Attachment disorders

Research over two decades has established attachment theory as a key concept within developmental psychopathology, although much remains to be under-stood about the specificity of attachment patterns and their interaction with other aspects of cognitive and social functioning in later development. Early attachment relationships are understood to arise out of an infant's need for proximity to an adult when in distress. Ainsworth and her colleagues found that the character of these relationships varied systematically in the general population (Ainsworth et al., 1978). These patterns of attachment have shown stability in the early years (Bretherton, 1985; Lamb, 1984; Van Ijzendoorn and Kroonenberg, 1988) — although there are counter findings (Belsky et al., 1996). The ‘insecure’ attachment patterns act as vulnerability factors for later social and psychological problems (Bretherton, 1985; Crockenberg, 1981; Crittenden, 1995). This is found for psychosocial adjustment (Cassidy, 1988) and psychiatric disorder, particularly in the presence of other stressors such as family dysfunction and social disadvantage (Lewis et al., 1984; Lyons-Ruth, 1996; Warren et al., 1997). Thus insecure or disorganised attachment patterns will inevitably be revealed as aetiological factors in many clinical presentations in early childhood. It is doubtful whether such insecure attachments (which could be thought of as a trait insecurity) should be considered as ‘disorders’ as such, but further research is needed to clarify their relationship to psychopathology (e.g. chapter 19). Zeanah (1996) has suggested that ‘attachment problems become psychiatric disorders when emotions and behaviours displayed in attachment relationships are so disturbed as to indicate or substantially to increase the risk of, persistent distress or disability’.