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Early attachment quality moderateseating disorder risk among adolescentgirlsStephanie Milana & Jenna C. Ackera

a Department of Psychology, University of Connecticut, Storrs, CT,USAAccepted author version posted online: 24 Feb 2014.Publishedonline: 19 Mar 2014.

To cite this article: Stephanie Milan & Jenna C. Acker (2014) Early attachment qualitymoderates eating disorder risk among adolescent girls, Psychology & Health, 29:8, 896-914, DOI:10.1080/08870446.2014.896463

To link to this article: http://dx.doi.org/10.1080/08870446.2014.896463

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Early attachment quality moderates eating disorder risk amongadolescent girls

Stephanie Milan* and Jenna C. Acker

Department of Psychology, University of Connecticut, Storrs, CT, USA

(Received 17 June 2013; accepted 11 February 2014)

Objective: There is growing evidence that children’s early relational environ-ment has lasting implications for physical and mental health. In this paper, wetest whether attachment insecurity in early childhood is associated withincreased responsivity to risk factors for eating disorders (EDs; e.g. pubertalweight gain, maternal negative affect) during adolescence.Design: Hypotheses were tested with longitudinal data from 447 girls (finalmean age = 15.1 years) over a 12-year period. Tests of direct effects, modera-tion and moderated mediation were conducted using nested structural equationmodels and bootstrapped estimates of direct and indirect effects.Results: Early attachment quality was not directly associated with disorderedeating attitudes and behaviours (DEABs), but did moderate relations betweenadolescent ED risk factors and DEABs. Specifically, among girls with aninsecure attachment history, higher BMI at age 15 directly predicted moreDEABs, while maternal negative affect and pubertal weight gain indirectlypredicted DEABs via greater preoccupation with parental relationships. Thesesame direct and indirect paths did not emerge among adolescent girls with asecure attachment history.Conclusion: Results delineate one way early attachment quality may contributeto EDs among some adolescent girls, and support recent efforts to incorporaterelational components into obesity and ED prevention programmes.

Keywords: eating disorder; attachment; adolescence; BMI; obesity; NICHD

Eating disorders (EDs) are associated with numerous medical complications and mortal-ity, subsequent increases in comorbid mental health symptoms, and functional impair-ment (Stice & Bulik, 2008). Given these significant consequences, it is critical toreduce the prevalence and impact of EDs, particularly among adolescent girls andyoung women. To date, however, treatments for EDs have had only limited successbecause the majority of individuals with symptoms do not seek treatment (Hart,Granillo, Jorm, & Paxton, 2011), and those who do are more likely to drop out thanindividuals with other diagnoses (Swift & Greenberg, 2012). In light of poor treatmentoutcomes, there have been calls for better prevention efforts to reduce the number ofpeople who subsequently develop disorders (e.g. Tanofsky-Kraff, 2012). In order forprevention efforts to be empirically grounded, more longitudinal research on thedevelopmental roots of EDs is needed.

*Corresponding author. Email: Stephanie.milan@uconn.edu

© 2014 Taylor & Francis

Psychology & Health, 2014Vol. 29, No. 8, 896–914, http://dx.doi.org/10.1080/08870446.2014.896463

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The present study examines the role that early attachment quality may play indisordered eating attitudes and behaviours (DEABs) during the transition toadolescence. Although only a small percentage of adolescents meet full criteria for anED diagnosis, many more report subthreshold symptoms, including frequent dieting,body dissatisfaction, fear of becoming fat and uncontrolled eating (Swanson, Crow,LeGrange, Swendsen, & Merikangas, 2011). These types of attitudes and behavioursheighten the likelihood for a subsequent ED, and often emerge and increase followingpuberty in girls (Abebe, Lien, & von Soest, 2012; Stice, Ng, & Shaw, 2010). Thus,understanding which adolescent girls are most at risk for developing these behavioursand attitudes can inform prevention efforts.

Attachment insecurity and disordered eating

Most prevailing models of EDs incorporate risk factors at the biological, psychologicaland social level. Within this broad literature, several recent papers have focused onattachment insecurity as a potentially important risk factor (for review, see Tasca,Ritchie, & Balfour, 2011). According to attachment theory, the quality of the earlyattachment relationship between the child and his or her primary caretaker has lastingimplications for social information processing, emotion regulation and self-evaluativeprocesses. Disturbances in these three domains also make individuals vulnerable to EDs(e.g. Aldao, Nolen-Hoeksema, & Schweizer, 2010; McFillin et al., 2012; Stice & Bulik,2008); consequently, attachment theory may be a fruitful model for understanding whysome individuals develop EDs. Indeed, significant associations have been foundbetween ED symptoms and self-report measures of attachment to parental figures (e.g.Goossens, Braet, Van Durme, Decaluwé, & Bosmans, 2012), self-report measures ofadult attachment style (e.g. Illing, Tasca, Balfour, & Bissada, 2010) and working modelinterviews (e.g. Barone & Guiducci, 2009). The vast majority of these studies havebeen cross-sectional, however. Thus, it is unclear if early attachment insecurity has last-ing implications for disordered eating, or how attachment-related vulnerabilities mightunfold over time.

In this paper, we examine two ways in which early attachment insecurity may relateto later ED symptoms. First, we test whether girls with an insecure attachment in pre-school years report more DEAB at age 15 than girls who exhibited secure attachmentsin early childhood (i.e. a direct, longitudinal association). Second, we test whether earlyattachment insecurity is associated with increased responsivity to specific ED risk fac-tors among adolescent girls. We tested this second model because assumptions aboutthe potential role of early attachment insecurity in EDs should be consistent with longi-tudinal research on attachment in developmental psychopathology literature. Specifi-cally, although attachment insecurity is frequently conceptualised as a risk factor formany forms of psychopathology, there is limited empirical support of main effects mod-els in which early insecurity directly predicts later maladjustment (for meta-analysis seeGroh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012). In contrast,attachment insecurity may have an indirect influence on later adjustment by contributingto differential responsivity to other risk factors, as has been found in a few longitudinalstudies (e.g. Kochanska, Barry, Stellern, & O’Bleness, 2009; Milan, Snow, & Belay,2009). From this perspective, attachment insecurity acts as one type of diathesis factorthat may increase the likelihood for a maladaptive response if an individual is exposed

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to certain environmental stressors (i.e. a source of differential vulnerability; Belsky &Fearon, 2002). Theoretically, attachment quality is presumed to influence social infor-mation processing, self-evaluation and how emotions are understood and regulated(Sroufe, Carlson, Levy, & Egeland, 1999). As a result of biases in these three areas,early attachment quality may moderate how adolescents respond when exposed to spe-cific risk factors for EDs, such as recent weight gain or a negative family emotional cli-mate. In this paper, we test this possibility. As shown in Figure 1, we hypothesised thatamong dyads with an insecure attachment in the first few years of life, negative mater-nal affect, weight and weight gain during the transition to adolescence would predictmore problematic or DEABs, both directly and indirectly (via greater insecurity in thecurrent adolescent–parent relationship). These same paths were not expected to emergeamong adolescent girls with a secure attachment history.

