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Attachment and Psychopathology
Attachment is a deep and lasting emotional relationship that links one person to another in time and space and is a basic, innate primary human need, as strong as any other need such as food and sleep. Children are biologically predisposed to use their parents as a safe harbour that provides them with comfort, care and protection when they feel uncomfortable or afraid, as well as a secure base from which they can explore their surroundings and always return to. In the short term, attachment protects the child from potential dangers and keeps them close to their parents, while in the long term it ends up providing the model on which other relationships will be based, this model or rather ‘filter’ for the unconscious perception of the Self, the Other and the World. This attachment system is organised and consolidated throughout early childhood, although it can be altered by new relational experiences.
Children with a secure attachment have had their needs for closeness, affection and physiological needs met the vast majority of the time, and can feel free to explore, play and express their feelings precisely because they trust their parents' support and care. With their parents' support and guidance, these children also learn how to regulate their emotions, i.e. to know, understand and express them in a way that is best for them and for others. They grow up with a perception that the world is essentially good and that they are loved, being able to trust people, establish relationships easily and creatively seek to explore and discover the world, as well as, as adults, valuing their childhood, describing it in an open, coherent and consistent way. However, when the parents' parental sensitivity to the child's needs is insufficient or even precarious, the child's attachment model could be dysfunctional and lead to major problems in the future in their relationships with others, with themselves and in regulating their emotions. Parental sensitivity can be understood as the parents' ability to perceive and read their children's signals with specificity, which requires dedication and a lot of attention to the child, as well as the readiness to respond to these signals in an appropriate way (they can indicate hunger, thirst, elimination needs, the need for attention, affection and comfort, communication, among others).
Other types of attachment identified and explored in the literature are the ambivalent insecure, avoidant insecure and disorganised (or fearful avoidant insecure) types.
Children with an ambivalent insecure attachment are those who have had their needs met in an irregular and inconsistent way, sometimes needing to shout to be seen and cared for or, even then, often not having their needs met. This also includes children who have experienced treatment that oscillates between love and hate, or between care and violence. These children grow up realising that the world and others are unpredictable and that affection and comfort are not guaranteed. In the face of frustrations and difficulties, these children are often difficult to comfort; after all, there is no guarantee that they won't be left alone with their frustrations again. As they grow up, in the absence of other significant relationships that are stable, constant and nurturing, these individuals may become people pleasers in order to ensure that they are accepted and loved, particularly by their parents. Throughout the development of their personalities and identities, they may end up developing what Winnicott (1965) defines as a false self: an annulment of themselves, their desires and needs in the name of accommodating to the expectations of others. Under these conditions, these people will be highly dependent on the approval of others and constantly preoccupied with these concerns, they will also have difficulty concentrating, very changeable self-esteem and mood, impulsiveness, intolerance of frustration, insecurity and difficulties in understanding their own emotions. In addition, because they have constantly inhibited and devalued their own emotions in the name of adapting to those of others, these same emotions (of sadness, anger, humiliation, guilt, shame, etc.), instead of being recognised and worked through, can end up converging on the Self, i.e. manifesting as internalising disorders (e.g. depression) or on the Other, externalising (e.g. oppositional and defiant behaviour, anger issues). It is also common for those who relate to an ambivalent anxious pattern to ‘lose themselves in the other’ in relationships, since, not having been seen, welcomed and understood, they may have an urge to try to understand themselves and feel valued from the other's point of view. It is common for people with this relational pattern to end up adopting self-destructive behaviours in the face of love break-ups, unconsciously resulting from the belief that they are ‘not worthy of love’, ‘not enough’, and so on. It is also possible that such difficulties make the individual more predisposed to developing certain personality disorders, such as borderline personality disorder, histrionic, dependent, obsessive-compulsive, among others.
Children with an insecure-avoidant attachment are those who have been neglected, most of the time having had their needs and signs of discomfort or desire for contact ignored or rejected. These children will grow up with a perception that the world is inhospitable and people can't be counted on, but before that, they will end up giving up on relationships, after all their core belief will be ‘I won't get their attention anyway, so why try?’. In addition, these individuals will develop and orientate themselves in such a way as to be solitary and not seek contact with other people, and may be hostile and aggressive, since they don't believe they have any influence on others, let alone be understood, which in turn will lead to other people not approaching them and thus remaining in vicious cycles. Other issues can be even more problematic, as neglect is interpreted in a child's mind as ‘nobody listens to me, nobody holds me, I don't affect anyone, therefore I don't exist’, which can lead to serious identity problems and personality disorders, such as schizoid, schizotypal and paranoid, which are more associated with a higher incidence of psychosis (e.g. schizophrenia). Also, with a continual lack of socio-emotional interaction, a person will end up having many difficulties in their emotional regulation as well as in their social integration.
