Is Our Early Attachment Our Destiny? Finding the Link Between Attachment Patterns and Personality Disorders 

Attachment is a recent popular topic that has entered the public eye, but psychological researchers have been investigating attachment patterns for decades. What is the relationship between early attachment personality disorders? Is there an overlap?  

APS’s journal Clinical Psychological Science features an article with a new perspective into how attachment style can be linked to personality disorders. In this episode of Under the Cortex, the two psychological scientists who wrote the article, Madison Smith from Northwestern University and Susan South from Purdue University talk with Özge Gürcanlı Fischer Baum about the role of early relationships in shaping one’s personality by addressing the undeniable need of forming attachment with loved ones. The conversation starts with Smith’s academic journey into linking the fields of attachment and personality science. The researchers also highlight the fact that attachment researchers and personality disorder experts do not typically talk to each other, but this research provides an opportunity to reduce this gap. 

Unedited transcript

[00:00:14.930] – APS Özge Gürcanlı Fischer Baum 

Do early attachments influence later relationships? What about the link between attachment and personality disorders? Is there a common structure? This is under the cortex. I am Özge Gürcanlı Fischer Baum with the Association for Psychological Science. To answer these questions, I have two experts with me today, Dr. Madison Smith from Northwestern University and Dr. Susan South from Purdue University. They recently published an article in APS’s journal, Clinical Psychological Science to explore whether attachment and personality disorders are connected. Madison and Susan, thank you for joining me today. Welcome to Under the Cortex. 

[00:01:00.200] – Madison Smith 

Thank you for having us. 

[00:01:01.520] – Susan South 

Yeah, it’s fun to be here. 

[00:01:02.880] – APS Özge Gürcanlı Fischer Baum 

I’m going to start right away. I am very excited that you are here. You know that attachment is a recent popular topic in the public eye, but psychological researchers have been investigating attachment patterns for decades. How did you first get interested in this topic? 

[00:01:24.730] – Madison Smith 

That’s a really good question. So I actually first discovered attachment and attachment theory for my research in graduate school. And later in graduate school, I was feeling a little bit hodgepodge with my research, and I think I found myself really thinking about and wanting a framework that would scaffold my research. I wanted something that I could use to really organize a lot of the findings that I had had so far. And so during this time, as I was thinking about this and really seeking this framework, I was also seeing patients. So I’m a clinical psychologist by training, and I was seeing patients, and I was being trained in clinical frameworks that sort of hearken more to, like, psychoanalytic traditions that touch upon attachment patterns as part of the therapy. And it additionally got me interested in it, but it sort of led me to seek out papers and other sources that would help me to serve the patients that I was seeing a little bit better. And this is when I started reading research by people like Ken Levy, by people like Judith Feeney, Chris Freely and others. So it was a journey to get to where I am now. 

[00:02:39.110] – Madison Smith 

But it really was a confluence of this research curiosity, wanting to serve my patients a little bit better and wanting to know if the thoughts and the ideas that I had were unusual or if other people thought them, too. 

[00:02:55.270] – APS Özge Gürcanlı Fischer Baum 

Yeah, it is a fascinating story. Susan, what about you? 

[00:03:00.010] – Susan South 

Well, I’m just so proud of Madison because she’s made these connections between two fields that just historically have not talked to each other, attachment theory and individual differences. Researchers really just haven’t talked to each other much. And so I think Madison, with her background and how she started getting involved in this, was uniquely suited to bridge attachment adult romantic attachment style and personality. 

[00:03:28.290] – APS Özge Gürcanlı Fischer Baum 

Right. But I want to take a step back. And medicine, you told us about your clinical experience in practice. Right. So why is it an important topic, attachment, for clinical researchers? 

[00:03:42.150] – Madison Smith 

Yeah, I think that’s a really good question. And I think part of the reason that I was really attracted to attachment and why I think it’s important for all clinical researchers to at least be aware of it as a thing, is I think it gives a depth of perspective that we don’t really get from a lot of other clinical theories. So I use the example of trait theories of personality a lot. If we’re looking at something like the five factor model of neuroticism, openness, conscientiousness, extroversion and agreeableness, those are things that seek to describe phenomena. Right. But they don’t explain it. They don’t explain the more elusive questions of, like, why does this happen? How does it play out in everyday life? But I think attachment is unique in that it gives this depth of perspective. It really speaks very elegantly to all of these different levels that we might be interested in. 

[00:04:40.880] – APS Özge Gürcanlı Fischer Baum 

Yeah. So you are connecting our emotions with the trait theory. So that is the exciting part for me. And when I read your article, I noticed that you highlight three main concepts. So emotional liability, detachment and vulnerability. Can you explain to our listeners what these concepts are and also why you chose these three concepts? 

