Disorganized Attachment Research Articles

Personality Models in the Context of Child and Adolescent Psychiatry - Development, Change, Stability and Research Perspectives

Personality models play an important role for the etiological understanding of abnormal development in clinical settings. In this selective review, relevant personality models are presented and, in particular, their developmental dynamics and adaptability over the life span, starting in childhood, are considered in detail. The focus is on the developmental psychopathological perspective of processes of ego-resiliency and self-regulation between the poles of disposition and social environment. This is particularly obvious in the discussion of developmental path models of personality dysfunction with experiences of abuse or disorganized attachment in the child's history. Psychopathologically, an ongoing impairment of self-regulation often results in stable patterns of maladaptation, which leads in the case of purely symptomatic treatment usually only to temporary behavioral modifications. On the other hand, the changeability of pathological personality traits through the use of targeted intervention approaches will favour of a positive outcome and contradicts a deterministic stability of personality characteristics. For future research perspectives in developmental psychopathology, various theoretical personality constructs are discussed and linked to clinical observations.

Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review.

Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review.

Attachment In Young Children In Different Periods Of Russian Society

Studies of attachment in different countries indicate negative changes in the distribution of attachment patterns in social risk children, as well as cultural differences in attachment distribution that emphasize the importance of socio-economic conditions in the formation of family life and parenting models. The current study compares the distribution of attachment patterns obtained in three studies of young children conducted in 1989 and 2017–2018, before and after a period of deep socio-economic and political crisis in Russian society, and in 1999 – early 2000s by the end of this period. In each study attachment quality was assessed in the Strange Situation. Results show that the distribution of attachment patterns in young Russian children corresponds to the “standard” distribution in studies of 1989 and 2017-2018, and indicates the significantly lower rates of secure attachment and higher rates of resistant and disorganized attachment in the study of 1999 – early 2000s. These results support the need of the positive socio-economic conditions in society favorably affecting the stability and security of family life and supporting the formation by young children the organized attachment and increase the rate of security.

Autism and attachment difficulties in adulthood : Overlap of symptoms

This article explores the overlap of symptoms between autism and attachment difficulties in adulthood. Clinicians express difficulties in differentiating between these conditions contributing to misdiagnosis. Distinguishing autism spectrum behaviors from behaviors relating to disorganized attachment can be challenging. Urgency is added by the fact that the number of cases is increasing in the diagnosis of autism spectrum disorder (ASD). It is becoming increasingly recognized that ASD shares phenotypic similarities with other traditionally distinct developmental conditions. This article aims enhance the clinicians' critical reasoning regarding the patient's behavior to distinguish if its autism or attachment-related behavior disorders. For us, the clearest differentiation factor seemed to be the nature of the behavior.

Intergenerational Transmission of Attachment between Incarcerated Mothers and Their Co-residing Children.

Maternal attachment representations and children's attachment to their mothers have been shown to be related while this association varies according to socioeconomic risk factors that these mother-child dyads are experiencing. In this regard, this study aims to investigate the intergenerational transmission of attachment between highly disadvantaged incarcerated mothers and their co-residing children and the mediating role of maternal sensitivity in the relationship between maternal and children's attachment representations. The study sample consists of 84 incarcerated mothers and their co-residing children. The maternal attachment was evaluated using the Doll Story Completion Task. Children's attachment and maternal sensitivity were assessed based on a 45-minute semi-structured mother-child interaction observation and rated through structured coding instruments. Hierarchical regression analyses revealed that mothers' anxious and avoidant attachment positively predicted children's disorganized attachment behaviors. Moreover, analyses showed that maternal sensitivity did not mediate the relationship between maternal and child attachment representations. Findings partially supported the discussion emphasizing that attachment transmission, as well as the mediating role of maternal sensitivity on this transmission, appeared to be weaker for disadvantaged mother-child dyads. Implications for future intervention programs aiming to support the attachment security and reduce the disorganization of children co-residing with their incarcerated mothers are discussed.

