Disorganized Attachment Research Articles

Foster children’s attachment representations: the role of type of maltreatment and the relationship with birth family

ABSTRACT Children in foster care are at risk of developing insecure and disorganized attachment, which is problematic for establishing new relationships in foster families. However, most previous studies have focused on attachment behaviors in young children rather than on attachment representations. We compared foster children’s attachment representations with those of a community group, analyzing also the contribution made by different factors to foster children’s attachment representations. We assessed the attachment representations of 109 children aged between 4 and 9 years (51 children in non-kin foster care and 58 community children) in southern Spain, using a narrative story stem measure. Case records information were collected for adversity and child protection variables. Foster children had fewer security and more avoidance indicators than their community counterparts, with those who had suffered more severe maltreatment scoring lower for security and higher for disorganization. Exposure to physical and emotional abuse and birth parents’ opposition to the foster placement predicted more disorganized attachment representations. Interventions with foster children should consider their heterogeneity in terms of attachment outcomes, and foster caregivers of abused children may need guidance in order to provide therapeutic caregiving.

Treating Externalizing Behaviors in Toddlers with ASD Traits Using Parent-Child Interaction Therapy for Toddlers: A Case Study

Up to 27% of children with autism spectrum disorder (ASD) experience clinically significant externalizing behavior. Child emotional dysregulation is thought to be one of the main reasons for the manifestation of externalizing behaviors during toddlerhood and has also been associated with insecure and disorganized parent-child attachment relationships. Parent-Child Interaction Therapy for Toddlers (PCIT-T) is an attachment and behavioral based parent training program targeted at children aged 12 to 24 months with externalizing behavior. This study assessed the effectiveness of PCIT-T in reducing child externalizing behavior as well as improving child emotional regulation and the parent-child attachment relationship in a child with moderate-to-severe ASD traits, low intellectual and adaptive functioning, externalizing behaviors within the clinical range, and a disorganized/insecure mother-child attachment relationship. The intervention occurred over a 12-week period and focused on improving positive parenting skills, parent emotional regulation, and child emotional regulation. Treatment progress was tracked using the Child Behavior Checklist Externalizing Behavior subscale, the Deverux Early Childhood Assessment for Toddlers Attachment/Relationship and Self-Regulation subscales, the Dyadic Parent-Child Interaction Coding System, version 4, and the Strange Situation Procedure. Study results provide preliminary support for the use of PCIT-T in reducing externalizing behavior, improving the parent-child attachment relationship and child emotional regulation. These results indicate that PCIT-T can be beneficial for children with ASD traits, however, further research with a larger sample size is needed to strength these findings.

Borderline Personality Disorder and Peers: A Scoping Review of Friendship, Victimization and Aggression Studies

Borderline personality disorder (BPD) is characterized by instability in interpersonal relationships. To date no reviews have scoped the extant research on peer relationship functioning for young people diagnosed with BPD or showing borderline personality features. The current review provides this scoping of studies on all facets of peer relationships, including friendship quality, peer victimization and bullying and peer aggression, and relevant studies of social–cognitive processes with relevance to peer relationships. From 282 studies identified up to August 2019, 39 studies were included for review. The majority of these were published between 2014 and 2019 (64%), with most studies using community samples (56.4%), conducted in the Unites States of America (51.3%) and over half (53.8%) with majority female (> 60% of the sample) participants, and over half (53.8%) with adolescent samples (mean age between 13 and 18 years). Most studies only addressed one domain of peer relationships (general k = 15; friendships k = 12; victimization k = 10; aggression k = 12). Only 8 studies (19.5%) were identified that included measures that crossed these domains. Borderline personality features were consistently associated with problematic functioning across facets of peer functioning. However, relatively few studies were located that examined multiple domains of peer relationship qualities, leaving an unclear and disjointed body of research. Some promising directions have received scant attention, including unrealistic expectations of friendship exclusivity and the sequelae when those expectations are not met. Studies that explicitly probe the developmental role of dysregulation, that assess bully/victim co-occurrence, and that consider the dynamics of thwarted expectations for exclusive “best-friend” roles, especially within the context of potential disorganized attachment histories, are needed.

