Attachment and psychopathology: a dynamic model of the insecure cycle

The role of environmental sensitivity in the experience and processing of emotions: implications for well-being

Several theories suggest that people differ significantly in their environmental sensitivity, defined as the capacity to perceive and process information about the environment. More sensitive people, who make up between 25% and 30% of the population, are not only more negatively affected by adverse experiences but also benefit disproportionately from positive ones, in line with differential susceptibility theory. Heightened emotional reactivity has been identified as one of the key markers of sensitivity. However, the current understanding of the relationship between sensitivity and the experience and processing of emotions remains limited. In the current paper we propose a new conceptual framework for the multiple ways in which environmental sensitivity may impact on different aspects of the experience and processing of emotions. This includes heightened perception of emotions, increased emotional reactivity, as well as the important role of emotion regulation for the well-being of highly sensitive people. In addition, we also consider rearing experiences in shaping sensitivity and emotion regulation. The reviewed empirical studies largely support the conceptual model but more research is needed to explore the dynamics between sensitivity and emotions further. Finally, we discuss several implications for well-being before making a case for the inclusion of individual differences in environmental sensitivity in affective science. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

Parent Emotion Regulation, Mindful Parenting, and Youth Attachment: Direct and Indirect Associations with Internalizing and Externalizing Problems

The direct associations between two dimensions of parent emotion regulation within the parent-youth relationship (dysregulation; suppression), mindful parenting, and youth internalizing and externalizing problems were examined among 759 parents of youth with significant behavioural or emotional problems. The indirect associations of parent emotion regulation and mindful parenting with youth functioning through youth attachment anxiety and avoidance were also investigated. Parent dysregulation was associated with internalizing symptoms both directly and through attachment anxiety, and with externalizing symptoms directly and through attachment anxiety and avoidance. Parent suppression was associated with internalizing symptoms through attachment anxiety, and with externalizing symptoms through attachment anxiety and avoidance. Mindful parenting was associated with lower internalizing symptoms through attachment anxiety and with lower externalizing symptoms through attachment anxiety and avoidance. Emotion regulation within parent-child relationships and mindful parenting may be critical components of parenting programs aimed at promoting youth attachment security and mental health.

Attachment style to body dissatisfaction, restrained eating, and disordered eating in adolescent girls: Differential weight communication mediators

Body dissatisfaction and eating behaviors are disproportionately elevated amongst adolescent girls. Family relationships represent a context in which adolescent girls' body image issues emerge. Thus, we integrated attachment and confirmation theories to examine whether weight related supportive messages (i.e., acceptance and challenge) mediated the relationship between attachment style (i.e., anxiety and avoidance) and body image outcomes (i.e., body dissatisfaction (BD), restrained eating (RE), and disordered eating (DE)). Acceptance refers to weight related support that is characterized by warmth and accepting messages; challenge refers to weight related support that is characterized by instrumental assistance and problem-solving messages. A sample of 106 adolescent girls, ages 11 to 21, completed self-report measures on attachment (Relationship Structures Questionnaire), acceptance and challenge (weight related Parental Behavior Questionnaire), body dissatisfaction (Eating Disorders Inventory), and eating behaviors (Dutch Eating Behavior Questionnaire; Eating Disorder Diagnostic Scale). Attachment anxiety directly related to all body image outcomes, whereas attachment avoidance only directly related to RE. Attachment avoidance only related to BD and DE indirectly through perceived acceptance. Those with high anxiety endorsed lower perceived challenge, whereas avoidant individuals endorsed lower perceived acceptance and challenge. We concluded that attachment dimension characteristics to be either hyperactivated regarding relationships (i.e., anxiety), or deactivated and distant (i.e., avoidance), are associated with how individuals perceive support, and in turn, are related to body image and eating behavior outcomes. Further, we clarify the differential roles of acceptance and challenge. Although both supportive, acceptance encompasses a layer of warmth that is more meaningful in body image, particularly for avoidantly attached individuals. By integrating qualities of attachment and supportive weight communication, we reveal that potential pathways of attachment to body image and eating behaviors.

The Mediating Role of Affect Dysregulation and Dissociation in the Relationship Between Attachment and Compulsive Online Shopping: A Path Analysis Model

Objective

Online shopping has been described by the scientific literature both for its benefits and the potential risks when excessive usage is involved. Indeed, compulsive online shopping is commonly conceptualized as a potential behavioural addiction that substantially impacts the lives of individuals afflicted by it. In light of this, the present research aimed at exploring the association between possible risk and protective factors for compulsive online shopping, by specifically exploring the role of adult attachment, affect dysregulation, and dissociation.

Method

285 participants (75% females, 25% males; Mage = 31.57, SD = 11.379) were involved in the research and completed an online survey. The collected data was analysed implementing a path analysis model.

Results

Results showed significant total effects in the relationship between secure/fearful attachment patterns and compulsive online shopping. Such associations were significantly mediated by the sequential effect of affect dysregulation and dissociation.

Conclusions

The present study provides useful information to guide tailored interventions concerning both preventive activity and clinical practice.

A qualitative exploration of depressed female Iranian adolescents' attachment narratives

It is assumed that depressed and suicidal adolescents struggle with issues reflecting insecure attachment. However, less is known about which insecure attachment-related themes characterize depression and suicidality in adolescents. To explore this further, semi-structured in-depth interview were conducted with 18 Iranian female adolescents (Mage = 16.6 ± 0.70), with depression and/or suicidal ideation or suicide attempts, who self-reported being insecurely attached. Qualitative data were analysed using thematic analysis. Three main themes were identified from the data: (1) quality of parenting, (2) attachment representation, and (3) attachment behavior. The theme parenting quality included the subthemes "emotionally absent", "emotionally supportive", "psychologically controlling", "overprotective", "punitive", "aggressive", and "passive". The theme attachment representation comprised: "not accepting", "not feeling loved", "not feeling understood", "lack of intimacy", "unreliable", "reliable", "mixed emotions", "hatred", and "dismiss and devaluation". The theme attachment behavior included "aggression", "relational avoidance", and "emotional role reversal". Findings point to the possible usefulness of attachment-based interventions to treat suicidal adolescents and their families in Iran. However, the results also showed culture-specific themes, pointing at the father-daughter relationship's unique importance, which deserves special attention in attachment-based interventions.

