PREVIOUS : Attachment & FOOD (#4a

IMAGE  ⬆️ = Regions w/ associated behaviors & functions

SITE : Attachment Theory in the Treatment of Bulimia

CNS Regulation of Binge- & Over- Eating
RESEARCH : Appetite & body weight regulation are controlled by the body’s central nervous system (CNS), the brain playing a central role in integrating inner & outer inputs to keep energy provisions in balance. Circuitry which controls eating is regulated by the attention, emotion/memory, cognitive-control & reward systems.

Changes in mental & emotional processes are implicated in the dysregulation of human eating behavior. Techniques used to examine appetitive include neuro-cognitive testing (via computer games), fMRI, PET & SPECT scans. Together they revealed the neuro-chemical determinants critical to understanding how the reward center in the brain is altered in obesity & emotional eating.    Brain LOBES ➡️

Some RESULTS
Insecure Attachment & their subtypes are linked to many brain functions  : 13 executive regions, 6 affect (emotions), 6 reward, 3 sensory, 1 social & 1 cerebellar. 

CHANGEs found in the :
— Executive function = high frequency of externalizing behaviors (aggression, antisocial & behavioral problems)
— Affective processing = high frequency of internalizing behavioral disorders (anxiety, depression, suicidality)
— Reward regions = higher frequency of substance abuse
— Social circuits = high frequency of excessive help-seeking, dependency & excessive social isolation 

Insecure adults required more of their executive control functions when faced with attachment-relevant stimuli (listen to infant crying) –  staying in the head to not feel. The excess stress could relate to a high prevalence of personality disorders.
— Resistant types, being highly emotional & obsessive, were less able to gather brain resources to stop negative thoughts
—  Avoidants showed poorer memory of attachment-related events (childhood trauma), linked to a higher prevalence of conduct disorders. 

 ♦︎        ♦︎       ♦︎

BULIMIA
The term refers to an eating disorder (ED) characterized by episodes of binge eating followed by compensatory behaviors such as purging, fasting, and/or excessive exercise.. It is the result of genetic predisposition along with the influence of psychosocial &/or environmental triggers.

Many studies have proven overlapping behaviors & addictive personality traits of substance abusers & Bulimics. In fact this ED commonly co-occurs with drug addictions,
EXP: the National Center on Addiction & Substance Abuse has shown that approximately 35% of all alcoholic women also have an ED. And 50% of people with EDs also struggle with substance abuse.

2 TYPES  – Because symptoms & behaviors of Bulimia are complex, it’s divided into :
Purging – The most commonly understood version, which involves the person binge eating, followed by such behaviors as vomiting &/or laxative/ diuretics/ enemas.
Non-Purging – This group do not expel food from the body as a way to deal with their self-loathing. Instead, they compensate by fasting or compulsive exercise, & rarely if ever purge.

A faulty reward-processing system seems to be an important feature of the diseases.
Brain studies reveal that neurological abnormalities contribute to the development of bulimia, a result of altered brain chemicals such as serotonin levels, which contribute to the dysregulation of mood, appetite, & impulse control.

EXP : Dopamine activity is altered in both bulimia & anorexia — but in opposite ways. While the reward circuits in women with anorexia are overly sensitive to food-related stimuli, women with Bulimia have a weaker-than-normal response in brain regions that are part of the dopamine-related reward circuitry.

STATISTICS = In the US as of 2023, Bulimia Nervosa :
▶︎ affects 4.7 million women, & 1.5 million men, although the number of males being diagnosed is expected to increase because of better awareness of how males display symptoms.

▶︎ As much as 25% of college age females use bingeing & purging as a weight loss method , with an average onset age of 18. Overall –
▶︎ 78% experience daily life impairment
▶︎ 43.9% experience severe impairment
▶︎ 8% are female, lasting more than 5 years, 5x more the men
▶︎ Only 3% receive treatment
▶︎ 3.9% will die from the disorder.

Bulimics are more likely to come from a family with a history of eating disorders, physical illness, & other mental health problems. Adult traits include the tendency to impulsivity & sensation seeking, typically present from childhood. But they have a secret life, keeping their eating disorder very private & hidden.
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NEXT : Attachment, Food & Others, #4c

PREVIOUS : S & I (#3)

BRAIN – Normal APPETITE
An key role of the brain is to ensure that there’s enough regularly circulating energy needed for smooth tissue functioning, as well as enough stored energy to cope with intervals when external provision is scarce (food). An important goal of the brain is to limit meal size, by coordinating several processes that allow the most effective circulation & storage quantity of energy-rich nutrients.

Brain centers (hypothalamus, brainstem & reward centers) provide signals that are integrated by peripheral nerves, resulting in appetite stimulation or satiety.

The hypothalamus acts as a main appetite regulatory center, playing a central role in orchestrating bodily responses to hunger & food, It provides peptides to the reward pathways, & controls the release of leptin, ghrelin & orexin, with one area increasing appetite, another reducing it. (IMAGE ⬇️ )

The meso-limbic reward pathway projects from the VAT into the NA in the limbic system (ventral tegmental area —>nucleus accumbens).  This pathway stimulates pleasure by increasing the release of dopamine.

