Comparison of attachment styles in adult patients with attention deficit hyperactivity disorder and major depressive disorder: a controlled preliminary study

Abstract

Aim: As a result of previous studies, it was demonstrated that attachment patterns in adults play an important role in the development and course of both attention deficit hyperactivity disorder (ADHD) and major depressive disorder (MDD). The aim of this study is to compare the attachment styles and related factors in the adults diagnosed with ADHD and MDD. Method: This study was carried out in psychiatry outpatient clinic of a second stage treatment center between June 2014 and October 2014 in Istanbul. The study included 33 ADHD patients, 31 MDD patients who first time admitted to the clinic within the specified time intervals and were applied SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders), and 31 healthy controls matched in terms of age, gender and marital status. MDB and ADHD groups were matched according to their Clinical Global Impression Scale (CGI-S) scores which have been applied by clinicians. DSM-IV-based Adult ADD/ADHD Diagnosis and Assessment Inventory (E-ADHD) has been filled by the participants. Those who gave 2 or 3 points to at least six of the nine questions of 1st or 2nd sections of E-ADHD were once again interviewed clinically in terms of ADHD, and were diagnosed with adult ADHD according to DSM-IV-TR criteria. Additionally, Hamilton Depression Scale (HAM-D) was applied by the clinician. All of the participants filled Experiences in Close Relationships (ECR) Inventory. Results: Significant differences were found between the three groups in terms of anxious attachment subtype scores determined through ECR. A significant difference in anxious attachment scores was found in MDD group when compared with healthy controls, whereas there wasn’t any difference between ADHD group and healthy controls. There weren’t any statistically significant differences between the number of people in terms of anxious, avoidant and secure attachment in three groups. There was a significant positive correlation between anxious attachment rates and E-ADHD hyperactivity subscale (E-ADHD-HA) scores (p= 0.007, r= 0.463) and HAM-D scores (p= 0.046, r= 0.361). There was a significant positive correlation between avoidant attachment rates and E-ADHD attention deficit hyperactivity disorder related features scores (E-ADHD-RF) (p= 0.002, r= 0.402). Conclusion: In this study, in contrast to previous studies, there weren’t any differences in terms of attachment patterns between the ADHD group, the MDD group and healthy controls. This finding might depend on the scale used, the age of the group or the predominance of women in the sample. However, it was concluded that MDD group exhibited anxious attachment pattern more frequently than the healthy control group. It can be said that insecure attachment may facilitate the development of MDD, may lead to progression of the disorder, and may affect the therapy negatively.