Effect of intrapersonal emotional competences on the relationship between attachment insecurity and severity of eating disorder symptoms in patients with restrictive anorexia

J Clin Psychol. 2020 Mar;76(3):476-492. doi: 10.1002/jclp.22877. Epub 2019 Nov 12.


Objective: Attachment insecurity and emotional competences (EC) form a key part of conceptual models of anorexia nervosa (AN). We explored the relationship between attachment dimensions and EC on the severity of eating disorders in patients diagnosed with restrictive AN.

Method: Sixty-three female patients with restrictive AN and 63 healthy participants completed self-report measures (eating symptoms, EC, attachment, depression, and anxiety).

Result: Patients with restrictive AN used fewer adaptive and more maladaptive regulation strategies and showed low levels of intrapersonal EC. The partial least squares path modeling analysis showed that high levels of attachment anxiety or avoidance lead to a decrease in intrapersonal EC, which in turn contributes to greater severity of eating symptoms in anorexic patients.

Conclusions: Lower intrapersonal EC played an important mediating role in the effects of attachment insecurity on the severity of eating disorders. The joint use of therapeutic programs that target both EC and attachment processes constitutes a promising approach.

Keywords: anorexia nervosa; attachment; emotion regulation; emotional dysregulation.

MeSH terms

  • Adolescent
  • Anorexia Nervosa / psychology*
  • Anxiety Disorders / psychology*
  • Emotional Regulation*
  • Female
  • Humans
  • Least-Squares Analysis
  • Multivariate Analysis
  • Object Attachment*
  • Surveys and Questionnaires
  • Young Adult