disorganized disoriented attachment in dissociated disorders. g. liotti, 1992

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D l S O R G A ~ I Z £ D

D l S O R J E ~ T E D

A T I A C H ~ I E : \ T 1:\ TIlE

ETIOLOGY

OF

THE

DISSOCLlffi E DISORDERS

Giovanni Lioui.

~ I D

Giovanni Lioni. ~ t D practices psychiatryand cogniti\ c

psy-

chotherapy

in Rome, haly. He is President

of the

halian

Association for

the

Research on

me

Ps) chopalhology

of the

Attachment

System (A.R.PAS.).

For reprints write Giovanni Liotti, M.D., A.R.PAS., Piazza

Tuscola 5 - 00183 Roma, Italy.

ABSTRACf

Jt

has

un

llwsted that multiple personality disorder (MPD) may

be seen as attachment di.wrdu, n l lm process oj

d ~ l a l ; h -

ment

(Barach, J991). To think in frons ofdisorgOl1iud/disorienled

(D) atladunmt sumsa txtter way oj

cOllcq>lualizingnot

only MPD,

but all

the

dissociaJive di.sordm in

nlation

to difficulties

xp -

mud in early attachment relationships. This paper reviews

recent

findings ronarning (disarga niur.J/diwrien./td) al/achment in infants

and its cornlates

in

llnresolved parental traumas quite often,

loss-

es

through death

oj

significant

others). It is proposed

that

D

attach

ment in inJancy

may

/tad

to

increased vulllerabilil)

to

dissociative

disorders

via a li7lking medwl/ism

J}roposed b

Main and He55e

1990 1992): parentalJrightened and/or Jrightening behavior.

Mothers ojdissociative /mtients

were

retJOrled much

more

often than

mothers ojother

ps) chiatric

patients to have suffered the loss through

death oja significant other in the

two

Jean before-two ),ean after

the patient s birth. This finding sUp/JOns the h) pothesis that many

dissociative patimts

may

have

been

infanu attached in a

disorga-

nized/disoriented way

to

at

kast

one attachment figure.

INTRODUCflON

In

a

recent paper,

Barach (1991) has cogently

called

attention toauachment-rclatcd lraumaticexperiences in the

etiologyofMuh,iple Personalit},Disorder (MPD). Barach (1991)

suggeststhalBowlbv SCOQcept

ofdetachmelH

(Bowlby, 1982,

1988) reflects a tret; of dissocialion.

Detachment depends

on lhe acu\ c exclUSion

from

conscious processing

of

infor

mation that

ould

activate

lhe

innate behavioral-motivational

system conlrOlling

attachment

behavior: in lhis sense, it

is

a

type ofdissociation. Dctachmenl

is

firslenacted by

lhe

child

within his/her early attachment relalionships as a conse

quence of the caregivers prolonged emotional or physical

unavailability. Since it is a

dy of keeping information seg

regated or

dissociated

from

conscious processing,

detach

ment

ma}

be seen,

according

to

Barach, as

an

early

type

of

196

dissociative defense, that sct the stage for reliance on dis

sociation as a response

to

llaterJ active abuse (Barach, 1991,

p 117

The

r«;ent discovcryofa

disorganized/disoriented

pat

tern

ofauachmem

(Main

Solomon, 1986, 1990) suggests

that much more than

detachment

may be

at

work within

early attachment relationships to set the stage for dissocia

tion

as a defensive reaction

to later traumatic

experiences

(Lioui, in press). In order to appreciale the possible impli

cation of disorganized/disoriented attachment in

the

eti

ology

of the

dissociative disorders, a previous

description of

the main

palterns

of early

attachmelll is

mandatory.

P TTERNS OF

ATTACHMENT

Ainsworth, Blchar, Walers

and

Wall (1978) have pro

vided the firstsystcmatic description ofhowaltachment behav

ior is shaped by

the

caregiver s behavior in infants about one

year old. The laboratol), procedure

designed

byAinsworth

Cl

al. (1978)

to

assess

the

dilTcrent forms

attachment

behav

ior may take in one-year-old

human

infants

is

known as the

Strange

Situation (55). In the SS, the infanl

is exposed

lo

an

unfamiliarcnvironmenlfrom which the accompanying par

en t

twice leaves for a few minutes

and

twice returns.

Three

main patterns or

attachment

were idenlified in the 55 by

Ainswonh and her collaborators: A (avoidant), B (secure),

and C (anxious-resistant).

The majorily

of

infants classify within

the

category

of

secureallac wJe 11

(B) in the SS. They cry

and

show clear signs

of missing the

mother during her

absences in the 55,

and

arc quickly

comforted

by he r

on

reunion. This pallern of

altachment has

been found

to correlate with the

mother s

sensitiviry

and

availabi

Ii

ty

10

the

signals

and

com

mun

ications

of the infant al home (see Brelherton, 1985, for a review).

A minority of infants show little or no distress during

separation from

the

motherduring the 55,and activelya\ oid

contact with he r

when she returns.

The mothers

of these

infants,

who

show an avoidant attachment (A),

er e found

actively rejecting of attachment behavior in the

home

envi

ronment. It

is

this

pattern

which seems

more

obviously link

able todetachmem, as defined in Barach s 1991

paper

(see,

e.g., Bowlby, 1980, p.70; Bowlby, 1988, p. 124). This is not,

however, the carly pattern of

attachment more

Iikel}

to

be

related to

manifest signs

of

dissociation in infants, as it will

be

argued belo

.

Another minor percentage

of

infants

are

highl) dis-

DbSOClHIO\ lol \. \0

Dttmbtr

lQll



tressed during separation from t he m o th er in th e SS and,

COlllrary to I.he secure babies, a re n ot quickly relieved from

theirdiscomforl when

lhe mOlherretums.

Since these infants

s ee m t o resist th e comfortolfered by th e motheron

reunion,

they

are said

to

show an anxious-resistant

patlern

ofauach

ment

C).

The

mothers

of

these babies

have

been

described

as unpredictably available to

t he ir c h il d re n s

r eque st s f or

c om fo rt a t h om e , a nd p ro ne

to

intrude upon th e

babies

autonomous

activities of

exploration

of th e

home

environ

ment.

In all t he s a mple s that have been observed within th e

SS in many different countries,

some

infants have appeared

1I1lclltJSlfiablein

th e

above

lhreefolddassification system A,B,

C) of

attachment

behavior. II is within this subgroup o f pre

viously undassifiable

infants

that

Main

an d Solomon 1986,

1990)

identified the


D) pattern

of attachment.

What

th e infants showing a disorg niud dis-

oriented D pa1tLrn

oj

~ h m m t

share

in common

is

th e dis

play o f odd, disorganized,

seemingly

inexplicable and

con

flicting behavior panerns in th e

parent s presence

Main

Solomon, 1986, 1990; Main

Hesse,

1992).

