Attachment-related psychodynamics

Compensatory effects of emotion avoidance in adult development

Although compensatory strategies can offset regulatory losses that occur in later adulthood, they often break down under conditions of over-activation. Two emotion regulation tasks examined compensatory effects related to attachment classification (AC). Study 1 examined emotional Stroop performance in young (17-39) and old adults (60-89). Among the elder, participants with dismissing AC showed increased response times (RTs) for anger and fear words, whereas participants with secure AC showed increased RTs for joy words. Participants with anxious AC responded slowest overall. In Study 2, heart rate (HR) was monitored while adult (25-82) mother-daughter pairs discussed three emotion events (conflict, neutral, happy). During conflict discussion, older dismissing women had highest initial HR and slowest recovery, whereas anxious older women had lowest initial HR and fastest recovery. Results suggest that in old age protective functions of dismissing AC break down under over-activation, whereas anxious AC may serve a protective role.

Emotion regulation strategies as mediators of the association between level of attachment security and PTSD symptoms following trauma in adulthood

Although, a link between attachment and posttraumatic stress disorder (PTSD) symptoms has been established, the mechanisms involved in this link have not yet been identified. Furthermore, attachment has been systematically measured by self-report questionnaires, which are prone to perceptual bias. The first goal of this study was to examine the link between PTSD symptoms and attachment security level, as measured with a security index created from the Adult Attachment Projective interview. The second goal was to test emotion regulation strategies as mediators of this link. Participants were recruited in hospital emergency rooms following trauma exposure in adulthood. The results showed that a higher level of attachment security was associated with fewer PTSD symptoms at one and three months post-trauma. The results also showed that substance use and emotion-focused strategies mediated the association between attachment and PTSD symptoms. Theoretical and clinical considerations that follow from these outcomes are discussed.

Attachment in adolescence: A move to the level of emotion regulation

The early adolescent's state of mind in the Adult Attachment Interview (AAI) is more closely linked to social interactions with peers, who are unlikely to serve as attachment figures, than it is to (i) qualities of the adolescent's interactions with parents, (ii) the AAI of the adolescent's mother, or (iii) the adolescent's prior Strange Situation behavior. This unexpected finding suggests the value of reconceptualizing AAI autonomy/security as a marker of the adolescent's capacity for emotion regulation in social interactions. Supporting this, we note that the AAI was originally validated not as a marker of attachment experiences or expectations with one's caregivers, but as a predictor of caregiving capacity sufficient to produce secure offspring. As such, the AAI may be fruitfully viewed as primarily assessing social emotion regulation capacities that support both strong caregiving skills and strong skills relating with peers.

Sex buffers intimates against the negative implications of attachment insecurity

Contextual models of relationships and recent theories of attachment system activation suggest that experiences that promote intimacy, such as sexual intercourse, may moderate the negative implications of attachment insecurity. In two independent studies, 207 couples reported their attachment insecurity, the frequency of their sexual intercourse over the past 30 days, their expectancies for their partner's availability, and their marital satisfaction, and in a 7-day diary they reported their daily sexual and relationship satisfaction and their expectancies for how satisfied they would be with their partners' availability the next day. Attachment avoidance was unrelated to marital satisfaction among spouses reporting more frequent sex, and attachment anxiety was unrelated to marital satisfaction among spouses reporting more daily sexual satisfaction. Both effects were mediated by expectancies for partner availability. These findings suggest that the effects of attachment insecurity are not immutable but vary according to the context of the relationship.

Early maternal separation and the trajectory of borderline personality disorder symptoms

Extended maternal separations before age 5 were evaluated as a predictor of long-term risk for offspring borderline personality disorder (BPD) symptoms in longitudinal data from a large random community sample. Early separations from mother predicted elevations in BPD symptoms assessed repeatedly from early adolescence to middle adulthood. Early separations also predicted a slower than normal rate of decline in symptoms with age. Other theoretically grounded risks were examined and shown to predict elevated BPD symptoms over the developmental trajectory. Long-term effects of early separations were largely independent of childhood temperament, child abuse, maternal problems, and parenting risks. These data provide the first prospectively collected data on the developmental course of BPD symptoms and suggest a series of environmental and other influences on these very disabling problems.

