Attachment and relationship problems in adolescents with anxiety

By Liam Davenport, medwireNews Reporter

Adolescents with anxiety disorders have greater attachment disorganization and higher levels of dysfunction in peer relationships compared with individuals without an Axis I diagnosis, US study findings indicate.

"Our results support the importance of investigating whether targeting dysfunctions in close relationships and enhancing the quality of relationships of youth experiencing anxiety disorders improves treatment outcome, particularly when included in therapies that have received empirical support," say Laura Brumariu, from Harvard Medical School in Cambridge, Massachusetts, and colleagues.

They add in the Journal of Anxiety Disorders: "While few treatments have been designed solely for the adolescent period, the literature provides empirical support for cognitive behavioral therapy. Despite these findings, a significant proportion of adolescents do not improve following state-of-the-art treatments."

The team assessed 109 late adolescents from low to moderate income families in an urban area using a series of interviews and questionnaires on psychopathology and relationships with parents and peers.

They note that 44 adolescents met the criteria for at least one anxiety disorder, 35 met the criteria for Axis I disorders other than anxiety, and 30 did not have an Axis I disorder.

Anxiety diagnoses included panic disorder, social phobia, obsessive-compulsive disorder, generalized anxiety disorder, post-traumatic stress disorder, agoraphobia, anxiety disorder not otherwise specified, and specific phobia. Of those with anxiety disorders, 34 met the criteria for other comorbid Axis I disorders.

Adolescents with anxiety disorders had higher levels of overall insecurity/disorganization than those without Axis I disorders, as well as higher levels of hostility/helplessness in their representation of attachment relationships and higher levels of disorientation in their interactions with their mothers.

There were no significant differences between participants with Axis I disorders other than anxiety and those with no such disorders on these three assessments.

Compared with unaffected individuals, adolescents with anxiety disorders also had higher levels of dysfunction in friendships, romantic relationships, and school relationships.

Dysfunction in the school domain was also seen in those with Axis I disorders other than anxiety, but not on any other domain.

Brumariu and team conclude: "The present results suggest… that adolescents with anxiety disorders may be especially prone to impairments in attachment and peer relationships."

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