Attachment Disorganization

Significance Attachment disorganization is important to mental health, and is predicted by differences in caregiving. Still, not all children are equally influenced by such environmental factors. We examined whether differences in brain structures important to stress regulation influence the relation between maternal sensitive caregiving and levels of disorganization. We assessed brains at birth, as children are not yet exposed to substantial variation in parenting at this point in time. Our findings indicate that differences in the hippocampus, a structure important to conflict and stress, influence the association between caregiving and child outcomes. If replicated, this work may allow for more targeted interventions, and suggests the need to enhance fear regulation capabilities in infants likely to be exposed to lower quality caregiving.

There is limited research on the role of childhood trauma in personality pathology according to Kernberg's psychodynamic model of internalized object relations. Because childhood trauma reflects the disruptions of these relations, it is expected to predict borderline personality organization, especially at the threshold of adulthood. Therefore, the main aim of this retrospective study was to examine the impact of childhood trauma on borderline personality organization in a community sample of emerging adults. Participants were 543 Greek individuals aged 18-29 (M = 21.45; 58.6 % females; 85.1 % university students). They completed the Greek versions of the Traumatic Antecedents Questionnaire (TAQ) and the Inventory of Personality Organization (IPO), which were tested for their factorial structure, reliability, and measurement invariance across gender, as few empirical data exist on the psychometric properties of these measures. Confirmatory factor analyses showed that the TAQ consisted of four factors, namely positive experiences, abuse, traumatic life events, and family chaos. The fivefactor theoretical structure of the IPO, namely primitive defenses, identity diffusion, reality testing, aggression, and moral values, was confirmed. Low to moderate links between childhood trauma and borderline personality organization were found, with stronger links emerging for abuse and family chaos. Structural equation modeling showed that the various forms of childhood trauma across the age periods studied (i.e., 0-6, 7-12, 13-18) significantly and differentially predicted the dimensions of borderline personality organization. The finding that stronger links emerged when trauma occurred in older ages may be attributed to the retrospective method of the study. Gender differences were also found; for example, personality pathology was more likely in men when abuse and traumatic life events occurred in younger ages and abuse was a more important risk factor for personality pathology in women. This study highlights the impact of childhood adversity on personality pathology in emerging adulthood, provides empirical support for Kernberg's psychodynamic model, and has useful implications for trauma-informed early screening, prevention, and intervention regarding personality pathology in young people. Limitations of this study and suggestions for future research are outlined.

The predictive relations between assessments in infancy and parent-and teacher-reported behavior problems at age 7 were investigated within a low-income sample. Infancy assessments indexed family adversity, parent-infant interaction at home, infant attachment, infant anger-distress at home, gender, and cognitive functioning. Among children at age 7 identified by teachers as highly externalizing, 83% were both disorganized in their attachment behavior in infancy and below the national mean in mental development scores at 18 months, compared with 13% of nonexternalizing children. Avoidant attachment behavior in infancy was associated with later internalizing symptoms rather than with externalizing symptoms. The behavior problem data reported by mothers suggested the possibility of attachment-related biases in maternal report data. The results indicate that mild mental lag in the context of a disorganized attachment relationship constitutes 1 early step on the pathway to school-age externalizing behavior.

The aim of this study was to broaden the understanding of the emotional difficulties of borderline personality organization (BPO) by reference to a meta-ability named 'orientation on the internal world', here conceptualized as mentalization and mindfulness, in the framework of object relation theory. It was assumed that it is not mentalization "in itself", but mainly its regulatory function, that is important for BPO. participants and procedure The clinical and control groups (30 individuals each) were examined using The Mental States Task, The Difficulties of Emotion Regulation Scale and The Mindful Attention Awareness Scale. results Individuals with BPO functioned worse than the control group in terms of mentalization, mindfulness, and emotion regulation. The relationship between BPO and the meta-abilities was mediated by emotional dysregulation: total mediation was revealed for one mentalization dimension, and partial mediation was observed for mindfulness. conclusions Orientation on emotional experience and emotional dysregulation are not independent predictors of BPO, but they can be treated as levels in the hierarchical model. Mentalization determines and influences emotion regulation in BPO.

