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INFORMATION TO USERS
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THE BIOPSYCHO SOCIAL ROLE OF MOTHER-INFANT ATTACHMENT
IN EMOTION REGULATION AND A MODEL OF PROJECTED
PSYCHOPATHOLOGY RESULTING FROM ATTACHMENT DEFICITS AND
DISTORTIONS
A DISSERTATION SUBMITTED TO THE FACULTY
OF
THE SCHOOL OF PROFESSIONAL PSYCHOLOGY
SPALDING UNIVERSITY
BY
VICKI LYNN HAYES
IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE
OF
DOCTOR OF CLINICAL PSYCHOLOGY
MARCH 26, 2001
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UMI Num ber. 999 998 9
Copyright 2001 by
Hayes, Vicki Lynn
All rights reserved.
__ ___ __ ®
UMIUMI Microform 9999989
Copyright 2001 by Bell & Howell Information and Learning Company.
All rights reserved. This microform edition is protected against
unauthorized copying under Title 17, United States Code.
Bell & Howell Information and Learning Company
300 North Zeeb Road
P.O. Box 1346 Ann Arbor, Ml 48106-1346
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Copyright © 2001 by Vicki L. Hayes
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THE BIOPSYCHOSOCIAL ROLE OF MOTHER-INFANT ATTACHMENT
IN EMOTION REGULATION AND A MODEL OF PROJECTED
PSYCHOPATHOLOGY RESULTING FROM ATTACHMENT DEFICITS AND
DISTORTIONS
A DISSERTATION SUBMITTED TO THE FACULTY
THE SCHOOL OF PROFESSIONAL PSYCHOLOGY
SPALDING UNIVERSITY
VICKI LYNN HAYES
IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE
DOCTOR OF CLINICAL PSYCHOLOGY
LOUISVILLE, KENTUCKY
OF
OF
APPROVED: DATE:
John A. James, Ph.D.
David L. Morgan, J ’h.D
DATE: ^ ^ (
David W. Richart, Ph.D.
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ACKNOWLEDGEMENTS
I take this opportunity to thank the members of my dissertation committee, Dr.
John A. James (chair), Dr. David L. Morgan, and Dr. David W. Richart, for granting me
the freedom to pursue this unusual dissertation, for their encouragement and support, for
their patience in grappling with such a lengthy document, and for their words of wisdom.
Each offered valued contributions and together they provided a terrific blend of
biopsychosocial perspectives, that not only enhanced the quality o f this work, but
enriched the thinking that shaped and produced it.
I especially want to thank Dr. John James, not just because he was my chair, but
because he has been an inspiration and mentor throughout my graduate career at
Spalding. John is the quintessential teacher. His classes were my absolute favorites,
introducing me to astounding subjects and new concepts regarding how human beings are
made that reshaped my thinking. He always left me wanting to learn even more (and still
does). Perhaps what I appreciate above all else is his genuine passion for psychology.
The respect, warmth, kindness, and support he has continued to show me mean a lot.
I want to thank Dr. James P. Bloch for his inspiration, understanding, unfailing
support, warmth, kindness, and incredible wisdom. Jim, too, has a passion for
psychology. He never stops thinking about it; he never stops learning. Always ten steps
ahead, no one knows more about attachment and attachment related psychopathology
than Jim Bloch.
Thanks also go to supervisors (and good friends) Drs. Nancy Schrepf, Terry
Pearson, Pat McGinty, Paul Stratton, and internship training director, Larry Gaupp who
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provided the freedom, respect, encouragement, mentoring, and mirroring I needed to
come into my own as an emerging, competent clinician.
I dedicate this dissertation to those individuals who have permitted me access to
their innermost selves—who entrusted me with their pain, vulnerabilities, and greatest
fears. It is hoped that through this work I have come to better understand the nature of
their wounds and what needs to be done to help heal them.
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ABSTRACT
This study (1) delineated the biopsychosocial roles of mother-infant attachment in
emotion regulation, (2) devised a developmental model for projecting psychopathology
resulting from attachment deficits and distortions, and (3) provided a demonstration of
the model’s effectiveness, using existing data. Contributions of mother-infant attachment
phenomena to emotion regulation in the developing child were delineated per each o f six
incremental age periods spanning 0-3 years o f age. Literature reviews synthesized six
strands o f data (available brain, developing brain, observable infant capabilities, relevant
developmental theories o f psychology, mother-infant attachment mechanisms,
psychopathology) from which a list o f projected enduring traits o f attachment deficits and
distortions were formulated per each o f the age periods. Data—selected for consistency
across neurobiological, neurophysiological, developmental, behavioral, and clinical
vantage points—were mapped together for the purpose of bringing a “bigger
(biopsychosocial) picture” into view. Predictive descriptions of psychopathology arising
from attachment deficits and distortions were formulated by working forward—in a
sequential, additive fashion—from the emerging end of the developmental trajectory, in
keeping with the model’s developmental premise and General Systems Theory principles.
Demonstrating the model’s effectiveness produced a theory of aberrant aggression
resulting from early infant trauma based on evidence of opioid mediated adaptations,
depletions, and deficiencies.
IV
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TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS............................................................................................... ii
ABSTRACT.........................................................................................................................
iv
LIST OF FIGURES............................................................................................................ viii
CHAPTER
L INTRODUCTION................................................................................................. 1
Background............................................................................................................. ........J
Purposes o f Dissertation........................................................................................ 8
Questions Addressed by Dissertation..................................................................
10
Research Methodology.......................................................................................... 11
Implications ............................................................................................................. 12
H. REVIEW OF ATTACHMENT THEORY MILESTO NES .............................. 13
EH. METHODOLOGY................................................................................................">oJJ
A Biopsychosocial M odel for Projecting Psychopathology Resulting from
Attachment Deficits and Distortions....................................................... 33
Adherence to General Systems Theory (and Evolution) Princip les................. 33
Interaction of Stress and Ability to Achieve Homeostas is................................. 42
Systematic Biopsychosocial Steps for Projecting Psychopathology
Resulting from Attachment Deficits and Distortions............................. 43
Definitions............................................................................................................... 46
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IV. RESULTS PART I: DETAILED DEMONSTRATION OF MODEL’S
EFFECTIVENESS FROM BIR TH -TW O MONTHS: (ANYTHING BUT)
AUTISM.......................................................................................................................50
The Nature o f Brain Development Following Birth................................................
50
Differentiation .................................................................................................51
Myelination ..................................................................................................... 57
Critical Periods................................................................................................59
Available Brain ............................................................................................................71
Structures........................................................................................................ 73
Neurophysio logy ............................................................................................ 77
Emotion Circuitry.......................................................................................... 82
Developing Brain: Coming (On-Line) Attractions ................................................. 92
Structures........................................................................................................ 92
Emotion Circuitry.......................................................................................... 98
Newborn Capabilities: Observable Phenomena .....................................................108
Developmental Theories of Psychology Rooted in Corresponding
Observable Phenomena................................................................................ 117
Developmental Tasks and Mechanisms o f Mother-Infant Attachment:
Birth to Two Months: Achieving Homeostasis......................................... 126
Mother as the Facilitating Environment.....................................................127
Mother-Infant Developmental Task: Achieving Homeostasis:
Arousal Regulation is a Two-Person Job .......................................137
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Psychopathology Resulting from Attachment Deficits and Distortions:
Birth to Two Months: Dysregulation of Arousal................................... 176
Infants of Depressed M others.......................................................................178
Traumatized Newborns................................................................................. 188
Summary: Nature o f Psychopathology Arising from
Developmental Period: Birth to Two Months.......................... — 243
IV. RESULTS PART II: SUMMARY OF PROJECTED PSYCHOPATHOLOGY
RESULTING FROM ATTACHMENT DEFICITS AND DISTORTIONS
DUR ING SEQUENTIAL AGE PERIODS FROM AGE 2-36
MONTHS...............................................................................................................
