199. Attachment Theory & Offender Behavior PART 2

backwards at where disorders form. And there are only two officially that are included in the Diagnostic and Statistical Manual that is reactive attachment disorder and disinhibited social engagement disorder.

really early childhood. It actually remains unclear whether it even occurs in children older than five, So this diagnosis is made pretty early on. Reactive attachment disorder can happen when the child's basic needs for comfort, affection, and nurturing aren't met and stable loving relationships with others just aren't developed. And I think, in a sense that's really putting it too lightly. Sometimes they talk about it like that in

the literature. Generally this is going to be due to high levels of neglect, abuse, or frequent changes in caregivers. The combination and severity of these factors directly impacts the child's inability to form healthy emotional bonds. However, most children who are severely neglected don't go on to develop reactive

attachment disorder. Remember we're still taking into account that humans and even children and babies are incredibly resilient, so children with reactive attachment disorder often show emotionally distant behaviors towards their caregivers and have difficulty managing their emotions. This can sometimes appear as aggression or violence, and to cope, they might even pull away from interactions with their caregivers, rarely seeking comfort when upset and showing little to no response

when comfort is actually offered. Basically, the behaviors of the children fall into two categories. The first is social and emotional disturbances, so this is unexplained irritability, sadness, or fearfulness during non threatening interactions with caregivers, and then the other

is aggressive or violent behaviors. Some children, even this young with reactive attachment disorder may display aggression towards their peers, animals, or even themselves, often as a result of unmet emotional needs and in a of course at this age to process really complex emotions. With proper treatment, children with reactive attachment disorder can learn to build healthier and more stable relationships. Treatment often focuses on creating a safe, nurturing environment and

encouraging positive interactions between the child and caregivers. Counseling and education for parents or caregivers can also play a really key role in supporting the child's development and is absolutely key. So children who grew up in Romanian orphanages often had trouble adapting to their new lives after being adopted, and MRI studies found that these children had smaller brains than average children. So just like a footnote to show how impactful this.

to them at all. So infants were basically wrapped and swaddling, They were fed, they were kept warm, their diapers were changed, but there was no body contact and there was no attention, and there was also very very little stimulation. So the kids as adults, I mean now, historically we have figured

out that there's a lot of developmental issues. I mean, it's interesting because the nurture informed the nature as it were, basically a lack of stimulation actually caused these individuals to have noticeably smaller brains than average for children at that physiological developmental stage. So again, if you want to go down a crazy, crazy but fascinating research hole, just go to the Wikipedia page four Romanian orphans and read on that.

It's fascinating. Now, the good news is that there are some evidence based interventions for rad But while I'm just going to quickly in a bit rattle off a few of them, I want to be really clear about treatment. And this is for anybody that's out there that is the parent to special needs children, to people who have relatives that are parents the special needs children, or somebody that's witnessing a mountdown in public, of which you may not have any idea of what's going on. This is

not a walk in the park. None of these treatment modalities is a magic wand to fix it. It's a slog at least the ones that I've witnessed. Although I have seen really really fantastic outcomes, it's not easy for the parents, and being such a stressful experience for both the parent and the child has to be understood that it requires a total buy in from parents or caregivers. Both parents and clinicians are going to face really unique challenges because they have to navigate a very complex and

emotionally charged process of healing. And as we've discussed so far, RAD is rooted in early trauma, neglect or inconsistent caregiving, and it leaves the children with deeply rooted trust issues and difficulties informing even understanding healthy relationships. The treatments are not about bandaging a wound, it is about demolation of

some faulty emotional foundation work. So parents that are trying to help the child with RAD are often caught in a tsunami of emotional ups and downs, a literal emotional roller coaster, if you'll be patient with my massacring of etymology and metaphors. At the same time, kids with RAD can push caregivers away while simultaneously needing them desperately, so

it's a confusing push pull dynamic for the kids. That's just exhausting for everyone, and it's not in common for parents to feel rejected or blamed for behaviors that they can't control or fix overnight, and sometimes the pushing away of any attempts at healing is a misfiring of defense mechanisms that individuals engage in because chaos has become the

baseline for the kids. Techniques like attachment based parenting require consistency, patience, and empathy even when a child exhibits rad behaviors like lying, stealing, aggression, and the child's resistance to closeness that stems from early trauma can make parents feel like they're pouring love into a bucket that has a hole in it, right, so they need to manage daily life like school work, and it's easy to see why the burnout becomes a real concern.