Contr.ldictions

in

movement pauern

e.g.,

approaching

t he p aren t with th e

head

averted)

which suggest c on trad ic ti on s i n i n te n ti o n,

v an d / o r

lackoforicntation

to the presentenvironment c.g.,

suddenimmobili a n ie d b a da z ed e x r es si on c ha r

acterize th e D infants. T he other re e

patterns of

atl. lch

ment are, in contrast, characterized by relatively well orga

nized

and oriented

behavioral

and auentional slrategies in

th e interaction with th e parentdmingtheSS ~ l a i n Hesse,

1992). It is noteworthy thatdetachment

may

conceivably be

a

consequence

o f extremely avoidant A) strategies of inter

action

with a rejecting,

hostile

parent.

detachment is thus

produced, it d oes n ot

bring

with itself

those alteration

of

consciousness

and those featurcsof dissociated behavior see

below) that seem

evident

in

some

D babiesobsen. ed byMain

and Solomon 1990).Disorganized/disoriented

attachment

seems, therefore, a different a nd m ore

suitablc

construct

than detachment as suggested by Barach, 1991) for study

in g the relationships

betwecn

early attachmentpauerns and

dissociative disorders.

Main

an d Hesse

1992) followed

upon

this hypothesis

of a l in k b etw ee n infant D attachment and dissociative dis

orders

as

advanced Liotti, IntrecciaJagli

Cecere, 1991),

w ith a review o f infant behavior suggestive o f dissociation

within their sample of D babies. In some of these babies,

they

i n de e d fo u nd

support

to

th e

hypothesis.

Here

I s um

marize

some o f their

observations

an d remarks.

Disorientation in th e

attachment

r e l ~ o n s h i p is, in itself,

suggestive o f a

disorder

o f consciousness

Main

Hesse,

1992).

This disorder of

consciousness

cann o t b e attributed

to a ny or ga nic dys func ti on of th e central nervous system:

Infants

that are disorganized/disoriented in th e SSwith one.

parent may show another

oriented

and organized)

pattern

of

attachment

behavior,

in th e

same situation

and in th e

s am e p er io d

of

their

life, with th e other

parent

Main

Solomon, 1986,

1990).

Some instanccsofatlachmentbehav

ior observed in th e

group

of D infants are straightfonvard

examples of

dissociated

actions. For instance:

Creepingly rapidly forn 3rd t o ~ r d father [a 12

month o ld i nfa nt

obsewed in th e SS ...

sudden

Iy

stopped

a n d t ur ne d her

head

to th e side an d

- while gazing

blanking

al th e

\\ 311- slapped

a toy

and

then

her

empty

hand on th e

floor

i n a c lc ar

ly

angry gesture,

still

\ \ ~ t h

head averted an d gaze

blank.

Thisinterruption

lasted onlythrce to four

seconds.

Sh e thencontinued her

Strong

approach

and

rcached

to be picked up.

Main

Solomon,

1990, p. 142)

Or, still more impressi\ c1y:

The baby {o n

reunion

with

mother after

th e first

separation

in

th e 55] hears mother s voice an d

turns an d

looks

t o l he d oo r.

Her look is initial

ly blank ...Looks

u p a t m ot he r, a ve ns

gaze

fo r a

moment, facial expression

then

d iv id es i n two

left

vs.

right half of face) uplifting left mouth

comcronly.ln these microseconds herc} cswiden

and asshe looks at mother th e

asymmctry

makes

he r

appear

puzzled, disgusted or fearful.

Herface

then

breaks into an extremely wide smile. Main

Solomon, 1990, p. 143)

These

behaviors

seem such clear and early indicators

of dissociation

that

a c lo se scrutiny o f th e

mechanisms

that

ma y

be responsible for their appearance-mechanisms that

ar e at

work

during

th e parent-ehild interactions in th e first

year

o f th e infant s

life-should

be of obvious interest fo r

an y

student of

dissociation.

PARENTAL

BEHAVIOR HYPOTHFSIZED

T O BE

RFSPONSmLE

FO R THE CHILD S

DISORGANIZED/DISORIENTED AITACHMENT

Main

Hessc 1990, 1992) have undertakcn a

careful

inquiry on the

p a re n t s a u it ud e s t ha t

may be related to 0

attachment in th e

child

r emember t h at t he p aren t s sensi

tivity and availability ar e related to securc B)

attachment,

t h e p aren t s

rejecting

attitudes ar e rel at ed t o avoidant A)

auachment,

and

th e parelH serratic,

unpredictable

positive

responses to th e child s requests for comfort ar e rel at ed t o

anxious-resistant e

attachment).

The main feature that differentiate parents o f 0 infants

from parents

of

A,

B,

and

C

infants

is

relaled

to

traumas that

have

no t

been successfully

elaborated

an d resolved

Main

Hesse, 1990, 1992). ParentsofD babicsseem, much more

often

t h an p a re n ts

of babies with other typesofauachment,

1 be

worried

by traumatic memories that

divert

lheir atten

t io n f ro m t he

requirements

of any efficient style

ofparenml

caregiving. These unresolved

traumasarc relatcd

to

pastabusc,

or to loss

through

death

of

significant Olhers-a finding by

Main and Hes se 1 99 0, 1 99 2) replicalcd by Ainsworth an d

Eichberg

1991).

Main an d Hesse 1990, 1992) advanced th e hypothe

sis thatfrighteningand/orfrightencd parentalbehaviordur

in g th e interaction with

lheir children

may be th e outcome

o f

parent s unresolved trauma

and

may explain

th e

origins

197

DbsocnnO\

\,,1

\

\u

t rmnbtf

1m



of

the child s disorganized/disoriented attachment behav

ior. Let us now look at the links between unresolved trau

ma in the parent, frightening parental behavior, an d disor

ganization

of

attachment in th e child.

Unresolved traumas tend

to activaw

the altachment

behavioral-motivational systemalong the whole life-span. Th e

attachment system, it should be remembered, is an innate

behavioral

comrol

system that motivates primates to search

for th e protective proximity of conspecifics whenever th e

individual

is

distressed,

threatened, or frightened

byenvi

ronmental

danger (Bowlby, 1982).

Attachment

behavior Mis

held to characterize

human

beings from

th e

cradle to the

grave (Bowlby, 1979, p. 129).

Parentswhose attachment system is activated bythe dis

tressing perhaps still frightening) memories

of

past unre

solved traumas may unwill ingly invert the normal attach

ment relationship with

their

children, act ing as if they

unconsciously expect

their

children to sooth

their

own dis

comfort (Bowlby, 1985).

When th e child fails to match

th e

parent unconscious

expectation to be

cared for an d i t is obvious that a chi ld

will

fail in such a task), the

parent

may

become

aggressive

an d

therefore

frightening to child. Anger

at

an

attachment

figure whofails

in

providing theexpected comfortisan aSpe< t

of

the functioning

of

the attachmentS)'stem:when the attach

ment relationship between a parent and a child is

imerted

(with the parent t reating the child as an attachment figure,

rather

than accepting to

meet

the child's requests for prox

imity an d comfort) thestage is setfor a

great

deal

of

parental

aggression directed toward the child (Bowlby, 1985).

