Bonds of security and their patterns across life.
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126 to 150 of 452Parental affectionless control and suicidality.
Objective: Although poor parental bonding is a known risk factor for suicidality, current literature is inconsistent about the relative role of low parental care and parental overprotection, as well as the combination of the two, termed "affectionless control". This review presents the current state of knowledge of the relationship between suicidality and these two aspects of parental bonding.
Method: The computerized databases Medline, PubMed, PsychINFO, PsychLit, and Google Scholar were searched using combinations of the following keywords: suicidality, suicide, suicide attempt, suicidal behavior, parental bonding, and parental bonding instrument. Using the results, we reviewed the reports on the relationship between suicidality and parental bonding as measured by validated parental bonding instruments.
Results: Twelve papers were analyzed. All of them used the parental bonding instrum…
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Towards a neuroscience of empathy: ontogeny, phylogeny, brain mechanisms, context and psychopathology.
Empathy allows individuals to share the affective states of others, predict others' actions, and stimulate prosocial behavior. Whilst the proximate mechanisms of empathy, modulated in part by neuropeptides such as oxytocin, control the ways we interact with our social environment, the ultimate causes seem to have arisen along with the mechanisms involved in mammalian parental care. The conceptual boundaries of empathy, however, have been blurred by definitional inaccuracies of mechanisms that can be regarded as phylogenetic precursors or physiological prerequisites for empathy, including mimicry and emotion contagion. Contextual factors such as early experiences with primary care-givers (attachment), current mood states and other environmental contingencies are capable of modulating empathy. Moreover, evidence suggests that there is also a "dark side" of empathy, namely envy and schadenf…
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Failures in interpersonal psychotherapy (IPT): factors related to treatment resistances.
Interpersonal psychotherapy (IPT) is an effective treatment for depression across the lifespan and across cultures. However, even when delivered with fidelity, some patients drop out and others do not improve sufficiently. Attention to IPT treatment attrition, dropout, nonresponse, or failure can elucidate its limitations and the opportunities to improve its effectiveness. Studies of factors known to moderate and negatively predict IPT depression treatment response are reviewed along with recommended modifications to improve outcomes. Although the risk of treatment failure always exists, it is possible to enhance treatment effectiveness by attending to the therapeutic alliance, strategically addressing depression, and adapting IPT to patient characteristics. These include adding pharmacotherapy, extending the course of treatment, and targeting specific symptoms or interpersonal vulnerabi…
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Implications of attachment theory and research for the assessment and treatment of eating disorders.
In this paper, we review the research literature on attachment and eating disorders and suggest a framework for assessing and treating attachment functioning in patients with an eating disorder. Treatment outcomes for individuals with eating disorders tend to be moderate. Those with attachment-associated insecurities are likely to be the least to benefit from current symptom-focused therapies. We describe the common attachment categories (secure, avoidant, anxious), and then describe domains of attachment functioning within each category: affect regulation, interpersonal style, coherence of mind, and reflective functioning. We also note the impact of disorganized mental states related to loss or trauma. Assessing these domains of attachment functioning can guide focused interventions in the psychotherapy of eating disorders. Case examples are presented to illustrate assessment, case form…
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Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods.
Personality disorders are associated with fundamental disturbances of self and interpersonal relations, problems that vary in severity within and across disorders. This review surveyed clinician-rated measures of personality psychopathology that focus on self-other dimensions to explore the feasibility and utility of constructing a scale of severity of impairment in personality functioning for DSM-5. Robust elements of the instruments were considered in creating a continuum of personality functioning based on aspects of identity, self-direction, empathy, and intimacy. Building on preliminary findings (Morey et al., 2011 /this issue), the proposed Levels of Personality Functioning will be subjected to extensive empirical testing in the DSM-5 field trials and elsewhere. The resulting version of this severity measure is expected to have clinical utility in identifying personality psychopath…
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Continuing bonds in adaptation to bereavement: Toward theoretical integration.