Narrative Story-Stem Tasks (NSST) assess young children's perceptions of close relationship qualities via the spontaneous narratives they create in response to story beginnings using doll-like figures. Most NSST research to date has focused on family relationships. This study extends this research to children's perceptions of relationships with teachers (caregiving and attachment) and peers (exploration, mutuality, and aggression) in school settings. Three new story-stems were created for this purpose. A racially and economically diverse sample (n = 39) was recruited from two school systems in the U.S. As predicted, girls were more likely to enact relational aggression in their narratives. Children attending the higher SES school were significantly more likely to enact representations of teachers as caregivers, and representations of parental and teacher caregiving were significantly associated. Parentreported perceptions of their children's teachers were significantly associated with children's narrative representations of attachment behaviour directed toward teachers. Implications for policy and services are discussed.

Why is disorganized attachment associated with punitive-controlling behavior in some, but caregiving-controlling in others? Hygen et al. (2014) proposed that variation in the Catechol-O-methyl transferase(COMT) Val158Met genotype explains this variation, providing preliminary data to this effect. We offer a conceptual replication, analyzing data on 560 children (males: 275) drawn from the NICHD Study of Early Child Care and Youth Development. As predicted, competitive model-fitting indicated that disorganized infants carrying Met alleles engage in more positive behavior and less negative behavior than other children at age 5 and 11, with the reverse true of Val/Val homozygotes, seemingly consistent with caregiving-controlling and punitive-controlling styles, respectively, but only in the case of maternal and not teacher reports, thereby confirmating a relationship-specific hypothesis.

Narrative Story-Stem Tasks (NSST) assess young children's perceptions of close relationship qualities via the spontaneous narratives they create in response to story beginnings using doll-like figures. Most NSST research to date has focused on family relationships. This study extends this research to children's perceptions of relationships with teachers (caregiving and attachment) and peers (exploration, mutuality, and aggression) in school settings. Three new story-stems were created for this purpose. A racially and economically diverse sample (n = 39) was recruited from two school systems in the U.S. As predicted, girls were more likely to enact relational aggression in their narratives. Children attending the higher SES school were significantly more likely to enact representations of teachers as caregivers, and representations of parental and teacher caregiving were significantly associated. Parentreported perceptions of their children's teachers were significantly associated with children's narrative representations of attachment behaviour directed toward teachers. Implications for policy and services are discussed.

This longitudinal study examined links between disorganization and atypical maternal behavior at 12 and 24 months in 71 adolescent mother-child dyads. Organized attachment and maternal not disrupted behavior were more stable than disorganization and disrupted behavior, respectively. At both ages, disorganization and maternal disrupted behavior were significantly correlated. Change in atypical maternal behavior predicted change in disorganization across time. The results provide substantial support for extant theories linking anomalous maternal behavior to the development of disorganized attachment. The Interesting-but-Scary paradigm, introduced in this study, promises to be a useful tool for assessing attachment and maternal behavior in toddlerhood.

Researchers returned to the home of Mary Ainsworth's original attachment study to explore the contributions of Ugandan children's representations of attachment interactions with their caregivers to their perceptions about gender. Researchers administered the Attachment Story-Completion Task (ASCT) and applied three attachment narrative coding systems and a gender stereotypes typology to the ASCT stories of 51 Ugandan children ages 5-7. Nine attachment narrative variables were applied to the children's responses to a series of five attachment story stems told using a family of dolls. The narratives emerging from the children's responses to these story stems were also coded independently for 14 masculine and 14 feminine gender stereotypes. Empathic relations among the dolls and narrative coherence were positively correlated with counterstereotypical gender representations only in girls. Attachment representations of a rejecting father were positively correlated with stereotypical gender representations only in boys. Representations of attachment avoidance were negatively correlated with counterstereotypical gender representations in both boys and girls. The findings suggested two different trajectories for the development of gender representation flexibility in boys and girls. This study contextualizes these findings against the backdrop of a country with rigid sex roles and a fast-growing child population.

