Criticisms of Attachment Theory PDF

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studies that are criticizing attachment theory with empirical data to support these claims...

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Criticism of Attachment Theory, 2020

Professor Michael Fitzgerald Department of Psychiatry, Trinity College, Dublin 2. Ireland. www.professormichaelfitzgerald.eu

16th January 2020

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Attachment Theory 2020

Attachment theory has a complex history, both positive and negative. This paper focuses on both. An  attachment is a tie based on the need for safety, security and protection. This need is paramount in infancy and childhood, when the developing individual is immature and vulnerable. The infants instinctively attach to their carers, (Prior and Glaser, 2006).

Bowlby’s contribution: Attachment theory was formulated by John Bowlby and was one of the most important, guiding, persuasive theories of the twentieth century and indeed, until today. It shaped child psychiatry, psychology, child care and our understanding of various problems of children and adolescents. Wells, (2014) pointed out that,  attachment theory has been the cornerstone of child and adolescent psychiatry for more than fifty years. This is correct. Understanding the attachment system became an essential to understanding a core component of being a human being. Slater, (2007) noted that Cortina and Marrone (2003) stated that,  attachment theory provides a coherent and empirically supported view of normal and pathological developmental processes and clinical phenomena . It overlaps with psychoanalysis and Fonagy (2001) in particular, has incorporated it into psychoanalysis, although for a very long time, psychoanalysts were very critical of attachment theory. Fonagy, (2001) points out that,  attachment theory is almost unique among psychoanalytic theories in bridging the gap between general psychology and clinical psychodynamic theory. Lai and Carr, (2018) state that,  attachment theory has been labelled one of the last, “grand theories”, not to have been completely dismissed, replaced or extensively revised . Sroufe et al, (2005) stated that attachment can be considered,  perhaps the most important developmental construct investigated. John Bowlby played a critical role in the reform and care of children in institutions and hospitals and the placement of children in adopted or fostering situations. This activity was enormously beneficial to children and remains so. Finally, according to Barth et al, (2005), attachment theory is,  the most popular theory for explaining parent/child 2

behaviour by professionals and clinicians . Of course, the idea of focusing on the attachment system does make sense to everyone and is an important part of human interactions.

Criticisms of Attachment Theory: Nevertheless, there has been a more critical view, particularly since the WHO report, Ainsworth et al, (1962) to the present time. Prugh et al, (1962) points out that the idea of gross maternal deprivation and,  affectionless characters is not supported. In 1938 and 1944 Hans Asperger described autistic psychopathy where many of Bowlby’s,  affectionless characters , really belong. Bowlby (Audry, 1962, WHO), used the phrase,  partial deprivation , which meant an,  unsatisfying relationship with the child’s mother. This was Bowlby’s most serious error because when he wrote about partial deprivation, which opened the, flood gates to any kind of parent/child interaction problems and allowed his original work to be misinterpreted and grossly over-expanded. Audry, (1962) criticises the,  single factor , maternal deprivation and describes this correctly as a,  crude factor and the  condition of maternal deprivation may be only among several others perhaps more important aspects of mother/child relationships. Audry, (1962) goes on to ask about, what of stimulating institutions such as the Kibbutzim, where maternally deprived children do not seem to become delinquents? . Audry, (1962) notes that Bowlby, (1952),  accepts that hereditary factors can in all probability, be ruled out as the major responsible factor, thus exposing the maternal deprivation factor as vitally important . This was a serious error as well as about 50% of the variants in personality is heritable (Plomin, 2018). Dr. Hilda Lewis, (1954) in her study of 500 children at a reception centre, was unable to demonstrate a clear connection between a child’s separation from his mother and a particular pattern of child’s behaviour. This was a serious and a very early criticism of Bowlby’s theories. The most severe criticism ever was by Allen, (2016) in Evidence Based Child & Adolescent Psychiatry, where he wrote,  a radical idea: a call to eliminate attachment disorder from the clinical lexicon . Indeed, Allen goes on to point out that, there is a lack of professional consensus on what exactly these terms mean, (attachment) and the manner in which they should be used . Bollen, (2000) notes that,  support for attachment theory remains equivocal, and the limits of the theory are not clearly defined … professionals must be aware of these limitations. Perring, 2

