Attachment Classifications Research Articles

Insecure and Unresolved/Disorganized Attachment in Patients With Psychogenic Nonepileptic Seizures.

Psychogenic nonepileptic seizures (PNES) are still poorly understood and difficult to treat. Attachment theory could add new aspects to the understanding of the multifactorial genesis and maintenance of PNES and the therapeutic needs of this patient group. The aim of the present study is to systematically assess attachment in adult patients with PNES with a focus on the role of unresolved/disorganized attachment. A cross-sectional design was chosen to compare patients with confirmed PNES (n= 44) and healthy controls (n= 44) matched for gender, age, and education. Attachment was assessed using the Adult Attachment Projective Picture System. Psychometric questionnaires included the Childhood Trauma Questionnaire; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) axis II disorders, Patient Questionnaire; the Somatoform Dissociation Questionnaire; and the Patient Health Questionnaire. We found significantly less secure (P= 0.006) and more unresolved/disorganized (P= 0.041) attachment classifications in the PNES group. Among patients with PNES, 7% were classified secure and 43% were classified unresolved/disorganized. Patients with an unresolved attachment representation were significantly more likely to be screened positive for personality pathology in the Structured Clinical Interview forDSM-IV axis II disorders, Patient Questionnaire (P= 0.03) and to report more emotional abuse in the Childhood Trauma Questionnaire (P= 0.007) than patients with other attachment classifications. Our findings suggest that unresolved/disorganized attachment might be the predominant attachment style in patients with PNES and might be associated with more severe personality pathology. This could be of therapeutic relevance. The present study is the first to assess adult attachment in patients with PNES using a semi-structured interview in comparison to matched healthy controls.

Attachment classification and years of service in a sample of human service providers working in child welfare

ABSTRACT Employee turnover is a pressing problem facing human service professions, especially professionals providing services in the child welfare system. Few studies have examined whether psychological characteristics contribute to turnover. Research suggests that insecure attachment representations may impact burnout and secondary traumatic stress, both common causes of turnover. However, little is known about whether attachment representations vary by years of service among human service providers working with the child welfare system. The purpose of this study was to determine if attachment classifications predicted number of years of service in a sample of 467 service providers working in the child welfare system. Participants completed a demographic questionnaire, including the number of years in the human service profession, and the Adult Attachment Interview (AAI). Multiple regression models were conducted to determine if attachment classification and demographic variables predicted number of years of service. Data revealed that having a dismissing attachment classification predicted more years of service. Having a preoccupied attachment classification predicted fewer years of service. Possible causes and well as implications of these differences are discussed.

International medical students' adaptation to university life in Turkey.

ObjectivesThe aim of this study is to determine the adaptation process of international medical school students to university life in Turkey. MethodsThe mixed method design study, including all the international students (n=127) studying at Ege University School of Medicine, is employed. Qualitative data were collected from 23 students selected by purposive sampling technique. Two instruments were utilized for collecting data: Student Adaptation to College Questionnaire (SACQ) and Brief COPE. Focus group interviews were performed for qualitative data collection. ResultsThe mean SACQ score of the medical students was found to be 407.44 (SD=68.29). The Academic Adjustment category included the themes of educational goals, different studying habits, accommodation, academic advisor, and scholarship. The Social Adjustment category included the themes of social interaction and support, differences, longing for family, discrimination and its effects on social life. The Personal/Emotional adjustment category included themes of psychological and physiological health problems. The Goal Commitment/Institutional Attachment category included themes of academic and social adaptation as well as the student’ communication with education management. ConclusionsThis study identifies to light critical issues in supporting international students with adaptation problems to university life in Turkey. It is clear that revising the content of education programs to enable international exchange is not sufficient enough by itself to meet the needs of international students.

On the Nature of the Mother-Infant Tie and Its Interaction With Freudian Drives.

