Attachment theory

Attachment theory has tremendous appeal in thinking about personality disordered offenders. This is partly because it is fairly easy to understand and intuitively makes sense to the experienced practitioner; it has a robust evidence base, and is integrative in its approach – that is, favouring no one particular clinical model. Understanding something about attachment theory is entirely compatible with basic training in taking a personal, family and social history from an offender. It simply provides a model with which to understand how the ‘pieces of the jigsaw’ fit together.

As already mentioned, attachment theory refers to the attachment relationship and attachment bond between a child and primary caregiver (an early maternal or paternal figure). The origins of the theory were described by Bowlby (a psychoanalyst) in 1969. He believed that infants are genetically predisposed to form attachments at a critical point in their first year of life in order to increase their chance of survival. Behaviours in the infant – smiling and crying – which attract a positive response from the caregiver help develop attachment. Infants become securely attached to caregivers who consistently and appropriately respond to their attachment behaviours. Over time, the infant needs to explore and learn from the environment (separate from the caregiver) while seeking out and keeping the caregiver close at hand during times of danger, thus protecting the infant from physical and psychological harm. Threat (when the baby is alarmed or anxious) activates the attachment system. Subsequent research by Ainsworth and later colleagues found that insensitively parented infants tend either to avoid the caregiver after a brief period of separation (anxious-avoidant), refuse to be comforted by him/her on return (anxious-resistant) or demonstrate disorganised attachments (alternating approach/avoidance behaviours) where the parent is simultaneously experienced as a source of distress and a source of comfort.

It is the caregiver’s response to the infant’s distress signals – holding, caressing, smiling, feeding and giving meaning – which allows for the development of reflective functioning in the infant. That is, this is how the child learns to understand their own thoughts and feelings, and to understand the mind and intentions of others. Over time, the securely attached child learns to manage their emotions and interpersonal behaviour; and to recognise the unspoken emotional states of others. However, the insecurely attached child may be more vulnerable to the possible effects of later experiences of abuse and adversity, resulting in greater difficulties in recovering from the impact of abuse experiences. More recent research in neurobiology supports the relationship between these psychological issues and important changes in brain chemistry, particularly in the ability to manage emotions and states of stress. Over time, this attachment system remains the key to interpersonal behaviour throughout the life span. However, the pathway to personality disorder is not determined by a difficult start in life. Research suggests that the behaviour of securely attached children can deteriorate, and the behaviour of insecurely attached children can improve, both in response to changes in the immediate environment.

Adolescent reappraisal

The most important time of change – both in repairing and in aggravating problems – is at adolescence. Puberty is the final period of rapid neurological change in the human brain, at a time when the social task is to transfer attachment relationships to peers and wider social institutions outside the family. With maturity, adolescents have the ability to change their understanding of themselves, their parents and the world generally, experimenting with alternative ideas and behaviours.

fig2-2By adulthood, the sense of self and attachment to others are much more likely to become self-perpetuating; this is due to the tendency for individuals to both select and create environments that confirm their existing beliefs. In individuals with personality disorder, this results in noticeable patterns in relating to others which are endlessly repeated, even though such relationships are usually problematic – perhaps including conflict, loneliness, rejection and unhappiness. These patterns have two particularly common features:

  • A difficulty in accurately interpreting the thoughts and feelings of others, and thus making assumptions about others which are distorted.
  • Relationships with others tend to trigger intense states of emotional arousal in response to perceived threat (often mis-read) which are difficult to regulate.

Attachment theory – in its simplest form – can be thought of as a triangle of relating, as shown in Figure 2.2.