Liotti, G. (2004) | References | Narcissus and the Child

What This Research Found

Giovanni Liotti's influential 2004 article proposed a revolutionary integration: that childhood trauma, disorganized attachment, and dissociation are not separate phenomena but "three strands of a single braid"—intertwined aspects of a single developmental pathway that extends from infancy through adulthood.

The core insight: disorganized attachment is dissociation. Building on Main and Hesse's research showing that frightened or frightening parental behaviour produces disorganized attachment, Liotti argued that the infant's response to this impossible situation is itself dissociative. When the attachment figure is simultaneously the source of safety and the source of threat, the infant cannot develop a coherent attachment strategy. The simultaneous activation of the attachment system (approach the caregiver) and the fear system (flee the threat) produces a breakdown in integrative function—the infant freezes, shows contradictory behaviours, enters trance-like states. This breakdown is dissociation at its earliest, most fundamental level.

Multiple, incompatible internal working models. Liotti's key theoretical contribution was explaining what happens in the infant's developing mind when coherent attachment is impossible. Rather than forming a unified model of self and other, the infant develops multiple, contradictory internal working models. In one model, the self is victim and the other is persecutor. In another, the roles reverse. In yet another, the self is rescuer. These models correspond to what Liotti called the "drama triangle"—the shifting configurations of victim, persecutor, and rescuer that the child experiences with an unpredictable caregiver. Crucially, these models cannot be integrated because they arise from genuinely contradictory experiences. They remain separate, each dominating consciousness in different states or contexts.

The three developmental pathways. Liotti outlined three trajectories that disorganized infants might follow into adulthood. In the first pathway, without further trauma and with more consistent later caregiving, the child eventually consolidates around one predominant working model—achieving relative integration with minimal symptoms. In the second pathway, where inconsistent caregiving continues but without severe trauma, the fragmented models persist; the person may function adequately under normal circumstances but experiences dissociative symptoms under stress. In the third pathway—the most damaging—ongoing severe trauma reinforces the fragmented models, preventing any integration. The child is predisposed to dissociation, experiences continued reinforcement of contradictory self-other representations, and faces repetitive severe trauma. This pathway leads toward dissociative disorders, potentially including dissociative identity disorder.

The bridge from infant disorganization to adult pathology. Liotti's model explained a puzzle that had long troubled researchers: why does childhood trauma predict dissociative disorders in adulthood? His answer was that the vulnerability begins before the trauma, in the disorganized attachment relationship itself. The infant whose attachment is disorganized has already developed the fragmented internal architecture that later traumas will exploit. When severe stress occurs in adulthood, the person with a history of disorganized attachment has no coherent self to maintain; they fragment along the fault lines established in infancy.

How This Research Is Used in the Book

Liotti's work on the relationship between disorganized attachment and dissociation provides essential theoretical grounding for Narcissus and the Child, particularly in understanding how narcissistic parenting produces its most severe effects. In Chapter 3: The Borderline Sibling, the book draws on this research to explain the developmental pathway from disorganized attachment to borderline personality disorder:

"Mary Main's research on disorganised attachment is difficult to watch. The videos show infants crawling towards their mother while looking away, as if approaching a cliff edge. They freeze mid-approach, hands outstretched, faces blank with confusion. One famous clip shows a toddler circling her mother in a wide arc, never getting closer than three feet, orbiting like a satellite that cannot land. These children cannot develop a coherent strategy for managing attachment needs because no strategy works. Go to mother and she might hurt you. Stay away and you might die."

This passage illustrates the "fright without solution" that Main and Hesse identified and that Liotti elaborated into his model of multiple internal working models. The book uses Liotti's framework to explain why survivors of narcissistic parenting experience such profound difficulties with identity integration—the fragmented internal representations formed in infancy persist into adulthood.

In Chapter 11: Neurological Contagion, the book extends Liotti's insights to explain how narcissistic relationships in adulthood can recreate disorganized attachment patterns:

"Or, most damagingly, they may develop disorganised attachment—the simultaneous activation of approach and avoidance that creates paralysis and dissociation."

The book uses Liotti's model to explain why adult survivors of narcissistic relationships develop dissociative symptoms—the narcissistic partner, like the frightening caregiver, becomes simultaneously source of attachment and source of threat, reactivating the early fragmentation.

