2 3
A t t a c h m e n t D i s o r g a n i z a t i o n
Unresolved Loss, Relational
and Lapses in
and Attentional
•>
KARLEN
DEBORAH
The conceptual cornerstone of our understanding
of disorganized attachment behaviors in infancy
was laid when Main and Solomon (1986) chose
the term "disorganized/disoriented" to describe
the diverse array of previously unrecognized
fearful, odd, disorganized, or overtly conflicted
behaviors exhibited during Ainsworth's strange
situation procedure. As described by Main and
Solomon (1986, 1990), infants are to be consid-
ered "disorganized/disoriented" when, for exam-
ple, they appear apprehensive, cry and fall hud-
dled to the floor, or put their hands to their
mouths with hunched shoulders in response to
their parents' return following a brief separation.
Other disorganized infants display conflicting
behavioral movements, such as turning in circles
while simultaneously approaching their parents.
Still others appear disoriented, freezing all move-
ments while exhibiting a trance-like expression.
Main and Hesse (1990, 1992; see also Hesse &
Mam, in press-a, in press-b) have proposed that a
parent who enters altered states of consciousness
during discussions of loss and trauma—states
such as trance-like or dissociative states—is
more likely to engage in inexplicably frightening
and/or frightened behavior,with a child. The
caregiver, who at once becomes the source of
comfort and the source of alarm, arouses contra-
dictory responses in the infant—that is, the in-
fant experiences inherently contradictory tenden-
520
Violence,
Behavioral
Strategies
LYONS-RUTH
JACOBVITZ
cies to both flee from and approach the caregiver,
resulting in an experience of "fright without so-
lution" (Main, 1995). Under this condition, a col-
lapse of behavioral strategies necessarily occurs
and the infant is likely to display mistimed, inter-
rupted, and/or incomplete movements and ex-
pressions, as well as the behaviors described di-
rectly above.
Main and colleagues' descriptions of disorga-
nized/disoriented behavioral patterns in infancy
(e.g., Main, 1973; Main & Solomon, 1986,1990;
Main & Weston, 1981) have led to an explosion
of more than 80 empirical and theoretical publi-
cations on the developmental origins, correlates,
and outcomes of attachment disorganization (see
van IJzendoorn, Schuengel, & Bakermans-
Kranenburg, in press). This chapter begins with a
review of the literature on attachment disorgani-
zation in infancy, including its definition, preva-
lence, and associated correlates in infant be-
havior. The second major section, "Family
Correlates of Disorganized Attachment Behav-
ior," summarizes studies of family risk factors,
parental states of mind regarding attachment as-
sessed with the Adult Attachment Interview
(AAI; George, Kaplan, & Main, 1984, 1985,
1996; Main & Goldwyn, 1998; Main, Kaplan, &
Cassidy, 1985), and frightened or frightening
parental behavior toward an infant. In the third
major section of the chapter, data describing the
 CHAPTER 23. Attachment Disorganization
longitudinal reorganization of disorganized in-
fant behavior into controlling forms of attach-
ment behavior are reviewed, along with evidence
linking both disorganized and controlling forms
of attachment behavior with disruptive behavior
disorders and dissociative symptoms. The fourth
section of the chapter reviews recent data and
theoretical models linking disorganized/control-
ling forms of attachment with adult violence,
trauma, and child maltreatment. The later devel-
opment of aggression and violence is only one of
a number of developmental pathways related to
early attachment disorganization, but it has re-
ceived the most consistent research attention and
is important because of the serious social conse-
quences of such behavior. It should be empha-
sized, however, that this is a pathway followed by
a minority of infants or adults in the disorganized
group. The final major section of the chapter,
"An Integrative Conceptual Framework: Loss,
Trauma, and the Relational Diathesis," outlines a
theoretical framework capable of encompassing
the diverse presentations of disorganized/con-
trolling attachment behavior across the lifespan.
It also offers a proposed model to account for
some of the variations in behavior and adaptation
within the disorganized spectrum at any given
age.
DISORGANIZED ATTACHMENT
BEHAVIOR IN INFANCY:
DEFINITION, PREVALENCE,
AND ASSOCIATED INFANT
CHARACTERISTICS
Definition of Disorganized/Disoriented
Behavior
Understanding the central role of fear in attach-
ment theory, including the infant's response to
situations that arouse anxiety, is critical to under-
standing attachment disorganization (Hesse &
Main, in press-a, in press-b; Main, 1995; Main &
Hesse, 1990). Bowlby's (1969) initial formula-
tion of attachment theory emphasized the organi-
zation of a diverse set of behaviors around the set
goal of maintaining physical proximity or con-
tact as a basis for describing how a child's tie to
the mother functions at the level of observable
behavior. During the first year of life, the infant's
attachment to the caregiver is expressed through
an increasingly sophisticated behavioral system
that functions at an evolutionary level to protect
the infant from harm and at a psychological level
521
to reduce infant distress and arousal and main-
tain a sense of security (Bowlby, 1969). Although
the infant continually monitors the physical loca-
tion of attachment figure(s), signs of danger or
potential danger to the infant (such as strange-
ness, hunger, fatigue, illness, injury, or cues to
anything frightening) result in higher levels of
activation of the infant's attachment behavioral
system. When the attachment system is strongly
aroused, physical interaction with the caregiver
(e.g., touching, clinging, cuddling) may be nec-
essary to terminate the infant's attachment be-
havior. When the. environment is benign and the
mother is present or her whereabouts are well
known, the child typically ceases to exhibit at-
tachment behavior and instead explores the envi-
ronment (Bowlby, 1969).
Separation from an attachment figure in unfa-
miliar circumstances, although not necessarily
truly dangerous, produces physiological arousal
in virtually all infants. This arousal is assumed to
be a preadapted mechanism to protect the infant
from harm, because separation from an adult
caregiver exposes the infant to an increased risk
of danger (Bowlby, 1969). What appear to vary
across infants are their responses to their care-
givers in the face of the arousal produced by sep-
aration in an unfamiliar environment. Ainsworth,
Blehar, Waters, and Wall (1978) discovered three
patterns of behavior displayed by infants when
they are distressed following an unwanted sepa-
ration from their caregivers in the strange situa-
tion. Some infants, termed "avoidant," show
minimal displays of affect. For example, they di-
rect attention toward objects and away from their
caregivers; they turn away or look away rather
than seek contact and comfort (Ainsworth et al.,
1978). Other infants, termed "resistant" (and al-
ternatively termed "ambivalent" by Ainsworth as
well as others), mingle proximity and contact-
seeking with angry behavior. For example, a re-
sistant infant may raise his or her arms, signaling
to be held, but then arch away and resist contact
as the caregiver tries to pick him or her up. Re-
sistant children seem unable to be comforted and
calmed by their caregivers, and rather than re-
turning to exploration following reunion, they
often continue to cry and otherwise exhibit dis-
tress as the reunion episode ends. Finally, "se-
cure" infants seek proximity and contact with lit-
tle or no avoidance or angry resistance toward
their caregivers. The contact and comfort they re-
ceive are effective in calming them, allowing
them to return to play. These three attachment
categories have been identified in families from
522 PART V. CLINICAL APPLICATIONS
a range of socioeconomic backgrounds in the
United States and in various cultures around the
world. (For comprehensive reviews, see Thomp-
son, Chapter 13; van IJzendoorn & Sagi, Chapter
31; and Weinfield, Sroufe, Egeland, & Carlson,
Chapter 4, this volume.)
For many years, researchers noted that some
infants did not fit the three established attach-
ment patterns (Crittenden, 1985; Lyons-Ruth,
Connell, Zoll, & Stahl, 1987; Main & Weston,
1981; Radke-Yarrow, Cummings, Kuczynski, &
Chapman, 1985). It was unclear what should be
done with children who did not fit the standard
categories. Researchers simply put these children
aside or forced them into the best-fitting attach-
ment category. The description of the disorga-
nized/disoriented attachment category was
grounded in a recognition that many infants in
the strange situation were difficult or impossible
to classify, as well as in the direct observation of
conflict behaviors in infants and toddlers (Main,
1973; Main & Solomon, 1986, 1990).
Based on ethologists' descriptions of "conflict
behaviors" observed in nonhuman primates (i.e.,
behaviors believed to result from the simultane-
ous activation of incompatible systems; see
Hinde, 1970), Main (1979; see also Main, 1973)
developed a scale for assessing "disorganized/
disordered" behaviors in human infants. This
scale was used to code infant behavior in a pro-
cedure in which each of a group of 1-year-old in-
fants was exposed to an initially silent, unmov-
ing, masked "clown" in the parent's presence
(Main & Weston, 1981). One week later, each in-
fant participated in Ainsworth's strange situation
procedure with the same parent. Thirteen percent
of the infants were judged "unclassifiable" with
Ainsworth's three-category attachment classifi-
cation system, and disorganized behavior in the
"clown session" was most pronounced among
these infants (Main & Weston, 1981).
To gain a better understanding of why some
infants were unclassifiable, Main and Solomon
(1986, 1990) reexamined over 200 anomalous
strange situation videotapes. They concluded that
most of the children seemed to lack any coher-
ent, organized strategy for dealing with the stress
of separation. Main and Solomon (1986, 1990)
provide several striking illustrations throughout
their texts. For example, one unclassifiable infant
cried loudly while attempting to gain her moth-
er's lap, then suddenly fell silent and stopped
moving for several seconds. Others were ob-
served approaching the parent with head averted;
rocking on hands and knees following an
abortive approach; moving away from the parent
to the wall when apparently frightened by the
stranger; screaming for the parent by the door
upon separation, then moving silently away at re-
union; raising hand to mouth in an apprehensive
gesture immediately upon reunion; and, while in
an apparently good mood, slowly swiping at the
parent's face with a trancelike expression. What
these infants had in common was the display of
one or several disorganized behaviors—that is,
contradictory movements and expressions corre-
sponding to an inferred contradiction in inten-
tions or plans (approaching a parent with head
averted), or behaviors that involved apprehension
either directly (fearful facial expressions, oblique
approaches) or indirectly (disoriented behaviors,
including dazed and trance-like expressions;
freezing of all movement at a parent's entrance).
Main and Solomon (1986, 1990) called this
new category "disorganized/disoriented." They
proposed that infants be considered disorga-
nized/disoriented when, in the presence of the
caregiver in the strange situation, they display
behaviors falling into one or more of the follow-
ing seven thematic headings:
1. Sequential display of contradictory behav-
ior patterns, such as very strong attachment
behavior suddenly followed by avoidance,
freezing, or dazed behavior.
2. Simultaneous display of contradictory be-
haviors, such as strong avoidance with
strong contact seeking, distress, or anger.
3. Undirected, misdirected, incomplete, and
interrupted movements and expressions—
for example, extensive expressions of dis-
tress accompanied by movement away
from, rather than toward, the mother.
4. Stereotypies, asymmetrical movements,
mistimed movements, and anomalous pos-
tures, such as stumbling for no apparent
reason and only when the parent is present.
5. Freezing, stilling, and slowed "underwater"
movements and expressions.
6. Direct indices of apprehension regarding
the parent, such as hunched shoulders or
fearful facial expressions.
7. Direct indices of disorganization and dis-
orientation, such as disoriented wandering,
confused or dazed expressions; or multiple
rapid changes in affect.
Disorganization in infancy was slow to be
identified, because the behaviors are fleeting and
often out of context. For example, disorganized
 CHAPTER 23. Attachment Disorganization
behavior is seen when a child who appears to be
in a good mood suddenly strikes at the mother, or
when a child stops with a dazed expression for
20 seconds during an approach to the* mother.
Such behaviors are clearly unusual from the per-
spective of a well-trained observer. Those who
are new to the system, however, may not take no-
tice-of such.behaviors, since they happen quickly
and' by definition lack coherence; they do not
make sense to the observer. However, high inter-
rater reliability on the classification of infant be-
havioral patterns as disorganized/disoriented has
been established in a variety of studies (Lyons-
Ruth, Connell, Grunebaum, & Botein, 1990;
Main &, Solomon, 1990; Owen & Cox, 1997),
while across all studies conducted to date relia-
bility (80%) is acceptable (van IJzendoorn,
Schuengel, & Bakermans-Kranenburg, in press).
Crittenden (1992) offers a somewhat different
conceptualization of children originally consid-
ered "unclassifiable." Similar to Main and her
colleagues, she proposes that some of these chil-
dren show a mixture of avoidant and resistant
strategies. Crittenden (1992), however, assigns
them to a "defended/coercive" category and sug-
gests that many of them should be viewed as dis-
playing an organized attachment pattern, because
they are strategically adapting their behavior to
the constraints present in the caregiving relation-
ship.
Theoretical Model
Main and Hesse (1990; see also Hesse & Main,
in press-a, in press-b) have hypothesized that dis-
organized infant attachment behavior arises from
the infant^ experiencing the attachment figure
herself as frightening. Infants are likely to find
their attachment figures frightening under sever-
al conditions. Some attachment figures engage in
directly frightening behavior, ranging from
creeping up from behind an infant and sliding
both hands around the infant's neck and throat to
incidents of physical or sexual abuse. Other at-
tachment figures, however, appear frightened of
their own infants. Hesse and Main (in press-b;
Main & Hesse, 1995) describe frightened pa-
rental behaviors as including entrance into disso-
ciative or trance-like states (e.g., freezing of all
movement with 'a "dead" stare, unblinking),
seeking safety and comfort from an infant (e.g.,
showing deferential behavior), and viewing an
infant as a source of alarm (e.g., one parent
backed away from her infant while stammering
in an unusual and frightened voice, "D-don't fol-
523
low me, d-don't"). Main and Hesse (1990; see
also Hesse & Main, in press-b) propose that
frightened parental behavior occurs spontaneous-
ly and is triggered internally, stemming from par-
ents' thoughts or from events or objects in the en-
vironment associated with their own traumatic
and/or. frightening -experiences. According to
these authors (Hesse & Main, in press-b; Main &
Hesse, 1990), the apparent inexplicability of
such frightened parental behavior will inevitably
be alarming to an infant.
A frightened or frightening attachment figure
presents an inherent conflict for an infant. Fear
of the parent activates the attachment system,
and the infant feels compelled to seek proximity;
however, proximity-seeking increases the infant's
fear, and he or.she then contradicts the approach.
The attachment figure is "at once the source of
and the solution to its alarm" (Main & Hesse,
1990, p. 163). This paradox results in a collapse
of the infant's behavioral and attentional strate-
gies. Unable to maintain a single coherent strate-
gy, the infant shows disorganized and/or disori-
ented attachment behavior. Although Hesse and
Main (in press-a, in press-b) have specified that
disorganized attachment behavior may stem from
experiences other than frightened or frightening
caregiving, the central conflict thought to distin-
guish disorganized infants from other insecurely
attached infants is that they cannot find a solu-
tion to the paradox of fearing the figures whom
they must approach for comfort in times of
stress. Infants frequently frightened by the pri-
mary caregiver are believed, then, to be exposed
repeatedly to experiences of "fright without solu-
tion" (Main, 1995).
Prevalence and Stability
of Disorganized Attachment Patterns
A meta-analysis conducted by van IJzendoorn,
Schuengel, and Bakermans-Kranenburg (in
press) indicated that the percentage of infants
classified as disorganized was 14% in middle-
class, nonclinical groups in North America (n =
1,882) and 24% in low-socioeconomic-status
(low-SES) samples (n = 493). Results of studies
investigating the stability over time of disorga-
nized attachment behaviors have been mixed.
The stability of the disorganized pattern in the
maltreatment study conducted by Barnett, Gani-
ban, and Cicchetti (in press) was 67% from 12 to
18 months and 81% from 18 to 24 months, com-
pared to stabilities of secure attachments of 75%
and 69%, respectively. Vondra, Hommerding,
1i
524 PART V. CLINICAL APPLICATIONS
and Shaw (in press) also reported a stability rate
of 67% in disorganized classifications from 12 to
18 months of age in a low-income sample. These
stability rates are much higher than Cicchetti and
Barnett (1991) reported among 30- to 48-month-
old maltreated preschoolers. Barnett et al. (in
press) attribute the change in apparent stability
across the two studies to Cicchetti and Barnett's
(1991) use of scoring criteria for the preschool
period based on the system of Cassidy, Marvin,
and the MacArthur Working Group on Attach-
ment (1991)—a coding system that has not been
used and refined in relation to high-risk samples
as extensively as the infant scoring system for
disorganization. *
Lyons-Ruth, Repacholi, McLeod, and Silva
(1991) reported a much lower stability rate from
12 to 18 months, primarily because of a substan-
tial increase in the number of disorganized attach-
ments from 12 to 18 months of age. Vondra et al.
(in press) and Beckwith and Rodning (1991) also
reported increases in disorganized attachment be-
havior from 12 to 18 months in low-income sam-
ples, and Barnett et al. (in press) reported a signif-
icant increase in vocal distress among
disorganized infants from 12 to 18 months (but
not from 12 to 24 months). Thus some shifts in in-
fant presentation of disorganized behavior are
likely to be occurring during this period, and these
deserve further description. Vondra et al. (1997)
also found that disruptive family events were re-
lated to change to a disorganized classification
from 12 to 18 months of age. A meta-analysis of
nine samples, including a total of 515 participants
from lower- and higher-SES backgrounds, indi-
cated significant stability of disorganized attach-
ments across time periods ranging from 1 to 60
months (r = .36, van IJzendoorn, Schuengel, &
Bakermans-Kranenburg, in press).
Temperament and Disorganized
Attachment Behavior
Given the behavioral maladaptation evident in
many disorganize&attachment behaviors, one im*
portant question is whether a difficult tempera-
ment, or individual differences in emotional reac-
tivity or behavioral disorganization, may underlie
or precede the disorganized attachment classifi-
cation. However, recent studies have shown that
infants are unlikely to be 'classified as dis-
organized with more than one caregiver (Main
& Solomon, 1990; Steele, Steele, & Fonagy,
1996; van IJzendoorn, Schuengel, & Bakermans-
Kranenburg, in press). For example, Main and
Solomon (1990) reported that 31 of 34 infants
classified as disorganized with one parent were
not classified as disorganized with the other par-
ent These findings' suggest that attachment disor-
ganization emerges within a particular, relation-
ship; they do not support the notion of attachment
disorganization as an individual trait or inborn
characteristic of the infant. Based on a meta-
analysis of 12 samples including 1,877
participants, van IJzendoorn, Schuengel, and-
Bakermans-Kranenburg (in press) reported a
nonsignificant association between disorganized
attachment behavior in infancy and constitutional'
and temperamental variables (r = .003). In the
eight studies (n = 1,639) that examined the associ-
ation between difficult temperament in particular
and disorganized attachment classification, the'
effect size (r = .02) was small and not significant.
Other types of evidence also indicate that indi-
vidual differences in emotional reactivity, infant
difficultness, or general behavioral disorganiza-
tion are unlikely to account for disorganized ate
tachment behavior. Following up V Carlson, Cic-
chetti, Barnett, and Braunwald's (1989) sample
of maltreated and nonmaltreated 1-year-olds',-
Barnett et al. (in press) explored directly whether
18- and 24-month-olds classified as disorga-
nized at 1 year were more emotionally reactive—
that is, exhibited higher levels of separation
distress—than nondisorganized infants. Emo-*
tionality was assessed by rating distress vocaliza-
tions at 15-second intervals to create a measure
combining peak distress level and duration of
distress. There were no significant relations be-
tween disorganized attachment classification and
emotionality ratings at 12, 18, or 24 months. In
addition, emotionality at 12 or 18 months did not
predict disorganization at a subsequent assess-
ment. Since high negative emotional reactivity is
a core component of the construct of difficult
temperarnent, this evidence also weighs against a
view of disorganized infants as having a general-
ly difficult temperament. In another longitudinal
study' following 157 infants from birth to 1-8
months, E. Carlson (1998) found that ratings of
attachment disorganization in the strange situa-
tion at 12 and 18 months were not related to maJ
ternal history of serious medical or psychologi-
cal problems, medical complications during
pregnancy or delivery, infant anomalies, Brazel-
ton Neonatal Behavioral Assessment Scale
(NBAS) scores when the infants were 7 and 10
days old, or infant temperament ratings at 3
months. Finally, Vondra et al. (in press)jbund no
relation between maternal ratings of difficultness*
 CHAPTER 23. Attachment Disorganization
or observers' ratings of fussy behavior at 12 or
18 months and infant disorganized classifica-
tions at 12 or 18 months.
However, in one study, disorganized attach-
ment patterns in infancy were predicted by new-
born behavioral organization. 'In a middle-
income sample of 88 mother-infant pairs, Span-
gler, Fremmer-Bombik, and Grossmann (1996)
found that infants displaying disorganized at-
tachment patterns exhibited lower orientation on
the Brazelton NBAS. Newborns' behavioral di-
mensions, however, did not predict the three or-
ganized attachment patterns. Since findings that
have related scores on the NBAS to both orga-
nized-and disorganized attachment patterns have
not replicated, caution is needed in interpreting
this finding- (E. Carlson, 1998; Crockenberg,
1981; Grossmann, Grossmann, Spangler, Suess,
& Unzner, 1985; Spangler et al., 1996).
Cortisol Secretion and Disorganized
Attachment Behaviors
Several studies haVe investigated the extent to
which attachment security helps children cope
with stress. In animal models, Cortisol secretion
is correlated with an animal's inability to mobi-
lize an effective strategy to cope with a stressor.
To date, three studies have examined the associa-
tion between infants' attachment behavior and
their stress levels as indexed by salivary Cortisol
levels. In two of the three studies, infants with
disorganized attachment classifications showed
significantly higher-cortisol levels than those of
secure infants in response to brief separations
(Hertsgaard, Gunnar, Erickson, & Nachmias,
1995; Spangler & Grossmann, 1993). Significant
differences in the level of salivary Cortisol were
not evident prior to participation in the strange
situation but did appear 30 minutes after the
strange situation (Spangler 8^ Grossmann, 1993).
These findings are consistent with Main and
Solomon's (1986) view that disorganized infant
behaviors reflect the lack of an effective strategy
for coping with stress; this lack results in higher
and more enduring levels of stress hormones af-
ter the strange situation.
Cognitive Correlates of Disorganized
Infant Attachment Behaviors
Few studies have explored the cognitive corre-
lates of infant disorganized attachment behavior.
However, Bowlby's (1969) formulation of the
complementary relations between attachment
525
and exploration posits that continued activation
of the attachment system will inhibit exploration
of the- environment. Therefore, some relations
between attachment and cognitive •development
may be expected. Studying low-income mothers
and their controls, Lyons-Ruth, Repacholi, et al.
(1991) found that irifant disorganized attachment
classification'was related to infant mental devel-
opment scores, even after maternal verbal JQ es-
timates, maternal involvement at home, and ma-
ternal hostile/intrusive behavior at home were
controlled for. They also found that infant disor-
ganization was related to a pattern of mild "men-
tal lag," in which mental scores on the Bayley
Scales of Infant Development lagged behind
Bayley motor scores by one half of a standard
deviation or more. Although only 33% of disor-
ganized infants and 8% of nondisorganized in-
fants displayed this pattern, this subgroup of dis-
organized infants contributed disproportionately
to the group of children who were highly exter-
nalizing by age 7 (Lyons-Ruth, Easterbrooks, &
Cibelli, 1997). Whether such cognitive effects
will also be observed in middle-income settings,
or whether these effects represent an interaction
between infant disorganization and other aspects
of the low-income environment, still needs to be
explored. A later section of this chapter discusses
cognitive effects in middle childhood.
FAMILY CORRELATES
OF DISORGANIZED ATTACHMENT
BEHAVIOR
Disorganized Attachment Behavior
and Family Risk Factors ^
The incidence of disorganized attachment classi-
fications in infancy has ranged from 13% to
82%, depending on the presence and types of
family risk factors. Serious family risk factors,
including child maltreatment, parental major de-
pressive disorder, parental bipolar disorder, and
parental alcohol intake have been associated with
significant increases in the incidence of disorga-
nized attachment patterns in infancy.
In both middle- and low-income samples, mal-
treatment by parents has been associated with
disorganization in infancy. In a study of physical-
ly abused toddlers from middle-income back-
grounds, George and Main (1979) initially de-
scribed abused toddlers' behaviors with their
peers and caregivers in a day care center. These
behaviors were similar to indices of disorga-
 526 PART V. CLINICAL APPLICATIONS
nized/disoriented infant behavior in the strange
situation; for example, the toddlers showed prox-
imity seeking accompanied by head aversion, de-
tours, and oblique approaches. V Carlson et al.
(1989) found that 82% of the maltreated infants
in their low-income sample were classified as
disorganized, compared to 18% of those in the
low-income control group. Lyons-Ruth et al.
(1990) found that 55% of maltreated infants who
had received extensive home-visiting services
were classifiable as disorganized.
Several studies have examined the relationship
between maternal depression and attachment dis-
organization, because depression in mothers has
been shown to be associated with both irritable
and inconsistent caregiving. The results of such
studies have^been mixed. Several studies have
found an association between maternal depres-
sion or bipolar disorder and attachment disorga-
nization in infants. Teti, Gelfand, Messinger, and
Isabella (1995), studying middle-income de-
pressed mothers in treatment, found that 40% of
the infants (aged 16—21 months) of depressed
mothers were classified as disorganized, com-
pared to 10% in the nondepressed group. In addi-
tion, using Crittenden's Preschool Assessment of
Attachment (PAA), they found that 29% of older
children of depressed mothers (aged 21-26
months) were also classified in the PAA "anx-
ious depressed," "defended/coercive," and "inse-
cure/other" groups compared to 9% of controls.
(Crittenden views these groups as comparable to
the disorganized attachment classification.) It is
, notable that the depressed mothers in this study
were all receiving psychotherapeutic treatment,
including medication when indicated, and that
I two-thirds had also received 1 year of additional
parenting services prior to these attachment as-
sessments.
In another study of middle-income families,
DeMulder and Radke-Yarrow (J 991) reported
that 50% of the infants and preschoolers of moth-
ers suffering from bipolar disorder were classified
as disorganized, compared to 25% of children of
unipolar depressed mothers, and 18% of the chil-
dren of controls. In addition, mothers of disorga-
nized/controlling children were the most negative
in their affect tone, displaying a high level of
downcast affect, high levels of more than one kind
of negative affect, and low levels of tenderness
and affection. Finally, in an intervention study of
depressed mothers on welfare and their controls,
Lyons-Ruth et al. (1990) reported that 62% of the
infants of chronically depressed low-income
mothers were classified as disorganized if the
families received no intervention services. Mater-
nal depressive symptoms in this sample were seri-
ous enough to warrant referral to a home-visiting
service and were stable over a 314-year period
(Alpern & Lyons-Ruth, 1991).
A meta-analysis of 16 studies (« = 1,053) ex-
amining the relationship between maternal de-
pressive symptoms and infant disorganization in
a wide variety of samples, however, showed only
a marginally significant relationship (r = .06,
p < .06; van Hzendoorn, Schuengel, & Baker-
mans-Kranenburg, in press). Only 3 of the 16
studies reported that infant disorganization was
more common among depressed mothers than
among nondepressed mothers. In a large Nation-
al Institute of Child Health and Human Develop-
ment (NICHD) study on day care, involving
1,131 families, no significant relationship was
found between attachment disorganization in in-
fants and the psychological adjustment of their
mothers, as assessed by the Center for Epidemio-
logic Studies Depression Scale and the Neurotf-
cism, Extraversion, and Openness Personality In-
ventory (NICHD Early Child Care Research
Network, 1997). It appears that more chronic and
severe maternal depression resulting in signifi-
cant clinical impairment is necessary before as-
sociations with infant disorganization become
apparent.
Only one study has examined the relationship
between maternal alcohol intake and attachment
disorganization in infants. O'Connor, Sigman,
and Brill,(1987) found that infants of middle-in-
come mothers who had consumed moderated
heavy amounts of alcohol prior to pregnancy
were more likely to be classified as disorganized
than a comparison group of infants whose moth-
ers were either abstinent or light drinkers. Repli-
cation of this finding is needed for confirmation.
Prevalence of Subgroups within the
Disorganized Attachment Category
by Family Risk Factors
The coding directions for assigning a disorga-
nized classification include instructions also to
assign a secondary best-fitting organized attach-
ment classification—either secure, avoidant, or
ambivalent—to each infant. In the disorganized/
secure subgroup, the infant seeks contact with the
caregiver without marked avoidance or ambiva-
lence and is soothed by his or her presence but
shows other unusual signs of hesitation, confu-
sion, apprehension, dysphoria, or conflict in rela-
tion to the caregiver. Disorganized/avoidant and
 CHAPTER 23. Attachment Disorganization 527

