Better off without you? - Attachment avoidance is linked to dissociative brain structural and functional patterns in patients with major depressive disorder and healthy controls

Abstract

Background: Attachment avoidance is a risk factor for major depressive disorder (MDD) and a prevalent characteristic among both healthy individuals and those with MDD. This study aims to investigate whether the structural and functional brain correlates of attachment avoidance differ in individuals with MDD and healthy controls (HC).

Methods: A total of n = 76 MDD patients and n = 76 HC matched by age and gender were assessed using the attachment avoidance scale of the Relationship Scales Questionnaire. Participants underwent a structural and functional MRI scan, using an emotion processing task. Interaction effects were examined using two ANCOVAs (group X attachment avoidance) on a whole-brain level.

Results: A significant group X attachment avoidance interaction effect on gray matter volume in the right amygdala and hippocampus-parahippocampus-complex (k = 439, t₁₄₅ = 4.97, x = 15, y = -4, z = -26, p_TFCE-FWE = 0.019) was revealed, accompanied by significant interaction effects on the reactivity toward negative faces in the frontal gyrus, caudate, and insula among other (k = 3329, t113 = 4.94, x = 34, y = 14, z = 24, p_TFCE-FWE = 0.007).

Conclusions: The results suggest that attachment avoidance is linked to distinct neuronal patterns in HC and MDD patients at the structural level and in reactivity to negative emotional stimuli located in regions associated with emotion perception and social cognition. The findings could be cautiously interpreted as neuronal correlates of hyper-, respectively hyposensitivity to socio-emotional cues and skill deficits in MDD patients, which could be specifically addressed in psychotherapy.

Keywords: Attachment avoidance; Depression; MDD; MRI; Neuroimaging; Social cognition.