Exploring the Associations of Personality and Sexual Health Using the DSM-5 Alternative Model for Personality Disorders

This study explored the relationships between sexual health indicators (i.e., sexual satisfaction, distress, and function) and the DSM-5 Alternative Model for Personality Disorders, a promising dimensional framework for assessing personality pathology. A sample of 489 participants seeking help in private practice clinics completed self-report measures of sexual satisfaction, distress, and function, as well as dyadic adjustment, psychological distress, romantic attachment, personality impairment, and pathological personality facets. Results first showed that participants reaching the cutoffs for a personality disorder had significantly higher sexual distress and lower sexual function compared to participants without a personality disorder. Second, path analyses controlling for psychological distress, dyadic adjustment, and romantic attachment revealed that, for women, the Criterion B Intimacy Avoidance facet was consistently linked with higher sexual distress and lower sexual satisfaction and function. For men, result patterns were more complex, linking Criterion B Separation Insecurity with high sexual distress, and Separation Insecurity and Intimacy Avoidance facets with low sexual function. In addition, Criterion B Irresponsibility, Rigid Perfectionism, as well as Criterion A Intimacy impairment were linked with higher sexual satisfaction. These findings improve our understanding of the links between personality and sexual health and provide support for considering personality difficulties in sexual health interventions.

Attachment and borderline personality disorder as the dance unfolds: A quantitative analysis of a novel paradigm

Current research on personality disorders strives to identify key behavioural and cognitive facets of patient functioning, to unravel the underlying root causes and maintenance mechanisms. This process often involves the application of social paradigms - however, these often only include momentary affective depictions rather than unfolding interactions. This constitutes a limitation in our capacity to probe core symptoms, and leaves potential findings uncovered which could help those who are in close relationships with affected individuals. Here, we deployed a novel task in which subjects interact with four unknown virtual partners in a turn-taking paradigm akin to a dance, and report on their experience with each. The virtual partners embody four combinations of low/high expressivity of positive/negative mood. Higher scores on our symptomatic measures of attachment anxiety, avoidance, and borderline personality disorder (BPD) were all linked to a general negative appraisal of all the interpersonal experiences. Moreover, the negative appraisal of the partner who displayed a high negative/low positive mood was tied with attachment anxiety and BPD symptoms. The extent to which subjects felt responsible for causing partners' distress was most strongly linked to attachment anxiety. Finally, we provide a fully-fledged exploration of move-by-move action latencies and click distances from partners. This analysis underscored slower movement initiation from anxiously attached individuals throughout all virtual interactions. In summary, we describe a novel paradigm for second-person neuroscience, which allowed both the replication of established results and the capture of new behavioural signatures associated with attachment anxiety, and discuss its limitations.

Measuring Change in Attachment Insecurity Using Short Forms of the ECR-R: Longitudinal Measurement Invariance and Sensitivity to Treatment

Attachment insecurity is important for psychotherapy both as an aspect influencing the therapeutic process as well as potential outcome variable of a treatment. Two German short forms of the Experiences in Close Relationships - Revised (ECR-R) have been proposed to assess individual differences in attachment anxiety and avoidance. In this research, we examined whether these questionnaires are suitable for measuring change in attachment anxiety and avoidance by testing longitudinal measurement invariance in two independent clinical samples (N1 = 493, N2 = 273) using a pre-post design. Results indicated that strict longitudinal measurement invariance can be assumed for both measures. Thus, changes in scale scores before and after treatment can be interpreted as changes in the latent dimensions of attachment anxiety and avoidance. Both questionnaires were also sensitive to treatment in that attachment insecurity was overall reduced after therapy. Although both measures appear to be generally suitable for investigating treatment effects, they exhibited consistent problems with structural validity across samples that should be reexamined in future research.

Attachment and Mindfulness as Mediators in the Relationship Between Childhood Adversity and Personality Outcomes

Past research has shown that those with greater experiences of adversity (abuse and neglect) tend to exhibit insecure attachments, more borderline symptoms, higher psychopathic traits, and are lower in mindfulness. Similarly, there have been positive relationships between insecure attachment styles and borderline and psychopathic traits as well as lower mindfulness and borderline and psychopathic traits. Further, adversity can have a detrimental effect on physical and mental health, including attachment and personality, which necessitate examining this further. The purpose of this study was to examine the indirect relationships between childhood adversity and borderline traits, Factor 1, and Factor 2 of psychopathy all through lower mindfulness, anxious attachment, and avoidant attachment respectively. In this study, using youth retrospective data (N = 395, age range = 12-18, M = 14.64, SD = 1.52), 3 separate mediation models are examined. As expected, the relationship between adversity and borderline traits was indirect through anxious attachment (β = 0.075, p < .01) and lower mindfulness (β = 0.069, p < .01). For psychopathic traits, the relationship was indirect through avoidant attachment (Factor 1: β = 0.078, p < .05; Factor 2: β = 0.071, p < .05) and lower mindfulness (Factor 1: β = 0.074, p < .01: Factor 2: β = 0.076, p < .01). The results suggest that lower mindfulness and insecure attachment are important factors in the expression of disordered personality. Therefore, both mindfulness and attachment-focused interventions could mitigate the harmful effects of adversity and the subsequent expression of disordered personality symptoms.

