Do Childhood Attachment Patterns Inform Our Relationship with Food?
Therapists agree that eating disorders are never—or at least almost never—about food. But what they are about is less clear. In her clinical experience, Los Angeles–based psychologist Traci Bank Cohen has noticed a correlation between insecure attachment styles and certain disordered eating behaviors. The theory is this: We develop secure or insecure attachment styles as infants based on our relationship with our primary caregivers, and these patterns can shape how we relate to ourselves and others for the rest of our lives. And for many of Cohen’s patients (primarily women), attachment issues manifest as food issues. The disordered eating behaviors become a way of filling or avoiding a deeper, often primitive emotional void. Identify this pattern and, Cohen believes, it’s possible to break it and redefine an unhealthy relationship to food.
A Q&A with Traci Bank Cohen, Psy.D.
What’s the connection you see between attachment/relationship issues and eating disorders? And what are the different attachment styles?
We are social beings. We need others to survive. We are not like other types of animals that can exist without caretakers shortly after birth. It’s evolutionarily advantageous to be part of a group; thousands of years ago, it was necessary to belong to a community for our protection. Today, we are certainly able to live more independently, but we need relationships in order to thrive.
The same is true for food. We need food to survive on a cellular level. So with that in mind—that we need both food and relationships for survival—it makes sense that psychologically, they are inherently connected. They serve to nourish us, keep us safe and healthy, and if we don’t get enough of them—food or relationships—we are starved.
When we talk about attachment in therapy, we are referring to how someone relates to themselves, others, and the world. We “attach” to our primary caregivers, and depending on how they respond to our needs, we learn how to respond in turn. In other words, we internalize the relationship we have with our caregivers, which translates to the relationship we have with ourselves. Attachment patterns are developed within the first year of life and likely solidified by age four. While your attachment style can be seen in all your interactions with others, when you are an adult, it is usually most activated within a romantic relationship. There are two primary types of attachments: secure and insecure. Within the insecure attachment style, there are three subtypes: preoccupied/anxious, dismissive, and disorganized.
Having a secure attachment style means that your primary caregiver was responsive to you most of the time and met your needs in a way that felt warm, safe, and consistent. When you needed attention, food, or comfort, your caregiver—usually a parent, and usually your mother—provided you with it and did so in a way that was not shaming or scary. When your mother said she was going out but would be back, she returned. When you skinned your knee, she mirrored your sadness by saying, “I’m sorry you got hurt. Let me make you feel better.” When you grow up with that kind of secure attachment style, you depend on others appropriately and allow yourself to be taken care of by others. You feel confident because your caretaker gave you the confidence that you are worthy and capable, that you aren’t a burden and don’t take up too much space. You were safe to explore the world because you knew that you had a secure base to come home to.
“Because children are egocentric, the infant grows into a child who thinks to herself: I must have done something wrong to make Mom go away. This is my fault. Which is likely similar to the dialogue the mother had with herself.”
Insecure attachment styles lack that consistency and warmth. A preoccupied/anxious attachment style usually comes from an environment in which the primary caregiver was anxious herself and able to meet her infant’s needs on an inconsistent basis. When she wasn’t preoccupied managing her own anxiety, the caregiver would be available to the infant but, perhaps overwhelmed with the guilt of not being a perfect mother, would then act intrusively or overwhelm the infant. As a result, the infant became attached to her caregiver when she was there and fearful that the caregiver would leave, instilling a sense of looming abandonment. Because children are egocentric, the infant grows into a child who thinks to herself: I must have done something wrong to make Mom go away. This is my fault. Which is likely similar to the dialogue the mother had with herself. These individuals then become adults who strongly desire close relationships but are afraid that they will not be able to sustain them. They are intensely afraid of rejection, which they internalize, are sensitive to criticism, and anxious to secure attachments; this often leaves them feeling empty and lonely.
A dismissive attachment style develops when an infant’s needs are not consistently met. Rather than having a caregiver who is apologetic for being unavailable, these children may be physically taken care of but emotionally are not connected. Caregivers who are detached, rejecting, or shaming can often produce an attachment style in which the child comes to expect that her needs will not be met, and in order to protect herself from disappointment, she will then distance herself from relationships; this is a defense mechanism (which is a way to think about all attachment styles, really). And because she has experienced relationships as unreliable or unpleasant, she won’t depend on others and doesn’t want to be depended upon. She cuts off her feelings because when she had strong emotions, she was told they were invalid and that she shouldn’t have been feeling that way in the first place. By distancing herself from her emotional experience, she keeps others at arm’s length and can become invisible by denying her feelings, needs, and relationships.
