Personality disorders and adult attachment dimensions in a mixed psychiatric sample: A multivariate study

The associations between personality disorders and adult attachment dimensions were assessed in a sample of 487 consecutively admitted psychiatric subjects. Canonical correlation analysis showed that two sets of moderately correlated canonical variates explained the correlations between personality disorders and adult attachment patterns. The first and second attachment variates closely resembled the avoidance and anxiety attachment dimensions, respectively. The first personality disorder variate was mainly characterized by avoidant, depressive, paranoid, and schizotypal personality disorders, whereas dependent, histrionic, and borderline personality disorders loaded on the second canonical variate. However, these linear combinations of personality disorders were different from those obtained from principal component analysis. The results extend previous studies linking personality disorders and attachment patterns and suggest the importance of focusing on specific constellations of symptoms associated with dimensions of insecurity.

Modeling the relationships between adult attachment patterns and borderline personality disorder: The role of impulsivity and aggressiveness

To obtain a better understanding of the associations among Borderline Personality Disorder (BPD), adult attachment patterns, impulsivity, and aggressiveness, we tested four competing models of these relationships: a) BPD is associated with the personality traits of impulsivity and aggressiveness, but adult attachment patterns predict neither BPD nor impulsive/aggressive features; b) adult attachment patterns are significant predictors of BPD but not of impulsive/aggressive traits, although these traits correlate with BPD; c) adult attachment patterns are significant predictors of impulsive and aggressive traits, which in turn predict BPD; and d) adult attachment patterns significantly predict both BPD and impulsive/aggressive traits. We assessed 466 consecutively admitted outpatients using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (V. 2.0), the Attachment Style Questionnaire, the Barratt Impulsiveness Scale-11, and the Aggression Questionnaire. Maximum likelihood structural equation modeling of the covariance matrix showed that model (c) was the best fitting model (chi(2) (21) = 31.67, p >.05, RMSEA = .023, test of close fit p >.85). This result indicates that adult attachment patterns act indirectly as risk factors for BPD because of their relationships with aggressive/impulsive personality traits.

The relationship of adult attachment to emotion, catastrophizing, control, threshold and tolerance, in experimentally-induced pain

Although insecure attachment has been associated with a range of variables linked with problematic adjustment to chronic pain, the causal direction of these relationships remains unclear. Adult attachment style is, theoretically, developmentally antecedent to cognitions, emotions and behaviours (and might therefore be expected to contribute to maladjustment). It can also be argued, however, that the experience of chronic pain increases attachment insecurity. This project examined this issue by determining associations between adult attachment characteristics, collected prior to an acute (coldpressor) pain experience, and a range of emotional, cognitive, pain tolerance, intensity and threshold variables collected during and after the coldpressor task. A convenience sample of 58 participants with no history of chronic pain was recruited. Results demonstrated that attachment anxiety was associated with lower pain thresholds; more stress, depression, and catastrophizing; diminished perceptions of control over pain; and diminished ability to decrease pain. Conversely, secure attachment was linked with lower levels of depression and catastrophizing, and more control over pain. Of particular interest were findings that attachment style moderated the effects of pain intensity on the tendency to catastrophize, such that insecurely attached individuals were more likely to catastrophize when reporting high pain intensity. This is the first study to link attachment with perceptions of pain in a pain-free sample. These findings cast anxious attachment as a vulnerability factor for chronic pain following acute episodes of pain, while secure attachment may provide more resilience. (c) 2006 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability

Pain self-efficacy and anxiety have each been shown to contribute substantially to pain intensity and pain-related disability. Although adult attachment theory has been related separately to chronic pain, anxiety, and self-efficacy, it has not before been investigated with either pain self-efficacy or anxiety in the context of chronic pain. This study investigated the interrelations between these aspects of the chronic pain experience and their relative contributions towards pain intensity and disability. A clinical sample of 152 chronic pain patients participated in this study, completing self-report measures of attachment, self-efficacy, pain intensity, and disability, prior to attending a multidisciplinary pain clinic. Results revealed that fearful and preoccupied (anxious) attachment categories were associated with low pain self-efficacy, while high scores on the attachment dimension of comfort with closeness were linked with high pain self-efficacy, particularly for males. Insecure attachment (whether defined in terms of categories or dimensions) was related to higher levels of anxiety. Pain self-efficacy proved a stronger predictor of pain intensity than did anxiety and was a stronger predictor of disability than pain intensity or anxiety. In addition, comfort with closeness moderated the associations between pain self-efficacy and disability, pain self-efficacy and pain intensity, and anxiety and disability. Together, these findings support the value of adopting an attachment theoretical approach in the context of chronic pain. Treatment considerations and future research directions are considered. (c) 2006 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Adoption, adult attachment security, and relationship outcomes

