Disordered Eating in College Students:

Disordered Eating in College Students: The Roles of Attachment to Fathers, Depression and Self-Esteem

The objective of this work is to write a research proposal investigating the attachment process in eating disorders, particularly among college women. This work intends to examine the number of college women with subclinical eating disorders in contrast to those with full-blown eating disorders. This work will include background information on attachment theory and processes in general and in eating disorders. This work will focus on the father-daughter attachment processes and the roles of depression and self-esteem.

Eating disorders among college students have been noted to be more prevalent than ever in today's colleges. Eating disorders include those of anorexia nervosa, bulimia nervosa, and other various eating disorders. The research of Cheng (2006) informs that eating disorders became common on college campuses beginning in the 1980s are still prevalent today. Estimates stated by researchers are that approximately 64% of college females have some type of eating disorder. External pressure from the media, peers, parents, and self-imposed standards are experienced by women in college. This is a time in their life when they are attempting to become autonomous intellectually and yet are still within the framework of society with its expectations for specific feminine type behavior and presentation of the female self in social settings. For the female in college whose mother had a poor self-image it has been shown in research to be very likely that the college female will have some affectation of these fears in her own life and personality composition. For the college female from a home where a father has had a great deal to say negatively concerning the weight of females in the household or otherwise in the environment, there exists fears of becoming overweight like those her father has had much negative to say about. Today's magazines and television shows include a constant onslaught of advertising for beauty products and weight loss products.

It has been widely acknowledged among clinical therapists that healthy development of self-esteem requires certain basic requirements be met first such as the requirement of safety and security and these two components of the individual's personality are believed by theorists to develop during infanthood and to be an evolving developmental function of the individual. This development follows through several stages in the individual's development until the final stage in late adolescence. The individual who is in the stage of late adolescence is the individual who is beginning to enter a stage of healthy psychological separation from their parents, that is if the individual is developing according to normal development for this age individual. Parental attachments which have not been appropriately formed during the individuals infant age, childhood, adolescence, and late adolescence result in certain psychological disorders in individuals which develop as 'coping mechanisms' as a method used by the individual in dealing with underlying issues. Failure to have a healthy attachment to the father for the young woman in college is likely to result in depression, a poor-self-image, low self-confidence, and result as well in the young woman having great difficulty with autonomous independence and self-direction. The work of Fairburn and Harrison (2003) relates that eating disorders are presently divided into three diagnostic categories: (1) anorexia nervosa; (2) bulimia nervosa; and (3) eating disorders. Cheng (2006) relates that since the 1980s "prevalence research has shown that eating disturbance is common on college campuses citing Drewnowki, Yee and Krahn (1998) and states that as many as "64% of college females exhibit some form of problematic eating behavior." It has been noted by Malloy and Herzberger (1998) that cultural standards are causative in women being dissatisfied with their bodies and have a negative body image based upon whether in their opinion as well as the opinion of their family members meet the standard which they perceive is the one to be align toward achieving. External pressures on women's perception of their own bodies have been widely acknowledged among professionals to have a great impact on the development of eating disorders. Malloy and Herzberger (1998) further noted that the ideal of beauty in the United States tends to have a negative effect on females in the U.S. through creation of a dilemma that holds the ideal of physical attractiveness relative to how thin one is. Individuals daily and continuously have images of thin and flawless bodies thrust upon them as the standards by which they should measure themselves. Females on college campuses are at a great risk for development of eating disorders due to the additional pressures for them to achieve both academically and socially. Within the framework of these realms of academic and social achievement is a strong emphasis on physical appearance. The work of Hart and Kenney (1997) states that this is associated with self-reports of various eating disorders. Root (2001) relates that eating disorders are often developed by women in college out of an intense pressure placed upon them to achieve combined with attempting to strive toward perfection. These women, finding perfection unattainable, often use dieting and exercise as an attempt of gaining control and order over their lives. This occurring disorder among college women is not bound to race or ethnicity, as reported in Crago, Shisslak and Estes (1996) who state that regardless of the woman's ethnic background, for women who interact with the majority white culture and whom are likely to adopt the attitudes of this culture. This is true as well with the perception of the ideal of being extremely think and perpetual dieting and ultimately placing themselves at risk for development of some type of eating disorder. The work of Barrocas (2006) entitled: Adolescent Attachment to Parents and Peers" relates that attachment bonds "exist in relationships across the lifespan. Adolescence may be a particularly crucial period for attachments relations." (2006) the work of Easterbrooks (1989) and others suggest that studies "point toward strong concordance between attachment to mother and father and other suggest that the mother-infant and father-infant attachment relationships are independent" such as cited in the work of Main and Weston (1981). Barrocas states: "One explanation for the strong rate of concordance is that parents who are more similar in childbearing approaches, such as sensitivity and availability, will have children who are attached similarly to both parents. The work of Main and Weston (1981) states findings that mother-infant and father-infant attachment were not dependent on one another. The importance of viewing mother-child and father-child relationship separate from one another, specifically during adolescence was explored by Doherty and Beaton (2004) since both relationships have different qualities that may affect later outcomes in life. Children experience their relationships with their mother and fathers in different ways. The work of Leaper (2000) states findings that children playing with either the mother or father differed depending upon the gender of the parent and child which indicates that both parents contribute differently to the development of the child. Also indicated is the different influence that the maternal and paternal parent has on the social outcomes of the child in terms of the child's development. There does appear to be a physical cause for eating disorders although those physical causes are psychologically and emotionally related to parental attachment according to the work of Fletcher (2005) who states: "Male and female rats exposed to maternal care show changes in the density of receptors in amygdale as adults. As adults, nurtured female pups had higher levels of oxytocin receptors." These results are stated to be: "suggestive of a neurological component influencing father's caring behaviors with their infants.... Probably the most important lessons to be drawn from the recent integration of neuroscience, psychology, psychiatry, physiology and anthropology is that male and female brains have significant differences in architecture and functioning and so mothers and fathers' parenting interactions may well show significant differences as a consequence of sex-specific, contrasting neuroanatomical features. Father's maleness ensures that they are not simply 'mother substitutes' when they are caring for and interacting with their infants." (Fletcher, 2005)

