Failure to resolve loss and compromised mentalizing in female inpatients with major depressive disorder
Abstract
Attachment and mentalizing are central concepts in research on the etiology, course, and treatment of depression. The goal of this cross-sectional study was to clarify the unique value of these constructs in characterizing the presence, severity, and chronicity of depression. We examined 50 female inpatients suffering from Major Depressive Disorder (MDD) in comparison to 47 matched healthy controls regarding their attachment states of mind, mentalizing capacities, and clinical variables indicating depression severity and chronicity (e.g. illness duration, number of hospitalizations). In the group of depressed patients, unresolved attachment with regard to loss was significantly overrepresented. Dimensionally, patients were more disorganized and more insecure, whereas there was no difference on the dismissing-preoccupied dimension between the two groups. Mentalizing was significantly lower in patients than in healthy controls. Logistic regression analysis revealed attachment insecurity, mentalizing deficits, and unresolved loss to be incrementally relevant to predict MDD. Correlations with clinical parameters in the group of depressed patients showed positive associations between mentalizing deficits, attachment insecurity, and variables indicating illness chronicity. Our findings highlight the relevance of the inability to resolve or reappraise loss experiences in depressive states.
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Few studies carried out in the context of loss have shown that mentalizing deficits are related to major depressive disorder and complicated grief.
“To date, the few studies carried out in the context of loss have shown that mentalizing deficits are related to major depressive disorder and complicated grief [17,18].”
Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,706 · see citing works
Hamilton, M. (1960) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.23.1.56 · Cited by 32,817 · cited 3× · see citing works
“, 1994) and the Hamilton Depression Rating Scale (HAM-D; Hamilton, 1960) were used.”
MethodInfluentialApplied Multiple Regression/Correlation Analysis for the Behavioral Sciences
Kemp, F. (2003) · Journal of the Royal Statistical Society Series D (The Statistician) · doi:10.1046/j.1467-9884.2003.t01-2-00383_4.x · Cited by 9,294 · see citing works
Attachment and Loss. Vol. 1. Attachment
Rever, G. W. (1972) · Psychosomatic Medicine · doi:10.1097/00006842-197211000-00011 · Cited by 8,446 · cited 3× · see citing works
“With this study, we have tried to build on the theory of depression and attachment (Bowlby, 1969, 1980) and expand existing empirical data.”
BackgroundMethodKessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., Rush, A. J., Walters, E. E., & Wang, P. S. (2003) · JAMA · doi:10.1001/jama.289.23.3095 · Cited by 7,988 · see citing works
Handbook of attachment: theory, research, and clinical applications
(2009) · Choice Reviews Online · doi:10.5860/choice.46-4135 · Cited by 3,818 · see citing works
Attachment and Loss: Vol.3: Loss : Sadness and Depression
Bowlby, J. (1980) · Cited by 2,659 · see citing works
Epidemiology of Adult <i>DSM-5</i> Major Depressive Disorder and Its Specifiers in the United States
Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.4602 · Cited by 1,737 · cited 2× · see citing works
“…Accepted 4 December 2021 KEYWORDS Adult attachment interview; unresolved attachment; reflective functioning; depression; chronicity Depression is one of the most prevalent and debilitating disorders worldwide, with increasing prevalence of 26% in women over the last 25 years (Hasin et al., 2018).”
BackgroundAffect regulation, mentalization, and the development of the self
Koh, E. (2004) · Australian & New Zealand Journal of Psychiatry · doi:10.1111/j.1440-1614.2004.01308.x · Cited by 1,709 · see citing works
George, C. C., Main, M., & Kaplan, N. M. (1985) · Routledge eBooks · doi:10.1037/t02879-000 · Cited by 1,386 · see citing works
Diagnosis and definition of treatment-resistant depression
Fava, M. (2003) · Biological Psychiatry · doi:10.1016/s0006-3223(03)00231-2 · Cited by 1,380 · see citing works
Adolescent Onset of the Gender Difference in Lifetime Rates of Major Depression: A Theoretical Model
Cyranowski, J. M., Frank, E., Young, E., & Shear, M. K. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.1.21 · Cited by 1,276 · cited 1× · see citing works
“According to Cyranowski et al. (2000), women are about twice as likely as men to experience a depressive episode, and differ from men with regard to the clinical presentation of depressive symptoms and the way depression develops.”
