Attachment disorder - definition, causes and therapy

Attachment disorder - definition, causes and therapy

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Binding disorder means not being able to build secure bonds with other people. Such attachment disorders are often the beginning of personality disorders such as borderline syndrome, a dissociative or narcissistic disorder, and multiple personality disorders. The essentials in brief:

  • There are two types of attachment disorder, reactive and uninhibited.
  • Despite similar symptoms, these should not be confused with the consequences of sexual abuse, early childhood autism, Asperger's syndrome, cognitive disorders or schizophrenia.
  • Attachment disorders arise from neglect, neglect, emotional cold, but also through traumatization in the womb as well as long hospital stays and chronic illnesses.

How does a binding disorder develop?

These disorders arise in childhood, often through traumatization, when children are mistreated, abused or neglected and / or do not experience physical or mental closeness from their parents. This does not meet their basic needs.

It does not have to be the parents' malicious intent. Loss of crucial relationships, breakdowns in the parents or mental and physical illnesses of the father and mother can also lead to such a disorder. A lack of support for the child can trigger a binding disorder as well as its opposite - overprotection, in which the child suffocates mentally and does not develop autonomy.

In addition, typical for some people who are disturbed by ties are ambivalent ties in childhood, in which the parents wavered between idealizing the child and demonizing, rejecting and supposedly recognizing it. Or hostility on the part of the parents, in which the child found out that the parents rejected and devalued it.

Typical causes

The following circumstances are known as causes of a binding disorder:

  • Mother or drug abuse during (in-utero trauma) and after pregnancy,
  • emotionally indifferent caregivers,
  • Depression of the mother after pregnancy,
  • Separation of parents and foster parents or changing foster parents
  • and chronic diseases in the early years, associated with medical interventions and / or chronic pain.

The attachment disorder with disinhibition arises essentially in the fifth year of life through neglect and emotional neglect.

Attachment or personality disorder?

In early childhood attachment disorders, a diagnosis up to the age of 15 is useful. From the age of 16, doctors diagnose personality disorders.

How many children suffer from attachment disorders?

Around 70 percent of all children are considered to be safely bound. Thanks to good experience and trust in the close caregivers, they have an increased resilience to mental illnesses that are associated with attachment problems. Such children are able to build stable relationships, both with friends and later with their partners.

Approximately 30 percent of all children are considered to be insecure. You either have an uncertain avoiding or an uncertain ambivalent relationship behavior. Avoiding means that they generally do not have close relationships because proximity is a threat to them. Ambivalent means a commute between closeness and distance, dependency and convulsively defended autonomy, closed and open, without bringing these necessary poles of interpersonal relationships into harmony. Such people are at much greater risk of developing mental illness. Binding disorders in the clinical sense are far less common. Those who suffer from this cannot build lasting relationships with other people.

The reactive attachment disorder

Children who suffer from it have little access to their feelings. Often they cannot name their own feelings, and can hardly distinguish between affection and rejection. They are often aggressive towards others or against themselves and behave contradictively in social relationships. They suffer from various fears. Your commute between attraction and rejection, idolizing or demonizing seems strange to other people. Outsiders can often not explain the harsh reactions, and those affected do not understand their behavior themselves. Serious cases of this disorder can affect children's physical growth.

Typical signs of a reactive disorder are:

  • Absurd relationship patterns with mixtures of approach, avoidance, resistance and encouragement,
  • impaired social gaming,
  • Car and foreign aggression,
  • Fearfulness / anxiety,
  • Over-caution,
  • Unhappiness, dejection, grief,
  • limited emotional reactions (unresponsive),
  • apathy
  • and so-called "frozen vigilance" (feeling of constant threat).

Uninhibited attachment disorder

These children cannot differentiate in social relationships. They crave attention, whether they receive it in a positive or negative sense. They cling to other people indiscriminately. If they are sad, they cry out to everyone or none at all. In addition to identical patterns of reactive attachment disorder, non-selective attachment behavior and inadequate reactions to relationships offered by caregivers can also appear as symptoms in the uninhibited form.

