Theories of attachment by Dr. Vaibhav Dua

Dr. Vaibhav Dua
PG-Resident
Dept. of Psychiatry
PES Institute of
Medical science &
Research
Theories of Attachment

Overview
 Introduction
 Stages of attachment
 Theory of Attachment by John Bowbly
 Internal working model
 Bowbly thieves study
 Species typical behavior pattern
 Lorenz Imprinting theory
 Harlow study on attachment

Overviewss
 Suomi study on monkey
 Anna freud observation
 Mary Ainsworth-insecure attachment theory
 Adult attachment interview by Mary Main
 Reflexive function
 Adult attachment & functioning
 Biology of attachment
 Disturbance in normal attachment behavior
 Reference

Introduction
 Attachment is an early ,stable,affectional
relationship between child and another person
usually a parent.
 Attachment theory is development in field of
study of relationship with objects.
 It characterize early forms of infant maternal
attachment and its consequences for further
development and for adult personality
functioning.

Stages of Attachment
 Rudolph Schaffer and Peggy Emerson (1964) studied 60
babies at monthly intervals for the first 18 months of life
(this is known as a longitudinal study).
 The children were all studied in their own home and a
regular pattern was identified in the development of
attachment.
 The babies were visited monthly for approximately one
year, their interactions with their carers were observed,
and carers were interviewed. A diary was kept by the
mother to examine evidence for the development of an
attachment.

 Three measures were recorded:
1. Stranger Anxiety response to arrival of a stranger.
2. Separation Anxiety distress level when separated
from carer, degree of comfort needed on return.
3. Social Referencing degree that child looks at
carer to check how they should respond to
something new (secure base).

 They discovered that baby's attachments develop in
the following sequence:
 Asocial (0 -6 weeks)
1. Very young infants are asocial in that many kinds of
stimuli, both social and nonsocial, produce a
favorable reaction, such as a smile.
 Indiscriminate Attachments (6 weeks to 7 months)
1. Infants indiscriminately enjoy human company and
most babies respond equally to any caregiver.
2. They get upset when an individual ceases to
interact with them.
3. From 3 months infants smile more at familiar faces
and can be easily comfortable by a regular
caregiver.

 Specific Attachment (7- 9 months)
1. Special preference for a single attachment figure. The baby
looks to particular people for security,comfort and
protection.
2. It shows fear of strangers (stranger fear) and unhappiness
when separated from a special person (separation anxiety).
 Multiple Attachment (10 months and onwards)
The baby becomes increasingly independent and forms several
attachments. By 18 months the majority of infants have form
multiple attachments.
 The results of the study indicated that attachments were most
likely to form with those who responded accurately to the baby's
signals, not the person they spent more time with. Schaffer and
Emerson called this sensitive responsiveness.

 Intensely attached infants had mothers who responded
quickly to their demands and, interacted with their child
Infants who were weakly attached had mothers who
failed to interact.
 Many of the babies had several attachments by 10
months old, including attachments to mothers, fathers,
grandparents, siblings and neighbors. The mother was
the main attachment figure for about half of the
children at 18 months old and the father for most of the
others.
 The most important fact in forming attachments is not
who feeds and changes the child but who plays and
communicates with him or her. Therefore,
responsiveness appeared to be the key to attachment

Theory of Attachment by John Bowbly
 John bowlby and his colleagues proposed
theory of attachment in 1966.
 They saw children who separated early from
their mother living in nurseries and hospitals
without permanent mother substitute.
 These children were unable to relate to other
peoples, afraid to explore or play.

• Four key characteristics of attachment:
• (1) proximity maintenance (wanting to be physically
near to the persons we are closest to);
• (2) safe haven (returning to attachment figure when
feeling frightened or sense of threat (perceived or
real));
• (3) secure base (the attachment figure represents a
secure base from which the child can explore their
environment and other relationships;
• (4) separation distress (anxiety when attachment figure
is absent).

