Abstract
This study sought to examine the extent to which family environment and attachment styles are concurrently related to eating disorders. The Adult Attachment Scale and the Family Environment Scale were administered to 25 anorexic and 33 bulimic female patients at intake in an eating disorder clinic, and 37 age-matched female controls. Eating disorder patients were found to be less secure, more avoidant, and more anxious than controls. The families of eating disorder patients were found to be less cohesive, expressive, and encouraging of personal growth than were controls. Low encouragement of personal growth and uncertain attachment styles may be manifestations of family difficulties in supporting the child during the process of separation individuation, and exploration of the outside world.
Similar content being viewed by others
REFERENCES
Ainsworth M. D. (1989). Attachment beyond infancy. American Psychologist, 44, 709–716.
Ainsworth M. D., Blehar, M. C., Waters, E., & Woll, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum.
American Psychiatric Association. (1994). Statistical and diagnostic manual of mental disorders (DSM-IV). Washington, DC: Author.
Armstrong, J. G., & Roth, D. M. (1989). Attachment and separation difficulties in eating disorders: A preliminary investigation. International Journal of Eating Disorders, 8, 141–155.
Bachar, E. (1998). The contribution of self psychology to the treatment of anorexia and bulimia. American Journal of Psychotherapy, 52, 147–165.
Bartholemew, K., & Horwitz, L. M. (1991). Attachment styles among young adults: A test of a four category model. Journal of Personality and Social Psychology, 61, 226–244.
Beumont. P.J.V., Russell, J. D., & Touyz, S. W. (1993). Treatment of anorexia nervosa. The Lancet, 26, 341–346.
Bowlby, J. (1969). Attachment and loss: Vol.1.Attachment. New York: Basic Books.
Bowlby, J. (1973). Attachment and loss: Vol.2.Separation: Anxiety and anger. New York: Basic Books.
Bowlby, J. (1980). Attachment and loss: Vol.3.Loss. New York: Basic Books.
Bowlby, J. (1988). A secure loss: Clinical applications of attachment theory. London: Routledge.
Brennan, K. A., & Shaver, P. R. (1995). Dimensions of adult attachment, affect regulation and romantic relationship functioning. Personality and Social Psychology Bulletin, 21, 267–283.
Brookings, J. B., & Wilson, J. F. (1994). Personality and family-environment predictors of self-reported eating attitudes and behaviors. Journal of Personality Assessment, 63, 313–326.
Bruch, H. (1970). Family background in eating disorders. In E. J. Anthony & C. Koupernick (Eds.), The child and his family (pp. 285–309) New York: Wiley-Interscience.
Bruch, H. (1973). Eating disorders: Obesity, anorexia nervosa, and the person within. New York: Basic Books.
Byng-Hall, J. (1995). Creating a secure family base: Some implications of attachment theory for family therapy. Family Process, 34, 45–58.
Byng-Hall, J., & Stevenson-Hinde, J. (1991). Attachment relationships with a family system. Infant Mental Health Journal, 12, 187–200.
Chassler, L. (1997). Understanding anorexia nervosa and bulimia nervosa from an attachment perspective. Clinical Social Work Journal, 25, 407–423.
Cole-Detke, H., & Kobak, R. (1996). Attachment process in eating disorder and depression. Journal of Consulting and Clinical Psychology, 64, 282–290.
Collins, N. L., & Read, S. J. (1990). Adult attachment, working models, and relationship quality in dating couples. Journal of Personality and Social Psychology, 58, 644–663.
Collins, N. L., & Read, S. J. (1994). Cognitive representations of attachment: The structure and function of working models. In K. Bartholemew, & D. Perlman (Eds.), Attachment Process in Adulthood (pp. 53–90). London: Jessica Kingsley.
Crisp, A. H., Harding, B., & McGuiness, B. (1974). Anorexia nervosa. Psychoneurotic characteristics of parents: relationship to prognosis. A quantitative study. Journal of Psychosomatic Research, 18, 167–173.
