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Anorexia nervosa and social network Buch, Wes 1988

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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  C o l u m b i a , 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 C o u n s e l l i n g Psychology)  We a c c e p t t h i s  thesis  required  as c o n f o r m i n g t o the standard  THE UNIVERSITY OF BRITISH COLUMBIA J u l y 1988 ©  M. Wesley Buch, 1988  In  presenting  degree at the  this  thesis in  University of  partial  fulfilment  of  the  requirements  for  an advanced  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  department  or  by  his  or  scholarly purposes may be her  representatives.  It  is  granted by the understood  that  head of copying  my 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  DE-6(3/81)  Q-pk^i^ T.  ii  ABSTRACT Aspects anorexic derived  the  (N=35) from  literature social  of  social  women  social  was  on  Inventory to  and  investigate  environmental analyses  of  Hotelling's Analyses  proportions  Bonferroni probability  of  significance The results.  of  null  the  several  does  not  i s not  other  Various For a  was  when  network  contrasting  in  or  Psychological were  used  personality  and  tested  it  to  the  reduce  the  the  statistical  majority  total  of  the size,  subjects, statistical  the  that  nosological and  of  network  control  possible  predictable  t-tests.  order  approaching  singular  the  The  explanations is  using  z-tests.  and  were  Statistical  z-tests.  for  anorexic  were  using  variable,  variables  result  in  the  Pattison  univariate  t - t e s t s and  example,  the  (FES)  determining  accepted  homogeneous  inevitably  by  performed  differentiated  discussed.  nervosa  error  social  means were  of  Pattison's  network v a r i a t i o n .  employed  univariate  one  significance. were  I  hypothesis  Only  significantly although  Type  was  Scale  the  Subjects  using  certain  followed  were  inequality  of  between  procedure  of  California  Environment  from  nature  perspective  variables  The  social  difference  T2  of  to  The  non-  hypotheses  and  systems t h e o r y .  contribution  variables  to  research  nervosa.  network  Family  (N=34) and  according  the  (PPI).  the  the  the  from  social  anorexic  and  anorexia  psychosocial  Inventory  (CPI)  theory  discussed  selected  Psychosocial  to  of  examined  network  (1977a) p s y c h o d y n a m i c compared  were  pertaining  network  networks  largely  results anorexia  entity  and  invariant  iii social  impairment.  anorexia social with  nervosa  network  I t was  may  yield  variables.  the degree  of  proposed  that  recent  typologies  s i g n i f i c a n t between-group Furthermore,  severity  and/or  social  variation in  networks  chronicity  of  may  vary  of the a n o r e x i c  condition. The  correlational  significant both  cohesion  support however, and  results.  from  and  family  support.  Regarding  independence network  interpersonal  non-significant  analyses  produced  environmental were  members.  effectiveness  correlations  several  with  statistically  (FES) v a r i a b l e s ,  positively correlated Contrary  to  hypotheses,  (CPI) achieved social  with  network  only size  weak and  iv  TABLE OF CONTENTS .ABSTRACT  . .  L I S T OF TABLES  i i  v i i  L I S T OF FIGURES  . . .  viii  ACKNOWLEDGEMENTS  ix  CHAPTER 1 - INTRODUCTION  1  Definitions  2  Etiology  3  A psychodynamic  psychosocial  systems p e r s p e c t i v e NATURE Early  . .  4  OF THE PROBLEM  6  i m p r e s s i o n i s t i c research  Recent  empirical research  A limitation empirical Social  of c u r r e n t research  11  network a n a l y s i s  social  . . 12  social  distress  network  network a s s o c i a l  Social  network:  subjective  . . .  paradigm  Social  context  perspectives  . . . .  personal  social  network  The  personal  social  network  The  zones of i n t i m a c y intimate  15 16 . 18  o b j e c t i v e and  The  as  14  c o n t e x t and  psychiatric The  6 .8  CHAPTER 2 - REVIEW OF THE LITERATURE The  .  psychosocial  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  18 20  21 network  . . . . 22  24  V  Social and  networks:  personal  environmental determinants  Normative  social  networks  Social  networks  Social  n e t w o r k s and  35  and m e n t a l  psychiatric distress Studies of p s y c h i a t r i c  health  populations  Comparative s t u d i e s of n o n - p s y c h o t i c (neurotic) psychiatric populations and t h e i r s o c i a l n e t w o r k s Comparative  studies  women and t h e i r Recapitulation Hypotheses their  networks  o f the problem  40 41  44  53 58  and a summary o f rationale  CHAPTER 3 - METHODOLOGY  59  68  o f t h e Study  68  Sample Data  38  of anorexic  social  theoretical  Purpose  . . . 31  68  Collection  Procedure  70  Instrumentation  70  The The  Pattison Psychosocial Inventory C a l i f o r n i a Psychological Inventory  70 74  The  Family Environment  77  Method  of Analysis  CHAPTER 4 - RESULTS Demographic Data  Scale  78  80 Analysis  R e s u l t s of Primary Data A n a l y s i s by H y p o t h e s i s Summary o f R e s u l t s  80  82 98  vi CHAPTER 5 - DISCUSSION  100  Evaluation  of Results  o f Demographic  Evaluation  of R e s u l t s  o f Primary Data  Limitations Implications Theory,  Analyses  . . . . 103  o f t h e Study f o rSocial  Therapy,  Implications  A n a l y s e s . . . . . 100  116 Network,  and R e s e a r c h  . 117  f o r Anorexia Research  120  Conclusion  121  FOOTNOTES BIBLIOGRAPHY  123 . . . . . . .  124  vii  LIST OF TABLES Table  1.  Types of S o c i a l  Table  2.  C o m p a r i s o n s o f t h e S o c i a l Network S i z e o f A n o r e x i c and C o n t r o l S u b j e c t s  83  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 A n o r e x i c and C o n t r o l S u b j e c t s  84  Comparisons of Frequency of Contact i n t h e S o c i a l Networks o f A n o r e x i c and C o n t r o l S u b j e c t s  85  Comparisons of High Contact Frequency R e l a t i o n s i n t h e S o c i a l Networks o f A n o r e x i c and C o n t r o l S u b j e c t s  87  C o m p a r i s o n s o f A m b i v a l e n t or N e g a t i v e R e l a t i o n s i n t h e S o c i a l Networks o f A n o r e x i c and C o n t r o l S u b j e c t s .  89  C o m p a r i s o n s o f t h e 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 o f A n o r e x i c and Control Subjects  90  Comparisons of the High Frequency of S u p p o r t R e l a t i o n s among t h e S o c i a l Networks o f A n o r e x i c and C o n t r o l Subjects  93  Comparisons of the High Frequency of R e c i p r o c a l S u p p o r t R e l a t i o n s among t h e S o c i a l Networks o f A n o r e x i c and Control Subjects  94  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  C o m p a r i s o n s o f t h e S o c i a l Networks 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 Subjects  110  Table  Table  Table  Table  Table  Table  Table  Table  Table  3.  4.  5.  6.  7.  8.  9.  10.  11.  Networks  19  of  viii  LIST OF FIGURES  Figure  1.  Zones o f S u b j e c t i v e  Social  Network  21  ix  ACKNOWLEDGEMENTS  In fitting own this  a  thesis  that  social study.  about  social  I e x p r e s s my  network  who  deep a p p r e c i a t i o n  have  These p e o p l e  networks,  been  so h e l p f u l  i t i s  particularly  t o t h e members o f my over  the course  a r e as f o l l o w s .  PAULA BUCH - my w i f e and c l o s e s t companion: Thank you for 'putting me through s c h o o l ' and f o r your w i l l i n g n e s s t o p r o o f r e a d and c r i t i q u e t h e s e v e r a l drafts of t h i s t h e s i s . Thank you most o f 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 d u r i n g t h o s e t i m e s when I was most o b s e s s e d w i t h my r e s e a r c h . REV. MARK & HILDA BUCH - my p a r e n t s : your e n c o u r a g e m e n t a n d s u p p o r t i v e n e s s beginning of t h i s research p r o j e c t .  Thank you f o r from t h e very  DR. JOHN F R I E S E N - 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 a t each s t a g e of my r e s e a r c h , and most o f a l l f o r 'sowing s e e d s ' i n my l i f e t h a t have c a p t u r e d my i m a g i n a t i o n . DR. LORETTE WOOLSEY - a member o f my t h e s i s c o m m i t t e e : Thank y o u f o r y o u r w i l l i n g n e s s t o p a r t i c i p a t e a s a committee member d u r i n g a s e a s o n w h e n .you w e r e 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 t h e 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 t o 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 those 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 together. PADDY DUCKLOW - my t h e r a p y s u p e r v i s o r a n d f r i e n d : Thank you f o r b e i n g t h e f i r s t t o see p o t e n t i a l i n me a s 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 t o d e v e l o p that p o t e n t i a l .  THE  CONGREGATION OF RICHMOND CHRISTIAN FELLOWSHIP-  Thank you f o r t h e g i f t for research purposes.  of a paid  month-long  sabbatical  of  1  CHAPTER 1 INTRODUCTION  A Canadian p e d i a t r i c i a n says a n o r e x i a nervosa i s r e a c h i n g e p i d e m i c l e v e l s among C a n a d i a n t e e n a g e r s and i t i s s t a r t i n g t o a f f e c t a d o l e s c e n t s as young as t w e l v e . D r . S u j a t h a Lena s a y s t h a t t h e i n c i d e n c e o f a n o r e x i a n e r v o s a among t e e n a g e g i r l s i n t h i s country has doubled i n the l a s t ten y e a r s and now a f f e c t s one i n a h u n d r e d (News Item, S e p t . 10, 1986, R a d i o S t a t i o n CJOR)  There i s mounting of  anorexia  Leichner  the of  is  past  has  the i n c i d e n c e  two d e c a d e s .  severe  cases  girls,  some  nervosa  & Eckert,  nervosa  (1986) s u g g e s t s  nervosa  and 1/100 among of a trend  attitudes prevailing  Feldman toward  may  girls towards  e t a l (1988),  cultural  puberty; o f age may  values  indeed,  earlier  be c o n c e r n e d  about  over  that the prevalence  o f age.  onset  of  anorexia  nervosa  that  and t h i n n e s s girls  their  (1985a) and i t s  of c h i l d r e n ' s girls  acquire  considerably  a s young  body  There  anorexia  1984), and R u s s e l l  nonobese  (1985)  has d o u b l e d  16 y e a r s  and f a t n e s s , f o u n d  "even  & Copeland  i n a recent review  of beauty  1985b;  be as h i g h a s 1/200 among  over  premenarchal  thinness  1987; R u s s e l l ,  of anorexia  Piktel  discussed  1978; L e i c h n e r , 1985;  Herzog  ( e g . , Lena e t a l , 1985; I r w i n ,  sequelae.  years  (Bemis,  F o r example,  of a n o r e x i a  evidence  recently  before  i s increasing  et a l , 1986).!  that  school  t h a t t h e i n c i d e n c e and p r e v a l e n c e  e t a l . , 1984; M i t c h e l l  Szmukler report  nervosa  evidence  image  as 5 or 6 and  have  2 readily  expressed  their  Unfortunately, anorexia general For  nervosa  1980)  14%  morbidity highest  and  21%.  recorded  surprising  &  syndrome  Garner,  1982),  Vandereycken (Andersen, such  compulsive  (1979,  Copeland  (1985) nervosa  related  that  and  nervosa claim  anorexia  is  that  a r e among t h e  point  to  to s t a r v a t i o n .  and t h e s u b j e c t  (eg.,  nervosa  Bruch,  nervosa  lifeIt i s  has been  of e x t e n s i v e  a  research  a continuum  and a v a r i a n t  disorder  (Rothenberg,  and v a l i d i t y .  endeavour  has been  diagnostic  criteria  i n this  a spectrum  (Cantwell  reliability  One  study,  of eating  psychiatric  e t a l , 1977),  1986).  anorexia  Efforts  nervosa  a r e as f o l l o w s :  disorders, obsessive-  continue  in  I I I (1980).  proposed  among  substantial  development  o f t h e DSM  1971;  disorders  and  nervosa with  important  the p u b l i c a t i o n f o r anorexia  (eg., Nylander,  of other  as a  1970, 1977; G a r f i n k e l  of behaviors  & Meermann, 1 9 8 4 ) ,  disorders  h a s been c o n c e p t u a l i z e d  1973; C r i s p ,  to p r e c i s e l y define  used  f o r anorexia  i n anorexia  researchers  and  &  complications  Anorexia  1983),  a s mood  by Hsu and h i s a s s o c i a t e s  decade.  Definitions. discrete  and t h e lethal.  rate  continues  of  t o be  rates  concern  awareness  professionals  syndrome  Herzog  therefore  ( p p . 190-191)!  the growing  f o r psychiatric disorders,  medical  the past  weight"  health  the m o r t a l i t y  major p u b l i c h e a l t h during  studies  and m o r t a l i t y  threatening hardly  that  of  mental  the anorexic  several  show  between  in spite  among  public,  example,  f e a r s of gaining  this The  by t h e DSM I I I ,  3 A.  Intense fear not d i m i n i s h  B.  D i s t u r b a n c e o f body image, e . g . , c l a i m i n g t o " f e e l f a t " even when e m a c i a t e d .  C.  Weight l o s s o f a t l e a s t 25% o f o r i g i n a l body w e i g h t o r , i f under 18 y e a r s o f a g e , w e i g h t l o s s from o r i g i n a l body w e i g h t p l u s p r o j e c t e d w e i g h t g a i n e x p e c t e d f r o m growth c h a r t s may be combined t o make t h e 25%.  D.  R e f u s a l t o m a i n t a i n body w e i g h t w e i g h t 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 t h a t would the weight l o s s (p. 6 9 ) .  Criticisms  of  t h e DSM  nervosa  have  The  I I I has been  the  DSM  only  o f becoming o b e s e , w h i c h does as w e i g h t l o s s p r o g r e s s e s .  been  anorexia  III diagnostic  reviewed  nervosa  elsewhere  recently  significant  oyer a minimal  to  criteria  (Powers  revised  change  account f o r for anorexia  & Fernandez,  (DSM I I I - R , 1987),  the d i a g n o s t i c  i s the a d d i t i o n  of  primary  1984).  although  criteria or  for  secondary  amenorrhea.  Etiology.  Anorexia nervosa  biological,  psychological  variety  of  etiological  genetic  predisposition,  vulnerable  personality,  patterns,  major  societal the  life  s u r p r i s i n g  and  factors onset family  change,  diversity  that  multidimensional  studied  and s o c i o c u l t u r a l  p r e s s u r e f o r extreme  number  h a s been  have  of  been  proposed, hormonal  organization  and  upper  class  these  middle  (Andersen, proposals,  some  researchers  approach  to the e t i o l o g y  various  perspectives,  of p u b e r t a l  thinness  from  have  and a  such  as  activity,  interactional status, 1985).  and  Given  i t i s hardly espoused  and t r e a t m e n t  a  of the  4 anorexic Katz,  syndrome  ( e g . , Bemis,  1985; P i a z z a  e t a l , 1980; V a n d e r e y c k e n  A multidimensional currency  among  interest  has  individual What  researchers  (Grigg,  links  social  posits into  needed,  colleagues  systems  i n their  views  behaviour  psychosocial  those both  the  to  this  to l a b e l  define  are r e l a t e d  primary  social  unit  of the  Sheppy,  1984).  define 2).  nervosa  and  the  personal (1977a)  i n t e r a c t i o n between  context,  and hence  uses the  of b e h a v i o u r . context  Such p e o p l e  matrix  Of  and h i s  Pattison  the psychodynamic  for social  that  by P a t t i s o n  o f an  the s o c i a l  social  theory  psychodynamic  t o t h e i n d i v i d u a l on  network,  the primary  milieu  perspective.  i s the  espoused  importance.  anorexic  c a n be t r a n s l a t e d  systems  the system  medical  syndrome.  i n Chapter  and t h e s o c i a l  psychosocial  represents  variables  as t h e p r o d u c t  of  of the  of a n o r e x i a  study  considerable  beginning  to e m p i r i c a l l y  i n t e r a c t i o n and v a l u e d  intimate that  who  1984).  i s an o v e r - a r c h i n g  psychosocial  to e m p i r i c a l l y  people  & Meermann,  1979;  of the anorexic  (discussed  psychology  attempted  Jones,  social  effort  network  term  1982;  i n the s o c i a l  perspective  psychosocial  individual  &  however,  features  interest  human  i n part,  whereby  psychodynamic  psychosocial  the very  and i n d i v i d u a l d i m e n s i o n s  mechanisms  particular  Garner,  the e x p r e s s i o n  1986; N o r r i s  the s p e c i f i c  A  since  nervosa:  i t s roots,  i s clearly  &  approach a f f i r m s a r e c o g n i t i o n of  i n anorexia  syndrome  1978; G a r f i n k e l  He h a s  i n terms of the b a s i s  of  comprise the social  system  o f t h e i n d i v i d u a l and  behaviour.  Pattison  further  5 suggests people and  that  the  psychosocial  i n each subgroup  work-social  individual, concept  modern  has  Second,  i t  family  Third,  issue  systems  i t  variety  of  patterns anorexic  of  that  is  as  does  and  (eg.,  (intrapsychic)  whereby  as  amenorrhea. are  Bruch,  Selvini-Palazzoli,  an  1973,  1974;  into  the  altered Recent  Sours,  1974,  a  literature 1979).  play  a  of  co-  eating offers  a  these i n t e r a c t i o n a l features  noteworthy  1980).  has  actor,  also  relations  Masterson,  a  nervosa.  Jones,  self-perceptions,  especially 1977;  but  specific  object  that  maintenance  theory,  such  &  i n t e r a c t i o n a l patterns and  and  venerable  i n the  Norris  systems  translated  nervosa  1987;  etiology  family  a  social  debated  the  several  anorexia  a  of  group  psychology)  as  be  (Nichols,  the  mechanisms  to  neighbors,  has  in  concerning  six  therapy.  theory  rooted  individual  that  in  treat in  to  group  blood-kin  systems i t  continues  theory  syndrome,  anorexia  regard  role  are  thinness,  to  (psychodynamic  the  implies  determining disorders,  First,  affirms  the  f o r who  a substantial literature  theoretical of  of  five  friends,  functional kinship  psychosocial  tradition  accumulated  relatives,  replacement  features.  theoretical  i s the  implications  Psychodynamic important  family,  contacts,  the  that  of  network, c o n s i s t i n g o f  of  the  desire  for  formulations  source  1977;  in  Ross,  this 1977;  6  NATURE OF THE PROBLEM The  early  yielded  such  anorexic profile as  literature  a consistent  patient  as  knowledge studies  the case  frontier,  particularly  Early  social  from p s y c h o d y n a m i c largely  h a s been  limited  nervosa  context  stereotypic.  challenged  family  nervosa  milieu  of the s o c i a l  i n the progression  from  anorexia  anorexia  research. provides  a  to c l i n i c a l  therapy  The  early  patient  research.  impressions  i n any  empirical  research.  general  of the anorexic  and f a m i l y  recent  interactional  this  d a t a , and,  of s c i e n c e by  has  of the  However,  upon c l i n i c a l - i m p r e s s i o n i s t i c  impressionistic  concerning immediate  profile  t o become  i s l a r g e l y based  i s often  concerning  literature  profile  of the  derived  largely  This  research i s  of the anorexic  and h e r  family. Psychodynamic  research  commonly  relationships  of the anorexic  controlling,  i n t r u s i v e , and d o m i n e e r i n g  ineffectual Garner, and  1982).  overly  showing is  father  a dependent  thought  identity  to  and  ( f o r a review,  The f a m i l y  involved  & Jones,  early  family  i s usually  and immature  interfere  1979).  systems  with  lives,  family  o f an  and a  passive,  as o v e r l y  with  the  the development  of  For example,  close  which  adolescent  1977; M i n t z ,  profile  &  anorexic  to her parents  et a l ,  over-  1978; G a r f i n k e l  described  A s i m i l a r family research.  mother,  attachment  (eg., Kalucy  the  as comprised  s e e Bemis,  i n one a n o t h e r ' s  autonomy  Norris  patient  depicts  has emerged Minuchin  1980; from et a l  7 (1978) s u g g e s t  that  symptomatology  of  intrafamilial  resolution.  dependency studies  Vandereycken,  often For  the  isolated  Garfinkel  & Garner,  having  lose  activities  The  has  who  anorexic  psychosomatic  based  upon  four  over-protectiveness,  tendency  also  has  pattern  rigidity,  only  anorexic  (eg_., 1982;  one  toward  been  unusually  found  populations  interest with  the  is  Jones,  & Garner in  typically  Crisp,  in  a  (Kog,  and close  number  of  Pierloot,  described  Dally  &  &  as  being  Gomez,  1979;  Neuman & H a l v o r s o n ,  friend  at  a  time  (1982) s u g g e s t  their  following  1980;  1981;  short-term  example, G a r f i n k e l  girls  child  1983).  Furthermore, socially  of  a  organization  enmeshment,  conflict  demographic  with  show a f a m i l y  characteristics: lack  families  friends  (Bruch,  that  early  1983),  in  1977).  most  anorexic  their  dieting  results:  By the t i m e t h e w e i g h t l o s s has p r o g r e s s e d t o the p o i n t of m e d i c a l i n t e r v e n t i o n , the a n o r e x i c may be t o t a l l y i s o l a t e d . This 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 s e n s e of s o c i a l i n a d e q u a c y (p. 8 ) . This  profile  of  peer  characteristic retrospective  of  Garfinkel  fifth  the  of  relationships deficits social (1982)  may  of &  193  Garner  restricting and  found  become  development suggest  been  bulimic  and  (1982)  found  anorexic  to  resulting 1985).  be  thus  especially in  restricting  were  them s a t i s f y i n g .  profound,  found  anorexics;  anorexics  (Andersen,  that  has  restricting  study  patients,  relations  that  involved  With in  less  a  time,  anorexic than in  lose  substantial  a l l sexual  one-  social  social  Finally, Garfinkel  patients  their  &  skill lag  in  Garner  interest  8 and  avoid  encounters  experiences The  do  occur,  profile  emerging  from  this  characterized by  nuclear  covertly a  of  as  family  limited  or  early  support  network  Chapter  to  however, may  i t may  methodology  of  milieu  may  be  For  the  briefly  virtual in  upon  include absence the  of  artifact Kog,  of  a  Pierloot  &  this  of  infrequent  of  direct  social  the  past  psychiatric  two  use  of and  empirical  profile  decades  populations  this  groups,  c o n s t r i c t e d , family-dominant  over  Such  (Garfinkel &  control  absence  as  clinical-  criticisms  the  and  context.  an  1978;  common  Nevertheless,  to the  repeatedly  be  dominated  criticized  procrustean well  example,  causality 1986).  and  be  based  (ej>. , Bemis,  in  bears social cross-  (reviewed  in  generated  by  2).  empirical  research.  impressionistic research of  are  become  though  s t u d i e s of v a r i o u s  Recent  1978;  even  resemblance  found  immediate  i n a psychotherapeutic  tendency  (Strober,  sectional  body  evoked  measures,  a striking  early  This p r o f i l e ,  1983).  assumption  social  enjoyed.  impressionistic research  impressionistic research  validated the  anorexic's  over-genera1ization  flawed  Vandereycken,  the  sexual  e x c l u s i v e , enmeshed  a  1982),  u s u a l l y not  If  r e l a t i o n s h i p s that  a  Garner,  are  sex.  isolated,  data  has  opposite  constricted, socially  impressionistic profile  the  they  early  conflicted.  stereotyped  with  family  Grigg,  interactional  1986;  Jacob,  1975;  The has  social been  studies Kog  profile  challenged  (for  reviews,  & Vandereycken,  by  a  growing  see  Bemis,  1985;  Sheppy,  9 1984;  Strober  more  rigorous  measures,  & Humphrey,  methodology  self-report  qualities), variability & et  1978).  (ej*.,  studies  control with  results  1986; Humphrey,  of  1982).  point  ten f a m i l i e s  employed  a  series  to v e r i f y  They  with  to  a  st ri k i n g  1986; H a r d i n g  e t a l . , 1986; Kog  Kog e t a l ( 1 9 8 5 ) ,  anorexia/bulimia  of standardized  Minuchin's  summarized  an  in a  nervosa  i n t e r a c t i o n tasks  psychosomatic  the r e s u l t s of t h e i r  a  psychometric  (Grigg,  1986; Humphrey  employed  observational  better  often  F o r example,  have  groups,  among t h e f a m i l i e s o f a n o r e x i c s  study  attempt  These  measures  their  a l , 1985; Y a g e r ,  patient, an  and  Lachenmeyer,  pilot  1987).  family study  model  in  (1975,  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 a p p e a r t o s u p p o r t t h e hypothesis that Minuchin's rather s t a t i c family t y p o l o g y s h o u l d be r e p l a c e d by a more d i m e n s i o n a l and dynamic a p p r o a c h t o f a m i l y f u n c t i o n i n g (Kog e t a l , 1985, 5 2 5 - 5 3 8 ) . Grigg  (1986)  recently  transactional syndrome!  patterns  Humphrey  daughter  interactions  sixteen  families  four  control  that  i t employed  (1986)  found  also  related  that  with  a  found  study  family  the  types  daughter  family  anorexic of  discriminated  bulimic-anorexic  This  separate  to  four  successfully  observational found  distinctly  exclusively  e t a l . (1986)  families.  has  three  parentbetween  and  twenty-  i s e s p e c i a l l y noteworthy  data.  Furthermore,  interactions  that  in  Humphrey  appear  to  discriminate  among  bulimic-anorexics,  classical  abstaining  anorexics  women  without  disorder.  Harding  and  Lachenmeyer differences  (1986),  an  however,  on any o f t h e f a m i l y  eating failed variables  to  &  find  significant  central  to Minuchin's  10 family  systems  enmeshment,  theory  and  rigidity)  anorexics  and  empirical  studies  developing  of anorexia  thirty  nervosa  in their  (eg_. ,  study  of  female  college  student  underline  Yager's  (1982)  stereotypes  of  the  overprotection, thirty  female  controls.  Such  caution  against  c h a r a c t e r i s t i c s of  anorexic  families. Several clinical and  recent  report  empirical  of over-involvement  anorexic-bulimic  Lachenmeyer, studies did  not  that  successfully  Strober,  1981; S t r o b e r  research al.,  (eg..,  clinical anorexic  degree  with  Sheppy,  of cohesion  between other  Bruch,  based  on  of  anorexic  Harding  1984).  empirical  These  families.  Such  research  (ej>. ,  et a l . , 1983),  early  1973; S e l v i n i - P a l a z z o l i ,  &  ( o r enmeshment)  such  e t a l . , 1981; G a r n e r  predictions  empirical  reports  of  with  t h e DSM  measuring  among  a previous  III) fell performance  studies  social  Herzog  maladjustment  students  family  two  patients.  social  using  1985;  1983;  t h e common  but  impressionistic 1974; M i n u c h i n e t  1978). Finally,  by  to  challenged  i n the f a m i l i e s  Squires,  consistent  have  (Berkowitz,  discriminate  are quite  contrary  &  an u n u s u a l  findings  are  patients  1986; Kagan  found  studies  isolation  et a l (1985), female  history  within  ecological  recently  and  medical  i n school,  social  research  nervosa  and l e i s u r e  and  found  that  (as defined  adjustment  independence.  strategy  in  i n v e s t i g a t i o n of  students,  t h e norm on s o c i a l  challenged  maladjustment  i n an  of anorexia  r e l a t i o n s h i p s , and e c o n o m i c an  have  scales  activities,  Sheppy  a matched  (1984), control  11 group,  d i d not f i n d  the  size  and  their  any s t a t i s t i c a l l y  or q u a l i t y  of the s o c i a l  networks  these  of recent  together,  suggest  that  diverse  and  the  examples  social  complex  correlates  rather  supports G a r f i n k e l & Garner's familial  for  anorexogenic  with  social  limitation  empirical of  research  anorexic  of t h e i r  focus  Little  and  research  hypotheses  the family One may  familial  give  their  nervosa,  a profile  the  has  been  be t h e g r e a t e r dynamics  greatest  of the s o c i a l  current  and f a m i l y  context  confined  for a  to a  broader  1977, 1979; C o n g e r , 1981;  1984; W i l k i n s o n done a  & O'Connor,  to e m p i r i c a l l y broader  social  and m a i n t e n a n c e  for this  Recent  and f a m i l y r e l a t i o n s h i p s ,  narrow  locus  theoretical salience  among  enthusiasm  research.  literature  implicate  reason  research  constellation,  exclusively  environment in  are  a v a r i e t y of  and dampens  empirical  i n the development  possible  nervosa This  family  research  kind.  i s almost  that  anorexia  single  1979; Sheppy,  example, t h e p s y c h o d y n a m i c to  females  empirical  invariant.  (eg., Bronfenbrenner,  1982).  activity  that  family  1967; P o w e l l ,  etiological  of  f a c t o r s o f any  has p r o v i d e d  Jackson,  nervosa.  anorexia  recommendations  ecological  than  of anorexic  (1982) p r e d i c t i o n t h a t  of current  patients  description despite  than  i n t e r r e l a t i o n s h i p s , not a  be a s s o c i a t e d  A  difference in  families.  Taken  will  significant  research  verify milieu  of  anorexia  of  research  of i n t r a p s y c h i c paradigms.  For  systems paradigms both  t h e o r e t i c a l and c l i n i c a l  attention  tend  to the  12 family  r e l a t i o n s h i p s of the anorexic,  reasons.  Another  empirical  methodology  which to  i s larger  Chapter  structure,  2)  social  (Sheppy,  support, two  differences  and  only  perception  suggest  regard  reciprocity  of  sectional  studies i n Chapter  surprising  could  of 2).  i n view  network  Sheppy her  h a s been  Furthermore, clinical  of anorexia  nervosa.  populations  is still  found  by  the  a  source  author  of  perceived support, profile  social  Together,  statistically  network  non-psychotic  than  broader  for  of anorexic  size,  of a  the  1983) i n v e s t i g a t e d t h e  as  a r e no  (reviewed  in clarifying  network'analysis.  social  of  strategy  promise  be  family  networks  significance  research.  great  field  psychopathology.  context  (Berkowitz,  there  overall  a prevailing  are  study  her  a social  function  of a n o r e x i c  t o network  contradicts  (reviewed  of  that  and  family  study  i n the s o c i a l  with  promise  i n the treatment  one  Another  research  social  holds  b u t was n o t a s o c i a l  studies  families  empirical  network r e s e a r c h  1984).  anorexic's  This  the a n o r e x i c ' s  analysis  i t s infancy:  measure  different  theory-driven  and o f t h e o r e t i c a l  considerable  and i n n o v a t i o n  However, s o c i a l in  analysis.  by r e c e n t  integration  can adequately  of i n t e r a c t i o n ,  of  network  be t h e l a c k o f a  the family  shows  quality  attempted  may  f o r very  and m a i n t e n a n c e o f i n d i v i d u a l  network  cross-section  that  than  the development  Social in  possibility  though  and  significant non-anorexic  family a  these  support  finding  found  psychiatric  that  i n cross-  populations  (1984) comments t h a t h e r r e s u l t s literature  review,  and  after  13 offering to  several  attain  this  social the  significance  data. The  explanations f o r the f a i l u r e she i n v i t e s  Her i n v i t a t i o n  present  study  network.  search  prompted  does  Such an a t t e m p t  exploration  relationship. of s o c i a l  anticipated  by  early  this  would  network  impressionistic  of the a n o r e x i c  social  network a n a l y s e s o f n o n - p s y c h o t i c  contribution  social this  network  study  certain  may  social  of c e r t a i n  variation well  be  suggestive  network  maintenance  of a n o r e x i a  etiological  position  studies. al  source  of  life  nervosa,  in this  which  of a  but r a t h e r  should  a  concerning the  repeatedly  dynamic  in  populations.  and f a m i l y  variables  to  The r e s u l t s  of  would  a  more  role  await  of  and/or  definitive prospective  recommends t h e p o s i t i o n  n o t be o v e r l o o k e d  found  psychiatric  although  nor  i s an  nervosa  i n the development  regard  problems as  study  co-determining  encourage a view of s o c i a l  a l l patient  resolution,  and  as  p a t t e r n or  of anorexia  be e x p l o r e d .  correlates  However, t h e a u t h o r  (1981b) who  patient  also  as e l u s i v e  by t h i s  research  personality  will  of  anorexogenic  interactional  correlates  context  analysis  an  prove  i s attempted  social  The  to find  likely  family  What  detailed  data  study.  not attempt  f o r an a n o r e x o g e n i c  parent-child  a more  o f h e r network  o f Hurd e t  n e t w o r k s as n e i t h e r t h e the  source  feature  i n treatment  of  their  of the p a t i e n t ' s interventions.  14  CHAPTER 2 REVIEW OF THE  Social theories  of  nervosa. and  factors the  For  example, of  related  1984;  to  special  interest &  theories  share  context  is  colleagues  the  context specific  that  a  the  social  and  seminal  social  work  variables.  with  of  1985;  What  appreciation  specific  concept  these  for  of  Pattison  the  upon  a  to  advanced  functional  women, and  social  the and  and  Of his  i t s morphology  literature,  are  personality  of  perspective.  pertaining  hypotheses  anorexic  the  Based  1)  s t r u c t u r a l , i n t e r a c t i o n a l and  networks  factors  shape a r e  1985).  n e t w o r k and  support  (Chapter  nervosa,  of  social and  of  theories  (Andersen,  network  populations.  reviewed  networks  an  follows,  psychosocial  psychiatric  anorexia  al,  are  nervosa.  from  the  theories  is  structure  network  whereas  et  the  many  anorexia  relationships  body w e i g h t  however,  review  is  to  social  1977),  to  r e s o l u t i o n of  related  and  Schwartz  of a n o r e x i a  network  psychosocial their  al,  common,  concerning  of  et  1982;  in  already  systems  sociocultural  interest  social  literature  to  explored  various  consideration  social  norms c o n c e r n i n g  literature  particular  factors  anorexic's  family  Garner,  context the  among  to  cultural  In  important  social  Rosman  Garfinkel  social  the  interest  (Miller,  an  e t i o l o g y , m a i n t e n a n c e , and  function  special  are  LITERATURE  review  of  and  the  the  social  concerning  aspects  of  correlation  the of  environmental  15  The  social  century  has  distress,  context and  witnessed in  part,  growing  i t s roots  one  hand,  On  psychiatric  epidemiology  milieu  to  the  adaptive  social  from  clinical  the  expansion and  of  more  complex  embedded  (Hurd  literature efforts,  in  et  this  al ,  empirical  methodology  ad  hoc  or  experimental  with  whereas  f a s h i o n without  summarizes  this  both  social  basic  innovation"  between though  state  (p.  followed the  two.  Bott's  literature,  which  (Hurd of  (1971)  study  r e f e r e n c e s to her  connectedness  and  conjugal  been  gradual  the  as  a  the  two  an  adequate, context  evolved  with  Erickson often  central  Pattison  of  little  hypothesis  relationships  are  (1981) of  clinical  the  that  have  even  clinical  relating  rare.  an  interaction  notes  in  of  theory  development  (1975)  cited  in  combination  intriguing  streams  These  however.  social have  is  clinical  1976).  "curious  and  larger  individual  provide the  evident  a  to  of  a l , 1980).  pathways,  is  i t is  l i n k a g e s to s c i e n t i f i c  research  example,  and  the  innovations  et  These  well-being  1973,  to  to assess  affairs  independent For  failed  from the  a common p r o b l e m ,  well defined  science  242).  Pattison,  the  of  individual  review  has  of  literature  has  for  treatment  research  there  a  psychiatric milieu  hand,  which  share  epidemiology  individual,  largely  see  other  the  twentieth  significance  within  1980;  regard,  large  the  the  from  social  individual  that  systems  t h o u g h commendable,  Psychiatric  the  literature  social  is a  of  f u n c t i o n i n g ; on  focus  the  links  maintenance  treatment  in  there  that  The  recognition that  has  individual.  social  the  a  psychiatric distress.  network  Clearly  what  16 is  needed  i s a  heuristic  f o r a  theoretical research  bits  has  the  system  recent  variety  its  inherent  disappearance  of the subject  been  recently  a d d r e s s e d by N i c h o l s  Another  contribution  literature. work  Of  of Pattison  P a t t i s o n ,  psychodynamic  emerged  theory  m a c r o s o c i a l  The  interest  from  from  to this  and  mid-range base  and  theory  particularly has  research  pertinent  the been  from  a  to t h e  Erickson  (1984),  network and  contributing  to the  an i s s u e  that has  the social study  i s the seminal  (Pattison, measuring  concept,  and an e m p i r i c a l  i n d i v i d u a l  network  1976, 1977a; the  intimate  grounded  i n an  methodology,  p r o c e s s e s  that  w i t h i n  a  framework.  social  social  h a s come  a  and  i n this  systems  noteworthy  actor,  a  (1987).  and h i s c o l l e a g u e s  network,  interdisciplinary l i n k s  as a s o c i a l  1980) i n defining  psychosocial  of  central  of  of a cybernetic  epistemology as  as  pertinent  contribution  to the family.  the concept  systemic  the  to collate  d i s c i p l i n e s  serve  the conceptual  systems,  Especially  of the i n d i v i d u a l  has c r i t i c i z e d  A major  (1985)  science  would  throughout  social  1981).  by L ' A b a t e  social  relationship however,  1 9 6 8 ) t o human  effort  of  the application  (Hoffman,  of  found  literatures.  from  that  integration  and p i e c e s  come  (Bertalanffy,  or metatheory  careful  and c l i n i c a l  regard  family  theory  network  social  paradigm.  The s o c i a l  anthropology as a construct  relationships.  Barnes  network  paradigm  f o rthe analysis  ( 1 9 5 4 ) was a p p a r e n t l y  the f i r s t  17 to  use  t h e c o n c e p t as  community seminal have  i n Norway.  work,  been  research  a mode  Family  Bott  and  significant  B e r k o w i t z , 1982;  1982;  Dunn, 1983;  Leinhardt,  1981;  Rogers  1983). has  The  a  &  limited  and  of  t o one  begun  Pattison, 1973,  1976,  1977b),  1977a,  community  Llamas,  1981;  for  a  illness  relationship,  see  among  i t has science  that  disciplines  (Pattison  (Pattison  et  Pattison  (Pattison, approach et  psychology  1976;  and  social et a l ,  (Pattison,  the  a l , 1979),  (Pattison,  been  a l , 1975;  1977a, to  be  only  theory  community m e n t a l h e a l t h  network  have  follows:  sociology  may  have  network  as  1981,  paradigm  social  1977b; stress-  psychiatric  social  1980).  Price,  Indeed,  1970),  1979,  Holland  Wellman,  ( L l a m a s e t a l , 1 9 8 1 ) , group p s y c h o t h e r a p y  Pattison,  Minor,  L i n , 1982;  epidemiology and  &  network  and  Carlos,  1983;  disciplines  therapy  psychiatry  social  &  to s o c i a l  family  family  1977b),  1973,  19876;  his associates  1977a),  1977),  method  Burt  however.  These  by  Pattison,  i n her  i t s h i s t o r i c a l development  practice  1975;  1982;  currency  elsewhere i n r e l a t i o n s h i p  (Pattison,  idea  of the s o c i a l  discussed  anthropology  the  small  subsequently, there  Mardsen  i n several  and  a  (eg., Anderson &  discipline,  coalesce.  Pattison  of  theory,  Shulman,  considerable  to  the  1981,  1977;  c l i n i c i a n s , and  and  Granovetter,  1981;  through developments  recently  in  1980;  Leinhardt,  study  developed  analysis  1982;  Kincaid,  concept  researchers traced  advances  Burt,  in a  network,  h i s t o r i c a l development  n o t been  become  social  Fischer,  1979;  analysis  (1971)  c o n n e c t e d w i t h network  1976;  &  of  (Pattison,  Pollster  &  18 Social network  network  suggests  relation  to  that  their  anthropologists Barnes,  McCallister  &  people  the  social  scientists  individual.  not  Based  1978;  social to  1974;  define  concept vague  and  America  (eg.,  &  Mitchell,  1973;  concept  (1981)  amorphous  Europe  Boissevain 1969, has  work  social  the  1974;  of  social  Whitten  provided  more p r e c i s e l y t h e  Llamas et a l  and  of  on  Mitchell,  network  The  exist in  s o c i o l o g i s t s from  Fischer,  1969),  do  context.  context.  Boissevain,  Wolfe,  the  social  social  and  1972;  as  social  a way  &  for  context  of  explains:  By i d e n t i f y i n g the a c t u a l s e t o f l i n k s w i t h i n w h i c h a p e r s o n may be embedded and by delineating their interconnections, or relationships, a level of a b s t r a c t i o n i s achieved w h i c h 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 p e r s o n / g r o u p d i c h o t o m i e s t o e n c o m p a s s an a n a l y s i s of the 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 o f the s o c i a l m i l i e u . The importance of this approach i s that i t has allowed for the e x a m i n a t i o n o f r e l a t i o n s h i p s among a s p e c i f i c number o f p e o p l e i n a v a r i e t y of normative c o n t e x t s a l o n g more than one dimension...In short, i t provides 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).  Social Social  networks  objective social system  part  the of  been  subjective. may  be  many  such  as  subjective  From  an  objective  as  an  inter-connected  by  the  viewed  (Pattison,  example, t h e r e personal,  specific  1977b).  social  two  perspectives.  from  interlocking For  and  studied  defined  analysis  used.  criteria,  objective  have  arbitrarily  criterion as  and  network  motivates be  network;  Any  networks,  are  several  perspectives: perspective, chain  criterion given  sets  categorical, action,  that  or that  person  depending  a  may  on  the  can  act  role-system  19 and  field  sets  (see  Table  1).  TABLE 1 TYPES OF Limited  SOCIAL NETWORKS*  Network  (set)  Unlimited Network  Any e x t r a c t of the t o t a l network b a s e d on some c r i t e r i o n a p p l i c a b l e t h r o u g h o u t t h e whole n e t w o r k . Personal Set  Categorical Set  Action Set  Role-System Set  Field Set  Set limited t o the l i n k s of one person  Set l i m i t e d to l i n k s involving persons of a certain t y p e or category  Set limited to l i n k s purposefully used f o r specific end  Set l i m i t e d to l i n k s involved in an o r g a n i z e d r o l e system or group  Set limited to l i n k s with a certain content (economic , political etc. )  *  Adapted from Whitten & Wolfe (1969) by P a t t i s o n  Of  particular  defines one  an  interest  extract  person,  or  the  discussed  below).  therefore,  a  family,  work,  assistance, of  set  social  web  as  the  social  the  limited  rumour,  the  (Hurd  et  treatment begin  set  the  of  (to  be  network or  set  used, such  recreation  a l , 1981). of  which  links  identified,  information,  delineation  of where t o  to  social  be  (1977b).  personal  criterion  r e l a t i o n s may  important  question  the  network  on  networks for  is  (egocentric)  Depending  criterion has  study  total  personal  worship  networks  clarifies  the  this  friendship,  or a  of  of  to  The social network conceived without applic a t i o n of limiting criteria  The  specific  implications  ,  notion  types  of  that  it  in  in constructing  as  a  social  20 system  f o r intervention  su-b.1ect.ive of  perspective a social  the social  individual the  units  o r group  individual  or group,  egocentric  personal  world  social  social  comprising  focal  knows  person those  relationships  referred  at least  or i n t e r a c t s  exists  with  This i s by t h e  t o as t h e p e r s o n a l o r  Erickson  network.  (1975)  bounded  a focal  defines a  grouping  person,  of  everyone t h e  the s e t of r e l a t i o n s h i p s  and t h e f o c a l independently  a  whom a n  defined  as t h e s o c i o c e n t r i c  with,  from  e t a l , 1981).  as "a f l e x i b l y  individuals that  or groups)  of relationships  network.  network  Conversely,  may be d e f i n e d i n t e r m s  (Llamas  the former  individuals  between  network  n e t w o r k , and t h e l a t t e r  personal  1977a).  (individuals  has c o n t a c t  phenomenologic  The  (Pattison,  person,  and t h e s e t  of the f o c a l  of  person" (p.  492). There personal report over  i s little  social  i n f o r m a t i o n concerning  networks  anthropological  1500 p e o p l e  however,  such  with  of i n d i v i d u a l s . data  suggesting  the extent  Llamas that  a -person i t may  i s not uniformly  population,  since  be a r r a n g e d  importance,  and i n t e r a c t i o n  into  (See F i g u r e 1 ) .  e t a l (1981)  a person  whom he o r s h e h a s p e r s o n a l  may  have  interactions;  related  zones  of the  to  this  of i n t i m a c y ,  21  FIGURE 1 ZONES OF SUBJECTIVE SOCIAL NETWORK*  *  Adapted from B o i s s e v a i n  The Boissevain geometric resulting  personal  social  (1974) s u g g e s t s space i n five  (1974) by P a t t i s o n  that  of v a r y i n g zones  persons  as  1. The p e r s o n a l z o n e : investment.  zones  intimacy.  i n a roughly  psychosocial distance Pattison  from ego, &  Pattison  as f o l l o w s : persons  w i t h whom one l i v e s  2. The i n t i m a t e zone: persons of high i m p o r t a n c e w i t h 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 z o n e : who are less important; interaction.  of  a r e arranged  of relationships.  (1981) summarizes t h e s e z o n e s  high  network  (1977b).  and h a s  psychosocial  p e o p l e w i t h whom one i n t e r a c t s b u t or important people with less  22 4. The nominal zone: i m p o r t a n c e and i n t e r a c t i o n .  people  known,  but  5. The e x t e n d e d z o n e : p e o p l e known a b o u t s i g n i f i c a n t o t h e r s (pp. 135-136).  The  intimate  associates social the  have  confined  network,  psychosocial  network),  which  discussed  above.  the  relations  psychological interaction (Pattison derives the  that  from  importance  may  not  be  the  extended some  or  the  subset  and  measured  are  there  and  the  called  psychosocial  zones  an  of  intimacy  in  because  terms  observable  and  rationale for this  of  social  important  clinical  his  personal  (also  the  defined is  t h e o r e t i c a l and  through  "psychosocial"  between ego  The  of  network  two  term  linked  Pattison  simply,  first  network  1981).  the  to  others  narrow  focus  s i g n i f i c a n c e of  t h e o r e t i c a l s i g n i f i c a n c e , Pattison  psychosocial existence"  kinship  instrumental  family,  be  a  psychosocial  the  ego,  to  lesser  network.  of  of  to  work  uses  this  can  the  and  an  of  network.  network,  Pattison  regard  unit  intimate  encompasses  both  that  their  kinship  & Pattison,  With  social  the  meaning  psychosocial  contends  psychosocial  or  of  network  (p.  s y s t e m s as  136).  social  psychosocial blood  neighbors,  and  close  recreational  activities  argues that  system kinship  relatives,  Noting  a  fundamental  the  historical  a major d e t e r m i n a n t  r e l a t i o n s h i p s , he basic  "represents  i n modern system,  relatives  associates (Pattison  et  by  from al,  the  (1981)  of  affective  nuclear  family  s o c i e t y , but  rather  comprised  of  marriage, church, 1975).  nuclear friends,  work, It  is  or this  23 collage  of  primary  relationships,  psychosocial  (1981) h i g h l i g h t s psychosocial individuals the  necessary  to-day  individual  in  are  the  physical  et  a l , 1981).  and  clinical  been summarized  by  supportive  may  that  supplies"  (p.  adaptation,  and  thus  Pattison  et  al  As  of  this  that day-  such,  the  structure  for  related  persons  psychosocial  (1975) as  al  "where  i s ultimately  well-being  the  here  184).  foundational  of  of  a person's  the  significance  et  relationships,  provide  psychological  Llamas  is  sustaining  residing"  functional  aspects  i t  interdependent  as  the  individual.  suggesting  seen  g r o w t h and  comprises  the  potentially  highly  network  to  The  the  that  of  "psychosocial  existence  psychosocial  group  network,  exist  then,  (Llamas  network  has  follows:  (1) the p s y c h o s o c i a l s y s t e m does e x i s t ; (2) i t e x e r t s b o t h p o s i t i v e and n e g a t i v e s a n c t i o n s and s u p p o r t s on t h e n u c l e a r f a m i l y and the i n d i v i d u a l ; (3) i t i s a f u n d a m e n t a l s o c i a l m a t r i x t h a t may p r o v e t o 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  clinical  expand  from  the  psychosocial In  implication individual  social  Pattison  approaches  psychodynamic  and  valued  the  network,  is  matrix  family  Pattison  contends  this  or  is  that to  treatment  the  larger  focus  context  must of  the  network.  summary,  personal  here  the  primary  importance;  to  interested  study that  the  hence,  in  psychosocial  social  his  orientation,  i s related  is  matrix of  i s , he  individual he  in  views the  subset  network, of  this is  a  the  terms  of  the  which  he  individual.  network  interested  of  in  with the  a way  interaction  relationships  in  this  24 matrix  as  or  social  the  being  determined  psychology  Characteristics social  network  relation  to  1981b). others (a  For (gas  tennis  coworker hours), is  multiple  (a  structural,  al, 1982; in  and  a  study, The that  social  the  these class  1977a;  Warheit  al,  et  Hurd social  et  may  network.  function  single  single  car  As  a  between  people  (Hurd  affective  repair  links  links  to  services  others  affective-instrumental  be  a  viewed and  1973;  1969;  network  and  &  &  Swindle,  Rau,  (see  social  Depner, 1985;  (see  1979; Hurd  support  with  age,  1982;  to  network of  1983;  the  of  the et  Israel,  Wood,  1984),  al,  1980,  literatures gender,  &  who  links  race,  Griffith,  Stokes  (a  work  Fischer  et  to  others  partner  description  Wellman,  vary  to  characteristics  network  characteristics  &  a  al,  links  Social  organization  Heller  psychosocial  (Antonucci  as  functional  social  tennis  friend).  et  after  mixed  also  (a  in  others  to  is  concept,  instrumental  instrumental  Mitchell,  Schulz  relationships.  linkage  be  variables,  links  specific  social  Pattison,  a  who  Granovetter,  1981b). suggest  and  interactional, of  the  interactional  affective  Laumann, 1973;  this  to  there  therefore  links  1977;  psychosocial  provides  friend),  may  the  multiple  clergyman  analysis  social  also  psychological  interpersonal  attendant),  partner),  and  of  specific  station  best  social  pertains  example,  who  also  other  a  of  by  1985;  Levin,  1986;  1982).  al  network  (1980) d e f i n e s as  "the  the  structural  relationship  or  characteristics  patterning  of  the  of  links  25 in  t h e network  characteristics  with  respect  may i n c l u d e  t o one a n o t h e r " the following  (p. 6).  Structural  variables.  Size (range): t h e number o f p e o p l e i n a n e t w o r k . T h e r e h a s been a " b i g g e r i s better" mentality 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 size. Whereas i t may be t r u e t h a t l a r g e r n e t w o r k s 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 n e t w o r k s may a l s o bring increased demands and i n c r e a s e d potential for unpleasant i n t e r a c t i o n s (Stokes, 1983). Politser (1980) s u g g e s t s a c u r v i l i n e a r r e l a t i o n between t h e s i z e o f a network and i t s a b i l i t y t o s a t i s f y o n e ' s n e e d s . Indeed, there i s research evidence f o r a threshold e f f e c t concerning s i z e : Brown e t a l (1975) f o u n d t h a t women w i t h 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 a l m o s t 10 t i m e s l e s s l i k e l y t o become d e p r e s s e d after a s e v e r e l y s t r e s s f u l l i f e e v e n t t h a n women w i t h o u t s u c h a confidant. C o n v e r s e l y , i f , a s P e a r l i n (1985) a r g u e s , s u p p o r t i s drawn f r o m d i f f e r e n t network s o u r c e s f o r different problems, a l a r g e r s o c i a l network with considerable variation i n i t scomposition i s preferable. 2. Composition (content): t h e number and k i n d o f r e l a t i o n s contained w i t h i n the network. This variable 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 o n l y one t y p e o f r e l a t i o n ) o r m u l t i p l e x (a l i n k w h i c h c o n s i s t s o f m u l t i p l e t y p e s o f r e l a t i o n s ) (Hurd e t a l , 1981a). Vaux & H a r r i s o n (1985) have demonstrated that composition i s related to s a t i s f a c t i o n w i t h network s u p p o r t . 3. Density: t h e e x t e n t t o w h i c h n e t w o r k members contact each o t h e r i n d e p e n d e n t l y of t h e f o c a l person, and i s computed a s t h e p r o p o r t i o n o f p e o p l e who c o u l d know one a n o t h e r ( l i n k s t h a t c o u l d e x i s t ) t o t h e p e o p l e who a c t u a l l y do know one a n o t h e r ( l i n k s t h a t do e x i s t ) (Mitchell, 1969; see a l s o Freeman, 1977, 1979, concerning c e n t r a l i t y ) . Hammer e t a l ( 1 9 7 8 ) reports 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 o f t h e mean d u r a t i o n o f the t i e . Hurd e t a l (1981b) p o i n t s t o t h e 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 . For example, a weakly i n t e r c o n n e c t e d n e t w o r k would have difficulty functioning collectively to mobilize s u p p o r t r e s o u r c e s d u r i n g 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 o f t h i s k i n d o f n e t w o r k may be t h e g r e a t e r pressure to conform b e h a v i o r a l l y t o network norms. S t o k e s (1983) h a s r e v i e w e d s t u d i e s w h i c h i n d i c a t e a c o m p l e x 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  support.  Hirsch  (1979,  1980) s u g g e s t s  26 t h a t dense support.  networks  provide  more,  but l e s s  satisfying,  4. Degree of connection: t h e a v e r a g e number o f relationships t h a t e a c h member h a s w i t h o t h e r n e t w o r k members. 5. Flow: the pattern of s e r i a l or a c t i v a t i o n s o f l i n k s (Hurd e t a l , 1 9 8 1 b ) .  parallel  6. Geographic proximity ( d i s p e r s i o n ) : the extent w h i c h network members l i v e n e a r t h e f o c a l p e r s o n .  to  7. Homogeneity: t h e d e g r e e t o w h i c h network members have s i m i l a r social attributes, 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 . Hurd  et  a l  characteristics theoretical (p.  6).  each  clinical may of are  may  be  suggest  Furthermore, influence  other.  i m p l i c a t i ons  influence  that  even  Hurd  link.  associated  social  structural  "statements  to transact (1973,  about  within  network  by o t h e r differences  variations  the  a network"  1983) h a s d i s c u s s e d t h e  of the p o s s i b i l i t y  support  network  members may  e t a l (1981b) h a s e l a b o r a t e d  Finally,  with  as  distant  and be i n f l u e n c e d  any d i r e c t  individual  Granovetter  Indeed,  that  conceived  p o s s i b i l i t y of a person  significant on  (1980)  that  members  on t h e members  i n the absence  i n network  i n network  experiences  network  have  function,  (Cutrona,  structure such  as  1986b; E l l ,  1984). The to the  interactional  the nature possible  Interactional  characteristics  of the l i n k s , importance  of  characteristics  and may those  of s o c i a l  be v i e w e d links  may i n c l u d e  refer  as i n d i c a t o r s  (Hurd the  networks  of  et a l , 1980).  following.  27 1. Directedness: 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 e x t e n t 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 a n d r e c e i v e d from network members. 2. Durability: the degree of s t a b i l i t y of a person's l i n k s w i t h network members, as i n d i c a t e d by t h e l e n g t h of t i m e n e t w o r k members have been known and t h e e x t e n t to which network r e l a t i o n s h i p s are changing. Social n e t w o r k s , i n c l u d i n g t h e p s y c h o s o c i a l network, a r e n o t s t a t i c b u t dynamic, s h i f t i n g and c h a n g i n g o v e r t i m e a s i n a k a l e i d o s c o p e due t o d i s r u p t i v e l i f e e v e n t s , s u c h as g e o g r a p h i c a l moves, m a j o r l i f e c y c l e t r a n s i t i o n s (Hays & O x l e y , 1986; S a u l n i e r , 1982), d i v o r c e ( M i l a r d o , 1 9 8 7 ) , and d e a t h ( W a l k e r e t a l , 1 9 7 7 ) , o r c h a n g i n g 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 t h a t i n a f i v e y e a r p e r i o d , 50 p e r c e n t o f the people i n the i n t i m a t e psychosocial network 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 that network a n a l y s i s i s " n o t a s e a r c h f o r a f i x e d social 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 s y s t e m o f r e l a t i o n s h i p s " ( p . 