Adolescent attachment and psychopathology

Journal of Consulting and Clinical Psychology1996. Vol. 64. No. 2, 244-25 3

Copyright 1996 by the American Psychological Association, Inc.0022-006X/96/J3.00

Adolescent Attachment and Psychopathology

Diana S. Rosenstein and Harvey A. HorowitzInstitute of Pennsylvania Hospital

The relationships among attachment classification, psychopathology, and personality traits were ex-

amined in a group of 60 psychiatrically hospitalized adolescents. The concordance of attachmentclassification was examined in 27 adolescent-mother pairs. Both adolescent and maternal attach-ment status were overwhelmingly insecure and were highly concordant. Adolescents showing a dis-

missing attachment organization were more likely to have a conduct or substance abuse disorder,narcissistic or antisocial personality disorder, and self-reported narcissistic, antisocial, and paranoid

personality traits. Adolescents showing a preoccupied attachment organization were more likely tohave an affective disorder, obsessive-compulsive, histrionic, borderline or schizotypal personalitydisorder, and self-reported avoidant, anxious, and dysthymic personality traits. The results supporta model of development of psychopathology based partially on relational experiences with parents.

Although there is now consensus that attachment is a promi-

nent developmental issue throughout the life span, relatively lit-

tle attention has been paid to the relation of attachment pro-

cesses to the development of psychopathology beyond child-

hood, particularly in the adolescent years (Sroufe & Rutter,

1984). Several prominent exceptions include studies of adoles-

cent aifect regulation and symptom reporting (Cole-Detke &

Kobak, 1996; Kobak & Sceery, 1988), and family interaction

patterns (Allen, Hauser, & Borman-Spurrell, 1996). The pur-

pose of this study is to identify the quality of attachment in

psychiatrically ill adolescents and their mothers and to explore

the role of attachment in the development of adolescent

psychopathology.

Attachment theory views development as a process of di-

rected change, of competencies, adaptive patterns and person-

ality emerging from the reorganization of previous patterns,

structures and competencies (Sroufe, 1979; Werner, 1957).

This viewpoint stresses the connections between the normal on-

togenetic process and pathologic development (Overton & Ho-

rowitz, 1991) and conceptualizes psychopathology as a devia-

tion from a normal developmental pathway in an effort toward

adaptation. From a developmental pathways perspective, the

Diana S. Rosenstein and Harvey A. Horowitz, Institute of Pennsylva-

nia Hospital.This research was supported by grants from the Sigmund R. Miller

Memorial Fund, Biomedical Grant in Aid of Research 1-2065-40, and

the 76 Fund and the Academic Development Fund of the Institute ofPennsylvania Hospital. This article is based on a dissertation written byDiana S. Rosenstein in partial fulfillment of the requirements for thedegree of doctor of philosophy, University of Pennsylvania.

We thank Peter Badgio, David Fink, Richard Summers, Thea Abul-El Haj, Carol Fultz, and Elizabeth Gorsch for AAI interviewing andRobert Pianta for AAI reliability coding. Thanks also to Bill Overtonand David Williams for careful critiques of earlier drafts of this article.

Correspondence concerning this article should be addressed to DianaS. Rosenstein, Department of Psychology, Institute of PennsylvaniaHospital, 111 North 49th Street, Philadelphia, Pennsylvania 19139.

quality of attachment plays a large part in determining an indi-

vidual's degree of vulnerability to developmental deviations

(Bowlby, 1980,1988). On the basis of the affective experiences

involved in seeking and receiving caregiving from primary at-

tachment figures, attachment becomes structuralized as an in-

ternal working model representing the relationship among the

self, the attachment figure, and the external world. Later expe-

rience is interpreted on the basis of this internal working model

so that continuity is one's sense of self is experienced. Thus, the

quality of the caregiver's emotional availability early in life is

fundamental to the nature of the child's relation to its attach-

ment figure and the internal working model that subsequently

develops.

Ainsworth was the first to classify individual differences in

infant behavior in a structured series of separation and reunion

experiences, the Strange Situation (Ainsworth, Blehar, Waters,

& Wall, 1978). On reunion, secure infants seek pleasurable

comforting and contact with the caregiver. There are several

variations of insecure reunion patterns. Avoidant infants are

indifferent to or ignore the caregiver. Ambivalent infants request

contact with the caregiver, although resist it when offered and

fail to be comforted. A newer insecure pattern, disorganized,

describes a group of infants who do not possess a coherent strat-

egy for responding to separation or reunion (Main & Solomon,

1986). Sensitive, attuned, and accepting caregivers enhance

their children's expectations that the attachment figure will be

available (Ainsworth et al., 1978). On the basis of this secure

internal working model, which expectably develops out of such

interactions, a strategy is formed that involves relative freedom

of attention to and coherent integration of information about

the attachment figure, as well as adaptive affect regulation.

