What Lies Beneath: Understanding Coercive Control in the Lives of Children of Divorce and Separation

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The information below is taken from the UK Crown Prosecution Website

The UK Government definition of coercive control is –

  • An act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim
  • Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour

3.1 Section 76 of the Serious Crime Act 2015 – Controlling or Coercive Behaviour in an Intimate or Family Relationship

For the purposes of this offence, behaviour must be engaged in ‘repeatedly’ or ‘continuously’. Another, separate, element of the offence is that it must have a ‘serious effect’ on someone and one way of proving this is that it causes someone to fear, on at least two occasions, that violence will be used against them. There is no specific requirement in the Act that the activity should be of the same nature. The prosecution should be able to show that there was intent to control or coerce someone.

The phrase ‘substantial adverse effect on Bs usual day-to-day activities’ may include, but is not limited to:

  • Stopping or changing the way someone socialises
  • Physical or mental health deterioration
  • A change in routine at home including those associated with mealtimes or household chores
  • Attendance record at school
  • Putting in place measures at home to safeguard themselves or their children
  • Changes to work patterns, employment status or routes to work

For the purposes of the offence A ‘ought to know’ that which a reasonable person in possession of the same information would know – s.76 (5).

A person guilty of an offence under this section is liable:

  • On conviction on indictment, to imprisonment for a term not exceeding five years, or a fine, or both;
  • On summary conviction, to imprisonment for a term not exceeding 6 months, or a fine, or both.

3.2 Relevant Behaviours

Prosecutors are advised that a pattern of controlling or coercive behaviour can be well established before a single incident is reported. In many cases the conduct might seem innocent – especially if considered in isolation of other incidents – and the victim may not be aware of, or be ready to acknowledge, abusive behaviour. The consideration of the cumulative impact of controlling or coercive behaviour and the pattern of behaviour within the context of the relationship is crucial. This approach will support the prosecutor to effectively assess whether a pattern of behaviour amounts to fear that violence will be carried out; or serious alarm or distress leading to a substantial adverse effect on usual day-to-day activities.

Further assistance can be obtained from the Statutory Guidance published by the Home Office pursuant to section 77(1) of the Serious Crime Act 2015.

Building on examples within the Statutory Guidance, relevant behaviour of the perpetrator can include:

  • Isolating a person from their friends and family
  • Depriving them of their basic needs
  • Monitoring their time
  • Monitoring a person via online communication tools or using spyware
  • Taking control over aspects of their everyday life, such as where they can go, who they can see, what to wear and when they can sleep
  • Depriving them access to support services, such as specialist support or medical services
  • Repeatedly putting them down such as telling them they are worthless
  • Enforcing rules and activity which humiliate, degrade or dehumanise the victim
  • Forcing the victim to take part in criminal activity such as shoplifting, neglect or abuse of children to encourage self-blame and prevent disclosure to authorities
  • Financial abuse including control of finances, such as only allowing a person a punitive allowance
  • Control ability to go to school or place of study
  • Taking wages, benefits or allowances
  • Threats to hurt or kill
  • Threats to harm a child
  • Threats to reveal or publish private information (e.g. threatening to ‘out’ someone)
  • Threats to hurt or physically harming a family pet
  • Assault
  • Criminal damage (such as destruction of household goods)
  • Preventing a person from having access to transport or from working
  • Preventing a person from being able to attend school, college or University
  • Family ‘dishonour’
  • Reputational damage
  • Disclosure of sexual orientation
  • Disclosure of HIV status or other medical condition without consent
  • Limiting access to family, friends and finances

This is not an exhaustive list and prosecutors should be aware that a perpetrator will often tailor the conduct to the victim, and that this conduct can vary to a high degree from one person to the next. It will be open to the courts to consider acts by a defendant and to conclude whether those acts constitute criminal behaviour.

There might be confusion about where the ‘appropriate’ dynamic of a relationship ends and where unlawful behaviour begins. The College of Policing Authorised Professional Practice on Domestic Abuse states: “In many relationships, there are occasions when one person makes a decision on behalf of another, or when one partner takes control of a situation and the other has to compromise. The difference in an abusive relationship is that decisions by a dominant partner can become rules that, when broken, lead to consequences for the victim.”


