Attachment Theory and Eating Disorders

This blog post addresses the link between attachment theory and eating disorders. Even though research on the topic is scarce, there is enough evidence of the strong relationship between insecure attachment styles and the development of eating disorders. Understanding the roots of eating disorders can help navigate the person through the process of healing.

“I am forever engaged in a silent battle in my head over whether or not to lift the fork to my mouth, and when I talk myself into doing so, I taste only shame. I have an eating disorder.”

Jena Morrow, author and eating disorders awareness advocate 

Despite inaccurate assumptions to the contrary, eating disorders are not a lifestyle choice. They are serious mental illnesses that cause our minds to distort what we see in the mirror and create an unhealthy relationship with food in an attempt to manage negative feelings. Eating disorders are obsessive, isolating, and emotionally painful. But – with appropriate support – also manageable. 

Additionally, eating disorders are highly complex and personal to everyone who has one. For this reason, we never want to lump peoples’ experiences into categories. Yet, as disorders with notable levels of secrecy, shame, and stigma, we do wish to highlight some potential factors that may lead to their development.

Eating disorders are like an iceberg – the symptoms are only the tip of the problem. 

Therefore, the more information available about them, the better. It helps us to chip away at underlying issues, bit by bit. What’s more, increased knowledge may help those struggling with an eating disorder to appreciate where their feelings and behaviors come from – and understand the best avenues to turn to for support. 

For these reasons, we will discuss the findings from research which demonstrate that the majority of adolescents and adults with eating disorders have a concurrent insecure attachment style. In addition, we also consider how an insecure attachment style may lead to the development of an eating disorder.

With this in mind, this article covers: 

• What eating disorders are
• Attachment styles and how they develop
• The links between eating disorders and insecure attachment
• Specific attachment styles and their association with eating disorders
• The role of caregiver behaviors in eating disorder onset and maintenance

The Attachment Project team aims to shed light on a worldwide disorder that massively impacts the lives of those who suffer from it. If you, or someone you know, is struggling with an eating disorder, please remember that knowledge – although important – does not replace therapy. A specialist in eating disorder treatment is always the right approach to understanding and managing these complex disorders.

What Are Eating Disorders?

Eating disorders are mental health conditions where people attempt to use food to cope with negative feelings and situations. This manifests as certain behaviors around food, such as eating too much or too little, and becoming consumed with body weight and shape. 

Although there is a range of different forms of eating disorders, the most common types are:

• Anorexia nervosa – in which someone tries to control their weight by undereating, overexercising, or both. The mortality rate for anorexia is amongst the highest of all psychological conditions. 
• Bulimia –  involves a loss of control over how much food is consumed and then taking drastic action such as purging to avoid putting on weight.
• Binge eating disorder – entails eating vast amounts of food until the individual feels uncomfortably full.

The symptoms of an eating disorder include:

• Changes in weight 
• Obsessing about weight and body shape
• Undereating
• Purging or taking laxatives after eating
• Overexercising 
• Mood changes such as anxiety, depression, or becoming withdrawn
• Creating strict habits or regimes around food
• Physical issues such as feeling cold and dizzy, and poor circulation
• Digestive problems
• Delayed signs of puberty or changes to the menstrual cycle

Anyone from any background, gender, religion, or culture can develop an eating disorder. They are not specific to any particular “type” of person. However, eating disorders commonly emerge during adolescence. The number of people with them has also increased dramatically over the last century. There’s a range of possible reasons for this increase in numbers, such as psychological, environmental, biological, and social factors. Yet, in recent years, there has been a focus on the link between insecure attachment and the development of eating disorders. 

What Are Attachment Styles?

When we were young, we developed templates for how the world works and how we fit into it. Those were based on our early relationships with our caregivers. If we had caregivers that were emotionally supportive, comforting, and available to our needs during times of stress and important developmental changes, then we developed a secure attachment style. As a result of this support, people with a secure attachment were taught that they were adequate and valuable.  

In comparison, if we grew up with caregivers who were inconsistent or rejecting of our needs, we may have started to see ourselves as inadequate and unloveable. Consequently, we may have developed one of the three insecure attachment styles: anxious, avoidant, or disorganized. 

