Page 76 - Personality disorders and insecure attachment among adolescents

2009; Levy et al., 2015; Venta et al., 2013). The distinction between borderline personality disorder (BPD) and other personality disorders is potentially of particular interest, because the origins of BPD in particular have been related to factors such as early childhood environment, caregiving relationships, and traumatic life events (Fonagy et al., 1996; M. Steele et al., 2015). Therefore, part of the aim of this study was to compare pre-treatment insecure attachment representations between BPD and other personality disorders in a sample of adolescent inpatients with clinically diagnosed personality disorders and deviations in attachment distribution from the normative pattern. Clinical theories and developmental models suggest that insecure attachment is central to the pathogenesis of the borderline psychopathology (Sharp et al., 2016). Existing research on BPD patients confirms such claims, as greater incidence of childhood maltreatment is reported in the said group compared to patients with other disorders (Cirasola, Hillman, Fonagy, & Chiesa, 2017; Courtney-Seidler et al., 2013). Evidence also suggests a predominance of preoccupied attachment representations in both adult and adolescent BPD patients, often in addition to unresolved patterns of attachment (Agrawal, Gunderson, Holmes, & Lyons-Ruth, 2004; Barone, Fossati, & Guiducci, 2011; Rosenstein & Horowitz, 1996; M. Steele et al., 2015). This group tends to report less love, more rejection, and more role reversal in their childhood relationships with caregivers (Barone, 2003). Recently, an association between adolescent attachment insecurity and BPD was found through its relation with emotion regulation and mentalizing abilities (Kim, Sharp, & Carbone, 2014; Sharp et al., 2016). Mentalizing refers to the ability to understand and differentiate the mental states of oneself and others, and to acknowledge the relation between underlying mental states and behaviour (Bateman & Fonagy, 2008, 2012). The few studies on associations between personality disorders other than BPD and insecure attachment have described connections between preoccupied attachment and histrionic, dependent, and avoidant personality disorder, and between dismissing attachment and paranoid, narcissistic, anti-social, and schizoid personality disorder (Levy et al., 2015). Hence, insecure attachment is likely to differ among different personality disorders in adolescence. A meta-analysis of the Adult Attachment Interview (AAI) (George, Kaplan, & Main, 1985; Main, Hesse, & Goldwyn, 2008) yielded two main recommendations (Bakermans-Kranenburg & van IJzendoorn, 2009) for the purpose of studying attachment representations among clinical groups. The first recommendation is to use the underlying continuous AAI scales for both childhood experiences with the parents (i.e., loving, rejecting) and the current state of mind with respect to these experiences (i.e., devaluing, coherence of mind) (Bakermans-Kranenburg & van IJzendoorn, 2009). The second is to introduce the ‘cannot classify’ category (CC) for scoring the respondents who cannot be placed in one of the organised categories of the AAI (secure, dismissing, and preoccupied) (Hesse, 2008). Thus far, the above recommendations have rarely been followed (Kouvo, Voeten, & Silvén, 2015; Scharf, 72