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

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