By David Joel Miller.
Are attachment problems a mental illness?
The way you relate to adults, especially your parents or primary caregiver during childhood can affect the way you relate to others the rest of your life.
Generally these kinds of problems show up in the very young child and if severe enough and noticed by a professional they will get diagnosed as a mental illness needing treatment. The only attachment disorder formally recognized as a “DSM” disorder is Reactive Attachment Disorder of Infancy or Early Childhood.
Any therapist in practice with adults will tell you that a lot of what we are working on with our adult clients are things from childhood that need to be addressed now because they are interfering with the clients relationships at home, at work or friendships. Or these problems are making the client miserable.
The notion that relationships between caregivers and children will affect their relationships the rest of their life came from many sources, but two, John Bowlby and Harry Harlow were especially important. Bowlby studied orphans after World War Two and Harlow studied monkeys raised by mechanical “mothers.”
Harlow found that monkey babies would nurse from “wire mothers” but when done would go cuddle with soft cloth “mothers” even though the cloth mothers provided no food. The conclusion here seems well established. Just providing for a child’s physical needs, food and shelter, is not enough. How that child is cuddled and loved affects their development for the rest of their life.
Bowlby discovered that some orphans had been so deficient in “mothering” that they could not relate appropriately to others as they matured. (We now think fathering is important also see “Fatherneed” by Pruett.)
Early relationships with a caregiver need to be sufficiently nurturing for the child to survive, so closeness is important. As the child grows they also need to develop autonomy, the belief they can do things without the caregiver. Balancing closeness and individuality are tasks humans must undergo to become separate adults who are still capable of close intimate relationships with others as adults.
How a child reacts to others is not solely the result of the parent’s behavior. Not every childhood problem is the mother’s fault. Some children are born fearful and clingy and others are born explorers. The difficult, cranky child can train the caregiver to leave it alone.
The application of Attachment theory has caused some problems when some of my colleagues jumped to unwarranted conclusions that every child’s behavior problems were the parents fault, often based on observing a child and parent interact during a relatively brief period of time.
Professionals who do attachment work describe children as having one of four ways of attaching to a caregiver. These are from attachment theory and not all people who use this theory agree on these labels and descriptions.
1. Secure attachment.
A securely attached child likes to be with the caregiver and is able to leave the caregiver and explore but runs back to the caregiver when frightened.
2. Avoidant attachment.
This child has come to expect that the caregiver will hurt them or will not meet their needs. This child does not seek out their caregiver and is just as likely to play with a stranger as with the parent.
These children are over quick to make new relationships with people they do not know and do not seem to get upset when the person they are with leaves.
Sometimes it is hard to tell if a child is avoidant with their caregiver or very, very secure and does not need much contact with the caregiver to feel safe. Parents with very outgoing self-confident children have been accused of failing to bond with their children because of the child’s ability to function without the parent in the room.
3. Anxiously or resistantly attached.
This child is fearful with or without the parent. This child can’t be reassured by either the parent or a stranger. Children like this may become angry when the caregiver leaves and continue to be angry when they return.
4. Disorganized attachment
Child becomes disorganized during interactions with caregiver. They may resort to the primitive “F’s” and freeze, flee or fight. This child may disassociate, speak incoherently or have loss of memory as a result of interacting with a caregiver they perceive as harmful.
These four “types” of attachment are not universally accepted and a person can have elements of one or more attachment style. A particular attachment style can vary from mild to strong in severity and all attachment styles are influenced by an individual’s personality.
The one attachment issue that has made its way into the DSM-4 and can be diagnosed as a separate mental illness is 313.89 Reactive Attachment Disorder of Infancy or Early Childhood which is then divided into two types, Inhibited Type (like resistant above) and Disinhibited type.
A person with disinhibited attachment disorder will form over close relationships with people they barely know. This is the type of person to stop a stranger on the street and then begin to tell them all about the most intimate personal issues of their life.
These clinical definitions are extreme cases.
Some adults will report their parents were never there for them and were non-affirming. This results in a personality style of being self-sufficient or avoiding others.
Other adults believe that their caregiver was over involved and controlling and did not allow them to develop a secure sense of self.
Learning life skills that may have been missing from your childhood learning can be described as “inner child work” or “re-parenting.” The goal for the client in these situations should be to develop the attachment skills that are lacking and to learn the developmental tasks that should have been learned at an earlier stage.
Various schools of psychotherapy will approach the task of addressing attachment issues in adults in quite different fashions.
Have you had to go back and work on attachment issues or do you still struggle with these problems? If something worked for you what worked?
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books