The antecedents and consequences of disorganised attachment and dissociation

Attachment researchers theorise that the primary antecedent of dissociation is disorganised attachment. However, the family and social contexts of this parent–child relationship are frequently ignored even though they play an important role in determining whether the unresolved attachment of the parent actually leads to the role confusion characteristic of disorganised attachment and dissociation in the child. This article will address first how the dynamics leading to disorganised attachment and dissociation are dependent on the larger family and social contexts; and second how both unresolved attachment and dissociation in the adolescent or adult are often maintained through the choice of a partner, the dissociative symptoms themselves and other social conditions to which these individuals are frequently exposed. Two case studies will illustrate this thesis. Finally, implications for treatment will be explored.

A randomized controlled trial for identifying the most suitable treatment for depression based on patients' attachment orientation.

Many active treatments exist for major depressive disorder (MDD), but little is known about their differential effects for various subpopulations of patients to guide precision medicine. This is the first randomized controlled trial (RCT) designed to identify differential treatment effects based on patients' attachment orientations. We tested an a priori preregistered hypothesis of the potential moderating effect of patients' attachment orientation on the outcome of supportive therapy (ST) versus supportive-expressive therapy (SET). The RCT was conducted between 2015 and 2021. Individuals with MDD were randomly assigned to 16-week ST or SET. The predefined primary outcome measure was the Hamilton Rating Scale for Depression. Hypotheses were formulated and preregistered before data collection. One hundred patients with MDD were enrolled, 57% women, average age 31.2 (SD = 8.25). Data were analyzed using the intention-to-treat approach. Our hypothesis that attachment anxiety is a significant moderator of treatment outcome was supported (B = -0.09, p = .016): Patients with higher levels of attachment anxiety showed greater treatment efficacy following SET than ST. Although the hypothesis regarding a potential moderating effect of avoidant attachment was not supported, sensitivity analyses revealed that individuals with disorganized attachment orientation (higher scores on both anxious and avoidant attachment) benefited more from SET than from ST (B = -0.07, p = .04). The findings support the clinical utility of patients' attachment orientation in selecting the most suitable treatment for individuals and demonstrate the methodological utility of RCTs predesigned to test theoretically based models of personalized treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Einschätzungen zu Bindungsbeziehungen und geäußerter Kindeswille in einer Stichprobe von Sachverständigengutachten zu Sorgerechtsstreitigkeiten (§ 1671 BGB)

For a sample of 103 court cases with parental conflicts regarding custody and residence results on attachment diagnostics by psychological court experts are reported. Attachment diagnostics was performed using multiple methods with two observations per parent. It was coded whether there were indications for a similar level of emotional security with both parents or more emotional security with one parent than the other. In addition, indications for attachment disorganization, manipulation of the child by one or both parents and children’s views regarding residence were coded. About 55% of the children showed indications for more emotional security with one than the other parent. 38% of the children did not express any preference regarding their preference. If a preference was expressed and if there were indications for more emotional security with one than the other parent, children most often wanted to live with the parent to whom they showed comparably more indications for emotional security. Manipulation, especially manipulation by both parents was associated with indications for attachment disorganization.

An Exploratory Study on Resting-State Functional Connectivity in Individuals with Disorganized Attachment: Evidence for Key Regions in Amygdala and Hippocampus.

Studies comparing organized (O) and unresolved/disorganized (UD) attachment have consistently shown structural and functional brain abnormalities, although whether and how attachment patterns may affect resting state functional connectivity (RSFC) is still little characterized. Here, we investigated RSFC of temporal and limbic regions of interest for UD attachment. Participants’ attachment was classified via the Adult Attachment Interview, and all participants underwent clinical assessment. Functional magnetic resonance imaging data were collected from 11 UD individuals and seven matched O participants during rest. A seed-to-voxel analysis was performed, including the anterior and the posterior cingulate cortex, the bilateral insula, amygdala and hippocampus as seed regions. No group differences in the clinical scales emerged. Compared to O, the UD group showed lower RSFC between the left amygdala and the left cerebellum (lobules VIII), and lower functional coupling between the right hippocampus and the posterior portion of the right middle temporal gyrus. Moreover, UD participants showed higher RSFC between the right amygdala and the anterior cingulate cortex. Our findings suggest RSFC alterations in regions associated with encoding of salient events, emotion processing, memories retrieval and self-referential processing in UD participants, highlighting the potential role of attachment experiences in shaping brain abnormalities also in non-clinical UD individuals.