A frightening parent presents a chi ld an d

an

infant

particularlyso) witha paradox that cannot be

solved-name

ly

to simultaneously flee from

th e

parent

as a

source of

dan

ger, an d to

approach

the parent (who necessarily is

thechild s

attachment

figure) as a haven

of

safety (Main, 1981). Th e

more the threatening condition, created

by

parentalaggres

sion, goes on in time an d increases in intensity, t he m or e

th e infant's attachment system is activated.

Th e

more the

attachment

system

is

activated,

t he m or e t he in fa nt

is driv

en to approach the attachment figurewho, in this paradoxical

situation, is the

threatening

parent

him/herself.

Increasing

th e

distance from the attachment figure

in

a threatening sit

uation (as implied by the child s tendency to flee from th e

threatening parent) causes

morc

fear an d more intense stri\'

ings to approach the attachment figure. A positi\'e feed-back

loop,

of

fear-> avoidance-> fear, is

thus created

in infants

dealing with a

threatening attachment

figure (Main, 1981).

At high intensity this loop may lead to

th e

collapse ofbehav

ioral and

attentional

strategies observed in disorga

nized/disoriented attachmentbehavior (Main Hesse, 1990).

may be hypothesized that innate behavioral-motivational

systems

other than attachment

(e.g.,

th e

behavioral system

controlling ritual agonistic b e h a \ ~ o r in primates: Gilbert,

1989) are activated in

th e

infant, together with

th e

attach

ment system, in

th e

effort to cope with this paradoxical sit

uation. Since the operations of these two innate behavioral

systems, the attachment system an d th e agonistic system,

ar e

mutually incompatible, dissociated actions necessarily

fol-

low

(e.g.,

th e

dissociated actions

of

th e

little girl in the first

198

vignette of the above paragraph, whoshowed th e overlap

of

approach toward th e father an d redirected aggression dur

ing the SS; it may

be

interesting to mention here that th e

father of this little girl suffered from homicidal an d suicidal

fantasies) .

Main

an d

Hesse (1990) hypothesized

that

frightened

aswell asfrightening parentalbehavior could placean infant

in an irresolvable situation. Frightened parental beha\'ior

during

interactionswith th e infantmayoccUTwhen th e trau

matized parent

responds

to distressing memories (possibly

only eaklyaccessible or dissociated) related

loss

or

abuse.

Frightened

pare nt al beha vi or

during

th e SS

ha s

been

described

by

Main an d Hesse (1990, 1992).

Th e

morc obvi

ous examples are frightened facial expressions as the infant

pursues proximity to the parent,

or

reaches to\\'ard the par

ent s face. Sometimes, however,

th e

parents fear is inferred

bystartlingvocal changes,

sudden

immobilizedpostures an d

trance-like, dazed expressions-all

of

this suggesting that

dissociati\'e defenses ar e operating in the parents as painful,

frightening memories

ar e

surfacing in their mind while they

are interactingwith

theirchildren in theSS.ln

afewSSobser

\'3.uons, immobilization accompanied by trance-like expres

sion in

th e

parent has

b ee n n ote d

to be immediately

fol-

lowed

by

disorganized/disoriented behavior

in

the infant.

From the infant s point

of

view what is frightening to

th e parent is unidenti fiable as to source (Main Hesse,

1990).

Th e

child s alarm in response to alarmed and/or

inexplicable parental expressions

is th e

effect

of

an imme

diate allunement of emotional states

that

has been well doc

umented by developmental psychologists (see Stern, 1985).

Th e

child s alarm will

be funher

exacerbated if t he pa re nt

indicates a tendency to flee from th e situation-and there

fore from

th e

infant itself. In this situation,

th e

frightened

infant's attempts to

a pp ro ac h t he a tt ac hm en t

figure as a

haven

of

safety leads

th e

parent to reduce

th e

infant s safe

ty through increased signs

of

fear, trance-like expressions

related to t he p ar en t s dissociative defenses in th e face

of

surfacing traumatic memories,

or

overt tendencies to flight

(Main Hesse, 1990, 1992).

Th e

different

implications in tl,e etiology

of

dissocia

tion

of th e

two attachment-related constructs---detachment

asaconsequenceofparental n o n r e s p o n s i \ ~ t y (Barach, 1991)

an d disorganized/disoriented attachment as a response to

frightened/frightening

parental behavior (Main Hesse,

1992)-may now be

more

fully understood A clinical exam

ple,

quoted

by Barach (1991) to illustrate how

detachment

may be

produced

in

th e

child

of

an emotionally unavailable

mother, may further clarify these different implications:

Fraibcrg, Adelson an d Shapiro (1974/1987)

provide a painfully vivid description of a disso

ciative

mother

an d

herchild sdetachment.

Th e

.mother

ha d been grudgingly

parented

by rela

tives after he r mother s postpartum

attempted

suicide andhad been sexuallyabused byherfather

an d a cousin. During a testing 5(:ssion, he r baby

begins to cry. is a hoarse, eerie cry...On tape,

we

see

th e

baby in

he r

mother s arms screaming

hopelessly;

she

dots

not

u

to

her mother

r

om

D ~ ~ O l \ T l O \

\uJ \o.l

DI'IftlW 99:



JOI The

mother

looksdislant, self·absorbed.She

makes

an absent geslUre to comfort the

baby,

then gives

up.

She looks away. The

screaming

cominues

for five dreadful minutes

on

tape. In

the background we hear Mrs. Adelson s voice,

geml) encouraging

the mother. \\ hal do

l on

do

to comfort

Mary when

she

cries like lhis?

(The

mother)

munnurssomethinginaudible

.. As

we watched this .ape laler. ..• we said toeach other

incredulously, It sas

if

this

mother doesn t

he r

her

b. \by scries

pp

104-105;

the

ilalicsarc mine)

(B.,rach,

I99J,

p.119).

If

Olle

looks for signs

ofdetachment

in the child of a trau

matized, dissociative paren

tas

the

mother

of the above vigneue,

one is lead to

put

the

emphasis-as

Barach does-on the

fact

that the

baby does

lot turn

to

the

mother for

comfort.

If, on the other side, one is looking for evidence

01 0

attach

ment, the emphasis

will

be put

l l

the

fact

that the

baby

k«j s

cr) illg{that is, asks

for

auemion

and

comfort)

while

t

sanutim. ilvoidsfull conlaelwith

the

molher.

This isan

index

of

conOictful

or

perhaps truly dissociatedattachment behav

ior, rather than a

hint

thai

the

child is becoming

delached.

That we arc here witnessing dissociated ralher than con

nictful

behavior

is suggested by

the

faCt

that the

baby s cry

has an Miequaliry. indicati\ e perhaps

of

an altered state

of

consciousness

contingem upon the

dissociation of execu

th e and monitoringconrrols (Hilgard, 1986). Furthermore,

ifone

looks only

to

the mother s

emotional

unavailability to

the infant s

cry s

me idea

of equaling

the chi ld s

sup

posed detachment to dissociation Icadsone to

do--one

miss

es

the

fact

tha t the mother s behavior

in

the

above

vigncne

is frightening to tJle infant (even if nOI directly threaten

ing).

