Clinical assessment of attachment patterns and personality disorder in adolescents and adults.

Abstract

The relevance of attachment theory and research for practice has become increasingly clear. The authors describe a series of studies with 3 aims: (a) to validate measures of attachment for use by clinicians with adolescents and adults, (b) to examine the relation between attachment and personality pathology, and (c) to ascertain whether factor analysis can recover dimensions of attachment reflecting both interpersonal and narrative style. In 3 studies, experienced clinicians provided psychometric data using 1 of 4 attachment questionnaires (2 adolescent and 2 adult samples). Attachment dimensions predicted both personality pathology and developmental experiences in predictable ways. Factor analysis identified 4 dimensions that replicated across adolescent and adult samples on the basis of a combination of interpersonal and narrative indicators: secure, dismissing, preoccupied, and incoherent/disorganized.

How Do I Connect? Attachment Issues in Adolescence

“…More recently, Westen and colleagues (2006) found a strong correlation between borderline personality disorder (BPD) in adolescents with both preoccupied and incoherent=disorganized attachment. They attribute these findings to the specific, ''push-pull dynamics and rejection sensitivity (preoccupied dimension) and the cognitive-linguistic slippage (incoherent=disorganized dimension) seen in the narratives of BPD patients'' (Westen et al, 2006(Westen et al, , p. 1078. Levy (2005) provides a similarly compelling argument linking attachment to BPD.…”

“…As opposed to the observable and measurable Strange Situation laboratory interactions between mother and child, attachment in adolescence assesses the quality of parent-child bonds along various dimensions and is measured vis-à-vis self-report inventories and narrative-based, semi-structured interviews (Benson, McWey, & Ross, 2006 it is important to discriminate between self-report versus interview methodology, as well as categorical versus dimensional approaches (Westen, Nakash, Thomas, & Bradley, 2006). Each dichotomy is touched upon below.…”

“…To date, researchers have unfortunately not been able to definitively determine what amount and type of prototypes=dimensions are to be considered essential to adolescent and adult attachment formation. Indeed, what are clearly needed are more assessments of the interrelationships of these different measures as well as their differential validity (Westen et al, 2006).…”

The neglected link between adult attachment and schizotypal personality traits

“…Arguably then, a robust theory of interpersonal functioning and emotion regulations can provide an empirically plausible conceptual framework for PDs. Indeed, the link between attachment and PDs has been demonstrated in psychiatric samples (Berry, Barrowclough, & Wearden, 2008;Fossati et al, 2003;Westen et al, 2006), and specific PDs, including borderline (De Zulueta, 1999), dependent (Livesley et al, 1990), and avoidant (Sheldon & West, 1990).…”

“…Research suggests that attachment provides a diathesis for psychopathology in adulthood (Lyddon & Sherry, 2001;Meyer et al, 2001;Ponizovsky, Nechamkin & Rosca, 2007;Shorey & Snyder, 2006;Westen et al, 2006). Moreover, the research agenda for the development of the DSM-V, as laid down by the APA taskforce (First et al, 2002), explicitly states the immediate need for empirical evidence on the role relational problems -of which attachment is arguably a fundamental component -play in the aetiology, comorbidity, diagnosis, and treatment of mental disorders.…”