[Addiction as an attachment disorder]. / Sucht als Bindungsstörung.

BACKGROUND: There is no commonly accepted model for describing the development and treatment of substance use disorders (SUD); however, over several decades the attachment theory has represented an important basis for the clinical handling of SUD. This study gives a systematic review of empirical studies regarding the relationship between SUD and disorders of attachment behavior. OBJECTIVE: Is there a positive relationship between disorders of attachment behavior and the presence of SUD? METHOD: Various databases (PsychInfo, Web of Science, PubMed) were systematically searched in order to pinpoint relevant studies in books and articles published in English or German. Based on the results 22 publications were selected. After a stricter limitation to original research, 12 articles could finally be accepted as eligible. RESULTS: A significant relationship was found between SUD and insecure attachment in 10 out of the 12 studies. CONCLUSION: Based on the results of the research studies reviewed the hypothesis to characterize SUD as a possible expression of an attachment disorder was confirmed. This corroborates the importance of considering attachment parameters in dealing with prevention and treatment of SUD. Further research might focus on non-substance-related addictive disorders and therapy outcome studies.

Attachment insecurity predicts responses to an interdisciplinary chronic pain rehabilitation program.

The aim of this study was to examine the hypothesis that attachment insecurity is associated with poorer responses to interdisciplinary treatment for chronic pain. Patients (n = 235) admitted to a 4-week interdisciplinary rehabilitation program were recruited. At pre-treatment, participants completed a battery of questionnaires assessing adult attachment styles and dimensions, as well as pain intensity, disability, self-efficacy, pain catastrophizing, and depressive symptoms. The latter measures were completed again at post-treatment. Nearly two-thirds of participants (65.5 %) reported having an insecure attachment style. Attachment insecurity was unrelated to pre- and post-treatment reports of pain intensity and pain-related disability, but was significantly associated with most other clinical variables at both time points. Regression analyses controlling for pre-treatment functioning indicated that attachment insecurity was associated with less improvement in pain catastrophizing, pain self-efficacy, and depressive symptoms. Further research is warranted to investigate the processes by which attachment characteristics influence patients' responses to chronic pain rehabilitation.

Psychiatric diagnostic screening of social maladaptive behaviour in children with mild intellectual disability: differentiating disordered attachment and pervasive developmental disorder behaviour.

BACKGROUND: Children with intellectual disability (ID) are at risk for maladaptive development of social relatedness. Controversy exists whether Pervasive Developmental Disorder (PDD) takes precedence over disordered attachment for describing maladaptive social behaviour. The aim of this study was to assess the prevalence of disordered attachment symptoms in children with ID referred for mental health diagnosis, and to study the potential diagnostic overlap between symptoms of disordered attachment and PDD symptoms. METHOD: Children (n = 102) in the age of 5-11 with IDs (borderline or mild; IQ 50-85) referred for psychiatric consultation were recruited. Parents were administered a screening interview for disturbances of attachment and teachers were administered a screening questionnaire for PDD. RESULTS: Behavioural symptoms of disordered attachment were reported for 42%* of the children, with 16%* showing symptoms of inhibited and 37%* showing symptoms of disinhibited attachment disorder. In 11% both types of symptoms were noted. Attachment disorder symptoms were not significantly associated with gender, ethnic background or age. Positive screening for PDD occurred for 27%. Positive screening for PDD was not significantly associated with symptoms of attachment disorder. CONCLUSIONS: Among children with ID referred for psychiatric consultation, Reactive Attachment Disorder (RAD) and PDD symptoms were both highly prevalent. RAD and PDD symptoms appear as distinct, but sometimes comorbid, forms of aberrant social relatedness.

It is time for a more integrated bio-psycho-social approach to ADHD.

The role of psychosocial factors in perpetuating and predisposing towards the development of attention deficit hyperactivity disorder (ADHD) symptoms has been neglected within the field of child mental health. Clinicians, when told that a child had a diagnosis of ADHD, have been found to underestimate the presence of psychosocial factors, and are less likely to ask about the possibility of neglect or abuse. This article details the considerable research showing links between ADHD symptoms and parental mental illness, child maltreatment, post-traumatic stress disorder (PTSD), attachment disorders and other environmental factors. Recent neuro-biological findings showing the impact on brain development of early abuse and attachment concerns are cited. The implications of these findings both for clinicians, and at policy level, are discussed, and the reasons underlying the need for a more integrated Bio-Psycho-Social approach to ADHD are outlined.

Early pathogenic care and the development of ADHD-like symptoms.