disorganized/ambivalent infants often display un- child maltreatment (Lyons-Ruth, Repacholi, et

expected combinations of distress, contact seek-
ing, avoidance, resistance, or other apprehensive
or conflict behaviors. In 20 studies across 25 sam-
ples (n = 1,219), van IJzendoorn, Schuengel, and
Bakermans-Kranenburg (in press) reported that,
in 34% of the cases, disorganized attachment was
accompanied by a secondary classification of
avoidance (disorganized/avoidant infants); in
14% of the cases, it was accompanied by a sec-
ondary secure classification (disorganized/secure
infants); and in 46% of the cases, disorganization
was accompanied by an ambivalent classification
(disorganized/ambivalent infants).
Although on most measures reviewed in this
chapter disorganized infants have shown similar
profiles regardless of the best-fitting secondary
classification, a few studies have found differ-
ences based on the secondary classification. For
example, the incidence of disorganized/secure
infants -was found to be highest in low-risk, mid-
dle-SES samples, as shown in Table 23.1 (Lyons-
Ruth, Repacholi, et al., 1991). Compared with
behavior shown by the disorganized/secure
group, disorganized forms of avoidant or am-
bivalent infant behavior have been associated
with low SES, with more severe maternal psy-
chosocial problems (e.g., chronic maternal de-
pression), and with a history of documented
al., 1991).
In addition, mothers of disorganized/insecure
infants were shown i n one study to be more in-
trusive and negative with their infants at home
than mothers of disorganized/secure infants. In
contrast, mothers of disorganized/secure infants
displayed more withdrawal from the infapt
(Lyons-Ruth, Repacholi, et al., 1991; see also the
sections below on frightened/frightening caregiv-
ing). Further work is needed to explore potential
subgroups in the disorganized category and to
assess whether such subgroups constitute distinct
precursors to the caregiving and punitive sub-
groups that emerge within the disorganized spec-
trum during the preschool period (see the section
on longitudinal studies below).
Disorganized Attachment Behavior
and Parental Unresolved States of Mind
on the AAI
Exploring the parental mental representations, or
internal working models of attachment relation-
ships, that are associated with infants' displays of
particular attachment patterns has deepened our
understanding of the intergenerational transmis-
sion of attachment. According to attachment the-
ory, as patterns of interaction and affective re-

