Personality profiles in eating disorders: rethinking the distinction between axis I and axis II

Relationship between attachment patterns and personality pathology in adolescents

OBJECTIVE

To explore the relationship between attachment status and personality pathology in a large clinical sample of adolescents.

METHOD

Two hundred ninety-four randomly selected psychiatrists and psychologists were each asked to provide data on a patient (aged 14-18 years) in treatment for maladaptive personality patterns. Clinicians completed several measures including a clinician-report attachment questionnaire, several measures of personality pathology, and a clinician-report version of the Child Behavior Checklist.

RESULTS

In both dimensional and categorical analyses, secure attachment was negatively correlated with personality pathology and positively correlated with healthy functioning, whereas disorganized/unresolved attachment was strongly associated with multiple forms of personality pathology. Anxious/ambivalent attachment tended to be associated with measures of withdrawal, internalization, and introversion. Avoidant attachment style was not associated with any single form of personality pathology.

CONCLUSION

The marked association between unresolved attachment and more severe psychopathology in adolescents, the lack of construct validity of avoidant personality disorder in adolescents, and the broader relations among attachment, personality, and psychopathology are discussed.

Whose evidence? Lessons from the philosophy of science and the epistemology of medicine

OBJECTIVE

To demonstrate the inadequacies of empiricism as a scientific foundation for evidence-based approaches to psychiatry.

METHOD

The principles of empiricism are reviewed in the light of developments in the philosophy of science and phenomenology. Case studies are selected from the history of physical sciences, biological science and clinical sciences (pathology, neuroscience, psychosocial science and psychopathology), paying particular attention to the role of observation in theory construction.

RESULTS

The principles of empiricism, particularly its view of the nature of observation as the basis of evidence do not reflect the historical reality of scientific theorizing and practice. Science has constructed alternative models of its own activity that do justice to the complexities of its subject matter, including the world of human experience and mental illness.

CONCLUSIONS

A failure to recognize both the limitations of empiricism in science and the conceptual richness of alternative formulations that accord more closely with the complexity of psychiatry's domain will result in a naïve model of science and inadequate understanding of the limitations of 'evidence' that guide the training, clinical practice and research in our profession. The consequences will be the intellectual, clinical and ethical impoverishment of psychiatry.