Adult attachment insecurity and hippocampal cell density

Main Biological Models of Resilience

Objective

Resilience is a complex process of adaptation to new conditions that would permit a positive outcome after adversities, traumas or other sources of stress. However, despite the growing interest in this topic, there is no universally accepted definition and no comprehensive bio-behavioural model. This systematic review aims to provide an overview of the main biological models that have been theorized to date, with a focus on new alternative theories to improve our understanding of the mechanisms underlying the development and strengthening of resilience, with potential implications for the prevention of some psychopathological disorders.

Method

This review was conducted according to PRISMA guidelines and includes 185 studies published in English in PubMed and Embase up to December 2023.

Results

Most studies use the stress-related model, which conceptualizes resilience as the absence of symptoms after the stressful event and mainly deal with the differences between stress-prone and resilient phenotypes in animals exposed to stress. However, the results of this search seem to suggest that resilience might be an independent construct with biological bases rooted in the stress system and the social brain, and widely sculptured by individual and environmental factors, especially early life events and affiliation.

Conclusions

This work contributes to ongoing efforts to understand the intricate mechanisms of resilience, while highlighting the potential of improving social relationships since our birth to promote coping strategies towards stress and traumas, and even a peaceful world.

Longitudinal associations between self-reported attachment dimensions and neurostructural development from adolescence to early adulthood

The existing literature suggests that individual differences in attachment may be associated with differential trajectories of structural brain development. In addition to maturation during infancy and childhood, developmental trajectories are characteristic of adolescence, a period marked by increasingly complex interpersonal relationships and significant neurostructural and functional plasticity. It remains to be examined whether attachment prospectively relates to neurostructural developmental trajectories during adolescence. In this longitudinal study, we investigated whether self-reported attachment dimensions of anxiety (AX) and avoidance (AV) could predict elements of cortical thickness (CT) and subcortical volume (SV) trajectories in 95 typically developing adolescents (12-19 years old at study baseline). Self-reported scores of AX and AV were obtained at study baseline, and neurostructural development was assessed at baseline and three timepoints over the four following years. Self-reported AX and AV were associated with steeper CT decreases in prefrontal cortical and cortical midline structures as well as anterior temporal cortex, particularly in participants younger at study baseline. Regarding SV, preliminary differential associations were observed between developmental trajectories and attachment dimensions. Our study suggests that interindividual differences in attachment contribute to shaping neurodevelopmental trajectories for several cortical and subcortical structures during adolescence and young adulthood.

Dynamics of personality: The Zurich model of motivation revived, extended, and applied to personality

Personality researchers are increasingly interested in the dynamics of personality, that is, the proximal causal mechanisms underlying personality and behavior. Here, we review the Zurich Model of Social Motivation concerning its potential to explain central aspects of personality. It is a cybernetic model that provides a nomothetic structure of the causal relationships among needs for security, arousal, and power, and uses them to explain an individual's approach-avoidance or "proximity-distance" behavior. We review core features of the model and extend them by adding features based on recent behavioral and neuroscientific evidence. We close by discussing the model considering contemporary issues in personality science such as the dynamics of personality, five-factor personality traits and states, and personality growth.

Affective Touch and Regulation of Stress Responses

Much has been documented on the association between stress and health. Both direct and indirect pathways have been identified and explored extensively, helping us understand trajectories from healthy individuals to reductions in well-being, and development of preclinical and disease states. Some of these pathways are well established within the field; physiology, affect regulation, and social relationships. The purpose of this review is to push beyond what is known separately about these pathways and provide a means to integrate them using one common mechanism. We propose that social touch, specifically affective touch, may be the missing active ingredient fundamental to our understanding of how close relationships contribute to stress and health. We provide empirical evidence detailing how affective touch is fundamental to the development of our stress systems, critical to the development of attachment bonds and subsequent social relationships across the life course. We will also explore how we can use this in applied contexts and incorporate it into existing interventions.

Cerebellar engagement in the attachment behavioral system

Brain structural bases of individual differences in attachment are not yet fully clarified. Given the evidence of relevant cerebellar contribution to cognitive, affective, and social functions, the present research was aimed at investigating potential associations between attachment dimensions (through the Attachment Style Questionnaire, ASQ) and cerebellar macro- and micro-structural measures (Volumetric and Diffusion Tensor Imaging data). In a sample of 79 healthy subjects, cerebellar and neocortical volumetric data were correlated with ASQ scores at the voxel level within specific Regions Of Interest. Also, correlations between ASQ scores and age, years of education, anxiety and depression levels were performed to control for the effects of sociodemographic and psychological variables on neuroimaging results. Positive associations between scores of the Preoccupation with Relationships (ASQ subscale associated to insecure/anxious attachment) and cortical volume were found in the cerebellum (right lobule VI and left Crus 2) and neocortex (right medial OrbitoFrontal Cortex, OFC) regions. Cerebellar contribution to the attachment behavioral system reflects the more general cerebellar engagement in the regulation of emotional and social behaviors. Cerebellar properties of timing, prediction, and learning well integrate with OFC processing, supporting the regulation of attachment experiences. Cerebellar areas might be rightfully included in the attachment behavioral system.

