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Katznelson H, Daniel SIF, Poulsen S, Lunn S, Buhl-Nielsen B, Sjögren JM. Disturbances in the experiences of embodiment related to attachment, mentalization and self-objectification in anorexia nervosa. J Eat Disord 2021; 9:137. [PMID: 34688309 PMCID: PMC8542305 DOI: 10.1186/s40337-021-00463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/19/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Body image disturbance is central to both the understanding and treatment of anorexia nervosa (AN); however, the underlying psychological processes involved are still not well understood. One way towards a better understanding of these mechanisms may be to explore the sense of embodiment in these patients in an attempt at integrating the role of the body in our understanding of the development of self in AN. It is hypothesized that difficulties in affective experiences of embodiment is related to insecure attachment, deficits in mentalization and self-objectification. METHODS Sixteen inpatients with AN were interviewed with the Mirror Interview (MI). In the interview, the individual is asked a set of questions related to thoughts and feelings about the body while standing in front of a full-length mirror. Furthermore, all patients were assessed with the Adult Attachment Interview, which was coded for both attachment and mentalization (operationalized by the Reflective Functioning scale; RF). Self-objectification was measured with the Objectified Body Consciousness Scale (OBCS). RESULTS Results from a multiple regression analysis showed that Global MI scores were significantly associated with Coherence of mind as an indicator of attachment, RF and scores on the OBCS. CONCLUSIONS The study suggests that affective experiences of embodiment in patients with AN are associated with negative attachment representations, mentalizing impairments and objectified body consciousness. Body image disturbance is a key diagnostic feature in anorexia nervosa but the underlying psychological processes are poorly understood. Recently, there has been a growing interest in how disturbances in the more psychological experience of the body (embodiment) in anorexia nervosa is related to both attachment, how individuals make sense of both themselves and others and the degree to which they tend to experience ourselves from the outside. In this pilot study, this was assessed with an innovative interview, the Mirror Interview, where the individual is asked a set of question while standing in front of a full length mirror. Results showed that difficulties in embodied experiences in patients with anorexia nervosa were related to more fundamental representations of self and self-objectification. This has potential implications for both the understanding and treatment of anorexia nervosa, as disturbances in body image may be seen as an underlying factor in the development of an eating disorder.
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Affiliation(s)
- Hannah Katznelson
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| | | | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Lunn
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Bernadette Buhl-Nielsen
- Psychotherapy Clinic, Department of Child and Adolescent Psychiatry, Region Zealand, Denmark
| | - Jan Magnus Sjögren
- Unit for Eating Disorders, Capital Region of Copenhagen, Psychiatric Centre Ballerup, Ballerup, Denmark
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Puttevils L, Vanderhasselt MA, Horczak P, Vervaet M. Differences in the use of emotion regulation strategies between anorexia and bulimia nervosa: A systematic review and meta-analysis. Compr Psychiatry 2021; 109:152262. [PMID: 34265598 DOI: 10.1016/j.comppsych.2021.152262] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE Research has identified abnormal emotion regulation (ER) as an underlying mechanism in the onset and maintenance of eating disorders. Yet, it still remains unclear whether different forms of ER, adaptive and maladaptive strategies, are similar across categories of eating disorders. METHOD A systematic review and meta-analysis were carried out to look at ER differences between anorexia nervosa (AN) and bulimia nervosa (BN), two common eating disorder pathologies with different eating patterns. RESULTS 41 studies were included in the meta-analysis. The results revealed no differences in the use of maladaptive ER strategies between individuals with AN and BN, however patients with AN tend to use less adaptive ER strategies as compared to patients with BN. CONCLUSIONS Making less use of adaptive strategies in AN might be due to low body weight and high levels of alexithymia which define AN. In order to improve treatment outcome in individuals suffering from AN, these findings suggest to focus more on improving the use of adaptive ER strategies.
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Affiliation(s)
- Louise Puttevils
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium.