BackgroundParental reflective functioning: An introduction
Slade, A. (2005) · Attachment & Human Development · doi:10.1080/14616730500245906 · Cited by 1,209 · see citing works
Fonagy, P., & Luyten, P. (2009) · Development and Psychopathology · doi:10.1017/s0954579409990198 · Cited by 1,146 · see citing works
Affective development in infancy
Brazelton, T. B., & Yogman, M. W. (1986) · Medical Entomology and Zoology · Cited by 1,145 · see citing works
The relation of attachment status, psychiatric classification, and response to psychotherapy.
Fonagy, P., Leigh, T., Steele, M., Steele, H., Kennedy, R., Mattoon, G., Target, M., & Gerber, A. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.64.1.22 · Cited by 1,124 · see citing works
Complicated grief and related bereavement issues for DSM-5
Shear, M. K., Simon, N. M., Wall, M. M., Zisook, S., Neimeyer, R. A., Duan, N., Reynolds, C. F., Lebowitz, B. D., Sung, S. C., Ghesquiere, A., et al. (2011) · Depression and Anxiety · doi:10.1002/da.20780 · Cited by 1,022 · see citing works
Bakermans‐Kranenburg, M. J., & van IJzendoorn, M. H. (2009) · Attachment & Human Development · doi:10.1080/14616730902814762 · Cited by 917 · see citing works
Handbook of Mentalizing in Mental Health Practice
Lazar, S. G. (2013) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000426331.79890.cf · Cited by 884 · see citing works
Meins, E., Fernyhough, C., Fradley, E., & Tuckey, M. R. (2001) · Journal of Child Psychology and Psychiatry · doi:10.1111/1469-7610.00759 · Cited by 799 · see citing works
REFLECTIVE-FUNCTIONING MANUAL Version 5 FOR APPLICATION TO ADULT ATTACHMENT INTERVIEWS
Fonagy, P., Target, M., Steele, H., & Steele, M. (1998) · UCL Discovery (University College London) · Cited by 668 · see citing works
Disorganized Infant, Child, and Adult Attachment: Collapse in Behavioral and Attentional Strategies
Hesse, E., & Main, M. (2000) · Journal of the American Psychoanalytic Association · doi:10.1177/00030651000480041101 · Cited by 577 · see citing works
Personality disorder and the outcome of depression: Meta-analysis of published studies
Newton-Howes, G., Tyrer, P., & Johnson, T. (2006) · British Journal of Psychiatry · doi:10.1192/bjp.188.1.13 · Cited by 537 · see citing works
Personality Assessment in DSM-5: Empirical Support for Rating Severity, Style, and Traits
Hopwood, C. J., Malone, J. C., Ansell, E. B., Sanislow, C. A., Grilo, C. M., McGlashan, T. H., Pinto, A., Markowitz, J. C., Shea, M. T., Skodol, A. E., et al. (2011) · Journal of Personality Disorders · doi:10.1521/pedi.2011.25.3.305 · Cited by 377 · see citing works
Adolescent attachment and psychopathology.
Rosenstein, D. S., & Horowitz, H. A. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.64.2.244 · Cited by 373 · see citing works
Reflective functioning: a review.
