Disorganized Attachment Style Research Articles

Family therapy and EMDR after child abuse and neglect: moderating effects of child attachment style and PTSD symptoms on treatment outcome

ABSTRACT Background: Effective and appropriate care and treatment for children in order to decrease the psychosocial problems that arose after experiencing child abuse and neglect (CAN) is of vital importance, given the severity of symptomatology that may develop. Objective: The purpose of the present study was to examine whether attachment style and core cluster Posttraumatic Stress Disorder symptoms acted as moderators for treatment outcomes of a new integrative treatment model for trauma and attachment. In this treatment model, family therapy is combined with EMDR and obstacles for trauma processing are tackled first. Method: we included children, ages 6–12 years, with a history of CAN, who did not respond to evidence-based trauma treatment. Target treatment outcomes were problems in attachment, posttraumatic stress symptoms, behaviour, and emotion regulation. We conducted a multiple-baseline ABC Single-Case Experimental Design (SCED). We categorized 12 participants into four groups of attachment style and core cluster PTSD symptoms: (1) non-disorganized & re-experiencing; (2) non-disorganized & avoidance/hyperarousal; (3) disorganized & re-experiencing; & (4) disorganized & avoidance/hyperarousal. We compared the four groups with each other and across time, and the interaction between groups and effect over time. We conducted non-parametric permutation tests and estimated q-values for false discovery rate control. Results: Children with a disorganized attachment style had more severe symptomatology in general, except for posttraumatic stress symptoms. The treatment appeared more effective in targeting and successfully treating children with a non-disorganized attachment style, and specifically children with a non-disorganized attachment style and re-experiencing as core cluster PTSD symptoms. Conclusion: Our study underlines the complexity of treating children who developed a complicated combination of symptomatology after CAN and calls for the continuous development of innovative interventions.

Associations of sexual dysfunction with problematic pornography use and attachment styles: a cross-sectional study of Hungarian-Spanish samples

IntroductionIn the last decades, growing evidence suggests, that young adults and even adolescents consume more and more pornographic content, which might lead to behavioural addictions. Excessive pornography use was found to be associated with higher rates of sexual dysfunctions, such as genital dysfunction or disorders related to desire, arousal, orgasm and pain. The role of attachment style on sexual function has still rarely been investigated.ObjectivesTo examine associations between sexual dysfunction, problematic pornography use and attachment styles in a Spanish-Hungarian sample.MethodsA cross-sectional comparative study was carried out in 2023 which included a Hungarian (N=447; 63% female; age: 30,5±9,8) and a Spanish sample (N=201; 72% female; age: 40,7±14) from the general population. In the online survey, we used the Arizona Sexual Experiences Scale (ASEX) to measure sexual dysfunction, the Problematic Pornography Use Scale (PPCS) to assess pornographic content consumption within the theoretical framework of addiction and the Relationships Questionnaire to explore the attachment styles of the subjects.Results13% of the Hungarian sample and 19% of the Spanish sample reported severe sexual dysfunction (ASEXTotal >19). The Hungarian sample reported more problems related to orgasm (climax and satisfaction). Overall, 7% of the Hungarian sample and 1% of the Spanish sample reported very severe problems (PPCSTotal >76) with pornography use. We found significant differences in every subscale and the Hungarian sample reportedly showed more difficulties in every aspect, especially in salience and mood change. Regarding attachment styles, the samples also showed significant differences (Hungarian: 31% secure, 26% anxious-ambivalent, 20% avoidant, 23% disorganized; Spanish: 53% secure, 11% anxious-ambivalent, 23% avoidant, 13% disorganized). In the combined sample, secure attachment style was associated with the least difficulties in sexual functioning, whereas subjects with anxious-ambivalent style reported more problems in sexual drive, arousal and erection. Disorganized attachment style was associated with the most severe dysfunction in orgasm (climax and satisfaction). The association between problematic pornography use and attachment styles was more consistent. Secure attachment style showed the least of problems, whereas subjects with anxious-ambivalent and disorganized attachment styles reported the most, especially in salience and mood change.ConclusionsOur findings showed significant intercultural differences between the two samples and highlighted the potential role of attachment styles in sexual functioning and problematic pornography use. A more profound understanding of the relationship between attachment and sexual functioning could facilitate potential treatment of sexual dysfunctions by addressing attachment issues in psychotherapy.Disclosure of InterestNone Declared

Attachment Styles and Language Performance in Middle Childhood; Investigating the Predictive Potential for Clinical Diagnosis

