Bridging parental attachment insecurity, social cognition, parenting, and temperament to elucidate the origins of antisocial orientation in preschoolers

This study aimed at investigating: (1) the effects of temperament and biological risk at birth on various developmental domains at toddler and preschool ages; (2) the interaction effects of the biological risk and temperament on development. Participants One hundred and ten full-term and 98 preterm children without significant physical or developmental disabilities and consisting of various biological risks were examined at toddler age (18-36 months) and preschool age (51-67 months). The Neonatal Medical Index was used to classify the biological risk level. Parental reports on the Chinese Toddler Temperament Scale at toddler age were collected and the temperament (easy, intermediate and difficult) of each child was assigned according to local norm. The Comprehensive Developmental Inventory for Infants and Toddlers was used for assessing child development at toddler and preschool ages. Other family variables were also collected as possible confounders for child development. Two-way ancova was conducted to analyse the predictability of biological risk and temperament, by controlling the potential family variables on child development. At toddler age, higher biological risk had significant adverse effects on both the Perceptual-motor developmental quotients (DQs) (F(1,201)= 19.4, P < 0.001) and Social-adaptive DQs (F(2,200)= 22.5, P < 0.001), while easy temperament had positive effects only on the Social-adaptive DQs (F(2,200)= 7.7, P < 0.01). At preschool age, none of the two factors had effects on DQs of the Comprehensive Developmental Inventory for Infants and Toddlers. There were no significant interactions between biological risk and temperament on DQs at both ages. The biological risk and temperament affected child development at toddler age but not at preschool age. No interaction of biological risk and temperament effects on the child development at toddler age existed. The effects of biological risk and temperament on child development were temporary for the children with relatively low biological risk.

BackgroundThe study is a part of the Danish High Risk and Resilience Study, Via 11 and aims to explore the developmental trajectories of psychotic experiences (PEs) and theory of mind in children born to parents with schizophrenia or bipolar disorder. In a cross sectional perspective we also aim to explore possible associations between PEs and social cognitive deficits, particularly hyper-theory-of-mind. We also wish to explore the significance of other potential risk factors for PEs such as cognitive biases, adverse life events, and insecure attachment styles. Earlier studies have shown that PEs during childhood are predictive of later psychotic disorders, especially if they persist over time. We expect the possible risk factors to have a cumulative effect.MethodsThe Danish High Risk and Resilience Study, Via 11, is the first follow-up of a cohort of 522 children and their parents. The cohort consists of children where one or both parents have been diagnosed with a schizophrenia spectrum disorder (N=202), children where one or both parents have been diagnosed with bipolar affective disorder (N=120) and children where neither of the parents have been diagnosed with these disorders (N=200). The children and their parents were assessed with a comprehensive assessment battery e.g. social- and neurocognitive tests and diagnostic interviews when the children were seven years old, and they will now be re-assessed for the first time at age 11. Data for this study is currently being collected as a part of the Via 11. Psychotic experiences will be assessed on the Scale of Prodromal Symptoms based on K-SADS interviews and with the Magical Thinking Questionnaire. Social cognitive skills will be assessed with Frith-Happé Animated Triangles and Theory-of-Mind Storybook Frederik. Cognitive bias i.e. jumping to conclusions will be assessed with the Beads task. Adverse life events will be assessed with the K-SADS interviews, the Child Trauma Screening Questionnaire, and with a questionnaire about bullying based on the Olweus Bully/Victim Questionnaire. Measures of neurocognitive and attentional deficits will also be included. Child attachment style was assessed with the Story Stem Assessment Protocol and emotion recognition with the ERT from Cantab.Hypotheses:-Age seven: Children in the two high risk groups will be have higher rates of insecure or disorganized attachment styles compared with children in the control group. We expect insecure and disorganized attachment to be associated with poorer social cognition (theory of mind and emotion recognition) and with worse general psychopathology and PEs.-Age 11: We expect children born to parents with schizophrenia spectrum disorders to report higher frequencies of PEs than children born to parents without these disorders. We expect children with PEs to have higher levels of general psychopathology and poorer levels of daily functioning than children without PEs. We expect children in the two high risk groups to have poorer theory of mind than children in the control group.-Age 11: We expect PEs to be associated with poor social cognition, particularly hyper theory-of-mind, higher rates of cognitive bias, adverse life events, neurocognitive and attentional impairments, and to be predicted by insecure and disorganized attachment styles.ResultsThe data collection started in March 2017. Results from the 11-year-follow-up are expected in 2020.DiscussionExamining PEs over time during childhood is important since it may improve our ability to identify children who are at a particularly high risk of developing psychotic disorders and other psychopathology later in life and thus to identify a particularly vulnerable subgroup towards whom early interventions should be targeted.

