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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

Abstract

Purpose

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.

Method

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.

Results

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.

Conclusion

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.

Keywords

Attachment Mentalization Recovery AAI Autonomy Eating disorders 

Notes

Acknowledgements

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).

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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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