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Complex Trauma and Intimacy Avoidance


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Evan, a highly successful, thirty-two-year-old mortgage broker, enters therapy complaining about a lengthy history of failed relationships. His romances nearly always start out well, with an intense physical attraction leading to great sex and a swift emotional escalation. However, after a few weeks or months he starts to feel smothered, and he begins the process of “checking out.” He starts to negatively judge many of the things he initially thought attractive about his partner, he loses the desire to engage and be sexual, he stops returning texts and phone calls, he breaks dates, and he basically does what we all do when we feel ambivalent about a relationship. But the more he distances himself, the more tightly his girlfriends seem to cling. Eventually he breaks it off with them, but not until he’s dragged them (and himself) through an emotional wringer. After his breakups, he completely loses his desire to date and to seek sex for many months. He continues to socialize; he merely stops dating and being sexual. In treatment, Evan worries that his prolonged periods of hyposexuality—the avoidance of sexual fantasies, desire, and activity—are unhealthy. He also wonders why he continually picks insecure, needy, demanding, and emotionally draining women as partners. “Is it me,” he asks, “or is it them?” 

 

Perhaps you’ve encountered a client like Evan. After a number of sessions these individuals typically reveal extensive histories of early-life trauma—neglect, abuse, abandonment, and the like—that clearly underlie their push-pull adult relationship attempts. In short, they seek sexual and romantic intensity and they know how to get the game going, but, thanks to their problematic early-life attachment experiences, they fear and eventually flee any sort of deep and lasting emotional connection. Interestingly, these intimacy avoidant, and at times sexually avoidant, clients tend to attract their mirror selves—men and women with their own early-life attachment trauma who miss obvious cues that the intimacy avoidant person is not emotionally available. Often these mirror-selves are active sex or love addicts. In short, the desperate yet ultimately nonintimate seduction of the sex or love addict entices the intimacy-phobic avoidant, drawing that person like a moth to flame. Unfortunately, these equally emotionally challenged partners can dance their romantic pas de deux almost endlessly without ever connecting in any meaningfully intimate way. So the likely answer to Evan’s question is: “It’s you, and it’s also them.”

 

What is Intimacy Avoidance?   

 

Intimacy avoidant people fear the smothering sensation caused by enmeshment with another person. When these men and women are in a relationship that starts to feel too close they begin the process of distancing themselves and eventually creating or forcing a usually painful breakup. Sometimes they string their ill-fated relationships together one after another; other times they avoid romantic and sexual relationships altogether—usually for finite periods of time like a few weeks, a few months or a few years, though occasionally forever. Common examples of intimacy avoidant people include:

 

 
  • The spinster or confirmed bachelor who has many friends but avoids dating and being sexual with others, with or without excuses for this behavior
  • The hard-working husband who rarely gets home in time to see his wife awake, let alone to interact with her in any meaningful way
  • The dutiful mother who pours her entire self into childcare, neglecting the emotional and sexual needs of her husband
  • The serial dater who bounces from one intense yet unfulfilling relationship to another, never allowing anyone to get too close
  • The “annual” dater who gets into a relationship that seems promising, sabotages it when the connection starts to feel enmeshed, and then avoids dating and sex for many months afterward
  • The modern couple—pairs who allow themselves to become more interested in and engaged with technology than each other 
  • The sex addict who is hypersexual and highly aroused by casual sex, but quickly becomes bored, distant, and nonsexual when a relationship turns intimate
  • The abusive partner (physical, verbal, etc.) who uses anger and judgment to push others away
  • The man or woman who loves and chases an abusive partner 
  • The addict (substance or behavioral) who escapes emotional connection—and therefore potential emotional discomfort—through use of intensely stimulating substances and/or behaviors

 

 

 
Nearly all intimacy avoidant men and women act as they do as the result of unresolved early-life attachment trauma and/or social anxiety that manifests in adult life as various forms of relational push and pull: I want you close to me, but I can’t tolerate the closeness. Then, after I push you away, I long for closeness, but not with you. And so it goes.

 

What about Avoidant Personality Disorder?  

 

Sometimes people confuse intimacy avoidance with Avoidant Personality Disorder (AvPD). Certainly the two issues can look similar in some respects and even appear in the same person, but they are definitely not the same thing. Personality disorders such as AvPD are considered to be relatively fixed and unchanging reflections of the self, whereas trauma-based intimacy avoidance can be treated in ways that result in profound life changes and the establishment of genuine, long-term, intimate connection. The DSM-5 summarizes AvPD with the following statement:

 

The essential [features are] a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation that begins by early adulthood and is present in a variety of contexts (American Psychological Association, 2013).

