Lavinia Barone

Developmental protective and risk factors in borderline personality disorder: A study using the Adult Attachment Interview

Mental representations and attachment in a sample of adults with Borderline Personality Disorder were assessed using the George, Kaplan and Main (1985) Adult Attachment Interview (AAI). Eighty subjects participated in the study: 40 nonclinical and 40 with Borderline Personality Disorder (BPD). The results obtained showed a specific distribution of attachment patterns in the clinical sample: free/autonomous subjects (F) represented only 7%, dismissing classifications (Ds) reached about 20%, entangled/preoccupied (E) 23% and unresolved with traumatic experiences (U) 50%. The two samples differed in their attachment patterns distribution by two (secure vs. insecure status), three (F, Ds and E) and four-way (F, Ds, E and U) categories comparisons. In order to identify more specific protective or risk factors of BPD, 25 one-way ANOVAs with clinical status as variable (clinical vs. nonclinical) were conducted on each scale of the coding system of the interview. Results support the hypothesis that some developmental relational experiences seem to constitute pivotal risk factors underlying this disorder. Results demonstrated potential benefits in using AAI scales in addition to the traditional categories. Implications for research and treatment are discussed.

Mental representations of attachment in Eating Disorders: a pilot study using the Adult Attachment Interview

Mental representations of attachment in a sample of adults with Eating Disorders (ED) were assessed using the Adult Attachment Interview (AAI). Sixty subjects participated in the study: 30 non-clinical and 30 clinical. The results obtained showed a specific distribution of attachment patterns in the clinical sample: 10% Free/Autonomous (F), 47% Insecure-Dismissing (Ds), 17% Insecure-Entangled/Preoccupied (E) and about 26% disorganized (CC/U). The two samples differed in their attachment pattern distribution and were significantly different on some coding system scales. Further information was obtained by analyzing differences between the three ED subtypes considered (i.e. Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder) and by investigating the differential role of the two parental figures in the definition of attachment representations. Results showed potential benefits in using the AAI coding system scales in addition to the main classifications in order to understand better the developmental issues involved in these disorders. Implications for developmental research and clinical nosology are discussed.

Attachment disorganization and borderline patients’ metacognitive responses to therapists’ expressed understanding of their states of mind: A pilot study

Abstract This study explores the relationship between psychotherapists’ validation interventions and patients’ metacognitive responses at the beginning of treatment of borderline personality disorder (BPD). A model of BPD based on disorganized attachment provides the hypothesis that, before patients’ internal working model of attachment has been corrected within the therapeutic relationship, therapist interventions that are likely to activate patients’ attachment system are also likely to induce temporary disorganization of patients’ metacognitive functions. Any validation intervention implies that therapists openly display an understanding and accepting attitude when they comment on patients’ reported experiences and is, therefore, likely to activate the patients’ attachment system. Linehans (1993) manual of dialectic–behavioral therapy (DBT) was used as a guideline to assess validation interventions adopted by therapists. The transcripts of the second individual session in the psychotherapy of 19 consecutive patients were analyzed. Checklists based on the DBT manual were used to identify therapists’ validating, supportive, and neutral interventions. The Metacognitive Assessment Scale was used to assess changes in specific aspects of patients’ metacognitive processes during therapeutic dialogues. Following validation interventions, patients’ responses revealed significantly higher rates of temporary metacognitive failure in comparison to the responses solicited by neutral intervention.

Attachment mental states and inferred pathways of development in borderline personality disorder: a study using the Adult Attachment Interview

We report the outcome of an investigation on how specific attachment states of mind and corresponding risk factors related to different DSM Axis I comorbidities in subjects with BPD. Mental representations of attachment in four BPD sub-groups (BPD and Anxiety/Mood Disorders, BPD and Substance Use and Abuse Disorders, BPD and Alcohol Use and Abuse Disorders, and BPD and Eating Disorders) were assessed in 140 BPD subjects using the Adult Attachment Interview (AAI). In addition to the global attachment picture in which Insecure organized (Dismissing 51% and Enmeshed 35%) and Insecure disorganized categories (40%) were overrepresented, significant differences in attachment category were found between the four BPD sub-groups. Axis I comorbidities corresponded with attachment features on the internalizing/externalizing functioning dimension of the disorder. Furthermore, specific constellations of inferred developmental antecedents and attachment states of mind corresponded differentially with the BPD sub-groups. Implications for developmental research and clinical nosology are discussed.

Psychometric Properties of the Manchester Child Attachment Story Task: An Italian Multicentre Study.

The paper describes a multicentre study of the psychometric properties of the Manchester Child Attachment Story Task in a sample of 230 Italian children aged 4 to 8 years. The tasks internal consistency and inter-rater reliability were investigated; in addition, multiple discriminant analysis was used to explore the contribution of individual coding system scale scores to overall categorical attachment classification. The instrument showed acceptable psychometric properties, especially with respect to Disorganization and Coherence scales. However, our results also suggest that some subscales of the coding system could be modified in order to improve reliability. The implications of our results for future research and further test validation are discussed.