2 2 6 ) . A l s o , as m e n t i o n e d above, d u r a b i l i t y has i m p l i c a t i o n s f o r the c o n n e c t e d n e s s o f network l i n k s . 3. Intensity ; the degree of emotional c l o s e n e s s between the focal person and n e t w o r k members. G r a n o v e t t e r (1973) h a s r e f e r r e d t o i n t e n s i t y a s t h e " s t r e n g t h o f t i e s , " and d e f i n e d i t as a " c o m b i n a t i o n o f the amount o f t i m e , t h e e m o t i o n a l i n t e n s i t y , t h e intimacy, and t h e r e c i p r o c a l services which c h a r a c t e r i z e the t i e " ( p . 1361). 4. Frequency: t h e amount o f c o n t a c t p e r s o n and n e t w o r k s . Research networks  of  has tended  the  functional  characteristics  t o f o c u s on t h e i r  affective).  This  meteoric  of i n t e r e s t  i n the concept  mediating  variable  relationship. development  Social  emphasis  i n the s t r e s s f u l network  i s likely  related  of s o c i a l  life  events  r e s e a r c h e r s have  i n two i m p o r t a n t ways.  of  social  supportive functions (eg.,  instrumental, rise  between t h e f o c a l  to the  support and  responded  as a  illness to  this  28 First,  there  are  specifically  that  focus  concept  of  the  a  number  network of  (Hall  &  Mueller,  1980;  Wellman,  of  this  advantages of  Wellman,  support  1985;  1981;  contention,  network  researchers  analysis'should  social  concept  support  of  either  or  Israel  as  1981;  &  have  stated  the  central  be  serve  Hammer, Wellman  who  a  substitute  Israel,  Hiscott,  (1982) m a r s h a l s  1982;  1985).  the  In  following  analysis:  (1) a n e u t r a l a p p r o a c h t h a t l e a v e s t h e r o l e o f s o c i a l s u p p o r t ( t h e e x t e n t and conditions under which ties a r e 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) the e x a m i n a t i o n of characteristics, in addition 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 ;  numerous to s u p p o r t ,  ne t w o r k and their  (3) the i n v e s t i g a t i o n o f t h e c o n t e x t o f 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 that m i g h t be p r o v i d e d by d i f f e r e n t t y p e s 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 relationships o t h e r than t h o s e t h a t o c c u r i n g r o u p s ( i e . , work, c h u r c h ) 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 s t u d y of component l i n k a g e s  how o v e r a l l network s t r u c t u r e and a f f e c t the f l o w of s o c i a l s u p p o r t ;  (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 well-being; and (7) the delineation of network 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 i n t e r v e n t i o n s aimed a t e n h a n c i n g health s t a t u s (p. 66). Brugha  (1984),  network that on  an  however,  variables  such  an  as  approach  underlying  related  to  the  person's  social  has  challenged  measures to  the  assumption number,  of  social  analysis that  the  relationships  the  of  social  diversity, with  idea  of  using  support. social  support  support and  others,  the an  He  is  social  contends is  based  positively  quality  assumption  of  a  that  29 obscures social  the  contribution  context  Second, networks  to  the  necessarily  to  "the  double-edged has  an  psychosocial  nature  important  networks;  theoretically  and  social  system  support  quality have  supportive  a l , 1981b; Wellman, 1 9 8 1 ) .  that  and  researchers  et  idea  personality  quantity  several  are  of  For of  of  this  focal  the  person.  1981b;  (p.  Hurd points  137),  an  investigation  psychosocial  comprises  social  (1982)  relations"  for  and  support.  whether  example, F i s c h e r  i s , the  the  social  a l l (Hammer,  personal  potentially  of  questioned  at  implication  that  characteristics  network  existing  Hurd  et  of  only  viable  al  (1981b)  explains: ...we must stress that a s o c i a l network i s not 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 a s s u m p t i o n t o be a m a j o r c o n c e p t u a l f l a w i n m o s t c l i n i c a l reports about s o c i a l network intervention. S o c i a l n e t w o r k s a r e j u s t t h a t . They may be supportive, destructive, i n s i g n i f i c a n t , or merely i n n o c u o u s . Or more p r e c i s e l y , s o c i a l n e t w o r k s 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 o f w h i c h a r e s u p p o r t i v e , or m o s t l y d e s t r u c t i v e , o r an a d m i x t u r e o f a r a n g e f r o m b e n e f i c e n t to n o x i o u s i n t e r a c t i o n s (p. 248). Hammer  (1981b)  restraint,  points  to  opposition,  such  aspects  of  social  networks  d e m a n d i n g n e s s , mere p r e s e n c e , and  range  as of  access. Research is  concerning  comparatively  al,  1983;  1987; 1984).  recent  Kessler  Riley This  anorexics, accompanied  &  et  by  (eg,,  Eckenrode,  that, a  negative Coyne  a l , 1985;  research in  the  has  1986;  &  Leffler Rook,  implications  an  fight  effects  obsession to  resist  of  s o c i a l networks  DeLongis, et  1986;  a l , 1986;  1984;  with  demands  Pagel  Sandler  f o r the  Fiore  &  et a l ,  Barrera,  s o c i a l networks  food to  and  eat,  et  of  slimness as  well  as  30 concomitant hostile  network  The the  dysphoria  is  likely  to  produce  ambivalent  or  even  interactions.  functional characteristics  f o l l o w i n g (Berkman, 1984;  Israel,  1. A f f e c t i v e support; c a r i n g , and l o v e .  the  of  social  networks  include  1982).  p r o v i s i o n of moral  support,  2. Instrumental 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 , s u c h as f i n a n c i a l h e l p , o r h e l p w i t h c h i l d care. 3. new  Cognitive support: access to d i v e r s e k n o w l e d g e , a d v i c e , and f e e d b a c k .  information,  4. Reciprocity: the quality and intensity of 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 o r a f f e c t i v e e x c h a n g e ( H u r d e t a l , 1981b). 5. M a i n t e n a n c e of shared world view.  social  6. Social outreach: social roles.  identity:  access  7. S t r e s s mediation: the maintaining, s t r e s s reducing s o c i a l networks. Several  typologies  processes  are  Breier  Strauss,  &  Mitchell 1977;  &  social  1974;  support  manifestations (Barrera,  1984;  1981;  Stokes & Wilson,  of  Wills,  Barrera  Schaefer 1985).  literature the  Cutrona, 1984).  contacts  f u n c t i o n and  Gottlieb,  1980;  social  of  a  and  stress generating, stress or b u f f e r i n g f u n c t i o n s o f  network  a v a i l a b l e (eg,,  Trickett,  Weiss,  of  to  validation  of  supportive  informal  & A i n l a y , 1983; 1979, et  Walker studies  specific  function  1986a; G o t t l i e b ,  also  of  1978;  Rook,  1985;  House,  a l , 1981;  There the  1983;  helping  1981; et a l , in  the  behavioral  social  networks  Vaux e t a l ,  1987;  31 Social The  networks;  personal  especially (eg.,  and  environmental  network  Argyle,  p e r s o n a l and  determinants  s u p p o r t i v e n e s s , have  1980;  Brugha,  1984;  1986;  Dunkel-Schetter  et  Heller  & Swindle,  Henderson,  Mitchell, 1986;  Parkes,  Tietjen, that  and  about (1983)  to  have  networks  do  by  Hirsch  provided  friends  and  support  they  a  simply  play  an  timely  affect  active  associates,  social  Moos,  1986; &  Byrne  and  a  he  Nadler,  (1977) to  the web  vary  idea of  proposed  1986; suggest  between  that  network  the ties  that  varying  in individuals'  choices  worlds.  individuals  the  1976;  Starker,  likely  reminder  role  Cauce,  1984;  differences  their  1987;  L a z a r u s & Folkman,  within  (1981) when  &  elsewhere  1986;  needs a r e  agent  networks,  Richman,  Furthermore,  reflect  structure  not  persons  Henderson  passive  p a t t e r n s may  how  example,  social  Philips,  1980;  a l , 1985,  attachment  a  1982;  et  situations.  i s not  highlighted  network  and  &  determinants.  discussed  Flaherty  Trickett,  Sarason  For  affiliative  individual  that  1986;  &  of  been  Bruhn  a l , 1987;  Mitchell  1985).  individuals  was  1983;  1982;  environmental  Heller  that  social  Swindle support  unidirectionally,  in determining amount  &  and  their  type  of  but  network network  receive:  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 " a g e n t i n t h e d e v e l o p m e n t and u s e o f a n e t w o r k . . . T h e a s s e t s and s k i l l s n e c e s s a r y t o e n t e r many n e t w o r k s a r e p e r h a p s as important i n understanding the "potency" of that n e t w o r k as a r e t h e n e t w o r k ' s a c t i v i t i e s and f u n c t i o n s (p. 91). Finally,  correlational  hypothesize social  a  network  studies,  statistically and  some  such  significant  independent  as  this  one,  correlation  variable  (eg.,  that  between anorexia  32 nervosa) are subject that and  to a serious  i s , the independent environmental  suggested  that  developed  social  general  social  Starker  rival  or i n t e r a c t i o n a l e f f e c t s  variables.  competent  F o r example,  persons  networks  as  a r e more  a  direct  hypothesis,  of  personality  Heller likely  result  (1979) t o have  of  their  has well more  competence.  Research researchers  uncontrolled  interest  h a s been  in this  sparse  area  and r e c e n t ,  ( 1 9 8 6 ) , on t h e b a s i s  among  social  however.  For  of h i s l i t e r a t u r e review,  network example,  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 t o a d d r e s s t h e i s s u e o f individual differences i n needs f o r s u p p o r t — personality variables, coping skills, and s o c i a l competence a r e r a r e l y c o n s i d e r e d ( p . 4 8 7 ) . Mitchell  (1982) n o t e d  that,  W h i l e t h e e f f e c t s o f s o c i a l network p a t t e r n s a r e b e i n g documented, very l i t t l e i s known a b o u t their determinants" (p. 388). Perhaps  this  concern,  reflected  to  empirically  forms  of  been  of a f f a i r s  establish  a s an i n i t i a l  an a w a r e n e s s  environmental  distress research  o f t h e need  processes  that  patterns.  F o r example,  concept  o f network  orientation,  concerning  members i n h e l p i n g negative  network  network  social  network  expectations  i s attributable  i n the s o c i a l  psychological  populations has  state  agenda.  and  and  of  whole, various  psychiatric  Nevertheless,  t o examine  Tolsdorf  there  t h e i n d i v i d u a l and  are shaped (1976)  by  social  introduced  the  a s e t o f b e l i e f s , a t t i t u d e s , and  person  orientation,  correlates  i n general  shape  paramount  l i t e r a t u r e as a  network  the p o t e n t i a l  the f o c a l  to the  usefulness  cope w i t h  a life  characteristic  of  of  network  problem.  A  psychiatric  33 patients,  involves  inadvisable, draw  on  lack  of support  1987;  utilize  special  al  The  therefore  resources  that  i t is  dangerous  to  individual  with  a  suffer,  from  a  b u t from an u n w i l l i n g n e s s  t h e network  data  interest  (1981a)  participation  of  on  gathered  to  three  from  a  network  participation  involuntary (ie,.  not to  maintain,  available  (Colletta,  or  (1981a) important exchange, alters  as  an  mixture  underlying  suggest  that  network  implications frequency  of  for a  F o r example,  opportunity  to  family  He  defines a  these  subject's modes  types  here  purposeful  of  are that  component  of  non-ascribed  and  social  an  style  social  that  Hurd  et a l  may  have  of  overall  i f i t i s assumed  network  individual's  perception the  kin  relationship  activity.  participation subject's  of  ( i e , role-bounded),  r e l a t i o n s h i p s (extended  both  establish  network  nuclear  f a m i l y dominant),  interaction  Hurd  network  reflecting  ascribed  by  social  r e l a t i o n s h i p s and  theses  a  social of  balanced.  as  of  of  operational  analyses  and  voluntary  r e p e r t o i r e and  reported.  equal  a  of  population:  socially  bounded),  Two  is  behavioral  factor  r e l a t i o n s h i p s (nuclear  (balanced). activity  types  i s the d i s c o v e r y  patterns  styles  specifically,  non-role  dominant),  of  k i n dominant,  for certain  interaction,  study  general  extended  preference  this model  the b a s i s  dominant,  an  beliefs  potentially  (p. 413).  o r i e n t a t i o n may  resources,  or  or  Vaux e t a l , 1 9 8 6 ) . Of  et  and  useless,  resources"  network  nurture,  s e t of e x p e c t a t i o n s  impossible,  network  negative  "a  support  number  people  relationships,  of  share the  34 smaller  sizes  consequence preferred by  the  of  of  nuclear  a  disinterest  degree of  subject  Also research  et  special  interest  Mitchell  environmental  variables  sample  of  35  diagnosis  family were  In  these  of  his  correlates  network  size;  positively reported cohesion but  the  and  was  cited  by  the  fewer  intimate  he  climate  to  lack  a the  desired  to  respondent  the (ie,  relationships needed  to  which  was  support of  more  cited). to  their  intimate cohesive  Mitchell  "examine  the  example, related  support  from  that  climate  peers;  and  significant  for  family of  size  indicated were  and  resources  of  positively in  style  social  dimensions  variables  from  the  a  extent  the  amount  number  whom had  these  dimensions:  to  a  of  Results  style  network  members  family  independence  related  of  and  obtained  problem-solving  and  overall  comparative  social  majority  network  especially  related  was  be  individual  the  family  subjects.  the  the  Mitchell  examined  social  of  to  the  35  network  positively  research  which  is  clients.  environmental  level  receiving,  study  related  and  problem-solving  related  negatively  further  family  social  the  may  role-boundedness  examining  outpatients,  psychiatric  of  interpersonal  in  or  in interpersonal  with  individual  in  are  study,  differences  associated  relationships  this  psychiatric  his  differences  support  that  schizophrenia,  individuals. individual  of  to  (1982)  psychiatric  of  in  networks  a l , 1981a).  of  characteristics  dominant  social ascription  (Hurd  of  family  was  clients  and  family  to  family members,  relationships the  family,  concluded individual  the that and  35 environmental  processes  network p a t t e r n s " ( p .  Normative primary  networks.  social  networks)  appear  structural  characteristics  precision  t o have  i s hampered  sample  o f community  an  average  et  a l (1978)  networks social  a  both  Africa, despite  and f o u n d cultural  eliciting network known  this  their  New  17 p e o p l e i n  class  data.  social  o f urban,  York,  surprising  connections structural  network  tended form,  individuals  members,  actually  that  of about 20  with  i n the techniques of immediate 6 t o 10  other, seen  percent  social  intimately  a n d p e r h a p s an regularly  40 network  a lower  B r i t a i n on  structure,  by t h e  members.  Of  of the p o s s i b l e  but with  i s , 5 or 6 c l u s t e r s  i n each,  with  i n network  an  to occur,  and r u r a l  M a l t a , and  of approximately  for a total  Hammer  from  differences  each  found  and London  individuals,  30 network members who were a l s o  s e t o f 40  suburban,  r e s e a r c h e r s from  consistency  knew  (1974)  network.  Vermont,  Specifically,  o f whom  although  network o f a b o u t  and m i d d l e  most  population,  F o r example,  by o t h e r  consisted  individual,  connected  data  p a t t e r n of  methodologies.  i n the intimate  v a r i a t i o n s -and  typically  members,  a core  that  study, p s y c h o s o c i a l  consistent  i n the general  gathered  network  additional focal  compared  class  social  by  suggests  r e s i d e n t s , whereas B o u s s e v a i n  i n metropolitan  working  (1980)  (in this  fairly  by d i v e r s e  o f 30 p e o p l e  network d a t a  Mueller  networks  J o n e s & F i s c h e r (1978) f o u n d a  and a r e shaped  387).  social  or immediate  shape  that  of 6  degree  a  distinct  or 7 h i g h l y of connection  36 across  clusters  using  (see  the P a t t i s o n  from  a  normative  "normal"  urban  important  friends  and  half  two-thirds  each  population  to the  (a  Nuclear  members,  being  multiple  to  of  other  often  life  a convenience  the  ratio  dominant, three and  for  Hurd  et  the  al  sample of 93  structural  analysis  revealed  of s o c i a l nuclear  extended  composition.  significantly  network p a t t e r n s t h a t  f a m i l y to  extended  f a m i l y dominant varied Nuclear  smaller  comprised  of  primarily  friends  members) and  and  family  overall  (18  nuclear co-workers  was same  network  data  living  New  e x i s t e n c e of  York three  were i d e n t i f i e d  both  Each  of  these  i n network  size  networks  were  members),  members  (4 members).  by  nuclear family  dominant  family  in  the  individuals  balanced.  network  network  matrix  using  family:  significantly  of  existed  semi-rural upstate the  with  instrumental  social  (1980),  "normal"  About  ratio  relationships and  to  relatives,  most v a l u e d and  a  people  relationships  affective  and  of  22-25  6 belonging  e t a l (1975) above, c o l l e c t e d  subpopulations  (5  sought  data  found  associates.  were t h e  Chicago,  types  of  5 or  social  California,  The  distinct  had  friends  people.  drawn from  areas.  people  interaction,  as P a t t i s o n  Southern  with  work  significant  instrument  in  s u b j e c t s , and  comprised  and  (1975),  network  connectedness-unconnectedness  however,  areas  semiopen  these  al  nuclear f a m i l y , other  social  f a m i l y and  most  be  et  collected  200  respondent,  and  social  60:40).  assistance;  of  of  to  clusters:  neighbors,  other  Pattison  Psychosocial Inventory,  of t h e f o l l o w i n g  to  Hammer, 1 9 8 0 ) .  p s y c h o s o c i a l network  considered each  also  (7  and  were  members),  Extended  family  37 dominant  n e t w o r k s had  composed  of  coworkers  extended  (5  average  family  members).  network  members,  sectors:  nuclear  Pattison functional  an  5  family, al  24  network members, p r i m a r i l y  (9 members), f r i e n d s  Balanced  with  et  of  or  6  networks  members  extended  c h a r a c t e r i s t i c s of  in  family,  (1979) f o u n d  the  had  (6 members), an  each  average of  f r i e n d s , and  following  (1) there are frequent contacts with network members, marked by positive emotional investment; exchange  of  22  network  coworkers.  i n t e r a c t i o n a l and  normal p s y c h o s o c i a l  (2) t h e r e is a reciprocal instrumental support;  four  and  networks:  most of the and intense  of  emotional  and  ( 3 ) t h e 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 t o be s t r e s s - r e d u c i n g , as opposed t o s t r e s s - i n d u c i n g or stress-maintaining; and (4) t h e network p r o v 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 s e t norms and s o c i a l e x p e c t a t i o n s f o r t h e management intercurrent stress. In  their  i n t e r a c t i o n a l analysis,  respondents members  had  within  nuclear  contact one  family  with  month;  dominant  over  networks  for  family  f r i e n d s h i p c l u s t e r s , and  relations  from  that  provided  they  amount and  of  dominant to  a  other  support  friends  contact  exchanged  network  as  Hurd being  et  network  unique,  revealing  a  nuclear  abandonment  contact  they  of  received, in  (1980) v i e w  that  of  relations within low  A l l respondents  particularly  participation style  a l l their  that  were  greatest al  found  patterns  sectors.  was  of  (1980)  contact  an  than  al  the  frequency  more s u p p o r t  sectors.  network  network  et  50%  however,  preference and  high  Hurd  of of  the  and  that  nuclear  the  vulnerable, fosters  indicated  nuclear  family family  however,  almost  the  due  exclusive  38 reliance in  a  on  a single  sector,  comparatively  provisions  of  the  nuclear  smaller  set  family  of  cluster,  network  embedded  relations  for  support:  B e c a u s e t h e l o s s o f a member, e s p e c i a l l y someone s e e n frequently, i s c r i t i c a l t o amount o f psycho-social supplies available, these network types are t h e o r e t i c a l l y more a t r i s k t h a n t h e other subtypes. T h i s w o u l d a p p e a r p a r t i c u l a r l y t o be t h e c a s e i f a change or d i s r u p t i o n i m p a c t e d the family. Because t h e s e network t y p e s do not r e l y on t h e i r e x t e n d e d k i n and because there i s evidence of disruption or disparity in their relationships with friends these n e t w o r k t y p e s a p p e a r as b e i n g t h e most v u l n e r a b l e i n c i r c u m s t a n c e s of s t r e s s f u l l i f e e v e n t s (p. 31).  S o c i a l networks and had  a  longstanding  health  and  structure  between  (including  the  health  at  in  situations practices to  stressors  structures disorders.  be  psychosocial least  the  are  that  the  or the  relationship of  and  social as  social  Kadushin  a  factors,  class, the  less  stressful;  individual  or  ways:  (1) (2)  against and  exacerbate  (3)  social  network  affect it  it  can  can  mental create mandate  or  sensitize  i t  can  existing  as  individual  social to  The  such  and  have  mental  mediating  (1983),  three  between  structure.  n e t w o r k ) i s presumed  environment;  alleviate  s o c i a l sciences  structural  following  more  immunize in  the  The  viewed  global  Following  that that  may  urbanization  health.  in  elements  network  modernization, mental  interest  various  psychosocial  mental h e a l t h .  him  produce  psychiatric  39 The networks (Marsella  research  i n v e s t i g a t i n g t h e r e l a t i o n s h i p between  and m e n t a l h e a l t h & Snyder,  may be a s s i g n e d  to four  social  general  1981).  1. S o c i a l n e t w o r k s as t h e l o c a t i o n o f r e s o u r c e s and support t h a t enhance m e n t a l h e a l t h ( e g . , B i l l i n g s & Moos, 1 9 8 2 ; F i n l a y s o n , 1 9 7 6 ; H e n d e r s o n e t a l , 1978, 1979, 1980; L i t w a k & 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; W a l k e r e t a l , 1 9 7 7 ) . There i s now a r i c h b o d y o f r e s e a r c h concerning social n e t w o r k s , 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 m e d i a t i n g v a r i a b l e i n t h e s t r e s s f u l l i f e e v e n t s and psychological well-being 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; Barrera, 1 9 8 6 ; B r o a d h e a d e t a l , 1983; Cohen & Syme, 1 9 8 5 ; C o h e n & W i l l s , 1985; D o h r e n w e n d & D o h r e n w e n d , 1 9 7 8 ; G o t t l i e b , 1983a; H e l l e r , 1979; H e l l e r & S w i n d l e , 1983; H e n d e r s o n , 1984; House & Kahn, 1985; J u n g , 1984; K e s s l e r e t 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 & D o u g h e r , 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; T u r n e r e t a l , 1983; Wortman & D u n k e l - S h e t t e r , 1987). 2. S o c i a l n e t w o r k s and t h e i r r e l a t i o n s h i p t o h e l p seeking behaviour and u t i l i z a t i o n o f s e r v i c e s ( e g . , B i r k e l & R e p p u c c i , 1983; G o u r a s h , 1978; H o r w i t z , 1977, 1978; M c K i n l a y , 1973; P e r r u c c i & T a r g , 1982; S a l l o w a y , 1973). 3. S o c i a l n e t w o r k s as a t h e r a p e u t i c approach ( e g . , A t 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 e t a l , 1981b; J a c o b s o n , 1986; K l i m a n & 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 e t al, 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, 1 9 8 5 ) . 4. T h e o r e t i c a l and c o n c e p t u a l aspects of s o c i a l n e t w o r k s and t h e i r r e l a t i o n t o 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 . , A n d e r s o n , 1 9 8 2 ; A n t o n u c c i , 1 9 8 5 ; Beels, 1 9 7 8 ; D ' A u g e l l i , 1 9 8 3 ; H a l l & Wellman, 1985; Hammer, 1963, 1981, 1983; Hammer e t a l , 1978; H e n d e r s o n e t a l , 1978, 1979; H i r s c h , 1985; H i r s c h & J o l l y , 1982; House & K a h n , 1 9 8 5 ; M a r s e l l a & S n y d e r , 1 9 8 1 ; 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 & T r e n e r r y , 1983; W o l f e , 1 9 8 1 ) .  areas  40 Social a  brief  n e t w o r k s and  review  social  given  to s e v e r a l  may  Although  studies  of  this  have  marriage,  be  social  general  where have  support,  between  distress  attention  in  will  be  psychiatric  psychiatric  and  the  category  stress-distress  appropriate,  used  such  most  categorical  as  rather  interactional therefore  detailed  support  of a c o n f i d a n t ,  p e r s e , and  psychiatric  is  assigned.  literature  and  following  of non-psychotic  this  included  social  presence  structural  networks  been  enormous of  studies  i t i s into  patients  indicative  the  comparative  The  the r e l a t i o n s h i p  and  In a d d i t i o n ,  anorexic  relationship from  characteristics  since  distress.  investigating  populations.  populations, that  of s t u d i e s  network  psychiatric  psychiatric  social  than  studies measures  integration,  direct  measures o f  characteristics  of  are not d i r e c t l y r e l e v a n t  social to  this  study. It  i s noted  literatures Phillips,  report  1981)  differences  social often  Hall  &  Israel,  ethnic  & Dohrenwend,  1982;  Kleiner,  1985;  1985;  or p s y c h i a t r i c  variables  1985;  (Griffith,  to  psychiatric  to s t r e s s  Warheit  1984;  Kleiner  e t a l , 1982) of  of the r e l a t i o n s h i p  of  distress,  Heller &  1983;  and i n d i c e s  e t a l , 1983;  1983;  support  Leavy,  or s t r e s s f u l l i f e  198.1; F i o r e Hammer,  social  distress.  e t i o l o g i c a l models  references  Wellman,  (Griffith,  and  o f s o c i a l network v a r i a b l e s  are several  include  t h e s o c i a l network  gender  well-being  network  Dohrenwend  and  that  i n studies  psychological There  here  Parker,  &  and  these  events (eg.,  Gottlieb,  1983;  Swindle,  1983;  1976;  Richman  &  41 Flaherty,  1985).  researchers are  Cohen  have  thought  to  have  symptoms, which  explain  the  level  then, of  only  assert  social  reviews  of  1982;  reviews mixed  of  their  a  analyses  effect  networks  on  of  effect  generally  an  that  indirect,  social  explanation  in  on  as  to  symptoms Cohen  et  al,  belonged  to  one  social  symptomatology,  exert  that  on  psychological  buffering  imply  which  networks  proposes  level  network  hypotheses  According  have  social  social  greatest  increases.  whose  two  of  the  posits  which  distress  Hurd have  et  Perrucci  &  (D'Augelli,  a l , 1980;  encompassed  Silberfeld,  Henderson et Targ,  schizophrenics Pattison, and  1982;  1978;),  1981; have  (Clark  populations.  investigate social  or  some  15  and  networks those  buffering  There  who  effect  several and  Greenblatt  Mueller,  comparative &  are  network v a r i a b l e s  E l l , 1984;  1983;  (Cohen  1980).  studies  Sokolovsky,  These  of  1978;  et  either Froland  a l , 1978a, 1978b; P a t t i s o n  et a l ,  1979;  Post,  Azim,  1975;  1962;  specific  & Cullen,  Sokolovsky typically  1983;  Leavy,  p s y c h i a t r i c populations  a l , 1979;  1979),  psychiatric  studies  psychiatric  et  on  that  well.  