Page 10 - Personality disorders and insecure attachment among adolescents

In need of developing effective treatments of personality disorders among adolescents, this thesis aims to examine the dropout and outcome of intensive psychotherapy and to identify factors that promote recovery during intensive psychotherapy for this group.
Insecure attachment in adolescence
Insecure attachment is a risk factor for developing a personality disorder (Levy, Johnson, Clouthier, Scala, & Temes, 2015; Venta, Shmueli-Goetz, & Sharp, 2013). Attachment is defined as mental representations that children form of relationships with their caregivers based on interactions with and adaptations to this care-giving environment (Bowlby, 1973). Prevalence rate of insecure attachment in clinical adult populations is found to be 73% (Bakermans-Kranenburg & van IJzendoorn, 2009). Research on the prevalence of insecure attachment among adolescents with mental health problems is scarce (M. van Hoof, N. D. J. van Lang, S. Speekenbrink, M. H. van IJzendoorn, & R. R. J. M. Vermeiren, 2015). Current attachment research suggests a diathesis-stress model in which current and past stressors, parent-child attachment, temperament and genes, all contribute to the emergence and understanding of psychopathology (M. Steele, Bate, Nikitiades, & Buhl-Nielsen, 2015). In clinical practice, a direct relationship is assumed between insecure attachment and personality disorders. However, up till now no systematic association has been found (Allen, 2008; Bakermans-Kranenburg & van IJzendoorn, 2009; Dozier, Stovall-McClough, & Albus, 2008; Levy et al., 2015; Sroufe, Egeland, Carlson, & Collins, 2005; Westen, Nakash, Thomas, & Bradley, 2006). This assumed relationship is likely since attachment theory provides a clinically useful and theoretically coherent model for understanding many of the intrapsychic and interpersonal aspects that are core to personality disorders (Cassidy, 2008; Levy et al., 2015). For early detection and treatment of personality disorders in adolescence, it is thus of clinical interest to know if insecure attachment and adolescent personality disorders are related and if insecure attachment differs between the different personality disorders (Allen, 2008; Bakermans-Kranenburg & van IJzendoorn, 2009; Levy et al., 2015; Venta et al., 2013). Therefore, it is crucial to investigate insecure attachment and personality disorders in adolescence.
This thesis therefore aims to examine if insecure attachment is associated with adolescent personality disorders and if insecure attachment representations differ by type of personality disorder. Furthermore, this thesis aims to examine outcome of intensive psychotherapy on adolescent insecure attachment.
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