Neurobiology of Disorganized Attachment: A Review of Primary Studies on Human Beings

This article describes and analyzes various aspects related to the neurobiology of disorganized attachment (DA), which is associated with personality, eating, affective, dissociative, and addictive disorders. We included primary studies in humans, published in PubMed from 2000 to 2022. Eight genetic and one epigenetic study were considered. Three molecular studies describe possible roles of oxytocin and cortisol, seven neurophysiological studies investigated functional correlates, and five morphological studies describe anatomical changes. Findings in candidate genes involved in dopaminergic, serotonergic, and oxytonergic systems have not been able to be replicated in large-scale human studies. Alterations in the functioning of cortisol and oxytocin are preliminary. Neurophysiological studies show changes in subcortical structures (mainly in the hippocampus) and occipital, temporal, parietal, and insular cortices. Since there is a lack of robust evidence on the neurobiology of DA in humans, the possible inferences of these studies are preliminary, which restricts their translation to clinical parameters.

Understanding attachment styles, adverse childhood events, alcohol use, and trauma in Black and Latino Men with criminal justice histories

Black and Latino men experience high rates of trauma before and during incarceration and upon release to the community. This study examines the association between trauma, adverse childhood experiences, and alcohol use on the adult attachment styles in a sample of 248 Black and Latino men with incarceration experiences. Most of the respondents indicated that they were single and never married (61.3%), earned less than $10,000 annually (84.3%), and were in a state prison facility during their last incarceration (60.9%). Findings indicate that most of the men scored above average in attachment anxiety (M = 5.14, SD = 1.34) and attachment avoidant subscales (M = 5.35, SD = 1.08). Close to 23% self-reported within the hazardous drinking range. In terms of trauma, the mean trauma score was 2.85 (SD = 2.97), suggesting that participants self-reported experiencing minimal trauma. Overall, Black and Latino men who experience incarceration demonstrate high rates of insecure attachments which were predicted by traumatic childhood experiences. To best serve this population, mental health treatment during incarceration and the community should enhance attachment security.

The vulnerability of insecure minds: The mediating role of mentalization in the relationship between attachment styles and psychopathology

Insecure attachment is linked to mentalizing difficulties and psychopathology. The current study aimed to examine if failures in mentalization, as observed in the form of uncertainty about mental states, mediated the relationship between attachment styles and global psychopathology in a group of 812 adults (66.5% females) from the community. Participants completed measures on attachment styles, uncertainty about mental states, and clinical symptoms. The authors found that uncertainty about mental states was a partial mediator of the associations between attachment styles and psychopathology. Furthermore, the findings supported the role of secure attachment in protecting from mentalization failures and psychopathology; on the contrary, increased scores on attachment styles involving a negative view of the self (preoccupied and fearful attachment styles) predicted high levels of uncertainty about mental states and psychopathology. Accordingly, clinicians may wish to promote mentalizing abilities in individuals who display a negative view of the self embedded in their attachment styles.

Insecure attachment as a transdiagnostic risk factor for major psychiatric conditions: A meta-analysis in bipolar disorder, depression and schizophrenia spectrum disorder

Insecure attachment has been suggested as a major risk factor for mental health problems as well as a key element for the development and trajectory of psychiatric disorders. The aim of this meta-analysis was to assess whether insecure attachment constitutes a global transdiagnostic risk factor in bipolar disorder, depression, and schizophrenia spectrum disorders. We conducted a PRISMA-based systematic quantitative review to explore the prevalence of insecure attachment among patients of three representative psychiatric disorders - major depression, schizophrenia spectrum disorders and bipolar disorder - in comparison with healthy controls (HC) from a transdiagnostic point of view. Effect sizes on differences of anxious, avoidant and insecure prevalence were calculated based on 40 samples including a total of n = 2927 individuals. Overall, results indicated a large effect on prevalence of insecure attachment across all disorders compared to HC (k = 30, g = 0.88, I² = 71.0%, p < 0.001). In a transdiagnostic comparison, the only difference was found in avoidant attachment, which was significantly lower (p = 0.04) compared to HC in the schizophrenia spectrum disorder subgroup (k = 10, g = 0.31, I² = 76.60%, p < 0.0001) than the depression subgroup subgroup (k = 12, g = 0.83, I² = 46.65%, p < 0.0001). The lack of further transdiagnostic differences between three distinct psychiatric disorders corroborates insecure attachment as a general vulnerability factor to psychopathology. Our findings warrant further investigations, which should explore the pathways from attachment insecurity towards psychopathology. Insecure attachment likely has implications on assessment, prediction and treatment of psychiatric patients.

