PMH-C Infant Bonding 4 — Questions and Answers
Question 1: An adoptive mother at 6 weeks reports she does not yet feel love for her adopted newborn. How should the clinician respond?
- Refer urgently for psychiatric evaluation for attachment disorder
- Normalize that bonding can develop gradually and explore any barriers or mental health concerns (Correct answer)
- Suggest the adoption may not be appropriate and discuss disruption
- Reassure her without further assessment
Correct answer: Normalize that bonding can develop gradually and explore any barriers or mental health concerns
Bonding in adoptive parents often develops over time; the clinician should normalize this while screening for depression, anxiety, or other barriers.
Question 2: Which of the following infant characteristics is MOST likely to challenge caregivers' bonding capacity?
- High birth weight
- Temperamentally 'difficult' or highly reactive infant (Correct answer)
- Female sex
- Delivery at 40 weeks gestation
Correct answer: Temperamentally 'difficult' or highly reactive infant
Infants with difficult temperaments who are hard to soothe place high demands on caregivers and can strain the developing attachment relationship.
Question 3: Which concept describes the clinician's observation of the quality of a mother's emotional investment and representational world around her infant?
- Object constancy
- Parental reflective functioning (Correct answer)
- Developmental surveillance
- Maternal gatekeeping
Correct answer: Parental reflective functioning
Reflective functioning (or mentalization) refers to a parent's capacity to hold the infant's inner states in mind, and is strongly linked to attachment quality.
Question 4: A mother discloses she has intrusive thoughts of accidentally harming her baby but is horrified by them and does not want to act on them. This MOST likely represents:
- Postpartum psychosis with intent to harm
- Ego-dystonic obsessional thoughts associated with postpartum OCD (Correct answer)
- Normal maternal ambivalence requiring no intervention
- Disorganized attachment to the infant
Correct answer: Ego-dystonic obsessional thoughts associated with postpartum OCD
Ego-dystonic intrusive harm obsessions are a hallmark of postpartum OCD; the mother's distress and lack of intent distinguish this from psychosis.
Question 5: Which aspect of the caregiving environment most strongly predicts transmission of attachment patterns across generations?
- Socioeconomic status
- Unresolved maternal loss or trauma (assessed via Adult Attachment Interview) (Correct answer)
- Number of siblings
- Geographic location
Correct answer: Unresolved maternal loss or trauma (assessed via Adult Attachment Interview)
Research using the Adult Attachment Interview shows that unresolved maternal loss or trauma is the strongest predictor of disorganized infant attachment.
Question 6: Which of the following is a core feature of 'disorganized attachment' in infants?
- Consistent proximity-seeking when distressed
- Contradictory or collapsed behavioral strategies when the caregiver is both a source of fear and comfort (Correct answer)
- Avoidance of the caregiver in all situations
- Strong preference for unfamiliar adults over the caregiver
Correct answer: Contradictory or collapsed behavioral strategies when the caregiver is both a source of fear and comfort
Disorganized attachment occurs when the caregiver is simultaneously the source of fear and comfort, producing contradictory, disoriented behaviors in the infant.
Question 7: A lactation consultant asks when to refer a breastfeeding mother who seems persistently disengaged during feeds. What is the BEST criterion for referral to perinatal mental health?
- After three failed latch attempts
- When emotional disengagement persists beyond two weeks and is accompanied by mood or anxiety symptoms (Correct answer)
- Only if the mother explicitly requests help
- When the infant fails to regain birthweight
Correct answer: When emotional disengagement persists beyond two weeks and is accompanied by mood or anxiety symptoms
Persistent emotional disengagement during feeding lasting beyond two weeks, especially with mood or anxiety symptoms, warrants mental health referral.
PMH-C Infant Bonding 4
An adoptive mother at 6 weeks reports she does not yet feel love for her adopted newborn.
How should the clinician respond?