The categories of attachment security and insecurity

Authored by Henry Strick van Linschoten

From the early days of Bowlby’s forensic work, attachment theory has also been applied to the severest forms of mental disorder and psychopathology, often rooted in trauma and abuse. Trauma therapy and innovations in working with (complex) trauma have extensively benefited from the perspectives of attachment theory.

Initially there may have been a thought that it was attachment security per se that had direct implications for mental health, but this was not confirmed by research. A main reason why the addition of disorganised attachment as a category to attachment patterns is so important, is that this pattern of attachment has a stronger (though still only partial) correlation with mental disorder. At least here the connection, and the scope for understanding, is much stronger than with milder forms of attachment insecurity.

Allen (2012) argues that although the specialist treatment of psychiatric disorders is often valuable, the complexity of the problems that clients present in the context of trauma, often requires a generalist approach based on an understanding of the attachment relationship. In psychological therapies in general, the client’s attachment patterns almost always from the background of therapy, even though treatment planning may not involve a direct focus on them. However, in other cases they are the agreed focus of therapeutic work, especially when the client’s current close relationships form the target of treatment.

There has been much research attempting to discover whether specific attachment patterns are linked to discreet psychiatric disorders. There has usually been an assumption that mental disorder is associated with insecure attachment patterns, but this has not been confirmed by the research that has taken place. There are only few studies that follow individuals for long periods of time (longitudinally). The majority of research has been conducted with attachment and psychiatric diagnosis established concurrently, which prevents drawing causal conclusions. It could be that (a) insecure attachment predisposes to mental disorder, (b) earlier established mental disorder affects attachment style, or (c) there is a mutually intensifying relationship between the two. Bakermans-Kranenburg & Van IJzendoorn (2009) analysed the first 10,000 AAIs reported in research literature and discovered that the results were marked by some contradictory findings, without an unequivocal connection between mental disorders and insecure attachment patterns.

Lyons-Ruth & Jacobvitz (2008), Dozier & Rutter (2008) and Dozier et al. (2008) give overviews of the importance of attachment disorganisation, the difficulty that children have to cope with extremes of deprivation, and the connections that have been found between attachment patterns and mental disorder. Pearlman & Courtois (2005) go deeper into the direct implications of attachment theory for psychotherapy with complex trauma clients.