Attachment Interview Research Articles

Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders.

This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.

Secure Attachment Representation in Adolescence Buffers Heart-Rate Reactivity in Response to Attachment-Related Stressors.

To date, we know very little about the effects of the differences in attachment classifications on the physiological correlates of stress regulation in adolescent age groups. The present study examined for the first time heart rate (HR) and heart rate variability (HRV) during an attachment interview in adolescents. HR and HRV data were collected during a baseline assessment as well as during the administration of the Adult Attachment Projective Picture System (AAP) in a community-based sample of 56 adolescents (26 females and 30 males, mean age = 16.05 years [SD = 1.10]). We additionally used the Adult Attachment Interview (AAI) in 50% of our sample to test the convergent validity. Adolescents with a secure attachment representation showed a higher HRV from baseline to the AAP interview compared to those with an insecure-dismissing (Ds) and the unresolved group. A comparison between the two insecure attachment groups showed no significant difference related to HR and HRV. Cohen’s Kappa (κ = 0.81) revealed an almost perfect agreement between the AAP and the AAI for the four-group classification. Our results indicate that adolescents with a secure attachment representation are more capable of dealing with attachment-related distress which is represented in higher HRV during an attachment interview.

Non-suicidal self-injury and attachment trauma in adolescent inpatients with psychiatric disorders

This study examined how non-suicidal self-injury disorder (NSSID) differs with respect to mental disorders, gender and attachment status in adolescent psychiatric patients. In particular, we analyzed attachment-related traumatic material underlying adolescent NSSID. Our sample consisted of 137 in-patient adolescents aged 12 to 18 years (73% female, Mage = 15.09, SD = 1.44; 27% male, Mage = 14.65, SD = 1.53). Forty-four patients (32.1%) fulfilled the diagnostic criteria for NSSID according to the DSM-5 and ninety-three patients (67.9%) did not meet diagnostic criteria for NSSID. Our results revealed a higher prevalence of NSSID in female patients and in patients with mood disorders. In the total sample, 52% of our in-patients were classified with an unresolved attachment status. The diagnostic subgroup analysis demonstrated a higher percentage of unresolved attachment status only in patients with eating disorders and NSSID. However, our in-depth analysis of the total sample revealed that patients with NSSID demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. In particular the theme of helplessness in interpersonal conflicts left them in a state of attachment dysregulation. Intervention strategies targeting traumatic attachment-related themes might be useful to reduce the number of adolescents engaging in NSSI.

Mothers of Children Diagnosed with ADHD: A Descriptive Study of Maternal Experience during the First Three Years of Treatment.

Background: Attention deficit hyperactivity disorder is the most common childhood psychiatric disorder. Current treatment strategies do not provide a convincing improvement on overall functioning, and further, reciprocity between ADHD and attachment has been suggested. This suggests that we do not fully comprehend the mechanisms of the disorder. This study was part of a larger project investigating factors of potential importance when a child is diagnosed with ADHD. Aim: In this current study we aimed to gain a clearer understanding about whether the mothers experienced the diagnostic process and treatment as helpful. Method: Sixty children newly diagnosed with ADHD and their mothers were included three years prior to this study. Fifty-two (87%) completed a survey about their experience with the diagnostic process and the years after in the psychiatric system and the secondary healthcare sector. Forty-three had also participated in an attachment interview in the original study and answered questions about this. Discussion: The follow-up questionnaire was based on conversations with the mothers was not meant to be used as a quantitative measure. However, one point to take is that the mothers did often not feel the help offered to be sufficient. In our opinion, this underlines that we are still far from understanding what ADHD is and what causes the differences in developmental trajectories as well as how differences in etiological factors may call for more customized approaches in treatment strategies.

Disorganized attachment in adolescence: Emotional and physiological dysregulation during the Friends and Family Interview and a conflict interaction.

