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Cited by 334Attachment and Relationship DynamicsPsychoanalysis and Psychopathology ResearchChild Abuse and Trauma

INTERGENERATIONAL TRANSMISSION OF ATTACHMENT IN ABUSED AND NEGLECTED MOTHERS: THE ROLE OF TRAUMA-SPECIFIC REFLECTIVE FUNCTIONING: Attachment, Reflective Function, and Trauma

Berthelot, Nicolas, Ensink, Karin, Bernazzani, Odette, Normandin, Lina, Luyten, Patrick, Fonagy, Peter·2015·Infant Mental Health Journal
DOI 10.1002/imhj.21499
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Abstract

There are still important gaps in our knowledge regarding the intergenerational transmission of attachment from mother to child, especially in mothers with childhood histories of abuse and neglect (CA&N). This study examined the contributions of reflective function concerning general attachment relationships, and specifically concerning trauma, as well as those of maternal attachment states of mind to the prediction of infant attachment disorganization in a sample of mothers with CA&N and their infants, using a 20-month follow-up design. Attachment and reflective functioning were assessed during pregnancy with the Adult Attachment Interview. Infant attachment was evaluated with the Strange Situation Procedure. The majority (83%) of infants of abused and neglected mothers were classified as insecure, and a significant proportion (44%) manifested attachment disorganization. There was a strong concordance between mother and child attachment, indicative of intergenerational transmission of attachment in parents with CA&N and their infants. Both unresolved trauma and trauma-specific reflective function made significant contributions to explaining variance in infant attachment disorganization. The findings of this study highlight the importance of trauma-specific mentalization in the intergenerational transmission of attachment by mothers with a history of childhood maltreatment, and provide new evidence of the importance of the absence of mentalization regarding trauma for infant attachment.

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Written from the paper’s full text.

TL;DR

In 57 mothers with childhood abuse and neglect (CA&N) and their infants, 83% of infants were insecure and 44% were disorganized; maternal unresolved trauma and trauma-specific reflective functioning (RF-T) each predicted infant attachment disorganization. RF-T, but not general reflective functioning, added unique prediction, suggesting trauma-specific mentalization is important in intergenerational transmission.

Key findings

  • Of 57 infants, 83% (n = 47) were insecure and 44% (n = 25) were disorganized. Mothers’ Adult Attachment Interview classifications were 32% secure (n = 18), 21% dismissing (n = 12), 5% preoccupied (n = 3), and 42% unresolved (n = 24). Mother–infant concordance was 72% for secure/insecure, χ²(1) = 4.53, p = .03, and 70% for disorganization, χ²(1) = 8.76, p = .003.
  • In hierarchical logistic regression, unresolved trauma alone accounted for 22% of variance in infant disorganization, χ²(1) = 6.67, p = .01. Adding RF-T produced a significant model, χ²(2) = 13.53, p = .001, accounting for 41% of variance, with both unresolved trauma and RF-T independently contributing. With RF-G instead of RF-T, the model was significant, χ²(2) = 7.09, p = .03, but only unresolved trauma predicted infant disorganization.
  • Mothers with low RF-T were 3.43 times more likely to have infants with disorganized attachment than mothers with high RF-T. A dose-response analysis found more maltreatment types predicted unresolved status, β = 1.14, Wald = 9.59, p < .01, OR = 3.13, but not RF-T, RF-G, or infant disorganization.

Methods

  • Prospective 20-month follow-up using a subset of a longitudinal study. Of 809 women screened with the Parental Bonding Instrument, 173 scored below the care cutoff; 100 were interviewed in the third trimester with the Childhood Experience of Care and Abuse interview and Adult Attachment Interview; 57 mother–infant dyads completed the Strange Situation Procedure at approximately 17 months. Mothers ranged from 19 to 41 years (M = 28.77, SD = 5.57); 78% were Caucasian, and 52% had annual family income below CAN$30,000.
  • Measures included the PBI for screening, CECA for abuse/neglect, AAI for attachment states of mind and reflective functioning, RF-T rated from AAI passages where abuse was probed or discussed using an RF-T addendum, and SSP for infant attachment. Analyses used chi-square tests for concordance, dose-response analysis, and hierarchical binary logistic regression predicting organized versus disorganized infant attachment.

