Recent attachment research suggests that children with avoidant attachment often underreport their psychological distress compared to their physiologic indicators of distress (neuroendocrine reactivity, startle response, event-related potentials). This pattern of behavior (referred to as psychobiological divergence) may confer risk for suboptimal coping behaviors, including substance use, sexual risk-taking, and non-suicidal self-injury (NSSI), because individuals who are not aware of or cannot express their emotional needs may engage in maladaptive strategies to regulate their emotions. In the current pilot study (N = 45 youth), we investigate whether psychobiological divergence of neuroendocrine and self-reported reactivity in middle childhood prospectively predicts health risk behaviors (HRBs) in adolescence. The results revealed that divergence was significantly associated with adolescents’ substance use and non-suicidal self-injury (NSSI), but not with their sexual behavior. Among adolescents currently reporting low levels of attachment security, divergence was associated with greater self-reported NSSI. Our results provide initial evidence that psychobiological divergence confers risk for substance use and NSSI in combination with current relational distress. We discuss the implications of our findings for adolescent development and clinical risk.
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Adrian, M., Zeman, J., Erdley, C., Lisa, L., & Sim, L. (2011). Emotional dysregulation and interpersonal difficulties as risk factors for nonsuicidal self-injury in adolescent girls. Journal of Abnormal Child Psychology, 39(3), 389–400. https://doi.org/10.1007/s10802-010-9465-3.
Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Oxford, England: Lawrence Erlbaum.
Ainsworth, M. S. (1979). Infant-mother attachment. American Psychologist, 34(10), 932–937. https://doi.org/10.1037/0003-066X.34.10.932.
Allen, J. P., & Land, D. (1999). Attachment in adolescence. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 319–335). New York, NY: Guilford Press.
Becoña Iglesias, E., Fernández del Río, F., Calafat, A., & Fernández-Hermida, J. (2014). Attachment and substance use in adolescence: a review of conceptual and methodological aspects. Adicciones, 26(1). 77-86. Retrieved from http://www.redalyc.org/html/2891/289130504010/.
Bonanno, G. A., Papa, A., Lalande, K., Westphal, M., & Coifman, K. (2004). The importance of being flexible: The ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychological Science, 15(7), 482–487. https://doi.org/10.1111/j.0956-7976.2004.00705.x.
Bonnet, A., Bréjard, V., & Pedinielli, J. L. (2013). Emotional dispositions and substance use: mediating effect of alexithymia. Psychological Reports, 112(1), 289–302. https://doi.org/10.2466/18.09.20.PR0.112.1.289-302.
Borelli, J. L., David, D. H., Crowley, M. J., Snavely, J. E., & Mayes, L. C. (2013). Dismissing children’s perceptions of their emotional experience and parental care: Preliminary evidence of positive bias. Child Psychiatry & Human Development, 44(1), 70–88. https://doi.org/10.1007/s10578-012-0310-5.
Borelli, J. L., Ho, L. C., Sohn, L., Epps, L., Coyiuto, M., & West, J. L. (2017). School-aged children’s attachment dismissal prospectively predicts divergence of their behavioral and self-reported anxiety. Journal of Child and Family Studies, 26(4), 1018–1028. https://doi.org/10.1007/s10826-016-0619-y.
Borelli, J. L., West, J. L., Weekes, N. Y., & Crowley, M. J. (2014). Dismissing child attachment and discordance for subjective and neuroendocrine responses to vulnerability: dismissing attachment and neuroendocrine response. Developmental Psychobiology, 56(3), 584–591. https://doi.org/10.1002/dev.21107.
Bowlby, J. (1999). Attachment and Loss. 2nd ed New York, NY: Basic Books. Vol. 1.
Bradley, M. M., & Lang, P. J. (1994). Measuring emotion: the self-assessment manikin and the semantic differential. Journal of Behavior Therapy and Experimental Psychiatry, 25(1), 49–59. https://doi.org/10.1016/0005-7916(94)90063-9.
Brennan, K. A., & Shaver, P. R. (1995). Dimensions of adult attachment, affect regulation, and romantic relationship functioning. Personality and Social Psychology Bulletin, 21(3), 267–283. https://doi.org/10.1177/0146167295213008.
