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Review ariticle | DOI: https://doi.org/10.31579/2637-8892/285
Istituto per lo studio delle psicoterapie (I.S.P.). Via San Martino della Battaglia n. 31, 00185, Rome, Italy.
*Corresponding Author: Giulio Perrotta, Istituto per lo studio delle psicoterapie (I.S.P.). Via San Martino della Battaglia n. 31, 00185, Rome, Italy.
Citation: Giulio Perrotta, (2024), The attachment theory and the “Perrotta Evolutionary Attachment Questionnaire” (PEA-Q1): a new proposed psychometric instrument for adolescents (14-17 years old) and adulthood (18-90 years old), Psychology and Mental Health Care, 8(6): DOI:10.31579/2637-8892/285
Copyright: © 2024, Giulio Perrotta. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 04 June 2024 | Accepted: 19 June 2024 | Published: 27 June 2024
Keywords: covid-19; mental health; healthcare workers; questionnaire
For more than half a century, attachment theory has explained the effects of maternal deprivation and the negative impact of traumatic events on a child's psychophysical growth; however, the literature has not yet been able to demonstrate what the correlation is between attachment style and the onset of a specific psychopathological personality picture. This narrative review focuses on the newly proposed psychometric instrument (Perrotta Evolutionary Attachment Questionnaire, PEA-Q1), for adolescents (14-17 years) and adults (18-90 years), which can fill this gap and can help the therapist shed light on the deeper childhood aspects of the patient undergoing clinical psychotherapy.
Since the 1950s Bowlby, Ainsworth and numerous researchers in the international scientific context have studied how the bond between a child and his significant figures develops. Beginning with the effects of maternal deprivation, the properties of attachment bonding, different attachment styles and continuity with relationship patterns in the adult have been studied. The resulting data have been systematized into "attachment theory," one of the foundational pillars of the current psychological sciences. Formulated initially by the British psychoanalyst John Bowlby, later, one of his students, Mary Ainsworth expanded these studies by describing three attachment styles: secure, ambivalent and avoidant; finally, in the late 1980s, researchers Main and Solomon introduced the last category: disorganized. (Perrotta, 2019a/b; Hazan, 1987)
Attachment theory describes how early relationships, in childhood, structure "Internal Working Models" (IWMs) in the child, that is, those operational models of the world and oneself in it, with the help of which he perceives events, predict the future and constructs his plans. In the operational model of the world that everyone builds for himself, a key feature is the notion we have of who the attachment figures are, and how they can be expected to respond. Similarly, in the operating model of self that each of us constructs, a key feature is our notion of how acceptable or unacceptable we are in the eyes of our attachment figures. These are early schemas that contain information about the self, the other, and the self-other relationship. From the IWMs developed in childhood, therefore, comes the attachment style that each of us expresses in relationships. They remain active throughout the life cycle operating outside of awareness. It is precisely this that determines their relative stability, but it is important to consider that each individual develops multiple IWMs as a result of the different significant relationships experienced, and each pattern is precisely because they are based on real, personal experiences and are subject to continuous reorganization, which continues throughout adult life. (Perrotta, 2020a; Santrock, 2017; Van Ijzendoorn, 1997; Bowlby, 1992/1989)
Mary Ainsworth (1965/1978/1982) later succeeded in supporting Bowlby's theory with empirical data, and first identified three distinct attachment patterns through a specially devised situation in the laboratory: the "Strange Situation Procedure" (SSP). Ainsworth, from observing groups of children who were reunited with their mothers after being separated, identified a first group of children who exhibited positive feelings toward their mothers, a second group who exhibited markedly ambivalent relationships, and a third group had non-expressive, indifferent or hostile relationships with their mothers. (Warren, 1997; Weiss, 1982; Vanghn, 1979)
At a later stage, Main and Solomon (1985/1990) introduced a fourth category, relating to children who, upon reunification with their mothers, exhibited behaviors that could not be attributed to any of the three described patterns. In this category, children were disoriented and confused in both intentions and behaviors. Therefore, this pattern was called disorganized/disoriented attachment (Carlson, 1998; Fonagy, 1996; Lyons-Ruth, 1987).
