Adult attachment, personality traits, and borderline personality disorder features in young adults

Good character: the implications of personality development and psychopathology for citizenship

The introduction of new legislation in 2006 brought about changes to the way citizenship applications were considered in the UK. Over the intervening years, several hundred children born in the UK have been denied British citizenship as a result of changes to the 'good character' requirement in the legislation - namely its extension to cover all those aged 10 years or older applying for citizenship, including individuals who were born in the UK. As a result of the formulaic way in which this requirement is assessed, citizenship can be denied on the basis of historical patterns of behaviour or offending from childhood. This article will consider whether the current approach to assessment of character in the context of applications for British citizenship is meaningful or appropriate, given developments in our understanding of normative psychological and neurological development and also the impact of psychosocial adversity, trauma, and broader psychopathological or neurodevelopmental conditions.

"Help Me Control My Impulses!": Adolescent Impulsivity and Its Negative Individual, Family, Peer, and Community Explanatory Factors

The literature shows that impulsivity, prevalent in adolescence, is negatively linked with a variety of psychosocial factors (e.g., positive interpersonal relationships, emotion regulation); however, there is limited research examining the relative contribution of multiple factors for this trait nor exploring how these factors influence the associations between impulsivity and risk-related outcomes. Drawing on multiple components of the unified theory of development (i.e., psychological variables, peers subsystem, community subsystem, family processes subsystem), this cross-sectional study aims to identify explanatory psychosocial variables (i.e., early memories of warmth and safeness, rational decision-making style, resilience, emotion regulation, coping, parental attachment, social group attachment, satisfaction with school and family-related variables) that are negatively related with impulsivity, in younger (13-15) and older (16-19 years) adolescents, and explore their moderating role in the associations between this trait and some risk-related outcomes (i.e., verbal aggression, anger, self-harm, other high-risk behaviors). A representative sample of 6894 adolescents (52.9% female) living in the Azores (Portugal), with ages ranging from 13 to 19 (M = 15.4), was used. Two stepwise multiple regressions, one for each age group, revealed that only emotion regulation, parental attachment, and social group attachment had a negative effect on impulsivity in both age groups; additionally, satisfaction with teachers also had this effect in younger adolescents. The first three variables weakened the positive associations between impulsivity and the risk-related outcomes. These results suggest that the psychological system and all subsystems of the social context measured play a relevant role in explaining adolescent impulsivity and that it may be reduced by promoting emotion regulation, positive parenting practices, healthier relationships with peers, and healthier relationships with teachers.

"Holding in Anger" as a Mediator in the Relationship between Attachment Orientations and Borderline Personality Features

Insecure attachment and difficulties in regulating anger have both been put forward as possible explanations for emotional dysfunction in borderline personality (BP). This study aimed to test a model according to which the influence of attachment on BP features in a subclinical population is mediated by anger regulation. In a sample of 302 participants, BP features were assessed with the Borderline features scale of the Personality Assessment Inventory (PAI-BOR), attachment was measured with the Experiences in Close Relationships-12 (ECR-12), and trait anger and anger regulation were assessed with the State and Trait Anger Expression Inventory-2 (STAXI-2). The results indicated that anger suppression emerged as a significant mediator of the associations between both anxious and avoidant attachment and BP traits, while anger control resulted as a marginal mediator in the association between attachment avoidance and BP. Suppressing anger may reflect different forms of cognitive or behavioural avoidance of anger, which may differ on the basis of attachment orientations. We argue that these results may have important clinical implications: the promotion of anger regulation in BP should be considered a critical treatment goal.

Relations between attachment, identity and borderline personality disorder symptom severity in male inpatients with alcohol use disorder

Insecure attachment style and borderline personality disorder (BPD) symptoms are related to the severity of alcohol use disorder (AUD) and can also complicate its course and treatment. We propose a theoretical model of relationships between adult attachment style and BPD and AUD symptom severity in which the sense of identity is a mediator. The aim of our study was to test this model in a sample of male inpatients with AUD. Male inpatients with AUD (N = 114) aged 22-72 years (M = 43.05; SD = 9.84) completed the Experiences in Close Relationships-Revised, the Multidimensional Identity Questionnaire, the Alcohol Use Disorders Identification Test and the Borderline Symptom List 23. Results showed that the sense of identity fully mediated the positive relationship between attachment anxiety and BPD symptom severity. There was also a positive indirect effect of attachment avoidance on BPD symptoms via weaker sense of identity. Contrary to hypothesis, AUD symptom severity was not related to attachment, identity or BPD symptoms in our sample. Sense of identity could be a possible target for interventions for insecurely attached men with AUD to reduce BPD symptoms.

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.

