Healthy attachment is essential for psychological, emotional, and social well-being throughout the lifespan.[1] Attachment refers to the way we learned to relate to ourselves and others in our early childhood. When we are infants, our connection to the world around us is in our relationship with our primary caregiver, usually a mother. The quality of this relationship has a significant influence on how we grow and develop in the years that follow.
Attachment trauma refers to a rupture in healthy attachment. Babies are born without the ability to self-regulate[2], so they need their caregivers to teach them regulation. If the caregiver does not attune to the baby’s needs, then the baby’s growth and development are jeopardised.
In cases where a child has been traumatised, which may occur through emotional, sexual, or physical abuse, or neglect[3], they suffer from ruptured attachment. They are subject to more physical and psychological health issues in later life than children who have not experienced such trauma.
Early Childhood
The importance of our early childhood (0-3 years) is emphasised in the landmark Adverse Childhood Experiences (ACE) Study.[4] The ACE study was conducted in the 1990s by CDC-Kaiser Permanente. 17,000 middle-class Americans participated in the study. All were asked about their exposure to adverse experiences in childhood, such as abuse, domestic violence, incarceration or mental illness of a family member, neglect, and substance abuse in the home.
The study delivered a questionnaire in which participants were asked about their level of exposure to the experiences above. The score of the questionnaire, which ranged from 0-9, reflects the number of adverse childhood experiences (ACEs) to which a person has been exposed. For example, a score of 3/9 means that a person had been exposed to three significant traumatic experiences.
Two important findings from the study have since informed researchers about the impact of ACEs. The first is that ACEs are far more common than previously known.[5] Given the socioeconomic status and availability of healthcare to the participants, the results highlight the worrying fact that ACEs must be significantly higher in lower socioeconomic groups without the same ease of access to healthcare.
The second is that exposure to ACEs directly impacts one’s health outcomes later in life.[6] The greater the ACE score, the greater one’s risk of developing physical or psychological illness, cognitive and emotional impairment, and adoption of health-risk behaviours, such as smoking and substance abuse.
Understanding Attachment
Our current understanding of attachment is based on the work of British psychologists John Bowlby and Mary Ainsworth. Bowlby began to research attachment and how it manifests as health and behaviours in the 1960s. Ainsworth expanded on Bowlby’s work in the ’70s and gave us what we know today as attachment theory.
Attachment theory suggests four attachment styles that develop in babies, which we then carry into our adult lives.[7] The four attachment styles are:
- Secure attachment
- Avoidant attachment
- Resistant attachment
- Disorganised attachment
Secure attachment develops when a caregiver is loving, affectionate, and attuned to the child’s emotional and psychological needs. Children who develop a secure attachment style are primed to experience nervous system regulation, emotional safety, self-confidence, healthy interpersonal relationships in adulthood, and the ability to cope with stress and distress effectively.
Avoidant attachment is a type of insecure attachment. This attachment style develops when a caregiver is not attuned to the emotional needs of the child. The child’s experience of distress is not met with love and affection. The child learns to hold in their emotions and is unlikely to look to their caregiver for comfort. This manifests later as distrust in relationships and unwillingness to show emotional vulnerability.
Resistant attachment is insecure attachment. This attachment style develops when a caregiver is inconsistent with their affection and attunement. The child cannot predict the emotional availability of the parent. Neediness and heightened emotional responses may be used to gain the caregiver’s attention. In adulthood, this attachment style manifests as insecurity, clinginess, and a constant seeking for reassurance.
Disorganised attachment develops in children whose caregivers were a source of threat. Caregivers are a safe haven for their babies, so when a caregiver is also a source of threat, the baby becomes deeply confused. They have no clearly defined strategy to get their emotional needs met. This attachment style can lead to unhealthy, even dangerous relationships in adulthood.
Attachment Trauma and the Brain
The brain is divided by its right and left hemispheres.[8] The right brain develops first, and the left brain later.[9] The left brain is responsible for the use of language, creativity, and abstract thinking. The right brain is responsible for our implicit understanding of the world around us.
Development of each hemisphere shifts from right to left as a child grows older. When a child experiences attachment trauma, the memory of that trauma is encoded in the right brain. In a child’s second year of life, the right brain has already had its first year of maturation. Thus, negative experiences, such as attachment trauma, are stored in the right brain. This is how it is set up as it continues to develop later.
According to American psychologist and neuropsychological researcher Dr Allan Schore, ‘the initial trajectory of the right brain is set up the attachment relationship. That’s critical, because the right brain has more connection into the body, into the autonomic nervous system, and into the hypothalamic-pituitary-adrenal (HPA) axis – the stress-regulating axis of the body.’[10]
The Impact of Attachment Trauma in Adulthood
Attachment trauma is stored in our implicit memory, which means we may not have access to a clear narrative or explicit memory of our trauma. These memories reside in the body, and can be triggered later in life, to manifest in our adult relationships and mistrust, fear of abandonment, and, as a result, problems with healthy interpersonal attachment.
