Monthly Archives: March 2014

Developmental Trauma: What You Can’t See…

Bessel van der KolkWhat you can’t see, can hurt you.

Dr. Bessel van der Kolk, MD (left) and leaders in brain science and attachment are calling for a hard look at developmental trauma.  Developmental Trauma Disorder (DTD) was identified by van der Kolk in 2005, but the psychiatric Powers That Be deny it exists. [FN1]

“Clearly our field would like to ignore social realities,” Dr. van der Kolk said recently, “and study genes…”

He’s also shown it’s at the root of borderline personality disorder and bipolar disorder, and  implies it’s at the root of most cases mis-diagnosed as  ADHD/ADD.  See his terrific May 10, 2013 speech at Yale: Youtube.com/watch?v=N2NTADxDuhA

I dubbed it “trauma since the sperm hit the egg” when I realized I had it.  Dr. Allan Schore calls it “trauma in the first 1000 days, conception to age two.”  It used to be called “complex PTSD” (C-PTSD) or “Early Trauma” (ET).

Developmental trauma starts in utero when we don’t have much more than a brain stem, and goes on during the pre-conscious years. It can continue until 24 or 36 months depending on when the thinking brain (frontal cortex) comes on line.  That’s up to 45 months living in general anxiety to non-stop terror — before age 3.  A very long time to an infant.

DTD occurs as a continual process, not discrete incidents, while a baby has not developed a thinking brain able to recall incidents.  Frequently it occurs before there are any discrete incidents.

“No one can see it” means “it never happened.”  As I’ve said, “No one beat me or raped me. What’s wrong with me?”  Try getting that treated.

Neuroscientists Dr. Daniel Siegel, MD, Dr. Bruce Perry MD and others detail how attachment failures cause developmental trauma in this video: www.youtube.com/watch?v=jYyEEMlMMb0 [FN2]

Insecure Attachment as the Cause

Allan Schore 2DTD is a “Relational Trauma, trauma in the context of a relationship” as Dr. Allan Schore (left), father of attachment theory in the U.S., identified it in the 1990s. [FN3] Only relational processes can explain DTD, not incidents.

Yet all the American Psychiatric Association (APA) can fathom is Post-Traumatic Stress Disorder (PTSD) — since it’s caused by a visible incident such as war injury or rape. Developmental trauma has no incident. It’s ingrained in brain and visceral tissue, with no obvious “big bang,” so some call it “little ‘t’ trauma,” as opposed to visible PTSD “Big ‘T’ Trauma.”

Insecure attachment and attachment disorder generally are the cause of developmental trauma, not vice versa, Dr. van der Kolk detailed in his May 2005 Psychiatric Annals pdf  noted above and in FN1.  He emphasized it again at Yale on May 10, 2013 (video link above).  He lists DTD’s symptoms as relational and chronic: inability to concentrate or regulate feelings; chronic anger, fear and anxiety; self-loathing; aggression; and self-destructive behavior. [FN4A]

Working with the National Center for Child Traumatic Stress Complex Trauma Network (NCTSN), van der Kolk reports that he ran a survey of 40,000 children nationally being treated for multiple traumas. Most of them  “do not meet the criteria for PTSD… (as) the majority of issues are not specific traumas, but issues in their attachment relationships,” he says.

Van der Kolk describes studies by his colleague Dr. Marylene Cloitre, on attachment problems as the cause of DTD.  “Marylene looked at chronic complex trauma symptoms, then she did child attachment interviews, Dr. Mary Main’s interviews, in which I hope all of you have been trained, because they are very very helpful to see what were peoples’ experiences of their childhoods,” he said [referring to the Adult Attachment Interview (AAI)]. [FN4B]

Dr. Cloitre found “that pure PTSD symptoms are a function of specific traumatic incidents, but the other symptoms she identified – affect dysregulation, mood regulation, anger expression, chronic suicidality, self-injury, disturbance in relations with self and others… do not occur in PTSD.  They are rather a function of a disturbed attachment relationship,” van der Kolk repeated.

Yet psychiatry, he says, “is not good at treating attachment difficulties. There is very little treatment” of it.  Innovative somatosensory healing programs at van der Kolk’s Trauma Center in Boston using “theater programs, yoga, martial arts for kids, etc. — to get them inter-personally attuned — are not standard treatment even though we do statistical research and publish it,” he notes.

The Body Keeps the Score

Bessel Book bodykeepsscoreBecause DTD happens before we have a thinking brain, the body is forced to store all the memories as somatic trauma. “There is somatization. The body keeps the score,” he says, the title of his latest book, “this is a somatic experience, and you become a terrified organism. Your immune system changes, your stress hormone system changes and your perception of your body changes.”

PTSD’s existence was hard to get recognized at first, too. It took Dr. van der Kolk and friends a chunk of the 1970s and ’80s to get the government to stop insisting that war trauma didn’t exist. Doctors finally established the diagnosis PTSD by showing that Vietnam vets were re-living discrete terrifying incidents from the past.

But “in fact there was no basis for any opinion about the prevalence” of any childhood trauma, even of childhood sexual abuse, before the 1995-1998 Adverse Childhood Experiences (ACE) Study,  study co-director Dr. Vincent J. Felitti, MD, notes. “That’s because such information is almost completely protected by shame and secrecy, by families, and by individuals.  Doctors also have been inhibited by our own ignorance and major gaps in our training, from asking into certain areas of patient history.” [ FN5]

In 1995 Felitti ran an obesity program at Kaiser Permanente in San Diego. But he had a 50% drop-out rate, just when those quitting were losing up to 100 pounds.  “As we interviewed almost 300 of the dropouts, every other person spoke of having childhood sexual abuse; most of them seemed to have been waiting to tell someone after hiding it for years,” Felitti said. “They also often mentioned verbal and physical abuse and other traumatic experiences such as watching their mother being beaten.

“We were amazed. I thought, ‘This can’t be true. People would know if that were true. Someone would have told me in medical school.’  [FN6]

“We wanted to know: to what degree does this happen in the whole population?  That’s how we created the ACE Study.  We took at first 8 and later a total of 10 categories of traumatic childhood experiences which we’d heard about from our obese patients, then found 17,421 average, middle-class adults who agreed to interviews.

“We were astonished to find that the percent of the general public who suffer from traumatic experiences in childhood and adolescence is far higher than imagined… Two-thirds (64-67%) of middle class subjects had one or more types of childhood trauma, and 38-42% had two or more types. One in six had an ACE Score of 4 or more; one in nine had an ACE Score of 5 or more.”  In less privileged populations the numbers are far higher.

Similarly, Dr. van der Kolk describes a patient in the 1980s who could not recall if she were sexually abused, yet drew portraits of her family with menacing genitals. “So we went to the textbook — Freedman,  Kaplan, & Sadock’s  ‘Comprehensive Textbook of Psychiatry’ — with which I sat for my board exam in psychiatry.  It said:  ‘Incest is very rare; it happens in 1 out of 1.1 million women.’   At the time there were about 200 million Americans, so I thought, ‘Hmm… About 100 million women, 110 women are incest victims; how come 47 of them are in my office?’/” [FN4 Yale video.]

“The text says it is also very benign,” he went on quoting it: ‘There’s no agreement about the role of father-daughter incest as a source of psychopathology. The act offers an opportunity to test a fantasy whose consequences are found to be gratifying and pleasurable…In many cases it allows for a better adjustment to the external world.  The large majority of them are none the worse for the experience ’. ”  [FN7]

Developmental Trauma: Psychiatrists Still in Denial

Shrink knitting my brainBut even today, until DTD is in the APA’s official Diagnostic and Statistical Manual of Mental Disorders (DSM), most mental health professionals will not diagnose or treat it, and no insurance company will cover it.

So in 2012 Dr. van der Kolk’s NCTSN network submitted data on 200,000 children around the world to the APA to document DTD.  He spoke on DTD before the National Association of State Mental Health Directors, which treats 6.1 million patients a year with a $29 billion budget, and they wrote to the APA urging that DTD be included in the next DSM-5 in 2013.