Dare, C., Eisler, I., Russel, G. F. M., & Szmukler, G. I. (1990). The clinical and theoretical impact of a controlled trail of family therapy in anorexia nervosa. Journal of Marital and Family Therapy, 16, 39–57.
Dare, C. Le Grange, D., Eisler, I., & Rutheford J. (1994). Redefining the psychosomatic family: family process of 26 eating disorder families. International Journal of Eating Disorders, 16, 211–226.
Deter, H. C., Herzog, W., & Manz, R. (1994). Do patient with anorexia nervosa return to psychological health? Results of a 12-year follow-up of 103 patients. [German]. Zeitschrift fur Psychosomatische Medizin und Psychoanalyse, 40, 155–173.
Dozier, M., Stovall, K. C., & Albus, K. E. (1999). Attachment and psychopathology in adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment theory: Research and clinical applications (pp. 497–519). New York: Guilford Press.
Eckert, E. D., Halmi, K. A., Marchi, P., Grove, W., & Crosby, R. (1995). Ten-year followup of anorexia nervosa: clinical course and outcome. Psychological Medicine, 25,143–156.
Erickson, E. H. (1968). Identity: Youth and crisis. New York: Norton.
Evans, L., & Wertheim, E. H. (1997). Intimacy patterns and relationship satisfaction of women with eating problems and the mediating effects of depression, trait anxiety and social anxiety. Journal of Psychosomatic Research, 44, 355–365.
Felker, K. R., & Stivers, C. (1994). The relationship of gender and family environment to eating disorder risk in adolescents. Adolescence, 29, 820–834.
Friedberg, N. L., & Lyddon, W. J. (1996). Self–other working models and eating disorders. Journal of Cognitive Psychotherapy: An International Quarterly, 10, 193–203.
Friedlander, M. L., & Siegel, S. M. (1990). Separation-individualization difficulties and cognitive-behavioral indicators of eating disorders among college women. Journal of Counseling Psychology, 37, 74–78.
Garfinkel, P. E., & Garner, D. M. (1982). Anorexia nervosa: A multidimensional perspective. New York: Brunner/Mazel.
Garner, D. M., & Garfinkel, P. E. (Eds.) (1997). Handbook of treatment for eating disorders (2nd ed.). New York: Guilford Press.
Goodsitt, A. (1986). Self psychology and the treatment of anorexia nervosa. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of psychotherapy for anorexia and bulimia (pp. 205–228). New York: Guilford Press.
Hazan, C., & Shaver, D. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511–524.
Head, S. B., & Williamson, D. A. (1990). Association of family environment and personality disturbance in bulimia nervosa. International Journal of Eating Disorders, 9, 667–674.
Heesacker, R. S., & Neimeyer, G. F. (1990). Assessing object relations and social cognitive correlates of eating disorder. Journal of Counseling Psychology, 37, 419–426.
Herzog, D. B., Greenwood, D. N., Dorer, D. J., Flores, A. T., Ekeblad, E. R., Richards, A., Blais, M. A. & Keller, M. B. (2000). Mortality in eating disorders: A descriptive study. International Journal of Eating Disorders, 28, 20–26.
Hobbs, W. L., & Johnson, C. N. (1996). Anorexia nervosa: An overview. American Family Physician, 54, 1273–1279.
Hochdorf, Z. (1999). Relationships between family environment, parental reaction toward “launching” and personal variables of soldiers in training. Unpublished doctoral dissertation. Haifa University, Israel.
Hodges, E. L., Cochrane, C. E., & Brewerton, T. D. (1998). Family characteristics of bingeeating disorder patients. International Journal of Eating Disorders, 23, 145–151.
Holmbeck, G. N. & Wandrei, M. L. (1993). Individual and relational predictors of adjustment in first year college students. Journal of Counseling Psychology, 40, 73–78.
Humphrey, L. L. (1986). Family relationships in bulimic-anorexic and nondistressed families. International Journal of Eating Disorders, 5, 223–232.
Humphrey, L. L. (1987). Comparison of bulimic-anorexic and non-distressed families using structural analysis of social behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 248–255.