Food activates the reward system, providing the feeling of pleasure, which in turn can lead to food-seeking, so that the person’s thinking about hunger motivate the action (memory of pleasure).  More….download full-text.  ) “Control of Food Intake and Appetite“.
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Insecure attachment styles are made up of negative mental images about close relationships —-> anxious or avoidant, preoccupied & dismissing <—- which have important implications in the development & maintenance of eating disorders.

ANOREXIA = traits
Anorectics are anxiety based – they think negatively about the world, experiencing it as a dangerous, overwhelming place. They’re also negative about themself – not seeing their body accurately as everyone else does, & as not friendly, pretty, or capable.

✒︎ They develop an OCD-like pattern because something feels out of order & they don’t know how to correct it. So they create rules to avoid food, which makes them less scared.

✒︎ Being reward dependent & perfectionistic, they want to be the very best, the top dog or they don’t feel ‘legitimate”
✒︎ But they’re also stressed because of low reward reactivity, so that even when they succeed, it doesn’t help them feel better.

✒︎ Their interoceptive** awareness (how we experience our body) is distorted so they misinterpret cues from their stomach, or other internal parts.
** INTEROception = Body Awareness
Muscles & joints have receptors that tell you where your body parts are.  Interoception works much the same way,  but the receptors are in your —> organs, including your skin. These receptors send messages about the body to the brain, helping to regulate vital functions such as hunger, thirst, digestion, or heart rate.
The Anorectic BRAIN : Researchers say an ongoing eating disorder can distort the brain’s reward circuitry. They lose weight everywhere, including inside the brain. This reduction is a danger to ED sufferer – as the volume drops, parts of the brain thin. The white matter shrinks & cells lose the ability to communicate clearly. Ironically, making decisions about their diet is the only thing that brings them relief & joy.

At ‘best’ the thinning breaks connections between brain areas, at worst it destroys cells. Areas affected include Attention, Impulsivity, Self-regulation & Social interactions. The damages also injures memory circuits, so anorectics can struggle to remember details about daily life, which can persist even after people enter recovery & regain weight .

No satisfaction : The release of Dopamine, from the hypothalamus, that should act as a reward (eating tasty food) —> is instead felt as punishment (for adding a snack).
EXP : Anorectics may feel happy when reading ingredient labels & finding hidden fat calories, and rewarded when they harm their bodies, such as : pushing food around the plate instead of eating it, excessive exercise, dropping an unhealthy amount of weight….

When brain cells that are normally used to signal happiness vs harm are reversed, & the alterations can make it very hard for the anorectic to make good choices. Since those switched neuro-transmitters provide physical rewards, telling the person they’re making the right choices, they’re not likely to see the need to get treatment.

RECOVERY : Brain structure & broken connections can’t be repaired, but anorectics can gather information, apply acceptance & develop new coping skills. They can come to understand & accept why changing eating habits is crucial. Since brain losses in this disease are progressive, early treatment will lessen the damage, & improve their life.
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NEXT : Attachment & Food – Bulimia, #4b

PREVIOUS :
Attachment & Food #2c

“Dysfunctional Individuation, Spiritual struggle & Identity…..a Developmental approach ”

TEENs – a Risk Factor
😡 Striving for Independence from attachment figures is a natural developmental need – to redefine relationships with them in line with the new needs of adolescence.
However, this often creates an internal struggle for the young person & resistance from parents.

On the one hand, the teen wants a sense of freedom & control over their own life but still crave the comfort & support of family. This inner & outer conflict causes intense stress.
When a balance is not reached, some teens try to cope with their frustration, fear & anger by restricting food, as a way to have what little control over their environment they can.

☼ Young people ages 15 to 24 with anorexia have a 10x higher risk of dying compared to non-ED peers, & of that group, 1 in 5 deaths is by suicide. (ED Treatment for Children & Teens)

This family battle is not unusual in our culture, a natural result of the “Separation & Individuation” process, but – in so many dysfunctional homes – it doesn’t end well.
The possibility for it to work out is influenced by the type of attachment bond members share.  It could be resolved slowly, perhaps uneasily – if parents & teens were healthy enough to openly, lovingly communicate thoughts, feelings & needs with each other, likely with some outside help.

So when parents provide support & encouragement for autonomy, the child can grow into their own person & be resilient, which in turn increases their ability to cope well in life.

Dysfunctional INDIVIDUATION
Attachment style is one of the variables in the study of eating disorders, specifically with Insecure adult attachment. While the style is relatively stable throughout ones lifetime, research suggests that our Internal Working Model** can be modified during the individuation process.
** IWNs are mental representation of our earliest relationships, which become the prototype for all others in the future.

When a person’s individuation is problematic (incomplete, distorted, thwarted), positive IWMs of ourself & others are harder to develop & hold on to.
Studies using the “Disordered Eating & Body Image Concerns” scale validate that dysfunctional individuation has a negative indirect effect on unhealthy forms of eating – identifying it as one important mediator ⬅️  between attachment style & ED.