Prospective Pathways From Impulsivity to Non-Suicidal Self-Injury Among Youth

Non-suicidal self-injury (NSSI) is a common behavior, particularly among adolescents and young adults. Impulsivity has been implicated as an important factor associated with NSSI, however prospective longitudinal research is lacking. Moreover, the relationship between impulsivity and other risk factors for NSSI is unclear. By examining longitudinal models including impulsivity, attachment, and distress we hope to elucidate the nature of the association between impulsivity and NSSI. 1,686 community-recruited young people (ages 14-25) with no NSSI in the past year were followed up for one year, completing self-report measures of the above factors. Impulsivity independently predicted new onset of NSSI over and above other risk factors, indicating heightened impulsivity is a prospective risk factor for NSSI. Psychological distress mediated the parenting-NSSI association.

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms

OBJECTIVE

The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample.

METHOD

123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used.

RESULTS

Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R² = .57 vs .51) and NSSI (R² = .29 vs .24) but less variance in bulimic symptoms (R² = .33 vs .39).

CONCLUSION

We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.

Insecure Attachment, Maladaptive Personality Traits, and the Perpetration of In-Person and Cyber Psychological Abuse

Although past findings show that insecure attachment and maladaptive personality traits confer risk for perpetrating intimate partner violence (IPV), little is known about how these factors may underpin psychological abuse (PA) committed in-person and via technology. This study examined whether borderline personality disorder (BPD) traits and psychopathic traits account for indirect effects of insecure attachment on the perpetration of face-to-face and cyber PA. Participants included a community-based sample (N = 200; M_age = 22.28 years) in Australia who completed a battery of online questionnaires. Results from bivariate correlations showed that elevated levels of attachment anxiety and avoidance, and higher scores on BPD traits and psychopathic traits, were significantly associated with the perpetration of both face-to-face and cyber PA. Findings from mediation analysis indicated that attachment anxiety was indirectly linked with the perpetration of both forms of PA via elevated scores on BPD traits and psychopathic traits. High levels of psychopathic traits accounted for the indirect effects of attachment avoidance on both forms of PA. Results support the theory that insecure attachment and maladaptive personality functioning might be involved in the development and/or maintenance of the perpetration of PA. These findings have implications for preventive and treatment programs for the perpetration of IPV in terms of shedding new light on potential risk factors for engagement in face-to-face and technology-based PA.

Borderline Personality Features, Anger, and Intimate Partner Violence: An Experimental Manipulation of Rejection

Individuals with borderline personality features may be susceptible to react to situational stressors with negative and interpersonally maladaptive emotionality (e.g., anger) and aggression. The current study attempted to test two moderated mediation models to investigate dispositional risk factors associated with borderline personality features and intimate partner violence (IPV). Results from an experimental rejection induction paradigm were examined using moderated regression to observe contextual reactions to imagined romantic rejection from a current romantic partner among individuals with borderline personality features. An ethnically diverse sample of 218 undergraduates at a large public university in the southwestern United States was recruited. Participants responded to demographic questions and self-report measures, and engaged in an experimental rejection induction paradigm. Borderline personality features was positively associated with rejection sensitivity, physical assault, and psychological aggression. Contrary to initial hypotheses, rejection sensitivity did not serve as a mediator of the relations between borderline personality features and physical assault and psychological aggression. However, trait anger mediated the relation between borderline personality features and psychological aggression. As such, trait anger may be an important explanatory variable in the relation between borderline personality features and psychological aggression specifically. Results of the rejection induction paradigm indicated that, for individuals who were asked to imagine an ambiguous rejection, the relation between borderline personality features and state anger post-rejection was strengthened. For individuals who imagined a critical rejection, there was no significant relation between borderline personality features and state anger post-rejection. Findings suggest that trait anger may be an important dispositional factor in the link between borderline personality features and IPV. In addition, contextual factors, such as ambiguous rejection by an intimate partner, may be especially relevant in activating anger or aggression in individuals with borderline personality features.

Exploration of the Spanish Version of the Attachment Style Questionnaire: A Comparative Study between Spanish, Italian, and Japanese Culture

Nowadays, there are several human attachment measures, most in the form of questionnaires that assess adult attachment styles. This study investigates the use of Feeney, Noller, Hanrahan, Sperling and Berman’s five-factors Attachment Style Questionnaire (ASQ, 1994), based on Bartholomew’s four-factors model (1991), and Hazan and Shaver’s three-factors model (1987). Nevertheless, no robust study has explored the ASQ questionnaire in Spanish compared to other cultures, such as Italian and Japanese. Therefore, the linguistic translation of the Spanish version of the ASQ was performed, based on the back-translation methodology. The results indicate that 5-factors ASQ Spanish version explains 43.67% of the variance, similar to the original English-Australian ASQ version. The Italian and Japanese versions explain 49.37% and 52.27% of the variance, respectively. No age correlation for any ASQ factors in the Japanese sample was found; meanwhile, the Spanish and Italian cultures showed a positive correlation with age and “Confidence” and negative correlation with age and “Relationships as Secondary” ASQ factors. Some transcultural differences and possible research approaches are addressed.

