The association between childhood adversity and attachment/relationship style in mood disorders

Background. Mood disorders (Major Depressive Disorder (MDD) and Bipolar Disorder Type I and Type II (BPI & BPII)) can have large negative impacts on individuals affected by them, and on the community as a whole. Childhood adversity has been found to be a risk factor for mood disorders. Additionally, childhood adversities, in the form of physical abuse and neglect, have been associated with insecure attachment styles in adulthood. Insecure attachment styles have also been found to be more prevalent in individuals with mood disorders compared to those without. The association between childhood adversity and attachment in mood disorder populations has not been well examined. Objectives. (1) To examine the prevalence and severity of different forms of childhood adversity in a clinical mood disorders population (patients with MDD, BPI or BPII). (2) To examine the prevalence of attachment styles in a clinical mood disorders population. (3A) To examine the association between different forms of childhood adversity and attachment styles in a clinical mood disorders population. (3B) To determine if mood disorder type modifies the association between childhood adversity and attachment style.Methods. This was a cross-sectional study of 230 outpatients from a university-based, tertiary-care clinic in Montreal, Quebec, with a diagnosis of MDD (N=71), BP type I (N=68), and BP type II (N=52). Psychiatric diagnoses were determined using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). Childhood adversity was assessed using the Childhood Experience of Care and Abuse Questionnaire, which measures antipathy, parental loss, neglect, role reversal, and physical, psychological, and sexual abuse. Attachment styles were assessed using the Experiences in Close Relationships Questionnaire, anxious and avoidant attachment styles were examined. One-way ANOVA and Tukey post-hoc tests were conducted for continuous variables, and chi-square tests were conducted for dichotomous variables, to examine the prevalence of childhood adversities and attachment styles within each diagnostic group. Linear regressions adjusted for age and sex were used to find the association between specific types of childhood adversity and insecure attachment in the mood sample.Results. Sixty-five percent of subjects experienced at least one form of childhood adversity. Fifty-eight percent suffered from physical abuse from at least one parent, about a quarter experienced marked antipathy, neglect and psychological abuse from at least one parent (25.9%, 22.4% and 27.4%, respectively), 32.4% suffered from sexual abuse, 26.0% experienced parental death or separation, and 15.9% experienced marked role reversal. The mean attachment score was 4.0 for anxious attachment and 3.8 for avoidant attachment, with the BPII group scoring higher than the BPI group (4.5 vs. 3.7) on anxious attachment, and both the BPII and MDD groups scoring higher than the BPI group (4.0 and 4.0 vs. 3.4) on avoidant attachment. Antipathy, psychological abuse and role reversal were found to be associated with both anxious and avoidant attachment, while parental loss and neglect were associated only with avoidant attachment. Mood disorder diagnosis was not detected to modify the association between childhood adversity and attachment style. Conclusion. Childhood adversity and insecure attachment styles are associated in people with mood disorders. This provides further evidence for clinicians to explore attachment styles and target interventions in mood disorder patients when there is a history of antipathy neglect or psychological abuse, or when issues such as non-adherence arise. Future studies should aim to refine the association between childhood adversity and attachment in mood disorders.

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