1
|
Lutz R, Lakey B. Evidence that specific personal relationships evoke maladaptive personality expression. ANXIETY, STRESS, AND COPING 2024; 37:205-218. [PMID: 37343294 DOI: 10.1080/10615806.2023.2225034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION This research applied relational regulation theory (RRT) to maladaptive personality as identified in the DSM-5, dimension trait model. RRT describes how individual social network members help people regulate their own affect, thought and action. Previous research found that people expressed different levels of normal personality dimensions and affect depending upon the network members that people were with or thinking about. METHODS College students (N = 719) rated their expression of maladaptive dimensions and affect when with important network members, as well as the interpersonal characteristics of network members. RESULTS People's maladaptive personality expression was strongly consistent across network members (recipient effects). Yet, personality expression also varied strongly depending upon which network member the recipient was with or thinking about (dyadic effects). PID-5 negative affectivity and PANAS negative affect more strongly reflected dyads than recipients. Antagonism and disinhibition more strongly reflected recipients than dyads. Network members who evoked maladaptive expressions were seen by recipients as unsupportive, unresponsive, as evoking conflict, attachment avoidance and attachment anxiety. However, the interpersonal constructs were mostly redundant in predicting maladaptive personality. Findings were replicated across random subsamples and gender. CONCLUSION The findings provide evidence that important personal relationships can evoke the expression of maladaptive personality.
Collapse
Affiliation(s)
- Rae Lutz
- Department of Psychology, Grand Valley State University, Allendale, MI, United States
| | - Brian Lakey
- Department of Psychology, Grand Valley State University, Allendale, MI, United States
| |
Collapse
|
2
|
Stapel B, Winter L, Heitland I, Löffler F, Bauersachs J, Westhoff-Bleck M, Kahl KG. Impact of congenital heart disease on personality disorders in adulthood. Eur J Prev Cardiol 2024:zwae030. [PMID: 38268119 DOI: 10.1093/eurjpc/zwae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND AIMS Adults with congenital heart disease (ACHD) constitute an ever-growing patient population characterized by high risks for cardiovascular- and mental disorders. Personality disorders (PDs) are associated with adverse physical and mental health. Studies assessing PD prevalence in ACHD are lacking. METHODS PD point prevalence was assessed in 210 ACHD by Structured Clinical Interview for Axis-II Personality Disorders (SCID-II) and compared to meta-analytical data from the general population. Depression and anxiety were measured by self-report (Hospital Anxiety and Depression Scale, HADS) and clinician-rating (Montgomery-Åsberg depression rating scale, MADRS). Childhood maltreatment was assessed with the Childhood Trauma Questionnaire and quality-of-life (QOL) with the World Health Organization QOL Scale. RESULTS PD prevalence was markedly higher in ACHD compared to general population (28.1% vs. 7.7%). Particularly borderline (4.8% vs. 0.9%) and cluster C (i.e. anxious or fearful; 17.1% vs. 3.0%) PDs were overrepresented. PD diagnosis was associated with a surgery age ≤12 years (χ²(1)=7.861, φ=.195, p=.005) and higher childhood trauma levels (U=2583.5, Z=-3.585, p<.001). ACHD with PD reported higher anxiety (HADS-A: U=2116.0, Z=-5.723, p<.001) and depression (HADS-D: U=2254.5, Z=-5.392, p<.001; MADRS: U=2645.0, Z=-4.554, p<.001) levels and lower QOL (U=2538.5, Z=-4.723, p<.001). CONCLUSIONS PDs, particularly borderline- and cluster C, are significantly more frequent in ACHD compared to general population and associated with depression, anxiety and decreased QOL. Data from the general population suggest an association with adverse cardiometabolic and mental health. To ensure guideline-based treatment, clinicians should be aware of the increased PD risk in ACHD.
Collapse
Affiliation(s)
- Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Lotta Winter
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| |
Collapse
|
3
|
Neves Horácio A, Bento A, Gama Marques J. Personality and attachment in the homeless: A systematic review. Int J Soc Psychiatry 2023; 69:1312-1326. [PMID: 36951386 PMCID: PMC10523821 DOI: 10.1177/00207640231161201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Homeless people present high rates of psychopathology, including personality disorders. Given the link between personality disorders and attachment, and the potential importance of these two traits for understanding homeless populations. AIMS Our aim was to review all studies focusing on attachment and on the full assessment of personality disorders in the homeless. METHOD Overall, 213 studies were screened through title and abstract. Of these, 63 articles were chosen for full-text assessment. RESULTS A total of 14 articles met eligibility criteria and were included in the present review. Six studies evaluated personality disorders and eight studies assessed attachment in the homeless. In general, reports suggested that personality disorders are highly common in the homeless, with frequencies ranging between 64% and 79% for any personality disorder. The most common personality diagnoses were paranoid (14%-74%), borderline (6%-62%), avoidant (14%-63%), and antisocial (4%-57%) personality disorders. Attachment reports differed in the methods used and presented diverse results and correlates. Even so, insecure types of attachment dominated in the homeless, accounting for 62% to 100% of the samples. CONCLUSIONS The high prevalence of personality disorders and insecure types of attachment in the homeless may impact intervention strategies for these people. The available literature evaluating attachment and the full assessment of personality disorders in the homeless is scarce, which supports the need for more research on these two topics.
Collapse
Affiliation(s)
- Andreia Neves Horácio
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - António Bento
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal
| |
Collapse
|
4
|
Goodman G, Blum B, Rentrop C, Malberg N, Agrawal P. The Efficacy of Two Group Interventions on Mental Representations, Attachment Security, and Trauma Symptoms in Ethnically and Socioeconomically Minoritized Young Adolescents in an Urban Middle School. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105789. [PMID: 37239519 DOI: 10.3390/ijerph20105789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Symptoms resulting from childhood trauma can negatively impact socioemotional well-being and school performance during early adolescence unless positive changes in attachment security and mental representations of significant relationships occur. A sample of 109 eighth grade urban students were randomly assigned to one of two weekly, one-hour, school-based group interventions-Storytelling/Story-Acting for Adolescents (STSA-A) or Mentalization-Based Treatment Group Intervention (MBT-G). The Object Relations Inventory (ORI), Adolescent Attachment Questionnaire (AAQ) and Child PSTD Stress Scale (CPSS) were administered to students and their primary group leaders at the beginning (October) and end (May) of the intervention protocol as outcome variables. Participants in both the STSA-A and MBT-G intervention conditions experienced significant increases in attachment security and decreases in trauma symptoms. Over the course of eight months of group intervention, affective valence of paternal mental representations significantly decreased for boys and for participants in the STSA-A condition, while affective valence of primary group leader mental representations significantly decreased for participants in the MBT-G condition. STSA-A and MBT-G were found to be efficacious at improving attachment security and reducing trauma symptoms in young adolescents. The strengths of each group intervention for addressing interpersonal issues unique to specific types of adolescents are discussed.
Collapse
Affiliation(s)
- Geoff Goodman
- Emory School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Bryan Blum
- Clinical Psychology Doctoral Program, Long Island University, Brooklyn, NY 11201, USA
| | - Carla Rentrop
- Institute for Psychoanalytic Training and Research, New York, NY 10128, USA
| | | | | |
Collapse
|
5
|
Mirabella M, Muzi L, Franco A, Urgese A, Rugo MA, Mazzeschi C, Speranza AM, McWilliams N, Lingiardi V. From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders. Eat Weight Disord 2023; 28:35. [PMID: 36997702 PMCID: PMC10063489 DOI: 10.1007/s40519-023-01562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Atheoretical and descriptive conceptualizations of eating disorders (EDs) have faced substantial criticism due to their limited ability to assess patients' subjective characteristics and experiences, as needed to determine the most appropriate treatment options. The present article provides an overview of the clinical and empirical literature supporting the potential contribution of the Psychodynamic Diagnostic Manual (PDM-2) to both diagnostic assessment and treatment monitoring. METHODS Following a discussion of the most relevant shortcomings of current diagnostic models of EDs and a description of the rationale and structure of the PDM-2, evidence supporting the core PDM-2 dimensions of ED patients' subjective experiences (i.e., affective states, cognitive processes, relational patterns, somatic/bodily experiences and states) are examined, alongside their relevance to ED diagnosis and treatment. RESULTS Overall, the reviewed studies support the diagnostic importance of these patterns of subjective experiences in EDs, highlighting their potential role as either predisposing or maintaining factors to target in psychotherapy. A growing body of multidisciplinary evidence also shows that bodily and somatic experiences are central to the diagnosis and clinical management of ED patients. Moreover, there is evidence that a PDM-based assessment may enable closer monitoring of patient progress during treatment, with regard to both subjective experiences and symptom patterns. CONCLUSIONS The study suggests that current diagnostic frameworks for EDs would benefit from the addition of a person-centered perspective that considers not only symptoms, but also patients' full range of functioning-including their deep and surface-level emotional, cognitive, interpersonal, and social patterns-to improve patient-tailored interventions. LEVEL OF EVIDENCE Level V, narrative review.