Studies  al,  other  of  hypothesis  researchers  those direct  one  exert  network  a  that  the  one  effects  effect  stressors  camps:  exert  as  of  the  direct  networks  social  two  a  (1986) s u g g e s t  espoused  symptoms:  whereas  social  al  generally  psychopathological networks  et  et found  Ratcliffe  clinical 1974;  populations,  Garrison,  a l , 1978;  &  1978;  Tolsdorf,  distortions in  primarily Pattison  1976;  network  &  Turner, structure  42 and  interaction  disruptions  patterns,  i n network  psychiatric  disorder  with  psychiatric  disorders  smaller  family, intimate the  smaller  less  the s i z e ,  (especially of  networks  are  although  may  be  i s also  some  respect  dense  evidence  quality  is  data  interaction  to suggest  psychopathology members for  tend  (Hurd  interaction,  (1967),  there  the l e s s  the support,  1980).  in a  t o network  the  study  of  psychotics degree  psychotics'  of  cases, network  i s generally exchange),  With less  and t h e r e  t h e more s e v e r e t h e with  one-way ( d e p e n d e n t ) , than  o f network  I n some  Interactions  rather  some  composition  symptomatology.  affective  populations,  for  of  appear to  by a h i g h  of  (eg., less  et a l ,  indeed,  i s also  proportion  psychiatric  t o be p r e d o m i n a n t l y  psychotic  Goldstein  that  portion  of a higher  regard  supportive  higher  or i n t e r c o n n e c t e d .  themselves manifest of  There  and c h a r a c t e r i z e d  members who to  regard  the p r o p o r t i o n  be  fewer  the degree  t o t h e network  F o r example,  the non-kin  less  with  that (ie.,  of  network c l u s t e r s  results  to  cluster  i l l persons; t o be  people  networks  and c o m p r i s e d  are unclear.  k i n tends  whereas  network  appears  I n some c a s e s ,  schizophrenics),  density,  there  the greater  patients.  that  personal  by  coworkers),  o f a skewedness w i t h  members  have  and  associated  Structurally,  non-psychiatrically  impairment.  psychiatric  1980).  smaller  and i n t e r c o n n e c t e d n e s s  evidence of  than  support,  as s i g n i f i c a n t l y  typically  size,  interconnected,  density  (Mueller,  friends,  relations  psychiatric be  in total  relatives,  i n network  relationships  with  are  deficits  reciprocal.  reciprocity  network  especially Blackman  networks  &  and  43 psychiatric network  symptoms,  reciprocity  participation  The  least  in  which  consequence,  prior  to onset  Furthermore, measure the  stage  symptom  to  this  the will  general  developed  by  settings  been  marked  by  severe  have  been 1984;  after  the  as a r e s u l t  of  the  onset  nature,  of  are not course  issue of a  As  criteria  vary  of n o n - p s y c h o t i c  i n greater  detail.  of  role  or  not as  a  whether  existed  i n onset).  the  means  widely.  linked  d i s o r d e r , nor  the p s y c h i a t r i c  the  d i s o r d e r (and  variables,  specifically  of a  the data;  of the d i s o r d e r ) or  t h e network  and  limitations,  nature  to a  to graded  p o p u l a t i o n of  i s a n o n - r p s y c h o t i c one, t h o s e  be r e v i e w e d  network  (Famuyiwa,  of a g l o b a l  to c l a r i f y  the d i a g n o s t i c  variables  less  manifest  other  findings  (and p e r h a p s p l a y e d an e t i o l o g i c a l  severity.  the  t h e more  perceived  correlational  emerged  variables  study  network  been  i s the  i n the n a t u r a l  of  f a r has  have  and  between  1981).  the nature  them,  network  These  i t i s impossible  have  relationship  network,  as  cultural  thus  differences  h e n c e may  obligation  respondent,  & Pattison,  reviewed  significant  p s y c h o l o g i c a l symptomatology:  other  analysis  of  these  the  a  et a l , 1980).  replicated  studies  of  (Hurd  Westermeyer  and  i n a mutual  symptomatology members  found  to  Finally, specific levels interest  studies investigating neurotic  populations  44  Comparative populations  and  comparative the  social  their  studies network  populations,  they  methods  of  more  less,  or  studies  have  on  close  associates  and  variously  network,"  nuclear  n e t w o r k , " and  colleagues  general in  from  et  is  of  examined  urban  of  sample  200  subjects.  subjects,  as  who  friends, ties  in  the  dead  or  to  nuclear  family.  different  all  focussed,  psychosocial  The  the using  network,  friends,  as  work to  neighbors,  and  the  the  smaller  controls,  far a  like,  "effective support  Pattison study  psychosocial the  network  of  Inventory.  These  samples  of of  a  normative  neurotic  networks  of  away,  with  had  on a  in  size  significant  fewer  reliance  and  neurotic  smaller  including  networks  because  employed  networks  were  and  instrument  often  higher  These  of  this  Psychosocial  psychosocial  and  psychiatric  "psychosocial  relevance  members),  co-workers,  analyzing  (Llamas et a l , 1981).  and  lived  have  studies  psychosocial  The  network  were and  the  of  using  recreation  the  concerning  compared  15  they  family,  1979).  special  subjects  psychotic  people  (1975,  Pattison  researchers  (typically  network"  following  purpose  purpose  the  these  group,"  data  the  this  work, c h u r c h , in  the  non-psychotic,  of  p s y c h i a t r i c populations  study,  common  extended  to  al  published  and  this  family,  "core  Pattison  have  permutation  "primary the  Although  Nevertheless,  referred  the  the  accomplished  some  and  they  shared  assessment.  (neurotic) psychiatric  networks.  c h a r a c t e r i s t i c s of  of  his  social  have  comprised  1*  of non-psychotic  relatives, involuntary  lower  density  45 or  interconnectedness ratio  the  control  and  expectations  distorted  group,  contact,  thus  either  had  to  variables  sample. and  reciprocity,  of  there  a  the n e u r o t i c  respondent.  their  findings  the  of  in was  negative  R e l a t i o n s h i p s were creating  behaviour  lower  of  Pattison  that  social  or  to  of  norms  correct  ratings  on  the  comparison  to  the  less and  frequency  weak  characterized  sense  half  set of  Furthermore,  example,  toward  as  reliable  much  frequency  thereby  approximately  guide  were  For  more  interactions.  subject  no  behavioral responses.  interactional normative  and  (30:70),  by  burden  of  emotional asymmetrical  and  obligation  e t a l (1979) summarized  p s y c h o s o c i a l network  of  the  neurotic  follows:  In m e t a p h o r i c terras, t h e n e u r o t i c s u b j e c t i s a t t h e hub of a wagon w h e e l , w i t h i n d i v i d u a l r e l a t i o n s h i p spokes sticking o u t and w i t h a b r o k e n 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 individuals 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 persons w i t h n e u r o t i c b e h a v i o r s , c o n s e q u e n t l y , i s l i k e l y b o t h t o i n d u c e s t r e s s and t o m a i n t a i n o r augment s t r e s s . Thus i t i s more l i k e l y t o c a t a l y z e t h e t r a n s f o r m a t i o n o f s t r e s s i n t o a n x i e t y and then i n t o neurotic-symptom b e h a v i o r s (p. 66).  2. social a  R a t c l i f f e & Azim (1975). networks  control  Two  paired  control list  sample  of  psychiatric  drawn  samples  were  for marital  significant  interpersonal  from  others  needs  (eg.,  who  patients  households  drawn  status,  T h e s e r e s e a r c h e r s compared  from  age  and  were  spending  the  from in  the  hospitals  same  subject pool  sex. depended free  two  the with  community. i n order  to  S u b j e c t s were a s k e d  to  upon  time  to  with,  meet  certain  talking  with  46 when  troubled, seeking  satisfaction indicated the  that  control  personal who  with  could  predominance  control  history  a  of  less  Network  reported  & Azim,  lower  i n explaining  of symptomatic  r e l a t i o n s h i p s with on  a  when  relatives  with  composition  their  members  reflected  a  k i n and  professional  friendship  relations.  with on  results,  results  friends  Results  network  married  their  in a  and  the  spouses.  suggested  network r e l a t i o n s ,  and  of  when compared t o  fewer  reliance  behaviour  significant  members.  compared  these  degree  satisfied  with  voluntary  patients,  their  patients,  and r e p o r t e d  upon.  lack  married  reliance  and s i n g l e  relations,  rate  network  of i n v o l u n t a r y r e l a t i o n s  group,  Ratcliffe  and  significantly  depended  and  Similarly,  were  from)  significant  married  group,  be  helpers,  these  both  network  advice  that  disruption  a of  leading to less  more  reliance  on  professionals.  3.  Henderson  psychosocial was  compared  groups  respective the  number  network) with  spent  network  members  cited  figures,  i n negative,  significantly  during  fewer  the previous  unpleasant  patients both  with  their  significantly  in  i n t h e community, t h e  fewer  social  (or  Although  amount o f t i m e  or p r e s e n t  group"  psychiatric  and d i d n o t d i f f e r  reported  the household  "primary  controls.  t h e same  of k i n a v a i l a b l e  attachment  The  o f 50 matched  approximately  group  time  a l (1978b).  o f 50 n o n - p s y c h o t i c  that  psychiatric  outside  et  good  friends  contacts with week,  conversation  and  and  spent  less  and  people more  time  in  47 affectively control as  neutral  group.  compared  support they  felt  94%  requirements This  used.  same  amount  reported  Henderson  the  group,  was  of by  by  sampling  similar  social  d i d not  network group;  considered  figures  that  interaction  the  severe  reported  Brugha  to  et  procedures  or  the  meet  al  group, the  t o whom  summary,  primary  group  i n both the  size  subject's  however,  (1982) i n D u b l i n  and  deficiencies  more  outside severe  could  instruments were  i t was  the  found  also  non-psychotic that  n e u r o t i c forms  of  depression  which  antedating their  appeared  symptoms.  to  be  that  were  in not  depressive  confirmed but  not  B r u g h a e t a l (1982,  o u t p a t i e n t s had  the  the f i n d i n g s  clearly  networks  in  found  household  be  depressed  were  c o n t a c t s and  only  retarded depressives.  that  personal  considerably  (1978b)  minor  In  the  that  persons  deficient  Brugha et a l t h e r e f o r e c o n c l u d e d al  or  sufficient.  appear  to  psychiatric  i n t h e numbers o f s o c i a l  p a t i e n t s with  et  compared  interaction.  psychiatric  with  their  of  s u b j e c t s was  replicated  design,  patients more  and  deficiencies  disorders.  also  was  Remarkably  non-psychotic  the  close  people,  36%  attachment  psychiatric  for social  significant  only  control  from  quality,  study  the  with  h i s c o l l e a g u e s (1978b) f o u n d  affective  where  the  af f e c t i o n a l l y  non-psychotic  and  of  obtained  H e n d e r s o n and of  Furthermore,  to  they  conversation  of in in  1984)  deficiencies  in  long-standing,  48 4.  Silberfeld  networks  of  outpatients group  of  a of  50  spent  mixed  patients,  of  the  type  of  of  in  proportionately  of  a l l their  friends  relations  in  relationships patients  to  patients  for  have to  "close"  had be  per  less  general  friends  control  patients,  over  and  friends,  visit,  of  data  t o t a l s o c i a l support practice nuclear  patients, and  patients. of  a l l  psychiatric  total  therefore  these  intimate  proportion  less  this  and  their  however,  and  of  were  proportion  practice same  less  spouse  there  with  the  network  relatives,  a greater  that were  reported  had  of  regardless  relationships  "close;"  The  to  members,  group;  general  groups  time  spent  his  economy  respect  proportion  relationships.  compared  preference relations.  less  with  network  invested  to  general  patients  greater  considered  intimate  as  a  both  spent  psychiatric them,  psychiatric  contrast  Interestingly,  these  their  as  S i l b e r f e l d found  with  fewer  comprised  an  time the  control  using  patients  to  social  matched  Psychiatric  less  relationships  to  with  contrast  Conversely,  a  patients,  networks  spent  of  of  the  psychiatric  reconstructing  compared  relationship. and  female  those  for  compared  50  practice  social  time  contact  children  type.  of  of  relationships.  when  their  duration  frequency or  in  with  method  in interpersonal  impoverished and  general  survey  researcher  sample  diagnosis  female  psychiatric  size  This  convenience  n e t w o r k measure a time  (1978).  time  with  suggests  that  available and  extended  show  to a  family  49 5.  Froland  social  networks  patients n = 20;  from  an  of three  a state  outpatient  control  group  social  network  groups,  relative  size  e t a l (1979).  having  fewer  long-term  less  be  correctly  were p a r t i c i p a n t s vary  with  f o r t h e poor  network  terras  sibling,  etc.),  inability feelings  in.  the s e v e r i t y  accounted  These  to  as a  of burden  program,  population the  the three  as f o l l o w s :  average  treatment smaller i n  different  sources of  interaction  with  degrees  of  change,  i n greater  disruption  i n the  networks  were a l s o  i n helping On  characterized  exchanges,  the health  and  basis  of  clients  were  less  network able to  as t o t h e t y p e o f t r e a t m e n t program This  finding  suggests that  of p s y c h i a t r i c adjustment  "disaffection  help  or  of the mental from  family  assistance  i n t h e network"  social  impairment.  experience of i n s t a b i l i t y obtain  groups ( i e . ,  general  less  the  and g r e a t e r  79.2% o f t h e m e n t a l  classified  a  from  friends;  relationships.  characteristics,  and  k i n ; fewer  resulting  mutuality  treatment  a day t r e a t m e n t  group,  and r e l a t i v e s ;  of s u p p o r t .  s a t i s f y i n g  with  examined  et a l described  clients  ties  and l o s s ,  having  n=27)  fewer  friends,  health  Froland of  researchers  n=30;  to the c o n t r o l  family,  as  clinic,  profile  and  availability  mental  hospital,  (n=30).  friends  instability  These  (p.86).  networks  Froland  health  they  et a l  clients in  (parents,  spouse,  i n relationships, without  and  engendering  50 6.  Famuyiwa  investigated patients anxiety  the s o c i a l  neurosis,  designed  were  density  of  received  lower tie et  the only  patients  and e m o t i o n a l a l suggested  When  variables  scores  that  of the g e n e r a l  ties,  society's  intolerance study  formation  of hypotheses  different  ethnic  support,  to the  material  aid,  to the o v e r a l l  difference  i n the networks  the c o n t r o l  group  reported  during  was i n  that  periods  they  of c r i s i s  network c h a r a c t e r i s t i c s were  place,  differences in  sector;  patients  In e x p l a i n i n g  however,  had  significantly  density,  i n t e n s i t y of  this being  result, a  as a whole behaviour"  n o t be g i v e n  society  ties  respect  for focal  (below) s i n c e  population,  of actual  the family  of n e u r o t i c will  o f network  significant  community  schedule  strength  patients  neurotic  " t h e work  microcosm  of t h i s  within  controls  support.  no  normal i n d i v i d u a l s . "  size,  support  social  were  sector,  than  with  n=85;  network v a r i a b l e s :  With  i s , neurotic  disorder,  semi-structured  significant  there  the co-worker  results  a  o f t h e number  as compared  that  by s e c t o r ,  mean  affective  of numerical  l e s s p o s i t i v e emotional  network  within  psychiatric  social  contacts.  the c o n t r o l group.  social  o f 153 N i g e r i a n  with  the f o l l o w i n g  support;  analyzed  researchers  i n t e n s i t y of t i e , emotional  network,  emotional  than  interviewed  to s o c i a l  neurotic  These  or p r i m a r y  as the q u o t i e n t  access  social  networks  (an e s t i m a t e  network s i z e ) ,  (1984).  n=68) and 72 " a p p a r e n t l y  to assess  calculated  and  Olatokunbo  (schizophrenia  Patients  focal  &  Famuyiwa  representative might  reflect  (p. 236).  as much  weight  The  i n the  t h e sample was drawn f r o m a and c o u n t r y  than  the studies  51 just  reviewed.  psychiatric unlike  It  is  patients  those  interesting,  had  reported  social for  however,  networks  patients  with  in  that  Nigerian  deficiencies  the  not  industrialised  societies.  Summary• indicate  a  positive  deficiencies enhancing network the  These  and the  non-psychotic credibility  development  of  psychiatric  There  composition  of  dominated  and  typically  and  et  with  affectively  unpleasant,  disruption analysis deficient  degree to  the  revealed in  time  a  weak  change,  that  positive  the  of  spent  emotional  et and  network of  a  sources  network  each of  contact. negative,  interaction, al  (1979)  loss,  during  and  reported  resulting  support.  in  Functional  patients time  of  analysis  with  psychiatric  support  the  family  different  frequency  Froland  networks  connected  composition  during  in  Structural  finding  contact  emotional  of  agents  Interactional  instability  availability  social  concerning  higher  fewer  greater  reciprocity.  of  a  thereby  sparsely  however,  friends.  of  or  (buffering)  more  finding  network  implicating  researchers  frequency  reported  asymmetrical  greater  long-term  amount  researchers  smaller,  some  social  symptomatology.  (1979) r e p o r t e d  less  less  a  others  al  fewer  protective  disagreement,  network,  revealed  members,  greater  the  Froland  friends  Several  was  network,  friends.  or  studies  morbidity,  hypotheses  causal  network.  a  of  revealed  between  psychiatric  as  typically  cross-sectional  association  variables  analysis  of  comparative,  of  were crisis  52 (Famuyiwa & O l a t o k u n b o , Discrepancies differences  in  and  of  subjects because of may  have  away  upon  a  personality  their  mutually  nature  have  quite  one  of  the  effect  for  levels  adversity,  of the  substantial  adequacy  predictive  function  of  that  personality  of  this than  around  them,  support  the  driving  they such  as  development  ability  studies.  to  of  form  support  although  association  example,  study  reported  actual  those  study  that  that  not  predictive  having  indices  Henderson was  more  conditions  or  For  significant  for  a  Clearly  hypotheses,  any  need.  symptoms i n p e r s o n s e x p o s e d  network  of  behaviour  longitudinal  However,  power,  Psychiatric  relationships.  and  with  symptoms and  to  a  had  of  satisfied  deficient  cross-sectional  indices  Henderson  variable,  longitudinal  expectations  adversity.  evidence  personal  onset  be  and  as  impaired  to  subsequent  provided  an  his  severity  data.  and  both  to  psychiatric  kind,  cannot  those  1978b) w i t h  s o c i a l network  the  their  al,  contrary  the  up  and  Furthermore,  third  to  attributable  relationships  on  led  and  i s prospective  (1981) f o l l o w e d  found,  or  underlying  et  of  one  social  effect  satisfying  (Henderson  network  relationships  may  be  cross-sectional  symptomatology  what i s needed  low  an  trait,  psychiatric  above  such  network  may  distress.  repelling  very  Henderson  social  their affective state;  Alternatively,  maintain  studies  r e a s o n s why  perceive  had  the  of  varying  several  based may  the  these  psychiatric  (1984) s u g g e s t s hypotheses  between  measures  symptomatology, chronicity  1984).  al  likely in  high  alone  et  the  to  had  (1981) to  be  a  social  53 environment in  symptom  Henderson  (eg.,  neuroticism  measures, summarized  alone  averaged  explained  over  h i sresearch  four  69% o f t h e v a r i a n c e  waves  of i n t e r v i e w i n g ) .  as f o l l o w s :  I n t h e C a n b e r r a work, t h e c o n c l u s i o n we have a r r i v e d a t i s that 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 p r o b a b l y h a s l i t t l e t o do w i t h t h e c a u s e s o f n e u r o s i s . The p e r c e i v e d a d e q u a c y w i t h w h i c h 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 i m p o r t a n t . What we do n o t know i s how much t h a t l i e s i n t h e a c t u a l p e r f o r m a n c e o f o t h e r s 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 ( H e n d e r s o n e t a l . , 1981, p. 1 9 7 ) . Here,  then,  i s a striking  cross-sectional symptomatology  data  concerning  With  narrows  to the s o c i a l  study,  this  Comparative  that  women.  network  patterns  sample  social  studies  upon  prospective of a t t e n t i o n  portion  interest  of the to this  nervosa.  women and t h e i r  social  two s t u d i e s a v a i l a b l e i n t h e l i t e r a t u r e  studies  network  just  Berkowitz  (1983).  or s o c i a l  are expected  to those  population  s u b j e c t s and t h e i r  by  the focus  of anorexia  of anorexic  similar  o f 16 a n o r e x i c  overturned  of c e n t r a l  based  and p s y c h i a t r i c  c o r r e l a t e s of that  the s o c i a l  These  networks  i n mind,  population  a diagnosis  assess  anorexic  1.  network  There a r e only  directly  psychotic  consideration  psychiatric  women w i t h  networks.  o f how h y p o t h e s e s  c a n be so c o n v i n c i n g l y  data.  non-psychotic  example  support  to yield  o f t h e more  general  of  social non-  reviewed.  Berkowitz  a n d 16 b u l i m i c  families,  and compared  obtained  a  convenience  non-hospitalized them w i t h  16  female  non-eating  54 disordered identify between  female  perceived  inventory  Perceived  families  support,  a s measured  (Procidano  women  Social  report  & Heller,  receiving  Support  (primarily  members  or f r i e n d s  measured Perceived  only  (Heller  family  Social  that  & Swindle,  Support  inventory  n e t w o r k ; however, i t does r e l i a b l e  friends,  and i s t h e r e f o r e  relevant  multivariate  family, failed that  as p e r c e i v e d  perceived  of  as a  of emotional subjects  by f a m i l y  members,  f a m i l i e s of anorexic  of s o c i a l  of perceived  of family  study. social  support  women  support,  and n o n - a n o r e x i c  of from  subjects, groups,  i n the study support.  d i d not perceive the  whereas  family  i s , social  successfully  and  Results  of emotional  subjects  d i d ; that  that the  and n o n - a n o r e x i c  source  family  Berkowitz  here  and n o n - a n o r e x i c  anorexic  members o f a n o r e x i c  non-anorexic  that  and n o n - a n o r e x i c  families  as a s o u r c e  perceived the  anorexic  their  However, f a m i l y  between  noted  areas  to t h i s  revealed  by a n o r e x i c  to discriminate i s , both  family  analysis  by  although  measure t h e l e v e l  i n the content  The  t o measure t h e  i s n o t a measure  supportiveness  and  h i s o r h e r needs f o r  1983),  network  the  anorexic  are f u l f i l l e d  I t i s duly  Social  families.  was d e s i g n e d  support)  support.  i s the l e v e l of  that  their  to  discriminate  by t h e P e r c e i v e d  from  inventory  emotional  study  1983),  t o w h i c h an i n d i v i d u a l p e r c e i v e s  support  i n order  v a r i a b l e s which might  Of s p e c i a l i n t e r e s t t o t h i s  emotional  non-anorexic  extent  and t h e i r  i n d i v i d u a l and f a m i l y them.  Support  subjects  support,  discriminated subjects.  members as  between  55 2.  Sheppy  parent, 30  family,  female  subjects of  and t h e i r  Chapter  3).  parents.  characterized  following  women  t o be  likely  to decrease  personality  factors,  the  enmeshed  quality  the  development  and  their  score,  parents. considered identified a  measure  obtaining  such  a global  t o be  of  was  of current  by t h e s u b j e c t perceived  a difference  and  event  and h e r p a r e n t s . reciprocity,  their  geographic  and  are l i k e l y outside  certain  to the  daughters of  liked  The q u a l i t y and  between  was the  inhibit family.  quality  and  a l l the  whether  with  daughters  and a g l o b a l  the average  o f t h e means  from  i n combination  score  of  review:  of the anorexic  importance,  than  i n anorexia, are  quality;  families  and  on t h e b a s i s  frequent  f o r the c o n t r o l  score  smaller  themselves  friends;  size  were  and t h e i r  her l i t e r a t u r e  isolate  data  Psychosocial  and e x p l a i n e d i n  parents  relationships  network  indices  of i n t e r a c t i o n  as i n t r o v e r s i o n ,  of s o c i a l  size  from  size  of anorexic  into  quality  control  were  subjects  that  precipitating  did likewise The  and  network  the s o c i a l  parents  and  a  study,  study of  matched  variables  anorexic  and t h e i r  heterosexual  reported  pooled  that  gleaned  34  the Pattison  networks  subjects  withdraw  especially  and  in this  satisfying  information  moves,  Sheppy  used  social  by a l e s s  of the c o n t r o l  friends,  by  of i n d i v i d u a l ,  i n a comparative  Her community  as measured  have  a variety  parents  Sheppy h y p o t h e s i z e d  would  anorexic  variables  their  (the instrument  families  the  and  network,  Inventory  Sheppy examined  and community  anorexics  social  those  (1984).  their people  or n o t ,  score  was  calculated  by  reciprocating  56 variables  ( i e . , kind  emotional then  and  of f e e l i n g s  instrumental  averaging  these  to expectations,  analysis  (Hotelling's  significant  difference  discriminant climate  discriminated control mothers' could  and  their  network  Sheppy,  "present  network  revealed  degree  between  score.  variables.  and  that  conclusion  that  unexpected  discovery  of  that  of s o c i a l  explaining atypical  the greater  variables  her s u r p r i s i n g  o f the c o n t r o l  Sheppy  group  two  which  and  and t h e  variables  Conversely, the the a d d i t i o n according  of  traits, of the (1984,  power  neuroticism) e t a l . , 1981).  pointed  to  Henderson's  predictive  (Henderson  results,  score  discriminators"  ( i n h i s case,  family  variables  qualities  i s reminiscent  variables  network  features  self-concept  and  stepwise  the p e r s o n a l i t y  t h e m s e l v e s a r e t h e most p o w e r f u l  difference  mean  results,  anorexics  115), a  a  two  at a l l with  These  argument  parents  the anorexic  These  characteristics  individual  that  Affiliation  mean  or q u a l i t y  interactional,  87.5% o f t h e s u b j e c t s .  a strong  size  However,  clinical  p.  scores.  statistically  parents.  was n o t i n c r e a s e d  network  a  and t h e i r  variables  Deviate  correctly classify  the s o c i a l  named, and  subject  anorexics  the daughters'  function  showed  o f 14 p e r s o n a l i t y ,  Psychopathic  discriminant of  p>.05)  i n psychosocial  to the greatest  groups:  of  the r e s u l t s of the m u l t i v a r i a t e  (Xr.=5.21,  analysis  and s o c i a l  degree  person  for individual  neither  r e c i p r o c i t y ) between subjects  f o r each  and  2  analysis  control  thoughts,  T , F ( 2 , 6 1 ) = 2 . 7 6 , p>.05) n o r t h e s u b s e q u e n t  discriminant  (perceived  support)  differences  Contrary  and  to  possibly  of  over In  certain  reflected  57 the  referral  the  data,  source the  type  administration, network be  of  and  analysis.  most  of her  She  the  suggested 115),  global  that a  The  i n c o n t r a d i c t i o n to  social  network  of  Contrary  networks  were e i t h e r  their  with  parents. was  social  network  data  detailed  size  analysis,  her  and/or i t s her  social  prompted  the  social  the  may  of  and  her  of the  patient.  their  nature  parents.  