-.-248
2- 5 Months: Symbiosis............................................................................................248
5-8 Months: Selective Attachment.......................................................................... 279
8-18 Months: Practicing............................................................................................296
18-24 Months: Rapprochement.......................................................................... — 318
24-36 Months Object Constancy .............................................................................327
V. DISCUSSION....................................................................................................... -...339
REFERENCES................................................................................................................... - .374
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LIST OF FIGURES
FIGURE 1 Emotional Brain Development: Ages 0-36 Months..................................338
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CHAPTER I
INTRODUCTION
There have been many approaches to understanding long-term psychopathology
with good agreement that such psychopathology is rooted in events o f early childhood.
However, most have elected to elucidate possible causal factors by extrapolating
backward from the point in the developmental trajectory at which symptoms are showing
themselves—adulthood. Such symptoms are quite salient compared to otherwise normal
adult features such as intellectual or physical capabilities, interests, competencies, or
behaviors. In this manner, they take on a mysterious, intriguing quality. However, if such
symptoms are viewed as clues to the developmental “age” at which psychopathology first
emerged, they can provide pathways back to what might have been going on in the
individual’s life that disrupted normal, healthy psychological development. Theorizing can
certainly be done working backwards, but speculation may remain vague with limited, if
any, legitimate opportunity to collect data that can retroactively confirm (or disaffirm)
hypotheses.
Another approach is to begin at the beginning of the developmental trajectory, to
catch psychopathology as it first emerges in direct relation to its precipitant. If
psychopathology represents abnormal or disrupted development, what has thrown normal
development o ff course? In order to explore the roots o f psychopathology in this manner,
several steps must be taken. First, normal developmental processes and their required
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conditions must be pinned down. Psychopathology might, therefore, be projected by
anticipating what would occur if critical aspects of those conditions were missing or
abe rrant-given developmentally determined capacities for adaptation—at various points
along the brain’s developmental trajectory.
As with all mammals, human development unfolds within the context of mother-
infant interaction. Therefore, deficits or distortions in this reciprocal relationship might be
causal factors giving rise to psychopathology. Should such causal factors go uncorrected,
perhaps fo r the duration of periods in which affected portions of the brain are becoming
formed and set in their ways, this would provide explanation for the long life and
intractability of such symptoms—symptoms that have been around so long they are often
considered to be characteristics of an individual’s personality.
It is the aim of this dissertation to generate a model for elucidating long-term
psychopathology using such a developmental, epigenetic approach. To develop the
model, contributions o f mother-infant attachment phenomena to emotion regulation in the
developing child will be delineated per each o f six incremental age periods spanning 0-3
years o f age. Literature reviews will synthesize six strands of data (available brain,
developing brain, observable infant capabilities, relevant developmental theories of
psychology, mother-infant attachment mechanisms, and psychopathology) from which a
list o f projected enduring traits of attachment deficits and distortions will be formulated
per each o f the age periods. Data will be selected for consistency across neurobiological,
neurophysiological, developmental, behavioral, and clinical vantage points and mapped
together for the purpose o f bringing a “bigger (biopsychosocial) picture” into view.
Predictive descriptions of psychopathology arising from attachment deficits and distortions
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will be formulated by working forward—in a sequential, additive fashion—from the
emerging end o f the developmental trajectory, in keeping with the model’s developmental
premise and General Systems Theory principles.
A detailed demonstration to determine effectiveness of proposed model steps will
be produced fo r the initial 0-2 Months age period. It is predicted, that by following model
steps, new insights into long-term psychopathology, continuing even into adulthood, will
be gained from conducting the demonstration.
Background
In his landmark 1945 article, “Hospitalism”, Rene Spitz brought to the fore that
young infants confined to foundling homes and other institutions during the first year of
life suffered dire consequences, primarily due to maternal deprivation. Not only did
institutionalized, mother-deprived children become “asocial, delinquent, feeble-minded,
psychotic, or problem children”, (p. 54), bu t they could die. In 1944, John Bowlby, the
English child psychiatrist from the Tavistok Clinic, began his studies o f the effects of
mother-infant separations on the development o f children’s personalities leading him to
develop his theory o f mother-infant attachment, first published in his 1958 article, “The
Nature o f a Child’s Tie to His Mother” , and culminating in his seminal trilogy: Attachment
(1969), Separation (1973), and Loss (1980). Bowlby’s writings remain the quintessential
work on attachment, generating a vast body o f research by developmentalists, biologists,
clinicians, behaviorists, and neurobiologists that continues to grow by leaps and bounds
into the 21st Century. The reason this work retains its edge, even at this time when new
technologies permit human as well as animal neurobiological discoveries at a breath-taking
pace, is that Bowlby’s conceptualization is rooted in evolutionary principles, biology,
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neurobiology, and natural behavioral observation. Bowlby was so taken with the theory
o f evolution that he penned a biography of Charles Darwin (1990). In part, through his
participation in the World Health Organization, he was exposed to and greatly influenced
by cutting edge scientists o f the 1950’s that included ethologist Konrad Lorenz; primate
biologist Harry Harlow; neurobiologists Miller, Galanter, Pribram, and Young (whose
control theories provided models for neurobiological substrates o f homeostatic behavior),
anthropologist Margaret Mead; developmentalists Sigmund Freud, Rene Spitz, Jean
Piaget, and Erick Erickson; and last, but certainly not least to this dissertation, general
systems theorist von Bertalanfly (Ainsworth & Bowlby, 1991; Bowlby, 1969).
John Bowlby’s theory captures the essence o f a biopsychosocial approach to
understanding and articulating phenomena of psychology and psychopathology. That his
work continues to hold up against vast new biological discoveries, and that the drive to
understand attachment phenomena has intensified, to include its role as the “facilitating
environment” (Winnicott, 1965) for the developing brain, nearly 50 years later, attes ts to
the advantage o f the biopsychosocial model. Part and parcel of this approach is the
understanding that living organisms are grounded in their evolutionary roots.
The scientists who have just completed the awesome achievement o f detailing the
entire human gene code (National Institutes of Health & Celera Genomics Corporation,
2001) shared that among their most amazing discoveries is that the evidence o f evolution
is so readily apparent. Fo r example—consistent with nature’s fondness for tinkering with
old systems to refine or produce new, even more adaptive functions in the service of
meeting existing environmental demands—human genes appear to be constructed by
mixing, matching, or “globbing” new parts onto old parts. Another discovery is that
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phenotypic presentations are not so hard wired as commonly believed, affording a great
deal of flexibility which, of course, can be an adaptive advantage should conditions
change. These scientists warned against the simplistic notion that one specific gene gives
rise to one particular trait or disease, stressing instead that environmental influence (at
multiple levels) provides the interactive context that guides genetic expression.
Intracellular protein dynamics, which also have a primary role in maintaining homeostasis
sensitive to environmental demands, appear to hold the key to the complexity of genetic
expression not just to the end o f maturation, but throughout the lifespan.
