The unsafe haven: Eating disorders as attachment relationships

Abstract

Attachment behaviours are associated with the patient-ED relationship, in which attachment insecurity is correlated with greater eating disorder control and patient submission. Some patients seem to incorporate the actions of the ED in their self-image, suggesting the presence of introjection. The patient-ED relationship may help explain patients' anxiety and ambivalence about change, seen from an attachment perspective. In treatment, it may be important to explore alternative safe havens and secure bases to the ED, such as interpersonal relationships and activities.

«In solitude is safeness»: a patient perspective on eating disorders in the context of multiple childhood trauma

“…Through these avoidant behaviors, we hypothesize that these patients end up in recurrent negative feedback loops, missing out on corrective information about the world and others. This is in line with avoidant personality traits predicting longstanding EDs when co-occurring with childhood sexual abuse (Vrabel et al, 2010), and that attachment processes seem to be at work in the ED-patient relationship for some, but not all (Fors en Mantilla et al, 2018).…”

Interviewing anorexia: How do individuals given a diagnosis of anorexia nervosa experience Voice Dialogue with their eating disorder voice? A qualitative analysis

“…For others, separating from the voice aroused fears about losing connection with their EDV. Emerging evidence suggests that the EDV may represent a key attachment in AN (Forsen Mantilla, Clinton, & Birgegard, 2019) and fulfils important needs such as guidance and companionship (Williams & Reid, 2012). Accordingly, distance from this part of the self may be accompanied by feelings of grief (Tierney & Fox, 2010).…”

The development and assessment of a scale to measure the experience of an anorexic voice in anorexia nervosa

“…The EAVE-Q could be used to measure if reductions in AV endorsement mediate these outcomes. Narrative therapy has also been proposed as a means of enabling people to explore more adaptive attachment relationships outside of their ED (Mantilla et al, 2018a); again, the EAVE-Q could be used to examine the validity of this claim. Furthermore, compassion-focused approaches (Goss & Allan, 2014) could enable individuals to be more kind and forgiving to their own perceived failings, counteracting negative internal encounters shaped by how they respond to the AV.…”

“…Researchers have drawn on aspects of dialogical self-theory (Hermans, Kempen, & Van Loon, 1992) to understand the AV, suggesting it represents an internal self-critical position that attempts to dominate the more rational self (Hendricks, 2003;Williams, King, & Fox, 2015;Williams & Reid, 2012). Furthermore, it has been associated with attachment theory, described as an intrapersonal, significant relationship that can affect someone's self-image (Mantilla, Clinton, & Birgegard, 2018a, 2018b.…”

“…However, the AV might be a barrier to accessing help because despite its negative consequences, its positive attributes may make it difficult to relinquish (Tierney & Fox, 2010;Williams et al, 2015). Attempts to encourage someone to break their bond with the AV may engender separation distress (Mantilla et al, 2018a).…”