Section II: Disorders
Disturbances of Attachment and Parental Psychopathology in Early Childhood

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Origins of Attachment Theory

The study of “attachment” now spans 4 decades and multiple domains; theory, research, psychobiology, and clinical application. This ever-expanding field of study owes its inception to Bowlby. Synthesizing object-relational and ethological perspectives, Bowlby theorized that the evolutionary interests of the species are best served by a biobehavioral caregiver-infant system that ensures the safety of the vulnerable human infant.1, 2 To that end, the human infant is biologically predisposed to

The Role of the Caregiver in Mutual Regulation/Attachment

Hofer99 first described what he called “hidden regulators,” that is, multiple microsystems that subserve the larger macrosystem of what Bowlby had termed “attachment.” Hofer discovered that in rodents a bidirectional process of regulation, a mechanism for relational feedback, would help the infant maintain basic physiologic homeostasis with regard to body temperature, arterial blood pressure, as well as sleep, feeding, and elimination patterns. In humans, Stern100 has referred to “affective

Summary and clinical implications

The clinical implications of this review are summarized by the following recommendations concerning the diagnosis and treatment of attachment disturbances. First, there is a need for careful psychiatric evaluation, diagnosis, and active treatment of three patients: the parent, the child-parent relationship, and the child—with attention to the accumulated effects of attachment disturbance on social and emotional development.130 Interventions that address the child's and parents' individual needs

Acknowledgments

The authors gratefully acknowledge the indispensable help of Ms. Jaime McCaw in the preparation of this manuscript.

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    This work was financially supported by the Bender-Fishbein Fund, the Sackler Institute for Developmental Psychobiology at Columbia University, and an NIH grant to the first author (K23-MH68405).

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