t s , when compared to g e n e r a l p a t i e n t s , were i m p o v e r i s h e d i n t h e i r s o c i a l networks with r e s p e c t to network s i z e and d u r a t i o n of time spent with network members, r e g a r d l e s s of the type of r e l a t i o n s h i p . P s y c h i a t r i c p a t i e n t s r e p o r t e d l e s s frequency of c o n t a c t and l e s s time spent with r e l a t i v e s , spouse or c h i l d r e n i n c o n t r a s t to the c o n t r o l group; and there were p r o p o r t i o n a t e l y fewer of t h e i r " c l o s e " r e l a t i o n s h i p s of t h i s type. Conversely, p s y c h i a t r i c p a t i e n t s had a g r e a t e r p r o p o r t i o n of a l l t h e i r r e l a t i o n s h i p s i n v e s t e d w i t h f r i e n d s , and t h e s e f r i e n d s c o m p r i s e d a g r e a t e r p r o p o r t i o n of t h e i r i n t i m a t e r e l a t i o n s i n c o n t r a s t t o g e n e r a l p r a c t i c e p a t i e n t s . I n t e r e s t i n g l y , b o t h groups had the same p r o p o r t i o n of a l l r e l a t i o n s h i p s c o n s i d e r e d to be " c l o s e ; " however, p s y c h i a t r i c p a t i e n t s spent l e s s time per v i s i t , and l e s s t o t a l time with these i n t i m a t e r e l a t i o n s h i p s . The data t h e r e f o r e suggests that p s y c h i a t r i c p a t i e n t s have l e s s t o t a l s o c i a l support a v a i l a b l e to them, as compared to g e n e r a l p r a c t i c e p a t i e n t s , and show a p r e f e r e n c e f o r f r i e n d s o v e r n u c l e a r and e x t e n d e d f a m i l y r e l a t i o n s . 49 5. Froland et a l (1979). These r e s e a r c h e r s examined the s o c i a l networks of t h r e e mental h e a l t h treatment groups ( i e . , p a t i e n t s from a s t a t e h o s p i t a l , n=30; a day treatment program, n = 20; an o u t p a t i e n t c l i n i c , n=27) and a g e n e r a l p o p u l a t i o n c o n t r o l group (n=30). F r o l a n d et a l d e s c r i b e d the ave r a g e s o c i a l network p r o f i l e of c l i e n t s from the t h r e e t r e a t m e n t groups, r e l a t i v e to the c o n t r o l group, as f o l l o w s : s m a l l e r i n s i z e h a v i n g fewer t i e s w i t h k i n ; fewer d i f f e r e n t s o u r c e s of f r i e n d s and fewer l o n g - t e r m f r i e n d s ; l e s s i n t e r a c t i o n w i t h f a m i l y , f r i e n d s , and r e l a t i v e s ; and g r e a t e r degrees of change, i n s t a b i l i t y and l o s s , r e s u l t i n g i n g r e a t e r d i s r u p t i o n i n the a v a i l a b i l i t y of support. These networks were a l s o c h a r a c t e r i z e d as h a v i n g l e s s m u t u a l i t y i n h e l p i n g e x c h a n g e s , and l e s s s a t i s f y i n g r e l a t i o n s h i p s . On t h e b a s i s o f n e t w o r k c h a r a c t e r i s t i c s , 79.2% of the mental h e a l t h c l i e n t s were able to be c o r r e c t l y c l a s s i f i e d as to the type of treatment program they were p a r t i c i p a n t s i n . T h i s f i n d i n g suggests that s o c i a l networks vary with the s e v e r i t y of p s y c h i a t r i c impairment. F r o l a n d et a l accounted f o r the poor adjustment of the mental h e a l t h c l i e n t s i n network terras as a " d i s a f f e c t i o n from f a m i l y ( p a r e n t s , spouse, s i b l i n g , e t c . ) , experience of i n s t a b i l i t y i n r e l a t i o n s h i p s , and i n a b i l i t y to o b t a i n h e l p or a s s i s t a n c e w i t h o u t e n g e n d e r i n g f e e l i n g s of burden i n the network" (p. 86). 50 6. Famuyiwa & Olatokunbo (1984). These r e s e a r c h e r s i n v e s t i g a t e d the s o c i a l networks of 153 N i g e r i a n p s y c h i a t r i c p a t i e n t s ( s c h i z o p h r e n i a or p r i m a r y a f f e c t i v e d i s o r d e r , n=85; anxiety n e u r o s i s , n=68) and 72 "apparently normal i n d i v i d u a l s . " P a t i e n t s were i n t e r v i e w e d w i t h a s e m i - s t r u c t u r e d s c h e d u l e designed to assess the f o l l o w i n g s o c i a l network v a r i a b l e s : s i z e , f o c a l d e n s i t y (an estimate of numerical s t r e n g t h of network t i e s , c a l c u l a t e d as the qu o t i e n t of the number of a c t u a l t i e s to the network s i z e ) , i n t e n s i t y of t i e , emotional support, m a t e r i a l a i d , and a c c e s s to s o c i a l c o n t a c t s . With r e s p e c t to the o v e r a l l s o c i a l network, the only s i g n i f i c a n t d i f f e r e n c e i n the networks of n e u r o t i c p a t i e n t s as compared with the c o n t r o l group was i n emotional support; that i s , n e u r o t i c p a t i e n t s r e p o r t e d t h a t they r e c e i v e d l e s s p o s i t i v e emotional support during p e r i o d s of c r i s i s than the c o n t r o l group. When s o c i a l network c h a r a c t e r i s t i c s were analyzed by s e c t o r , t h e r e were no s i g n i f i c a n t d i f f e r e n c e s i n s o c i a l network v a r i a b l e s w i t h i n the f a m i l y s e c t o r ; however, w i t h i n the co-worker s e c t o r , n e u r o t i c p a t i e n t s had s i g n i f i c a n t l y lower mean scores than c o n t r o l s f o r f o c a l d e n s i t y , i n t e n s i t y of t i e and emotional support. In e x p l a i n i n g t h i s r e s u l t , Famuyiwa et a l s u g g e s t e d t h a t "the work p l a c e , being a r e p r e s e n t a t i v e microcosm of the g e n e r a l community as a whole might r e f l e c t s o c i e t y ' s i n t o l e r a n c e of n e u r o t i c b e h a v i o u r " (p. 236). The r e s u l t s of t h i s study w i l l not be given as much weight i n the formation of hypotheses (below) s i n c e the sample was drawn from a d i f f e r e n t e t h n i c p o p u l a t i o n , s o c i e t y and country than the s t u d i e s 51 j u s t r e v i e w e d . I t i s i n t e r e s t i n g , however, t h a t N i g e r i a n p s y c h i a t r i c p a t i e n t s had s o c i a l networks with d e f i c i e n c i e s not u n l i k e t h o s e r e p o r t e d f o r p a t i e n t s i n t h e i n d u s t r i a l i s e d s o c i e t i e s . Summary• T h e s e c o m p a r a t i v e , c r o s s - s e c t i o n a l s t u d i e s i n d i c a t e a p o s i t i v e a s s o c i a t i o n b e t w een s o c i a l n e t w o r k d e f i c i e n c i e s and n o n - p s y c h o t i c p s y c h i a t r i c m o r b i d i t y , t h e r e b y e n h a n c i n g the c r e d i b i l i t y of h y p o t h e s e s i m p l i c a t i n g s o c i a l network v a r i a b l e s as c a u s a l or p r o t e c t i v e ( b u f f e r i n g ) agents i n t h e d e v e l o p m e n t of p s y c h i a t r i c symptomatology. S t r u c t u r a l  a n a l y s i s t y p i c a l l y r e v e a l e d a s m a l l e r , more s p a r s e l y connected n e t w o r k . T h e r e was d i s a g r e e m e n t , however, c o n c e r n i n g the composition of the network, some r e s e a r c h e r s f i n d i n g a f a m i l y dominated network, and o t h e r s f i n d i n g a higher composition of f r i e n d s . F r o l a n d et a l (1979) r e p o r t e d fewer d i f f e r e n t sources of f r i e n d s and fewer long-term f r i e n d s . I n t e r a c t i o n a l a n a l y s i s t y p i c a l l y r e v e a l e d l e s s f r e q u e n c y of c o n t a c t w i t h n e t w o r k members, w i t h l e s s amount of time spent during each c o n t a c t . S e v e r a l r e s e a r c h e r s r e p o r t e d a g r e a t e r f r e q u e n c y of n e g a t i v e , a f f e c t i v e l y u n p l e a s a n t , or weak e m o t i o n a l i n t e r a c t i o n , and g r e a t e r asymmetrical r e c i p r o c i t y . F r o l a n d et a l (1979) repo r t e d a g r e a t e r degree of change, i n s t a b i l i t y and l o s s , r e s u l t i n g i n d i s r u p t i o n to the a v a i l a b i l i t y of network support. F u n c t i o n a l  a n a l y s i s r e v e a l e d t h a t the networks of p s y c h i a t r i c p a t i e n t s were d e f i c i e n t i n p o s i t i v e e m o t i o n a l support during time of c r i s i s 52 (Famuyiwa & Olatokunbo, 1984). D i s c r e p a n c i e s between these s t u d i e s may be a t t r i b u t a b l e to d i f f e r e n c e s i n measures of s o c i a l n e t w o r k and p s y c h i a t r i c symptomatology, and the v a r y i n g nature of the k i n d , s e v e r i t y and c h r o n i c i t y of p s y c h i a t r i c d i s t r e s s . F u r t h e r m o r e , Henderson (1984) suggests s e v e r a l reasons why one cannot be s a t i s f i e d with hypotheses based upon such c r o s s - s e c t i o n a l d a t a . P s y c h i a t r i c s u b j e c t s may p e r c e i v e t h e i r s o c i a l r e l a t i o n s h i p s as d e f i c i e n t because of t h e i r a f f e c t i v e s t a t e ; or t h e i r symptoms and behaviour may have had a r e p e l l i n g e f f e c t on those around them, d r i v i n g away the v e r y network r e l a t i o n s h i p s and s u p p o r t they n e e d . A l t e r n a t i v e l y , an u n d e r l y i n g t h i r d v a r i a b l e , s u c h as a p e r s o n a l i t y t r a i t , may have l e d both to the development of p s y c h i a t r i c symptomatology and to an impaired a b i l i t y to form or maintain mutually s a t i s f y i n g p e r s o n a l r e l a t i o n s h i p s . C l e a r l y what i s needed i s p r o s p e c t i v e l o n g i t u d i n a l s t u d i e s . For example, Henderson (1981) fo l l o w e d up h i s c r o s s - s e c t i o n a l study r e p o r t e d above (Henderson et a l , 1978b) with a l o n g i t u d i n a l study t h a t found, q u i t e c o n t r a r y to e x p e c t a t i o n s and hypotheses, t h a t not one of the s o c i a l network i n d i c e s had any s i g n i f i c a n t p r e d i c t i v e e f f e c t f o r the subsequent onset of symptoms i n persons exposed to low l e v e l s of a d v e r s i t y . However, f o r t h o s e h a v i n g h i g h a d v e r s i t y , the adequacy of network s u p p o r t i n d i c e s a l o n e had s u b s t a n t i a l p r e d i c t i v e power, although Henderson et a l (1981) provided evidence that t h i s a s s o c i a t i o n was more l i k e l y to be a f u n c t i o n of p e r s o n a l i t y than of a c t u a l c o n d i t i o n s i n the s o c i a l 53 environment (eg., n e u r o t i c i s m alone e x p l a i n e d 69% of the va r i a n c e i n symptom measures, averaged over four waves of i n t e r v i e w i n g ) . Henderson summarized h i s r e s e a r c h as f o l l o w s : In the Canberra work, the c o n c l u s i o n we have a r r i v e d at i s t h at the a c t u a l a v a i l a b i l i t y of s o c i a l r e l a t i o n s h i p s probably has l i t t l e to do with the causes of n e u r o s i s . The p e r c e i v e d adequacy w i t h which o t h e r s meet t h e i n d i v i d u a l ' s requirements, e s p e c i a l l y under a d v e r s i t y , seems much more important. What we do not know i s how much that l i e s i n the a c t u a l performance of others and how much i s t h e p r o d u c t o f some i n t r a - p e r s o n a l a t t r i b u t e (Henderson et a l . , 1981, p. 197). Here, then, i s a s t r i k i n g example of how hypotheses based upon c r o s s - s e c t i o n a l data concerning s o c i a l networks and p s y c h i a t r i c symptomatology can be so c o n v i n c i n g l y overturned by p r o s p e c t i v e d a t a . With t h i s c o n s i d e r a t i o n i n mind, the focus of a t t e n t i o n narrows to the s o c i a l network c o r r e l a t e s of that p o r t i o n of the non-psychotic p s y c h i a t r i c p o p u l a t i o n of c e n t r a l i n t e r e s t to t h i s study, women with a d i a g n o s i s of anorexia nervosa. Comparative s t u d i e s of anorexic women and t h e i r s o c i a l  networks. There are only two s t u d i e s a v a i l a b l e i n the l i t e r a t u r e t h a t d i r e c t l y a s s e s s the s o c i a l network or s o c i a l support of a n o r e x i c women. These s t u d i e s a re e x p e c t e d to y i e l d s o c i a l network p a t t e r n s s i m i l a r to t h o s e of the more g e n e r a l non-ps y c h o t i c p o p u l a t i o n j u s t reviewed. 1. Berkowitz (1983). B e r k o w i t z o b t a i n e d a convenience sample of 16 a n o r e x i c and 16 b u l i m i c n o n - h o s p i t a l i z e d female s u b j e c t s and t h e i r f a m i l i e s , and compared them with 16 non-eating 54 d i s o r d e r e d female s u b j e c t s and t h e i r f a m i l i e s i n o r d e r t o i d e n t i f y i n d i v i d u a l and f a m i l y v a r i a b l e s which might d i s c r i m i n a t e between them. Of s p e c i a l i n t e r e s t to t h i s study i s the l e v e l of perc e i v e d emotional support, as measured by the Perceived S o c i a l Support i n v e n t o r y (Procidano & H e l l e r , 1983), that anorexic and non-anorexic women r e p o r t r e c e i v i n g from t h e i r f a m i l i e s . The P e r c e i v e d S o c i a l Support i n v e n t o r y was designed to measure the extent to which an i n d i v i d u a l p e r c e i v e s that h i s or her needs f o r s u p p o r t ( p r i m a r i l y e m o t i o n a l support) are f u l f i l l e d by f a m i l y members or f r i e n d s ( H e l l e r & Swindle, 1983), although Berkowitz measured o n l y f a m i l y support. I t i s duly noted here t h a t the P e r c e i v e d S o c i a l S u p p o r t i n v e n t o r y i s not a measure of s o c i a l network; however, i t does r e l i a b l e measure the l e v e l of per c e i v e d n e t w o r k s u p p o r t i v e n e s s i n the c o n t e n t a r e a s of f a m i l y and f r i e n d s , and i s t h e r e f o r e r e l e v a n t to t h i s s t u d y . R e s u l t s of the m u l t i v a r i a t e a n a l y s i s r e v e a l e d t h a t s o c i a l s u p p o r t from f a m i l y , as p e r c e i v e d by a n o r e x i c and n o n - a n o r e x i c s u b j e c t s , f a i l e d to d i s c r i m i n a t e between anorexic and non-anorexic groups, t h a t i s , both a n o r e x i c and n o n - a n o r e x i c women i n the st u d y p e r c e i v e d t h e i r f a m i l i e s as a s o u r c e of e m o t i o n a l s u p p o r t . However, f a m i l y members of anorexic s u b j e c t s d i d not pe r c e i v e the fa m i l y as a source of emotional support, whereas f a m i l y members of n o n - a n o r e x i c s u b j e c t s d i d ; t h a t i s , s o c i a l s u p p o r t , as  p e r c e i v e d by f a m i l y members, s u c c e s s f u l l y d i s c r i m i n a t e d between the f a m i l i e s of anorexic and non-anorexic s u b j e c t s . 55 2. Sheppy (1984). Sheppy examined a v a r i e t y of i n d i v i d u a l , parent, f a m i l y , and community v a r i a b l e s i n a comparative study of 30 female a n o r e x i c s and t h e i r p a r e n t s and 34 matched c o n t r o l s u b j e c t s and t h e i r p arents. Her community v a r i a b l e s were i n d i c e s of s o c i a l network, as measured by the P a t t i s o n P s y c h o s o c i a l I n v e n t o r y (the instrument used i n t h i s study, and explained i n Chapter 3 ) . Sheppy hypothesized that a norexic s u b j e c t s and t h e i r f a m i l i e s w o u l d h ave s o c i a l networks t h a t were s m a l l e r and c h a r a c t e r i z e d by a l e s s s a t i s f y i n g q u a l i t y of i n t e r a c t i o n t han those of the c o n t r o l s u b j e c t s and t h e i r parents on the b a s i s of the f o l l o w i n g i n f o r m a t i o n gleaned from her l i t e r a t u r e r e v i e w : a n o r e x i c women w i t h d r a w and i s o l a t e t h e m s e l v e s from t h e i r f r i e n d s , e s p e c i a l l y h e t e r o s e x u a l f r i e n d s ; f r e q u e n t g e o g r a p h i c moves, r e p o r t e d to be a p r e c i p i t a t i n g event i n an o r e x i a , are l i k e l y to d e c r e a s e n e t w o r k s i z e and q u a l i t y ; and c e r t a i n p e r s o n a l i t y f a c t o r s , such as i n t r o v e r s i o n , i n combination with the enmeshed q u a l i t y of ano r e x i c f a m i l i e s are l i k e l y to i n h i b i t the development of s o c i a l r e l a t i o n s h i p s o u t s i d e the f a m i l y . Sheppy pooled the s o c i a l network data of the ano r e x i c daughters and t h e i r parents i n t o a g l o b a l s i z e score and a g l o b a l q u a l i t y s c o r e , and d i d l i k e w i s e f o r the c o n t r o l d a u g h t e r s and t h e i r p a r e n t s . The s i z e s c o r e was the average of a l l the p e o p l e c o n s i d e r e d to be of c u r r e n t importance, whether l i k e d or not, i d e n t i f i e d by the s u b j e c t and her pa r e n t s . The q u a l i t y score was a measure of p e r c e i v e d r e c i p r o c i t y , and was c a l c u l a t e d by o b t a i n i n g a d i f f e r e n c e of the means between the r e c i p r o c a t i n g 56 v a r i a b l e s ( i e . , kind of f e e l i n g s and t h o u g h t s , and degree of e m o t i o n a l and i n s t r u m e n t a l support) f o r each person named, and then averaging these d i f f e r e n c e s f o r i n d i v i d u a l s u b j e c t s c o r e s . Contrary to e x p e c t a t i o n s , n e i t h e r the r e s u l t s of the m u l t i v a r i a t e a n a l y s i s ( H o t e l l i n g ' s T 2, F(2,61)=2.76, p>.05) nor the subsequent d i s c r i m i n a n t a n a l y s i s (Xr.=5.21, p>.05) showed a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n p s y c h o s o c i a l network s i z e or q u a l i t y ( p e r c e i v e d r e c i p r o c i t y ) between a n o r e x i c s and t h e i r parents and c o n t r o l s u b j e c t s and t h e i r p a r e n t s . However, a s t e p w i s e d i s c r i m i n a n t a n a l y s i s of 14 p e r s o n a l i t y , i n t e r a c t i o n a l , f a m i l y c l i m a t e and s o c i a l network v a r i a b l e s r e v e a l e d that two v a r i a b l e s d i s c r i m i n a t e d to the g r e a t e s t degree between the a n o r e x i c and c o n t r o l groups: the daughters' A f f i l i a t i o n mean score and the mothers' Psychopathic Deviate mean s c o r e . These two v a r i a b l e s could c o r r e c t l y c l a s s i f y 87.5% of the s u b j e c t s . Conversely, the d i s c r i m i n a n t f u n c t i o n was not i n c r e a s e d at a l l with the a d d i t i o n of the s o c i a l network v a r i a b l e s . These r e s u l t s , a c c o r d i n g t o Sheppy, "present a strong argument that the p e r s o n a l i t y t r a i t s , c l i n i c a l c h a r a c t e r i s t i c s and s e l f - c o n c e p t q u a l i t i e s o f t h e anore x i c s themselves are the most powerful d i s c r i m i n a t o r s " (1984, p. 115), a c o n c l u s i o n t h a t i s r e m i n i s c e n t o f H e n d e r s o n ' s u n e x p e c t e d d i s c o v e r y of t h e g r e a t e r p r e d i c t i v e power of i n d i v i d u a l d i f f e r e n c e v a r i a b l e s ( i n h i s case, n e u r o t i c i s m ) over t h a t of s o c i a l network v a r i a b l e s (Henderson et a l . , 1981). In e x p l a i n i n g her s u r p r i s i n g r e s u l t s , Sheppy p o i n t e d to c e r t a i n a t y p i c a l f e a t u r e s of the c o n t r o l group which p o s s i b l y r e f l e c t e d 57 the r e f e r r a l source of her s u b j e c t s or the method of o b t a i n i n g t h e d a t a , t h e t y p e of i n s t r u m e n t a t i o n employed and/or i t s a d m i n i s t r a t i o n , and f i n a l l y the g l o b a l n a t u r e of her s o c i a l network a n a l y s i s . She suggested t h a t "a d e t a i l e d a n a l y s i s could be most r e v e a l i n g " ( p . 115), a s u g g e s t i o n t h a t prompted the present study. Summary. The s t u d i e s of Berkowitz (1983) and Sheppy (1984) y i e l d e d r e s u l t s i n c o n t r a d i c t i o n to the emerging p r o f i l e of the s o c i a l network of t h e n o n - p s y c h o t i c p s y c h i a t r i c p a t i e n t . Contrary to hypotheses and e x p e c t a t i o n s , Sheppy did not f i n d t h a t the s o c i a l networks of her anorexic s u b j e c t s and t h e i r p a r e n t s were e i t h e r s i g n i f i c a n t l y s m a l l e r i n s i z e or d e f i c i e n t i n q u a l i t y when compared with the s o c i a l networks of her c o n t r o l s u b j e c t s and t h e i r p a r e n t s . However, the s p e c i f i c nature of the a n o r e x i c s o c i a l network was obscured i n Sheppy's study by the p o o l i n g of s o c i a l network data from a n o r e x i c s u b j e c t s and t h e i r p arents. A more d e t a i l e d a n a l y s i s of the s o c i a l network d a t a from her a n o r e x i c s u b j e c t s a l o n e may r e v e a l s i g n i f i c a n t d i f f e r e n c e s i n network s i z e and q u a l i t y . Although Berkowitz d i d not use a s o c i a l network measure or a n a l y s i s , her r e s u l t s do give a r e l i a b l e i n d i c a t i o n of network support w i t h i n the f a m i l y c l u s t e r . In her study, Berkowitz a l s o found s u r p r i s i n g r e s u l t s : a n o r e x i c and c o n t r o l s u b j e c t s d i d not s i g n i f i c a n t l y d i f f e r i n t h e i r p e r c e p t i o n of f a m i l y as a source of s o c i a l support. T h i s f i n d i n g i s a l l the more s u r p r i s i n g s i n c e 58 the a n o r e x i c s u b j e c t s s c o r e d s i g n i f i c a n t l y h i g h e r than non-a n o r e x i c s u b j e c t s on a s e l f - r a t e d d e p r e s s i o n s c a l e , and i t has been suggested that depressed mood may i n t e r f e r e with the a b i l i t y to p e r c e i v e s o c i a l support (Procidano & H e l l e r , 1979). Recapitulation of the problem. The immediate s o c i a l m i l i e u of the a n o r e x i c p a t i e n t has been d e s c r i b e d i n t h e e a r l y psychodynamic and f a m i l y therapy l i t e r a t u r e with such c o n s i s t e n c y as to become s t e r e o t y p i c . I t i s c u r i o u s , however, t h a t t h i s s o c i a l p r o f i l e b e a r s s t r i k i n g resemblance to the c o n s t r i c t e d , f a m i l y - d o m i n a n t s o c i a l network f o u n d r e p e a t e d l y i n c r o s s -s e c t i o n a l s t u d i e s of non-psychotic p s y c h i a t r i c p o p u l a t i o n s , and y e t i s s t r o n g l y c h a l l e n g e d by r e c e n t f a m i l y i n t e r a c t i o n a l s t u d i e s of such p o p u l a t i o n s . Furthermore, the c u r r e n t e m p i r i c a l r e s e a r c h c o n c e r n i n g a n o r e x i a n e r v o s a has been l i m i t e d t o a d e s c r i p t i o n of the f a m i l y environment and f a m i l y r e l a t i o n s h i p s a s s o c i a t e d with a n o r e x i a nervosa d e s p i t e recommendations i n the l i t e r a t u r e f o r a b r o a d e r e c o l o g i c a l f o c u s . Such r e s e a r c h i s unable to e m p i r i c a l l y v e r i f y e t i o l o g i c a l h y p o t h e s e s from the s o c i a l network l i t e r a t u r e r e l a t e d to the co-determining r o l e of c e r t a i n s o c i a l n e t w o r k p a t t e r n s i n t h e d e v e l o p m e n t and m a intenance of n o n - p s y c h o t i c p s y c h i a t r i c d i s o r d e r s . Only one s o c i a l network a n a l y s i s of an a n o r e x i c p o p u l a t i o n could be found i n the l i t e r a t u r e (Sheppy, 1984). T h i s s t u d y , c o n t r a r y to e x p e c t a t i o n s and h y p o t h e s e s , d i d not f i n d any s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s i n the s i z e or r e c i p r o c i t y of anorexic 59 and non-anorexic p s y c h o s o c i a l networks, and thus strengthens the case of r e c e n t f a m i l y i n t e r a c t i o n a l r e s e a r c h . However, Sheppy (1984) employed a g l o b a l a n a l y s i s of her data, and recommended that a more d e t a i l e d a n a l y s i s may r e v e a l s i g n i f i c a n t d i f f e r e n c e s i n s p e c i f i c network v a r i a b l e s . Such i s the mandate of t h i s study. Hypotheses and a summary of t h e i r t h e o r e t i c a l rationale. The f o l l o w i n g hypotheses w i l l be t e s t e d i n t h i s study. 1. There i s a s t a t i s t i c a l l y s i g n i f i c a n t difference between the s o c i a l networks of anorexic and control subjects. Hypotheses r e l a t e d to the s t r u c t u r a l aspects of per c e i v e d  s i z e and composition of s o c i a l networks. 1.1. The s i z e of the s o c i a l networks of anorexic s u b j e c t s are s i g n i f i c a n t l y smaller than those of the control subjects. A t r u n c a t e d s o c i a l network i s c o n s i s t e n t l y r e p o r t e d i n s t u d i e s of n o n — p s y c h o t i c p s y c h i a t r i c p a t i e n t s (as d i s c u s s e d above) , and i n c l i n i c a l r e p o r t s of the anor e x i c and her f a m i l y ( d i s c u s s e d i n C h a p t e r 1 ) . F u r t h e r m o r e , e l e v a t e d d e p r e s s i o n s c o r e s commonly r e p o r t e d among ano r e x i c women (eg., Berkowitz, 1983; Hatsukami et a l , 1984; Herzog, 1984; Katz, 1987; Swift et a l , 1986; Y e l l o w l e e s , 1985) suggest that anorexic women engage i n w i t h d r a w a l b e h a v i o r s t h a t a r e n o t c o n d u c i v e t o n e t w o r k development and maintenance. 1.2. There are s i g n i f i c a n t l y fewer f r i e n d s i n the s o c i a l networks of anorexic subjects than i n the s o c i a l networks of control subjects. 60 1.3. There are s i g n i f i c a n t l y fewer heterosexual f r i e n d s or b o y f r i e n d s i n the s o c i a l networks of a n o r e x i c s u b j e c t s than i n the s o c i a l networks of control subjects. The tendency of the anorexic to withdraw from f r i e n d s , and to a v o i d h e t e r o s e x u a l f r i e n d s i s commonly r e p o r t e d i n t h e l i t e r a t u r e (as di s c u s s e d i n Chapter 1; eg_. , C r i s p et a l , 1980; Bruch, 1978; S e l v i n i , 1978; Y e l l o w l e e s , 1985). Indeed, the presence of sexual c o n f l i c t s i n women with e a t i n g d i s o r d e r s has been w e l l documented (e_g_. , Beumont et a l , 1981; Leon et a l , 1 9 8 5 ) , e s p e c i a l l y among c l i n i c i a n s w i t h a p s y c h o d y n a m i c o r i e n t a t i o n (eg_. , Sloan & L e i c h n e r , 1986). T h i s hypothesis i s an attempt to e m p i r i c a l l y confirm these c l i n i c a l o b s e r v a t i o n s . 