Low quality in early attachment bondings as possible predictor of adult depressive disorder

Bassa qualità dei legami d’attaccamento precoci come fattore predittivo di disturbi depressivi nell’adulto

C. Visioli1, R. Senatore2, B. Lepri1, L. Tondo1,3

1 Centro Lucio Bini per la ricerca sui Disturbi dell’Umore, Cagliari; 2 Dipartimento di Psicologia, Università di Cagliari; 3 Department of Psychiatry Harvard Medical School, McLean Hospital, Boston, MA

Developmental antecedents described by Internal Working Models (IWM) of attachment may be predictors of adult psychopathology. Studies carried out to study attachment in adults point out that internalized models of relationship in childhood may be associated with psychiatric pathology during adulthood. Low levels of care and high levels of control in parental bondings, and also current insecure relationships, have been often detected in patients with depressive disorders.


In order to investigate the association between current style of attachment and past experiences and to evaluate the connection between depressive symptoms and attachment.


We compared a group of patients with DSM-IV-TR major depressive episode or dysthymic disorder (DG) with a control group (CG) and assessed their security in attachment relationships, security- insecurity levels in current relationships, and the association between past memories and current relational style. The final sample of 187 subjects have been evaluated with two questionnaires: Parental Bonding Instrument (PBI) and Attachment Style Questionnaire (ASQ). DG (N = 86) from a mood disorder outpatient clinic in Cagliari (Sardinia) were compared to a GC (N = 101). Data were statistically analyzed by ANOVA and MANOVA.


Consistent with clinical experience, we found significant results for both PBI and ASQ. Patients with depressive disorder showed: a) lower parental Care (Maternal: GD = 20.8 < GC = 26.1; Paternal: GD = 17.9 < GC = 22.4); b) higher Control-Overprotection (Maternal: GD = 19.1 > GC = 13.2; Paternal: GD = 16.3 > GC = 11.4; Table II); in current relationships, c) lower levels of Confidence (GD = 28.9 < GC = 32.5); d) higher scores in Relationships as Secondary (GD = 16.6 > GC = 14.1); e) similarly higher values at Preoccupation with Relationships (GD = 30.7 > GC = 25.7); and f) higher score at Need for Approval (GD = 24.2 > GC = 17.4; Table II). Variables independently and significantly associated with depressive disorder were lower level of Maternal Care and higher scores at Relationships as Secondary and at Need for Approval (Table III). Conclusions
Our findings tend to confirm the association between depressive disorder and past “affectionless control”-type bondings, which may be associated with insecure attachment styles in childhood. In the same depressive group, current relationships appeared also defined by insecurity on the direction of both Avoidance and Anxiety. These characteristics are in fact usually found in the typical lack of confidence and self-esteem of depressive patients. Moreover, attachment insecurity appears to be a common feature of psychopathological populations, including depressive persons. An assessment with explanatory indexes, such as those associated with early and current attachment style, may help to enhance symptomatology description by DSM-IV, referring to lifelong concrete and meaningful experiences. Having knowledge of emotional experiences and individual beliefs starting in early attachment relationships may provide to the clinician useful information to feel with the patient, his situations of vulnerability and, thus, the only and particular significance of symptoms that express his current pain. Such an assessment also can account for those persons who do not fit in all standardized diagnostic criteria.

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