Adult Attachment Style, Obsessive-Compulsiveness, and Response to a Stressful Situation

Nicole Hall, Ethan Smith, Jacob Linders and Tirso Aquino

Abstract

In previous research, certain attachment styles, particularly those high in anxiety or avoidance, have been found to be associated with obsessive-compulsive disorder. Additionally, those same attachment styles have been found to affect stress and anxiety in individuals. The current study addresses both of these findings in three hypotheses: 1) attachment style will have a main effect on obsessive-compulsiveness 2) attachment style will have a main effect on response to a stressful situation, and 3) an interaction between attachment style and obsessive-compulsiveness will produce an effect on the stress response. Results indicated that attachment style is a predictor of obsessive-compulsiveness, but not stress-reactivity. Implications are discussed.

Keywords: attachment style, obsessive-compulsiveness, anxiety, stress

INTRODUCTION

Obsessive-Compulsive Disorder

The malady obsessive compulsive (OCD) disorder affects 1.2% of Americans and up to 1.8% of the world’s population (APA, 2013). OCD is primarily characterized by obsessions and compulsions, the former being recurrent, invasive, and undesired thoughts and the latter being repetitive behaviors or thoughts that an individual is highly motivated to perform in order to reduce anxiety. OCD is a cross-cultural psychological impairment that can have severe functional consequences. (APA, 2013).

OCD prevalence in college is strikingly different than nationwide or worldwide prevalence. In a study by Sulkowski, Mariaskin, and Storch (2011), they found that out of a sample of 358 undergraduate students of an American institution, five percent of them could be diagnosed with obsessive-compulsive symptoms. Looking at an even broader picture, seventy percent of those students reported skin picking, twenty-two percent reported hair pulling urges, and thirty percent obsessed about physical flaws. These items represent the spectrum of obsessive-compulsive symptoms.

Adult Attachment Style

Bowlby (1958) proposed the evolutionary and developmental theory that a child develops an attachment to its mother for survival. In the 1960s and 1970s, groundbreaking research concerning infants’ relationship with their mothers built on Bowlby’s Attachment Theory. Ainsworth and Bell (1970) investigated the attachment, or the enduring bond that influences the need for closeness. Through the observations made during the Strange Situation scenario, Ainsworth identified three main attachment styles: secure, ambivalent, and avoidant. Attachment during infancy has shown to become an important personality factor, prevailing into adolescence and adulthood and affecting romantic relationships as well as relationships with friends and siblings (Ainsworth, 1982). Building on the original models of attachment, Bartholomew and Horowitz (1991) created the Four Category Model, which focused on adults’ attachment. This model categorizes adult attachment through the dimensions of Anxiety and Avoidance. The combination of anxiety and avoidance creates the categories of Secure, Preoccupied, Fearful, and Dismissing (see Figure 1).

Figure 1 (Shaver & Fraley, 2004)

Psychopathology and Personality

Psychopathology and the personality factor of attachment style may seem unrelated, but there is evidence for a relationship. OCD has been found to be associated with certain attachment styles. In children, overall insecure attachment as well as insecure attachment subscales were found to be predictive of OCD symptoms (Rezavana, et. al, 2012). In a slightly more relevant sample consisting of undergraduate students, attachment styles high in the avoidance and anxiety dimensions predicted OCD-related thoughts and symptoms; the study found that subjects with the aforementioned attachment styles scored higher on the Pauda Inventory Revised OCD scale. Additionally, those symptoms were mediated by obsessive compulsive beliefs (Doran, et. al, 2009). Shaker and Homelyi (2011) found that a significant seventy-eight percent of clinical patients that were already diagnosed with OCD were assessed to be high in the anxiety dimension of attachment. Complementing this study are the findings of Ivarsson, Granqvist, Gillberg, & Broberg (2010), in which a dismissing style was evident in pre-diagnosed OCD patients.

