Attachment theory, metacognitive functions and the therapeutic relationship in eating disorders

J. Bowlby's attachment theory is used to explore a fundamental motivational force in human behaviour, namely the search for physical and emotional protective intimacy according to an integrated viewpoint remote from Freud's drive-based approach. This theory has received contributions from ethology, the neurosciences, psychoanalysis, cognitive psychology and evolutionary epistemology. Attachment patterns or styles express both the mental and behavioural strategies adopted by individuals to cope with their attachment needs, and their relational history in this area. Experiences of adequate quality promote metacognitive functions, namely a set of mental processes whose role is to protect the individual from psychopathological suffering and construct and articulate a sense of self. Attachment theory and metacognition are the underlying assumptions of reflections on the dynamics marking the development of sometimes very difficult relationships between therapists and eating disorder (ED) patients, who are being increasingly classed as "severe patients" on account of their interpersonal characteristics.