Despite reports that adopted persons are destined for poor psychological and relational adjustment, this conclusion remains controversial. Previous research on this topic has been inconclusive, and has failed to provide a complex assessment of the predictors of adjustment. For instance, whether attachment security plays a key role in later relationship outcomes remains unresolved. This paper presents the results of a longitudinal study of adults who were adopted as infants, and a comparison sample of adults who grew up with both biological parents. Two research questions were addressed: differences in attachment security between the two samples, and the predictive relations between initial attachment scales and relationship variables (e.g., risk in intimacy, loneliness) assessed at follow-up. Attachment profiles at Time 1 indicated less security in the adopted sample than the comparison sample, and these differences were maintained at follow-up. However, adoptees who had not searched for birth relatives did not differ from the comparison sample. Although sample (adopted / comparison) was an important predictor of some relationship variables, it became less influential when attachment measures were included. Discussion focused on the complex factors that influence attachment security, and the need for in-depth study of the relational experiences of adopted people.

Attachment insecurity, depression, and the transition to parenthood

In a longitudinal study of adult attachment and depression during the transition to parenthood, 76 couples completed questionnaires on three occasions: during the second trimester of pregnancy, and six weeks and six months postbirth. On the first and second occasions, the couples were also interviewed about their experiences of pregnancy and parenthood, respectively. Measures were also completed at similar time intervals by a comparison group of 74 childless couples. Attachment security was assessed in terms of the dimensions of discomfort with closeness and relationship anxiety. Relationship anxiety was less stable for transition wives than for other participants. Relationship anxiety also predicted increases in new mothers' depressive symptoms, after controlling for a broad range of other risk factors. However, the association between relationship anxiety and maternal depression was moderated by husbands' caregiving style. Maternal depression was linked to increases in husbands' and wives' attachment insecurity and marital dissatisfaction. Results are discussed in terms of the impact of depression and negative working models of attachment on couple interaction.

On the dimensionality of the Attachment Style Questionnaire in Italian clinical and nonclinical participants

This study examined the utility of the Attachment Style Questionnaire (ASQ) in an Italian sample of 487 consecutively admitted psychiatric participants and an independent sample of 605 nonclinical participants. Minimum average partial analysis of data from the psychiatric sample supported the hypothesized five-factor structure of the items; furthermore, multiple-group component analysis showed that this five-factor structure was not an artifact of differences in item distributions. The five-factor structure of the ASQ was largely replicated in the nonclinical sample. Furthermore, in both psychiatric and nonclinical samples, a two-factor higher order structure of the ASQ scales was observed. The higher order factors of Avoidance and Anxious Attachment showed meaningful relations with scales assessing parental bonding, but were not redundant with these scales. Multivariate normal mixture analysis supported the hypothesis that adult attachment patterns, as measured by the ASQ, are best considered as dimensional constructs.

Does physical pain augment anxious attachment?

This study tested the hypothesis derived from social pain theory (MacDonald & Leary, 2005) that pain affect serves as a signal of perceived social exclusion. Participants ranging in experience of persistent physical pain completed measures of pain affect, anxious and avoidant attachment, anxiety, and depression. Higher levels of pain affect were found to relate to higher levels of anxious, but not avoidant, attachment. Further, anxious attachment partially mediated the relation between pain affect and emotional distress. These data support the conclusion that one reason individuals with persistent pain experience anxiety and depression is because of heightened concerns over rejection. The data also support the conclusion that anxious attachment is more strongly related to the fight-flight-freezing system than avoidant attachment.