Figure 1. Hypothesised pathways to disordered eating expected to be moderated by earlyattachment quality.

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Family context and ED symptoms: early attachment as a moderator

The family context of adolescent EDs has been widely studied. Although the narrowview that parents are the cause of EDs has been dispelled, there is consistent evidenceof greater negativity (e.g. parental intrusiveness, hostility, negative emotionality) inmany families of adolescents reporting ED symptoms. These associations are modest,however, suggesting the likely presence of moderating factors (for review see Jacobi,Hayward, de Zwaan, Kraemer, & Agras, 2004). For example, Weisburch and colleaguesfound that high parental negative affect contributed to eating pathology only amongyoung women high in emotion contagion (Weisbuch, Ambady, Slepian, & Jimerson,2011). The authors concluded that these individuals become more distressed in responseto negative affect in others, which is then manifest in symptomatic ways. Theoretically,early attachment security may have a similar effect because of its role in the develop-ment of emotion regulation processes (Diamond & Fagundes, 2008). In particular, earlyinsecurity in girls is associated with higher emotional sensitivity during adolescence(Murray, Halligan, Adams, Patterson, & Goodyer, 2006). Adolescents with a history ofearly attachment insecurity may therefore experience more subjective distress and dys-regulation in response to negative affect in mothers when compared to peers with asecure attachment history, and as a result exhibit more symptomatic behaviour whenexposed to this specific risk factor (moderation in path a in Figure 1).

Maternal negative affect is manifest and experienced differently in each family.Thus, the effect of maternal negative affect on DEABs may not be direct, but insteadmay be mediated by how the adolescent views the current relationship. During adoles-cence, individual differences in representations of relationships with attachment figureshave been conceptualised on preoccupied (or anxious-ambivalent) and dismissing (oravoidant) dimensions (Paley, Conger, & Harold, 2000). Individuals who score high onthe preoccupied dimension display an excessive sense of involvement in attachmentrelationships, high need for approval, and frequent worry about rejection and abandon-ment. Those high on the dismissing dimension devalue the importance of attachmentrelationships and are uncomfortable with closeness. High levels of maternal negativeaffect are associated with these two adolescent relationship styles (Paley et al., 2000),and these attachment styles are in turn are predictive of increased weight concern, bodydissatisfaction and disordered eating (for review see Tasca et al., 2011).

We hypothesised this indirect path (maternal negative affect→ perceived relation-ship style→ DEABs) may be more likely to occur in dyads with an insecure attachmenthistory because of attachment-related vulnerabilities in social information processingand emotion regulation. Although there is relatively low stability between measures ofattachment security from early childhood and adolescence (see Fraley, 2002), earlyattachment insecurity can have a lasting influence on parent–adolescent relationships(e.g. Becker-Stoll, Fremmer-Bombik, Wartner, Zimmermann, & Grossmann, 2008). Inparticular, children who form insecure attachments are thought to have working modelsof relationships that result in biases in how social information is subsequently pro-cessed, potentially through selective attention or memory about caretaker’s behaviours(e.g. Chae, Ogle, & Goodman, 2009). As a result of these biases, adolescents with ahistory of early attachment insecurity may be especially prone to forming negativerepresentations of the current parent–adolescent relationship when they experience lessoptimal parenting (i.e. high levels of maternal negative affect). Conversely, children

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with secure attachment histories may interpret later parenting behaviours more favour-ably because they are viewed through the filter of a more positive working model ofthe relationship. In this way, the extent to which maternal negative emotions predictadolescents’ current mental representations of attachment relationships (e.g. preoccupa-tion and dismissiveness) may vary depending on early attachment history (moderationin b paths Figure 1). As described above, individuals with an insecure attachmenthistory may then experience greater dysregulation in response to felt insecurity in thecurrent relationship (moderation in c paths in Figure 1).

Weight, weight gain and ED symptoms: early attachment as a moderator

In longitudinal studies, the prevalence of ED symptoms increases during the early teenyears when pubertal weight gain occurs (Abebe et al., 2012). These findings are consis-tent with evidence that weight changes often precede the emergence of ED symptoms(Thomas, Butryn, Stice, & Lowe, 2011). Yet while pubertal weight gain occurs fornearly all adolescent girls, only a small subset develops ED symptoms. Thus, weightand weight gain are likely experienced in different ways depending on other factors.Because early attachment quality is believed to impact the development of self-systemprocesses (Cicchetti & Toth, 1994), it may influence how children view their body. Spe-cifically, an insecure attachment is predictive of a less positive, less stable and moreexternally dependent self-view (e.g. Goodvin, Meyer, Thompson, & Hayes, 2008;Srivastava & Beer, 2005). If adolescents with an insecure attachment history have amore contingent self-view, then weight or weight gain may be interpreted as meaningsomething negative about the self more globally. Consequently, they may be prone toDEABs in response to relatively high weight or weight gain during this period(moderation in d paths in Figure 1).

We also hypothesised that weight and weight gain indirectly influence ED symp-toms in adolescents with an insecure attachment by increasing preoccupation or dismis-siveness in the current parent–child relationship. According to attachment theory, feltsecurity in relationships partially reflects an individual’s belief that she is able and wor-thy of eliciting support and affection from important others. If an adolescent’s sense ofself is affected by higher weight or weight gain, then her sense of interpersonal securitymay also be jeopardised (Murray, 2006). Indeed, higher BMI is associated with moreinsecurity on self-report measures of attachment (e.g. Wilkinson, Rowe, Bishop, &Brunstrom, 2010). This relation may be strongest in those with a history of early attach-ment insecurity because of more contingent links between evaluations of the self and ofthe quality of relationships. Thus, we included these potentially paths in the hypothe-sised model (moderation in e paths in Figure 1).

