We’ve brought up this concept in a lot of our discussions of traumatization and trauma-related disorders and in attachment specific disorders that are classified with trauma disorders in the DSM-V. However, we have not dived into the theory, disorders of attachment or in depth of how it relates to trauma. In this two part article we will cover this information.

Attachment theory is a bedrock of our current understanding of child development in their ability to form relationships, have a stable affect, understand emotions, regulate their nervous system and self-sooth. It is one of the earliest and most important stages of development when talking about emotions and relationships.

Effects of Attachment:

1. Ability to be aware of your emotions
2. Ability to rebound from distress, harm, or tragedy 
3. Ability to regulate physical arousal states
4. Ability to self-sooth, and what form we turn to
5. Connection to the body
6. Communication skills
7. Core belief formation
8. Emotional intelligence levels
9. Empathic abilities
10. Formation their self-image/identity
11. Generally, the way people interact with others
12. Likelihood of being able to assert their needs
13. Schema formation
14. The health of their Self-esteem
15. Trust formation

Developmental Stages of Attachment

It all starts in the womb where the mother’s emotional and physical health start the attachment process. The process continues throughout the early periods of life, crucially in the first 9 or so years. Importantly by age 9, the mind has formed a solid identity construct.

Attachment within the first year of life is thought to be in four stages:

1. Pre-attachment stage: From birth up to 3 months, infants do not show any particular attachment to a specific caregiver. The infant’s signals, such as crying and fussing, naturally attract the attention of the caregiver and the baby’s positive responses encourage the caregiver to remain close.
2. Indiscriminate attachment: From roughly 6 weeks to 7 months, infants begin to show preferences for primary and secondary caregivers. During this phase, infants begin to develop a feeling of trust that the caregiver will respond to their needs. They start to become better at distinguishing between familiar and unfamiliar people as they approach seven months of age. They also respond more positively to the primary caregiver.
3. Discriminate attachment: From about 7 to around 11 months infants show a strong attachment and preference for one person. This is their primary caregiver and the most important person in their attachment development. This person will likely have been there since the beginning and their attunement does matter before in forming a trust. Primary caregivers are overwhelmingly the mother. The infant will experience anxiety when separated (separation anxiety) and will experience distress around strangers (stranger anxiety).
4. Multiple attachments: After roughly 9 months babies begin to form strong emotional bonds with other caregivers beyond the primary. This often includes the father, older siblings, and grandparents.

Attachment Formation Through Attunement

Attunement: how reactive a person is to another’s emotional needs and moods. A well-attuned person will respond with appropriate language and behaviours based on another person’s emotional state.

“Alleydog.com’s online glossary”

Attunement is a key phrase in understanding attachment how it works and why it is so influential in the child’s overall development and well being. It is done between the primary caregiver and child. Mothers are more likely to be the attachment figure, and it is the most common term in the literature. Though fathers, other parents, grandparents, other legal guardians or even someone like a nanny can be the primary caregiver. All of this applies to these other forms of caregivers (besides the aspects during the gestational period)

Attunement is the process by which babies become connected and form the groundwork for how they will attach moving forward in life. The primary caregiver’s interactions with the infant and child during these stages of development (neurobiological and psychosocial) are what define your healthy attachment.

Attunement In Practice:

Attunement is made up of the ways a mother reacts and shifts her behaviour to react to her child and be able to soothe the baby back to a physiologically regulated state. When the mother and child are playing together, putting a kid to bed, changing a baby, snuggling with each other or feeding the baby attunement is formed. It’s important to understand it’s not about always preventing a child from becoming upset every time, it’s about responding and caring when it happens, otherwise known as repair.

When the mother does this and is able to soothe the baby they learn that their mother is there for them, that when they are stressed they can calm back down, and what the process of calming down feels like in the body. This teaches trust, a key factor of attachment, and allows for further emotional bonds to be built on this.

This physiological regulation is also key here, babies can’t regulate their emotions, stress responses or body. The mother being there is important because they learn the very basics of how soothing works. When the body goes through the process of being distressed and unregulated then can come back to a resting state and regulated one it learns how to do this going forward.

Ways Attunement is Seen:

Note: This will vary from person to person with what the baby and mother are comfortable with. Factors that influence this are disability other neurdivergencies.

• Eye Contact
• Physical contact, hugging, cuddling, tickling and carrying.
• Making faces at each other
• Playing games. Will change as the child grows: Peek-a-boo, with toys, chase
• Talking with the baby, baby talk is considered helpful
• The posture the mother and child take are in synchronicity
• Other forms of audio stimulation like humming and singing.
• Matching breathing with a child
• Involving the child in family activities.

