The Significance of Family-of-Origin Dynamics for Adults' Health and Psychological Wellbeing: The Perspective of Bowen Family System Theory

*Viktorija Cepukiene*

#### **Abstract**

Bowen family system theory describes family interactional processes that are carried across the generations and determine an individual's level of autonomy and emotional reactivity as well as the global functioning of the family. According to the theory, any personal, health-related, or relational issues can be explained as a result of diffused anxiety produced by destructive interactional patterns among family members. Although many studies are revealing the relationship between early family life experiences and functioning in adulthood, there is still a lack of studies exploring the complex mediational models based on Bowen theory that would reveal associations between different family-of-origin variables and adults' health as well as psychological well-being. The chapter defines the main assumptions of Bowen theory as well as summarizes the main results of three studies demonstrating how family and personal factors defined by Bowen theory, such as family emotional system, triangulation, differentiation of self, relate to adults' health and psychological well-being.

**Keywords:** Bowen family system theory, family emotional system, triangulation, differentiation of self, interparental relationship, adults, health, well-being

#### **1. Introduction**

The quality of life of an adult is determined by the interaction of many factors, yet psychological well-being and physical health can be considered as the essential variables ensuring the quality of life. Therefore, researchers seek to understand what factors and how they contribute to a person's psychological well-being and physical health. Numerous studies reveal the importance of individual psychological and physical factors for these variables, but the significance of family interactional dynamics has become increasingly recognized over the last few decades. There is strong evidence that more favorable interactions with a spouse/partner usually predict better health as well as psychological well-being outcomes of an adult [1–3]. Additionally, the newest data suggest that broader family interactional context accounts for the significant changes in a person's physical health and

morbidity as well as in psychosocial functioning (e.g., [4–9]). Thus, the body of research provides clear evidence that supports the necessity to understand physical health and psychological well-being from a systemic perspective. However, understanding the associations between variables without a clear theory is difficult to achieve. Bowen family systems theory (BFST) is a systemic theory binding together family processes and individual factors. It has been vastly studied and has gained recognition for explaining different intrapsychic as well as interpersonal phenomena in the interactional context of the nuclear and genetic family [7, 10–16]. Bowen [17] claimed that an individual's physical and emotional issues could be explained by the interactional processes in the family system. The chapter defines the main assumptions of the BFST as well as summarizes the main results of three studies demonstrating how family and personal factors defined by the BFST, such as family emotional system, triangulation, differentiation of self, relate to adults' health and psychological well-being.

#### **2. The main ideas of the Bowen family systems theory**

The BFST describes different interactional processes that are carried across the generations and determine an individual's level of autonomy and emotional reactivity as well as the global functioning of the family [17, 18]. According to the theory, any personal or relational issue/symptom can be explained as a result of diffused anxiety produced by destructive interactional patterns among family members [15, 17]. Bowen described six interrelated concepts that address family processes, with differentiation of self (DoS), regarded as the central one as it appears in the manifestation of every other phenomenon described by Bowen [19]. It explains two fundamental aspects of psychosocial functioning: the ability to separate own feelings from thinking and to remain capable of making decisions under stress as well as the ability to develop close intimate relationships while remaining autonomous [12, 14, 16, 17, 20]. The DoS develops within the significant relationships with parents whose DoS shapes their mutual relationship as well as the relationship with their children and is transferred to the next generation through the nuclear family emotional system (NFES), triangulation, and family projection [17].

NFES can be referred to as a cumulative phenomenon since it binds the rest of the five concepts together (DoS, triangulation, multigenerational transmission process, family projection process, emotional cutoff) and explains the pathways of symptom development. The evolution of NFES begins even before an adult decides to have an intimate relationship. NFES develops gradually and depends on the quality of relationships with families-of-origin, the adjustment of partners to each other before having children as a two-person system, and their adjustment as a threeperson system when a child is born. The partners' level of DoS plays a critical role in the development of NFES since the lower DoS predicts more fusion and anxiety between the partners. Bowen [18] postulated that a person usually subconsciously chooses a partner with a similar level of DoS. The lower DoS predicts more fusion and anxiety between the partners. Partners with low differentiation are emotionally reactive, have little personal autonomy, seek emotional support, appraisal, and needs' gratification. Under stress, they cannot think clearly and make effective decisions, tend to become overreactive and overwhelmed by the emotions. Marital discord usually develops 'when neither spouse will "give in" to the other in the fusion, or when the one who has been giving in or adapting refuses to continue' [17, p. 115]. The conflict can manifest with a wide range of interactional patterns from simple quarrels to overt violent acts as well as alienating from each other. Despite the tendency to establish a partnership with a person who has a similar level