[00:05:05.570] – Madison Smith 

Yeah, absolutely. So before I actually answer your question, I did want to make the point that these things are on spectra and dimensions. So I do think it’s important for listeners to be aware of the fact that everyone has some level of these things. It’s not like a yes no type of thing, that everyone has some emotional content to their personality. It’s really only when things get to a very extreme level or it causes distress to somebody experiencing it or to somebody close to them, that it really becomes personality pathology. And I use that term intentionally because I think personality disorders can be very diagnostic, and personality pathology is something broader and sort of more accessible to folks. So to actually answer your question, these were the three areas that we found some commonalities between attachment and personality pathology. So emotional liability. And this might be a very unscientific answer, but I think of it in my mind as, like, bad stuff, right? It’s the tendency to experience negative emotions, regardless sort of what that emotion is more often and more intensely detachment. On the other hand, I like to think about is, like, the tendency for people to distance themselves from others. 

[00:06:24.780] – Madison Smith 

Right? So individuals very, very high in this trait may be uncomfortable in social situations and they may not really seek out close relationships. And again, this isn’t necessarily a problem. Some people prefer not to have many close relationships, which is completely normal and fine. But detachment is really the extreme variant of that someone who really has no relationships at all, for instance. And then lastly, vulnerability, how we defined it in the paper is this general sensitivity to the thoughts and the opinions of others. Right. So someone very, very high in this trait might be sensitive to rejection, they might be easily influenced by social situations, and they might be highly dependent on other people to make decisions for them or to guide their activities of daily living, for instance. 

[00:07:17.550] – APS Özge Gürcanlı Fischer Baum 

And when you were connecting these concepts with the personality disorders, were there other notions that you used or were there other patterns that you discovered? 

[00:07:30.610] – Madison Smith 

Yeah. So there were a couple of other really key concepts that we found that really didn’t share a whole lot of commonality with attachment. And those two broadly correspond to the two other factors of the five factor bottle. Right. So it’s what we termed, or what other people have termed oddity. So it’s this tendency to maybe have odd ideas or very fanciful ideas about how the world works, to maybe have a very active imaginary life. Some people even define this as part of the psychosis spectrum, although that’s a point of contention as well. And then the other one was antagonism. Right. So the tendency to have some level of meanness towards other people, to disrespect the rights of others and to just sort of disregard other people and their rights. Right. So this would encompass things like fraud, like assault someone who is very interpersonally antagonistic. 

[00:08:39.990] – APS Özge Gürcanlı Fischer Baum 

And in your study, you tested two different groups, college students and adults receiving psychological treatment. What was the reason behind this choice? And then can you also tell us about your results a little bit? 

[00:08:57.390] – Madison Smith 

Yeah, absolutely. So in terms of the sample question, when we think about college students, also, this is a very privileged group of people, and we know that this doesn’t really represent the US population. Right. So I wanted to at least make an attempt to have some of my findings be relevant to the people who might be experiencing the things that I was studying. At the same time, I also wanted to ensure that the findings that I had weren’t only applicable to that group, right. That we could have, just like attachment theory itself, some level of universality. And so I did want to also recruit college students to have, and excuse my use of this term, it’s not the strictest use of this term, but a quote, unquote, control group of healthy folks that I could sort of compare my findings in now in terms of the sort of second part to your question, which was the main study findings, I do think the main takeaway from this project is that at least the way we’re measuring attachment, or insecure romantic attachment specifically, and personality pathology really cannot be considered separate things. Right. So these sorts of theoretical and measurement traditions have been developed separately. 

[00:10:18.290] – Madison Smith 

Right. They’ve been developed in completely separate circles. As you mentioned, clinical researchers don’t often dip their toes into attachment, and attachment itself is split between a couple of different camps. So I think the main finding from this project is that we can’t really misconstrue these things as completely separate anymore. Now, I want to be clear in saying that this doesn’t mean that the experience of insecure attachment and the experience of personality pathology or the larger theories themselves are exactly the same. That’s going to take more research up to the point of metaanalysis. But I do think this was an important first step in sort of urging us a little bit more towards let’s not separate things that are actually the same. 

[00:11:10.630] – APS Özge Gürcanlı Fischer Baum 

Yeah. So can you tell us a little bit more about that? What type of attachment style goes with what type of personality disorder? I know it is not a direct relationship. It is not as black and white as I am forming this question, but what is your intuition in general, based on your evidence? 

[00:11:31.710] – Madison Smith 

Yeah. So what we found in the study is that those three areas that I described earlier, the emotional ability, detachment and vulnerability, are really the three areas where the measurement traditions of personality pathology and the measurement traditions of attachment really can’t, at least statistically, we’re not separate from each other. Right. And so when we actually look at the very specific results for emotional liability specifically, and to be clear, I measured attachment as anxious attachment and avoidant attachment. Avoidant attachment being the tendency to be uncomfortable with close social relationships, to not want to rely on other people, and anxious attachment being this extreme need for closeness to others or to an attachment figure. We really saw both of those things cohering with emotional ability. Right. And this is pretty consistent with some theories of what we call disorganized attachment, which is sort of just the combination of these two or like the fluctuation between anxious and avoidant attachment. And that looks what we sort of wrote in our paper, that looks really similar to someone who has trouble regulating their emotions. And so that’s actually exactly what we found in terms of the detachment and the vulnerability. 

