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Subtle Breaks In Attachment: Invisible Trauma And The Emergence Of Bulimia Nervosa


 Background: It is known that complex traumatic experience contributes to the emergence of bulimia nervosa (BN). Yet cognitive behavioural therapy, with or without medication, remains the western medical model’s treatment of choice, regardless of its poor long-term outcomes. Incidence of BN is rising, whilst treatment success eludes most sufferers. This research set out to dig deep into the lived experience of BN in order to uncover new clues linking BN’s aetiology to treatment options; and the research argues for the adoption of trauma-informed protocols for BN, as these fit more effectively with causation. Taking the previously under-researched, but known-to-be significant father-daughter relationship as its starting point, the research reveals a raft of new findings pointing to the pervasive consequences of subtle attachment trauma in this relationship. In light of this, the research informs a clear recommendation for a trauma-informed treatment approach and provides hope for those living with the condition. Methods: A hermeneutic phenomenological, detail-rich study of women in recovery from BN was carried out. A qualitative study was considered to be in sufficient contrast to existing research approaches as to offer up the greatest possibility of new insights into BN. Results: Subtle attachment failures, present in the father-daughter relationship, strongly contribute to complex traumatic experience and are instrumental in the development of BN. Many of these attachment failures lack the overtly dramatic nature of abuses such as physical violence, yet create powerful pre-conditions for the development of bulimic symptomatology. They are rooted in safety-seeking and survival aspects of the attachment bond, causing confusion in aspects of self-worth and anxiety about belonging. The resulting uncertain search for secure nurturing is directly reflected in the push-pull dynamic of the binge/compensation cycle of BN. Conclusions: BN arises in response to complex traumatic experience as a survival mechanism aimed at ensuring psychological and physical protection. Complex traumatic experience is, however, a multi-faceted concept in which subtle breaks in father-daughter attachment play a pivotal role. Therefore, adopting a staged, multi-modal complex trauma treatment model, aimed at building safety, agency and relationship skills for those seeking help, may offer hope for more successful treatment outcomes.