Recovery from eating disorder 1 year after start of treatment is related to better mentalization and strong reduction of sensitivity to others

  • Greet S. KuipersEmail author
  • Sandra den Hollander
  • L. Andries van der Ark
  • Marrie H. J. Bekker
Original Article



To investigate whether recovery from an eating disorder is related to pre-treatment attachment and mentalization and/or to improvement of attachment and mentalization during treatment.


For a sample of 38 anorexia nervosa (AN) and bulimia nervosa (BN) patients receiving treatment the relations between attachment security, mentalization, comorbidity and recovery status after 12 months (not recovered or recovered), and after 18 months (persistently ill, relapsed, newly recovered, or persistently recovered) were investigated. Attachment security and mentalization were assessed by the Adult Attachment Interview at the start of the treatment and after 12 months. Besides assessing co-morbidity—for its effect on treatment outcome—we measured psycho-neuroticism and autonomy because of their established relations to both eating disorder symptoms and to attachment security.


Recovery both at 12 months and at 18 months was related to higher levels of mentalization; for attachment, no significant differences were found between recovered and unrecovered patients. Patients who recovered from AN or BN also improved on co-morbid symptoms: whereas pre-treatment symptom severity was similar, at 12 months recovered patients scored lower on co-morbid personality disorders, anxiety, depression, self-injurious behaviour and psycho-neuroticism than unrecovered patients. Improvement on autonomy (reduced sensitivity to others; greater capacity to manage new situations) in 1 year of treatment was significantly higher in recovered than in unrecovered patients.


A focus on enhancing mentalization in eating disorder treatment might be useful to increase the chances of successful treatment. Improvement of autonomy might be the mechanism of change in recovering from AN or BN.

Level of Evidence

Level III cohort study.


Attachment Mentalization Recovery AAI Autonomy Eating disorders 



The authors thank Mrs. C. Vierboom for her contribution to conducting the AAI, and Ms. Z. van Loenhout for her contribution to processing the data.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states there are no conflicts of interest.

Ethical approval

This study has been approved by the Netherlands Medical Ethical Committee for Mental Health Institutions (Medisch-Ethische Toetsingscommissie Instellingen Geestelijke Gezondheidszorg, METIGG).