These issues can be a source of distress, especially when there is no clear and immediate origin for one’s distress. As such, those who have experienced attachment trauma, a major characteristic of which is a tendency to engage in health-risk behaviours, may be likely to misuse and abuse substances, and engage in violent or aggressive behaviour toward themselves and others.
Treatment for Attachment Trauma
Attachment trauma, also known as relational trauma, can be challenging to treat. One major issue in treatment is that the memory of attachment is stored in the right brain, in our implicit memory. Thus, there is often no explicit memory or narrative of the trauma itself.
We usually notice the consequences of attachment trauma as we enter adulthood. It affects our psychological, social, and emotional well-being, so when we enter adulthood and notice issues in our professional and romantic relationships, we may sense that there is some unfinished business deeply rooted in the nervous system.
Attachment trauma is not a mental illness itself. Still, it can set the stage for psychopathology and health-risk behaviours to occur. The presence of attachment trauma often arises in therapy, in which the client has sought treatment for another reason.
Trauma-focused therapies can help clients of any age identify and address their traumatic past. Popular and effective trauma-focused approaches to treatment include:
- Trauma-focused Cognitive Behavioural Therapy
- Eye Movement Desensitisation and Reprocessing (EMDR)
- Somatic Experiencing
The field of trauma treatment is relatively new but is growing at a rapid pace. Extensive research in recent decades has led to the discovery and foundation of the above trauma-focused solutions to the range of issues faced by those who have survived traumatic events. The above modalities are evidence-based and have been found highly effective in many clients.[11] Characteristic of trauma-focused care are the following:
- Work towards healthy attachment and emotional resilience
- Address traumatic stress and negative self-beliefs (shame, low self-worth)
- Experience-based (experiential) – verbalisation is not always necessary. The focus is more on achieving a feeling of safety and groundedness in the body.
- Enhancement of emotional regulation and self-management skills
- Involves family members in treatment where necessary to promote holistic healing
At Khiron House, we offer the above treatment modalities to our clients. We understand the complex nature of trauma, especially trauma that has occurred in childhood. We also understand that healing is possible. Our treatment programs are evidence-based and trauma-informed. We can provide the most appropriate and effective care for each one of our clients.
If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).
[1] Rees, Corinne. “Childhood attachment.” The British journal of general practice : the journal of the Royal College of General Practitioners vol. 57,544 (2007): 920-2. doi:10.3399/096016407782317955
[2] National Research Council (US) and Institute of Medicine (US) Committee on Integrating the Science of Early Childhood Development; Shonkoff JP, Phillips DA, editors. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington (DC): National Academies Press (US); 2000. 5, Acquiring Self-Regulation. Available from: https://www.ncbi.nlm.nih.gov/books/NBK225568/
[3] De Bellis, Michael D, and Abigail Zisk. “The biological effects of childhood trauma.” Child and adolescent psychiatric clinics of North America vol. 23,2 (2014): 185-222, vii. doi:10.1016/j.chc.2014.01.002
[4] Felitti, V J et al. “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.” American journal of preventive medicine vol. 14,4 (1998): 245-58. doi:10.1016/s0749-3797(98)00017-8
[5] Felitti, Vincent J. “The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead.” The Permanente journal vol. 6,1 (2002): 44-47.
[6] Felitti, Vincent J. “The Relation Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead.” The Permanente journal vol. 6,1 (2002): 44-47.
[7] Simpson, Jeffry A, and W Steven Rholes. “Adult Attachment, Stress, and Romantic Relationships.” Current opinion in psychology vol. 13 (2017): 19-24. doi:10.1016/j.copsyc.2016.04.006
[8] de Haan, Edward H F et al. “Split-Brain: What We Know Now and Why This is Important for Understanding Consciousness.” Neuropsychology review vol. 30,2 (2020): 224-233. doi:10.1007/s11065-020-09439-3
[9] Chiron, C et al. “The right brain hemisphere is dominant in human infants.” Brain : a journal of neurology vol. 120 ( Pt 6) (1997): 1057-65. doi:10.1093/brain/120.6.1057
[10] PsychAlive, director. Dr. Allan Schore on Attachment Trauma and the Effects of Neglect and Abuse on the Brain. YouTube, YouTube, 6 May 2014, www.youtube.com/watch?v=AB51V3fAAvs.
[11] Seidler, Guenter H, and Frank E Wagner. “Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study.” Psychological medicine vol. 36,11 (2006): 1515-22. doi:10.1017/S0033291706007963