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Paula Horczak
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium
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3
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Monteleone AM, Ruzzi V, Patriciello G, Pellegrino F, Cascino G, Castellini G, Steardo L, Monteleone P, Maj M. Parental bonding, childhood maltreatment and eating disorder psychopathology: an investigation of their interactions. Eat Weight Disord 2020; 25:577-589. [PMID: 30734225 DOI: 10.1007/s40519-019-00649-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/28/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Childhood trauma and parental bonding have been widely recognized as risk factors for eating disorders (EDs). However, their interplay in determining ED psychopathology has been poorly investigated. Consequently, we have assessed their interaction with core ED psychopathological symptoms. METHODS Fifty-seven patients with anorexia nervosa, 43 with bulimia nervosa and 77 healthy women completed the Childhood Trauma Questionnaire, the Parental Bonding Instrument and the Eating Disorder Inventory-2. Chi square test and regression analyses with a moderation model were performed to investigate the interplay between childhood trauma, parental bonding and ED symptoms such as ineffectiveness, social insecurity, drive to thinness, interoceptive awareness, impulsivity and perfectionism. RESULTS Compared to controls, patients with EDs showed higher levels of trauma and parental control perception and lower levels of parental care. Childhood maltreatment was more prevalent in patients with the affectionless control parental style. Moderation analyses revealed that higher maternal control significantly predicted the ED symptom of social insecurity only when participants experienced lower levels of emotional abuse. CONCLUSIONS These findings demonstrate an interplay between deranged problematic parental bonding and childhood trauma in promoting a possible vulnerability to social insecurity, one of the most central dimensions of ED psychopathology. This interaction might have psychotherapeutic implications. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Alessio Maria Monteleone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy.
| | - Valeria Ruzzi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy
| | - Giuseppina Patriciello
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy
| | - Francesca Pellegrino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Giovanni Castellini
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Luca Steardo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Naples, Italy
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Cortés-García L, Takkouche B, Seoane G, Senra C. Mediators linking insecure attachment to eating symptoms: A systematic review and meta-analysis. PLoS One 2019; 14:e0213099. [PMID: 30845244 PMCID: PMC6405186 DOI: 10.1371/journal.pone.0213099] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/14/2019] [Indexed: 11/20/2022] Open
Abstract
In the last two decades, the number of studies focused on the mediators connecting insecure attachment with Eating Disorders (EDs), at both clinical and sub-clinical level, has considerably increased. However, there has not been a systematic synthesis of this literature to date. To fill this gap, the current meta-analytic review aimed at identifying and quantifying the extent to which mediators contribute to the explanation of this relationship. The present study was registered with PROSPERO (CRD42017076807). A comprehensive search process in seven different electronic databases retrieved 24 studies that examined how insecure attachment leads to ED symptoms through mediation analysis. Standardized regression coefficients of the indirect and total paths of 21 mediation models were pooled. Studies were coded and ranked for quality. We found evidence to show that maladaptive emotion regulation and depressive symptoms had the highest effect size for mediation (mediation ratio [PM] = 0.71). Further, body dissatisfaction, neuroticism, perfectionism, mindfulness and social comparison had significant, but moderate to low mediating effects (PM = 0.21–0.58). The methodological quality of these studies was mostly low to moderate and potential areas for development were highlighted. Our findings support the direct targeting of these psychological constructs in prevention programs and treatment of EDs. Future investigations addressing the time sequence between the variables will provide valuable clues to untangle the prospective contribution of each variable on the development and maintenance of eating pathology.
