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Little is known about the links between anxiety disorders and parent–child attachment disorganization and quality of peer relationships in late adolescence. This study examined the quality of attachment and peer relationships among adolescents with and without anxiety disorders in a sample of 109 low- to moderate-income families. Psychopathology was assessed with the SCID-I. Attachment disorganization and dysfunction in peer relationships were measured using semi-structured interviews and behavioral observations. Adolescents with anxiety disorders and comorbid conditions showed higher levels of attachment disorganization across three measurement approaches, as well as higher levels of dysfunction in peer relationships than those with no Axis I diagnosis. Adolescents without anxiety disorders but with other Axis I disorders differed only in the quality of school relationships from those with no diagnoses. The pattern of results suggests that pathological anxiety, in the context of other comorbidities, may be a marker for more pervasive levels of social impairment.

Disoriented, punitive, and caregiving/role-confused attachment behaviors are associated with psychopathology in childhood, but have not been assessed in adolescence. A total of 120 low-income late adolescents (aged 18–23 years) and parents were assessed in a conflict-resolution paradigm. Their interactions were coded with the Goal-Corrected Partnership in Adolescence Coding Scales. Confirmatory factor analysis demonstrated that the three disorganized constructs (punitive, caregiving, and disoriented interaction) were best represented as distinct factors and were separable from a fourth factor for collaboration. The four factors were then assessed in relation to measures of attachment disorganization, partner abuse, and psychopathology. Results indicate that forms of disorganized behavior first described in early childhood can also be reliably assessed in adolescence and are associated with maladaptive outcomes across multiple domains.

The current paper expands on Ainsworth’s seminal construct of maternal sensitivity by exploring the developmental pathways associated with one particular form of insensitivity: maternal withdrawal. Drawing on longitudinal data from infancy to age 20 in a high-risk cohort, we highlight how maternal withdrawal over the first eight years of life is associated with child caregiving behavior and with maternal role confusion, as well as with features of borderline and antisocial personality disorders. We also present evidence for the specificity of this pathway in relation to other aspects of maternal insensitivity and other aspects of child adaptation. To illuminate these pathways we both review recent published work and report new findings on the middle childhood and adolescent components of these trajectories. Finally, we consider the implications for assessment of maternal behavior in high-risk samples and indicate directions for productive future work.

The primary objective was to assess whether prospectively observed quality of parent–child interaction in infancy and middle childhood contributed to the prediction of borderline symptoms and recurrent suicidality/self-injury in late adolescence. Adolescents (mean 19.9 years) from 56 families participating in a longitudinal study since infancy (retention rate 74%) were assessed on the SCID-II for symptoms of borderline personality disorder (BPD), including suicidality/self-injury. Early clinical risk was indexed by clinical referral to parent–infant services. Attachment security and parent–child interaction were assessed from videotape at 18 months and 8 years. Severity of childhood abuse was rated from interview and self-report measures. Maternal withdrawal in infancy was a significant predictor of both borderline symptoms and suicidality/self-injury in late adolescence. Disorganized controlling child behavior at age 8 contributed independently to the prediction of borderline symptoms. The effect of maternal withdrawal was independent of, and additive to, variability explained by severity of childhood abuse. Borderline symptoms and suicidality/self-injury may be preceded developmentally by disturbed interactions as early as 18 months of age. A parent–child transactional model is proposed to account for the findings.

The study evaluated the association between maternal disrupted communication and the reactivity and regulation of the psychobiology of the stress response in infancy. Mothers and infants were recruited via the National Health Service from the 20% most economically impoverished data zones in a suburban region of Scotland. Mothers (N = 63; M age = 25.9) and their 4-month-old infants (35 boys, 28 girls) were videotaped interacting for 8 min, including a still-face procedure as a stress inducer and a 5-min coded recovery period. Saliva samples were collected from the dyads prior to, during, and after the still-face procedure and later assayed for cortisol. Level of disruption in maternal communication with the infant was coded from the 5-min videotaped interaction during the recovery period which followed the still-face procedure. Severely disrupted maternal communication was associated with lower levels of maternal cortisol and a greater divergence between mothers' and infants' cortisol levels. Results point to low maternal cortisol as a possible mechanism contributing to the mother's difficulty in sensitively attuning to her infant's cues, which in turn has implications for the infant's reactivity to and recovery from a mild stressor in early infancy.