Characterisation of self-defining memories in criminals with antisocial personality disorder

Early aversive events are key factors in the development of antisocial personality disorder (ASPD) and are known to impact the ability to produce specific autobiographical memories and to modify self-construction. The present study assessed identity construction in forensic inpatients suffering from ASPD by comparing the characteristics (specificity, integration, valence, topic and period) of self-defining memories (SDM) of persons with ASPD hospitalised in a forensic hospital to those of control participants. Offenders with ASPD had difficulty in retrieving purely specific single events and tended to recall memories comprising multiple events. In addition, they produced significantly less meaning-making from their past experiences (low integration). These characteristics of SDM could be due to a defensive process used by offenders with ASPD in which they do not integrate aversive experiences, thereby creating a vicious circle where maladjustment of their personality is maintained.

Schema modes mediate the effect of emotional abuse in childhood on the differential expression of personality disorders

BACKGROUND

There is sound evidence that childhood maltreatment increases the likelihood of developing personality disorders (PDs). However, research on the possible mechanisms involved in the relationship between childhood maltreatment and PDs is scarce. One potential mediator of the maltreatment-PD relationship are schema modes, reflecting dynamic states of cognition, emotion, and behaviour.

AIMS

The current study aimed to explore the mediating effect of schema modes on the association between childhood maltreatment and the expression of Cluster B (borderline and antisocial) and C (avoidant and dependent) PDs.

METHOD

Within a mixed sample of N = 120 clinical PD patients and non-clinical participants, a multivariate path model including interview-assessed childhood maltreatment (emotional abuse, emotional neglect, sexual abuse, and physical abuse), schema modes (child, parent, coping and healthy modes), and borderline, antisocial, avoidant and dependent PDs was explored.

RESULTS

The path model depicted five significant indirect links from emotional abuse on PDs via distinct schema modes. The impact of emotional abuse on borderline PD was mediated by child and coping modes, while parent modes mediated the link to antisocial PD. Healthy modes acted as a mediator on dependent and avoidant PDs.

CONCLUSIONS

The results indicate emotional abuse as a main predictor of schema mode clusters and emphasize the mediating role of schema modes on the maltreatment-related pathways towards PDs. Therapeutic implications are discussed with a special focus on healthy modes.

Romantic attachment style and borderline personality pathology: A meta-analysis

Borderline Personality Disorder (BPD) implies profound impairment in interpersonal relationships, particularly romantic relationships (Daley, Burge, & Hammen, 2000). Insecure attachment bears striking resemblance to BPD traits in both empirical and theoretical work (Levy, Johnson, Clouthier, Scala, & Temes, 2015) and may be particularly suited for understanding the BPD-related deficits in romantic functioning. Despite several qualitative reviews concluding that secure attachment is disrupted in those with BPD traits, no consensus has emerged regarding the form of this disruption (Levy et al., 2015), with most reviews focusing on whether BPD is best captured as high levels of attachment anxiety or attachment avoidance. The purpose of the current review is to provide a quantitative synthesis of the strength and direction of the associations between attachment insecurity and BPD traits. Searches on PsycINFO and Pubmed resulted in 27 effect sizes that measured BPD and adult romantic attachment on the two primary dimensions of anxiety and avoidance (Fraley, Waller, & Brennan, 2000). Results demonstrated that attachment anxiety correlates most strongly with BPD traits (r = 0.48); however, attachment avoidance also evinced a significant effect (r = 0.30). Findings from regression analyses indicate that attachment anxiety and avoidance interact, suggesting a particularly strong relationship between attachment disorganization and BPD traits.

Attachment and Borderline Personality Disorder

Borderline personality disorder is associated with predominant insecure and unresolved attachment representations, linked history of trauma, impaired cognitive functioning and oxytocin levels, and higher limbic activations. Two randomized clinical trials on transference-focused psychotherapy assessed change of attachment representation and reflective functioning. The first showed that transference-focused psychotherapy was superior, demonstrating significant improvements toward attachment security and higher reflective functioning. The second randomized clinical trial study on transference-focused psychotherapy compared with therapy as usual replicated these results and additionally showed a significant shift from unresolved to organized attachment in the transference-focused psychotherapy group only, suggesting its effectiveness in traumatized patients.

Physical pain recruits the nucleus accumbens during social distress in borderline personality disorder

Patients with borderline personality disorder (BPD) often engage in dangerous self-injurious behaviors (SIBs) as a maladaptive technique to decrease heightened feelings of distress (e.g. negative feelings caused by social exclusion). The reward system has recently been proposed as a plausible neural substrate, which may influence the interaction between social distress and physical pain processing in patients that engage in SIBs. Using functional magnetic resonance imaging (fMRI) in 20 adult BPD patients with a history of SIBs and 23 healthy controls (HCs), we found a hyper-activation of the nucleus accumbens (NAcc) and amygdala when painful stimuli were presented to BPD patients (but not HCs) in a state of heightened distress, induced via social exclusion. This differential NAcc activity was mediated by anxious attachment style, which is a key developmental feature of the disorder. Altogether, these results suggest a neural mechanism underlying the pathophysiology of SIBs in these patients, which is likely reinforced via the reward system.

