Academic journal article Journal of Nursing Measurement

Measuring Perceived Mutuality in Women with Eating Disorders: The Development of the Connection-Disconnection Scale

Academic journal article Journal of Nursing Measurement

Measuring Perceived Mutuality in Women with Eating Disorders: The Development of the Connection-Disconnection Scale

Article excerpt

This article describes the development and psychometric testing of the Connection- Disconnection Scale (CDS), the only self-report measure designed to assess perceived mutuality experienced in close relationships by women with eating disorders. Item development was informed by relational-cultural theory and focus groups with patients and recovered individuals. Content and construct validity, test-retest reliability, and internal consistency were examined in samples of female outpatient (n = 131) and partial hospitalization (n = 85) patients. Factor analysis with promax rotation for each version of the CDS in outpatients resulted in a single-factor model explaining 77.53% of the variance for CDS-Mother, 71.86% for CDS-Father, 77.79% for CDS-Partner, and 67.67% for CDS-Friend. Cronbach's alphas ranged from .97 to .99 for both samples. Overall, the CDS demonstrated good discriminant and convergent validity with moderate to strong correlations between CDS parent forms and the Parental Attachment Questionnaire, Dyadic Adjustment Scale, and the Social Support Questionnaire. Regression equations revealed that scores on CDS parent forms were inversely related to several subscale scores on the Eating Disorders Inventory*2. The CDS is a reliable and valid measure of perceived mutuality that can enrich relational understanding of the etiology and treatment of eating disorders in women.

Keywords: perceived mutuality; mutuality; relationships; eating disorders

Much of the eating disorder literature addresses various cognitive-behavioral conceptual models that inform the etiology and treatment of women with eating disorders (Fairburn & Cooper, 1989, Fairburn, Marcus, & Wilson, 1993; Wilson & Fairburn, 1993). These models have evolved over time and incorporate newer thinking from cognitive science such as interpersonal schemas as well as constructs from the literature regarding emotional responding and interpersonal patterns (Meyer, Waller, & Waters, 1998; Safran & Segal, 1996; Wonderlich, Mitchell, Peterson, & Crow, 2001). Additionally, therapy models have recently incorporated work related to interpersonal deficits, emotion regulation, perfectionism, and self-esteem (Fairburn, 1997; Fairburn, Cooper, & Shafran, 2003; Wilfley et al., 1993). However, there is still an inadequate consideration of interpersonal factors, including the client-therapist relationship, in the conceptual models related to eating disorder etiology and treatment.

While some of the theoretical and empirical work in the eating disorders field identifies the quality of interpersonal relationships as influential in the development of and recovery from eating disorders (Fairburn, Welch, Doll, Davies, & O'Connor, 1997; Treasure, Smith, & Crane, 2007; van Furth et al., 1996), there is a lack of empirical work specifically examining the experience of connection or disconnection women with eating disorders have in relationships with close others. One construct from relational-cultural theory that describes a more connected relationship with others is called perceived mutuality (Genero, Miller, Surrey, & Baldwin, 1992). Perceived mutuality is a back-and-forth flow of thoughts, feelings, and activity between people in relationship (Genero et al., 1992) and is characterized by what Miller and Stiver (1997) named the "five good things," that is, a bidirectional experience of increased self-worth; empowerment; clarity about oneself, the other, and the relationship; energy or zest for life; and desire for more connection with others.

The experience of perceived mutuality is important for men's and women's psychological development, resistance to illness, and recovery (Spencer, 2000) but potentially even more so for women, who are socialized to grow in and through connection with others (Chodorow, 1978; Gilligan, 1991; Miller & Stiver, 1997). Repetitive experiences (internally or externally generated) leading to a sense of severe and/or chronic disconnection from others, characterized by low perceived mutuality, could threaten psychological growth, increase vulnerability to illness, and obstruct recovery (Genero et al. …

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