Collapse
Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Laura Muzi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy.
| | - Anna Franco
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Alessia Urgese
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Michele A Rugo
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Nancy McWilliams
- Graduate School of Applied and Professional Psychology, Rutgers University, Lambertville, NJ, USA
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
6
|
Pollard C, Bucci S, Berry K. A systematic review of measures of adult disorganized attachment. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:329-355. [PMID: 36775812 DOI: 10.1111/bjc.12411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/13/2023] [Accepted: 01/22/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Disorganized attachment has been identified as an important factor in the development and maintenance of mental health problems. Further research is required to understand the mechanism by which this attachment pattern predisposes individuals to develop, and maintain, personal and social difficulties and mental health problems utilizing valid and reliable measurement tools. The assessment of adult disorganized attachment is therefore important for both applied psychologists and researchers. METHOD We conducted a systematic review using the COSMIN guidelines to identify and critically appraise instruments which measure adult disorganized attachment. A systematic database search was performed using MEDLINE, EMBASE, Web of Science, PsychInfo and CINHAL in accordance with PRISMA guidelines. RESULTS Database searching provided 5757 results, with 18 measures identified across 27 eligible papers which were critically evaluated. Measurement properties were promising for the Childhood Disorganization and Role Reversal Scale, Psychological Treatment Inventory-Attachment Styles Scale, Attachment Style Questionnaire - Short Form and the Adult Attachment Interview. However, overall, due to inconsistent quality of methodology and reporting of results, it is challenging to reach sufficient conclusions and suggestions regarding the best instrument to use to measure adult disorganized attachment. CONCLUSION The Childhood Disorganization and Role Reversal Scale, Psychological Treatment Inventory-Attachment Styles Scale. Attachment Style Questionnaire-Short-Form and Adult Attachment Interview are the best available measures of disorganized attachment in adulthood. This review highlights the need for further psychometric testing of existing measures, or development of new instruments, grounded in sound methodology.
Collapse
Affiliation(s)
- Catherine Pollard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| |
Collapse
|
7
|
Biberdzic M, Tan J, Day NJS. "It's not you, it's me": identity disturbance as the main contributor to interpersonal problems in pathological narcissism. Borderline Personal Disord Emot Dysregul 2023; 10:3. [PMID: 36721254 PMCID: PMC9890803 DOI: 10.1186/s40479-022-00209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/29/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Core impairments in self and other functioning typify individuals with personality disorder. While interpersonal dysfunction is a known element of narcissistic disorders, empirical research investigating intrapersonal elements is lacking. The aim of this study was to investigate the internal representations of individuals with grandiose and vulnerable features, as manifested through their attachment styles, and the specific role of identity disturbance in explaining the relationship between pathological narcissism and maladaptive interpersonal functioning. METHODS A sample of 270 university students completed the Brief Pathological Narcissism Inventory (B-PNI), the Severity Indices of Personality Problems (SIPP), the Relationship Questionnaire (RQ), and the Inventory of Interpersonal Problems (IIP-32). RESULTS Both vulnerable and grandiose narcissism were positively associated with both fearful and preoccupied attachment, and negatively associated with secure attachment, whilst grandiose narcissism was also positively associated with dismissive attachment. Furthermore, unstable representations of self, poor self-reflective functioning, and low sense of purpose fully mediated the relationship between interpersonal problems and grandiose narcissism while partially mediating the relationship between interpersonal problems and vulnerable narcissism. CONCLUSIONS Overall, our findings suggest that for individuals presenting with narcissistic features, capacity for adaptive interpersonal functioning is grounded by deficits in identity integration. Implications of these findings are discussed.
Collapse
Affiliation(s)
- Marko Biberdzic
- University of Wollongong, Illawarra Health and Medical Research Institute and School of Psychology, Wollongong, Australia.
| | - Junhao Tan
- University of Wollongong, Illawarra Health and Medical Research Institute and School of Psychology, Wollongong, Australia
| | - Nicholas J S Day
- University of Wollongong, Illawarra Health and Medical Research Institute and School of Psychology, Wollongong, Australia
| |
Collapse
|
8
|
An integrative perspective on the role of touch in the development of intersubjectivity. Brain Cogn 2022; 163:105915. [PMID: 36162247 DOI: 10.1016/j.bandc.2022.105915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
Touch concerns a fundamental component of sociality. In this review, we examine the hypothesis that somatomotor development constitutes a crucial psychophysiological element in the ontogeny of intersubjectivity. An interdisciplinary perspective is provided on how the communication channel of touch contributes to the sense of self and extends to the social self. During gestation, the transformation of random movements into organized sequences of actions with sensory consequences parallels the development of the brain's functional architecture. Brain subsystems shaped by the coordinated activity of somatomotor circuits to support these first body-environment interactions are the first brain functional arrangements to develop. We propose that tactile self-referring behaviour during gestation constitutes a prototypic mode of interpersonal exchange that supports the subsequent development of intersubjective exchange. The reviewed research suggests that touch constitutes a pivotal bodily experience that in early stages builds and later filters self-other interactions. This view is corroborated by the fact that aberrant social-affective touch experiences appear fundamentally associated with attachment anomalies, interpersonal trauma, and personality disorders. Given the centrality of touch for the development of intersubjectivity and for psychopathological conditions in the social domain, dedicated research is urged to elucidate the role of touch in the evolution of subjective self-other coding.
Collapse
|
9
|
Löffler A, Kleindienst N, Neukel C, Bekrater-Bodmann R, Flor H. Pleasant touch perception in borderline personality disorder and its relationship with disturbed body representation. Borderline Personal Disord Emot Dysregul 2022; 9:3. [PMID: 35101119 PMCID: PMC8805331 DOI: 10.1186/s40479-021-00176-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/20/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by altered perception of affective stimuli, including abnormal evaluation of nociceptive input. However, whether or not perceptual alterations are present for its positive counterpart, i.e. pleasant touch (PT), has not yet been examined. METHODS In the present study, we applied standardized PT stimuli to the hands of 25 patients with BPD and 25 healthy controls (HC) and compared their perception. We used the affect-modulated acoustic startle response as a physiological correlate of affective processing. We further explored the effect of PT stimulation on dissociative experiences in BPD. RESULTS Compared to HC, BPD perceived PT as less pleasant and less intense. The effect on perceived valence of touch was large even after controlling for the effect of reduced perceived intensity of touch (ƞ2 = .29). We further found qualitative alterations in touch perception in BPD, who rated the touch as significantly rougher and firmer compared to HC. There was a positive correlation between perceived valence of touch and changes in dissociative experiences in terms of body ownership of the stimulated body part from pre to post stimulation, suggesting that a more negative evaluation of touch is associated with an increase in body-related dissociative experiences, while a positive perception of touch might be related to a reduction of these dissociative experiences. CONCLUSIONS Our results confirm BPD-associated disturbances in the processing of affective somatosensory stimuli and indicate that not only pain perception but also pleasant touch perception is diminished in BPD. We discuss the role of altered touch perception for BPD psychopathology and its potential role for new treatment approaches.
