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Attachment in anorexia nervosa: An exploration of associations with eating disorder psychopathology and psychiatric symptoms

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Abstract

Previous research on attachment and eating disorder has to a great extent presupposed direct links between states of mind with respect to attachment and eating disorder diagnoses. The authors provide a brief review stating that no such association can be found in current literature. The authors suggest that the association might exist on the level of eating disorder pathology and psychiatric symptoms, rather than diagnostic level. Based on 20 Adult Attachment Interviews coded with the Dynamic-Maturational method from patients diagnosed with anorexia, the authors explore the associations between attachment and diagnostic subgroups, eating disorder psychopathology (Eating Disorder Inventory — 2nd edition), and psychiatric symptoms. All patients were coded within the range of insecure attachment. State of mind with respect to attachment did not differentiate between diagnostic subgroup and eating disorder pathology. Individuals classified as dismissing reported higher levels of anxiety-related distress than those classified as preoccupied or mixed dismissing/preoccupied. A high frequency of unresolved traumas and losses was found. The findings support previous reports of high frequencies of insecure attachment and unresolved traumas in anorexic patients. The high level of anxiety-related stress in the dismissing group lead the author to suggest that attachment plays a role in the patient’s handling of distress following the eating disorder, rather than in the disorder itself.

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References

  1. O’Kearney R.: Attachment disruption in anorexia nervosa and bulimia nervosa: a review of theory and empirical research. Int. J. Eat. Disord., 20, 115–127, 1996.

    Article  PubMed  Google Scholar 

  2. Ward A., Ramsay R., Treasure J.: Attachment research in eating disorders. Br. J. Med. Psychol., 73, 35–51, 2000.

    Article  PubMed  Google Scholar 

  3. Ward A., Ramsay R., Turnbull S., Steele M., Steele H., Treasure J.: Attachment in anorexia nervosa: a transgenerational perspective. Br. J. Med. Psychol., 74, 497–505, 2001.

    Article  PubMed  CAS  Google Scholar 

  4. Bowlby J., Attachment and loss, Vol. 1: Attachment. London, Pimlico, 1969.

    Google Scholar 

  5. Sroufe L.A., Waters E.: Attachment as an organizational construct. Child Dev., 48, 1184–1199, 1977.

    Article  Google Scholar 

  6. Bowlby J.: Attachment and loss, Vol. 2: Separation. Anger and Anxiety. London, Pimlico, 1973.

    Google Scholar 

  7. Main M., Kaplan N., Cassidy J.: Security in infancy, childhood, and adulthood: a move to the level of representation. In: Bretherton I., Waters E. (Eds.), Growing points of attachment theory and research. Monogroups of the Society for Research in Child Development, 50 (serial No. 209) 1985, pp. 66–104.

    Article  Google Scholar 

  8. Crittenden P.M.: Danger and development: the organisation of self-protective strategies. Monographs of the Society for Research in Child Development, Serial No. 258, 64, 145–171, 1999.

    Article  Google Scholar 

  9. Dozier M., Chase Stovall K., Albus K.E.: Attachment and psychopathology in adulthood. In: Cassidy J., Shaver P.R. (Eds.), Handbook of attachment. Theory, research and clinical applications. London/New York, The Guilford Press, 1999, pp. 497–519.

    Google Scholar 

  10. Ainsworth M.D.S., Blehar M.C., Waters E., Wall S.: Patterns of attachment: a psychological study of the strange situation. Hillsdale, NJ, Laurence Erlbaum Associates Publishers, 1978.

    Google Scholar 

  11. Lyons-Ruth K., Jacobvitz D.: Attachment dizorganisation: unresolved loss, relational violence, and lapses in behavioral and attentional strategies. In: Cassidy J., Shaver P.R. (Eds.), Handbook of attachment. Theory, research, and clinical implications. London/New York, The Guilford Press, 1999, pp. 520–554.

    Google Scholar 

  12. Crittenden P.M.: Toward an integrative theory of trauma: a Dynamic-Maturational approach. In: Cicchetti D., Toth S. (Eds.), The Rochester Symposium on Developmental Psychopathology. Rochester, Rochester University Press, 1997, pp. 34–84.

