Academic journal article Canadian Psychology

An Attachment Theoretical Framework for Personality Disorders

Academic journal article Canadian Psychology

An Attachment Theoretical Framework for Personality Disorders

Article excerpt

In this article, we propose that John Bowlby and Mary Ainsworth's attachment theory provides a cogent, empirically based, clinically useful, and theoretically coherent model for understanding many of the intrapsychic and interpersonal aspects that are central to personality disorders (PDs). This theoretical framework brings both parsimony and breadth to the conceptualisation of the etiology, maintenance, and treatment of PDs. Further, attachment theory is consistent with research findings from a host of studies across multiple domains of knowledge, including evolutionary biology, ethology/comparative psychology, developmental psychology, experimental social-personality psychology, and neuroscience (Fonagy, Luyten, & Strathearn, 2011; Levy, Beeney, & Temes, 2011).

Difficulties with attachment are often at the heart of most PDs (Levy, 2005). Antisocial (AS), narcissistic (N), avoidant (AV), and schizoid (SZ) PDs, for example, are characterised by impoverished interpersonal relationships. On the other hand, those with borderline personality disorder (BPD) and dependent personality disorder (DPD) tend to struggle with intense feelings of aloneness and fears of abandonment (Gunderson & Lyons-Ruth, 2008). Individuals with BPD tend to have intense and stormy relationships (Levy, 2005), whereas those with dependent pathology appear incapable of functioning without the aid of others (Bornstein, 1993). Such interpersonal challenges have been hypothesised to stem from underlying maladaptive attachment schemas (e.g., Fonagy et al., 1995; Gunderson, 1996; Levy & Blatt, 1999). Our goal is to outline and elaborate on attachment theory as a foundation for the etiology and pathology of PDs and to highlight the implications of this theory for treatment. We begin with a review of attachment theory and its empirical basis, reviewing findings from neurobiological and developmental literatures linking attachment and PDs. We then examine the role of attachment in psychotherapy process and outcome. Finally, we summarise the implications of attachment theory for understanding PDs and present directions for future research.

Attachment Theory

Early interactions between child and caregiver are at the core of attachment theory. The affective bond that develops between caregiver and infant is the developmental nucleus of identity formation, intrapersonal regulation, and interpersonal attitudes (Bowlby, 1973, 1977). The attachment bond, according to Bowlby, is a complex, behavioural system that has functioned throughout human evolution to protect the infant from danger by seeking security from a caregiver guardian, thus enhancing the infant's likelihood of survival and eventual reproduction. At the same time, this bond promotes comfort during stressful periods, reducing negative affect and allowing the infant to develop a healthy, realistic, and coherent sense of self (Fonagy, 1999).

Although this adaptive form of attachment is perhaps ideal, Bowlby suggested that other modes of attachment exist. He hypothesised that security of attachment derives from a caregiver's reliable and sensitive provision of love and comfort, as well as food and warmth. Infants with a caregiver who meets their biological and psychological needs turn to their caregiver when experiencing distress, fear, or other needs (safe haven), while otherwise exploring their surroundings with a sense that the caregiver is looking out for them (secure base). However, if the infant's needs are not met by a caregiver, then adaptive attachment is disrupted. These infants are unable to garner support from their caregiver when distressed or are limited in their ability to explore during stress-free times. Thus, differences in styles of behaviour surrounding the caregiver as safe haven and secure base reveal underlying disparities in the formation of the infant- caregiver bond.

Ainsworth, Blehar, Waters, and Wall (1978) adapted Bowlby's conceptualisation of attachment differences in a seminal study using what they termed the "Strange Situation," a procedure consisting of several separation and reunion episodes between an infant and his or her caregiver. …

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