The

self-absorption (indicative of a trdnce-like state),

the absent gestures, the voice that whispers something

inaudible are,

from tlle

infant s

point

of

view, all inexplica

ble and

frightening

non-verbal messages. At

the

same time,

the

mother is

there,

and docs

not give straightforward sig

nals of rejecting

the infant s

requests for allention as would

have

done

the

mother

ofan avoidant infanL. Straightforn ard

signals of rejection

are,

one could

argue,

potentially

much

more explicable (for inslance,

by

assuming that the sel f is

unIO\ able and

the

mother unloving) and

therefore much

lessfrightcningto lhe child, Dissociated, frightened

and

fiight

ening parcnlal

behavior-ratherman simple

emotional

non

responsivil) -Seemsatwork in thcgcncsisofdissociated altach

melll

behavior

in tile child.

The infant s disorganized/disoric: nted attachment

behavior, t may

be

hypothesized, correspond

to the

con

struction ofan

internal

working model

of

selfand the attach

ment

figure (Bowlby, 1973, 1979, 1980) that is multiple

and

incoherent, Multiple

internal

working models, as

it

will now

be

argucd. may be he ld responsible for the 0 child s later

predisposition

to

dissociation in

the

face of further trau

matic experiences.

LIOTII

MULTIPLE WORKlNC MODEL

OF

SELF

IN

o

INFANTS

Con

tem

porarytheories

ofcognitive dC\ e1opmenIstem

mingfrom the firstinterpcrsonal experiences in the infant s

life

(Stern,

1985) allow for

some inferences

concerning the

cognilive

represcnlations

of

self

and

other

people

(inter

personal

cognitive

schemata: see

Safran, 1990)

that

may

be

constnlctedstemming from different

pauemsof

attachment.

For more details, and some

empirical evidence

supponing

these inferences,

thai

will be now presented in a very

schematicform,

the reader mayconsultsome

recent research

and rcviewpapcrs

by

Brethenoll (1985, 1990) ,Cassidy ( 1988),

and

Main, Kaplan

and

Cassidy (1985).

Secure (B) infants construct illlernal working models

ofsc1f and

the attachmcnt

figure

thal are

notably

cohcrent

and unitary . On the basis of these early working models, thc

self

comes later to be proposition

ally

represented

as lovable,

and

the

attachment figure as trust\ ,ortJly and available in

case

of

need.

Avoidant (A)

childrcn

also

construel

coher

ent

interpersonal schemata,

in which

the self

is

portrayed

as unlovable

and

tJle attachment figure as rejecting

or

hos

tile.

Later

on,

tJ1C

parent may

be

idealized and a

second

interpersonal

schema may

be

constructed on Ihe basis

of

this idealization (Bowlby, 1973, 1980, 1988). In

the absence

of

such an idealization

or

beforc t takes place, howe, er, the

a\ oidanl child s

first-hand

information

is

such

as

to

corre

spond

to

the consu-uelion of a coherent, unitary represen

tation of

self

and

the attachment

figure, Anxious-resistant

(C) children mayconsu-uctsincc tJle beginning (that

is,

before

any

idealization of

the parents) double. models

of

self

and

the attachment figure. In one model, stemming from the

inslances

of

positive interaction with the attachment figure,

Ihe

self

is portrayed as lovable and

the

atlachmelH figure as

available; in the other model, stemming from the unpre

dictable episodes of unavailabilityof

the

att.-lchment figure,

the selfisportrayed as threatencd

by

loneliness

and

the attach

ment. figure as

untrustworthy: The

cognitive apparatus may

gradually

become

capable of treating these two models as

the

basis for issues ofambiv.llCllcc (Attili, 1989)

thal

may

be

dealtwith

without

dissociation. 0

children,

on the contrary,

may

construct

multiple. incoherent

or

incompatible mod

elsofselfand the attachment figure (Main, 1991)-notsim

ply ambivalent ones.

is

conceivable tJlat tJle capacity for

illlcgration of

me child

sconsciousnessand memory is exceed·

ed

when, during the same attachment interaction,

t is

cou

fronted

wlth

multiple models

of

self,

the

attachment

figure

and

the at tachment relationship. Massive dissociation

will

then take place. Let us nON

examine

how

multiple models

of

selfcan be constructed by D children-at least. by those

ochildren thal have been exposed,when infants, tocxtreme

forms of frightened/frightcning parental behavior.

When conEron ted itha frightened/frightening auach

mcnt figure, a child may construct

the self

as helplessly vul

nerable

and

the attachmelll figure as mreatening. The 0

child, however, has also ground for

constructing

the auach·

ment

figure as helpless

and

vulnerable (the

parent

looks

inexplicably

frightened),

and

the self

as

threatening-that

is,

endowed with mysteriously dangerous potentialities that

99

[ } ~ {

HTlO\.

\01

\. \0

t Dm mbl r

Iq92



DISORGANIZED ATTACHMENT

AND

DISSOCIATION

may

be

responsible for the

attachment

figure s

frightened

expressions while the child is approaching him/her ~ h i n

Hesse. 1990). This view arme self as threatening may

be

reinforced

if

as suggested alxwe,

anger

related to the ago

nistic sr-;tem (ralhcr than to the atl.achment system) is mobi

lized while the

child

approaches the frightened

altachmcnt

figure. Evidence

that children

that have

been

disorga

nized

disoriented infan l S in the

5S construct

models of the

self as bad

is

JlOW available (Cassidy. 1988).

A third interpersonal

schema

may be

consuucted by

0

children

on

the basis

of

the parent s tendency to somehow

invCrllhe attachment relationship (i.e., th e parent

uncon

sciouslyexpects lhe infant

to

soothe his/her discomfort).

Im crtcd

auachment

relationship set the stage for the

child s

self-perception as the rescuer

of

the frightened, distressed

parent. It has been in fact observed

that

children classified

as

Dwhen

12-18month old displa} protective

attiwdes

toward

their parents when examined at school age (Main, Kaplan

Cassidy, 1985, p. 96). How this early

representation

ohhe

selfas

the rescuer

of

a

frightened, traumatized

parent

may

be related to feelings of

being doomed

to fail

and being

incompetent,

and/or to

classical psychoanalytic issucs of

omnipotence, is readily apparent.

The

rescuer, the victim

and the persecutor

of

the

frightened/frightening

attach

ment

figure are, thus, self-represent. \tions that may simul

taneously

outgrow from

the

early

cxperience

of disorga

nized/disoricnted

altachment.