There are thus 4 adults "attachment styles" into which each of us falls (Espugnatore, 2023; Pastore, 2019; Perrotta, 2019a):
The DSM 5-TR (APA, 2022), the manual that encompasses all pathological forms recognized by the American Psychological Association, in its latest edition, counts 2. Both present inappropriate attachment modes compared to what is expected for developmental age, but symptomatically they are the opposite of each other (Fabiano, 2021; Atkinson, 2019; Hornor, 2019; Greenberg, 1993):
There are many tests of attachment style in adults. Often self-report instruments, whose fundamental limitation is to measure only what you are aware of. For this reason, accurate measurement requires a broader psychodiagnostic assessment with an experienced clinician. (Bartholomew, 1995/1997)
One of the earliest psychometric instruments developed was Bartholomew and Horowitz's (1995) "Relationship Questionnaire", which allowed one to identify the style in which one identifies most and the degree to which one falls into each style. Again, the Attachment Story Completion Task (ASCT), assessed attachment representations through the presentation of 5 stories on attachment issues, of which the child had to provide narrative completion through the use of a series of dolls representing the main characters in the family. Then there are Q-sort methods, such as the Attachment Q-sort (Perrotta, 2019b), which allows for the detection and assessment of some simple attachment behaviors of the child in the natural environment, covering a wider period than the SS (up to 5 years) and possibly being applied to dyads other than the mother-child dyad (thus also assessing multiple attachments). The Separation Anxiety Test - SAT (Perrotta, 2019b) detects children's responses to stimuli of a semiprojective nature because it follows the assumption that the child projects onto a series of attachment-activating stimuli in his or her mental organizations in this regard. This test consists of 6 photographs depicting various separation situations, which are shown to the subject telling him or her what feelings the character in the picture experiences and what strategies he or she will implement to cope with the situation. For adults, on the other hand, George, Kaplan and Main's (1985) Adult Attachment Interview (AAI) is used, which is also used for adolescent mothers, being careful, however, to keep in mind the possible underestimation of existing difficulties or the attempt to appear to live up to the proposed situations (degree of social desirability). The AAI is probably the best psychometric test most widely used in adults and written in a semi-structured questionnaire in which interviews are recorded and graded according to various parameters. The Adult Attachment Interview has made it possible to define 3 internal representative models of the self and attachment figures in adulthood and consequently allows a classification of adults into as many categories (Dazzi, 2010):
2.1. Preamble
For more than half a century, attachment theory has been explaining the effects of maternal deprivation and the negative impact of traumatic events on a child's psychophysical growth; however, the literature has not yet been able to demonstrate what the correlation is between attachment style and the onset of a specific psychopathological personality picture. This dyscrasia is explained by the multifactorial nature of psychopathological disorders (Perrotta, 2020b), in that the current dysfunctional personality profile is the consequence of one or more psychologically stressful or traumatizing events, unresolved and reinforced over time to maintain active destructive and/or self-destructive power. It is therefore unlikely that identifying the specific childhood attachment style can determine with certainty the corresponding psychopathological development, as so many other factors such as life experiences (a), education received and stimuli from the family environment (b), extended social context such as school and friendship (c), physical health status (d), genetically based neurobiological predispositions (e) and behavioral reinforcers to certain cognitive states (f) are needed.
In the writer's opinion, however, identifying with a good probability of correctness of the adult attachment style (derived from IWMs) helps to better frame the current personality profile, both in its functional and dysfunctional components.
A theory (Perrotta Evolutive Attachment Theory, PEA-t) and its model (Perrotta Evolutive Attachment Model, PEA-m) were developed to proceed with this task, to fill the main clinical gaps in modern attachment theory, use the new psychometric instrument based on these assumptions (Perrotta Evolutive Attachment Questionnaire, PEA-Q1).
2.2. Perrotta Evolutive Attachment Theory (PEA-t)
Attachment theory (AT), as also reflected in the contributions of researchers in the last three decades, succeeds admirably in explaining the properties of the attachment bond, the different styles identified, and the continuity with relationship patterns in the adult through the use of the concept of internal operating model, but despite efforts to adapt this theory to modern clinical practice this theory fails to explain the correlations, in a comprehensive manner, with personality profiles, because the basic approach was not clinical but evolutionary, that is, the purpose was to explain the effects of maternal deprivation and childhood trauma but not to correlate them with their possible psychopathological evolution. PEA-t, shares with TA the concept of "subjective infant attachment", as an individual's internal dynamic system on a cognitive-behavioral basis and concerning his or her ability to form deep emotional and/or sentimental bonds with the human and animal figures who care for them during life, and the concept of "internal working model", as the container of mental representations from which "attachment behaviors" then originate throughout the subject's developmental stage, i.e., the behaviors we put into practice during our human relationships; unlike AT, however, PEA-t seeks to address the need for clinical correlation with the individual personality profile, thus making some corrections (explicated in the corresponding model, PEA-m) that might facilitate this [Table 1].
