Borderline and antisocial personality scores as mediators between attachment and intimate partner violence

Court-mandated male batterers (n = 192) attending an intervention program completed measures examining adult attachment orientations (anxious and avoidant), personality disorders (borderline and antisocial), type of violence (psychological and physical), and social desirability. Structural equation modeling was used to determine whether there were significant relationships between anxious attachment and physical and psychological violence that are mediated by either borderline or antisocial personality disorders. Social desirability was included in both models as a covariate. Results indicated that personality disorders fully mediated the relationship between avoidant attachment and physical as well as psychological violence. Personality disorders only partially mediated the relationship between anxious attachment and psychological violence. Implications for intervention are discussed.     

Boundary Ambiguity and Borderline Personality Traits: Implications for Treatment for Adolescent Girls in Foster Care

This article explores the relationship between boundary ambiguity and borderline personality traits in adolescent girls in foster care. Boundary ambiguity is a family systems concept: family members are uncertain about who is in or out of the family—in either psychological or physical presence or absence. In foster care, it can be assumed that an adolescent girl has experienced trauma significant enough to be removed from her family. The connection between early childhood trauma and attachment disruption in addition to the connection between insecure/disorganized attachment and borderline personality disorder leads to the conclusion that these same adolescents are at high risk for developing borderline personality traits. The sample consists of 40 caseworkers from New England’s child protection departments and therapists from residential programs working with adolescent girls. They completed the Shedler-Westen Assessment Procedure for Adolescents to determine the presence of personality disruption as well as a variation of Pauline Boss’s Boundary Ambiguity Scale #1, and demographic questionnaires. The results find a significant correlation between boundary ambiguity and borderline personality traits. These findings provide directions for future research in clinical treatment and child welfare policy making.     

Self-Medication, Traumatic Reenactment, and Somatic Expression in Bulimic and Self-Mutilating Behavior

A psychoanalytic framework provided direction for research on the association between binge-purging (bulimic) and self-mutilating behaviors, comparing them for similarities and differences. The similarities in the multiple functions and psychosomatic processes served by these behaviors are presented, as well as the phenomenon of symptom substitution. Both behaviors tend to be practiced by those with severe personality and dissociative disorders and post-traumatic stress disorder. Both serve ego-compensatory needs in the absence of the adequate ability to regulate and modulate emotions, moods, and tensions. They may serve as compensatory attempts to differentiate self and object, define and differentiate body boundaries, master severe childhood trauma by means of psychophysiological addictive reenactments, and to express emotion.     

Personality disorders, coping strategies, and posttraumatic stress disorder in women with histories of childhood sexual abuse

Using a treatment-seeking sample of adult female survivors of childhood sexual abuse, the relationships between coping strategies, personality disorders (PD) and Posttraumatic Stress Disorder (PTSD) were explored. A variety of PDs were found to exist in this population, with avoidant, antisocial, dependent PDs having higher frequencies than borderline PD. Avoidant coping and PTSD severity significantly correlated with many of these PDs. PTSD severity and avoidant coping were also significantly correlated. Additionally, women with PTSD displayed higher rates of avoidant and dependent PDs, as well as more avoidant coping, than did women without PTSD. Results support a more complex conceptualization of the trauma-related symptoms that occur in adult survivors of childhood sexual abuse that incorporate the relationships between avoidant coping, personality disorders, and PTSD.     

Understanding Anorexia Nervosa and Bulimia Nervosa from an Attachment Perspective

Using the Attachment History Questionnaire (AHQ), 30 female anorectic and bulimic inpatients were compared to a control group of 31 primarily female social work students to determine the connection between anorexia and bulimia and early childhood attachment relationships. As predicted, the results indicated that the anorectics and bulimics differed significantly from the controls on all four subfactors of the AHQ: secure attachment base (Factor 1), parental discipline (Factor 2), threats of separation (Factor 3), and peer affectional support (Factor 4). Post hoc comparisons between the eating-disordered group and the controls on the fifty-one individual items of the AHQ showed that within Factor 1, the items involving feelings of being unwanted, alone, helpless, and of shame and guilt, clearly and significantly discriminated between groups. Within Factor 3, the item addressing the child feeling responsible for parental happiness produced significance. The results of this study are interpreted in relation to John Bowlby's attachment theory and the clinical implications are discussed.     