Adult attachment in bipolar 1 disorder

OBJECTIVES

To determine how security of adult attachment style is related to the mania, major depression and euthymic mood states in bipolar 1 (BP1) disorder.

DESIGN

An observational cross-sectional study.

METHOD

One hundred and seven BP1 patients (34 in a manic type episode, 30 in major depressive episode, and 43 in remission) and 41 healthy controls similar in age, gender, reading age, and education were recruited. The groups were compared on self-reported mean and preferred attachment style controlling for psychiatric comorbidity.

RESULTS

Preferred attachment style was insecure in 84 (78%) BP1 patients but only 13 (32%) healthy controls (chi(2)=34.3, df=3, and p<.001). Healthy controls reported higher secure attachment, lower anxious, and lower preoccupied attachment scores than all groups of patients with bipolar disorder, although the scores for secure attachment in mania and preoccupied attachment in euthymic patients were not significantly different from healthy controls. Overall, within the bipolar groups, anxious attachment style varied little with mood but mania was associated with higher secure and preoccupied attachment style, and depression with higher preoccupied and lower dismissing attachment style scores.

CONCLUSIONS

Insecure attachment is found in most patients with BP1 disorder. Attachment style is affected by mood episodes so it should be assessed when a patient with bipolar disorder is in remission with minimal residual depressive or manic symptoms.

Assessing patterns of adult attachment in medical patients

OBJECTIVE

Patterns of adult attachment affect physical health and yet are unfamiliar to many clinicians. The purpose of this review was to derive descriptions of prototypic patterns of adult attachment that are relevant to health care.

METHODS

Observations from attachment research using diverse methods to measure adult attachment were reviewed. A synthetic approach was used to integrate these observations into coherent descriptions of prototypic patterns of attachment.

RESULTS

Four patterns of adult attachment (secure, preoccupied, dismissing and fearful) are distinguished by prototypic patterns in intimate relationships, affect regulation, use of social support, trait descriptors, mentalization and narrative coherence. These patterns are linked to health care relationships and health outcomes.

CONCLUSION

Prototypic descriptions of patterns of adult attachment may guide clinicians in appreciating individual differences in interpersonal style that affect the health of patients.

Sensitivity of self-beliefs in obsessive compulsive disorder

Aspects of self-concept have been implicated in recent cognitive theories of obsessive compulsive disorder (OCD). It has been proposed that OCD is associated with perceptions of incompetence in self-domains considered important by the individual. A previous study in nonclinical individuals found that such "sensitivity of self" in the areas of job competence, morality and social acceptability was associated with elevated OCD symptoms and related beliefs. This study examined whether self-sensitivity is related to higher OCD symptoms and cognitions in individuals with OCD, and whether such self-sensitivity is specific to OCD versus other anxiety disorders. Clinical samples with OCD (N=30), other anxiety disorders (N=20) and a community control sample (N=32) participated in the study. It was found that in the OCD group, sensitivity in moral domains, but not job competence or social acceptability, was associated with higher levels of OCD symptoms and OCD-related beliefs. Sensitivity in the domains of morality and job competence was found in the OCD cohort, whereas individuals with other anxiety disorders did not show such sensitivity, suggesting some specificity of relationships to OCD. Implications for theory and therapy are discussed.

Use of pain threshold reports to satisfy social needs

OBJECTIVE

To examine the hypothesis that experimental threats to social belongingness, interacting with individual differences in attachment security, cause modification of pain threshold reports by individuals who report high pain thresholds at baseline.

METHODS

In each of three studies, baseline pain threshold and tolerance were assessed in response to a pain task (cold pressor pain in Studies 1 and 2, finger pressure pain in Study 3). Participants then completed a measure of attachment security and were randomly assigned to a social exclusion or control condition (exclusion from a computer game in Study 1, recalling past rejection experiences in Studies 2 and 3). The pain task was administered again to examine the effects on pain threshold and tolerance.

