Malcolm West

Attachment Organization and History of Suicidal Behavior in Clinical Adolescents.

One hundred thirty-three adolescents in psychiatric treatment participated in a case-comparison study investigating the association of attachment patterns with a history of suicidal behaviors. The comparison group comprised 64 adolescents who had never experienced suicidal ideation or behaviors; the case group included 69 adolescents with histories of suicidal behavior (n = 53) and severe suicidal ideation (n =16). Attachment patterns were assessed using the Adult Attachment Interview. In accordance with definitions provided in the scoring system, 86% of case and 78% of comparison adolescents in psychiatric treatment had experienced attachment-related trauma. Lapses in the monitoring of reasoning or discourse occurred during the attempted discussion of these events in 73% of adolescents in the case group but in only 44% of adolescents in the clinical comparison group (p = .002), suggesting that cognitive disorganization may be an important variable mediating between traumatic experience and suicidal behavior. Female adolescents and older adolescents were significantly more likely than other adolescents to be in the case group. Preoccupied attachment, in interaction with unresolved-disorganized attachment, was associated with the case group, whereas dismissing attachment was associated with the comparison group.

Prototypicality Ratings of Dsm-iii Criteria for Personality Disorders

Although DSM-III personality disorder criteria have demonstrated acceptable reliability, the question of validity has not been adequately addressed. A first step in establishing the validity of diagnoses is to establish the validity of the criteria used to assess each diagnosis. The content validity of diagnostic criteria was investigated in relation to the larger set of potential criteria culled from the psychiatric literature. For each DSM-III axis II diagnosis, a panel of clinicians rated how prototypical each potential criterion was of the diagnosis in question. The results reveal problems with the organization and content of the criteria for most diagnoses. Many DSM-III criteria are composed of several statements linked by conjunctions or disjunctions. These component statements often received markedly different ratings, suggesting that criteria should be single statements. For most diagnoses, traits not included in DSM-III received higher ratings than did some DSM-III criteria. Suggestions are made to improve the distinctiveness and content validity of paranoid, schizoid, antisocial, borderline, avoidant, dependent, and compulsive personality disorders. The results for schizotypal personality disorder suggest that many clinicians are uncertain about this diagnosis. These findings provide a systematic way to modify definitions that contrasts with the more arbitrary ways in which diagnoses have previously been defined and redefined.

An approach to the delineation of adult attachment. Scale development and reliability

The authors present the results of a project to develop scales to measure the features of adult attachment using a construct-oriented approach. Adult attachment is defined in terms of eight features: proximity seeking, secure base effect, separation protest, feared loss of the attachment figure, reciprocity, availability, responsiveness of the attachment figure, and use of the attachment figure. Each feature was defined and a large item pool to tap all dimensions was derived from item nominations by clinicians, researchers, and lay subjects. The resultant scales were administered to a small sample for preliminary empirical testing. Analyses of internal reliability for each scale resulted in the elimination of items that detracted from reliability. After editing, all scales had satisfactory internal consistency. A discriminant-functions analysis provided suggestive evidence that this method of defining and measuring adult attachment would have relevance for identifying psychopathology.

Adolescent Attachment Questionnaire: A Brief Assessment of Attachment in Adolescence.

The Adolescent Attachment Questionnaire (AAQ), a brief questionnaire to assess attachment characteristics in adolescents, was developed and validated in a large normative sample (n = 691) and a sample of 133 adolescents in psychiatric treatment. The AAQ is a self-report questionnaire consisting of 3 scales of 3 statements each, with Likert-type responses from strongly disagree to strongly agree. The Availability scale assesses the adolescents confidence in the availability and responsiveness of the attachment figure. TheGoal-Corrected Partnershipscale assesses the extent to which the adolescent considers and is empathetic to the needs and feelings of the attachment figure. The Angry Distress scale taps the amount of anger in the adolescent–parent relationship. All scales demonstrate satisfactory internal reliability and agreement between scores for adolescents (n = 91) from the normative sample who completed the AAQ twice. Adolescents in the clinical sample also completed the Adult Attachment Interview (AAI); the AAQ demonstrated high convergent validity with the AAI.

