Attachment disorder: Breaking unhealthy patterns and forming deeper connections

• A clinical attachment disorder is a rare diagnosis in children. In adults, relationship difficulties are more often linked to personality disorders or different attachment styles.
• When fear of commitment and fear of loss collide, this can create a  difficult relationship dynamic.
• Psychotherapy can help identify and change unhealthy behavioural patterns. Health insurance covers treatment if it is prescribed by a doctor.

People experience relationships in many different ways. Yet many of us have similar expectations of a partnership, such as love, trust and reliability. Today, when someone finds it difficult to form a deeper relationship, this is often described on social media as an attachment disorder.

In everyday language, the term is increasingly applied to adults. However, it originally referred to a diagnosis in child and adolescent psychiatry. Affected children experience developmental difficulties that significantly influence how they interact with others.

There are many reasons why someone may develop insecure attachment patterns. These may be linked to a violent or abusive environment, but this is not always the case.

“An attachment disorder can also develop if, for example, a parent is seriously ill and therefore unable to be sufficiently available to the child,” says Dr Mark Ebneter, chief consultant for psychotherapy and psychosomatic medicine.

Medical diagnostic systems such as ICD-10 distinguish between two forms:

• With the reactive attachment disorder, children tend to avoid their caregivers, rarely seek comfort and are excessively anxious or vigilant. 
• With the disinhibited attachment disorder, children behave with unusual familiarity towards strangers and seek close contact immediately.

“A child’s experiences with their caregivers form a kind of blueprint for their attachment behaviour later in life,” says Mark Ebneter. Not all early patterns lead to a clinical diagnosis in adulthood. However, insecure attachment styles can make it more difficult to build and maintain fulfilling relationships. 

Paediatrician and psychiatrist John Bowlby first described attachment theory in the 1950s. It was later developed further by developmental psychologist Mary Ainsworth. Her work forms the basis of the four attachment styles:

• Secure: Trusts themselves and others, can accept closeness while remaining independent.
• Insecure-avoidant: Avoids closeness for fear of rejection. 
• Insecure-ambivalent: Strongly focused on caregivers and prone to fear of loss. 
• Insecure-disorganised: Alternates between longing for closeness and suddenly withdrawing.

Although “attachment disorder” isn’t a diagnosis used for adults, “relationship problems are often a key feature of other adult diagnoses, such as personality disorders,” says Ebneter.

For example, when the emotional ups and downs of borderline personality disorder affect relationships: intense closeness is followed by sudden rejection. By contrast, people with dependent personality disorder tend to be more submissive and constantly seek reassurance.

Everyone has a bad day once in a while. However, certain relationship patterns – especially when they occur repeatedly – can make it difficult to maintain a loving relationship. These include:

• Difficulty allowing emotional intimacy and building trust
• An excessive need for closeness and reassurance
• Severe mood swings
• Impulsive reactions 
• Difficulty expressing emotions and needs clearly
• Fear of criticism and rejection

Fear of commitment and fear of loss may seem like opposites, but on closer examination, they often share the same root cause: the attempt to protect oneself from further painful relationship experiences.

• Fear of commitment can cause people to withdraw as soon as a relationship becomes closer and more serious.
• Fear of loss can cause people to cling to a partner, put their own needs aside and constantly seek reassurance.

When the two come together, a relationship dynamic develops that Mark Ebneter explains as follows: “Someone with an anxious attachment style often chooses a partner with an avoidant attachment style because their apparent independence is appealing. Although this relationship dynamic can be surprisingly stable, it is also highly stressful for both partners.”

If recurring behavioural patterns are affecting your quality of life, therapy may be recommended. An initial consultation with your family doctor can help establish whether these difficulties are part of a treatable condition, such as a personality disorder, depression or an adjustment disorder, or whether couples therapy could help. 

Psychotherapy has shown promising results for some personality disorders, such as with avoidant personality disorder and borderline personality disorder. According to Mark Ebneter, even patients with complex post-traumatic stress disorder (cPTSD) have a good chance of improvement.

Complex PTSD can develop, for example, when someone experiences repeated trauma at a young age. “According to study findings, approximately 80% of those affected no longer meet the diagnostic criteria for complex PTSD after completing treatment. This doesn’t mean that they are cured or completely symptom-free, but it does show that modern psychotherapy methods are effective.”

Psychotherapy can also help people address and change unhealthy relationship patterns and fears. Various approaches are available:

• Cognitive behavioural therapy: Helps you recognise current behavioural patterns and practice new, healthier ways of communicating.
• Depth psychologically grounded psychotherapy: Focuses on unconscious conflicts and childhood experiences.
• Specific approaches: Methods such as schema therapy, mentalisation-based therapy (MBT) and group therapy incorporating bodywork and creative techniques can help people rebuild their connection with themselves and others.

Since 1 July 2022, treatment by a psychotherapist has been covered by basic insurance (OKP), provided that the therapy is prescribed by a doctor with the relevant specialist qualification. 

However, it may take some time before an appointment becomes available. A survey of medical specialists conducted in 2024 shows that adults have to wait an average of 41 days between making initial contact and attending their first appointment. For children and adolescents, the average waiting time is 56 days.

Couples therapy must be paid for privately, although waiting times are generally much shorter. 

A clinical attachment disorder is a rare condition diagnosed in childhood and often associated with neglect. In adults, relationship difficulties are more commonly linked to insecure attachment styles or personality disorders.

Although these patterns may be deeply ingrained, therapeutic practice shows that change is possible. With professional support and the courage to develop greater self-awareness, you can break unhealthy relationship patterns and find new ways to build more stable, fulfilling partnerships.