Hey :)

Attachment is the “emotional bond” between a child and their caregiver. It’s relevant to personality disorders since it influences the child’s “capacity to form mature intimate relationships in adulthood”. It “influences and organizes motivational, emotional, and memory processes that involve caregivers”. Attachment is associated with “emotional regulation, social relatedness” and the “development of self-reflection and narrative”, all things that are impacted by personality disorders.

Attachment Styles

Attachment styles are made up of two dimensions:

the distinction between self and others

“valence”: positive vs. negative evaluation

Most people will exhibit more than one attachment style.

The five styles are:

secure: positive view of self and others

preoccupied: negative view of self, positive view of others

dismissing: positive view of self, negative view of others

fearful: negative view of self and others

disorganized: fluctuating positive and negative views of self and others

Preoccupied style: DPD, OCPD & HPD

Negative view of self (“a sense of personal unworthiness”)

Positive view of others

Tend to be very “externally oriented in their self-definitions”, i.e. look to others to define them

Dismissing style: SZPD

Positive view of self (“a sense of self that is worthy and positive”)

Negative view of others, which “typically manifests as mistrust”

See themselves as “emotionally self-sufficient”

See others as emotionally unresponsive

Therefore they “dismiss the need for friendship and contact with others”

Fearful style: PPD

Negative view of self and others

Expectation that others are untrustworthy & will reject them

Don’t trust themselves or others

Believe themselves to be “special and different”

Hypervigilant against threats and “unexpected circumstances”

Preoccupied-fearful style: AVPD

Negative view of self

Fluctuates between negative and positive view of others

Want to be liked and accepted but fear rejection and abandonment, so they avoid and withdraw

Fearful-dismissing style: ASPD, NPD, STPD

Fluctuates between negative and positive view of self

Negative view of others

See themselves as “special and entitled”

Acknowledge their need for others, as well as others’ potential to hurt them

Use others to meet their needs but are fearful and dismissing of them

Disorganized style: BPD

Fluctuates between negative and positive view of self and others

This style develops from trauma

Associated with dissociation & PTSD

Seems to shift among the other attachment styles

(More on disorganised attachment & dissociation)

As promised, Anon, here’s a VERY quick and dirty rundown of disorganized attachment and the role it plays in the development of dissociation. Sorry it took so long ;–; This doesn’t even begin to cover it, but I hope it at least gives people a basic understanding.

Please remember, this is so incredibly brief and barely scratches the surface. It’s a really interesting field of research, and it has a lot of important (and good!) implications to therapy techniques and models. I highly encourage people that are interested to look through some of the below resources, or make a request for any specific aspects you want discussed further. Apparently, left to my own devices with a broad topic, I fail to be coherent.

What is disorganized attachment (DA)?

There are technically 4 types of attachment between a child and caregiver, differentiated by response patterns. The first 3 types (secure, insecure-avoidant, and insecure-ambivalent) are considered forms of “organized attachment”, despite the negative behaviours associated with it, because even if they’re not “secure”, the behaviour patterns are still organized and, more importantly, consistent. In other words, in all 3 types of organized attachment, the child knows exactly what they need to do to meet their emotional needs, and the patterns in their behaviour are considered organized.

In DA, though, the child is confused, and there’s no pattern to their behaviour. They’re torn between wanting to flee to, and flee from the caregiver. When a caregiver is unpredictable and traumatizing, the child has a difficult time establishing a consistent view of the caregiver, and of themselves. In other words, the caregiver is both needed, and someone to be avoided, and the child may not understand what makes them a “good” or “bad” child, as the caregiver’s behavior is often confusing and unpredictable.

It’s summed up quite well in this image:

What causes disorganized attachment?

All the same standard things you would already know about. Abuse, neglect, behaviour that’s frightening, intrusive or insensitive, and disrupted affective communication, but it really boils down to, “A parent’s consistent failure to respond appropriately to their child’s distress, or by a parent’s inconsistent response to their child’s feelings of fear or distress.” And this happens in childhood. The way a baby or very young child form attachments are the base building blocks that a child will use to build their relationships with people in the future. 

