"I'm Fat, and You Don't Love Me": How Early Attachment Insecurity May Cause Eating Disorders

Tuesday, June 14, 2016 by Meg   •   Filed under General

We've talked a lot on this blog about depression. Anxiety. Trauma. Social issues. Motherhood. Self Harm. It's about freaking time we got around to eating disorders. 

I'm not interested in telling you a bunch of stuff you already know, things you've already heard. It's easy to say, "These are the behaviors these conditions encompass, so stop doing that." And unfortunately, people who have no idea what the fuck they're talking about use phrases like this regularly.

But it ISN'T THE FOOD. Eating disorders are not about meals. They're usually about control. And those issues start young, sometimes before you've mastered the use of a knife and fork.   

Attachment has become a catch phrase used to describe an evolutionarily relevant parenting style. But this isn't about today's children. This is about the kids today's women used to be. Because early attachment plays a role in bodily dissatisfaction and eating disordered behavior.

What Eating Disorders Look Like 

Anorexia and Bulimia usually include some element of the following:

  • Negative or distorted body image 
  • Social withdrawal
  • Preoccupation with food/obsessive thoughts
  • Intense emotions, such as anger, anxiety or depression often coupled with periods of emotional lability or lack of emotional response
  • Trouble sleeping
  • Intense fear of gaining weight 
  • May exercise heavily
  • Menstrual irregularities
  • Irregular heartbeats 
  • Thin 
  • Often cold

While anorexia tends to involve avoiding food or starvation, bulimics eat heavily and then use laxatives or vomiting to purge what they've eaten. 

Binge eaters may also have the same distorted body image, food preoccupation and emotional issues. However, binge eaters use food as comfort but don't compensate by vomiting. Instead, they often eat quickly and alone to the point of physical discomfort.  

In all of these cases, deep shame punctuates eating experiences. 

This is not about ordinary, "Do these pants make me look fat," thinking. Eating disorders affect up to 24 million people nationwide, the majority of them women. Many speculate that the mechanisms involved in eating disorders are similar to those in self-harming behaviors (theories discussed in detail here). In those with eating disorders, preoccupation with food or eating takes over normal activities and ends up being used as a coping mechanism. 

It's not really about the food. It's about emotional control.

So where does that lack of control begin? 

Minimalist Guide to Insecure Attachment

Secure attachments in childhood are paramount for teaching kids how to handle their emotions. Born with immature nervous systems, infants rely on their parents to help them relax by holding them and responding to their needs consistently and appropriately. When left to their own devices, babies don't learn. While some may internalize (or hold in) emotions and seem calm, real control over those feelings may not be there. There is nothing more frightening to an infant than the lack of a caregiver. At any other time in our history, a child alone was a child dead. The innate drive towards togetherness--and stress at loneliness--is normal and expected.

To create insecurity, an infant needs to have caregivers who are consistently unavailable or who do not respond appropriately to their needs, such as not feeding them when they are hungry, not holding them when they are scared or not changing them when they are physically uncomfortable. Inconsistent caregiving, abuse, neglect or trauma can all trigger attachment insecurity as well. 

Caregiving doesn't have to be perfect. It just has to be good enough so that the child learns that their needs will be met, their emotions matter and that there will be someone there to help them when their feelings get too big and scary. Through this connection, they learn how to deal with emotions independently. 

But it's a little more than that, because insecure attachment can also trigger shame, according to Daniel Siegel, author of Mindsight because thinking, “I am bad” is safer to a child than, “My parents are unreliable and scary”. This is why shame and guilt are such prominent features in cases of early abuse or attachment insecurity. Shame allows children to avoid a fear that caregivers might be unreliable or dangerous. They are flawed but they are safe. And this safety in shame often remains throughout life until addressed. 

Insecure Attachment and Eating Disorders

Recent studies seem to indicate that those with early attachment issues or separation anxiety may be more at risk for eating disordered behavior. According to Roman research published in the "British Journal of Clinical Psychology," women who had current eating disorders reported higher rates of separation anxiety during childhood. This study also confirmed the results of earlier research that linked anorexia and bulimia to insecure attachment2. Additional studies have confirmed these links3

So, eating disordered behaviors are higher in those with early attachment problems and early separation anxiety issues.This could be because those with attachment problems tend to have higher levels of mental health issues overall, which could affect later body image and the eating disordered behaviors. That insecurity may also make people more sensitive to public shame and marketability factors, leading them to respond more strongly to slights to their reproductive "value" (attractiveness).  In other words, if I am highly sensitive to how attractive (or marketable) everyone else is, I might eat less if I think it will make me more attractive to potential partners, particularly if I already believe myself to be "less than" due to insecurity. 

Other research, presented in Darwinian Psychiatry, notes that too much weight loss--like that present in anorexia--may also serve an evolutionary purpose by delaying ovulation if the competition for partners is perceived to be high7. So, if my self worth is low enough that I don't believe I can compete, it is in my best interests to find a way to postpone reproduction--through stopping menstrual cycles--or to adapt a less attractive body type--such as extreme thinness--as opposed to settling for a less than ideal mate.  

But, additional research suggests that there might be another contributor related to attachment besides the higher rates of mental health issues, low self-worth or attractiveness insecurity. Early attachment experiences may promote the dumping of excessive stress hormones, a primitive response to prepare those in stressful situations for fight or flight. Because that much fight or flight is an evolutionarily unexpected situation, such high volumes of stress hormones may throw the whole body out of whack. 