The affective bond between an infant and its caregiver, the so-called mother-infant tie, was analyzed by various reputable psychologists (e.g., Ainsworth, Clark, Erikson, Anna Freud, Harlow, Klein, Spitz, and Winnicott) but both the basic tenets of the bond and the importance of the trauma of maternal deprivation for personality disorders in adults were introduced by Bowlby. Although Bowlby was a trained psychoanalyst, he rejected central cornerstones of Freudian theory (esp. drive theory) and used concepts promulgated by renowned ethologists (Tinbergen and Lorenz) to establish his framework of “instinctive behavior” that has been developed further into the concept of “attachment theory” under the influence of Mary Ainsworth. However, since any precise experimental facts were lacking when Bowlby formulated his ideas on the concept of instinctive behavior, the whole framework is a descriptive, category-driven approach (like the ones of Freudian drives). In order to connect the mother-infant tie – as propounded by Bowlby – with experimental data, this manuscript undertakes a biochemical analysis of it because this strategy proved somewhat successful in relation to Freudian drives. The analysis unfolded that the neurochemical oxytocin, released by the action of sensory nerves, is of utmost importance for the operation of the mother-infant tie. Furthermore, multiple evidences have been presented to the fact that there is strong interaction between unconsciously operating Freudian drives and the consciously acting mother-infant tie (that is now classified as a drive). The outlined interaction in conjunction with the classification of attachment urges as drives gave a very detailed insight into how a SEEKING-derived reward can be evoked during operation of the mother-infant tie. In summary, there is no need to marginalize either the mother-infant tie or Freudian drives but rather there is need to respect both (principally different) impulses in moving toward a more extensive description.

The reliability of clinical, history-based attachment classifications: an exploratory study

Objective: Mental health professionals frequently classify children’s attachment style using a combination of the parent/caregiver interview, an interview with the child, the interviewer’s clinical impressions, and at times, the child’s responses to projective tests not aimed at eliciting attachment specific information. However, no studies have been conducted on the validity or reliability of attachment classifications based on developmental histories. This study aimed to investigate the accuracy of history-based attachment classifications. Method: Attachment classifications based on intake interviews, administered to 35 eight to twelve-year- old children and their caregivers attending an outpatient mental clinic service in a government hospital in Johannesburg, were compared to classifications obtained through the Attachment Story Completion Test (ASCT). The level of agreement between rates and across assessment measures was analysed. Results: The association between ASCT and history-based attachment classifications was poor. Conclusion: The possible misclassification of children’s attachment styles according to histories has implications for both diagnosis and treatment.

Factor structure of the Friends and Family interview.

The aim of this study was to specify the latent construct structure of the Friends and Family Interview (FFI: Steele & Steele, 2005) based on its dimensional scale coding protocol. The FFI is a semi-structured interview measuring attachment in middle childhood. We analyzed data from 341 FFI interviews with children aged 7-12years, recruited in the Scandinavian Öresund Region. Exploratory Factor Analysis revealed a three-component model as best fitting the data. The first component, denoting attachment security, gathered all dimensional scales for evidence of secure base/safe haven regarding mother/father and coherence in the child's narrative style, along with scales regarding reflective functioning, self-perception, and social functioning. The second component comprised preoccupying feelings of anger, but also derogation. The third component gathered all scales coding idealization. Inter-relations among the components were consistent with attachment theory, and respondents' scores for all three components differed significantly across the four categorical attachment classifications. Affect regulation of negative emotion through anger and through derogation co-occurred, and was distinct from regulation through maintaining a belief that things are better than they appear (idealization). These two affect regulation strategies appeared commonly when reflective functioning, and an organized self-perception, and positive peer relations were less in evidence. The multi-dimensional FFI coding system appears to measure successfully these diverse features of the child's narrative provided in response to the interview. Overall, our findings support the construct validity of the FFI and provide further evidence of its usefulness for assessing attachment in middle childhood and early adolescence.

Advances in research on attachment-related psychotherapy processes: seven teaching points for trainees and supervisors.

While the rich body of attachment theory and research has inspired many psychotherapists, trainees and less experienced clinicians interested in attachment-informed work can often feel unsure about what processes are attachment-related and how to attend to them during therapy. Recent advances in attachment-informed psychotherapy research offer some practical guidance. Studies published over the last five years show that patients and therapists of different attachment classifications communicate in distinct ways during therapy sessions. In particular, Talia and his colleagues have introduced the Patient Attachment Coding System and the Therapist Attunement Scales, two measures that accurately predict patients’ and therapists’ Adult Attachment Interview and Reflective Functioning score based on the occurrence of distinct communication markers during therapy sessions. This paper discusses the implications of these recent studies for psychotherapy training and presents seven teaching points for supervisors and for the next generation of clinicians.