A family reunion of "clinical cousins": Attachment and emotion in four family-oriented therapy models

Attachment theory and the science of emotion provide a strong foundation for intervention at the family system level. Four therapeutic models in particular, Attachment-Based Family Therapy, Emotion-Focused Family Therapy, Dyadic Developmental Psychotherapy, and Emotionally Focused Family Therapy, demonstrate how a broad and accurate view of attachment relationships and emotion can be utilized to effectively intervene for a variety of presenting problems in a relational and empathic way for all involved. This paper continues a conversation that began at the Summit for Attachment and Emotion in Family Therapy in 2021 and aims to foster openness, collaboration, and affirmation between four different models of family therapy with shared theoretical roots. The presenters at the Summit and the authors of this paper view similarities across these models as validating and differences as opportunities to serve more families in unique ways, learning from one another's creativity to promote healing within families in the most effective and efficient ways possible. The paper frames the value of attachment theory and emotion science for family therapy, discusses the importance of learning from a variety of models with shared theoretical roots, presents brief summaries of the four models presented at the Summit, compares the models for similarities and complementarities, and shares highlights from each of the presenters from the Summit.

The Rating of Emotional Abuse in Childhood (REACH) Questionnaire: A new self-report measure assessing history of childhood emotional abuse

BACKGROUND

A history of childhood emotional abuse (CEA) is prevalent among adults with affective disorders; therefore, a comprehensive measure of it is vital. The Rating of Emotional Abuse in Childhood Questionnaire (REACH) was developed to assess history of CEA in relation to parental behaviours of threat, ignoring, humiliation/denigration, scapegoating, antipathy, and overcontrol/conditionality in a single measure. This paper investigated the psychometric properties of REACH in a community sample and proposes values for classifying individuals as high-risk for CEA.

METHOD

A convenience sample of N = 483 adults (Female, 78.3%) was recruited to complete questionnaires that included the REACH alongside measures of mental health, insecure attachment, emotion regulation, and childhood abuse. A subset of participants (n = 198) completed the REACH 7 days later.

RESULTS

Factor analysis indicated a 2-factor model provided a good fit. Factors were named 'threatening' and 'devaluing'. A total scale score of CEA was also recommended. The threatening, devaluing, and total scales demonstrated strong psychometric properties with high internal consistency, test-retest reliability, and convergent validity, while cutoff values for identifying a high-risk CEA group demonstrated good discriminant utility.

CONCLUSIONS

The results support REACH as a valid measure and suggest a history of CEA should be measured in relation to threatening and devaluing CEA as they represent unique dimensions of CEA even though they often co-occur.

Do parental attachment and prosocial behavior moderate the impairment from depression symptoms in adolescents who seek mental health care?

We investigated parental attachment and prosocial behavior as social protective indicators in adolescents (age 11-17) with symptoms of depression in a clinical setting. Specifically, we tested the moderating effect of these factors on the relation between symptoms of depression and their impairment on daily life. The Development and Well-Being Assessment, as completed by children, mothers, and fathers, was used, and hierarchical multiple regression analyses were conducted for these three perspectives. From the adolescents' reports we only found a significant effect of symptoms on impairment indicating that a higher number of symptoms were related to higher impairment. For the mothers and fathers, a higher score on the adolescents' prosocial behavior was related to a lower impairment from depression symptoms on the daily life of the adolescent and the family. Only for the mothers did a higher score on prosocial behavior buffered the effect of symptoms on impairment, while a higher parental attachment score was associated with a lower impairment. Further, when examining maternal and paternal attachment separately, we found that, only the mothers, reported less impairment from the symptoms when they perceived that the adolescent was attached to the father, and paternal attachment even buffered the effect of symptoms on impairment. To conclude, our results indicate that social protective factors, from the parent's perspective, are likely to have a beneficial effect in clinical practice and should be taken into account when examining impairment scores. Future studies should investigate whether additional protective indicators from the adolescents' perspective, such as quality of parental attachment or family climate, may have a positive impact on their daily functioning.

Mediating role of splitting in relation to attachment styles and shopping addiction

Introduction

Shopping can provide a sense of satisfaction and pleasure; however, if a person's excessive involvement in this behavior starts to negatively impact other aspects of their life, similar to other addictive behaviors like excessive internet use, gaming, and gambling, it may be classified as pathological. Given the lack of agreement regarding the classification of excessive shopping tendencies as a separate mental health condition or addictive behavior, taking a socio-emotional approach to explore the psychological factors that precede this behavior, may offer a better comprehension of it.

Methods

The purpose of this study was to examine the relationship between attachment styles and excessive shopping behavior, as well as to investigate the potential mediating effect of defense mechanisms like splitting on this relationship. Using convenience sampling, a group of 457 stock market employees (116 female, 341 male) between the ages of 24 and 60 were recruited. The researchers utilized a set of validated psychological questionnaires to assess the employees attachment styles, shopping addiction, and splitting tendencies.

Results

The results obtained from both the mediation model and path analysis suggest that attachment styles do not have a direct relationship with shopping addiction. Nonetheless, the study supports the impact of insecure anxious and avoidan attachment styles on splitting. Furthermore, the findings confirm that splitting has a mediating effect on the relationship between attachment styles and splitting.

Discussion

The present study enhanced our comprehension of the subconscious mechanisms underlying shopping tendencies. Specifically, the findings suggest that excessive tendencies towards shopping can be considered a maladaptive response resulting from insecure attachment styles and the unconscious utilization of the splitting defense mechanism.

Middle childhood attachment-based family therapy: Theory and model description

In middle childhood, the first manifestations of mental health problems can emerge and become a precursor of mental health issues in adolescence. Given that weak parent-child attachment can contribute to this distress, it is possible that strengthening the attachment bond could reduce risk trajectory. Unfortunately, evidence-based attachment-focused interventions are lacking at this age. Attachment-based family therapy (ABFT) is a well-studied intervention for troubled adolescents and has the potential to be extended downward to children. However, ABFT for adolescents focuses on mentalization and trauma conversation strategies that may be developmentally advanced for children's capacities. Therefore, we modified the intervention strategies to be more developmentally sensitive to childhood. Middle childhood ABFT (MCABFT) builds on the theory that insecure attachment develops through a learning process that can be interrupted and reorganized to promote secure attachment development. MCABFT uses less conversation and more play and puts parents more at the center of the therapy compared with ABFT for adolescents. In this article, we describe MCABFT's theoretical and clinical model.

Temporal pathways from attachment insecurity to paranoia in a heterogeneous clinical sample: An experience sampling study

INTRODUCTION

There has been growing interest in the role of attachment mechanisms in the onset and maintenance of paranoia. The latest systematic reviews of mixed samples of healthy individuals and psychiatric patients have revealed that increased trait attachment anxiety and avoidance are associated with experiencing paranoia, with trait attachment anxiety showing a stronger association. Few studies have examined attachment and paranoia in naturalistic conditions via the Experience Sampling Method.

