Adult attachment, depression, and eating disorder symptoms: The mediating role of affect regulation strategies

Reduction of peripersonal comfort space correlate with eating disorder symptoms in young adolescents: a network analysis approach

Background

Peripersonal Space (PS) is represented as the immediate area surrounding an individual. The extent of PS changes in relation to several factors, including emotional states, type of relationship or psychopathology. Attachment anxiety has an impact on the social adaptability of peripersonal space and anxiety and fear are associated with an expansion of peripersonal space, possibly serving as a mechanism of self-protection. Peripersonal space appears to be intricately linked to various psychiatric conditions like anxiety disorders and converging evidence suggests that social maladjustment may predict or exacerbate eating disorder symptoms expression.

Methods

Fifty-eight healthy adolescents (38F, 20M) performed a comfort distance estimation task to assess peripersonal space. The Adolescent/Adult Sensory Profile (AASP) was used to assess sensory profiles and the SAFA protocol to investigate psychopathological aspects. Data was analysed using Network Analysis, estimating a Gaussian Graphical Models with a Bayesian approach.

Results

We found that the task related to comfort estimation distance demonstrated a correlation with the visual scale of the Adolescent/Adult Sensory Profile (AASP). Additionally, a correlation was observed with the Eating Disorder scale of the SAFA protocol. The touch scale also was negatively correlated with Eating disorder symptoms but not with the comfort estimation task.

Conclusion

Our results demonstrate a relation between peripersonal space and eating disorder symptoms in healthy adolescents in line with previous findings in adults with eating disorders diagnosis. These findings suggest that socio-emotional difficulties may be possible precursors or reinforce for the development of an eating disorder symptoms.

Insecure attachment and eating disorder symptoms: Intolerance of uncertainty and emotion regulation as mediators

OBJECTIVE

Literature on eating disorder (ED) symptoms of Black, Indigenous, and People of Color (BIPOC) group is extremely scarce. This study aimed to understand the mechanisms underlying the associations between insecure attachment and ED symptoms and examine whether these mechanisms differed between White and BIPOC groups.

METHOD

The study investigated direct and indirect relationship between attachment anxiety/avoidance and ED symptoms via intolerance of uncertainty (IU) and emotion regulation strategies of suppression and reappraisal. Further, we examined whether the proposed mechanisms equally represented White versus BIPOC using Multigroup Structural Equation Model (MG-SEM). A total of 1227 college students (48.50% BIPOC and 51.50% White) completed research questionnaires.

RESULTS

Results showed that IU and suppression mediated the relations between insecure attachment and ED symptoms for both White and BIPOC groups. Uniquely, reappraisal mediated the relations between insecure attachment and ED symptoms for the White group, but not for the BIPOC group.

DISCUSSION

The implications of the findings for culturally informed practice are discussed, including targeting increasing tolerability of uncertainties and improving emotion regulation to mitigate ED symptoms for those with insecure attachment.

Does adult attachment mediate the relationship between primary emotion traits and eating disorder symptoms?

Objectives

Primary emotion traits and attachment patterns, have been linked to various mental disorders. This study aims to shed more light on the less studied relationship with eating disorder (ED) symptoms.

Methods

A total of 921 non-clinical subjects (69.9% females) were assessed for primary emotions traits (B-ANPS-GL), attachment insecurity (ECR-RD8), and eating disorder pathology (EDE-Q8). A theoretically derived model was evaluated by means of a path analysis with attachment anxiety as assumed mediator variable.

Results

Global problematic eating behavior showed negative correlations with the positive emotions PLAY, CARE, and LUST (r = -0.10 to -0.24), positive correlations with the negative primary emotions ANGER, FEAR, and SADNESS (r = 0.12-0.27), as well as with attachment anxiety (r = 0.22, all p < 0.01). Path analyses revealed direct effects between eating behavior pathology with LUST (β = -0.07 to -0.15) and FEAR (β = 0.12-0.19; all p < 0.05). The association of SADNESS and Weight (β = 0.05) and Shape Concern (β = 0.06, p < 0.001) was fully mediated by attachment anxiety. Overall, the path model explained 17% of the variance for attachment anxiety and 6% of the Restraint, 13% for Eating, 10% for Weight and 14% for Shape Concern Subscales.

Discussion

The findings shed light on the multifactorial relationship between affective traits, attachment security, and eating disorder pathology. In line with previous research, the results emphasize the role of attachment and affective functioning in ED symptoms.

Exploring effectiveness of CBT in obese patients with binge eating disorder: personality functioning is associated with clinically significant change

BACKGROUND

Binge eating disorder (BED), as the most prevalent eating disorder, is strongly related to obesity and other somatic and psychiatric morbidity. Despite evidence-based treatments a considerable number of BED patients fail to recover. There is preliminary evidence for the association between psychodynamic personality functioning and personality traits on treatment outcome. However, research is limited and results are still contradictory. Identifying variables associated with treatment outcome could improve treatment programs. The aim of the study was to explore whether personality functioning or personality traits are associated with Cognitive Behavioral Therapy (CBT) outcome in obese female patients with BED or subthreshold BED.

METHODS

Eating disorder symptoms and clinical variables were assessed in 168 obese female patients with DSM-5 BED or subthreshold BED, referred to a 6-month outpatient CBT program in a pre-post measurement design. Personality functioning was assessed by the Developmental Profile Inventory (DPI), personality traits by the Temperament and Character Inventory (TCI). Treatment outcome was assessed by the Eating Disorder Examination-Questionnaire (EDE-Q) global score and self-reported binge eating frequency. According to the criteria of clinical significance, 140 treatment completers were categorized in four outcome groups (recovered, improved, unchanged, deteriorated).

RESULTS

EDE-Q global scores, self-reported binge eating frequency and BMI significantly decreased during CBT, where 44.3% of patients showed clinically significant change in EDE-Q global score. Treatment outcome groups showed significant overall differences on the DPI Resistance and Dependence scales and the aggregated 'neurotic' scale. Significant overall differences were found between groups on TCI Harm avoidance, although post hoc t-tests were non-significant. Furthermore, multiple logistic regression analysis, controlling for mild to moderate depressive disorder and TCI harm avoidance showed that 'neurotic' personality functioning was a significant negative predictor of clinically significant change.