Mothers’ Attachment Representations and Children’s Brain Structure

Ample research demonstrates that parents’ experience-based mental representations of attachment—cognitive models of close relationships—relate to their children’s social-emotional development. However, no research to date has examined how parents’ attachment representations relate to another crucial domain of children’s development: brain development. The present study is the first to integrate the separate literatures on attachment and developmental social cognitive neuroscience to examine the link between mothers’ attachment representations and 3- to 8-year-old children’s brain structure. We hypothesized that mothers’ attachment representations would relate to individual differences in children’s brain structures involved in stress regulation—specifically, amygdala and hippocampal volumes—in part via mothers’ responses to children’s distress. We assessed 52 mothers’ attachment representations (secure base script knowledge on the Attachment Script Assessment and self-reported attachment avoidance and anxiety on the Experiences in Close Relationships scale) and children’s brain structure. Mothers’ secure base script knowledge was significantly related to children’s smaller left amygdala volume but was unrelated to hippocampal volume; we found no indirect links via maternal responses to children’s distress. Exploratory analyses showed associations between mothers’ attachment representations and white matter and thalamus volumes. Together, these preliminary results suggest that mothers’ attachment representations may be linked to the development of children’s neural circuitry related to stress regulation.

Neural basis underlying the trait of attachment anxiety and avoidance revealed by the amplitude of low-frequency fluctuations and resting-state functional connectivity

Background

Attachment theory demonstrates that early attachment experience shapes internal working models with mental representations of self and close relationships, which affects personality traits and interpersonal relationships in adulthood. Although research has focused on brain structural and functional underpinnings to disentangle attachment styles in healthy individuals, little is known about the spontaneous brain activity associated with self-reported attachment anxiety and avoidance during the resting state.

Methods

One hundred and nineteen individuals participated in the study, completing the Experience in Close Relationship scale immediately after an 8-min fMRI scanning. We used the resting-state functional magnetic resonance imaging (rs-fMRI) signal of the amplitude of low-frequency fluctuation and resting-state functional connectivity to identify attachment-related regions and networks.

Results

Consequently, attachment anxiety is closely associated with the amplitude of low-frequency fluctuations in the right posterior cingulate cortex, over-estimating emotional intensity and exaggerating outcomes. Moreover, the functional connectivity between the posterior cingulate cortex and fusiform gyrus increases detection ability for potential threat or separation information, facilitating behavior motivation. The attachment avoidance is positively correlated with the amplitude of low-frequency fluctuation in the bilateral lingual gyrus and right postcentral and negatively correlated with the bilateral orbital frontal cortex and inferior temporal gyrus. Functional connection with attachment avoidance contains critical nodes in the medial temporal lobe memory system, frontal-parietal network, social cognition, and default mode network necessary to deactivate the attachment system and inhibit attachment-related behavior.

Conclusion and implications

These findings clarify the amplitude of low-frequency fluctuation and resting-state functional connectivity neural signature of attachment style, associated with attachment strategies in attachment anxiety and attachment avoidance individuals. These findings may improve our understanding of the pathophysiology of the attachment-related disorder.

Revised short screening version of the attachment questionnaire for couples from the German general population

In order to ensure the concentration, compliance and motivation of the participants, a short version of 12 items was extracted from the “Experiences in Close Relationships Questionnaire (ECR)”. Even though this short English version shows equally good validity and reliability as the long version, there have been no representative norm values and psychometric characteristics available for the short version in German. Therefore, the German 12-item ECR was implemented in a representative sample of 1,127 males and 1,237 females (mean age M = 49.93; SD = 12.31) from the general public (N = 2,364). The reliability values of the German 12-item ECR in the representative sample are not as good as the long version with the 36- items version (Alpha = .54–72), and the 12-item ECR factorial structure failed to show the factorial validity. Since the EFA revealed that only half the items loaded on the expected factors, an even shorter form with six items was construed and tested psychometrically. Even though the item numbers were reduced, the reliability values of the German 6-item ECR improved and were as good as the long version with 36 items (Alpha = .73–90). Furthermore, factorial validity could be shown by CFA (CFI = .981, SRMR = .038, RMSEA = .079, TLI = .964) with scalar invariance across gender and age. In sum, the 6-item ECR is a reliable and factorial scalar attachment questionnaire. Due to its shortness, it is applicable to different research fields. However, reference data from a clinical sample are still missing.