Poor family functioning mediates the link between childhood adversity and adolescent nonsuicidal self-injury

BACKGROUND

Non-suicidal self-injury (NSSI) is a common harmful behavior during adolescence. Exposure to childhood family adversity (CFA) is associated with subsequent emergence of NSSI during adolescence. However, the pathways through which this early environmental risk may operate are not clear.

AIMS

We tested four alternative hypotheses to explain the association between CFA and adolescent-onset NSSI.

METHODS

A community sample of n = 933 fourteen year olds with no history of NSSI were followed up for 3 years.

RESULTS

Poor family functioning at age 14 mediated the association between CFA before age 5 and subsequent onset of NSSI between 14 and 17 years.

CONCLUSIONS

The findings support the cumulative suboptimal environmental hazards (proximal family relationships as a mediator) hypothesis. Improving the family environment at age 14 may mitigate the effects of CFA on adolescent onset of NSSI.

Impaired Maintenance of Interpersonal Synchronization in Musical Improvisations of Patients with Borderline Personality Disorder

Borderline personality disorder (BPD) is a serious and complex mental disorder with a lifetime prevalence of 5.9%, characterized by pervasive difficulties with emotion regulation, impulse control, and instability in interpersonal relationships and self-image. Impairments in interpersonal functioning have always been a prominent characteristic of BPD, indicating a need for research to identify the specific interpersonal processes that are problematic for diagnosed individuals. Previous research has concentrated on self-report questionnaires, unidirectional tests, and experimental paradigms wherein the exchange of social signals between individuals was not the focus. We propose joint musical improvisation as an alternative method to investigate interpersonal processes. Using a novel, carefully planned, ABA' accompaniment paradigm, and taking into account the possible influences of mood, psychotropic medication, general attachment, and musical sophistication, we recorded piano improvisations of 16 BPD patients and 12 matched healthy controls. We hypothesized that the insecure attachment system associated with BPD would be activated in the joint improvisation and manifest in measures of timing behavior. Results indicated that a logistic regression model, built on differences in timing deviations, predicted diagnosis with 82% success. More specifically, over the course of the improvisation B section (freer improvisation), controls' timing deviations decreased (temporal synchrony became more precise) whereas that of the patients with BPD did not, confirming our hypothesis. These findings are in accordance with previous research, where BPD is characterized by difficulties in attachment relationships such as maintaining strong attachment with others, but it is novel to find empirical evidence of such issues in joint musical improvisation. We suggest further longitudinal research within the field of music therapy, to study how recovery of these timing habits are related to attachment experiences and interpersonal functioning in general.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

Cross-sectional questionnaire study.

CONCLUSIONS

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

An Investigation into the Roles of Theory of Mind, Emotion Regulation, and Attachment Styles in Predicting the Traits of Borderline Personality Disorder

Objective: Borderline personality disorder is one of the most complex and prevalent personality disorders. Many variables have so far been studied in relation to this disorder. This study aimed to investigate the role of emotion regulation, attachment styles, and theory of mind in predicting the traits of borderline personality disorder. Method: In this study, 85 patients with borderline personality disorder were selected using convenience sampling method. To measure the desired variables, the questionnaires of Gross emotion regulation, Collins and Read attachment styles, and Baron Cohen's Reading Mind from Eyes Test were applied. The data were analyzed using multivariate stepwise regression technique. Results: Emotion regulation, attachment styles, and theory of mind predicted 41.2% of the variance criterion altogether; among which, the shares of emotion regulation, attachment styles and theory of mind to the distribution of the traits of borderline personality disorder were 27.5%, 9.8%, and 3.9%, respectively.‎‎ Conclusion: The results of the study revealed that emotion regulation, attachment styles, and theory of mind are important variables in predicting the traits of borderline personality disorder and that these variables can be well applied for both the treatment and identification of this disorder.

The relation between attachment, personality, internalizing, and externalizing dimensions in adolescents with borderline personality disorder

The relation between attachment and personality features is an important field to explore in adolescent borderline personality disorder (BPD), and previous research has shown that personality features may be conceptualized within latent internalizing and externalizing dimensions. This cross-sectional study used a structural equation model to examine the association between the BPD participants' perception of attachment and personality features, mediated by the underlying internalizing/externalizing personality dimensions. Data were analyzed for 60 adolescents, ages 15 to 18 years, diagnosed with BPD who completed attachment and personality self-report measures. The authors' results showed a good fit of the model, suggesting a significant association between attachment and the internalizing/externalizing dimensions, which simultaneously congregate and influence personality traits. The perception of attachment anxiety was positively related to the internalizing dimension and at the same time negatively related to the externalizing dimension. However, the perception of attachment avoidance was not related to internalizing or externalizing personality dimensions.

Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study

Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.

Metacognition moderates the relationship of disturbances in attachment with severity of borderline personality disorder among persons in treatment of substance use disorders

OBJECTIVES

Borderline personality disorder traits have been observed to be linked with both insecure attachment styles as well as deficits in mentalizing and metacognition. Less is known, however, about how attachment style does or does not interact with deficits in mentalizing and metacognition to create, sustain, or influence levels of borderline personality disorder traits. In this study, we examined the hypothesis that metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems, moderates the relationship of anxious attachment style with the severity of borderline personality disorder traits.

METHODS

Concurrent assessments were gathered of metacognitive mastery using the Metacognitive Assessment Scale Abbreviated, anxious attachment style using the Experiences of in Close Relationships Scale, and borderline personality disorder traits using the Structured Clinical Interview for DSM-IV Axis II Disorders. Participants were 59 adults in an early phase of recovery from substance use disorders in a residential setting.

RESULTS

Multiple regression revealed that metacognitive mastery moderated the relationship of anxious attachment style with the number of borderline personality disorder traits. A median split of the anxious attachment and metacognitive mastery scores was performed yielding 4 groups. An analysis of covariance revealed that participants with higher levels of anxious attachment and poorer metacognitive mastery had more borderline personality disorder traits did than the other groups after controlling for levels of psychopathology.

CONCLUSION

Insecure attachment may be associated with higher number of borderline personality disorder traits in the presence of deficits in metacognitive mastery. Patients with substance use and borderline personality disorder traits may benefit from treatment which addresses metacognitive mastery.

Narcissism and relational representations among psychiatric outpatients

Pathological narcissism is associated with maladaptive interpersonal behavior, although less is known regarding the internal relational representations of narcissistic patients. The authors examined the relationship between pathological narcissism and two constructs that reflect internal representations of relational patterns: quality of object relations and attachment style. Patients attending a psychiatric day treatment program (N = 218) completed measures of narcissism, general psychiatric distress, and attachment style in terms of attachment avoidance and anxiety. A semistructured interview was used to assess quality of object relations. Multiple regression analysis was conducted, controlling for general psychiatric distress. Pathological narcissism was associated with anxious attachment, but not with avoidant attachment. Narcissism was also associated with lower levels of quality of object relations. The implications of these results are discussed in terms of internal representations of self-other relations.

Parental knowledge of adolescent activities: links with parental attachment style and adolescent substance use

Parents' knowledge of their adolescents' whereabouts and activities is a robust predictor of adolescent risk behavior, including the use of drugs and alcohol. Surprisingly few studies have attempted to identify parental characteristics that are associated with the degree of parental knowledge. The present study is the first to examine how parental attachment style relates to mother, father, and adolescent reports of parental knowledge. Further, we used structural equation modeling to test the associations among parents' attachment styles, reports of parental knowledge, and adolescents' alcohol and marijuana use. Participants included 203 adolescents (M age = 14.02, SD = .91) living in 2-parent households and their parent(s). As predicted, mothers' and fathers' insecure attachment styles were negatively associated with self-reported and adolescent-reported parental knowledge, and all 3 reports of parental knowledge were negatively related to adolescent substance use. Mothers' and fathers' attachment styles were unrelated to adolescent substance use. However, evidence emerged for indirect effects of parental attachment style on adolescent substance use through reports of parental knowledge. Implications for prevention efforts and the importance of multiple reporters within the family are discussed.

Attachment and social cognition in borderline personality disorder: Specificity in relation to antisocial and avoidant personality disorders

Theory and research point to the role of attachment difficulties in borderline personality disorder (BPD). Attachment insecurity is believed to lead to chronic problems in social relationships, attributable, in part, to impairments in social cognition, which comprise maladaptive mental representations of self, others, and self in relation to others. However, few studies have attempted to identify social-cognitive mechanisms that link attachment insecurity to BPD and to assess whether such mechanisms are specific to the disorder. For the present study, empirically derived indices of mentalization, self-other boundaries, and identity diffusion were tested as mediators between attachment style and personality disorder symptoms. In a cross-sectional structural equation model, mentalization and self-other boundaries mediated the relationship between attachment anxiety and BPD. Mentalization partially mediated the relationship between attachment anxiety and antisocial personality disorder (PD) symptoms, and self-other boundaries mediated the relationship between attachment anxiety.

Depressed parents' attachment: effects on offspring suicidal behavior in a longitudinal family study

OBJECTIVE

To investigate relationships of depressed parents' attachment style to offspring suicidal behavior.

METHOD

244 parents diagnosed with a DSM-IV depressive episode completed the Adult Attachment Questionnaire at study entry. Baseline and yearly follow-up interviews of their 488 offspring tracked suicidal behavior and psychopathology. Survival analysis and marginal regression models with correlated errors for siblings investigated the relationship between parent insecure attachment traits and offspring characteristics. Data analyzed were collected 1992-2008 during a longitudinal family study completed January 31, 2014.

