Psychobiology of Attachment and Trauma—Some General Remarks From a Clinical Perspective (Part 1/2): “Early representatives of psychoanalysis argued that the roots of human social motivation are primarily physical and sensory (hunger, sexuality) 1/31
and that satisfaction and/or frustration of these needs lead to the infant’s initial approach to the mother. John Bowlby (1907–1990) strongly opposed this theoretical approach. Based on numerous empirical observations he developed a different theory: 2/31
the infant’s hunger for its mother’s love and presence is as great as its hunger for food. Attachment is therefore a “primary motivational system” with its own workings. Rene Spitz had made similar empirical observations with orphaned children some years earlier. 3/31
Although carers in orphanages adequately met children’s basic nutritional and hygienic needs, they failed to deliver reliable emotional support; the care they received belied a disconcerting, psychosomatic failure to thrive, in addition to a high mortality rate. 4/31
Bowlby verified his attachment theory with some pioneering publications: Along with the infant’s emotional and cognitive development and the care of its mother, a strong emotional connection is gradually developed under favorable conditions. 5/31
Furthermore, Bowlby suggested that early attachment experience creates internal working models as “life-long templates.” These templates create an affective as well as cognitive matrix for future relationship patterns. 6/31
Research suggests that the majority of children, who grow up under positive interpersonal and social circumstances, form a stable attachment security; a crucial factor for the development of children’s emotional, cognitive, and interpersonal competence. 7/31
On the other hand, exposure to trauma in early childhood significantly interferes with the ability to form secure attachments. Despite experiencing trauma such as neglect and abusive behavior, all children continue seeking proximity and develop distinct attachment patterns. 8/31
Secure Attachment: Trust, reciprocity, intimacy, and love are higher structured psychological qualities of affective experience in such a primary relational context. These affective exchanges are the basis of attachment; motivationally coupled with the reward system. 9/31
Imminent danger initiates a social orientation reaction, a turn towards a familiar face, a contact search with vocalization that allows for verbal communication. When this response does not lead to a signal of security, reaction patterns of fight and flight are mobilized. 10/31
In traumatic situations, which emphasize hopelessness in addition to states of helplessness, this leads to immobilization, passive avoidance, and freezing in a dissociative state. 11/31
When parents accompany the child in play, non-intrusively directing its attention and encouraging constructive solutions in a commonly shared focus, they securely anchor the child’s perceptions and feelings with the outside world. 12/31
The child gradually learns to perceive himself as an intentional agent. In the distinction between means and ends, action and result, this allows effectively controlling instrumental behavior in many everyday situations. 13/31
Insecure Attachment: This is the result of mostly unsuccessful early affective coordination processes. This may be the result of an emotionally unstable and probably insecurely attached primary carer, or related to an inherently difficult temperament of the child. 14/31
Overall, both partners consider the interactions as less rewarding. Non-containing and in-congruency, leading for example to inappropriately excitatory, anxious-worried or dismissive affect reflections, prevent the development of stable affect representations. 15/31
They undermine the secure creation of a boundary between self and object representations. Schemata of unsecure, worthless, ashamed, guilty self versus schemata of unreliable, dangerous, confusing, rejecting objects may also be a consequence. 16/31
This child shows a strong sensitivity and hypervigilance towards potential threats in the social environment. From a neurobiological perspective, mature mentalization achievements can only succeed up to states of a moderately elevated arousal. 17/31
Controlled mentalization, however, fails in states of high or extreme arousal. Here, the predominant reaction pattern of “fight-flight” and danger-oriented vigilance prevails. Upregulated and abrupt changes may occur between panicked timidity and aggressive hostility. 18/31
Individuals with “anxious-avoidant” attachment patterns have learned to classify social contacts as potentially dangerous and unsettling and prefer to avoid them. Instead, they may have developed compensatory techniques to strengthen their independence. 19/31
However, their retrievable cognitive self and object schemata are usually rigid. These strategies also require enormous defensive energy. The associated increased intra-organism stress level may contribute to significant mental and physical health risks long term. 20/31
“Disoriented-disorganized attachment”: Attachment trauma translates to the overwhelming experience of feeling alone in the midst of an unbearable emotional state or, worse, realizing the attachment person itself is the cause of overwhelming distress. 21/31
Exposition to a traumatizing attachment figure impairs basic ability to achieve a secure attachment; the expectation that all relationships are dominated by mistrust; shattering emotional distress and undermines the ability to effectively regulate this emotional distress. 22/31
And it is usually incompatible with the development of a mature mentalization. Attachment trauma may occur in the form of a basic interpersonal neglect (omission trauma) or in the form of physical, mental or sexual abuse (commission trauma). In many cases, both. 23/31
Attachment trauma often leads to a “disoriented-disorganized” attachment. A disorganized attachment pattern in turn imparts an increased risk of further abuse and neglect. Attachment traumata, however, do not happen in an empty social context. 24/31
Massive problems in parental care are empirically associated with numerous unfavorable psychosocial stressors, e.g. severe chronic marital conflict, parental psychiatric morbidity and violent environment. 25/31
Attachment trauma forces the child into a developmental dilemma with no way out, a constant “horror without resolution”: Traumatic anxiety, fear, or panic is associated with the presence of a central attachment figure. 26/31
However, this situation inevitably activates the natural “attachment system” and provides a motivation to find presumed safety in the person through an intense search for closeness, which may further increase emotional distress. 27/31
This developmental paradox consists in maximum activation of an approaching tendency to the traumatizing attachment figure with simultaneous activation of the escape system without, however, being able to achieve consistent behavioral management. 28/31
In other social interactions with the attachment figure, the child themselves may actively replicate the incompatible parental care behavior in a desperate bid to regain emotional control of the actual relational situation. 29/31
The child struggles to resolve its dilemma of closeness and distance in dealing with the attachment person by alternating between a controlling-punishing versus controlling-caring behavioral pattern.” 30/31
Lahousen, T., Unterrainer, H., & Kapfhammer, H. (2019). Psychobiology of Attachment and Trauma—Some General Remarks From a Clinical Perspective. Addictive Disorders, Frontiers in Psychiatry. Adapted for Twitter. This thread is not the whole article. 31/31
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