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Gepubliceerd in: Cognitive Therapy and Research 3/2010

01-06-2010 | Original Article

Adult Attachment Orientations, Depressive Symptoms, Anger, and Self-Directed Aggression by Psychiatric Patients

Auteurs: Barbara Gormley, Dale E. McNiel

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 3/2010

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Abstract

This study applied adult attachment theory to better understand self-directed aggression, defined as suicide attempts and nonsuicidal self-injury, reported by 109 hospitalized psychiatric patients. As expected, patients with higher levels of adult attachment anxiety were more likely to report suicide attempts and self-injury. We tested depressive symptoms and anger as mediators of the relationship between attachment orientations and self-directed aggression. As hypothesized, depressive symptoms partially mediated the relationship between attachment anxiety and self-directed aggression, but unexpectedly, anger did not. The results support that levels of depression partially explain the associations between attachment anxiety and self-directed aggression. Subsidiary analyses suggested that patients with higher levels of adult attachment avoidance were more likely to report histories of nonsuicidal self-injury but not suicide attempts. Implications for research and practice are discussed.
Literatuur
go back to reference Adam, K. S., Sheldon-Keller, A. E., & West, M. (1996). Attachment organization and history of suicidal behavior in clinical adolescents. Journal of Consulting and Clinical Psychology, 64, 264–272.CrossRefPubMed Adam, K. S., Sheldon-Keller, A. E., & West, M. (1996). Attachment organization and history of suicidal behavior in clinical adolescents. Journal of Consulting and Clinical Psychology, 64, 264–272.CrossRefPubMed
go back to reference Alexander, P. C., & Anderson, C. L. (1994). An attachment approach to psychotherapy with the incest survivor. Psychotherapy, 31, 665–675. Alexander, P. C., & Anderson, C. L. (1994). An attachment approach to psychotherapy with the incest survivor. Psychotherapy, 31, 665–675.
go back to reference American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
go back to reference Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226–244.CrossRefPubMed Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226–244.CrossRefPubMed
go back to reference Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. A. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.PubMed Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. A. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.PubMed
go back to reference Bifulco, A., Moran, P. M., Ball, C., & Bernazzani, O. (2002). Adult attachment style. I: Its relationship to clinical depression. Social Psychiatry & Psychiatric Epidemiology, 37, 50–59.CrossRef Bifulco, A., Moran, P. M., Ball, C., & Bernazzani, O. (2002). Adult attachment style. I: Its relationship to clinical depression. Social Psychiatry & Psychiatric Epidemiology, 37, 50–59.CrossRef
go back to reference Biringen, Z. (1994). Attachment theory and research: Application to clinical practice. American Journal of Orthopsychiatry, 64, 404–420.CrossRefPubMed Biringen, Z. (1994). Attachment theory and research: Application to clinical practice. American Journal of Orthopsychiatry, 64, 404–420.CrossRefPubMed
go back to reference Blair-West, G. W., Cantor, C. H., Mellsop, G. W., & Eyeson-Annan, M. L. (1999). Lifetime suicide risk in major depression: Sex and age determinants. Journal of Affective Disorders, 55, 171–178.CrossRefPubMed Blair-West, G. W., Cantor, C. H., Mellsop, G. W., & Eyeson-Annan, M. L. (1999). Lifetime suicide risk in major depression: Sex and age determinants. Journal of Affective Disorders, 55, 171–178.CrossRefPubMed
go back to reference Bongard, S., Müller, C., Heiligtag, U., Rüddel, H., & Hodapp, V. (2001). Dispositional expression of anger and suicidal acts of patients of a psychosomatic hospital. Zeitschrift Fuer Klinishche Psychologie, Psychiatrie und Psychotherapie, 49, 185–196. Bongard, S., Müller, C., Heiligtag, U., Rüddel, H., & Hodapp, V. (2001). Dispositional expression of anger and suicidal acts of patients of a psychosomatic hospital. Zeitschrift Fuer Klinishche Psychologie, Psychiatrie und Psychotherapie, 49, 185–196.
