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Young woman sitting in a dark room, wearing a one-piece jumpsuit, obsessing over her weight with a measuring tape in hand.

Eating Disorder Treatment Based on Attachment Theory

According to the National Eating Disorders Association, “eating disorders are real, complex, and devastating conditions that can have serious consequences for health, productivity, and relationships.” Claiming that eating disorders are a fad, or merely a poor lifestyle choice is harmful to the millions of people who struggle with them. Eating disorders are serious and potentially life-threatening. This mental health disorder can impact a person’s health both physically and emotionally.

Better Understanding Eating Disorders

The NEDA reports that “in the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or EDNOS.” However, they also acknowledge that a large number of cases go unreported. But why? There are many reasons why a person may choose not to divulge their eating disorder, but most signs point to the personal nature of the condition. In fact, the majority of individuals who struggle with an eating disorder also experience body dissatisfaction and disordered eating attitudes and behaviors. All of these issues relate back to our self-image and self-esteem, which can be difficult (though necessary) topics to talk about.

It is possible to overcome an eating disorder. Studies show that success rates for treatment are largely dependent on whether or not the individual chooses to seek help early on. The earlier treatment is initiated, the more likely it is to be successful. The longer a person waits to seek treatment, the more time and opportunity the eating disorder has to become an ingrained aspect of daily lives and routines. This means that it can be harder to break and overcome (though still not entirely impossible.)

Eating Disorder Treatment

What also matters is how one approaches the treatment of the disorder. For example, some clinicians and researchers believe that how a patient developed their eating disorder doesn’t really matter for treatment. Many therapists argue that treatment should be based on what is necessary for patients to recover. Other professionals like Dr. Judy Scheel, President of Cedar Associates Foundation, disagree on this topic. The mission of the Cedar Associates Foundation, a non-profit organization, is to assist in the prevention, education, and research of eating disorders. In her line of work, which spans 20 years, Dr. Scheel has found reason for her belief that “uncovering causation enables the individual to understand motivations (what purposes the eating disorder and its symptoms serve in someone’s life.)   Knowing the factors driving the proverbial bus can support informed decisions about what is necessary in maintaining recovery and long term health and well-being.”

Dr. Scheel notes that patients diagnosed with eating disorders have been shown to also have profound interpersonal and psychological issues. Because of this, treatment and the recovery process can be long and challenging. According to Dr. Scheel, “research repeatedly affirms that pre or co-existing anxiety and/or depression co-occur with eating disorders.” These co-existing conditions are what make people with eating disorders particularly susceptible to criticism, shame, and fear, especially with regards to behaving in a manner that they consider to be imperfect. Many researchers are now beginning to find that perhaps these qualities stem from childhood attachment issues.

Dr. Scheel explains that “Many in the psychodynamic and psychoanalytic camps would agree that these fragile interpersonal qualities are the outcrop of childhood attachment experiences and their intensity is compounded as a child grows throughout life.” Thus, she concludes that “eating disorders therefore are ‘natural’ consequences as they attempt on the one hand to correct the vulnerable states  through perfection and fitting into the culture as well as are the means in which to punish the individual for being imperfect i.e. having vulnerabilities.”

The Attachment Theory

Attachment theory is a psychological model that attempts to describe the dynamics of long-term and short-term interpersonal relationships between humans. This method has been invaluable to the study and treatment of eating disorders. The Attachment Theory respects the relationship between the therapist and patient as a significant vehicle for recovery. The role of the therapist is to create a safe and understanding environment for the patient. This environment allows for the development of trust. It is through that trust that an opportunity unfolds where patients may be able to deal with their negative emotions and confront their behaviors. Patients can discuss their self-destructive impulses and conflicted relationships within the trusting environment constructed by the therapist. As Dr. Scheeler puts it: “compassion, forgiveness and empathy therefore have an opportunity to be experienced and shared. Attachment Theory provides a natural framework in the relationship between therapist and patient.”

Dr. Scheeler does advise, however, that the Attachment Theory approach doesn’t work for the therapist who is uncomfortable with a more intense relationship with their patients. Practicing Attachment Theory requires a high level of control over one’s own emotional responses. The therapist must be comfortable with discussing various topics of an emotional and psychologically impactful nature. Dr. Scheel explains that “if a therapist is uncomfortable with feelings of anger, or cannot tolerate their patients’ dependency, or is uncomfortable with discussing sex and sexuality, then Attachment Theory is not likely a comfortable lens from which to practice.  If a therapist has not confronted their own competitive issues or lacks compassion and empathy creating a safe place for the truth to be told is hampered.”

Assuming that the therapist is able to practice it, the Attachment Theory provides a useful technique for dealing with conditions such as eating disorders. In fact, there are  researchers who suggest that the emotional, intuitive impact of therapists may be more influential than the cognitive or behavioral suggestions. Or, as Dr. Scheel says: “the relationship between patient and therapist are paramount in treatment and recovery as the attachment patterns developed in childhood are contemporarily unavoidable and necessary to be played out in psychotherapy.” In this way, Attachment Theory enlists the therapist’s creativity, as well as their knowledge about their patient’s disorder and related issues. Through this unique method, they can provide a healing opportunity for their patient that is incomparable to any other existing form of treatment.

 

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