The attachment styles that we develop are critical to successfully managing developmental life changes. Those include adjusting to physical changes during adolescence, forming a strong sense of independent identity, and setting life goals. Essentially, our attachment styles act as a buffer against potential psychological harm. 

Attachment Theory and Eating Disorders

Essentially, having an insecure attachment style is a confirmed risk factor for developing an eating disorder. That may sound like a blanket-statement, but studies have shown that roughly 70 to 100 percent of people with anorexia nervosa also have an insecure attachment style. They also show that insecure attachment styles predispose individuals to the other forms of eating disorders too.

What’s more, this discovery wasn’t only in people diagnosed with a specific eating disorder. Insecure attachment was also found to be a risk factor for disordered eating patterns, which don’t quite warrant an eating disorder diagnosis. Such patterns include chronic restrained eating, compulsive eating, and heightened focus on appearance. 

Also, there is evidence to suggest that insecure attachment is a risk factor for the signs of an eating disorder before it actually manifests. These signs include concerns about being overweight, dissatisfaction with body shape, restricting eating, and binge eating. 

Therefore, it could be said that eating disorder symptoms are the outward expression of the deep psychological and emotional issues that often result from insecure attachment styles. 

Of course, not everyone with an insecure attachment style has an eating disorder. And not everyone with an eating disorder has an insecure attachment. Having an insecure attachment style alone may not be a sufficient explanation for why some people develop an eating disorder.

However, emotion regulation difficulties, perfectionism, low self-esteem, and unhealthy coping mechanisms impact the development of eating disorders. And all of these are associated with insecure attachment. What’s more, each of these factors also maintains and strengthens eating disorders’ symptoms. 

4 Reasons Why Insecure Attachers Might Develop Eating Disorders

1. Emotional dysregulation

People with insecure attachment styles tend to have difficulties regulating their negative emotions. For this reason, they tend to use unhealthy coping strategies to manage their feelings. For instance, someone high in attachment avoidance tends to push down or inhibit their emotions. And, in contrast, people high in attachment anxiety tend to heighten theirs. 

This being the case, it’s plausible to propose that some insecurely attached people attempt to reduce their negative feelings about themselves through behaviors such as dieting to achieve the “perfect” body, binge eating to distract and increase mood, and purging to avoid gaining weight. These actions serve as a form of escapism – allowing people relief from their painful emotions. 

Yet, these behaviors don’t alleviate the insecure attacher’s negative feelings for very long. The cycle of behaviors is triggered every time they face distress or upset. 

Want to discover how well you regulate your emotions? Take our free quiz now!

2. Inaccurate self-beliefs

As a result of how insecure attachers’ needs were met during childhood, they often develop inaccurate beliefs about themselves. They often think that they’re “worthless,” “less-than,” or “unlovable.”

These dysfunctional self-beliefs may lead to insecure attachers excessively comparing themselves to others whom they see as “better.” Because they are incapable of accurately seeing themselves for who they truly are, this comparison often worsens an insecure attachers self-image and can promote disordered eating in an attempt to feel better about themselves. 

Furthermore, an insecure bond with caregivers may lead insecure attachers to search for connections with alternative sources –  which in some cases may lead to obsessions with celebrities. This infatuation may also lead to a comparison effect. This, in turn, could lead to negative body image, over-exercising, and preoccupation with food and diet. Yet, as author Cheri K. Erdman said: “Even the models we see in magazines wish they could look like their own image.”

3. Perfectionism

Insecure attachers may be particularly prone to perfectionism. Some may develop certain aesthetic standards, such as striving for thinness or trying to achieve perfect musculature. What’s more, the perfectionism associated with insecure attachment causes people to be overly self-critical. Therefore, unhealthy eating patterns may help someone with an insecure attachment feel like they’re coming to terms with their dissatisfaction with their body type or weight.

It is also possible that insecure attachers hope to achieve outward acceptance and approval by achieving a “perfect” standard. But if they do not reach these physical goals, their frustration with their body shape increases. And this would further heighten the risk of developing eating disorders.