And in saying rejected or blamed, I don't want to minimize the impact that all this has on a harried and exhausted parent. The parent is trying to follow a prescribed treatment protocol, manage their kids explosive or angry damaging behaviors,

and then manage their own adult reactivity to it. That's so much, and that's like something that an outsider cannot see or understand, Like if you're seeing you know it's just so easy to throw off judgment on how kids are being parented in your view when you just see something happening at Target or Costco, or in a parking lot or a restaurant or on a plane or something.

work like that. Modalities like diadic development, psycotherapy, trauma focused CBT, which is cognitive behavioral therapy or attachment and behavioral catchup can offer templates and frameworks, but carrying them out requires a good bit of flexibility and creativity to meet that particular kid's needs. As an additional challenge, RAD often comes with a side order of other behavioral or emotional challenges like ADHD, generalized anxiety disorder, or even conduct disorders, making

diagnosis and treatment a really layered puzzle. As we've referred to in the past, Diagnosing children is a challenge, and it should be a challenge because quick diagnoses of children, at least to me, is just always a sign of a clinician phoning it in. Clinicians have to tread carefully with parents, ensuring that they feel supported but not blamed, as unresolved feelings of guilt or frustration can create roadblocks

in the treatment process. All of these approaches demand long term commitment, and that can be tough for families juggling other responsibilities or dealing with financial strain. And the reality is is like, we're incredibly lucky here in southern California, Like we have so many resources within our schools even to help with these types of things, and there are areas of our country that don't have anything like this

at all, and parents struggle. There's also the idea of cultural challenges that stem from class from socioeconomic status from age and such. I can't tell you the number of times that I've had to have really tough conversations with parents who refuse to accept diagnoses, and then those that get caught up in diatribes that begin with well, back in my day, we didn't have any of this nonsense, we didn't have all this autism stuff, we didn't have

all this reactive attachment to sort. You know, they just want to kind of have a very closed view of it. But most of these treatment modalities require parents to be active participants, and of course that is going to feel uncomfortable if trust between parent and child is already shaky from the precipitating behaviors. So building a therapeutic alliance with a child who struggles to trust can take time, and

lots of it. The progress can be slow, like glacially slow, and it can also be nonlinear or recursive, and that can leave exhausted parents and clinicians questioning whether or not their efforts are working. Patience is the key in one of the many challenges. So now that I've expanded on the challenges, there are really really great success stories out there. Amazing breakthroughs happen when a child starts seeking comfort, making

eye contact, or expressing affection, it's a game changer. So healing from rad is a marathon, it's not a sprint. And while the journey is going to be really tough, the possibility of success will literally alter the path of

the kid's life and that is well worth it. So just without going too far into it, Like diadic developmental therapy, it focuses on enhancing the relationship between the caregiver and the child and you know, fostering that sort of nurturing environment that may not have been there initially, and that

focuses on the importance of creating positive interactions. Diadic development, I think is also the one where there are periods, especially in older children, where the kid has to sit between the parents hours a day, Like if we're going to eat dinner, if we're going to watch television, you're sitting between us so that actually our bodies are touching, which is very fascinating, right, Like I'm sure some people would have like an absolute terrible reaction to that, like, oh,

what a terrible idea. But what you're doing is you're rewiring a person to understand that there's trust and safety in the containment of the relationship. It's fascinating stuff.

