Page 91 - Personality disorders and insecure attachment among adolescents
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applicable to our results, although not concerning the high number of CC adolescents. The overrepresentation of the preoccupied in our sample may be indicative of severe problems experienced during the separation-individuation phase.
As no relation is found between the type of personality disorder and the (forced) attachment classification, the high number of CC adolescents in our study is difficult to explain. A tentative hypothesis is that there is an association between high-risk adolescents and CC category in general. Most inpatient adolescents with personality pathology are high risk, and characterised by a combination of severe As-I and As-II psychopathology and suicidal thoughts and behaviours. Interestingly, the few clinical adolescent AAI studies that introduced the CC category also identified high ratios of CC adolescents in comparison to non-clinical adolescents (Allen et al., 1996; M. J. van Hoof, N. D. van Lang, S. Speekenbrink, M. H. van IJzendoorn, & R. R. Vermeiren, 2015). However, the sample in this study is too small to draw firm conclusions. Thus far, the CC category is grouped together with U-trauma and U-loss responses (Bakermans-Kranenburg & van IJzendoorn, 2009). The CC category needs further study to validate its role in the development of (adolescent) personality disorders, and especially in high-risk adolescent samples.
With regard to implications for prevention programs and clinical practice, our findings suggest with great caution that the relationship with the father during the transition from childhood to adolescence requires further attention. Adolescents who described their fathers in a devaluing way were more likely (OR 1.7) to be diagnosed with BPD. Furthermore, adolescents who spoke in an idealising or devaluing way about their father were significantly associated with the odds of having a non-residential father. Future research is needed to examine whether BPD is likely to develop in adolescence in the absence of paternal positive attachment behaviour in combination with the devaluation state of mind towards the father. Secure paternal attachment seemed to protect an adolescent against BPD by helping develop ego-resiliency, which is important in adjusting to the challenges of adolescence (Kim et al., 2014). Furthermore, one may wonder whether there is a ‘sensitive period’ in the relationship with the father during transition from childhood to adolescence that is comparable to the sensitive period in early childhood in the relationship with the mother (Kouvo et al., 2015; Portu-Zapirain, 2013).
Prospective part of this study
During intensive MBT, significant changes were observed in categorical and dimensional adolescent attachment representations as well as in symptoms of distress. As assumed, at post- treatment, the number of securely attached adolescents increased by 24.2%. Additionally, the sample
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