Individual Differences in Romantic Attachment

Abstract. In the 1980s, psychologists extended attachment theory into the domain of adult romantic bonds by proposing that romantic love can be conceptualized as a process of becoming attached ( Hazan & Shaver, 1987 ). From this perspective, individuals differ in two primary attachment dimensions: anxiety, the extent to which they worry about abandonment in their romantic relationships, and avoidance, the extent to which they are uncomfortable with interdependence and closeness. Research suggests that people perceive the rearing environment as a primary cause of people’s romantic attachment styles ( Tillman et al., 2008 ). If it is, family members should be similar in attachment-related anxiety and avoidance. To test this idea, we collected romantic attachment data on 965 US college students and the family members they nominated (205 siblings, 245 mothers, and 182 fathers). The students and family members in our sample showed negligible-to-weak resemblance in attachment-related anxiety and avoidance. Because previous studies have shown substantial similarity between identical twins and weak similarity between fraternal twins in romantic attachment styles, our data reinforce the possibility that nonshared environmental influences (such as individuals’ specific relationship histories) and genetic influences are the primary sources of individual differences in attachment-related anxiety and avoidance.

Genetics of adult attachment: An updated review of the literature

Attachment style, which has been theorized to be rooted in childhood bonding experiences, influences adult cognitive, emotional and interpersonal functioning. Despite its relationship with early experiences, research indicates that the continuity of attachment style across childhood and adulthood is only partial, being a malleable tendency that is shaped throughout development, with an increasing influence of genetics, as it occurs in other cognitive and behavioral phenotypes. Genetic research indicates that up to 45% of the variability in anxious and 39% in avoidant adult attachment style could be explained by genetic causes, but the precise mechanisms remain unclear. A narrative review is conducted analyzing the existing literature regarding the implication of candidate genes related to oxytocin, dopaminergic pathways, serotonergic pathways and brain-derived neurotrophic factor in adult attachment, with both vulnerability and differential susceptibility approaches, yielding mixed results. We highlight the lack of genome-wide studies and the scarcity of epigenetic investigation. Based on the existing data, we conclude that the genetics of adult attachment is an area that requires further research to clarify its etiological role and that it should be preferably approached as an interaction between nature and nurture.

Attachment as a framework to facilitate empowerment for people with severe mental illness

OBJECTIVES

Recovery and empowerment have evolved into key objectives in the treatment and care of people with severe mental illness (SMI), and interest has grown in the role of social relationships in recovery. This study is the first to explore whether attachment styles are related to levels of empowerment, and secondly, whether attachment anxiety and attachment avoidance are associated with lower empowerment levels, independently of quality and frequency of social contact.

DESIGN

We used a cross-sectional design.

METHODS

In a sample of 157 participants with SMI in outpatient care, associations between attachment (Revised Adult Attachment Scale), self-reported social functioning, and empowerment (Netherlands Empowerment List) were assessed.

RESULTS

Attachment anxiety and attachment avoidance were both associated with lower levels of empowerment. A stepwise multiple regression analysis showed that the prediction of empowerment was significantly improved by adding attachment anxiety and attachment avoidance to quality and frequency of social contact. Attachment anxiety, attachment avoidance, and quality of social contact were significant predictors; frequency of social contact was not.

CONCLUSIONS

Although our design does not allow causal conclusions, our results highlight the importance of interpersonal processes and behaviours as routes to improving empowerment for people with SMI. A promising approach might thus consist of securing attachment bonds with significant others so that the self and the other are perceived as reliable resources. Our findings also feature the importance of reciprocity and equality in social relationships. Taken together, our study emphasizes the value of social, contextualized interventions in recovery work for people with SMI.

PRACTITIONER POINTS

Working towards attachment safety in interpersonal relations may be important in recovery-oriented treatment and care for people with severe mental illness (SMI). Helping people with SMI to recognize and change how they tend to relate themselves to others may promote engagement and effectiveness of recovery-oriented treatment and care. Reciprocity and equality in social relationships as vital complements to the more one-sided nature of 'standing alongside' and offering support may be important requisites for empowerment.

Exploring How UK Adults' Attachment Style in Romantic Relationships Affects Engagement in Controlling Behaviours

Copious studies have identified a link between disorganised attachment and engagement in controlling caregiving or controlling punitive behaviours. Studies have suggested that consistently engaging in these behaviours can cause difficulties within relationships and contribute to the development of a personality disorder. Most of the literature thus far has focused on engagement in controlling behaviours by children with a disorganised attachment style, despite there being theoretical grounds to suggest they may also be used by adults and across all types of insecure attachment. This study aimed to address these gaps by looking at adult attachment style and engagement in controlling behaviours in romantic relationships, across all insecure attachment styles; avoidant, anxious and disorganised. The current study recruited a non-clinical sample; specifically, 149 English-speaking adults, living in the UK, between the ages of 18 and 77 years old (M = 34.28, SD = 14.90). The participants answered an anonymous online questionnaire containing four self-report measures which assessed the participants' attachment security and organisation, caregiving style and engagement in punitive behaviours. The results indicated that participants who scored higher in disorganised attachment were more likely to use controlling punitive behaviours in their romantic relationships. Moreover, participants who reported a more insecure-anxious attachment style were more likely to use compulsive caregiving behaviours in their romantic relationships. In contrast, participants who reported a higher insecure avoidant attachment style were less likely to use compulsive caregiving behaviours in their romantic relationships. These results have implications for adult attachment theory and aid the understanding of some of the behaviours that can be harmful within romantic relationships. The findings could be used to help at-risk individuals develop healthy interpersonal relationship going forward.