RESULTS

Those with high anxious attachment and high baseline pain thresholds reported higher postmanipulation pain thresholds in the exclusion conditions than in the control conditions. Those with low anxious attachment and high baseline pain thresholds reported lower postmanipulation pain thresholds in the exclusion conditions than in the control conditions. No differences were found for pain tolerance.

CONCLUSIONS

Across studies, results suggested that postmanipulation pain threshold reports of individuals with high baseline pain thresholds were particularly responsive to social exclusion. The form of the response was dependent on the level of anxious attachment. The present studies provide evidence that variance in pain threshold reports not accounted for by pain intensity may reflect the use of pain reports to satisfy social needs. This work also suggests that baseline measures of pain thresholds may, in interaction with psychological variables, have predictive power beyond serving as a control variable.

Maternal personal resources and children's socioemotional and behavioral adjustment

The study examined the role of three maternal personal resources [sense of coherence (SOC), attachment style, and social/emotional feelings of loneliness] in explaining children's socioemotional adjustment (self-rated loneliness and SOC, and mother-rated child behavior) and children's (self-rated) secure attachment. The sample included 58 mother-child dyads (27 boys and 31 girls) aged 8-11 years. Preliminary analyses indicated significant group differences between mothers with high or low scores on the two subscales of the attachment scale (i.e., avoidance and anxiety), on their SOC, and their social/emotional loneliness. Findings revealed that maternal SOC significantly contributed to all child socioemotional adjustment measures and attachment scores. In addition, the current findings demonstrated the role of maternal anxious attachment in explaining children's externalizing behaviors. Discussion focused on the unique value of maternal characteristics for understanding social and emotional adjustment among school-age children.

HPA system regulation and adult attachment anxiety: individual differences in reactive and awakening cortisol

Early life experiences can influence hypothalamus-pituitary-adrenal (HPA) axis regulation in adulthood, in both animals and humans. In humans, they have also been shown to influence adult attachment styles. However, the relationship between adult attachment styles and HPA axis regulation is largely unexplored. The present study investigated the relationship among varying levels of attachment anxiety and avoidance with both the cortisol response to acute stress (CRS) and the cortisol response to awakening (CRA) in 48 adult women. Attachment-unrelated stress was induced by a laboratory stress task. Saliva for free cortisol assessment was sampled before and after the stress task in the laboratory and at home on 2 consecutive days in the morning after awakening. We found that attachment anxiety but not attachment avoidance was associated with cortisol measures. Attachment anxiety was positively correlated with CRS and negatively with CRA. Finally, the two cortisol parameters were negatively associated with one another. The results are discussed with respect to (1) recent findings suggesting that the HPA system and hippocampus are programmed during critical development periods, establishing a certain trajectory of physiological responsiveness throughout life, and (2) a model that links development of the hippocampus with self development.

Coregulation, Dysregulation, Self-Regulation: An Integrative Analysis and Empirical Agenda for Understanding Adult Attachment, Separation, Loss, and Recovery

An integrative framework is proposed for understanding how multiple biological and psychological systems are regulated in the context of adult attachment relationships, dysregulated by separation and loss experiences, and, potentially, re-regulated through individual recovery efforts. Evidence is reviewed for a coregulatory model of normative attachment, defined as a pattern of interwoven physiology between romantic partners that results from the conditioning of biological reward systems and the emergence of felt security within adult pair bonds. The loss of coregulation can portend a state of biobehavioral dysregulation, ranging from diffuse psychophysiological arousal and disorganization to a full-blown (and highly organized) stress response. The major task for successful recovery is adopting a self-regulatory strategy that attenuates the dysregulating effects of the attachment disruption. Research evidence is reviewed across multiple levels of analysis, and the article concludes with a series of testable research questions on the interconnected nature of attachment, loss, and recovery processes.

