Psych · Foundations — developmental science
Attachment theory and early relationships
Also known as Attachment theory · Strange Situation · Adult Attachment Interview · Secure base · Internal working models · Reactive attachment disorder · Disinhibited social engagement disorder · Attachment styles
Exam-exhaustive fellowship reference on attachment theory — Bowlby secure base/safe haven, Ainsworth Strange Situation patterns (secure/insecure/disorganised), Adult Attachment Interview states of mind, internal working models and mentalization, clinical implications for personality/trauma/parenting, and the critical distinction between attachment styles and DSM/ICD attachment disorders (RAD/DSED). FRANZCP-primary, globally tagged.
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Red flags
- Equating insecure attachment style with a clinical diagnosis or moral failure of parenting
- Diagnosing RAD/DSED without a history of insufficient care and multi-setting observation
- Missing autism spectrum disorder or ADHD while over-attributing social problems to attachment
- Coercive holding, rebirthing, or rage-reduction attachment therapies — associated with harm
- Using attachment labels alone to predict violence, custody outcomes, or risk without proper tools
- Assuming attachment is fixed for life — earned security and intervention effects exist
Meet the patient
A 16-year-old in her fourth foster placement self-harms after every perceived rejection, swings between clinging to her keyworker and refusing to speak to her, and last week walked off with a stranger at the bus stop. She was neglected in early childhood and spent ages two to five in an institution before any stable care.[15][18]
The registrar writes "attachment disorder" in the margin. The consultant's first question on the ward round: "Is this a style or a disorder — and what would have to be true for each?" Everything below exists to answer that question at fellowship depth.[15][16]
References18ShowHide
- [1]Bowlby J The making and breaking of affectional bonds. I. Aetiology and psychopathology in the light of attachment theory. An expanded version of the Fiftieth Maudsley Lecture, delivered before the Royal College of Psychiatrists, 19 November 1976 Br J Psychiatry, 1977.PMID 843768
- [2]Bowlby J Attachment and loss: retrospect and prospect Am J Orthopsychiatry, 1982.PMID 7148988
- [3]Bowlby J Developmental psychiatry comes of age Am J Psychiatry, 1988.PMID 3276225
- [4]Ainsworth MD Patterns of infant-mother attachments: antecedents and effects on development Bull N Y Acad Med, 1985.PMID 3864510
- [5]Hazan C, Shaver P Romantic love conceptualized as an attachment process J Pers Soc Psychol, 1987.PMID 3572722
- [6]Hesse E, Main M Disorganized infant, child, and adult attachment: collapse in behavioral and attentional strategies J Am Psychoanal Assoc, 2000.PMID 11212184
- [7]Schuengel C, Bakermans-Kranenburg MJ, Van IJzendoorn MH Frightening maternal behavior linking unresolved loss and disorganized infant attachment J Consult Clin Psychol, 1999.PMID 10028209
- [8]Granqvist P, Sroufe LA, Dozier M, et al. Disorganized attachment in infancy: a review of the phenomenon and its implications for clinicians and policy-makers Attach Hum Dev, 2017.PMID 28745146
- [9]Fonagy P, Target M Attachment and reflective function: their role in self-organization Dev Psychopathol, 1997.PMID 9449001
- [10]Fonagy P, Target M, Gergely G, et al. Attachment and borderline personality disorder. A theory and some evidence Psychiatr Clin North Am, 2000.PMID 10729934
- [11]Fonagy P, Bateman AW Adversity, attachment, and mentalizing Compr Psychiatry, 2016.PMID 26654293
- [12]Fonagy P, Luyten P A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder Dev Psychopathol, 2009.PMID 19825272
- [13]Fearon RP, Bakermans-Kranenburg MJ, van Ijzendoorn MH, et al. The significance of insecure attachment and disorganization in the development of children's externalizing behavior: a meta-analytic study Child Dev, 2010.PMID 20438450
- [14]Groh AM, Roisman GI, van Ijzendoorn MH, et al. The significance of insecure and disorganized attachment for children's internalizing symptoms: a meta-analytic study Child Dev, 2012.PMID 22235928
- [15]Zeanah CH, Chesher T, Boris NW Practice Parameter for the Assessment and Treatment of Children and Adolescents With Reactive Attachment Disorder and Disinhibited Social Engagement Disorder J Am Acad Child Adolesc Psychiatry, 2016.PMID 27806867
- [16]Gleason MM, Fox NA, Drury S, et al. Validity of evidence-derived criteria for reactive attachment disorder: indiscriminately social/disinhibited and emotionally withdrawn/inhibited types J Am Acad Child Adolesc Psychiatry, 2011.PMID 21334562
- [17]Chaffin M, Hanson R, Saunders BE, et al. Report of the APSAC task force on attachment therapy, reactive attachment disorder, and attachment problems Child Maltreat, 2006.PMID 16382093
- [18]Fox NA, Nelson CA 3rd, Zeanah CH The Effects of Psychosocial Deprivation on Attachment: Lessons from the Bucharest Early Intervention Project Psychodyn Psychiatry, 2017.PMID 29244624