The obvious “big picture” (vs. piece meal) advantage of coming to understand
psychology phenomena from a biopsychosocial (three or more tiered systems) approach is,
needless to say, offset by the added complexity. This is where general systems theory
comes to the rescue by providing a few hard and fast rules o f nature that absolutely cannot
be violated. Therefore, systems theory provides the frame for placing one overlay o f data
atop the next as well as the means o f weeding out extraneous, systems-inconsistent
material. Examples of systems rules that are critical to the formulation of the model
proposed in this dissertation are that systems evolve from simple to complex, systems are
hierarchical with higher order systems subsuming all components of the subsystems that
comprise them, and that the integrity of higher order systems is, therefore, dependent upon
the integrity of their lower order systems. Systems exchange energy with and are
dependent upon their environmental systems for their ongoing development and survival.
Should such energy not be forthcoming, systems can begin to unravel, losing their
complexity, perhaps becoming disorganized altogether in the process called entropy
(James, 1999).
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To tease out characteristics of psychopathology arising from attachment deficits
and distortions, the logical first step (albeit a. daunting one) is to understand how
“normal” mother-infant attachment operates as the context for facilitating the development
of the human brain. The subject o f this dissertation, therefore, demands beginning at the
beginning, and following the brain’s epigenetic course o f increasing sophistication and
reorganization as it gains momentum along its developmental trajectory. To begin at
birth, when phenomena are more “simple” and easier to grasp also demonstrates how
nature’s tools (often simply retooled) are used time and again, lending order to the
increasing complexity. The concept o f how/ developing brains reinvent or reorganize
themselves as more sophisticated inform ation processing systems come on-line—adding a
new twist, yet based on information already^ collected by lower systems—is perhaps best
articulated by Greenough, Black, and Wallace (1987) who refer to this process as “stage-
setting” (p. 553).
Two other percepts developed by these theorists are “experience-expectant” and
“experience-dependent” information mecha_nisms utilizing the brain’s plasticity in
interaction with its environment to obtain amd incorporate information required for
ongoing development and optimal survival. Experience-expectant systems refer to
emergent brain components—coming on board during infancy—that require (are genetically
hard wired for) specific types of stimuli from the environment to spur their normal
development. If the expected stimuli are no t forthcoming or are somehow distorted
during the span of that brain part’s developmental window, abnormal development will
ensue. No t only did Harry Harlow’s (H arlow & Zimmerman, 1958) work with primates
provide some of the most compelling evidemce that the physical contact w ith a soft mother
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provides a more potent, desirable stimulus to an infant than even food, he was able to
demonstrate that infants who are deprived of their mothers during “critical periods” of
their development suffer dire, permanent psychopathological consequences (Deets &
Harlow, 1971).
For efficiency; to gain a simplified, more understandable view; and to aim for as
much precision as possible, the au thor o f this dissertation made the decision to pin down
the neurobio logical subsystem bones first, then overlay only those social, developmental,
behavioral, and clinical observations that fit the bones. Fortunately, Jaak Panksepp
provided a place to start. This neurobiologist (Panksepp et al., 1978) identified a critical
biological substrate by discovering the role o f endogenous opioids in mediating mother-
infant attachment (that will be discussed in depth throughout this dissertation). In
addition, Panksepp has reconceptualized human emotions based on the neurobiological
circuits giving rise to them. He has utilized evolutionary principles and sorted through
vast numbers o f animal studies—many o f which he and colleagues conducted themselves—
to develop constructs that are so tangible they provide a fairly tight, concrete (vs. elusive,
abstract) frame for understanding emotions, particularly as they arise from within the
social-emotional context of the mother-infant attachment relationship. Once getting used
to some new descriptive names and ways of looking at emotions, Panksepp’s
reformulations provide practical insights into otherwise baffling observations of emotional
behavior.
Jaak Panksepp (1998) conceptualizes each emotion system as a genetically
predetermined, organized neural circuit that responds “unconditionally to stimuli arising
from major life-challenging circumstances” (p. 48), provides feedback (feelings), solves a
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particular set o f problems, and organizes adaptive behaviors or other responses in relation
to the environment for the ultimate goals o f survival and reproduction. Emotion circuits
“organize diverse behaviors by activating o r inhibiting motor subroutines and concurrent
autonomic-hormonal changes that have proved adaptive in the face o f such life-challenging
circumstances during the evolutionary history of the species” (p. 49).
Ability to delineate biological substrates is a logical litmus test for any theory of
psychology, because without biology, psychology would cease to exist. And, in this day
and age, neurobio logical discoveries (i.e. Harry Chugani’s PET scans showing the
ascendancy of each new brain subsystem as it comes on board and subsequent
reorganization—from brainstem to cortex—over the course o f the developing human brain)
are beginning to fill in the gaps where previously theoretical “intervening variables” had to
serve as stand-ins to explain as o f yet to be understood psychological observations (James,
1999, p. 19). John James (1999) proposes that
Systems theory would suggest that as the gap represented by brain complexity is
reduced, intervening variables will be replaced by concrete systems models that can
specify the physical path o f the (Energy/Information) through the brain. Those
scientific psychologists who wish to construct models of behavioral functioning
that will interface and articulate with those models developed by sciences using
concrete systems will have to formulate their research using terminology and
concepts tha t map onto concrete systems, (p. 23)
The author of this dissertation plans to follow this approach.
Purposes of This Dissertation
The purposes of this dissertation are to (1) delineate the biopsychosocial roles of
mother-infant attachment in emotion regulation, (2) devise a developmental model for
projecting psychopathology resulting from attachment deficits and distortions, and (3)
provide a demonstration of the model’s effectiveness, using existing data. Inherent goals
S
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Questions Addressed by this Dissertation
1. What components of attachment theory inform this work?
2. Can biological substrates be identified that can account for observations o f infant
behavior and tenets of existing developmental theories of psychology?
3. What are the nature and functions o f mother-infant attachment, particularly as they
relate to emotion regulation in the developing child?
4. What are the biological substrates (brain structures, psychopharmacology, and
emotion circuitry) involved in mother infant attachment?
5. Do environmental factors affect human brain development? If yes, how?
6. What are the nature and sources o f attachment deficits and distortions (infant trauma)
and their relationship to emotion dysregulation?
7. What are the biological substrates (brain structures, psychopharmacology, and
emotion circuitry) involved in separation, prolonged separation, attachment deficits,
and attachment distortions (infant trauma)?
8. What risk factors to resiliency (i. e. from loss, illness, physical pain, subsequent
traumatic event) are likely to emerge from attachment deficits and distortions?
9. What are some predicted enduring traits resulting from attachment deficits and
distortions? How might they look at various points along the developmental
continuum?
10. Can attachment related psychopathology for children and adults be identified by
working forward from the emergent end of the developmental trajectory (vs.
extrapolating attachment deficits and distortions by working backward from
adulthood)? If yes, what are the advantages and disadvantages to this approach?
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Research Methodology
A biopsychosocial model for projecting psychopathology resulting from
attachment deficits and distortions, adherent to general systems theory principles, will be
delineated (CHAPTER IH). Model steps will be followed in developing a demonstration
of its effectiveness for age 0-2 months (CHAPTER IV-RESULTS: PART I). Using an
abbreviated process, projected vulnerabilities resulting from the types o f attachment
deficits and distortions tha t might emerge pe r each of six age periods (0-2, 2-5, 5-8, 8-18,
18-24, and 24-36 months) will be summarized (CHAPTER IV-RESU LTS: PART II).
Advantages and disadvantages o f this model as well as its implications for assessment,
treatment, and prevention will be addressed (CHAPTER V-DISCUSSION).