data  significant  anorexic  the p o o l i n g  their  network  parents  subjects  of the  by  that  in quality  control  study  social  from  of A her  differences in  quality. d i d not use do  give  a  results:  differ  anorexic  in their  This  finding  a  social  reliable  the f a m i l y c l u s t e r .  support.  profile  d i d not f i n d  s u b j e c t s and  reveal  (1984)  or d e f i c i e n t  i n Sheppy's  of  alone  results  surprising  Sheppy  subjects  networks  from a n o r e x i c  Berkowitz  within  anorexic  Sheppy  psychiatric  smaller i n size  analysis  and  her  significantly social  obtaining  a n a l y s i s could  that  emerging  non-psychotic  obscured  subjects  Although  found  the  However, t h e s p e c i f i c  network  anorexic  of  the  social  support  the  significantly  compared  network  of  (1983) and  t o h y p o t h e s e s and e x p e c t a t i o n s ,  social  more  nature  "a d e t a i l e d  s t u d i e s of Berkowitz  results  and  of  employed  suggestion  yielded  when  t h e method  study.  Summary.  the  or  instrumentation  finally  r e v e a l i n g " (p.  present  subjects  network  indication  In her study, and  perception  control  measure of  network  Berkowitz  also  s u b j e c t s d i d not  o f f a m i l y as a s o u r c e  i s a l l t h e more  or  surprising  of  since  58 the  anorexic  anorexic been to  subjects  subjects  suggested  perceive  on  that  social  the  a  support  anorexic  of  as  stereotypic.  become  social  profile  family  bears  family-dominant sectional yet  is  studies  strongly  studies  of  research  such  associated  with  literature to  social  network  social  in  the  network  family  expectations significant  is  with  curious,  found  by  to  family  nervosa  the  has  a n a l y s i s of  and  despite  to  Such  hypotheses co-determining  in  the  1984).  This  hypotheses,  did  or  to  find  in  from  a  could  role  study, any  is  of and  Only be  the  the  development  (Sheppy,  size  empirical  research  the  not  and  limited  psychiatric disorders.  the  cross-  family relationships  population  in  in  current  anorexic  differences  this  constricted,  recommendations  etiological  patterns  an  that  interactional  been  e c o l o g i c a l focus.  non-psychotic  early  psychiatric populations,  recent  related  the  milieu  consistency  repeatedly  Furthermore,  verify  such  has  ability  the  however,  resemblance  nervosa  network  and  the  in  non-  it  social  described  environment  broader  literature  with  immediate  literature  network  literature  of  It  anorexia  empirically  maintenance social  a  been  therapy  anorexia  for  unable  has  challenged  the  interfere  and  The  populations.  of  scale,  problem.  non-psychotic  concerning  description  certain  of  mood may  striking  social  depression  than  & H e l l e r , 1979).  patient  and  higher  (Procidano  the  psychodynamic to  significantly  self-rated  depressed  Recapitulation of  scored  one  found  contrary  to  statistically  reciprocity  of  anorexic  59 and  non-anorexic  case  of recent  (1984) that in  employed  psychosocial family  networks,  and t h u s  strengthens the  i n t e r a c t i o n a l research.  a global  analysis  However,  of her data,  a more  detailed  a n a l y s i s may r e v e a l  specific  network  variables.  Such  Sheppy  and recommended  significant  differences  i s t h e mandate  of  this  study.  Hypotheses The  following  and a summary  hypotheses w i l l  of t h e i r  be t e s t e d  theoretical  i n this  rationale.  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 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 and c o n t r o l subjects. Hypotheses size  related  and c o m p o s i t i o n  to the s t r u c t u r a l aspects  of s o c i a l  of  perceived  networks.  1.1. The s i z e o f 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 a r e s i g n i f i c a n t l y s m a l l e r than those of the control subjects. A  truncated  studies  social  network  of non—psychotic  a b o v e ) , and i n c l i n i c a l (discussed scores 1983; al,  i n Chapter  commonly Hatsukami  development  1).  Furthermore,  among  anorexic  1985) s u g g e s t  behaviors  that  patients  of the anorexic  e t a l , 1984; H e r z o g ,  1986; Y e l l o w l e e s ,  withdrawal  psychiatric  reports  reported  i s consistently  (as  women  anorexic  in  discussed  and h e r f a m i l y  elevated  1984; K a t z ,  that  reported  depression  (eg.,  Berkowitz,  1987; S w i f t e t women engage i n  are not conducive  to  network  and m a i n t e n a n c e .  1.2. T h e r e a r e s i g n i f i c a n t l y f e w e r 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 o f c o n t r o l s u b j e c t s .  60 1.3. T h e r e a r e s i g n i f i c a n t l y fewer heterosexual friends o r b o y f r i e n d s i n t h e 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 to  tendency  avoid  heterosexual  literature Bruch,  friends  (as discussed  1978; S e l v i n i ,  presence been  of the anorexic  of sexual  well  1985),  orientation attempt  (eg_. , S l o a n  to e m p i r i c a l l y confirm  e t a l , 1980; Indeed, the  eating  d i s o r d e r s has  with  1986).  these  i n the  e t a l , 1981; Leon  clinicians  & Leichner,  reported  1985).  i n women w i t h  (e_g_. , B e u m o n t among  f r i e n d s , and  1; eg_. , C r i s p  1978; Y e l l o w l e e s ,  documented  from  i s commonly  i n Chapter  conflicts  especially  t o withdraw  a  et a l ,  psychodynamic  This hypothesis  clinical  i s an  observations.  1.4. A s i g n i f i c a n t l y g r e a t e r p r o p o r t i o n of the t o t a l s o c i a l network o f a n o r e x i c s u b j e c t s , as compared t o control s u b j e c t s , i s composed o f n u c l e a r f a m i l y members. Studies above)  yield  hypothesis. &  Azira  psychiatric  contradictory F o r example,  (1975),  proportion fewer  of non-psychotic  members  social  sample,  networks  friends,  systems families  theory  to  1979),  this  Ratcliffe  or involuntary  r e l a t i o n s h i p s and  of the s o c i a l  showed  (1978)  a  greater  networks  of t h e i r  reports  that the  a higher  proportion of  relationships.  support  which  regard  report  Silberfeld  o f h i s sample  or voluntary  Theoretical  whereas  (discussed  e t a l (1978b)  f r i e n d s were c h a r a c t e r i s t i c  psychiatric  with  P a t t i s o n e t a l (1975,  and H e n d e r s o n  of family  findings  populations  for this  points  (eg., Minuchin  hypothesis  t o t h e enmeshed  comes  from  quality  e t a l , 1978; S e l v i n i ,  1978),  family  of anorexic a  quality  61 that  is  unlikely  relationships describes the  image of  the  for  to  anorexics  when  a  person  Andersen  a  family.  this  the  need  frequent  to  on  is  and  a perfect  disruptions  network  close  as  impoverishment  in  usually  development  of  the  reports  and  that  with  only  short-lived. peer  one  family  and  (1981)  friendships, i t is  on  and  a result  loyalty,  Jones  is  a similar  friends,  maintain  then  the  (1984)  dependent  developed, even  social  Sheppy  network  relationships. of  of  solely  network  emphasis  significance in  (1985) p a i n t s  from  to  absence  time  Furthermore,  i s o l a t e d and  family an  development  withdrawing  relationship  that  etiological  of  the  as  an  have  at  suggests  due  moves,  that  one  family  quality  peer  as  community,  geographic  enmeshed  the  anorexic  support  the  foster  outside  anorexic's  another  to  Jones  relations  anorexia  has  nervosa.  portrait:  S o c i a l l y , most p a t i e n t s e x h i b i t i m m a t u r e i n t e r a c t i o n p a t t e r n s , becoming even more d e p e n d e n t 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 parents. Dating a c t i v i t i e s stop i f t h e y were p r e s e n t , and good f r i e n d s a r e a b a n d o n e d . As t h e y e a r s 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 p r o f o u n d , and p a t i e n t s may be y e a r s b e h i n d t h e i r p e e r s s o c i a l l y (p. 49). This reported nervosa family in  in  dominant study  three  identified The  the  nuclear  of  in  of  the  family  anorexic  and  impressionistic  Chapter  network  1),  pattern  normative  distinct by  the  early  (discussed  their  found  portrait  types ratio  of  corresponds  network  by  network family pattern  is  to  anorexia  the et  These patterns to  commonly  of  Hurd  networks.  social nuclear  family  research  discovered  social of  dominant  and  her  al  be  (1980)  researchers that  extended  could  nuclear  were  family.  identified  62 by  a  2:1  ratio  Furthermore, significantly the  nuclear  of each  family  nuclear  family  workers  (4 members).  nuclear  family  Hurd  network  were  and w e r e  since  friends  would  r e l i a n c e on a s i n g l e network  cluster,  embedded  f o r provisions  dominant  network  pattern  control  subjects,  of support.  study  Finding  vulnerable  of  an a l m o s t  s e t of a nuclear  subjects,  lend  that the  the nuclear  smaller  would  smaller  of primarily  to foster  sector,  among t h e a n o r e x i c  of this  F o r example,  hypothesized  be t h e most  i n a comparatively  varied  (5 members) and c o -  i t appeared  exclusive  relations  family.  significantly  comprised  e t a l (1980)  network  patterns  extended  subpopu 1 ations  networks  (7 members),  dominant  to  s i z e and c o m p o s i t i o n .  members),  members  family  the three  dominant  (18 network  three  of  b o t h i n network  overall  the  nuclear  family network family  but not the  support  t o Hurd's  to the i n t e r a c t i o n a l aspects  of s o c i a l  hypothesis. Hypotheses  related  networks• 1.5. There i s s i g n i f i c a n t l y l e s s frequency o f c o n t a c t w i t h a l l network s e c t o r s other than n u c l e a r f a m i l y i n t h e s o c i a l networks o f 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 o f c o n t r o l s u b j e c t s . 1.6. A s i g n i f i c a n t l y g r e a t e r p r o p o r t i o n o f the t o t a l number o f h i g h c o n t a c t frequency r e l a t i o n s ( i e , network members c o n t a c t e d a t l e a s t once a week) i s found among the f a m i l y members o f the s o c i a l networks o f a n o r e x i c as compared t o c o n t r o l s u b j e c t s , whereas a s i g n i f i c a n t l y s m a l l e r p r o p o r t i o n o f the t o t a l number o f high contact frequency relations i s f o u n d among r e l a t i v e s , f r i e n d s , managers ( b o s s ) , and o t h e r members o f 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 a s compared t o control subjects. These  hypotheses  build  on t h e t h e o r e t i c a l  foundation  of  63 hypotheses  1.1  a  family  nuclear  finding  by  network  and  Hurd  is  frequency  1.2.  dominant et  al  and  an  assume t h a t  network,  (1980)  characterized  relations  clusters,  They  that  by  within  abandonment  and  a  a  subjects  seeks  replicate  preference  low  to  nuclear  nuclear of  anorexic  family for  family  contact  the  dominant  high  and  have  contact  friendship  relations  from  other  network s e c t o r s . 1.7. A n o r e x i c s u b j e c t s have a s i g n i f i c a n t l y h i g h e r p r o p o r t i o n of n e t w o r k r e l a t i o n s v i t h whom they f e e l ambivalent or n e g a t i v e about than c o n t r o l s u b j e c t s . Studies social  of  non-psychotic  networks  psychiatric  characterized  by  a  populations  higher  number  reveal  of  weak,  o negative, for 1975,  affectively  control  samples  1979).  A connection  interactions  thoughts  i s assumed  study  negative  and  then  psychotic  psychiatric  characterized than  such  thoughts  overall,  i s the 1.8. degree toward  by  is  is  that  greater towards  inferred  anorexic  degree  for that  of  their the show  case  P a t t i s o n et a l ,  negative  i f the  populations  a higher  or  the  unpleasant  feelings  and  subjects  of  ambivalence  or  network  members  studies  of  social  number of weak or n e g a t i v e  non-  networks  interactions  case f o r normative p o p u l a t i o n s . A n o r e x i c s u b j e c t s have a s i g n i f i c a n t l y h i g h e r of ambivalence or n e g a t i v e f e e l i n g s and thoughts t h e i r p a r e n t s than c o n t r o l s u b j e c t s .  Clinical literature,  support  a l , 1978b;  ambivalent  here,  and  et  than  between weak or a f f e c t i v e l y  show a s i g n i f i c a n t l y  feelings  interactions  (Henderson  network  this  unpleasant  reports, suggest  particularly  that  anorexic  from  the  daughters  psychodynamic have  a  powerful  64 ambivalence mother" systems food  particularly  (Bemis,  toward  1978).  literature  Hypothesis  a  covert  daughters  related  "scolding  Furthermore,  suggest  between a n o r e x i c  their  to  and  the  and  reports  power their  overbearing  from  struggle parents  functional  the  family  surrounding  (Miller,  aspects  of  1984). social  networks. 1.9. T h e r e i s a s i g n i f i c a n t l y g r e a t e r p r o p o r t i o n of 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 exchanged w i t h i n the nuclear family c l u s t e r and significantly less within t h e o t h e r c l u s t e r s o f 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 i n comparison to c o n t r o l subjects. This of  hypothesis  hypotheses  that  1.1  are  comprised  characterized relations  by  reported  friendship  1979)  found  and  on  the  logically  subjects  have  primarily  of  preference  members  to by  anorexics  by  the  constricted  for  a  higher  for social  will  degree support  social  family  high  the  come  from  the  of  of  neurotic  et  was  the  al  case  then of  family (1975,  subjects  dependence  than  sources  nuclear  Pattison  and  frequency  clusters,  primary  1.4;  networks  members  contact  friendship  that  networks  foundation  follows hypothesis  Furthermore,  social  theoretical  nuclear  hypothesize  clusters.  that  characterized network  a  1.2,  builds  w i t h i n t h e n u c l e a r f a m i l y and  i s reasonable  support and  and  i s , i f anorexic  that  it  again  were  upon  family  for  control  subjects. Hypotheses personality  related  to  social  network  correlates  factors.  2. The s o c i a l networks of personality t r a i t s .  anorexic  s u b j e c t s vary  with  of  65  2.1. T h e r e 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 i n t e r p e r s o n a l e f f e c t i v n e s s s c o r e s , 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 s i z e and support (emotional, instrumental). Heller  &  competence  Swindle  contributes  predilections There  has  (1983)  to  link  been  a  to  reports  such  introversion,  avoidance Strober,  1980;  traits  expected  to  CPI  him  of  these  on  statistically empirical  Of  to  the  derived  on  the  elsewhere  by  Gough  Social  of  al.,  1976;  personality in  interpersonal  turn,  for  be  the  reasonably  sample  i s the  (1968) and  (Do),  Presence  conceptual  parallels.  basis  of  Capacity (Sp),  these a factor  scales,  (1972) with  analysis.  this  cluster  by  style, for  of  and  Status  Self-acceptance  similarity  Megargee  of  interpreted  However, Gough o r g a n i z e d of  nervosa,  effective  effectiveness,  Dominance  (Wb).  basis  not  particular interest  are  (Sy),  in  et  Such  degree  and  interpersonal  Smart  is  them.  clinical  and  1986).  and  network v a r i a t i o n ,  interpersonal  scales  1986;  The  social  r e l a t i o n s h i p among  Well-being,  insecurity  women may,  organized  Well-being  scales  to  1984).  Sociability and  anorexia  anorexic  anorexic  from  correlates  Strober,  been o b t a i n e d  referring  adequacy;  (Sa),  has  originally  as  (Cs),  among  contribute  data  the  support  of  social  abilities  in  relationships.  (Sheppy,  scales  that  elicit  Baroffio,  1981;  that  consistency  social &  suggested  individual's  and  personality  Scott  suggest  effectiveness  others  Strober,  interpersonal  study  of  (e£. ,  the  remarkable  empirical as  to  have  the  this cluster rather has  than  shown  an  exception  of  66 It  i s proposed  elevation scales Sa)  on t h e i r  perceive  supportive this  that  anorexic  i n the i n t e r p e r s o n a l  (based  will  here  social  cluster  they  network t h a n  show  effectiveness cluster  mean  have  who  scores  i n Do,  a significantly  an  of CPI  Cs, Sy, Sp, &  l a r g e r and more  anorexic  s u b j e c t s who  the s o c i a l  network  score  low i n  of s c a l e s .  Hypotheses environmental  that  pooled,  subjects  related  to  c o r r e l a t e s of  variables.  3. 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 vary environmental c h a r a c t e r i s t i c s .  with  3.1. There w i l l be a negative c o r r e l a t i o n between the f a m i l y c l i m a t e v a r i a b l e of cohesion, as measured by the Family Environment S c a l e (FES), and s o c i a l network s i z e as p e r c e i v e d by anorexic s u b j e c t s . 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 f a m i l y c l i m a t e v a r i a b l e of independence, as measured by the Family Environment S c a l e (FES), and s o c i a l network s i z e 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 . 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 f a m i l y c l i m a t e v a r i a b l e s o f cohesion and independence, as measured by the Family Environment S c a l e (FES), and s o c i a l network s u p p o r t ( e m o t i o n a l and i n s t r u m e n t a l ) r e c e i v e d from a l l s o u r c e s as p e r c e i v e d by a n o r e x i c 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 f a m i l y c l i m a t e v a r i a b l e of cohesion, as measured by the F a m i l y E n v i r o n m e n t S c a l e ( F E S ) , and s o c i a l network s u p p o r t ( e m o t i o n a l and i n s t r u m e n t a l ) 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 s u b j e c t s , b u t 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 o u t s i d e the f a m i l y . 3.5. There w i l l be a negative c o r r e l a t i o n between the f a m i l y c l i m a t e v a r i a b l e of independence, as measured by the Family Environment S c a l e (FES), and s o c i a l network s u p p o r t ( e m o t i o n a l and i n s t r u m e n t a l ) 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 s u b j e c t s , b u t a 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 s o c i a l network support from sources o u t s i d e the f a m i l y .  67 Mitchell outpatients, the  (1982), found that  higher  F E S ) were a s s o c i a t e d  expectations. received and  i n h i s comparative  With  from  with  increased  emphasis greater regard  on  levels  network  to the average  members, p<,05)  both were  of network and  independence  degree  cohesion  of network  levels  within  The  with  o f network  A replication  family  1984);  that  increased friends  levels  the f a m i l y ,  the  support.  With  associated  t h e emphasis  on  level  i s proposed here,  elsewhere f o r the s u b j e c t s i s , anorexic  f e w e r network of o v e r a l l  i n comparison  the  the perceived  (1982) r e s u l t s  c o h e s i o n and i n d e p e n d e n c e ,  have s i g n i f i c a n t l y  greater  from t h e f r i e n d s  The g r e a t e r  the greater  associated  friends.  of M i t c h e l l ' s  FES d a t a o b t a i n e d  (Sheppy,  of support.  p<.05)  (r=.29,  p<.01) was s i g n i f i c a n t l y  the family,  support from  of support  significantly  support.  independence  (r=.43,  psychiatric  members, c o n t r a r y t o  to the average degree o f support r e c e i v e d  independence  family  (r=.32,  cohesion  increased  using  regard  of  o f c o h e s i o n ( a s measured by  the respondent's p e r c e p t i o n  cluster, with  w i t h fewer  a l l network  independence  levels  study  a s measured  who  to anorexic  score  study  high i n  by t h e F E S ,  members and r e p o r t  network  c o h e s i o n and i n d e p e n d e n c e .  subjects  of t h i s  will  significantly  support  and  support  subjects  who  score  from  low i n  68  CHAPTER 3 METHODOLOGY  PURPOSE OF THE STUDY The  present  comparative social are  cross-sectional  design  network  and  of relevance  that  and s e l f - r e p o r t  correlates  of s i g n i f i c a n c e  of anorexia  to a curious  reported  repeatedly  found  populations,  and t h e v a r i a b l e  empirical social  studies.  milieu  empirically and  social  women  the nuclear  using  family  analyses  an e c o l o g i c a l t o encompass  correlates theory  research of  found  study  of the s o c i a l  explore  of the anorexic and  psychiatric  i n more r e c e n t  contradictory  the present  to  systems  impressionistic  of these  causal-  i n the l i t e r a t u r e ;  profile  profile  a  These  psychosocial  social  social  examine t h e n a t u r e  views  of the  was d e s i g n e d  profiles focus  to  of anorexic  that  the broader  extends personal  network.  Another contribution to  In view  nervosa.  network  of the anorexic,  non-anorexic  beyond  i n social  i n order  contradiction  invariant  i n early  employed  data  t o psychodynamic  i s , the l a r g e l y  commonly  study  social  purpose of certain  network  of the study personality  was  to investigate  and e n v i r o n m e n t a l  the  variables  variation.  SAMPLE A sample  subsaraple collected  o f 69 y o u n g f o r another  women  study  were  (Sheppy,  drawn 1984).  from  a  larger-  Of t h e s e ,  34  69 had  received  served  a psychiatric  diagnosis  as matched c o n t r o l  of anorexia  subjects.  The two  were matched f o r age, sex and s o c i o e c o n o m i c by  B l i s h e n ' s Socioeconomic The  medical  anorexic  bulimic  both  anorexics  (1=18.3, anorexia weight  SD=2.29), nervosa.  loss  diagnosis  specified  anorexia  nervosa  the i l l n e s s  subjects from  had  from  made  criteria  of  who  by  satisfied  was  was  never  amenorrhea  the  DSM  on  III.  years  The  anorexic  of  3  mean  sample  but  t o 23  now years  age  Two  60  for  women whose their  of the of  other  onset  and t h e mean  to  other  body w e i g h t ,  of  duration  of the  whereas a l l o t h e r s  period  from  III criteria  (SD=16.05).  menstruated,  15  the b a s i s  (SD=1.91)  months  for a  determined  volunteer  from  15% t o 23% s t a n d a r d  16.2  as  abstaining  i n age  a psychiatrist  23.5  This  t h e r e were f i v e  i n t h e DSM  of subjects  referrals  previously  ranging  Although  ranged  was  and  (N = l l ) ,  and 35  (1976).  to a p s y c h i a t r i s t .  abstaining  groups  status  s u b j e c t s were c o n s e c u t i v e  practitioners  included  Index  nervosa,  anorexic  had s u f f e r e d  months  (X=13.4,  SD=12.45). The  control other  subjects  units  and  care  for nonpsychiatric  obtaining  a  attention, would ranged  be  community  were  agencies,  controlled  factors for.  f r o m 43 k i l o g r a m s  and  who  such The  t o 68  as  from  were  conditions.  sample o f s u b j e c t s illness  obtained  practice  receiving  medical  I t was  were  of  kilograms.  hoped  that  a l l receiving  stress  weight  family  medical  r e a c t i o n s to the c o n t r o l  by  illness  subjects  70  DATA COLLECTION PROCEDURE The subjects of  data  were  were  contacted  questionnaires  this  study,  the  Environment During  a  research were  gathered  which  a  and  the  The  demographic  questionnaires  month  and  period.  received  instruments  Pattison  p r o c e d u r e s were e x p l a i n e d  given.  18  Psychological  the  interview,  an  researcher,  included  California  Scale,  brief  by  over  of  battery  relevance  Inventory,  the  Psychosocial information  and  a  All  to  Family  Inventory.  was  obtained,  questionnaire instructions  were  left  to  be  completed  at  leisure.  INSTRUMENTATION The  Pattison Psychosocial  self-report  questionnaire  empirically  determine  that  theoretically  individual. system  Hurd  that  the  al  was  (PPI).  the  primary  ( 1 9 8 1 c ) has  The  developed  psychodynamic  comprises et  Inventory  in  PPI  is a  order  to  social  support  social  matrix  of  social  support  defined  this  system the  as,  a subset o f r e l a t i o n s f r o m t h e g l o b a l s o c i a l network l i m i t e d by the s y m m e t r i c o r a s y m m e t r i c p r o v i s i o n o f support, affective and/or i n s t r u m e n t a l , which i s f o c u s s e d around a p a r t i c u l a r i n d i v i d u a l (p. 2 ) . This  instrument  assesses  and  i n t e r a c t i o n s with  the  subject's  populations 1977a).  been  Indeed*  Hurd  individuals  family,  psychosocial  have  from  the  number social,  network.  studied  of and  Both  (eg_. , Hurd  et a l (1981c) r e p o r t  within  eleven  people,  different  relationships,  community normal et  and  members  psychiatric  a l . , 1980;  that  over  populations  of  Pattison,  five  hundred  defined  by  71 their  psychiatric  following  social  status network  have been s t u d i e d .  The PPI measures t h e  variables:  1. Size refers t o t h e number of s o c i a l network members, a n d i s d e t e r m i n e d by t h e number o f p e o p l e listed. 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 d e t e r m i n e d by t h e t y p e o f r e l a t i o n s h i p l i s t e d . Several o r i e n t i n g c a t e g o r i e s a r e s u g g e s t e d by t h e P P I : f a m i l y , r e l a t i v e s , f r i e n d s , c o - w o r k e r s , and o t h e r s ) . 3. D u r a b i l i t y r e f e r s t o t h e number members have been known.  of years  network  4. F r e q u e n c y o f c o n t a c t r e f e r s t o t h e amount o f 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, o r by l e t t e r . 5. K i n d and S t r e n g t h o f F e e l i n g s and T h o u g h t s r e f e r s t o t h e d e g r e e 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 ) of emotional 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 t o 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 t h o u g h t s ; 4=mostly m o d e r a t e , 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 n e g a t i v e ; 2=mostly m o d e r a t e , n e g a t i v e f e e l i n g s and t h o u g h t s ; l = m o s t l y v e r y s t r o n g , n e g a t i v e f e e l i n g s and t h o u g h t s . 6. I n s t r u m e n t a l Help r e f e r s to the frequency of concrete, p r a c t i c a l assistance, and i s r a t e d on a 5p 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—often; 3=on some o c c a s i o n s ; 2 = r a r e l y ; l°not a t a l l . 7. E m o t i o n a l S u p p o r t i s u n d e r s t o o d as s e l f - e v i d e n t , and i s rated on a 5 - p o i n t s c a l e as f o l l o w s : 5=very frequently; 4 = p f t e n ; 3=on some o c c a s i o n s ; 2—rarely; l=not a t a l l . 8. Symmetrical Reciprocity r e f e r s to the extent to w h i c h s o c i a l network members a r e p e r c e i v e d t o 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 h e l p , and e m o t i o n a l support. The  PPI  i s based  on  incorporates  variables  interpersonal  relationships.  follows  by P a t t i s o n  that  (1977a):  the  work  of  Adams  are i n d i c a t i v e These  variables  of  (1967),  and  significant  a r e summarized  as  72 1. The r e l a t i o n s h i p h a s a r e l a t i v e l y h i g h d e g r e e o f i n t e r a c t i o n , w h e t h e r f a c e - t o - f a c e , by t e l e p h o n e , o r by letter. I n o t h e r words, a p e r s o n i n v e s t s i n t h o s e w i t h whom he h a s c o n t a c t . 2. The r e l a t i o n s h i p h a s a s t r o n g e m o t i o n a l i n t e n s i t y . The d e g r e e o f i n v e s t m e n t i n o t h e r s i s r e f l e c t e d i n t h e i n t e n s i t y o f f e e l i n g toward t h e o t h e r . 3. The e m o t i o n i s generally positive. Negative r e l a t i o n s h i p s a r e m a i n t a i n e d o n l y when o t h e r v a r i a b l e s f o r c e t h e maintenance of the r e l a t i o n s h i p , such as a boss or spouse. 4. T h e r e l a t i o n s h i p h a s an i n s t r u m e n t a l b a s e . That i s , not only i s the other person held i n p o s i t i v e e m o t i o n a l r e g a r d , b u t he c a n be c o u n t e d on t o p r o v i d e concrete assistance. 