Doll therapy intervention for women with dementia living in nursing homes: a randomized single-blind controlled trial protocol

BACKGROUND

Doll therapy is a non-pharmacological intervention for people with dementia aimed to reduce distressing behaviours. Reliable results on the efficacy of Doll therapy for people with dementia are needed. The concept of attachment theorised by Bowlby has been proposed to explain the Doll therapy process, but it has not been proven to influence the response to doll presentation.

METHODS/DESIGN

This single-blind, randomised controlled trial will involve people with dementia living in nursing homes of the Canton Ticino (Switzerland). Participants will be randomised to one of two interventions: Doll Therapy Intervention or Sham Intervention with a non-anthropomorphic object, using a 1:1 allocation ratio. The two interventions will consist of 30 daily sessions lasting an hour at most, led by a trained nurse for an hour at most. We will enrol 64 participants per group, according to power analysis using an estimated medium effect size (f = 0.25), an alpha level of 0.05, and a power of 0.8. The primary goal is to test the efficacy of the Doll Therapy Intervention versus the Sham Intervention as the net change in the following measures from baseline to 30 days (blinded outcomes): the Neuropsychiatric Inventory-Nursing Home administered by a trained psychologist blinded to group assignment, the professional caregivers' perceived stress scale of the Neuropsychiatric Inventory-Nursing Home, patients' physiological indices of stress (salivary cortisol, blood pressure and heart rate) and interactive behaviours. The secondary goal is to assess the relationship between attachment styles of people with dementia (detected by means of the Adult Attachment Interview to the patients' offspring) and their caregiving behaviours shown during the Doll Therapy Intervention.

DISCUSSION

This is the first single-blind, randomised controlled trial on the efficacy of Doll therapy for dementia and an explanatory model of the response of people with dementia to doll presentation.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT03224143. Retrospectively registered on 21 July 2017.

Attachment in Patients with Bipolar and Unipolar Depression: A Comparison with Clinical and Non-clinical Controls

Background

A link between depression and insecure attachment has long been postulated. Although many studies examined the relationship between depressive symptoms and attachment, relatively few studies were performed on patients diagnosed with depression. Also, research on patients with bipolar disorder is scarce.

Objective

We aimed at testing the association between attachment insecurity and unipolar and bipolar depression.

Methods

We studied 21 patients with bipolar disorder, current episode depressed, and three age- and sex-matched groups, each consisting of 21 individuals: patients with major depressive disorder, recurrent episode; patients with epilepsy; non-clinical participants. The Experience in Close Relationships questionnaire was used to assess adult attachment style.

Results

Patients with both bipolar and unipolar depression displayed significantly higher scores on attachment-related avoidance as compared with patients with epilepsy and non-clinical participants. Also, patients with bipolar depression scored significantly higher on attachment-related anxiety than all other groups. In both psychiatric groups, attachment dimensions were not significantly correlated with global clinical severity or severity of depression.

Conclusion

Despite some study limitations, our results are consistent with some previous studies and provide support to Bowlby's seminal hypothesis that attachment insecurity may predispose to depression. Attachment theory may provide a valuable theoretical framework for future research and for guiding treatment.

Disentangle the neural correlates of attachment style in healthy individuals

Since its development and theorisation in the 60s, attachment theory has greatly influenced both clinical and developmental psychology suggesting the existence of complex dynamics based on the relationship between an infant and its caregiver, that affects personality traits and interpersonal relationships in adulthood. Many studies have been conducted to explore the association between attachment styles and psychosocial functioning and mental health. By contrast, only a few studies have investigated the neurobiological underpinnings of attachment style, showing mixed results. Therefore, in this review, we described current evidence from structural and functional imaging studies with the final aim to disentangle the neural correlates of attachment style in healthy individuals. Overall, different attachment styles have been correlated with volumetric alterations mainly in the cingulate cortex, amygdala, hippocampus and anterior temporal pole. Consistently, functional imaging studies suggested patterns of activations in fronto-striatal-limbic circuits during the processing of social and attachment-related stimuli. Further studies are needed to clarify the neurobiological signature of attachment style, possibly taking into consideration a wide range of demographic, psychosocial and clinical factors that may mediate the associations between the style of attachment and brain systems (e.g., gender, personality traits, psychosocial functioning, early-life experience).