Externalizing behaviors and attachment disorganization in children of different-sex separated parents: The protective role of joint physical custody.

The aim of this study was to examine the relationship between externalizing behaviors and the quality of attachment representations in preschool children, and to determine if family type and custody arrangement had a moderating effect on this relationship. The participants were 33 girls and 31 boys (n=64) aged between three and six years (M=4.75; SD=0.87years) and their mothers. Among them, 36 came from "intact" families, 13 were living mainly with their mothers and 15 were in joint physical custody. Children's attachment representations were assessed with the Attachment Story Completion Task (Bretherton, Ridgeway & Cassidy, 1990). Mothers reported on their child's behavior problems using the Child Behavior Checklist (Achenbach & Rescorla, 2001) and on their alliance with the father using the Parenting Alliance Inventory (Abidin & Brunner, 1995). Although children's externalizing behaviors were found to be associated with the disorganization of their attachment representations, this relationship was significantly weaker and was non-significant for children in joint physical custody. Thus, the results of this pilot study suggest that joint custody may protect children of separated parents from the effects of attachment disorganization on externalizing behaviors.

Inconsolable Infantile States and the Challenges of Meeting Them

Occasionally a patient comes along who is so frozen in an infantile state of disorganized attachment that the patient cannot take what the therapist is offering yet cannot leave the therapist either. Instead the two remain stuck in an unholy scenario of protracted destructive enactments, chronic mis-attunement, and rigid indigestible projective identifications. These seemingly impossible therapeutic encounters can include psychotic transferences, negative therapeutic reactions, or impasses. This article examines two such cases in detail and explores possible ways of understanding what failed in each of them and the impact of this on the therapist.

The challenges affecting foster care in a “failed-state” context: Case of the SEDI child protection network in South-Kivu Province, Democratic Republic of Congo

Foster care is widely described as an effective approach for the relief and protection of children experiencing abuse and neglect in their homes. Less recognized is the particularly challenging experience of foster carers in “failed-state” settings and the resulting effects on foster children’s reintegration process. In the Democratic Republic of Congo, DRC, no public out-of-home care is established for vulnerable children. In July 2017, “Foyer Ekabana”11“Foyer Ekabana” is a catholic church-based residential care agency in Bukavu town, eastern DRC. Ekabana literally derives from the local Mashi language spoken in South-Kivu: Eka: Home and Bana: children [Children’s Home], launched a network of parents at parish level who willingly accepted to foster vulnerable children, named “Secours à l’enfant en difficulté,22Relief to a child in difficult situationSEDI”. While this network is an innovative foster care approach, it remained not a panacea for the reintegration of all vulnerable children. The placement process and motivations were based on the child’s physical protection, disregarding other key aspects of reintegration such as primary caregivers’ involvement or the psychosocial wellbeing of foster children. Using a phenomenological research design, this study delves into the motivations and challenging experience of foster carers in South-Kivu. Three major challenges to foster care emerged from the themes of the study: the context of generalized poverty; the poor legal & organizational framework and the lack of adequate manpower and resources. This article also emphasized protracted disorganized attachment risks among foster children, in addition to reflections for an integrated out-of-home care protocol in post-conflict settings.

Attachment disorganization and severe psychopathology: A possible dialogue between attachment theory and control-mastery theory.

Attachment disorganization and severe psychopathology: A possible dialogue between attachment theory and control-mastery theory.