5. The r e l a t i o n s h i p i s s y m m e t r i c a l l y r e c i p r o c a l . That is, the other person r e t u r n s t h e s t r o n g positive feeling, a n d may c o u n t on y o u f o r i n s t r u m e n t a l assistance. T h e r e i s an a f f e c t i v e a n d i n s t r u m e n t a l q u i d p r o quo ( p . 1 2 4 9 ) . The  PPI i s d i v i d e d  subjects this  to l i s t  here  elicit  supportive  i s that  those  of distress  argue  that  liked  even  i f they  and d i s l i k e d  reporting subjects  (Hurd  report  them  or not."  whom  and w i l l  a priori  serves  likely Also,  t h e PPI c a p t u r e s  are inactive.  are included  e t a l . , 1981c).  Hurd  The  engages i n upon  during  e t a l (1981c)  on t h e number o f potential  support  persons  to avoid  F o r a l l network  t h e a g e , s e x , and l e n g t h  the  as a cue w h i c h  Furthermore,  i n order  to  means.  call  restrictions  asks  l i f e at  It i s left  the subject  most  part  i n your  "important"  instruction  with  t o be l i s t e d  The f i r s t  who a r e i m p o r t a n t  e t a l , 1981c).  by n o t p l a c i n g  members  providers  people  (Hurd  two p a r t s .  a s t o what this  interactions  times  network  you l i k e  of the subject  assumption will  " a l l persons  moment, w h e t h e r  discretion  into  both  biased  members, t h e  o f t i m e known.  Subjects  73 are  then  asked  variables, variables Feelings and  using  their  network  five-point  are i n t e r a c t i o n a l  and T h o u g h t s ,  feels fourth  variable  There concerning also  network  noted  support  colleagues  the psychometric (1984)  network  and  eight  matching  (1981c).  Three  PPI  using  controls  coefficient  recovers  Positive  group  after  an a v e r a g e  group  after  an a v e r a g e  2 used  a Pearson  examine strong  the s t a b i l i t y  and  of  four these  S t r e n g t h of  measure b o t h t h e  and how  the subject  him o r h e r i n r e t u r n .  little  The  information  published  of the PPI, a  deficiency  i n her e x c e l l e n t instruments.  tests  o f 51  network  days  social  and h i s  undertaken  Test  1 used with  members  on  patients a  simple  which  the  subsequent  were f o u n d f o r t h e p s y c h i a t r i c (r=.70),  and f o r t h e c o n t r o l  ( r = . 7 7 ) , and 32  product-moment of the s i z e  Hurd  were  the consistency  o f 12 days  c o r r e l a t i o n s were f o u n d  by  of seven p s y c h i a t r i c  f o r sex.  correlations  of  However, t h e t e s t - r e t e s t  of r e l i a b i l i t y  a sample  social  review  investigated  t o examine  t h e same  members  properties  matched  interviews.  Test  (Kind  to  of Contact.  o f t h e PPI h a s b e e n  these researchers  Three  items which  perceive  i s Frequency  and s o c i a l  reliability  of network  members  Wood  scales.  i n nature  i s ,unfortunately,  by  according  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 ) ,  perceptions  that  members  Likert  have c o r r e s p o n d i n g q u e s t i o n n a i r e  subject's  by  to rate  correlation  of the s o c i a l  o f 51 days  ( r = . 9 6 8 ) , and f o r t h e c o n t r o l  average  o f 12 days  (r=.987) and 32 days  (r=.985).  (r=.68).  coefficient  network.  f o r the p s y c h i a t r i c  average  days  group group, Test  to  Again, a f t e r an after  an  3 used a  74 simple  percentage  subpopulation repeated  to  examine  assignments.  their  categories  average  days;  their  51  an  32  days.  social  network  the  sizes  and  his  of  members over  author,  only  be  as  of  statistical  Studies  of  the  California  developed  by  enduring  The  and  pencil  test  f o r use  and  70  have  a  higher. study,  In v i e w o f  PPI  present  reading the  i t i s noteworthy  CPI  the  the  same  generally  i s the  opinion of  of  the  since  PPI  sample  for c o n t r o l s , N=ll)  were  reported.  still  to  they  forthcoming.  (CPI).  assess  The  CPI  positive  characteristics  was and  within  a  i s a s e l f - a d m i n i s t e r e d , paper  at  youthfulness that  are  promising,  individuals  ability  of  reliability  are  (1975)  personality  with  recovery  g r o u p , N=7;  of the  Gough  Furthermore,  It  P s y c h o l o g i c a l Inventory  Harrison  normal p o p u l a t i o n .  the  interviews  significance  average  c o r r e l a t i o n s and  the  the  an  time  the  predicted. that  the  that  impressive.  t e n t a t i v e and  validity  interpersonal  who  size  an  repeated  of  conclude  same  after  subjects  colleagues the  the  time  time a f t e r  (for psychiatric  tests  The  of  subsequent  however,  the  subjects  to  the  are  as  of  repeated  group,  c o n s i s t e n t l y 91%  89%  both  on  time  regarded  were s m a l l  no  d a y s , and  of  members  c o n t r o l group,  c o r r e l a t i o n s regarding  decline  present  should  and  the  network  c o n s i s t e n t l y 86%  assignments  that  psychiatric  social  f o r the  stability  suggest  and  12  Hurd  subpopulation  of  consistency  the  assignments  average of  longitudinal  high  and  subpopulation  after of  of  For  assignment  relationship  the  CPI  between  the  of  ages  fourth-grade  the  was  the  sample o f  mainly  the  of  level  12 or  present  constructed  for  75 use  with  young  instructions, CPI  consists  into  were  males  and  the  of  individual  54).  The  important concepts  and  in  will  be  Megargee's  or  one  indicates  of  a  plotted  sample, has  18  to  and  analysis  effectiveness.  The  converted  scales.  somewhat  of  area  (Megargee,  to  in  in  age,  1972).  predict  and/or  6000  biased  wide r a n g e  i s "to  These  sample  what  an  identify  (Gough,  to  interaction" be  1968,  (Gough, i s the  of  the  level  of  and  the  to  the  relevant behaviour 1975,  p.  first  statistically  The  hour.  personality characteristics  study  factors  of  are  18  interpersonal  present  reading  fairly  social  of  person's  an  i n a c e r t a i n way"  circumstance"  five  on  context,  hypothesized  the  to  that  though  scales  "addressed living  the  normative  a  specified  described  factor  minutes  original  the  understanding  (1972)  interpersonal  a  45  geographic  of  "are  i n t e r e s t to  comprise  and  are  social  culture,  particular  The  each  do  selected  setting,  scales  of  an  including  statements  subjects,  status,  scales  for  prediction  which  white  will  i n d i v i d u a l s who  on  females.  purpose  from  ( T - s c o r e s ) and  standardized 7000  time,  true-false  scores  socioeconomic  p.  468  d i r e c t i o n of  The  Testing  o r d i n a r i l y ranges  standard  scales  adults.  CPI.  This  any  5).  five  Of  scales  derived  social  individual  in  from  cluster poise  scales  are  follows. 1. Dominance measures a r e a s of l e a d e r s h i p ability, s u c h 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 t h e e x t e n t to which a person i s l i k e l y to take c h a r g e of a situation.  of and as  76 2. C a p a c i t y f o r Status measures s p e c i f i c trait v a r i a b l e s that are thought to e v e n t u a l l y l e a d to a position of s t a t u s such as p e r s e v e r a n c e , selfd i r e c t i o n , a m b i t i o n , and s e l f - c o n f i d e n c e . This item a l s o r e f l e c t s an a b s e n c e o f f e a r s o r a n x i e t i e s , a h i g h degree of s o c i a l c o n s c i e n c e , i n t e r e s t i n b e l o n g i n g to various groups, and an i n t e r e s t in literary and aesthetic a c t i v i t i e s . 3. S o c i a b i l i t y was i n t e n d e d t o measure t h e e x t e n t t o w h i c h a p e r s o n 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 b e e n g e n e r a l i z e d t o d i f f e r e n t i a t e b e t w e e n 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 sociable from s o m e o n e who i s more introverted, w i t h d r a w n , and p r o n e t o 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 Presence measures the e x t e n t p e r s o n 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 .  to  which  a  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 c o m f o r t a b l e and s e c u r e s e l f - w o r t h , and a c a p a c i t y f o r i n d e p e n d e n t t h i n k i n g and a c t i o n . In  general,  satisfactory, inventories.  the  reliability  comparing  coefficients  average  .83.  of  coefficients  .70,  s t i l l  Measures  of  variability that  the  average  consequently, Correlations therefore scales.  suggested  the  test  items,  a  .71  of  for  scales are certain  of  with one  an  year)  from  .60  to  stability.  considerable  Megargee  relatively  degree  after  moderate  c o n s t r u c t i o n s are  is  test-retest  .90,  ranging  a l l 18  CPI  personality  and  indicate  but  the  other  (retest  level  consistency  scale  between  suggest  a  of  short-term  between  long-term  correlation  the  with  were somewhat l o w e r ,  internal among  validity  (1967) f o u n d  ranging  Although  reliability they  favorably  Hase & G o l d b e r g  reliability  and  (1972)  scales adequate  high,  redundancy  reports is  .63;  overall.  however, among  the  and 18  77 Work has  on t h e p r e d i c t i v e  been  (Gough,  emphasized 1975).  developing interpersonal  The by  1974;  instrument  the  & Moos, that  1981).  focuses  family's  that  validity  primary  socially  aim o f  relevant  The FES was d e v e l o p e d  climate  FES  of the family  i s a 90-item,  on t h e i n t e r p e r s o n a l dimensions),  i n the family  o r g a n i z a t i o n a l (maintenance  families  &  of  d i m e n s i o n s ) , and  system-maintenance The  on a l a r g e  Moos,  self-report  the d i r e c t i o n s  dimensions).  (Moos  (Moos,  r e l a t i o n s h i p s among  (growth  and  have been s t a n d a r d i z e d  distressed  subscales  Gough's  (FES).  The  (relationship  characteristics  and  with  the s o c i a l  growth emphasized  subscales  o f t h e CPI  of d i s c r i m i n a n t  predicts  Environment Scale  members  personal  that  validity  b e h a v i o u r s and o r i e n t a t i o n s .  Moos t o a s s e s s  Moos  family  i s i n keeping  instrument  Family  Rudolf  at the expense  This  an  and c o n c u r r e n t  FES  sample  1981).  of normal  Two  are of p a r t i c u l a r i n t e r e s t to the present  has t e n  of  these  study.  1 . C o h e s i o n measures the extent to which family members a r e c o n c e r n e d and c o m m i t t e d t o t h e f a m i l y , and the d e g r e e t o w h i c h f a m i l y members a r e h e l p f u l and s u p p o r t i v e o f each o t h e r . 2. I n d e p e n d e n c e measures t h e degree t o which f a m i l y members are encouraged t o be a s s e r t i v e , selfs u f f i c i e n t , t o make t h e i r own d e c i s i o n s , and t o t h i n k things out f o r themselves. The  subscales  consistencies retest have  (ranging  reliability  attested  Clayton,  o f t h e FES  & Max,  to  from  (ranging  have  moderate  to high  internal  .61 t o .78) and s a t i s f a c t o r y from  the construct  .68  to .86).  validity  1979; Moos & Moos, 1 9 8 1 ) .  of  Over  test-  50  studies  t h e FES  (Moos,  78  METHOD OF ANALYSIS In  analyzing  calculated Sometimes  according an  members,  the to  as  and a t o t h e r  as  boyfriend,  all  f o r each  network  network  was  persons  by  f r i e n d s , or high  was  o f network  For  i n making  1.5;  Table  calculating  5)  t h e mean  f a m i l y members o n l y ,  on t h e f r e q u e n c y  of contact  these  z-tests  were  between  anorexic  were  measures  performed and  was  of  were  rating  persons  on  frequency  score  of  f o r each across  calculated  pji P12 n.j n 2 trl. #  = = = =  a  across  a  single contact subject  a l l network members  independent  only  to determine  as  A  whether  differences  ( t ) and p r o p o r t i o n s  z-test  follows  t - t e s t s and  (Glass  for &  ~  Hopkins,  P12  p r o p o r t i o n of anorexic s u b j e c t s proportion of c o n t r o l subjects number o f a n o r e x i c - ) s u b j e c t s number o f c o n t r o l s u b j e c t s £..l£P.ll) + ".2JJP.12J n  .l  + n.2  (z)  independent  288) :  where  such  f o r some a n a l y s e s  and n o n - f a m i l y  computed,  i n order  £11  support  scale.  significant.  z =  o f network  network members,  rating  c o n t r o l g r o u p means  statistically  proportions  a  were  hypotheses.  cluster  as t h e a v e r a g e  or a c l u s t e r example,  means  frequency  Furthermore,  computed  and  specific  on a p a r t i c u l a r  members, n u c l e a r  Once  of  t i m e s on p a r t i c u l a r  (Hypothesis  obtained  proportions  dictates  or boss.  subject  variable.  comparisons  the  family,  relations,  score  data,  a n a l y s i s focused  such  mother,  PPI  1984,  79 The  Bonferroni  levels  that  inequality  led  to  an  size  of  frequency the  third  variables  results  Bonferroni In  of  contact  concerned  were  environmental their  social  using  the  first  to  seven to  followed was  assess  set  in  networks,  a  rate  concerned  three  the  mothers, with  up  by  and  of on  four  social  second  sets  of  network  involved  the  categories;  functional  rating  the  fourth  to  fathers.  Significant  t-tests.  Again,  respect  used  to  control  the  contribution anorexic of  .05.  the  and  univariate  series  significance  relationship  interactional  c h a r a c t e r i s t i c s of  Pearson  establish  categories;  ratings  variables  inequality  order  The  respect  rating  to  a n a l y s e s were c o n d u c t e d  relationship  with  same s e v e n T2  T2  variables. three  used  o v e r a l l Type I e r r o r  Three H o t e l l i n g ' s dependent  was  Type I of  the  the  error. personality  women t o  correlations  involved  variations  were  and in  performed  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 first,  a  results  of  results  of  review  of  the  the  analyses  demographic  primary  are data  data analyses  by  discussed  as  follows:  analyses,  and  then  the  hypothesis.  DEMOGRAPHIC DATA ANALYSIS The  demographic  elsewhere, be  and  therefore  undertaken  the  and  duration  T  residence  between  matching on  families  attained and  Socioeconomic  by  Sheppy  her  socioeconomic  (1984)  findings  will  indication  that  anorexic  the and  for  control  the  level  analysis  of  groups  matching control  of  according  the  and  ( F ( 3 , 6 0 ) = 0.25  ,  were  found  control anorexic business,  to  Blishen's 1976).  between  p>.05),  p r o c e d u r e s were a d e q u a t e . groups  to  The  indicated  education  differences  and  by  & McRoberts,  height  significant  and  represented  Blishen age,  status  70%  of  significant  groups.  anorexic  personnel 1967;  dieted  statistically  and  number  members who  were s a t i s f a c t o r y .  (Blishen,  control  no  status,  socioeconomic  socioeconomic  T2  family  anorexic  procedures  statistically and  of  revealed  professional  Index  anorexic  the  a  Hotelling's no  of  regarding  this variable  managerial,  revealed  the  finding  families  A  discussed  a b r i e f r e v i e w of  analysis  2  of  nonsignificant the  only  been  i l l n e s s e s , number  differences  that  have  here.  Hotelling's stressors  data  also the  another Likewise,  be  similar  81 regarding each  family  family, Two  group  size,  and  the  analyses was  the  duration  were  representative T  statistically  significant  population  a  to  of  determine  CPI  t-tests  (Cohesion  and  control  the  may  between  control  deviation  this  group  of  and  a l l mean  the  agencies  differences attributable  with  CPI  that  mean.  are  (1984)  Since from  the  family  FES  circumstances  due  in  by  fact,  this  study  group  means  means.  The  i n d i c a t e that  suggests tbe  of  the  these  referral  sources  subjects  practice  units  samples  other their  may  changes i n the or  were  or  conditions,  illness  the  that  control  climate to  to  an  control  representative  population  family  p<.01);  control  nonpsychiatric  and  ,  population  not  found  between  analyses  for i n part  t o i n d i v i d u a l and  stressful  these  Sheppy  for  scores  related  than  study  services  FES  difference  revealed  by  accounted  of  variables  (p<.05)  subjects.  medical  community  overall  although  ( F ( 1 0 , 2 4 ) = 3.80  FES  higher  of  be  control  receiving  of  the  population.  differences of  of  scores  d i f f e r e n c e s found  subjects  general  an  A  2  Independence)  significantly  significant  control  population.  p<.005),  significant  population  univariate  were  in  Hotelling's  statistically and  the  found  analysis  group  sisters  scores  standard  T  overall  i f  general  difference  one  and  residence.  the  (F(18,16)=4.39,  within  brothers  family  of  analysis  2  means  fell  Likewise,  of  of  conducted  Hotelling's  scores  number  other  be face life  stressors. Finally,  a  Hotelling's  T  2  analysis  of  CPI  scores  yielded  no  82 significant bulimic these  differences  subjects  anorexic  (F=0.79, p>.05).  two g r o u p s  combined  between  were  On t h e b a s i s  considered  f o r subsequent  abstainer  and  of t h i s  homogeneous  anorexic analysis,  and t h e i r  scores  analyses.  RESULTS OF PRIMARY DATA ANALYSES BY HYPOTHESIS H y p o t h e s i s 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 d i f f e r e n c e between the s o c i a l networks of a n o r e x i c and control subjects. This  general  hypotheses  hypothesis that  differences  addressed  between a n o r e x i c  Hypotheses size  was i n v e s t i g a t e d  related  and c o m p o s i t i o n  more  by means  specific  and c o n t r o l  of nine sub-  social  subjects.  to the s t r u c t u r a l aspects  of s o c i a l  network  of  perceived  networks.  H y p o t h e s i s 1.1. The s i z e o f 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 s i g n i f i c a n t l y s m a l l e r than those of the c o n t r o l s u b j e c t s . Hypothesis 1.2. There a r e 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 o f 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 o f 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 1.3. There are s i g n i f i c a n t l y 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 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 than i n the networks o f c o n t r o l s u b j e c t s .  fewer social social  In  matrix  order  constructed each  that  anorexic  relationship sex  were  these  consisted  Based  hypotheses,  of the s o c i a l  and c o n t r o l  categories:  friends.  deviations  to test  subject  total  upon  calculated,  this  size, data  a  network  according total  size  was  scores f o r  to the following  f r i e n d s , and o p p o s i t e  matrix,  univariate  data  means  t-tests  were  and  standard  performed,  83 and  a Hotelling's  these  computations  T  analysis  2  was c o n d u c t e d .  a r e summarized  i n Table  The r e s u l t s o f  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  Total  Size  Total  Friends  CONTROLS _(N=35) Xc SD  t  2-tail P  11.65  4.54  16.03  7.54  2.91  0.005*  5.15  3.85  7.57  4.70  2.34  0.022  1.85  1.67  2.54  2.17  1.47  0.145  Opposite-sex Friends  * Result achieved the required l e v e l of s i g n i f i c a n c e o v e r a l l Type 1 e r r o r r a t e o f .05 f o r the e n t i r e t a b l e . For H o t e l l i n g ' s T2 a n a l y s i s , F(3,65) = 3.0313, p<.05.  The  Hotelling's  significant regard  of  difference  to social  Subsequent  significantly  an o v e r a l l  statistically  between a n o r e x i c and c o n t r o l  subjects with  network  univariate  the social  subjects,  T2 a n a l y s i s  t-tests  networks  differ  size  found  f o r an  (F(3,65)  revealed  of anorexic  (p<.05) from  that  only  subjects  the s o c i a l  and t h e r e f o r e o n l y H y p o t h e s i s  = 3.0313,  p<.05).  the t o t a l  size  was f o u n d t o  networks  of control  1.1. was a c c e p t e d .  84 Hypotheais 1.4. A s i g n i f i c a n t l y g r e a t e r p r o p o r t i o n o f the t o t a l s o c i a l network o f a n o r e x i c s u b j e c t s , a s compared t o c o n t r o l s u b j e c t s , i s composed o f n u c l e a r f a m i l y members. Proportions and  z-tests  these  calculated  were p e r f o r m e d  significance of  were  i n order  o f any p r o p o r t i o n a l  computations  f o r each  relationship  to establish  differences  a r e summarized  category,  the s t a t i s t i c a l  found.  The r e s u l t s  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 CATEGORY  ANOREXICS (N=34)  CONTROLS (N=35)  z  p  F a m i l y Members Father Mother Siblings Brothers Sisters  .30 .09 .09 .12 .06 .06  .27 .06 .06 .15 .07 .07  0 .28 0 .47 0 .47 -0 .36 -0 .17 -0 .17  0. 390 0. 319 0. 319 0. 641 0. 568 0. 568  Relatives  .19  .19  0 .00  0. 500  Friends Opposite-sex Same-sex  .44 .16 .28  .47 .16 .31  -0 .25 0 .00 -0 .27  0. 599 0. 500 0. 606  Boss/Supervisor  .01  .03  -0 .59  0. 722  Other  .06  .04  0 .38  0. 352  Results the  social  of t h i s analysis networks  composed  of nuclear  between  anorexic  composition Hypothesis  reveal  o f both family  anorexic  members.  and c o n t r o l  yielded  that  one-third of  and c o n t r o l  subjects i s  A z-test  networks  a statistically  1.4. i s t h e r e f o r e  j u s t under  rejected.  of the differences  i n nuclear,  non-significant  family result.  85 Hypotheses  related  to the interactional  aspects  of social  networks. H y p o t h e s i s 1.5. There i s s i g n i f i c a n t l y l e s s frequency of c o n t a c t w i t h a l l network s e c t o r s o t h e r than n u c l e a r f a m i l y i n t h e s o c i a l networks o f 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 o f c o n t r o l s u b j e c t s . In  order  to test  this  d e v i a t i o n s were c a l c u l a t e d subjects  on t h e F r e q u e n c y o f C o n t a c t at least  once  2=usually  at least  once e v e r y  year).  T h e mean  obtained: family  members.  ratings  were examined  t-tests, of  these  s i x months; f o r three  a l l nuclear  forstatistical  and a H o t e l l i n g ' s T  2  a r e summarized  —  standard  and c o n t r o l  at least  daily;  o n c e a month;  1-usually at least network  categories  once were  f a m i l y members, and a l l n o n -  D i f f e r e n c e s between  analyses  and  v a r i a b l e (5=usually  a week; 3 = u s u a l l y  ratings  a l l members,  means  of the r a t i n g s of anorexic  4=usually  a  hypothesis,  anorexic  and c o n t r o l  significance  by u n i v a r i a t e  a n a l y s i s was c o n d u c t e d . i n Table  mean  Results  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 (N= =34) SD Xa  NETWORK CATEGORY All  3 .88  0 .54  3 .94  0 . 60  Family  4 .45  0 .67  4 .41  Non-Family  3 .59  0 .69  3 .75  Members  Nuclear All  CONTROLS <N=-35) SD Xc  For H o t e l l i n g ' s  T  z  analysis,  t  2- t a i l P  0,.50  0. 620  0 .71  .27  0. 791  0 .66  1,.02  0. 311  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  significance  at  t h e .05  differences  i n frequency  distinguish  between  indicate  that  thereby  of c o n t a c t  patterns  and c o n t r o l  subjects  weekly  contact  weekly  t o monthly c o n t a c t w i t h  Although  with  these  dominated  frequency  statistically ratings  nuclear  mean  scores  of c o n t r o l  Hypothesis  Mean  network social  p a t t e r n , they  scores  d a i l y or  members, a n d  network  members.  of a f a m i l y -  d i d not d i f f e r  t h e mean  according  that  do n o t c o l l e c t i v e l y  i n the d i r e c t i o n  way w i t h  subjects  suggesting  groups.  social  non-family  were  statistical  h a d , on t h e a v e r a g e ,  family  of contact  significant  to obtain  level,  anorexic  anorexic  failed  frequency  i na  of contact  t o independent  t-tests.  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 t h e t o t a l number o f h i g h c o n t a c t frequency r e l a t i o n s i s f o u n d among t h e f a m i l y members o f t h e s o c i a l networks o f a n o r e x i c as compared t o c o n t r o l s u b j e c t s , whereas a s i g n i f i c a n t l y s m a l l e r p r o p o r t i o n o f the t o t a l number o f 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 , f r i e n d s , managers ( b o s s ) , and other members o f the s o c i a l networks o f a n o r e x i c as compared to c o n t r o l s u b j e c t s . This  hypothesis  Hypothesis order  1.5. b u t d i f f e r s  to test  a frequency  a  week)  or 5  category  from  on  this  between  rating  (usually  1.6., s o c i a l of 4 (usually  contacted  PPI frequency  relations." subset  anorexic  t h e same  theoretical  in i t sstatistical  Hypothesis  received  frequency  addresses  data  daily)  analysis.  network contacted  were  members at least  and d e s c r i b e d  and c o n t r o l  data, groups  and z - t e s t s were  In who once  s e l e c t e d by network as "high  An a n a l y s i s o f p r o p o r t i o n s was  of frequency  i s s u e as  contact conducted  of d i f f e r e n c e s  performed.  The r e s u l t s  87 of  these analyses  a r e 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 CATEGORY  ANOREXICS (N=34)  P r o p o r t i o n o f HCF Relations i n Total S o c i a l Network  CONTROLS (N=35)  z  P  .64  .64  0.00  0.500  .38 .11 .12 .15 .09 .06  .35 .08 .09 .17 .09 . .09  0.26 0.43 0.41 -0.23 0.00 -0.47  0.397 0.334 0.341 0.591 0.500 0.681  P r o p o r t i o n o f HCF R e l a t i o n s That A r e : Family  Members  Father Mother Siblings Brothers Sisters  Relatives  .11  .09  0.28  0.390  Friends Opposite-sex Same-sex  .42 .15 .27  .49 .15 .34  -0.58 0.00 -0.63  0.719 0.500  Boss/Supervisor  .02  .04  -0.49  0.688  Other  .07  .03  0.76  0.224  1.  High c o n t a c t frequency r e l a t i o n s a r e those network members who a r e contacted a t l e a s t once a week. High  social  network  Of t h a t of  contact  nuclear  with  membership  64%, 38% o f h i g h  proportion way  frequency  family that  r e l a t i o n s comprise  o f both a n o r e x i c contact  i n the s o c i a l  does  the s o c i a l  not d i f f e r  frequency  64% o f t h e t o t a l  and c o n t r o l  subjects.  r e l a t i o n s a r e composed  networks o f a n o r e x i c  subjects, a  in a statistically  significant  networks o f c o n t r o l s u b j e c t s .  This f i n d i n g ,  88 in  fact,  constitutes  contact are  frequency  primarily  relations Indeed,  relations  composed  t o be  networks  of high  of both  of the expectation  i n the s o c i a l  of nuclear  found  i t i s friends,  proportion  1.6.  a reversal  outside  networks  f a m i l y members the nuclear  anorexic  frequency  and c o n t r o l  few  family  relations  high  of anorexics  with  n o t f a m i l y , who c o n s t i t u t e  contact  that  such  boundary.  the greatest i n the s o c i a l  subjects.  Hypothesis  i s therefore rejected.  Hypothesis 1.7. Anorexic s u b j e c t s haye a s i g n i f i c a n t l y h i g h e r p r o p o r t i o n o f network r e l a t i o n s with whom they f e e l ambivalent or n e g a t i v e about than control subjects. In o r d e r  to t e s t  this  hypothesis,  received  a rating  Thoughts  and F e e l i n g s Towards  equally  mixed  moderate, negative from  feelings  the s o c i a l  Others  network subset  Scale  feelings  & thoughts;  & thoughts)  were  data.  analyses  a r e summarized  Social  network  members  social  network  of the t o t a l  difference significance  social  i n these  o f p r o p o r t i o n s was  i n Table  anorexic  and t h o u g h t s  membership, network  proportions  whereas  category  were  of these  total  by network  strong,  groups  results  feelings  very  and z - t e s t s o f  and c o n t r o l  whom  2=raostly  data,  anorexic  or negative  & thoughts;  An a n a l y s i s  about  of  o f t h e PPI (3=about  selected  of frequency  and S t r e n g t h  l=mostly  between  ambivalent  network members who  on t h e K i n d  and n e g a t i v e  feelings  on t h i s  differences  21%  positive  negative  conducted  The  of 3 or l e s s  social  of control  have  26% o f  members  the  comprise  subjects.  