Implications of attachment theory and research for the assessment and treatment of eating disorders.

Abstract

In this paper, we review the research literature on attachment and eating disorders and suggest a framework for assessing and treating attachment functioning in patients with an eating disorder. Treatment outcomes for individuals with eating disorders tend to be moderate. Those with attachment-associated insecurities are likely to be the least to benefit from current symptom-focused therapies. We describe the common attachment categories (secure, avoidant, anxious), and then describe domains of attachment functioning within each category: affect regulation, interpersonal style, coherence of mind, and reflective functioning. We also note the impact of disorganized mental states related to loss or trauma. Assessing these domains of attachment functioning can guide focused interventions in the psychotherapy of eating disorders. Case examples are presented to illustrate assessment, case formulation, and group psychotherapy of eating disorders that are informed by attachment theory. Tailoring treatments to improve attachment functioning for patients with an eating disorder will likely result in better outcomes for those suffering from these particularly burdensome disorders.

Cognitive-behavioral and attachment interventions in the transdiagnostic treatment of bulimia nervosa and binge eating disorder

“…Family structure and communication are also central to the concept of the psychosomatic (e.g. anorectic) family (Minuchin, Rosman, & Baker, 2009) and the person-al traits which are influenced by these family characteristics are also crucial for eating disorder patients (Tasca, Ritchie, & Balfour, 2011;Túry & Pászthy, 2008).…”

“…As disturbances of personality and family functioning are among the most important predisposing, precipitating and maintaining factors for eating disorders, (Túry & Pászthy, 2008), in eating disorders attachment could be viewed as a system mediating between interpersonal and intrapersonal experiences. Attachment functioning may play a particularly important role in cases where there are comorbid psychopathologies, emotion-processing deficits, personality disorders and insecure attachment, as these patients respond less well to simple, symptom-focused therapies (Myers et al, 2006;Tasca et al, 2011). In spite of these highly important contributory mechanisms of attachment to eating disorder symptoms, mainstream treatment models emphasize the biological, cultural, or most often cognitive-behavioral traits of these disorders, without taking into account dynamic concepts or attachment issues .…”

“…In spite of these highly important contributory mechanisms of attachment to eating disorder symptoms, mainstream treatment models emphasize the biological, cultural, or most often cognitive-behavioral traits of these disorders, without taking into account dynamic concepts or attachment issues . Although, a limited number of studies evaluating attachment interventions as a treatment for eating disorders showed that improvement in attachment functioning was associated with better outcomes (Maxwell, Tasca, Ritchie, Balfour, & Bissada, 2014;Roberts, Gotlib & Kassel, 1996;Tasca et al, 2011;.…”

Mediating Role of Cognitive Emotion Regulation Strategies on the Relationship between the Attachment Styles and Emotional Problems: A Path Analysis

“…For example, Wei and colleagues (15) determine that affect regulation perform as mediator between attachment dimensions and negative mood in a sample of college students. In another research declared that emotion focused coping mediate in the relationship between attachment anxiety and body image disturbances, depression and problem eating, hence can assert that affect regulation strategies has role in mediating the relationship between attachment dimensions and both depressive and eating disorder (ED) symptoms (25,26). Hilbert and Tuschen-Caffier (27) also found that binge eating was preceded by difficulty in regulating affect in females with Bulimia nervosa.…”

Neuroimaging and Attachment in Eating Disorders: Parental Love Nurtues the Brain

“…In particular, the AAI coding system considers the Coherence of Mind and the Coherence of Transcript as the most accurate indicator of the state of mind with respect to attachment [39]. The poor CoM which has been found in AN patients suggests difficulty in creating a narrative process on psychological development, self-awareness and incoherencies on the report of their own experiences [40,41]. CoM and CoT positively correlated with the volume of GM in a network of brain areas comprising the temporal poles, both amygdalae, the midbrain, the thalamus and the anterior and middle sections of cingulate cortex [27,30].…”