OBJECTIVES

The present study examined whether experiences of attachment anxiety and avoidance fluctuate in the flow of daily life, and whether a within-person change in both attachment states precedes the experience of momentary paranoia, and negative and positive emotions.

METHODS

Thirty-seven clinical participants and twenty-six healthy controls were studied over six consecutive days using the Experience Sampling Method (ESM). An experience-in-close-relationships questionnaire (ECR-R 16 SF) was used to capture trait attachment dimensions. Several ESM items were used to capture momentary negative and positive affect, paranoia and attachment insecurity states.

RESULTS

The findings revealed that fluctuations in both attachment insecurity states were significantly higher in the clinical group. A prior elevated attachment anxiety and avoidance was followed by an increase in negative affect in the next moment and elevated attachment avoidance was additionally followed by a decrease in positive affect and an increase in paranoia.

CONCLUSION

Our findings reveal the specific temporal associations between momentary attachment insecurity states as predictors of change in emotions/affects and paranoia, along with evidence that state attachment avoidance has a superior impact on momentary affect and paranoia compared to state attachment anxiety. These results contrast with those of recent cross-sectional studies.

Piloting attachment psychoeducation provided to parents of children with severe disabilities: Testing the feasibility of a digital micro-intervention

BackgroundA digital micro-intervention offering attachment psychoeducational videos was explored regarding its feasibility in parents of children with severe disabilities. Method: A mixed-methods study (including daily diaries and one-time questionnaires) with 16 parents (75.0% female) of children with severe disabilities (up to 10 years of age) was done during a three-week intervention. Results: Parents were positive about the video series and almost no drop-out occurred. The videos stimulated their learning and thinking and offered parents some personal meaning. Preliminary efficacy tests showed no major changes in parents' parenting self-efficacy (PSE) or perceptions of statements on parent-child attachment. Conclusions: The study showed promising results regarding the micro-interventions' acceptability and implementation. The limited efficacy testing did not show major changes in parents' PSE. Further research is needed to investigate the differential relevance of the micro-intervention, based on parents' needs, as well as its optimal embeddedness in a broader intervention trajectory.

Attachment patterns and autobiographical episodic memory functioning: A systemic review of adult studies to advance clinical psychological science

Patterns of insecure attachment are associated with psychopathology but the mechanisms involved remain poorly understood. Cognitive science proposes that attachment patterns are influenced by the autobiographical memory system and in turn influence its ongoing functioning. Disturbances in autobiographical memory represent cognitive risks for later emotional difficulties. We systemically reviewed 33 studies (in 28 articles) examining the association between attachment patterns and autobiographical episodic memory (AEM) in individuals from the age of 16 (i.e., from young to older adulthood). Attachment patterns were associated with key areas of AEM phenomenology, including intensity and arousal; detail, specificity, and vividness; coherence and fragmentation; and accuracy and latency. These associations appeared to be moderated by contextual and individual factors; mediated by emotional regulation and schema-based processing; linked to mental health outcomes. Attachment patterns may also influence the impact of certain AEM-based manipulations. We conclude by providing a critical discussion and a research agenda for bringing together attachment, memory, and emotion, with a view to promote mechanism-driven treatment innovation in clinical psychology.

Cumulative family stress and externalizing problems: Secure base script knowledge as a protective factor

The current study examined whether secure base script knowledge can buffer against higher concurrent externalizing problems and against relative increases in externalizing problems associated with cumulative family stress. We conducted a one-year longitudinal study with two waves between 2017 and 2019 in which 272 Dutch-speaking Western European children from Flanders (47.8% boys, M age = 10.20 , SD age = 0.60 $$ {M}_{\mathrm{age}}=10.20,{SD}_{\mathrm{age}}=0.60 $$ ) participated. Secure base script knowledge was associated with lower concurrent externalizing problems (f²  = 0.03). High levels of secure base script knowledge also buffered against relative increases in externalizing problems associated with cumulative family risk (f²  = 0.02). These findings suggest that secure base script knowledge can mitigate the negative effects of a stressful family environment on externalizing problems.

A Family Systems Perspective on Attachment Security and Dependency to Mother and Father in Preschool: Differential and Reciprocal Effects on Children's Emotional and Behavioral Problems

Attachment security and dependency play a decisive role for children's mental health. From a family systems perspective, reciprocal effects of dyadic attachment to each parent within the same family on child symptomatology may well offer additional insights in developmental processes as parents and children influence each other consistently. This study examined the influence of child-mother as well as child-father attachment security and dependency on maternal, paternal, and observed ratings of children's emotional and behavioral problems. A total of 124 families with preschool children participated in this study. Attachment security, dependency, and symptomatology of the children were independently observed during home visits. Furthermore, mothers and fathers rated child symptoms. Results revealed promotive effects of attachment security to both parents on observed child symptoms. Furthermore, we found a significant actor effect of child-mother attachment security, as well as a significant partner effect of child-father dependency on maternal ratings of child symptomatology. Attachment security to both parents is promotive for child mental health. The family systems perspective clarifies the meaning of child-father relationships for maternal perception of the own child.

Children’s and Adolescents’ Pet Attachment, Empathy, and Compassionate Responding to Self and Others

The research shows that children’s and adolescents’ attachments with pets play an important role in their social and emotional lives. However, little research exists on how children and adolescents show compassion toward themselves and others and how this caring ability relates to their attachment with pets. This study explored the relations among children’s and adolescents’ compassion, empathy, and attachment to their pets. Sixty-one Canadian youths aged 7–15.9 years (M = 11.35) participated in this study (n = 38 g, 23 b) and completed self-report questionnaires including the Lexington Attachment to Pets scale, subscale of Dispositional Positive Emotions, Self-compassion scale for children, and Bryant’s Index of Empathy for Children and Adolescents (IECA). The results showed older adolescents were more likely than younger children to score high on cognitive and emotional dimensions of empathy and be less likely to feel alone and isolated. High levels of emotional pet attachment related to high levels of the ability to feel sad when witnessing others in distress and high levels of mindful, compassionate, and self-responding feelings of compassion for others. The results also showed that those participants who experienced intensified emotional attachment toward their pets (either current or in the past), were less likely to judge themselves in negative ways. Overall, our findings suggest that children’s emotional attachments with pets relate to their ability to respond to themselves and others in kind and compassionate ways and not necessarily their ability to understand another person’s emotions.

