Discussion

Implications •  Low Secure attachment, high Fearful attachment, and high Dismissing

attachment styles were associated with higher symptomology. •  Increasing Secure attachment may improve markers of positive

outcomes in treatment. Higher Secure attachment may have potential to aid in reducing depression, drive for thinness, body dissatisfaction, and bulimic symptoms.

Limitations •  Although attachment style is a robust variable in explaining

depression and anxiety, there are other variables that could account for these symptoms.

•  As the RSQ was designed as a continuous measure, utilizing it categorically for each style may limit interpretation as comparisons of greater or lesser attachment.

•  The limited sample size might have impacted the results.

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Background Eating disorders (EDs) are shown to be related to attachment loss (Broberg, Hjalmers, and Nevonen, 2001; Ward, Ramsay, and Treasure, 2000; Cole-Detke & Kobak, 1996). Fearful-avoidant and anxious-preoccupied attachment are associated with greater body dissatisfaction, eating-related symptoms, and poorer treatment outcomes independent of ED diagnosis (Arcelus, Haslam, Farrow, and Meyer, 2013; Keating, Tasca, and Hill, 2013; Illing, Tasca, Balfour, and Bissada, 2010). There is greater prevalence of insecure attachment style among those with EDs than in non-clinical samples (Zachrisson, & Skårderud, 2010). In non-ED samples, insecure attachment styles are associated with greater psychiatric symptoms, including anxiety and depression (Doumas, Blasey, and Mitcehll, 2007). Yet, the relationships between attachment dynamics, anxiety/depression, and ED pathology in a clinical sample has not yet been well explored. The current study hypothesized: (1)  There would be significant differences between level of attachment styles.

Fearful and preoccupied attachment styles will be more present than any other attachment styles.

(2) Lower secure attachment style would be associated with greater anxiety, depression, and ED pathology.

(3)  Greater fearful and preoccupied attachment dynamics would be associated with greater depression, anxiety, and ED pathology.

Method

The sample consisted of 135 patients with EDs (44% BN, 35% AN, and 21% EDNOS). The participants were 13% male and 87% female and the mean age was 28.3 (SD = 10.9). The large majority identified as Caucasian (74%), and the rest of the sample was comprised of Hispanic (12%), Asian (5%), and Other (9%). Upon admission to a treatment program in Southern CA, ED patients completed measures of attachment, ED symptomology, depression, and anxiety. • Relationship Scale Questionnaire. The Relationship Scale Questionnaire (RSQ; Bartholomew and Horowitz, 1991) assesses characteristic styles in close relationships using 30 Likert scale items.

• ED symptomology. The Eating Disorder Inventory-3 (EDI-3; Garner, 2004) is a 91 Likert scale items that measures psychological themes prevalent in individuals with eating disorders. Four subscales were used: Drive for Thinness, Bulimia, Body Dissatisfaction, and a combined ED Risk Composite.

• Anxiety. The Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, and Steer, 1988) measures the severity of anxiety using 21 Likert scale items.

• Depression. The Beck Depression Inventory (BDI-II; Beck, Steer, and Brown, 1996) assesses level of depression using 21 Likert scale items.

Attachment Dynamics and Eating Disorder Symptoms in a Clinical Treatment Group

1The Bella Vita; 2Fuller Theological Seminary; 3West Los Angeles Veteran�s Affairs Medical Center; 4 University of Michigan

Sandy Tadrous1,2, Joseph Barsuglia1,3, Timothy J. Arentsen1,2, Shaina Smith1,2, Charlotte Sandy4, Christopher D. Keiper1,2, Patricia L. Pitts1, and Alexis D. Abernethy2

Results

A within-subjects repeated measures ANOVA with Greenhouse-Geisser correction was used to control for systematic intercorrelations using the same instrument (Vassey & Thayers, 1987). Significant differences were found in attachment styles, F(2.3, 302.2) = 54.05, p <.001, ηp

2 = .29. The most highly endorsed attachment styles were Dismissing (M = 3.66, SD = 0.53) and Fearful (M = 3.54, SD = 0.95), while Secure attachment was the least endorsed (M = 2.61, SD = 0.59). RSQ attachment styles are displayed in Figure 1.

