Eating disorder is one of the most common psychological disorders among female adolescents. It is considered, along with other psychological disorders such as agoraphobia, depression, and obsessive-compulsive disorders, as a disorder that has a strong relationship with parental attachment (1). Researchers to date seem to agree that families with adolescents with eating disorders tend to have insecure parental attachment style (4 9 12). However, the relationship between the attachment style and the development of eating disorders is not so simple; there are many other variables interrelated with each other. In this paper, some of the important variables among them will be discussed as well as parental attachment. The other variables include: separation-individuation, family dysfunctions, gender roles, and issues involving transitions of environment most adolescents experience.
As an individual gets older and starts to explore the world outside of one's own family, one eventually starts to develop self-identity separate from his or her family (3). Unlike a self-identity of children which is closely tied to the child's perceptions of relation to his or her family members, that of adolescents involves a sense of separate entity from their parents and other family members. This process of achieving independent self-identity is called separation-individuation and thought to play an important role in the development of eating disorders (3 6 9 12). The problems with this process are thought to have an influence on adolescents' psychological development, increasing the risks of cognitive, affective, and behavioral problems such as eating disorders (6). This is a traditional model of psychoanalytic theory, which originally involved attachment to and separation of infants from their mothers 6). Today, this model has a broader sight of attachment and separation involving not only infants, but also adolescents and even adults. It holds the view of continuity that emphasizes the importance of early experience and the persistent influence of the experience on various aspects of life, such as intime relationships, expressiveness of feelings, and self-esteem, in adolescence and adulthood.
One of the components of separation-individuation that seems to be of the greatest importance in understanding the development and maintenance of eating disorders is conflictual independence (9). This type of independence involves not having excessive guilt, responsiblity, anger, and distrust toward parents. Adolescents who have an insecure attachment to their parents are likely to have these negative feelings toward their parents and, since insecure attachment is characterized by a lack of involvement and open communication about feelings of family members, the negative feelings of adolescents are not expressed to their parents, staying in their minds without being solved (11). These supressed affective expressions of adolescents as well as other family members lead the adolescents to have lower conflictual independence and more separation-individuation difficulties (7 9). Adolescents with eating disorders may be expressing their repressed feelings toward parents by self-destructive ways of binging, purging, and fasting (9). In particular, adolescents with anorexia nervosa tend to have parents who do not express their negative feelings openly, which does not provide the adolescents a proper model of successful conflict solving; rather, a self-destructive model is presented to them (12).
Insecure parental attachment may also lead adolescents to separation-individuation difficulties by making adolescents fail to develop thier identity separate from relation to others. Adolescents with insecure parental attachment experience distrust toward their parents and fear and anxiety of being rejected by them at the same time (6 11). As a consequence, these adolescents tend to worry more about relationships and have lower self-confidence (3 8 11). Their main focus in developing self-identity becomes how they act and who they are in relation to others, especially parents, and consequently, they have difficulties achieving independece and autonomy aside of their relationships with thier parents.
There may also be a direct relationship between insecure parental attachment and separation-individuation difficulties. Parents with insecure attachment with their adolescent child may be less liklely to encourage the exploration of independence and autonomy of their child than parents with secure attachment and, in some cases, they may actually be interfering with the independence of their child (6 9). Therefore, adolescents who have an insecure attachment with their parents may have more difficulties establishing their independent identity and autonomy separate from their parents whan adolescents whoh ave secure attachment with thier parents. SInce a family of adolescents with eating disorders tends not to encourage independence of them (4 8 9), and female adolescents with eating disorders tend to have diminished sense of individuality (3), the development of eating disorders may then be the maladaptive form of searching autonomy and self-identity of the adolescents, who do not know how they can achieve them or who are not permitted to do so by their parents (12)>
One of the common characteristics of the families of adolescents with eating disorders is role reversal of a parent/parents and a daughter (8 9 12). In such afamilies with role reversal, at least one parent tries to place a priority on his or her own need over a child's needs; whereas, a daughter, instead of parents, provides emotional support for one or both parent(s), usually her mother (4 12). The adolescent daughter needs to set aside her own needs and wants for that of her pearnts'. Although role reversal does not characterize inseucre parental attachment, this reversal in role does increase the likelihood of adolescents' separation-individuation difficulties (9), which may eventually increase the likelihood of developing eating disorders (3 6 9 12).
Parental attachment can also be interfered with significantly by problems and dysfunctions of a family, such as incest and alcoholism of parents. A family with higher levels of dysfunction is more likely to have insecure parental attachment thana family with lower levels of dysfunction, primarily due to the denial and distortion of family members around the dysfunction (8 10). Moreover, the dysfunctions of a family interfer with the adolescents' development of social competencies, such as personal effectiveness and control in interpersonal relationships (8). Since women with eating disorders tend to lack social competencies, female adolescents who have been going through family dysfunction may develop eating disorders in order to compensate for a lack of perceived personal effectiveness and the ability to regulate strong emotions (8). Even though most women who went through family dysfunction during adolescence did not develop eating disorders, since incidents of child abuse and battering are common family history of adolescents with eating disorders, the relationship should not be overlooked 4).
Gender Role and Transition
Another aspect of the relationship between parental attachment and eating disorders is the issue of gender role and transition which most female adolescents experience. While women are socialized to value interpersonal relationships and to develop their self-identity in relation to others, female adolescents also experience pressures toward autonomy and independence as one oft he developmental tasks to be achieved (2 6 9). This conflict is likely to lead female adolecents to the state of identity confusion, according to the psychosocial theory.
This confusion of female adolescents about thier self-identity is, moreover, encountered by further distress of the changes in the environment that most late adolescents must experience after graduating high school. In the transition from high school to other social environments, male adolescents are more likely to be emotionally well-adjusted than female adolescents (11) and female adoelscents tend to need more emotional support from their parents than male adolescents do possibly because women are socialized to seek support during stressful life events while men are socialized to solve the problem on their own (2 5). Calloni and Handal (1992) found, in their reserach of gender differences regarding the level of parental attachment, that women tend to maintain connectedness to thier mother over time while men's maternal attachment decreased. Not only do women maintain their attachment to parents, but the level of attachment actually seems to increase just after the graduation of high school, especially when they start college life (2 5). This increase in attachment may be interpreted as a response to increased psychological distress due to the environmental changes.
In the state of the conflict and distress brought by confusing female gender roles and socialization and environmental changes, parental attachment style plays a role in the level of adjustment for female adolescents (11). While parental attachmet style does not influence men's adjustment as much as it does on females' adjustment, secure parental attachment leads to better adjustment in the new environment for female adolescents than insecure parental attachment (1 6 11). Since women tend to experience more worry, anxiety, and depression than men do (11), they may need more secure attachment and emotional support during stressful time of life than men do. Although these studies were conducted without any specific intention to assess adolescents with eating disorders, it seems reasonable to generalize the results of them to the extent that the distress involving gender role, socialization, and transition experienced during late adolescence may have an impact on the development of eating disorders among female adolescents.
Parental attachment, especially during adoelscence when an individual starts to achieve one's self-identity and self-awareness, must serve functions of both consistent emotional support and facilitation of independent exploration of adolescents (5 6 7 11). It is neither dependency nor neglect; it has both aspects of support and autonomy depending on adolescents' states of mind and environment since attachment has an adaptive functioning to the development of adolescents and their changing environment. Parents should place priority on their adolescent child and excessive closeness as well as disengagement is dysfunctional (5). Achieving the balance between individuation and connectedness is the most important in order for adolescents to develop healthy psychological functioning.