Dissociative experiences and anger proneness in late adolescent females with different attachment styles
Bowlby’s attachment theory (Bowlby, 1969, 1973, 1980) pointed out the evolutionary function of the mother-child relationship, which inspired Ainsworth’s research on the “Strange Situation” (Ainsworth et al., 1978)–a structured observational procedure designed to investigate attachment behavior in the child. Ainsworth described four response patterns, foremost among them being a secure reaction, namely distress during separation with rapid recovery on the return of the mother (caregiver) and also the use of the mother as a “secure base” for exploration. Insecure reactions to separation were classified into two main types: avoidant and ambivalent-resistant. Avoidant children exhibit little negative emotion together with strong physiological activation and a persistent attention to toys after reunion with the mother; children defined as ambivalent express love and hate, and resist the mother’s approaches: “… these insecure-resistant infants became markedly upset upon separation from the mother, yet appeared unable to obtain comfort from her when she returned. Reunions were marked by continued displays of distress, intermittent displays of anger, and an apparent inability to return to exploration and play” (Main & Morgan, 1996, p. 113). The fourth attachment style, insecure-disorganized-disoriented, is a residual category of “unclassifiable” reactions, and includes children who show stereotypic movements or immobilized behavior with a dazed expression or a contradictory approach to the caregiver, keeping the face averted.
Attachment theory has inspired research on attachment styles in close relationships over the life-span. Hazan and Shaver (1987; Shaver & Hazan, 1992) extended the three main attachment styles to young adults in order to examine romantic relationships. They found the same relative frequencies of secure, avoidant, and ambivalent-resistant patterns observed in infancy.
The recent literature on attachment has provided support for the hypothesis that attachment style influences the management of emotion in childhood and adolescence (Mikulincer, 1998; Spangler & Zimmerman, 1999; Grossman et al., 1999; Phipps, 2000; West et al., 2000; David & Ronitte, 2000). In particular, insecure attachment has been reported to be a predisposing factor for disorders involving affect regulation and modulation of autonomic arousal (Taylor et al., 1997; Bekendam, 1997; Zimmerman, 1999). Mikulincer (1998) evaluated attachment style in self-reports of anger, measured via the Multidimensional Anger Inventory (Siegel, 1986), and noted lower levels of anger proneness and more adaptive responses in secure than in insecure individuals. Moreover, escapist responses and lack of awareness of the physiological signs of anger were noted for avoidants, while ambivalent-resistants tended to direct anger inward, coupled with a lack of control. In contrast to Mikulincer, Biernbaum (1999) reported the tendency to turn anger against the self in both styles of insecure attachment.
Anger is considered a basic emotion, often connected with fear; it can be expressed outwardly, inwardly, held in, or controlled and resolved (Izard, 1993; Spielberger et al., 1995; Pavek et al., 1995; Parker, 1998). Expressed anger may lead to interpersonal, occupational, and family conflicts, negative evaluations by others, negative self-concept, and low self-esteem (Kassinove, 1995). The experience of anger is salient in female development, and there are social pressures toward the assumption of traditional sex role coping strategies (Cox et al., 1999). In certain socio-cultural contexts, anger in females has been, and continues to be, especially threatening for gender self-image (Dutton & Aron, 1989; Thomas, 1991). Anger is just as significant in male development (see Kring, 2000), but the issue of gender differences in the experience of anger is not dealt with in this study.
From the point of view of self-psychology, G. S. Klein (1976) emphasized that personality development requires the integration of anger experience and aggressive behavior in an adaptive self-schema. The management of anger is a basic element of social adaptation and a critical developmental task in adolescence: the mode of anger expression, whether internalized or externalized, has been found to be connected to several psychopathological conditions, such as reduced impulse control, depression, and suicidal tendencies (Silver et al., 2000; Cautin, Overholser, & Goetz, 2001). The experience of intense anger and hostility may become particularly threatening for the coherence of the self, requiring the activation of massive defense mechanisms such as repression or dissociation (Singer, 1995). Originally formulated as a discontinuity in awareness in Pierre Janet’s psychopathological theory, dissociation is generally conceptualized as a protective response to severe trauma, such as rape, natural disasters, psychological ill-treatment, violence or sexual abuse; it serves as a defense mechanism against overwhelming fear, pain, feelings of helplessness, and anger (Putnam, 1991; Spiegel, 1993; Chu, 1996; Marcy, 1998; Chu et al., 1999; Sheiman, 1999). Dissociation maybe employed for managing the anger arising from trauma and psychic conflict, but this may be incompatible with the prevailing self-schema.