Attachment theories

Psychiatrist John Bowlby designed a model of attachment based on biology and as a criticism of psychoanalysis in the 1950s. So he realized that numbness in children, the “inner emptiness”, is a result of traumatization as a result of the separation of important caregivers. For this, he examined war orphans in particular.

According to Bowlby, the infant is looking for a close and caring person. This begins right after birth, and this attachment behavior is vital for the baby. In the first year of life, the infant "organizes" with its most important caregiver an interactive attachment system. Attachment behavior shows itself as clinging, chasing, as well as protest, sadness, despair and ultimately resignation when the caregiver leaves the child.

This attachment behavior is activated by separation from the caregiver, internal or external threats, pain and danger - it does not matter whether it is a perceived or real danger. The appropriate response is that the attachment person now gives the baby security and protects the child from threats. In the baby, the striving for attachment is not necessarily contrary to his striving to explore the world, but the more secure the child feels bound, the less afraid it is of the "world out there".

Very important: Fear, pain and fatigue activate the child's need for attachment, the closeness to the caregiver eliminates it. The authoritarian upbringing, as it has a tradition in Germany and how it was particularly represented by the Nazis, in no way leads to an independent child.

Instructions on how to make the baby cry, not to pamper it so that it learns to be alone, are not only ethically a disaster, they also do not lead to the child finding its way in the world. On the contrary: there is a sequence of needs that can no longer be lifted as little as putting on your shoes first and then tying them up: only when the child feels emotionally safe through a satisfied need for attachment does he or she explore the environment.

This exploration increases significantly in the second and third year of life, but the child remains in contact with the mother's eyes and body. The child's attachment behavior and parental care are inextricably linked. So attachment is not a secondary drive, but an independent motivation system that represents an elementary evolutionary behavior - from the birth of a person to his death.

Sensitivity and intention

But it's not just about being “friendly” to the child, it's sensitive. Child signals are often unspecific and the caregiver has to tap them regardless of their own needs. This is not a magic trick, but a biological ability of the mother, but this must be active in this process: the child can regulate itself better and better with increasing age, but at the same time this means that it changes its ways of getting attention and the mother has to constantly adapt to it.

If the interplay between the two works, the child is bound securely to the mother, which gives the growing person psychological stability for the rest of life. Sensitivity here means perceiving the child as an intentional being. The attachment person does what is appropriate for the child in the right rhythm. So both move in the same affect. Incidentally, mismatching often occurs in harmonious parent-child relationships. This can be seen from the fact that the child screams or howls and draws attention to its needs.

If the dialogue with the attachment figure is interrupted, the child expresses itself loudly, and if the attachment figure restores the dialogue in such situations, this strengthens the positive core of the relationship and a secure attachment. However, if the child succeeds repeatedly and not in the long term in restoring this affective exchange, it experiences itself to be ineffective, the bond becomes insecure, the child lacks basic trust in his later life. It gives up the intentional attempts to balance the relationship, and the child's basic expectation becomes negative.

Sensitivity is important, but a lack of sensitivity does not automatically lead to an insecure person with attachment disorders if there are other interactions such as a feeling of togetherness, synchronicity, acceptance and love for parents. In short: Even if the child learns that the caregiver does not always understand its signals, but still knows that it is accepted and loved by them, it will hardly develop a binding disorder.

Attachment disorder and loss of reality

It is typical of a child's attachment disorder that they have problems distinguishing imagination from reality, which is due to the fact that their ability to understand their own motives and those of others has been wasted. In many attachment disorders, the phase of magical thinking extends into the teenage years, while attachment figures from the age of six understand the difference between reality and fantasy.

The connection disorder shows itself in connection with it, in problems, to differentiate between themselves and others. For example, they often don't understand whether they're angry or someone else is on them. Your image of other people is diffuse. They have poor control over their emotions. This has to do with the attachment disorder in that the child makes the discovery in the attachment, to be an “I”. This begins in the defiance phase at the age of three, and in children with strong ties, from the age of four, this leads to a distinction between their own needs and those of others.

