Attachment Processes and Eating Disorders in Families: Research and Clinical Implications

Abstract

Given the essentially interpersonal nature of eating and food, it is perhaps interesting to note that eating disorders such as anorexia nervosa (henceforth anorexia) have typically been considered an intra-psychic phenomenon. This has featured conceptualisations, such as distorted body image, internalisation of gendered expectations of slimness in women, and biological explanations of hereditary predispositions (O’Shaugnessy & Dallos, 2009). In contrast, there have also been explanations which suggest interpersonal processes; for example, Bruch (1973) conceptualised anorexia in terms of a conflictual and enmeshed mother-daughter relationship. This came to be regarded as ‘mother-blaming’, and consequently there has been little research which has attempted to explore the role of family dynamics in the causation of eating disorders. However, systemic family therapy developed a number of approaches to working with eating disorders which assumed family dynamics as causal (Minuchin, Rosman, & Baker, 1978; Palazzoli, 1974). Contemporary practice in the United Kingdom (NICE, 2004) recommends systemic family therapy as the treatment of choice for children under the age of 16 (Dare, Eisler, Russell, & Smukler, 1990).