There is lack of clarity in the scientific literature concerning the adaptive functions of continuing versus relinquishing bonds to deceased persons. It remains unclear what type of bonds or underlying processes are related to (mal)adaptive bereavement outcomes. Furthermore, empirical research has rarely been theoretically-driven. Thus, the purpose of this article is to outline a theoretical model for predicting the (mal)adaptiveness of continuing-relinquishing bonds. Attachment theory provides a generic framework for understanding patterns of individual differences in the impact of continuing bonds. Within this framework, using bereavement-specific models compatible with attachment theory, (1) ways of coping with the bond to the deceased can be linked to outcome (using the Dual Process Model, Stroebe & Schut, 1999), and (2) related cognitions about the deceased person proposed (drawing …
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Neurobiology of human affiliative behaviour: implications for psychiatric disorders.
Purpose of review: Most of our previous knowledge about neurobiology of affiliation is based on animal research. However, during the last couple of years, there has been a surge of research investigating the neurobiological underpinnings of human affiliative behaviour. This article aims to review recent brain imaging and neuropeptide studies that investigated human affiliation.
Recent findings: Findings from brain-imaging studies have increased our knowledge of the neural networks critical for sensitivity to social reward, social cooperation and empathy. Some of the inter-individual and between-sex differences in personality and temperament appear to be driven by structural and functional variations in the brain regions processing social rewards. Furthermore, oxytocin exerts its effects by modulating affiliation-related neural networks. Impairments in affiliation-related brain networks a…
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Social withdrawal in childhood.
Socially withdrawn children frequently refrain from social activities in the presence of peers. The lack of social interaction in childhood may result from a variety of causes, including social fear and anxiety or a preference for solitude. From early childhood through to adolescence, socially withdrawn children are concurrently and predictively at risk for a wide range of negative adjustment outcomes, including socio-emotional difficulties (e.g., anxiety, low self-esteem, depressive symptoms, and internalizing problems), peer difficulties (e.g., rejection, victimization, poor friendship quality), and school difficulties (e.g., poor-quality teacher-child relationships, academic difficulties, school avoidance). The goals of the current review are to (a) provide some definitional, theoretical, and methodological clarity to the complex array of terms and constructs previously employed in th…
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Betancourt TS, Khan KT (2008)reviewMEDLINE-indexed journal, not yet read by usInternational review of psychiatry (Abingdon, England)294 citations The mental health of children affected by armed conflict: protective processes and pathways to resilience.
This paper examines the concept of resilience in the context of children affected by armed conflict. Resilience has been frequently viewed as a unique quality of certain 'invulnerable' children. In contrast, this paper argues that a number of protective processes contribute to resilient mental health outcomes in children when considered through the lens of the child's social ecology. While available research has made important contributions to understanding risk factors for negative mental health consequences of war-related violence and loss, the focus on trauma alone has resulted in inadequate attention to factors associated with resilient mental health outcomes. This paper presents key studies in the literature that address the interplay between risk and protective processes in the mental health of war-affected children from an ecological, developmental perspective. It suggests that fu…
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The development of borderline personality disorder--a mentalizing model.
This paper describes a mentalization-based model of the development of borderline personality disorder (BPD). The model takes into account constitutional vulnerability and is rooted in attachment theory and its elaboration by contemporary developmental psychologists. The model suggests that disruption of the attachment relationship early in development in combination with later traumatic experiences in an attachment context interacts with neurobiological development. The combination leads to hyper-responsiveness of the attachment system which makes mentalizing, the capacity to make sense of ourselves and others in terms of mental states, unstable during emotional arousal. The emergence of earlier modes of psychological function at these times accounts for the symptoms of BPD. The model has clinical implications and suggests that the aim of treatment is not only to encourage development o…
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An attachment-based model of complicated grief including the role of avoidance.
Introduction: Complicated grief is a prolonged grief disorder with elements of a stress response syndrome. We have previously proposed a biobehavioral model showing the pathway to complicated grief. Avoidance is a component that can be difficult to assess and pivotal to treatment. Therefore we developed an avoidance questionnaire to characterize avoidance among patients with CG.