Collapse
Affiliation(s)
- Annette Löffler
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany
| | - Nikolaus Kleindienst
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Centre for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Robin Bekrater-Bodmann
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159, Mannheim, Germany.
| |
Collapse
|
10
|
Neuroticism and positive coping style as mediators of the association between childhood psychological maltreatment and social anxiety. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02360-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Smith MS, South SC. Call to arms: Research directions to substantiate a unified model of attachment and personality pathology. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2021. [DOI: 10.1111/spc3.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Madison Shea Smith
- Department of Psychological Sciences Purdue University West Lafayette Indiana USA
| | - Susan C. South
- Department of Psychological Sciences Purdue University West Lafayette Indiana USA
| |
Collapse
|
12
|
Voestermans D, Eikelenboom M, Rullmann J, Wolters-Geerdink M, Draijer N, Smit JH, Thomaes K, van Marle HJF. The Association Between Childhood Trauma and Attachment Functioning in Patients With Personality Disorders. J Pers Disord 2021; 35:554-572. [PMID: 32163027 DOI: 10.1521/pedi_2020_34_474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Attachment (mal)functioning and a history of childhood trauma (CT) are both considered psychological determinants of personality disorders (PDs). Their interaction, however, remains largely uninvestigated. In this study, the authors assessed adult and childhood attachment style in a sample of patients with diverse PDs (N = 75) and determined the relation with both occurrence and severity of CT. The authors found that the sample was characterized by severe attachment malfunctioning and high levels of CT. Using cross-tabulations and analysis of variance, the authors showed that patients with a fearful or dismissive attachment style experienced more severe CT than patients with a preoccupied attachment style. Patients reporting an affectionless control bonding style to either parent suffered frequent and severe CT. Although temporal causality cannot be determined, these findings stress the necessity to screen for CT in PDs and suggest that attachment-centered psychotherapy for these patients may benefit from preceding or concurrent trauma treatment.
Collapse
Affiliation(s)
| | - Merijn Eikelenboom
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | | | | | - Nel Draijer
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam, The Netherlands
| | - Jan H Smit
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Kathleen Thomaes
- Arkin Institute for Mental Health, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam, The Netherlands
| | - Hein J F van Marle
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam, The Netherlands.,GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.,Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| |
Collapse
|
13
|
Gilbert MC, Blakey R. Exploring How UK Adults' Attachment Style in Romantic Relationships Affects Engagement in Controlling Behaviours. Front Psychol 2021; 12:649868. [PMID: 34276475 PMCID: PMC8279754 DOI: 10.3389/fpsyg.2021.649868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/03/2021] [Indexed: 11/21/2022] Open
Abstract
Copious studies have identified a link between disorganised attachment and engagement in controlling caregiving or controlling punitive behaviours. Studies have suggested that consistently engaging in these behaviours can cause difficulties within relationships and contribute to the development of a personality disorder. Most of the literature thus far has focused on engagement in controlling behaviours by children with a disorganised attachment style, despite there being theoretical grounds to suggest they may also be used by adults and across all types of insecure attachment. This study aimed to address these gaps by looking at adult attachment style and engagement in controlling behaviours in romantic relationships, across all insecure attachment styles; avoidant, anxious and disorganised. The current study recruited a non-clinical sample; specifically, 149 English-speaking adults, living in the UK, between the ages of 18 and 77 years old (M = 34.28, SD = 14.90). The participants answered an anonymous online questionnaire containing four self-report measures which assessed the participants' attachment security and organisation, caregiving style and engagement in punitive behaviours. The results indicated that participants who scored higher in disorganised attachment were more likely to use controlling punitive behaviours in their romantic relationships. Moreover, participants who reported a more insecure-anxious attachment style were more likely to use compulsive caregiving behaviours in their romantic relationships. In contrast, participants who reported a higher insecure avoidant attachment style were less likely to use compulsive caregiving behaviours in their romantic relationships. These results have implications for adult attachment theory and aid the understanding of some of the behaviours that can be harmful within romantic relationships. The findings could be used to help at-risk individuals develop healthy interpersonal relationship going forward.
Collapse
Affiliation(s)
- Molly C Gilbert
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Robert Blakey
- Department of Psychology, University of Bath, Bath, United Kingdom
| |
Collapse
|
14
|
Alareqe NA, Roslan S, Taresh SM, Nordin MS. Universality and Normativity of the Attachment Theory in Non-Western Psychiatric and Non-Psychiatric Samples: Multiple Group Confirmatory Factor Analysis (CFA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5770. [PMID: 34072158 PMCID: PMC8198184 DOI: 10.3390/ijerph18115770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
This study tests for the first time the validity of universality and normativity assumptions related to the attachment theory in a non-Western culture, using a novel design including psychiatric and non-psychiatric samples as part of a comprehensive exploratory and advanced confirmatory framework. Three attachment assessments were distributed to 212 psychiatric outpatients and 300 non-psychiatric samples in Yemen. The results of the fourteen approaches of exploratory factor analysis (EFA) produce a similar result and assertion that the psychiatric outpatients tend to explore attachment outcomes based on multi-methods, while the non-psychiatric samples suggest an attachment orientation based on multi-traits (self-other). The multiple group-confirmatory factor analysis (MG-CFA) demonstrates that the multi-method model fits the psychiatric samples better than the non-psychiatric samples. Equally, the MG-CFA suggests that the multi-traits model also fits the psychiatric samples better than the non-psychiatric samples. Implications of the results are discussed.
Collapse
Affiliation(s)
| | - Samsilah Roslan
- Department of Foundations of Education, Faculty of Educational Studies, Universiti Putra Malaysia (UPM), Selangor 43400, Malaysia;
| | - Sahar Mohammed Taresh
- Department of Foundations of Education, Faculty of Educational Studies, Universiti Putra Malaysia (UPM), Selangor 43400, Malaysia;
| | - Mohamad Sahari Nordin
- Department of Educational Psychology and Counseling, International Islamic University Malaysia (IIUM), Selangor 53100, Malaysia;
| |
Collapse
|
15
|
Simonsen S, Eikenaes IUM, Bach B, Kvarstein E, Gondan M, Møller SB, Wilberg T. Level of alexithymia as a measure of personality dysfunction in avoidant personality disorder. Nord J Psychiatry 2021; 75:266-274. [PMID: 33146059 DOI: 10.1080/08039488.2020.1841290] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Avoidant Personality Disorder (AvPD) is considered a mild to moderate personality disorder. However, few studies have focused on the heterogeneity of AvPD in terms of symptoms and severity. In the current study we set out to replicate and extend earlier findings showing that there is variation among patients with AvPD in terms of alexithymia and, further, that this variation is especially associated with specific facets of personality functioning and is not explained by measures of depression, symptom severity, or co-occurring personality disorder traits. METHOD We used intake data from a sample of AvPD patients (n = 56) who had been treated in similar outpatient services. Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20). Patients filled out questionnaires that were analysed using linear regression models. RESULTS AND CONCLUSIONS Using well-established cut-off points for low, intermediate and high levels of alexithymia we found an almost equal distribution of alexithymia groups in our sample. Alexithymia was associated with higher personality dysfunction on twelve out of sixteen facets of personality functioning. For eight of these personality facets the alexithymia total score explained significant variance even after controlling for self-reported depression, symptom severity and clinician ratings of personality disorder. Results suggest that AvPD is heterogeneous and that alexithymia may be important as an indicator of severity of specific personality dysfunction.
Collapse
Affiliation(s)
| | | | - Bo Bach
- Center for Personality Disorder Research, Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Elfrida Kvarstein
- Section for Personality Psychiatry and Specialized Treatments, Oslo University Hospital/Institute for Clinical medicine, University of Oslo, Oslo, Norway
| | | | | | - Theresa Wilberg
- Department for Research and Innovation, Clinic for Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
16
|
Nakash O, Nagar M, Razon L, Westen D. Association Between Attachment Patterns and Personality Disorders: A Multimethod Multi-Informant Study Using a Clinical Sample. J Nerv Ment Dis 2021; 209:386-394. [PMID: 33625070 DOI: 10.1097/nmd.0000000000001310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT We investigated the association between personality disorders (PDs) and attachment patterns, and examined the construct validity of attachment patterns against adaptive functioning. We used a multimeasure multi-informant approach, which allowed us to disentangle the effects of the methods and to examine the utility of the various methods for measuring these constructs. The participants included 80 clinicians and 170 clinical outpatients, recruited via convenience sampling. Results showed that secure attachment was positively associated with adaptive functioning, whereas insecure patterns were negatively associated with adaptive functioning. Both categorical and dimensional PD diagnoses were associated with insecure attachment patterns. However, after controlling for comorbidity among the PD diagnoses, only some findings remained significant, most notably the association between borderline PD and the clinicians' assessment of preoccupied and incoherent/disorganized attachment, and the patients' self-reported attachment anxiety. Our findings underscore the importance of controlling for comorbidity in examining the associations between attachment patterns and PDs.