Healthy VS Unhealthy Attunement:

Consistency is one of the keys here when a child has their needs met consistently they will learn to trust they will be met and know that you will be able to calm down when distressed. It does not have to be perfect, and a parent will be distracted, confused, tired or just new to this. The important part is that when a child calls out most of the time a caregiver is there and can understand a need is there. If there is repeated ignoring of them calling for help, dismissal of the needs, negative reactions or detachment the child will give up, a key factor in developing insecure attachment.

Repair and rupture are an important concept to understand when dealing with interpersonal relationships. Rupture refers to when there is a break in the stability of relationships. In attunement, it is seen when a caregiver misunderstands what the baby needs or can’t get to the child promptly. In general life, this is most commonly understood as fights. Repair is the ability for the relationship to be brought back to baseline and for the need that was missed to be met. As we grow older repair has to be between both parties, but the ability to understand the emotional and nonverbal communication and embodied feeling is learned through these early repair experiences.

Other Factors in Attachment:

Attunement is inherently an interpersonal relational process between caregiver and child, usually mother and child. But there are some factors besides the actions of the caregiver that can influence healthy attachment development.

Children who are born premature or extreme ill who have to spend a lot of time in the NICU and/or long term inpatient treatment as a very young child can struggle with health attunement and struggle with insecure attachment as children and adults. This knowledge has led to showing that as much interaction with parents and nursing staff is important. Hospitals try and allow as much physical contact as possible and if this is impossible due to the health status of the infant or mother then contact through protective tools (gloves, masks, incubators etc) and as much verbal and visual connection as can be done. (Flacking, et al., 2012 & Pennestri, et al., 2015)

Disabilities like autism can also influence how attachment forms due to different kinds and struggles understanding non-verbal communication. This creates unique struggles in forming a secure attachment, autistic kids sadly have higher rates of insecure attachment then other children however it is perfectly possible for those on the Autism Spectrum to form healthy attachment if their caregivers give in the time. (Rutgers, et al., 2007). Gratefully having parents who are aware of how to work with their autistic child and adjust some behaviour there is a likelihood you can have a securely attached child. (Pehlivantürk, 2004)

Other developmental disorders have also seen to have impacts on attachment for a combination of the above reasons if they have physical health issues, like Down Syndrome. ADHD has also had implications on attachment, often for the same behavioural discrepancies like Autism.

Reactive attachment disorder (RAD) has autism as a differential criterion. This is done because there is trouble in some people to understand autistic behaviour to see the difference between normal behaviour for those of us on the spectrum and those of us on the spectrum who are also suffering from attachment issues. We will discuss attachment disorders in part two.

Attachment Styles

“If a mother cannot meet the baby’s impulses and needs the baby learns to the be the mother’s idea of what a baby is”

van der kolk, 2005, pg 115

Attachment styles organize the patterns of behaviours and cognition formed through different experiences of attachment with the primary caregivers. This is important to understand because what kind of attachment a person had with their primary caregiver will essentially carry throughout life because as discussed above it has huge effects on the way the brain develops its understanding of the world.

There are four kinds of attachment:

1. Secure. (Secure and organized)
2. Avoidant. Insecure and organized
3. Ambivalent/Anxious. Insecure and organized
4. Disorganized. Insecure and disorganized

Rates of attachment styles:

1. 62% Secure attachment
2. 15% Avoidant attachment
3. 9% Ambivalent/Anxious attachment
4. 15% Disorganized attachment

(Ijzendoorn, Schuengel, & Bakermans–Kranenburg 1999 225-49)

Secure Attachment:

Secure attachment is a healthy, organized and stable attachment. Attunement happened and needs were met as a baby and child consistently, but of course, does not have to be always. A child with a secure attachment was likely not neglected (material or emotional), abused or experienced early childhood trauma.

When there is relational rupture repair happened. When there was severe distress happened they had people to depend on to support them. They learned coping strategies and skills to be able to become more independent. This also means that they can be separated from their parents as is developmentally appropriate and be able to take care of their own needs, but still reach out to the parent when soothing is needed when fear, confusion, pain or practical needs arise.

A secure attachment helps the kid develop an internal locus of control. The securely attached person will understand their agency in situations, and how they can control their own emotions and how they affect other people. They are taught to be able to face difficult situations and that they can have a role in changing them.