Double binds, dissociation, and attachment to the perpetrator in families and oppressive groups

Dependence on a traumatising, narcissistic leader creates double binds for members of oppressive religious and political groups much as it does for the children of a traumatising caregiver. These double binds result in disorganised attachment to the perpetrator. In order to survive, the dependent person must focus, with exquisite attention, on every word, action, thought, and desire of the narcissist. In the process, the dependent often loses all sense of self and agency. To cope with the competing demands of this double bind, two dissociated self-states are developed: 1) a subservient, idealising state to maintain attachment, and 2) a self-protective state that preserves power by identifying with the aggressor. A similar process may take place when members of oppressive groups become dependent on a traumatising leader. Members are kept in a state of fear, continuously activating their attachment systems, which motivates them to stay close and look to the leader for protection. They may be induced to accept the leader's unethical behaviour blindly and doubt their own perceptions of reality. Examples of attachment to the abuser in families and in two cult-like groups, the Nation of Islam, led by Malcolm X, and the Naropa Institute under Chögyam Trungpa, are discussed.

Parent-Child Interaction Therapy with Toddlers in a community-based setting: Improvements in parenting behavior, emotional availability, child behavior, and attachment.

Parent-Child Interaction Therapy with Toddlers (PCIT-T) is a new attachment-based parenting intervention designed to meet the needs of children aged 12-24 months presenting with challenging behaviors. This study examined outcomes of the first phase of PCIT-T, Child Directed Interaction-Toddler (CDI-T), 4-months post treatment. Participants were 56 toddlers (Child Mage=19.13 months) referred to receive CDI-T over an 8-week period at an Australian community-based child behavior treatment clinic for treatment of difficult toddler behaviors. Participants completed questionnaires and observational measures at baseline (Time 1), post-treatment (Time 2), and 4-month follow-up (Time 3). At both Time 2 and Time 3, there were statistically significant increases in observed positive parenting skills and emotional availability and decreases in negative parenting behaviors and child noncompliance. There were also significant improvements in parent-reported child externalizing and internalizing behaviors, parental stress, and maternal depression. There was a pattern of a shift away from attachment insecurity and attachment disorganization. Results suggest that the CDI-T phase of PCIT-T is a promising intervention for toddlers presenting with behavioral issues. Future studies should be conducted to assess efficacy in other settings, using larger samples and utilizing randomized controlled designs.

Mothers' self-reported emotion dysregulation: A potentially valid method in the field of infant mental health.

In the current study, we evaluated the extent to which mothers reported emotion dysregulation on the Difficulties with Emotion Regulation Questionnaire (DERS) (a) converged with physiological indices of emotion dysregulation while parenting, (b) correlated with maternal sensitivity, and (c) predicted infant attachment disorganization and behavior problems in a sample of 259 mothers and their infants. When infants were 6 months old, mothers' physiological arousal and regulation were measured during parenting tasks and mothers completed the DERS. Maternal sensitivity was observed during distress-eliciting tasks when infants were 6 and 14 months old. Infant attachment disorganization was assessed during the Strange Situation when infants were 14 months old and mothers reported on infants' behavior problems when infants were 27 months old. Mothers who reported greater emotion regulation difficulties were more physiologically dysregulated during stressful parenting tasks and also showed lower levels of maternal sensitivity at 6 months. Mother-reported dysregulation predicted higher likelihood of infant attachment disorganization and more behavior problems. Results suggest that the DERS is a valid measure of maternal emotional dysregulation and may be a useful tool for future research and intervention efforts aimed toward promoting positive parenting and early child adjustment.

Disorganized Attachment pattern affects the perception of Affective Touch

Touch, such as affective caress, can be interpreted as being pleasant. The emotional valence that is assigned to touch is related to certain bottom-up factors, such as the optimal activation of C-tactile (CT) afferents. Tactile processing with a hedonic or emotional component has been defined as affective touch—a component that CT fibers are likely to convey. Tactile deficiencies are frequent in the psychiatric population but also in healthy people with disorganized attachment; accordingly, it is likely that affective difficulties in adults with disorganized attachment are reflected in altered perception of affective touch. To test this hypothesis, we combined methods from clinical psychology, psychophysics, and neuroimaging. We found that people with a history of traumatic parental bonds and a disorganized attachment pattern perceive a “caress-like” stimulus as being unpleasant, whereas participants with organized attachment consider the same tactile stimulation to be pleasant. Further, unlike in organized adults, the responses of disorganized adults to CT and non-CT stimulation activated limbic and paralimbic structures in a fight-or-flight manner, suggesting that early experiences with parental deficiencies shape the physiological responses of peripheral CT fibers and central nervous networks.