Default defenses: the character defenses of attachment-anxiety and attachment-avoidance

Contemporary attachment researchers claim that attachment-anxiety is associated with a hyperactivating defense strategy while attachment-avoidance is associated with a deactivating defense strategy. However, to date, no study has comprehensively examined the basic patterns of specific defense expression in the two dimensions of attachment insecurity (anxiety/avoidance). To address this research gap, the current study aimed to assess the character defenses associated with attachment-avoidance and attachment-anxiety, incorporating a broad spectrum of psychological defenses. The main objective was to understand what differentiates attachment-avoidance and attachment-anxiety in defensive functioning. In this study of online questionnaire design (N = 250), university undergraduates aged between 17 to 65 completed the Experiences in Close Relationship Scale (ECR) and the Defense Style Questionnaire (DSQ-60). The results show that the two dimensions of insecure attachment exhibit different defensive patterns. Regarding the main findings, attachment-avoidance uniquely predicted defensive isolation, and attachment-anxiety uniquely predicted the defenses splitting, projective identification, anticipation, acting out, passive-aggression, reaction formation, and undoing. Overall, the results indicate that attachment-anxiety is a significant predictor of global defensive functioning, over and above that of attachment-avoidance. One implication of this study is that the two-dimensional model of adult attachment may offer a promising framework for organizing psychological defenses. We discuss the significance of this concerning the future of the empirical study of psychological defenses. The discussion also considers the clinical application and relevance to attachment-based psychotherapy.

Review of the Current Knowledge of Reactive Attachment Disorder

Reactive attachment disorder (RAD), classified under Trauma and Stressor Related Disorders in the DSM-5 manual, is a childhood psychiatric illness due to familial or social neglect or due to maltreatment. It is characterized by an inhibited and withdrawn social and emotional behavior toward an adult caregiver, typically before the age of 5. Neurobiological changes in patients with RAD have been shown to be substantially significant with features such as loss of grey matter volume and neurotransmitter deficiencies that not only impact the ability to form healthy attachments but also increase the risk of comorbidities such as depression and anxiety. Different theories, including the current mediation hypothesis and learning theory of attachment, showed childhood maltreatment from caregivers and desensitization toward deficiencies in social development in children from special education teachers to be key components in the development of RAD. Patients with RAD had an increased risk of developing psychiatric comorbidities, including learning disabilities and mood disorders. Institutionalized care and childhood maltreatment have a significant impact on the development of RAD. RAD is an underdiagnosed and underreported condition with significant repercussions that can severely impact the development of a child. By being able to raise awareness and promote further research into refining the diagnostic methodology, treatment protocols, and long-term follow-up, children afflicted with this condition may be able to develop better socio-emotional bonds and reduce the incidence of comorbidities such as depression and attention deficit hyperactivity disorder.

Parents' reflective functioning and their agreement on treatment goals in attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents

This study examined the trajectories of parents' reflective functioning over the course of individual preparatory sessions with the therapist in attachment-based family therapy (ABFT) for Israeli sexual minority young adults and their nonaccepting parents, and whether such reflective functioning was associated with parents' agreement on the goals for subsequent conjoint corrective attachment sessions. Three parents with good agreement on treatment goals were compared to three parents with poor agreement on treatment goals. Parents' in-session reflectivity regarding their child's experience of nonacceptance, and regarding the quality of their relationship with their child, was observationally measured at the session level. Reflective functioning increased over time among those parents who reported good agreement with the treatment goals. There were no changes in parents' reflective functioning in the poor agreement group. Findings suggest the potential importance of facilitating parents' reflective functioning in ABFT, before conducting conjoint corrective attachment sessions. Research and clinical implications are discussed.

Dynamics of attachment and emotion regulation in daily life: uni- and bidirectional associations

Attachment theory proposes that the activation of the attachment system enacts emotion regulation (ER) to maintain security or cope with insecurity. However, the effects of ER on attachment states and their bidirectional influences remain poorly understood. In this ecological momentary assessment study, we examined the dynamics between attachment and ER. We hypothesised that attachment states and ER influence each other through time. Specifically, we hypothesised bidirectional short-term cycles between state attachment security and reappraisal, state attachment anxiety and rumination, and state attachment avoidance and suppression. We also tested how trait attachment is related to state attachment and ER. One hundred twenty-two participants (M_age = 26.4) completed the Experiences in Close Relationship-Revised and reported state attachment and ER seven times daily for seven days. The results were only partly consistent with our cycle hypotheses yet revealed a cycle between low state attachment security and rumination that was attenuated by reappraisal. Moreover, rumination and suppression predicted increased insecure states, and reappraisal predicted increased secure and insecure states. Finally, trait attachment showed associations with state attachment and ER. Our study suggests regulatory dynamics between attachment and ER and opens important questions about their functional relationship in maintaining attachment-related behavioural patterns and emotional well-being.

An innovative approach to lifelong delayed ejaculation: does attachment style play a role?

PURPOSE

To examine whether there is a correlation between attachment styles, which is a developmental psychology theory, and lifelong DE.

METHODS

The research was planned as prospective, multi-centric and cross-sectional study. Thirty patients who were consecutively admitted to the urology outpatient clinic and diagnosed with lifelong DE and 30 age-matched healthy controls were included in the study. All participants gave a detailed medical history and underwent a complete physical examination, and their laboratory and endocrine (prolactin and testosterone) results were evaluated. Additionally, all patients had to fill out socio-demographic information form, the Experiences in Close Relationships-Revised (ECR-R) Questionnaire, Arizona Sexual Experiences Scale (ASEX), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI).

RESULTS

The mean age of the DE patients was 33.5 ± 7.5 years. In the DE group, insecure attachment (both anxious and avoidant attachment), anxiety and depression scores were found to be significantly higher (p < 0.001, effect size medium or large) than the control group. Ejaculation times (both for vaginal intercourse and masturbation) were correlated with both insecure (anxious and avoidant) attachment types, as well as their anxiety and depression scores (p < 0.001). The ASEX satisfaction, ejaculation and total scores were found to be higher in DE patients (higher scores indicating greater sexual dysfunction) than in the control group.

CONCLUSION

The large and significant relationships found between lifelong DE and attachment insecurities point to childhood developmental processes. The findings may help us better understand lifelong DE. There is a need for further extensive research on this subject.