Developmental vs. social personality models of adult attachment and mental ill health

Both the developmental and social personality approaches to the study of adult attachment are concerned with understanding those factors that describe an individuals quality of relational adaptation and risk for mental ill health. This paper examines the theoretical and methodological assumptions of these alternative models and how these assumptions have markedly different implications for addressing clinical issues. It is suggested that recent evidence necessarily leads to the conclusion that mental and relational difficulties, such as partner violence and victimization, borderline personality, dissociation, suicidal behaviour and other clinical symptomology thought to be related to experiences of severe relationship distress, are best explained in terms of attachment disorganization rather than as normative forms of attachment insecurity or fearful avoidant adult romantic attachment.

The cast-6: development of a short-form of the Children of Alcoholics Screening Test.

The 30-item Children of Alcoholics Screening Test (CAST) is shortened to a 6-item scale (CAST-6) using Principal Components Analysis of CAST responses for three distinct samples: outpatient substance abusers, outpatient psychiatric patients, and medical students. The face validity, internal consistency, and discriminatory ability of the CAST-6 are examined. The CAST-6 is judged to compare favorably with the full CAST and to provide a more efficient way to identify adult children of alcoholics.

Assessing attachment: convergent validity of the adult attachment interview and the parental bonding instrument

OBJECTIVE The aim of this study was to determine whether or not the Parental Bonding Instrument (PBI) can provide information about parent-child attachment that is comparable to information obtained from the Adult Attachment Interview (AAI), a more complex measure of attachment. METHOD One hundred and thirty emotionally and/or behaviourally disturbed adolescents (73 male, 57 female; ages 13-19 years, x = 15.3 +/- 1.47 years) participating in a study of attachment and suicidality completed the PBI and the AAI. Data from these measures were compared within participants. RESULTS Maternal care and overprotection on the PBI differed significantly by AAI attachment classification (F3,122 = 2.79, p = 0.012), with autonomous participants showing the most optimal and unresolved participants the least optimal PBI results. Maternal love and maternal involvement/role reversal on the AAI were significant predictors of maternal care and maternal overprotection, respectively, on the PBI (R2 = 0.15; R2 = 0.16). These predictions improved when AAI scales measuring idealisation and involving anger towards the mother were included in the regression analyses (R2 = 0.35; R2 = 0.20). Autonomous participants on AAI showed the highest scale correlations across instruments. CONCLUSIONS Attachment information obtained from the PBI and the AAI is comparable in participants with optimal attachment histories, but not in participants showing idealisation or anger towards their mothers. Caution is, therefore, advisable when using the PBI to obtain attachment information in clinical samples where suboptimal attachment histories are likely.

Abuse and violence in intimate adult relationships: new perspectives from attachment theory

Previous attachment writing about violence between intimate adult partners has implicated the role of insecure attachment. This paper proposes that insecure attachment is not sufficient to explain intimate partner violence. Instead, it is suggested that recent evidence leads to the conclusion that such violent behavior is best explained in terms of attachment disorganization, a more profound form of relational insecurity. We discuss the contributions of this perspective to intervention.

Attachment and dysthymia: the contributions of preoccupied attachment and agency of self to depression in women.

The present research evaluated a conceptual model that links preoccupied attachment to dysthymic disorder in women. From an original community sample of 420 women, 129 women were identified with depressive symptomatology as assessed by the Centre for Epidemiological Studies Depression scale (CES-D). Twenty-four of these 129 women were diagnosed as dysthymic disordered according to the Structured Clinical Interview for DSM-III-R-non-patient edition (SCID-NP). Attachment patterns were assessed using the Adult Attachment Projective (AAP). The results indicate that preoccupied attachment was associated with dysthymia. Discussion concerns the processes that may underlie the association between preoccupied attachment and depression, with attention to the possibly complicating factor of unresolved mourning.

The assessment of dimensions relevant to adult reciprocal attachment

The development and potential clinical uses of the Adult Attachment Dimensions Questionnaire is described. The seven scales of the Adult Attachment Dimensions Questionnaire relate to the aspects of a relationship formed to promote and maintain security. The underlying theory is founded on John Bowlbys work on the attachment behavioural system. The empirical validation was accomplished through three studies involving a clinical group and a non clinical group in a hospital setting and respondents to a community survey. Psychometric validation included measures of internal reliability, test-retest reliability, and construct validity through factor analysis. The resultant 35 item questionnaire should be useful to both clinicians and researchers interested in the characterization of the attachment system for adults.