  1. 1.
    Kuipers GS, Bekker MHJ (2012) Attachment, mentalization and eating disorders: a review of studies using the adult attachment interview. Curr Psychiatry Rev 8(4):326–336. doi: 10.2174/157340012803520478 CrossRefGoogle Scholar
  2. 2.
    Tasca GA, Balfour L (2014) Attachment and eating disorders: a review of current research. Int J Eat Disord 47(7):710–717. doi: 10.1002/eat.22302 CrossRefPubMedGoogle Scholar
  3. 3.
    Zachrisson HD, Skårderud F (2010) Feelings of insecurity: review of attachment and eating disorders. Eur Eat Disord Rev 18(2):97–106. doi: 10.1002/erv.999 CrossRefPubMedGoogle Scholar
  4. 4.
    Bowlby J (1988) A secure base: parent-child attachment and healthy human development. Basic Books, New YorkGoogle Scholar
  5. 5.
    De Wolff MS, Ijzendoorn MH (1997) Sensitivity and attachment: a meta-analysis on parental antecedents of infant attachment. Child Dev 68(4):571–591. doi: 10.1111/j.1467-8624.1997.tb046218.x CrossRefPubMedGoogle Scholar
  6. 6.
    Candelori C, Ciocca A (1998) Attachment and eating disorders. In: Bria A, Ciocca A, De Risio S (eds) Psychotherapeutic issues in eating disorders: models, methods and results. Società Editrice Universo, Rome, pp 139–153Google Scholar
  7. 7.
    Ramacciotti A, Sorbello M, Pazzagli A, Vismara L, Mancone A, Pallanti S (2000) Attachment process in eating disorders. Eat Weight Disord 6:166–170. doi: 10.1007/BF03339766 CrossRefGoogle Scholar
  8. 8.
    Ward A, Ramsay R, Turnbull S, Steele M, Steele H, Treasure J (2001) Attachment in anorexia nervosa: a transgenerational perspective. Br J Med Psychol 74(Pt 4):497–505. doi: 10.1348/000711201161145 CrossRefPubMedGoogle Scholar
  9. 9.
    Zachrisson HD, Kulbotten GR (2006) Attachment in anorexia nervosa: an exploration of associations with eating disorder psychopathology and psychiatric symptoms. Eat Weight Disord 11(4):163–170. doi: 10.1007/BF03327567 CrossRefPubMedGoogle Scholar
  10. 10.
    Ringer F, Crittenden PM (2007) Eating disorders and attachment: the effects of hidden family processes on eating disorders. Eur Eat Disord Rev 15(2):119–130. doi: 10.1002/erv.761 CrossRefPubMedGoogle Scholar
  11. 11.
    Barone L, Guiducci V (2009) Mental representations of attachment in eating disorders: a pilot study using the adult attachment interview. Attach Hum Dev 11(4):405–417. doi: 10.1080/14616730902814770 CrossRefPubMedGoogle Scholar
  12. 12.
    Dias P, Soares I, Klein J, Cunha JP, Roisman GI (2011) Autonomic correlates of attachment insecurity in a sample of women with eating disorders. Attach Hum Dev 13(2):155–167. doi: 10.1080/14616734.2011.55400 CrossRefPubMedGoogle Scholar
  13. 13.
    Illing V, Tasca GA, Balfour L, Bissada H (2010) Attachment insecurity predicts eating disorder symptoms and treatment outcomes in a sample of women. J Nerv Ment Dis 198(9):653–659. doi: 10.1097/NMD.0b013e3181ef34b2 CrossRefPubMedGoogle Scholar
  14. 14.
    Keating L, Tasca GA, Bissada H (2014) Pre-treatment attachment anxiety predicts change in depressive symptoms in women who complete day hospital treatment for anorexia and bulimia nervosa. Psychol Psychother 88(1):54–70CrossRefGoogle Scholar
  15. 15.
    Hesse E, Main M (2000) Disorganized infant, child, and adult attachment: collapse in behavioral and attentional strategies. J Am Psychoanal Assoc 48(4):1097–1127. doi: 10.1177/00030651000480041101 (discussion 175–187) CrossRefPubMedGoogle Scholar
  16. 16.
    Main M (2000) The organized categories of infant, child, and adult attachment: flexible vs. inflexible attention under attachment-related stress. J Am Psychoanal Assoc 48(4):1055–1096. doi: 10.1177/00030651000480041801 (discussion 175–187) CrossRefPubMedGoogle Scholar
  17. 17.
    Lorenzini N, Fonagy P (2013) Attachment and personality disorders: a short review. Focus J Lifelong Learn Psychiatry 11(2):155–166. doi: 10.1176/appi.focus.11.2.155 CrossRefGoogle Scholar
  18. 18.
