Attachment Theory
OVERVIEW
Conceived in the 1950s, British developmental psychologist and psychiatrist John Bowlby coined Attachment Theory, one of the most popular and empirically-grounded theories relating to parenting.
Noting that “bonding” and “attachment” differ greatly, Bowlby found there are four types of infant-parent attachment: three organized types (secure, avoidant and anxious/resistant) and one disorganized type. The quality of such attachment is primarily determined by a caregiver’s response to the infant when the infant’s feelings of safety and security are threatened; this quality of the infant-parent/caregiver attachment is deemed to be a powerful predictor of a child’s later social and emotional outcome.[1]
BACKGROUND
Attachment Theory’s developmental history began in the 1930s, with Bowlby's growing interest in the link between maternal loss (i.e. deprivation) and later personality development. Bowlby formulated his theory’s initial blueprint drawing on ethology, control systems theory, and psychoanalytic thinking.[2]
At the time, there were four major theories regarding an infant’s needs. The most popular theory stated that attachment forms because a mother satisfies their infant’s physiological needs (e.g. nourishment and warmth). Another popular theory noted that babies relate to their mother because their mother is attached to the breast at which they feed. The third theory presumed there was an innate need to physically cling to another human. The fourth theory, which Bowlby could barely contain his disdain for, noted that infants crave a return to the womb, causing the infant to naturally seek their mother and her embrace. Additionally, in much of Freud’s classical writings, the connective tie of an infant to its mother was absent, noting that the relationship of a child to its mother during the first two years of its life was a non-issue.[3]
Conventional wisdom purported that infants were only interested in mothers because “mothers feed them.” Bowlby sought to develop his theory on attachment as he was “profoundly unimpressed by” the aforementioned notion and regarded it all as “complete rubbish,” which he “knew wasn’t true” and which was completely contrary to his clinical experience. Further, he needed to expand upon his theory due to critics insisting children in his earlier maternal deprivation studies were not suffering from the loss of their mother nor of a mothering figure but “simply from a lack of adequate stimulation.” In the studies, many of the babies who had suffered lengthy separations from their mothers had been placed in institutions where they were left “in near total isolation for much of the day with no one and nothing to play with.”[4] Behaviorists utilized data from Bowlby’s research to state that the love of a mothering figure was completely unnecessary to one’s healthy emotional development. Aghast with the notion that all a child needed was enough stimulation and that it didn’t matter if there was a single person with whom the infant could form a meaningful relationship, Bowlby enthusiastically sought to develop a theory highlighting the role and necessity of attachment in infants. Utilizing ethnological studies, he formulated that separations from one’s mother were developmentally disastrous because they thwarted an instinctual need, in that a baby’s efforts to attain attention and care are “biologically programmed.”[5]
THEORETICAL COMPONENTS
One key factor in his theory was that Bowlby differentiated “attachment” from the concept of “bonding.” The former suggests a complex, developing process whereas the latter suggests an instantaneous event. Noting that attachment was akin to love, he sought to define a new series of developmental stages based on the maternal bond. These attachment behaviors were said to be instinctual and rooted in the biological fact that “proximity to a mother/caregiver is both essential to survival as well as satisfying” – and that proximity begets feelings of love, security and joy. Moreover, a disruption of such conjures anxiety, grief and depression.[6]
Attachment makes a child feel safe, secure and protected[7] as they use their primary caregiver as a secure base from which to explore, a haven of safety and source of comfort.[8] “Bonding” was a concept developed by Klaus and Kennell[9] who implied that parent-child bonding depended on skin-to-skin contact during a critical period early in a child’s life. While this concept of bonding has been proven to be erroneous and to have nothing to do with attachment, many professionals and nonprofessionals continue to use the terms “attachment” and “bonding” interchangeably. Notably, while bonding has not been shown to predict any aspect of child outcome, research demonstrates that attachment is a powerful predictor of a child’s later social and emotional outcome.[10]
Overall, instinctual responses within the attachment system exist due to their survival value; however, as an infant becomes cognizant of where their care is coming from, the phenomenon of love develops, causing the infant to become more fully attached to their caregiver.[11] Coining the term, “monotropy,” Bowlby created intense psychological debate. Critics misunderstood the concept to convey that a child only attaches to one caregiver; however, Bowlby’s concept intended that a person can attach to several people but that there is actually a hierarchy of attachment – with one person who is their central attachment figure, who is “loved above all others and whose presence most insures a feeling of security.”[12]
