Attachment and Eating Disorders: A Review of Current Research

International Journal of Eating Disorders (Impact Factor: 3.13). 11/2014; 47(7). DOI: 10.1002/eat.22302
Source: PubMed


Attachment insecurity may confer risk for developing an eating disorder. We describe domains of attachment functioning that are relevant to eating disorders including: affect regulation, interpersonal style, coherence of mind, and reflective functioning. Research since 2000 on attachment and eating disorders related to these domains is reviewed.

We searched MedLine/Pubmed and PsycINFO from January 2000 to February 2014 and kept articles that: were empirical, included adults with a diagnosed eating disorder, and used a standard attachment measure. We retained 50 relevant studies.

Compared to controls, those with eating disorders had higher levels of attachment insecurity and disorganized mental states. Lower reflective functioning was specifically associated with anorexia nervosa. Attachment anxiety was associated with eating disorder symptom severity, and this relationship may be mediated by perfectionism and affect regulation strategies. Type of attachment insecurity had specific negative impacts on psychotherapy processes and outcomes, such that higher attachment avoidance may lead to dropping out and higher attachment anxiety may lead to poorer treatment outcomes.

Research to date suggests a possible relationship between attachment insecurity and risk for an eating disorder. More research is needed that uses attachment interviews, and longitudinal and case control designs. Clinicians can assess attachment insecurity to help inform therapeutic stances and interventions.