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Affiliation(s)
- Laura Cortés-García
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
- * E-mail:
| | - Bahi Takkouche
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
| | - Gloria Seoane
- Department of Social Psychology, Basic and Methodology, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Carmen Senra
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain
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Attachment and eating disorders: a research update. Curr Opin Psychol 2019; 25:59-64. [DOI: 10.1016/j.copsyc.2018.03.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/07/2018] [Accepted: 03/10/2018] [Indexed: 12/26/2022]
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Adult Attachment and Differentiation of Self-Constructs: A Possible Dialogue? CONTEMPORARY FAMILY THERAPY 2019. [DOI: 10.1007/s10591-019-09489-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sternheim LC, Fisher M, Harrison A, Watling R. Predicting intolerance of uncertainty in individuals with eating disorder symptoms. J Eat Disord 2017; 5:26. [PMID: 28883918 PMCID: PMC5580198 DOI: 10.1186/s40337-017-0152-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 05/10/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Intolerance of Uncertainty (IU) is recognized for its contribution to various psychopathologies, in particular anxiety and depression. Studies highlight the relevance of IU for Eating Disorders (EDs) however, potential factors contributing to IU in EDs remain unstudied. METHODS Three hundred and forty-nine women with ED symptoms and 214 individuals without ED symptoms were recruited and compared on levels of IU, insecure (anxious and avoidant) attachment styles, extraversion and openness. Secondly, the contribution of these factors to IU were tested. RESULTS Compared to the non-ED group, the ED group scored higher on IU, insecure attachment, and lower on extraversion and openness. Regression analyses confirmed that higher insecure attachment, and lower extraversion predicted higher IU scores in the ED group, and that insecure attachment predicted higher IU scores in the non-ED group. CONCLUSIONS Results confirm the relevance of IU to ED, and demonstrate that personality traits and insecure attachment styles contribute to IU in ED. Findings add to the growing literature on IU in ED and suggest that people with EDs may benefit from clinical interventions targeting IU.
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Affiliation(s)
- Lot C. Sternheim
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
- Social, Health and Organisation Psychology, Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Martin Fisher
- School of Psychotherapy & Psychology, Regent’s University London, London, UK
| | - Amy Harrison
- School of Psychotherapy & Psychology, Regent’s University London, London, UK
- Ellern Mede Service for Eating Disorders, London, UK
| | - Rosamond Watling
- School of Psychotherapy & Psychology, Regent’s University London, London, UK
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Kuipers GS, Hollander SD, van der Ark LA, Bekker MHJ. Recovery from eating disorder 1 year after start of treatment is related to better mentalization and strong reduction of sensitivity to others. Eat Weight Disord 2017. [PMID: 28643289 DOI: 10.1007/s40519-017-0405-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To investigate whether recovery from an eating disorder is related to pre-treatment attachment and mentalization and/or to improvement of attachment and mentalization during treatment. METHOD For a sample of 38 anorexia nervosa (AN) and bulimia nervosa (BN) patients receiving treatment the relations between attachment security, mentalization, comorbidity and recovery status after 12 months (not recovered or recovered), and after 18 months (persistently ill, relapsed, newly recovered, or persistently recovered) were investigated. Attachment security and mentalization were assessed by the Adult Attachment Interview at the start of the treatment and after 12 months. Besides assessing co-morbidity-for its effect on treatment outcome-we measured psycho-neuroticism and autonomy because of their established relations to both eating disorder symptoms and to attachment security. RESULTS Recovery both at 12 months and at 18 months was related to higher levels of mentalization; for attachment, no significant differences were found between recovered and unrecovered patients. Patients who recovered from AN or BN also improved on co-morbid symptoms: whereas pre-treatment symptom severity was similar, at 12 months recovered patients scored lower on co-morbid personality disorders, anxiety, depression, self-injurious behaviour and psycho-neuroticism than unrecovered patients. Improvement on autonomy (reduced sensitivity to others; greater capacity to manage new situations) in 1 year of treatment was significantly higher in recovered than in unrecovered patients. CONCLUSION A focus on enhancing mentalization in eating disorder treatment might be useful to increase the chances of successful treatment. Improvement of autonomy might be the mechanism of change in recovering from AN or BN. LEVEL OF EVIDENCE Level III cohort study.
