Disorganised attachment in the pathogenesis and the psychotherapy of borderline personality disorder
Controlled studies suggest that attachment insecurity is a risk factor for Borderline Personality Disorder (BPD), as it is for other mental disorders (for reviews, see Agrawal et al. 2004; and Dozier, Stovall-McClough and Albus 2008). Disorganisation of early attachment and associated adult states of mind have been studied in relation to the pathogenesis of and psychotherapy for BPD more than other dimensions and types of attachment insecurity. Quite a number of clinical and empirical research studies suggest that, although it is not a speci¿ c risk factor for BPD, attachment disorganisation plays an important role in borderline psychopathology (e.g. Bateman and Fonagy 2004; Buchheim and George 2011; Dozier, Stovall-McClough and Albus 2008; Holmes 2004; Howell 2008; Levy, Beeney and Temes 2011; Liotti 2007, 2011a, 2011b; Lyons-Ruth et al. 2007; Morse et al. 2009; Steele and Siever 2010). These studies support the idea that the fundamental features of BPD can be explained by a developmental model based on attachment disorganisation. Although we lack conclusive research evidence for the hypothesis that the developmental pathways leading to the disorder begin with early attachment disorganisation in the majority of BPD cases (Levy 2005), two controlled studies suggest that this may indeed be the case (Carlson, Egeland and Sroufe 2009; Lyons-Ruth et al. 2007).