title: Attachment and eating disorders: a review of current research.
abstract: OBJECTIVE
  Attachment insecurity may confer risk for developing an eating disorder. We describe domains of attachment functioning that are relevant to eating disorders including: affect regulation, interpersonal style, coherence of mind, and reflective functioning. Research since 2000 on attachment and eating disorders related to these domains is reviewed.
  
  
  METHODS
  We searched MedLine/Pubmed and PsycINFO from January 2000 to February 2014 and kept articles that: were empirical, included adults with a diagnosed eating disorder, and used a standard attachment measure. We retained 50 relevant studies.
  
  
  RESULTS
  Compared to controls, those with eating disorders had higher levels of attachment insecurity and disorganized mental states. Lower reflective functioning was specifically associated with anorexia nervosa. Attachment anxiety was associated with eating disorder symptom severity, and this relationship may be mediated by perfectionism and affect regulation strategies. Type of attachment insecurity had specific negative impacts on psychotherapy processes and outcomes, such that higher attachment avoidance may lead to dropping out and higher attachment anxiety may lead to poorer treatment outcomes.
  
  
  CONCLUSIONS
  Research to date suggests a possible relationship between attachment insecurity and risk for an eating disorder. More research is needed that uses attachment interviews, and longitudinal and case control designs. Clinicians can assess attachment insecurity to help inform therapeutic stances and interventions.
authors.affiliation: The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Giorgio A
authors.initials: GA
authors.lastname: Tasca
authors.forename: Louise
authors.initials: L
authors.lastname: Balfour
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000523:psychology*; D001068:Feeding and Eating Disorders / Q000523:psychology* / Q000628:therapy; D006801:Humans; D011613:Psychotherapy; D019962:Reactive Attachment Disorder / Q000523:psychology*; D012307:Risk Factors; D016896:Treatment Outcome
keywords: anorexia nervosa; attachment; binge eating disorder; bulimia nervosa; eating disorders