TABLE 23.1. Subtypes of Disorganized Attachment Behavior Reported in Previous Studies by Risk
Status of Sample
Age of infant
(in months) n Risk status n(D) % D/secure
Low risk
Main & Solomon (1990) 12-18 268 Middle-class 34 61.7
Ainsworth & Eichberg (1991) 12-18 45 Middle-class 15 53.3
Moderate risk
O'Connor, Sigman, & Brill (1987) 12 46 Middle-class 16 S0.0
(12 prenatal
heavy drinkers)
High risk:
Lyons-Ruth, Connell, Grunebaum, & 18 70 Low-income/ 33 30.3
Botein(1990) at-risk
Carlson, Cicchetti, Barnett, & 11-16 43 Low-income/ 22 27.3
Braunwald (1989) maltreated
Spieker & Booth (1988) 13 60 Low-income/ 17 5.9°
at-risk
Note: Comparing distribution of D/secure and D/insecure subclassifications within the disorganized category by low, moderate,
or high risk, x2 (2, « = 120) = 9.77, p < .01 (Spieker & Booth, 1988, omitted due to different reporting procedures). From
Lyons-Ruth, Repacholi, McLeod, and Silva (1991). Copyright 1991 by Cambridge University Press. Reprinted by permission.
"20 uncertain B (secure) eliminatedfrom,sample.
 528 PART V. CLINICAL APPLICATIONS
sponse are repeated in close relationships over
time, children build expectations about future in-
teractions with parents and others that guide their
interpretations and behaviors in new situations.
As these expectations, which are largely uncon-
scious, become elaborated and organized they
are termed "internal working models of attach-
ment relationships." These working models of
self and others tend to perpetuate themselves in
the absence of specific influences for change and
become incorporated as stable interpersonal ten-
dencies which endure over time and guide later
parental behavior (Bowlby, 1973; Bretherton,
this volume).
Main, Kaplan, and Cassidy (1985) have dem-
onstrated that when parents' representations of
their childhood attachment relationships are ex-
plored in an open-ended interview format, four
broad classifications of the adult's state of mind
regarding attachment can be reliably assigned
(George, Kaplan, & Main, 1984, 1985, 1996;
Main & Goldwyn, 1998). These four classifica-
tions, labeled "autonomous," "dismissing," "pre-
occupied," and "unresolved," predict the four in-
fant attachment classifications: "secure,"
"avoidant," "resistant" (or "ambivalent") and
"disorganized." Adults classified as secure "val-
ue attachment relationships and regard attach-
ment experiences as influential, but they are rela-
tively independent and objective regarding any
: particular experience or relationship" (Main &
Goldwyn, 1998, p. 159). Secure adults are aware
of the nature of their experiences with their par-
ents during childhood and have considered the
effects of these experiences on them. Adults con-
sidered secure appear free to explore their
thoughts and feelings during the course of the in-
terview. Adults classified as dismissing devalue,
minimize, or dismiss the importance of attach-
ment relationships and experiences. They may
dismiss possible imperfections in their parents in
the face of contradictory evidence or they may
contemptuosly derogate attachment figures or at-
tachment-related experiences. Finally, adults
classified as preoccupied appear "confused, un-
objective and preoccupied with past relationships
within the family and/or past experiences" (Main
& Goldwyn, 1998, p. 168). Preoccupied adults
may appear "passive and vague, fearful and over-
h whelmed, and/or angry, conflicted, and uncon-
vincingly analytical" (Main '& Goldwyn, 1998,
p. 168) during discussions of early family rela-
tionship experiences. Recent studies have
demonstrated that an adult's internal working
model of attachment, assessed prior to the birth
of the first child, predicts the security of the in-
fant-parent attachment relationship at 1 year
(van IJzendoorn, 1995; see Crowell, Fraley, &
Shaver, Chapter 20, and Hesse, Chapter 19, this
volume, for discussions of the AAI).
The unresolved classification is assigned to
adults who show signs of disorientation and dis-
organization during discussions of potentially
traumatic events (i.e., loss by death, physical
abuse, or sexual abuse). As detailed by Main and
Goldwyn (1998), one such index is a lapse in the
monitoring of discourse, whereby the speaker en-
ters a state of mind in which he or she no longer
appears appropriately conscious of the interview
situation and has in fact "lost awareness of the
discourse context." Main and Morgan (1996)
provide striking examples: "Some adults fall
silent in the middle of a sentence discussing loss
or trauma, and then complete the sentence 20
seconds or more later, as if no time had passed.
Others may never complete the sentence, as-*he
died, and his face [52-second pause]. I guess J
was just finishing high school'" (p. 125). Indica-
tions of losing the discourse context include a
sudden shift to an odd or poetic phrasing in dis-
cussing loss or trauma. For example, "She was
young, she was lovely, she was dearly beloved by
all who knew her and who witnessed her as she
was torn from the ground at its moment of splen-
dor" (Main & Goldwyn, 1998, p. 123).
Other indices of unresolved loss or trauma in-
volve lapses in the monitoring of reasoning.
Lapses in the monitoring of reasoning are usually
brief and should not be confused with "irra-
tional" thinking in the transcript as a whole.
These lapses can take several forms, including
indications of a belief that a lost person is simul-
taneously dead and alive (in a physical rather
than a religious sense). For example, one speaker
said, "It's probably better that he is dead, because
now he can get on with being dead and I can get
on with raising a family" (Main & Goldwyn,
1998, p. 118). Such lapses may also include dis-
belief that the person is dead (e.g., discussing a
parent in the present tense even though the parent
died 20 years earlier). Like disorganized infants,
parents classified as unresolved are also given a
best-fitting alternate classification that identifies
the pattern most closely corresponding to the
overall organization of the interview (e.g., unre-
solved/autonomous) .
Early loss of a parent through death has been
associated with infant disorganization. Main and
Hesse (1990) reported that 15% of the adults in
their sample had lost a parent through death be-
 CHAPTER 23. Attachment Disorganization
fore having completed high school; 56% of these
parents had infants classified as disorganized.
Put another way, only 8% of the parents of
avoidant, resistant, or secure babies had experi-
enced such loss, whereas 39% of the parents of
disorganized babies had done so. Lyons-Ruth,
Repacholi, et al. (1991) reported a similar associ-
ation between parental death and infant disorga-
nization. Early loss of an attachment figure in it-
self, however, does not inevitably lead to infant
disorganization (Ainsworth & Eichberg, 1991).
Rather, the lack of resolution of the loss, as re-
vealed in parents' lapses in the monitoring of rea-
soning and discourse during discussions of loss
on the AAI, is what forecasts attachment disorga-
nization in their infants. A meta-analysis of nine
studies (« = 548) revealed an effect size of .65
(r = .31) for the relation hetween child disorgani-
zation and parental unresolved status (van IJzen-
doorn, 1995). The effect sizes across studies var-
ied very strongly in relation to the amount of
training coders had received in the system for
coding disorganized attachment, with more train-
ing being associated with stronger effect sizes.
Unresolved Parental States of Mind
and Frightened/Frightening Caregiving
One of the critical questions needing further
study is why unresolved loss or trauma on the
part of parents is related to their infants* display
of disorganized attachment behavior. To what ex-
tent are lapses in the monitoring of discourse and
reasoning in discussions of loss and trauma relat-
ed to the quality of care parents provide their
children, and how do these caregiving behaviors
contribute to disorganized infant attachment be-
haviors? Lapses in the monitoring of reasoning
and discourse are notable because they involve a
sudden shift or alteration in the quality of dis-
course. Hesse (1996) suggests that these lapses
involve "frightening and/or overwhelming expe-
riences that may momentarily be controlling or
altering discourse" (p. 8). Hesse and Main (in
press-a, in press-b) suggest that such a parent is
still overwhelmed either by a past experience of
maltreatment, which is inherently frightening, or
by "incompletely remembered loss experiences."
When the still-traumatized parent responds to
memories or ideas surrounding loss or trauma,
Main and Hesse (1990) propose that the parent
will engage in frightened and frightening behav-
ior with the infant. More recently, Jacobvitz,
Hazen, and Riggs (1997), Schuengel, van IJzen-
doorn, Bakermans-Kranenburg, and Blom (in
529
press), and Lyons-Ruth, Bronfman, and Parsons
(in press) tested aspects of Main and Hesse's
(1990) hypothesis regarding the role of fright-
ened or frightening parental behavior as the me-
diator of the effect of unresolved parental states
of mind on infant disorganization. Results of the
three studies converged in somewhat unexpected
ways.
Using Main and Hesse's (1995) coding system
for identifying frightened or frightening behav-
iors, Jacobvitz et al. (1997) found very strong as-
sociations between a. prenatal assessment of ma-
ternal unresolved loss on the AAI and a mother's
display of frightened or frightening behaviors to-
ward her firstborn infant at 8 months in a sample
of 113 middle-income families. Frightening ma-
ternal behaviors included unusual vocal patterns,
such as simultaneously voicing and devoicing in-
tonations; baring teeth; invasions into vulnerable
areas of the infant's personal space, such as
hands suddenly, silently sliding from behind
across the infant's throat; sudden looming into
the infant's face; and movements or postures that
seemed to be part of a pursuit/hunt sequence
(Main & Hesse, 1992b, 1995; see also Main &
Hesse, 1990). One mother in the study conducted
by Jacobvitz and her colleagues (1997; see also
Thalhuber, Jacobvitz, & Hazen, 1998) appeared
to enter a trance-like state, sitting immobilized in
an uncomfortable position (with her hand in the
air) and blankly staring into space for 50 consec-
utive seconds. She entered into what appeared to
be an altered state on several occasions for a total
of 5 minutes during a 20-minute feeding session.
This mother was classified as unresolved on the
AAI. Indications that a mother was afraid of her
baby included instances in whicK.the mother
handled the baby as if the baby were an inani-
mate object and in which the mother moved her
hand away suddenly as if fearful of being hurt
(see Hesse & Main, in press-b).
As predicted, then, mothers classified prena-
tally as unresolved differed significantly from
mothers not classified as unresolved on the 9-
point frightened/frightening scale. However,
mothers classified as unresolved did not differ
significantly from other mothers on any other
negative parenting interaction patterns observed
in the mothers' homes, including maternal insen-
sitivity, interference, or rejection (Jacobvitz et
al., 1997). This difference between unresolved
mothers and other mothers occurred regardless
of whether the unresolved mothers were given a
secondary secure or insecure adult classification
(Jacobvitz, 1998). Not all mothers classified as
 530 PARTY. CLINICAL APPLICATIONS
unresolved, however, engaged in frightened or
frightening behaviors toward their infants. Com-
pared to unresolved mothers who were also as-
signed a secondary insecure classification, unre-
solved mothers who were also assigned a
secondary secure (i.e., autonomous) classifica-
tion showed a marginally significant trend in the
direction of engaging in fewer frightened or
frightening behaviors toward their infants.
In a sample of 85 mother-child dyads, Schuen-
gel et al. (in press) found a relation between ma-
ternal unresolved loss on the AAI when an infant
was 12 months old and maternal display of fright-
ened or frightening behaviors toward the infant at
10 or 11 months using the Main and Hesse
(1992b) coding system, but this finding occurred
only among th&subgroup of mothers classified as
unresolved/insecure on the AAI (analogous to the
disorganized/insecure infant subgroup). Like Ja-
cobvitz et al. (1997), Schuengel et al. (in press)
found that mothers classified as unresolved/
insecure displayed significantly more frightened
or frightening behaviors than mothers classified
as unresolved/secure. However, in a more puz-
zling finding that goes counter to the findings re-
ported by Jacobvitz (1998), Schuengel et al. (in
press) found that mothers classified as secure
i displayed significantly more frightened or fright-
ening behaviors than did mothers classified
unresolved/secure. This finding, if replicated,
suggests some overall behavioral inhibition on the
part of mothers classified as unresolved/secure,
since the secure but not unresolved mothers dis-
played more frightened or frightening behaviors
than did this unresolved subgroup. One explana-
tion for the discrepant findings across the two
studies is that Jacobvitz and her colleagues creat-
ed a more stressful situation for mother and child
than did Schuengel et al. (in press). In the Jacob-
vitz et al. (1997) study, mothers were instructed to
feed their babies, play with them, and change their
babies' clothes. Not only were parents forced to
interact with their children, but most of the 8-
month-olds resisted having their clothes changed.
Schuengel et al. (in press), in contrast, did not
structure the home observations. Stressful condi-
tions may trigger thoughts associated with earlier
losses or trauma, resulting in the display of fright-
ened and/or frightening caregiving behavior.
To understand further why some mothers clas-
sified unresolved did or did not display fright-
ened or frightening behaviors toward their in-
fants, Jacobvitz and her colleagues explored
factors associated with the loss experience.
Bowlby (1980) has suggested that the closer the
relationship of the person lost, the more difficult
the resolution process, particularly if the death
occurred during childhood. Ainsworth and Eich-
berg (1991) did not find this to be the case; they
found no significant association between either a
mother's age when the loss occurred or her rela-
tionship to the deceased (e.g., attachment figure
vs. someone else) and unresolved states of mind
on the AAI. Replicating Ainsworth and Eich-
berg's study with a larger sample (n = 113), Ja-
cobvitz (1998) also found that the mother's age
when the loss occurred was unrelated to the
mother's resolution of loss but did find that
mothers who were unresolved were more likely
to have lost a parent than to have lost a less im-
portant figure. Moreover, both the mother's age
when the loss occurred and the mother's relation-
ship to the deceased discriminated between unre-
solved mothers who engaged in frightened or
frightening behavior toward their infants and
those who did not (Jacobvitz et al., 1997). Nine-
ty-one percent of unresolved mothers who either
lost an attachment figure or were younger than
17 when the unresolved loss occurred engaged in
frightened or frightening behaviors toward their
infants. In contrast, only 20% of the unresolved
mothers who were 17 or older when the loss oc-
curred and did not lose an attachment figure dis-
played frightened or frightening behavior (Jacob-
vitz et al., 1997). Therefore, degree of kinship
and timing of the loss may be important in pre-
dicting whether the mother's unresolved state of
mind impinges on her caregiving behavior.
Frightened/Frightening Caregiving
and Disorganized Attachment Behavior
in Infancy
Schuengel, van IJzendoorn, Bakermans-Kranen-
burg, and Blom (1997, in press) and Lyons-Ruth,
Bronfman, and Parsons (in press) tested Main
and Hesse's hypothesis that maternal frightened
and/or frightening behavior would be related to
the infant's attachment disorganization. In the
study by Schuengel et al. (in press), maternal
frightened or frightening behavior marginally
predicted infant disorganized attachment classi-
fication (p <.05, one-tailed). However, the sub-
scale for maternal dissociated behavior more
strongly predicted infant disorganized behavior,
as did a broader set of maternal "disorganized"
behaviors that included the frightened or fright-
ening behavior codes (Schuengel et al., 1997).
Schuengel et al. (1997, in press) did not examine
maternal frightened or frightening behaviors sep-
 CHAPTER 23. Attachment Disorganization
arately for the two subgroups of disorganized in-
fants, as they did for the two subgroups of unre-
solved mothers. It is notable that maternal self-
reported scores on the Dissociative Experiences
Scale (DES) did not predict infant disorganiza-
tion nor did the closeness of kin of a mother's ex-
perienced loss. Lyons-Ruth and Block (1996)
also failed to find a relation between maternal
scores on the DES and infant disorganization.
Similar to Schuengel et al. (1997), Lyons-
Ruth, Bronfman, and Parsons (in press) found
that a broader set of maternal behaviors that in-
cluded the frightened or frightening behavior
codes (Main & Hesse, 1992b) significantly pre-
dicted an infant's rating for disorganized behav-
ior and marginally predicted an infant's disorga-
nized attachment classification. Lyons-Ruth and
colleagues expanded on Main and Hesse's con-
struct of frightened or frightening behavior to im
elude two other broad aspects of maternal behav-
ior hypothesized to be theoretically related to
infant fear and disorganization of attachment
strategies. These included extreme parental mis-
attunement to the specific content of an infant's
attachment-related communications and the dis-
play of competing caregiving strategies that both
elicited and rejected infant attachment affects
and behaviors. This broader set of behaviors,
termed "disrupted affective communication be-
tween mother and infant," included codes for af-
fective communication errors, role confusion,
negative/intrusive behaviors, disorientation, and
withdrawal. Maternal behavior was coded in the
strange situation at 18 months among 65 moth-
er-infant dyads. When the frightened or frighten-
ing behavior codes were analyzed separately,
they significantly predicted infant disorganized
behavior. However, with all frightened or fright-
ening behaviors excluded, the level of disrupted
maternal affective communication also signifi-
cantly predicted infant disorganization.
However, when the two subgroups of disorga-
nized infants were examined separately on the
frequency of maternal frightened or frightening
behavior and on the frequency of disrupted com-
munication more generally, only the mothers of
disorganized/insecure infants differed signifi-
cantly from mothers of infants with organized
patterns of attachment. This finding echoed
Schuengel et al.'s (in press) identification of ele-
vated frightened or frightening behavior only
among mothers in the unresolved/insecure sub-
group. Mothers of infants in the disorganized/
insecure subgroup showed elevated rates of
frightening behavior, affective communication
531
errors, hostile/intrusive behavior, and role confu-
sion, compared to mothers of organized infants.
However, mothers of disorganized/secure in-
fants were distinguished from mothers of orga-
nized infants when the patterning of maternal
frightened or frightening behavior and disrupted
communication was taken into account. Mothers
of disorganized/secure infants exhibited a fear-
ful, inhibited pattern of behavior. This pattern
was characterized by subtle frightened behavior
in the absence'of high levels of frightening, dis-
sociated, and-role-reversed maternal behavior. In
addition, mothers of disorganized/secure infants
exhibited a pattern of withdrawn, but not hostile,
interaction on the disrupted communication
codes (Lyons-Ruth, Bronfman, & Atwood, in
press).
A study of 20 village-living mother-infant
dyads in the Dogon ethnic group. of Mali, an
African country, provides preliminary cross-
cultural support for a relationship between
frightened or frightening maternal behavior and
attachment disorganization (True, Pasani, Ryan,
& Oumar, 1998). Although none of the mothers
scored above the midpoint on the frightened or
frightening behavior scale, infants whose moth-
ers scored above 1 on the frightened or frighten-
ing behavior scale were more often classified as
disorganized in the strange situation than infants
whose mothers showed no frightened or frighten-
ing indices.
Taken together, these studies suggest that ma-
ternal frightened or frightening behaviors are re-
lated both to infant disorganized attachment sta-
tus and to parental unresolved states of mind.
However, the most broadly based applications of
the coding inventories for fear-related maternal
behaviors were the most successful in predicting
disorganized infant behavior. In addition, it ap-
pears that the overall patterning of parental be-
haviors within the disorganized spectrum may
take quite different forms. Because of these po-
tential differences in the profiles of maternal be-
havior within the disorganized classification, fu-
ture researchers may need to plan their data
analyses carefully to capture both the fearful,
inhibited subgroup and the more pervasively
frightening subgroup.
Other Studies of the Caregiving
Behavior of Disorganized Infants
Several prospective longitudinal studies follow-
ing disorganized infants over time have demon-
strated that their mothers may show a particularly
532 PART V. CLINICAL APPLICATIONS
impaired ability to engage in well-attuned affec-
tive communications with their young children.
Harm, Castino, Jarosinski, and Britton (1991) ex-
amined mother-infant interactions at 20 months
among 67 low-income adolescent mothers and
their infants (the infant's attachment strategies
had been assessed at 13 months). In this sample
of low-income adolescent mothers, 60% of the
infants were classified as disorganized with a
secondary insecure classification. They found
that negotiation of conflict was significantly im-
paired among mothers of disorganized/insecure
infants. The secure 20-month-olds and their
mothers in this study were the most likely to
make social initiations, initiate nonaggressive
conflict behavior, and follow nonaggressive con-
flict with further nonaggressive conflict. The
small number of toddlers with insecure but orga-
nized attachment strategies demonstrated inter-
mediate levels of initiative and intermediate fre-
quencies of nonaggressive conflict initiations. In
contrast, compared to the other toddlers, those
previously classified as disorganized/insecure
more often initiated aggressive conflict with their
mothers and refused their mothers' social initia-
tives, and were the least likely to initiate social
exchanges with their mothers. Moreover, aggres-
sive conflicts initiated by the children in the dis-
organized/insecure group were less likely to be
resolved than those initiated by their mothers. In
addition, compared to the other mothers, mothers
of disorganized infants (regardless of their sec-
ondary classification) were less affectionate.
They initiated more interactions but complied
less frequently with their children's initiatives.
This study indicates that mother-toddler ex-
changes in dyads from the disorganized/insecure
group were more often conflicted and asynchro-
nous.
Other longitudinal studies have reported simi-
lar results. Main et al. (1985), studying a middle-
income sample, initially reported that mothers of
disorganized infants and mothers of avoidant in-
fants exhibited low fluency and balance in dis-
course with these same children at age 6 (see
Strage & Main, 1985). .Similarly, Easterbrooks,
Lyons-Ruth, Biesecker, and Carper (1996), in a
low-income sample, showed that mothers of 18-
month-old infants classified as disorganized
were rated lower in emotionalyavailability when
they were observed with their children at 7 years
of age. Similar results were reported by Moss,
Parent, Gosselin, Rousseau, and St-Laurent
(1996) in their study of a middle-income sample.
Mothers of children classified as controlling at
ages 5 to 7 displayed the least reciprocal and
least balanced communication, compared to
mothers of children in other attachment cate-
gories.
Spieker and Booth (1988), studying low-
income mothers and infants, conducted a number
of analyses of measures taken both prenatally
and at 6 weeks and 3 months postpartum. Moth-
ers of disorganized infants did not differ from
mothers of secure infants on 23 interview mea-
sures of social support, emotional symptoms, OP
satisfaction with available resources. However,
mothers of both disorganized and avoidant in-
fants were rated lower than mothers of secure in-
fants on total teaching skills and on positive par-
ent-infant mutuality.
Ratings of maternal rnsensitivity, as assessed
using Ainsworth's sensitivity-insensitivity scale,
have not been associated with attachment dis-
organization in infancy. In a meta-analysis of
12 studies, van IJzendoorn, Schuengel, and
Bakermans-Kranenburg (in press) reported no
significant relationship between disorganized at-
tachment in infants and ratings of parental insen-
sitivity. The sensitivity-insensitivity scale, which
is a global rating of maternal caregiving, does
not appear to be differentiated and specific
enough regarding the affective communications
involved in fear-related behavior to predict infant
disorganization.
LONGITUDINAL
REORGANIZATION
OF DISORGANIZED FORMS
OF ATTACHMENT BEHAVIOR
INTO CONTROLLING FORMS
OF ATTACHMENT BEHAVIOR
Two prospective longitudinal studies have
demonstrated a shift from disorganized behavior-
during infancy to controlling behavior with
mothers (of either a punitive or a caregiving
type) at 6 years of age (Main & Cassidy, 19,88;
Warmer, Grossmann, Fremmer-Bombik, &
Suess, 1994). In a study of 33 families in Berke-
ley, California, Main and Cassidy (1988) devel-
oped an assessment of parent-child attachment
at age 6. Children's behavioral and verbal re-
sponse patterns to a reunion with a parent after
an hour-long separation were classified into four
categories that corresponded to the four infant at-
tachment classifications, including "secure,"
"avoidant," "ambivalent," and "controlling."
Children are classified as "controlling" if they
 CHAPTER 23. Attachment Disorganization 533

"seem to actively attempt to control or direct the
parent's attention and behavior and assume a role
which is usually considered more appropriate for
a parent with reference to a child" (Main & Cas-
sidy, 1988, p. 418 ).'Eighty-four percent of the
infants classified as disorganized at 1 year were
also classified as displaying controlling behavior
toward the parent when they were 6 years old
(Main & Cassidy, 1988). Combining data from
two studies (Main & Cassidy, 1988; Wartner et
al., 1994), van IJzendoorn, Schuengel, and Bak-
ermans-Kranenburg (in press) reported a strong
association (r = .55) between attachment disorga-
nization in infancy and later controlling attach-
ment behavior. Interestingly, after correcting for
coding error, van IJzendoorn and his colleagues
found that continuity from attachment disorgani-
zation in infancy to controlling behavior during
the preschool years was much stronger than
short-term stability either in disorganized attach-
ment behavior in infancy or in controlling behav-
ior in preschool children (Main & Cassidy,
1988). The array of studies exploring correlates
of disorganized attachment behavior at later ages
is reviewed below and summarized in Table 23.2.
Controlling Attachment Behavior
and Parental Internal Models
Like disorganized behavior in infancy, control-
ling/disorganized behavior in preschool children
has been related to mothers' mental representa-
tions of attachment. Several researchers have re-
ported an association between controlling/disor-
ganized behavior in children and unresolved loss
or trauma (as assessed on the AAI) in their moth-
ers (George & Solomon, 1996;.'Greenberg,
Speltz, DeKlyen, & Endriga, 1991). George and
Solomon (1996) have further extended our un-
derstanding of the mental representations of
caregiving among mothers whose children were
classified as controlling (see also George &
Solomon, Chapter 28, this volume). In semi-
structured interviews about mothers' relation-
ships to their 6-year-olds, George and Solomon

TABLE 23.2. Longitudinal Outcomes of Disorganization in Infancy and Correlates of Controlling

Behavior in Preschool and Elementary School
Outcomes and correlates
Authors Children's ages Assessment instruments of disorganization
Carlson (1998) 18, 24, and 42 Strange situation, Main Less confident with mothers
months; 4'/2-5 and Solomon coding; (24 months); avoidance of
years; grades 1,2, birth complications; mothers (42 months);
3, 6; 1714 years Neonatal Behavioral dissociation and
Assessment Scale; Carey internalizing behavior
Infant Temperament (grades 1, 2, 3, and 6), lower
Questionnaire; emotional health rank
observations of (Grades 1,2, 3, and 6);
mother-child interactions; overall behavior problems,
preschool behavior internalizing problems, &
problem index; teachers' dissociative symptoms (1714
completion of Child years); and higher ratings of
Behavior Checklist and psychopathology in general
emotional health rank; and dissociation specifically
Schedule of Affective on the K-SADS (17& years)
Disorders and
Schizophrenia for School-
Age Children (K-SADS)
Cohn (1990) 6 years Main and Cassidy system; No significant results for
peer behavior nomina- girls or boys, but
tions; teacher and peer disorganized unclassifiable
liking ratings; teacher infants were not included
completion of Classroom
Adjustment Rating Scales
and Health Resources
Inventory
(continued)
 534
TABLE 23.2. (continued)
Authors
DeMulder & Radke-Yarrow
(1991)
Greenberg, Speltz, DeKlyen,
&Endriga(1991)
Harm, Castino, Jarosinski,
&Britton(1991)
Hubbs-Tait, Osofsky,
Hann,&Culp(1994)
Jacobsen et al. (1994)
Jacobvitz & Hazen (in press)
I-
Kaplan (1987)
Lyons-Ruth, Alpern, &
Repacholi (1993)
Lyons-Ruth, Easterbrooks,
&Cibelli(1997)
l» (
PART V. CLINICAL APPLICATIONS
Outcomes and correlates
Children's ages Assessment instruments of disorganization
Preschool Main and Cassidy system Mothers of controlling
preschoolers displayed the
most negative affective tone
Preschool Main and Cassidy system; Diagnosis of oppositional
DSM-III-R criteria defiant disorder
13 and 20 Strange situation, Main Fewest social initiatives and
months and Solomon coding; more refusals of mothers'
observations of mother- initiatives; initiation of
infant interactions conflict by aggressive
behavior
13 and 54 Strange situation, Main Externalizing behavior
months and Solomon coding; problems; no relationship
Child Behavior Checklist between attachment and
and Child Behavior maternal reports of
Checklist Social Scale children's social skills and
completed by mothers friendship
7,9,12,15, and Piagetian cognitive tasks; Lower self-confidence,
17 years Chandler's perspective- difficulties with deductive
taking task, Kaplan's reasoning, including poor
coding; behavioral ratings performance on syllogistic
of self-confidence by reasoning task
interviewers
18,20,24,30, Strange situation, Main Controlling behavior toward
36,42, and 54 and Solomon coding; mothers, either caregiving or
months observations of punitive; fearful/
mother-child and disorganized responses;
father-child interactions, emotional disconnection;
of family dinners, of and aggression toward peers
interactions with two
different peers, and of
peer interactions in
preschool classrooms
1 and 6 years Strange situation, Main Fearful/disorganized (e.g.,
and Solomon coding; catastrophic fantasies) or
Kaplan's Separation silent responses
Anxiety Test
18 months; Strange situation, Main Hostile/aggressive behavior
5 years and Solomon coding; toward peers at age 5
home observations of
mother-infant
interactions; Bayley
Scales of Infant
Development; teachers'
completion of Preschool
Behavior Questionnaire
18 months; Strange situation, Main Externalizing behavior
7 years and Solomon coding; problems at age 7; mild
home observations of mental lag combined with
mother-infant disorganization at 18 months
interactions; Bayley was ariskfactor for
Scales of Infant externalizing problems
(continued)
 CHAPTER 23. Attachment Disorganization 535

