Eating disorder psychopathology: The role of attachment anxiety, attachment avoidance, and personality functioning

Klein, Eva Margaretha; Benecke, Cord; Kasinger, Christoph; Brähler, Elmar; Ehrenthal, Johannes C.; Strauß, Bernhard; Ernst, Mareike

doi:10.1016/j.jpsychores.2022.110975

Cited by 13 publications

(6 citation statements)

References 61 publications

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“…The associations between eating pathology and attachment insecurity, were stronger for global ED pathology, as well as across all subscales for attachment anxiety than with attachment avoidance. Accordingly, these tendencies toward attachment anxiety were also found, for example, in Tasca and Balfour (2014) and Klein et al (2022) .…”

Section: Discussionmentioning

confidence: 71%

“…To this end, mediation models by Tasca et al (2009) found partial mediation effects through emotional reactivity on the relationship between attachment insecurity and eating disorder symptomatology, among other factors. Furthermore, Klein et al (2022) demonstrated associations between attachment anxiety and eating disorder symptoms. This association was fully mediated by personality functioning in a path analysis.…”

Section: Introductionmentioning

confidence: 96%

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Does adult attachment mediate the relationship between primary emotion traits and eating disorder symptoms?

Roithmeier,

Fuchshuber,

Prandstätter

et al. 2024

Front. Psychol.

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ObjectivesPrimary emotion traits and attachment patterns, have been linked to various mental disorders. This study aims to shed more light on the less studied relationship with eating disorder (ED) symptoms.MethodsA total of 921 non-clinical subjects (69.9% females) were assessed for primary emotions traits (B-ANPS-GL), attachment insecurity (ECR-RD8), and eating disorder pathology (EDE-Q8). A theoretically derived model was evaluated by means of a path analysis with attachment anxiety as assumed mediator variable.ResultsGlobal problematic eating behavior showed negative correlations with the positive emotions PLAY, CARE, and LUST (r = −0.10 to −0.24), positive correlations with the negative primary emotions ANGER, FEAR, and SADNESS (r = 0.12–0.27), as well as with attachment anxiety (r = 0.22, all p < 0.01). Path analyses revealed direct effects between eating behavior pathology with LUST (β = −0.07 to −0.15) and FEAR (β = 0.12–0.19; all p < 0.05). The association of SADNESS and Weight (β = 0.05) and Shape Concern (β = 0.06, p < 0.001) was fully mediated by attachment anxiety. Overall, the path model explained 17% of the variance for attachment anxiety and 6% of the Restraint, 13% for Eating, 10% for Weight and 14% for Shape Concern Subscales.DiscussionThe findings shed light on the multifactorial relationship between affective traits, attachment security, and eating disorder pathology. In line with previous research, the results emphasize the role of attachment and affective functioning in ED symptoms.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 96%

Does adult attachment mediate the relationship between primary emotion traits and eating disorder symptoms?

Roithmeier,

Fuchshuber,

Prandstätter

et al. 2024

Front. Psychol.

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“…From a psychodynamic perspective, EDs are hypothesized to be related to deficits in the interactive regulation of emotional states, due to early interpersonal and familial patterns characterized by entanglement and emotional neglect [91]. More specifically, research has shown that attachment insecurity may be pivotal for determining the onset, maintenance, and course of eating pathologies [92]. For instance, empirical studies have found that maladaptive perfectionism, hypermentalization, and difficulties in emotion regulation mediate the effects of insecure attachment on ED symptomatology; furthermore, maladaptive affect regulation associated with attachment insecurity may play a key role in the expression and maintenance of disordered eating and ED symptoms [93].…”

Section: Interpersonal Patternsmentioning

confidence: 99%

“…For instance, empirical studies have found that maladaptive perfectionism, hypermentalization, and difficulties in emotion regulation mediate the effects of insecure attachment on ED symptomatology; furthermore, maladaptive affect regulation associated with attachment insecurity may play a key role in the expression and maintenance of disordered eating and ED symptoms [93]. Overall, research suggests that attachment-related internal working models, which have their roots in early caregiving relationships, might lead to difficulties in affect regulation, perfectionism, and adult attachment insecurity that, in turn, may determine higher vulnerability to ED symptoms, including body dissatisfaction [92].…”