ATTACHMENT THEORY AND RESEARCH APPLIED TO THE CONCEPTUALIZATION AND TREATMENT OF PATHOLOGICAL NARCISSISM

This article focuses on the relevance of attachment theory and research in the conceptualization and treatment of pathological narcissism. It is proposed that the relational context of individual development and the interpersonal interpretative capacities that emerge as part of the attachment system may be salient factors in the etiology and treatment of narcissism. Included is an overview of research on attachment models and their correlation to adult psychopathology and to narcissistic personality disorders. It is suggested that internalization and maintenance of a “secure base” and improvement in self-reflective functioning informs and enriches the clinical treatment of adults with narcissistic features.     

Family environment and adult attachment as predictors of psychopathology and personality dysfunction among inpatient abuse survivors

The current study explored the role of early family environment and adult attachment style in explaining long-term outcomes among child abuse survivors. Adult patients (N = 80) in a trauma treatment program were assessed for clinical diagnosis and administered a multiscale questionnaire. Hierarchical regression analyses were significant for dissociative identity disorder (DID), substance abuse, anxiety disorder, posttraumatic stress, somatization, and six personality disorder dimensions. Adult attachment styles were significant predictors of most outcome variables. Of particular note was the strong contribution of attachment avoidance to DID. Five family environment scales (Independence, Organization, Control, Conflict, Expressiveness) also contributed to various psychopathological outcomes. Evidence emerged supporting a mediating role for attachment style in the link between family independence and five personality disorder dimensions.     

The Effects of Polyvictimization and Quality of Caregiver Attachment on Disclosure of Illegal Sexual Behavior

ABSTRACT

The current study examined the relationship among self-disclosure of illegal sexual behaviors and two conceptually relevant constructs in psychotherapy: childhood polyvictimization (i.e., cumulative types of victimization experienced during childhood) and caregiver attachment. Participants consisted of 63 adolescent males participating in mandated treatment for illegal sexual behavior. Childhood polyvictimization and caregiver attachment were expected to predict self-disclosure of illegal sexual behaviors. Quality of caregiver attachment was also expected to mediate the relationship between polyvictimization and disclosure. Consistent with our main hypothesis, results indicate that quality of caregiver attachment mediated the relationship between childhood polyvictimization and self-disclosure of illegal sexual behaviors in psychotherapy. The current findings highlight the impact of polyvictimization on important therapeutic processes as well as the importance of assessing for multiple types of victimization in adolescents who engage in illegal sexual behavior. Further clinical implications regarding the use of trauma-informed approaches during sex offender treatment are discussed.     

Dangerous and severe parenting disorder? Personality disorder,parenting and new legal proposals

The Government has proposed new legal measures for the management of people with personality disorders who are dangerous to others. In this paper, it is argued that there is no reason why these proposed measures should not apply to those individuals with personality disorders who are parents and present a severe risk of harm to their own children. New measures that provided a legal and clinical framework for the provision of assessment and possible therapy for personality disordered parents who pose a risk to their children would ful?l a real need which is not being met. Copyright © 2003 John Wiley & Sons, Ltd.     

THE EFFICACY OF MARITAL AND FAMILY THERAPY: AN EMPIRICAL OVERVIEW, CONCLUSIONS, AND RECOMMENDATIONS

Based primarily on the contributions to this Special Issue of JMFT, this article provides an overview of the empirical research on the efficacy of marital and family therapy for the following disorders and problems: schizophrenia; affective (mood) disorders; slected externalizing, internalizing, and pervasive developmental disorders of childhood; adolescent conduct disorder; marital distress and the prevention of divorce; alcoholism; adult and adolescent drug abuse; and various chronic adult, adolescent, and childhood physical disorders. Convincing scientific evidence supports the efficacy of broadly defined marital and family therapy for the treatment of many disorders, as well as its superiority to standard and individual treatments for certain disorders and populations. We conclude with recommendations for future research as well as for collaborative initiatives between marital/family therapists and other professionals working in the marriage and family field.     

