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Body Dissatisfaction in Women With Eating Disorders: Relationship to Early Separation Anxiety and Insecure Attachment

From the Department of Neuroscience, University of Rome, Rome, Italy.

Address correspondence and reprint requests to Alfonso Troisi, MD, Department of Neuroscience, University of Rome Tor Vergata, via Guattani 14, 00161 Rome, Italy. E-mail: alfonso.troisi{at}uniroma2.it

Objective: It has been suggested that an insecure style of attachment may be one of the factors implicated in the etiology of body dissatisfaction, which, in turn, is a risk factor for eating disorders. The present study analyzed the association among early separation anxiety, insecure attachment, and body dissatisfaction in a clinical sample of 96 women with anorexia nervosa (n = 31) or bulimia nervosa (n = 65).

Methods: Body dissatisfaction was measured using the Body Shape Questionnaire (BSQ), early separation anxiety was measured using the Separation Anxiety Symptom Inventory (SASI), and adult attachment style was measured using the Attachment Style Questionnaire (ASQ).

Results: In both anorectic and bulimic women, BSQ scores were strongly correlated with SASI and ASQ scores. In a hierarchical regression model controlling for the confounding effects of body mass index and depressive symptoms, early separation anxiety and preoccupied attachment emerged as significant predictors of high levels of body dissatisfaction.

Conclusions: Based on the cross-sectional findings of this study, insecure attachment appears to be a consistent correlate of negative body image evaluations in women with either anorexia nervosa or bulimia nervosa. If future prospective studies will confirm that an insecure style of attachment plays a role in promoting the development of body dissatisfaction, prevention and treatment of disordered eating pathology might be enhanced by focusing greater attention on attachment relationships.

Key Words: body dissatisfaction • separation anxiety • insecure attachment • anorexia nervosa • bulimia nervosa

Abbreviations: AN = anorexia nervosa; ASQ = Attachment Style Questionnaire; BDI = Beck Depression Inventory; BN = bulimia nervosa; BMI = body mass index; BSQ = Body Shape Questionnaire; SASI = Separation Anxiety Symptom Inventory.