Multiple literature reviews will be conducted to (1) delineate the biopsychosocial
roles o f mother-infant attachment in emotion regulation and (2) demonstrate the
effectiveness of the proposed Biopsychosocial Model for Projecting Psychopathology
Resulting from Attachment Deficits and Distortions. All research questions (above) will
be addressed in the process. To accomplish these tasks, data—selected for consistency
across developmental, neuropsychological, psychopharmacological, behavioral and clinical
vantage points—will be pulled together for the purpose o f bringing a “bigger
(biopsychosocial) picture” into view.
Literature reviews will synthesize six strands of data (available brain, developing
brain, observable infant phenomena, relevant developmental theories of psychology,
mother-infant attachment mechanisms, psychopathology) from which a list of projected
enduring traits of attachment deficits and distortions can be formulated, per each of six
incremental age periods from 0-36 months. Predictive descriptions o f what individuals
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with attachment deficits and distortions would look like at various points along the
developmental continuum will be formulated by working forward—in a sequential, additive
fashion—from the emerging end o f the developmental trajectory, in keeping with the
model’s developmental premise.
Due to the synthesized nature and exceptional length o f this document, this
dissertation’s committee has granted special permission to utilize a large number of
extended quotations and to utilize single-spacing for extended quotations vs. the
customary double-spacing generally required for dissertations. Special headings for the
six sequential age periods: "Autism", "Symbiosis", "Selective Attachment", "Practicing",
"Rapprochement", and "Object Constancy", are terms formulated by Margaret Mahler,
Fred Pine, and Anni Bergman (1975) for these developmental periods as delineated in
their landmark theoretical work, The Psychological Birth o f the Human Infant.
Implications
The significance of the proposed model is that it will provide a more systematic
and consistent developmental, biopsychosocial framework for acquiring data, formulating
hypotheses, researching, conceptualizing, assessing, and treating attachment related
psychopathology. It can be used to elucidate environmental contributions to the
development of psychopathology, providing hope of prevention. It can also be used to
identify, protect, and enhance essential factors for establishing a healthy psychological
foundation.
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CHAPTER II
Review of Attachment Theory Milestones
There is universal agreement tha t the first individual to propose a theory for human
mother infant attachment was the English child psychiatrist from the Tavistok Clinic in
London—John Bowlby. Following his undergraduate studies in medicine at Cambridge
University, Bowlby worked as a volunteer in a residential school for maladjusted children.
Two children at this school made a notable impression on him, an impression that served
to steer him into the course o f his life’s work:
One was an isolated, affectionless adolescent who had never experienced a stable
relationship with a mother figure, and the other was an anxious child who followed
(me) around like a shadow. Largely because o f these two children, (I) resolved to
continue (my) medical studies toward a specialty in child psychiatry and
psychotherapy, and was accepted as a s tudent for psychoanalytic training.
(Ainsworth & Bowlby, 1991, p. 333)
While working at the London Child Guidance Clinic in 1944, Bowlby completed his first
research study on the role played by parents in the development of a child’s personality,
noting that experiences o f mother-child separation or deprivation of maternal care were
much more common among 44 juvenile thieves than among control group subjects. Those
who had such experiences were also m ore likely to be “affectionless” (Ainsworth &
Bowlby, 1991).
His work was soon interrupted by World War II. Following the war, Bowlby and
associates reorganized the Tavistok Clinic which became part of the National Health
Service; and he became its consulting psychiatrist and Director for the Department for
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Children and Parents. He started his own research unit there in 1948. Convinced that the
effects o f real events in a child’s life were far more important than a child’s fantasy life
(the popu lar notion of the day for fellow psychoanalysts like Melanie Klein), he focused
the work o f this unit on the “effects o f early separation from the mother because
separation was an event on record, unlike disturbed family interaction, of which, in those
days, there were no adequate records” (Ainsworth & Bowlby, 1991, p. 333-334) One
member of the team, a social worker named James Robertson who had worked for a time
in Anna Freud’s nursery during the war, undertook a study in which he observed the
behavior o f young children upon separation from their mothers in three different
institutional settings. He also, whenever possible, observed the children in interaction with
their parents in their homes before and after their separations (stays in the institutions).
During this same period of time, Bowlby was asked to prepare a report fo r the
World Health Organization on “what was known of the fate of children without families”
(Ainsworth & Bowlby, 1991, p. 334) leading him to travel widely and to read all available
literature on separation and maternal deprivation (Ainsworth & Bowlby, 1991). Much of
the literature described abandoned or orphaned infants who ended up in institutions such
as foundling homes, as was especially the case during World Wars I and n .
Perhaps the most historically significant example of such work was provided by
Rene A.. Spitz in his 1945 article entitled Hospitalism. Through interviews with physicians
and administrators and review of records and other accounts, Spitz reported that mortality
rates o f infants under the age o f two years who were placed in institutions in the United
States and Europe from the turn of the century ranged from 31.7% to 90% compared to
10% of children in the general population. As hospital conditions improved and more
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children survived, a new problem emerged: “institutionalized children practically without
exception developed subsequent psychiatric disturbances and became asocial, delinquent,
feeble-minded, psychotic, or problem children” (p. 54). The general agreement was that
two factors were responsible for the “psychological injury” suffered by these children:
Lack of stimulation and absence o f the child’s mother.
In his own study (1945), Spitz used developmental quotients obtained at two
four-month intervals to compare four groups of children with differing living conditions,
(1) children from professional homes in a large city, (2) children from an isolated fishing
village o f499 inhabitants, where living conditions and medial care were considered very
poor, (3) children placed in a nursery within a penal facility for delinquent girls. (Mothers
of these infants were “mostly delinquent minors as a result of social maladjustment or
feeble-mindedness, or because they are physically defective, psychopathic, or criminal (p.
60).”), and (4) children from an urban area who had been placed in a foundling home (“A
certain number o f the children housed have a background not much better than that of the
Nursery children; but a sufficiently relevant number come from socially well-adjusted,
normal mothers whose only handicap is inability to support themselves and their children”
(p. 60).) Findings were astounding; developmental quotients for the Foundling Home
Group had plummeted compared to the others: Group 1 (Professional) = 133 to 131;
Group 2 (Fishing Village) = 107 to 108; Group 3 (Nursery) = 101.5 to 105; Group 4
(Foundling Home) = 124 at 4 months, dropping to 72 at 8 months, and to 45 at 24
months. And, even more horrific,
In spite o f the fact that hygiene and precautions against contagion were
impeccable, the children showed, from the third month on, extreme susceptibility
to infection and illness of any kind .. .O f a total of 88 children up to the age of 2 14,
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23 died... In the ward o f children ranging from 18 months to 2 1/2 years only two
of the twenty-six surviving children speak a couple o f words. The same two are
able to walk. A third child is beginning to walk. Hardly any of them can eat
alone. Cleanliness habits have not been acquired and all are incontinent, (p. 59)
Why had such drastic deterioration not occurred in the other groups—particularly
the Nursery group? An important difference between the Nursery and Foundling Home
conditions was that the infants in the Nursery were able to spend a great deal of time with
their mothers, who were encouraged by staff to play and interact with their children.
These infants were also in sight and sound of other babies and their mothers, particularly
when—at age six months—they were moved to larger rooms holding up to five babies each.
They lived in well-lit, reasonably stimulating surroundings and always had toys.
