Abstract
Little is known about the contribution of attachment insecurity to Obsessive–Compulsive Disorder (OCD), though speculations have been extensive. We aimed to study how states of mind (SoM) with regard to attachment relate to OCD with and without depressive disorder (DD). We interviewed 100 adolescents, 25 each with OCD, DD, OCD plus DD and general population controls, using the Adult Attachment Interview (AAI) to assess attachment SoM. In the AAI, interviewees are asked about both generalized/semantic and biographical/episodic descriptions of childhood experience. Discourse styles are coded and classified by a blinded coder. While about half of the adolescents from the general population had secure SoM (52%), most adolescents in the clinical groups did not: OCD 12%; DD 8%; and DD + OCD 4% (Fisher’s exact test, p = 0.0001). SoM with regard to attachment profiles differed significantly across the groups with 60% of participants with OCD classified as dismissing (Ds), 40% of the DD group as unresolved with regard to loss or abuse (U) and 28% as cannot classify, while 44 and 36%, respectively, of those with OCD + DD group were classified as either Ds or U (Fisher’s exact test, p = 0.0001). Different kinds of SoM reflecting insecure attachment differentiated the clinical groups studied, with OCD predominantly showing dismissing traits and depression attachment SoM commonly associated with severe adverse events. Such differences might play distinct roles in the pathogenic processes of the psychiatric disorders, or be the result of the cognitive states associated with OCD and DD.
Similar content being viewed by others
Abbreviations
- SoM:
-
States of mind
- OCD:
-
Obsessive compulsive disorder
- DD:
-
Depressive disorder
- F:
-
Free/autonomous attachment
- Ds:
-
Dismissing of attachment
- E:
-
Enmeshed/preoccupied with childhood attachment experience
- CC:
-
Cannot classify
- U:
-
Unresolved with regard to loss and/or abuse
References
Ainsworth MDS, Blehar MC, Waters E, Wall S (1978) Patterns of attachment. Erlbaum, Hillsdale
Bakermans-Kranenburg MJ, van IJzendoorn MH (1993) A psychometric study of the adult attachment interview: reliability and discriminant validity. Dev Psychol 29:870–879
Bowlby J (1973) Attachment and loss, volume II separation: anxiety and anger. Penguin Books, London
Bowlby J (1980) Attachment and loss, volume III loss: sadness and depression. Penguin Books, London
Bowlby J (1982) Attachment and loss: volume 1: attachment. Pelican Books, New York
Carlson EA (1998) A prospective longitudinal study of attachment disorganization/disorientation. Child Dev 69:1107–1128
Crowell JA, Waters E, Treboux D, O’Connor EO, Colon-Downs C, Feider O, Golby B, Posada (1996) Discriminant validity of the Adult Attachment Interview. Child Dev 67:2584–2599
Diamond GM, Diamond GS, Hogue A (2007) Attachment-based family therapy: adherence and differentiation. J Marital Fam Ther 33:177–191
Doron G, Kyrios M (2005) Obsessive compulsive disorder: a review of possible specific internal representations within a broader cognitive theory. Clin Psychol Rev 25:415–432
Dozier M, Stoval-McClough KC, Albus KE (2008) Attachment and psychopathology in adulthood. In: Cassidy J, Shaver P (eds) Handbook of attachment, 2nd edn. The Guilford Press, New York, pp 718–744
Duggal S, Carlson EA, Sroufe LA, Egeland B (2001) Depressive symptomatology in childhood and adolescence. Dev Psychopathol 13:143–164
Fonagy P, Gergely G, Target M (2007) The parent–infant dyad and the construction of the subjective self. J Child Psychol Psychiatry 48:288–328
George C, Kaplan N, Main M (1996) The Adult Attachment Interview. Unpublished manuscript
Hesse E (2008) The Adult Attachment Interview: historical and current perspectives. In: Cassidy J, Shaver PR (eds) Handbook of attachment: theory, research and clinical applications, 2nd edn. Guilford, New York, pp 465–473
Heyman I, Fombonne E, Simmons H, Ford T, Meltzer H, Goodman R (2001) Prevalence of obsessive–compulsive disorder in the British nationwide survey of child mental health. Br J Psychiatry 179:324–329
Ivarsson T (2008) Obsessive–compulsive disorder in adolescence: an AAI perspective. In: Steele H, Steele M (eds) Clinical applications of the adult attachment interview. Guildford, New York
Ivarsson T, Melin K, Wallin L (2008) Categorical and dimensional aspects of co-morbidity in obsessive–compulsive disorder (OCD). Eur Child Adolesc Psychiatry 17:20–31
Kaufman J, Birmaher B, Brent DA, Ryan ND, Rao U (2000) K-SADS-PL. J Am Acad Child Adolesc Psychiatry 39:1208–1212
Kobak RR, Ferenz Gillies R (1995) Emotion regulation and depressive symptoms during adolescence: a functionalist perspective, special issue: emotions in developmental psychopathology. Dev Psychopathol 7:183–192
