Attachment Theory: Understanding Early Bonds & Emotional Development
What is Attachment Theory?
Attachment theory is a psychological and evolutionary framework explaining children's innate need to form emotional and physical bonds, or 'attachments,' with primary caregivers. These attachments provide stability, security, and the foundation for future relationships and emotional regulation.
The Origins of Attachment Theory
John Bowlby’s Pioneering Work
John Bowlby, a British psychoanalyst, developed attachment theory in the 1930s. His work emphasized that infants have a biological drive to form attachments for survival. A key element of Bowlby’s theory is monotropy, which highlights an infant’s strong preference for a primary caregiver as a secure base.
Mary Ainsworth & The Strange Situation Experiment
Mary Ainsworth expanded on Bowlby’s work, introducing the secure base concept. Her famous Strange Situation Experiment assessed how infants react to temporary caregiver absence and reunion, leading to the classification of attachment styles.
The Strange Situation and Attachment
The Four Stages of Attachment DevelopmentIndiscriminate Orientation – Newborns respond to all caregivers equally.
Preference for Familiar Caregivers – Infants begin recognizing and preferring specific caregivers.
Active Attachment Behaviors – Children actively seek closeness and security from caregivers.
Goal-Corrected Partnerships – Older children understand caregivers’ emotions and behaviours and adjust accordingly.
Types of Attachment: Secure vs. InsecureSecure Attachment
Secure attachment develops through consistent, responsive caregiving. Infants learn that their needs will be met, leading to:
Greater resilience and emotional regulation
Willingness to explore independently
Stronger interpersonal relationships
Insecure AttachmentInsecure attachment arises from inconsistent or neglectful caregiving and is categorized into:
Ambivalent/Anxious Attachment – Children are clingy and fear abandonment.
Avoidant Attachment – Children emotionally withdraw and avoid dependence on caregivers.
Disorganised Attachment – A mix of fear and confusion, often resulting from trauma or neglect.
Prenatal Attachment: The Foundations of Bonding Before Birth
Attachment begins before birth. By the 20th week of gestation, an unborn child may start to sense touch. Gentle caressing and massaging the abdomen and responding to the baby's movements initiate a positive communicative exchange. The fetus' auditory development is continuous; around the 23rd week, they can detect the mother's heartbeat, and by the 25th week, they can discern external sounds. Engaging with the baby through speech, reading, or singing soothes and encourages voice recognition. Mindfulness exercises may alleviate anxiety for both mother and child, fostering a bond and mutual awareness.
Pregnancy is a critical period for expectant parents to engage in both physical and mental preparation. It marks the beginning of attachment, where the mother, father, and child start to forge their unique connection.
Nevertheless, even if a pregnancy is fraught with anxiety or distress, a nurturing environment after birth can offer restorative benefits.
Attachment in Infants & Early Childhood
Introduction
Attachment is children's tendency to seek closeness and contact with a particular caregiver when they experience distress, illness, or fatigue. Being attached to a protective caregiver enables infants to manage their negative emotions during stressful times and investigate their surroundings, even in slightly intimidating stimuli. As a significant developmental achievement in a child's life, attachment is a crucial matter throughout one's life. In adults, the concept of attachment influences their perceptions of the challenges in close relationships, especially those between parents and children, as well as their self-image.
Development of attachment
Attachment is believed to evolve through four stages. The first stage involves indiscriminate orientation and signalling to people, where the infant appears "tuned" to certain frequencies of environmental signals, predominantly those of human origin, like voices. In the second stage, the infant begins to show a preference for certain caregivers, likely initially through smell and then visually, marking the phase of orienting and signalling to specific individuals. It is not until the infant exhibits active attachment behaviours, such as seeking closeness and following their attachment figure, that they progress to the third stage, the phase of true attachment, characterized by staying near a particular person through signalling and movement. The fourth stage, the goal-corrected partnership, is reached when children can understand their parents' or caregivers' intentions and perceptions and adjust their plans and actions accordingly.
What is Secure Attachment?
Through consistent positive interactions, infants develop a secure attachment to a caregiver. This bond teaches them to trust that they will be cared for by others.
Securely attached children tend to experience less intense reactions to stress, show a greater willingness to try new things and explore independently, become more adept at solving problems, and establish stronger relationships with others.
What is an Insecure Attachment?
Infants whose experiences with a caregiver are negative or unpredictable are more likely to develop an insecure attachment. Children who are insecurely attached have learned that adults are not reliable and do not trust easily. Children with insecure attachments may avoid interactions, reject others, intensify distress, and display anger, anxiety, or fear. Initially identified by Bowlby and later expanded upon by Ainsworth's research, insecure attachment can be classified into three categories. In children, attachment styles are categorized as ambivalent, avoidant, and disorganized. In adults, these correspond to anxious (or preoccupied), avoidant (or dismissive), and disorganised (or fearful-avoidant) attachment styles.
