TY - JOUR
T1 - Attachment in individuals with eating disorders compared to community controls: A systematic review and meta-analysis
AU - Jewell, Thomas
AU - Apostolidou, Eleni
AU - Sadikovic, Kevser
AU - Tahta-Wraith, Kirsty
AU - Liston, Sarah
AU - Simic, Mima
AU - Eisler, Ivan
AU - Fonagy, Peter
AU - Yorke, Isabel
N1 - Funding Information:
This study was supported through funded research time via a National Institute of Health and Social Care Research (NIHR), Development and Skills Enhancement Award NIHR302102 awarded to Tom Jewell. The funder played no role in any aspect of the study, including the decision to conduct this review.
Publisher Copyright:
© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.
PY - 2023/3/14
Y1 - 2023/3/14
N2 - Objective: Individuals with eating disorders are known to have higher rates of insecure attachment compared to community controls, but the factors underlying this finding are poorly understood. We conducted the first meta-analysis comparing attachment in eating disorder samples compared to community controls that included quality assessment, publication bias and moderation analysis. Method: We pre-registered our meta-analysis (CRD42019146799) and followed PRISMA guidelines. We searched PsychINFO, Embase, Medline, CINAHL, and Scopus for publications. Attachment scores were extracted, and Cohen's d calculated for each study using a random effects model. Results: In total, 35 studies were included in the meta-analysis and six studies were summarized in a narrative review. Eating disorder samples showed higher rates of insecure attachment compared to community controls, with a large effect size, across measurement methods and different attachment dimensions. Blinding of assessors moderated effect sizes for attachment interview studies, but no other moderators were significant. Discussion: Risk of insecure attachment is elevated in individuals with eating disorders, albeit heterogeneity is high and largely unexplained. Clinicians may need to take this into account in their work, particularly given the association between attachment insecurity and challenges to therapeutic alliance. Future studies comparing eating disorder samples with community samples should control for general psychopathology. Public Significance: Attachment is a broad concept referring to a person's thoughts, feelings and behaviors in relation to close others. This systematic review and meta-analysis found that individuals with eating disorders are lower in attachment security than community controls, regardless of attachment construct or measurement approach. Attachment may be relevant in influencing eating disorder recovery, the development of therapeutic alliance, and potentially clinical outcomes, although more research is needed.
AB - Objective: Individuals with eating disorders are known to have higher rates of insecure attachment compared to community controls, but the factors underlying this finding are poorly understood. We conducted the first meta-analysis comparing attachment in eating disorder samples compared to community controls that included quality assessment, publication bias and moderation analysis. Method: We pre-registered our meta-analysis (CRD42019146799) and followed PRISMA guidelines. We searched PsychINFO, Embase, Medline, CINAHL, and Scopus for publications. Attachment scores were extracted, and Cohen's d calculated for each study using a random effects model. Results: In total, 35 studies were included in the meta-analysis and six studies were summarized in a narrative review. Eating disorder samples showed higher rates of insecure attachment compared to community controls, with a large effect size, across measurement methods and different attachment dimensions. Blinding of assessors moderated effect sizes for attachment interview studies, but no other moderators were significant. Discussion: Risk of insecure attachment is elevated in individuals with eating disorders, albeit heterogeneity is high and largely unexplained. Clinicians may need to take this into account in their work, particularly given the association between attachment insecurity and challenges to therapeutic alliance. Future studies comparing eating disorder samples with community samples should control for general psychopathology. Public Significance: Attachment is a broad concept referring to a person's thoughts, feelings and behaviors in relation to close others. This systematic review and meta-analysis found that individuals with eating disorders are lower in attachment security than community controls, regardless of attachment construct or measurement approach. Attachment may be relevant in influencing eating disorder recovery, the development of therapeutic alliance, and potentially clinical outcomes, although more research is needed.
UR - http://www.scopus.com/inward/record.url?scp=85150659261&partnerID=8YFLogxK
U2 - 10.1002/eat.23922
DO - 10.1002/eat.23922
M3 - Review article
SN - 0276-3478
VL - 56
SP - 888
EP - 908
JO - International Journal of Eating Disorders
JF - International Journal of Eating Disorders
IS - 5
ER -