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“The relationship between an individual’s self-harm and their attachment system is inextricably linked”

Grocutt (2009, p. 97)

Emerging from psychoanalysis, object relations theory, developmental

psychology and ethology (particularly Lorenz’s 1935 study of imprinting in geese; and Harlow and Zimmermann’s 1958 pioneering work on the effects of maternal

deprivation in rhesus monkeys) attachment theory espouses a systemic approach, conceptualising the individual in a series of reciprocal relationships throughout the life cycle, but founded upon the first relationship between an infant and their primary caregiver. Central to Bowlby’s attachment theory is that this initial relationship is internalized as a cognitive representation or working model of the self and other,

82 forming the archetype upon which future relationships are based (Bowlby, 1998, 2012). Through the strange situation study, Ainsworth and Bell (1970) identified three patterns of attachment in infant-mother dyads, which later research indicated, largely persisted through adolescence and adulthood (Hazan & Shaver, 1987). Securely attached infants of a “good-enough caregiver” (Winnicott, 1965) develop a working model that others are helpful, supportive and can be trusted; and that they in turn are worthy of receiving this care and support (Ainsworth, 1989; Bowlby, 1998, 2012). Paramount to the current study, it is through this secure attachment that the child also learns to organise and regulate their affect and experiences, learning to cope effectively with negative

emotions and employ adaptive affect-regulation techniques (i.e., seek social support, or use cognitive or behavioural coping strategies).

According to the attachment paradigm, early childhood traumas involving neglect, sexual abuse, violence, separation or loss often cause interruptions to

interactions with caregivers, significantly altering the developing working models about self, others and the individual’s perceptions about their worthiness to receive care and security (Grocutt, 2009; Simpson & Porter, 1981; Van der Kolk, Perry, & Herman, 1991). As such, children whose early attachments are characterised by these traumas or inconsistency, indifference, rejection, inattentiveness or dismissiveness may develop insecure attachment patterns which Ainsworth and Bell (1970) asserted, manifested either as anxious-ambivalent, or avoidant. Main and Solomon (1986) later proposed the addition of a disorganized/disoriented attachment pattern to Ainsworth and Bell’s original categorisation. These insecure attachment patterns are not necessarily features of daily interpersonal interactions but are expressed in response to the need for comfort or a sense of security when under stress or emotionally overwhelmed (Brumariu, Obsuth, & Lyons-Ruth, 2013).

83 Insecure attachment styles have been associated with a number of other

psychological variables, diagnoses, behaviours and adjustment (Brumariu et al., 2013; Cooper et al., 1998). The relationship between trauma and insecure attachments has been well documented (Bowlby, 1998, 2012; Low, Jones, MacLeod, Power, & Duggan, 2000; Van der Kolk et al., 1991). A strong link between low self-esteem and insecure attachment has also been repeatedly recorded in the literature (Armsden & Greenberg, 1987; Barnum & Perrone-McGovern, 2017). Greater levels of insecure attachment have been recorded in adolescents who met the criteria for anxiety disorders (Brumariu et al., 2013), and children with diagnoses of depression (Armsden, McCauley, Greenberg, Burke, & Mitchell, 1990). Individuals with insecure attachment styles have

demonstrated a range of maladaptive affect-regulation techniques, such as alcohol or substance abuse (Caspers, Cadoret, Langbehn, Yucuis, & Troutman, 2005; Stein, Milburn, Zane, & Rotheram-Borus, 2009), risk taking behaviours (Cooper et al., 1998), and promiscuous sexual behaviours (Dempster, Rogers, Pope, Snow, & Stoltz, 2015).

Given the relationships between attachment, self-esteem, trauma, and the use of other maladaptive coping strategies or affect regulation techniques, a relationship with self-injurious behaviours is highly probable. However, the influence of the perceived quality of parental attachment on the engagement of NSSI or DSH in nonclinical populations has been underexplored to date (Gratz et al., 2002; Hallab & Covic, 2010; Heath, Toste, Nedecheva, & Charlebois, 2008; Hilt, Nock et al., 2008; Kimball & Diddams, 2007) with much of the earlier research undertaken in clinical samples (Bezirganian, Cohen, & Brook, 1993; Carroll, Schaffer, Spensley, & Abramowitz, 1980; Marchetto, 2006; Simpson & Porter, 1981; Van der Kolk, Perry, & Herman, 1991). Several studies have found that individuals who self-injure have less secure attachments with their parents than those who did not engage in NSSI (Hallab & Covic,

84 2010; Hilt, Nock et al., 2008; Kimball & Diddams, 2007; Martin et al., 2011).