Disorganized attachment styles develop in what we would consider a chaotic system and are usually associated with trauma—either the infant/child experiencing this herself or the primary caregiver having unresolved trauma that gets passed on transgenerationally. These caregivers respond to the needs of their infants in a way that is frightening and unreliable. There can even be some form of emotional, physical, or sexual abuse that occurs. Their primary caregivers served simultaneously as both their safe haven and their source of danger, confusing the infant as to whether their caregiver was the protector or the person they needed protection from. The child learns that she is not safe, that others cannot be trusted, and that her world is confusing and disorienting. Often women who develop a disorganized attachment style demonstrate significant difficulties in relationships, confusing love with abuse, and are challenged to navigate their inner world as they often feel on edge and inherently unworthy.
How does this relate to food and disordered eating?
There have been a handful of studies (which you can read about in “Related Research,” below) on attachment styles and eating disorders, and the general findings show us that there is a correlation between insecure attachment styles and disordered eating behaviors, low self-esteem, anxiety, and depression. To take it a step further, I have conceptualized how attachment styles might manifest in eating disorder symptoms from my clinical experience. This theory isn’t always applicable, but I have seen a pattern of certain attachment styles manifest with specific eating behaviors. It’s important to note that while we are looking at eating disorders and disordered eating through an attachment lens, this is a much more complex and messy subject that doesn’t necessarily fall into such neat categories.
“Fullness, when we’re talking about physical sensation, can often replace the feeling of being full in relationships.”
Binge eating: I have found that often women who have a preoccupied/anxious attachment style will gravitate toward binge eating behavior. These are women who experience themselves as inadequate and are so afraid of being abandoned that they are left feeling empty inside. As a way to feel whole or full, the woman turns to food for comfort. The more you eat, the more full you feel. Fullness, when we’re talking about physical sensation, can often replace the feeling of being full in relationships. Similar to making plans with a friend, women who binge also make plans to do so. Often time is spent thinking about when the binge will happen and what foods will be consumed, planning their day around the binge, perhaps even avoiding certain foods prior to make the binge that much more fulfilling. There’s something to look forward to with a binge: You’re essentially meeting an old friend, someone who has always been there for you. You aren’t empty anymore; you feel full, so full perhaps that the discomfort distracts you from any other feelings you may have. After the binge is over, the woman will engage in self-criticism and shame, once again taking her away from the original experience of emotional pain that led to the binge in the first place.
Restricting: In conjunction with my anecdotal experience, research has also supported a correlation between women with dismissive attachment styles and those who restrict their food intake. These women tend to demonstrate more perfectionistic tendencies, which serves to keep them from feeling the messiness and depths of their emotions. She is usually the person who appears to have it all together and is incredibly self-reliant. She believes her needs will not be met by others, so she adapts by not asking for anything. A false sense of confidence may emerge, whereby she denies dependence on anyone or anything, including food. As a strategy, she diligently cuts ties with anything that nourishes her, also including food. When her world feels disordered, she’s the first to put it in order—restrict, cut back, and work out mathematical equations computing calories earned and calories burned. She dismisses relationships, needs, wants, feelings, and food intake.
“When her world feels disordered, she’s the first to put it in order—restrict, cut back, and work out mathematical equations computing calories earned and calories burned.”
Binge and purge/restrict/overexercise: In my practice, I have seen a number of clients who have experienced some form of trauma and subsequently fall into the category of disorganized attachment style. These are women who, as infants, were frightened by their primary caregivers and potentially suffered from abuse, neglect, or both. Because they were raised in an environment with such mixed signals and have not been able to distinguish between safe and unsafe relationships, they tend to be confused not just by others but by their own experiences as well. When a woman is not feeling certain whether she is hungry or satisfied, happy or disgusted, angry or sad, she might eat past capacity as a way to numb the emotional pain, and purge—i.e., vomit, take laxatives, obsessively exercise—in order to empty herself and feel nothing again. There’s a concept in therapy that we repeat what we don’t repair. As much as one may want to avoid and move past trauma, people often reenact it unconsciously in some capacity. With the binge-purge cycle, symbolically, women both want and fear food/love. They want to feel connected and satisfied in their relationships but also are disgusted or afraid of them. This makes sense in light of the fact that the person who represented love and safety—the caregiver—may have also been the abuser. She is always searching for a safe harbor, and neither bingeing nor purging makes her feel that she’s found one, so she vacillates between the two, trying to make sense of her experience.
