Exploring the relationship between peer attachment, and disordered eating behaviours and body dissatisfaction in adolescence: a systematic review

OBJECTIVE: Adolescence is a critical period in the development of eating disorders (ED) and the influence of peers becomes increasingly evident in shaping behaviour. Insecure attachment to parents is associated with higher ED risk, but the impact of attachment to peers is unknown. This systematic review aims to ascertain the role of peer attachment in ED symptoms and body dissatisfaction in adolescents. METHODS: Electronic databases Medline, Embase, PsychINFO, and Scopus were searched using the search terms related to adolescents, eating disorders, peers, and attachment. RESULTS: Out of the 19 included studies (n = 15 cross-sectional, n = 4 Longitudinal), most (n = 17) used the Peer subscale of the 'Inventory of Parent and Peer Attachment (IPPA)' to measure peer attachment. The prevalence of insecure attachment was higher in populations with ED symptoms compared to those without. Lower attachment scores were associated with higher ED symptomology and body dissatisfaction. Out of the 3 subscales of the IPPA, alienation emerged as the most significant predictor of symptomology. DISCUSSION: Insecure attachment to peers may be a risk factor in the development of ED symptoms and body dissatisfaction, but the protective role of secure attachment remains unclear. More longitudinal research is required to disentangle this relationship and ascertain the clinical significance of peer attachment in prognosis or intervention.