In Chapter 12: The Unseen Child, the relationship between gaslighting and dissociation is explored through this lens:

"When mirroring is systematically distorted, the brain develops fragmented, contradictory networks. The child may simultaneously know and not know something is true. This cognitive dissonance creates chronic anxiety and contributes to dissociative disorders."

Why This Matters for Survivors

If you were raised by a narcissistic parent, Liotti's research provides a profound reframing of experiences that may have seemed inexplicable or shameful.

Your fragmented sense of self makes developmental sense. If you experience confusing shifts in how you perceive yourself—feeling like a victim one moment, guilty and persecutory the next, compelled to rescue in another—you are not unstable or weak. You are experiencing the multiple internal working models that formed when your caregiver presented contradictory faces: sometimes terrifying, sometimes terrified, occasionally comforting. Your developing mind did the only thing possible: it created separate models for each configuration. These models were never integrated because they couldn't be—they arose from genuinely incompatible experiences with what felt like betrayal trauma. What feels like instability is actually your brain's creative solution to an impossible developmental situation.

Your dissociative experiences have roots in your earliest relationships. If you "space out" during conflicts, feel disconnected from your body during stress, or lose time when relationships feel threatening, these are not signs of severe mental illness appearing from nowhere. Liotti's research shows that dissociation begins in infancy for those with disorganized attachment. The freeze response, the blank-faced staring, the trance-like states documented in disorganized infants—these are the same processes you may experience in adulthood, reactivated by situations that unconsciously echo the impossible bind of your early life. Understanding dissociation as an attachment phenomenon can reduce shame and provide direction for healing.

The drama triangle explains confusing relationship patterns. If you find yourself cycling through victim, persecutor, and rescuer roles—with yourself and with others—you are not playing games or being dramatic. You are experiencing the drama triangle that was encoded into your internal working models before you could speak. Your narcissistic parent may have shifted between punishing you (persecutor), appearing helpless and needy (victim), and occasionally being warm (rescuer). You learned that relationships involve this constant shifting, that both you and others can occupy any role at any time. Recognizing the drama triangle can help you step outside it—observing when you are being pulled into these roles rather than automatically enacting them.

Healing is possible, but requires understanding the depth of the patterns. Liotti's research explains why healing from narcissistic parenting is more complex than recovering from discrete traumatic events. The fragmentation begins in infancy, before conscious memory, and is encoded in the architecture of how you experience self and relationships. But this same research points toward healing: the therapeutic relationship can provide the coherent, non-frightening attachment experience that allows new, integrated models to form alongside the old fragmented ones. Change is slower and harder than for those with organized attachment, but it is real. Earned security is possible.

Clinical Implications

For psychiatrists, psychologists, and trauma-informed clinicians, Liotti's integration of attachment theory and dissociation research has direct implications for assessment and treatment.

Assessment must look beyond trauma history to attachment organization. Patients with dissociative symptoms often present with histories of childhood trauma. But Liotti's model suggests that the timing and context of trauma matter as much as its occurrence. Assess specifically for whether the trauma occurred within the attachment relationship—whether the caregiver was the source of threat. Patients whose dissociation arose from disorganized attachment with a frightening caregiver require different treatment considerations than those whose dissociation arose from trauma outside the attachment relationship. Look for hypervigilance to relational cues and emotional flashbacks triggered by intimacy. The Adult Attachment Interview can identify "Unresolved/Disorganized" status through lapses in monitoring when discussing loss or trauma.

Expect the drama triangle to manifest in therapy. Patients with histories of disorganized attachment will experience the therapist through their fragmented internal working models. At times, the patient may perceive the therapist as persecutor (threatening, judging, about to harm). At other times, as victim (helpless, needing rescue, unable to handle the patient's intensity). At other times, as rescuer (the only one who can save them, idealized). These shifting perceptions are not resistances to be confronted but manifestations of the multiple models to be understood. Metacommunication about these shifts—gently noting when the patient seems to be perceiving you differently—can build the reflective capacity that allows integration.

