Clinical Implications

The field of attachment began with Bowlby's clinical work with disordered patients. Since then, researchers have remained interested in links between early attachment history and the development of psy-chopathology. Work with institutionalized children demonstrates that the failure to form attachment relationships can lead to serious mental health problems. Most research, however, concerns associations between the quality of care children receive from attachment figures and later behavior. For example, infants with ambivalent attachment relationships are more likely to develop later anxiety disorders, while those with disorganized attachment relationships are more likely to develop later dissociative disorders, where individuals lose touch with reality. There is lit

Attachment figures—such as this teacher—-provide comfort to children in times of stress by offering a safe haven from situations that may appear dangerous or unsettling. (Stephanie Maze/Corbis)

tle evidence for specific links between types of insecurity and types of disorders. Instead, insecurity seems to operate as a risk factor that is neither a necessary nor a sufficient cause for disorders. Not surprisingly, there is evidence that a secure attachment relationship functions as a protective factor for children; in other words, security may protect children from the effects of other risk factors associated with psychopa-thology, such as their own difficult temperaments.

The processes through which early attachment relationships lead to later disorders are not well understood. Most theorists, however, believe that internal working models must moderate any link between the two. Models characterized by anger, mistrust, anxiety, and fear may lead children not only to behave aggressively but also to interpret the behaviors of others, even kind behaviors, negatively. In fact, the early memories of people with personality disorders are characterized by marked distortions and inconsistencies that reflect their negative attributions of themselves and others. More research on internal working models, especially with respect to their resistance to change, could help direct future therapeutic efforts with both children and adults.

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