Terror of Desire: The Etiology of Eating Disorders from an Attachment Theory Perspective

A variety of social, emotional and physical factors have been suggested as contributing to or causing the development of eating disorders. Cultural pressures, family dysfunction, sexual abuse, genetics, and chemical imbalance have all been offered as possibilities. There is one comprehensive theory, which has been given little attention in the literature of eating disorders,1 which seems to me to provide a useful framework for illuminating how each of these factors contributes to these painful and potentially dangerous disorders. Each of these factors can be understood as a form or effect of attachment disruption or disturbance. In my own experience of sixteen years treating eating disorders, this perspective has greatly enhanced my ability to take an effective therapeutic stance with these challenging patients.

Attachment theory is the name given to the body of work that describes the process of bonding between mother and infant, and the consequences, primarily to the infant, of the disruption of that bond. It describes the patterns of human behavior “that serve to assure those physical and psychological intermeshings of individuals that enhance survival” (Stern, 1985, p. 137). The work of John Bowlby is the cornerstone of attachment