Fifty-six middle-income children ages 5 to 10 were videotaped completing five stories thematically related to attachment experiences and classified according to representation of attachment disorganization (D, non-D). Mothers completed a self-report questionnaire assessing three core components of personality organization-identity diffusion, primitive defenses, and failure of reality testing-and two other self-report questionnaires assessing current depression and trait and state anger. Finally, mothers completed a questionnaire assessing their children's externalizing behavior. A series of multiple regression analyses demonstrated that identity diffusion and disorganized attachment representa

Introduction Reflective function is developed in the context of secure attachment and corresponds to the ability to understand one’s mental states and those of others. Thus, identity develops, which relates to the experience of self as unique, continuous and coherent. Objective To identify reflective function and identity features in adolescents with clinical and nonclinical symptoms of mental health problems. Method Participants were 188 Brazilian high school students aged 14-17 years: 30.3% with clinical symptoms and 69.9% with nonclinical symptoms. Results Adolescents with clinical symptoms showed lower levels of reflective function and greater disintegration of identity. Conclusion Adolescence is a vulnerable time for mental health problems associated with reflective function and identity. Early identification of symptoms is a matter that needs attention to prevent future consequences.

Introduction Reflective function is developed in the context of secure attachment and corresponds to the ability to understand one’s mental states and those of others. Thus, identity develops, which relates to the experience of self as unique, continuous and coherent. Objective To identify reflective function and identity features in adolescents with clinical and nonclinical symptoms of mental health problems. Method Participants were 188 Brazilian high school students aged 14-17 years: 30.3% with clinical symptoms and 69.9% with nonclinical symptoms. Results Adolescents with clinical symptoms showed lower levels of reflective function and greater disintegration of identity. Conclusion Adolescence is a vulnerable time for mental health problems associated with reflective function and identity. Early identification of symptoms is a matter that needs attention to prevent future consequences.

Fifty-six middle-income children ages 5 to 10 were videotaped completing five stories thematically related to attachment experiences and classified according to representation of attachment disorganization (D, non-D). Mothers completed a self-report questionnaire assessing three core components of personality organization-identity diffusion, primitive defenses, and failure of reality testing-and two other self-report questionnaires assessing current depression and trait and state anger. Finally, mothers completed a questionnaire assessing their children's externalizing behavior. A series of multiple regression analyses demonstrated that identity diffusion and disorganized attachment representa

Research has suggested adverse childhood experiences (ACEs) as a transdiagnostic risk factor for a variety of affective disorders. They are also linked with a parent's tendency toward affect dysregulation and hyperarousal, which may interfere with parenting and children's wellbeing. On the other hand, maternal mentalization can serve as a moderating factor that can help parents regulate their arousal, shielding children during adverse circumstances. We studied the mediated links between ACEs and mothers' and children's psychopathology symptoms during COVID-19 to determine whether maternal mentalization and the child's age moderate these links. Using results from 152 Israeli mothers of children aged 3–12 years recruited during the month-long lockdown in Israel, we documented that the mothers' ACEs were linked with increased risk of depressive and anxiety symptoms and with children's internalizing and externalizing behaviors. Moreover, as hypothesized, the ...

Objective: Several developmental models of borderline personality disorder (BPD) emphasize the role of disrupted interpersonal relationships or insecure attachment. As yet, attachment quality and the mechanisms by which insecure attachment relate to borderline features in adolescents have not been investigated. In this study, we used a multiple mediational approach to examine the cross-sectional interplay between attachment, social cognition (in particular hypermentalizing), emotion dysregulation, and borderline features in adolescence, controlling for internalizing and externalizing symptoms. Method: The sample included 259 consecutive admissions to an adolescent inpatient unit (Mage = 15.42, SD = 1.43; 63.1% female). The Child Attachment Interview (CAI) was used to obtain a dimensional index of overall coherence of the attachment narrative. An experimental task was used to assess hypermentalizing, alongside self-report measures of emotion dyregulation and BPD. Results: Our findings suggested that, in a multiple mediation model, hypermentalizing and emotion dysregulation together mediated the relation between attachment coherence and borderline features, but that this effect was driven by hypermentalizing; that is, emotion dysregulation failed to mediate the link between attachment coherence and borderline features while hypermentalizing demonstrated mediational effects. Conclusions: The study provides the first empirical evidence of well-established theoretical approaches to the development of BPD.

