Introduction:
This investigation will attempt to answer to question, “To what extent is there a correlation between patients suffering from Paranoid Personality Disorder (PPD) during adulthood and the level of attachment they experienced as a child?” This question is relevant as Paranoid Personality Disorder (PPD) affects nearly 7 million Americans each year, and affects 30% of all institutionalized psychiatric patients, making it the most common personality disorder in American society.
Despite being the most prevalent personality disorder, psychologists are not able to determine the causes of PPD. Paranoid Personality Disorder is a disorder in which patients suffer from paranoia, and a ceaseless mistrust and suspicion of others, even when there is no reason to be suspicious. Sufferers of PPD often misinterpret the motive of others, and believe that every individual they are suspicious of, is attempting to harm them for personal gain. Patients suffering from PPD often exhibit odd and eccentric ways of thinking, thus causing them to demonstrate significant impairment in academic, occupational, and social functioning. This impairment often leads to poor ability to work and converse in groups, and high criticism of other people, yet hypersensitive to criticism of self.
One significant link to PPD is the level of attachment that an individual received during childhood. Attachment, in psychological terms, Attachment Theory, as developed by John Bowlby, explains that humans are biologically “pre-programmed” to form relationships as a method of survival. These relationships are the basis for adolescent and adulthood relationships. The importance of these relationships can be shown in the popular study conducted by Mary Ainsworth. This study helped outline the importance of relationships during infancy, and how such forms of separation anxiety are ignited through abandonment or unhealthy external factors. There are several factors of the degrees of attachment that directly affects the level of anxiety of an individual. These factors include, but are certainly not limited to, relationships with parental figures, especially with an individual’s mother, and external, environmental factors. There are different arguments as to what is more important to a child during their first years of living. One psychologist argues that clinging and following their mother is the most important action to a toddler, as opposed to sucking and crying (Bretherton 1992). The most common experiment used to reference attachment during childhood is most commonly referred to as the “The Strange Situation” by Mary Ainsworth. It is found that when a child is left alone in a room with toys, the child is likely to cry as a result of the isolation. It is also observed that when a child is left in a room with a stranger, the same result occurs. The crying alleviates when the mother is introduced to its mother once again. Separation and stranger anxiety are results of the exposure to new adults and the loss of presence (Ainsworth 1969).
These behaviors may explain the sources and etiologies of PPD. Individuals that experienced high levels of secure attachment during childhood maintain stable and healthy relationships with individuals in society. However, individuals that experienced high levels of insecure attachment during childhood maintain poor, and unhealthy relationships. This is a direct cause of several personality disorders, especially Paranoid Personality Disorder.
“The Strange Situation” and Social Anxieties:
The key principles and understanding outlining the Attachment Theory can be best demonstrated and observed through the Strange Situation, conducted by Mary Ainsworth. In the Strange Situation, a child undergoes several experimental factors such as being alone with the parental figure, or being alone with a completely unfamiliar stranger (Ainsworth 1969). These factors exist so that the researchers could observe the various responses exhibited by the toddler. During the procedure, a mother would stay within close proximity to the child at play. Then, when instructed, the mother would leave the room and would later be replaced by the stranger. The response of the child was recorded for further analysis (Ainsworth 1969).
The level of attachment and care that was given to the child since birth could have been an indicator of the response recorded by the child. Secure attachments could be defined as being able to explore when they have the knowledge of a secure base to return to in times of need. A child that has constant physical and emotional care provided to them by their parental role models are considered to possess secure attachments. It is expected that when a child is separated from their mother, the child will respond by crying and showing an immense amount of distress. This response is a result of separation anxiety due to secure attachment. The child trusts the parent to be able to care for them at any given time. This exploration can be found through observing the child, mother, and stranger in the same area. On the contrary, a child that experiences a low level of attachment, or avoidant attachment, may exhibit behavior that is considered emotionless. Essentially, a child of this nature would simply not respond to the absence of the mother and continue the activity that they were performing beforehand. This relates to the topic as the child that possesses a low form of attachment does not interact with the surrounding people due to a large, existing amount of independence. This independence is demonstrated later on in life as the child will not be as willing to interact with the society in which he or she inhabits.
In the experiment, when all three individuals were present, the child was content with the stranger and even attempted to engage and play with the stranger. However, when the mother left the room, the child began to be avoidant of the stranger. This is a result of possessing a secure attachment to the child’s parent, mainly due to the fact that the child acknowledges that the mother is no longer able to provide a “safety net” as the child explores. This anxiety is known as stranger anxiety (Ainsworth 1969). Symptoms of stranger anxiety include being quiet and staring at the stranger in hopes to process what is familiar. This relates to the topic as the level of high attachment deems the child’s behavior to be insecure. The child’s main goal, in this stage, is to rediscover the parental figure so that they can achieve the level of security that is satisfactory to them. However, a child that possesses an avoidant attachment will exhibit an ambivalent behavioral style towards the attachment figure. The child will commonly demonstrate dependent behavior, but will reject the attachment figure when they engage in interaction.