given instruction on how to interact with their kids. Now ours was done with an old timy phone, which sounds incredibly archaic, I know, but there are really incredible videos online on YouTube of people engaging in parent child interaction therapy where parents have like a bluetooth microphone in their ear, and there's a clinician outside the mirror coaching them on how to give their kids praise. And this one is actually done with the parents who basically, because of their

own upbringing, really didn't have any parenting skills. Sure, and the transformation that happens is unbelievable. Like you just see the kids break into these huge smiles when they get a compliment and immediately just launch themselves physically at their parents for a hug. The parents are just they're emotional in the interviews afterwards because they're sharing, you know, now I see how powerful this was. I wish I had had this, but I definitely want to have this, you know,

for my child. Then there's also trauma focused cognitive behavioral therapy, and this one is really important and different from the other ones because it's looking through that window of children who have experienced trauma, and it integrates trauma sensitive interventions with cognitive behavioral techniques are at the level the child can understand, and the idea there is to reduce trauma related symptoms. So if you reduce the symptoms, then you

can go do the foundational work. So many other things involved here. You have to have an assessment that is really comprehensive. It can't be a fifteen minute interview by telehealth with a nurse practitioner who has no background in this, like you just you can't have that. You have to have caregiver involvement, like you've pointed out so beautifully, It's

not necessarily going to be the biological parents. It may maybe the biological parents have realized that what they were doing was neglectful or abusive and they're being allowed back into the process. That's always great. Our studies show as much as we have a reaction to or you know what, I won't even generalize it to other people. My bias, which is incorrect. I have an incorrect bias that I

am sharing. My incorrect bias is to say, take the kid out of that environment, get them out, get them out, don't let them back in. Maybe that's because of my own avoidant attachment style. That could be it, because the studies show that generally speaking, children will do better in their biological environment if the offending behaviors, if the aberran or the unhealthy toxic behaviors can be modified, and we have to hold hope right that they can. If we can do.

the child. If you're interested in looking up more information, the legitimate sources we suggest are the American Academy of Child and Adolescent Psychiatry, the Mayo Clinic, and the Journal of the American Academy of Child and Adolescent Psychiatry. This episode is just makes me so grateful for the work that people who specialize in child psychology and psychiatry do, because man, what a really tough road some of these

can be. And I say it all the time, there's a mental health professional cutout for every type of work there is, and I'm just so grateful for those that are drawn towards this type of work. The prognosis on RAD indicates that with early and appropriate intervention, children with this disorder can develop healthier attachment patterns and improve their

emotional and social functioning. However, without treatment, RAD can lead to persistent relational difficulties and an increased risk of mental health issues later in life, as well as the acting out, violent or severe behaviors that we've highlighted already. So again, treatment and early early identification and then intervention so important. Research shows that attachment disorders in juvenile's behavior generally falls into three categories. So typically we look at antisocial conduct,

which is like lying, stealing, manipulation. We look at aggression, both verbal and physical aggression are common, especially when children feel threatened or abandoned. And then we look at emotional and dysregulation. Are there extreme outbursts, what's their impulsivity, like the difficulty of forming friendships because of the emotions that go along with that. So let's quickly examine a couple of real life cases based on behavioral patterns commonly associated

with attachment related issues. So not all disorders necessarily, but at the very least insecure attachment styles, or perhaps there are some suspected attachment disorder going on here. So first one is the case of Mary Bell from nineteen sixty eight out of England. At age ten, Mary Bell was convicted of the manslaughter of two boys age three and four.

The murders involved asphyxiation and acts of mutilation. So in terms of Mary's attachment background, she grew up in an abusive household where she experienced neglect and was exposed to violence and exploitation. Her mother was reportedly physically and emotionally abusive, contributing to severe attachment disruptions, and then behaviorally, Mary exhibited

a lack of empathy. She showed greater impulsivity and an inability to form meaningful social bonds, which are all hallmarks of disorganized attachment.

So was that learned behavior from the emotional and physical abuse that she experienced. It's hard to tell at this point, but it is very interesting and very uncommon. You don't see that type of abject cruelty in children. Eric Smith nineteen ninety three, USA. At age thirteen, Eric lured a four year old boy into the woods and killed him by strangulation and blunt forced trauma. Smith reportedly endured bullying and emotional neglect, and this may have contributed to feelings

of alienation and anger. The home environment in which he resided may have aggravated his difficulties in forming secure attachments. And then the noted behavioral traits that we have access to are indicated as isolation, anger, and really an inability to connect with his peers, And all these three definitely would be indicative of attachment disturbances, all right. So the other diagnosable disorder under attachment disorders is inhibited social engagement disorder.

