Attachment and mentalization and their association with child and adolescent eating pathology: A systematic review
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OBJECTIVE: Insecure attachment and mentalizing difficulties have been associated with eating pathology in adulthood. However, it is unclear whether eating pathology is associated with attachment or mentalization in children. The aim of this study is to systematically review the literature in this emerging field. METHOD: Electronic databases were used to search for articles. RESULTS: Twenty-two studies were identified. In the 15 studies investigating attachment, an association with eating pathology was found in all studies. Mentalizing difficulties and eating pathology were found to be correlated in the seven studies which examined their association. DISCUSSION: In keeping with the adult literature, cross-sectional studies of children and adolescents consistently report associations with eating pathology. There is some evidence from prospective studies that insecure attachment may be a risk factor for the development of eating pathology in adolescence. The literature on mentalization and eating pathology suggests that adolescents with anorexia nervosa may have difficulties in recognizing emotions. Further research using clinical samples and well-validated measures of attachment and mentalization are required to shed further light on this area.
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Failures in mentalizing contribute to explaining pathways to depression and anxiety.
“It turned out that failures in mentalizing contribute to explaining pathways to depression and anxiety.”
From Failures in Reflective Functioning and Reported Symptoms of Anxiety and Depression in Bereaved Individuals: A Study on a Sample of Family Caregivers of Palliative Care Patients (2022) · cites this paper as [15]
The Discussion reports limited evidence linking mentalizing difficulties with child and adolescent eating pathology, while Implications for theory describes mentalizing failures under affective arousal. Neither section says that those failures explain pathways to depression or anxiety; searches for those outcomes found no supporting passage in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredLuyten and colleagues argued that mentalizing impairment rooted in insecure attachment relationships and more generally in adverse early childhood experiences may lead to major depressive disorder.
“For example, Luyten and colleagues argued that mentalizing impairment rooted in insecure attachment relationships and more generally in adverse early childhood experiences may lead to major depressive disorder [15].”
From Failures in Reflective Functioning and Reported Symptoms of Anxiety and Depression in Bereaved Individuals: A Study on a Sample of Family Caregivers of Palliative Care Patients (2022) · cites this paper as [15]
The Mentalization and Implications for theory sections discuss how insecure or misattuned attachment relationships may relate to mentalizing difficulties, but in the context of eating pathology. Searches for Luyten, major depressive disorder, and adverse early childhood experiences found no passage attributing the claimed argument to Luyten or linking that pathway to major depressive disorder. Page numbers were not available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measured
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- Authors
- Jewell, T., Collyer, H., Gardner, T., Tchanturia, K., Simic, M., Fonagy, P., & Eisler, I.
- Affiliations
- King's College London (GB)
- University College London (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- Corresponding author
- Jewell, Tom
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2015-12-22
- Volume
- 49
- Issue
- 4
- Pages
- 354-373
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W2209362319
- Cited by
- 139
- References
- 125
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 17 · 2023: 15 · 2022: 14 · 2021: 13 · 2020: 12 · 2019: 18 · 2018: 15 · 2017: 9 · 2016: 4 · 2015: 3
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- green
- discovery.ucl.ac.uk
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0514-10157, CDRF-2014-05-024)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- insecure attachment, mentalization, eating pathology, eating disorders in children, adolescent eating disorders, anorexia nervosa, emotion recognition, eating disorder risk
- MeSH terms
- Adolescent, Adult, Feeding and Eating Disorders, Child, Cross-Sectional Studies, Emotions, Female, Humans, Male, Object Attachment, Prospective Studies, Risk Factors, Young Adult, Theory of Mind
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