Examining the Relationship between Childhood Sexual Abuse and Borderline Personality Disorder: Does Social Support Matter?

The relationship between childhood sexual abuse and borderline personality disorder is a prominent issue in the etiological research on borderline personality disorder. This study further explored the relationship between childhood sexual abuse and the development of borderline personality features while evaluating the moderating role of a primary social support source in a sample of 290 female undergraduate students enrolled at a major southeastern university. Consistent with previous research, retrospective self-reports of childhood sexual abuse and low social support were both positively correlated with current borderline personality features. It was hypothesized that the presence of a supportive relationship at the time the childhood sexual abuse occurred would moderate the relationship between childhood sexual abuse and borderline personality features. This moderation hypothesis was not supported in the current study, but post-hoc analyses reveal the need to further examine how we define social support following childhood sexual abuse. This research is a stepping stone toward the prevention of borderline personality disorder following childhood sexual abuse.     

Examining the relationship between childhood sexual abuse and borderline personality disorder: does social support matter?

The relationship between childhood sexual abuse and borderline personality disorder is a prominent issue in the etiological research on borderline personality disorder. This study further explored the relationship between childhood sexual abuse and the development of borderline personality features while evaluating the moderating role of a primary social support source in a sample of 290 female undergraduate students enrolled at a major southeastern university. Consistent with previous research, retrospective self-reports of childhood sexual abuse and low social support were both positively correlated with current borderline personality features. It was hypothesized that the presence of a supportive relationship at the time the childhood sexual abuse occurred would moderate the relationship between childhood sexual abuse and borderline personality features. This moderation hypothesis was not supported in the current study, but post-hoc analyses reveal the need to further examine how we define social support following childhood sexual abuse. This research is a stepping stone toward the prevention of borderline personality disorder following childhood sexual abuse.     

Opioid Use Disorder,Attachment, and Parenting: Key Concerns for Practitioners

In the United States, the current epidemic of opioid use disorders impacts many parents and their children. Historically, interventions for parents with substance use disorders have focused on two separate areas, achieving and maintaining abstinence and learning parenting skills. These interventions do not address the parent/child relationship, and the impact of parental opioid use disorder on attachment. Insecure attachment, particularly disorganized attachment, negatively affects the child’s development and safety. Attachment should always be considered when doing a safety assessment or planning an intervention for parents with opioid use disorders. This conceptual paper describes the impact of parental opioid use on attachment across the developmental span of childhood, highlighting research about opioid use disorder, parenting, and attachment which is relevant for practitioners working with parents with opioid use disorders, as child protection workers, substance abuse counselors, or therapists. Identification, attachment assessment tools, and empirical research on attachment-based interventions are discussed.     

Understanding Attachment Transitions Through the Lived Experiences of Young Black Gay and Bisexual Men

We conducted a mixed-methods study to identify factors that influence transitions in attachment style between childhood and adulthood among 28 young Black gay and bisexual men (YBGBM) in the United States. We used a phenomenological approach to data integration, with the major component to the results being garnered from the qualitative interviews. We organized our results by four attachment transition groups: stable secure (secure attachment in childhood and young adulthood), stable insecure (insecure attachment in childhood and young adulthood), secure to insecure (secure in childhood and insecure in adulthood) and insecure to secure (insecure in childhood and secure in adulthood). Within each of the typologies, two major themes emerged: social support and religion. Generally, transitions from secure to insecure attachment were related to experiences of perceived rejection by a parental figure during adolescence that corresponded with sexual orientation disclosure. Transitions from insecure to secure attachment appeared to be related to the absence of an attachment figure early in life, but with the acquisition of an attachment figure during early to late adolescence. The findings from our study suggest a need for attachment-based approaches to social support interventions, as well as for an increased understanding of social and cultural factors that impact attachment changes among practitioners who use attachment-based therapy models for YBGBM.     