Specific feature of modern attachment theory (AT)
|
Specific feature of “Perrotta Evolutionary Attachment Theory” (PEA-t) |
Equality/ Difference AT PEA | ||
| Studies the properties of attachment bonding, different styles, and continuity with relational patterns in the adult | Studies the properties of attachment bonding, different styles, and continuity with relational patterns in the adult |
| ||
| Studies the individual's internal operating patterns to explain his or her emotional-behavioral profile | Studies the individual's internal operating patterns to explain his or her emotional-behavioral profile |
| ||
| Explains the correlation between attachment style and psychopathological personality profile | Explains the correlation between attachment style and psychopathological personality profile |
| ||
| To childhood attachment, identifies the structural and functional components of the personality profile | To childhood attachment, identifies the structural and functional components of the personality profile |
| ||
| Identifies 4 attachment styles, to functional and dysfunctional personality dynamics | Identifies 4 attachment styles, to functional and dysfunctional personality dynamics |
| ||
| For each attachment style, identify the specific subtypes, of functional and and dysfunctional personality dynamics | For each attachment style, identify the specific subtypes, of functional and and dysfunctional personality dynamics |
|
Table 1: Comparison table on the characteristics of the two theories compared. The symbol marked with the green tick indicates that both theories have the same characteristic, while the symbol marked with the red cross indicates that the two theories diverge on that specific characteristic.
2.3. Perrotta Evolutive Attachment Model (PEA-m)
The explanatory model (Perrotta Evolutive Attachment Model, PEA-m) of PEA-t introduces 2 correctives to AT, namely:
Attachment style |
Subtype style |
Representation style |
Description of characteristics |
Secure |
Consistent-Faithful (1-2-3) |
Earth | The subject is capable of keeping his or her promise or oath (1), with fidelity and consistency between what was stated and what was fulfilled (2), living serenely with the consequences of his or her choice (3). |
Involved- Open (4-5-6) |
Fire | The subject is passionate about his or her own experience (1), he or she can engage others politely and respectfully (2), and tends to be open to life's opportunities (3). | |
Protective-Reserved (7-8-9) |
Water | The subject is protective of people for whom he or she has feelings but without being oppressive or limiting (1), he or she can maintain reserve about situations in which there might be overexposure (2), and he or she can keep secrets received in private confidence (3). | |
Generous-Altruistic (10-11-12) |
Air | The subject is generous toward people for whom he has feelings (1) and selfless toward those he does not know, in both cases without, however, sacrificing himself or others related to him (2), managing to balance all aspects of relationships without excess or deprivation (3). | |
Available-Kind (13-14-15) |
Water | The subject is helpful toward people for whom he has feelings (1) and kind toward those he does not know, in both cases without, however, sacrificing himself or others related to him (2), managing to ensure the right amount and quality in human relationships (3). | |
Balanced-Rational (16-17-18) |
Earth | The subject is balanced to life events capable of bringing about emotional decompensation (1) and is capable of being rational even when the factual circumstances are markedly stressful (2), managing to support himself and others in a decisive and mediating manner, without anxiogenic or distressing excesses (3). | |
Accommodating-Social (19-20-21) |
Air | The subject is welcoming toward people for whom he has feelings (1) and sociable toward those he does not know, in both cases, however, without sacrificing himself or others related to him (2), managing not to be intrusive or excessive (3). | |
Sensitive-Empathetic (22-23-24) |
Water | The subject is sensitive toward people for whom he or she has feelings (1) and empathetic toward those he or she does not know, in both cases without, however, compromising himself or herself (2), managing not to be negatively affected (3). | |
Courageous-Adventurous (25-26-27) |
Fire | The subject is courageous toward life and its challenges (1) and is adventurous when it comes to new opportunities (2), managing not to put himself in danger or overexpose himself (3). | |
Energetic-Hot (28-29-30) |
Fire | The subject is energetic toward life and its challenges (1) and is warm and passionate when it comes to new opportunities (2), while avoiding being excessive, uncomfortable or intrusive (3). | |
Responsible-Trustworthy (31-32-33) |
Earth | The person is responsible toward people for whom he or she has feelings (1) and is trustworthy toward those he or she does not know or colleagues at work or in his or her social circle, in both cases without being too rigid or intransigent (2), managing to ensure the right ratio between presence and absence (3). | |
Imaginative-Eclectic (34-35-36) |
Air | The subject is imaginative to his behavioural experience (1) and is eclectic to new challenges (2), yet manages to remain consistent with his principles and concrete in his actions (3). | |
