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What role DOES attachment play in eating disorders?

Posted Nov 29 2011 6:58am
Those who would say that attachment problems play a significant role in causing an eating disorder to happen take a great risk. The potential harm of having parents doubt their most basic relationship with a child, and that even unknown and inadvertent "issues" could trigger an often fatal mental disorder - is a serious thing to take on. At the moment when a parent is most vulnerable and most in need of calm confidence and courage there is enormous import: to every chance comment on the Internet, book picked up at the library, and especially a professional consultation. These messages can save or lose a life if they change the direction of treatment.

So, what is the evidence behind the idea that attachment problems "contribute to the development" of an eating disorder? (this is very very very different than whether families with a current eating disorder patient suffer from attachment problems - as it is one of the symptoms of the disorder for the patient and one of the most disorienting illnesses for a family to face and find care)

Some people took up the challenge of one leading advocate of the attachment theory by taking that advocate's list of supporting literature under an intellectual magnifying glass
Attachment research and eating disorders: a review of the literature. O'Shaughnessy R, Dallos R.
Child and Adolescent Mental Health Service at Alder Hey Children's Hospital, Liverpool, UK.

Opinion based - discussion of literature only

Attachment disruption in anorexia nervosa and bulimia nervosa: A review of theory and empirical research   Richard O'Kearney Article first published online: 6 DEC 1998 – International Journal ofEating Disorders
Opinion based and "few inferences about the role of attachment processes in the etiology and maintenance of eating disorders can be drawn"

Clin Child Psychol Psychiatry. 2008 Apr;13(2):305-22. A qualitative exploration of relationship and attachment themes in families with an eating disorder. Dallos R, Denford S. Department of Clinical Psychology, University of Plymouth,
A study of Four families of ED patients shows "a set of common themes across the families: False or Fragile Reality, Troubled Relationships, Arguments and Triangulation, Lack of Comfort, and Negative Relationships with Food." Of course it does, there is a loved one in the family with an ED, that means there is a a very worried family trying to care for and hopefully refeed an eating disordered person. An extremely difficult task...you should try it sometime so you understand what you are talking about.

Relationship between parental attachment and eating disorders in an inpatient and a college sample.
Kenny, Maureen E.; Hart, Kathleen Journal of Counseling Psychology, Vol 39(4), Oct 1992, 521-526. doi Inconclusive study - this is a case of the chicken or the egg. If you had a loved one refusing to eat, you would be worried and watching someone you care for fading away before your eyes not knowing how to help them is torture. Of course there is angst, of course there is discord. Asking mentally ill ED patients whether they have good relationships with their frantically worried families is not an effective study.

Attachment research in eating disorders Dr. Anne Ward1,*, Rosalind Ramsay2, Janet Treasure3
Article first published online: 16 DEC 2010 DOI: 10.1348/000711200160282 – 2000 The British Psychological Society
This is a review of literature - "Insecure attachment is common in eating disordered populations" This quote doesn't mean anything considering they are talking about ED patients i.e. those who are mentally ill and usually psychotic in their behaviour as a result of malnutrition. These patient behaviour/thought processes/ and beliefs are know to resolve once full nutrition and ideal weight has been restored for some time.
Lest you think that critique of attachment theory and eating disorders is some sort of parent defensiveness, I can say that a lot of professionals are as well - and former patients. Here is just one eating disorder professional speaking up with the kind of concern and clarity that I'm seeing more and more of in the field.  

The reason this topic causes such frustration is that so many parents have had to fight for their children hampered by clinical professionals who thought of them as inherently pathological, broken people in need of "healing" - instead of reasonably confused and frightened loved ones in need of information, good science, and excellent clinical consultation. When you nearly go under while saving your child from drowning you probably feel pretty passionately about water safety from that day on!

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