Self-body relations: attachment, maladaptive schemas, and emotion regulation in eating disturbances

Self-concept deficits and difficulties with emotion have long been implicated in the development and maintenance of eating disorders (ED). This thesis aimed to integrate various emotion-regulation, self-regulation, and sociocultural models of ED pathology within an overarching framework of attachment theory. Such an integrated ‘self/emotion-regulation model’ of ED pathology posits that negative feelings about the self and unexpressed emotions are displaced onto the body and that ED pathology represents the maladaptive function of attempting to manage these painful internal experiences and to enhance self-worth via the body and achievement of idealised standards. This integrated self/emotion-regulation model was explored in a series of four studies using two distinct heterogeneous samples of women. In accordance with emotion-regulation models of ED pathology, the first study explored the roles of various forms of emotional inhibition (negative beliefs about emotion, ambivalence over emotional expressiveness, silencing-the-self and divided-self schemas), in individually and uniquely explaining variance in ED pathology and examined the possible mediating and moderating role of negative emotionality in the associations between each form of emotional inhibition and ED pathology. The second study then investigated the direct and indirect roles of a number of emotion regulation strategies (reappraisal, suppression, rumination, reflection, and emotional reflection), negative beliefs about emotion, negative emotionality, and depressive symptoms in contributing to variance in ED pathology within path models. In testing features of the integrated self/emotion-regulation model of ED pathology, the third study explored the role of feelings of low self-worth (internalised shame and low self-esteem), externalised self-perceptions (self-objectification and body surveillance), body shame, and depressive symptoms in directly and indirectly contributing to variance in ED pathology. Finally, the fourth study investigated the structural associations among insecure attachment styles (anxiety and avoidance), defectiveness/shame schemas, emotional inhibition, unrelenting standards (perfectionism), body shame, depressive symptoms and ED pathology within a path model. The results need to be interpreted with some caution due to a number of limitations, the most notable of which is the use of cross-sectional designs. Nevertheless, taken together the current findings provide preliminary support for an integrated self/emotion-regulation model of ED pathology grounded in attachment theory. Specifically, in support of emotion regulation models of ED pathology, findings suggest that various forms of emotion inhibition (in particular, negative beliefs about emotion), and other maladaptive emotion-regulation strategies serve to increase the experience of negative emotion, which in turn may trigger ED pathology as a means of alleviating this experience. In support of self-regulation models of ED pathology, findings suggest that negative feelings about the self (low self esteem, internalised shame) are externalised (via increased self-objectification and body surveillance) and displaced onto the body, thereby increasing body shame and giving rise to depressive symptoms and ED pathology. Finally, within a broad self/emotion-regulation model, findings suggest that insecure attachment styles contribute to negative feelings about the self (defectiveness/shame), emotional inhibition, and unrealistically high standards, which are externalised onto the body (in the form of body shame), and thereby contribute to depressive symptoms and ED pathology. Such evidence highlights the need for therapeutic interventions for young women with EDs to also address underlying difficulties with insecure attachment, feelings of low self worth, difficulties with emotion regulation and other maladaptive schemas in order to enhance the efficacy of current treatments and improve therapy outcomes.