By contrast—although they received adequate clothing, food, and medical
attention—Foundling Home infants were kept in bleak, dimly lit cubicles with sheet-draped
cots for up to 18 months where they received no stimulation, could see no other babies,
and had no access to their own mothers (other than for the few cases where they were
breast fed by their mothers who did not, in other ways, interact with them. Interestingly,
all Foundling Home infants were breast fed—usually by wet nurses—up to age three
months. This may account for why children in this younger group had a better illness
survival rate than did older infants.) Foundling Home infants didn’t even have a toy to
look at or play when Spitz and colleagues first arrived on the scene. For months on end
(up to age 10-12 months), these little ones were left to lie in their cribs—without human
contact for most of the day—to the point their tiny bodies left hollows in the bedding
which further restricted their movement.
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Spitz noted that while the Nursery babies had a steady rise in development, the
Foundling Home babies began to show a rapid drop in development of body mastery after
the end o f the third month. He attributed this decline to the fact that “as soon as the
babies in Foundling Home are weaned the modest human contacts which they have had
during nursing at the breast stop, and their development falls below normal” (p. 66). He
developed an extremely perceptive hypothesis to account for this phenomenon-one that
foreshadowed theories and findings o f Margaret Mahler who delineated psychological
developmental stages for children up to four years o f age based on the type and quality of
interaction with their mothers (Mahler, Pine, & Bergman, 1975) and contemporary
attachment theorists such as Edward Tronick and Daniel Stem. He noted that “libidinal
cathexis” (p. 68), i.e. investment o f interest in toys, was made possible by emotional
development afforded through the interaction with the mother or mother substitute, and
that this interaction appeared to be a critical factor in a baby’s developmental progress:
A progressive development o f emotional interchange with the mother provides the
child with perceptive experiences of its environment. The child learns to grasp by
nursing at the mother’s breast and by combining the emotional satisfaction of that
experience with tactile perceptions. He learns to distinguish animate objects frominanimated ones by the spectacle provided by his mother’s face in situations
fraught with emotional satisfaction. The interchange between mother and child is
loaded with emotional factors and it is in this interchange that the child learns to
play. He becomes acquainted with his surroundings through the mother’s carrying
him around; through her help he learns security in locomotion as well as in every
other respect. This security is reinforced by her being at his beck and call. In
these emotional relations with the mother the child is introduced to learning, and
later to imitation. We have previously mentioned that the motherless children in
Foundling Home are unable to speak, to feed themselves, or to acquire habits of
cleanliness: it is the security provided by the mother in the field o f locomotion, the
emotional bait offered by the mother calling her child that “teaches” him to walk.
When this is lacking, even children two to three years old cannot walk. (p. 68)
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In developing his theory o f attachment Bowlby was also notably influenced by the
work o f Charles Darwin (Bowlby wrote a biography of Darwin in 1990.); Sigmund Freud
for his emphasis on defense mechanisms and the significance of traumatic events during
early childhood; ethologists Konrad Lorenz and Robert Hinde for their wo rk on imprinting
patterns of baby geese and other animals; Harry Harlow for his studies o f affiliative
behaviors in primates; and Miller, Galanter, Pribram, and Young whose control theories
provided models for neurobiological substrates of homeostatic behavior (Ainsworth &
Bowlby, 1991; Bowlby, 1969). Bowlby’s attraction to ethological and biological
explanations grew as he found Freud’s theory valuable—but insufficient to adequately
describe or explain the phenomena he was observing. He was drawn to the use of
observation in field studies, descriptions of imprinting in birds, and discussion of active,
goal directed behavior patterns that would begin and cease given particular types o f cues,
responses, or circumstances in the environment. A particularly stimulating source of fresh
vantage points and exciting new ideas was Bowlby’s membership in an “international and
interdisciplinary study group on the psychobiology of the child convened by the World
Health Organization” which met yearly during the 1950’s. “Among the members were
Piaget, Lorenz, and Margaret Mead, and among guest speakers were Julian Huxley, von
Bertalanffy, and Erik Erikson.” (Ainsworth & Bowlby, 1991, p. 335).
An American contemporary o f Bowlby, Harry F. Harlow, was making important
discoveries about the significance of “affection” in mother-infant attachment in the
research he was conducting at his University o f Wisconsin primate lab (Harlow, 1958;
Harlow & Zimmerman, 1958). He provided a vivid description in perhaps his most
famous study, The Nature o f Love, in 1958. In three years of previous work with
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monkeys, many of the animals had been separated from their mothers with the justification
that they would live longer if provided supplemented nourishment from the human
investigators. Harlow (1958) provides an account o f the observations that led him to
begin his affection studies:
During the course o f these studies we noticed that the laboratory-raised babies
showed strong attachment to the cloth pads (folded gauze diapers) which were
used to cover the hardware-cloth floors o f their cages. The infants clung to these
pads and engaged in violent temper tantrums when the pads were removed and
replaced for sanitary reasons We also discovered during some allied
observational studies that a baby monkey raised on a bare wire-mesh cage floor
survives with difficulty, if at all, during the first five days of life We were
impressed by the possibility that, above and beyond the bubbling fountain o f breast
or bottle, contact comfort might be a very important variable in the development of
the infant’s affection for the mother, (p. 675)
For his Nature of Love study, Harlow constructed two types o f surrogate monkey
mothers. The first “was made from a block of wood, covered with sponge rubber, and
sheathed in tan cotton terry cloth. A light bulb behind her radiated heat” (p. 676). The
second was “made of wire-mesh, a substance entirely adequate to provide postural
support and nursing capability, and she is warmed by radiant heat” (p. 676). Some of the
monkeys received their milk from the cloth mothers, some from the wire mothers,
although they had access to both. The amount o f time was recorded for how long the
baby monkeys spent clinging to the two types of mothers from the time they were 1 day
old up to 25 days of age. The results were startling. Even those babies fed by the wire
monkeys preferred the cloth mothers. Babies fed by the cloth monkeys spent 15 to 18
hours a day on the cloth mothers and none on the wire mothers. Babies fed by the wire
mothers started out spending about 6-12 hours a day clinging to the cloth mothers, with
this time increasing steadily to the point that by age 16 days, they were spending up to 15-
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18 hours a day on the cloth mothers. They, too, spent as little time as possible (only time
necessary to feed) with the cold, unappealing wire mothers throughout the 25 day period.
In addition, these infants had softer stools, leading Harlow to conclude there was
“psychosomatic involvement” (p. 677). In his discussion of the findings, Harlow offered
these remarks:
We were not surprised to discover that contact comfort was an important basic
affectional or love variable, but we did not expect it to overshadow so completely
the variable of nursing; indeed, the disparity is so great as to suggest that the
primary function o f nursing as an affectional variable is that o f insuring frequent
and intimate body contact o f the infant with the mother, (p. 677)
Harlow’s studies, complete with gut-wrenching photographs of distressed infant monkeys,
were a tremendous influence in Bowlby’s work. Deets and Harlow (1971) conducted
another landmark study in which they provided evidence of critical periods for healthy
emotional development. A half century later, primate research by Gary Kraemer, Stephen
Suomi, and others continues to provide some o f the most compelling findings regarding
the long-term social, emotional, and biological developmental consequences of maternal
deprivation.
Bowlby first published an articulation of his new theory in 1958 in the article, The
Nature o f a Child’s Tie to his Mother. However, this modest initial effort to put forth an
ethological model for parent-child interaction amidst the prevailing psychoanalytic/object
relations school of thought was eclipsed by what remains the definitive work on
attachment: his trilogy of books entitled Attachm ent (1969), Separation (1973), and Loss
(1980). Bowlby drew from Robertson’s work; readings regarding human, primate, and
othe r animal infants; and 20 years o f his own observations stemming from work with
parents and children to demonstrate remarkably consistent separation and reunion
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behavior patterns in infants and young children—the backbone o f his theory o f attachment.