RESULTS

Parental avoidant attachment predicted offspring suicide attempts at a trend level (P = .083). Parental anxious attachment did not predict offspring attempts (P = .961). In secondary analyses, anxious attachment in parents was associated with offspring impulsivity (P = .034) and, in offspring suicide attempters, was associated with greater intent (P = .045) and lethality of attempts (P = .003). Avoidant attachment in parents was associated with offspring impulsivity (P = .025) and major depressive disorder (P = .012). Parental avoidant attachment predicted a greater number of suicide attempts (P = .048) and greater intent in offspring attempters (P = .003). Results were comparable after adjusting for parent diagnosis of borderline personality disorder.

CONCLUSIONS

Insecure avoidant, but not anxious, attachment in depressed parents may predict offspring suicide attempt. Insecure parental attachment traits were associated with impulsivity and major depressive disorder in all offspring and with more severe suicidal behavior in offspring attempters. Insecure parental attachment merits further study as a potential target to reduce risk of offspring psychopathology and more severe suicidal behavior.

Measuring impulsivity in daily life: the momentary impulsivity scale

Impulsivity is a core feature of many psychiatric disorders. Traditionally, impulsivity has been assessed using retrospective questionnaires or laboratory tasks. Both approaches neglect intraindividual variability in impulsivity and do not capture impulsivity as it occurs in real-world settings. The goal of the current study was to provide a method for assessing impulsivity in daily life that provides both between-individual and within-individual information. Participants with borderline personality disorder (BPD; n = 67) or a depressive disorder (DD; n = 38) carried an electronic diary for 28 days and responded to 9 impulsivity items up to 6 times per day. Item distributions and iterative exploratory factor analysis (EFA) results were examined to select the items that best captured momentary impulsivity. A brief 4-item scale was created that can be used for the assessment of momentary impulsivity. Model fit was good for both within- and between-individual EFA. As expected, the BPD group showed significantly higher scores on our Momentary Impulsivity Scale than the DD group, and the resulting scale was moderately correlated with common trait impulsivity scales.

Maternal Attachment Style and Responses to Adolescents' Negative Emotions: The Mediating Role of Maternal Emotion Regulation

OBJECTIVE

Previous research has examined the developmental consequences, particularly in early childhood, of parents' supportive and unsupportive responses to children's negative emotions. Much less is known about factors that explain why parents respond in ways that may support or undermine their children's emotions, and even less is known about how these parenting processes unfold with adolescents. We examined the associations between mothers' attachment styles and their distress, harsh, and supportive responses to their adolescents' negative emotions two years later and whether these links were mediated by maternal emotion regulation difficulties.

DESIGN

Mothers in a longitudinal study (n = 230) reported on their attachment style, difficulties regulating their emotions, and their hypothetical responses to their adolescents' negative emotions, respectively, at consecutive laboratory visits one year apart.

RESULTS

Mothers who reported greater attachment-related avoidance and anxiety reported having greater difficulties with emotion regulation one year later. Emotion dysregulation, in turn, predicted more distressed, harsher, and less supportive maternal responses to adolescents' negative emotions the following year. In addition, greater avoidance directly predicted harsher maternal responses two years later.

CONCLUSIONS

These findings extend previous research by identifying maternal attachment style as a predictor of responses to adolescent distress and by documenting the underlying role of emotion dysregulation in the link between adult attachment style and parenting.

Child maltreatment, personality pathology, and stalking victimization among male and female college students

Self-report college student surveys on childhood maltreatment, and borderline and narcissistic personality features are examined to determine their influence on stalking victimization vulnerability. Stalking victimization was measured using Spitzberg and Cupach's (2008) Obsessive Relational Intrusion scale. Ordinary least squares (OLS) regression models were run separately for men (N = 677) and women (N = 1,017). Results indicated childhood sexual maltreatment and borderline traits were associated with stalking victimization among both men and women. These were the only significant relationships for men (R2 = .10). For women, stalking victimization was also associated with narcissistic grandiosity and vulnerability and with a child sexual abuse by borderline features interaction (R2 = .13), demonstrating women reporting prior sexual abuse and borderline personality pathology are especially vulnerable. Methodological and policy implications are discussed.

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.