Early Secure Attachment as a Protective Factor Against Later Cognitive Decline and Dementia

The etiology of neurodegenerative disorders such as dementia is complex and incompletely understood. Interest in a developmental perspective to these pathologies is gaining momentum. An early supportive social environment seems to have important implications for social, affective and cognitive abilities across the lifespan. Attachment theory may help to explain the link between these early experiences and later outcomes. This theory considers early interactions between an infant and its caregiver to be crucial to shaping social behavior and emotion regulation strategies throughout adult life. Furthermore, research has demonstrated that such early attachment experiences can, potentially through epigenetic mechanisms, have profound neurobiological and cognitive consequences. Here we discuss how early attachment might influence the development of affective, cognitive, and neurobiological resources that could protect against cognitive decline and dementia. We argue that social relations, both early and late in life, are vital to ensuring cognitive and neurobiological health. The concepts of brain and cognitive reserve are crucial to understanding how environmental factors may impact cognitive decline. We examine the role that attachment might play in fostering brain and cognitive reserve in old age. Finally, we put forward the concept of affective reserve, to more directly frame the socio-affective consequences of early attachment as protectors against cognitive decline. We thereby aim to highlight that, in the study of aging, cognitive decline and dementia, it is crucial to consider the role of affective and social factors such as attachment.

Cultural Attachment: From Behavior to Computational Neuroscience

Cultural attachment (CA) refers to processes that allow culture and its symbols to provide psychological security when facing threat. Epistemologically, whereas we currently have an adequate predictivist model of CA, it is necessary to prepare for a mechanistic approach that will not only predict, but also explain CA phenomena. Toward that direction, we here first examine the concepts and mechanisms that are the building blocks of both the prototypical maternal attachment as well as CA. Based on existing robust neuroscience models we associate these concepts and mechanisms with bona fide neurobiological functions to advance an integrative neurobiological model of CA. We further discuss the unresolved relationship of CA to other similar socio-cognitive concepts such as familiarity. Overall aim of the paper is to highlight the importance of integrating CA theory to computational approaches to culture and evolution (such as predictive processing computations explaining niche construction), as this will allow a dynamic interpretation of cultural processes.

Attachment Dimensions and Spatial Navigation in Female College Students: The Role of Comfort With Closeness and Confidence in Others

There is preliminary evidence suggesting that hippocampal functioning is associated with attachment style. However, it is unknown if attachment is also associated with hippocampal-related cognitive function such as spatial learning and recall. This study aims to verify if attachment dimensions are associated with spatial learning and recall. Sixty-five female participants were recruited and were evaluated using the Adult Attachment Scale-R and tested on a virtual maze navigation task (VMT) at one moment (exploratory trial + 3 trials) and 24 h later (3 trials). There was a significant Moment × Trial × Close-Depend interaction for the outcome time, F(2,126) = 3.807, p = 0.025, with post hoc analysis indicating that the High Close-Depend group displayed significant improvements between Trial 1 and Trial 3 in the post-test assessment. Conversely, the Low Close-Depend group displayed significant improvements between Trial 1and Trial 3 but on the pre-test assessment. Furthermore, the Low Close-Depend group presented significant better performance in pre-test Trial 3 in comparison to the High Close-Depend group. Thereby, it seems that low comfort with proximity and trust in others is associated with reduced spatial recall, although spatial learning performance was actually superior in these participants. It is possible that reduced exposure to social interaction and meaningful relationships may be reduced in the Low Close-Depend group, leading to modifications in hippocampal function and, ultimately, reduced spatial recall. Oppositely, participants in the High Close-Depend group may not display typical spatial learning in the proposed task as they are more willing to freely explore the presented environment.

Insecure Attachment and Hypothalamus-Pituitary-Adrenal Axis Functioning in People With Eating Disorders

OBJECTIVE

Childhood attachment experiences affect adult emotion regulation and ability to cope with stressors. Therefore, insecure attachment may influence the functioning of the hypothalamic-pituitary-adrenal (HPA) axis and a dysregulation of HPA axis has been found in insecure attached healthy individuals. The effects of attachment on HPA axis activity have never been investigated in eating disorders (EDs). Therefore, we assessed the relationships between insecure attachment and the cortisol awakening response (CAR) in adults with EDs.

METHODS

Seventy-eight patients with EDs (43 with anorexia nervosa, 35 with bulimia nervosa) were recruited. They completed the Experience in Close Relationships questionnaire, which provides a rating of two insecure attachment dimensions (anxiety and avoidance) and collected saliva samples to measure the CAR. Differences in the CAR between groups with high and low attachment anxiety and between groups with high and low attachment avoidance were evaluated by repeated measures two-way analysis of variance.

RESULTS

Patients with high attachment anxiety showed a reduced CAR compared with those with low attachment anxiety (F1,76 = 7.31, p = .008). The CAR did not differ between the groups with high and low attachment avoidance (F1,76 = 0.01, p = .93). Patients with high levels of insecure attachment showed a more severe eating-related psychopathology.

CONCLUSIONS

Our data show, for the first time, a specific association of the anxious attachment with the HPA axis activity in EDs and suggest a possible role of attachment in the biological vulnerability to stress of adult patients with EDs.