The role of insecure attachment and psychological mechanisms in paranoid and depressive symptoms: An exploratory model

Attachment theory is considered an important theoretical framework for understanding the ontogenesis of psychopathology. In this regard, insecure attachment styles have been associated with the development and maintenance of paranoid and depressive symptoms. Furthermore, different psychological processes (i.e., self-esteem and experiential avoidance) have been identified as mediating mechanisms between the relationship of insecure attachment and these symptoms. Nowadays, there is a more positive view in psychology focusing on factors that contribute to well-being, although little is known about the role of these psychological well-being variables as mediators between insecure attachment and psychopathology. For thus, the aim of this study was to test one explorative structural equation model of insecure attachment on paranoid and depressive symptoms through psychological mediating mechanisms to elucidate the processes involved in each of them. To evaluate the model, 141 individuals with severe psychiatric conditions participated in the study. The results revealed good model fit, highlighting that avoidant attachment has a direct and indirect effect on the symptoms, while anxious attachment has only an indirect effect through mediating mechanisms. On the other hand, lower levels of self-acceptance and environmental mastery have been identified as important processes associated with paranoid and depressive symptoms. However, less positive relationships were a significant mediating mechanism only for paranoid ideation symptoms. These results have important clinical implications by shedding light on the relationship between insecure attachment, paranoid and depressive symptoms, and the psychological mediating mechanisms involved in this relationship, which may be considered key variables in clinical treatments.

Attachment style and mental health during the later stages of COVID‐19 pandemic: the mediation role of loneliness and COVID-19 anxiety

Background

An insecure attachment style is an important risk factor for psychological problems. The aim of this study was to use Bartholomew and Horowitz’s model (Bartholomew and Horowitz in J Pers Soc Psychol 61(2): 226, 2019) to test a sample of Italian individuals to determine the mediation role of loneliness and COVID-19-related anxiety symptoms in the relationship between attachment styles and mental health issues in the context of the pandemic.

Method

A cross-sectional research study was conducted using a sample of 330 Italian participants (82.1% women; mean age = 34.3 years; SD = 13.16) who completed online self-reported measures of attachment styles (RQ), loneliness (RULS), COVID-19-related anxiety symptoms (C-19ASS) and mental health problems (GHQ-12). Serial mediation analyses were performed, and bootstrap tests were included.

Results

Our results supported the hypothesized model with respect to each attachment style (p < 0.001). In particular, insecure attachment styles predict mental health problems both directly and indirectly, through loneliness and COVID-19-related anxiety symptoms. In addition, loneliness directly influences mental health problems and also mediates the relationship between insecure attachment styles and COVID-19-related anxiety symptoms which, in turn, positively predict mental health problems.

Conclusions

Our findings reinforce the importance of attachment in people’s processes of adapting to experiences during the coronavirus pandemic. The study makes an important contribution to developing effective prevention and intervention strategies to support people’s wellbeing in the context of the pandemic.

Turkish Version of the Psychosis Attachment Measure: A Reliability and Validity Analysis

Background

There is a need for a tool to assess the attachment in psychosis in the Turkish-speaking population. This study aims to evaluate the validity and reliability of the Turkish version of the Psychosis Attachment Measure of patients with schizophrenia.

Methods

The sample of this study consists of 80 patients diagnosed with schizophrenia who have applied to a psychiatry outpatient clinic. Researches completed Positive and Negative Syndrome Scale and Calgary Depression Scale for schizophrenia. Patients were then asked to fill out the Psychosis Attachment Scale and Adult Attachment Style Scale by themselves.

Results

The structure and content of the factor structure are suitable for the Turkish version (P < .001). In assessing the test-retest internal consistency for the Turkish version of Psychosis Attachment Measure, Cronbach's alpha values range from 0.738 to 0.922. The retest correlations for the subscales prove good retest reliability (P < .001).

Conclusion

The findings show the Turkish version of the Psychosis Attachment Measure to be a reliable and valid measure for evaluating the attachment styles of patients with schizophrenia.

Attachment and the Development of Psychopathology: Introduction to the Special Issue

When Bowlby [...]

Exploring everyday state attachment dynamics in middle childhood

The current study explored dynamics of secure state attachment expectations in everyday life in middle childhood, specifically state attachment carry-over and reactivity to experiences of caregiver support in the context of stress. In two independent samples (one community sample, N = 123; one adoption sample, N = 69), children (8–12 years) daily reported on their state attachment for respectively 14 and 7 consecutive days. Additionally, they reported daily on their experiences of distress and subsequent experiences of caregiver support. Results in both samples indicated that secure state attachment on a day-to-day basis is characterized by a significant positive carry-over effect, suggesting that state attachment fluctuations are (partially) self-predictive. In Study 1, experiencing no support following distress significantly related to intraindividual decreases in secure state attachment; in Study 2, experiencing effective support during distress related to intra-individual increases in secure state attachment. Taken together, the current studies provide novel and important insights into how state attachment temporally evolves on a day-to-day basis in middle childhood.

Models of mental health problems: a quasi-systematic review of theoretical approaches

BACKGROUND

Mental health and mental illness have been contested concepts for decades, with a wide variety of models being proposed. To date, there has been no exhaustive review that provides an overview of existing models.

AIM

To conduct a quasi-systematic review of theoretical models of mental health problems.

METHODS

We searched academic databases, reference lists, and an electronic bookshop for literature that proposed, endorsed, reviewed, or critiqued such models. Papers, book chapters, and books were included with material by researchers, clinicians, non-medical professions, and service users writing between 2000 to June 2020 being considered. The study was registered with the Open Science Framework (No. osf.io/r3tjx).

RESULTS

Based on 110 publications, we identified 34 different models which were grouped into five broader categories. Many models bridged two or more categories. Biological and psychological approaches had the largest number of models while social, consumer and cultural models were less diversified. Due to the non-empirical nature of the publications, several limitations in terms of search and quality appraisal apply.

CONCLUSIONS

We conclude that mental health care needs to acknowledge the diversity of theoretical models on mental health problems.

A Learning Theory Approach to Attachment Theory: Exploring Clinical Applications

Although clinicians typically acknowledge the importance of insecure attachment as one factor that can contribute to children's psychopathology, translating attachment theory into clinical practice has proved a challenge. By specifying some of the mechanisms through which the child's attachment develops and changes, learning theory can enhance attachment based approaches to therapy. Specifically, interventions building on operant (parent management training) and classical (exposure therapy) learning can be used to stimulate new learning that increases the child's security and confidence in the parent's availability and responsiveness. To explore the clinical application and utility of a Learning Theory of Attachment (LTA), we focus on two attachment-focused interventions: Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) and Middle Childhood Attachment-based Family Therapy (MCAT). VIPP-SD is an evidence-based parent management training designed to promote sensitive parenting and secure attachment in early childhood. MCAT is a recently developed intervention that uses exposure to stimulate secure attachment in middle childhood. LTA sheds light on the mechanisms set in train by VIPP-SD and MCAT facilitating the induction of professionals in clinical applications.