Limitations

  • Stated: the sample of 57 mother–infant dyads, though large relative to related studies, would need to be larger to eliminate possible type 2 errors; few mothers had antipathy and neglect without other abuse, limiting power to examine other maltreatment types; retrospective self-reports of childhood maltreatment may have recall biases; and the suggested causal relationship remains hypothetical.
  • Evident from the text: RF-T could only be coded for childhood abuse, not neglect or other potentially traumatic incidents, because the AAI provides detailed abuse questions but not comparable questions for neglect or other trauma. The sample is also specific to high-risk mothers with CA&N, mostly Caucasian and low-income, so generalizability beyond this population is not established in the paper.

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Crossref · 10.1002/imhj.21499

Cites

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Claims the paper makes

0 of 41 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Abstract · p. 2

    In the sample, 44% of infants manifested attachment disorganization.

    “a significant proportion (44%) manifested attachment disorganization”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Abstract · p. 2

    There was a strong concordance between mother and child attachment in parents with CA&N and their infants.

    “There was a strong concordance between mother and child attachment, indicative of intergenerational transmission of attachment in parents with CA&N and their infants.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Abstract · p. 2

    In the sample of abused and neglected mothers and their infants, 83% of infants were classified as insecure.

    “The majority (83%) of infants of abused and neglected mothers were classified as insecure”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Relationship between adult attachment, reflective function, and infant attachment · p. 19

    Mothers with low RF-T were 3.43 times more likely to have infants with attachment disorganization than were mothers with histories of trauma but high RF-T.

    “Mothers with low RF-T were 3.43 times more likely to have infants with attachment disorganization than were mothers with histories of trauma but high RFT.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Relationship between adult attachment, reflective function, and infant attachment · p. 19

    Mothers with histories of sexual and/or physical abuse and high RF-T predominantly had infants with organized attachment strategies during the SSP.

    “Figure 1 shows that mothers with histories of sexual and/or physical abuse and high RF-T predominantly had infants with organized attachment strategies during the SSP.”
    Quote in the paperSubstantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 36
  • The quote only partly states this claim. 2

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    Findingown data
    § Abstract · p. 2

    Both unresolved trauma and trauma-specific reflective function made significant contributions to explaining variance in infant attachment disorganization.

    “Both unresolved trauma and trauma-specific reflective function made significant contributions to explaining variance in infant attachment disorganization.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Discussion · p. 21

    Mentalization regarding trauma, but not mentalization about attachment relationships, predicted infant attachment disorganization.

    “Furthermore, mentalization regarding trauma, but not mentalization about attachment relationships, predicted infant attachment disorganization.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Preliminary analyses · p. 18

    There were no significant associations between infant attachment disorganization and socio-demographic characteristics.

    “Similarly, there were no significant associations between infant attachment disorganization and socio-demographic characteristics.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Participants · p. 10

    The majority (73%) of the sample reported marked maltreatment of at least one type.

    “The majority (73%) reported marked maltreatment of at least one type.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Preliminary analyses · p. 18

    Of the 57 mothers with histories of abuse or neglect, 32% (n = 18) were classified as secure, 21% (n = 12) as dismissing, 5% (n = 3) as preoccupied, and 42% (n = 24) as unresolved.

    “Of the 57 mothers with histories of abuse or neglect, 32% ( n = 18) were classified as secure, 21% ( n = 12) as dismissing, 5% ( n = 3) as preoccupied, and 42% ( n = 24) as unresolved.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Preliminary analyses · p. 18

    Fisher's exact test showed that there were no statistically significant relationships between infant attachment security and demographic variables such as education (p = .76), annual earnings (p = .17), or marital status (p = .12).

