Insecure attachment and maladaptive schema in disordered eating: The mediating role of rejection sensitivity

Abstract

Aim: The current study aimed to assess insecure attachment and the disconnection and rejection domain of maladaptive schema in the context of disordered eating. Rejection sensitivity (RS) was proposed as a mediator between maladaptive schema and disordered eating.

Method: The sample consisted of 108 female participants with a lifetime eating disorder diagnosis and 508 female control participants. Participants were asked to complete a number of self-report measures related to insecure attachment (anxious and avoidant), maladaptive schema (emotional deprivation, abandonment, mistrust, social isolation, and defectiveness), RS (interpersonal and appearance-based), and disordered eating.

Results: Path analysis indicated that anxious attachment was associated with disordered eating through multiple pathways involving emotional deprivation, abandonment, interpersonal RS, and appearance-based RS. Avoidant attachment was not related to disordered eating behaviours.

Conclusion: The results indicate that both interpersonal and appearance-based RS are important mediators for the relationships between insecure attachment, maladaptive schema, and disordered eating.

Key practitioner message: The results from the current study suggest that insecure attachment leads to maladaptive schema, which in turn leads to sensitivity to rejection and subsequent disordered eating behaviour. Attachment anxiety, but not attachment avoidance, was related to greater endorsement of all five schemas in the disconnection and rejection domain. Path analysis revealed that, of the schema in the disconnection and rejection domain, only emotional deprivation and abandonment were related to disordered eating. Interpersonal and appearance-based rejection sensitivity were significant mediators of the relationship between emotional deprivation and disordered eating as well as the relationship between abandonment and disordered eating. Differentiating between schemas within schema domains has clinical value in further understanding the pathway to disordered eating. The schemas of emotional deprivation and abandonment are implicated in disordered eating, suggesting the need to target these schemas in schema therapy.

Keywords: appearance; disordered eating; eating disorder; path analysis; rejection sensitivity; schema.