TABLE 23.2. (continued)

Outcomes and correlates
Authors Children's ages Assessment instruments of disorganization
Development; teachers'
completion of Child
Behavior Checklist

Main & Cassidy (1988) 1 and 6 years Strange situation, Main Controlling (role-reversing)
and Solomon coding; behavior toward parent,
Main & Cassidy system either punitive or caregiving
Moss, Parent, Gosselin, 3-5 years; Main and Cassidy system; Lower social competence in
Rousseau, & St-Laurent 1-7 years questionnaires completed preschool; behavior
(1996) by parents and teachers', problems shown over time,
including the Preschool with no clear pattern of
Socio-Affective Profile internalizing or externalizing
and Child Behavior problems
Checklist
Moss, Rousseau, Parent, 5-7 years; Main and Cassidy system; Externalizing and
St-Laurent, & Saintong 9-11 years questionnaires completed internalizing behavior
(1998) by teachers, including the problems in boys and girls;
Preschool Socio-Affective lower mathematics scores
Profile and Child and lower academic self-
Behavior Checklist esteem at age 8 than secure
or resistant children
Ogawa, Sroufe, Weinfeld, 12,18,24,42, Strange situation, Main Dissociation at 16 to 1714
Carlson, & Egeland (1997) 54, and 61 and Solomon coding; years and 19 years; higher
months; grades Child Behavior Checklist dissociation scores at age 19
1,2,3,6; 16, completed by mothers and for young adults classified
1714, and 19 teachers; life stress as disorganized in infancy
years measures; assessments of who also faced trauma (vs.
physical abuse, neglect, 19-year-olds who were not
and witnessing trauma; classified as disorganized or
Putnam's Child were classified as
Dissociative Checklist; disorganized but did not
K-SADS; Dissociative experience trauma)
Experiences Scale
Shaw, Owens, Vondra, 6-9,18 months; Strange situation, Main Disorganization at 1 year
Keenan, & Winslow (1996) 1,2, 3, and 5 and Solomon coding; combined withparent ratings
years mothers' completion of of difficultness at age 2
Infant Characteristics predicted aggression at age 5
Questionnaire, Child
Behavior Checklist,
Personality Research
Form, Marital Adjustment
Test, Child-Rearing
Disagreements Scale, and
Parenting Daily Hassles
Speltz, Greenberg, & 5-7 years Main and Cassidy system; Aggression and
DeKlyen(1990) DSM-in-R criteria externalizing behaviors
toward peers
Solomon, George, & 6 years Main and Cassidy system; Depiction of self and
de Jong (1995) children's response to caregiver as frightening
stories about a hurt knee, (e.g., themes of catastrophe
a monster in the bedroom, and helplessness), or

(continued)
536 PART V. CLINICAL APPLICATIONS
TABLE 23.2. (continued)
Authors Children's ages
Teti, Gelfand, Messinger, 16-21 months;
& Isabella (1995) 21-26 months
Warmer, Grossmann, 1, 5, and 6 years
Fremmer-Bombik, & Suess
(1994)
(1996) found that a helpless parental stance was
related significantly to controlling attachment
behavior on the part of a child. In some cases,
this helpless stance involved failing to provide
reassurance and protection to the child, while in
other cases the helpless stance included fear ei-
ther of the child or of the mother's own loss of
control in some way. In still other cases, the
mother described feeling that the child was in
control of the relationship, either because of the
child's precocious positive capabilities or be-
cause of the child's unmanageability. Moreover,
in George and Solomon's (1996) middle-income
sample, 62% of parents with unresolved loss or
trauma described their relationships with their
children in helpless terms. Helpless stances have
not yet been related to disorganized attachment
behavior in infancy, however.
Disorganized/Controlling Attachment
Patterns and Children's Internal
Representations of Attachment Figures
As described earlier, an infant's display of disor-
ganized attachment behaviors is thought to occur
because the infant is faced with an unresolvable
paradox. When fear is aroused, the infant experi-
ences unresolvable conflict with respect to seek-
ing comfort from a frightened or a frightening
caregiver who is also the only haven of safety.
Several studies examining children's depictions
of self and caregiver show that many children
classified as disorganized in infancy still display
"fright without solution" at age 6 (Main, 1995).
Outcomes and correlates
Assessment instruments of disorganization
and parent-child complete inhibition
separation and reunion
Strange situation, Main Maternal depression was
and Solomon coding; associated with anxious
Crittenden's Preschool depressed, defended/
Assessment of Attachment coercive, and insecure/other
preschool classifications
Strange situation, Main Infant disorganization was
and Solomon coding; associated with controlling
Main and Cassidy system; behavior at age 6; social
observations of preschool incompetence in play groups
play groups; social (5 years) was associated with
perceptions task (cartoons controlling behavior at age 6
depicting themes of
aggression)
Kaplan (1987) administered her Separation
Anxiety Test to children in the Berkeley sample
to assess children's responses to drawings of
parent-child separations. The responses of chil-
dren classified as disorganized at 1 year were
fearful and disorganized. Some children ap-
peared afraid and yet unable to do anything
about it, while others remained silent throughout
the task. Still others engaged in catastrophic fan-
tasies, indicating that the attachment figure
would be hurt or killed.
In another study of a middle-income sample of
69 kindergartners, children were asked to re-
spond to a set of doll play stories about attach-
ment-related themes (Solomon, George, & de
Jong, 1995). The doll play of controlling children
was characterized by themes of catastrophe and
helplessness, including nightmares and violent
fantasies, or by complete inhibition of play.
Compared to the other children in the study,
those classified as controlling more often depict-
ed themselves as helpless and their caregivers as
frightening. Although this helpless stance in
kindergartners has not been linked empirically
with attachment disorganization in infancy, such
helplessness is compatible theoretically with a
collapse of behavioral strategies resulting in an
inhibition of attachment behavior. Jacobsen et al.
(1992) also found an association between chil-
dren's controlling behavior with the caregiver
and fearful and disorganized responses to a series
of cartoon illustrations depicting a parent-child
separation and coded with Kaplan's system (see
Kaplan, 1987).
 CHAPTER 23. Attachment Disorganization
Disorganized/Controlling Attachment
Patterns and Cognitive Correlates
Several studies have demonstrated associations
between disorganized/controlling attachment
patterns and the quality of children's cognitive
functioning. In a 10-year longitudinal study as-
sessing 85 Icelandic children at ages 7, 9,12,15,
and 17, Jacobsen, Edelstein, and Hofmann (1994)
examined the relationship between attachment
security assessed at age 7 and later cognitive
functioning. Both disorganized/controlling chil-
dren and other insecure children differed from
secure children on Piagetian tasks assessing con-
crete and formal operational reasoning from 7 to
15 years of age. These cognitive differences
by attachment group disappeared when self-
confidence was controlled. However, on the sub-
set of formal operational measures that assessed
syllogistic reasoning, disorganized/controlling
children differed significantly from other secure
and insecure children from ages 9 to 17, and these
differences remained when self-confidence, IQ,
and attention problems were included in the
analyses. Disorganized/controlling children
were particularly likely to give contradictory
responses on these tasks compared to other at-
tachment groups, and attachment group differ-
ences increased with age, with disorganized/
controlling adolescents as a group never reaching
formal operational level. However, these results
need replication due to the small number of
disorganized/controlling children in the analyses
of syllogistic reasoning (« = 6). The syllogistic
reasoning tasks involved answering hypothetical
questions posed by an experimenter rather than
the direct experimentation involved in the other
Piagetian tasks with objects. Jacobsen et al.
(1994) suggest that disorganized children may
perform poorly because they are particularly vul-
nerable to deregulated thought processes gener-
ated by their anxieties regarding the reactions of
others. In another longitudinal study following 35
children in Germany over 5 years, Jacobsen,
Huss, Fendrich, Kruesi, and Ziegenhain (1997)
examined the relationship between attachment
and self-regulatory abilities related to cognitive
functioning. Compared to the other children,
those classified as disorganized/controlling had
the most difficulty waiting on a standard delay-of-
gratification task.
All of these difficulties with cognitive func-
tioning suggest that disorganized children may be
at risk for academic problems. Moss, Rousseau,
Parent, St-Laurent, and Saintong (1998) found
537
that children classified as disorganized at age 5-7
had lower mathematics scores and lower academ-
ic self-esteem at age 8 than did children classified
as secure or resistant: Moreover, such results were
obtained even after the children's IQs were con-
trolled for. As in the findings reported by Jacob-
sen et al. (1994), the relationship between disor-
ganized/controlling attachment and mathematics
performance disappeared after children's self-
confidence with schoolwork was controlled for.
Disorganized/Controlling Attachment
Patterns and the Development
of Peer Relationships
Most studies of the relationship between attach-
ment disorganization and peer interaction have
relied on behavior checklists completed by moth-
ers and/or teachers, as shown in Table 23.2. Only
a few studies have obtained ratings of friendship
quality from the peers themselves or from
trained observers (Cohn, 1990; Jacobvitz &
Hazen, in press; Wartner et al, 1994). In one
cross-sectional study of 40 children, trained ob-
servers rated 6-year-olds classified as disorga-
nized/controlling as more incompetent in play
quality and conflict resolution than secure chil-
dren, but the ratings of disorganized/controlling
children's friendship quality did not differ from
those given to avoidant children (Wartner et al.,
1994). Furthermore, compared with secure chil-
dren, disorganized/controlling children were rat-
ed as more incompetent overall in three or more
(but not in two or fewer) of the areas assessed. In
another cross-sectional study, in which ratings of
peer liking, sociometric status, and peer nomina-
tions were obtained from the -children them-
selves, disorganized/controlling children did not
differ from the other attachment groups (Cohn,
1990). However, contrary to other investigators,
nine children who were disorganized/unclassifi-
able were eliminated from the study, creating a
small and possibly unrepresentative group of
children in the disorganized/controlling category.
Few studies have examined the. development
of peer relationships among children classified
as disorganized in infancy. As part of a larger
longitudinal study conducted by Hazen, Jacob-
vitz, and Hazen (in press) followed 66 infants
over 3 years who had been classified as secure,
avoidant, resistant, or disorganized at 18 months.
Mother-child, father-child, and peer interactions
were videotaped when the children were 20, 26,
32, 44, and 56 months old. At each age, mother-
child and father-child interactions were video-
538 PARTY. CLINICAL APPLICATIONS
taped in play, cleanup, and problem-solving situ-
ations. In addition, at all five ages, each child
was videotaped in the day care classroom and in
dyadic play and cleanup with two different peers
identified by the child's teacher as "friends," or
children with whom the child interacted most.
Preschoolers classified as secure, avoidant, or
resistant in infancy behaved in similar ways with
the two different peers. However, based on case
study data, children classified as disorganized at
18 months were observed to act quite differently
with one peer as compared to another at both the
44- and 56-month assessments. For example, one
child spent much of his interaction with one peer
trying to annoy him, shining a flashlight in his
eyes, using a puppet to try to grab his nose, and
periodically shoving toy animals in his face. With
the other peer, however, the same child did not
interact at all and progressively withdrew. By the
end of the session, he was lying face down and
burying his head under a large pillow.
Jacobvitz and Hazen (in press) have proposed
that disorganized children may be more likely
than other children to carry unintegrated models
of the same caregiver into their interactions with
peers, such that they draw on different models
with different peers. Moreover, only after a disor-
ganized child develops a way to interact with the
caregiver (e.g., using controlling behavior) may
the child be able to develop a consistent behav-
ioral style, even though often not an optimal one,
for interacting with peers. In the Jacobvitz and
Hazen study, children who took longer to estab-
lish more consistent ways of interacting with their
caregivers also took longer to sustain peer interac-
tions, even aggressive or passive interchanges.
Disorganized/Controlling Attachment
Patterns and the Development
of Behavior Problems
Recent studies demonstrate an association be-
tween attachment disorganization and the devel-
opment of peer aggression or externalizing be-
haviors. Early studies of low-income samples
'that used only the three traditional attachment
classifications reported that avoidant attachment
behavior in infancy predicted aggressive behav-
ior toward peers in preschool (Troy & Sroufe,
1987) and elementary school (Renken, Egeland,
Marvinney, Mangelsdorf, & Sroufe, 1989). Stud-
ies of middle-income samples did not replicate
those findings (Bates, Maslin, & Frankel, 1985;
Fagot & Kavanaugh, 1990; Goldberg, Perotta,
Minde, & Corter, 1986; Lewis, Feiring, McGuf-
fog, & Jaskir, 1984). In a subsequent study of a
low-income sample that included the disorga-
nized classification, Lyons-Ruth, Alpern, and
Repacholi (1993) found that avoidant behavior
was often displayed in combination with disorga-
nized behavior in low-income samples and the
disorganized component predicted later aggres-
sion, whether or not the disorganization included
avoidant behaviors. Several more recent longitu-
dinal studies distinguishing between avoidant
and disorganized/controlling attachments have
replicated this association (Goldberg, Gotowiec,
& Simmons, 1995; Hubbs-Tait, Osofsky, Harm,
& Culp, 1994; Lyons-Ruth et al., 1997; Shaw,
Owens, Vondra, Keenan, & Winslow, 1996; see
also van IJzendoorn et al., in press).
Cross-sectional studies have also found an as-
sociation between children's disorganized/con-
trolling behavior with mother and aggression or
externalizing behaviors. In two studies of clinic-
referred preschoolers with oppositional behavior
and their normal controls, oppositional pre-
schoolers were more often classified as control-
ling toward their mothers (Greenberg et al.,
1991; Speltz, Greenberg, & DeKlyen, 1990). In a
cross-sectional sample of low-risk preschoolers,
controlling children were rated higher by parents
and teachers on both internalizing and external-
izing behavior (Solomon et al., 1995). Finally, in
another cross-sectional study of low-risk 5- to 7-
year-olds, children classified as controlling
scored lower on maternal ratings of social com-
petence and higher on a checklist of childhood
behavior problems also completed by mothers
(Moss et al., 1996). At a 2-year follow-up, teach-
ers rated 7- to 9-year-olds previously classified
as controlling higher on internalizing and exter-
nalizing behaviors (Moss et al., 1998).
However, in one prospective longitudinal
study, avoidant or resistant attachments at age 1
also predicted aggression in preschool when oth-
er risk factors were present at age 2 (Shaw et al.,
1996). In another longitudinal study following
low-income children from birth to adolescence,
infants classified as disorganized scored higher
on teacher ratings of dissociative behavior and
internalizing behavior in first, second, third, and
sixth grades, and on both internalizing behavior
and overall psychopathology in adolescence (E.
Carlson, 1998).
Cohn (1990) also assessed teacher-rated be-
havior problems in a cross-sectional study using
all four attachment categories. She found that
ambivalent boys were rated as displaying the
most behavior problems. However, contrary to
 CHAPTER 23. Attachment Disorganization
most other investigators, she discarded the data
from 8 boys judged to be disorganized/unclassi-
fiable, leaving only 4 boys in the disorganized/
controlling group; Wartner et al. (1994) also cod-
ed all four attachment groupings at age 6 and
coded problem behaviors based on half-day ob-
servations of children's play groups. Problem be-
haviors included a -low threshold for distress,
tics, social isolation, hostility, and temper out-
bursts. No differences were found among the at-
tachment groupings in such a brief observation.
Other recent studies of both low- and middle-
income samples have reported a relation between
an avoidant attachment pattern and internalizing
rather than externalizing problems (Goldberg et
al., 1995; Hubbs-Tait et al., 1994; Lyons-Ruth et
al., 1997; Moss et al., 1996). One study that dis-
tinguished between children cross-classified as
disorganized and avoidant from those classified
as avoidant found only elevated internalizing
problems among avoidant children, and elevated
externalizing and internalizing problems among
children classified as both disorganized and
avoidant (Lyons-Ruth et al., 1997).
On the basis of these data, we might expect
disorganized attachment relationships in infancy
to predict social-relational disorders of child-
hood characterized by aggressive control tactics
and by mixed externalizing and internalizing
symptoms. However, Lyons-Ruth et al. (1997)
found that only 25% of disorganized infants in a
high-risk sample were rated specifically as high-
ly externalizing at age 7, whereas 50% were rat-
ed over the clinical cutoff score for generally
maladaptive behavior at age 7. Similarly, follow-
ing children prospectively from 18 to 54 months
of age, Jacobvitz and Hazen (in press) found that
some preschoolers classified as disorganized/dis-
oriented in infancy later displayed hostile/ag-
gressive behaviors toward peers. However, other
children appeared disconnected—for example,
moving backward when peers approached, cau-
tiously sidestepping along the wall when ap-
proaching peers, or burying their heads under
pillows in the corner of the room during a peer
interaction task. These findings suggest that the
forms of later maladaptation associated with ear-
ly disorganization may not be entirely captured
by conventional checklists for internalizing and
externalizing symptoms. Instead, more subtle
and more organizationally oriented assessments
may be needed of the odd, intrusive, controlling,
or incompetent social behaviors that may be cor-
relates of disorganized/controlling attachment
patterns.
539
Attachment Disorganization and
Altered States of Consciousness
in Young Adulthood
Main and Hesse (1990, 1992a; see also Hesse &
Main, in press-a) have proposed that parents who
are unresolved with respect to loss or trauma may
be vulnerable to entering altered states of con-
sciousness, such as trance-like states. Support for
this hypothesis comes from a study of 140 low-
risk subjects who were administered the AAI and
the Tellegen Absorption Scale (TAS), which in-
cludes items such as "I sometimes 'step outside'
my usual self and experience an entirely different
state of mind," and "At times I feel the presence of
someone who is not physically there" (Hesse &
van IJzendoorn, in press-a). Unresolved subjects
showed significantly elevated scores on the TAS
when compared with subjects classified into the
remaining adult attachment categories (au-
tonomous, dismissing, preoccupied, and cannot
classify). See also MuscettX Dazzi, De Coro,
Ortu, and Speranza (in press) for a discussion of
the relationship between unresolved attachment
status and dissociative symptoms.
Main and Hesse (1990) have proposed that
parents who temporarily enter altered states of
consciousness will be more likely to engage in
inexplicably frightened and/or frightening behav-
ior with their children. Frightened and/or fright-
ening parental behavior is theorized to arouse
contradictory responses in an infant, who simul-
taneously experiences tendencies to approach
and to flee from the caregiver, resulting in attach-
ment disorganization in the child. Because hyp-
notic states can be induced by using "confusion
techniques" (e.g., very rapidly urging.a subject to
engage in contradictory movements that cannot
be carried out simultaneously), Liotti (1992; see
also Liotti, in press-a, in press-b) has proposed
that disorganization and disorientation in infancy
will increase a child's vulnerability to altered
states or dissociative disorders (e.g., fugues,
trance states, dissociative identity disorder, expe-
riences of depersonalization and derealization,
and ideas of possession).
Empirical support for Liotti's hypothesis
comes from a prospective longitudinal study fol-
lowing 129 children from birth to age 172/2 (E.
Carlson, 1998). Infants classified as disorga-
nized at 12 and 18 months of age (vs. the other
infants) more often displayed symptoms of dis-
sociation in elementary school and high school,
as reported by teachers on the Teacher Report
Form of the Child Behavior Checklist, and by the
540 PART V. CLINICAL APPLICATIONS