But the APA refused and in June 2013, issued DSM-5 without mention of developmental trauma. Van der Kolk in his Yale video ridicules the APA for asking only two questions on child trauma in preparing DSM-5: “1. Can we assume life was pretty good growing up? and  2. Was anyone in your family a drug addict or an alcoholic?”

“Clearly our field would like to ignore social realities,” van der Kolk responds, “and study genes or biological functions — because for us to actually find out how the environment shapes the brain, would get us into very difficult situations.”

The APA refusal letter actually made a veiled dig against the Adverse Childhood Experience (ACE) Study and denied that “childhood adverse experiences” are a “substantive” problem – which is outrageous.  Dr. van der Kolk read that letter at Yale in May 2013 and let ’em have it:

APA:  “The consensus was there was just too little evidence to include DTD in the DSM-5. There have not been any published accounts about children with this disorder.”
Dr. vdK aside: “No, because it’s not in the textbooks!”

APA: “The notion that childhood adverse experiences lead to substantive developmental reduction is more clinical intuition than a research-based fact. “
Dr. vdK aside: “We submitted research data on 200,000 children from around the world to substantiate our diagnosis.”

APA: “The statements made cannot be backed up by prospective studies.”
Dr. vdK aside: “Actually, they can.”

Dr. van der Kolk could make a lot more money as a TV comedy star, after dealing with this idiocy for a lifetime. Despite the tragedy, his psychiatrist audience also had a good laugh — the APA is that absurd.

Developmental trauma is the “invisible” part of “the Silent Epidemic of Attachment Disorder.” [FN8]. DTD can happen as a by-product when a mother or her child are beaten or sexually abused – but it also happens on a wide-spread basis with no visible incident.

Perhaps 20-40% of our population goes through life never knowing they even have DTD. That’s why many of them go on to become leaders of industry and government. That’s why Dr. van der Kolk has said that the US Congress is “dissociated,”  or they’d feel the simple human compassion to know that sending youth to war brings back a flood of PTSD suicides.  (To me that means more than 50% of Congress has attachment problems, which is why they made a career of trying to control others. ) [FN9]

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  van der Kolk, Bessel, MD, “Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories,” Psychiatric Annals 35:5, 401-408, May 2005   www.traumacenter.org/products/pdf_files/preprint_dev_trauma_disorder.pdf
This article also details how developmental trauma is attachment-based:  “Early patterns of attachment inform the quality of information processing throughout life [11]. Secure infants learn to trust both what they feel and how theyunderstand the world…. (more),” he reports.
But “When caregivers are emotionally absent, inconsistent, frustrating, violent, intrusive, or neglectful, children are liable to become intolerably distressed and unlikely to develop a sense that the external environment is able to provide relief. Thus, children with insecure attachment patterns have trouble relying on others to help them, while unable to regulate their emotional states by themselves. As a result, they experience excessive anxiety, anger and longings to be taken care of. These feelings may become so extreme as to precipitate dissociative states or self-defeating aggression…”
Dr. van der Kolk has been Medical Director of The Trauma Center in Boston for 30 years (www.traumacenter.org).

FN2  Daniel Siegel, MD, et.al, “Trauma, Brain & Relationship: Helping Children Heal,” www.youtube.com/watch?v=jYyEEMlMMb0
Introductory video on Attachment Disorder and how development of the mind-body system can cause trauma. Copies at www.postinstitute.com/dvds.

FN3  Schore, Allan N., PhD, “Effects of Early Relational Trauma on Right Brain Development, Affect Regulation, & Infant Mental Health,” 2001, www.trauma-pages.com/a/schore-2001b.php

FN4A  van der Kolk, Bessel, MD: Video, Yale University, May 10, 2013, “Childhood Trauma, Affect Regulation, and Borderline Personality Disorder,” http://acesconnection.com/video/bessel-van-der-kolk-childhood-trauma-affect-regulation-borderline

FN4B  Cloitre, Marylene, et. al, (NYU Child Study Center, Department of Psychiatry, New York University Medical College,  marylene.cloitre@nyumc.org), “Attachment organization, emotion regulation, and expectations of support in a clinical sample of women with childhood abuse histories,”   Journal of Traumatic Stress, 2008 Jun;21(3):282-9. doi: 10.1002/jts.20339.  Abstract: Despite the consistent documentation of an association between compromised attachment and clinical disorders, there are few empirical studies exploring factors that may mediate this relationship. This study evaluated the potential roles of emotion regulation and social support expectations in linking adult attachment classification and psychiatric impairment in 109 women with a history of childhood abuse and a variety of diagnosed psychiatric disorders. Path analysis confirmed that insecure attachment was associated with psychiatric impairment through the pathways of poor emotion regulation capacities and diminished expectations of support. Results suggest the relevance of attachment theory in understanding the myriad psychiatric outcomes associated with childhood maltreatment and in particular, the focal roles that emotion regulation and interpersonal expectations may play. http://www.ncbi.nlm.nih.gov/pubmed/18553408

FN5   Vincent J. Felitti, MD;  Robert F. Anda, MD, MS;  “The Lifelong Effects of Adverse Childhood Experiences,” Chapter 10 of Chadwick’s “Child Maltreatment,” Sexual Abuse and Psychological Maltreatment, Encyclopedic Vol 2 of 3, STM Learning, Inc., Saint Louis, p.203-215; March, 2014

FN6   Stevens, Jane, “The Adverse Childhood Experience Study” — the largest, most important public health study you never heard of — began in an obesity clinic,”  ACEsTooHigh.com

FN7  Freedman, Alfred M., Kaplan, Harold I., & Sadock, Benjamin J.,  “Comprehensive Textbook of Psychiatry,” 2nd Edition, Williams and Wilkins Co., Baltimore, 1975; 2609 pages.  Now in 9th edition; known since 4th edition as “Kaplan and Sadock’s.”

FN8  Lanius, Ruth A., MD; Vermetten, Eric; Pain, Claire; Editors, “The Impact of Early Life Trauma on  Health and Disease: The Hidden Epidemic,” Cambridge University Press, 2010. “Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician,” American Academy of Pediatrics,  2012 (New York Times 1-7-12), and many more.

FN9  van der Kolk, Bessel, MD, “What Neuroscience Teaches Us About the Treatment of Trauma,” June 6, 2012 webcast, National Institute for the Clinical Application of Behavioral Medicine  (NICABM) : Most of Congress is “dissociated,” van der Kolk told this 2012 globally-televised webcast, or they’d feel the simple human compassion to know that sending youth to war brings back a flood of PTSD suicides. We already knew from Korea and Vietnam that “for every solider that will die on the battlefield, there will be 30 suicides, as is happening right now,” van der Kolk said.  But “society dissociates from the reality of it and then Congress says, ‘Oh, gosh, isn’t that amazing!’  No it’s not amazing, that’s what happens!”
Short promo clip: http://www.nicabm.com/nicabmblog/how-trauma-traps-survivors-in-the-past/
Link to buy video, mp3 audio, transcripts: http://www.nicabm.com/trauma-2012-new/
On Congress, see also http://www.theatlantic.com/politics/archive/2014/06/why-it-matters-that-politicians-have-no-experience-of-poverty/371857/

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The Adult Attachment Interview (AAI): Mary Main in a Strange Situation

Mary Main & Dan Siegel December-2010-UCLA(Updated 4-12-17) Only 55% of us had “secure attachment” as infants, according to research on 6,282 infant-parent pairs during 1977-1999. This would worry us all if we knew what it meant, because the other 45% suffer “insecure attachment.”  That means almost half of us have trouble with committed relationships. [1, 2]

This is because the attachment we had as kids continues all our lives, according to related research on over 10,500 adults during 1982-2009.  Plus, we pass on our “insecurity” to our children. [3]

These are the “quiet blockbuster” results of two extended, linked studies. First, using the “Strange Situation” procedure, Dr. Mary Ainsworth and her successor Dr. Mary Main studied infant attachment. (Dr. Main & Dr. Daniel J. Siegel, above.)

Second, Dr. Main used the Adult Attachment Interview (AAI) to study the infant’s adult parents. Results showed that almost half the adults were not securely attached, either, and this corresponded to their own infants’ attachment.

This 45% “insecure” figure starts to explain why we’ve got a 50% divorce rate. If (like me) you’ve tried dating after divorce, it won’t surprise you that science shows almost half the adults out there can’t manage a secure, committed, relationship. Ouch, you’ve experienced it.