Caldwell, J. G., & Shaver, P. R. (2012). Exploring the cognitive-emotional pathways between adult attachment and ego-resiliency. Individual Differences Research, 10(3), 141–152. Retrieved from https://www.researchgate.net/profile/Phillip_Shaver/publication/285726418
Cassidy, J. (1994). Emotion regulation: influences of attachment relationships. Monographs of the Society for Research in Child Development, 59(2-3), 228–249. https://doi.org/10.1111/j.1540-5834.1994.tb01287.x.
Cassidy, J., & Berlin, L. J. (1994). The insecure/ambivalent pattern of attachment: Theory and research. Child Development, 65(4), 971–991. https://doi.org/10.1111/j.1467-8624.1994.tb00796.x.
Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44(3), 371–394. https://doi.org/10.1016/j.brat.2005.03.005.
Compas, B. E., Connor-Smith, J., & Jaser, S. S. (2004). Temperament, stress reactivity, and coping: Implications for depression in childhood and adolescence. Journal of Clinical Child & Adolescent Psychology, 33(1), 21–31. https://doi.org/10.1207/S15374424JCCP3301_3.
Cooper, M. L., Agocha, V. B., & Sheldon, M. S. (2000). A motivational perspective on risky behaviors: The role of personality and affect regulatory processes. Journal of Personality, 68(6), 1059–1088. https://doi.org/10.1111/1467-6494.00126.
Cooper, M. L., Shaver, P. R., & Collins, N. L. (1998). Attachment styles, emotion regulation, and adjustment in adolescence. Journal of Personality and Social Psychology, 74(5), 1380 https://doi.org/10.1037/0022-35184.108.40.2060.
Cyders, M. A., & Smith, G. T. (2008). Emotion-based dispositions to rash action: Positive and negative urgency. Psychological Bulletin, 134(6), 807 https://doi.org/10.1037/0022-35220.127.116.110.
Daughters, S. B., Reynolds, E. K., MacPherson, L., Kahler, C. W., Danielson, C. K., Zvolensky, M., & Lejuez, C. W. (2009). Distress tolerance and early adolescent externalizing and internalizing symptoms: The moderating role of gender and ethnicity. Behaviour Research and Therapy, 47(3), 198–205. https://doi.org/10.1016/j.brat.2008.12.001.
Diener, M. L., Isabella, R. A., Behunin, M. G., & Wong, M. S. (2008). Attachment to mothers and fathers during middle childhood: Associations with child gender, grade, and competence. Social Development, 17(1), 84–101. https://doi.org/10.1111/j.1467-9507.2007.00416.x.
Dorard, G., Berthoz, S., Phan, O., Corcos, M., & Bungener, C. (2008). Affect dysregulation in cannabis abusers. European Child & Adolescent Psychiatry, 17(5), 274–282. https://doi.org/10.1007/s00787-007-0663-7.
Dozier, M., & Kobak, R. R. (1992). Psychophysiology in attachment interviews: Converging evidence for deactivating strategies. Child Development, 63(6), 1473–1480. https://doi.org/10.1111/j.1467-8624.1992.tb01708.x.
Dozier, M., Stovall-McClough, K. C., & Albus, K. E. (2008). Attachment and psychopathology in adulthood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (Vols. 1–2, pp. 718–744). New York, NY: Guilford Press.
Fagundes, C. P., Diamond, L. M., & Allen, K. P. (2012). Adolescent attachment insecurity and parasympathetic functioning predict future loss adjustment. Personality and Social Psychology Bulletin, 38(6), 821–832. https://doi.org/10.1177/0146167212437429.
Feeney, J. A. (2000). Implications of attachment style for patterns of health and illness. Child: Care, Health and Development, 26(4), 277–288. https://doi.org/10.1046/j.1365-2214.2000.00146.x.
Feeney, J. A., Kelly, L., Gallois, C., Peterson, C., & Terry, D. J. (1999). Attachment style, assertive communication, and safer-sex behavior. Journal of Applied Social Psychology, 29(9), 1964–1983. https://doi.org/10.1111/j.1559-1816.1999.tb00159.