In spite of abundant evidence supporting the clinical and theoretical connections between anger and dissociative disorders (Loewenstein, 1991; Spiegel, 1993; Michelson & Ray, 1996), these associations have received scant attention in normal individuals (see Ray, 1996) especially during adolescence, where emotional dysregulation and transient dissociative phenomena are common experiences (Putnam, 1993). Late adolescence is the developmental phase in which interpersonal relationships, particularly with friends and romantic partners, become increasingly important and may lead to conflictual situations that elicit emotional responses and activate defensive reactions. Sanders et al. (1989) found that dissociative experiences were positively related to self-reported stressful events and trauma in an adolescent college population.
Considering attachment style in terms of a bipartite typology (secure versus insecure pattern), several studies have reported a strong connection between insecure attachment and pathological dissociation (Barach, 1991; Blizard, 1997; Liotti, 1999a). However, the differential role of the ambivalent-resistant and avoidant insecure attachment styles in dissociative tendency has been little investigated. Research has mainly focused on vulnerability factors in the development of dissociative disorders in subjects classified as disoriented-disorganized (Main & Morgan, 1996; Main & Hesse, 1990; Liotti, 1992, 1993, 1999b; Ogawa et al., 1997; Carlson, 1998).
Anderson and Alexander (1996) reported a positive correlation between insecure attachment in romantic relationships and dissociation in a sample of 92 adult female survivors of incest. The same results were recently obtained by Kretz (1999) in a sample of nonclinical females. Similarly, Hahn (1995) found a negative correlation between secure attachment and dissociative experiences in 109 college women; furthermore, both insecure patterns (avoidant and ambivalent-resistant) were positively related to dissociation scores. From this perspective, van der Kolk (1996) hypothesized that secure attachment protects individuals against trauma and pathological dissociation (van der Kolk described how trauma leads to problems with the regulation of affective states, such as anger, anxiety, and depressive mood). Previously, van der Kolk and Fisler (1994) discussed the role of secure attachment with caregivers in helping children to develop both a capacity to modulate physiological arousal and a sense of safety, which favors characterological adaptations, including the capacity for overcoming shame, self-hatred, problems with self-efficacy, and difficulties in coping with interpersonal conflicts. Finally, studying interactions between romantic attachment and the effects of childhood abuse in predicting self-care and dissociation in nonclinical females, Kepkep (1997) found relationships between security of attachment, abuse history, and dissociation that supported van der Kolk’s hypothesis.
The purpose of the present study was to investigate the relationships between dissociative experiences, anger proneness, and attachment styles in a nonclinical sample of late adolescent females. In particular, we examined van der Kolk’s hypothesis regarding the role of secure attachment in protecting against pathological dissociation and affect dysregulation. We expected to find a dissociative tendency–as a defense mechanism against negative emotions, especially anger–in females classified as insecurely attached in close relationships. Possible differences between avoidant and ambivalent-resistant females were also investigated. In addition, we sought to evaluate the relationship between dissociative tendency and anger management, hypothesizing higher dissociation in insecure females because of their proneness to physiological hyperarousal and affect dysregulation. Finally, the tendency of insecurely attached females to experience anger in close relationships (Mikulincer, 1998) should favor the use of massive defensive strategies, such as dissociation, in order to preserve a sense of continuity and integrity of the self (Klein, 1976).
One hundred sixty-two females (mean age = 17.5 years, SD = 1.0, range = 16-24 years), students at a teachers training college in Tuscany (Italy), were recruited as volunteers during a school-based prevention program on problem behaviors in youth. They were assessed using the following tests.