We examined the prediction that the interaction between Glucocorticoid Receptor Gene (NR3C1) methylation, stress, and experienced maternal support predicts anxious and avoidant attachment development. This was tested in a general population sample of 487 children and adolescents (44% boys, Mage = 11.84, SDage = 2.4). These children were followed over a period of 18 months. In line with the prediction, we found that NR3C1 methylation moderates the effect of maternal support during stress on anxious attachment development 18 months later. More stressed children who experienced less maternal support reported increased anxious attachment when their NR3C1 gene was highly methylated. This effect could not be explained by children's level of psychopathology. No effects were found for attachment avoidance. These data provide the first prospective evidence that epigenetic processes are involved in attachment development. (PsycINFO Database Record

The activation relationship refers to the emotional bond a child develops with a parent that helps ensure the regulation of risk-taking during child exploration of the surrounding environment. As a complement to Bowlby’s attachment theory, activation relationship theory provides a greater understanding of the impact of fathering on child development, focusing primarily on parental stimulation of risk-taking and control during child exploration. The overarching objective of this article is to better understand the association between children’s relationship quality with both parents, via the activation to father and the attachment to mother relationships, and child externalizing behaviors in a clinical sample. Fifty two-parent families (40 boys and 10 girls) were recruited at random from a population of children receiving treatment at the perinatal and early childhood psychiatry clinic. Results with 44 children (with complete cases) showed that overactivated preschoolers displayed mo...

This study examined the psychopathology and socioemotional functioning of school-aged children treated during infancy and a comparison group of children without symptoms or treatment history. Our goal was to identify the factors associated with the continuity of psychopathology from infancy to childhood. The sample comprised 54 Israeli children, 30 with treatment history as infants in an infant mental health clinic and 24 with no treatment history. A 2 × 2 study design, with treatment history (treated/non-treated) and current psychiatric diagnosis (diagnosed vs. non-diagnosed), was used and group differences in children’s psychopathology (Development and Well-Being Assessment (DAWBA)), socioemotional functioning (Vineland Adaptive Behavior Scales–Second Edition (VABS-II)), maternal stress (Parenting Stress Index-Short Form (PSI/SF)) and psychopathology (Symptom Checklist-90-Revised (SCL-90-R)), family functioning (Family Assessment Device (FAD)), and mother–child relational patterns...

Background: Developmental Language disorders (DLD) are developmental disorders that can affect both expressive and receptive language. When severe and persistent, they are often associated with psychiatric comorbidities and poor social outcome. The development of language involves early parent-infant interactions. The quality of these interactions is reflected in the quality of the child's attachment patterns. We hypothesized that children with DLD are at greater risk of insecure attachment, making them more vulnerable to psychiatric comorbidities. Therefore, we investigated the patterns of attachment of children with expressive and mixed expressive-receptive DLD. Methods: Forty-six participants, from 4 years 6 months to 7 years 5 months old, 12 with expressive Specific Language Impairment (DLD), and 35 with mixed DLD, were recruited through our learning disorder clinic, and compared to 23 normally developing children aged 3 years and a half. The quality of attachment was measured using the Attachment Stories Completion Task (ASCT) developed by Bretherton. Results: Children with developmental mixed language disorders were significantly less secure and more disorganized than normally developing children. Conclusions: Investigating the quality of attachment in children with DLD in the early stages could be important to adapt therapeutic strategies and to improve their social and psychiatric outcomes later in life.

Several theoretical perspectives suggest that knowledge of children's perceptions of and beliefs about their parents' depression may be critical for understanding its impact on children. This paper describes the development and preliminary evidence for the psychometric properties of a new measure, the Children's Perceptions of Others' Depression-Mother Version (CPOD-MV), which assesses theoretically and empirically driven constructs related to children's understanding and beliefs about their mothers' depression. These constructs include children's perceptions of the severity, chronicity, and impairment of their mothers' depression; self-blame for their mother's depression; and beliefs about their abilities to deal with their mother's depression. The CPOD-MV underwent two stages of development: (1) a review of the literature to identify key constructs, focus groups to help generate items, and clinicians' ratings on the relevance and comprehensibility of the drafted items and (2) a study of the measure's psychometric properties. The literature review, focus groups, and itemreduction techniques yielded a 21-item measure. Reliability, factor structure, and discriminant, convergent, and concurrent validity were tested in a sample of 10-to 17-year-old children whose mothers had been treated for depression. The scale had good internal consistency; factor structure suggestive of a single construct; and discriminant, concurrent, convergent, and incremental validity, suggesting the importance of measuring children's perceptions of their mothers' depression beyond knowledge of mothers' depression symptom level when explaining which children have the greatest risk for emotional and behavioral problems among children of depressed mothers. These findings support continued development and beginning clinical applications of the scale.