Building upon an infant’s attachment behaviors, Bowlby noted that actions such as crying and smiling do not actively attach an infant to their parent – they attach the parent/caregiver to the infant.[13] Further, he stated that none of the instinctual attachment responses are more primary than the other. He saw the action of sucking as important to attachment as it contributes to a child’s sense of security. In that, Bowlby disapproved of weaning a child six months of age, noting that, “In my experience, most infants through much of the second year of life need a great deal of sucking and thrive on milk from a bottle at bedtime.” Additionally, in the second year, behaviors such as clinging and following one’s caregiver peak. Bowlby noted that anxiety, fear, illness and fatigue will cause a child to increase attachment behaviors.[14]
Bowlby’s Attachment Theory notes there are four types of infant-parent attachment: three ‘organized’ types (secure, avoidant and anxious/resistant) and one ‘disorganized’ type. The quality of attachment that an infant develops with a specific caregiver is primarily determined by the caregiver’s response to the infant when the infant’s feelings of safety and security are threatened[15] (e.g. when ill, physically hurt or emotionally upset or frightened.) At approximately six months of age, infants begin to anticipate specific caregivers’ responses to their distress, shaping their own behaviors accordingly to deal with distress in the presence of that caregiver.[16-18] Thus, three “organized” primary patterns of attachment in response to distress have been identified:
Secure - Infants whose caregivers consistently respond and attend to distress in reassuring, sensitive, and loving ways feel secure knowing the expression of negative emotion will elicit comfort from their caregiver.[19] This causal relationship in dealing with distress is both organized and secure in that the caregiver is reliable to provide comfort when the infant is distressed. Those exhibiting secure attachment patterns seek proximity to, and maintain contact with, the caregiver until they feel safe again.[20]
Avoidant - Infants whose caregivers consistently respond to distress in a manner which is insensitive and rejecting of the infant’s needs (e.g. ignoring, ridiculing or becoming annoyed) also develop an organized strategy for dealing with their distress. In response to the aforementioned behavior of a caregiver, an infant will learn to avoid their caregiver when distressed as well as minimize their displays of negative emotion while in the presence of the caregiver.[21] The strategy is categorized as organized because the child knows what behavior to do regarding their rejecting caregiver (i.e., they will avoid the caregiver in times of need). This avoidant strategy is also categorized as “insecure” due to the increased risk for developing adjustment problems.[22]
Anxious/Resistant - Infants whose caregivers respond in inconsistent, unpredictable and/or distancing ways, suffer amplified distress. To deal with this distress in an organized way, the infant will consistently display extreme negative emotions to draw the attention of their inconsistently responsive caregiver. This strategy is said to be organized because the child knows that by dealing with an inconsistently responsive caregiver, a consistently distressed infant cannot possibly be missed or ignored by the inconsistently responsive caregiver. This resistant strategy is also categorized as being insecure due to the associated risk for developing social and emotional maladjustment.[23]
Disorganized - Infants exposed to caregivers with atypical behavior are prone to developing disorganized attachment. Roughly 15% of infants in low psycho-social risk and 82% of those in high-risk situations do not use the aforementioned organized strategies for dealing with stress and negative emotion.[24] Atypical caregiver behaviors include those which can be described as: frightening, frightened, dissociated, sexualized or otherwise atypical,[25] and are not limited to when the child is distressed. Zeanah et al. (1999) note evidence suggesting that caregivers who display atypical behaviors often have a history of unresolved mourning or unresolved emotional, physical or sexual trauma, or are otherwise traumatized (for example, with PTSD).[26]
DISCUSSION
The importance of attachment cannot be understated, as the quality of the infant-parent/caregiver attachment is deemed a powerful predictor of a child’s later social and emotional outcome. While 60% of society is categorized as being healthily attached, 40% present with insecure attachment styles.[27] A normally developing child will develop some level of attachment with any caregiver providing regular physical and/or emotional care. An attachment relationship develops, regardless of the quality of that care; attachment relationships occur even in severe cases of caregiving neglect and abuse. Hence, there will always be an attachment between the parent/caregiver and child – the quality of attachment will, however, vary. Further, children form differing attachment relationships with their various caregivers based on how each caregiver responds to the child in duress. A child can have an organized/secure attachment with one caregiver, as well as a disorganized attachment with another.[28] In cases where a child is subjected to multiple foster placements, neglect or institutionalization, they may develop disorders of non-attachment.[29]
