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Biomedical subjects

P Fonagy

Publications and source records attributed to P Fonagy.

At least 19 recordsLinked to original sources
PubMed2006

Factors that predict infant disorganization in mothers classified as U in pregnancy.

The unresolved (U) state of mind in parents has been validated by its association with infant attachment disorganization (D), yet all studies show a transmission gap, and a proportion of individuals classified as U have infants who are not D. This paper reports on 31 mothers who showed the characteristic lapses in thinking and reasoning of the unresolved/disorganized state of mind in relation to stillbirth (U(sb)), when assessed with the Adult Attachment Interview (AAI) in the pregnancy after stillbirth. Seventeen (55%) of their infants were D at 1 year old. We evaluate social, attachment, and psychiatric variables to establish whether there are differences in U(sb) individuals that will predict infant D. In this population of U mothers, social and attachment factors did not predict infant D, but U(sb) mothers of non-D infants showed significantly higher levels of depression and of intrusive thoughts on the posttraumatic stress disorder (PTSD) scale in pregnancy, and showed higher levels of intrusive thoughts when the infant was 1 year old. We discuss possible interpretations of these findings.

Adjustment Disorders↗
PubMed2005

Bridging the transmission gap: an end to an important mystery of attachment research?

The authors provide a context for this special section by arguing that the attachment relationships of infancy fulfil an evolutionary role in ensuring that the brain structures that come to subserve social cognition are appropriately organised and prepared to equip the individual for the collaborative existence with other people for which his or her brain was designed. Processes as fundamental as gene expression or changes in receptor densities can be seen as direct functions of the extent of understanding of mental states provided by the caregiving environment. If the attachment relationship is indeed a major organiser of brain development, it is even more important to understand the processes that underpin the transgenerational transmission of attachment patterns. The contributions of the papers in the special section to understanding the role of reflective function in the development of attachment and social cognition are reviewed, and the implications for the development of both theory and practice are explored.

Adult↗
PubMed2004

Factors associated with the unresolved classification of the Adult Attachment Interview in women who have suffered stillbirth.

The "unresolved" state of mind with respect to loss or trauma as assessed in the Adult Attachment Interview is common in clinical and forensic groups, as well as in mothers whose infants are classified as disorganized in their attachment relationship to them. However, questions remain about what the unresolved state represents and what factors predict the unresolved state. This case controlled study reports on 64 women who had suffered stillbirth and who were pregnant with their next child. The study explores attachment, psychiatric, and social factors associated with the unresolved state or higher unresolved scores with respect to stillbirth. Women who had experienced stillbirth were more likely to be unresolved than control women. Although a similar number of stillbirth and control women had experienced childhood trauma, only women who had experienced stillbirth were unresolved with respect to this trauma, suggesting the unresolved state may be evoked or reevoked by subsequent traumatic loss. Higher unresolved scores in relation to stillbirth were predicted by childhood trauma, poor support from family after the loss, and having a funeral for the infant. The results are discussed in terms of the woman's sense of being causal in the loss.

Adaptation, Psychological↗
PubMed2001

Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up.

OBJECTIVE: The aim of this study was to determine whether the substantial gains made by patients with borderline personality disorder following completion of a psychoanalytically oriented partial hospitalization program, in comparison to patients treated with standard psychiatric care, were maintained over an 18-month follow-up period. METHOD: Forty-four patients who participated in the original study were assessed every 3 months after completion of the treatment phase. Outcome measures included frequency of suicide attempts and acts of self-harm, number and duration of inpatient admissions, service utilization, and self-reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment. RESULTS: Patients who completed the partial hospitalization program not only maintained their substantial gains but also showed a statistically significant continued improvement on most measures in contrast to the patients treated with standard psychiatric care, who showed only limited change during the same period. CONCLUSIONS: The superiority of psychoanalytically oriented partial hospitalization over standard psychiatric treatment found in a previous randomized, controlled trial was maintained over an 18-month follow-up period. Continued improvement in social and interpersonal functioning suggests that longer-term changes were stimulated.

Borderline Personality Disorder↗
PubMed2001

Creating a peaceful school learning environment: a controlled study of an elementary school intervention to reduce violence.

OBJECTIVE: The impact of a manual-based antiviolence program on the learning climate in an elementary school over 4 years was compared with the outcome in a control school. METHOD: The two schools were matched for demographic characteristics. The intervention in the experimental school was based on zero tolerance for bullying; the control school received only regular psychiatric consultation. Disciplinary and academic achievement data were collected in both schools. RESULTS: The experimental school showed significant reductions in discipline referrals and increases in scores on standardized academic achievement measures. CONCLUSIONS: A low-cost antiviolence intervention that does not focus on individual pathology or interfere with the educational process may improve the learning environment in elementary schools.

Achievement↗
PubMed2001

A model for brief assessment of attachment and its application to women in inpatient treatment for trauma-related psychiatric disorders.