The DSM-V TR recognizes two distinct forms of attachment disorder: reactive attachment disorder and disinhibited social engagement disorder. The first involves the inability to attach to a preferred caregiver, and the second involves indiscriminate sociability and disinhibited attachment behaviours. Currently, the DSM-5 does not recognise attachment disorders in adults, so an adult is unlikely to receive this diagnosis.
Attachment & Adolescence: Shifts in Emotional Bonds
During adolescence, attachment needs evolve:
Secure adolescents are expected to hold their mothers at a higher rate than all other support figures, including fathers, significant others, and best friends.
Insecure adolescents identify more strongly with their peers than their parents as their primary attachment figures. Their friends are seen as a significantly strong source of attachment support.
Dismissing adolescents minimise parental attachment and prioritise self-reliance.
Preoccupied adolescents would rate their parents as their primary source of attachment support and would consider themselves as a much less significant source of attachment support.
Freeman H, Brown BB (2001). "Primary Attachment to Parents and Peers during Adolescence: Differences by Attachment Style". Journal of Youth and Adolescence.
Attachment Disorders (RAD & DSED)
Attachment disorders are the psychological result of significant social neglect, that is, the absence of adequate social and emotional caregiving during childhood, disrupting the normative bond between children and their caregivers. These disorders, formerly considered a single diagnosis, are now, according to DSM-5, divided into reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). For reactive attachment disorder (RAD), there must be a history of gross neglect, lack of contingent responses, and little or no attention, interaction, and affection. For disinhibited social engagement disorder (DSED), there must be a history of multiple caregivers, sequential changes in caregivers, disrupted relationships, and placement with different people for long periods. The child does not develop preferential attachments and secure base behaviour toward one person but instead develops an undifferentiated closeness with anyone approaching.
Diagnosis
No laboratory studies yield results that are directly relevant to attachment disorders, although studies related to neglect and nutritional deprivation exist. No imaging studies are used to diagnose attachment disorders, and no specific histologic findings are related to attachment disorders.
The specific DSM-5 diagnostic criteria for RAD are as follows:
Diagnostic Criteria A. A consistent pattern of inhibited, emotionally withdrawn behaviour toward adult caregivers, manifested by both of the following:
1. The child rarely or minimally seeks comfort when distressed.
2. The child rarely or minimally responds to comfort when distressed.
B. A persistent social and emotional disturbance characterized by at least two of the following:
1. Minimal social and emotional responsiveness to others.
2. Limited positive affect. 296 3. Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.
C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
2. Repeated changes in primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
3. Rearing in unusual settings severely limiting opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
D. The care in Criterion C is presumed to be responsible for the disturbed behaviour in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).
E. The criteria for autism spectrum disorder are not met.
F. The disturbance is evident before age five years.
G. The child has a developmental age of at least nine months.
Specify if: Persistent: The disorder has been present for over 12 months.
Specify current severity: Reactive attachment disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.
The specific DSM-5 TR diagnostic criteria for DSED are as follows:
Diagnostic Criteria A. A pattern of behaviour in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:
1. Reduced or absent reticence in approaching and interacting with unfamiliar adults.
2. Overly familiar verbal or physical behaviour (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
3. Diminished or absent checking back with adult caregivers after venturing away, even in unfamiliar settings.
4. Willingness to go off with an unfamiliar adult with minimal or no hesitation.
B. The behaviours in Criterion A are not limited to impulsivity (as in attention-deficit/hyperactivity disorder) but include socially disinhibited behaviour.
C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
1. Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caregiving adults.
2. Repeated changes in primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
3. Rearing in unusual settings severely limiting opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
D. The care in Criterion C is presumed responsible for the disturbed behaviour in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).
E. The child has a developmental age of at least nine months. Specify if: Persistent: The disorder has been present for over 12 months.
Specify current severity: Disinhibited social engagement disorder is specified as severe when the child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.
References
Referencing from the theories and works of:
John Bowlby
James Robertson
Mary Ainsworth
Donald Winnicott
Margaret Mahler
Bowlby, J. (1944). "Forty-Four Juvenile Thieves: Their Characters and Home Life." International Journal of Psychoanalysis, 25, 107–27.
Bowlby, J. (1988). A Secure Base: Clinical Applications of Attachment Theory. London: Routledge.
https://www.child-encyclopedia.com/
Attachment Disorders: Practice Essentials, Background, Pathophysiology (medscape.com)