An attachment disorder is a disorder that usually occurs in childhood, with a pathological (morbid) relationship between the affected child and the caregivers, i.e. usually the parents. This includes disruption of attachment and social interactions.
Often there is inappropriate behavior or behavior that is inappropriate to the situation. A distinction is made between reactive attachment disorder (inhibited form) and attachment disorder with disinhibition (uninhibited form). The attachment disorder usually occurs in children within the first five years of life. But adults can also suffer from attachment disorders, which differ in their symptoms from attachment disorders in children.
There are many causes of attachment disorder.
These are often causes that lead to an attachment disorder within the first five years of life.Depending on whether it is an inhibited or uninhibited form of attachment disorder, different causes are in the foreground.
In the case of a reactive attachment disorder, i.e. the inhibited form, the cause is often traumatic. Physical abuse or neglect can lead to attachment disorder. Sexual abuse in early childhood is also a possible cause. If there is a chronic serious illness, which is associated with many stays in medical facilities and painful examinations or interventions, this can also lead to a disorder of attachment. Birth trauma or premature birth can also be possible causes.
In the case of an attachment disorder with disinhibition, however, the focus is on emotional neglect and neglect. With these children there is often no caregiver or only little contact with other people, which means that it is not possible to learn how to deal with a stable bond.
Also read the following related article: Fear of loss in children.
Attachment disorder after trauma
In many cases, trauma can be the cause of attachment disorder. Different types of trauma are distinguished.
The most common form is physical trauma, for example through severe physical abuse or sexual abuse. As a result, an attachment disorder of the inhibited form develops more often.
In some cases, premature birth or birth trauma can lead to an attachment disorder. The latter is often associated with alcohol or drug abuse by the mother.
Also read: Alcohol during pregnancy
Disorder of attachment between mother and child
In some cases, attachment disorder can also occur between a mother and her baby or child. There is a disturbed relationship between the two.
This can often be explained by an interplay of several factors. These include, for example, psychological problems or stress on the mother. A typical decisive characteristic is that the mother is overwhelmed by the situation, e.g. through separation from the child's father or dissatisfaction with himself.
Another possible cause can be a disease in the child, whether physical or mental. The baby or child, on the other hand, is often neglected due to the excessive demands on the mother or may even experience violence on the part of the mother.
In order to be able to start treatment for an attachment disorder between a mother and her child, the various existing conflicts must first be carefully analyzed in order to identify possible triggers for the attachment disorder. Once this analysis has been completed, a joint, long-term mother-child therapy should be sought in order to restore the relationship between the two.
An attachment disorder has different accompanying symptoms, depending on the type of attachment disorder.
What they all have in common are the disturbed relationships and contacts with people from their surroundings and close contacts. This is often accompanied by contradictory or conflicting behavior. This means that, on the one hand, an inappropriately excessive, trusting behavior can be observed and, on the other hand, a dismissive behavior. The latter is also often associated with aggressive and angry intentions.
A reactive attachment disorder also leads to great fearfulness and an often unhappy mood. This makes it more difficult to access the affected people and to be able to speak openly with them about their emotions.
In addition, so-called apathy, i.e. indifference, often occurs. In the case of an attachment disorder with disinhibition, on the other hand, there is often a disruption of attachment behavior that is independent of the person. This means that increased inclining behavior without maintaining a certain distance can also occur with strangers.
More on this: Behavioral problems in children
What can be signs in children?
In children, attachment disorders show excessive caution and pronounced fearfulness.
In addition, clear disturbances can be seen when being with people, including other children. Occasional aggression and outbursts of anger can also occur.
The children mostly show themselves as emotionally unstable personalities, which shows in alternating or contradicting actions with strong affection and dislike. This can be explained by the lack of a constant reference person. These signs are not situational in children.
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Attachment disorders with disinhibition
An attachment disorder with disinhibition is a disturbed change in social interactions without certain own barriers being observed.
A leading symptom is unspecific attachment behavior with excessive friendliness. This often also refers to people from the environment who are otherwise unimportant for the person concerned. There is a very strong need for attention. Who is looking for this and who may be found plays a subordinate role. When those affected are sad, they often seek consolation from people they are otherwise unfamiliar with. This is illustrated by the term “disinhibition”.
