Skip to main content
SpringerLink
Log in

A Meta-Analysis of the Dependency–Eating-Disorders Relationship: Strength, Specificity, and Temporal Stability

  • Published:
Journal of Psychopathology and Behavioral Assessment Aims and scope Submit manuscript

Abstract

Meta-analysis of studies examining the dependency–eating-disorders relationship revealed that (1) there is a positive association between interpersonal dependency levels and eating disorder symptoms/diagnoses (r = .25); (2) this relationship is comparable in anorexic and bulimic participants; (3) although dependent personality disorder symptoms are elevated in eating-disordered participants, so are the symptoms of several other personality disorders; and (4) when eating disorder symptoms remit, dependency levels decrease. Conclusion: There is a statistically significant link between interpersonal dependency and eating disorders, but this relationship is modest in magnitude, nonspecific, and varies with eating disorder symptom levels. Clinical, empirical, and theoretical implications of these findings are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

REFERENCES

  • Agras, W. S. (1987). Eating disorders. Elmsford, NY: Pergamon Press.

    Google Scholar 

  • American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. rev.).Washington, DC: Author.

    Google Scholar 

  • Ames-Frankel, J., Devlin, M. J., Walsh, T., Strasser, T. J., Sadik, C., Oldham, J. M., & Roose, S. P. (1992). Personality disorder diagnoses in patients with bulimia nervosa. Journal of Clinical Psychiatry, 53, 90–96.

    PubMed  Google Scholar 

  • Beck, A. T., Epstein, N., Harrison, R. P., & Emery, G. (1983). Development of the Sociotropy-Autonomy Scale: A measure of personality factors in psychopathology. Unpublished manuscript, University of Pennsylvania School of Medicine.

  • Bers, S. A., & Quinlan, D. M. (1992). Perceived-competence deficit in anorexia nervosa. Journal of Abnormal Psychology, 101, 423–431.

    PubMed  Google Scholar 

  • Blatt, S. J. (1974). Levels of object representation in anaclitic and introjective depression. Psychoanalytic Study of the Child, 24, 107–157.

    Google Scholar 

  • Blatt, S. J. (1995). Representational structures in psychopathology. In D. Cicchetti & S. Toth (Eds.), Rochester symposium on developmental psychopathology (Vol. 6, pp. 1–33). Rochester, NY: University of Rochester Press.

    Google Scholar 

  • Blatt, S. J., D'Afflitti, J. P., & Quinlan, D. M. (1976). Experiences of depression in normal young adults. Journal of Abnormal Psychology, 85, 383–389.

    PubMed  Google Scholar 

  • Bornstein, R. F. (1993). The dependent personality. New York: Guilford.

    Google Scholar 

  • Bornstein, R. F. (1994). Construct validity of the Interpersonal Dependency Inventory: 1977- 1992. Journal of Personality Disorders, 8, 64–76.

    Google Scholar 

  • Bornstein, R. F. (1995). Interpersonal dependency and physical illness: The mediating roles of stress and social support. Journal of Social and Clinical Psychology, 14, 225–243.

    Google Scholar 

  • Bornstein, R. F. (1996). Construct validity of the Rorschach Oral Dependency Scale: 1967- 1995. Psychological Assessment, 8, 200–205.

    Google Scholar 

  • Bornstein, R. F. (1999). Interpersonal dependency and physical illness: A meta-analytic review of retrospective and prospective studies. Journal of Research in Personality, 32, 480–497.

    Google Scholar 

  • Bornstein, R. F., & Greenberg, R. P. (1991). Dependency and eating disorders in female psychiatric inpatients. Journal of Nervous and Mental Disease, 179, 148–152.

    PubMed  Google Scholar 

  • Brownell, K. D., & Fairburn, C. G. (Eds.). (1995). Eating disorders and obesity: A comprehensive handbook. New York: Guilford.

    Google Scholar 

  • Bruch, H. (1962). Perceptual and conceptual disturbances in anorexia nervosa. Canadian Journal of Psychiatry, 26, 187–194.