 

Generally speaking, AvPD arises from the same underlying genetic and environmental factors as intimacy avoidance and sexual addiction. However, on the avoidance spectrum, AvPD is an extreme manifestation affecting arenas of adult life that include but are not even remotely limited to intimate relationships. For instance, individuals with AvPD will decline promotions at work because they fear new responsibilities will expose them to criticism, they avoid new activities and experiences of any kind because they fear failure and humiliation, they expect to be rejected in social settings so they avoid them like the plague, etc. 

 

Certainly it is possible for intimacy avoidant people to also have AvPD, but the vast majority do not. In fact, many intimacy avoidant people are quite confident in most areas of life. They climb the corporate ladder, they have large groups of friends, and they display most of the other outward signs of success and happiness. They are simply avoidant when it comes to lasting romantic and/or sexual intimacy. 

 

Early-Life Complex Trauma  

 

Trauma is a word that psychotherapists tend to throw around a lot, especially since the inclusion of posttraumatic stress disorder (PTSD) in the DSM more than thirty years ago. That said, many traumatized clients have little to no understanding prior to clinical intervention of the fact that they’ve ever experienced any sort of psychological trauma. They simply don’t understand what it actually is.

 

My dear friend and colleague, Dr. Christine Courtois, an internationally renowned trauma expert, likes to use the following definition when discussing trauma and its effects: 

 

Trauma stands apart from normal events in its intensity and impact. It is often sudden, unanticipated, and out of the blue, making it all the more shocking. Trauma can include exposures and incidents that anyone would identify as overwhelming, such as physical or sexual assault, combat, major accidents, rape, domestic and community violence, child abuse, and terrorist attacks. It can also include exposures and incidents that are less easily identified, such as rejection, neglect, abandonment, bullying, and emotional abuse. Traumas can occur on a one-time basis, on a time-limited basis (as in an accident, a robbery, or a weather disaster), or repeatedly to the point of becoming chronic (as in child abuse and human trafficking). It is often hard for a traumatized individual to make sense of trauma from his or her everyday perspective (Courtois, 2014).

 

Needless to say, Christine’s definition is both broad and subjective, meaning trauma can involve any type of harm you can think of, and the way in which that harm is experienced is dependent on the individual. Consider a car wreck: A mother who has her children in the car is likely to be severely traumatized by the experience, whereas a guy who drives race cars for a living and has been in dozens of high-speed wrecks may walk away almost completely unfazed. One thing that is abundantly clear when it comes to trauma is that people who’ve been traumatized in the past can and often do experience a wide variety of symptoms and behavioral manifestations in the present—ongoing emotional discomfort, shame, low self-esteem, bad dreams, addiction, anger management issues, and an inability to form and/or maintain intimate relationships, to name just a few. 

 

There are several basic types of trauma (Allen, 2005; Briere & Scott, 2006; Courtois & Ford, 2013; Courtois, 2014), including:

 

 
  • Impersonal Trauma—natural disasters, accidents, illness, disability
  • Identity Trauma—related to a person’s inherent and mostly unchangeable personal characteristics, including gender, race, ethnicity, sexual identity, and sexual orientation
  • Community Trauma—related to a person’s membership in a community or group, such as a family, tribe, religion, or political organization
  • Interpersonal Trauma—acts of harm deliberately caused/committed by one or more people, usually with premeditation, including neglect, abandonment, abuse, assault or community violence

 

 

 
Again, the experience of trauma is always subjective. Nevertheless, certain traumas are typically more damaging than others. Among these is a specific form of interpersonal trauma referred to as attachment trauma (or betrayal trauma). Attachment trauma involves the abuse of an intimate relationship, most commonly either the parent/child relationship or the spousal relationship. In most cases, the greater the degree of attachment between the perpetrator and the victim, the more damaging the trauma is likely to be. This is because the betrayal occurs in the context of an intimate relationship, meaning the damage is caused by someone the victim wants and usually needs to love and trust. Exacerbating the situation is the fact that attachment traumas are usually chronic in nature, occurring and reinforcing themselves repeatedly over time, driving the damage ever-more-deeply into the victim’s psyche (Allen, 2005; Courtois, 2014).

 

Nearly always, intimacy avoidant adults have suffered chronic attachment trauma during childhood via repeated physical neglect, psychosocial neglect (emotional and cognitive unavailability), emotional abuse, physical abuse, and/or sexual abuse (overt or covert) perpetrated by parents, siblings or other relatives. Additionally, chronic early-life attachment trauma can also occur at the hands of teachers, coaches, clergy, bullies, and others. It is possible for chronic attachment trauma to happen even when the individual is not directly victimized. For example, children who witness domestic violence may not have the abuse directed at them specifically, but they nonetheless suffer by living in a fear-based, unpredictable environment. Unsurprisingly, the greater the child’s level of attachment to the victim and/or the perpetrator, the more traumatic this witnessing will be (Allen, 2005; Courtois, 2014). 