We adapted self-report measures of attachment style to the psychological assessment of women in specialized inpatient treatment for trauma-related disorders. The study employed 2 measures of adult attachment style, the Relationship Questionnaire (Bartholomew & Horowitz, 1991) and the Adult Attachment Scale (Collins & Read, 1990) as well as our Current Attachment Relationships questionnaire, which assesses the extent of social support in secure attachments. We administered these measures to 99 patients and to a convenience sample of 154 women in the community. We found modest correspondence between the 2 attachment style measures and substantial relations between attachment styles and range of secure attachment relationships. Women in the trauma sample reported insecure attachment styles and relatively few secure attachment figures. We discuss the implications of these findings for clinical assessment.

Adult↗
PubMed2001

Experimental protocols for investigating relationships among mother-infant interaction, affect regulation, physiological markers of stress responsiveness, and attachment.

Gergely and Watson's (1996) social biofeedback theory of parental affect mirroring applies the conditional probability model of contingency perception to parent-child interactions. Infants are first evaluated at birth on neurological and temperament measures. Infants are also evaluated at 6 and 12 months on tasks that study social interactional determinants, infant attachment, and physiological reactions. The Strange Situation is completed at 12-15 months of age. The authors describe how the combination of these experimental and observational procedures allows specific developmental hypotheses to be investigated about the quality of contingent parental affect regulation, sensitivity to internal states, and security of attachment.

Affect↗
PubMed2001

The human genome and the representational world: the role of early mother-infant interaction in creating an interpersonal interpretive mechanism.

The author discusses the interrelationship of genetic predisposition, experiences in the first 3 years of life, and psychological disturbance in later development. The current emphasis on genetic determinism has led to the popular misconception that early relationships with caregivers play a relatively minor role in the development of mental disorder. The author argues that early attachment relationships matter because the mental mechanism moderating the expression of individual genotypes is intrinsically linked to the relationship with the primary caregiver. Attachment in infancy has the primary evolutionary function of generating a mind capable of inferring things about other people's minds, their thoughts, ideas, motivations, and intentions. The child needs to be able to make these inferences to arrive at a representation of the self in terms of a set of stable and generalized intentional attributes. Awareness of others' thoughts and feelings is necessary to ensure social collaboration. This formulation underscores the vital importance of parent training for the normal emotional and cognitive development of a child and the prevention of major psychological disturbance.

Adolescent↗
PubMed2001

Disorganised attachment behaviour among infants born subsequent to stillbirth.

There is limited evidence that siblings of stillborn infants are more vulnerable to psychological problems. This case-controlled study examines the relationship between previous stillbirth and the next child's pattern of attachment and explores factors in the mother which may be associated with and which may explain the pattern of infant attachment. We examined 53 infants next-born after a stillbirth, and 53 control infants of primigravid mothers. Maternal demographic, psychiatric, and attachment data were collected in pregnancy, and self-report measures of depression collected in the first year. Infant attachment patterns to the mothers were assessed when the infants were 12 months old using the Ainsworth Strange Situation Procedure. Infants next-born after stillbirth showed significant increase in disorganisation of attachment to the mother compared with control infants (p < .04). The difference was not accounted for by differences in psychiatric symptoms or demography. It was strongly predicted by maternal unresolved status with respect to loss as measured in the Adult Attachment Interview, and less strongly by maternal experience of elective termination of pregnancy and by the mother having seen her stillborn infant. The study adds weight to previously reported clinical observations, that infants born after stillbirth may be at risk of an increase in psychological and behavioural problems in later childhood. The strong association between disorganisation of infant attachment and maternal state of mind with respect to loss suggests that the mother's state of mind may be causal, and raises interesting questions about the mechanism of intergenerational transmission. Given the existing evidence of later developmental problems, longer-term follow-up of these children would be valuable.

Adult↗
PubMed2000

Attachment and borderline personality disorder. A theory and some evidence.

An attachment theory approach to severe personality disorder is described. Evidence is presented that suggests that representations of attachment relationships and attachment behaviors of patients with this diagnosis are commonly disorganized in character. It is argued that the capacity to develop mental representations of mental states in self and other (reflective function) develops in the context of attachment relationships and that disorganization of attachment undermines this process. Such disorganization can be associated with trauma but may also be linked to other biological and psychosocial deficits. Many of the clinical characteristics of patients with borderline personality disorder may be seen as consequences of disordered self-organization and a limited rudimentary capacity to think about behavior in mental state terms. The relevance of this model for the practice of psychotherapy with this group of patients is discussed.

Adult↗
PubMed2000

The place of psychodynamic theory in developmental psychopathology.

Psychoanalysis ushered in this century. Will its influence on developmental psychopathology end in the next? The paper explores some critical obstacles in the way of psychodynamic research, including the fragmentation of psychoanalytic theory. the relative independence of theory from its clinical and empirical base, the predominance of inductive scientific logic, the polymorphous use of terms, the privacy of clinical data, the dominance of the reconstructionist stance, and the isolation of psychoanalysis from psychology and neurobiology. Notwithstanding these limitations, core psychoanalytic precepts are not only consistent with some of the most important advances of the last decade but may also be helpful in elaborating these new discoveries in the next century. Psychoanalysis is centered on the notion that complex, conflicting, unconscious representations of mental states constitute a key facet of normal and abnormal development. This notion retains its power, and deserves a prominent position among the major frames of reference to guide developmental science in the next century.