Testing the mid-range model: Attachment in a high risk sample.

Infant attachment is a key predictor of later socioemotional functioning, but it is not clear how parental responsivity to infant expressive behavior is associated with attachment outcomes. A mid-range model of responsivity holds that both unresponsive and highly reactive parental behaviors lead to insecure and disorganized attachment. We examined the relationship between maternal (and infant) contingent responsivity and attachment in a high-risk sample. Participants were 625 infant-mother pairs from a longitudinal study of children with and without prenatal drug exposure and variable levels of associated social risks. Infant-mother pairs participated in the Face-to-Face/Still-Face paradigm (FFSF) at 4-months and in the Strange Situation Procedure (SSP) at 18-months. A model incorporating both linear and quadratic responsivity effects indicated that mothers who were either very high (reactive) or very low (unresponsive) in responsivity were more likely to have infants with disorganized attachment outcomes. While maternal responsivity was associated with attachment disorganization, no associations between maternal responsivity, and attachment security/insecurity were detected. Infant responsivity to mother was not associated with attachment outcomes. The findings suggest the importance of mid-range levels of maternal responsivity in the development of organized attachment among infants facing high levels of prenatal and social risk.

Attachment Representations in Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD).

Attention-Deficit/Hyperactivity Disorder (ADHD) in children is associated with several adverse family characteristics, such as higher parenting stress, more conflicted parent–child relationships, lower parental competence, and higher levels of parental psychopathology. Hence, children with ADHD more often grow up under suboptimal circumstances, which may impact the development of their attachment representations. Here, we investigated whether children with ADHD have more insecure and disorganized attachment representations than their typically developing peers, and which factors could explain this association. We included 104 children between 4 and 11 years old, 74 with ADHD (without Conduct Disorder) and 30 typically developing control children. Children completed a state-of-the-art story stem task to assess their attachment representation, and we measured parents’ expressed emotion (as an index of parent–child relationship quality), parents’ perceived sense of competence, parental education levels, and parent-rated ODD symptoms of the child. We found that, after controlling for multiple comparisons, children with ADHD had less secure and more ambivalent and disorganized attachment representations relative to their typically developing peers. These group differences were independent of comorbid ODD and parental education levels. There were no group differences on avoidant attachment representations. Explorative analyses within the ADHD group showed that attachment representations were not related to parent–child relationship quality, perceived parenting competence, parental education levels, and comorbid ODD symptoms. We conclude that children with ADHD disproportionately often have attachment problems. Although this conclusion is important, treatment implications of this co-occurrence are yet unclear as research on ADHD and attachment is still in its infancy.

Maternal trauma but not perinatal depression predicts infant-parent attachment

Understanding if maternal depression is a predictor of infant-parent attachment classification is important to furthering knowledge about the early pathways and predictors of socio-emotional development. Yet few studies that have utilised the Strange Situation Procedure, the gold standard for measurement of infant-parent attachment, have examined antenatal depression as a predictor of attachment, and none has also included a measure of maternal trauma. This study uses data on 224 women recruited in early pregnancy and followed up until 12months postpartum. Maternal depression was measured in pregnancy using the Structured Clinical Interview for the DSM and repeat Edinburgh Postnatal Depression Scale as well as Stressful Life Events scale across pregnancy and postpartum including items on domestic violence. A past history of trauma was measured using the Childhood Trauma Questionnaire. Attachment was measured using the Strange Situation Procedure (SSP) at 12months postpartum. We found that maternal depression was not associated with insecure or disorganized attachment. However, a maternal history of childhood trauma and current domestic violence both predicted insecure-avoidant attachment at 12months, whereas increased number of stressful life events prior to conception and in pregnancy was associated with insecure-resistant attachment. Neither trauma, past or current, nor depression predicted disorganized attachment. In the first study to have included measures of antenatal depression, maternal childhood trauma, and current stressful events as predictors of infant attachment measured using the SSP, we found maternal experiences of past and current trauma but not depression were significant predictors of infant-parent attachment security.

Configurations of mother-child and father-child attachment as predictors of internalizing and externalizing behavioral problems: An individual participant data (IPD) meta-analysis.