It's also diagnosed in childhood. In this case, the child lacks appropriate nurturing and affection from parents for any number of reasons, emotionally unavailable parents to just full on intentional neglect. As a result of these unfulfilled needs, the child is not closely bonded to parents and is as comfortable with strangers as they are with their primary caregivers. That could be maybe seen as an advantage, but we could also

see how that could absolutely be problematic. Right. It's not good to immediately trust everybody in your environment as a child. The symptoms can look like this. No fear of adult strangers and no shyness when meeting new people for the first time. Behavior that is overly friendly or talkative to strangers, including hugging or cuddling of unknown adults. Another way to look at this is that there's no hesitation around strangers.

Even when departing with an unfamiliar person. This individual does not look to parents or their caregivers for permission to approach strangers. So it's like this defense mechanism that we just assume is normal in children just doesn't exist at all, And you can see already in this description how it

can be problematic. Symptoms like this can continue into the teenage years, where clearly that can get you in a lot of trouble, especially as a young woman, right but the condition is not known necessarily to last into adulthood. There are some similarities with RAD in terms of the etiology of the disorder, but the child with RAD is not necessarily friendly with unknown people. And as far as risk goes, infants and young children between the ages of six months and two years are more at risk of

developing d SD if they've been institutionalized. And as far as risk goes, infants and young children between the ages of six months and two years are at more risk of developing DSA if they've been institutionalized, for instance, after being abandoned or left in orphanages after the loss of birth parents, or if they spend time in changing or

inconsistent family environs like foster care. I think it's really important for us to note that although most of the research has been done with children who were in foster care, by no means do most children in these situations end up experiencing DSED. The data shows that about one quarter of young children in foster care developed this disorder, So

it's higher than it should be. It's higher than we want it to be, but we're not saying just across the board that all kids in foster care will develop this. There are parts of the research community that specialize in this area that question whether or not DSD should continue to be classified as an attachment disorder, because there's a camp that asserts that the indiscriminate friendliness exhibited by these children is thought to be independent of the child's attachment

or lack of attachment primary caregivers. So there actually is a diagnosis that has to do with brain structure that puts some children more at risk of this, and we won't go into that because it's fascinating. Law and order I think is done like two or three episodes about kids that get trafficked because they can't discriminate like this. But it's another area that'll be determined by more robust research.

are impacting adult behavior. But when we're talking about d s D and it said that really like this isn't a thing necessarily in adulthood. I think it speaks to the power of how social norms then start to shape our behavior at a certain yes point, right.

any of those flavored waters. But the idea of people like falling into this trap of labeling themselves when they're in distress, like, you know, I, you know, is something wrong with me? Do I have borderline? Am I antisocial?

And do I am I? This? Am I that? And you know the way we respond to that is that many adults, when under duress, when you are not in your best functioning or your best regulation, you may tend to exhibit something that is reminiscent of one of the ones that we used to say, the word the cluster be. But it doesn't mean that you have antisocial personality disorder,

doesn't mean that you have narcissistic personality disorder. It means that when you're under a great deal of stress, this may be a default position that you take temporarily just to keep yourself safe. So when we talk about attachment styles, I feel like there's nuance to be explored in that way.

I don't think we'd have to dig very far in the examples that we used just now with the kids and then in yesterday's episode with the adults to think that, Yeah, the nature, the environment of growing up in these particular environments clearly is going to have an impact. Maybe it's not a full on result of a style that is permanent and unchanging, but certainly there's going to be an influence and something that is reminiscent of the parameters we've been discussing.

attachment disorders. And I think you'll probably see very quickly how there's this concerning overlap to many of the criminals that we gave brief profiles on earlier, but generally what we're going to see, and primarily we're still talking about kiddo's here juveniles in terms of these disorders and how they're starting to act out. One very common one is

theft and substance abuse. Right, kid who repeatedly is stealing from stores, experimenting with drugs, This is going to be an indication that the child is really trying to figure out how to regulate their emotions and their behaviors. Not that they're having that very clear thought, right, but they're just trying to sort of control what's inside. So the theft, the substance abuse could be sort of searching for that controller, coping for the type of emotional pain that they are experiencing.

