8/17/2019 Disorganized Disoriented Attachment in Dissociated Disorders. G. Liotti, 1992
http://slidepdf.com/reader/full/disorganized-disoriented-attachment-in-dissociated-disorders-g-liotti-1992 1/9
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
8/17/2019 Disorganized Disoriented Attachment in Dissociated Disorders. G. Liotti, 1992
http://slidepdf.com/reader/full/disorganized-disoriented-attachment-in-dissociated-disorders-g-liotti-1992 2/9
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
disorganized/disoriented
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
8/17/2019 Disorganized Disoriented Attachment in Dissociated Disorders. G. Liotti, 1992
http://slidepdf.com/reader/full/disorganized-disoriented-attachment-in-dissociated-disorders-g-liotti-1992 3/9
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:
8/17/2019 Disorganized Disoriented Attachment in Dissociated Disorders. G. Liotti, 1992
http://slidepdf.com/reader/full/disorganized-disoriented-attachment-in-dissociated-disorders-g-liotti-1992 4/9
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
8/17/2019 Disorganized Disoriented Attachment in Dissociated Disorders. G. Liotti, 1992
http://slidepdf.com/reader/full/disorganized-disoriented-attachment-in-dissociated-disorders-g-liotti-1992 5/9
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
8/17/2019 Disorganized Disoriented Attachment in Dissociated Disorders. G. Liotti, 1992
http://slidepdf.com/reader/full/disorganized-disoriented-attachment-in-dissociated-disorders-g-liotti-1992 6/9
(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
disorganized/disoriented
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
8/17/2019 Disorganized Disoriented Attachment in Dissociated Disorders. G. Liotti, 1992
http://slidepdf.com/reader/full/disorganized-disoriented-attachment-in-dissociated-disorders-g-liotti-1992 7/9
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
8/17/2019 Disorganized Disoriented Attachment in Dissociated Disorders. G. Liotti, 1992
http://slidepdf.com/reader/full/disorganized-disoriented-attachment-in-dissociated-disorders-g-liotti-1992 8/9
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
8/17/2019 Disorganized Disoriented Attachment in Dissociated Disorders. G. Liotti, 1992
http://slidepdf.com/reader/full/disorganized-disoriented-attachment-in-dissociated-disorders-g-liotti-1992 9/9
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