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Dissociation, Traumatic Attachments, and Self-Harm: Eating Disorders and Self-Mutilation

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Abstract

Self-harm, such as eating disorders and self-mutilation, represents dissociated compensatory attempts to serve self-regulatory functions. Self-harm develops when the child who has become attached to those who have inflicted pain and suffering maintains that attachment by inflicting pain on himself. Brain imaging studies have found that the communication pattern between parent and child shapes the way the child’s attachment system adapts to experiences with the attachment figure, literally hardwiring the child’s brain. The good news is that a safe and secure attachment is very good medicine and can rewire the brain. An attachment-based multi-phase approach to treatment is presented.

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References

  • Ainsworth, M., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment. Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Angier, N. (1994). Mother’s milk found to be potent cocktail of hormones. The New York Times, Sec. C, P. 1, Col. 1, Science Desk.

  • Armstrong, J., & Roth, D. (1989). Attachment and separation difficulties in eating disorders: A preliminary investigation. International Journal of Eating Disorders, 8, 141–155.

    Article  Google Scholar 

  • Benedek, T. (1959). Parenthood as a developmental phase. In Psychoanalytic investigations: Selected papers, 1973 (pp. 377–407). New York, NY: Quadrangle.

  • Blanck, G., & Blanck, R. (1974). Ego psychology: Theory and practice. New York, NY: Columbia University Press.

    Google Scholar 

  • Blizard, R. (2003). Disorganized attachment, development of dissociated self-states, and a relational approach to treatment. Journal of Trauma and Dissociation, 4(3), 27–50.

    Article  Google Scholar 

  • Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. New York, NY: Basic Books.

    Google Scholar 

  • Bowlby, J. (1973). Attachment and Loss: Vol. 2. Separation: Anxiety and anger. New York, NY: Basic Books.

    Google Scholar 

  • Bretherton, I. (1995). The origins of attachment theory: John Bowlby and Mary Ainsworth. In S. Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: Social, developmental, and clinical perspectives (pp. 45–84). Hillsdale, NJ/London: The Analytic Press.

    Google Scholar 

  • Bromberg, P. (1998). Standing in the spaces: Essays on clinical process, trauma, and dissociation. Hillsdale, NJ/London: The Analytic Press.

    Google Scholar 

  • Chassler, L. (1997). Understanding anorexia nervosa and bulimia nervosa from an attachment perspective. Clinical Social Work Journal, 25(2), 407–423.

    Article  Google Scholar 

  • Davies, J., & Frawley, M. (1994). Treating the adult survivor of childhood sexual abuse: A psychoanalytic perspective. New York, NY: Basic Books.

    Google Scholar 

  • Demitrack, M., Putnam, F., Brewerton, T., Brandt, H., & Gold, P. (1990). Relation of clinical variables to dissociative phenomena in eating disorders. American Journal of Psychiatry, 147, 1184–1188.

    PubMed  Google Scholar 

  • Deutsch, F. (1959). On the mysterious leap from the mind to the body. New York, NY: International Universities Press.

    Google Scholar 

  • Farber, S. (1995). A psychoanalytically informed understanding of the association between binge-purge behavior and self-mutilating behavior: A study comparing binge-purgers who self-mutilate severely with binge-purgers who self-mutilate less severely or not at all. Dissertation Abstracts International. (UMI Number 99603317).

  • Farber, S. (1997). Self-medication, traumatic reenactment, and somatic expression in bulimic and self-mutilating behavior. Clinical Social Work Journal, 25(1), 87–106.

    Article  Google Scholar 

  • Farber, S. (2000). When the body is the target: Self-harm, pain, and traumatic attachments. Northvale, NJ: Jason Aronson.

    Google Scholar 

  • Farber, S. (2003). Ecstatic stigmatics and holy anorexics, medieval and contemporary. Journal of Psychohistory, 31(2), 183–204.

    Google Scholar 

  • Farber, S. (2004). Safety first, interpretations later: An attachment paradigm for psychotherapy with the self-harming patient. Mental Health News, 6, 4, 29–30.

    Google Scholar 

  • Farber, S. (2005). Free association reconsidered: The talking cure, the writing cure. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 33(2), 249–273.

    Article  PubMed  Google Scholar 

  • Farber, S., Jackson, C., Tabin, J., & Bachar, E. (2007). Death and annihilation anxieties in anorexia nervosa, bulimia, and self-mutilation. Psychoanalytic Psychology, 24(2), 289–305.

    Article  Google Scholar 

  • Fonagy, P. (2001). Attachment theory and psychoanalysis. New York, NY: Other Press.

    Google Scholar 

  • Fonagy, P., & Target, M. (1995). Understanding the violent patient: The use of the body and the role of the father. International Journal of Psycho-Analysis, 76, 487–501.

    PubMed  Google Scholar 

  • Fonagy, P., Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York, NY: Other Press.