adolescents themselves on the Schedule of Af- age, or at least a month's separation of mother
fective Disorders and Schizophrenia for School- and child before age 54 months; n = 10); (2)
Age Children (K-SADS). Moreover, attachment young adults classified as disorganized during
disorganization in infancy showed a significant infancy who had faced such trauma (•« = 35); and
association with scores on the Dissociative Expe- (3) other young adults not previously classified
rience Scale at age 17V2 (r = .36; Carlson, 1998). as disorganized (n = 83). This group was not di-
Indirect evidence for Liotti *s hypothesis comes vided by trauma history. A significant elevation
from studies examining the relationship between in DES scores was found only among 19-year-
dissociative disorders in adults and their parents* olds classified as disorganized during infancy
experiences of important losses near the time of who had experienced trauma, providing further
their own births. Liotti, Intreccialagli, and Cecere support for Liotti's theory. It is also notable that
(1991) reasoned that if a parent's unresolved re- 78% of those classified as disorganized during
sponse to loss predicts attachment disorganiza- infancy had experienced later trauma. This high
tion in the infant, then loss near the birth of an rate suggests that caregiving environments asso-
infant should increase the likelihood of a disorga- ciated with infant disorganization also place the
nized attachment to the mother. Attachment disor- infant at risk for further exposure to trauma or
ganization, in turn, should increase a person's loss.
propensity to enter an altered state of conscious-
ness. Liotti et al. (1991) asked 46 patients diag-
nosed as suffering from dissociative disorders and DISORGANIZED/CONTROLLING
119 patients with other psychiatric diagnoses ATTACHMENTS AND
whether their mothers had suffered a loss through RELATIONSHIP VIOLENCE,
death of a parent, sibling, spouse or another child TRAUMA, AND MALTREATMENT
during the 2 years before or after their births. Ap-
proximately 62% of the dissociative patients and Prospective Cohorts and Deviant
only 13% of the controls were the offspring of Groups: Complementary Research
mothers who had lost an important person near Strategies in the Study of Attachment
the time of the patient's birth. Given the emerging web of relations linking un-
Hesse and van IJzendoorn (in press-b) report- resolved trauma, dissociation, and maladaptive
ed similar results in a study of two low-risk sam- social behavior to disorganized forms of attach-
ples («'s = 138 and 308). Young adults were ment in infancy and childhood, investigators are
asked whether their own parents had lost another beginning to consider the implications, of these
child or another loved one within 2 years preced- data for delineating the pathways to adult rela-
ing or following their births. Reports of loss of a tional violence and maltreatment. The body of
child or another loved one within two years of work just reviewed, tracing pathways prospec-
their births were related to elevated levels of ab- tively from prebirth parental states of mind to at-
sorption in an altered state of reality, as assessed tachment status in infancy to outcomes in child-
on Tellegen's Absorption Scale. hood and adolescence, exemplifies one critical
Not all infants classified as disorganized show strategy for testing tenets of attachment theory.
dissociative symptoms later in life. Based on the This approach asks how many disorganized in-
prevailing view of dissociation. as a defense fants have .maladaptive outcomes. However, the
against trauma (see Putnam; 1997), Liotti (1992, most seriously traumatized children, such as
in press-a) has further proposed that infants clas- those in violent or criminal families or those sub-
sified as disorganized will be particularly vulner- jected to multiple foster placements, will be un-
able to dissociative disorders if traumatic cir- derrepresented in most longitudinal studies.
cumstances continue or appear in later life. Identifying children who are disorganized in
Empirical support for this idea comes from a lon- infancy and then studying the various outcomes
gitudinal study following 168 children from birth of such early patterns over time needs to be com-
to age 19. Ogawa, Sroufe, Weinfield, Carlson, plemented by a second-research strategy—a fol-
and Egeland (1997) compared scores on the DES low-back strategy. This strategy involves asking
for three groups: (1) young adults classified as how many children or adults with the most de-
disorganized during infancy who had not faced viant relational pathologies have disorganized/
trauma (defined as near-catastrophic events [in- controlling attachment histories. Attachment the-
cluding death of a family member] at any age, ory makes strong predictions that the subset of
life-threatening illnesses before 54 months of children and adults with seriously pathological
 CHAPTER 23. Attachment Disorganization
relational behavior should have histories of dis-
organized attachment patterns in infancy or
childhood, as well as further exacerbating fac-
tors. Identifying the forms of relational patholo-
gy consistent with- these predictions, as well as
the forms of later pathology not related to attach-
ment history, requires supplementing normative
and prospective samples with samples already
displaying serious deviance. The public policy
importance of attachment theory and research
will derive in part from the degree to which the
most serious later relational disorders are cap-
tured within the larger groups who are classified
as disorganized/controlling in early life. There-
fore, relations among attachment, violence, and
maltreatment will continue to be pivotal in test-
ing tenets of attachment theory and in stimulat-
ing new ideas.
Adequate exploration of the relations between
disorganized forms of attachment and disordered
forms of adult or child relational behavior will
necessarily continue to involve a recursive pro-
cess of observation and instrument development.
For example, the identification and description of
disorganized forms of infant attachment behavior
emerged partially from theoretically incongruous
findings. Namely, in studies of maltreated infants
using the initial three-category attachment classi-
fication system, sizable proportions of maltreated
infants were classified as secure (Crittenden,
1985; Lyons-Ruth et al., 1987). Those incongru-
ous findings became part of a recursive process.
First, methods of assessing attachment in low-risk
populations were extended to studying high-risk
populations. Then assessment instruments were
revised to include the atypical adaptations en-
countered in high-risk environments and reap-
plied in high-risk studies, with a much better fit to
the data (e.g., Crittenden, 1985; Lyons-Ruth et al.,
1987, 1990; Main & Solomon, 1986, 1990). This
process began with research on attachment in in-
fancy and has not progressed to the same point in
the study of age groups beyond infancy. Over the
next decade, more differentiated subgroupings
and coding procedures are likely to emerge in as-
sessments of older children, adolescents, and
adults as a critical mass-of research develops on
high-risk populations in these age groups. The
continual development of well-validated attach-
ment assessment instruments for the study of at-
tachment organization in groups at very high risk
for attachment disorganization is one current
frontier of attachment research (see also Dozier,
Stovall, & Albus, Chapter 22, and Hesse, Chapter
19,.this volume).
541
An Attachment Perspective
on Relationship Violence
Attachment theory has a fundamental contribu-
tion to make in placing serious relational disor-
ders, such as violent or maltreating behavior,
into a broader conceptual context—a context
that includes concepts of internal working mod-
els, mental segregation, and controlling relation-
al behavior. An attachment perspective on vio-
lence and abuse needs to integrate four basic
aspects of attachment theory: (1) the presence of
an attachment behavioral control system; (2) the
role of anger in that control system; (3) the op-
eration of both intersubjective and intrapsychic
mechanisms in channeling the experience and
expression of attachment-related affects, as well
as the fear, anger, and unregulated physiological
arousal resulting from frustration of attachment
goals; and (4) the intergenerational transmission
of relational patterns. These basic postulates of
an attachment model are reviewed in detail in
other chapters of the present volume.
Of particular relevance to the study of vio-
lence, Bowlby (1973) has pointed out that anger
is a natural response to frustration and serves as
an important communicative signal to the attach-
ment partner that something is awry. If the at-
tachment relationship is in jeopardy or the at-
tachment figure is unresponsive, anger is one
way of increasing the intensity of the communi-
cation to the attachment figure. Thus anger may
occur in the service of the attachment relation-
ship. To the extent that the increased emotional
signaling works well enough to elicit the part-
ner's ongoing participation in protection and
arousal regulation, the attachment,relationship
will maintain a consistent and predictable, albeit
possibly insecure, organization.
Should the child's increased anger and distress
fail to elicit an adequate parental response to the
child's fearful arousal, however, increasingly fran-
tic and futile anger and distress may mount, and
strategic behavioral organization may break down
or take increasingly deviant forms as the commu-
nication fails to achieve its goal. Bowlby (1980)
described these processes as part of the "protest"
and "despair" phases of the child's response to
loss of the caregiver in the absence of an adequate
substitute. When an infant is confronted not with
a loss but with a fearful infant-caregiver relation-
ship, attempts to organize a consistent strategy ap-
pear to disintegrate into the conflict;.behaviors
represented in disorganized attachment behavior.
Such conflict behaviors may appear in the.form of
542 PARTY. CLINICAL APPLICATIONS
anger or distress and alternate with fear and
avoidance, or may appear in disguised forms (e.g.,
inexplicable, aim-inhibited action sequences).
Therefore, in the absence of adequate caregiving
regulation of fearful arousal, various intersubjec-
tive, intrapsychic, and physiological compensato-
ry mechanisms are set in motion, resulting in mal-
adaptive, contradictory, or controlling behavioral
and mental organizations. Violence in mtimate re-
lationships can be one outcome of such a devia-
tion in the organization of attachment relation-
ships, and one in which great intensity of positive
longing, anger, and fear may be combined with a
lack of felt security, lapses in attention, dysfluent
communication, and unregulated arousal.
The relations between attachment and adult
maltreatment^ physical aggression, or violence
need to be explored from at least two perspec-
tives—that of the recipient of aggression or mal-
treatment, and that of the aggressor or perpetra-
tor of maltreatment. We first consider the effects
of maltreatment on children from an attachment
perspective and then consider the still fragmen-
tary evidence concerning working models of at-
tachment among adults who are either recipients
or perpetrators of maltreatment, violence, or
abuse.
Child Maltreatment and Attachment
Child Outcomes and Family Correlates
of Child Maltreatment
A large literature deals with aspects of the adap-
tation of maltreated children outside the context
of attachment research (see reviews by Cicchetti,
Lynch, Schonk, & Todd-Manly, 1992; Wolfe,
1985). A complete review of this literature goes
beyond the scope of the present chapter. The lit-
erature is briefly summarized here, however, in
order to examine how an attachment perspective
deepens and extends our understanding of the
developmental pathways associated with child
and adult aggression.
Not surprisingly, the literature on child abuse
and neglect has established that many negative
developmental outcomes are associated with
maltreatment. Peer relations are disturbed, with
maltreated children exhibiting more withdrawal
from and avoidance of their peers. Physically
abused children, in particular^ display more ag-
gression toward other children (George & Main,
1979; Mueller & Silverman, 1989). Maltreated
children also display unusual or aggressive be-
havior in response to the distress of peers (Main
& George, 1985) and have more depressive
symptoms (Kazdin, Moser, Colbus, & Bell;
1985).
The school functioning of maltreated children'
is also compromised, compared to that of con-
trols. Sexually abused children are a noted ex-
ception to this pattern, however, as elaborated
further below (Eckenrode, Laird, & Doris, 1993).
There are suggestions that representational mod-
els of self and other are more negatively toned
and less coherent among maltreated children
(Lynch & Cicchetti, 1991; Schneider-Rosen &
Cicchetti, 1991). In relation to the family envk
ronment, maltreated children experience distor-
tions in ongoing parent-child interaction, in'ad-
dition to specific incidents of abuse (Crittenden,
1981; Lyons-Ruth, Connell, & Zoll, 1989). As
noted earlier, Carlson et al. (1989) found that
82% of maltreated infants displayed disorga-
nized patterns of attachment to their caregivers,
compared to only 17% of socioeconomically
similar controls. Lyons-Ruth et al. (1990) ob-
tained figures of 55% among maltreated infants
and 34% among low-income controls in a con-
text where all maltreating families had received
clinical home-visiting services. Thus there is am-
ple evidence that maltreated children experience
more negative family relationships and exhibit
poorer developmental outcomes on multiple di-
mensions, as well as having early disorganized
attachment relationships. As parents themselves,
maltreated children are at elevated risk for mal-
treating their own children (Egeland, Jacobvitz,
& Papatola, 1987; Kaufman & Zigler, 1987).
Children's Physiological Adaptations
to Maltreating Environments
In addition to the earlier-reviewed elevated corti-'
sol responses to stress among disorganized in-
fants, evidence is accruing that the most ex-
tremely impaired early attachment relationships
are associated with even more pervasive changes
in the organization and functioning of the hypoL
thalamic-pituitary-adrenal (HPA) axis. M. Carl-
son et al. (1995) found that normal diurnal-varia-
tion in Cortisol secretion was altered* among
Romanian orphans, with peak values occurring
in late morning or early afternoon, rather than* at
rising. M. Carlson and Earls (1997) also'fourid
that degree of Cortisol elevation among Roman-
ian orphans was related to decrements in-infant
developmental scores on the Bayley Scales.
Boyce, Champoux, Suomi, and Gunnar (1996)
found similar alterations in diurnal cycles of Cor-
tisol secretion among rhesus monkeys raised^ in
social isolation.
 CHAPTER 23. Attachment Disorganization
Blunted Cortisol responses to stress may be an-
other outcome of particularly deviant early at-
tachment experiences. Kraemer and Clarke
(1996) reported that compared to mother-reared
monkeys, rhesus monkeys randomly assigned to
a peer-rearing condition showed subsequent
blunting of physiological responses to stress,
while still showing behavioral signs of distur-
bance (see also Clarke, T993). Similarly, Hart,
Gunnar, and Cicchetti (1995) found that school-
age children who were maltreated were less like-
ly to show Cortisol elevations after conflicts with
peers than were nonmaltreated children. Hart et
al. (1995) speculated that when a child is ex-
posed to chronic stress in abusive family con-
texts, the HPA axis may down-regulate to avoid
chronic hyperactivation. The low Cortisol levels
observed among Vietnam veterans exposed to
combat provide convergent support among hu-
man subjects for the hypothesis that unbuffered
stress leads to down-regulation of the HPA axis
(Boscarino, 1996; Yehuda, Southwick, Giller,
Ma, & Mason, 1990).
These more extreme alterations in functioning
of the HPA axis have not yet been studied in rela-
tion to disorganized/controlling attachment pat-
terns per se. More work is now needed exploring
the interrelations among very deviant early at-
tachment experiences, disorganized attachment
behaviors, cognitive development, and chronical-
ly elevated or blunted physiological responses to
stress.
Disorganized/Disoriented Attachment
Patterns and the Maltreated Child
The attachment literature has made several im-
portant contributions to the conceptualization
and further development of the literature on mal-
treatment. The first contribution has been an at-
tachment organizational perspective on the un-
derstanding of these multiple negative correlates.
The postulate that early infant-caregiver rela-
tional patterns are represented and carried for-
ward as prototypes for how to interact with oth-
ers in close relationships shifts the conceptual
framework from a narrower focus on abuse inci-
dents per se to a more organizational view of the
integrated behavioral, affective, physiological,
and representational patterns that are being trans-
mitted from parent to child (Crittenden &
Ainsworth, 1989).
A more recent and specific contribution of at-
tachment research is the finding that the disorga-
nization of the attachment relationship, rather
than simply its insecurity, may be a central
543
mechanism in the emergence of many of the dis-
turbances associated with 'maltreatment. There-
fore, we predict that maltreatment should also be
associated with the developmental sequelae of
disorganized attachment patterns—sequelae that
also appear in nonmaltreated groups, including
disorganized/controlling attachment patterns,
verbal deficits; aggressive and other maladaptive
behavior problems, altered physiological re-
sponses to stress, and contradictory and uninte-
grated mental representations of relationships.
The literature on developmental outcomes
among maltreated children just reviewed is con-
sistent with these predictions, although the pre-
dictions have not yet been thoroughly tested us-
ing attachment assessments per se.
Once the mental and behavioral components
of disorganized attachment patterns are consid-
ered, the question emerges of whether children or
adults who have been recipients of sexual or
physical maltreatment will display patterns of
behavior not shared with other children with dis-
organized attachment histories. There are indica-
tions in the literature that the type of abuse does
affect the way social behavior and symptomatol-
ogy are organized later in childhood or adult-
hood. For example, in several studies, hospital-
ized sexually abused girls were more likely to
present dissociative and posttraumatic symp-
toms, whereas physically abused hospitalized
adolescents were more likely to present de-
pressive symptoms and conduct symptoms
(Deblinger, McLeer, Atkins, Ralphe, & Foa,
1989; McLeer, Callaghan, Henry, & Wallen,
1994; Pelcovitz et al., 1994). Consistent with this
picture, physically abused school children were
more likely to perform poorly academically, to
be sent to the principal more often, and to be sus-
pended from school more often, while sexually
abused girls exhibited none of these school prob-
lems (Eckenrode et al., 1993). In adulthood,
mothers who had been physically abused in
childhood were more likely to be intrusive and
covertly hostile in interactions with their infants,
while mothers who had been sexually abused but
not physically abused were more likely to be
withdrawn and uninvolved with their infants but
were not more likely to be hostile (Lyons-Ruth &
Block, 1996). Overall, it appears that sexually
abused women are less likely than physically
abused women to act aggressively toward others,
more likely to conform to social expectations,
and more likely to use dissociative defenses to
maintain areas of appropriate'social functioning.
Lyons-Ruth and Block (1996) have speculated
that the different stances of physically abused
544 PARTY CLINICAL APPLICATIONS
and sexually abused mothers toward their infants
are related to the abused women's differential
overt identification with the aggressor or the vic-
tim position in the earlier abusive relationship.
Identification with a sexual aggressor may be
psychologically unlikely for women, whereas
identification with a physically abusive parent
may be more psychologically and behaviorally
feasible. Consistent with an attachment frame-
work, however, difficulties in intimate relation-
ships, vinintegrated mental representations, nega-
tive self-concepts, and problems with affect
regulation are expected to be core features of a
disorganized attachment relationship. These fea-
tures should be common to identification with
either the aggressor or the victim position in an
abusive relationship. The abuse literature con-
firms that both groups of maltreated adolescents
display these core features.
In summary, qualitative differences between
children or adults who have suffered physical or
sexual abuse and children or adults whose disor-
ganized attachment relationships stem from oth-
er kinds of traumatic attachment-related experi-
ences have yet to be demonstrated. Although
differences between these groups may be antici-
pated, these distinctions have not yet been made
and remain at the frontier of current work.
States of Mind Regarding Attachment
among Violent, Maltreating,
or Maltreated Adults
Unresolved States of Mind
among Maltreating or Maltreated Adults
From an attachment perspective, there is a strong
presumption that a maltreating caregiver is a
frightened or frightening caregiver whose current
mental state is characterized by a lack of resolu-
tion of loss or trauma, resulting in contradictory
and unintegrated mental contents. However, em-
pirical data addressing this prediction are rare.
Few studies have examined maltreating adults'
own internal models of attachment. Some data
are available relating these adults' own histories
of trauma or abuse to attachment-related' out-
comes in adulthood. Lyons-Ruth and colleagues
have demonstrated a link between the severity of
trauma or abuse in a mother's own childhood and
her child's display of disorganized rather than or-
ganized forms of insecure behavior, as well as
her own display of withdrawn or hostile behavior
toward the child (Lyons-Ruth & Block, 1996;
Lyons-Ruth, Zoll, Connell, & Grunebaum,
1989). Several other studies have related re-
sponses on the AAI to an adult's earlier history of
trauma. These studies have implicated both unre-
solved (U) states of mind and rarer states of
mind, such as "preoccupied/overwhelmed by
trauma" (E3) and "cannot classify" (CC), as se-
quelae of maltreatment. These two rarer AAI
subgroups are described briefly before we pre-
sent the empirical findings.
Both the preoccupied/overwhelmed by trauma
(E3) and cannot classify (CC) AAI subgroups oc-
cur rarely in low-risk samples but are seen with
increasing frequency among clinical populations
(see Hesse, this volume). Neither AAI subgroup
has a corresponding infant attachment subgroup,
and neither subgroup has been validated against
infant data. As described by Main and Goldwyn
(1998), both of these AAI subgroups may also be
given a primary classification of unresolved with
respect to loss or trauma if they also meet the cod-
ing criteria for lack of resolution.
The preoccupied/overwhelmed by trauma (E3)
subgroup is one of three subtypes of a preoccu-
pied state of mind identified in the Main and
Goldwyn (1998) AAI coding manual. This adult
subtype has no corresponding infant resistant
subtype as its expected intergenerational coun-
terpart, as do the other two preoccupied sub-
types. Because of its rarity, this subtype also re-
ceives a relatively brief description in the coding
manual and has no corresponding detailed cod-
ing scale for identifying and rating overwhelmed
manifestations in the transcript, as do the other
two preoccupied subtypes. Interviews are classi-
fied as preoccupied/overwhelmed by trauma if
material related to traumatic experiences repeatr
edly intrudes into the interview context. Adults
whose interviews are classified as E3 are often
grouped with adults in the other two preoccupied
subgroups for purposes of data analysis, and, the-
oretically, their infants are expected to display re-
sistant attachment patterns rather than disorga-
nized attachment patterns.
Adult interviews are placed in the cannot clas-
sify (CC) category when the discourse manifests
a collapse of strategy at a global level rather than
only during discussions of loss or trauma (Hesse/
1996; Minde & Hesse, 1996). This global break-
down in strategy is characterized by the display
of two contrasting states of mind over the course
of the interview that should be incompatible (dis-
missing and preoccupied), or by a general inabil-
ity to implement an organized stance (as seen in
transcripts with low coherence scores, as well as
low scores for both dismissing and preoccupied
strategies).
Patrick, Hobson, Castle, Howard, and Maugh-
 CHAPTER 23. Attachment Disorganization
an (1994) found that 9 of 12 clinic patients ex-
hibiting borderline personality disorder were
classified as both preoccupied/overwhelmed by
trauma (E3) and unresolved with respect to
childhood trauma.-The remaining three patients
with borderline personality disorder were classi-
fied preoccupied/overwhelmed by trauma only.
In contrast, clinic patients with dysthymic disor-
der were significantly less likely to show these
unresolved/overwhelmed characteristics on inter-
view, despite a similarly high rate of childhood
trauma. Comparable results, including the high
rates of childhood trauma among psychiatric pa-
tients compared to controls, were reported by
Fonagy et al. (1996). Neither of these studies
coded the cannot classify category. Stalker and
Davies (1995), studying 40 women in psychiatric
treatment who were sexually abused in child-
hood, also found that 7 of 8 abused women with
borderline personality organization (88%) were
classified as unresolved on the AAI, and that 5 of
these 7 (71%) were also classified in the preoc-
cupied group (the authors did not provide a
breakdown of the frequencies of the three sub-
types in the preoccupied group). Among all sex-
ually abused women, 60% were classified as un-
resolved, and 88% of those were also classified
in the preoccupied group. Stalker and Davies
also reported that 37.5% of both resolved and
unresolved women also met criteria for the can-
not classify category, although this category was
not considered in their data analyses.
Thus childhood trauma that eventuates in adult
borderline personality disorder is clearly associ-
ated with a concomitant unresolved and over-
whelmed state of mind with respect to attach-
ment. Sexual abuse survivors in psychiatric
treatment are also likely to show these character-
istics, whether or not they also exhibit borderline
personality disorder, but psychiatric patients
with dysthymic disorder are not, even in the con-
text of a history of trauma. These data support
the prediction from attachment theory that adults
with severe problems in maintaining close rela-
tionships—a characteristic associated with bor-
derline personality disorder—will exhibit unre-
solved states of mind with respect to attachment.
However, the data also indicate that indices of
lack of resolution of trauma by themselves are
not sufficient to capture these states of mind.
These studies have been conducted among clini-
cal samples rather than general-population sam-
ples, however, so they represent the more im-
paired end of the spectrum of trauma-exposed
adults. General-population samples are needed to
fully explore the distribution of attachment-relat-
545
ed states of mind among adults exposed to child-
hood trauma.
Disorganized Attachment Patterns
and Violence between Intimate Partners
We have noted above the overlap in correlates of
disorganized attachment patterns and correlates
of childhood abuse. West and George (1998)
have pointed to a similar overlap in the correlates
associated with disorganized attachment rela-
tionships and those associated with marital vio-
lence. They have proposed that violence in inti-
mate relationships is tooted in disorganized
attachment relationships and have outlined a
model of marital relational violence based on the
literature on disorganized/controlling attachment
patterns. West and George (1998) have further
pointed out that marital, violence is associated
with a constellation of adult characteristics that
are also related to disorganized/unresolved at-
tachment relationships. This constellation in-
cludes a history of trauma or abuse, borderline
personality organization, intense abandonment
anxiety, controlling behavior toward the partner,
and unintegrated or dissociated mental contents
associated with trauma.
There are still relatively few data directly ex-
ploring the attachment behaviors or states of
mind of those who display marital violence,
however. Owen and Cox (1997) found that ele-
vated rates of marital conflict observed between
marital partners in a laboratory assessment were
associated with elevated rates of disorganized at-
tachment classifications on the part of their in-
fants. However, Shaw et al. (1996) did not repli-
cate this finding. Steiner, Zeanah, Stuber, Ash,
and Angell (1994) found that mothers who re-
ported higher levels of partner violence were
more likely to have infants with disorganized at-
tachments. In the study by Lyons-Ruth and Block
(1996), infants of mothers who were not abused
but had witnessed violence between others in
childhood were as likely to display a disorga-
nized attachment strategy as were infants whose
mothers had directly experienced physical or
sexual abuse. Bearman and Ogawa (1993) re-
ported, in particular, that mothers who displayed
indicators of lack of resolution in relation to vio-
lence witnessed in childhood were more likely to
have infants classified as disorganized.
The few existing studies of marital violence
and AAI responses suggest that in addition to un-
resolved states of mind, rarer adult states of mind
such as preoccupied/overwhelmed by trauma
(E3) and cannot classify (CC) appear with in-
 546 PART V. CLINICAL APPLICATIONS
creased frequency among both perpetrators and
victims of violent behavior. Holtzworth-Monroe,
Stuart, and Hutchinson (1997) found that male
batterers were significantly more often classified
cannot classify on the AAI than were nonbatter-
ers, and Sullivan-Hanson (1990), studying bat-
tered women, found that women in shelters had a
high prevalence of E3 classifications on the AAI
(the unresolved classification was not coded in
that study).
Two other studies have examined states of
mind with respect to attachment among mentally
disturbed criminal offenders. Levinson and Fon-
agy (1998) collected AAIs from 22 mentally dis-
turbed criminal offenders. Both offenders and
nonclinical controls were less likely than psychi-
atric controls to be classified as unresolved (36%
and 0% vs. 82%). Eighty-two percent of offend-
ers, but only 36% of psychiatric controls and 4%
of normals, had been abused in childhood, and
current anger toward attachment figures was de-
scribed as "intense" among offenders. Both of-
fenders and psychiatric controls were more likely
to be classified preoccupied than nonclinical
controls (45% and 64% vs. 14%). Levinson and
Fonagy did not report whether most of the people
classified as preoccupied were in the E3 (over-
whelmed by trauma) subgroup. Because the
group of criminal offenders would be strongly
predicted to show unresolved states of mind with
respect to attachment, based on their histories of
i-' abuse, current anger, and violent behavior toward
others, these findings run counter to theory.
Although Levinson and Fonagy found that of-
fenders were less likely to display unresolved
states of mind than psychiatric controls, a study
by van IJzendoorn, Feldbrugge, et al. (in press) of
40 mentally disturbed criminal offenders did not
replicate that finding—a difference that may be
accounted for by the latter authors' inclusion of
cannot classify codes with unresolved codes in re-
porting the data, van IJzendoorn, Feldbrugge, et
al. (in press) found that autonomous AAI classifi-
cations were almost absent (5%) among offend-
ers, while the combined unresolved/cannot classi-
fy groups constituted 53% of the sample. This
distribution is a significant departure from the
distribution of AAI classifications reported in
low-risk middle-income samples, where about
14% are classified as unresolved (van IJzen-
doorn, Schuengel, & Bakermans-Kranenburg, in
press). However, criminal offenders were not
more likely than other clinical groups to display
unresolved or cannot classify states of mind, van
IJzendoorn and coworkers did not present the fre-
quencies for unresolved and cannot classify sub-
groups separately, however, nor did they report'
how many unresolved subjects received a subclas-
sification of E3 or CC.
The data as a whole suggest that violence-
prone and disturbed men may be particularly
likely to display the more globally contradictory
states of mind associated with the cannot classify
category, while abused and distressed women
may be more likely to display both unresolved
and overwhelmed (E3) states of mind with re-
spect to attachment. As discussed in more depth
in the next section of this chapter, however, we
would not expect this division to be a rigid one.
Rather, we would expect the abused-abuser in-
ternal working model of attachment to include
representations of both positions in this dyadic
relational pattern, with the potential for either
overwhelmed or contradictory states of mind to
be expressed, depending on context, tempera-
ment, gender role, and other factors.
Data are particularly needed tying these rarer
groups (including the CC and E3 classifications)
to infant and child attachment data, since the
parental risk factors associated with these groups
overlap with the risk factors for infant disorgani-
zation. On the basis of their sample of sexually
abused women, Stalker and Davies (1995) sug-
gested that the AAI categories need continued
expansion "to avoid placing individuals with rel-
atively mild information-processing distortions
in the same category as those with serious distor-
tions. Delineation of the subgroups of the cate-
gory currently labeled cannot classify (CC) may
be the means by which such expansion can be
achieved" (p. 238). We would also add the E3
subgroup to the group of AAI categories for
which more infant data and coding description
are needed. This emerging evidence of the preva-
lence of E3 and CC states of mind among violent
or abused adults suggests that there may be a
wider spectrum of parental states of mind that
would be expected to predict infant disorganiza-
tion beyond the unresolved group alone. Further
research on the childhood antecedents and inter-
generational outcomes associated with these
adult states of mind will be crucial to under-
standing the interface between attachment rela-
tionships and psychopathology. Further explo-
ration of the attachment-related correlates both
of childhood abuse and of adult violence and
psychiatric disorder constitutes an active area of
current attachment research, and new findings
are likely to emerge (see Dozier et al., Chapter
22, and Hesse, Chapter 19, this volume).
 CHAPTER 23. Attachment Disorganization
AN INTEGRATIVE CONCEPTUAL
FRAMEWORK: LOSS, TRAUMA,
AND THE RELATIONAL DIATHESIS
The literature reviewed in this chapter .on disor-
ganized/controlling attachment patterns, unre-
solved loss or trauma, and frightened or frighten-
ing caregiving behavior raises a number of
issues. A recurring theme regarding the disorga-
nized attachment category across the lifespan is a
theme of contradictory and unintegrated behav-
ioral strategies and mental contents. Contradic-
tions are observed within such an individual's be-
havioral strategies and mental contents and
contradictions are also observed at the level of
the composition of the disorganized group,
which includes such sharply contrasting sub-
groups as punitive versus caregiving and fright-
ened versus frightening. Here we point to three
of the most pressing questions raised by this lit-
erature and elaborate a framework to account for
such apparent discontinuities.
One question that merits more attention in the
literature is why some experiences of loss,
parental death, or trauma become resolved and
others do not. A second related question that has
not been addressed is how processes of intergen-
erational transmission of disorganized forms of
attachment work. In the model to date, caregivers
are viewed as developing an unresolved state of
mind in relation to a specific experience of loss
or trauma—an experience usually occurring later
than the first few years of life and often much
later. In contrast, infants are viewed as develop-
ing a disorganized attachment strategy through
exposure to their caregivers' unintegrated fear.
This leads to the conundrum that if a disorga-
nized infant grows up without further loss or
trauma, then he or she will not be codable as un-
resolved on the AAI. Do we assume, then, that
all disorganized infants grow out of disorganized
forms of attachment behavior unless further un-
resolved loss or trauma occurs? Or is a caregiv-
er's frightened or frightening behavior sufficient
in itself to lead to intergenerational transmission
of disorganized attachment behavior? A third
question posed by the current data is how to ex-
plain the apparently very different behavioral and
mental organizations that emerge out of a com-
mon fear-based dynamic. Why are some parents
frightened and some frightening, some disorga-
nized infants approaching and some avoiding,
and some controlling children battling with their
parents while others are caregiving toward their
parents?
547
Lyons-Ruth, Bronfman, and Atwood (in press)
have pointed out that placing the process of fear
and its modulation into a relational context
points to a way out of these impasses. If attach-
ment disorganization or lack of resolution is a
function both of the intensity of fear-producing
experience and of the adequacy of the attachment
relationship to help resolve the fearful affect,
then potential answers emerge. At one end of the
spectrum, particularly abrupt or shocking trau-
ma, or trauma that also impairs the caregiver,
may be sufficient in itself to disorganize the at-
tachment strategy of a child or adult who has had
otherwise adequate attachment relationships. At
the other end of-the spectrum, even the norma-
tive distress-producing experiences of infancy
may remain unbuffered and lead to disorganized
attachment responses in the presence of a fright-
ened or frightening caregiver who experiences
unresolved fear in relation to the infant's attach-
ment behaviors. If the early attachment relation-
ship remains disorganized/controlling through-
out childhood, further loss or trauma may not be
necessary for intergenerational transmission of
disorganization to occur.
In this relational-diathesis model, organized
dismissing or preoccupied attachment relation-
ships should provide sufficient protection and
caretaking in response to uncomplicated experi-
ences of loss to allow integrated mental function-
ing. Only if the loss or traumatic experience falls
well outside the norm should we expect to see
the kinds of behavioral and mental lapses associ-
ated with disorganization. Similarly, only if the
degree of communication and protection avail-
able from the attachment figure falls outside the
spectrum associated with organized attachment
strategies should we expect to see disorganized
attachment responses even in the absence of loss
or trauma. This implies that there should be an
additive or interactive effect between the pres-
ence and characteristics of the trauma and the
quality of the childhood attachment relation-
ship in producing disorganized/controlling/unre-
solved states. This stress-relational-diathesis
model is consistent with the primate literature
demonstrating that peer-nurtured monkeys that
have experienced early maternal deprivation (the
relational diathesis) display adequate social be-
havior until stressed, at which time the early rela-
tional diathesis becomes manifest again in atypi-
cal social behaviors. By itself, however, the stress
is not sufficient to produce atypical behaviors in
peers that have not been maternally deprived
(Suomi, 1991).
 548 PART V. CLINICAL APPLICATIONS
The concept of a relational diathesis, or vul-
nerability to disorganization in the face of trau-
ma, is foreshadowed in Bowlby's (1980) discus-
sion of the conditions affecting the course of
mourning. He states that "adults whose mourn-
ing takes a pathological course are likely before
their bereavement to have been prone to make af-
fectional relationships of certain special, albeit
contrasting, kinds" (p. 202). He lists the three
classes of affectional relationships as those "suf-
fused with overt or covert ambivalence," those in
which "there is a strong disposition to engage in
compulsive caregiving," and those in which
"there are strenuous attempts to claim emotional
self-sufficiency and independence of all affec-
tional ties" (p. 202). A similar point was made by
Freud (1917/1957), who described persons prone
to pathological "mourning as those who have ex-
perienced marked but consciously unacceptable
ambivalence toward the lost person. In short, the
more insecure the underlying attachment, the
more difficult the mental resolution of a loss be-
comes.
Ainsworth and Eichberg (1991) provided em-
pirical grounding for this concept in their finding
that mothers who were classified as unresolved
in relation to past loss or trauma were more like-
ly to receive secondary classifications of preoc-
cupied or dismissing rather than autonomous on
the AAI (for meta-analytic data, see van IJzen-
doorn, Schuengel, & Bakermans-Kranenburg, in
press). Although in all the above-cited literature
the relevant processes were placed in the adult
personalities or states of mind of the bereaved, it
is in keeping with Bowlby's broader theory to de-
I rive these states of mind in part from patterns of
caregiving experienced in childhood.
In conceptualizing the childhood relational
processes most likely to interfere with the resolu-
tion of loss or trauma, however, we should distin-
li guish between those caregiving behaviors that al-
low the maintenance of organized but insecure
attachment patterns, such as the preoccupied or
dismissing classifications, and those caregiving
behaviors more likely to be associated with dis-
organized or controlling patterns of child attach-
ment. At present, from a parent's AAI data alone,
a distinction cannot be made between the par-
|S ent's carrying forward the experience of a disor-
ganized or controlling attachment relationship
from childhood and the parent's further experi-
ence of a loss or trauma that fails to be resolved.
Longitudinal data from infancy or childhood will
be needed to assess separately how the preva-
lence and severity of childhood trauma and the
extent of insecurity in early attachment relation-
ships contribute to the intergenerational trans-
mission of disorganization. We predict, however,
that trauma will both occur more frequently and
be more difficult to resolve in the context of an
already disorganized caregiving system, suggest-
ing both direct and indirect effects of early disor-
ganized caregiving on later adult outcomes. The
data of Ogawa et al. (1997) provide some support
for these predictions in relation to adult dissocia-
tive symptoms, as noted earlier.
Finally, the sharply contrasting behavioral
styles that make up the disorganized category,
such as punitive or caregiving control in child-
hood, can be viewed as stemming from the nature
of the relational diathesis itself. If a caregiver has
not experienced comfort and soothing in relation
to his or her own early fear-evoking experiences,
the infant's pain and fear will evoke unresolved
fearful affects in the caregiver, including memo-
ries of his or her own helplessness as a child in
obtaining comfort. To prevent reexperiencing his
or her own unresolved fearful affects, the care-
giver must restrict attention and responsiveness
to the infant's fear and distress. As a result, the
caregiver's fluid responsiveness to the infant's at-
tachment-related cues will inevitably be restrict-
ed (Fraiberg, Adelson, & Shapiro, 1975; Main,
1995, 1996; Main et al., 1985; Strage & Main,
1985). The more pervasive these restrictions, the
more the caregiver's mental states take prece-
dence over the infant's attachment-related com-
munications and initiatives. To the extent that the
caregiver's unresolved fearful experiences are at-
tended to at the expense of attention to the child's
current states, the interaction between the two
partners will become less balanced and less mu-
tually regulated to meet the needs of both part-
ners.
Such unbalanced relational processes provide
a conceptually powerful construct that can order
many additional aspects of the findings regard-
ing disorganized attachment patterns. Both
Bowlby (1980) and his forebears in psychoana-
lytic scholarship emphasized that mental repre-
sentations of relationships are inherently dyadic
(see also Sroufe & Fleeson, 1986). What is repre-
sented is not only the individual's way of partici-
pating in the relationship—for example, as the
coercively controlled child—but the entire
dyadic relational pattern of controlled child >and
controlling parent. The more the parent must re-
spond to his or her own need to regulate fearful
arousal rather than to the child's states, the more
skewed these relational polarities become, -and
the more discontinuous and self-contradictory
are the internalized models that accommodate
 CHAPTER 23. Attachment Disorganization
both relational possibilities (e.g., "I should ac-
cept external control and take no initiative" vs. "I
should control the other by overriding the other
person's initiative").
In a relational model, the unintegrated duali-
ties that recur in the disorganized group both at
the individual level (unintegrated mental con-
tents) and at the level of the disorganized group
as a whole (frightened or frightening behavior,
coercive or caregiving behavior, chaotic or inhib-
ited play) can be understood as partially rooted in
a disorganized child's history of participation in
such unbalanced relationships. Inherent in a
model of unbalanced relationships is an asym-
metry of power in which one partner's (attach-
ment-related) goals or initiatives are elaborated
at the expense of the other's. By definition, then,
one partner is more helpless in the relationship
and the other more controlling, whether the con-
trol is exerted through active aggression or
through the more covert mechanisms of with-
drawal, guilt induction, or self-preoccupation
(see Fraiberg et al., 1975, and Zahn-Waxler &
Kochanska, 1990, for examples). Thus, a help-
less versus hostile/controlling dyadic dichotomy
in relationship roles should he especially evident
among individuals in disorganized attachment
relationships, and this may partially account for
the bifurcation into punitive or caregiving
stances that occurs among disorganized infants
during the preschool period. Because such inter-
nal models include both contradictory relation-
ship roles, however, an individual with such a
model may mentally or behaviorally activate ei-
ther role sequentially or simultaneously, depend-
ing on contextual and temperamental factors;
this may lead to highly contradictory behavioral
or mental sequences.
Lyons7Ruth and Atwood (1998) present pre-
liminary evidence that these helpless or hos-
tile/controlling stances can be identified in the
AAI, independently of indices of unresolved
states of mind. These authors have speculated
that these two AAI patterns are associated with
the overwhelmed by trauma (E3) and cannot
classify (CC) subgroups that often seem to clus-
ter with the unresolved classification. In this for-
mulation, the E3 and CC subgroups represent
overall states of mind that correspond to an
unbalanced helpless versus hostile/controlling
internal working model, which may manifest
itself in either helpless or hostile interpersonal
stances (or both in alternation) and should
be tied to childhood experiences of participation
in very unbalanced or controlling relationships.
A fuller exposition of this model is available
549
in Lyons-Ruth, Bronfman, and Atwood (in
press).
Lyons-Ruth and Atwood (1998) have devel-
oped initial conventions for coding hostile/con-
trolling or helpless states of mind on the AAI,
and Hesse (1996; Minde & Hesse, 1996) has de-
scribed the more interview-wide characteristics
that constitute the CC designation. More needs to
be done to conceptualize and code the extremes
of relational imbalance in childhood, both as re-
vealed by the AAI and as observed in parent-
child transactions, to better differentiate hostile/
controlling or helpless states of mind from the
less extreme parental rejection or' overinvolve-
ment consistent with the child's maintenance of
an organized attachment strategy.
CONCLUSIONS
In summary, Main and colleagues' (Main et al.,
1985; Main & Solomon, 1986, 1990) discovery
of a disorganized attachment pattern in infancy
has opened up new ground in understanding the
interface between development and psycho-
pathology. Theoretically, Main and coworkers
(Hesse & Main, in press; Main & Hesse, 1990;
Main & Morgan, 1996) have pointed to "fear
without solution" as the core dilemma facing in-
fants who display inexplicable and conflicting at-
tachment behaviors. These authors have pro-
posed that frightened or frightening maternal
behaviors, such as trance-like or dissociative
states, sudden unusual vocal patterns, or sudden
looming into the infant's face, are related to the
mother's earlier unresolved trauma. When cues
in the current environment activate-these uninte-
grated trauma-related representations, fear-relat-
ed maternal behaviors occur out of context and
are therefore inexplicable to the infant. Such in-
explicable behaviors are likely to alarm the in-
fant. Since infants rely on their attachment fig-
ures to protect them from harm should dangers
arise, fear stemming from their own caregivers
places infants in an unresolvable paradox. Such
an attachment figure is "at once the source of
and the solution to [an infant's] alarm" (Main &
Hesse, 1990, p. 163). At the same time that the
infant experiences a tendency to approach the
caregiver for comfort, the infant experiences a
competing tendency to flee.
Competing and irreconcilable tendencies to
move toward and away from the caregiver, who is
both the source of alarm and the haven of safety,
intensifies the infant's fear, resulting in a col-
lapse of behavioral and attentional strategies.
 550 PARTY CLINICAL APPLICATIONS
Contradictory behavioral tendencies inhibit the
infant from employing the strategies used by oth-
er infants who are alarmed—namely, seeking
comfort and support from the caregiver (i.e., evi-
dence of security), shifting attention away from
the caregiver (i.e., avoidance), or oscillating be-
tween seeking and resisting comfort (i.e., am-
bivalent or resistant behavior). As elaborated ear-
lier, attachment disorganization in infancy
forecasts controlling behavior with caregivers,
t ciety for Research in Child Development, 50(1-2, Serial
aggressive and fearful peer relationships, and in-
ternalizing and externalizing problems in
preschool, kindergarten, and elementary school,
as well as dissociative symptoms and elevated
psychopathology during adolescence.
The parent's fearful affect, which is thought to
underlie frightened and frightening caregiving
behavior, is related theoretically to the parent's
lack of resolution of fear-arousing experiences of
loss or trauma. "Lack of resolution" refers here
to the failure to integrate fully the reality of the
loss or traumatic experience and to rework men-
tal representations of attachment experiences. To
the extent that multiple, conflicting, and uninte-
grated models of past traumatic experiences are
maintained in segregated areas of consciousness,
a caregiver is likely to display conflicting and un-
integrated behaviors with his or her own child.
As a result, affects or behaviors related to earlier
trauma may be reactivated unpredictably in
parent-child interactions in ways that are not
monitored by an overarching, integrated, and co-
herent parental state of mind. These basic theo-
retical postulates are gaining substantial support
from recent empirical studies. In turn, new ques-
tions are emerging that have to do with exploring
the limiting conditions of these propositions, and
with determining how processes related to disor-
ganization of attachment strategies interface with
the three organized classifications on the one
hand and with clearly defined psychopathology
on the other. In this direction lie some of the fu-
ture developments of attachment theory and re-
search.
*s
REFERENCES
Ainsworth, M. D. S., Blehar, M., Waters, E., & Wall, S.
(1978). Patterns of attachment. Hillsdale, NJ: Erlbaum. Cicchetti, D., & Barnett, D. (1991). Attachment organization
Ainsworth, M. D. S., & Eichberg, C. G. (1991). Effects on in- in maltreated preschoolers. Development and Psychopath-
fant-mother attachment of mother's unresolved loss of an
attachmentfigureor other traumatic experience. In C. M. Cicchetti, D., Lynch, M., Schonk, S., & Todd-Manly, J.
Parkes, J. Stevenson-Hinde, & P. Marris (Eds.), Attach-
ment across the life cycle (pp. 161-183). London: Rout- maltreated children. In R. D. Parke & G. M. Ladd (Eds.),
ledge.
Alpern, L., & Lyons-Ruth, K. (1993). Preschool children at
social risk: Chronicity and timing of maternal depressive Clarke, A. S. (1993). Social rearing effects on HPA axis ac-
symptoms and child behavior problems at school and
at home. Development and Psychopathology, 5, 371-387.
Barnett, D., Ganiban, J., & Cicchetti, D. (in press). Maltreat-
ment, emotional reactivity, and the development of Type
D attachments from 12 to 24 months of age. In J. Vondra
& D. Barnett (Eds.), Atypical patterns of infant attach-
ment: Theory, research, and current directions. Mono-
graphs of the Society for Research in Child Development.
Bates, J. E., Maslin, C. A., & Frankel, K. A. (1985). Attach-
ment security, mother-child interaction, and temperament
as predictors of behavior problem ratings at age three
years. In I. Bretherton & E. Waters (Eds.), Growing points
of attachment theory and research. Monographs of the So-
No. 209), 167-193.
Beckwith, L., & Rodning, C. (1991, April). Stability and cor-
relates of attachment classificationsfrom13 to 36 months
in a sample of preterm infants. In R. S. Marvin & J. Cas-
sidy (Chairs), Attachment during the preschool years: Ex-
amination of a new measure. Symposium conducted at the
biennial meeting of the Society for Research in Child De-
velopment, Seattle, WA.
Berman, D., & Ogawa, J. R. (1993, April). Seeing is believ-
ing: Observed trauma as an alternate route to unresolve
status in the Adult Attachment Interview. Poster presented
at the biennial meeting of the Society for Research in
Child Development, New Orleans, LA.
Boscarino, J. (1996). Post-traumatic stress disorder, exposure
to combat, and lower plasma Cortisol among Vietnam vet-
erans: Findings and clinical implications. Journal of Con-
sulting and Clinical Psychology, 64, 191-201.
Bowlby, J. (1969). Attachment and loss: Vol. I. Attachment'.
New York: Basic Books.
Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation:
Anxiety and anger. New York; Basic Books.
Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss. New
York: Basic Books.
Boyce, T. W., Champoux, M., Suomi, S. I., & Gunnar, M. R.
(1995). Salivary Cortisol in nursery-reared rhesus mon-
keys: Reactivity to peer interactions and altered Circadian
activity. Developmental Psychobiology, 28, 12.
Carlson, E. A. (1998). A prospective longitudinal study of
disorganized/disoriented attachment. Child Development,
69, 1970-1979.
Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K.
(1989). Disorganized/disoriented attachment relationships
in maltreated infants. Developmental .Psychology, 25,
525-531.
Carlson, M., Dragomir, C, Earls, F., Farrell, M., Macovei, O.,
Nystrom, P., & Sparling, J. (1995). Effects of social depri-
vation on Cortisolregulationin institutionalized Romanian
infants. Society forNeurosciences Abstracts, 218, 12.
Carlson, M., & Earls, F. (1997). Psychological and neuroen-
docrinological sequelae of early social deprivation in in-
stitutionalized children in Romania. Annals of the New
York Academy ofSciences, 807, 419-428.
Cassidy, J., Marvin, R. S., & The MacArthur Working Group
on Attachment. (1991). Attachment organization in
preschool children: Coding guidelines (3rd ed.). Unpub-
lished manuscript.
ology, 5,397-431.
(1992). An organizational perspective on peer relations in
Family-peer relationships: Modes of linkage (pp. 345-
383). Hillsdale, NJ: Erlbaum.
tivity over early development and in response to stress in
 CHAPTER 23. Attachment Disorganization 551