    Google Scholar 

  • Bruch, H. (1982). Anorexia nervosa: Therapy and theory. American Journal of Psychiatry, 132, 1531–1538.

    Google Scholar 

  • Bulik, C. M., Sullivan, P. F., Weltzin, T. E., & Kaye, W. H. (1995). Temperament in eating disorders. International Journal of Eating Disorders, 17, 251–261.

    PubMed  Google Scholar 

  • Cloninger, C. R. (1987). The Tridimensional Personality Questionnaire. St. Louis, MO: Washington University School of Medicine.

    Google Scholar 

  • Cohen, S. (1977). Statistical power analysis for the behavioral sciences. New York: McGraw-Hill.

    Google Scholar 

  • Dowson, J. H. (1992). Associations between self-induced vomiting and personality disorder in patients with a history of anorexia nervosa. Acta Psychiatrica Scandinavica, 86, 399–404.

    PubMed  Google Scholar 

  • Fairburn, C. G. (1996). Overcoming binge eating. New York: Guilford.

    Google Scholar 

  • Fairburn, C. G. (1997). Eating disorders. In D. M. Clark & C. G. Fairburn (Eds.), Science and practice of cognitive behavior therapy(pp. 209–241). New York: Oxford University Press.

    Google Scholar 

  • Friedlander, M. L., & Siegel, S. M. (1990). Separation- individuation difficulties and cognitive- behavioral indicators of eating disorders among college women. Journal of Counseling Psychology, 37, 74–78.

    Google Scholar 

  • Garner, D. M., & Garfinkel, P. E. (1979). The Eating Attitudes Test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 9, 273–279.

    PubMed  Google Scholar 

  • Garner, D. M., & Olmstead, M. P. (1984). Manual for the Eating Disorders Inventory. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  • Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). The Eating Disorder Inventory. In P. L. Darby, P. E. Garfinkel, D. M. Garner, & D. V. Coscina (Eds.), Anorexia nervosa: Recent developments in research (pp. 173–184). New York: Liss.

    Google Scholar 

  • Gartner, A. F., Marcus, R. N., Halmi, K., & Loranger, A. W. (1989). DSM-III-R personality disorders in patients with eating disorders. American Journal of Psychiatry, 146, 1585–1591.

    PubMed  Google Scholar 

  • Gough, H. G., & Heilbrun, A. B. (1965). The Adjective Check List manual. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Gough, H. G., & Heilbrun, A. B. (1983). The Adjective Check List manual(Rev. ed.). Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Gwirtzman, H. E., Roy-Byrne, P., Yager, J., & Gerner, R. H. (1983). Neuroendocrine abnormalities in bulimia. American Journal of Psychiatry, 140, 559–563.

    PubMed  Google Scholar 

  • Halmi, K. A. (1997). Models to conceptualize risk factors for bulimia nervosa. Archives of General Psychiatry, 54, 507–509.

    PubMed  Google Scholar 

  • Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. New York: Academic Press.

    Google Scholar 

  • Herzog, D. B., Keller, M. B., Lavori, P. W., Kenny, G. M., & Sacks, N. R. (1992). The prevalence of personality disorders in 210 women with eating disorders. Journal of Clinical Psychiatry, 53, 147–152.

    PubMed  Google Scholar 

  • Hirschfeld, R. M. A., Klerman, G. L., Gough, H. G., Barrett, J., Korchin, S. J., & Chodoff, P. (1977).A measure of interpersonal dependency. Journal of Personality Assessment, 41, 610–618.

    PubMed  Google Scholar 

  • Hoek, H. W. (1995). The distribution of eating disorders. In K. D. Brownell & C. G. Fairburn (Eds.), Eating disorders and obesity: A comprehensive handbook (pp. 207–211). New York: Guilford.

    Google Scholar 

  • Humphrey, L. L. (1987). Comparison of bulimic- anorexic and nondistressed families using structural analysis of social behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 248–255.

