No abstract

We examined the extent to which attachment insecurity was related to eating disorder (ED) symptoms, and predictive of treatment outcomes. Women diagnosed with anorexia nervosa (AN) restricting subtype (ANR), AN binge purge subtype (ANB), or bulimia nervosa (BN) completed an attachment scale pretreatment, and ED symptom scales pretreatment (N = 243) and post-treatment (N = 157). A comparison sample of 126 non-ED women completed attachment scales on 1 occasion. Those with EDs had significantly higher attachment insecurity than non-ED. ANB was associated with higher attachment avoidance compared with ANR and BN, and higher attachment anxiety compared with BN. Higher attachment anxiety was significantly related to greater ED symptom severity and poorer treatment outcome across all EDs even after controlling for ED diagnosis. Attachment dimensions substantially contribute to our understanding of ED symptoms and treatment outcome. Addressing attachment insecurity when treating those with EDs may improve treatment outcomes.

Researchers have known for years about the negative impact on Type I error rates caused by dependencies in hierarchically nested and longitudinal data. Despite this, group treatment researchers do not consistently use methods such as multilevel models (MLMs) to assess dependence and appropriately analyse their nested data. The goals of this study are to review some of the study design issues with regard to hierarchically nested and longitudinal data, discuss MLMs for assessing and handling dependence in data, and present a guide for developing a three-level growth MLM that is appropriate for group treatment data, design, and research questions. The authors present an example from group treatment research to illustrate these issues and methods.

Adult attachment and group process research are emerging areas of research for treating eating disorders. In this study, we examined several aspects of group processes: the weekly growth of group therapy climate, the relationship between group climate growth and outcomes, and the impact of the group on individual experiences of group climate. Further, we assessed the relationship between adult attachment dimensions and these group processes. Women (n = 264) diagnosed with an eating disorder completed attachment scales pre-treatment, eating disorder symptom scales pre- and post-treatment, and group climate scales weekly during treatment. Treatment consisted of a specialized eating disorders group-based day hospital program with rolling admissions. Engaged group climate increased and Avoidance group climate decreased across weeks of treatment. Engaged group climate growth was associated with improved eating disorder symptoms post-treatment. Higher attachment avoidance at pre-treatment was related to lower Engaged group climate at week 1, and was related to a greater impact of the group on the individual's experience of group engagement. Clinicians might improve group processes and outcomes by tailoring interventions to individuals' attachment avoidance when treating women for eating disorders.