The above information should make it apparent that what is being seen when children are prevented from having a relationship with a parent after divorce or separation, falls within the range of behaviours which are considered to be coercive control by the UK Government. In particular those behaviours which limit access to friends and family, isolation or threats to harm the child, controlling the ability to go to school, taking control over their everyday lives, is exactly the kind of parenting behaviour which causes the child to align strongly with the controlling parent and reject the other. When I work with children who are being controlled by a parent, I see the evidence in the child’s withdrawal from friendship groups, relationships with loved adults, significant patterns of interrupted school attendance and sometimes the physical as well as emotional and psychological barricading of the child within the four walls of parental control. The problem of children’s alignment and rejection is, without doubt, one of coercive control as well as other co-morbidities, control behaviours are seen in mothers as well as fathers, although how each displays that may be different.

My interest in this area is primarily because of the numbers of mothers who become alienated from their children after divorce and separation, whose children are rejecting them without foundation in circumstances where patterns of coercive control behaviours have switched from the mother to the children. What is being done to the children in these circumstances, is exactly the same as what was being done to the mother prior to the relationship ending. In such cases, mothers often ask me, why have they aligned with their father when they witnessed him being abusive and it was clear to them as well as to me, that what he was doing was wrong?’ This is of course, the same question which many people ask of women who do not leave abusive partners. Why can’t they leave, when they are aware he is controlling, is the question. The answer lies in coercive control strategies, which strip the other of their executive functioning and prevent even the capacity to imagine what life would look like outside of that control. If you consider how children are utterly dependent upon a parent, it is not difficult to imagine why they cannot leave a situation where their lives are completely under parental control.

Coercive control is not just a feminist issue

One does not have to look through a feminist lens to understand coercive control in the lives of mothers and children after divorce and separation. It is not necessary to employ a belief in ‘patriarchy’ to recognise that coercive control is psychological and emotional child abuse and it causes a distinct pattern of behaviour in children, which can be recognised by the presence of psychological splitting. When children reject their mothers in situations where they are being controlled by their fathers, they do so in exactly the same pattern as when they reject their fathers when they are being controlled by their mothers. In each case the behaviours being seen in parents are similar, although usually there are gendered aspects to those behaviours.

Paternal Control

For example, fathers will control children using a mixture of overt threat of harm and control over their connection to the outside world. Fathers cause children to feel extreme anxiety when they are threatening in this way, which causes the onset of a dynamic called ‘identification with the aggressor’ It is this dynamic which causes children to cling to an abusive father and at times to mimic the behaviours which are being used to control them. This is why children who were seen to love their mother and to want to be with her, can be seen to switch to complete rejection of her with contemptuous blame and often allegations that she is mad/bad/dangerous to their wellbeing. This very obvious pattern of overt coercive control is what we have been trained to expect by people who analyse family behaviours through a feminist lens. Even so, many mothers who face this horrendous pattern of psychological and emotional abuse, are still not believed or understood, this is because the feminist lens, which focuses upon the idea that all women and children must be believed, cannot account for the reason why some children reject their mothers, often with vehement allegations against them.

Maternal Control

Mothers are more likely to control their children through a dynamic called abandonment threat. This behaviour, which can be subtle (when you are away I feel sad) to overt (if you go to daddy I may not be here when you get back), causes life long harm and is quite simply a cruelty which causes a child to conform to the covert requirements of a parent. Such behaviour is no less coercive in that it controls the child’s responses to relationships with others, it also strips the child of autonomy and capacity to form views and opinions which are different to those of a controlling parent. Because of the way in which the problem of coercive control is dominated by feminist theory, we are prevented from understanding that women too can use control behaviours with their children.