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    • "In accordance with the aforementioned literature, it was expected that grandiose narcissism (Time 2; T2) would serve as a mediator for freshman students with initial high attachment avoidance (Time 1; T1) in relation to subsequent dieting (T2), whereas vulnerable narcissism (T2) would serve as a mediator for freshman students with initial high attachment anxiety (T1) in relation to subsequent bulimic behaviors (T2). To test these hypotheses, we conducted analyses using a latent variable (LV) structural equation modelling (SEM) approach, controlling for initial (T1) levels of the endogenous (i.e., dependent) LVs (i.e., grandiose and vulnerable narcissism, dieting and bulimic behaviors), and holding body mass index (BMI), depression, stress, anxiety, and self-esteem levels as (observed) time-varying covariates (see statistical analyses), to reduce their potential effects on the relationships between the LVs under investigation (e.g., Mikulincer & Shaver, 2012; Tasca & Balfour, 2014). "
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    ABSTRACT: Objective: This study aimed to build on existing literature by examining the potential mediating role of two variants of narcissism (grandiosity and vulnerability) in explaining part of the underlying mechanism by which insecure (avoidant and anxiety) attachment affects behavioral elements of eating pathology (dieting and bulimic behaviors). Method: Longitudinal data collected from 2,055 freshman college students (52.2% women; mean age 18.34 years) were analysed using a latent variable structural equation modelling approach, controlling for initial levels of the endogenous (i.e., dependent) latent variables and holding body mass index, anxiety, stress, depression, and self-esteem levels as time-varying covariates. Results: The effect of attachment anxiety on future bulimic behaviors was fully mediated through vulnerable narcissism (i.e., no significant direct link between attachment anxiety and bulimic behaviors), whereas grandiose narcissism fully mediated the association between attachment avoidance and future dieting behaviors. Dieting also predicted future bulimic behaviors and served as an additional (full) mediator between grandiose narcissism and bulimic behaviors. Differences in the strength of these associations across gender were not observed, and all indirect effects were statistically significant. Conclusion: Overall, the findings (a) seem to support the theoretical postulations linking different insecure attachment experiences to different narcissistic tendencies, (b) imply that specific insecure attachment patterns may pass through different mediating pathways (narcissistic grandiosity and vulnerability) to specific behavioral elements of eating pathology (dieting and bulimic behaviors) regardless of gender, and (c) suggest that individuals with high grandiose narcissistic levels may not be protected from bulimic behaviors as previously indicated.
    No preview · Article · Nov 2015 · Journal of Clinical Psychology
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    • "It is thus necessary to explore different features of obese subjects to further characterize them and to personalize and improve treatments. Among pathogenic factors, early attachment experiences has been claimed as a co-factor in the development of obesity and eating disorders (Abbate-Daga, Gramaglia, Amianto, Marzola, & Fassino, 2010; Kiesewetter et al., 2010; Tasca & Balfour, 2014). High child separation anxiety and insecure adult attachment style are common among women with anorexia nervosa and bulimia nervosa (Amianto, Abbate Daga, Morando, Sobrero, & Fassino, 2011; Fassino, Amianto, & Abbate-Daga, 2009; Fassino, Amianto, Rocca, & Abbate-Daga, 2010; Milan & Acker, 2014), and relate to body dissatisfaction (Abbate-Daga et al., 2010). "
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    ABSTRACT: Early inadequate attachment experiences are relevant co-factors in the development of obesity and Binge Eating Disorder (BED), which often concurs with obesity. The relationship of parental bonding with personality and psychopathology may influence treatment strategies for obese subjects, either affected or not with BED. In this study, 443 obese women (BMI ≥ 30 kg/m(2) ), including 243 with and 200 without BED, and 158 female controls were assessed with regards to attachment, personality and eating psychopathology measures. Clusters obtained using the scores of the Parental Bonding Instrument (PBI) were compared with each other and with a control subjects' group. Lower scores of parental bonding distinguished obese subjects with respect to healthy controls. The cluster analysis revealed two clusters of parenting among obese subjects. The larger one displayed intermediate care and overprotection between controls and the smaller cluster, with the exception of paternal overprotection which is similar to controls. This larger cluster was characterized by low persistence and levels of psychopathology which are intermediate between healthy controls and the smaller cluster. The smaller cluster displayed lower care and higher overcontrol from both parents. It also displays more extreme personality traits (high novelty seeking and harm avoidance, and lower self-directedness and cooperativeness) and more severe eating and general psychopathology. Different parenting dynamics relate to different personality patterns and eating psychopathology of obese subjects, but not to binge eating conducts. Personality differences between parenting clusters are more extensive than those between BED and non-BED subgroups. The two different typologies of obese subjects based on parenting may be relevant for treatment personalization. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.
    Full-text · Article · Nov 2015 · European Eating Disorders Review
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    • "A similar model was examined for the avoidant attachment style. However, it was hypothesized that there would be no significant association with binge eating, since deactivating strategies are more common in individuals high in avoidance (Hunter & Maunder, 2001; Tasca & Balfour, 2014) and since the relationship between over-controlled emotion regulation strategies and binge eating remains unclear. "
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    ABSTRACT: Objectives: It has been suggested that obesity stigmatization contributes to negative mental health outcomes, particularly among overweight individuals. This study examined the effects of exposure to media-portrayed anti-obesity messages on women's state self-esteem, body esteem, and food intake. It was hypothesized that exposure to anti-obesity messages would result in decreased state self-esteem and body esteem and in increased food intake, and that these effects would be more pronounced in individuals with either higher BMI or stronger perceived pressure to be thin. Method: Participants were randomly assigned to one of three experimental conditions in which they either: read a fictitious media article containing either anti-obesity messages or non-obesity-related health messages, or completed a neutral control task (word search). State self-esteem and body esteem were measured before and after the manipulation. Participants also completed a candy taste rating task and ad lib consumption was surreptitiously measured. Results: There was no main effect of condition on either psychological outcome variable or on grams consumed. Higher perceived sociocultural pressure to be thin was associated with a decrease in body esteem after reading the anti-obesity article only. Having a higher BMI was associated with greater candy intake in the word search condition. This trend was also apparent in the sun exposure condition, but not in the anti-obesity condition. Discussion: Exposure to anti-obesity messages appears to decrease weight-related body esteem in women who already feel strong pressure to be thin, and may lead heavier women to suppress their food intake.
    Full-text · Article · Nov 2015 · Eating behaviors
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