#### *The Significance of Family-of-Origin Dynamics for Adults' Health and Psychological Wellbeing… DOI: http://dx.doi.org/10.5772/intechopen.95354*

of differentiation, one partner usually has a slightly higher level of differentiation, and, in turn, he or she absorbs less undifferentiation and anxiety by communicating over-protectiveness, worry, or criticism to the less functional partner. The latter soaks up more of undifferentiation and anxiety, accepting her helplessness, powerlessness. Such interactions allow avoiding a conflict; however, they strengthen the unequal positions of the partners by allowing the more functional partner to gain more strength while the less functional partner develops emotional, social, or physical symptoms. Such interactional dynamics result in high levels of anxiety in the couple that has to be channeled somewhere else. Within the triadic systems, parents with low DoS tend to transfer their diffused anxiety to children through triangulation processes. Kerr and Bowen [19] noted that the two-person system is unstable because of the constant fluctuation of anxiety levels between partners and as it increases, the two-person system forms a triangle by involving a third person in their relationship. After pulling a child into their conflictual relationship, parents usually seek the child's compassion, emotional support, or openly set a child against a partner. In this way, a child is forced to support the side of one of the parents, mediate in their conflict, comfort, etc., which may lead to a loyalty conflict in a child. Therefore, continual triangulation may result in children's mental or physical health problems and has detrimental effects on a child's development as well as functioning in adulthood [21, 22]. Involvement in triangulation does not enable children to become more differentiated than parents, restricts their autonomy, and strengthens emotional reactivity and anxiety [15, 18, 23–25]. Summarizing, NFES reflects the levels of differentiation and anxiety in the family system through three presumable patterns of the symptoms: chronic marital problems, physical or psychological illness of a partner, impairment of a child [19].

This chapter aims to present and discuss the results of three studies based on the Bowen family system theory. Thus, the next sections will present the summary of the studies aimed at examining the role of various family-of-origin variables on adults' physical health and psychological well-being. Since some study measures and data analysis methods are shared among all three studies, the sections Measures and Data analysis, as well as General discussion, are integrated, while the sections Participants and Results are separate for each study.

#### **3. Research**

#### **3.1 Measures**

1. *Interparental relationship quality* was measured by Retrospective Measure on Interparental Relationship Quality [26] in Study 2 and 3. This is a 21-item selfreport questionnaire that retrospectively measures interparental relationship quality of adult respondents who grew up with both of their parents. The IPRQ has a structure of three factors: (1) destructive relationship (conflicts, violence, expression of anger, unhappiness and fear, non-constructive ways of conflict resolution, the involvement of children into interparental conflicts); (2) harmonious relationship (constructive ways of conflict resolution, expression of positive emotions, happiness, mutual respect and regard, accord over parenting and domestic duties); (3) avoidant relationship (avoidant and indifferent interactional patterns). The items are evaluated on a 5-point scale from 1 (totally disagree) to 5 (totally agree). The items defining destructive interactional patterns have reversed scoring, and higher scale scores reflect fewer signs of destructive communication. For the present sample, Cronbach's α were: (1) .91, (2) .93, (3) .53, and for total score – .93.


the scale reflect lower levels of perceived intimacy and autonomy within the family-of-origin. Cronbach's α for the present sample was .96.


#### **3.2 Data analysis**

In Study 1 and 2 hierarchical series of multiple regression analyses were conducted to explore the contribution of study variables to the prediction of psychological well-being (six subscales of PWBS) as the dependent variable. To estimate the effect size for a hierarchical multiple regression in each step Cohen's *f* 2 was calculated. According to Cohen's [35] guidelines, *f* <sup>2</sup> ≥ 0.02, *f* <sup>2</sup> ≥ 0.15, and *f* <sup>2</sup> ≥ 0.35 represent small, medium, and large effect sizes, respectively.

In Study 3 a mediation analysis was performed to test the impact of interparental relationship quality, triangulation, family emotional system, the DoS, and satisfaction with a couple relationship on adult's physical and emotional health. A path analysis was carried out using the Maximum Likelihood method and the following goodness-of-fit indices [36]: model Chi-Square, the Root Mean Square Error of Approximation (RMSEA), the Standardized Root-Mean-Square Residual (SRMR), Tucker-Lewis Index (TLI), Goodness of Fit Index (GFI) and Comparative Fit Index (CFI). TLI, GFI, and CFI values greater than 0.90 are considered acceptable, whereas the ones higher than 0.95 are considered excellent. RMSEA and SRMR values lower than 0.08 are considered acceptable, whereas values close to 0.05 are considered as good [37]. Bootstrap re-sampling was applied to test the significance of the mediation paths, using 5000 bootstrap samples and 95% confidence intervals.