Teaching Note—Understanding the Impact of Childhood Adversity on Social Work Students

ABSTRACT Social work students often come to the profession with their own history of childhood difficulty and adversity. Although these experiences frequently motivate students to become social workers, they can also impede a professional’s ability to practice effectively. This teaching note presents the literature regarding the impact of the attachment category and childhood history of adversity on helping professionals. We describe classroom activities that can be used in educating social work students about the potential impact of their history on social work practice.

Attachment and the archive: barriers and facilitators to the use of historical sociology as complementary developmental science.

This article explores historical sociology as a complementary source of knowledge for scientific research, considering barriers and facilitators to this work through reflections on one project. This project began as a study of the emergence and reception of the infant disorganized attachment classification, introduced in the 1980s by Ainsworth's student Mary Main, working with Judith Solomon. Elsewhere I have reported on the findings of collaborative work with attachment researchers, without giving full details of how this came about. Here, I will offer personal reflections arising from the process, and my work in what Hasok Chang has called history as "complementary science."

Revisiting the African origins of attachment research-50 years on from Ainsworth: A descriptive review.

Culture plays a significant role in the variations observed in the manifestation, expression, and meaning of attachment behaviors. Africa is home to multiple cultures, with distinct organizations of caregiving relationships underlying the development of attachment. This review aims to consolidate knowledge about African attachment by describing studies of infant attachment conducted in Africa since Mary Ainsworth's Ugandan findings in 1967. Electronic databases were searched with the terms "Africa" ("attachment" or "bond") and "infant." Nine studies that assessed infant attachment style with self-report or observation methods were included, but spanned only five countries. The Strange Situation Procedure was most frequently used. Most studies described dyads living in peri-urban or township areas. Multiple socioeconomic factors affecting living conditions were identified, including, unemployment, financial difficulties, limited education, poor housing, single parenthood, lack of partner support, substance abuse, and depression. Overall distributions of attachment classification proportions appear consistent with global attachment-classification patterns. Despite adverse conditions, secure attachment was relatively widespread, and some populations had low rates of avoidant attachment. Relatively high rates of disorganized attachment were found when the category was included. Africa remains an understudied continent regarding infant attachment. The continent's cultural diversity may hold important truths necessary for understanding the complex relationship between infant and attachment figure.

Attachment as a Predictor of Psychological and Sexual Wellbeing Among Transgender Women in New York City

Transgender women are disproportionately affected by HIV and experience high rates of depression and anxiety. The importance of secure attachment in buffering against negative sexual and mental health outcomes is well established. However, few studies have examined attachment among transgender women. We recruited a community-based convenience sample of 213 transgender women in New York City (Mage =34.3; SD = 11.7). The majority were women of color (75.6%), almost half identified as heterosexual (47.4%), and 34.7% were HIV-positive. Preliminary analyses examined the sample distribution across attachment categories using the Revised Experiences in Close Relationships scale. Specifically, Brennan, Clark and Shaver’s guidelines were used for categorization (43.19% fearful, 22.5% preoccupied, 21.6% dismissive, and 12.7% secure). Regression analyses examined the association of dimensional attachment anxiety, attachment avoidance, and their interaction with depression, anxiety, self-efficacy for condom use, temptations for condomless sex, and condomless sex acts. Results indicated a positive association between attachment anxiety and depression, anxiety, temptations and probability for condomless sex; and also between attachment avoidance and condomless sex probability. A significant interaction indicated that individuals with low attachment anxiety and attachment avoidance (i.e., secure) had the greatest condom use self-efficacy and the lowest probability of engaging in condomless sex.

Are people with an intellectual disability at increased risk of attachment difficulties? A critical review.

Attachment difficulties are associated with a range of adverse outcomes in mental health, and people with intellectual disabilities (IDs) may be at greater risk of experiencing difficulties in their attachment relationships. This review critically evaluated recent research measuring the prevalence of attachment difficulties in people with ID. Eight studies met the inclusion criteria, and a higher prevalence of insecure and disorganized attachment classifications, and symptoms of attachment disorder, was found across a number of subgroups of people with diagnoses of ID. However, the validity and reliability of measures of attachment have not been empirically established in this population, and control groups were not always appropriate. These findings indicate the need to (1) develop reliable and standardized assessments of attachment for people with ID and (2) evaluate the efficacy of attachment-based interventions in relation to reducing psychological distress, mental health problems and expression of behaviours experienced by others as challenging.

Patients' Adult Attachment Interview classification and their experience of the therapeutic relationship: are they associated?

