Discussion of “Eating Disorders and Attachment: A Contemporary Psychodynamic Perspective:” Does the Attachment Model of Eating Disorders Indicate the Need for Psychodynamic Treatment?

Tasca and Balfour have done admirable work highlighting the importance of attachment security in the psychopathology of eating disorders (EDs), and their contributions are extremely valuable. For their points to be fully appreciated by the research and treatment-research communities, additional data are needed in key areas. Research is needed to help clarify the relative roles and cause-and-effect relationships between attachment insecurity, reflective functioning, and emotion regulation in the development and maintenance of EDs. Tasca and Balfour furthermore call their model “psychodynamic,” and call for psychodynamically informed treatment for patients with attachment insecurity. For this call to be heeded, additional research is needed to examine whether the unique elements of psychodynamic psychotherapy have particular benefit for patients with insecure attachment styles. The unique psychodynamic elements considered in this comment include a therapeutic focus on reflective functioning, the patient's developmental history, the “unconscious,” and the transference and countertransference. The utility of a non-directive (or patient-directed) therapeutic process is also considered. Investigation of these treatment issues could be extremely useful to practitioners and patients alike.