Insecure attachment styles, Cluster B Personality Disorders, and gender as risk factors for substance abuse diagnoses

This quantitative study used attachment theory as a guide to explore the associations between three insecure attachment styles (ambivalent, avoidant, and mixed), four Cluster B Personality Disorders (Cluster B PDs), and substance abuse (SUD) in a sample of male and female psychiatric patients ( N = 442). Attachment theory is a useful frame for understanding SUD and the Cluster B PDs because of the theory's emphasis on emotional regulation and coping strategies. There is increasing evidence that insecure attachment is a risk factor for psychopathology. Based on findings in the attachment literature, the following questions were addressed: Using Pilkonis' (1988) attachment measure and attachment categories, which insecure attachment styles (IAS) are risk factors for SUD, and is this risk the same for men and women? Specifically, the study examined whether ambivalent and mixed insecure attachment styles increase the risk for SUD and whether an avoidant attachment style indicates risk for SUD. Logit regression models (controlling for age and race) found no associations between avoidant, ambivalent, or mixed attachment styles and SUD. There were no significant main effects of gender or significant interactions between gender and the insecure attachment styles. Based on previous empirical findings linking Cluster B PDs with SUD, a second research question focused on which of the Cluster BPDs were risk factors for SUD and whether there were gender differences in these relations. The following hypotheses were tested: Histrionic (HPD), Antisocial (APD), and Borderline (BPD) personality disorders were predicted to increase the risk of SUD, whereas Narcissistic (NPD) was not expected to be associated with risk for SUD. The logit analysis of these issues controlled for age, race, and other Axis II diagnoses (Cluster A and C PDs). There were main effects for type of Cluster B PD and gender. Specifically, Borderline PD (BPD) was associated with increased risk for SUD and, with the possible exception of NPD, males were consistently at a higher risk for SUD when considering either a Cluster B PD or no Cluster B PD. Gender did not interact with the Cluster B PDs. Age and race produced significant main effects in both models and are discussed separately. Although the findings were not all as expected, the results suggest the value of further investigation of risk factors for SUD that are not biologically based.;Key words: attachment, insecure attachment, personality disorders, substance abuse...