Personality and attachment in the homeless: A systematic review

Abstract

Background: Homeless people present high rates of psychopathology, including personality disorders. Given the link between personality disorders and attachment, and the potential importance of these two traits for understanding homeless populations. Aims: Our aim was to review all studies focusing on attachment and on the full assessment of personality disorders in the homeless. Method: Overall, 213 studies were screened through title and abstract. Of these, 63 articles were chosen for full-text assessment. Results: A total of 14 articles met eligibility criteria and were included in the present review. Six studies evaluated personality disorders and eight studies assessed attachment in the homeless. In general, reports suggested that personality disorders are highly common in the homeless, with frequencies ranging between 64% and 79% for any personality disorder. The most common personality diagnoses were paranoid (14%–74%), borderline (6%–62%), avoidant (14%–63%), and antisocial (4%–57%) personality disorders. Attachment reports differed in the methods used and presented diverse results and correlates. Even so, insecure types of attachment dominated in the homeless, accounting for 62% to 100% of the samples. Conclusions: The high prevalence of personality disorders and insecure types of attachment in the homeless may impact intervention strategies for these people. The available literature evaluating attachment and the full assessment of personality disorders in the homeless is scarce, which supports the need for more research on these two topics.