1.4. A s i g n i f i c a n t l y greater proportion of the t o t a l s o c i a l network of anorexic subjects, as compared to c o n t r o l s u b j e c t s , i s composed of n u c l e a r f a m i l y members. Stu d i e s of non-psychotic p s y c h i a t r i c p o p u l a t i o n s ( d i s c u s s e d a b o v e ) y i e l d c o n t r a d i c t o r y f i n d i n g s w i t h r e g a r d t o t h i s h y p o t h e s i s . For example, P a t t i s o n et a l (1975, 1979), R a t c l i f f e & Azira (1975), and Henderson et a l (1978b) r e p o r t a g r e a t e r p r o p o r t i o n of f a m i l y members or i n v o l u n t a r y r e l a t i o n s h i p s and fewer f r i e n d s were c h a r a c t e r i s t i c of the s o c i a l networks of t h e i r p s y c h i a t r i c sample, whereas S i l b e r f e l d (1978) r e p o r t s t h a t the s o c i a l networks of h i s sample showed a h i g h e r p r o p o r t i o n of f r i e n d s , or v o l u n t a r y r e l a t i o n s h i p s . T h e o r e t i c a l support f o r t h i s hypothesis comes from f a m i l y systems theory which p o i n t s to the enmeshed q u a l i t y of anorexic f a m i l i e s (eg., Minuchin et a l , 1978; S e l v i n i , 1978), a q u a l i t y 61 t h a t i s u n l i k e l y t o f o s t e r t h e d e v e l o p m e n t o f s o c i a l r e l a t i o n s h i p s o u t s i d e the f a m i l y . Furthermore, Sheppy (1984) d e s c r i b e s the anorexic as withdrawing from network f r i e n d s , and the a n o r e x i c ' s f a m i l y as i s o l a t e d and s o l e l y dependent on one another f o r support due to the need to maintain a p e r f e c t f a m i l y image to the community, frequent network d i s r u p t i o n s as a r e s u l t of geographic moves, an emphasis on network l o y a l t y , and the enmeshed q u a l i t y of f a m i l y r e l a t i o n s h i p s . Jones (1981) r e p o r t s that a n o r e x i c s have an absence of c l o s e f r i e n d s h i p s , and t h a t when a peer r e l a t i o n s h i p i s developed, i t i s u s u a l l y with only one p e r s o n at a time and even then i s s h o r t - l i v e d . J o n e s s u g g e s t s t h a t t h i s i m p o v e r i s h m e n t i n p e e r r e l a t i o n s has e t i o l o g i c a l s i g n i f i c a n c e i n the development of a n o r e x i a nervosa. Andersen (1985) p a i n t s a s i m i l a r p o r t r a i t : S o c i a l l y , most p a t i e n t s e x h i b i t immature i n t e r a c t i o n p a t t e r n s , becoming even more dependent and c h i l d l i k e i n r e l a t i o n s h i p to t h e i r p arents. Dating a c t i v i t i e s stop i f they were present, and good f r i e n d s are abandoned. As the years go on, d e f i c i t s i n s o c i a l s k i l l s become profound, and p a t i e n t s may be years behind t h e i r peers s o c i a l l y (p. 49). T h i s p o r t r a i t of the a n o r e x i c and her f a m i l y i s commonly r e p o r t e d i n the e a r l y i m p r e s s i o n i s t i c r e s e a r c h of a n o r e x i a nervosa ( d i s c u s s e d i n Chapter 1), and corresponds to the n u c l e a r f a m i l y dominant network p a t t e r n d i s c o v e r e d by Hurd et a l (1980) i n t h e i r study of normative s o c i a l networks. These r e s e a r c h e r s found three d i s t i n c t types of s o c i a l network p a t t e r n s that were i d e n t i f i e d by the r a t i o of nuclear f a m i l y to extended f a m i l y . The n u c l e a r f a m i l y dominant network p a t t e r n could be i d e n t i f i e d 62 by a 2:1 r a t i o o f n u c l e a r f a m i l y t o e x t e n d e d f a m i l y . F u r t h e r m o r e , e a c h o f t h e t h r e e s u b p o p u 1 a t i o n s v a r i e d s i g n i f i c a n t l y both i n network s i z e and composition. For example, the n u c l e a r f a m i l y dominant networks were s i g n i f i c a n t l y s m a l l e r o v e r a l l (18 network members), and were c o m p r i s e d of p r i m a r i l y nuclear f a m i l y members (7 members), f r i e n d s (5 members) and co-workers (4 members). Hurd et a l (1980) h y p o t h e s i z e d t h a t the nucle a r f a m i l y dominant network would be the most v u l n e r a b l e of the three network p a t t e r n s s i n c e i t appeared to f o s t e r an almost e x c l u s i v e r e l i a n c e on a s i n g l e network s e c t o r , the nucl e a r f a m i l y c l u s t e r , embedded i n a c o m p a r a t i v e l y s m a l l e r s e t of network r e l a t i o n s f o r p r o v i s i o n s of support. F i n d i n g a nu c l e a r f a m i l y dominant network p a t t e r n among the anor e x i c s u b j e c t s , but not the c o n t r o l s u b j e c t s , of t h i s s t u d y would le n d support to Hurd's h y p o t h e s i s . H y potheses r e l a t e d to the i n t e r a c t i o n a l aspects of s o c i a l  networks• 1.5. There i s s i g n i f i c a n t l y l e s s frequency of contact with a l l network sectors other than nuclear family i n the s o c i a l networks of anorexic subjects than i n the s o c i a l networks of control subjects. 1.6. A s i g n i f i c a n t l y greater proportion of the t o t a l number of high contact frequency r e l a t i o n s ( i e , network members contacted at lea s t once a week) i s found among the family members of the s o c i a l networks of anorexic as c o m p a r e d t o c o n t r o l s u b j e c t s , w h e reas a s i g n i f i c a n t l y smaller proportion of the t o t a l number of h i g h c o n t a c t f r e q u e n c y r e l a t i o n s i s found among r e l a t i v e s , friends, managers (boss), and other members of the s o c i a l networks of anorexic as compared to control subjects. These h y p o t h e s e s b u i l d on the t h e o r e t i c a l f o u n d a t i o n of 63 hypotheses 1.1 and 1.2. They assume that anorexic s u b j e c t s have a n u c l e a r f a m i l y dominant network, and seeks to r e p l i c a t e the f i n d i n g by Hurd et a l (1980) t h a t a n u c l e a r f a m i l y dominant n e t w o r k i s c h a r a c t e r i z e d by a p r e f e r e n c e f o r h i g h c o n t a c t f r e q u e n c y r e l a t i o n s w i t h i n n u c l e a r f a m i l y and f r i e n d s h i p c l u s t e r s , and an abandonment of low c o n t a c t r e l a t i o n s from other network s e c t o r s . 1.7. Anorexic s u b j e c t s have a s i g n i f i c a n t l y higher p r o p o r t i o n of network r e l a t i o n s v i t h whom they f e e l ambivalent or negative about than control subjects. S t u d i e s of n o n - p s y c h o t i c p s y c h i a t r i c p o p u l a t i o n s r e v e a l s o c i a l n e t w o r k s c h a r a c t e r i z e d by a h i g h e r number of weak, o n e g a t i v e , a f f e c t i v e l y unpleasant i n t e r a c t i o n s than i s the case f o r c o n t r o l samples (Henderson et a l , 1978b; P a t t i s o n et a l , 1975, 1979). A connection between weak or a f f e c t i v e l y unpleasant network i n t e r a c t i o n s and a m b i v a l e n t or n e g a t i v e f e e l i n g s and thoughts i s assumed here, such that i f the anorexic s u b j e c t s of t h i s study show a s i g n i f i c a n t l y g r e a t e r degree of ambivalence or negative f e e l i n g s and t h o u g h t s towards t h e i r network members o v e r a l l , t h e n s u p p o r t i s i n f e r r e d f o r the s t u d i e s of non-p s y c h o t i c p s y c h i a t r i c p o p u l a t i o n s t h a t show s o c i a l networks c h a r a c t e r i z e d by a higher number of weak or negative i n t e r a c t i o n s than i s the case f o r normative p o p u l a t i o n s . 1.8. Anorexic s u b j e c t s have a s i g n i f i c a n t l y higher degree of ambivalence or negative feelings and thoughts toward t h e i r parents than control subjects. C l i n i c a l r e p o r t s , p a r t i c u l a r l y from t h e p s y c h o d y n a m i c l i t e r a t u r e , s u g g e s t t h a t a n o r e x i c d a u g h t e r s have a p o w e r f u l 64 ambivalence p a r t i c u l a r l y toward t h e i r " s c o l d i n g and o v e r b e a r i n g mother" (Bemis, 1978). F u r t h e r m o r e , r e p o r t s from the f a m i l y systems l i t e r a t u r e suggest a c o v e r t power s t r u g g l e s u r r o u n d i n g food between anorexic daughters and t h e i r parents ( M i l l e r , 1984). H y p o t h e s i s r e l a t e d to the f u n c t i o n a l a s p e c t s of s o c i a l  networks. 1.9. There i s a s i g n i f i c a n t l y greater proportion of emotional and i nstrumental support exchanged within the n u c l e a r f a m i l y c l u s t e r and s i g n i f i c a n t l y l e s s w i t h i n the other c l u s t e r s of the s o c i a l networks of anorexic subjects i n comparison to control subjects. T h i s h y pothesis again b u i l d s on the t h e o r e t i c a l f o u n d a t i o n of hypotheses 1.1 and 1.2, and l o g i c a l l y f o l l o w s h y p o t h e s i s 1.4; that i s , i f a n o r e x i c s u b j e c t s have c o n s t r i c t e d s o c i a l networks t h a t are c o m p r i s e d p r i m a r i l y of n u c l e a r f a m i l y members and c h a r a c t e r i z e d by a p r e f e r e n c e f o r h i g h c o n t a c t f r e q u e n c y r e l a t i o n s w i t h i n the n u c l e a r f a m i l y and f r i e n d s h i p c l u s t e r s , then i t i s r e a s o n a b l e to h y p o t h e s i z e t h a t the p r i m a r y s o u r c e s of support r e p o r t e d by a n o r e x i c s w i l l come from the n u c l e a r f a m i l y and f r i e n d s h i p c l u s t e r s . F u r t h e r m o r e , P a t t i s o n et a l (1975, 1979) found t h a t the s o c i a l networks of n e u r o t i c s u b j e c t s were c h a r a c t e r i z e d by a h i g h e r degree of dependence upon f a m i l y network members f o r s o c i a l support than was the case f o r c o n t r o l s u b j e c t s . H y p o t h e s e s r e l a t e d t o s o c i a l n e t w o r k c o r r e l a t e s of p e r s o n a l i t y f a c t o r s . 2. The s o c i a l networks of anorexic subjects vary with personality t r a i t s . 65 2.1. There w i l l be a p o s i t i v e c o r r e l a t i o n between in t e r p e r s o n a l effectivness scores, as measured by the C a l i f o r n i a P s y c h o l o g i c a l Inventory (CPI), and s o c i a l network size and support (emotional, instrumental). H e l l e r & S w i n d l e ( 1 9 8 3 ) have s u g g e s t e d t h a t s o c i a l c o m p e t e n c e c o n t r i b u t e s t o t h e i n d i v i d u a l ' s a b i l i t i e s and p r e d i l e c t i o n s to l i n k to others and e l i c i t s u p p o r t from them. T h e r e has been a r e m a r k a b l e c o n s i s t e n c y i n c l i n i c a l and e m p i r i c a l r e p o r t s of p e r s o n a l i t y c o r r e l a t e s of a n o r e x i a nervosa, s u c h as i n t r o v e r s i o n , s o c i a l i n s e c u r i t y and i n t e r p e r s o n a l a v o i d a n c e (e£. , S c o t t & B a r o f f i o , 1986; Smart et a l . , 1976; S t r o b e r , 1980; S t r o b e r , 1981; S t r o b e r , 1986). Such p e r s o n a l i t y t r a i t s s u g g e s t t h a t t h e a n o r e x i c i s n o t e f f e c t i v e i n i n t e r p e r s o n a l r e l a t i o n s h i p s . The degree of i n t e r p e r s o n a l e f f e c t i v e n e s s among anorexic women may, i n t u r n , be r e a s o n a b l y expected to c o n t r i b u t e to s o c i a l network v a r i a t i o n , CPI data has been obtained elsewhere f o r the sample of t h i s study (Sheppy, 1984). Of p a r t i c u l a r i n t e r e s t i s the c l u s t e r of s c a l e s o r i g i n a l l y organized by Gough (1968) and i n t e r p r e t e d by him as r e f e r r i n g to i n t e r p e r s o n a l e f f e c t i v e n e s s , s t y l e , and adequacy; these s c a l e s are Dominance (Do), C a p a c i t y f o r S t a t u s ( C s ) , S o c i a b i l i t y ( S y ) , S o c i a l Presence (Sp), S e l f - a c c e p t a n c e (Sa), and Well-being (Wb). However, Gough organized t h i s c l u s t e r of s c a l e s on the b a s i s of c o n c e p t u a l s i m i l a r i t y r a t h e r than s t a t i s t i c a l l y d e r i v e d p a r a l l e l s . Megargee (1972) has shown an e m p i r i c a l r e l a t i o n s h i p among these s c a l e s , with the exception of W ell-being, on the b a s i s of a f a c t o r a n a l y s i s . 66 I t i s propo s e d here t h a t a n o r e x i c s u b j e c t s who show an e l e v a t i o n i n the i n t e r p e r s o n a l e f f e c t i v e n e s s c l u s t e r of CPI s c a l e s (based on t h e i r pooled, mean scores i n Do, Cs, Sy, Sp, & Sa) w i l l p e r c e i v e t h a t they have a s i g n i f i c a n t l y l a r g e r and more sup p o r t i v e s o c i a l network than anorexic s u b j e c t s who score low i n t h i s c l u s t e r of s c a l e s . H y potheses r e l a t e d to the s o c i a l network c o r r e l a t e s of environmental v a r i a b l e s . 3. The s o c i a l networks of anorexic subjects vary with environmental c h a r a c t e r i s t i c s . 3.1. There w i l l be a negative c o r r e l a t i o n between the family climate variable of cohesion, as measured by the Family Environment Scale (FES), and s o c i a l network size as perceived by anorexic subjects. 3.2. There w i l l be a posit i v e c o r r e l a t i o n between the family climate variable of independence, as measured by the Family Environment Scale (FES), and s o c i a l network size as perceived by anorexic subjects. 3.3. There w i l l be a posit i v e c o r r e l a t i o n between the family climate variables of cohesion and independence, as measured by the Family Environment Scale (FES), and s o c i a l network support (emotional and instrumental) r e c e i v e d from a l l sources as perceived by anorexic subjects. 3.4. There w i l l be a posit i v e c o r r e l a t i o n between the family climate variable of cohesion, as measured by the Family Environment Scale (FES), and s o c i a l network support (emotional and instrumental) from family as p e r c e i v e d by a n o r e x i c s u b j e c t s , but a n e g a t i v e c o r r e l a t i o n between cohesion and s o c i a l network support from sources outside the family. 3.5. There w i l l be a negative c o r r e l a t i o n between the family climate variable of independence, as measured by the Family Environment Scale (FES), and s o c i a l network support (emotional and instrumental) from family as p e r c e i v e d by a n o r e x i c s u b j e c t s , but a p o s i t i v e c o r r e l a t i o n between independence and s o c i a l network support from sources outside the family. 67 M i t c h e l l (1982), i n h i s c o m p a r a t i v e s t u d y of p s y c h i a t r i c o u t p a t i e n t s , found that higher l e v e l s of cohesion (as measured by the FES) were a s s o c i a t e d with fewer network members, c o n t r a r y to e x p e c t a t i o n s . With r e g a r d to the average degree of support r e c e i v e d from a l l network members, both cohesion ( r = . 2 9 , p<.05) and i n d e p e n d e n c e (r=.32, p<,05) were s i g n i f i c a n t l y a s s o c i a t e d w i t h i n c r e a s e d l e v e l s of network s u p p o r t . The g r e a t e r the emphasis on c o h e s i o n and i n d e p e n d e n c e w i t h the f a m i l y , the g r e a t e r the respondent's p e r c e p t i o n of network s u p p o r t . With regard to the average degree of support r e c e i v e d from the f r i e n d s c l u s t e r , independence (r=.43, p<.01) was s i g n i f i c a n t l y a s s o c i a t e d w i t h i n c r e a s e d l e v e l s of support. The g r e a t e r the emphasis on independence w i t h i n the f a m i l y , the g r e a t e r the p e r c e i v e d l e v e l of network support from f r i e n d s . A r e p l i c a t i o n of M i t c h e l l ' s (1982) r e s u l t s i s proposed here, using FES data obtained elsewhere f o r the s u b j e c t s of t h i s study (Sheppy, 1984); t h a t i s , a n o r e x i c s u b j e c t s who score high i n f a m i l y cohesion and independence, as measured by the FES, w i l l have s i g n i f i c a n t l y fewer network members and r e p o r t s i g n i f i c a n t l y i n c r e a s e d l e v e l s of o v e r a l l network s u p p o r t and s u p p o r t from f r i e n d s i n com p a r i s o n to a n o r e x i c s u b j e c t s who s c o r e low i n f a m i l y cohesion and independence. 68 CHAPTER 3 METHODOLOGY PURPOSE OF THE STUDY The p r e s e n t c r o s s - s e c t i o n a l s t u d y employed a c a u s a l -c o m p a r a t i v e d e s i g n and s e l f - r e p o r t d a t a i n o r d e r to e x p l o r e s o c i a l network c o r r e l a t e s of anorexia nervosa. These c o r r e l a t e s are of s i g n i f i c a n c e to psychodynamic p s y c h o s o c i a l systems theory and of r e l e v a n c e to a c u r i o u s c o n t r a d i c t i o n i n the l i t e r a t u r e ; t h a t i s , the l a r g e l y i n v a r i a n t s o c i a l p r o f i l e of the anorexic commonly r e p o r t e d i n e a r l y i m p r e s s i o n i s t i c r e s e a r c h and r e p e a t e d l y found i n s o c i a l network a n a l y s e s of p s y c h i a t r i c p o p u l a t i o n s , and the v a r i a b l e s o c i a l p r o f i l e found i n more rec e n t e m p i r i c a l s t u d i e s . In view of these c o n t r a d i c t o r y views of the s o c i a l m i l i e u of the a n o r e x i c , the present study was designed to e m p i r i c a l l y examine the nature of the s o c i a l p r o f i l e s of anorexic and non-anorexic women using an e c o l o g i c a l f o c u s t h a t e x t e n d s beyond the n u c l e a r f a m i l y to encompass the b r o a d e r p e r s o n a l s o c i a l network. A n o t h e r p u r p o s e o f t h e s t u d y was t o i n v e s t i g a t e the c o n t r i b u t i o n of c e r t a i n p e r s o n a l i t y and environmental v a r i a b l e s to s o c i a l network v a r i a t i o n . SAMPLE A subsaraple of 69 young women were drawn from a larger-sample c o l l e c t e d f o r another study (Sheppy, 1984). Of these, 34 69 had r e c e i v e d a p s y c h i a t r i c d i a g n o s i s of a n o r e x i a nervosa, and 35 served as matched c o n t r o l s u b j e c t s . The two groups of s u b j e c t s were matched f o r age, sex and socioeconomic s t a t u s as determined by B l i s h e n ' s Socioeconomic Index (1976). The anorexic s u b j e c t s were c o n s e c u t i v e r e f e r r a l s from other medical p r a c t i t i o n e r s to a p s y c h i a t r i s t . T h i s v o l u n t e e r sample i n c l u d e d both a b s t a i n i n g and p r e v i o u s l y a b s t a i n i n g b u t now b u l i m i c a n o r e x i c s (N = l l ) , r a n g i n g i n age from 15 to 23 years (1=18.3, SD=2.29), who s a t i s f i e d the DSM I I I c r i t e r i a f o r anore x i a nervosa. Although there were f i v e a n o r e x i c women whose weight l o s s ranged from 15% to 23% standard body weight, t h e i r d i a g n o s i s was made by a p s y c h i a t r i s t on the b a s i s of the other c r i t e r i a s p e c i f i e d i n the DSM I I I . The mean age of on s e t of anorexia nervosa was 16.2 years (SD=1.91) and the mean d u r a t i o n of the i l l n e s s was 23.5 months (SD=16.05). Two of the anorexic s u b j e c t s had never menstruated, whereas a l l others had s u f f e r e d from a m e n o r r h e a f o r a p e r i o d o f 3 t o 60 months (X=13.4, SD=12.45). The c o n t r o l s u b j e c t s were o b t a i n e d from f a m i l y p r a c t i c e u n i t s and other community agencies, and were r e c e i v i n g m e d i c a l c a r e f o r n o n p s y c h i a t r i c c o n d i t i o n s . I t was hoped t h a t by o b t a i n i n g a sample of s u b j e c t s who were a l l r e c e i v i n g m e d i c a l a t t e n t i o n , i l l n e s s f a c t o r s such as s t r e s s r e a c t i o n s to i l l n e s s would be c o n t r o l l e d f o r . The weight of the c o n t r o l s u b j e c t s ranged from 43 kilograms to 68 ki l o g r a m s . 70 DATA COLLECTION PROCEDURE The d a t a were g a t h e r e d over an 18 month p e r i o d . A l l s u b j e c t s were contacted by a r e s e a r c h e r , and r e c e i v e d a b a t t e r y of q u e s t i o n n a i r e s which i n c l u d e d the instruments of r e l e v a n c e to t h i s study, the C a l i f o r n i a P s y c h o l o g i c a l I n v e n t o r y , the F a m i l y E n v i r o n m e n t S c a l e , and the P a t t i s o n P s y c h o s o c i a l I n v e n t o r y . During a b r i e f i n t e r v i e w , demographic i n f o r m a t i o n was o b t a i n e d , r e s e a r c h procedures were exp l a i n e d and q u e s t i o n n a i r e i n s t r u c t i o n s were g i v e n . The q u e s t i o n n a i r e s were l e f t t o be completed a t l e i s u r e . INSTRUMENTATION The P a t t i s o n P s y c h o s o c i a l Inventory (PPI). The PPI i s a s e l f - r e p o r t q u e s t i o n n a i r e t h a t was d e v e l o p e d i n o r d e r t o e m p i r i c a l l y d e t e r m i n e the psychodynamic s o c i a l support system t h a t t h e o r e t i c a l l y comprises the p r i m a r y s o c i a l m a t r i x of the i n d i v i d u a l . Hurd et a l (1981c) has d e f i n e d t h i s s o c i a l support system as, a s u b s e t of r e l a t i o n s from the g l o b a l s o c i a l network l i m i t e d by the symmetric or asymmetric p r o v i s i o n of s u p p o r t , a f f e c t i v e a n d / o r i n s t r u m e n t a l , which i s focussed around a p a r t i c u l a r i n d i v i d u a l (p. 2). T h i s i n s t r u m e n t a s s e s s e s the number of people, r e l a t i o n s h i p s , and i n t e r a c t i o n s with f a m i l y , s o c i a l , and community members of the s u b j e c t ' s p s y c h o s o c i a l network. Both normal and p s y c h i a t r i c p o p u l a t i o n s have been s t u d i e d (eg_. , Hurd et a l . , 1980; P a t t i s o n , 1977a). Indeed* Hurd et a l (1981c) r e p o r t that over f i v e hundred i n d i v i d u a l s from w i t h i n eleven d i f f e r e n t p o p u l a t i o n s d e f i n e d by 71 t h e i r p s y c h i a t r i c s t a t u s have been s t u d i e d . The PPI measures the f o l l o w i n g s o c i a l network v a r i a b l e s : 1. S i z e r e f e r s t o t h e number of s o c i a l network members, and i s d e t e r m i n e d by the number of people l i s t e d . 2. Content r e f e r s to r e l a t i o n s h i p c a t e g o r i e s , and i s determined by the type of r e l a t i o n s h i p l i s t e d . S e v e r a l o r i e n t i n g c a t e g o r i e s are suggested by the PPI: f a m i l y , r e l a t i v e s , f r i e n d s , co-workers, and o t h e r s ) . 3. D u r a b i l i t y r e f e r s to the number of years network members have been known. 4. F r e q u e n c y of c o n t a c t r e f e r s to the amount of i n t e r a c t i o n t h e r e i s w i t h s o c i a l network members, whether f a c e - t o - f a c e , by phone, or by l e t t e r . 5. Kind and Strength of F e e l i n g s and Thoughts r e f e r s to the degree and d i r e c t i o n ( w h e t h e r p o s i t i v e o r n e g a t i v e ) o f e m o t i o n a l i n t e n s i t y , and i s r a t e d a c c o r d i n g to a 5 - p o i n t s c a l e as f o l l o w s : 5=mostly v e r y s t r o n g , p o s i t i v e f e e l i n g s and thoughts; 4=mostly moderate, p o s i t i v e f e e l i n g s and t h o u g h t s ; 3=about e q u a l l y mixed p o s i t i v e and negative; 2=mostly moderate, negative f e e l i n g s and thoughts; l=mostly very s t r o n g , negative f e e l i n g s and thoughts. 6. I n s t r u m e n t a l Help r e f e r s to the f r e q u e n c y of c o n c r e t e , p r a c t i c a l a s s i s t a n c e , and i s ra t e d on a 5-po i n t s c a l e as f o l l o w s : 5=very f r e q u e n t l y ; 4 — o f t e n ; 3=on some o c c a s i o n s ; 2=rarely; l°not at a l l . 7. E m o t i o n a l Support i s understood as s e l f - e v i d e n t , and i s r a t e d on a 5 - p o i n t s c a l e as f o l l o w s : 5=very f r e q u e n t l y ; 4 =pften; 3=on some o c c a s i o n s ; 2 — r a r e l y ; l=not at a l l . 8. S y m m e t r i c a l R e c i p r o c i t y r e f e r s to the extent to which s o c i a l network members are p e r c e i v e d to r e t u r n e m o t i o n a l i n t e n s i t y , i n s t r u m e n t a l help, and emotional support. The P P I i s b a s e d on t h e work of Adams ( 1 9 6 7 ) , and i n c o r p o r a t e s v a r i a b l e s t h a t a re i n d i c a t i v e o f s i g n i f i c a n t i n t e r p e r s o n a l r e l a t i o n s h i p s . These v a r i a b l e s are summarized as f o l l o w s by P a t t i s o n (1977a): 72 1. The r e l a t i o n s h i p has a r e l a t i v e l y h i g h degree of i n t e r a c t i o n , whether f a c e - t o - f a c e , by telephone, or by l e t t e r . In other words, a person i n v e s t s i n those with whom he has c o n t a c t . 2. The r e l a t i o n s h i p has a strong emotional i n t e n s i t y . The degree of investment i n others i s r e f l e c t e d i n the i n t e n s i t y of f e e l i n g toward the other. 3. The emotion i s g e n e r a l l y p o s i t i v e . N e g a t i v e r e l a t i o n s h i p s are maintained only when other v a r i a b l e s f o r c e the maintenance of the r e l a t i o n s h i p , such as a boss or spouse. 4. The r e l a t i o n s h i p has an i n s t r u m e n t a l base. That i s , not o n l y i s the o t h e r p e r s o n h e l d i n p o s i t i v e emotional regard, but he can be counted on to provide concrete a s s i s t a n c e . 