Epigenetic modification of the oxytocin and glucocorticoid receptor genes is linked to attachment avoidance in young adults

Attachment in the context of intimate pair bonds is most frequently studied in terms of the universal strategy to draw near, or away, from significant others at moments of personal distress. However, important interindividual differences in the quality of attachment exist, usually captured through secure versus insecure - anxious and/or avoidant - attachment orientations. Since Bowlby's pioneering writings on the theory of attachment, it has been assumed that attachment orientations are influenced by both genetic and social factors - what we would today describe and measure as gene by environment interaction mediated by epigenetic DNA modification - but research in humans on this topic remains extremely limited. We for the first time examined relations between intra-individual differences in attachment and epigenetic modification of the oxytocin receptor (OXTR) and glucocorticoid receptor (NR3C1) gene promoter in 109 young adult human participants. Our results revealed that attachment avoidance was significantly and specifically associated with increased OXTR and NR3C1 promoter methylation. These findings offer first tentative clues on the possible etiology of attachment avoidance in humans by showing epigenetic modification in genes related to both social stress regulation and HPA axis functioning.

Attachment orientations and emotion regulation

According to attachment theory, individual differences in the availability and responsiveness of close relationship partners, beginning in infancy, and the resulting formation of fairly stable attachment orientations are crucial for understanding the ways people experience and regulate emotions. In this article, we review what has been learned during the last decade about attachment-related individual differences in emotion regulation. We begin with a brief account of the hypothesized links between different forms of attachment insecurity (anxiety, avoidance) and strategies people use in regulating distress and coping with threatening events. We then review findings from correlational and experimental studies showing that individual differences in attachment orientation are reflected in cognitive, behavioral, and neural patterns of emotion regulation.

The impact of cultural differences in self-representation on the neural substrates of posttraumatic stress disorder

A significant body of literature documents the neural mechanisms involved in the development and maintenance of posttraumatic stress disorder (PTSD). However, there is very little empirical work considering the influence of culture on these underlying mechanisms. Accumulating cultural neuroscience research clearly indicates that cultural differences in self-representation modulate many of the same neural processes proposed to be aberrant in PTSD. The objective of this review paper is to consider how culture may impact on the neural mechanisms underlying PTSD. We first outline five key affective and cognitive functions and their underlying neural correlates that have been identified as being disrupted in PTSD: (1) fear dysregulation; (2) attentional biases to threat; (3) emotion and autobiographical memory; (4) self-referential processing; and (5) attachment and interpersonal processing. Second, we consider prominent cultural theories and review the empirical research that has demonstrated the influence of cultural variations in self-representation on the neural substrates of these same five affective and cognitive functions. Finally, we propose a conceptual model that suggests that these five processes have major relevance to considering how culture may influence the neural processes underpinning PTSD.

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.

What's in a singer's voice: The effect of attachment, emotions and trauma

Research shows that negative experiences in childhood have a long-lasting impact on one's psychological outcomes and one's physiology. The voice is a crucial means of expression, and its complex physiology is believed to be reflective of emotional and mental states. Parenting practices (particularly those contributing to insecure attachment) and traumatic experiences in childhood may thus also influence vocal characteristics. Except for literature on psychogenic voice disorders, the relationship between such experiences and the 'normal' voice is generally unexplored; we propose that a potential relationship is most likely to emerge in singers, for whom the voice is a more central part of their sense of self. In this paper, we test the hypothesis that vocal characteristics relate to attachment and trauma history. Study 1: 25 singers (age 18-35) completed an attachment history questionnaire (ECR-R) and the Singing Voice Handicap Index. Voice range profile and perturbation measures were recorded and analyzed for voice quality assessment. Study 2: 26 singers (age 19-33) completed the attachment history questionnaire, the Childhood Trauma Questionnaire, and the State and Trait Anxiety Inventory. They were also administered the Test of Self-Conscious Affect to assess shame and guilt proneness. Voice range profile, perturbation, and spectrogram measures were recorded and analyzed. The results indicated that anxious attachment, shame, and emotional neglect can predict vocal acoustic measures of intensity and, to some extent, perturbation. This suggests the need to address attachment, shame, and trauma history patterns in the aspiring performer.

Adult attachment style and cortisol responses in women in late pregnancy

Background

Recent research has documented the association between attachment and cortisol rhythms. During pregnancy, when attachment patterns are likely to be activated, elevated levels of cortisol are associated with negative effects for the mother and the foetus. The aim of the present study was to examine the association of adult attachment style and cortisol rhythms in pregnant women.

Methods

Eighty women in the third trimester of pregnancy participated in the study. Adult attachment was assessed using the Adult Attachment Scale – Revised (AAS-R). Participants collected 4 samples of salivary cortisol at two different days; 3 samples were collected in the morning immediately after wakeup and one sample was collected by bedtime.

