attachment disorder



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Subtypes of
Attachment Disorder


ANXIOUS ATTACHMENT DISORDER

The primary emotion Anxious AD {AxAD} children feel is anxiety and their anxiety usually appears connected to abandonment in some form- e.g., parents will leave or reject the child from the family or totally ignore the AxAD child in favor of a preferred sibling. However, there is a deeper terror lurking in AxAD children: psychologically, “no one is home”. They have a terrifying sense of no existence of their own and a need for attention from others to somehow “confirm” their existence. Usually, whatever AxAD children are worried about will be dismissed with indifference. However, they are working very hard, all the time, to protect themselves from abandonment and from experiencing their internal sense of “non-existence”.

One way AxAD children do this is to appear to emotionally relate to others, and thus, they can exhibit what looks like attachment behaviors. AxAD children use this apparent closeness as a tranquilizer to quiet and avoid their own feelings. AxAD children devote their hypervigilance to determining what others want from them. In the absence of needing relief from their anxiety, AxAD children can be indifferent to, or rejecting of, interaction.

The primary behavioral maneuver AxAD children rely on is superficial charm; AxAD children are the most skilled of all AD children at presenting a charming façade. Their behavior varies dramatically depending upon with whom they’re interacting. They almost always deceive adults outside the home, particularly teachers, for AxAD children generally manage themselves quite well at school.

When not motivated to be charming, AxAD children are likely to revert to whining and complaining about a variety of things. AxAD children always need to be doing something so that they do not get near to their terror within. These are the children most likely to incessantly chatter, ask pointless questions, and make meaningless statements. AxAD children lie a high percentage of the time and they never acknowledge having lied. They are proficient at lying about lying. These children work diligently to “manage” the adults’ liking of them. Drawing on their superficial charm, AxAD children will present themselves “as if they are…” to procure the adults liking them.

AxAD children rarely express thoughts that are truly “their own”. The demand to be “real” frightens them. They are very skilled at eliciting clues from the environment; and often ask, “What do you want me to say?” Answers are then crafted around those clues. Such answers can sound insightful, but are typically meaningless. It is easy to underestimate AxAD children’s abilities to evade real feeling.`

AxAD children can be very intrusive, conversationally and spatially. While their intrusive behavior can be quite irritating, it is not motivated by a wish to create distance; but by the wish to be part of things without the skills to do so more gracefully. Verbally, this manifests as constantly interrupting, to the point that they may need to put their hands over their mouths to control the impulse.

AxAD children are quite skilled at setting others up, particularly siblings and peers. These children will seek peer friendships, but those friendships tend to be superficial and with younger children. If asked, AxAD children will report having numerous friends regardless of the true circumstances. In adolescence, if prior therapeutic progress has not been made, AxAD children, and particularly girls, are quite likely to substitute sexual promiscuity for friendship.

Historically, most AxAD children lost someone they were attached to early on. They seek to replicate this experience with subsequent adults. Pressure will be exerted on parents to remake themselves in the image of the lost attachment figure, and when parents don’t cooperate; the AxAD child becomes resentful. This resentment frequently gets expressed by somehow hurting the parent while being physically affectionate and by spreading false stories of mistreatment by their parents. AxAD children are the most skilled, of all AD children, at spinning believable tales of abuse by their parents.

In therapy, AxAD children are rarely openly defiant or irritatingly passive-aggressive; and hence, they can appear to be making progress when, in fact, little of significance is occurring. They can lapse into tears in an effort to influence the therapist to not challenge them so much. In terms of techniques, both EMDR and neurophysiological exercises such as Brain Gym, can be quite useful.


AVOIDANT ATTACHMENT DISORDER

The predominant emotion internally, in Avoidant AD {AvAD} children is sadness. However, the world sees little or none of their sadness. AvAD children believe their sadness is infinite, and should they lapse into it, they see no exit. Hence, they go to extraordinary lengths to avoid any expression of it, and usually effectively shield themselves from even recognizing their sadness. Their internal shields work so well that they often truly do not think they are sad. What AvAD children do feel is an anxious edge in quieter moments. They rarely relax, lest their sadness “creep up” on them. Their hypervigilance is more about deflecting anything that might activate their sadness rather than simply scanning for direct hostile threats. As physical / emotional closeness carries a high potential for triggering their sadness, AvAD children avoid it. Attitudinally, AvAD children are contemptuous of sadness- they define it as the “stuff of sissies”. AvAD children present themselves as omnipotent and without need for others. About half of these children lie somewhere along the spectrum of depressive disorders.