Attachment in institutionalized children: a review and meta-analysis.

In this article we review the literature on attachment patterns in institutionalized children and then perform a meta-analysis on data from 10 attachment studies involving 399 children in institutional settings. We computed the overall attachment distribution of secure, insecure, and disorganized rates and explored the effect of a set of moderating variables (i.e., country of institutionalization, attachment assessment procedure, age at entry, and age at assessment). To overcome bias related to the small number of studies, we conducted both classical and Bayesian meta-analysis and obtained comparable results. Distribution of childrens attachment patterns was: 18% secure, 28% insecure, and 54% disorganized/cannot classify. Compared to their family-reared peers, children living in an institution were found to be at greater risk for insecure and disorganized attachment, with a similar medium effect size for both distributions (d=0.77 and d=0.76, respectively). The following moderating variables were associated with insecure attachment: representational assessment procedures (d=0.63) and Eastern European countries of origin (d=1.13). Moderators for disorganized attachment were: Eastern European countries of origin (d=1.12), age at institution entry before the first birthday (d=0.93), and age at assessment under three years of age (d=0.91). Implications for child development and policies are discussed.

Attachment and social competence: a study using MCAST in low-risk Italian preschoolers.

The Manchester Child Attachment Story Task (MCAST) is a story stem method suitable for children aged about 4 to 8, aimed at assessing childrens attachment representations with a doll-play format that is evaluated with a series of dimensional scales and classifications. Although this instrument has already been validated in previous studies, not all of the findings have been conclusive. The aims of the present study were (1) to examine the factor structure of the MCAST scales, and (2) to test the association between childrens dichotomized MCAST classifications and factors with social competence, using the Social Competence and Behavior Evaluation Scale (SCBE) with a normative group of Italian preschoolers (age range 4.4 to 6.1). Results obtained from a sample of 64 children confirm the association of MCAST attachment classifications (security vs. insecurity and organization vs. disorganization) with both social skills and behavioral problems. Further independent studies on the variables analyzed are recommended for corroborating the findings obtained.

Emotional availability: theory, research, and intervention.

Attachment theory (Bowlby, 1969) and its limitations are first described. Next, emotional availability (EA; Biringen et al., 1998; Biringen, 2008) is introduced as an expansion upon the original conceptualization of the parent–child attachment relationship. As a construct and as a measure, EA considers the dyadic and emotional qualities of adult–child relationships. EA is predictive of a variety of child outcomes, such as attachment security, emotion regulation, and school readiness. Recently developed programs to enhance adult–child EA are described.

Parenting Stress: The Roles of Attachment States of Mind and Parenting Alliance in the Context of Adoption

SYNOPSIS Objective. To examine whether parent’s attachment states of mind and parenting alliance contribute to parental stress in the potentially demanding context of adoption. Design. Fifty mother–father pairs (n = 100) completed the Adult Attachment Interview within six months of adoption to investigate attachment states of mind. The Parenting Stress Index-Short Form (PSI/SF) and the Parenting Alliance Measure questionnaires were administered two years after adoption to evaluate stress and the parenting alliance. Results. Multivariate regression models showed that unresolved attachment predicted stress to a greater extent than insecure attachment and, together with low parenting alliance, significantly contributed to explaining levels of stress perceived by parents. In mothers, but not in fathers, parenting alliance moderated the effect of an unresolved state of mind on parenting stress. Conclusion. Unresolved attachment states of mind and the parenting alliance singly, and even more so jointly, influence stress experienced by parents. Understanding of the family’s adjustment to adoption may benefit from an in-depth analysis of the role of individual and dyadic variables involved in childrearing.

Adult attachment interviews of women from low-risk, poverty, and maltreatment risk samples: comparisons between the hostile/helpless and traditional AAI coding systems

The main aim of this study was to investigate the correlates of a Hostile-Helpless (HH) state of mind among 67 women belonging to a community sample and two different at-risk samples matched on socio-economic indicators, including 20 women from low-SES population (poverty sample) and 15 women at risk for maltreatment being monitored by the social services for the protection of juveniles (maltreatment risk sample). The Adult Attachment Interview (AAI) protocols were reliably coded blind to the samples’ group status. The rates of HH classification increased in relation to the risk status of the three samples, ranging from 9% for the low-risk sample to 60% for the maltreatment risk sample to 75% for mothers in the maltreatment risk sample who actually maltreated their infants. In terms of the traditional AAI classification system, 88% of the interviews from the maltreating mothers were classified Unresolved/Cannot Classify (38%) or Preoccupied (50%). Partial overlapping between the 2 AAI coding systems was found, and discussion concerns the relevant contributions of each AAI coding system to understanding of the intergenerational transmission of maltreatment.