Medically unexplained symptoms and attachment theory: The BodyMind Approach

© 2019 Payne and Brooks. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.This article discusses how The BodyMind Approach ® (TBMA) addresses insecure attachment styles in medically unexplained symptoms (MUS). Insecure attachment styles are associated with adverse childhood experiences (ACEs) and MUS (Adshead and Guthrie, 2015) and affect sufferers' capacity to self-manage. The article goes on to make a new hypothesis to account for TBMA's effectiveness (Payne and Brooks, 2017), that is, it addresses insecure attachment styles, which may be present in some MUS sufferers, leading to their capacity to self-manage. Three insecure attachment styles (dismissive, pre-occupied and fearful) associated with MUS are discussed. TBMA is described and explanations provided of how TBMA has been specifically designed to support people's insecure attachment styles. Three key concepts to support insecure attachment styles involved in the content of TBMA are identified and debated: (a) emotional regulation; (b) safety; and (c) bodymindfulness. There is a rationale for the design of TBMA as opposed to psychological interventions for this population. The programme's structure, facilitation and content, takes account of the three insecure attachment styles above. Examples of how TBMA works with their specific characteristics are presented. TBMA has been tested and found to be effective during delivery in the United Kingdom National Health Service (NHS). Improved self-management has potential to reduce costs for the NHS and in General Practitioner time and resources.Peer reviewe

An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children

To explore attachment narratives in children diagnosed with reactive attachment disorder (RAD). Method: We compared attachment narratives, as measured by the Manchester Child Attachment Story Task, in a group of 33 children with a diagnosis of RAD and 37 comparison children. Results: The relative risk (RR) for children with RAD having an insecure attachment pattern was 2.4 (1.4-4.2) but 30% were rated as securely attached. Within the RAD group, children with a clear history of maltreatment were more likely to be Insecure-Disorganised than children without a clear history of maltreatment. Conclusions: Reactive attachment disorder is not the same as attachment insecurity, and questions remain about how attachment research informs clinical research on attachment disorders

A Multilevel Meta‑Analysis

Insecure attachment to primary caregivers is associated with the development of depression symptoms in children and youth. This association has been shown by individual studies testing the relation between attachment and depression and by meta-analyses focusing on broad internalizing problems instead of depression or adult samples only. We therefore meta-analytically examined the associations between attachment security and depression in children and adolescents, using a multilevel approach. In total, 643 effect sizes were extracted from 123 independent samples. A significant moderate overall effect size was found (r = .31), indicating that insecure attachment to primary caregivers is associated with depression. Multivariate analysis of the significant moderators that impacted on the strength of the association between attachment security and depression showed that country of the study, study design, gender, the type of attachment, and the type of instrument to assess attachment uniquely contributed to the explanation of variance. This study suggests that insecure attachment may be a predictor of the development of depression in children and adolescents. When treating depression in children, attachment should therefore be addressed

Attachment representations and early interactions in drug addicted mothers: a case study of four women with distinct Adult Attachment Interview classifications

open4Drug addiction is considered a major risk factor that can influence maternal functioning at multiple levels, leading to less optimal parental qualities and less positive interactive exchanges in mother-child dyads. Moreover, drug abusers often report negative or traumatic attachment representations regarding their own childhood. These representations might affect, to some extent, later relational and developmental outcomes of their children. This study explored whether the development of dyadic interactions in addicted women differed based on attachment status. The longitudinal ongoing of mother-child emotional exchanges was assessed among four mothers with four different attachment statuses (F-autonomous, E-preoccupied, Ds-dismissing, and U-unresolved/with losses). Attachment representations were assessed using the Adult Attachment Interview ( George et al., 1985), while mother-child interactions were evaluated longitudinally during videotaped play sessions, through the Emotional Availability Scales (Biringen, 2008). As expected, the dyad with the autonomous mother showed better interactive functioning during play despite the condition of drug-abuse; the mother proved to be more affectively positive, sensitive, and responsive, while her baby showed a better organization of affects and behaviors. On the other side,insecure mothers seemed to experience more difficulties when interacting with their children showing inconsistency in the ability to perceive and respond to their babies’ signals. Finally, children of insecure mothers showed less clear affects and signals. While differences between secure and insecure dyads appeared clear, differences between insecure patterns where less linear, suggesting a possible mediating role played by other factors. Clinical implications and suggestions for future research are discussed.openPorreca, A.; De Palo, F.; Simonelli, A.; Capra, N.Porreca, Alessio; DE PALO, Francesca; Simonelli, Alessandra; Capra, N

Attachment and Reflective Functioning in Women With Borderline Personality Disorder