    “Fisher's exact test showed that there were no statistically significant relationships between infant attachment security and demographic variables such as education ( p = .76), annual earnings ( p = .17), or marital status ( p = .12).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Participants · p. 10

    In the sample, 58% reported physical abuse, 39% sexual abuse, 79% neglect, and 86% antipathy from a parental figure.

    “58% reported physical abuse, 39% sexual abuse, 79% neglect, and 86% antipathy from a parental figure.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Preliminary analyses · p. 18

    One-way analysis of variance revealed no significant differences in infant attachment security related to maternal age.

    “Furthermore, one-way analysis of variance revealed no significant differences in infant attachment security related to maternal age.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data
    § References · p. 37

    General reflective functioning (RF-G) did not significantly predict infant disorganized attachment, B=.40, SE=.40, Wald=.98, ns.

    “RF-G | .40 | .40 | .98 |”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § References · p. 36

    Among mothers classified as non-unresolved, 8 of 33 (24%) infants were classified as secure.

    “| Secure | 6 | (33) | 4 | (10) | 2 | (8) | 8 | (24)”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § References · p. 35

    In the current sample, 9 infants (16%) were classified as ambivalent.

    “| Ambivalent | 9 (16%) | 182 (9%) | 24 (15%) |”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § References · p. 36

    Among mothers classified as secure, 6 of 18 (33%) infants were classified as secure.

    “| Secure | 6 | (33) | 4 | (10) | 2 | (8) | 8 | (24)”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingown data
    § References · p. 36

    Among mothers classified as insecure, 4 of 39 (10%) infants were classified as secure.

    “| Secure | 6 | (33) | 4 | (10) | 2 | (8) | 8 | (24)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Intergenerational transmission of attachment: from maternal unresolved trauma to infant disorganized attachment · p. 4

    These disorganized behaviours are considered to reflect an approach/avoidance conflict and the absence of an organized strategy to deal with stress.

    “These behaviours are considered to reflect an approach/avoidance conflict and the absence of an organized strategy to deal with stress”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation
    § Intergenerational transmission of attachment: from maternal unresolved trauma to infant disorganized attachment · p. 4

    Infants with attachment disorganization display apprehension toward the caregiver and contradictory, interrupted, stereotypic, or dissociated behaviours when their attachment system is activated.

    “Infants with attachment disorganization display apprehension toward the caregiver and contradictory, interrupted, stereotypic, or dissociated behaviours when their attachment system is activated”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Main & Solomon, 1990

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Intergenerational transmission of attachment: from maternal unresolved trauma to infant disorganized attachment · p. 4

    These behaviours are thought to develop as a result of parent-child interactions in which the parent's reactions evoke fear in the infant, or the infant's behaviours evoke fear in the parent.

    “and are thought to develop as a result of parent-child interactions in which the parent's reactions evoke fear in the infant, or the infant's behaviours evoke fear in the parent”
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    • cites Barnett & Vondra, 1999

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    • cites Lyons-Ruth, Bronfman, & Parsons, 1999

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    • cites Main & Hesse, 1990

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    Premisecitation
    § Intergenerational transmission of attachment: from maternal unresolved trauma to infant disorganized attachment · p. 4

    The rate of infant attachment disorganization in nonclinical middle-class samples is relatively low (15%).

    “While the rate of infant attachment disorganization in nonclinical middle-class samples is relatively low (15%)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites van IJzendoorn et al., 1999 source

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    Premisecitation
    § Reflective functioning · p. 6

    Parental mentalization mediated the transmission of attachment.

    “Slade (2005) developed a methodology for assessing parental mentalization about the child and showed that parental mentalization mediated the transmission of attachment (Slade et al., 2005).”
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    • cites Slade et al., 2005

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    Premisecitation
    § Reflective functioning · p. 6

    Mothers' appropriate mind-related comments when interacting with their infants predicted attachment security.