The data were analyzed using SPSS Version 23 and AMOS Version 23.

#### **3.3 Study 1**

The objective of the study was to test the prognostic value of adults' current family dynamics reflected by NFES on adults' physical health.

#### *3.3.1 Participants and procedure*

The study was conducted online in 2017 in Lithuania. Respondents were recruited from various social networking websites intended for family issues. Before starting their participation, respondents were presented with an informed consent covering the primary goal of the study, voluntary participation, confidentiality, data protection, and contacts of the researcher.

Inclusion criteria were the following: intimate relationships at the moment of participation in the study and having a child from 3 to 18 years. The final sample consisted of 282 participants of whom 95% (*n* = 267) were women. The average age of the participants was 36.27 (*SD* = 5.78) years, ranging from 21 to 53 years. Most participants (*n* = 247, 88%) were married, the rest 35 (12%) cohabitated with one's intimate partner. The average duration of the relationship was 13.08 years (*SD* = 6.03). Twelve percent (*n* = 34) of the participants indicated within 5 years being diagnosed with physical illnesses, such as arthritis, diabetes, epilepsy, hypertension, migraine, cancer, etc.

#### *3.3.2 Results*

Two three-step hierarchical multiple regressions were performed for both subscales of PHS (Objective health indicators, Subjective health indicators) as the dependent variables. Each hierarchical multiple regression analysis consisted of three blocks of independent variables which were subscales of NFES (Personal distress, Constructive relationship with a partner, Destructive relationship with a partner, Child's problems), presence of illness at the moment of the survey, and control variables (gender and age). The variance inflation factors (VIF) and tolerance factors for each of the single predictor variable were no larger than 4 (ranging between 1.1 and 2.6) and no smaller than 0.25 (ranging between 0.39 and 0.95), respectively, suggesting no collinearity between independent variables. The results of the final regression models are presented in **Table 1**.


*The Significance of Family-of-Origin Dynamics for Adults' Health and Psychological Wellbeing… DOI: http://dx.doi.org/10.5772/intechopen.95354*

*Note: NFES = nuclear family emotional system; PD = personal distress; DRP = destructive relationship with a partner; CRP = constructive relationship with a partner; CP = child's problems; HI = health issues; CV = control variables.*

*\*p < .05.*

*\*\*p < .01.*

*\*\*\*p < .001.*

#### **Table 1.**

*Three models of hierarchical multiple regression analyses with subscales of physical health (PHS) as the dependent variables (N = 282).*

Analysis unraveled quite apparent differences between the results of regression analysis when predicting objective and subjective health indicators in terms of significant independent variables and effect size. Although in the first model personal distress, the only scale of NFES, significantly predicted objective health, its effect size was small and after adding the presence of illness into the regression the personal distress lost its predictive value. The final model explained 36% of the variance of adults' objective health and the only significant predictor in the context of other independent variables was the presence of illness: those adults who have diagnosed illness reports more objective indicators of health's problems. Differently, in the regression analysis of subjective health three scales of NFES sustained their significant predictive values after adding the presence of illness and the effect size of the latter was small when the effect size of NFES was medium. The final model explained 25% of the variance of the dependent variable and revealed that higher personal distress, more signs of a destructive relationship with a partner, more severe child's problems, and presence of illness predict more indicators of subjectively evaluated physical health's problems. The similarity between both models was associated to control variables (gender and age) – neither of them had predictive power and the effect size was equal to zero in both cases.

The hierarchical multiple regression analysis was repeated with the total score of NFFS instead of its scales aiming to examine the predictive value of the NFES as a whole (see **Table 2**).


*Note: NFES = nuclear family emotional system; HI = health issues; CV = control variables. \*p < .05.*

*\*\*p < .01.*

*\*\*\*p < .001.*

#### **Table 2.**

*Three models of hierarchical multiple regression analyses with subscales of physical health (PHS) as the dependent variables (N = 282).*

The results presented in **Table 2** are very similar to those in **Table 1**, nevertheless, one difference was found. When predicting objective health, the NFES (total score) sustained significant predictive value after adding the presence of illness into the equation. Thus, the worse objective health of adults is predicted by the worse NFES and presence of illness, although the effect size of the first was small and of the second one was large.