Finally, children with a disorganised or fearful-avoidant attachment are those who have not only been neglected most of the time, but when they have been cared for, it has been in a violent and abusive way. These children grow up with a high level of fear of their parents and their environment, seeing the world and others as a source of danger. In addition, they may see themselves as undeserving of love and have serious difficulties in developing empathy and pro-social behaviour, because ‘no matter what I do, I will always be punished, I just have to protect myself and survive’. They may be more predisposed to developing different personality disorders, such as paranoid disorder, anti-social behaviour, among others.
However, it is very important to point out that although a child may have grown up with a specific insecure or disorganised attachment style with their parents, their personal attachment system and way of conceiving the Self, the Other and the World may also be influenced by their relationship with other carers. If the child has other secure, stable, affectionate and supportive relationships with other members of the extended family or with education and mental health professionals, these experiences can balance out their traumatic experiences. Furthermore, although attachment is structurally formed in early childhood, i.e. in the first three years of age, an individual's internal attachment models can be altered in later relationships at other stages of life. Structural means the basic schema for understanding situations and people as threatening, welcoming or trustworthy, as well as a person's emotional and hormonal response to these approaches. This structure is also reflected in neurological terms, since in the early years there is an explosion of brain development and the generation of new neural connections in the child, and this depends on the specific interaction between their genetics and their interaction with the environment. A child who has always received affection and response from their parents, for example, will have neural networks formatted for closeness, and will also be more likely to produce oxytocin, also known as the social hormone, which promotes attachment and the pleasure of feeling connected. This same child will probably also have been stimulated more, played with, talked to, and so their brain will end up developing more. In the case of other children, this may not be the case, since children who live in fear of their parents will be constantly activating the physiological system of flight or fight, of fear, with a lot of adrenaline and stress hormones (which can be toxic) being produced. Neglected children will also end up showing significant differences from those with secure attachments, showing much lower than expected neural development. However, as said, it is possible to change these attachment patterns, but for those individuals who had dysfunctional attachments in childhood, this task will be much more arduous: it will require many future responsive, supportive relationships and, above all, with people who are understanding and patient with their behavioural and emotional responses which, unfortunately, were generated and adapted to a dysfunctional environment in which they grew up. It's also worth pointing out that the reverse is also possible; a child who has developed a secure attachment model may end up adopting a different one throughout their life. Imagine that a child had a so-called ‘perfect’ childhood, but when they started to grow up and wanted to become independent, perhaps their wishes, desires and needs were not respected by their parents or were even assaulted. With time and repeated experiences of this different nature, the attachment model that was once the legacy of a secure child can become that of an insecure, ambivalent or avoidant adolescent. With this new model, the adolescent may start to relate to their peers on the basis of insecurity, anxiety or fear, thus reproducing more dysfunctional relationships and fuelling a dysfunctional attachment model. For example, young people or adults with insecure attachments can end up craving almost unattainable objects of love, in order to resolve the inner conflict that they are worthy of love even from those who initially rejected them. Such biased choices usually culminate in ineffective relationships or without reciprocity, thus confirming internal attachment models.
Finally, it can be concluded that attachment plays an important role in the way individuals perceive themselves, the others and the world, as well as regulating their emotions. Although there is no linear relationship between types of attachment and psychopathologies, it is essential for understanding dysfunctional dynamics in individuals' interpersonal and intrapersonal relationships (their own thoughts and emotional regulation) to delve into self-knowledge and re-elaborate past experiences. In the therapeutic field, it is necessary to provide a secure base for comfort and exploration of one's own experiences, beliefs and feelings, thus enabling change. After all, despite everything, a being never is, but is being depending on a great complexity of factors that contribute to maintaining what a person claims to be.
References:
Ainsworth, M. D., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment.
Ainsworth, M. (1989). Attachment beyond infancy. American psychologist, 44, (4), 709-716
American Psychiatric Association (2014). DSM-5: Diagnostic and Statistical Manual of Mental Disorders. Artmed Editora.
Bartholomew, K. et Griffin, D. (1994). Models of the self and the other: fundamental dimensions underlying measures of adult attachment. Journal of personality and social psychology, 67, (3), 430-445;
Bowlby, J. (1982). Attachment and loss: retrospect and prospect. American journal of Orthopsychiatry, 52(4), 664.
Bowlby, J. (2018). The nature of the child's tie to his mother 1 (pp. 222-273). Routledge.
Cassidy, J., & Shaver, P. R. (1999). Handbook of attachment.
Harlow, H. F. (1958). The nature of love. American psychologist, 13(12), 673.
Juffer, F. E., Bakermans-Kranenburg, M. J., & Van Ijzendoorn, M. H. (2008). Promoting positive parenting: An attachment-based intervention. Taylor & Francis Group/Lawrence Erlbaum Associates.
Perry, P. (2019). The Book You Wish Your Parents Had Read (and Your Children Will Be Glad That You Did): THE# 1 SUNDAY TIMES BESTSELLER. Penguin UK.
Winnicott, D. (1965). The Maturational Processes and the Facilitating Environment. London: Hogarth Press/Institute of Psychoanalysis.
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