Psychopathology of Attachment: The Ties That Bind

Hi, this is Scott and I'll be back next episode of Psychology and Plugged. Thanks to all of our new and long-term listeners. I appreciate the opportunity to do this every week and continue to reach out. I will give you contact information at the end of this episode. And I know I've been trying to get in contact with a colleague in Australia to talk about a really important form of treatment, which is equine therapy. It's just a matter of coordinating time zones. So I'm going to go back to a topic that I did recently because after I did that episode, I got a lot of emails and texts and phone calls in terms of attachment. And I didn't realize this. This is our, this is our 252nd podcast. So again, very grateful for all of you guys who've been following us. So a lot of the questions were related to personality structure. And I've done a lot of episodes if you've been following this for a while on attachment. And you know, borderline has been one of the probably the most frequent episode. And one that I get a lot of calls about, but a lot of people have set up neurology valves. There's kind of them with me. In particular, one to know more about their personality structure if it's disorder or not. And I thought it would be important to revisit attachment theory. And when I did it, I did it more like as a developmental model, like secure, avoidant, and bivalent disorganized. But I wanted to go a little deeper this time and to not just like really what attachment is, but what happens when it breaks. And you know, every form of personality, psych pathology, trauma narratives, distorted self-beliefs, distorted beliefs about others, distorted beliefs about the world, the conclusion they're drawn can, you know, essentially be traced back to attachment. And in clinical psychology, I think we sometimes act as if disorders exist in isolation. Depression here, borderline there, PTSD, anxiety, narcissism. As they're almost like separate continents on the same map. And what I've learned doing neuropsychological assessments, especially in the psychological aspect of it, the MMPI, the Rorschach particular, the thematic apprehception test, incomplete sentence blanks, is attachment really is the map. It's essentially the soil from which forms of psych pathology grow. So I just wanted to dig a little deeper. And I've made this into kind of a or a educational podcast in my mind in terms of going through the different personality disorders. You know, healing attachment doesn't, it doesn't really just simply resolve symptoms. It can in many ways, I think, re-wire the the the organism for safety, for trust, for connection. And that's why I'm I decided to come back to this topic because every attachment isn't a chapter of psychology. It's really the whole book if you think about it metaphorically. So just to kind of, you know, prevesit before getting to the different disorders, and I'm not going to get into the different attachment styles, but I will loop them up that I did in the other other episode. But, you know, attachment is not necessarily sentimental, it's biological. From birth, an infant's survival depends on attunement. And, you know, when caregivers, mother, dad, grandmother, grandfather, foster parents, when caregivers respond consistently, they're soothing, feeding, they're mirroring. The infant's parasympathetic nervous system, it learns regulation. And the prefrontal cortex gains control over the amygdala, which I've talked about. And distress can essentially be calmed by another's presence. And conversely, I think when caregiving is inconsistent and consistent or frightening, the brain wires for survival, cortisol floods the system, the amygdala kind of becomes just trigger happy. And, you know, a child can grow into an adult that lives on high alert and misreading every neural cue as a potential threat. So those, what we say, like, mostly unstable or reactive delts that we see clinically, their brains are simply running an old survival script. And the whole principle of neuroplasticity, the brain's ability to grow new neuronal connections is crucial. Because from a therapeutic standpoint, you know, cognitive therapy, we're not just challenging, you know, maladaptive cognitions, but trying to offer new experience that create what I would say, like, be like almost a form of like neural repair and, you know, neural restructuring. So in doing so, I'm going to go through the different personality disorders in terms of how attachment, insecure, ambivalent, disorganized, secure, how it manifests. So if we start with, I guess, let's walk through them, one by one, borderline personality disorder. I love you, don't leave me. If you really want to witness a attachment rupture in its peers form, walk to a person with borderline dynamics, they crave closeness, befear it, test love, then panic when it waivers, you know, and really perceived the management, abandonment. And then again, when I'm saying they, this is just for the sake of conversation, not reducing somebody just to a pronoun. But they're, they're not necessarily as manipulative, they're, they're essentially terrified because their emotional, emotional system was never mirrored long enough to develop object concy or pj term object permans. So every absence feels like a complete annihilation. And in therapy, you kind of work to survive their storms. You, you, you stay steady and the steadiness and the consistency becomes the new attachment template, more or less. And consistency, not necessarily confrontation, at least initially, is part of the cure, is mirroring a, you know, consistent appointments, consistently responding. And in the appropriate level, narcissistic personality disorder, if I shine, I won't be shamed. This is the core, I was a mantra, but I kind of put one for each of the different disorders. And narcissism is really attachment trauma behind a mirror in some ways. And these individuals were valued for performance, not, not presence, not for who they are, but for what they, they could do. And what they learned is if I'm perfect, then I'm safe. And grandiosity masks fragility. It, it, uh, control covers shame because narcissists are essentially vapid and they present the exterior for what they want, admiration and adulation. And when you can respond therapeutically with empathy, empathy instead of humiliation, the mask and sometimes soften and true emotion can emerge. But a lot of times this happens when somebody with narcissistic personality disorder really hits rock bottom. And, you know, the treatment is