A Cluster Analysis of Attachment Styles in Patients with Borderline Personality Disorder, Bipolar Disorder and ADHD

Overview

Journal Borderline Personal Disord Emot Dysregul

Publisher Biomed Central

Date 2024 Oct 30

PMID 39472982

Authors

I Kouros

M Isaksson

L Ekselius

M Ramklint

Affiliations

Soon will be listed here.

Abstract

Background: Insecure adult attachment has been associated with psychiatric disorders characterized by emotional dysregulation, such as borderline personality disorder (BPD), bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD). However, little is known about the differences in attachment patterns between these diagnostic groups. The aim of this study was to identify clusters of adult attachment style in a cross-diagnostic group of patients with BDP and/or BD and/or ADHD and explore the characteristics of these clusters based on temperament profile, childhood trauma and psychiatric diagnoses.

Methods: K-means cluster analysis was used to identify subgroups, based on the Attachment Style Questionnaire Short Form dimensions, in a clinical cohort of 150 young adults (113 women and 37 men, mean age ± SD = 23.3 ± 2.1) diagnosed with BPD, and/or BD, and/or ADHD.

Results: Three distinct clusters were identified: a secure, an insecure/avoidant-anxious and an insecure/avoidant cluster. These three clusters differed in temperament profile and related psychiatric diagnoses.

Conclusions: The three clusters of attachment in individuals with BPD, BD and/or ADHD could support differentiation between the disorders as well provide information usable for planning of treatment.

Citing Articles

Explainable AI for Bipolar Disorder Diagnosis Using Hjorth Parameters.

Saghab Torbati M, Zandbagleh A, Daliri M, Ahmadi A, Rostami R, Kazemi R Diagnostics (Basel). 2025; 15(3).

PMID: 39941246 PMC: 11817202. DOI: 10.3390/diagnostics15030316.

Clinical symptoms and functional impairment in attention deficit hyperactivity disorder (ADHD) co-morbid tic disorder (TD) patients: a cluster-based investigation.

Jiang Z, Xu H, Zhang A, Yu L, Wang X, Zhang W BMC Psychiatry. 2025; 25(1):100.

PMID: 39905386 PMC: 11796001. DOI: 10.1186/s12888-025-06558-0.

References

Insel T, Cuthbert B, Garvey M, Heinssen R, Pine D, Quinn K . Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010; 167(7):748-51. DOI: 10.1176/appi.ajp.2010.09091379. View

Simeon D, Yehuda R, Cunill R, Knutelska M, Putnam F, Smith L . Factors associated with resilience in healthy adults. Psychoneuroendocrinology. 2007; 32(8-10):1149-52. DOI: 10.1016/j.psyneuen.2007.08.005. View

Brandstrom S, Schlette P, Przybeck T, Lundberg M, Forsgren T, Sigvardsson S . Swedish normative data on personality using the Temperament and Character Inventory. Compr Psychiatry. 1998; 39(3):122-8. DOI: 10.1016/s0010-440x(98)90070-0. View

Cloninger C, Svrakic D, Przybeck T . A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993; 50(12):975-90. DOI: 10.1001/archpsyc.1993.01820240059008. View

Dalmaijer E, Nord C, Astle D . Statistical power for cluster analysis. BMC Bioinformatics. 2022; 23(1):205. PMC: 9158113. DOI: 10.1186/s12859-022-04675-1. View

Williams J, GIBBON M, First M, Spitzer R, Davies M, Borus J . The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. Arch Gen Psychiatry. 1992; 49(8):630-6. DOI: 10.1001/archpsyc.1992.01820080038006. View

Erkoreka L, Zamalloa I, Rodriguez S, Munoz P, Mendizabal I, Zamalloa M . Attachment anxiety as mediator of the relationship between childhood trauma and personality dysfunction in borderline personality disorder. Clin Psychol Psychother. 2021; 29(2):501-511. DOI: 10.1002/cpp.2640. View

Engel G . The need for a new medical model: a challenge for biomedicine. Science. 1977; 196(4286):129-36. DOI: 10.1126/science.847460. View

Haggerty G, Hilsenroth M, Vala-Stewart R . Attachment and interpersonal distress: examining the relationship between attachment styles and interpersonal problems in a clinical population. Clin Psychol Psychother. 2009; 16(1):1-9. DOI: 10.1002/cpp.596. View

10.

Horberg N, Kouros I, Ekselius L, Cunningham J, Willebrand M, Ramklint M . Early Trauma Inventory Self-Report Short Form (ETISR-SF): validation of the Swedish translation in clinical and non-clinical samples. Nord J Psychiatry. 2019; 73(2):81-89. DOI: 10.1080/08039488.2018.1498127. View

11.

Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P . Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997; 36(7):980-8. DOI: 10.1097/00004583-199707000-00021. View

12.

Lobbestael J, Leurgans M, Arntz A . Inter-rater reliability of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID I) and Axis II Disorders (SCID II). Clin Psychol Psychother. 2010; 18(1):75-9. DOI: 10.1002/cpp.693. View

13.

Kim J, Lee H, Lee K . Influence of temperament and character on resilience. Compr Psychiatry. 2013; 54(7):1105-10. DOI: 10.1016/j.comppsych.2013.05.005. View

14.

Lilienfeld S, Treadway M . Clashing Diagnostic Approaches: DSM-ICD Versus RDoC. Annu Rev Clin Psychol. 2016; 12:435-63. PMC: 5154554. DOI: 10.1146/annurev-clinpsy-021815-093122. View

15.

Chotai J, Jonasson M, Hagglof B, Adolfsson R . Adolescent attachment styles and their relation to the temperament and character traits of personality in a general population. Eur Psychiatry. 2005; 20(3):251-9. DOI: 10.1016/j.eurpsy.2004.11.008. View

16.

Corbisiero S, Morstedt B, Bitto H, Stieglitz R . Emotional Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder-Validity, Predictability, Severity, and Comorbidity. J Clin Psychol. 2016; 73(1):99-112. DOI: 10.1002/jclp.22317. View

17.

Crow T, Levy K, Bradley B, Fani N, Powers A . The roles of attachment and emotion dysregulation in the association between childhood maltreatment and PTSD in an inner-city sample. Child Abuse Negl. 2021; 118:105139. PMC: 8292198. DOI: 10.1016/j.chiabu.2021.105139. View

18.

Peng W, Liu Z, Liu Q, Chu J, Zheng K, Wang J . Insecure attachment and maladaptive emotion regulation mediating the relationship between childhood trauma and borderline personality features. Depress Anxiety. 2020; 38(1):28-39. DOI: 10.1002/da.23082. View

19.

Bowlby J . The making and breaking of affectional bonds. II. Some principles of psychotherapy. The fiftieth Maudsley Lecture. Br J Psychiatry. 1977; 130:421-31. DOI: 10.1192/bjp.130.5.421. View

20.

Masso Rodriguez A, Hogg B, Gardoki-Souto I, Valiente-Gomez A, Trabsa A, Mosquera D . Clinical Features, Neuropsychology and Neuroimaging in Bipolar and Borderline Personality Disorder: A Systematic Review of Cross-Diagnostic Studies. Front Psychiatry. 2021; 12:681876. PMC: 8220090. DOI: 10.3389/fpsyt.2021.681876. View