CONCLUSION

Maladaptive ('neurotic') personality functioning is significantly associated with a less favorable outcome after CBT in patients with binge eating. Moreover, 'neurotic' personality functioning is a predictor of clinically significant change. Assessment of personality functioning and personality traits could support indication for more specified or augmented care, tailored towards the patients' individual strengths and vulnerabilities.

TRIAL REGISTRATION

This study protocol was retrospectively evaluated and approved on 16-06-2022 by the Medical Ethical Review Committee (METC) of the Amsterdam Medical Centre (AMC). Reference number W22_219#22.271.

Negative childhood events and the development of the anorexic voice: A grounded theory

BACKGROUND

Many individuals diagnosed with anorexia nervosa (AN) describe their disorder as being represented by an internal 'anorexic voice' (AV). Previous studies have identified associations between eating psychopathology and multifarious forms of adverse life experiences.

AIMS

This study explores the relationship between adverse experiences in childhood and the development of the AV.

MATERIALS AND METHODS

Twelve women who had the experience of the AV in the context of a diagnosis of AN took part in semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology.

RESULTS

Participants recalled feeling unsafe in a variety of relationships and a theory was constructed in which the AV provides a sense of conditional safety, becoming increasingly hostile and belittling when it is disobeyed, revealing similar characteristics to abusers and bullies in childhood.

DISCUSSION

Findings are related to the broader literature on the link between trauma and eating disorders, and to existing theories of internal voices.

CONCLUSIONS

The findings have implications for a trauma-focused approach when working with the AV.

ДЕВІАНТНА СПЕЦИФІКА САМОСВІДОМОСТІ ЛЮДИНИ З ХАРЧОВОЮ АДИКЦІЄЮ: ТЕОРЕТИЧНИЙ РАКУРС ПРОБЛЕМИ

Мета. У статті здійснено теоретичний аналіз психологічних особливостей  самосвідомості особистості з харчовою адикцією, зокрема в ракурсі девіантності. Методи. Для реалізації мети дослідження було задіяно методи наукового теоретичного вивчення : аналіз, синтез, абстрагування, узагальнення. Результати. Огляд науково-психологічної джерелознавчої бази дав змогу констатувати, що проблема адиктивної харчової поведінки особистості дуже ускладнено впливає на її самоусвідомлення і тісно поєднана з девіантністю. Людина з харчовою адикцією піддається негативній стереотипізації, кепкуванню, гандикапізму, сегрегації та іншим принизливим ставленням. Це може накладати на неї травмогенну стигму і спонукати до усамітнення, самовтечі або й девіантних моделей поведінки. Харчова адикція корелює з харчовою депривацією та супроводжується численними особистісними комплексами і проявами, нервово-психічною анорексією, булімією, компульсивним переїданням тощо. Розлади харчової поведінки співмірні з патогенністю, зумовлюють виникнення амбівалентності, когнітивно-афективної розбалансованості, що загалом негативно впливає на якість самоусвідомлення та самореалізації в мікро- і макросоціумі. Висновки. У контексті вивчення девіантної поведінки людини окреме вагоме місце займають Харчові адикції істотно ускладнюють особистісну психо- і соціогенезу людини. Самоусвідомлення особистості з харчовими розладами відбувається дуже специфічно і проблемно, оскільки заторкується базовий людський інстинкт до їжі, тому типовими є перепади самооцінки, хисткість самоакцептації, дифузність самототожнення тощо. У стимулюванні девіантно-адиктивного вектору споживання, ідентифікації та самореалізації особистості досить часто маніпулятивну роль відіграє реклама харчових продуктів. Харчові адикції блокують повноцінне самоусвідомлення, зокрема позитивне самоосмислення та самоприйняття особистістю своєї тілесності, та зазвичай негативно впливають на її психофізичне здоров’я.

State of Mind Assessment in Relation to Adult Attachment and Text Analysis of Adult Attachment Interviews in a Sample of Patients with Anorexia Nervosa

BACKGROUND

Attachment theory represents one of the most important references for the study of the development of an individual throughout their life cycle and provides the clinician with a profound key for the purposes of understanding the suffering that underlies severe psychopathologies such as eating disorders. As such, we conducted a cross-sectional study with a mixed-methods analysis on a sample of 32 young women with anorexia nervosa (AN); this study was embedded in the utilized theoretical framework with the following aims: 1. to evaluate the state of mind (SoM) in relation to adult attachment, assuming a prevalence of the dismissing (DS) SoM and 2. to analyze the linguistic attachment profile emerging from the transcripts of the AAIs.

METHODS

Interviews were transcribed verbatim, coded, and analyzed using the linguistic inquiry and word count (LIWC) method.

RESULTS

The results were observed to be consistent with the referenced literature. The prevalence of a DS SoM (68.75%) is observed in the study sample, whereas the results of the lexical analysis of the stories deviate from expectations. Notably, the lexical results indicate the coexistence of the dismissing and entangled aspects at the representational level.

CONCLUSIONS

The study results suggest a high level of specificity in the emotional functioning of patients with AN, with a focusing on a pervasive control of emotions that is well illustrated by the avoidant/ambivalent (A/C) strategy described in Crittenden's dynamic-maturational model. These findings and considerations have important implications for clinical work and treatment, which we believe must be structured on the basis of starting from a reappraisal of emotional content.

The Relationship Between Attachment and Self-Injurious Behaviors in the Child and Adolescent Population: A Systematic Review of the Literature

Adolescents have high rates of self-injurious behavior (SIB), with suicide being the second leading cause of death. A consistent relationship between individual attachment and SIB was previously found in adult population; however, no such review has been undertaken for the child and adolescent population. A systematic search of PubMED, OVID, and PsychINFO up to March 31, 2020 was performed. Twenty-two articles met the inclusion criteria. Of the 22 articles, 21 found a positive association between attachment insecurity and SIB. Our results show a consistent relationship between attachment insecurity and SIB in children and adolescents, complementing the results found in the adult literature. These findings make a case for preventive strategies aimed at reducing self-injurious behaviors in youth by targeting attachment security.