5. The r e l a t i o n s h i p i s symmetrically r e c i p r o c a l . That i s , the o t h e r p e r s o n r e t u r n s t h e s t r o n g p o s i t i v e f e e l i n g , and may c o u n t on you f o r i n s t r u m e n t a l a s s i s t a n c e . There i s an a f f e c t i v e and i n s t r u m e n t a l quid pro quo (p. 1249). The PPI i s d i v i d e d i n t o two p a r t s . The f i r s t p a r t asks s u b j e c t s to l i s t " a l l persons who are important i n your l i f e at t h i s moment, whether you l i k e them or not." I t i s l e f t to the d i s c r e t i o n of the s u b j e c t as to what " i m p o r t a n t " means. The assumption here i s that t h i s i n s t r u c t i o n serves as a cue which w i l l e l i c i t t h o s e p e o p l e w i t h whom the s u b j e c t e n g a g e s i n s u p p o r t i v e i n t e r a c t i o n s and w i l l most l i k e l y c a l l upon during times of d i s t r e s s (Hurd et a l , 1981c). A l s o , Hurd et a l (1981c) argue that by not p l a c i n g a p r i o r i r e s t r i c t i o n s on the number of network members to be l i s t e d the PPI captures p o t e n t i a l support p r o v i d e r s even i f they are i n a c t i v e . Furthermore, persons both l i k e d and d i s l i k e d a re i n c l u d e d i n o r d e r t o a v o i d b i a s e d r e p o r t i n g (Hurd et a l . , 1981c). For a l l network members, the s u b j e c t s r e p o r t the age, sex, and le n g t h of time known. Subjects 73 are then asked to r a t e t h e i r network members ac c o r d i n g to f o u r v a r i a b l e s , u s i n g f i v e - p o i n t L i k e r t s c a l e s . T h r e e of t h e s e v a r i a b l e s are i n t e r a c t i o n a l i n n a t u r e ( K i n d and S t r e n g t h of F e e l i n g s and Thoughts, Instrumental Help, and Emotional Support), and have corresponding q u e s t i o n n a i r e items which measure both the s u b j e c t ' s p e r c e p t i o n s of network members and how the s u b j e c t f e e l s t h a t network members p e r c e i v e him or her i n r e t u r n . The f o u r t h v a r i a b l e i s Frequency of Contact. There i s , u n f o r t u n a t e l y , l i t t l e i n f o r m a t i o n p u b l i s h e d concerning the psychometric p r o p e r t i e s of the PPI, a d e f i c i e n c y a l s o noted by Wood (1984) i n her e x c e l l e n t r e v i e w of s o c i a l support and s o c i a l network instruments. However, the t e s t - r e t e s t r e l i a b i l i t y of the PPI has been i n v e s t i g a t e d by Hurd and h i s co l l e a g u e s (1981c). Three t e s t s of r e l i a b i l i t y were undertaken by these r e s e a r c h e r s using a sample of seven p s y c h i a t r i c p a t i e n t s and e i g h t c o n t r o l s matched f o r sex. T e s t 1 used a s i m p l e matching c o e f f i c i e n t to examine the c o n s i s t e n c y w i t h which the PPI r e c o v e r s the same s o c i a l network members on subsequent i n t e r v i e w s . P o s i t i v e c o r r e l a t i o n s were found f o r the p s y c h i a t r i c group a f t e r an average of 51 days (r=.70), and f o r the c o n t r o l group a f t e r an average of 12 days (r=.77), and 32 days (r=.68). Test 2 used a Pearson product-moment c o r r e l a t i o n c o e f f i c i e n t to examine the s t a b i l i t y of the s i z e of the s o c i a l network. Again, strong c o r r e l a t i o n s were found f o r the p s y c h i a t r i c group a f t e r an average of 51 days (r=.968), and f o r the c o n t r o l group, a f t e r an average of 12 days (r=.987) and 32 days (r=.985). Test 3 used a 74 s i m p l e p e r c e n t a g e to e x a m i n e t h e c o n s i s t e n c y o f r e p e a t e d s u b p o p u l a t i o n assignments. For the p s y c h i a t r i c group, s u b j e c t s repeated t h e i r assignment of s o c i a l network members to the same r e l a t i o n s h i p c a t e g o r i e s c o n s i s t e n t l y 86% of the time a f t e r an average of 51 days; and f o r the c o n t r o l group, s u b j e c t s repeated t h e i r s u b p o p u l a t i o n a s s i g n m e n t s c o n s i s t e n t l y 91% of the time a f t e r an average of 12 days, and 89% of the time a f t e r an average o f 32 d a y s . Hurd and h i s c o l l e a g u e s c o n c l u d e t h a t t h e l o n g i t u d i n a l s t a b i l i t y of both the s i z e c o r r e l a t i o n s and the s u b p o p u l a t i o n a s s i g n m e n t s are i m p r e s s i v e . Furthermore, they suggest that the c o r r e l a t i o n s r e g a r d i n g the recovery of the same s o c i a l network members on subsequent i n t e r v i e w s are g e n e r a l l y high and d e c l i n e over time as p r e d i c t e d . I t i s the o p i n i o n of the p r e s e n t a u t h o r , however, t h a t the r e l i a b i l i t y of the PPI should only be regarded as t e n t a t i v e and promising, s i n c e sample s i z e s were small ( f o r p s y c h i a t r i c group, N=7; f o r c o n t r o l s , N=ll) and no t e s t s of s t a t i s t i c a l s i g n i f i c a n c e were r e p o r t e d . S t u d i e s of the v a l i d i t y of the PPI are s t i l l forthcoming. The C a l i f o r n i a Psychological Inventory (CPI). The CPI was d e v e l o p e d by H a r r i s o n Gough (1975) to a s s e s s p o s i t i v e and e n d u r i n g i n t e r p e r s o n a l p e r s o n a l i t y c h a r a c t e r i s t i c s w i t h i n a normal p o p u l a t i o n . The present CPI i s a s e l f - a d m i n i s t e r e d , paper and p e n c i l t e s t f o r use with i n d i v i d u a l s between the ages of 12 and 70 who have a re a d i n g a b i l i t y at the f o u r t h - g r a d e l e v e l or h i g h e r . In view of the y o u t h f u l n e s s of the sample of the present study, i t i s noteworthy that the CPI was mainly c o n s t r u c t e d f o r 75 use with young a d u l t s . T e s t i n g time, i n c l u d i n g the r e a d i n g of i n s t r u c t i o n s , o r d i n a r i l y ranges from 45 minutes to an hour. The CPI c o n s i s t s of 468 t r u e - f a l s e s t a t e m e n t s t h a t are c o n v e r t e d i n t o standard scores ( T -scores) and p l o t t e d on 18 s c a l e s . These s c a l e s were s t a n d a r d i z e d on an o r i g i n a l normative sample of 6000 males and 7000 females. The sample, though somewhat biased i n the d i r e c t i o n of white s u b j e c t s , has a f a i r l y wide range i n age, s o c i o e c o n o m i c s t a t u s , and g e o g r a p h i c a r e a (Megargee, 1972). The purpose of each of the 18 s c a l e s i s "to p r e d i c t what an  i n d i v i d u a l w i l l do i n a s p e c i f i e d context, and/or to i d e n t i f y i n d i v i d u a l s who w i l l be d e s c r i b e d i n a c e r t a i n way" (Gough, 1968, p. 54). The s c a l e s are "addressed to p e r s o n a l i t y c h a r a c t e r i s t i c s i m p o r t a n t f o r s o c i a l l i v i n g and s o c i a l i n t e r a c t i o n " and the c o n c e p t s s e l e c t e d " a r e h y p o t h e s i z e d t o be r e l e v a n t t o t h e p r e d i c t i o n and understanding of i n t e r p e r s o n a l behaviour i n any s e t t i n g , c u l t u r e , or c i r c u m s t a n c e " (Gough, 1975, p. 5 ) . Of p a r t i c u l a r i n t e r e s t to the present study i s the f i r s t f i v e s c a l e s which comprise one of f i v e f a c t o r s s t a t i s t i c a l l y d e r i v e d from Megargee's (1972) f a c t o r a n a l y s i s of the CPI. T h i s c l u s t e r of s c a l e s i n d i c a t e s a p e r s o n ' s l e v e l o f s o c i a l p o i s e and i n t e r p e r s o n a l e f f e c t i v e n e s s . The i n d i v i d u a l s c a l e s a r e as f o l l o w s . 1. Dominance measures a r e a s of l e a d e r s h i p a b i l i t y , such as v e r b a l f l u e n c y , p e r s u a s i v e n e s s , and the extent to which a p e r s o n i s l i k e l y t o t a k e c h a r g e o f a s i t u a t i o n . 76 2. C a p a c i t y f o r S t a t u s m e a s u r e s s p e c i f i c t r a i t v a r i a b l e s t h a t a r e t h o u g h t to e v e n t u a l l y l e a d to a p o s i t i o n o f s t a t u s s u c h as p e r s e v e r a n c e , s e l f -d i r e c t i o n , ambition, and s e l f - c o n f i d e n c e . T h i s i t e m a l s o r e f l e c t s an absence of f e a r s or a n x i e t i e s , a high degree of s o c i a l c o n science, i n t e r e s t i n belonging to v a r i o u s g r o u p s , and an i n t e r e s t i n l i t e r a r y and a e s t h e t i c a c t i v i t i e s . 3. S o c i a b i l i t y was intended to measure the extent to which a person p a r t i c i p a t e s i n s o c i a l a c t i v i t i e s , but more r e c e n t l y has been g e n e r a l i z e d to d i f f e r e n t i a t e between a p e r s o n who i s o u t g o i n g , e x t r o v e r t e d , and s o c i a b l e f r o m someone who i s more i n t r o v e r t e d , withdrawn, and prone to a v o i d i n g s o c i a l v i s i b i l i t y . 4. S o c i a l P r e s e n c e measures the e x t e n t to which a person i s s e l f - c o n f i d e n t and a s s e r t i v e . 5. S e l f - a c c e p t a n c e i s intended to i d e n t i f y i n d i v i d u a l s who d i s p l a y a comfortable and secure s e l f - w o r t h , and a c a p a c i t y f o r independent t h i n k i n g and a c t i o n . In g e n e r a l , the r e l i a b i l i t y and v a l i d i t y of the CPI i s s a t i s f a c t o r y , c o m p a r i n g f a v o r a b l y w i t h o t h e r p e r s o n a l i t y i n v e n t o r i e s . Hase & Goldberg (1967) found short-term t e s t - r e t e s t r e l i a b i l i t y c o e f f i c i e n t s ranging between .71 and .90, w i t h an a v e r a g e of .83. A l t h o u g h l o n g - t e r m ( r e t e s t a f t e r one year) r e l i a b i l i t y c o e f f i c i e n t s were somewhat lower, ranging from .60 to .70, t h e y s t i l l s u g g e s t e d a l e v e l of moderate s t a b i l i t y . M e a s u r e s o f i n t e r n a l c o n s i s t e n c y i n d i c a t e c o n s i d e r a b l e v a r i a b i l i t y among the t e s t items, but Megargee (1972) r e p o r t s t h a t t h e a v e r a g e c o r r e l a t i o n f o r a l l 18 s c a l e s i s .63; c o n s e q u e n t l y , the s c a l e c o n s t r u c t i o n s are adequate o v e r a l l . C o r r e l a t i o n s between s c a l e s are r e l a t i v e l y h i g h , however, and t h e r e f o r e s u g g e s t a c e r t a i n degree of redundancy among the 18 s c a l e s . 77 Work on the p r e d i c t i v e and concurrent v a l i d i t y of the CPI has been emphasized at the expense of d i s c r i m i n a n t v a l i d i t y (Gough, 1975). T h i s i s i n keeping with Gough's primary aim of d e v e l o p i n g an i n s t r u m e n t t h a t p r e d i c t s s o c i a l l y r e l e v a n t i n t e r p e r s o n a l behaviours and o r i e n t a t i o n s . The Family Environment Scale (FES). The FES was developed by Rudolf Moos to assess the s o c i a l c l i m a t e of the f a m i l y (Moos, 1974; Moos & Moos, 1981). The FES i s a 90-item, s e l f - r e p o r t instrument that focuses on the i n t e r p e r s o n a l r e l a t i o n s h i p s among f a m i l y members ( r e l a t i o n s h i p d i m e n s i o n s ) , the d i r e c t i o n s of perso n a l growth emphasized i n the f a m i l y (growth dimensions), and t h e f a m i l y ' s o r g a n i z a t i o n a l a nd s y s t e m - m a i n t e n a n c e c h a r a c t e r i s t i c s ( m a i n t e n a n c e d i m e n s i o n s ) . The FES has t e n subscales that have been s t a n d a r d i z e d on a l a r g e sample of normal and d i s t r e s s e d f a m i l i e s (Moos & Moos, 1981). Two of t h e s e subscales are of p a r t i c u l a r i n t e r e s t to the present study. 1 . C o h e s i o n measures the e x t e n t to which f a m i l y members are concerned and committed to the f a m i l y , and the degree to which f a m i l y members are h e l p f u l and sup p o r t i v e of each other. 2. Independence measures the degree to which f a m i l y members a r e e n c o u r a g e d t o be a s s e r t i v e , s e l f -s u f f i c i e n t , to make t h e i r own d e c i s i o n s , and to th i n k t h i n g s out f o r themselves. The s u b s c a l e s of the FES have moderate to high i n t e r n a l c o n s i s t e n c i e s (ranging from .61 to .78) and s a t i s f a c t o r y t e s t -r e t e s t r e l i a b i l i t y (ranging from .68 to .86). Over 50 s t u d i e s have a t t e s t e d to the c o n s t r u c t v a l i d i t y of t h e FES (Moos, Cl a y t o n , & Max, 1979; Moos & Moos, 1981). 78 METHOD OF ANALYSIS In a n a l y z i n g the PPI d a t a , p r o p o r t i o n s and means were c a l c u l a t e d a c c o r d i n g to the d i c t a t e s of s p e c i f i c h y p o t h e s e s . Sometimes an a n a l y s i s focused on a p a r t i c u l a r c l u s t e r of network members, such as f a m i l y , f r i e n d s , or high frequency of s u p p o r t r e l a t i o n s , and at other times on p a r t i c u l a r network members, such as mother, b o y f r i e n d , or boss. Furthermore, f o r some analyses a score f o r each s u b j e c t was computed as the average r a t i n g across a l l network persons or a c l u s t e r of network persons on a s i n g l e network v a r i a b l e . For example, i n making frequency of c o n t a c t comparisons (Hypothesis 1.5; Table 5) a score f o r each s u b j e c t was o b t a i n e d by c a l c u l a t i n g the mean r a t i n g a c r o s s a l l network members, nuclear f a m i l y members only, and non-family members only on the frequency of c o n t a c t s c a l e . Once these measures were computed, independent t - t e s t s and z - t e s t s were performed i n order to determine whether d i f f e r e n c e s between anorexic and c o n t r o l group means ( t ) and p r o p o r t i o n s (z) were s t a t i s t i c a l l y s i g n i f i c a n t . A z - t e s t f o r i n d e p e n d e n t p r o p o r t i o n s was c a l c u l a t e d as f o l l o w s ( G l a s s & Hopkins, 1984, 288) : z = £11 ~ P12 where p j i = p r o p o r t i o n of anorexic s u b j e c t s P12 - p r o p o r t i o n of c o n t r o l s u b j e c t s n.j = number of anorexic-) s u b j e c t s n #2 = number of c o n t r o l s u b j e c t s t r l . = £..l£P.ll) + ".2JJP.12J n . l + n.2 79 The B o n f e r r o n i i n e q u a l i t y was used to e s t a b l i s h s i g n i f i c a n c e l e v e l s t hat l e d to an o v e r a l l Type I e r r o r r a t e of .05. Three H o t e l l i n g ' s T2 analyses were conducted on four s e t s of dependent v a r i a b l e s . The f i r s t set concerned the s o c i a l network s i z e of t h r e e r e l a t i o n s h i p c a t e g o r i e s ; the second i n v o l v e d the frequency of c o n t a c t r a t i n g s i n three r e l a t i o n s h i p c a t e g o r i e s ; the t h i r d c o n c e r n e d seven i n t e r a c t i o n a l and f u n c t i o n a l r a t i n g v a r i a b l e s with r e s p e c t to mothers, and the f o u r t h i n v o l v e d the same seven r a t i n g v a r i a b l e s with r e s p e c t to f a t h e r s . S i g n i f i c a n t T2 r e s u l t s were f o l l o w e d up by u n i v a r i a t e t - t e s t s . A g a i n , the B o n f e r r o n i i n e q u a l i t y was used to c o n t r o l Type I e r r o r . In o r d e r to a s s e s s the c o n t r i b u t i o n of p e r s o n a l i t y and environmental c h a r a c t e r i s t i c s of a n o r e x i c women to v a r i a t i o n s i n t h e i r s o c i a l networks, a s e r i e s of c o r r e l a t i o n s were performed using the Pearson product-moment c o r r e l a t i o n c o e f f i c i e n t . 80 CHAPTER 4 RESULTS The r e s u l t s of the a n a l y s e s are d i s c u s s e d as f o l l o w s : f i r s t , a r e v i e w of demographic d a t a a n a l y s e s , and then the r e s u l t s of the primary data analyses by h y p o t h e s i s . DEMOGRAPHIC DATA ANALYSIS The demographic data have been d i s c u s s e d by Sheppy (1984) elsewhere, and t h e r e f o r e only a b r i e f review of her f i n d i n g s w i l l be undertaken here. H o t e l l i n g ' s T2 a n a l y s i s of socioeconomic s t a t u s , number of s t r e s s o r s and i l l n e s s e s , number of f a m i l y members who d i e t e d and the d u r a t i o n of r e s i d e n c e r e v e a l e d no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s between the a n o r e x i c and c o n t r o l g r o u p s . The n o n s i g n i f i c a n t f i n d i n g r e g a r d i n g socioeconomic s t a t u s i n d i c a t e d t h a t the m atching p r o c e d u r e s f o r the a n o r e x i c and c o n t r o l f a m i l i e s on t h i s v a r i a b l e were s a t i s f a c t o r y . 70% of the a norexic f a m i l i e s a t t a i n e d a socioeconomic l e v e l represented by business, m a n a g e r i a l , and p r o f e s s i o n a l p e r s o n n e l according to B l i s h e n ' s Socioeconomic Index ( B l i s h e n , 1967; B l i s h e n & McRoberts, 1976). A H o t e l l i n g ' s T2 a n a l y s i s of age, height and education a l s o r e v e a l e d no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s between the a n o r e x i c and c o n t r o l groups ( F ( 3 , 6 0 ) = 0.25 , p>.05), a n o t h e r i n d i c a t i o n t hat the matching procedures were adequate. Likewise, t h e a n o r e x i c and c o n t r o l g r o u p s were found to be s i m i l a r 81 r e g a r d i n g f a m i l y s i z e , the number of b r o t h e r s and s i s t e r s i n each f a m i l y , and the d u r a t i o n of f a m i l y r e s i d e n c e . Two analyses were c o n d u c t e d to d e t e r m i n e i f the c o n t r o l g r o u p was r e p r e s e n t a t i v e o f t h e g e n e r a l p o p u l a t i o n . A H o t e l l i n g ' s T 2 a n a l y s i s of CPI s c o r e s f o u n d an o v e r a l l s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e between c o n t r o l group and p o p u l a t i o n means (F(18,16)=4.39, p<.005), a l t h o u g h a l l mean s c o r e s f e l l w i t h i n one s t a n d a r d d e v i a t i o n of t h e mean. L i k e w i s e , a H o t e l l i n g ' s T 2 a n a l y s i s of FES s c o r e s found an o v e r a l l s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e between c o n t r o l group and p o p u l a t i o n s c o r e s ( F ( 1 0 , 2 4 ) = 3.80 , p<.01); i n f a c t , u n i v a r i a t e t - t e s t s of the FES v a r i a b l e s r e l a t e d to t h i s s t u d y ( C o h e s i o n and Independence) r e v e a l e d t h a t c o n t r o l group means were s i g n i f i c a n t l y higher (p<.05) than p o p u l a t i o n means. The s i g n i f i c a n t d i f f e r e n c e s found by these analyses i n d i c a t e that the c o n t r o l s u b j e c t s of t h i s study are not r e p r e s e n t a t i v e of the g e n e r a l p o p u l a t i o n . Sheppy ( 1 9 8 4 ) s u g g e s t s t h a t t h e s e d i f f e r e n c e s may be accounted f o r i n p a r t by tbe r e f e r r a l sources of the c o n t r o l s u b j e c t s . S i n c e the c o n t r o l s u b j e c t s were r e c e i v i n g m e d i c a l s e r v i c e s from f a m i l y p r a c t i c e u n i t s or other community a g e n c i e s f o r n o n p s y c h i a t r i c c o n d i t i o n s , t h e i r d i f f e r e n c e s w i t h CPI and FES p o p u l a t i o n s a m p l e s may be a t t r i b u t a b l e to i n d i v i d u a l and f a m i l y c l i m a t e changes i n the face o f s t r e s s f u l c i r c u m s t a n c e s due t o i l l n e s s or o t h e r l i f e s t r e s s o r s . F i n a l l y , a H o t e l l i n g ' s T 2 a n a l y s i s of CPI scores y i e l d e d no 82 s i g n i f i c a n t d i f f e r e n c e s between an o r e x i c a b s t a i n e r and a n o r e x i c b u l i m i c s u b j e c t s (F=0.79, p>.05). On the b a s i s of t h i s a n a l y s i s , these two groups were considered homogeneous and t h e i r s c o r e s combined f o r subsequent a n a l y s e s . RESULTS OF PRIMARY DATA ANALYSES BY HYPOTHESIS Hypothesis 1. There i s a s t a t i s t i c a l l y s i g n i f i c a n t difference between the s o c i a l networks of anorexic and control subjects. T h i s g e n e r a l hypothesis was i n v e s t i g a t e d by means of nine sub-h y p o t h e s e s t h a t a d d r e s s e d more s p e c i f i c s o c i a l n e t w o r k d i f f e r e n c e s between anorexic and c o n t r o l s u b j e c t s . H y potheses r e l a t e d to the s t r u c t u r a l aspects of per c e i v e d s i z e and composition of s o c i a l networks. Hypothesis 1.1. The s i z e of the s o c i a l networks of anorexic subjects are s i g n i f i c a n t l y smaller than those of the control subjects. Hypothesis 1.2. There are s i g n i f i c a n t l y fewer friends i n the s o c i a l networks of anorexic subjects than i n the s o c i a l networks of control subjects. H y p o t h e s i s 1.3. There are s i g n i f i c a n t l y fewer h e t e r o s e x u a l f r i e n d s or b o y f r i e n d s i n the s o c i a l networks of a n o r e x i c s u b j e c t s than i n the s o c i a l networks of control subjects. In o r d e r t o t e s t t h e s e h y p o t h e s e s , a d a t a m a t r i x was co n s t r u c t e d that c o n s i s t e d of the s o c i a l network s i z e scores f o r each a n o r e x i c and c o n t r o l s u b j e c t a c c o r d i n g to the f o l l o w i n g r e l a t i o n s h i p c a t e g o r i e s : t o t a l s i z e , t o t a l f r i e n d s , and opposite sex f r i e n d s . Based upon t h i s data matrix, means and standard d e v i a t i o n s were c a l c u l a t e d , u n i v a r i a t e t - t e s t s were p e r f o r m e d , 83 and a H o t e l l i n g ' s T 2 a n a l y s i s was conducted. The r e s u l t s of these computations are summarized i n Table 2 as f o l l o w s . TABLE 2 COMPARISONS OF THE SOCIAL NETWORK SIZE OF ANOREXIC (N=*34) AND CONTROL (N=35) SUBJECTS NETWORK CATEGORY ANOREXICS (N=34) Xa SD CONTROLS _(N=35) Xc SD t 2 - t a i l P Total Size 11.65 4.54 16.03 7.54 2.91 0.005* Total Friends 5.15 3.85 7.57 4.70 2.34 0.022 Opposite-sex Friends 1.85 1.67 2.54 2.17 1.47 0.145 * Result achieved the req u i r e d l e v e l of s i g n i f i c a n c e for an ov e r a l l Type 1 error rate of .05 for the entire table. For Hotelling's T2 analysis, F(3,65) = 3.0313, p<.05. The H o t e l l i n g ' s T2 a n a l y s i s found an o v e r a l l s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e between anorexic and c o n t r o l s u b j e c t s with r e g a r d t o s o c i a l n e t w o r k s i z e ( F ( 3 , 6 5 ) = 3.0313, p<.05). Subsequent u n i v a r i a t e t - t e s t s r e v e a l e d that only the t o t a l s i z e of t h e s o c i a l n e t w o r k s o f a n o r e x i c s u b j e c t s was found to s i g n i f i c a n t l y d i f f e r (p<.05) from the s o c i a l networks of c o n t r o l s u b j e c t s , and t h e r e f o r e only Hypothesis 1.1. was accepted. 84 Hypotheais 1.4. A s i g n i f i c a n t l y greater proportion of the t o t a l s o c i a l network of anorexic s u b j e c t s , as compared to c o n t r o l subjects, i s composed of nuclear family members. Pr o p o r t i o n s were c a l c u l a t e d f o r each r e l a t i o n s h i p category, and z - t e s t s were performed i n order to e s t a b l i s h the s t a t i s t i c a l s i g n i f i c a n c e of any p r o p o r t i o n a l d i f f e r e n c e s found. The r e s u l t s of these computations are summarized i n Table 3 as f o l l o w s . TABLE 3 COMPARISONS OF IDENTIFICATION OF SPECIFIC NETWORK MEMBERS BY ANOREXIC (N=34) AND CONTROL (N» =35) SUBJECTS NETWORK ANOREXICS CONTROLS z p CATEGORY (N=34) (N=35) Family Members .30 .27 0 .28 0. 390 Father .09 .06 0 .47 0. 319 Mother .09 .06 0 .47 0. 319 S i b l i n g s .12 .15 -0 .36 0. 641 B rothers .06 .07 -0 .17 0. 568 S i s t e r s .06 .07 -0 .17 0. 568 Relatives .19 .19 0 .00 0. 500 Friends .44 .47 -0 .25 0. 599 Opposite-sex .16 .16 0 .00 0. 500 Same-sex .28 .31 -0 .27 0. 606 Boss/Supervisor .01 .03 -0 .59 0. 722 Other .06 .04 0 .38 0. 352 R e s u l t s of t h i s a n a l y s i s r e v e a l that j u s t under o n e - t h i r d of the s o c i a l networks of both a n o r e x i c and c o n t r o l s u b j e c t s i s composed of nuc l e a r f a m i l y members. A z - t e s t of the d i f f e r e n c e s between a n o r e x i c and c o n t r o l n e t w o r k s i n n u c l e a r , f a m i l y c o m p o s i t i o n y i e l d e d a s t a t i s t i c a l l y n o n - s i g n i f i c a n t r e s u l t . Hypothesis 1.4. i s t h e r e f o r e r e j e c t e d . 85 Hypotheses r e l a t e d to the i n t e r a c t i o n a l aspects of s o c i a l  networks. Hypothesis 1.5. There i s s i g n i f i c a n t l y less frequency of contact with a l l network sectors other than nuclear family i n the s o c i a l networks of anorexic subjects than i n the s o c i a l networks of control subjects. In o r d e r to t e s t t h i s h y p o t h e s i s , means and s t a n d a r d d e v i a t i o n s were c a l c u l a t e d of the r a t i n g s of anor e x i c and c o n t r o l s u b j e c t s on the Frequency of Contact v a r i a b l e (5=usually d a i l y ; 4=usually at l e a s t once a week; 3=usually at l e a s t once a month; 2=usually at l e a s t once every s i x months; 1-usually at l e a s t once a y e a r ) . The mean r a t i n g s f o r t h r e e network c a t e g o r i e s were obtained: a l l members, a l l n u c l e a r f a m i l y members, and a l l non-f a m i l y members. D i f f e r e n c e s between an o r e x i c and c o n t r o l mean r a t i n g s were examined f o r s t a t i s t i c a l s i g n i f i c a n c e by u n i v a r i a t e t - t e s t s , and a H o t e l l i n g ' s T 2 a n a l y s i s was conducted. R e s u l t s of these analyses are summarized i n Table 4 as f o l l o w s . — TABLE 4 COMPARISONS OF FREQUENCY OF CONTACT IN THE SOCIAL NETWORKS OF ANOREXIC (N=34) AND CONTROL SUBJECTS (N=35) ANOREXICS CONTROLS NETWORK (N= =34) <N= -35) 2- t a i l CATEGORY Xa SD Xc SD t P A l l Members 3 .88 0 .54 3 .94 0 . 60 0, .50 0. 620 Nuclear Family 4 .45 0 .67 4 .41 0 .71 .27 0. 791 A l l Non-Family 3 .59 0 .69 3 .75 0 .66 1, .02 0. 311 For Hotelling's T z analysis, F(3,65) = 0.6679, p>.05. 