Prioritize safety and stabilization before trauma processing. Liotti's model explains why rushing to process traumatic memories in patients with disorganized attachment can cause harm. These patients lack the integrated self-structure needed to hold traumatic material without fragmenting further. Standard trauma protocols that work for patients with organized attachment may trigger dissociation rather than processing. Phase-oriented treatment—extensive stabilization work before any trauma processing—is not optional for this population. Building the capacity for integrated experience, developing emotional regulation skills, expanding the window of tolerance, and establishing a stable therapeutic alliance are prerequisites that may take years.

The therapeutic relationship is the intervention. For patients whose primary developmental injury was in the attachment relationship, the therapeutic relationship itself is the primary mechanism of change. The therapist must provide what the original caregiver could not: consistent, predictable, non-frightening presence. Over time, this corrective attachment experience allows new internal working models to form. The patient learns—not cognitively but experientially—that attachment figures can be reliable rather than terrifying. This is slow work, requiring patience with the inevitable ruptures and repairs that occur as old patterns are activated and gradually modified.

Consider body-based approaches. The freeze response and dissociation documented in disorganized infants are fundamentally somatic states—conditions of the body as much as the mind. Talk therapy alone may not access states encoded before language developed. Approaches that work directly with the body—Somatic Experiencing, sensorimotor psychotherapy, trauma-sensitive yoga—may help patients complete the interrupted defensive responses that froze in infancy. The goal is helping the nervous system learn that approach and avoidance are not the only options, that there are ways to remain present in relationship without fragmenting.

Broader Implications

Liotti's integration of trauma, dissociation, and disorganized attachment has implications far beyond the individual therapy relationship.

The Intergenerational Transmission of Fragmentation

The three strands of Liotti's braid—trauma, dissociation, and disorganized attachment—transmit across generations through specific mechanisms. Parents with unresolved trauma and disorganized attachment show frightened or frightening behaviour with their own children, producing disorganization in the next generation. The parent's dissociative episodes during caregiving create the "fright without solution" that fragments the infant's developing self. This is not metaphorical inheritance but documented process—intergenerational trauma transmitted through the attachment relationship itself. Understanding this mechanism suggests intervention points: treating parental trauma before transmission occurs, providing attachment-focused parent-infant therapy when disorganization is detected, supporting parents to recognize when their own dissociative states are affecting their caregiving.

Relationship Patterns and Intimate Partner Violence

The drama triangle dynamics that Liotti documented in disorganized attachment help explain patterns in intimate partner violence. Both perpetrators and victims often have histories of disorganized attachment, and their relationships can be understood as enactments of the victim-persecutor-rescuer configurations encoded in their internal working models. The victim who returns to the abuser—the trauma bond that defies logic—the perpetrator who alternates between violence and remorse, the cycles of rescue and punishment—these patterns make sense when understood as two people with fragmented internal representations finding terrible confirmation of their early models. Interventions must address not just current violence but the underlying attachment disorganization that perpetuates cycles.

Diagnostic Considerations: The Spectrum of Dissociation

Liotti's model suggests that dissociative disorders exist on a spectrum with disorganized attachment at its foundation. Mild dissociative symptoms in adulthood may represent the second developmental pathway—persistent fragmented models that become symptomatic under stress. Severe dissociative disorders, including dissociative identity disorder, may represent the third pathway—the full expression of unintegrated internal working models in the context of ongoing severe trauma leading to complex PTSD. This understanding has implications for the longstanding debate about dissociative identity disorder: rather than a discrete condition, it may represent the extreme end of a developmental continuum that begins in infant disorganization.

Borderline Personality Disorder as Attachment Disorder

Liotti's work supports understanding borderline personality disorder as fundamentally an attachment disorder arising from disorganization. The identity disturbance, affective instability, and chaotic relationships characteristic of BPD can be understood as manifestations of the multiple, incompatible internal working models that Liotti described. The patient with BPD is not manipulating or choosing instability; they are experiencing the fragmented models formed when attachment was impossible. This reframing has treatment implications: rather than focusing on behavioural symptoms, treatment should address the underlying attachment disorganization through long-term, relationship-focused approaches.

