Mediating role of depressive symptoms linking insecure attachment and disordered eating in adolescents: A multiwave longitudinal study

Abstract

Research has supported a link between insecure attachment and disordered eating in adolescents; however, how this influence is exerted remains unclear. This study explored whether depressive symptoms constitute a pathway through which insecure attachment to parents predicts subsequent development of disordered eating in the transition from childhood to adolescence. The study also examines whether there are differential effects regarding the attachment figure, child's gender, or reciprocity between variables. A community-based sample of Spanish youth (n = 904; 49.4% girls) was followed biennially from age 10 to 16 years. Attachment, depressive symptoms, and disordered eating were measured using the Inventory of Parental and Peer Attachment, Children's Depression Inventory, and Children's Eating Attitudes Test, respectively. Prospective data were analyzed using a dynamic panel model, which accounts for unmeasured time-invariant factors. Whereas insecure attachment to the father did not predict later depression or disordered eating, higher insecure attachment to the mother at ages 10 and 12 years predicted more disordered eating at ages 14 and 16 years via increased depressive symptoms at ages 12 and 14 years. No child's gender-specific or reverse mediational effects were found. This study suggests that an increase in depressive symptoms might be one mechanism by which insecure attachment exerts its influence on the development of eating disorders symptomatology in adolescence. Intervention efforts aimed at strengthening particularly the mother–child attachment relationship may reduce the vulnerability to develop depressive symptoms and disordered eating.

Family, friends, and feelings: the role of relationships to parents and peers and alexithymia in adolescents with anorexia nervosa

“…The inability to reflect upon one’s feelings may cause discomfort and may also impede the ability to generate appropriate reactions to one’s feelings (i.e., adaptive emotion regulation; [ 30 ]). Eating disorder symptoms could then arise as an attempt to counteract the discomfort [ 26 ] or as a maladaptive way to regulate or escape from negative emotions [ 26 , 66 ], for example by distraction by weight-loss behaviors or by feeling “less” in the state of starvation.…”

“…Eating disorder symptoms could then arise as an attempt to counteract Fig. 1 Results of the mediation analyses of alexithymia mediating relations between relationship quality to mothers (a), fathers (b), and peers (c) and eating disorder symptoms the discomfort [26] or as a maladaptive way to regulate or escape from negative emotions [26,66], for example by distraction by weight-loss behaviors or by feeling "less" in the state of starvation.…”

“…Maybe this is because peer relationships not only influence alexithymia but are also influenced by alexithymia: Alexithymia may not only result from inadequate relationships, especially to parents [64], but may also lead to difficulties in establishing and sustaining friendships with peers, as the inability to recognize and communicate one's feelings interferes with intimacy within relationships and might contribute to individuals being perceived as emotionally distant and withdrawn [39]. This lack of good friendships with peers might then influence eating disorder psychopathology in different ways: (1) peers have been suggested to be an important source for "normative" standards, especially regarding appearance [23,67] and the lack of the normalizing influence 7 of the peer group might lead to a greater endorsement of problematic eating attitudes and behaviors in adolescents [25,70], (2) poor peer relationships might involve teasing about weight and physical appearance, which has been found to be a predictor for unhealthy eating attitudes and behaviors [71], (3) relatedly, difficulties in peer relations might lead adolescents to engage in disordered eating behaviors as an attempt to gain social approval and acceptance [67], and (4) importantly, social isolation and the lack of good friendships could cause or be accompanied by low self-esteem or depressive symptoms [25,67,72] that might trigger disordered eating behavior as a means to either achieve positive self-worth or deal with negative affect [25,66,72]. These multiple pathways might explain the particularly important role that peer relationships seem to play for eating disorder psychopathology.…”

Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa (Thesis)

“…Apostolidou et al (in preparation) recommend that future studies in this area need to control for psychopathology, report data on duration of illness, and employ longitudinal designs to understand the course of attachment security over time.3.9.3 Community studies of attachment and eating pathologyThree recent studies have begun to shed light on the issue of change in attachment over time in adolescents. The most sophisticated of these are two studies byCortés- García et al (2019b;2020a) which used a cross-lagged panels design to investigate the relationship between eating pathology and attachment in a sample of 908 adolescent boys and girls across four time-points. At Time 1, the mean age of the sample was around age 10.…”

“…However, the authors do not report whether the association between insecure attachment at age 10 and eating pathology at age 16 remained significant when controlling for depressive symptoms at age 10. Comparing the first and second studies(Cortés-García et al, 2019b;2020a), it is striking that the prospective associations between attachment and eating pathology at the subsequent timepoint (e.g. Time 1 to Time 2) are only significant in the first study, which did not include depression.…”