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Attachment Issues and Disorder Treatment

What are Attachment Issues?

The term “attachment issues” broadly describes problems related to social relationships, behavior, and mood resulting from an early childhood failure to attach with a primary caregiver. This failure to attach can lead to a lack of self worth and trust, fear of intimacy, anger, a need for control, and the belief that the world is a frightening and unsafe place. The symptoms of attachment issues in children are highly variable but often consist of behavior that is incongruous with their age; for example, a toddler that cannot be comforted by contact with familiar adults, or an 8 year old who is excessively friendly or outgoing with strangers.

The most serious form of attachment issues is Reactive Attachment Disorder, or RAD. This condition is common in children who were moved from home to home in foster care, raised in an orphanage, abused, or taken from their primary caregiver after a bond had been established. The symptoms of RAD include an aversion to physical affection, a need to be in control, excessive anger, difficulty showing care, and an underdeveloped sense of empathy. RAD can be further divided into two patterns of symptoms: inhibited and disinhibited. Inhibited symptoms include being emotionally withdrawn, resistant to support, extreme awareness of surroundings but low responsiveness, and negative reactions to touch. Disinhibited symptoms include extreme and indiscriminate comfort seeking, co-dependence, appearing to act younger than their chronological age, and chronic anxiety.

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What are the causes of Attachment Issues?

Attachment issues are the result of failure to forge attachments with one’s primary caregivers as a young child. Abuse, neglect, being under the care of a large number of caregivers who rotate frequently, sudden separation from a caregiver, or a lack of attention and responsiveness from a caregiver can all contribute to attachment issues. These experiences with primary caregivers during early years are of particular importance as they are the foundation of all future relationships.

A common term used to delineate different forms of attachment issues is “attachment patterns.” The first of these patterns, secure attachment, essentially describes a child who successfully attached to their caregiver. These children feel comfortable performing exploratory behavior when their caregiver is present, show signs of distress when their caregiver is not present, and appear to be happy when their caregiver returns. The second, anxious-ambivalent attachment, is thought to be the result of unpredictable responsiveness from primary caregivers. Children with this pattern of attachment are leery of unfamiliar things, unlikely to explore even in the presence of their caregiver, become highly distressed at the departure of their caregiver, and show ambivalence upon their return. The third pattern, anxious-avoidant attachment, is characterized by a child ignoring and avoiding their caregiver, and having little to no reaction when their caregiver comes and goes. This pattern of attachment is thought to be the result of conditioning a child to believe that communicating their emotional needs will not influence their caregiver to meet their needs. Lastly, disorganized/disoriented attachment refers to disorganized responses to the coming and going of their caregiver, such as fear, simultaneous but conflicting emotional displays, stereotypic or jerky movements, or dissociation.

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What is the prognosis for Attachment Issues?

There are a variety of options available to treat attachment issues. In general, the earlier attachment problems are identified, the easier it is to treat them. The majority of these treatments focus on increasing the responsiveness of the primary caregiver, or if this is not possible, establishing a new primary caregiver. Family therapy can be helpful for educating the parents about the symptoms and effective interventions for attachment issues, and often involve rewarding activities that aim to strengthen the bond between the child and their caregivers. Individual therapy can help those with attachment issues learn to monitor their emotions and behavior. For younger children with attachment problems, play therapy can teach them the skills needed to appropriately interact with their peers. Medication can be used to manage symptoms of attachment issues, such as hyperactivity, anxiety, or depression, but must be used in combination with therapy in order to achieve lasting results.

How do attachment problems relate to personality issues?

Internal representations of relationships are formed during the early attachment process. When the healthy attachment process is disrupted, a child can become confused in how they view interpersonal relationships. They may perceive others as anxiety-provoking, threatening or untrustworthy. These representations can affect a person’s perception of the world and their pattern of interpersonal behaviors. When attachment is severely disrupted early in childhood, adult problems which are sometimes labeled as “personality disorders (narcissistic, borderline, histrionic, dependent)” can manifest.

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