Disorganized Attachment, Development of Dissociated Self States, and a Relational Approach to Treatment

Abstract

ABSTRACT Disorganized (D) attachment, and the double-bind characteristics of the relationships that foster it, form a basis for theoretical approaches to understanding the development of alternating, dissociated self states with incompatible, idealizing/devaluing or victim/persecutor models of attachment, such as are observed in borderline personality and dissociative disorders. This model proposes that the double binds inherent in abuse by a primary caretaker are likely to generate two or more dissociated self states, with contradictory working models of attachment. In contrast, because dissociated states ensuing from extra-familial trauma can be expected to have been constructed primarily around fear, all parts of the self will operate according to the same attachment paradigm. Because relationships within the family of origin appear at least as important as trauma in the development of dissociated self states, this has important implications for treatment of child abuse survivors. D attachment may result from several parental behaviors: abuse, neglect, frightening, intrusive or insensitive manner; and disrupted affective communication. Longitudinal research demonstrates that D attachment in infancy predicts dissociation in childhood and early adulthood. Theoretical models describing the relationships among D attachment, the development of segregated internal working models of attachment, and the emergence of dissociated self states will be discussed. A relational approach to therapy calls for consideration of attachment issues in creating the frame for therapy and tailoring treatment to the individual trauma survivor. The therapist can serve as a relational bridge between dissociated self states, allowing the patient to internalize a working model of the therapeutic relationship. This interaction provides a vehicle for integrating dissociated self states and opportunity for development of more flexible, adaptive models of being with others.