Karlen Lyons-Ruth

Chapter IV. Maternal Frightened, Frightening, or Atypical Behavior and Disorganized Infant Attachment Patterns

A central question in the study of atypical attachment relationships in infancy is whether interactive processes between caregiver and infant are associated with the infant’s display of disorganized strategies (Main & Hesse, 1990). Attachment theory locates one central influence on the infant’s attachment strategies in the interplay between parent and infant over the 1st year, especially in the degree of sensitive responsiveness to the entire range of the infant’s affectively charged communications (Ainsworth, Blehar, Waters & Wall, 1978). Linkages between appropriate parental responsiveness and secure infant attachment strategies have been supported in a number of empirical studies (Ainsworth et al., 1978; Belsky, Rovine, & Taylor, 1984; Grossmann, Grossmann, Spangler, Seuss, & Unzner, 1985; Londerville & Main, 1981; van IJzendoorn, 1995). These earlier studies, however, were undertaken prior to the discovery of the disorganized/disoriented infant attachment pattern. They explored the relation between maternal behavior and the three organized infant attachment strategies only (ambivalent/avoidant/ secure). With the increasing recognition that a sizable proportion of infants from families with serious social risk factors display disorganized forms of attachment strategies, the question of whether disorganized behaviors emerge in the context of particular patterns of parent-infant interaction also must be addressed. The issues of whether and how mother-infant interactive processes are related to disorganization of infant attachment patterns gains additional importance from recent findings that early disorganized or controlling

The two‐person unconscious: Intersubjective dialogue, enactive relational representation, and the emergence of new forms of relational organization

The Two-Person Unconscious: Intersubjective Dialogue, Enactive Relational Representation, and the Emergence of New Forms of Relational Organization Karlen Lyons-Ruth, Ph.D. RECENT PSYCHOANALYTIC THEORY HAS MOVED INCREASINGLY toward a relational, intersubjective, and social— constructivist stance. In this view the psychoanalytic encounter is seen as mutually coconstructed between two active participants, with the subjectivities of both patient and analyst contributing to the form and content of the dialogue that emerges between them (McLaughlin, 1991; Hoffman, 1992; Ogden, 1994). The current emphasis in analytic writing on the importance of enactments in the treatment situation attempts to keep the lens focused squarely on the point of contact between the two analytic participants and on the form of the implicit transactions that emerge between them (e.g., Ogden, 1994). Clinical descriptions acknowledge the active contributions of both partners to the co-construction of the enactment, even though the primary clinical interest may be in those features of the enactment that echo problematic aspects of the patients interactions with other important people (Jacobs, 1991; Hoffman, 1992). Enactments have been viewed as

The disturbed caregiving system: Relations among childhood trauma, maternal caregiving, and infant affect and attachment

The interrelations among maternal childhood experiences of physical or sexual abuse, adult trauma-related symptoms, adult caregiving behavior, and infant affect and attachment were investigated among 45 low-income mothers and their 18-month-old infants. A history of physical abuse was associated with increased hostile-intrusive behavior toward the infant, increased infant negative affect, and a decreased tendency to report trauma-related symptoms. A history of sexual abuse was associated with decreased involvement with the infant, more restricted maternal affect, and more active reporting of trauma-related symptoms. Infants of mothers who had experienced childhood violence or abuse were not more likely to display insecure attachment strategies than infants of mothers who had not experienced trauma. However, the form of insecure behavior was significantly different. Insecure infants of violence-exposed mothers displayed predominantly disorganized strategies, whereas insecure infants of mothers with benign childhoods or neglect only displayed predominantly avoidant strategies. Results are discussed in relation to Main and Hesses (1990) concept of frightened or frightening behavior and to current literature on psychological sequelae of trauma.

Infant Attachment Strategies, Infant Mental Lag, and Maternal Depressive Symptoms: Predictors of Internalizing and Externalizing Problems at Age 7.

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 mother suggested the possibility of attachment-related biases in maternal report data. The results indicate that child mental lag in the context of a disorganized attachment relationship constitutes 1 early step on the pathway to school-age externalizing behavior.

Attachment Studies with Borderline Patients: A Review

&NA; Clinical theorists have suggested that disturbed attachments are central to borderline personality disorder (BPD) psychopathology. This article reviews 13 empirical studies that examine the types of attachment found in individuals with this disorder or with dimensional characteristics of BPD. Comparison among the 13 studies is handicapped by the variety of measures and attachment types that these studies have employed. Nevertheless, every study concludes that there is a strong association between BPD and insecure attachment. The types of attachment found to be most characteristic of BPD subjects are unresolved, preoccupied, and fearful. In each of these attachment types, individuals demonstrate a longing for intimacy and—at the same time—concern about dependency and rejection. The high prevalence and severity of insecure attachments found in these adult samples support the central role of disturbed interpersonal relationships in clinical theories of BPD. This review concludes that these types of insecure attachment may represent phenotypic markers of vulnerability to BPD, suggesting several directions for future research.