In the last decade of his career, Jeremy Safran became increasingly interested in investigating the ways in which attachment representations influence the therapeutic relationship. In this paper, we test such influence in a sample of thirty outpatients who received Brief Relational Therapy by comparing their independently coded pre-treatment Adult Attachment Interview (AAI) with their narratives in a post-treatment interview about the relationship with the therapist (the Patient Relationship Interview at Termination, PRI-T). The PRI-T was coded with the following three measures: i) The Patient Attachment to Therapist Rating Scale (PAT-RS), which assesses the quality of the patient’s attachment relationship to the therapist; ii) the Coherence scale from the AAI, adapted for use on the PRI-T; and iii) the Patient Attachment Classification System (PACS), which measures generalized differences in how individuals convey their experiences and feelings. Results suggest that patients’ AAI predicts how they experience, represent, and communicate about the therapeutic relationship at the end of treatment, as shown by the PAT-RS, the Coherence scale adapted for use on the PRI-T, and the PACS applied to the PRI-T. These findings lend support to Safran and others’ hypothesis that patients’ AAI-status plays a role in patients’ representations of the relationship with the therapist.

Attachment categories or dimensions: The Adult Attachment Scale across three generations in Poland

Even though previous attachment taxometric studies supported the conclusion that attachment is rather dimensional than categorical construct, they also did not provide consistent support against categorical approach. Addressing limitations of previous taxometric studies on adult attachment, we asked two research questions: Is attachment as measured by the Adult Attachment Scale (AAS) categorical or dimensional? What is the predictive validity of categorical and dimensional approaches? To answer these questions, data of the AAS from 869 parents, 575 adolescents, and 500 grandmothers from the same families in Poland were analyzed. Taxometric analyses were replicated across three generations providing weak evidences to support the dimensional approach. Clustering methods provided an additional support revealing that empirically derived categories of attachment are based on security level but not on qualitatively different attachment patterns. Analyses testing predictive effects of categorical compared to dimensional approaches to attachment assessment revealed that a dimensional approach is more valid than a categorical approach in testing hypotheses related to the intergenerational transmission of attachment.

Parent mind-mindedness, sensitivity, and infant affect: Implications for attachment with mothers and fathers

Previous research examining links between parenting and attachment has focused on behavioral aspects of parenting such as sensitivity. However, by assessing how parents reflect on infants' mental states (mind-mindedness) we gain a broader understanding of parenting and how it impacts attachment. Mothers, fathers, and their infants (N = 135) participated in the Still Face Paradigm (SFP) at 3-, 5-, and 7- months of age, and the Strange Situation with mothers at 12 months and fathers at 14 months. Parent sensitivity and infant affect were coded from the SFP and all videos were transcribed and later coded for parents' use of appropriate and non-attuned mind-mindedness toward their infants. Attachment with each parent was coded from the Strange Situation. Mixed effects models examined trajectories of parents' mind-mindedness in relation to parent sensitivity and infant affect across attachment groups. Significant differences between parent gender and attachment category were detected. Specifically, parents who were less sensitive were also less mind-minded toward insecure-avoidant infants; parents used more non-attuned mind-mindedness when infants had higher negative affect. Findings suggest that, in addition to parent sensitivity, parents' use of appropriate and non-attuned mind-mindedness during a parent-infant interaction provides insight into the developing attachment relationship for mothers and fathers.

Incongruence Between Implicit Attachment Schemes and Unconscious Attachment Representations.

Assessments based on reaction time and language-based interviews postulate that unconscious attachment processes be measured. Nevertheless, a possible empirical equivalence of these two approaches has not yet been investigated. To fill this void, the Adult Attachment Interview and the Implicit Association Test were implemented with a group of patients with panic disorder (n = 157, mean age = 29, SD = 2.47) based on the Structured Clinical Interview for DSM-IV, axis I and II disorders and a group of healthy individuals (n = 138). In total, the securely attached individuals showed significantly more positive attitudes toward their mother than the insecurely attached individuals. In the healthy individuals, the secure and disorganized classifications showed significantly more positive attitudes toward the mother in comparison with the insecure attachment classification, as well as the patient group. In summary, implicit attachment patterns based on reaction times are not equivalent to an attachment representation based on language markers. For the disorganized attachment representation, no differences were present between the information processing of the memory/association network and the autobiographic memory function.

