Eating disorders (ED) typically develop during adolescence, and prevalence rates have dramatically increased over the past century. There are a number of environmental, social, biological and psychological factors that may influence the likelihood of developing an eating disorder such as anorexia nervosa (AN). Emerging research is now focusing on the potential links between early attachment and anorexia.
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What is anorexia nervosa?
AN is a psychological disorder which has one of the highest mortality rates among psychological conditions. Symptoms include maintaining a body weight at least 15% below the expected according to age and height, an extreme fear of gaining weight, as well as a distorted body image.
Weight loss in those with this condition is self-induced and often involves avoiding fattening food, induced vomiting, purging, the use of diuretics or excessive exercise. The condition typically affects females ten times more often than males, and occurs most often in adolescent girls and young women.
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Causes of anorexia nervosa
Research suggests there are several biological, cognitive, environmental and socio-cultural factors that are associated with the onset and maintenance of AN. Modern research has focused on the potential links between the relationships or attachments formed during infancy and the odds of developing AN.
Attachments in infancy
It is suggested that attachment is an important factor which can affect how young people cope with challenging changes during adolescence. Theories surrounding attachment propose that secure attachments can provide comfort and emotional support, and availability, particularly during periods of change or heightened stress.
As children develop into adolescents, they begin to internalize interactions with their parents or guardians. Specifically, they develop “internal working models of attachment” which stem from the different ways their parents responded to their attachment behavior.
Infants who are securely attached to their caregivers tend to think of themselves as being competent and valuable due to their parents’ understanding and responsiveness.
The converse is seen in infants with poor attachments to their caregivers who often view themselves as being incompetent and unlovable. This can be seen in environments where caregivers show rejecting or inconsistent responses to their children.
Overall, having secure quality attachments can be extremely beneficial in dealing with developmental tasks during adolescence such as adjusting to physical change, defining goals, or creating a personal identity, which can act as a buffer for psychological risks.
Attachment and anorexia
Research has found that those with AN tend to have an insecure attachment style, which is an established risk factor for other ED too.
Approximately 70 percent to 100 percent of those with ED have an insecure attachment style. It is thought that such attachment styles are often associated with poor self-concept and low identity differentiation, which are linked to the probability of developing AN.
Others suggest that those with insecure attachment types are less aware and less able to accept the present moment, leading to impaired recognition of hunger and satiety in addition to reduced acceptance of their bodies.
In addition to this, it is argued that those who do not form healthy relationships in infancy may seek to develop connections with other sources. This, in turn, could lead to an adverse obsession with celebrities, body image, and exercising or fixating on their food and diet.
Attachment anxiety and anorexia
Those with attachment anxiety typically have a negative sense of self. They will often expect separation from or abandonment by others, and may become preoccupied with the responsiveness or availability of others around them. Some researchers suggest that this type of attachment might be linked to the binge eating or purging behavior seen in AN.
Furthermore, research involving young people with AN and other ED concluded that there was a positive relationship between the levels of attachment anxiety and symptom severity.
Subsequent research which examined pre-treatment attachment anxiety on depressive symptoms post-treatment found that those with anxious attachment styles showed less reduction in symptoms compared to avoidant styles.
One explanation for this is that those with anxious attachment styles may have an increased need for approval. Due to the hyperactivation of their emotions, this may result in a lack of effective coping strategies which can cause comparison and unrealistic standards.
This hypothesis is consistent with a body of research which shows that hyperactivating strategies are linked to attachment anxiety.
Attachment avoidance and anorexia
With respect to the above, those with avoidant attachment styles are also characterized by a general negative sense of others. Individuals with this attachment type tend to be self-reliant and avoid intimate relationships. It is thought that such attachment type might be associated with dietary restriction which can lead to AN.
By understanding how early attachment can influence the likelihood of developing eating disorders such as anorexia, effective treatment methods could be employed to address the associated feelings caused by insecure attachments. This, in turn, could lead to a reduction in the severity of symptoms in those with AN.