Editor’s note: Early attachment trauma can also occur due to non-abusive circumstances, such as when a child is separated from their primary caregivers due to medical concerns. However, this article focuses primarily on attachment trauma caused by neglect and abuse.

Early attachment trauma is a distressing or harmful experience that affects a child’s ability to form healthy interpersonal relationships. It includes abuse, abandonment, and neglect of an infant or child prior to age two or three. These traumas can have subtle yet long-lasting effects on a person’s emotional health.

Understanding Infant Memory

As adults, or even children, we cannot recall narrative memory from our lives as infants. For most, the concept of memory is thought of as the ability to recall events, usually in the form of cognitions and images. In general, people cannot recall any events prior to ages three or four. Because of this, there is a pervasive and inaccurate view that infants do not recall any experiences, including traumatic experiences.

In fact, the human brain has multiple ways to recall experience. Think about it. Infants, at some point, obviously learn to walk and talk. Everything that occurs in our human experience is stored in our memory. However, not everything is stored narratively or explicitly. We have motor, vestibular, and emotional memory as well.

All incoming sensory information creates neuronal patterns which are “imprinted” in our brains. These neuronal patterns are a form of memory. We create memory “templates,” or stored patterns, the majority of which are non-cognitive and preverbal. These templates will influence us for the rest of our lives.

When Attachment Trauma Occurs

Unfortunately, when attachment interruptions (such as abandonment) occur in infancy, abnormal associations may be created. Physiological state memories, motor vestibular memories, and emotional memories are stored, and they can be triggered in later life. These triggers can manifest as mistrust or fear of interpersonal attachment.

Since the original template for how relationships work was formed in early childhood, all future relationships can be corrupted. The person may find themselves struggling with difficulties in relationships, particularly with respect to trust, bonding, and intimacy—the core elements of healthy attachment. Part of the problem may be the person having absolutely no cognitive awareness of the source of their fears or that they were betrayed in infancy. This can make treatment efforts difficult.

The brain is designed to change in response to experience, and all experience has an impact on the brain. With respect to traumatic experiences, the impact is on the parts of the brain involved with stress and fear. These would be the parts of the brain known as the limbic system (e.g., amygdala), neuroendocrine system (pituitary-adrenal axis), and the cortical systems; all of which can be altered in traumatized children.

The Inner Working Model

How a person relates to the self and others as an adult involves their “inner working model,” which consists of:

• How they see themselves (Am I worthy? Am I loved?)
• How they see others (Are they available? Are they responsive?)
• How they see the world (Is it safe? Is it fair?)

This inner working model has developed since birth and involves how relationships worked in the person’s life. Was the person attuned to and connected with? Or were they left to fend for themselves, crying themselves to sleep each day? The experiences people had with their parents and other important relationships shaped their developing inner working models.

As people progress through life, their working models can become further developed and influenced by each new experience. Remember, the brain is elastic (neuroplasticity), and neural connections can be “rewired” through experiencing all of life’s different influences.

That being said, the relationship templates people seem to draw upon the most are those created in early life. The job of psychotherapy, using the knowledge of neuroplasticity, is to create adaptive working model templates in place of maladaptive ones.

Barriers to Treatment

The problem with early attachment injuries is that while implicit memory is affected, there is no explicit or narrative memory to recall.

This can create the following constraints in therapy:

• There is no image from memory to draw upon.
• There is no language associated with the psychological injury.
• There is no cognition associated with the early attachment trauma.
• There is no awareness of the injury.
• There is no body sensation associated with the hurt.
• There is no recognition of a hurt to repair or release.

Instead, therapist and client must “work with the gaps.” Veracity need not be challenged in the process. The goal will be to process implicit memory. This is good to know, but how does one, exactly, process implicit memory?

Working with the Adult with Attachment Trauma

The psychological injuries could involve both the self as well as one’s interpersonal relationships. Perhaps victims of early attachment disruption have an “internal attachment disorder,” mirroring the emotional injuries experienced in early childhood. Perhaps victims of this type of neglect have learned to alienate from both self and others as an essential survival strategy.

A key to recovery is learning to identify the person’s various parts of self. In order to heal the “hurt inner infant,” one has to be cognizant of the fact that there are various “parts” to one’s psyche, and each needs recognition.

It is helpful to realize that unresolved internal attachment issues can surface as otherwise normal life stressors that evoke the fears and feelings of one’s disowned, abandoned inner parts. You can help your client heal by teaching them to embrace the parts of self that were unconsciously “disowned,” even as these parts are causing havoc in their current life. This process involves befriending the parts of self by listening internally and paying attention to the likes, dislikes, fears, fantasies, and habits of each one.

