Pathways between insecure attachment and eating disorder symptoms: a network analysis study exploring the roles of early maladaptive schemas and emotion dysregulation

Abstract

This study aimed to investigate the interrelationships between insecure attachment, early maladaptive schemas (EMS), emotion dysregulation, and eating disorder (ED) symptoms. Our primary aim was to explore how attachment anxiety and attachment avoidance were positioned in relation to ED symptoms in a broader network of cognitive and affective processes. The study sample included 760 participants (81.7% female), consisting of 120 participants with lifetime ED diagnosis and 640 controls. Participants completed several self-report measures assessing attachment, EMS, emotion dysregulation, and ED symptomatology. An undirected network model was estimated for the full sample. Attachment anxiety was most closely associated with EMS nodes, particularly schemas in the disconnection/rejection domain. In contrast, attachment avoidance showed stronger associations with emotion-dysregulation nodes, especially lack of emotional awareness and lack of emotional clarity. ED symptoms were most strongly connected with emotion dysregulation, including associations between eating concerns and non-acceptance of emotional responses, and between objective binge eating and impulse-control difficulties. Findings suggest that disconnection/rejection schemas and emotion dysregulation may be important features in the association between insecure attachment and ED symptoms. Future longitudinal, experimental studies are needed to test the directionality and clinical significance of these associations.