In Attachment , Bowlby provided his oft-cited description of the predictable sequence of
separation and reunion behaviors in young children: protest, despair, and detachment:
The initial phase, tha t o f protest, may begin immediately or may be delayed;it lasts from a few hours to a week or more. During it the young child appears
acutely distressed at having lost his mother and seeks to recapture her by the full
exercise o f his limited resources. He will often cry loudly, shake his cot, throw
himself about, and look eagerly towards any sight or sound which might prove to
be his missing mother. All his behavior suggests strong expectation that she will
return. Meantime he is apt to reject all alternative figures who offer to do things
for him, though some children will cling desperately to a nurse ...
During the phase o f despair, which succeeds protest, the child’s
preoccupation with his missing mother is still evident, though his behaviour
suggests increasing hopelessness. The active physical movements diminish or
come to an end, and he may cry monotonously or intermittently. He is withdrawn
and inactive, makes no demands on people in the environment, and appears to be
in a state of deep mourning. This is a quiet stage, and sometimes, clearly
erroneously, is presumed to indicate a diminution of distress...
Because the child shows more interest in his surroundings, the phase of
detachment which sooner or later succeeds protest and despair is often welcomed
as a sign of recovery. The child no longer rejects the nurses; he accepts their care
and the food and toys they bring, and may even smile and be sociable. To some
this change seems satisfactory. When his mother visits, however, it can be seen
that all is not well, for there is a striking absence o f the behaviour characteristic of
the strong attachment normal at this age. So far from greeting his mother he may
seem hardly to know her; so far from clinging to her he may remain remote and
apathetic; instead o f tears there is a listless turning away. He seems to have lost allinterest in her. (p. 27-28)
Another key component o f Bowlby’s theory is the concept o f “internalized
working models” for self in relation to others, rooted in initial and continuing experiences
with attachment figures:
each individual builds working models o f the world and o f himself in it, with the
aid o f which he perceives events, forecasts the future, and constructs his plans. In
the working model of the world that anyone builds, a key feature is his notion o fwho his attachment figures are, where they may be found, and how they may be
expected to respond. Similarly, in the working model o f the self that anyone builds
a key feature is his notion o f how acceptable or unacceptable he himself is in the
eyes of his attachment figures. On the structure o f these complementary models
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are based that person’s forecasts o f how accessible and responsive his attachment
figures are likely to be should he turn to them for support. And.. .also, whether he
feels confident that his attachment figures are in general readily available or
whether he is more or less afraid that they will not be available—occasionally,
frequently, or most o f the time. (Bowlby, 1973, p. 203)
In his book Separation (1973), Bowlby focused attention on fear and anxiety
experienced by the young child upon separation from mother. Colleague Mary Ainsworth
utilized the concepts put for th in this work in developing her now famous “Strange-
Situation” studies which served as the basis for delineating patterns of secure vs. anxious
attachment (Ainsworth & Bowlby, 1991; Ainsworth, Blehar, Waters, & Wall, 1978). In
Loss, Bowlby described the grie f and mourning process of adults and children when
confronted with the loss of a close loved one. An extremely precise definition of
attachment is provided by Bowlby in his 1988 book, A Secure Base:
In re-examining the nature of the child’s tie to his mother, traditionally referred to
as dependency, it has been found useful to regard it as the resultant o f a distinctive
and in part pre-programmed set o f behaviour patterns which in the ordinary
expectable environment develop during the early months of life and have the effect
o f keeping the child in more or less close proximity to his mother-figure. By the
end o f the first year the behaviour is becoming organized cybemetically, which
means, among other things, that the behaviour becomes active whenever certain
conditions obtain and ceases when certain other conditions obtain. For example, achild’s attachment behaviour is activated especially by pain, fatigue, and anything
frightening, and also by the mother being or appearing to be inaccessible. The
conditions that terminate the behaviour vary according to the intensity o f its
arousal. At low intensity they may be simply sight or sound of the mother,
especially effective being a signal from her acknowledging his presence. At higher
intensity termination may require his touching or clinging to her. At highest
intensity, when he is distressed and anxious, nothing but a prolonged cuddle will
do. The biological function o f this behaviour is postulated to be protection,
especially protection from predators, (p. 3)
Mary D. Salter Ainsworth’s work would come to provide much o f the evidence
that supported Bowlby’s theory. She entered a course of study in psychology as an
undergraduate at the University of Toronto in Canada “hoping to understand how she had
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come to be the person she was, and what her parents had to d o with it.” (Ainsworth &
Bowlby, 1991, p. 334). During this time she was drawn to thie work o f one of her
professors, William E. Blatz, who had recently “formulated thieory o f security as an
approach to understanding personality development” (Ainsworth & Bowlby, 1991, p.
334). Among the various types o f security he described was *he “immature dependent
security” o f young children tha t accounted for their need o f a secure base of parental
availability from which to explore and leam and to which they could retreat when that
exploration and learning became too frightening. He had alscn acknowledged that agents
akin to defense mechanisms could provide a temporary kind o f security, although they did
not deal with the source o f insecurity—“like treating a tooth a^che with an analgesic” (p.
334). For her 1940 dissertation, Ainsworth “constructed two» self-report paper-pencil
scales intended to assess the degree to which a person was secure rather than insecure” in
order to obtain additional data for this theory, (p. 334).
In 1950, Ainsworth left the University o f Toronto w h« n her husband Leonard
pursued his Ph.D. at the University of London. Jobless, she an sw ered an advertisement in
the Times Educational Supplement for a position as a developmental researcher at the
Tavistock Clinic “investigating the effect on personality development o f separation from
the mother in early childhood.” (p. 335). Needless to say she: got the job, beginning a life
long collaboration with John Bowlby. She was particularly intr igued by his hypotheses for
separation anxiety and provides this account o f his theory (Ainsw orth Sc Bowlby, 1991):
Separation anxiety occurs when attachment behavior 5s activated by the absence of
the attachment figure, but cannot be terminated. It di ffe rs from fright, which is
aroused by some alarming or noxious feature of the environment and activates
escape responses. However, fright also activates attachment behavior, so that the
baby not only tries to escape from the frightening stimulus but also tries to reach a
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haven o f safety—the attachment figure. Later in infancy the baby is capable of
expectant anxiety in situations that seem likely to be noxious or in which the
attachment figure is likely to become unavailable...only a specific figure, usually
the mother figure, could terminate attachment behavior completely once it had
been intensely activated...hostility toward the mother is likely to occur when
attachment behavior is frustrated, as it is when the child is separated from her,
rejected by her, or when she gives major attention to someone else. When suchcircumstances are frequent or prolonged, primitive defensive processes may be
activated, with the result that the child may appear to be indifferent to its mother
.. .o r may be erroneously viewed as healthily independent, (p. 336)
Ainsworth and followers amassed a body o f research that included field studies
(i.e. her description o f mothers and infants in Uganda in the early 1950’s), data from a
1963-1964 longitudinal study in Baltimore described in Patterns o f Attachment
(Ainsworth, Blehar, Waters, & Wall, 1978), and countless replications by other
investigators using her Strange-Situation technique to assess secure vs. anxiously attached
infants all over the world.
