The Adult Attachment Interview and self-reports of attachment style: an empirical rapprochement

The Complex Trauma Questionnaire (ComplexTQ): development and preliminary psychometric properties of an instrument for measuring early relational trauma

Research on the etiology of adult psychopathology and its relationship with childhood trauma has focused primarily on specific forms of maltreatment. This study developed an instrument for the assessment of childhood and adolescence trauma that would aid in identifying the role of co-occurring childhood stressors and chronic adverse conditions. The Complex Trauma Questionnaire (ComplexTQ), in both clinician and self-report versions, is a measure for the assessment of multi-type maltreatment: physical, psychological, and sexual abuse; physical and emotional neglect as well as other traumatic experiences, such rejection, role reversal, witnessing domestic violence, separations, and losses. The four-point Likert scale allows to specifically indicate with which caregiver the traumatic experience has occurred. A total of 229 participants, a sample of 79 nonclinical and that of 150 high-risk and clinical participants, were assessed with the ComplexTQ clinician version applied to Adult Attachment Interview (AAI) transcripts. Initial analyses indicate acceptable inter-rater reliability. A good fit to a 6-factor model regarding the experience with the mother and to a 5-factor model with the experience with the father was obtained; the internal consistency of factors derived was good. Convergent validity was provided with the AAI scales. ComplexTQ factors discriminated normative from high-risk and clinical samples. The findings suggest a promising, reliable, and valid measurement of early relational trauma that is reported; furthermore, it is easy to complete and is useful for both research and clinical practice.

Adolescent Attachment Trajectories with Mothers and Fathers: The Importance of Parent-Child Relationship Experiences and Gender

This longitudinal study investigated how attachment with mothers and fathers changes during adolescence, and how gender and parent-child relationship experiences are associated with attachment trajectories. The relative importance of specific positive and negative relationship experiences on attachment trajectories was also examined. An initial sample of 223 adolescents reported on relationship experiences and attachment avoidance and anxiety with mothers and fathers in grades 6, 8, 10, and 12 (final N=110; Mage=11.90 years at onset, SD=.43). Mothers and fathers reported on relationship experiences with adolescents. Hierarchical linear modeling showed that security with parents increased during adolescence. Positive relationship experiences (companionship, satisfaction, approval, support) predicted increases in security and negative experiences (pressure, criticism) predicted decreases in security. Females reported less avoidance than males.

Narcissism and relational representations among psychiatric outpatients

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.

Emotional awareness as a pathway linking adult attachment to subsequent depression

Although research links insecure adult attachment with depression, the emotional processes accounting for this association over time remain relatively unexplored. To address this gap, this study investigated whether deficits in emotional awareness serve as one explanatory process. Adult female caregivers (N = 417, Mage = 37.83) completed questionnaires annually for 3 years. As anticipated, attachment avoidance exerted an indirect effect on depression via emotional awareness. Attachment anxiety directly predicted subsequent depression, but the indirect effect through emotional awareness was nonsignificant. These results suggest that an avoidant attachment style interferes with the effective processing of emotions, thereby placing women at risk for depression. This research implicates emotional awareness as a potential target for interventions aimed at reducing depressive symptoms in mothers with avoidant attachment styles.

Client attachment security predicts alliance in a randomized controlled trial of two psychotherapies for bulimia nervosa

OBJECTIVE

This study investigated the relation between clients' attachment patterns and the therapeutic alliance in two psychotherapies for bulimia nervosa.

METHOD

Data derive from a randomized clinical trial comparing cognitive-behavioral therapy (CBT) and psychoanalytic psychotherapy (PPT) for bulimia nervosa. Client attachment patterns were assessed with the Adult Attachment Interview. Independent raters scored audiotapes of early, middle, and late therapy sessions for 68 clients (175 sessions) using the Vanderbilt Therapeutic Alliance Scale.

RESULTS

Client attachment security was found to be a significant (p = .007) predictor of alliance levels at the three measured time points, with clients higher on attachment security developing stronger alliances with their therapists in both treatments as compared to clients higher on attachment insecurity. No evidence was found to support a hypothesized interaction whereby dismissing clients would develop weaker alliances in PPT and preoccupied clients would develop weaker alliances in CBT.

CONCLUSIONS

As the first study to examine client attachment and therapeutic alliance using observer-based instruments, this study supports the theoretical assumption that clients with secure attachment patterns are likely to develop stronger alliances with their therapist across different treatment settings.

Attachment insecurity and obsessive-compulsive personality disorder among inpatients with serious mental illness

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.