    Abbate-Daga G, Gramaglia C, Amianto F, Marzola E, Fassino S (2010) Attachment insecurity, personality, and body dissatisfaction in eating disorders. J Nerv Ment Dis 198(7):520–524. doi: 10.1097/NMD.0b013e3181e4c6f7 CrossRefPubMedGoogle Scholar
  19. 19.
    Tasca GA, Kowal J, Balfour L, Ritchie K, Virley B, Bissada H (2006) An attachment insecurity model of negative affect among women seeking treatment for an eating disorder. Eat Behav 7(3):252–257CrossRefGoogle Scholar
  20. 20.
    Troisi A, Di Lorenzo G, Alcini S, Nanni RC, Di Pasquale C, Siracusano A (2006) Body dissatisfaction in women with eating disorders: relationship to early separation anxiety and insecure attachment. Psychosom Med 68(3):449–453. doi: 10.1097/01.psy.0000204923.09390.5b CrossRefPubMedGoogle Scholar
  21. 21.
    Cole-Detke H, Kobak R (1996) Attachment processes in eating disorder and depression. J Consult Clin Psychol 64(2):282–290. doi: 10.1037/0022-006X.64.2.282 CrossRefPubMedGoogle Scholar
  22. 22.
    Barnes MA, Caltabiano ML (2017) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord 22(1):177–184. doi: 10.1007/s40519-016-0280-x CrossRefPubMedGoogle Scholar
  23. 23.
    Tasca GA, Szadkowski I, Illing V, Trinneer A, Grenon R, Demidenko N (2009) Adult attachment, depression, and eating disorder symptoms: the mediating role of affect regulation strategies. Personal Individ Differ 47(6):662–667. doi: 10.1016/j.paid.2009.06.006 CrossRefGoogle Scholar
  24. 24.
    Ty M, Francis AJ (2013) Insecure attachment and disordered eating in women: the mediating processes of social comparison and emotion dysregulation. Eat Disord 21(2):154–174. doi: 10.1080/10640266.2013.761089 CrossRefPubMedGoogle Scholar
  25. 25.
    Dakanalis A, Timko CA, Zanetti MA, Rinaldi L, Prunas A, Carrà G et al (2014) Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: a latent mediated and moderated structural equation modeling analysis across diagnostic groups. Psychiatry Res 215(1):176–184. doi: 10.1016/j.psychres.2013.10.039 CrossRefPubMedGoogle Scholar
  26. 26.
    Keating L, Tasca GA, Hill R (2013) Structural relationships among attachment insecurity, alexithymia, and body esteem in women with eating disorders. Eat Behav 14(3):366–373. doi: 10.1016/j.eatbeh.2013.12.003 CrossRefPubMedGoogle Scholar
  27. 27.
    Fonagy P, Leigh T, Steele M, Steele H, Kennedy R, Mattoon G et al (1996) The relation of attachment status, psychiatric classification, and response to psychotherapy. J Consult Clin Psychol 64(1):22–31. doi: 10.1037/0022-006X.64.1.22 CrossRefPubMedGoogle Scholar
  28. 28.
    Maxwell H, Tasca GA, Grenon R, Faye M, Ritchie K, Bissada H, Balfour L (2017) Change in attachment dimensions in women with binge-eating disorder following group psychodynamic interpersonal psychotherapy. Psychother Res 205(1):1–15. doi: 10.1080/10503307.2017.1278804
  29. 29.
    Carter JC, Mercer-Lynn KB, Norwood SJ, Bewell-Weiss CV, Crosby RD, Woodside DB et al (2012) A prospective study of predictors of relapse in anorexia nervosa: implications for relapse prevention. Psychother Res 200(2):518–523. doi: 10.1016/j.psychres.2012.04.037 CrossRefGoogle Scholar
  30. 30.
    Fonagy P, Target M, Steele H, Steele M (1998) Reflective-functioning manual, version 5.0, for appliciation to adult attachment interview London: University of College LondonGoogle Scholar
  31. 31.
    Bateman AW, Fonagy P (2004) Psychotherapy for borderline personality disorder: mentalization based treatment. Oxford University Press, OxfordCrossRefGoogle Scholar
  32. 32.
    Caglar-Nazali HP, Corfield F, Cardi V, Ambwani S, Leppanen J, Olabintan O et al (2014) A systematic review and meta-analysis of ‘systems for social processes’ in eating disorders. Neurosci Biobehav Rev 42:55–92. doi: 10.1016/j.neubiorev.2013.12.002 CrossRefPubMedGoogle Scholar
  33. 33.
    Kuipers GS, van Loenhout Z, van der Ark LA, Bekker MH (2016) Attachment insecurity, mentalization and their relation to symptoms in eating disorder patients. Attach Hum Dev 18(3):250–272. doi: 10.1080/14616734.2015.1136660 CrossRefPubMedGoogle Scholar
