Adult attachment status and psychological disorder: the predictive validity of adult attachment in violent, personality-disordered patients

This thesis explores the role of attachment in a group of violent, personality-disordered patients in a high secure hospital. The research examines the mental representation of attachment and the perception of parenting, as assessed by the Adult Attachment Interview and the Parental Bonding Instrument, in this patient group and examines whether these differ from those of non-violent psychiatric patients. A prospective study examines whether the attachment measures predict change across a range of outcomes for this group of violent, personality-disordered patients. This thesis begins with a qualitative literature review on attachment and the development of psychopathology, focussing on attachment and psychiatric disorder in adulthood. The question as to whether particular attachment classifications are associated with specific psychiatric disorders is further investigated by a systematic review and meta-analyses. The meta-analytic results show that insecure attachment acts as a general vulnerability factor for the development of mental disorder. The distribution of Adult Attachment Interview classifications in these violent, personality-disordered patients significantly differed from non-violent patients. In particular there was an over-representation of individuals with Dismissing and Cannot Classify states of mind and an under-representation of patients who were Unresolved for loss and trauma. Additionally the violent personality-disordered patients had an impaired capacity to mentalize as evidenced by their low level of reflective functioning; especially patients with Dismissing attachments. This deficit is seen as a critical mediating mechanism between Dismissing attachment states of mind and violent behaviour. No one attachment measure predicted change across the outcome measures. However patients with Dismissing and Cannot Classify attachment representations improved in terms of the frequency and severity of their violent and aggressive behaviour. Patients with Preoccupied states of mind made the least progress. The results suggest that these particular attachment states of mind are predictive of change in the violent behavioural trajectory of these patients

Impaired social status of growth hormone deficient adults as compared to controls with short or normal stature

Summary OBJECTIVES In adults with growth hormone deficiency (GHD) social problems have been reported, but so far the relative contributions of GHD, additional pituitary deficiencies and short stature have not been distinguished. We therefore compared social data from GHD patlents wlth soclal date from controls wlth short or normal stature. Furthermore we Investigated whether social problems are caused solely by the deficiency of OH or also by the associated absence of other pitultary hormones. DESIGN A questionnaire was sent to patient8 and controls with items on education, profession, income, partner and living situation. PATIENTS Two hundred and ten GHD patients treated in chlldhood but not in adulthood wlth GH (93 isolated GHD (IGHD), 111 patients with multiple pltultary deficiency (MPD)) were compared wlth 53 short controls (helght In chlldhood <third percentile for population) and 39 normal stature controls. RESULTS There were no differences between short and normal controls. There were also no differences between IGHD and MPD patients in any of the Investigated Items. GHD patients did not differ from controls on education level, but scored lower on the profession scale, had a lower Income and had a partner less often; If they had a partner they less often had children; also, more of them lived with their parents