It’s important to note that it’s not just abuse that can cause a child to form DA. Sometimes loving caregivers who have experienced trauma themselves can behave in confusing ways toward the child, especially if they are suffering untreated PTSD or DID themselves. This happens because of the caregiver’s own inability to control their emotions. Traumatized parents can have a difficult time managing their emotions and providing a sense of security for the child even though they are not abusive or neglectful. Anger or fear can erupt unexpectedly and traumatize the child. 

As well, “Disorganized attachment is often the result of intergenerational parenting patterns. This means parents are responding to their children in the same unhealthy ways their own parents responded to them when they were children.”

What role does disorganized attachment play in dissociation?

This one is… A bit tough. There’s a lot of factors in play and so much ground to cover.

First, when discussing dissociation, it’s talking about it in a general sense. Everyone is capable of dissociating, and it’s simply when you become detached from reality in response to trauma– at any age, for any kind of traumatic event.  It’s also important to note that without a secure attachment style, an overwhelming event is more likely to be perceived as trauma. Basically, though, dissociation is a general symptom in this regard, not specific to any single disorder. DA is linked to dissociation, and from there, combined with other symptoms someone may be experiencing, it can become problematic and be assigned to specific mental disorders. 

So, the child needs to maintain a relationship with the caregiver– they have no one else to turn to, so the child can develop dissociation as a way to make sense of themselves, and to maintain a child-caregiver relationship. They may “forget” the abuse, or deny it. “It is an adaptive and defensive strategy that enables the child to function within the relationship, but it often leads to the development of a fragmented sense of self.” This fragmented sense of self may or may not develop into something worse– namely, BPD and DID based on severity, frequency, and whether there was any sense of reprieve (i.e. a child can avoid the worst of dissociative symptoms if one of their parents was more supportive, because it helps them build some positive attachments).

Children with DA and suffering from abuse “are likely to generate two or more dissociated self states, with contradictory working models of attachment,” in order to handle their confusing relationship with the caregiver. From there, “It is proposed that the propensity to react to traumatic events with dissociation is related to disorganization of early attachment and its developmental sequelae.” This is fundamentally the basis of why DID can’t form once the child creates an integrated sense of self. It is theorized that DA and dissociative disorders are inexplicably linked together. You can have DA and not develop DID/OSDD, but you can’t have DID/OSDD without DA. 

A lot of new research is suggesting that it’s not so much trauma as we know it (physical and sexual abuse) that is linked to dissociation, but that trauma is something that is far more discrete and insidious (longterm inconsistent and confusing parenting styles linked to DA) and that it’s only part of “a complex web of environmental, societal, familial, and genetic factors that are all likely to interact in ways that we have only begun to understand.” This is something I firmly believe in and attribute to a lot of the endogenic claims of having no trauma (and under this theory, “overwhelming events” also constitute trauma). 

Interestingly, it’s theorized that different types of attachment are linked to different mental disorders. “Attachment insecurity can therefore be viewed as a general vulnerability to mental disorders, with the particular symptomatology depending on genetic, developmental, and environmental factors.” Going back to the 4 types of attachment, the 3 insecure types can be linked to basically all types of disorders. They are all linked to depression, anxiety, OCD, PTSD, eating disorders and suicidal tendencies, but those with anxious attachment are more likely to develop things like DPD, HPD and BPD and are drawn to co-dependent relationships. Those with avoidant attachment are more likely to develop things like SPD and APD and form addictive habits, and those with disorganized attachment are more likely to develop DID/OSDD. 

Sources:

Identifying Attachment Problems

How Disorganized Attachment Can Lead to Dissociation

Disorganized Attachment

Disorganized Attachment, Development of Dissociated Self States, and a Relational Approach to Treatment

Trauma, Dissociation, and Disorganized Attachment: Three Strands of a Single Braid

From Infant Attachment Disorganization to Adult Dissociation: Relational Adaptations or Traumatic Experiences?