(2014) is critical of the,  putative and amorphous relational disorders. This, broad  brush, amorphous diagnosis of relationship disorder, attachment disorder is most unhelpful. It led to vague thinking, (Keil et al, 2017). Chaffin et al, (2006) makes similar criticism that the terms,  attachment disorder, attachment problems and attachment therapy have no clear, specific or consensus definitions , and that the, omnibus  term attachment disorders … (can) refer to a broad selection of children , with relationship difficulties. This is rather vague and unsatisfactory. Chaffin et al, (2006) and colleagues at the American Professional Society on the Abuse of Children noted that,  attachment disorders is an ambiguous term and the term attachment disorder has no broadly agreed or precise meaning. The term is not part of any accepted standard nosology or system for classifying behavioural mental disorders. Officially, there is no such disorder, but reactive attachment disorder is a better accepted diagnosis and is in DSM 5 and ICD 11 draft, (2019). Woolgar and Scott, (2013) also highlighted the clinical confusion that occurs between,  attachment disorder, attachment patterns, disorganised attachments and attachment difficulties.

O’Connor and Zeanah, (2003) suggest that,  the definition of attachment disorder might be expanded to include problems in social relationships with peers and social cognitive problems indexed by a difficulty in understanding the thoughts and feelings of self and other . This would only confuse the attachment literature more and would lead to even further expansion into the neurodevelopmental disorders including ASD and ADHD. Indeed, this is where many of the so-called attachment disorder diagnosis belonged. Woolgar and Scott, (2013) state that the attachment construct,  refers to accessing protection and safety, which is different from relationships disorders, but these concerns are often confused in clinical situations, leading to misdiagnosis.

Specificity: The controversy over the definition of attachment does somewhat undermine the attachment concept as a specific phenomenon. It is very non-specific and involves so many elements. The following is an example

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of this, maternal sensitivity, is discussed a lot in attachment literature but van der Boom states that the concept of sensitivity is,  too abstract and too coarse to capture the subtle nuances of parental behaviour (Prior and Glaser, 2014). Indeed, Rutter et al, (2009) pointed out that,  parental sensitivity on its own is only a minor influence , on patients’ social relationships. Most of the issues in the etiology of psychiatric disorder are non-specific and overlap with other disorders. Bowlby’s idea of the,  specificity (Bowlby, 1979), of the mother/child bond is not sustained and the problems in the mother/child relationship leading to specific attachment disorder is not supported. Breuer, (1999) noted that,  research on attachment has not been able to identify specific parental behaviours that lead to secure attachment between infant and caregiver. This lack of specificity is part of the reason why you sense that the brain and early childhood do not tell you specifically what to do . Upadhyauada, (2019) also notes the,  non-specificity of early childhood adversity and subsequent childhood psychopathology (Jokiranta-Olkoniemi et al, 2016). Of course, drug and alcohol abuse during pregnancy is a significant factor and can give the features of attachment problems in offspring. This is a serious etiological factor, not mentioned by Bowlby and would occur in families where there is a serious deprivation, both antenatally and the parents make continue the drug alcohol abuse postnatally, interfering with their ability to parent. It is not surprising that Cowan et al, (2007) stated that the evidence for a,  single working model of attachment is weak . Cowan et al, (2007) goes on to point out that there is a necessity to,  integrate notions of generality and specificity.

Genes and environment: Kendler et al, (2006) stated that in studies of genes and environment,  non-specificity was more common than was specificity. It was rare to find a set of genetic risk factors or particular environmental risk factors that affected only one disorder . Bakermans-Kranenburg et al, (2007) stated that there is evidence for gene: environmental interactions explaining individual differences in attachment security and disorganisation and that genes are responsible for differential susceptibility , but Kendler et al, (2006) state that their research do not indicate that,  DSM got it right , in their classification suggesting that there are specific sets of genetic factors for each disorder. 2

Further criticisms of attachment disorder: Berghaus, (2011) points out that the,  proponents of attachment theory have lost their way. As they try to make attachment related to everything that comes after, and major component of psychopathology, they ignore much of the scientific evidence . Slater, (2007) points out that,  definitions of reactive attachment disorder are not helpful in meeting the needs of young people since they draw insufficiently on developmental research in this field and perhaps consequently, lack an understanding of a range of appropriate interventions . Romanian orphanage children,  were able to form attachment relationships with their adoptive parents , (Chisholm, 1998). Attachment disorder is used throughout this paper with its various meanings as used in the peer reviewed scientific literature.