LITERATURE REVIEW

The work of Williams and Kelly (2005) made a comparison of mother-adolescent and father-adolescent relationships and state findings that the father-adolescent attachment relationship was related to behavioral problems among adolescents. Few studies have been conducted that examine the attachment of female children to the father or the impacts or effects of a lack of a healthy attachment to the father. Attachment theory is a theory of personality development first conceived of by John Bowlby in explaining a function of the child-caregiver relationship, which is a relationship that evolves. "Gene survival was thought to be enhanced by the selection of favored attachment behaviors that increased child-caregiver proximity, leader to the greater likelihood of protection for the child." (Ma, 2007) a great amount of empirical research in a variety of settings supports attachment theory.

David Howe writes in the work entitled: "Attachment Theory, Child Maltreatment and Family Support" that "The quality and character of children's close relationships is proving to be the central concept linking the myriad of factors that have a bearing on development. Relationships provide the key experience that connects children's personal and social worlds. It is within the dynamic interplay between these two worlds that minds form and personalities grow, behavior evolves and social competence begins." (1999) Howe relates that it is being acknowledged increasingly that "...psychologically, the individual cannot be understood independently of his or her social and cultural context. The infant dos not enter the world as a priori discrete psychological being. Rather, the self and personality form as the developing mind engages with the world in which it finds itself." (Howe, 1999) Therefore, Howe relates that there is: "...no 'hard boundary' between the mental condition of individuals and the social environments in which they find themselves. The interaction between individuals and their experiences creates personalities. This is the domain of the psychosocial." (Howe, 1999) the work of Howe additionally states that attachment behavior "...brings infants into close proximity to their main carers. It is within these relationships that children learn about themselves, other people and social life in general. Young children interact with their parents and other family members, and in so doing, develop an understanding of both themselves and other people." (1999) Children learn, within these relationships, appropriate organization of expression, behavior and emotions. Howe writes that later on the child will gain an understanding of emotions and begin to note the affective states of other and the "social context in which interpersonal life takes place." (1999) Healthy relationships in the child's growth and development assist the child to become an individual that is secure and autonomous although not adverse to accepted help when needed.