Child Welfare and Early Intervention

Liotti's developmental model underscores the critical importance of early intervention. The disorganization that predisposes to later dissociation and personality pathology is observable in infancy through the Strange Situation Procedure or related assessments. Identifying at-risk parent-infant dyads—particularly where parents have unresolved trauma or show signs of adverse childhood experiences affecting their caregiving—and providing attachment-focused intervention could prevent the establishment of fragmented internal working models. The return on investment for such early intervention, measured in reduced later mental health burden, substance abuse, criminal justice involvement, and intergenerational transmission, would likely be substantial.

Training Implications for Mental Health Professionals

Liotti's integration of attachment and dissociation research suggests that mental health training should systematically address both domains. Many clinicians receive training in either attachment or trauma/dissociation but not in their integration. Understanding disorganized attachment as the developmental foundation for later dissociation—and the drama triangle as the mechanism—provides clinicians with a coherent framework for understanding complex presentations that otherwise seem bewildering. Training in recognizing and working with attachment dynamics in the therapeutic relationship is as essential as training in trauma processing techniques.

Limitations and Considerations

Liotti's influential model has limitations that inform how we apply it clinically and understand its scope.

The specificity of the pathway requires more research. While Liotti's model elegantly connects disorganized attachment to later dissociation, not all disorganized infants develop dissociative symptoms, and not all dissociative adults have documented disorganized attachment. Individual differences in temperament, the availability of compensatory attachment figures, genetic factors affecting stress reactivity, and the presence or absence of later trauma all influence outcomes. The model describes a pathway of vulnerability, not destiny.

The drama triangle may be culturally specific. The victim-persecutor-rescuer configurations that Liotti describes may reflect Western cultural frameworks for understanding relationship roles. How disorganized attachment manifests in cultures with different relational frameworks—different conceptualizations of hierarchy, interdependence, and suffering—requires further research. The core insight about fragmented internal representations likely applies cross-culturally, but the specific content of those representations may vary.

Assessment of infant disorganization is complex. The Strange Situation Procedure requires specialized training to administer and score reliably. In clinical practice, assessing adult attachment status through the Adult Attachment Interview also requires extensive training. More accessible assessment tools that reliably identify disorganization would enhance the model's clinical utility.

The relationship between disorganized attachment and specific dissociative symptoms needs elaboration. Liotti's model explains the general connection between attachment disorganization and dissociative vulnerability, but the mechanisms by which specific symptoms (depersonalization, derealization, amnesia, identity alteration) emerge from specific attachment experiences require further research. The three pathways Liotti outlined are general trajectories; what determines which specific symptoms manifest along each pathway remains unclear.

Historical Context

Giovanni Liotti's 2004 article represented the culmination of decades of work integrating attachment theory with clinical practice. His interest in attachment began in 1975, shortly after the English translation of Bowlby's first volume of Attachment and Loss. Through correspondence with Bowlby himself, Liotti developed an appreciation for how attachment theory could inform cognitive therapy—the field he was simultaneously helping to establish in Italy.

The conceptual groundwork for the article was laid by Main and Hesse's 1990 discovery that frightened and frightening parental behaviour produces disorganized attachment. Their "fright without solution" formulation—describing the infant's impossible situation when the attachment figure is also the source of threat—provided the starting point for Liotti's extension to dissociation.

The field of dissociation research had developed largely separately from attachment research, with its own history tracing back to Pierre Janet's work in the late 19th century. Janet had described dissociation as a failure of integration—the inability to hold disparate elements of experience in unified consciousness. Liotti recognized that this was precisely what Main and Hesse were documenting in disorganized infants: a breakdown of integrative function when contradictory attachment and fear systems were simultaneously activated.

By 2004, Liotti had synthesized these streams into a coherent developmental model. The article appeared at a moment when the field was ready for such integration—when attachment researchers were exploring the developmental outcomes of disorganization, and trauma researchers were seeking to understand the developmental origins of dissociation. Liotti's "three strands" metaphor captured both the distinctiveness of each phenomenon and their fundamental interweaving.

Liotti continued developing these ideas until his death in 2018, particularly elaborating the "controlling" strategies that some disorganized children develop—controlling-punitive and controlling-caregiving patterns that represent attempts to manage the impossible parent-child relationship. His colleagues, particularly Onno van der Hart, have continued elaborating his theoretical contributions, ensuring that his legacy continues to influence clinical practice and research.

Trauma, Dissociation, and Disorganized Attachment: Three Strands of a Single Braid

APA Citation