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Affiliation(s)
- Greet S Kuipers
- Unit for Eating Disorders, GGZ Breburg, PO Box 770, 5000 AT, Tilburg, The Netherlands.
| | | | - L Andries van der Ark
- Research Institute of Child Development and Education, University of Amsterdam, PO Box 15776, 1001 NG, Amsterdam, The Netherlands
| | - Marrie H J Bekker
- Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
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Nancarrow A, Hollywood A, Ogden J, Hashemi M. The Role of Attachment in Body Weight and Weight Loss in Bariatric Patients. Obes Surg 2017; 28:410-414. [PMID: 28681263 PMCID: PMC5778169 DOI: 10.1007/s11695-017-2796-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose The aim of this study is to explore the role of attachment styles in obesity. Material and Methods The present study explored differences in insecure attachment styles between an obese sample waiting for bariatric surgery (n = 195) and an age, sex and height matched normal weight control group (n = 195). It then explored the role of attachment styles in predicting change in BMI 1 year post bariatric surgery (n = 143). Results The bariatric group reported significantly higher levels of anxious attachment and lower levels of avoidant attachment than the control non-obese group. Baseline attachment styles did not, however, predict change in BMI post surgery. Conclusion Attachment style is different in those that are already obese from those who are not. Attachment was not related to weight loss post surgery.
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Affiliation(s)
- Abigail Nancarrow
- Department of Clinical Health Psychology and Neuropsychology, St Georges University Hospital NHS Foundation Trust, London, UK
| | - Amelia Hollywood
- Health Services Research School of Pharmacy, Whiteknights, PO Box 226, Reading, RG6 6AP UK
| | - Jane Ogden
- Department of Psychology, University of Surrey, Guildford, GU2 7XH UK
| | - Majid Hashemi
- GI Services, University College London Hospital, Ground Floor West, 250 Euston Road, London, NW1 2PG UK
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Amianto F, Northoff G, Abbate Daga G, Fassino S, Tasca GA. Is Anorexia Nervosa a Disorder of the Self? A Psychological Approach. Front Psychol 2016; 7:849. [PMID: 27378967 PMCID: PMC4906654 DOI: 10.3389/fpsyg.2016.00849] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/20/2016] [Indexed: 01/26/2023] Open
Abstract
The debate concerning the pathogenesis and the maintaining factors of eating disorders, anorexia nervosa in particular, is ongoing especially since therapeutic interventions do not result in satisfactory and enduring rates of remission. This paper presents a model for the pathogenesis of eating disorders, based on the hypothesis of a deficiency in the development of the self. We present the theory in light of new evidence concerning the role of attachment insecurity in the development and maintenance of eating disorders. In particular, we define the self in eating disorders in a comprehensive way by taking into account recent evidence from experimental psychology and neurobiology. The paper considers the development of the self in terms of its synchronic (i.e., experienced in the moment) and diachronic (i.e., experienced as continuous over time) aspects. Both synchronic and diachronic aspects of the self are relevant to the expression of eating disorder symptoms. Further, the maturation of the self is interwoven with the development of attachment functioning from infancy to adolescence. This interplay between these developmental processes of the self and of attachment could be crucial in understanding the pathogenesis of eating disorders. The final part of the paper suggests a neurobiological link between the theory of the self in the eating disorders and the spatiotemporal functioning of the brain. Disturbances in spatiotemporal functioning may represent the neurobiological pathway by which deficiencies in the self is related to attachment functions in individuals with eating disorders.