Psychological Correlates of Excessive Healthy and Orthorexic Eating: Emotion Regulation, Attachment, and Anxious-Depressive-Stress Symptomatology

Orthorexia nervosa, the pathological obsession with eating healthy, shares risks and significant comorbidity with other mental disorders. Based on a behavioral conceptualization of the overlap, emotion regulation, attachment style, and anxious-depressive-stress symptomatology are prominent but insufficiently researched endophenotypes for orthorexia nervosa. This study aimed at identifying ways in which difficulties in emotion regulation and attachment-related anxiety and avoidance become apparent in orthorexia nervosa and healthy orthorexia. Additionally, the moderating role of anxious, depressive, and stress symptoms was explored. A convenience sample of 399 adults (266 women) completed questionnaires to measure orthorexia nervosa and healthy orthorexia, difficulties in emotion regulation, partnership-related bond, and anxious-depressive-stress symptomatology. The healthy orthorexia subscale was negatively associated with lack of emotional awareness but no other subscale of difficulties in emotion regulation or attachment-related anxiety and avoidance. Orthorexia nervosa scores were positively linked to difficulties in emotion regulation as well as attachment-related anxiety and avoidance. Multiple linear regression indicated non-acceptance of emotional responses and impulse control difficulties to be the strongest predictors for orthorexia nervosa. Both subscales also mediated the effects of attachment style on orthorexia nervosa with anxious-depressive-stress symptomatology moderating some of these effects. Individuals with higher orthorexia nervosa tendencies showed difficulties in emotion regulation, a common feature also of affective and eating disorders. Improvement in understanding the psychological features of orthorexia nervosa can enable a better differentiation from other disorders, advances in the development of treatment approaches and treatment planning, and outlines directions for future research on mechanisms.

The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach

Background

Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology.

Methodology

A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency.

Results

The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI.

Discussion

The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.

Alexithymia and Parental Bonding in Women with Genitopelvic Pain/Penetration Disorder

OBJECTIVE

The role of emotion regulation and alexithymia in the pathophysiology of genitopelvic pain/penetration disorder (GPPPD) is emphasized. Parental bonding is linked to emotion regulation and alexithymia. This study aimed to examine the relationships between parental bonding, alexithymia, and GPPPD.

PATIENTS AND METHODS

Sixty-four patients with GPPPD were enrolled in the study, and 60 controls were matched for demographic features. Toronto Alexithymia Scale (TAS-20) was used to evaluate alexithymia, the Bonding to Parents Scale (BPS) was used to assess parental bonding, and sexual functions were assessed via Golombok-Rust Inventory of Sexual Satisfaction (GRISS).

RESULTS

The rate of alexithymic traits was statistically higher in the GPPPD group than in the controls (p = 0.005). Patients with GPPPD obtained higher scores on the maternal care/control (p = 0.003) and maternal overprotection (p = 0.008) compared to controls. Difficulty describing feelings factor of alexithymia (p = 0.012) emerged as a predictor of group membership (GPPPD vs controls). To test whether alexithymia was significantly associated with parental bonding, all subjects were divided into two subgroups, alexithymic and non-alexithymic. When the subgroups were compared in terms of parental attitudes, maternal (p = 0.034) and paternal (p = 0.006) overprotection subscale scores were higher in the alexithymic group than in the non-alexithymic group.

DISCUSSION

According to the results, alexithymic traits are characteristic of patients with GPPPD; however, although patients with GPPPD may experience difficulties with perceived parental bonding, this factor does not appear to be a predictor of GPPPD.

Mediating Mechanisms of Perfectionism: Clinical Comorbidity of OCD and ED

Obsessive-compulsive disorder (OCD) and eating disorders (ED) share common causal factors and often represent similar entities. Studies on obsessive-compulsive disorders and eating disorders reveal a significant correlation between maladaptive perfectionism. The objective of this study is to evaluate the predictive variables of perfectionism in patients diagnosed with Anorexia Nervosa (AN), Bulimia Nervosa (BN) and OCD using a structural equation model (SEM). The sample consisted of 187 participants (60.9% women, 39.1% men) with a mean age of 26.68 (SD = 10.97). The findings reveal that the model is the same in all the disorders evaluated, achieving an adequate fit: χ2 = 7.95 (p = 0.000), RMSEA = 0.087 (95% confidence interval: 0.00 to 0.02), CFI = 0.991, TLI = 0.951 and with an overall predictive capacity of around 30% (CD = 0.318). It is recommended that future studies address the subtypes of disorders evaluated using longitudinal designs.

The vulnerability of insecure minds: The mediating role of mentalization in the relationship between attachment styles and psychopathology

Insecure attachment is linked to mentalizing difficulties and psychopathology. The current study aimed to examine if failures in mentalization, as observed in the form of uncertainty about mental states, mediated the relationship between attachment styles and global psychopathology in a group of 812 adults (66.5% females) from the community. Participants completed measures on attachment styles, uncertainty about mental states, and clinical symptoms. The authors found that uncertainty about mental states was a partial mediator of the associations between attachment styles and psychopathology. Furthermore, the findings supported the role of secure attachment in protecting from mentalization failures and psychopathology; on the contrary, increased scores on attachment styles involving a negative view of the self (preoccupied and fearful attachment styles) predicted high levels of uncertainty about mental states and psychopathology. Accordingly, clinicians may wish to promote mentalizing abilities in individuals who display a negative view of the self embedded in their attachment styles.

A cross-cultural study of the effect of parental bonding on the perception and response to criticism in Singapore, Italy and USA

Parents play a primary and crucial role in emotional socialisation processes in children where individuals learn the expression, understanding and regulation of emotions. Parenting practices and dimensions of the parent-child relationship have been associated with social and emotional processes in children. As criticism involves negative emotional reactions and emotion regulation, the parent-child relationship is likely to influence an individual's perception and response to criticism. Hence, the present study investigated the relationship of parental bonding and the perception and response to criticism in three different countries-Singapore, Italy and USA. Adult participants (n = 444) completed the Parental Bonding Inventory (PBI) and measures of criticism. Parental care, overprotection and country were found to be significant predictors of a tendency to perceive criticism as destructive. Higher levels of parental care predicted a lower tendency to perceive criticism as destructive while higher levels of parental overprotection predicted a higher tendency to perceive criticism as destructive. US American participants were found to have a significantly higher tendency to perceive criticism as destructive compared to Italian and Singaporean participants. The findings align with past research on the role of the parent-child relationship in the socio-emotional development of children as well as providing insight into a specific aspect in social interaction; perception and response to criticism, being affected. Future studies can look to investigate this relationship further in different countries in light of cultural variation in parenting styles and emotion experience, expression and regulation.