EDs usually develop in dysfunctional parent-child relationships – from a the lack of empathic mirroring & the mother’s discouragement of independence in early childhood.  If the child tries to express their own personality, separation anxiety gets triggered, leading to depression & hopelessness, formed by negative mental pictures (IWSs) of relationships.

When the S & I process goes awry (incomplete individuation) it can cause —-> emotion dysregulation, poor self-image & trouble knowing what their needs are. Continuing the spiral —> there’s a lack of confidence in one’s coping skills to manage life’s challenges —> which can set them up for an ED.
This pattern is a reliable predictor of poor adjustment in late adolescence, as either unhealthy dependence (Anxiety) or unhealthy independence (Avoidance).

Even when parents think they’re well-meaning, if they’re subtly controlling &/or manipulative, their behavior will backfire, leaving harmful after-effects.
Adult-children from that background report they had or still have a hard time mentally & emotionally separating from family. Insecure attachment plus the personality dimension of self-criticism add up to a risk factor for adolescent suicide fantasies or attempts.

NEXT : FOOD – #4

PREVIOUS : Attachment & Food #2b

8 COMMON Eating Disorders
PICA — eating nonfood items with no nutritional value. Although it can be normal for children under age 2 to put various objects in their mouth, any similar activity after that represents a serious problem

RUMINATION disorder — repeatedly regurgitating recently eaten food, followed by spitting out, re-chewing, or swallowing it. These people do not have nausea, vomiting urges or food disgust – but it is linked with neglect, stress &/or lack of stimulation.
OTHERS:
(ARFID) Avoidant/restrictive food intake disorder
(BED) Binge eating disorder and Overeating ⬇️
(OSFED) Other specified feeding or eating disorders
(UFED) Unspecified feeding or eating disorders
Also in posts:  Anorexia, Bulimia, Orthorexia

“SOCIAL MEDIA  DIET“-  50 studies in 17 countries indicated that social media usage contributes to eating disorders with body image worry, & overall poor mental health affected by social comparisons, absorbing the thin / fit ideal as valid, & considering oneself as a ‘thing’ rather than a whole person. (Toxic world of Social Media Diet Culture“)
(“Balance your media diet”) and (Social Media Diet – for moderation)

♢ A study of 463 college students (Chongqing, China) looked at addiction to social networking sites (SNS), based on research evidence that emotion dysregulation plays a role in maintaining addictive behavior – such as eating disorders, problematic phone & internet use, gambling,…..
Results indicated that attachment anxiety correctly predicted SNS addiction & that poor emotion regulation mediates (affects) this connection.

SUB-Categories of EDs
♦︎ Asperger’s preferences – for starches & snack foods, & more frequent rejection of fruits & vegetables.
♦︎ Autism – autistic children are bothered by color – they like plain beige foods (pasta, chips…)
♦︎ Brumotactillo-phobia – fear of different foods touching each other
♦︎ Isolationism – eating one food item in its entirety before moving on to the next

♦︎ Mortuusequus-phobia : fear of tomato ketchup. (Australian slang meaning “dead horse”)
♦︎ Neophobia – reject or be reluctant to try new or unfamiliar foods
♦︎ Pseudodys-phagia – in its severe form, the irrational fear of swallowing. In its minor form, of choking.
♦︎ Sensory Food Autism – kids on the spectrum often express a strong preference for foods that feel a certain way in their mouth.

CO-OCCURING Disorders
As much as 80% of EDs are triggered, sustained by & intertwined with mental health conditions  (EXP for Bulimia). A dual-diagnosis can worsen a person’s symptoms & complicate treatment.
✒︎ INFO from website “Eating Disorder HOPE“
A study with 2400 people found that 94% of those hospitalized for ED also had a mental health disorder, such as OCD/ Trichotillomania (pulling hair out), SAD, PTSD, ADHD,  ….

☀︎ Major Depressive disorder (92%)
☀︎ Anxiety disorders (GAD) (48 – 81%)
☀︎ Borderline PD (up to 54%) . Self-injury (61%)
☀︎☀︎ Substance abuse – 50%, over 5x higher than in the general population

NOTE ***As of 2008, about 10 out of every 1,000 children experience neglect or abuse in the United States! It’s likely higher now because of covid (2020+)

Severe ED Medical Complications
☻ Mortality rates – conservative estimates : Anorexia = 4%, Bulimia =  3.9%.  Others = 5.9%

☻ Diabulimia / ED-DMT1 – One of the most dangerous, when a person with type-1 diabetes intentionally skips their insulin dosage to lose weight. Restricting insulin as well as food can cause dizziness & fainting, slowness to heal from cuts & bruises, organ failure caused by diabetic ketoacidosis, strokes, various staph & other infections, and death.
☻ Purging – Withdrawal & Detox treatment from purging  (self-induced vomiting, laxative &/or diuretic abuse) is physically harsh, & exposes internal damage : abdominal pain, constipation /irritable bowel, duodenal obstruction, edema, eye pain, gastroparesis, hypotension, liver problems,  trouble swallowing….. (More….)

