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  • Author or Editor: Szalai Tamás Dömötör x
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Background

The transdiagnostic model of eating disorders provides an evidence-based cognitive-behavioral treatment approach, emphasizing the maintaining factors of low selfesteem, perfectionism, mood intolerance and interpersonal difficulties. Although attachment quality is associated with these factors, there is no treatment model focusing on both attachment-related and cognitive-behavioral maintaining factors of the symptoms.

Aims

The aim was to construct and test a multilevel treatment model, which integrates attachment interventions into the transdiagnostic treatment of eating disorders.

Methods

Relevant aspects of attachment functioning were joined together with the four cognitive-behavioral maintaining factors of the symptoms, and attachment interventions were incorporated into an extended transdiagnostic treatment of a bulimia nervosa and a binge eating disorder patient.

Results

Attachment domains could be integrated into the transdiagnostic model of eating disorders at both the case conceptualization and treatment level. The improvement of attachment functioning was related to treatment outcomes at a one month follow-up.

Conclusions

When attachment dysfunctions contribute to precipitating or maintaining mechanisms of eating disorder symptoms a multilevel treatment targeting both the relevant aspects of attachment and cognitive-behavioral functioning can be suggested. Randomized controlled studies with different intervention groups are required to confirm the result of these case studies.

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Author: Szalai Tamás Dömötör
Restricted access

Background

Attachment theory has been used in personalized treatments since decades. It is a major framework for understanding images of the self, affect regulation, reflective functions and interpersonal relationships. The improvement of attachment functioning is associated with positive treatment outcomes in eating disorders. However, attachment interventions have not been summarized in their psychotherapy.

Aims

The aim was to review the relevance of attachment features in the psychotherapy of eating disorders.

Methods

A literature review was carried out for empirical review and case studies, using the terms “eating disorder” and “attachment” from 1987 until 2017. From the 320 matches, 50 relevant studies were integrated into this review.

Results

The relationship between dysfunctional attachment and eating disorders could be conceptualized in seven ways, including transgenerational transmissions and mediator personality traits. Attachment can mediate between early experiences and adult symptoms, between intra- and interpersonal experiences, or may moderate the relationship between the risk factors and maladaptive eating. Attachment features also display a direct relationship with eating disorders, or may underlie their maintaining mechanisms. Nine psychotherapeutically relevant mediator factors could be identified, namely the patient’s self-concept and emotion-regulation, the conflation of self-esteem and body satisfaction, a sensitive interpersonal style, levels of perfectionism, depression, alexithymia, mentalization and reflective functions.

Conclusions

The assessment of attachment dysfunctions in the individual symptomatology may facilitate personalized case models. For patients with severe attachment dysfunctions, multimodal psychotherapies targeting the described focal points could be recommended. Randomized, controlled studies are required to test the efficacy of the interventions summarized, and to determine indications.

Open access

Absztrakt:

Bevezetés: A kötődési diszfunkciók meghatározzák a borderline személyiségzavart, amely a multiimpulzivitás gyakori háttértényezője. A kötődés és a multiimpulzív evészavarok kapcsolata mégis szinte feltáratlan. Célkitűzés: Multiimpulzív és klasszikus evészavarosok, illetve evészavartól mentes személyek kötődésének összehasonlítása; továbbá feltárni, hogy a kötődés mennyire magyarázza a multiimpulzív tüneteket. Módszer: Keresztmetszeti online kérdőíves vizsgálat (148 nő, átlagéletkor: 30,9 év), amely e három csoportban mérte az anyai, apai és felnőtt kötődést, a depressziót, a szorongást, az evészavar- és multiimpulzív tüneteket. Eredmények: Az evészavartól mentes csoport 41,3%-a, a klasszikus evészavarosok 17,6%-a, a multiimpulzív csoport 11,8%-a biztonságosan kötődött. A legsúlyosabb evészavartünetek (F(2) = 17,733) és legalacsonyabb apai gondoskodás (F(2) = 3,443) a multiimpulzív evészavarosokat jellemezték. A kötődési aggodalmaskodás és bizalmatlanság a multiimpulzív tünetek 14,5%-át magyarázta, ám a depresszióra korrigálva csak utóbbi bizonyult a multiimpulzivitás prediktorának (t = 5,166, p<0,01). Következtetés: A multiimpulzív személyek tüneti és kötődési szempontból is az evészavarosok különálló csoportját alkotják. A negatív hangulatok kezelése terápiás potenciállal bírhat esetükben. Az apai gondoskodás, kötődési aggodalmaskodás, bizalmatlanság terápiás jelentőségének feltárásához longitudinális vizsgálatok szükségesek. Orv Hetil. 2017; 158(27): 1058–1066.

Open access