Self-reports of role confusion with the parent in childhood are associated with a variety of adverse outcomes. However, role-confusion has been studied primarily from the point of view of the child. The current study evaluated an instrument for assessing role confusion from maternal interviews rather than from child observations or self-reports in adulthood. Fifty-one mothers participating in a longitudinal study since their own child's infancy were administered the Experiences of Caregiving Interview (C. George & J. Solomon, 1996) when the child was age 20. Interviews were coded using the newly developed Parental Assessment of Role Confusion (PARC; L. Vulliez-Coady & K. Lyons-Ruth, 2009). Maternal PARC scores were related to observational measures of role-confusion in interaction with the child both in infancy and late adolescence. PARC scores also were related to mothers’ hostile-helpless states of mind on the Adult Attachment Interview (C. George, N. Kaplan, & M. Main, 1984, 1985, 1986) and to the extent of Unresolved loss, but not Unresolved Trauma. PARC scores also were related to mothers’ self-reports of helplessness experienced in the parenting role. Discriminant validity of the PARC was demonstrated in that role confusion on the PARC was not related to hostile or disoriented forms of parent–child interaction. Implications for clinical assessment of role confusion are discussed.

Comments on an article Children of mothers with borderline personality disorder: Identifying parenting behaviors as potential targets for intervention by Stepp, Whalen, Pilkonis, Hipwell, and Levine (see record 2011-05873-001). The authors have offered us an extremely timely paper, given the surge of interest in borderline psychopathology in general, and its parenting correlates in particular. This is an ambitious overview that assesses the current state of knowledge concerning the parenting of mothers with borderline personality disorder (BPD). The authors also grapple with what we can make of this literature in setting directions for prevention/intervention strategies for children of parents with BPD. This was a comprehensive and thoughtful review. This commentary elaborate on three issues brought to the fore by the current paper.

Socially disinhibited or indiscriminate behavior (IB) has traditionally been investigated using caregiver reports. More recently, an observational measure based on the Strange Situation Procedure (M. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978), the Rating of Infant and Stranger Engagement (RISE; C. Riley, A. Atlas-Corbett, & K. Lyons-Ruth, 2005), was validated in home-reared at-risk children. The present study aimed to validate the RISE in an institutionally reared sample using the caregiver report, to assess whether IB assessed with the RISE was elevated among the institutionalized children, and to explore potential risk factors associated with IB. The study was conducted among 74 institutionalized toddlers aged 11 to 30 months. Sociodemographic questionnaires were used to assess pre-admission experiences, and aspects of institutional placement were coded from the children's files in the institution and staff's report. Institutionalized children displayed high frequencies of IB as assessed on the RISE, and this instrument was validated against caregiver report. Pre-admission experiences of the institutionalized children in their biological families—namely, prenatal risk and maternal emotional neglect risk—predicted IB. Results suggest that the RISE is adequate to use among institutionally reared toddlers and point to aspects of the early familial environment that may be implicated in IB.

The relation between early mother–infant interaction and later socio-emotional development has been well established. The present study addresses the more recent interest in the impact of maternal caregiving on cognitive development and their role in decision-making in young adulthood. Using data from a prospective longitudinal study on attachment, prediction from early mother–infant interactions at age 18 months and from verbal and nonverbal cognitive skill at age 5 were examined as predictors of a substance use disorder (abuse/dependence) in young adulthood (age 20) on the Structured Clinical Interview for DSM-TV (SCID). Results reveal that the mother's withdrawal from interaction with the infant at age 18 months, coded using the AMBIANCE coding system (Atypical Maternal Behavior Instrument for Assessment and Classification), was associated with the child's lower nonverbal cognitive scores but not verbal cognitive scores at age 5. In addition, maternal withdrawal at 18 months predicted a clinical diagnosis of substance use disorder (alcohol/cannabis) at age 20. Finally, nonverbal reasoning at age 5 mediated the relationship between early maternal withdrawal and substance use disorder (alcohol/cannabis) in young adulthood. Findings indicate the need for further work examining how early maternal withdrawal affects nonverbal cognitive development by school entry, and how these nonverbal deficits further contribute to maladaptive coping strategies such as substance use by young adulthood.

