Attachment anxiety and avoidance as mediators of the association between childhood maltreatment and adult personality dysfunction.

This paper tests the hypothesis that the association between childhood maltreatment and adult personality dysfunction is at least partially attributable to insecure attachment, that is that attachment style mediates the relationship between childhood maltreatment and adult personality dysfunction. Associations between childhood trauma, as measured by the Childhood Trauma Questionnaire (CTQ), anxious and avoidant attachment in romantic relationships, as measured by the Experiences in Close Relationships-Revised (ECR-R), and five personality domains, as measured by the Severity Indices of Personality Problems (SIPP-118), were examined in a sample of 72 psychiatric inpatients. The SIPP-118 domains included relational capacities, identity integration, self-control, responsibility, and social concordance. The direct effect of childhood trauma on all SIPP-118 domains was not significant after controlling for the indirect effect of attachment. In regression modeling, a significant indirect effect of childhood trauma via adult attachment style was found for SIPP-118 relational capacities, identity integration, self-control, and social concordance. Specifically, anxious attachment was a significant mediator of the effect of childhood trauma on self-control, identity integration, and relational domains. These results suggest that childhood trauma impacts a broad range of personality domains and does so in large part through the pathway of anxious romantic attachment style.

How do different types of childhood maltreatment relate to adult personality pathology?

There are insufficient data investigating the relative associations between different kinds of childhood maltreatment and the severity of adult personality pathology. Personality pathology and childhood maltreatment (sexual, physical, and emotional abuse and neglect) were assessed in 156 nonpsychotic psychiatric patients. Measures included the Personality Diagnostic Questionnaire for DSM-IV (PDQ-4+), the Childhood Trauma Questionnaire (CTQ), the Multidimensional Neglectful Behavior Scale (MNBS), and the Conflict Tactics Scales Parent-Child version (CTSPC-CA). Bivariate logistic regression analyses revealed each maltreatment type to significantly correlate with adult personality pathology. However, in multivariate logistic analyses controlling for education, neglect and emotional abuse were the only significant predictors of adult personality pathology (adjusted odds ratio [AOR] for MNBS neglect, 3.60; AOR for CTQ emotional abuse, 3.81). Analysis of the CTSPC-CA yielded a strong effect on maternal (AOR, 3.71) but not paternal neglect. These data suggest that clinicians should routinely evaluate for histories of neglect and emotional abuse, particularly in patients with marked personality pathology.

Severity of personality disorders and domains of general personality dysfunction related to attachment.

This is the first study to link attachment to both severity of total DSM-IV personality disorder (PD) traits and domains of general personality dysfunction, using a sample of 72 inpatients from New York City. We assessed a measure of global PD severity and the core domains of personality functioning using the severity indices of personality problems (SIPP-118). Attachment was measured with the experience in close relationships-revised (ECR-R) and the relationship style questionnaire (RSQ). Global PD severity correlated most strongly with attachment anxiety (r = 0.65). Regression of the SIPP-118 domains on attachment produced models that accounted for a substantial proportion of variance in those scales (R(2) ranging from 28.2 to 54.2%). SIPP-118 relational capacities were the strongest predictor of ECR-R avoidance (ß = -0.88) and anxiety (ß = -0.58), as well as RSQ secure (ß = 0.53) and fearful (ß = -0.65). In conclusion, insecure attachment strongly related to the severity of global PD traits and specifically to relational capacities, which are a higher-order domain of general personality dysfunction. These findings provide further evidence that interpersonal problems are at the core of PDs and that attachment could constitute an important mediator of the social dysfunction in persons with personality pathology.

Are there differential relationships between different types of childhood maltreatment and different types of adult personality pathology?

While considerable data support the relationship between childhood trauma and adult personality pathology in general, there is little research investigating the specific relationships between different types of childhood maltreatment and adult personality disorders. The present study tested a model incorporating five a priori hypotheses regarding the association between distinct forms of childhood maltreatment and personality pathology in 231 psychiatric patients using multiple self-report measures (Personality Diagnostic Questionnaire-4th Edition, Child Trauma Questionnaire, Conflict in Tactics Scale Parent-Child Child-Adult, and Multidimensional Neglectful Behavior Scale). Step-wise linear regressions supported three out of five hypotheses, suggesting independent relationships between: physical abuse and antisocial personality disorder traits; emotional abuse and Cluster C personality disorder traits; and maternal neglect and Cluster A personality disorder traits after controlling for co-occurring maltreatment types and personality disorder traits. Results did not support an independent relationship between sexual abuse and borderline personality traits nor between emotional abuse and narcissistic personality disorder traits. Additionally, there were three unexpected findings: physical abuse was independently and positively associated with narcissistic and paranoid traits and negatively associated with Cluster C traits. These findings can help refine our understanding of adult personality pathology and support the future development of clinical tools for survivors of childhood maltreatment.