Parent-Adolescent Attachment Patterns in Inpatient Adolescents with Comorbid Borderline Personality Disorder and Substance Use

Although Borderline Personality Disorder (BPD) is often comorbid with substance use (SU), both have been associated with unique attachment strategies. BPD is associated with preoccupation and disorganization while SU is associated with dismissal and disorganization. Taken together, adolescents with comorbid conditions may appear more disorganized and lack a clear pattern of strategies. Previous research on attachment and comorbidity has not studied how these may present differently in adolescence, a period when most symptoms are first presented, and early interventions are most effective. Therefore, the present study examined attachment patterns of inpatient youths (N=392) with BPD and SU alone, as well as with comorbid BPD and SU. Using a multi-method approach, we utilized self- and parent-reported questionnaires and clinical interviews. Our findings suggest that comorbid adolescents were significantly less likely to report disorganization when compared to youth with BPD only. In addition, comorbid adolescents scored higher in dismissal with both parents and idealization with their fathers, though this effect did not reach significance. Overall, our findings provide information on how health care providers can assist adolescents with comorbid conditions based on their specific attachment needs.