An attachment perspective on psychopathology

since it’s autism acceptance month, I thought I’d do an OCD Project post about the overlap between autism and OCD!

fast facts:

17% of autistic folk also have OCD

autistic people are twice as likely as allistic to receive a late diagnosis of OCD

people with OCD are four times more likely to receive a late diagnosis of autism than those without

overlapping symptoms:

repetitive behaviours

anxiety

hoarding

sensory issues

executive dysfunction

desire for routine

what do they look like together?

this is a complicated question, because both OCD and autism can have a lot of different symptoms and presentations. but common issues include:

increased chance of alexithymia, which you can read about here

autistic people often get overwhelmed more easily than allistic people, which means we may also have a lower anxiety threshold before we turn to a compulsion

over-reliance on stimming can turn stims into compulsions — because almost anything can become a compulsion

high likelihood of thought spirals and meltdowns feeding into each other

increased likelihood of communication challenges, making it harder for others to understand what they’re doing and why

in conclusion:

favourite person/obsessive dynamics. both disorders often involve a favourite person and general obsessive/possessive behaviour towards others.

intense, unstable self image. with both disorders, there is often a strong sense of underlying shame. however, our egos can violently switch between thinking we're better than everyone else, and worse. we often split on ourselves, seeing ourselves either as the best person ever or the worst.

splitting on others. both disorders may often involve seeing others as either really great, or really awful. with npd, it may look like either "i'm better than this person" or "this person is better than me".

dependent behaviour. while in npd this may be more covert, the reality is that we really depend on supply and receiving validation from others. likewise, in bpd we often depend on positive attention to feel reassured and to feel like people are not going to abandon us.

attention seeking. considering both disorders involve some level of dependency, it's no surprise that both borderlines and narcissists may engage in attention seeking behaviours.

manipulative behaviour. people with both disorders are prone to manipulating others to receive our needs. in npd, we feel like admitting to having needs is a weakness, and in bpd we feel like others will not want to meet our needs or they will leave us for being "too needy". so, people with either disorder may resort to manipulation tactics to have our needs met because we feel uncomfortable expressing them

It's that we have a hard time regulating our self esteem. As do many other neurodivergents as well as traumatized individuals.

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A huge, gigantic part of NPD is that we have more than the normal amount of shame-proneness. Meaning, we feel ashamed very easily and when we feel it we feel it powerfully. So powerfully that it is difficult to process it. Often it's easier for us to become frustrated, angry, and act on unhealthy coping mechanisms instead. Self harm, isolation, not allowing oneself to be vulnerable, taking drugs/alcohol, and (sometimes) take out the anger on others.

Another thing to note is that average people's self esteem do go up and down, but not as easily as it is for NPDs (as well as BPD, ADHD, and others as well). For the average person, one mistake or one account of humiliation may not budge their over-all self esteem. But for a lot of NPDs, it will. One thing goes wrong and the suddenly shame becomes over-welming to the point where we either self harm or search for validation in any way possible to lessen the physical pain we feel with that shame.

That shame (of course) stems from childhood neglect, abuse, or trauma in general. Being pushed into feeling a lot of shame and then punished if you were to express that shame as a child creates an unhealthy notion that shame itself is something to be ashamed of. That there is something inherently wrong with us if we do something shameful. And NPDs are set up to not be able to cope with that.

Fortunately, newer therapists are trying to undo the damage & stigma that past therapists have caused for NPDs. They've developed plans to helping us with our rapidly fluctuating self esteem that includes:

creating your own sense of identity that can not be affected by an outsider's point of view (the concept "Imagine yourself on an island with all your nessecities but no other people. What would you do and who would you become?" is used)

being able to create your own validation or "supply"

allowing yourself to feel and process shame in a safe place where you can confidently stop yourself from returning to old, unhealthy coping mechanisms

create healthier habits of self regulation when feelings of anger, shame, and self-hate become too overwhelming

I think it's extremely important to note that the idea that symptoms surrounding how you feel emotionally inherently make you perform certain actions is very ableist.

Someone with NPD is more likely to be abused than act abusive due to how easy it is to manipulate our self esteem and make us rely on you for validation/supply.