Mediating Role of Narcissism, Vulnerable Narcissism, and Self-Compassion in the Relationship Between Attachment Dimensions and Psychopathology

OBJECTIVE

This study aimed to test the mediation effect of narcissism, vulnerable narcissism, and self-compassion in the relationship between attachment dimensions and psychopathology.

METHODS

The sample included 203 students, of whom 134 (66%) were women and 69 (34%) men with ages between 18 and 36 years [(mean: 20.73 (SD = 2.86)]. In this study, inventory of experiences in close relationships, Beck depression scale, Beck anxiety scale, narcissistic personality inventory, vulnerable narcissism scale, and self-compassion scale were used.

RESULTS

Anxious attachment was positively correlated with vulnerable narcissism and narcissistic personality traits, negatively with self-compassion, and positively with depression and anxiety. However, avoidant attachment was negatively correlated with vulnerable narcissism and narcissistic personality traits. Self-compassion was negatively associated with vulnerable narcissism, depression, and anxiety. When mediating effects were tested, it was found that narcissistic personality traits and vulnerable narcissism had mediating effects both in the relationship between anxious attachment and anxiety and in the relationship between anxious attachment and depression.

CONCLUSION

As it is known that insecure attachment is associated with the development of many psychopathologies in terms of preventive mental health, it is thought that it will be important to consider the dimensions of self-compassion and narcissism in the prevention programs to be carried out. Considering the mediating effect of self-compassion, targeting the development of an individual's non-judgmental attitude toward himself or herself can prevent possible psychological problems and create a buffering effect.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

Genes and environment in attachment

In the last two decades, there has been increasing research interest in disentangling the contribution of genetic and environmental factors to individual differences in attachment, and in identifying the genes involved in shaping attachment. Twin studies suggest that as attachment changes during the course of development, genetic factors may play a progressively more important role, while shared environmental effects might decrease. However, most of this literature is limited by low power, measurement issues, and cross-sectional design. The findings of molecular genetic studies are, overall, inconclusive. The literature on main genetic effects and gene-by-environment interactions on attachment is filled with inconsistent and unreplicated findings. Also, most studies are underpowered. Challenges for future research are to identify the unshared environmental mechanisms involved in shaping attachment, and to better elucidate the genes involved and their interaction with the environment. Some pioneer studies suggested that the incorporation of epigenetic processes into G × E interaction models might represent a promising future way for investigating the complex, dynamic interplay between genes, environment, and attachment.

Parental divorce is associated with an increased risk to develop mental disorders in women

BACKGROUND

Parental divorce has been associated with reduced well-being in young adults. It is, however, unclear whether this finding is clinically relevant as studies using structured clinical interviews are missing. This study, therefore, investigated if young adults with divorced parents are at risk to develop mental disorders. Furthermore, differences in parental care, social connectedness, chronic stress and traumatic experiences between children of divorced and non-divorced parents were investigated.

METHODS

121 women (mean age: 23 years) were interviewed using the Structured Clinical Interview for DSM-IV Axis I (i.e., major mental disorders) and II (i.e., personality disorders) Disorders and asked to complete questionnaires assessing parental care, social connectedness (loneliness, attachment anxiety and avoidance), chronic stress, childhood trauma and depression.

RESULTS

Young adults of divorced parents had a higher risk for Axis I but not Axis II disorders as compared to young adults of non-divorced parents. Participants from divorced families as compared to non-divorced families reported more depression, loneliness, childhood trauma, attachment avoidance, attachment anxiety, chronic stress and less paterntal care.

LIMITATIONS

Due to the cross-sectional design of this study, conclusions about causality remain speculative.

CONCLUSION

The increased vulnerability of children of divorced parents to develop mental disorders, and to experience more chronic stress, loneliness, attachment avoidance, attachment anxiety, and traumatic experiences during childhood is alarming and highlights the importance of prevention programs and psycho-education during the process of parental divorce. Parental support with regard to adequate caregiving is needed to help parents to better support their children during and after their divorce.

Differences in Parenting Stress, Parenting Attitudes, and Parents' Mental Health According to Parental Adult Attachment Style

Objectives:

We aimed to compare the differences in parenting stress, parenting attitudes, and parents’ mental health between different adult attachment styles.

Methods:

Forty-four parents who completed a parental education program were enrolled in our study. They completed the Korean version of the Experience of Close Relationship Revised, Korean-Parenting Stress Index-Short Form, Maternal Behavior Research Instrument, and Symptom Checklist-90-Revised.

Results:

The avoidant attachment score positively correlated with parenting stress. The anxious attachment score showed a positive relationship with parenting stress, hostile parenting attitude, and psychopathology, but a negative association with an affectionate parenting attitude. The secure attachment group exhibited a more autonomous, affectionate parenting style and a less hostile parenting attitude and less parenting stress than the insecure attachment group. Dismissing-avoidant attachment parents reported significantly higher parenting stress scores than secure attachment parents. Preoccupied and fearful-avoidant attachment parents displayed a more hostile parenting style than secure attachment parents. Dismissing-avoidant and preoccupied parents reported a less affectionate parenting attitude than secure attachment parents.

