Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Int J Eat Disord. 2023 May;56(5):888-908. doi: 10.1002/eat.23922. Epub 2023 Mar 14.
Individuals with eating disorders are known to have higher rates of insecure attachment compared to community controls, but the factors underlying this finding are poorly understood. We conducted the first meta-analysis comparing attachment in eating disorder samples compared to community controls that included quality assessment, publication bias and moderation analysis.
We pre-registered our meta-analysis (CRD42019146799) and followed PRISMA guidelines. We searched PsychINFO, Embase, Medline, CINAHL, and Scopus for publications. Attachment scores were extracted, and Cohen's d calculated for each study using a random effects model.
In total, 35 studies were included in the meta-analysis and six studies were summarized in a narrative review. Eating disorder samples showed higher rates of insecure attachment compared to community controls, with a large effect size, across measurement methods and different attachment dimensions. Blinding of assessors moderated effect sizes for attachment interview studies, but no other moderators were significant.
Risk of insecure attachment is elevated in individuals with eating disorders, albeit heterogeneity is high and largely unexplained. Clinicians may need to take this into account in their work, particularly given the association between attachment insecurity and challenges to therapeutic alliance. Future studies comparing eating disorder samples with community samples should control for general psychopathology.
Attachment is a broad concept referring to a person's thoughts, feelings and behaviors in relation to close others. This systematic review and meta-analysis found that individuals with eating disorders are lower in attachment security than community controls, regardless of attachment construct or measurement approach. Attachment may be relevant in influencing eating disorder recovery, the development of therapeutic alliance, and potentially clinical outcomes, although more research is needed.
与社区对照相比，已知饮食障碍个体的不安全依恋率较高，但对这一发现的潜在因素知之甚少。我们进行了首次荟萃分析，比较了饮食障碍样本与社区对照的依恋情况，其中包括质量评估、发表偏倚和调节分析。
我们预先注册了我们的荟萃分析（CRD42019146799）并遵循 PRISMA 指南。我们在 PsychINFO、Embase、Medline、CINAHL 和 Scopus 中搜索出版物。使用随机效应模型从每项研究中提取依恋评分并计算 Cohen's d。
共有 35 项研究纳入荟萃分析，其中 6 项研究进行了叙述性综述。无论测量方法和不同的依恋维度如何，饮食障碍样本的不安全依恋率均高于社区对照，具有较大的效应量。评估者的盲法调节了依恋访谈研究的效应量，但没有其他调节因素具有统计学意义。
尽管存在高度异质性且大部分无法解释，但饮食障碍个体的不安全依恋风险增加。临床医生在工作中可能需要考虑到这一点，特别是考虑到依恋不安全感与治疗联盟挑战之间的关联。未来比较饮食障碍样本和社区样本的研究应控制一般心理病理学。
依恋是一个广泛的概念，指的是一个人与亲密他人的思想、感受和行为。本系统评价和荟萃分析发现，与社区对照组相比，饮食障碍个体的依恋安全性较低，无论依恋结构或测量方法如何。依恋可能与影响饮食障碍康复、治疗联盟的发展以及潜在的临床结果有关，尽管需要更多的研究。
