Change in attachment states of mind of women with binge‐eating disorder

Abstract

Insecure and unresolved/disorganized attachment states of mind may impact affect regulation and interpersonal functioning that contribute to binge eating in women with binge-eating disorder (BED). Group psychological treatment may facilitate changes from insecure to secure and from unresolved-disorganized to non-unresolved/disorganized attachment states of mind. This study used attachment theory to understand better the psychopathology of BED and co-morbid overweight status and to understand better the treatment response of patients with BED who receive group psychotherapy. Women with BED attended group psychodynamic interpersonal psychotherapy and completed the Adult Attachment Interview pretreatment and 6 months posttreatment. Matched samples of overweight women without BED and normal-weight women without BED completed the Adult Attachment Interview at 1 time point. Women with BED had significantly higher rates of preoccupied and unresolved/disorganized attachment states of mind compared to normal-weight women without BED and had similar rates of insecure and unresolved/disorganized attachment states of mind compared to overweight women without BED. Of the women with BED who had an insecure and/or unresolved/disorganized attachment states of mind at pretreatment, about 60% demonstrated clinically relevant changes to secure and to non-unresolved/disorganized states of mind at 6 months post group psychodynamic interpersonal psychotherapy. Results indicated that some women with BED may benefit from interventions that help them regulate hyperactivated affect and create coherent narratives. Both women with BED and overweight women without BED may benefit from treatments that help them develop more adaptive affect regulation strategies related to unresolved/disorganized attachment states of mind.

An Integrative Approach to Clinical Decision-Making for Treating Patients With Binge-Eating Disorder

“…Compared to a mixed treatment-seeking ED comparison sample, those with BED had slightly lower levels of interpersonal distrust and social insecurity, but similar levels on all other social and interpersonal problem indicators. These findings are consistent with previous reports of patients with BED (Ivanova et al, 2017; Maxwell, 2017). The interpersonal model of BED, which has been tested in empirical studies (e.g., Ivanova et al, 2017), suggests that interpersonal problems may lead to negative affect or affect dysregulation that then precipitate binge eating.…”

How are early maladaptive schemas and DSM‐5 personality traits associated with the severity of binge eating?

“…Finally, another pattern that characterized BED-obese was the presence of the dependence/incompetence EMS. This result could be explained with the latest research on the attachment system in patients with BED, in which it was observed that low levels of parental care could have triggered greater confusion and uncertainty in adequately responding to the high frequency of unpleasant emotional experiences (Maxwell et al, 2017). These experiences have thus contributed to the deficient development of their character, a more severe psychopathological symptomatology and greater difficulty in identifying the sensations of hunger and satiety and accurately distinguishing them from other emotions (Tasca et al, 2018).…”

Disorder‐specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode

“…Research in the field of traumatic experiences distinguishes between the effects of non‐interpersonal traumas (i.e., accidents, physical illness, and natural disasters), interpersonal traumas (i.e., child abuse and maltreatment, domestic violence, and sexual abuse), and adverse childhood circumstances (i.e., difficult upbringing conditions). Recently published studies demonstrated that patients with an eating disorder (ED) often report emotional abuse, mental health problems in parents, or parental divorce during their upbringing (Lejonclou, Nilsson, & Holmqvist, ; Maxwell et al, ). It is also suggested that sexual trauma is related more often to bulimia nervosa (BN) or AN binge‐eating/purging type, than to AN, restrictive type (AN‐R; Brewerton, ; Jaite et al, ).…”