| Popis: |
The current state of knowledge makes it necessary to consider other theoretical frameworks to account for symptom presentation and treatment outcomes for women with an eating disorder (ED). Attachment theory is a theoretical framework that could playa central role in our understanding and treatment of EDs. This thesis consists of two studies that examine the role of adult attachment in understanding: (1) ED symptom expression and treatment outcome among a sample of women with anorexia nervosa restricting subtype (ANR), AN binge purge subtype (ANB) or bulimia nervosa (BN), and (2) group treatment processes among women with ANR, ANB, BN and eating disorder not otherwise specified (EDNOS) receiving treatment in day hospital group-based program with rolling admissions. In the first study women diagnosed with ANR, ANB, or BN completed an attachment scale pre-treatment, and ED symptom scales pre-treatment (N = 243) and post-treatment (N = 157). A comparison sample of 126 non-ED women completed attachment scales on one occasion. Those with EDs had significantly higher attachment insecurity than non-ED. ANB was associated with higher attachment avoidance compared to ANR and BN, and higher attachment anxiety compared to BN. Higher attachment anxiety was significantly related to greater ED symptom severity and poorer treatment outcome across all EDs even after controlling for ED diagnosis. In the second study women (N= 264) diagnosed with an ED completed attachment scales pre-treatment, ED symptom scales pre- and post-treatment, and group climate scales weekly during treatment. Engaged group climate increased and Avoidance group climate decreased across weeks of treatment. Engaged group climate growth was associated with improved ED symptoms post-treatment. Higher attachment avoidance at pre-treatment was related to lower Engaged group climate at week 1, and was related to a greater impact of the group on the individual's experience of group engagement. Overall, attachment dimensions substantially contribute to our understanding of ED symptoms and treatment outcome. Addressing attachment insecurity when treating those with EDs may improve treatment outcomes. Furthermore, clinicians might improve group processes and outcomes by tailoring interventions to individuals' attachment avoidance when treating women for EDs. |