 Bowlby’s concept of ‘monotropic’ attachment (i.e.
preferred attachment figure (usually the mother
above all others).
 John bowbly concluded:-
It is essential for mental health that the infants and
young child should experience warm, intimate and
continuous relationship with his mother or permanent
mother substitute in which both find satisfaction &
enjoyment.

age Reaction of child Proximity maintaing
behavior
Till age of 3 months Attraction to social
objects in general and to
human in particular
Shows proximity
maintaining behavior.
3-6 month of age Distinguishes familiar
from unfamiliar people
and from primary
caretaker from other
familiar persons.
Directed more at familiar
persons, particularly at
primary caretaker.
6months -1 year Develops true attachment
to primary caretaker
Direct towards primary
care taker.
At 1 year age Reacts negatively to
seperation from primary
caretaker

Bowlby Attachment theory postulates:-
 When faced with threat, illness or exhaustion children will
seek proximity to their caregivers or “Secure Base”.
 A protective response from caregiver relieve the child’s
attachment needs, who can then return to play or
exploratory behavior.
 This protective response will get secure in their knowledge
for help in any further need, this provide conditions for
“Secure Attachment”.
 Though child builds up an “internal working model” of a
secure robust self and responsive others.

 Secure attachment arises out of responsive
and sensitive parenting and is contrasted
with “insecure attachment”
 Insecure attachments –as a factor
predisposing to adult neurosis.

Questions raises after john bowbley
attactment theory
 Bowbly emphasis on pivotal role of mother?
 Does regular day care for infants and young
children interfere with attachment to parents?
 Why does it happen at all?

Internal working model
 The philosopher Kenneth Craik had noted the ability of
thought to predict events. He stressed the survival value of and
natural selection for this ability.
 This internal working model allows a person to try out
alternatives mentally, using knowledge of the past while
responding to the present and future.
 Bowlby applied Craik's ideas to attachment.

 Bowbly argued that human infant motivated by hardwired attachment
system,
 To seek:-
1. external goal of safety in proximity to small numbers of identified
caregivers.
2. internal goal of felt security.
 This internal subjective sense of security is influenced by experience of
caregiver’s emotional & physical avaibility in times of need and is
modified by infant’s temperamental makeup.

 From usual biobehavior shift at 7 to 9 months of age through
the first 3 years of life, infants are thought to begin to form
internal representation of their relationships with imporatant
caregivers.
 These representations form the basis for intense emotional
bond between infants and their primary caregivers and
behavior in later relationships

 If the caregiver consistently denies the infant access, an
avoidant organization develops.
 If the caregiver inconsistently grants access, an
ambivalent organization develops.
 A parent's internal working model that is operative in the
attachment relationship with her infant can be accessed by
examining the parent's mental representations.

Bowlby’s Thieves maternal deprivation study
 Aim:
To investigate the effects of maternal deprivation
on children in order to see whether delinquents
have suffered deprivation.
According to the Maternal Deprivation
Hypothesis, breaking the maternal bond with the
child during the early stages of its life is likely to
have serious effects on its intellectual, social and
emotional development.

 Procedure:
 Bowlby interviewed 44 adolescents who were
referred to a child protection program in London
because of stealing- i.e. they were thieves.
 Bowlby selected another group of 44 children to act
as ‘controls’- individuals referred to clinic because of
emotional problems, but not yet committed any
crimes.
 He interviewed the parents from both groups to state
whether their children had experienced separation
during the critical period and for how long. (do you
see any problems with this?)

 Conclusion:
Affectionless psychopaths show little concern
for others and are unable to form
relationships.
Bowlby concluded that the reason for the anti-
social behavior and emotional problems in the
first group was due to maternal deprivation.

Bowlby’s 44 Thieves
 Findings:
 More than half of the juvenile thieves had been
separated from their mothers for longer than 6 months
during their first five years.
 In the control group only 2 had had such a separation.
 He also found several of the young thieves (32%) showed
'affectionless psychopathy' (they were not able to care
about or feel affection for others).
 None of the control group were affectionless
psychopaths.

Species Typical Behavior Pattern
 Ethology is concerned with behaviour patterns that
typical of particular species of animals-with emphasis on
the evolution of these patterns and,thus adaptive value.
 Species typical behavior:-is a type of behavior pattern
that all normal members of the species must display the
behavior under certain circumstances.
 Fixed action pattern:-many species typical behavior
consists of relatively fixed and inflexible patterns of
movement triggered by a particular stimulus, or event in
the environment. such stimulus called a releaser, and
their behavior released by such a stimulus called as fixed
action pattern.

Lorenz's Imprinting Theory
 Lorenz (1935) took a large clutch of goose eggs and kept
them until they were about to hatch out. Half of the eggs
were then placed under a goose mother, while Lorenz
kept the other half beside himself for several hours.
 When the geese hatched Lorenz imitated a mother
duck's quacking sound, upon which the young bird
regarded him as their mother and followed him
accordingly. The other group followed the mother goose.

