Mental Health on the Line: The Effect of Attachment Trauma on Immigrant Families Facing Separation or Deportation

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Lucybel Mendez, M.S., Jacqueline O. Moses, M.S., & Jacqueline B. Duong, B.A.

Lucybel Mendez, M.S.

In the past decade, U.S. immigration policies have impacted the lives of immigrant families from Latinx countries.  Recently, the “zero-tolerance” policy has enforced the criminal prosecution of adults illegally crossing the U.S. border, including parents and caregivers traveling with children (Department of Justice Office of Public Affairs, 2018).  As a result, more than 2,600 children, some as young as 18 months (Kriel, 2018), have been forcibly separated from their families and placed in either the custody of a sponsor or held in a detention shelter (Valverde, 2018; Shapiro & Sharma, 2018).  As of August 2018, 497 children (22 of whom are younger than 5) remain separated from their parents or caregivers and in federal shelters scattered throughout the U.S.- Mexico border (Shapiro & Sharma, 2018). Furthermore, immigration policies have affected thousands of children who are U.S. citizens.  According to U.S. Immigration and Customs Enforcement fiscal reports, between 2015 and the end of 2017, a total of 87,351 parents were deported and subsequently separated from their U.S. citizen children (U.S. Department of Homeland Security, U.S. Immigration and Customs Enforcement [ICE] 2015a,b; ICE 2016a,b; ICE 2017a,b).  The potential adverse consequences of recent immigration policies and enforcements on the well-being of children and adolescents are still not clear.  Attachment trauma theory may explain the negative effects of forced separation and inform effective prevention and intervention efforts for vulnerable Latinx families.

Separation, Deportation, and Attachment Trauma

Jacqueline Moses, M.S.

Family separation and parental deportation can affect children’s attachment systems. According to attachment theory (Bowlby, 1969), children’s attachment systems develop in infancyand help them organize early relational experiences (Sroufe & Waters, 1977; Waters & Sroufe, 2017).  The attachment system then becomes a guiding working model for their later interpersonal, emotional, and cognitive development (Kerig & Becker, 2010; Sroufe & Waters, 1977).  This system also promotes children’s survival by helping them cope with fearful and stressful situations (Bowlby, 1969; Bowlby,1973; Kobak, Cassidy, Zir, 2004).  Specifically, this framework posits that attachment figures, often parents or guardians, facilitate coping with traumatic experiences and provide protection and comfort to their children. Thus, any real or perceived threat to the availability of an attachment figure, such as brief separation from a parent, constitutes a threat to children’s survival and can result in fear, intense anxiety, and subsequent traumatic reactions (Bowlby, 1973; Kobak et al., 2004).  These reactions are acutely more pronounced when children find themselves in unfamiliar environments or surrounded by strangers. Among adolescents, more extreme threats to the attachment figure, such as permanent separation, may also activate the attachment system and elicit fear and anxiety.

Jacqueline Duong, B.A.

Attachment theorists have posited that such activation of the attachment system may result in attachment trauma, which is conceptualized as the disruption of the attachment bond through forced separation of children from their attachment figures (Kobak et al., 2004).  These separations are often prolonged, involve limited familial contact, and have no clear resolution (e.g., family reunification).  Forced family separation and parental deportation are also likely to impact children’s perceptions of their attachment figures’ availability (Dreby, 2015; Gonzalez, 2015).  Therefore, forced family separations occurring under current immigration policies may result in the activation of the attachment systems and subsequent attachment traumatization of thousands of young children and adolescents.

