Aggression and Suicidal Behavior During Latency

1. Aggression and Suicidal Behavior During Latency • What is latency? • Follows conflicts produced by Oedipus Complex • Sexual and aggressive drives become latent or dormant, becoming sublimated in industrious activities (e.g., hobbies, sports) • Peer relationships assume greater importance

2. Problems during Latency • Conflicts from the Oedipal period as well as earlier periods (oral, anal periods) are poorly resolved or not resolved at all • Attachment insecurities assume different forms • secure –confidence in relationships, goal-corrected partnership, autonomy • Casual –minimizing or dismissing of attachment needs • Busy – distracting oneself from affective components of attachment through activity or displacement of fears onto others (projection, reaction formation) • Controlling • Punitive • Caregiving

3. Resulting symptomatology—aggression or depression • Possible etiologies • Wants to hurt others because not Oedipal victor, not in control of parents (anal), or not getting basic security needs met (oral) • Wants to hurt self because of guilty feelings over being Oedipal victor, fantasies of having destroyed mother (oral), need to destroy internal representation of mother or father, need to activate caregiver’s concern

4. Attachment Disorganization In Prepubertal Psychiatric Inpatients • Three traditional patterns of attachment (A, B, C) • Fourth category (D) • Four proposed subtypes of D—looking for organization within disorganization • Direct-aggressive outward • Direct-aggressive inward • Indirect-aggressive pseudosecure • Indirect-aggressive displaced

5. Each attachment pattern subtype is coherently related to both psychiatric diagnosis and clinical symptomatology, as well as to what we know about the relationship to the mother (but diagnosis and symptomatology can imply other pathways) • Each child had experienced significant separation from a significant or primary caregiver

6. Psychotic features could be related to disturbances in the attachment relationship (difficulties with separation) • Is the disorganization attachment-relevant, or more global psychosis? • Is the disorganization attachment-relevant, or more neurologically based? • Could florid psychotic features (in subtype 1 and 2) develop into more reality-based disorganization (in subtypes 3 and 4)?

7. Effects of Attachment Disorganization during Latency I (Solomon et al.) • Children who appear controlling upon reunion appear frightened (chaotic or inhibited) in story completions • Frightened children appear more aggressive at home and more hostile at school then children with organized attachment strategies • Development of coding system related to development sample (p. 460, 2nd column)

8. 6/13 D, 4/27 non-D fell into highest quartile on CBCL • 7/11 D, 4/29 non-D fell into lowest quartile of ISCS

9. Effects of Attachment Disorganization During Latency II (Easterbrooks et al.) • Do attachment security and verbal intelligence moderate the effects of psychosocial risk on behavioral adaptation (aggression in classroom)? • How psychosocial risk is measured • Family income • AFDC status (welfare) • Maltreatment reports to DSS • Law enforcement problems during past two years • Serious injuries or hospitalization of child during past two years • Maternal depression (CES-D) ≥ 16 (clinical cutoff) • Sum = sum of yes scores to all six areas (composite risk)

10. Correlation matrix • Risk related to attachment security (p < .05) • Risk not related to attachment avoidance (n.s.) • Risk marginally related to verbal intelligence (p <.10) • Attachment security related to verbal intelligence (p <.05) • Attachment avoidance related to verbal intelligence (p <.05) • Attachment security related to attachment avoidance (p <.001) • Risk related to externalizing, total behavior problems • Attachment security related to internalizing, externalizing, total behavior problems • Attachment avoidance related to internalizing, externalizing, total behavior problems • Verbal intelligence not related to behavior problems

11. Predictions (R+A+V+R*A+R*V  behavior problem) • Risk predicted externalizing and total problems in both mother and father reports • Attachment security predicted internalizing, externalizing, and total problems, but only in teacher reports • No interaction effects in behavior-problems analyses • Verbal intelligence did not predict behavior problems • Insecure attachments more likely to appear in clinical range than secure attachments (88% vs. 45%, 100% controlling)

12. Suicidal Behavior During Latency • Maternal suicidal ideas and gestures (severity) related to child’s treatment status (p < .01) • Prevalence of diagnosis • Inpatient: conduct disorder, MDD, Organic Brain Syndrome, PDD, Schizophrenia, BPD • Outpatient: adjustment disorder • Nonpatient: anxiety disorder

13. Variables associated with suicidal behavior • Recent general psychopathology • Preoccupation with death • Recent and past depression • Introjection (inpatient, nonpatient) • Past general psychopathology • Recent aggression (outpatient)