Section: Interpersonal Patternsmentioning

confidence: 99%

From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders

Mirabella

Muzi

Franco³

et al. 2023

Eat Weight Disord

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Purpose Atheoretical and descriptive conceptualizations of eating disorders (EDs) have faced substantial criticism due to their limited ability to assess patients’ subjective characteristics and experiences, as needed to determine the most appropriate treatment options. The present article provides an overview of the clinical and empirical literature supporting the potential contribution of the Psychodynamic Diagnostic Manual (PDM-2) to both diagnostic assessment and treatment monitoring. Methods Following a discussion of the most relevant shortcomings of current diagnostic models of EDs and a description of the rationale and structure of the PDM-2, evidence supporting the core PDM-2 dimensions of ED patients’ subjective experiences (i.e., affective states, cognitive processes, relational patterns, somatic/bodily experiences and states) are examined, alongside their relevance to ED diagnosis and treatment. Results Overall, the reviewed studies support the diagnostic importance of these patterns of subjective experiences in EDs, highlighting their potential role as either predisposing or maintaining factors to target in psychotherapy. A growing body of multidisciplinary evidence also shows that bodily and somatic experiences are central to the diagnosis and clinical management of ED patients. Moreover, there is evidence that a PDM-based assessment may enable closer monitoring of patient progress during treatment, with regard to both subjective experiences and symptom patterns. Conclusions The study suggests that current diagnostic frameworks for EDs would benefit from the addition of a person-centered perspective that considers not only symptoms, but also patients’ full range of functioning—including their deep and surface-level emotional, cognitive, interpersonal, and social patterns—to improve patient-tailored interventions. Level of evidence Level V, narrative review.

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“…Their course is known to be complicated by persisting PD, but with PD remission, concomitant improvement of mental distress and symptom disorders is also described (29)(30)(31)(32). Such parallel developments suggest an important interplay between mental distress and personality dysfunction (33)(34)(35)(36)(37). In studies of PD treatments, measures of symptom distress are usually included among outcomes (38)(39)(40).…”

Section: Introductionmentioning

confidence: 99%

Improvement of personality functioning among people treated within personality disorder mental health services. A longitudinal, observational study

Kvarstein,

Frøyhaug,

Pettersen

et al. 2023

Front. Psychiatry

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ObjectiveEvidence-based personality disorder (PD) treatments are dominated by interventions targeting Borderline PD, although clinical populations characteristically include different PD features and severity. Personality functioning is a new concept intended to capture common features across PDs. This study aimed to investigate longitudinal improvement of personality functioning in a clinical sample assigned to PD treatment.MethodAn observational, large, longitudinal study of patients in PD treatments on specialist mental health service levels (N = 1,051). DSM-5 PDs were systematically assessed on referral. Personality functioning was repeatedly assessed (LPFS-BF-2.0), supplemented by symptom distress (anxiety: PHQ-GAD-7, depression: PHQ-9), and social/occupational activity (WSAS, work/study activity). Statistics were linear mixed models.ResultsThirty per cent had personality difficulties below PD threshold. Among PDs, 31% had Borderline (BPD), 39% Avoidant (AvPD), 15% not otherwise specified, 15% other PDs, and 24% > one PD. More severe initial LPFS-BF was associated with younger age, presence of PD and increasing number of total PD criteria. Across PD conditions, LPFS-BF, PHQ-9 and GAD-7 improved significantly (overall effect size 0.9). Mean duration of PD treatment was 15 (SD 9) months. Drop-out rates were low (12%). LPFS-BF improvement-rates were higher for BPD. Younger age was moderately associated with slower PHQ-9 improvement. Work/study activity was initially poor, poorer levels associated with AvPD and younger age, and improvement was non-significant across PD conditions. AvPD was associated with slower WSAS improvement-rates.ConclusionPersonality functioning improved across PD conditions. The results highlight BPD improvements. The study points to challenges concerning AvPD treatment, poor occupational activity and age-related differences.

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Eating disorder psychopathology: The role of attachment anxiety, attachment avoidance, and personality functioning

Cited by 13 publications

References 61 publications

Does adult attachment mediate the relationship between primary emotion traits and eating disorder symptoms?

Does adult attachment mediate the relationship between primary emotion traits and eating disorder symptoms?

From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders

Improvement of personality functioning among people treated within personality disorder mental health services. A longitudinal, observational study

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