86 The H o t e l l i n g ' s T2 a n a l y s i s f a i l e d to o b t a i n s t a t i s t i c a l s i g n i f i c a n c e a t t h e .05 l e v e l , t h e r e b y s u g g e s t i n g t h a t d i f f e r e n c e s i n frequency of c o n t a c t p a t t e r n s do not c o l l e c t i v e l y d i s t i n g u i s h between anorexic and c o n t r o l g r o u p s . Mean s c o r e s i n d i c a t e t h a t a n o r e x i c s u b j e c t s had, on the average, d a i l y or weekly co n t a c t with n u c l e a r f a m i l y s o c i a l network members, and weekly to monthly c o n t a c t with non-family s o c i a l network members. Although these mean scores were i n the d i r e c t i o n of a f a m i l y -dominated frequency of co n t a c t p a t t e r n , they d i d not d i f f e r i n a s t a t i s t i c a l l y s i g n i f i c a n t way with the mean frequency of cont a c t r a t i n g s of c o n t r o l s u b j e c t s a c c o r d i n g to independent t - t e s t s . Hypothesis 1.5. i s t h e r e f o r e r e j e c t e d . Hypothesis 1.6. A s i g n i f i c a n t l y greater proportion of the t o t a l number of high contact frequency r e l a t i o n s i s found among the f a m i l y members of the s o c i a l networks of anorexic as compared to control subjects, whereas a s i g n i f i c a n t l y smaller proportion of the t o t a l number of high contact frequency r e l a t i o n s i s found among r e l a t i v e s , f r i e n d s , managers (boss), and other members of the s o c i a l networks of anorexic as compared to control subjects. T h i s h y p o t h e s i s a d d r e s s e s the same t h e o r e t i c a l i s s u e as Hypothesis 1.5. but d i f f e r s i n i t s s t a t i s t i c a l a n a l y s i s . In o r d e r t o t e s t H y p o t h e s i s 1.6., s o c i a l network members who r e c e i v e d a frequency r a t i n g of 4 ( u s u a l l y contacted at l e a s t once a week) or 5 ( u s u a l l y contacted d a i l y ) were s e l e c t e d by network category from PPI frequency data and d e s c r i b e d as "high c o n t a c t frequency r e l a t i o n s . " An a n a l y s i s of p r o p o r t i o n s was conducted on t h i s subset of f r e q u e n c y d a t a , and z - t e s t s of d i f f e r e n c e s between anorexic and c o n t r o l groups were performed. The r e s u l t s 87 of these analyses are summarized i n Table 5 as f o l l o w s . TABLE 5 COMPARISONS OF HIGH CONTACT FREQUENCY (HCF) RELATIONS1 IN THE SOCIAL NETWORKS OF ANOREXIC (N=34) AND CONTROL (N=35) SUBJECTS NETWORK ANOREXICS CONTROLS z P CATEGORY (N=34) (N=35) Proportion of HCF Relations i n Total Social Network .64 .64 0.00 0.500 Proportion of HCF Relations That Are: Family Members .38 .35 0.26 0.397 Father .11 .08 0.43 0.334 Mother .12 .09 0.41 0.341 S i b l i n g s .15 .17 -0.23 0.591 Brothers .09 .09 0.00 0.500 S i s t e r s .06 . .09 -0.47 0.681 Relatives .11 .09 0.28 0.390 Friends .42 .49 -0.58 0.719 Opposite-sex .15 .15 0.00 0.500 Same-sex .27 .34 -0.63 Boss/Supervisor .02 .04 -0.49 0.688 Other .07 .03 0.76 0.224 1. High contact frequency r e l a t i o n s are those network members who are contacted at least once a week. High c o n t a c t frequency r e l a t i o n s comprise 64% of the t o t a l s o c i a l network membership of both a n o r e x i c and c o n t r o l s u b j e c t s . Of that 64%, 38% of high c o n t a c t frequency r e l a t i o n s are composed of n u c l e a r f a m i l y i n the s o c i a l networks of ano r e x i c s u b j e c t s , a p r o p o r t i o n t h a t does not d i f f e r i n a s t a t i s t i c a l l y s i g n i f i c a n t way with the s o c i a l networks of c o n t r o l s u b j e c t s . T h i s f i n d i n g , 88 i n f a c t , c o n s t i t u t e s a r e v e r s a l of the e x p e c t a t i o n t h a t h i g h c o n t a c t frequency r e l a t i o n s i n the s o c i a l networks of an o r e x i c s are p r i m a r i l y composed of n u c l e a r f a m i l y members w i t h few such r e l a t i o n s to be found o u t s i d e the n u c l e a r f a m i l y boundary. Indeed, i t i s f r i e n d s , not f a m i l y , who c o n s t i t u t e the g r e a t e s t p r o p o r t i o n of h i g h c o n t a c t f r e q u e n c y r e l a t i o n s i n the s o c i a l networks of both a n o r e x i c and c o n t r o l s u b j e c t s . H y p o t h e s i s 1.6. i s t h e r e f o r e r e j e c t e d . Hypothesis 1.7. Anorexic subjects haye a s i g n i f i c a n t l y higher proportion of network r e l a t i o n s with whom they f e e l a m b i v a l e n t or n e g a t i v e about than c o n t r o l subjects. In order to t e s t t h i s h y p o t h e s i s , s o c i a l network members who r e c e i v e d a r a t i n g of 3 or l e s s on the Ki n d and S t r e n g t h of Thoughts and F e e l i n g s Towards Others Scale of the PPI (3=about e q u a l l y mixed p o s i t i v e and negative f e e l i n g s & thoughts; 2=raostly moderate, n e g a t i v e f e e l i n g s & thoughts; l=mostly very s t r o n g , negative f e e l i n g s & thoughts) were s e l e c t e d by network category from the s o c i a l network data. An a n a l y s i s of p r o p o r t i o n s was co n d u c t e d on t h i s s u b s e t of f r e q u e n c y d a t a , and z - t e s t s of d i f f e r e n c e s between anorexic and c o n t r o l groups were performed. The r e s u l t s of these analyses are summarized i n Table 6. S o c i a l network members about whom anorexic s u b j e c t s have ambivalent or negative f e e l i n g s and thoughts comprise 26% of the t o t a l s o c i a l network membership, whereas such members comprise 21% of the t o t a l s o c i a l network of c o n t r o l s u b j e c t s . The d i f f e r e n c e i n t h e s e p r o p o r t i o n s d i d not a c h i e v e s t a t i s t i c a l s i g n i f i c a n c e (p>.05), and t h e r e f o r e Hypothesis 1.7. i s r e j e c t e d . 89 TABLE 6 COMPARISONS OF AMBIVALENT OR NEGATIVE (A/N) RELATIONS1 IN THE SOCIAL NETWORKS OF ANOREXIC (N=34) AND CONTROL (N=35) SUBJECTS NETWORK ANOREXICS CONTROLS z P CATEGORY (N=34) (N=35) Proportion of A/N Relations i n S o c i a l Network .26 .21 0.23 0.409 Proportion of A/N Relations That Are: Family Members .34 .24 0.92 0.179 Father .10 .07 0.45 0.326 Mother .12 .06 0.87 0.192 S i b l i n g s .13 .12 0.13 0.448 Brothers .06 .03 0.60 0.274 S i s t e r s .07 .08 -0.16 0.564 Relatives .13 .15 -0.24 0.595 Friends .42 .50 -0.67 0.749 Opposite-sex .15 .18 -0.34 0.633 Same-sex .26 .33 -0.64 0.739 Boss/Supervisor .04 .08 -0.36 0.641 Other .07 .03 0.76 0.224 1. Ambivalent or negative r e l a t i o n s are those network members who received a score of 3 or less on the Kind and Strength of Thoughts and Feelings Towards Others Scale of the Pattison Psychosocial Inventory. Hypothesis 1.8. Anorexic subjects haye a s i g n i f i c a n t l y higher degree of ambivalence or negative feelings and thoughts toward t h e i r parents than control subjects. T h i s hypothesis was t e s t e d by comparing the average r a t i n g of p a r e n t s by a n o r e x i c and c o n t r o l s u b j e c t s on the emotional i n t e n s i t y s c a l e of the PPI. Mean r a t i n g s and t h e i r s t a n d a r d d e v i a t i o n s were c a l c u l a t e d , u n i v a r i a t e t - t e s t s were performed, 90 and a H o t e l l i n g ' s T 2 a n a l y s i s was conducted (see Table 7). TABLE 7 COMPARISONS OF THE INTERACTIONAL AND FUNCTIONAL RATINGS OF PARENTS IN THE SOCIAL NETWORKS OF ANOREXIC (N=32) AND CONTROL (N=*35) SUBJECTS ANOREXICS CONTROLS =32) =35) 2 - t a i l 1. MOTHER Xa SD Xc SD t P Contact 4.66 0.70 4.80 0.47 0.99 0.325 Feelings/ Thoughts 3.91 1.25 4.49 0.98 2.12 0.038 Reciprocity 4.08 0.97 4.60 0.74 2.50 0.015 Instrumental Support 4.17 1.10 4.40 0.70 1.03 0.309 Reciprocity 4.45 0.82 4.71 0.52 1.58 0.120 Emotional Support 3.75 1.27 4.23 0.81 1.86 0.068 Reciprocity 4.03 1.28 4.57 0.61 2.23 0.029 * Result achieved the re q u i r e d l e v e l of s i g n i f i c a n c e for an ov e r a l l Type 1 error rate of .05 for the entire table. For Hotelling's T2 analysis, F(7,59) = 1.2305, p>.05. ANOREXICS CONTROLS (N= =31) (N=32) 2 - t a i l 2. FATHER Xa SD Xc SD t P Contact 4.58 0.77 4.53 0.89 -0.24 0.814 Feelings/ Thoughts 3.84 1.26 4.38 0.90 1.95 0.056 Reciprocity 4.19 1.01 4.39 0.77 0.88 0.385 Instrumental Support 3.63 1.11 4.02 0.90 1.52 0.134 Reciprocity 4.24 1.06 4.06 1.11 -0.66 0.513 Emotional Support 3.32 1.31 3.50 0.93 0.62 0.535 Reciprocity 3.60 1.36 3.89 1.12 0.94 0.351 * Result achieved the r e q u i r e d l e v e l of s i g n i f i c a n c e for an ov e r a l l Type 1 error rate of .05 for the entire table. For Hotelling's T 2 analysis, F(7,55) « 1.7114, p>.05. 91 H o t e l l i n g ' s T2 a n a l y s e s of i n t e r a c t i o n a l and f u n c t i o n a l s o c i a l network d a t a r e g a r d i n g both p a r e n t s d i d n o t a t t a i n s t a t i s t i c a l s i g n i f i c a n c e a t the .05 l e v e l , thereby i n d i c a t i n g the absence of c o l l e c t i v e d i f f e r e n c e s i n t h i s data s e t . Group mean r a t i n g s o f e m o t i o n a l i n t e n s i t y r e v e a l e d t h a t , on the average, anorexic s u b j e c t s have mostly moderate p o s i t i v e f e e l i n g s and thoughts (a mean r a t i n g of 4) toward both t h e i r mother and f a t h e r , although the range of e m o t i o n a l i n t e n s i t y toward both p a r e n t s extended from a m b i v a l e n c e ( i e . , a mean r a t i n g of 3: about e q u a l l y mixed, p o s i t i v e and negative f e e l i n g s & thoughts) to mostly very s t r o n g , p o s i t i v e f e e l i n g s & thoughts (ie_. , a mean r a t i n g of 5 ) . T h i s f i n d i n g d o e s n o t s u p p o r t t h e n o t i o n , s u g g e s t e d i n the l i t e r a t u r e , t h a t a n o r e x i c s u b j e c t s have "a powerful ambivalence" toward t h e i r mothers, and weak, ambivalent f e e l i n g s toward t h e i r f a t h e r s . Furthermore, independent t - t e s t s of t he d i f f e r e n c e s b e t w een a n o r e x i c and c o n t r o l s u b j e c t s r e g a r d i n g e m o t i o n a l i n t e n s i t y toward t h e i r p a r e n t s d i d not achieve s t a t i s t i c a l s i g n i f i c a n c e . Hypothesis 1.8. i s t h e r e f o r e r e j e c t e d . H y p o t h e s i s r e l a t e d to the f u n c t i o n a l a s p e c t s of s o c i a l  networks. Hypothesis 1.9. There i s a s i g n i f i c a n t l y greater p r o p o r t i o n of e m o t i o n a l and in s t r u m e n t a l support exchanged w i t h i n the n u c l e a r f a m i l y c l u s t e r and s i g n i f i c a n t l y l e s s w i t h i n the other c l u s t e r s of the s o c i a l networks of anorexic subjects i n comparison to control subjects. In order to t e s t t h i s h y p o t h e s i s , the emotional support and 92 i n s t r u m e n t a l help r a t i n g s of each s o c i a l network member were c o l l a p s e d i n t o a s i n g l e mean r a t i n g of frequency of support. These mean r a t i n g s were c a l c u l a t e d f o r both frequency of support g i v e n to and r e c e i v e d from network members. Separate analyses were conducted f o r those s o c i a l network members who were g i v e n support e i t h e r o f t e n (a mean r a t i n g of 4) or very f r e q u e n t l y (a mean r a t i n g of 5) from anorexic and c o n t r o l s u b j e c t s , and f o r t h o s e members who r e c i p r o c a t e d such s u p p o r t ; the former were c h a r a c t e r i z e d as "high frequency of support r e l a t i o n s , " and the l a t t e r as " h i g h f r e q u e n c y of r e c i p r o c a t e d support r e l a t i o n s . " Each a n a l y s i s aggregated the frequency of support data a c c o r d i n g t o n e t w o r k c a t e g o r y . The p r o p o r t i o n s and z - t e s t s of each a n a l y s i s are summarized i n Tables 8 and 9 (see next two pages). R e s u l t s i n d i c a t e t h a t a p p r o x i m a t e l y 50% of the s o c i a l networks of a n o r e x i c s u b j e c t s a r e composed of s o c i a l network members with whom there i s a high frequency of support exchanged ( i e , both given and r e c i p r o c a t e d ) . Of t h i s 50%, nucl e a r f a m i l y members co m p r i s e 33% and f r i e n d s comprise approximately h a l f . These p r o p o r t i o n s do not conform to e x p e c t a t i o n s suggested by the l i t e r a t u r e ; i n d e e d , t h e y c o n s t i t u t e a r e v e r s a l o f s u c h e x p e c t a t i o n s , that i s , the g r e a t e s t p r o p o r t i o n of high frequency of support r e l a t i o n s are to be found o u t s i d e the n u c l e a r f a m i l y boundary. F u r t h e r m o r e , d i f f e r e n c e s i n p r o p o r t i o n s between a n o r e x i c and c o n t r o l groups f o r both high frequency of support g i v e n ( T a b l e 8) and r e c i p r o c a t e d ( T a b l e 9) d i d n o t a t t a i n s t a t i s t i c a l s i g n i f i c a n c e . Hypothesis 1.9. i s t h e r e f o r e r e j e c t e d . 93 TABLE 8 COMPARISONS OF THE HIGH FREQUENCY OF SUPPORT (HPS) RELATIONS1 AMONG THE SOCIAL NETWORKS OF ANOREXIC (N=34) AND CONTROL (N=35) SUBJECTS NETWORK CATEGORY Proportion of HPS Relations i n the Social Network Proportion of HPS Relations That Are: ANOREXICS CONTROLS (N=34) (N=35) .50 .53 -0.25 0.599 Family Members Father Mother S i b l i n g s Brothers S i s t e r s Relatives Friends Opposite-sex Same-sex Boss/Supervisor Other .33 .09 .12 .13 .05 .08 .16 .48 .16 .32 .01 .02 .31 .07 .10 .14 .07 .08 .10 .55 .15 .40 .03 .01 0.18 0.31 0.27 -0.12 -0.35 0.00 0.74 -0.58 0.11 -0.69 -0.59 0.34 0.429 0.378 0.394 0.548 0.637 0.500 0.230 0.719 0.456 0.755 0.722 0.367 1. High frequency of support r e l a t i o n s are those network members who receive instrumental and or emotional support "often" from the subject (that i s , they receive a score of 4 or 5 on the Instrumental or Emotional Support Scales of the Pattison Psychosocial Inventory). 94 TABLE 9 COMPARISONS OF THE HIGH FREQUENCY OF RECIPROCAL SUPPORT (HFRS) RELATIONS1 AMONG THE SOCIAL NETWORKS OF ANOREXIC (N=34) AND CONTROL (N=35) SUBJECTS NETWORK ANOREXICS CONTROLS z P CATEGORY (N=34) (N=35) Proportion of HFRS Relations i n the Social Network .47 .49 -0.17 0.568 Proportion of HFRS Relations That Are: Family Members .34 .34 0.00 0.500 Father .11 .09 0.28 0.390 Mother .14 .12 0.25 0.401 S i b l i n g s .09 .13 -0.53 0.702 Brothers .02 .06 -0.84 0.800 S i s t e r s .06 .07 -0.17 0.568 Relatives .15 .09 0.77 0.221 Friends .46 .52 -0.50 0.692 Opposite-sex .17 .14 0.34 0.367 Same-sex .29 .38 -0.79 0.785 Boss/Supervisor .00 .02 -0.83 0.797 Other .05 .03 0.42 0.337 1. High frequency of re c i p r o c a l support r e l a t i o n s are those network members who are perceived by the subject to give instrumental and or emotional support "often" ( i e , they received a score of 4 or 5 on the Reciprocal Instrumental or Emotional Support Scales of the Pattison Psychosocial Inventory). H y p o t h e s e s r e l a t e d t o s o c i a l n e t w o r k c o r r e l a t e s of  p e r s o n a l i t y and environmental f a c t o r s . 2. The s o c i a l networks of anorexic subjects vary with personality t r a i t s . T h i s hypothesis was examined with g r e a t e r s p e c i f i c i t y by the f o l l o w i n g sub-hypothesis. 2.1. There w i l l be a p o s i t i v e c o r r e l a t i o n between interpersonal effectiveness scores, as measured by the C a l i f o r n i a P s y c h o l o g i c a l Inventory (CPI), and s o c i a l network size and support (emotional, instrumental). 3. The s o c i a l networks of anorexic subjects vary with environmental c h a r a c t e r i s t i c s . T h i s h y p o t h e s i s was l i k e w i s e e x a m i n e d w i t h g r e a t e r s p e c i f i c i t y by the f o l l o w i n g sub-hypotheses. 3.1. There w i l l be a negative c o r r e l a t i o n between the family climate variable of cohesion, as measured by the Family Environment Scale (FES), and s o c i a l network size as perceived by anorexic subjects. 3.2. There w i l l be a p o s i t i v e c o r r e l a t i o n between the family climate variable of independence, as measured by the Family Environment Scale (FES), and s o c i a l network size as perceived by anorexic subjects. 3.3. There w i l l be a p o s i t i v e c o r r e l a t i o n between the family climate variables of cohesion and independence, as measured by the Family Environment Scale (FES), and s o c i a l network support (emotional and instrumental) r e c e i v e d from a l l sources as perceived by anorexic subjects. 3.4. There w i l l be a p o s i t i v e c o r r e l a t i o n between the family climate variable of cohesion, as measured by the Family Environment Scale (FES), and s o c i a l network support (emotional and instrumental) from family as p e r c e i v e d by a n o r e x i c s u b j e c t s , but a n e g a t i v e c o r r e l a t i o n between cohesion and s o c i a l network support from sources outside the family. 96 3.5. There w i l l be a negative c o r r e l a t i o n between the family climate variable of independence, as measured by the Family Environment Scale (FES), and s o c i a l network support (emotional and instrumental) from family as p e r c e i v e d by a n o r e x i c s u b j e c t s , but a p o s i t i v e c o r r e l a t i o n between independence and s o c i a l network support from sources outside the family. I n o r d e r t o t e s t t h e s e h y p o t h e s e s , t h e f o l l o w i n g d a t a was s e l e c t e d f o r a n a l y s i s : t h e mean s i z e o f e a c h s u b j e c t ' s s o c i a l n e t w o r k , t h e mean I n t e r p e r s o n a l E f f e c t i v e n e s s s c o r e o f e a c h s u b j e c t ( i j e , t h e mean o f Do, C s , Sy, Sp and Sa s c o r e s on t h e C P I f o r e a c h s u b j e c t ) , t h e raw s c o r e s o f e a c h s u b j e c t f o r t h e FES v a r i a b l e s o f C o h e s i o n and I n d e p e n d e n c e , and t h e P P I mean r a t i n g s o f e a c h s u b j e c t f o r t h e n i n e c a t e g o r i e s o f p e r c e i v e d ( e m o t i o n a l and i n s t r u m e n t a l ) s u p p o r t f r o m a l l s o u r c e s , e m o t i o n a l s u p p o r t f r o m a l l s o u r c e s , i n s t r u m e n t a l s u p p o r t f r o m a l l s o u r c e s , p e r c e i v e d s u p p o r t f r o m f a m i l y , e m o t i o n a l s u p p o r t f r o m f a m i l y , i n s t r u m e n t a l s u p p o r t f r o m f a m i l y , p e r c e i v e d s u p p o r t o u t s i d e f a m i l y , e m o t i o n a l s u p p o r t o u t s i d e f a m i l y , i n s t r u m e n t a l s u p p o r t o u t s i d e f a m i l y , p e r c e i v e d s u p p o r t f r o m f r i e n d s , e m o t i o n a l s u p p o r t f r o m f r i e n d s , a n d i n s t r u m e n t a l s u p p o r t f r o m f r i e n d s . C r o s s - c o r r e l a t i o n a l a n a l y s e s were c o n d u c t e d w i t h t h i s d a t a u s i n g t h e P e a r s o n p r o d u c t - m o m e n t c o r r e l a t i o n c o e f f i c i e n t . E s t i m a t e s o f t h e s t a t i s t i c a l s i g n i f i c a n c e o f t h e s e c o r r e l a t i o n s were o b t a i n e d u s i n g t w o - t a i l p r o b a b i l i t i e s . The r e s u l t s o f t h e c o r r e l a t i o n a l a n a l y s e s a r e s u m m a r i z e d on T a b l e 10 ( s e e f o l l o w i n g p a g e ) . 97 TABLE 10 CROSS-CORRELATIONS BETWEEN 13 SOCIAL NETWORK VARIABLES AND 3 TRAIT VARIABLES (ANOREXIC SUBJECTS ONLY; N=34) VARIABLE INTERPERSONAL EFFECTIVENESS COHESION INDEPENDENCE SIZE .27 .22 .05 PERCEIVED SUPPORT FROM ALL SOURCES -.10 .47 .25 Emotional Support From A l l Sources .01 .42 .32 Instrumental Support From A l l Sources -.18 .44 .15 PERCEIVED SUPPORT FROM FAMILY -.00 .70* .46 Emotional Support From Family - . o r .60* .61* Instrumental Support From Family .01 .66* .15 PERCEIVED SUPPORT OUTSIDE FAMILY -.17 .18 .09 Emotional Support Outside Family -.07 .10 .05 Instrumental Support Outside Family -.24 .22 .11 PERCEIVED SUPPORT FROM FRIENDS -.17 -.08 -.10 Emotional Support From F r i e n d s .00 -.15 -.06 Instrumental Support From F r i e n d s -.31 -.0.1 -.13 * Result achieved the r e q u i r e d l e v e l of s i g n i f i c a n c e for an o v e r a l l Type 1 error rate of .05 for the entire table. 98 Only f o u r c o r r e l a t i o n s achieved s t a t i s t i c a l s i g n i f i c a n c e a t the .05 l e v e l . The FES v a r i a b l e of Cohesion showed a s t r o n g , p o s i t i v e c o r r e l a t i o n with P e r c e i v e d Support From Family (r=.70, p<.001) as p r e d i c t e d by Hypothesis 3.4. However, c o n t r a r y to H y p o t h e s i s 3.4., there were weak, p o s i t i v e c o r r e l a t i o n s (r=.18, p>.05) between Cohesion and P e r c e i v e d Support Outside the Family that f a i l e d to achieve s t a t i s t i c a l s i g n i f i c a n c e . Hypothesis 3.4. i s t h e r e f o r e r e j e c t e d . The FES v a r i a b l e of Independence showed a s i g n i f i c a n t , p o s i t i v e c o r r e l a t i o n (r=.61, p<.001) with Emotional Support From F a m i l y , i n c o n t r a d i c t i o n to Hypothesis 3.5. Although a weak, p o s i t i v e c o r r e l a t i o n was found between Independence and P e r c e i v e d S u p p o r t O u t s i d e Family (r=.09, p>.05) i n support of Hypothesis 3.5., t h i s c o r r e l a t i o n d i d not achieve s t a t i s t i c a l s i g n i f i c a n c e . Hypothesis 3.5. i s t h e r e f o r e r e j e c t e d . None of t h e o t h e r c o r r e l a t i o n s a c h i e v e d s t a t i s t i c a l s i g n i f i c a n c e . As a consequence, Hypotheses 2 and 3, and t h e i r sub-hypotheses are a l l r e j e c t e d . SUMMARY OF RESULTS H o t e l l i n g ' s T 2 analyses of the demographic data suggest that matching p r o c e d u r e s were s a t i s f a c t o r y , and t h a t a n o r e x i c a b s t a i n e r s and b u l i m i c s were s u f f i c i e n t l y homogeneous t o be combined f o r s u b s e q u e n t a n a l y s e s . The c o n t r o l s u b j e c t s , however, do not appear to be r e p r e s e n t a t i v e of the g e n e r a l p o p u l a t i o n on m e a s u r e s o f p e r s o n a l i t y ( C P I ) and f a m i l y 99 environment (FES). R e s u l t s o f t h e p r i m a r y d a t a a n a l y s e s r e v e a l e d few s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s between the a n o r e x i c and c o n t r o l g r o u p s . As p r e d i c t e d by H y p o t h e s i s 1.1., a n o r e x i c s u b j e c t s were found to have s m a l l e r s o c i a l networks (Xa=11.65, SD=4.54) than c o n t r o l s u b j e c t s (Xc=16.03, SD=7.54), a d i f f e r e n c e t hat achieved s t a t i s t i c a l s i g n i f i c a n c e at the .05 l e v e l using the B o n f e r r o n i i n e q u a l i t y . However, the s u b s t a n t i a l , o v e r l a p p i n g v a r i a b i l i t y of the mean s i z e s cores r a i s e s questions as to the m e a n i n g f u l n e s s of t h i s f i n d i n g . The f a i l u r e of other s o c i a l network d i f f e r e n c e s to achieve s t a t i s t i c a l s i g n i f i c a n c e l e d to the r e j e c t i o n of Hypotheses 1.2. to 1.9. H y p o t h e s i s 1 was thereby rendered untenable, except i n the case of s o c i a l network s i z e . F u r t h e r m o r e , t h e f a i l u r e of p e r s o n a l i t y ( C P I ) , e n v i r o n m e n t a l (FES) and s o c i a l network v a r i a b l e s ( P P I ) t o s i g n i f i c a n t l y c o r r e l a t e i n p r e d i c t e d d i r e c t i o n s l e d to the r e j e c t i o n of Hyp o t h e s e s 2 and 3, and t h e i r s u b - h y p o t h e s e s . A l t h o u g h t h e r e was a s i g n i f i c a n t , p o s i t i v e c o r r e l a t i o n between c o h e s i o n and p e r c e i v e d s u p p o r t f r o m f a m i l y , ( e m o t i o n a l , i n s t r u m e n t a l , and combined s u p p o r t ) , t h i s f i n d i n g c o n t r i b u t e d o n l y p a r t i a l s u p p o r t to H y p o t h e s i s 3.4. T h e r e was a l s o a s i g n i f i c a n t , p o s i t i v e c o r r e l a t i o n between i n d e p e n d e n c e and emotional support from f a m i l y ; however, t h i s f i n d i n g a c t u a l l y c o n t r a d i c t e d Hypothesis 3.5. The primary hypotheses of t h i s study (Hypotheses 1, 2, and 3) were t h e r e f o r e a l l r e j e c t e d . 100 CHAPTER 5 DISCUSSION The purpose of t h i s study was to compare the s o c i a l networks of anorexic and non-anorexic women, and to expl o r e the v a r i a t i o n of a n o r e x i c s o c i a l networks w i t h p e r s o n a l and e n v i r o n m e n t a l c h a r a c t e r i s t i c s . Q u a n t i t a t i v e and q u a l i t a t i v e (both p o s i t i v e and n e g a t i v e ) s o c i a l network v a r i a b l e s were e x a m i n e d . In t h e f o l l o w i n g d i s c u s s i o n , the r e s u l t s of the demographic and primary data analyses w i l l be evaluated, l i m i t a t i o n s of the study w i l l be presented, and the i m p l i c a t i o n s of the study f o r s o c i a l network and anorexia r e s e a r c h w i l l be ex p l o r e d . EVALUATION OF RESULTS OF DEMOGRAPHIC ANALYSES The s o c i o e c o n o m i c d a t a a n a l y s i s i s c o n s i s t e n t w i t h the common demographic f i n d i n g of a preponderance of ano r e x i c women from upper-middle c l a s s or upper c l a s s f a m i l i e s (Sheppy, 1984). 