What Lies Beneath

Of course all of these behaviours are those which are seen when children become alienated. Whilst there is a drive in some quarters to suggest that alienation is simply psychological control of children, I would argue that this is not the case. Alienation remains a word which I associate with children who are subjected to the wide range of parental behaviours which cause the same behavioural display in a child. When a child is induced to regress to the use of the defence of psychological splitting by coercive control or any other behaviour, alienation of the self from the self is what triggers the onset of the projection onto parents of the division into good/bad. The child at the heart of a family system which features coercive control, displays behaviours which clearly demonstrate the shift to a defensive position. In Kleinian terms, what is called the splitting of the object, cannot occur without a splitting of the subject (ego), which put simply means that the child who splits their parents into good/bad, has already experienced a defensive splitting in the sense of self.

The Child who splits their parents into good/bad has already experienced a defensive splitting in the self.

Family Separation Clinic 2023

The reality is that in situations where children reject a parent, their voice is likely to be adapted to the control behaviours of a parent to whom they are aligned. This is true for children who reject mothers because they are being controlled by fathers and children who reject fathers because they are being controlled by mothers. To truly understand this problem in divorce and separation and to truly protect ALL children as well as ALL mothers and fathers who are being harmed, one must recognise that children in post divorce situations, adapt their behaviours and in doing so, they speak with an adapted voice, which is not their own true view but one which reflects the wishes and feelings of the parent with control over them. This is how we work with coercive control outside of a feminist paradigm and I would argue, in doing so it is more protective of children because it works with the widest perspective possible, not the feminist split narrative of mothers good/fathers bad.

Children who are rejecting their mothers after divorce and separation and portraying their mothers as abusive, in situations where there is no evidence to support these claims, are suffering from coercive control at the hands of their fathers. Children who are rejecting their fathers after divorce and separation and portraying their fathers as abusive, in situations where there is no evidence to support these claims, are suffering from coercive control at the hands of their mothers. The evidence for this is in the child’s behavioural presentation and the patterns of power and control which is held over them by a parent who is likely to say that they really really want a child to have a relationship with the rejected parent ‘if only that parent would change their ways.’ In this respect, fathers portray mothers as having mental health problems, as not being very maternal or as somehow deficient in other ways, whilst mothers portray fathers as being abusive and harmful, controlling and demanding. The behaviours which are seen are likely to fall into what we expect from mothers/fathers and are polarised, what is missing in both situations is ambivalence.

Mothers in the rejected position share much with fathers in the rejected position, not least that their children are being psychologically, mentally and emotionally abused in a world which has not yet awakened in a uniform way to this form of child abuse. Meanwhile, as the efforts to obfuscate the harm which is being caused to children continues, ironically in a format which is the very essence of what feminists call DARVO – which is actually the use of primitive defences to deny, split off and project the blame for one’s own behaviours onto someone else, (thereby relieving the self of shame). In the midst of this, children are losing their mothers and their fathers and are being left to deal with the life long aftermath of something they have absolutely no control over.

Therefore, those of us who know what lies beneath, must continue to say what we see despite the efforts to silence us, so that everyone, everywhere, finally understands the truth of what is happening to children of divorce and separation.


Dear Reader

I am no stranger to being the recipient of negative projections (DARVO), from those who seek to hide the harm which is being done to children of divorce and separation, so much so that I thought long and hard about writing about coercive control of children in divorce and separation right now. In the current climate in the UK, it would be very easy to remain silent due to fear of more harassment and more lies about who I am and the work that I do.

I have decided to speak up now, because of the number of mothers I work with, both in Family Proceedings and in our Listening Circles and on our Holding up a Healthy Mirror course, who are shamed, blamed and denied by their children in situations where they have been subjected to a campaign of coercive control post divorce or separation. Mothers who share a great deal with fathers in the rejected position and who gain a great deal from working with those men in support settings. These mothers have no real voice, because theirs is silenced when they try to speak from the perspective of their children being alienated.

Quietly, behind the scenes however, these mothers and fathers who are true victims of coercive control, work through the issues which cause so much pain with mutual support and a huge amount of dignity. We don’t hear about these women and men who work together, because the issue of coercive control is constantly portrayed within the toxic framework of a manufactured gender war.

These groups of parents prove however, that one does not have to be a feminist to be concerned about coercive control in the lives of mothers, fathers and their children after divorce and separation or to understand how to manage such situations in the best interests of children and their healthy parents. I appreciate each and every one of the hundreds of mothers and fathers I have worked with over the past year, each of whom recognises the harm that they are suffering from the campaigns to obfuscate the reality of what is happening to children in divorce and separation. The courage to write about coercive control at this point in time, comes from those mothers and fathers.