Explaining the relationship between insecure attachment and partner abuse: the role of personality characteristics

Studies have found that male batterers are more often insecurely attached as compared with nonbatterers. However, it is still not clear how insecure attachment is related to domestic violence. Many studies compared batterers and nonbatterers regarding pathological personality characteristics that are related to attachment (e.g., dependency, jealousy) and generally found that batterers report more personality characteristics. However, these studies did not investigate which role these characteristics played in the relationship between insecure attachment and battering. The first aim of this study is to test which personality characteristics are good candidates to explain the relationship between insecure attachment and domestic violence. The second aim is to test whether personality characteristics are predictive of battering over and above attachment. Seventy-two mainly court-mandated family-only males who were in group treatment for battering are allocated to a securely and an insecurely attached group and compared with 62 nonbatterers. Using questionnaires, self-esteem, dependency, general distrust, distrust in partner, jealousy, lack of empathy, separation anxiety, desire for control, and impulsivity were assessed. This was the first study that examined distrust, separation anxiety, and desire for control in relation to battering. The results show that the relationship between insecure attachment and domestic violence can be explained by separation anxiety and partner distrust. Moreover, only partner distrust increased the risk for battering over and above insecure attachment. The findings suggest the presence of two subtypes among batterers based on attachment style, which has similarities to the family-only and dysphoric-borderline subtypes suggested by Holtzworth-Munroe and Stuart. Implications of the present findings for therapy are discussed.

Adult attachment in the clinical management of borderline personality disorder

Borderline personality disorder (BPD) is a common psychiatric disorder associated with severe functional impairment, high rates of suicide and comorbid psychiatric illness, intensive use of treatment, and high costs to society. The etiology and pathogenesis of BPD are still uncertain, although an interaction between biological and psychosocial factors has been proposed to explain how the condition develops. Attachment disturbances represent one of the developmental risk factors that have been most consistently found to be associated with BPD, with a number of studies reporting a significant strong association between insecure attachment and BPD, notwithstanding the variety of measures and attachment types employed in these studies. In this article, the author first reviews clinical descriptions and research findings concerning the association between attachment disturbances and BPD and then discusses how attachment theory may help clinicians who work with patients with BPD better understand the psychopathology of the illness and plan treatment.

Predicting borderline personality disorder features from personality traits, identity orientation, and attachment styles in Italian nonclinical adults: issues of consistency across age ranges

The aims of this study were to assess whether Borderline Personality Disorder (BPD) features could be predicted by Big Five traits, impulsivity, identity orientation, and adult attachment patterns in a sample of 1,192 adult nonclinical participants, and to evaluate the consistency of these regression models across four age groups (<30 years, 30-39 years, 40-49 years, and >50 years, respectively). In the full sample, measures of neuroticism (N), impulsivity, and anxious insecure attachment were substantial predictors of BPD features (adjusted R(2) = .38, p < .001). Attachment scales were significant predictors of BPD features across all age groups, but different scales were relevant in different age groups. Our results suggest that in nonclinical populations, BPD may represent a complex constellation of personality traits and disturbed attachment patterns.

Relational health as a mediator between betrayal trauma and borderline personality disorder

A frequently studied hypothesized cause of borderline personality disorder (BPD) is experiencing interpersonal trauma. A recent study by L. A. Kaehler and J. J. Freyd (2009 ) found a connection between betrayal trauma and BPD characteristics, with higher betrayal traumas associated with greater BPD characteristics. The present study seeks to expand upon that study by investigating relational health as a potential mediator for the association between betrayal trauma and BPD. A sample of 165 college students completed measures of betrayal trauma life events, relational health, and BPD traits. Mediation analyses showed significant partial mediation for total relational health (bootstrap coefficient = .0168) and its community subscale (bootstrap coefficient = .0204); however, significant mediating effects for the mentor and friend subscales were not found. Given the significant finding for only the community subscale, which may be driving the total relational health effect seen, the results suggest that connection with a valued community may be an important protective factor for BPD after one experiences betrayal trauma.

Attachment and its vicissitudes in borderline personality disorder

This article reviews the recent literature on attachment and attachment-related constructs in borderline personality disorder, with attention given to how recent findings in this area may inform understanding of the mechanisms underlying the etiology, maintenance, and treatment of the disorder. Most findings on this topic have stemmed from three major areas of research, each of which is reviewed in this article: 1) developmental psychopathology studies; 2) experimental psychopathology studies, particularly those using a neuroscience approach; and 3) treatment studies that have examined variables relevant to attachment. Overall, these findings suggest that attachment and related constructs may factor greatly into the underlying psychopathology of borderline personality disorder and may significantly impact the process and outcome of psychotherapy for the disorder. These findings are discussed as they relate to existing theories and ongoing debates in the field, and the implications for future research and clinical practice are highlighted.

[Links between personality disorders, attachment disorders and violent behavior: a literature review]

Past research has established that personality disorders and attachment disorders are important risk factors for the perpetration of violent acts in a context of an intimate relationship. Very few studies have been conducted linking personality and attachment disorders to violent behaviors outside of the domestic violence context. This paper proposes to address this gap by reviewing the literature and linking these important concepts to general violence. This will allow a better understanding of the dynamics of violence and possibly open the door to new research and interventions taking into account both attachment and personality disorders as prodromic factors.

