Adult Attachment Style in Anorexia Nervosa: A Parental and Transgenerational Perspective

Introduction The literature highlights the importance of early attachment relationships in the adaptive individual development and contends that attachment bonds, characterized by security, may be protective factors towards later distressing, maladaptive and psychopathological situations (Cassidy & Shaver; 1999). In particular, referring to eating disorders, patients with anorexia nervosa (AN) are related with a higher incidence of insecure style. In a recent review, Ward et al. (2000) report a preponderance of insecure pattern among the population with eating disorders but remark the difficulty in identifying a specific attachment category, because of the variety of the instruments employed to assess this construct. Moreover, the role of attachment representations of parents and their transgenerational transmission to AN patients is scarcely taken into account in empirical studies on eating disorders, focusing quite exclusively in the inquiry of patient pattern of attachment. Objective The aim of our work is to: (1) study adult patterns of attachment in patients with Anorexia Nervosa (AN), comparing them with a group of subjects belonging to normative population; the first hypothesis is to verify if the insecure patterns is predominant in the AN sample, as suggested by the literature; (2) investigate whether there is a difference in the Adult Attachment Stiles in the parents of subjects, comparing respectively the distribution of attachment patterns in the parents of clinical and control groups; (3) verify the transgenerational transmission of the adult attachment style in AN and normative sample. In other words, the aim is to investigate the correspondence between styles of attachment of the anorexics with those of both their parents. As parents grow their children with the relationship abilities they have internalized during their life, and as the particular way of interaction with their children contributes to attachment bond, we surmise that there should be some continuity between attachments in the two generations. Method The “Adult Attachment Questionnaire” (AAQ, Shaver & Hazan, 1995) was administered to 30 anorexic patients with Anorexia Nervosa (AN), according to the DSM-IV (APA, 1994), (restrictive type = 16; binge/purging type = 14). AAQ was also administered to 30 control-group non-patient Ss. and to their parents. Results and Discussion Results show a significant difference between AN patients and control-subjects in their Adult Attachment Style (Chi-square=24.25, p. = .001). In AN patients a higher frequency of insecure attachment of the “avoidant” subtype was observed (56,7% vs. 3,3%). With respect to the parental Attachment Style, preliminary results show no differences between the two groups of parents, i.e. both groups show more frequently a “secure” type of attachment. The results also indicate a lack of transmission in attachment representations across generations in AN families. Summarizing, these findings point out difficulties and insecurity in Adult Attachment representations in patients affected with Anorexia Nervosa. Anorexic group are characterized by a predominant avoidant style of relation that affects not only their food-related behaviors but also their intimate and affective involvement. From an etiologic point of view, this finding is in line with the hypothesis that claims the importance of early attachment relationships in the development of the disorder. Despite this result, adult attachment style in parents of AN subjects do not differ from the normative population, disconfirming the hypothesis of transmission of attachment in AN and the linking of parental attachment representation and the development of the disorder.