Katznelson, H. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.12.003 · Cited by 369 · see citing works
The heterogeneity of “major depression”
GOLDBERG, D. (2011) · World Psychiatry · doi:10.1002/j.2051-5545.2011.tb00061.x · Cited by 335 · see citing works
A prospective investigation of the development of borderline personality symptoms
Carlson, E. A., Egeland, B. R., & Sroufe, L. A. (2009) · Development and Psychopathology · doi:10.1017/s0954579409990174 · Cited by 329 · see citing works
Personality disorder and the mental representation of early social experience
Patrick, M. P. H., Hobson, R. P., Castle, D. J., Howard, R. J., & Maughan, B. (1994) · Development and Psychopathology · doi:10.1017/s0954579400004648 · Cited by 283 · see citing works
Spielmans, G. I., Berman, M. I., Linardatos, E., Rosenlicht, N. Z., Perry, A., & Tsai, A. C. (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001403 · Cited by 275 · see citing works
van IJzendoorn, M. H., Caspers, K., Bakermans-Kranenburg, M. J., Beach, S. R. H., & Philibert, R. (2010) · Biological Psychiatry · doi:10.1016/j.biopsych.2010.05.008 · Cited by 264 · see citing works
Hesse, E., & Main, M. (1999) · Psychoanalytic Inquiry · doi:10.1080/07351699909534265 · Cited by 260 · see citing works
Borderline personality disorder and emotion dysregulation
Chapman, A. L. (2019) · Development and Psychopathology · doi:10.1017/s0954579419000658 · Cited by 255 · see citing works
Friborg, O., Martinsen, E. W., Martinussen, M., Kaiser, S., Øvergård, K. T., & Rosenvinge, J. H. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.08.023 · Cited by 242 · see citing works
Newton‐Howes, G., Tyrer, P. J., Johnson, T. L., Mulder, R., Kool, S., Dekker, J., & Schoevers, R. A. (2013) · Journal of Personality Disorders · doi:10.1521/pedi_2013_27_070 · Cited by 211 · see citing works
Adult attachment representations and depressive symptoms: A meta-analysis
Dagan, O., Facompré, C. R., & Bernard, K. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.04.091 · Cited by 201 · see citing works
Maternal attachment state of mind moderates the impact of postnatal depression on infant attachment
McMahon, C. A., Barnett, B., Kowalenko, N. M., & Tennant, C. C. (2006) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2005.01547.x · Cited by 197 · see citing works
Zhou, X., Keitner, G. I., Qin, B., Ravindran, A. V., Bauer, M., Giovane, C. D., Zhao, J., Liu, Y., Fang, Y., Zhang, Y., et al. (2015) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyv060 · Cited by 195 · see citing works
Comorbidity of personality disorders and unipolar major depression: A review
Corruble, E., Ginestet, D., & Guelfi, J. (1996) · Journal of Affective Disorders · doi:10.1016/0165-0327(95)00091-7 · Cited by 191 · see citing works
Brain mechanisms underlying the impact of attachment-related stress on social cognition
Nolte, T., Bolling, D. Z., Hudac, C. M., Fonagy, P., Mayes, L., & Pelphrey, K. A. (2013) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2013.00816 · Cited by 176 · see citing works
Self-citationEnsink, K., Bégin, M., Normandin, L., & Fonagy, P. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.30611 · Cited by 173 · see citing works
Mentalizing in female inpatients with major depressive disorder
Fischer-Kern, M., Fonagy, P., Kapusta, N. D., Luyten, P., Boss, S., Naderer, A., Blüml, V., & Leithner, K. (2013) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e3182845c0a · Cited by 157 · see citing works
Self-citationChanges in attachment representations during psychological therapy
Taylor, P., Rietzschel, J., Danquah, A., & Berry, K. (2015) · Psychotherapy Research · doi:10.1080/10503307.2014.886791 · Cited by 150 · see citing works
Luyten, P., & Fonagy, P. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.008 · Cited by 142 · see citing works
Internal structure of the reflective functioning scale.
