Eating disorders, like many mental illnesses, can make you feel isolated and alone. It can be difficult to know how to connect with your loved ones or truly let in support. Having trouble relating to others can be a common experience. In fact, there’s an entire theory that helps explain it. Attachment styles describe the different patterns people have when connecting with others. Each of the four styles is rooted in our relationship to our caregivers as children, and they impact how we see ourselves and our relationships as we grow up. Though having an insecure attachment style isn’t uncommon, it does seem to increase the likelihood that someone will develop an eating disorder. The connection between eating disorders and attachment styles is a perpetuating cycle that can make those suffering feel even more alone in their struggles. Here, we give some background into attachment theory, explain the connection between insecure attachments and eating disorders, and give some insight into how attachment theory can support treatment methods.

What Are Attachment Styles?

The term “attachment” delves into the profound emotional connections that shape our lives from infancy to adulthood. These connections, beginning with the bonds we forge with our parents as helpless babies and continuing through our relationships as grown-ups, serve as the very foundation of how we connect with the people around us. While attachment theory has gained a certain level of popularity, particularly in the context of dating and romantic relationships, its roots extend much deeper into our psyche. Attachment styles represent our psychological responses to the way we connect with our primary caregivers and how we subsequently navigate the potential challenges of neglect or abuse. Before we get into the relationship between attachment styles and eating disorders, let’s zoom out to understand the basics of attachment theory. 

Bowlby’s Attachment Theory

British psychologist John Bowlby paved the way for attachment theorists with his work observing babies’ connections with their caregivers. He found that attachment starts right after we are born as children have an innate drive to get validation and connection from their parents or guardians. From an evolutionary perspective, when children receive attention and comfort from their attachment figures, they are more likely to survive. 

The core of attachment theory is this: when caregivers are responsive to their children’s needs, those children are more likely to develop a sense of security in exploring the world.

Bowlby’s attachment theory examines caregivers’ roles in creating their child’s emotional landscape. This connection, or lack thereof, impacts how people navigate their future relationships. In turn, this can affect someone’s relationship with food, body image, and their overall emotional well-being. 

Types of Attachment Styles

Unfortunately, this means the opposite of this is true as well. When caregivers neglect or reject their children, they tend to learn that they cannot rely on their parents to give them what they need. In response, they may become anxious or pull away from caregivers and avoid seeking help. Attachment theory breaks down our responses into four attachment styles: anxious, avoidant, disorganized, and secure.  

• Anxious Attachment: Unreliable caregivers who aren’t able to meet all the child’s needs can leave the child with a fear of abandonment. Anxiously attached individuals may become overly dependent on relationships. 
• Avoidant Attachment: If the child feels unloved and rejected by their caregiver, they will learn to avoid reaching out to others for help, resulting in an avoidant attachment style.
• Disorganized Attachment: If the caregiver is sometimes available and sometimes neglectful or abusive, the child will crave closeness yet be fearful of vulnerability. The child may feel conflicted, desiring comfort from their caregiver, while also becoming fearful of them. 
• Secure Attachment: If the caregiver is positive, loving, and available for their child, the child will learn to have a secure and trusting bond with others.

These attachment styles lay the groundwork for how we perceive our relationships with everyone. In the context of eating disorders, these styles can shape how individuals deal with their emotions, self-worth, and coping strategies. Understanding these attachment relationships helps us see the connection between our emotional bonds and the journey toward healing from eating disorders.

Eating Disorders Are Mental Illnesses

Before we get into the relationship between attachment styles and eating disorders, let’s make sure we’re on the same page about EDs. Eating disorders are often misunderstood by the general population (and historically, medical providers). Eating disorders are serious mental illnesses that result in disturbances with one’s relationship with food and their body, and can have severe consequences for one’s physical health. Because eating disorders can have such drastic physical symptoms, sometimes the underlying mental health issues may take the backburner. It’s critical to view the interconnections between mental health and physical health together in eating disorder treatment. Researchers who study emotional regulation have theorized that disordered eating behaviors often result from an effort to deal with dysregulated emotions. Eating disorders become a response to either distract from or avoid dealing with uncomfortable emotions. 

As with many mental illnesses, the causes of eating disorders are quite nuanced. While some people may be genetically predisposed, there are so many environmental and situational factors that come into play. One of these factors is attachment style. People who have insecure attachments may be more likely to develop an eating disorder. Here, we go over the research that looks at these connections. 

Eating Disorders and Insecure Attachment Styles

Our unique attachment styles, etched into our emotional DNA through early interactions with caregivers, impact our relationship with food, body image, and emotional equilibrium. The connection between attachment styles and eating disorders offers a window into the potential causes and roots of disordered eating behaviors.

Recent research has found a main link between insecure attachments and the onset of eating disorders. An investigation into the determinants of eating disorders has revealed that insecure attachment styles may be predictors of disordered eating. For example, a meta-analysis by Tasca and Balfour in 2014 found that 80-100% of individuals grappling with eating disorders exhibited insecure attachment styles.

Moreover, different types of eating disorders are more commonly related to certain insecure attachment styles. A 2017 investigation illuminated distinct patterns in how attachment anxiety and avoidance relate to specific behaviors characteristic of eating disorders. Additionally, the study found these trends between attachment styles and disordered eating are mostly similar across genders, though women tend to use binge eating as an escape from emotions more commonly than men. Among all participants, there  seemed to be a link between avoiding emotions and restrictive eating.

