Theoretic Foundations of Attachment - Research Paper Example

Attachment and Early Childhood, and Its Implications on Mental Health Introduction Personality disorders are enduring individual mannerisms that entail the intrapersonal, interpersonal and social components; whereas the intrapersonal component deals with dysfunctional control of arousal, impulse and emotions, the interpersonal component concerns broken relationship patterns while the social component deals with conflicting relations with others and social institutions. Attachment theory shades significant insights into the subject of personality disorders since it accounts for all three components of these disorders (Lyddon & Sherry, 2001); this paper will explore the theoretic foundations of attachment in early childhood, and its implications on mental health while providing a case study analysis in support of the theoretic arguments. Literature Review: Theoretic foundations of attachment Individuals often have unique ways of relating in intimate relationships, particularly to various attachment figures such as one’s parents, romantic partners and children, for the purposes of safety and survival (Mauricio, Jenn & Lopez, 2007), and this is the scope of attachment theory. The Attachment theory posits that the affective infant-caregiver bond influences the infant’s emerging self-concept and developing view of the social context (Levy, 2005); Goldenson, Geffner, Foster and Clipson (2007) highlight that infants internalize early experiences with caregivers as the models of their self and others. From the moment a child is born, its interactions with the primary caregivers does form the foundation for the development of personality and this interaction also fashions later close relationships, expectations of acceptance in social groups as well as reaction to rejection. The attachment figure needs to constantly provide stability and safety to the infant in times of severe stress to enable the establishment of a secure base that will allow the infant to explore their surroundings (Schmitt, Lahti & Piha, 2008). The repeated interactions of the infant with ‘significant others’ in social relations informs its mental models of itself and others (Lyddon & Sherry, 2001); the child’s capacities to understand, express emotions, regulate stress, and control attention are based on the early attachment relations. The behavioral patterns of infants in strange situations highlights four distinct attachment patterns namely secure/autonomous, anxious/preoccupied, avoidant/dismissing, and disorganized types, which corresponds to the attachment styles in adults, secure, avoidant, anxious and unresolved respectively. Securely attached infants are uncomfortable in strange environments and are distressed by caregivers’ absence while the avoidant types may not be bothered by the separation from primary caregivers, due to a ‘hyper-deactivation’ of their attachment system (Lorenzeni, 2013). Precisely, a ‘hyper-deactivation’ of the attachment system is noted through individuals’ desire to be alone and to handle stress using non-interpersonal mechanisms without seeking proximity to others. The anxious infants, on the other hand, are less explorative, highly distressed by separation, and often does not settle immediately after reunion with caregivers, due to the corresponding hyper activation of proximity and protection-seeking behaviors (Lawson & Brossart, 2013). Anxious types also present with a chronic hypersensitivity to red lights of rejection or abandonment and have intense undesirable emotions while the disoriented infants present with undirected or weird behavior like head banging in strange situations. Genetic factors have been attributed to the individual differences in adult attachment anxiety (46%) as well as attachment avoidance (36%) (Lorenzeni, 2013), but not with personality disorders (Sherry, Lyddon & Henson, 2007); genetic factors’ influence on attachment security is estimated at between 23%-45%. Nonetheless, attachment styles and personality traits in adulthood are largely associated with environmental factors, particularly the secure presence of a competent and sensitive attachment figure that responds to the verbal and non-verbal cues of the infant promptly. Consistent and accurate reflection of a child’s acute affective states leads to the formation of secure attachment that greatly enhances its capacity to understand not only its social, but also its internal world; thus, secure attachment leads to adaptive functioning of individuals (Riggs et al., 2007). The styles of attachment persist into adulthood across all genders, languages and cultures, which form the basis for the increasing associations between the attachment theory and personality disorders. Further implications for mental health Early attachment styles have inevitable implications for personality disorder diagnosis, development of personality disorder, as well as treatment