Attachment Distress Research Articles

Neural Correlates of Attachment Representation in Patients With Borderline Personality Disorder Using a Personalized Functional Magnet Resonance Imaging Task.

BackgroundFear of abandonment and aloneness play a key role in the clinical understanding interpersonal and attachment-specific problems in patients with borderline personality disorder (BPD) and has been investigated in previous functional Magnet Resonance Imaging (fMRI) studies. The aim of the present study was to examine how different aspects of attachment representations are processed in BPD, by using for the first time an fMRI attachment paradigm including personalized core sentences from the participants’ own attachment stories. We hypothesized that BPD patients would show increased functional involvement of limbic brain regions associated with fear and pain (e.g., the amygdala and the anterior cingulate cortex) when presented personalized attachment relevant stimuli representing loneliness compared to healthy controls (HC).MethodsWe examined the attachment classifications of 26 female BPD patients and 26 female HC using the Adult Attachment Projective Picture System (AAP). We used an fMRI-adapted attachment paradigm to investigate the neural correlates of attachment. All participants were presented three personalized (vs. neutral) sentences extracted from their AAP attachment narrative, combined with standardized AAP pictures representing being alone (monadic) or in interactive (dyadic) attachment situations.ResultsAs expected, the classification of unresolved attachment was significantly greater in BPD compared to HC. BPD patients showed increased fMRI-activation in brain areas associated with fear, pain, and hyperarousal than HC when presented with personalized attachment-relevant alone stimuli. In particular, pictures with monadic attachment situations induced greater anterior medial cingulate cortex, anterior insula, amygdala, thalamus and superior temporal gyrus activation in the patient group.ConclusionThe results point to increased fMRI-activation in areas processing emotional distress and painful experiences in BPD patients. In particular, the emotional cascade reflecting attachment distress was evoked by combining monadic pictures, representing abandonment and aloneness, with the patients’ personalized narrative material. Our results confirmed and replicated previous results that illustrate once again the high relevance of aloneness and feelings of abandonment for BPD in the context of attachment trauma. Moreover, our results support the hypothesis of hypermentalization in response to attachment distress as a core feature of social-cognitive impairment in BPD associated with common treatment implications across different therapeutic orientations.

Disorder-specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode.

For the first time, the present study investigates disorder‐specific attachment characteristics and childhood trauma in adolescent inpatients with anorexia nervosa (n = 30, girls/boys: 28/2, age: M = 14.84, SD = 1.20), a major depressive episode (n = 30, girls/boys: 27/3, age: M = 15.14, SD = 1.50), and controls (n = 60, girls/boys: 44/16, age: M = 16.10, SD = 1.20). We used the Structured Clinical Interview to diagnose Axis I disorders, the Adult Attachment Projective Picture System to classify attachment representations, and the Childhood Trauma Questionnaire to assess child maltreatment. Our findings demonstrate an overrepresentation of the unresolved attachment status in the patient samples. A one‐way analysis of variance succeeded by Bonferroni post hoc tests indicated that adolescents with anorexia nervosa show more isolation and dissolution of boundaries between life and death when confronted with situations of solitude. Although they report moderate to severe levels of traumatic childhood experiences, they tend to minimize those. Adolescents with a major depressive episode report higher levels of emotional abuse and neglect in their childhood, leaving them in a state of failed protection and danger during attachment distress. Integrating these attachment‐related characteristics into specific psychotherapeutic interventions might be associated with a better outcome in that age group.

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

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.

Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study.

Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.

Promises, Promises.

Presenting a pledge to another establishes expectation in the recipient for the commitment to be fulfilled, particularly when a promise is devoid of coercion. Defaulting on a commitment may damage relationships between people and may predispose the disenchanted recipient to distrust those who proffer succeeding commitments. God's advocates who have been disappointed by God's evident under-delivery may experience a crisis of faith, exemplified in attachment distress, when disappointment intimates God has over-promised his providence, which questions the nature and, ultimately, the relevance of God.

Therapeutic Assessment Case Study: Treatment of a Woman Diagnosed With Metastatic Cancer and Attachment Trauma

This article presents a Therapeutic Assessment (TA) case study of a woman recovering from 4 years of intense medical treatment for stage IV cancer. The inclusion and utility of using the Adult Attachment Projective Picture System (AAP) in the TA is highlighted. The client's attachment classification as unresolved helped identify that her current experiences with dissociation and problems restructuring her life following cancer remission were related to severe childhood sexual abuse, which she had suppressed for decades. The AAP also provided information regarding the unconscious defensive processes the client employed to cope with attachment distress and her inability to find comfort and support from others. These findings were instrumental in guiding the subsequent psychotherapy. The TA process, particularly the assessor–client relationship, facilitated an experience of containing her previously unintegrated and dysregulated affect. A single-case experiment using daily measurements suggested that participation in TA coincided with symptomatic improvements in multiple domains. These improvements were maintained during 4 months of biweekly psychotherapy after the completion of the TA. This case illustrates the applicability of the TA model in health care settings, demonstrates the usefulness of the AAP in the context of TA, and provides empirical support for the effectiveness of the TA model in initiating symptom improvement.

A multi-modal approach to the study of attachment-related distress

The present study aimed at providing a comprehensive analysis of individual differences in the regulation of attachment distress as measured through different components of the emotional response, including neuroendocrine reactions, subjectively experienced affect, and proximity seeking behaviour. Emotional responses were measured before, during, and after the induction of attachment distress in a sample of couples. Analyses using multi-level modelling revealed that, in both men and women, attachment anxiety was related to physiological (i.e., cortisol) and subjective emotional distress responses, whereas attachment avoidance most consistently predicted subjective and behavioural responses to distress. In addition to one's own attachment style, partner's attachment style was also found to modulate emotional and behavioural responses to relational stress, in both couple members. Attachment style was also found to moderate the interrelations between emotional indices, revealing interesting information on the regulatory strategies underlying attachment anxiety and avoidance.

Testing the function of attachment hierarchies during emerging adulthood

J. Bowlby (1969/1997) suggested that one aspect of healthy development included the shift of attachment functions from parent to peer. This proposal was tested in a sample of undergraduates and results suggested that there was no advantage for individuals with a peer network compared to those with a family network. There was, however, a difference in attachment–distress associations between groups. Consistent with previous research, attachment anxiety was positively associated with distress for both groups. Although attachment avoidance was positively associated with distress for individuals with a predominantly family network, avoidance was not associated with distress for individuals with a predominantly peer network. Discussion highlights two interpretations for these findings, which focus on the importance that attachment may have on the experience of distress as well as current research findings exploring the attachment–distress relationship over time.

Measuring Continued Attachment to Parents: The Continued Attachment Scale—Parent Version

Continued attachment to parents has correlated with measures of adjustment in both school and peer situations at least through the transition to college. The measurement of parental attachment has relied primarily on self-reports of the quality of the parental relationship in terms of support, encouragement, autonomy, and dependency. Bowlby's original theory and research relied more on reactions to separation, which Berman called “attachment distress” in adults. The present study examined the psychometric properties of the Continued Attachment Scale—Parent version which measures cognitive and emotional responses to the perceived separation from parents. Data from 216 college students were collected on the scale as well as several scales selected to evaluate convergent and construct validities. The scale showed good reliability. Scores were highly correlated with attachment scale scores that measure support, encouragement, and closeness. Correlations with measures of emotional state and personality differed for men and women but generally suggested that the scale assesses a distinct domain of experience related to continued closeness to parents and to depression.