Thread by @drlouisehansen

Disoriented-Disorganized Attachment Pattern and Increased Risk of Further Traumatization (Part 2/2): “Established insecure attachment patterns are empirically associated with a higher rate of traumatic events and subsequent trauma. 1/23

Further trauma has a disastrous impact on affective and socio-cognitive development. Sexual or aggressive exposures of abuse by a parent, for example, are particularly devastating if they are based on a previous relational context of emotional neglect. 2/23

They may promote “identification with the aggressor” and, as a result, may create intrapsychic relational representations of “perpetrators and victims” in rapid reversals. However, this dominant pattern is based on a massive obstruction of general mentalization functions. 3/23

Due to the overwhelming destructive affects in the trauma itself, it is often not possible to correctly record the event between perpetrator and victim in the sense of an identifiable object-subject relation; maintaining a strong risk of further traumatization. 4/23

Intensive clinical and neuroscientific research has led to the following insight into some of the more debilitating consequences of attachment trauma: Dissociative symptoms result from a failure to integrate trauma-related information (“compartmentalization”) 5/23

and from an increased use of the evolutionarily anchored protective mechanism of depersonalization and derealization (“detachment”). About one third of all PTSD patients, especially those with a history of early attachment trauma, present a special dissociative type. 6/23

In the time dimension of our consciousness, the intact functionality of the autobiographical memory, can clearly differentiate between a current experience, a retrospective memory, or a future-oriented presentation. 7/23

In traumatically altered states of consciousness, this confident performance of the self may be completely suspended by flashbacks and fixed to an involuntarily revived traumatic timeline. Intrusive recollections may occur and cause great emotional distress. 8/23

The first-person perspective can be lost in traumatically dissociative altered states of consciousness, when one’s own thoughts or memories can only be perceived in the form of voices. 9/23

Even if the persons basic schemata are shaken to the very core of security, trust, self-worth, dependency, autonomy, control, intimacy, and hope, the basic structure of personal identity, however, is usually not split in this state. 10/23

A state of depersonalization can appear: perceiving own body in a third person perspective and a self that is separated from bodily sensations, only mentally observing oneself (“out-of- body experiences”). 11/23

In conditions of autonomic hyperarousal triggered by normal waking consciousness, agonizing and disturbing body sensations in turn can completely control acute life and may be associated with the fear of loss of control. 12/23

Finally, in the dimension of emotional regulation, two poles are determined by a state of total emotional numbness on the one hand and by conditions of trauma-related affective states of overwhelming anxiety, horror, panic, shame, and guilt, on the other. 13/23

Neurobiological research approaches have so far been performed mostly in adults who had severe trauma either in early developmental stages or later on in life, often in adolescence or adulthood; 14/23

they exhibited a series of mental disorders that were to be conceptualized as associated clinical sequelae, such as a PTSD, complex PTSD, dissociative disorders, serious personality disorders, in particular of the borderline-type, 15/23

but also variants of chronic depression, anxiety, somatization syndrome, chronic suicidal behavior or substance-related disorders. Significant psychopathological, psychodynamic and trauma-related overlaps are noted between these different states. 16/23

Findings previously associated with individual diagnostic categories, e.g. in neuroimaging, are now increasingly evaluated as a more general characteristic imprint of just these early trauma exposures: 17/23

With an overactive system of threat perception and evaluation, a significantly reduced reward system and a severely restricted higher-cortical control and executive system, 18/23

there may be not only massive vulnerabilities from the early traumatic developmental history into later stages of life, but also drastically reduced chances of successful processing. 19/23

Current empirical data of neuroimaging emphasizes the main modes of pathological processing of traumatic experiences, the mode of “autonomous hyperarousal” on the one hand and “dissociative depersonalization and derealization” on the other (see above). 20/23

Conclusion: While secure attachment provides a vital foundation for healthy development, an insecure and, above all, a disoriented and disorganized attachment is associated with increased risks for numerous mental and somatic diseases. 21/23

Although traumata in the early attachment period provide a serious legacy, this is not an absolutely irreversible fate for one’s own existence and subsequent generations, as impressively shown by special psychotherapeutic approaches.” 22/23

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. 23/23