outcomes; generally, a vast proportion of the insecure attachment features in adulthood are concomitant to the signs and symptoms of personality disorders (Fossati et al., 2005). For instance, numerous studies on attachment types in individuals in the DSM-IV cluster show that they have higher rates of insecure attachment while individuals with secure attachment are hardly diagnosed with borderline personality disorder (BPD) as well as avoidant personality disorder. Whereas anxious adults are prone to histrionic, avoidant, borderline and dependent personality disorders, due to their hypersensitivity to rejection and anxiety, avoidant adults are more likely to present with schizoid, narcissistic, paranoid, as well as antisocial personality disorders. Anxious individuals are more likely to present with BPD, unlike individuals with the other attachment types, especially in the presence of unresolved trauma; BPD is also highly associated with individuals with unsettled attachment patterns (Levy, 2005). The varied attachment patterns and their allied risks are attributable to varied developmental pathways and the development of enduring strategies to regulate emotion and social contract relies greatly on the stability inherent in particular attachment styles. Individuals that are securely attached not only trust their attachment figures, but also perceive little threats in their surroundings, and are able to push through all kinds of environmental challenges; similarly, since they can process information in a fluid and non-defensive way, secure individuals are hardly troubled by personality disorders and often continue to establish effective attachment relations throughout their lives. Contrariwise, avoidant individuals are prone to negative emotions and high attachment needs since they are more likely to lack support of attachment figures and to ignore environmental threats, due to what has been termed as ‘compulsive self-reliance’ (Lorenzeni, 2013). Consequently, the avoidant individuals are constantly predisposed to the frequent activation of the attachment system, followed by its allied distress and anger, which eventually culminates to the tendencies of compulsive care-seeking and over-dependency that are characteristic of the group. The unresolved adults are mostly troubled by personality disorders since they often have abusive attachment figures or who are unresolved due to their individual losses or abusive experiences. The development of secure attachment in later life is highly dependent on the quality of early life infant-caregiver interactions; effective quality interactions are necessary for the formation of secure attachments. Since secure emotional attachment is essential for the establishment of a healthy personality, unsecure children are prone to childhood trauma, which is associated with disorganized attachment style adults (Lorenzeni, 2013). A vast proportion of individuals with personality disorders have been found to have personal experiences of childhood trauma including sexual abuse and neglect; personality disorder cases are four time more likely to have suffered childhood trauma. Individuals that suffer trauma early in life are highly predisposed to antisocial behavior, borderline disorder, and aggressive personality disorders, as well as the risk for dependent, depressive, and schizoid personality disorders. Precisely, antisocial, narcissistic, borderline and passive-aggressive personality disorders are mostly associated with infantile neglect but, unlike the rest of the disorders, BPD is likely to be as a result of childhood abuse and neglect (Minzenberg, Poole & Vinogradov, 2008). Nonetheless, attachment and biological dispositions exert a significant influence on the effects of trauma, which implies that not all cases of early trauma are predisposed to adult psychopathology. The high correlation between insecure attachments and personality disorders and other mental illnesses also implies that the characteristics of each attachment style inevitably influence the success of psychotherapeutic approaches (Lorenzeni, 2013). Whereas research is not yet conclusive on whether the securely attached patients have better results compared to the avoidant and disorganized attachment types, attachment anxiety is thought to have negative effects on outcomes while attachment avoidance is believed to have no effects whatsoever. Attachment also predicts dropout as adult avoidant types are more likely to fall out of treatment due to lack of commitment, attachment or engagement with the therapist or treatment; anxious and avoidant individuals are more likely to drop out due to perceived abandonments by therapists in the form of last-minute cancellations or scheduled trips and due to perceived dependence on the therapist and treatment respectively. Moreover, attachment has implications for the therapeutic alliance, which later influences outcomes; whereas secure patients will