Taubner, S., Hörz, S., Fischer-Kern, M., Doering, S., Buchheim, A., & Zimmermann, J. (2013) · Psychological Assessment · doi:10.1037/a0029138 · Cited by 131 · see citing works
Self-citationThe Role of Mentalization in the Psychoanalytic Treatment of Chronic Depression
Taubner, S., Kessler, H., Buchheim, A., Kächele, H., & Staun, L. (2011) · Psychiatry · doi:10.1521/psyc.2011.74.1.49 · Cited by 128 · see citing works
Personality disorders and depression
D, M. F. M., Farabaugh, A. H., Sickinger, A. H., WRIGHT, E., Alpert, J. E., Sonawalla, S. B., Nierenberg, A. A., & Worthington, J. J. (2002) · Psychological Medicine · doi:10.1017/s0033291702005780 · Cited by 120 · see citing works
MURRAY, L., HALLIGAN, S. L., ADAMS, G., PATTERSON, P., & GOODYER, I. M. (2006) · Development and Psychopathology · doi:10.1017/s0954579406060263 · Cited by 114 · see citing works
Chiesa, M. C., & Fonagy, P. (2013) · Personality and Mental Health · doi:10.1002/pmh.1245 · Cited by 114 · see citing works
Lemma, A., Target, M., & Fonagy, P. (2010) · Psychoanalytic Psychotherapy · doi:10.1080/02668734.2010.513547 · Cited by 105 · see citing works
Buchheim, A., Hörz‐Sagstetter, S., Doering, S., Rentrop, M., Schuster, P., Buchheim, P., Pokorný, D., & Fischer‐Kern, M. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000460257 · Cited by 81 · see citing works
Self-citationKöhler, S., Chrysanthou, S., Guhn, A., & Sterzer, P. (2018) · Depression and Anxiety · doi:10.1002/da.22835 · Cited by 75 · see citing works
Linking childhood emotional abuse and adult depressive symptoms: The role of mentalizing incapacity
Li, E. T., Carracher, E., & Bird, T. (2019) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2019.104253 · Cited by 75 · see citing works
Reflective functioning as predictor of working alliance and outcome in the treatment of depression.
Ekeblad, A., Falkenström, F., & Holmqvist, R. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000055 · Cited by 74 · see citing works
A prevention and promotion intervention program in the field of mother–infant relationship
Ammaniti, M., Speranza, A. M., Tambelli, R., Muscetta, S., Lucarelli, L., Vismara, L., Odorisio, F., & Cimino, S. (2006) · Infant Mental Health Journal · doi:10.1002/imhj.20081 · Cited by 71 · see citing works
Fischer‐Kern, M., & Tmej, A. (2019) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2019.65.2.162 · Cited by 64 · see citing works
Self-citationTransference-Focused Psychotherapy for Borderline Personality Disorder
Yeomans, F. E., Clarkin, J. F., & Kernberg, O. F. (2014) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615371006 · Cited by 64 · see citing works
Mentalization and depressive symptoms in a clinical sample of adolescents and young adults
Murri, M. B., Ferrigno, G., Penati, S., Muzio, C., Piccinini, G., Innamorati, M., Ricci, F., Pompili, M., & Amore, M. (2016) · Child and Adolescent Mental Health · doi:10.1111/camh.12195 · Cited by 63 · see citing works
Scott, L. N., Kim, Y., Nolf, K. A., Hallquist, M. N., Wright, A. G. C., Stepp, S. D., Morse, J. Q., & Pilkonis, P. A. (2013) · Journal of Personality Disorders · doi:10.1521/pedi_2013_27_099 · Cited by 62 · see citing works
Bressi, C., Fronza, S., Minacapelli, E., Nocito, E. P., Dipasquale, E., Magri, L., Lionetti, F., & Barone, L. (2016) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12110 · Cited by 52 · see citing works
Mentalisierungsfähigkeit bei depressiven Patientinnen: Eine Pilotstudie
Fischer‐Kern, M., Tmej, A., Kapusta, N. D., Naderer, A., Leithner, K., Löffler‐Stastka, H., & Springer-Kremser, M. (2008) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2008.54.4.368 · Cited by 50 · see citing works
Self-citationDoes reflective functioning mediate the relationship between attachment and personality?