Attachment Style and Stress

Certain attachment styles have been shown to respond to distress and anxiety worse than others. Meyers (1998) suggested that undergraduates with a secure attachment style handle stress and anxiety better than the insecure undergraduates according to their lower levels of stress on the California Q-set measure of distress and personal competence. When controlling for cultural differences, it was found that both German and Turkish university students with an anxious attachment style (either preoccupied or fearful) had a moderate association with psychological distress, as measured by the Brief Symptoms Inventory. There was additionally a weak, but still significant, association with avoidant attachment styles (Turan et al. 2016). From a nonspecific community sample, it was found that participants with secure or dismissing attachments scored lower on the State-Trait Anxiety Inventory than those with a fearful or preoccupied attachment style, meaning that the latter two attachment styles displayed more anxiety (Surcinelli, Rossi, Montebarocci, & Baldaro, 2010). Kemp and Neinmeyer (1999) also investigated attachment style and stress response. Data showed that those with preoccupied attachment would exhibit “intrusive symptoms” (p391). In contrast to this evidence, subjects with intellectual disabilities and secure attachments experienced lower levels of stress and anxiety (Janssen, Schuenge, & Stolk, 2002). Additionally, secure attachment style predicted stress-reducing behaviors such as planning, help-seeking, and cognitive restructuring (Terzi and Cankaya, 2009).

Present Study

Because of this literature review we have multiple hypotheses. Our first hypothesis is that a small, private, liberal arts student body population will reflect the work of Doran et al. (2009) in that those with an attachment style with high anxiety or high avoidance will display more obsessive-compulsive symptoms. Our second hypothesis is that out of the population mentioned previously, those with a secure attachment style will respond to a stressful situation less maladaptively than those with a dismissing, fearful, or preoccupied style. Our final hypothesis is that there will be an interaction between attachment style and obsessive-compulsivity. In this interaction, we predict that those with a fearful, dismissing, or preoccupied attachment and a high score on the OCD inventory will respond to a stressful situation the worst.

METHODS

Participants

Forty-one participants were recruited from a private, liberal arts college in central Missouri. These participants were recruited through the institution’s psychology department and included twenty females and twenty-one males aging from eighteen to twenty-four years old (M=19.6). Participants included those in introductory psych classes as well as upper-level courses. Extra credit was offered by the professors of the classes from which the sample was drawn.

Methods

Adult attachment style was measured using the online version of the Evaluation of Close Relationships-Revised (ECR-R; Fraley, Waller, & Brennan, 2000). This inventory was vetted by Graham & Unterschute (2014): in the comparison of the ECR-R with the Adult Attachment Scale, the Revised Adult Attachment Scale, the Evaluation of Close Relationships, and the Adult Attachment Questionnaire, the ECR-R had the highest reliability.

Obsessive-compulsivity was measured using the Revised Obsessive Compulsive Inventory (OCI-R). This revision proved to be both highly reliable and valid in its measure of obsessive compulsivity when compared to the Saving Inventory Revised, the Hoarding Rating Scale, and the Beck Anxiety Inventory. Although it was created using the DSM IV, the obsessive compulsivity facet still reflects accuracy and precision in accordance to the DSM-V diagnosis. (Wootton et al., 2015).

Stress was measured using a unique inventory created by the researchers, the Stress and Anxiety Inventory (SAI; See Appendix A). Items assessing state stress and anxiety were selected and adapted from the Six-Item Short Version of the State-Trait Anxiety Inventory (STAI-Y6; Marteau & Bekker, 1992), the Depression Anxiety Stress Scale (DASS; Lovibond, 1983), and the Headington Institute “How Stressed are You” self-report (www.headington-institute.org, 2007). The STAI-Y6’s internal reliability was vetted by Bayrampour, McDonald, Fung, and Suzanne Tough (2014). For the SAI, the researchers used items from this inventory that pertained to state anxiety. An evaluation by Lovibond and Lovibond (1995) found that the DASS effectively distinguished between depression, anxiety, and stress, and the anxiety and stress facets correlated with each other, and that the DASS had convergent validity with the Beck Anxiety Inventory. Questions related to stress and anxiety were selected for the SAI.

