Are People with Poor Differentiation of Self at Risk of Developing Eating Disorders? A Study of Jewish and Arab Participants

Purpose: In light of findings that Israeli Arabs report higher prevalence of eating disorders (EDs) than Israeli Jews and that higher rates of the risk of EDs have been reported by females than males, the first aim of this study was to further investigate the cultural and gender differences in differentiation of self (DoS) and risk of developing EDs among Israeli young adults. The second aim was to examine whether DoS is associated with the risk of EDs. Methods: Of the 859 participants (670 females, mean age 26.8), 440 were Jewish and 419 were Arab. Participants took the Eating Attitudes Test (EAT-26) and completed the Differentiation of Self-Revised (DSI-R) questionnaire.Results: Results revealed that Jewish participants had significantly lower diet, bulimia, and total EAT-26 scores than their Arab counterparts, while Jewish female participants had higher dieting and lower emotional cutoff scores than Jewish male participants. In addition, Jews who reported higher levels of risk of EDs showed higher levels of BMI, emotional reactivity, emotional cutoff, and fusion with others. Arabs who reported higher levels of risk of EDs reported higher levels of BMI and emotional cutoff and lower levels of I-position. Conclusion: People with high risk of EDs may have difficulty maintaining intimate family relationships. In distressing situations, they tend to disconnect rather than share with or gain support from significant others. In each culture, the risk of EDs increases for differently: among the Arab participants, when feelings and needs remain unexpressed; among the Jewish participants, even when they have symbiotic family relationships.Level of evidence: Level V, cross-sectional descriptive study

The Relationship between Type 2 Diabetes, Differentiation of Self, and Emotional Distress: Jews and Arabs in Israel

Type 2 diabetes mellitus (T2DM) is considered a global epidemic, and is constantly on the rise. In Israel, the percentage of diabetics in the Arab population is twice that found in the Jewish population (12% and 6.2%, respectively). Findings suggest that low differentiation of self (DoS: emotional reactivity+ fusion with others, I-position, emotional cutoff) may raise vulnerability to certain physiological pathologies by increasing susceptibility to psychological distress. The major goal of this study was to test differences in DoS and emotional distress (anxiety and depressive symptoms) between diabetic and healthy participants. The second aim was to examine cultural differences within these metrics. Another purpose was to examine the relationship between DoS and emotional distress among healthy and diabetic participants. The sample included 261 participants, of whom 154 were healthy and 107 were diabetic. Diabetics reported more severe depressive symptoms, higher levels of anxiety and emotional cutoff and lower levels of I-position than healthy individuals. The groups did not differ in their levels of emotional reactivity + fusion with others. Arabs demonstrated higher levels of emotional cutoff, anxiety and depressive symptoms and lower levels of I-position than Jews. However, Arabs and Jews did not differ in their levels of emotional reactivity + fusion with others. Emotional reactivity + fusion with others contributed the most to diabetes among Arabs, while depressive symptoms contributed the most among Jews. Finally, among Jewish participants, age was positively correlated with emotional cutoff and depressive symptoms. Emotional cutoff was positively correlated with anxiety and depressive symptoms. Emotional reactivity + fusion with others was positively correlated with anxiety. Among Arab participants, age was positively correlated with emotional cutoff, anxiety and depressive symptoms. I-position was negatively correlated with all study variables. Emotional cutoff was positively correlated, anxiety and depressive symptoms. Emotional reactivity + fusion with others was positively correlated with anxiety and depressive symptoms.

Differentiation of Self and Hope Mediated by Resilience: Gender Differences

The intent of the present study was to examine the associations among differentiation of self, resilience and hope. Extending Bowen’s family systems theory to adolescents in a middle eastern culture, we anticipated age and gender-based differences in the level of the constructs as well as in the associations among them. Employing a multistage cluster sampling procedure, a sample of 300 adolescents (132 girls and 168 boys) ranging in age from 14 to 19 years old (M = 16.36 years; SD = 1.24) were recruited from junior and senior high schools in Khoramabad. Data were collected through self-report measures, Differentiation of Self Inventory, Connor-Davidson Resilience Scale and Snyder Hope Scale, and analyzed via descriptive statistics, correlations and bootstrap analyses. Higher scores of differentiation were related to greater resilience and hope. Scores on I-position, emotional cutoff and fusion with others were also associated with resilience and hope. Age and gender differences emerged in certain components of differentiation. However, a moderated mediation analysis revealed no moderating effects of age and gender in the association between differentiation and resilience. Separate gender based bootstrapping results for mediation highlighted the specific indirect paths that resilience has in the relationship between I-position and hope in adolescent boys and between emotional closeness (low emotional cutoff) and hope in adolescent girls. Findings are discussed with regard to the cross-cultural validity of Bowen family systems theory.

The Role of Differentiation of Self Dimensions in the Anxiety Problems

Bowen’s multigenerational family theory emphasizes the importance of autonomy and interdependence in individual development and focuses on the role played by the differentiation of self processes on the psychological health at the individual, dyadic, and systemic levels. Starting from these premises, the main objective of our investigation was to explore the differences, in the levels of anxiety and differentiation of self, between a control group ( n = 69) and a sample of adults seeking therapeutic services for anxiety ( n = 47). To better specify our results, in a second step, we also explored which of the differentiation of self dimensions could increase or reduce the likelihood that an individual belonged to the anxiety group or to the control group. We found that lower levels of I-position, and higher levels of emotional cutoff and fusion with others, display higher levels of anxiety-related problems. Moreover, emotional cutoff and fusion with other traits emerged as a predictor of the probability of seeking support for anxiety disorders.

Individuals With Type 2 Diabetes: An Exploratory Study of Their Experience of Family Relationships and Coping With the Illness

Purpose The purpose of this qualitative study is to explore familial patterns that may be related to type 2 diabetes (T2DM) and to patients’ ways of coping with the illness. Methods A purposive sample of 32 Israeli Jewish (n = 12) and Arab (n = 20) individuals with T2DM were recruited from a community population and interviewed about their familial experiences and their illness. Interview data were analyzed using Colaizzi’s phenomenological method. Results Many participants, particularly from the Arab society, reported familial patterns that suggest fused relationships and emotional cutoff. They described highly close and positive family relationships, on one hand, but demonstrated unwillingness to share their difficulties with their family members, on the other hand. Precipitating stressful or traumatic events and day-to-day stress appeared as leading perceived causes of the illness. Maintaining an appropriate lifestyle, stress reduction, and family support were the main coping strategies with the illness. Conclusions The findings suggest a possible avenue in which fusion with family members and inability to attenuate emotional distress by sharing difficulties with others may contribute to the development of T2DM. Assessment of such family dynamics and ways of coping with stress could lead to more appropriately nuanced treatment for individuals with T2DM and prediabetes.