Family Separation Clinic News

Spring/Summer Term Listening Circles 2023

The spring term listening circles will begin on 18th April 2023 at 19:00 GMT and will run through to the end of July. Listening circles are for all parents in the rejected position, their family and friends and any professionals who support them who would like to attend. Parents can purchase a ticket and share the link with two others in order to ensure that they obtain the maximum amount of benefit. I will announce the dates and subjects for each circle just before Easter.

Holding up a Healthy Mirror

This course is now fully booked and we will shortly be recording it for watch on demand on a new platform which is devoted to helping parents in the rejected position and the practitioners who work with them.

Higher Level Understanding – Development Group

I will write to everyone who has signed up for this group with arrangements for start up shortly.

Summer Saturday Seminars

In May and June I will be running monthly Saturday Seminars for parents who have completed the Holding up a Healthy Mirror Course. These seminars will be focused upon developing mentalisation skills in order to help others to develop their capacity to help their children. As part of these Saturday Seminars, (which will run for four hours each time), we will meet parents who have received their children in residence transfer and children themselves who are now over the age of 18, who were helped by therapeutic parenting in residence transfer.

The purpose of these seminars is to provide focused space to build therapeutic parenting skills alongside space to develop practice, consider different elements of how therapeutic parenting helps and to understand the attachment maladaptations which are seen when children align and reject. Hearing from parents and children who have gone through this process of recovery, enables understanding of how operationalising the approach used by the Family Separation Clinic, to assist recovery and integration, provides long term healing and protection from further harm.

Summer Saturday Seminars will be announced just before Easter.


FSC is now in a period of intensive development of new resources for parents and the professionals who work with them and because of this our service delivery will be limited for a short period of time. If you are seeking to instruct the Clinic in Family Proceedings, please note that we cannot accept any new instructions until the autumn and only then in the High Court of England and Wales, Republic of Ireland or Hong Kong.

6 responses to “What Lies Beneath: Understanding Coercive Control in the Lives of Children of Divorce and Separation”

  1. A. D. Rosewell

    Thank you for your good work, Karen. Yes, it takes courage and nerves of steel to enlighten others about the true dynamics involved in parental alienation. My own step-children have been alienated from their father by their mother who told him straight out that she would ensure that he never see his children again over his failure to proceed with his post-divorce life in the manner she directed. I witnessed this, and heard her repeat it more than once. She intentionally set about to use the children as weapons. The viciousness in her voice was frightening, yet she publicly wears a “Miss America smile” and spins inconsistent stories about her victimhood that those around her eat right up— therein perhaps inadvertently reinforcing the alienation to the children. While feminist theory is, I believe, largely correct about a great deal, the blind spot concerning the female ability to engage in horrific behavior constantly undermines its credibility, and in the end, allows for the destruction of the well-being of an infinite number of children (and parents). Yes, the old addage that “hurt people hurt people “ is true. But “hurt people” must not be allowed to freely engage in maladaptive behaviors that harm innocent and powerless others, too often children, in the process. The alienator’s own healing of old, formative wounds must begin with responsibility for dealing with their own issues in a healthy manner. Indulgence and excuses only perpetuate harm.

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  2. CG

    …..”This behaviour, which can be subtle (when you are away I feel sad) ……”

    We bought tickets for my husband’s son to travel to see his paternal grandparents (having not seen them for some time). Although the Mother initially reluctantly agreed, he didn’t then come, saying he couldn’t travel because …”Mum misses me too much if I’m away for more than a night”.

    And on being asked why he couldn’t come for an overnight, the answer was he had to “spend time” with his (maternal) grandparents (with whom he lived full-time…….)

    In the Guardian’s report the comment was made that he felt responsible for his mother (despite being only 13 at the time) – this was portrayed as a good thing, and a reason he shouldn’t see his Father (as him seeing or spending time with his Father upset his Mother). This wasn’t questioned and instead used as vindication for a non-contact order.