In this investigation we examined the developmental correlates and predictors of maternal emotional availability in interactions with their 7-year-old children among a sample of families at psychosocial risk. We found developmental coherence in maternal interactive behavior, and in the relations between maternal emotional availability and children's functioning in middle childhood. Mothers and children were observed at home and in a laboratory playroom in infancy to assess maternal interactive behavior and child attachment security. When children were 7 years of age, dyads were observed in the lab; maternal emotional availability was coded using the Emotional Availability Scales, and children's disorganized and controlling attachment behavior was assessed. Classroom teachers reported on children's behavior problems; at age 8, children reported on their depressive symptoms. Results showed that aspects of maternal emotional availability (sensitivity, nonhostility, nonintrusiveness [passive/withdrawn behavior]) were associated with children's functioning in middle childhood: (a) controlling and disorganized attachment behavior, (b) behavior problems in school, and (c) self-reported depressive symptoms. Maternal emotional availability in childhood was predicted by early mother-infant relationship dysfunction (maternal hostility, disrupted communication, and infant attachment insecurity).

Few studies have evaluated the separate contributions of maltreatment and ongoing quality of parent–child interaction to the etiology of antisocial personality features using a prospective longitudinal design. One hundred twenty low-income young adults (aged 18–23) were assessed for extent of antisocial personality disorder (ASPD) features on the Structured Clinical Interview for Diagnosis (M.B. First, R.L. Spitzer, M. Gibbon, & J.B.W. Williams, 1997) for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994) Axis II, for presence of maltreatment on the Conflict Tactics Scale (M.A. Straus, S.L. Hamby, D. Finkelhor, D.W. Moore, & D. Runyan, 1998), Traumatic Experiences Scale (L. Dutra, J.F. Bureau, B. Holmes, A. Lyubchik, & K. Lyons-Ruth, 2009), and Adult Attachment Interview (C. George, N. Kaplan, & M. Main, 1984), and for referral in infancy to parent–infant clinical services. Fifty-six of these families had been studied longitudinally since the first year of life. In infancy, attachment disorganization and disrupted mother–infant interaction were assessed; in middle childhood, disorganized-controlling attachment behaviors were reliably rated. In kindergarten and second grade, behavior problems were assessed by teacher report. In cross-sectional analyses, maltreatment was significantly associated with ASPD features, but did not account for the independent effect of early referral to parent–infant services on ASPD features. In longitudinal analyses, maternal withdrawal in infancy predicted the extent of ASPD features 20 years later, independently of childhood abuse. In middle childhood, disorganized attachment behavior and maladaptive behavior at school added to prediction of later ASPD features. Antisocial features in young adulthood have precursors in the minute-to-minute process of parent–child interaction beginning in infancy.

Borderline personality disorder (BPD) has been associated with deviations in cortisol in response to interpersonal stressors. Identifying mechanisms contributing to such deviations may help to address emotional dysregulation and the increased risk of self-destructive behavior. While dysfunctional relationships to caregivers have been widely reported among individuals with BPD, their contribution to cortisol hyperresponsiveness has yet to be investigated. Fifty-one females (aged 18–24years) participated to assess the impact of BPD and the quality of protective care in mother-daughter relationships on stress responsiveness. Seventeen females with BPD and twenty females without BPD participated with their mothers in a videotaped parent-young adult conflict discussion. Fourteen non-BPD females without their mothers were assessed for cortisol levels without stress exposure. Salivary cortisol samples were collected at lab entry and 20 and 40min after the onset of the discussion. Results revealed a higher overall cortisol response in the BPD group upon lab entry. BPD participants reported less experienced protection in the mother-daughter relationship which was associated with higher cortisol levels on lab entry and higher distress at study end. Results point to the perceived quality of parental protection as likely to modulate the activity of the stress response system among BPD patients.

