EMOTIONAL DYSREGULATION AND ATTACHMENT DIMENSIONS IN FEMALE PATIENTS WITH BULIMIA NERVOSA
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BACKGROUND: The aim of this study was to examine whether there is a difference in the dimensions of attachment and difference in emotional regulation between the group of female patients suffering from bulimia nervosa (BN) and the control group. We also wanted to examine whether emotional regulation has a mediating role in the relationship between dimensions of attachment and severity of BN symptoms. SUBJECTS AND METHODS: The study included a total of 100 female participants from 15 to 25 years of age (M=20.40, SD=3.26). The clinical group consisted of 50 patients suffering from BN, and the control group consisted of 50 healthy female subjects. RESULTS: =7.41, p=0.00) emotional dysregulation than participants of the control group. We also found that the mediation effect of emotional regulation on the association between anxiety and BN symptoms was statistically significant (z'=4.43, p=0.00). CONCLUSIONS: Patients suffering from BN showed significantly higher levels of attachment related anxiety and avoidance as well as significantly higher level of difficulties in emotional regulation than healthy controls. Attachment anxiety proved to be a significant predictor of symptoms BN, suggesting that the attachment related anxiety is stronger correlate of BN symptoms than avoidance, and may represent a risk factor for more severe BN symptoms. It was also found that the relationship between attachment related anxiety and BN symptoms were mediated by emotional regulation.
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When a child's sense of attachment becomes chronically disorganized, lifelong problems with relationships, the core sense of self or identity, suicidality, and addictions may develop.
“When a child’s sense of attachment becomes chronically disorganized, lifelong problems with relationships, the core sense of self or identity, suicidality, and addictions may develop [80, 104, 114, 164, 167].”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [80]
Empirical evidence shows that the core features of cPTSD are distinct clinically and conceptually from PTSD.
“empirical evidence showing that the core features of cPTSD are distinct clinically and conceptually from PTSD has resulted in a revised formulation of cPTSD [18, 20, 80]”
From Complex PTSD and borderline personality disorder (2021) · cites this paper as [80]
Cites
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.51.6.1173 · Cited by 91,542 · see citing works
(1969) · Cited by 18,340 · see citing works
Gratz, K. L., & Roemer, L. (2004) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/b:joba.0000007455.08539.94 · Cited by 8,942 · cited 4× · see citing works
“00 Primary school 2 (4) 0 (0) High school 32 (64) 28 (56) Tertiary vocational school 8 (16) 2 (4) University 8 (16) 20 (40)”
MethodInfluentialAttachment styles among young adults: A test of a four-category model.
Bartholomew, K., & Horowitz, L. M. (1991) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.61.2.226 · Cited by 7,729 · see citing works
Romantic love conceptualized as an attachment process.
Hazan, C., & Shaver, P. (1987) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.52.3.511 · Cited by 6,247 · cited 1× · see citing works
“Originally, attachment was conceptualized in categorical terms of three categories: secure, anxious and avoidant (Hazan & Shaver 1987), with avoidant later being divided into two categories (Bartholomew & Horowitz 1991).”
BackgroundThe prevalence and correlates of eating disorders in the National Comorbidity Survey Replication
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.03.040 · Cited by 4,973 · see citing works
An Item-Response Theory Analysis of Self-Report Measures of Adult Attachment
Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.78.2.350 · Cited by 3,385 · see citing works
The SCOFF questionnaire: Assessment of a new screening tool for eating disorders
Morgan, J. F., Reid, F., & Lacey, J. H. (1999) · BMJ · doi:10.1136/bmj.319.7223.1467 · Cited by 1,416 · see citing works
Attachment-related psychodynamics
Shaver, P. R., & Mikulincer, M. (2002) · Attachment & Human Development · doi:10.1080/14616730210154171 · Cited by 1,294 · see citing works
Personality and eating disorders: A decade in review
Cassin, S. E., & von Ranson, K. M. (2005) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.04.012 · Cited by 832 · see citing works
Gratz, K. L., & Roemer, L. (2008) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-008-9102-4 · Cited by 700 · see citing works
The accuracy of self-reported weights
Stunkard, A. J., & Albaum, J. (1981) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/34.8.1593 · Cited by 624 · see citing works
Harrison, A., Sullivan, S. A., Tchanturia, K., & Treasure, J. L. (2010) · Psychological Medicine · doi:10.1017/s0033291710000036 · Cited by 472 · see citing works
Svaldi, J., Griepenstroh, J., Tuschen-Caffier, B., & Ehring, T. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2011.11.009 · Cited by 408 · see citing works
Body Image in an Interpersonal Context: Adult Attachment, Fear of Intimacy and Social Anxiety
Cash, T. F., Thériault, J., & Annis, N. M. (2004) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.23.1.89.26987 · Cited by 356 · see citing works
Anorexia nervosa as a disorder of emotion dysregulation: Evidence and treatment implications.