70% of the a n o r e x i c s u b j e c t s of t h i s study came from f a m i l i e s where t h e hea d o f t h e h o u s e h o l d was i n a p r o f e s s i o n a l , m a n a g e r i a l , or b u s i n e s s c a r e e r . However, a trend toward the i n c r e a s i n g i n c i d e n c e of anor e x i a n e r v o s a i n women from l o w e r -c l a s s households i s a l s o r e f l e c t e d i n the ano r e x i c women of the present study whose parents were l a b o r e r s or on we l f a r e (Sheppy, 1984). D u r a t i o n of r e s i d e n c e , a measure of geographic s t a b i l i t y , was examined (Sheppy, 1984), s i n c e i t was assumed that geographic 101 d i s r u p t i o n s were r e l a t e d to changes i n s o c i a l networks. No s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e was found i n d u r a t i o n of r e s i d e n c e , although anorexic s u b j e c t s d i d r e p o r t fewer years i n t h e i r c u r r e n t g e o g r a p h i c a l l o c a t i o n (Xa=8.10 y e a r s , SD=5.87; Xc=11.21 years, SD=7.27). The H o t e l l i n g ' s T2 a n a l y s i s of the CPI s c o r e s of a n o r e x i c a b s t a i n e r and b u l i m i c s u b j e c t s d i d not r e v e a l s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s (Sheppy, 1984). However, the CPI i s a measure of p e r s o n a l i t y , not s o c i a l network. I t i s p o s s i b l e , t h e r e f o r e , t h a t s i g n i f i c a n t d i f f e r e n c e s e x i s t i n the s o c i a l networks of t h e s e two s u b - g r o u p s ; i f so, the a s s u m p t i o n of homogeneity has been v i o l a t e d w i t h r e g a r d to s o c i a l network c h a r a c t e r i s t i c s by the combination of t h e s e sub-groups i n t o a s i n g l e experimental sample. T h i s p o s s i b i l i t y w i l l be taken up i n g r e a t e r d e t a i l l a t e r i n t h i s chapter (see Table 11). The i n a b i l i t y of H o t e l l i n g ' s T2 analyses to f i n d s i g n i f i c a n t d i f f e r e n c e s between c o n t r o l group and general p o p u l a t i o n means on the CPI and FES r a i s e s doubts about the r e p r e s e n t a t i v e n e s s of the c o n t r o l sample, and may be another c o n t r i b u t i n g f a c t o r to the i n a b i l i t y o f t h e s t a t i s t i c a l a n a l y s e s to f i n d s i g n i f i c a n t d i f f e r e n c e s between the anorexic and c o n t r o l groups. I t would be more germane to t h i s s t u d y , however, to compare the s o c i a l network p r o f i l e of the c o n t r o l group to the s o c i a l network p a t t e r n s found by P a t t i s o n and h i s c o l l e a g u e s i n urban p o p u l a t i o n samples. The s o c i a l network that emerges from c o n t r o l group data i s comprised of 16 people, with a range of 8 - 24. Of these 16 102 people, approximately 4 (27%) are nu c l e a r f a m i l y members, 3 (19%) are r e l a t i v e s , 8 (47%) are f r i e n d s (3 opposite-sex f r i e n d s ; 5 same-sex f r i e n d s ) , and 1 i s from some other r e l a t i o n a l category. These network members are u s u a l l y contacted at l e a s t once a week, and r e c e i v e p o s i t i v e r a t i n g s f o r e m o t i o n a l i n t e n s i t y , i n s t r u m e n t a l h e l p and e m o t i o n a l s u p p o r t . I f the value of a r e l a t i o n s h i p c a t e g o r y i s i n d i c a t e d by the s i z e , f r e q u e n c y of c o n t a c t , and r e c i p r o c a t e d i n s t r u m e n t a l and emotional support, f r i e n d s are the most h i g h l y valued members of the s o c i a l networks of the c o n t r o l group o u t s i d e of the nu c l e a r f a m i l y . T h i s s o c i a l network p r o f i l e a p p r o x i m a t e s t h a t found by P a t t i s o n and h i s c o l l e a g u e s i n t h e i r PPI data from a normative urban p o p u l a t i o n (N=200), except i n s i z e and composition. P a t t i s o n (1977a) found a s o c i a l network of 20 - 30 people, composed of 5 or 6 people i n each of the f o l l o w i n g c l u s t e r s : f a m i l y , r e l a t i v e s , f r i e n d s , n e i g h b o r s , and work or s o c i a l c o n t a c t s . The s i z e of s o c i a l networks i n the g e n e r a l p o p u l a t i o n e x h i b i t a h i g h degree of v a r i a b i l i t y , however, with estimates of the i n t i m a t e p s y c h o s o c i a l network ranging from 17 (Jones & F i s c h e r , 1978; F i s c h e r , 1982) to 30 (Boussevain, 1974; Wellman, 1981). I t i s t h e r e f o r e concluded that the s o c i a l network p r o f i l e of the c o n t r o l group of t h i s s t u d y i s l a r g e l y r e p r e s e n t a t i v e of the t y p i c a l s o c i a l network found i n the general p o p u l a t i o n by other s t u d i e s which d e f i n e and measure the s o c i a l network s i m i l a r to the PPI. 103 EVALUATION OF RESULTS OF PRIMARY DATA ANALYSES The o n l y s o c i a l n e t w o r k v a r i a b l e t h a t s i g n i f i c a n t l y d i f f e r e n t i a t e d a n orexic from c o n t r o l s u b j e c t s was a q u a n t i t a t i v e v a r i a b l e , t o t a l network s i z e . T h i s r e s u l t r e p l i c a t e s a common f i n d i n g i n t h e s o c i a l n e t w o r k l i t e r a t u r e of an i n v e r s e r e l a t i o n s h i p between s o c i a l network s i z e and p s y c h o p a t h i c symptomatology (ej>. , Brugha et a l . , 1982; Cohen & Sokolovsky, 1978; E r i c k s o n , 1975; F r o l a n d e t a l , 1979; Hammer, 1980; Henderson et a l , 1978b; Llamas et a l . , 1981; P a t t i s o n et a l . , 1975; R a t c l i f f e & Azim, 1975; S i l b e r f e l d , 1978). I t i s the p o s i t i o n of the present author, however, t h a t t h i s r e s u l t i s not p a r t i c u l a r l y m e a n i n g f u l , s i n c e t h e r e was c o n s i d e r a b l e , o v e r l a p p i n g v a r i a b i l i t y i n the mean s i z e s c o r e s . For example, anorexic s o c i a l networks v a r i e d from 7 - 1 6 members, and c o n t r o l s o c i a l networks v a r i e d from 8 - 24 members. F u r t h e r m o r e , a l t h o u g h s m a l l e r n e t w o r k s i z e may be a p r e d i c t o r o f r e h o s p i t a l i z a t i o n (Cohen & Sokolovsky, 1978) and of p s y c h i a t r i c symptoms and mood ( W i l c o x , 1 9 8 1 ) , i t does not i n d i c a t e a q u a l i t a t i v e l y i n f e r i o r network a c c o r d i n g to the r e s u l t s of t h i s s t u d y , as no s i g n i f i c a n t q u a l i t a t i v e network d i f f e r e n c e s were found. The t o t a l number of network f r i e n d s approached s i g n i f i c a n c e at the .05 l e v e l with the average anorexic s u b j e c t r e p o r t i n g f i v e f r i e n d s , and the average c o n t r o l s u b j e c t r e p o r t i n g seven or e i g h t f r i e n d s . Again, these mean s i z e s c o r e s were c h a r a c t e r i z e d by s u b s t a n t i a l , o v e r l a p p i n g v a r i a b i l i t y , thereby r e n d e r i n g t h e i r 104 i n t e r p r e t a t i o n p r o b l e m a t i c . A c u r i o u s and unexpected p o r t r a i t of anorexic women i n t h e i r s o c i a l context emerges from the data of t h i s study. I t appears  t h a t a n o r e x i c women are embedded i n a s o c i a l network t h a t ,  a l t h o u g h somewhat s m a l l e r , a p p r o x i m a t e s the t y p i c a l s o c i a l  n e twork of n o n - a n o r e x i c women on q u a l i t a t i v e i n d i c e s . One ex p l a n a t i o n of t h i s s o c i a l p o r t r a i t i s that a n o r e x i a nervosa i s not a homogeneous or s i n g u l a r n o s o l o g i c a l e n t i t y . Indeed, there i s a growing consensus on the l i k e l y p r e s e n c e of homogeneous s u b t y p e s w i t h i n the l a r g e anorexic p o p u l a t i o n ( S t r o b e r , 1983). These subtypes may be a s s o c i a t e d with d i f f e r e n t i a l p a t t e r n s of f a m i l y h i s t o r y and pr e m o r b i d d e v e l o p m e n t a l c h a r a c t e r i s t i c s , c l i n i c a l p r e s e n t a t i o n , and outcome. There a r e , i n f a c t , a t l e a s t two t y p o l o g i e s of anorexic women c u r r e n t l y a v a i l a b l e t h a t show i n t i m a t i o n s o f b e t w e e n - g r o u p d i f f e r e n c e s i n s o c i a l i m p a i r m e n t ( G r i g g , 1986; S t r o b e r , 1 9 8 3 ) . A l t e r n a t i v e l y , s i g n i f i c a n t d i f f e r e n c e s i n s o c i a l impairment among ano r e x i c women may simply r e f l e c t v a r y i n g degrees of c h r o n i c i t y and s e v e r i t y i n t h e i r anorexic c o n d i t i o n (eg.., C r i s p , 1980; G a r f i n k e l & Garner, 1982). A c c o r d i n g to t h i s e x p l a n a t i o n , the v i r t u a l absence of s i g n i f i c a n t s o c i a l network d i f f e r e n c e s i n the present study may be a t t r i b u t a b l e to the low degree of c h r o n i c i t y and s e v e r i t y i n the anorexic sample. Another e x p l a n a t i o n of the s o c i a l p o r t r a i t of t h i s study i s th a t s o c i a l network c h a r a c t e r i s t i c s are s t a b l e and lon g s t a n d i n g , and do not s i g n i f i c a n t l y vary with the onset and n a t u r a l course 105 of psychopathology such as a n o r e x i a nervosa; i f so, i t r a i s e s the p o s s i b i l i t y t h a t the s o c i a l network i s l a r g e l y the product of c e r t a i n p e r s o n a l i t y t r a i t s , s u c h as a f f i l i a t i v e t e n d e n c y ( M e h r a b i a n , 1976; Brugha, 1984), or i s even a p e r s o n a l i t y v a r i a b l e i n i t s e l f . Support f o r t h i s e x p l a n a t i o n comes from a study by Henderson & Moran (1983) that examined p r o s p e c t i v e data f o r changes i n s o c i a l r e l a t i o n s h i p s accompanying the o n s e t and r e m i s s i o n of n e u r o t i c symptoms. They concluded t h a t , ...when n e u r o t i c symptoms a r i s e , there i s no evidence t h a t the s o c i a l network i s a f f e c t e d , but rows with c l o s e others i n c r e a s e . When n e u r o t i c symptoms improve, t h e r e a r e no s t a t i s t i c a l l y s i g n i f i c a n t changes i n s o c i a l r e l a t i o n s h i p s at four and e i g h t months; and the changes at 12 months can be explained as r e g r e s s i o n to the mean (p. 471). T h i s c o n c l u s i o n s u p p o r t s a much d i f f e r e n t v i e w o f t h e r e l a t i o n s h i p between s o c i a l context and psychopathology than that o b t a i n e d by c r o s s - s e c t i o n a l s t u d i e s s u c h as t h o s e w h i c h p r o l i f e r a t e i n t h e s o c i a l n e t w o r k l i t e r a t u r e . I n d e e d , Henderson's stu d y i s worthy of s p e c i a l a t t e n t i o n as a r a r e example of l o n g i t u d i n a l r e s e a r c h i n a f i e l d t h a t has been dependent f o r too long on c r o s s - s e c t i o n a l data. Furthermore, a s t u d y by B r u g h a e t a l ( 1 9 8 2 , 1984) f o u n d t h a t d e p r e s s e d p s y c h i a t r i c p a t i e n t s had d e f i c i e n c i e s i n t h e i r s o c i a l networks which appeared to be l o n g - s t a n d i n g , c o n s i d e r a b l y a n t e d a t i n g t h e i r symptoms. These r e s e a r c h e r s summarize t h e i r f i n d i n g s concerning d e p r e s s i v e d i s o r d e r s and s u p p o r t i v e s o c i a l networks as f o l l o w s : Depleted s o c i a l networks have been r e p e a t e d l y shown to be a c h a r a c t e r i s t i c of d e p r e s s e d o u t p a t i e n t s and of cases of acute p s y c h o l o g i c a l d i s o r d e r i d e n t i f i e d i n general p o p u l a t i o n surveys. However, the absence of an 106 expected a s s o c i a t i o n between p r i m a r y s o c i a l network v a r i a b l e s and r e c e n t s e p a r a t i o n s and l o s s e s from others who are a f f e c t i v e l y c l o s e argues a g a i n s t a d i r e c t and i m m e d i a t e c a u s a l l i n k b e t w e e n s o c i a l n e t w o r k d e f i c i e n c i e s a n d e p i s o d e s o f d e p r e s s i o n . A c o n s i d e r a t i o n of the l i t e r a t u r e on the e v o l u t i o n of primate s o c i a l behaviour and of contemporary d a t a on the constancy of s o c i a l network c h a r a c t e r i s t i c s , both over time and i n d i f f e r e n t c u l t u r a l s e t t i n g s , suggests that a b i o c u l t u r a l p e r s p e c t i v e needs to be maintained. A c c o r d i n g l y , an a f f i l i a t i v e tendency i n man may be the cause r a t h e r than the r e s u l t of the formation of s o c i a l g roups, and c o n s t i t u t i o n a l e x p l a n a t i o n s as w e l l as f a c t o r s i n the i n d i v i d u a l ' s s o c i a l environment w i l l have to be considered both i n f u r t h e r s c i e n t i f i c work and a l s o , presumably, i n the design of any t h e r a p e u t i c s t r a t e g i e s (pp. 73-74). F i n a l l y , S a r a s o n and h i s c o l l e a g u e s (1986) have r e c e n t l y conducted a s e r i e s of s t u d i e s t h a t e x p l o r e d the p o t e n t i a l o f s o c i a l support, a q u a l i t a t i v e v a r i a b l e of s o c i a l networks, as an i n d i v i d u a l d i f f e r e n c e v a r i a b l e . Other r e s e a r c h e r s have presented t h e i r views of the developmental o r i g i n s of s o c i a l support as an i n d i v i d u a l d i f f e r e n c e v a r i a b l e (ej>. , Bruhn & P h i l i p s , 1987; F l a h e r t y & Richman, 1986). There a re s e v e r a l a l t e r n a t i v e e x p l a n a t i o n s of the o v e r a l l p a t t e r n of r e s u l t s i n the present study that a l l share a common u n d e r l y i n g a s s u m p t i o n : r e a l d i f f e r e n c e s e x i s t i n the s o c i a l networks of ano r e x i c women, but these were not found because of in h e r e n t d e f i c i e n c i e s i n the present study. The most important of t h e s e c o n c e r n s sample s i z e . A l t h o u g h t h e s t a t i s t i c a l procedures used i n the present study were r i g o r o u s , there are a number of d i f f e r e n c e s t h a t i n d i c a t e t r e n d s r a t h e r t h a n s i g n i f i c a n c e . A l a r g e r sample s i z e would have i n c r e a s e d the power of t h e s t a t i s t i c a l t e s t s , t h e r e b y i n c r e a s i n g t h e 107 p r o b a b i l i t y of d e t e c t i n g a c t u a l d i f f e r e n c e s ( presuming they e x i s t e d ) on s e v e r a l s o c i a l network v a r i a b l e s i n t h i s study t h a t were on the verge of a c h i e v i n g s t a t i s t i c a l s i g n i f i c a n c e . For example, the s o c i a l network s i z e of the f r i e n d s h i p c l u s t e r (Table 2), a v a r i a b l e of importance to one of the h y p o t h e s e s of the p r e s e n t study, f a i l e d to achieve s i g n i f i c a n c e by a very narrow margin u s i n g the B o n f e r r o n i i n e q u a l i t y (Xa=5.15 (SD=3.85); Xc=7.57 (SD=4.70); t=2.34, p=0.022; the B o n f e r r o n i i n e q u a l i t y r e q u i r e s at l e a s t 0.017 i n order to achieve the necessary l e v e l of s i g n i f i c a n c e f o r an o v e r a l l Type I e r r o r r a t e of .05 f o r the whole of Table 2). The f o l l o w i n g formula was used i n order to d e t e r m i n e the sample s i z e of each group ( i e . , a n o r e x i c s and c o n t r o l s ) n e c e s s a r y to d e c l a r e a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e between the a n o r e x i c (Xa) and c o n t r o l (Xc) means (Snedecor & Cochran, 1980): R e s u l t s i n d i c a t e that approximately 87 s u b j e c t s a r e needed i n e a c h group i n o r d e r to a c h i e v e a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e u s i n g the B o n f e r r o n i i n e q u a l i t y . T h i s f i n d i n g s u g g e s t s t h a t a l a r g e r sample s i z e ( i j e . , N=174) c o u l d have i n c r e a s e d the power of the present study s u f f i c i e n t l y to d e t e c t a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e between anorexic and c o n t r o l n where £ = Xa - Xc * t i = (<?^2n - 2) t 2 = (2(l-p),2n-2) oC = .017 A = .90 s = 4.3024 (pooled estimate) 108 group means p e r t a i n i n g to the s i z e of the f r i e n d s h i p c l u s t e r of network members (as s u m i n g , of c o u r s e , t h a t such a d i f f e r e n c e a c t u a l l y e x i s t e d ) ; y e t t h e s t a t i s t i c a l s i g n i f i c a n c e t h u s o b t a i n e d w o u l d s t i l l have been p r o b l e m a t i c s i n c e the s i z e d i f f e r e n c e i n number of f r i e n d s i s so small (Xa=5.15; fc=7.75) as to r a i s e the question of i t s meaningfulness. Furthermore, i t i s reasonable to suppose that such a sample s i z e would a l s o have i n c r e a s e d the p r o b a b i l i t y of d e t e c t i n g s i g n i f i c a n t d i f f e r e n c e s p e r t a i n i n g to other s o c i a l network v a r i a b l e s on the verge of s t a t i s t i c a l s i g n i f i c a n c e i n the present study. I t i s noteworthy, however, that the m a j o r i t y of the s o c i a l network d i f f e r e n c e s i n t h i s study were nowhere near a c h i e v i n g s t a t i s t i c a l s i g n i f i c a n c e . In summary, i n c r e a s i n g the sample s i z e of the present study might have r e s u l t e d i n f i n d i n g s e v e r a l a d d i t i o n a l , s t a t i s t i c a l l y s i g n i f i c a n t s o c i a l network d i f f e r e n c e s ; however, i t i s more reasonable to accept the n u l l h y p o thesis f o r the m a j o r i t y of the comparisons of t h i s s t u d y , s i n c e most pf the s o c i a l network d i f f e r e n c e s were f a r from a c h i e v i n g s t a t i s t i c a l s i g n i f i c a n c e . Another e x p l a n a t i o n i s that the r e s u l t s of the present study have been biased by p o o l i n g the data from a b s t a i n i n g and b u l i m i c a n o r e x i c s when there were s i g n i f i c a n t s o c i a l network d i f f e r e n c e s between them; i f so, the homogeneity of the an o r e x i c sample has been compromised, a p o s s i b i l i t y t h a t may have r e s u l t e d i n o b s c u r i n g r e a l d i f f e r e n c e s between the a n o r e x i c and c o n t r o l groups. For example, on the one hand, i t i s reasonable to assume t h a t the s o c i a l networks of anorexic s u b j e c t s change with the 109 n a t u r a l h i s t o r y o f t h e a n o r e x i c s y n d r o m e , b e c o m i n g more i m p o v e r i s h e d as the e f f e c t s of s t a r v a t i o n and i t s concomitants become more pronounced. In t h i s case, the s o c i a l networks of a b s t a i n i n g a n o r e x i c s would show g r e a t e r i m p o v e r i s h m e n t than b u l i m i c s u b j e c t s or c o n t r o l s due to the e f f e c t s of a d v a n c i n g s t a r v a t i o n ( C r i s p , 1980; G a r f i n k e l & Garner, 1982). On the other hand, the b u l i m i c a n o r e x i c s of t h i s s t u d y may be a t a more advanced s t a g e on the road to r e c o v e r y ; t h a t i s , s i n c e a l l ano r e x i c s u b j e c t s were r e c e i v i n g some form of t h e r a p e u t i c medical care, i t i s p o s s i b l e that the an o r e x i c women of t h i s study were at d i f f e r e n t stages of r e c o v e r y . Furthermore, i t i s reasonable to assume t h a t s o c i a l network p a t t e r n s would tend to normalize over the c o u r s e of s u c c e s s f u l t r e a t m e n t . In t h i s c a s e , the s o c i a l networks of b u l i m i c a n o r e x i c s would be expected to r e f l e c t an i n c r e a s i n g resemblance to the general p o p u l a t i o n . In order to t e s t the homogeneity of the a n o r e x i c sample w i t h r e s p e c t to s o c i a l network dimensions, a b s t a i n i n g and b u l i m i c a n o r e x i c s were compared a c c o r d i n g to the s o c i a l network v a r i a b l e s of the PPI. Means and standard d e v i a t i o n s were c a l c u l a t e d , a H o t e l l i n g ' s a n a l y s i s was performed, f o l l o w e d by a s e r i e s of u n i v a r i a t e t -t e s t s . The r e s u l t s of these analyses are summarized i n Table 11 (next page). Both the H o t e l l i n g ' s T^ a n a l y s i s and the independent t - t e s t s of s p e c i f i c network d i f f e r e n c e s f a i l e d to a c h i e v e s t a t i s t i c a l s i g n i f i c a n c e , a f a i l u r e t h a t may be r e l a t e d to the small sub-sample s i z e s . Furthermore, the s o c i a l network p r o f i l e s of the 110 a n o r e x i c a b s t a i n e r s and b u l i m i c s do not appear s u b s t a n t i a l l y d i f f e r e n t from the s o c i a l network p r o f i l e of the c o n t r o l group. I t i s t h e r e f o r e c o n c l u d e d t h a t the m i x t u r e of a b s t a i n i n g and b u l i m i c a n o r e x i c s i n the e x p e r i m e n t a l sample i s u n l i k e l y to account f o r the v i r t u a l absence of s i g n i f i c a n t r e s u l t s i n the present study. TABLE 11 COMPARISONS OF THE SOCIAL NETWORKS OF ABSTAINING (N=23) AND BULIMIC (N=10) ANOREXIC SUBJECTS NETWORK CATEGORY ABSTAINERS (N=23) Xa SD BULIMICS (N=10) Xb SD t 2 - t a i l P Age 33.01 6.99 32.49 8.26 0.19 0.854 Years Known 11.31 3.11 9.75 2.85 1.36 0.185 Total Size 11.35 4.59 11.90 4.65 -0.32 0.754 Frequency of Contact 3.77 0.54 4.16 0.47 -1.96 0.059 Emotional Intensity 3.90 0.87 4.09 0.33 -0.65 0.519 Reciprocity 4.09 0.65 3.90 0.36 0.87 0.392 Instrumental Help 3.52 0.71 3.31 0.74 0.75 0.456 Reciprocity 3.37 0.77 3.43 0.37 -0.23 0.821 Emotional Support 3.45 0.81 3.07 0.62 1.30 0.205 Reciprocity 3.59 0.81 3.45 0.38 0.49 0.626 * Result achieved the r e q u i r e d l e v e l of s i g n i f i c a n c e for an ov e r a l l Type 1 error rate of .05 for the entire table. For Hotelling's T 2 analysis, F(10,22) - 1.6286, p>.05. I l l Response s e t s may a c c o u n t , i n p a r t , f o r the absence of s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s between the anorexic and c o n t r o l groups of the p r e s e n t s t u d y . For example, c e n t r a l t endency e r r o r i s o f t e n encountered i n s c a l e - t y p e data such as tha t of the PPI where s u b j e c t s may s e l e c t an e g o c e n t r i c midpoint on a s c a l e i n t e r v a l as t h e i r "average" response. A l t e r n a t i v e l y , s o c i a l d e s i r a b i l i t y i s e s p e c i a l l y worrisome i n anorexia r e s e a r c h which r e l i e s on s e l f - r e p o r t data alone (Bruch, 1973, 1978; C r i s p , 1980; G a r f i n k e l & Garner, 1982). For example, Kog & Vandereycken (1985) suggest that the tendency to deny problems, not uncommon among ano r e x i c p a t i e n t s , may s e r i o u s l y d i s t o r t response p a t t e r n s . Sampling e r r o r may account f o r the f i n d i n g t h a t the c o n t r o l group of t h i s s t u d y i s not r e p r e s e n t a t i v e o f t h e g e n e r a l p o p u l a t i o n . T h i s l a c k of r e p r e s e n t a t i v e n e s s may t h e r e f o r e be obscuring r e a l d i f f e r e n c e s that e x i s t between the ano r e x i c group and the g e n e r a l p o p u l a t i o n . However, s i n c e the c o n t r o l group appears to approximate normative, urban s o c i a l network data using the PPI, i t i s u n l i k e l y t h a t the c o n t r o l group i s the source of the sampling e r r o r . A f i n a l e x p l a n a t i o n c o n c e r n s the p o s s i b i l i t y t h a t the present study f a i l e d to examine s o c i a l network v a r i a b l e s t h a t would have s i g n i f i c a n t l y d i s t i n g u i s h e d a norexic from non-anorexic women. For example, d e n s i t y , m u l t i p 1 e x i t y , and p e r c e i v e d adequacy of r e l a t i o n s h i p s are s o c i a l network v a r i a b l e s t h a t have been found to d i s t i n g u i s h p s y c h i a t r i c and n o r m a l s a m p l e s (Henderson et a l . , 1978b; Morin & Seidman, 1986). A l t e r n a t i v e l y , 112 i t i s p o s s i b l e that the PPI lac k e d the necessary s e n s i t i v i t y to de t e c t a c t u a l d i f f e r e n c e s between the anorexic and c o n t r o l groups of t h i s study. In summary, the n u l l hypothesis i s accepted f o r a l l s o c i a l network v a r i a b l e s i n the present study except t o t a l s i z e ; t h a t i s , there are v i r t u a l l y no s i g n i f i c a n t d i f f e r e n c e s i n the s o c i a l networks of the anorexic and non-anorexic women of t h i s s t u d y . The n o n - s i g n i f i c a n t p a t t e r n of r e s u l t s i s l i k e l y due to the low c h r o n i c i t y and s e v e r i t y of the ano r e x i c syndrome r e p o r t e d by the experimental sample. Furthermore, the r e s u l t s are congruent with i n c r e a s i n g i n d i c a t i o n s i n the l i t e r a t u r e t h a t a n o r e x i a n e r v o s a does not i n e v i t a b l y l e a d to p r e d i c t a b l e and l a r g e l y i n v a r i a n t s o c i a l d e f i c i e n c i e s . For example, recent f a m i l y i n t e r a c t i o n a l r e s e a r c h i n d i c a t e s that the r e l a t i o n s h i p between the anorexic and her most immediate s o c i a l network members, h e r f a m i l y , i s c h a r a c t e r i z e d by c o n s i d e r a b l e d i v e r s i t y , c o n t r a r y to the p r o p o s a l s of e a r l y i m p r e s s i o n i s t i c r e s e a r c h (eg_. , G r i g g , 1986; Kog et a l . , 1985; Yager, 1982). Furthermore, two recent s t u d i e s ( d i s c u s s e d p r e v i o u s l y ) have chal l e n g e d c l i n i c a l r e p o r t s of s o c i a l i s o l a t i o n and maladjustment among anorexic p a t i e n t s (Herzog et a l . , 1985; Sheppy, 1984). Indeed, r e s u l t s of the present study i n d i c a t e t h at the l a r g e s t p r o p o r t i o n of the a n o r e x i c ' s s o c i a l network i s composed of f r i e n d s (44%) who are contacted u s u a l l y at l e a s t once a week (nb. , they compose 42% of the a n o r e x i c ' s high frequency r e l a t i o n s ) , are regarded with mostly moderate, p o s i t i v e f e e l i n g s and thoughts, and r e c i p r o c a t e emotional and i n s t r u m e n t a l 113 s u p p o r t a t l e a s t on some o c c a s i o n s i f not o f t e n . Of t h e s e f r i e n d s , two of an average of f i v e are t y p i c a l l y members of the opposite sex, a f i n d i n g that i s h a r d l y congruent with G a r f i n k e l & G a r n e r ' s (1982) d e s c r i p t i o n of the s e x u a l l y d i s i n t e r e s t e d and opposite-sex avoidant anorexic women! F i n a l l y , Berkowitz (1983) found t h a t both anorexic and non-anorexic women p e r c e i v e t h e i r f a m i l i e s as a source of emotional support, a f i n d i n g reproduced i n the p r e s e n t s t u d y . F u t u r e r e s e a r c h s h o u l d c o n s i d e r the p o s s i b i l i t y t h a t the nature of the s o c i a l network v a r i e s with the c h r o n i c i t y and/or s e v e r i t y of the a n o r e x i c c o n d i t i o n of the a n o r e x i c sample. A l t e r n a t i v e l y , s i g n i f i c a n t d i f f e r e n c e s i n s o c i a l network v a r i a t i o n may be found to d i s c r i m i n a t e between subtypes of anorexia nervosa. The o n l y o t h e r s t a t i s t i c a l l y s i g n i f i c a n t r e s u l t s of the present study were found i n the c o r r e l a t i o n a l a n a l y s e s . These a n a l y s e s were an attempt to r e p l i c a t e the f i n d i n g of M i t c h e l l ( 1 9 8 2 ) t h a t i n d i v i d u a l and e n v i r o n m e n t a l v a r i a b l e s were s i g n i f i c a n t c o r r e l a t e s o f s o c i a l network d i m e n s i o n s among p s y c h i a t r i c p a t i e n t s . With r e s p e c t to e n v i r o n m e n t a l v a r i a b l e s , M i t c h e l l found that f a m i l y cohesion (as measured by the FES) was n e g a t i v e l y c o r r e l a t e d w i t h network s i z e (r=-.44, p<.01), but p o s i t i v e l y c o r r e l a t e d with network s u p p o r t (r=.29, p<.05). The p r e s e n t study reproduced the p o s i t i v e c o r r e l a t i o n between f a m i l y cohesion and network s u p p o r t , but o n l y w i t h r e s p e c t to f a m i l y support (r=.70, p<.001). There was a weak, p o s i t i v e c o r r e l a t i o n w i t h 114 support o u t s i d e the f a m i l y (r=.18, p>.05), and a weak n e g a t i v e c o r r e l a t i o n w i t h s u p p o r t from f r i e n d s (r=-.08, p>.05). These l a t t e r c o r r e l a t i o n s d i d not achieve s t a t i s t i c a l s i g n i f i c a n c e a t the .05 l e v e l . However, the present study f a i l e d to reproduce a negative c o r r e l a t i o n between f a m i l y cohesion and network s i z e ; indeed, a s t r o n g , p o s i t i v e , and s i g n i f i c a n t c o r r e l a t i o n was found (r=.61, p<.001). I t a p p e a r s , t h e r e f o r e , t h a t the degree of f a m i l y cohesion i s r e l a t e d to the degree of f a m i l y support, as one would i n t u i t i v e l y expect; however, such c o h e s i o n does not c r e a t e l e s s need (or s a n c t i o n ) f o r seeking r e l a t i o n s h i p s beyond the f a m i l y system as M i t c h e l l has suggested. M i t c h e l l found t h a t f a m i l y independence was s i g n i f i c a n t l y r e l a t e d t o g e n e r a l n e t w o r k s u p p o r t ( r = . 3 2 , p < . 0 5 ) , and p a r t i c u l a r l y to support from peers (r=.43, p<.01). The present study d i d f i n d a modest, p o s i t i v e c o r r e l a t i o n between f a m i l y i n d e p e n d e n c e and g e n e r a l network s u p p o r t ( r = . 2 5 ) , but t h i s r e l a t i o n s h i p was n o t s i g n i f i c a n t (p=. 