Conclusion:

There were differences in parenting stress, parenting attitudes, and parents’ mental health depending on the adult attachment style. More specific education and interventions based on parental attachment type are necessary for parents.

Examining the role of attachment in the relationship between childhood adversity, psychological distress and subjective well-being

Childhood adversity is associated with a wide range of detrimental psychological consequences. This study examined the mediating role of relationship-specific attachment (avoidance and anxiety) in the associations between childhood adversity and both psychological distress and subjective well-being. University students (N=190) across the Republic of Ireland completed self-report measures including the Adverse Childhood Experiences scale, Experiences in Close Relationships - Relationship Structures scale, Depression Anxiety and Stress scales and measures of subjective well-being. One hundred and twenty-eight participants (67.4%) reported experiencing at least one adverse childhood experience. Childhood adversity was associated with symptoms of psychological distress and subjective well-being. All such associations were mediated by certain relationship-specific attachment dimensions. Of these, attachment anxiety in general relationships was the most prominent mediator for both psychological distress and subjective well-being. Attachment to one's father and to one's romantic partner did not mediate any association. These findings indicate that attachment, in particular relationships, is an important factor in the associations between childhood adversity and both psychological distress and subjective well-being as an adult. One's attachment anxiety in general relationships is particularly important in these associations. Therapeutic interventions addressing these attachment domains may offset the detrimental effects of childhood adversity. Future research is required using a longitudinal design.

The Evolutionary Life History Model of Externalizing Personality: Bridging Human and Animal Personality Science to Connect Ultimate and Proximate Mechanisms Underlying Aggressive Dominance, Hostility, and Impulsive Sensation Seeking

The present work proposes an evolutionary model of externalizing personality that defines variation in this broad psychobiological phenotype resulting from genetic influences and a conditional adaptation to high-risk environments with high extrinsic morbidity-mortality. Due to shared selection pressure, externalizing personality is coadapted to fast life history strategies and maximizes inclusive fitness under adverse environmental conditions by governing the major trade-offs between reproductive versus somatic functions, current versus future reproduction, and mating versus parenting efforts. According to this model, externalizing personality is a regulatory device at the interface between the individual and its environment that is mediated by 2 overlapping psychobiological systems, that is, the attachment and the stress-response system. The attachment system coordinates interpersonal behavior and intimacy in close relationships and the stress-response system regulates the responsivity to environmental challenge and both physiological and behavioral reactions to stress. These proximate mechanisms allow for the integration of neuroendocrinological processes underlying interindividual differences in externalizing personality. Hereinafter I further discuss the model's major implications for personality psychology, psychiatry, and public health policy.

Allostatic load and comorbidities: A mitochondrial, epigenetic, and evolutionary perspective

Stress-related pathophysiology drives comorbid trajectories that elude precise prediction. Allostatic load algorithms that quantify biological "wear and tear" represent a comprehensive approach to detect multisystemic disease processes of the mind and body. However, the multiple morbidities directly or indirectly related to stress physiology remain enigmatic. Our aim in this article is to propose that biological comorbidities represent discrete pathophysiological processes captured by measuring allostatic load. This has applications in research and clinical settings to predict physical and psychiatric comorbidities alike. The reader will be introduced to the concepts of allostasis, allostasic states, allostatic load, and allostatic overload as they relate to stress-related diseases and the proposed prediction of biological comorbidities that extend rather to understanding psychopathologies. In our transdisciplinary discussion, we will integrate perspectives related to (a) mitochondrial biology as a key player in the allostatic load time course toward diseases that "get under the skin and skull"; (b) epigenetics related to child maltreatment and biological embedding that shapes stress perception throughout lifespan development; and

Adult Attachment, Social Adjustment, and Well-Being in Drug-Addicted Inpatients

In recent years, attachment studies have gathered overwhelming evidence for a relation between insecure attachment and drug addiction. The existing literature predominantly addresses attachment styles and little attention is given to attachment-pattern-oriented studies. The current study explored how attachment, social adjustment, and well-being interact in 40 (28 men, 12 women; ages 20-52 years, M = 32.3, SD = 9.4) inpatients with drug addiction. The Adult Attachment Projective Picture System (AAP), the Social Adjustment Scale-Self-report (SAS-SR), and the General Health Questionnaire-28 (GHQ-28) were administered. Descriptive statistics were computed as well as differences between patterns of attachment in all variables were measured. None of the inpatients showed a secure attachment pattern: 7 scored as dismissing (18%), 5 preoccupied (12%) and 28 unresolved (70%). AAP stories were mainly connected with themes of danger, lack of protection, and helplessness. Inpatients classified as unresolved reported significantly higher maladjustment on the SAS-SR and GHQ-28 than those with resolved attachment patterns. Implications for clinicians and researchers are presented.

