Attachment in Patients with Bipolar and Unipolar Depression: A Comparison with Clinical and Non-clinical Controls

Angelo Picardi1, *, Mauro Pallagrosi2, Laura Fonzi7, Giovanni Martinotti3, Emanuele Caroppo4, Giulio Nicolò Meldolesi5, Giancarlo Di Gennaro6, Marco De Risi6, Massimo Biondi2
1 Centre of Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
2 Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
3 Department of Neuroscience and Imaging, University “G.d'Annunzio”, Chieti, Italy
4 Department of Mental Health, Rome 2 Local Health Unit, Catholic University of Sacred Heart, Rome, Italy
5 “Neurone” Foundation for Research in Neuropsychobiology and Clinical Neurosciences, Rome, Italy
6 Epilepsy Surgery Unit, IRCCS Neuromed, Pozzilli, Italy
7 Italian Psychoanalytic Society, Rome, Italy

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© 2019 Picardi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Italian National Institute of Health, Centre of Behavioural Sciences and Mental Health, Viale Regina Elena, 299 - 00161 Rome, Italy; Tel: +39 06 49904200; Fax: +39 06 49904182;



A link between depression and insecure attachment has long been postulated. Although many studies examined the relationship between depressive symptoms and attachment, relatively few studies were performed on patients diagnosed with depression. Also, research on patients with bipolar disorder is scarce.


We aimed at testing the association between attachment insecurity and unipolar and bipolar depression.


We studied 21 patients with bipolar disorder, current episode depressed, and three age- and sex-matched groups, each consisting of 21 individuals: patients with major depressive disorder, recurrent episode; patients with epilepsy; non-clinical participants. The Experience in Close Relationships questionnaire was used to assess adult attachment style.


Patients with both bipolar and unipolar depression displayed significantly higher scores on attachment-related avoidance as compared with patients with epilepsy and non-clinical participants. Also, patients with bipolar depression scored significantly higher on attachment-related anxiety than all other groups. In both psychiatric groups, attachment dimensions were not significantly correlated with global clinical severity or severity of depression.


Despite some study limitations, our results are consistent with some previous studies and provide support to Bowlby's seminal hypothesis that attachment insecurity may predispose to depression. Attachment theory may provide a valuable theoretical framework for future research and for guiding treatment.

Keywords: Unipolar depression, Bipolar disorder, Epilepsy, Emotion regulation, Hyphothesis, Non-clinical controls.