We examined whether positive implications of mother-child mutually responsive orientation, demonstrated earlier at toddler and preschool age, extend longitudinally into early school age. The focus of the present study was on the long-term consequences of mutually responsive orientation for the development of conscience. Mutually responsive orientation encompassed shared cooperation and shared positive affect between mother and child. It was measured as a composite of those qualities observed in dyadic naturalistic interactions and reported by mothers, at toddler and preschool age. Children's conscience was assessed at early school age (N = 83) using multiple measures, including observations of moral behavior, alone and in the peer context, and moral cognition. Mother-child mutually responsive orientation at toddler and preschool ages predicted children's future conscience, even after controlling for the developmental continuity of conscience. Model-fitting analyses revealed that mutually responsive orientation at toddler age had a direct effect on future conscience, not mediated by such orientation at preschool age. The findings extend those of earlier work that revealed the importance of mother-child mutually responsive orientation for socialization, and they confirm the value of the relationship approach to social development, including long-term outcomes.

To better understand attachment from a cross-cultural and historical perspective, I have amassed over 200 cases from the ethnographic and archaeological records that reveal cultural models (D'Andrade and Strauss 1992) of infancy. The 200 cases represent all areas of the world, historical epochs from the Mesolithic to the present and all types of subsistence patterns (Appendix 1). The approach is inductive where cases with similar models of infancy are clustered into archetypes. My principal finding from this analysis is that, in the broadest overview, infants are, effectively, placed on probation and not immediately integrated into the society. Attachment failure is not seen as a potential problem but, rather, premature attachment to an infant whose existence may be fleeting is to be guarded against. Most societies view infants and even children as not-yet-persons. Infants are born into a state of liminality or incompleteness. Among the Wari, a baby is compared to unripe fruit as it is “still being made” (Conklin and Morgan 1996: 672) and the Nankani reserve judgment on the infant's humanity until they can be certain it is not a spirit or bush child (Denham et al 2010: 608). My presentation of results will first identify the main factors that give rise to delaying personhood and, second, to the cultural models which justify and guide the transformation of babies into persons. Variability in the way this non-personhood is characterized and in the steps that must occur to complete the process of constructing a person is great but not infinite. Hence, in the second half of the chapter, I will identify and discuss several archetypal cultural models of infancy. Attachment and Attachment Parenting In the middle of the last century, John Bowlby (1953), an English psychotherapist, advanced a set of ideas about the emotional ties between a mother and her infant and the deleterious effects of maternal deprivation. These propositions are now widely known as “attachment theory.” A critical component of the theory was its universality; all mother-child dyads must engage in behaviors, which build and strengthen mutual bonds during a critical period from six-eighteen months. The theory has, since then, gathered adherents across a broad spectrum from developmental psychologists testing for evidence of “secure” versus “avoidant” or “ambivalent/resistant” attachment (Ainsworth, et al 1978) to social workers who point to attachment failure as the root of criminal behavior. Numerous empirical studies have extended attachment to non-industrialized societies with mixed results but, overall, they suggest considerable cross-cultural variability (Keller, 2007; van IJzendoorn and Sagi-Schwartz 2008; Tomlinson et al, 2010). There has, nevertheless, been a steady escalation in the expectation for adequate parenting to prevent attachment failure (Karen 1998; Newton and Schore 2008). Recently, attachment theory can be regarded as having morphed into a kind of secular religion where mothers worship at the altar of “attachment parenting.” That is, among the social elite in the US, “attachment” has become synonymous with good, correct child rearing. This “movement” is supported by many quasi-scientific parenting volumes as well as by web-based organizations. The goal of Attachment.org is to provide help for “each wounded child with attachment disorder [which is caused by, for example] ‘Caring for baby on a timed schedule or other self-centered parenting.’” Much of the advice-to-parents literature suggests that full-scale attachment parenting is supported by anthropological research (especially on topics like the frequency of nursing and physical contact between mother and infant) and is, therefore “natural.” Failure to embrace the whole suite of prescribed parenting practices is, therefore, unnatural. One confirmed apostate in the new attachment parenting faith is noted US media personality Erica Jong. She characterizes attachment parenting as “You wear your baby, sleep with her and attune yourself totally to her needs [then wonders how one can] do this and also earn the money to keep her.” Another, more credible, dissenting perspective is provided by a study of attachment in Germany. In spite of the fact that, using standardized measures, “Two-thirds of the Bielfeld children were classified as ‘insecurely attached,’” the authors reject the possibility that these children are at risk of developing personality disorders (LeVine and Norman 2001: 97). And they suggest that the behavior of German mothers is guided by a cultural model of child development that cautions against excessive attention being paid to the infant:

• Child traumas, attachment styles and social cognition were assessed in bipolar adults. • Participants were grouped: secure vs insecure (anxious, avoidant) attachment styles. • Participants with insecure attachment styles had more psychiatric hospitalizations. • Attachment anxiety was associated with childhood trauma but improved social cognition. • Social cognition in bipolar disorder is associated with the quality of early relational context. • Limitations include cross-sectional study design, use of self-report measures. Individuals with Bipolar Disorder (BD) present problems in Social Cognition (SC), a process associated with the quality of early attachment experiences. The experience of traumatic events in childhood threatens the quality of attachment. Attachment theory provides a comprehensive paradigm for understanding the role of early adversity on psychological functioning. However, early experiences have been largely neglected in BD research and clinical practice. We examined the moderating role of attachment in the relationship between childhood traumatic experiences and SC in a sample of 76 adults with BD. Early traumatic experiences were assessed using the Childhood Trauma Questionnaire (CTQ), SC was measured with the Hinting Task Test and attachment was examined using the Experience in Close Relationships questionnaire (ECR). Higher scores on attachment anxiety were positively associated with early traumatic events and better SC performance. Results suggest that attachment anxiety may be acting as an adaptive strategy in bipolar people who have suffered traumatic childhood experiences. The present study was observational and cross-sectional. Therefore, findings cannot be used to infer causality. Additionally, we assessed both attachment and trauma using self-report measures. Future studies should consider longitudinal designs with observer-rated measures such as standardized interviews. Our findings reinforce the importance of early childhood experiences in the development of SC in people with BD, challenging some traditional understandings of SC deficits as part of the genetic dimension of the disorder.

BackgroundPain is common in most diseases and is usually treated by medical and physical approaches (medications, exercise). Limited attention has been given to whether non-medical approaches (such as emotion regulation abilities including self-compassion) can help further reduce the pain experienced. Scleroderma (systemic sclerosis), a painful and complex autoimmune connective tissue and vascular disease, was examined in this study in relation to psychological aspects of pain and the links of pain to (1) early life experiences, (2) current insecure attachment style, (3) physiological arousal (negative, hyper-arousal), and (4) personal emotion regulation (self-compassion). Knowledge about these relationships may help in the treatment of pain.Participants and procedureParticipants (120) from Australia (39) and the United Kingdom (81) completed an online or a hard copy survey; 78 participants remained for analysis after screening.ResultsWe found that poor or limited positive early life experiences and a current insecure (dismissive) attachment style contributed significantly to experiencing elevated levels of pain. We also found that negative early life experiences and limited emotion regulation (low self-compassion) predicted hyper-arousal, which in turn was associated with experienced pain. Insecure dismissive attachment style and hyper-arousal were significantly correlated.ConclusionsThese findings suggest that negative childhood experiences and an insecure dismissive attachment style may determine how emotional experiences are regulated or managed by individuals in disease-related pain. Implications include that interventions addressing attachment style and self-compassion may help reduce pain in the individuals concerned, thus helping supplement the effectiveness of current medication and physical approaches.

