Disorganized attachment, loneliness, & Self-mutilation: A MEDIATIONAL MODEL By Holly Rosen

Existing literature Disorganized (Type D) attachment first arose from the notion that not all infant responses in the Strange Situation could be placed in the original patterns defined by Ainsworth (Duschinsky, 2015). Described infants who were seen to display various disoriented, fearful, or conflicted behaviors in the Strange Situation Disorganized children display observable characteristics such as “contradictory behavioral patterns,” freezing, stilling, and slowed movements (Granqvist et al., 2017). As a result, these children exhibit behaviors of both avoidant and anxious/ambivalent types; seeking proximity, yet apprehensive (Ouellette, 2004). Can result from childhood abuse, neglect, or parental unresolved loss or trauma

Existing literature cont. Loneliness has been defined “as a feeling of disconnectedness from a desired belonginess to a group or for a close relationship” (Campbell, 2013). The prevalence of loneliness is reported to be as high as 20% for school-age children (Laine, Neitola, Auremaa, & Laakkonen, 2010 Avoidance and ambivalence have been positively correlated with increased loneliness. Loneliness in childhood is linked to risk factors for developing psychological distress such as phobia, depression, and anxiety (Lasgaard, Goossens, Bramsen, Trillingsgaard, & Eliklit, 2011; Newsom, Mallow, Watson, Miner, & Legg, 2013). Loneliness has also been associated with deliberate self-harm (DSH) or self-mutilating behaviors (Rönkä, Taanila, Koiranen, Sunnari, & Rautio, 2013).

Existing literature cont. Self-mutilation or self-injurious behaviors such as cutting, burning, scratching, and biting oneself are very common among children and adolescents Engagement in self-mutilation at age 12 significantly predicted self-harm at 15 Research shows that self-mutilation is also the strongest predictor of suicide Those who begin self-mutilation in childhood performed the behavior for longer durations and reported employing a variety of methods compared those who began self-harming in adolescence or adulthood (Palmer, 2016, p. 2).

HypothesEs Will follow mediational model (Baron & Kenny, 1986). IV  MV  DV Disorganized attachment  Loneliness  Self-Mutilation Disorganized attachment will predict self-mutilating behaviors, disorganized attachment will predict loneliness, and loneliness will predict self-mutilating behaviors. After controlling for loneliness, there will be a nonsignificant correlation between disorganized attachment and self-mutilating behaviors and a highly significant correlation between loneliness and self-mutilating behaviors

Participants 75 children (N = 75), 52% males and 48% females, ages 8-12 years (M = 10.2 years; SD = 1.6) Participants were in treatment for recurring self-harm behaviors and had been engaging in self-mutilation for at least six months. Participants did not have a reported history of suicidal behavior or ideation. Participants were recruited from various outpatient treatment facilities in the metropolitan East coast areas. The mean yearly income of the children’s caregivers was 49,240 (M = 49,240; SD = 1.5).

measures Demographic Questionnaire: age, gender, race/ethnicity, socioeconomic status, education level, individuals with whom they lived, and geographic location, facility, length of treatment Child Attachment Interview (CAI): ● informed by the Adult Attachment Interview (AAI) ● 19 question, semi-structured, interview that asks the participant direct questions about relationships and focuses on situations in which the attachment system would presumably be activated ● Coding of attachment classifications is based on video-recorded interviews, in which linguistic and behavioral elements are analyzed. The CAI transcript is evaluated by assigning a score ranging from 1 to 9 to nine descriptive scales (e.g., Emotional Openness). ● High internal consistency (a = .87), good test-retest reliability and construct specificity to attachment, and sound discriminant validity