Aspects of Parent-Child Interaction from Infancy to Late Adolescence Are Associated with Severity of Childhood Maltreatment through Age 18.

Childhood maltreatment (CM) is a pervasive public health problem worldwide, with negative health consequences across the lifespan. Despite these adverse outcomes, identifying children who are being maltreated remains a challenge. Thus, there is a need to identify reliably observable features of parent–child interaction that indicate risk for CM and that can instigate strategically targeted family supports. The aim of this longitudinal study was to assess multiple aspects of observed mother–child interaction from infancy to late adolescence as risk indicators of the overall severity of CM by age 18. Mother–child dyads were assessed in infancy (N = 56), at age 7 years (N = 56), and at age 19 years (N = 56/110). Severity of CM through age 18 was indexed by combined prospective and retrospective assessments. Interactions associated with severity of CM by age 18 included maternal hostility in infancy, maternal withdrawal in infancy and middle childhood, child disorganized attachment behavior in middle childhood and late adolescence, as well as hostile and role-confused interactions in late adolescence. This study identifies new indices of maternal and child behavior as important risk indicators for the severity of CM. These indices could be used to improve early identification and tailor preventive interventions for families at risk for CM.

Attachment representations in children with disruptive behavior disorders: A special focus on insecurity in middle childhood.

According to the emotional and social problems encountered in disruptive behaviour disorder (DBD), there is little available information regarding the attachment processes during middle childhood. Therefore, this study aims to investigate the attachment representations to both caregivers in a sample of 84 children, aged 8-12 years (N = 42 with a diagnosis of DBD; N = 42 as a comparison group). Attachment is assessed through the Child Attachment Interview, a semi-structured interview that incorporates both narrative and behavioural assessments of attachment, permits the assessment of attachment representations using dimensional and categorical approaches, and allows for the detection of disorganisation to both parents individually. Our results point to the presence of high frequencies of insecure attachment (more than 80%) in the DBD group, with a higher percentage of dismissing attachment, and an over-representation of disorganised attachment (more than 50%). Higher levels of dismissal and lower levels of security are found in DBD than in the comparison group. No attachment differences with respect to both parents are found. Understanding how different aspects of attachment during a specific developmental phase plays a role within the broader emotional functioning of DBD has great potential to lead to innovations in evaluations and treatment processes.

The Association between Attachment Styles and Physical Intimate Partner Violence Perpetration and Victimization: A Meta‐Analysis

In this meta-analysis, we examine attachment styles-something commonly incorporated into couples therapy-and their association with physical intimate partner violence (IPV) perpetration and victimization among men and women. This meta-analysis incorporated 33 studies that looked at the association between four different attachment styles and IPV. This study examined the strength of the correlation among different attachment styles and IPV perpetration and victimization, examined gender differences in the strength of the association among attachment styles and IPV, and compared the strength of the association with IPV among different attachment styles. We found that anxious attachment, avoidant attachment, and disorganized attachment styles were all significantly associated with physical IPV perpetration and victimization. Secure attachment was significantly negatively related to IPV perpetration and victimization. There was a significantly stronger association between avoidant attachment and IPV victimization for women compared to men. Clinical implications related to the importance of fostering secure attachments when working with couples or individuals who have experienced IPV are addressed.