Attachment insecurity predicts responses to an interdisciplinary chronic pain rehabilitation program

The aim of this study was to examine the hypothesis that attachment insecurity is associated with poorer responses to interdisciplinary treatment for chronic pain. Patients (n = 235) admitted to a 4-week interdisciplinary rehabilitation program were recruited. At pre-treatment, participants completed a battery of questionnaires assessing adult attachment styles and dimensions, as well as pain intensity, disability, self-efficacy, pain catastrophizing, and depressive symptoms. The latter measures were completed again at post-treatment. Nearly two-thirds of participants (65.5 %) reported having an insecure attachment style. Attachment insecurity was unrelated to pre- and post-treatment reports of pain intensity and pain-related disability, but was significantly associated with most other clinical variables at both time points. Regression analyses controlling for pre-treatment functioning indicated that attachment insecurity was associated with less improvement in pain catastrophizing, pain self-efficacy, and depressive symptoms. Further research is warranted to investigate the processes by which attachment characteristics influence patients' responses to chronic pain rehabilitation.

Attachment classification, psychophysiology and frontal EEG asymmetry across the lifespan: a review

In recent years research on physiological response and frontal electroencephalographic (EEG) asymmetry in different patterns of infant and adult attachment has increased. We review research findings regarding associations between attachment classifications and frontal EEG asymmetry, the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenocortical axis (HPA). Studies indicate that insecure attachment is related to a heightened adrenocortical activity, heart rate and skin conductance in response to stress, which is consistent with the hypothesis that attachment insecurity leads to impaired emotion regulation. Research on frontal EEG asymmetry also shows a clear difference in the emotional arousal between the attachment groups evidenced by specific frontal asymmetry changes. Furthermore, we discuss neurophysiological evidence of attachment organization and present up-to-date findings of EEG-research with adults. Based on the overall patterns of results presented in this article we identify some major areas of interest and directions for future research.

Emotion regulation as a mediator in the relationship between attachment and depressive symptomatology: A systematic review

BACKGROUND

Attachment theory has been conceptualised as an emotion regulation theory. Research attributes the occurrence of depressive symptoms to a dysfunction of emotion regulation. Anxious attachment and avoidant attachment, which are two dimensions of insecure attachment, are hypothesised to lead to the development of hyperactivating and deactivating emotion regulation strategies.

METHODS

This systematic review examines the literature on the role of emotion regulation and its relationship with attachment and depressive symptomatology. Furthermore, we examined evidence for hyperactivating and deactivating strategies.

RESULTS

Nineteen papers were identified. Adolescent studies demonstrated associations of varying strength and found unreliable and contradictory results for emotion regulation as a mediator. Conversely, adult studies provided strong evidence for emotion regulation as a mediator. The hypothesis that hyperactivating strategies mediate anxious attachment and depressive symptoms was consistently supported. Mixed evidence was provided for deactivating strategies as mediators to avoidant attachment and depressive symptomatology.

LIMITATIONS

Limitations of methodology and quality of studies are identified with particular attention drawn to problems with conceptual singularity and multicollinearity.

CONCLUSIONS

Despite mixed variable findings, this review indicates that emotion regulation is a mediator between attachment and depression. Hyperactivating strategies, in particular, have been consistently noted as mediators for anxious attachment and depressive symptomatology, whereas evidence for deactivating strategies as mediators between avoidant attachment and depressive symptoms has been mixed. Future research should test the mediators of attachment and symptoms and examine theoretically grounded models of psychopathology, such as metacognitive and cognitive models using clinical samples.

Parents' self-reported attachment styles: a review of links with parenting behaviors, emotions, and cognitions

For decades, attachment scholars have been investigating how parents' adult attachment orientations relate to the ways in which they parent. Traditionally, this research has been conducted by developmental and clinical psychologists who typically employ the Adult Attachment Interview (AAI) to measure adult attachment. However, dating back to the mid-1990s, social and personality psychologists have been investigating how self-reported adult attachment styles relate to various facets of parenting. The literature on self-reported attachment and parenting has received less attention than AAI research on the same topic and, to date, there is no comprehensive review of this literature. In this article, we review more than 60 studies of the links between self-reported attachment styles and parenting, integrate the findings to reach general conclusions, discuss unresolved questions, and suggest future directions. Finally, we discuss the potential benefits to the study of parenting of collaborations among researchers from the developmental and social attachment research traditions.

Adult attachment style as a risk factor for maternal postnatal depression: a systematic review

Background

Postnatal depression (PND) is an important health problem of global relevance for maternal health and impacts on the health and wellbeing of the child over the life-course. Multinational data is hard to locate, the economic burden of PND on health care systems have been calculated in several countries, including Canada and in the UK. In Canada, health and social care costs for a mother with PND were found to be just over twice that of mothers with no mental illness. The extra community care cost for women with PND living in the UK was found to be £35.7 million per year.

Method

We carried out a systematic search to the literature to investigate the associations between attachment style and PND, using meta-narrative analysis methods, reporting statistical data and life narratives. The following databases were searched: PsycInfo, PsycExtra Web of Science, The Cochrane Library and Pubmed. We focused on research papers that examined adult attachment styles and PND, and published between 1991 and 2013. We included any papers showing relationship between maternal adult attachment and PND. Out of 353 papers, 20 met the study inclusion criteria, representing a total of 2306 participants. Data from these 20 studies was extracted by means of a data extraction table.