Attachment disorder and ASD: Woolgar and Scott, (2014) note that Prior and Glaser, (2006) state that,  there needs to be evidence that the attachment system has failed and that no discriminated attachment figure has been achieved. Unfortunately, this does not help and does not make a differentiation from ASD. O’Connor and Zeanah, (2003) point out that,  the central concern is whether or not a selective or discriminating attachment relationship exists between the child and his/her caretaker. This has been posed as a distinction between disorders of attachment versus disorders of non-attachment . The problem is that ASD, which is a wide spectrum of children have some who are attached and others who are not attached. This is characteristic of the massive variability of children on the spectrum and indeed, in most child psychiatric conditions. Disorganised attachment is seen in children with ASD and ADHD. Like many features in psychiatry, it is a relatively nonspecific feature. ASD is common at 1/59 CDC; ADHD 6.9% and RAD is very rare.

Spectrum diagnosis: O’Connor and Zeanah, (2003) point out that,  we simply do not have the necessary information in how attachment disorders connect with individual differences in attachment quality – and indeed, if a direct 2

connection can be made . They also point out that,  several features of the diagnostic formulation of attachment disorder are incompatible with the research and theoretical tradition developed by Bowlby. There is no clear reason why attachment disorder cannot be on a spectrum like so many other disorders in child psychiatry and indeed most psychiatric conditions are on a spectrum.

Woolgar and Scott, (2014) point out that the construct attachment disorder is often used in the, absence  of effective terms to describe something bizarre and atypical presentations in children. This is an important point, but most of the children with,  bizarre and atypical presentations have ASD. A missed diagnosis of ASD is a very major problem as it deprives the children of ASD treatments and commonly happens in clinical practice. Indeed, going back to an older classification, pervasive developmental disorders, (DSM 4/TR) which is an over-arching category, many of the so-called attachment disorder diagnosis in the past could have been fitted in under this category for example PDD NOS.

In DSM 5, (APA, 2013),  RAD is essentially the absence of a preferred attachment to anyone , Lyons-Ruth et al, (2014). This feature is not uncommonly associated with ASD and is not specific to RAD. DSM 5 states that,  RAD occurs in less than 10% of severely neglected children and a diagnosis is rarely seen in general clinical practice , (Allen, 2016). Zeanah et al, (1993) stated that in relation to DSM IV (1994) the criteria in relation to the attachment area were,  inadequate to describe children who had seriously disturbed attachment relationships . DSM III-R (APA, 1987), RAD,  was marked by distinctive social relatedness in most contexts . Of course, this is also typical of ASD. This DSM in relation to RAD, also stated that, a persistent failure to initiate a response to most social situations . This is classically seen in ASD. It also stated that what separated this diagnosis from ASD was,  grossly pathogenic care. The problem here was that in a busy clinical practice almost any form of poor care,  very partial deprivation was used instead of grossly pathogenic care. Richter and Volkmar, (1994) concluded that, RAD,  as defined in DSM III-R was not compatible with developmentally derived conceptualisation of attachment disorder, (Allen, 2016). Boris et al, (2004) suggested that both DSM and ICD 10 criteria for RAD …  may be too restrictive, making 2

underdiagnosis possible . The opposite is actually much more correct. There’s no evidence of underdiagnosis of RAD, but the problem is overdiagnosis of a rare disorder called RAD. Alternative criteria for attachment disorder were suggested by Zeanah et al, (2000) has a list of criteria, all of which can be seen commonly in ASD.