Oxytocin and cortisol in romantically unattached young adults: associations with bonding and psychological distress

Despite extensive research on the involvement of oxytocin (OT) in mammalian bonding, less is known about its role in human social affiliation across the life cycle. Forty-five romantically unattached young adults participated. Plasma oxytocin and salivary cortisol were assessed using enzyme immuno-assay, and self-report measures of bonding, attachment, anxiety, and depression were collected. Oxytocin was associated with bonding to own parents and inversely related to psychological distress, particularly depressive symptoms. Cortisol was related to attachment anxiety. Regression analysis indicated that the adult's representations of bonding to parents predicted OT levels above and beyond cortisol, psychological distress, and attachment. Findings are consistent with antistress models of oxytocin and suggest that oxytocin may play a role in bonding-related cognitions across the life span.

Attachment styles, earlier interpersonal relationships and schizotypy in a non-clinical sample

OBJECTIVES

This paper investigates associations between adult attachment style, relationships with significant others during childhood, traumatic life-events and schizotypy.

DESIGN

Relationships between attachment and hypothesized correlates were investigated in a cross-sectional design using an analogue sample. The reliability of the attachment and trauma measures was investigated using a test-retest design.

METHODS

Three hundred and four students completed the self-report version of the Psychosis Attachment Measure (PAM), maternal and paternal versions of the Parental Bonding Instrument, the Attachment History Questionnaire, a measure of trauma and the Oxford-Liverpool Inventory of Feelings and Experiences scale through an internet website.

RESULTS

As predicted, there were statistically significant associations between insecure attachment in adult relationships and experiences of negative interpersonal events. Both earlier interpersonal experiences and adult attachment style predicted schizotypy, and adult attachment style emerged as an independent predictor of positive schizotypal characteristics.

CONCLUSIONS

The findings support associations between adult attachment style and previous interpersonal experiences and between adult attachment and schizotypy. The PAM is a reliable and valid instrument that can be used to explore attachment styles in analogue samples and associations between attachment styles and psychotic symptoms in clinical samples.

Emotion regulation in emerging adult couples: temperament, attachment, and HPA response to conflict

Difficulty managing the stress of conflict in close relationships can lead to mental and physical health problems, possibly through dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, the neuroendocrine stress response system. Temperament, an individual characteristic, and attachment, a dyadic characteristic, have both been implicated in emotion regulation processes and physiological reactivity, yet there is no clear consensus on how the two work together to influence the stress response, especially after childhood. The present study investigated the ways in which temperament and attachment together predict HPA response in emerging adult couples. Analyses using multilevel modeling (HLM) found that partners' dyadic fit on attachment avoidance impacted females' cortisol response patterns, and attachment avoidance further moderated the effect of males' emotionality on both their own and their partners' cortisol. Results are discussed in terms of emotional coregulation processes in romantic attachment.

The Experiences in Close Relationship Scale (ECR)-short form: reliability, validity, and factor structure

We developed a 12-item, short form of the Experiences in Close Relationship Scale (ECR; Brennan, Clark, & Shaver, 1998) across 6 studies. In Study 1, we examined the reliability and factor structure of the measure. In Studies 2 and 3, we cross-validated the reliability, factor structure, and validity of the short form measure; whereas in Study 4, we examined test-retest reliability over a 1-month period. In Studies 5 and 6, we further assessed the reliability, factor structure, and validity of the short version of the ECR when administered as a stand-alone instrument. Confirmatory factor analyses indicated that 2 factors, labeled Anxiety and Avoidance, provided a good fit to the data after removing the influence of response sets. We found validity to be equivalent for the short and the original versions of the ECR across studies. Finally, the results were comparable when we embedded the short form within the original version of the ECR and when we administered it as a stand-alone measure.

Childhood sexual abuse, attachment, and trauma symptoms in college females: the moderating role of attachment

OBJECTIVE

The present study tests a model linking attachment, childhood sexual abuse (CSA), and adult psychological functioning. It expands on previous work by assessing the degree to which attachment security moderates the relationship between a history of child sexual abuse and trauma-related symptoms in college females.

