Psychobiology Of Attachment And Trauma—Some General Remarks From A Clinical Perspective

“Early representatives of psychoanalysis argued that the roots of human social motivation are primarily physical and sensory (hunger, sexuality) 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:

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.

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.

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.

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.

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.

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.

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.

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.

In traumatic situations, which emphasize hopelessness in addition to states of helplessness, this leads to immobilization, passive avoidance, and freezing in a dissociative state.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.”

Disoriented-Disorganized Attachment Pattern and Increased Risk of Further Traumatization: Established insecure attachment patterns are empirically associated with a higher rate of traumatic events and subsequent trauma.

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.

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.

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.

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”)

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.

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.

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.

This 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.

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.

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”).

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.

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.

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; 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, 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.

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:

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

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).

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.

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.”

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.

Now you know the power of Trauma Informed Care. Let’s turn this framework into a mindset for personal, social and political change. If you are unable to, you might need help first, to get safe or become ‘unstuck’ from trauma. Reach out for trauma informed care. #YouBelong

With love,

Dr Dr Louise Hansen
Psychologist
PhD in Psychology
Human Rights Activist

#HealingTrauma #Justice4Australia #YouBelong

Trauma Informed World was inspired by Kopika and Tharnicaa; two faces that remind us everyday of Australia’s cruel refugee system. One of many systems in Australia that remind us of the negative operation of power. #HomeToBilo

You can listen my talk with Dr Cathy Kezelman AM, President of Blue Knot Foundation on my own healing journey, training and study and how it has informed my work and advocacy for a trauma informed world here:

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