 Lorenz found that geese follow the first moving
object they see, during a hour critical period after
hatching. This process is known as imprinting, and
suggests that attachment is innate and programmed
genetically.
 Imprinting has consequences, both for short term
survival, and in the longer term forming internal
templates for later relationships.
 Imprinting occurs without any feeding taking place.

 Hess (1958) showed that although the imprinting
process could occur as early as one hour after
hatching, the strongest responses occurred between
12 and 17 hours after hatching, and that after 32
hours the response was unlikely to occur at all.
 Lorenz and Hess believe that once imprinting has
occurred it cannot be reversed, nor can a gosling
imprint on anything else.

 Ethologists pointed that animal infants become
imprinted on a mother figure-clinging following closely
that attachment in human infants.
 During certain sensitive periods,infant of species are
biologically programmed to imprint on some objects in
enviroment.
 Imprinting is trigerred by specific releasers in the
enviroment.
 Some ethologists argued that attachment in human
operates like imprinting on other animals.
 Researher harry harlow in 1958 has done some research
to shed some light on yhis issue.

Harlow’s study on attachment
 Harlow studied monkeys.
 The rearing condition designed by harlow for his
baby monkeys involved surrogate mothers-artificial
stand-ins for monkey’s real mothers.

Harlow’s research setup:-
 Each monkey was equipped with a surrogate mother.
 One group had cylinder made of wire mesh with a block
of wood as its head.
 The other group had block of wood covered with sponge
rubber then terry cloth.
 Behind each mother was a light bulb provided radiant
heat for infants.
 For one group of babies ,wire “mother” had the nursing
bottle.
 For second group of babies the cloth “mother "had
nursing bottle.

Reaction of monkey
reared with wire
mother
Reaction of monkey
reared with cloth
mother
1. On frightened 1. Made little efforts to go
their mother.
1. Clungs tightly to their
mother.
2. Threw themselves on
floor
3. cried
4, grimaced
6. Rocking back & forth
while covering their face
with their hands
2. Attachment level 1. developed no
attachment
1. Developed strong
attachment
3. Other observed
behaviour
1. Strange behavior
2. Self destructive
behaviour
3. Paced their cages for
hours.
4. Bit themselves
5. Pulled out their own

 Further research by harlow group showed that many
of adverse effects of parent deprivation are
reversible.

Harlow studies point about attachment &
adoptation
1. Attachment was not merely due to feeding.
2. It reveal a basic need for contact with a soft warm
surface; harlow called this a need for “contact
comfort”.
3. Contact comfort may operate like a releaser. With
contact comfort attachments were formed;without
it, attachments were not formed.
4. Many of the ill effects of being reared without
parents may sometimes be reversed or prevented
by close peer relationships.

Study on monkey by Suomi
 A study conducted by Suomi et al., in 1974 on monkey.
 In this study monkeys had been isolated for 6 months.
 They started showing strange behavior as descried in
harlow study.
 They were given therapy.
 The therapist were 3 months old normal, energetic
female monkeys.
 Six months of living with this peer therapist resulted in
improvement in socially deprived misfit behavior.
 Another six months led's to a virtually complete recovery.

Anna freud observation:-
 Anna freud and sophie dann brought the six Jewish
orphaned children from Nazi’s concentration camps to
bulldogs bank England for care.
 By then their age was 3-4 years,
 Initially the children were wild and hostile towards
adults.
 They were remarkably attached and affectionate to one
another.
 They were extremely generous in sharing food and warm
clothing with each other.
 They insisted on being together at all times.
 Gradually formed attachment to those who cared for
them and adjusting to social demands of polite society.

Mary Ainsworth-insecure attachment theory
 Mary Ainsworth’s study based on “Strange Situation
Procedure”(SSP).
 Comprised of structured, unfamiliar situation
compromised of increasing level of stress like Strange
room, Strange Adult and Separation from caretaker.
 Observation of infants focused primarily on proximity
seeking & contact maintaining behavior during reunions
with caregiver.
 Validity:-development of stranger fear & mobility by 9
month and loss its validity by 18 month of age as child
cognitive development permits different responses to
seperation e.g. symbolic representation & language.