Dissociative Experience Scale
The Dissociative Experience Scale (DES; Bernstein & Putnam, 1986; Carlson & Putnam, 1993) measures dissociative experiences and is composed of 28 items rated on a visual analogue scale. Subjects mark a point on a line between two extremes to indicate the percentage of time during which they experience a variety of dissociative phenomena (from 0% to 100%). The DES score ranges from 0 to 100 and represents the average response for all items. Factor analytic studies have yielded an understanding of the structure of the DES: the trifactorial model, adopted in the present study and confirmed by Fabbri Bombi et al. (1996) for the Italian version of the DES, is most frequently employed (Ross et al., 1990; Carlson & Putnam, 1993; Ross et al., 1995). According to this model, the DES is composed of the following three subscales: (1) Amnestic Dissociation, which involves the performance of actions for which the subject has no memory (i.e., item 3: “some people have the experience of finding themselves in a place and having no idea how they got there”); (2) Absorption and Imaginative Involvement, which concerns becoming so immersed in an activity as to become completely unaware of the surroundings (i.e., item 17: “some people find that when they are watching television or a movie they become so absorbed in the story that they are unaware of other events happening around them”); (3) Depersonalization-Derealization, which refers to altered perceptions of self and the environment, such as the experience of feeling disconnected from one’s own body, feelings, and thoughts (i.e., item 13″ “some people have the experience of feeling that their body does not seem to belong to them”).
Dissociation is commonly conceived as a continuum, from normality to psychopathology, defined using both quantitative (dimensional) and qualitative (typological) criteria. The cut-off point indicating the presence of pathological dissociation (a still debatable matter) is a DES score higher than 15-20. However, several authors have stressed that the DES is not a diagnostic screening tool for dissociative disorders. Diagnostic screening would require a complete psychiatric assessment, including use of the Structured Clinical Interview for DSM-IV Dissociative Disorders (Steinberg et al., 1991; Carlson & Putnam, 1993).
Waller, Putnam, and Carlson (1997) selected 8 items (3, 5, 7, 8, 12, 13, 22, and 27) as constituting a new subscale, designed to identify a tendency to experience pathological dissociation–the DES-Taxometric score (DES-T). This brief 8-item questionnaire has been validated by applying a method for distinguishing typological from dimensional constructs (taxometric analysis). Developed by Meehl (Meehl, 1992, 1995; Meehl & Yonce, 1994), this method was applied to 228 patients with dissociative identity disorder (formerly known as multiple personality disorder) and 228 normal controls. The taxometric findings empirically justified the distinction between two types of dissociative phenomena, permitting separation of the items associated with the dissociative continuum from those connected with dissociative disorders (i.e., item 3: “some people have the experience of finding themselves in a place and having no idea how they got there”; item 8: “some people are told that they sometimes do not recognize friends or family members”).
The DES has been shown to be a reliable and valid measure for the assessment of dissociative experiences, both in clinical and nonclinical samples (Bernstein & Putnam, 1986; Steinberg et al., 1991; Carlson & Putnam, 1993), and to have a similar factorial structure in psychiatric and nonpsychiatric groups (Sanders & Green, 1994). While the original normative sample examined by Bernstein and Putnam (1986) consisted of 31 nonclinical late adolescents (age range = 18-21), subsequent studies applied the DES to clinical and nonclinical adolescents of various ages and found more dissociative experiences in early than in late adolescence (Ross et al., 1989). This same trend of decreasing dissociation with increasing age was confirmed in our sample (see Table 1).
An adolescent version of the DES (A-DES) has been developed, and it is appropriate for ages 12 to 17 (Smith & Carlson, 1996; Armstrong et al., 1997). The concurrent validity of this version was studied by correlating scores on the A-DES with scores on the DES in a sample of 46 college students (aged 18-21). Results revealed a high correlation between these two versions. While not used here, the A-DES appears to show promise as a measure of dissociation in adolescents.
An Italian version of the DES (Fabbri Bombi et al., 1996) was administered in the present study. Using a sample of Italian college students, Mazzotti and Cirrincione (2001) reported good validity and reliability for this version.
