Traumatic experiences during childhood, from the perspective of John Bowlby’s Attachment Theory, can affect the emergence of psychopathology during adulthood. According to Marrone et al. (2001), are considered potentially traumatic experiences events such as natural disasters, which are the result of technological causes such as air, sea, or nuclear accidents, also separations of parents by various circumstances such as migratory movements, imprisonment, or health-related events, such as the death of a loved one, amputations, or hospital stays. Loss and grief experiences are also potentially traumatic. These facts, however, are likely to affect a person’s mental health and are different from what we call complex trauma. This happens when the lack of protection that a human being feels is caused by the parents themselves who have been constituted by the child as protective clinging figures. This chapter covers the forms of abuse and the different types of abuse.

The Attachment Theory studies in depth the experiences of childhood trauma, and more specifically the trauma suffered in the framework of the relationship with the parental figures during this stage, ie the complex trauma. In this sense, according to Marrone et al. (2001), the most severe effects produced by traumatic situations are those generated by humans, and more particularly by an attachment figure during childhood. According to Sadurní (2011), childhood trauma caused by protective clinging figures is very likely to affect mental health, generating pathology, or affecting the creation of an insecure internal operating model or attachment system. insecure of the future adult.

A secure internal operating model, or secure attachment style, involves the ability to develop confident and healthy relationships, based on self-confidence and one’s own abilities to develop in the environment. An insecure operating model, or insecure attachment style, is characterized by difficulty in establishing trusting and healthy relationships, and insecurity about one’s own abilities to develop in the environment. In addition, it is common, as we will see, for people who have developed an insecure internal operating model to also experience psychopathological disorders.

Thus, the Attachment Theory studies, among other things, the relationship between traumatic experiences lived during childhood, psychopathology, and the style of attachment developed. Lorenzini and Fonagy (2014) mention the correlation between insecure operating models and some personality disorders. In fact, personality disorders are unlikely to be present among people who have developed a safe internal operating model, given that, having relied on their primary attachment figures, they perceive the environment as unthreatening and therefore they have not had the need to use excessive defense mechanisms, present in personality disorders.

In contrast, potentially traumatic experiences in the context of the relationship with primary attachment figures can affect not only an insecure attachment style, but also personality disorders. In this sense, Lorenzini and Fonagy (2014) point out that:

Patients with personality disorders have high rates of childhood trauma (73% report abuse, of which 34% is sexual abuse, and 82% report neglect). Compared to healthy adults, patients with personality disorders are 4 times more likely to have suffered trauma during childhood (Johnson et al. 1999). Physical abuse in childhood increases the risk of antisocial, borderline, passive-aggressive, schizoid, and addictive personality disorders (McGauley et al. 2011). Childhood neglect is associated with the risk of developing antisocial, borderline, narcissistic, passive-aggressive, and avoidant personality disorders (Batlle et al., 2004; Bennet, 2005; Johnson et al., 1999).

On the other hand, the relationship between trauma, insecure internal operative links, and psychopathology is not limited to personality disorders. Marrone et al. (2001) point out that trauma to attachment relationships can make people more vulnerable to developing various psychiatric syndromes, such as post-traumatic stress disorder, chronic somatic pain, depression, eating disorders, addiction to drugs as well as dissociative disorders.

In contrast, the development of resilience is a protective factor against the development of psychopathological disorders. The development of resilience depends primarily on the security of the attachment in childhood and adolescence. On the other hand, resilience can also be cultivated during adulthood, whether the person’s internal operating model is safe or insecure.

As for the treatment given to psychopathology in the Theory of the Affective Link, it integrates biological aspects with the psychosocial ones. Thus, if particularly serious mental disorders are taken into account, such as schizophrenia, which has traditionally been considered to be caused by exclusively endogenous factors. Marrone et al. (2001) point out that this view is probably too simplistic, and that the development of this disorder is explained, if at all, by the presence of both factors. On the one hand, genetic predisposition. On the other hand, the presence of dysfunctional family relationships.

In this sense, and in relation to this last point mentioned regarding the possible causes of the development of schizophrenia, we see that the view that the Attachment Theory has on the etiology of psychopathology presents the specificity that it considers that this is due to a combination of biological and psychosocial factors. Thus, the Attachment Theory, as far as psychopathology and its treatment is concerned, can act as a bridge between biological or biological psychiatry and psychodynamic psychiatry, insofar as, although it considers that in certain disorders the pharmacological treatment is inevitable, also maintains that only with this type of treatment and without performing psychotherapy can not occur a reorganization of internal operating models or the development of reflexive capacity. According to Main (2001), the ability to help patients with their own biographies of attachment through psychotherapy can be a protective factor and bring about positive changes in the life of the subject who has developed a  clinical difficulties. In order to be able to make this protective factor effective and make positive changes in the life of the person who experiences an insecure operating model and / or clinical difficulties through the psychotherapeutic bond, at a practical and concrete level, the Attachment Theory proposes a type of intervention that, methodologically, according to Marrone et al. (2001) consists of “1) obtaining, modifying, and integrating internal operative models of oneself and significant others, and 2) promoting reflective thinking” (p. 413). To make the above possible, in the framework of a treatment based on the Theory of the Affective Bond, according to Sadurní (2019), it is recommended that it include the following principles or aspects to be treated:

  1. Establishment of a therapeutic space that provides a secure base.
  2. Exploration of the patients demand and their affective relationships in their current life.
  3. Help the patient explore what expectations he has about the behavior of others, the affective responses he hopes to find in others (and whether the relationship he is establishing with the therapist can also be included).
  4. Explore the experiences of attachment throughout childhood and adolescence and how they have affected you.
  5. Relate the experiences of holding on to the emotional difficulties of your present. Identification of the internal operating model you have built in the past and how they influence the reactions and behavior of the present.
  6. Foster reflective awareness about this model of functioning and promote changes in their present life.
  7. Work on the trauma in a more focused way (in the event that the tests have diagnosed a post-traumatic disorder or a complex trauma).
  8. Work with the patient to be aware of the steps taken and the changes made.
  9. Preparation for the end of therapy gradually separating the sessions over time and seeing how the patient can tolerate without disorganizing again the absence of the therapist.

It is in this framework that a therapeutic link can be generated from which to heal traumas, treat psychopathology, and re-develop internal operating models so that the safe elements take center stage with respect to the insecure, thus enhancing that the person’s life can be fuller and more satisfying.

Bibliographic references:

Lorenzini, N., & Fonagy, P. (2014). Apego y trastornos de la personalidad: breve revisión. Revista de Psicoanalisis y Psicoterapia2, 1-44.

Main, M. (2001). Las categorías organizadas del apego en el infante, en el niño, y en el adulto: Atención flexible versus inflexible bajo estrés relacionado con el apego. Aperturas psicoanalíticas8.

Marrone, M., Diamond, N., Juri, L., & Bleichmar, H. (2001). La teoría del apego: un enfoque actual. Madrid: Psimática.

Sadurní, M. (2011). Vincle afectiu i desenvolupament humà. Barcelona: Editorial UOC.

Trauma, psychopathology and psychotherapy based on John Bowlby’s Attachment Theory