young rhesus monkeys. Developmental Psychobiology, George, C, & Main, M. (1979). Social interaction of young
26, 433-447. abused children: Approach, avoidance, and aggression.
Cohn, D. (1990). Child-mother attachment in six-year-olds Child Development, 50, 306-318.
and social competence in school. Child Development, 61,George, C, & Solomon, J. (1996). Representational models
152-162. of relationships: Links' between caregiving and attach-
Crittenden, P. M. (1981) Abusing, neglecting, problematic, ment. Infant Mental Health Journal, 17. 198-216.
and adequate dyads: Differentiating by patterns of interac- Goldberg, S., Gotowiec, A., & Simmons, R. J. (1995). In-
tion. Merrill-Palmer Quarterly, 27. 201-208. fant-mother attachment and behavior problems in healthy
Crittenden, P. M. (1985). Maltreated infants: Vulnerability and chronically ill preschoolers. Development and Psy-
andresilience.Journal of Child Psychology and Psychia-chopathology, 7, 267-282.
try, 26, 85-96. Goldberg, S., Perotta, M., Minde, K., & Corter, C. (1986).
Crittenden, P. M. (1992). Quality of attachment in the Maternal behavior and attachment in low birthweight
preschool years. Development and Psychopathology, 4,twins and singletons. Child Development, 57, 34—46.
209-241. Greenberg, M. T., Speltz, M. L., DeKlyen, M., & Endnga,
Crittenden, P. M., & Ainsworth, M. D. S. (1989). Child mal- M. C. (1991). Attachment security in preschoolers with
treatment and attachment theory. In D. Cicchetti & V. Carl- and without externalizing behavior problems: A replica-
son (Eds.), Child maltreatment: Theory and research on tion. Development and Psychopathology, 3, 413-430.
the causes and consequences of child abuse and neglect Grossmann, K., Grossmann, K. E., Spangler, G., Suess, G., &
(pp. 432-463). New York: Cambridge University Press. Unzner, L. (1985). Maternal sensitivity and newborn's
Crockenberg, S. (1981). Infant irritability, mother respon- orientation responses as related to quality of attachment in
siveness, and social support influences on the security of northern Germany. In I. Bretherton & E. Waters (Eds.),
infant attachment. Child Development, 52, 857-865. Growing points of attachment theory andresearch.Mono-
Deblinger, E., McLeer, S., Atkins, M., Ralphe, D., & Foa, E. graphs of the Societyfor Research in Child Development,
(1989). Post-traumatic stress in sexually abused, physical- 50(1-2 Serial No. 209), 233-256.
ly abused, and nonabused children. Child Abuse and Ne-Harm, D. M., Castino, R. J., Jarosinski, J., & Britton, H.
glect, 13, 403-408. (1991, April). Relating mother-toddler negotiation
DeMulder, E. K., & Radke-Yarrow, M. (1991). Attachment patterns to infant attachment and maternal depression
with affectively ill and well mothers: Concurrent behav- with an adolescent mother sample. In J. Osofsky & L.
ioral correlates. Development and Psychopathology, 3,Hubbs-Tait (Chairs), Consequences of adolescent parent-
227-242. ing: Predicting behavior problems in toddlers and
Easterbrooks, A. M., Lyons-Ruth, K., Biesecker, G., & Carp- preschoolers. Symposium conducted at the biennial meet-
er, A. (1996). Infancy predictors of emotional availability ing of the Society for Research in Child Development,
in middle childhood: The role of attachment and maternal Seattle, WA.
depression. In J. Robinson (Chair), Emotional availability Hart, J., Gunnar, M., & Cicchetti, D. (1995) Salivary Cortisol
in mother-child dyads: Predictors across development in maltreated children: Evidence of relations between neu-
and risk status. Symposium conducted at the International roendocrine activity and social competence. Development
Conference on Infant Studies, Providence, RI. and Psychopathology, 7, 11-12.
Eckenrode, J., Laird, M., & Doris, J. (1993). School perfor- Hertsgaard, L., Gunnar, M., Erickson, M. F., & Nachmias,
mance and disciplinary problems among abused and M. (1995). Adrenocortical response to the strange situa-
neglected children. Developmental Psychology, 29, 53-62.tion in infants with disorganized/disoriented attachment
Egeland, B., Jacobvitz, D., & Papatola, K. (1987). Intergen- relationships. Child Development. 66, 1100-1106.
erational continuity of parental abuse. In J. Lancaster & R. Hesse, E. (1996). Discourse, memory, and the Adult Attach-
Gelles (Eds.), Biosocial aspects of child abuse (pp. ment Interview: A note with emphasis on the emerging
255-278). San Francisco: Jossey-Bass. cannot classify category. Infant Mental Health Journal,
Fagot, B. I., & Kavanagh, K. (1990). The prediction of anti- 17, 4-11.
social behavior from avoidant attachment classifications. Hesse, E., & Main, M. (in press-a). Frightened behavior in
Child Development, 61, 864-873. traumatized but non-maltreating parents: Previously unex-
Fonagy, P., Leigh, T., Steele, M., Steele, H„ Kennedy, G., aminedriskfactor for offspring. Psychoanalytic Inquiry.
Mattoon, M., Target, M., & Gerber, A. (1996). The rela-Hesse, E., & Main, M. (in press-b). Disorganization in infant
tion of attachment status, psychiatric classification, and and adult attachment: Description, correlates, and impli-
response to psychotherapy. Journal of Consulting and cations for developmental psychopathology. Journal of
Clinical Psychology. 64. 22-31. the American Psychanalytic Association.
Fraiberg, S., Adelson, E., & Shapiro, V. (1975). Ghosts in theHesse, E., & van IJzendoorn, M. (in press-a). Propensities to-
nursery. Journal of the American Academy of Child Psy- wards absorption are related to lapses in the monitoring of
chiatry, 74,387-421. reasoning or discourse during the Adult Attachment Inter-
Freud, S. (1957). Mourning and melancholia. In J. Strachey view; A preliminary investigation. Attachment and Hu-
(Ed. and Trans.), The standard edition of the completeman Development.
psychological works of Sigmund Freud (Vol. 14, Hesse, pp. E., & van IJzendoorn, M. (in press-b). Parental loss of
237-260). London: Hogarth Press. (Original work pub- close family members and propensities toward absorption
lished 1917) in offspring. Developmental Science.
George, C, Kaplan, N., & Main, M. (1984) Adult Attachment Hinde, R. A. (1970). Animal behavior: A synthesis of etholo-
Interview (1st ed.). Unpublished manuscript, University gy and comparative psychology (2nd ed.). New York: Mc-
of California at Berkeley. Graw-Hill.
George, C, Kaplan, N., & Main, M. (1985). Adult Attach- Holtzworth-Munroe, A., Stuart, G. L., & Hutchinson, G.
ment Interview (2nd ed.). Unpublished manuscript, Uni- (1997). Violent vs. nonviolent husbands: Differences in
versity of California at Berkeley. attachment patterns, dependency, and jealousy. Journal of
George, C, Kaplan, N., & Main, M. (1996). Adult Attach- Family Psychology, 11, 314-331.
ment Interview (3rd ed.). Unpublished manuscript. Uni- Hubbs-Tait, L., Osofsky, J., Hann, D., & Culp, A. (1994).
versity of California at Berkeley. Predicting behavior problems and social competence in
552 PARTY. CLINICAL APPLICATIONS