Mary Ainsworth-insecure attachment theory
 Mary Ainsworth have researched different patterns of
insecure attachment and conditions under which they arise.
 Procedure:-
1. She introduced strange situation test in which an infant is
left in care of a stranger for a few minutes.
2. The observer then notes how infant copes both with the
separation and with the reunion.
 This observation leads to classification of attachment:-
1. Secure attachment
2. Insecure-avoidant
3. Insecure-ambivalent or insecure resistant
4. Insecure-disorganized

Secure attachment
 The infants tends to seek proximity and contact with
the attachment figure
 Shows preference for the mother over stranger
 Shows very little distress before and after seperstion.

Insecure -Avoidant
• No sign of distress by mother’s absence
• Showed little interest when she returned
• Infant okay with stranger and plays normally when
stranger is present
• Stranger will be treated similar to the mother (does not
seek contact).
• Mother & stranger are able to comfort infant equally well
• Mothers tend to be insensitive or not interested in
children
• Research has suggested that this attachment style might
be
• a result of abusive or neglectful caregivers.
• Characteristic of 15% of infants

Insecure -Avoidant
 Had experienced rude and aggressive parenting.
 Avoids mother or caretaker during reunion.
 Does not differentiate greatly between caretaker and
stranger.
 More vulnerable to adult disorders like:-
1. Borderline personality disorder
2. Histrionic personality disorder
3. Dependent personality disorder

Insecure-Ambivalent
 Had experienced inconsistent parenting.
 But clings on inconsistent and find difficuly in exploratory
behavior even when threat has passed.
 Infants resists contact and interaction with mother.
 There is great distress at reunion.
• Intensely distressed when mother left
• Apparent fear of stranger – and avoids stranger
• Clinginess mixed with rejection on return may approach mother but
may resist contact (or even push her away)

 Fear of exploration (insecure behaviour) and cries more
 Research suggests that ambivalent attachment is a result
of poor maternal availability. These children cannot
depend on their mother (or caregiver) to be there when
the child is in need
 Characteristic of 15% of infants

Insecure-Disorganized
 Had parents who are emotionally intrusive or absent
and abusive.
 Disorganized children behave in bizarre ways when
threatened.
 It is severe form of insecure attachment.
 Child shows contradictory patterns and unusual
patterns of negative emotions
 As a possible precursor of severe personality disorder
and dissociative phenomena in adolescence and
early adulthood.

Adult attachment interview by Mary Main
 Mary Main has developed a psychodynamic
interview schedule, the Adult Attachment
Interview(AAI).
 Adult attachment interview
1. which is rated for the interviewee’s narrative style.
2. in long term follow up in children whose
attachment pattern have been classified in infancy.

 As with response to threat in childhood, adult’s way of
talking about themselves and their lives vary enormously.
 Insecure speech patterns are:-
1. Secure autonomous style:-
talks freely about themselves and their past pain in
coherent and apposite way.
2. Insecure dismissive style:-
unelaborated speech lacking metaphor and vividness.
3. Insecure preoccupied style:-
rambling and emotionally laden.
4. Insecure unresolved style:-
evident break in continuity and logical flow.

 These insecure speech patterns manifests underlying
psychobiological relational dispositions.
 AAI measures reflective functioning.

Reflexive function
 Definition:-
The way we speak about ourselves reveals the state of
our inner world.
Peter Fonagy defined it as capacity to represent
experience.
Describing the capacity to perceive and thinks about
intentionality of self and others.
 This capacity reflects formation of coherent
representation of psychic world of others especially
caregiver and of subjects own internal states.

Reflexive function
 High levels of reflexive functioning in mother were
found to contribute significantly to secure
attachment of their infants.
 It is buffer against psychiatric disturbances.
 Enhancement of Reflexive function is
psychotherapeutic strategy.

Adult attachment & couple functioning:-
 Childhood attachment patterns are remarkably stable
through adulthood.
 Adult attachment pattern describe in 2 domains:-
1. Seeking or avoiding attachment
2. Fear of intimacy
 Adult attachment classification:-
1. Secure attachment
2. Insecure attachment
a) Preoccupied attachment
b) Fearful avoidant attachment
c) Dismissive avoidant attachment

Secure Attachment
 Feels worthy of love.
 View partner as trustworthy.
 Responsive and seek and givre security enhancing
support
 Solve problem by mutual negotiation
 Have high comitment and intimaty.

