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Past attempts at linking attachment work with theories o f BPD psychopathology have stressed the common characteristics shared by the preoccupied attached and the individual with BPD e.g. an intolerance o f aloneness and terror o f abandonment (Gunderson, 1996). Others, have additionally focused on the similarities between disorganised attachment and BPD (De Zulueta, 1999; Fonagy, 2000). However, the nature o f the overlap between personality disorder and attachment styles remains

unclear (Meyer et al, 2001). Sable (1997) suggested that the research into personality disorders indicates that they should be understood as the outcome o f disturbances in the organisation o f attachment behaviour, along a continuum o f secure versus insecure. BPD functioning would fall toward the extreme o f insecure, with more disorganisation, rigid defenses and traumatic histories (Adam et al, 1995).

There is also empirical evidence o f the association between attachment styles and PD. Research by Meyer et al (2001) demonstrated an inverse correlation between security o f attachment and PD. At least seven studies have demonstrated that patients with BPD have extremely insecure attachment relationships (mostly preoccupied) characterised by alternating fear o f involvement and intense neediness (e.g. Bartholomew et al, 2001; Patrick et al, 1994; Stalker & Davies, 1995).

Patrick et al (1994) compared 12 patients who met 7 out o f 8 DSM III criteria for BPD, with 12 dysthymic patients who met no BPD criteria. Despite the small sample size, they found that all 12 Individuals with BPD were preoccupied on the AAI and 9 o f the 12 were unresolved (disorganised), with respect to loss, trauma and abuse compared to 2 in the dysthymic group.

Salzman et al (1997) sought to establish whether disturbed attachment to the mother was more strongly related to BPD than to abuse in a non-clinical population. They reported data that attachment had a more powerful statistical relationship to BPD than a history o f childhood abuse. In their first study they found that all participants meeting criteria for BPD were classified as ambivalently attached. However in their

second study more BPD participants were classified as avoidant (Salzman et al, 1997), indicating a lack o f stability in their research findings.

Research by Nickell et al (2002) controlled for both Axis I and Axis II pathology and found that BPD features in a student population were significantly associated with preoccupied attachment, beyond what could be accounted for by childhood loss or abuse. Interestingly, when they did not control for other personality disorders, avoidant attachment also emerged as a significant predictor o f BPD features and childhood sexual abuse appeared as a significant unique predictor. (Indicating, that the study by Salzman et al (1997) might have been confounded by comorbidity). As a result o f these findings, they argue that parental bonding patterns and attachment styles show a unique relationship with borderline features and should be considered in aetiological models o f BPD. However, they used a non-clinical sample and only 2% o f their participants actually met diagnostic criteria for BPD. It is unclear if they would have found the same results if this research were carried out on a BPD sample.

Ludolph et al (1990) found that a history o f disrupted attachment, rejection, abuse and chaotic family environment significantly distinguished between adolescent girls with BPD, and psychiatric controls. However this research can be criticised on the basis that BPD cannot be diagnosed before early adulthood and because no data were presented indicating the relative strength o f these associations (e.g. the overlap among predictors).

In a study by Fonagy et al (1996), seventy five percent o f individuals diagnosed with BPD were also classified as preoccupied on the AAI (N=36) and 89% o f the BPD

group were classified as disorganised. They found overwhelming support for the association o f psychiatric disorder with unresolved difficult early relationships, which is in line with the predictions o f attachment theory (Bowlby, 1980, 1988). In particular, the most specific relationship found in the study was between BPD diagnoses and attachment classification. They also found that the AAI predicted treatment response, which needs following up with longitudinal research.

In studies o f AAI narratives o f patients with BPD, the classification o f preoccupied attachment has been most frequently assigned (Fonagy, 2000). It seems that the preoccupied pattern o f attachment can alternate unpredictably with a disorganised attachment pattern (Gunderson, 1996). This displays itself as the denial o f dependent needs, the apparent absence o f separation anxiety and reluctance or fearfulness about becoming attached.

In summary, research into attachment and BPD appears to demonstrate a clear relationship between the two concepts, even when controlling for Axis I and other Axis II disorders. However, some o f the studies have used non-clinical participants with features o f BPD and most o f the research has been carried out on patients who meet DSM III criteria for BPD. It will be interesting to see if the relationship between BPD and attachment is affected when the ninth criterion is included. In addition, all these studies have used either the AAI or a mixture o f self-report measures o f attachment. But, evidence is accumulating that these may not be the best methods o f identifying attachment styles (see below).