  34. 34.
    Rothschild-Yakar L, Levy-Shiff R, Fridman-Balaban R, Gur E, Stein D (2010) Mentalization and relationships with parents as predictors of eating disordered behavior. J Nerv Ment Dis 198(7):501–507. doi: 10.1097/NMD.0b013e3181e526c8 CrossRefPubMedGoogle Scholar
  35. 35.
    Pedersen SH, Lunn S, Katznelson H, Poulsen S (2012) Reflective functioning in 70 patients suffering from bulimia nervosa. Eur Eat Disord Rev 20(4):303–310. doi: 10.1002/erv.2158 CrossRefPubMedGoogle Scholar
  36. 36.
    Skårderud F (2007) Eating one’s words, part II: the embodied mind and reflective function in anorexia nervosa–theory. Eur Eat Disord Rev 15(4):243–252. doi: 10.1002/erv.778 CrossRefPubMedGoogle Scholar
  37. 37.
    Rothschild-Yakar L, Waniel A, Stein D (2013) Mentalizing in self vs. parent representations and working models of parents as risk and protective factors from distress and eating disorders. J Nerv Ment Dis 201(6):510–518. doi: 10.1097/NMD.0b013e3182948316 CrossRefPubMedGoogle Scholar
  38. 38.
    Oldershaw A, Hambrook D, Tchanturia K, Treasure J, Schmidt U (2010) Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients. Psychosom Med 72(1):73–79CrossRefGoogle Scholar
  39. 39.
    Katznelson H (2014) Reflective functioning: a review. Clin Psychol Rev 34(2):107–117. doi: 10.1016/j.cpr.2013.12.003 CrossRefPubMedGoogle Scholar
  40. 40.
    Dozier M, Chase Stovall-McClough K, Albus KE (2008) Attachment and psychopathology in adulthood. In: Cassidy J, Shaver M (eds) Handbook of attachment: theory, research, and clinical application. Guilford Press, New York, pp 718–744Google Scholar
  41. 41.
    Klump KL, Bulik CM, Kaye WH, Treasure J, Tyson E (2009) Academy for eating disorders position paper: eating disorders are serious mental illnesses. Int J Eat Disord 42(2):97–103. doi: 10.1002/eat.20589 CrossRefPubMedGoogle Scholar
  42. 42.
    Vrabel KR, Rø Ø, Martinsen EW, Hoffart A, Rosenvinge JH (2010) Five-year prospective study of personality disorders in adults with longstanding eating disorders. Int J Eat Disord 43(1):22–28. doi: 10.1002/eat.20662 CrossRefPubMedGoogle Scholar
  43. 43.
    Claes L, Vandereycken W, Vertommen H (2004) Personality traits in eating-disordered patients with and without self-injurious behaviors. J Pers Disord 18(4):399–404. doi: 10.1521/pedi.2004.18.4.399 CrossRefPubMedGoogle Scholar
  44. 44.
    Levy KN, Meehan KB, Kelly KM, Reynoso JS, Weber M, Clarkin JF et al (2006) Change in attachment patterns and reflective function in a randomized control trial of transference-focused psychotherapy for borderline personality disorder. J Consult Clin Psychol 74(6):1027–1040. doi: 10.1037/0022-006X.74.6.1027 CrossRefPubMedGoogle Scholar
  45. 45.
    Rossouw TI, Fonagy P (2012) Mentalization-based treatment for self-harm in adolescents: a randomized controlledtrial. J Am Acad Child Adol Psychiatry 51(12):1304–1313. doi: 10.1016/j.jaac.2012.09.018 CrossRefGoogle Scholar
  46. 46.
    Karatzias T, Chouliara Z, Power K, Collin P, Yellowlees A, Grierson D (2010) General psychopathology in anorexia nervosa: the role of psychosocial factors. Clin Psychol Psychother 17(6):519–527. doi: 10.1002/cpp.701 CrossRefPubMedGoogle Scholar
  47. 47.
    Mikulincer M, Shaver PR (2007) Attachment bases of psychopathology. Attachment in adulthood: structure, dynamics and change. The Guilford Press, New York, pp 369–404Google Scholar
  48. 48.
    Bekker MH, Croon MA, van Belkom EG, Vermee JB (2008) Predicting individual differences in autonomy-connectedness: the role of body awareness, alexithymia, and assertiveness. J Clin Psychol 64(6):747–765. doi: 10.1002/jclp.20486 CrossRefPubMedGoogle Scholar
  49. 49.
    Brandt-Dominicus J (2006) Multidisciplinaire Richtlijn Eetstoornissen: richtlijn voor de diagnostiek en behandeling van eetstoornissen [multidisciplinary guidelines for eating disorders: guidelines for diagnosis and treatment of eating disorders]. Trimbos Instituut, UtrechtGoogle Scholar
  50. 50.
    Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G* power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Method 39(2):175–191. doi: 10.3758/BF03193146 CrossRefGoogle Scholar
  51. 51.
    Fassino S, Pièro A, Tomba E, Abbate-Daga G (2009) Factors associated with dropout from treatment for eating disorders: a comprehensive review. BMC Psychiatry 9:67. doi: 10.1186/1471-244X-9-67 CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Van Strien T (2002) Eating disorder inventory II. Nederlandse versie [EDI-II NL]. Lisse, Netherlands: Swets & ZeitlingerGoogle Scholar
  53. 53.
    Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E et al (1998) The mini-international neuropsychiatric interview [MINI]: the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 20:22–33Google Scholar
  54. 54.
    First MB, Spitzer RL, Gibbon M, Williams JBW (1996) Structured clinical interview for DSM-IV axis I disorders, clinician version [SCID—CV]. American Psychiatric Press, Washington, DCGoogle Scholar
  55. 55.
    First M, Gibbon M, Spitzer R, Williams J, Benjamin L (1997) Structured clinical interview for DSM-IV Axis II personality disorders [SCID-II]. American Psychiatric Press, Washington, DCGoogle Scholar
  56. 56.
    George C, Kaplan N, Main M (1996) Adult attachment interview 3. University of California at Berkeley, Berkeley, CAGoogle Scholar
  57. 57.
    Van IJzendoorn MH, Bakermans-Kranenburg MJ, Schuengel C, Juffer F (1999) Gehechtheidsbiografisch interview (adult attachment interview). University of Leiden, Leiden, The NetherlandsGoogle Scholar
  58. 58.
    Garner DM (1991) Eating disorder inventory-2. Psychological Assessment Resources, OdessaGoogle Scholar
  59. 59.
    Spielberger CD (1983) Manual for the state trait anxiety inventory [STAI]. Consulting Psychologists Press, Palo AltoGoogle Scholar
  60. 60.
    Van der Ploeg H, Defares P, Spielberger C (1979) Zelfbeoordelingsvragenslijst [state trait anxiety inventory] lisse. Swets and Zeitlinger BV, The NetherlandsGoogle Scholar
  61. 61.
    Derogatis LR (1977) SCL-90-: administration, scoring, and procedures manual. Clinical Psychometrics Research, BaltimoreGoogle Scholar
  62. 62.
    Arrindell W, Ettema J (1986) SCL-90: Handleiding bij een multidimensionele psychopathologie-indicator [manual for a multidimensional psychopathology indicator]. Swets & Zeitlinger, LisseGoogle Scholar
  63. 63.
    Bekker MHJ (2015) Autonomie-gehechtheidsschaal 30 [AGS-30]: handleiding. [Autonomy connectedness scale 30: scale and manual]. Houten, Netherlands: Bohn, Stafleu Van LoghumGoogle Scholar
  64. 64.
    Claes L, Vandereycken W (2007) The self-injury questionnaire-treatment related: construction, reliability and validity in a sample of female eating disorder patients. In: Goldfarb PM (ed) Psychological tests and testing research trends. Nova Science Publishers, New York, pp 111–139Google Scholar
  65. 65.
    Main M, Goldwyn R, Hesse E (2002) Adult attachment scoring and classification systems. Unpublished manuscript. University of California at BerkeleyGoogle Scholar
  66. 66.
    Van Hoof M-J, Lang ND, Speekenbrink S, Ijzendoorn MH, Vermeiren RR (2015) Adult attachment interview differentiates adolescents with childhood sexual abuse from those with clinical depression and non-clinical controls. Attach Hum Dev 17(4):354–375. doi: 10.1080/14616734.2015.1050420 CrossRefPubMedGoogle Scholar
  67. 67.
    IBM/SPSS (2010) IBM SPSS statistics for windows, version 19.0 [computer software]. Armonk, NY: AuthorGoogle Scholar
  68. 68.
    Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Series B (Methodol) 57:289–300Google Scholar
  69. 69.
    Benjamini Y, Yekutieli D (2001) The control of the false discovery rate in multiple testing under dependency. Ann Stat 29:1165–1188. doi: 10.1214/aos/1013699998 CrossRefGoogle Scholar
  70. 70.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, HillsdaleGoogle Scholar
  71. 71.
