Attachment theory — structured clinical viva

Examiners want fluent movement from theory → classification → mechanism → adult psychopathology → disorders vs styles → safe treatment stance. The mother vignette invites unresolved loss, frightening behaviour, and intergenerational risk without blaming language.[1][3][4][6]

An evolved behavioural system organising proximity under threat; caregiver as secure base and safe haven; builds internal working models of self/other; lifelong but revisable.[1]

A avoidant (minimise), B secure (seek–soothe–explore), C resistant (intense, hard to settle), D disorganised (strategy collapse/contradiction). Coding emphasises reunions.[2][3]

Semi-structured interview; classification by discourse coherence. Unresolved/disorganised: lapses in monitoring of reasoning/discourse around loss or trauma. Mother’s dissociation when discussing sibling death raises hypothesis of unresolved loss — specialised coding needed for formal classification.[3][4]

Early neglect → insecure/disorganised IWMs; abandonment sensitivity; mentalizing fails under interpersonal stress → self-harm as regulation/proximity protest. Mentalization-based models of BPD explicitly integrate attachment adversity and reflective function failure.[5][6]

Styles = common strategies/models. RAD/DSED = rare disorders after insufficient care with specific inhibited vs indiscriminate phenotypes. Adult BPD features are not diagnosed as RAD.[7]

Unresolved parental trauma/loss associated with frightening behaviour and infant disorganisation risk. Support parental mental health, reflective parenting, and safety; do not moralise. Assess any child safeguarding needs if she becomes a parent using local thresholds.[4][5]

Offer mentalization-informed/structured PD therapies, crisis planning, treat comorbidity, and a reliable therapeutic secure base. Refuse coercive holding/rebirthing attachment therapies (harm risk). No drug treats attachment pattern itself.[6][8][7]