T128. ATTACHMENT REPRESENTATIONS IN CHILDREN AT FAMILIAL HIGH RISK OF SEVERE MENTAL DISORDERS. ASSOCIATIONS WITH PSYCHOPATHOLOGY, LEVEL OF FUNCTIONING, AND PSYCHOTIC EXPERIENCES

BackgroundThere is evidence of higher rates of insecure and disorganized attachment in infancy in children born to parents with severe mental disorders, but evidence on attachment in middle childhood for these children is lacking. This study aims to explore attachment representations in seven-year-old children born to parents with schizophrenia or bipolar disorder. We also aim to explore possible associations between attachment and psychopathology, level of functioning, and psychotic experiences in these children.- We expect that children at familial high risk will have the highest levels of insecure and disorganized attachment. We expect that population based controls will have the lowest levels of insecure and disorganized attachment and higher levels of security than children at familial high risk.- We expect higher levels of insecure and disorganized attachment to be associated with an increased risk of psychopathology, and psychotic experiences and with lower levels of functioning, whereas we expect higher levels of secure attachment to be associated with a lower risk of psychopathology, and psychotic experiences, and with higher levels of functioning.MethodsThe Danish High Risk and Resilience Study VIA 7 is a prospective cohort study of 522 seven-year-old children born in Denmark. 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). Attachment representations were assessed with the Story Stem Assessment Protocol whereas psychopathology, level of functioning, and psychotic experiences were assessed with K-SADS.ResultsData analyses are ongoing but preliminary results indicate that there are no significant differences in attachment representations between the three groups of children, but that there are associations between higher rates of insecure and disorganized attachment and a higher risk of psychopathology. Results will be presented at the SIRS-conference.DiscussionUnderstanding attachment and its correlates in children at familial high risk of severe mental disorders is important in order to strengthen our understanding of developmental trajectories towards mental disorders in these children.

The revised Psychosis Attachment Measure: Measuring disorganized attachment.

ObjectivesThe Psychosis Attachment Measure (PAM) is currently the most widely used and validated measure of attachment in psychosis. However, the PAM does not assess disorganized attachment, the type of attachment that has been most closely linked with vulnerability to psychosis. This study aimed to expand the PAM to capture the concept of disorganized attachment and to examine its psychometric properties in a psychosis sample.MethodsClinical and academic experts in the field of psychosis and service user representatives were asked to assess the comprehensiveness and comprehensibility of the pool of disorganized items. This process resulted in 12 items hypothesized to capture disorganized attachment that were included with the original items of the PAM. A sample of 144 individuals with either a self‐reported diagnosis of, or treatment for, a psychosis‐related condition completed a battery of online measures comprising the revised PAM, existing measures of adult disorganized attachment and constructs hypothesized to be conceptually related to disorganized attachment.ResultsAn exploratory factor analysis was conducted with three factors retained; these were labelled anxious, avoidant and disorganized attachment. The factors displayed good internal consistency and test–retest reliability and the disorganized factor displayed good construct validity with related measures and constructs.ConclusionsThese results provide preliminary evidence that the revised PAM captures the concept of disorganized attachment. However, confirmatory psychometric evaluation of the revised PAM is required, within a separate psychosis sample, to confirm its factor structure. The relationship between these results and the current literature, in addition to the clinical and research implications, are discussed.Practitioner points We present an expanded version of the Psychosis Attachment Measure (PAM), revised to capture the concept of disorganised attachment in adulthood. This expanded measure showed good reliability and the new disorganized subscale demonstrated construct validity.These results provide preliminary evidence that disorganized attachment can be measured using a simple self‐report measure with individuals with psychosis.Further research is required to confirm the structural dimensionality of the revised PAM within a new sample using confirmatory factor analysis.Following further psychometric validation the use of this measure has the potential to be expanded to other mental health conditions in which disorganized attachment has been implicated in the development and maintenance of difficulties, for example, trauma‐related conditions and borderline personality disorder.