Results

We found that attachment and PND share a common aetiology and that ‘insecure adult attachment style’ is an additional risk factor for PND. Of the insecure adult attachment styles, anxious styles were found to be associated with PND symptoms more frequently than avoidant or dismissing styles of attachment.

Conclusion

More comprehensive longitudinal research would be crucial to examine possible cause-effect associations between adult attachment style (as an intergenerational construct and risk factor) and PND (as an important maternal mental health), with new screening and interventions being essential for alleviating the suffering and consequences of PND. If more is understood about the risk profile of a new or prospective mother, more can be done to prevent the illness trajectory (PND); as well as making existing screening measures and treatment options more widely available.

Electronic supplementary material

The online version of this article (doi:10.1186/s40359-014-0056-x) contains supplementary material, which is available to authorized users.

Discrepancies About Adolescent Relationships as a Function of Informant Attachment and Depressive Symptoms

Developmental scientists studying interpersonal relationships often find that informants disagree in their reports, and two theoretical perspectives suggest that these discrepancies may be predictable. In two studies of adolescents' interpersonal relationships, we examined two factors that may predict the absolute magnitude and the direction of the discrepancies in reports about several types of relationships. Specifically, we examined informants' depressive symptoms and attachment as predictors of absolute and directional discrepancies in reports about (a) adolescents' relationships with peers, (b) parent-adolescent relationships, and (c) adolescents' friendships. Findings revealed that informant depressive symptoms sometimes were associated with discrepancies. In contrast, informant attachment more consistently accounted for absolute and directional discrepancies.

Attachment and eating disorders: a review of current research

OBJECTIVE

Attachment insecurity may confer risk for developing an eating disorder. We describe domains of attachment functioning that are relevant to eating disorders including: affect regulation, interpersonal style, coherence of mind, and reflective functioning. Research since 2000 on attachment and eating disorders related to these domains is reviewed.

METHOD

We searched MedLine/Pubmed and PsycINFO from January 2000 to February 2014 and kept articles that: were empirical, included adults with a diagnosed eating disorder, and used a standard attachment measure. We retained 50 relevant studies.

RESULTS

Compared to controls, those with eating disorders had higher levels of attachment insecurity and disorganized mental states. Lower reflective functioning was specifically associated with anorexia nervosa. Attachment anxiety was associated with eating disorder symptom severity, and this relationship may be mediated by perfectionism and affect regulation strategies. Type of attachment insecurity had specific negative impacts on psychotherapy processes and outcomes, such that higher attachment avoidance may lead to dropping out and higher attachment anxiety may lead to poorer treatment outcomes.

DISCUSSION

Research to date suggests a possible relationship between attachment insecurity and risk for an eating disorder. More research is needed that uses attachment interviews, and longitudinal and case control designs. Clinicians can assess attachment insecurity to help inform therapeutic stances and interventions.

Caregiving antecedents of secure base script knowledge: a comparative analysis of young adult attachment representations

Based on a subsample (N = 673) of the NICHD Study of Early Child Care and Youth Development (SECCYD) cohort, this article reports data from a follow-up assessment at age 18 years on the antecedents of secure base script knowledge, as reflected in the ability to generate narratives in which attachment-related difficulties are recognized, competent help is provided, and the problem is resolved. Secure base script knowledge was (a) modestly to moderately correlated with more well-established assessments of adult attachment, (b) associated with mother-child attachment in the first 3 years of life and with observations of maternal and paternal sensitivity from childhood to adolescence, and (c) partially accounted for associations previously documented in the SECCYD cohort between early caregiving experiences and Adult Attachment Interview states of mind (Booth-LaForce & Roisman, 2014) as well as self-reported attachment styles (Fraley, Roisman, Booth-LaForce, Cox, & Holland, 2013). (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Genetic and environmental influences on adolescent attachment

BACKGROUND

Twin studies consistently point to limited genetic influence on attachment security in the infancy period, but no study has examined whether this remains the case in later development. This study presents the findings from a twin study examining the relative importance of genetic and environmental influences on attachment in adolescence.

METHODS

The sample included 551 twin pairs aged 15 years recruited from the larger Twins Early Development Study (TEDS). Attachment was assessed using a semistructured interview, the Child Attachment Interview.

RESULTS

We found robust associations between MZ twins' scores for Coherence and their overall security of attachment (r = .42, p < .001; kappa = .26, p < .001), but substantially lower associations for DZ twins (r = .20, p = .001; kappa = .09, p = .20), suggesting genetic influence on adolescent attachment (and substantial nonshared environment). Model-fitting analyses confirmed this impression, indicating approximately 40% heritability of attachment and negligible influence of the shared environment.

