Successful relationships require the ability to engage in the give-and-take of occasional conflict. For people with personality disorders, this conflict can become a tremendous source of anxiety. When you and your partner disagree, how do you try to turn things around for the better? Do you tell yourself the problem isn’t real and try to forget the whole thing? What happens the next time you disagree about the very same issue? Can you still run away from it?

New research shows that people with personality disorders find conflict to be an almost insurmountable challenge. They fear that their partner will abandon them if they don’t retreat when the battle lines become drawn. On the other hand, they may turn this fear into a set of demanding behaviors in which they try to force their partners to comply with their wishes. Joseph Beeney and colleagues (2019), of the University of Pittsburgh School of Medicine, believe that attachment style is the key factor determining what happens during relationships for people with personality disorders. The research team tested a complex model involving the so-called actor-partner interdependence model (APIM), which made it possible for them to test how relationships between key variables within one partner in a relationship are associated with those same variables in their partner. The APIM views dyadic (two-person) interactions as evolving over time as each person’s behavior influences, and is influenced by, the other’s.

There is a solid body of evidence showing the importance of attachment style to happiness in relationships. Attachment style refers to the conceptions you have of yourself based on the way you were raised by your caregivers in your early life. Securely attached individuals feel that they can rely on their partners because they were given a solid home base as young children. By contrast, individuals who are insecurely attached are constantly on guard for the possibility that important people in their lives will leave them behind. As children, their parents may have been too preoccupied with themselves to devote attention to them, or their parents may actually have neglected them for significant periods of time. In adulthood these individuals find it difficult to accept the love of a partner who they fear might abandon them, so they avoid close relationships or anxiously cling to their partner out of fear they will be left behind.

With this background, you can understand how attachment style can set the stage for people to develop a personality disorder in adulthood. They have a shaky foundation to their personalities that, in turn, creates further problems in relationships as they avoid or anxiously cling to their partners. Their conflict styles will reflect this disturbance as well. Beeney and his colleagues, then, proposed that the severity of one individual’s personality disorder severity would be associated their own and their partner’s attachment anxiety and avoidance. Attachment anxiety would, furthermore, be linked to their own tendency to make demands on their partner who, in turn, would withdraw. Both partners would suffer reduced relationship satisfaction as a result.

Thus, in the words of the authors, “Pairings of elevated attachment anxiety in one person and elevated attachment avoidance in another are thought to lead to relationship dysfunction because each person has a pathway to ‘felt security’ that may activate central concerns and fears of the other” (p. 276).  The test of the APIM involved first examined whether partners picked partners similar to themselves in personality disorder, attachment style, and level of overall interpersonal functioning. The next step was to see how all of this played out when the couples were involved in an actual conflict.

Recruiting from a community population, the University of Pittsburgh researchers arrived at a final sample of 260 individuals in 130 couples who either met the screening criteria for borderline personality disorder, any other personality disorder, or a mental health disorder other than a personality disorder. The majority of the participants cohabitated, and had been in the same relationship for approximately 4-1/2 years. The screening consisted of a careful interview process in which skilled diagnosticians evaluated each individual using a clinical rating scale for personality and other psychological disorders. In addition to the diagnosis, clinicians also rated the severity of the personality disorder in each participant. Panels of clinicians also rated the adult attachment style of each study member as well as their levels of interpersonal functioning. The participants themselves rated their relationship satisfaction.

The main test of the APIM involved ratings made by clinicians of the partners as they discussed an area of conflict in their relationship, on such topics as finances, sex, household chores, and childcare. The measure of “demand” included behaviors of blaming and pressures for change. The “withdrawal” ratings included avoidance, lack of discussion, and withdrawal itself.

As the authors expected, the couples showed, within themselves, moderate similarity, “meaning people may pair with partners with a similar degree of interpersonal problems, and/or shape and reinforce similar difficulties over time.” These similarities played out in their resolution of conflict in “dynamic, theoretically consistent ways” (p. 281). As the authors hypothesized, people with more severe personality disorders showed higher levels of attachment anxiety and avoidance in themselves; their partners showed higher attachment anxiety. Having higher attachment anxiety was not, as had been predicted, related to more demanding behavior during conflict.  People high in attachment anxiety were, however, more likely to exhibit withdrawal during conflict as were their partners. Thus, as the authors conclude, “behaviors other than demand may also promote withdrawal, or relationship history can ‘train’ partners to adopt this strategy, regardless of whether demand is present within any specific conflict” (p. 282).

How do these features of interactions among partners based on attachment anxiety relate to relationship satisfaction? You might imagine that the patterns of demanding behavior followed by withdrawal would have a negative impact on the way that people feel about their relationships. Once again, the authors were able to trace the impact of attachment anxiety on relationship satisfaction via the route of withdrawal by the partner. As they note, “People with elevated attachment anxiety have negative views of conflict and are less likely to maintain open communication and collaboration,” leading in turn to "protest behavior" by the partner” who resorts to sulking or giving the partner the silent treatment in an effort to “spark approach behaviors.” Neither of these, the authors go on to observe, “appear to be healthy for relationships” (p. 283).

People with personality disorders, then, are likely to form relationships with partners who share their level of severity, as shown in this study. As a result, they lose out on the opportunity to benefit from the potential benefits of having a partner who can provide them with the type of supportive feedback that could help them overcome their attachment difficulties. The authors suggest that interventions could benefit these couples by helping them replace withdrawal with healthier methods of communication. At the same time, they could be helped to recognize each other’s bids for connection.

To sum up, this study of attachment styles and relationship in people with personality disorders shows the downward spiral that can lead people already insecurely attached to gain less rather than more support from their partners. Fulfillment in relationships with your partners requires, the University of Pittsburgh study suggests, finding ways to build those assurances into your communication, especially when you find yourself tackling the difficult topics that inevitably become a part of a couple’s life together.

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New research shows the role of personality disorders in relationship problems.

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Fulfillment at Any Age

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For people with personality disorders, relationships can present a challenge. New research shows attachment style’s role in creating those relationship problems.

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Beeney, J. E., Stepp, S. D., Hallquist, M. N., Ringwald, W. R., Wright, A. G. C., Lazarus, S. A., … Pilkonis, P. A. (2019). Attachment styles, social behavior, and personality functioning in romantic relationships. Personality Disorders: Theory, Research, and Treatment, 10(3), 275–285. doi:10.1037/per0000317