SPECIAL ARTICLE

Attachment, information processing,

and psychiatric disorder
PATRICIA M. CRITTENDEN
Family Relations Institute,
Miami,
FL 33176, USA
Attachment theory is a theory about protec- These meanings, however, reflect the child’s
tion from danger and the need to find a repro- experience and, therefore, they may not be the
ductive partner (1-4). As a theory of psycho- same meanings and strategies used by the par-
pathology, it is concerned with the effects of ents. Postulating the role of protection and
exposure to danger and the failure to find a sat- reproduction in organizing human behavior
isfying reproductive relationship on mental and permits attachment theorists to interpret psy-
behavioral functioning. When these effects chopathological behavior as maladaptive
extend far beyond the threatening circum- attempts to protect the self or find a reproduc-
stances themselves, they can be considered psy- tive partner.
chopathological. Attachment theory is also a
developmental theory. Thus, unlike other theo-
DEVELOPMENTAL PSYCHOPATHOLOGY
ries of psychological disorder, it traces individu-
als’ developmental pathways from infancy to Attachment theory presumes that the same
adulthood. Indeed, most of the work on attach- developmental processes regulate both norma-
ment has been done in infancy and early child- tive and disordered development. This permits
hood, thus providing a sound developmental the separate bodies of empirical research to be
base from which to understand later pathology. brought together to inform one another (5). The
In addition, the developmental emphasis per- processes of primary interest are: a) the ways in
mits a focus on the interactive outcomes of mat- which the brain transforms sensory stimuli to
urational processes, individual differences in generate meaningful representations of the rela-
genetic inheritance, and individual differences tion of self to context, b) the ways in which the
in experience. The outcomes are individuals’ mind regulates the application of these repre-
strategies for protecting the self and progeny sentations to the organization of behavior, and
and for seeking a reproductive partner. These c) the organizations of self-protective and repro-
strategies, i.e., the patterns of attachment, pro- ductive behavior.
vide both a description of interpersonal behav-
ior and a functional system for diagnosing psy-
The brain and transformations
chopathology. This perspective offers several
advantages for the understanding of psycho- Universal genetic factors, in the context of
pathology. environmental conditions, regulate maturation.
As the brain matures, it becomes capable to
transform incoming sensory stimuli in increas-
INNATE ORGANIZING MOTIVATIONS
ingly sophisticated ways. These permit increas-
Attachment theory proposes that humans ingly complex representation of the relations
have an innate propensity to organize self-pro- between past and future. That is, the only infor-
tectively and, after puberty, sexually. In infancy mation that we have is information about the
and childhood, attachment figures both provide past, whereas the only information that we need
protection and teach children how to make is information about the future. Information
meaning of the information available to their about the past is transformed to yield represen-
minds. After puberty, the protective function is tations of the probable relation of self to context
integrated with the reproductive function and in the future.
both are directed to a sexual partner. This rela- The simplest transformations respond to two
tionship produces the next generation of chil- features of stimuli: the temporal order in which
dren to whom parents will be protective attach- stimulation is received and its intensity. The for-
ment figures. In that role, they act on their own mer yields information about causation and
understanding of what is dangerous and safe, operates according to the principles of behav-
thus creating the environment in which their ioral learning theory. Disorders tied to this
children learn to make self-relevant meanings. transformation include disorders of inhibition