The early studies of Bowlby led to his intrigue concerning to specific findings arising from his work in the 1940s and 50s that examined the long-term developmental impact on children who had either suffered some type of emotional diversity as children or who had been separated from their parents for long period of time. It was the belief of Bowlby that these children suffered from a range of behavioral, mental health, and emotional problems, which could be linked to these early experiences of loss or diversity. Secondly, Bowlby and Robertson found in a series of observations conducted in the early 1950s that when young children were separated from their mothers that they all experienced an identifiable sequence of behaviors. Howe states: "The children's first reaction to the loss was to protest with inconsolable crying, sometimes coupled with attempts to find or follow the missing mother. This was followed by a period of despair, apathy and listlessness. If the separation continued over several days or weeks, the children would enter a third phase of quiet detachment, withdrawal and an apparent lack of interest in the lost caregiver. In this final phase, there was the appearance of recovery, but play and relationships had a perfunctory quality to them. If reunion with the caregiver did eventually take place, children showed a mixture of anger, crying, clinging and rejection." (Howe, 1999) From these findings, Bowlby held that children form a very strong bond with the primary caregiver and when this bond was broken children were caused great distress. The work of Belsky and Cassidy (1994) relates that the emotions and behaviors linked to attachment are best observed in situations of distress, which involve fear, danger, conflict and social challenges, as well as threats to the physical and emotional availability of the caregiver and the caregiver's responsiveness, which may include the following three sites of anxiety-provoking stimuli:

1) Within the child;

2) Within the environment; and 3) Within the attachment figure.

According to Belsky and Cassidy (1994), 'within the child' stimuli is such as when the child is sick, hungry, tired, or hurt while 'within the environment' stimuli includes any thing or event within the child's environment which is threatening or frightening and finally, 'within the attachment figure' includes the child being unsure of the location of the attachment figure or unsure of the attachment figure's behavior expressed as being unresponsive, hostile or abusive. When these attachments behaviors are activated, the child becomes unable to participate in other developmental experiences including playing and exploration. The work of Ainsworth suggests that at link exists between the attachment and exploration in that the infant "uses the attachment figure as a secure base from which to explore." (Ainsworth, et al., 1978) the research, which follows in the present study review of literature, intends to provide indications, which suggest that the insecure attachment to the father by a child of the female gender results in many females, by the time they reach college, developing an eating disorder, which stems from an insecure father-attachment earlier in life.

The work of Allen, et al. (2001) entitled: "A Model for a Brief Assessment of Attachment and Its Application to Women in Inpatient Treatment for Trauma-Related Psychiatric Disorders" published in the Journal of Personality Assessment reports an adaptation self-report measures of attachment style to the psychological assessment of women in specialized inpatient treatment for trauma-related disorders. Employed in this study were two measures of adult attachment style: (1) the Relationship Questionnaire; and (2) the Adult Attachment Scale as well as a questionnaire developed by Allen et al. (2001) and referred to as the Current Attachment Relationships questionnaire which is stated to make an assessment of "...the extent of social support in secure attachments." (Allen et al., 2001) Allen et al. (2001) reports administering these measures to 99 patients and to a convenience sample of 154 women in the community. Findings state a modest correspondence was found between the two attachment style measures and substantial relations between attachment styles range of secure attachment relationships. Women in the trauma sample reported insecure attachment styles and relatively few secure attachment figures. " (Allen, 2001)

There are various types of eating disorders and these are associated in psychology with a psychological disorder which culminates or becomes apparent as being a coping mechanism used by individuals although most times unbeknownst to that individual as such. The work of DeCairos (2005) entitled: "Eating Disorders: An Examination of a Psychological Illness as a Coping Mechanism and it's Underlying Issues" states that many times, females who have been sexually assaulted by family members are more likely to have symptoms of an eating disorder than women who were either sexually assaulted by someone outside the family or were not assaulted at all and cites McComb (2001) p.168. Because adolescence is a critical time of development and for females this is a time when their self-perception develops and as well a time in which 'internal working models' (Bowlby, 1973) begin to form which are the models by which the child develops their expectations of both self and others.

The work of Margolese, Markiewicz and Doyle (2001) entitled: "Attachment to Parents, Best Friend, and Romantic Partner: Predicting Different Pathways to Depression in Adolescence" published in the Journal of Youth and Adolescence states: "Negative working models of self and others that are associated with insecure attachment relationships might be a precursor to the pattern of expectations and cognitions seen in depression. Insecure attachment relationships produce low internalized feelings of felt security."

