Preoccupied but not dismissing attachment states of mind are associated with nonsuicidal self-injury

Scripted attachment representations of current romantic relationships: measurement and validation

This report describes the development and validation of a new coding system for the Current Relationship Interview (CRI) that assesses individual differences in secure base script knowledge with respect to adult romantic partners. Drawing on data from the Minnesota Longitudinal Study of Risk and Adaptation (N = 116) a coding system was developed to parallel the secure base script coding system for the Adult Attachment Interview. Specifically, CRIs conducted in adulthood were re-coded for the extent to which the interviews reflected script-like expectations that romantic partners are available and provide effective support in times of distress (CRIsbs). CRIsbs was moderately associated with the traditional coding system for the CRI and showed concurrent and/or predictive validity in relation to observed and self-reported romantic relationship quality as well as interview ratings of the effectiveness with which adults engaged in romantic relationships. Theoretical and practical benefits of the CRIsbs coding system are discussed.

A longitudinal study of adolescents engaged in Non-Suicidal Self Injury (NSSI): clinical follow-up from adolescence to young adulthood

The main aim of the current study is to examine the demographic and clinical factors that predict a continuity of the use of Mental Health Services (MHS) in adulthood by subjects who have engaged in non-suicidal-self-injury behaviors (NSSI) and have been followed in MHS in their teen years. A cohort of 147 participants was selected from an original sample of 267 adolescent patients recruited from the Child and Adolescent Outpatient Psychiatric Services. Patients were divided into two groups: those who had engaged in NSSI (NSSI-group), and those who had not (non-NSSI-group). Rate of use of MHS in adulthood was calculated for both groups and univariate analyses and binary logistic regression analysis were applied. In the NSSI-group, two factors appeared to influence a continuity of the use of MHS in adulthood. Prosocial behavior was associated with a greater use of MHS in adulthood whereas behavioral problems were associated with less use. Only prosocial behavior was maintained in the regression model as a predictor. Our findings could have implications for clinical practice with NSSI patients and highlight the importance of working on specific areas that could prevent treatment abandonment in the transition from adolescence to adulthood.

Profiles of Emotion Dysregulation Among University Students Who Self-Injure: Associations with Parent-Child Relationships and Non-Suicidal Self-Injury Characteristics

More research is needed to understand the different vulnerability profiles of university students who engage in non-suicidal self-injury (NSSI). This study sought to classify university students (n = 479; 83.8% female) aged 17-25 years (M = 18.77; SD = 1.42) who had engaged in NSSI within the past year into latent profiles based on their self-perceived difficulties in regulating both positive and negative emotions. Independent samples of students who had a past history of NSSI but had not self-injured within the previous year (n = 439; 82.9% females; M_age = 19.03, SD = 1.62) and who had no history of NSSI (n = 1551; 69.9% females; M_age = 19.02, SD = 1.55) were recruited for comparison purposes. Latent cluster analyses revealed three emotion regulation profiles within the NSSI sample-the Average Difficulties (47.4%), Dysregulated (33.0%), and Low Difficulties (19.6%) profiles-each of which differed meaningfully from both comparison samples on mean emotion regulation difficulties. Students across profiles also differed in their self-reported experiences with parents, particularly with fathers (pressure, antipathy, unresolved attachment, psychological control), and in the extent to which they felt alienated from parents. Lastly, students across profiles differed in the frequency, methods, functions, and addictive properties of their NSSI. Findings highlight that university students who self-injure experience distinct patterns of difficulties with emotion regulation, which are associated with variation in parent-child relational risk factors and NSSI outcomes.

Attachment-Related Representations and Suicidal Ideations in Nonsuicidal Self-Injury Adolescents with and without Suicide Attempts: A Pilot Study

OBJECTIVES

Consistent with the debate surrounding the association between nonsuicidal self-injury (NSSI), suicidal intent, and suicidal behavior, and between NSSI and dysregulation processes, we attempted to analyze suicide intent and emotion dysregulation in NSSI adolescents, in the framework of the attachment representations and exploring these clues of emotion dysregulation characteristics of insecure attachment. Furthermore, we intended to focus on these attachment-related segregated systems regarding death and suicidal ideations, to explore how differently they would characterize self-injuring adolescents with and without suicide attempts.

METHODS

Thirty-four NSSI inpatient adolescents, 17 with suicide attempts, 17 without suicide attempts, and 17 healthy controls (age 11-17) were assessed using Adult Attachment Projective, which allows for the classification of attachment status and related emotion dysregulation and segregated systems.

RESULTS

The majority of the NSSI group with and without suicide attempts showed unresolved (disorganized) attachment-related representations and clues of damaged reflective functions, whereas only the NSSI with suicide attempts showed clues of impaired interpersonal relationships. The two clinical groups used words expressing suicidal intent, whereas the healthy group did not.

CONCLUSIONS

Therapists are encouraged not to underestimate suicidal ideation in NSSI regardless of whether or not they have already attempted suicide.

