There continues to be some lack of clarity about the nature of attachment disorders. One aspect about which there is consensus is that, whatever the precise nature of these difficulties, they only arise following very adverse early caregiving experiences in the child's life, to the extent that one might conceptualise the disorders as 'post severe caregiving adversity disorders'. This is, however, unsatisfactory, as a disorder cannot be characterised by its antecedents alone.
The adverse early caregiving environment is most probably one of severe neglect characterised by lack of a consistent and available caregiver. However, the term maltreatment has also been used to describe the affected children's early experiences (e.g. Boris et al. 2004) and, indeed, ICD-10 (but not DSM-IV-TR) includes psychological and physical abuse and injury as well as neglect. This is problematic since maltreatment includes both neglect (omission) and abuse (commission). As will be discussed below, the postulated explanation for how attachment disorders evolve is based on an absence of an available or responsive caregiver to whom to attach. While abuse can occur alongside serious neglect or changes of caregiver, abuse on its own would be insufficient to explain attachment disorder. Abuse is associated with a developed, albeit disorganised, attachment. It is therefore safer to assume that it is absence-omission which is implicated as the pre-condition for attachment disorders. This can occur in three caregiving contexts: (1) (some) institutions, (2) repeated changes of primary caregiver and (3) extremely neglectful identifiable primary