 

Dr. John Briere, another renowned trauma expert, would likely add here that it is not so much the actual traumatic events that serve as the greatest indicator of ongoing adult emotional challenges, it’s how those events were handled and worked through—or not—within the family and/or the community (Briere, 1992, 1996).

 

Childhood Trauma Influences Adult Attachment   

 

In Evan’s initial therapy sessions, he insists that his childhood was just fine—perfectly normal and probably better than most. He states that he has no interest in wasting time dissecting his early life, and that he instead wants to focus on his adult relationship issues. As therapy progresses, however, he reveals that his father was rarely home, working long hours as an attorney for the city—sitting in on evening council meetings, late-night planning sessions, and the like. He says his mother didn’t seem to mind, as long as there was plenty of money for her to spend. She obsessed about the house, the yard, her wardrobe, and her son. Evan says he can’t remember a time she wasn’t hovering nearby, watching him, even when he wanted her to simply let him be. She would ask for his opinion, while standing in bra and panties, about what she should wear, how she looked, and how frustrated she was that his father was gone all the time. Yes, he liked the special attention he got from her, but he didn’t like that his friends and even his father called him a “mama’s boy.” In retrospect, he says, his relationship with his mother was “a little too close.” He also admits that she was incredibly moody, swinging from manic happiness to angry depression and back again without any predictable cause. He wonders if that’s why his father chose to work such long hours. 

 

Evan’s experience with his mother likely qualifies as covertly incestuous (Adams, 2011; Courtois, 2010), or at least as narcissistic parenting, both of which can and do play into adult-life intimacy disorders of all stripes, including Evan’s penchant for intimacy avoidance. 

 

This result rather closely follows standard attachment theory, initially developed by psychologist John Bowlby in the 1950s. Essentially, Bowlby found that when caregivers are consistently available and responsive in healthy ways, children typically experience secure attachment (Bowlby, 1988). In other words, children feel confident that home/love/family is a safe haven where they can reliably find comfort, security, protection, nurturance, validation, and assistance with emotional regulation. With this reliable refuge consistently available, the child can comfortably depart, wander, explore, experience, learn, and grow—returning on an as needed basis. Over time, children will naturally wander further away, for longer periods of time, eventually becoming separate individuals with positive self-esteem and their own identities. 

 

Unfortunately, not all caregivers are entirely emotionally healthy; this is where problems arise. Caregivers who are absent, neglectful, intrusive, inconsistent, demanding, needy, anxious, depressed, impaired, addicted, and/or unpredictable in their response inevitably create conditions of insecurity in their children, causing those kids to become both externally focused and hypervigilant. This ongoing sense of uncertainty and doubt—the lack of safe haven—can be incredibly traumatizing, stunting a child’s ability to explore, to learn, to experience, and to grow. 

 

It is important to note that attachment styles tend to develop very early in life, and they tend to be relatively stable over the lifespan. So individuals who experience secure attachment as kids tend to also seek and find secure attachment in their adult relationships. Conversely, individuals who do not experience secure attachment in childhood tend to struggle with deep emotional connections later in life. This is absolutely the case with intimacy-avoidant people like Evan and probably most, if not all, of the “clingy” women he dates. 

 

The good news is that attachment styles need not be permanently locked in. With effort and proper guidance, people who were not blessed with secure attachment early in life can learn it through therapy and/or other healthy and healing relationships, resulting in what is known as “earned security.” In this way, intimacy-phobic individuals like Evan can overcome their childhood wiring and develop true intimacy and lasting emotional connection. 

 

Treating Intimacy Avoidance and Other Manifestations of Early-Life Trauma  

 

Intimacy avoidant clients, including sex and love addicted clients, are usually relatively functional in most areas of life, even though they are suffering from the aftereffects of chronic early-life attachment trauma that they have often not even identified as traumatic. Evan is a prime example. Successful in his career and attractive to women, Evan nevertheless struggles to form lasting attachments. Despite his reticence to admit that his upbringing was somewhat less than adequate, his disorganized attract-discard-avoid attachment style rather strongly suggests that his father’s emotional neglect and his mother’s enmeshment and inconsistence are underlying factors in his current relationship woes. As a boy, one parent was not present, while the other was smothering, had poor boundaries, and was highly narcissistic. Not exactly a safe haven for young Evan and not exactly surprising that he now struggles with intimacy. 