    Google Scholar 

  • Grotstein, J. (1993). Boundary difficulties in borderline patients. In L. B. Boyer, & P. Giovacchini (Eds.), Master clinicians on treating the regressed patient (pp. 107–141). Northvale, NJ: Jason Aronson.

    Google Scholar 

  • Hansburg, H. (1986). Detection of self-destructive tendencies in early adolescence. In Researches in separation anxiety: A third volume on the separation anxiety test (pp. 225–256). Malaber, FL: Robert E. Krieger.

  • Hofer, M. (1995). Hidden regulators: Implications for a new understanding of attachment, separation, and loss. In S. Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: Social, developmental, and clinical perspectives (pp. 203–230). Hillsdale, NJ: The Analytic Press.

    Google Scholar 

  • Holmes, J. (1996). Attachment, intimacy, autonomy: Using attachment theory in adult psychotherapy. Northvale, NJ: Jason Aronson.

    Google Scholar 

  • Howell, E. (2005). The dissociative mind. Hillsdale, NJ/London: Analytic Press.

    Google Scholar 

  • Hurvich, M. (2003). The place of annihilation anxieties in psychoanalytic theory. Journal of the American Psychoanalytic Association, 51(2), 579–616.

    PubMed  Google Scholar 

  • Khantzian, E. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142,11, 1259–1264.

    Google Scholar 

  • Kohl, M., Foulon, C., & Guelfi, J. D. (2004). Hyperactivity and anorexia nervosa: Behavioural and biological perspective. Encephale, 30(5), 492–499.

    PubMed  Google Scholar 

  • Kroll, J. (1993). PTSD/borderlines in therapy: Finding the balance. New York, NY: W.W. Norton.

    Google Scholar 

  • Krueger, D. (1989) Body self and psychological self: Developmental and clinical integration in disorders of the self. New York, NY: Brunner/Mazel.

    Google Scholar 

  • Liotti, G. (1995). Disorganized/disoriented attachment in the psychotherapy of the dissociative disorders. In S. Goldberg, R. Muir, & J. Kerr (Eds.), Attachment theory: Social, developmental, and clinical perspectives (pp. 343–363). Hillsdale, NJ/London: The Analytic Press.

    Google Scholar 

  • Liotti, G. (2006). A model of association based on attachment theory and research. Journal of Trauma and Dissociation, 7(4), 55–73.

    Article  PubMed  Google Scholar 

  • Loewald, H. (1960). On the therapeutic action of psychoanalysis. International Journal of Psycho-Analysis, 41, 16–33.

    PubMed  Google Scholar 

  • Loewald, H. (1991). Psychoanalysis as an art and the fantasy character of the psychoanalytic situation. In G. Fogel (Ed.), The work of Hans Loewald: An introduction and commentary (pp. 123–152). Northvale, NJ: Jason Aronson.

    Google Scholar 

  • Lyons-Ruth, K. (2003). Dissociation and the parent-infant dialogue: A longitudinal perspective from attachment research. Journal of the American Psychoanalytic Association, 51(3), 883–911.

    Article  PubMed  Google Scholar 

  • Lyons-Ruth, K., & Jacobwitz, D. (1999). Attachment disorganization: Unresolved loss, relational violence, and lapses in behavioral, attentional strategies. In J. Cassidy, & P. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 520–554). New York, NY: Guilford Press.

    Google Scholar 

  • Main, M., Kaplan, N., & Cassidy, J. (1985). Security in infancy, childhood, adulthood: A move to the level of representation. In I. Bretherton & E. Waters (Eds.), Monographs of the society for research in child development (Vol 50(1–2), Serial No. 209, pp. 66–104).

  • Main, M., & Morgan, H. (1996). Disorganization and disorientation in infant strange behavior: Phenotypic resemblance to dissociative states. In L. K. Michelson, & W. J. Ray (Eds.), Handbook of dissociation: Theoretical, empirical and clinical perspectives (pp. 107–138). New York, NY: Plenum Press.

    Google Scholar 

  • Main, M., & Solomon, J. (1986). Discovery of a new, insecure-disorganized disoriented attachment pattern. In T. Brazelton & M. Yogman (Eds.), Affective development in infancy (pp. 95–124). Norwood, NJ: Ablex.

    Google Scholar 

  • McDougall, J. (1989). Theaters of the body: A psychoanalytic approach to psychosomatic illness. New York, NY: W.W. Norton.

    Google Scholar 

  • Miller, D. (1994). Women who hurt themselves: A book of hope and understanding. New York, NY: Basic Books.

    Google Scholar 

  • Nelson, J. (2005). Seeing through tears: Crying and attachment. New York, NY: Brunner-Routledge.

    Google Scholar 

  • Nijenhuis, E. (2004). Somatoform dissociation: Phenomena, measurement, and theoretical issues. New York, NY: W. W. Norton & Company.