‘Something else’ in child psychotherapy with traumatised adopted children

ABSTRACT There is a small cohort of traumatised adopted children whose fear of separation from parents, and fear of hostility and rejection from the therapist, prevent them from being able to make use of the therapist’s thoughts and words. Some children are in such heightened states of alarm and dissociation that they are unable to play. This personal account of clinical development recounts growing awareness of the extent to which some highly traumatised children’s mentalizing capacity in therapy is dependent on their neurophysiological regulation. Therapy with such children must therefore begin by attending to the alarmed body, triggered by the anticipation of what is termed ‘relational trauma’. Moving beyond psychoanalytic and attachment theory to draw on ethological studies, relational trauma behaviour can be understood as a symptom of humans in agonic mode; this is a group behaviour mode observed in higher primate troops when they are experiencing compromised resource acquisition and stress. Such troops organise themselves in relations of dominance and appeasement that are aggressively enforced and resemble disorganised attachment behaviours. Fear-infused relationships are designed to reduce uncertainty and increase intra-group predictability. Parent-child homeostasis therefore needs to be understood within its familial, historical, geo-political and socio-economic context. Helping traumatised families move from agonic to benign hedonic mode arguably requires the double task of reducing environmental stressors and transforming fear-fuelled hostile-helpless relations into those of mutuality, reciprocity and understanding. This paper argues that such support involves a form of social activism on the one hand, and recognition and acceptance that the subject of therapy is primarily the parent(s)-child dyad, on the other. Any effective therapy must address trauma triggers in all subjects. Finally, some novel ways of transforming hostile-helpless behaviours into safe nurturing reciprocal interactions are suggested, with clinical illustrations.

The Long-Term Association of Disorganized Attachment and Harsh Parenting With Brain Morphology: A Large Population-Based Study

The Long-Term Association of Disorganized Attachment and Harsh Parenting With Brain Morphology: A Large Population-Based Study

The role of psychological and social factors in the relationship between attachment and suicide: A systematic review.

Insecure attachment is widely accepted to be a risk factor for suicidal thoughts and behaviour. To increase our understanding of this distal association, the current systematic review aimed to evaluate empirical evidence that has investigated the role of psychosocial mechanisms within this relationship. Sixteen original research articles were identified, with the majority carrying out mediational analyses to test their hypotheses. Substantial heterogeneity was found across studies with regards to their theoretical approach to assessing attachment, suicide-related outcomes, sample population, statistical analyses, and the psychological factors under investigation. Nevertheless, this emergent evidence base indicates that a range of predisposing, precipitating, and crisis-state factors may mediate the association between attachment security and suicidality. Studies that investigated moderating factors did not report significant findings, and the mediating role for psychiatric diagnoses remains unclear. Furthermore, this emerging research base is limited by an over-reliance on cross-sectional designs and self-reported data. Longitudinal and experimental designs are required to verify causal pathways and to investigate whether trait vulnerabilities interact with acute stressors to increase suicide risk. Finally, disorganized attachment has been overlooked so far and should be given greater consideration going forward.

Preconception and perinatal predictors of offspring attachment disorganization: Advancing the replicated evidence.

Attachment disorganization in early childhood is an influential yet modifiable risk factor for later mental health problems. Beyond established transmission through parents' unresolved attachment representations and caregiving sensitivity, little replicated evidence exists for wider determinants of offspring attachment disorganization. This study examined the replicated evidence for psychosocial risk factors in the preconception, prenatal, and postnatal periods. We identified all relevant longitudinal studies, and examined all risk relationships for which evidence existed in two or more cohorts (48 effects, 17 studies, N = 6,099). Study-specific and pooled risk associations were estimated and a range of moderators evaluated. Mothers' low socioeconomic status (r = .28, k = 2), perinatal loss of a child (r = .26, k = 2), caregiving intrusiveness (r = .31, k = 2), and infant male sex (r = .26, k = 4) predicted offspring attachment disorganization. Maternal sensitivity (r = -.25, k = 6) and higher metacognition during pregnancy (r = -.23, k = 3) predicted lower risk of offspring attachment disorganization. Findings suggest the origins of offspring disorganized attachment include but extend beyond maternal unresolved attachment representations and caregiving. We discuss implications for theory and for identification of modifiable risk pathways in the perinatal window.