Nazzaro, M. P., Boldrini, T., Tanzilli, A., Muzi, L., Giovanardi, G., & Lingiardi, V. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.06.045 · Cited by 48 · see citing works
Reiner, I., Bakermans‐Kranenburg, M. J., van IJzendoorn, M. H., Fremmer‐Bombik, E., & Beutel, M. E. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.02.024 · Cited by 41 · see citing works
Ivarsson, T., Granqvist, P., Gillberg, C., & Broberg, A. G. (2010) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-010-0120-x · Cited by 31 · see citing works
Mentalisierung und chronische Depression
Staun, L., Kessler, H., Buchheim, A., Kächele, H. U., & Taubner, S. (2010) · Psychotherapeut · doi:10.1007/s00278-010-0752-9 · Cited by 26 · see citing works
Raby, K. L., Verhage, M. L., Fearon, P. R. M., Fraley, R. C., Roisman, G. I., van IJzendoorn, M. H., Schuengel, C., Madigan, S. L., Oosterman, M., Bakermans‐Kranenburg, M. J., et al. (2020) · Development and Psychopathology · doi:10.1017/s0954579420000978 · Cited by 26 · see citing works
Reflective functioning in postpartum depressed women with and without comorbid personality disorder.
Cordes, K., Smith‐Nielsen, J., Tharner, A., Katznelson, H., Steele, H., & Væver, M. S. (2017) · Psychoanalytic Psychology · doi:10.1037/pap0000135 · Cited by 23 · see citing works
Fizke, E., Buchheim, A., & Juen, F. (2013) · Psihologija · doi:10.2298/psi1302161f · Cited by 22 · see citing works
Barone, L., & Carone, N. (2020) · Attachment & Human Development · doi:10.1080/14616734.2020.1738510 · Cited by 22 · see citing works
Changes in Attachment Representation in Psychotherapy: Is Reflective Functioning the Crucial Factor?
Tmej, A., Fischer‐Kern, M., Doering, S., Alexopoulos, J., & Buchheim, A. (2018) · Zeitschrift für psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2018.64.3.222 · Cited by 18 · see citing works
Self-citationTaubner, S., Schulze, C. I., Kessler, H., Buchheim, A., Kächele, H., & Staun, L. (2015) · Psychotherapie Forum · doi:10.1007/s00729-015-0032-9 · Cited by 8 · see citing works
Bindungsrepräsentation bei stationär behandelten chronisch-depressiven Patientinnen
Fischer‐Kern, M., Nolte, T., Kadi, B., & Naderer, A. (2014) · Psychotherapeut · doi:10.1007/s00278-014-1079-8 · Cited by 4 · see citing works
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Lenzo, V., Sardella, A., Musetti, A., Petralia, M. C., Grado, I., & Quattropani, M. C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191911930 · Cited by 10 · see citing works
“To date, the few studies carried out in the context of loss have shown that mentalizing deficits are related to major depressive disorder and complicated grief [17,18].”
Background
- Authors
- Fischer-Kern, M., Tmej, A., Naderer, A., Zimmermann, J., & Nolte, T.
- Affiliations
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
- Medical University of Vienna (AT)
- University of Kassel (DE)
- Wellcome Centre for Human Neuroimaging (GB)
- Venue
- Attachment & Human Development
- Publisher
- Informa UK Limited
- Published
- 2021-12-24
- Volume
- 24
- Issue
- 4
- Pages
- 503-524
- ISSN
- 1461-6734 (ISSN-L)
- 1469-2988
- OpenAlex
- W4200295973
- Cited by
- 14
- References
- 72
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 5 · 2022: 1
- FWCI
- 1.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Attachment & Human Development (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Jubiläumsfonds of the Austrian National Bank
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- major depressive disorder, unresolved loss, mentalization, insecure attachment, disorganized attachment, depression severity, female inpatients
- MeSH terms
- Mentalization, Cross-Sectional Studies, Major Depressive Disorder, Female, Humans, Inpatients, Treatment Failure
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