Unresponsive, interfering, rejecting, and otherwise insensi-

tive parenting is expected to foster the development of insecure

working models in the offspring. Main (1990) has proposed

that when caregivers are insensitive, offspring may develop con-

ditional or secondary attachment strategies to permit continued

maintenance of proximity and self-organization. Children

whose caregivers are consistently inaccessible or rejecting tend

244

SPECIAL SECTION: ADOLESCENT ATTACHMENT 245

to develop a strategy of minimizing the output of attachment

behaviors (Main, 1990). These avoidant children appear to

have little need for the attachment figure and show little overt

distress, although they are are angered and made anxious by

rejection. Children of inconsistently available caretakers de-

velop a strategy of maximizing attachment behaviors, because

they are fearful of the caregiver's potential inaccessibility

(Main, 1990). Efforts by the caregiver to soothe these ambiva-

lent children are not always welcomed. Children with a disorga-

nized attachment have no coherent strategy to respond to sepa-

ration or reunion. Each of the insecure models, based on incon-

sistencies among the child's experience, behavior, and the

responses of the caregiver, is highly vulnerable to fragmentation

or incoherence, producing multiple, inconsistent models. Some

of the models remain unconscious as a result of a defensive

effort that allows the child to cope with painful affects elicited

by the caregiver's incompetence (Bowlby, 1973). Limitations

in the cognitive capacities of young children may make them

especially vulnerable to multiple models, whose unconscious

nature makes them less easily revised than models based in se-

curity (Main, 1991). Defensively biased multiple models form

the initial stages of defensive structures that can ultimately lead

to distortions in personality and psychopathology.

In support of this view, insecure attachment has been suggested

as a risk factor in the development of childhood psychopathology

(Lewis, Feiring, McGuffog, & Jaskir, 1984; Sroufe & Egelund,

1989). The connection between avoidant attachment and antiso-

cial or disruptive behavior has most frequently been reported

(Renken, Egeland, Marvinney, Mangelsdorf, & Sroufe, 1989;

Speltz, Greenberg, & DeKlyen, 1991). Ambivalent attachment

has been associated with social withdrawal in infants and toddlers

(Rubin & Lollis, 1988) and with loneliness (Berlin, Cassidy, &

Belsky, 1991). However, in many studies, the number of ambiva-

lent infants has been so small as to preclude analysis of the associ-

ated psychopathology.

Pathologic outcomes from an insecure attachment organization

assumes developmental continuity in the mental organization of

attachment. There is increasing evidence that the quality of attach-

ment is stable to age 6 (Main & Cassidy, 1988; Main, Kaplan, &

Cassidy, 1985; Wartner, Grossman, Fremmer-Bombik, & Suess,

1994), to age 10 (Grossman & Grossman, 1991) and through

midadolescence (Urban, Carlson, Egeland, & Sroufe, 1991). A

related idea is that continuity in the organization of attachment

exists across generations. Maternal and child attachment organi-

zation has shown a high degree of correspondence in studies using

retrospective, cross-sectional and prospective designs (Benoit &

Parker, 1994; Fonagy, Steele, & Steele, 1991; Radojevic, 1992;

Ward & Carlson, 1995). The argument for intergenerational trans-

mission closely follows the argument for stability of attachment

organization within an individual. The unconscious nature of in-

ternal working models of attachment and their resistance to

change guides expectations and evaluations of relationships, allow-

ing one to construct new relationships consonant with internal

working models. The behavior of the mother with the child is

therefore guided by her internal working models, determining the

quality of her relationship to her child.

Since the development of the Adult Attachment Interview

(AAI; George, Kaplan, & Main, 1985), the biased mental models

of attachment in insecure adolescents and their parents can be

studied and linked with the adolescents' difficulties in interper-

sonal and intrapsychic functioning. This study constitutes the first

reported use of the AAI with an inpatient psychopathological ad-

olescent population, and the first concurrent assessment of mater-

nal and adolescent attachment organization. The AAI classifies the

overall coherence observed in an individual's description, integra-

tion, and evaluation of attachment-related experiences. The four

AAI classifications—autonomous, dismissing, preoccupied, and

unresolved—were designed to parallel the infant attachment clas-

sifications, secure, avoidant, ambivalent, and disorganized, respec-

tively, in the similarity of internal working models and in the de-

fensive strategies employed (Main etal., 1985).

Autonomous adolescents and adults value attachment relation-

ships and regard attachment-related experiences as influential.

Their view of parents is objective, coherent, and consistent, al-

though flexible enough to incorporate new ideas gained through

reflection on attachment experiences. Individuals with a dismiss-

ing attachment, using a minimizing strategy, either dismiss the im-

portance of attachment or the depth of influence attachment has

on themselves. The impact of negative experiences with attach-

ment figures (particularly experiences of rejection) is negated

through normalization, idealization of parents, or poor memory

for childhood. Adolescents and adults with a preoccupied attach-

ment, using a maximizing strategy, appear confused and entangled

by attachment relationships, and lack the objectivity to move be-

yond their preoccupation. An unresolved attachment results from

unintegrated responses to trauma or loss surrounding attachment

figures in childhood. Unresolved individuals experience disorga-

nization and disorientation when describing these events, as man-

ifest in irrational thought processes about the trauma or loss, un-

founded fear, unfounded guilt, and continuing disbelief that the

events occurred. Because the disorganization occurs only in dis-

cussing loss or traumatic events, another underlying attachment

organization should be discernable in the remainder of the attach-

ment discourse.

From the standpoint of psychopathology, associations be-

tween the AAI as a measure of attachment insecurity and in-

creased symptomatology have consistently been shown for ado-

lescents. Kobak and Sceery (1988) confirmed theoretically de-

rived predictions about the association between adolescent

attachment classification and strategies of affect regulation

based on representations of self and others. Dismissing attach-

ment was associated with denial of distress or symptoms, poor

support from parents, and perception by others as hostile. Pre-

occupied attachment was associated with self-report of distress,

although high levels of parental support and poor dating skills.

