An evaluation of the specific mechanism by which attachment affects eating psychopathology.

Introduction: although from 96 to 100% of individuals with eating disorders (EDs) reported insecure attachment, the specific mechanisms by which each adult insecure attachment dimension affects ED symptomatology remain to date unknown and unexplored. This study examined maladaptive perfectionism (i.e., personal standards, doubts about actions, and concern over mistakes) as both a mediator and a moderator of the relationship between insecure attachment styles and eating disorder (ED) symptomatology in a clinical, treatment seeking sample (n = 403). Differences in mediation and moderation effects across diagnostic groups [Anorexia Nervosa (n =101), Bulimia Nervosa (n =167), or Eating Disorder Not Otherwise Specified (n =135)] were explored as well. Methods: insecure anxious and avoidant attachment style, maladaptive perfectionism, and ED symptomatology were assessed and data were analysed using latent structural equation modelling. Results: regardless of the diagnostic group, maladaptive perfectionism served as a mediator between insecure attachment patterns and ED symptomatology. It also interacted with insecure attachment to predict higher levels of ED symptoms – highlighting the importance of both insecure attachment styles and maladaptive aspects of perfectionism as treatment targets. Conclusions: overall, these findings provide evidence that maladaptive perfectionism is an important mechanism that can explain, in part, the relationship between insecure attachment and severity of ED symptoms. Additionally, the findings are consistent with recent discussions on the classification and treatment of EDs that have highlighted similarities between ED diagnostic groups. In light of the similarities between different diagnostic groups, our results could be viewed through the lens of the Transdiangostic Model of EDs.