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Exploring Attachment Patterns in Patients With Comorbid Borderline Personality and Substance Use Disorders

Schindler, Andreas PhD*; Sack, Peter-Michael PhD

The Journal of Nervous and Mental Disease: November 2015 - Volume 203 - Issue 11 - p 820–826
doi: 10.1097/NMD.0000000000000377
Original Articles

Studies exploring attachment patterns in samples of patients with borderline personality disorder (BPD) report a combination of preoccupied and fearful-avoidant patterns. This has been interpreted as reflecting the approach-avoidance dilemma of BPD. Comorbid substance use disorders (SUD) have not been considered in these studies, despite the high proportions of SUD among BPD patients and despite the more avoidant attachment in SUD samples. This cross-sectional, naturalistic study explores attachment patterns in a sample of comorbid (BPD and SUD) patients, comparing them to two samples of patients with either SUD or BPD only. Within-group comparisons replicated findings of both preoccupied and fearful-avoidant attachment in BPD and comorbid groups. But between-group comparisons showed that comorbid patients were significantly less preoccupied (p = 0.018) and more dismissing-avoidant (p = 0.030). Although both groups were similar in several psychiatric measures, attachment patterns of the comorbid group were more similar to substance abusers than to borderline patients.

*Department for Personality and Stress Disorders and †German Center for Addiction Research in Childhood and Adolescence, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Send reprint requests to Andreas Schindler, PhD, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. E-mail:

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