The current study examined the effects of attachment on autonomy, relatedness, and emotion regulation during an attachment interview (Friends and Family Interview; FFI) and a Parent×Child Conflict interaction (Family Interaction Task; FIT) in 49 adolescents (11 to 17 years old). Disorganized adolescents displayed behaviors promoting autonomy and relatedness less frequently and at a lower extent than organized ones in the FIT with mothers but not with fathers. Disorganized adolescents also showed a steeper decrease in heart rate variability (HRV) than organized ones, during both the FFI and the FITs. Moreover, disorganized adolescents responded with a more marked increase in skin conductance level to the FIT with mothers than organized individuals. Dismissing adolescents showed behaviors promoting autonomy and relatedness less frequently and to a lesser extent than secure ones, while displaying more often behaviors undermining autonomy and relatedness in the FITs. Dismissing adolescents also showed a more pronounced decrease in HRV during the FFI than secure and preoccupied individuals; no differences were found between these groups in HRV during the FITs. The results suggest that disorganized adolescents had more difficulties in regulating their emotions during both the FFI and the FITs, whereas dismissing individuals seemed effectively challenged only during the interview.

L’Échelle de Relation d’Objet et de Cognition Sociale de Westen : résultats préliminaires sur une population française d’adolescentes suicidantes hospitalisées

Objectives1) First, we will present a synthetic translation of the Object Relationship and Social Cognition Scale of the so-called “G” or Global Form (SCORS-G) as designed by Westen in 1985 and which is based on clinical experience, research, and theory. Coding can be done of narratives from clinical interviews, research interviews, recounted dreams, or stories from the Thematic Apperception Test (TAT). The authors identified several distinct areas – such as the complexity of people's representations, the emotional tone of people's representations, emotional investment in relationships and moral norms, and the understanding of social causality – that are conceptualized as cognitive, emotional, and motivational processes that mediate interpersonal functioning. Their goal is to capture patterns, expectations, affects, desires, fantasies, and conflicts that the person involves in his interpersonal relationships. 2) Secondly, we wish to report the preliminary results of a study of hospitalized and non-clinical adolescent girls. MethodWe transcribed (verbatim) 31 attachment interviews (AAI) that were coded independently by three coders with SCORS-G. Intercotatory fidelity is at a perfectly acceptable level. ResultsHospitalized, in-patient adolescent girls have significantly lower scores than the control group for all four dimensions of SCORS (from ( p < 0,004 to p < 0,0001 depending on the domain). Based on the overall results of the clinical group, we could say that their representations of themselves and of others are not clearly differentiated and integrated; that they have a minor capacity for shaping mental life; that their expectations and interpersonal attributions have a mixed but rather negative emotional coloration; that their investment in people and in moral values remains conventional and stereotyped, but with guilt over the transgression of morality; and that finally their descriptions of interpersonal events have shortcomings or incongruities that require “work” in order for them to be fully understood. On the other hand, non-clinical adolescent girls describe people in a more advanced way, are aware of the impact of their behavior on others, and relate more complex subjective experiences with a mixed and balanced but rather positive emotional sensitivity. DiscussionThe description of relationships shows the existence of conventional feelings of friendship, attention, love, and empathy in relationships. The subject is concerned with moral values, feels guilt, and respects the figures of authority. Narratives about relationships are frank, clear, and direct; individuals’ actions come from the way they feel about and interpret situations. ConclusionsThus, through this specific work, we can appreciate the role of mental processes in the formation of thoughts, feelings, behaviors, and interpersonal interactions.

Unresolved Attachment Mediates the Relationship Between Childhood Trauma and Impaired Personality Functioning in Adolescence.

The present study investigates the mediating effect of attachment trauma on the relationship between childhood maltreatment and personality functioning in 199 adolescents (12-18 years) using a novel approach of an in-depth analysis of attachment-related traumatic contents during an attachment interview (AAP). Our findings demonstrate that adolescents with a high amount of traumatic attachment-related material show a lower resilience when facing traumatic childhood experiences, resulting in a greater severity of personality dysfunction. In particular, the associations between emotional abuse and neglect and the domains of identity, empathy, self-direction, and intimacy were mediated by the severity of attachment trauma. These results advance our understanding of the different nuances of attachment-related traumatic material and how they might shape personality structure in an adolescent age group.