The psychological concept of attachment is constantly evolving. Approximately 70 years after attachment theory was first introduced by John Bowlby in the late 1940s, the notion of attachment is still in flux with continually changing ideas of what it means to be a good parent. One path along which attachment as a concept is moving from academia to everyday life is the philosophy of attachment parenting which was first established in the US by William and Martha Sears. Ideas about attachment theory and attachment parenting are frequently accompanied by critical comments on “Western” cultures. This critical perspective on modernity, individualism, and autonomy is portrayed in the first part of this article. The second part traces attachment as a concept transferred to Turkey. Rather than studying academic work on attachment in Turkey, this article focuses on popularized versions of attachment theory which gain ground as part of the parenting philosophy of attachment parenting. This article analyzes parents’ blogs, websites, self-help books, fieldwork protocols, and interviews with parenting trainers and parents themselves. It focuses on how popular scientific use of attachment parenting in Turkey is accompanied by discussions of cultural identity, cultural values, and belonging. The article shows that attachment theory and parenting are used in quite diverse ways to comment on Turkish (parenting) culture, ranging from anglophile readings to more conservative appropriations of attachment theory as Anatolian education. These forms of popularizing attachment theory challenge the sociological concept of psychologization.

BackgroundA secure attachment style could promote more intimacy in romantic relationships, while an insecure attachment style could be correlated with less positive romantic relationships in adulthood. Numerous studies have noted that a secure attachment to parents was correlated with lower levels of aggression, whereas insecure attachments were associated with higher levels of aggression. We aimed to investigate the role of the attachment system as a mediator of the expression of aggressiveness during adolescence. Specifically, we considered that the attachment to parents and peers could influence one’s attachment to a romantic partner.MethodsWe empirically tested whether there were relationships of parent and peer attachment on aggressiveness mediated by romantic attachment style. Participants of the study included 411 students.ResultsResults indicated that for males an insecure father-child attachment style seems to be associated with higher levels of anxiety and avoidance in romantic attachments and then with aggressiveness. For females, an insecure mother-child attachment style seems to be associated with higher levels of aggressiveness.ConclusionThe attachment to parents and to peers plays a key role in defining romantic attachment according to gender, and these dimensions in turn tend to affect the levels of aggressiveness.

Impaired Theory of Mind (ToM) and insecure (adult) attachment styles have been found in persons with schizophrenia as well as in their healthy siblings. ToM refers to the ability to infer mental states of self and others including beliefs and emotions. Insecure attachment is proposed to underlie impaired ToM, and comprises avoidant (discomfort with close relationships, high value of autonomy) and anxious (separation anxiety, dependency on others) attachment. Insight into the association between attachment style and ToM is clinically relevant, as it enhances our understanding and clinical approach to social dysfunction in schizophrenia. Therefore, we studied the association between insecure attachment styles and ToM in patients with schizophrenia, their siblings, and healthy controls. A total of 111 patients with a diagnosis in the schizophrenia spectrum, 106 non-affected siblings and 63 controls completed the Psychosis Attachment Measure, the Conflicting Beliefs and Emotions, a subsection of the Wechsler Adult Intelligence Scale, and the Childhood Trauma Questionnaire-Short Form. Severity of symptoms was assessed with the Community Assessment of Psychic Experiences and the Positive and Negative Syndrome Scale. After controlling for sex, intelligence, history of trauma and symptom severity, avoidant attachment was significantly associated with cognitive as well as with affective ToM, showing U-shaped associations, indicating better ToM performance for patients with lower or higher levels of avoidant attachment compared to medium levels. Anxious attachment in patients was associated with more problems in cognitive ToM. The results from this study support the idea that an anxious attachment style is associated with worse ToM performance in patients. Results also suggested a potential protective role of higher levels of avoidant attachment on ToM. These findings bear clinical relevance, as activation of (insecure) attachment mechanisms may affect interpersonal relations, as well as therapeutic working alliance. Further clarification is needed, especially on associations between ToM and avoidant attachment.

In primary care frequent attenders with medically unexplained symptoms (MUS) pose a clinical and health resource challenge. We sought to understand these presentations in terms of the doctor-patient relationship, specifically to test the hypothesis that such patients have insecure emotional attachment. We undertook a cohort follow-up study of 410 patients with MUS. Baseline questionnaires assessed adult attachment style, psychological distress, beliefs about the symptom, non-specific somatic symptoms, and physical function. A telephone interview following consultation assessed health worry, general practitioner (GP) management and satisfaction with consultation. The main outcome was annual GP consultation rate. Of consecutive attenders, 18% had an MUS. This group had a high mean consultation frequency of 5.24 [95% confidence interval (CI) 4.79-5.69] over the follow-up year. The prevalence of insecure attachment was 28 (95% CI 23-33) %. A significant association was found between insecure attachment style and frequent attendance, even after adjustment for sociodemographic characteristics, presence of chronic physical illness and baseline physical function [odds ratio (OR) 1.96 (95% CI 1.05-3.67)]. The association was particularly strong in those patients who believed that there was a physical cause for their initial MUS [OR 9.52 (95% CI 2.67-33.93)]. A possible model for the relationship between attachment style and frequent attendance is presented. Patients with MUS who attend frequently have insecure adult attachment styles, and their high consultation rate may therefore be conceptualized as pathological care-seeking behaviour linked to their insecure attachment. Understanding frequent attendance as pathological help seeking driven by difficulties in relating to caregiving figures may help doctors to manage their frequently attending patients in a different way.