cooperate fully with the therapist, whom they perceive to be responsive and emotionally available, avoidant patients often feel threatened and will be unwilling to cooperate with the therapist. Unlike the two categories, anxious patients will in fact wish to be with the therapist much longer, and to even extend their relationship outside the limitations of therapy; nevertheless, given that care-giving behavior is influenced by attachment, the therapist’s attachment style also underpins both the process and outcomes of treatment. Whereas therapists with anxious attachment styles often establish powerful therapeutic alliances, the quality of their alliances often decline over time due to patients’ interpersonal distress; on the other hand, a session between an avoidant therapist and an anxious patient has no depth. A Case Study and Analysis of Anti-Social Personality The effects of neurofeedback training on affect regulation are highlighted in the case of a fifty-year old man named Lyle, who is characterized by fear, rage, heavy drinking, unemployment as well as multiple unsuccessful treatments (Fisher, 2007). Besides being diagnosed with ADHD and attachment disorder, Lyle also met the criteria for antisocial personality disorder since he was often over aroused and was unable to regulate his emotions, especially fear and rage. Lyle’s bouts of antisocial behavior included physical assault, destruction of property, nearly fatal over-speeding, verbal fights, and alcoholism; by the time he was beginning treatment, Lyle had been sober for nearly seventeen years and was a constant attendee of AA meetings. Lyle’s childhood had been a chaotic one given that he was born to a depressed, alcoholic mother, who neglected him due to her own state and addiction and an absentee father; furthermore, Lyle’s mother had no capacity to self-regulate, and this underpins Lyle’s inability to do so in adulthood. Lyle was a bully at school and his schoolmates avoided him for fear of being bullied, thus he never established any social bonds at school; he never performed well in class despite that he was intelligent, and believing that he was a looser as his mother often told him, he dropped out of college. Hypothetically, Lyle experienced states of fear in his delicate infancy period due to his mother’s inability to soothe him, a terror that has persisted throughout his adulthood since internalized childhood experiences often form the model for conceptualizing one’s self and others (Lorenzeni, 2013). In that case, Lyle’s numerous diagnoses such as ADHD, conduct and anxiety disorder, antisocial personality disorder, as well as reactive attachment disorder are attributable to his early childhood experiences with his primary caregiver (unresponsive alcoholic mother). Similarly, given that his father was rarely present in his life, there was no one to contradict Lyle’s self-concept of a ‘looser’, which endured through to his adulthood with the implication that he could not fit anywhere in the job market. Lyle’s alcoholism can be attributable to his attempt to self-medicate the pervasive fear that prowled in his conscious mind and to tame his explosive rage. Despite the loss of his father and older brother in childhood, Lyle reports feeling little grief over these deaths since fear and rage consumed him more than anything else, thereby denying him the capacity to love and feel empathy. Lyle’s relationships were primarily instrumental, not only in his circumscribed world, but also in the course of therapy; he hated and feared his mother at the same time while resenting her and her unending criticisms to the point of wishing she died in the nursing home. In as much as the effects of early relational trauma persist into adulthood, adults are also capable of change due to the evident endurance of brain plasticity; thus, treatment approaches exploits brain plasticity to enhance brain functioning despite developmental impairment. Neeurofeedback, brain biofeedback that draws from the operant conditioning of brain-firing frequencies, treatment began by carrying out a comprehensive clinical assessment including clinical and family history; moreover, assessment included medical history and physical status report covering physiological markers including sleep, blood pressure as well as bowel function (Fisher, 2007). This assessment revealed Lyle’s arousal emotionally, psychologically and physically thereby leading to the profiling of Lyle as over-aroused; sensors were then attached to Lyles’s head to record his real time electroencephalogram (EEG) on a computer. Lyle then played a video game corresponding to his EEG, changing the amplitude of targeted brain frequencies; brain frequencies are associated with states of arousal, thus, Lyle was rewarded for achieving and maintaining the required frequencies in appropriate hemispheres. At the end of treatment after 87 sessions with the therapist, Lyle is no longer driven by fear, no longer