Intergenerational attachment patterns and dissociation in adolescents with eating disorders: An exploratory study

The relationships among attachment classification, eating disorder symptomatology and levels of dissociative experiences were explored in a group of 25 adolescents diagnosed with eating disorders, using the Adult Attachment Interview (AAI) and self-report measures. AAI transcripts were classified for attachment status and Reflective-self Functioning (RSF). Twenty mothers of adolescents were also interviewed using the AAI, and the concordance of attachment classification was examined in adolescent-mother pairs. They were found to be highly concordant on 2-way (insecure-secure) attachment ratings and resolution status, but mothers' and daughters' levels of RSF were not significantly associated. These findings are discussed in terms of attachment theory and the transmission of attachment patterns across generations. A high proportion (76%) of eating disordered adolescents were insecurely attached, and insecure attachment was associated with severity of symptoms. Most adolescents were dismissing in attachment organisation and demonstrated low RSF. As predicted, high levels of dissociation were related to bulimic symptoms, and being unresolved to trauma was associated with high levels of dissociation and bulimic and self-harming behaviours. Adolescents reporting high dissociative experiences tended to have and mothers who were unresolved to loss/trauma, which is discussed in the context of transgenerational attachment and dissociation. A model is proposed, expanding on existing theoretical models, to link attachment, dissociation, and bulimic symptoms. Clinical implications and ideas for further research are suggested