Methods: We further explain our complicated grief model and provide results of a study of 128 participants in a treatment study of CG who completed a 15-item Grief-related Avoidance Questionnaire (GRAQ). RESULTS OF AVOIDANCE ASSESSMENT: Mean (SD) GRAQ score was 25. 0 +/- 12.5 with a range of 0-60. Cronbach's alpha was 0.87 and test re-test correlation was 0.88. Correlation analyses showed good convergent and discriminant validity. Avoidance of reminders of the loss contributed to functional impairment after contr…
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Feldman R (2007)reviewMEDLINE-indexed journal, not yet read by usJournal of child psychology and psychiatry, and allied disciplines688 citations Parent-infant synchrony and the construction of shared timing; physiological precursors, developmental outcomes, and risk conditions.
Synchrony, a construct used across multiple fields to denote the temporal relationship between events, is applied to the study of parent-infant interactions and suggested as a model for intersubjectivity. Three types of timed relationships between the parent and child's affective behavior are assessed: concurrent, sequential, and organized in an ongoing patterned format, and the development of each is charted across the first year. Viewed as a formative experience for the maturation of the social brain, synchrony impacts the development of self-regulation, symbol use, and empathy across childhood and adolescence. Different patterns of synchrony with mother, father, and the family and across cultures describe relationship-specific modes of coordination. The capacity to engage in temporally-matched interactions is based on physiological mechanisms, in particular oscillator systems, such as…
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The parent-infant dyad and the construction of the subjective self.
Developmental psychology and psychopathology has in the past been more concerned with the quality of self-representation than with the development of the subjective agency which underpins our experience of feeling, thought and action, a key function of mentalisation. This review begins by contrasting a Cartesian view of pre-wired introspective subjectivity with a constructionist model based on the assumption of an innate contingency detector which orients the infant towards aspects of the social world that react congruently and in a specifically cued informative manner that expresses and facilitates the assimilation of cultural knowledge. Research on the neural mechanisms associated with mentalisation and social influences on its development are reviewed. It is suggested that the infant focuses on the attachment figure as a source of reliable information about the world. The construction…
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Brain basis of early parent-infant interactions: psychology, physiology, and in vivo functional neuroimaging studies.
Parenting behavior critically shapes human infants' current and future behavior. The parent-infant relationship provides infants with their first social experiences, forming templates of what they can expect from others and how to best meet others' expectations. In this review, we focus on the neurobiology of parenting behavior, including our own functional magnetic resonance imaging (fMRI) brain imaging experiments of parents. We begin with a discussion of background, perspectives and caveats for considering the neurobiology of parent-infant relationships. Then, we discuss aspects of the psychology of parenting that are significantly motivating some of the more basic neuroscience research. Following that, we discuss some of the neurohormones that are important for the regulation of social bonding, and the dysregulation of parenting with cocaine abuse. Then, we review the brain circuitry…
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Family issues in child anxiety: attachment, family functioning, parental rearing and beliefs.
Family studies have found a large overlap between anxiety disorders in family members. In addition to genetic heritability, a range of family factors may also be involved in the intergenerational transmission of anxiety. Evidence for a relationship between family factors and childhood as well as parental anxiety is reviewed. Four groups of family variables are considered: (I) attachment; (II), aspects of family functioning, such as marital conflict, co-parenting, functioning of the family as a whole, and sibling relationships; (III) parental rearing strategies; and (IV) beliefs that parents hold about their child. The reviewed literature provides evidence for an association between each of these family factors and child anxiety. However, there is little evidence as yet that identified family factors are specific to child anxiety, rather than to child psychopathology in general. Moreover,…
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Gilbert P (2006)reviewMEDLINE-indexed journal, not yet read by usPsychological medicine113 citations Evolution and depression: issues and implications.