4. Reduced mindfulness

It’s also possible that people with insecure attachment styles are less aware and accepting of the present moment. Insecure attachers tend to engage in emotional processes such as worrying, ruminating, or denial. All of these processes take the individual out of the present moment. This difficulty in achieving a mindful state strongly affects some peoples’ ability to recognize hunger and satiety, and also feel accepting of their weight and body shape – all of which are particularly present in disorders such as bulimia and binge eating. 

Specific Attachment Styles and Eating Disorders

The evidence supporting the link between attachment theory and eating disorders is strong. And yet, the association between different attachment styles and particular eating disorders is still inconclusive. 

Therefore, most of the available information discusses eating disorders and insecure attachment in general – regardless of the specific insecure attachment style. Nevertheless, we will delve into the details that are available in our attempt to support your understanding of how eating disorders develop.

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I. Anxious attachment and eating disorders

Anxious attachers are prone to heightened emotions and often struggle with managing their intense feelings of distress around their negative sense of self. They expect to be rejected or abandoned by those close to them, so they often have an increased need for approval. This need may result in setting unrealistically high standards for themselves, and comparing themselves to others. These attitudes leave anxious attachers particularly at risk for eating disorders – and they’re also prone to experiencing increased severity of symptoms. 

What’s more, the “emotional hunger” associated with the anxious attachment style may be a risk factor for the binging and purging cycle of bulimia. 

II. Avoidant attachment and eating disorders

Avoidant attachers learned to cope with the feeling that their needs were rejected as children by shutting down their attachment system, forging a sense of self-reliance, and a general distrust of others. For these reasons, it is unsurprising that the evidence suggests that an avoidant attacher’s tendency to detach or distance themselves from distressing emotions essentially represents a “turning away” from painful experiences – similar to the way someone with anorexia denies their physical hunger. As a result, the avoidant attachment style may explain the strict dietary habits that someone with an eating disorder tends to engage in.

Additionally, avoidant attachers tend to set high standards of perfectionism for themselves, which may put them at further risk of developing an eating disorder.

III. Disorganized attachment and eating disorders

Issues associated with disorganized attachment, such as feelings of unresolved trauma and loss, may play a substantial role in the development of eating disorders. In fact, the greater the level of trauma in early years, the more serious the symptoms of an eating disorder tend to be. 

What’s more, depending on whether a disorganized attacher falls more highly on the dimension of attachment anxiety or avoidance may determine the form of unhealthy eating patterns or restrictions they engage in. For example, if a disorganized attacher displays more anxious symptomatology, they may engage in binging and purging to curb their feelings of distress around their appearance and weight gain. Moreover, if they fall more on the avoidant dimension, they may restrict their calorie intake in an attempt to strive for the “perfect” aesthetic and detach from distressing emotions. 

Caregiver Behaviors and Eating Disorders

Overall, some of the main highlights from research on why someone develops an eating disorder is a level of confusion around how caregivers behave, as well as how caregivers manage their teenagers’ burgeoning desires for independence. Let’s take a look at how these factors may become risk factors for eating disorders:

Disrupted attempts for independence as a risk factor for eating disorders 

As teenagers, we naturally start to strive for independence from our attachment figures. Therefore, we attempt to redefine our relationships with our caregivers in line with our new adolescent needs. However, doing so is often easier said than done. 

This need for independence can often create an internal struggle for a teen. On the one hand, they desire a sense of freedom and control over their own lives. On the other hand, they still seek comfort and support from their caregivers. As a result of this battle of needs, a teenager often feels intense inner stress and conflict.

This internal battle can only be resolved when caregivers and teens openly communicate their thoughts, feelings, and needs with each other. However, the ability to do so is usually influenced by the type of attachment bond that a teenager and caregiver share.

Unfortunately, when a balance is not reached, a teenager may attempt to cope with their negative feelings in unhealthy ways such as restricting food, as they are striving for control and independence in one of the few ways they can. 

