The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults

Abstract

IntroductionWe investigated the impact of attachment distress on affect-centered mentalization in a clinical and a non-clinical sample, comparing mentalization in a baseline condition to mentalization under a condition of attachment distress.MethodsThe sample consisted of 127 adults who underwent inpatient psychosomatic treatment, and 34 mentally healthy adults. Affect-centered mentalization was assessed by analyzing participants’ narratives on interpersonal situations in a baseline condition with the Levels of Emotional Awareness Scale (LEAS), and an experimental condition inducing attachment distress with the Adult Attachment Projective Picture System (AAP). Unlike the LEAS, the AAP is specifically designed to trigger attachment distress. In both conditions, the narratives were evaluated using the LEAS scoring system. Additionally, we assessed the impact of childhood trauma on affect-centered mentalization with the Childhood Trauma Questionnaire (CTQ).ResultsWhile the non-clinical sample displayed the same level of affect-centered mentalization in both conditions, the majority of the clinical sample reached higher scores in the attachment distress condition. There was no strong relationship between reported trauma and mentalization scores.DiscussionOur findings lend strong empirical support to the assumption that affect-centered mentalization is modulated by attachment-related distress. Several possible explanations for the differences between and within the clinical and the non-clinical sample are discussed.

The impact of attachment threat on mental state identification: The mediating role of negative emotion and the moderating role of attachment styles

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Are Affective Temperaments, Emotional Abuse, and Neglect Involved in Mentalization Abilities in Patients With Psychiatric Disorders?

“…A recent cohort study with magnetic resonance imaging (Tozzi et al, 2020) confirmed that the severity and type of childhood maltreatment influence brain maturation, particularly in regions involved in mentalization abilities. A negative association between childhood maltreatment and mentalization is supported by studies in children (Ensink et al, 2017; Tessier et al, 2016) and adolescents (Quek et al, 2017), although studies on clinical samples are still inconsistent (Brüne et al, 2016; Chiesa and Fonagy, 2014; Herrmann et al, 2018; Weijers et al, 2018).…”

Looking at a beautiful moon while immersed in a lake of petroleum: Narratives from Italian individuals with hikikomori

“…Indeed, hikikomori life stories are characterized by traumatic experiences concerning separation and loss of significant others and by psychosomatic complaints involving body image distress since childhood and early adolescence. Given the impact of attachment distress on affect-centered mentalization and the relevance of the frustrating experiences of loss and separation for the onset of psychosomatic symptoms (Herrmann et al, 2018), a failed mourning process due to an unresolved loss can be hypothesized. Within a psychosomatic frame (Aisenstein & Rappoport de Aisemberg, 2010), the potential reduced mentalization of loss/separation episodes reported by participants (e.g., romantic relationship breakup, significant others' death, or loved ones' illness) may have generated a form of death anxiety, which is avoided by repressing aggressive impulses and projecting narcissistic libido onto the body, thus resulting in psychosomatic distress.…”