d i d not achieve  (p>.05), and t h e r e f o r e H y p o t h e s i s  6.  subjects  comprise  such  performed.  The  statistical  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 CATEGORY  ANOREXICS (N=34)  Proportion of A/N R e l a t i o n s i n S o c i a l Network  CONTROLS (N=35)  z  P  0.23  0.409  .26  .21  .34 .10 .12 .13 .06 .07  .24 .07 .06 .12 .03 .08  0.92 0.45 0.87 0.13 0.60 -0.16  0.179 0.326 0.192 0.448 0.274 0.564  Relatives  .13  .15  -0.24  0.595  Friends Opposite-sex Same-sex  .42 .15 .26  .50 .18 .33  -0.67 -0.34 -0.64  0.749 0.633 0.739  Boss/Supervisor  .04  .08  -0.36  0.641  Other  .07  .03  Proportion of A/N R e l a t i o n s That A r e : Family Members Father Mother Siblings Brothers Sisters  1.  0.76  0.224  Ambivalent o r n e g a t i v e r e l a t i o n s a r e those network members who r e c e i v e d a score o f 3 or l e s s on the Kind and Strength of Thoughts and F e e l i n g s Towards Others S c a l e o f the P a t t i s o n P s y c h o s o c i a l Inventory. Hypothesis 1.8. Anorexic s u b j e c t s haye a s i g n i f i c a n t l y h i g h e r degree o f ambivalence o r n e g a t i v e f e e l i n g s and thoughts toward t h e i r parents than c o n t r o l s u b j e c t s . This  of  hypothesis  parents  intensity deviations  was t e s t e d  by a n o r e x i c  scale were  by c o m p a r i n g  and c o n t r o l  of the P P I . calculated,  Mean  the average  subjects  ratings  univariate  on t h e e m o t i o n a l  and t h e i r  t-tests  rating  were  standard performed,  90 and  a Hotelling's  T  2  a n a l y s i s was c o n d u c t e d  (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  1.  ANOREXICS =32) SD Xa  MOTHER  Contact Feelings/ Thoughts Reciprocity Instrumental Support Reciprocity Emotional Support Reciprocity  4.66  CONTROLS =35) SD Xc  0.70  4.80  0.47  t  2-tail P  0.99  0.325  4.08  0.97  1.25  4.49  0.98 0.74  2.50  2.12  0.038  4.17 4.45  1.10 0.82  4.40 4.71  0.70 0.52  1.03 1.58  0.309 0.120  3.75 4.03  1.27 1.28  4.23 4.57  0.81 0.61  1.86 2.23  0.068 0.029  3.91  4.60  0.015  * R e s u l t a c h i e v e d t h e r e q u i r e d l e v e l o f s i g n i f i c a n c e f o r an o v e r a l l Type 1 e r r o r r a t e o f .05 f o r the e n t i r e t a b l e . For H o t e l l i n g ' s T2 a n a l y s i s , F(7,59) = 1.2305, p>.05.  2.  ANOREXICS (N= =31) SD Xa  FATHER  Contact Feelings/ Thoughts Reciprocity Instrumental Support Reciprocity Emotional Support Reciprocity  4.58  0.77  CONTROLS (N=32) SD Xc 4.53  0.89  0.90  t  2-tail P  -0.24  0.814  1.95  0.056  3.84  1.26  4.38  4.19  1.01  4.39  0.77  0.88  3.63 4.24  1.11 1.06  4.02 4.06  0.90 1.11  1.52 -0.66  0.134 0.513  3.32 3.60  1.31 1.36  3.50 3.89  0.93 1.12  0.62 0.94  0.535 0.351  0.385  * R e s u l t a c h i e v e d t h e r e q u i r e d l e v e l o f s i g n i f i c a n c e f o r an o v e r a l l Type 1 e r r o r r a t e o f .05 f o r the e n t i r e t a b l e . For H o t e l l i n g ' s T a n a l y s i s , F(7,55) « 1.7114, p>.05. 2  91 Hotelling's social  network  statistical the  and  to  mostly  rating  suggested  differences  rating  the range from  mixed,  5).  of e m o t i o n a l  positive  This  & thoughts  i n the l i t e r a t u r e ,  that  anorexic  toward  feelings  toward  fathers.  achieve  feelings not  the differences  between  emotional  statistical  that,  intensity  does  their  set.  their  ( i e . , a mean  their  support  mothers,  intensity  significance.  toward  Group on t h e  feelings  mother and toward  rating &  both o f 3:  thoughts)  (ie_. , a mean the  notion,  subjects  have  "a  and weak, a m b i v a l e n t  Furthermore, anorexic  attain  indicating  positive  both  finding  ambivalence"  regarding  data  and n e g a t i v e f e e l i n g s  positive  functional  d i d not  revealed  o f 4) toward  ambivalence  and  thereby  i n this  intensity  powerful  of  parents  s u b j e c t s have m o s t l y moderate  very strong,  of  both  a t t h e .05 l e v e l ,  emotional  extended  equally  of i n t e r a c t i o n a l  regarding  ( a mean  although  parents about  of  anorexic  thoughts  father,  data  of c o l l e c t i v e  ratings  average,  analyses  significance  absence  mean  T2  independent  and their  Hypothesis  control  t-tests  subjects  parents  d i d not  1.8. i s t h e r e f o r e  rejected.  Hypothesis  related  to  the f u n c t i o n a l  aspects  of  social  networks. H y p o t h e s i s 1.9. There i s a s i g n i f i c a n t l y greater proportion o f e m o t i o n a l and i n 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 t h e o t h e r c l u s t e r s o f 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 i n comparison t o control subjects. In  order to test  this  hypothesis,  t h e e m o t i o n a l s u p p o r t and  92 instrumental collapsed  help  into  ratings  a  single  T h e s e mean r a t i n g s given  conducted  support mean  rating  those  Each  as  network  of a n o r e x i c  both  members  that  expectations, of  support  friends  anorexic given  that  they  and c o n t r o l  statistical  8)  comprise  and  constitute  f r e q u e n t l y (a  the former  support  and t h e  relations."  data  according  z-tests  50%  two of  a  f o r both  Hypothesis  were  of  each  pages).  the  of s o c i a l  social network  exchanged  50%, n u c l e a r f a m i l y approximately  half.  reversal  by t h e  of  such  frequency  outside the nuclear family  differences  reciprocated  significance.  given  to e x p e c t a t i o n s suggested  a r e t o be f o u n d  groups  analyses  were  i s , the g r e a t e s t p r o p o r t i o n of high  Furthermore,  (Table  of support  of support  Of t h i s  support.  relations,"  and  frequency  were  s u b j e c t s , and f o r  of support  a r e composed  i s a high  3 3 % and  relations  boundary.  of support  approximately  subjects  indeed,  who  support;  proportions  T h e s e p r o p o r t i o n s do n o t c o n f o r m literature;  and c o n t r o l  and r e c i p r o c a t e d ) .  comprise  members  o f 4) o r v e r y  such  of  Separate  i n T a b l e s 8 and 9 ( s e e n e x t  whom t h e r e  given  members.  the frequency  indicate  member  frequency  of reciprocated  The  a r e summarized  members w i t h (ie,  aggregated  f o r both  rating  frequency  frequency  network  of frequency  network  reciprocated  category.  Results networks  social  anorexic  as " h i g h  analysis  analysis  who  "high  rating  network  ( a mean  o f 5) from  characterized  to  often  members  latter  from  f o r those  either  mean  social  were c a l c u l a t e d  t o and r e c e i v e d  were  of each  in proportions high  (Table  frequency 9)  between  of  support  d i d not  attain  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 P r o p o r t i o n o f HPS R e l a t i o n s i n the S o c i a l Network  ANOREXICS (N=34)  CONTROLS (N=35)  .50  .53  -0.25  .33 .09 .12 .13 .05 .08  .31 .07 .10 .14 .07 .08  0.18 0.31 0.27 -0.12 -0.35 0.00  0.429 0.378 0.394 0.548 0.637 0.500  Relatives  .16  .10  0.74  0.230  Friends Opposite-sex Same-sex  .48 .16 .32  .55 .15 .40  -0.58 0.11 -0.69  0.719 0.456 0.755  Boss/Supervisor  .01  .03  -0.59  0.722  Other  .02  .01  0.34  0.367  0.599  P r o p o r t i o n o f HPS R e l a t i o n s That Are: Family Members Father Mother Siblings Brothers Sisters  1.  High frequency o f support r e l a t i o n s a r e those network members who r e c e i v e i n s t r u m e n t a l and o r emotional support " o f t e n " from the s u b j e c t ( t h a t i s , they r e c e i v e a score o f 4 or 5 on the Instrumental o r Emotional Support S c a l e s o f 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 CATEGORY  ANOREXICS (N=34)  CONTROLS (N=35)  z  P  .47  .49  -0.17  0.568  .34 .11 .14 .09 .02 .06  .34 .09 .12 .13 .06 .07  0.00 0.28 0.25 -0.53 -0.84 -0.17  0.500 0.390 0.401 0.702 0.800 0.568  Relatives  .15  .09  0.77  0.221  Friends  .46 .17 .29  .52 .14 .38  -0.50 0.34 -0.79  0.692 0.367 0.785  Boss/Supervisor  .00  .02  -0.83  0.797  Other  .05  .03  0.42  0.337  P r o p o r t i o n o f HFRS R e l a t i o n s i n the S o c i a l Network P r o p o r t i o n o f HFRS R e l a t i o n s That A r e : Family  Members  Father Mother Siblings Brothers Sisters  Opposite-sex Same-sex  1.  High frequency o f r e c i p r o c a l support r e l a t i o n s a r e those network members who a r e p e r c e i v e d by the s u b j e c t t o g i v e i n s t r u m e n t a l and o r emotional support " o f t e n " ( i e , they r e c e i v e d a score o f 4 or 5 on t h e R e c i p r o c a l Instrumental or Emotional Support S c a l e s o f the P a t t i s o n P s y c h o s o c i a l Inventory).  Hypotheses personality  and  related  environmental  to  social  network  following  was  of  factors.  2. The s o c i a l networks of a n o r e x i c personality t r a i t s . This hypothesis  correlates  examined w i t h  s u b j e c t s vary  greater  with  specificity  by  the  sub-hypothesis.  2.1. T h e r e 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 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 s , 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 s i z e and support (emotional, i n s t r u m e n t a l ) . 3. 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 vary environmental c h a r a c t e r i s t i c s . This specificity  hypothesis by  the  was  following  likewise  examined  with  with greater  sub-hypotheses.  3.1. There w i l l be a n e g a t i v e c o r r e l a t i o n between the f a m i l y c l i m a t e v a r i a b l e of cohesion, as measured by the Family Environment S c a l e (FES), and s o c i a l network s i z e 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 . 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 f a m i l y c l i m a t e v a r i a b l e of independence, as measured by the Family Environment S c a l e (FES), and s o c i a l network s i z e 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 . 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 f a m i l y c l i m a t e v a r i a b l e s of cohesion and independence, as measured by the Family Environment S c a l e (FES), and s o c i a l network s u p p o r t ( e m o t i o n a l and instrumental) r e c e i v e d f r o m a l l s o u r c e s as p e r c e i v e d by a n o r e x i c 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 f a m i l y c l i m a t e v a r i a b l e of cohesion, as measured by the F a m i l y E n v i r o n m e n t S c a l e ( F E S ) , and s o c i a l network s u p p o r t ( e m o t i o n a l and i n s t r u m e n t a l ) 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 s u b j e c t s , b u t a negative c o r r e l a t i o n between cohesion and s o c i a l network support from sources o u t s i d e the f a m i l y .  96 3.5. There w i l l be a n e g a t i v e c o r r e l a t i o n between the f a m i l y c l i m a t e v a r i a b l e of independence, as measured by the Family Environment S c a l e ( F E S ) , and s o c i a l network s u p p o r t ( e m o t i o n a l and i n s t r u m e n t a l ) from f a m i l y as perceived by anorexic s u b j e c t s , but a positive 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 s o c i a l network support from sources o u t s i d e the f a m i l y . In  order  to  test  these  selected  for  analysis:  network,  the  mean  subject for  (ije,the  each  of  each  and  of  the  mean o f the  Cohesion  subject  for  Cs,  raw  scores  and the  a l l sources,  perceived  support  instrumental family, outside support  family, from  the  Pearson  the  statistical  using  are  of  Sp of  following  each  nine  emotional  outside  perceived  were  significance  of  probabilities.  summarized  on  Table  these The 10  for  the  FES  mean  (emotional support  family,  support  outside  friends,  with  this  of  the  following  support  emotional  from  correlations  results  ratings  from  coefficient.  (see  CPI  a l l sources,  support  conducted  each  the  instrumental  from  social  of  emotional from  was  on  perceived  support  family,  instrumental  analyses  PPI  perceived  support  score  scores  the  support  family,  and  and  data  subject's  subject  a l l sources,  family,  support  Sa  c a t e g o r i e s of  from  from  and each  Independence,  product-moment c o r r e l a t i o n  two-tail  analyses  from  friends,  Cross-correlational  Sy,  instrumental  support  emotional  size  Do,  instrumental) support  from  mean  the  Interpersonal Effectiveness  subject),  variables  hypotheses,  friends. data  using  Estimates were  of  obtained  correlational page).  97 TABLE 10 CROSS-CORRELATIONS BETWEEN 13 SOCIAL NETWORK VARIABLES AND 3 TRAIT VARIABLES (ANOREXIC SUBJECTS ONLY; N=34) INTERPERSONAL EFFECTIVENESS  COHESION  INDEPENDENCE  .27  .22  .05  -.10  .47  .25  .01  .42  .32  -.18  .44  .15  -.00  .70*  .46  -.or  .60*  .61*  .01  .66*  .15  -.17  .18  .09  Emotional Support Outside Family  -.07  .10  .05  Instrumental Support Outside Family  -.24  .22  .11  -.17  -.08  -.10  .00  -.15  -.06  -.31  -.0.1  -.13  VARIABLE  SIZE PERCEIVED SUPPORT FROM ALL SOURCES Emotional Support From A l l S o u r c e s Instrumental Support From A l l S o u r c e s  PERCEIVED SUPPORT FROM FAMILY Emotional Support From F a m i l y Instrumental From F a m i l y  Support  PERCEIVED SUPPORT OUTSIDE FAMILY  PERCEIVED SUPPORT FROM FRIENDS Emotional Support From F r i e n d s Instrumental From F r i e n d s  Support  * Result achieved the required l e v e l of s i g n i f i c a n c e o v e r a l l Type 1 e r r o r r a t e o f .05 f o r the e n t i r e t a b l e .  f o r an  98 Only the  .05  four level.  positive p<.001)  correlations  as  3.4.,  failed  Cohesion  and  variable  correlation  Family,  in  positive  correlation  Support  Outside  weak,  showed  From  3.4.  positive  (r=.70,  contrary  correlations Outside  significance.  at  a strong,  Family  However,  P e r c e i v e d Support  of  Independence  (r=.61,  contradiction was  H y p o t h e s i s 3.5. of  to  the  significance.  d i d not  other  As  sub-hypotheses  a  Hypothesis between  (r=.09,  i s therefore  showed  p<.001) w i t h  found  Family  correlation  None  Cohesion  significance  to  (r=.18,  the  Family  Hypothesis  3.4.  rejected.  FES  this  of  Hypothesis  t h e r e were  positive  3.5.,  by  statistical  P e r c e i v e d Support  to achieve s t a t i s t i c a l  therefore The  variable  with  predicted  p>.05) between  is  FES  correlation  Hypothesis  that  The  achieved  a  significant,  Emotional 3.5.  Support  Although  From  a  weak,  I n d e p e n d e n c e and P e r c e i v e d  p>.05) i n achieve  support  of  Hypothesis  statistical  significance.  achieved  statistical  rejected.  correlations  consequence,  Hypotheses  2  and  3,  and  their  are a l l r e j e c t e d .  SUMMARY OF RESULTS Hotelling's matching  T  2  a n a l y s e s of the demographic data suggest  procedures  abstainers  and  combined  for  however,  do  population  were  bulimics  subsequent not on  appear measures  satisfactory,  were  sufficiently  analyses. to  be  of  The  and  anorexic  homogeneous control  representative personality  that  that  to  be  subjects,  of  the  general  (CPI)  and  family  99 environment  (FES).  Results  of  statistically  the  primary  significant  control  groups.  subjects  were  As  found  t o have  control  that  statistical  inequality.  variability  o f t h e mean  network the  rejection  thereby size.  social  size  Furthermore,  the  SD=7.54), a  difference  a t t h e .05 l e v e l  to  of other  i n the case of  of s o c i a l  personality  ( F E S ) and  social  significantly  correlate  i n predicted  directions  2  their  of Hypotheses  Although  there  cohesion  and  instrumental, only  partial  contradicted The  perceived  positive from  and  variables  positive  support  and combined  support  3,  a significant,  support  significant, emotional  was  and  network  from  to Hypothesis correlation family;  There  this  network (CPI),  l e d to the  between  (emotional,  finding  between  1 was  (PPI) to  correlation  3.4.  however,  l e d to  sub-hypotheses.  family,  support), this  social  Hypothesis  environmental  rejection  as t o the  significance  1.9.  failure  using the  overlapping  questions  statistical  except  anorexic  (Xa=11.65,  The f a i l u r e  1.2.  few  networks  raises  finding.  untenable,  1.1.,  the substantial,  scores  to achieve  revealed  t h e a n o r e x i c and  Hypothesis  significance  of Hypotheses  rendered  between  smaller  However,  of t h i s  differences  by  analyses  s u b j e c t s (Xc=16.03,  Bonferroni  meaningfulness  differences  predicted  SD=4.54) t h a n achieved  data  contributed was  also  independence finding  a  and  actually  H y p o t h e s i s 3.5.  primary  hypotheses  of t h i s  3) were t h e r e f o r e a l l r e j e c t e d .  study  (Hypotheses  1, 2, and  100  CHAPTER 5 DISCUSSION  The  purpose of t h i s  of  anorexic  of  anorexic  and n o n - a n o r e x i c social  characteristics. negative) following data  was t o compare  women, and t o e x p l o r e  networks  with  network  personal  v a r i a b l e s were  discussion, the r e s u l t s  analyses  the s o c i a l  will  be e v a l u a t e d ,  research w i l l  environmental  (both  p o s i t i v e and  examined.  o f t h e demographic limitations  In t h e  and  primary  of the study  and t h e i m p l i c a t i o n s o f t h e s t u d y  anorexia  networks  the v a r i a t i o n  and  Q u a n t i t a t i v e and q u a l i t a t i v e  social  presented, and  study  will  for social  be  network  be e x p l o r e d .  EVALUATION OF RESULTS OF DEMOGRAPHIC ANALYSES The common from 70%  socioeconomic  demographic  upper-middle  finding class  of the anorexic  where  t h e head  managerial, increasing class  of  incidence  study  analysis  or upper  class  of t h i s  the household career.  of anorexia  i s also  i s consistent  of a preponderance  subjects  or business  households  present  data  whose p a r e n t s  was  nervosa  (Sheppy,  came  in a  However,  reflected  of anorexic  families study  with  from  the women  1984).  families  professional,  a trend  i n women  i n the anorexic  toward t h e  from  lower-  women  of the  were l a b o r e r s o r on w e l f a r e  (Sheppy,  1984). Duration was  examined  of residence, (Sheppy,  a measure  of geographic  1984), s i n c e i t was assumed  that  stability, geographic  101 disruptions  were  statistically residence, their  although  measure  therefore, networks  that  has  The  been  CPI  the  by  detail  sample.  later  FES  of  raises  differences  between the  networks.  No  in  of  duration  fewer  (Xa=8.10  years  years,  the  to  may  patterns  found  Pattison  samples.  The  by  social of  16  the  T2  in  SD=5.87;  and  his  network t h a t  find  into up  to  means  factor  find  to  significant  to  compare  the  to  the  social  i n urban  8 -  24.  on  the  I t would  of  in  of  groups.  colleagues  a  significant  representativeness  control  range  of  network  taken  population  emerges from c o n t r o l a  social  social  contributing  group  the  assumption  be  a  11).  to  general  is  possible,  sub-groups  Table  the  CPI  is  in  to  analyses  however,  with  the  It  the  these  anorexic  statistically  exist  so,  analyses and  of  However,  (see  about  control  people,  of  another  study,  of  reveal  regard  group and  anorexic  profile  i f  chapter  be  scores  possibility will  statistical  this  CPI  network.  with  doubts  network  comprised  report  differences  Hotelling's  of  is  social  This  in this  s a m p l e , and  germane  did  1984).  combination  inability  more  found  not  sub-groups;  between c o n t r o l  and  control  not  violated  the  inability  differences the  two  experimental  greater  was  the  did  (Sheppy,  significant  these  of  subjects  personality ,  of  location  analysis  bulimic  characteristics single  T2  differences  homogeneity  subjects  social  SD=7.27).  and  of  in  difference  anorexic  Hotelling's  significant  changes  geographical  Xc=11.21 y e a r s ,  abstainer  to  significant  current  The  related  be  social network  population group Of  data  these  16  102 people, are  approximately  relatives,  same-sex  8  4 ( 2 7 % ) a r e n u c l e a r f a m i l y members, 3 ( 1 9 % )  (47%) are friends  friends),  and 1 i s from  some o t h e r  T h e s e network members a r e u s u a l l y and  receive  positive  instrumental relationship contact, friends of  help  category  and  group  profile  colleagues  emotional  (N=200), e x c e p t social  PPI d a t a  from  30  1974; Wellman,  (Boussevain,  study found  the s o c i a l  17 ( J o n e s  network  i s largely  found  by  family,  of  Pattison urban  social  and h i s  population found  of 5 or 6 people i n relatives,  contacts.  The  exhibit  a  friends,  size high  of  social  degree  of  of the intimate p s y c h o s o c i a l  & F i s c h e r , 1978; F i s c h e r , 1982) t o 1981).  profile  It i s therefore  of the c o n t r o l  r e p r e s e n t a t i v e of the t y p i c a l  network  This  P a t t i s o n (1977a)  composed  i n t h e g e n e r a l p o p u l a t i o n by o t h e r  measure t h e s o c i a l  family.  a normative  estimates  network r a n g i n g  frequency  networks  population  however, w i t h  of a  members o f t h e s o c i a l  from  social  i n the general  variability,  the s i z e ,  and c o m p o s i t i o n .  or  intensity,  support,  o f 20 - 30 p e o p l e ,  and work  once a week,  and e m o t i o n a l  that  of the f o l l o w i n g c l u s t e r s :  networks  by  5  category.  I f the value  outside of the nuclear  i n size  network  neighbors,  that  support.  i s indicated  approximates  i n their  at least  f o r emotional  reciprocated instrumental  the c o n t r o l  each  ratings  friends;  relational  contacted  a r e t h e most h i g h l y v a l u e d  network  a  and  (3 o p p o s i t e - s e x  similar  group social  s t u d i e s which  to the PPI.  concluded of  this  network  d e f i n e and  103  EVALUATION OF  RESULTS OF  The  social  only  differentiated variable,  in  (ej>. ,  Erickson,  1975;  et  al,  Ratcliffe  position  of  the  overlapping anorexic social  Llamas  Azim,  rehospitalization and  in  mood  network  inferior  study,  significant  no  al.,  mean  8  -  24  size  network  an  &  this  et  the  result  is  not  considerable, For  example,  it  according  to  predictor  and does  of not  the  of  psychiatric indicate  results  network  control  Furthermore,  a  1978)  al.,  is  members, and  be  1980;  It  scores.  may  qualitative  Sokolovsky,  1978).  members.  1981),  inverse  Hammer,  was  7-16  common  Pattison  there  from  a  psychopathic  1979;  1981;  size  quantitative  of  and  however, t h a t  Sokolovsky,  (Wilcox,  qualitatively as  the  a  Cohen  al,  since  from  &  size  Silberfeld,  varied  (Cohen  was  replicates  1982;  et  et  1975;  varied  smaller  al.,  author,  networks  networks  symptoms  et  1978b;  significantly  literature  Brugha  meaningful,  social  result  network  variability  although  This  Froland  that  subjects  social  present  particularly  control  network  1975;  &  variable  size.  social  between  symptomatology  Henderson  from  network  the  relationship  1978;  network  anorexic  total  finding  PRIMARY DATA ANALYSES  a  of  this  differences  were  found. The at  the  total .05  friends, friends.  number  level  and  the  Again,  substantial,  with  of  network  the  mean  overlapping  approached  average anorexic  average c o n t r o l these  friends  size  subject scores  variability,  subject  reporting were  significance  reporting seven  or  five eight  characterized  thereby  rendering  by  their  104 interpretation  problematic.  A curious social that  context  network  women  somewhat  a growing  subtypes These  within  subtypes  family  history  clinical least  two t y p o l o g i e s  show  intimations  significant may  simply  their  reflect  anorexic  1982).  be  anorexic Another  that and  social  i n social  condition  social  attributable  the  1986; S t r o b e r ,  varying  According  significant  women  degrees  (eg..,  to this network  entity.  differences  t o t h e low d e g r e e  nervosa i s there  o f homogeneous 1983).  patterns  of  characteristics,  There  are, i n fact,  currently  available  differences 1983).  i n  at that  social  Alternatively,  among a n o r e x i c women and s e v e r i t y  1980; G a r f i n k e l  explanation,  One  (Strober,  of chronicity  Crisp,  social  Indeed,  differential  impairment  that,  indices.  presence  and o u t c o m e .  of between-group  differences  network  anorexia  population  with  I t appears  the t y p i c a l  developmental  of anorexic  (Grigg,  social  i s that  anorexic  and p r e m o r b i d  study.  qualitative  nosological  be a s s o c i a t e d  presentation,  impairment  on  on t h e l i k e l y  the large  may  in a  portrait  or s i n g u l a r  consensus  of this  approximates  women  social  o f a n o r e x i c women i n t h e i r  the data  smaller,  of this  a homogeneous  portrait  a r e embedded  of non-anorexic  explanation  is  emerges f r o m  anorexic  although  not  and u n e x p e c t e d  the v i r t u a l  &  Garner,  absence o f  i n the present  of chronicity  in  study  and s e v e r i t y  may in  sample. explanation network  of the s o c i a l  characteristics  do n o t s i g n i f i c a n t l y  vary  with  portrait  are stable the onset  of this  study i s  and l o n g s t a n d i n g , and n a t u r a l  course  105 of  psychopathology  possibility certain  s u c h as  that  the  personality  (Mehrabian,  1976;  variable  in  study  Henderson  for  by  remission  in  of  such  as  affiliative  1984),  or  is  & Moran  neurotic  this  (1983) t h a t  largely  i t raises  traits,  for  is  i f so,  network  Support  social  nervosa;  social  Brugha,  itself.  changes  anorexia  the  even  a  explanation examined  symptoms.  They c o n c l u d e d  product  of  tendency  personality comes  from  prospective  r e l a t i o n s h i p s accompanying  the  the  a  data  onset  and  that,  ...when n e u r o t i c symptoms a r i s e , t h e r e i s no e v i d e n c e t h a t t h e s o c i a l n e t w o r k i s a f f e c t e d , b u t rows w i t h close others increase. When n e u r o t i c symptoms i m p r o v e , there a r e no statistically 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 a t f o u r and e i g h t months; and the c h a n g e s a t 12 months can be e x p l a i n e d as r e g r e s s i o n t o the mean ( p . 4 7 1 ) . This  conclusion  relationship obtained  between s o c i a l  by  in  Henderson's of  the  study  is  for  study  Brugha  psychiatric  too  et  al  patients  which appeared  t o be  symptoms.  These  depressive  disorders  on  had  different  of  such  in  as  a  field  1984)  found  deficiencies in  researchers  supportive  than  that  their  their  social  which  Indeed, as  that  a  has  social  antedating  findings  n e t w o r k s as  their  concerning follows:  general  an  However, t h e  a  networks  to of in  surveys.  been  depressed  D e p l e t e d s o c i a l n e t w o r k s have been r e p e a t e d l y shown be a c h a r a c t e r i s t i c o f d e p r e s s e d o u t p a t i e n t s and c a s e s of a c u t e 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 population  rare  Furthermore, that  considerably  summarize  the  those  attention  c r o s s - s e c t i o n a l data. (1982,  of  literature.  