go back to reference Brennan, K. A., & Shaver, P. R. (1995). Dimensions of adult attachment, affect regulation, and romantic relationship functioning. Personality and Social Psychology Bulletin, 21, 267–283.CrossRef Brennan, K. A., & Shaver, P. R. (1995). Dimensions of adult attachment, affect regulation, and romantic relationship functioning. Personality and Social Psychology Bulletin, 21, 267–283.CrossRef
go back to reference Brent, D. A., Emslie, G. J., Asarnow, J., Spirito, A., Ritz, L., Vitiello, B., et al. (2009). Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study. American Journal of Psychiatry, 166, 418–426.CrossRefPubMed Brent, D. A., Emslie, G. J., Asarnow, J., Spirito, A., Ritz, L., Vitiello, B., et al. (2009). Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study. American Journal of Psychiatry, 166, 418–426.CrossRefPubMed
go back to reference Brown, M. Z., Comtois, K. A., & Linehan, M. A. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorders. Journal of Abnormal Psychology, 111, 198–202.CrossRefPubMed Brown, M. Z., Comtois, K. A., & Linehan, M. A. (2002). Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorders. Journal of Abnormal Psychology, 111, 198–202.CrossRefPubMed
go back to reference Comtois, K. A. (2002). A review of interventions to reduce the prevalence of parasuicide. Psychiatric Services, 53, 1138–1144.CrossRefPubMed Comtois, K. A. (2002). A review of interventions to reduce the prevalence of parasuicide. Psychiatric Services, 53, 1138–1144.CrossRefPubMed
go back to reference Cooper, M. L., Shaver, P. R., & Collins, N. L. (1998). Attachment styles, emotion regulation, and adjustment in adolescence. Journal of Personality and Social Psychology, 74, 1380–1397.CrossRefPubMed Cooper, M. L., Shaver, P. R., & Collins, N. L. (1998). Attachment styles, emotion regulation, and adjustment in adolescence. Journal of Personality and Social Psychology, 74, 1380–1397.CrossRefPubMed
go back to reference Eagle, M. N. (2006). Attachment, psychotherapy, and assessment: A commentary. Journal of Consulting and Clinical Psychology, 74, 1086–1097.CrossRefPubMed Eagle, M. N. (2006). Attachment, psychotherapy, and assessment: A commentary. Journal of Consulting and Clinical Psychology, 74, 1086–1097.CrossRefPubMed
go back to reference Fonagy, P., Leigh, T., Steele, M., Steele, H., Kennedy, R., Mattoon, G., et al. (1996). The relation of attachment status, psychiatric classification, and response to psychotherapy. Journal of Consulting and Clinical Psychology, 64, 22–31.CrossRefPubMed Fonagy, P., Leigh, T., Steele, M., Steele, H., Kennedy, R., Mattoon, G., et al. (1996). The relation of attachment status, psychiatric classification, and response to psychotherapy. Journal of Consulting and Clinical Psychology, 64, 22–31.CrossRefPubMed
go back to reference Fraley, R. C., & Waller, N. G. (1998). Adult attachment patterns: A test of the typological model. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 77–114). New York: Guilford. Fraley, R. C., & Waller, N. G. (1998). Adult attachment patterns: A test of the typological model. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 77–114). New York: Guilford.