    “Meins' findings that mothers' appropriate mindrelated comments when interacting with their infants predicted attachment security”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Meins, 2013 source

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    • cites Meins, Fernyhough, Fradley & Tuckey, 2001

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    Premisecitation
    § Intergenerational transmission of attachment: from maternal unresolved trauma to infant disorganized attachment · p. 4

    Very high rates of infant attachment disorganization have been reported in maltreated infants (77-90%).

    “very high rates have been reported in maltreated infants (77-90%)”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Barnett, Ganiban, & Cicchetti, 1999

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    • cites Carlson, Cicchetti, Barnett & Braunwald, 1989 source

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    • cites Cicchetti, Rogosch, & Toth, 2006 source

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    Premisecitation
    § Reflective functioning · p. 6

    The relationship between parental RF and infant attachment disorganization was mediated by atypical parental behaviours during interaction with their infants.

    “Grienenberger et al. (2005) showed that the relationship between parental RF and infant attachment disorganization was mediated by atypical parental behaviours during interaction with their infants.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Grienenberger et al. (2005) source

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    Premisecitation
    § Reflective functioning · p. 7

    Good mentalization capacities are theorized to be at the core of resilience processes following abuse and neglect.

    “good mentalization capacities are theorized to be at the core of resilience processes following abuse and neglect”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Allen, 2013

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    • cites Berthelot, Ensink, & Normandin, 2013a,b

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    • cites Fonagy, Gergely, Jurist, & Target, 2002

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    Premisecitation
    § Intergenerational transmission of attachment: from maternal unresolved trauma to infant disorganized attachment · p. 6

    The mechanisms underlying the association between maternal unresolved trauma and infant disorganized attachment remain inadequately understood.

    “the mechanisms underlying the association between maternal unresolved trauma and infant disorganized attachment remain inadequately understood (Madigan, Bakermans-Kranenburg, van IJzendoorn, Moran, Pederson, & Benoit, 2006).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Madigan, Bakermans-Kranenburg, van IJzendoorn, Moran, Pederson, & Benoit, 2006 source

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  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given
    § Reflective functioning · p. 7

    In the context of CA&N, mentalization regarding trauma may be expected to be particularly important for the regulation of affects such as fear, anger and vulnerability.

    “In the context of CA&N, mentalization regarding trauma may be expected to be particularly important for the regulation of affects such as fear, anger and vulnerability”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation
    § Reflective functioning · p. 7

    The mother's capacity to mentalize and think of early attachment relationships in mental-state terms accounted for the link between the mother's attachment representations and infant attachment; all those with high levels of mentalization had securely attached infants, while the vast majority of those with low levels of mentalization had insecure infants.

    “Fonagy et al. (1994) found that the mother's capacity to mentalize and think of early attachment relationships in mental-state terms accounted for the link between the mother's attachment representations and all those with high levels of mentalization had securely attached infants, while the vast majority of those with low levels of mentalization had insecure infants.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Fonagy et al. (1994) source

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    Interpretationown data
    § Discussion · p. 20

    Together, these findings suggest that many mothers with CA&N struggle to respond adequately to their infant's attachment needs and foster the development of secure and organized attachments.

    “Together, these findings suggest that many mothers with CA&N struggle to respond adequately to their infant's attachment needs and foster the development of secure and organized attachments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Measures · p. 11

    The psychometric properties of the PBI have been shown to be good.

    “The psychometric properties of the instrument have been shown to be good (Kay, Niven, Parker, & Hadzi-Pavlovic, 2005; Parker, 1989; Safford, Alloy, & Pieracci, 1997).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Kay, Niven, Parker, & Hadzi-Pavlovic, 2005

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    • cites Parker, 1989

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    • cites Safford, Alloy, & Pieracci, 1997

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    Premisecitation
    § Measures · p. 11

    Low parental care has been shown to be associated with abuse.