Depression is well recognized to be rooted in the down-regulation of positive affect systems. This paper reviews some of the social and non-social theories that seek to explain the potential adaptive advantages of being able to tone down positive affect, and how dysfunctions in such affect control can occur in some contexts. Common to most evolutionary theories of depression is the view that loss of control over aversive events and/or major resources/rewards exert downward pressure on positive affect. Social theories, however, suggest that it is loss of control over the social environment that is particularly depressogenic. Two evolutionary theories (the attachment-loss, and the defeat-loss theories) are briefly reviewed and their interaction considered. It is suggested that phenotypes for toning down positive affect, in the face of loss of control, may become more severe in the context …
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How interpersonal motives clarify the meaning of interpersonal behavior: a revised circumplex model.
Circumplex models have organized interpersonal behavior along 2 orthogonal dimensions--communion (which emphasizes connection between people) and agency (which emphasizes one person's influence over the other). However, many empirical studies have disconfirmed certain predictions from these models. We therefore revised the model in 4 ways that highlight interpersonal motives. In our revision: (a) the negative pole of communion is indifference, not hostility; (b) a given behavior invites (not evokes) a desired reaction from the partner; (c) the complement of a behavior is a reaction that would satisfy the motive behind that behavior; (d) noncomplementary reactions induce negative affect. If the motive is unclear, the meaning of the behavior is ambiguous. This ambiguity helps explain failures in social support, miscommunications in everyday life, and features of most personality disorders.…
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Levy KN (2005)reviewMEDLINE-indexed journal, not yet read by usDevelopment and psychopathology128 citations The implications of attachment theory and research for understanding borderline personality disorder.
Borderline personality disorder (BPD) is a highly prevalent, chronic, and debilitating psychiatric problem characterized by a pattern of chaotic and self-defeating interpersonal relationships, emotional lability, poor impulse control, angry outbursts, frequent suicidality, and self-mutilation. Recently, psychopathology researchers and theorists have begun to understand fundamental aspects of BPD such as unstable, intense interpersonal relationships, feelings of emptiness, bursts of rage, chronic fears of abandonment and intolerance for aloneness, and lack of a stable sense of self as stemming from impairments in the underlying attachment organization. These investigators have noted that the impulsivity, affective lability, and self-damaging actions that are the hallmark of borderline personality occur in an interpersonal context and are often precipitated by real or imagined events in re…
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Adult attachment style and maternal-infant bonding: the indirect path of parenting stress.
Background: The quality of maternal-infant bonding is related to important child outcomes. The literature has assumed that the ability to form relationships is a relatively stable trait, and research studies have suggested that a mother's attachment style in close adult relationships is related to mother-infant bonding. The transition to parenthood is also often stressful, and the adult attachment style may relate to parenting stress in the first year after birth. Such stress could possibly have a negative relationship with the mother-infant bond. In the present study, we examined the associations between maternal adult attachment styles and the quality of mother-infant bonding and whether this relationship is mediated by parenting stress.
Methods: The present study sample comprised 168 women (mean age 31.0 years, SD 4.23 years). Between weeks 31 and 41 of gestation, the anxious and avoi…
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Robakis TK, Zhang S, Rasgon NL, Li T, Wang T, Roth MC, Humphreys KL, Gotlib IH, Ho M, Khechaduri A, Watson K, Roat-Shumway S, Budhan VV, Davis KN, Crowe SD, Ellie Williams K, Urban AE (2020)MEDLINE-indexed journal, not yet read by usTranslational psychiatry34 citations Epigenetic signatures of attachment insecurity and childhood adversity provide evidence for role transition in the pathogenesis of perinatal depression.
Early life adversity and insecure attachment style are known risk factors for perinatal depression. The biological pathways linking these experiences, however, have not yet been elucidated. We hypothesized that overlap in patterns of DNA methylation in association with each of these phenomena could identify genes and pathways of importance. Specifically, we wished to distinguish between allostatic-load and role-transition hypotheses of perinatal depression. We conducted a large-scale analysis of methylation patterns across 5 × 106 individual CG dinucleotides in 54 women participating in a longitudinal prospective study of perinatal depression, using clustering-based criteria for significance to control for multiple comparisons. We identified 1580 regions in which methylation density was associated with childhood adversity, 3 in which methylation density was associated with insecure attac…
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A longitudinal study of maternal attachment and infant developmental outcomes.