Results

Results found group significant differences in the cortisol diurnal oscillation (F_(1,71) = 26.46, p < .001,), with secure women reporting a steep decrease in cortisol from awakening to bedtime, while women with fearful avoidant attachment reported no changes. No group differences were found regarding the cortisol awakening response.

Conclusions

These results highlight the importance of considering attachment patterns during pregnancy, suggesting fearful avoidant attachment style as a possible risk factor for emotional difficulties and dysregulation of the neuroendocrine rhythms.

Post-traumatic stress disorder symptoms in first-time myocardial infarction patients: roles of attachment and alexithymia

AIMS

To explore the roles of attachment and alexithymia in the severity of post-traumatic stress disorder symptoms and to specify the relationship between sub-dimensions of attachment, alexithymia and posttraumatic stress disorder symptoms in patients with first-time myocardial infarction in mainland China.

BACKGROUND

Patients experiencing myocardial infarction have a risk of developing post-traumatic stress disorder symptoms. However, there have been few studies on the roles of attachment and alexithymia.

DESIGN

A cross-sectional survey design.

METHODS

Ninety-seven patients participated in the assessment of post-traumatic stress disorder symptoms, attachment and alexithymia from June-December in 2012. To assess post-traumatic stress disorder symptoms and their correlates, we administered the Post-traumatic Stress Disorder Checklist-Civilian Version, the 20-item Toronto Alexithymia Scale and the Experiences in Close Relationships Scale 5-17 days after the remission of first myocardial infarction attack.

RESULTS

Twenty-five (25·77%) patients met the criteria of posttraumatic stress disorder symptoms. Greater attachment anxiety and avoidance were associated with more severe posttraumatic stress disorder symptoms. Except for externally oriented thinking, all dimensions of alexithymia were significantly correlated with post-traumatic stress symptoms. In the regression model, attachment anxiety and difficulties identifying feelings were found to be predictive and the total regression equation explained 24·2% variance of posttraumatic stress disorder symptoms among myocardial infarction patients.

CONCLUSION

First-time myocardial infarction patients were at risk of developing posttraumatic stress disorder symptoms. Attachment anxiety and difficulties identifying feelings were positively associated with posttraumatic stress disorder symptoms in the early stage of myocardial infarction rehabilitation. It is essential to evaluate the causal relationship between attachment, alexithymia and posttraumatic stress disorder symptoms in longitudinal studies.

Quantifying behaviors of children with Sanfilippo syndrome: the Sanfilippo Behavior Rating Scale

The Sanfilippo Behavior Rating Scale (SBRS), a 68 item questionnaire, has been developed to assess the behavioral phenotype of children with Sanfilippo syndrome and its progression over time. Fifteen scales rate orality, movement/activity, attention/self-control, emotional function including anger and fear, and social interaction. Items within scales intercorrelate; measures of internal consistency are adequate. Twelve scales are grouped into 4 abnormality clusters: Movement, Lack of fear, Social/emotional and Executive Dysfunction. A Loess age-trajectory analysis showed that Lack of Fear, Social/Emotional and Executive Dysfunction increased steadily with age; Orality and Mood/Anger/Aggression leveled off. Movement peaked around 6years, then declined as children's excessive/purposeless actions stopped. Compared with standard scales, SBRS Movement was appropriately associated with the Vineland Motor scale; SBRS Lack of Fear had significant associations with the Autism Diagnostic Observation Schedule (ADOS), indicating a symptom overlap between Sanfilippo syndrome and autism. This suggests that reduced fearfulness may be the most salient/sensitive SBRS marker of disease progression. Volumetric MRI showed that increased Lack of Fear was significantly associated with reduced amygdala volume, consistent with our hypothesis that the behavior seen in Sanfilippo syndrome is a variant of Klüver-Bucy syndrome. Hippocampal volume loss had twice the effect on Social-Emotional Dysfunction as amygdala loss, consistent with a hippocampal role in attachment and social emotions. In conclusion, the SBRS assesses the Sanfilippo behavioral phenotype; it can measure behavior change that accompanies disease progression and/or results from treatment.

Biological stress regulation in female adolescents: a key role for confiding

Attachment behaviors play a critical role in regulating emotion within the context of close relationships, and attachment theory is currently used to inform evidence-based practice in the areas of adolescent health and social care. This study investigated the association between female adolescents' interview-based attachment behaviors and two markers of hypothalamic-pituitary-adrenal axis activity: cortisol and dehydroepiandrosterone (DHEA). Unlike the classic stress hormone cortisol, there is very limited investigation of DHEA-a quintessential developmental hormone-in relation to attachment, especially in adolescents. Fifty-five healthy females mean age 14.36 (±2.41) years participated in the attachment style interview. A smaller cortisol awakening response was related to anxious attachment attitudes, including more fear of rejection, whereas greater morning basal DHEA secretion was only predicted by lower levels of reported confiding in one's mother. These attachment-hormone relationships may be developmental markers in females, as they were independent of menarche status. These findings highlight that the normative shifts occurring in attachment to caregivers around adolescence are reflected in adolescents' biological stress regulation. We discuss how studying these shifts can be informed by evolutionary-developmental theory.