Children with insecure attachments to their caregivers, particularly those who are anxious or depressed, are prone to developing anxiety disorders, especially separation anxiety.[30] Avoidant children are likely to disregard body signals and may soil, wet, overeat or vomit.[31] Insecure attachment can derive not only from caregiving abuse, neglect or inconsistency but also in overprotection and a disallowment of independence appropriate for a child’s age. Additionally, some caregivers simply don’t know how to provide proper guidance, encouragement and coaching children need, thus leading to children developing a fear of independence as they develop a fear of abandonment or exaggerated fears of the world away from their caregiver.[32]
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders notes the symptoms of childhood separation anxiety disorder, appearing in children younger than 18 years, who exhibit three of the following:[33]
Excessive distress about actual or anticipated separation from home or parents.
Persistent concern about losing parents or about some harm coming to them if the child is not with them.
Persistent fear of being lost or kidnapped when separated from parents.
Persistent reluctance to go to school because of fear of separation.
Persistent reluctance to be alone — with or without parents at home or significant adults in other places.
Persistent reluctance to sleep away from home or go to sleep without a parent nearby.
Repeated nightmares about separation from parents.
Repeated complaints of headaches and other physical symptoms when anticipating separation from parents.
Of the four patterns of attachment, disorganized attachment during infancy and early childhood is a powerful predictor for serious psychopathology and maladjustment.[34-41] Noting the relation between adverse childhood experiences and adult health, VJ Felitti (2002) noted that disturbed childhood attachment relates to ill-health in adults (physically and psychologically) and includes major causes of mortality.[42]
Disorganized attachment is over-represented in groups of children with clinical problems; nearly 80% of maltreated infants have disorganized attachment.[43-45] The more dysfunctional the attachment, the more prominent the secondary consequences are, such as: difficulty in understanding emotions, body signals and relationships, lack of empathy, and poor stress regulation. Those with dysfunctional attachment are prone to suffering ADHD, Asperger's Syndrome, Conduct Disorder, and Obsessive Compulsive Disorder (OCD).[46]
In an article published by The Journal of the Royal College of General Practitioners, C. Rees (2007) noted that, “Disturbed childhood attachment is a key factor in intergenerational parenting difficulties and predisposes children to substance abuse, homelessness, promiscuity, early pregnancy, and criminality.”[47] Children with disorganized attachment are further more vulnerable to stress,[48,49] have problems with regulation and control of negative emotions,[50] display oppositional, hostile, aggressive behaviors and coercive styles of interaction.[51-56]
Regarding school-age children, disorganized attachment in infancy has been linked to a myriad of issues. Research has found this attachment leads to: poor peer interactions and unusual or bizarre behavior in the classroom,[57] greater likelihood of dissociative behavior and internalizing symptoms in middle childhood[58] as well as high levels of teacher-rated social and behavioral difficulties in class.[59,60] Disorganized attachment with a caregiver who has a difficult temperament has been found to be a predictor of aggressive behavior in children at five years of age.[61] Academically, it has been found that children classifying as disorganized with their primary caregiver at ages five to seven years have lower mathematics attainment,[62] likely due to the effects on their self-esteem and confidence in the academic setting.[63] Children with disorganized attachment presenting with low social self-esteem often suffer in the rejection of their peers.[64-66]
Disorganized attachment further causes problems into adolescence. Those with disorganized attachment with their primary caregiver during infancy project higher levels of overall psychopathology at 17 years of age,[67] and those classified as disorganized at five to seven years of age exhibit impaired formal operational skills and self-regulation.[68] Further, this cohort is more vulnerable to altered states of mind, such as dissociation in young adulthood.[69-70] However, a 1999 meta-analysis of 12 studies (n=734) addressing the association of disorganization and externalizing behavior problems,[71] found effect sizes ranging from 0.54 to 0.17, with a mean correlation coefficient of 0.29; hence, the relation is not completely straightforward. Lyons-Ruth (1996)[72] found that 25% of children with disorganized attachment in infancy were not disturbed at seven years of age; however, it is unknown whether issues presented in this population later in life. Further, it appears that the majority of children with disorganized attachment suffer adverse outcomes.[73]