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.

Can Sensory- and Attachment-Informed Approaches Modify the Perception of Pain? An Experimental Study

Accumulating evidence linking pain with both attachment and sensory processing variables introduces the possibility that attachment- and sensory-informed strategies may modify pain experiences. The aim of this study was to investigate this proposition using an experimentally induced pain procedure. Pain perceptions of individuals using either a sensory-informed (weighted modality) or an attachment-informed (secure base priming) coping strategy were compared with those of individuals using no designated coping strategy. An independent measures experimental study design was used with a convenience sample of 272 pain-free adults. Experimental participants (n = 156) were randomly allocated to either an attachment (n = 75) or a sensory (n = 81) intervention group. Data from these participants were compared to those of 116 participants involved in an earlier cold pressor study in which no coping strategy was used. All participants completed the same sensory, attachment, and distress questionnaires and participated in the same cold pressor pain test. ANCOVAs revealed that participants in the sensory- and attachment-informed intervention groups reported significantly higher pain thresholds than the control group. Participants allocated to the sensory group also reported higher pain intensity scores than the control group. There were no significant differences in pain tolerance between the three groups after controlling for covariates. While further research is required, findings encourage further consideration of sensory- and attachment-informed strategies for people anticipating a painful experience.

Attachment-based family therapy: Theory, clinical model, outcomes, and process research

Attachment-based family therapy (ABFT; Diamond G.S. et al., 2014) is an empirically supported treatment designed to capitalize on the innate, biologically based, caregiving instinct and adolescent need for attachment security. This therapy is grounded in attachment and emotional processing theory and provides an interpersonal, process-oriented, trauma-informed approach to treating adolescents struggling with suicide and associated problems such as depression and trauma. ABFT offers a clear structure and road map to help therapists quickly address the attachment ruptures that lie at the core of family conflict, which can fuel adolescent distress. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanisms of change. In this paper, we provide an overview of the theories underlying the model, the clinical strategies that guide the treatment, the outcome research that demonstrates efficacy, and the process research that explores the proposed mechanisms of change.

The Relationship Between Defense Mechanisms and Attachment as Measured by Observer-Rated Methods in a Sample of Depressed Patients: A Pilot Study

Despite many theoretical and clinical writings, the theorized connection between defense mechanisms and adult attachment in depressed patients has received little empirical attention. This is the first study to examine patients’ defense mechanisms in relation to their attachment in a clinical sample of depressed patients and also the first to use observer-rated measures for assessing both defense mechanisms and attachment. In this pilot study, we aimed to investigate the relationship between patients’ attachment and their use of defense mechanisms in psychotherapy sessions, as well as patterns of change over treatment. We conducted a secondary analysis of data from a randomized controlled trial of 30 patients receiving psychotherapy for major depression. Session transcripts were previously coded for defense mechanisms using the Defense Mechanisms Rating Scales, and depression severity data were collected by the clinician-rated HRSD-17 and the self-report BDI-II. Patients’ attachment was assessed in two transcripts, one in an early session and a second in a late session, using the novel observer-rated Patient Attachment Coding System. In contrast with expectations, in the early phase of therapy, preoccupied attachment-related characteristics were significantly positively related to overall defensive functioning and negatively related to Depressive immature defenses. In the late phase of treatment, preoccupied attachment-related characteristics were negatively correlated with Non-depressive immature defenses. Moreover, as expected, early-phase defense use was related to late phase attachment; specifically, early neurotic and immature Depressive and Non-depressive defenses predicted an increase in avoidant, whereas immature Non-depressive defenses predicted a decrease in preoccupied attachment-related characteristics over the course of treatment, after controlling for early attachment effects. The results imply a longitudinal relationship between defenses and change in attachment-related characteristics over the course of treatment in a depressed sample and warrant further research about the relationship between defenses and attachment during psychotherapy.

State Attachment Variability: Between- and within-Person Level Associations with Trait Attachment and Psychological Problems

Research suggests that inter-individual differences in the degree of state attachment variability are related to differences in trait attachment and psychological problems between children. In this study, we tested whether such associations are also relevant at a within-person level, and if so, whether intra-individual fluctuations in the degree of variability were predictive of or predicted by intra-individual fluctuations in trait attachment and psychological problems. Children (N = 152; M_age = 10.41 years, SD_age = 0.60 at time 1) were tested three times over a period of one year. At each timepoint, children reported on their expectations of maternal support in different distressing situations. Additionally, we administered measures of trait attachment to children and psychological problems to children and their mothers. We used Random-Intercept Cross-Lagged Panel Models to distinguish between-person from within-person associations between these constructs over time. The results revealed that the degree of state attachment variability was mainly relevant to understand differences between children in trait attachment and psychological problems: children who overall showed more state attachment variability were overall less securely attached at a trait-level and reported more psychological problems. Although evidence for within-person associations was less robust, there was some indication that the degree of state attachment variability might be related to the development of trust and psychological problems at a within-person level.

An empirical test of prototype and revisionist models of attachment stability and change from middle childhood to adolescence: A 6-year longitudinal study

We examined the prototype v. revisionist models of attachment stability with a five-wave, 6-year, longitudinal study of attachment security from middle childhood to adolescence in a White Western European sample (N = 157; Wave 1 M_age  = 10.91, SD = 0.87; 52% female). Attachment was assessed using both questionnaire (Experiences in Close Relationships) and narrative-based measures (Attachment Script Assessment). In addition, a set of potential moderators of prototype-like stability were examined. Results indicated that data from both attachment assessments best fit the prototype model. Moderator analyses indicated that male sex significantly undermined the influence of an attachment prototype and parent-child conflict and parental divorce enhanced the influence of an attachment prototype on stability.

Effects of Father and Mother Attachment on Depressive Symptoms in Middle Childhood and Adolescence: The Mediating Role of Emotion Regulation

Background: Attachment and emotion regulation play a decisive role in the developmental pathways of adaptation or maladaptation. This study tested concurrent and longitudinal associations between the attachment to mother and father, sadness regulation, and depressive symptoms. Methods: A total of 1110 participants from middle childhood to adolescence completed measures of attachment, emotion regulation, and depressive symptomatology. In total, 307 of them participated in the longitudinal assessment. Results: Results revealed attachment affects emotion regulation strategies and depressive symptoms. Furthermore, we found linear effects of the cumulative number of secure attachment relationships on adaptive and maladaptive deactivating sadness regulation, as well as on depressive symptoms. Longitudinal analysis showed the significant mediating role of sadness regulation in the relationship between attachment and depressive symptoms. Conclusions: Adaptive and maladaptive deactivating sadness regulation explain the longitudinal effects of attachment on depressive symptoms. Insecurely attached children and adolescents use maladaptive and adaptive sadness regulation strategies, but differ in their hierarchy of strategy use.

