Implications of Attachment Theory and Reasearch for the Assessment and Treatment of Eating Disorders



In this paper, we review the research literature on attachment and eating disorders and suggest a
framework for assessing and treating attachmentfunctioning in patients with an eating disorder.
Treatment outcomes forindividuals with eating disorders tend to be moderate. Those with attachment-
associated insecurities are likely to be the leastto benefitfrom current symptom-focused therapies. We
describe the common attachment categories (secure, avoidant, anxious), and then describe domains of
attachmentfunctioning within each category: affectregulation,interpersonal style, coherence of mind,
and reflective functioning. We also note the impact of disorganized mental states related to loss or
trauma. Assessing these domains of attachmentfunctioning can guide focused interventions in the
psychotherapy of eating disorders. Case examples are presented to illustrate assessment, case formula-
tion, and group psychotherapy of eating disorders that are informed by attachmenttheory. Tailoring
treatments to improve attachmentfunctioning for patients with an eating disorder willlikely resultin
better outcomes forthose suffering from these particularly burdensome disorders.