Collapse
Affiliation(s)
| | | | - Liat Razon
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Drew Westen
- Department of Psychology and Psychiatry, Emory University, Atlanta, Georgia
| |
Collapse
|
17
|
Rahmati Kankat L, Farhadi M, Valikhani A, Hariri P, Long P, Moustafa AA. Examining the Relationship Between Personality Disorder Traits and Inhibitory/Initiatory Self-Control and Dimensions of Self-Compassion. PSYCHOLOGICAL STUDIES 2020. [DOI: 10.1007/s12646-020-00582-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
18
|
Too Much Too Soon?: Borderline Personality Disorder Symptoms and Romantic Relationships in Adolescent Girls. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1995-2005. [PMID: 31240430 DOI: 10.1007/s10802-019-00570-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the centrality of adult romantic relationships to the conceptualization of borderline personality disorder (BPD), little is known about the earlier development of this interdependency during adolescence. Thus, we examined the co-development of romantic relationships and BPD symptoms from ages 15 to 19 in a large urban sample of girls (N = 2310) in the Pittsburgh Girls Study. We had two major aims. First, we sought to examine associations between BPD symptoms and romantic relationship involvement (number of partners, importance of relationship) and relational insecurity (concerns about infidelity and tactics to maintain relationship) during adolescence. Second, we investigated mutual influences and temporal precedence of BPD symptoms and four specific romantic relationship characteristics (perceived support and antagonism, verbal and physical aggression) during adolescence using latent growth curve models (LGCMs). Results indicated that BPD symptoms were associated with increased involvement in romantic relationships and heightened relational insecurity across adolescence. Furthermore, higher BPD symptoms at age 15 predicted increases in antagonism, verbal aggression, and physical aggression across ages 15 to 19. Conversely, perceptions of higher levels of relationship support at age 15 predicted steeper increases in BPD symptoms across ages 15 to 19, suggesting a potential negative influence of early involvement in close romantic relationships. These findings demonstrate the reciprocal nature of romantic relationship functioning and BPD symptoms during adolescence and suggest novel prevention targets for youth at risk for BPD.
Collapse
|
19
|
Khosravi M, Kasaeiyan R. The relationship between neuroticism and suicidal thoughts among medical students: Moderating role of attachment styles. J Family Med Prim Care 2020; 9:2680-2687. [PMID: 32984107 PMCID: PMC7491799 DOI: 10.4103/jfmpc.jfmpc_1200_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/26/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022] Open
Abstract
Aim: The present study strives to find an experimental response to these questions: “Is the relationship between neuroticism and suicidal thoughts a simple relationship? Or are there other psychopathological variables such as attachment styles that also affect it?” Subjects and Methods: In this cross-sectional study, 376 medical students were selected from the three major cities of Iran using multi-stage sampling method from July 2018 to September 2018 and were evaluated using the demographic information questionnaire, Beck Scale for Suicidal Ideation (BSSI), the Revised NEO Personality Inventory (NEO-FFI), and the Adult Attachment Questionnaire (AAQ). Results: The overall prevalence of having suicidal thoughts among Iranian medical students was 17%. Moreover, the prevalence of suicide among the female, widowed, separated, and divorced students was higher than others. There was also a significant correlation between suicidal thoughts, gender, relational status, neuroticism, avoidant insecure attachment style, secure attachment style, and anxious/ambivalent insecure attachment style. Additionally, the attachment styles have a moderating role in the relationship between neuroticism and suicidal thoughts. Conclusion: Based on the current study, it is concluded that despite the presence of neuroticism in medical students, the attachment styles can reduce the risk of suicide as moderator variables. Hence, attachment styles can be considered a potential treatment goal in the prevention of suicide.
Collapse
Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry and Clinical Psychology, Zahedan University of Medical Sciences, Zahedan, Slamic Republic of Iran
| | - Rashya Kasaeiyan
- Department of Clinical Psychology, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran
| |
Collapse
|
20
|
Dimensional investigation of individual differences in personality disorder traits based on the three-dimensional model of personality self-regulation. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-01031-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
21
|
Disorganized Attachment pattern affects the perception of Affective Touch. Sci Rep 2020; 10:9658. [PMID: 32541672 PMCID: PMC7295781 DOI: 10.1038/s41598-020-66606-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/14/2020] [Indexed: 12/02/2022] Open
Abstract
Touch, such as affective caress, can be interpreted as being pleasant. The emotional valence that is assigned to touch is related to certain bottom-up factors, such as the optimal activation of C-tactile (CT) afferents. Tactile processing with a hedonic or emotional component has been defined as affective touch—a component that CT fibers are likely to convey. Tactile deficiencies are frequent in the psychiatric population but also in healthy people with disorganized attachment; accordingly, it is likely that affective difficulties in adults with disorganized attachment are reflected in altered perception of affective touch. To test this hypothesis, we combined methods from clinical psychology, psychophysics, and neuroimaging. We found that people with a history of traumatic parental bonds and a disorganized attachment pattern perceive a “caress-like” stimulus as being unpleasant, whereas participants with organized attachment consider the same tactile stimulation to be pleasant. Further, unlike in organized adults, the responses of disorganized adults to CT and non-CT stimulation activated limbic and paralimbic structures in a fight-or-flight manner, suggesting that early experiences with parental deficiencies shape the physiological responses of peripheral CT fibers and central nervous networks.
Collapse
|
22
|
Picardi A, Giuliani E, Gigantesco A. Genes and environment in attachment. Neurosci Biobehav Rev 2020; 112:254-269. [PMID: 32014527 DOI: 10.1016/j.neubiorev.2020.01.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/24/2019] [Accepted: 01/30/2020] [Indexed: 02/07/2023]
Abstract
In the last two decades, there has been increasing research interest in disentangling the contribution of genetic and environmental factors to individual differences in attachment, and in identifying the genes involved in shaping attachment. Twin studies suggest that as attachment changes during the course of development, genetic factors may play a progressively more important role, while shared environmental effects might decrease. However, most of this literature is limited by low power, measurement issues, and cross-sectional design. The findings of molecular genetic studies are, overall, inconclusive. The literature on main genetic effects and gene-by-environment interactions on attachment is filled with inconsistent and unreplicated findings. Also, most studies are underpowered. Challenges for future research are to identify the unshared environmental mechanisms involved in shaping attachment, and to better elucidate the genes involved and their interaction with the environment. Some pioneer studies suggested that the incorporation of epigenetic processes into G × E interaction models might represent a promising future way for investigating the complex, dynamic interplay between genes, environment, and attachment.
Collapse
Affiliation(s)
- Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Eugenia Giuliani
- Department of Molecular Medicine, Sapienza University, Viale Regina Elena, 291-293, 00161 Rome, Italy
| | - Antonella Gigantesco
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| |
Collapse
|
23
|
Basten C, Touyz S. Sense of Self: Its Place in Personality Disturbance, Psychopathology, and Normal Experience. REVIEW OF GENERAL PSYCHOLOGY 2019. [DOI: 10.1177/1089268019880884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sense of self (SOS) is a cornerstone of psychological inquiry and therapy and is a defining feature of a range of psychological conditions including borderline personality disorder, yet it is poorly understood. SOS is that continuous experience of being a complete and authentic person who feels in control of their own activities. It is a part of normal development of the self and, when weakened by trauma or developmental neglect, is a vulnerability for developing many different disorders, including depression and dissociative, personality, and eating disorders. This review aims to provide a working definition and description of SOS and to summarize its transdiagnostic role in contributing to psychological disorders. To achieve this aim, the article encompasses and unites the literature from various theoretical domains including developmental psychology, identity theory, cognitive psychology, personality disorders, and psychodynamic theories. Implications are raised for psychological therapy and research into psychopathology and its underpinnings.