The neural correlates of attachment security in typically developing children

This study investigated neural correlates of children’s attachment security using functional magnetic resonance imaging. Fifty-one boys’ attachment styles (age mean = 9.5 years, SD = 0.61) were assessed with the Separation Anxiety Test (SAT). We created an fMRI version of the SAT to activate children’s attachment system in fMRI environment and contrasted two conditions in which children were instructed to infer the specific feeling of the boy in the picture or to identify objects or physical activities. In the final fMRI analysis (N = 21), attachment security could be detected at the neural level corresponding to the behavioural differences in the attachment interview. Securely attached children showed greater activation in the frontal, limbic and basal ganglia area which included the dorsolateral prefrontal cortex, amygdala, cingulate cortex and striatum, compared to other children who had lower quality of attachment. These regions have a key role in socio-emotional information processing and also represent a brain network related to approach and avoidance motivation in humans. Especially the striatum, strongly linked to reward processing underpinning social approach and avoidance motivation, showed the largest effects in these differences and also positively correlated with emotional openness scores in SAT. This suggests that the quality of attachment configures the approach and avoidance motivational system in our brain mediated by the striatum.

Facial Behavior During an Attachment Interview in Patients With Complicated Grief.

The present study investigated differences in various aspects of facial behavior among female patients with complicated grief (CG; n = 18) and healthy controls (n = 18) during the assessment of their attachment representation using the Adult Attachment Projective Picture System. All patients were classified with an unresolved attachment status. On a behavioral level, they demonstrated longer gazing behavior away from the interviewer and the picture stimuli, more speech pauses, less smiling toward the interviewer, and more crying, especially in response to stimuli portraying the theme of loss. Focusing on the in-depth analysis of death-related stimuli using the Facial Action Coding System, patients demonstrated less facial affective behavior, less disgust, and less smiling in response to these stimuli compared with the healthy controls. The impaired capacity of patients with CG responding in an affective appropriate manner regarding bereavement might be interpreted as a specific emotion dysregulation when their attachment and mourning system is activated.

Insecure attachment representations and child personal narrative structure: implications for delayed discourse in preschool-age children

The internal working model of attachment has been assessed through attachment interviews and story-stems that exhibit differentiated patterns in adult and child narratives. This study examined variation in length and structure of children’s independent personal narratives by attachment representations, discriminating between insecure-avoidant and insecure-ambivalent, and we tested attachment insecurity as a predictor of developmental delay in narrative discourse. Sixty-five preschool-age children completed the Attachment Story Completion Task-Revised and recalled three recent past events. Secure children told longer personal narratives than both avoidant and ambivalent children, and secure children’s narrative structure was more coherent than that of ambivalent children but not avoidant children. Likewise, the two insecure categories differentially predicted delayed discourse. Ambivalent children were 10 times more likely to exhibit delayed discourse than secure children, whereas avoidant children were not at significantly greater risk. Differential developmental outcomes of avoidant and ambivalent children are discussed and conclusions are drawn about the role of child attachment in storing, accessing and communicating memories about everyday lived experiences.

Attachment and eating disorders: a review of current research.

Attachment insecurity may confer risk for developing an eating disorder. We describe domains of attachment functioning that are relevant to eating disorders including: affect regulation, interpersonal style, coherence of mind, and reflective functioning. Research since 2000 on attachment and eating disorders related to these domains is reviewed. We searched MedLine/Pubmed and PsycINFO from January 2000 to February 2014 and kept articles that: were empirical, included adults with a diagnosed eating disorder, and used a standard attachment measure. We retained 50 relevant studies. Compared to controls, those with eating disorders had higher levels of attachment insecurity and disorganized mental states. Lower reflective functioning was specifically associated with anorexia nervosa. Attachment anxiety was associated with eating disorder symptom severity, and this relationship may be mediated by perfectionism and affect regulation strategies. Type of attachment insecurity had specific negative impacts on psychotherapy processes and outcomes, such that higher attachment avoidance may lead to dropping out and higher attachment anxiety may lead to poorer treatment outcomes. Research to date suggests a possible relationship between attachment insecurity and risk for an eating disorder. More research is needed that uses attachment interviews, and longitudinal and case control designs. Clinicians can assess attachment insecurity to help inform therapeutic stances and interventions.

