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Insecure Attachment and Trauma in Obesity and Bariatric Surgery

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Psychiatric Care in Severe Obesity

Abstract

The purpose of this chapter is to discuss an aspect of the psychosocial context of obesity that transcends diagnostic categories and is especially relevant to the management of severely obese patients. In particular, we will describe the relational context of obesity and the importance of insecure attachment and interpersonal trauma. In doing so we will try to make the case that patient-centered care (and perhaps surgical outcomes) can be improved by attending to the consequences of trauma and to ways in which the treatment of obesity is influenced by feelings of interpersonal security or insecurity.

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Notes

  1. 1.

    Since fearful attachment among these primary care patients increased with ACE exposure, from 11 % in those with no exposure to ACE to 46 % in those exposed to four or more ACE categories (p<0.001), it is reasonable to wonder if insecure attachment could serve as a mediator between childhood adversity and subsequent obesity. Indeed, in this sample, we used PROCESS [29] to test the indirect effect of exposure to ACE on BMI, through insecure attachment and found a significant indirect effect through attachment avoidance (95 % confidence interval 0.13–0.75), and a nonsignificant effect through attachment anxiety (95 % confidence interval −0.25–0.21).

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Authors and Affiliations

  1. Division of Consultation-Liaison Psychiatry, Department of Psychiatry, Mount Sinai Hospital, University of Toronto, Room 1285-B, 600 University Ave., Toronto, ON, Canada, M5G 1X5

    R. G. Maunder & J. J. Hunter M.D., F.R.C.P.C.

  2. Institute of Medical Science, University of Toronto, Toronto, ON, Canada

    Tho Lan Le Ph.D. (Candidate)

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Correspondence to R. G. Maunder .

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Editors and Affiliations

  1. Toronto Western Hospital Bariatric Surgery Program, Centre for Mental Health, University Health Network, Toronto, Ontario, Canada

    Sanjeev Sockalingam

  2. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

    Raed Hawa

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Maunder, R.G., Hunter, J.J., Le, T.L. (2017). Insecure Attachment and Trauma in Obesity and Bariatric Surgery. In: Sockalingam, S., Hawa, R. (eds) Psychiatric Care in Severe Obesity. Springer, Cham. https://doi.org/10.1007/978-3-319-42536-8_4

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