In sum, the current study tests whether early attachment quality may be a source ormarker of differential vulnerability to EDs, such that girls with a history of insecurity areprone to DEABs in response to specific risk factors during the transition to adolescence.These hypotheses were tested using longitudinal data and tests of moderation andmoderated mediation, as depicted in Figure 1. We expected that adolescent girls with ahistory of early insecurity would be more likely to report DEABs when faced with mater-nal negative affect and higher weight or weight gain, and that some of these effects wouldbe mediated through greater relationship preoccupation or dismissiveness. These samedirect and indirect paths were not expected to emerge among adolescent girls with a

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secure attachment history. Although males are increasingly recognised as being vulnerableto body size and weight preoccupation, we focused specifically on girls because of theirincreased vulnerability following puberty, and because many symptoms and problematicattitudes measured in this study (e.g. drive for thinness) do not reflect the body concernstypically reported by early adolescent boys (Stice & Bulik, 2008).

Methods

Participants and procedures

Results from this study are based on the National Institute of Child Health and HumanDevelopment (NICHD) Study of Early Child Care (for full description of study seehttp://secc.rti.org). Briefly, 1364 families from 10 geographic areas across the UnitedStates were recruited during hospital visits to mothers shortly after the birth of a child in1991. The sample was representative of the catchment areas from which families weredrawn: 25% identified as belonging to a racial/ethnic minority group (13% African-American, 6% Latino, 6% other groups), 11% of the mothers had not completed highschool and 23% were unmarried. Data have been collected from parents, children, teach-ers and through observational measures at periodic interviews occurring between onemonth and 15 years. Procedures have been standardised across sites and interviewers aretrained and monitored for consistency. Because of our interest in EDs during thetransition to adolescence, the current study focuses only on girls (659 of 1364 or 49%).Of the 659 families of girls, 479 (73%) participated in the age 15 assessment (mean age= 15.1 years, SD = 1.7 months, range = 14.8–15.7). Of these, 32 dyads did not participatein the preschool attachment assessment, leaving 447 adolescent girls in the presentanalysis. Included and excluded families of girls were compared on demographiccharacteristics at baseline. In families not included, mothers had less education (13.7 vs.14.5 years), t(656) = −3.72, p < .001, d = .29, a lower income-to-needs ratio (2.37 vs.2.95), t(617) = −2.27, p < .05, d = .18, and were more often unmarried (39% vs. 23%),χ2(1, N = 659) = 15.5, p < .001, r = .15. In multivariate logistic regression, the NagelkerkeR2 for these three variables predicting attrition was .05. There were no differences byother demographic factors or preschool attachment status.

Measures

Demographic characteristics

Analyses included the following demographic covariates: maternal education level (lessthan high school, high school graduate, some college, four-year degree or higher), race/ethnicity and presence of biological father in the home.

Age of menarche

Age of menarche was used as a covariate to account for individual differences in puber-tal development since early puberty is associated with both weight gain and ED symp-toms. Beginning at age 9, mothers were asked at each interview (age 9, 11, 12 and 15)if their daughter had her period yet, and if so at what age. To minimise the effect ofrecall bias, the age given by the mother at the earliest interview in which she said her

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daughter had experienced menarche was used. At the age 15 interview, 1% of girls hadnot yet had their periods. In order to include these girls in analysis, they were assignedan age of menarche that corresponded with their next birthday.

BMI and pubertal weight change

During lab-visit interviews, girls’ height and weight were recorded by a trained researchassistant. Change in BMI from age 9 to 15 was used to reflect pubertal weight gain,and BMI at age 15 was used to reflect current weight.1

Maternal negative affect

Mother’s self-reports of depression, anxiety and anger at three times points (Age 11,Age 12 and Age 15) were used to assess negative emotional distress during early ado-lescence. The Center for Epidemiologic Studies Depression Scale (CES-D; Radloff,1977) was used to measure maternal depressive symptoms. The CES-D is a widelyused, 20-item measure with well-documented psychometric properties. Mothers reporthow often in the last week they have experienced cognitive, somatic and affective com-ponents of depression on a 0 (not at all) to 4 (5–7 days) scale. Anger and anxiety wereassessed with 10 state items from State-Trait Anger Scale and (STAS; Spielberger,Jacobs, Russell, & Crane, 1983) and 10 state items from the State-Trait Anxiety Inven-tory (STAI; Spielberger, 1989). At each assessment, mothers reported on their feelingsover the past week using a 1–5 scale similar to the CES-D scale described above.Alpha reliability coefficients for the measures at the different time points were all high,ranging from .75 to .91. The CES-D, STAI and STAS were highly correlated with eachother at each time point (r’s > .5) and cross-time points (r’s > .45). Thus, scores for eachemotion domain were averaged across the three time points (i.e. average depression,average anxiety and average anger) and then these scores were used as indicators of alatent factor reflecting overall maternal negative emotions during early adolescence.

Preoccupied and dismissive relationship style

Domains from the Behavioural Systems Questionnaire (BSQ; Furman & Wehner, 1999)were used as indicators of preoccupied and dismissive relationship style latent factors atage 15. The BSQ is a self-report measure assessing adolescents’ perceived secure, pre-occupied and dismissing relational style with a specified partner (e.g. parent, bestfriend). The measure includes 27 items on a five-point Likert scale addressing typicalattachment, caregiving and affiliation behaviours. In previous studies, the secure,preoccupied and dismissing scales were found to be moderately to highly correlatedwith parallel scales on adult measure of attachment styles and relate to mother and childreports of relationship characteristics (Branstetter, Furman, & Cottrell, 2009).Preoccupied attachment (3 items, α = .67), caregiving (3 items, α = .64) and affiliation (3items, α = .70) subdomain scores were used as indicator variables of a preoccupiedrelational style factor and dismissive attachment (3 items, α = .65), caregiving (3 items,α = .72) and affiliation (3 items, α = .65) were used as indicator variables of a dismissiverelational style factor. We did not use the secure subdomains to reduce collinearity andto be consistent with adult attachment style measures. Because the items ask about

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‘parents’ generically, respondents were asked to endorse whom they were thinkingabout after completing the measure. Over 95% of adolescents indicated their mother ormaternal figure and 85% indicated their father or father figure.

Disordered eating attitudes and behaviours

Disordered eating at age 15 was measured with the Eating Attitudes Test-26 (EAT-26;Garner, Olmsted, Bohr, & Garfinkel, 1982), a widely used self-report measure com-prised of 26 statements that describe behavioural and attitudinal characteristics of indi-viduals with EDs or at risk for developing EDs. Items assess dieting and compensatorybehaviours, drive for thinness, food preoccupation and perceived pressure from othersto gain weight and/or control eating. Responses for the EAT-26 are on a six-point Likertscale ranging from Never to Always. Scores of never, rarely, and sometimes arerecoded to equal 0, often equals 1, usually equals 2 and always equals 3. Total scorescan range from 0 to 78, with scores above 20 indicating a potential ED. Although theEAT-26 does not directly measure all DSM IV ED symptoms, it can differentiate indi-viduals with and without EDs, as well as those with subclinical symptoms (Mintz &O’Halloran, 2000).