CONCLUSIONS

The results suggest that genes may play an important role in adolescent attachment and point to the potentially distinct aetiological mechanisms involved in individual differences in attachment beyond early childhood.

Alexithymia and adult attachment representations: associations with the five-factor model of personality and perceived relationship adjustment

Several studies have demonstrated associations between alexithymia, adult attachment styles, personality traits, and relationship adjustment. Only two studies, however, have explored associations between alexithymia and attachment representations. As part of a larger investigation of maternal and infant attachment, the current study explored this association in a sample of 97 pregnant women; in addition, measures of alexithymia and domains of the five-factor model (FFM) of personality were compared in predicting attachment security, assessed with the Adult Attachment Interview Coherence of Mind mind scale, and perceived relationship adjustment. Alexithymia negatively predicted coherence of mind; the domains of the FFM did not add significantly to the prediction. The Openness-to-Experience domain predicted relationship adjustment better than alexithymia. Contrary to findings from studies that assessed adult attachment styles, coherence of mind was unrelated to relationship adjustment and the FFM. The results suggest that alexithymia does not uniquely predict relationship adjustment beyond the domains of the FFM.

Kin rejection: social signals, neural response and perceived distress during social exclusion

Across species, kin bond together to promote survival. We sought to understand the dyadic effect of exclusion by kin (as opposed to non-kin strangers) on brain activity of the mother and her child and their subjective distress. To this end, we probed mother-child relationships with a computerized ball-toss game Cyberball. When excluded by one another, rather than by a stranger, both mothers and children exhibited a significantly pronounced frontal P2. Moreover, upon kin rejection versus stranger rejection, both mothers and children showed incremented left frontal positive slow waves for rejection events. Children reported more distress upon exclusion than their own mothers. Similar to past work, relatively augmented negative frontal slow wave activity predicted greater self-reported ostracism distress. This effect, generalized to the P2, was limited to mother- or child-rejection by kin, with comparable magnitude of effect across kin identity (mothers vs. children). For both mothers and children, the frontal P2 peak was significantly pronounced for kin rejection versus stranger rejection. Taken together, our results document the rapid categorization of social signals as kin relevant and the specificity of early and late neural markers for predicting felt ostracism.

Parental attachment style: examination of links with parent secure base provision and adolescent secure base use

The secure base construct represents one of attachment theory's most important contributions to our understanding of parent-child relationships and child development. The present study represents the first examination of how parents' self-reported attachment styles relate to parental secure base provision and adolescent (mean age = 16.6 years, SE = .59) secure base use during an observed parent-adolescent interaction. Further, the present study is the first to examine how fathers', as well as mothers', attachment styles relate to observed behavior in a parent-child interaction. At the bivariate level, maternal avoidance, but not anxiety, was negatively associated with observed adolescent secure base use. In addition, path analysis revealed that maternal avoidance was indirectly related to less adolescent secure base use through mothers' self-reported hostile behavior toward their adolescents and through adolescents' less positive perceptions of their mothers. Further, paternal anxiety, but not avoidance, was indirectly related to less adolescent secure base use through fathers' self-reported hostile behavior toward their adolescents. No significant findings emerged in relation to parental secure base provision. We discuss these results in the context of attachment theory and suggest directions for future research.

Self-reports of faulty parental attachments in childhood and criminal psychopathy in an adult-incarcerated population: an integrative literature review

This study examined self-reports of psychopathic offenders' childhood interactions with their parents to better understand what variables influence adult criminal psychopathy. The findings showed that childhood separations, physical abuse and indifferent parenting styles were more prominent in self-reports of incarcerated male psychopaths than with incarcerated males who were not psychopathic. To better understand the worldview of the criminal psychopath, and the trajectory of psychopathy, there is a need for more studies that examine childhood interactions with parental figures as reported by the adult criminal psychopath.

ABSTRACT

Despite the high percentage of incarcerated psychopaths, few studies attempt to assess the past parent-child bonds of these individuals by asking them to report childhood attachments with their parents. Currently, there is limited data regarding common variables that contribute to a break in parent-child attachment and later adult criminal psychopathy. The data that presently exist concentrate on juvenile or community samples and do not explore the attachment variables that continue into adult criminal psychopathy. This paper presents the current literature regarding self-reports of childhood attachment to parents as indicated by male-incarcerated adult psychopaths compared with self-reports of childhood attachment to parents as indicated by male-incarcerated adult non-psychopaths. Variables that influence a break in attachment between the offenders and their parents and suggestions for future clinical research are provided.

A systematic review of attachment and psychosis: measurement, construct validity and outcomes

OBJECTIVE

This review sought to identify, summarise and critically evaluate studies that investigated attachment amongst individuals with psychosis.

