Cognitive-behavioral and attachment interventions in the transdiagnostic treatment of bulimia nervosa and binge eating disorder

Abstract

Background The transdiagnostic model of eating disorders provides an evidence-based cognitive-behavioral treatment approach, emphasizing the maintaining factors of low selfesteem, perfectionism, mood intolerance and interpersonal difficulties. Although attachment quality is associated with these factors, there is no treatment model focusing on both attachment-related and cognitive-behavioral maintaining factors of the symptoms. Aims The aim was to construct and test a multilevel treatment model, which integrates attachment interventions into the transdiagnostic treatment of eating disorders. Methods Relevant aspects of attachment functioning were joined together with the four cognitive-behavioral maintaining factors of the symptoms, and attachment interventions were incorporated into an extended transdiagnostic treatment of a bulimia nervosa and a binge eating disorder patient. Results Attachment domains could be integrated into the transdiagnostic model of eating disorders at both the case conceptualization and treatment level. The improvement of attachment functioning was related to treatment outcomes at a one month follow-up. Conclusions When attachment dysfunctions contribute to precipitating or maintaining mechanisms of eating disorder symptoms a multilevel treatment targeting both the relevant aspects of attachment and cognitive-behavioral functioning can be suggested. Randomized controlled studies with different intervention groups are required to confirm the result of these case studies.