Running head: ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 1

Association between Attachment Styles and

Obsessive-Compulsive Personality Traits in Young Adults

University of Karachi

December, 2018
Running head: ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 2
Abstract
The purpose of this literature review is to explore attachment patterns in young adults with

Obsessive-Compulsive Personality traits. Attachment theory explains how interpersonal

functioning in adulthood is associated to early interactions. People with Obsessive

Compulsive Personality Disorder (OCPD) have difficulties in interpersonal functioning. This

study seeks to analyze the relationship between Obsessive-Compulsive traits and insecure

attachment. The present study reviews original theories as well as current research.

Knowledge about association between OCPD traits and attachment would be helpful in

understanding the risk factors of OCPD and also in developing treatment.

ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 3

Attachment theory is often employed to explain the causes of psychological disorders.

It has been used extensively to explain the etiology of personality disorders (Dozier, Stovall-

McClough, & Albus, 2008). Purpose of this paper is to explore literature that investigates

connection between traits of Obsessive-Compulsive Personality, and attachment styles

proposed by attachment theory. Main focus of this paper is attachment patterns in young

adults with Obsessive-Compulsive traits.

This paper will begin by analyzing impairment in interpersonal functioning associated

with traits of Obsessive-Compulsive Personality Disorder (OCPD). Then basic concepts of

attachment theory will be briefly described before reviewing major theoretical perspectives

and empirical researches in the field.

Literature Review

OCPD and Impaired Interpersonal Functioning

People with OCPD have impaired interpersonal functioning. They prioritize working

over spending time with family and friends. People with OCPD traits have difficulty

assigning tasks to others and they find it inordinately difficult to work in groups. They need

control over everything (Kring, Johanson, Davidson & Neale, 2012). In addition, people with

Obsessive Compulsive Personality find it difficult to express love and other positive emotions

but they frequently express anger and other negative emotions which scare people away

(Villemarette-Pittman et al., 2004). These traits indicate impaired ability to form and

maintain healthy and satisfying relationships. Compromised interpersonal functioning is

intricately tied to insecure attachment (Gallo, Smith, & Ruiz, 2003). Insecure attachment

styles are also proposed to be a cause of constant anxiety (Bowlby, 1973) which may explain
certain traits of OCPD such as difficulty discarding useless objects, miserliness and excessive

perfectionism.

ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 4

Attachment Theory

John Bowlby (1969, 1973) was the first to develop attachment theory of personality

development, which states that early interactions of a child with their caregivers determine

how their personality develops. According to him, responses of caregivers towards the child

shape two basic attitudes: attitude towards self (self-esteem) and attitudes towards caregivers

(interpersonal trust). When the responses of the caregiver show the infant that he or she is

important to them, the child develops high self-esteem. When the caregiver’s behavior shows

that they do not value or love the infant, he or she develops low self-esteem. When the

caregiver is available to the child and fulfills his or her needs, the child develops high

interpersonal trust. When the child perceives that his or her caregiver is unreliable or

untrustworthy, they develop low interpersonal trust. According to Hazan and Shaver (1987),

these early attitudes carry into adulthood.

Childhood experiences determine how we behave later in relationships and what we

expect from relationships (Hazan & Shaver, 1987). A person with both high self-esteem and

high interpersonal trust forms a secure attachment style: an attachment pattern low in both

anxiety and avoidance. Having secure attachment mean that the person perceives that they

can rely on their attachment figures to provide feelings of protection, comfort and safety.

Secure attachment style is speculated to be associated with healthy personality functioning

(Bowlby, 1973). Persons with high interpersonal trust but low self-esteem develop anxious

attachment style characterized by constant fear and anxiety that they will be abandoned by

their attachment figure. According to Bowlby, such persons are likely to become “guilt
ridden and conscientious”. Opposite of anxious attachment style is avoidant attachment style,

which is characterized by low interpersonal trust but high self-esteem. People with avoidant

ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 5

attachment style show excessive self-reliance and maintain distance from others (Bowlby,

1979).

Nowadays, attachment styles are not viewed as separate categories, but rather are

understood as existing on two dimensions: avoidance and anxiety. Securely attached people

are low on both dimensions. Individuals with insecure attachment style are high on both or

either of these two dimensions (Shaver & Mikulincer, 2009).

Low High
Anxiety Anxiety Figure 1. The four
categories of attachment in young adults
Low Anxious-
Avoidanc Secure Preoccupied as described by
Bartholomew and Horowitz (1991)
e
People who are High Fearful- both high in anxiety
Avoidanc Dismissing Avoidant
(low self-esteem: e believing they are not

worthy of love and others will leave them) and high on avoidance (low trust of others)

display fearful-avoidant attachment style (Bartholomew & Horowitz, 1991).