    PubMed  Google Scholar 

  • Hsu, L. K. G. (1990). Eating disorders. New York: Guilford.

    Google Scholar 

  • Hyler, S. E., Rieder, R. O., Williams, J. B. W., Spitzer, R. L., Hendler, J., & Lyons, M. (1988). The Personality Diagnostic Questionnaire: Development and preliminary results. Journal of Personality Disorders, 2, 229–237.

    Google Scholar 

  • Jacobson, R. J., & Robins, C. J. (1989). Social dependency and social support in bulimic and nonbulimic women. International Journal of Eating Disorders, 8, 665–670.

    Google Scholar 

  • Kennedy, S. H., McVey, G., & Katz, R. (1990). Personality disorders in anorexia nervosa and bulimia nervosa. Journal of Psychiatric Research, 24, 259–269.

    PubMed  Google Scholar 

  • KDS Systems. (1971). KDS-3A:KDS Systems Affective Profile Test. West Haven, CT: Author

    Google Scholar 

  • Keys, A., Brozek, J., Henschel, A., Mickelsen, O., & Taylor, H. L. (1950). The biology of human starvation. Minneapolis, MN: University of Minnesota Press.

    Google Scholar 

  • Lacey, J. H., Coker, S., & Birtchnell, S. A. (1986). Bulimia: Factors associated with its etiology and maintenance. International Journal of Eating Disorders, 5, 475–487.

    Google Scholar 

  • Lenihan, G. O., & Kirk, W. G. (1990). Personality characteristics of eating-disordered outpatients as measured by the Hand Test. Journal of Personality Assessment, 55, 350–361.

    PubMed  Google Scholar 

  • Levin, A. P., & Hyler, S. E. (1986). DSM-III personality diagnosis in bulimia. Comprehensive Psychiatry, 27, 47–53.

    PubMed  Google Scholar 

  • Loranger, A. W., Susman, V. L., Oldham, J. M., & Russakoff, L. M. (1986).Personality disorder examination. Unpublished manuscript, Cornell University School of Medicine.

  • Lucas, A. R., Crowson, C. S., O'Fallon, W. M., & Melton, L. J. (1999). The ups and downs of anorexia nervosa. International Journal of Eating Disorders, 26, 397–405.

    PubMed  Google Scholar 

  • Masling, J. M., Rabie, L., & Blondheim, S. H. (1967). Obesity, level of aspiration, and Rorschach and TAT measures of oral dependence. Journal of Consulting Psychology, 31, 233–239.

    PubMed  Google Scholar 

  • McLaughlin, E. F., Karp, S. A., & Herzog, D. B. (1985). Sense of ineffectiveness in women with eating disorders. International Journal of Eating Disorders, 4, 511–523.

    Google Scholar 

  • Millon, T. (1977). Millon Clinical Multiaxial Inventory manual. Minneapolis, MN: National Computer Systems.

    Google Scholar 

  • Millon, T. (1987). Millon Clinical Multiaxial Inventory-II manual. Minneapolis, MN: National Computer Systems.

    Google Scholar 

  • Moos, R. H., Insel, P. M., & Humphrey, B. (1974). Family Environment Scale. Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Narduzzi, K. J., & Jackson, T. (2000). Personality differences between eating-disordered women and a nonclinical comparison sample: A discriminant classification analysis. Journal of Clinical Psychology, 56, 699–710.

    PubMed  Google Scholar 

  • Nietzel, M. T., & Harris, M. J. (1990). Relationship of dependency and achievement/autonomy to depression. Clinical Psychology Review, 10, 279–297.

    Google Scholar 

  • Norman, D., Blais, M. A., & Herzog, D. (1993). Personality characteristics of eating-disordered patients as identified by the Millon Clinical Multiaxial Inventory. Journal of Personality Disorders, 7, 1–9.

    Google Scholar 

  • Oates-Johnson, T., & DeCourville, N. (1999). Weight preoccupation, personality, and depression in university students: An interactionist perspective. Journal of Clinical Psychology, 55, 1157–1166.