An unsettled question in attachment theory and research is the extent to which children's attachment patterns with mothers and fathers jointly predict developmental outcomes. In this study, we used individual participant data (IPD) meta-analysis to assess whether early attachment networks with mothers and fathers are associated with children's internalizing and externalizing behavioral problems. Following a pre-registered protocol, data from 9 studies and 1,097 children (mean age: 28.67 months) with attachment classifications to both mothers and fathers were included in analyses. We used a linear mixed effects analysis to assess differences in children's internalizing and externalizing behavioral problems as assessed via the average of both maternal and paternal reports based on whether children had two, one, or no insecure (or disorganized) attachments. Results indicated that children with an insecure attachment relationship with one or both parents were at higher risk for elevated internalizing behavioral problems compared with children who were securely attached to both parents. Children whose attachment relationships with both parents were classified as disorganized had more externalizing behavioral problems compared to children with either one or no disorganized attachment relationship with their parents. Across attachment classification networks and behavioral problems, findings suggest (a) an increased vulnerability to behavioral problems when children have insecure or disorganized attachment to both parents, and (b) that mother-child and father-child attachment relationships may not differ in the roles they play in children's development of internalizing and externalizing behavioral problems.

Attachment disorganisation and poor maternal discipline in early childhood: independent contributions to symptoms of conduct problems

ABSTRACT Conduct problems (CP) are common behaviour difficulties in young children. Poor parenting and caregiver-child attachment relationships are important risk factors of CP, but more research is required to understand their concurrent contribution to CP in the early childhood years. We examined the association of maternal-reported conduct problems (CP) (Strengths and Difficulties Questionnaire) with maternal-reported harsh and inconsistent discipline (Preschool-Alabama Parenting Questionnaire) and children’s representations of attachment (Manchester Attachment Story Task) in a sample of children between 4 and 6 years old (n = 66). Correlation analysis showed that CP were associated with attachment insecurity, high levels of attachment disorganisation, and maternal harsh and inconsistent discipline. Regression analysis showed that disorganisation and inconsistent discipline explained unique variance in CP ratings even after controlling for the effects of confounding variables. The findings suggest that attachment disorganisation and aspects of poor maternal discipline in early childhood reflect parallel processes with unique contributions to CP.

Disrupted affective communication characterizes mothers of infants with disorganized but also ambivalent attachments: An Israeli study.

This study examined whether maternal disrupted communication, which is associated with disorganized infant attachment, also characterizes mothers of ambivalent infants. The study, conducted in Israel, included a Jewish sample (N=163; 68 Girls) from diverse socioeconomic status, collected between 1991 and 1993 in an earlier study. The sample over-represented ambivalent and disorganized attachments. Attachment was assessed in the Strange Situation Procedure (SSP) at 12months and disrupted communication was coded from the SSP using the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; Lyons-Ruth et al., 1999). Mothers of ambivalent infants showed higher disrupted communication than mothers of secure, avoidant, and disorganized infants. The findings shed further light on the correlates of ambivalent attachment and call for research regarding maternal and infant characteristics that differentiate ambivalent versus disorganized attachment.

Associations between Turkish incarcerated mothers’ sensitivity and their co-residing children’s attachment: The moderating role of children’s temperament

ABSTRACT This study investigated the associations between incarcerated mothers’ sensitivity and their co-residing children’s attachment security. Furthermore, the moderating role of children’s temperament on the associations between maternal sensitivity and children’s attachment security was examined. The study sample consisted of 84 incarcerated mothers (Mage = 29.9, SD = 5.6) and their 12- to 43-month-old (M = 25.3, SD = 8.3) children who co-resided with them in prison facilities. Maternal sensitivity and child’s attachment were assessed by observation of mother-child interaction using the Maternal Sensitivity Scale and the Turkish Toddler Attachment Sort-60, respectively. Mothers reported their children’s temperamental features (i.e. negative emotionality and effortful control) using the Early Childhood Behavior Questionnaire. Results showed that maternal sensitivity was related positively to children’s secure attachment and negatively to children’s disorganized attachment. Furthermore, children’s negative emotionality and effortful control moderated the associations between maternal sensitivity and children’s attachment. Specifically, maternal sensitivity negatively predicted children’s avoidant attachment only for children with low negative emotionality and with high effortful control. Additionally, maternal sensitivity negatively predicted children’s anxious attachment only for children with low effortful control. Results are discussed in terms of sample-specific experiences, contextual factors, and the differential susceptibility hypothesis.