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Affiliation(s)
- Federico Amianto
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa ON, Canada
| | - Giovanni Abbate Daga
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Secondo Fassino
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Giorgio A Tasca
- Psychology, The Ottawa Hospital, University of Ottawa, Ottawa ON, Canada
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Pennesi JL, Wade TD. A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions? Clin Psychol Rev 2016; 43:175-92. [PMID: 26781985 DOI: 10.1016/j.cpr.2015.12.004] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/09/2015] [Accepted: 12/20/2015] [Indexed: 12/21/2022]
Abstract
Despite significant advances in the development of prevention and treatment interventions for eating disorders and disordered eating over the last decade, there still remains a pressing need to develop more effective interventions. In line with the 2008 Medical Research Council (MRC) evaluation framework from the United Kingdom for the development and evaluation of complex interventions to improve health, the development of sound theory is a necessary precursor to the development of effective interventions. The aim of the current review was to identify the existing models for disordered eating and to identify those models which have helped inform the development of interventions for disordered eating. In addition, we examine the variables that most commonly appear across these models, in terms of future implications for the development of interventions for disordered eating. While an extensive range of theoretical models for the development of disordered eating were identified (N=54), only ten (18.5%) had progressed beyond mere description and to the development of interventions that have been evaluated. It is recommended that future work examines whether interventions in eating disorders increase in efficacy when developed in line with theoretical considerations, that initiation of new models gives way to further development of existing models, and that there be greater utilisation of intervention studies to inform the development of theory.
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Kuipers GS, van Loenhout Z, van der Ark LA, Bekker MHJ. Attachment insecurity, mentalization and their relation to symptoms in eating disorder patients. Attach Hum Dev 2016; 18:250-72. [PMID: 26812372 DOI: 10.1080/14616734.2015.1136660] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the relationships of attachment security and mentalization with core and co-morbid symptoms in eating disorder patients. METHOD We compared 51 eating disorder patients at the start of intensive treatment and 20 healthy controls on attachment, mentalization, eating disorder symptoms, depression, anxiety, personality disorders, psycho-neuroticism, autonomy problems and self-injurious behavior, using the Adult Attachment Interview, the SCID-I and II and several questionnaires. RESULTS Compared with the controls, the eating disorder patients showed a higher prevalence of insecure attachment; eating disorder patients more often than controls received the AAI classification Unresolved for loss or abuse. They also had a lower level of mentalization and more autonomy problems. In the patient group eating disorder symptoms, depression, anxiety, psycho-neuroticism and autonomy problems were neither related to attachment security nor to mentalization; self-injurious behavior was associated with lesser attachment security and lower mentalization; borderline personality disorder was related to lower mentalization. In the control group no relations were found between attachment, mentalization and psychopathologic variables. DISCUSSION Eating disorder patients' low level of mentalization suggests the usefulness of Mentalization Based Treatment techniques for eating disorder treatment, especially in case of self-injurious behavior and/or co-morbid borderline personality disorder.
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Affiliation(s)
- Greet S Kuipers
- a GGZ Breburg, Unit for Eating Disorders , Tilburg , The Netherlands
| | - Zara van Loenhout
- a GGZ Breburg, Unit for Eating Disorders , Tilburg , The Netherlands
| | - L Andries van der Ark
- b Research Institute of Child Development and Education , University of Amsterdam , Amsterdam , The Netherlands
| | - Marrie H J Bekker
- c Department of Medical and Clinical Psychology , Tilburg University , Tilburg , The Netherlands
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Compare A, Tasca GA. The Rate and Shape of Change in Binge Eating Episodes and Weight: An Effectiveness Trial of Emotionally Focused Group Therapy for Binge-Eating Disorder. Clin Psychol Psychother 2014; 23:24-34. [DOI: 10.1002/cpp.1932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Angelo Compare
- Human and Social Science; University of Bergamo and Human Factors and Technology in Healthcare Research Centre; Bergamo Italy
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Tasca GA, Balfour L. Attachment and eating disorders: a review of current research. Int J Eat Disord 2014; 47:710-7. [PMID: 24862477 DOI: 10.1002/eat.22302] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Attachment insecurity may confer risk for developing an eating disorder. We describe domains of attachment functioning that are relevant to eating disorders including: affect regulation, interpersonal style, coherence of mind, and reflective functioning. Research since 2000 on attachment and eating disorders related to these domains is reviewed. METHOD We searched MedLine/Pubmed and PsycINFO from January 2000 to February 2014 and kept articles that: were empirical, included adults with a diagnosed eating disorder, and used a standard attachment measure. We retained 50 relevant studies. RESULTS Compared to controls, those with eating disorders had higher levels of attachment insecurity and disorganized mental states. Lower reflective functioning was specifically associated with anorexia nervosa. Attachment anxiety was associated with eating disorder symptom severity, and this relationship may be mediated by perfectionism and affect regulation strategies. Type of attachment insecurity had specific negative impacts on psychotherapy processes and outcomes, such that higher attachment avoidance may lead to dropping out and higher attachment anxiety may lead to poorer treatment outcomes. DISCUSSION Research to date suggests a possible relationship between attachment insecurity and risk for an eating disorder. More research is needed that uses attachment interviews, and longitudinal and case control designs. Clinicians can assess attachment insecurity to help inform therapeutic stances and interventions.