Disorganized/controlling attachment in preschool has been found to be associated with maternal and child maladjustment, making it of keen interest in the study of psychopathology. Additional work is needed, however, to better understand disorganized/controlling attachment occurring as early as age 3 years. The primary aims of this study were to evaluate risk factors and outcomes associated with disorganized/controlling behavior at age 3 years and to evaluate the risk factors and outcomes differentiating the four subtypes of disorganized/controlling attachment. Analyses were conducted with the first two phases of the National Institute of Child Health & Human Development Study of Early Child Care and Youth Development, a prospective study of 1,364 children from birth. At 36 months of age, across the attachment-relevant domains of maternal well-being, mother–child interactions, and child social adaptation, the disorganized/controlling group evidenced the most maladaptive patterns in comparison to both secure and insecure-organized groups. At 54 months of age, the disorganized/controlling group displayed the highest levels of internalizing and externalizing behavior problems, as rated by mothers and teachers, and the lowest quality relationships with teachers. Significant differences found among the disorganized/controlling subtypes indicated that the behaviorally disorganized and controlling-punitive subtypes had more maladaptive patterns across variables than did the controlling-caregiving and controlling-mixed subtypes.

Background: In the development of borderline personality disorder (BPD) both genetic and environmental factors have important roles. The characteristic affective disturbance and impulsive aggression are linked to imbalances in the central serotonin system, and most of the genetic association studies focused on serotonergic candidate genes. However, the efficacy of dopamine D2 receptor (DRD2) blocking antipsychotic drugs in BPD treatment also suggests involvement of the dopamine system in the neurobiology of BPD. Methods: In the present study we tested the dopamine dysfunction hypothesis of impulsive self- and other-damaging behaviors: borderline and antisocial traits were assessed by Structured Clinical Interview for Diagnosis (SCID) for DSM-IV in a community-based US sample of 99 young adults from low-to-moderate income families. For the BPD trait analyses a second, independent group was used consisting of 136 Hungarian patients with bipolar or major depressive disorder filling out self-report SCID-II Screen questionnaire. In the genetic association analyses the previously indicated polymorphisms of the catechol-O-methyl-transferase (COMT Val158Met) and dopamine transporter (DAT1 40 bp VNTR) were studied. In addition, candidate polymorphisms of the DRD2 and DRD4 dopamine receptor genes were selected from the impulsive behavior literature. Results: The DRD2 TaqI B1-allele and A1-allele were associated with borderline traits in the young adult sample (p = 0.001, and p = 0.005, respectively). Also, the DRD4 -616 CC genotype appeared as a risk factor (p = 0.02). With severity of abuse accounted for in the model, genetic effects of the DRD2 and DRD4 polymorphisms were still significant (DRD2 TaqIB: p = 0.001, DRD2 TaqIA: p = 0.008, DRD4 -616 C/G: p = 0.002). Only the DRD4 promoter finding was replicated in the independent sample of psychiatric inpatients (p = 0.007). No association was found with the COMT and DAT1 polymorphisms. Conclusions: Our results of the two independent samples suggest a possible involvement of the DRD4 -616 C/G promoter variant in the development of BPD traits. In addition, an association of the DRD2 genetic polymorphisms with impulsive self-damaging behaviors was also demonstrated.

This prospective 20-year study assessed associations between maternal depressive symptoms in infancy, childhood, and adolescence, and child and adolescent depressive symptoms in a sample of families at high psychosocial risk. Maternal symptomatology was assessed with the Center for Epidemiological Studies Depression Scale (CES-D) when children were infants (12 months), school-aged (age 8), and adolescents (age 19). Children's depressive symptoms were measured at age 8 (Dimensions of Depression Profile for Children and Adolescents) and age 19 (CES-D). Maternal depressive symptoms during infancy contributed to the prediction of child depressive symptoms at age 8, after controlling for concurrent maternal depressive symptoms, clinical risk in infancy, and gender. Clinical risk in infancy marginally contributed to the prediction model. Disorganization of attachment in infancy and maternal hostility were independent predictors of depressive symptoms at age 8 and did not mediate the relation between maternal and child depressive symptoms. Depressive symptoms in adolescence were predicted by gender, children's depressive symptoms at age 8, maternal depressive symptoms in adolescence, and maternal depressive symptoms in infancy. There was no moderating effect of gender. Adding to previous evidence on the importance of early maternal depression, maternal depressive symptoms during infancy were related to the development of depressive symptoms in childhood and adolescence even when other variables of potential relevance were controlled.

