An Attachment Theoretical Framework for Understanding Personality Disorders: Developmental, Neuroscience, and Psychotherapeutic Considerations


  • Kenneth N. Levy Department of Psychology, The Pennsylvania State University, Department of Psychiatry, Joan and Sanford I. Weill Medical College of Cornell University
  • Benjamin N. Johnson Department of Psychology, Pennsylvania State University
  • J. Wesley Scala Department of Psychology, Pennsylvania State University
  • Christina M. Temes Department of Psychology, Pennsylvania State University
  • Tracy L. Clouthier Department of Psychology, Pennsylvania State University


attachment theory, developmental psychopathology, personality disorder, psychopathology, psychotherapy, neuroscience


In this paper we propose that John Bowlby's attachment theory provides a theoretically coherent, empirically based, and clinically useful model for understanding personality pathology. This theoretical framework brings parsimony and breadth to the conceptualization of the etiology, maintenance, and treatment of personality disorders (PDs). Attachment theory can explain both the intrapersonal and interpersonal difficulties common in those with PDs and is consistent with findings from studies across multiple domains of knowledge, including evolutionary biology, ethology/comparative psychology, developmental psychology, experimental social-personality psychology, and neuroscience.PDs are characterized by significant interpersonal challenges. Recently, these challenges have been hypothesized to stem from underlying maladaptive attachment schemas. Our goal is to outline and elaborate on attachment theory as a foundation for the etiology and pathology of PDs and to highlight the implications of this theory for treatment. We begin with a brief review of attachment, describing its conceptualization and assessment in both children and adults in order to examine PD development. This theoretical foundation is supported by a body of empirical research, from which we present findings from neurobiological and developmental literatures linking attachment and PDs. We then examine the role of attachment in the psychotherapy process and in treatment outcome. Further, we outline research reporting changes in attachment patterns as a result of treatment. Finally, we summarize the implications of attachment theory for understanding PDs and present possible directions for future research.