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

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 SecureAutonomous AvoidantDismissing ResistantPreoccupied

Clinical Implications Depressive Disorders Anxiety 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)

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