Attachment theory proposes that psychological functioning and affect regulations are influenced by the attachment we form with others. Early relationships with parents or caregivers lay the foundations for attachment styles. These styles are proposed to influence how we relate to others during our life can be modified by the relationships and events we experience in our lifespan. A secure attachment style is associated with a capacity to manage distress, comfort with autonomy and the ability to form relationships with others, whereas insecure attachment can lead to dysfunctional relationships, emotional and behaviour avoidance. Attachment theory provides a useful framework to inform our understanding of relationship difficulties in people with psychosis. This paper aims to complement recent systematic reviews by providing an overview of attachment theory, its application to psychosis, including an understanding of measurement issues and the clinical implications offered. A narrative review was completed of the measures of attachment and parental bonding in psychosis. Its clinical implications are also discussed. The paper also explores the link between insecure attachment styles and illness course, social functioning and symptomatology. The following questions are addressed: What are the key attachment measures that have been used within the attachment and psychosis literature? What are the results of studies that have measured attachment or parental bonding in psychosis and what clinical implications can we derive from it? What are some of the key questions for future research from these findings in relation to the onset of psychosis research field? The most commonly used measures of attachment in psychosis research are reviewed. Self-report questionnaires and semi-structured interviews have mainly been used to examine attachment styles in adult samples and in recent years comprise a measure specifically developed for a psychosis group. The review suggests that insecure attachment styles are common in psychosis samples. Key relationships were observed between insecure, avoidant and anxious attachment styles and psychosis development, expression and long-term outcome. Attachment theory can provide a useful framework to facilitate our understanding of interpersonal difficulties in psychosis that may predate its onset and impact on observed variability in outcomes, including treatment engagement. Greater attention should be given to the assessment of attachment needs and to the development of interventions that seek to compensate for these difficulties. However, further investigations are required on specifying the exact mechanisms by which specific attachment styles impact on the development of psychosis and its course.

It has been argued that attachment theory could enhance our knowledge and understanding of psychotic phenomenology. We systematically reviewed and critically appraised research investigating attachment and psychotic phenomenology in clinical and non-clinical samples. We searched databases Pub Med, PsycINFO, Medline and Web of Science using the keywords. Attachment, Adult Attachment, Psychosis, Schizotypy and Schizophrenia and identified 29 studies assessing adult attachment in combination with psychotic phenomenology. The findings indicated that both insecure anxious and insecure avoidant attachment are associated with psychotic phenomenology. Insecurely attached individuals are more vulnerable to developing maladaptive coping strategies in recovering from psychosis. The importance of attachment experiences for processing social information, mentalization skills and developing social relationships, including therapeutic relationships, in samples with psychosis is also highlighted. Attachment style is a clinically relevant construct in relation to development, course and treatment of psychosis. Understanding the role of attachment in symptoms may help to gain insight into the development or persistence of symptoms. Associations between attachment and recovery style suggest that it may be helpful to improve attachment security in a context of therapeutic relationships or other social relationships before encouraging people to explore their experiences of psychosis. Associations between insecure attachment and impaired mentalization skills may help in understanding interpersonal difficulties and this knowledge can be used to improve recovery.