Feeney, J. A., Noller, P., & Patty, J. (1993). Adolescents’ interactions with the opposite sex: Influence of attachment style and gender. Journal of Adolescence, 16(2), 169–186. https://doi.org/10.1111/j.1559-1816.1999.tb00159.x.
Gratz, K. L. (2003). Risk factors for and functions of deliberate self-harm: An empirical and conceptual review. Clinical Psychology: Science and Practice, 10(2), 192–205. https://doi.org/10.1093/clipsy.bpg022.
Greenberg, M. T. (1999). Attachment and psychopathology in childhood. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 469–496). New York, NY: Guilford Press.
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348–362. https://doi.org/10.1037/0022-3518.104.22.1688.
Gross, J. J., & Levenson, R. W. (1997). Hiding feelings: The acute effects of inhibiting negative and positive emotion. Journal of Abnormal Psychology, 106(1), 95–103. https://doi.org/10.1037/0021-843X.106.1.95.
Gunnar, M. R. (1991). The psychobiology of stress in early development: Reactivity and regulation. Minneapolis, MN: International Society for the Study of Behavioral Development.
Hankin, B. L., & Abramson, L. Y. (2001). Development of gender differences in depression: An elaborated cognitive vulnerability–transactional stress theory. Psychological Bulletin, 127(6), 773 https://doi.org/10.1037/0033-2909.127.6.773.
Heath, N. L., & Nixon, M. K. (2009). Assessment of nonsuicidal self-injury in youth. In N. L. Heath & M. K. Nixon (Eds.), Self-injury in youth: The essential guide to assessment and intervention (pp. 143–170). New York, NY: Routledge.
Kerns, K. A., Aspelmeier, J. E., Gentzler, A. L., & Grabill, C. M. (2001). Parent–child attachment and monitoring in middle childhood. Journal of Family Psychology, 15(1), 69–81. https://doi.org/10.1037/0893-322.214.171.124.
Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. American Journal of Psychiatry, 142, 1259–1264. https://doi.org/10.1037/0022-006X.64.6.1152.
Klonsky, E. D. (2007). The functions of deliberate self-injury: A review of the evidence. Clinical psychology review, 27(2), 226–239. https://doi.org/10.1016/j.cpr.2006.08.002.
Kovacs, M., Joormann, J., & Gotlib, I. H. (2008). Emotion (Dys)regulation and links to depressive disorders. Child Development Perspectives, 2(3), 149–155. https://doi.org/10.1111/j.1750-8606.2008.00057.x.
Lemelin, C., Lussier, Y., Sabourin, S., Brassard, A., & Naud, C. (2014). Risky sexual behaviours: The role of substance use, psychopathic traits, and attachment insecurity among adolescents and young adults in Quebec. The Canadian Journal of Human Sexuality, 23(3), 189–199. https://doi.org/10.3138/cjhs.2625.
Lieberman, M., Doyle, A. B., & Markiewicz, D. (1999). Developmental patterns in security of attachment to mother and father in late childhood and early adolescence: Associations with peer relations. Child Development, 70, 202–213. https://doi.org/10.1111/1467-8624.00015.
Lloyd, E. E., Kelley, M. L., & Hope, T. (1997, April). Self-mutilation in a community sample of adolescents: Descriptive characteristics and provisional prevalence rates. In annual meeting of the Society for Behavioral Medicine, New Orleans, LA.
Luster, T., & Small, S. A. (1994). Factors associated with sexual risk-taking behaviors among adolescents. Journal of Marriage and the Family, 56(3), 622–632. doi: www.jstor.org/stable/352873
MacPherson, L., Magidson, J. F., Reynolds, E. K., Kahler, C. W., & Lejuez, C. W. (2010). Changes in sensation seeking and risk‐taking propensity predict increases in alcohol use among early adolescents. Alcoholism: Clinical and Experimental Research, 34(8), 1400–1408. https://doi.org/10.1111/j.1530-0277.2010.01223.x.
Magar, E. C., Phillips, L. H., & Hosie, J. A. (2008). Self-regulation and risk-taking. Personality and Individual Differences, 45(2), 153–159. https://doi.org/10.1016/j.paid.2008.03.014.