Kihlstrom (2005) has recently called attention to the need for prospective longitudinal studies of dissociation. The present study assesses quality of early care and childhood trauma as predictors of dissociation in a sample of fifty-six low income young adults followed from infancy to age 19. Dissociation was assessed with the Dissociative Experiences Scale; quality of early care was assessed by observer ratings of mother-infant interaction at home and in the lab; and childhood trauma was indexed by state-documented maltreatment, self-report, and interviewer ratings of participants’ narratives. Regression analysis indicated that dissociation in young adulthood was significantly predicted by observed lack of parental responsiveness in infancy, while childhood verbal abuse was the only type of trauma that added to the prediction of dissociation. Implications are discussed in the context of previous prospective work also pointing to the important contribution of parental emotional unresponsiveness in the development of dissociation.

Objective The Personal Attitude Scale (PAS; Hooley, 2000) is a method that is under development for identifying individuals high in Expressed Emotion based on personality traits of inflexibility, intolerance, and norm-forming. In the current study, the goal was to measure the association between this maternal attitudinal inflexibility, early hostile or disrupted mother-infant interactions, and hostile-aggressive behavior problems in the child. Methods In a prospective longitudinal study of 76 low-income mothers and their infants, it was predicted that maternal PAS scores, assessed at child age 20, would be related to difficulties in early observed mother-infant interaction and to hostile-aggressive behavioral difficulties in the child. Results Results indicated that maternal difficulties in interacting with the infant in the laboratory were associated with maternal PAS scores assessed 20 years later. Hostile-aggressive behavior problems in the child at age five were also predictive of PAS scores of mothers. However, contrary to prediction, these behavior problems did not mediate the association between mother-infant interaction difficulties and maternal PAS scores, indicating that the child's hostile-aggressive behavior problems did not produce the link between quality of early interaction and later maternal attitudinal inflexibility. Conclusions The current results validate the PAS against observable mother-child interactions and child hostile-aggressive behavior problems and indicate the importance of future work investigating the maternal attitudes that are associated with, and may potentially precede, parent-infant interactive difficulties. Practice implications These findings regarding the inflexible attitudes of mothers whose interactions with their infants are also disrupted have important clinical implications. First, once the stability of the PAS has been established, this measure may offer a valuable screening tool for the prenatal identification of parents at risk for difficult interactions with their children. Second, it suggests routes for more cognitive interventions around helping less flexible parents shift perspectives to better take account of their child's outlooks and needs.

Background Women with borderline personality disorder have conflictual interpersonal relations that may extend to disrupted patterns of interaction with their infants. Aims To assess how women with borderline personality disorder engage with their 12 to 18-month-old infants in separation–reunion episodes. Method We videotaped mother–infant interactions in separation–reunion episodes of the Strange Situation test. The mothers were women with borderline personality disorder, with depression, or without psychopathological disorder. Masked ratings of maternal behaviour were made with the Atypical Maternal Behavior Instrument for Assessment and Classification. Results As predicted, a higher proportion (85%) of women with borderline personality disorder than women in the comparison groups showed disrupted affective communication with their infants. They were also distinguished by the prevalence of frightened/disoriented behaviour. Conclusions Maternal borderline personality disorder is associated with dysregulated mother–infant communication.

Main, Kaplan, and Cassidy's (1985) conceptualizations of disorganization in infancy and controlling behavior in preschool forged new directions in attachment research. However, there currently is no valid coding system for behavioral manifestations of attachment after 7 years of age. The present study presents the validity of an instrument for coding both disorganized and role-reversed behavior from ages 7 to 9; the Middle Childhood Disorganization and Control (MCDC) scales. In the present study, 43 mother–child dyads at socio-economic risk, followed from infancy, were assessed on the MCDC at age 8. Analyses revealed that children with higher combined punitive/disorganized scores were significantly more likely to: (1) come from families referred for clinical home visiting because of concerns about the quality of the parent–infant relationships; (2) have higher scores for disorganization in infancy if from the clinically-referred subgroup; (3) are more likely to show disorganized representations; and (4) show higher externalizing and internalizing behavior problems. Higher caregiving MCDC scores were associated with more maternal withdrawal behavior in infancy. In conclusion, the present study provided the first validity data for an observational measure of disorganization and control in middle childhood.

