Attachment, mentalization and personality in intimate partner violence

Violence against women and girls is both a human rights and a public health issue. It is a global phenomenon, which adversely af- fects individuals who experience it and carries social and financial costs for the societies in which it occurs. Recent global prevalence figures indicate that about 1 in 3 (35%) of women worldwide have experienced either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime. Worldwide, almost one third (30%) of women who have been in a relationship report that they have experienced some form of physical and/or sexual violence by their intimate partner. The report also details that glob- ally as many as 38% of murders of women are committed by an intimate partner (WHO, 2013). The term “violence against women” indicates many forms of violence, including violence by an intimate partner and rape/sexual assault and other forms of sexual violence perpetrated by someone other than a partner (non-partner sexual violence), as well as female genital mutilation, trafficking of women, etc. Intimate partner violence (IPV) is one of the most common forms of violence against women and includes physical, sexual, and emotional abuse and controlling behaviours by an intimate partner (WHO, 2012). It has been examined from a range of theoretical perspectives, one of those being attachment theory, identified as a way to assess several psychosocial risk factors for violence (Mahalik et al., 2005). In the previous literature, the child’s exposure to vio- lence in the family resulted as a major predictor of subsequent ex- posure to IPV victimization (Widom, et al., 2008). Furthemore child’s exposure to violence in the family resulted as a major pre- dictor of subsequent exposure to IPV victimization. Research on abused and traumatized samples has shown high frequencies of unresolved/disorganized attachment in adults. Attachment disor- ganization is associated with major problems of affect regulation and mentalizing deficits. An extensive body of research highlighted that mentalization was elaborated in terms of polarities (Fonagy et al., 2012). Moreover research findings strengthen existing evidence that partner violence contributes to women’s poor mental health. Women assaulted by an intimate partner experience significant health consequences including injury, chronic pain, gastrointestinal problems, sexually transmitted infections, depression, suicidality, post-traumatic stress disorder, and death. Despite the increasingly well-documented literature on this association there has been rel- atively less empirical focus on the interactions between IPV and personality disorders (PDs). The assumption of the interaction be- tween inherited susceptibility and environmental factors, such as traumatic experiences (Paris 1996), could lead us to the hypothesis that these victims are at high risk of developing PD symptoms. Back et al. (1982) examined the personality features of battered women in a psychiatric facility and found that 83% of them were given a diagnosis of borderline, passive-dependent, or passive-aggressive PDs. Other researchers have observed a high prevalence of antiso- cial PD and obsessive–compulsive disorder accompanied by more frequent paranoid ideation in female victims (2008). Moreover, Shields et al. (1990) found a positive correlation between the severity and extent of current IPV and the severity of borderline per- sonality disorder. Although there is a lack of homogeneity in the re- sults available due to the variability of the sample (size, context from which women were recruited, such as shelters or clinics), the personality assessment instruments, and the criteria for intimate partner violence, the general conclusion is that IPV and PDs are frequently and positively associated (Cogan and Porcerelli 1996). This study has three aims: to analyze the relationship between child- hood trauma and victimization in adulthood; to investigate attach- ment and mentalization ability in order to identify specific mentalizing and attachment profiles of women IPV victims; to in- vestigate the associations between personality features and IPV. Despite the increasingly well-documented literature on this asso- ciation there has been relatively less empirical focus on the inter- actions between IPV and personality disorders. A sample of forty women, recruited through anti-violence centers, were administered the Adult Attachment Interview (AAI, George et al., 1984) and com- pleted the Reflective Functioning Questionnaire (RFQ, Fonagy et al., 2016). The hostile/helpless coding system (Lyons-Ruth & Melnick, 2004), the Complex Trauma Questionnaire (ComplexTQ, Vergano et al., 2015), and the Reflective Functioning Scale (RFS, Fonagy et al., 1998) were applied to AAI transcripts. The interviews were au- diotaped and transcribed verbatim. Coding was conducted by two trained coders, and certified as reliable in the use of the AAI. The protocols were double coded for RFQ, ComplexTQ and RFS. The cli- nicians completed Shedler-Westen Assessment Procedure–200 (Shedler et al., 2014), Modes of Mentalization Scale (MMS; Gagliardini et al., 2017) and Polarities of Mentalization Scale (PMS; Gagliardini e Colli, 2017). Data have shown a higher percentage of women with disorganized attachment and an over-activation of au- tomatic and affective mentalization aspects. Results will be dis- cussed in terms of clinical and theoretical implications. Efforts to understand the etiology of intimate partner violence are critical to reduce this public health threat.