Extant research has demonstrated that compared to adults with insecure attachment styles, more securely attached parents tend to be more responsive, sensitive, and involved parents, resulting in improved outcomes for their children. Less studied is the influence of a mother's attachment style on her attachment to her unborn child during pregnancy and the consequent developmental outcomes of the child during early childhood. Thus, the aim of this prospective longitudinal study was to examine the relationship between maternal-fetal attachment (MFA) during pregnancy and infant and toddler outcomes and the role of mothers' attachment style on early childhood developmental outcomes in an economically disadvantaged sample of women and their children. Gamma regression modeling demonstrated that an avoidant maternal attachment style (b = .98, 95 % CI [.97, .98], p < 0.001) and post-partum depres…
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Parenting self-efficacy: links with maternal depression, infant behaviour and adult attachment.
Background: This study examined predictors of parenting self-efficacy (PSE) in a sample of first-time mothers during the first year after childbirth and evaluated the effect of a brief, intensive, mother-infant residential intervention on PSE and infant behaviour.
Methods: 83 primiparous women with infants aged 0-12 months admitted to a residential parent-infant program participated in a structured clinical interview for DSM-IV diagnosis of depressive and anxiety disorders and completed questionnaires assessing psychological distress, adult attachment and childhood parenting experiences. During their residential stay, nurses recorded infant behaviour using 24-hour charts.
Results: Results showed PSE to be inversely correlated with maternal depression, maternal anxiety and attachment insecurity. Low levels of parental abuse during childhood, avoidant attachment, male infant gender and dep…
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Prolonged grief and attachment security: A latent class analysis.
The death of a loved one has been associated with a wide range of mental health outcomes. Attachment theory is one of the primary paradigms for understanding bereavement outcome, yet there is comparatively little examination of the relationship between attachment style and bereavement responses. In this study we use Latent Class Analysis to identify subgroups of bereaved individuals based on patterns of prolonged grief (PG) and major depression symptom co-occurrence in 285 bereaved individuals. We then explored the relationship between these subgroups and attachment anxiety and avoidance. Three new subgroups of individuals were identified: one showing high levels of PGD and depression (PGD/depression), one showing high depression (Depression), and one showing few symptoms (Low). Attachment anxiety significantly differentiated between the three groups; the highest levels of attachment anx…
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Oxytocin receptor polymorphism and childhood social experiences shape adult personality, brain structure and neural correlates of mentalizing.
Introduction: The oxytocin system is involved in human social behavior and social cognition such as attachment, emotion recognition and mentalizing (i.e. the ability to represent mental states of oneself and others). It is shaped by social experiences in early life, especially by parent-infant interactions. The single nucleotid polymorphism rs53576 in the oxytocin receptor (OXTR) gene has been linked to social behavioral phenotypes.
Method: In 195 adult healthy subjects we investigated the interaction of OXTR rs53576 and childhood attachment security (CAS) on the personality traits "adult attachment style" and "alexithymia" (i.e. emotional self-awareness), on brain structure (voxel-based morphometry) and neural activation (fMRI) during an interactive mentalizing paradigm (prisoner's dilemma game; subgroup: n=163).
Results: We found that in GG-homozygotes, but not in A-allele carriers, in…
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The association of family support and wellbeing in later life depends on adult attachment style.
The current study examines the association between family support and wellbeing in the elderly, paying particular attention to the possible moderating role of attachment style. Data from a community-dwelling, ethnically diverse, elderly sample (N = 1118) were analyzed to determine the best linear combination of emotional support, instrumental support, and attachment styles predicting wellbeing. Emotional support generally was associated with higher wellbeing whereas instrumental support was related to decreased wellbeing. As expected, however, these associations were qualified by attachment style. Receiving emotional support had stronger positive and instrumental support less negative effects on the wellbeing of elderly individuals with higher attachment security. Given increased longevity, family networks may become important sources of support for the elderly. Work detailing when, how,…
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