 

It is important to keep in mind that trauma is subjective—colored by the ways in which a particular person experiences and processes a specific event or series of events. So the amount of pain Evan experienced from his father’s relative absence may or may not be significant to him today, with the same holding true with his mother’s enmeshment and mood swings. The depth of the damage will only be revealed over the course of Evan’s therapy. That said, his pattern of allowing women to get only so close before he pushes them away, along with his periods of sexual and romantic inactivity following breakups, strongly indicates the presence of a profound and sad attachment disorder that will not easily be overcome. 

 

In treatment, it is important to ferret out intimacy avoidance patterns and their origins—most often some form of neglect, abandonment, emotional/physical/sexual abuse, and/or emotional enmeshment (such as covert incest) by a parent or another primary caregiver. Childhood experiences that commonly contribute to intimacy avoidance include:

 

 
  • Being raised by a smothering or narcissistic parent whose needs supersede those of the child
  • Being emotionally, physically, and/or sexually abused by a primary caretaker or sibling
  • Growing up in a home where there is persistent and profound mental illness, addiction, or both
  • Witnessing the emotional, physical, and/or sexual abuse of a primary caretaker or sibling
  • Growing up in a home where a sibling or parent has a profound emotional or physical impairment/illness (and there is no balance of attention and focus)
  • Being physically, emotionally, and/or socially neglected or abandoned
  • Being treated as a parent’s confidante, companion, or surrogate spouse (covert incest)
  • Needing or being forced to fill an adult’s role in the family, such as caring for siblings (especially in single-parent homes or addicted households)
  • Being or feeling responsible for a troubled parent (an addict, an invalid, someone who is mentally ill) 

 

 

 
Complicating matters is that fact that many intimacy-challenged survivors of chronic attachment trauma present with co-occurring issues—addictions, depressive disorders, anxiety disorders, anger management issues, chaotic lifestyles, and the like (Allen, 2005; Courtois, 2014; Delmonico, 1996)—that must be stabilized safely before underlying trauma can effectively be addressed. Essentially, clients need to achieve a modicum of stability, particularly in cases of addiction, before deeper and earlier issues can effectively be addressed. Nevertheless, education about early-life attachment trauma and its connection to the client’s present-day intimacy avoidance should begin early on, if for no other reason than the need for contextual analysis and shame reduction (Courtois & Ford, 2013; Courtois, 2014).

 

After this initial “client safety and stability” stage of treatment, coping skills for dealing with the desire to avoid and/or escape the oppressive sensation of emotional attachment via intimacy avoidance—like Evan’s tendency to form, abruptly end, and then avoid intense sexual/romantic attachments—can be developed, usually in conjunction with the deeper therapeutic work of reexperiencing, processing, and resolving the client’s early-life attachment traumas. Usually this type of long-term healing involves some combination of social skills training, cognitive therapies, group therapy, social learning, and perhaps medication, similar to the treatment of complex (multilayered) trauma in general (Allen, 2005; Courtois, 2010, 2014; Courtois & Ford, 2013; Raja, 2012).

 

 
 
 
References  
 
Adams, K. M. (2011). Silently seduced: When parents make their children partners (Rev. & updated ed.). Deerfield Beach, FL: Health Communications.
 
Allen, J. G. (2005). Coping with trauma: Hope through understanding (2nd ed.). Washington, DC: American Psychiatric Publishing.
 
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
 
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, NY: Basic Books.
 
Briere, J. (1992). Child abuse trauma: Theory and treatment of the lasting effects. Newbury Park, CA: Sage Publications.
 
Briere, J. (1996). Therapy for adults molested as children beyond survival (Rev. & expanded ed.). New York, NY: Springer.
 
Briere, J., & Scott, C. (2006). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. Thousand Oaks, CA: Sage.
 
Courtois, C. A. (2010). Healing the incest wound: Adult survivors in therapy (2nd ed.). New York, NY: W.W. Norton & Company.
 
Courtois, C. A. (2014). Treating complex traumatic stress disorders: Scientific foundations and therapeutic models (Paperback ed.). New York, NY: Guilford Press.
 
Courtois, C. A., & Ford, J. D. (2013). Treatment of complex trauma: A sequenced, relationship-based approach. New York, NY: Guilford Press.
 
Delmonico, D. L. (1996). Childhood abuse and multiple addictions: Research findings in a sample of self-identified sexual addicts. Sexual Addiction & Compulsivity, 3, 258–68.
 
Raja, S. (2012). Overcoming trauma and PTSD: A workbook integrating skills from ACT, DBT, and CBT. Oakland, CA: New Harbinger.
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