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Pretreatment unresolved-disorganized attachment status in eating disorder patients associated with stronger reduction of comorbid symptoms after psychotherapy

ABSTRACT Research shows that the Unresolved-disorganized attachment representation (U), resulting from experiences of loss or abuse, is associated with a range of psychiatric conditions. However, clinical implications of U are yet unclear. Objective: To investigate how U is related to symptoms and recovery of eating disorder (ED) patients. Method: First, 38 ED patients starting psychotherapeutic treatment were compared to 20 controls without ED on the prevalence of U, assessed with the Adult Attachment Interview. Second, in the patient group relations between U and ED symptoms, depression, anxiety and subjective experience of symptoms were investigated. Third, we compared, 1 year afterwards, recovery of patients with and without U. Results: The prevalence of U was higher in ED patients than in controls. Symptom severity was not related to U. ED patients with U at the start of treatment improved significantly more regarding anxiety, depression and subjective experience of symptoms than did patients without U. Discussion: The differential recovery of ED patients with or without U confirms the trauma-related heterogeneity of patients found in other diagnostic groups and calls for further investigation into the treatment needs of patients with different attachment representations.