Structural relationships among attachment insecurity, alexithymia, and body esteem in women with eating disorders

•We assessed the relations among attachment insecurity, alexithymia, and body esteem.•300 women with eating disorders completed pre-day hospital questionnaires.•Attachment anxiety was directly negatively related to body esteem.•Alexithymia mediated the relationship between attachment avoidance and body esteem.•Therapists may focus on attachment and affect regulation in eating disorder treatment.

Patients with eating disorders tend to experience low levels of body esteem. To assess the psychosocial processes that may predict low body esteem in these individuals, we assessed the structural interrelations among attachment anxiety, attachment avoidance, alexithymia, and body esteem in a cross-sectional sample of patients with eating disorders. We tested a model in which alexithymia mediates the relationship between attachment insecurity and body esteem. Participants were 300 women with anorexia nervosa (n = 109), bulimia nervosa (n = 130), and eating disorders not otherwise specified (n = 61) who completed pretreatment self-report questionnaires at intake for a day hospital treatment program. We found a direct and negative relationship between attachment anxiety and body esteem. Additionally, attachment avoidance had an indirect negative relationship to body esteem through alexithymia. These results indicate that therapists may attend to attachment insecurity and affective regulation strategies when addressing body image issues in patients with eating disorders.