Attachment mental states and inferred pathways of development in borderline personality disorder: a study using the Adult Attachment Interview

Abstract

We report the outcome of an investigation on how specific attachment states of mind and corresponding risk factors related to different DSM Axis I comorbidities in subjects with BPD. Mental representations of attachment in four BPD sub-groups (BPD and Anxiety/Mood Disorders, BPD and Substance Use and Abuse Disorders, BPD and Alcohol Use and Abuse Disorders, and BPD and Eating Disorders) were assessed in 140 BPD subjects using the Adult Attachment Interview (AAI). In addition to the global attachment picture in which Insecure organized (Dismissing 51% and Enmeshed 35%) and Insecure disorganized categories (40%) were overrepresented, significant differences in attachment category were found between the four BPD sub-groups. Axis I comorbidities corresponded with attachment features on the internalizing/externalizing functioning dimension of the disorder. Furthermore, specific constellations of inferred developmental antecedents and attachment states of mind corresponded differentially with the BPD sub-groups. Implications for developmental research and clinical nosology are discussed.

Attachment and emotional understanding: a study on late‐adopted pre‐schoolers and their parents

“…The possibility of insecure or disorganized attachment is higher when the primary relationship is inadequate and children are exposed to extreme life events such as institutional care (Vorria et al 2003;Zeanah et al 2005). If an insecure pattern is combined with disorganization of attachment, the risk for specific impairment in psychological well-being definitely increases (van IJzendoorn et al 1999;Lyons-Ruth & Jacobvitz 2008;Barone et al 2011).…”

“…If an insecure pattern is combined with disorganization of attachment, the risk for specific impairment in psychological well‐being definitely increases (van IJzendoorn et al . 1999; Lyons‐Ruth & Jacobvitz 2008; Bakermans‐Kranenburg & van IJzendoorn 2009; Barone et al . 2011).…”

Adult Attachment Interview differentiates adolescents with Childhood Sexual Abuse from those with clinical depression and non-clinical controls

“…These classifications have been associated with diverse psychiatric disorders in adults such as PTSD (Harari et al, 2009), borderline personality disorder (Agrawal, Gunderson, Holmes, & Lyons-Ruth, 2004;Barone, Fossati, & Guiducci, 2011;Lyons-Ruth, Brumariu, Bureau, Hennighausen, & Holmes, 2014;Lyons-Ruth, Bureau, Holmes, Easterbrooks, & Brooks, 2013), and anti-social personality disorder (Levinson & Fonagy, 2004;van IJzendoorn 2 M.-J. van Hoof et al et al, 1997).…”

Application of EMDR Therapy for Borderline Personality Disorder

“…In studies reviewed by Agrawal et al using the AAI from 50% to 80% of patients with BPD were classified as "unresolved." On the other hand, a recent study by Barone, Fossati, and Guiducci (2011) using the AAI found Insecure Organized (Dismissing 51% and Preoccupied 35%) and Disorganized (Unresolved-Cannot Classify) categories (40%) were overrepresented on a global view of subjects with BPD, with significantly different distribution of attachment classification found in four BPD subgroups (co-occurring mood/anxipossible when significant structural dissociation (van der Hart, Nijenhuis, & Steele, 2006) is present, because in these cases a specific "progressive approach" is needed to identify and work through dissociative phobias and safely access traumatic material (Gonzalez & Mosquera, 2012). The relationship between structural dissociation and BPD is too complex to be developed in this article (see Mosquera et al, 2011, for a comprehensive review of this topic).…”