#### **3.4 Study 2**

The objective of the study was to examine the prognostic values of interparental relationship quality observed during childhood, DoS, and satisfaction with a current couple relationship on adults' psychological well-being.

#### *3.4.1 Participants and procedure*

Lithuanian online survey software program (http://www.apklausk.lt) was used to design and host the survey in 2018. The first web page of the survey covered a short description and information about the purpose of the study, voluntary participation, opportunity to withdraw oneself from the study at any time, confidentiality, data protection as well as the contacts of the researcher.

There were three main inclusion criteria for participation in the study: being 18–55 years old, growing with both parents during childhood, and being in a romantic relationship at the moment of participation in the study for at least one year. The final sample consisted of 905 respondents who satisfied all inclusion criteria and who consented to their data being used in the study. Ninety two percent (*n* = 833) of respondents were women, the mean age was 38.49 (*SD* = 9.46) years. Most of the study participants (*n* = 653, 72%) were married, 136 (15%) cohabitated, and 116 (13%) were dating with a romantic partner. The average duration of

the relationship was 13.87 years (*SD* = 8.61). Education of the respondents was as follows: 587 (65%) respondents completed university studies; 134 (15%) studied in the college; 58 (6%) completed professional training; 115 (13%) finished secondary education, and education of 11 (1%) respondents was lower than secondary education.

#### *3.4.2 Results*

The research objective was implemented by running six four-step hierarchical multiple regressions for each subscale of PWBS (Autonomy, Environmental mastery, Personal growth, Positive relations, Purpose in life, Self-acceptance) and PWBS total score as the dependent variable. Each hierarchical multiple regression analysis consisted of four blocks of independent variables which were subscales of interparental relationship quality (Destructive relationship, Harmonious relationship, Avoidant relationship), DoS (Emotional reactivity, I-position, Emotional cutoff, Fusion with others), satisfaction with couple relationship quality (Satisfaction with an emotion-focused relationship, Satisfaction with a behavior-focused relationship) as well as control variables (gender, age, and education). The variance inflation factors (VIF) and tolerance factors for each of the single predictor variable were no larger than 4 (ranging between 1.0 and 3.5) and no smaller than 0.25 (ranging between 0.29 and 0.96), respectively suggesting no collinearity between independent variables. The results of the final regression models are presented in **Table 3**.

The results revealed that 44.8% of the variance of the participants' autonomy can be attributed to the main three blocks of predictors tested in the analysis. Only 0.4% of the variance can be explained by control variables and the change in *R*<sup>2</sup> adding the control variables was nonsignificant. Although all four models were statistically significant (*F*Model1 = 7.58, *p* < .001; *F*Model2 = 106.43, *p* < .001; *F*Model3 = 82.63, *p* < .001), the greatest change in *R*<sup>2</sup> was produced by the block of the DoS – this block accounted for 42.9% of the variance of the participants' autonomy with a large effect size (*f* 2 = .75), while effect sizes of the rest of the independent variables' blocks were small. The final model (see **Table 3**) explained 45% of the variance and showed that a better autonomy of adults is predicted by their stronger I-position, lower emotional cutoff, lower fusion with others, and younger age with I-position as the strongest predictor in the final model.

The results of hierarchical multiple regression analysis predicting environmental mastery revealed that all four models were statistically significant (*F*Model1 = 21.27, *p* < .001; *F*Model2 = 99.81, *p* < .001; *F*Model3 = 86.79, *p* < .001), though the variance explained varied depending on the predictors' blocks. The main three blocks of predictors explained 46.1% of the variance of the environmental mastery variable, whereas control variables explained only 0.7% of the variance. The most significant change in *R*<sup>2</sup> was provided by the block of the DoS explaining 37% of the variance of the dependent variable (a large effect size; *f* 2 = 0.59). The final model (see **Table 3**) accounted for 46.8% of the variance and showed that a more harmonious interparental relationship perceived in childhood, lower emotional reactivity, stronger I-position, lower emotional cutoff, higher satisfaction with a behavior-based couple relationship, and older age predict higher environmental mastery of adults. The strongest predictor in the final model was I-position.

All four models predicting personal growth were statistically significant (*F*Model1 = 10.11, *p* < .001; *F*Model2 = 41.51, *p* < .001; *F*Model3 = 32.34, *p* < .001) with the main three blocks of predictors accounting for 23.8% of the variance of dependent variable, whereas control variables explained only 2.4% of the variance. Similarly,

