Can Attachment Theory Help Explain the Relationship Some People Have With Their ' Anorexia Voice'?

Posted on February 20, 2019

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Since young, our relationships with our primary caregivers like our parents, serves as a guideline or a script for our future relationships. This is known as the “attachment theory”, where how an individual perceives what a meaningful relationship entails, is very much shaped by their attachments to their parents or primary caregivers. This in turn has been said to possibly affect and influence one’s relationship with their eating disorder (ED) and may have important consequences with regards to its severity. Researchers sought to work towards this direction to better understand ED.

The attachment theory posits that a parent that is protecting and nurturing, will lead a child to feel trust, developing a secure attachment and expecting a protection-trust dynamic in their future relationships. Conversely, a troubled caregiver-child relationship would result in insecure attachment style that could lead to downstream consequences and perceptions of relationships such as how it is normal for people who care about you to attack you as well. Furthermore, these attachments also serve as scripts on what might be appropriate ways to treat ourselves, where those with insecure attachments may believe it is appropriate to attack and judge oneself. The tricky thing with attachment is that they are hard to change, and once the dynamic is formed we gravitate towards them especially in times of distress.

EDs have been evidenced to be more common in individuals with less secure or insecure attachment styles. At a glance, there are noticeable parallels in attachment dynamics and how these individuals experience ED. An example would be in times of distress, those with ED become more likely to engage in counterproductive eating behaviours for comfort where prevention from doing so increases their levels of distress even more. Delving deeper, researchers have found a deeper connection between the attachment theory and the experience of ED which they have labelled as the “anorexic voice”. This is when symptoms of ED are maintained through harsh and forceful self-judgements, coupled with self-instructed behaviours attributed to the anorexic condition. However, this “anorexic voice” though negative and antagonistic, is often still considered an ally rather than an enemy, similar to certain insecure attachment relationships leading to the plausibility of this association.

To confirm if the association holds true, Emma Forsén Mantilla and her team from the Karolinska Institute in Sweden carried out a correlational study with 148 women diagnosed with ED recruited from outpatient units in Sweden. Consistent with previous literature, their results indicated that ED behaviours were more pronounced in individuals with less secure attachment styles. Additionally, they wanted to track if these individuals turned their insecure attachment patterns inwards in terms of their attachments to their ED. Results from that also indicated that individuals with less secure attachments tended to perceive their ED as more controlling, see themselves as less autonomous, and engage in self-blame. This association between overall attachment and ED is thus clearly explained through the self-blame and controlling quality to their ED that these individuals experience.

With the results from this study, it is possible that individuals with insecure attachments style have an increased tendency to internalise blame and expect a controlling relationship. This can then manifest itself in the form of an ED, producing the ED symptoms accordingly. It could also explain why some individuals are so resistant to treatment as recovering or “losing” their ED is akin to losing someone that “gets” you. Ultimately, this research may be useful for treatment intervention in terms of identifying aspects of one’s relationship with ED that appears most strongly associated to the actual ED behaviours. This would be especially useful for psychologists using narrative therapy as ED would be characterised as an external entity in a relationship. Moreover, it could help in relapse prevention as they tackle difficulties in forming relationships, enabling them to form better relationships for emotional support.

Category(s):Eating Disorders

Source material from BPS Research Digest