EPA-0142 – Neural changes in depressed patients during psychodynamic psychotherapy: An fMRI Study

Neuroimaging studies of depression have demonstrated treatment-specific changes involving the limbic system and regulatory regions in the prefrontal cortex. While these studies have examined the effect of short-term, interpersonal or cognitive-behavioural psychotherapy, the effect of long-term, psychodynamic intervention has never been assessed. Here, we investigated recurrently depressed ( DSM-IV ) unmedicated outpatients ( N =16) and control participants matched for sex, age, and education ( N =17) before and after 15 months of psychodynamic psychotherapy. Participants were scanned at two time points, during which presentations of attachment-related scenes with neutral descriptions alternated with descriptions containing personal core sentences previously extracted from an attachment interview. Outcome measure was the interaction of the signal difference between personal and neutral presentations with group and time, and its association with symptom improvement during therapy. Signal associated with processing personalized attachment material varied in patients from baseline to endpoint, but not in healthy controls. Patients showed a higher activation in the left anterior hippocampus/amygdala, subgenual cingulate, and medial prefrontal cortex before treatment and a reduction in these areas after 15 months. This reduction was associated with improvement in depressiveness specifically, and in the medial prefrontal cortex with symptom improvement more generally. This is the first study documenting neurobiological changes in circuits implicated in emotional reactivity and control after long-term psychodynamic psychotherapy.

Fremdenfeindlichkeit durch erlebte Ausstoßungsprozesse - eine tiefenhermeneutische Reflexion eines Einzelfalls

A single case study is presented from a feasibility study on social, psychic and neurobiological causes of violence in adolescence focusing on right-wing extremist and xenophobic youth. Results from psychological assessments and a structured biografical reconstruction are analyzed. The case illustrates a typical developmental path of a right-wing, xenophobic and violent male adolescent who experienced early and repeated exclusion and social marginalization. Results from psychological testing demonstrated additional developmental risk factors, such as disorganized attachment representations and low mentalizing abilities. A depth-hermeneutic analysis ofa sequence during the attachment interview as well as a reflection of the research setting further illustrates how experiences of exclusion are re-enacted by a combination of fear of abandonment and aggression.

Positive Interactions and Avoidant and Anxious Representations in Relationships with Parents, Friends, and Romantic Partners

We examined associations between positive interactions and avoidant and anxious representations in relationships with parents, friends, and romantic partners. Two hundred adolescents completed questionnaires, observations, and attachment interviews. From a between-person perspective, those adolescents with more positive interactions overall had less avoidant representations. Within persons, more positive interactions were relative to one's own average level in relationships, the less avoidant representations were for that type of relationship. Adolescents were less anxious about a particular type of relationship if they have positive interactions in their other types of relationships. Finally, representations were primarily predicted by interactions in the same type of relationship; interactions in other relationships contributed little. The findings underscore the importance of examining representations of particular types of relationships.

Play it again: neural responses to reunion with excluders predicted by attachment patterns

Reunion behavior following stressful separations from caregivers is often considered the single most sensitive clue to infant attachment patterns. Extending these ideas to middle childhood/early adolescence, we examined participants' neural responses to reunion with peers who had previously excluded them. We recorded event-related potentials among nineteen 11- to 15-year-old youth previously classified on attachment interviews (11 secure and 8 insecure-dismissing) while they played a virtual ball-toss game (Cyberball) with peers that involved fair play, exclusion and reunion phases. Compared to secure participants, dismissing participants displayed a greater increment in the N2 during reunion relative to fair play, a neural marker commonly linked to expectancy violation. These data suggest a greater tendency toward continued expectations of rejection among dismissing children, even after cessation of social exclusion. In turn, the link between self-reported ostracism distress and neural signs of negative expectancy at reunion was moderated by attachment, such that self-reports were discordant with the neural index of expectancy violation for dismissing, but not for secure children.

1223 The Effect of Extremely Preterm Birth on Adult Relationships

BackgroundThe traumatic births of Extremely Preterm (EPT) infants and long hospital stay may affect parent-child interaction, the child’s attachment security negatively and impact relationships in adult life.AimTo investigate whether EPT...

Changes in Prefrontal-Limbic Function in Major Depression after 15 Months of Long-Term Psychotherapy