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Affiliation(s)
- Giorgio A Tasca
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Delvecchio E, Di Riso D, Salcuni S, Lis A, George C. Anorexia and attachment: dysregulated defense and pathological mourning. Front Psychol 2014; 5:1218. [PMID: 25389412 PMCID: PMC4211560 DOI: 10.3389/fpsyg.2014.01218] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/08/2014] [Indexed: 11/13/2022] Open
Abstract
The role of defensive exclusion (Deactivation and Segregated Systems) in the development of early relationships and related to subsequent manifestations of symptoms of eating disorders was assessed using the Adult Attachment Projective Picture System (AAP). Fifty-one DSM-IV diagnosed women with anorexia participated in the study. Anorexic patients were primarily classified as dismissing or unresolved. Quantitative and qualitative analyses of defensive exclusion were carried out. Results showed potential benefits of using the AAP defense exclusion coding system, in addition to the main attachment classifications, in order to better understand the developmental issues involved in anorexia. Discussion concerned the processes, such as pathological mourning, that may underlie the associations between dismissing and unresolved attachment and anorexia. Implications for developmental research and clinical nosology are discussed.
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Affiliation(s)
- Elisa Delvecchio
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università di PadovaPadua, Italy
| | - Daniela Di Riso
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università di PadovaPadua, Italy
| | - Silvia Salcuni
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università di PadovaPadua, Italy
| | - Adriana Lis
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università di PadovaPadua, Italy
| | - Carol George
- Department of Psychology, Mills CollegeOakland, CA, USA
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The association between adult attachment style, mental disorders, and suicidality: findings from a population-based study. J Nerv Ment Dis 2013; 201:579-86. [PMID: 23817155 DOI: 10.1097/nmd.0b013e31829829ab] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Attachment theory categorically assesses how a person perceives and experiences interpersonal relationships. Attachment style is linked to numerous physical and psychological phenomena; however, there is a paucity of research examining its relationship to suicide ideation and attempt in adults. Our study addresses this and investigates the relationship of adult attachment style and mental disorders in a nationally representative sample. Using data from the National Comorbidity Survey Replication (N = 5692, aged >18 years), multiple logistic regression analyses were conducted to examine these relationships. After adjusting for confounding variables, insecure attachment styles were associated with greater reporting of suicidal ideation, attempt, and all mental disorder categories analyzed (adjusted odds ratio range, 1.13-1.81). Secure attachment styles were associated with a decreased likelihood of reporting suicidal ideation, attempt, and any anxiety disorder (adjusted odds ratio range, 0.67-0.91). Clinicians should be aware of attachment issues in their patients to ensure better health outcomes and more effective physician-patient relationships.