METHOD

The following computerised databases searched were CINAHL<1980 to December 2012; EMBASE<1980 to December 2012; Ovid MEDLINE (R)<1980 to December 2012; PsychINFO<1980 to December 2012; and Google Scholar<1980 to December 2012.

RESULTS

We identified 22 papers describing 21 studies comprising 1453 participants, with a mean age of 35.0 years (range of 12-71 years), of whom 68.4% (n=994) were male. Of our sample, 1112 (76.5%) had a diagnosis of schizophrenia. We found small to moderate associations between greater attachment insecurity (as reflected in anxiety and avoidance) and poorer engagement with services, more interpersonal problems, more avoidant coping strategies, more negative appraisals of parenting experiences and more severe trauma. We also found small to modest associations between attachment insecurity and more positive and negative symptoms and greater affective symptom problems.

CONCLUSION

Attachment theory may be useful as a means of understanding the developmental and interpersonal basis of recovery and adaptation in the context of psychosis. However, further research comprising more representative samples in their first episode and using prospective designs is required.

Associations between adult attachment style, emotion regulation, and preschool children's food consumption

OBJECTIVE

The goal of this study was to test 3 serial mediation models of how caregiver adult attachment style influences children's food consumption through its influence on emotion regulation. Three mediators that have been shown to increase the risk for pediatric obesity and that are likely to be influenced by negative emotion regulation strategies in everyday family interactions were chosen: (1) caregiver feeding practices (2) family mealtime routines, and (3) child television (TV) viewing.

METHOD

A total of 497 primary caregivers of 2.5- to 3.5-year-old children reported on their own attachment style, typical responses to their children's negative affect, feeding styles, mealtime and TV viewing routines, and their children's consumption of healthful and unhealthful foods.

RESULTS

Insecure mothers were more likely to use punishing or dismissing responses to their children's negative affect, and negative emotion regulation predicted the increased use of emotion-related feeding styles and fewer mealtime routines. These variables, in turn, were found to predict children's unhealthful food consumption, documenting serial mediational influences. With respect to TV viewing, caregiver insecurity influenced child food consumption indirectly through its direct effect on child TV viewing.

CONCLUSION

Taken together, these data suggest that insecure attachment may put parents at a risk for using negative emotion regulation strategies in response to their children's distress, which may also have important implications for the interpersonal environment surrounding food and the development of children's early eating behaviors.

Daily parenting engagement among new mothers and fathers: the role of romantic attachment in dual-earner families

We investigated the association of prenatal assessments of mothers' and fathers' self-reported romantic attachment anxiety and avoidance with the time mothers and fathers reported in proximity-focused and exploration-focused engagement with their infants at 9 months postpartum. Our sample of 136 dual-earner couples came from a larger longitudinal study of the transition to parenthood. Time in proximity-focused (interactions that emphasize physical or emotional connection) and exploration-focused (activities that stimulate and build knowledge of the world) engagement on workdays and nonworkdays were measured using time diaries. Using actor-partner interdependence models, we found significant across-partners associations between romantic attachment and parental engagement. In particular, analyses revealed interesting interactions: fathers higher in avoidance spent more time in exploration-focused engagement on workdays when mothers were more anxious, whereas mothers higher in anxiety spent more time in proximity-focused engagement on nonworkdays when fathers were more avoidant. Moreover, fathers demonstrated a compensatory pattern of engagement in response to mother's greater attachment anxiety or avoidance. Findings support the utility of studying romantic attachment within a family system and extend the literature on correlates of early parental engagement.

Attachment, affective temperament, and personality disorders: a study of their relationships in psychiatric outpatients

BACKGROUND

As the result of extensive translational and cross-disciplinary research, attachment theory is now a construct with significant neuropsychiatric traction. The correlation of attachment with other influential conceptual models (i.e. temperament and personality) is therefore of interest. Consequently, we explored how two attachment dimensions (attachment anxiety and attachment avoidance) correlated with measures of temperament and personality in 357 psychiatric outpatients.

METHODS

We performed a retrospective review of four questionnaires (the Experiences in Close Relationship scale (ECR-R), Temperament and Character inventory (TCI), Temperament Evaluation of the Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A), and Personality Self-Portrait Questionnaire (PSQ)). Frequency measures and correlations were examined, as was the predictive value of attachment security for a personality disorder (PD).

RESULTS

Significant, robust correlations were found between attachment anxiety and (1) several negative affective temperaments (dysthymic and cyclothymic); (2) several indices of personality pathology (low self-directedness (TCI), DSM-IV paranoid, borderline, histrionic, avoidant and dependent personality traits). Attachment avoidance had fewer large correlations. In an exploratory model, the negative predictive value of attachment security for a PD was 86%.

LIMITATIONS

Subjects were a relatively homogeneous subset of ambulatory psychiatric outpatients. PD diagnoses were via self-report.

