Review of attachment interventions in eating disorders: Implications for psychotherapy

Abstract

Background: Attachment theory has been used in personalized treatments since decades. It is a major framework for understanding images of the self, affect regulation, reflective functions and interpersonal relationships. The improvement of attachment functioning is associated with positive treatment outcomes in eating disorders. However, attachment interventions have not been summarized in their psychotherapy. Aims: The aim was to review the relevance of attachment features in the psychotherapy of eating disorders. Methods: A literature review was carried out for empirical review and case studies, using the terms "eating disorder" and "attachment" from 1987 until 2017. From the 320 matches, 50 relevant studies were integrated into this review. Results: The relationship between dysfunctional attachment and eating disorders could be conceptualized in seven ways, including transgenerational transmissions and mediator personality traits. Attachment can mediate between early experiences and adult symptoms, between intra-and interpersonal experiences, or may moderate the relationship between the risk factors and maladaptive eating. Attachment features also display a direct relationship with eating disorders, or may underlie their maintaining mechanisms. Nine psychotherapeutically relevant mediator factors could be identified, namely the patient's self-concept and emotionregulation, the conflation of self-esteem and body satisfaction, a sensitive interpersonal style, levels of perfectionism, depression, alexithymia, mentalization and reflective functions. Conclusions: The assessment of attachment dysfunctions in the individual symptomatology may facilitate personalized case models. For patients with severe attachment dysfunctions, multimodal psychotherapies targeting the described focal points could be recommended. Randomized, controlled studies are required to test the efficacy of the interventions summarized, and to determine indications.

Development of the Modified Yale Food Addiction Scale Version 2.0 summary version in a representative sample of Czech population

“…Szalai [31] conducted the review using the terms "eating disorder" and "attachment" from 1987 until 2017. From the 320 matches, he used 50 relevant studies which he integrated into his article.…”

Attachment, Mentalization, Emotion Dysregulation, and Empathy in Eating Disorders

“…Illing et al (2010) found that higher attachment anxiety was significantly correlated with greater severity of ED symptoms and worse treatment outcomes in a clinical sample. Different studies proved that attachment anxiety and avoidance were associated with higher levels of ED symptoms (Szalai, 2019), whereas the decrease of attachment anxiety was associated with lower symptom severity and better treatment outcomes (Tasca, 2019). A recent pilot study (Zeeck et al, 2021) on mentalization-based treatment has shown that only 5.3% of the sample ( n = 38) with ED showed secure attachment, whereas most of the sample (composed of young women) had an avoidant-withdrawn attachment style (47.4%).…”

Body image perception is associated with nutritional status of adolescent girls: A cross-sectional study in Denpasar City, Bali Province, Indonesia

“…Additionally, no significant difference was observed between those with abnormal nutritional status and those with normal nutritional status in terms of experiencing eating disorders. 10 Adolescents with a higher BMI tend to feel uncomfortable or ashamed of their body shape. The notion of a slim and slender physique being deemed the ideal body shape can lead adolescents to control or reduce their food intake based on their own thoughts, often resulting in disordered eating behaviors.…”

“…8 The interconnection between body perception, eating disorders, and nutritional status needs to be understood to identify the complex issues that impact the psychological development of adolescents. 7,9,10 The Austria Academy for Eating Disorders (2006) states that various forms of eating disorders are reported to occur in 4.0% of adolescents and young adults. Approximately 95% of patients are females, and these disorders typically develop during adolescence and sometimes in adulthood.…”