Healing the “Inner Infant”

This involves imagery: visualization and learning to see within. Part of the process involves learning to embrace one’s inner infant by holding it close and nurturing the part of self that is vulnerable and lacking in trust. Healing will come as the person learns how to meet their inner unmet needs from infancy. Judgment has no helpful role in this process; instead, self-compassion and acceptance are key to recovery.

The Role of Others

In addition to working with oneself, healing broken inner working models and relationship templates requires developing and nurturing healthy relationships with others. This can be done by being in relationships with people who already have a secure attachment style. It can also be accomplished through therapy and with the help of support groups.

References:

1. Fisher, J. (n.d.) Healing Early Attachment Injuries by Listening to Our Trauma: Using Sensorimotor Psychotherapy to Speak with Shameful Inner Parts. Retrieved from: https://www.psychotherapynetworker.org/blog/details/695/healing-early-attachment-injuries-by-listening-to-our
2. Garza, N. (n.d.) Learning to See Differently: Why the Adult Attachment Model Succeeds When Others Fail. Retrieved from: https://www.fulsheartransition.com/our-program/treatment/adult-attachment-model
3. Paulsen, S.L. (2017). When there Are No Words: Repairing Early Trauma and Neglect from the Attachment Period with EMDR Therapy. Bainbridge Island, WA: Bainbridge Institute for Integrative Psychology.
4. Perry, B. (2014). Helping Traumatized Children A Brief Overview for Caregivers. Published by: The Child Trauma Academy. Retrieved from: https://childtrauma.org/wp-content/uploads/2014/01/Helping_Traumatized_Children_Caregivers_Perry1.pdf
5. Pietromonaco, P.R. & Barrett, L.F.(2000). The Internal Working Models Concept: What Do We Really Know About the Self in Relation to Others? Review of General Psychology Copyright 2000 by the Educational Publishing Foundation 2000, Vol. 4, No. 2, 155-175.

As much as we would love to envelop our kids in bubble wrap and follow them around everywhere, our job is ultimately to teach them to take care of and stand up for themselves. In recognition of National Child Abuse Prevention Month this April, and because childhood sexual abuse is an important issue to educate children about, I am sharing some tips for teaching kids about sexual abuse and body safety.

Nothing can guarantee our children’s safety, but talking to them about consent and their bodies and teaching them how to find a safe grown-up to tell if abuse does take place can both reduce the risk of abuse happening and prevent further abuse. Having open and ongoing conversations with your children about their bodies can help them feel empowered and confident and show them they have you on their team, no matter what. [fat_widget_right]

1. Make sure you are emotionally regulated first.

First and foremost, do what you can to get emotionally regulated and come from a place of love, not a place of fear. If you are panicking and overly fearful, your kids will pick up on it. As a trauma therapist, I have heard many stories from people who tried to tell their parents about abuse they experienced. Some report their parents responded appropriately, but far more report their parents either didn’t believe them or became so emotionally upset that their feelings became the center of the attention. Rather than the parent staying as regulated as possible so the child could trust them with their feelings, the parent’s trigger took up all the emotional space. This can make the child feel they not only have to navigate through the abuse on their own, but are now responsible for managing their parents’ feelings as well.

Set conversations up with the message, “Your body is awesome, strong, and beautiful, and it is my job as your caregiver to help you have a good relationship with your body and keep it healthy and safe.” Being able to have these conversations from a calm place will help build trust between you and your child. This is not to say the topic is not a difficult one, because it is. But talking about bodies should be as casual and calm as teaching kids to buckle their seat belt or cross the street.

As a trauma therapist, I have heard many stories from people who tried to tell their parents about abuse they experienced. Some report their parents responded appropriately, but far more report their parents either didn’t believe them or became so emotionally upset that their feelings became the center of the attention.

2. Use real names for body parts and start young!

Another difficult topic for many parents is using real names for body parts. Call a penis a “penis,” not a “wee wee.” Call a vagina a “vagina” and not a “hoo hoo.” Giving private parts nicknames implies there is something to be ashamed of. You can talk about how private parts—breasts, vaginas, bottoms, and penises—are very sensitive; you may notice children play with themselves rather casually. You can say to them, “Those parts of our bodies are special, and they can be very sensitive, but they are only for you to touch.”