1 5 4 ) . C o n t r a r y t o M i t c h e l l ' s r e s u l t s , however, a weak, negative c o r r e l a t i o n was found between f a m i l y independence and support from f r i e n d s (r=-.10), a c o r r e l a t i o n t h at was a l s o n o n - s i g n i f i c a n t (p=.574). T h i s f i n d i n g does not support M i t c h e l l ' s s uggestion t h a t " i n c r e a s e d emphasis on autonomy w i t h i n the f a m i l y may encourage the c l i e n t to t ake more i n i t i a t i v e i n e s t a b l i s h i n g v i a b l e f r i e n d s h i p p a t t e r n s o u t s i d e the household" (p. 397). Indeed, the f i n d i n g i n t h i s study t h a t f r i e n d s comprise the l a r g e s t p r o p o r t i o n of high frequency supporters (see Table 9) suggests t h a t f a m i l y cohesion 115 does not i n h i b i t nor does f a m i l y i n d ependence encourage the development of s u p p o r t i v e f r i e n d s h i p s . A s i m i l a r c o n c l u s i o n a p p l i e s to the weak and n o n - s i g n i f i c a n t c o r r e l a t i o n s between f a m i l y cohesion, independence, and s o c i a l network s i z e . With r e g a r d to p e r s o n a l i t y v a r i a b l e s , the c o r r e l a t i o n s between i n t e r p e r s o n a l e f f e c t i v e n e s s and s o c i a l network s i z e and support were a l l weak and n o n - s i g n i f i c a n t . These c o r r e l a t i o n a l r e s u l t s are c o u n t e r - i n t u i t i v e and m y s t i f y i n g . For example, there i s a growing l i t e r a t u r e that p o i n t s to s i g n i f i c a n t a s s o c i a t i o n between s o c i a l competence and s o c i a l networks (ej>. , Cauce, 1986; H e l l e r & Swindle, 1983; Holohan & Wilcox, 1978; Sarason et a l . , 1985, 1986). I t i s p o s s i b l e t h a t a l a r g e r sample would have r e s u l t e d i n a s t r onger p o s i t i v e c o r r e l a t i o n between i n t e r p e r s o n a l e f f e c t i v e n e s s and s o c i a l network s i z e than the one obtained by the present study (r=.27, p>.05). F u t u r e s t u d i e s of a n o r e x i a n e r v o s a s h o u l d c o n t i n u e to i n v e s t i g a t e the s o c i a l network c o r r e l a t e s of p e r s o n a l i t y v a r i a b l e s , e s p e c i a l l y those p e r s o n a l i t y t r a i t s . In t h i s regard, i t i s noteworthy that Strober & Humphrey (1987), i n t h e i r review of f a m i l y i n f l u e n c e s i n a n o r e x i a nervosa and b u l i m i a suggest the f o l l o w i n g : . . . i t seems l i k e l y t h a t c e r t a i n p e r s o n a l i t y f a c t o r s , which may be g e n e t i c a l l y d e t e r m i n e d , predispose the i n d i v i d u a l to g r e a t e r s e n s i t i v i t y and v u l n e r a b i l i t y to p o w e r f u l f a m i l i a l and s o c i a l experiences t h a t impinge ad v e r s e l y on s e l f - e s t e e m and s e l f - e f f i c a c y (p. 659). 116 LIMITATIONS OF THE STUDY The f o l l o w i n g i s a d i s c u s s i o n of s e v e r a l noteworthy-l i m i t a t i o n s of the present study. An i m p o r t a n t l i m i t a t i o n of the present study concerns i t s d e s i g n . A c r o s s - s e c t i o n a l s t u d y s i m p l y cannot c a p t u r e t h e temporal dynamic between s o c i a l network p a t t e r n s and the n a t u r a l h i s t o r y of a n o r e x i a nervosa, nor, i n the event of s i g n i f i c a n t f i n d i n g s , can such a design e s t a b l i s h the d i r e c t i o n of c a u s a l i t y . The present study f a i l e d to d i s t i n g u i s h between phases of the n a t u r a l h i s t o r y of a n o r e x i a n e r v o s a , and thus women with symptoms of v a r y i n g s e v e r i t y were pooled together i n t o a s i n g l e experimental sample. For example, the d u r a t i o n of i l l n e s s i n the a n o r e x i c s u b j e c t s of t h i s study ranged from 4 months to 5 years (Sheppy, 1984). Some r e s e a r c h e r s (e&., C r i s p , 1980; G a r f i n k e l & G a r n e r , 1982) s u g g e s t t h a t t h e c h r o n i c a n o r e x i c may have d i f f e r e n t c h a r a c t e r i s t i c s t h a n t h e a n o r e x i c who has j u s t developed the syndrome. Consequently, i t i s p o s s i b l e t h a t the more c h r o n i c and d e b i l i t a t i n g the anorexic syndrome, the more i m p o v e r i s h e d the s o c i a l network, both i n t e r m s o f n e t w o r k q u a n t i t y and q u a l i t y . The p r e s e n t s t u d y used s e l f - r e p o r t d a t a d e r i v e d from a m e a s u r e of p e r c e i v e d s o c i a l network c h a r a c t e r i s t i c s . The d i f f e r e n c e s between a c t u a l and p e r c e i v e d s o c i a l networks and  s o c i a l s u p p o r t have r e c e i v e d i n c r e a s i n g a t t e n t i o n among r e s e a r c h e r s ( A n t o n u c c i & I s r a e l , 1986; Berkman, 1984; Cutrona, 1986b; Gore, 1981; H e l l e r & Lakey, 1985; K l e i n e r , 1984; Procidano 11.7 & H e l l e r , 1983; Sarason & Sarason, 1985; Vaux & Athanassopulou, 1987; Wethington & K e s s l e r , 1986). Researchers have recommended the c o l l e c t i o n of s o c i a l network data by i n t e r v i e w r a t h e r than s e l f - r e p o r t q u e s t i o n n a i r e , and the use of o b j e c t i v e measures so as t o o b t a i n d a t a p e r t a i n i n g to the a c t u a l (y_s p e r c e i v e d ) q u a n t i t y and q u a l i t y of the s o c i a l networks of anorexic p a t i e n t s . However, measures of p e r c e i v e d s o c i a l network c h a r a c t e r i s t i c s , such as the PPI, a r e not to be d e v a l u e d because they do not n e c e s s a r i l y measure the a c t u a l s o c i a l network, e s p e c i a l l y i n view of Henderson's (1981) f i n d i n g that only the p e r c e i v e d adequacy, not t h e a c t u a l a v a i l a b i l i t y , o f s o c i a l r e l a t i o n s h i p s i s p r e d i c t i v e of the development of n e u r o t i c symptomatology under c o n d i t i o n s of a d v e r s i t y . IMPLICATIONS FOR SOCIAL NETWORK THEORY, THERAPY AND RESEARCH C r o s s - s e c t i o n a l s t u d i e s of the r e l a t i o n s h i p between s o c i a l network and psychopathology have tended to f i n d t h a t the s o c i a l networks of s u b j e c t s from p s y c h i a t r i c and g e n e r a l p o p u l a t i o n s r e v e a l e d s i g n i f i c a n t d i f f e r e n c e s . T h i s r e p e a t e d f i n d i n g has encouraged r e s e a r c h e r s to c o n t i n u e t h e i r i n v e s t i g a t i o n of the a s s o c i a t i o n between s o c i a l context and p s y c h i a t r i c d i s o r d e r . The r e s u l t s of the present study, however, c h a l l e n g e the i n v a r i a n t n a t u r e of t h i s a s s o c i a t i o n , and r a i s e q u e s t i o n s about the v a l i d i t y of the assumption t h a t s o c i a l networks have e t i o l o g i c a l s i g n i f i c a n c e i n the o n s e t of psychopathology. S o c i a l network d i f f e r e n c e s may o n l y emerge i n c h r o n i c and s e v e r e a n o r e x i a . 118 A l t e r n a t i v e l y , such d i f f e r e n c e s may only emerge i n a s s o c i a t i o n w i t h c e r t a i n subtypes of anorexia nervosa. A f r u i t f u l l i n e of f u t u r e r e s e a r c h may t h e r e f o r e be an i n v e s t i g a t i o n of the s o c i a l network c o r r e l a t e s of anorexic groups that s i g n i f i c a n t l y d i f f e r i n degree of c h r o n i c i t y , s e v e r i t y or type of a n o r e x i c c o n d i t i o n . F u r t h e r m o r e , s o c i a l network v a r i a n c e may be r e l a t e d to c e r t a i n premorbid p e r s o n a l i t y t r a i t s that remain r e l a t i v e l y u n p e r t u r b e d by the o n s e t of a n o r e x i c symptomatology (ej>. , Brugha, 1984; Cauce, 1986; Henderson et a l . , 1981; S a r a s o n e t a l . , 1985; S t r o b e r , 1983); i t i s a l s o p o s s i b l e t h a t the s o c i a l network i t s e l f c o n s t i t u t e s an i n d i v i d u a l d i f f e r e n c e v a r i a b l e . A nother a r e a of promise f o r f u t u r e r e s e a r c h , then, i s the p r o s p e c t i v e i n v e s t i g a t i o n of p e r s o n a l i t y v a r i a b l e s , s o c i a l n e t w o r k c h a r a c t e r i s t i c s and i n d i c e s of anorexic pathology i n the g e n e r a l p o p u l a t i o n i n o r d e r to c a p t u r e the t e m p o r a l dynamic between d i s p o s i t i o n a l and s o c i a l v a r i a b l e s before and a f t e r the emergence of anorexic symptoms. The outcome of such an i n v e s t i g a t i o n might w e l l have s i g n i f i c a n t i m p l i c a t i o n s f o r t h e e t i o l o g y and treatment of a n o r e x i a nervosa. P e r s o n a l i t y v a r i a b l e s may have been r e s p o n s i b l e f o r the s i g n i f i c a n t s o c i a l network d i f f e r e n c e s between p s y c h i a t r i c and p o p u l a t i o n samples i n p r e v i o u s c r o s s - s e c t i o n a l r e s e a r c h . For example, p e r s o n a l i t y v a r i a b l e s , s u c h as n e u r o t i c i s m , may p r e d i s p o s e people to complain and exaggerate problems i n t h e i r s o c i a l networks. As a c onsequence, s i g n i f i c a n t a s s o c i a t i o n s between s o c i a l network v a r i a b l e s and p s y c h i a t r i c d i s t r e s s would 119 emerge from the d a t a due to s y s t e m a t i c b i a s i n s e l f - r e p o r t s ( H e n d e r s o n et a l . , 1981; S c h r o e d e r , 1982). F u r t h e r c r o s s -s e c t i o n a l , s o c i a l network s t u d i e s of p s y c h i a t r i c p o p u l a t i o n s should t h e r e f o r e i n c l u d e p e r s o n a l i t y measures i n order to c o n t r o l f o r s ystematic b i a s i n s e l f - r e p o r t s . A c c e p t i n g the n u l l h ypothesis f o r the m a j o r i t y of r e s u l t s i n the present study r e p r e s e n t s a t h r e a t to the v a l u e of s o c i a l network i n t e r v e n t i o n s ( f o r a r e v i e w , see T r i m b l e , 1980; a l s o K l i m a n & T r i m b l e , 1983) t h a t attempt to i n c r e a s e the s i z e , f r e q u e n c y of c o n t a c t , e m o t i o n a l i n t e n s i t y , or e m o t i o n a l and i n s t r u m e n t a l supportiveness of the s o c i a l networks of a n o r e x i c women.. In n o n - p s y c h o t i c d i s o r d e r s such as a n o r e x i a , i t i s g e n e r a l l y assumed t h a t the p e r s o n a l r e l a t i o n s h i p s between a p a t i e n t and t h e o t h e r s a r o u n d h e r , e s p e c i a l l y f a m i l y and t h e r a p i s t , w i l l have a s u b s t a n t i a l e f f e c t on the course of her d i s o r d e r , h o p e f u l l y f o r the b e t t e r . The v a l i d i t y of t h i s assumption may be q u e s t i o n a b l e , however, f o r p s y c h i a t r i c p a t i e n t s with anorexia nervosa and other n e u r o t i c c o n d i t i o n s (Henderson et a l . , 1981). There i s an a d d i t i o n a l i m p l i c a t i o n from t h i s study f o r P a t t i s o n ' s p s y c h o s o c i a l systems theory ( P a t t i s o n , 1976, 1977a). A major p r e m i s e of p s y c h o s o c i a l systems t h e o r y i s t h a t the p r i m a r y g r o u p of the i n d i v i d u a l i s not the f a m i l y but the i n t i m a t e p s y c h o s o c i a l network, as e m p i r i c a l l y measured by the PPI. T h i s network i s s a i d to comprise the f u n c t i o n a l k i n s h i p group and the p r i m a r y , psychodynamic s o c i a l s y s t e m o f t h e 120 i n d i v i d u a l (Hurd et a l . , 1980; P a t t i s o n , 1977a). A l t h o u g h the p r e s e n t s t u d y does not b o l s t e r c o n f i d e n c e i n the e t i o l o g i c a l s i g n i f i c a n c e of the i n t i m a t e p s y c h o s o c i a l network, i t d e f i n i t e l y p o i n t s to the i m p o r t a n c e of r e l a t i o n s h i p s o u t s i d e the nucl e a r f a m i l y , e s p e c i a l l y f r i e n d s , as attachments of moderate, p o s i t i v e e m o t i o n a l i n t e n s i t y , and sources of emotional and i n s t r u m e n t a l support. IMPLICATIONS FOR ANOREXIA RESEARCH The o v e r a l l p a t t e r n of r e s u l t s from the present study do not support the p r o f i l e of the a n o r e x i c ' s immediate s o c i a l m i l i e u t h a t has emerged from e a r l y i m p r e s s i o n i s t i c r e s e a r c h ; t h a t i s , the s o c i a l networks of the anorexic women of t h i s study c annot be c h a r a c t e r i z e d as c o n s t r i c t e d , s o c i a l l y i s o l a t e d , and dominated by n u c l e a r f a m i l y r e l a t i o n s h i p s . On the c o n t r a r y , the s o c i a l networks of t h e s e women res e m b l e t h o s e of the c o n t r o l group, except f o r a modest s i z e d i f f e r e n c e ; hence, the ano r e x i c ' s s o c i a l networks were composed p r i m a r i l y of f a m i l y and f r i e n d s with whom the a n o r e x i c women t y p i c a l l y enjoyed weekly c o n t a c t , moderate and p o s i t i v e e m o t i o n a l i n t e n s i t y , and f r e q u e n t s u p p o r t . F u t u r e s o c i a l network s t u d i e s o f a n o r e x i c women c o u l d h e l p f u l l y i n v e s t i g a t e p e r s o n a l i t y v a r i a b l e s such as n e u r o t i c i s m that vary with s o c i a l network dimensions (eg_. , p e r c e i v e d adequacy of s o c i a l network; see, Henderson et a l . , 1978b, 1981) and th a t d i s t i n g u i s h a n o r e x i c f r o m n o n - a n o r e x i c women ( S t r o b e r , 1980), or t h a t d i s c r i m i n a t e between s u b t y p e s of a n o r e x i a n e r v o s a ( S t r o b e r , 121 1983); i f so, p e r s o n a l i t y v a r i a b l e s may be found t o mediate a s i g n i f i c a n t r e l a t i o n s h i p between s o c i a l networks and e a t i n g d i s o r d e r s . CONCLUSION The c o n c e p t s of s o c i a l network and s o c i a l s u p p o r t have become i n c r e a s i n g l y p o p u l a r i n r e c e n t y e a r s , and have become i m p o r t a n t r e s e a r c h t o o l s f o r examining p s y c h o s o c i a l f a c t o r s i n p s y c h i a t r i c d i s o r d e r . These concepts have had p a r t i c u l a r appeal b e c a u s e of t h e i r p r o m i s i n g i m p l i c a t i o n s f o r t h e r a p e u t i c i n t e r v e n t i o n . U n f o r t u n a t e l y , p r o g r e s s i n t h i s f i e l d has been hampered by c o n c e p t u a l ambiguity, a p l e t h o r a of measures with d i f f e r i n g o p e r a t i o n a l i z a t i o n s of the s o c i a l network and s o c i a l support c o n s t r u c t s , and a p a u c i t y of s t u d i e s using a p r o s p e c t i v e d e s i g n and a c l e a r t h e o r e t i c a l b a s e . The p r e s e n t s t u d y h i g h l i g h t s t h e need f o r p r o s p e c t i v e s t u d i e s t h a t a s s e s s i n d i v i d u a l d i f f e r e n c e s as w e l l as s o c i a l network v a r i a b l e s and i n d i c e s of p s y c h i a t r i c d i s o r d e r . Future s t u d i e s should a l s o have adequate sample s i z e s , vigorous s e l e c t i o n c r i t e r i a , and measures of s o c i a l network with ac c e p t a b l e r e l i a b i l i t y and v a l i d i t y . Only i n t h i s way i s i t p o s s i b l e to o b t a i n r e l i a b l e r e s u l t s t h a t c o n s t i t u t e an advance on e x i s t i n g s o c i a l network r e s e a r c h of p s y c h i a t r i c p o p u l a t i o n s i n g e n e r a l , and a n o r e x i a n e r v o s a i n p a r t i c u l a r . 122 FOOTNOTES 1. True i n c i d e n c e and prevalence r a t e s have been confounded by m i l d e r cases going unreported ( P i k t e l , 1986), heightened p u b l i c and medical awareness, c e r t a i n p ersonal b i a s e s ( E c k e r t , 1985), and the use of r e t r o s p e c t i v e data from i n s u f f i c i e n t l y v a l i d a t e d q u e s t i o n n a i r e s and s a m p l e s t h a t a r e l i m i t e d i n s i z e and demographic v a r i a b l e s ( L e i c h n e r , 1985). 123 BIBLIOGRAPHY Adams, B.N. (1967). I n t e r a c t i o n theory and the s o c i a l network. Sociometry, 30, 64-78. A l l o w a y , R. , & B e b b i n g t o n , P. ( 1 9 8 7 ) . The b u f f e r theory of s o c i a l support - a review of the l i t e r a t u r e . P s y c h o l o g i c a l  Medicine, 17, 91-108. A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n ( 1 9 8 0 ) . D i a g n o s t i c and  s t a t i s t i c a l m a n u a l o f m e n t a l d i s o r d e r ( 3 r d ed . ) . Washington, D.C: Author. A m e r i c a n P s y c h i a t r i c A s s o c i a t i o n ( 1 9 8 7 ) . D i a g n o s t i c and  s t a t i s t i c a l manual of mental d i s o r d e r (3rd ed., R e v i s e d ) . Washington, D.C: Author . Andersen, A.E. (1983). Anorexia nervosa and b u l i m i a : A spectrum of e a t i n g d i s o r d e r s . J o u r n a l of Adolescent H e a l t h Care, 4_, 15-21. Andersen, Arnold E. (1985). P r a c t i c a l comprehensive treatment of  a n o r e x i a n e r v o s a and b u l i m i a . B a l t i m o r e : John Hopkins U n i v e r s i t y P r e s s . Anderson, B. , & C a r l o s , M.L. ( 1 9 7 6 ) . What i s s o c i a l network theory? In T. Burns & W. Buckley ( E d s . ) , Power and c o n t r o l : S o c i a l s t r u c t u r e s and t h e i r t r a n s f o r m a t i o n . Beverly H i l l s , CA: Sage. Anderson, C. (1982). The community conn e c t i o n : The impact of s o c i a l networks on f a m i l y and i n d i v i d u a l f u n c t i o n i n g . In F. Walsh ( E d . ) , Normal f a m i l y processes (pp.. 425-445). NY: G u i l f o r d . Antonucci, T.C. (1985). S o c i a l support: T h e o r e t i c a l advances, re c e n t f i n d i n g s and p r e s s i n g i s s u e s . In I.G.. Sarason & B.R. S a r a s o n ( E d s . ) , S o c i a l s u p p o r t : T h e o r y , r e s e a r c h , and  a p p l i c a t i o n s (pp. 321-370). The Hague, The Netherlands: Martinus N i j h o f f . A n t o n u c c i , T . C , & Depner, C E . (1982). S o c i a l s u p p o r t and i n f o r m a l h e l p i n g r e l a t i o n s h i p s . In T.A. W i l l s (Ed.), B a s i c  p r o c e s s e s i n h e l p i n g r e l a t i o n s h i p s (pp. 233-254). NY: Academic P r e s s . A n t o n u c c i , T.C. & I s r a e l , B.A. (1986). V e r i d i c a l i t y of s o c i a l support: A comparison of p r i n c i p a l and network members' responses. J o u r n a l of C o n s u l t i n g and C l i n i c a l Psychology, 54, 432-437. 124 A r g y l e , M. (1980). I n t e r a c t i o n s k i l l s and s o c i a l competence. In P. Feldman & J . Orford ( E d s . ) , P s y c h o l o g i c a l problems; The  s o c i a l c o n t e x t (pp. 123-150). C h i c h e s t e r : John Wiley & Sons. A t t n e a v e , C. ( 1976 ) . S o c i a l n e t w o r k s as t h e u n i t o f i n t e r v e n t i o n . In P. Guerin (Ed.), Family therapy: Theory  and p r a c t i c e (pp. 220-232). NY: Gardner P r e s s . B a r r e r a , M., J r . (1981). S o c i a l support i n the adjustment of pregnant a d o l e s c e n t s : Assessment i s s u e s . In B.G. G o t t l i e b ( E d . ) , S o c i a l networks and s o c i a l s u p p o r t (pp. 69-96). Beverly H i l l s , CA: Sage. B a r r e r a , M. , J r . ( 1 9 8 6 ) . D i s t i n c t i o n s between s o c i a l support c o n c e p t s , m e a s u r e s , and m o d e l s . American J o u r n a l of  Community Psychology, 14, 413-445. B a r r e r a , M., J r . , & A i n l a y , S.L. (1983). The s t r u c t u r e of s o c i a l support: A conceptual and e m p i r i c a l a n a l y s i s . J o u r n a l of  Community Psychology, 11, 133-143. B e e l s , C.C. ( 1 9 7 8 ) . S o c i a l n etworks, the f a m i l y , and the s c h i z o p h r e n i c p a t i e n t . S c h i z o p h r e n i a B u l l e t i n , 4_, 512-521. Bemis, K e l l y M. (1978). Current approaches to the e t i o l o g y and treatment of anorexia nervosa. P s y c h o l o g i c a l B u l l e t i n , 85, 593-615. Berkman, L.F. (1984). A s s e s s i n g the p h y s i c a l h e a l t h e f f e c t s of s o c i a l networks and s o c i a l support. Annual Review of P u b l i c  H ealth, 5, 413-432. Berkowitz, B. (1983). The i m p l i c a t i o n s of f a m i l y c h a r a c t e r i s t i c s i n the c l a s s i f i c a t i o n and treatment of a n o r e x i a nervosa and b u l i m i a . U n p u b l i s h e d d o c t o r a l d i s s e r t a t i o n , Ohio S t a t e U n i v e r s i t y , Ohio. Berkowitz, S.D. (1982). An i n t r o d u c t i o n to s t r u c t u r a l a n a l y s i s . Toronto: Butterworths. B e r t a l a n f f y , L.V. ( 1 9 6 8 ) . G e n e r a l systems t h e o r y — a c r i t i c a l r e v i e w . In W. Buckley (Ed.), Modern systems r e s e a r c h f o r  the b e h a v i o r a l s c i e n t i s t . Chicago: A l d i n e . Beumont, P.J.V., Abraham, . S.F. , & Simson, K.G. (1981). The psychosexual h i s t o r i e s of a d o l e s c e n t g i r l s and young women with anorexia nervosa. P s y c h o l o g i c a l Medicine, 11, 131-140. B i l l i n g s , A.G., & Moos, R.H. ( 1 9 8 2 ) . S o c i a l s u p p o r t and f u n c t i o n i n g among community and c l i n i c a l groups: A panel model. J o u r n a l of B e h a v i o r a l Medicine, 5, 295-311. 125 B i r k e l , R.C., & R e p p u c c i , N.D. ( 1 9 8 3 ) . S o c i a l n e t w o r k s , i n f o r m a t i o n - s e e k i n g , and the u t i l i z a t i o n of s e r v i c e s . American J o u r n a l of Community Psychology, 11, 185-205. Bishop, S.M. (1984). P e r s p e c t i v e s on i n d i v i d u a l - f a m i l y - s o c i a l network i n t e r r e l a t i o n s . I n t e r n a t i o n a l J o u r n a l of Family  Therapy. 6, 124-135. Blackman, S., & G o l d s t e i n , K. (1967). R e c i p r o c i t y networks i n the community and m a n i f e s t p s y c h o l o g i c a l symptomatology. Unpublished paper. Presented at the 38th Annual Meeting of the E a s t e r n P s y c h o l o g i c a l A s s o c i a t i o n , Boston. B l i s h e n , B. ( 1 9 6 7 ) . A socioeconomic index f o r occupations i n Canada. Canadian Review of So c i o l o g y and Anthropology, 4_, 41-53. B l i s h e n , B. , & McRoberts, H.A. (1976). A r e v i s e d socioeconomic index f o r occupations i n Canada. Canada Review of S o c i o l o g y  and Anthropology, 13., 71-79. B o i s s e v a i n , J . , & M i t c h e l l , J.C. (Eds.)(1973). Network a n a l y s i s ;  S t u d i e s i n human i n t e r a c t i o n . The Hague, N e t h e r l a n d s : Morton. B o i s s e v a i n , J . ( 1 9 7 4 ) . F r i e n d s o f f r i e n d s : N e t w o r k s ,  manipulators and c o a l i t i o n s . NY: S t . Martin's Press. B r e i e r , A. & S t r a u s s , J . S . ( 1 9 8 4 ) . The r o l e o f s o c i a l r e l a t i o n s h i p s i n the r e c o v e r y from p s y c h o t i c d i s o r d e r s . American J o u r n a l of P s y c h i a t r y , 141, 949-955. Broadhead, W.E., K a p l a n , B.H., Sherman, A . J . , Wagner, E.H., Schoenbach, V.J., Grimson, R., S i e g f r i e d , H., T i b b l i n , G., & Gehlbach, S.H. (1983). The e p i d e m i o l o g i c e v i d e n c e f o r a r e l a t i o n s h i p between s o c i a l support and h e a l t h . American  J o u r n a l of Epidemiology, 117, 521-537. Bronfenbrenner, U. (1977). Toward an experimental e c o l o g y o f , human development. American P s y c h o l o g i s t , 32, 513-531. B r o n f e n b r e n n e r , U. (1979). The ecology of human development. Cambridge, Mass.: Harvard U n i v e r s i t y P r e s s . Brown, G., B h r o l c h a i n , M., & H a r r i s , T. (1975). S o c i a l c l a s s and p s y c h i a t r i c d i s t u r b a n c e among women i n an urban p o p u l a t i o n . S o c i o l o g y , 9, 225-254. Bruch, H. (1973). E a t i n g d i s o r d e r s : O besity, a n o r e x i a nervosa,  and the person w i t h i n . NY: B a s i c Books. 126 Bruch, H. (1977). P s y c h o l o g i c a l antecedents of anorexia nervosa. In R.A. V i g e r s k y (Ed.), Anorexia nervosa (pp. 1-10). NY: Raven P r e s s . B r u c h , H. ( 1 9 7 8 ) . The g o l d e n cage: The enigma of anorexia  nervosa. Cambridge, Mass.: Harvard U n i v e r s i t y P r e s s . Brugha, T.S. (1984). P e r s o n a l l o s s e s and d e f i c i e n c i e s i n s o c i a l networks. S o c i a l P s y c h i a t r y , 19, 69-74. Brugha, T.S., Conroy, R., Walsh, N., Delaney, W. , O'Hanlon, J . , Dondero, E. , D a l y , L. , H i c k e y , N., & Bourke, G. (1982). S o c i a l networks, attachments and support i n minor a f f e c t i v e d i s o r d e r s . B r i t i s h J o u r n a l of P s y c h i a t r y , 141, 249-255. Bruhn, J.G., P h i l i p s , B.U. (1987). A d e v e l o p m e n t a l b a s i s f o r s o c i a l s u p p o r t . J o u r n a l of B e h a v i o r a l Medicine, 10, 213-229. Burt, R.S. (1980). Models of network s t r u c t u r e . Annual Review  of S o c i o l o g y . 6, 79-141. Burt, R.S. (1981). Studying s t a t u s / r o l e s e t s as e r s a t z network p o s i t i o n s i n mass s u r v e y s . S o c i o l o g i c a l Methods and  Research, 9_, 313-337. B u r t , R.S. ( 1 9 8 2 ) . Toward a s t r u c t u r a l t h e o r y of a c t i o n :  Network models of s o c i a l s t r u c t u r e , p e r c e p t i o n , and a c t i o n . NT: Academic P r e s s . B u r t , R.S., & M i n o r , M.J. ( E d s . ) ( 1 9 8 2 ) . A p p l i e d network  a n a l y s i s . B e v e r l y H i l l s , CA: Sage. C a n t w e l l , C P . , S t u r z e n b e r g e r , S., B u r r o u g h s , J . ( 1 9 7 7 ) . A n o r e x i a n e r v o s a : An a f f e c t i v e d i s o r d e r ? A r c h i v e s of  General P s y c h i a t r y . 3_4, 1087-1093. Cauce, A.M. ( 1 9 8 6 ) . S o c i a l networks and s o c i a l competence: E x p l o r i n g the e f f e c t s of e a r l y a d o l e s c e n t f r i e n d s h i p s . American J o u r n a l of Community Psychology, 14, 607-628. C l a r k , A.W., & C u l l e n , W.S. (1974). S o c i a l support: A counter to pathogenic communication. I n t e r p e r s o n a l Development, 5_, 50-59. Cohen, C.I., & A d l e r , A. (1986). Assessing the r o l e of s o c i a l network i n t e r v e n t i o n s w i t h an i n n e r - c i t y p o p u l a t i o n . American J o u r n a l of O r t h o p s y c h i a t r y , 56, 278-288. Cohen, C.I., & Sokolovsky, J . (1978). S c h i z o p h r e n i a and s o c i a l n e t w o r k s : E x - p a t i e n t s i n the i n n e r c i t y . S c h i z o p h r e n i a B u l l e t i n , 4, 546-560. 127 Cohen, C.I., T e r e s i , J . , & Holmes, D. (1 9 8 6 ) . Assessment of s t r e s s - b u f f e r i n g e f f e c t s of s o c i a l networks on p s y c h o l o g i c a l symptoms i n an i n n e r - c i t y e l d e r l y p o p u l a t i o n . American  J o u r n a l of Community Psychology, 14, 75-91. Cohen, S., & Syme, S.L. ( 1 9 8 5 ) . I s s u e s i n t h e s t u d y and a p p l i c a t i o n of s o c i a l s u p p o r t . In S. Cohen & S.L. Syme (E d s . ) , S o c i a l support and h e a l t h (pp. 3-22). NY: Academic Pr e s s . Cohen, S., & W i l l s , T.A. (1985). S t r e s s , s o c i a l support, and the b u f f e r i n g h y p o t h e s i s . P s y c h o l o g i c a l B u l l e t i n . 98, 310-357. C o l l e t t a , N.D. (1987). C o r r e l a t e s of young mothers' network o r i e n t a t i o n s . J o u r n a l of Community Psychology, 15, 149-160. Conger, R.D. (1981). The assessment of d y s f u n c t i o n a l f a m i l y s y s t e m s . In B.B. Lakey & A.E. Kazdin ( E d s . ) , Advances i n c l i n i c a l c h i l d p s y c h o l o g y ( 4 t h Ed., pp. 199-242). NY: Plenum P r e s s . Coyne, J.C., & DeLongis, A. (1986). Going beyond s o c i a l support: The r o l e of s o c i a l r e l a t i o n s h i p s i n a d a p t a t i o n . J o u r n a l of  C o n s u l t i n g and C l i n i c a l Psychology, 54, 454-460. C r i s p , A.H. (1970). P r e m o r b i d f a c t o r s i n a d u l t d i s o r d e r s o f weight with p a r t i c u l a r r e f e r e n c e to primary a n o r e x i a nervosa ( w e i g h t p h o b i a ) : A l i t e r a t u r e r e v i e w . J o u r n a l o f  Psychosomatic Research, 14, 1-22. C r i s p , A.H. (1977). D i a g n o s i s and outcome of anorexia nervosa: The S t . George's view. Proceedings of the Royal S o c i e t y of  Medicine. 