During the last trial of the Strange Situation, the child is reunited with their parent (Ainsworth 1969). During this period, a child that has received a high level of care and attachment will rejoice with happiness to be reunited with their caretaker. However, a child that has received a low level of attachment will express little to no interest due to the return of the parent. This behavior is similar to sufferers of PPD, and is demonstrated mainly due to the fact that the child does not possess an emotional bond to the parent. As this child develops, it will be likely that the child will not maintain healthy relationships as the child will not be acclimated to the interactions. This relates to the topic as a level of high of attachment shows signs of stability. If the child fails to develop any feelings of security from the attachment figure, then they will likely fail to develop feelings of security to other individuals during adulthood. Accordingly, these children exhibit difficulty moving away from the attachment figure to explore novel surroundings. When distressed, they are difficult to soothe and are not comforted by interaction with the attachment figure. This behavior results from an inconsistent level of response to their needs from the primary caregiver.
Contact Comfort:
Harry Harlow is widely known for his works in the field of developmental psychology. He is primarily known for his experiment on maternal separation and isolation of monkeys. His experiment outlined the principles of contact comfort and the importance of consistent care giving. In his experiment, Harlow theorized that the infant monkeys would require a source of comfort that was not a biological necessity such as food and water (Harlow 1932). To test this hypothesis, Harlow created two “surrogate mothers” for the infant monkeys to choose who to receive care from. One of these “mothers” was coated with wiring, that is intended to be extremely uncomfortable. Although these surrogate mothers were uncomfortable, they provided nourishment for the infant monkey. The other mother was coated in cloth that was intended to be a comforting factor to the monkey. However, this type of surrogate mother did not the provide the biological necessities required to live. The results of the experiment found that Regardless of which surrogate provided the nourishment, the infant monkeys spent more time with the cloth surrogate than the wire surrogate. By the age of about three weeks, all of the monkeys were spending around 15 hours a day in contact with the cloth surrogate (Harlow 1932). No animal spent more than 1-2 hours in any 24- hour period on the wire surrogate. Later on in the experiment, Harlow placed those isolated monkeys into environments with other monkeys. The formerly isolated monkeys were too depressed to even reproduce and interact with the other monkeys. This depression within the monkeys led to invaluable lives as they died shortly after.
These results are aligned in Harlow’s theory of contact comfort which refers to the physical and emotional comfort that an infant receives from being in physical contact with its mother is a direct resultant of its well-being as an adult. Since the infant monkeys were removed from their mother’s placement immediately after birth, the attachment to their biological mothers was never fulfilled or formed. This failure for relationships to form was harmful to the monkey’s well-being as they were not able to interact in a healthy manner. This lack of social interaction was partially due to the fact that they were unable to trust strangers, similarly to the infants in Ainsworth’s Strange Situation study. This behavior was mainly based upon the initial suspicion of the motives of the other monkeys. They had assumed that the other monkeys were attempting to harm them, and the isolated monkeys did not possess the abilities, nor the resources to find comfort. They grew anxious and doubted the loyalty of others. Also, as the monkeys that were forcibly immersed back into society continue to inhabit the area, they began to isolate themselves more and more as each day passed. This is because patients of PPD often hold grudges, and misinterpret every action that they witness everyday. These traits that developed in the monkeys after the experimentation period are similar to those that suffer from PPD. Most of these monkeys presented feelings of being victimized. This is similar to those that suffer from PPD as patients often feel like they are being constantly exploited and persecuted by some people. This mistrust often led to difficulties forming bonds and completing tasks. This behavior is similar to those who suffer from PPD as these patients find it difficult to establish relationships with their family members.
There is a possibility of a connection between the prevalence of PPD and the level of attachment as it is also mentioned in the findings that when Harlow brought some other infant monkeys up on their own but with 20 minutes a day in a playroom with three other monkeys, he found they grew up to be quite normal emotionally and socially. Since there was a high level of social interaction, the attachment levels between monkey augmented and developed. The presence of another monkey brought comfort to the monkeys lives as they were able to act normally in terms of emotions and social variability. This can be applied to humans as we interact in similar ways. It is observed that the more experiences one encounters, the more balanced they are as they develop into a fully functioning individual. Since Harlow restricted the monkeys’ social interaction, they developed and demonstrated the symptoms similar to those patients that suffer from PPD.
Adult Relationships
Hazan and Shaver (1987) were two of the first researchers to explore Bowlby’s ideas in the context of romantic relationships. According to Hazan and Shaver, the emotional bond that develops between adult romantic partners is partly a function of the same motivational system that increases the emotional bond between infants and their caregivers. Hazan and Shaver noted that the relationship between infants and caregivers and the relationship between adult romantic partners share similar features. In Hazan and Shaver’s case studies, the researchers looked at a number of couples, examining the nature of the attachments between them, and then observed how those couples reacted to various stressors and stimuli. In the case of adults, it would seem that a strong attachment is still quite important. For example, in cases where the adults had a weak attachment, there were feelings of inadequacy and a lack of intimacy on the part of both parties (Hazan and Shaver 1994). When attachments were too strong, there were issues with codependency. The relationships functioned best when both parties managed to balance intimacy with independence.
This is important to the research as the level of attachment is the independent factor of adult relationships. Hazan and Shaver’s case studies show that