Objective: By exploring the language abilities of primary school children in attachment narratives and uncover potential associations between attachment styles and expressive indicators, this study investigated whether language performance can serve as a primary predictive measure for diagnosing attachment styles and injuries, particularly in cases where traditional assessment methods fall short. Methods and Materials: This descriptive and qualitative research involved a statistical population of 100 elementary school children selected through random sampling from four locations in Tehran between 2017 and 2019. Attachment styles of the children were assessed using the Finzi questionnaire. Subsequently, two story prompts devised for Iranian children, following the MacArthur Story Completion approach, were administered according to the prescribed protocol. Qualitative coding was employed to analyze all stages of recording, implementation, and children's language performance. Then, the frequency of codes within each attachment style was assessed. Findings: "Speech coherence" emerged as a significant indicator for secure children, while avoidant children displayed "briefness of expression" and "avoidance of response." Anxious children exhibited "talkativeness," "jumping from branch to branch," and "argument slippage," while disorganized children demonstrated "inability to respond" and "ambiguity" as key traits for early diagnosis of attachment style. Furthermore, only disorganized children showed a noticeable difference in the number of words expressed between the two stories. The primary distinction between these stories pertained to the presence of threats from parents or strangers. Conclusion: This study suggests that attachment styles can be predicted through language performance within this sample size. Specifically, "talkative" in anxious attachment style, "avoidance of response" in avoidant attachment style, and "ambiguity and confusion" in disorganized attachment style are noteworthy indicators. Expanding the research to a larger sample size is likely to yield more precise results.

Maladaptive daydreaming in Individuals with Disorganized Attachment Style: A Case Report

Maladaptive daydreaming is an unrecognized clinical syndrome that encompasses an unhealthy use of fantasy. Hereunder we report on the case of a 19-year-old South Asian girl with a disorganized attachment style who adopted Maladaptive daydreaming as a coping mechanism. The patient sought fantastical proximity with a famous personality to compensate for the lack of an inclination to pursue a healthy romantic relationship in real life. Deteriorating relationships with friends and family, social anxiety, and cascades of unimpressive academic performances prompted the patient to browse for answers on the internet. She discovered the 16-item Maladaptive Daydreaming scale (MDS-16) on which she scored above the cut-off score. Subsequent psychotherapy sessions wherein she was encouraged to journal her MD breaks and practice mindfulness meditation led to the patient reporting significant improvements in her professional and personal life and better control over her yearnings to daydream. We report this case to raise awareness for a disorder that shows semblances of behavioral addiction and risks being misdiagnosed or even undetected in some clinical contexts.

Self-Selected Music for Relational Trauma: Commentary on the Psychotherapy Case of "James"

This commentary discusses Dr. Paul Blimling’s (2019) composite case of James, a patient with a history of severe childhood interpersonal trauma, who responded remarkably well to individual psychotherapy augmented with the targeted use of self-selected music. I describe how music and psychotherapy both have their origins in the shamanistic practices of our hunter-gatherer ancestors, such that combining psychotherapy and music together is a reconciliation of sorts. The Case of James demonstrates how music can be used in psychotherapy with a counter-dependent patient, to help the patient to access sensitive, vulnerable feelings that normally would never be expressed to another person. In this case, the therapist’s keen sensitivity to the patient’s disorganized attachment style created an environment in which the patient eventually felt safe lowering his defenses and expressing his emotions in the treatment—with the help of five songs. Aside from the direct, visceral benefits of the music itself, the process of asking a relationally traumatized patient to select a song has other potential benefits. For example, it supports the patient’s sense of self (which, in the relationally traumatized patient, is likely fragmented), and it may reduce the "hot seat" feeling with a self-conscious patient, by shifting focus from the patient to the song. Songs selected by patients in advance of a session versus songs selected during a session may provide different types of information, and may have different types of benefits. If I were working with a patient such as James, two additional possibilities I would consider are (a) helping the patient to develop practical skills for managing overwhelming emotions, and (b) making the patient’s goals a more prominent focus throughout the treatment.

5.68 Factors Related to Disorganized Attachment Style of Trauma-Affected Young Children in a Therapeutic Daycare Setting

5.68 Factors Related to Disorganized Attachment Style of Trauma-Affected Young Children in a Therapeutic Daycare Setting

The early care environment and DNA methylome variation in childhood.

