attachment - psychiatry aspect

1. Attachment theory
Jeet nadpara

2. History
• The theory was firstly developed by John Bowlby in 1969.
Bowlby believed that an individuals attachment style was developed during childhood
and was influenced by the child’s relationships with their primary care givers. He also
held the belief that the attachment style would be durable into adulthood and would
influence the way that individual related to others throughout their lifespan (Bowlby,
1969).
• Mary Ainsworth was another influential attachment theorist who is known for her
‘strange situation’ experiments. Ainsworth would observe the attachment styles of
children by placing the child in a new environment and record their reactions to their
primary care givers exiting the room and then returning (Tracy & Ainsworth, 1981).

3. • Bowlby believed that the earliest bonds formed by children with their caregivers
have a tremendous impact that continues throughout life. According to Bowlby,
attachment also serves to keep the infant close to the mother, thus improving the
child's chances of survival.
• Attachment is an emotional bond to another person. Psychologist John Bowlby
(1907-1990) described attachment as a "lasting psychological connectedness
between human beings“.
• According to Mary Ainsworth (1913-1999), attachment "may be defined as an
affectional tie that one person or animal forms between himself and another specific
one – a tie that binds them together in space and endures over time."

4. • Ainsworth was a Bowlby’s colleague who expanded the attachment theory. She
said attachment is not just a connection between two people; it is a bond that
involves a desire for regular contact with that person and the experience of
distress during separation from that person.
The Components of Attachment By John Bowlby
There are four key components of attachment:
Safe Haven: When the child feel threatened or afraid, he or she can return to the
caregiver for comfort and soothing.
Secure Base: The caregiver provides a secure and dependable base for the child to
explore the world.
Proximity Maintenance: The child strives to stay near the caregiver, thus keeping
the child safe.
Separation Distress: When separated from the caregiver, the child will become
upset and distressed.

5. Phases Of Attachment
1. The first attachment phase is sometimes called pre-attachment stage(birth to 8 or 12
weeks), babies orient to their mothers, follows them with their eyes over 180 degree range and
turn towards and move rhythmically with their mothers voice.
2. In the second phase, sometimes called attachment in the making (8 to 12 weeks to 6
months), infants become attach to one or more person in the environment.
3. In the third phase, sometimes called clear cut attachment (6 through 24 months), infants
cry and show other signs of distress when separated from the care taker or mother. Sometimes
seeing the mother after separation is sufficient for crying to stop.
4. In the fourth phase (25 months and beyond), the mother figure is seen as independent, and a
more complex relationship between the mother and child develops.

6. Quality of Attachment
• Bowlby also suggested the quality of this attachment relationship is strongly
influenced by experiences and repeated interactions between the infant and the
primary caregiver. The success of the attachment bond depends on the caregiver's
ability to understand and respond to the infant's physical and emotional needs.
• When caregiver and baby are in sync with each other, a secure attachment is formed.
Baby feels safe knowing the caregiver will always be there when needed. It was
found, through studying children raised in institutions prior to being doubted that after
the sensitive period, this first attachment relationship can develop, but with greater
difficulty. Hazan and Shaver have also produced evidence that securely attached
infants go on to have stable, secure adult relationships, as Bowlby's theory predicts.

7. Ainsworth's “Strange Situation”
In her 1970's research, Mary Ainsworth expanded greatly upon Bowlby's original
work. Her ground breaking "Strange Situation" study revealed the profound effects of
attachment on behaviour. In the study, researchers observed children between the ages
of 12 and 18 months as they responded to a situation in which they were briefly left
alone and then reunited with their mothers.
Based upon the responses the researchers observed, Ainsworth described three major
styles of attachment
1. secure attachment,
2. ambivalent-insecure attachment and
3. avoidant-insecure attachment.

