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Chapter 7: Getting on the Same Wavelength: Attachment and Attunement
Chapter 7 discusses the origins and details of attachment theory. Attachment theory was developed by John Bowlby in order to explain and categorize the bonds children and caregivers. These bonds are primarily secure or insecure, with secure bonds featuring a high level of attunement, or sensitivity to the emotional needs of each other. Secure attachment often predicts good outcomes for children, unless disrupted by later trauma. Insecure attachment is where the trouble arises. Insecure attachment may be anxious, avoidant, or disorganized. Disorganized attachment forms in abusive or neglectful situations, when a child longs for attachment with their caregivers and yet understands that they are threats. Children with disorganized attachment styles often have issues self-regulating in childhood that will later translate into aggression, impulsive behavior, and suicidal tendencies in adulthood.
Chapter 8: Trapped in Relationships: The Cost of Abuse and Neglect
This chapter describes the impact of child abuse on survivors well into their adult lives. Van der Kolk’s patient Marilyn typifies this experience. Having been raped by her father repeatedly in childhood, she was unable to maintain romantic and sexual relationships in adulthood. On the surface, she was able to have a “normal” life outside of romance, but in reality she felt emotionally numb. She also developed an autoimmune disease, something that incest survivors were found to be at risk of due to an immune system imbalance that causes it to attack itself. Abuse as a child changes a person both physically and mentally, and creates a map of the world in which they are unable to identify mistreatment and see themselves as the problem. Because of this, children are unable to effectively cope and repress the experience, often dissociating the negative emotions of the experience from the abuse itself.
Chapter 9: What’s Love Got to Do With It?
Chapter 9 examines the relationship between the diagnostic system and childhood trauma. Van der Kolk argues that survivors of trauma are underserved by currently available diagnoses. This leads to an incorrect diagnosis of a host of comorbid conditions such as bipolar disorder, depression, and ADHD, which focus more on their symptoms than the source and lead to incorrect treatment. Van der Kolk and his colleague Judith Herman conducted a study on the relationship between childhood trauma and borderline personality disorder (BPD), finding that 81 percent of patients in their study diagnosed with BPD reported childhood abuse or neglect. Another study run by Dr. Vincent Felitti, known as the Adverse Childhood Experiences (ACE) Study, found that these traumatic experiences were seldom an isolated incident, with 87 percent of respondents reporting 2 or more. Those who reported more incidents also tended to have higher rates of chronic depression, suicide attempts, and substance abuse.
Chapter 10: Developmental Trauma: The Hidden Epidemic
Chapter 10 discusses the prevalence of childhood abuse and neglect, as well as the lack of attention paid to it by the medical community. Van der Kolk points out the hundreds of thousands of children struggling in foster care, jail, and other government programs, often with behavioral issues and several comorbid diagnoses that do not get to the base of their problems. Currently available diagnoses address only symptoms, when the relationship between the child and caregiver(s) is what actually needs addressing. In an attempt to create a solution for these underserved and often misdiagnosed children, van der Kolk helped to create the National Child Traumatic Stress Network, and later helped to propose Developmental Trauma Disorder, or DTD, for inclusion in the DSM. However, this diagnosis was rejected.