The Psychological and Behavioral Effects of Attachment Trauma

Attachment trauma as a result of forced family separation and parental deportation may derail the development of a healthy attachment system.  A secure attachment system promotes healthy functioning and mental health among children (Ainsworth, 1979; Bowlby, 2008).  Attachment trauma, however, is likely to decrease the likelihood of the emergence of a secure attachment and increase maladaptive attachment styles (e.g., anxious, avoidant, disorganized; Davies, 2011; Kobak et al., 2004).  Furthermore, attachment trauma can result in a number of negative psychological and behavioral outcomes among children and adolescents.  Although little is known about the effects of family separation, specifically for the families separated because of the “zero-tolerance” policy, literature on the forced detention of unaccompanied immigrant children from diverse countries suggests that these children have high rates of posttraumatic stress disorder (PTSD), anxiety, depression, and suicidal ideation (Baily et al., 2014; Teicher, 2018).  Moreover, researchers have found elevated posttraumatic stress symptoms among Latinx children who have been forcibly separated from a caregiver through parental detention or deportation (Gonzalez, 2015; Rojas-Flores, Clements, Hwang-Koo, & London, 2017).  Parental deportation has also been linked to increased anxiety and depression symptoms among children (Brabeck, Lykes, & Hunter, 2014; Dreby, 2012; Dreby, 2015). Notably, parental separation and deportation has been associated with high levels of teacher-reported externalizing behavior,and has contributed to higher rates of delinquency and substance use among children and adolescents (Rojas-Flores,et al., 2017; Rubens et al., 2013; McQueen, Getz, Bray, 2003).  Thus, it is plausible that current immigration policies pose a substantial threat to children’s psychological and behavioral well-being by precipitating attachment trauma.

Clinical Implications

Family reunification for separated families should be of highest priority given the adverse mental health outcomes linked to attachment disruptions.  In the cases of many reunited families, treatment is essential in managing associated traumatic reactions (Zayas, Aguilar-Gaxiola, Yoon, & Rey, 2015).  Accordingly, there is a need for trauma-informed, culturally-sensitive, evidence-based interventions for vulnerable children and families during the reunification process.  Based on the attachment theory framework (Bowlby, 1973; Kobak et al., 2004), a key component for effective treatment following attachment disruption is to restore secure attachment by re-establishing the caregiver as available and trustworthy, thereby strengthening the parent-child relationship.  For example, therapists may encourage the parent and child to share their emotions on the family separation or deportation during sessions in order to promote empathy and closeness in the relationship.  Therapists may also encourage parents to identify their support networks, such as extended family, to help with parenting stress and family dysfunction that can result from the traumatic experience (Juffer, Bakermans-Kranenburg, van IJzendoorn, 2017).  Further, culturally-appropriate interventions that center on Latinx values including family constructs (e.g., familismo, machismo, marianismo), interpersonal factors (e.g., personalismo, respeto, simpatía), and religious or folk beliefs (e.g., fatalísmo, espiritualismo) may also increase engagement in services among immigrant families (de Arellano, Danielson, & Felton, 2012; Rojas-Flores, et al., 2017).

Trauma-focused cognitive behavioral therapy (TF-CBT), an evidence-based treatment for children and adolescents with PTSD, has been culturally-adapted for Latinx families,and thus may be an appropriate intervention for reunified families (de Arellano, Danielson, & Felton, 2012). Developed by Cohen and Manarinno (2008), TF-CBT is a multicomponent treatment that equips families with psychoeducation, parenting strategies, and coping skills for continued stress management after a traumatic event.  Psychoeducation is an ongoing process during which parents and caregivers are initially informed of the child’s diagnosis and the TF-CBT treatment model.  In later sessions, families are provided with information about the impact of trauma on children and family members, the nature of PTSD, and information to normalize the child’s and parents’ reactions. TF-CBT also equips caregivers with basic parenting strategies such as praise, selective attention (attending to the child’s positive behaviors), appropriate time-out, and contingency reinforcement that may be individually tailored to each family to manage behaviors that may result from PTSD.  Therapists also assist parents and children in gaining cognitive coping skills, including identifying thoughts related to upsetting events, determining the feelings and behaviorsassociated with those thoughts, and evaluating whether these thoughts are accurate and helpful.  Conjoint parent and child sessions emphasize strengthening the parent-child relationship and processing experienced trauma by developing a narrative of traumatic events from the child’s perspectiveand sharing it with his or her parent.  Each TF-CBT component can be individually tailored to specific traumatic events.  In the case of family reunification, TF-CBT would address and manage traumatic reactions as a result of forced separation and parental deportation.  Trauma-informed interventions with an explicit emphasis on cultural and contextual factors are needed to increase relevance, expand reach, and maximize benefits for Latinx immigrant families experiencing deportation or separation.