Collapse
Affiliation(s)
| | - Stephen Touyz
- The University of Sydney, Sydney, New South Wales, Australia
- InsideOut Institute, Sydney, New South Wales, Australia
| |
Collapse
|
24
|
Ramirez-Castillo D, Garcia-Roda C, Guell F, Fernandez-Montalvo J, Bernacer J, Morón I. Frustration Tolerance and Personality Traits in Patients With Substance Use Disorders. Front Psychiatry 2019; 10:421. [PMID: 31258496 PMCID: PMC6588127 DOI: 10.3389/fpsyt.2019.00421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/28/2019] [Indexed: 12/26/2022] Open
Abstract
Previous research has suggested the prevalence of certain personality traits, some of which are related to a disorganized attachment, in substance abuse disorders. Further, frustration tolerance (FT) has been proposed as an important factor in addiction, both at the inception-following the "self-medication" hypothesis-and regarding treatment compliance. In turn, an inadequate response to frustrating events has been also associated with a disrupted attachment. Our goal is to explore the mediational role of FT in the relationship between personality traits and two different treatments for substance addiction: therapeutic community (TC) and ambulatory treatment (AT). Eighty-four subjects with substance abuse disorder were recruited in total (22 female), including 46 volunteers (13 female) in TC and 38 (9 female) in AT. They were assessed with Rosenzweig's test for FT and the Millon Clinical Multiaxial Inventory-III (MCMI-III) test to evaluate personality factors. By comparing with a control sample (335 volunteers, 268 female), we found that FT was lower in patients. Between therapeutic groups, FT was significantly lower in TC. Depressive, antisocial, sadistic, negativistic, schizotypal, borderline, paranoid, anxiety, dysthymia, alcohol use, drug use, posttraumatic stress disorder (PTSD), thought disorder, and delusional disorder traits were suggestive of pathology in the clinical samples and were significantly different between control, AT, and TC groups. Further, anxiety and PTSD traits were higher in TC than in AT. A mediational analysis revealed that the effect of anxiety and PTSD scales on therapeutic group was partially mediated by FT. In conclusion, FT and its interplay with personality traits commonly related to disorganized attachment (anxiety and PTSD) might be important factors to consider within therapeutic programs for persons with substance addiction.
Collapse
Affiliation(s)
- David Ramirez-Castillo
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
- Department of Health Sciences, Public University of Navarra, Pamplona, Spain
| | - Carlos Garcia-Roda
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- Faculty of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Francisco Guell
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | | | - Javier Bernacer
- Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Ignacio Morón
- Department of Psychobiology and Research Center for Mind, Brain, and Behavior (CIMCYC), University of Granada, Granada, Spain
| |
Collapse
|
25
|
Slade A, Holmes J. Attachment and psychotherapy. Curr Opin Psychol 2019; 25:152-156. [DOI: 10.1016/j.copsyc.2018.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
|
26
|
Abstract
Borderline personality disorder is associated with predominant insecure and unresolved attachment representations, linked history of trauma, impaired cognitive functioning and oxytocin levels, and higher limbic activations. Two randomized clinical trials on transference-focused psychotherapy assessed change of attachment representation and reflective functioning. The first showed that transference-focused psychotherapy was superior, demonstrating significant improvements toward attachment security and higher reflective functioning. The second randomized clinical trial study on transference-focused psychotherapy compared with therapy as usual replicated these results and additionally showed a significant shift from unresolved to organized attachment in the transference-focused psychotherapy group only, suggesting its effectiveness in traumatized patients.
Collapse
Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innrain 52, Innsbruck 6020, Austria.
| | - Diana Diamond
- City University of New York, Personality Disorders Institute, Weill Medical Center of Cornell University, New York University, New York, NY, USA
| |
Collapse
|
27
|
Trait anxiety not acting as mediator in relationship between attachment and Cluster B personality disorders in criminal offenders. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-0063-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
28
|
Laverdière O, Descôteaux J, Beaulieu-Tremblay T, Simard V. Attachment assessment in clinical practice: Factor structure of the attachment questionnaire. J Clin Psychol 2018; 75:546-561. [PMID: 30368817 DOI: 10.1002/jclp.22716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Attachment theory is of great relevance to psychotherapy process and outcome. The labor-intensive and time-consuming nature of attachment codification impedes its widespread use in clinical practice. The Attachment Questionnaire (AQ), a clinician-rated instrument, was developed to address these limitations. However, the status of validation of the AQ remains preliminary. The objective of this study is to further validate the AQ by evaluating its factor structure and convergent validity. METHODS To this end, 389 psychotherapists completed the AQ and assessed patients' personality disorders and level of functioning. RESULTS Factor analyses revealed that a five-factor solution provided a better fit than the original four-factor solution. The additional factor, inhibited exploration, captured difficulties in open, nondefensive, exploration of memories and their effects. Correlations between AQ factors and criterion variables support the convergent validity of the AQ. CONCLUSIONS These results are discussed in light of patients' characteristics and recent advances in attachment research.
Collapse
Affiliation(s)
- Olivier Laverdière
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jean Descôteaux
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Valérie Simard
- Département de Psychologie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| |
Collapse
|
29
|
Valikhani A, Abbasi Z, Radman E, Goodarzi MA, Moustafa AA. Insecure Attachment and Subclinical Depression, Anxiety, and Stress: A Three-Dimensional Model of Personality Self-Regulation As a Mediator. THE JOURNAL OF PSYCHOLOGY 2018; 152:548-572. [DOI: 10.1080/00223980.2018.1468727] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
| | - Zahra Abbasi
- Islamic Azad University, Science and Research Branch
| | | | | | | |
Collapse
|
30
|
Gambin M, Wozniak-Prus M, Sharp C. Executive functions and attachment to mother and father in inpatient female and male adolescents. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2018. [DOI: 10.1080/17405629.2018.1511419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
- Menninger Clinic, Houston, TX, USA
| |
Collapse
|
31
|
Abstract
Countertransference (CT) is usually conceptualized as emerging in the course of psychotherapy. This study explores whether CT manifests itself in the context of assessment and if the modality of exposure to participants (interviewer and observer) affects the intensity and nature of CT. Evaluators either led (direct exposure) or observed (indirect exposure) a 6-hour interview with a subject focusing on attachment and personality. Interviewers and evaluators then completed a measure of CT, the Therapist Response Questionnaire for a total of 43 subjects. Results show significant CT reactions for both interviewers and observers that were globally as intense in both conditions, although lower positive/satisfying and helpless/inadequate CTs were reported by observers. Moreover, intraclass correlations suggest that interviewers' and observers' CT reactions toward the same interviewee show an important degree of similarity. These results highlight the presence of CT in assessment contexts and support the existence of an objective part to CT reactions.