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Park JY, Baek SY, Kim HS, Lim JH, Kim TH. Testing the Biobehavioral Family Model in Understanding the Eating Problems of Adolescent Girls. CHILD HEALTH NURSING RESEARCH 2013. [DOI: 10.4094/chnr.2013.19.3.228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Su-Yon Baek
- College of Nursing, Yonsei University, Seoul, Korea
| | - Hee-Soon Kim
- College of Nursing·Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Jung-Ha Lim
- Department of Home Economics Education, College of Education, Korea University, Seoul, Korea
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Goossens L, Braet C, Van Durme K, Decaluwé V, Bosmans G. The Parent–Child Relationship as Predictor of Eating Pathology and Weight Gain in Preadolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 41:445-57. [DOI: 10.1080/15374416.2012.660690] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Pace U, Cacioppo M, Schimmenti A. The moderating role of father's care on the onset of binge eating symptoms among female late adolescents with insecure attachment. Child Psychiatry Hum Dev 2012; 43:282-92. [PMID: 22076662 DOI: 10.1007/s10578-011-0269-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The present study examined the association between quality of attachment, perception of the father's bond, and binge eating symptoms in a sample of female late adolescents. In total, 233 female students aged between 18 and 20 years completed measures on binge eating, quality of attachment and parent-child relationship. Data showed that respondents with binge symptoms reported lower scores on secure attachment and father's care, and higher scores on preoccupied and fearful attachment. Binge eating symptoms were associated with father's care, but not with father's overprotection. Also, binge symptoms were negatively associated with secure attachment styles, and positively with preoccupied and fearful attachment. The data, finally, provided evidence that at higher levels of preoccupied attachment, the impact of binge symptoms tended to be lower when father's care was high.
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Affiliation(s)
- Ugo Pace
- Department of Human and Social Science, Kore University of Enna, Enna, Italy.
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Abstract
The relative contribution of genetic and environmental influences to individual differences in attachment security is still incompletely understood. We assessed attachment style with the Experiences in Close Relationships questionnaire in a volunteer sample of 677 twins (43% male) ages 23-24 years drawn from the population-based Italian Twin Register, who belonged to 244 complete pairs (46% monozygotic) and 189 unmatched pairs. Genetic structural equation modeling was performed with the Mx program. Genetic effects accounted for 45% and 36% of individual differences in attachment-related anxiety and avoidance, respectively. Furthermore, the covariation between anxiety and avoidance was found to be mainly due to genetic factors, with heritability of the latent attachment security phenotype estimated at 62%. Unshared environmental factors explained the remaining proportion of variance. Although our findings are best regarded as preliminary given some study limitations, they suggest that both nature and nurture contribute to individual differences in adult attachment.
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Affiliation(s)
- Angelo Picardi
- Mental Health Unit, Center of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy.
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Goossens L, Braet C, Bosmans G, Decaluwé V. Loss of control over eating in pre-adolescent youth: the role of attachment and self-esteem. Eat Behav 2011; 12:289-95. [PMID: 22051362 DOI: 10.1016/j.eatbeh.2011.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 05/31/2011] [Accepted: 07/19/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study aimed to add to the limited literature on the role of self-esteem and attachment for the explanation of loss of control over eating (LC) among pre-adolescent boys and girls. METHOD Self-report questionnaires were administered to a community sample of 555 children (8-11 years; 47% female). RESULTS Children reporting LC (17.6% of the sample) were characterized by a lower self-esteem and less secure attachment toward both of their parents. No gender differences emerged. Moreover, the relation between self-esteem and LC was fully mediated by attachment toward mother and partially mediated by attachment toward father. DISCUSSION The present study provides preliminary evidence for the idea that the influence of self-esteem on LC seems to operate through a third variable that is an insecure relationship with the parents. Longitudinal research is needed to further elucidate the influence of interpersonal factors on the development of LC.
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Affiliation(s)
- Lien Goossens
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium.