And if 45% of us were “insecurely attached” in 1999, what’s the rate in 2017? In the almost 20 years since, we’ve become an “e-society” with email, cell phones, texting and computers further trashing our ability to relate in person. Psychotherapists interviewed for this blog said that a round number of “about 50%” insecure attachment is conservative.  Some say our insecure rate is higher.

In fact, the 2009 study of over 10,500 Adult Attachment Interviews said that secure attachment had fallen by another 17.1%, since the 1999 secure estimate of 55% above. That would mean 46% were secure in 2009 and the insecure rate was up to 54%–more than half the population.  [3]

Here’s more “about 50%” data. The Adverse Childhood Experiences (ACE) Study showed that 66% of 17,337 middle class adults had one or more types of childhood trauma, and 42% had two or more types. In less privileged populations these numbers are over 70%.  A U.S. average of all economic groups would show 50% or more suffer two or more types of ACE trauma.

That means, for example, they experienced both childhood physical and sexual abuse, or both childhood emotional abuse and neglect.

The ACE Study lists 10 such abuses, including traumas that happen to newborns (physical and emotional neglect). Such trauma puts children into “fight-flight,” a chronic state proven to shut down the organism’s capacity for feelings of attachment and love. [4]

Half of us have some degree of attachment trauma and don’t even know it.  Let’s get informed; then we can heal. If we didn’t get securely attached as kids, we can develop “earned secure attachment.”  “It’s possible to change attachment patterns,” as Dr. Main’s colleagues say. [5]

 Strange Situation  Experiment

bowlby-johnAttachment Theory isn’t new; it just gets too little air time. British psychiatrist John Bowlby (left) developed it in the 1950s while working on the post-war orphan crisis. [6]  Bowlby believed that all infants would seek to stay close to parents, since such “attachment” promotes survival. In 1952, he published a study of toddlers’ responses to separation from parents. It showed that “when toddlers were placed in unfamiliar surroundings that provided no stable caregivers, they underwent three… stages of response to separation: protest, despair, and finally detachment,” writes Dr. Main. [7]

Mary Ainsworth ca 1990Dr. Mary Ainsworth studied with Bowlby in London 1950-54, then researched his concept of “proximity-seeking behavior” in infant-mother pairs in Kampala, Uganda, published as “Infancy in Uganda” (1967).  Then she found “astonishing similarities” in Baltimore, MD pairs. [7]

Ainsworth created the Strange Situation in the early 1970s, as a science experiment at Johns Hopkins in Baltimore to document this infant behavior. “Ainsworth structured the Strange Situation to include three of Bowlby’s ‘natural clues to danger’… to arouse babies to seek proximity” to the parent, Main says. Researchers watch and video-tape through one-way glass, as infant-mother pairs react to apparent danger.  First a baby responds to a strange lab room; then to two entrances of a strange person; then to  two different separations from its mother (details in footnote 8). [8]

Babies were expected to stay close to parents as Bowlby thought.  Babies “that Ainsworth termed ‘secure,’ play and explore happily prior to separation; show signs of missing the parent during separation, such as crying and calling; seek proximity immediately upon the parent’s return; then return to play and exploration, ‘secure’ once again in the parent’s presence,” reports Main. [8]

But 30% of babies did not act secure–they avoided mom.  They showed no preference between mom and the stranger.  “While a majority of infants behaved as expected and were termed secure, to Ainsworth’s amazement six showed little or no distress at being left alone in the unfamiliar environment, then avoided and ignored the mother on her return,” Main reports (emphasis added). [7]

Ainsworth decided to categorize these babies separately as “avoidant” of mother. Now she had two types: (A) Insecure Avoidant and (B) Secure. She concluded that moms of avoidant babies didn’t respond or have the sensitivity to understand the babies’ real need, so infants felt “insecure.”  [8]

Still later Ainsworth saw that of the insecure babies, some had yet a third reaction: actually, they were “ambivalent” about mom. They were very distressed when mom left, but on her return, they alternated between avoiding and frantic clinging–plus, they never calmed down. Research showed that ambivalent attachment results from moms who are sometimes available, sometimes not, so babies learn they can’t depend on people.

So “surprisingly, Ainsworth found that infant responses to separation and reunion fell into three distinct, coherently organized patterns of attachment,” and added a third category: (C) Insecure Ambivalent, Main reports. [8, 9]

By 1977 Ainsworth had developed an “American standard distribution” for infants of “about” (A) Insecure Avoidant 20%, (B) Secure 70%; and (C) Insecure Ambivalent 10%. By 1988, Strange Situation research using Ainsworth’s three categories had been done with 2,000 infant-parent pairs in 32 studies  in 8 countries.  Some countries varied, but global results averaged the same. [9]

Scary Parents

Mary Main BerkeleyIn 1973 Mary Main became Ainsworth’s grad student at Johns Hopkins in Baltimore, working on the Strange Situation experiments from their start. After her doctorate Main moved to Berkeley, to see if Ainsworth’s Kampala and Baltimore findings would replicate. [8]  In 1977 Main did a Strange Situation study of 189 Bay Area infant-parent pairs which did replicate Ainsworth’s results. [8, 10]

But by 1979 Dr. Main was making her own discoveries—out of concern about the parents.

“In none of Ainsworth’s original observations was the possibility considered that some mothers… could also be frightening,” Main notes.

“For my dissertation at Johns Hopkins, I watched 50 children in the Strange Situation… Using Ainsworth’s three-part classification (secure, avoidant and ambivalent), I found at least five infants could not be classified…

“I had visited most of the mothers in their homes,” Main wrote, “and I knew that at least three of the five mothers of the un-classifiable infants had behaved most peculiarly with their offspring. One—frighteningly, to me—had treated her toddler as an animal.” [8]

Ainsworth was concerned, too; in fact, she’d put some babies in her Secure set only because they didn’t fit her other two sets, Main writes. [8]

By 1985, Main decided to “extend attachment theory to include the import of infant exposure to anomalous fear-arousing parental behaviors (Main & Hesse, 1990)… in conjunction with the discovery of a fourth Strange Situation attachment category, ‘insecure-disorganized/disoriented’ (or ‘D’) (Main & Solomon, 1990)…

“We proposed that fear of the parent could account for many instances of disorganized behavior, since the infant’s natural haven of safety will have simultaneously and paradoxically become the source of its alarm (Hesse & Main, 1999, 2000),” Main reports. [8 p.257; 11]

Main and Ainsworth agreed that some 15% of babies actually form a new, fourth group: (D) Insecure Disorganized. Their mothers were so frightening that the babies couldn’t develop any consistent response. These infants “exhibited a diverse array of inexplicable or overtly conflicted behaviors in the parent’s presence” including “disorganization, disorientation, and confusion,” Main wrote. This included crying loudly then suddenly freezing; ignoring the parent to rock on hands and knees; moving away; raising hand to mouth in fear; or swiping at the parent’s face. [8, 11]

This finding that 15% of average U.S. babies are so insecure they’re almost incoherent was so shocking, it was checked for years. [2, 10, 11]  But the number held. Worse, among children of American adolescent mothers the rate is over 31%, and is over 25% in many Third World nations. [12]

To remove the 15% of disorganized babies from Ainsworth’s original estimate of 70% secure, would reduce the secure set to 55%.  If so, Main would have four categories: avoidant 20%, secure 55%, ambivalent 10%, and disorganized, 15%.  [1, 11]

What was up with parents that 45% of their kids couldn’t manage secure attachment?

That was how researchers read Main’s documents for the 20 years from 1990 to 2010. [ 2, 10, 11]

That 55% Figure

I first heard this “55% secure” figure in 2010 from therapist Dr. Henry Cloud, New York Times best-selling author of “Boundaries.” He’s also the author of “Safe People,” a book whose point is that many folks we meet are able to relate, but almost as many are not. Asked for numerical odds at a lecture, he said that 55% are securely attached but 45% are insecure.  Later I asked therapists at a UCLA therapists’ conference, who also said that professionals commonly speak of 55% secure.