Ainsworth’s Strange Situation experiments, detailed in Patterns o f Attachm ent
(Ainsworth, Blehar, Waters, & Wall, 1978), involved observing infants in each of the
following 8 sequential conditions o r “episodes”:
1. Mother, baby, & observer. (30 sec.) Observer introduces mother and baby to
experimental (playroom), then leaves
2. Mother & baby. (3 min.) Mother is nonparticipant while baby explores; if
necessary, play is stimulated after 2 minutes
3. Stranger, mother, & baby. (3 min.) Stranger enters. First minute: Stranger
silent. Second minute: Stranger converses with mother. Third minute:
Stranger approaches baby. After 3 minutes mother leaves unobtrusively.
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4. Stranger & baby. (3 min.) First separation episode. Stranger’s behavior is
geared to that o f baby.
5. Mother & baby. (3 min.) First reunion episode. Mother greets and/or
comforts baby, then tries to settle him again in play. Mother then leaves,
saying “bye-bye”.
6. Baby alone. (3 min.) Second separation episode.
7. Stranger & baby. (3 min.) Continuation o f second separation. Stranger enters
and gears her behavior to that of baby
8. Mother & baby. (3 min.) Second reunion episode. Mother enters, greets
baby, then picks him up. Meanwhile stranger leaves unobtrusively, (p. 37)
Pre-separation interactions o f infants and their mothers were noted. Infants were
then observed in the separation and reunion conditions at which time they were sorted into
one o f three groupings based on anxiety level and relationship style. Whenever possible,
infants and mothers were observed before and after the test in the natural setting of their
homes. Ainsworth and colleagues thus identified three patterns of attachment. Ainsworth
(1979) summarizes the three patterns:
Group B (Secure) babies use their mothers as a secure base from which to explore
in the preseparation episodes; their attachment behavior is greatly intensified by the
separation episodes so that exploration diminishes and distress is likely; and in the
reunion episodes they seek contact with, proximity to , or at least interaction with
their m others ... .Group B babies were more cooperative and less angry than either
A or C Babies.Group C (Insecure-Ambivalent-Resistant) babies tend to show some signs
of anxiety even in the preseparation episodes; they are intensely distressed by
separation; and in the reunion episodes they are ambivalent with the mother,seeking close contact with her and yet resisting contact or interaction.
Group A (Insecure-Avoidant) babies, in sharp contrast, rarely cry in the
separation episodes and, in the reunion episodes, avoid the mother, either mingling
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proximity-seeking and avoidant behaviors or ignoring her altogether...Group A
babies were even more angry than those in Group C. (p. 932)
Ainsworth also observed patterns o f behavior in mothers that corresponded to
each o f the three styles of attachment seen in their infants. Mothers of Secure infants were
responsive and sensitive to their infants’ signals across all contexts. This was not the case
for mothers of insecure infants, whose responsiveness to infant signals was inconsistent at
best, ill-timed, inappropriate, or even nonexistent (Ainsworth, 1979). The most troubling
findings were for mothers o f Avoidant infants:
In regard to interaction in close bodily contact, the most striking finding is that the
mothers of avoidant (Group A) babies all evinced a deep-seated aversion to it,
whereas none of the other mothers did. In addition they were more rejecting,more often angry, and yet more restricted in the expression o f affect than were
Group B or C mothers. (Ainsworth, 1979, p. 933)
That similar patterns of infant attachment have been found in Strange-Situation
studies conducted in diverse cultures throughout the world (Grossman & Grossman, 1990;
Main, 1990; Sagi, 1990) lends support to the biological aspect o f Bowlby’s theory. And,
reliable findings that these attachment patterns persist over time (Cassidy & Main, 1984;
Cicchetti, Toth, & Lynch, 1995; Matas, Arend, & Sroufe, 1978) are consistent with
Bowlby’s notion o f an internalized working model. There is even some evidence to
suggest that an individual’s attachment pattern extends into adulthood. A body of work
on adult patterns of relating has emerged from Phillip Shaver’s findings that adult love
relationships can be characterized as Secure, Avoidant, or Anxious/Ambivalent (Hazan
and Shaver, 1987). One particularly fascinating finding in his studies is that the three
patterns of attachment exist in adulthood in roughly the same percentages as in early
infancy (Secure: 56% in adulthood vs. 60% in infancy; Avoidant: 23-25% in adulthood vs.
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20% in infancy; and Anxious/Ambivalent: 19-20% in adulthood vs. 20% in infancy).
Shaver suggests that the same internalized working model o f self in relation to others that
first emerges within the context o f that all-important initial experience with the parent
continues to organize on e’s social beliefs and behaviors throughout the lifespan.
An individual who was instrumental to Ainsworth in conducting, interpreting,
compiling, and expanding her work was colleague Mary Main. Main and others
(Crittenden, 1985a, 1985b; Egeland and Sroufe, 1981a, 1981b; Spieker and Booth, 1985)
who conducted Strange Situation studies had observed that there were a group of infants
in middle class samples—and especially in high-risk samples from abusive and/or neglecting
families—whose unclassifiable behaviors showed marked departures from Secure,
Ambivalent, or Avoidant criteria. In 1986, Main and Solomon introduced a fourth
“Insecure-Disorganized/Disoriented Attachment Pattern” (Pattern D) (p. 95). Unlike the
overly independent Avoidant and highly dependent Ambivalent patterns, this pattern was
remarkable for its lack o f organized behavior when the infant was confronted with a
difficult, stressful situation. Main was astonished to discover that all previously
unclassifiable infants fit one or more criteria of this 4th pattern, rendering it unnecessary to
elucidate additional patterns as had been expected. Parents o f these infants are
characterized as abusing, neglecting, and/or having mental illness (i.e. Bipolar Disorder,
Major Depression), thereby creating the “most extreme o f family conditions” (p. 107). The
Disorganized/Disoriented pattern o f attachment has also been found to persist over time
(Cassidy & Main, 1984; Lyons-Ruth, 1996; Lyons-Ruth & Easterbrooks, 1997).
Mary Main’s work was also instrumental in demonstrating that patterns of
attachment extend across generations. In her 1984 landmark study, she and Goldwyn
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utilized the Berkeley Adult Attachment Interview (AAI) to determine the quality of
children’s attachments with their mothers based on the mothers’ verbal recollections of
childhood interactions with their own mothers. Subjects were 30 mothers (largely white,
middle class) whose infants had been tested six years prio r to determine their pattern of
attachment (Secure, Ambivalent, or Avoidant). Mothers’ interviews were rated by
investigators who had no knowledge o f children’s pre-determined attachment patterns.
Mother interview results were then compared to the predetermined child attachment
patterns. Findings showed
a significant positive relationship between apparent rejection by mother in
childhood and inability to recall childhood, and there was a strong relationship
between rejection by m other in childhood and idealization o f mother now. Finally,the more rejected the mother was by her own mother in childhood , the less
coherent she appeared to be in discussing attachment relationships and experience
now. All three findings were significantly predictive of a woman’s rejection of her
own infant, (p. 213)
However, those parents w ho’d had a negative experience growing up—but were able to
give a cohesive, detailed recollection (indicating they had been able to work through and
integrate their experience)—had developed healthy, secure attachments with their own
infants.
Based on his interpretation o f Ainsworth’s research, Daniel Stem (1983; 1985)
honed in on “affect attunement” of the mother with her infant as the critical process
involved in the initial regulation o f the child’s emotional states. In his book, The
Interpersonal World o f the Infant (1985), he defines affect attunement as “the
performance of behaviors that express the quality o f feeling o f a shared affect state
without (simply) imitating the exact behavioral expression o f the inner state” (p. 142).
Similar to the concept o f sensitivity to infant signals, this process involves parental
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resonance with the child’s feeling state conveyed by some type o f matching o f the child’s
expressive behavior. The channel of modality o f expression used by the mother to match
the infant’s behavior is frequently, i f not mostly, different from the channel or modality
used by the child; and what is being matched is not so much the child’s behavior, but some
aspect o f the behavior that reflects the child’s feeling state.