Suicidality in the elderly: Role of adult attachment

Attachment styles reflect interpersonal relationship patterns in many ways. Although there is increasing evidence regarding the relationship between attachment styles and suicidality in adults, few studies have been conducted among the elderly population. Present study aims to investigate the link between attachment style and risk of suicidality in elderly people. A secondary analysis of cross-sectional data among geriatric outpatients at psychiatric clinics in Thailand with respect to whether patients had depressive disorders according to DSM-IV by using Mini-Neuropsychiatric Interviews (MINI). MINI-Module C was used to assess suicidality. Other measures included the experience of close relationship questionnaire and a brief cognitive assessment, Mental Status Examination T10. One-hundred and ninety-one elderly people were included, 50.8% females and 119 (62.3%) had depressive disorder. Anxiety attachment predicted suicidality, determined with questions related to the following areas; "want to hurt myself", "suicidal ideation", "suicidal planning", and "suicidal attempted in lifetime". Anxiety attachment style was significantly increased the level of suicide risk. We concluded that high anxious attachment, such as preoccupied attachment style, was associated with suicidality in elderly people. Further investigation focusing on variables associated with attachment and suicidality, particularly depression or anxiety, is warranted.

Physical pain recruits the nucleus accumbens during social distress in borderline personality disorder

Patients with borderline personality disorder (BPD) often engage in dangerous self-injurious behaviors (SIBs) as a maladaptive technique to decrease heightened feelings of distress (e.g. negative feelings caused by social exclusion). The reward system has recently been proposed as a plausible neural substrate, which may influence the interaction between social distress and physical pain processing in patients that engage in SIBs. Using functional magnetic resonance imaging (fMRI) in 20 adult BPD patients with a history of SIBs and 23 healthy controls (HCs), we found a hyper-activation of the nucleus accumbens (NAcc) and amygdala when painful stimuli were presented to BPD patients (but not HCs) in a state of heightened distress, induced via social exclusion. This differential NAcc activity was mediated by anxious attachment style, which is a key developmental feature of the disorder. Altogether, these results suggest a neural mechanism underlying the pathophysiology of SIBs in these patients, which is likely reinforced via the reward system.

Attachment states of mind among internationally adoptive and foster parents

The first aim of the current study was to examine the latent structure of attachment states of mind as assessed by the Adult Attachment Interview (AAI) among three groups of parents of children at risk for insecure attachments: parents who adopted internationally (N = 147), foster parents (N = 300), and parents living in poverty and involved with Child Protective Services (CPS; N = 284). Confirmatory factor analysis indicated the state of mind rating scales loaded on two factors reflecting adults' preoccupied and dismissing states of mind. Taxometric analyses indicated the variation in adults' preoccupied states of mind was more consistent with a dimensional than a categorical model, whereas results for dismissing states of mind were indeterminate. The second aim was to examine the degree to which the attachment states of mind of internationally adoptive and foster parents differ from those of poverty/CPS-referred parents and low-risk parents. After controlling for parental age, sex, ethnicity, and socioeconomic status, (a) internationally adoptive parents had lower scores on the dismissing dimension than the sample of community parents described by Haltigan, Leerkes, Supple, and Calkins (2014); (b) foster parents did not differ from community parents on either the dismissing or the preoccupied AAI dimension; and (c) both internationally adoptive and foster parents had lower scores on the preoccupied dimension than poverty/CPS-referred parents. Analyses using the traditional AAI categories provided convergent evidence that (a) internationally adoptive parents were more likely to be classified as having an autonomous state of mind than low-risk North American mothers based on Bakermans-Kranenburg and van IJzendoorn's (2009) meta-analytic estimates, (b) the rates of autonomous states of mind did not differ between foster and low-risk parents, and

Childhood abuse and neglect, attachment states of mind, and non-suicidal self-injury

This investigation examined preoccupied attachment states of mind as both a risk factor for non-suicidal self-injury (NSSI) and as a mechanism by which prospectively assessed childhood experiences of abuse and neglect predicted the frequency/severity of NSSI behavior up to age 26 years in 164 individuals (83 females) who were followed from birth in the Minnesota Longitudinal Study of Risk and Adaptation. Preoccupied (but not dismissing) states of mind regarding both childhood caregivers and adult romantic partners were correlated with more frequent/severe NSSI. Furthermore, preoccupied states of mind regarding caregivers partially accounted for the association between childhood abuse/neglect and NSSI. This work represents a rare prospective test of a developmental psychopathology framework for understanding NSSI behavior, in which atypical caregiving experiences are carried forward through attachment representations of caregivers that reflect behavioral risk.

Childhood abuse and neglect and insecure attachment states of mind in adulthood: Prospective, longitudinal evidence from a high-risk sample

The present report used data from the Minnesota Longitudinal Study of Risk and Adaptation to investigate the factor structure and childhood abuse and/or neglect related antecedents of adults' attachment states of mind in a high-risk sample. Adult Attachment Interviews (AAIs) were collected when participants were age 26 years (N = 164) and Current Relationship Interviews (CRIs) were collected from participants (N = 116) and their romantic partners when target participants were between ages 20 and 28 years (M = 25.3 years). For both the AAI and the CRI, exploratory factor analyses revealed that (a) attachment state of mind scales loaded on two weakly correlated dimensions reflecting dismissing and preoccupied states of mind and (b) ratings of unresolved discourse loaded on the same factor as indicators of preoccupied states of mind. Experiencing any subtype of abuse and/or neglect, especially during multiple developmental periods, and experiencing multiple subtypes of abuse and/or neglect during childhood were associated with risk for preoccupied (but not dismissing) AAI states of mind regarding childhood relationships with caregivers. Analyses focused on the particular subtypes, and perpetrators indicated that the predictive significance of childhood abuse/neglect for adult's AAI preoccupied states of mind was specific to experiences of abuse (but not neglect) perpetrated by primary caregivers. In addition, experiencing chronic or multiple subtypes of childhood abuse and/or neglect increased risk for dismissing (but not preoccupied) CRI states of mind regarding adult romantic partners.