[00:13:00.830] – Madison Smith 

We saw detachment, really going along with avoidant attachment. Right. So again, these things are defined almost identically. Where I describe detachment as like distancing oneself from close others and avoidant attachment is almost exactly described the same. And so we really saw those two going together. And then lastly, for vulnerability, that really went along with anxious attachment, which I think makes a lot of sense. Right. Someone who is very dependent on other people and really requires others approval, is very sensitive to rejection, probably also wants to ensure the extreme closeness of that person so they can rely on that individual for those types of things. 

[00:13:51.130] – APS Özge Gürcanlı Fischer Baum 

Yeah. And I like how you talk about your results because I know that you are being careful, you are avoiding not to label personal disorders by category. Right. So I think that’s a huge contribution of your research. And I have two more questions for you before I let you go to both of you. So one, where are you going to go with your current results? The communalities you find are remarkable and I would love to personally see more research in this area. And second, do you think your results apply to cross cultural contexts? 

[00:14:36.330] – Madison Smith 

Yeah, that’s a really good question. And I think ironically, my answer to both of those questions will probably be about the same. So one of the other findings from this paper that I was really interested in and spurred a lot of my future thought was we separated our sample by gender and we looked at how these things might sort of go together for men versus women. These were cisgender men, cisgender women. And we found some important differences that I won’t get into the weeds on, but so that got me really interested in how these things manifest uniquely for different portions of the population. Right. And so I sort of ensured, to the extent possible, working on a graduate student budget, I wanted to try and ensure representativeness in the constructs that I had understudy. Right. So that’s why I recruited a treatment seeking sample and college students. But I do think it’s an open question as to whether insecure attachment and personality pathology, sort of as larger constructs and theories or as simple measurement traditions, are truly invariant across different portions of the population. So for instance, we have some good evidence for personality pathology. 

[00:16:01.190] – Madison Smith 

And you’re absolutely right that the field is moving away from diagnostic categories. So when I describe things, I’m describing a perfect prototype, but that’s not really how we talk as the field anymore. We talk in terms of spectra and dimensions and things like that. We have a good sense that personality pathology, how we’re measuring it, is invariant across things like sex. And we know that as a theory, attachment has a really good level of universality. But we do have some measurement controversies. I think still existing in terms of whether these things function similarly. For instance, sexual and gender minorities for people of different socioeconomic statuses, for people of different disability statuses. And so my current position is actually in a research institute focused on sexual and gender minority health. And a lot of my work now is looking towards sex, gender and sexuality as moderators of these things and looking at how these communities may uniquely experience or be stigmatized by our current labels for these things. 

[00:17:12.890] – APS Özge Gürcanlı Fischer Baum 

What do you think, Susan? What do you think the next steps are? I know that this joint research unit, and I know it is medicine’s baby, but what are your insights about the feature? 

[00:17:24.510] – Susan South 

What I think is really fascinating about this study is the fact that there wasn’t really a good corollary between antagonism from personality pathology and attachment. That’s where the attachment measures constructs, whatever you want to call it, that are currently in use and that Madison used really sort of failed to capture that type of Persona pathology. And I find that incredibly interesting because there are so many pitfalls of being high in antagonism, and those people are out there. There are people out there who just are at the extreme, extreme edge of antagonism, and they are a problem to themselves and certainly to society. So I’m really interested in how attachment might be extended to describe those people. What’s missing from the attachment theory right now that might be able to describe them? So I think that’s a really important area for future research. 

[00:18:25.170] – APS Özge Gürcanlı Fischer Baum 

Yeah. Well, Madison, is there anything else that you would like to share with our listeners? 

[00:18:33.490] – Madison Smith 

No, I think we’ve pretty well covered it. I think, if anything, that I’ll leave folks with. I think the really magical part of this project for me was being able to read these original sources and connect to the ideas very slowly and difficulty at times, but to connect these ideas sort of across decades in some cases. And so I would encourage folks to read some of the sources that I cite in this paper. I cited things that really influence my own thinking and to form their own conclusions about these things. I also love talking with folks about this and chewing on these ideas. So folks are more than welcome to contact me and love chatting about these things. 

[00:19:23.750] – APS Özge Gürcanlı Fischer Baum 

Well, yeah. So people should keep an open eye, right. And then an open heart too when they try to understand this field and how the field is moving away from categories. 

[00:19:36.650] – Madison Smith 

Absolutely. 

[00:19:37.850] – APS Özge Gürcanlı Fischer Baum 

Yeah. Well, Madison and Susan, thanks again for joining us today. 

[00:19:42.750] – Madison Smith 

Thank you. 

[00:19:43.710] – Susan South 

Thanks very much. 

[00:19:45.210] – APS Özge Gürcanlı Fischer Baum 

This is Özge Gürcanlı Fischer Baum with APS, and I have been speaking to Dr. Madison Smith from Northwestern University. And Dr. Susan South from Purdue University. If you want to learn more about this research, visit psychologicalscience.org.