    The school stopped the Father being able to join in school occasions with the same reason, that allowing the Father to watch his son at school events upset the Mother.

    I pray that this is now different for anyone starting into a court process.

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  3. arizonalegalsystemsurvivors

    I subscribe to and read all of your posts, and am grateful for your insights. You make the most sense of all the voices out there and I appreciate your sound research. Thank you. Please keep them coming!

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  4. Lorna Flormoe

    Thank you so much Karen! Your work, courses and circles have given me new hope and understanding, and things that I can learn and work on, when just a little over a year ago, I felt hopeless. You are an earthy angel!

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  5. Bob Rijs

    Psychosis, Trauma and Dissociation: Evolving Perspectives on Severe Psychopathology Second Edition

    An Attachment Perspective on Schizophrenia: The Role of Disorganized Attachment, Dissociation, and Mentalization – Andrew Gumley and Giovanni Liotti

    Trauma and Loss in the Lives of Primary Caregivers of Psychiatric Patients

    A further marker for risk of attachment and caregiver disorganization is the presence of trauma and loss in the lives of primary caregivers. Two studies (Liotti, Pasquini, and The Italian Group for the Study of Dissociation, 2000; Pasquini, Liotti, Mazzotti, Fassone, Picardi, and the Italian Group for the Study of Dissociation, 2002) have explored the relationship between borderline personality disorder (BPD), dissociative disorders, and severe traumas or losses suffered by the mothers of adult patients in the two years before or after the patients’ birth (shown to increase the risk for infant attachment disorganization in other studies, Van IJzendoorn et al., 1999). In comparison to clinical (anxiety and affective disorder) controls, both the dissociative and borderline groups showed a significantly higher frequency of major losses and severe traumas in the lives of the patients’ mothers in the years around the patients’ birth. In light of the robust evidence linking unresolved traumas and losses in the mother to attachment disorganization in the offspring (Van IJzendoorn et al., 1999), it was hypothesized that the specific pathogenic effect of the mothers’ traumas and losses which fostered fragmentation and splitting of the self in the patients was produced via early disorganized attachment.

    These two studies (Liotti et al., 2000; Pasquini et al., 2002) also examined the connection between childhood traumatic experiences (assessed through a semi‐structured trauma interview) and dissociation or splits in the sense of self in the patients (assessed through the Dissociative Experience Scale and the Structured Clinical Interview for DSM‐IV Dissociative Disorders [SCID‐D]). Childhood trauma in the patients and losses and/or traumas in the lives of the mothers were found to be independent risk factors for the development of both borderline and dissociative disorders. In other words, the risk of developing a dissociative disorder or borderline personality disorder, rather than another type of mental disorder less associated with fragmentation of self‐experience, was increased by two (theoretically) independent past conditions: (i) the patient’s mother was mourning over a loss (or dealing with a serious trauma) during the patient’s infancy and (ii) the patient’s childhood had been plagued by severe traumatic experiences (losses and/or sexual, emotional, and physical abuse). This combination of risk factors may also be relevant to understanding the developmental pathways of individuals diagnosed with schizophrenia, as a third study suggests.

    Persons diagnosed with schizophrenia were not included in the control group in the two studies discussed above because it was felt that schizophrenia, unlike the anxiety and affective disorders included in the control group, might be affected by fragmentation of mental states similar to those seen in borderline and dissociative conditions.

    Instead, a third (inpatient) study was conducted (Miti & Chiaia, 2003) in which 41 patients with dissociative disorders or borderline personality disorder were compared to 62 patients, primarily diagnosed with schizophrenia. No differences were found between those diagnosed with dissociative disorders or borderline personality disorder and schizophrenia with regard to the amount of losses and traumas experienced by the mothers, which was high in all three groups. This finding is consistent with clinical observations reported by Walsh (1978) that parents of young patients diagnosed with schizophrenia reported losses suffered just before or after the patient’s birth much more often than parents of young patients with different diagnoses. It is therefore not unreasonable to propose that disorganization of caregiving and attachment arising from trauma and loss may play a role in the development of schizophrenia and other psychoses.