Muted neural response to distress among securely attached people

Neural processes that support individual differences in attachment security and affect regulation are currently unclear. Using electroencephalography, we examined whether securely attached individuals, compared with insecure individuals, would show a muted neural response to experimentally manipulated distress. Participants completed a reaction time task that elicits error commission and the error-related negativity (ERN)-a neural signal sensitive to error-related distress-both before and after a distressing insecurity threat. Despite similar pre-threat levels, secure participants showed a stable ERN, whereas insecure participants showed a post-threat increase in ERN amplitude. These results suggest a neural mechanism that allows securely attached people to regulate distress.

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.

Maternal interpersonal affiliation is associated with adolescents' brain structure and reward processing

Considerable animal and human research has been dedicated to the effects of parenting on structural brain development, focusing on hippocampal and prefrontal areas. Conversely, although functional imaging studies suggest that the neural reward circuitry is involved in parental affection, little is known about mothers' interpersonal qualities in relation to their children's brain structure and function. Moreover, gender differences concerning the effect of maternal qualities have rarely been investigated systematically. In 63 adolescents, we assessed structural and functional magnetic resonance imaging as well as interpersonal affiliation in their mothers. This allowed us to associate maternal affiliation with gray matter density and neural responses during different phases of the well-established Monetary Incentive Delay task. Maternal affiliation was positively associated with hippocampal and orbitofrontal gray matter density. Moreover, in the feedback of reward hit as compared with reward miss, an association with caudate activation was found. Although no significant gender effects were observed in these associations, during reward feedback as compared with baseline, maternal affiliation was significantly associated with ventral striatal and caudate activation only in females. Our findings demonstrate that maternal interpersonal affiliation is related to alterations in both the brain structure and reward-related activation in healthy adolescents. Importantly, the pattern is in line with typical findings in depression and post-traumatic stress disorder, suggesting that a lack of maternal affiliation might have a role in the genesis of mental disorders.

Neuroscience of human social interactions and adult attachment style

Since its first description four decades ago, attachment theory (AT) has become one of the principal developmental psychological frameworks for describing the role of individual differences in the establishment and maintenance of social bonds between people. Yet, still little is known about the neurobiological underpinnings of attachment orientations and their well-established impact on a range of social and affective behaviors. In the present review, we summarize data from recent studies using cognitive and imaging approaches to characterize attachment styles and their effect on emotion and social cognition. We propose a functional neuroanatomical framework to integrate the key brain mechanisms involved in the perception and regulation of social emotional information, and their modulation by individual differences in terms of secure versus insecure (more specifically avoidant, anxious, or resolved versus unresolved) attachment traits. This framework describes how each individual's attachment style (built through interactions between personal relationship history and predispositions) may influence the encoding of approach versus aversion tendencies (safety versus threat) in social encounters, implicating the activation of a network of subcortical (amygdala, hippocampus, striatum) and cortical (insula, cingulate) limbic areas. These basic and automatic affective evaluation mechanisms are in turn modulated by more elaborate and voluntary cognitive control processes, subserving mental state attribution and emotion regulation capacities, implicating a distinct network in medial prefrontal cortex (mPFC), superior temporal sulcus (STS), and temporo-parietal junction (TPJ), among others. Recent neuroimaging data suggest that affective evaluation is decreased in avoidantly but increased in anxiously attached individuals. In turn, although data on cognitive control is still scarce, it points toward a possible enhancement of mental state representations associated with attachment insecurity and particularly anxiety. Emotion regulation strategies such as reappraisal or suppression of social emotions are also differentially modulated by attachment style. This research does not only help better understand the neural underpinnings of human social behavior, but also provides important insights on psychopathological conditions where attachment dysregulation is likely to play an important (causal) role.

Reliability of self-reported attachment style in patients with severe psychopathology

Little is known about whether severe psychopathology influences the assessment of self-reported attachment style. Fifty-eight randomly selected adult psychiatric inpatients completed the Experiences in Close Relationship questionnaire (ECR; Brennan, Clark, & Shaver, 1998) and were administered the 24-item Brief Psychiatric Rating Scale (BPRS; Ventura et al., 1993) and the Hamilton Depression Rating Scale (HDRS; Hamilton, 1960) at both admission and discharge. The Structured Clinical Interview for DSM-IV (SCID-I; First, Spitzer, Gibbon, & Williams, 1996) was used to establish Axis I diagnoses. The ECR scales showed good internal consistency and absolute stability both in patients with (n = 24) and without (n = 34) a psychotic disorder. Relative stability was only fair among patients with psychotic disorders but good among patients without psychotic disorders. Neither higher BPRS or HDRS scores, nor the presence of a psychotic disorder, significantly reduced the retest reliability of the ECR scales. These findings suggest that self-report measures might provide a reliable assessment of attachment style in patients with severe psychopathology, except for the most severely impaired patients.