Italian Version of the State-Trait Anger Expression Inventory
The State-Trait Anger Expression Inventory (STAXI; Spielberger, 1988) is a psychometric measure for evaluating different facets of anger. It assesses the intensity and the frequency with which anger is experienced and expressed, providing 8 different scores. The two main scales are: State Anger (S-Anger), an indicator of emotional state, ranging from mild irritation or annoyance to extreme fury and rage; and Trait Anger (T-Anger), which evaluates the proneness to anger as a personality disposition. Trait Anger is scored using two subscales, referring mainly to personality (T-Anger/Temperament) and situation (T-Anger/Reaction). Anger may be directed inward (Anger/In) or outward (Anger/Out; i.e., through aggressive behavior such as verbal criticism, insults, profanities, assaulting others, or destroying objects). Finally, anger may be controlled (Anger/Control) as well as expressed (Anger/Expression). The validity of the STAXI has been established using a sample of adolescents and adults (age ranges: 12-18, 19-25, and 26 and above); it demonstrated good psychometric properties (see Spielberger, 1988).
Adult Attachment Questionnaire
The Adult Attachment Questionnaire (AAQ; Hazan & Shaver, 1987; Shaver & Hazan, 1992) presents respondents with three alternative descriptions of their feelings in close relationships and asks them to choose the one that best describes their experience (i.e., representing a secure, ambivalent, or avoidant relationship style). It then asks them to rate each of these descriptions of feelings (i.e., relationship styles), indicating on a 1-7 scale how well or poorly it corresponds to their own feelings. Two kinds of scores are thus obtained: categorical and rating, respectively.
RESULTS AND DISCUSSION
Mean scores for the total sample are presented in Table 2 (DES) and Table 3 (STAXI). DES scores were higher than for Fabbri Bombi et al.’s sample (1996), which included males and older subjects; STAXI scores were not significantly different from those for the normative groups reported by Spielberger (1988).
DES total scores were positively correlated (using the Pearson product-moment correlation coefficient) with STAXI scores (Table 4), especially (in decreasing order) with State Anger, Anger/In, Trait Anger, Anger/Expression, and Anger/Out; DES factorial subscales presented the same general pattern. The results for Absorption were similar to those for Amnesia. Depersonalization was positively correlated with State Anger (with the highest coefficient), Anger/In, Trait Anger, and Anger/Expression. DES-T was positively correlated (in decreasing order) with State Anger, Anger/In, Trait Anger, Anger/Expression, and T-Anger/Reaction. These findings support the hypothesis that there is an association between the intensity of the experience of anger and the recourse to dissociative defenses in late adolescent females, suggesting the possible role of dissociation as a coping strategy in affect regulation.
Anger/Out correlated with Amnesia but not the other subscales, which may indicate an adaptive forgetting of socially unacceptable aggressive behavior. Depersonalization, together with the DES-T, correlated highly with Anger/in. These results may confirm, in a nonclinical sample, the defensive function of the depersonalization experiences described in patients with depersonalization-derealization disorder (Steinberg, 1993; Coons, 1996), namely protection against emotional distress and conflictual aspects of anger. Moreover, the significant negative correlation between Absorption and Anger/Control may indicate that the focusing of attention on internal processes is connected with poorer anger inhibition.
Comparison of attachment styles revealed significant differences (using one-way ANOVA) on DES total and factorial scores (Table 5). Insecure females, particularly ambivalent ones, showed significantly higher DES total scores than did secure females (t = 2.9, p < .005), and the same tendency was found for the DES subscales. A higher F value was obtained for Depersonalization, where ambivalent females scored significantly higher than secure females (t = 3.1, p < .005) and avoidant females (t = 1.9, p < .05). Ambivalent females also had significantly higher scores than secure females on Amnesia (t = 2.2, p < .05), Absorption (t = 2.3, p < .05), and DES-T (t = 3.3, p < .001). The insecure subsample scored significantly higher than the secure group on Absorption (t = 2.4, p < .05), Depersonalization (t = 2.9, p < .005), DES-T (t = 2.4, p < .05), and DES total (t = 3.1, p < .005). As predicted, the insecurely attached females, particularly the ambivalent-resistant ones, showed a dissociative tendency, suggesting a recourse to dissociation for the overwhelming fear-anger experiences that result from both relational conflicts and severe trauma.
Spearman’s rank correlations between DES scores and ratings of the three relational styles are presented in Table 6. High DES scores were associated with ratings of both insecure attachment styles, ambivalent and avoidant, replicating the findings obtained by Hahn (1995) with the same instruments (AAQ and DES). Ambivalent ratings correlated positively with Amnestic dissociation, and avoidant ratings correlated positively with Depersonalization. DES-T scores correlated positively with both avoidant and ambivalent ratings, supporting the connection between insecure attachment and pathological dissociation observed in clinical samples.