Early attachment security

A modified Strange Situation procedure was used to assess attachment security(Cassidy, Marvin, & The MacArthur Working Group on Attachment, 1992). The assess-ment was done when children were 36 months (SD = 1.6 months). In the modifiedStrange Situation, mother and child are initially put in a room together and then gothrough a series of separations and reunions. The overall organisation of children’sbehaviour during the separations and reunions is classified. In this system, Secure (B)children seem able to resolve the stress of the separation and resume a comfortableinteraction with the parent upon return. Insecure-avoidant (A) children maintain neutral-ity toward the parent and express little positive or negative emotion toward the parent,even after reunion. Insecure-ambivalent (C) children show fussy, helpless or resistantbehaviour toward the parent and heightened distress during the separation, yet may notappear consoled by the parent’s return. Insecure-controlling/other (D) children are con-trolling (e.g. role reversal or punitive behaviour toward parent) or show combinationsof strategies, such as avoidance and ambivalence. Consistent with attachment theory,classifications using the MacArthur system are predicted by maltreatment, maternalpsychological adjustment, parenting attitudes and observed sensitivity and predictmother- and teacher-rated behavioural problems (e.g. Moss, Bureau, Cyr, Mongeau, &St-Laurent, 2004; NICHD ECCRN, 2001). At each site, administrators follow a stand-ardised protocol. Videos were sent to a central location and coded by a team of threeindependent coders. These three coders passed the minimum 75% agreement at thelevel of A, B, C and D classifications with Jude Cassidy. Intercoder reliability was cal-culated based on 867 randomly paired cases. A consensus code was assigned for dis-agreements. Intercoder agreement before consensus conferencing on the four-categoryclassification was 76% (κ = .58).

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Analytic plan

Prior to analyses, data were analysed for normality and the presence of outliers usingunivariate and graphical approaches. The EAT-26 scale was log transformed to reducepositive skew. T-tests were used to test for main effects of attachment history on allvariables. Then, we used a multi-group nested SEM model to first test for factorialinvariance in the measurement model, and then test for group differences in paths ofinterest (a–e paths in Figure 1) by attachment history. This was done using nestedmodel comparisons followed by pairwise critical ratio tests (Byrne, 2001). Finally, themagnitude and significance of indirect effects was calculated using 2000 bootstrappedsamples and bias-corrected confidence intervals in SEM. Bootstrapping techniques offera better test of mediation than Sobel tests because they do not rely on the tenuousassumption that indirect effects are normally distributed (Edwards & Lambert, 2007).Models were estimated using full-information maximum likelihood (FIML) inAMOS 19.

Results

Table 1 presents mean scores and standard deviations for study variables for the sampleand by attachment history. Attachment categories were as follows: 261 (59%) Secure,17 (4%) Avoidant, 78 (17%) Resistant and 91 (20%) Disorganised. As shown, adoles-cent girls with secure and insecure attachment histories differed on maternal educationand whether the child’s biological father was in the home at age 15, but did not differon any other variables. These sociodemographic variables were included as covariates

Table 1. Mean scores for the total sample and by early attachment history.

CharacteristicTotalsample

Secureattachment(n = 261)

Insecureattachment(n = 186)

Test ofdifference

Racial/ethnic minority 18% 16% 19% χ2 (447) = 1.98Maternal education – HS

degree or less60% 55% 66% χ2 (447) = 4.89*

Biological father in household 64% 69% 58% χ2 (447) = 4.98*Average income-to-need ratio 4.1 (3.0) 4.2 (2.9) 3.9 (3.2) t(445) = −1.08Age of menarche 11.99 (1.21) 12.08 (1.22) 11.94 (1.20) t(440) = −1.16Pubertal BMI change 4.8 (2.8) 4.8 (2.8) 4.8 (2.7) t(426) = .08BMI grade 15 22.93 (4.95) 22.89 (4.93) 23.00 (5.01) t(426) = .82Average maternal depression 9.54 (7.73) 9.49 (7.76) 9.61 (7.70) t(445) = .16Average maternal anxiety 17.52 (4.77) 17.61 (4.93) 17.39 (4.54) t(445) = −.50Average maternal anger 13.92 (3.53) 13.92 (3.56) 13.93 (3.49) t(445) = .02Preoccupied affiliation 2.22 (.72) 2.18 (.67) 2.29 (.78) t(443) = 1.56Preoccupied caregiving 2.26 (.73) 2.26 (.72) 2.27 (.76) t(443) = .09Preoccupied attachment 2.05 (.73) 2.03 (.71) 2.10 (.72) t(443) = .96Dismissive affiliation 1.98 (.92) 1.97 (.82) 1.98 (.83) t(443) = .16Dismissive caregiving 2.51 (.79) 2.53 (.82) 2.47 (.75) t(443) = −.83Dismissive attachment 2.60 (.96) 2.60 (.96) 2.60 (.97) t(443) = .08Disordered eating 6.50 (7.60) 6.71 (7.42) 6.22 (7.86) t(445) = −.66

*p < .05.

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in subsequent analysis to reduce potential confounding effects. Of note, there was nomain effect of attachment history on EAT 26 scores. Across the sample, 5% of adoles-cents had EAT-26 scores above the clinical cut-off score recommended to identify indi-viduals likely to meet criteria for an ED (Mintz & O’Halloran, 2000). Although noaccepted subthreshold score has been established, 16% of girls had scores above cut-offs that have been used in broad screening for ED risk (see Rivas, Bersabé, Jiménez,& Berrocal, 2010). The proportion of girls above the clinical cut-off did not vary byattachment history (4.8 and 5.7%; χ2(1, N = 447) = .18, p = .67). In other words, therewas no evidence of a direct association between attachment quality in early childhoodand EAT-26 scores in adolescence.

We then tested whether early attachment security moderated paths from adolescentinterpersonal and weight risk factors to DEABs. First, the measurement model wastested to ensure good fit of the conceptualised latent constructs (maternal negativeaffect, preoccupied relational style and dismissive relational style) and invariance of fac-tor loadings and variance between the two attachment groups. The overall measurementmodel provided a good fit to the data (χ2 = 131.9, df = 59, CFI = .98, RMSEA = .037),with factor loadings all statistically significant and above .5. A model with factor load-ings/variances constrained to be equal for adolescents with a secure and insecure attach-ment history did not result in a significantly worse fit to the data that the unconstrainedmodel (diff χ2 = 10.18, p = .12, df = 6). These results indicate factorial invariance, mean-ing the latent variables had the same structure for both attachment groups and thusseem to be measuring the same constructs. Correlations between latent factors and allother variables for by attachment history are presented in Table 2.

