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Since Bowlby (1958, cited in Bowlby, 1969) originally introduced the theory of attachment it has been written about extensively and a vast amount of research has contributed to the development of the theory. In more recent years research has focused on the possible link between attachment and psychopathology. The major aim of the present meta-analysis was to contribute to this research effort by establishing the magnitude of the effect size for the relationship between attachment security and internalizing psychopathology; and attachment security and externalizing psychopathology, in children and adolescents. Four separate meta-analyses were conducted investigating internalizing and externalizing problems in cross-sectional and prospective studies. A comprehensive literature search was conducted to identify relevant studies for inclusion in the analysis. Identified studies were assessed for eligibility according to stringent inclusion and exclusion criteria. A total of 23 studies contributing 45 effect size correlations, involving 3793 different participants were considered eligible for inclusion. Relevant information was extracted and coded from the studies before the analyses were conducted. For cross-sectional studies the mean effect size correlation for attachment security and internalizing psychopathology was r = -0.24 (k = 14; p <0.01; 95% CI = -0.31, -0.17). For attachment security and externalizing psychopathology the mean effect size was r = -0.28 (k = 16; p <0.01; 95% CI = -0.34, -0.21). In terms of prospective studies the mean effect size correlation for attachment security and internalizing psychopathology was r = -0.17 (k = 8; p = 0.01; 95% CI = -0.28, -0.04); and for externalizing psychopathology it was r = -0.09 (k = 7; p = 0.02; 95% CI = -0.16, -0.01). When attachment security and psychopathology were measured concurrently, there was evidence of a negative association for both internalizing and externalizing psychopathology. Although the magnitude of effect was smaller for prospective studies evidence was also found for the predictive validity of a lower level of attachment security in the development of both internalizing and externalizing psychopathology. Theoretical explanations for these findings are presented and the research and clinical implications are discussed in terms of the limitations of the study.

„Comorbidity“ among mental disorders is commonly observed in both clinical and epidemiological samples. The robustness of this observation is rarely questioned; however, what is at issue is its meaning. Is comorbidity „noise“ – nuisance covariance that researchers should eliminate by seeking „pure“ cases for their studies – or a „signal“ – an indication that current diagnostic systems are lacking in parsimony and are not „carving nature at its joints?“ (Krueger, p. 921). With these words, Krueger started a discussion on the structure of mental disorders, which suggested that a 3-factor model of common mental disorders existed in the community. These common factors were labeled „anxious-misery,“ „fear“ (constituting facets of a higher-order internalizing factor), and „externalizing.“ Along with similar evidence from personality research and psychometric explorations and selective evidence from genetic and psychopharmacologic studies, Krueger suggested that this model might not only be phenotypically relevant, but might actually improve our understanding of core processes underlying psychopathology. Since then, this suggestion has become an influential, yet also controversial topic in the scientific community, and has received attention particularly in the context of the current revision process of the Manual of Mental Disorders (Fifth Edition) (DSM-V) and the International Classification of Diseases, 11th Revision (ICD-11). Focusing on anxiety disorders, this article critically discusses the methods and findings of this work, calls into question the model’s developmental stability and utility for clinical use and clinical research, and challenges the wide-ranging implications that have been linked to the findings of this type of exploration. This critical appraisal is intended to flag several significant concerns about the method. In particular, the concerns center around the tendency to attach wide-ranging implications (eg, in terms of clinical research, clinical practice, public health, diagnostic nomenclature) to the undoubtedly interesting statistical explorations.