When parenting fails: alexithymia and attachment states of mind in mothers of female patients with eating disorders

Abstract

Introduction: In recent years alexithymia and attachment theory have been recognized as two parallel research lines trying to improve the information on the development and maintenance of eating disorders (EDs). However, no research has analyzed these constructs among patients’ families. In this study we compared alexithymia and attachment in mothers of patients with EDs and a control group. Further, we hypothesized that mothers of daughters with EDs with insecure and unresolved states of mind will reported high levels of alexithymia. Lastly, we explored the daughters’ evaluations of maternal alexithymia.Methods: 45 mothers of ED women and 48 mothers of healthy controls (N = 93) matched for age and socio-demographic variables were administered by the Toronto Alexithymia Scale-20 (TAS-20) (S), while two sub-groups of “ED” mothers (n = 20) and “non-ED” ones (n = 22) were assessed by the Adult Attachment Interview (AAI). Moreover, the Observer Alexithymia Scale (OAS) was administered to the daughters for evaluating maternal alexithymia.Results: Regarding alexithymia, no differences were found between ED and non-ED mothers according to the TAS-20, while ED mothers showed more unresolved AAI classifications than non-ED mothers. No correlations were found between the TAS-20 and the AAI. Lastly, ED mothers were evaluated more alexithymic by their daughters with the OAS than those in the control group, and their alexithymic traits were significantly correlated with dismissing states of mind (idealization and lack of memory) in the AAIs.Discussion: Our results highlighted an interesting discrepancy among mothers with ED daughters between the low level of alexithymia provided by their self-reports and the high level of alexithymia observed by their daughters, although the OAS showed severe methodological limitations. Maternal attachment states of mind characterized by the lack of resolution of past losses could be connected to a confusing and incoherent quality of parenting.

Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch's Foundation Lecture?

“…The specific quality of the attachment to the primary caregivers has been extensively investigated in eating disorders. The data confirm what Bruch describes in her lecture and indicate that both adults (Tasca & Balfour, ; Zachrisson & Skarderud, ) and adolescents (Gander, Sevecke, & Buchheim, ; Jewell et al, ) with anorexia nervosa recall insecure patterns of attachment, often characterised by attachment devaluation or difficulties of processing loss and trauma (Pace, Cavanna, Guiducci, & Bizzi, ). A recent meta‐analysis concluded that the effect for insecure attachment in adult patients is large ( d = 1.3) (Caglar‐Nazali et al, ).…”

“…A recent meta‐analysis concluded that the effect for insecure attachment in adult patients is large ( d = 1.3) (Caglar‐Nazali et al, ). Interestingly, a similar pattern of attachment is seen in patients' mothers (Ward et al, ; Pace et al, ).…”

Parental and Adult Attachment and Eating Symptomology in Eating Disorder Patients and Sine Morbo Individuals

“…In line with this, lower parental care and higher parental control can be associated with worse personality traits and psychological functioning and stronger ED symptoms (Amianto et al, 2015). Although more studies focus on the mother-child relationship in ED patients (Claydon et al, 2016;Pace et al, 2015), present results also underline the association between the degree of paternal care and the severity of ED symptoms among ED patients. Similarly, Horesh et al (2015) found that patients with overprotective or avoidant paternal bonding presented higher levels of depression and worse eating and body shape concerns (including more severe food-restraint) than those who experienced caring and benevolent father-daughter relationships.…”

“…In line with this suggestion, ED patients suffer from separation anxiety (Troisi et al, 2005) and ED symptoms usually engage parental involvement, decreasing the distance with their parents (Orzolek-Kronner, 2002). Mothers of anorexic females reported themselves low levels of alexithymia, while their daughters perceived high maternal alexithymia (Pace et al, 2015). This hints at the differences in the perception of the degree of emotional responsiveness in ED families.…”

Attachment in eating-disordered outpatients with and without borderline personality disorder

“…From a clinical perspective, it may be beneficial to consider attachment state of mind assessed by the AAI during the clinical assessment of patients with ED, with and without co-morbidity with BPD, as it may shed light on the ability to engage patients in treatment relationships and also may provide some insight into potential vulnerability for rupture of patient-therapist relationship and better specialized interventions (Dazzi and Zavattini, 2011;Pace et al, 2015a).…”