A controlled study of attachment representations and emotion regulation in female adolescent with anorexia nervosa

Background: Several recent studies highlighted that both attachment insecurity and emotion regulation difficulties form a key part of conceptual models of anorexia nervosa (AN), but they had never been analyzed in the same controlled study. Method: This study examined the attachment states of mind, assessed by the Adult Attachment Interview (AAI), and emotion regulation difficulties, measured by the Difficulties in Emotion Regulation Scale (DERS), among 25 girls with AN diagnosis aged 14-18 years (M age=16.52, SD= 1.23), and 25 general population controls, matched for gender, age, years of education and SES. Results. The AN group reported both significantly higher attachment insecurity (75% vs 46%, Fisher Exact Test, p=.04), dismissing (Ds) in particular (χ²=6.41, df=2, p=.03), and difficulties with emotion regulation than non-clinical controls. Two AAI’s scales connected to Ds classification – idealization of mother and lack of recall – were significantly correlated to lack of emotional awareness and clarity. Conclusions. Our results provide support for conceptualization of AN emphasizing the role of attachment insecurity and emotional dysregulation in the development and maintenance of this restrictive type of eating disorder. These findings may have implications for treatment programs which may prove more fruitful integrating attachmentbased intervention with clinical work focused on development of emotion regulation abilities.