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Attachment Theory in the Treatment of Bulimia
Contributor: Leigh Bell, BA, writer for Eating Disorder Hope
Bulimia is enveloped in secrecy. Bingeing in isolation. Locking the bathroom door and running water to dissolve the sound of purging.
Research uncovers links between bulimic behavior and a lack of attachment to others, both past and present day. Psychotherapists are also looking at how improving attachment issues can foster recovery from an eating disorder.
Attachment Theory
The relationship is based on the attachment theory, which believes a healthy attachment between child and the primary caretaker gives the child security and confidence to purposefully explore the world.
The child believes and trusts based on experience that the primary caretaker will be present. Someone to mend a childhood skinned knee, an adolescent broken heart, a cautious young adult; and then the child, now adult, has the freedom to launch into life. A multitude of research suggests failure to create these attachments causes problems in childhood and throughout life.
“Children who are securely attached as infants tend to develop stronger self-esteem and better self-reliance as they grow older. These children also tend to be more independent, perform better in school, have successful social relationships, and experience less depression and anxiety.”
Think about a safety net below a trapeze artist. When he knows the net is there, he is more confident, attempts greater tricks, and as a result, performs better. Without the net, he fears falling and doesn’t challenge personal comfort levels. He’s insecure.
Insecurities
Insecure attachment patterns among women with eating disorders are linked to mistrust, fear of abandonment, and avoiding being close to another person. The negative attachment pattern can be “anxious:” a child grows up consistently worrying the caretaker will leave and, then as an adult, consistently seeks care from others.
There is also the avoidant attachment pattern in a child who doesn’t attach with the caretaker feels rejected and, then, grows up avoiding attachment with others.
People with eating disorders tend to have both patterns and “draw others close while, simultaneously pushing them away.”
Women with anorexia and bulimia often don’t trust people, keep things to themselves, and are uncomfortable and/or dissatisfied in close relationships. Some may find a close relationship with bulimia is easier than with people. In the eating disorder, they have control while shutting out the world – but for only so long.
Anxiety Levels
Research also links severity of eating disorder symptoms to depth of attachment anxiety – more anxiety equates greater eating disorder symptoms, and less successful treatment outcomes.
“Self-esteem and security are intimately linked. If we have good self-esteem based on secure attachment, we know we will be alright, but without a secure base, fears persist.” Without this security, it’s difficult to develop and trust healthy relationships.
This is even harder for someone in the throes of bulimia. Reaching out is frightening, and when help does arrive, it’s hard to trust it.
If someone with bulimia enters therapy afraid of attachment how can he or she reap the benefits of the therapeutic relationship? But, in fact, the therapeutic relationship is “foundational” in healing attachment issues, according to a book on attachment therapy by David J. Wallin.
“The patient’s relationship with the therapist has the potential to generate fresh patterns of affect regulation and thought, as well as attachment,” Wallin writes.
It’s often this way: That of which we are most afraid often has the greatest power to heal.
Therapists also use the attachment history to learn more about the client, rather than to design a therapeutic treatment based upon it. How a client is or was attached to loved ones is another piece of information to better understand some, but by no means all, psychotherapy patients.
Community Discussion – Share your thoughts here!
Support is important in the recovery from disordered eating? Where have you found ongoing support and how has that affected your recovery?
About the Author:
Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals. We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on October 9, 2015. Published on EatingDisorderHope.com