essentially recognition. And it's essentially, you know, seeing the, you know, the scared child beneath, beneath the armor, just like, you know, total pulling occurred in the words of the vase. Anti social personality disorder is essentially love wasn't safe. So I learned to dominate. And anti social traits, they really grow from deprivation and not evil. And when, when care is replaced by chaos, um, what the child is essentially learning is that power equals survival and an empathy never formed because no one modeled it. And, you know, therapeutically, therapy requires boundaries first and empathy second because, you know, complete violation of any, you know, whether they're legal rules or just societal standards is part of the diagnostic profile of anti social personality. Um, but, you know, with consistency, I think even calisards develop some sense of conditional empathy, um, which is, I think proof that, you know, attachment circuits, circuits still exists. So hopefully kind of seeing like a theme of like what were these early underpinnings, um, histrionic, seamy, or I disappear. And the histrionic child equated attention with love. And if they weren't dazzling, if they weren't shining, then they were invisible. So they, they, what, what is happening? They grew into adults who perform a motion rather than feel it. And, you know, beneath the glamour is the fear of being forgotten. And you can see the, you know, the last, these four anti social, borderline, histrionic and narcissism are in the cluster B personality group. Um, avoidant personality is if you don't get close, you can't reject me. So avoidant personalities, they, they long for companionship and connection, but they expect humiliation and, and shame. And affection, one's, affection, one's burned, so distance becomes protection in a way. And they, they appeared detached or indifferent, but really kind of ache for acceptance. Um, dependent personality, I can't stand alone. And dependent individuals were over protected into helplessness. Autonomy was punished and compliance was rewarded. And now they outsource their sense of self, the, you know, similar, but different. Um, there's a lot of similarities between dependency and borderline personality disorder. One, one big difference is a dependent person generally will not get mad and have the emotional volatility that you will see in borderline pathology. But outsourcing the self, and again, like the borderline acting like a chameleon in terms of modifying in order to safeguard against harm, even abandonment with dependency, but also giving other people an inordinate amount of control over their sense of self and identity. Obsessive, compulsive personality disorder, not to be confused with just OCD is if I'm perfect, no one will leave. And obsessive compulsive personality disorder is anxious attachment really disguised as precision. And again, very different from the clinical aspect of OCD, because, you know, critical or unpredictable caregivers basically taught the child that mistakes lose love and control really become the substitute for connection. And perfection soothes terror. Um, paranoid personality disorder. Trust is a trap. And paranoid individuals generally were raised amid betrayal and unpredictability. The world is a scary and hostile place. And others are not to be trusted. And attachment required vigilance. And they expect exploitation. So they preemptively attack. So it's if this is not a sick, a psychotic disorder, but it had the paranoid ideation is the hyper vigilance of seeking out real or imagined perceived threats to the sense of self. Skitzoid personality disorder, it's easier not to need. And I think these, these children, kind of children of emotional droughts and their needs, their needs were met materially, but ignored emotionally. And they withdrew to survive neglect. And as adults, they equate solitude with safety and they have an indifference to being around other people. And sometimes they have, you know, us otter esoteric interest, but and Skitzo type of personality disorder. When reality feels unsafe and Skitzo type of personality, they generally they grew up in chaos or parental psychosis. So they were never able to internalize coherent model of safety. And fantasy filled the void for them. And exit eccentricity became the armor. Skitzo type of can be one that could turn into actual psychotic symptoms of hallucinations and delusions, but because it's personality, it's learned. So kind of I think can like tie a tie together that all the personally styles disordered or not is really a map of adaptation. And from the ones that I just described, there's I think a common theme of fear, a common theme of diss, these are the artifacts of dysregulated attachment styles growing up. And as you may remember from other podcasts, personality, what this whole construct is, disordered or not, is crystallized between five and eight years of age. And that that's fascinating, but it's also scary to think about simultaneously. So, you know, the borderline reaches the narcissist fortifies the avoid and hides the anti-social attack dependence claim obsessive OCPD they control histrionic performs the paranoid guards, the skitzoid withdraws, and the skitzo type of escapes into imagination. That's the simplest explanation that I can just in terms of explaining again, not reducing people to these, you know, simplistic terms, but is a good is a good framework, but they're they're different defenses with the same wound, because the nervous system never learned safety and connection. And this is where John Bulby was right that the internal working model of the self of really the sense of self is built upon the reliability of other people. So, it becomes problematic in adolescence or later childhood, early later adolescence adulthood, when these patterns, these personality disorders are now adversely impacting someone's social, emotional, occupational, and/or academic functioning. When these styles, it's having a personality disorder can be incredibly exhausting for individuals, because, you know, consistency is a really important part of treatment for any type of work with individuals with a personality disorder. And, you know, like I said, consistency and appointments in returning phone calls and being available to an appropriate degree. So, I just wanted to just, I made notes of some different therapeutic techniques of how to, you know, heal attachment. I mean, I think, you know, I still stab by and, you know, borderline personality, because that's one, for the few people I see for therapy, that's