STATISTICS
☼ EDs have the 2nd highest mortality rate of any psychiatric disorder, after opioid misuse
☼ Most common :  Binging & OSFED (Other….)
☼ Prevalence for the over 40  : Women = 3.5%, and Men = 1-2%, mostly untreated

☼ Men are just as vulnerable to ED as women : Anorexia, 25%,  Binge 36% ,  Bbulimia  25%
☼ Rates have increased in all populations, but at a faster rate in male- lower socioeconomic- older patients

☼ Stressful life events can trigger an ED onset : relationship problems & breakups, death of a loved one, change of job, retirement, menopause…. especially if they pile up

☼ People of color have the same rate of ED, but are significantly less likely to receive help for it (MORE….)

☼ Rates of all EDs are generally higher in the LGBTQ+ community

☼ Older patients are more susceptible to complications, such as osteoporosis, arrhythmia, heart problems, gastro-paresis, depression, anxiety, & substance misuse (SUD).

SITE for many STATs = Categories  «
NEXT :

PREVIOUS : Attachment & Food #1

SITE: Prevalence of Eating Disorders in Adults, Co-morbidity with Other Mental Disorders (2001-2004 USA)

PERSONALITY & Eating Disorders (ED)
Character is defined as the sum of personality traits acquired through experience, including novelty seeking, harm avoidance, reward dependence, total persistence, & self-directedness.
Scientists have found distinct personality traits in people with eating disorders & that they’re relatively specific to each disorder.

Some studies associated aspects of these traits with alterations in serotonin & dopamine signaling. There is also evidence that maladaptive personality traits of borderline, histrionic & schizotypal disorders precede the development of EDs.

The two strongest risk factors for ED are Neuroticism & Perfectionism (anorexia), based on the “Big Five”- Neuroticism, Extraversion, Openness (to experience), Agreeableness, & Conscientiousness. EXPs for some ED categories :
✒︎ sufferers score high on harm avoidance, impulsivity, obsessive-compulsiveness, reward dependence & sensation seeking
✒︎ combined with low self-direction, assertiveness, & cooperativeness.

✑ People with high scores for novelty-seeking were more likely to overeat or binge-eat, while
✑ a low value for novelty-seeking was linked with anorexia
✑ Low scores for persistence were associated with patients dropping out of cognitive behavior therapy CBT) inpatient treatment for ED, and
✑ bulimic patients, with high self-directedness scores, showed a rapid & sustained response to CBT.

Personality type also matters for outcomes. Using the Big Five model, Fairburn et.al. showed that improvement is more likely when personality features are addressed along with ED symptoms. EXP :
♚ under-controlled / impulsive, & avoidant/ insecure (attachment) patients have a poorer prognosis, than
♚ high-functioning ED patients, who fare better than average. (MORE…)

A review of 70 studies about ED  identified 3 personality facets – Trust, Anxiety, Depression – that share the most variance (highly similar scores) with general psycho-pathology. ED symptoms are a result of combining :
♚ low🔻levels of personality functioning, with
♚ high🔺levels of insecure attachment (= 77% of the total study).

UNHEAlTHY Personality ADULTS

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ADULTS
Until recently eating disorders were considered only an adolescent problem. Now there’s growing evidence that adults also suffer from untreated EDs, which threaten their health & well-being, because of:
✒︎ eating habits that result in the condition going undiagnosed & untreated
✒︎ being diagnosed as teens, & continue into adulthood
✒︎ being triggered by inter-personal or environmental stresses / trauma (divorce, death, choking incident, fat-shaming)
✒︎ peri-menopause hormonal shifts triggering an ED in some women. Social-media pressure to look younger/ thinner can be another factor.

EXP : Research noted that roughly 9.2% US adults with ED meet the criteria for ARFID  (Avoidant/Restrictive Food Intake Disorder).  It can affect them by limiting professional advancement, if they don’t attend company outings or entertain clients. Personally, they may find social & romantic events curtailed by a fear of being judged for their limited portions.
Recovery centers for adults focus on understanding & correcting the three subtypes : Sensory sensitivities, Fear of aversive consequences & Lack of interest.

Exercise Addiction
While not technically an EDs, compulsive exercise is commonly associated with them (anorexia & bulimia), harming a person’s physical & mental health. Especially when combined with disordered eating behaviors, excessive exercise can cause problems with the heart, bone density, bone & tendon injuries….
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This behavior can interfere with a person’s social life, & career. Addicts will exercise in inappropriate situations & at inappropriate times, in bad weather, make it a requirement for “permission” to eat, & compulsively resume after an injury or illness before full recovery…..
(More  …. )   ♥︎ Even if an eating disorder isn’t apparent, exercise addiction does require physical & emotional treatment.

