The relevance of the attachment theory perspective

Kamis, 14 Januari 2010

There have been many past attempts to illuminate the symptomatology of BPD using attachment theory. Implicitly or explicitly, Bowlby’s (1973) suggestion that early experience with the caregiver serves to organize later attachment relationships has been used in explanations of psychopathology in BPD.

For example, it has been suggested that the borderline person’s experiences of interpersonal attack, neglect, and threats of abandonment may account for their perception of current relationships as attacking and neglectful (Benjamin 1993). Others have suggested that individuals with BPD are specifically characterized by a fearful and pre-occupied attachment style reflecting ‘an emotional template of intimacy anxiety/anger’ (Dutton et al. 1994b). In studies of adult attachment interview (AAI) narratives of BPD patients, the classification of pre-occupied is most frequently assigned (Fonagy et al. 1996) and, within this, the confused, fearful, and overwhelmed sub-classification appears to be most common (Patrick et al. 1994). Past attempts at linking work on attachment with theories of borderline pathology have stressed the common characteristic shared by the ambivalently attached/pre-occupied and borderline groups ‘to check for proximity, signaling to establish contact by pleading or other calls for attention or help, and clinging behaviors’ (Gunderson 1996).

Borderline patients also tend to be unresolved with regard to their experience of trauma or abuse (Patrick et al. 1994; Fonagy et al. 1996). There is no doubt that borderline individuals are insecure in their attachment, but descriptions of insecure attachment from infancy or adulthood provide an inadequate clinical account for several reasons. (1) Anxious attachment is very common; in working class samples the majority of children are anxiously attached (Broussard 1995). (2) Anxious patterns of attachment in infancy correspond to relatively stable adult strategies (Main et al. 1985), yet the hallmark of the disordered attachments of borderline individuals is the absence of stability (Higgitt and Fonagy 1992). (3) In both delinquent and borderline individuals there are variations across situations or types of relationships. The delinquent adolescent is, for example, aware of the mental states of others in his gang and the borderline individual is at times hypersensitive to the emotional states of mental health professionals and family members. (4) The clinical presentation of borderline patients frequently includes a violent attack on the patient’s own body or that of another human being. It is likely that the propensity for such violence must include an additional component that predisposes such individuals to act upon bodies rather than upon minds. An adequate account of the relationship between the individual’s early attachment environment and their later manifestation of the symptoms of BPD requires that the way the individual experiences that environment be taken into account, and that the mere fact of experiencing it, which in Cartesian fashion has historically been viewed as an unproblematic given, be viewed as an achievement determined by developmental factors.