Neurotic |
Scary-Avoidanting (37-38-39) |
Avoidant | The subject is fearful of circumstances and people he or she does not know (1) and avoids fearful sources or sources that he or she believes to be harmful or dangerous (2), even without objective data to confirm this (3). |
Fearful- Self-Sabotaging (40-41-42) |
Phobic-Somatic | The subject is fearful of circumstances and people he does not know (1) and sabotaging opportunities for growth or challenge to overcome his fears (2), even if the stimuli for change turn out to be positive or otherwise functional for the growth goal (3). | |
Hypervigilant-Controlling (43-44-45) |
Obsessive | The subject is hypervigilant toward circumstances and people he or she does not know (1) and controlling to situations or people he or she knows or already handles (2), distortively justifying to himself or herself the reason for this need without objective data to confirm it (3). | |
Rabid-Impulsive (46-47-48) |
Emotional | The subject is angry toward circumstances and people he knows (1), and impulsive to new people and circumstances (2), even though there may be other solutions to be implemented (3). | |
Dramatic |
Passive-Cold (49-50-51) |
Deflected | The subject is passive to circumstances and people he knows (1), and cold to new people and circumstances (2), although there may be other solutions to be implemented that can give him new stimuli (3). |
Ambiguous-Ambivalent (52-53-54) |
Humoral | The subject is ambiguous in his emotional-affective manifestations by constantly seeking reassurance and certainty to feelings or relationships (1), is not clear and transparent in his actions, always letting a certain double purpose or self-interest shine through (2), and tends to have frequent mood swings even when not justified by factual circumstances (3). | |
Idealizing-Devaluating (55-56-57) |
Borderline | The subject is conditioned by the circumstances of the moment without any objective emotional control (1), experiencing moments of idealization (2) and moments of unjustified devaluation (3). | |
Omnipotent-Destructive (58-59-60) |
Narcissist | The subject is self-centered (1), monothematic in the relationship citing reasons for suffering always at the expense of other people (2) and enacts destructive and toxic behaviors in personal, family and romantic relationships (3). | |
Fragmented |
Suspicious-Aggressive (61-62-63) |
Abuser | The person is suspicious (1), aggressive in the relationship alleging reasons for suffering always at the expense of other people (2) and enacts sabotaging and toxic behaviors in personal, family and romantic relationships (3). |
Withdrawn-Defensive (64-65-66) |
Hermit | The subject is withdrawn (1), unjustifiably defensive in the relationship citing reasons for suffering always on other people (2) and enacts self-destructive and toxic behaviors in personal, family and romantic relationships (3). | |
Paranoid-Hyperprotective (67-68-69) |
Paranoid | The subject is paranoid (1), tends to have delusional fantasies in the relationship without objective feedback (2) and enacts overprotective and toxic behaviors in personal, family and romantic relationships (3). | |
Unresolved-Disorganized (70-71-72) |
Schizo-Dissociated | The subject is dissociated (1), tends to disorganized fantasies which he pours into the relationship (2) and enacts destructive and self-destructive behaviors in the personal, family and romantic relationship (3). |
Table 2: Table of characteristics of attachment styles and subtypes, with specific descriptions.
Figure 1: Table of characteristics of attachment styles and subtypes, with specific descriptions.
The Perrotta Evolutive Attachment Questionnaire (PEA-Q1), in 72 items with L0-5 response, was developed to have a psychometric instrument capable of identifying attachment style in adolescents and adults, investigating structural and functional dimensions of the individual profile. Validation studies are in progress. The questionnaire was structured for a target age range of 14 years to 90 years, based on the Perrotta Integrative Clinical Interviews 3 (PICI-3), section A (adolescents and adults) (Perrotta, 2024), and it is preferable that it take place in the presence of the administering therapist, and who already has prior clinical knowledge of the subject underwriting the responses, to avoid cognitive distortion or active manipulation by the subject. [Appendix 1]
Having administered the questionnaire, in a single solution and without a time limit, the administering therapist will proceed to scoring the score, according to the following rules of interpretation:
| Substyle | Attachment style (type) | Matching item |
| Earth |
Secure
| 1, 2, 3, 16, 17, 18, 31, 32, 33 |
| Air | 10, 11, 12, 19, 20, 21, 34, 35, 36 | |
| Water | 7, 8, 9, 13, 14, 15, 22, 23, 24 | |
| Fire | 4, 5, 6, 25, 26, 27, 28, 29, 30 | |
| Avoidant |
Neurotic
| 37, 38, 39 |
| Phobic-somatic | 40, 41, 42 | |
| Obsessive | 43, 44, 45 | |
| Emotional | 46, 47, 48 | |
| Deflected |
Dramatic
| 49, 50, 51 |
| Humoral | 52, 53, 54 | |
| Borderline | 55, 56, 57 | |
| Narcissist | 58, 59, 60 | |
| Abuser |
Fragmented | 61, 62, 63 |
| Hermit | 64, 65, 66 | |
| Paranoid | 67, 68, 69 | |
| Schizo-dissociated | 70, 71, 72 |
Table 3: Matching of items for individual subtypes of attachment style.
