Attachment research in eating disorders

AIM: In a recent review, disturbances in attachment have been linked with eating disorder symptomatology. However, because of the limitations of study design, few inferences could be drawn about these processes in the aetiology and maintenance of eating disorder. Since that review, there has been further development in the instruments used and the publication of several further studies of attachment processes in eating disorders. We reviewed the field, expecting that greater clarity may have emerged in the 3 years since the previous review. METHOD: A review of the literature was carried out, using the computer search PsychLIT, Medline, Embase and The Cochrane Library. RESULTS: There have been more studies published in this area in the last 3 years than in the entire period up until then. These can broadly be divided into those carried out in clinical and non-clinical populations, with greater weight ascribed to the former. The vast majority of studies found that attachment processes, by whatever method measured, are abnormal in eating disordered populations. Attachment style (dismissing versus preoccupied) may be linked with eating disorder diagnostic subgroup. CONCLUSIONS: Insecure attachment is common in eating disordered populations, with implications for therapy. Further work with refined instruments may clarify whether or not there is a specific association between attachment style and eating disorder subgroup. However, such an association is likely to be complicated and it may be more fruitful to study specific aspects of attachment, rather than global attachment style, in relation to eating disorder behaviour. The transgenerational transmission of attachment is a fruitful area for further investigation in eating disordered populations.