    “low parental care has been shown to be associated with abuse (Cosden & Cortez-Ison, 1999).”
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    • cites Cosden & Cortez-Ison, 1999

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    § Measures · p. 11

    The CECA has shown good psychometric properties.

    “The CECA has shown good psychometric properties (Bifulco et al., 1994).”
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    • cites Bifulco et al., 1994 source

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    Premisecitation
    § Measures · p. 12

    Studies using severe versus non-severe CECA criteria indicate that women who have experienced severe abuse are at significantly higher risk for depression, although women who had experienced 'some' abuse were also at elevated risk of depression.

    “Studies using these criteria indicate that women who have experienced severe abuse are at a significantly higher risk for depression, although women who had experienced 'some' abuse according to CECA criteria were also at an elevated risk of depression (Bifulco & Moran, 1998).”
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    • cites Bifulco & Moran, 1998

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    § Measures · p. 14

    The RF coding system has been demonstrated to have good psychometric properties.

    “The RF coding system has been demonstrated to have good psychometric properties (Fonagy et al., 1998; Taubner et al., 2013).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Fonagy et al., 1998

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    • cites Taubner et al., 2013 source

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    Study design and conductnone given
    § Measures · p. 14

    In the present study, RF was rated by two qualified raters who were trained by the developers of the RF coding system and have more than 10 years of experience in rating RF of adults, parents and children.

    “In the present study, RF was rated by two qualified raters who were trained by the developers of the RF coding system and have more than 10 years of experience in rating RF of adults, parents and children.”
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    Premisecitation
    § Measures · p. 16

    The SSP is widely used and its validity has been demonstrated in major long-term studies.

    “The SSP is widely used and its validity has been demonstrated in major long-term studies (Sroufe, 2005).”
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    • cites Sroufe, 2005 source

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    Study design and conductnone given
    § Measures · p. 14

    The coder was blind to abuse and neglect as assessed by the CECA, to the goal of the study, and to the composition of the sample.

    “The coder was blind to abuse and neglect as assessed by the CECA, to the goal of the study, and to the composition of the sample.”
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    Study design and conductnone given
    § Measures · p. 14

    In the present study, transcripts were coded by a rater who was trained to reliably adhere to the coding standards of the Berkeley laboratory of Mary Main and Erik Hesse.

    “In the present study, transcripts were coded by a rater who was trained to reliably adhere to the coding standards of the Berkeley laboratory of Mary Main and Erik Hesse.”
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    Study design and conductnone given
    § Measures · p. 15

    RF raters were blind to other measures.

    “RF raters were blind to other measures.”
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    Study design and conductown data
    § Measures · p. 16

    In this sample, 50% of the tapes were double coded with 100% agreement for the organized attachment classifications and 97% agreement for infant attachment disorganization.

    “In this sample, 50% of the tapes were double coded with 100% agreement for the organized attachment classifications and 97% agreement for infant attachment disorganization.”
    Quote in the paperNot a substantial claim

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    Study design and conductown data
    § Measures · p. 16

    After 9 hours of training, excellent agreement between raters was achieved. The four raters then rated 20 protocols; the intraclass correlation between the four raters was .87, suggesting excellent reliability.

    “After 9 hours of training, excellent agreement between raters was achieved. The four raters then rated 20 protocols; the intraclass correlation between the four raters was .87, suggesting excellent reliability.”
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    Premisecitation
    § Measures · p. 13

    Studies suggest that the AAI has good psychometric properties, as evidenced by high test-retest reliability, validity, and stability over time.

    “Studies suggest that the AAI has good psychometric properties, as evidenced by high testrest reliability, validity, and stability over time (Bakermans-Kranenburg & van IJzendoorn, 1993;”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Bakermans-Kranenburg & van IJzendoorn, 1993

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    • cites Benoit & Parker, 1994

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    Study design and conductown data
    § Procedure · p. 9

    There were no significant differences between mothers who agreed to participate in the second assessment and those who refused in terms of security of attachment, presence of unresolved trauma or loss, reflective functioning, or socio-demographic characteristics such as age, education and annual income.

