One’s birth may not come to mind as a potential adverse or traumatic experience when we think of ACEs, yet we know that it can be a significant component of an individual’s development, particularly if their birth was premature. How and why might being born premature present similar to trauma?
Driven to Connect
The father of attachment theory, John Bowlby, believed the nature of an infant’s drive for connection to their mother served a purpose beyond the simple purpose of feeding (1982). Instead of a drive to solely obtain nourishment, Bowlby postulated that an infant seeks to remain close to their mother for a sense of security and safety (Briere & Scott, 2015). Thus, the quality of that mother-child relationship became the model for future relationships (Bowlby, 1947). What was not yet discovered was how this model helped the child’s nervous system begin to wire and develop their innate expectations for future relational interactions (Montgomery, 2013).
The Effect of Premature Birth on Attachment
When a baby is not born premature or with medical complications, they spend the immediate minutes, days, and weeks in constant proximity to their mother (Briere & Scott, 2015). A baby born prematurely often spends that crucial time for attachment and development of neural pathways (Moutsiana et al., 2014) in the neonatal intensive care unit, or NICU (Wolke, 2018). While research is still drawing connections to attachment, being born preterm has long-term effects on areas such as cognitive development, relationships, academics, and mental health (Bilgin, Mendonca, & Wolke, 2018). It is possible these issues are, in part, the result of limited early attachment opportunities for preterm babies while their system is also in distress without a consistent co-regulatory figure (Lemola, 2015).
Trauma and Attachment Commonalities
Reactivity, poor affect regulation, low self-esteem, fear, dissociation, and relational difficulties could be symptoms of either trauma or insecure attachment (Clark, et al. 2015; Brumariu, 2015; Liotti, 2004; Georganda, 2019; Yee & Shiota, 2015). Keeping this in mind, an individual with these symptoms may not have experienced a traumatic event, but rather a rupture or injury to their attachment, immediately after birth or otherwise, that has had a ripple effect in their life. On the other side of the same coin, an individual who has experienced a traumatic event may have had some predisposition to developing symptoms due to preterm birth and its effect on their attachment.
Ask About Birth
Overall, it is important that mental health professionals not underestimate how a client’s birth may have contributed to their current mental health. As mother-child connection after birth begins the process of building one’s attachment and developing the autonomic nervous system (Newman, Sivaratnam, & Komiti, 2015; Moutsiana et al., 2014), an individual’s preterm birth has the potential for effects similar to adverse childhood experience.
References
Bilgin, A., Mendonca, M., & Wolke, D. (2018). Preterm Birth/Low Birth Weight and Markers Reflective of Wealth in Adulthood: A Meta-analysis. Pediatrics, 142(1), 1–13.
Bowlby, J. (1982). Attachment and loss: Retrospect and prospect. American Journal of Orthopsychiatry, 52(4), 664–678.
Bowlby, J. (1947). The Study of Human Relations in the Child Guidance Clinic. Journal of Social Issues, 3(2), 35–41.
Briere, J. N., & Scott, C. (2015). Principles of trauma therapy: a guide to symptoms, evaluation, and treatment. Los Angeles, CA: Sage.
Brumariu, L. E. (2015). Parent-Child Attachment and Emotion Regulation. New Directions for Child and Adolescent Development, (148), 31–45.
Clark, C., Classen, C., Fourt, A., & Shetty, M. (2015). Treating the trauma survivor: an essential guide to trauma-informed care. New York, NY: Routledge, Taylor & Francis Group.
Georganda, E. T. (2019). Attachment and Affect Regulation Theories and the Existential/Developmental Model. Existential Analysis: Journal of the Society for Existential Analysis, 30(2), 239–247.
Kirkpatrick, L. A., & Hazan, C. (1994). Attachment styles and close relationships: A four-year prospective study. Personal Relationships, 1(2), 123–142.
Lemola, S. (2015). Long-term outcomes of very preterm birth: Mechanisms and interventions. European Psychologist, 20(2), 128–137.
Liotti, G. (2004). Trauma, dissociation, and disorganized attachment: Three strands of a single braid. Psychotherapy: Theory, Research, Practice, Training, 41(4), 472–486.
Montgomery, A. (2013). Toward The Integration of Neuroscience and Clinical Social Work. Journal of Social Work Practice, 27(3), 333–339.
Moutsiana, C., Fearon, P., Murray, L., Cooper, P., Goodyer, I., Johnstone, T., & Halligan, S. (2014). Making an Effort to Feel Positive: Insecure Attachment in Infancy Predicts the Neural Underpinnings of Emotion Regulation in Adulthood. Journal of Child Psychology and Psychiatry, 55(9), 999–1008.
Newman, L., Sivaratnam, C., & Komiti, A. (2015). Attachment and early brain development – neuroprotective interventions in infant–caregiver therapy. Translational Developmental Psychiatry, 3, 1–N.PAG.
Wolke, D. (2018). Preterm birth: high vulnerability and no resiliency? Reflections on van Lieshout et al. (2018). Journal of Child Psychology & Psychiatry, 59(11), 1201–1204.
Yee, C. I., & Shiota, M. N. (2015). An insecure base: Attachment style and orienting response to positive stimuli. Psychophysiology, 52(7), 905–909.
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