Attachment to Diagnosis.

We are born completely vulnerable, defenceless and totally dependent. The new born infant’s primary instinct, and most important action, is to form an attachment to a caregiver to whom it becomes totally dependent upon in meeting its needs. Without this attachment the infant’s very survival is at risk. The infant brain, at this point, is working on deeply primitive and basic mammalian programming from our distant past and in the mammalian world attachment means survival and a loss of attachment means death. This is a powerful driving instinct in a human infant just as it is in all other mammalian infants. To a human infant’s brain a loss of attachment to the primary caregiver = death. This is why a healthy infant will usually cry whenever they are separated from their caregiver. This effect is known as “Secure Attachment” and is normal and healthy behaviour for the infant. Every time an infant is separated from a primary caregiver, they experience it as a threat to survival. This is all fine as long as the separation is for short intervals and the primary caregiver returns in due course. This experience of separation and reunion may actually be beneficial to the infant because the infant eventually learns that the primary caregiver returns and that separation, in short intervals, is OK.

But what happens when the primary caregiver doesn’t return? As mentioned above, the infant experiences this loss as a threat to survival, but whereas the above involves short bursts of stressful separation, the infant that suffers permanent separation suffers a prolonged or even permanent state of stress.

And prolonged states of stress can lead to complications in the development of the infant brain and even brain damage caused by enduring an excess of cortisol in the blood that gets in to the brain and kills brain cells. Brain scans of Romanian orphans, in a recent study, have shown an overall reduction in brain volume compared to “healthy” children (see below image);

“These images illustrate the negative impact of neglect on the developing brain. In the CT scan on the left is an image from a healthy 3-year-old with an average head size. The image on the right is from a 3-year-old suffering from severe sensory-deprivation neglect. This child’s brain is significantly smaller than average and has abnormal development of cortex.” These images are from studies conducted by a team of researchers from the Child Trauma Academyexternal link led by Bruce D. Perry, M.D., Ph.D. (Reprinted with permission.)

This is why disrupted attachment in early life can lead to so many complications in later life and is associated with a vast array of dysfunctional symptoms and various diagnoses.

But let us look again at the attachment process; if this early attachment need is not met or disrupted, it leads to attachment complications further down the line. The symptoms of these complications can develop in to dysfunctional behaviour that attracts various diagnostic criteria being applied to them.

We never lose this attachment instinct and it may be part of what leads us in to relationships later on in life, we often experience it as a need to belong to something, feel a part of something, something bigger. I would hypothesise that the more we feel we need to belong or attach, the less we have developed a personal sense of security, i.e. the more insecure we are at a very personal level. And conversely, the more comfortable we are not belonging, the more this may indicate a personal sense of security, i.e. the more secure we are.

Now here’s where the problem with diagnoses comes in; if a person has experienced incomplete or disrupted attachment and subsequently developed symptoms of an associated disorder and seeks a psychological diagnosis for their symptoms, they will have an increased need to attach (belong) to someone or something and a lot of their symptoms will be associated with and a response to that need. When you give someone with a powerful desire to attach, something to attach to, they are likely to form a strong bond that is difficult to break.

It’s a well discussed phenomenon, where a patient develops attachment feelings towards their therapist/counsellor/psychologist, but it is a less discussed phenomenon where a patient actually forms an attachment to their diagnosis.

I have frequently come across people that have expressed “I am Borderline”, or “I am Antisocial”, or “I am Bipolar”, etc. and it is the “I am” bit that concerns me. Clearly, to me at least, these people are identifying themselves with their diagnosis. Perhaps even defining themselves with their diagnosis? In effect, belonging to their diagnosis, and, more importantly, their diagnosis belonging to them.

I have witnessed and tested this attachment in online psychology forums where I have questioned a person about their diagnosis and experienced an aggressive defensive/protective reaction, as if the person was protecting, or even clinging to their diagnosis, confirming my hypothesis that they feel that their diagnosis belongs to them and that they perceive you as someone who threatens to take it away from them. I would hypothesise that a person may in fact manifest symptoms of a diagnosis, that perhaps they were not exhibiting before, after being diagnosed in order to form a stronger bond with their diagnosis. It has been suggested by a few in the field that have, for instance, criticisms of DID (dissociative identity disorder), that the full development of separate personalities (rather than separate aspects of the same personality) only occurs after the initial diagnosis, to fit in with and enforce the diagnosis. Could this be, in some cases, a case of unconsciously forming or strengthening attachment/bonding to the diagnosis?

Surely, if the aim of psychology is to free people from their dysfunctional symptoms, then having them or those in their environment form an attachment to a diagnosis of those symptoms and therefore clinging to their symptoms as defining elements of their identity is counterproductive to that desired goal?

On the flip side, you’ve also got the psychologist/psychiatrist that will become defensive of their diagnosis of a patient, if someone else’s point of view on that diagnosis is challenging their initial diagnosis. there too, we can see an attachment and the instinct to protect that attachment.