go back to reference Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item response theory analysis of self- report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350–365.CrossRefPubMed Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item response theory analysis of self- report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350–365.CrossRefPubMed
go back to reference Fuendeling, J. M. (1998). Affect regulation as a stylistic process within adult attachment. Journal of Social and Personal Relationships, 15, 291–322.CrossRef Fuendeling, J. M. (1998). Affect regulation as a stylistic process within adult attachment. Journal of Social and Personal Relationships, 15, 291–322.CrossRef
go back to reference George, C., & West, M. (1999). Developmental vs. social personality models of adult attachment and mental ill health. British Journal of Medical Psychology, 72, 285–303.CrossRefPubMed George, C., & West, M. (1999). Developmental vs. social personality models of adult attachment and mental ill health. British Journal of Medical Psychology, 72, 285–303.CrossRefPubMed
go back to reference Gormley, B. (2004). Application of adult attachment theory to treatment of chronically suicidal, traumatized women. Psychotherapy: Theory/Research/Practice/Training, 41, 136–143.CrossRef Gormley, B. (2004). Application of adult attachment theory to treatment of chronically suicidal, traumatized women. Psychotherapy: Theory/Research/Practice/Training, 41, 136–143.CrossRef
go back to reference Hammen, C. L., Burge, D., Daley, S. E., Davila, J., Paley, B., & Rudolph, K. D. (1995). Interpersonal attachment cognitions and prediction of symptomatic responses to interpersonal stress. Journal of Abnormal Psychology, 104, 436–443.CrossRefPubMed Hammen, C. L., Burge, D., Daley, S. E., Davila, J., Paley, B., & Rudolph, K. D. (1995). Interpersonal attachment cognitions and prediction of symptomatic responses to interpersonal stress. Journal of Abnormal Psychology, 104, 436–443.CrossRefPubMed
go back to reference Hankin, B. L., Kassel, J. D., & Abela, J. R. Z. (2005). Adult attachment dimensions and specificity of emotional distress symptoms: Prospective investigations of cognitive risk and interpersonal stress generation as mediating mechanisms. Personality and Social Psychology Bulletin, 31, 136–151.CrossRefPubMed Hankin, B. L., Kassel, J. D., & Abela, J. R. Z. (2005). Adult attachment dimensions and specificity of emotional distress symptoms: Prospective investigations of cognitive risk and interpersonal stress generation as mediating mechanisms. Personality and Social Psychology Bulletin, 31, 136–151.CrossRefPubMed
go back to reference Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511–524.CrossRefPubMed Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511–524.CrossRefPubMed
go back to reference Hintikka, J., Viinamaki, H., Koivumaa-Honkanen, H.-T., Saarinen, P., Tanskanen, A., & Lehtonen, J. (1998). Risk factors for suicidal ideation in psychiatric patients. Social Psychiatry and Psychiatric Epidemiology, 33, 235–240.CrossRefPubMed Hintikka, J., Viinamaki, H., Koivumaa-Honkanen, H.-T., Saarinen, P., Tanskanen, A., & Lehtonen, J. (1998). Risk factors for suicidal ideation in psychiatric patients. Social Psychiatry and Psychiatric Epidemiology, 33, 235–240.CrossRefPubMed
go back to reference Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence and risk factors for lifetime suicide attempts in the national comorbidity survey. Archives of General Psychiatry, 56, 617–626.CrossRefPubMed Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence and risk factors for lifetime suicide attempts in the national comorbidity survey. Archives of General Psychiatry, 56, 617–626.CrossRefPubMed
go back to reference Kidd, T., & Sheffield, D. (2005). Attachment style and symptom reporting: Examining the mediating effects of anger and social support. British Journal of Health Psychology, 10, 531–541.PubMed Kidd, T., & Sheffield, D. (2005). Attachment style and symptom reporting: Examining the mediating effects of anger and social support. British Journal of Health Psychology, 10, 531–541.PubMed
go back to reference Kimball, J. S., & Diddams, M. (2007). Affect regulation as a mediator of attachment and deliberate self-harm. Journal of College Counseling, 10, 44–53. Kimball, J. S., & Diddams, M. (2007). Affect regulation as a mediator of attachment and deliberate self-harm. Journal of College Counseling, 10, 44–53.
go back to reference Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 23, 226–239.CrossRef Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical Psychology Review, 23, 226–239.CrossRef
go back to reference Klonsky, E. D., Oltmans, T. F., & Turkheimer, E. (2003). Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. American Journal of Psychiatry, 160, 1501–1508.CrossRefPubMed Klonsky, E. D., Oltmans, T. F., & Turkheimer, E. (2003). Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. American Journal of Psychiatry, 160, 1501–1508.CrossRefPubMed
go back to reference MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007a). Mediation analysis. Annual Review of Psychology, 58, 593–614.CrossRefPubMed MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007a). Mediation analysis. Annual Review of Psychology, 58, 593–614.CrossRefPubMed
go back to reference MacKinnon, D. P., Fritz, M. S., Williams, J., & Lockwood, C. M. (2007b). Distribution of the product confidence limits for the indirect effect: Program PRODCLIN. Behavior Research Methods, 39, 384–389.PubMed MacKinnon, D. P., Fritz, M. S., Williams, J., & Lockwood, C. M. (2007b). Distribution of the product confidence limits for the indirect effect: Program PRODCLIN. Behavior Research Methods, 39, 384–389.PubMed
go back to reference Maiuro, R. D., O’Sullivan, M. J., Michael, M. C., & Vitaliano, P. P. (1989). Anger, hostility, and depression in assaultive versus suicide-attempting males. Journal of Clinical Psychology, 45, 531–541.CrossRefPubMed Maiuro, R. D., O’Sullivan, M. J., Michael, M. C., & Vitaliano, P. P. (1989). Anger, hostility, and depression in assaultive versus suicide-attempting males. Journal of Clinical Psychology, 45, 531–541.CrossRefPubMed
go back to reference McKeon, R. (2009). Suicidal behavior. Cambridge, MA: Hogrefe & Huber. McKeon, R. (2009). Suicidal behavior. Cambridge, MA: Hogrefe & Huber.