72 World Psychiatry 1:2 - June 2002

and compulsion. The transformation based on intensity or early adulthood can be very complexly distorted pat-
generates feelings and physiological arousal; associative terns of behavior.
learning modifies the eliciting stimuli. The anxiety disor-
ders are associated with too great and too generalized
Self-protective organizations of behavior
arousal. These two transformations can be made at or
before birth. Ainsworth’s classic work identified three basic patterns
More complex representations are generated as the of attachment (7). Type A individuals tend to omit feelings
brain matures; by processing the initial transformation from processing and to act in accordance with expected
through additional parts of the brain, additional meanings consequences. Type C individuals do the opposite: they
are generated. For example, infants can exclude some act in accordance with their feelings with little attention to
information about the past from further processing, thus consequences. Both tend to over-estimate the probability
distorting the representation of the probable future. Young of danger and act in an unnecessarily self-protective man-
children can distort the retained information while con- ner. Type B individuals use both sources of information;
currently excluding some information from representa- they have balanced mental processes and adaptive behav-
tion; the effect is greater distortion of representation than ior. Crittenden (8) has expanded the array of strategies to
was possible in infancy. By the school years, children can include compulsive Type A strategies and obsessive Type
falsify information, that is, they can represent the opposite C strategies. These reflect commonly recognized forms of
of what is expected and, by acting on that representation, maladaptive behavior. They differ from symptom-based
they can mislead others about their future behavior. These diagnoses in that strategies are seen as a functional
sorts of transformations enable individuals to regulate the attempt to reduce danger as represented, albeit erroneous-
probability with which they identify danger. The more an ly, by the individual.
individual feels threatened by imminent and severe dan-
ger, the less error can be tolerated; consequently, distort-
DEVELOPMENTAL PATHWAYS
ing transformations usually increase the probability of
over-identifying danger. Attachment theory addresses the process by which nor-
mal development differentiates into a wide range of
human displays, including those considered psychopatho-
The mind and representation
logical. A particular advantage of this perspective is that
The transformations yield dispositional representa- the most serious disorders of adolescence and adulthood,
tions, i.e., patterns of neurological activity that dispose the personality disorders and psychoses, can be seen as
individuals to act in some manner (6). Depending upon the cumulative effect of a series of developmental trans-
whether the representation is based on temporal order or formations, each of which adds distortion to previously
intensity of stimulation, individuals are disposed to distorted functioning. That is, given numerous branching
behave based on expected consequences or on feelings. points in development, the cumulative effect of always
The various representations that are generated may dis- selecting the distorted pathway leading away from balance
pose an individual to incompatible responses. In that case, and normality will be an array of serious disorders that,
the mind must select which response to enact or construct when viewed only in adulthood, appear incomprehensi-
a new response. This occurs in the cortex, the last portion ble. Following the behavior forward from infancy renders
of the brain to mature fully. the accretion of distortion comprehensible, albeit, in a
When the estimation of danger is very high, individuals person-specific manner.
are propelled into action on the basis of the precortical
representation that signaled threat most clearly. This rep-
Representation as a mediating variable
resentation is likely to be an over-estimation of threat, and
because it has been processed only precortically, the error Recognizing that behavior results from the process of
cannot be discerned or corrected. Thus, behavior will mental representation helps to explain why individuals
often be maladaptive. When this happens sufficiently exposed to similar dangers can have different outcomes
often, it is deemed psychopathological. Because of corti- and why genetically identical individuals exposed to dif-
cal immaturity and greater vulnerability to danger, chil- ferent threats have different outcomes. The representa-
dren are at particular risk for over-attributions of danger tional process, rather than genes or experience directly,
and maladaptive responses. Development promotes the organizes individuals’ behavior. This suggests the need to
correction of these errors, except in cases of severe, on- differentiate between contributing, necessary, and suffi-
going, and deceptive danger. In these cases, the pervasive cient conditions for psychopathology. There is little evi-
and ambiguous nature of threat increases the probability dence that genes alone are sufficient to cause mental ill-
of incompletely processed information regulating behav- ness, nor is it evident that they are an essential condition.
ior. Together with increasingly sophisticated precortical To the contrary, genetic influence more often functions as
distortions of representation, the outcome in adolescence a contributing factor. Neither, however, does experience