His cross-modal emphasis is consistent with initial organization of the central
nervous system in the newborn, involving brain-stem mechanisms that coordinate multi
modal sensory-motor processing systems. The infant’s orienting response, turning to
locate mother’s voice in space and linking it to her face, is an example. Stem, (1985)
believes that infant biological mechanisms and abilities for engaging the environment are
far more sophisticated a t a very early age than previously thought. Although Bowlby
would certainly agree with this observation, he and Ainsworth focussed their attention on
older infants who had already formed a selective attachment with their mothers, an event
that begins about six months o f age. Stem stresses that the socialization afforded by
mother-child interaction is critical to healthy emotional development from the beginning of
an infant’s life.
Attachment theorists Edward Tronick and Tiffany Field demonstrated that a
mother’s emotional unavailability (i.e. from depression) can be as devastating to her infant
as physical unavailability (Field 1985, 1998; Tronick, 1986; Tronick et al., 1978). A
powerful illustration o f what happens to infants when emotional feedback is not
forthcoming from their mothers emerged in Tronick’s famous “still face” experiments
(Tronick, 1986; Tronick et al, 1978). In these studies mothers were asked to engage in
normal interaction with their infants. In the middle o f the interaction, the parent was
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instructed to go “still-faced” (remain impassive and emotionafly expressionless). Typically
these healthy infants, looking puzzled, would initially make several attempts to engage
their mothers; but~after repeated failures to engage her~woulld eventually look down and
withdraw. This sequence of events happened within a matter o f minutes.
Like Daniel Stem, Edward Tronick (1986) believes th a t the mother’s response to
her child is a key factor in helping the infant establish regulation o f emotional states from
the beginning o f life. Tronick links relationship to biological functioning as he describes a
dyadic process whereby the primary care-giver assists her infa_nt to achieve homeostasis by
regulating arousal in her infant. The infant can utilize self-d irected regulatory behaviors to
obtain self-comfort (i.e. sucking, rocking) or to decrease sensory stimulation (i.e. turning
head away). However, due to the infant’s immature neurological organization and lack of
coordination, these behaviors—which serve to decrease con tact with the external
environment~are not sufficient. Another way the child seeks to regulate emotions is
through other directed behavior which serves to engage the emvironment (mother) for
assistance. Tronick, like Stem, notes that:
When the mother responds appropriately to her infantas other-directed regulatory
displays, the infant is able to maintain both self-regulaltion and regulation o f the
interaction, and positive emotions are generated. W hen the mother fails to
respond, the infant’s regulatory efforts are unsuccessful, and negative emotions are
generated, (p.7)
Jaak Panksepp was the first to explore and identify neairobiological substrates for
mother-infant attachment phenomena. Spurred by the discovery in 1972 of the
endogenous opioids, Panksepp was able to demonstrate that a form o f endogenous opioid
analgesia, or pain relief, appears to obtain in baby chicks, puprpies, and other animals upon
acquiring contact comfort and reassurance from the mother. IPanksepp suggests that
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attachment behavior and opiate addiction are very closely related in that they appear to be
mediated by the same systems in the central nervous system. He notes that separation
from the object of attachment and opiate withdrawal produce similar painful symptoms
(Panksepp, 1986, 1998; Panksepp et al., 1978; Panksepp, Siviy, & Normansell, 1985).
Most recently, Allan Schore has proposed that the “visuoaffective” component of
mother-infant attachment facilitates infant frontal lobe development. In his book, A ffect
Regulation and the Origin o f the S e lf (1994), he theorizes that a primary function of
mother-infant attachment is to stimulate development of the frontal lobes, particularly the
right orbitofrontal lobe—key to healthy social-emotional functioning. He pinpoints age
11-18 months (corresponding to Margaret Mahler’s Practicing Stage) as an important
time frame for this dopamine-driven developmental process that occurs when mother
connects with her baby through the eyes. Eye contact, during a time the child is also
becoming upright and mobile, enables the youngster to obtain some distance (and
eventually separation) from mom—permitting the freedom to explore that spurs further
development o f the cortex.
The attachment milestones thus selected and described are essential to the
biopsychosocial premise o f the model proposed in this dissertation. Because attachment
theory—from its inception—has linked social-emotional development to its biological and
ethological roots, its percepts remain fresh and relevant, even against the litmus test of
burgeoning findings from state-of-the-art neurobiological research. Because attachment
theory is aligned with the principles of Systems Theory, attachment phenomena (i.e.
homeostatic processes) identified at the molecular, neurobiological, individual, dyadic, and
social system levels will probably retain a consistency that would not be true for other
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theories which depart from these standards. Attachment provides a classic example of
how biology and environment-infant and mother—become engaged in the dance of
reciprocity.
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CHAPTER m
METHODOLOGY
A Biopsychosocial Model for Projecting Psychopathology Resulting from
Attachment Deficits and Distortions
This section will propose a biopsychosocial model fo r elucidating development
dependent patterns of psychopathology—with focus on emotion dysregulation—resulting
from attachment deficits and distortions. Using the model, predictions for typical
symptomatic presentations that would emerge during six incremental age periods from
age 0 to 36 months o f age will be formulated, based on the developmental status of brain
structures, psychopharmacology, and emotion circuits available to the infant at those
points in time. Key to this model is that proposed descriptions of attachment related
psychopathology for children and adults will be constructed by working forward—
sequentially and additively (consistent with brain structures and circuitry coming on
line)—from the emergent end of the developmental trajectory toward adulthood vs.
extrapolating backward from adulthood.
Adherence to General Systems Theory Principles
Key to this biopsychosocial model is its adherence to the guiding principles of
General Systems Theory that apply to all systems in nature (James, 1999). Meeting these
standards provides an initial litmus test for any such model or theory that attempts to
elucidate the nature of phenomena that exist in nature. Therefore, incorporating general
systems principles from this model’s inception increases the likelihood that its
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components have internal consistency and that predictive descriptions deriving from the
model are consistent with findings from an array o f disciplines attempting to study the
same phenomena from differing vantage points or system levels (i.e. neurobiological,
individual, social). Becau se higher order systems cannot violate systemic principles o f
the subsystems tha t comprise them, another litmus test for a model’s viability is that
biological substrates can accoun t for the individual and social psychological phenomena
it addresses. Therefore, although this model is focused on individual psychopathology
and addresses the attachm ent o r social-related context from which it derives, it is
biologically based. Systems principles that represent recurring themes emerging in the
phenomena addressed by th is model will now be discussed.
(1) Systems Evolve from Simple to Complex
Systems change in two possible directions: toward decreased organization
(entropy) or toward increased organization (evolution). Systems evolve (develop) from
simple to complex. The biological, individual, and social phenom ena addressed by this
model will be presented in a m anner that reflects their increasing complexity through the
sequential, additive, organizational, and reorganizational processes involved in human
development. The simple-to-complex theme emerges time and again at each system
level.
Examples include:
• neuron, migration o f neurons to target sites, grouping of neurons with harmonious
firing patterns into components o f brain structures, organization o f brain
structures and neurotransmitters into emotion circuits
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• infant’s ability to tolerate arousal o f increasing duration, intensity over time as the
autonomic nervous system matures in interaction with the modulating effects of
increasingly sophisticated emotion systems (emerging sequentially) and
experience
• the development of motoric abilities from sitting up by self, to crawling, walking,