These three

possibilities

do not,

however,

exhaust

thc

potentialiry for the construction

of

multiple imerpersonal

schemata

provided by

0 an3chments.Thc parent, although

perhapswith a frightened expression, is at time at least phys

ically available to the

disorganized/disoricllted child-and

therefore at

least a prototypical version

of

the

self-repre

sentation as lovable

and

of the attachment figure as loving

is possible. In other moments, however, when the conse

quences of the unrcsolvcd traumas lcad the

parent

to with

drawfrom the relationshipwith the child (becauseofdepres

sion, alcohol abuse, or

lhc

like),

lhe

child also has reasons

for conslructing the self

as abandoned and

unlovable

and

the attachmenl figure as

deserting or

neglccting.

It

should

nOl be assumed thal every

0 infant is

actual

ly bound to develop and simultaneously entertain all these

models of

self and

the

attachmem

figure. CreaL variations

in the parents

frightcned/frighLening

behavior, and in the

corresponding

infants

disorganiution/disorientation

ranging

from extremelymild

to

extremely

severe-have

been

observed

and

inferred insamplesof

infants Main

Hesse,

1990,

1992:

~ a i n

Solomon, 1990).

The

varietiesofattach

ment

LO a frightened/frightening parenlallow fordiITerent

qualities

and number

of

interpersonal

schemata.

LeL

us now consider how the simultaneous construc

tion of multiple, incompatible

representations of

self

and

the auachmentfigure, as it may take place in

D

babies, could

pu t the dissociative dynamics of

human memory and

con

sciousness into motion.

200

DISSOCIATION AND

MULTIPLE WORKlNG

MODEL

OF

SELF

Contemporary cognitive thcories

of

conscious and

unconscious processing (see, e.g., Baars, 1988; Kihlstrom,

1987; Spiegel, 1991)

are

based

on

the view

thal

information,

both pertaining

to

different

sensory

channels

and

organized

in separate

complex domains of

mcaning,

is

proccssed in a

parallel

distributed

process

outside

of

consciousness.

Consciousness, in these models, is related to the scquclllial

processing

of

information

that

becomes

thcn availablc for

propositional (lexical) reprcsentation.

The

propositionalsuuc

lures ofself-knowledge, according La some of these models,

playa

y

role in the

continuous,

serial, conscious selection

and

integration

(sequential orchestration: see also Tinnin

1990) of thc information that is

being

unconsciously pro

cessedin a parallel distributed

way

Ifthesuucturcsof

propo

sitional self-knowledge

arc fragmented rather

than coher

ent, compeLing

rather than

harmoniously

orchestrated,and

mutually

incompatible

rather

than

reciprocally

integrated,

the serial organization of information may

be hindered.

Simultaneous

or

rapidly alternating incompatiblc, dissoci

ated actions may

then

be obsclvcd, while

allered

states

of

consciousness will

be

subjectively experienced. Trance-like

states such as those observed bolh in

infants

and

in adults

suffering from

MPD

or from otherdissociativedisordersmay

thus be related

10 Lhe

existenceofmultiple, incoherent, mutu

allyincompatible modeisofself(Spiegel, 199I;Tinnin, 1990).

The

swiLch process (PuUlam, 1988) that leads from

an

aspect of a multiple

model

of

self

to

another (or

in

MI D

patients, from

one

alter personality to

another)

can be prof

itably

examined

in

tcrms

of

Edelman s theory

of

con

sciousness

(Edelman,

1989)-a

theory

that

masterfully com

bines

biological-evolutionary,

neurophysiological,

connectionist

and

psychological themes. According

to

Edelman, a primary form of consciousness,

shared

by

man

and at lcast

some

other animal species, emerges from the

matching

ofongoing perceptual information relaled 1.0 out

side reality with a particular

memory

structure. This mem

y

structure

relates information

pertaining

to the biologi

cal self (e.g., viscer<ll

and

emotional information) 10 stored

infonnation pertaining to outside reality (christcned nOL-

self-by Edelman, 1989). Ongoing

pcrceptual

information

that is assimilated to the not-selfaspect oflhis memoryStruc

ture is thus evaluated

according

to

the

related

memory

of

the

self. Primaryconsciousness

(PC)

emerges

from this pro

cess.

PC

is the basis for a

higher

level of consciousness, spe

cific to human beings, for which a

conceptual memory

of

the disLinction between self

and

noL se1f is necessary.

The

conceptual mcmory

of

self/not-self is

the

immediate

antecedent of

the propositional, verbalizable aspects

of

self

knowledge.

In

this sense, thc

highcr-order

consciousness

(HOC)

ofhurnan beings is related

lO

the sequential nature

oflailguagc and

to the analytic-lexical

operations

of the left

hemispherc

in

right-handedpeople. (see

Tinnin,

1990).

The

working model of self

and

the

attachment

figure is an early

aspect of the concepwal memory of self-not self. In

order

for the processes of HOC LO proceed properly, the match

ing

of

ongoing

e l l ~ r o n m e n t a l

information

with a

coherent

Dl iWnmO\.\ot\.\o

t ~ r

1tJ



(if not unitary) conceptual memol) of self/not-self is nec

essary. If the conceptual memory schemata

ofthe

sclf/not

self

distinction

against which the ongoing environmental

information

is

given moment matched, are

multiple

and

incompatiblc,

HOC will t end to collapsc. It is likely

that,

in

th i p rticul r moment

thc

subjective experience of the per

son will tend to be reduce to the PC.

An

altered state of con

sciousness will be

experienced,

inside which Lhe non-eon

cepmal,

non-verbali7.able aspects of the biological

self

(,isceral and emotional information) will be

confronted

with

stored

and ongoing information concerning outside reali

ty. If twn or

more

of the incompatible

conceptual

models

of self/not-sclf

alternate

rapidly during this

altered

state of

consciousness, dissociated act ions (each related to one of

these incompatible models) such as tnOSe observed in D

babies during the 55 may make their appearance.

one

among the

competing

conceptual models (let us label it

CM

I) is then selected for Lhe matching

wiLh

ongoing

envi

ronmental informaLion, the altered state of consciowness

will

come to an

end,

and

HOC will

be resumed.

An

amne

sia

barrier,

however, will separate

the infonnation pertain

ing to eM 1

from

that pertainingto

other

models

C \.l2, CM3,

etc.) when they,·, ill

be eventually

called into operation

by

new configurations ofenvironmental stlmuli.

Until the

pro

cessofswitching

from one

CM

to anoLher in matching envi

ronmental information is completed,

an

altered state

of

con

sciousness (that is, a lapse

of

HOC and a rcsurgence

of PC)

will

be

subjectively

experienccd.

The abovc descript ion applies equally well

to

the

switches ofintemalworking

models

in 0 in fants during the

interaction with the frightened/frightening parents,

and to

the switches of alters in patients suffering from

MPD.

This

structural

similarity suggests

to look more

closely

for

a

p0s

sible etiological relationship between

~ I P

or other disso

ciative disorders, and


attachmen t.

o

ATTACHMENTAND

THE

ETIOLOGY OF

THE

DISSOCIATIVE DISORDERS

At

least three developmental pathways are laid open

by

multiple

models of self, as those that have been here

hypothesized

to s tem from an early D atlachmenL Two of

thesedevelopmental pathways may. it

responsible to hypoth

esize. lead to diS5OCiati, e disorders (one of them to

rela·

tively

mild

form of dissociative

disorders,

the

other

to the

most

severeform, i.e., MPD).

