UNDERSTANDING PATHOLOGICAL EMOTIONAL ATTACHMENT: CAUSES, SYMPTOMS, AND TREATMENT

Positive relationships facilitate a sense of emotional security and trust. However, a significant proportion of the human population cannot connect with other individuals and form meaningful relationships. This is referred to as an attachment disorder, usually developing in childhood and influencing an individual's beliefs, thought structures, and behaviours throughout their life. Pathological emotional attachment manifests disordered attachment styles, which we will explore in this article.

Attachment disorders are complex conditions that can significantly impact an individual's mental, physical, and emotional well-being. These disorders can present in various ways, such as being either too attached to others or socially withdrawn, distrusting others, and having difficulty making and maintaining relationships.

We can better understand and address this challenging issue by identifying the causes and symptoms of pathological emotional attachment and examining the available treatment options. With dedication and the right support, individuals with pathological emotional attachment can work towards healthier relationships and improved overall well-being.

Defining Attachment

Attachment is a form of emotional relationship or psychological connectedness - feelings of closeness to others - that one develops between human beings (parents, siblings, friends, spouses, etc.). It is the foundation for human development, largely influencing our ability to forge interpersonal relationships and develop a sense of belonging.

Early childhood experiences influence the child's development and behaviour, impacting their ability to form meaningful relationships with others. Children learn a great deal through observation. Observing their caregivers, they learn and mimic different behaviours, languages, communication styles, and conflict-resolution techniques. When we are reared by individuals who fail to adequately care for and provide for us, we learn to relate to them and others in maladaptive ways.

John Bowlby, a British psychologist and pioneer in developmental psychology, defines attachment as the propensity to make strong emotional bonds - meaningful relationships - with others in our surroundings. He argued, moreover, that relationships are a basic component of human nature, acting as a means to exchange information, comfort, care, and pleasure.

Attachment Theory

Attachment theory is a psychological concept that explores the dynamics of long-term interpersonal relationships. Attachment theory identifies distinct attachment patterns established in early childhood through infant interactions with caregivers. Before children begin school, their main social interactions occur with attachment figures (i.e. caregivers and family members). From these early interactions, children learn about behaviour and communication and also learn to create expectations about people and the world around them. Children with caregivers who provide for them develop secure attachment styles, whereas those with inconsistent or inattentive caregivers develop insecure attachment styles. Here, we will explore these subtypes.

Secure attachment style

A secure attachment style is the foundation for healthy emotional bonds in a child's life, allowing them to trust in the presence and support of their caregiver. It enables a child to feel secure in close relationships and trust that others will be receptive to their needs. Children with secure attachment styles become confident that their caregiver will meet their needs and grow up to experience less relationship anxiety, fear, or apprehension.

In contrast, pathological emotional attachment is related to unhealthy forms of attachment that can result in the following:

• Difficulty forming emotional bonds with others
• Lack of trust
• Anger
• A need for control

Attachment anxiety, a detrimental factor in psychotherapeutic outcomes, is correlated with insecure attachment styles and can have a lasting impact on an individual's ability to regulate emotions and form secure attachments in adulthood. There exist three insecure attachment styles:

Anxious/Ambivalent or Resistant Attachment

An anxious/ambivalent attachment style is characterised by a fear of abandonment and a constant need for reassurance. A child whose caregiver has unpredictable or inconsistent availability for them may develop this attachment style. Individuals with this attachment style often feel insecure in their relationships, constantly craving intimacy as reassurance.

Avoidant Attachment

Children whose caregivers are not attuned to their needs quickly learn that they cannot rely on them to meet their needs consistently. As adults, individuals with this attachment style are typically uncomfortable with closeness, value their independence in relationships, and may even fear intimacy.

Disorganised/Disoriented Attachment

Children with a disorganised/disoriented attachment style often have unpredictable, sometimes chaotic, behaviour patterns. These individuals often feel internal chaos, often exhibited as hyper-reactivity and being "on edge". This attachment style is commonly seen as a result of trauma or abuse, often leading to push-pull behaviours, resembling quick shifts between seeking closeness (proximity seeking) and pushing people away - wanting love but fearing love.

Understanding people's attachment types helps identify and explain their behavioural and relationship patterns, allowing specialists to better identify potential causes, symptoms, and treatment options to address this challenging issue.

Disordered Attachment

Attachment disorders are mental disorders that can arise from a lack of consistent emotional connection with a parent or primary caregiver. These disorders are associated with pathological emotional attachment and can manifest in various forms, such as Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED). Let's take a closer look at these two distinct attachment disorders and how they relate to pathological emotional attachment.

