Attachment Theory and Psychopathology

What is Attachment?

• Enduring emotional tie• Internal working model• Secure base for exploration• Foundation for future relationships

Assessment of Attachment in Infancy

• Strange Situation as standard setting for observing infant attachment

• Variety of mildly stressful events including separations and reunions with mother– focus is on reunion behaviour

Categories of Infant Attachment

• Organized Attachment– Secure, Avoidant, & Ambivalent

• Disorganized Attachment

Secure Relationship

• Greets parent on reunion• Comfort seeking if upset• Comfort is effective in soothing• Security allows confidence in exploration• Balance of attachment and exploration

Avoidant Relationship

• Behaves independent of mom• Lack of greeting on reunion• Focus on exploration without reference

to mother - distraction from negative emotion

Resistant Relationship

• Lack of exploration• Typically distressed at separation• Anger or passivity interferes with

being comforted on reunion

Distribution of Organized Patterns

0

10

20

30

40

50

60

70

North America Germany Israel

Percent

Secure

Avoidant

Ambivalent

Clinical Implications

• Securely Attachment Infants:– more competent with peers– more competent problem solvers– less vulnerable to behaviour problems– more self confident

Clinical Implications

• Avoidant and Resistant attachment:– More hostile with peers– Peer victimization– More behaviour problems

Resistant - linked to anxiety disorder in adolescence

Disorganized Relationship

• First noticed in infants with a history of maltreatment

• Breakdown in the organization of the attachment system

• Theorized to relate to fear of the parent “fright without solution”

• 15% in non-clinical samples; as high as 80% in at-risk samples

Signs of Disorganization

• Approach parent in odd ways • Move away from parent when upset or

frightened• Freeze • Show fear of parent

Clinical Implications

• Poor regulation of negative emotions• Oppositional defiant behaviour• Hostile-aggressive behaviour• Coercive and punitive styles of interacting

with peers and family members• Dissociative Disorders

Attachment and Family Drawings

See overheads

Adult Attachment and Psychopathology

AAI Questions

• Description of childhood relationships• Five adjectives with episodic memories• Upset and separation experiences• Abuse and loss• Relationships since childhood• Relationship with own child

Organized Categories

• Autonomous (60% of population)– coherent with little self deception– values attachment relationships

• Dismissing (22% of population)– limits activation by idealization, lack of memory, or

devaluing attachment figures– emphasis on fun or material aspects of relationship limits

emotional aspects • Preoccupied (17% of population)

– entangled with parents - weak sense of self– memories, but difficulty providing objective overview

Strange Situation and AAI’s

Secure Autonomous

Avoidant Dismissing

Resistant Preoccupied

Clinical Implications

Depressive DisordersAnxiety Disorders

Borderline Personality Disorder

Depressive Disorders

• Rosenstein & Horowitz (1996)• 32 psychiatrically hospitalized adolescents• 31% were dismissing• 69% were preoccupied

Anxiety Disorders

• Fongay et al. (1996)• 66% Preoccupied• 18% Dismissing• 16% Autonomous

Borderline Personality Disorder

• Patrick et al. (1994)– 12 Borderline patients– 100% preoccupied

• Fonagy et al. (1996)– 36 Borderline patients– 75% preoccupied– 17% dismissing– 8% autonomous

Attachment Interventions

Van den Boom (1994)

Van den Boom (1994)

• Train caregivers in sensitive responsiveness (increase maternal sensitivity)

• To do this you need to:– Improve the mothers’ ability to monitor,

perceive, and respond to the infant’s signals and needs accurately

Supporting Secure Attachment

Intervention Study– 100 highly irritable infants– 3 home visits between 6 and 9 months focused

on enhancing sensitivity– ‘Intervention’ mothers more sensitive– 65% of intervention and 28% of control coded

as secure in strange situation