Copious studies have identified a link between disorganised attachment and engagement in controlling caregiving or controlling punitive behaviours. Studies have suggested that consistently engaging in these behaviours can cause difficulties within relationships and contribute to the development of a personality disorder. Most of the literature thus far has focused on engagement in controlling behaviours by children with a disorganised attachment style, despite there being theoretical grounds to suggest they may also be used by adults and across all types of insecure attachment. This study aimed to address these gaps by looking at adult attachment style and engagement in controlling behaviours in romantic relationships, across all insecure attachment styles; avoidant, anxious and disorganised. The current study recruited a non-clinical sample; specifically, 149 English-speaking adults, living in the UK, between the ages of 18 and 77 years old (M = 34.28, SD = 14.90). The participants answered an anonymous online questionnaire containing four self-report measures which assessed the participants' attachment security and organisation, caregiving style and engagement in punitive behaviours. The results indicated that participants who scored higher in disorganised attachment were more likely to use controlling punitive behaviours in their romantic relationships. Moreover, participants who reported a more insecure-anxious attachment style were more likely to use compulsive caregiving behaviours in their romantic relationships. In contrast, participants who reported a higher insecure avoidant attachment style were less likely to use compulsive caregiving behaviours in their romantic relationships. These results have implications for adult attachment theory and aid the understanding of some of the behaviours that can be harmful within romantic relationships. The findings could be used to help at-risk individuals develop healthy interpersonal relationship going forward.

Impaired Theory of Mind (ToM) is found in adults with schizophrenia and is associated with paranoid symptoms. Insecure attachment is proposed to underlie impaired ToM as well as paranoia. Insight into associations between insecure attachment and impaired ToM skills may help clinicians and patients to understand interpersonal difficulties and use this knowledge to improve recovery. This study used a visual perspective-taking task to investigate whether cognitive ToM is already impaired in adolescents with early psychosis as compared to controls. Also investigated was whether perspective-taking and paranoia are associated with insecure (adult) attachment. Thirty-two adolescent patients with early psychosis and 78 healthy controls participated in this cross-sectional study design and completed the level 1 perspective-taking task, psychopathology assessments (CAPE, PANSS), paranoid thoughts (GPTS), attachment style (PAM) and the WASI vocabulary. Patients did not significantly differ in level-1 perspective-taking behaviour compared to healthy controls. No significant associations were found between perspective-taking, paranoia and attachment. Insecure attachment was significantly related to paranoid thoughts, after controlling for illness-related symptoms. No impairment of level-1 perspective-taking was found in adolescent patients with early psychosis compared to healthy controls. Results indicate that level-1 perspective-taking is not impaired during the early stages of psychotic illness. The association between paranoia and attachment support previous findings and provide further insight into the nature of psychotic symptoms. Understanding the role of attachment in paranoia may help patients and their care workers to gain insight into the reasons for the development or persistence of symptoms. Future research should compare early psychosis samples with more chronic samples to explore whether perspective-taking deteriorates during the course of the illness.

Since its first description four decades ago, attachment theory (AT) has become one of the principal developmental psychological frameworks for describing the role of individual differences in the establishment and maintenance of social bonds between people. Yet, still little is known about the neurobiological underpinnings of attachment orientations and their well-established impact on a range of social and affective behaviors. In the present review, we summarize data from recent studies using cognitive and imaging approaches to characterize attachment styles and their effect on emotion and social cognition. We propose a functional neuroanatomical framework to integrate the key brain mechanisms involved in the perception and regulation of social emotional information, and their modulation by individual differences in terms of secure versus insecure (more specifically avoidant, anxious, or resolved versus unresolved) attachment traits. This framework describes how each individual's attachment style (built through interactions between personal relationship history and predispositions) may influence the encoding of approach versus aversion tendencies (safety versus threat) in social encounters, implicating the activation of a network of subcortical (amygdala, hippocampus, striatum) and cortical (insula, cingulate) limbic areas. These basic and automatic affective evaluation mechanisms are in turn modulated by more elaborate and voluntary cognitive control processes, subserving mental state attribution and emotion regulation capacities, implicating a distinct network in medial prefrontal cortex (mPFC), superior temporal sulcus (STS), and temporo-parietal junction (TPJ), among others. Recent neuroimaging data suggest that affective evaluation is decreased in avoidantly but increased in anxiously attached individuals. In turn, although data on cognitive control is still scarce, it points toward a possible enhancement of mental state representations associated with attachment insecurity and particularly anxiety. Emotion regulation strategies such as reappraisal or suppression of social emotions are also differentially modulated by attachment style. This research does not only help better understand the neural underpinnings of human social behavior, but also provides important insights on psychopathological conditions where attachment dysregulation is likely to play an important (causal) role.