    Google Scholar 

  • Perry, B., Pollard, R., Blakely, T., Baker, W., & Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and “use-dependent” development of the brain: How states become traits. Infant Mental Health Journal, 16, 271–291.

    Article  Google Scholar 

  • Roffman, J., Marci, C., Glick. D., Dougherty, D., & Rauch, S. (2005). Neuroimaging and the functional neuroanatomy of psychotherapy. Psychological Medicine, 35(10), 1385–1398.

    Article  PubMed  Google Scholar 

  • Rosen, P., Walsh, B., & Rode, S. (1990). Interpersonal loss and self-mutilation. Suicide and Life Threatening Behavior, 20, 177–184.

    PubMed  Google Scholar 

  • Sachs, A. (2004). The many acts of self-harm: An act of multiplicity and dissociation. Presented at the Centre for Child Mental Health Conference, Bodies Under Attack: Children and Young People Who Hurt Themselves, Starve Thenselves, or Want to be Dead. London.

  • Scaer, R. (2005). The trauma spectrum: Hidden wounds and human resiliency. New York, NY: W.W. Norton.

    Google Scholar 

  • Schore, A. (1997). Interdisciplinary developmental research as a source of clinical models. In M. Moskowitz, C. Monk, C. Kaye, & S. Ellman (Eds.), The neurobiological and developmental basis for psychotherapeutic intervention (pp. 1–71). Northvale, NJ: Jason Aronson.

    Google Scholar 

  • Siegel, D. (1999). The developing mind: How relationships and the brain interact to shape who we are. New York, NY: Guilford Press.

    Google Scholar 

  • Simeon, D., Stanley, B., Frances, A., Mann, J. J., Winchel, R., & Stanley, M. (1992). Self-mutilation in personality disorders: Psychological and biological correlates. American Journal of Psychiatry, 149, 221–226.

    PubMed  Google Scholar 

  • Steele, M., & Steele, H. (2007). The development of mentalization: Recent findings from the London longitudinal study of intergenerational patterns of attachment. Paper presented at the Annual Conference of the Society of the New York School for Psychoanalytic Psychotherapy and Psychoanalysis, New York, NY.

  • Steiner, J. (1996). The aim of psychoanalysis in theory and practice. International Journal of Psycho-Analysis, 77(6), 1073–1082.

    PubMed  Google Scholar 

  • Taylor, G. (1987). Psychosomatic medicine and contemporary psychoanalysis. Madison, CT: International Universities Press.

    Google Scholar 

  • Taylor, G., Bagby, R., & Parker, J. (1991). The alexithymia construct: A potential paradigm for psychosomatic medicine. Psychosomatics, 32(2), 153–164.

    PubMed  Google Scholar 

  • Tillman, J. (1999). Erotized transference and self-mutilation. The Psychoanalytic Review, 86(5), 709–719.

    Google Scholar 

  • Tustin, F. (1986). Autistic barriers in neurotic patients. London: Karnac.

    Google Scholar 

  • van der Kolk, B. (1988). The trauma spectrum: The interaction of biological and social events in the genesis of the trauma response. Journal of Traumatic Stress, 1(3), 273–290.

    Google Scholar 

  • van der Kolk, B. (1989). The compulsion to repeat the trauma: Re-enactment, revictimization, and masochism. Psychiatric Clinics of North America, 12, 389–411.

    PubMed  Google Scholar 

  • van der Kolk, B. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry, 1, 253–265.

    Article  PubMed  Google Scholar 

  • van der Kolk, B., Perry, J., & Herman, J. (1991). Childhood origins of self-destructive behavior. American Journal of Psychiatry, 149, 1665–1671.

    Google Scholar 

  • Winchel, R., & Stanley, M. (1991). Self-injurious behavior: A review of the behavior and biology of self-mutilation. American Journal of Psychiatry, 148(3), 307–317.

    Google Scholar 

  • Winnicott, D. (1953). Transitional objects and transitional phenomena. International Journal of Psycho-Analysis, 34(47), 510–516.

    Google Scholar 

  • Winnicott, D. (1965). The maturational processes and the facilitating environment. New York, NY: International Universities Press.

    Google Scholar 

  • Woodruff, M. (1999) Flesh made word: Cutting back to the mother. The Psychoanalytic Review, 86(5), 701–708.

    Google Scholar 

  • Wurtman, J., Wurtman, R., Growdon, J., Henry, P., Lipscomb, A., & Zeisel, S. (1981). Carbohydrate craving in obese people: Suppression by treatments affecting serotonergic transmission. International Journal of Eating Disorders, 1, 2–15.

    Article  Google Scholar 

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    Sharon K. Farber

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  1. Sharon K. Farber
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Farber, S.K. Dissociation, Traumatic Attachments, and Self-Harm: Eating Disorders and Self-Mutilation. Clin Soc Work J 36, 63–72 (2008). https://doi.org/10.1007/s10615-007-0104-6

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