It is also important to talk to them about not touching other people’s private parts. This means talking to young children as well. I began talking to my sons about their bodies from the time they were babies. Talking about their bodies casually has given my boys the ability to be comfortable talking to me about their privates. Although these conversations can be awkward and at times, humorous, the fact that my boys can talk to me about their bodies tells me I am a safe person for them to come to. There are countless stories of children not talking to parents or caregivers about abuse because they had no language about it; there was no guidance from healthy, well-boundaried caregivers. Their only guidance was from the perpetrator, who inevitably instilled shame and secrecy.

3. Teach what healthy touch is and is not.

Teaching children what not to do is vital, and talking to them about what healthy touch looks like is also very important. Our pediatrician always says, “The only time it is okay for another person to touch or look at our private parts is when they are keeping us safe, healthy, or clean.” Teaching children what healthy touch looks like gives them a framework for listening to their own intuition about what is not safe or healthy. If you have older teenagers that are starting to experiment with sex, this will be a different conversation. Having continuous conversations about sex and consent is extremely important. We not only have to teach kids about saying no to things, but also what it means for them (and for their partners) to say yes. Sex is pleasurable, and we must be able to be honest about that. Otherwise, they are once again navigating these waters without adult guidance.

4. Let children know they are in charge of their bodies.

Another notion we must come to grips with as parents is that our children are in charge of their own bodies. Think about it—can we control where and when they pee? What and when they eat? Where and when they sleep? No. We can and need to have structure, boundaries, schedules, and rules around these areas, but ultimately, children are in charge of their bodies and need us to teach them how to make good choices about taking care of themselves when we are not around to watch their every move.

If we try to control our children too much, they will learn either to rebel or to submit. This also means they should be in charge of when and to whom they give affection. Not forcing them to give grown-ups a hug or kiss is a way of teaching consent. You can provide alternatives. Give options like “How would you like to say goodbye? An air high five, a fist bump, or just a wave?” I often say, “We don’t have to do anything with our bodies that doesn’t feel right, but we do have to treat people with respect. So, I’d like for you to choose how you want to say goodbye.”

Teaching children what healthy touch looks like gives them a framework for listening to their own intuition about what is not safe or healthy.

5. Create a culture of believing children and avoid shame-based language.

Encourage children to talk to you if someone ever tries to touch them or coerces them into unhealthy touch. Reassure them you will believe them and help them get through it. Teach them to use their strong voice, and role play saying things like, “It’s not okay for you to touch me like that!” Creating a culture in the family of recognizing shame is also very helpful in creating open lines of communication.

Instead of calling children “bad” when they misbehave in some way, say instead they have made a “bad choice.” Discerning between these two may enable them to continue having open communication with you as they get older. Behavior and character are very important because perpetrators count on children believing the abuse is something they want, asked for, or deserved. Empowering children to believe they are strong, loveable humans, regardless of any mistakes they make, will help.

Thinking about someone hurting our children can feel overwhelming and unbearable. However, all we can do is empower them with language and unconditional love. Having ongoing, calm conversations about consent, their bodies, and healthy touch can reduce their risk of being victimized and empower them to have a healthy relationship with their bodies throughout their lives.

My therapy practice is in Fairfax County, one of the wealthiest counties, with some of the best schools, in the nation. It is diverse and densely populated with well-educated residents who are overwhelmingly employed in business and professional services. Fairfax County is home to the Central Intelligence Agency (CIA) and the National Counterterrorism Center (NCTC), and is only a short distance from the nation’s government and leading policy makers. The town in which I work was voted one of the best cities for raising families in the state of Virginia.

Despite the wealth, access to education, and proximity to the country’s main resources for enforcing security in our nation, not all children here are safe. Like children everywhere, they are vulnerable to the atrocities of child abuse.

In 2016, SafeSpot, a local children’s advocacy center that supports families and facilitates the investigation of child sexual and severe physical abuse allegations, served more than 375 children who were impacted by abuse, the overwhelming majority of whom alleged sexual abuse. SafeSpot also worked with children who were traumatized by witnessing domestic violence.

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Most people would agree child abuse is a heartbreaking issue, yet many believe it’s not something that could happen to anyone they know or love. On the contrary, child abuse happens everywhere—in all types of homes, families, neighborhoods, schools, churches, and communities. No population, culture, or socioeconomic group is immune. Child abuse is likely present somewhere in your very own network.

National statistics show more than 700,000 children are abused annually in the United States, with 90% of alleged abusers in some way related to the victims. RAINN (Rape, Abuse & Incest National Network) reports that every 98 seconds, an American is sexually assaulted. Every eight minutes, that victim is a child. One in four women and one in six men are sexually abused as children.

People who abuse children are not just creepy strangers who lurk behind bushes or abduct children in vans. They often include people we encounter every day, people their victims know, love, and trust. People who abuse can be grandparents, uncles, aunts, cousins, moms, dads, teachers, coaches, mentors, neighbors, and family friends.