Prenatal adversity shapes child neurodevelopment and risk for later mental health problems. The quality of the early care environment can buffer some of the negative effects of prenatal adversity on child development. Retrospective studies, in adult samples, highlight epigenetic modifications as sentinel markers of the quality of the early care environment; however, comparable data from pediatric cohorts are lacking. Participants were drawn from the Maternal Adversity Vulnerability and Neurodevelopment (MAVAN) study, a longitudinal cohort with measures of infant attachment, infant development, and child mental health. Children provided buccal epithelial samples (mean age = 6.99, SD = 1.33 years, n = 226), which were used for analyses of genome-wide DNA methylation and genetic variation. We used a series of linear models to describe the association between infant attachment and (a) measures of child outcome and (b) DNA methylation across the genome. Paired genetic data was used to determine the genetic contribution to DNA methylation at attachment-associated sites. Infant attachment style was associated with infant cognitive development (Mental Development Index) and behavior (Behavior Rating Scale) assessed with the Bayley Scales of Infant Development at 36 months. Infant attachment style moderated the effects of prenatal adversity on Behavior Rating Scale scores at 36 months. Infant attachment was also significantly associated with a principal component that accounted for 11.9% of the variation in genome-wide DNA methylation. These effects were most apparent when comparing children with a secure versus a disorganized attachment style and most pronounced in females. The availability of paired genetic data revealed that DNA methylation at approximately half of all infant attachment-associated sites was best explained by considering both infant attachment and child genetic variation. This study provides further evidence that infant attachment can buffer some of the negative effects of early adversity on measures of infant behavior. We also highlight the interplay between infant attachment and child genotype in shaping variation in DNA methylation. Such findings provide preliminary evidence for a molecular signature of infant attachment and may help inform attachment-focused early intervention programs.

FROM PROXIMITY SEEKING TO RELATIONSHIP SEEKING: WORKING TOWARDS SEPARATION FROM THE “SCAREGIVERS”

Traditionally psychoanalysis showed interest in the child’s ambivalent relationship towards the object. Psychoanalysis also did not put great emphasis on the role of fear in a child’s life, in particular fear that has been inflicted by the caregivers (Slade, 2013). It was Mary Main who placed fear in the face of attachment needs and named it as disorganized attachment style. The research findings have given us a new lens into the way we see human behavior as displayed in many of our traumatized clients. The child’s need for both protection and autonomy are universal and has been at the heart of object relations and attachment theories. It is there where matters of core-relatedness and a developed sense of self are most involved. This paper discusses a client who suffered extensive sexual abuse. Her attachment to her mother, who I called her “scaregiver,” was preoccupied, enmeshed and coercive as well as being disorganized. The lack of boundaries and the controlling relationship the client had with her mother was re-enacted in the therapeutic dyad. This paper explores these dynamics and how attachment-based psychotherapy enabled a move towards safety for the client followed by better functioning, and more so enabled her to move towards intersubjectivity, a deeper understanding of her lack of boundaries, separateness and need for autonomy.

Exploring disorganized attachment style among Malay mothers in Malaysia: A study using the Attachment Style Interview

ABSTRACTThis article explores emerging themes involving disorganized attachment style among Malay Muslim mothers using the Attachment Style Interview (ASI). Analysis of the 18 mothers with disorganized attachment style (those with combined anxious and avoidant styles) utilized themes deemed important from the attachment research literature and selected based on a careful reading of the narrative cases. These include more extreme negative interpersonal experiences than found in other insecure attachment style descriptors, and included partner violence and related isolation/social exclusion. It also indicated more complex cognitive-affective disturbance including mixed or contradictory dependency patterns and both angry and fearful attitudes to others. We discuss the concept of disorganized attachment style in relation to abuse, social exclusion, and its implication for psychopathology, intervention, and treatment.

Psychotherapy of borderline personality disorder: critical factors and proposals of intervention

Borderline personality disorder (BPD) represents a significant therapeutic challenge. Critical factors in psychotherapeutic treatment of patients with BPD are noticeable and strictly related to the psychopathological dimensions of this disorder: affective and relational instability, behavioral impulsivity and precarious definition of identity. These features are emphasized by therapeutic intervention and become evident during the course of the treatment. Psychotherapeutic setting induces BPD patient to actualize the dysfunctional relational patterns that have been acquired during childhood. Specific critical factors concern the characteristics of the patient (risk of suicide, aggressive behaviors, chronic course of the disorder, disorganized attachment style), of the therapist (therapeutic skills, training, countertransference, risk of burnout) and of the setting of psychotherapy (patients selection, therapeutic alliance, need to set limits, duration and end of therapy). In Otto Kernberg's and Marsha Linehan's models of psychotherapy specific for DBP the authors identify substantially overlapping objectives and modalities of intervention. In particular, therapists should take care of patient safety, maintain boundaries of therapeutic setting and promote the development of psychotherapeutic process. The aim of this article is to analyze the main critical factors affecting psychotherapeutic process in patients with BPD. Objectives and priorities that therapist should consider to address these issues will be discussed. We will also try to make clear why interpersonal psychotherapy adapted to DBP can represent one of the therapeutic models that may be useful to manage and resolve these difficulties.