Socially indiscriminate attachment behavior has been repeatedly observed among institutionally reared children. Socially indiscriminate behavior has also been associated with aggression and hyperactivity. However, available data rely heavily on caregiver report of indiscriminate behavior. In addition, few studies have been conducted with samples of home-reared infants exposed to inadequate care. The current study aimed to develop a reliable laboratory measure of socially indiscriminate forms of attachment behavior based on direct observation and to validate the measure against assessments of early care and later behavior problems among home-reared infants. Strange Situation episodes of 75 socially at-risk mother–infant dyads were coded for infant indiscriminate attachment behavior on the newly developed Rating for Infant–Stranger Engagement. After controlling for infant insecure–organized and disorganized behavior in all analyses, extent of infant–stranger engagement at 18 months was significantly related to serious caregiving risk (maltreatment or maternal psychiatric hospitalization), observed quality of disrupted maternal affective communication, and aggressive and hyperactive behavior problems at age 5. Results are discussed in relation to the convergent and discriminant validity of the new measure and to the potential utility of a standardized observational measure of indiscriminate attachment behavior. Further validation is needed in relation to caregiver report measures of indiscriminate behavior.

This paper explores the development of BPD as it might emerge in the child's early interpersonal reactions and how such reactions might evolve into the interpersonal pattern that typifies BPD. It begins to bridge the relevant bodies of clinical literature on the borderline's prototypic interpersonal problems with the concurrently expanding relevant literature on early child development. We will start by considering how a psychobiological disposition to BPD is likely to include a constitutional diathesis for relational reactivity, that is, for hypersensitivity to interpersonal stressors. Data relevant to this disposition's manifestations in adult clinical samples and to its heritability and neurobiology will be reviewed. We then consider how such a psychobiological disposition for interpersonal reactivity might contribute to the development of a disorganized-ambivalent form of attachment, noting especially the likely contributions of both the predisposed child and of parents who are themselves predisposed to maladaptive responses, leading to an escalation of problematic transactions. Evidence concerning both the genetics and the developmental pathways associated with disorganized attachments will be considered. Emerging links between such developmental pathways and adult BPD will be described, in particular the potential appearance by early- to middle-childhood of controlling-caregiving or controlling-punitive interpersonal strategies. Some implications from this gene-environment interactional theory for a better developmental understanding of BPD's etiology are discussed.

Recent high-risk longitudinal studies have documented a unique contribution of the quality of the early mother–child relationship to diverse forms of psychopathology in young adulthood, even with family economic status, later traumatic experiences, and some genetic factors controlled. In addition, measures of attachment-related deviations in caregiver–infant interaction predict more than measures of infant attachment behavior alone. This article reviews those findings in the context of cross-disciplinary thinking on the importance of shared subjectivities in human evolution and development and in the context of recent studies beginning to map the intersection between processes of interaction and the development of the child's propensities to share mental states with others.

Hypothalamic–pituitary–adrenal axis dysregulation after stress was found to be associated with borderline personality disorder (BPD). Nine female BPD young adults and 12 control subjects were investigated for stress reactivity and recovery after an interpersonal conflict discussion with their mothers. BPD subjects showed a delayed cortisol response after psychosocial stress.

The aim of this study was to determine whether women with borderline personality disorder (BPD) are more likely than those with dysthymia to manifest contradictory Hostile-Helpless (HH) states of mind. A reliable rater blind to diagnosis evaluated features of such mental representations in transcripts of Adult Attachment Interviews from 12 women with BPD and 11 women with dysthymia of similar socioeconomic status (SES), all awaiting psychotherapy. In keeping with three hierarchical (non-independent) a priori predictions regarding the mental representations of women with BPD, the results were that (a) all those with BPD, compared with half the group with dysthymia, displayed HH states of mind; (b) those with BPD manifested a significantly higher frequency of globally devaluing representations; and (c) they exhibited a strong trend toward identifying with the devalued hostile caregiver (58% BPD vs. 18% dysthymic). In addition, significantly more BPD than dysthymic patients made reference to controlling behavior towards attachment figures in childhood. These findings offer fresh insights into the nature of BPD and extend previous evidence concerning affected individuals' patterns of thinking and feeling about childhood attachment figures.