children of adolescent mothers. Family Relations, 43, [Unresolved mourning in mothers and development of
439-446. dissociative disorders in children: A case-control study].
Jacobsen, T„ Edelstein, W., & Hofmann, V. (1994). A longi- Rivista di Psichiatria, 26, 283-291.
tudinal study of the relation between representations of at- Lynch, M., & Cicchetti, D. (1991). Patterns of relatedness in
tachment in childhood and cognitive functioning in child- maltreated and nonmaltreated children: Connections
hood and adolescence. Developmental Psychology, 30, among multiple representational models. Development
112-124. and Psychopathology, 3. 207-226.
Jacobsen, T., Huss, M., Fendrich, M., Kruesi, M. J. P., & Lyons-Ruth, K., Alpem, L., & Repacholi, B. (1993). Disor-
Ziegenhain, U. (1997). Children's ability to delay gratifi- ganized infant attachment classification and maternal psy-
cation: Longitudinalrelationsto mother-child attachment. chosocial problems as predictors of hostile-aggressive be-
Journal of Genetic Psychology, 158, 411-426. havior in the preschool classroom. Child Development,
Jacobsen, T., Ziegenhain, U., Muller, B., Rottmann, U., Hof- 64, 572-585.
mann, V., & Edelstein, W. (1992, September). PredictingLyons-Ruth, K., & Atwood, G. (1998) Elaborating the con-
stability of mother-child attachment patterns in day-care cept of unresolved mental states: A relational diathesis
childrenfrominfancy to age 6. Poster presented at the model of hostile-helpless states of mind. Unpublished
Fifth World Congress of Infant Psychiatry and Allied Dis- manuscript.
ciplines, Chicago. Lyons-Ruth, K., Bronfman, E., & Atwood, G. (in press). A
Jacobvitz, D. (1998, March). Frightening caregiving: Links relational diathesis model of hostile-helpless states of
with mothers' loss and trauma. Paper presented at the bi-mind: Expressions in mother-infant interaction. In J.
ennial meeting of the Southwestern Society for Research Solomon & C. George (Eds.), Attachment disorganisa-
in Human Development, Galveston, TX. tion. New York: Guilford Press.
Jacobvitz, D., & Hazen, N. (in press). Developmental path- Lyons-Ruth, EC, & Block, D. (1996). The disturbed caregiv-
ways from infant disorganization to childhood peer rela- ing system: Relations among childhood trauma, maternal
tionships. In J. Solomon & C. George (Eds.), Attachment caregiving, and infant affect and attachment. Infant Men-
disorganization. New York: Guilford Press. tal Health Journal, 17, 257-275.
Jacobvitz, D., Hazen, N., & Riggs, S. (1997, April). Disorga- Lyons-Ruth, K., Bronfman, E., & Parsons, E. (in press). Ma-
nized mental processes in mothers, frightening/frightened ternal disrupted affective communication, maternal fright-
caregiving, and disoriented/disorganized behavior in in- ened or frightening behavior, and disorganized infant at-
fancy. In D. Jacobvitz (Chair), Caregiving correlates and tachment strategies. In J. Vondra & D. Barnett (Eds.),
longitudinal outcomes of disorganized attachments inAtypical in- patterns of infant attachment: Theory, research,
fants. Symposium conducted at the biennial meeting of and current directions. Monographs of the Society for Re-
the Society for Research in Child Development, Washing- search in Child Development.
ton, DC. Lyons-Ruth, K., Connell, D., & Zoll, D. (1989). Patterns of
Kaplan, N. (1987). Individual differences in 6-year-olds'maternal behavior among infants atriskfor abuse: Rela-
thoughts about separation: Predictedfromattachmenttions to with infant attachment behavior and infant develop-
mother at age 1. Unpublished doctoral dissertation, Uni- ment at 12 months of age. In D. Cicchetti & V. Carlson
versity of California at Berkeley. (Eds.), Child maltreatment: Theory and research on the
Kaufman, J., & Zigler, E. (1987). Do abused children be- causes and consequences of child abuse and neglect (pp.
come abusive parents? American Journal of Orthopsychi-464-494). New York: Cambridge University Press.
atry, 57, 186-192. Lyons-Ruth, K., Connell, D., Grunebaum, H., & Botein, S.
Kazdin, A. E., Moser, J., Colbus, D., & Bell, R. (1985). De- (1990). Infants at social risk: Maternal depression and
pressive symptoms among physically abused and psychi- family support services as mediators of infant develop-
atrically disturbed children. Journal of Abnormal Psy- ment and security of attachment. Child Development, 61,
chology, 94, 298-307. 85-98.
Kraemer, G. W., & Clarke, A. S. (1996). Social attachment, Lyons-Ruth, K., Connell, D., Zoll, D., & Stahl, J. (1987). In-
brain function, and aggression. Annals of the New York fants at socialrisk:Relations among infant maltreatment,
Academy ofSciences, 794, 121-135. maternal behavior, and infant attachment behavior. Devel-
Levinson, A., & Fonagy, P. (1998). Criminality and attach- opmental Psychology, 23, 223-232.
ment: The relationship between interpersonal awareness Lyons-Ruth, K., Easterbrooks, A., & Cibelli, C. (1997). In-
and offending in a prison population. Manuscript submit-fant attachment strategies, infant mental lag, and maternal
ted for publication. depressive symptoms: Predictors of internalizing and ex-
Lewis, M., Feiring, C, McGuffog, C, & Jaskir, J. (1984). ternalizing problems at age 7. Developmental Psychology,
Predicting psychopathology in six-year-oldsfromearly 33, 681-692.
social relations. Child Development, 55, 123-136. Lyons-Ruth, K., Repacholi, B., McLeod, S-, & Silva, E.
Liotti, G. (1992). Disorganized/disoriented attachment in the (1991). Disorganized attachment behavior in infancy:
etiology of the dissociative disorders. Dissociation, 4, Short-term stability, maternal and infant correlates, and
196-204. risk-related subtypes. Development and Psychopathology,
Liotti, G. (in press-a). Understanding the dissociative 3. 377-396.
processes: The contribution of attachment theory. Psycho- Lyons-Ruth, K., Zoll, D., Connell, D., & Grunebaum, H.
analytic Inquiry. (1989). Family deviance and family disruption in child-
Liotti, G. (in press-b). Disorganization of attachment as a hood: Associations with maternal behavior and infant
model for understanding dissociative psychopathology. In maltreatment during thefirsttwo years of life. Develop-
J. Solomon & C. George (Eds.), Attachment disorganiza- ment and Psychopathology, 1, 219-236.
tion. New York: Guilford Press. Main, M. (1973). Exploration, play, and cognitive function-
Liotti, G., Intreccialagli, B., & Cecere, F. (1991). Esperienza ing as related to child-mother attachment. Unpublished
di lutto nella madre e facilitazione dello sviluppo di dis- doctoral dissertation, Johns Hopkins University.
turbi dissociativi nella prole: Unto studio caso-controllo. Main, M. (1979). Scale for disordered/disoriented infant be-
 CHAPTER 23. Attachment Disorganization 553