Checking online, I found an authoritative report in “Pediatric Child Health” by Dr. Diane Benoit, MD. “Infants with secure attachment greet and/or approach the caregiver and… are able to return to play, which occurs in 55% of the general population,” she writes.

“Infants with insecure-avoidant attachment fail to greet and/or approach, appear oblivious to their caregiver’s return… in 23% of the general population. Infants with insecure-resistant [ambivalent] attachment are extremely distressed by separations and cannot be soothed at reunions, displaying much distress and angry resistance” and can’t return to play, “in 8%.” Benoit earlier reports that “in normal, middle class families, about 15% of infants develop disorganized attachment.” Her first three categories above add to 86%, leaving 14% disorganized.

“Of the four patterns of attachment, secure, avoidant, resistant and disorganized, disorganized attachment in infancy and early childhood is recognized as a powerful predictor for serious psychopathology and maladjustment in children. Children with disorganized attachment are more vulnerable to stress, have problems with regulation and control of negative emotions, display oppositional, hostile, aggressive behaviours…” Dr. Benoit says (emphasis added). [1]

Similar numbers were reported by van IJzendoorn, one of Benoit’s sources, in 1999. His global total of 6,282 infants in 10 countries was 51.5% secure, 17.4% avoidant, 10.6% ambivalent, and 20.5% disorganized. (Data from developing nations perhaps produced the large disorganized rate.)  Statistics for 2,104 North American infants were cited as 62% secure, 15% avoidant, 9% ambivalent, and 15% disorganized. [2, p.233, p. 229]

“Studies show that between 35% and 45% of all children in the US experience some kind of attachment issue,” reported GoodTherapy.org, a respected therapists’ website [13]

“About 55 percent to 65 percent of children fall into the ‘secure’ attachment category,” wrote attachment scholar Sean Brotherson in 2005, “while about 10 percent to 15 percent show an ‘insecure-resistant/ambivalent’ pattern, 20 percent to 25 percent show an “insecure-avoidant” pattern and 15 percent to 20 percent an “insecure-disorganized.” [14]

“Disorganized” or Not?

Recently, however, there has been enough misuse of the term “disorganized” by courts and social services, that Dr. Main’s network seems to have resumed citing only the three 1978 Ainsworth categories.

“Main, Hesse, and Hesse (2011, p.441) have criticized the ‘widespread’ and ‘dangerous’ presumption that infants can be divided into four categories,” wrote History of Psychology magazine recently. “ ‘The reification of our work from its context… has lead readers to treat D as a category equivalent in kind to ABC, rather than recognizing it… runs orthogonal to the basic Ainsworth patterns’,” Dr. Judith Solomon is quoted to say. [15]

That would put securely-attached back up to Ainsworth’s 1978 figure of 70%  – despite many studies showing our attachment rate has fallen. [3]

Yet in numerous writings over 20 years, Main, Solomon and colleagues called the disorganized group a “new fourth category.” They also repeatedly wrote that when only three categories were in use, most disorganized infants had been “forced” into the “secure” category. This happened only because they didn’t fit the other two categories, but in fact these infants were not secure, they often wrote.

That’s why the use of four categories is so “widespread,” as in the quote from Dr. Benoit above about the “four patterns of attachment, secure, avoidant, resistant and disorganized.”

Perhaps others have abused the term “disorganized” to mis-label children as “hostile, aggressive, coercive” or to otherwise harm kids.  Perhaps law suits have resulted from this. That’s awful.

Yet while I respect and revere Dr. Main’s group, the notion that 70% of flesh and blood Americans have suddenly become “secure” just by using different words, or due to lawsuits, makes no sense. It’s certainly not my experience nor the experience of any therapist with whom I’ve spoken.

It also leaves most of the 50% of us with emotional pain from attachment trauma alone, without recognition or a voice, and with no idea that we even need help, let alone any idea how to get healing. That’s why I’m speaking up.

Examples of the original wording by Dr. Main’s group feature:

“By 1985, our laboratory had developed a number of new methods for assessing attachment. Besides Ainsworth’s original tripartite analysis of the Strange Situation procedure… we emphasize… disorganized attachment, devised by us as a new category of infant Strange Situation behavior…” [8, p.257]

“The next discovery… was based on the simultaneous breakthrough reported by Main and Solomon (1986, 1990) that a fourth Strange Situatio classification—disorganized/disoriented—could now be recognized. Infants were placed in this fourth category (see Lyons-Ruth & Jacobvitz, Chapter 28, and Solomon & George, Chapter 18, this volume) when they failed to maintain the behavioral organization characteristic of those classified as secure, avoidant, or ambivalent/ resistant… by 1990 infants were termed disorganized/ disoriented in the Strange Situation when, for example, they approached the parent with head averted, put hand to mouth in a gesture indicative of apprehension…or rose to approach the parent, then fell prone to the floor…” [10, p.572]

“[T]he limits of the traditional Ainsworth et al. (1978) coding system became apparent because many children with an established background of abuse or neglect nevertheless had to be forced into the secure category… Disorganization of attachment is usually considered a type of insecure attachment…” 2, p.226]

“Our chapter begins with a review of previous studies reporting difficulties in “forcing” each infant in a given sample into one of the three major categories… However, the majority of these…disorganized-disoriented infants would have been identified as secure… had we forced them into the standard classification system.” [11, p.97-8]

Dr. Ainsworth herself, co-authoring a volume with Dr. Main in 1990, writes: “… it is acceptable to consider adding…the fourth D category that Main identified as disorganized… Now that so much careful work has been done to explore the ramifications of this new category, it may be accepted as a valuable extension of the Strange Situation classificatory system.” [16]

Whatever one thinks about categories, Dr. Benoit’s closing advise on achieving secure attachment says it all:

“During the first six months of life, promptly picking up a baby who is crying is associated with four major outcomes by the end of the first year of life. First, the baby cries less. Second, the baby has learned to self-soothe. Third, if the baby needs the caregiver to soothe him/her, the baby will respond more promptly. And finally, the caregiver who responded promptly and warmly most of the time (not all the time; nobody can respond ideally all of the time) to the baby’s cries, will have created secure, organized attachment with all of the associated benefits.” [1]

The Adult Attachment Interview (AAI)

Mary Main '09 Bowlby-Ainsworth award(Inge Bretherton,Everett Waters)Moving on to adults, by 1982 Main had seen enough disorganized babies to conclude that there must be a lot of scary parents.

Now she needed a way to document the behavior of the parents. [17] (Right: Dr. Main (center) receives the 2009 Bowlby-Ainsworth Attachment Award.)

That’s how the AAI came about.  It was created in 1982 to discern the level of secure, loving attachment the parents had during their own childhoods with their babies’ grandparents. Parents were asked “both to described their attachment-related childhood experiences – especially their early relations with parents – and to evaluate the influence of these experiences on their development and current functioning.”

Parents were studied not just on facts they gave, but on how coherent a narrative they could produce quickly. That’s easy for folks who had a secure childhood, but difficult for folks who did not. The AAI questions are designed to “surprise the unconscious” to yield information about the “state of mind with regard to attachment” that might not otherwise show up. Each AAI was taped and transcribed verbatim. Then transcripts were classified by specific patterns by independent trained specialists. [18, 10]

In 1982 Main also created the “Berkeley Longitudinal Study” to take 67 Bay Area infant-parent pairs from her 1977 Strange Situation and study them for a generation. In 1977 the babies were 12-18 months old.  Main and her team re-studied these pairs when the kids reached age 6 in 1982, and studied the kids again when they reached 19 in 1995.  [8, 10]  In 1982 Main and her team gave three different tests to the Bay Area pairs:

— 1. The parents were given the AAI (without their children).  [8, 10]

— 2. The six year olds were again studied with their parents in the Strange Situation (as they’d been studied in 1977 as infants).

— 2. The “sixes” were also individually (without parents) given a new Separation Anxiety Test (SAT): they were shown pictures of children being separated from their parents, then asked how they felt. This was taped, transcribed and sorted by Main’s student Nancy Kaplan into Ainsworth’s three sets: secure, avoidant and ambivalent. [19, 8]

Dr Main’s initial 1982 AAI results were so important that it’s a tragedy that your doctor never learned this in medical school; your therapist (and mine) never heard of it; you’ve never heard of it; and so you have to read about it here, since the media doesn’t report it.