Main, M. (1981). Avoidance in the service of attachment: A working paper. Behavioral Development: The Bielefeld Interdisciplinary Project, 651–693.
Martin, J., Bureau, J. F., Lafontaine, M. F., Cloutier, P., Hsiao, C., Pallanca, D., & Meinz, P. (2017). Preoccupied but not dismissing attachment states of mind are associated with nonsuicidal self-injury. Development and Psychopathology, 29(2), 379–388. https://doi.org/10.1017/S0954579417000050.
Martin, J., Bureau, J. F., Yurkowski, K., Lafontaine, M. F., & Cloutier, P. (2016). Heterogeneity of relational backgrounds is associated with variation in non-suicidal self-injurious behavior. Journal of Abnormal Child Psychology, 44(3), 511–522. https://doi.org/10.1007/s10802-015-0048-1.
Martin, J., Raby, K. L., Labella, M. H., & Roisman, G. I. (2017). Childhood abuse and neglect, attachment states of mind, and non-suicidal self-injury. Attachment & Human Development, 1–22. https://doi.org/10.1080/14616734.2017.1330832
Mayer, J., & Filstead, W. J. (1979). The Adolescent Alcohol Involvement Scale. An instrument for measuring adolescents’ use and misuse of alcohol. Journal of Studies on Alcohol, 40(3), 291–300. https://doi.org/10.15288/jsa.1979.40.291.
McWilliams, L. A., & Bailey, S. J. (2010). Associations between adult attachment ratings and health conditions: Evidence from the national comorbidity survey replication. Health Psychology, 29(4), 446–453. https://doi.org/10.1037/a0020061.
Mikulincer, M., & Shaver, P. R. (2003). The attachment behavioral system in adulthood: Activation, psychodynamics, and interpersonal processes. Advances in Experimental Social Psychology, 35, 53–152. https://doi.org/10.1016/S0065-2601(03)01002-5.
Mikulincer, M., Dolev, T., & Shaver, P. R. (2004). Attachment-related strategies during thought suppression: Ironic rebounds and vulnerable self-representations. Journal of Personality and Social Psychology, 87(6), 940–956. https://doi.org/10.1037/0022-35126.96.36.1990.
Moberg, D. P. (2003). Screening for alcohol and other drug problems using the Adolescent Alcohol and Drug Involvement Scale (AADIS). Madison, WI: Center for Health Policy and Program Evaluation, University of Wisconsin-Madison. https://uwphi.pophealth.wisc.edu/programs/evaluation-research/adis/manual.pdf Retrieved from.
Moretti, M. M., & Peled, M. (2004). Adolescent-parent attachment: Bonds that support healthy development. Paediatrics & Child Health, 9(8), 551–555. https://doi.org/10.1093/pch/9.8.551.
Pietromonaco, P. R., Uchino, B., & Dunkel Schetter, C. (2013). Close relationship processes and health: Implications of attachment theory for health and disease. Health Psychology, 32(5), 499–513. https://doi.org/10.1037/a0029349.
Puig, J., Englund, M. M., Simpson, J. A., & Collins, W. A. (2013). Predicting adult physical illness from infant attachment: A prospective longitudinal study. Health Psychology, 32(4), 409–417. https://doi.org/10.1037/a0028889.
Reynolds, S., Searight, H. R., & Ratwik, S. (2014). Adult attachment styles and rumination in the context of intimate relationships. North American Journal of Psychology, 16(3), 495–506.
Richards, J. M., & Gross, J. J. (2000). Emotion regulation and memory: the cognitive costs of keeping one’s cool. Journal of Personality and Social Psychology, 79(3), 410–424. https://doi.org/10.1037/0022-35188.8.131.520.
Sbarra, D. A., & Borelli, J. L. (2013). Heart rate variability moderates the association between attachment avoidance and self-concept reorganization following marital separation. International Journal of Psychophysiology, 88(3), 253–260. https://doi.org/10.1016/j.ijpsycho.2012.04.004.
Scharfe, E., & Eldredge, D. (2001). Associations between attachment representations and health behaviors in late adolescence. Journal of Health Psychology, 6(3), 295–307. https://doi.org/10.1177/135910530100600303.