    “However, there were no significant differences between mothers who agreed to participate and those who refused in terms of security of attachment,  2 (1, N = 100) = 1.67, p = .20, the presence of unresolved trauma or loss,  2 (1, N = 100) = 1.48, p = .22, reflective functioning, t (98) = 0.10, p = .92, or socio-demographic characteristics such as age, t (93) = -0.64, p = .53, education ( p = .39”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § Discussion · p. 22

    For parents with CA&N, mentalization regarding trauma may be particularly important for the monitoring and regulation of their own reactions of distress, helplessness, or fear when faced with infant distress, and may allow them to prioritize and respond to the distress and needs of the infant.

    “For parents with CA&N, mentalization regarding trauma may be particularly important for the monitoring and regulation of their own reactions of distress, helplessness, or fear when faced with infant distress, and may allow them to prioritize and respond to the distress and needs of the infant.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data
    § Discussion · p. 22

    It is not the experience of trauma per se, but the absence of mentalization regarding trauma that underlies the risk of infant attachment disorganization.

    “This highlights the importance of trauma-specific mentalization and suggests that it is not the experience of trauma per se, but the absence of mentalization regarding trauma that underlies the risk of infant attachment disorganization.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Discussion · p. 24

    The study had a prospective design and used state of the art measures of attachment in mothers and infants.

    “While this study has several strengths, such as a prospective design and the use of state of the art measures of attachment in mothers and infants”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Discussion · p. 24

    The sample size was 57 mother-infant dyads, which was rather large in comparison to related studies.

    “even though our sample size of 57 mother-infant dyads was rather large in comparison to related studies (Fonagy et al., 1994; Slade et al., 2005; Suchman et al., 2010; van IJzendoorn, 1995)”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Fonagy et al., 1994 source

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    • cites Slade et al., 2005

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    • cites Suchman et al., 2010 source

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    Interpretationnone given
    § Discussion · p. 24

    The causal relationship suggested between the variables under study remains hypothetical.

    “Finally, the causal relationship suggested between the variables under study remains hypothetical.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § Discussion · p. 22

    This suggests that mentalization is not necessarily determined by the characteristics of trauma, nor is there a direct link between exposure to trauma per se and infant attachment.

    “This suggests that mentalization is not necessarily determined by the characteristics of trauma, nor is there a direct link between exposure to trauma per se and infant attachment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning
    § Discussion · p. 22

    The findings of the present study provide further support for Fonagy's (1993) conceptualization of the 'ghosts in the nursery' as an absence, and clarifies that it is not an absence of mentalization per se, but more specifically an absence of mentalization regarding trauma that has the most important implications.

    “The findings of the present study provide further support for Fonagy's (1993) conceptualization of the 'ghosts in the nursery' as an absence, and clarifies that it is not an absence of mentalization per se, but more specifically an absence of mentalization regarding trauma that has the most important implications.”
    Quote in the paperSubstantial claim
47 of 47

  • The paper relies on this without support.

    There is a relative absence of research on the intergenerational transmission of attachment in mothers with CA&N.

    “At this stage however, there is a relative absence of research on the intergenerational transmission of attachment in mothers with CA&N.”

  • The paper relies on this without support.

    There is an absence of research on the relationship between maltreatment, attachment, and reflective function.

    “given the absence of research on the relationship between maltreatment, attachment, and reflective function, we used the lower CECA cut-off”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Maternal unresolved state of mind regarding the trauma and low reflective functioning about the trauma independently contributed to infant disorganization of attachment.

    “Furthermore, they found that maternal unresolved state of mind regarding the trauma and low reflective functioning about the trauma independently contributed to infant disorganization of attachment.”

    From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Berthelot et al., 2015

  • Children of abused and neglected mothers were classified as insecure in 83% of cases and disorganized in almost half of the cases, with high concordance between maternal and child attachment.

