Page 91 - Personality disorders and insecure attachment among adolescents

AAI Despite the fact that we did not experience any problems conducting AAI in clinical practice, its distinctiveness and developmental fit for adolescents and a high-risk clinical sample in general may be questioned. Furthermore, Warmuth and Cummings (Warmuth & Cummings, 2015) encourage researchers to use the AAI as a measure of adult – and not adolescent attachment representations – and especially of parents caregiving capacity and ability to nurture secure infants. Introducing an AAI scoring and classification system especially designed for adolescents should be considered. Notwithstanding, this study showed that investigating both the underlying continuous AAI scales and the CC category of the AAI and personality disorders may be beneficial. With the use of the continuous AAI scales, the possible relationship between paternal attachment and BPS in adolescents was found. The AAI scales and five-way AAI classifications (F, E, D, U, CC) better covered the complexity of personality disorders and insecure attachment than the three-way (F, E, D) or four-way AAI classifications (F, E, D, U/CC combined). The use of a quasi-dimensional attachment scale could be useful for the purpose of treatment evaluation, although this type of assessment of the severity of AAI attachment classifications requires further investigation. The main questions concerning this assessment are, first, whether different categories actually represent the severity of attachment insecurity and fit a quasi-dimensional scale, second, whether the dismissive category should be regarded as a less insecure attachment category compared to the preoccupied category (Strauss, Mestel, & Kirchmann, 2011), and, third, how the unresolved/disorganised category, which is superimposed on the three main attachment classifications, fits within the order. Notwithstanding, this AAI study showed that attachment insecurity is prone to change, particularly in patients with personality disorders. Strengths and limitations Three limitations of this study should be mentioned. First, the differences in Axis I disorders were not accounted for since it is difficult to motivate adolescents to participate in extensive research protocols. Furthermore, given the diversity in our small sample, we were unable to examine Axis I disorders, especially in combination with the AAI. Second, our results are limited in their generalisability due to the sample size, as well as the lack of a control group. In the nonrandomised evaluation of an inpatient program, external validity was used to obtain generalisable knowledge of the patient group and treatment evaluation. Further, there are ethical and practical objections to randomisation in a high-risk adolescent group, such as the one here, whose results had been insufficient in outpatient or usual treatment. Third, the AAI coder was aware of the nature of the 87