Measures cont. ● Revised UCLA Loneliness Scale (R-UCLA): ● 20-item self-report inventory that is designed to understand one’s subjective experience of loneliness and feelings of isolation ● 4-point Likert scale (never [1], rarely[2], sometimes[3], often[4]); Items indicated with an asterisk are reverse scored; all other items are scored on a continuous basis. ●well-established internal consistency (a = .94), high construct and convergent validity, and high test-retest reliability (r = .73) ● Deliberate Self-Harm Inventory-Youth Version (DSHI-Y) ● 6-item measure; assesses the presence and frequency of self-harm behaviors, without suicidal intent. ● 5-point Likert-type scale ● Clinicians are informed about increased risk of suicide, depression, anxiety, & personality disorder, in knowing the average number of methods of DSH and frequency over time periods ● demonstrates adequate test-retest reliability, high internal consistency (a = .91), and adequate construct, discriminant, and convergent validity

procedure The variables were not actively manipulated, making the study non-experimental. All participants completed demographic questionnaires and 2 self-report measures, the R-UCLA, and the DSHI-Y for about 30 minutes. Disorganized attachment was assessed qualitatively ● numbers were assigned to represent disorganized attachment (0), and non- disorganized attachment (secure, avoidant, anxious) (1). ● A licensed psychologist conducted and video-recorded the interview. ● The interview duration ranged from 20 minutes to 1 hour and 20 minutes. ● 3 trained, doctoral students coded the material and identified attachment classifications. Coders produced an interrelated reliability coefficient of .86.

Data analysis The mediational model involves four criteria. ●[IV] predicts [DV]. ●[IV] predicts [MV] ●[MV] predicts [DV] A hierarchical regression analysis will demonstrate that when controlling for [DV], [IV] becomes nonsignificant and no longer significantly predicts [DV]. In addition, the Pearson correlation between [MV] and [DV] becomes highly significant. This informs the researcher that loneliness mediates or explains the indirect relationship between disorganized attachment and self-mutilation. Researchers used SPSS software to conduct a hierarchical regression analysis, performed at an alpha level of p < .05 (Baron & Kenny, 1986).

results Significant A hierarchical regression analysis at an alpha level of p < .05 revealed that disorganized attachment was significantly and positively correlated with loneliness (r = .86) as well as with self-mutilation (r = .75) among children aged 8-12. When controlling for loneliness in the hierarchical regression analysis, the significant correlation between disorganized attachment and self-mutilation became nonsignificant, and the correlation between loneliness and self-mutilation became extremely significant (r = .94). Loneliness, therefore, mediates the relationship between disorganized attachment and self-mutilation. Support for mediational model/hypothesis Nonsignificant ● No significant correlation was found between disorganized attachment and loneliness. ● Lack of support for mediational model/hypothesis

limitations ● Nonsignificant relationship between disorganized attachment and loneliness ● A possible explanation for this finding could be that other negative affective states such as depression or anxiety are more prevalent than loneliness in children with disorganized attachment. ● Pattern of “inconsistent conceptual definitions” of self-harm found in the literature. This lack of consensus about the operational definition of deliberate self-harm could lead researchers to unknowingly measure different constructs and behaviors, but label it the same ● DSHI-Y measures non-suicidal intent. Because individuals who self-harm experience affect instability, particularly when diagnosed with BPD, it may not be reasonable to presume that someone who does not have suicidal intent at one point will not alter this mentality ● Children’s biases in answering questions on the CAI, such as idealizing or strategically making excuses for an abusive attachment figure, in an effort to protect him or her. Such biases may be difficult for some practitioners to pick up on, and illustrates the importance of licensed psychologists who have relevant experience to serve as administrators of the CAI.

IMPLICATIONS / FUTURE RESEARCH Need for licensed practitioners to code properly and pick up on dormant behaviors (i.e. disorganized attachment) Significant correlation between disorganized attachment and loneliness reflects the effects of the lack of attachment security found in this attachment classification. Type D children possess a low level of attachment security, as they have conflicted feelings about their attachment figure, and have great difficulty in “utilizing the caregiver as a safe haven. ● Can provide clinicians and researchers with insight as to where a child’s self- mutilation might have originated from or encourage them to investigate the child’s upbringing --> inform treatment plans ● The variable of loneliness requires more research/improved dialogue among providers, as it “carries a health risk” that negatively affects not only mental health, but physical health as well (Rönkä et al., 2013).