A model of dissociation based on attachment theory and research.

The article offers an historical review of studies on the role played by attachment processes in dissociative psychopathology. The treatise proceeds from Bowlby's first insights, through Main and her collaborators' empirical studies on attachment disorganization, to the first formulation of the hypothesis linking disorganized early attachment to pathological dissociation. Recent research supporting the hypothesis is then reviewed. It is concluded that infant attachment disorganization is in itself a dissociative process, and predisposes the individual to respond with pathological dissociation to later traumas and life stressors. Four implications of this theory are interspersed in the review and are discussed in the final section: (1) pathological dissociation should be viewed as a primarily intersubjective reality hindering the integrative processes of consciousness, rather than as an intrapsychic defense against mental pain; (2) early defenses against attachment-related dissociation are based on interpersonal controlling strategies that inhibit the attachment system; (3) dissociative symptoms emerge as a consequence of the collapse of these defensive strategies in the face of events that powerfully activate the attachment system; (4) psychotherapy of pathological dissociation should be a phase-oriented process focused primarily on achieving attachment security, and only secondarily on trauma work. Research studies on the psychotherapy process could test some predictions of this model.