Pearson, J; (2007) Evaluating an alternative coding manual for the AAI for use with people with Personality Disorders. Doctoral thesis , UCL (University College London).

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Abstract

Several theorists have proposed that attachment theory provides a good grounding for the understanding of the development of Personality Disorders (PD). As a result many studies have now used adult attachment measures with this clinical group. The relevance of attachment theory to the development of psychopathology and more specifically of personality pathology has been outlined and the main findings from the research to-date reviewed. The most consistent finding in the literature is the association between Personality Disorder diagnosis and insecure attachment types. Most research has focused on Borderline PD (BPD). Early studies show an association between preoccupied and fearfully preoccupied attachment types and BPD. High rates of lack of resolution with respect to trauma are also seen in Adult Attachment Interviews (AAI). However, the results of more recent research are less conclusive and suggest that sub-types within the BPD diagnosis may be associated with different attachment styles. There is less research on other Personality Disorders, and much of this looks across categories rather than at specific Personality Disorders. However, there is some evidence to suggest that Personality Disorders might be divisible along dimensions of attachment avoidance and attachment anxiety. The range of different attachment measures used in studies makes comparison across studies difficult and the classification of AAI interviews as 'cannot classify' is over- represented in this population. Difficulties in administration of interview based methods and inconsistencies in findings across studies have led to the concern that assessment methods designed for use with normative samples may have reduced reliability and validity with Personality Disorder samples. It is proposed that future research focuses on the development of measures of attachment that draw on specific constructs relevant to attachment in Personality Disordered populations. 1.0 Introduction Literature on attachment theory and Personality Disorder was found by conducting literature searches using the Psychinfo and Medline data bases. The search terms used were: attachment and personality, Personality Disorder or specific Personality Disorders such as Borderline. Additional papers were found in the reference sections of key studies reviewed. All papers that had used either interview or self-report adult attachment measures with either Personality Disordered clinical participants or with Personality Disorder features in non-clinical samples were included. Papers that were excluded included papers that considered clinical symptoms associated with personality functioning such as sex offending or spousal abuse, but not Personality Disorder specifically. 2.0 Attachment theory The origins of attachment theory come from the joint work of John Bowlby and Mary Ainsworth (Bretherton, 2000). Bowlby proposed that all organisms display a range of instinctive behaviours that in more complex organisms may be goal-directed and organised into complex plan hierarchies. The functions of these 'behavioural systems' are to promote survival and procreation (Bretherton, 2000). Bowlby viewed atachment as an innate behavioural system that is responsive to environmental demands. He defined attachment behaviour as that which has the intended outcome of promoting the infant's proximity to the attachment figure and therefore has the evolutionary function of protecting the child from danger (Bretherton, 2000). Throughout the course of infancy these behaviours become focused on the primary caregivers who are the most responsive to the child's needs. By the time the child is able to move around and explore its environment the infant is able to use the attachment figure as a 'secure-base' from which to explore and to return to for protection or comfort (Ainsworth, 1967). From these early attachment relationships in infancy it is hypothesised that the young child comes to construct internalised or mental working models (IWMs) of the interaction patterns that they have experienced with principal attachment figures (Bretherton & Munholland, 1999). These internal working models are 'operable' models of the self and attachment partner formed on the basis of experience and serve to regulate, interpret and predict the attachment figure's and the self's attachment related behaviour, thoughts and feelings (Bretherton & Mulholland, 1999). From this theoretical perspective Ainsworth (1978) devised a classification system to measure attachment patterns in young toddlers (12-20 months of age). This is a laboratory based procedure designed to capture the balance of exploratory and attachment behaviours under conditions of gradually increasing stress (Solomon, George, 1999). The procedure involves two periods of brief separation. During these separations and subsequent reunions with the attachment figure the infant is coded into one of four categories, securely attached (B), Anxious: Avoidant (A), Anxious: Ambivalent/resistant (C), and Disorganised/Disorientated (D).

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