    PubMed  Google Scholar 

  • Oldham, J. M., Skodol, A. E., Kellman, H. D, Hyler, S. E., Doidge, N., Rosnick, L., & Gallaher, P. E. (1995). Comorbidity of Axis I and Axis II disorders. American Journal of Psychiatry, 152, 571–578.

    PubMed  Google Scholar 

  • Patton, C. J. (1992). Fear of abandonment and binge eating:Asubliminal psychodynamic activation investigation. Journal of Nervous and Mental Disease, 180, 484–490.

    PubMed  Google Scholar 

  • Pendleton, L., Tisdale, M., & Marler,M. (1991). Personality pathology in bulimics versus controls. Comprehensive Psychiatry, 32, 516–520.

    PubMed  Google Scholar 

  • Pfohl, B., Stangl, D., & Zimmerman, M. (1983). The structured interview for DSM-III personality disorders. Iowa City, IA: University of Iowa School of Medicine.

    Google Scholar 

  • Piran, N., Lerner, P., Garfinkel, P. E., Kennedy, S. H., & Brouillette, C. (1988). Personality disorders in anorexic patients. International Journal of Eating Disorders, 7, 589–599.

    Google Scholar 

  • Powers, P. S., Coovert, D. L., Brightwell, D. R., & Stevens, B. A. (1988). Other psychiatric disorders among bulimic patients. Comprehensive Psychiatry, 29, 503–508.

    PubMed  Google Scholar 

  • Robins, C. J., Ladd, J.,Welkowitz, J., Blaney, P. H., Diaz, R., & Kutcher, G. (1994). The Personal Style Inventory. Journal of Psychopathology and Behavioral Assessment, 16, 277–300.

    Google Scholar 

  • Rogers, R. L., & Petrie, T. A. (1996). Personality correlates of anorexic symptomatology in female undergraduates. Journal of Counseling and Development, 75, 138–144.

    Google Scholar 

  • Rosenthal, R. (1979). The ”file drawer” problem and tolerance for null results. Psychological Bulletin, 86, 638–641.

    Google Scholar 

  • Rosenthal, R. (1984). Meta-analytic procedures for social research. Beverly Hills, CA: Sage.

    Google Scholar 

  • Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158, 632–634.

    PubMed  Google Scholar 

  • Schmidt, N. B., & Telch, M. J. (1990). Prevalence of personality disorders among bulimics, nonbulimic binge eaters, and normal controls. Journal of Psychopathology and Behavioral Assessment, 12, 169–185.

    Google Scholar 

  • Skodol, A. E., Oldham, J. M., Hyler, S. E., Kellman, H. D., Doidge, N., & Davies, M. (1993). Comorbidity of DSM-III-R eating disorders and personality disorders. International Journal of Eating Disorders, 14, 403–416.

    PubMed  Google Scholar 

  • Smith, M. C., & Thelen, M. H. (1984). Development and validation of a test for bulimia. Journal of Consulting and Clinical Psychology, 52, 863–872.

    PubMed  Google Scholar 

  • Sohlberg, S., & Norring, C. (1995). Co-occurrence of ego function change and symptomatic change in bulimia nervosa. International Journal of Eating Disorders, 18, 13–26.

    PubMed  Google Scholar 

  • Spitzer, R. L., Williams, J. B. W., & Gibbon, M. (1987). Structured clinical interview for DSM-III-R personality disorders. New York: New York State Psychiatric Institute.

    Google Scholar 

  • Stice, E. (1994). Review of evidence for a sociocultural model of bulimia nervosa, and an exploration of the mechanisms of action. Clinical Psychology Review, 14, 633–661.

    Google Scholar 

  • Stice, E., & Agras, W. S. (1999). Subtyping bulimicwomen along dietary restraint and negative affect dimensions. Journal of Consulting and Clinical Psychology, 67, 460–469.

    PubMed  Google Scholar 

  • Strauss, J., & Ryan, R. M. (1987). Autonomy disturbances in subtypes of anorexia nervosa. Journal of Abnormal Psychology, 96, 254–258.