Securely attached people will be able to form further relationships that are healthy and reinforce this attachment style. It is a key factor in resilience and the ability to withstand the natural struggles a person goes through in life. This style will last into life unless there is a severe enough trauma, usually, a complex trauma breaks that down.

Characteristics of A Securely Attached Adult:

• Well regulated stress responses
• Has a sense of agency over their life
• Can practice good repair in their adult relationships
• Can usually express their emotions
• Stable identity and self-concept
• Trusts based on actions
• Has solid foundational beliefs.

Thankfully, most people have a secure attachment style. The reason being as we discussed there is no need to be a “perfect parent” just to be there, to want and try to know your kid. A secure attachment does not mean life is perfect or a lack of struggles, it just gives people a strong base to grow from and a home (metaphorically & often literally) to return to.

Avoidant or Dismissive Attachment

Avoidant attachment comes from a consistently dismissive, unavailable, and/or rejecting parent(s). When the child reached out to get support no one is there to offer it. The parent can sometimes miss out on providing material needs but always fails to provide the emotional support the kid needs. Healthy physical contact is often not provided, they are not taught to communicate with others, and are left with a distrust that anyone will provide support. They can end up being “adultified” forced to be overly self-sufficient, they can handle situations but this can sometimes be a false maturity if the were unable to internally develop.

They learn that reaching out gets them nothing and shutdown. These kids will likely not express their emotions outwardly and struggle to view themselves as part of a larger story. They learn they have to self-sooth and that they can only depend on themselves. When dysregulated the turn into themselves, because reaching out was futile during their formative years.

In the Strange Situation (Ainsworth & Bell 1970) study on Attachment Theory saw children with this attachment do not look for parents when they become distressed. They show no preference when soothing is offered by adults. This was shown as early as 8 months. Children with this style of attachment will sometimes even void their parents completely.

This style of attachment can be connected to the experiences of childhood emotional neglect (CEN). CEN is a chronic lack of any emotional support, having parents who belittle emotions and dismiss the concerns of their children.

It often creates an idea that the internal, emotional, vulnerable person we all are on the inside doesn’t matter. The need to be wanted for all we are is deep within all people when this part of us is dismissed those with avoidant attachment shut it down and wall it off. This can create a rift in identity because it creates a mindset where they can often deal with things on a material basis but fail to ever feel their emotions.

Thought Patterns Associated With Avoidant Attachment:

• Emotions are a sign of weakness/vulnerability
• I will do it all on my own
• It’s a sign of strength to no express emotions
• It’s my fault for not giving my parents/caregivers a chance to know me
• My emotions don’t matter, are shameful, overreactions, worthless etc
• No one will be there for me
• Nobody cares for my feelings
• No one will help me if I’m hurt
• People can’t hurt me if I don’t let them in
• Something is wrong with me

Characteristics of An Avoidantly Attached Adult:

• Won’t express feelings to other people
• Lack of an understanding of their feelings and emotions
• Will be hyper-independent and avoid seeking help, even when it is needed
• Being distant will fear safer than reaching out
• Lack of healthy communication skills
• Will have difficulty with conflict resolution
• Doesn’t know how to comprehend their own emotions and social needs
• Might experience a degree of alexithymia
• Will likely be more introverted
• Will likely make things into intellectual problems instead of ones of emotional and relational rupture
• Will handle stress and dysregulation on their own through self-soothing, but often lacks healthy ways of doing so
• Relationships will often struggle because others will likely view them as closed off, cold or lacking love for the person.
• Relationships might feel strained because the connection is difficult to make on a deeper level.

This is an organized attachment style meaning it happens regularly and the person with this attachment responses to internal dysregulation is predictable.

Ambivalent, Preoccupied or Anxious Attachment

Throughout this section, we will use the term anxious attachment. The caregivers of an ambivalent attached person were inconsistent with their attunement and attention and were at times obtrusive. In this case, obtrusive refers to the parents emotionally relying on the child for their own emotional needs.

From day to day the child never knew if the were going to have attunement and support from their parents. The parents flip-flopped between being there and not being there. There was a lack of parental focus on the kid. Often when they were there they slid into the obtrusive pattern.

The term ambivalent is related to this style of attachment because when people research attachment in babies they see the kids with this attachment would look for comfort by crying out and search for their caregiver similarly to a securely attached ones but with these babies when the parent came back and made attempts at repair the child didn’t react or went blank.