Collapse
|
32
|
Letourneau NL, Hart JM, MacMaster FP. Association Between Nonparenting Adult’s Attachment Patterns and Brain Structure and Function. SAGE Open Nurs 2017. [DOI: 10.1177/2377960816685572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nicole Lyn Letourneau
- Faculty of Nursing, University of Calgary, AB, Canada
- Cumming School of Medicine (Pediatrics & Psychiatry), University of Calgary, AB, Canada
| | - J. Martha Hart
- Faculty of Nursing, University of Calgary, AB, Canada
- Cumming School of Medicine (Pediatrics & Psychiatry), University of Calgary, AB, Canada
| | - Frank P. MacMaster
- Cumming School of Medicine (Pediatrics & Psychiatry), University of Calgary, AB, Canada
- Strategic Clinical Network for Addictions and Mental Health, Alberta Heath Services, University of Calgary, AB, Canada
| |
Collapse
|
33
|
Powers A, Fani N, Carter S, Cross D, Cloitre M, Bradley B. Differential predictors of DSM-5 PTSD and ICD-11 complex PTSD among African American women. Eur J Psychotraumatol 2017; 8:1338914. [PMID: 28649302 PMCID: PMC5475321 DOI: 10.1080/20008198.2017.1338914] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Complex posttraumatic stress disorder (CPTSD) is proposed for inclusion in the ICD-11 as a diagnosis distinct from posttraumatic stress disorder (PTSD), reflecting deficits in affective, self-concept, and relational domains. There remains significant controversy over whether CPTSD provides useful diagnostic information beyond PTSD and other comorbid conditions, such as depression or substance use disorders. Objective: The present study examined differences in psychiatric presentation for three groups: traumatized controls, DSM-5 PTSD subjects, and ICD-11 CPTSD subjects. Method: The sample included 190 African American women recruited from an urban public hospital where rates of trauma exposure are high. PTSD was measured using Clinician Administered PTSD Scale for DSM-5 and CPTSD was measured using clinician administered ICD-Trauma Interview. Psychiatric diagnoses and emotion dysregulation were also assessed. In a subset of women (n = 60), emotion recognition was measured using the Penn Emotion Recognition Task. Results: There were significant differences across groups on current and lifetime major depression (p < .001) and current and lifetime alcohol and substance dependence (p < .05), with CPTSD showing the highest rates of comorbidities. CPTSD women also showed significantly higher levels of childhood abuse and lower rates of adult secure attachment. Multivariate analysis of variance showed significantly more severe PTSD and depression symptoms and, as expected, more severe emotion dysregulation and dissociation, compared to DSM-5 PTSD and traumatized control groups. Individuals with CPTSD also had higher levels of emotion recognition to faces on a computer-based behavioural assessment, which may be related to heightened vigilance toward emotional cues from others. CPTSD women had better facial emotion recognition on a computer-based assessment, which may suggest heightened vigilance toward emotional cues. Conclusions: Our results suggest clear, clinically-relevant differences between PTSD and CPTSD, and highlight the need for further research on this topic with other traumatized populations, particularly studies that combine clinical and neurobiological data.
Collapse
Affiliation(s)
- Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GAUSA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GAUSA
| | - Sierra Carter
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GAUSA
| | - Dorthie Cross
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GAUSA
| | - Marylene Cloitre
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GAUSA
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GAUSA.,Atlanta VA Medical Center, Atlanta, GAUSA
| |
Collapse
|
34
|
Chiesa M, Cirasola A, Williams R, Nassisi V, Fonagy P. Categorical and dimensional approaches in the evaluation of the relationship between attachment and personality disorders: an empirical study. Attach Hum Dev 2016; 19:151-169. [PMID: 27899055 DOI: 10.1080/14616734.2016.1261915] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although several studies have highlighted the relationship between attachment states of mind and personality disorders, their findings have not been consistent, possibly due to the application of the traditional taxonomic classification model of attachment. A more recently developed dimensional classification of attachment representations, including more specific aspects of trauma-related representations, may have advantages. In this study, we compare specific associations and predictive power of the categorical attachment and dimensional models applied to 230 Adult Attachment Interview transcripts obtained from personality disordered and nonpsychiatric subjects. We also investigate the role that current levels of psychiatric distress may have in the prediction of PD. The results showed that both models predict the presence of PD, with the dimensional approach doing better in discriminating overall diagnosis of PD. However, both models are less helpful in discriminating specific PD diagnostic subtypes. Current psychiatric distress was found to be the most consistent predictor of PD capturing a large share of the variance and obscuring the role played by attachment variables. The results suggest that attachment parameters correlate with the presence of PD alone and have no specific associations with particular PD subtypes when current psychiatric distress is taken into account.
Collapse
Affiliation(s)
- Marco Chiesa
- a Research Department of Clinical, Educational and Health Psychology, University College London , London , UK.,b Research Department, Cassel Hospital , Richmond , UK
| | - Antonella Cirasola
- c Child Attachment and Psychological Therapies Research Unit, The Anna Freud Centre & University College London
| | - Riccardo Williams
- d Department of Dynamic and Clinical Psychology , "Sapienza" University of Rome , Rome , Italy
| | - Valentina Nassisi
- d Department of Dynamic and Clinical Psychology , "Sapienza" University of Rome , Rome , Italy
| | - Peter Fonagy
- a Research Department of Clinical, Educational and Health Psychology, University College London , London , UK
| |
Collapse
|
35
|
Cohen LJ, Ardalan F, Tanis T, Halmi W, Galynker I, Von Wyl A, Hengartner MP. Attachment anxiety and avoidance as mediators of the association between childhood maltreatment and adult personality dysfunction. Attach Hum Dev 2016; 19:58-75. [DOI: 10.1080/14616734.2016.1253639] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
36
|
Buchheim A, Erk S, George C, Kächele H, Martius P, Pokorny D, Spitzer M, Walter H. Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study. Front Hum Neurosci 2016; 10:389. [PMID: 27531977 PMCID: PMC4969290 DOI: 10.3389/fnhum.2016.00389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.
Collapse
Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck Innsbruck, Austria
| | - Susanne Erk
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
| | - Carol George
- Department of Psychology, Mills College Oakland, CA, USA
| | - Horst Kächele
- International Psychoanalytic University Berlin Berlin, Germany
| | | | - Dan Pokorny
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm Ulm, Germany
| | - Manfred Spitzer
- Department of Psychiatry III, University of Ulm Ulm, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
| |
Collapse
|
37
|
Beeney JE, Wright AGC, Stepp SD, Hallquist MN, Lazarus SA, Beeney JRS, Scott LN, Pilkonis PA. Disorganized attachment and personality functioning in adults: A latent class analysis. Personal Disord 2016; 8:206-216. [PMID: 26986959 DOI: 10.1037/per0000184] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Though researchers have attended to disorganized attachment in infants and children, they have infrequently focused on the character of disorganized attachment in adults. In this study, we aimed to identify clusters of participants based on attachment levels and styles, seeking to better delineate severity and stylistic differences in disorganized attachment than has been previously articulated. We used a new assessment approach focused on a hierarchy of attachment organization, including secure, insecure (dismissive and preoccupied), rigid-controlling (hostile control and compulsive caregiving), and disorganized (contradictory, impoverished, and unresolved) levels of attachment. Clinical evaluators used information from diagnostic and attachment-based interviews to rate participants on each of these aspects of attachment. Latent class analysis (LCA) revealed a 4-class solution, including a secure (n = 33), insecure (n = 110), and 2 disorganized classes. One disorganized class (disorganized-oscillating) was characterized by elevations on contradictory and preoccupied styles (n = 77) and another (disorganized-impoverished) showed elevations on impoverished and dismissive styles (n = 53). The disorganized-oscillating class exhibited elevated personality disorder (PD) severity and general symptom severity, borderline personality disorder (BPD), histrionic, and antisocial dimensional scores, and the most severe identity disturbance compared with the other classes. The impoverished-dismissive class exhibited the highest avoidant and schizoid PD dimensional scores of the classes, and higher PD severity compared with the insecure and secure classes. These results highlight the possibility of identifying distinct classes of attachment organization, differentiated both by aspects of severity and interpersonal style. They also shed light on the manifestation of attachment disorganization in adults. (PsycINFO Database Record
Collapse
Affiliation(s)
- Joseph E Beeney
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | | | - Sophie A Lazarus
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Julie R S Beeney
- Department of Educational Psychology and Special Education, Pennsylvania State University
| | - Lori N Scott
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine
| |
Collapse
|
38
|
Waller C, Wittfoth M, Fritzsche K, Timm L, Wittfoth-Schardt D, Rottler E, Heinrichs M, Buchheim A, Kiefer M, Gündel H. Attachment representation modulates oxytocin effects on the processing of own-child faces in fathers. Psychoneuroendocrinology 2015. [PMID: 26221767 DOI: 10.1016/j.psyneuen.2015.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Oxytocin (OT) plays a crucial role in parental-infant bonding and attachment. Recent functional imaging studies reveal specific attachment and reward related brain regions in individuals or within the parent-child dyad. However, the time course and functional stage of modulatory effects of OT on attachment-related processing, especially in fathers, are poorly understood. To elucidate the functional and neural mechanisms underlying the role of OT in paternal-child attachment, we performed an event-related potential study in 24 healthy fathers who received intranasal OT in a double-blind, placebo-controlled, within-subject experimental design. Participants passively viewed pictures of their own child (oC), a familiar (fC) and an unfamiliar child (ufC) while event-related potentials were recorded. Familiarity of the child's face modulated a broad negativity at occipital and temporo-parietal electrodes within a time window of 300-400ms, presumably reflecting a modulation of the N250 and N300 ERP components. The oC condition elicited a more negative potential compared to the other familiarity conditions suggesting different activation of perceptual memory representations and assignment of emotional valence. Most importantly, this familiarity effect was only observed under placebo (PL) and was abolished under OT, in particular at left temporo-parietal electrodes. This OT induced attenuation of ERP responses was related to habitual attachment representations in fathers. In summary, our results demonstrate an OT-specific effect at later stages of attachment-related face processing presumably reflecting both activation of perceptual memory representations and assignment of emotional value.