SENIORS  : If an older adult is suffering from an ED, it’s likely they’ve been plagued with the problem for decades. And sadly, since it’s gone on for so long, they’ve gotten used to the symptoms — the actions, thoughts, & feelings are simply a part of life. So, as things get worse, it’s less likely they’ll ask for help in their ‘golden’ years.

Because doctors & society still focus on treatment for adolescents & young adults, seniors are marginalized. And many signs are mistaken for other illnesses, or as a common part of aging.
Family members might also assume that malnutrition, diarrhea, vomiting, hair loss, reactions to prescription meds…. are a natural progression of aging, when these could very well be direct effects of a serious health disorder. (“Elder Eating Disorders“)

NEXT : Attachment &amp; FOOD (#3)

PREVIOUS : Food (#1)

SITE : access FREE
amazing worksheets in “Transforming the Living Legacy of Trauma”

RESOURCE : HELP LINE  – National Eating Disorders Association

BOOK : “Attachment, Relationships & Food – From Cradle to Kitchen

Personal FACTORS
Some influences that contribute to a person’s food choices include individual characteristics such as = attitudes, beliefs & knowledge about food, ethnicity, taste preference & special diet requirements.
In the US – the order of importance has been reported as : taste, cost, nutrition, convenience & weight concerns.
In contrast, information compiled from 15 European member states listed theirs as : quality/freshness = 74%, price = 43%, taste = 38%, ‘trying to eat healthy’= 32% and ‘what my family wants to eat’= 29%.

Other determinants :
Biological = health status, hunger level, appetite, taste buds
Economic = availability, cost, personal income
Physical =  access, education, cooking skills, time
Psychological = guilt / shame, moods, stress
Social = culture, family, peers & meal patterns. (More…. expanded)

PSYCHOLOGICAL Reasons INSECURE Attachers DEVELOP an ED
😱 Emotional dysregulation
Insecures tend to have a hard time regulating (coping with) painful emotions.
Strongly Avoidant people suppress or deny feelings, while very Anxious are ‘high strung’, with hyper-intense emotions (not the the same as being a “Sensitive”).

Insecurely attached people may try to lessen their inner turmoil by activities like dieting to get the “perfect” body, binge eating to improve their mood, or purging to avoid gaining weight. These are forms of escapism, but of course – it doesn’t work. The vicious cycle gets re-activated every time Insecures face any kind of upset. (“Window of tolerance” scroll down)

Without Recovery, they naturally use unhealthy strategies that try to sidestep those feelings – instead of learning how to manage anxiety & anger safely & maturely.

😇 Perfectionism
In general, Insecure attachers are prone to perfectionism (especially Anorectics), in the form of self-criticism, based on believing the toxic family rules they grew up with. They hope to be accepted & approved of by family, mates & friends, if only they could reach their “perfect” image.

Some Insecures will develop an ideal aesthetic standard, such as unrealistic thinness or perfect musculature. So an unhealthy eating pattern may let them feel like they’re doing something to ‘fix’ physical flaws.
A 2023 study examining the connection between attachment to parents & friends and adolescents with ED, showed that trouble with trust, communication & alienation correlated with their body dissatisfaction.

NOTE: Adaptive perfectionism includes high but achievable standards for oneself, a preference for organization & order, a feeling of satisfaction & effectiveness when tasks are completed.
Maladaptive perfectionism involves unrealistically high standards with critical self-evaluation (debilitating self-doubt about actions, intense obsession over mistakes, & feeling like a failure due to them (More….)

🥸 Inaccurate self-beliefs
Related to self-criticism, Insecures come to false conclusions about themself because of how poorly their needs were met in childhood, such as thinking they’re “worthless, less-than, unlovable” . One symptom is obsessively comparing themselves to others they see as “better.”
Not getting the right kind of parental mirroring as kids, they’re not able to see their body and Self accurately. Always coming up short, the negative comparisons keep eroding their self-image, which can encourage & promote disordered eating, in the delusion they’ll feel better about themself.

😎 Lack of Mindfulness
Generally, people with Insecure attachment styles are less awake in the present moment, not aware of what they’re thinking & feeling. In terms of T.E.A., they tend to worry (E), obsess (T) & over-focus on a distracting activity such as tv & social media. (A). There are also pockets of dissociation in one or more areas of their life, numb to their needs & self-care.

Most defense mechanisms take the person out of the present – they’re either in the past (ïf only”) or in the future (:what if”). Not paying attention to ‘where they are’ throughout the day can strongly affect some peoples’ ability to recognize physical hunger or fullness, or accept their weight & body shape – especially relevant in bulimia & binge eating.

The connection between lack of mindfulness, dysfunctional attachment, & eating disorders can be expressed in several ways : via trans-generational transmissions, between intra- & inter-personal experiences, in the mediation of personality traits, the link between maintaining-mechanisms and risk factors such as mood disorders, between EDs & dysfunctional family traits (active parental addictions, discouraging autonomy, enmeshment, overprotection, rigidity, triangulation, suppression of conflicts ….)
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NEXT : Food -#3

PREVIOUS : Attachment & Siblings

SITEs : ▫️ “How diet culture can lead to eating disorders”

🍔 🍟  🥤🍏  🥦 🥑
Attachment theory is expressed as an emotion regulation theory, & more than 80% of all adult ED patients studied have an Insecure attachment.

