Abstract
In the present article we review findings from an emerging body of research on attachment issues in adolescents with eating disorders from a developmental perspective. Articles for inclusion in this review were identified from PsychINFO (1966–2013), Sciencedirect (1970–2013), Psychindex (1980–2013), and Pubmed (1980–2013). First, we will outline the crucial developmental changes in the attachment system and discuss how they might be related to the early onset of the disease. Then we will report on the major results from attachment studies using self-report and narrative instruments in that age group. Studies with a developmental approach on attachment will be analyzed in more detail. The high incidence of the unresolved attachment pattern in eating disorder samples is striking, especially for patients with anorexia nervosa. Interestingly, this predominance of the unresolved category was also found in their mothers. To date, these transgenerational aspects are still poorly understood and therefore represent an exciting research frontier. Future studies that include larger adolescent samples and provide a more detailed description including symptom severity and comorbidity would contribute to a better understanding of this complex and painful condition.
Highlights
We focus on anorexia nervosa (AN), bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS) as the primary conditions in adolescents and we excluded studies solely concentrating on obesity, binge eating disorder (BED) or feeding disorders in childhood
These results indicate that the increased need for approval and the hyperactivation of emotions in anxiously attached patients may impair their ability to develop useful coping strategies leading to a comparison with unrealistic standards. This is consistent with results from a growing number of studies demonstrating that hyperactivating strategies are mediators for attachment anxiety and depressive symptomatology in adolescents and adults (Tasca et al, 2009; Malik et al, 2014). Even though these findings suggest that attachment anxiety influences symptom severity, only very little is known about the role of an insecure attachment style on the eating disorders (ED) symptom change during and after treatment
In our systematic analysis we found 13 studies using self-report measures of attachment and eight studies employing narrative instruments like the attachment interview (AAI) and the attachment projective picture system (AAP) in an adolescent and young adult sample
Summary
The aim of this article is to review studies looking at attachment issues and their relation to adolescent ED from a developmental perspective. The aim of this article was to review the literature which examines the associations between attachment patterns and ED with a focus on adolescence
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