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Romantic Attachment in Patients with Mood and Anxiety Disorders



Romantic attachment is the establishment of a relationship with a partner and is strongly influenced by the individual's attachment style. While several studies have shown that attachment style may contribute to the development of psychopathology, less information is available for romantic attachment.The aim of the present study was to compare romantic attachment styles among patients with different mood and anxiety disorders and control subjects.


The study sample included a total of 126 outpatients, 62 of whom were affected by bipolar disorders, 22 by major depressive disorder (MDD), 27 by panic disorder, 15 by obsessive-compulsive disorder, and 126 healthy control subjects. Romantic attachment was assessed by means of the Italian version of the “Experiences in Close Relationships” (ECR) questionnaire.


The results showed that the secure attachment style was more frequent in the control group, while the preoccupied style prevailed among the patients, with no difference among the diagnostic categories.The scores of the ECR anxiety and avoidance scales were significantly higher in the patients than in the control subjects. A trend toward higher ECR anxiety scale scores in women with panic disorder was detected, with the opposite being true for MDD.


Our findings indicate that patients with different psychiatric disorders would be characterized by higher scores on both the ECR anxiety and the avoidance scales, as well as by the preoccupied style of attachment. In addition, women with panic disorder and MDD seem to be characterized by, respectively, higher and lower scores of the ECR anxiety scale than men.


Corresponding author

Please direct all correspondence to: Donatella Marazziti, MD, University of Pisa, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, via Roma, 67, 1-56100 Pisa, Italy; Tel: 39-050-835412, Fax: 39-050-21581; E-mail:


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1.Ainsworth, MDS, Blehar, MC, Waters, E, Wall, S. Patterns of Attachment: Assessed in the Strange Situation and at Home. Hillsdale, NJ: Erlbaum Inc; 1978.
2.Bifulco, A, Moran, PM, Ball, C, Lillie, A. Adult attachment style. II. Its relationship to psychosocial depressive-vulnerability. Soc Psychiatry Psychiatr Epidemiol. 2002;37:6067.
3.Bowlby, J. Attachment and Loss: Attachment. New York, NY: Basic Books; 1969.
4.Bowlby, J. Attachment and Loss. Separation: Anxiety and Anger. New York, NY: Basic Books; 1973.
5.Bowlby, J. Attachment and Loss: Loss, Sadness and Depression. New York, NY: Basic Books; 1980.
6.Klohnen, EC, Bera, SJ. Behavioral and experiential patterns of avoidantly and securely attached women across adulthood: a 31-year longitudinal perspective. J Pers Soc Psychol. 1998;74:211223.
7.Waters, E, Merrick, S, Treboux, D, Crowell, J, Albersheim, L. Attachment security in infancy and early adulthood: a twenty-year longitudinal study. Child Dev. 2000;71:684689.
8.Gillespie, CF, Nemeroff, CB. Early life stress and depression: childhood trauma may lead to neurobiologically unique mood disorders. Curr Psychiatry Rep. 2005;10:17.
9.Kaufman, J, Plotsky, PM, Nemeroff, CB, Charney, DS. Effects of early adverse experiences on brain structure and function: clinical implications. Biol Psychiatry. 2000;15;48:778790.
10.Amini, F, Lewis, T, Lannon, L, et al.Affect, attachment, memory: contributions toward psychobiologic integration. Psychiatry. 1996;59:213239.
11.Siegel, DJ. The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are. New York, NY: Guilford Press; 1999.
12.Grossman, KE, Grossman, K. Attachment Across the Life Cycle. London, England: Routledge Press; 1991:4567.
13.Goldberg, D. Vulnerability, destabilization and restitution in anxious depression. Acta Psychiatr Scand. 2003;418(suppl 2):8182.
14.Allen, JP, Hauser, ST, Borman-Spurrell, E. Attachment theory as a framework for understanding sequelae of severe adolescent psychopathology: an 11-year follow-up study. J Consult Clin Psychol. 1996;64:254263.
15.Bartholomew, K, Horowitz, LM. Attachment styles among young adults: a test of a four-category model. J Pers Soc Psychol. 1991;61:226244.
16.Troisi, A, D'Argenio, A. The relationship between anger and depression in a clinical sample of young men: the role of insecure attachment. J Affect Disord. 2004;79:269272.
17.Hazan, C, Shaver, P. Romantic love conceptualized as an attachment process. J Pers Soc Psychol. 1987;52:511524.
18.Brennan, KA, Clark, CL, Shaver, PR. Attachment Theory and Close Relationships. New York, NY: Guilford Press; 1998:4676.
19.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press; 1994.
20.First, MB, Spitzer, RL, Gibbon, M, Williams, JBW, eds. Structured Clinical Interview for DSM-IV Axis I Disorders–Patient Edition (SCID-IP Version 2.0 4/97 revision). New York, NY: Biometrics Research Department, New York State Psychiatric Institute; 1997.
21.Picardi, A, Bitetti, D, Puddu, P, Pasquini, P. Further evidence of the validity of the Italian version of the questionnaire “Experiences in Close Relationships” (ECR): a self-report instrument to assess adult attachment [Italian]. The Italian Journal of Psychopathology. 2000;35:114120.
22.Gjerde, PF, Onishi, M, Carlson, KS. Personality characteristics associated with romantic attachment: a comparison of interview and self-report methodologies. Pers Soc Psychol Bull. 2004;30:14021415.
23.Riggs, GA, Paulson, A, Tunnell, E, Sahl, G, Atkinson, HI, Ross, CA. Attachment, personality, and psychopathology among adult inpatients: self-reported romantic attachment style versus Adult Attachment Interview states of mind. Dev Psychopathol. 2007;19:263269.
24.Mickelson, KD, Kessler, RC, Shaker, PR. Adult attachment in a nationally representative sample. J Pers Soc Psychology. 1997;73:10921106.
25.van IJzendoorn, MH. Adult attachment representations, parental responsiveness, and infant attachment: a meta-analysis on the predictive validity of the Adult Attachment Interview. Psychol Bull. 1995;117:387403.
26.van IJzendoorn, MH, Bakermans-Kranenburg, MJ. Attachment representations in mother, father, adolescents, and clinical groups: a meta-analytic search for normative data. J Consult Clin Psychol. 1996;64:1:821.
27.Fonagy, P, Leigh, T, Steele, M, et al.The relation of attachment status, psychiatric classification, and response to psychotherapy. J Consult Clin Psychol. 1996;64:2231.
28.West, M, Rose, MS, Verhoef, MJ, Spreng, S, Bobey, M. Anxious attachment and self-reported depressive symptomatology in women. Can J Psychiatry. 1998;43:294297. Ruiter, C, van Ijzendoorn, MH. Agoraphobia and anxious-ambivalent attachment: an integrative review. J Anxiety Disord. 1992;6:365381.
30.Sperling, MB, Sharp, JL, Fishler, PH. On the nature of attachment in a borderline population: a preliminary investigation. Psychol Report. 1991;68:543546.
31.Evans, L, Wertheim, EH. Intimacy patterns and relationship satisfaction of women with eating problems and the mediating effects of depression, trait anxiety and social anxiety. J Psychosom Res. 1998;44:355365.
32.Muller, RT, Sicoli, LA, Lemieux, KE. Relationship between attachment style and posttraumatic stress symptomatology among adults who report the experience of childhood abuse. J Trauma Stress. 2000;13;2:321332.
33.Fonagy, P, Steele, H, Steele, M. Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. Child Dev. 1991;62:891905.
34.Radke-Yarrow, M, Cummings, EM, Kuczynski, L, Chapman, M. Patterns of attachment in two- and three-year-olds in normal families and families with parental depression. Child Dev. 1985;56:884893.
35.Myhr, G, Sookman, D, Pinard, G. Attachment security and parental bonding in adults with obsessive-compulsive disorder: a comparison with depressed out-patients and healthy controls. Acta Psychiatr Scand. 2004;109:447456.

Romantic Attachment in Patients with Mood and Anxiety Disorders


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