European Psychiatry - Volume 41 - April 2017

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S552 25th European Congress of Psychiatry / European Psychiatry 41S (2017) S521–S582
by responding with adequate affective adjustment. High levels of
insecure attachment are present in adults with Eating Disorders
(EDs).
Objectives The variables that mediate the association between
attachment style and EDs have not been investigated enough. The
possibility exists that the endogenous stress response system is
involved.
Aims To appraise the role of the endogenous stress response
system, we studied the effect of attachment styles on the
hypothalamus-pituitary-adrenal (HPA) axis functioning in ED
patients.
Methods Fifty- two women with EDs and 25 healthy women
completed the ECR questionnaire to assess their attachment style.
Saliva samples were taken in the morning to measure the Cor-
tisol Awakening Response (CAR). Moreover, the saliva cortisol
response to the Trier-Social-Stress-Test (TSST) was measured in 30
ED patients and 15 healthy controls.
Results Patients with avoidant attachment showed an increased
CAR compared to both healthy controls and to patients with anx-
ious and secure attachment styles. In the initial TSST phase, cortisol
levels decreased in the secure attachment group but not in patients
with avoidant attachment. In the TSST stress response phase,
the cortisol raise was higher in insecure patients and delayed in
avoidant ones.
Conclusions In adults with EDs, attachment styles affect the HPA
axis functioning and this could have a role in the pathophysiology
of EDs.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0454
Insidious: The relationship between
patients and their eating disorders
and its impact on ED symptoms,
illness duration and self-image
E. Forsén Mantilla ∗ irgegård
Karolinska Institute, Department of clinical neuroscience, Stockholm,
Sweden
∗ Corresponding author.
Patients with eating disorders (EDs) often spontaneously talk about
their disorder in terms of a symbolic other (a demon, a voice,
a guardian). Further, externalizing exercises where patients are
encouraged to separate their true self from their ED self are
common in some treatment approaches. Yet, no previous quanti-
tative study has investigated this phenomenon. We examined the
patient-ED relationship (using the interpersonal structural analysis
of social behavior methodology) and its implications for ED symp-
toms, illness duration and self-image. Participants were 16–25
year old female patients (N = 150) diagnosed with anorexia nervosa
(N = 55), bulimia nervosa (N = 33) or eating disorder not otherwise
specified (N = 62). Results suggested that patients had compre-
hensible and organized relationships with their EDs. EDs were
primarily experienced as acting critical and controlling towards
patients. Higher ED control was associatedwithmore ED symptoms
and longer illness duration, especially when coupled with patient
submission. Patients reacting more negatively towards their EDs
than their EDs were acting towards them had lower symptom lev-
els and more positive self-images. Externalizing one’s ED, relating
to it like a symbolic other, seemed to make sense to patients and
depending on its quality seemed to influence ED symptoms, illness
duration and self-image. We put forward both clinical and theo-
retical implications based on the assumption that the patient-ED
relationship may function in similar ways as real-life interpersonal
relationships do.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV0455
Anorexia nervosa and attachment
H. De la Red Galleg ∗ lonso Sánchez
A. Álvarez Astorga ómez Sánchez odríguez Andrés
S. Cepedello Pérez De Lorenzo Calzón De Uribe Viloria
M. Gómez García odríguez Campos
F. De Uribe Ladrón de Cegama
1 Clinical Universitary Hospital, Valladolid, Psychiatry Department,
Tudela de Duero, Spain
2 Clinical Universitary Hospital, Valladolid, Department of Psychiatry,
Valladolid, Spain
3 Clinical Universitary Hospital, Valladolid, Psychiatry, Valladolid,
Spain
4 Clinical Universitary Hospital, Valladolid, Department of Psychiatry,
Tudela de Duero, Spain
∗ Corresponding author.
Introduction Attachment is an innate programming whereby a
child seeks for security. There is scientific and empirical evidence
that insecure attachment is usual in eating disorder patients
Objectives To highlight the relevance of attachment between
child and caregivers, as well as its significance in therapeutic
approach.
Methods A 17-year-old girl hospitalized after attending to
emergency department due to fainting. BMI: 12.89. She reports
restrictive behavior since age 11 that her mother regards as “child
issues”. Divorced parents, she grew up with her mother, diagnosed
of hypochondria, who mentions not understanding why she is not
the one who is hospitalized.
Results During hospitalization, she turned 18-years-old.
Guardianship of her younger siblings was removed to her
mother. She had a secure relationship with her 24-year-old sister,
so she decided to move in with her. Later on, she had a positive
progress, maintaining the gained weight and mood stability,
although cognitive distortions persist.
Conclusions Among developmental and maintaining factors of
eating disorders, impaired attachment is becoming increasingly
interesting. Even though the main goal of treatment is weight
restoration, exploring attachment patterns can facilitate to achieve
that aim. This clinical case emphasizes the importance of attach-
ment in eating disorders among child and young adults.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
Reference
[1] Münch AL, Hunger C, Schweitzer J. An investigation of the
mediating role of personality and family functioning in the asso-
ciation between attachment styles and eating disorder status.
BMC Psychol 2016;4:36.
EV0456
Immunity and eating disorders.
Clinical description of a case
M.D.H. Gallego ∗ lvarez Astorga Alonso Sánchez
R. Hernández Antón , E. Mayor Toranzo , I. Sevillano Benito ,
M.S. Hernández García , M.S. Geijo Uribe ,
F. De Uribe Ladrón de Cegama
1 Clinical Universitary Hospital, Valladolid, Psychiatry Department,
Tudela de Duero, Spain
2 Clinical Universitary Hospital, Valladolid, Psychiatry Department,
Valladolid, Spain
∗ Corresponding author.
Introduction Recently, there is an increasing interest in the link
between anorexia nervosa and autoimmune diseases. Studies show