the one disorder primarily treat. I can tell you, it is treatable, it is curable, and anybody who tells you otherwise, they're wrong. So, like CBT, the modality that I was trained in and used primarily, CBT challenges attachment-based distortions that, you know, need equals weakness, and everyone leaves these, these over-generalized dichotomous thinking, you know, if you go back to the episode on cognitive distortions or rational beliefs, Robert Lee, he's 17. And so, you know, behavioral experiments replace avoidance with approach. And the neural pathways are a fear, tend to be overwritten by an experience of safety. Another therapeutic technique is schema therapy, or in what's called like reparenting, and this is where you're really identifying core schemas, abandonment, mistrust, defectiveness, and providing a corrective emotional experience. Internal family systems work is also important. It invites like exiled parts of home, and the self learns compassion for protectors, and internal attachments replace external dependency. There's, you know, mindfulness, polyvagal approaches where, you know, attachment lives in the body, and polyvagal exercises like breathing, grounding, gentle movement, kind of shift the autonomic state from defense to connection. And in this, you know, this technique is, you know, healing really isn't just about remembering safety. It's actually, in many ways, it's feeling it. And with mindfulness, it turns the secure attachment inward. And breath and awareness really become the internal caregiver and mindfulness is the definition is essentially awareness without judgment, simply just noticing. Sometimes, you know, with, you know, spiritual integration, attachment and spirituality can really be intertwined because those be trade by parents, caregivers often see God or higher power as being rejecting. And healing attachment is, you know, can restore faith. It's not necessarily religious, but more existential. The belief that connection is, is possible. As you guys done, the huge Bruce Springsteen fan, and I don't know if who's, I mean, the movie was great, but I was maybe why, you know, these thoughts sometimes pop into my mind at what I want to do, what I'm going to talk about for the podcast, but it's in 1980 wrote The River. And well, great song. They kind of, I think ties all this together is the ties that bind. And one line is you can't break the ties that bind. I think that was referencing a spiritual truth that, you know, attachment really is our first, our first theology, our first introduction to it. The faith that someone larger will catch us when we fall. And, you know, for securely attached children that their faith, I think, matures in the trust. And for the wounded, it really shatters into skepticism and fear. It's, I don't believe that any of us are born broken, but I do believe that we are born connected in many ways. And the breakening, and the fears, and all the anxieties about this unpredictable world, it really happens in the absence of love and the absence of consistency in the absence of purity of intention. But healing can, I think, happen in return. The happiness, I think, it, it, it, it, um, it happens in, in its return. So I just wanted to do this episode. And, um, because of everybody's interest in like the different personality styles and disorders of how they connect to attachment. And again, a lot of it is about perception. Two people can grow up in the same environment, very similar, um, and have two very different reactions and interpretations and narratives. So, uh, no two people see the same thing the same way. And I've worked with enough people to say confidently that yes, perception. I've heard multiple stories of similar histories that have taken very different trajectories. But when you think about, you know, five, eight years, eight, uh, five, eight years of age, what the world is imprinting. And if, if our basic capacity, our basic, you know, design as humans to, you know, survival. And that's why I think survival is attached, my name is the pun. That's why survival thing has connected so much to attachment and personality styles because if the world is unpredictable, if it's disorganized, if it's insecure, if those early connections, it imprints something and it creates a personality style that results in an individual living life with a variety of beliefs and cognitive distortions that through effective psychotherapy and my training perspective, cognitive therapy, personality. If you can learn, if you can learn how to view yourself and learn how to view other people and learn how to view the world and make the therefores, it doesn't make sense that you can learn a different way to view yourself for the people in the world. That's why personal disorders are treatable, if not curable, because it's learned. And that is the power of cognitive therapy. It takes work and it takes sometimes, you know, behavioral experimentation and CBT to test out hypotheses, but that's why I strongly always encourage people to get a comprehensive neuropsychologically evaluation and I appreciate all the people that come to see me from whether it's from the podcast or people that are just, you know, local and mass chooses that, well, see if something's going on whether the personality is worse or not, but to get the answers and not just the diagnosis, but the specific architecture of how whatever pathology manifests specific to you. And that is what the testing is able to give. Yes, it gives a specific answer, but because of the, because of the uniqueness and complexity of individuals, it's not a one-size-fits-all model. And I could tell you from doing therapy, especially with those with personality disorders, there is no way without having information from the assessments, especially things like the workshop and the thematic epireception tests and the MMP without having that, I would, you would never know that you would never get to that stuff in treatment. But anyhow, hopefully this was enjoyable and I appreciate your continued journey doing this, you know, following that our program. If you try to get ahold of me on Buzzsprout where I do the platform, I do the podcast on, I can't respond. I know that people have reached out asking for response. So please get ahold of me through psychology today and my email, because right to my phone, psychology [email protected]. I try my best to get back to as many people if I haven't, just keep reaching out. And until next time, take care of yourself, take care of each other, be well, and I will talk to you. Bye guys. [BLANK_AUDIO]