Relationships between self-reported childhood traumatic experiences, attachment style, neuroticism and features of borderline personality disorders in patients with mood disorders

BACKGROUND

Co-occurring borderline personality disorder (BPD) features have a marked impact on treatment of patients with mood disorders. Overall, high neuroticism, childhood traumatic experiences (TEs) and insecure attachment are plausible aetiological factors for BPD. However, their relationship with BPD features specifically among patients with mood disorders remains unclear. We investigated these relationships among unipolar and bipolar mood disorder patients.

METHODS

As part of the Helsinki University Psychiatric Consortium study, the McLean Screening Instrument (MSI), the Experiences in Close Relationships-Revised (ECR-R), the Short Five (S5) and the Trauma and Distress Scale (TADS) were filled in by patients with mood disorders (n=282) in psychiatric care. Correlation coefficients between total scores of scales and their dimensions were estimated, and multivariate regression (MRA) and mediation analyses were conducted.

RESULTS

Spearman's correlations were strong (rho=0.58; p<0.001) between total scores of MSI and S5 Neuroticism and moderate (rho=0.42; p<0.001) between MSI and TADS as well as between MSI and ECR-R Attachment Anxiety. In MRA, young age, S5 Neuroticism and TADS predicted scores of MSI (p<0.001). ECR-R Attachment Anxiety mediated 33% (CI=17-53%) of the relationships between TADS and MSI.

LIMITATIONS

Cross-sectional questionnaire study.

CONCLUSIONS

We found moderately strong correlations between self-reported BPD features and concurrent high neuroticism, reported childhood traumatic experiences and Attachment Anxiety also among patients with mood disorders. Independent predictors for BPD features include young age, frequency of childhood traumatic experiences and high neuroticism. Insecure attachment may partially mediate the relationship between childhood traumatic experiences and borderline features among mood disorder patients.

Cross-Cultural Comparison of Personality Traits, Attachment Security, and Satisfaction With Relationships as Predictors of Subjective Well-Being in India, Sweden, and the United States

Personality traits like Neuroticism and Extroversion, Satisfaction With Relationships, and Attachment Security are among the most important predictors of subjective well-being (SWB). However, the relative contribution of these predictors to SWB is seldom tested, and even more rarely tested cross-culturally. In this study, we replicate and extend Galinha, Oishi, Pereira, Wirtz, and Esteves, aiming to identify the strongest predictors of SWB, and in what way that contribution is universal or culture-specific, across such collectivist-individualist countries as India, Sweden, and the United States ( N = 1,622). Structural equation modeling showed that Satisfaction With Relationships is a stronger predictor of SWB in India, while Neuroticism is a stronger predictor of SWB in Sweden and the United States, results consistent with prior Portuguese and Mozambican samples. These findings suggest that Satisfaction With Relationships is probably a stronger predictor of SWB in more collectivistic and less developed countries, while low Neuroticism is a stronger predictor of SWB in more individualistic and highly developed countries. Across all samples, Attachment Security and Extroversion showed very weak or nonsignificant effects on SWB above the contribution of Neuroticism and Satisfaction With Relationships, consistent with prior results. Neuroticism significantly mediated the relationship between Attachment Security, SWB, and Satisfaction With Relationships.

Oxytocin receptor polymorphism and childhood social experiences shape adult personality, brain structure and neural correlates of mentalizing

INTRODUCTION

The oxytocin system is involved in human social behavior and social cognition such as attachment, emotion recognition and mentalizing (i.e. the ability to represent mental states of oneself and others). It is shaped by social experiences in early life, especially by parent-infant interactions. The single nucleotid polymorphism rs53576 in the oxytocin receptor (OXTR) gene has been linked to social behavioral phenotypes.

METHOD

In 195 adult healthy subjects we investigated the interaction of OXTR rs53576 and childhood attachment security (CAS) on the personality traits "adult attachment style" and "alexithymia" (i.e. emotional self-awareness), on brain structure (voxel-based morphometry) and neural activation (fMRI) during an interactive mentalizing paradigm (prisoner's dilemma game; subgroup: n=163).

RESULTS

We found that in GG-homozygotes, but not in A-allele carriers, insecure childhood attachment is - in adulthood - associated with a) higher attachment-related anxiety and alexithymia, b) higher brain gray matter volume of left amygdala and lower volumes in right superior parietal lobule (SPL), left temporal pole (TP), and bilateral frontal regions, and c) higher mentalizing-related neural activity in bilateral TP and precunei, and right middle and superior frontal gyri. Interaction effects of genotype and CAS on brain volume and/or function were associated with individual differences in alexithymia and attachment-related anxiety. Interactive effects were in part sexually dimorphic.

CONCLUSION

The interaction of OXTR genotype and CAS modulates adult personality as well as brain structure and function of areas implicated in salience processing and mentalizing. Rs53576 GG-homozygotes are partially more susceptible to childhood attachment experiences than A-allele carriers.