The

thirddcvelopmental

path

way is compatible with normal functioning of

Lhe person

ality. Let liS examine these three possibili ties, be... inningwith

t h ~

I. One

of

the various modeisofLhe sclfand thc

auach

menL figure stemming from a D attachment may be select

ed much morc often than

the others

during

the

interper

sonal interactions the

chi ld comes to

be

engaged in. This

may depend

on

relatively

minor

degrees

of

exposure to

parental

frightened/frightening behavior, on the

stabiliz

inginfluenceofattachment

figures

different

from the fright

ened/frightening parent,

or on the

gradual elaboration

of

personal traumaticmemories

b),

the parent as the child grows

older. In th is case, switches of different

representational

models are rare, and the cognitive-emotional development

rna) proceed along lines compatible with unimpaired per

sonality

function. The existence

of latent, dissociated mod

els

of

a D attachment in a

child whose

developmcnt turns

ou t favorably may

reneet

itself in a pal Licular proneness

normal dissociative experiences

(from

intense

involvement

in daydreaming to

mild fonns

of

derealization). As

an oth

e n ~ i s e

normal

adult, such a

former

0 infant may score high

in the Dissociative Experiences Scale (for a study of disso

ciative

experiences

in a non-elinical

population

see Ross,

Joshi

Currie, 1990), or may be highly hypnotizable

(Hilgard, 1986; Bliss. 1986).

2.lfthe child entertaininga multiple model

ofDattach

ment has less favorable communicative experiences

than in

the above described case, but is

no t

exposed to scrious mal

treatment or sexual abuse, he or she may

become

predis

posed 10 develop a relativelymild dissociative disorderwhen

confronLed,as an adult,with specific interpersonal stressors

(in particular, unhappyrelationshipsinvolvinganachment).

It

is likely

that

switches

of

the

different models

of

self

,ill

continue

to happen while such a child is

confronted

with

unhappy even i fnot

directly

traumatic interpersonal

events

within the familyand in

his/her

extrafamilial life. Dissociation

may

thus

become a facilitated way of responding to inter

personal difficulties.

3.

The

various

models of

the

self

stemming from

an

early 0 attachment may become

the

basis

on

which

the

first

alter

pcrsonaliLiescharacterizing a MPD

are

dcveloped. This

is

likely to happen

if

the 0 child

becomes

the

vicLim

of seri

ous physical orsexualabuse (see,e.g

.•

Bliss, 1986;Ross, 1989).

The

sequence

of etiological events may be schematized as

follows: (a) The predisposition to dissociate

implied

by the

multiple model

of

a previous 0

attachment

constitutes

the

ground

for (b) entering in an altered state ofconsciousness

while (c) abuse is taking place.

(d )

One among the already

existingmodels of the selfmay be used as a template for the

construction ofan

alter

personality during this

altered

state

of consciousness

(primary

consciousness

according to

Edelman (1989). e The recurrence of the abuse strength

ens the

process

ofconstruction of the alter, which becomes

then more and more easily

relatable

to propositional

Sll UC

tures and able to sustain the process of higher order c o n ~

sciousness.

I

Switches

between

the primary

personality

and

the alter will correspondingly imply e\ en briefer States of

altered

(primary)

consciousness: the phenomenology of

trance-hke expressions

and

dazed behavior

while

the

switch

is

taking place

may become more difficult to observe, while

at the

same time

the

amnesic

barrier

between Lhe primary

personality

and

l

alter remains

functioning.

(g)

Different

models of

the

self stemming

from

the early D attachment

may be

used.

in the face of

different pattems

of

traumatic

experiences.

for the

construction of

different

alters. These

first alters, being grounded on

the

reality-based

models

of

D attachment, mal

resemble real

people

more than

per

sonalities

developed later--eitherout of

intense absorption

in imagination, o r o u t o f ~ e b o r t e

pretending ,

Ross. 1989,

p.

109).

The above hypothesis on the etiology of the dissocia

tive disorders leaves

open

the possibility

that

massive disso-

201



DISORGANIZED

ATTACHMENT

AND DISSOCIATION

e ia ti on i n response to severe

traumas

takes p la ce eve n in

children with a

pattern

o f

attachment

different

from th e dis

organized/disoriented onc. is

however

likely that,

in

th e

absence of

multiple models

of

D altachmcnl or

of

a gcnct

icallydclcrmined

high hypnolizability (Bliss, 1986), th e expe

rience

of

abuse sets th e stage for psychopathological dis

lUrbanccs

other

than th e

dissociative disorders.

Th e

etiological model outlined above is also compati

bl e with th e possibility that D attachment, combined with

other specific r isk factors (e.g. , a

genetic

predisposition to

schizophrenia)

ma y

be

a e n ~ l o p m e n t l

step

in

th e

genesis

of

psychopathological

syn dr omes d if ferent f ro m t he

disso

ciative disorders. In this case, massive dissociative experi

ences should be expected

a

constitute at least an aspect

of

th e psychopathological syndrome.

EVIDENCE LINKING D AITACHMENT

TO

DISSOCIATIVE DISORDERS

The

hypothesis

that

there

is

a high

incidence

of

trans

generational

transmission of dissociation

and MPD

(Braun,

1985)

could

find

supportin some recentfindings of

research

on

th e

intergenerational transmission

of

attachment pat

tenls (Main, 1991). Clinical observations pointing

a

th e fact

that many MPD

patients

have been traumatized by parents

who themselves suffer from MPD remind closely t he ph e

nomenology

of

frightened parents

who

are frightening

to

theirchildren highlightened byMain

an d

Hesse (1990,1992).

Dissociative parental

behaviorduringtheSS

has been noted,

even

onlysporadically, to be immediately followed by infant's

dissociative behavior (Main Hesse, 1992).

There

is,

then,

a

coherent theme,

related to

th e

effect

of

traumas across

generations,

that

seems to

ru n

across

research

on

D attach

ment and research on 1\1PD both

seen

as intergenerational

or

family problems. This research

theme

could, in th e

near

future, provide

strong

evidence for

th e

hypothesis

that

D

attachment is

often th e

first devdopmenL.1.1 step in

th e

gen

esis o f a dissociative disorder.

Indirect evidence that a D

pattern o f attachment

may

playa role in

th e

etiology

of

th e

dissociative

disorders comes

from a consideration

of

th e dynamics

of

attachment mobi

lized inside

th e

therapeutic relationship during

th e

treat

mentofdissociative patients.