Revising the borderline diagnosis for DSM-V: an alternative proposal

The changes in the borderline personality disorder (BPD) diagnosis proposed by the DSM-V personality disorder work group involve radical changes in format (prototype and dimensions) and descriptive characteristics (traits). Changes of this magnitude will create an unwelcome and potentially harmful discontinuity with the definition that has guided BPD research and the development of disorder-specific therapies. This paper offers an alternative proposal that was developed in collaboration with clinical and research leaders. It includes modification of existing criteria, use of a diagnostic algorithm based on phenotypes, and giving BPD a hierarchical relationship vis-à-vis other personality disorders. These changes are incremental, diminish overlap and heterogeneity, sustain clinical and research development, and will improve utilization.

Oxytocin can hinder trust and cooperation in borderline personality disorder

We investigated the effects of intranasal oxytocin (OXT) on trust and cooperation in borderline personality disorder (BPD), a disorder marked by interpersonal instability and difficulties with cooperation. Although studies in healthy adults show that intranasal OXT increases trust, individuals with BPD may show an altered response to exogenous OXT because the effects of OXT on trust and pro-social behavior may vary depending on the relationship representations and expectations people possess and/or altered OXT system functioning in BPD. BPD and control participants received intranasal OXT and played a social dilemma game with a partner. Results showed that OXT produced divergent effects in BPD participants, decreasing trust and the likelihood of cooperative responses. Additional analyses focusing on individual differences in attachment anxiety and avoidance across BPD and control participants indicate that these divergent effects were driven by the anxiously attached, rejection-sensitive participants. These data suggest that OXT does not uniformly facilitate trust and pro-social behavior in humans; indeed, OXT may impede trust and pro-social behavior depending on chronic interpersonal insecurities, and/or possible neurochemical differences in the OXT system. Although popularly dubbed the 'hormone of love', these data suggest a more circumspect answer to the question of who will benefit from OXT.

Modeling stability and change in borderline personality disorder symptoms using the revised Interpersonal Adjective Scales-Big Five (IASR-B5)

Personality disorders have been defined as "stable over time." However, research now supports marked change in the symptoms of these disorders and significant individual variability in the trajectories across time. Using the Longitudinal Study of Personality Disorders (Lenzenweger, 2006), we explore the ability of the Revised Interpersonal Adjective Scales--Big Five (IASR-B5; Trapnell & Wiggins, 1990) to predict individual variation in initial value and rate of change in borderline personality disorder symptoms. The dimensions of the IASR-B5 predict variability in initial symptoms and rates of change. Interaction effects emerged between Dominance and Conscientiousness, Love and Neuroticism, and Conscientiousness and Neuroticism in predicting initial symptoms; and between Dominance and Love and Love and Neuroticism in predicting rates of change, suggesting that the effects of broad domains of personality are not merely additive but conditional on each other.

Becoming a caregiver: attachment theory and poorly performing doctors

CONTEXT

In this paper, I review a theoretical paradigm (attachment theory) which facilitates an understanding of how human care-giving and care-eliciting behaviours develop and are maintained over the lifespan. I argue that this paradigm has particular utility in: (i) the training of doctors; (ii) understanding why some doctors and medical students experience high levels of stress, and (iii) developing interventions to help those who struggle to manage high levels of work-related stress.

METHODS

I carried out a review of key texts and previously published studies of attachment styles in caregivers.

RESULTS

Large-scale epidemiological studies, using valid and reliable measures, show that insecure attachment styles are found in a proportion of normal populations of both males and females. Insecure attachment is associated with impaired stress management and subtle deficits in care-giving sensitivity. It is reasonable to assume that a proportion of students entering medical training and doctors with performance problems may have insecure attachment styles which influence how they approach their training experience and how they manage occupational stress.

CONCLUSIONS

Attachment theory is a useful paradigm for thinking about training as a professional caregiver. Insecure early attachment experiences may be a risk factor for poor stress management in some medical students and doctors who are exposed to increasing demands as carers. These findings lead to suggestions for possible research and support interventions.

An attachment perspective on borderline personality disorder: advances in gene-environment considerations

Accumulating evidence points to severe relationship dysfunction as the core epigenetic expression of borderline personality disorder (BPD). In adulthood, BPD is typified by disorganization within and across interpersonal domains of functioning. When interacting with their infants, mothers with BPD show marked withdrawal and frightening or frightened behavior, leading to disorganized infant-mother attachments. Linked to both infant disorganization and BPD is a maternal state of mind typified by unresolved mourning regarding past loss or trauma. Early risk factors for BPD in adulthood include maternal withdrawal in infancy and separation of 1 month or more from mother in the first 5 years of life. Likely contributing biological factors include genes linked to dopamine, serotonin, the hypothalamic-pituitary-adrenal axis, and neuropeptides. The complex gene-environment picture emerging confers risk or protection against BPD pathology in ways consistent with infants varying biological sensitivity to context. This line of research may refine early risk assessment and preventive mental health services.