Self-Compassion as a Mediator of the Relationship between Adult Women's Attachment and Intuitive Eating

Despite growing interest in intuitive eating-a non-dieting approach to eating that is based on feeding the body in accordance with physiological and satiety cues-research on its determinants is scarce. The present study aimed to examine the associations between dimensions of adult attachment (i.e., anxiety and avoidance) and intuitive eating, and the mediating role of self-compassion in these relationships. The sample comprised 201 French-Canadian young adult women (M = 25.1, SD = 4.6). Participants completed self-report questionnaires through an online survey. Results of the structural equation model demonstrated that attachment-related anxiety and avoidance were negatively associated with intuitive eating, and these relationships were at least partially mediated by self-compassion. Findings suggest that women who have high levels of attachment anxiety or avoidance engage in less intuitive eating partly because they are less self-compassionate. Results highlight the importance of self-compassion in facilitating adaptive eating behaviors in adult women, especially if they have an insecure attachment style to romantic partners.

Emotional Regulation as a Remedy for Teacher Burnout in Special Schools: Evaluating School Climate, Teacher's Work-Life Balance and Children Behavior

This research aimed to identify whether improvement in working conditions, children’s classroom behavior and work-life balance can lower teacher burnout ratio in Pakistan’s special schools by using techniques such as emotions regulation. The researcher employed a quantitative research methodology to fulfill the research’s purpose. The data for this research was collected using a questionnaire-based instrument. The confirmatory factor analysis and structural equation modeling techniques were used to test the construct validity and underlying structural relationships. The findings demonstrated that the impacts of all three variables are significant in reducing job burnout in teachers. Emotional regulation helps decrease the impact of working conditions and the children’s behavior. Nevertheless, it does not aid work-life balance as it requires other techniques of emotional regulation. The research is significant as it highlights the importance of overall working conditions’ improvement for teachers working with special needs children. The improvements are essential because the teachers must take extra effort and emotions into their job compared to a typical teacher. The researcher has highlighted the key finding, implications and limitations of this research besides suggesting directions for future research to facilitate peer researchers.

Effects of cognitive-behavioral and psychodynamic-interpersonal treatments for eating disorders: a meta-analytic inquiry into the role of patient characteristics and change in eating disorder-specific and general psychopathology in remission

BACKGROUND

Cognitive behavior therapy (CBT) and psychodynamic-interpersonal therapies (PIT) are two widely used and conceptually different outpatient treatments for eating disorders (EDs). To better understand how these treatments works, for whom, and under what circumstances, there is a need for knowledge about how outcomes are affected by diagnosis, comorbidity, changes in psychopathology, and study design.

METHOD

Reports on the effects of CBT and PIT for eating disorders were searched. Rates of remission and changes in ED specific- and general psychopathology were computed. Regression models were made to predict event rates by changes in specific- and general psychopathology, as well as ED diagnosis and study design.

RESULTS

The remission rate of CBT for binge eating disorder was 50%, significantly higher than the effect for other diagnostic groups (anorexia = 33%, bulimia: 28%, mixed samples 30%). The number of studies found for PIT was limited. All effect sizes differed from zero (binge eating disorder = 27%, anorexia = 24%, bulimia = 18%, mixed samples = 15%), but the precision of the estimates was low, with some lower-bound confidence intervals close to zero. For CBT, change in ED specific psychopathology predicted remission only when controlling for ED diagnosis, while change in general psychopathology did not predict remission at all. The predictive value of change in psychopathology for PIT, and the potential impact of comorbid personality disorders could not be analyzed due to a lack of studies. There was no difference in effects between randomized controlled trials and observational studies.

CONCLUSIONS

CBT showed consistent remission rates for all EDs but left a substantial number of patients not in remission. Extant evidence suggest that PIT is not consistently effective in achieving remission for patients with EDs, although this finding is uncertain due to a small number of eligible studies. A group of patients with eating disorders may, however, require therapy aimed at strengthening deficits in self functions not easily ameliorable by cognitive behavioral techniques alone. Further research should be aimed at identifying treatment interventions that helps patients change behavior, while strengthening self-functions to substitute eating-disordered behavior in the long-term.

Bonding With Parents, Body Image, and Sociocultural Attitudes Toward Appearance as Predictors of Eating Disorders Among Young Girls

A more holistic approach to treatment and prevention focuses on identifying the multiple risk and protective factors for eating disorders. However, there is a lack of research verifying the nature of the relationship between patterns of bonding with parents, sociocultural attitudes toward appearance, body image, and their role in developing or preventing eating disorders. The main aim of the study was to verify whether there is a specific set of risk or/vs. protective factors/measures for behaviors and dispositions related to the development of eating disorders. The study group consisted of 134 young Polish females (M = 14.92; SD = 1.349), with an average body mass index. The variables were measured using the Parental Bonding Instrument, the Sociocultural Attitudes Toward Appearance Questionnaire-3, The Multidimensional Body-Self Relations Questionnaire, and the Eating Disorder Inventory 3. Stepwise regression analysis was applied. Statistical analysis showed that bonding with parents (including maternal overprotection), body image (including overweight pre-occupation, fitness evaluation, health orientation, and self-classified weight), and sociocultural attitudes toward appearance (such as searching for information, pressures, and internalization) are predictors of eating disorder risks. On the other hand, maternal and paternal care (aspects of patterns of bonding with parents), positive fitness evaluation, positive appearance evaluation, and satisfaction with one's body were found to be the most significant protective factors. The results may improve prevention and intervention aimed at increasing protective factors.

Relationship between Trauma History and Eating Disorders in Adolescents

Reasons for developing an eating disorder (ED) are complex, yet one plausible risk factor gaining more relevance in adolescents with EDs is childhood trauma. The current study is the first to examine the presence of childhood trauma in relation to ED symptomatology in adolescents using DSM-5 criteria. It was hypothesized that patients with more traumatic experiences also have more severe ED symptoms. 112 therapists currently treating adolescent patients diagnosed with an ED completed an online survey consisting of a DSM-5 ED symptom checklist and a childhood trauma questionnaire on a current adolescent patient whom they have seen for at least eight sessions. Children with multiple traumatic experiences and the severity of those experiences demonstrated a relationship to overall ED (r = .179, p = .059) and bulimia symptoms (r = .183, p = .054), specifically binging (r = .188, p = .047). and purging (r = .217, p = .021). In addition, logistic regression analyses indicated that adolescents high on bulimia nervosa (B = 4.694, p = .044) were more likely to have been traumatized victims of violence. Exploratory analyses support prior literature that suggest similarities between adolescents' lack of control of the experienced trauma(s) with lack of control of ED symptoms. These findings highlight the importance of exploring trauma history when treating an adolescent with an ED, especially bulimia.