Procedure

Participants were brought into a room where they completed the online version of the ECR-R on a computer followed by a print version of the OCI-R. When finished, the participants were then given the Anagram Task: a 10-item world puzzle designed by the researchers that was constructed to be impossible to complete (see Appendix B). This was impossible to complete because out of the ten puzzles, only five of them could actually be solved; They were told that they had seven minutes to complete the puzzles and that they had to complete at least six of the puzzles in order for their data to be used; however, to reiterate, only five were solvable. This deception was used to create a stressful situation by making the completion of the task imperative. Once the seven minutes were up, the task was collected and the participants completed the SAI.

RESULTS

A one-way ANOVA was conducted to examine the influence of adult attachment style and obsessive-compulsiveness A main effect of attachment style was found on attachment style and obsessive-compulsiveness scores. A significant difference in obsessive-compulsive symptoms was found between groups reporting different attachment styles, F(3, 40) = 3.519, p=.024, η²=.22. In a Post-Hoc comparison, those with a secure attachment style (M=20.1, SD=10.8) were significantly less obsessive-compulsive than those with a dismissing attachment style (M=44.0, SD=15.6), p=.013. Additionally, those with a preoccupied attachment style (M=22.8, SD=8.4) were less obsessive-compulsive than those with a dismissing attachment style, p=.041. A one-way ANOVA was also used to examine the influence of attachment style on the response to a stressful situation. There was no main effect, F(3,40)=.61, p=.61, η²=.05. Attachment style did not affect the scores of the Stress/Anxiety Inventory after being in a stressful situation. Participants with a secure style (M=27.3, SD=15.1) did not score lower on the SAI after the stressful situation than those with a preoccupied (M=32.3, SD=12.96), fearful, (M=36.3, SD=12.9), or dismissing (M=32.5, SD=13.4) style. Finally, a two-way ANOVA was used to examine if attachment style interacted with obsessive-compulsiveness to produce effects on the stress/anxiety scores. No interaction was found, F(8,40)=.54, p=.35, η²=.17.

DISCUSSION

The present study aimed to examine the relationship between attachment style, obsessive-compulsivity and stress/anxiety. Our first hypothesis, which proposed that participants with an insecure attachment style (which is either high in anxiety, avoidance, or both) would display more obsessive-compulsive symptoms. This hypothesis was based on the idea that high anxiety and high avoidance styles would correspond to obsessive-compulsiveness more than others (Doran, et. al, 2009; Ivarsson, Granqvist, Gillberg, & Broberg; 2010; Shaker and Homelyi, 2011; Rezavana, et. al, 2012). This was supported by the significant difference between secure and dismissive participants and the second significant difference between preoccupied and dismissive participants. In the first comparison, the cause of the variation might be attributed to the levels of avoidance. Secure and dismissive attachment styles are both low anxiety, but the dismissive type is high in avoidance. In the second comparison, the preoccupied and dismissive styles were also significantly different, with the higher obsessive-compulsions being the dismissive styles. The preoccupied style is the opposite of the dismissive style in that it is high in anxiety and low in avoidance. These two comparisons together point to avoidance being the dimension having the most effect on obsessive-compulsiveness. We hypothesize that since those with the dismissive style are untrusting of and distant from others, they bond instead with ritualistic behavior. The results from the first ANOVA offers insight into attachment style’s predicative power over obsessive compulsiveness.

An important finding was that when the fearful, dismissive, and preoccupied styles were grouped together as a general “insecure” style and their obsessive-compulsive scores were compared to those of the secure attachment style with a t-test, there was no significant difference. Only when the styles were separated into the unique categories of dismissive, preoccupied, and fearful and then analyzed with an ANOVA and post-Hoc comparison was there significance. This means the three styles that are all collectively labeled as “insecure” vary from each other, and these variations are important in affecting obsessive-compulsiveness.

Despite past research that connected attachment style with stress and anxiety (Meyers, 1998; Kemp and Neinmeyer, 1999; Janssen, Schuenge, & Stolk, 2002; Surcinelli, Rossi, Montebarocci, & Baldaro, 2010; Turan et al. 2016), the second hypothesis that those with a secure attachment style would respond less maladaptively to a stressful situation was not supported[AB1] . Also regarding the acclaimed attachment style-stress/anxiety relationship, the third hypothesis regarding the interaction was not supported either; those with an insecure attachment style and high obsessive-compulsivity did not respond the worst to the stressful situation. One possible influential factor is that in the literature, the nature of the stress and anxiety, whether it be state or trait, was not clear. The present study focused on state-stress and state-anxiety, but the sources may have referred to these mood characteristics as innate traits. However, we believe that due to previous studies that vetted two of the three original inventories that made up the SAI, that the SAI was constructly sound.

