Étude pilote – un nouvel éclairage attachementiste de l’anorexie mentale : les adolescentes anorexiques ont-elles un attachement insécure ?

Abstract

ObjectivesAnorexia nervosa is a severe pathology with prevalence among women and the quality of family functioning is involved in the development and the persistence of this disorder and as such is a therapeutic tool of major importance. Among the numerous conceptualisations and models of these familial interactions, attachment theory, originating from John Bowlby's work, provides a useful tool for understanding the interaction of individual and family characteristics, much needed in our clinical work with anorexia nervosa. Attachment theory also integrates solid measures with clinically meaningful constructs. Previous research on attachment and eating disorders has hypothesized direct links between insecure attachment and diagnoses of eating disorders. The aim of the current study is to explore styles of attachment in adolescent girls with anorexia nervosa and in a “healthy” control group with a new self-report attachment questionnaire, the Inventory of Parental Representation. Patients and methodsThis quantitative study is based on the Inventory of Parental Representation completed by six in- and outpatient adolescent girls diagnosed with restrictive anorexia nervosa and six adolescent girls from the general population with no psychiatric disorder. ResultsOur results showed no difference between the clinical and the control groups. All 12 adolescents girls (from both groups) had secure parental representations and attachment styles, although there was a higher proportion of insecure-preoccupied attachment styles in the clinical group for paternal representations, compared to the control group. ConclusionOur results are not in agreement with the current literature and previous findings, which generally tend to find more insecure attachments in eating disorder populations. Firstly most of the studies on attachment in eating disorders are based on adults’ samples but recent research focusing on adolescents obtained findings in line with ours. Indeed, in spite of the fact that some continuity can be observed in attachment strategies from childhood to adulthood, it is possible that the observed pattern of attachment and its relative influence change over the course of development. Although these contradictory findings may not invalidate the link between insecure attachment and psychopathology, they tend to favour more developmental conceptualisations of the role of attachment in anorexia nervosa. Secondly, we recruited patients with no distinction of therapeutic modalities at the time of the study (in- or outpatients). The experience of hospitalisation, which may trigger traumatic separation, the foundation of Bowlby's theory, may contribute to the deactivation and reorganisation of the subject's internal representation models; in contrast, outpatient care may not generate this type of reorganisation. Thirdly, patients from our study all benefited from a multidisciplinary approach including family therapy. The influence of family interventions on attachment strategies must be taken into account since such treatment may contribute to the improvement of the quality of attachment, as suggested by Bowlby. Finally it is possible that the association might exist at the level of eating disorder pathology and of psychiatric symptoms, rather than at a diagnostic level.