Attachment patterns

tend often

to emerge inside th e therapeutic relationship,

thatare

notably

similarto thepatterns

of

a

ttachment

observedin the55 (Liotti,

1991). Patientssuffering from

th e

dissociativedisorders often

oscillate quicklybetween clinging

a

th e therapist, emotionally

withdrawing from hi m

or

her,

and

becoming frightened as

if

expecting

to

be

assaulted by t he t herapi st (efr. Barach,

1991, p. 120). Sometimes the display by these incompatible

types

o f

interpersonal

behavior

is almost

simultaneous,

tak

ing placewithin a single session: in this case, th e

patient

may

show a trance-like

or

dazed expression while shifting from

an att it ud e to

th e

other. This

is

of course, strongly remi

niscen to f

some

instancesof

disorganized/

disorien te d behav

io r observed in infants during the 55

More direct evidence in support

of

th e

hypothesis

that

D

attachment

is an

antecedent

of th e dissociative disorders

comesfrom a

recent

studyby

Uotti,

lntreccialagli

an d

Cecere

202

(1991).

Th e

statistical finding

that

th e parents

of

0 infants

often sufferfrom unresolved traumas related to th e loss

through

e th

n ll chmentfigure o r

other related

traumas, (Main

Hesse, 1990; Ainsworth Eichberg, 1991) allows for an

easily testable hypothesis:

If mostpatients

suffering

from

dis

sociative disorders have been disorganized/disoriented

infants,

then

dissociative

patients

should

be,

moreoften than

other

psychiatric patients,

th e

offspring o f parents who s u f ~

fered aserious loss through death

of

asignificantother imme

diately

before or

immediately after the patients birth. Uotti

et al. (1991) have asked a group

of

46 patientssuffering

from

various dissociative disorders th e cases ),

and

to a group

of

119 patients with

other

psychiatric diagnosis th e con

trols ), th e following question: Did

your mother

suffer

th e

loss through

death

of

on e of her

parents, a sibling, a child,

or her husband

in

th e

two years

before-two

years after

your

birth? About 62

of

th e

cases an d only about 13

of

th e

controls answered this question in th e

affirmative-a

dif

ference

Ulat is statistically highly significant (Liotti et aI.,

1991).

There

is,

then,

evidence

that

a

high percentage of

th e

mothers of

dissociative patients were

mourning

over a seri

ou s loss in th e period during which theirchildren were becom

ing

attached to them.

Frightening

memories

an d

feelings

a re p ar t

o f most unresolved

mourning

processes (Bowlby,

1980: Parkes, 1972;Worden, 1982). In

order

to explain Liotti's

findi ng U olt i, Intreccialagli, and

Cecere,

1991), then,

it

may be hypothesized

that

unresolved

mourning

processes

in th e mothers

of

as many as 62 of their cases (dissocia

tive patients) couldhavebeen th e source,

orone

ofUlesources,

offrightened

behaviorwhile

dealing

with

th e

infants. These

infants,

then, could

have

acquired their

vulnerability to

th e

dissociative

disorders

through

th e

mediation

of

disorga

nized/disoriented

attachment.

CONCLUSION

Th e

possibility o f tracing th e etiology o f th e dissocia

tive disorders back to

an

earlydisorganized/disoriented attach

ment, if

confirmed,

could have important consequences for

research, preventionand therapy. Dissociation could become

a

major

topic for hlrther research

on

infants' socio-cogni

tive developmental

processes-a

research area

that

is prov

in g

able to clarify many

complex

issues o f adult psychology

an d psychopathology (Stern, 1985). Prevention

of

th e

dis

sociative disorders

could

make

resource

of

specifically tai

lored counseling services offered to parents wh o

ar e

suffer

in g

from serious losses

or other

unresolved traumas while

taking

care

of

their

infant children. Therapists treating dis

sociativc paticnts could find solid theoretical grounds for

the understanding of th e

relationships between (a) attach

ment

dynamics in th e patient s

present

and

past

interper

sonal world including the therapeutic relationship),

an d

(b) dissociative defenses, symptoms

an d

experiences. is

worth hoping,

then, that

th e observations

and

th e hypothe

ses reported in thisarticlewill

b e t he

objectoffurther inquiry.

•

D I S S O C L \ T I O ~ . \ o l

4 t « nlber 99



REFERENCES

Ainsworth,t\I.D.S.. B1char,M., Walers.E., Wall,S. (1978). Pall ,u

QJaltachmenl. I-lilbdalc, NJ: Erlbaum.

Ainswonh, M.D.S..

E i c h ~ r g , C . I 9 9 I .

ElTects on infalll-moth

cr attachment

of mother's

unresolved loss of an auachmcnt fig-

ure,

or

othcr trdumatic cxperiences. In C.M.Parkes,J.stc\·cnson

Hinde

P.Marris (Eels.),

AI/at/ullt'ltt

aams

thdifu:yck(pp.I60-183).

London: Routledge.

Auili,

G.

(1989). TIle case of ambh.lIellcc: The interface between

emotional and cognitive dC\·elopmclll. In A.DeRibaupierre (Ed.),

Transitioll m ~ d l Q n i J 1 f t S in childdtwlopmmt (pp.214-229) .Cambridge:

Cambr idge Uni\'Crsi()'I'Tess.

Baars. BJ. 1988). A l o g n i t i ~ IJuory of ro,lMiousne.J.J. Cambridge;

Cambridge

Uni\'ersity l'Tess.

Barach, P.M.M.(1991). Multiple personali\}'

disorder

as an

anach

ment disorder. DfSSOCM110N IV, 117-123.

Bliss, E..L (1986). MlIltipf, pmc,wlity,

alliM

disorrkr:s, and h)pnosis.

O ford:

Oxford Unh'ersily I>ress.

Bowlby,

J.

(1973).

Allachmnll and

loss. Vol.2: &pamtion. London:

Hog-drth Press.

Bowlby,J. ( 1979). The maJringand brtakingof

aff((;tionallxmds.

London:

T'l\istock.

BowlbY,J. (1980). Allachmenl and foss. Vol.J: Loss. London:

Hoganh

Press.

Bowlby, J. (1982).

AI/achmenl and

IOI.\. Vol. J:

AllachllUnl.

(2nd edi

lion). London: Hog'lrth Press.

Bowlby,j. (1985). Violence in lhe family asa function orthe altach

mcnt syslcm, AmeriwlljO lnlal oJPsychoanalysis, 44: 9·27.

Bowlby,

J. 1988).

A UCUr t Ixm. London: Routlcdgc.

Braun, B.G. (1985).

The

transgenerntional incidence

of

dis.socia

tion and multiple personality disorder: A preliminary

rcpon.

In

R.P,KJurt (Ed.), Childhood

(1IlItcede711$ of

mulliph /J wnality diwrdn

(pp.167-196). Washinglon: American Psychiatric Press.

Bretherton, I. (1985). Allllchmcnt tllCOry: Reu pspeetand prospect.

In I.Brethertoli E.Walers (Eels.) Growing points in allachment

theory and research.

Monographs

of

thl Socin, for

~ r

in Child

Drodof1mn1l.

50(1-2), 3-35.

Brethertoll,I.(1990).

Opcn

COllllllunication

and internal

working

models: Their role in thede\ elopmen tofanachment relationships.

In R.A.Thompron (Ed.),

Sod(Mfllotional

droeWpmnll, Nebraska

S)mposiumon Moti\'ation.