BPD'S INTERPERSONAL HYPERSENSITIVITY PHENOTYPE: A GENE-ENVIRONMENT- DEVELOPMENTAL MODEL

This paper explores the development of BPD as it might emerge in the childs early interpersonal reactions and how such reactions might evolve into the interpersonal pattern that typifies BPD. It begins to bridge the relevant bodies of clinical literature on the borderlines prototypic interpersonal problems with the concurrently expanding relevant literature on early child development. We will start by considering how a psychobiological disposition to BPD is likely to include a constitutional diathesis for relational reactivity, that is, for hypersensitivity to interpersonal stressors. Data relevant to this dispositions manifestations in adult clinical samples and to its heritability and neurobiology will be reviewed. We then consider how such a psychobiological disposition for interpersonal reactivity might contribute to the development of a disorganized-ambivalent form of attachment, noting especially the likely contributions of both the predisposed child and of parents who are themselves predisposed to maladaptive responses, leading to an escalation of problematic transactions. Evidence concerning both the genetics and the developmental pathways associated with disorganized attachments will be considered. Emerging links between such developmental pathways and adult BPD will be described, in particular the potential appearance by early- to middle-childhood of controlling-caregiving or controlling-punitive interpersonal strategies. Some implications from this gene-environment interactional theory for a better developmental understanding of BPDs etiology are discussed.

Expanding the concept of unresolved mental states: Hostile/Helpless states of mind on the Adult Attachment Interview are associated with disrupted mother–infant communication and infant disorganization

In a recent meta-analysis, only 53% of disorganized infants were predicted by parental Unresolved states of mind on the Adult Attachment Interview (AAI). The goal of this study was to identify additional predictors of infant disorganization on the AAI by developing and validating an interview-wide coding system for Hostile/Helpless (H/H) parental states of mind with respect to attachment. Maternal AAls were collected from 45 low-income mothers with high rates of childhood trauma when their children were age 7; Strange Situation assessments had been collected at 18 months of age. AAIs were independently coded using both the Main and Goldwyn coding system and newly developed codes for H/H states of mind. Results indicated that the H/H coding system displayed discriminant validity in that it did not overlap substantially with the Unresolved, Cannot Classify, or Fearfully Preoccupied by Traumatic Events categories in the Main and Goldwyn coding system. Second, H/H states of mind accounted for variance in disorganized infant behavior not associated with the Unresolved classification. Third, H/H states of mind were significantly related to maternal disrupted affective communication as coded by the Atypical Maternal Behavior Instrument for Assessment and Classification coding system, and maternal disrupted communication mediated the relations between H/H states of mind and infant disorganization.

Disorganized attachment behavior in infancy: Short-term stability, maternal and infant correlates, and risk-related subtypes

This study of 71 low-income mothers and infants examined whether the disorganized/disoriented (D) infant attachment classification is best viewed as a single category or whether at least two subgroups exist, corresponding to the forced-secure and forced-insecure alternate classifications. Correlates of the D classification as a whole, and of the two subtypes of disorganized behavior, were examined in five domains, including 6-month stability, maternal childhood history of loss, severity of maternal psychosocial risk, maternal behavior toward the infant at home, and infant mental development. Results indicated that the two subtypes of disorganized infant attachment behavior differed in age of emergence, maternal childhood history, severity of associated family risk factors, and the extent of the mothers lack of involvement with the infant at home. Across both D subtypes, disorganization of attachment strategies was associated with less optimal maternal behavior at home and with decreased mental development scores at 18 months. Results are discussed in relation to Main and Hesses (1990) theory of the role of fear-inducing parental behavior in the genesis of disorganized infant attachment behavior and in relation to Aber, Allen, Carlson, and Cicchettis (1989) concept of secure readiness to learn.

Childhood Adversity is Associated with Left Basal Ganglia Dysfunction During Reward Anticipation in Adulthood

BACKGROUND Childhood adversity increases the risk of psychopathology, but the neurobiological mechanisms underlying this vulnerability are not well-understood. In animal models, early adversity is associated with dysfunction in basal ganglia regions involved in reward processing, but this relationship has not been established in humans. METHODS Functional magnetic resonance imaging was used to examine basal ganglia responses to: 1) cues signaling possible monetary rewards and losses; and 2) delivery of monetary gains and penalties, in 13 young adults who experienced maltreatment before age 14 years and 31 nonmaltreated control subjects. RESULTS Relative to control subjects, individuals exposed to childhood adversity reported elevated symptoms of anhedonia and depression, rated reward cues less positively, and displayed a weaker response to reward cues in the left globus pallidus. There were no group differences in right hemisphere basal ganglia response to reward cues or in basal ganglia response to loss cues, no-incentive cues, gains, or penalties. CONCLUSIONS Results indicate that childhood adversity in humans is associated with blunted subjective responses to reward-predicting cues as well as dysfunction in left basal ganglia regions implicated in reward-related learning and motivation. This dysfunction might serve as a diathesis that contributes to the multiple negative outcomes and psychopathologies associated with childhood adversity. The findings suggest that interventions that target motivation and goal-directed action might be useful for reducing the negative consequences of childhood adversity.

Dissociation and the parent-infant dialogue: A longitudinal perspective from attachment research

Two longitudinal attachment studies of families at social risk have now followed their cohorts of infants to late adolescence. Several key findings have emerged related to outcomes of interest to psychoanalysts. First, data from both studies indicate that disorganized attachment behaviors in infancy are important precursors of later dissociative symptomatology. Second, this early vulnerability is related to patterns of parent-infant affective communication, particularly quieter behaviors like emotional unavailability or role reversal, and does not appear to reside in the infant alone. Finally, the results suggest that the quality of the attachment relationship may in part account for why some people exposed to later trauma develop dissociative symptoms and others do not. To paraphrase Dori Laub (1993), the mothers seeing and not knowing in infancy may be a precondition of her childs knowing and not knowing in late adolescence. It remains unclear, however, whether the early relationship is predictive due primarily to the onset of an internal defensive process in infancy or whether its predictive power resides primarily in enduring patterns of parent-child dialogue that continually reinforce the childs segregated and contradictory mental contents.