ATTACHMENT DISORDER:
A LIFE-LONG TRAUMA
The Diagnostic and Statistical Manual of Mental Disorders is the 2013 update of the diagnostic tool published by the American Psychiatric Association.
The Personality Inventories for DSM-5 measure maladaptive personality traits in 5 domains: negative affect, detachment, antagonism, disinhibition, and psychoticism. For children ages 11 and older, there are brief forms with 25 items. The full versions with 220 items are for adults. The DSM-5 Checklist is a questionnaire that measures the degree (mild, moderate, or severe) of a substance use disorder to which a person meets diagnostic criteria.
Studies of normative development suggest that attachment bonds become evident between the ages of 6 and 9 months, indicated by preferential seeking of comfort from selected individuals when distress is triggered through separation from the principal caregiver. A child trusts that his needs are understood and will be met intuitively. He is secure in the knowledge that if his environment is scary or insecure, his caregiver is available as his protector and refuge to be comforted.
The lack of early parental attachment, or emotional abuse in infancy and early childhood, contributes to an insecure feeling of rejection and damages a child’s mental health for life, leading to anxiety and ADHD. The first 3 years are crucial for building a solid foundation for emotional regulation and resilience. Attachment patterns are “formed in the context of early experiences with caregivers, and later maintained by interpersonal relationships in adulthood”. Children who are traumatized are at risk of developing complications with attachment.
In traditional native cultures, the child is nurtured in a marsupial manner, prioritizing skin bonding with his caregiver. The communal life enhances physical and emotional bonding and spontaneous social interaction. The Western culture has failed to meet children’s needs on both counts.
According to the attachment theory created by John Bowlby. There are 4 stages of development in children:
1st The pre-attachment, from birth to 6 weeks.
2nd The attachment-in-the-making, from 6 weeks to 6–8 months.
3rd The clear-cut attachment, from 6–8 months to 18–24 months.
4th The formation of reciprocal relationships is from 18–24 months and beyond.
Separation anxiety appears when infants form attachments around 6 months of age and peaks at approximately 18 months old. When separated from their primary caregiver within that period, they experience anxiety through fretfulness and weariness. They demonstrate either an avoidance of relationships for fear of rejection or being overly attached. Along with relationship difficulties, children face attachment trauma as a result of humiliation, shame, and guilt from their caregivers.
There are 2 major forms of insecure attachment disorders identified by the ICD-10 (International Classification of Diseases):
1- Reactive attachment disorder (RAD) is characterized by social withdrawal and divergent behavior failing to seek and respond to comfort, internalizing anxiety, and demonstrating depressive symptoms. By not providing a positive, stimulating, and interactive environment for a child, RAD leads to lifelong problems in behavior, relationships, social interactions, mental and physical health, and intellectual development, in many cases leading to addiction. Treatment and support for the child’s development may be through a constant replacing caregiver to encourage a stable attachment, through love, nurturing, caring, and responsiveness. This helps the child develop healthy relationships for life and improves their emotional and social well-being.
There is insufficient research on signs and symptoms of RAD beyond infancy, remaining uncertain at precisely what age children demonstrate signs other than withdrawal, fear, sadness, apprehension; irritability, and aggression.
Common signs of RAD in children:
- Lack of bonding or affection for caregivers.
- Easy detachment.
- Oppositional or reproachful behavior.
- Lack of eye contact.
- Serious demeanor, unable to smile.
- Acute bursts of anger.
- Lack of fear.
- Offensive or bullying others.
Disinhibited social engagement disorder (DSED) is characterized by socially disinhibited outgoing behavior. Interactions with strangers in unfamiliar situations indicate impulsivity in social situations. It combines both the anxious and avoidant attachment conditions. Such persons experience intense anxiety and high avoidance in relationships. It is also called a disorganized attachment. Those with an anxious attachment pursue persistent closeness and those with an avoidant attachment, feel overwhelmed by the demand for intimacy. Anxious attachment is the unhealthiest of the two disorganized attachment types. A significant contributor to depression, anxiety, and low self-esteem in those with a history of childhood neglect or physical abuse. Persons with DSED represent indiscriminate sociability, with the need for closeness and a fear of rejection — contradictory mental states and behaviors. It is the rarest and the most extreme form of insecure attachment as it results from very specific kinds of trauma.
Treatment for attachment disorders involves therapy, counseling, and parenting skill classes. It is highly prevalent in maltreated children, suggesting that neglect and various forms of abuse in parental behaviors play a role in the development of this pattern of attachment. In some cases, medication or mental health support is recommended. Treatments are designed to help children learn to form healthy attachments and develop better coping skills. An adolescent or adult with DSED may display hyperactivity, extreme trust in people not well-known, and a lack of social boundaries.
Adults with disorganized attachment pursue a loving relationship but then detach or lash out at a partner who gives them that love. Their behaviors indicate difficulties in their self-belief and with trusting others. Such issues can potentially lead to mental health problems such as mood disorders. CBT (Cognitive Behavioral Therapy) helps individuals recognize and challenge negative thought patterns that contribute to dismissive-avoidant behaviors. By reframing these beliefs, they can develop more adaptive responses in their relationships. Adults may require consulting a mental health professional.
Disorganized/disoriented attachment stems from intense fear, often as a result of childhood trauma, neglect, or abuse. Adults with this type of insecure attachment tend to feel they don’t deserve love or closeness in a relationship.
You have surely come across ‘gaslighting’. Sometimes it could be ‘scapegoating’. A thin line separates the two. It depends on the aggressor. I am working on this subject for an article next month. Stay connected and follow to be promptly informed.
The worst trauma is trying to please a toxic person to acknowledge and accept you, yet feeling constantly rejected. It is an endless dance of imposed power and authority on one hand, and a lack of it on the receiving end, devoid of any consideration…losing oneself in the process!”
An excellent “continuité de semaine” !
Sammy RNAJ
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