Main M, Goldwyn R, Hesse E (2003) Adult attachment scoring and classification system. In: Main M (ed) Assessing attachment through discourse, drawings and reunion situations (working title). Cambridge University Press, New York, (accepted for publication)
Main M, Solomon R (1990) Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In: Greenberg MT, Cicchetti D, Cummings EM (eds) Attachment in the preschool years: theory, research and intervention. University of Chicago Press, Chicago, pp 121–160
Parker G, Tupling H, Brown LB (1979) A parental bonding instrument. Br J Med Psychol 52:1–10
Pauls DL (2008) The genetics of obsessive compulsive disorder: a review of the evidence. Am J Med Genet C Semin Med Genet 148:133–139
Rosenstein DS, Horowitz HA (1996) Adolescent attachment and psychopathology. J Consult Clin Psychol 64:244–253
Sroufe LA, Egeland B, Carlson EA, Collins WA (2005) The development of the person. The Guildford Press, New York
Thompson R (2008) Early attachment and later development. In: Cassidy J, Shaver PR (eds) Handbook of attachment: theory, research and clinical applications, 2nd edn. Guilford, New York, pp 348–365
Turgeon L, O’Connor KP, Marchand A, Freeston MH (2002) Recollections of parent–child relationships in patients with obsessive–compulsive disorder and panic disorder with agoraphobia. Acta Psychiatr Scand 105:310–316
Valderhaug R, Ivarsson T (2005) Functional impairment in clinical samples of Norwegian and Swedish children and adolescents with obsessive–compulsive disorder. Eur Child Adolesc Psychiatry 14:164–173
Valleni-Basile LA, Garrison CZ, Jackson KL, Waller JL, McKeown RE, Addy CL, Cuffe SP (1994) Frequency of obsessive–compulsive disorder in a community sample of young adolescents. J Am Acad Child Adolesc Psychiatry 33:782–791
Van Grootheest DS, Bartels M, van Beijsterveldt CE, Cath DC, Beekman AT, Hudziak JJ, Boomsma DI (2008) Genetic and environmental contributions to self-report obsessive–compulsive symptoms in Dutch adolescents at ages 12, 14, and 16. J Am Acad Child Adolesc Psychiatry [Epub ahead of print]
van Grootheest DS, Cath DC, Beekman AT, Boomsma DI (2005) Twin studies on obsessive–compulsive disorder: a review. Twin Res Hum Genet 8:450–458
van IJzendoorn MH, Schuengel C, Bakermans-Kranenburg MJ (1999) Disorganized attachment in early childhood: meta-analysis of precursors, concomitants, and sequelae. Dev Psychopathol 11:225–249
van IJzendoorn MH (1995) Adult attachment representations, parental responsiveness, and infant attachment: a meta-analysis on the predictive validity of the adult attachment interview. Psychol Bull 117:387–403
van IJzendoorn MH, Bakermans-Kranenburg MJ (1996) Attachment representations in mothers, fathers, adolescents, and clinical groups: a meta-analytic search for normative data. J Consult Clin Psychol 64:8–21
van IJzendoorn MH, Bakermans-Kranenburg MJ (2008) The distribution of adult attachment representations in clinical groups: a meta-analytic search for patterns of attachment in 105 AAI studies. In: Steele H, Steele M (eds) Clincial applications of the adult attachment interview, 1st edn. The Guilford Press, New York, pp 69–96
Vogel PA, Stiles TC, Nordahl HM (1997) Recollections of parent–child relationships in OCD out-patients compared to depressed out-patients and healthy controls. Acta Psychiatr Scand 96:469–474
Warren SL, Huston L, Egeland B, Sroufe LA (1997) Child and adolescent anxiety disorders and early attachment. J Am Acad Child Adolesc Psychiatry 36:637–644
Waters E, Merrick S, Treboux D, Crowell J, Albersheim L (2000) Attachment security in infancy and early adulthood: a twenty-year longitudinal study. Child Dev 71:684–689
Watson HJ, Rees CS (2008) Meta-analysis of randomized, controlled treatment trials for pediatric obsessive–compulsive disorder. J Child Psychol Psychiatry 49:489–498
Welner Z, Reich W, Herjanic B, Jung KG, Amado H (1987) Reliability, validity, and parent–child agreement studies of the Diagnostic Interview for Children and Adolescents (DICA). J Am Acad Child Adolesc Psychiatry 26:649–653
Acknowledgments
We are grateful to the Söderström-Königska Research foundation for economical support and to the interviewees who told us about their lives, a task that sometimes was painful. We are also grateful to Inger Ivarsson for transcribing the interviews.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ivarsson, T., Granqvist, P., Gillberg, C. et al. Attachment states of mind in adolescents with Obsessive–Compulsive Disorder and/or depressive disorders: a controlled study. Eur Child Adolesc Psychiatry 19, 845–853 (2010). https://doi.org/10.1007/s00787-010-0120-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00787-010-0120-x