Families in Eating Disorders: An Attachment Perspective

Attachment theory claims that early interactions between the child and the caregivers promote the development of internal working modelsAttachment theoryinternal working models that are attitudes and expectations toward oneself and toward the others’ availability, which persist during adulthood and guide interactions and the ability to manage stressful situations. Insecure attachment patterns are associated with poor mental health. This chapter reviews the occurrence of insecure attachment in individuals with an eating disorder (ED) diagnosis and the association between insecure attachment and ED psychopathology severity. Psychological mechanisms and biological processes have been suggested as potential mediators of this association. In the former group, difficulties in emotion regulation have shown the strongest evidence. Reduced reflective functioning, negative self-view, altered perception of body feelings (i.e., heightened reliance on external sources of validation), and interpersonal problems have also exhibited some evidence. An interactionAttachment theoryinternal working models between early or present traumatic events, insecure attachment, and ED psychopathology has also been suggested but needs to be further explored. Recent experimental studies displayed that insecure attachment confers an endogenous vulnerability (higher cortisol production and autonomic reactivity) to interpersonal stress in individuals with EDs, and future studies are recommended to identify the biological basis of this association (namely, exploring the role of the oxytocin system). Limitations of literature studies, such as lack of longitudinal investigation and methodological flaws, are also discussed. Attachment theory can be proposed as a developmental framework to conceptualize EDs that provides clinical indications to promote more personalized and process-oriented therapeutic approachesPersonalized and process-oriented therapeutic approaches.