Attachment , personality & psychopathology among adult inpatients : Self-reported romantic attachment style vs . AAI states of mind

The present study examined self-reported romantic attachment style and Adult Attachment Interview (AAI) states of mind regarding early attachment relationships, personality dimensions, and psychopathology in a psychiatric sample of trauma survivors. Inpatients (N = 80) admitted to a hospital trauma treatment program were administered the Experiences in Close Relationships Scale, AAI, Millon Clinical Multiaxial Inventory – III, Dissociative Experiences Scale, and Dissociative Disorder Interview Schedule. Self-report and AAI attachment classifications were not related and different results emerged for the two measures. Self-reported romantic attachment style was significantly associated with personality dimensions, with Fearful adults showing the most maladaptive personality profiles. Findings suggested that self-report dimensions of self and other independently contribute to different forms of psychological dysfunction. AAI Unresolved Trauma was uniquely associated with dissociation and PTSD, whereas Unresolved Trauma and Unresolved Loss jointly contributed to schizotypal and borderline personality disorder scores. The differences in findings between the two measures are discussed with a view toward the developmental and clinical implications. Acknowledgments This project was partially funded by the Department of Psychology and Philosophy at Texas Woman’s University and the Ross Institute. We are grateful to the staff and patients of the Timberlawn Psychiatric Hospital Trauma Program for their time. In addition, we wish to express our appreciation to Dante Cicchetti and the editorial reviewers, whose insightful suggestions substantially enhanced the manuscript. Correspondence should be sent to Dr. Shelley Riggs at the University of North Texas, Dept. of Psychology, P.O. Box 311280, Denton, TX 76203-1280, riggs@unt.edu. Attachment, Personality, and Psychopathology 3 Following earlier research supporting links between attachment patterns and normal and abnormal development in children, applications of attachment theory to the study of adolescent and adult functioning have recently proliferated. Despite the rapid growth of the adult attachment literature, relatively few studies have investigated adult attachment processes and the development of psychopathology. Childhood maltreatment has for some time been considered to have detrimental effects on the attachment system and appears to be a primary pathway to insecurity and psychological maladjustment in later life (Adam, 1994; Cicchetti & Toth, 1995). Currently, however, studies examining links between childhood trauma and adult attachment are limited by their use of community or college samples (e.g., Anderson & Alexander, 1996; Muller, Lemieux, & Sicoli, 2001; Roche, Runtz, & Hunter, 1999). In an effort to extend the application of adult attachment constructs and assessments to a clinical population, the present study investigated the links between adult psychiatric patients’ attachment representations, personality and psychopathological symptoms. A further goal was to evaluate the relative utility of different conceptualizations and methods of assessing adult attachment in an inpatient population characterized by a history of severe trauma. Adult Attachment Research Conceptual and Methodological Issues A major debate developed in the late 1980s and 1990s between two lines of attachment research, distinguished by conceptual and methodological differences. Both research traditions conceptualize the adult attachment system according to Bowlby’s (1969, 1973, 1980) early formulations as a set of mental representations of self and other formed in early parent-child relationships and carried forward to influence subsequent personality development, interpersonal relationships, and mental health in adulthood. Each research group also identifies adult Attachment, Personality, and Psychopathology 4 attachment classifications that parallel the infant attachment patterns initially recognized by Ainsworth and her colleagues (Ainsworth, Blehar, Waters, & Wall, 1978), and later expanded by Crittenden (1985) and Main and her colleagues (Main & Hesse, 1990; Main & Solomon, 1986). However, the two branches of research diverge in their focus of study and their approach to measuring adult attachment constructs. The first line of adult attachment research emerged from the discipline of developmental psychology and generally focuses on early childhood experiences with parents. Typically, developmental researchers have employed the interview method to assess adults’ current mental representations with respect to early parent-child attachments. Of particular interest to these researchers was how parents’ internal working models of early attachment experiences in the family of origin might predict their caregiving behaviors and their infants’ attachment behavior. Based on Bowlby’s (1980, 1988) original conception of