The attachment style we develop is crucial to whether or not we’re able to successfully deal with developmental stages. They include adjusting to physical changes during adolescence, forming a strong sense of an independent identity, & setting life goals. Basically, our attachment style is a way to buffer against actual & potential psychological anxiety or harm.

Some people are born with a predisposition to focus on food for pleasure & comfort, not just for survival. (Others have a stronger pull toward sports, or chemicals, or sex, or performing….as primary).
If a food-person also has any one of the Insecure attachment  styles – they can be at risk for an eating disorder, or it’s precursor – unhealthy  eating patterns with signs of a disorder that’s “waiting in the wings”. Signs can be : chronic restricted or compulsive eating, a heightened focus on appearance, worry about being overweight & being dissatisfied with body shape.

3 MAIN TYPES
♨︎ Anorexia nervosa – trying to control weight by under-eating &/or over-exercising. 
♨︎ Bulimia – loss of control over how much food is consumed, then purged to avoid putting on weight
♨︎ Binging – eating vast amounts of food until uncomfortably full. (List of signs for each type)

Eating disorders (ED) are not a lifestyle choice, rather an outward expressions of deep psychological & emotional distress, ‘encouraged’ by Insecure attachment styles. They are serious illnesses marked by an unhealthy relationship to food, used to manage negative feelings. They’re emotionally painful, obsessive & isolating, mentally distorting what the person sees when looking in the mirror. (More in posts : Attachment & Eating 1 & 2)

Evidence from meta-analysis research supports a strong link between insecure attachment styles & eating disorders, for the majority of adolescents & adults who were canvassed.
EXP 1 : One study of “food issues” showed that all the women involved were Anxiously attached, who identified having unhealed trauma or loss, especially with their mother.

It’s been established that the Anxious mother neglects her child’s emotional needs because she is too preoccupied with her own, & in a role-reversal she expects & demands that the child provide hers instead.
Because food is intimately connected with nurturing, the child’s response to emotional (& often physical) abuse & neglect can include how it reacts to eating — either over-focused on food as a symbol of longing for mom or rejecting it as a way to express anger at her.

EXP 2 : The quality of a father’s bond & his emotional availability is also hugely important to a developing child.  Infants have the same connection-seeking behavior toward dad (arms outstretched) as they do with mom. Babies also react strongly to a father’s ‘still’ face. Over time, his repeated unresponsiveness takes a toll on their emotional development – affecting the child’s sense of safety. 

S0 – the fathers’ Avoidant style becomes another risk factor. Studies that have examined his role – found that an insecure bond with the father / father figure can predispose a child to developing an eating disorder.
In particular, the father being inattentive, detached &/or controlling – especially at meal times – can leave the child with anxiety about eating, using ‘food restraint’, & self-hate about body shape & appearance.

So understanding what underpins eating disorders (ED) must include either or both parents’ unresolved issues, not just those of the suffering teen.

Eating Disorder (ED) SYMPTOMS  = The highest incidence of ED occurs between ages 10 & 19, but diagnosing correctly is challenging because symptoms of the various kinds & their behaviors overlap. Fortunately, most harmful complications are reversible with improved nutrition, & by stopping abnormal eating & purging.
Prognosis :
☀︎ Recovery from anorexia nervosa becomes much less likely the longer the illness persists (mortality rate increases).
☆ This finding contrasts with that of bulimia nervosa – the chance of recovery becomes higher the longer the illness’s duration.

🔽 LIST combines characteristics of several styles. Symptoms vary across types, so someone struggling with an ED won’t have all of these, or not all at once.
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NEXT : FOOD – #2

PREVIOUS : Attachment –  FRIENDS

BOOK : “Bridging Bonds: Strengthening Sibling Relationships”

⭐️ primary caregiver usually = the mother

1. GENERAL

☆ Attachment is not just a ‘good relationship’, but is a much deeper bond based on how well another (trustworthy) person serves as a continued source of emotional security. This also applies to Siblings.

💌 A Secure connection with mother makes it more likely that our sibling connections are also Secure.
BUT – if Insecurely attached early on, there’s a 75% likelihood of developing Insecure connections with most others, & be 6x more likely to have insecure adult intimate mating.
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ROLES : In unhealthy families, often when there are only 2 kids, one may be more accommodating, sensitive & helpful, while the other may be loud, aggressive & controlling. With several children, one may be chosen by a parent to be the scapegoat, & perhaps one designated as the golden child, while the others will be invisible or escape as soon as they can. These differences can lead to broken trust  & alienation.

Later on – Insecurely attached adults who’ve experienced childhood mistreatment will be distrustful & emotionally distant, with several mental health problems, including depression, anxiety, co-dependence, personality disorders & various addictions….