70, 464-470. C r i s p , A.H. ( 1 9 8 0 ) . A n o r e x i a n e r v o s a : L e t me be. London: Academic P r e s s . C r i s p , A.H., Hsu, L.K.G., Harding, B., & Hartshorn, J . (1980). C l i n i c a l f e a t u r e s o f a n o r e x i a n e r v o s a . J o u r n a l o f  Psychosomatic Research, 24, 179-191. C u t r o n a , C.E. (1 9 8 6 a ) . B e h a v i o r a l m a n i f e s t a t i o n s of s o c i a l s u p p o r t : A m i c r o a n a l y t i c i n v e s t i g a t i o n . J o u r n a l of  P e r s o n a l i t y and S o c i a l Psychology, 51, 201-208. C u t r o n a , C.E. (1 9 8 6 b ) . O b j e c t i v e d e t e r m i n a n t s of p e r c e i v e d s o c i a l support. J o u r n a l of P e r s o n a l i t y and S o c i a l  Psychology, 50, 349-355. D a l l y , P., & Gomez, (1979). A n o r e x i a n e r v o s a . London: W. Heinneman Medical Books. I 128 D ' A u g e l l i , A. (1983). S o c i a l support networks i n mental h e a l t h . In J.K. W h i t t a k e r & J . G a r b a r i n o ( E d s . ) , S o c i a l support  networks: Informal h e l p i n g i n the human s e r v i c e s (pp. 71-106). NY: A l d i n e P u b l i s h i n g Go. Dohrenwend, B.S., & Dohrenwend, B.P. (1981a). Socioenvironmental f a c t o r s , s t r e s s , and psychopathology. American J o u r n a l of  Community Psychology, 9_, 128-159. Dohrenwend, B.S., & Dohrenwend, B.P. (1981b). The 1980 d i v i s i o n 27 award f o r d i s t i n g u i s h e d c o n t r i b u t i o n s t o community psychology and community mental h e a l t h . American J o u r n a l of  Community Psychology, 9_, 123-164. D u n k e l - S c h e t t e r , C , Folkman, S., & L a z a r u s , R.S. (1 9 8 7 ) . C o r r e l a t e s o f s o c i a l s u p p o r t r e c e i p t . J o u r n a l o f  P e r s o n a l i t y and S o c i a l Psychology, 53, 71-80. Dunn, W.N. (1983). S o c i a l network theory. Knowledge, 4_, 453-461. E c k e r t , E.D. (1985). C h a r a c t e r i s t i c s of anor e x i a nervosa. In J . E . M i t c h e l l ( E d . ) , A n o r e x i a n e r v o s a and b u l i m i a :  D i a g n o s i s a nd t r e a t m e n t ( p p . 3 - 2 8 ) . M i n n e a p o l i s : U n i v e r s i t y of Minnesota P r e s s . E l l , K. ( 1 9 8 4 ) . S o c i a l networks, s o c i a l support, and h e a l t h s t a t u s : A review. S o c i a l S e r v i c e Review, 58, 133-149. E r i c k s o n , G.D. (1984). A framework and themes f o r s o c i a l network i n t e r v e n t i o n . Family Process, 23, 187-198. E r i c k s o n , G.D. ( 1 9 7 5 ) . The c o n c e p t of p e r s o n a l network i n c l i n i c a l p r a c t i c e . Family Process, 14, 487-498. Famuyiwa, 0.0., & Olatokunbo, M.A. (1984). S o c i a l networks of N i g e r i a n p s y c h i a t r i c p a t i e n t s . The I n t e r n a t i o n a l J o u r n a l of  S o c i a l P s y c h i a t r y , 30, 231-239. Feldman, W., Feldman, E., & Goodman, J.T. (1988). C u l t u r e versus b i o l o g y : C h i l d r e n ' s a t t i t u d e s toward t h i n n e s s and f a t n e s s . P e d i a t r i c s , 81, 190-194. F i o r e , J . , B e c k e r , J . , & Coppel, D.B. (1983). S o c i a l network i n t e r a c t i o n s : A b u f f e r or a s t r e s s . American J o u r n a l of  Community Psychology, 11, 423-439. F i n l a y s o n , A. (1 9 7 6 ) . S o c i a l networks as c o p i n g r e s o u r c e s . S o c i a l Science and Medicine, 10., 97-103. F i s c h e r , C S . (1982). To dwell among f r i e n d s : P e r s o n a l networks  i n town and c i t y . Chicago: U n i v e r s i t y of Chicago Press. 129 F i s c h e r , C.S., Jackson, R., Stueve, C. , Gerson, K., Jo n e s , L. (1977). Networks and p l a c e s : S o c i a l r e l a t i o n s i n the urban  s e t t i n g . NY: Free P r e s s . F l a h e r t y , J.A., & Richman, J.A. (1986). E f f e c t s of childhood r e l a t i o n s h i p s on the a d u l t ' s c a p a c i t y t o f o r m s o c i a l supports. American J o u r n a l of P s y c h i a t r y , 143, 851-855. F r o l a n d , C , B r o d s k y , G., O l s o n , M. , & S t e w a r t , L. ( 1 9 7 9 ) . S o c i a l s u p p o r t and s o c i a l a d j u s t m e n t : I m p l i c a t i o n s f o r m e n t a l h e a l t h p r o f e s s i o n a l s . Community M e n t a l H e a l t h  J o u r n a l . 15., 82-93. G a r f i n k e l , P.E., & Garner, D..M. (1982). Anorexia nervosa: A  mu l t i d i m e n s i o n a l p e r s p e c t i v e . NY: Brunner/Mazel. G a r n e r , D.M., G a r f i n k e l , P.E., & 0'Shaughnessy, M. ( 1 9 8 3 ) . C l i n i c a l and p s y c h o m e t r i c c o m p a r i s o n between b u l i m i a i n a n o r e x i a and b u l i m i a i n n o r m a l w e i g h t women. I n Understanding Anorexia Nervosa and B u l i m i a : Report of the Fourth Ross Conference on Medical Research. Columbus, Ohio: Ross L a b o r a t o r i e s . G a r r i s o n , J . E . (1981). C l i n i c a l c o n s t r u c t i o n of a c t i o n s o c i a l networks. I n t e r n a t i o n a l J o u r n a l of Family Therapy, Winter, 258- 267. G a r r i s o n , V. (1978). Support systems of s c h i z o p h r e n i c and non-s c h i z o p h r e n i c Puerto Rican migrant women i n New York C i t y . S c h i z o p h r e n i a B u l l e t i n , 4_, 561-596. G l a s s , G.V., & Ho p k i n s , K.D. (1 9 8 4 ) . S t a t i s t i c a l methods i n  education and psychology (2nd Ed.). Englewood C l i f f s , Jew J e r s e y : P r e n t i c e - H a l l , Inc. Gore, S. (1981). S t r e s s - b u f f e r i n g f u n c t i o n s of s o c i a l supports: An a p p r a i s a l and c l a r i f i c a t i o n of r e s e a r c h models. In B.S. Dohrenwend & B.P. Dohrenwend ( E d s . ) , S t r e s s f u l l i f e events  and t h e i r c o ntexts (pp. 202-222). NY: P r o d i s t . G o t t l i e b , B.H. (1 9 7 8 ) . The development and a p p l i c a t i o n of a c l a s s i f i c a t i o n scheme o f i n f o r m a l h e l p i n g b e h a v i o r s . Canadian J o u r n a l of B e h a v i o r a l S c i e n c e , 10, 105-115. G o t t l i e b , B.H. (1979). The primary group as s u p p o r t i v e m i l i e u : A p p l i c a t i o n s to community psychology. American J o u r n a l of  Community Psychology, 7_, 469-480. G o t t l i e b , B.H. ( 1 9 8 3 a ) . S o c i a l s u p p o r t as a f o c u s f o r i n t e g r a t i v e r e s e a r c h i n psychology. American P s y c h o l o g i s t , 38, 278-287. 130 G o t t l i e b , B.H. (1983b). S o c i a l support s t r a t e g i e s : G u i d e l i n e s  f o r mental h e a l t h p r a c t i c e . B e v e r l y H i l l s , CA: Sage. , Gough, H.G. (1968). An i n t e r p r e t e r ' s s y l l a b u s f o r the C a l i f o r n i a P s y c h o l o g i c a l Inventory. In P. McReynolds (Ed.), Advances  i n p s y c h o l o g i c a l assessment ( V o l . 1, pp. 53-79). Palo A l t o : Science & Behavior Books, Inc. Gough, H.G. (1975). C a l i f o r n i a P s y c h o l o g i c a l Inventory manual. Palo A l t o : C o n s u l t i n g P s y c h o l o g i s t Press, Inc. Gourash, N. (1978). Help-seeking: A review of the l i t e r a t u r e . American J o u r n a l of Community Psychology, 6_, 413-421. G r a n o v e t t e r , M. (1973). The s t r e n g t h of weak t i e s . American  J o u r n a l of S o c i o l o g y , 78, 1360-1380. G r a n o v e t t e r , M. (1983). The s t r e n g t h of weak t i e s : A network theory r e v i s i t e d . In R. C o l l i n s (Ed.), S o c i o l o g i c a l theory  1983 (pp. 201-233). San F r a n c i s c o : Jossey-Bass. G r e e n b l a t t , M. , B e c e r r a , R.M., & S e r a f e t i n i d e s , E.A. (1982). S o c i a l networks and mental h e a l t h : An overview. American  J o u r n a l of P s y c h i a t r y , 139, 977-984. G r i f f i t h , J . (1985). S o c i a l support p r o v i d e r s : Who are they? Where are t h e y met? and t h e r e l a t i o n s h i p of n e t w o r k c h a r a c t e r i s t i c s to p s y c h o l o g i c a l d i s t r e s s . B a s i c and ^ A p p l i e d S o c i a l Psychology, 6_, 41-60. G r i g g , D a r r y l N. ( 1 9 8 6 ) . F a m i l y t r a n s a c t i o n a l p a t t e r n s a s s o c i a t e d w i t h t h e symptom o f a n o r e x i a n e r v o s a . Unpublished M.A. t h e s i s , the U n i v e r s i t y of B r i t i s h Columbia, Vancouver, Canada. H a l l , A., & Wellman, B. ( 1 985). S o c i a l networks and s o c i a l support. In S. Cohen & S.L. Syme ( E d s . ) , S o c i a l s u p p o r t  and h e a l t h (pp. 3-22). NY: Academic Press. Hammer, M. ( 1 9 6 3 ) . I n f l u e n c e of a s m a l l s o c i a l networks as f a c t o r s on mental h o s p i t a l admission. Human O r g a n i z a t i o n , 22, 243-251. Hammer, M. (1980). S o c i a l access and the c l u s t e r i n g of p e r s o n a l c o n n e c t i o n s . S o c i a l Networks, 2_, 305-325. Hammer, M. (1981a). S o c i a l networks and the long term p a t i e n t . In S. Budson & M. Barofsky ( E d s . ) , The c h r o n i c p s y c h i a t r i c  p a t i e n t i n the community: P r i n c i p l e s of treatment. NY: Spectrum. 131 Hammer, M. (198 1 b ) . S o c i a l s u p p o r t s , s o c i a l n etworks, and s c h i z o p h r e n i a . S c h i z o p h r e n i a B u l l e t i n , 7_» 45-57. Hammer, M. (1983). "Core" and " e x t e n d e d " s o c i a l networks i n r e l a t i o n t o h e a l t h and i l l n e s s . S o c i a l S c i e n c e and  Medicine. 17, 405-411. Hammer, M. , Makiesky-Barrow, S., & Gutwirth, L. (1978). S o c i a l networks and s c h i z o p h r e n i a . S c h i z o p h r e n i a B u l l e t i n , 4_, 522-545. H a r d i n g , Thomas P., & L a c h e n m e y e r , J.R. ( 1 9 8 6 ) . F a m i l y i n t e r a c t i o n p a t t e r n s and lo c u s of c o n t r o l as p r e d i c t o r s of the presence and s e v e r i t y of anor e x i a nervosa. J o u r n a l of  C l i n i c a l Psychology. 42, 440-448. Hase, H.D. , & G o l d b e r g , L.R. (1967). Comparative v a l i d i t y of d i f f e r e n t s t r a t e g i e s of c o n s t r u c t i n g p e r s o n a l i t y i n v e n t o r y s c a l e s . P s y c h o l o g i c a l B u l l e t i n , 67, 231-248. Hatsukami, Dorothy K. , M i t c h e l l , J . E . , & E c k e r t , E.D. (1 9 8 4 ) . E a t i n g d i s o r d e r s : A v a r i a n t of mood d i s o r d e r s ? P s y c h i a t r i c  C l i n i c s of North America. 7_, 349-365. Hays, R.B., Oxley, D. (1986). S o c i a l network development and f u n c t i o n i n g d u r i n g a l i f e t r a n s i t i o n . J o u r n a l o f  P e r s o n a l i t y and S o c i a l Psychology, 50, 305-313. H e l l e r , K. (1979). The e f f e c t s of s o c i a l support: P r e v e n t i o n and treatment i m p l i c a t i o n s . In A.P. G o l d s t e i n & F.H. Kanfer (E d s . ) , Maximizing treatment g a i n s : T r a n s f e r enhancement i n  psychotherapy. NY: Academic P r e s s . H e l l e r , K. , & Lakey, B. (1985). P e r c e i v e d support and s o c i a l i n t e r a c t i o n among f r i e n d s and c o n f i d a n t s . In I.G. Sarason & B.R. Sarason ( E d s . ) , S o c i a l support: Theory, r e s e a r c h , and  a p p l i c a t i o n s (pp. 287-300). The Hague, The Netherlands: Martinus N i j h o f f . H e l l e r , K. , & Swindle, R.W. (1983). S o c i a l networks, p e r c e i v e d s o c i a l support, and coping w i t h s t r e s s . In R.D. F e l n e r , L.A. Jason, J . Moritsugu, & S.S. Farber ( E d s . ) , P r e v e n t i v e  p s y c h o l o g y : T h e o r y , r e s e a r c h and p r a c t i c e i n community  psychology (pp. 87-103). Elmsford, NY: Pergamon. H e n d e r s o n , S. (1981). S o c i a l r e l a t i o n s h i p s , a d v e r s i t y and n e u r o s i s : An a n a l y s i s of p r o s p e c t i v e o b s e r v a t i o n s . B r i t i s h  J o u r n a l of P s y c h i a t r y , 138, 391-398. 132 Henderson, S. (1982). The s i g n i f i c a n c e of s o c i a l r e l a t i o n s h i p s i n the e t i o l o g y of n e u r o s i s . In CM. Parkes & J . Stevenson ( E d s . ) , The p l a c e of attachment i n human behavior (pp. 205-231). NY: B a s i c Books. H e n d e r s o n , S. ( 1 9 8 4 ) . I n t e r p r e t i n g the e v i d e n c e on s o c i a l support. S o c i a l P s y c h i a t r y , 19, 49-52. Henderson, S., Bryne, D.C, & Duncan-Jones, P. (1981). Neurosis  and the s o c i a l environment. A u s t r a l i a : Academic Press. Henderson, S., Byrne, D.C, Duncan-Jones, P., Adcock, S., S c o t t , R. , & S t e e l e , G.P. ( 1 9 7 8 a ) . S o c i a l b o n d s i n t h e e p i d e m i o l o g y of n e u r o s i s : A p r e l i m i n a r y communication. B r i t i s h J o u r n a l of P s y c h i a t r y , 132, 463-466. Henderson, S., Byrne, D . C , Duncan-Jones, P., S c o t t , R., & Adcock, S. ( 1 9 8 0 ) . S o c i a l r e l a t i o n s h i p s , a d v e r s i t y , and n e u r o s i s : A study of a s s o c i a t i o n s i n a general p o p u l a t i o n sample. B r i t i s h J o u r n a l of P s y c h i a t r y , 136, 574-583. Henderson, S., Duncan-Jones, P., McAuley, H., & R i t c h i e , K. (1978b). The p a t i e n t ' s primary group. B r i t i s h J o u r n a l of  P s y c h i a t r y . 132. 74-86. Henderson, S., Duncan-Jones, P., Byrne, D.C, Adcock, S., and S c o t t , R. (1979). Neurosis and s o c i a l bonds i n an urban p o p u l a t i o n . A u s t r a l i a n and New Z e a l a n d J o u r n a l o f  P s y c h i a t r y . L3, 121-125. Henderson, S., & Moran, P.A.P. ( 1 9 8 3 ) . S o c i a l r e l a t i o n s h i p s d u r i n g the onset and r e m i s s i o n of n e u r o t i c symptoms: A p r o s p e c t i v e community study. B r i t i s h J o u r n a l of P s y c h i a t r y , 143. 467-472. Her z o g , D a v i d B. (1984). Are a n o r e x i c and b u l i m i c p a t i e n t s depressed? American J o u r n a l of P s y c h i a t r y . 141, 1594-1597. H e r z o g , D.B., & Copeland, P.M. (1985). E a t i n g d i s o r d e r s . The  New England J o u r n a l of Medicine. 313. 295-303. Herzog, D.B., Pepose, M., Norman, D.K., & R i g o t t i , N.A. (1985). E a t i n g d i s o r d e r s and s o c i a l maladjustment i n female medical students. The J o u r n a l of Nervous and Mental Disease. 173, 734-737. H i r s c h , B . J . n e t w o r k s : Community ( 1 9 7 9 ) . P s y c h o l o g i c a l A m u l t i m e t h o d a n a l y s i s . Psychology. 7, 263-277. d i m e n s i o n s of s o c i a l American J o u r n a l of 133 H i r s c h , B.J. (1980). N a t u r a l support systems and c o p i n g w i t h m a j o r l i f e c h a n g e s . A m e r i c a n J o u r n a l o f Community  Psychology. 8_, 159-172. H i r s c h , B . J . (1981). S o c i a l networks and the coping process: C r e a t i n g p e r s o n a l communities. In B. G o t t l i e b (Ed.), S o c i a l  networks and s o c i a l support. Beverly H i l l s : Sage. H i r s c h , B.J. (1985). S o c i a l networks and the ecology of human development: Theory, r e s e a r c h and a p p l i c a t i o n . In I.G. S a r a s o n & B.R. S a r a s o n ( E d s . ) , S o c i a l s u p p o r t : Theory,  r e s e a r c h , and a p p l i c a t i o n s (pp. 117-136). The Hague, The Netherlands: Martinus N i j h o f f . H i r s c h , B.J., & J o l l y , E.A. (1982). Role t r a n s i t i o n s and s o c i a l networks: S o c i a l support f o r m u l t i p l e r o l e s . In V.L. A l l e n & E. van de V l i e r t ( E d s . ) , Role t r a n s i t i o n s : E x p l o r a t i o n s  and e x p l a n a t i o n s (pp. 39-51). NY: Plenum P r e s s . Hoffman, L. (1981). Foundations of f a m i l y therapy. NY: B a s i c Books. Holahan, C.J., Wilcox, B.L. (1978). R e s i d e n t i a l s a t i s f a c t i o n and f r i e n d s h i p formation i n h i g h - and l o w - r i s e student housing: an i n t e r a c t i o n a l a n a l y s i s . J o u r n a l of E d u c a t i o n a l  Psychology, 70, 237-241 H o l l a n d , P.W., & L e i n h a r d t , S. (1979). S t r u c t u r a l sociometry. In S. L e i n h a r d t & P.W. H o l l a n d ( E d s . ) , P e r s p e c t i v e s i n  s o c i a l network a n a l y s i s . NY: Academic P r e s s . Horwitz. A. (1977a). S o c i a l networks and pathways to p s y c h i a t r i c treatment. S o c i a l F orces, 56., 86-105. Horwitz, A. (1977b). The pathways i n t o p s y c h i a t r i c t r e a t m e n t : Some d i f f e r e n c e s between men and women. J o u r n a l of Health  and S o c i a l Behavior, !18, 169-178. H o r w i t z , A . ( 1 9 7 8 ) . F a m i l y , k i n and f r i e n d n e t w o r k s i n p s y c h i a t r i c h e l p s e e k i n g . S o c i a l Science and Medicine, 12, 297-304. House, J.S. (1981). Work s t r e s s and s o c i a l support. Reading, Mass: Addison-Wesley. House, J.S., & Kahn, R.L. (with the a s s i s t a n c e of J.D. McLeod and D. W i l l i a m s ) ( 1 9 8 5 ) . Measures and c o n c e p t s o f s o c i a l s u p p o r t . In S. Cohen & S.L. Syme ( E d s . ) , S o c i a l support  and h e a l t h (pp. 83-108). NY: Academic P r e s s . Hsu, L.K.G., C r i s p , A.H., & H a r d i n g , B. ( 1 9 7 9 ) . Outcome of anorexia nervosa. Lancet, 1, 61-65. 134 Hsu, L.K.G. (1980). Outcome of anorexia nervosa. A review of the l i t e r a t u r e (1954-1978). A r c h i v e s of General P s y c h i a t r y , 37, 1041-1046. Humphrey, Laura L. (1986). S t r u c t u r a l a n a l y s i s of p a r e n t - c h i l d r e l a t i o n s h i p s i n e a t i n g d i s o r d e r s . J o u r n a l of Abnormal  Psychology, 95, 395-402. Humphrey, L a u r a L., A p p l e , R.F., & Kirschenbaum, D.S. (1986). D i f f e r e n t i a t i n g b u l i m i c - a n o r e x i c from normal f a m i l i e s using i n t e r p e r s o n a l and b e h a v i o r a l o b s e r v a t i o n a l systems. J o u r n a l  of C o n s u l t i n g and C l i n i c a l Psychology, 54, 190-195. Hurd, G.S., Lex, B.W., & P a t t i s o n , E.M. (1981a). Congruence of p e r s o n a l s o c i a l n e t w o r k s and m a r i t a l s a t i s f a c t i o n . Unpublished paper. Presented at the American A s s o c i a t i o n f o r the Advancement of Science Meetings (January)* Toronto, Canada. Hurd, G.S,, Llamas, R., & P a t t i s o n , E.M. (1980). The s t r u c t u r e and f u n c t i o n of normal s o c i a l networks. Unpublished paper, Department of P s y c h i a t r y , M e d i c a l C o l l e g e of Georgia. Hurd, G.S., P a t t i s o n , E.M., & Llamas, R. (1981b). Models of s o c i a l network i n t e r v e n t i o n . I n t e r n a t i o n a l J o u r n a l of  Family Therapy, 3_, 246-257. Hurd, G.S., P a t t i s o n , E.M., & Smith, J.E. (1981c). T e s t s , r e -t e s t r e l i a b i l i t y of s o c i a l network s e l f r e p o r t s : The P a t t i s o n P s y c h o s o c i a l Inventory (PPI). Unpublished paper. P r e s e n t e d to t h e Sun B e l t S o c i a l N etwork C o n f e r e n c e ( F e b r u a r y ) , Tampa, F l o r i d a . I r w i n , M. ( 1 9 8 4 ) . E a r l y o n s e t a n o r e x i a n e r v o s a . S o u t h e r n  M e d i c a l J o u r n a l , 77, 611-614. I s r a e l , B.A. (1982). S o c i a l networks and h e a l t h s t a t u s : L i n k i n g t h e o r y , r e s e a r c h , and p r a c t i c e . P a t i e n t C o u n s e l l i n g and  Health Education, 4, 65-79. J a c k s o n , D.D. (1967). The i n d i v i d u a l and the l a r g e r c o n t e x t s . Family Process, 6, 139-147. J a c o b , T. (1975). Family i n t e r a c t i o n s In d i s t u r b e d and normal f a m i l i e s : A m e t h o d o l o g i c a l and s u b s t a n t i v e r e v i e w . P s y c h o l o g i c a l B u l l e t i n , 82, 33-65. J a c o b s o n , D.E. ( 1 9 8 6 ) . Types and t i m i n g of s o c i a l s u p p o r t . J o u r n a l of Health and S o c i a l Behavior, 27, 250-264. Jones, D. (1981). S t r u c t u r a l d i s c o n t i n u i t y and the development of a norexia nervosa. S o c i o l o g i c a l Focus, 14, 233-245. 135 J o n e s , L.M., & F i s c h e r , C S . ( 1 9 7 8 ) . S t u d y i n g e g o c e n t r i c networks by mass s u r v e y . Working paper #284. Berkeley: I n s t i t u t e of Urban and Regional Development, U n i v e r s i t y of C a l i f o r n i a . Jung, J . (1984). S o c i a l support and i t s r e l a t i o n to h e a l t h : A c r i t i c a l e v a l u a t i o n . B a s i c and Ap p l i e d S o c i a l Psychology, 5, 143-169. K a d u s h i n , C. ( 1 9 8 3 ) . M e n t a l h e a l t h and the i n t e r p e r s o n a l environment: A r e e x a m i n a t i o n of some e f f e c t s of s o c i a l s t r u c t u r e on mental h e a l t h . American S o c i o l o g i c a l Review, 48, 188-198. Kagan, D.M., & S q u i r e s , R.L. (1985). Family cohesion, f a m i l y a d a p t a b i l i t y , and e a t i n g behaviors among c o l l e g e s t u d e n t s . I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , 4_, 267-279. Kalucy, R.S., C r i s p , A.H., & Harding, B. (1977). A study of 56 f a m i l i e s with an o r e x i a nervosa. B r i t i s h J o u r n a l of Medical  Psychology, 50, 381-395. Katz , J a c k L. (1985). Some r e f l e c t i o n s on the nature of the e a t i n g d i s o r d e r s : On the need f o r h u m i l i t y . I n t e r n a t i o n a l  J o u r n a l of E a t i n g D i s o r d e r s , 4, 617-626. Katz, Jack L. (1987). E a t i n g d i s o r d e r and a f f e c t i v e d i s o r d e r : R e l a t i v e s or merely chance a c q u a i n t a n c e s ? Comprehensive  P s y c h i a t r y , 28, 220-228. K e s s l e r , R.C, & McLeod, J.D. (1985). S o c i a l support and mental h e a l t h i n community samples. In S. Cohen & S.L. Syme ( E d s . ) , S o c i a l s u p p o r t and h e a l t h (pp. 219-240). NY: Academic P r e s s . K e s s l e r , R.C, McLeod, J.D., & Wethington, E. (1985). The c o s t s of c a r i n g : A p e r s p e c t i v e on the r e l a t i o n s h i p between sex and p s y c h o l o g i c a l d i s t r e s s . In I . C Sarason & B.R. Sarason ( E d s . ) , S o c i a l support: Theory, r e s e a r c h , and a p p l i c a t i o n s (pp. 491-506). The Hague, The N e t h e r l a n d s : M a r t i n u s N i j h o f f . K e s s l e r , R . C , P r i c e , R.H., & Wortman, C.B, (1 9 8 5 ) . S o c i a l f a c t o r s i n psychopathology: S t r e s s , s o c i a l s u p p o r t , and coping p r o c e s s e s . Annual Review of Psychology, 36, 531-572. K i e s l e r , C.A. (1985). P o l i c y i m p l i c a t i o n s of r e s e a r c h on s o c i a l support and h e a l t h . In S. Cohen & S.L. Syme (E d s . ) , S o c i a l  support and h e a l t h (pp. 347-364). NY: Academic P r e s s . 136 K l e i n e r , R.J. ( 1 9 8 4 ) . The s o c i a l network as an e t i o l o g i c a l f a c t o r i n mental i l l n e s s and as a t h e r a p e u t i c approach. In V. H u d o l i n ( E d . ) , S o c i a l p s y c h i a t r y (pp. 307-328). NY: Plenum P r e s s . K l e i n e r , R.J., & Parker, S. (1976). Network p a r t i c i p a t i o n and p s y c h o s o c i a l impairment i n an urban e n v i r o n m e n t . In P. Meadows & E. H. M i z r u c h i ( E d s . ) , Urbanism, u r b a n i z a t i o n , and  change. Reading, MA: Addison-Wesley. K l i m a n , J . , & T r i m b l e , D.W. (1983). Network therapy. In B. Wolman & G. S t r i e k e r ( E d s . ) , The handbook of f a m i l y and  m a r i t a l therapy.. NY: Plenum P r e s s . Kog, E., P i e r l o o t , R., & Vandereycken, W. (1983). M e t h o d o l o g i c a l c o n s i d e r a t i o n s of f a m i l y r e s e a r c h i n a n o r e x i a n e r v o s a . I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , 2_, 79-84. Kog, E., & Vandereycken, W, (1985). Family c h a r a c t e r i s t i c s of a n o r e x i a n e r v o s a and b u l i m i a : A r e v i e w of the r e s e a r c h l i t e r a t u r e . C l i n i c a l Psychology Review, 5_, 159-180. Kog, E., Vandereycken, W., & Vertommen, H. ( 1 9 8 5 ) . Towards a v e r i f i c a t i o n of the psy c h o s o m a t i c f a m i l y model: A p i l o t s t u d y of ten f a m i l i e s w i t h an a n o r e x i a / b u l i m i a n e r v o s a p a t i e n t . I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , 4_, 525-538. Laumann, E. (1973). Bonds of p l u r a l i s m : The form and substance  of urban s o c i a l networks. NY: Wiley. L a z a r u s , R.S., & Folkman.m S. (1984). S t r e s s , a p p r a i s a l , and  coping. NY: S p r i n g e r . Leavy, R.L. (1983). S o c i a l support and p s y c h o l o g i c a l d i s o r d e r : A review. J o u r n a l of Community Psychology, 11, 3-21. L e f f l e r , A., Krannich, R.S., & G i l l e s p i e , D.L. (1986). Contact, support, and f r i c t i o n : Three f a c e s of networks i n community l i f e . S o c i o l o g i c a l P e r s p e c t i v e s , 29, 337-355. Le i c h n e r , P. (1985). The epidemiology of anorexia and b u l i m i a . U n p u b l i s h e d paper, Department of P s y c h i a t r y , U n i v e r s i t y of Manitoba, Winnipeg, Manitoba, Canada. L e i c h n e r , P., A r n e t t , J . , Srikameswaran, S., & V u l c a n o , B. (1984). Screening f o r a n o r e x i a n e r v o s a and b u l i m i a i n a Can a d i a n s c h o o l age p o p u l a t i o n . Unpublished manuscript, Department of P s y c h i a t r y , U n i v e r s i t y of Manitoba, Winnipeg, Manitoba, Canada. 137 L e i n h a r d t , S. (Ed.,) (1977)* S o c i a l n e t w o r k s : A d e v e l o p i n g  paradigm.. NY: Academic Press. L e n a , S.M., G o l d b e r g , E . , & R o s s i , M. ( 1 9 8 5 ) . C l i n i c a l i m p l i c a t i o n s of e a r l y d i a g n o s i s and management of a n o r e x i a n e r v o s a i n 12 yea r o l d s . U n p u b l i s h e d paper, Adolescent M e d i c i n e C l i n i c , H o s p i t a l f o r S i c k C h i l d r e n , T o r o n t o , O n t a r i o , Canada. Leon, G.R., L u c a s , A.R., C o l l i g a n , R.C., Ferdinande, R.J., & Kamp, J . ( 1 9 8 5 ) . S e x u a l , body-image, and p e r s o n a l i t y a t t i t u d e s i n an o r e x i a nervosa. J o u r n a l of Abnormal C h i l d  Psychology. 