Body Image Issues 1/5: Early Attachment

As a psychotherapist, a chartered psychologist, a trustee of the Body Dysmorphic Disorder Foundation and a person with lived experience of eating struggles, I have written this blog series in the hope of sharing what I believe to be some key considerations when working with people experiencing body image struggles – including clinical diagnoses like eating disorders and body dysmorphic disorder (BDD).

In future blogs we will look at shame, sense of self, and the sensory and nervous systems. But I want to begin our exploration with the primary attachment relationship, because our earliest caregiving experiences offer a template for all relational connections and, importantly, for our sense of self. It is through these primary attachment relationships that we build our internal working models, learn how to self-regulate our emotions and acquire the foundations for our felt identity. In over 20 years of lived and clinical experience, I am yet to meet or work with someone experiencing these struggles for whom a consideration of early attachment relationships has not been beneficial and elucidating.

Early caregiving and attachment – the basics

Within good enough caregiving the true self of the infant is celebrated and enabled to flourish. The caregiver takes in and offers back the infant’s emotional states to the infant in a more digestible form, while their balanced nervous system informs the development of the robust nervous system of the infant. A secure attachment is present.

When there is an insecure and/or disorganised attachment pattern between the primary caregiver and infant, the true self of the infant can be quashed. A false self may emerge from the dread of losing connection with the caregiver, a dread synonymous with the fear of physical and emotional death. Infants will do everything in their power, including laying aside their true self if necessary, to keep their caregiver close; to feel soothed and safe: to survive.

How does this link to our relationship with our body and with food?

In infancy, we find ourselves in the gaze of our primary attachment figure(s). If this gaze is frightening or ‘blank’, we may later seek to find ourselves in other ‘mirrors’, such as in the looking glass. If our early relational experiences have been less than affirming, we are likely to find ‘more of the same’ wherever we look, including finding more fear, disgust, ambivalence, scrutiny etc. within the mirror. In essence, we find a false self there.

Within eating disorders, the relationship with food can be seen as a mirror for the insecure early attachment relationship. This is because, to the infant, the primary caregiver is synonymous with the taking in of food.

A rejection of this food, as in the case of anorexia, can be understood as a rejection of the ongoing and painful symbiosis (a developmental stage in which the infant experiences the caregiver not as a unique entity but as the source of need-satisfaction) with the early caregiver and conceptualised as an insecure-avoidant attachment.

Oscillation between desperately taking in food then rejecting (purging) it, as in bulimia, can be conceived as a manifestation of an insecure-ambivalent attachment. The person desperately yearns to take the caregiver in, while simultaneously defending themselves against the symbiosis: a tension between the ‘attach’ and ‘defend’ drives.

People who have experienced disorganised attachments, on the other hand, may find themselves moving painfully between extreme ways of relating to food – perhaps including consuming unpalatable food items like frozen bread – and eating to the point of physical danger to the self.

How can we work with this in therapy?

Exploring early attachment relationships with our clients is a complex process. This is because these experiences are predominantly non-verbal and live in the procedural, implicit memory. Systemic family therapy, with the inclusion of multiple generations where possible, can be incredibly beneficial, as can the sensitive creation of Genograms.

Somatic practices which tap into the ‘silent talk’ of the body are also helpful as this is where early relational experiences sit, beneath the level of conscious awareness.

Much will also be revealed to us about our clients’ attachment histories within the transference / countertransference. As therapists, we often find ourselves in the position of second-chance attachment figures for these clients – so I can’t over-emphasise the importance in this work of us having awareness around our own attachment histories and their possible ongoing resonances.

With repeated experiences of attunement and containment, our clients can (re)-discover their capacity for autoregulation, negating the compulsion to turn to self-soothing feeding and associated practices. Clients can also be supported to move through the process of individuation and to move beyond their fawning position of laying aside their needs to stay close to others, particularly to attachment figures. In this way they can re-find the essence of their true self, wherein there is a respect, even love, for the physical body, including its appearance.

In my next blog, in January, I will be considering the role of shame in body image struggles, including a foray in to the psychobiology of early shame experiences.