Mothers’ transmission of trauma may lead to eating disorders

A study on adult women with eating disorders determined that all the women involved were anxiously attached. The study further reported that these women felt a lack of unresolved trauma or loss, especially with their mothers. This discovery aligns with the findings of other studies that discuss how a mother’s unresolved personal trauma may impede her ability to respond to her child’s needs sensitively. As a result, transgenerational transmission of trauma may play a vital role in the development of an eating disorder. So, it may broaden our understanding of how eating disorders develop if we not only consider a teenager’s trauma, but also their mothers.  

Interestingly, seeing as it is thought that anxious mothers superimpose their own needs on their children, we might expect these children to feel overly reliant on their mothers to establish their own sense of self. However, it has actually been found that adolescents with eating disorders tend to idolize their caregivers. And they see their mothers as encouragers of independence. 

Yet, as adults, women with eating disorders often report a role reversal with their mothers. Although these womens’ relationships with their mothers are loving, they are also often characterized by neglectful, rejecting actions on behalf of the mothers, as well as confusion about how adult daughters now seem to take on the parenting role. All of which can maintain unhealthy attitudes around eating and food. 

Fathers’ avoidant actions may be a risk factor for eating disorders

As most of the findings from research are based on self-reports from people with eating disorders, it’s often found that fathers tend to be somewhat left out of the discussion. Yet, the couple of studies that have examined the role of the father in the development of an eating disorder found that an insecure bond with a father figure can predispose someone to an eating disorder. 

In particular, when a father figure is avoidant, detached, controlling, and less attentive, their child tends to show greater food restraint, anxiety about eating, and concern with their body shape and appearance. Undoubtedly, more studies on the father’s role in the development of eating disorders would likely provide some interesting findings. 

Final Thoughts on Attachment Theory and Eating Disorders

If you have an eating disorder, there may be times in your journey of recovery when you feel like the distance you have yet to go is insurmountable. In moments like these, try to focus on how far you have come – the successes you’ve had when the road has been tough and how resilient you clearly are to have dealt with so many challenges in life and still be fighting. You are more than calorie counting, what the weighing scales tell you, and an attachment style. 

“There is no magic cure. No making it all go away forever. There are only small steps upward: an easier day, an unexpected laugh, a mirror that doesn’t matter anymore.” – Laurie Halse Anderson, author.

We hope that the information provided within this article helps you to break down and understand the unhealthy attitudes around food and The Self which tend to predispose people to eating disorders, and also maintain them. Remember – although knowledge is a powerful tool, it cannot replace theatment. If you are struggling with your self-perceptions, negative moods, or patterns around food, then it’s vital that you speak to a medical or health professional. 

References

Allen, J. P., & Miga, E. M. (2010). Attachment in adolescence: A move to the level of emotion regulation. Journal of social and personal relationships, 27(2), 181–190.

Brewerton TD. (2007). Eating disorders, trauma, and comorbidity: focus on PTSD. Eating Disorders, 15(4), 285-304.

Cortés-García, L., Takkouche, B., Seoane, G., & Senra, C. (2019). Mediators linking insecure attachment to eating symptoms: A systematic review and meta-analysis. PloS one, 14(3), e0213099.

Delvecchio, E., Di Riso, D., Salcuni, S., Lis, A., & George, C. (2014). Anorexia and attachment: dysregulated defense and pathological mourning. Frontiers in psychology, 5, 1218. 

Gander, M., Sevecke, K., & Buchheim, A. (2015). Eating disorders in adolescence: attachment issues from a developmental perspective. Frontiers in psychology, 6, 1136. 

Horesh, N., Sommerfeld, E., Wolf, M., Zubery, E., & Zalsman, G. (2015). Father-daughter relationship and the severity of eating disorders. European Psychiatry, 30(1), 114-20.

Ringer, F. & McKinsey Crittenden, P. Eating disorders and attachment: the effects of hidden family processes on eating disorders. European Eating Disorders Review, 15(2), 119-130.

Zachrisson H., & Kulbotten G. (2006). Attachment in anorexia nervosa: an exploration of associations with eating disorder psychopathology and psychiatric symptoms. Eating and Weight Disorders, 11, 163–170.