Policy Implications

Policy reform also may be leveraged to combat the adverse effects of forced family separation on immigrant families.  Primarily, policy reform should emphasize the protection of children and families’ rights during the immigration process to prevent forced separation (Brabeck et al., 2014).  From a mental health services perspective, immigrant families need greater access to adequate mental health care.  Moreover, there is a need for the reevaluation of immigration policies that have significantimpact on access to mental health services in this population (Rodríguez, Young, & Wallace, 2015).  An integrative care approach embedded within the immigration process may also increase accessibility of mental health services.  Trauma-informed and culturally sensitive services and resources may be delivered to families at each level of contact throughout the immigration process by social workers, immigration workers, primary care physicians, legal and financial experts, and other professionals (Lustig et al., 2003).  State-wide implementation of trauma-informed care and increased accessibility of services may be particularly impactful in states with higher rates of deportation (e.g., California, Texas).  Previous research demonstrates TF-CBT can be scaled up and implemented in community settings (Webb, Grasso, Laurenceau, & Deblinger, 2014).  Local, state-wide, and federal initiatives should further consider extending support for integrative systems of mental health care for separated families (Sigel, Benton, Lynch, & Kramer, 2013).


Recent immigration policies have negatively impacted the well-being of immigrant families by forcibly separating children from their parents.  These forced family separations threaten perceived availability of attachment figures, are unplanned,and have no clear resolution.  Attachment trauma perpetuated by forced family separation may result in the development of insecure attachment styles. Additionally, attachment trauma experienced by immigrant families may contribute to negative psychological (e.g., PTSD, anxiety, depression) and behavioral (e.g., delinquency, substance use) outcomes among children and adolescents.  Increased accessibility for trauma-informed, culturally-sensitive, contextually relevant, evidence-based services may help ameliorate negative mental health consequences and unmet needs among immigrant families affected by immigration policies.  I mmigration policy reform should, first and foremost, focus on the protection of children and families’ rights during the immigration process; and second, increase resources for mental health services to prevent attachment trauma and its debilitating sequelae (Brabeck et al., 2014).


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Lucybel Mendez, M.S. is a third-year graduate student in the Clinical Psychology doctoral program at the University of Utah. Her research interests focus on the experiences of underprivileged populations, in particular, the risk and resilience processes implicated in juvenile-justice involved youths’ developmental trajectories. Lucy’s clinical interests and experiences include assessment and evidence-based treatment of youth and families who have experienced traumatic exposure. Further, she is committed to the promotion of culturally competent mental health care for underserved populations.

Jacqueline Moses, M.S. is a fourth-year doctoral candidate in the Clinical Science in Child Adolescent Psychology program at Florida International University. Her research interests center on strengths-based, contextually relevant, and culturally accessible models of mental health care for youth and families of color living in urban poverty. Jackie’s clinical interests and experiences include mental health consultation to staff and youth in urban afterschool programs, assessment and interventions for youth who have experienced maltreatment, and mental health care for juvenile justice-involved youth.

Jacqueline Duong, B.A. is a 1st year Masters Student in the M.A. Psychology Program at San Diego State University. She is interested in the mechanisms underlying intergenerational transmission of trauma and resilience as well as the neurobiological aspect of early adversity. Jacky’s clinical interests include examining how parenting and family processes may increase risk of or be protective against mental health issues.