Inimically, Heath et al., (2008) found no differences on their measure of attachment between college students who engaged in NSSI and students who had no history of NSSI, yet this could be largely ascribed to the small sample size (n = 23).

Interestingly, there appears to be some significant gender differences between parent attachment patterns and gender. Gratz et al. (2002) reported a positive association between insecure attachment to fathers and DSH in females, but not in males. Whilst two other studies (Hallab & Covic, 2010; Hilt, Nock et al., 2008) revealed that the influence of parental attachment on self-injury was not equal, with paternal attachment showing greater significance in the maintenance of NSSI, than maternal attachment across experimental conditions. Research in other related areas, has indicated that the impact of the perceived quality of the paternal relationship is not peculiar to NSSI. Demidenko, Manion, and Lee (2015) found that adolescent girls with a diagnosis of depression had poorer perceived attachment to fathers, than nondepressed participants. Whilst in a study on suicide attempts, of the three relationship domains, paternal attachment was the only significant predictor of suicide attempts (Sheftall, Mathias, Furr, & Dougherty, 2013). This highlights the differing impact each individual parent can have on NSSI (Hallab & Covic, 2010; Hilt, Nock et al., 2008). Finally, employing path analysis Hallab and Covic (2010) revealed that the pathway between attachment and DSH was not a direct one, and was mediated by stress, with father attachment showing the strongest impact on DSH.

Whilst the influence of parental attachment has a long history in the clinical literature, the role of extrafamilial attachments is still a relatively new area of research (Armsden & Greenberg, 1987; Laible, 2007). During childhood and adolescence, as

85 children spend more time at school in the company of their peers, they increasingly rely on their peers as a source of support and security, in the absence of physical parental proximity (Allen, Uchino, & Hafen, 2015; Hazen & Shaver, 1994; Laible; Nickerson & Nagle, 2005). Providing that the peer proves a secure and stable base over recurrent times of need, the security of this attachment relationship is internalized (Hazen & Shaver). These peer attachments do not replace the parents as attachment figures (Hazen & Shaver; Laible; Nickerson & Nagle, 2005). In fact, research indicates the role of parental attachment persists through this period, and continues to predict psychological wellbeing into young adulthood (Allen et al.; Armsden & Greenberg; Laible; Nickerson & Nagle). According to Hazen and Shaver’s model, parents are relegated a step down in the attachment hierarchy, until they are supplanted by a romantic partner as the primary attachment figure in adulthood.

Peer relationships have a significant influence on our social, behavioural and emotional functioning (Armsden & Greenberg; Hallab & Covic, 2010; Laible; Nickerson & Nagle). In fact, Laible (2007) found that peer attachment had a stronger direct relationship with all facets of social and emotional development than parent attachment in a sample of late adolescents and young adults. However, only Hallab and Covic (2010) have explicitly investigated the relationship between peer attachment and NSSI. The erudition on self-injurious behaviours has explored factors closely related to peer attachment, such as perceived social support (Andrews et al., 2014; Muehlenkamp et al., 2013; Rotolone, & Martin, 2012; Tatnell et al., 2014); and the quality of peer communication (Hilt, Cha, & Nolen-Hoeksema, 2008), further highlighting the influence of peers on NSSI. Indeed, Rotolone, and Martin (2012) reported that low social support was the strongest predictor of engagement in NSSI. Comparably, Claes et al. (2010) found that adolescents who engaged in NSSI had less positive relationships

86 with same-sex peers than their counterparts who did not self-injure. However, it could not be ascertained whether the perceived negative relationships existed prior, or subsequent to the initiation of their NSSI; and no measure of attachment was incorporated into their study.

As early as 1967, Grunebaum and Klerman identified the difficulty individuals who self-injure have with trusting others, asserting “while superficially these young women may appear socially adept, they are markedly impaired in their ability to trust and share with their peers…”(p. 533). In support of this, Hilt, Cha, & Nolen-Hoeksema (2008) discovered that poor quality peer communication predicted engagement in NSSI for social reinforcement when subjected to high levels of peer victimization.

Furthermore, they reported that the combined interaction of peer communication and peer victimization predicted both social positive and negative reinforcement,

implicating the engagement of NSSI in multiple and complex interpersonal functions. The relationship between peer attachment and NSSI warrants further exploration to ascertain what effects it has on the initiation, maintenance and cessation of self- injurious behaviours.