Attachment and Parenting in Adult Patients with Anxiety Disorders

Angelo Picardi1, *, Emanuele Caroppo2, Elisa Fabi3, Serena Proietti4, Giancarlo Di Gennaro5, Giulio Nicolò Meldolesi5, 6, Giovanni Martinotti7, 8
1 Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
2 RM-B Local Health Unit, Department of Mental Health, Rome, Italy
3 Department of Neurology and Psychiatry, Policlinico Umberto I, Sapienza University of Rome, Italy
4 Department of Psychiatry and Psychology, Catholic University of Rome, Italy
5 Epilepsy Surgery Unit, IRCCS Neuromed, Pozzilli, Italy
6 Neurone' Foundation for Research in Neuropsychobiology and Clinical Neurosciences, Rome, Italy
7 Neuropsychiatric Facility ‘Villa Maria Pia’, Rome, Italy
8 Department of Neuroscience and Imaging, University "G.d'Annunzio", Chieti, Italy

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© Picardi et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Italian National Institute of Health, Centre of Epidemiology, Surveillance and Health Promotion, Mental Health Unit, Viale Regina Elena, 299 - 00161 Rome, Italy; Tel: +39 06 49904200; Fax: +39 06 49904182; E-mail:



The literature suggests that dysfunctional parenting and insecure attachment may increase risk of anxiety-related psychopathology. This study aimed at testing the association between anxiety disorders, attachment insecurity and dysfunctional parenting while controlling for factors usually not controlled for in previous studies, such as gender, age, and being ill.


A sample of 32 non-psychotic inpatients with SCID-I diagnosis of an anxiety disorder, either alone or in comorbidity, was compared with two age- and sex-matched control groups consisting of 32 non-clinical participants and 32 in-patients with drug-resistant epilepsy. Study measures included the Experience in Close Relationships questionnaire (ECR) and the Parental Bonding Instrument (PBI).


The patients with anxiety disorders scored significantly higher on attachment-related anxiety and avoidance than patients with drug-resistant epilepsy and non-clinical participants. These findings were independent of comorbidity for mood disorders. ECR scores did not differ among diagnostic subgroups (generalized anxiety disorder, panic disorder, other anxiety disorders). Patients with anxiety disorders scored significantly lower on PBI mother’s care and borderline significantly lower on PBI father's care than patients with drug-resistant epilepsy.


Although limitations such as the relatively small sample size and the cross-sectional nature suggest caution in interpreting these findings, they are consistent with the few previous adult studies performed on this topic and corroborate Bowlby's seminal hypothesis of a link between negative attachment-related experiences, attachment insecurity, and clinical anxiety. Attachment theory provides a useful theoretical framework for integrating research findings from several fields concerning the development of anxiety disorders and for planning therapeutic interventions.

Keywords: : Attachment, parenting, stress, emotion regulation, anxiety, epilepsy.