That is absolutely related to those attachment disruptions, is we've been I.

the thought process, the cognitive process of this child. Is the action the behavior for stimulation or is it an outlet, right for some inner turmoil that's going on, and it's being done by, Hey, I'm going to violate these social norms, which is scary, right. It's sort of the precursor of conduct disorder, which is a precursor to antisocial personality disorder

later down the line. So, really, as much as it can be examined, teased out, and then understood, what we're dealing with a child at this age.

version of that makes you a better person. Sure, but this seems to be like a distortion of that behavior and it goes just beyond and are they going just beyond because they were raised in an environment where the baselines were off to begin with. It just raises a lot of questions, doesn't it.

then little remorse is shown afterwards. Insecure, avoidant or disorganized attachment may underpin this lack of emotional connection that we then see. Remember we were talked about these attachment styles do at times impact the way people view themselves, but certainly also how they view others.

So this, for an example, might be a younger child who kills small animals in secret, and this behavior can often correlate with disorganized attachment and with that comes a lack of empathy that can be stemmed from those abusive environments. It could also be a reflection of a lot of other things, right, I mean kind of a skezoid presentation where that we've talked before about that devoid of emotional

connection to even the concept of life and suffering. So you know, we've seen interview after interview with children that have done this where they say they killed the animals because they wanted to kind of see how all of that worked.

But those are those are kind of the babies.

You know, when we were putting together the outline for the show, you said, we've already we've already used this example before, and we may have. At two hundred plus episodes, we may have. So I apologize, folks, but it's also for Shiloh and I that we gave up on The Walking Dead at various points just because it went off the rails. But we thought, you know, the first few seasons were was such a really good show.

for a child to take. Her character, Lizzie exhibits behaviors that can be understood through the lens of attachment disorders and trauma really really clearly, particularly disorganized attachment styles. She's erratic and extreme in her actions, and this suggests that she struggled to form a stable sense of trust or safety in her relationships. I mean, clearly that's going to be aggravated by living in a post apocalyptic world where caregiving figures are inconsistent and dying all the time and

life threatening situations are just the norm. So what the writers do really well is they create this character that shows a profound misunderstanding of relationship and emotional connection. And it can be that she over cares about certain people or certain objects while showing an inconsistent or lack of empathy and difficulty distinguishing reality from fantasy. Again, really good writing,

really good acting. Lizzie has this belief that the Walkers are the zombies, but I don't use the zombie word, that there's still people, and she just engages in dangerous actions that she keeps secretive for several episodes, and this highlights that she has an awareness that what she's doing is not going to be accepted by the adults that are really supposed to be taking care of her, and it shows that she's really has challenges navigating these social bonds,

regulating her emotions and such, and those kind of behaviors really do align with traits that are seen in children with disorganized attachment. I don't want to go too far into it because I just think it's fascinating, but she has this weird, giggly presentation towards one of the walkers that looked like he was like a good looking kid in his twinings before he died, and you know, she feeds him on a regular basis. She'll feed him animals

and stuff. And then they find where she's been dissecting frogs, and she knows that she's got to hide it because it's going to get her in trouble. It's a heartbreaking character arc that really beautifully done, and just I love the way that that's presented.

it's interesting because the did I hear something? You know? There's this theme, right of this intense pathological attachment to his mom that stems from this really immeshed I think is like the hallmark of what we think of an ameshed relationship in media. And then you and I are always like, wait, what are we doing pathologizing the mom and what did the mom do wrong? What was a

podcast we met in London? Don't blame the mother, don't blame Yeah, a lovely woman who does a podcast and she's well, at the time we're in London, she's pregnant. So we told her we love the name of her show,

because we're often saying things like that. But anyway, back to Norman, I mean, I think some people can say, you know, this is the epitome of this development of dissociative identity disorder, but clearly he has not been able to form healthy relationships and those attachments or lack of attachments have resulted in very violent behaviors, but he hides under that influence of his mother persona.

