Eating disorders and attachment: The effects of hidden family processes on eating disorders

Aim: This study examined pattern of attachment in cohort of women with an eating disorder to determine what types of self-protective strategies they used, and further whether there was a specific relationship between strategy and diagnosis. Method: The participants were 62 young women with an eating disorder (19 with anorexia nervosa, 26 with bulimia nervosa and 17 with bulimic anorexia). Attachment was assessed using the Adult attachment interview (AAI), classified using Crittenden's Dynamic-Maturational Method. Results: The results indicated that all women with an eating disorder were anxiously attached. About half used an extreme coercive Type C strategy while most of the others combined coercion with an extreme dismissing Type A strategy. The content of the AAIs suggested lack of resolution of trauma or loss among the mothers and also of hidden family conflict between the parents. This in turn elicited extreme strategies for generating parent-child contingency from the daughters. Conclusions: Central in almost all cases was the women's confusion regarding how parental behaviour was tied causally to their own behaviour. Questions are raised regarding the focus of treatment. (C) 2006 John Wiley & Sons, Ltd and Eating Disorders Association.