Internal barriers that are usually present, which prevent you from randomly approaching strangers, are dismantled and the person disinhibited, so to speak. Sometimes, however, no consolation is sought.
In such an attachment disorder, the causes often lie in severe child neglect. There is no learning of a constant social bond with a caregiver, which greatly reduces the chance of receiving the desired attention.
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Differences in attachment disorders in children and adults
There are various manifestations of attachment disorder, which of course differ from one another in children and adults.
In children, attachment disorder often arises from traumatic causes.
Different triggers come into question, there are often connections with physical and / or sexual violence, but extreme neglect or a clearly intact parental home can lead to a disorder of attachment in a child. This has an extreme effect on the child's behavior.
Depending on the type of attachment disorder, the child may have difficulty interacting with important caregivers in the environment. This often manifests itself in ambivalent, i.e. divided behavior. On the one hand, excessive confidence with a loss of distance is observed, but on the other hand there is also aggression or ignorance of the important person. Furthermore, problems often arise when dealing with children of the same age.
Often the affected children are also emotionally unstable and fluctuate between different emotional states. These often include fear, unhappiness, a lack of emotions and aggression towards yourself and those around you. There are official diagnostic criteria for attachment disorder in children.
Long-term psychotherapeutic treatment is sought as therapy.
In adults today, the concept of attachment disorder has to be viewed from different perspectives.
This includes adults who already suffer from an attachment disorder in childhood due to trauma such as the one described above. This attachment disorder is often present when adequate therapy was not carried out in childhood or was not carried out consistently. This can lead to avoidant behavior towards people in the immediate vicinity. Often the adults affected were not able to properly overcome the trauma from childhood and are therefore strongly influenced and restricted in their everyday behavior. Therefore, psychotherapeutic or psychiatric treatment should be sought.
In today's society, the concept of attachment disorder in adults is often equated with the fact that there is a tendency towards looser attachments and a fear of firm promises of a serious partnership. This can also be viewed as a kind of attachment disorder, which, however, has less traumatic causes and does not necessarily have to be treated by psychiatric care.
Treating attachment disorder is often a long process. A behavior therapy approach is in the foreground.
In order to create a constant, safe environment, the treatment should, if possible, take place in an outpatient setting, e.g. a psychotherapeutic practice. In general, the treatment should be supervised by a specialist in psychiatry or psychotherapy. In this way it can be guaranteed that the problems of the person concerned can be adequately addressed. Psychiatric or psychotherapeutic care is usually a long-term process. It is important that a safe and stable relationship can be established between the person concerned and the therapist. Otherwise, the success of the treatment is very limited due to the lack of confidence on the part of the person concerned.
There is no drug therapy for attachment disorder in this sense. However, supportive medication can be given. The focus is usually on treating accompanying illnesses.
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An attachment disorder is often a long-lasting clinical picture. The attachment disorder usually begins in early childhood and is therefore very formative in crucial years of development. It is therefore understandable that those affected need a long time to be able to switch back to normal attachment behavior.
Overall, the duration depends on the type of therapy and the consistent implementation of the treatment. Often, with a good and adapted psychotherapeutic or psychiatric treatment, a duration of several years can be expected.
In order to diagnose an attachment disorder, other disorders must first be ruled out.
It is often not easy to distinguish between direct psychological or physical problems (caused by mistreatment or abuse) and the resulting attachment disorder. It is therefore important to carry out a detailed examination with various tests. Furthermore, the diagnosis of the attachment disorder includes the occurrence of corresponding symptoms within the first five years of life.
Is there a reliable test for attachment disorder?
A reliable test to confirm an attachment disorder as a diagnosis does not exist in this form.
Numerous tests can be found on the Internet that can provide evidence of an attachment disorder. However, a reliable statement about the existence of an attachment disorder cannot be made on the basis of these tests. Therefore, a psychiatrist should be consulted if there are any signs of attachment disorder. Possible indications of an attachment disorder should not be underestimated, as it is a serious illness and can cause long-term damage to the person concerned.
To identify the possible signs, a few questions that could indicate an attachment disorder can help. The focus is on whether the person concerned has close contact persons or people they trust in their environment. The fear of being hurt and the need for security is also a central element. In addition, attention should be paid to whether there is a great need for retreat and solitude.