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Disorganised Attachment — MRCPsych Paper B MCQ

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HardPsychotherapyDisorganised AttachmentMRCPsych Paper B

During a Strange Situation reunion, an infant approaches the caregiver but abruptly freezes, averts their gaze while continuing to approach, and displays contradictory approach–avoidance behaviour. The attachment pattern is classified as disorganised/disoriented (Type D). According to Main and Hesse's "fright without solution" account, which caregiver behaviour is most specifically associated with this classification?

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Correct answer: E — Frightened, frightening or dissociative behaviour

The correct answer is E. Main and Hesse proposed that frightened, frightening or dissociative caregiver behaviour can create "fright without solution": activation of the attachment system drives the infant towards the caregiver for safety, while fear of that same caregiver drives avoidance. This incompatible approach–flight tendency is reflected in freezing, apprehension, disorientation and contradictory behaviour. The association is probabilistic rather than diagnostic or inevitably evidence of maltreatment. Consistently sensitive care is associated with secure attachment. Inconsistent availability is more characteristic of ambivalent/resistant attachment, while rejecting or emotionally unavailable care is associated with avoidant strategies. Overprotection may inhibit exploration but is not the caregiver pattern specifically implicated in Main and Hesse's account of Type D attachment.

Reference: British Psychological Society, Incorporating Attachment Theory into Practice: Clinical Practice Guideline for Clinical Psychologists working with People who have Intellectual Disabilities, section 2.1, 2017. https://www.rcpsych.ac.uk/docs/default-source/members/faculties/intellectual-disability/bps-attachment-guidelines.pdf?sfvrsn=a83ef76b_2