Differentiation of the self and the body and adjustment to motherhood - A latent class analysis

BACKGROUND

Self-differentiation is a recognized predictor of adjustment to transitional periods of the life cycle, such as transition to motherhood. Less, however, is known about body differentiation, its relational pattern with self-differentiation, and its effect on adjustment to motherhood. The aims of this research were to identify distinct subgroups of differentiation among pregnant women (T1) and to examine the predictive role of these classes in adjustment to motherhood, two-months postpartum (T2).

METHODS

Two studies were conducted. In Study 1, the basic clusters structure was examined among a sample of non-pregnant women (N = 583), who filled out questionnaires assessing their self- and body differentiation. In addition, stability across five months was assessed. In Study 2, the cluster classification was validated and the relational pattern to the adjustment to motherhood was tested. Three-hundred-and-ninety-four women filled out a battery of questionnaires assessing their self- and body differentiation during pregnancy (T1), and the body experience, maternal efficacy, mother-infant bonding, and depression two-months postpartum (T2).

RESULTS

Results of Study 1's latent class analysis revealed four classes:" differentiated," "moderate," "body-differentiated," and "undifferentiated," comprising women with low levels of body-self differentiation. This structure was replicated in Study 2. In addition, a series of analyses indicated that women classified as "differentiated" during their pregnancies (T1) demonstrated higher levels of adjustment to motherhood (T2), while those classified as "undifferentiated" at T1 reported the lowest levels of adjustment at T2.

CONCLUSIONS

The findings suggest a new body-self differentiation classification and emphasize that clinical interventions for women forming their new identities as mothers should target both concepts.

Insecure Attachment and Technology Addiction Among Young Adults: The Mediating Role of Impulsivity, Alexithymia, and General Psychological Distress

Previous studies have emphasized the effect of insecurity attachment on youth's Internet and smartphone addiction. In this study, we examine the mediating role of alexithymia, impulsivity, and general psychological distress in the relationship between insecure attachment dimensions and technology addiction. Data were collected from 539 adolescents and young adults, mostly women (N = 378; 70.1 percent), aged 19.76 ± 1.99 years. Participants completed self-report measures of attachment insecurity, psychological risk factors (i.e., impulsivity, psychological distress, and alexithymia), and technology addiction (i.e., problematic Internet use, smartphone, and Internet addiction). The gender-related (i.e., multi-group) mediation model was tested through a path analysis with both observed and latent variables. Attachment anxiety had no direct effect on technology addiction, whereas attachment avoidance had a small negative direct effect, but only among women. Insecure attachment dimensions were significantly associated with psychological risk factors, whereas the latter had a significant, direct association with technology addiction. Psychological risk factors significantly mediated the association between insecure attachment dimensions and technology addiction. Finally, the tested model was gender-invariant. Findings suggest that insecure attachment dimensions have an indirect effect on the development of technology addiction mediated almost entirely by higher levels of psychological risk factors. Such findings might have relevant implications to inform any treatment plan for young adults who are overinvolved with technology activities and so to deliver patient-tailored interventions.

Attachment style and parental bonding: Relationships with fibromyalgia and alexithymia

Objectives

Fibromyalgia (FM) is a chronic pain syndrome, and alexithymia, which is a condition that is characterised by deficits in emotional self-awareness, is highly prevalent among individuals with FM. Insecure attachment styles and inadequate parental care appear to play an important role in the onset and maintenance of both alexithymia and chronic pain. Therefore, the present study aimed to examine the associations between attachment styles, parental bonding, and alexithymia among patients with FM and healthy controls (HC).

Methods

All participants completed a battery of tests that assessed alexithymia, attachment styles, and parental bonding. Two logistic regression models were tested to examine whether these variables predict (a) group membership (i.e. patients with FM vs. HC) and (b) the likelihood of having alexithymia (i.e. among patients with FM and HC).

Results

Alexithymia (i.e. difficulty identifying and describing feelings subscales of the 20-item Toronto Alexithymia Scale) significantly predicted group membership (i.e. the likelihood of having FM). On the other hand, educational level and dismissive attachment (i.e. the discomfort with closeness and relationships as secondary subscales of the Attachment Style Questionnaire) were the only significant predictors of the likelihood of having alexithymia.

Conclusions

These findings highlight both the relevance of alexithymic traits to the definition of FM and centrality of an insecure attachment style to the manifestation of alexithymia.

Cognitive and Emotional Empathy in Anorexia Nervosa: The Role of Attachment Insecurity, Intrapersonal, and Interpersonal Emotional Competences

The present research examined a model that evaluates the mediating role of both intrapersonal and interpersonal emotional competences (ECs) between attachment insecurity and the cognitive and emotional dimensions of empathy in patients with anorexia nervosa (AN). Women with AN completed the Experiences in Close Relationships Scale, the Profile of Emotional Competence, the Interpersonal Reactivity Index, the State-Trait Anxiety Inventory, and the Beck Depression Inventory. The results revealed that intrapersonal EC mediated the relationships between attachment insecurity (i.e., attachment anxiety and attachment avoidance) and emotional empathy in patients with AN. Importantly, a high emotional empathy in AN was associated with increased depression and anxiety symptoms. The results also indicated that a high level of attachment avoidance was indirectly associated with lower cognitive empathy through lower levels of interpersonal EC in AN. The present study emphasizes the importance of differentiating affective empathy from cognitive empathy and suggests clinical interventions in patients with AN.

The Role of Metacognitions on the Relationship Between Adult Attachment and Mood Symptoms in Individuals with Obesity

In order to examine psychological mechanisms contributing to the development and maintenance of mood symptoms experienced by individuals with obesity, this study focused on the mediator role of metacognitions in the relationship between adult attachment dimensions (anxious and avoidant) and mood symptoms (depression and anxiety). A 184 individuals with Body Mass Index (BMI) of 30 or above completed a battery of instruments including measures of attachment styles, metacognitive beliefs and processes, depression, and anxiety symptoms. Multiple mediation analyses with bootstrapping demonstrated that while attachment anxiety was predictive of greater levels of depression and anxiety through the effect of beliefs about uncontrollability and dangerousness of worry, metacognitive factors have no mediator role in the relationship between avoidant attachment and mood symptoms. Findings suggest in particular that anxious attachment and metacognitive characteristics might be considered in case conceptualizations and intervention strategies for the psychological problems experienced by individuals with obesity.Level of Evidence: Level V: Descriptive (cross-sectional) study.