Validity: Slater, (2007) points out that,  the validity of the diagnosis, (attachment disorder) has remained largely untested , (Zeanah and Emde, 1994). Zeanah, (1996) has argued that,  the conditions are actually more maltreatment disorders than attachment disorders . The complexity and confusion of the attachment concept is commented on by Chisholm, (1998), that,  even Romanian orphanage children (classified) as secure display indiscriminate friendship, I cannot agree that their indiscriminate friendships should be equated with attachment disorder.

Prevalence of RAD: Sroufe et al, (2005) found in his follow-up of high risk samples study,  only two or three out of one hundred and eighty children studied , fitted categories of attachment disorders. Upadhyaya et al, (2019) stated that RAD was rare at 6.38 per 10,000/10,000. For Gleason et al, (2011), the incidence of RAD cases treated in specialised healthcare services for severely neglected children in Eastern European orphanages only, 4.6%  of their children showed inhibited RAD and 31.8% disinhibited RAD . There is certainly no one-to-one relationship between severe neglected and RAD. At follow-up, Allen, (2016) stated that, RAD …is not related to the child’s concurrent attachment behaviour and therefore is not a sign of disordered attachment.

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Further discussion of attachment disorder: Partial deprivation: Bowlby, (1951) noted that,  a child is deprived even if living at home if his mother is unable to give him the loving care all children need , and he went on to elaborate this when he wrote about, (a) an unconsciously rejecting attitude underlying a loving one; (b) an excessive demand for love and reassurance on the part of the parent and, (c) the parent obtaining unconscious satisfaction from the child’s behaviour, despite conscious condemnation of it . This is all very psychoanalytic and speculative. He doesn’t provide data for what was written here.

Eyer, (1992) pointed out that maternal deprivation included,  effects of institutionalisation, stimulus deprivation, neglect, separation from mother, multiple and discontinuous caretakers, distortions in the qualities of caretaking – rejection, overprotection, ambivalence and complete social isolation. Maternal deprivation came to encompass a vast array of different ideas and almost became the theory of,  all causality, in relation to psychopathology. Sluckin and Sluckin, (1982) state that,  it is said that foolish or reprehensible child rearing practices, particularly on the part of the mother, and distortions on the formation of the mother’s attachment to her offspring are responsible for the various unsatisfactory aspects of the child’s physical and psychological development … and for the exclusive role for the mother in the formation of a bond , and the chargers of separation have been modified in the face of empirical evidence. Holmes, (1993) pointed out that Bowlby claimed that,  maternal deprivation produced physical, intellectual, behavioural and emotional damage , and that,  even brief separations from the mother in the first five years of life had lasting consequences.

Day care: Slater, (2007) notes that Belsky and Vine, (1988) stated that separation due to day care,  may interfere with the construction of secure attachment relationships . A large scale study, (N equals 1357) by the National Institute of Child Health and Human Development found that,  child care by itself constituted neither a risk 2

nor benefit for the development of the mother/child attachment . Prior and Glaser, (2006) noted that Chisholm, (1998) stated that,  although the children’s experiences in the orphanages constituted a risk factor, early institutional care alone did not foretell later attachment security, other stressors were required. Angles, (1980) stated that,  evidence of the absence, weakness or distortion of the usual affectional bond between parent and child can be found in virtually every case of child abuse. This is not proven. This is going way beyond the evidence and an example of attachment theory trying to,  explain everything.

Aetiology: O’Connor et al, (2000) pointed out that approximately,  70% of the children exposed to profound deprivation of more than two years did not exhibit marked/severe attachment disorder indicates that grossly pathogenic care is not a sufficient condition for attachment disorder to occur . O’Connor et al, (2000) pointed out that approximately,  70% of the children exposed to profound deprivation of more than two years did not exhibit marked/severe attachment disorder indicates that grossly pathogenic care is not a sufficient condition for attachment disorder behaviour to occur . This seriously undermines attachment theory. Breuer, (1999) noted that Ross Thomson, (1998) concluded that the evidence,  indicates that except in extreme circumstances, early influences are not deterministic but rather predispositional, with the strength of their effects on later behaviour moderated by a variety of factors that may subsequently enhance, undermine or alter their relation to hypothesized consequences . Thompson, (1998) also stated that,  developmental theorists have for so long regarded early experience as foundational for later development that the emergence of voices questioning the formative significance of infancy for later socio pers...