Attachment, mentalizing, and eating disorder symptoms in adolescent psychiatric inpatients and healthy controls: a test
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ORIGINAL ARTICLE
Attachment, mentalizing, and eating disorder symptoms in adolescent psychiatric inpatients and healthy controls: a test of a mediational model L. Cortés‑García1 · V. McLaren2 · S. Vanwoerden2 · C. Sharp2 Received: 19 April 2020 / Accepted: 10 September 2020 © Springer Nature Switzerland AG 2020
Abstract Objective Research has supported a link between insecure attachment and eating disorders (EDs) in adolescents; however, mechanisms accounting for this association remain unclear. Growing evidence suggests impaired mentalizing as a potential mechanism. Yet, little is known about the relationship between mentalizing and ED symptoms or how it relates to the link between attachment and EDs in adolescents. This study examined mentalizing deficits in adolescents with ED symptoms relative to psychiatric and healthy controls and tested a mediational model, wherein mentalizing capacity mediates the relationship between attachment and ED symptoms. Method Inpatient adolescents with EDs and other pathology (n = 568) and healthy controls (n = 184) were administered the child attachment interview, the movie for the assessment of social cognition and the diagnostic interview schedule for children to assess attachment, mentalizing and ED symptoms, respectively. Results Inpatients showed lower attachment security and more hypermentalizing than healthy adolescents. Hypermentalizing explained the association between insecure attachment and ED symptoms. Conclusions These findings suggest potential utility of targeting mentalizing in prevention and treatment of EDs in adolescents. Level of evidence Level III, case-control analytic study. Keywords Eating disorder symptoms · Mentalizing · Attachment · Adolescents · Mediation analysis
Introduction Eating disorders (EDs), including anorexia and bulimia nervosa (AN and BN), present considerable public health concern due to their detrimental clinical and social impact [1]. EDs are associated with psychiatric and physical problems, high rates of persistence and recurrence, and elevated This article is part of the Topical Collection on Psychopathological models and Eating and Weight Disorders. * L. Cortés‑García [email protected] 1
Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela. Campus Vida, Calle Xosé María Suárez Núñez, s/n, 15782 Santiago de Compostela, A Coruña, Spain
Department of Psychology, University of Houston, Houston, TX, United States
2
risk for mortality [2, 3]. Importantly, the highest incidence of EDs, specifically AN and BN, is during adolescence [4]. Therefore, it is crucial to identify factors that contribute to the causation and maintenance of EDs at this developmental stage. In this regard, insecure attachment and mentalizing difficulties represent two aspects of socioemotional development systematically associated with EDs [5–7]. However, few studies have examined both constructs simultaneously in association with ED symptoms among clinical adolescents [8]. This study a
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