Genes and environment in attachment

In the last two decades, there has been increasing research interest in disentangling the contribution of genetic and environmental factors to individual differences in attachment, and in identifying the genes involved in shaping attachment. Twin studies suggest that as attachment changes during the course of development, genetic factors may play a progressively more important role, while shared environmental effects might decrease. However, most of this literature is limited by low power, measurement issues, and cross-sectional design. The findings of molecular genetic studies are, overall, inconclusive. The literature on main genetic effects and gene-by-environment interactions on attachment is filled with inconsistent and unreplicated findings. Also, most studies are underpowered. Challenges for future research are to identify the unshared environmental mechanisms involved in shaping attachment, and to better elucidate the genes involved and their interaction with the environment. Some pioneer studies suggested that the incorporation of epigenetic processes into G × E interaction models might represent a promising future way for investigating the complex, dynamic interplay between genes, environment, and attachment.

Attachment in Patients with Bipolar and Unipolar Depression: A Comparison with Clinical and Non-clinical Controls

Background

A link between depression and insecure attachment has long been postulated. Although many studies examined the relationship between depressive symptoms and attachment, relatively few studies were performed on patients diagnosed with depression. Also, research on patients with bipolar disorder is scarce.

Objective

We aimed at testing the association between attachment insecurity and unipolar and bipolar depression.

Methods

We studied 21 patients with bipolar disorder, current episode depressed, and three age- and sex-matched groups, each consisting of 21 individuals: patients with major depressive disorder, recurrent episode; patients with epilepsy; non-clinical participants. The Experience in Close Relationships questionnaire was used to assess adult attachment style.

Results

Patients with both bipolar and unipolar depression displayed significantly higher scores on attachment-related avoidance as compared with patients with epilepsy and non-clinical participants. Also, patients with bipolar depression scored significantly higher on attachment-related anxiety than all other groups. In both psychiatric groups, attachment dimensions were not significantly correlated with global clinical severity or severity of depression.

Conclusion

Despite some study limitations, our results are consistent with some previous studies and provide support to Bowlby's seminal hypothesis that attachment insecurity may predispose to depression. Attachment theory may provide a valuable theoretical framework for future research and for guiding treatment.

An Integrative Approach to Clinical Decision-Making for Treating Patients With Binge-Eating Disorder

Transtheoretical integrative decision-making models help clinicians to use patient factors that are known to predict outcomes in order to inform individualized treatment. Patient factors with a strong evidence base include: functional impairment, social support and interpersonal functioning, complexity and comorbidity, coping style, level of resistance, and level of subjective distress. Among those with binge-eating disorder (BED), patient factors have not been extensively characterized relative to norms or other clinical samples. We used an integrative decision-making model of these six patient factor domains related to patient outcomes to characterize a sample of 424 adults seeking treatment for BED. Data were from medical charts, a demographics questionnaire, and validated psychometric scales. We then compared these data to published data from normative and other eating disorder (ED) samples. Results showed that the average patient with BED: (1) was significantly more functionally impaired compared to non-clinical norms but somewhat less impaired than other patients with ED, (2) demonstrated clinically significant problems in social support and interpersonal functioning, (3) presented with complex comorbid pathology and high levels of chronicity, (4) used a more internalizing coping style compared to the norm and other ED samples, (5) had low levels of resistance to interventions, and (6) experienced a moderately high level of subjective distress indicating good motivation for treatment. Corresponding recommendations to these findings are that the average patient with BED should be provided higher intensity treatment that is longer in duration, interpersonally focused, directive in nature, and emphasizing self-reflection and insight. Despite the nomothetic nature of the findings, clinicians are encouraged to assess these patient domains when developing an ideographic case conceptualization and to tailor precision treatment to the individual patient with BED.

Effect of intrapersonal emotional competences on the relationship between attachment insecurity and severity of eating disorder symptoms in patients with restrictive anorexia

OBJECTIVE

Attachment insecurity and emotional competences (EC) form a key part of conceptual models of anorexia nervosa (AN). We explored the relationship between attachment dimensions and EC on the severity of eating disorders in patients diagnosed with restrictive AN.

METHOD

Sixty-three female patients with restrictive AN and 63 healthy participants completed self-report measures (eating symptoms, EC, attachment, depression, and anxiety).

RESULT

Patients with restrictive AN used fewer adaptive and more maladaptive regulation strategies and showed low levels of intrapersonal EC. The partial least squares path modeling analysis showed that high levels of attachment anxiety or avoidance lead to a decrease in intrapersonal EC, which in turn contributes to greater severity of eating symptoms in anorexic patients.

CONCLUSIONS

Lower intrapersonal EC played an important mediating role in the effects of attachment insecurity on the severity of eating disorders. The joint use of therapeutic programs that target both EC and attachment processes constitutes a promising approach.

Attachment Patterns in Subjects Diagnosed With a Substance Use Disorder: A Comparison of Patients in Outpatient Treatment and Patients in Therapeutic Communities

The purpose of the present study is to analyze the quality of attachment in substance abuse patients in outpatient treatment vs. patients in therapeutic communities in order to identify the role of attachment insecurity in choosing a care system. The sample consisted of 127 subjects (107 males and 20 females); 97 were outpatients (83 males) and 30 therapeutic community patients (24 males). Attachment with respect to current, significant relationships was assessed using the Relationship Questionnaire. In the outpatient subgroup, the prevailing attachment style was preoccupied; for the therapeutic community patients, the prevailing attachment style was dismissive. The dimensions of care (how the caregiver is perceived as loving and caring) and overprotection (how the caregiver is perceived as intrusive and interfering)-evaluated by means of the Parent Bonding Instrument-were higher in the outpatient subgroup. Scores were higher with respect to maternal subscales regardless of treatment modality. No differences emerged with respect to self-perceived symptoms (SCL-90-R) between the subgroups; however, fearful-avoidant and dismissive-avoidant individuals reported higher self-perceived symptom regardless of treatment modality. Understanding the distribution of different attachment patterns with respect to the treatment modality may improve efficacious interventions, attuning them to the individual and his or her developmental environment.