I think Gus van Sant was the director. But what's different, Oh, Julian Moore is in it too, So what's different is that he allowed the actors to have their own interpretation, so it wasn't like Vince Vaughn based his performance on line readings on the original Norman Bates in Psycho, and what you get to see, which I think is really well done by Vaughn, is just how odd Norman is because the original portrayal, so Anthony Perkins has a great

interpretation of this character. It's classic, you know, and there's I have no criticisms of it, but I think that something that Vince Vaughn does in terms of attachment is

that he's a little bit more obvious. It's like it's not quite so subtle, which I think is way more appropriate for someone that has dissociative identity disorder, that lives an isolated life, that has engaged in these types of killings before, has this fascination with death, Like, you know, like, let's not make it quite so attractive because Vince Vaughn is a good looking guy, but he's acting so quirky and buggy and weird, right, Like he makes it more sense.

Ripley's manipulative behaviors and his a moral personality. I think what is really cool, though, is that the movies build out this idea. Yes, he's manipulative and he's a moral The movie builds out with Matt Damon desperately needing these attachments, almost like a dommer in the way like I don't know how to make it work long term, but I need these things, or I need the accouterments of this lifestyle.

And then of course with the mini series there's really a lot more psychopathic interpretation of the character that also is really great. But in the novel, high Smith writes Ripley as an orphan from a very early age because his parents drowned in an accident when he was a child, and then he was raised by an abusive ant. The ant is described as emotionally abusive and often belittles him,

mocks him, and it's a toxic relationship. And it's meant to understand that this person has developed with a true sense of inadequacy and mistrust of the world around him. In the books, he's really depicted as a loaner, somebody who seems never able to form any meaningful connections with

anybody during his formative years. So he's also and this is a great window that you get from the novels, is that he is really aware from a young age of his socioeconomic difference from the people that are around him, and he wants to escape that. He wants to be successful and have all of the bells and whistles that come with that. Interesting, I just as I'm saying this,

I'm looking at our notes. The tender Swindler kind of emerges as somebody like that, the idea that comes from this incredibly radically poor background and just creates this whole fantasy that he's able to keep going over the years

and taking advantage of people. But Ripley's childhood appears to align with the traits of disorganized or avoidant attachment styles because he demonstrates with a lack of trust he can't form genuine connections, and also he has this ability to manipulate others without any remorse.

has actually murdered her somehow. But both the book and the movie do a really good job of showing how her parental influence has started to shape some of her personality. So her parents are quite narcissistic, quite detached in terms of how their parenting style was, which tends to show how probably you know, her distorted thinking and behavior formed and is underneath kind of her very well put together

presentation on the outside. Yes, so Amy's manipulation and her deceitful behavior obviously goes really really dark, but it points to an anxious, preoccupied attachment style. There is the fear of abandonment, there is the desire for control, and that really tends to lead some extreme actions to maintain some sort of weird perceived relational stability in her life through doing this to her husband and to her family and

to the media and the community. So I have a chance to read the book, I never read the book.

really fascinating. I thought it was really fascinating. First is like she's such a brilliant manipulator, and Gillian Flynn writes this so well that in the first few chapters you really don't know what's happening. You don't know, I mean, it seems like it's all real. But then you start questioning everything, like maybe her husband is crazy. Does the sister even exist? Nobody like you know, because they're all these things of like he has these conversations, but nobody

else is acknowledging the sister until they do. So there's like it's really great because it's very unsettling. Yeah, but one of the things that the movie does not elaborate on is. I mean, they talk about it, but you really get the impact of it in the books is that her parents are so narcissistic and amy is such a narcissistic extension for them that she doesn't really exist except to fulfill their needs and their authors of children's books,

and they write books about her adventures. But then there's these questions of what did they set her up for? And she ends up really taking advantage of people throughout her life. She ruins several people's lives as from when she's in high school all the way through college and young adulthood. And you kind of see a taste of it in the movie where he goes to interview people, but in the book you see a much more terrible depth of what she does to people and just completely

ruins their lives. And you realize that part of it may have been so that her parents would have something to write about how she overcame this awful thing that

she actually set up very very interesting stuff. But again, like we're saying in the big picture of all of this is that these attachment styles, if you think of them conceptually within a then diagram, there's overlap between personality disorders, neurodevelopmental issues interspersed with like organic and traumatic brain injury, all sorts of things that come to bear to give us an understanding of these factors. It's just fascinating stuff.

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little taste fantastic conversation. We can't wait for you to hear it anything else. Doctor Scott's no.