Social relationships and children’s perceptions of adversity

Having sensitive, contingent, and supportive social relationships has been linked to more positive outcomes after experiences of early childhood adversity. Traditionally, social relationships are construed as moderators that buffer children from the effects of exposure to adverse events. However, recent data support an alternative view: that supportive social relationships influence children’s later outcomes by shaping their perceptions of safety and stress, regardless of the particular events to which children are exposed. This perspective has implications for understanding vulnerability and resilience in children.

Attachment and the Development of Depressive Symptoms in Adolescence: The Role of Regulating Positive and Negative Affect

Although widely accepted, attachment theory's hypothesis that insecure attachment is associated with the development of depressive symptoms through emotion regulation strategies has never been longitudinally tested in adolescence. Additionally, previous research only focused on strategies for regulating negative affect, whereas strategies for regulating positive affect may also serve as a mechanism linking insecure attachment to depressive symptoms. This study aimed to fill these research gaps by testing whether the association between attachment and change in depressive symptoms over time is explained by strategies for regulating negative and positive affect in adolescence. Adolescents (N = 1706; 53% girls; Mage = 12.78 years, SDage = 1.54 at Time 1) were tested three times, with a 1-year interval between measurement times. They reported on their attachment anxiety and avoidance at Time 1, depressive symptoms at Times 1 and 3, and regulation of negative affect (brooding and dampening) and positive affect (focusing and reflection) at Time 2. The results from multiple mediation analyses showed that more anxiously attached adolescents developed more depressive symptoms via increased brooding and dampening. More avoidantly attached adolescents developed more depressive symptoms via decreased focusing. These findings provide longitudinal support for attachment theory's emotion regulation hypothesis, and show that the regulation of both negative and positive affect is important.

Accounting for auto-dependency in binary dyadic time series data: A comparison of model- and permutation-based approaches for testing pairwise associations

Many theories have been put forward on how people become synchronized or co-regulate each other in daily interactions. These theories are often tested by observing a dyad and coding the presence of multiple target behaviours in small time intervals. The sequencing and co-occurrence of the partners' behaviours across time are then quantified by means of association measures (e.g., kappa coefficient, Jaccard similarity index, proportion of agreement). We demonstrate that the association values obtained are not easy to interpret, because they depend on the marginal frequencies and the amount of auto-dependency in the data. Moreover, often no inferential framework is available to test the significance of the association. Even if a significance test exists (e.g., kappa coefficient) auto-dependencies are not taken into account, which, as we will show, can seriously inflate the Type I error rate. We compare the effectiveness of a model- and a permutation-based framework for significance testing. Results of two simulation studies show that within both frameworks test variants exist that successfully account for auto-dependency, as the Type I error rate is under control, while power is good.

Maternal pre- and postnatal substance use and attachment in young children: A systematic review and meta-analysis

Maternal substance use has often been associated with insecure and disorganized child attachment. We evaluated this association with a meta-analysis of young children and, further, systematically reviewed mediating and moderating factors between maternal substance use and child attachment. We performed a systematic database search of quantitative English language studies on child attachment that included substance-using mothers and their children below 6 years of age. Eleven studies (N = 1,841) met the inclusion criteria and were included in the meta-analysis of attachment security and seven (N = 1,589) studies were included in the meta-analysis of attachment disorganization. We found that maternal substance use was negatively associated with secure attachment in children, but the effect size was small (r = -.10). The association with disorganized attachment was not significant (r = .15). Related to moderating and mediating factors (k = 6), we found evidence on the role of teratogenic and sociological factors on child attachment. Most importantly, the impact of cumulative risks was vital. However, literature was scarce, and studies varied in risk of bias, leaving many unanswered questions on other potential factors underlying the development of attachment in these high-risk children. We discuss the results considering clinical implications and future directions.

Corrective attachment episodes in attachment-based family therapy: the power of enactment

Corrective attachment episodes, therapeutic enactments designed to increase openness and trust between young adults and their parents, are the purported primary change mechanism in attachment-based family therapy. This study examined whether sequences of therapist interventions, young adults' productive emotional processing, and parental behaviors thought to reflect corrective attachment episodes were characteristic of good versus poor outcome cases. Thirty conjoint attachment sessions were analyzed using the THEME algorithm. Results revealed that only in good outcome cases were there four-step sequences hypothesized to facilitate attachment. One sequence began with the therapist focusing on the young adult's primary adaptive emotions, followed by the young adult's productive emotional processing of their vulnerable emotions, followed by the therapist empathizing with and validating the parent, followed by parents' expressions of warmth toward their young adult. The second sequence began with the therapist focusing on the young adult's unmet attachment needs, followed by the young adult productively processing their vulnerable emotions, followed by the parent expressing a willingness to fulfill their young adult's attachment needs, followed by parents' expressions of warmth toward their young adult. Findings provide an empirically-based clinical map for conducting therapeutic enactments in family therapy and have implications for treatment development, therapist training and supervision.

Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation

Mentalizing capacities depends on the quality of primary attachment interactions with caregivers who thinks of the child as a subject with mental states. Operationalized as reflective functioning, mentalization is crucial for regulating emotions and developing of a coherent sense of identity, for interacting with individuals making sense to own and others mental states, and for distinguishing internal and external realities without distortions. Although the clinical literature on interplay between mentalization, attachment, and emotional regulation is rich, the empirical research is limited. This study sought to explore connections between reflective functioning, attachment styles, and implicit emotion regulation, operationalized as defense mechanisms, in a group of depressive patients. Twenty-eight patients were interviewed using the adult attachment interview (AAI) and diagnosed using the Psychodynamic Chart-2 of the Psychodynamic Diagnostic Manual, Second Edition. The reflective functioning scale and the defense mechanisms rating scale Qsort were applied to AAI transcriptions to assess reflective functioning and defensive profile. Patients with secure attachment showed significantly higher levels in reflective functioning and overall defensive functioning as compared to those with insecure attachment. Good reflective functioning and secure attachment correlated with mature defenses and specific defensive mechanisms that serve in better regulating affective states. Overall, the relationship between mentalization, attachment and emotion regulation lay the foundations for the delineation of defensive profiles associated with attachment patterns and reflective functioning in depressive patients. The systematic assessment of these psychological dimensions with gold-standard tools may help in tailoring personalized therapeutic interventions and promoting more effective treatments.