Amazing Results You’ve Never Heard

Mary Main, Erik Hesse '09 Bolwby-Ainsworth AwardFirst: Main noticed that the initial 1982 adult AAIs fell into categories very similar to those into which infants had fallen years earlier in the Strange Situation.  As Main had only Ainsworth’s three infant categories in 1982, she at first classified adults into Secure (matching infant “Secure”);  Dismissing (matching infant “Avoidant”); and Preoccupied (matching infant “Ambivalent”).  (Dr. Main and Dr. Hesse, above.)

Main was astonished to find that the more adults who took the AAI, the more the adult data (in three categories) statistically converged on Ainsworth’s “standard distribution” for infants: 20%, 70%, 10%.  [10, p.552]

Second: the levels of adult attachment in the adults’ 1982 AAIs corresponded specifically to the attachment to that adult which their own infant exhibited in the 1977 Strange Situation.  “Secure-autonomous (“valuing of attachment relationships and experiences) was associated with infant Strange Situation security,” reports Dr. Main’s co-author Dr. Erik Hesse, and this was true of all categories.

Thus, a marked relation between a parent’s hour-long discussion of his or her own attachment history, and the offspring’s Strange Situation behavior 5 years previously, had been uncovered.” [10, p.552]

Third: the match of each parent’s own attachment with their baby’s attachment five years back was at an unheard-of level. It correlated 75% of the time, in a field where a 20% correlation is highly significant.  [8, 10]

Fourth: the six year olds’ responses to parents in the Strange Situation in 1982 correlated strongly to their 1977 responses as infants — five years earlier. These kids at six responded to parents just as they had as infants, in the same percents. [7]

Fifth: the six year olds’ 1982 solo responses to the Separation Anxiety Test also produced the same results and percentages as their response to parents in the 1982 Strange Situation.

Sixth: In 1986, Main published her discovery of the fourth infant category of disorganized, and quickly found that if adults were sorted into four analogous categories, again results were the same.

“The next discovery regarding the AAI was based on the simultaneous breakthrough reported by Main and Solomon (1986, 1990) that a fourth Strange Situation (infant) classification—disorganized/disoriented—could now be recognized,” Hesse reports.By 1990, it had been shown that unresolved AAI status in a parent was predictive of disorganized attachment in the infant…  91% of unresolved mothers had infants who had been judged disorganized with them in the Strange Situation 5 years earlier…

“Thus there was now an AAI category corresponding to and predictive of each of the four Strange Situation categories…  In 1996… in a combined (meta-anlytic) sample of 584 non-clinical mothers… a four-way analysis showed… 16% dismissing, 55% secure-autonomous, 9% preoccupied, and 19% unresolved,” (emphasis added). In 2008, a global sample of AAIs for 1,012 average mothers showed the same results. [10]

These numbers for adults are astonishingly similar to the statistics for infants cited by Benoit, van IJzendoorn and others reviewed above: 23% avoidant, 55% secure, 8% ambivalent, and 14% disorganized.

“Just over 50 percent are secure, around 20 percent are anxious, 25 percent are avoidant, and the remaining 3 to 5 percent fall into a fourth, less common disorganized category,” Dr. Amir Levine, MD states in the popular 2010 book “Attached,” speaking of adults. [20]

Finally: When the 1977 infants reached age 19 in 1995, they too were given the Adult Attachment Interview.  Again results correlated strongly: the 19 year olds’ responses in the 1995 AAI correlated precisely to their infant behavior in the 1977 Strange Situation, their 1982 behavior at six, and to their parents’ 1982 responses to the AAI. [8]

Bottom line?  The Strange Situation predicts an infant’s emotional behavior for life, and the AAI proves it.  [8, 10]

“Researchers worldwide have replicated the relation originally uncovered in the Bay Area study between a parent’s status in the Adult Attachment Interview and an infant’s Strange Situation response to that same parent… The same average parent-to-child, secure/insecure match of 75% holds even when the interview is conducted before birth of the first child

“Describing the strength of this relation across studies conducted several years ago, van IJzendoorn (1995) calculated that it would take 1,087 further attempted replications, every one yielding insignificant results, to reduce the present relation between adult and infant attachment status to insignificance,” Main concluded in 2000 (emphasis added). [7, p.1091]

That’s not all.

Our attachment rate has fallen even further since 1999-2000, around the time that electronic devices began to increasingly replace human interaction.

“Well-developed human beings can self-regulate their emotional state by being with other humans. But what about people who regulate their emotional state with objects?” i.e. electronics, warned neuroscientist Dr. Stephen Porges in 2014.

“We’re in a world now being literally pushed on us, by people who are challenged in their own social and emotional regulation, and we’re calling this ‘social networking.’ We’re using computers, we’re texting — we’re stripping the human interaction from all interactions… We’re allowing the world to be organized upon the principles of individuals who have difficulty regulating emotionally in the presence of other human beings.” [21]

Harsh economic reality, meanwhile, has turned parents who can still manage to give attentive, attuned care to infants into an endangered species.

“For decades to protect the mother-infant bonding, there were families around it, there weren’t single individuals raising babies, there wasn’t early day care,” warned UCLA’s Dr. Allan Schore in a 2012 interview.

“The early day protections have been lost,” he said, “so as a result… there is an increase in psychiatric disorders in this country and the reason is that we have not protected this early phase of infant life, the early mother bonding…”

Schore, the top attachment scholar known as the “American Bowlby,” cited the 2009 study of 10,000 adult AAIs using three attachment categories which showed that from 1999 to 2009, secure attachment fell by 17.1%.   [3]

Using four attachment categories, if 55% were secure in 1999, then after a 17% drop, only 46% were secure in 2009.

That means 54% of the population was insecure as of 2009, if disorganized infants have not simply disappeared.

This insecure percentage has risen since 2009, and will continue to rise, as long as we raise infants in a society flooded with enough electronic devices and bad economic priorities to render their parents incapable of attachment.

A first step would be to address the information and policy vacuum regarding this “silent epidemic.” [22]

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

Benoit, Diane, MD, FRCPC (2004) “Infant-parent attachment: Definition, types, antecedents, measurement and outcome,” Paediatr Child Health, Oct 2004; 9(8) p. 541–545, retrieved April 12, 2017 from: www.ncbi.nlm.nih.gov/pmc/articles/PMC2724160/  “Infants with secure attachment greet and/or approach the caregiver and… are able to return to play, which occurs in 55% of the general population… Infants with insecure-avoidant attachment fail to greet and/or approach, appear oblivious to their caregiver’s return… in 23% of the general population. Infants with insecure-resistant [ambivalent] attachment are extremely distressed by separations and cannot be soothed at reunions, displaying much distress and angry resistance” and can’t return to play, “in 8%.” Benoit earlier reports that “in normal, middle class families, about 15% of  infants develop disorganized attachment.” Her first three categories above add to 86%, leaving 14% disorganized.

van IJzendoorn MH, Schuengel C, Bakermans-Kranenburg MJ (1999) “Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants and sequelae.” Dev Psychopathol. 1999; 11:225–49. https://openaccess.leidenuniv.nl/bitstream/handle/1887/1530/168_212.pdf?sequence=1  “During  the past 10 years nearly 80 studies on disorganized attachment involving more than 6,000 infant-parent dyads [6,281 pairs total, Table 1, p.233] have been carried out….In  normal middle class families about 15% of the infants develop disorganized attachment behavior.  In other social contexts and clinical groups this percent may become twice or even three times higher (eg in cases of maltreatment) … Disorganization… is usually considered a type of insecure attachment.”

