Attachment-Disorder-as -a-Curable-Disease

Attachment Disorder As A (Curable) Disease

Working with children who have Attachment Disorder can be confusing and exhausting given the child’s unpredictability and loss of control.

In this blog post we are going to look at how Attachment Disorder is a disease of the brain and nervous system, as well as understand that the unpredictability and loss of control are a part of, and fundamental, to the disease process.  

Attachment Disorder can often be observed from many different angles, just like an elephant has many different angles and features!

In the big picture, insecure attachment or Attachment Disorder is a brain and nervous system disease that like many different diseases, bleeds into all parts of one’s life.

Root Imbalance in the Brain and Nervous System

Attachment Disorder can also be viewed as a disease that has its root imbalance in the brain and nervous system.

The brain has structural and functional changes, meaning these changes can be seen on brain imaging and also by observation of its thought process and function in daily life.

The nervous system also has maladaptive patterns that can be tracked physiologically using measurement tools.

How is it that having an insecure attachment or Attachment Disorder can cause these measurable changes in the brain and nervous system? Isn’t this just an emotional problem that can be overcome by changing one’s thinking?

For example, if a person has diabetes, changing their thinking will not change their underlying disease process, which is diabetes. Instead they can use their cognitive ability, or thinking processes, to change how they eat and take their medicines in order to help minimize the severity of their disease. But thinking about a cure for the disease will not cure their diabetes.

This is the same with attachment. A secure attachment is necessary for one to have optimal physical and mental health. It’s developed in the first year of life through an infant’s social and emotional interactions with their primary caregiver as shown clearly by Dr. Mary Ainsworth in her Strange Situation study (1973).

Development of a Secure Attachment

By no means does a mother figure need to be “perfect” in order to have her child securely attach to her, but there needs to be enough attachment behaviors of attunement, mirroring, and repairing of the relationship when it is broken. Rocking, physical touch, and eye contact are all features of the development of a secure attachment.

The healthy development of an infant requires enough of these positive social and emotional interaction with its primary caregiver in order for the child to feel heard, understood, and safe. For instance, the physical development of a child happens naturally when enough quantity and quality of nutrition is provided. Similarly, a secure attachment happens naturally with the normal interactions between a mother and her baby.

A mother does not usually think consciously about mirroring her baby’s emotions or attuning to its emotional state.

These are interactions that a parent does unconsciously and instinctively; however, this may be impaired if the parent has an Attachment Disorder.

Attachment Disorder develops when these normal and instinctual interactions are inadequate for whatever reason.

In fact, a secure attachment is as necessary as food and water for the healthy development of the brain and body.

When an attachment occurs (and let’s clarify that we are talking about a secure attachment), it shouldn’t be thought of as a bonus to a child’s development, but as  essential for the healthy development of that child’s brain and nervous system.  

Even starting in utero and throughout the development of the infant stage, the mind and body become intricately connected. The emotional development of an infant cannot be separated from its physical development, just as the mind and body cannot be separated entirely in its functions. They each affect one another. 

It is this connection between the emotional and physical that creates the the different symptoms of the disease of Attachment Disorder.

The Disease Model of Attachment Disorder

A brain and nervous system that develops under a perception of feeling unsafe, either physically or emotionally, will lead to the disease of Attachment Disorder with its characteristic chaotic survival defenses.

Thus, the emotional and social development of children directly affects the development of their brains and nervous systems. Emotional and social development affects how the brain connects between different structures and systems, how these systems are wired, and how the nervous system responds to stress, as well as its ability to regulate or come back to a calm, responsive state.  

Insecure attachments and Attachment Disorder are occurring at higher rates in the general population, than in previous generations. Of course, there are those children who have been adopted or in the foster care system that are logically at higher risk of having insecure attachments or Attachment Disorder.   However, the Sutton Trust released a study in March 2014 reporting that 40% of children among the U.S. population have an insecure attachment.  

Perhaps this higher rate of Attachment Disorder also suggests that something has changed socially to cause the reduction of the quantity and quality of instinctual parenting of a mom with her infant.

It seems that in our modern society, even a good parent may be too preoccupied, too distracted, or too stressed to provide the quantity and quality of positive emotional and social interactions with their growing child. We must also consider that each generation that has a higher percentage of insecure attachments, will affect the next generation, leading them to have an even higher percentage of Attachment Disorder.  

Changes in Brain and Nervous System in Attachment Disorder

However, going back to the disease model of Attachment Disorder, let’s look at some of the specific functional differences in the brain and nervous system of a child who develops Attachment Disorder.  

Dopamine Reward System

One of the most important systems of our brain is the reward and pleasure center, also known as the dopamine reward system.

In this picture of the brain, the pink and blue dots represent the location of the dopamine reward system.  

The dopamine reward system is a communication process in the brain that uses the neurotransmitters of dopamine, oxytocin, and endogenous opiates to have us feel reward and pleasure in different situations.

Individuals who have insecure attachments and/or Attachment Disorder have brains where the reward and pleasure centers are imbalanced and are therefore rewired differently.

The dopamine reward system is part of our survival, and unconsciously provides a big driving force for our psychology, because we will continue to seek those things that give us more reward and pleasure.

This includes the pleasure we get from food, sex, and relationships with others if we have a secure attachment.  

