Relation between increasing attachment security and weight gain: a clinical study of adolescents and their parents at an outpatient ward
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1.
Falun Hospital
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2.
Karolinska Institute
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3.
California Institute of Technology
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4.
Umeå University
Abstract
Purpose: We wanted to evaluate the impact of a relational focus in the treatment of adolescent ED-patients and their parents at an intensive outpatient ward, based on attachment theory, combined with a family approach and psychodynamic principles. Our aim was to investigate the distribution of different attachment styles among the adolescent ED-patients and their parents, and to find out if they could change by the treatment.
Methods: Swedish adolescents (n = 33; 3 boys, 30 girls) and their parents (n = 60; 34 mothers, 26 fathers) participated. Measures: Attachment Style Questionnaire (ASQ), Body Mass Index (BMI) and Children's Global Assessment Scale (CGAS) before and after treatment.
Results: The adolescents were high on Need for Approval (ASQ4) of the Insecure/Anxious scale before treatment (in contrast to the parents). The patients had a significant decrease in ASQ4 after treatment, which correlated inversely to the increase in BMI but not to CGAS. The mothers showed features of the Secure/Confident style, fathers of the Insecure/Avoidant with elevated Relationships as Secondary (ASQ2).
Conclusions: Treatment with a relational and a family focus has impact on attachment insecurity in adolescent ED-patients and outcomes in terms of BMI. It is important to engage the parents, who need to help the adolescents to separate at that developmental stage. A secure therapeutic context, which enables mentalizations and allows new relational experiences, is essential. The ASQ-instrument is useful in indicating how the treatment of ED-adolescents is proceeding.
Level of evidence: Level IV: evidence obtained from multiple time series with the intervention.
Copyright and License
© The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Acknowledgement
We are grateful to all patients and parents participating in the study. The authors wish to thank the staff, especially Lars Carlsson for his work with the database, and Kerstin Pennonen, head, and an important facilitator at the ward. Thanks to Oscar Gezelius for the graphics.
Funding
Open access funding provided by Umea University. This study was done in cooperation with the Department of Psychology, Umeå University. Open Access funding enabled by BIBSAM and its Member Institutions and the Olaison Fund at the Center of Clinical Research Dalarna, Falun.
Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CMEG, BAW and BMW. The first draft of the manuscript was written by CMEG. All authors commented and worked through the previous versions of the manuscript, read, discussed, and accepted the final manuscript.
Data Availability
The data sets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Conflict of Interest
The authors declare no competing interests.
Ethics
This study was done in compliance with ethical standards in accordance with the Declaration of Helsinki and was approved by the Central Research Ethical Vetting Board in Stockholm, Sweden (Archive number: Ö 16-2010).
We confirm that consent to publish has been received from all participants, both ED-patients and their parents.
Informed consent to participate in this research study was obtained from all individual adolescent ED-patients and parents included in the study. The parents signed on behalf of underage children. We gave assurance that refusal to participate in the study would not compromise the patient's treatment in any way. No incentives were given.
Files
40519_2023_Article_1611.pdf
Additional details
Identifiers
- PMCID
- PMC10564661
Funding
- Umea University