Interpersonal stress regulation and the development of anxiety disorders: an attachment-based developmental framework

Anxiety disorders represent a common but often debilitating form of psychopathology in both children and adults. While there is a growing understanding of the etiology and maintenance of these disorders across various research domains, only recently have integrative accounts been proposed. While classical attachment history has been a traditional core construct in psychological models of anxiety, contemporary attachment theory has the potential to integrate neurobiological and behavioral findings within a multidisciplinary developmental framework. The current paper proposes a modern attachment theory-based developmental model grounded in relevant literature from multiple disciplines including social neuroscience, genetics, neuroendocrinology, and the study of family factors involved in the development of anxiety disorders. Recent accounts of stress regulation have highlighted the interplay between stress, anxiety, and activation of the attachment system. This interplay directly affects the development of social-cognitive and mentalizing capacities that are acquired in the interpersonal context of early attachment relationships. Early attachment experiences are conceptualized as the key organizer of a complex interplay between genetic, environmental, and epigenetic contributions to the development of anxiety disorders - a multifactorial etiology resulting from dysfunctional co-regulation of fear and stress states. These risk-conferring processes are characterized by hyperactivation strategies in the face of anxiety. The cumulative allostatic load and subsequent "wear and tear" effects associated with hyperactivation strategies converge on the neural pathways of anxiety and stress. Attachment experiences further influence the development of anxiety as potential moderators of risk factors, differentially impacting on genetic vulnerability and relevant neurobiological pathways. Implications for further research and potential treatments are outlined.

Examining the association between adult attachment style and cortisol responses to acute stress

The quality of social relationships may contribute to variations in biological stress responses, thereby affecting health risk. The association between an important indicator of social relationships, adult attachment style, and cortisol has been relatively unexplored. The present study examined adult romantic attachment style and cortisol responses to acute laboratory stress. Salivary cortisol was measured in response to two behavioural tasks, a colour/word interference task and mirror tracing task, in 498 healthy men and women from the Heart Scan study, a subsample of the Whitehall II cohort. Participants were classified as secure, fearful, preoccupied or dismissive on the basis of responses to the Relationship Questionnaire. Cortisol output was lowest in the fearful group, followed by the preoccupied group, with both secure and dismissive groups having higher levels. The results from this study tentatively support the proposition that attachment style is a factor in determining the manifestation of HPA dysregulation.

Anxious attachment style and salivary cortisol dysregulation in healthy female children and adolescents

BACKGROUND

Attachment style has been linked with basal cortisol secretion in healthy adult women. We investigated whether dysregulation in basal cortisol secretion may be evident in younger healthy females.

METHODS

Sixty healthy females aged 9-18 years (mean 14.16, SD ± 2.63 years) participated in the Attachment Style Interview (ASI). Eight saliva samples, synchronised to awakening, were collected per day on two consecutive weekdays to examine the cortisol awakening response (CAR) and the subsequent diurnal decline.

RESULTS

Participants exhibiting an anxious attachment style had higher cortisol levels on awakening, in contrast to those who were securely attached. The anxious insecure group also showed an attenuated CAR compared to all other participants. Attachment style groups did not differ in cortisol secretion over the remainder of the day.

CONCLUSIONS

These findings indicate that the same pattern of cortisol dysregulation associated with disorder in adulthood manifests as a function of anxious (but not avoidant) insecure attachment style in females during healthy childhood and adolescence.

Seven Steps Toward Freedom and Two Ways to Lose It

Psychological approaches often conceptualize “free will” as self-determined decision-making. However, the functional mechanisms potentially underlying volitional freedom or its limitations have barely been elaborated. Starting from a functional definition of volition, we illustrate how personality systems interactions (PSI) theory may contribute to explaining underlying mechanisms of volitional freedom. Specifically, based on neurobiological evidence, this theory postulates that degrees of volitional freedom increase with an increasing involvement of more complex levels of psychological functioning (e.g., from habits and affective impulses toward motives, specific goals, intentions, and more global, personal goals). We will demonstrate how, at a psychological level, demand-related stress limits the pursuit of specific goals, whereas threat-related stress limits self-congruent choice of specific goals. Empirical evidence will be reported that relate to these two possible ways of losing volitional (“top-down”) control. In addition, we report on neurobiological findings supporting the present view of volitional freedom and its limitations.