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Demidenko N, Tasca GA, Kennedy N, Bissada H. The Mediating Role of Self-Concept in the Relationship Between Attachment Insecurity and Identity Differentiation Among Women with an Eating Disorder. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2010. [DOI: 10.1521/jscp.2010.29.10.1131] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Attachment insecurity predicts eating disorder symptoms and treatment outcomes in a clinical sample of women. J Nerv Ment Dis 2010; 198:653-9. [PMID: 20823727 DOI: 10.1097/nmd.0b013e3181ef34b2] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined the extent to which attachment insecurity was related to eating disorder (ED) symptoms, and predictive of treatment outcomes. Women diagnosed with anorexia nervosa (AN) restricting subtype (ANR), AN binge purge subtype (ANB), or bulimia nervosa (BN) completed an attachment scale pretreatment, and ED symptom scales pretreatment (N = 243) and post-treatment (N = 157). A comparison sample of 126 non-ED women completed attachment scales on 1 occasion. Those with EDs had significantly higher attachment insecurity than non-ED. ANB was associated with higher attachment avoidance compared with ANR and BN, and higher attachment anxiety compared with BN. Higher attachment anxiety was significantly related to greater ED symptom severity and poorer treatment outcome across all EDs even after controlling for ED diagnosis. Attachment dimensions substantially contribute to our understanding of ED symptoms and treatment outcome. Addressing attachment insecurity when treating those with EDs may improve treatment outcomes.
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Zachrisson HD, Skårderud F. Feelings of insecurity: review of attachment and eating disorders. EUROPEAN EATING DISORDERS REVIEW 2010; 18:97-106. [PMID: 20148392 DOI: 10.1002/erv.999] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Attachment theory has received increasing attention from clinicians and researchers in the field of eating disorders. This paper is an updated review on theoretical approaches in the field, and of studies employing the Adult Attachment Interview. METHOD We searched the major databases such as PsycInfo and Science Direct for empirical and theoretical studies on attachment and eating disorders, and these are reviewed. RESULTS Theoretical approaches on attachment and eating disorders highlight either retrospective, general risk or attachment theoretical statements. There is greater prevalence of insecure attachment in the eating disordered population than in non-clinical samples. However, there is no sufficient evidence to conclude about specific mechanisms for this connection. DISCUSSION The theoretical approaches vary in their theoretical grounding, specificity and empirical support. AAI-based research on attachment and eating disorders is still at an early stage. More advanced studies are required for the field to move forward.
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Affiliation(s)
- Henrik Daae Zachrisson
- Regional Department for Eating Disorders, Oslo University Hospital, Ullevål, Oslo, Norway.
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Tasca GA, Szadkowski L, Illing V, Trinneer A, Grenon R, Demidenko N, Krysanski V, Balfour L, Bissada H. Adult attachment, depression, and eating disorder symptoms: The mediating role of affect regulation strategies. PERSONALITY AND INDIVIDUAL DIFFERENCES 2009. [DOI: 10.1016/j.paid.2009.06.006] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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O'Shaughnessy R, Dallos R. Attachment research and eating disorders: a review of the literature. Clin Child Psychol Psychiatry 2009; 14:559-74. [PMID: 19759074 DOI: 10.1177/1359104509339082] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this article is to review the clinical literature which examines the association between attachment patterns and eating disorders with a focus on anorexia nervosa, and to examine the varieties of methods and measures employed in attachment research. A literature review was carried out and the relevant articles are examined in terms of their contribution to this area. The literature indicates a number of important considerations when working with this group, including extreme separation anxiety and unresolved loss and trauma, and discusses the implications of these findings for treatment. The results also indicate conflicting evidence regarding associations between attachment style and eating disorder subgroup suggesting that severity of disorder matters more than eating disorder subtype. The different ways of investigating attachment patterns and experiences are explored in this paper. It is suggested that the attachment classification system runs the risk of reducing complex human experience to typologies and that qualitative research might help to address this problem.
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Affiliation(s)
- Ruth O'Shaughnessy
- Child and Adolescent Mental Health Service at Alder Hey Children's Hospital, Liverpool, UK.
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Langenbach M, Subic-Wrana C. Conscious and unconscious identification of female anorectic patients in in-patient psychotherapy. PSYCHODYNAMIC PRACTICE 2009. [DOI: 10.1080/14753630902811326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- Giorgio A Tasca
- University of Ottawa, Regional Centre for Eating Disorders, The Ottawa Hospital, 501 Smyth Road, Box 400, Ottawa, ON, Canada K1H 8L6.
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