Neuroimaging studies of depression have demonstrated treatment-specific changes involving the limbic system and regulatory regions in the prefrontal cortex. While these studies have examined the effect of short-term, interpersonal or cognitive-behavioural psychotherapy, the effect of long-term, psychodynamic intervention has never been assessed. Here, we investigated recurrently depressed (DSM-IV) unmedicated outpatients (N = 16) and control participants matched for sex, age, and education (N = 17) before and after 15 months of psychodynamic psychotherapy. Participants were scanned at two time points, during which presentations of attachment-related scenes with neutral descriptions alternated with descriptions containing personal core sentences previously extracted from an attachment interview. Outcome measure was the interaction of the signal difference between personal and neutral presentations with group and time, and its association with symptom improvement during therapy. Signal associated with processing personalized attachment material varied in patients from baseline to endpoint, but not in healthy controls. Patients showed a higher activation in the left anterior hippocampus/amygdala, subgenual cingulate, and medial prefrontal cortex before treatment and a reduction in these areas after 15 months. This reduction was associated with improvement in depressiveness specifically, and in the medial prefrontal cortex with symptom improvement more generally. This is the first study documenting neurobiological changes in circuits implicated in emotional reactivity and control after long-term psychodynamic psychotherapy.

Genetic and attachment influences on adolescents’ regulation of autonomy and aggressiveness

Adolescence is a time when intense emotions are elicited within the parent-adolescent relationship, often when autonomy subjectively is endangered. As emotion dysregulation is one of the risk processes for the development of psychopathology, adolescence may be perceived as a highly sensitive period for maladjustment. Inter-individual differences in emotionality and emotion regulation have been shown to be influenced or moderated by molecular genetic differences in the serotonin transporter gene (5-HTT) and by attachment patterns. We investigated whether both the 5-HTT and attachment are associated with emotionality and emotion regulation in an observed adolescent-mother interaction and the personality traits aggressiveness and anxiety in adolescence. Ninety-one adolescents at age 12 were observed in interaction with their mothers during a standardized emotion-eliciting social task to assess emotionality and emotion regulation in relation to autonomy. Adolescents' aggressiveness and anxiety were assessed by mother report. Concurrent attachment quality was determined by an attachment interview. DNA samples were collected in order to assess the 5-HTTLPR, a repeat polymorphism in the promoter region of the serotonin transporter gene. While the short allele of the serotonin transporter gene was associated with a higher overall rate of autonomy behaviors, attachment security was related to more agreeable and less hostile autonomy. A significant interaction revealed a moderating effect of attachment security. Carriers of the short version of the 5-HTTLPR showed more agreeable autonomy when they had a secure attachment behavior strategy but showed more hostile autonomy when they were insecurely attached. Carriers of the short version of the 5-HTTLPR and insecurely attached adolescents were rated as more aggressive. The study suggests a gene-attachment interaction in adolescents where the adolescent's attachment status moderates a genetically based higher negative reactivity in response to threats to autonomy in social interactions.

The concept of coherence in attachment interviews: Comparing attachment experts, linguists, and non-experts

Coherence is a central construct in attachment interviews. Nevertheless, the concept has never been the main focus of a study in the attachment field. The present study examined whether coherence in attachment interviews is defined differently by experts trained in attachment theory, by linguists, and by non-experts. The 72-item Coherence Q-sort (CQS) was used to determine the profile of a prototypical coherent interview. Results indicated that attachment experts could be reliably distinguished from the (combined) other groups: attachment experts emphasized quality and manner more than all other groups, linguists emphasized quantity and relevance more than attachment experts, and higher educated non-experts valued relevance more than attachment experts. Defining coherence in attachment interviews is thus more than just applying Grice's linguistic maxims; expertise in attachment theory is critical for defining interview coherence. Consequences for the coding of the AAI by non-attachment experts, as well as computer coding (im)possibilities are discussed.

Gender nonconformity, childhood rejection, and adult attachment: a study of gay men.

Several childhood factors are reported to be associated with a homosexual orientation in men, including gender nonconformity and rejection by parents and peers. The purpose of this study was to explore the associations between these childhood factors and attachment anxiety (the tendency to experience anxiety regarding potential loss and rejection in close relationships) and attachment avoidance (the tendency to avoid versus seek out closeness in relationships) in gay and bisexual men. A community sample of 191 gay and bisexual men completed questionnaires and an attachment interview. Gender nonconformity was significantly associated with paternal, maternal, and peer rejection in childhood. In addition, paternal and peer rejection, but not maternal rejection, independently predicted attachment anxiety. Peer rejection and, to a lesser extent, paternal rejection mediated the association between gender nonconformity and attachment anxiety. Finally, peer rejection mediated the association between paternal rejection and attachment avoidance. Findings highlight the role of gender nonconformity in contributing to childhood rejection and the importance of peer relationships in the socialization of gay men.