The role of fearful attachment in depersonalization disorder

Abstract

This study's goal was to systematically investigate attachment styles in Depersonalization Disorder (DDD), and their relationship to dissociation severity and childhood trauma history. Forty-two participants with DSM-IV DDD and 53 healthy controls (HC) without lifetime Axis I and II disorders were administered the Relationships Questionnaire and the Relationship Scales Questionnaire, based on Bartholomew's anxiety-avoidance orthogonal model of secure, dismissive, preoccupied, and fearful attachment; the Dissociative Experiences Scale; and the Childhood Trauma Questionnaire. DDD was characterized by a significantly higher prevalence of insecure attachment (66.7%) compared to controls (34.0%), largely accounted for by fearful attachment (45.2% of all DDD participants). In the DDD group, of the four attachment styles only fearful was predictive of both normative and pathological dissociation, accounting for 17% - 18% of the variance. Childhood maltreatment made a significant hierarchical contribution to the prediction of dissociation beyond fearful attachment, and the effect of fearful attachment on dissociation was indirectly mediated by childhood trauma. In the control group, dissociation was predicted by fearful attachment but was not associated with childhood trauma. Implications of the findings are discussed, highlighting the potentially important role of trauma-based relational fear in this dissociative disorder.