CONCLUSIONS

Clinically, these findings highlight the significant overlap between attachment, affective temperament, and personality and support the value of attachment as a screen for PDs. More broadly, given our growing understanding of the neurobiology of attachment (i.e. links with the oxytocin system), these results raise interesting questions about underlying biological systems and psychiatric treatment.

Genetic contributions to continuity and change in attachment security: a prospective, longitudinal investigation from infancy to young adulthood

BACKGROUND

Longitudinal research has demonstrated that individual differences in attachment security show only modest continuity from infancy to adulthood. Recent findings based on retrospective reports suggest that individuals' genetic variation may moderate the developmental associations between early attachment-relevant relationship experiences and adult attachment security. The purpose of this study was to use a prospective, longitudinal design to investigate genetic contributions to continuity and changes in attachment security from infancy to young adulthood in a higher risk sample.

METHODS

Infant attachment security was assessed using the Strange Situation Procedure at 12 and 18 months. Adults' general attachment representations were assessed using the Adult Attachment Interview at ages 19 and 26. Romantic attachment representations were assessed with the Current Relationship Interview (CRI) at ages 20-21 and ages 26-28. Individuals were genotyped for variants within the oxytocin receptor (OXTR), dopamine D4 receptor (DRD4), and serotonin transporter linked polymorphic region (5-HTTLPR).

RESULTS

The continuity of attachment security from infancy into young adulthood was consistently moderated by OXTR genetic variation. Infant attachment security predicted the security of adults' general and romantic attachment representations only for individuals with the OXTR G/G genotype. This interaction was significant when predicting adult attachment security as measured by the Adult Attachment Interview at ages 19 and 26 and the CRI at ages 26-28. Dopamine D4 receptor and 5-HTTLPR genetic variation did not consistently moderate the longitudinal associations between attachment security during infancy and adulthood.

CONCLUSIONS

This study provides initial longitudinal evidence for genetic contributions to continuity and change in attachment security from infancy to young adulthood. Genetic variation related to the oxytocin system may moderate the stability of attachment security across development.

Attachment and parenting in adult patients with anxiety disorders

Background:

The literature suggests that dysfunctional parenting and insecure attachment may increase risk of anxiety-related psychopathology. This study aimed at testing the association between anxiety disorders, attachment insecurity and dysfunctional parenting while controlling for factors usually not controlled for in previous studies, such as gender, age, and being ill.

Methods:

A sample of 32 non-psychotic inpatients with SCID-I diagnosis of an anxiety disorder, either alone or in comorbidity, was compared with two age- and sex-matched control groups consisting of 32 non-clinical participants and 32 in-patients with drug-resistant epilepsy. Study measures included the Experience in Close Relationships questionnaire (ECR) and the Parental Bonding Instrument (PBI).

Results:

The patients with anxiety disorders scored significantly higher on attachment-related anxiety and avoidance than patients with drug-resistant epilepsy and non-clinical participants. These findings were independent of comorbidity for mood disorders. ECR scores did not differ among diagnostic subgroups (generalized anxiety disorder, panic disorder, other anxiety disorders). Patients with anxiety disorders scored significantly lower on PBI mother’s care and borderline significantly lower on PBI father's care than patients with drug-resistant epilepsy.

Conclusions:

Although limitations such as the relatively small sample size and the cross-sectional nature suggest caution in interpreting these findings, they are consistent with the few previous adult studies performed on this topic and corroborate Bowlby's seminal hypothesis of a link between negative attachment-related experiences, attachment insecurity, and clinical anxiety. Attachment theory provides a useful theoretical framework for integrating research findings from several fields concerning the development of anxiety disorders and for planning therapeutic interventions.

An attachment primer for couple therapists: research and clinical implications

According to attachment theory, humans are relational beings and even a child's earliest experiences with caregivers have a profound effect on emotional development and an overall approach to relationships. With increasing regularity, couple therapy has utilized attachment language as a conceptual tool, but more work is needed to understand the full clinical implications of attachment theory. These include understanding the intergenerational nature of attachment and adapting the delivery, timing, and pace of interventions to client attachment strategies. In this article, we summarize the origins of attachment theory, its measurement, the role of attachment in couple relationships, attachment stability and change, and ways that attachment informs therapy process and intervention. We hope that this article will provide an impetus for couple therapists to expand their conceptualization and use of attachment in their clinical work and for couple researchers to conduct more clinically relevant, attachment-oriented process research.