Objectives The short allele of the serotonin transporter linked polymorphic region (5HTTLPR) has been associated with anxiety, major depressive disorder, and suicidality. The impulsive self- and other-damaging behaviors seen in borderline personality disorder (BPD) and antisocial personality disorder (APD) also have substantial comorbidity with depression but are associated with more severe environmental stressors. This study tested the hypothesis of an association between the short allele of the 5HTTLPR and borderline or antisocial traits in young adulthood. Methods The 5HTTLPR was genotyped among 96 young adults from low- to moderate-income families (62 without and 34 with BPD or APD features). Features of borderline and antisocial personality disorder were assessed with the Structured Clinical interview for Diagnosis (SCID)-Axis II. Results The number of short 5HTTLPR alleles was significantly related to incidence of BPD or APD traits, as well as to each set of traits independently. Male gender and quality of care in infancy were also associated with incidence of BPD and APD traits but did not account for the association with the short allele. Depressive disorders were not associated with the short allele in this sample. Conclusions Young adults of lower socioeconomic status who carry the short 5HTTLPR allele may be especially vulnerable to developing antisocial or borderline traits by young adulthood.

Disorganized attachment is an early predictor of the development of psychopathology in childhood and adolescence. Lyons-Ruth, Bronfman, and Parsons (1999) developed the AMBIANCE coding scheme to assess disrupted communication between mother and infant, and reported the link between maternal behavior and disorganized attachment. The Hungarian group found an association between a polymorphism of the DRD4 gene and disorganized attachment (Gervai et al., 2005; Lakatos et al., 2000, 2002). The present collaborative work investigated the interplay between genetic and caregiving contributions to disorganized attachment. Mother–infant dyads (138), from a Hungarian low-social-risk sample (96) and a US high-social-risk sample (42), were assessed for infant disorganized attachment behavior, for DRD4 gene polymorphisms, and for disrupted forms of maternal affective communication with the infant. In accord with literature reports, we found a robust main effect of maternal AMBIANCE scores on infant disorganization. However, this relation held only for the majority of infants who carried the short form of the DRD4 allele. Among carriers of the 7-repeat DRD4 allele, there was no relation between quality of maternal communication and infant disorganization. This interaction effect was independent of degree of social risk and maternal DRD4 genotype.

Recent work in developmental psychology and primatology indicates that human infants are distinguished from other primates by the end of the 1st year by their awareness that others have subjective states like their own. This early appearing awareness of the subjectivity of others forms the basis for the subsequent negotiation and elaboration of “we-ness,” that is, of shared orientations toward the world that allow the child to enter into collaborative relations with others. It is argued that this gradual working out of collaborative strategies for the elaboration of shared meanings is a principal function of joint pretend play in early childhood, and this is one of the critical developmental functions addressed in psychodynamic play therapy. Developmental theory and research contributing to this perspective is integrated with excerpts from children's joint pretend play and from play therapy case material to illustrate the precarious and improvisational nature of the negotiation of shared meaning.

Cost-efficient prenatal assessments are needed that have the potential to identify those at risk for parent/infant relational problems. With this goal in mind, an additional attachment style description was added to the Relationship Questionnaire (Bartholomew & Horowitz, 1991), an established self-report attachment measure, to create the Relationship Questionnaire: Clinical Version (RQ-CV). The additional description represents a profoundly-distrustful attachment style: “I think it's a mistake to trust other people. Everyone's looking out for themselves, so the sooner you learn not to expect anything from anybody else the better.” The RQ-CV was applied to a sample of 44 low-income mothers who had participated in a previous study of the impact of family risk factors on infant development. After first controlling for demographic risk factors and for other insecure adult attachment styles, mother's profound-distrust was associated with three independent assessments of the quality of maternal interactions with the infant assessed 20 years earlier. In particular, profound-distrust was related to more hostile, intrusive, and negative behaviors toward the infant. The results are discussed within the framework of attachment theory.