US government-funded early home visiting services are expanding significantly. The most widely implemented home visiting models target at-risk new mothers and their infants. Such home visiting programs typically aim to support infant-parent relationships; yet, such programs' effects on infant attachment quality per se are as yet untested. Given these programs' aims, and the crucial role of early attachments in human development, it is important to understand attachment processes in home visited families. The current, preliminary study examined 94 high-risk mother-infant dyads participating in a randomized evaluation of the Healthy Families Durham (HFD) home visiting program. We tested (a) infant attachment security and disorganization as predictors of toddler behavior problems and (b) program effects on attachment security and disorganization. We found that (a) infant attachment disorganization (but not security) predicted toddler behavior problems and (b) participation in HFD did not significantly affect infant attachment security or disorganization. Findings are discussed in terms of the potential for attachment-specific interventions to enhance the typical array of home visiting services.

We examined how maternal depression, anxiety, hostility, mentalization, negative intentionality (NI), and unsupportive emotion socialization (UES) predict child internalizing and externalizing problem behaviors (CIEPB). Mothers (N = 537) of toddlers (M age = 23.26 months, Range 10-44 months) completed the Brief Symptom Inventory, the Parental Reflective Functioning Questionnaire, the Infant Intentionality Questionnaire, the Coping with Children's Negative Emotions Scale, and the Child Behavior Checklist. All maternal symptoms negatively predicted mentalization and positively predicted NI, UES, and CIEPB. NI and UES mediated the relationship between maternal symptoms and CIEPB. Negative intentionality mediated the link between maternal hostility and internalizing behaviors, indicating a possible intervention area. Mentali-zation had an effect on externalizing behaviors only for high-SES, anxious mothers, underscoring the role of SES. Thus, the relationship between maternal symptoms, cognitive and behavioral parenting characteristics and CIEPB supports the multifinality principle for early childhood psychopathology development and shows the importance of screening for maternal symptoms and CIEPB. Keywords Maternal symptoms · Mentalization · Negative intentionality · Unsupportive emotion socialization · Child problem behaviors Early childhood problem behaviors are known to be the first indicators of adjustment issues [1, 2], which are leading factors in the development of various psychological problems such as depression [3], substance abuse, and anxiety [4]. Two categories of problem behaviors have been extensively explored-namely, internalizing and externalizing behaviors [5]. Externalizing behaviors involve aggressive behaviors and hyperactivity in children, triggered by anger, fear, and frustration, whereas internalizing behaviors typically indicate anxiety and depression in the form of social withdrawal and fearfulness [5]. These problem behaviors become detectable from as early as 12 months [6, 7] and are likely to persist from early childhood [8] into adolescence [9] and adulthood [10]. A wide array of environmental factors and parental characteristics , such as personality [11] and parenting behaviors can contribute to the complexity of child development [12] and the occurrence of problem behaviors. Individual differences in parental psychopathology, cognitions about parenting, and emotion socialization are highly salient factors in child development. In the relevant literature, parental psychopathology, cognitions, and socializing behaviors are listed as critical etiological factors with unique as well as joint contributions to problem behaviors in young children [13]. For example, maternal depressive symptomatology [14] and maternal anxiety [15] have been associated with both externalization and internalization problems in children [16-18]. Since psychopathology is also linked with negative cognitions about the self, the world, and the future [19], it can also contribute to negative cognitions and attri-butions towards children [20] as well as negative maternal parenting behaviors and unsupportive emotion socialization [21]. However, there is a lack of research focusing on how

Objectives Externalizing behavior problems are considered to be a serious impediment to a child's development, and therefore it is important to identify their predictors. In this study, we investigated the connections between school-aged boys' externalizing problems, the mother's reflective functioning (RF) and the mother's perception of her childhood relationship with her own caregivers. Methods The study sample comprised 39 school-age boys diagnosed with externalizing behavior problems together with their mothers. A child's psychopathology was assessed using the Child Behavior Checklist and Teacher Report Form. Our assessment of the mothers' mentalizing capacities was based on the Adult Attachment Interview and Reflective Functioning Scale. The perception of a mother's childhood relationship with her parents was assessed using the Parental Bonding Instrument. Results The analysis revealed that more severe cases of aggressive and rule-breaking behavior in boys were associated with lower RF in mothers, as well as with a mother's perception of her childhood relationship with her own parents as less autonomous. More aggressive behavior in boys was also associated with a mother's perception of herself as experiencing a higher degree of care from her father during her own childhood. Conclusions These are only preliminary findings and we have discussed them with a view to understanding the possible ways in which a mother's RF and the intergenerational context of relationship quality are associated with externalizing behavior problems in middle childhood.