3 Bakermans-Kranenburg MJ, van IJzendoorn MH (2009) “The first 10,000 Adult Attachment Interviews,” Attach Hum Dev. 2009 May; 11(3): 223-63. Retrieved April 12, 2017 from https://www.researchgate.net/
publication/24440045_The_first_10000_Adult_Attachment_Interviews_
Distributions_of_adult_attachment_representations_in_clinical_and
_non-clinical_groups  http://www.ncbi.nlm.nih.gov/pubmed/19455453
This study showed a 17.1% drop in the secure category from the authors’ previous 1999 study to 2009. It used adult analogs of only Ainsworth’s three 1978 categories: 20% dismissing, 70% secure, 10% preoccupied (=100%).  The 17.1% secure drop was reported as 23% dismissing, 58% secure, 19% preoccupied (=100%). It also showed “18% additionally coded for unresolved loss or other trauma.” Many of the 18% would be classed “disorganized” were all four categories used, but instead were “forced” into three categories. Since historically most disorganized subjects were “forced” into the secure category, the 58% secure number includes a significant number of disorganized.
–Interview with Dr. Allan N. Schore by David Roy Green, World Healing Electronic Network, July 2012, minute 39, retrieved April 12, 2017 from http://whenworldwide.org/films/dr-allan-n-schore-full-interview/  Schore cites the secure attachment drop in the 2009 study above. “There is concern about this… that what was there for decades to protect the mother-infant bonding situation, there were families around it, there weren’t single individuals raising babies, there wasn’t early day care… the early day protections have been lost…so as a result of that, I’m now writing that there is an increase in psychiatric disorders in this country and the reasons is that we have not protected this early phase of infant life, the early mother bonding…”

Felitti VJ, MD; Anda RF, MD, et. al, 1998, “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study,” American Journal of Preventive Medicine 1998;14:245–258.  Detailed article: http://acestoohigh.com/2012/10/03/the-adverse-childhood-experiences-study-the-largest-most-important-public-health-study-you-never-heard-of-began-in-an-obesity-clinic/ For a popular text, see Karr-Morse, Robin, Wiley, Meredith,  “Scared Sick,”  Penguin Basic Books, 2012

5  Siegel, Daniel J. , MD,The Developing Mind: How Relationships and the Brain interact to shape who we are,” 1999 Guilford Press.  Earned secure attachment occurs when we began life with insecure attachment, but “are now securely attached… individuals whose experiences of childhood… produce insecure attachment (avoidant, ambivalent, or disorganized),” but  “…had a significant emotional relationship with a close friend, romantic partner, or therapist, which allowed them to develop… secure” attachment.
Dr. Mary Main, Dr. Erik Hesse, Dr. Daniel J. Siegel, Dr. Marion Solomon, “Adult Attachment Interview with Mary Main,” Lifespan Learning Institute, Los Angeles, Jul 9, 2010 video: https://www.youtube.com/watch?v=YJTGbVc7EJY   “It is possible to change attachment patterns, and we can help people as therapists to get the kind of new experiences that creates changes within people especially given the neuroplasticity of the brain,” says Dr. Solomon.
Siegel, Daniel J. , MD, “The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration,” W.W. Norton, 2010;   “Mindsight: The New Science of Personal Transformation,” Random House, 2010  “Mindfulness has been shown to be effective in healing insecure attachment. The purpose of both psychotherapy and mindfulness practice is to provide this internalized secure base. Attunement, whether it is internal in mindfulness, or interpersonal in attachment, is what leads to a sense of secure base.”
Siegel, 2007, Wallin, 2007, p. 5-6  “The regular exercise of mindful awareness seems to promote the same benefits–bodily and affective self-regulation, attuned communication with others, insight, empathy, and the like–that research has found to be associated with childhood histories of secure attachment,” Siegel writes. “ Mindfulness and secure attachment alike are capable of generating… the same invaluable psychological resource: an internalized secure base.”

Bowlby, John, “The Nature of a Child’s Tie to His Mother,” British Psychoanalytical Society, London, 1958; “Attachment and Loss,” New York, Basic Books, 1969

Main, Mary,  2000, “The Adult Attachment Interview: Fear, attention, safety and discourse processes;” also titled “The Organized Categories of Infant, Child, and Adult Attachment: Flexible vs. Inflexible Attention Under Attachment-Related Stress,” Jour of Amer Psychoanalytic Assoc, 48:1055-1095; 2000.  *p.1091: “The same average parent-to-child, secure/insecure match of 75% holds even when the interview is conducted before birth of the first child…”  Retrieved March 14, 2014 from Lifespanlearn.org/documents/Main.pdf

Main, Mary, 2005, with Hesse, Erik & Kaplan, Nancy, “Predictability of Attachment Behavior and Representational Processes at 1, 6, and 19 Years of Age – The Berkeley Longitudinal Study,” Chapter 10 of “Attachment from Infancy to Adulthood: The Major Longitudinal Studies,” edited by Klaus E. Grossmann, Karin Grossmann, and Everett Waters, pp. 245–304, New York: Guilford Press. Main refers to it as “Regensburg;” retrieved June 4, 2014 from https://lifespanlearn.org/documents/5.Main Regensburg 2005 .pdf
–Main’s summary of the Strange Situation in this document:
“Ainsworth structured the Strange Situation procedure to include three of Bowlby’s ‘natural clues to danger’ in eight episodes:  1. Introduction to the room.  2. Mother and infant are left alone in a toy-filled environment whose unfamiliarity supplies the first natural clue to danger.  However, the mother’s presence is expected to provide the infant with security sufficient for exploration and/or play.  3. Providing a second clue to danger, a stranger joins the mother and infant.  4. The mother leaves the infant with the stranger, providing two combined clues to increased danger. 5. The mother returns, and the stranger departs…. Many infants initially seek proximity but then, reassured of their mothers’ nearness, resume play. 6.  The mother leaves, and the infant remains entirely alone in the unfamiliar setting. Infant distress can be strong at this point, and this episode is often terminated rapidly. 7. The stranger, rather than the mother, enters the room. 8. The mother returns… By now, most infants are expected to be crying, and actively not only seeking proximity to mothers, but also… indicating a strong desire to be held… Nonetheless, they are expected to settle and renew interest in exploration and play…
“Somewhat surprisingly, Ainsworth found that infant responses to separation and reunion in this procedure fell into three distinct, coherently organized patterns of attachment (“secure,” “insecure-avoidant,” and “insecure-ambivalent” (Ainsworth, Blehar, Waters, & Wall, 1978)… Given the length and complexity of this chapter, we suggest individuals divide reading to its three central parts (secure attachment, pp. 261–273; avoidant attachment, pp. 273–279; and disorganized attachment pp. 279–288).”

van Ijzendoorn, Marinus H.; Kroonenberg, Pieter M. (1988)  “Cross-Cultural Patterns of Attachment: A Meta-Analysis of the Strange Situation,” Child Development,Vol 59 No 1, Feb 1988, p.147–56; (1988 global replication of Ainsworth’s three categories; written before Main’s 4th category developed 1986-1990).   Retrieved July 2, 2016  from https://openaccess.leidenuniv.nl/bitstream/handle/1887/11634/7_702_111.pdf
Ainsworth, Mary D.S., Blehar, M.C., et al, “Patterns of attachment: A psychological study of the  Strange Situation,” Erlbaum, Hillsdale, NJ, 1978

10  Hesse, E., (2008) “The Adult Attachment Interview: Protocol, Method of Analysis, and Empirical Studies,” Chapter 25 of Cassidy, Jude &  Shaver, Phillip R. (Eds), “Handbook of Attachment: Theory, research, and clinical applications,” 2nd edition, 2008, p. 552-598, New York, Guilford Press, retrieved June 4, 2014 from http://icpla.edu/wp-content/uploads/2012/10/Hesse-E.-Adult-Attachment-Int-Protocol-Method-ch.-25.pdf
van IJzendoorn MH & Bakermans-Kranenburg,MJ (1996). “Attachment representations in mothers, fathers, adolescents and clinical groups,” Journal of Consulting and Clinical Psychology Vol 64(1), Feb 1996, 8-21. http://dx.doi.org/10.1037/0022-006X.64.1.8

11 Main, M., & Solomon, J. (1990). “Procedures for identifying infants as disorganized/disoriented during the Ainsworth strange situation,” in Greenberg, M. T., Cicchetti, D., & Cummings, M. (Eds.),. Attachment in the preschool years: Theory, research, and intervention (pp. 121-160), University of Chicago Press
Main M, & Hesse E. (1990). “Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening behavior the linking mechanism?” Chapter 5 in: Greenberg MT, Cicchetti D, Cummings EM, eds., Attachment in the Preschool Years, University of Chicago Press; 1990 p 161–82
Main M, & Solomon J (1986). “Discovery of an insecure disoriented attachment pattern: procedures, findings and implications for the classification of behavior,” in Brazelton T, Youngman M. Affective Development in Infancy. Norwood, NJ: Ablex; 1986. p. 95–124.  https://www.scribd.com/document/253355881/Discovery-of-an-Insecure-Disorganized-Disoriented-Attachment-Pattern-Main-Solomon-1986
p.96 “In this chapter we describe commonalities observed in the behavior of 55 12- to 20-month-old  [55 twelve- to twenty-month-old]  infants whose strange situation behavior could not be classified using the traditional (A,B,C) classification system, infants who would nonetheless have been assigned (“forced”) into one of these three classifications.
p.97: Our chapter begins with a review of previous studies reporting difficulties in “forcing” each infant  in a given sample into one of the three major categories.
p.98:  “However, the majority of these “unclassified” (now, disorganized-disoriented) infants would have been identified as secure (group B) with the parent in the Strange Situation, had we forced them into the standard classification system.”