internal working models as largely acting outside of awareness, the Adult Attachment Interview (AAI; George, Kaplan, & Main, 1985) was designed to assess present state of mind with respect to early attachment-related experiences by means of discourse analysis. Using a technique described as “surprising the unconscious” (George et al., 1985), the AAI probes for detailed information regarding childhood relationships with parents, the influence of these experiences on personality, and experiences of loss or trauma. Under the Main and Goldwyn (1998) scoring system, attachment status is determined by the extent to which participants can discuss their experiences openly in a collaborative, balanced, and highly coherent fashion, rather than by the reported quality of those experiences per se. Thus, individuals with a history of adverse experiences might nevertheless be classified as secure, provided their narratives are coherent and do not violate the principles of collaborative speech. The AAI identifies four classifications analogous to the four infant Strange Attachment, Personality, and Psychopathology 5 Situation classifications: (a) Secure/Autonomous, (b) Dismissing (c) Preoccupied and, (d) Unresolved/disorganized. Secure parents whose AAI narratives are coherent, consistent, and collaborative tend to demonstrate sensitive and responsive caregiving and have secure infants, whereas three distinct patterns of discourse violation predict three different caregiving styles and three types of insecure attachment in infants (Lyons-Ruth, Bronfman, & Parsons, 1999; Main & Hesse, 1990; Main, Kaplan, & Cassidy 1985; van IJzendoorn, 1995). Secure individuals value attachment relationships and recognize the importance of attachment-related experiences, while remaining relatively autonomous and objective with regard to particular experiences or relationships. In contrast, insecure individuals share an inability to fully integrate early memories in a coherent and believable manner. Dismissing adults attempt to limit or minimize the influence of attachment relationships by dismissing, devaluing or conversely idealizing attachment relationships and experiences. Preoccupied individuals are characterized by excessive current involvement in early attachment relationships, manifested in a generalized state of confusion, passivity or preoccupying anger. Finally, the Unresolved classification, like the disorganized infant classification, is assigned in conjunction with one of the three previous categories when lapses in the monitoring of reasoning and/or discourse are noted during discussions of loss or traumatic abuse in childhood. The second line of adult attachment research emerged from social and personality psychology and focuses on current relationships with romantic partners, which are assumed to be outgrowths of early attachment bonds. Although theoretically related, adult romantic attachment style is conceptually distinct from the construct measured by the AAI. Romantic attachments presumably are rooted in the same innate system and are related to early attachments, but they Attachment, Personality, and Psychopathology 6 differ from parent-child bonds in several important ways, including reciprocity of attachment and caregiving, and sexual mating (Hazan & Zeifman, 1999). In addition, rather than measuring unconscious mental representations regarding past relationships with parents like the AAI, with few exceptions, these researchers measure adult romantic attachment using self-report instruments assumed to assess consciously held attitudes regarding close relationships without specifying a particular partner (Bartholomew, 1997; Jacobvitz, Curran, & Moller, 2002; Simpson & Rholes, 2002). The constructs measured by self-reports are viewed as “convenient surface indicators of differences in attachment-related cognitions, emotions, and behavioral tendencies which are partly unconscious” (Shaver & Mikulincer, 2002, p. 137). Following seminal work by Hazan and Shaver (1987), Bartholomew (1990; Bartholomew & Horowitz, 1991) proposed a model of adult attachment that describes attachment patterns in terms of a self-other polarity. Models of self and other can be dichotomized as either positive or negative and various combinations of these two dimensions represent four prototypes of adult attachment: (a) Secure adults have positive models of self and positive models of others, (b) Dismissive-avoidant adults have a positive model of self, but a negative model of others, (c) Conversely, Preoccupied adults have a negative model of self and a positive model of others, and (d) Fearful-avoidant adults have a negative model of both self and other. A negative model of self appears more closely associated with anxiety about loss and abandonment, and a negative model of other appears more closely associated with avoidant behavior (Blatt & Levy, 2003). The bulk of the literature on adult attachment consists of studies using self-reports because they require less effort, less time, and less expense. However, th