    “Further support came from a recent study (Berthelot et al., 2015) that found that children of abused and neglected mothers were classified as insecure in 83% of cases and disorganized in almost half of the cases, with high concordance between maternal and child attachment.”

    From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Berthelot et al., 2015

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(98) = 0.1reported p = .92 · recomputed p = .921

    “t (98) = 0.10, p = .92”

  • Consistentt(93) = -0.64reported p = .53 · recomputed p = .524

    “t (93) = -0.64, p = .53”

  • Consistentt(35) = 0.48reported p = .64 · recomputed p = .634

    “t (35) = 0.48, p = .64”

  • Consistentt(55) = 0.43reported p = .67 · recomputed p = .669

    “t (55) = 0.43, p = .67”

4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Secure/insecure concordant dyads total 41, not 42

    Minor

    Table 2 shows 6 dyads in which both mother and infant were secure and 35 in which both were insecure. These sum to 41 concordant dyads, not the reported 42.

    Reported 42 · recomputed 41

  • Maternal and paternal screening cutoffs are reversed

    Minor

    The recruitment procedure gives a cutoff of 24 for mothers and 27 for fathers, while the measure description gives 27 for maternal figures and 24 for paternal figures.

2 of 2

The citation lists haven’t been fetched yet

References 79 · Cited by 334

Research works printed but not linked: 9

  1. Berthelot, 2013b, Efficient mentalisation of trauma [Mentalisation efficiente du trauma], Carnet de notes sur les maltraitances infantiles, 131, 6
  2. Bion, 1962, The psychoanalytic study of thinking, International Journal of Psychoanalysis, 43, 306
  3. Ensink, 2014, Attachment and reflective function specific to trauma in pregnant women with histories of abuse and neglect, Frontiers in Psychology, 5, 1
  4. Luyten, 2012, Mentalizing in clinical health practice
  5. Lyons-Ruth, 1999, Atypical patterns of infant attachment: Theory, research, and current directions. Monographs of the Society for Research in Child Development, 64, 67
  6. Main, 2002, Classification and scoring systems for the Adult Attachment Interview
  7. Main, 1985, Growing points in attachment theory and research. Monographs of the Society for Research in Child Development, 50, 66
  8. Main, 1990, Attachment in the preschool years, 121
  9. Tarabulsy, 2000, Attachment and development: the role of early relationships in human development, 1

Authors
Berthelot, N., Ensink, K., Bernazzani, O., Normandin, L., Luyten, P., & Fonagy, P.
Affiliations
  • Institut Universitaire en Santé Mentale de Québec (CA)
  • Université Laval (CA)
  • Université de Montréal (CA)
  • University College London (GB)
  • Anna Freud Centre (GB)
Corresponding author
Berthelot, Nicolas
ORCID
Venue
Infant Mental Health Journal
Publisher
Wiley
Published
2015-02-18
Volume
36
Issue
2
Pages
200-212
ISSN
0163-9641 (ISSN-L)
DOI
10.1002/imhj.21499
OpenAlex
W1906833093
Semantic Scholar
23a1a34df4f95963b1861bf2a15dc005e4865057
Cited by
334
References
79
Citations by year
2026: 13 · 2025: 26 · 2024: 28 · 2023: 35 · 2022: 18 · 2021: 67 · 2020: 42 · 2019: 24 · 2018: 31 · 2017: 21 · 2016: 23 · 2015: 6
FWCI
44.18
Type
journal article
Language
en
Open access
closed
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 195 d)
Locations
  • Infant Mental Health Journal (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
National Institute for Health and Care Research (NF-SI-0510-10228, NF-SI-0514-10157)
Topics
  • Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Keywords
intergenerational transmission of attachment, childhood abuse and neglect, mentalization, insecure attachment, unresolved trauma, child abuse
MeSH terms
Adolescent, Adult, Child Abuse, Female, Humans, Infant, Longitudinal Studies, Mother-Child Relations, Mothers, Object Attachment, Pregnancy, Young Adult, Theory of Mind

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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