Next, a nested model comparison was used to test whether the structural paths ofinterest (i.e. regression path) differed by attachment history. The dismissive relationalstyle factor was not related to EAT-26 scores, weight variables or maternal negativeaffect in either attachment group; thus, the model was rerun without this variableincluded to ease interpretation and presentation. The unconstrained model (i.e. noequality constraints on regression paths across the two attachment groups) provided agood fit to the data (χ2 = 79.41, df = 76, p = .37, CFI = .99, RMSEA = .010). A χ2 dif-ferential test indicated that constraining the paths of interest to be equal across attach-ment groups led to a significantly worse fit to the data (diff χ2 = 14.45, df = 7,p < .05). In other words, the structural model (i.e. the regression paths) differed foradolescents with a secure vs. insecure attachment history. Follow-up pairwise contrastsusing critical ratio z tests indicated three paths were significantly larger for adolescentswith an insecure attachment history (i.e. moderation by early attachment quality).Figure 2 presents standardised coefficients and R2 values by attachment group for thefinal model.

The direct path from maternal negative affect to EAT-26 scores was not significantfor the insecure or secure attachment group, (β = .05, p = .57 vs. β = .08, p = .21, respec-tively; z = .27, p > .05). In contrast, the path from maternal negative emotions to the pre-occupied relationship style factor was significantly larger in adolescents with aninsecure compared to a secure attachment history (β = .30, p < .01 vs. β = .01, p = .64;z = 2.20, p < .01). The path from preoccupied relationship style to EAT-26 scores wassignificant only for those with an insecure attachment history, although the magnitudeof the group difference was not statistically significant (β = .35, p < .01 vs. β = .15,p = .11; z = 1.01, p > .05). The association between weight variables and disordered

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Table2.

Correlatio

nsbetweenvariablesforadolescentswith

secure

andinsecure

earlyattachmenthistory.

12

34

56

78

910

11

1.Minority

status

–−.28***

−.37*

**−.32***

−.16*

.06

.10

.08

.26*

*.01

.07

2.Maternaleducation

−.26*

**–

.30*

**−.28***

.31***

−.15

−.13

−.15*

−.38*

**−.08

−.003

3.Biologicalfather

inho

usehold

−.31*

**.32***

–−.34***

.17*

−.03

−.08

−.15

−.27*

*−.07

−.16*

4.Incometo

need

ratio

−.33*

**−.26***

−.37*

**–

−.16*

.06

.10

.08

.26*

*.003

.03

5.Age

ofmenarche

−.22*

*.15*

.15*

−.22***

–−.24*

*−.32***

.02

−.27*

.01

−.10

6.Pub

ertalweigh

tgain

.17*

*−.29***

−.27*

**.18**

−.25***

–.75***

.08

.28*

*.10

.16*

7.BMIage15

.15*

−.26***

−.22*

**.15*

−.32***

.71*

**–

.01

.17

.03

.27***

8.Maternalnegativ

eaffect

factor

.17*

*−.18**

−.14*

.17**

−.08

.12

.15*

–.36*

**.17*

.15*

9.Preoccupied

relatio

nshipstyle

factor

.36*

**−.29***

.21*

**.37***

−.28**

.21*

.26**

.11

–.37*

**.34***

10.Dismissive

relatio

nshipstyle

factor

.15*

−.04

−.15*

.15*

−.13*

.07

.04

.05

.38*

**–

.18*

11.DEABs

.02

−.02

−.04

.06

−.09

.11

.15*

.10

.16*

.11

–

Notes:Valuesin

theup

perqu

adrant

reflectcorrelations

forchild

renwith

aninsecure

attachmenthistory(n

=18

6);values

inthelower

quadrant

reflectcorrelations

forchil-

dren

with

asecure

attachmenthistory(n

=261).DEABs=Disorderedeatin

gattitudes

andbehaviours.

***p

<.001

;**

p<.01;

*p<.05.

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eating also varied by attachment history group. Age 15 BMI predicted disordered eatingfor adolescents with an insecure attachment history but not those with a secureattachment history (β = .38, p < .01 vs. β = .11, p = .27; z = 1.69, p < .05). Pubertalweight gain did not predict EAT-26 scores in either group, but significantly predictedpreoccupation with parental relationships in adolescent girls with an insecure attachmenthistory but not those with a secure attachment history (β = .31, p < .01 vs. β = .003,p = .98; z = 1.81, p < .05). Together, the overall model accounted for 22% of the vari-ance in EAT-26 scores for adolescents with an insecure attachment history, but only 5%of the variance for adolescents with a secure attachment history.

Both maternal negative affect and pubertal weight gain predicted preoccupied rela-tional style, and a preoccupied relationship style predicted EAT-26 scores. Conse-quently, we calculated the magnitude of direct and indirect effects (via preoccupation)from maternal negative affect and weight variables to EAT-26 scores using bootstrap-ping to calculate bias-corrected 95% confidence intervals. Results are presented inTable 3. As shown, among adolescents with a secure attachment history, none of thedirect or indirect effects were statistically significant. In contrast, for adolescent girlswith an insecure attachment history, there were both direct and indirect significant

Figure 2. Standardised beta weights for adolescent girls with a secure (n = 261) and insecure(n = 186) preschool attachment history.Note: Values before the slash are parameter estimates for adolescents with an insecure attachmenthistory. Values after the slash are parameter estimates for adolescents with a secure attachmenthistory. The model included maternal education, biological father in household, minority statusand age of menarche as covariates.

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effects. Specifically, maternal negative affect and pubertal weight gain had significantindirect effects on EAT-26 scores via greater preoccupation with parental relationships,while higher current BMI directly predicted higher EAT-26 scores.

Post hoc analysis

For descriptive purposes, post hoc tests were conducted to identify potential differencesbetween types of early insecure attachment (i.e. avoidant, resistant and disorganised). Aone-way ANOVA of the four attachment classifications on EAT-26 scores was not sig-nificant. Given small sample sizes, we did not run multi-group SEM but insteadcomputed separate multiple regressions with four variables of interest (maternal negativeaffect, preoccupied relational style, BMI and pubertal weight change) predictingEAT-26 scores in the four groups. The model accounted for 3% of the variance inEAT-26 scores for the secure group, 44% for the avoidant group, 23% for the resistantgroup and 19% for the disorganised group. There was no indication that the effects inthe overall insecure attachment group were driven by one particular subgroup, althoughthese results should be interpreted cautiously given small sample sizes. We also reranthe SEM nested model with adolescent self-reported depression scores included as acovariate given comorbidity and intergenerational continuity; the pattern of resultsremained.

