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Psychiatry Res. 2014 Jan 30;215(1):176-84. doi: 10.1016/j.psychres.2013.10.039. Epub 2013 Nov 18.

Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: a latent mediated and moderated structural equation modeling analysis across diagnostic groups.

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Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Department of Psychiatry, S. Gerardo Hospital, Monza, Italy; Clinical and Health Psychology Unit, San Raffaele Hospital, Milan, Italy. Electronic address:
Behavioral and Social Sciences Department, University of the Sciences, Philadelphia, PA, USA.
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Catholic University, Rome, Italy; Department of Psychiatry, A. Gemelli, University General Hospital, Rome, Italy.
Department of Psychology, University of Milano-Bicocca, Milan, Italy; Personality Disorder Lab, Milan, Italy.
Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, London, United Kingdom.
Faculty of Psychology, Catholic University, Milan, Italy; Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy.
Department of Psychiatry, S. Gerardo Hospital, Monza, Italy; Department of Neurosciences and Biomedical Technologies, University of Milano-Bicocca, Milan, Italy.


Although 96-100% of individuals with eating disorders (EDs) report insecure attachment, the specific mechanisms by which adult insecure attachment dimensions affect ED symptomatology remain to date largely unknown. This study examined maladaptive perfectionism as both a mediator and a moderator of the relationship between insecure attachment (anxiety and avoidance) and ED symptomatology in a clinical, treatment seeking, sample. Insecure anxious and avoidant attachment, maladaptive perfectionism, and ED symptomatology were assessed in 403 participants from three medium size specialized care centres for EDs in Italy. Structural equation modeling indicated that maladaptive perfectionism served as mediator between both insecure attachment patterns and ED symptomatology. It also interacted with insecure attachment to predict higher levels of ED symptoms - highlighting the importance of both insecure attachment patterns and maladaptive aspects of perfectionism as treatment targets. Multiple-group comparison analysis did not reveal differences across diagnostic groups (AN, BN, EDNOS) in mediating, main and interaction effects of perfectionism. These findings are consistent with recent discussions on the classification and treatment of EDs that have highlighted similarities between ED diagnostic groups and could be viewed through the lens of the Trans-theoretical Model of EDs. Implications for future research and intervention are discussed.


Attachment anxiety; Attachment avoidance; Eating disorders; Mediator; Moderator; Perfectionism; Structural equation modeling

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