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Participants completed questionnaires evaluating ED psychopathology (Eating Disorders Examination Questionnaire) and body uneasiness (body uneasiness test). For the assessment of adult attachment, the Experiences in Close Relationships\u2010Revised was administered at baseline. Bivariate latent change score analysis within the structural equation modeling framework was performed to investigate the evolution of ED psychopathology and body uneasiness, their longitudinal interplay, and the role of attachment style as an outcome predictor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After treatment, all psychopathological features showed an overall improvement. Higher baseline levels of body uneasiness predicted a worse course of ED psychopathology. The change in body uneasiness over time depended on changes over time in ED psychopathology, but not vice versa. Insecure attachment predicted a worse longitudinal trend of ED psychopathology, and, through this impairment, it indirectly maintained higher levels of body uneasiness, as confirmed by mediation analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The role of attachment insecurity as a predictor of treatment outcome suggests the need for an integration of the cognitive\u2010behavioral conceptualization of EDs with a developmental perspective that considers attachment\u2010related issues.<\/jats:p><\/jats:sec><jats:sec><jats:title>Public significance statement<\/jats:title><jats:p>Considering the burden of EDs in terms of public health and the unsatisfactory response to standard treatments, the identification of outcome predictors is of considerable clinical interest. This study demonstrated that attachment insecurity was associated with worse longitudinal trends of ED psychopathology and body uneasiness in patients with AN and BN treated with CBT\u2010E, highlighting the importance of personalizing treatment programs taking into account a developmental perspective on these disorders.<\/jats:p><\/jats:sec>","DOI":"10.1002\/eat.23762","type":"journal-article","created":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T12:17:25Z","timestamp":1655986645000},"page":"1054-1065","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Attachment insecurity predicts worse outcome in patients with eating disorders treated with enhanced cognitive behavior therapy: A one\u2010year follow\u2010up study"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4755-3879","authenticated-orcid":false,"given":"Eleonora","family":"Rossi","sequence":"first","affiliation":[{"name":"Psychiatry Unit, Department of Health Sciences University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3623-7096","authenticated-orcid":false,"given":"Emanuele","family":"Cassioli","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Health Sciences University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Martelli","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Health Sciences University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Melani","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Health Sciences University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3933-1766","authenticated-orcid":false,"given":"Vivienne M.","family":"Hazzard","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Behavioral Sciences University of Minnesota Medical School  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross D.","family":"Crosby","sequence":"additional","affiliation":[{"name":"Sanford Center for Biobehavioral Research  Fargo North Dakota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0659-153X","authenticated-orcid":false,"given":"Stephen A.","family":"Wonderlich","sequence":"additional","affiliation":[{"name":"Sanford Center for Biobehavioral Research  Fargo North Dakota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valdo","family":"Ricca","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Health Sciences University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1265-491X","authenticated-orcid":false,"given":"Giovanni","family":"Castellini","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Health Sciences University of Florence  Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23206"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.nmd.0000235795.51683.99"},{"key":"e_1_2_11_5_1","first-page":"321","article-title":"Eye movement desensitization and reprocessing (EMDR) and eating disorders: A systematic review","volume":"14","author":"Balbo M.","year":"2017","journal-title":"Clinical Neuropsychiatry: Journal of Treatment Evaluation"},{"key":"e_1_2_11_6_1","first-page":"265","article-title":"The confluence of perfectionism, body dissatisfaction, and low self\u2010esteem predicts bulimic symptoms: Clinical implications","volume":"31","author":"Bardone A. 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