Adolescents classified as insecure are more likely to engage in

drug abuse (Allen et al., 1996). The associations in female par-

ticipants between depression and preoccupied attachment sta-

tus and eating disorders and dismissing attachment status

(Cole-Detke & Kobak, 1996) underscore the importance of

gender in both attachment organization and diagnosis for

adolescents.

It is the hypothesis of this study that continuity within the

mental organization of attachment throughout the life span and

between generations is of central importance in the psychopa-

thology of adolescence. Therefore, a high correspondence

246 ROSENSTEIN AND HOROWITZ

should occur between adolescent and maternal attachment clas-

sifications. In addition, specific forms of adolescent psychopa-

thology should be associated with distinct kinds of mental orga-

nizations regarding attachment. Psychiatric disorders in which

distress is denied, affect is contained, and in which symptomatic

expression is directed against others, as in conduct disorder or

narcissistic personality disorder, are hypothesized to co-occur

with a dismissing attachment organization. Disorders in which

distress is acknowledged, affect is unmodulated, and symptom-

atic expression is directed toward the self, as in depressive and

anxiety disorders or histrionic personality disorder, are thought

to be found in individuals with a preoccupied attachment orga-

nization. In addition, the links between attachment and person-

ality and psychopathology should be differentially influenced by

gender.

Method

Participants

Participants included 60 adolescents (32 male, 28 female) admittedto a private psychiatric hospital and 27 of their mothers. Ages of theadolescents ranged between 13.08 and 19.75 years (M = 16.36 years).

Participants were predominately White (95%). Forty-five percent werefrom intact families, 37% were living with single parents, and 18% were

from blended families. All adolescents admitted to the hospital wereinvited to participate. Six adolescents' participation was contraindi-cated on clinical grounds (e.g., acute psychosis) or by mental retarda-

tion (Wechsler Intelligence Scale for Children—Revised [ WISC-R] orWechsler Adult Intelligence Scale—Revised [WAIS-R] Full Scale IQ <

65). The sample was deliberately unselected to obtain attachment dataon adolescents with a broad range of psychopathology. Of the 122 pa-tients approached, 63 agreed to participate with parental consent.Three participants' data were lost by tape recorder malfunction. Fifty-

nine adolescents (38 male, 21 female) refused to participate. Mothersof the first 47 adolescent participants were asked to participate, and 31agreed. Four mothers' data were lost by tape recorder malfunction dur-

ing either their or their adolescent's interview.

Procedures

Adolescent participants participated in diagnostic and personality as-sessments. Both adolescents and mothers were given the attachmentinterview.

Measures

Diagnostic assessment: Structured Clinical Interview for Diagno-

sis—Patient version (SCID-P; Spitzer, Williams, & Gibbon, 1987).This semistructured diagnostic interview was developed to reliably pro-duce zDiagnosticand Statistical Manual for Mental Disorders(3rded.,

revised; DSM-III-R; American Psychiatric Association, 1987) Axis I(major psychiatric disorder) diagnosis for adults. Although the in-terview has not been validated on adolescents, DSM-III-R criteria formaking the specific diagnoses covered by the interview are the same foradolescents and adults. Where appropriate, DSM-III-R diagnoses notdirectly assessed by the SCID-P were made and marked as tentativepending corroboration from another research diagnostic source.

Psychological test battery. This test battery was administered withoutthe examiner's knowledge of the patient's participation in this study. Thebattery consisted of objective and projective personality tests, screening fororganic impairment and an IQ test, either the WISC-R (Wechsler, 1974,

for those under age 16) or WAIS-R (Wechsto; 1981; for those age 16 orolder). IQ scores (^ferbal, Performance, and Fun Scale).and DSM-III-Rdiagnoses (both Axis land Axis 11) made as a result of this assessment were

used as study data. IQ data were available for 59 adolescents. Verbal IQranged from 77-141 (M = 102.75,50 = 14.36), Performance IQ rangedfrom 68-134 (M= 104.51, SD= 15.50), and Full Scale IQ ranged from74-134 (M= 103.73, SD= 14.33).

The final research diagnosis, made by the administrative psychiatristsassociated with the adolescent treatment units, was based on informa-

tion from the two independent sources, supplemented by their knowl-edge of the patients, ensuring accuracy and completeness of the diagno-

sis. The broad range of major psychiatric diagnoses was then sorted

into several categories to allow sufficient numbers for analysis. Thesecategories were (a) conduct disorder (CD), including oppositional de-

fiant disorder; (b) affective disorder (AFF), including major depres-

sion, dysthymic disorder, and schizoaffective disorder; and (c) sub-stance abuse (SA). All combinations of these categories were used so

that the complexity of psychopathology in participants with comorbiddiagnoses would be reflected in the data. The match between the SCID-

P and psychological testing diagnoses was 71% for CD, 79% for AFF,and 58% for CD plus AFF. Overall kappa was .754.