Extending the Transdiagnostic Model of Attachment and Psychopathology

Research has suggested that high levels of attachment insecurities that are formed through interactions with significant others are associated with a general vulnerability to mental disorders. In the present paper, we extend Ein-Dor and Doron's (2015) transdiagnostic model linking attachment orientations with internalizing and externalizing symptoms, to include thought disorder spectrum symptoms. Specifically, we speculate on the processes that mediate the linkage between attachment insecurities and psychosis and obsessive compulsive disorder (OCD) symptoms, and indicate the different contexts that might set a trajectory of one individual to one set of symptoms while another individual to a different set of symptoms.

Implicit Attitude Toward Caregiving: The Moderating Role of Adult Attachment Styles

Attachment and caregiving are separate motivational systems that share the common evolutionary purpose of favoring child security. In the goal of studying the processes underlying the transmission of attachment styles, this study focused on the role of adult attachment styles in shaping preferences toward particular styles of caregiving. We hypothesized a correspondence between attachment and caregiving styles: we expect an individual to show a preference for a caregiving behavior coherent with his/her own attachment style, in order to increase the chance of passing it on to offspring. We activated different representations of specific caregiving modalities in females, by using three videos in which mothers with different Adult Attachment states of mind played with their infants. Participants' facial expressions while watching were recorded and analyzed with FaceReader software. After each video, participants' attitudes toward the category "mother" were measured, both explicitly (semantic differential) and implicitly (single target-implicit association task, ST-IAT). Participants' adult attachment styles (experiences in close relationships revised) predicted attitudes scores, but only when measured implicitly. Participants scored higher on the ST-IAT after watching a video coherent with their attachment style. No effect was found on the facial expressions of disgust. These findings suggest a role of adult attachment styles in shaping implicit attitudes related to the caregiving system.

Severity of personality disorders and domains of general personality dysfunction related to attachment

This is the first study to link attachment to both severity of total DSM-IV personality disorder (PD) traits and domains of general personality dysfunction, using a sample of 72 inpatients from New York City. We assessed a measure of global PD severity and the core domains of personality functioning using the severity indices of personality problems (SIPP-118). Attachment was measured with the experience in close relationships-revised (ECR-R) and the relationship style questionnaire (RSQ). Global PD severity correlated most strongly with attachment anxiety (r = 0.65). Regression of the SIPP-118 domains on attachment produced models that accounted for a substantial proportion of variance in those scales (R(2) ranging from 28.2 to 54.2%). SIPP-118 relational capacities were the strongest predictor of ECR-R avoidance (β = -0.88) and anxiety (β = -0.58), as well as RSQ secure (β = 0.53) and fearful (β = -0.65). In conclusion, insecure attachment strongly related to the severity of global PD traits and specifically to relational capacities, which are a higher-order domain of general personality dysfunction. These findings provide further evidence that interpersonal problems are at the core of PDs and that attachment could constitute an important mediator of the social dysfunction in persons with personality pathology.

The Attachment Paradox: How Can So Many of Us (the Insecure Ones) Have No Adaptive Advantages?

Bowlby's (1969/1982) attachment theory has generated an enormous body of research and conceptual elaborations. Although attachment theory and research propose that attachment security provides a person with many adaptive advantages during all phases of the life cycle, numerous studies indicate that almost half of the human species can be classified as insecurely attached or insecure with respect to attachment. It seems odd that evolution left humans in this vulnerable position unless there are some advantages, under at least some conditions, to anxious and avoidant attachment styles. We argue that a social group containing members with different attachment patterns may be more conducive to survival than a homogeneous group of securely attached individuals. In making this argument, we extend the scope of attachment theory and research by considering a broader range of adaptive functions of insecure attachment strategies. We also present preliminary data to support our argument.

Associations of working models of the self and other with Cloninger's personality dimensions

The present study examined the associations of working models of the self and other, one of the key concepts of Bowlby's attachment theory, with the seven dimensions of Cloninger's personality model. The subjects were 542 healthy Japanese volunteers. Working models of the self and other were assessed by the Relationship Scales Questionnaire, and the seven dimensions of personality were evaluated by the Temperament and Character Inventory. In the correlation analysis, the self-model was correlated most strongly with self-directedness (SD) (r=0.50, P<0.001) and second strongly with harm avoidance (HA) (r=-0.43, P<0.001), while the other-model was correlated most strongly with cooperativeness (C) (r=0.43, P<0.001) and second strongly with reward dependence (RD) (r=0.41, P<0.001). In the principal component analysis, the self-model formed a group with SD and HA, while the other-model formed a group with C and RD. The present study suggests that the self-model is reflected in SD and HA, while the other-model is reflected in C and RD.

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.

Application of EMDR Therapy for Borderline Personality Disorder

There is a growing interest in the use of eye movement desensitization and reprocessing (EMDR) therapy beyond posttraumatic stress disorder (PTSD) where its application is well established. With strong scholarly consensus that early traumatic and adverse life experiences contribute to the development of borderline personality disorder (BPD), EMDR would appear to offer much to the treatment of persons with BPD. However, given the specific characteristics of these clients, the application of EMDR therapy to their treatment can be challenging and necessitates several minor adaptations of the standard EMDR procedures for PTSD. This article provides an orientation to principles and strategies for safely and effectively preparing clients with BPD for EMDR therapy and for accessing and reprocessing the traumatic origins of BPD. Clinical examples are provided throughout.