go back to reference McNiel, D. E., Eisner, J. P., & Binder, R. L. (2003). The relationship between aggressive attributional style and violence by psychiatric patients. Journal of Consulting and Clinical Psychology, 71, 399–403.CrossRefPubMed McNiel, D. E., Eisner, J. P., & Binder, R. L. (2003). The relationship between aggressive attributional style and violence by psychiatric patients. Journal of Consulting and Clinical Psychology, 71, 399–403.CrossRefPubMed
go back to reference Mikulincer, M. (1998). Adult attachment style and individual differences in functional versus dysfunctional experiences of anger. Journal of Personality and Social Psychology, 74, 513–524.CrossRefPubMed Mikulincer, M. (1998). Adult attachment style and individual differences in functional versus dysfunctional experiences of anger. Journal of Personality and Social Psychology, 74, 513–524.CrossRefPubMed
go back to reference Mikulincer, M., & Orbach, I. (1995). Attachment styles and repressive defensiveness: The accessibility and architecture of affective memories. Journal of Personality and Social Psychology, 68, 917–925.CrossRefPubMed Mikulincer, M., & Orbach, I. (1995). Attachment styles and repressive defensiveness: The accessibility and architecture of affective memories. Journal of Personality and Social Psychology, 68, 917–925.CrossRefPubMed
go back to reference Muehlenkamp, J. J., Swanson, J. D., & Brausch, A. M. (2005). Self-objectification, risk taking, and self-harm in college women. Psychology of Women Quarterly, 29, 24–32.CrossRef Muehlenkamp, J. J., Swanson, J. D., & Brausch, A. M. (2005). Self-objectification, risk taking, and self-harm in college women. Psychology of Women Quarterly, 29, 24–32.CrossRef
go back to reference Nixon, M. K., Cloutier, P., & Jansson, S. M. (2008). Nonsuicidal self-harm in youth: A population-based survey. Canadian Medical Association Journal, 17, 306–312. Nixon, M. K., Cloutier, P., & Jansson, S. M. (2008). Nonsuicidal self-harm in youth: A population-based survey. Canadian Medical Association Journal, 17, 306–312.
