Initial research on disorganized attachment focused on “fright without solution”, i.e. the irresolvable dilemma caused when the person you rely on for comfort and protection is harmful and frightening (Hesse and Main 2000). Subsequent research has identified a number of other parenting behaviors associated with disorganized attachment, summarized in Table 8.2.

Follow-up studies of dyads with disorganized attachment during infancy find that many of these dyads go on to develop a controlling pattern of attachment (Hesse and Main 2000). The child appears to have resolved the dilemma of “fright without solution” by taking charge of the relationship with the parent in either a punitive or caregiving manner. Characteristics of disorganized and disorganized-controlling attachment in preschool-aged children are shown in Table 8.3.

In community samples, around 15 % of preschool-aged children exhibit disorganized or disorganized-controlling patterns of attachment with their caregivers (Greenberg et al. 1991; Moss et al. 2004; Speltz et al. 1999; Speltz et al. 1990). Rates are considerably higher (around 40 %) in preschoolers with clinically depressed mothers (Toth et al. 2006) and preschoolers referred for disruptive behavior (Greenberg et al. 1991; Speltz et al. 1999; Speltz et al. 1990). About 50 % of dyads identified as at risk for maltreatment exhibit a disorganized attachment relationship (Bernard et al. 2012; Moss et al. 2011).

As shown in Table 8.4, several different interventions based on attachment theory lead to reduction in disorganized/controlling attachment . These interventions share an emphasis on increasing sensitive responsiveness and reducing disorganized caregiving behaviors. Several of these interventions use video feedback to reinforce sensitive responsiveness and help parents reflect on aspects of their behavior that are disorganizing for their child (see Table 8.5.)

The Adult Attachment Interview (AAI) state of mind associated with disorganized/controlling attachment is unresolved (disorganized/disoriented) (U/d) (Main and Goldwyn 1998; Steele and Steele 2008). Two types of disorganizing/disorienting experiences are assessed by the AAI; loss of an important relationship through death and abuse by an attachment figure. Bowlby notes the loss of an attachment figure is inherently disorganizing and disorienting as the individual has organized their feelings, thoughts, and actions around a specific, important person (Bowlby 1969, 1980). Bowlby defines healthy mourning as accepting the loss of an attachment figure and reorganizing feelings, thoughts, and actions consistent with this change in the real world (Bowlby 1969, 1980). In the AAI, extreme behavioral reactions to the loss of a loved one and lapses in the monitoring of thoughts or discourse that occur more than a year following the death of a loved one are indicators or unresolved/disorganized/disoriented (U/d) attachment. Examples of indicators of unresolved attachment are provided in Table 8.6. Abuse by an attachment figure is inherently disorganizing and disorienting as the person the child is biologically predisposed to go to for comfort and protection is also the source of pain and anxiety. Continuing pain, regret, and sadness about abuse is not considered disorganized or disoriented. In fact, clinical observations suggest parents who are able to remember the pain and sadness associated with abuse by a parent are less likely to abuse their own children (Fraiberg et al. 1975).

The majority of parents (53 %) in a disorganized dyad have an unresolved/disorganized state of mind (Ud) associated with attachment loss , abuse, or trauma (Van Ijzendoorn 1995). Mothers in disorganized dyads have been described as being in a continuing state of fear (Beebe et al. 2010). In community samples, rates of unresolved/disorganized state of mind range from 6 to 25 % (Bakermans-Kranenburg and van Ijzendoorn 2009). Rates among adults adopted as infants and foster mothers are near the top of this range (Caspers et al. 2007; Dozier et al. 2001). Rates are higher among adults seeking parent management training to address their child’s conduct problems or psychotherapy services for themselves. In a study of parents participating in parent management training for a child with disruptive behavior, 43 % exhibit unresolved/disorganized state of mind (Routh et al. 1995). 72 % of patients seeking treatment for Posttraumatic Stress Disorder related to childhood abuse (Stovall-McClough and Cloitre 2003) and 32 % of patients receiving treatment for Borderline Personality Disorder (Levy et al. 2006) exhibit unresolved/disorganized state of mind.