Traumatic Attachment: Clinical Reasoning for Attachment Trauma

Attachment trauma refers to the persistent and severe breakdowns in the relationship between a child and her or his caregiver, resulting in negative outcomes for the child’s mental, physical, behavioral, and relational well-being and representing one of the major risk factors for mental disorders, worsening clinical picture, prognosis, and response to treatment, regardless of the specific diagnosis and the therapeutic method employed. Attachment trauma causes a psychopathological vulnerability that dimensionally includes alterations and disruptions in biological regulatory systems, difficulties in self-regulation and its associated functions, detachment and dissociation, challenges in forming and maintaining relationships, difficulties in mentalizing, and the development of pathogenic beliefs about oneself and others. These psychopathological dimensions interact with each other causing difficulties in treatment. Hence, it is of utmost importance for clinicians to carry out a thorough evaluation of the potential manifestation and repercussions of attachment trauma while discerning remarkable indications and manifestations in a patient. This emphasizes the vital requirement of explicitly incorporating the examination and resolution of attachment trauma into therapeutic interventions.