    Google Scholar 

  13. Candelori C., Ciocca A.: Attachment and eating disorders. In: Bria P., Ciocca A., de Risio S. (Eds.), Psychotherapeutic issues on eating disorders. Rome, Società Editrice Universo, 1998, pp. 139–153.

    Google Scholar 

  14. Cole-Detke H., Kobak R.: Attachment processes in eating disorder and depression. J. Consult. Clin. Psychol., 64, 282–290, 1996.

    Article  PubMed  CAS  Google Scholar 

  15. Orzolek-Kronner C.: The effect of attachment theory in the development of eating disorders: can symptoms be proximity-seeking?. Child and Adolescent Social Work Journal, 19, 421–435, 2002.

    Article  Google Scholar 

  16. Wilkinson S.R.: Coping and complaining: attachment and the langauge of dis-ease. London, Routledge, 2003.

    Book  Google Scholar 

  17. Ramacciotti A., Sorbello M., Pazzagli A., Vismara L., Mancone A., Pallanti S.: Attachment processes in eating disorders. Eat. Weight Disord., 6, 166–170, 2001.

    PubMed  CAS  Google Scholar 

  18. Strober M., Yager J.: A developmental perspective on the treatment of anorexia nervosa in adolescence. In: Garner D.M., Garfinkel P.E. (Eds.), Handbook of psychotherapy for anorexia nervosa and bulimia. New York/London, The Guilford Press, 1985, pp. 363–390.

    Google Scholar 

  19. Serpell L., Troop N.: Psychological factors. In: Treasure J., Schmidt U., van Furth E. (Eds.), Handbook of eating disorders. Chichester, Wiley, 2003, pp. 151–167.

    Google Scholar 

  20. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition. Washington, D.C., American Psychiatric Association, 1994.

    Google Scholar 

  21. Fairburn C.G., Cooper Z.: The Eating Disorder Examination (12th edition). In: Fairburn C.G. (Ed.), Binge eating: nature, assessment and treatment. New York, The Guilford Press, 1993, pp. 317–331.

  22. Hesse E.: The Adult Attachment Interview. Historical and current perspectives. In: Cassidy J., Shaver P.R. (Eds.), Handbook of attachment. Theory, research, and clinical implications. London/New York, 6The Guilford Press, 1999, pp. 395–433.

    Google Scholar 

  23. Garner D.M.: Eating Disorder Inventory-2. Psychological Assessment Resources, Inc., Odessa, FL, 1991.

    Google Scholar 

  24. Nevonen L., Broberg A.G.: Validating the Eating Disorder Inventory-2 (EDI-2) in Sweden. Eat. Weight Disord., 6, 59–67, 2001.

    PubMed  CAS  Google Scholar 

  25. Derogatis L.R.: SCL-90: administration, scoring, and procedures manual. Baltimore, Clinical Psychometric Research, Inc., 1977.

    Google Scholar 

  26. Cohen J.: Statistical power analysis for the behavioral sciences, 2nd edition. Hillsdale, NJ, Lawrence Erlbaum Associates Publishers, 1988.

    Google Scholar 

  27. Eisler I., Le Grange D., Asen E.: Family interventions. In: Treasure J., Schmidt U., van Furth E. (Eds), Handbook of eating disorders. Chichester, Wiley, 2003, pp. 291–310.

    Google Scholar 

  28. Crittenden P.M.: Attachment and psychopathology. In: Goldber S., Muir R., Kerr J. (Eds.), Attachment theory. Social, developmental, and clinical perspectives. 1995, Hillsdale, NJ, The Analytic Press, pp. 367–406.

    Google Scholar 

  29. Belsky J., Fearon R.M.P.: Infant-mother attachment security, contextual risk, and early development: a moderational analysis. Dev. Psychopathol., 14, 293–310, 2002.

    Article  PubMed  Google Scholar 

  30. Schmidt U., Tiller J., Blanchard M., Andrews B., Treasure J.: Is there a specific trauma precipitating anorexia nervosa? Psychol. Med., 27, 523–530, 1997.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Henrik Daae Zachrisson Cand. Psychol. (Msc in Psychology).

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Zachrisson, H.D., Kulbotten, G.R. Attachment in anorexia nervosa: An exploration of associations with eating disorder psychopathology and psychiatric symptoms. Eat Weight Disord 11, 163–170 (2006). https://doi.org/10.1007/BF03327567

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