Adult Attachment Ratings (AAR): an item response theory analysis

The Adult Attachment Ratings (AAR) include 3 scales for anxious, ambivalent attachment (excessive dependency, interpersonal ambivalence, and compulsive care-giving), 3 for avoidant attachment (rigid self-control, defensive separation, and emotional detachment), and 1 for secure attachment. The scales include items (ranging from 6-16 in their original form) scored by raters using a 3-point format (0 = absent, 1 = present, and 2 = strongly present) and summed to produce a total score. Item response theory (IRT) analyses were conducted with data from 414 participants recruited from psychiatric outpatient, medical, and community settings to identify the most informative items from each scale. The IRT results allowed us to shorten the scales to 5-item versions that are more precise and easier to rate because of their brevity. In general, the effective range of measurement for the scales was 0 to +2 SDs for each of the attachment constructs; that is, from average to high levels of attachment problems. Evidence for convergent and discriminant validity of the scales was investigated by comparing them with the Experiences of Close Relationships-Revised (ECR-R) scale and the Kobak Attachment Q-sort. The best consensus among self-reports on the ECR-R, informant ratings on the ECR-R, and expert judgments on the Q-sort and the AAR emerged for anxious, ambivalent attachment. Given the good psychometric characteristics of the scale for secure attachment, however, this measure alone might provide a simple alternative to more elaborate procedures for some measurement purposes. Conversion tables are provided for the 7 scales to facilitate transformation from raw scores to IRT-calibrated (theta) scores.

Relationship duration moderates associations between attachment and relationship quality: meta-analytic support for the temporal adult romantic attachment model

Although research has examined associations between attachment dimensions and relationship outcomes, theory has ignored how these associations change over time in adult romantic relationships. We proposed the Temporal Adult Romantic Attachment (TARA) model, which predicts that the negative associations between anxious and avoidant attachment on one hand and relationship satisfaction and commitment on the other will be more negative as relationship durations increase. Meta-analyses largely confirmed that negative associations between both insecure attachment dimensions and both relationship outcomes were more negative among longer relationship durations in cross-sectional samples. We also explored gender differences in these associations. The present review not only integrates the literature on adult attachment and romantic relationship satisfaction/commitment but also highlights the importance of relationship duration as a key moderator of the associations among these variables. We discuss the broad implications of these effects and our meta-analytic findings for the TARA model, attachment theory, and romantic relationships.

John HK, Ruiz SK. Linguistic indicators of wives' attachment security and communal orientation during military deployment

Military deployment affects thousands of families each year, yet little is known about its impact on nondeployed spouses (NDSs) and romantic relationships. This report examines two factors-attachment security and a communal orientation with respect to the deployment-that may be crucial to successful dyadic adjustment by the NDS. Thirty-seven female NDSs reported on their relationship satisfaction before and during their partner's deployment, and 20 also did so 2 weeks following their partner's return. Participants provided a stream-of-consciousness speech sample regarding their relationship during the deployment; linguistic coding of sample transcripts provided measures of each participant's (a) narrative coherence, hypothesized to reflect attachment security with respect to their deployed spouse; and (b) frequency of first person plural pronoun use (we-talk), hypothesized to reflect a communal orientation to coping. More frequent first person plural pronounuse-we-talk-was uniquely associated with higher relationship satisfaction during the deployment, and greater narrative coherence was uniquely associated with higher relationship satisfaction during postdeployment. Discussion centers on the value of relationship security and communal orientations in predicting how couples cope with deployment and other types of relationship stressors.

Anxiety levels in clinically referred children and their parents: examining the unique influence of self-reported attachment styles and interview-based reflective functioning in mothers and fathers

OBJECTIVE

Although much is known about childhood anxiety disorders, the differential contributions by mothers and fathers to child anxiety is poorly understood. This study examined the relation between child anxiety and parental level of psychopathology, attachment style, and reflective functioning (RF).

DESIGN

Thirty-eight clinically anxious children aged 7-12 years (55.3% female) referred for treatment and their parents (37 mothers, 34 fathers) participated in the study.

METHOD

Reflective functioning was coded based on Adult Attachment Interviews. Self-report questionnaires on attachment and psychopathology were administered.

RESULTS

Paternal psychopathology, attachment avoidance, and attachment anxiety as well as maternal attachment anxiety were associated with child anxiety. Mothers had higher RF abilities than fathers. Lower levels of RF in mothers and higher levels of attachment avoidance in fathers explained 42% of the variance in anxiety levels of the child.

CONCLUSION

Mothers and fathers may provide unique contributions to the development of child anxiety. The findings highlight the importance of considering fathers as well as mothers in research and treatment for childhood anxiety disorders.

Attachment and Parental Divorce

One of the assumptions of attachment theory is that disruptions in parental relationships are prospectively related to insecure attachment patterns in adulthood. The majority of research that has evaluated this hypothesis, however, has been based on retrospective reports of the quality of relationships with parents—research that is subject to retrospective biases. In the present research, the authors examined the impact of parental divorce—an event that can be assessed relatively objectively—on attachment patterns in adulthood across two samples. The data indicate that parental divorce has selective rather than diffuse implications for insecure attachment. Namely, parental divorce was more strongly related to insecure relationships with parents in adulthood than insecure relationships with romantic partners or friends. In addition, parental insecurity was most pronounced when parental divorce took place in early childhood. This finding is consistent with hypotheses about sensitive periods in attachment development.