Pearson correlations between RSQ attachment styles and symptoms are shown in Table 1. Secure attachment was negatively correlated with Depression, Body Dissatisfaction and ED Risk at a moderate level and was weakly negatively correlated with the Bulimia subscale. Fearful attachment was positively associated with Depression as well as Body Dissatisfaction and ED Risk. Preoccupied attachment was weakly correlated with Bulimia scores, while Dismissing attachment was positively correlated with Depression and weakly correlated with Bulimia scores.

Presented at the 122nd Annual American Psychological Association Meeting (August, 2014).

Figure 1

Note. Error bars represent one standard deviation. All attachment styles significantly differ at p < .01 except Fearful and Dismissing (NS).

Table 1 Bivariate Pearson Correlations for Main Study Variables ___________________________________________________________________________

M SD 1 2 3 4 5 6 7 8 9 ___________________________________________________________________________ 1. Secure 2.61 0.59 -- -- -- -- -- -- -- -- -- 2. Fearful 3.54 0.95 -.57** -- -- -- -- -- -- -- -- 3. Precoccu. 3.19 0.77 .03 .01 -- -- -- -- -- -- -- 4. Dismiss. 3.66 0.53 -.43** .46** -.15 -- -- -- -- -- -- 5. Depress. 28.08 12.53 -.43** .37** -.04 .28** -- -- -- -- -- 6. Anxiety 22.95 11.88 -.16 .13 .05 .03 .62** -- -- -- -- 7. Thinn. 50.23 9.43 -.29** .11 .01 -.06 .43** .26** -- -- -- 8. Bod Di. 49.55 10.48 -.31** .26** .02 .05 .50** .23** .65** -- -- 9. Bulimia 49.95 10.57 -.21* .15 .24** .17* .22* -.00 .17* .15 -- 10. ED Co 48.45 10.63 -.31** .21* .06 .10 .49** .25** .74** .75**.51** ___________________________________________________________________________ Note. *p ≤ .05, **p ≤ .01. Preoccup. = Preoccupied Attachment Style; Dismiss = Dismissing Attachment Style; Depress. = Depression; Thinn. = Drive for Thinness; Bod Di. = Body Dissatisfaction; ED Co = Eating Disorder Risk Composite

Arcelus, J., Haslam, M., Farrow, C., & Meyer, C. (2013). The role of interpersonal functioning in the maintenance of eating psychopathology: A systematic review and testable model. Clinical Psychology Review, 33, 156-167. doi: 10.1016/j.cpr.2012.10.009.

Broberg, A. G., Hjalmers, I., & Nevonen, L. (2001). Eating disorders, attachment and interpersonal difficulties: a comparison between 18- to 24-year-old patients and normal controls. European Eating Disorders Review, 9(6), 381-396. doi:10.1002/erv421.

References Cole-Detke, H., & Kobak, R. (1996). Attachment processes in eating disorders and

depression. Journal of Consulting and Clinical Psychology, 64(2), 282-290. Illing, V., Tasca, G. A., Balfour, L., & Bissada, H. (2010). Attachment insecurity predicts

eating disorder symptoms and treatment outcomes in a clinical sample of women. J Nerv Ment Dis, 198(9), 653-659. doi: 10.1097/NMD.0b013e3181ef34b2

Keating, L., Tasca, G. A., & Hill, R. (2013). Structural relationships among attachment insecurity, alexithymia, and body esteem in women with eating disorders. Eating Behaviors,14(3), 366-373. doi: 10.1016/j.eatbeh.2013.06.01

Vasey, M. W., & Thayer, J. F. (1987). The continuing problem of false positives in

repeated measures ANOVA in psychophysiology: A multivariate solution. Psychophysiology, 24(4), 479-486.

Ward, A., Ramsay, R., & Treasure, J. (2000). Attachment research in eating disorders. British Journal of Medical Psychology, 73, 35-51

Zachrisson, H., & Skårderud, F. (2010). Feelings of insecurity: Review of attachment and eating disorders. European Eating Disorders Review, 18(2), 97-106.