73
determine outcomes. Attachment theory, through its have been subjected to different histories of danger as well
emphasis on individual representation of events, suggests as different current exposure to danger, differences in dis-
a process by which similar circumstances could yield dif- tributions of strategies and disorders tied to strategy would
ferent outcomes. Attachment researchers have developed be expected (8).
a series of age-specific assessments to permit researchers
and clinicians to assess individuals’ representations.
OPPOSITE STRATEGIES; OPPOSITE TREATMENTS
In this approach, Type A and C are psychological oppo-
PREVENTION
sites. The transformations that lead to Type A are based on
By tracing developmental pathways indicative of pro- a different characteristic of the incoming signal and are
gressive risk, attachment theory fosters prevention. If risk processed through different parts of the brain than are the
were treated early on, the number of adolescents and transformations associated with Type C. Because they
adults who would experience the late-forming and most result from opposite processes, they are likely to be cor-
severe psychiatric conditions, i.e., personality disorders rected by opposite forms of treatment. For example, a Type
and psychoses, might be reduced. Further, attachment the- A individual might benefit from techniques that focused
ory suggests what sorts of experiences might lead to risk on feeling and somatic representation of feeling, whereas
for psychopathology. this treatment might increase somatic symptoms of stress
in a Type C individual. Similarly, a Type C individual
might benefit from a behavioral approach emphasizing
DISTORTION, STRATEGY, AND MEANING
self-relevant contingencies, whereas this might expand the
When mental transformation and representation are repertoire of compulsive behavior of a Type A person.
viewed developmentally and as self-protective and repro-
ductive strategies, much of the incomprehensible behavior
VALIDITY AND DIRECTIONS FOR FURTHER RESEARCH
of very disturbed adolescents and adults becomes mean-
ingful. For example, delusional behavior can be viewed as Published studies of infants and preschool-aged chil-
a series of small distortions that culminate in a inscrutable dren suggest the validity of attachment theory and its rela-
fantasy. Initially, intense sensory stimulation yields physio- tion to risk for psychiatric disorder. Unfortunately, there is
logical arousal. With repetition, this effect can be augment- little published work using this model with adolescents
ed by increasing attention to more subtle elicitors, includ- and adults.
ing especially somatic feelings. Recalling the experience On the other hand, it is only recently that a suitable tool
can then recreate the physiological state in the absence of has been developed to test hypotheses relating adults’ self-
external stimuli. Next, by imagining possible events that protective attachment strategies and psychiatric disorder.
didn’t actually happen, arousal can be generated and then The Adult Attachment Interview (AAI, 9) has been modi-
maintained or augmented by attentional processes. Finally, fied to permit analysis of a wide range of distortions of
imagining impossible events can yield a delusional reality information processing (10,11). Unpublished dissertation
that feels somatically exactly like reality. At all steps, arous- research using the modified AAI suggests that these dis-
al functions to elicit the motivating affective state that the tortions are associated differentially with several types of
individual feels is necessary for safety. Identifying the psychiatric disorder. In addition, these studies suggest that
process by which layers of distortion are added, in a devel- disorders with different symptoms may sometimes be
opmental sequence tied to brain maturation, has several functionally similar at the levels of distorting transforma-
advantages. It makes maladaptive behavior meaningful; tions and functional self-protective strategy. If this is the
this will help therapists to communicate with patients. It case, treatment might be improved by clustering patients
indicates developmentally earlier points that might be on the basis of these similarities rather than symptom-
open to intervention and prevention. And it suggests new based diagnoses.
approaches to treatment, particularly treatments that
address the strategic function of the distorted process. For
CONCLUSIONS
example, in the case of delusions, treatment might address
both the somatic arousal process and also the subjective Attachment theory focuses on protection and repro-
need to identify every possible source of danger. duction as central organizing functions and on the array
of ways that these may be realized as the interactive out-
come of universal maturational processes, individual
CULTURE AND PSYCHOPATHOLOGY
genetic differences, and unique environmental contexts.
The emphasis on the role of experienced danger permits Its contributions to understanding psychopathology
interpretation of cultural differences in distributions of include a model of functional diagnoses (as opposed to
self-protective (attachment) strategies and prevalence of symptom-based diagnoses), development-based hypothe-
psychiatric disorders. Because different cultural groups ses regarding the relation of childhood experiences to later

74 World Psychiatry 1:2 - June 2002

psychopathology, and an information processing model 6. Damasio AR. Descartes’ error: emotion, reason, and the
with implications for treatment. human brain. New York: Avon Books, 1994.
7. Ainsworth MDS. Infant-mother attachment. Am Psychol
1979;34:932-7.
References
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