    PubMed  Google Scholar 

  • Striegel-Moore, R. H. (1995). A feminist perspective on the etiology of eating disorders. In K. D. Brownell & C. G. Fairburn (Eds.), Eating disorders and obesity (pp. 224–229). New York: Guilford.

    Google Scholar 

  • Striegel-Moore, R. H., Silberstein, L. R., & Rodin, J. (1993). The social self in bulimia nervosa: Public self-consciousness, social anxiety, and perceived fraudulence. Journal of Abnormal Psychology, 102, 297–303.

    PubMed  Google Scholar 

  • Strober, M. (1995). Family- genetic perspectives on anorexia nervosa and bulimia nervosa. In K. D. Brownell & C. G. Fairburn (Eds.), Eating disorders and obesity (pp. 212–218). New York: Guilford.

    Google Scholar 

  • Thelen, M. H., Farmer, J., Wonderlich, S., & Smith, M. (1991). A revision of the Bulimia Test: The BULIT-R. Journal of Consulting and Clinical Psychology, 59, 119–124.

    Google Scholar 

  • Tisdale, M. J., Pendleton, L., & Marler, M. (1990). MCMI characteristics of DSM-III-R bulimics. Journal of Personality Assessment, 55, 477–483.

    PubMed  Google Scholar 

  • Wagner, E. E. (1983). The Hand Test: Manual for administration, scoring, and interpretation. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Wiederman, M.W., & Pryor, T. L. (1997). MCMI-II personality scale scores among women with anorexia nervosa or bulimia nervosa. Journal of Personality Assessment, 69, 508–516.

    PubMed  Google Scholar 

  • Wold, P. N. (1983). Anorexic syndromes and affective disorder. Psychiatric Journal of the University of Ottawa, 8, 116-119.

    PubMed  Google Scholar 

  • Wonderlich, S. A., Swift, W. J., Slotnick, H. B., & Goodman, S. (1990). DSM-III-R personality disorders in eating disorder subtypes. International Journal of Eating Disorders, 9, 607–616.

    Google Scholar 

  • Yager, J., Landsverk, J., Edelstein, C. K., & Hyler, S. E. (1989). Screening for Axis II personality disorders in women with bulimic eating disorders. Psychosomatics, 30, 255–262.

    PubMed  Google Scholar 

  • Yates, W. R. (1989). Current perspectives on the eating disorders, I: History, psychological, and biological aspects. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 813–828.

    PubMed  Google Scholar 

  • Yates, W. R., Sieleni, B., Reich, J., & Brass, C. (1989). Comorbidity of bulimia nervosa and personality disorder. Journal of Clinical Psychiatry, 50, 57–59.

    PubMed  Google Scholar 

  • Zanarini, M. C., Frankenburg, F. R., & Chauncey, D. L. (1987). The Diagnostic Interview for Personality Disorders: Interrater and test-retest reliability. Comprehensive Psychiatry, 28, 467–480.

    PubMed  Google Scholar 

  • Zanarini, M. C., Frankenburg, F. R., Pope, H. G., Hudson, J. I., Yurgelun-Todd, D., & Cicchetti, C. J. (1990). Axis II comorbidity of normal-weight bulimia. Comprehensive Psychiatry, 30, 20–24.

    Google Scholar 

  • Zborowski, M. J. (1998). A comprehensive investigation of putative correlates of bulimia among college-age women: Object relations, dependency, ego defenses, trait anxiety, and depression. Addictive Behaviors, 23, 47–55.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Gettysburg College, Gettysburg, Pennsylvania, 17325

    Robert F. Bornstein

Authors
  1. Robert F. Bornstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bornstein, R.F. A Meta-Analysis of the Dependency–Eating-Disorders Relationship: Strength, Specificity, and Temporal Stability. Journal of Psychopathology and Behavioral Assessment 23, 151–162 (2001). https://doi.org/10.1023/A:1010913203679

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1010913203679

Search

Navigation