Fifty-five percent of participants had an AFF; 13%, a CD; and 20%,AFF plus CD. Twelve percent of participants did not fit into these cate-

gories, 2 with an anxiety disorder, 1 with substance abuse (SA) alone, Iwith attention deficit disorder alone, 2 with atypical psychoses, and 1

participant with a multiple personality disorder. Half the participants

had a comorbid SA diagnosis. Diagnosis from chart review, psychologi-cal testing, or both was available for 51 of the 59 adolescents refusing

participation. Twelve percent had CD, 45% had AFF, and 16% had AFF

plus CD. The distribution of diagnoses is close to the study sample with

two exceptions; an overrepresentation among the adolescents refusingparticipation of psychotic disorders (16%) and personality disorders

without an Axis I diagnosis (10%).

Psychiatric symptoms and personality dimensions. The Millon Clini-

cal Multiaxial Inventory (MCMI; Millon, 1983) is a 175-item self-reportpersonality and diagnostic inventory with specific usefulness in diagnosingpersonality disorders and dimensions. Scoring yields ratings on 20 dimen-

sions corresponding to DSM-III-R personality disorders and symptom-atic scales. The 20 subscales show high test-retest reliability. Mean corre-

lations across personality scales is .73 (Overholser, 1990).

Symptom Checklist—90—Revised (SCL-90-R). The SCL-90

(Derogatis, 1977) is a 90-item self-report survey of symptoms typicallyreported by medical and psychiatric patients. The participant rates the

presence or absence and intensity of each symptom. Scoring yields threeratings of global emotional functioning and nine symptom clusters. In-

ternal consistency coefficients (Cronbach's a) and split-half reliabilities(Spearman-Brown) for the scale have been reported as .98 (Hoffman &

Overall, 1978).

AAI. The AAI (George et al., 1985) is a semistructured interview

designed to elicit memories of childhood interactions with parents. Theinterview yields an attachment classification based on the individual'scurrent state of mental organization expressed in the coherency of

thought and feeling regarding attachment. The interview transcript is

scored on eleven 9-point scales. Three scales represent the content ofthe adult's probable childhood experiences and childhood relationshipto each parent (e.g., loving, rejecting, involving). Eight scales assesscurrent state of mind, including formal aspects of the transcript's co-herency, facility of memory, and ability to mitigate strong negative affect(e.g., coherency, lack of memory, angry preoccupation, uninvolvedderogation). A major attachment classification is made independent ofsubscale scores, but subscale scores are expected to load differentiallyon each attachment classification. Bakermans-Kranenburg and van U-

zendoom (1993) report the test-retest reliability of the AAI at a 78%


match (K = .63), whereas Benoit and Parker (1994) found a 90% match

(K = .79). All transcripts were scored by the first author, blind to theidentities of the participants and diagnostic variables, using the Adult

Attachment Classification System Manual, Version 5.0 (Main & Gold-wyn, 1985-1991). Robert Pianta coded 25% of the transcripts for reli-

ability. Both coders were trained at the 1988 Charlottesville, Virginia,AA1 workshop conducted by Mary Main and Erik Hesse, and achievedacceptable reliability on a set of training transcripts. Agreement on clas-sifications for this study reached a kappa of .540. Consensual data,

achieved by rater discussion, were used for analysis.

Results

Adolescent A ttachment

Because participants with unresolved attachment display

their lack of resolution only in discussing loss or traumatic

events, their underlying secondary attachment classifications

should be apparent in the remaining AAI discourse. Therefore,

data on attachment classifications were analyzed twice, once us-

ing a four-category system including the unresolved category,

and once using the traditional three categories. Using the four-

category system, 38% were dismissing, 2% autonomous, 42%

preoccupied, and 18% unresolved. Using the three-category

system, 3% of participants were autonomous, 47% dismissing,

and 50% preoccupied. These very high rates of insecure attach-

ment were expected on the basis of similar rates found in other

psychopathological populations (100% of adults with serious

psychopathology, Dozier, 1990; 84% of clinic-referred pre-

school children with behavior disorders, Speltz, Greenberg, &

DeKlyen, 1991). However, pervasive attachment insecurity has

not been shown for psychiatrically ill adolescents before.

Attachment and Intelligence

The role of intelligence in determining attachment classifi-

cation was examined (Table 1). Using a series of one-way anal-

yses of variance (ANO\As), Verbal, Performance and Full

Scale IQ scores were unrelated to attachment classification in

both the three- and four-category systems. In addition, IQ

scores did not relate to Axis I diagnosis or gender. When the

autonomous group was removed from the analysis because of

its small size (« = 2), the relationship of IQ to attachment, gen-

der, and diagnosis remained statistically insignificant.

Attachment and Major Psychiatric Diagnosis

The autonomous group was removed from all subsequent

analyses comparing attachment groups because of its small size.

To test the hypothesis that CDs and AFFs would be associated

with dismissing and preoccupied attachment, respectively, a se-

ries of likelihood ratio chi-square analyses were performed. As

expected, significant associations between attachment and Axis

I diagnosis were found using both the four- and three-category

attachment classifications (Table 2). CD alone was associated

with a dismissing attachment. AFF alone was associated with a

preoccupied attachment. Participants with concurrent CDs

and AFFs were likely to have a dismissing classification. Unre-

solved attachment was associated with AFFs, with or without

comorbid CD. One autonomous participant was primarily un-

resolved with an AFF, and the other had a CD.

