From that first night in Warsaw, we saw things in Casey that took us aback – the uncontrollable tantrums, primal-type screaming, near imperviousness to discipline and lack of coping skills, among other things that evolved as she grew older. But we saw them as nothing more than parenting and behavioral challenges because the vast majority of the time Casey was so absolutely delightful. These were mere distractions that could be dealt with by “proper” (i.e. strict) parenting and discipline.

How wrong we were and how little we knew!

Erika and I hadn’t even heard of the phrase “attachment disorder” until Casey’s third and last therapist brought it up in a debrief session to discuss her refusal to continue therapy. My initial reaction was dismissive – another convenient disorder, just like ADD, ADHD or OCD. Everybody has a disorder! But after getting so close to a proper – if possibly accidental – diagnosis, she veered off in a direction that she was convinced was at the root of Casey’s problems – pot. Indeed, Casey was a teenager who smoked pot just like I did, but that wasn’t the root cause of her problem. Without seeming blasé about teen drug use, I’ve never heard of pot smoking resulting in suicide. That’s straight out of the 1930’s movie Reefer Madness.

Attachment disorder was never again discussed, and the following year Casey was dead. When I revisited that phrase years later while writing my book, I was shocked. It explained everything.

So What Is Attachment Disorder (a/k/a reactive attachment disorder)?

The disorder was an outgrowth of the work, beginning in the 1950’s, by British psychoanalyst, John Bowlby, considered by many the father of attachment theory. He was joined in his work by psychologist Mary Ainsworth. They believed that mental health and behavioral problems could be attributed to early childhood, suggesting that children come into the world biologically pre-programmed to form attachments with others, their form of survival. The main points of their theory are summarized below.

1. Though a child may have multiple attachments, she has an innate need for a primary bond to one main attachment figure, usually the mother. Any breakdown of this maternal attachment could lead to serious negative consequences. The child behaves in ways that elicit contact or proximity to the caregiver. When she experiences heightened arousal, she signals her caregiver (by crying, smiling, locomotion, etc.). Instinctively, caregivers, by creating a reciprocal pattern of interaction, instill in the child a sense of safety in her environment.

2. A child should receive the continuous care of this single most important attachment figure for approximately the first two years of life. Bowlby claimed that mothering is almost useless if delayed until after two and a half to three years and, for most children, if delayed till after 12 months.

3. If the attachment figure is broken or disrupted during the critical two-year period the child can suffer irreversible long-term consequences, including delinquency, reduced intelligence, increased aggression, depression, affection-less psychopathy.

4. The child’s attachment relationship with their primary caregiver – the prototype for future relationships – leads to the development of an internal working model with three main features: (1) a model of others as being trustworthy, (2) a model of the self as valuable, and (3) a model of the self as effective when interacting with others.

Mother and Child watching each other (Photo credit: Wikipedia)

Attachment disorders arise – simply put – when this primary attachment is broken or was never properly formed in those crucial first years of infancy. Wikipedia defines it broadly as a disorder of mood, behavior and social relationships arising from a failure to form normal attachments to primary care giving figures in early childhood, resulting in problematic social expectations and behaviors. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers after about 6 months of age but before about three years of age, frequent change of caregivers or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts.

We’ll discuss how attachment disorders can manifest in children in subsequent posts.