The predominant behavioral strategy utilized by AvAD children is passive-aggressive behavior. Various behaviors are employed for their nuisance effect in order to pollute the air with tension, which minimizes chances of their sadness being awakened. Tasks are commonly done quite slowly to generate frustration in others, which again buffers any sadness. Promises made are usually broken for the same reason. The speech of AvAD children is sprinkled with muttering which is yet another passive-aggressive variant to create irritation and block sadness. AvAD children do not engage in incessant chattering, and when they do, that can indicate that their sadness has been stirred.

Given their dislike of physical contact, AvAD children stiffen up when touched. Hugging them is like hugging a board. As touch taps their sadness, AvAD children, when touched, may well: complain of being hurt or of not feeling well, insist that the touch is making them itch and they must scratch, or engage in physically self-abusive behavior, all in an effort to distarct themselves from any emergent sadness. Attempts to impose physical closeness when it is not wanted may be met with physical aggression, not as a direct expression of anger, but as a way to shift the context away from possibly activating sadness. AvAD children also habitually overreact to minor cuts or discomforts.

In terms of treatment, physical holding is frequently necessary with AvAD children to access their sadness. When the breakthrough comes, AvAD children can feel suicidal for a period of time. It is useful to remind them that they were alone initially when they experienced their sadness, but there are others present to help them now.


AMBIVALENT ATTACHMENT DISORDER

The leading emotion in children with Ambivalent Attachment Disorder {AmAD} is anger and rage. These children are openly angry, attitudinally, verbally, and behaviorally, most of the time. This is the subtype most interested in fire, gore, and death and least developed in terms of conscience and values. They are almost wholly incapable of giving or receiving affection. AmAD children have histories of multiple placements and about half of them are not living in family environments. About 1/3 of these children are psychopathic - they understand the impact of their behavior on others, and they simply are indifferent.

The behavioral lead card of children with AmAD is direct aggression. These children are not passive aggressive, but directly oppositional and demanding. If manipulation does not obtain them what they want, AmAD children will become aggressive. They are willing to destroy their own and others’ property and to hurt animals and other children. With adults they are quite likely to be overtly threatening, but the actual use of aggression depends upon their appraisal of the likelihood they will get hurt. They are quite comfortable explicitly telling others to get away from them. AmAD children derive excitement from risk-taking behavior and commonly do not understand the inherent danger involved.

AmAD children see scarcity everywhere, and therefore what is wanted should be taken as it is not going to be given by anyone. Having to hurt someone to get what is wanted is viewed simply as “the cost of doing business”, and the other person is seen as deserving being hurt for having been in the way.

AmAD children are deliberate academic underachievers, based on the principle that the lower the expectations, the less you have to do. A good number of them are placed in LD programs as a result of their chronic underachievement. Their behavior tends to be equally problematic at home and school, and AmAD children get suspended as early as preschool.

AmAD children attempt the use of superficial charm to influence others. However they are typically quite incompetent at this and come across as transparently, and unappealingly, manipulative. Their invented tales of abuse at the hands of their parents are also clumsily crafted and easy to dismiss.


DISORGANIZED ATTACHMENT DISORDER

The characteristic emotion of children with Disorganized Attachment Disorder {DAD} is overwhelming and unmanageable anxiety. There is always some degree of neurological impairment present in DAD, and many of these children suffered IUE to alcohol and / or drugs. The overwhelming anxiety leads to significantly disordered thinking and behavior that can mimic bipolar disorder. Associations can be highly illogical such that no thread can be followed. Behavior can be bizarre, unpredictable, perseverative, and wholly unrelated to the situation.

DAD children are vulnerable to systemic dysregulation. After they recollect themselves, DAD children can feel some remorse for their behavior. However, their remorse does not alter their behavior because their behavior is driven by overwhelming anxiety, which goes unaffected by remorse. Underneath the disorganization of DAD is another type of AD, which is more observable when the child is not systemically dysregulated.

The characteristic behavior of children with DAD is, paradoxically, being behaviorally disorganized over time. This chronic disorganization leads to the problematic behaviors frequently shifting, and the relevant adults feel they are forever chasing new problems. DAD children tend to be excessively friendly with strangers, but they do so in a syrupy, bizarre manner that is ineffectual. Children with DAD can look like they are dissociating, and when they appear this way, they are usually listening to internal voices. If asked about voices or delusions, DAD children typically deny both. These voices can communicate very bizarre content, which can influence behavior and further compound the disorganization.

Due to their neurological impairment, a high percentage of DAD children need to be placed on antipsychotic medication which serves as “glue” for their vulnerable nervous systems.


Acknowledgement is due Elizabeth Randolph Ph.D. for her work on delineating the subtypes of Attachment Disorder, upon which this article is partially based.


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