Adolescent substance abuse also showed a significant rela-

tionship to attachment classification for the three-category sys-

tem only, x2( 1, N = 29) = 4.48, p < .034. As predicted, the SA

group was almost twice as likely to have a dismissing organiza-

tion as the non-SA group. The associations among SA in com-

bination with other Axis I diagnoses and attachment classifica-

tion were significant only using the four-category system, xa(6,

N=29)= 14.752, p < .022. However, the pattern of results was

the same using the three-category system. In the SA group,

those with CD were strongly associated with a dismissing clas-

sification. Participants with comorbid CD + AFF + SA tended

toward a dismissing classification. Participants with AFF and

SA were split between preoccupied and dismissing classifica-

tions. Overall SA is not as strong a predictor of dismissing at-

tachment as is CD.

Gender Differences

As anticipated, strong gender differences were found both in

attachment classification and diagnosis using a series of likeli-

hood ratio chi-square analyses. Because neither male nor fe-

male participants were favored within the unresolved category,

the four-category system was dropped from all analyses of gen-

der differences. As displayed in Table 3, male adolescents were

significantly more likely to have a dismissing organization than

preoccupied (66% vs. 34%) and to have a dismissing attach-

ment than female adolescents (75% vs. 25%). Female adoles-

cents were more likely to have a preoccupied organization than

dismissing (68% vs. 25%) and to have a preoccupied attach-

ment than male participants (63% vs. 37%). The two partici-

pants with an autonomous attachment were female. This pat-

tern of gender differences is consistent with all other studies of

adolescents or pathological populations using the AAI (Dozier,

1990; Kobak & Sceery, 1988). Although AFFs were the most

common diagnoses among male and female participants, as ex-

pected, male participants were more likely than female partici-

pants to have a CD (Table 3). Conversely, female adolescents

showed very high rates of AFF alone, with consequent low rates

of CD with or without comorbid AFF. No significant gender

differences in the distribution of diagnoses were found in the

SA group. However, twice as many male adolescents as female

adolescents had SA diagnoses.

To test for the role of gender in determining of both attach-

ment classification and diagnosis, we analyzed the relationship

between attachment and diagnosis for each gender separately

with likelihood ration chi squares (Table 4). A three-way log-

linear analysis could not be used because of small cell sizes.

Attachment classification for male participants only showed a

significant relationship to diagnosis. The relationship was very

strong between CDs and a dismissing attachment for male par-

ticipants. Male adolescents with AFFs alone were equally likely

to have a dismissing or preoccupied attachment. However, all

male adolescents with a preoccupied attachment had AFFs. For

female adolescents, the rate of CD alone was so low (N = 1) that

the relationship between AFFs and preoccupied attachment

may have been obscured.


Table 1

1Q as a Function of Attachment, Diagnosis, and Gender

Attachment, diagnosis,and gender

AttachmentFour-category system

DismissingAutonomousPreoccupiedUnresolvedF(3, 55)P

Three-category systemDismissingAutonomousPreoccupiedF(2, 56)

PDiagnosis

CDCD + AFFAFFF (2, 49)

PGender

MaleFemalet(57)

P

n

231

2312

282

29

71233

2732

VIQ

M

104.04118.00103.3997.75

0.54<.66

102.96116.50101.59

1.01<.37

106.8395.17

103.592.90<.07

104.41101.34

0.82<-42

SD

14.280.00

16.0510.56

13.662.12

15.23

6.9411.4213.68

13.9714.75

PIQ

M

106.26115.00103.04103.08

0.41<.74

106.07116.00102.21

1.012<.37

108.67106.92103.38

0.59<.56

105.52103.66

0.45<.65

SD

16.440.00

15.0715.78

15.551.41

15.72

12.4412.9915.04

16.7314.60

FIQ

M

105.26118.00103.6599.75

0.61<.61

104.50117.00102.07

1.10<.34

108.50100.00103.78

0.83<.44

105.19102.50

0.71<.48

SD

14.680.00

15.2412.13

13.901.41

14.94

6.5710.6913.87

14.6714.16

Note. VIQ = Verbal IQ; PIQ = Performance IQ; FIQ = Full Scale IQ; CD = conduct disorder, CD + AFF= concurrent conduct disorder and affective disorder; AFF = affective disorder.

Attachment, Symptoms, and Personality

Three analyses were conducted to examine the relation be-

tween varying aspects of symptomatic and personality function-

ing and attachment classification. In the first analysis, all SCL-

90 scales were entered as independent variables in a simulta-

neous regression procedure, with attachment classification as

the independent variable, yielding no significant results, F(9,

43) = 0.737, p < .673. Self-acknowledged symptomatic distress

is a weak discriminator of attachment groups in this clinical

sample, likely resulting from the attenuated range of scores.

The second analysis examined the interrelation of personality

dimensions and attachment classification. Participants were

classified for each scale on the basis of scores reaching a clinical

level (base rate > 74). A series of likelihood ratio chi squares

examined the relationship between MCMI classification and di-

agnosis or attachment classification. Results showed that the

dismissing group differed significantly from the preoccupied

group by being more antisocial, narcissistic, and paranoid, with

a trend for drug abuse (Table 5). By contrast, the preoccupied

group was significantly more avoidant, with a trend for anxiety

and dysthymia. The term avoidant, as used on the MCMI, de-

Table 2

Relation Between Major Psychiatric Disorders

and Attachment Classification

System and attachment CD CD + AFF AFF Total

Four-category"DismissingPreoccupiedUnresolved

Three-category11

DismissingPreoccupied

610

61

615

93

8196

1022

202111

2526

Note. CD = conduct disorder; CD -I- AFF = concurrent conduct dis-order and affective disorder, AFF = affective disorder.1 x2(4, f f = 52) = 18.584,,p< .001. b

X2(2, If = 51) = 11.694,p< .003.