New classification of the distal attachment of the fibularis brevis — Anatomical variations and potential clinical implications

Although the lateral compartment of the leg is characterized by a high degree of morphological variation, very little information exists on the morphological variability of the fibularis brevis muscle (FBM) and fibularis digiti quinti (FDQ). The main aim of the study was to characterize the morphology of the FBM tendon and its accessory bands, to classify them and to determine the incidence of FDQ. The work attempts to determine the relationship between the types of the insertion of the FBM tendon and the occurrence of FDQ. Classical anatomical dissection was performed on 102 lower limbs fixed in 10% formalin solution. The morphology of the insertion of the FBM and of the FDQ was evaluated. The FBM was present in all specimens. Two types of insertion were observed, the most common being Type I (70.6%): a single distal attachment in which the tendon inserts into the tuberosity at the base of the fifth metatarsal bone. The second most common was Type II (29.4%); this group was divided into three subtypes (A-C). The FDQ was present in 17.7% of specimens and always with Type I FBM. Both the FBM tendon and FDQ present significant morphological variation. Two main types of the FBM tendon determine the presence of the FDQ. II Basic Science Research.

Pleasure in parenting and father-child attachment security

ABSTRACTThis study examined relations between father-child attachment security and both paternal sensitivity and fathers’ pleasure in parenting. At 12 months of age sensitivity was coded from father-infant interactions and pleasure in parenting was coded from fathers’ interviews assessing attitudes toward the parenting role. Father-child dyads participated in the Strange Situation Procedure assessing attachment relationship quality. Sensitivity was related to more pleasure in parenting, but neither variable alone predicted attachment security. However, pleasure in parenting moderated the association between sensitivity and attachment. Moreover, the concordance between sensitivity and pleasure in parenting differed markedly across attachment classifications. In secure relationships fathers showed strong concordance between sensitivity and pleasure in parenting. Fathers in avoidant relationships demonstrated high sensitivity coupled with low pleasure in parenting, whereas fathers in disorganized relationships showed low sensitivity coupled with high pleasure in parenting. Results speak to the importance of integrating cognitive, affective, and behavioral aspects of parenting in father-child attachment research.

The influence of attachment representations and co-parents’ scripted knowledge of attachment on fathers’ and mothers’ caregiving representations

ABSTRACTDespite increased engagement of men in parenting, paternal caregiving representations have not been investigated, and potential gender differences in the links between parents’ attachment representations and their caregiving representations are unexplored. The present study investigated fathers’ and mothers’ (N = 77) representations of caregiving, and links to their own and their co-parents’ current mental representations of attachment. Parents were interviewed with the Adult Attachment Interview (AAI) and the Parental-Caregiving Attachment Interview (P-CAI), and co-parents’ attachment scripts were measured with the Attachment Script Assessment (ASA). Our results demonstrate several similarities between mothers’ and fathers’ caregiving representations, but gender differences emerged in probable rejecting and neglecting parental behaviors. For both fathers and mothers, we found systematic differences in caregiving-specific state of mind dimensions on the P-CAI, depending on the parent’s attachment classification on the AAI. Importantly, co-parent attachment security, but not parent gender was associated with the likelihood of being classified as autonomous with respect to caregiving.

Frenal attachment and its association with oral hygiene status among adolescents in Dakshina Kannada population: A cross-sectional study.

Background and Objective:Frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to interference in the plaque control or due to muscle pull. Identifying labial frenum attachment and its association with oral hygiene helps in primary prevention of gingival health. The purpose of this study was to examine the prevalence of the various types of maxillary labial frenum attachment and its association with oral hygiene status in adolescent population.Methodology:A total of 300 adolescents between 13 and 18 years were selected randomly. They were clinically examined for maxillary frenum attachment. Placek's classification of the labial frenum attachments was used to check the origin of frenum. Oral hygiene index (simplified) was recorded and results were subjected to statistical analysis.Results:Among 300 examined children 53% were males and 47% were females. The prevalence of the maxillary labial frenum was gingival type (39%) followed by mucosal (28.3%), papillary (23.7%), and papillary penetrating type (9.0%). The gingival type of frenal attachment was statistically significant among different age of children and also between different types of frenal attachment and oral hygiene status (p value < 0.001). There was no significance between frenum attachment and gender.Conclusion:The type of frenal attachment is strongly associated with oral hygiene status. as the age progresses the frenum tends to migrate apically. However, our study did not reveal any relationship between the gender and type of frenal attachment.