Research evidence suggests that insecurity in attachment is connected to distress,

impaired functioning and psychopathology. In adults, insecure attachment styles have been

found to be associated with loneliness, anxiety, depression, physical symptoms, negative

affectivity, neuroticism, low self-esteem, and maladaptive strategies for coping with negative

affect (Hazan & Shaver, 1987; Carnelley et al., 1994; Simpson, 1990; Shaver & Brennan,

1992; Brennan & Morris, 1997; Brennan & Shaver, 1995; Thorberg & Lyvers, 2010).
ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 6

Attachment Patterns in Individuals with OCPD Traits

Theoretical perspectives.

Some authors suggest that insecure attachment in OCPD results when parents provide

affection contingent on child’s performance (Lenzenweger & Clarkin, 2005). This might be

the reason that individuals with OCPD traits focus excessively on work. Guidano and Liotti

(1983) proposed that people with OCPD traits have an ambivalent attachment style

characterized by an unstable sense of self. They believe that they are loved and worthy of

love, and unloved and unworthy of love both at the same time. People with OCPD do not

tolerate uncertainty because maintaining certainty is important for them to have integrated

sense of self. The seek control to resolve inconsistency in sense of self. The authors further

hypothesize that this ambivalent attachment pattern in obsessive-compulsive personality is

developed due to a parenting style which discourages emotional expression and lacks positive

reward. Parents of persons with OCPD tend to be emotionally unexpressive, set high

standards for their children and only provide positive reward that is conditional (Guidano &

Liotti, 1983).

Kyrios (1988) theorized that individuals acquire five core beliefs through early

interactions: 1) beliefs about self-importance or unimportance (self-esteem), 2) beliefs about

whether or not others are trustworthy, 3) perceptions of control over one’s environment, 4)

acquiring roles that make up identity, and 5) abidance to religious, moral or ethical codes that

is important for one’s sense of self. When children are securely attached, they feel trust in

themselves, others and the world around them. This trust makes them feel safe to explore and

discover their environment (Bowlby, 1973). Exploration of environment helps them develop

a sense of control over self and environment. It also facilitates them learn how to deal with
ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 7

difficulties, complexities and uncertainties of the world. Exploration of environment

promotes social and cognitive skills. In people with OCPD, early interactions failed to meet

their basic emotional needs, hence obstructing acquisition of sense of security. People with

OCPD have not developed appropriate trust and dependency on oneself, other and

environment (Bowlby, 1973, 1988; Kyrios, 1998).

Evidence from empirical studies.

Aaronson, Bender, Skodol and Gunderson (2006) conducted a study in which they

compared attachment styles in OCPD with attachment styles in Borderline Personality

Disorder. They found that persons with OCPD demonstrate significantly less insecure

attachment as compared to persons with Borderline Personality Disorder. However, the

mentioned study did not compare attachment style in OCPD with that of other personality

disorders. Also, the study did not include any control group consisting of people without

psychopathology. Furthermore, the test they used to assess attachment style, the Reciprocal

Attachment Questionnaire (RAQ), does not have established test norms to describe what

scores comprise secure attachment.

OCPD has high comorbidity with depression, and obsessive-compulsive disorder

(Diaconu, &Turecki, 2009; Garyfallos, 2010). Depression and obsessive-compulsive

disorder are found to present with insecure adult attachment style (Bifulco, Moran, Ball &

Bernazzani, 2002; Doron et al., 2011). In addition, people with eating disorders show high

levels OCPD traits. Women with both anorexia nervosa and bulimia nervosa score higher on

measures of inflexibility, perfectionism, rule following, cautiousness, and drive for order and

symmetry, as compared to healthy control group (Anderluh et al., 2003). Eating disorders

have been found to be strongly associated with insecure attachment style (Amianto, 2016).
ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 8

Therefore, it can be reasonably argued that OCPD traits are associated with insecure

attachment.

In a study, self-reports from 28 OCPD patients were acquired to assess parental care

and overprotection patterns. Nordahl and Stiles (1997) found that OCPD was significantly

associated with lower parental care and high parental overprotection as compared to healthy

participants. Perceived parental overprotectiveness has found to be positively associated with

low interpersonal trust and less secure attachment (van Ingen et al., 2015). Low levels of

parental care are also found to be associated with insecure attachment (Wiseman, Mayseless

& Sharabany, 2005). Hence, it can be reasoned that there might be an association between

OCPD and insecure attachment.