1988

(pp.57-113).lincoln \'E: Uni\ ersity

of

Nebraska

Press.

Cassidy,J. (1988). Th c self as relalcd to child-mother attachlllcnt

at six. Child Drodof1l1lt:lll,

59,121-134.

Edelman, G.M. (1989). The

mnnnbered

prtsm/:

A

MologicaJ Ihevl y of

COn.sciOUSlltsS.

New York: Basic

Books.

Gilbert,

P.

(1989).

f [ u l I l o I l I I O I U r t a l i d s u f f m n g H i I I s d a l e ~ :

Erlbaum.

Hilgard,

[.R.

(1986). Dividedronsciollsnus:

Multiphamtrol.5

in hllmon

thought and ottitm. Expanded edition. New York: Wiley.

KihlstromJ.F. (1987).11\ccogniti\·c unconscious. Scit lta 237,1445

1452.

Uotti,G. (1991).

Pattcrnsofauachmentand

theassessmentorilller

~ r s o l l a l schemata:

nderstanding

and

changing

difficult patient

therapist relationshipin cognitivepsychotherap}'.Journal

oJOIgnitWi

PsyduHhempy,5.105-114,

UOlli, G. (in press). Disorganized

attachment

and

dissociati\'c

cXIX

ricnccs: An iI1uStr.ltioll of tlIe dC\'elopmen tal-elhological approach

tocognith'e

lherapy.ln

Ii.Rosen T.Kuehl

....

cin (Eels),

Cognilillt

thnapy

in oc(iol/.

San Francisco, CA: Jossc)'·Bass.

Liotti, G.. lntreccialagli, 13 Cecere, F. (1991). FsperiellZa di Itmo

nclla madre e facilitazionc

dello

sviluppo di dislUrbi dissociath'i

nella pmle: Uno slUdio caso-controllo. (Unresolved mourning in

mothers and dC\'e1opment of dissociati\'e disorders in childrcn: A

case<onlrol study). JUl/isUl Ii i

Psichialria,

26,283-291.

Main, (1981). A\'oidance;n the se ';ce ofattachmem. In K.

Immdmann, C.Barlow, L. PCU'inovitch

Main (Eels.),

BelWl/ioral

develo/JlIletll:

Til,

8itl fdd

inlerdisciplilwr')' projtct (pp.651-693).

Cambridge:

Cambridge

University Prcss.

Main, M. (1991). Met<lcogn;lj\,e knowledge, metacognitivc moni

toring, and singular (coherent)

vs.

multiple (incohcrent) modd

of attachment. III C.M.Parkes,J.slevenson·Hinde P. Marris (Eds.),

Altlldwumt

l TOS

Ihe lift C) clt

(pp.127-159).London: Routledge.

Main,

M.,

Kaplan. N.,&Cassidy,J. (1985). Sccurityin infancy,child.

hood and

adulthood:

A move to the level of

reprcsentation.

In

I.Brethel ton E.Waters (Eds.), Growingpoints in allac1uncllt

the·

o )' and reseill'ch. Monographs

of

tilt

Society

fur RLsearch ill Child

Drotlopmt /lt,

50 1-2), 66-104.

Main, M.. I·Jesse, E.(1990). Parents' unresoh'cd traumatic expe

riences are related to infantdisorgani7.edaltachmentstatus:

Is

fright

encd and/or frightening b c h a \ ~ o r thc linking mechanism? In

M.T.Greenberg, D.Cicchetti E..M.

Cummings

(Eels.), A l I a c h ~ 1 1

iI/ the prmhool

)'tal'

(pp.161-182). Chicago: University of Chicago

Prcss.

~ f a i n M., Hesse, E. (1992). Auaccamemo disorganizzato/dis

oriemato Nell

infamia

e Slati mentali dissociati nei genitor i

(Disorganized/disoriented infantbeha\ior in the strangesiruation,

lapses in

the

monitoring

of

reasoning and discourse

dur ing lhc

parcnts'AduhAttachmclU Imen.iew,anddissociath·cslates: In sup

pon ofUoni 's

hrpothesis.) Tanslated [into Italian] byV. Chiarini

203

D1 l

()(lHIO\,

101 \ \0

t l«mbtl

lCl t2



DISORGANIZED ATTACHMENT AND DISSOCIATION

and

published in M.Ammanili

D.Stcrn (Eds.), A t t a C a 1 l l P l t o ~ p s i -

wanalisi Anachmcol and Ps)'choanalysis) (pp.86-140). Bari:

L'llerza.

Main, M., Solomon,]. (1986). Disco\ ery ofa nev;, insecure-dis

organized/disoriented

auachmenl

pallem.

In T.R. Brazelton

~ · Y o g m a n

(Eds.).

ffutiw

devdopmmt in inJancy

(pp.95-124).

Norwood: Ablex.

Main,M., Solomon,j. 1990). Procedures for identifying

infanti

asdisorganized/disorienledduringtheAinsworthSlr.lIlgeSirualion.

In M.T.Greenberg,D.Cicchelti E.M.Cummings Eds. ,Attachmmt

in th t

J1mdwoi]tOn

(pp.121.160). Chicago: Uni\'ersil)'

of

Chicago

PrCM.

Parkes. eM (1972). ~ S i l l d ; ~ ofgri fin

aduillift.

New

York : hllemational

Universities Press.

Putnam,F.W. (1988).

The S\> itch

process

in multiple

personalitydis

order

and other

slale-Change disorders..

DISSOCJA770N,1

(1), 24-32.

Ross,

CA

(1989). Multiple personality disorder: Diagnosis,

dini-

cal features,

and

u·e;;Hment.

New

York:John

Wiley

Sons.

Ross,

CA,Joshi,S.,

Currie R (1990). Dissociati\'e experiences

in

the general

population.

Amtrican

JOllrnal

ofPsychiatry,

147, 1547

1552.

Safran,j.

(1990). Toward a refinementofcognitive

lherapyin

Iighl

of

inlcrpcrsonallhcory.

I Thcory. anical Pl cJwlogy RroinJJ,

10,

87-105.

Spiegel, D. (1991). Hypnosis, dissocialion

and trauma: Hidden

and

overt observers. In J.LSinger Ed. ,

Repression

and dissociation:

lmplimliom for pmonality thtfJry, psychopathOlogy and health (pp.121

141). Chicago: The University of Chicago Press.

Slern, D (1985). Theillltrpersonalwor oJthe inJant. New York: Basic

Books.

Tinnin, L (1990). Mental unilY, allcrcd states of consciousnessand

dissociation. DtSSOClA71 N 1II, (3), 154-159.

Worden, W (1982). Griif counseling and grieftherapy. New York:

Springer.

ACKNOWLEDGMENT

The author

is

deeply

indebted

to MaryMain and Erik Hesse

for their suggestions

and

help in developing the ideasexpressed

in this paper.

204

disorganized disoriented attachment in dissociated disorders. g. liotti, 1992

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