Preschool Children Without 7-repeat DRD4 Gene More Likely to Develop Disorganized Attachment Style


 
 
 
 Background: A disorganized attachment style is characterized by fearful and disoriented behaviours when a child is separated from their caregiver. Its presence is an early predictor of the later development of psychopathology, including depression. This study seeks to determine the effects of one environmental factor - the incidence of low birth weight - and one genetic factor - the presence of the long (7-repeat) polymorphism of the dopamine D4 receptor (DRD4) gene - on the development of disorganized attachment between the child and the mother.
 Methods: We sampled 251 mother-child dyads from the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) project. We measured birth weight and DRD4 genotype, and assessed attachment style using modified separation-reunion procedure.
 Results: Birth weight did not have a significant effect on disorganized attachment (b=-0.001, t(230)=0.006, p=0.910). Presence of DRD4 7-repeat polymorphism had a significant negative effect on presence of disorganized attachment style (b=-1.196, t(230)=0.411, p=0.004).
 Conclusion: Children without the DRD4 7-repeat allele were more likely to display a disorganized attachment style compared to children with the DRD4 7-repeat allele. This indicates that the 7-repeat allele of the DRD4 gene may serve as a protective factor against disorganized attachment.
 
 
 

Association between childhood maltreatment and adult emotional dysregulation in a low-income, urban, African American sample: Moderation by oxytocin receptor gene

The ability to effectively regulate emotions and a secure attachment style are critical for maintaining mental health across the life span. The experience of childhood maltreatment interferes with normal development of emotional regulation and dramatically increases risk for a wide range of psychiatric disorders in adulthood. The central nervous system oxytocin systems are critically involved in mediating social attachment and buffering psychophysiological responses to stress. We therefore investigated the impact of childhood maltreatment and an oxytocin receptor (OXTR) single nucleotide polymorphism (rs53576) and their interaction on emotional dysregulation and attachment style in adulthood in a sample of low-income, African American men and women recruited from primary care clinics of an urban, public hospital. Consistent with prior research, we found that the severity of childhood maltreatment was associated with increased levels of emotional dysregulation in adulthood. Childhood maltreatment was also positively associated with ratings of disorganized/unresolved adult attachment style and negatively associated with ratings of secure adult attachment style. There was no direct association between rs53576 and emotional dysregulation or ratings of adult attachment style. However, there were significant interactions between rs53576 and childhood maltreatment in predicting level of adult emotional dysregulation and attachment style. Specifically, G/G genotype carriers were at risk for increased emotional dysregulation when exposed to three or more categories of childhood abuse. In addition, G/G genotype carriers exhibited enhanced disorganized adult attachment style when exposed to severe childhood abuse compared to A/A and A/G carriers. Our findings suggest that A allele carriers of OXTR rs53576 are resilient against the effects of severe childhood adversity, by protection against emotional dysregulation and disorganized attachment.

An Attachment Based Approach to Child Custody Evaluation: A Case Study

This child custody consultation, conducted in a rural Texas community, addressed the immediate placement needs of a 5-year-old female, Jamie. The child had been in foster care for 1 year, and her biological mother was seeking reinstatement of full custody. During supervised visitation sessions, Jamie displayed behaviors that are associated with a disorganized attachment style and/or seizure activity, while the mother exhibited behaviors indicative of an insecure attachment style and the inability to be emotionally available to her child. The Adult Attachment Inventory was administered to the mother as a measure of attachment while Jamie was tested for neurotransmitter activity at baseline and immediately after visitation. The results of these objective measures are presented and the implications for their use in child custody cases are discussed.

Attachment Disorganization and Its Relevance to Sexual Offending

The theoretical nature of attachment disorganization within two separate research traditions, are reviewed. Studies of attachment style related to sexual offending are then critically evaluated, with particular reference to the use of the self-report methodology for studying adult attachment styles. Here, it is argued that these studies may not have taken sufficient account of the disorganized attachment style or used a methodology that was able to adequately capture attachment disorganization. In that attachment disorganization could account for some of the known features of sexual offenders, such as aggression and socioaffective problems. We then suggest that if attachment disorganization is found in some serious sexual offenders this could have implications for treatment. Possible ways of increasing the validity of self-reported attachment style are also discussed within this paper.

Attention Deficit Hyperactivity Disorder is Associated with Attachment Insecurity

The literature on attention deficit hyperactivity disorder (ADHD) and attachment is reviewed, and we describe an investigation of the relationship between attachment insecurity and ADHD. Nineteen boys, aged 5–10 years with DSM-IV diagnoses of ADHD were compared with 19 control children on three representational measures assessing internal working models of attachment and the self: the Separation Anxiety Test, the Self Interview, and a Family Drawing rated with an attachment-based scoring system. Consistent support was found for the hypothesis that ADHD is associated with insecurity of attachment, with the ADHD group obtaining poorer scores on all three measures. The nature of attachment insecurity in the ADHD group was one of heightened emotional expression characterized by strong, out of control affects, and was consistent with an anxious-ambivalent or disorganized attachment style. We argue that quality of attachment with primary caregivers should be assessed when children present with symptoms of ADHD, and that where insecure attachment relationships are found, treatment must incorporate relationship-building components.