A healthy brain with a secure attachment is wired from infancy to derive dopamine, oxytocin and endogenous opiates from relationships.

This means that the individual who has a secure attachment from rewarding social and emotional interactions with their mother during infancy will continue to get reward and pleasure from healthy relationships throughout the rest of their life.  

A brain that does not have a secure attachment, will not get these essential chemicals from relationships.

In actuality, they become more stressed within relationships, which feeds into the primary imbalance in the nervous system called dys-regulation.

One interesting study in 2014 based out Netherlands and Michigan found that the attachment style of salespeople determined how their Dopamine Reward System was wired and correlated with their style of convincing people to buy!

Nervous System Dysregulation

Dysregulation as in the case with Attachment Disorder refers to a disruptive and maladaptive nervous system process.

The surface symptom of nervous system dysregulation will be emotional dysregulation, which on-going studies link to many of the physical diseases, especially involving the gut and mental health, such as suicide.

Here is a link to one article correlating dysregulation with increased suicide.    

Thus, Attachment Disorder is a disease that is characterized by a need for other external sources of brain chemicals and of regulation. This is to keep the brain and nervous system regulated, so that the individual has the ability to handle both the stresses and joys of life.  

Regulation Theory

As in Regulation Theory developed by Allan Schore, and summarized by Dr. Philip Flores, “The degree to which a person can regulate their own emotions is determined by the length and strength of their earliest attachment experiences.”

Ultimately, it is an insecure attachment that causes a person to become unable to regulate their emotions, leading to the unpredictability and loss of control of their own behaviors and emotions as they try to regulate themselves.  

This is a very powerful cycle, because when a brain finds something, anything, that can help regulate and provide it the dopamine and other chemicals that are necessary for life, the brain will continue to go back to that behavior or substance. The more immediate the effect is from the behavior or substance, the more reinforcing it is.  

The brain and nervous system, which are continually rewiring to maximize efficiency and survival, will then rewire to make these behaviors or substances the default, so that it goes to that location of the brain automatically, bypassing all thought process.  

Brain and Shame

It is important to remember that a brain will choose to adapt and crave these behaviors or substances, despite the very real negative consequences it will have on that person’s life, because the brain goes into survival mode without these vital chemicals.

As soon as the brain gets the dopamine and opiates, the brain is able to come out of survival mode.

However, this often leads to guilt, shame, and feeling awful about doing what they had previously vowed they would never do again.

Whether it is an adult addict or a child with Attachment Disorder, it is very common for them to feel awful about what they have done… after the fact. In the moment, they are single-minded and there is almost nothing you can do to stop them from either going to their drug or, for the child, going to their destructive behavior.

However, afterwards, you can get tears, remorse, and promises that they will try harder and be better in the future. In that moment, those feelings are very heartfelt.

Some people tend to get confused about whether or not showing remorse over their hurtful and destructive behaviors proves that they do not have Attachment Disorder.

However, when Attachment Disorder is seen as a brain disease on a spectrum of severity of disease, showing remorse after cycles of behaviors they cannot get out of, is a sign of lesser severity of disease than those children who do not have empathy or remorse for their destructive behavior.  

Cycle of Addiction

Here is a picture of this cycle as developed by Patrick Carnes in any addiction process. I think you will see just how similar the two diseases are!Therefore, if we do not get our brain and nervous system regulated by the production of chemicals through healthy relationships, we will ultimately turn to other substances and behaviors to help regulate what is lacking.

By doing this, it will naturally reinforce addictive substances and behaviors, because of their rapid onset and powerful effect.   

In this sense, insecure attachment or Attachment Disorder can be seen as a very similar brain disease as Addiction.

In fact, there are professionals who view Addiction and Attachment Disorder as the same neurobiological disease.  

As you can see, Attachment Disorder can get complicated when observing all of the changes within the brain and nervous system that are associated with it.

Remember the big picture, Attachment Disorder is a disease that influences all parts of the brain and body, and thus all aspects of one’s life.

It is a result of inadequate relational experiences, and yet also results in poor relational experiences.  

How have you viewed insecure attachment or Attachment Disorder?  

In what ways can you relate to the behaviors of this disease?

Encouraging you on your journey~

Dr. Aimie

Related: Emotionally Stuck In Infancy

 

1 Comment

  • M. de Jong

    Reply Reply June 27, 2017

    Hello, as a fostermom and FASD educator for the Dutch FASD Foundation, I felt I should point out the combination of FASD/RAD as a dual diagnosis, and how this restricts the ability to learn (because of the brain damage) and thus sets limits to a cure or outgrowing RAD. I know that within the FASD community, RAD is usually seen as part of the FASD umbrella diagnosis. However, with some children (as they grow into their teens and twenties), the RAD seems to become more prevalent, even developing into a cluster B personality disorder when they become adults. Showing for instance in the complete absence of regret or remorse, combined with full intent and carefully constructed acts of stealing, lying and false accusations (with FASD it is usually more impulsive, act before they think kind of behaviour, with regret after the fact).
    Also, some RAD experts believe some kids diagnosed with FASD in fact have ‘just’ RAD… It is hard to untangle the multi-diagnosed behaviours of these kids, and every professional looks at them through his/her own glasses of specialistic area. Making it that much harder on the parents to figure things out on their own.

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