[Psychometric evaluation of the Experiences in Close Relationships Revised German 12-item version (ECR-RD 12) in a sample of psychotherapeutic inpatients]

Psychometric evaluation of the Experiences in Close Relationships Revised German 12-item version (ECR-RD 12) in a sample of psychotherapeutic inpatients Objectives: The ECR-R assesses the self-description of adult attachment strategies in romantic relationships. The present study evaluates the psychometric properties of the German 12-item short version ECR-RD 12 in a large sample of patients in psychotherapeutic inpatient treatment. Method: Inpatients in psychotherapeutic treatment (N = 2231) were assessed using the ECR-RD 12 and other clinical questionnaires. Its psychometric properties and factor structure of were evaluated. Results: The psychometric properties of the short form measure were in line with the German full length version (ECR-RD). In contrast to theoretical assumptions, factor analysis suggested a three factor solution in the present sample. Discussion: The ECR-RD 12 can be recommended as a screening measure for assessing attachment styles in inpatient psychotherapeutic settings. Further studies are required to investigate the factor structure of the measure in clinical samples.

Five-year-olds' facial mimicry following social ostracism is modulated by attachment security

Social ostracism triggers an increase in affiliative behaviours. One such behaviour is the rapid copying of others' facial expressions, called facial mimicry. Insofar, it remains unknown how individual differences in intrinsic affiliation motivation regulate responses to social ostracism during early development. We examined children's facial mimicry following ostracism as modulated by individual differences in the affiliation motivation, expressed in their attachment tendencies. Resistant and avoidant tendencies are characterized by high and low affiliation motivation, and were hypothesized to lead to facial mimicry enhancement or suppression towards an ostracizing partner, respectively. Following an ostracism manipulation in which children played a virtual game (Cyberball) with an includer and an excluder peer, mimicry of the two peers' happy and sad facial expressions was recorded with electromyography (EMG). Attachment was assessed via parent-report questionnaire. We found that 5-year-olds smiled to sad facial expressions of the excluder peer, while they showed no facial reactions for the includer peer. Neither resistant nor avoidant tendencies predicted facial mimicry to the excluder peer. Yet, securely attached children smiled towards the excluder peer, when sad facial expressions were displayed. In conclusion, these findings suggest a modulation of facial reactions following ostracism by early attachment.

Current Perspectives on the Management of Reactive Attachment Disorder in Early Education

Children with Reactive Attachment Disorder (RAD) have special educational needs that are challenging for teachers in early education. In the current contribution, we will discuss a large body of research suggesting that stimulating these children's attachment development is feasible for teachers and potentially a successful strategy to ensure that these children thrive better in the classroom and socially. The current overview discusses research and theory on RAD and RAD treatment and results in the formulation of specific recommendations for the successful management of children with RAD in the classroom.

Reactive attachment disorder symptoms and prosocial behavior in middle childhood: the role of Secure Base Script knowledge

BACKGROUND

Children with attachment disorder show prosocial behavior problems. Children with a reactive attachment disorder show inhibited and emotionally withdrawn behavior. Consequently, these children typically display prosocial behavior problems. However, the underlying mechanism between reactive attachment disorder and prosocial behavior problems is still unclear and findings in literature are mixed.

METHODS

The current study investigated the role of children's attachment representations in this association. Attachment representations reflect knowledge about a cognitive script regarding the attachment figure as a source for support (Secure Base Script). We tested whether secure base script knowledge 1) mediates or 2) moderates the link between reactive attachment disorder and prosocial behavior problems in 83 children (6-11 years; 83.1% boys) recruited from special education schools for children with behavioral problems. Children completed a pictorial Secure Base Script Test. Their reactive attachment disorder symptoms were assessed during an interview with the primary caregivers. Primary caregivers and teachers filled out a prosocial behavior questionnaire about the child.

RESULTS

Results did not support the mediation hypothesis, but evidence for the moderation hypothesis was found. Secure base script knowledge attenuated the negative association between attachment disorder symptoms and prosocial behavior.

CONCLUSIONS

These findings contribute to the discussion about the link between attachment representations and attachment disorders.

Vulnerability Factors Associated with Lifetime Posttraumatic Stress Disorder among Veterans 40 Years after War

Vulnerability factors for posttraumatic stress disorder (PTSD) development are still controversial. Our aim was to study the vulnerability factors for the development of war-related PTSD over a period of 40 years after exposure. A cross-sectional, observational study was carried out on 61 male traumatized war veterans, taking into consideration adverse childhood experiences (ACE), attachment orientations, number of non-war-related traumatic events, and war experiences. Lifetime PTSD was assessed by using the Clinician-Administered PTSD Scale. Insecure attachment styles were significantly associated with lifetime PTSD and even after adjustment for war exposure this was still significant. Non-war-related traumatic events were not associated with lifetime PTSD, whereas ACE were associated with lifetime PTSD. War-related experiences were also associated with lifetime PTSD, except for injury or disease. The results for our sample show that, 40 years after war, the intensity of war-related experiences and ACE were significantly and independently associated with the development of lifetime PTSD. Insecure attachment was significantly associated with lifetime PTSD, which, in turn, are both positively associated with war exposure. These findings may have implications for patient care, as they constitute a strong argument that attachment-focused therapies could well be necessary 40 years after trauma.

Exposure to animal suffering, adult attachment styles, and professional quality of life in a sample of Italian veterinarians

Contextual and individual risk factors of veterinarians’ professional quality of life are being debated. Research suggests that attachment styles are relevant predictors of professional quality of life; however, their role in work-related well-being of veterinarians is yet to be ascertained. In the present study, self-report measures on exposure to animal suffering, adult attachment styles, and professional quality of life were administered to 1,445 Italian veterinarians (70% females) aged 24 to 74 years old; sociodemographic information and information on workload were also collected. Female gender, higher levels of ordinary workload, on-call hours per week, exposure to animal suffering, together with fearful and preoccupied attachment styles were significantly associated with lower levels of veterinarians’ quality of life. This suggests that work-related factors may combine with individual psychological features in promoting or disadvantaging the professional quality of life of veterinarians. Implications of these findings for promoting veterinarians’ quality of life and directions for future research are discussed.

The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis

INTRODUCTION

Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation.

METHODS

One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome.

RESULTS

Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress.

CONCLUSIONS

The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.