12  “Among children of American adolescent mothers, the rate is over 31% (Broussard 1995). Disorganized attachment is also common among the Dogon of Mali (~25%, True et al 2001), infants living on the outskirts of Cape Town, South Africa (~26%, Tomlinson et al 2005) and undernourished children in Chile (Waters and Valenzuela 1999),” reports [1] above.

13 “Attachment Issues,” unsigned, GoodTherapy.Org, July 3, 2015, retrieved April 3, 2017 from http://www.goodtherapy.org/learn-about-therapy/issues/attachment ]

14 “Understanding Attachment in Young Children,” Brotherson, Sean, Bright Beginnings #6, Oct. 2005, North Dakota State University, Fargo, ND, retrieved April 3, 2017 from http://www.ag.ndsu.edu/pubs/yf/famsci/fs617.pdf

15 “The Emergence of the Disorganized/Disoriented (D) Attachment Classification, 1979–1982,” by Robbie Duschinsky, Hist Psychol. 2015 Feb; 18(1): 32–46, retrieved 4-10-17 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321742/  Cited within which: “Attachment theory and research: Overview with suggested applications to child custody,” Main M., Hesse E., & Hesse S., Family Court Review, 49, 426–463, 2011 ]

16 Ainsworth, Mary, PhD,  “Epilogue: Some Considerations Regarding Theory and Assessment Relevent to Attachments beyond Infancy,” in “Attachment in the Preschool Years,” ed. M.T. Greenberg, D. Ciccheti & E.M. Cummings, Chicago University Press, 1990, p463-488; quote p.480.

17  George, Carol, Kaplan, Nancy, & Main, Mary, “Adult Attachment Interview,” Unpublished MS, Department of Psychology, University of California at Berkeley, third ed. 1996.  Original 74-page MS dated 1984, 1985, 1996.  Described in [10] Hesse 2008.  Retrieved March 20, 2014 from   http://stantatkin.com/wp-content/uploads/2012/04/AAI-Protocol.pdf, now removed.  See also Main 1985; Main & Goldwyn 1984

18  Main, Mary B., “Adult Attachment Interview Protocol,” 11 pgs, 20 questions, no date or publisher. Dr. Main requires intensive training for use of the AAI.  The questions per se, marked “Do not reproduce this material without permission of the author,” were retrieved most recently April 12, 2017 from http://www.psychology.sunysb.edu/attachment/measures/content/aai_interview.pdf
UCLA’s Lifespan Learning Institute in Los Angeles holds AAI workshops and has an extensive CD lectures on the AAI at www.lifespanlearn.org

19  Kaplan, Nancy, (1987), Separation Anxiety Test (SAT): “Individual differences in six-year-olds’ thoughts about separation: Predicted to actual experiences of separation,”  Unpublished doctoral dissertation, University of California, Berkeley.
Kaplan, N. (2003, April), “The development of attachment in the Bay Area study: One year, six years, nineteen years of age.” Paper at the biennial meeting of the Society for Research in Child Development, Tampa, FL.

20 “Attached: The New Science of Adult Attachment,” Dr. Amir Levine, MD & Rachel Heller, MA, Tarcher 2010; useful reviews at http://www.goodreads.com/book/show/9547888-attached

21 Porges, Stephen, PhD, p. 15 of “Polyvagal Theory,” National Institute for the Clinical Application of Behavioral Medicine (NICABM), April 2012, retrieved July 21, 2014 from http://www.stephenporges.com/images/NICABM%20April%202012.pdf

22 Brous, Kathy, “The Silent Epidemic of Attachment Disorder,”
http://attachmentdisorderhealing.com/the-silent-epidemic-of-attachment-disorder/

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From Grassroots to Hollywood

Felitti, Morgan Rose SoCal ACEs 3-7-14Dr. Vincent Felitti, MD again joined our SoCal (Southern California) ACEs Group  March 7 for our  alternate-month San Diego meeting. He’s shown with author-activist Morgan Rose (details below).  I felt so grateful.

Earlier March 7 we began with the alternate-month meeting of the San Diego Trauma-Informed Guide Team (SD-TIGT),  on what we can do to create a trauma-informed and ACEs-informed society. The mission of  SD-TIGT is to promote the development and provision of trauma-informed services in San Diego County’s agencies and systems by collaboration, advocacy and education to achieve transformation.  Leaders discussed training community leaders  and a trauma-informed care workforce.

Several focused on making trauma recovery “consumer-driven.”  They reported success with it after forming committees of parents, youth, and other clients  to do peer-led trauma-prevention training and learn empathic methods help each other and help children to recover.  We also discussed the latest brain science on Developmental Trauma by MDs Bessel van der Kolk, Bruce Perry, and Daniel Siegel.  Perhaps San Diego County might create a Trauma Remediation Center modeled on Dr. van der Kolk’s Trauma Center in Boston and Dr. Perry’s ChildTrauma Academy in Houston?

SoCal ACEs meeting

Next, SoCal ACEs met separately.  Dr. Felitti related his efforts since the 1990s to promulgate the ACE Study results in the U.S. and worldwide medical literature, traveling to Washington to meet personally with Senators, traveling the world and beating the drum generally with policy leaders.  He repeated his hope to see an article in The New Yorker about the ACE Study, “because my wife says that if policy leaders are too busy to get it, this way maybe their wives will pick up on it and get active.”

Dr. Felitti emphasized his vision that now we need to communicate directly to the hearts of the public “grassroots,” in ways that meet people “where they are” (that’s trauma-informed).  He’d like to see a popular TV series, maybe a soap, depicting attached, loving parenting in one story thread, versus  an ACE childhood and what that does to people in another thread.  He thinks it would hit average viewers directly in the heart where it counts.  He’d like to see movies, too. “Look at Sesame Street, ” he said; it shows a TV series or film that really speaks to ordinary folks can be lucrative.

Dana Brown & TICS Cherokee Point SchoolDana Brown, Project Director of San Diego’s Trauma-Informed Community Schools (TICS), briefed us on their grassroots efforts. Funded by The California Endowment, it’s a systems-change initiative in densely-populated City Heights. TICS goes deep in the community to support parent and youth leadership and school staff where they work and live; it’s “place-based.”  Dana (left) helps a student leader with kids at Cherokee Point Elementary.

Click here for Jane Stevens’ incredibly moving report “At Cherokee Point Elementary, kids don’t conform to school; school conforms to kids.”  Tears of sorrow and joy…

TICS programs help community leaders discover their strengths and empowers them, creating leaders who sustain themselves by advocacy and efficacy.   San Diego State University support TICS inter-generational mentoring by training community leaders in child/family development, in-home health, and more.  Parent leaders have led four “Train the Trainer” Workshops including three on trauma-informed methods since Oct., 2013.  See the ACE Study in action, with all the science and the heart, in Dana’s educational report at: TICS programs at Cherokee Point  (second item under Dr. Felitti).