Table 3

Gender Differences in Attachment Classification and Diagnosis

Classification and diagnosis Male Female Total

AA1 classification8

DismissingPreoccupied

Major psychiatric disorders'1

CDCD + AFFAFF

2111

69

13

719

23

20

2830

81233

Note. AAI = Adult Attachment Interview; CD = conduct disorder;CD + AFF = concurrent conduct disorder and affective disorder, AFF= affective disorder.' X2( 1, N = 58) = 8.863, p < .003. " x\2, N •* 53) = 6.559, p < .04.


Table 4

Relation Between Diagnosis and Attachment Classification

for Male and Female Participants

Gender andclassification

Female"DismissingPreoccupied

Male"DismissingPreoccupied

n participants with:

CD

01

60

CD + AFF

12

81

AFF

514

58

Total

617

199

Note. CD = conduct disorder; CD + AFF = concurrent conduct dis-order and affective disorder; AFF = affective disorder.1 *2(2, N = 23) = 0.683, p < .711. " X

2(2, N = 28) = 11.563,p < .003.

scribes an individual who withdraws from interpersonal in-

teraction for fear of criticism or rebuffbut who is highly inter-

ested in others, partially to alleviate their anxiety. All findings

were consistent with prediction. CD alone was significantly as-

sociated with antisocial and paranoid features, whereas AFF

alone was associated with avoidance, anxiety, and dysthymia.

These results demonstrate that the relationship between MCMI

personality traits and attachment classification was not strictly

a function of diagnosis.

A third analysis examined the relationship of an Axis II

(personality disorder) diagnosis of DSM-I1I-R and attach-

ment classification. Forty percent (24 participants) had an Axis

II diagnosis. All were in addition to an Axis I diagnosis of AFF.

Although the numbers of participants were insufficient for sta-

tistical analysis, the anticipated relationships between specific

personality disorders and their associated attachment classifi-

cation were found. Both participants with obsessive-compulsive

personality disorder were female adolescents and had preoccu-

pied attachments. Both participants with narcissistic personal-

ity disorders were male adolescents and had dismissing organi-

zations. Both participants with histrionic personality disorder

were female, with preoccupied attachments. The participant

with a schizotypal personality disorder was male and had a pre-

occupied attachment. Only borderline personality disorder oc-

curred in large numbers—14 of the 24 participants with per-

sonality disorders. The majority was female and more likely to

have a preoccupied organization (64%) than a dismissing one

(29%). Interestingly, 10 male adolescents (and 3 female

adolescents) with a borderline personality disorder refused to

participate in the study.

Maternal Attachment Classification

Of the 27 mothers who were interviewed with the AAI, 4 were

dismissing; 2, autonomous; 10, preoccupied; and 11, unre-

solved. The entire group of mothers with an unresolved attach-

ment had secondary insecure classifications. The predicted as-

sociation of concurrent maternal and adolescent attachment

classifications was confirmed using a likelihood ratio chi square

analysis (Table 6). With the three-category system, the match

was 81% (K = .615). The match for the four-category system

was not calculated, because the unresolved category was not

necessarily expected to co-occur in mothers and adolescents.

This is because the timing of the trauma or loss producing the

lack of resolution in either partner would not necessarily occur

within the period in which transmission is thought to take

place.

Tables

Clinical Elevations (Base Rate > 74) on Millon Mulliaxial Personality Inventory Scales

for Insecure Attachment Groups and Diagnosis

Attachment classification Diagnosis

Rating scale

SchizoidAvoidantDependentHistrionicNarcissisticAntisocialCompulsivePassive-aggressiveSchizotypalBorderlineParanoidAnxietyDysthymiaAlcohol abuseDrug abuse

Dismissing(n = 24)

356

1314110

13048995

11

Preoccupied(n = 28)

9138

12620

15172

171746

P

.08

.04*

.73

.42

.005**

.001**

.97

.34

.43

.02*

.058

.058

.80

.059

CD

003544020131113

AFF(n = 32)

91310171260

211

102

222149

P

.14

.05*

.37

.17

.18

.014*

.14

.66

.47

.004**

.017*

.03*

.78

.29

Note. All I tests are two-tailed. CD - conduct disorder, AFF = affective disorder.


Table 6

Relation Between Maternal and Adolescent

Attachment Classification

Adolescentattachment

DismissingAutonomousPreoccupied

Dismissing

500

Maternal attachment

Autonomous

0I

1

Preoccupied

40

16

Note. x2(l,W = 27) = 12.655,p<.0001.Boldfacednumbersindicate

predicted associations.