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.

The association between adult attachment style, mental disorders, and suicidality: findings from a population-based study

Attachment theory categorically assesses how a person perceives and experiences interpersonal relationships. Attachment style is linked to numerous physical and psychological phenomena; however, there is a paucity of research examining its relationship to suicide ideation and attempt in adults. Our study addresses this and investigates the relationship of adult attachment style and mental disorders in a nationally representative sample. Using data from the National Comorbidity Survey Replication (N = 5692, aged >18 years), multiple logistic regression analyses were conducted to examine these relationships. After adjusting for confounding variables, insecure attachment styles were associated with greater reporting of suicidal ideation, attempt, and all mental disorder categories analyzed (adjusted odds ratio range, 1.13-1.81). Secure attachment styles were associated with a decreased likelihood of reporting suicidal ideation, attempt, and any anxiety disorder (adjusted odds ratio range, 0.67-0.91). Clinicians should be aware of attachment issues in their patients to ensure better health outcomes and more effective physician-patient relationships.

The Role of Personality Traits, Attachment Style, and Satisfaction With Relationships in the Subjective Well-Being of Americans, Portuguese, and Mozambicans

Personality traits, attachment security, and satisfaction with relationships are each important predictors of subjective well-being (SWB). However, no studies have included these predictors together to analyze the unique contribution of each to SWB. Furthermore, most studies are empirically based in Western/industrialized societies, and few studies include African countries. This article addresses the unique contribution of extroversion, neuroticism, attachment security, and satisfaction with relationships to SWB across three samples of 1,574 university students: 497 from North Carolina (United States of America), 544 from Maputo (Mozambique), and 533 from Lisbon (Portugal). Structural equation modeling analysis showed that in the American sample, emotional stability was a more important predictor of global SWB than satisfaction with relationships. In the Mozambican sample, satisfaction with relationships was far more important as a predictor of SWB than emotional stability. In the Portuguese sample, emotional stability and satisfaction with relationships were equally important predictors of SWB. The main difference between the three samples was the contribution of satisfaction with relationships to SWB. Similarities between the three samples include the low or nonsignificant contributions of extroversion and attachment to SWB, above and beyond the contribution of satisfaction with relationships and neuroticism, suggesting they may be sharing variance in the prediction of SWB.

A twin study of attachment style in young adults

The relative contribution of genetic and environmental influences to individual differences in attachment security is still incompletely understood. We assessed attachment style with the Experiences in Close Relationships questionnaire in a volunteer sample of 677 twins (43% male) ages 23-24 years drawn from the population-based Italian Twin Register, who belonged to 244 complete pairs (46% monozygotic) and 189 unmatched pairs. Genetic structural equation modeling was performed with the Mx program. Genetic effects accounted for 45% and 36% of individual differences in attachment-related anxiety and avoidance, respectively. Furthermore, the covariation between anxiety and avoidance was found to be mainly due to genetic factors, with heritability of the latent attachment security phenotype estimated at 62%. Unshared environmental factors explained the remaining proportion of variance. Although our findings are best regarded as preliminary given some study limitations, they suggest that both nature and nurture contribute to individual differences in adult attachment.

An attachment perspective on psychopathology

In recent years, attachment theory, which was originally formulated to describe and explain infant-parent emotional bonding, has been applied to the study of adolescent and adult romantic relationships and then to the study of psychological processes, such as interpersonal functioning, emotion regulation, coping with stress, and mental health. In this paper, we offer a brief overview of the attachment perspective on psychopathology. Following a brief account of attachment theory, we go on to explain how the study of individual differences in adult attachment intersects with the study of psychopathology. Specifically, we review research findings showing that attachment insecurity is a major contributor to mental disorders, and that the enhancement of attachment security can facilitate amelioration of psychopathology.

Effects of parental relations and upbringing in troubled adolescent eating behaviors

Family relations may constitute a risk for developing eating problems. Not enough is known about parent-child relationship quality and upbringing in food situations. Self-report data from 80 high school students (45 males) showed that females had more eating problems than males, and their problems were related both to insecure mother attachment, controlling for body/weight dissatisfaction, and to more memories of childhood food rules. Secure mother attachment was related to decreased eating problems, via increasing body/weight satisfaction. Especially the mother- daughter relationship seems to affect adolescent girls' eating habits and can either protect against or enhance the risk for eating problems.

The relationship between attachment, personality and antisocial tendencies in a prison sample: a pilot study

This study examined the role of adult attachment and personality in relation to antisocial tendencies (i.e. convictions for violence and interpersonal problems in romantic relationships) in Norwegian prison inmates (N=92). Attachment styles and personality were measured using self-report questionnaires (RSQ; Griffin & Bartholomew, 1994; and NEO-FFI, Costa & McCrae, 1992a). The prison inmates scored higher on avoidant than on anxious attachment style. While age and agreeableness (negatively associated) emerged as significant predictors of violence, anxious attachment explained most of the variances in aggression in intimate relationships. The study suggests that different types of antisocial tendencies could have different attachment and general personality correlates.