Humphrey, L. L. (1988). Relationship within subtypes of anorexic, bulimic and normal families. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 544–551.
Johnson, C., & Flach, A. (1985). Family characteristics of 105 patients with bulimia. American Journal of Psychiatry, 142, 1321–1324.
Johnson, S. M. (2002). Emotionally focused couple therapy with trauma survivors: Treating attachment bonds. New York: Guilford Press.
Johnson, S. M., Maddeaux, C., & Blouin, J. (1998). Emotionally focused family therapy for bulimia: Changing attachment patterns. Psychotherapy, 35, 238–247.
Kagan, D., & Squires, R. (1985). Family cohesion, family adaptability and eating disorders. International Journal of Eating Disorders, 4, 267–279.
Kenny, M. (1991, July). Attachment and eating disorders. Paper presented at the annual convention of the American Psychological Association. San Francisco.
Kenny, M., & Hart, K. (1992). Relationship between parental attachment and eating disorders in an inpatient and college sample. Journal of Counseling Psychology, 39, 521–526.
Kobak, R., & Cole, H. (1994). Attachment and meta-monitoring: Implications for adolescent autonomy and psychopathology. In D. Cicchetti & S. L. Toth (Eds.), Rochester Symposium on developmental psychopathology: Disorders and disfunctions of the self (Vol 5, pp. 267–297). Rochester, NY: University of Rochester Press.
Kog, E., & Vandereycken, W. (1989). Family interaction in eating disorder patient and normal controls. International Journal of Eating Disorders, 8, 11–23.
Kog, E., Vandereycken, W., & Vertommen, H. (1985a). Towards a verification of the psychosomatic family model: A pilot study of ten families with an anorexia/bulimia nervosa patient. International Journal of Eating Disorders, 4, 525–538.
Kog, E., Vandereyckern, W., & Vertommen, H. (1985b). The psychosomatic family model: A critical analysis of family interaction concepts. Journal of Family Therapy, 7, 31–44.
Lapsley, D. K., Rice, K. G., & Shadid, G. E. (1989). Psychological separation and adjustment to college. Journal of Counseling Psychology, 36, 286–294.
Latzer, Y. (1993). Patterns of verbal communication among parents of anorectic female adolescents. Unpublished research thesis for D.Sc., Israel Institute of Technology, Haifa, Israel.
Latzer, Y. & Gaber, L. B. (1998). Pathological conflict avoidance in anorexia nervosa: family perspectives. Contemporary Family Therapy, 20, 539–551.
Leon, G. R., Lucas, A. R., Colligan, R. C., Ferdinande, R. J., & Kamp, J. (1985). Sexual, body image, and personality attitudes in anorexia nervosa. Journal of Abnormal Child Psychology, 13, 245–258.
Lyon, M., Chatoor, I., Atkins, D., Silber, T., Mosimann, J., & Gray, J. (1997). Testing the hypothesis of the multidimensional model of anorexia nervosa in adolescents. Adolescence, 32, 101–111.
Maddocks, S., & Kaplan, A. S. (1991). The prediction of positive treatment response in bulimia nervosa: A study of patient variables. British Journal of Psychiatry, 159, 846–849.
Marcia, E. J. (1980). Identity in adolescence. In J. Adellson (Ed.), Handbook of adolescent Psychology (pp. 159–187). New York: Wiley.
Mazor, M. (1994). The connection between attachment styles and family types. Unpublished master's thesis, Bar Ilan University, Israel.
Mikulincer, M., & Arad, D. (1999). Attachment working models and cognitive openness in close relationships: A test of chronic and temporary accessibility affects. Journal of Personality and Social Psychology, 77, 710–725.
Mikulincer, M., & Florian, V. (1995). Appraisal of and coping with a real stressful situation: The contribution of attachment styles. Personality and Social Psychology Bulletin, 21, 406–414.
Mikulincer, M., & Florian, V. (1998). The relationship between adult attachment styles and emotional and cognitive reactions and stressful events. In J. A. Simpson & W. S. Rhodes (Eds.), Attachment theory and close relationships (pp. 143–165). New York: Guilford Press.