| Analysis components | Matching item |
| Structural element A1 (Emotional stability) | 16, 17, 18, 21, 22, 23, 31, 32, 33, 46, 47, 48, 55, 56, 57, 67, 68, 69 |
| Structural element A2 (Bonding strength) | 1, 2, 3, 13, 14, 15, 28, 29, 30, 37, 38, 39, 40, 41, 42, 49, 50, 51 |
| Structural element A3 (Ability to love) | 4, 5, 6, 7, 8, 9, 34, 35, 36, 43, 44, 45, 52, 53, 54, 58, 59, 60 |
| Structural element A4 (Confidence in the future) | 10, 11, 12, 19, 20, 21, 25, 26, 27, 61, 62, 63, 64, 65, 66, 70, 71, 72 |
| Functioning axis X (security-insecurity) | 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 25, 26, 27, 28, 29, 30, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 61, 62, 63, 64, 65, 66 |
| Functioning axis Y (efficiency-inefficiency) | 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 31, 32, 33, 34, 35, 36, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 67, 68, 69, 70, 71, 72 |
| Attachment style: Secure | 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36 |
| Attachment style: Neurotic | 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48 |
| Attachment style: Dramatic | 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60 |
| Attachment style: Fragmented | 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72 |
Table 4: Matching of items for individual subtypes of attachment style.
Analysis components |
Interpretation of scores on the specific scale |
| Structural element A1 (Emotional stability) | 0-20 (weak), 21-45 (mediocre), 46-70 (sufficient), 71-90 (adequate) |
| Structural element A2 (Bonding strength) | 0-20 (weak), 21-45 (mediocre), 46-70 (sufficient), 71-90 (adequate) |
| Structural element A3 (Ability to love) | 0-20 (weak), 21-45 (mediocre), 46-70 (sufficient), 71-90 (adequate) |
| Structural element A4 (Confidence in the future) | 0-20 (weak), 21-45 (mediocre), 46-70 (sufficient), 71-90 (adequate) |
| Functioning axis X (security-insecurity) | 0-45 (weak), 46-90 (mediocre), 91-135 (sufficient), 136-180 (adequate) |
| Functioning axis Y (efficiency-inefficiency) | 0-45 (weak), 46-90 (mediocre), 91-135 (sufficient), 136-180 (adequate) |
| Attachment style: Secure | 0-45 (not relevant), 46-90 (weakly relevant), 91-135 (sufficiently relevant), 136-180 (markedly relevant) |
| Attachment style: Neurotic | 0-15 (not relevant), 16-30 (weakly relevant), 31-45 (sufficiently relevant), 46-60 (markedly relevant) |
| Attachment style: Dramatic | 0-15 (not relevant), 16-30 (weakly relevant), 31-45 (sufficiently relevant), 46-60 (markedly relevant) |
| Attachment style: Fragmented | 0-15 (not relevant), 16-30 (weakly relevant), 31-45 (sufficiently relevant), 46-60 (markedly relevant) |
| Total score | <0> |
Table 4: Matching of items for individual subtypes of attachment style. Total score (Difference between the score of the safe style and the summation of the other dysfunctional styles).
This narrative review on the topic of attachment theory has produced a new psychometric proposal (Perrotta Evolutionary Attachment Questionnaire, PEA-Q1), to be administered to adolescents (14-17 years) and adults (18-90 years), which may be able to fill the gap of a lack of a technical instrument on evolutionary attachment and correlations with psychopathological disorders, thus helping the therapist to shed light on the deeper childhood aspects of the patient in psychotherapy. Validation studies of this tool are underway to test its stability, efficiency, and effectiveness in terms of diagnostics.
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