Attachment and Personality Disorders: A Short Review

Attachment theory is a biopsychosocial model referring to a person’s characteristic ways of relating in close relationships, such as with parents, children, and romantic partners. These ways of relating are learned during early infancy and mold subsequent intimate relationships. An adult who is securely attached has internalized a reliable relationship to his/her caregivers in infancy, and thus is capable of adapting to different social contexts and, more importantly, of maintaining an adequate equilibrium between self-regulation and interpersonal regulation of stress. Insecure adult attachment styles are divided into 1) anxious/preoccupied (individuals are hypersensitive to rejection and show compulsive care- and attention-seeking behavior); 2) avoidant/dismissing (individuals are hyposensitive to social interactions, and are socially isolated); and 3) unresolved/disorganized (individuals are unable to cope under stress, thus suffering pervasive affective dysregulation). This review discusses the theoretical, psychological, neuroscientific, and developmental aspects of attachment from an evidence-based perspective. It provides an updated account of the science regarding attachment and its relevance to the etiology, diagnosis, and treatment of mental illness. It examines the privileged relation between attachment and personality disorders (PDs) from multiple angles in order to introduce the most recent psychotherapeutic advances, based on attachment research, for the treatment of PDs, particularly borderline PD. Three effective, evidence-based psychotherapeutic interventions are described: Mentalization-Based Treatment, Transference-Focused Psychotherapy and Schema-Focused Therapy.