Schindler, A., & Bröning, S. (2015). A Review on Attachment and Adolescent Substance Abuse: Empirical Evidence and Implications for Prevention and Treatment. Substance Abuse, 36(3), 304–313. https://doi.org/10.1080/08897077.2014.983586.
Schindler, A., Thomasius, R., Petersen, K., & Sack, P.-M. (2009). Heroin as an attachment substitute? Differences in attachment representations between opioid, ecstasy and cannabis abusers. Attachment & Human Development, 11(3), 307–330. https://doi.org/10.1080/14616730902815009.
Schindler, A., Thomasius, R., Sack, P.-M., Gemeinhardt, B., & Küster, U. (2007). Insecure family bases and adolescent drug abuse: A new approach to family patterns of attachment. Attachment & Human Development, 9(2), 111–126. https://doi.org/10.1080/14616730701349689.
Smith, G. T., & Cyders, M. A. (2016). Integrating affect and impulsivity: The role of positive and negative urgency in substance use risk. Drug and Alcohol Dependence, 163, S3–S12. https://doi.org/10.1016/j.drugalcdep.2015.08.038.
Spangler, G. (1998). Emotional and adrenocortical responses of infants to the strange situation: The differential function of emotional expression. International Journal of Behavioral Development, 22(4), 681–706. https://doi.org/10.1080/016502598384126.
Spangler, G., & Grossmann, K. E. (1993). Biobehavioral organization in securely and insecurely attached infants. Child Development, 64(5), 1439–1450. https://doi.org/10.1111/j.1467-8624.1993.tb02962.x.
Thorberg, F. A., & Lyvers, M. (2010). Attachment in relation to affect regulation and interpersonal functioning among substance use disorder in patients. Addiction Research & Theory, 18(4), 464–478. https://doi.org/10.3109/16066350903254783.
Tracy, J. L., Shaver, P. R., Albino, A. W., & Cooper, M. L. (2003). Attachment styles and adolescent sexuality. In P. Florsheim (Ed.), Adolescent romance and sexual behavior: Theory, research, and practical implications (pp. 137–159). Mahwah, NJ: Lawrence Erlbaum Associates.
White, L. O., Wu, J., Borelli, J. L., Rutherford, H. J. V., David, D. H., Kim–Cohen, J., & Crowley, M. J. (2012). Attachment dismissal predicts frontal slow-wave ERPs during rejection by unfamiliar peers. Emotion, 12(4), 690–700. https://doi.org/10.1037/a0026750.
Wills, T. A., Walker, C., Mendoza, D., & Ainette, M. G. (2006). Behavioral and emotional self-control: relations to substance use in samples of middle and high school students. Psychology of Addictive Behaviors, 20(3), 265–278. https://doi.org/10.1037/0893-164X.20.3.265.
Winters, K. C., Botzet, A., Anderson, N., Bellehumeur, T., & Egan, B. (2001). Screening and assessment study, Wisconsin Division of juvenile corrections, alcohol and other drug abuse. Madison, WI: University of Minnesota. Minneapolis: Center for Adolescent Substance Abuse Research. Retrieved from https://uwphi.pophealth.wisc.edu/programs/evaluation-research/adis/winters-report.pdf.
Zimmermann, G. (2010). Risk perception, emotion regulation and impulsivity as predictors of risk behaviours among adolescents in Switzerland. Journal of Youth Studies, 13(1), 83–99. https://doi.org/10.1080/13676260903173488.
J.B.: conceptualized the design, executed the study, conducted the data analyses, and wrote the manuscript. L.H.: collaborated with the writing of the Introduction and Discussion. L.E.: designed the adolescent follow-up assessment, conceptualized the hypotheses, and contributed to analyses and writing.
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee of Pomona College and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study. Parents completed consent forms, and children completed assent forms.
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Borelli, J.L., Ho, L. & Epps, L. School-aged Children’s Psychobiological Divergence as a Prospective Predictor of Health Risk Behaviors in Adolescence. J Child Fam Stud 27, 47–58 (2018). https://doi.org/10.1007/s10826-017-0870-x
- Psychobiological divergence
- Neuroendocrine reactivity
- Health risk behaviors