Bonding and Attachment Explained
In my quest to uncover my strange, peculiar and disturbing personality characteristics that are directly related to my adopted status, the principle psychological foundation of Attachment is the simple answer.
I am the watcher of other children are playing, as I do not know how to participate, and well aware that I am NOT welcome to join in. This is a recognized mental and physical behavior that is a constant in my personality.
I have always been the outsider in the adoptive family group that does not belong and is not welcome to intrude. My learned and conditioned behavior of being inferior to my adoptive family, was practiced throughout my childhood by being isolated from participating in family activities, discussions or watching TV.
Due to my inability to form authentic, or normal relationships, I feel comfort in isolation and solitude. In childhood I was always content in my isolation, playing alone, I was happy and occupied by solely myself. When my name was yelled, my first thought was fear, always under the threat of being punished by my adoptive parents, as the only reason for them to call my name was not to come and join the family's activity.
In adulthood, my extreme difficulty in relating to other human beings became pronounced. I would be written up at work for not participating in after hours dinner parties, happy-hour and various other activities with fellow staff members. Life was hard enough dealing with people at work, why would I want to do it without getting paid, or see the same people from work that if I was fired, would never talk to me again...The effort to force or develop friendships is a difficult concept for me to grasp.
Leaving my adoption fog, post biological reunion and in my self-discovery within adoptee education I began to read basic principles of human interaction.
I realized that I had no concept of too many common knowledge topics, like a large piece of the human experience is missing from my brain. Learning the basic concepts of human interaction has been vital to my emotional growth and post adoption education has allowed me to grasp so many ideas of cause and effect that I was completely ignorant of.
ADOPTEE ATTACHMENT DISORDER began with forced birth separation, multiple foster homes, and the adoption to replace a deceased child is known to create psychopathology in children.
In my adopted infancy I was not nurtured, had multiple outside caregivers and was sent away to live with adoptive grandparents in the first three years of life (the window of opportunity for attachment). The grieving mother adopted a replacement baby to fill the void of loss from her third infant that was stillborn. The stay-home mother of two biological sons was indifferent, ambivalent and felt hostility toward the adopted child's neediness. I was programmed to believe that I was nothing, but adoption made me a servant, which is better than nothing?
Classification of Attachment
Percentage at One Year
Response in Strange Situation
Explores with M in room; upset with separation; warm greeting upon return; seeks physical touch and comfort upon reunion
Ignores M when present; little distress on separation; actively turns away from M upon reunion
Little exploration with M in room, stays close to M; very distressed upon separation; ambivalent or angry and resists physical contact upon reunion with M
Insecure: disorganized/ disoriented
Confusion about approaching or avoiding M; most distressed by separation; upon reunion acts confused and dazed — similar to approach-avoidance confusion in animal models
What other factors influence bonding and attachment?
Any factors that interfere with bonding experiences can interfere with the development of attachment capabilities. When the interactive, reciprocal "dance" between the caregiver and infant is disrupted or difficult, bonding experiences are difficult to maintain. Disruptions can occur because of primary problems with the infant, the caregiver, the environment, or the "fit" between the infant and caregiver.
Infant: The child's "personality" or temperament influences bonding. If an infant is difficult to comfort, irritable, or unresponsive compared to a calm, self-comforting child, he or she will have more difficulty developing a secure attachment. The infant's ability to participate in the maternal-infant interaction may be compromised due to a medical condition, such as prematurity, birth defect, or illness.
Caregiver: The caregiver's behaviors can also impair bonding. Critical, rejecting, and interfering parents tend to have children that avoid emotional intimacy. Abusive parents tend to have children who become uncomfortable with intimacy, and withdraw. The child's mother may be unresponsive to the child due to maternal depression, substance abuse, overwhelming personal problems, or other factors that interfere with her ability to be consistent and nurturing for the child.
Environment: A major impediment to healthy attachment is fear. If an infant is distressed due to pain, pervasive threat, or a chaotic environment, they will have a difficult time participating in even a supportive caregiving relationship. Infants or children in domestic violence, refugee situations, community violence, or war zone environments are vulnerable to developing attachment problems.
Fit: The "fit" between the temperament and capabilities of the infant and those of the mother is crucial. Some caregivers can be just fine with a calm infant, but are overwhelmed by an irritable infant. The process of reading each other's non-verbal cues and responding appropriately is essential to maintain the bonding experiences that build in healthy attachments. Sometimes a style of communication and response familiar to a mother from one of her other children may not fit her new infant. The mutual frustration of being "out of sync" can impair bonding.
How does abuse and neglect influence attachment?
There are three primary themes that have been observed in abusive and neglectful families. The most common effect is that maltreated children are, essentially, rejected. Children who are rejected by their parents will have a host of problems including difficulty developing emotional intimacy; some of these are listed below. In abusive families, it is common for this rejection and abuse to be transgenerational. The neglectful parent was neglected as a child; they in turn pass on the way they were parented. Another theme is "parentification" of the child. This takes many forms. One common form is when an immature young woman becomes a single parent. The infant is treated like a playmate and very early in life like a friend. It is common to hear these young mothers talk about their four-year-old as "my best friend" or "my little man." In other cases, the adults are so immature and uninformed about children that they treat their children like adults — or even like another parent. As a result, their children may participate in fewer activities with other children who are "immature." This false sense of maturity in children often interferes with the development of same-aged friendships. The third common theme is the transgenerational nature of attachment problems — they pass from generation to generation.
