In recent years the role of disorganized or disoriented attachment representations has been stressed. Unresolved attachments are suggested to be important in the emergence of disorders with a dissociative component, such as posttraumatic stress disorder, and to make individuals more vulnerable to developing psychopathology. Here we draw on the accumulated data collected with the Adult Attachment Interview (AAI) to test the hypothesis that in clinical groups insecure attachment categories are overrepresented, in particular the insecure-unresolved category. Furthermore, we explore systematic patterns in the association between attachment representations and clinical disorders, in particular the potential link between dismissing attachments and externalizing problems compared to the possible overrepresentation of preoccupied and unresolved classifications in the case of internalizing disorders. Our previous meta-analysis focusing on these issues was conducted more than a decade ago. Because the number of AAI studies has increased dramatically (more than 9,000 individuals participated in the AAI since its inception), it is now time to take stock of the available evidence for a more grounded association between attachment representations and clinical disorders.(PsycInfo Database Record (c) 2022 APA, all rights reserved)