attachment theory and psychopathology. what is attachment? enduring emotional tie internal working...
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Attachment Theory and Psychopathology
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What is Attachment?
• Enduring emotional tie
• Internal working model
• Secure base for exploration
• Foundation for future relationships
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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
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Categories of Infant Attachment
• Organized Attachment– Secure, Avoidant, & Ambivalent
• Disorganized Attachment
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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
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Avoidant Relationship
• Behaves independent of mom
• Lack of greeting on reunion
• Focus on exploration without reference to mother - distraction from negative emotion
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Resistant Relationship
• Lack of exploration
• Typically distressed at separation
• Anger or passivity interferes with being comforted on reunion
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Distribution of Organized Patterns
0
10
20
30
40
50
60
70
North America Germany Israel
Percent
Secure
Avoidant
Ambivalent
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Clinical Implications
• Securely Attachment Infants:– more competent with peers– more competent problem solvers– less vulnerable to behaviour problems– more self confident
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Clinical Implications
• Avoidant and Resistant attachment:– More hostile with peers– Peer victimization– More behaviour problems
Resistant - linked to anxiety disorder in adolescence
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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
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Signs of Disorganization
• Approach parent in odd ways
• Move away from parent when upset or frightened
• Freeze
• Show fear of parent
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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
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Attachment and Family Drawings
See overheads
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Adult Attachment and Psychopathology
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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
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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
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Strange Situation and AAI’s
Secure Autonomous
Avoidant Dismissing
Resistant Preoccupied
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Clinical Implications
Depressive Disorders
Anxiety Disorders
Borderline Personality Disorder
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Depressive Disorders
• Rosenstein & Horowitz (1996)
• 32 psychiatrically hospitalized adolescents
• 31% were dismissing
• 69% were preoccupied
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Anxiety Disorders
• Fongay et al. (1996)
• 66% Preoccupied
• 18% Dismissing
• 16% Autonomous
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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
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Attachment Interventions
Van den Boom (1994)
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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
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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