ABSTRACT

This thesis is drawing upon regulation theories rooted in attachment theory in the exploration of how maladaptive emotion regulation contributes to the development of bulimic symptoms and what the clinical implications for individual psychotherapy are of this. The exploration of the research questions is divided in three parts.

First a review of the research into bulimia and emotion regulation that documents a connection between the two phenomena and between bulimia and insecure attachment is presented. Four signs of maladaptive emotion regulation in bulimic populations are identified. These are a high occurrence of negative emotions, an increased occurrence of alexithymia, a limited mentalization ability and a tendency to experiential avoidance.

In the second part signs of maladaptive emotion regulation are related to the symptoms of bulimia in a theoretical exploration based on the work of Peter Fonagy and Allan N. Schore. It is demonstrated how the unsecure attachment patterns avoidant and ambivalent are connected to different forms of maladaptive emotion regulation that in varying ways make the individual vulnerable to using bulimic symptoms as a primitive form of self regulation.

In part three the clinical implications of an etiological understanding of bulimia as connected to maladaptive emotion regulation are presented based on the exploration in part two and recommendations to clinical practice according to Fonagy and Schore. It is described how treatment informed by regulation theory will focus on the therapist’s emotional and verbal regulation of emotions that causes the client regulatory difficulties. These interventions are assumed to improve the client’s ability to emotion regulation. Depending on attachment patterns clients will need to develop different aspects of the skills involved in adaptive emotion regulation.

Finally the evidence based treatment methods for bulimia – cognitive behavioral therapy and interpersonal psychotherapy – are presented shortly with the purpose to discuss how the etiological and clinical contributions of regulation theory can qualify psychotherapeutic treatment of bulimia. From the definition of emotion regulation in this thesis the evidence based treatment methods also work with emotion regulation, but different kinds of therapy concentrates on varying levels in the regulation process. It is argued that emotion regulation must be understood in an attachment perspective since different therapeutic methods and interventions can have their justification in different phases of therapy depending on the client’s attachment pattern and the related form of maladaptive emotion regulation.