As the field of attachment has expanded over the past four decades, the perturbations in the relational context which give rise to disturbances of attachment are increasingly, though by no means conclusively, understood. In Part I, this article reviews the historical and current state of research regarding normative attachment classification, the diagnosis of Reactive Attachment Disorder, and the proposed categories of Secure Base Distortions and Disrupted Attachment Disorder. In Part II, the article explores the role of parental psychopathology and the manner in which disturbed caregiver self-regulation leads to disturbances in the mutual regulation between caregiver and infant. The question of the relationship between particular types of maternal pathology and particular forms of attachment disturbance is examined through recent research on the association between maternal posttraumatic stress disorder (PTSD), Atypical Maternal Behavior, and child scores on the Disturbances of Attachment Interview (DAI). The authors present original research findings to support that the presence and severity of maternal violence-related PTSD were significantly associated with secure base distortion in a community pediatrics sample of 76 mothers and preschool-age children. Clinical implications and recommendations for treatment of attachment disturbances conclude the article.
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