Attachment Style & Psychopathology

By Aspasia Venieri

How the attachment style and the early maladaptive schemas can develop psychopathology

According to Bowlby (1982, 1988), infants have an innate repertoire of behaviors that helps them maintain the proximity of others for their survival and coping with distress and threats. He suggested that this attachment system is active throughout life and adults also seek proximity and support when stressed. It develops from early relational experiences with the attachment figures (Bowlby, 1969, 1973). The memories of these experiences, create internal working models (IWM) for the self and others, which are stable attachment styles that guide one’s relational expectations, emotions, and behaviors (Fraley & Schaver, 2000). Ainsworth et. al. (1978), as well as several longitudinal studies reviewed by Milkulincer & Shaver (2003, 2007), and Brennan et al. (1998) measure the attachment along 2 dimensions: Attachment Anxiety & Attachment Avoidance. The attachment styles that derive are the following:

Ι. Anxious Attachment

People with an anxious attachment style in their relationships worry that the other people will not be available and supportive in times of need. Accordingly, they make efforts to maintain closeness to others through hyperactivating strategies (Feenlay & Noller, 1990; Milkulincer et.al.,1998). They appraise threats as extreme and their own coping resources as deficient. They are vigilant regarding potential threats and dangers (Cassidy & Kodak, 1998).

In cognitive therapy, the restrictive Internal Working Models of people with anxious attachment are not deleted but changed through the activation of new or more adaptive ones (Bouton, 2004). Bosmans et al. (2010) suggest the development of new attachment related cognitive schemas which can arise from the relationship with an accepting therapist, increased mentalization experiences, and new more compassionate understanding of previous negative interaction with attachment figures.

ΙΙ. Avoidant Attachment

People with avoidant attachment distrust the people’s goodwill & capacity to help. They make efforts to maintain independence & self-reliance through deactivating strategies. They are reluctant to seek help, based on their previous experiences with their caregivers who were unavailable when they needed them as young children. They deal with stress on their own relying on cognitive and behavioral distancing strategies that suppress threat related thoughts (Birnbaum et. al., 1997; Fraley & Schaver, 1997; Lussier et. al., 1997)

Both, the anxious and the avoidant attachment type possess internal working models of unavailable, unreliable, frustrating, rejecting attachment figures which lead to relevant emotions and behaviors (Milkulincer & Schaver, 2003, 2007).

ΙΙΙ. Fearful Avoidant Attachment

People who combine the internal working models and the behaviors of the above two dimensions develop a Fearful Avoidant Attachment Style feeling more vulnerable under stress (Milkulincer & Schaver, 2003, 2007).

ΙV. Secure Attachment

People with a secure attachment style possess well developed Internal working models of comfort, security, positive self-regard, and have confidence in proximity seeking for support as a means of coping with threats. They hold optimistic attitudes about coping with life’s challenges, possess self-efficacy and remain emotionally stable (Milkulincer & Florian, 1995; Milkulincer et al., 2003; Shorey et al., 2003).

The Internal Working Models that derive from the parental attachment style and affect the way people attach to other people can be conceptualized and have been approached as cognitive schemas (Schorpita & Barlow, 1996; Holmes, 1993; Mason et. al., 2005; Bosmans et. al., 2010; Baldwin et. al., 1993; Bretherton, 1990; Collins & Read, 1994; Waters & Waters, 2006). Schemas are cognitive structures for screening, coding, recalling & evaluating impinging stimuli. They are stable cognitive patterns, specific rules that govern the information processing behavior (Clark, Beck & Alford, 1999).

The anxious attachment style is associated with the ‘sentinel’ schema, which provides faster detection of threat, vigilance, alerting others about danger, efforts to get others provide support. The avoidant attachment style is associated with the rapid fight, flight schema in narratives of threatening events, where the importance of the threatening stimuli is minimized and quick self-protective action is taken, either by escaping or by fighting against the danger (Ein-Dor et al., 2011).

Childhood Emotional Abuse (CEA) predicts insecure attachment in adulthood more than sexual or physical abuse (Riggs & Kaminski, 2010). Furthermore, there is a link between anxious attachment style with physical and psychological forms of intimate partner violence/ perpetrator (Henderson et al., 2005), as well as the use of drugs and decreased emotional maturity (Mortazavi et al., 2012).

The Early Maladaptive Schemas (EMS) are like the internal working models but are not limited only to interpersonal relationships with other people; they may be components of IWMs (Simard et al., 2011). A specific maladaptive schema may remain deactivated until a schema contingent in context or increased in distress activates it. This could explain the attachment’s cross temporal instability. (Fraley,2007; Sroufe, Egeland & Kreutzer, 1990). Every attachment style is associated with a different frequency of Early Maladaptive Schemas. The Fearful Avoidant, which is also called Disorganized by other theorists, has the highest frequency of EMSs, and then the Anxious or else Preoccupied attachment style (Mason et al., 2005).

The unmet childhood needs for secure attachment and adverse experiences may lead to the development of EMSs in adulthood (Young et al., 2003).

Unmet needs:

· Secure attachment to others

· Autonomy, competence & sense of identity

· Freedom to express needs & emotions

· Spontaneity to play

· Realistic limits & self-control

Young et. al. (2003) developed a taxonomy of EMS and assigned them to 5 domains, which differ in cognitive content.

1. Disconnection / Rejection: It is related to traumatic or abusive experiences during childhood.

· There can be no safety, security, contact and response from other people – Emotional Deprivation.

· A relationship with a significant other will not last - Abandonment, Instability

· Others will do anything to satisfy their own needs - Mistrust, Abuse

· One does not belong to any group - Social isolation, Alienation

2. Impaired Autonomy and Performance:

· One cannot function successfully autonomously – Failure

· One is incapable of handling problems – Dependency, Incompetence

· A catastrophe will happen - Vulnerability to harm or illness

3. Overvigilance & Inhibition:

· Not able to control his feelings & impulses - Inhibition

· Must succeed in professional and private life - Unrelenting standards, Hypercriticism

4. Impaired Limits:

· Has difficulty respecting and giving rights and competence to others - Entitlement, Grandiosity

· Is intolerant to frustration towards achieving goals - Insufficient self-control, Self- discipline

5. Other Directedness:

· Is submissive and gives control if his/her life in order to avoid others’ anger - Subjugation

· Satisfies the needs of others, often to self-detriment - Self- sacrifice

Hoffart et al, (2005) separated Young et. al. (2003) schemas in 4 categories:Disconnection, Impaired autonomy , Impaired Limits and Exaggerated Standards

Research shows that these Schemas are associated with psychopathology. Depression, anxiety, eating disorders, emotional exhaustion as well as bad interpersonal relationships and worse adaptation are some of the problems they seem to predict (Freeman et al., 2002; Rittenmeyer, 1997; Stiles, 2004). Schemas of social isolation/alienation, dependency/incompetence, caught obedience, self- control /inadequate self-discipline were the most important predictors of addictive tendencies (Bakhsi & Nikmanesh, 2013).

Cognitive Behavioral Therapy – CBT focuses on identifying the attachment style and the Early maladaptive Schemas that lead to psychopathology and through a wide range of techniques it substitutes it with new or more adaptive positive schemas.

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