Co-Occurring Substance Use and Personality Disorders: Current Thinking on Etiology,Diagnosis, and Treatment

ABSTRACT

Despite the high prevalence of personality disorders among substance abusing individuals, the literature on these co-occurring disorders is limited. This paper reviews the literature and provides the most current data on the demographics, the criteria for diagnosing both personality disorders and substance use disorders, and the effects of substance abuse and co-occurring personality disorders, particularly antisocial and borderline, on prognoses and treatment approaches. Recommendations for further research on these co-occurring disorders are provided.     

Childhood abuse and psychiatric impairment in a sample of welfare to work women

Since 1996, individuals who participate in welfare programs are mandated to find employment. Welfare recipients may have difficulty transitioning to the work force due to impairments in psychosocial functioning. Examples include mental health and substance use disorders, medical problems, academic and learning difficulties, and lack of resources such as childcare and transportation. In addition, many welfare recipients have histories of abuse and violence, which further complicate their job finding efforts given the documented relationship between past maltreatment and psychiatric impairment. An area unexplored is the relationship between a history of childhood abuse and psychiatric impairment in Welfare to Work (WtW) recipients. We evaluated the relationships among demographics, personality pathology, substance abuse, cognitive functioning, and histories of childhood abuse in a group of 158 WtW recipients in order to assess predictors of psychiatric impairment. Results suggest that participants with higher levels of psychiatric impairment also had higher levels of interpersonal problems related to personality pathology, higher drug and alcohol use impairment, and endorsed more severe histories of childhood abuse. Personality pathology, alcohol use severity, and self-reported childhood abuse emerged as the best predictor of psychiatric impairment in this WtW sample. These results have implications for identifying individuals at risk for unsuccessful transition into the work force and for the development of effective rehabilitation strategies that considers the unique needs of women in WtW programs.     

Subclinical Psychopathic Traits and Romantic Attachment in Treatment-Seeking Couples

Subclinical psychopathic personality traits have been associated with multiple indicators of couple distress and romantic attachment insecurities but essentially in community samples. This study examined dyadic associations between primary and secondary psychopathy and attachment anxiety and avoidance, assessed with self-reported measures, in 183 French-Canadian cohabiting partners seeking couple therapy. Two Actor-Partner Interdependence Models were tested: Model 1 considered psychopathic traits as independent variables and Model 2 treated attachment insecurities as independent variables. Analyses revealed that in both partners, secondary psychopathy was associated with attachment anxiety and avoidance (Models 1 and 2), while primary psychopathy was not only associated with attachment anxiety (Model 2; actor associations). Partner effects between primary and secondary psychopathy in men and women's attachment anxiety were also found in both models. These findings complement those reported in community samples and have clinical implications for treatment-seeking couples.     

Female domestic violence offenders: their attachment security, trauma symptoms, and personality organization

Unlike male domestic violence offenders, female domestic violence offenders have traditionally been overlooked in research and theory, despite the fact that females also have high rates of domestic violence perpetration. Towards the aim of extending extant research on male and female pepetrators of domestic violence, we examined attachment style, trauma symptoms, and personality organization in 33 female offenders receiving mandated treatment for domestic violence. These offenders were compared to 32 nonoffending women receiving psychological treatment. The Experiences in Close Relationships Revised (ECR-Revised) was used to examine adult attachment, the Trauma Symptom Inventory (TSI) was used to examine trauma symptomology, and finally, the Millon Clinical Multiaxial Inventory III (MCMI-III) was used to examine cluster B personality traits. Analyses indicated that female domestic violence offenders reported less attachment security, more trauma-related symptoms, and more personality psychopathology (Antisocial, Borderline, and Dependent Subscales) than did nonoffender clinical comparison women.     

Adverse Childhood Experiences and Gambling: Results From a National Survey

Pathological gambling disorder and problem gambling are addictive disorders with severe consequences for individuals, families, and society. Knowledge about associations between childhood adverse experiences (i.e., physical, sexual, and emotional abuse) and gambling pathology in adulthood is limited. Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), associations between adverse childhood experiences and lifetime gambling status were tested. Strong bivariate associations between adverse childhood experiences and gambling status were found, which were attenuated with the inclusion of clinical covariates. Adverse childhood experiences might be related to pathological gambling in adulthood, but this relationship might not be gambling-specific.