Table 3. Bootstrapped estimates of standardised total, direct and indirect effects from maternalnegative affect and weight variables to EAT-26 scores via preoccupied relationship style.

Predictor and group

Effect sizes

(total) <direct> {indirect via preoccupied}

Predictor: maternal negative affect

� Insecure attachment history (n = 186)(.15*) <.05> {.10*}

� Secure attachment history (n = 261) (.09) <.08> {.01}

Predictor: age 15 BMI

� Insecure attachment history (n = 186)(.35**) <.38** {−.03}

� Secure attachment history (n = 261) (.12) <.10> {.02}

Predictor: pubertal weight gain

� Insecure attachment history (n = 186) (−.11) <−.19> {.08*}

� Secure attachment history (n = 261) (.00) <−.02> {.02}

*p < .05; **p < .01.

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Discussion

There are multiple developmental pathways leading to EDs. In this paper, we tested forthe presence of a potential attachment-related pathway among adolescent girls. Asexpected, early attachment quality was not associated with differences in self-reportedDEABs during early adolescence. Although many studies have examined attachmentinsecurity and EDs, most of these have not been longitudinal investigations includingearly attachment measures. Based on the current data spanning 12 years, insecureattachment in the preschool years does not increase the likelihood for DEABs in mid-adolescence in a community sample. The two attachment history groups also did notdiffer in BMI at age 15 or pubertal weight change. Thus, there was no evidence thatearly attachment insecurity directly predicts differences in adolescent weight or weightgain, or ED-related symptoms. In contrast, results did support our hypothesis that earlyattachment quality may influence how adolescent girls respond to specific individual(weight and weight gain) and interpersonal (maternal negative affect) ED risk factorspresent during the transition to adolescence, with girls with an insecure history morelikely to have unhealthy responses.

Contrary to hypothesis, greater maternal negative affect and pubertal weight gainbetween age 9 and 15 did not directly predict more DEABs in either attachment group.This may be because mothers reported on their negative affect and weight was mea-sured objectively; thus, these measures do not capture variations in how adolescentsactually experienced these potential risk factors. Consistent with this possibility, therewas evidence of indirect effects from both maternal negative affect and pubertal weightgain on DEABs via preoccupation with the parental relationship, but only among ado-lescents with a history of an insecure attachment. Because of earlier attachment insecu-rity, these girls may be hypersensitive to the behaviours of attachment figures, and thusbecome preoccupied with the relationship when mothers experience heightened negativeaffect. Similarly, girls with a history of earlier attachment insecurity may have strongeror more contingent connections between their sense of self and their sense of worth orsatisfaction in relationships (Murray, 2006). As a result, undesired weight gain (i.e. anegative change in the self) may be interpreted as a reason for significant others to notvalue them or the relationship. Preoccupation with parental relationships in turn pre-dicted DEABs only among adolescent girls with an insecure attachment history. Plausi-bly, for adolescent girls with attachment vulnerabilities, eating may be an emotionregulation strategy for dealing with feelings of insecurity or negative emotions associ-ated with interpersonal stress (e.g. Burns, Fischer, Jackson, & Harding, 2012). Alterna-tively, they may view food restraint or purging as strategies to ‘improve’ themselves,and thus be more likable to others (e.g. Gilbert & Meyer, 2005).

We also found that higher current BMI directly predicted more DEABs, but againonly among the insecure attachment history. It is worth noting that the direction of mul-tivariate associations between current BMI (positive) and pubertal weight gain (nega-tive) on DEABs suggest it was girls who were the heaviest at 15 and the heaviest priorto puberty who reported the most symptoms. Girls who have been relatively heavy fora longer period have likely received the most critical feedback about their weight; forthose with an insecure attachment history, this negative self-relevant information maybe interpreted in more psychological detrimental ways. In a study of adolescent boysand girls in the same NICHD SECC sample, cumulative markers of early caregiving

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risk (but not attachment insecurity) predicted adolescent weight, with maternalsensitivity having the strongest effect (Anderson, Gooze, Lemeshow, & Whitaker,2012). Together with our findings, these results suggest that some aspects of the earlycaregiving environment (e.g. maternal sensitivity) may contribute to weight gain, whileother early caregiving factors (e.g. attachment insecurity) may contribute to differencesin how girls interpret and respond to their weight. As a result, the early relational envi-ronment may influence both biological and psychological processes underlying theemergence of EDs.

Interestingly, preoccupation with parental relationships, but not dismissiveness, pre-dicted DEABs in this sample. In many other studies, both anxious and avoidant stylesare associated with eating pathology (see Tasca et al., 2011 for review). Although themeasure used in this study does not directly map onto adult attachment domains, thepreoccupied and dismissive domains broadly reflect the attitudes and behaviours seen inadult self-reported anxious and avoidant attachment styles. Adult attachment measurestypically ask about romantic partners or generalised others, however. Dismissivenessmay have a different meaning in the parent–child relationship compared to these typesof relationships because residential and economic dependency mean there are feweroptions for avoiding intimacy or dismissing the importance of the relationship. It is alsopossible that preoccupation in attachment relationships is particularly detrimental duringadolescence, potentially because of the normative increase in social concern during thisperiod (e.g. Cooper, Shaver, & Collins, 1998).

In recent work by Tasca and colleagues (2011), attachment style has emerged as animportant predictor of treatment success for women with EDs. Based on this research,they have developed clinical practice suggestions for addressing attachment vulnerabili-ties in the context of ED treatment. Our findings suggest that attachment constructs alsomay be important factors to consider in designing targeted prevention efforts. Thismight include incorporating relational components into efforts to prevent EDs andobesity (e.g. Tanofsky-Kraff, 2012) and delivering programmes to adolescents who arelikely to have an insecure attachment history (e.g. girls with a maltreatment history orin foster care).

