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The unsafe haven: Eating disorders as attachment relationships
Karolinska Inst, Stockholm Cty Council, Ctr Psychiat Res, Dept Clin Neurosci, Norra Stationsgatan 69,7 Tr, S-11364 Stockholm, Sweden..ORCID iD: 0000-0001-9550-3820
Karolinska Inst, Stockholm Cty Council, Ctr Psychiat Res, Dept Clin Neurosci, Norra Stationsgatan 69,7 Tr, S-11364 Stockholm, Sweden.;Inst Eating Disorders, Oslo, Norway..ORCID iD: 0000-0002-3536-6059
Karolinska Inst, Stockholm Cty Council, Ctr Psychiat Res, Dept Clin Neurosci, Norra Stationsgatan 69,7 Tr, S-11364 Stockholm, Sweden..
2019 (English)In: Psychology and Psychotherapy: Theory, Research and Practice, ISSN 1476-0835, E-ISSN 2044-8341, Vol. 92, no 3, p. 379-393Article in journal (Refereed) Published
Abstract [en]

Objectives Some patients with eating disorders (EDs) seem to experience their illness as an entity, a symbolic other to whom they relate, and which may influence both symptom levels and self-image. Extending previous research, this study investigated whether the patient-ED relationship has attachment qualities. Design Structural Analysis of Social Behaviour was used to operationalize the patient-ED relationship, and the Attachment Style Questionnaire was used to measure attachment. Method We examined ED patients' (N = 148) relationship with their ED, attachment behaviour, symptoms, and self-image. Attachment dimensions of Confidence, Anxious/ambivalence, and Avoidance were found to be significantly correlated with aspects of the patient-ED relationship. Introjection (i.e., whether ED actions were incorporated into patients' self-image) was investigated by examining the match between self-image profiles and the actions of patients' EDs. A double mediation model was tested in which ED control/emancipation and patients' Self-blame mediated the effect of attachment security on ED symptoms. Results Attachment insecurity was associated with greater ED control and patient submission. In 28.5% of patients, there was a high degree of correlation between self-image and ED action profile. Data supported the mediation model. Conclusions Attachment processes appear to be associated with the manner in which ED patients relate to their disorder, at least in some cases. Attempts to maintain psychological proximity to the ED as an introjected attachment figure may help to explain treatment resistance and ambivalence about change. This perspective may be useful in treatment. Practitioner points Attachment behaviours are associated with the patient-ED relationship, in which attachment insecurity is correlated with greater eating disorder control and patient submission. Some patients seem to incorporate the actions of the ED in their self-image, suggesting the presence of introjection. The patient-ED relationship may help explain patients' anxiety and ambivalence about change, seen from an attachment perspective. In treatment, it may be important to explore alternative safe havens and secure bases to the ED, such as interpersonal relationships and activities.

Place, publisher, year, edition, pages
WILEY , 2019. Vol. 92, no 3, p. 379-393
Keywords [en]
eating disorders, the patient-eating disorder relationship, attachment behaviors, self-image, introjection
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:gih:diva-7752DOI: 10.1111/papt.12184ISI: 000482379600004PubMedID: 29781234OAI: oai:DiVA.org:gih-7752DiVA, id: diva2:1795163
Available from: 2023-09-07 Created: 2023-09-07 Last updated: 2023-09-07

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Forsén Mantilla, Emma

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