    Fittig E, Jacobi C, Backmund H, Gerlinghoff M, Wittchen H-U (2008) Effectiveness of day hospital treatment for anorexia nervosa and bulimia nervosa. Eur Eat Disord Rev 16(5):341–351. doi: 10.1002/erv.883 CrossRefPubMedGoogle Scholar
  72. 72.
    Ravitz P, Maunder R, Hunter J, Sthankiya B, Lancee W (2010) Adult attachment measures: a 25-year review. J Psychosom Res 69(4):419–432. doi: 10.1016/j.psychores.2009.08.006 CrossRefPubMedGoogle Scholar
  73. 73.
    Luyten P, Fonagy P, Lowyck B, Vermote R (2012) The assessment of mentalization. In: Bateman AW, Fonagy P (eds) Handbook of mentalizing in mental health practice. American Psychiatric Publishing, Washington, DC, pp 43–65Google Scholar
  74. 74.
    Robinson P, Hellier J, Barrett B, Barzdaitiene D, Bateman A, Boogaardt A et al (2016) The NOURISHED randomised controlled trial comparing mentalisation-based treatment for eating disorders (MBT-ED) with specialist supportive clinical management (SSCM-ED) for patients with eating disorders and symptoms of borderline personality disorder. Trials 17:549. doi: 10.1186/s13063-016-1606-8 CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Balestrieri M, Zuanon S, Pellizzari J, Zappoli-Thyrion E, Ciano R, ResT-MBT (2015) Mentalization in eating disorders: a preliminary trial comparing mentalization-based treatment (MBT) with a psychodynamic-oriented treatment. Eat Weight Disord 20(4):525–528. doi: 10.1007/s40519-015-0204-1 CrossRefPubMedGoogle Scholar
  76. 76.
    Kezelman S, Touyz S, Hunt C, Rhodes P (2015) Does anxiety improve during weight restoration in anorexia nervosa? A systematic review. J Eat Disord 3(1):7. doi: 10.1186/s40337-015-0046-2 CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Eckert ED, Goldberg SC, Halmi KA, Casper RC, Davis JM (1982) Depression in anorexia nervosa. Psychol Med 12(01):115–122. doi: 10.1017/S003329170004335X CrossRefPubMedGoogle Scholar
  78. 78.
    Keel PK, Brown TA (2010) Update on course and outcome in eating disorders. Int J Eat Disord 43(3):195–204. doi: 10.1002/eat.20810 CrossRefGoogle Scholar
  79. 79.
    Fichter MM, Quadflieg N, Hedlund S (2006) Twelve-year course and outcome predictors of anorexia nervosa. Int J Eat Disord 39(2):87–100. doi: 10.1002/eat.20215 CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Bekker M (1993) The development of an Autonomy scale based on recent insight into gender identity. Eur J Pers 7:177–194. doi: 10.1002/per.2410070304 CrossRefGoogle Scholar
  81. 81.
    Hartmann A, Zeeck A, Barrett MS (2010) Interpersonal problems in eating disorders. Int J Eat Disord 43(7):619–627. doi: 10.1002/eat.20747 CrossRefPubMedGoogle Scholar
  82. 82.
    Gander M, Sevecke K, Buchheim A (2015) Eating disorders in adolescence: attachment issues from a developmental perspective. Front Psychol 6:1136. doi: 10.3389/fpsyg.2015.01136 CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Skårderud F, Fonagy P (2012) Eating disorders. In: Bateman AW, Fonagy P (eds) Handbook of mentalizing in mental health practice. American Psychiatric Publishing, Washington, DC, pp 347–383Google Scholar
  84. 84.
    Pace CS, Cavanna D, Guiducci V, Bizzi F (2015) When parenting fails: alexithymia and attachment states of mind in mothers of female patients with eating disorders. Front Psychol 6:1145. doi: 10.3389/fpsyg.2015.01145 CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    Steele H, Steele M, Fonagy P (1996) Associations among attachment classifications of mothers, fathers, and their infants. Child Dev 67:541–555. doi: 10.2037/1131831 CrossRefPubMedGoogle Scholar
  86. 86.
    de la Rie S (2008) Eating disorders and treatment from different perspectives: Erasmus University Rotterdam, The NetherlandsGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Unit for Eating DisordersGGZ BreburgTilburgThe Netherlands
  2. 2.Den Hollander Van den BroekVughtThe Netherlands
  3. 3.Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
  4. 4.Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands

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