Reactive Attachment Disorder (RAD)

Reactive Attachment Disorder (RAD) typically affects infants or young children. It is characterised by an inability to develop strong emotional bonds and find comfort in caregivers. Recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a trauma- and stressor-related disorder, RAD is often associated with significant neglect or deprivation, repeated changes in primary caretakers, or being raised in institutional settings.

Children with RAD often display inhibited and emotionally withdrawn behaviour, rarely seeking or responding to comfort when distressed. This can lead to difficulty forming emotional bonds, lack of trust, anger, and a need for control, all of which are hallmarks of pathological emotional attachment.

Disinhibited Social Engagement Disorder (DSED)

Disinhibited Social Engagement Disorder (DSED) is another form of attachment disorder related to pathological emotional attachment. Adults with DSED may exhibit avoidance or ambivalence in relationships, as well as disorganised or inconsistent behaviour. These attachment styles can significantly influence the development of long-lasting strategies to regulate emotion and social contact, which are crucial for healthy relationships.

Research has indicated that children who experience attachment trauma may be at an increased risk of developing dissociative identity disorder (DID). Formerly known as multiple personality disorder, DID is characterised by the presence of at least two distinct (alternate) personality states. This highlights the potential long-term consequences of pathological emotional attachment and its connection to other mental health disorders.

Signs and Symptoms of Pathological Emotional Attachment in Adults

As individuals with pathological emotional attachment progress into adulthood, their attachment issues can manifest in various ways. Signs and symptoms may include:

• Difficulty forming emotional bonds
• Difficulty with boundaries
• Engaging in risky behaviours
• Difficulty forming romantic relationships
• Difficulty trusting others
• Expressing anxiety in relationships
• Separation anxiety
• Needing constant reassurance
• Pushing partners away
• Persistent social and emotional problems
• Emotional withdrawal (i.e. not seeking or responding to comfort when distressed)

Attachment disorders in adults, such as RAD and DSED, can result in avoidance or ambivalence in relationships and disorganised or inconsistent behaviour. These attachment styles can significantly impact an individual's ability to form secure and healthy relationships in adulthood.

By recognising these signs of pathological emotional attachment, we can better understand the challenges those affected face and seek appropriate treatment options to address these issues and improve overall mental health and well-being.

Diagnosing Pathological Emotional Attachment

Diagnosing pathological emotional attachment in adults involves evaluating the specific criteria outlined in the DSM-5 for disorders such as RAD and DSED. For instance, the diagnostic criteria for RAD include a consistent pattern of inhibited, emotionally withdrawn behaviour toward caregivers and rarely seeking or being responsive to comfort when distressed.

In addition to relying on diagnostic criteria, a psychiatrist or psychologist can conduct a comprehensive evaluation to diagnose attachment disorders through:

• Observing interactions between child and parents or caregivers.

• Gathering information about interactions with parents or caregivers and others.

• Asking questions about the pattern of behaviour over time and in different situations.

• Inquiring about the home and living situation since birth.

• Evaluating parenting and caregiving styles and abilities.

Moreover, psychologists can employ the use of questionnaires. The Adult Attachment Interview is a structured set of questions designed to assess the quality of early relationships that an adult had with their primary caregiver. Through this assessment, mental health professionals can:

• Identify attachment patterns.
• Understand their potential impact on adult relationships.
• Gain insights into how pathological emotional attachment can develop.
• Understand how it can affect an individual's personality and relationships in adulthood.

By accurately diagnosing pathological emotional attachment, mental health professionals can develop a personalised treatment plan to address the unique challenges faced by each individual and provide appropriate support for overcoming these issues.

Causes of Pathological Emotional Attachment

Attachment disorders are multifaceted and can arise for a variety of reasons. However, they are typically rooted in childhood experiences. Child-caregiver experiences are the foundation of how children learn to view and develop relationships throughout their lives. Inconsistent or neglectful caregivers, for example, may play a part in attachment disorders in childhood and attachment issues in adulthood. Other childhood experiences influencing attachment include:

• Physical or emotional abuse or neglect from caregivers.
• Rejected, dismissed, and shamed by caregivers for their emotions.
• Traumatic loss.
• Repeated changes in primary caretakers (i.e. foster care), thus limiting opportunities for forming stable attachments.
• Being reared in institutional settings.

