Attachment disruption in anorexia nervosa and bulimia nervosa: A review of theory and empirical research

OBJECTIVE: To critically review both the theoretical propositions about the connections between attachment disruption and eating disorders and the empirical work directly examining these associations. METHOD: The major theoretical positions advocating an influential role for disruptions in the early development of secure attachments in the development of eating disorders were identified and a comprehensive review of empirical studies derived from these positions undertaken. RESULTS: There is evidence for the presence of attachment disturbances in eating-disordered populations and for an association of these disturbances with key aspects of eating disorder psychopathology. DISCUSSION: Because of the limitation of the single pathway conceptualization adopted by the theoreticians and researchers reviewed, few inferences about the role of attachment processes in the etiology and maintenance of eating disorders can be drawn from the existing literature. The paper argues for the development of multifactorial and process-orientated models of the role of attachment functions in the pathogenesis of eating disorders.