Insecure attachment and impairments in reflective functioning (RF) are thought to play a critical role in borderline personality disorder (BPD). In particular, the mentalization-based model argues that insecure attachment indirectly accounts for increased BPD features, notably via disruption of RF capacities. Although the mediation relationship between attachment, RF, and BPD is supported by previous evidence, it remains to be directly tested in adults with BPD. In the current study, a sample of 55 female adult BPD patients and 105 female healthy controls completed a battery of self-report measures to investigate the interplay between attachment, RF capacities, and BPD clinical status. Overall, the results showed that BPD patients predominantly reported insecure attachment, characterized by negative internal working models of the self as unlovable and unimportant to others, and decreased RF abilities. Our findings further indicated that actual RF capacities mediated the relationships between adult insecure attachment and BPD clinical status

Insecure attachment during infancy predicts greater amygdala volumes in early adulthood

Background The quality of the early environment is hypothesized to be an influence on morphological development in key neural areas related to affective responding, but direct evidence to support this possibility is limited. In a 22-year longitudinal study, we examined hippocampal and amygdala volumes in adulthood in relation to early infant attachment status, an important indicator of the quality of the early caregiving environment. Methods Participants (N = 59) were derived from a prospective longitudinal study of the impact of maternal postnatal depression on child development. Infant attachment status (24 Secure; 35 Insecure) was observed at 18 months of age, and MRI assessments were completed at 22 years. Results In line with hypotheses, insecure versus secure infant attachment status was associated with larger amygdala volumes in young adults, an effect that was not accounted for by maternal depression history. We did not find early infant attachment status to predict hippocampal volumes. Conclusions Common variations in the quality of early environment are associated with gross alterations in amygdala morphology in the adult brain. Further research is required to establish the neural changes that underpin the volumetric differences reported here, and any functional implications

Association Between Insecure Attachment and ADHD:Environmental Mediating Factors

OBJECTIVE: Psychological theories have postulated an association between insecure attachment and ADHD. The objective of this study is to investigate possible association between insecure attachment and ADHD in children and adults.METHOD: Review of literature was performed using the PsycINFO, Medline, and EMBASE databases.RESULTS: Twenty-nine studies were included in the review. Overall, the studies showed that parental attachment problems and environmental mediating factors were significantly associated with childhood ADHD. Adults with ADHD had a much higher incidence of insecure attachment styles than reported in the general population.CONCLUSION: There seems to be a clear association between ADHD and insecure attachment. It is likely that early intervention in the form of parent training and pharmacological treatment may prevent development of attachment problems. But such studies have not been carried out. Furthermore, adults with ADHD might need treatment for their lack of attachment competences as well. More research on this topic is much needed.</p

Attachment and effortful control : relationships with maladjustment in early adolescence

Based on former research, it can be assumed that attachment relationships provide a context in which children develop both the effortful control (EC) capacity and the repertoire of responses to regulate distress. Both are important to understand children’s (mal)adjustment. While the latter assumption has been supported in several studies, less is known about links between attachment and EC. We administered questionnaires to measure anxious and avoidant attachment or trust in maternal support in two samples of early adolescents. EC was reported by the child in Sample 1 ( n = 244), and by mother in Sample 2 ( n = 177). In both samples, mothers reported children’s maladjustment. Consistent with predictions, insecure attachment was related to reduced EC. Moreover, EC indirectly linked insecure attachment to maladjustment. This study provides evidence that studying EC is important to understand the self-regulatory mechanisms explaining the link between attachment and (mal)adjustment in early adolescence. </jats:p

Attachment Styles and Identity Status: An Exploratory Study

The present study explored relations between attachment models and identity statuses among young adults. In terms of Erikson’s and Bowlby’s psychosocial theories, internal working models suggestive of a secure infant-caregiver attachment history provide a foundation for successful identity formation; insecure working models may be more likely to relate to other identity statuses. A sample of 320 adults aged 20-35 years completed (on Amazon Mechanical Turk) self-report measures pertaining to internal working models and identity statuses. The result indicates that vast majority of participants, even those with insecure attachment, were identity achievers. However, they have different tendency toward Moratorium and Foreclosure (exploration and commitment) across different attachment styles. Specifically, secure attachment tend to evidence higher level of commitment but lower lever of exploration (more in Foreclosure, less in Moratorium), compared to insecure attachment. Preoccupied individuals, on the other hand, were more likely to be explorative, but found it harder to make commitment (more in Moratorium, less in Foreclosure), compared to individuals with other attachment styles. Limitation and future direction of this study was discussed.No embargoAcademic Major: Psycholog