Attachment and Personality Disorders: A Short Review

Abstract

Attachment theory is a biopsychosocial model referring to a person's characteristic ways of relating in close relationships, such as with parents, children, and romantic partners.These ways of relating are learned during early infancy and mold subsequent intimaterelationships. An adult who is securely attached has internalized a reliable relationship to his/her caregivers in infancy, and thus is capable of adapting to different social contexts and, more importantly, of maintaining an adequate equilibrium between self-regulation and interpersonal regulation of stress. Insecure adult attachment styles are divided into 1) anxious/preoccupied (individuals are hypersensitive to rejection and show compulsive care-and attention-seeking behavior); 2) Avoidant/dismissing (individuals are hyposensitive to social interactions, and are socially isolated); and 3) unresolved/disorganized (individuals are unable to cope under stress, thus suffering pervasive affective dysregulation). This review discusses the theoretical, psychological, neuroscientific, and developmental aspects of attachment from an evidence-based perspective. It provides an updated account of the science regarding attachment and its relevance to the etiology, diagnosis, and treatment of mental illness. It examines the privileged relation between attachment and personality disorders (PDs) from multiple angles in order to introduce the most recent psychotherapeutic advances, based on attachment research, for the treatment of PDs, particularly borderline PD. Three effective, Attachment and personality disorders -Lorenzini and Fonagy 2 evidence-based psychotherapeutic interventions are described: Mentalization-Based Treatment, Transference-Focused Psychotherapy and Schema-Focused Therapy.Attachment and personality disorders -Lorenzini and Fonagy 3 Introduction: Attachment and its relevance to personality disorders Attachment theory, conceived by John Bowlby (1), refers to a person's characteristic ways of relating in intimate relationships to "attachment figures", often one's parents, children, and romantic partners (2, 3). From birth, the interactions of an infant with his/her primary caregivers will establish a base for personality development and will mold subsequent close relationships, expectations of social acceptance, and attitudes to rejection. A secure base is formed when the attachment figure (usually the mother) provides stability and safety in moments of stress, which allows the infant to explore his/her surroundings. Thus, the child creates a set of mental models of him/herself and others in social interactions ("internal working models"), based on repeated interactions with significant others (4).These early attachment relations are crucial for the acquisition of capacities for affect and stress regulation, attentional control, mentalization, and for the infant's sense of selfagency (5).The attachment literature has been dominated by operationalized assessments of characteristic patterns of relating. Most influential were observations of individual ...

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

“…The perceived anxious-ambivalent attachment style was found to be a developmental risk factor for anxiety-and mood-related problems, where subjects are anxiety prone and easily frustrated (a pattern of affective frustration and inward aggression), whereas the avoidant style may be prone to develop anger-and aggression-related problems,and subjects feel more detached from others and lack empathy (a pattern of antisocial, paranoid, and narcissistic traits) (Meyer & Pilkonis, 2005). Even though there are discrepancies among different authors, previous studies have pointed to the avoidant qualities of BPD functioning (Levy, 2005;Lorenzini & Fonagy, 2013), although evidence is weaker than for other insecure forms of attachment (Hesse, 2008;Levy, 2005;Levy, Meehan, Weber, Reynoso, & Clarkin, 2005;Scott et al, 2009). Other authors have detected the anxious-ambivalent classification (Barone, Fossati, & Guiducci, 2011;Levy, 2005;Scott et al, 2009), and some have called attention to the crucial role of unresolved/disorganized attachment in borderline functioning (Fonagy et al, 1996;Hesse, 2008;Levy, 2005;Lorenzini & Fonagy, 2013).…”

“…Attachment theory has provided a conceptual framework to understand the developmental course associated with personality disorders (Agrawal, Gunderson, Holmes, & Lyons-Ruth, 2004;Bradley, Conklin, & Westen, 2007;Fonagy, 2000;Fonagy et al, 1996;Fonagy & Luyten, 2009;Hesse, 2008;Levy, 2005;Levy, Beeney, & Temes, 2011;Lorenzini & Fonagy, 2013;Meyer & Pilkonis, 2005). According to attachment theory, during early childhood children form an internal working model of self and other based on the affective experiences with the caregivers and attachment figures (Steele, Bate, Nikitiades, & Buhl-Nielsen, 2015).…”

“…According to Bradley et al (2007), the most common attachment pattern associated with BPD is the preoccupied (which is analogous to anxious/ambivalent in infancy and childhood), considering that the unresolved is a qualifier rather than one of the three primary attachment patterns. A combination of unresolved and preoccupied attachment has been associated with BPD in adolescents as well as adults (Fon-agy et al, 1996;Lorenzini & Fonagy, 2013;Nakash-Eisikovits, Dutra, & Westen, 2002). So insecure forms of attachment may serve as a risk factor predisposing to the development of BPD, and instability in interpersonal relationships can be regarded as a phenotypic trait of the disorder along with affective instability and impulsivity (Agrawal et al, 2004;Clarkin & De Panfilis, 2013;Levy, Beeney, & Temes, 2011;Steele et al, 2015).…”

“…Therefore one finds a strong consensus that insecure forms of attachment are associated with BPD (Hesse, 2008;Lorenzini & Fonagy, 2013;Meyer & Pilkonis, 2005). Notwithstanding, there appears not to be a unitary insecure attachment pattern that describes all individuals with BPD.…”

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

“…The selection of this group of disorders was motivated by a number of considerations. Both AVPD and ASPD are disorders in which attachment difficulties have been implicated (Lorenzini & Fonagy, 2013), and both share high comorbidity with BPD (e.g., Skodol et al, 2002). In addition research suggests a shared environmental and biological risk for BPD and ASPD (Beauchaine & Klein, 2009).…”