Mikulincer, M., & Horesh, N. (1999). Adult attachment style and perception of others: The role of protective mechanisms. Journal of Personality and Social Psychology, 76, 1022–1034.
Mikulincer, M., & Nachshon, O. (1991). Attachment styles and patterns of self disclosure. Journal of Personality and Social Psychology, 61, 321–331.
Mikulincer, M., & Orbach, I. (1995). Attachment styles and repressive defensiveness: the accessibility and architecture of affective memories. Journal of Personality and Social Psychology, 68, 917–925.
Millikin, J. W., & Johnson, S. M. (2002). Telling tales; Disquisitions in emotionally focused therapy. Journal of Family Psychotherapy, 11, 75–79.
Minuchin, S., Baker, B. L., Rosman, B. L., Milman, L., & Todd, T. C. (1975). A conceptual model of psychosomatic illness in children: Family organization and family therapy. Archives of General Psychiatry, 32, 1031–1038.
Minuchin, S., Rosman, B. L., & Baker, B. L. (1978). Psychosomatic families: Anorexia nervosa in context. Cambridge, MA: Harvard University Press.
Moos, R. H., & Moos, B. S. (1976). A typology of family social environment. Family Process, 15, 357–371.
Neumarker, K. J. (1997). Mortality and sudden death in anorexia nervosa. International Journal of Eating Disorders, 21, 206–212.
Noller, P. & Callan. (1986). Adolescence and parent perceptions of family cohesion and adaptability. Journal of Adolescence, 9, 97–106.
North, C., Giwers, S., & Byram, V. (1995). Family functioning in adolescent anorexia nervosa. British Journal of Psychiatry, 167, 673–678.
Ohannessian-McCauley, C., Lerner, R. M., Lerner, J. V., & Von Eye, A. (1995). Discrepancies in adolescents' and parents' perceptions of family functioning and adolescent emotional adjustment. Journal of Early Adolescence, 15, 490–516.
Ordman, A. M., & Kirschenbaum, D. S. (1986). Bulimia: Assessment of eating, psychological adjustment and familial characteristics. International Journal of Eating Disorders, 5, 865–878.
Rice, K. G., Fitzgerald, D. P., Whaley, T. J., & Gibbs, C. L. (1995). Cross-sectional and longitudinal examination of attachment, separation-individuation and college student adjustment. Journal of Counseling and Development, 73, 463–474.
Selvini-Palazzoli, M. (1974). Self-starvation: From the interpsychic to the transpersonal. London: Chancer Press.
Smetana, J. G. (1988). Adolescents and parents conceptions of parental authority. Child Development, 59, 321–335.
Stern, S. L., Dixon, K. N., Jones, D., Lake, M., Nemzer, E., & Sansone, R. (1997). Family environment in anorexia nervosa and bulimia. Unpublished manuscript.
Strober, M. (1981). The significance of bulimia in juvenile anorexia nervosa: An explanation of possible etiologic factors. International Journal of Eating Disorders, 1, 28–43.
Strober, M., & Humphrey, L. L. (1987). Familial contribution to the etiology and course of anorexia nervosa and bulimia. Journal of Counseling and Clinical Psychology, 55, 654–659.
Szmukler, G. I., Eisler, I., Russel, G. F. M. & Dare, C. (1985). Anorexia nervosa, parental “expressed emotion” and dropping out of treatment. British Journal of Psychiatry, 147, 265–271.
Thienmann, M. & Steiner, H. (1993). Family environment of eating disordered and depressed adolescents. International Journal of Eating Disorders, 14, 43–48.
Treasure, J. & Campbell, C. (1994). The case for biology in the etiology of anorexia nervosa. Psychological Medicine, 24, 3–8.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Latzer, Y., Hochdorf, Z., Bachar, E. et al. Attachment Style and Family Functioning as Discriminating Factors in Eating Disorders. Contemporary Family Therapy 24, 581–599 (2002). https://doi.org/10.1023/A:1021273129664
Issue Date:
DOI: https://doi.org/10.1023/A:1021273129664