Causes of estrangement include parental preference, physical disparity, a mental or psychological disability, & intense disagreements based on toxic rules. Also envy, distorted communication, an unwillingness to reveal feelings, lack of conflict resolution skills, even a different world view.

a. But it’s not automatically true for every sibling – surveys indicate that only about half (56%) mimic the mother-child style bond, even if they grew up in the same household,…. (see ‘Sib-Violence’ below).
✐ Other factors affecting how sibs get along include individual temperament, birth order, love-language preference & culture.

b. 💌 Someone in the other half (44% group) may provide their sibs protection against the harmful effects of insecure parental attachment. Studies found that older siblings can act as a comforting base for younger ones, who may then be able to gain the confidence to explore their surroundings & learn how to relate to & communicate with others – the way Secure kids do.

Feelings of emotional warmth & positive attention between sibs can partly make up for anything unavailable from mom & dad, & be a buffer against painful life events, such as parental separation or family death. This helps children develop healthy coping strategies to manage  a variety of stresses, making them less likely to use tactics like physical aggression, bullying, theft & defiance OR to withdraw & isolate – as a reaction to emotions pain.

🕳️ Another consideration is how children cope with the death of a sibling. For one thing – they can feel invisible, as their whole life is thrown into turmoil, especially for the younger ones because of the traumatic effect on the mother.

For another, this loss creates a need in surviving children for support rather than withdrawal, regardless of attachment style. Studies as the ones from PA & TX note that because siblings are important attachment objects, they can be bridging objects for each other – to modify aggressions, displace hostility, & transform incestuous fantasies.

2. TOXIC
In families where alcoholism & severe narcissism &/or domestic violence are rampant, ‘normal’ sibling rivalry can easily escalate to cruelty.

Sibling violence is a power imbalance that makes it hard or impossible for the harmed child to protest, or defend themself. This is equally true for any gender combination or attachment style.  Obviously, children are greatly influenced by watching how the adults treat each other or are treated by others (spouse, close relatives, new partners….)  (MORE…)

Unfortunately, much harmful words & actions happen when adults are not around. And if it does, often parents will minimized the violence because of widely-held beliefs that it helps toughen kids up & prepares them for life.  So it’s not identified as abuse, even when a child is obviously injured.
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PREVIOUS : Attachment & FRIENDSHIP

BOOK : “The Body Keeps the Score” and REVIEW
COURSE : The Neurobiology of Attachment and How that Profoundly Impacts the Treatment of Trauma

1. MEDICAL
Attachment styles can shape physical stress-responses because they function as strategies for coping with distress, dealing with emotions, ‘explaining’ identity & moderating behaviors – in close relationships.
A person’s self-regulation ability & relationship interactions influence how they respond to stress at a physical level (cortisol reactivity/ recovery, cardiovascular reactivity, inflammation-related responses) & contribute to health outcomes over time.
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HEALTH ANXIETY
Also known as hypochondriacs or Somatic symptom disorder. It usually shows up in behavior patterns, with a strong belief that something is wrong with them – usually physiologically, but sometimes psychologically also. They may focus on a specific illness, or look for signs of something serious without having any one problem in mind.

People with Health Anxiety are more likely to constantly consult their doctor & request testing, sure they’re “dying” of something terrible. However – typically, instead of feeling relieved when every medical exam comes back Normal, they’re sure something was wrong with the test or the doctor misread the results.

Others may react by not seeking care – avoiding the doctor entirely. This anxiety can have the opposite effect – convinced hospitals are risky places & determine to stay away. This can be a big problem when real treatable conditions go undiagnosed.  Harvard estimates ; 4% – 5%  (maybe as much as 12%)

CHART ▼ From a Greek  study exploring INSECURE Attachment & Health Anxiety. Results highlighted that inter-personal (alienation from others) and perceptual factors (tendency to focus on bodily sensations) play key roles in maintaining this condition, noting the importance of Anxious and Avoidant attachment in safety-seeking behaviors.

Health anxiety symptoms
▸ Avoid hospitals & doctor appointments OR call “every 5 minutes” with a complaint & worry
▸ Constantly anxious about general health
▸ Frequently scan the body for something wrong
▸ Preoccupied re. health for at least 6 months, even if the ‘illnesses’ they’re worried about change over that time
▸ Over-estimate the risks of getting a disease & jump to worst-case scenarios
▸ Spend a lot of time reading about different symptoms (cyberchondria)
▸ Worry a lot about having or getting a serious illness
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⬆️ Attachment style in medically unexplained symptoms & long-term illness
A UK study of medically unexplained symptoms (MUS) indicates that attachment insecurity is common in people with different forms of MUS & certain long-term physical conditions.

Insecure attachment is not in itself a pathology, but represents a struggle to manage stress & distress effectively.
It is common in the general population, about 40%, fairly equally divided between Ambivalent & Avoidant types.

