Page 77 - Personality disorders and insecure attachment among adolescents
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Introduction
Attachment insecurity is likely to influence the onset and treatment of personality disorders in adolescence (M. Steele et al., 2015). Adolescence is a stage of life that is eminently characterised by change and instability (Kaltiala-Heino & Eronen, 2015). One can, therefore, question what psychotherapy contributes to this natural process of separation-individuation. In personality disorders, transference-focused psychotherapy, instead of dialectical behaviour therapy or psychodynamic supportive psychotherapy, is shown to change adult attachment representations (Levy et al., 2006). So far, however, it has not been demonstrated, by using the gold standard of attachment assessment, the Adult Attachment Interview (AAI) (Main, Goldwyn, & Hesse, 1998), that mentalization-based treatment (MBT) (Bateman & Fonagy, 2006, 2012) is able to achieve such a impact. Hence, it is of clinical relevance to examine adolescent attachment insecurity and the influence of MBT on this problem among severely disordered adolescents. Therefore, the aim of this study was to assess attachment using the AAI in adolescents with a personality disorder before and after undergoing an intensive MBT program (Bateman & Fonagy, 2006, 2012; Hauber, 2010), to relate possible changes in attachment to changes in psychological distress, and to examine if MBT alters attachment representations.
Considering the evolving state of personality disorder classifications and the difficulty to diagnose personality disorders in adolescence (Laurenssen, Hutsebaut, Feenstra, Van Busschbach, & Luyten, 2013), the analysis of the differences between a sample of highly disturbed adolescents and a non-clinical sample could help advance the understanding of personality disorders in adolescence. It is now well established that adolescent attachment distribution in non-clinical groups is more likely to show dismissing attachments and lower preoccupation in comparison to normative adult attachment distributions (Bakermans-Kranenburg & van IJzendoorn, 2009). Also, the percentage of unresolved attachment representations in adolescents is found to be lower than in adults (18% compared to 11%). Whether this applies to the attachment distribution of clinical adolescents with personality disorders is unknown. This insight is potentially valuable for early detection and development of effective treatment for this group.
While studies on the outcome of psychotherapy on adult attachment are scarce, to our knowledge, no such studies have been conducted among adolescents. This is unfortunate, as adolescence is the period when personality disorders (Feenstra et al., 2011; Rossouw & Fonagy, 2012; Tyrer et al., 2015) and several major mental health disorders develop (Kessler, Chiu, Demler, & Walters, 2005). Since insecure attachment is known to contribute to the emergence of mental health disorders (M. Steele et al., 2015), specific information is needed on how to alleviate insecure attachment in adolescents. For this purpose, it is crucial to determine whether insecure attachment differs among different personality disorders (Allen, 2008; Bakermans-Kranenburg & van IJzendoorn,
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