In short: It is only because the attachment person and child develop their interplay together and the child knows that the attachment person understands his signals, does awareness arise at all to “get his own way through”, that is, that the child wants something that the caregiver does not want. In later life, self-harm and suicidal tendencies often occur in those with attachment disorders. Mental pain and dissociative conditions are common. Those affected often have the feeling that something "bad" lives in them.

What is not a binding disorder?

The medical diagnosis of attachment disorder differs from psychosocial problems resulting from sexual and physical abuse of children as well as from the type of autism. Symptoms also overlap with cognitive disabilities, schizoid personality disorders, some extreme psychoses, and adjustment disorders.

In contrast to early childhood autism, speech is normal in both forms of attachment disorder. However, this also applies to Asperger syndrome. The previous history is crucial for the diagnosis, because attachment disorders are socially acquired, while autistic disorders have a genetic basis. Cognitive disabilities go hand in hand with limited intelligence; this is not the case with binding disorders. In contrast to schizophrenia, there are no delusions.

What types of ties are there?

Safe is considered the "healthiest" attachment style. Such people easily come close to others emotionally. They feel good when others need them and they need others, at the same time have no problems being alone and are not afraid of not being accepted. Such people were able to build secure bonds in their childhood.

People with anxious-ambivalent ties want to have great emotional closeness to others, but believe that others do not want this emotional closeness. They feel uncomfortable without close relationships, but are afraid that others will see them less positively than they see these other people. People who avoid indifference are afraid of close relationships, want to be self-sufficient. It makes them uncomfortable that they need others and that others need them. Anxious avoiders want close relationships, but fear to be hurt if they allow closeness.

How can attachment disorders be treated?

Psychotherapy in adults promises little success in attachment disorders. In children, they make little sense without involving the caregivers. Small children can sometimes get their disorder under control in game therapies, but only as a supportive measure. The adult attachment persons need professional advice and support in any case. Ultimately, the attachment disorder can only be compensated for by the child experiencing an environment that is stable and promotes child development.

Since the caregivers are mostly part of the problem (except for long stays in hospital as a trigger, for example), it often only helps to remove the child from their surroundings. Educators, teachers and foster families must be informed about the child's disorder and work together to tackle existing development problems. Often an inpatient stay is necessary, depending on the severity of the disorder.

Outpatient treatment

Outpatient treatment includes informing the family attachment about the symptoms, the course and the prognosis as well as advice about the behavior towards the child by means of reflection / supervision. In addition, there is the advice of educators who are in contact with the child.

Educating the child is necessary and adapts to age and comprehension. Psychotherapeutic individual and group sessions are also appropriate. For certain developmental disorders, functional therapies such as speech therapy, occupational therapy or physiotherapy are appropriate.

Semi-stationary treatment

Here, for example, a child is accommodated and treated daily in child and adolescent psychiatry. This requires a high level of willingness for cooperation by the caregivers in the family.

Inpatient treatment

In severe cases, inpatient treatment is necessary. Here the child can no longer integrate into a stable environment and needs longer therapy before this is possible again. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • Professional associations and specialist societies for neurology, psychiatry and psychotherapy, psychosomatic medicine: Neglect by parents causes binding problems in children, (accessed: June 26, 2019), neurologen-und-psychiater-im-netz.org
  • German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP): S2K guideline on mental disorders in infants, toddlers and preschoolers, as of September 2015, detailed view of guidelines
  • Prof. Dr. Guy Bodenmann: Attachment and mental disorders in children and adolescents, University of Zurich (accessed: June 26, 2019), psychologie.uzh.ch
  • Brisch, Karl Heinz: Attachment Disorders: From Attachment Theory to Therapy, Klett-Cotta, 16th Edition, 2019
  • American Academy of Child and Adolescent Psychiatry: Attachment Disorders (accessed: June 26, 2019), aacap.org
  • Mayo Clinic: Reactive attachment disorder (accessed: June 26, 2019), mayoclinic.org

ICD codes for this disease: F94ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

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