havior in response to the Main and Weston clown ses- Theory, research, and intervention (pp. 121-160). Chica-
sions. Unpublished manuscript, University of California go: University of Chicago Press.
at Berkeley. Main, M., & Weston, D. R. (1981). The quality of the tod-
Main, M. (1995). Recent studies in attachment: Overview, dler's relationship to mother and to father: Related to con-
with selected implications for clinical work. In S. Gold- flict behavior and the readiness to establish new relation-
berg, R. Muir, & J. Kerr (Eds.), Attachment theory: So- ships. Child Development. 52, 932-940.
cial, developmental, and clinical perspectives McLeer, (pp. S., Callaghan, M., Henry, D., & Wallen, J. (1994).
407-474). Analytic Press: Hillsdale, NJ. Psychiatric disorders in sexually abused children. Journal
Main, M. (1996). Introduction to the special section on at- of the American Academy of Child and Adolescent Psychi~
tachment and psychopathology: 2. Overview of the field atry, 33. 313-319.
of attachment. Journal of Consulting and Clinical Psy- Minde, K., & Hesse, E. (1996). The role of the Adult At-
chology, 64. 237-243. tachment Interview in parent-infant psychotherapy: A
Main, M., & Cassidy, J. (1988). Categories of response to re- case presentation. Infant Mental Health Journal, 17, 115—
union with the parent at age 6: Predictedfrominfant at- 126.
tachment classifications and stable over a 1-month peri- Moss, E., Parent, S., Gosselin, C, Rousseau, D., & St-Lau-
od. Developmental Psychology. 24, 415-426. rent, D. (1996). Attachment and teacher-reported behavior
Main, M., & George, C. (1985). Response of abused and dis- problems during the preschool and early school-age peri-
advantaged toddlers to distress in agemates: A study in the od. Development and Psychopathology, 8, 511-525.
day care setting. Developmental Psychology. 21, 407- Moss, E., Rousseau, D., Parent, S., St-Laurent, D., & Sain-
412. tong, J. (1998). Correlates of attachment at school age:
Main, M., & Goldwyn, R. (1998). Adult attachment scoring Maternal reported stress, mother-child interaction, and be-
and classification system. Version 6.3. Unpublished man- havior problems. Child Development, 69, 1390-1405.
uscript, University of California at Berkeley. Mueller, E., & Silverman, N. (1989). Peer relations in mal-
Main, M., & Hesse, E. (1990). Parents* unresolved traumatic treated children. In D. Cicchetti & V. Carlson (Eds.),
experiences are related to infant disorganized attachment Child maltreatment: Theory and research on the causes
status: Isfrightenedand/or frightening parental behavior and consequences of child abuse and neglect (pp.
the linking mechanism? In M. T. Greenberg, D. Cicchetti, 529-578). New York: Cambridge University Press.
& E. M. Cummings (Eds.), Attachment in the preschool Muscetta, S., Dazzi, N., De Coro, A., Ortu, F., & Speranza,
years: Theory, research, and intervention (pp. 161-182). A. M. (in press). States of mind[with respect to attachment
Chicago: University of Chicago Press. and change in a psychotherapeutic relationship: A study
Main, M., & Hesse, E. (1992a). Disorganized/disoriented of the coherence of transcript in short-term psychotherapy
infant behavior in the strange situation, lapses in the mon- with an adolescent. Psychoanalytic Inquiry.
itoring ofreasoningand discourse during the parent's National Institute of Child Health and Human Development
Adult Attachment Interview, and dissociative states. (NICHD) Early Child Care Research Network. (1997).
In M. Ammaniti & D. Stem (Eds.), Attachment and The effects of infant child care on infant-mother attach-
psycho-analysis (pp. 80-140). Rome: Guis, Laterza & ment security: Results of the NICHD study of early child
Figl. care. Child Development, 68, 860-879.
Main, M., & Hesse, E. (1992b). Frightening frightened, dis- O'Connor, M. J ., Sigman, M., & Brill, N. (1987). Disorgani-
sociated, or disorganized behavior on the part of a par- zation of attachment inrelationto maternal alcohol con-
ent: A coding system for parent-infant interactions (4th sumption. Journal of Consulting and Clinical Psychology,
ed.). Unpublished manuscript, University of California at 55, 831-836.
Berkeley. Ogawa, J. R., Sroufe, L. A., Weinfield, N. S., Carlson, E. A.,
Main, M., & Hesse, E. (1995). Frightening,frightened,dis- & Egeland, B. (1997). Development and the fragmented
sociated, or disorganized behavior on the part of the par- self: Longitudinal study of dissociative symptomatology
ent: A coding system for parent-infant interactions (5th in a nonclinical sample. Development and Psychopatholo-
ed.). Unpublished manuscript. University of California at gy, 9, 855-879.
Berkeley. Owen, M. T., & Cox, M. J. (1997). Marital conflict and the
Main, M., Kaplan, N., & Cassidy, J. (1985). Security in in- development of infant-parent attachment relationships.
fancy, childhood, and adulthood: A move to the level of Journal of Family Psychology, 11, 152-164.
representation. In I. Bremerton & E. Waters (Eds.), Grow- Patrick, M., Hobson, R. P., Castle, P., Howard, R., & Maugh-
ing points of attachment theory and research. Monographs an, B. (1994). Personality disorder and mental representa-
of the Society for Research in Child Development, 50(1-2, tion of early social experience. Development and Psy-
Serial No. 209), 66-104. chopathology, 6, 375-388.
Main, M., & Morgan, H. (1996). Disorganization and disori- Pelcovitz, D., Kaplan, S., Goldenberg, B., Mandel, F.,
entation in infant strange situation behavior: Phenotypic Lehane, J., & Guarrera, J. (1994). Post-traumatic stress
resemblance to dissociative states? In L. K. Michelson & disorder in physically abused adolescents. Journal of the
W. J. Ray (Eds.), Handbook of dissociation: Theoretical, American Academy of Child and Adolescent Psychiatry,
empirical, and clinical perspectives (pp. 107-138). New33, 305-312.
York: Plenum Press. Putnam, F. W. (1997). Dissociation in children and adoles-
Main, M., & Solomon, J. (1986). Discovery of a new, inse- cents: A developmental perspective. New York: Guilford
cure-disorganized/disoriented attachment pattern. In T. B. Press.
Brazelton & M.W. Yogman (Eds.), Affective development Radke-Yarrow, M., Curnmings, E. M., Kuczynski, L., &
in infancy (pp. 95-124). Norwood, NJ: Ablex. Chapman, M. (1985). Patterns of attachment in two- and
Main, M., & Solomon, J. (1990). Procedures for identifying three-year-olds in normal families and families with
infants as disorganized/disoriented during the Ainsworth parental depression. Child Development, 56, 884-893.
strange situation. In M. T. Greenberg, D. Cicchetti, & E. Renken, B., Egeland, B., Marvinney, D., Mangelsdorf, S., &
M. Cummings (Eds.), Attachment in the preschool years:Sroufe, L. A. (1989). Early childhood antecedents of ag-
554 PARTY.' CLINICAL APPLICATIONS

gression and passive-withdrawal in early elementary Sullivan-Hanson, J. M. (1990). The early attachment and
school. Journal of Personality, 5, 257-281. current affectional bonds of battered women: Implication
Schneider-Rosen, K., & Cicchetti, D. (1991). Early self- for the impact of spouse abuse on children. Unpublished
knowledge and emotional development: Visual self- doctoral dissertation, University of Virginia.
recognition and affective reactions to mirror self-image inSuomi, S. (1991). Early stress and adult emotional reactivity
maltreated and nonmaltreated toddlers. Developmental in rhesus monkeys. In The childhood environment and
Psychology. 27, 481-488. adult disease. (Ciba Foundation Symposium 156, pp.
Schuengel, C, van IJzendoorn, M., Bakermans-Kranenburg, 171-188). Chichester, England: Wiley.
M., & Biom, M. (1997, April). Frightening, frightened Teti, D. M., Gelfand, D. M., Messinger, D. S., & Isabella, R.
and/or dissociated behavior, unresolved loss, and infant (1995). Maternal depression and the quality of early at-
disorganization. In D. Jacobvitz (Chair), Caregiving cor- tachment: An examination of infants, preschoolers, and
relates and longitudinal outcomes of disorganized attach- their mothers. Developmental Psychology, 34, 361-376.
ments in infants. Symposium conducted at the biennial Thalhuber, K., Jacobvitz, D., & Hazen, N. L. (1998, March).
meeting of the Society for Research in Child Develop- Effects of mothers' past traumatic experiences on moth-
ment, Washington, DC. er-infant interactions. Paper presented at the biennial
Schuengel, C, van IJzendoorn, M., Bakermans-Kranenburg, meeting of the Southwestern Society for Research in Hu-
M., & Blom, M. (in press) Frightening, frightened and/or man Development, Galveston, TX
dissociated behavior, unresolved loss, and infant disorga- Troy, M., & Sroufe, L. A. (1987). Victimization among
nization. Journal of Consulting and Clinical Psychology.preschoolers: Role of attachment relationship history.
Shaw, D. S., Owens, E. B., Vondra, J. I., Keenan, K., & Journal of the American Academy of Child and Adoles-
Winslow, E. F".~(l"996). Earlyriskfactors and pathways in cent Psychiatry, 26, 166-172.
the development of early disruptive behavior problems. True, M., Pasani, L., Ryan, R., & Oumar, F. (1998). Mater-
Development and Psychopathology, 8, 679-699. nal behaviors related to disorganized infant attachment in
Solomon, J., George, C, & de Jong, A. (1995). Children clas- West Africa. Paper presented at the annual meeting of the
sified as controlling at age six: Evidence of disorganized Western Psychological Association, Albuquerque, NM.
representational strategies and aggression at home and at van IJzendoorn, M. H. (1995). Adult attachment representa-
school. Development and Psychopathology, 7, 447-463.tions, parental responsiveness, and infant attachment: A
Spangler, G., Fremmer-Bombik, E., & Grossmann, K. meta-analysis on the predictive validity of the Adult At-
(1996). Social and individual determinants of infant at- tachment Interview. Psychological Bulletin, 117,
tachment security and disorganization. Development and 387-403.
Psychopathology, 17, 127-139. van JJzendoom, M-, Feldbrugge, J., Derks, F., de Ruiter, C,
Spangler, G., & Grossmann, K. E. (1993). Biobehavioral or- Verhagen, M., Philipse, M., van der Staak, C, & Riksen-
ganization in securely and insecurely attached infants. Walraven, J, (in press). Attachmentrepresentationsof
Child Development, 64. 1439-1450. personality disordered criminal offenders. American Jour-
Speltz, M. L., Greenberg, M. T., & DeKlyen, M. (1990). At- nal of Orthopsychiatry.
tachment in preschoolers with disruptive behavior: A van IJzendoorn, M. H., Schuengel, C, & Bakermans-Kra-
comparison of clinic-referred and nonproblem children. nenburg, M.J. (in press). Disorganized attachment in early
Development and Psychopathology, 2, 31-46. childhood: Meta-analysis of precursors, concomitants,
Spieker, S. J., & Booth, C. (1988). Maternal antecedents of and sequelae. Development and Psychopathology.
attachment quality. In J. Belsky & T. Nezworski (Eds.), Vondra, J., Hommerding, K. D., & Shaw, D. S. (in press).
Clinical implications of attachment (pp. 300-323). Hills-Stability and change in infant attachment in a low-income
dale, NJ: Erlbaum. sample. In J. Vondra & D. Barnett (Eds.), Atypical pat-
Sroufe, L. A., & Fleeson, J. (1986). Attachment and the con- terns of infant attachment: Theory, research, and current
struction of relationships. In W. Hartup & Z. Rubin directions. Monographs of the Society for Research in
(Eds.), Relationships and development (pp. 51-72). Hills-Child Development.
dale, NJ: Erlbaum. Warmer, U. G., Grossmann, K., Fremmer-Bombik, E., &
Stalker, C, & Davies, F. (1995). Attachment organization Suess, G. (1994). Attachment patterns at age six in south
and adaptation in sexually abused women. Canadian Germany: Predictability from infancy and implications for
Journal ofPsychiatry, 40, 234-240. preschool behavior. Child Development, 65, 1014-1027.
Steele, H., Steele, M., & Fonagy, P. (1996). Associations West, M.„ & George, C. (1998). Abuse and violence in inti-
among attachment classifications of mothers, fathers, and mate adult relationships: New perspectives from attach-
their infants. Child Development, 67, 541-555. ment theory. Unpublished manuscript.
Steiner, H., Zeanah, C. H., Stuber, M., Ash, P., & Angell, R.Wolfe, D. A. (1985). Child abusive parents: An empirical re-
(1994). The hidden faces of trauma: An update on child view and analysis. Psychological Bulletin, 97, 461-482.
psychiatric traumatology. Scientific Proceedings of theYehuda, R., Southwick, S. M., Nussbaum, G., Wahlby, V.,
Annual Meeting of the American Academy of Child and Giller, E. L., & Mason, J. W. (1990). Low urinary Cortisol
Adolescent Psychiatry, 31. excretion in patients with post-traumtic stress disorder.
Strage, A., & Main, M. (1985, April). Attachment and par- Journal ofNervous and Mental Disease. 178, 366-369.
ent-child discourse patterns. In M. Main (Chair), Attach- Zahn-Waxler, C, & Kochanska, G. (1990). The origins of
ment: A move to the level of representation. Paper pre-guilt. In R. Thompson (Ed.), Nebraska Symposium on MoJ
sented at the biennial meeting of the Society for Research tivation: Vol. 36. Socioemotional development (pp.
in Child Development, Toronto. 183-258). Lincoln: University of Nebraska Press.