8. episode Person present Change
1 Parent, infant Enter room
2 Parent, infant, stranger Unfamiliar adult joins the dyad
3 Infant, stranger Parent leaves
4 Parent, infant Parent returns, stranger leaves
5 Infant, stranger Parent leaves, Stranger returns
6 Parent, infant Parent returns, stranger leaves
All episodes are usually 3 min long, it can be shortened if the infant becomes
too distressed

9. Secure Attachment
• Securely attached children exhibit distress when separated from caregivers and
are happy when their caregiver returns. Remember, these children feel secure
and able to depend on their adult caregivers. When the adult leaves, the child
may be upset but he or she feels assured that the parent or caregiver will return.
• When frightened, securely attached children will seek comfort from caregivers.
These children know their parent or caregiver will provide comfort and
reassurance, so they are comfortable seeking them out in times of need.

10. Ambivalent Attachment
• Ambivalently attached children usually become very distressed when a parent
leaves. This attachment style is considered relatively uncommon.
• Research suggests that ambivalent attachment is a result of poor maternal
availability. These children cannot depend on their mother (or caregiver) to be
there when the child is in need.

11. Avoidant Attachment
• Children with an avoidant attachment tend to avoid parents or caregivers.
When offered a choice, these children will show no preference between a
caregiver and a complete stranger.
• Research has suggested that this attachment style might be a result of abusive
or neglectful caregivers. Children who are punished for relying on a
caregiver will learn to avoid seeking help in the future.

12. Children who do not form secure attachments -
• Research suggests that failure to form secure attachments early in life can have a
negative impact on behaviour in later childhood and throughout the life. Children
diagnosed with oppositional-defiant disorder (ODD), conduct disorder (CD) or
post-traumatic stress disorder (PTSD) frequently display attachment problems,
possibly due to early abuse, neglect or trauma. Clinicians suggest that children
adopted after the age of six months have a higher risk of attachment problems.
• While attachment styles displayed in adulthood are not necessarily the same as
those seen in infancy, research indicates that early attachments can have a serious
impact on later relationships. For example, those who are securely attached in
childhood tend to have good self-esteem, strong romantic relationships and the
ability to self-disclose to others. As adults, they tend to have healthy, happy and
lasting relationships.

13. • Attachment disorders are characterized by biopsychosocial pathology that results
from maternal deprivation, a lack of care by, and interaction with, the mother or
caregiver.
• Failure to thrive syndromes, psychosocial dwarfism, separation anxiety disorder,
avoidant personality disorder, depressive disorder, delinquency, academic
problems and borderline intelligence have been traced to negative attachment
experiences.
Bowlby described a predictable set and sequences of behavior patterns in children
who are separated from their mothers for long period of time
More than 3 months
Protest, in which the child protects the separation by crying, calling out, and
searching for the lost person

14. Despair, in which the child appears to lose hope that the mother will return; and
Detachment, in which the child emotionally separates himself or herself from the
mother.
Child in detachment stage responds in an indifferent manner when the mother returns;
the mother has not been forgotten, but the child is angry at her for having gone away
in the first place and fears that she will go away again.
Anaclitic depression,
Also known as hospitalism, was first described by rene spitz in infants who had made normal
attachemts but were then suddenly separated from their mothers for varying time and placed
in institutions or hospitals. The children become depressed, withdrawn, non responsive, and
vulnarable to physical illness but recovered when their mothers returned or when surrogate
mothering was available.

15. Relationship disorders
• A person’s psychological health and sense of well being depend significantly on the
quality of his or her relationship and attachment to others, and a core issue in all close
personal relationship is establishing and regulating that connection.
• Adults with an anxious ambivalent attachment style tend to be obsessed with romantic
partners, suffers from extreme jealousy, and have a high divorce rate.
• Person with avoidant attachment style are relatively un-invested in close relationship, although
they often feel lonely, they seem afraid of intimacy and tend to withdraw when there is stress
Or conflicts in the relationship.
Break up rates are high.
• Person with secure attachment style are highly invested in relationships and tend to behave
without much possessiveness or fear of rejection.

16. Thank you !