Child↗
PubMed2000

Attachment and borderline personality disorder.

The author outlines his concept of reflective function or mentalization, which is defined as the capacity to think about mental states in oneself and in others. He presents evidence to suggest that the capacity for reflective awareness in a child's caregiver increases the likelihood of the child's secure attachment, which in turn facilitates the development of mentalization in the child. He proposes that a secure attachment relationship offers the child a chance to explore the mind of the caregiver, and in this way to learn about minds; he formulates this model of the birth of the psychological self as a variation on the Cartesian cogito: "My caregiver thinks of me as thinking and therefore I exist as a thinker." This model is then applied to provide insight into some personality-disordered individuals who were victims of childhood abuse. The author proposes (1) that individuals who experience early trauma may defensively inhibit their capacity to mentalize to avoid having to think about their caregiver's wish to harm them; and (2) that some characteristics of severe borderline personality disorder may be rooted in developmental pathology associated with this inhibition. He offers evidence for and some qualifications of this model, and argues that the therapeutic effect of psychoanalysis depends on its capacity to activate patients' ability to evolve an awareness of mental states and thus find meaning in their own and other people's behavior.

Adult↗
PubMed2000

Cassel Personality Disorder Study. Methodology and treatment effects.

BACKGROUND: The effectiveness of hospital-based treatment models for personality disorder is still uncertain. AIMS: To compare effectiveness of two models of psychosocial intervention for personality disorder. METHOD: Two samples of people with personality disorder allocated to a one-stage treatment model (in-patient treatment with no after care) and to a two-stage model (shorter in-patient admission followed by outreach therapy) are prospectively compared. RESULTS: Subjects in the two-stage sample did significantly better on global assessment of mental health (according to the Global Assessment Score (GAS)) at 6 and 12 months and on social adjustment (according to the Social Adjustment Scale (SAS)) at 12 months. Significant differences in rates of reliable improvement on the GAS (43% v. 17%) and SAS (39% v. 15%) in favour of the two-stage condition were found at 12 months. Subjects with borderline personality disorder (BPD) allocated to the two-stage model improved significantly more than such patients in the one-stage model. CONCLUSIONS: A long-term phased model which combines hospital-based and community-based strategies has advantages over a purely in-patient model for the treatment of BPD.

Adult↗
PubMed2000

Effectiveness of psychotherapeutic treatment of personality disorder.

BACKGROUND: Psychiatrists have been criticised for failing to develop adequate treatment for personality disorder. Psychotherapeutic treatments are promising, but their effectiveness is uncertain. AIMS: To investigate the evidence for effectiveness of psychotherapeutic treatment for personality disorder. METHOD: Systematic literature review. RESULTS: There is evidence for the effectiveness of psychotherapy for personality disorder. Problems of case identification, comorbidity, randomisation, specificity of treatment and outcome measurement are inadequately addressed. Authors mainly relied on cohort studies. Evidence neither suggests superiority of one type of therapy over another nor indicates which subgroups of patients should be offered psychotherapy as in-patient, day patient, or out-patient. CONCLUSIONS: New research strategies are needed to show that personality change is both measurable and clinically meaningful. Effectiveness studies using randomised controlled designs are required. The literature suggests that effective treatment should be long-term, integrated, theoretically coherent and focused on compliance.

Cohort Studies↗
PubMed2000

Playing with reality: III. The persistence of dual psychic reality in borderline patients.

This paper is a contribution towards understanding the difficulties of severely borderline patients as they are uncovered within the psychoanalytic process. The authors aim to extend a model from previous papers, bringing a developmental perspective to bear on self-representation and self-organisation. This model rests on an understanding of the child's experience of psychic reality in both normal and neurotic people. The authors explore the relevance of these developmental ideas in thinking about severe borderline and related disturbances seen in adult patients, from the point of view of both understanding the pathology and considering technique. Illustrations are given from a case that helped to prompt the formulation of these states in terms of persistent, pervasive distortions of the experience of psychic reality. There is then an attempt to elucidate the difficulties of borderline patients in tolerating both separation and intimacy, consideration of the way in which bodily experiences may be used as an equivalent of mental experience or contact, and a discussion of the impact of disturbances in the experience of psychic reality on the analytic process.

Adult↗
PubMed2000

Lives through time: an ideographic approach to the study of resilience.

The authors describe and illustrate an ideographic method for the study of resilience. The method assumes that resilience is an unfolding and dynamic process in which the individual and the social environment interact to produce a life course over time. Using retrospective and prospective data, the authors present a case study of a profoundly troubled boy, first seen as a preschooler and then followed up in early adulthood with a battery of clinical interviews. The methodology presented provides a way to study resilience as a dynamic process and to reveal and make sense of counterintuitive findings. In contrast to historical or epidemiological methods, the approach also permits exploration of the role of intrapsychic processes in facilitating change.

Adaptation, Psychological↗