Attachment

The second stage in answering the question ‘does attachment style correlate with coping style in individuals with BPD?’ is to identify a valid and reliable method o f measuring attachment. This research utilised a new method o f measuring attachment, the Attachment Q-sort.

D o individuals with BPD differ from a psychiatric comparison group with respect to

their attachment style?

Based on previous literature on attachment, two hypotheses were identified. The first hypothesis was that the BPD group and the psychiatric comparison group would differ with regards to preoccupied and disorganised attachment. This hypothesis was not supported by the results obtained with this small population studied. There were no significant differences between the two groups with regards to attachment style (Table 9).

However, the difference between the two groups’ scores on preoccupied attachment and disorganised attachment approached significance. This trend in the data is consistent with the hypothesis that individuals in the BPD group would score higher than the psychiatric comparison group on the preoccupied and disorganised scales o f the Attachment Q-sort. It is also consistent with attachment models o f BPD (De Zulueta, 1999; Fonagy, 2000) and the research into attachment and BPD, where preoccupied attachment and the sub classification o f disorganised attachment have most commonly been assigned (Patrick et al, 1994; Fonagy, et al. 1996). It appears that the most likely explanation for the lack o f a significant difference is that there is not enough power due to the small sample size (Type 2 error).

Are the attachment results explained by the use o f a new attachment measure?

Alternatively, one could argue that it is not sample size but the lack o f sensitivity o f the Q-sort, or the use of only one Q-sort attachment target that has resulted in failure to find a significant difference between the two groups.

In relation to the question o f the sensitivity o f the Attachment Q-sort, it has been demonstrated that the AAI can discriminate between two groups o f 12 individuals with BPD and 12 individuals with dysthymia (Patrick et al, 1994). Although the groups were smaller than the groups in this study, individuals in the BPD group met 7 out o f 8 DSM III criteria for BPD and those in the dysthymic group met none o f the criteria for BPD. In the current sample, no such clear distinction was made between the two groups. Almost all o f the participants in the comparison group met a number o f criteria for BPD, and individuals in the BPD group met between 5 and 9 criteria for the diagnosis. This makes it more likely that, in this study, a larger sample size would be required to find significant differences between the two groups. It is therefore hypothesised that sample size, rather than the insensitivity o f the Attachment Q-sort, is the reason that significant differences in preoccupied and disorganised attachment scores were not found between the BPD and psychiatric comparison group. One way o f exploring this hypothesis further would be to administer both the Attachment Q- sort and the AAI in a sample where both Axis I and Axis II disorders are controlled for.

The fact that the two groups did not differ with regards to either secure or dismissing attachment is also unlikely to be due to the insensitivity o f the Attachment Q-sort. It is probably explained by the high degree o f psychopathology in the psychiatric

comparison group, which is a result o f insecure attachment relationships in childhood - a major aetiological factor in many models o f mental illness.

The fact that similar, if not significant, results to other studies o f attachment were found makes it highly likely that, in a larger sample, the Attachment Q-sort would be effective at discriminating between attachment styles in a BPD group and a psychiatric comparison group. Concurrent research by Fonagy and colleagues (in preparation) comparing attachment classifications on the AAI and attachment styles as measured by the Attachment Q-sort, indicates that it is a reliable measure o f adult attachment styles. The data trends also provide support for the hypothesis that attachment can be measured as a continuous rather than a categorical variable. Further research is needed to assess the impact o f using one target attachment figure on the sensitivity o f the Attachment Q-sort.

Is attachment related to psychopathology?

W ithin the two groups there were no significant correlations between attachment style and number o f BPD criteria met on the SCID II, or severity o f psychopathology as measured by the GSI (Table 11). This may reflect the minimal variance in BPD severity and general psychopathology within each o f the groups. Post hoc analyses o f the entire sample also indicated that there appeared to be no significant relationships between any o f the attachment styles and SCID II scores (Table 12). Bearing in mind the relationship demonstrated between attachment and BPD in previous research, it is likely that that this outcome is due to the sample size.

The post hoc analyses showed a small but significant correlation between scores on the GSI and the preoccupied and disorganised attachment styles o f the Attachment Q- sort (Table 12). This finding is consistent with other research that has demonstrated a relationship between attachment style and severity o f psychiatric symptoms as measured on the GSI (Fonagy et al, 1996), and with Bowlby (1973) and Schore’s (1994) suggestion that parental misattunement is a precursor to psychopathology. However, this finding must be treated with caution as this is a post hoc correlation and only significant at p<.05. It could therefore be the result o f a Type 1 error. (Alternatively, as already discussed, this may be a reflection o f the overlap between severity o f BPD and severity o f psychopathology, because the GSI is a more sensitive measure than the SCID II in a small sample).