Discussion

In this psychiatric sample, the adolescent's state of mind with

respect to attachment was related to clinical diagnosis and, with

more limited support, to personality dimensions. The attach-

ment group contrasts were not the result of differences in intel-

ligence or general severity of psychopathology. Gender differ-

ences further specify the relationships among quality of attach-

ment, personality, and psychopathology. A striking similarity

between the adolescents' and their mothers' attachment classi-

fications was also found. Relationships between adolescent at-

tachment and psychopathology and between maternal and ado-

lescent attachment organization in a clinically disturbed popu-

lation have not previously been shown.

The findings are consistent with a developmental pathways

perspective in which internal working models of attachment,

guiding patterns of behavior, and affect regulation, give rise to

attachment strategies. These attachment strategies produce

differential vulnerability to psychiatric syndromes and person-

ality traits. Our results showed that the psychiatric syndromes

and personality traits theoretically expected to arise from each

of the attachment strategies were associated with the respective

insecure attachment classifications. Adolescents using a dis-

missing attachment organization rely on an attachment strategy

that minimizes distressing thoughts and affects associated with

rejection by the attachment figure. Thus, psychiatric disorders,

such as CD or SA, in which overt denial or downplaying of dis-

tress, coupled with actions that display those distressing affects,

did occur in the context of a dismissing attachment organiza-

tion. This association is consistent with previous work that

linked behavior disorders to avoidant attachment in childhood

(Speltz et al., 1991). Conversely, adolescents using a preoccu-

pied attachment strategy rely on maximization of the attach-

ment system, in which signals of distress intended to draw in

an inconsistent attachment figure are pronounced. Therefore,

psychiatric disorders, such as AFFs, in which negative affects

are acknowledged or even exaggerated, although in an incoher-

ent form, occurred in the context of a preoccupied attachment

organization.

Diagnostic criteria as assessed through behavior and attach-

ment classification as assessed by internal representations seem

to be tapping the same salient dimensions of experience. This is

not to say, however, that a classification of internal representa-

tions of attachment is the same activity as making a psychiatric

diagnosis. Many other environmental and constitutional fac-

tors, such as family history of psychopathology, trauma, and

unfavorable social or economic conditions, coupled with inse-

curity in attachment relations contribute toward the ultimate

emergence of psychiatric disturbance. What is so salient about

attachment in this process is the very early onset of deviation

from a normal developmental pathway, making for sensitivity

to the imposition of other risk factors. This study was limited in

that it assessed psychopathology and attachment concurrently,

providing no direct evidence for a developmental pathways

model. A longitudinal investigation could better serve this goal.

The association between preoccupied attachment and AFF

in adolescents is in keeping with the finding of Cole-Detke

and Kobak (1996), although this link has not been consis-

tently found in young or school-aged children or in dysthy-

mic adults (Patrick, Hobson, Castle, Howard, & Maughan,

1994). A developmental phenomenon may be responsible.

The rates of depression increase in adolescence, particularly

for girls, who formed the bulk of the participants with depres-

sion and preoccupied attachment this study. It may be only

with the transition to adolescence, and the renewed press for

autonomy that adolescence brings, that relational patterns

characteristic of preoccupied individuals, which discourage

autonomy and encourage overinvolvement with the parent,

take on renewed import. Cole-Detke and Kobak (1996) iden-

tify guilt and an "overfocus" on a depressed parent as salient

in the etiology of the child's depression. Because of the ado-

lescent's focus on the depressed parent, the adolescent fails to

learn a means to regulate negative affect and lacks explor-

atory competence to learn these skills from other sources. In-

terestingly, this parent-adolescent dynamic anticipates our

finding of close correspondence between maternal and ado-

lescent attachment styles. What is suggested is that maternal

depression and preoccupation causes the mother to turn to

her child for provision of her own attachment needs and alle-

viation of her distress, thus perpetuating from one generation

to the next similarity in attachment and defensive styles.

As with major psychiatric disorders, the relationship between

personality functioning and attachment rests on the similarity

in strategies used to regulate against painful negative affects

while simultaneously maintaining involvement with the attach-

ment figure. The two groups of adolescents with insecure states

of mind were distinguishable by the quality of their self-re-

ported personality functioning. Adolescents with self-reported

narcissistic, antisocial, and paranoid personality traits were

likely to have a dismissing attachment. Preoccupied attachment

was linked with self-reported avoidant, anxious, and dysthymic

personality traits. Observed personality functioning as mea-

sured by diagnoses of personality disorders provided more

modest differentiation of the two groups with insecure classifi-

cations. It was surprising to find that the two groups of adoles-

cents with insecure states of mind did not differ on the amount

or kind of self-reported psychiatric symptoms experienced. The

failure to find this previously reported difference (Kobak &

Sceery, 1988) most likely represents a ceiling effect. Both

groups of adolescents with insecure states of mind reported

clinically significant levels of psychic distress and symptoms.Perhaps the fact of psychiatric hospitalization mitigated against


the tendency of adolescents with a dismissing classification to

deny that they are in distress and have psychiatric problems.