The work of Kerns and Barth (1995) entitled: "Attachment and Play: Convergence Across Components of Parent-Child Relationships and Their Relations to Peer Competence" reports a study which examined: (1) linkages between attachment security and physical play interactions in mother-child and father-child dyads, and (2) linkages between these parenting components and peer competence. The study included 54 preschoolers, with 27 of them girls who participated with their fathers and mothers. Parents are reported to have completed the Attachment Q-set and parent-child dyads were observed in a physical play session that was evaluated for play engagement and quality. Evaluated by teachers were the children in terms of their popularity and friendly and cooperative behavior. Findings of the study state: "Mother-child dyads with more securely attached children had higher rates of play engagement. In father-child dyads with more securely attached children, fathers issued more directives and children made more suggestions and positive responses. Mother-child play quality and father-child attachment were most strongly associated with preschool measures. Findings suggest that attachment and play are relatively independent components." (Kerns and Barth, 1995)

The work of DeCairos (2005) notes that paternal behavior "...especially overprotection, makes an individual feel like they are inadequate or ineffective, and we know that ineffectiveness is linked to perfectionism, which is linked to body dissatisfaction, and can lead to disordered eating." DeCairos relates the findings of Mehler and Anderson (1999), whose study illustrated that: "Attitudes and values are absorbed at a young age, and these are the force behind wanting to lose weight, which can be started by one specific incident such as a comment by a mother, which will trigger something, especially in an individual that is predisposed to an eating disorder." (2005)

The work of Jonathan P. Schwartz (2004) entitled: "Relationship Between Attachment to Parents and Psychological Separation in College Students" published in the Journal of College Student Development reports a study, which investigated "the relationship between attachment to parents and psychological separation in college students. The study included three hundred sixty-eight undergraduate students who completed the Inventory of Parent and Peer Attachment and the Psychological Separation Inventory. Schwartz states that recent research has had as its focus "the role and importance of the separation process of young adults from their parents in late adolescence and its affect on career exploration and adjustment to college.. A number of theorists and researcher have concluded that late adolescence is an important developmental period in which young adults can create an autonomous identity separate from their parents. Impaired psychological separation from parents has been related to psychological symptoms of distress and difficulty with personal adjustment in college population. The process of psychological separation has been conceptualized as finding a balance between enmeshment with parents and complete disengagement and isolation." (Swartz, 2005) Beneficial for successful psychological separation of the late adolescent individual is "an adaptive level of attachment to parents..." (Schwartz, 2005)

The work of Bowlby (1982) and Ainsworth (1989) conceived of parental attitude as providing a means of being secure for the child while the child feels safe to explore his environment confidently, securely, with the parent readily available to them. Swartz states that adjustment to college life "has been conceptualized as a separation from parents wherein individuals experience anxiety and act out their attachment styles. A secure base allows individuals to explore new roles and try independence. If individual experience 'felt security' they may begin the psychological separation process and develop their own identity." (2005) Swartz cites Josselson (1988); Lapsley and Edgerton (2002); and Levy Blat, and Shaver (1998) stating: "secure attachment has been found to facilitate independence and health separation from parents." (2005)

The work of Swartz reports: "Because theory and research has suggested that the process of attachment and separation may occur differently for women and men [as cited in the work of (Block, 1984); (Gilligan, 1982); (Lucas, 1997); (Marcia, 1980); and (Schultheiss and Blustein, 1994) as cited in Swartz (2005)] "...also explored if attachment to mothers and fathers is associated with psychological separation differently for men and women." (Swartz, 2005) Swartz states findings from the study conducted among 368 college students that in both men and women in college:

the association between attachment and psychological separation with fathers accounted for the most variance. This finding suggests the important role fathers play in balancing attachment and separation from the family. In addition, for both males and females there was an association with psychological separation, particularly from fathers, and the aspects of attachment of low trust and high communication with fathers. For men it was important that there also was low alienation from fathers. It may be that to separate and become less dependent on fathers, it is necessary to assert independence in a way that creates a breach in trust with fathers. In turn, high trust in parents may symbolize reliance or dependence; therefore, low trust may be necessary for separation. Maintaining positive communication with fathers may provide individuals a secure base to assert their independence and explore their own values and ideas. These findings appear similar to Bowen's (1978) theory of differentiation of self, where healthy individuals are able to balance intimacy and autonomy within their families of origin." (Swartz, 2005)