    Early disorganized attachment – it has been argued – is a risk factor for psychopathology because it produces responses to later traumas and losses that are characterized by fragmentation of self‐experience (Liotti, 1992, 2004, 2006; Ogawa et al., 1997).

    Traumas and losses suffered from childhood to adolescence increase the risk not only of developing dissociative and borderline conditions, but also of developing psychotic disorders (Morgan, Kirkbride, Leff, et al., 2007; Verese et al., 2012; for a review, see Chapter 9 of this book). In a meta‐analysis of childhood adversity and risk of psychosis, Verese et al. (2012) found that childhood adversity increased risk of psychosis, and that this was significant for all types of adversity including sexual, physical, and emotional abuse, bullying, and neglect. Among 13–16 year olds, severity of trauma (bullying) was linked to psychosis in a ‘dose–response’ fashion, and cessation of trauma was linked to reduced risk (Verese et al., 2012).

    This indicates that the likely direction of effect is from trauma to psychosis (Kelleher et al., 2013). One could hypothesize, therefore, that the psychopathological pathway – leading from early attachment disorganization to dissociative states of mind via the impact of later traumas/losses – increases the risk for every type of disorder associated with a fragmented sense of self, including schizophrenia.

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  6. Bob Rijs

    Psychosis, Trauma and Dissociation: Evolving Perspectives on Severe Psychopathology Second Edition

    An Attachment Perspective on Schizophrenia: The Role of Disorganized Attachment, Dissociation, and Mentalization – Andrew Gumley and Giovanni Liotti

    Metacognition, Mentalization, and Affect Regulation

    Macbeth, Gumley, Schwannauer, and Fisher (2011) found that dismissing attachment was associated with low levels of reflective functioning – the individual’s understanding of the thoughts, feelings, intentions, and goals of self and others, and the interaction of these phenomena in terms of making sense of their own and others’ behaviour in the context of attachment relationships. Reflective functioning is a competency underpinning the interpersonal aspects of affect regulation, and is a construct closely related to metacognition, mentalization, and theory of mind. Metacognition (i.e. the ability to monitor and reflect on mental states and inner experiences) can be conceptualized as a multifaceted skill, composed of a number of independent abilities (Semerari, DiMaggio, Nicolò, Procacci, & Carcione, 2007). It could be considered a composite mental function, including an array of sub‐functions needed to understand one’s own behaviour and the behaviour of others through: (i) the attribution of mental states to others and to self (theory of mind, TOM), (ii) taking the perspectives of others, (iii) differentiating similar mental states (e.g. between fatigue and sadness), (iv) putting together integrated and coherent representations of self and others with corresponding narratives, and (v) differentiating from external reality those processes that are generated internally, such as thoughts (source memory).

    Fonagy (Bateman & Fonagy, 2004; Fonagy et al., 2003) argue that different, though related, concepts such as ‘metacognition’ and ‘TOM’ may be ultimately reduced to the capacity to reflect on experience, and have called this overall capacity ‘mentalization’ or ‘reflective functioning’. Mentalization refers to ‘mind‐mindedness’, and reflective functioning describes the processes by which mind‐mindedness is acquired. Mentalization may be defined as the process by which we come to understand that having a mind mediates our experience of the world via the representation of psychological states. It refers to an intentional stance characterized by the interpersonal awareness that experiences give rise to certain beliefs and emotions, and that particular beliefs, desires, and intentions tend to result in corresponding types of behaviour. This intentional stance is essential to the creation of a continuity of self‐experience that is the underpinning of a coherent self‐structure.

    Since Frith (1992), the association between mentalization (which he called ‘theory of mind’) and the core symptoms of schizophrenia has been an important area of research. Robust evidence has now emerged to show that mentalization is impaired among persons with a diagnosis of schizophrenia compared to non‐patient controls (Sprong, Schothorst, Vos, et al., 2007). Sprong and colleagues (2007) found that mentalization was impaired among patients in remission, which indicates that deficits in this overall capacity are not merely a consequence of acute symptoms and may reflect a more stable vulnerability factor for the development of schizophrenia. Sprong et al.’s (2007) meta-analysis found that individuals diagnosed with schizophrenia, whose states of mind were disorganized by acute psychotic experiences, performed more poorly in mentalization tasks than patients with more organized states of mind (paranoid patients and patients in remission). This finding is consistent with the proposal that acute and disorganizing psychotic experiences are linked to the collapse of self‐reflective capacity, which in turn may be the consequence of the collapse in the controlling strategies (or of the disinhibition of attachment needs) that kept at bay the dissociating influence of a disorganized IWM of early attachment.