Insecure Attachment and Increased Stress Responsiveness

Many prominent researchers, including Dr. Robert Sapolsky, believe that early stress responses, like those present in attachment issues, influence later hormonal regulation6. In Why Zebras Don't Get Ulcers Sapolsky explains that the amount of stress hormones produced in early life teaches the body how much it needs to produce later. If early environments are highly stressful, either from lack of attachment to caregivers or from other danger in the environment, infants' bodies produce larger amounts of stress hormones in order to respond appropriately for survival. 

This is great news if you will need a heightened stress response to constantly flee from tigers. Less so if you find yourself producing vast quantities of hormones that have no avenue for release because you never learned how to regulate emotional responses. It's a nasty soup of high discomfort and very little control. 

When faced with this, people try to control what they can. Some people engage in self-harm (discussed here). Some beat the dog. Sometimes, the thing they can control is food. In altering eating, individuals may find temporary relief from unwanted emotions. 

But it doesn't stop there. Because the very thing eating disordered individuals use for control may well be causing additional emotional problems when other systems get thrown out of balance as a result. This leads to a cycle that triggers more eating disordered behaviors when they cannot control these new emotions either. 


Malnourishment, Depression and the Endocrine System

Some early research argued that the depression and anxiety seen in eating disordered individuals was the result of the lack of nutrients, but recent research is disproving these ideas. While malnutrition can heighten depression, anxiety and obsessions, studies have also shown that symptoms of depression and other mental health disturbances remain even after weight restoration5. So, even after people are adequately nourished and at a healthy weight, they keep the depression. This indicates that the anxiety and depressive responses themselves are a part of the disease as opposed to the result of simple malnourishment. This would fit with Sapolsky's theories on stress regulation. 

So what happens when you stress an already overburdened system, prone to depression and anxiety, by heightening the stress with malnourishment? You may trigger issues with other systems, including the endocrine, which may make depression worse.

The endocrine system includes a series of glands that produce hormones. According to Harvard researchers, low androgen levels may contribute to higher rates of depression, anxiety and eating-disordered thought patterns4

Androgens are a class of hormones that are generally associated with male sexual development, but that also affect female sexuality and bone health. This study found that eating-disordered women with less testosterone had higher levels of anxiety and depression compared to their eating-disordered, but less depressed, counterparts. The more dysfunction, and the less resulting testosterone, the worse the depression. 

So, women with eating disorders have anxiety and depression at far higher rates than the general population, and a higher percentage of eating disordered women show this particular malfunction in the endocrine. Once the endocrine system starts to malfunction, it seems that additional depressive responses can take root. And if there's one thing that people struggling with emotional control need, it's additional emotions to deal with. The disordered eating steps in to control the emotions caused by a malfunctioing chemical system, which causes further deterioration in the system itself. 

But something is still missing. It makes sense that people are seeking to control out-of-control emotions or hormonal systems. Why the obsession with eating itself?

It is possible that the anxiety process triggers scary thought cycles (discussed here) and the type of thought is coincidental. Many women also learn to be dissatisfied with their bodies growing up, due to mothers who had a less than ideal self-image or because of early name-calling, which would certainly prime them for scary thoughts in this arena. It is also likely that societal misrepresentations of female beauty and shaming may make the obsessive thoughts about being fat or ugly more likely to occur in women, leading to the higher rates of these particular disorders among them. 

Obviously, it's more than obsessive thoughts, since most people who have scary thought patterns don't act on them. But with underlying issues in stress regulation, individuals may have more severe responses when they find themselves unable to deal with their emotions.

So, according to this particular model, the formula for creating an eating disorder might look like this:

  • Attachment insecurity
  • Inability to regulate emotions/lack of coping skills for stress responses
  • High levels of circulating stress hormones
  • Need to seek control
  • A particular type of scary thought/obsessive thought pattern that revolves around food and body image
  • Eating disordered behavior to control unwanted emotions
  • Additional depression once endocrine system gets bad enough, leading to more need for emotional control
  • Repeat steps 4-7

While these are not the only explanations (see related theories here), there is reason to suggest that a multi-faceted approach would be more useful than any one alone. From physical health and hormonal regulation, to cognitive techniques for disordered thoughts, to therapies to address attachment insecurities, there are may levels of balance in any human being. (Please see treatment avenues in relation to self-harm here, as treatment for eating disorders may follow a similar path.)  It is our complexity as humans that can make complete diagnosis difficult. But it also gives us a number of different avenues for attack. 

Related Posts: 

  1. http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/
  2. http://www.ncbi.nlm.nih.gov/pubmed/15826346
  3. http://www.ncbi.nlm.nih.gov/pubmed/16738078
  4. http://www.ncbi.nlm.nih.gov/pubmed/17592924
  5. http://www.ncbi.nlm.nih.gov/pubmed/9138049
  6. http://www.amazon.com/Zebras-Dont-Ulcers-Third-Edition/dp/0805073698
  7. http://www.amazon.com/Darwinian-Psychiatry-Michael-McGuire/dp/0195116739

Topic-Relevant Resources

Why Zebras Don't Get Ulcers
Primatologist/biologist Robert Sapolsky on stress and your brain. Good stuff.