Greet S Kuipers1, Sandra den Hollander2, L Andries van der Ark3, Marrie H J Bekker4. 1. Unit for Eating Disorders, GGZ Breburg, PO Box 770, 5000 AT, Tilburg, The Netherlands. g.kuipers@ggzbreburg.nl. 2. Den Hollander Van den Broek, Piacenzastraat 19, 5262 EN, Vught, The Netherlands. 3. Research Institute of Child Development and Education, University of Amsterdam, PO Box 15776, 1001 NG, Amsterdam, The Netherlands. 4. Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
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.
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.
Authors: Hilary Maxwell; Giorgio A Tasca; Renee Grenon; Megan Faye; Kerri Ritchie; Hany Bissada; Louise Balfour Journal: Psychother Res Date: 2017-01-27
Authors: Ani C Keshishian; Nassim Tabri; Kendra R Becker; Debra L Franko; David B Herzog; Jennifer J Thomas; Kamryn T Eddy Journal: Compr Psychiatry Date: 2019-01-11 Impact factor: 3.735