Mentalizing Self and Other and Affect Regulation Patterns in Anorexia and Depression

The study aimed to examine two constructs: general mentalizing processes and the specific component of affective mentalizing regarding self and others alongside the construct of affect regulation patterns in female adolescent and young adult inpatients with anorexia nervosa (AN; n = 41), depression (n = 20) and controls (n = 53). We further examined the predictive ability of affect regulation to eating-disorder (ED) symptoms beyond that of the mentalizing variables, and their potential role in mediating between mentalizing, depression and ED symptoms. We used tools assessing reflective functioning (RF), complex emotion recognition and theory of mind (ToM), alexithymia, affect regulation, depression, and ED symptoms. The AN and depression groups exhibited lower general mentalizing and higher alexithymia, emotional reactivity, and emotional cutoff patterns than controls, but showed no greater disturbance in ToM. The two clinical groups did not differ on any of these variables. Elevated mentalizing and adequate affect regulation patterns separately predicted lower severity of ED symptoms. Nonetheless, affect regulation did not add to the predictive value of mentalizing variables. Specifically, elevated alexithymia, and depressive symptomatology, but not RF, predicted greater ED symptomatology. Moreover, alexithymia directly accounted for elevated ED symptoms and also indirectly connected with ED symptoms via emotional hyperactivation and elevated depressive symptoms. These findings suggest that deficiencies in mentalization and affect regulation are not unique to AN, but may rather associated with psychopathology in general. Nonetheless, alexithymia and depression may increase ED-related symptomatology. Affect regulation deficiencies are mainly related with depressive symptoms and emotional hyperactivation is indirectly related with AN via the depressive symptoms.

Self-Injurious Behaviors and Adult Attachment: A Review of the Literature

Self-injurious behaviors (SIB) continue to afflict a significant segment of the clinical and general population, sometimes with fatal consequences. The development of SIB seems to share developmental pathways and mechanisms similar to attachment insecurity. To date, no reviews have explored their relationship. A search of publication databases PubMed and PsychInfo from 1969 through April 2018 was conducted and 17 papers met inclusion criteria. Of the 17 articles identified, 13 reported a positive relationship and 1 reported a negative relationship between attachment insecurity and SIB. Both attachment anxiety and avoidance seem to play a role in the risk for SIB, possibly through different mechanisms and likely with different impacts on the choice for either self-harm or suicide attempts.

Assessment of Family Functioning and Eating Disorders - The Mediating Role of Self-Esteem

The aim of the study was to measure whether people at increased risk for eating disorders (EDs) and people without an increased risk of EDs differ from each other in the assessment of family functioning (FF) and self-esteem (SE) dimensions. Moreover, the correlations between FF, EDs, and SE were verified, looking for the mediating role of SE in the context of the FF and EDs. The research was conducted on the group of 160 people aged from 18 to 47 years, including 74 people at increased risk for EDs. We used: The Family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve); The SCOFF Questionnaire; The Multidimensional Self-Esteem Inventory, MSEI. Analyses indicate that the compared groups differ significantly in terms of EDs, assessment of FF, and all components of SE, in such a way that people without an increased risk of EDs are characterized by a more positive assessment of FF and higher SE in all its dimensions. All SE dimensions, except defensive high SE, are mediators in the relationship of FF with EDs. In therapeutic interactions, it is worth focusing on the SE dimensions, as they are one of the mediation elements in the relationship between the assessment of FF and EDs.

Mediators linking insecure attachment to eating symptoms: A systematic review and meta-analysis

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 [P_M] = 0.71). Further, body dissatisfaction, neuroticism, perfectionism, mindfulness and social comparison had significant, but moderate to low mediating effects (P_M = 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.

Psychopathology Factors That Affect the Relationship Between Body Size and Body Dissatisfaction and the Relationship Between Body Dissatisfaction and Eating Pathology

Although high body mass index (BMI) alone does not invariably lead to body dissatisfaction (BD) and BD alone does not invariably lead to eating pathology (EP), research has suggested that there are clear relationships between each predictor and its respective criterion. We have a limited understanding of the factors that explain why some women at higher risk for BD (because of their BMI) do not report being dissatisfied with their bodies and why some women who are highly dissatisfied, do not engage in pathological eating behaviors. The present study examined such factors. A university sample of New Zealand women (N = 166) completed the Personality Assessment Inventory (Morey, 1991) and questionnaires measuring BD and EP. The tendency to report lower BD than would be predicted by one's BMI, and the tendency to report lower EP than would be expected based on one's BD, were characterized by lower overall distress (i.e., lower levels of anxiety and depression) and greater mood stability compared to those who followed the predicted outcome. Greater understanding of the factors that protect high-risk women from BD and EP may contribute to prevention and intervention strategies.

Momentary predictors of binge eating: An attachment perspective

INTRODUCTION

According to attachment theory, individuals who are preoccupied with the possibility of rejection are prone to emotion dysregulation, which research has found to be related to disordered eating. The current study examined naturalistic momentary relationships between binge eating, depressive symptoms, emotion dysregulation, and attachment anxiety.

METHOD

Participants were 55 undergraduate women who owned a mobile phone and who had binge eaten at least once during the past 28 days. All participants were screened to confirm the presence of binge eating and then completed trait measures of attachment anxiety. Participants then received seven text messages per day for 14 days. Texts contained links to state measures of depressive symptoms, state emotion dysregulation, and recent binge eating.

RESULTS

Momentary depressive symptoms predicted subsequent binge eating. Aspects of emotion dysregulation (i.e., nonacceptance of emotional responses and difficulty modulating one's emotions) mediated the relationship between attachment anxiety and binge eating.

DISCUSSION

Depressed mood often triggers binge eating. Additionally, attachment anxiety seems to predict binge eating through emotion dysregulation. Interventions for binge eating should address both attachment anxiety and emotion dysregulation in order to maximize therapeutic benefit.