Objective: Several developmental models of borderline personality disorder (BPD) emphasize the role of disrupted interpersonal relationships or insecure attachment. As yet, attachment quality and the mechanisms by which insecure attachment relates to borderline features in adolescents have not been investigated. In this study, we used a multiple mediational approach to examine the cross-sectional interplay between attachment, social cognition (in particular hypermentalizing), emotion dysregulation, and borderline features in adolescence, controlling for internalizing and externalizing symptoms. Methods: The sample included 259 consecutive admissions to an adolescent inpatient unit (M age = 15.42, SD = 1.43; 63.1% female). The Child Attachment Interview (CAI) was used to obtain a dimensional index of overall coherence of the attachment narrative. An experimental task was used to assess hypermentalizing, alongside self-report measures of emotion dyregulation and BPD. Results: Our findings suggested that, in a multiple mediation model, hypermentalizing and emotion dysregulation together mediated the relation between attachment coherence and borderline features, but that this effect was driven by hypermentalizing; that is, emotion dysregulation failed to mediate the link between attachment coherence and borderline features while hypermentalizing demonstrated mediational effects.

Two psychodynamic treatments for children with externalizing behaviors are compared:
Regulation-Focused Psychotherapy for Children with Externalizing Behaviors (RFP-C) and
Mentalization Based Psychotherapy for Children (MBT-C). Although these two treatments encompass
a variety of similar interventions, the treatments differ as follows: MBT-C primarily addresses the
child’s subjective sense of self (social cognition system) whereas RFP-C primarily targets the child’s
defenses against unpleasant emotions (implicit emotion regulation system). With both approaches,
clinicians can manage their countertransference by using an active psychotherapeutic technique when
working with children who exhibit externalizing behaviors.

The aim of this study was to assess the reliability and validity of the Child Behavior Checklist (CBCL) as completed by doctoral-level clinicians in the treatment of adolescents. We asked 294 randomly selected, experienced psychiatrists and psychologists to describe a patient aged 14 to 18 in treatment for personality pathology. Clinicians completed the CBCL (parentreport version) and measures of adaptive functioning, personality pathology, and family and developmental history, which served as criterion variables to test the validity of the CBCL as completed by clinicians. Most CBCL scales demonstrated acceptable reliability. Validity estimates were impressive, and the data revealed clinically meaningful associations between specific CBCL scale scores and developmental and family history variables. Confirmatory factor analysis showed that the factorial structure of the clinician-report CBCL resembled that of the parent-report CBCL, with the exception of a substantially lower correlation between higher order internalizing and externalizing factors. The data suggest that clinical judgment can be both reliable and valid when quantified using psychometrically sound instruments.

Fifty-six middle-income children ages 5 to 10 were videotaped completing five stories thematically related to attachment experiences and classified according to representation of attachment disorganization (D, non-D). Mothers completed a self-report questionnaire assessing three core components of personality organization—identity diffusion, primitive defenses, and failure of reality testing—and two other self-report questionnaires assessing current depression and trait and state anger. Finally, mothers completed a questionnaire assessing their children's externalizing behavior. A series of multiple regression analyses demonstrated that identity diffusion and disorganized attachment representations independently predicted externalizing behavior, particularly aggressive behavior. Identity diffusion alone predicted delinquent behavior. Two potential developmental pathways of externalizing behavior are delineated as a function of the significant roles played by maternal personality organization and disorganized attachment representations. Even in a nonclinical sample, mothers’ identity diffusion—a key component of borderline personality organization— made a direct contribution to externalizing behavior over and above disorganized attachment representations. This finding suggests that mothers of children with externalizing behavior need psychotherapy to integrate split-off self and object representations and thus provide a coherent parenting experience, while their children need to perceive a coherent image of themselves in the mind of the therapist to facilitate affect regulation