Collapse
Affiliation(s)
- Christiane Waller
- University of Ulm, Department of Psychosomatic Medicine, Ulm, Germany.
| | - Matthias Wittfoth
- Department of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hannover, Germany
| | | | - Lydia Timm
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Dina Wittfoth-Schardt
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Edit Rottler
- University of Ulm, Department of Psychosomatic Medicine, Ulm, Germany
| | - Markus Heinrichs
- University of Freiburg, Department of Psychology, Freiburg i.Br., Germany
| | - Anna Buchheim
- University of Innsbruck, Department of Psychology, Innsbruck, Austria
| | - Markus Kiefer
- University of Ulm, Department of Psychiatry, Ulm, Germany
| | - Harald Gündel
- University of Ulm, Department of Psychosomatic Medicine, Ulm, Germany
| |
Collapse
|
39
|
Talia A, Miller-Bottome M, Daniel SI. Assessing Attachment in Psychotherapy: Validation of the Patient Attachment Coding System (PACS). Clin Psychol Psychother 2015; 24:149-161. [DOI: 10.1002/cpp.1990] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Alessandro Talia
- Department of Psychology; University of Copenhagen; Copenhagen Denmark
| | | | - Sarah I.F. Daniel
- Department of Psychology; University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
40
|
Pedersen G, Eikenæs I, Urnes Ø, Skulberg GM, Wilberg T. Experiences in Close Relationships – Psychometric properties among patients with personality disorders. Personal Ment Health 2015; 9:208-19. [PMID: 26033784 DOI: 10.1002/pmh.1298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 04/08/2015] [Accepted: 05/04/2015] [Indexed: 11/07/2022]
Abstract
Patients with personality disorders represent maladaptive attachment strategies, influencing the quality of their interpersonal relationships. Within these patient populations, it is important to have a measure, easily applied, to assess such strategies. A widely used instrument is Experiences in Close Relationships (ECR), assessing two constructs called avoidance and anxiety. Lately, two short forms of ECR have been proposed, called ECR-S and ECR-N12. The aim of this study is to investigate the psychometric properties of the Norwegian @version of ECR and its two short forms in a sample of patients with mainly personality disorders. An internal consistency and confirmatory factor analysis of ECR, ECR-S and ECR-N12 from 495 patients was conducted, as well as an exploratory factor analysis of ECR. The internal consistency of ECR was found questionable. Confirmatory factor analysis revealed a poor model fit based on ECR and ECR-S. The ECR-N12 revealed a mediocre fit, indicating a potential for improvement. Exploratory factor analysis indicated two different aspects of avoidance and three aspects of anxiety. This five-factor solution was called ECR-FF. Inferences from scores based on ECR should be derived with care. A revision of ECR and ECR-N12 is warranted, and further studies are needed to investigate the validity of ECR-FF.
Collapse
Affiliation(s)
- Geir Pedersen
- Department of Personality Psychiatry, Clinic of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingeborg Eikenæs
- Department for Group Psychotherapy, Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Øyvind Urnes
- Department of Personality Psychiatry, Clinic of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Theresa Wilberg
- Department of Research and Development, Clinic of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
41
|
Kuiper S, McAulay C, McLean L, Malhi G. The relationship between bipolar disorders, anxiety, and trauma - implications for clinical practice. Australas Psychiatry 2015; 23:378-81. [PMID: 26059037 DOI: 10.1177/1039856215588212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the relationship between bipolar spectrum disorders, anxiety disorders, trauma, and personality function. METHOD A cohort of 37 diagnostically challenging bipolar spectrum patients, including both bipolar and personality disordered patients, were assessed using the Structured Combined Interview for DSM-IV to establish diagnosis of bipolarity and anxiety. Diagnoses were then quantitatively related to personality function, using the DSM-5 Level of Personality Function Scale, and to attachment, using the Relationship Questionnaire and Relationship Style Questionnaire. RESULTS Number of comorbid anxiety disorders was significantly related to both personality and attachment, but not to bipolar status. Patients with more than one anxiety disorder were significantly more likely to have an underlying disturbance of personality. CONCLUSIONS The presence of multiple anxiety disorders in bipolar spectrum patients may indicate heightened risk of an underlying personality disorder. Replication in a larger and more representative sample is needed.
Collapse
Affiliation(s)
- Sandy Kuiper
- CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Claire McAulay
- CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Loyola McLean
- Discipline of Psychiatry, University of Sydney, Sydney, NSW, and; Westmead Psychotherapy Program for Complex Traumatic Disorders, Westmead Hospital, Sydney, NSW, Australia
| | - Gin Malhi
- CADE Clinic, Royal North Shore Hospital, Sydney, NSW, and; Discipline of Psychiatry, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
42
|
Kealy D, Ogrodniczuk JS, Joyce AS, Steinberg PI, Piper WE. Narcissism and relational representations among psychiatric outpatients. J Pers Disord 2015; 29:393-407. [PMID: 23398104 DOI: 10.1521/pedi_2013_27_084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pathological narcissism is associated with maladaptive interpersonal behavior, although less is known regarding the internal relational representations of narcissistic patients. The authors examined the relationship between pathological narcissism and two constructs that reflect internal representations of relational patterns: quality of object relations and attachment style. Patients attending a psychiatric day treatment program (N = 218) completed measures of narcissism, general psychiatric distress, and attachment style in terms of attachment avoidance and anxiety. A semistructured interview was used to assess quality of object relations. Multiple regression analysis was conducted, controlling for general psychiatric distress. Pathological narcissism was associated with anxious attachment, but not with avoidant attachment. Narcissism was also associated with lower levels of quality of object relations. The implications of these results are discussed in terms of internal representations of self-other relations.
Collapse
Affiliation(s)
- David Kealy
- 1 Department of Psychiatry, University of British Columbia
| | | | | | | | | |
Collapse
|
43
|
Wiltgen A, Adler H, Smith R, Rufino K, Frazier C, Shepard C, Booker K, Simmons D, Richardson L, Allen JG, Fowler JC. Attachment insecurity and obsessive-compulsive personality disorder among inpatients with serious mental illness. J Affect Disord 2015; 174:411-5. [PMID: 25553401 DOI: 10.1016/j.jad.2014.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/04/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obsessive-compulsive personality disorder (OCPD) is characterized by traits such as extreme rigidity, perfectionism, and controlling behavior, all of which have a negative impact on interpersonal functioning. Attachment theory provides a useful framework to elucidate the interpersonal dysfunction characteristic of OCPD; yet, there is a dearth of attachment research on OCPD in the context of severe mental illness. METHODS Attachment security and personality disorders were assessed in adult inpatients with severe mental illness. Propensity Score Matching (PSM) was used to match OCPD and control subjects on age, gender, number of psychiatric disorders, and number of criteria endorsed for borderline personality disorder. RESULTS Consistent with hypotheses, the OCPD group (n=61) showed greater attachment avoidance than controls (n=61), and the avoidance was manifested in a predominance of the most insecure attachment style, fearful attachment. Correlations between attachment anxiety/avoidance with specific OCPD diagnostic criteria revealed that attachment avoidance was correlated with four of eight OCPD criteria across the full sample. Within the subset of OCPD patients, attachment avoidance was significantly correlated with OCPD criterion 3 (is excessively devoted to work and productivity to the exclusion of leisure activities and friendships). LIMITATIONS The use of self-report measure of attachment and the high burden of illness in the SMI population may not generalize to interview based assessment or outpatients, respectively. CONCLUSIONS Findings attest to the severity of impairment in interpersonal functioning and attachment avoidance, in particular, is characteristic of OCPD patients. These results suggest that viable treatment targets include interpersonal functioning along with more classical features of OCPD such as perfectionism and obsessiveness in task performance.