The effects of child abuse are devastating and typically long-lasting, including a lifetime of potential struggles with mental health issues, low self-esteem, increased risk of drug abuse/addiction, and patterns of dysfunctional and unhealthy relationships.

The realities of child abuse are alarming, but developing an awareness of the problem brings the increased ability to prevent or at least identify when child abuse occurs.

The effects of child abuse are devastating and typically long-lasting, including a lifetime of potential struggles with mental health issues, low self-esteem, increased risk of drug abuse/addiction, and patterns of dysfunctional and unhealthy relationships.

Tips for Parents to Prevent and Address Child Abuse

• Educate yourself on the statistics of child abuse and understand that even your own children could be at risk. You may know somebody who is or has the potential to be abusive, so know where to go or who to call in your community if at any time you suspect or discover a child is being hurt or threatened.
• Listen and validate when a child reveals abuse. Very rarely do children lie about abuse. Try to remain open, calm, curious, and nonjudgmental if a child reports or alludes to having been abused.
• I cannot stress enough how important it is to remain calm. It’s obviously gut-wrenching to hear your child may have been hurt, and it’s further challenging and complicated when the allegations are made against somebody you know and trust. But your initial reaction may determine whether the child shuts down and bottles up the violation, or reports and ultimately ends the trauma to seek healing.
• Often, children will report only parts of what happened or may pretend it happened to someone else in order to gauge how an adult will react. Be patient and allow the child to feel safe enough to continue opening up. Responding emotionally or with judgment, blame, or disbelief may cause the child to shut down and avoid talking about the abuse.
• From early on, begin facilitating conversations with your children, letting them know they can come to you about anything, no matter what anyone else says. Abuse is hard for children to comprehend, let alone talk about. They often internalize a sense of fear, embarrassment, and shame, and wind up believing they are at fault or somehow to blame for what happened. Further, people who abuse frequently coerce silence via emotional abuse, warnings the victim won’t be believed, and by threats of harm to the victim or their loved ones. Teach your children it’s your job to protect them, not the other way around, and demonstrate unconditional love so they feel safe enough to talk to you.
• Use age-appropriate language and find moments to educate your children about their bodies, about appropriate versus inappropriate touch, and about sexuality as they get older. Sex and sexuality are often awkward, uncomfortable, or taboo topics in many families; however, it’s important that you, as the adult, demonstrate and model that embarrassing or difficult topics are still important and do not need to be off-limits or avoided.
• While it’s unhealthy to isolate or shelter our children, we can be selective about what daycares, schools, and activities they participate in. Ensure that background checks are done on any individuals working directly with children, and advocate for staff trainings on the prevention, recognition, and reporting of child abuse. Communicate regularly with your children about the other adults and peers in their lives.
• The signs of abuse are not always easy to recognize without hindsight; however, step in and talk to your child if you notice any emotional or behavioral changes, such as increased anxiety, withdrawal, isolating, rebellion, or angry outbursts. It’s important to explore any signs of physical abuse, including bruises, rashes, or swelling. Pay attention to physical problems, such as urinary tract infections, or frequent complaints of things like headaches or stomachaches that aren’t medically explained. Understand it’s normal for children to be inquisitive and exploratory regarding gender and sexuality, but watch out for any sexual behavior, language, or curiosity that does not seem age-appropriate.

Help for Perpetrators of Child Abuse

If you are someone who has abused or believe you have the potential to abuse a child, I urge you to get help from a mental health professional who can assist you in exploring the roots of this insidious problem. While most children who are abused do not go on to repeat the cycle of abuse, many abusers were, in fact, victims of child abuse themselves. This history of abuse needs to be dealt with so you can attain a life free from the guilt, shame, and destruction of hurting others.

Spreading Awareness of Child Abuse Prevention

April is National Child Abuse Prevention Month. Prevent Child Abuse America has designated the pinwheel as the national symbol for child abuse prevention. Please help spread awareness of the realities of child abuse by displaying a pinwheel in your workplace, organization, or community. The more we talk about and spread awareness regarding the realities of child abuse, the closer we come to ending it.

References:

1. National statistics on child abuse. (2014). Retrieved from http://www.nationalchildrensalliance.org/media-room/media-kit/national-statistics-child-abuse
2. Pinwheels for prevention. (n.d.). Retrieved from http://preventchildabuse.org/resource/pinwheels-for-prevention
3. Scope of the problem: Statistics. (2016). Retrieved from https://www.rainn.org/statistics/scope-problem