Attachment and Eating Disorder Treatment

Contributor: Shelby White, LCSW, RYT – Therapist at Fairhaven Treatment Center

Eating disorders are more than a set of behaviors toward food. In fact, looking at eating behaviors as a way to soothe and regulate deep emotional pain or get one’s deep relational needs met can be key in treating them.

Likewise, research is more commonly suggesting that clients who struggle with eating disorders are more likely to have difficulties forming and maintaining secure attachments with others. This idea highlights how important attachment-based therapy can be in the recovery process for attachment and eating disorders.

What is Attachment

John Bowbly (1973) developed the idea of “Attachment” when studying infant and caregiver relationships. According to Bowbly, infants instinctively develop attachment behaviors based on the level of safety and security provided by their caregivers.

For example, if caregivers consistently respond with emotional attunement and safety when their infant cries, cling or becomes vigilant, the infant begins to develop a long-lasting sense of trust that they will have their attachment needs met. All this is to say, attachment behaviors start in infancy and continue to show up throughout our lives.

Bowlby believed there were two types of Attachment: secure and insecure. After researching adults’ attachment behaviors, Mary Ainsworth (1978) proposed that Bowbly’s insecure attachment could be broken down into two more subtypes: dismissing (avoidant) and preoccupied (anxious).

• Dismissing/ Avoidant Attachment Style– Those with this attachment style generally experience difficulty expressing their emotions and generally dismiss the importance of close relationships. This attachment style can seem cut off from their emotions or minimize emotional experiences. (Tasca & Balfour)
• Preoccupied/Anxious Attachment Style– Those with this attachment style are highly preoccupied with attachment relationships and easily anticipate loss and abandonment. Generally, those with this attachment style can easily access emotions related to the loss of a relationship. (Tasca & Balfour)

Targeting Attachment and Eating Disorders

It’s easy to see that Eating Disorders are often exasperated by body dissatisfaction. This can look like internalized negative beliefs about one’s body, low self-esteem related to appearance, and compulsive behaviors to control one’s body appearance.

When reviewing research on Attachment and Eating Disorders, Giorgio A. Tasca and Louise Balfour found that many prominent studies reflect that there is a connection between high levels of body dissatisfaction and the need for approval in eating disorder clients, and attachment insecurity, particularly anxious/ preoccupied attachment style.

These findings underscore the importance of targeting body dissatisfaction in clients through an attachment lens in order to build awareness of unmet attachment needs and approval-seeking behaviors.

One evidence-based therapy skill that is more commonly associated with attachment-focused treatment is “Mentalization.”

Bateman & Fonagy (2012) define Mentalization as “the ability to understand the mental states of oneself and others and is considered to be partly constitutionally given, and partly acquired through the transactional process between attachment figures.”

In other words, mentalization is the tool we use to interpret others’ behaviors, emotional expressions, and thoughts without having to communicate their meanings verbally. Interestingly, Eating Disorder patients have been found to have high levels of insecure attachment and significantly low mentalizing abilities in comparison to other control groups (Kuipers, Loenhout, Van der Ark, Bekker).

Because mentalization plays such a huge role in feeling confident that one’s attachment needs are going to be met, this therapeutic skill is crucial in treating patients with high levels of attachment insecurity. For this reason, Mentalization-Based therapy is being more commonly suggested in the treatment of patients with Eating Disorders.

Moreover, the therapeutic relationship between a client and therapist can itself act as a catalyst for shifting insecure attachment styles in clients (Mikulincer, Shaver, Berant). If the therapist is adequately and emotionally attuned to the client and offers stable boundaries, they can play a role in helping a client with insecure attachment form a healthy attachment relationship.

This is just a brief look at the research showing that Attachment issues often underly Eating Disorder symptoms. It is never too early or too late to reach out for help if you are struggling with an eating disorder and attachment issues.

If you think your eating disorder is rooted in attachment insecurity, look for a therapist who specializes in attachment or is familiar with therapies like Mentalization.

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References:

[1] Bowbly, J. Attachment and Loss. New York: Basic Books, 1980

[2] Ainsworth M. Belhar M., Waters E., Wall S. Patterns of Attachment. Hilldale, NJ: Erbaum, 1978

[3] Mikuliner, M. R., Shaver, P. R., & Berant, E. R. (2013). An Attachment Perspective on Therapeutic Processes and Outcomes. Journal of Personality, 81(6), 606–616.

[4] Tasca, G. A., & Balfour, L. (2014). Attachment and Eating Disorders: A review of Current Research. International Journal of Eating Disorders, 47(7), 710–717.

[5] Kuiperes, G. S., van Loenhour, Z., van der Ark, L. A., & Bekker, M. H. J. (2016). Attachment Insecurity, Mentalization and their relation to symptoms in eating disorder patients. Attachment & Human Development, 18(3), 250–272.

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About the Author:

Shelby White, LCSW, RYT holds credentials as a Licensed Master Social Worker in both TN and MS and is currently receiving supervision towards her LCSW credential. In addition to being a therapist at Fairhaven Treatment Center, she is also a Registered Yoga Teacher and enjoys teaching yoga with a focus on emotional release and regulation.

She believes the body holds knowledge about our emotional and attachment patterns and the only way to truly shift these deeply embedded patterns is through attending to the body’s knowledge. Shelby seeks to utilize body-oriented therapies in combination with Cognitive Behavioral, Dialectical Behavioral, and other cognitive therapies to assist clients in healing trauma wounds, shifting maladaptive patterns, and creating a life guided by their values.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on October 28, 2019,  on EatingDisorderHope.com
Reviewed & Approved on October 28, 2019, by Jacquelyn Ekern MS, LPC