The relation of borderline personality disorder and borderline

traits to attachment organization was complex and contradic-

tory in this study. Adolescents showing clinical levels of border-

line personality traits failed distinctively to have a preoccupied

classification. However, adolescents with a borderline personal-

ity disorder tended to have a preoccupied classification, agree-

ing with the report of Patrick et al. (1994). The lack of consis-

tent association between the borderline construct and preoccu-

pied attachment in this study may be explained by differences in

methodology between the two studies. The Patrick et al. (1994)

sample contained only female adolescents and required a more

stringent definition of borderline personality disorder (seven of

eight DSM-IIl-R criteria vs. five of eight in our sample), with

no dysthymic criteria. All in our group of adolescents with bor-

derline personality disorder had an AFF (dysthymia being the

least severe form) and most had a comorbid CD. The greater

heterogeneity of our borderline group may have accounted for

the higher incidence of dismissing attachment in these adoles-

cents. One limitation was the tendency of male adolescents with

borderline personality disorder to refuse participation in our

study, shrinking the group to a size inappropriate for statistical

manipulation and skewing it in favor of female adolescents. Fur-

ther studies should include a larger group of adolescents with

borderline personality disorder, balancing gender, to better char-

acterize the relationship to attachment organization.

Setting aside comparisons with other studies, two other

points may explain discrepancies in the relation between at-

tachment classification and the borderline construct. The first

involves the lack of coordination of definitions of borderline

between the DSM-III-R borderline personality disorder diag-

nosis and the MCMI borderline scale. On the MCMI, border-

line traits are part of a cluster of traits, including narcissistic,

antisocial, and histrionic, bound together through exploitative

interpersonal relations, the ability to discount dissonant infor-

mation and stimulus seeking behavior. The latter qualities are

more descriptive of a dismissing than preoccupied organization

of attachment.

Secondly, inconsistency in attachment organization within

diagnostic groups may point to the lack of complete specificity

of attachment classifications and the multiplicity of underlying

working models of attachment; that is, according to Main and

Goldwyn (1985-1991), elements of the other insecure attach-

ment organization should be present in the AAI records of each

insecure group, particularly at the extremes. The relative pre-

dominance of each insecure classification determines the ulti-

mate organization. Instruments tapping personality traits (such

as the MCMI), which are complexly determined and overlap

across traits, may capture the nonexclusive nature of attach-

ment classification. As Pianta (1992) suggests, the attachment

organizations and their concomitant behaviors appear to be in

an adaptive hierarchy. As one form of the organization breaks

down, a new underlying organization emerges. Close family

members are often the only ones able to see the defensive nature

of the individual's behavioral organization and understand their

underlying vulnerability (Dozier, Stevenson, Lee, & Velligan,

1991). Similar layering of adaptive organizations may occur in

individuals who have multiple concurrent diagnoses, which

provide more limited predictive power to attachment classifi-

cation. These ideas underscore the importance of looking be-

yond surface symptomatic presentations to the often unstated

organizing representations of relationships and their associated

motivating affects.

Gender differences emerged in the organization of attach-

ment security and in the attribution of psychiatric diagnoses.

The majority of male adolescents had dismissing classifications,

whereas most female adolescents were classified as preoccupied.

Overall, the relationship between attachment and clinical diag-

nosis was not simply a reflection of gender differences. Discrim-

ination of attachment classification emerged although the ma-

jority of male and female participants had AFFs. A dismissing

classification in male adolescents was not in itself associated

with a specific diagnosis. However, the inclusion of CD as all or

part of a male adolescent's diagnosis almost perfectly predicted

a dismissing classification (14 of 15 participants). As Bowlby

(1944) described from his clinical observations, the presence of

CD in male adolescents is pivotal in anticipating their attach-

ment organization. Parallel associations between attachment

and clinical diagnosis for female adolescents were not found.

Very small numbers of female adolescents with CD alone pro-

vided insufficient statistical power to replicate the association

between preoccupied attachment and depression in female ad-

olescents (Cole-Detke&Kobak, 1996).

Finally, there is the very high concordance between adoles-

cent and maternal attachment classification to consider. Al-

though in this sample the association was high, maternal preoc-

cupied status was the least predictive of adolescent status. Sub-

sequent analysis of the mismatched mother-adolescent pairs

showed that a group of four adolescents with dismissing classi-

fication all had mothers with preoccupied organizations. Three

of the four were male adolescents with a primary unresolved

classification. Their interviews showed a unique feature. All

claimed lack of memory for childhood, yet seemed to the in-

terviewer as if they were holding back from discussing painful

experiences that they wished they had forgotten. They were pas-

sively noncompliant with the interview, answering questions

only minimally. The fourth adolescent, who was female, exhib-

ited the same withholding posture but seemed angry and defi-

ant. These four participants may have a split combination of

dismissing and preoccupied attachment analogous to the avoid-

ant-ambivalent classification Crittenden (1988) has found in a

sample of maltreated infants, and subsumed within Main and

Goldwyn's (1985-1991) classification system under the "can-

not classify" designation.

While not directly studied in this investigation, the conso-

nance between adolescent and maternal attachment classifica-

tion lends support to Bowlby's (1973) claim that styles of adap-

tation and defensive bias arise in the context of mother-child

interaction. Maternal behavior is, in turn, a function of her

mental organization of her own attachment experiences. Ac-

cording to this logic, maternal attachment patterns are internal-

ized by the child through working models and maintained both

by the defensive biases inherent in the models and by continuing

interaction with the attachment figure. If the extremity of the

_ adolescent's psychopathology were influencing current mental


organization, then one would not expect to find correspondence

to maternal attachment. The fact of such a correspondence ar-

gues against the idea of the adolescent's psychopathology en-

tirely determining attachment organization and leads back

again to a model based in developmental psychopathology.

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Accepted May 5, 1995 •

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