One-way ANOVA on STAXI scores (Table 7) revealed significant differences between attachment style groups. Insecure females had higher scores on State Anger (higher in ambivalents) and Anger/In (higher in avoidants) than secure females. Specifically, on State Anger there were significant differences between ambivalents and secures (t = 2.8, p < .01), avoidants and secures (t = 2.8, p < .01), and secures and insecures (t = 3.0, p < .01). Mikulincer (1998) found that ambivalents experienced more intense feelings of anger, a finding that was replicated in our sample, while their lower anger control was not confirmed here. Insecure females, especially ambivalent ones, reported more intense anger experiences, while avoidants were more likely to direct anger inward.
Spearman’s rank correlations between STAXI and AAQ (Table 8) tended to confirm the connection between ambivalent attachment style and State Anger reported by Mikulincer (1998). The avoidant attachment style correlated positively, in decreasing order, with Anger/In, Anger/Expression, and State Anger. The secure attachment style, on the other hand, correlated negatively with Anger/In, T-Anger/Temperament, and State Anger. Our findings support the predicted relationship between insecure attachment and anger proneness in late adolescence, showing the disposition of avoidant females to direct anger inwardly (whereas Mikulincer, with a different self-report instrument, noted the same results for ambivalents). In our opinion, the turning of anger inward in avoidants could be related to a proneness to physiological hyperarousal which is inconsistent with self-reported anger experience. The higher Anger/In scores of avoidant females could be related to their tendency to negate overt anger expression, producing a discrepancy between self-report and psychobiological indices of emotional arousal (Spangler & Grossman, 1993; Mikulincer, 1995).
The significantly higher DES scores (total, subscales, and DES-T) in insecure females provide support for van der Kolk’s hypothesis regarding the protective function of secure attachment against trauma and pathological dissociation. Moreover, our results confirm, in a nonclinical sample, the link between anger and dissociation observed in psychiatric patients. Our findings seem to indicate a coherent pattern: self-reported anger is higher in insecure females, who are likely to develop a tendency to use dissociation as a coping style. Further, examination of the two insecure relational styles reveals higher DES scores (especially DES-T) in ambivalent girls, who report a more intense experience of anger, and more anger directed inward in avoidant females. The ways anger is managed, together with insecure attachment styles (particularly the ambivalent relational style), seem therefore to be personality factors affecting dissociative tendency in late adolescent females.
Our results confirm the importance of psychological intervention, on the part of educational agencies and mental health services, in helping adolescents to integrate anger experiences in gendered self-schema as a means of preventing emotional disturbances (Kellner & Bry, 1999). Further research is needed to replicate the present findings in adolescent males and to clarify the role of attachment patterns in close relationships.
DES Means and Standard Deviations for the Different
Amnesia Absorption lization
16 years M 11.3 32.9 9.7
(n = 38) SD 10.2 14.8 9.5