go back to reference O’Connor, R. C., Connery, H., & Cheyne, W. M. (2000). Hopelessness: the role of depression, future directed thinking and cognitive vulnerability. Psychology, Health & Medicine, 5, 155–161.CrossRef O’Connor, R. C., Connery, H., & Cheyne, W. M. (2000). Hopelessness: the role of depression, future directed thinking and cognitive vulnerability. Psychology, Health & Medicine, 5, 155–161.CrossRef
go back to reference Rudd, M. D., Joiner, T. E., Trotter, D., Williams, B., & Cordero, L. (2009). The psychosocial treatment of suicidal behavior: A critique of what we know (and don’t know). In P. K. Kleespies (Ed.), Behavioral emergencies: An evidence based resource for evaluating and managing risk of suicide, violence, and victimization (pp. 339–350). Washington, D.C.: American Psychological Association.CrossRef Rudd, M. D., Joiner, T. E., Trotter, D., Williams, B., & Cordero, L. (2009). The psychosocial treatment of suicidal behavior: A critique of what we know (and don’t know). In P. K. Kleespies (Ed.), Behavioral emergencies: An evidence based resource for evaluating and managing risk of suicide, violence, and victimization (pp. 339–350). Washington, D.C.: American Psychological Association.CrossRef
go back to reference Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. (2007). Rebuilding the Tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors part 2: Suicide-related ideations, communications, and behaviors. Suicide and Life-threatening Behavior, 7, 264–277.CrossRef Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. (2007). Rebuilding the Tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors part 2: Suicide-related ideations, communications, and behaviors. Suicide and Life-threatening Behavior, 7, 264–277.CrossRef
go back to reference Simpson, J. A., Rholes, W. S., & Nelligan, J. S. (1992). Support seeking and support giving within couples in an anxiety-provoking situation: The role of attachment styles. Journal of Personality and Social Psychology, 62, 434–446.CrossRef Simpson, J. A., Rholes, W. S., & Nelligan, J. S. (1992). Support seeking and support giving within couples in an anxiety-provoking situation: The role of attachment styles. Journal of Personality and Social Psychology, 62, 434–446.CrossRef
go back to reference Spielberger, C. D. (1991). State-trait anger expression inventory (STAXI) professional manual: Revised research edition. Odessa, FL: Psychological Assessment Resources. Spielberger, C. D. (1991). State-trait anger expression inventory (STAXI) professional manual: Revised research edition. Odessa, FL: Psychological Assessment Resources.
go back to reference Townsend, E., Hawton, K., Altman, D. G., Arensman, E., Gunnell, D., Hazell, P., et al. (2001). The efficacy of problem-solving treatments after deliberate self-harm: Meta-analysis of randomized controlled trials with respect to depression, hopelessness, and improvement in problems. Psychological Medicine, 31, 979–988.CrossRefPubMed Townsend, E., Hawton, K., Altman, D. G., Arensman, E., Gunnell, D., Hazell, P., et al. (2001). The efficacy of problem-solving treatments after deliberate self-harm: Meta-analysis of randomized controlled trials with respect to depression, hopelessness, and improvement in problems. Psychological Medicine, 31, 979–988.CrossRefPubMed
go back to reference Wei, M., Mallinckrodt, B., Larson, L. M., & Zakalik, R. A. (2005). Adult attachment, depressive symptoms, and validation from self versus others. Journal of Counseling Psychology, 52, 368–377.CrossRef Wei, M., Mallinckrodt, B., Larson, L. M., & Zakalik, R. A. (2005). Adult attachment, depressive symptoms, and validation from self versus others. Journal of Counseling Psychology, 52, 368–377.CrossRef
go back to reference Weissman, M. M., Bland, R. C., Canino, G. J., Greenwald, S., Hwu, H. G., Joyce, P. R., et al. (1999). Prevalence of suicide ideation and suicide attempts in nine countries. Psychological Medicine, 29, 9–17.CrossRefPubMed Weissman, M. M., Bland, R. C., Canino, G. J., Greenwald, S., Hwu, H. G., Joyce, P. R., et al. (1999). Prevalence of suicide ideation and suicide attempts in nine countries. Psychological Medicine, 29, 9–17.CrossRefPubMed
go back to reference Welch, S. S. (2001). A review of the literature on the epidemiology of parasuicide in the general population. Psychiatric Services, 52, 368–375.CrossRefPubMed Welch, S. S. (2001). A review of the literature on the epidemiology of parasuicide in the general population. Psychiatric Services, 52, 368–375.CrossRefPubMed
go back to reference West, M., & George, C. (2002). Attachment and dysthymia: The contributions of preoccupied attachment and agency of self to depression in women. Attachment and Human Development, 4, 278–293.CrossRefPubMed West, M., & George, C. (2002). Attachment and dysthymia: The contributions of preoccupied attachment and agency of self to depression in women. Attachment and Human Development, 4, 278–293.CrossRefPubMed
Metagegevens
Titel
Adult Attachment Orientations, Depressive Symptoms, Anger, and Self-Directed Aggression by Psychiatric Patients
Auteurs
Barbara Gormley
Dale E. McNiel
Publicatiedatum
01-06-2010
Uitgeverij
Springer US
Gepubliceerd in
Cognitive Therapy and Research / Uitgave 3/2010
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI
https://doi.org/10.1007/s10608-009-9267-5

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