METHOD

Self-reports of attachment, childhood sexual abuse, and adult psychological functioning were obtained from 324 female undergraduate students attending a Southeastern U.S. university. Separate analyses were conducted examining the potential moderating role for close-adult, parent-child, and peer attachment styles.

RESULTS

In this sample, 37.7% of participants reported sexually abusive experiences prior to age 16. History of child sexual abuse was consistently associated with higher levels of trauma-related symptoms and lower levels of attachment security in close-adult, parent-child, and peer relations. Additionally, attachment security was consistently associated with trauma-related symptoms. Close-adult, parent-child, and peer attachment differentially moderated trauma-related symptoms. Specifically, in peer relationships, the strength of the relationships between attachment measures and trauma symptoms were greater for CSA survivors than for non-abused participants. The opposite pattern of results was found for attachment in parental and close-adult relationships.

CONCLUSION

Results suggest that attachment security in peer and parent relationships protects against the negative effects of CSA, while only weak, marginally significant protective effects were observed for close-adult relationships. Only modest support was found for the conceptualization of attachment as a moderator of the relationship between CSA and trauma-related symptoms. However, the results suggest that attachment security at least partially protects against negative CSA outcomes.

Alexithymia and global psychosocial functioning: a study on patients with skin disease

OBJECTIVE

The relationship between alexithymia and psychosocial functioning has been investigated in a few studies using indirect measures of adaptation. We aimed at directly evaluating the relationship between alexithymia and global psychosocial functioning, as measured by a standardised scale.

METHODS

A large, consecutive sample of dermatological inpatients (N=545) completed the 20-item Toronto Alexithymia Scale and the Skindex-29 and were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I disorders and the Global Assessment of Functioning (GAF) scale.

RESULTS

Multiple regression analysis was used to control for likely determinants of psychosocial functioning such as age, sex, education, burden of skin symptoms, and psychiatric morbidity. The GAF score was associated with psychiatric morbidity (beta=-.63, P<.001), alexithymia (in particular, the difficulty identifying feelings subscale) (beta=-.19, P<.001), and burden of skin symptoms (beta=-.07, P<.05).

CONCLUSION

Given the well-known association between poor psychosocial functioning and several behavioural risk factors for health, our study may provide a further reason for clinicians to pay attention to alexithymic features among their patients.

Attachment, personality, and psychopathology among adult inpatients: Self-reported romantic attachment style versus Adult Attachment Interview states of mind

The present study examined self-reported romantic attachment style and Adult Attachment Interview (AAI) states of mind regarding early attachment relationships, personality dimensions, and psychopathology in a psychiatric sample of trauma survivors. Inpatients (N = 80) admitted to a hospital trauma treatment program were administered the Experiences in Close Relationships Scale, AAI, Millon Clinical Multiaxial Inventory-III, Dissociative Experiences Scale, and Dissociative Disorder Interview Schedule. Self-report and AAI attachment classifications were not related, and different results emerged for the two measures. Self-reported romantic attachment style was significantly associated with personality dimensions, with fearful adults showing the most maladaptive personality profiles. Findings suggested that self-report dimensions of self and other independently contribute to different forms of psychological dysfunction. AAI unresolved trauma was uniquely associated with dissociation and posttraumatic stress disorder, whereas unresolved trauma and unresolved loss jointly contributed to schizotypal and borderline personality disorder scores. The differences in findings between the two measures are discussed with a view toward the developmental and clinical implications.

Attentive processing of threat and adult attachment: a dot-probe study

We examined selective attention to threat stimuli as a function of individual differences in adult attachment. Participants completed a dot-probe task in which a general threat word, attachment-related threat word, general positive or attachment-related positive word was presented together with a neutral word. Results showed that attachment anxiety and avoidance were associated with an attentional bias away from attachment threat words. This attentional avoidance effect was best predicted by the interaction between attachment anxiety and avoidance and not by their unique main effects. The findings are discussed in terms of attachment theory and its relation to attentional biases observed in psychopathology.