17 years M 10.4 31.0 11.2
(n = 67) SD 10.4 19.1 14.8
18 years M 8.9 26.5 7.8
(n = 45) SD 9.3 15.0 12.6
19-24 years M 5.5 27.9 7.4
(n = 12) SD 5.5 14.0 11.4
DES (Total) DES-T
16 years M 14.5 13.3
(n = 38) SD 7.2 9.7
17 years M 14.0 13.1
(n = 67) SD 9.9 15.1
18 years M 11.5 10.4
(n = 45) SD 7.9 12.1
19-24 years M 11.2 11.3
(n = 12) SD 6.9 9.4
DES Means, Standard Deviations, and Score Ranges (Total Sample)
Amnesia Absorption lization DES (Total) DES-T
M 9.8 30.0 9.6 13.2 12.3
SD 9.8 16.8 12.9 8.6 12.8
Range 0-53 2-76 0-77 1-46 0-71
STAXI Means, Standard Deviations and Score Ranges (Total Sample)
M SD Range
S-Anger 13.2 5.3 10-39
T-Anger 21.7 5.2 7-38
T-Anger/Temperament 7.5 2.6 4-16
T-Anger/Reaction 10.5 2.7 5-21
Anger/In 17.4 4.4 8-31
Anger/Out 15.9 3.9 9-30
Anger/Control 19.9 5.6 8-32
Anger/Expression 29.3 9.8 10-59
Correlations Between DES and STAXI
DES (Total) Amnesia Absorption
S-Anger .40 **** .28 **** .37 ****
T-Anger .32 **** .27 **** .32 ****
T-Anger/Temperament .18 * .14 .18 *
T-Anger/Reaction .23 ** .18 * .22 **
Anger/In .38 **** .28 **** .33 ****
Anger/Out .16 * .17 * .15
Anger/Control .11 -.07 -.16 *
Anger/Expression .29 ** .24 ** .29 ***
S-Anger .45 *** .38 ****
T-Anger .22 ** .28 ***
T-Anger/Temperament .14 .14
T-Anger/Reaction .13 .16 *
Anger/In .37 **** .34 ****
Anger/Out .05 .14
Anger/Control -.01 -.08
Anger/Expression .19 * .26 ***
* p <.05, ** p < .01, *** p <.001, **** p < .0001
Comparison of Attachment Style Groups on DES (One-Way ANOVA)
Amnesia Absorption lization
Avoidant M 9.4 32.2 11.3
(n = 37) SD 11.4 17.8 13.0
Ambivalent M 13.0 34.9 15.0
(n = 32) SD 10.6 18.7 17.7
Secure M 8.9 27.4 7.1
(n = 93) SD 8.6 15.3 10.0
Insecure M 11.1 33.5 13.0
(n = 69) SD 11.1 18.1 15.4
F value 2.2 2.9 5.2
p value .11 .058 .007
DES-T DES (Total)
Avoidant M 12.4 14.0
(n = 37) SD 14.3 9.1
Ambivalent M 18.1 16.7
(n = 32) SD 15.9 10.5
Secure M 10.2 11.7
(n = 93) SD 10.2 7.3
Insecure M 15.1 15.2
(n = 69) SD 15.2 9.8
F value 4.8 4.3
p value 0.09 .015
Correlations Between DES Scores and AAQ Rating Scales
Avoidant Ambivalent Secure
DES (Total) .16 * .18 * -.11
Amnesia .17 * .25 ** -.08
Absorption .09 .12 -.15
Depersonalization .21 ** .17 * -.12
DES-T .18 .16 * -.07
* p < .05, ** p < .01
Comparison of Attachment Style Groups on STAXI (One-Way ANOVA)
Avoidant Ambivalent Secure
(n = 37) (n = 32) (n = 93)
M SD M SD M SD
S-Anger 14.0 4.1 15.3 7.4 12.2 4.5
T-Anger 21.7 6.1 21.5 5.7 21.8 4.7
T-Anger/Temperament 7.8 3.3 7.4 2.3 7.4 2.5
T-Anger/Reaction 10.6 2.9 10.8 3.2 10.4 2.5
Anger/In 19.1 4.5 18.1 5.0 16.5 3.9
Anger/Out 15.1 3.2 15.8 4.0 16.3 4.2
Anger/Control 20.4 5.4 20.7 5.0 19.5 5.9
Anger/Expression 29.3 8.8 29.2 9.7 29.3 10.2
(n = 69)
M SD value value
S-Anger 14.6 5.9 4.9 .008
T-Anger 21.6 5.9 0.0 .96
T-Anger/Temperament 7.6 2.8 0.3 .70
T-Anger/Reaction 10.7 3.0 0.3 .76
Anger/In 18.6 4.8 5.4 .005
Anger/Out 15.4 3.6 1.2 .29
Anger/Control 20.5 5.2 0.7 .49
Anger/Expression 29.2 9.2 0.0 .99
Correlations Between STAXI Scores and AAQ Rating Scales
Avoidant Ambivalent Secure
S-Anger .16 (^) .16 (^) -.17 *
T-Anger .14 (^) .00 -.12
T-Anger/Temperament .08 .05 -.18 *
T-Anger/Reaction .05 .02 -.13 (^)
Anger/In .30 *** .12 -.19 *
Anger/Out .02 .07 -.02
Anger/Control -.08 .02 .09
Anger/Expression .20 * .06 -.13 (^)
(^) p < .10, * p < .05, ** p < .01, *** p < .001
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Mauro Pini, Department of Philosophy, University of Pisa.
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