Emotion Regulation and Parental Bonding in Families of Adolescents With Internalizing and Externalizing Symptoms

Parental bonding and emotional regulation, while important to explain difficulties that may arise in child development, have mainly been studied at an individual level. The present study aims to examine alexithymia and parental bonding in families of adolescents with psychiatric disorders through different generations. The sample included a total of 102 adolescent patients with psychiatric disorders and their parents. In order to take a family level approach, a Latent Class Analysis was used to identify the latent relationships among alexithymia (Toronto Alexithymia Scale), perceived parental bonding (Parental Bonding Instrument) and the presence of adolescent internalizing or externalizing psychiatric symptoms (Youth Self-Report). Families of internalizing and externalizing adolescents present different and specific patterns of emotional regulation and parenting. High levels of adolescent alexithymia, along with a neglectful parenting style perceived by the adolescent and the father as well, characterized the families of patients with internalizing symptoms. On the other hand, in the families with externalizing adolescents, it was mainly the mother to remember an affectionless control parental style. These results suggest the existence of an intergenerational transmission of specific parental bonding, which may influence the emotional regulation and therefore the manifestation of psychiatric symptoms.

Are attitudes towards emotions associated with depression? A Conceptual and meta-analytic review

OBJECTIVES

We performed a conceptual and meta-analytic review of the relationship between negative cognitive and affective evaluations of negative emotional experiences (negative ATE) and depression. We examined the negative ATE-depression relationship in terms of three ATE constructs: fear of emotion, non-acceptance of emotion, and distress intolerance. We also explored whether the negative ATE-depression relationship differs as a function of specific emotions.

METHODS

Seventy articles with a total sample of 19950 adults were included in the general analysis, and 10 studies with a total sample of 1726 were included in the emotion-specific analysis.

RESULTS

In the general analysis, negative ATE was associated with depression with a medium to large effect. Notably, this effect size was stronger than previously observed associations between emotion regulation strategies and depression (Aldao et al., 2010). In the emotion-specific analysis, negative attitudes towards depressive affect had a particularly strong association with depression.

LIMITATIONS

Limitations include heterogeneity in effect sizes and a small number of samples for the emotion-specific analyses.

CONCLUSIONS

The present review is the first to establish a systematic relationship between negative ATE and depression. We close with suggestions for future work designed to understand why negative ATE is related to depression, which can lead to understanding of depression's etiology and ways to refine interventions to alter ATE.

Self-differentiation and eating disorders in early and middle adolescence: A cross-sectional path analysis

This study examines the impact of self-differentiation, alexithymia and psychological distress on eating disorder symptoms in young and middle adolescence. Four hundred fifty-one adolescents completed self-report measures. Early and middle adolescents were categorized into two groups (12-14 years and 15-17 years) to represent distinct developmental stages. Significant differences were found between younger and older adolescents. The association between low self-differentiation and both eating disorders symptoms and psychological dimensions related to eating attitudes was stronger in early adolescence than in middle adolescence. The association between low self-differentiation and eating disorder symptoms was mediated by alexithymia and psychological distress in middle adolescence. Taken together, these findings suggest that self-differentiation could be useful in understanding psychological distress and alexithymia in eating disorders.

Reliability and validity of the Experiences in Close Relationships Scale-12: Attachment dimensions in a clinical sample with eating disorders

OBJECTIVE

Attachment insecurity is a potential risk factor for the development and maintenance of eating disorders (EDs). To date, there are multiple psychometrically sound questionnaires for the evaluation of attachment in both clinical and healthy populations, such as the Experience in Close Relationships (ECR) scale. Composed by two subscales (i.e., attachment anxiety and avoidance), the ECR scale was recently adapted to a shorter, 12-item version (ECR-12). However, a validation of the ECR-12 among patients with EDs is still lacking. The present study sought to investigate the psychometric properties of the ECR-12, when used in a treatment-seeking sample with EDs.

METHOD

A total of 1,262 treatment-seeking patients with various ED diagnoses completed the ECR-12, together with a commonly used measure of ED psychopathology (Eating Disorder Inventory-2). Subsamples also completed the Attachment Style Questionnaire (n = 66) or underwent a Day Hospital Program (n = 128).

RESULTS

A multigroup confirmatory factor analysis indicated that the ECR-12 maintained its two-factor structure across the ED diagnostic groups. In addition, the scale demonstrated good convergent validity, internal consistency, concurrent, and incremental validity. Finally, both ECR-12 subscales demonstrated adequate test-retest reliability.

DISCUSSION

Our results provide preliminary evidence of the psychometric properties of ECR-12 in assessing attachment anxiety and avoidance among patients with EDs. This short scale could help clinicians tailor interventions for EDs that take into account attachment dimensions.

Attachment, Emotion Regulation Difficulties, and Disordered Eating Among College Women and Men

In this study, we examined a structural equation model in which attachment anxiety and avoidance were associated with binge eating and restricted eating behaviors through distinct emotion regulation difficulties of emotional reactivity and emotional cutoff among college women ( n = 744) and men ( n = 200). As predicted, attachment anxiety was associated with emotional reactivity which, in turn, was associated with binge eating. Attachment avoidance was associated with emotional cutoff which, in turn, was associated with restricted eating, both in college women and men. Two gender differences were found: the association between emotional cutoff and binge eating was statistically significant only for women, and the association between emotional reactivity and binge eating was stronger for men than for women. Clinical implications are suggested, specifically the importance of addressing attachment insecurities and distinct emotion regulation difficulties related to serving college women and men with binge eating and/or restricted eating behaviors.

Recovery from eating disorder 1 year after start of treatment is related to better mentalization and strong reduction of sensitivity to others

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.

Do changes in affect moderate the association between attachment anxiety and body dissatisfaction in children? An experimental study by means of the Trier Social Stress Test

OBJECTIVE

Previous studies have already found a positive association between attachment and disordered eating attitudes and behaviors in children and adolescents. However, to our knowledge, no experimental studies have examined whether changes in negative and/or positive affect moderate the association between attachment anxiety and body dissatisfaction in children.

METHOD

A controlled laboratory setting was used to investigate whether changes in state negative and/or positive affect moderate the association between attachment anxiety and body satisfaction in a sample of 81 children (M_age=11.74). The changes in state affect were caused by the exposure to a performance-related stressor using the Trier Social Stress Test for Children.

RESULTS

Children with high levels of attachment anxiety reported a decrease in body satisfaction, but only if the TSST-C led to a decrease in their positive affect.

DISCUSSION

Early detection and intervention programs may benefit from addressing insecure attachment and maladaptive emotion regulation in children.