Now, narrowing focus on studies that directly assessed correlation of OCPD traits

with attachment patterns:

Patients hospitalized for OCPD show greater attachment avoidance as compared to

controls (Wiltgen et al, 2015). Results of their study indicated that the most prevalent

attachment style in OCPD patients was fearful-avoidant attachment style, a pattern

characterized by greatest attachment insecurity. They found significant correlations between

attachment avoidance and some of the OCPD traits across the whole sample (61 OCPD

inpatients and 61 controls). Attachment avoidance had a Pearson’s correlation of .38 with

criterion 3 of DSM-IV excessive devotion to work and prioritizing work over leisure),

correlation of .25 with criterion 6 (reluctance in delegating tasks or working with others

unless other people submit to their standards) and correlation of .27 with criterion 8

(inflexibility and stubbornness). All these correlations had significance levels higher than .

01. The limitation of the mentioned study is that it was conducted on people with severe
ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 9

mental illness which required them to be hospitalized. Therefore, it has limited

generalizability to people with less severe OCPD traits.

Secure Fearful Preoccupied Dismissing Now, as we have reviewed

some general research evidence

Dismissing; 15.90%;
16% supporting the notion that OCPD
Secure; 31.70%; 32%
traits are related to insecure

attachment, let us further

Preoccupied;
21.20%; 21% concentrate our attention to

connection between attachment and

OCPD traits only in young adults: A

Fearful; 31.20%; 31% study conducted by Brannen and

Shaver (1998) explored association

between attachment styles and

various personality disorders. Their

sample consisted of adolescents and young adults enrolled in first year of undergraduate

psychology course. This can be considered a limitation of this study that their sample was

biased: it was not representation of general population as their participants were all

psychology students. However, a great proportion of research in psychology is conducted on

psychology students. Results of Brannen and Shaver’s study indicate that insecure

attachment is connected to all the personality types they investigated. The test they used, a

revised version of the Personality Diagnostic Questionnaire, was very likely to diagnose

people as having a personality disorder who do not actually have it (high rates of false

positives). Therefore, 384 participants out of total sample of 1056 were found to have OCPD

traits (around 27%). See figure 2 to compare the prevalence of different attachment patterns
in people with OCPD traits. The pie chart is made by using data from Brennan and

Shaver’s study (1998).

ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 10

A more recent study was conducted in Iran by Zakei et al. on 260 college

undergraduate students. All of their participants were young adults: in age range of 21-26.

They found positive Pearson’s correlation of .22 between ambivalent attachment style and

OCPD traits and correlation of .36 between avoidant attachment style and OCPD (P<0.001,

for both). Their results demonstrated absence of any significant relationship between secure

attachment style and OCPD (Zakei et al., 2017). The limitation of this study is that the

reliability and validity of the translated version of the test they used to assess OCPD was not

known. Crucial information is also missing and there are mistakes in the research article that

hint that the study might not have been conducted very professionally.

The importance of these two studies, Brannen and Shaver’s and Zakei et al.’s, is that

the participants did not have any severe mental illness, so the relationship between OCPD

traits and attachment style is generalizable to healthy young adult population.

So far, majority of the research conducted on relationship between attachment styles

and OCPD traits relied on self reports to assess attachment styles. It is important to consider

the possibility that people with OCPD traits might not have much insight into their

attachment patterns.

Conclusion

Most of the studies conducted on OCPD and attachment indicates positive

relationship between OCPD traits and insecure attachment, especially avoidant and

ambivalent attachment styles. However, number of research studies, that investigate the
relationship between OCPD and attachment, is sparse. More research is needed to determine

the role of attachment processes in development of OCPD traits. Also, it is important to

ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 11

conduct research using more recent criteria provided by DSM-5. Majority of researches done

on OCPD and attachment have employed DSM-IV criteria. Criteria for OCPD have since

changed by the publication of DSM-5 (American Psychiatric Association, 2013).

Knowledge about association between OCPD and attachment patterns can provide

insight into risk factors of OCPD as well as useful solutions to effective treatment for people

with OCPD. Also, people who enter counseling for other reasons often have maladaptive

traits of personality disorders which further impair functioning and cause distress to them

(Kring, Johanson, Davidson & Neale, 2012). Knowledge of more effective treatment can

also be used to help these individuals adjust better to life. According to Baron and

Branscombe, attachment patterns are not fixed in stone; they can be changed (2012).

Cognitive behavioral therapy can be used to help people with OCPD change internalized

beliefs about self and other. Interpersonal therapy can be utilized to improve interpersonal

functioning. Improved relationship quality might be helpful to change attachment patterns.

ATTACHMENT STYLES AND OCPD TRAITS IN YOUNG ADULTS 12

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