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Attachment Theory and Psychopathology

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

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Attachment Theory and Psychopathology

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  1. Attachment Theory and Psychopathology

  2. What is Attachment? • Enduring emotional tie • Internal working model • Secure base for exploration • Foundation for future relationships

  3. 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

  4. Categories of Infant Attachment • Organized Attachment • Secure, Avoidant, & Ambivalent • Disorganized Attachment

  5. 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

  6. Avoidant Relationship • Behaves independent of mom • Lack of greeting on reunion • Focus on exploration without reference to mother - distraction from negative emotion

  7. Resistant Relationship • Lack of exploration • Typically distressed at separation • Anger or passivity interferes with being comforted on reunion

  8. Distribution of Organized Patterns

  9. Clinical Implications • Securely Attachment Infants: • more competent with peers • more competent problem solvers • less vulnerable to behaviour problems • more self confident

  10. Clinical Implications • Avoidant and Resistant attachment: • More hostile with peers • Peer victimization • More behaviour problems Resistant - linked to anxiety disorder in adolescence

  11. 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

  12. Signs of Disorganization • Approach parent in odd ways • Move away from parent when upset or frightened • Freeze • Show fear of parent

  13. 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

  14. Attachment and Family Drawings See overheads

  15. Adult Attachment and Psychopathology

  16. 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

  17. 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

  18. Strange Situation and AAI’s Secure Autonomous Avoidant Dismissing Resistant Preoccupied

  19. Clinical Implications Depressive Disorders Anxiety Disorders Borderline Personality Disorder

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

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

  22. 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

  23. Attachment Interventions Van den Boom (1994)

  24. 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

  25. 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

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