Morgan Rose, MS, founder of America’s Angel (with Dr. Felitti at top), told us about her America’s Angel Campaign, a national initiative to end ACEs and promote education about the ACE Study. Its board includes top psychologists and trauma-informed leaders such as James Sporleder, former Principal of Lincoln High (see Jane Steven’s Huff Post “Lincoln High School’s ‘Out of School Suspensions’ reduced by 85%.” )

Morgan stressed her “to the heart” idea to to have 100 Celebrity Parents make TV spots and do a media blitz to spur parents to learn about positive, attached parenting. For example, celebrity dads will speak on how dads can “Be the Daddy They Deserve.”  Morgan gave Dr. Felitti her new book (photo again at top) aimed to be a hit with teens and moms, “On Becoming NaughtABimbeaux”  It’s based on 13 years of research into the psychology of relationships and intimacy.  The book has five pages on the ACE Study and its relevance to choosing a spouse capable of creating a healthy family, and a Facebook page.

“Frozen” No Mas

Felitti - Kathy Nov 1, 2013 San Diego SoCal ACEs 812403753_2874569586_0It left me thinking how to organize one of Morgan’s Celebrity Parents to get a hit movie made as Dr. Felitti dreams.  A TV series couldn’t be far behind.  (Dr. Felitti and me at our previous SoCal ACEs meeting.)
Look at what a hit the film “Frozen” is (over $1 billion revenue), with that lead song “Let It Go” about how Elsa can’t hold in her traumatized emotions anymore.  Click for video:  ” ‘Conceal, don’t feel/ don’t let them know!’ / Well,now they know!”  She’s gonna feel what she feels!  People have had it with being traumatized, yet society doesn’t want to hear.

Dr. Felitti is onto something with his TV and Hollywood vision.  So are Morgan and Dana. That’s a billion dollars of grassroots emotions connecting out there.

Betcha that’s why “Avatar” was such a hit, when at the end the giant heroine Neytiri picks up her fiancee Jake with his tiny, broken body, looks into his eyes, and says “I see you.”  That means: “I see your soul, I love you for who you truly are.”

I don’t know if Hollywood’s more ready to face the facts in the ACE Study than are the Senators whom Dr. Felitti met.  But ordinary people crave to be accepted for who they really are.  People are tired of being Frozen.  So many are forced into that box: “conceal, don’t feel, don’t let them know,” don’t show your true Self.

Because our true Selves hurt; the ACE Study showed that two-thirds (64-67%) of  17,421 middle class subjects had one or more types of childhood trauma, and 38-42% had two or more types.  In less privileged populations, these numbers are far higher. A national average of all economic groups would likely show 50% or more suffer severe trauma from ACEs.  There’s money in an exposee, and it’d do all our hearts good to be out of the closet.

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

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The Hole in Half of Us

Brousblog1a Perry brains X-secThe Adult Attachment Interview (AAI) study since 1994 shows that  50% of Americans have some degree of failed attachment in childhood.  These are rigorous psychiatric studies of the general public which have nothing to do with “addicts.”  It’s not just about “them.”  [FN1]

It’s about “the hole in me” inside half of us.  Secure attachment is necessary for the neurons in a baby’s brain to develop. “The hole” is caused by any problematic bonding with the mother.  That means “parts of my brain are dark” — the neurons just don’t fire. (Above left: normal 3 year old. Right: major attachment disorder)

No coincidence, 50% of Americans also abuse not only alcohol and drugs (including prescriptions) but also tobacco, food, gambling, internet porn, sex…  Those of us who’d never “use” anything, often become work-aholics.  All these, abused, often cause premature death.

Until we treat the underlying childhood trauma, says Dr. Vincent J. Felitti, nothing will change and people will keep dying early. That’s the point of his 2003 “The Origins of Addiction: Evidence from the Adverse Childhood Experiences (ACE) Study,” published here last week:  click here.  [FN2]

“My point is that there is a Public Health Paradox,” Dr. Felitti wrote in transmitting his article, “wherein some of our most difficult public health problems are actually unconsciously attempted solutions, at the individual patient level, to problems that are unrecognized because they are lost in time and then protected by shame, by secrecy, and by major social taboos against exploring certain realms of human experience…

“Needless to say, vacuous cautionary advice doesn’t do much, coming from people who have no idea what has gone on.  Thus, ‘Obesity is bad for you,’ but it’s sexually protective; ‘Smoking is bad for you,’ but nicotine has been known for almost a century to have potent anti-anxiety, anti-depressant, appetite suppressant, and anger suppressant activity.  Moreover, those occur within 15-20 seconds of inhalation, whereas the risks, which are certainly real, occur in 15-20 years.”

“The current public health approach of repeated cautionary warnings has demonstrated its limitations,” as Dr. Felitti put it in his 2003 piece, “perhaps because the cautions do not respect the individual when they exhort change without understanding.”

Treat ACES  vs Early Death

BrousBlog7a ACE pyramidDr. Felitti is elegant and to the point: unless we treat Adverse Childhood Experiences per se, people will find something, somehow, anyhow, to numb the emotional pain of childhood trauma.  Details on the ACE pyramid. [FN3]

“People with attachment-based developmental trauma can start to feel so threatened that they get into a fight-flight alarm state, and the higher parts of the brain shut down first,” neuroscientist Dr. Bruce Perry, MD told a 2013 UCLA conference.

“First the stress chemicals shut down their cortex (thinking brain).  It’s instinct; they can’t control it.  Now they physically can not think. Ask them to think and you only make them more anxious.

“Next the more primitive emotional brain (limbic brain) goes. They have attachment trauma so people seem threatening; they don’t get reward from emotional or relational interaction. Their own emotions feel like a threat to them.

“Now the only part of the brain left functioning is the most primitive: the brain stem and diencephalon cerebellum (reptilian brain).  Here they can get rewards, but only from sweet/salty/fatty foods, drugs, sex — only the strongest sources of opiates can sooth these lower brain parts.

“They know cognitively it’s wrong to steal from Grandma, they may even love Grandma, but the brain is state-dependent.  At that moment, cognitive thinking or emotional-relational consequences, just can’t relieve their anxiety.  They are in such distress in the lower parts of the brain that they need the food, drugs, etc.  too badly.

“You can get to the point where you can’t even reach the lower part of the brain.  If you’re so ramped up and anxious, the only thing you want is to relieve the distress, and the only thing that can do it is to drink.  Alcohol will reduce anxiety, and make us more vulnerable to other unhealthy forms of reward pleasure.”

The problem is that the emotional pain from ACE is buried inaccessibly deep in our neural structures since our brains first developed, so we don’t even know it’s there.

“If you want a person to use relational reward, or cortical thought -– first the lowest parts of the brain have got to be regulated,” Perry concludes.  “We must regulate people, before we can possibly persuade them with a cognitive argument or compel them with an emotional affect.”

Perry has proven in thousands of clinical trials that the only way to do this is to treat the underlying childhood issues. [FN4]

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Kathy’s news blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.

Footnotes

FN1  George, C., Kaplan, N., Main, Mary, “An Adult Attachment Interview,” Unpublished MS, University of California at Berkeley, 1994;  and Ainsworth, Mary D.S., Blehar, M.C., et al, “Patterns of attachment: A psychological study of the  Strange Situation,” Erlbaum, Hillsdale, NJ, 1978

FN2  Felitti, Vincent J. , MD, “The Origins of Addiction: Evidence from the Adverse Childhood Experiences Study,” English version of the article published in Germany as:
Felitti VJ, “Ursprünge des Suchtverhaltens – Evidenzen aus einer Studie zu belastenden Kindheitserfahrungen,” Praxis der Kinderpsychologie und Kinderpsychiatrie, 2003; 52:547-559.

FN3 ACE Study Pyramid, www.cdc.gov/ace/pyramid.htm; and “Adverse Childhood Experiences by Vince Felitti, MD,” 13 min video, Academy on Violence and Abuse, 2006: www.youtube.com/watch?v=GQwJCWPG478

FN4  Perry, Bruce D., MD, PhD, “Born for Love: The Effects of Empathy on the Developing Brain,” Annual Interpersonal Neurobiology Conference “How People Change,” UCLA, Los Angeles, March 8, 2013 (unpublished).  See also Perry, B.D. and Hambrick, E. (2008) The Neurosequential Model of Therapeutics. Reclaiming Children and Youth, 17 (3) 38-43, at: http://childtrauma.org/nmt-model/references/

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