It is important to note that previously secure attachments can change suddenly following abuse and neglect. The child's perception of a consistent and nurturing world may no longer "fit" with their reality. For example, a child's positive views of adults may change following physical abuse by a baby-sitter.
Are attachment problems always from abuse?
No, in fact the majority of attachment problems are likely due to parental ignorance about development rather than abuse. Many parents have not been educated about the critical nature of the experiences of the first three years of life. With more public education and policy support for these areas, this will improve. Currently, this ignorance is so widespread that it is estimated that one in three people has an avoidant, ambivalent, or resistant attachment with their caregiver. Despite this insecure attachment, these individuals can form and maintain relationships — yet not with the ease that others can.
What specific problems can I expect to see in maltreated children with attachment problems?
The specific problems that you may see will vary depending upon the nature, intensity, duration, and timing of the neglect and abuse. Some children will have profound and obvious problems, while some will have very subtle problems that you may not realize are related to early life neglect. Sometimes these children do not appear to have been affected by their experiences. However, it is important to remember why you are working with the children and that they have been exposed to terrible things. There are some clues that experienced clinicians consider when working with such children; these are listed below.
Developmental delays: Children experiencing emotional neglect in early childhood often have developmental delay in other domains. The bond between the young child and her caregivers provides the major vehicle for developing physically, emotionally, and cognitively. It is in this primary context that children learn language, social behaviors, and a host of other key behaviors required for healthy development. Lack of consistent and enriched experiences in early childhood can result in delays in motor, language, social, and cognitive development.
Eating: Odd eating behaviors are common, especially in children with severe neglect and attachment problems. They will hoard food, hide food in their rooms, or eat as if there will be no more meals even if they have had years of consistent available foods. They may have failure to thrive, rumination (throwing up food), swallowing problems and, later in life, odd eating behaviors that are often misdiagnosed as anorexia nervosa.
Soothing behavior: These children will use very primitive, immature and bizarre soothing behaviors. They may bite themselves, head bang, rock, chant, scratch, or cut themselves. These symptoms will increase during times of distress or threat.
Emotional functioning: A range of emotional problems is common in maltreated children, including depressive and anxiety symptoms. One common behavior is "indiscriminant" attachment. All children seek safety. Keeping in mind that attachment is important for survival, children may seek attachments — any attachments — for their safety. Non-clinicians may notice abused and neglected children are "loving" and hug virtual strangers. Children do not develop a deep emotional bond with relatively unknown people; rather, these "affectionate" behaviors are actually safety-seeking behaviors. Clinicians are concerned because these behaviors contribute to the abused child's confusion about intimacy, and are not consistent with normal social interactions.
Inappropriate modeling: Children model adult behavior — even if it is abusive. Maltreated children learn that abusive behavior is the "right" way to interact with others. As you can see, this potentially causes problems in their social interactions with adults and other children. For children who have been sexually abused, they may become more at-risk for future victimization. Boys who have been sexually abused may become sexual offenders.
Aggression: One of the major problems with these children is aggression and cruelty. This is related to two primary problems in neglected children: (1) lack of empathy and (2) poor impulse control. The ability to emotionally "understand" the impact of your behavior on others is impaired in these children. They really do not understand or feel what it is like for others when they do or say something hurtful. Indeed, these children often feel compelled to lash out and hurt others — most typically something less powerful than they are. They will hurt animals, smaller children, peers and siblings. One of the most disturbing elements of this aggression is that it is often accompanied by a detached, cold lack of empathy. They may show regret (an intellectual response) but not remorse (an emotional response) when confronted about their aggressive or cruel behaviors.
Responsive adults, such as parents, teachers, and other caregivers make all the difference in the lives of maltreated children. The next article in this series, "Bonding and Attachment in Maltreated Children: How You Can Help," suggests some strategies to use to make a difference in a child's life.
*Adapted in part from: "Maltreated Children: Experience, Brain Development and the Next Generation" (W.W. Norton & Company, New York, in preparation)
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Dr. Bruce D. Perry, M.D., Ph.D., is an internationally recognized authority on brain development and children in crisis. Dr. Perry leads the ChildTrauma Academy, a pioneering center providing service, research and training in the area of child maltreatment (www.ChildTrauma.org). In addition he is the Medical Director for Provincial Programs in Children's Mental Health for Alberta, Canada. Dr. Perry served as consultant on many high-profile incidents involving traumatized children, including the Columbine High School shootings in Littleton, Colorado; the Oklahoma City Bombing; and the Branch Davidian siege. His clinical research and practice focuses on traumatized children-examining the long-term effects of trauma in children, adolescents and adults. Dr. Perry's work has been instrumental in describing how traumatic events in childhood change the biology of the brain. The author of more than 200 journal articles, book chapters, and scientific proceedings and is the recipient of a variety of professional awards.