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Cited by 24Personality Disorders and PsychopathologyPsychoanalysis and Psychopathology ResearchChild Abuse and Trauma

Mapping the road from childhood adversity to personality disorder: The role of unresolved states of mind

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Cirasola, Antonella, Hillman, Saul, Fonagy, Peter, Chiesa, Marco·2017·Personality and Mental Health
DOI 10.1002/pmh.1365
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Abstract

Childhood adversity has been found to be an important aetiological factor in the development of personality disorder (PD) in several studies. However, the role of disorganized attachment with unresolved mental states for traumatic experiences requires further investigation. This study explores the relationship between childhood adversities, unresolved states of mind, PD diagnosis and psychiatric distress. Two hundred forty‐five adult participants, 124 from a clinical PD group and 121 non‐psychiatric controls were assessed using the Structured Clinical Interview for DSM‐IV, the Cassel Baseline Questionnaire, the Symptom Checklist‐90‐R and the Adult Attachment Interview, in order to ascertain presence of PD, childhood adversity, level of psychiatric distress and unresolved states of mind. Within the overall unresolved (U‐overall) attachment category, a distinction was made between unresolved for abuse (U‐abuse) and unresolved for loss (U‐loss). The results indicated that childhood adversity was significantly associated with unresolved states of mind, as well as with overall PD diagnosis, paranoid PD, borderline PD, avoidant PD and psychiatric distress. Mediation analyses confirmed that U‐overall and U‐loss were significant mediators between childhood adversity and PD diagnoses, but surprisingly, U‐abuse was not a significant mediator. The strength, limitations and clinical implications of the findings are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

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  1. Dozier, M.K., Stowall-McColough, C., & Albus, K.E. (2008). Attachment and psychopathology in adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of Attachment Theory and Research (2nd ed., pp. 718-744). New York: Guilford Publications.
  2. Fonagy, P, Luyten, P, Bateman, A, Gergerly, G, Strathearn, L., Target, M, & Allison, E. (2010). Attachment and personality pathology. In J. L. Clarkin, P. Fonagy & G. O. Gabbard (Eds.), Psychodynamic Psychotherapy for Personality Disorders: A Clinical Handbook. (1st edition ed., pp. 37-88). Washington DC.: American Psychiatric Publishing.
  3. Hesse, E. (2016). The Adult Attachment Interview Protocol, Method of Analysis, and Selected Empirical Studies: 1985-2015. In J. Cassidy & P. R. Shaver (Eds.), Hanbook of Attachment (3rd ed., pp. 553-597). London: Guilford Press.
  4. Main, M., & Hesse, E. (1990). Adult lack of resolution of attachment-related trauma related to infant disorganizedented behavior in the Ainsworth strange situation: Linking parental states of mind to infant bebavior in a stressful situation. In M. T. Greenberg, D. Cicchetti & M. Cummings (Eds.), Attachment in the Preschool Years: Theory, Research and Intervention (pp. 339-426). Chicago: University of Chicago Press.
  5. Main, M., Hesse, E. , & Goldwyn, R. (2008). Studying differences in language usage in recounting attachment history: An introduction to the AAI. In H. Steele & M. Steele (Eds.), Clinical applications of the Adult Attachment Interview. (pp. 31-68). New York: Guilford Press.
  6. Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In M. T. Greenberg, D. Cicchetti & E. M. Cummings (Eds.), Attachment During the Preschool Years: Theory, Research and Intervention (pp. 121-160). Chicago: University of Chicago Press.

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Authors
Cirasola, A., Hillman, S., Fonagy, P., & Chiesa, M.
Affiliations
  • Anna Freud Centre (GB)
  • University College London (GB)
Corresponding author
Chiesa, Marco
ORCID
Venue
Personality and Mental Health
Publisher
Wiley
Published
2017-01-19
Volume
11
Issue
2
Pages
77-90
ISSN
  • 1932-8621 (ISSN-L)
  • 1932-863X
DOI
10.1002/pmh.1365
OpenAlex
W2575090148
Cited by
24
References
61
Citations by year
2025: 2 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 9 · 2020: 2 · 2019: 1 · 2018: 2
FWCI
1.70
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Personality and Mental Health (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
National Institute for Health and Care Research (NF-SI-0514-10157)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Keywords
childhood adversity, personality disorders, disorganized attachment, unresolved loss, paranoid personality disorder, borderline personality disorder, avoidant personality disorder, psychiatric distress, mediation
MeSH terms
Adult Survivors of Child Adverse Events, Adult, Cross-Sectional Studies, Female, Humans, Male, Object Attachment, Personality Disorders, Surveys and Questionnaires, Stress, Psychological, Case-Control Studies, Diagnostic and Statistical Manual of Mental Disorders, Young Adult

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