    In the context of attachment‐related discourse, impairments in metacognition are associated with higher negative symptoms, poorer early adolescent social adjustment, and reduced likelihood of seeking help in a crisis (Macbeth et al., 2014). Childhood sexual trauma is associated with poorer awareness of others’ mental states but not impaired self‐reflexivity, suggesting that traumatic experiences may shape how metacognition is deployed (Lysaker et al., 2011). McLeod, Gumley, Macbeth, Schwannauer, and Lysaker (2014) found that impairments in self-reflexivity, understanding others’ mental states, and mastery of interpersonal problems using mental state information, predicted lower rates of recovery of positive and negative symptoms at 6months and 12months. These findings remained significant when controlling for severity of respective positive and negative symptoms during the first episode of psychosis, duration of untreated psychosis, and also levels of premorbid social and academic functioning.

    Deficits in the development of mentalization may be caused, or made worse, by attachment dynamics caused by the abusive behaviour of the primary caregivers. Interactions with an abusive caregiver during childhood and adolescence produce their pathogenetic effects in three ways: (i) they are a repetition of the condition causing attachment disorganization in infancy (the attachment figure is at the same time the source of care and the cause of fear), (ii) they cause peritraumatic and post‐traumatic dissociative responses of their own, and (iii) they directly hinder the victims’ capacity to reflect on their own mental state, and infer the mental state of their caregiver. Indeed, it is a difficult, if not impossible, task for a child to reflect on the intentions of a caregiver who seems to deliberately want to harm them (Fonagy et al., 2003).

    A mentalization deficit hinders the capacity for affect regulation in both personal and interpersonal domains, as well as the capacity to reconsider unusual (dissociative) experiences in the light of common sense and other people’s opinions. It could be argued, therefore, that a more severe mentalization deficit distinguishes schizophrenia from other problems, such as the dissociative and borderline disorders. While people with schizophrenia and dissociative/borderline personality disorders show impairments in metacognitive and reflective functioning to a similar degree (see, for example, Macbeth et al., 2011), the underpinning attachment‐based affect regulation strategies are likely to be quite different. Dissociative/borderline personality disorders reveal a more unstable and fragmented affect regulation system characterized by contradictory strategies and frequent traumatic intrusions leading to a mentalizing system vulnerable to collapse. In contrast, Gumley, Schwannauer, et al. (2014) found low rates of contradictory strategies in their first episode sample and a predominance of avoidant attachment in those who have a poor recovery (and trajectory into a schizophrenia diagnosis). This is consistent with the propositions made earlier that in schizophrenia the trajectory from disorganization to psychosis in adulthood may be shaped by the resolution of disorganization through avoidance of attachment or inhibition of the attachment system.

    While this organization creates greater stability in the short term, the developmental cost of this is: (i) impairments in the awareness of self and others’ mental states and (ii) under‐developed affect regulation systems leading to (iii) greater sensitivity to stress and negative affect producing the context for internal experiences (e.g. thoughts, feelings, images) being experienced as fragmented, compartmentalized, segregated, and external to the self (e.g. auditory hallucinations). In support of this, deficits in source memory have been linked to voices and other hallucinations (Brebion, Gorman, Malaspina, & Amador, 2004; Johns, Gregg, Allen, & McGuire, 2006). Problems in source memory have been found in schizophrenia (Vinogradov, Willis‐Shore, Poole, et al., 1997), but have also been seen in pathological responses to traumas (McNally, Clancy, Barrett, & Parker, 2005) and in borderline personality disorder where, interestingly, it correlates strongly with hostility and paranoid ideation (Minzenberg, Fisher‐Irving, Poole, & Vinogradov, 2006).

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