Collapse
Affiliation(s)
- Anika Wiltgen
- Menninger Clinic 12301 Main St Houston TX 77035, USA
| | - Herman Adler
- Menninger Clinic 12301 Main St Houston TX 77035, USA
| | - Ryan Smith
- Menninger Clinic 12301 Main St Houston TX 77035, USA
| | - Katrina Rufino
- Menninger Clinic 12301 Main St Houston TX 77035, USA; University of Houston, Downtown 1 Main St, Houston, TX 77002, USA
| | | | | | - Kirk Booker
- Menninger Clinic 12301 Main St Houston TX 77035, USA
| | | | | | - Jon G Allen
- Menninger Clinic 12301 Main St Houston TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - J Christopher Fowler
- Menninger Clinic 12301 Main St Houston TX 77035, USA; Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| |
Collapse
|
44
|
Beeney JE, Stepp SD, Hallquist MN, Scott LN, Wright AGC, Ellison WD, Nolf KA, Pilkonis PA. Attachment and social cognition in borderline personality disorder: Specificity in relation to antisocial and avoidant personality disorders. Personal Disord 2015; 6:207-15. [PMID: 25705979 DOI: 10.1037/per0000110] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Theory and research point to the role of attachment difficulties in borderline personality disorder (BPD). Attachment insecurity is believed to lead to chronic problems in social relationships, attributable, in part, to impairments in social cognition, which comprise maladaptive mental representations of self, others, and self in relation to others. However, few studies have attempted to identify social-cognitive mechanisms that link attachment insecurity to BPD and to assess whether such mechanisms are specific to the disorder. For the present study, empirically derived indices of mentalization, self-other boundaries, and identity diffusion were tested as mediators between attachment style and personality disorder symptoms. In a cross-sectional structural equation model, mentalization and self-other boundaries mediated the relationship between attachment anxiety and BPD. Mentalization partially mediated the relationship between attachment anxiety and antisocial personality disorder (PD) symptoms, and self-other boundaries mediated the relationship between attachment anxiety.
Collapse
Affiliation(s)
| | | | | | | | | | - William D Ellison
- Rhode Island Hospital, Warren Alpert Medical School, Brown University
| | | | | |
Collapse
|
45
|
Olssøn I, Dahl AA. Comparison of patterns and strength of adult attachment in patients with Axis I, Axis I+II disorders and a community sample. Nord J Psychiatry 2014; 68:464-71. [PMID: 24320020 DOI: 10.3109/08039488.2013.859298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adult attachment patterns influence the quality of close relationships, and they are therefore important for treatment planning in psychiatry. AIM This study compares the patterns and strength of adult attachment in patients with Axis I, Axis I+II disorders and individuals of a general population sample. METHODS Patients were recruited from a psychiatric outpatient clinic, 72 with Axis I disorders and 72 with Axis I+II disorders. The patients and a normative community sample (n = 437) filled in the Experiences in Close Relationships questionnaire. RESULTS The proportion of insecure attachment differed significantly between all groups: 40% in the community sample, 64% in the Axis I group and 90% in the Axis I+II group. On the dimensional anxiety and avoidance subscales, a similar significant gradient was observed related to the strength of attachment. CONCLUSION A definite gradient was observed concerning patterns and strength of attachment in relation to the severity of psychopathology.
Collapse
Affiliation(s)
- Ingrid Olssøn
- Ingrid Olssøn, M.D., Ph.D., Department of Psychiatry, Innlandet Hospital Trust , N-2318 Hamar , Norway
| | | |
Collapse
|
46
|
Delvecchio E, Pazzagli C, Di Riso D, Chessa D, Mazzeschi C. Attachment pattern and cognitive skills: an exploratory study in an Italian non-clinical sample. Percept Mot Skills 2014; 116:830-46. [PMID: 24175457 DOI: 10.2466/03.10.pms.116.3.830-846] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bowlby (1973) stated that the attachment relationship between a child and parents might help the child learn many skills important for survival, with a lifelong effect. However, there is a scarcity of research into attachment and intelligence in adulthood. This study examines the relationship between attachment status and cognitive skills in an Italian non-clinical sample of 101 young adults (M age = 22.6 yr.; SD = 1.8). The Adult Attachment Projective Picture Stimuli and the Wechsler Adult Intelligence Scale-Revised were administered to participants and four-way attachment classifications were analyzed regarding participants' IQ. Statistically significant differences were found for Full Scale IQ and Verbal IQ, with Dismissing participants scoring higher than Unresolved participants. Similar results were obtained for two-way attachment patterns with Resolved participants scoring higher than Unresolved. Implications regarding different attachment patterns and the concept of trauma are discussed.
Collapse
Affiliation(s)
- Elisa Delvecchio
- Department of Developmental Psychology and Socialization, University of Padova, Italy.
| | | | | | | | | |
Collapse
|
47
|
Exposure to maternal pre- and postnatal depression and anxiety symptoms: risk for major depression, anxiety disorders, and conduct disorder in adolescent offspring. Dev Psychopathol 2014; 25:1045-63. [PMID: 24229548 DOI: 10.1017/s0954579413000369] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study evaluated whether exposure to maternal pre- or postnatal depression or anxiety symptoms predicted psychopathology in adolescent offspring. Growth mixture modeling was used to identify trajectories of pre- and postnatal depression and anxiety symptoms in 577 women of low socioeconomic status selected from a prenatal clinic. Logistic regression models indicated that maternal pre- and postnatal depression trajectory exposure was not associated with offspring major depression, anxiety, or conduct disorder, but exposure to the high depression trajectory was associated with lower anxiety symptoms in males. Exposure to medium and high pre- and postnatal anxiety was associated with the risk of conduct disorder among offspring. Male offspring exposed to medium and high pre- and postnatal anxiety had higher odds of conduct disorder than did males with low exposure levels. Females exposed to medium or high pre- and postnatal anxiety were less likely to meet conduct disorder criteria than were females with lower exposure. To the best of our knowledge, this is the first study to examine the effect of pre- and postnatal anxiety trajectories on the risk of conduct disorder in offspring. These results suggest new directions for investigating the etiology of conduct disorder with a novel target for intervention.
Collapse
|
48
|
Abstract
Consistent with attachment theory and a developmental psychopathology framework, a growing body of research suggests that traumatic parental separations may lead to unique pathways of personality adaptation and maladaptation. The present study both examined personality characteristics and identified personality subtypes of adolescents with histories of traumatic separations. Randomly selected psychologists and psychiatrists provided data on 236 adolescents with histories of traumatic separations using a personality pathology instrument designed for use by clinically experienced observers, the Shedler-Westen Assessment Procedure. Using a Q factor analysis, five distinct personality subtypes were identified as follows: internalizing/avoidant, psychopathic, resilient, impulsive dysregulated, and immature dysregulated. Initial support for the validity of the subtypes was established on the basis of axis I and axis II pathology, adaptive functioning, developmental history, and family history variables. The personality subtypes demonstrated substantial incremental validity in predicting adaptive functioning, above and beyond demographic variables and histories of other traumatic experiences.
Collapse
|
49
|
Barnes R, Josefowitz N. Forensic Assessment of Adults Reporting Childhood Sexualized Assault: Risk, Resilience, and Impacts. PSYCHOLOGICAL INJURY & LAW 2014. [DOI: 10.1007/s12207-014-9184-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
50
|
Forensic Assessment of Adults Reporting Childhood Sexualized Assault: a Lifespan Developmental Analysis. PSYCHOLOGICAL INJURY & LAW 2014. [DOI: 10.1007/s12207-014-9185-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|