Limitations and conclusion

The current findings should be interpreted in light of study limitations. First, results arebased on a community sample during early adolescence, where the prevalence of EDsymptoms is generally low. Although even subclinical levels of ED symptoms are asso-ciated with worse functioning over time (Wade, Wilksch, & Lee, 2012), findings fromthis study may not generalise to clinical populations. Second, although the EAT-26 is avalidated, widely used measure, the approach used in this study (nomothetic analysisaimed at predicting individual differences in EAT-26 scores) may produce differentresults from idiographic approaches aimed at characterising individuals with diagnosabledisorders. Similarly, this measure does not distinguish between different ED diagnoses;thus, our results do not add to our understanding of specific types of EDs. There is,however, evidence that ED diagnoses are less distinct during adolescence, with manyteens meeting criteria for different ED disorders over time (Ackard, Fulkerson, &Neumark-Sztainer, 2011). Finally, it is important to note that early attachment securitymay be a marker of children who are particularly responsive to environmental

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conditions without playing any causal role, potentially because of genetic factors suchas variations in the serotonin transporter gene (5-HTTLPR) that have also been linkedto EDs (Karwautz et al., 2011). Similarly, the correlational nature of this study leavesopen the possibility of reciprocal or reverse relations between variables in the hypothe-sised model (e.g. DEABs may lead to more preoccupation with the parent–adolescentrelationship among girls with an insecure attachment history). Similarly, the NICHDsample includes families from a broad economic range in the US, but underrepresentsfamilies of colour, particularly Asian-American and Latino families. Findings thereforemay not generalise to different regions or racial/ethnic groups.

Risk factors associated with EDs do not affect all adolescents similarly. In thispaper, we tested whether girls with a history of early attachment insecurity were partic-ularly likely to experience problematic eating attitudes and behaviours when exposed tospecific ED risk factors during transition to adolescence. Our results support thishypothesised pathway, and highlight one way the early relational context may have acomplex but lasting effect on the mental and physical health of adolescents. Our find-ings also support growing efforts to incorporate relational components into programmesaimed at reducing obesity and disordered eating, and promoting the health of adoles-cents.

AcknowledgementsThe NICHD Study of Early Child Care and Youth Development was supported by the EuniceKennedy Shriver National Institute of Child Health and Human Development (NICHD) through acooperative agreement (U10) that calls for a scientific collaboration between NICHD staff andparticipating investigators. We gratefully acknowledge the data-set provided by this study that ismade available to researchers, and express our appreciation to NICHD and study investigators,personnel and participants.

Note1. Because delta variables can cause problems of interpretation because of multicollinearity,

models were run with just BMI 15 included and with BMI 15 and BMI 9 included. The pat-tern of results was consistent across models.

References

Abebe, D., Lien, L., & von Soest, T. (2012). The development of bulimic symptoms from adoles-cence to young adulthood in females and males: A population-based longitudinal cohortstudy. International Journal of Eating Disorders, 45, 737–745.

Ackard, D. M., Fulkerson, J. A., & Neumark-Sztainer, D. (2011). Stability of eating disorderdiagnostic classifications in adolescents: Five-year longitudinal findings from a population-based study. Eating Disorders: The Journal of Treatment & Prevention, 19, 308–322.

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies acrosspsychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237.

Anderson, S., Gooze, R., Lemeshow, S., & Whitaker, R. (2012). Quality of early maternal–childrelationship and risk of adolescent obesity. Pediatrics, 129, 132–140.

Barone, L., & Guiducci, V. (2009). Mental representations of attachment in eating disorders: Apilot study using the AAI. Attachment & Human Development, 11, 405–417.

Psychology & Health 911

Dow

nloa

ded

by [

] at

00:

56 3

0 Se

ptem

ber

2014

Becker-Stoll, F., Fremmer-Bombik, E., Wartner, U., Zimmermann, P., & Grossmann, K. E.(2008). Is attachment at ages 1, 6 and 16 related to autonomy and relatedness behaviors ofadolescents in interaction with their mothers? International Journal of Behavioral Develop-ment, 32, 372–380.

Belsky, J., & Fearon, R. (2002). Infant–mother attachment security, contextual risk, and earlydevelopment: A moderational analysis. Development & Psychopathology, 14, 293–310.

Branstetter, S., Furman, W., & Cottrell, L. (2009). The influence of representations of attachment,maternal–adolescent relationship quality, and maternal monitoring on adolescent substanceuse: A 2-year longitudinal examination. Child Development, 80, 1448–1462.

Burns, E., Fischer, S., Jackson, J., & Harding, H. (2012). Deficits in emotion regulation mediatethe relationship between childhood abuse and later eating disorder symptoms. Child Abuse &Neglect, 36, 32–39.

Byrne, B. (2001). Structural equation modeling with AMOS: Basic concepts, applications andprogramming. Mahwah, NJ: Lawrence Erlbaum Press.

Cassidy, J., Marvin, R., & The MacArthur Working Group. (1992). Attachment organization inpreschool children manual (4th ed.). Unpublished manuscript, University of Virginia.

Chae, Y., Ogle, C., & Goodman, G. (2009). Remembering negative childhood experiences: Anattachment theory perspective. In J. Quas & R. Fivush (Eds.), Emotion and memory in devel-opment: Biological, cognitive, and social considerations (pp. 3–27). New York, NY: OxfordUniversity Press.

Cicchetti, D., & Toth, S. (1994). Rochester symposium on developmental psychopathology: Disor-ders and dysfunctions of the self. Rochester, NY: University of Rochester Press.

Cooper, M., Shaver, P., & Collins, N. (1998). Attachment styles, emotion regulation, and adjust-ment in adolescence. Journal of Personality and Social Psychology, 74, 1380–1397.

Diamond, L., & Fagundes, C. (2008). Developmental perspectives on links between attachmentand affect regulation over the lifespan. In R. V. Kail (Ed.), Advances in child developmentand behavior (Vol. 36, pp. 83–134). San Diego, CA: Elsevier Academic Press.

Edwards, J., & Lambert, L. S. (2007). Methods for integrating moderation and mediation: A gen-eral analytical framework using moderated path analysis. Psychological Methods, 12, 1–22.

Fraley, R. (2002). Attachment stability from infancy to adulthood: Meta-analysis and modeling ofdevelopmental mechanisms. Personality and Social Psychology Review, 6, 123–151.

Furman, W., & Wehner, E. (1999). The Behavioral Systems Questionnaire-Revised. Unpublisheddocument, University of Denver.

Garner, D., Olmsted, M., Bohr, Y., & Garfinkel, P. (1982). The Eating Attitudes Test: Psychomet-ric features and clinical correlates. Psychological Medicine, 12, 871–878.

Gilbert, N., & Meyer, C. (2005). Fear of negative evaluation and the development of eating psy-chopathology: A longitudinal study among nonclinical women. International Journal of Eat-ing Disorders, 37, 307–312.

Goodvin, R., Meyer, S., Thompson, R. A., & Hayes, R. (2008). Self-understanding in early child-hood: Associations with child attachment security and maternal negative affect. Attachment &Human Development, 10, 433–450.

Goossens, L., Braet, C., Van Durme, K., Decaluwé, V., & Bosmans, G. (2012). The parent–childrelationship as predictor of eating pathology and weight gain in preadolescents. Journal ofClinical Child & Adolescent Psychology, 41, 445–457.