The kids with this attachment might learn they have to go to behavioural extremes to get any response from the adult. This causes a pattern of behaviour often seen as misbehaviour ending them up with more difficulties as they are seen as kids who won’t behave. Another common response is they might hit the other side and constantly try to do everything right becoming both very compliant and a showoff.

This attachment can form essentially an upside-down attunement dynamic with caregiver and child. The kid becomes more attuned to the parent then the parent is to the kid. The child is doing the work to sooth and help the parent deal with their life. A parentification dynamic might form, causing the child to be overly connected to their caregiver’s needs.

Anxiety forms and these people cannot regulate it. The nervous system is predisposed to jump to anxiety concerning other people, especially with intimate relationships. These people were likely never taught how to cope with their dysregulated state and can not bring themselves back to baseline. These people can often not internally handle anything and can be hyper reliant on others. This can form codependence.

Thought Patterns Associated With Anxious Attachment:

• Everyone is going to abandon me
• Hope is for suckers
• I can’t depend on others
• I have to make a lot of noise for anyone to care for me
• I’m too much for everyone
• Life is not fair
• No one will ever really love me
• Other people are just a coin toss on how they will react to me

Characteristics of An Anxiously Attached Adult:

• Can be preoccupied with past incidents of stress
• Can push others away in fear of abandonment
• Constantly looks for validation of their emotions and perspectives
• Have a pattern of volatile relationships
• Is often seen as overly clingy with other people
• Struggles with fear of abandonment
• Will deal with anxiety and preoccupation around other people
• Will often blame other people and blame themselves at the same time

This is an organized form of attachment, this means the brain was able to form a normalized pattern of responses to something. A strategy to deal with problems is formed.

Disorganized Attachment

Disorganized attachment is formed from abusive, traumatic, and/or generally severely unstable lives. Essentially they are stuck in a situation of violence and can not find any comfort from caregivers. Often this is from living in an abusive home and the parents are no source of repair, attunement or comfort. The key factor here is they are in a situation where they need they’re parent/caregiver to survive but the parents are a source of fear. The child here is set into consistent fear and have no method to heal and bring themselves to a state of calm. This causes the child to not develop a consistent and effective response to relational rupture and emotional/nervous system dysregulation.

The parents of these children are often abusive towards the child, this does not have to be physical to meet the fear criteria emotional/psychological abuse, severe neglect and sexual all fall into this fear category. If there is domestic violence between caregivers this can also leave the child with disorganized attachment. Parents of disorganized attached children often have unintegrated trauma and attachment issues themselves. As well as be experiencing trauma during the time they are parenting the child. This is part of where the cycle of abuse is a real factor. However, parents with trauma who have processed their trauma do not have to raise children with their attachment issues.

Those with disorganized attachment develop a nervous system that is dysregulated which can cause hypervigilance, anxiety, anger, heightened emotional reactivity, and predisposes this person to mental health issues and physical health issues. They never form a sense of being viscerally safe.

This reaction is caused by the survival and “fear” circuits in the brain fire off at the same time as the “attach” sections of the brain. With the brain trying to search for support and escape at the same time it causes a collapse response. This leads to a lack of cohesive and stable response to dysregulation and relational rupture causing them those with this attachment style to suffer worse from these issues.

Children with this attachment will often display a mix of ambivalent/anxious and avoidant style behaviours. Confusion is often displayed as well in young children.

Over time you can see the attachment falter it creates a downward spiral. This lack of attachment leads to severe dissociative responses during distress and in the identity formation. It is the highest predictor of struggling with dissociative tendencies and dissociative disorders.

Thought Patterns Associated With Disorganized Attachment:

• I don’t want to be here
• I’m flawed on a base level/I’m a bad person
• Life is unsafe
• People are deeply untrustworthy
• Periods of emotional blank outs/deep numbness
• Why don’t people love me?

Characteristics of an Adult with Disorganized Attachment:

• Aggressive tendencies will sometimes occur
• Altered pain tolerance
• Difficulties in their familial relationships outside of the family of origin
• Have an unstable self-identity
• Have health issues related to stress/trauma
• Have hyperactive fawn and freeze responses
• Lacks coping skills to deal with distress
• Often suffer from mental health issues related to trauma (C-PTSD/PTSD)
• Poor self-esteem
• Severe hypervigilance
• Struggles with education and employment
• Unstable relationships
• Will deal with dissociative tendencies and/or dissociative disorders (DID/OSDD)
• Will often have had multiple traumatic experiences

Informational Article: Attachment Theory (Pt 2)

Works Cited