Understanding Eating Disorders and Difficulties Through Attachment
When we think about eating disorders, our minds often jump to images of thinness portrayed in the media, or to ideas of control, perfectionism, and body dissatisfaction. While these elements play a role, they’re only part of the picture. What lies beneath the surface is often a far more complex emotional landscape and our earliest relationships in life.
In their 2006 paper published in the European Eating Disorders Review, Dr. Ringer and Dr. Crittenden explore this deeper dimension through the lens of attachment theory. Their research, “Eating Disorders and Attachment: The Effects of Hidden Family Processes on Eating Disorders,” offers a powerful reminder: eating disorders are rarely just about food, they’re often about relationships, safety, and the ways we learn (or don’t learn) to express emotion.
Attachment Patterns and Emotional Survival
Ringer and Crittenden’s work is grounded in the Dynamic-Maturational Model (DMM) (2025) of attachment - a framework that emphasises how individuals adapt their behaviour to stay emotionally safe in their caregiving environments. According to the DMM, children develop strategies to manage their needs depending on the consistency, availability, and emotional responsiveness of their caregivers.
For example, in families where emotional needs are ignored, minimised, or met with hostility, children may learn to suppress their emotions entirely (an avoidant strategy). In more chaotic or unpredictable environments, they may develop hypervigilant, anxious patterns of seeking approval and control (an ambivalent strategy). These strategies are designed to help the child survive emotionally in their family system, but over time, they can evolve into rigid, maladaptive coping mechanisms.
The Role of Hidden Family Processes
What makes these dynamics so difficult to address is that they’re often ‘hidden’. Families may appear outwardly functional, even loving, while emotional communication beneath the surface remains confusing, inconsistent, or unsafe. Parents may be unaware of the subtle messages they send about emotional expression, bodily control, or worth. Over time, these hidden messages can become internalised in harmful ways.
For many individuals with eating disorders, food and body become the battlegrounds where unresolved emotional tensions play out. Restriction, bingeing, purging, or obsessive behaviours often serve as ways to manage feelings of chaos, emptiness, or powerlessness that stem from early relational wounds.
Why This Matters for Treatment
Understanding the attachment-based roots of eating disorders has significant implications for treatment. Rather than focusing solely on behaviours or body image, therapists explore the emotional and relational context of the disorder. What feelings are being managed through food? What family patterns may have shaped the person’s sense of identity, worth, or emotional safety?
Recovery, from this perspective, involves bringing into awareness unconscious thinking patterns and belief systems, so that one can learn how to feel differently. It may mean developing new ways of relating to others, building secure attachments, and making sense of past experiences that were too confusing or painful to process at the time.
Moving Toward Healing
One of the most powerful messages in Ringer and Crittenden’s work is this: eating disorders are not simply personal failings or isolated psychological issues, but are often survival strategies born in environments where emotional needs were misunderstood or unmet. Recognising this opens the door to a more compassionate, trauma-informed approach to care.
Healing takes time. It involves both the body and the heart. And most importantly, it often begins with feeling truly seen, heard, and understood, perhaps for the first time.
References
Ringer, F., & Crittenden, P. M. (2006). Eating disorders and attachment: The effects of hidden family processes on eating disorders. European Eating Disorders Review, 15(2), 119–130. https://doi.org/10.1002/erv.770
Family Relations Institute. (n.d.). The DMM Model. Retrieved May 13, 2025, from https://familyrelationsinstitute.org/dmm-model/