Groh, A., Roisman, G., van IJzendoorn, M., Bakermans-Kranenburg, M., & Fearon, R. (2012).The significance of insecure and disorganized attachment for children’s internalizing symp-toms: A meta-analytic study. Child Development, 83, 591–610.

Hart, L. M., Granillo, M., Jorm, A. F., & Paxton, S. J. (2011). Unmet need for treatment in theeating disorders: A systematic review of eating disorder specific treatment seeking amongcommunity cases. Clinical Psychology Review, 31, 727–735.

912 S. Milan and J.C. Acker

Dow

nloa

ded

by [

] at

00:

56 3

0 Se

ptem

ber

2014

Illing, V., Tasca, G., Balfour, L., & Bissada, H. (2010). Attachment insecurity predicts eatingdisorder symptoms and treatment outcomes in a clinical sample of women. The Journal ofNervous and Mental Disease, 198, 653–659.

Jacobi, C., Hayward, C., de Zwaan, M., Kraemer, H., & Agras, W. (2004). Coming to terms withrisk factors for eating disorders: Application of risk terminology and suggestions for a generaltaxonomy. Psychological Bulletin, 130, 19–65.

Karwautz, A., Wagner, G., Waldherr, K., Nader, I., Fernandez-Aranda, F., Holliday, J., … Trea-sure, J. (2011). Gene–environment interaction in anorexia nervosa: Relevance of non-sharedenvironment and the serotonin transporter gene. Molecular Psychiatry, 16, 590–592.

Kochanska, G., Barry, R., Stellern, S., & O’Bleness, J. (2009). Early attachment organizationmoderates the parent–child mutually coercive pathway to children’s antisocial conduct. ChildDevelopment, 80, 1288–1300.

McFillin, R., Cahn, S., Burks, V., Levine, M., Loney, S., & Levine, R. (2012). Social informa-tion-processing and coping in adolescent females diagnosed with an eating disorder: Towarda greater understanding of control. Eating Disorders: The Journal of Treatment & Prevention,20, 42–59.

Milan, S., Snow, S., & Belay, S. (2009). Maternal and child depressive symptoms: Preschoolattachment as a moderator of risk. Developmental Psychology, 12, 63–81.

Mintz, L., & O’Halloran, M. (2000). The Eating Attitudes Test: Validation with DSM-IV eatingdisorder criteria. Journal of Personality Assessment, 74, 489–503.

Moss, E., Bureau, J., Cyr, C., Mongeau, C., & St-Laurent, D. (2004). Correlates of attachment atage 3: Construct validity of the preschool attachment classification system. DevelopmentalPsychology, 40, 323–334.

Murray, L., Halligan, S., Adams, G., Patterson, P., & Goodyer, I. (2006). Socioemotional develop-ment in adolescents at risk for depression: The role of maternal depression and attachmentstyle. Development and Psychopathology, 18, 489–516.

Murray, S. L. (2006). Self-esteem: Its relational contingencies and consequences. In M. Kernis(Ed.), Self-esteem issues and answers: A sourcebook of current perspectives (pp. 350–358).New York, NY: Psychology Press.

NICHD Early Child Care Research Network. (2001). Child care and family predictors of pre-school attachment and stability from infancy. Developmental Psychology, 37, 847–862.

Paley, B., Conger, R., & Harold, G. (2000). Parents’ affect, adolescent cognitive representations,and adolescent social development. Journal of Marriage and Family, 62, 761–776.

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the generalpopulation. Applied Psychological Measurement, 1, 385–401.

Rivas, T., Bersabé, R., Jiménez, M., & Berrocal, C. (2010). The Eating Attitudes Test (EAT-26):Reliability and validity in Spanish female samples. The Spanish Journal of Psychology, 13,1044–1056.

Spielberger, C. D. (1989). State-Trait Anxiety Inventory: Bibliography (2nd ed.). Palo Alto, CA:Consulting Psychologists Press.

Spielberger, C., Jacobs, G., Russell, S., & Crane, R. (1983). Assessment of anger: The State-TraitAnger Scale. Advances in Personality Assessment, 2, 159–187.

Srivastava, S., & Beer, J. (2005). How self-evaluations relate to being liked by others: Integratingsociometer and attachment perspectives. Journal of Personality and Social Psychology, 89,966–977.

Sroufe, L., Carlson, E., Levy, A., & Egeland, B. (1999). Implications of attachment theory fordevelopmental psychopathology. Development and Psychopathology, 11, 1–13.

Stice, E., & Bulik, C. (2008). Eating disorders. In T. P. Beauchaine & S. P. Hinshaw (Eds.), Childand adolescent psychopathology (pp. 643–669). Hoboken, NJ: Wiley.

Stice, E., Ng, J., & Shaw, H. (2010). Risk factors and prodromal eating pathology. Journal ofChild Psychology and Psychiatry, 51, 518–525.

Psychology & Health 913

Dow

nloa

ded

by [

] at

00:

56 3

0 Se

ptem

ber

2014

Swanson, S., Crow, S., LeGrange, D., Swendsen, J., & Merikangas, K. (2011). Prevalence andcorrelates of eating disorders in adolescents: Results from the national comorbidity surveyreplication adolescent supplement. Archives of General Psychiatry, 68, 714–723.

Swift, J., & Greenberg, R. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80, 547–559.

Tanofsky-Kraff, M. (2012). Psychosocial preventive interventions for obesity and eating disordersin youths. International Review of Psychiatry, 24, 262–270.

Tasca, G., Ritchie, K., & Balfour, L. (2011). Implications of attachment theory and research forthe assessment and treatment of eating disorders. Psychotherapy, 48, 249–259.

Thomas, J., Butryn, M., Stice, E., & Lowe, M. (2011). A prospective test of the relation betweenweight change and risk for bulimia nervosa. International Journal of Eating Disorders, 44,295–303.

Wade, T., Wilksch, S., & Lee, C. (2012). A longitudinal investigation of the impact of disorderedeating on young women’s quality of life. Health Psychology, 31, 352–359.

Weisbuch, M., Ambady, N., Slepian, M., & Jimerson, D. (2011). Emotion contagion moderatesthe relationship between emotionally-negative families and abnormal eating behavior. Interna-tional Journal of Eating Disorders, 44, 716–720.

Wilkinson, L., Rowe, A., Bishop, R., & Brunstrom, J. (2010). Attachment anxiety, disinhibitedeating, and body mass index in adulthood. International Journal of Obesity, 34, 1442–1445.

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] at

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