Can you change your attachment style?
This is a difficult question, but my belief and experience tell me that for the most part, yes, it’s possible. Think about your attachment style as the hardware of a computer. This is what you’re working with as your base, and all the programs that are installed in the computer become your default mode. That being said, if you want to run different software, you have to buy new programs and install them. It takes resources—time, money, energy—and skill to do so. The same is true for attachment. This is what we call “earned secure attachment.” In other words, people who developed an insecure attachment style early in life, through healing relationships—therapy, friendships, or a romantic partner—worked toward a more secure attachment style. In therapy, this often develops when you have a therapist validate your experiences, serve as a secure base, have unconditional positive regard for you, be consistent, and, in a way, re-parent the wounded child within you.
To continue the computer analogy, if you think of the hardware as old or less than optimal (your primary attachment style), you can install newer software (earned secure attachment style) that will make the computer run more smoothly. But there still may be hiccups when a program shuts down unexpectedly or isn’t compatible with your computer. In relationships, while you can develop an earned secure attachment style, in times of distress, you may fall back into your default mode. But being mindful of your reactions and patterns will keep you operating from a more secure space.
How do you redefine your relationship with food and eating?
Recovery from disordered eating begins with understanding that the behavior was adaptive for some time. It served as a coping skill that kept you functioning in a system that supported it. It means having self-compassion—saying to yourself, “I did the best I could with what I have. Now I know better.” This goes hand in hand with therapy. Creating more space in your life where you can be connected to your emotional experience helps to dislodge the stranglehold that eating and dieting can have on you. Once you are able to feel your feelings authentically and have a safe environment to process and explore them, you will be able to honor them rather than hide from them. You will learn the difference between physical hunger and emotional hunger. You will be able to tend to the emotional pain rather than soothe yourself by inflicting physical pain, either starving or eating so much that you are uncomfortably full. In order to understand the behavior, you must understand what function it served.
“Recovery from disordered eating begins with understanding that the behavior was adaptive for some time. It served as a coping skill that kept you functioning in a system that supported it.”
Another piece of healing is reconnecting with your body and becoming familiar with the principles of intuitive eating. This means that you pay attention to what your body is needing and wanting and eating because you are physically, not emotionally, hungry.
What can kick-start positive body image?
While you should strive to love and appreciate and accept your body most of the time, I think it’s important to acknowledge that no matter how body-positive you are, it’s okay to still have days when you feel uncomfortable or desire something to be different. Your body changes throughout your life and therefore your relationship with your body changes with it. The goal, overall, is to create a loving relationship with your body. You get only one in this lifetime, so it’s a relationship that you want to nurture, not torture.
“No matter how body-positive you are, it’s okay to still have days when you feel uncomfortable or desire something to be different.”
Practice mindfulness. Having a more loving and positive relationship with your body begins with mindfulness, which means nonjudgmental, present awareness. It’s important to develop this skill because without this component, you aren’t able to tune in to how you’re really feeling, which is the key to unlocking underlying emotional pain. Additionally, being mindful also means being aware of when you engage in critical self-talk or body-shaming. Be careful of body checking. When you stare at yourself for an extra moment in the mirror or obsess over a photo you don’t like. It’s hard to reduce this behavior, but acknowledging that you’re doing it is a start.
Cultivate self-compassion and gratitude. This means not beating yourself up for what your body isn’t but appreciating and truly being grateful for what your body is and what it can do. Rather than, say, focusing on the size of your thighs, take a moment to express gratitude for the ability to walk or run or even read this article. It sounds simple, but this slight shift in perspective makes a big difference.
Quiet your inner critic. When you notice that you’re speaking unkindly to yourself, ask yourself these questions: 1) How do I feel when I speak to myself this way? 2) If I weren’t speaking to myself this way, how would I be feeling right now? 3) Whose voice is this? It’s not yours, even if you think it is. You learned this critical talk from somewhere. 4) What do I need in order to take care of myself right now?
