The Link Between Eating Disorders and Attachment Styles

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By Gia Marson, Ed.D.

The desires for bonding, love, connection, closeness, and intimacy are natural parts of the human experience. Not only that, reliable, close, meaningful relationships can positively impact our lives, bringing us more joy, better health, and even greater longevity.

So what do our relationships have to do with eating, body image, and eating disorders? Many studies suggest that relational dynamics can trigger and maintain eating problems—and also provide support in recovery from them. So it stands, then, that attachment styles may hold some keys to healing from body dissatisfaction, binge eating disorder, anorexia nervosa, bulimia, and other disordered eating behaviors.

Attachment styles describe the ways in which people establish and maintain relationships. Attachment styles may be secure or insecure, but here are the main ones:

Secure attachment is characterized by a positive perception of self and others along with the capacity to create and sustain close connections, tolerate differences and separations, and maintain effective emotional coping.

Anxious attachment is an insecure attachment style characterized by a need for reassurance, trouble trusting others, and fear of abandonment.

Avoidant attachment is an insecure attachment style characterized by avoiding close connections and a tendency to dismiss feelings and push away from increased intimacy.

Disorganized attachment is an insecure attachment style characterized by inconsistent or conflicting responses to close connections.

What the science says about attachment styles and eating

“The role of attachment insecurity as a predictor of treatment outcome suggests the need for an integration of the cognitive-behavioral conceptualization of EDs with a developmental perspective that considers attachment-related issues.” —Rossi et al (2022)

A 2019 meta-analysis of attachment styles and eating disorders revealed that people with anxious or avoidant attachment styles are the most vulnerable to developing eating disorders. Difficulty with establishing and maintaining close relationships, trusting others, intimacy, and exerting self-control over one’s emotional responses are characteristics of these attachment styles—and these traits may contribute to the development of eating disorders. For instance, a poor relationship with food may serve as a coping mechanism for managing difficult emotions or as an attempt at regaining control of one's life. The authors of this meta-analysis argue that addressing attachment issues may be crucial to recovery from an eating disorder and that attachment styles may change over the course of treatment.

In a 2022 study, researchers looked at the connection between insecure attachment styles and how well patients with eating disorders responded to enhanced cognitive behavior therapy (CBT-E). The findings suggest a substantial link between attachment insecurity and treatment outcomes, including lower rates of remission and higher rates of eating disorder psychopathology. These results indicate that people with eating disorders may want to ask their therapist about the role of any relationship patterns that reveal challenges with creating or maintaining closeness.

Another study, in 2021, examined the relationship between attachment to parents and friends and body dissatisfaction in adolescents with eating disorders. It noted that issues of trust, communication, and alienation correlated with body dissatisfaction. The researchers suggest that maintaining good relationships and working toward a secure attachment style with parents and peers may provide a protective effect against body dissatisfaction.

Because eating disorders have a high risk of chronicity, potential for long-term health problems, and a significant mortality rate, learning more about outcome predictors can lead to more potentially powerful treatments and higher rates of recovery.

How adopting a secure attachment style can help with recovery from an eating disorder

Interdependence can be quite helpful in developing resilience and in recovering from an eating disorder. A network of dependable connections can provide a sense of security, acceptance, and belonging, all of which can contribute to increased self-worth and self-acceptance. Trustworthy relationships offer both emotional support to get through the difficulties of recovery as well as practical support when it comes to meal preparation, helpful distraction during hard times, and planning enjoyable activities as a way to stay motivated for recovery.

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We know that supportive relationships are a key to building a life worth living—and they may also be a key to recovery from an eating disorder. Creating secure, healthy connections by asking for support from dependable friends, family members, or specialists can be part of your healing journey.

How to practice secure attachment as an adult

“An important implication of attachment research is that it's possible to develop a secure state of mind as an adult, even in the face of a difficult childhood. Early experience influences later development, but it isn't fate: therapeutic experiences can profoundly alter an individual's life course… The brain continues to remodel itself in response to experience throughout our lives, and our emerging understanding of neuroplasticity is showing us how relationships can stimulate neuronal activation and even remove the synaptic legacy of early social experience.” —Sroufe and Siegel

In eating disorder treatment, the practice of creating secure attachment patterns may center around food, body image, exercising, and thoughts. A therapist may encourage clients to choose your relationships over the eating disorder or to reach for people, not food. For example, a therapist might encourage a client to show up for a good friend by attending their birthday party, participating, and celebrating by eating cake, rather than allowing anxious thoughts about the food or social situation to potentially harm the relationship. Or a therapist might encourage a lonely client to reach out to a friend and make a plan to meet up, rather than to grab food in an attempt to avoid feelings of isolation.

The following are just some skills an individual might practice while learning to develop a more secure style of attachment with the people they care about:

• Developing effective communication skills
• Establishing clear, helpful boundaries
• Showing understanding and kindness
• Relying on internal validation, rather than seeking reassurance
• Tolerating time and space apart without feeling abandoned or rejected
• Asking for and offering support
• Responding rather than reacting
• Trusting the overall goodness of yourself and of those important to you
• Offering close friends the benefit of the doubt
• Forgiving mistakes, and not taking them personally
• Keeping self, other, and “us” in mind
• Accepting differences
• Expressing openness and respect
• Having confidence in knowing yourself and your values

Talking to a therapist or other mental health expert to resolve any relationship problems or difficulties can help. Keep in mind that developing a trusting therapeutic relationship is a process that takes patience, just like any relationship. Beyond therapy, spending time establishing close, caring bonds, social support, and relationships skills may be a significant aspect of the prevention of body dissatisfaction for adolescents and healing for individuals with eating disorders. Even if you developed an insecure style of attachment as a young person, you can still make progress toward secure attachments with others as an adult.