When Insecure people become ill, their attachment system is especially activated, since illness (real or perceived) is experienced as life-threatening, so a sense of vulnerability increases.
When identifying themselves as ‘patients’, they may experience intense dependence on the professionals, triggered by their early internal working model of the world.
Ironically, Insecure adults have trouble believing they’ll get the help they long for,  so don’t trust medical caregivers

CHRONIC PAIN  – There’s increasing recognition that unhealthy adult attachment styles play a role in the experience of pain…. & can be a risk factor for chronic pain which does not respond to ordinary analgesia. 

Also, Insecure attachment in physically healthy adults is associated with obsessions about minor “aches & pains” causing increased pain-related worry, even projecting suffering & death. It can take the form of hypochondria, hyper-vigilance about health, as well as a reduced pain threshold, & poor coping ability with actual pain.  (MORE…..)
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2. RECOVERY GROWTH
Healing from trauma is one of the most challenging things we do because we’re missing one key experience – a stable, secure relationship. RECOVERY has to include finding PPT (people, places, things) that will provide steady, caring connections to help us grow.
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RESILIENCE (15 posts)
“Mindful people can better cope with difficult thoughts & emotions without becoming overwhelmed or shutting down feelings. Pausing to observe the mind can help resist getting drawn into wallowing when triggered” – Tom Jacobs

Being mindful increases happiness, improves the ability to bounce back from difficulties, reducing physiological & psychological responses to stress.

Research has established these effects : they found that the higher the levels of mindfulness —> the higher the levels of resilience. And, resilience is strengthened by being able to form attachments.  Combined, they helped to lower the levels of attachment insecurity, anxiety & avoidance.
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PREVIOUS : Anxious behaviors – Explained (#2)

POSTs : “Friends – Real ” (Part 1 # 2) // INVENTORY

SECURE
You’re able to form nurturing friendships, & work through conflicts that arise. You recognize your value as a person as well as that of others, & understand boundaries that come with friendships. EXP: you’re not one to take things personally if your friends cancel plans last minute…..

Your strong self-assurance allows you to form trusting & lasting relationship with anyone, able to reach out & connect to people, but also respect their boundaries. Your friendships are healthy, & it’s unlikely you have resentments or repressed feelings, since you like to find all kinds of interesting social groups & share them with your friends.

Anxious-PREOCCUPIED
You likely struggle with anxiety about & an intense focus on your friendships – attuned to their needs but rarely considering your own. You may not be aware of having low self-esteem, but you do depend too much on other’s assurances to feel loved & cared about. So, if a ‘good’ friend doesn’t text you back, you take it personally, blaming yourself for the silence.

About forming close friendships – you often worry that people  don’t reciprocate your feelings. However, if you a safe & secure friendship comes along, you’re likely to sabotage its value by obsessively negative thoughts that these healthy friends couldn’t possibly like you.
This can create a rift between you, threatening the connections. Seeing them hang out with other people makes you  convinced you’re not important to them & not really cared for – making you clingy, jealous & possessive.

Your friendship-history has been a roller-coaster ride, but it doesn’t have to stay that way forever. You can help yourself by correcting your toxic beliefs which will help to regulate your emotions when triggered by a situations that makes you anxious.  Ask yourself  &/or a trusted friend if your opinions are realistic.

Fearful-AVOIDANT
This type is a mixture of Anxious & Dismissive. What separates the 2 styles is that this type actually craves intimate friendships, so you’re constantly bouncing between wanting to be close & scared of rejection. Because of this inner conflict you come off as detached & distrustful, even though it comes from fear, which keeps you from connecting with strong & secure people.

This often leads to conflicts with someone in your friendship circle, even if you don’t mean to. EXP:  you miss hanging out with your friends but when you see them, you pick a fight with one or more of them.
Your unpredictable moods & ‘difficult’ attitude make it hard for your them to be with you. Not letting yourself be mutually vulnerable will eventually strain the relationships.

Even so, you can develop a secure attachment style, with a few tweaks. Understand that your thoughts & emotions may not be an accurate feedback loop about what’s going on in your friendship. Rather – it may have been a projection or trigger from old wounds. Instead, work on developing appropriate boundary with your friends so they know what can upset you & what you need in terms of closeness & intimacy.

DISMISSIVE-avoidant
You’re usually pretty happy with yourself – social, easygoing & generally fun to be around. But, you’re also too independent & self-reliant. Your special form of kryptonite is getting too close or personal with others, because being that vulnerable makes you uncomfortable & feel suffocated. So you disconnect emotionally.

You keep social bonds superficial because of your struggles with trust & intimacy, which prevents you from making deep connections with friends. And when you have too much on your plate, you’re not likely to ask for support or help from others even though you really need it.

To improve your social life, decide to slowly get in touch with your fear of personal closeness & mistrust of others.
Talk honestly to close friends, sharing your deepest concerns, even asking for compassionate feedback. Letting them get to know your true self (strengths & limitations) will allow them to be there for you in a way that may surprise you.  In time, this will improve you trust issues & gain a secure attachment style.

Modified from :
“Attachment & Friendship” by Nina Fazil (5/22)

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