Adult Attachment Representations and Body Image.

In modern literature, the body image is interpreted as a multidimensional construct, which is considered important for both individual development and quality of life. The body image is central to the self-concept and has important consequences for mental functioning. A negative body image can result in adverse psychosocial consequences for both sexes. For a long time in the professional literature the study of socio-cultural factors on the development of the body image has prevailed. This line of research creates social constructivism, in which the earliest attachment relations are eliminated, and instead the idea is suggested that external sources have a direct influence. The present text proposes an approach to the body image as a development construct, arising and developing in the attachment relations, related to the provision of security and protection. Attachment disturbances, as well as attachment disorganization, are defined as the inability to provide security and protection. Attachment relationships in connection with the development of body image develop through the mechanisms of reflection, sensitive responses to the child’s signals and synchronous relationships. In the first months of human life, the attachment needs are first and foremost the needs of the body, which are satisfied by the responses of the primary caregiver. The topic of body image discusses attachment disorganization, the understanding of attachment trauma, and the “enactment” of the loss on the body’s territory. Trauma always involves loss. Griefs that cannot be mourned and injuries that cannot be represented seem to be central to understanding the body’s problematization.

Attachment representations among school-age children with intellectual disability

BackgroundResearch data documenting a high risk of insecure and disorganized attachment among children with intellectual disability (ID) in infancy and early childhood raises the question of mutual influences between ID and attachment in later childhood. AimsThe objectives of the present study were to examine attachment among school-age children with ID and whether attachment varies according to level of intellectual functioning, adaptative functioning, and presence of a genetic syndrome (i.e. Down syndrome). MethodsAttachment among 54 children with ID aged 8−12 years (30 with Down Syndrome, 24 with non-specific ID) was assessed using the Attachment Story Completion Task, and compared with that of 108 typically developing children, 54 of the same chronological age and 54 of the same mental age. OutcomesResults show (1) less security among children with ID than among same-age controls (2) more disorganization among children with ID compared to the two control groups, (3) a link between attachment disorganization and level of adaptive functioning among children with ID and (4) no difference in attachment between children with DS and children with non-specific ID. ConclusionsChildren with ID remain vulnerable to disorganization during late childhood. More research is needed to understand the factors underlying disorganized attachment representations.

Validity and reliability of the Chinese version of adult disorganized attachment scale in Chinese adults

Validity and reliability of the Chinese version of adult disorganized attachment scale in Chinese adults

Emotional-behavioral problems, attachment and verbal skills in late-adopted adolescents: The role of pre-adoption adversities and adoption variables

BackgroundThere are few studies on late-adopted adolescents' outcomes -e.g., emotional-behavioral problems, attachment and cognitive status- and their possible predictive factors, none from Italy. Objective: This paper aimed to investigate emotional-behavioral problems, attachment representations, and verbal skills in late-adopted adolescents in Italy and to explore the predictive role of pre-adoption adversities and adoption variables for worse adoptees' outcomes. Participants and settingThe study included N = 79 late-adopted (mean age at adoption = 6 years) adolescents, between 11 and 18 years, placed via both intercountry and domestic adoption. MethodsParents provided information about pre-adoption and adoption history and filled the Children's Behavior Checklist 6–18 for measuring participants' emotional-behavioral problems. Attachment representations were assessed through the Friend and Family Interview administered directly to adolescents, like the verbal comprehension index of the Wechsler Intelligence Scale for Children (4th edition) for measuring participants' verbal IQ. ResultsMaltreatment and its interaction with multiple placements were the main predictors of other problems—i.e., social, thought, and identity difficulties (respectively, p = .007 and p = .029)—while intercountry adoption was the unique predictor of both externalizing and total problems (respectively, p = .047 and p = .015). However, domestic adoption was the most important predictor both for higher insecurity and disorganized attachment representations and lower verbal skills (all p < .044); even stronger if domestic adoption interacted with pre-adoptive institutionalization. ConclusionsPre-adoption adversities as well as domestic vs. intercountry adoption, but not the age at placement, contributed to adolescent adoptees' developmental outcomes.