One aspect of the study might be of reasonable concern. The insignificant results for the second and third hypotheses, which contradict the reviewed literature, may come from the content validity of the stressful situation. There was no previous research validating the Anagram task as a stress-inducing task, which is a clear disadvantage. A second aspect that may be confounding is the striking difference between the number of participants who were secure or preoccupied and those who were fearful or dismissive. Fortunately, all four attachment styles were accounted for, but the low representation of the fearful and dismissive styles may have been problematic.

There are multiple implications for these results. The first implication is related to parenting techniques. In order to prevent future obsessive-compulsiveness in their children, parents could utilize strategies to make their relationship with their newborn or infant more secure. Regarding treatment of OCD, clinicians could try to reduce avoidance in their patients. Knowing one’s attachment style could generally help people be aware of their predisposition to be obsessive-compulsive. Finally, the study’s findings stress the importance of openness, closeness, and empathy in romantic, platonic, and familial relationships.

Based on the current study, we propose several new directions for investigation. Future research may entail a larger sample size, mainly with the goal of gathering a larger number of the less common attachment styles: dismissing and fearful. Due to the questionable construct validity of the stressful situation, a different manipulation might induce the desired response. Finally, attachment styles’ effect on other psychopathologies could be investigated.

In conclusion, the results concerning attachment style’s influence on obsessive-compulsiveness are reflective of past literature. Not only does it support other related literature about attachment style and OCD’s relationship, but this study also adds finding not previously addressed. Firstly, it suggests that examining each unique attachment style is very critical compared to examining the general insecure style. Secondly, it identifies avoidance as key influencing factor in obsessive-compulsiveness. Overall, the findings suggest that personality is a piece in the puzzle of psychological disorders.

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Appendix A

Stress and Anxiety Inventory

Please indicate how you feel at the present moment.

Not at all Not really Neutral Partially Absolutely

1. My heart is beating faster

than usual. 1 2 3 4 5

1. I am perspiring (eg. Hands,

face, underarms). 1 2 3 4 5

1. I feel myself shaking or

Trembling 1 2 3 4 5

1. I was relieved to be done

with the task. 1 2 3 4 5

1. Before the task, I feared that

I would be “thrown” by something

trivial or unfamiliar. 1 2 3 4 5

1. I am worried that I might make a

fool of myself. 1 2 3 4 5

1. I am close to panic. 1 2 3 4 5
2. I feel faint. 1 2 3 4 5
3. I find it difficult to relax. 1 2 3 4 5
4. I feel like I have a lot of nervous

energy. 1 2 3 4 5

1. I feel agitated. 1 2 3 4 5
2. I feel irritable 1 2 3 4 5
3. I feel rather touchy. 1 2 3 4 5
4. I really just want to leave and get

on with my day. 1 2 3 4 5

1. I find it hard to concentrate. 1 2 3 4 5
2. I can’t stop thinking about

the task, even though it is over. 1 2 3 4 5

1. I have trouble feeling hopeful. 1 2 3 4 5
2. I feel emotionally or socially

distant from other people 1 2 3 4 5

1. I would feel better by consuming alcohol or

other drugs 1 2 3 4 5

1. I feel overwhelmed. 1 2 3 4 5

Appendix B

Anagram Task

Unscramble the word and write it on the blank.

The theme is ‘animals’

1. NPSERTE __________________

2. LALORIG __________________

3. UGRAJA ___________________

4. OOLKAP ___________________

5. PNODLHI ___________________

6. ERLAMN ____________________

7. MSTARHE ___________________

8. TERRIHE ____________________

9. BOPREH _____________________

10. WORAPA ____________________

[AB1]Explanation should be given here