Acceptance. So much of how we look is genetic and biological, and although there’s an illusion that we can control how we look by managing our weight, research has shown that we all actually have a set point, or a predetermined/preferred body weight range. What this means is that you must go to extreme means to fall below this range, to go against nature and where your body wants to live. When you accept that your body looks like this right now, even if you do want to change something about it, you move toward a healthier relationship with yourself. Shaming or punishing your body for not looking a certain way is self-abuse, and being angry that your body doesn’t look differently keeps you in a negative feedback loop.
Speak to yourself as you would speak to a friend. Would you say the things you say to yourself to a friend? When you feel the urge to criticize yourself for not looking a certain way, take a moment, take a breath, and pretend that you are talking to your best friend. How would you respond to her if you heard her speak to herself the way you’re speaking to yourself right now? Self-compassion is the antidote to shame.
Decrease time spent on social media. There have been numerous studies recently that have demonstrated the negative impact social media has had on society, causing more anxiety and depression. When you compare yourself to someone else’s curated or Photoshopped story, you are setting yourself up to feel inadequate. Rather than scrolling through your feed, reach out to a friend. Authentic human connection and interaction feel much more satisfying than passively observing someone else’s life.
Throw out your scale. Period.
What are helpful resources?
Therapy: Find a therapist you connect with. I cannot stress this enough. This is the crux of healing. It is within the therapeutic relationship that you can be re-parented and create a healthy, healing, and secure relationship. In therapy, you can process your core wounds, gain insight, and learn more adaptive coping skills. You can create an earned attachment style.
Dietitian: Often the in-depth, psychological, and emotional work you do with your therapist has nothing to do with the food itself. To reconnect with your body and physical hunger cues—noting they are different from emotional hunger—a dietitian will help you create a meal plan, provide psychoeducation on the importance of food and nutrients, and help reinvigorate your sense of appreciation and love of food rather than fear or disgust by it.
Intensive outpatient treatment/residential center: If you believe that your eating behaviors are getting in the way of leading a fulfilling life and/or your health is at risk, intensive outpatient or residential treatment may be appropriate. The severity of one’s eating disorder or disordered eating will dictate the type and length of treatment, but there are a number of reputable programs that have a multidisciplinary approach, which includes a medical doctor, a psychiatrist, a dietitian, an individual therapist, and a group therapist. They say it takes a village… [Editor’s note: As a starting point, see our guide to programs for healing eating disorders.]
Books on Eating
The Food and Feelings Workbook by Karen R. Koenig, L.C.S.W., M.Ed.
Life without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too by Jenni Schafer
When Food Is Love: Exploring the Relationship between Eating and Intimacy by Geneen Roth
Eating in the Light of the Moon: How Women Can Transform Their Relationship with Food through Myths, Metaphors, and Storytelling by Anita A. Johnston Ph.D.
Eating Mindfully: How to End Mindless Eating and Enjoy a Balanced Relationship with Food by Susan Albers, Psy.D.
Intuitive Eating: A Revolutionary Program That Works by Evelyn Tribole, M.S., R.D., and Elyse Resch, R.D., F.A.D.A.
Books on Attachment and Transformation
Attachment in Psychotherapy by David J. Wallin
A Secure Base: Parent-Child Attachment and Healthy Human Development by John Bowlby
Attachments: Why You Love, Feel, and Act the Way You Do by Dr. Tim Clinton and Dr. Gary Sibcy
Mindsight: The New Science of Personal Transformation by Daniel J. Siegel, M.D.
Traci Bank Cohen, Psy.D., is a licensed psychologist (PSY29418) and cofounder of Westside Psych, a group psychology practice located in West Los Angeles. Cohen provides individual, couples, and group therapy. She specializes in women’s issues, including eating disorders and disordered eating, maternal mental health, anxiety, depression, and self-esteem. Cohen uses an integrative approach to treatment which combines relational, emotion-focused, and evidence-based practices. In addition to her group practice, Cohen is an adjunct professor at Pepperdine University Graduate School of Education and Psychology.
The views expressed in this article intend to highlight alternative studies. They are the views of the expert and do not necessarily represent the views of goop. This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.