In adulthood, attachment issues can manifest as a variety of unhealthy behaviours in their relationships with friends, romantic partners, and even their own children. These behaviours may include:

• Extreme clinginess to others
• Poor impulse control
• Lack of fear of strangers
• Intense fear of strangers
• Difficulty maintaining eye contact
• Lack of affection towards caregivers
• Withdrawn mood
• Oppositional behaviour
• Intense bursts of anger
• Self-destructive behaviours

Treatment Options for Pathological Emotional Attachment

Various treatment options are available for addressing pathological emotional attachment, including therapy, medication and pharmacotherapy, and attachment-oriented interventions. Psychotherapy, such as cognitive-behavioural therapy (CBT), mentalisation-based treatment (MBT), and schema-focused therapy (SFT), are typically the primary treatment for childhood attachment disorders and can also be beneficial for adults displaying symptoms of these disorders.

Psychotherapy Approaches

Cognitive Behavioural Therapy (CBT)

CBT is a structured, problem-focused form of psychotherapy that helps people identify, question, and change their thoughts, attitudes, and beliefs that cause them difficulty. Individuals learn to restructure how they view themselves, others, and the world around them, replacing negative beliefs with more adaptive ones. Through the use of tools such as cognitive restructuring, mindfulness, and communication skills training, CBT can be useful in helping individuals gain more control over their emotions and behaviours.

Mentalisation-Based Treatment (MBT)

MBT is a psychotherapeutic approach that focuses on helping individuals comprehend different mental states. Mentalisation - the ability to understand one's own and others' thoughts and feelings that underlie behaviour - is an important capacity we use daily. Individuals with attachment disorders may have difficulty with mentalising, often struggling to understand the emotions of those around them. MBT helps individuals strengthen their metallisation skills by making sense of their beliefs, assumptions, and experiences and linking them to their own and others' behaviour.

Schema-Focused Therapy (SFT)

SFT is an approach that recognises people's schemas - broad mental models - that help them make sense of their beliefs and experiences. Schemas work as mental 'shortcuts' that help us quickly organise and retrieve information. Schemas developed from childhood experiences where one's needs were not significantly met are described as maladaptive schemas and play a role in difficulties that an individual may have in developing relationships or relating to others. Maladaptive schemas are dysfunctional in that they cause individuals to perceive threats in situations where there are none and maintain certain types of relationships or attachment styles. SFT, focusing on processing childhood memories and modifying their associated negative emotions, aims to help individuals understand their fundamental needs and learn adaptive ways to meet those needs.

Medication and Pharmacotherapy

While there is no specific medication or pharmacotherapy for treating pathological emotional attachment, they can be used to manage severe behavioural symptoms such as explosive anger or sleep issues. Selective serotonin reuptake inhibitors (SSRIs) may be effective in helping individuals with excessive emotional responsiveness, depression, or anxiety.

Coping Strategies for Pathological Emotional Attachment

Managing pathological emotional attachment can be difficult, but by implementing various coping strategies, individuals can work towards establishing more adaptive attachment patterns. Therapy, counselling, parenting skills classes, and practising self-care (i.e. being compassionate towards oneself) are all positive steps that individuals can take towards fostering positive interactions and improving relationships.

Strategies to manage pathological emotional attachment may include establishing boundaries, being assertive, and communicating effectively with one's partner. While relationships are all about reciprocity, one must remain aware of one's needs and prioritise self-care. Individuals with attachment disorders may develop a belief that self-care is selfish, but it is important to remember that you can't pour from an empty cup. To work towards healthier relationships, we must first take care of ourselves.

Humans are social creatures, meaning that we need social relationships to survive. Evolutionarily, humans who stick together in groups - like wolves in packs - tend to live longer than those who are more socially isolated. Social connections work similarly in that individuals who are well-surrounded and have positive, healthy relationships tend to be healthier and less likely to be anxious, depressed, chronically ill, etc.

Engaging in positive relationships with others is an important yet often overlooked quality we possess. Pathological emotional attachment, however, impacts an individual's ability to form healthy relationships throughout their life and also affects their behaviours and interpretation of the world around them.

The Kusnacht Practice is equipped to support individuals with pathological emotional attachment in working towards developing healthier relationships and an improved overall sense of well-being. With health and care excellence, our psychiatric and medical teams are dedicated to your well-being, providing personalised therapies tailored to your individual needs and goals. Whether it be for an attachment disorder or other mental health concerns, our team is here to support you.

If you or someone you know has a pathological emotional attachment, consider reaching out to find out how we can help.