Reactive Attachment Disorder (RAD) is a condition wherein an infant or young child does not form a secure, healthy emotional bond with their primary caretaker(s). Children with RAD rarely seek or show signs of comfort, seeming almost fearful of their caretakers; these children are often irritable, sad, and may report feeling unsafe and/or alone. Reactive attachment disorder is most common among children between 9 months and 5 years who have experienced physical or emotional neglect or abuse.[74] The concept of RAD, however, has been controversial in several regards. The diagnosis of RAD, whether using criteria from the International Classification of Diseases: Clinical Descriptions and Diagnostic Guidelines[75] or Diagnostic and Statistical Manual of Mental Disorders, 4th edition,[76] was developed without the benefit of data. Additionally, research evidence to support its validity are sparse.[77] Zeanah et al. (1993, 2000) criticized the criteria for RAD as “inadequate to describe children who have seriously disturbed attachment relationships rather than no attachment relationships.”[78-79] Another criticism with the psychiatric diagnosis of RAD is that it suggests that the attachment difficulties lie within the child (i.e. the child receives the psychiatric diagnosis), while the concept of attachment involves the relationship between a child and caregiver.[80]
Healthy behaviors of parents/caregivers lead to secure attachment, which affect an infant throughout the duration of life. When stressed, frustrated or angry, child protection workers as well as health and mental professionals recommend that parents place a baby safely in a crib (i.e. instead of shaking, yelling at or otherwise harming the child). However, it is noted that one should be cognizant of how frequently the child is placed in the crib and is not otherwise responded to. Professionals find it is acceptable for a child to cry during certain medical situations (e.g. when intrusive medical procedures need to be done to save the life of a child, treat a sick infant or give immunizations). However, it is advised that the primary caregiver be present to promptly hold and comfort the infant during the aforementioned situations. Further, during the first six months of life, it is not advised to let a baby cry despite the old adage that it is “good for their lung development,” that comforting a crying baby will “spoil” them or because the baby “needs to find their own ways to self-soothe.” Conversely, it has been found to be acceptable to let a baby cry during the second six months of life (e.g. using the Ferber method) when the crying is not related to attachment, such as when the child is not physically hurt, ill or frightened/emotionally distressed.[81] Longitudinal research by Egeland et al. (1995) and van IJzendoorn (1992) have demonstrated that having a loving primary caregiver, and developing organized and secure attachment to said primary caregiver, acts as a protective factor against both social and emotional maladjustment for infants and children.[82-83]
Childhood attachment reflects in adult personal, social, and professional relationships, as well in one’s own approach to parenting. Adult attachment style has also been found to relate to how one handles trauma and loss,[84] as well as their career choice (e.g. medical students with secure attachments are more likely to select a career in primary care than those with avoidant or anxious patterns).[85] In sociological contexts, individual and societal benefits stemming from attachment styles are reflected in historical and cultural variations in approaches to emotional expression, education, discipline, and individual rights. Societies benefitting from individualism (individual strengths) tend to foster insecure attachment styles. Specifically, Goertzel et al. (2004) noted that characteristics such as authoritarianism and strategic decisiveness, which are important to the organization, defense and development of society, tend to promote avoidant attachment. However, this attachment pattern may also be eminent in the fields of mathematics, computers as well as invention. It has been noted that persons who thrive on the validation of others often enrich society in roles which help others, as socialites, or performers. Further, insecure attachment may fuel creative genius, which has been observed to rarely thrive on one’s personal contentment.[86]
Contributed by: Jennifer (Ghahari) Smith, Ph.D.
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4 Ibid. (pp. 89).
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6 Ibid.
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19 Ibid.
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80 Benoit D. (2004)
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