experiences rage and is calmer; moreover, he willingly and meaningfully engages in therapeutic relationship, which implies that neurofeedback is effective for fear-driven disorders. The mentalization-based treatment of personality disorders describes the process through which patients perceive themselves and others, not only in terms of subjective states, but also in terms of mental processes. Using this approach, mental states are deemed to be the mind’s misinterpretations of its own experience and thus the experience of others; metallization draws from attachment theory. According to attachment theory, an individual’s understanding of others is based on the presence of caring, responsive, and non-threatening primary caregivers in one’s childhood (Lorenzeni, 2013). In that respect, Lyle’s problems of affect regulation as well as attention control can be attributed to his dysfunctional infantile attachment relationships, which thoroughly inhibited his ability to develop a functional mentalizing capacity. Under stressful conditions, activation of Lyle’s flawed attachment system undermines his mentalization capacity, thereby leading to the corresponding misunderstanding of social causality, as well as cognitive and emotional instabilities. A mentalization based treatment stabilizes a patient’s self-concept while helping them to maintain an appropriate level of arousal on the backdrop of a balanced therapist-patient attachment relationship. Conclusion Ultimately, the interactions of an infant with primary caregivers are very crucial since these early interactions eventually form the models through which infants view themselves and significant others, as well as their adaptive functioning capacities through life. Since attachment security is associated with high adaptive functioning capabilities that are crucial for safety and survival, attachment theory offers a meaningful framework through which the development and endurance of personality disorders can be studied and understood; precisely, the attachment theory provides a lens that can be used to explore the interpersonal challenges and adaptations that are unique to personality pathology. Similarly, attachment theory forms the basis for understanding the corresponding development of self-concept and the difficulties inherent in the processes of defining the self and self-regulation that is characteristic of patients diagnosed with personality disorders. References Fisher, S.F. (2007). Neurofeedback, Affect Regulation and Attachment: A Case Study and Analysis of Anti-Social Personality. International journal of behavioural consultation and therapy 3(1): 109-117. Fossati, A., Feeney, J. A., Carretta, I., Grazioli, F., et al. (2005). Modeling the relationships between adult attachment patterns and borderline personality disorder: The role of impulsivity and aggressiveness. Journal of Social and Clinical Psychology, 24(4), 520-537.  Goldenson, J., Geffner, R., Foster, S. L., & Clipson, C. R. (2007). Female domestic violence offenders: Their attachment security, trauma symptoms, and personality organization. Violence and Victims, 22(5), 532-45.  Lawson, D. M., & Brossart, D. F. (2013). Interpersonal problems and personality features as mediators between attachment and intimate partner violence. Violence and Victims, 28(3), 414-28.  Levy, K. N. (2005). The implications of attachment theory and research for understanding borderline personality disorder.Development and Psychopathology, 17(4), 959-86.  Lorenzeni, N., & Fonagy P. (2013). Attachment and Personality Disorders: A Short Review. The Journal of lifelong learning in Psychiatry, 11(2): 155-166. Lyddon, W. J., & Sherry, A. (2001). Developmental personality styles: An attachment theory conceptualization of personality disorders. Journal of Counseling and Development : JCD, 79(4), 405-414. Mauricio, A. M., Jenn-Yun Tein, & Lopez, F. G. (2007). Borderline and antisocial personality scores as mediators between attachment and intimate partner violence. Violence and Victims, 22(2), 139-57.  Minzenberg, M. J., Poole, J. H., & Vinogradov, S. (2008). A neurocognitive model of borderline personality disorder: Effects of childhood sexual abuse and relationship to adult social attachment disturbance. Development and Psychopathology,20(1), 341-68. Riggs, S. A., Paulson, A., Tunnell, E., Sahl, G., Atkison, H., et al. (2007). Attachment, personality, and psychopathology among adult inpatients: Self-reported romantic attachment style versus adult attachment interview states of mind. Development and Psychopathology, 19(1), 263-91.  Schmitt, F., Lahti, I., & Piha, J. (2008). Does attachment theory offer new resources to the treatment of schizoaffective patients? American Journal of Psychotherapy, 62(1), 35-49. Sherry, A., Lyddon, W. J., & Henson, R. K. (2007). Adult attachment and developmental personality styles: An empirical study. Journal of Counseling and Development : JCD, 85(3), 337-348.  Read More