The objective of this study was to assess whether a mediated model of change could account for the long-term effects of infant home-visiting services observed at ages 5 and 7 years in a high-risk cohort. Participants were 41 mothers and infants from low-income families who were referred to parent–infant home-visiting services during the first 9 months of life due to concerns about the caretaking environment. Services ended when infants reached 18 months of age. Families received between 0 and 18 of weekly home visits based on infant age of entry into the study. During childhood (ages 5 and 7 years), teachers rated children's behavior problems using standardized instruments. Early home-visiting services accounted for positive child outcomes at 18 months, 5 years, and 7 years of age; however, earlier positive outcomes related to intervention did not account for intervention-related effects at later ages. Further inspection of the data revealed that two additional principles, one of escalating morbidity among less intensively served groups and one of generalized family problem-solving skills, were needed to account for the pattern of effects over time. We conclude that the “domino models” assessed by mediational analyses may be too simple to capture the intervention-related change processes occurring in high-risk cohorts over time.

Taylor and colleagues (2000) proposed that males tend to display fight or flight responses to threat while females are more likely to display affiliative “tend or befriend” responses. In light of this hypothesis, gender differences in infant attachment behaviors were examined in a sample of 65 low-income mother–infant dyads, half of whom were referred to a home-based intervention service because of concerns about the quality of caregiving. Attachment behaviors were assessed in the Ainsworth Strange Situation when infants were 18 months old, and maternal behaviors were coded both for frightened or frightening behaviors, using the Main and Hesse (1992) coding inventory, and for disrupted affective communication using the Atypical Maternal Behavior Instrument for Assessment and Classification assessment tool (AMBIANCE; Lyons-Ruth, Bronfman, & Parsons, 1999). Results indicated that as maternal behavior became more frightening, female infants tended to approach their mothers more than male infants. These gender differences in response to maternal frightening behavior also were evident in the clinically referred subsample. The results suggest that gender-based differences in tendencies to show affiliative behaviors to threat may complicate interpretation of attachment behavior in clinical contexts. ©2005 Michigan Association for Infant Mental Health.

In a recent meta-analysis, only 53% of disorganized infants were predicted by parental Unresolved states of mind on the Adult Attachment Interview (AAI). The goal of this study was to identify additional predictors of infant disorganization on the AAI by developing and validating an interview-wide coding system for Hostile/Helpless (H/H) parental states of mind with respect to attachment. Maternal AAIs were collected from 45 low-income mothers with high rates of childhood trauma when their children were age 7; Strange Situation assessments had been collected at 18 months of age. AAIs were independently coded using both the Main and Goldwyn coding system and newly developed codes for H/H states of mind. Results indicated that the H/H coding system displayed discriminant validity in that it did not overlap substantially with the Unresolved, Cannot Classify, or Fearfully Preoccupied by Traumatic Events categories in the Main and Goldwyn coding system. Second, H/H states of mind accounted for variance in disorganized infant behavior not associated with the Unresolved classification. Third, H/H states of mind were significantly related to maternal disrupted affective communication as coded by the Atypical Maternal Behavior Instrument for Assessment and Classification coding system, and maternal disrupted communication mediated the relations between H/H states of mind and infant disorganization.

Clinical theorists have suggested that disturbed attachments are central to borderline personality disorder (BPD) psychopathology. This article reviews 13 empirical studies that examine the types of attachment found in individuals with this disorder or with dimensional characteristics of BPD. Comparison among the 13 studies is handicapped by the variety of measures and attachment types that these studies have employed. Nevertheless, every study concludes that there is a strong association between BPD and insecure attachment. The types of attachment found to be most characteristic of BPD subjects are unresolved, preoccupied, and fearful. In each of these attachment types, individuals demonstrate a longing for intimacy and—at the same time—concern about dependency and rejection. The high prevalence and severity of insecure attachments found in these adult samples support the central role of disturbed interpersonal relationships in clinical theories of BPD. This review concludes that these types of insecure attachment may represent phenotypic markers of vulnerability to BPD, suggesting several directions for future research.