Attachment, mentalizing, and eating disorder symptoms in adolescent psychiatric inpatients and healthy controls: a test of a mediational model

Objective Research has supported a link between insecure attachment and eating disorders (EDs) in adolescents; however, mechanisms accounting for this association remain unclear. Growing evidence suggests impaired mentalizing as a potential mechanism. Yet, little is known about the relationship between mentalizing and ED symptoms or how it relates to the link between attachment and EDs in adolescents. This study examined mentalizing deficits in adolescents with ED symptoms relative to psychiatric and healthy controls and tested a mediational model, wherein mentalizing capacity mediates the relationship between attachment and ED symptoms. Method Inpatient adolescents with EDs and other pathology ( n = 568) and healthy controls ( n = 184) were administered the child attachment interview, the movie for the assessment of social cognition and the diagnostic interview schedule for children to assess attachment, mentalizing and ED symptoms, respectively. Results Inpatients showed lower attachment security and more hypermentalizing than healthy adolescents. Hypermentalizing explained the association between insecure attachment and ED symptoms. Conclusions These findings suggest potential utility of targeting mentalizing in prevention and treatment of EDs in adolescents. Level of evidence Level III, case-control analytic study.