Early pathogenic care that is characterised by disregard for the child's basic emotional needs can lead to severe global psychosocial and cognitive dysfunction and deviant developmental trajectories of brain maturation. Reactive attachment disorder (RAD) is a developmental disorder associated with early pathogenic care that is characterised by markedly disturbed ways of relating socially in most contexts. In addition to other severe emotional dysfunctions, children suffering from RAD often display a high number of comorbid attention deficit/hyperactivity disorder (ADHD) symptoms such as inattention, impulsivity and hyperactivity. It is not yet clear whether ADHD-like symptoms in children exposed to pathogenic care represent a true comorbidity of ADHD or similarities in behavioural dysfunction with a different neurodevelopmental pathway in terms of a phenocopy. In this review, we summarise the findings on the neurobiological consequences of early pathogenic care. Pathogenic care is considered a form of care by a primary caretaker involving a lack or a loss of expectable care, e.g., by early separation, frequent change in caregivers, institutionalisation or neglect. The reviewed studies suggest that a primary dysfunction of limbic brain circuits after early pathogenic care might lead to an interference by motivational or emotional cues impinging on prefrontal executive functions resulting in behavioural similarities with ADHD. Thus, the complex phenotype observed after early pathogenic care might be best described by a dimensional approach with behavioural and neurobiological similarities to ADHD coinciding to a certain degree as a function of early experience. Based on this evidence, suggestions for the treatment of ADHD-like symptoms in children after adverse early life experiences are provided.

Eating disorders and multi-level models of emotion: an integrated model.

This paper examines the relationship between emotions, depression and eating disorders. Initially, a review is undertaken of the current state of the research and clinical literature with regard to emotional factors in eating disorders. This literature is then integrated within a version of the multi-level model of emotion proposed by Power and Dalgleish. The aim of this paper is to incorporate a basic emotions, multi-modal perspective into developing a new emotions-based model that offers a theoretical understanding of psychological mechanisms in eating disorders. Within the new Schematic Propositional Analogical Associative Representation System model applied to eating disorders, it is argued that the emotions of anger and disgust are of importance in eating disorders and that the eating disorder itself operates as an inhibitor of emotions within the self. It is hoped that the development of a multi-levelled model of eating disorders will allow for the construction of number of specific testable hypotheses that are relevant to future research into the psychological treatment and understanding of eating disorders.

Los trastornos de la vinculación en la infancia: el perfil psicosomático / Attachment disorders in childhood: psychosomatic profile

Los autores exponen un caso clínico y analizan los contenidos psicopatológicos:1. Forma de presentación: trastorno alimentación.2. Relación parento-filial: agresiva.3. Contenido básico: trastorno vinculación (AU)

Occupational assault among community care workers.

The author presents the findings of a study that attempted to analyze the frequency, trend, and pattern of workplace assaults among community care workers who provide care for severely emotionally and behaviorally disturbed children in a state government agency in Australia between 1997 and 2000. He identifies the high risk groups and discusses activities for prevention opportunities.

Assessment of anxiety in young children.

Anxiety disorders are highly prevalent and disabling conditions that can be identified in young children. Observations of infant temperament and attachment relationships have shown that certain early infant behaviors can be linked to later anxiety disorders. Research involving play narrative stories, pictures, cartoons, and puppets has demonstrated preliminary validity for new assessment methods of young children. Preliminary studies also have been conducted with new questionnaires and diagnostic interviews. Additional research is needed to refine these methods and to develop new comprehensive measures that focus specifically on different aspects of anxiety in young children.

Little orphan Anastasia. The analysis of an adopted Russian girl.

It is becoming commonplace for analysts to hear about or encounter in their clinical work adopted children from Korea, China, Eastern Europe, or Russia. There is wide variation in the orphanage experience from one area to another and also in the manner in which the transitional phase from orphanage to adoptive parents is carried out. Not surprisingly, the experience of being an orphan carries with it lifelong implications and repercussions, particularly in the area of self/object relations. Some of the problems of being an orphan are obvious at the time of adoption. Others unfold only in the course of subsequent development. We are increasingly called upon to assist adoptive families whose children are struggling amid much pain and confusion with the aftermath of the threefold experience of becoming an orphan, being raised in an orphanage, and joining a family of another culture. This essay describes in some detail the infancy and early childhood of "Little Orphan Anastasia" as she picks through the emotional rubble of her infancy and samples the embarrassment of rich nurture in her current life with her adoptive parents, the Carters. This is followed by a description of the opening phase of her analysis, in which I sketch some of her attempts to fashion an adapted identity that is more congruent with her life before and after her adoption.

[Model of residential psychoanalytic integrative parent-child therapy]. / Modell einer stationären psychoanalytischen integrativen Eltern-Kindtherapie.

Deriving from an integrative psychoanalytic concept for single grownup patients treatment in a psychotherapeutic clinic based on the integrative model of P. Janssen the author tries to apply this model and to expand it to the treatment of families in a similar context. This setting mainly relies on three columns: 1. the psychoanalytic group therapy of the parents (or the mother resp. father), 2. the psychoanalytic psychotherapy of the child (resp. children) and 3. the psychotherapy sessions with the family, resp. the single therapy sessions of the grown up patients. This clinical model offers the opportunity to distinguish between accompanying children and children as patients in a stricter sense. The psychodynamic processes of transference, countertransference and resistance are integrated in and by regular team sessions. This paper discusses the parallel processes in the different applied therapeutic methods and their positive mutual influences on each other centered around a detailed case vignette of a family (a mother with two boys) that underwent psychotherapeutic treatment in the described manner for 12 weeks.