Attachment in individuals with eating disorders compared to community controls: A systematic review and meta-analysis

Abstract

Introduction: Individuals with eating disorders are known to have higher rates of insecure attachment compared to community controls, but the factors underlying this finding are poorly understood. We conducted the first meta-analysis comparing attachment in eating disorder samples compared to community controls that included quality assessment, publication bias and moderation analysis. Method: We pre-registered our meta-analysis (CRD42019146799) and followed PRISMA guidelines. We searched PsychINFO, Embase, Medline, CINAHL and Scopus for publications. Attachment scores were extracted, and Cohen’s d calculated for each study using a random effects model.Results: In total, 35 studies were included in the meta-analysis and six studies were summarized in a narrative review. Eating disorder samples showed higher rates of insecure attachment compared to community controls, with a large effect size, across measurement methods and different attachment dimensions. Blinding of assessors moderated effect sizes for attachment interview studies, but no other moderators were significant. Discussion: Risk of insecure attachment is elevated in individuals with eating disorders, albeit heterogeneity is high and largely unexplained. Clinicians may need to take this into account in their work, particularly given the association between attachment insecurity and challenges to therapeutic alliance. Future studies comparing eating disorder samples with community controls should control for general psychopathology.

A systematic review of social rank perception and contribution to eating disorder psychopathology in individuals with eating disorders

“…The relationship between such variables and social rank has not received much attention, but it could be argued that belonging to a marginalized or diverse group could detrimentally impact one's perception of social rank. Most of the studies did not also control for psychopathology, which makes it hard to determine whether the perception of low social rank could be accounted for by higher levels of psychopathology (e.g., anxiety and depression) in the ED group relative to the control group (Jewell et al, 2023). As reported above, the review included mainly cross-sectional studies, which limits the conclusions that can be drawn on the role of social rank in the development of EDs.…”