Biology of attachment
 In psycho physiological research on attachment, studied on:-
1. autonomic responses, such as heart rate or respiration
2. activity of the hypothalamic–pituitary–adrenal axis.
 Infants' physiological responses have been measured during the Strange
Situation procedure looking at individual differences in infant temperament
and the extent to which attachment acts as a moderator.
 There is some evidence that the quality of care giving shapes the development
of the neurological systems which regulate stress.
 Role of inherited genetic factors in shaping attachments: polymorphism of
the gene coding for the D2 dopamine receptor has been linked to anxious
attachment and another in the gene for the 5HT2Am serotonin receptor with
avoidant attachment.

Disturbance in normal attachment behavior
leads to:-
 Reactive attachment disorder
 Disinhibited Social Engagement Disorder
 Conduct disorder
 Personality disorder

DSM-5 Criteria for Reactive Attachment Disorder
(RAD)
A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult
caregivers, manifested by both of the following:
The child rarely or minimally seeks comfort when distressed.
The child rarely or minimally responds to comfort when distressed.
B. A persistent social or emotional disturbance characterized by at least two of the following:
Minimal social and emotional responsiveness to others
Limited positive affect
Episodes of unexplained irritability, sadness, or fearfulness that are evident even during
nonthreatening interactions with adult caregivers.
C. The child has experienced a pattern of extremes of insufficient care as evidenced by at
least one of the following:
Social neglect or deprivation in the form of persistent lack of having basic emotional needs
for comfort, stimulation, and affection met by caring adults
Repeated changes of primary caregivers that limit opportunities to form stable attachments
(e.g., frequent changes in foster care)
Rearing in unusual settings that severely limit opportunities to form selective attachments
(e.g., institutions with high child to caregiver ratios)

D. The care in Criterion C is presumed to be responsible for
the disturbed behavior in Criterion A (e.g., the disturbances
in Criterion A began following the lack of adequate care in
Criterion C).
E. The criteria are not met for autism spectrum disorder.
F. The disturbance is evident before age 5 years.
G. The child has a developmental age of at least nine months.
Specify if Persistent: The disorder has been present for more
than 12 months.
Specify current severity: Reactive Attachment Disorder is
specified as severe when a child exhibits all symptoms of
the disorder, with each symptom manifesting at relatively
high levels.

DSM-5 Criteria for Disinhibited Social
Engagement Disorder
A. A pattern of behavior in which a child actively approaches and
interacts with unfamiliar adults and exhibits at least two of the
following:
Reduced or absent reticence in approaching and interacting with
unfamiliar adults.
Overly familiar verbal or physical behavior (that is not consistent with
culturally sanctioned and with age-appropriate social boundaries).
Diminished or absent checking back with adult caregiver after
venturing away, even in unfamiliar settings.
Willingness to go off with an unfamiliar adult with little or no
hesitation.
B. The behaviors in Criterion A are not limited to impulsivity (as in
Attention-Deficit/Hyperactivity Disorder) but include socially
disinhibited behavior.

C. The child has exhibited a pattern of extremes of insufficient care as
evidenced by at least one of the following:
Social neglect or deprivation in the form of persistent lack of having basic
emotional needs for comfort, stimulation and affection met by
caregiving adults.
Repeated changes of primary caregivers that limit ability to form stable
attachments (e.g., frequent changes in foster care).
Rearing in unusual settings that severely limit opportunities to form
selective attachments (e.g., institutions with high child to caregiver
ratios).
D. The care in Criterion C is presumed to be responsible for the disturbed
behavior in Criterion A (e.g., the disturbances in Criterion A began
following the pathogenic care in Criterion C).
E. The child has a developmental age of at least nine months.
Specify if Persistent: The disorder has been present for more than 12
months.
Specify current severity: Disinhibited Social Engagement Disorder is
specified as severe when a child exhibits all symptoms of the disorder,
with each symptom manifesting at relatively high levels.

References
 Comprehensive textbook of psychiatry by Kaplan &
Sadock 9th Edition
 New Oxford Textbook of Psychiatry by Michael G
Gelder 2nd Edition
 Introduction to Psychology by Clifford T. Morgan &
Richard A. King 7th Edition.

Theories of attachment by Dr. Vaibhav Dua

Theories of attachment by Dr. Vaibhav Dua

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