1_3, 245-258. Litwak, E., & S z e l e n y i , I. (1969). Primary group s t r u c t u r e s and t h e i r f u n c t i o n s : K i n , n e i g h b o r s and f r i e n d s . American  S o c i o l o g i c a l Review, 34, 465-481. Llamas, R., P a t t i s o n , E.M., & Hurd, G. (1981). S o c i a l networks: A l i n k between p s y c h i a t r i c epidemiology and community mental h e a l t h . I n t e r n a t i o n a l J o u r n a l of Family Therapy, F a l l , 180-192. Marsden, P.V., & L i n , N. ( E d s . ) ( 1 9 8 2 ) . S o c i a l s t r u c t u r e and  network a n a l y s i s . B e v e r ly H i l l s , CA: Sage. M a r s e l l a , A.J. & Snyder, K.K. (1981). S t r e s s , s o c i a l supports, and s c h i z o p h r e n i c d i s o r d e r s : Toward an i n t e r a c t i o n a l model. S c h i z o p h r e n i a B u l l e t i n , J_, 152-163. M a s t e r s o n , J . F . ( 1 9 7 7 ) . P r i m a r y a n o r e x i a n e r v o s a i n the b o r d e r l i n e a d o l e s c e n t : An o b j e c t - r e l a t i o n s view. In P. H a r t o c o l l i s ( E d . ) , B o r d e r l i n e p e r s o n a l i t y d i s o r d e r s . NY: I n t e r n a t i o n a l U n i v e r s i t i e s P r e s s . M c K i n l a y , J.B. (1 9 7 3 ) . S o c i a l networks, l a y c o n s u l t a t i o n and hel p - s e e k i n g behavior. S o c i a l F o r c e s , 51, 275-292. Megargee, E . I . (1972). The C a l i f o r n i a P s y c h o l o g i c a l Inventory. San F r a n c i s c o : Jossey-Bass. M e h r a b i a n , A. ( 1 9 7 6 ) . Q u e s t i o n n a i r e measures of a f f i l i a t i v e t e n d e n c y and s e n s i t i v i t y to r e j e c t i o n . P s y c h o l o g i c a l  Reports, 38, 199-209. Mi l a r d o , R.M. (1987). Changes i n s o c i a l networks of women and men f o l l o w i n g d i v o r c e . J o u r n a l of Family Issues, 8_, 78-96. M i l l e r , Sharon, G. ( 1 9 8 4 ) . F a m i l y t h e r a p y o f t h e e a t i n g d i s o r d e r s . In P.S. Powers & R.C. Fernandez ( E d s . ) , Current  treatment of anorexia nervosa and b u l i m i a (pp. 92-112). NY: Karger Press. 138 Mintz, I r a L. (1980). Anorexia nervosa: The c l i n i c a l syndrome and i t s dynamic i m p l i c a t i o n s . The J o u r n a l of the Medical  S o c i e t y of New J e r s e y , 77, 333-339. Minuchin, S., Baker, L., Rosman, B.L., Liebman, R., Milman, L., & Todd, T.C. (1975). A c o n c e p t u a l model of p s y c h o s o m a t i c i l l n e s s i n c h i l d r e n . Family o r g a n i z a t i o n and f a m i l y therapy. A r c h i v e s of General P s y c h i a t r y , 32, 1031-1038. M i n u c h i n , S., Rosman, B*, & Baker, L. (1978)* Psychosomatic  f a m i l i e s : Anorexia nervosa i n context. London: Harvard U n i v e r s i t y P r e s s . M i t c h e l l , J.C. (1969). The concept and use of s o c i a l networks. In J.C. M i t c h e l l ( E d . ) , S o c i a l networks i n urban s i t u a t i o n s (pp. 1-50). Manchester, U.K.: Manchester U n i v e r s i t y P r e s s . M i t c h e l l , J*E., & E c k e r t , E.D. (1987). Scope and s i g n i f i c a n c e of e a t i n g d i s o r d e r s . J o u r n a l of C o n s u l t i n g and C l i n i c a l  Psychology, 5_5, 628-634. M i t c h e l l , R.E. (1982). S o c i a l networks and p s y c h i a t r i c c l i e n t s : The p e r s o n a l and environmental context. American J o u r n a l of  Community Psychology, 10, 387-401. M i t c h e l l , R.E., B i l l i n g s * A.G., & Moos, R.H. (1982). S o c i a l s u p p o r t and w e l l - b e i n g : I m p l i c a t i o n s f o r p r e v e n t i o n programs. J o u r n a l of Primary P r e v e n t i o n , 3_, 77-98. M i t c h e l l , R.E., & T r i c k e t t , E. J . ( 1 9 8 0 ) . Task f o r c e r e p o r t : S o c i a l networks as mediators of s o c i a l support. Community  Mental Health J o u r n a l , 16, 27-45i M o o s , R.H. ( 1 9 7 6 ) . The human c o n t e x t : E n v i r o n m e n t a l  determinants of behavior. NY: Wiley. Moos, R.H. (1984). C o n t e x t and c o p i n g : Toward a u n i f y i n g c o n c e p t u a l f r a m e w o r k . A m e r i c a n J o u r n a l of Community  Psychology, 12, 5-36. Moos, RiH., & Moos., B.S. (1981). F a m i l y E n v i r o n m e n t S c a l e  manual. Palo A l t o : C o n s u l t i n g P s y c h o l o g i s t s P r e s s . Morin, R., & Seidman, E. (1986). A s o c i a l network approach and the r e v o l v i n g door p a t i e n t . S c h i z o p h r e n i a B u l l e t i n , 12, 262-273. M u e l l e r , D.P. (1980). S o c i a l networks: A promising d i r e c t i o n f o r r e s e a r c h on the r e l a t i o n s h i p of the s o c i a l environment to p s y c h i a t r i c d i s o r d e r . S o c i a l Science & Medicine, 14, 147-161. 139 Nadlei-j A. (1986). Self-esteem and the seeking and r e c e i v i n g of he l p : T h e o r e t i c a l and e m p i r i c a l p e r s p e c t i v e s . Progress i n  Experimental and P e r s o n a l i t y Research, 14, 115-163. Neuman, P a t r i c i a A., & Halvorson, P.A. (1983). Anorexia nervosa  and b u l i m i a : A handbook f o r c o u n s e l l o r s and t h e r a p i s t s . NY: Van Nostrand Reinhold Company. N i c h o l s , Michael P. (1987). The s e l f i n the system: Expanding  the l i m i t s of f a m i l y therapy. NY: Brunner/Mazel. N o r r i s , D.L., & Jones, E. (1979). Anorexia n e r v o s a — A c l i n i c a l study of ten p a t i e n t s and t h e i r f a m i l y systems. J o u r n a l of  Adolescence, 2_, 101-111. Nylander, I. (1971). The f e e l i n g of being f a t and d i e t i n g i n a s c h o o l p o p u l a t i o n : An e p i d e m i o l o g i c i n t e r v i e w i n v e s t i g a t i o n . Acta Sociomedica S c a n d i n a v i c a , 3_, 17—26. Pagel, M.D., E r d l y , W.W., & Becker, J . (1987). S o c i a l networks: We get by w i t h (and i n s p i t e o f ) a l i t t l e help from our f r i e n d s . J o u r n a l of P e r s o n a l i t y and S o c i a l Psychology, 53, 793-804. P a t t i s o n , E.M. (1973). S o c i a l system psychotherapy. American  J o u r n a l of Psychotherapy, 17, 396-409. P a t t i s o n , E.M. (1976). P s y c h o s o c i a l system t h e r a p y . In R.G. H e r s c h o w i t z S B. Levy ( E d s . ) , The changing mental h e a l t h  scene (pp. 127-152). NY: Spectrum. P a t t i s o n , E.M. (1977a). A t h e o r e t i c a l - e m p i r i c a l base f o r s o c i a l system therapy. In E.F. F o u l k s , J . Westermeyer, & A.R. Favozza ( E d s . ) , Current p e r s p e c t i v e s i n c u l t u r a l p s y c h i a t r y (pp. 217-253). NY: Spectrum. P a t t i s o n , E.M. (1977b). C l i n i c a l s o c i a l systems i n t e r v e n t i o n s . P s y c h i a t r y D i g e s t , 38, 25-33. P a t t i s o n , E.M. ( 1 9 8 0 ) . I n t r o d u c t i o n : The s o c i a l network paradigm. I n t e r n a t i o n a l J o u r n a l of Family Therapy, Winter, 241-245. P a t t i s o n , E.M., D e F r a n e i s c o , D., Wood, P., F r a z i e r , H., & Crowder, J . (1975). A p s y c h o s o c i a l k i n s h i p model f o r f a m i l y therapy. American J o u r n a l of P s y c h i a t r y , 132, 1246-1251. P a t t i s o n , E.M., Llamas, R., & Hurd, G. (1979). S o c i a l network mediation of a n x i e t y . P s y c h i a t r i c Annals, 9_, 56-67. 140 P a t t i s o n , E.M., & P a t t i s o n , M.L. ( 1 9 8 1 ) . A n a l y s i s o f a s c h i z o p h r e n i c p s y c h o s o c i a l network. S c h i z o p h r e n i a B u l l e t i n , 7, 135-142. P e a r l i n , L . I . (1985). S o c i a l s t r u c t u r e and processes of s o c i a l support. In S. Cohen & S.L. Syme (Eds.)* S o c i a l support and  h e a l t h (pp. 3-22). NY: Academic P r e s s . Pearson, J.E. (1986)* The d e f i n i t i o n and measurement of s o c i a l s u p p o r t . J o u r n a l of Counseling and Development, 64, 390-395. P e r r u c c i , R. & T a r g , D. ( 1 9 8 2 ) . M e n t a l p a t i e n t s and s o c i a l  networks. Boston: Auburn House, P e r r u c c i , R., & Targ, D. (1982). Network s t r u c t u r e and r e a c t i o n s to primary deviance of mental p a t i e n t s . J o u r n a l of Health  and S o c i a l Behavior, 23, 2-17. P h i l l i p s , S. (1981). Network c h a r a c t e r i s t i c s r e l a t e d to the w e l l - b e i n g of normals: A comparative base. S c h i z o p h r e n i a  B u l l e t i n , 7, 117-123. P i a z z a , E., P i a z z a , N., & R o l l i n s , N. (1980). Anorexia nervosa: C o n t r o v e r s i a l aspects of therapy. Comprehensive P s y c h i a t r y , 21, 177-189. P i k t e l , H.M. (1986). Anorexia nervosa. Medicine, 36, 5299-5310. P i l i s u k , M,, & F r o l a n d , C. (1978). K i n s h i p , s o c i a l networks, s o c i a l support and h e a l t h . S o c i a l Science and Medicine, 12, 273-280. P o l i t s e r , P.E. (1980). Network a n a l y s i s and the l o g i c of s o c i a l support. In R.H. P r i c e & P.E. P o l i t s e r ( E d s . ) , E v a l u a t i o n  and a c t i o n i n the s o c i a l environment. NY: Academic P r e s s . P o l i t s e r , P.E.., & P a t t i s o n , E.M. (1979). Mental h e a l t h f u n c t i o n s of community groups. Group, 10, 19-26. P o l i t s e r , P.E.., & P a t t i s o n , E.M. ( 1 9 8 0 ) . S o c i a l c l i m a t e s i n community g r o u p s : Toward a taxonomy. Community Mental  Health J o u r n a l , 16, 187-200. P o r r i t t , D. ( 1 9 7 9 ) . S o c i a l s u p p o r t i n c r i s i s : q u a n t i t y or q u a l i t y ? S o c i a l Science & Medicine, 13, 715-721. Post, F. ( 1 9 6 2 ) . The s o c i a l o r b i t of p s y c h i a t r i c p a t i e n t s . J o u r n a l of Mental Science, 108, 759-771. 141 P o w e l l , D.R. ( 1 9 7 9 ) . F a m i l y - e n v i r o n m e n t a l n e t w o r k s and n e i g h b o r h o o d s . J o u r n a l of R e s e a r c h and Development i n  Education, 13, 1-11. Powers, P a u l i n e S., & Fernandez, R.C. (1984). I n t r o d u c t i o n . In P.S. Powers & R.C. Fernandez ( E d s . ) , Current treatment of  anorexia nervosa and b u l i m i a (pp. 1-17). NY: Karger Press. P r i c e , F.V. (1981). Only c o n n e c t ? I s s u e s i n c h a r t i n g s o c i a l networks. S o c i o l o g i c a l Review, 29, 283-312. Procidano, M.E., & H e l l e r , K. ( 1 9 8 3 ) . Measures of p e r c e i v e d s o c i a l s u p p o r t f r o m f r i e n d s and f r o m f a m i l y : Three v a l i d a t i o n s t u d i e s . A m e r i c a n J o u r n a l of Community  Psychology, 11, 1-24. Q u e v i l l o n , R., & T r e n e r r y , M.R. ( 1 9 8 3 ) . R e s e a r c h on r u r a l d e p r e s s i o n : I m p l i c a t i o n s of s o c i a l networks f o r theory and treatment. I n t e r n a t i o n a l J o u r n a l of Mental Health, 12, 45-61. R a t c l i f f e , W.D., & A z i m , H. ( 1 9 7 5 ) . S o c i a l n e t w o r k s of p s y c h i a t r i c p a t i e n t s and n o r m a l s . U n p u b l i s h e d p a p e r . Presented at the Canadian P s y c h i a t r i c Conference, B a n f f . Richman, J.A., & F l a h e r t y , J.A. (1985). S t r e s s , coping resources and p s y c h i a t r i c d i s o r d e r s : A l t e r n a t i v e paradigms from a l i f e c y c l e p e r s p e c t i v e . Comprehensive P s y c h i a t r y , 26, 456-465. R i l e y , D. , & E c k e n r o d e , J . ( 1 9 8 6 ) . S o c i a l t i e s : Subgroup d i f f e r e n c e s i n c o s t s and b e n e f i t s . J o u r n a l of P e r s o n a l i t y  and S o c i a l Psychology, 51, 770-778. Rogers, E.M., & K i n c a i d , D.L. (1981). Communication networks:  Toward a new paradigm f o r r e s e a r c h . NY: Free P r e s s . Rook, K.S. (1984). The n e g a t i v e s i d e of s o c i a l i n t e r a c t i o n : Impact on p s y c h o l o g i c a l w e l l - b e i n g . J o u r n a l of P e r s o n a l i t y  and S o c i a l Psychology, 46, 1097-1108. Rook, K.S. (1985). The f u n c t i o n s of s o c i a l bonds: P e r s p e c t i v e s from r e s e a r c h on s o c i a l s u p p o r t , l o n e l i n e s s and s o c i a l i s o l a t i o n . In I.G. Sarason & B.R. Sarason ( E d s . ) , S o c i a l  s u p p o r t : Theory, r e s e a r c h , and a p p l i c a t i o n s . The Hague, The Netherlands: Martinus N i j h o f f . Rosman, B.L., Minuchin, S., Baker, L. , & Liebman, R. (1977). A f a m i l y approach to a n o r e x i a nervosa: Study, treatment and outcome. In R.A. Vigersky (Ed.), Anorexia nervosa (pp. 341-348). NY: Raven Press. 142 Ross, J.L. (1977). Anorexia nervosa: An overview. B u l l e t i n of  the Menninger C l i n i c , .41, 418-436. R o t h e n b e r g , A l b e r t ( 1 9 8 6 ) . E a t i n g d i s o r d e r as a modern obsessive-compulsive syndrome. P s y c h i a t r y , 49, 45-53. R u s s e l l , Gerald F.M. (1985a). Premenarchal a n o r e x i a nervosa and i t s sequelae. J o u r n a l of P s y c h i a t r i c Research, 19, 363-369. R u s s e l l , Gerald F.M. (1985b). The changing nature of a n o r e x i a n e r v o s a : An i n t r o d u c t i o n to the conference. J o u r n a l of  P s y c h i a t r i c Research, 19,, 101-109. S a l l o w a y , J . C , & D i l l o n , P.B. (1973). A comparison of f a m i l y networks and f r i e n d networks i n h e a l t h c a r e u t i l i z a t i o n . J o u r n a l of Comparative Family S t u d i e s , 4_, 131-142. Sandler, I.N., & B a r r e r a , J r . , M. (1984). Toward a multimethod a p p r o a c h t o a s s e s s i n g t h e e f f e c t s of s o c i a l s u p p o r t . American J o u r n a l of Community Psychology, 12, 37-52. Sarason I . C , & Sarason, B.R. (1985). S o c i a l support - i n s i g h t s from assessment and experimentation. In I . C Sarason & B.R. S a r a s o n ( E d s . ) , S o c i a l s u p p o r t : T h e o r y , r e s e a r c h , and  a p p l i c a t i o n s (pp. 39-50). The Hague, The N e t h e r l a n d s : Martinus N i j h o f f . S a r a s o n , B.R.., S a r a s o n , I . C , Hacker, T.A., & Basham, R.B. (1985). Concomitants of s o c i a l s u p p o r t : S o c i a l s k i l l s , p h y s i c a l a t t r a c t i v e n e s s , and gender. J o u r n a l of P e r s o n a l i t y  and S o c i a l Psychology, 49, 469-480. S a r a s o n , I . C , S a r a s o n , B.R., & Sheari n , E.N. (1986). S o c i a l s u p p o r t as an i n d i v i d u a l d i f f e r e n c e v a r i a b l e : I t s s t a b i l i t y , o r i g i n s , and r e l a t i o n a l a s p e c t s . J o u r n a l of  P e r s o n a l i t y and S o c i a l Psychology, 50, 845-855. S a u l n i e r , Kathryn (1982). Networks, change and c r i s i s : The web of support. Canadian J o u r n a l of Community Mental Health, 1_, 5-23. Schaefer, C , Coyne, J . C , & Lazarus, R.S. (1981). The h e a l t h -r e l a t e d f u n c t i o n s of s o c i a l support. J o u r n a l of B e h a v i o r a l  Medicine. 4, 381-406. S c h o e n f e l d , P. (1986). Network therapy: M o b i l i z i n g the wider system. Networker, Jan-Feb. 18-19. S c h r a d l e , S.B., & Dougher, M.J. (1985)* S o c i a l support as a m e d i a t o r of s t r e s s : T h e o r e t i c a l and e m p i r i c a l i s s u e s . C l i n i c a l Psychology Review. 5_, 641-661. 143 Schroeder, D. ( 1 9 8 2 ) . E f f e c t s of s t r e s s f u l l i f e e v e n t s and n e u r o t i c i s r a on i l l n e s s and i l l n e s s behavior: R e t r o s p e c t i v e and p r o s p e c t i v e a p p r o a c h e s . U n p u b l i s h e d d i s s e r t a t i o n p r o p o s a l , John Hopkins U n i v e r s i t y . Schulz, R., & Rau, M.T. (1985). S o c i a l support through the l i f e course. In S. Cohen & S.L. Syme ( E d s . ) , S o c i a l support and  h e a l t h (pp. 129-149). NY: Academic P r e s s . Schwartz, D.M., Thompson, M. , & Johnson, C.L. (1985). Anorexia nervosa and b u l i m i a : The s o c i o c u l t u r a l c o n t e x t . In Steven W. Emmett ( E d . ) , Theory and treatment of a n o r e x i a nervosa  and b u l i m i a : B i o m e d i c a l , s o c i o c u l t u r a l , and p s y c h o l o g i c a l  p e r s p e c t i v e s (pp. 95-112). NY: Brunner/Mazel. S c o t t , Ronald L. , & B a r o f f i o , J.R. (1986). An MMPI a n a l y s i s of s i m i l a r i t i e s and d i f f e r e n c e s i n t h r e e c l a s s i f i c a t i o n s of e a t i n g d i s o r d e r s : A n o r e x i a n e r v o s a , b u l i m i a , and morbid o b e s i t y . J o u r n a l of C l i n i c a l Psychology, 42, 708-713. S e l v i n i - P a l a z z o l i , M. ( 1 9 7 4 ) . S e l f - s t a r v a t i o n . London: Chaucer. S e l v i n i - P a l a z z o l i , M. (1978). S e l f - s t a r v a t i o n : From i n d i v i d u a l .  to f a m i l y therapy i n the treatment of a n o r e x i a nervosa. NY: Janson Aronson. Sheppy, M. (1984). An e c o l o g i c a l - s y s t e m s a n a l y s i s of a n o r e x i a nervosa. Unpublished d o c t o r a l d i s s e r t a t i o n , The U n i v e r s i t y of B r i t i s h Columbia, Vancouver, Canada. Shulman, N. (1979). Network a n a l y s i s : A new a d d i t i o n to an o l d bag of t r i c k s . Acta S o c i o l o g i c a , 19, 307-323. Shumaker, S.A., & Brownell, A. (1984). Toward a theory of s o c i a l s u p p o r t : C l o s i n g c o n c e p t u a l gaps. J o u r n a l of S o c i a l  I s s u e s, 40, 11-36. S i l b e r f e l d , M. ( 1 9 7 8 ) . P s y c h o l o g i c a l symptoms and s o c i a l s upports. S o c i a l P s y c h i a t r y , 13, 11-17. S l o a n , G., & L e i c h n e r , P. ( 1 9 8 6 ) . I s t h e r e a r e l a t i o n s h i p b e tween s e x u a l a b u s e or i n c e s t and e a t i n g d i s o r d e r s ? Canadian J o u r n a l of P s y c h i a t r y , 31, 656-660. Smart, D.E., Beumont, P.J.V., & George, G.C.W. ( 1 9 7 6 ) . Some p e r s o n a l i t y c h a r a c t e r i s t i c s of p a t i e n t s w i t h a n o r e x i a nervosa. B r i t i s h J o u r n a l of P s y c h i a t r y , 128, 57-60. Snedecor, G.W., & Cochran, W.G. (1980). S t a t i s t i c a l methods (7th Ed.). Ames, l a . : Iowa State U n i v e r s i t y P r e s s . 144 S o k o l o v s y , J . , Cohen, C , B e r g e r , D., & G e i g e r , J . ( 1 9 7 8 ) . Personal networks of ex-mental p a t i e n t s i n a Manhattan SRO h o t e l . Human O r g a n i z a t i o n , 37, 5-15. S o u r s , J . A , ( 1 9 7 4 ) . The a n o r e x i a n e r v o s a s y n d r o m e . I n t e r n a t i o n a l J o u r n a l of P s y c h o a n a l y s i s , 55, 567-576. Sours, J.A. (1980). S t a r v i n g to death i n a sea of o b j e c t s ; The  anorexia nervosa syndrome. NY: Aronson. Speck, R.V. ( 1 9 6 7 ) . Psychotherapy of the s o c i a l network of a s c h i z o p h r e n i c . Family Process, 6_, 208-214. S t a r k e r , J . (1986). M e t h o d o l o g i c a l and c o n c e p t u a l i s s u e s i n r e s e a r c h on s o c i a l s u p p o r t . H o s p i t a l and Community  P s y c h i a t r y , 37, 485-490. Stokes, J.P. (1983). P r e d i c t i n g s a t i s f a c t i o n with s o c i a l support f r o m s o c i a l n e t w o r k s t r u c t u r e . A m e r i c a n J o u r n a l of  Community Psychology, 11, 141-152. S t o k e s , J.P..., & L e v i n , I . ( 1 9 8 6 ) . Gender d i f f e r e n c e s i n p r e d i c t i n g l o n e l i n e s s from s o c i a l network c h a r a c t e r i s t i c s . J o u r n a l of P e r s o n a l i t y and S o c i a l Psychology, 51, 1069-1074. Stokes, J.P,, & Wilson, D.G. (1984). The i n v e n t o r y of s o c i a l l y s u p p o r t i v e b e h a v i o r s : D i m e n s i o n a l i t y , p r e d i c t i o n , and g e n d e r d i f f e r e n c e s . A m e r i c a n J o u r n a l o f Community  Psychology, 12, 53-69. S t r o b e r , M. (1980). P e r s o n a l i t y and symptomatological f e a t u r e s i n young, nonchronic anorexic nervosa p a t i e n t s . J o u r n a l of  Psychosomatic Research, 24, 353-359. S t r o b e r , M. (1981). The s i g n i f i c a n c e of b u l i m i a i n j u v e n i l e a n o r e x i a n e r v o s a : An e x p l a n a t i o n of p o s s i b l e e t i o l o g i c f a c t o r s . I n t e r n a t i o n a l J o u r n a l of E a t i n g D i s o r d e r s , 1_, 28-43. St r o b e r , M. (1983). An e m p i r i c a l l y d e r i v e d typology of anorexia nervosa. In P.L. Darby, P.E. G a r f i n k e l , D.M. Garner, & D.V. C o s c i n a ( E d s . ) , Anorexia nervosa: Recent developments i n  r e s e a r c h (pp. 185-196). NY: Alan R. L i s s . S t r o b e r , M. (1986). Anorexia nervosa: H i s t o r y and p s y c h o l o g i c a l concepts. In K.D. Brownell & J.P. Foreyt ( E d s . ) , Handbook  of e a t i n g d i s o r d e r s ; P h y s i o l o g y , psychology, and treatment  of o b e s i t y , a n o r e x i a , and b u l i m i a (pp. 231-246). NY: B a s i c Books. St r o b e r , M., & Humphrey, L.L. (1987). F a m i l i a l c o n t r i b u t i o n s to the e t i o l o g y and course of a n o r e x i a n e r v o s a and b u l i m i a . J o u r n a l of C o n s u l t i n g and C l i n i c a l Psychology, 55, 654-659. 145 S t r o b e r , M. , S a l k i n , B., Burroughs, J . , & M o r r e l l , W. ( 1 9 8 1 ) . V a l i d i t y of the b u l i m i a - r e s t r i c t e r d i s t i n c t i o n i n anorexia n e r v o s a . The J o u r n a l of Nervous and Mental Disease, 170, 345-351. S w i f t , W i l l i a m J . , Andrews, D. , & Barlclage, N.E. (1986). The r e l a t i o n s h i p b e t w een a f f e c t i v e d i s o r d e r and e a t i n g d i s o r d e r s : A review of the l i t e r a t u r e . American J o u r n a l of  P s y c h i a t r y , 143, 290-299. Szmukler, G., McCance, C , McCrone, L.., & Hunter, D. (1986). Anorexia nervosa: A p s y c h i a t r i c case r e g i s t e r s t u d y from Aberdeen. P s y c h o l o g i c a l Medicine, 16, 49-58. T h o i t s , P.A. ( 1 9 8 2 a ) . C o n c e p t u a l , m e t h o d o l o g i c a l , a n d t h e o r e t i c a l problems i n studying s o c i a l support as a b u f f e r a g a i n s t l i f e s t r e s s . J o u r n a l of Health and S o c i a l Behavior, 23, 145-159. T h o i t s , P.A. ( 1 9 8 2 b ) . L i f e s t r e s s , s o c i a l s u p p o r t , and p s y c h o l o g i c a l v u l n e r a b i l i t y : E p i d e m i o l o g i c a l c o n s i d e r a t i o n s . J o u r n a l of Community Psychology, 10, 341-362. T i e t j e n , A.M. (1985). The s o c i a l networks and s o c i a l support of married and s i n g l e mothers i n Sweden. J o u r n a l of Marriage  and the Family, May, 489-496. T o l s d o r f , C.C. (1976). S o c i a l networks, support, and coping: An e x p l o r a t o r y study. Family Process, 15, 407-417. T r i m b l e , D a v i d ( 1 9 8 0 ) . A g u i d e to the network t h e r a p i e s . Connections, 3_, 9-21. T u r n e r , R. J . , F r a n k e l , G., & L e v i n , D.M. ( 1 9 8 3 ) . S o c i a l support: c o n c e p t u a l i z a t i o n , measurement, and i m p l i c a t i o n s f o r mental h e a l t h . Research i n Community and Mental Health, 3, 67-111. Turner, S.L. (1979). D i s a b i l i t y among s c h i z o p h r e n i c s i n a r u r a l c o mmunity: S e r v i c e s and s o c i a l s u p p o r t . R e s e a r c h i n  Nursing and He a l t h , 2_, 151-161. Vandereycken, W., & Meermann, R. (1984). Anorexia nervosa: A  c l i n i c i a n ' s guide to treatment. B e r l i n : W. de Gruyter. Vaux, A., & Athanassopulou, M. (1987). S o c i a l support a p p r a i s a l s and network r e s o u r c e s . J o u r n a l of Community Psychology, 15, 537-556. 146 Vaux, A., Burda, P., & Stewart, D. (1986). O r i e n t a t i o n toward u t i l i z a t i o n of s u p p o r t r e s o u r c e s . J o u r n a l of Community  Psychology, 14, 159-170. Vaux, A., & H a r r i s o n , D. (1985). Support network c h a r a c t e r i s t i c s a s s o c i a t e d with support s a t i s f a c t i o n and pe r c e i v e d support. American J o u r n a l of Community Psychology, 13, 245-268. Vaux, A., R i e d e l , S., & S t e w a r t , D. (1 9 8 7 ) . Modes of s o c i a l s u p p o r t : The S o c i a l S u p p o r t B e h a v i o r s (SS-B) S c a l e . American J o u r n a l of Community Psychology, 15, 209-237. Walker, K.N... MacBride, A., & Vachon, M.L.S. (1 9 7 7 ) . S o c i a l s u p p o r t networks and the c r i s i s of bereavement. S o c i a l  Science and Medicine, 11, 35-41. Wellman, B. (1979). The community q u e s t i o n . American J o u r n a l of  So c i o l o g y , 84, 1201-1231. Wellman, B. (1981). Applying network analyses to the study of support. In B.H. G o t t l i e b ( E d . ) , S o c i a l networks and s o c i a l  support (pp. 171-200). B e v e r l y H i l l s : Sage. Wellman, B. (1983). Network a n a l y s i s : Some b a s i c p r i n c i p l e s . In R. C o l l i n s (Ed.), S o c i o l o g i c a l theory 1983 (pp. 155-200). San F r a n c i s c o : Jossey-Bass. Wellman, B., & H i s c o t t , R. (1985). From s o c i a l support to s o c i a l network. In I.G. S a r a s o n & B.R. S a r a s o n ( E d s . ) , S o c i a l  s u p p o r t : Theory, r e s e a r c h , and a p p l i c a t i o n s . The Hague, The Netherlands: Martinus N i j h o f f . Westermeyer, J . , & P a t t i s o n , E.M. (1981). S o c i a l networks and m e n t a l i l l n e s s i n a p e a s a n t s o c i e t y . S c h i z o p h r e n i a  B u l l e t i n , .7, 125-134. W e t h i n g t o n , E., & K e s s l e r , R.C. (1 9 8 6 ) . P e r c e i v e d s u p p o r t , r e c e i v e d support, and adjustment to s t r e s s f u l l i f e e v e n t s . J o u r n a l of Health and S o c i a l Behavior, 27, 78-89. Whitten, N.E., J r . , & Wolfe, A.W. (1969). Network a n a l y s i s . In J . Honigmann ( E d . ) , The handbook of s o c i a l and c u l t u r a l  anthropology. Chicago: Rand McNally. W i l c o x , B.L. ( 1 9 8 1 ) . S o c i a l s u p p o r t , l i f e s t r e s s , and p s y c h o l o g i c a l a d j u s t m e n t : A t e s t o f t h e , b u f f e r i n g h y p o t h e s i s . American J o u r n a l of Community Psychology, 9_, 371-386. W i l k i n s o n , C h a r l e s B. , & O'Connor, W.A. (1982). Human ecology and mental i l l n e s s . American J o u r n a l of P s y c h i a t r y , 139, 985-990. 147 W i l l s , T.A. ( 1 9 8 5 ) . S u p p o r t i v e f u n c t i o n s o f i n t e r p e r s o n a l r e l a t i o n s h i p s . In S. Cohen & S.L. Syme ( E d s . ) , S o c i a l  support and h e a l t h (pp. 61-82). NY: Academic P r e s s . Wolfe, A.W. (1981). D i s c u s s i o n . S c h i z o p h r e n i a B u l l e t i n . 7_, 173-180. Wood, Y.R. (1984). S o c i a l support and s o c i a l networks: Nature and measurement. In P. McReynolds & G.J. Chelune ( E d s . ) , Advances i n p s y c h o l o g i c a l measurement ( V o l . 4, pp. 312-353). San F r a n c i s c o : Jossey-Bass. Wortman, C.B., & D u n k e l - S c h e t t e r , C. (1987). Conceptual and methodological i s s u e s i n the study of s o c i a l support. In A. Baum, & J . E . S i n g e r ( E d s . ) , Handbook of p s y c h o l o g y and  h e a l t h : S t r e s s ( V o l . 5, pp. 63-108). H i l l s d a l e , N J : Lawrence Erlbaum A s s o c i a t e s . Wortman, C.B., & Lehman, D.R. (1985). Reactions to v i c t i m s of l i f e c r i s e s : Support attempts that f a i l . In I.G. Sarason & B.R. Sarason ( E d s . ) , S o c i a l support: Theory, r e s e a r c h , and  a p p l i c a t i o n s ( 4 6 3 - 4 8 9 ) . The Hague, The N e t h e r l a n d s : Martinus N i j h o f f . Yager, J . (1982). Family i s s u e s i n the pathogenesis of anor e x i a nervosa. Psychosomatic Medicine, 44, 43-60. Y e l l o w l e e s , A . J . ( 1 9 8 5 ) . A n o r e x i a and b u l i m i a i n a n o r e x i a nervosa: A study of p s y c h o s o c i a l f u n c t i o n i n g and a s s o c i a t e d p s y c h i a t r i c symptomatology. B r i t i s h J o u r n a l of P s y c h i a t r y , 146, 648-652. 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
https://iiif.library.ubc.ca/presentation/dsp.831.1-0053743/manifest

Comment

Related Items