special  research  view  psychopathology  studies  long-standing,  and  and  network  worthy  long  much  context  social  longitudinal  dependent by  a  cross-sectional  proliferate  example  supports  absence of  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 f r o m o t h e r s who a r e a f f e c t i v e l y c l o s e a r g u e s a g a i n s t a d i r e c t and immediate causal link between social network deficiencies and e p i s o d e s of d e p r e s s i o n . A c o n s i d e r a t i o n o f t h e l i t e r a t u r e on t h e e v o l u t i o n o f p r i m a t e s o c i a l b e h a v i o u r and o f c o n t e m p o r a r y d a t a on t h e c o n s t a n c y o f s o c i a l network c h a r a c t e r i s t i c s , b o t h o v e r t i m e 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 , s u g g e s t s t h a t a b i o c u l t u r a l p e r s p e c t i v e needs t o be m a i n t a i n e d . A c c o r d i n g l y , an a f f i l i a t i v e t e n d e n c y i n man may be t h e cause r a t h e r than the r e s u l t o f t h e f o r m a t i o n o f s o c i a l g r o u p s , 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 a s w e l l as f a c t o r s i n t h e i n d i v i d u a l ' s s o c i a l environment will have t o be c o n s i d e r e d b o t h 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 , p r e s u m a b l y , i n t h e d e s i g n o f 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). Finally,  Sarason  conducted  a series  social  support,  individual their  individual  pattern  variable.  are several  of r e s u l t s  real  inherent  deficiencies  procedures number  of  used  power  of  of social &  of  a s an  presented  support  a s an  Philips,  1987;  explanations of the o v e r a l l  study  sample  but these  size.  i n the present  A larger  that  a l l share exist  were  Although were  indicate size  tests,  the  thereby  have  of  important  statistical  rigorous,  would  common  because  The most  trends  a  i n the s o c i a l  n o t found  study.  study  sample  the s t a t i s t i c a l  that  differences  i n the present  differences  significance.  networks,  r e s e a r c h e r s have  (ej>. , B r u h n  i n the present  assumption:  concerns  recently  the p o t e n t i a l  of social  origins  alternative  o f a n o r e x i c women,  these  have  1986).  networks  of  Other  variable  (1986)  explored  variable  o f the developmental  & Richman,  underlying  that  a qualitative  difference  There  h i s colleagues  of s t u d i e s  difference  views  Flaherty  and  there  rather  are a than  increased the  increasing  the  107 probability existed) were  of  on  on  several  the  verge  example, t h e 2),  a  detecting  v a r i a b l e of  present margin  study, using  importance  the  requires  at  least  significance of  0.017  2).  the  controls)  necessary  (Snedecor  sample  between  & Cochran,  one  the  inequality p=0.022;  overall  to  the  Type  to  of  declare  a  anorexic  cluster  by  a  the  was  For  of  the  narrow  (SD=3.85);  Bonferroni  group  inequality  necessary of  .05  used  in  level  for  the  order  to  (ie. , anorexics  statistically (Xa)  that  (Table  very  (Xa=5.15  I error rate  each  study  hypotheses  achieve  f o l l o w i n g formula  size  the  friendship  of  they  significance.  significance  i n order  The  determine  of the  achieve  t=2.34,  f o r an  Table  difference  to  (presuming  variables in this  statistical  to  Bonferroni  (SD=4.70);  whole  achieving  failed  differences  network  network s i z e  Xc=7.57  of  social  of  social  actual  and  and  significant  control  (Xc)  means  1980):  n where  £ = Xa - Xc * t i = (<?^2n - 2) t = (2(l-p),2n-2) oC = .017 A = .90 s = 4.3024 ( p o o l e d 2  Results each  indicate  group  difference  in  that order  using  suggests  that  increased  the  statistically  a  the  estimate)  approximately to  achieve  a  Bonferroni  larger  power o f t h e significant  sample present  87  subjects  are  statistically  inequality.  size study  (ije.,  needed  in  significant This  N=174)  sufficiently  d i f f e r e n c e between a n o r e x i c  finding  could  have  to d e t e c t and  a  control  108 group  means p e r t a i n i n g  network  members  actually  would  difference to  raise  s t i l l  the question to  increased  the  pertaining  to  statistical however,  In  yet  suppose  that  that  study  resulted  social  nowhere  reasonable  in  comparisons  of  differences  were  Another been  anorexics between been  groups. that  the  sample  the  since  i s that  social  on  differences  study  from  i t i s more  social  of the network  significance.  abstaining  and  between  may  the  have  anorexic  subjects  bulimic  sample  has  resulted  in  and  on t h e one hand, i t i s r e a s o n a b l e of a n o r e x i c  study  differences  of the a n o r e x i c  that  might  statistically  f o r the majority the  in  significance.  however,  statistical  the data  of  I t i s noteworthy,  additional,  pf  have  verge  the r e s u l t s of the p r e s e n t  possibility  networks  i tis  also  the  statistical  most  size  differences  s i g n i f i c a n t s o c i a l network  differences  F o r example,  would  network  hypothesis  the  Furthermore,  study.  differences;  thus  f c = 7 . 7 5 ) as  significant  social  i f so, the homogeneity  real  (Xa=5.15;  of  difference  since  variables  achieving  a  significance  size  detecting  several  study,  were  a  such  cluster  t h e sample s i z e o f t h e p r e s e n t  by p o o l i n g  compromised,  obscuring  a  f a r from a c h i e v i n g  when t h e r e  them;  near  explanation  biased  of  the n u l l  this  that  i s so s m a l l  i n the present  network  to accept  friendship  problematic  network  finding  social  course,  been  of  the majority  were  the  statistical  such  probability other  of  of i t s meaningfulness.  significance  significant  have  the have  summary, i n c r e a s i n g  have  of  i n number o f f r i e n d s  reasonable  this  (assuming,  existed);  obtained  to the s i z e  change  control t o assume with  the  109 natural  history  impoverished become  more  (Crisp,  advanced  stage  anorexic  different  to  assume  an  the  to  of r e c o v e r y .  of  network  resemblance  the homogeneity  social  network  compared Means  analysis tests. (next  dimensions,  according  and  standard was  the  The r e s u l t s  at  treatment.  anorexic  a  network  In  to  this  be e x p e c t e d  with  followed  of these  variables  calculated,  by  a  analyses  series  were  i t i s reasonable tend  sample  study  normalize case,  a  the  to r e f l e c t In o r d e r t o r e s p e c t to  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  d e v i a t i o n s were  more  i s , since a l l  women o f t h i s  Furthermore,  to the s o c i a l  performed,  advancing  be  to the general p o p u l a t i o n .  of  than  On t h e o t h e r  may that  of  of t h e r a p e u t i c medical  n e t w o r k s o f b u l i m i c a n o r e x i c s would  increasing  of  1982).  p a t t e r n s would  successful  networks  effects  recovery;  the anorexic  i t s concomitants  social  study  some form  more  impoverishment  the  this  to  the  & Garner,  of  becoming  and  greater  due  road  that  social  the c o u r s e  test  were  of the PPI.  Hotelling's  of u n i v a r i a t e  a r e summarized  i n Table  t11  page). Both  of  stages  that  case,  show  anorexics  i t i s possible  social  would  s u b j e c t s were r e c e i v i n g  at  over  In t h i s  1980; G a r f i n k e l  on  syndrome,  of s t a r v a t i o n  subjects or c o n t r o l s  the bulimic  care,  anorexic  the e f f e c t s  anorexics  starvation hand,  as  the  pronounced.  abstaining bulimic  of  the H o t e l l i n g ' s  specific  network  significance, sample  sizes.  a  T^ a n a l y s i s  differences  failure  that  Furthermore,  and t h e i n d e p e n d e n t  failed may  be  the s o c i a l  to  achieve  related network  t-tests  statistical  to the s m a l l subprofiles  of the  110 anorexic  abstainers  different It  from  i s therefore  bulimic  and b u l i m i c s  the s o c i a l concluded  anorexics  do n o t a p p e a r  network that  profile  account  f o r the v i r t u a l  present  study.  absence  of the c o n t r o l  the mixture  i n the experimental  substantially group.  of abstaining  sample  and  i s u n l i k e l y to  of s i g n i f i c a n t r e s u l t s  i nthe  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-tail 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  11.35  4.59  4.65  -0.32  0.754  Size  11.90  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  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  -0.23  0.821  * R e s u l t a c h i e v e d t h e r e q u i r e d l e v e l o f s i g n i f i c a n c e f o r an o v e r a l l Type 1 e r r o r r a t e o f .05 f o r the e n t i r e t a b l e . For H o t e l l i n g ' s T a n a l y s i s , F(10,22) - 1.6286, p>.05. 2  Ill Response  sets  statistically control  that on  of  error  the present  i s often  o f t h e PPI where  a scale  social  which r e l i e s  that  among a n o r e x i c Sampling of  error  study This  account  i s not  t o deny  problems,  midpoint  research  f o r the f i n d i n g  that of  general  therefore  be  group  the c o n t r o l  group  a p p e a r s t o a p p r o x i m a t e n o r m a t i v e , u r b a n s o c i a l network d a t a  using  the general  population.  the  PPI, i t i s u n l i k e l y  the  sampling A  would  explanation  study  failed  concerns  group  i s the source of  For example,  adequacy  of r e l a t i o n s h i p s to  density,  the p o s s i b i l i t y  social  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  found  since  the c o n t r o l  t o examine  women.  been  However,  error.  final  present  that  between  the c o n t r o l  the  may  patterns.  the anorexic  and  exist  n o t uncommon  d i s t o r t response  representative  that  as  1973, 1978; C r i s p ,  of representativeness  real differences  such  Alternatively,  i n anorexia  (Bruch,  central  data  an e g o c e n t r i c  worrisome  may s e r i o u s l y  lack  i n scale-type  and  F o r example, Kog & V a n d e r e y c k e n  the tendency  may  For example,  select  of  the anorexic  "average" response.  1982).  patients,  this  population. obscuring  may  i s especially  & Garner,  suggest  group  subjects  f o r the absence  between  study.  on s e l f - r e p o r t d a t a a l o n e  Garfinkel  (1985)  i n part,  encountered  i n t e r v a l as t h e i r  desirability  1980;  account,  s i g n i f i c a n t differences  groups  tendency  may  network  anorexic  variables from  multip 1e x i t y ,  psychiatric  ( H e n d e r s o n e t a l . , 1978b; M o r i n & Seidman,  and  and  normal  1986).  the that  non-anorexic  a r e s o c i a l network v a r i a b l e s  distinguish  that  perceived that  have  samples  Alternatively,  112 it  i s possible that  detect of  a c t u a l d i f f e r e n c e s between  this  summary,  network  there  are v i r t u a l l y  hypothesis  and s e v e r i t y  experimental increasing  sample. indications  her  proposals  groups  by  (discussed isolation  network  considerable  the l a r g e s t  n e t w o r k i s composed once  1984).  a week  1982).  Indeed,  relations),  feelings  and t h o u g h t s ,  due t o t h e low reported  by t h e  anorexia  family  invariant  interactional  between t h e a n o r e x i c and her  family,  research  (eg_. , G r i g g , two r e c e n t  clinical  anorexic results  compose  patients  to the 1986;  studies  (Herzog  of the present  are contacted  social  usually at  moderate,  and r e c i p r o c a t e e m o t i o n a l  et  study  42% o f t h e a n o r e x i c ' s mostly  i s  r e p o r t s of s o c i a l  of the anorexic's  with  with  nervosa  contrary  ( 4 4 % ) who  are regarded  study.  diversity,  proportion  (nb. , t h e y  that  a r e congruent  that  Furthermore,  among  of f r i e n d s  frequency  size;  of t h i s  syndrome  members,  impressionistic  and m a l a d j u s t m e n t  that  women  recent  p r e v i o u s l y ) have c h a l l e n g e d  1985; Sheppy,  total  t o p r e d i c t a b l e and l a r g e l y  social  of e a r l y  for a l l social  i s likely  i n the l i t e r a t u r e  e t a l . , 1985; Y a g e r ,  indicate  of r e s u l t s  F o r example,  immediate  characterized  least  to  d i f f e r e n c e s i n the s o c i a l  i n d i c a t e s that the r e l a t i o n s h i p  most  al.,  and c o n t r o l  except  of the anorexic  lead  deficiencies.  research  study  Furthermore, the r e s u l t s  not i n e v i t a b l y  social  sensitivity  i s accepted  and n o n - a n o r e x i c  non-significant pattern  does  the anorexic  no s i g n i f i c a n t  of the anorexic  chronicity  Kog  the n u l l  v a r i a b l e s i n the present  networks The  the necessary  study.  In  is,  t h e PPI l a c k e d  high  positive  and i n s t r u m e n t a l  113 support  at least  friends,  two o f an a v e r a g e  opposite  sex, a f i n d i n g  Garner's  (1982)  opposite-sex found  that  families in  on some  both  anorexic  that  chronicity  and/or  network  subtypes  present  only  analyses (1982)  variation  were  were  research  of the s o c i a l  statistically  found  an a t t e m p t  to r e p l i c a t e  of social  respect  family  reproduced  consider the  condition  o f the  differences i n  t o d i s c r i m i n a t e between  results  of the  analyses.  These  the f i n d i n g  environmental  to environmental  cohesion with with  reproduced  network  (r=.70,  their  network  of M i t c h e l l  variables dimensions  were among  patients.  correlated  and  should  i n the c o r r e l a t i o n a l  correlates  study  a finding  significant  significant  correlated  perceive  nervosa.  and  that  (1983)  network v a r i e s w i t h t h e  be f o u n d  individual  With  of the  Berkowitz  significant  that  psychiatric  members  women  of the anorexic  may  these  d i s i n t e r e s t e d and  Finally,  support,  Alternatively,  other  study  women!  Of  with G a r f i n k e l &  of the sexually  Future  severity  of anorexia  The  are typically  and n o n - a n o r e x i c  the nature  sample.  i f not often.  i s h a r d l y congruent  of emotional  study.  possibility  social  that  anorexic  as a s o u r c e  anorexic  of five  description  avoidant  the present  occasions  (as measured  network network  There  (r=.29,  correlation  but only  Mitchell  found  by t h e F E S ) was n e g a t i v e l y  (r=-.44,  support  the p o s i t i v e  support,  p<.001).  size  variables,  with  was a weak,  p<.01), p<.05).  but p o s i t i v e l y The  present  between f a m i l y c o h e s i o n  respect positive  to family  support  correlation  with  114 support  outside  correlation latter the  with  level.  negative indeed,  cohesion  less  need  (or  Mitchell related  to  particularly did  to  find  independence  and  relationship  was  Mitchell's  between  not  does  not  emphasis  on  to  more  take  patterns  a  also  initiative  in  that  friends  supporters  (see  Table  degree  of  support, does  as not  beyond  and  (r=.25),  support  non-significant  (p. 397).  but  this  that  Indeed,  was  This  "increased the  client  friendship  the f i n d i n g  p r o p o r t i o n of that  to  (r=-  (p=.574).  viable  suggests  family  friends  encourage  largest  present  correlation  from  suggestion  and  Contrary  negative  f a m i l y may  The  between  (p=. 154).  weak,  9)  p<.05),  p<.01).  support  the  significantly  (r=.32,  establishing  comprise  was  correlation  Mitchell's the  found  relationships  (r=.43,  network  o u t s i d e the household"  study  frequency  support  however,  the  a  size;  was  cohesion  independence  positive  within  network  family  such  at  to reproduce  and  of  These  significance  correlation  seeking  significant  support  p>.05).  failed  degree  peers  t h a t was  autonomy  study  negative  suggested.  f a m i l y independence  .10), a c o r r e l a t i o n finding  from  general  results,  has  family  modest,  statistical  however,  network  support a  the  sanction) for  general  weak  therefore, that  to  expect;  a  (r=-.08,  significant  appears,  that  and  family cohesion  as M i t c h e l l  found  friends  present  and  i s related  intuitively  p>.05),  achieve  between  It  the f a m i l y system  this  not  However, t h e  p<.001).  would  found  did  from  a strong, positive,  family  create  (r=.18,  support  correlation  (r=.61,  study  family  correlations  .05  one  the  family  in  high  cohesion  115 does  not  inhibit  development applies  to  family  of  does  family  supportive  the  weak  cohesion,  With  nor  and  friendships.  to  interpersonal  effectiveness  support  were  and  results  are  is  a  growing  between Heller 1985,  1986).  resulted  present  nervosa  (1987), and  It  is  and  In in  bulimia  of  points  and  possible  &  t h i s regard,  the  a  size  p>.05).  continue  suggest  For  example,  larger  Sarason sample  to  Future  investigate  variables,  family  one  studies the  that  influences  1986;  et a l . ,  would  have  obtained of  social  by  anorexia network  personality  Strober & in  there  interpersonal  e s p e c i a l l y those  i t i s noteworthy of  the  and  association  (ej>. , C a u c e ,  1978;  than  size  correlational  significant  Wilcox,  that  network  p o s i t i v e c o r r e l a t i o n between  (r=.27,  review  to  correlations  These  s o c i a l networks  Holohan  personality  their  social  between  size.  the  mystifying.  s o c i a l network  study  should  correlates traits.  1983;  in a stronger  effectiveness the  and  l i t e r a t u r e that  Swindle,  and  the  conclusion  correlations  non-significant.  s o c i a l competence &  similar  variables,  between  counter-intuitive  encourage  s o c i a l network  personality  a l l weak  A  non-significant  i n d e p e n d e n c e , and  regard  independence  anorexia  Humphrey nervosa  following:  . . . 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 factors, w h i c h may be g e n e t i c a l l y d e t e r m i n e d , p r e d i s p o s e the i n d i v i d u a l t o 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 t o p o w e r f u l f a m i l i a l and s o c i a l e x p e r i e n c e s t h a t i m p i n g e a d 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  following  limitations An  A  temporal history  findings, The the  between  can  such  present  varying  experimental  s u b j e c t s of  (Sheppy,  1984).  Garner,  1982)  developed more  chronic  impoverished quantity The measure  and  of  nor,  in  to  that  the  social  event  the  the  significant of  causality.  between and  phases  thus  together  natural  women  with  the d u r a t i o n of i l l n e s s  i n the  from  4 months  Crisp,  chronic the  the  into  of  single  ranged  network,  capture  of  the d i r e c t i o n  Consequently,  the  its  a  than  debilitating  concerns  p a t t e r n s and  pooled  the  and  cannot  nervosa,  were  study  syndrome.  noteworthy-  study  distinguish  example,  this  suggest  to  1980;  who  i t i s possible  anorexic both  syndrome,  in  terms  years  Garfinkel  anorexic  anorexic  5  may  have  has  just  that the  of  &  the more  network  quality. study  used  perceived between  support  researchers  simply  Some r e s e a r c h e r s (e&.,  present  differences social  severity For  several  present  network  anorexia  characteristics the  study  failed of  sample.  anorexic  different  the  a design e s t a b l i s h  history  of  of  social  nervosa,  study  of  study.  limitation  anorexia  natural  symptoms  discussion  cross-sectional  dynamic of  a  of the p r e s e n t  important  design.  is  social  actual  have  network  and  received  (Antonucci  1986b; G o r e , 1981;  self-report  Heller  &  data  social  increasing 1986;  & Lakey,  1985;  from  characteristics.  perceived  Israel,  derived  Berkman, Kleiner,  The  networks  attention 1984; 1984;  a  and  among Cutrona,  Procidano  11.7 &  Heller,  1987; the  1983;  Wethington  to  and  However, such  as  social  data  PPI,  of  of of  are  the  revealed  use  to  not  to  association results  of  nature  of of  actual finding  differences  Athanassopulou, recommended rather  objective actual  devalued  measures  (y_s  so  perceived)  anorexic  network  than  patients.  characteristics, do  not  s o c i a l network, e s p e c i a l l y i n  view  that  only of  of  because  the  perceived  social  neurotic  they  adequacy,  relationships symptomatology  is  under  adversity.  SOCIAL NETWORK THEORY, THERAPY AND studies  subjects  from  researchers between the  to  of  the  have  relationship  tended  psychiatric  the in may  continue  s o c i a l context  present  this  significance  of  social  be  &  interview  the  significant differences.  encouraged  validity  by  s o c i a l networks of  psychopathology  of  the  development  Cross-sectional  networks  Vaux  R e s e a r c h e r s have  data  availability,  IMPLICATIONS FOR  and  and  perceived  (1981)  actual  predictive  network  network  the  measure t h e  Henderson's  conditions  of  1985;  1986).  pertaining  quality  the  the  Sarason,  Kessler,  measures  necessarily  not  &  questionnaire,  obtain  quantity  of  &  c o l l e c t i o n of  self-report as  Sarason  study,  assumption the only  onset  that of  emerge  and This  their and  and  find  that  social  populations  repeated  finding  investigation  the  has the The  invariant about  the  have e t i o l o g i c a l  psychopathology. and  of  disorder.  questions  networks  chronic  the  social  general  challenge  raise  social  in  between  psychiatric  however,  association,  to  RESEARCH  Social  severe  network  anorexia.  118 Alternatively, with  certain  future  degree  of  premorbid the  Cauce,  area  1986;  Henderson  anorexic  it  constitutes of  promise  for  characteristics  and  population  in  dispositional anorexic have  treatment  of  and  indices  significant anorexia  samples  social  related  relatively (ej>. ,  Sarason that  to  the  temporal  b e f o r e and  in  s u c h an  Another prospective network  the  dynamic  after  1985;  network  social  pathology  1984;  al.,  social  is  certain  Brugha,  variable.  variables,  the  condition.  unperturbed  et  the  then,  implications  network in  may  have  differences  previous  the  general between  emergence  i n v e s t i g a t i o n might  for  the  complain a  network  and  etiology  responsible  between  such  as  exaggerate  consequence, variables  been  and  for  the  psychiatric  and  cross-sectional  variables,  to As  differ  nervosa.  personality  networks.  significantly  be  anorexic  of  social  may  research,  outcome o f  variables  population  between  The  of  line  the  difference  variables  fruitful  anorexic  possible  of  association  of  1981;  capture  social  social  social  also  in  type  remain  al.,  individual  symptoms.  people  or  that  A  that  symptomatology et  to  emerge  investigation  groups  personality  significant  predispose  an  variance  future  order  Personality  example,  is  an  of  well  traits  of  only  nervosa.  severity  network  onset  1983);  be  anorexic  chronicity, social  may  anorexia  therefore of  investigation  of  of  personality  Strober, itself  may  correlates  Furthermore,  by  differences  subtypes  research  network in  such  and  research.  For  neuroticism,  may  problems  significant psychiatric  in  their  associations  distress  would  119 emerge  from  the  (Henderson sectional, should for  et  to  social  systematic  Schroeder,  network  studies  bias  in  1982).  of  self-reports  Further  psychiatric  systematic  bias in  present  Kliman  represents  Trimble,  frequency  of  women..  1983)  patient  and  therapist, disorder, assumption  will  may  anorexia  al.,  1981).  Pattison's  have  be  is  an  of  intimate  psychosocial  and  for  the  and  of  network the  the  other  primary,  to  increase  the  or  such  as  of  especially  effect  on The  size,  the  and  anorexic  anorexia,  relationships  her,  also  emotional  networks  implication  i t is  between family  course  validity  theory  to  as  from  systems is  her this  patients  not  the  comprise  the  study  is  for  that  the  but  the  by  the  family  functional system  et  1977a).  measured  social  a  and  of of  1976,  theory  empirically  psychodynamic  this  (Pattison,  in  social  n e u r o t i c c o n d i t i o n s (Henderson  individual  said  of  however, f o r p s y c h i a t r i c  network, is  value  1980;  better.  psychosocial  group  group  substantial  additional  primary  This  a  around  of r e s u l t s  Trimble,  social  personal  p s y c h o s o c i a l systems  premise  PPI.  the  the  intensity,  the  questionable,  nervosa  control  see  attempt  of  majority  to  review,  disorders  others  hopefully  with  There  that  the  a  f o r the  threat  emotional  non-psychotic assumed  a  that  supportiveness  In  generally  (for  contact,  instrumental  major  hypothesis  interventions &  to  self-reports.  the n u l l  study  cross-  populations  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 o r d e r  network  A  due  a l . , 1981;  Accepting the  data  kinship of  the  120 individual present  (Hurd  study  significance  e t a l . , 1980; P a t t i s o n ,  does  not b o l s t e r  of the intimate  points  to the importance  family,  especially  emotional  confidence  psychosocial  as attachments  and s o u r c e s  Although the  i n the e t i o l o g i c a l  network,  of relationships  friends,  intensity,  1977a).  i t  outside  definitely  the nuclear  o f moderate,  of emotional  and  positive  instrumental  support.  IMPLICATIONS FOR ANOREXIA RESEARCH The  o v e r a l l pattern  support that the  the p r o f i l e  h a s emerged social  characterized  by  nuclear  networks except  the  family  anorexic  positive social  network  with  anorexic  On  primarily  intensity,  studies  personality  social  research;  of t h i s  hence,  and f r i e n d s  discriminate  between  subtypes  women  with  support.  women  could  of anorexia  vary  of s o c i a l  distinguish  1980),  nervosa  Future  that  adequacy  (Strober,  whom  helpfully  as n e u r o t i c i s m  (eg_. , p e r c e i v e d  non-anorexic  group,  moderate and  s e e , H e n d e r s o n e t a l . , 1978b, 1981) and t h a t from  cannot  the anorexic's s o c i a l  and f r e q u e n t  such  milieu  the s o c i a l  of the c o n t r o l  weekly c o n t a c t ,  of anorexic  do n o t  that i s ,  study  the contrary,  of family  variables  study  i s o l a t e d , and d o m i n a t e d  those  enjoyed  s o c i a l network dimensions  network;  socially  resemble  women t y p i c a l l y  immediate  women  size difference;  composed  emotional  investigate  of the anorexic  women  the present  impressionistic  relationships.  of these  were  early  as c o n s t r i c t e d ,  f o r a modest  networks  of the a n o r e x i c ' s  from  networks  be  of r e s u l t s from  or  that  (Strober,  121 1983);  i f so, p e r s o n a l i t y  significant  variables  relationship  between  may  be  found  social  to mediate  networks  and  a  eating  disorders.  CONCLUSION The become  concepts  of  increasingly  important  popular  research  psychiatric because  social  tools  disorder.  of  their  intervention.  promising  Unfortunately,  by  differing  operationalizations  support  constructs,  design  and  individual indices adequate  a  differences  of p s y c h i a t r i c sample  sizes,  of  s o c i a l network w i t h  in  this  constitute psychiatric particular.  ambiguity,  advance  have  have  a  for  in this plethora  field  base.  been  of measures  with  using The  disorder.  Future  vigorous  selection  acceptable  on  to  studies  obtain  existing i n general,  a  and  prospective study assess  variables  should and  also  and have  measures  and v a l i d i t y .  reliable  social  social  that  criteria,  reliability  and  present  network  social  appeal  has  as w e l l  as  factors i n  therapeutic  of the s o c i a l network of s t u d i e s  have  become  had p a r t i c u l a r  studies  populations  support  and  for prospective  i s i t possible an  years,  progress  theoretical  need  social  implications  and a p a u c i t y  clear  the  way  i n recent  These c o n c e p t s  conceptual  and  f o r examining p s y c h o s o c i a l  hampered  highlights  network  Only  results  that  network  research  of  anorexia  nervosa  in  122  FOOTNOTES  1. 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