Perceived parental reactions to adolescent distress: development and validation of a brief measure

Although adolescence is a time of individuation with increased reliance on peers, research indicates that, despite a deliberate distancing from parents, adolescents continue to seek the support and console of parental attachment figures in times of distress. The Perceived Parental Reactions to Adolescent Distress (PRAD) is a brief self-report measure developed to examine adolescents' perception of parental response under conditions of distress as measured by four conceptually and empirically distinct parental reactions to distress: Comfort, Self-Focus, Avoidance and Harshness. Across two studies involving a total of 738 high school students, we developed the PRAD and substantiated its robust psychometric properties, including evidence for reliability as well as internal and criterion validity. Sources of individual differences in the test-scores were also explored. Empirical as well as practical importance of assessing parental reactions to adolescent distress is discussed with regard to both the attachment and adolescent development literature.

Measuring scripted attachment-related knowledge in middle childhood: the Secure Base Script Test

Secure base scripts (SBS) are thought of as the earliest, rudimentary mental representations of attachment, comprising temporally and causally related events occurring in interactions between children and their attachment figures. SBS have been studied in preschool children, adolescents and adults, but there is little research relating SBS to other attachment measures in middle childhood. Here, the Secure Base Script Test (SBST), a narrative-based measure of attachment scripts in middle childhood, was developed and evaluated. In two studies with 7-12-year-olds (total N = 261), high internal consistency, inter-rater reliability and discriminant validity was established. SBS knowledge was consistent across different contexts and relationships and converged strongly with security and coherence in representations assessed by the Friends and Family Interview and moderately with self-reported attachment security. Furthermore, SBS knowledge predicted children's capacity to respond to distress in an adaptive way. Our findings may be taken to provide some first evidence for generalized scripted attachment knowledge already in middle childhood.

Levels of personality functioning and their association with clinical features and interpersonal functioning in patients with personality disorders

Recently, the DSM-5 Personality and Personality Disorders Work Group has proposed a multiple level approach toward the classification and diagnosis of personality disorders (PDs), with the first level entailing a rating of impairments in levels of personality functioning. Although a number of measures that assess levels of personality functioning have been validated, given its prominent status in the DSM-5 proposal and contemporary theories of personality pathology, the Work Group has called for more research in this area (e.g., Bender, Morey, & Skodol, 2011). In response to this call, this study investigates the relationship between two major, well-validated dimensional measures of levels of personality functioning, that is, the Differentiation-Relatedness Scale (DR-S; Diamond, Blatt, Stayner, & Kaslow, 1991), as scored on the Object Relations Inventory (ORI; Blatt, Wein, Chevron, & Quinlan, 1979), and the Inventory of Personality Organization (IPO; Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001), a self-report instrument, and their relationship with different measures of clinical and interpersonal functioning in 70 patients with a PD. First, results showed that higher levels of differentiation and relatedness of descriptions of self and significant others, and of the self in particular, were negatively related to indices of personality functioning as assessed by the IPO. Lower levels of personality functioning, as measured with both the DR-S and the IPO, were positively related to severity of depression, symptomatic distress, self-harm, and interpersonal problems. Finally, results showed that the DR-S and the IPO independently predicted clinical features and interpersonal functioning. Hence, this study lends further support for the concurrent and predictive validity of the DR-S and the IPO in assessing levels of personality functioning. However, more research concerning the validity of these measures in assessing levels of personality functioning is needed. Suggestions for further research are formulated.

Sniffing around oxytocin: review and meta-analyses of trials in healthy and clinical groups with implications for pharmacotherapy

The popularity of oxytocin (OT) has grown exponentially during the past decade, and so has the number of OT trials in healthy and clinical groups. We take stock of the evidence from these studies to explore potentials and limitations of pharmacotherapeutic applications. In healthy participants, intranasally administered OT leads to better emotion recognition and more trust in conspecifics, but the effects appear to be moderated by context (perceived threat of the 'out-group'), personality and childhood experiences. In individuals with untoward childhood experiences, positive behavioral or neurobiological effects seem lowered or absent. In 19 clinical trials, covering autism, social anxiety, postnatal depression, obsessive-compulsive problems, schizophrenia, borderline personality disorder and post-traumatic stress, the effects of OT administration were tested, with doses ranging from 15 IU to more than 7000 IU. The combined effect size was d=0.32 (N=304; 95% confidence interval (CI): 0.18-0.47; P<0.01). However, of all disorders, only studies on autism spectrum disorder showed a significant combined effect size (d=0.57; N=68; 95% CI: 0.15-0.99; P<0.01). We hypothesize that for some of the other disorders, etiological factors rooted in negative childhood experiences may also have a role in the diminished effectiveness of treatment with OT.