Disorganized attachment

Disorganized attachment is actually the lack of a coherent style or pattern for coping. Organized attachments include the secure, and insecure (avoidant) and insecure (ambivalent) styles. While ambivalent and avoidant styles are not totally effective, they are strategies for dealing with the world. Disorganized attachment has been defined as the momentary breakdown of the usual organized attachment strategies. It is thought to be caused by frightening or frightened parental behaviour, or loss or trauma in the parents (Main & Hesse 1990). Human interactions are experienced as erratic, thus children cannot form a coherent interactive template. If the child uses the caregiver as a mirror to understand the self, the disorganized child is looking into a mirror broken into a thousand pieces. It is more severe than learned helplessness as it is the model of the self rather than of a situation.

This was not one of Ainsworth's initial three categories of attachment, known in research as 'A', 'B' and 'C', but was identified by Mary Main in subsequent research and is known as 'D'.

Disorganized attachment is the most insecure type of attachment and constitutes a risk factor for a range of psychopathologies. It should not be equated with Reactive attachment disorder, but extreme indications of disorganized attachment may be regarded as an attachment disturbance (Ijzendoorn, Bajermans-Kranenburg and Juffer 2005).

History
The term was first clarified by Main and Solomon (1986) when they chose the term 'disorganized/disoriented' to describe an array of behaviours exhibited during Mary Ainsworths 'strange situation' procedure that did not fit existing classifications. These behaviours had been noted by researchers for many years. The behaviours were fearful, conflicted and disorganized. Main and Solomon (1986,1990) and Main and Hesse (1990,1992) described infants displaying a variety of behaviours such as appearing apprehensive, crying and falling huddled to the floor, turning circles whilst approaching their parents or freezing all movement whilst exhibiting a trance like expression. If the caregiver is a source of alarm as well as a source of comfort, contradictory responses are aroused in the infant, in other words to both flee and approach the caregiver. A collapse of behavioural strategies occurs. Main and Solomon concluded that the children seemed to lack any coherent, organized strategy for dealing with the stress of separation, an essential element of attachment behaviour. Behaviours included approaching the parent with head averted, rocking following an abortive approach, screaming for the parent but then moving silently away upon reunion, apprehensive gestures or 'swiping' at a parents face with a trancelike expression. The essence of these behaviours is that they are contradictory as to movements and/or expressions, with an inferred contradiction as to intentions or plans. pp522

Acording to Lyons-Ruth and Jacobvitz (1999) this classification was followed by and 'explosion...of empirical and theoretical publications on the devlopmental origins, correlates and outcomes of attachment disorganization'.p520

Theoretical models
Main and Hesse hypothesized that disorganized infant attachment behaviour arises from experiencing the attachment figure as frightening. This can arise under several conditions: directly frightening behaviour, physical or sexual abuse, or frightened behaviours on the part of the attachment figure. The latter can include entering dissociative or trance states, seeking safety or comfort from the infant or viewing the infant as a source of alarm and it appears to be triggered internally from the parents own traumatic experiences. The conflict for the infant arises because fear activates the attachment system compelling the infant to seek proximity to the attachment figure. However, proximity seeking increases the infants fear. The paradox of the attachment figure being "at once the source of and the solution to the alarm" (Main & Hesse 1990) results in a collapse of the infants behavioural and attentional strategies.

Crittenden (1992) suggested that many of these children actually show a mixture of avoidant and resistant strategies and assigns them to a 'defended/coercive' category. This should be viewed as an organised category because the behaviour is strategically adapted to constraints present in the caregiving relationship.

Prevalence
A meta-analysis published in 1999 by van IJzendoorn, Schuengel and Bakermans-Kranenburg indicated that the percentage of infants classified as disorganized was 14% in middle-class, non-clinical groups in North America and 24% in low socio-economic status groups. Studies on the stability of disorganized patterns have produced very mixed results although significant stability ranging from 1 to 60 months is found. Studies have also indicated that infants are unlikely to be classified as disorganized with more than one caregiver suggesting that disorganization is unlikely to be an inborn trait or personality of an infant. A variety of studies indicate that serious family risk factors including child maltreatment, parental major depressive or bipolar disorder and parental alcohol intake are associated with with significant increases in the incidence of disorganized attachment patterns in infancy. V.Carlson et al (1989) found that 82% of their sample of maltreated, low-income infants were disorganized as opposed to 18% in the control group. Lyons Ruthe (1989) found 55% of her sample of maltreated infants who had received home visiting services were classfied as disorganized. Teti, Gelfand, Messinger and Isabella (1995) found 40% of the infants of their group of depressed middle income mothers were clasified as disorganized as opposed to 10% in the non-depressed control group. DeMulder and Radke-Yarrow (1991) found 50% of infants and preschoolers of bipolar mothers were classified as disorganized as opposed to their control groups with 25% of depressed mothers and 18% of non-depressed.Lyons-Ruth found 62% of infants of chronically depressed low income mothers to be disorganized.

Disorganized classification and 'controlling' attachment behaviour
Two longditudinal studies, combined by van IJzendoorn et al (1999), reported a strong association between attachment disorganization in infancy and controlling behaviour during pre-school years. This correlate is stronger than any stability in either disorganized attachment behaviour in infancy or controlling behaviour in pre-school children. Studies indicate that controlling/disorganized behaviour is related to the mothers mental representation of attachment. Some association has been reported between controlling/disorganized behaviour in children and unresolved loss or trauma in the mothers. A helpless parental stance appears to be significantly related to controlling attachment behaviour in children but has not yet been related to disorganized attachment in infancy.

Child maltreatment
There is some evidence that extremely impaired early attachment relationships are associated with pervasive changes in the organisation and functioning of the hypothalamic-pituitary-adrenal (HPA) axis. Research on Romanian orphans found unusual degrees of cortisol elevation on orphanage infants. Another consequence may be the blunting of cortisol responses to stress. Hart-Gunner and Ciccetti found maltreated school age children were less likely to show cortisol elevations after conflicts with peers than were non-maltreated children. It is thought that the disorganization of attachment rather than its insecurity may be central in the emergence of many of the disturbances associated with maltreatment.

Effects
In summary, attachment disorganization in infancy forecasts controlling behaviour with caregivers, aggressive and fearful peer relationships and internalizing and externalizing problems in early school years as well as dissociative symptoms and psychopathology during adolescence. p550 It is predicted that core features of disorganized attachment relationships, as opposed to sequalae that may have other causes, would be difficulties in intimate relationships, unintegrated mental representations, negative self concepts and problems with affect regulation. According to Lyons-Ruth and Jacobvitz (1999), however, qualitative differences between those who have suffered abuse and those who's disorganized attachment relationships stem from other experiences have yet to be demonstrated.p544

This pattern of attachment is likely to develop into the psychiatric diagnosis of Reactive attachment disorder These children may be described as experiencing trauma-attachment problems and are likely to develop Reactive Attachment Disorder, which is a psychiatric diagnosis. The clinical formulation of [Complex post traumatic stress disorder]] is a clinical perspective on this set of problems. The trauma experienced is the result of abuse or neglect, inflicted by a primary caregiver, which disrupts the normal development of secure attachment. As was mentioned earlier, such children are at risk of developing a disorganized attachment. Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms, as well as depressive, anxiety, and acting-out symptoms.