Haynos, A. F., & Fruzzetti, A. E. (2011) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2011.01250.x · Cited by 314 · see citing works
Sibley, C. G., & Liu, J. H. (2004) · Personality and Individual Differences · doi:10.1016/s0191-8869(03)00165-x · Cited by 285 · see citing works
Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Smith, T. L., Klein, M. H., Mitchell, J. E., & Crow, S. J. (2014) · Psychological Medicine · doi:10.1017/s0033291713001098 · Cited by 270 · see citing works
Emotion avoidance in patients with anorexia nervosa: Initial test of a functional model
Wildes, J. E., Ringham, R. M., & Marcus, M. D. (2009) · International Journal of Eating Disorders · doi:10.1002/eat.20730 · Cited by 240 · see citing works
Attachment and eating disorders: A review of current research
Tasca, G. A., & Balfour, L. (2014) · International Journal of Eating Disorders · doi:10.1002/eat.22302 · Cited by 227 · see citing works
Affect, Attachment, Memory: Contributions Toward Psychobiologic Integration
Amini, F., Thomas, L., Lannon, R. A., Louie, A. K., Baumbacher, G., Teresa, M., & Schiff, E. Z. (1996) · Psychiatry · doi:10.1080/00332747.1996.11024764 · Cited by 202 · see citing works
Tasca, G. A., Szadkowski, L., Illing, V., Trinneer, A., Grenon, R., Demidenko, N., Krysanski, V. L., Balfour, L., & Bissada, H. (2009) · Personality and Individual Differences · doi:10.1016/j.paid.2009.06.006 · Cited by 189 · see citing works
Feelings of insecurity: Review of attachment and eating disorders
Zachrisson, H. D., & Skårderud, F. (2010) · European Eating Disorders Review · doi:10.1002/erv.999 · Cited by 161 · see citing works
Illing, V., Tasca, G. A., Balfour, L., & Bissada, H. (2010) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181ef34b2 · Cited by 139 · see citing works
Racine, S. E., & Wildes, J. E. (2013) · International Journal of Eating Disorders · doi:10.1002/eat.22145 · Cited by 127 · see citing works
Clinical Features and Physiological Response to a Test Meal in Purging Disorder and Bulimia Nervosa
Keel, P. K., Wolfe, B. E., Liddle, R. A., Young, K. P. D., & Jimerson, D. C. (2007) · Archives of General Psychiatry · doi:10.1001/archpsyc.64.9.1058 · Cited by 104 · see citing works
Dimensions of Emotion Dysregulation in Bulimia Nervosa
Lavender, J. M., Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Engel, S. G., Mitchell, J. E., Crow, S. J., Smith, T. L., Klein, M. H., Goldschmidt, A. B., et al. (2014) · European Eating Disorders Review · doi:10.1002/erv.2288 · Cited by 103 · see citing works
A Meta-Analysis of the Diagnostic Accuracy of the SCOFF
Botella, J., Sepúlveda, A. R., Huang, H., & Gambara, H. (2013) · The Spanish Journal of Psychology · doi:10.1017/sjp.2013.92 · Cited by 83 · see citing works
Recent research of relationships among eating disorders and personality disorders
Grilo, C. M. (2002) · Current Psychiatry Reports · doi:10.1007/s11920-002-0007-8 · Cited by 70 · see citing works
Personality disorders in 545 patients with eating disorders
Godt, K. D. (2007) · European Eating Disorders Review · doi:10.1002/erv.844 · Cited by 63 · see citing works
Coates, T. J., Jeffery, R. W., & Wing, R. R. (1978) · Addictive Behaviors · doi:10.1016/0306-4603(78)90016-3 · Cited by 62 · see citing works
Personality and psychopathological traits of males with an eating disorder
Fernández‐Aranda, F., Aitken, A., Badia, A. M. T. I., Giménez, L., Solano, R., Collier, D. A., Treasure, J. L., & Vallejo, J. (2004) · European Eating Disorders Review · doi:10.1002/erv.603 · Cited by 58 · see citing works
Evans, L., & Wertheim, E. H. (2005) · European Eating Disorders Review · doi:10.1002/erv.621 · Cited by 45 · see citing works
Esbjørn, B. H., Breinholst, S., Niclasen, J., Skovgaard, L. F., Lange, K., & Reinholdt‐Dunne, M. L. (2015) · PLoS ONE · doi:10.1371/journal.pone.0137218 · Cited by 9 · see citing works
Race, Social Class, and Bulimia NervosaPreprint
Ham, J. C., Iorio, D., & Sovinsky, M. (n.d.) · RePEc: Research Papers in Economics · Cited by 7 · see citing works
ADULT ATTACHMENT, BULIMIA NERVOSA AND RELATIONSHIP SATISFACTION
Iickman, K. (1998) · Cited by 1 · see citing works
Sernec, K., Mrevlje, G. V., Čarapič, J., Weber, U., & Zalar, B. (2015) · PubMed · Cited by 1 · see citing works
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Prefit, A.-B., Cândea, D. M., & Szentagotai-Tătar, A. (2019) · Appetite · doi:10.1016/j.appet.2019.104438 · Cited by 341 · see citing works
Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review
Paulus, F. W., Ohmann, S., Möhler, E., Plener, P. L., & Popow, C. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.628252 · Cited by 335 · see citing works
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Ford, J. D., & Courtois, C. A. (2021) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-021-00155-9 · Cited by 209 · see citing works
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Cortés‐García, L., Takkouche, B., Seoane, G., & Senra, C. (2019) · PLoS ONE · doi:10.1371/journal.pone.0213099 · Cited by 58 · see citing works
Costanzo, G., Marchetti, D., Manna, G., Verrocchio, M. C., & Falgares, G. (2022) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-022-01417-3 · Cited by 14 · see citing works
Han, G., Wang, C. D. C., Jin, L., & Bismar, D. (2022) · International Journal for the Advancement of Counselling · doi:10.1007/s10447-021-09462-w · Cited by 13 · see citing works
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Ortiz, G. G. R., Tapia, C. J. R., Martínez, B. A. E., & Icaza, D. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.908926 · Cited by 10 · see citing works
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Pineda-García, G., Serrano‐Medina, A., Ochoa-Ruiz, E., & Martínez, A. L. (2021) · Healthcare · doi:10.3390/healthcare9111435 · Cited by 5 · see citing works
Azzi, R., Samaha, S., Malaeb, D. N., Akel, M., Azzi, V., Hallit, S. R., & Obeïd, S. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04847-0 · Cited by 3 · see citing works
Cortés‐García, L., Calvo, C. M., & Senra, C. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.852977 · Cited by 3 · see citing works
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Psiholozi na Klinici za psihijatriju i psihološku medicinu Kliničkog bolničkog centra Zagreb
Klinika za psihijatriju i psihološku medicinu, K. B. C. Z., Akrap, L., Jakšić, N., Klinika za psihijatriju i psihološku medicinu, K. B. C. Z., Franc, A. C., Klinika za psihijatriju i psihološku medicinu, K. B. C. Z., Oelsner, K., Klinika za psihijatriju i psihološku medicinu, K. B. C. Z., Jakovina, T., Klinika za psihijatriju i psihološku medicinu, K. B. C. Z., et al. (2022) · Socijalna psihijatrija · doi:10.24869/spsih.2022.200
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Friederich, H., Zipfel, S., & Wild, B. (2024) · Springer eBooks · doi:10.1007/978-3-031-46096-8_66
Štrosar, I., Rudan, V., Kušević, Z., Majić, G., Ćavar, Z., Jakovina, T., & Antić, M. (2024) · Psychiatria Danubina · doi:10.24869/psyd.2024.359
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(2025) · IGI Global eBooks · doi:10.4018/979-8-3373-0664-3.ch002
(2025) · IGI Global eBooks · doi:10.4018/979-8-3373-0664-3.ch015
Jakovina, T., Begovac, I., Batista, M., Jakovina, I. Ž., & von Wietersheim, J. (2026) · Psychiatria Danubina · doi:10.24869/psyd.2026.23
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- Authors
- Department of Psychological Medicine, U. H. C. Z., Jakovina, T., Crnkovic Batista, M., Department of Pediatrics, C. H. C. S. M., Razic Pavicic, A., Department of Psychological Medicine, U. H. C. Z., School of Medicine, U. O. Z., Zuric Jakovina, I., Faculty of Humanities and Social Sciences, U. O. R., Begovac, I., Department of Psychological Medicine, U. H. C. Z., & School of Medicine, U. O. Z.
- Affiliations
- University Hospital Centre Zagreb (HR)
- Corresponding author
- Jakovina, Trpimir
- Venue
- Psychiatria Danubina
- Publisher
- Medicinska Naklada d.o.o.
- Published
- 2018-03-15
- Volume
- 30
- Issue
- 1
- Pages
- 72-78
- ISSN
- 0353-5053 (ISSN-L)
- OpenAlex
- W2792085354
- Cited by
- 19
- References
- 37
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 3 · 2019: 2
- FWCI
- 1.47
- Type
- journal article
- Language
- en
- Open access
- green
- hrcak.srce.hr
- Licence
- other-oa
- Locations
- Psychiatria Danubina (publishedVersion)
- PubMed (publishedVersion)
- University of Zagreb University Computing Centre (SRCE) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Keywords
- bulimia nervosa, emotional dysregulation, attachment, attachment anxiety, attachment avoidance, female patients, mediation, young women
- MeSH terms
- Adolescent, Adult, Affective Symptoms, Anxiety Disorders, Female, Humans, Psychometrics, Surveys and Questionnaires, Reference Values, Croatia, Reactive Attachment Disorder, Bulimia Nervosa, Young Adult
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