In some cases, eating disorders may be partially a psychological response to insecure attachments. These early emotional bonds, marked by an absence of consistent emotional support and the perpetual specter of rejection, can leave an enduring mark. The subsequent struggles with disordered eating can be seen as an attempt to cope with the emotional void left by these early attachment wounds. As a result, someone may seek solace and/or control through food when emotional bonds have proven unreliable or elusive. Here, we take a closer look at the three types of insecure attachments and how they specifically relate to eating disorders.

Anxious Attachment and Eating Disorders

An anxious attachment is characterized by an enduring fear of rejection or abandonment. For individuals carrying the weight of this emotional burden, their quest for a stable emotional footing can become intertwined with their relationship with food. 

Individuals with anxious attachment styles are notably prone to heightened emotions, grappling with the challenge of managing intense feelings of distress. This heightened emotional reactivity, can create a complex relationship with food and body dissatisfaction, where eating becomes tied to emotions rather than a need for nourishment.

In some cases, food can become an emotional refuge—a source of comfort that stands in for the caregiver or loved one who, in their perception, might reject them. Within this emotional backdrop, emotional eating may tend to take root, further exacerbating the risk of disordered eating patterns. 

Anxiously attached people often have a desire for approval from others, which comes with cycles of self-comparison and self-doubt. This propensity to measure oneself against others may further drive for emotional soothing through food. As a result, anxiously attached individuals find themselves at a heightened risk for bulimia nervosa and bingeing and purging behaviors. The emotional landscape of anxious attachment, compounded by negative self-perception and poor self-esteem, can increase the likelihood of someone developing an eating disorder. 

Avoidant Attachment and Eating Disorders

Those with avoidant attachment patterns have a deep-seated distrust of others and a fervent commitment to self-reliance. Emotional engagement with others feels scary, so avoiding these potentially painful experiences is paramount. 

These individuals tend to disengage from interpersonal relationships, putting up emotional barriers to protect themselves from the pain of abandonment or rejection. This psychological maneuver is similar to anorexia nervosa, where someone starts restricting their food intake  as a way to assert control over their own body. Avoidant attachment, in essence, becomes an “emotional starvation”, a coping strategy to navigate emotional vulnerability.

A defining feature of avoidant attachment is the setting of high standards and an unrelenting pursuit of perfectionism. This concentration on perfection can manifest as a potent risk factor for the development of eating disorders, especially when combined with our culture’s obsession with the “thin ideal.” As a result, we tend to see adolescents and adults with anorexia nervosa struggling with an avoidant attachment style and low self-esteem.

The avoidance strategy, cultivated through early experiences of emotional unavailability from caregivers, extends to their relationship with food. They may be more likely to try and control their food and their bodies, mirroring their broader approach to interpersonal relationships.

Disorganized Attachment and Eating Disorders

Disorganized attachment styles often emerge from childhood trauma or abuse. Individuals with disorganized attachment styles may have found themselves in the care of unpredictable caregivers, whose behaviors were challenging to anticipate. This tumultuous upbringing can give rise to a complex emotional landscape where they have both a yearning for intimacy and a fear of close relationships.

For those with disorganized attachment, food can become a source of both solace and distress. The craving for emotional connection can sometimes be projected onto food, with the act of eating representing a quest for emotional nourishment. Individuals may resort to binge eating as a means of momentarily filling the emotional void left by their unpredictable caregivers. In other situations, they may cope similarly to an avoidant-attached individual. This may manifest as restrictive eating behaviors, mirroring the emotional distancing they employ in their relationships. 

Treating Attachment Insecurity alongside Eating Disorders

Working with attachment styles in therapeutic settings can provide a more holistic approach to eating disorder recovery. Doing so helps clinicians and therapists address both the surface-level eating disorder symptoms and the deeper emotional dimensions of how that person relates to others. We know how important a supportive community is in eating disorder recovery. Helping patients develop more secure attachment styles can help them feel more supported and aid in eating disorder treatment. 

Customized Treatment Strategies

Bringing attachment theory into treatment can better help clinicians customize interventions. For instance, those with anxious attachment tendencies may benefit from strategies that concentrate on enhancing emotional regulation skills. Conversely, individuals with avoidant attachment styles may find value in therapeutic approaches that facilitate the establishment of secure interpersonal bonds, fostering trust in both relationships with others and their relationship with food.

Tending to Unmet Emotional Needs

Attachment theory can help us understand the emotional voids that some individuals with eating disorders may fill with their relationship with food. By acknowledging these unresolved emotional needs, individuals can develop more adaptive coping mechanisms and find alternative outlets for emotional nourishment.

Cultivating Secure Attachments

Insecure attachments often bring up self-critical and comparative thought patterns. Helping individuals develop secure attachment styles can improve their self-compassion and self-acceptance. Acknowledging and working through the underlying issues of these mental illnesses can help create a better foundation for long-term recovery. Additionally, insecure attachment styles make it more difficult for people with eating disorders to rely on their support systems throughout the recovery process. It’s also important to educate loved ones about attachment theory, which can help them to offer more empathetic support.

Working Toward Eating Disorder Recovery

Incorporating attachment theory into eating disorder treatment can result in a more person-centric approach to recovery. It acknowledges that eating disorders transcend beyond food or body image concerns, delving deep into emotional and relational dynamics. By tackling these underlying factors and tailoring treatment to an individual’s unique attachment style, clinicians can provide a more effective and compassionate route to recovery. 

At The Alliance, we can help connect those struggling with eating disorders and their loved ones with a range of support–including outpatient providers, support groups, and treatment centers. Through our free, therapist-staffed helpline and free, weekly, therapist-led support groups, The Alliance is here to support you every step of the way.