Attachment Trauma, Limerence & Clinical Red Flags: When to Refer Clients for Higher-Level Care

Love, Risk, and Clinical Complexity

Valentine’s Day may be lighthearted in pop culture, but for many clients, this season surfaces deep patterns of relational dysregulation. The flowers and heart-shaped chocolates often mask pain points rooted in attachment trauma, obsessive infatuation (limerence), and emotional vulnerability, particularly among individuals with co-occurring disorders.

As clinicians, therapists, and referral partners, it’s critical to recognize when these patterns reflect not just romantic challenges, but clinical red flags indicating the need for a higher level of care.

When Valentine’s Day Becomes a Trigger

For individuals with anxious or disorganized attachment styles, emotionally ambiguous or unstable relationships can provoke intense stress.¹ These clients may present with:

• Escalated mood symptoms (depression, anxiety, irritability)
• Heightened interpersonal conflict
• Cravings or relapse risk for those with SUD
• Obsessive thought spirals or suicidal ideation

These patterns often spike during relational stressors; holidays, breakups, or even early-stage infatuation (link to client facing blog). Left untreated, these symptoms can worsen over time and become barriers to recovery or therapy engagement.

Attachment Trauma: How It Shows Up in Clinical Presentations

Clients with unresolved attachment trauma may exhibit behaviors commonly mistaken for personality disorders or mood instability. In reality, many of these are adaptive survival strategies rooted in early relational environments.²

Common clinical presentations include:

• Obsessive/compulsive rumination over romantic interests
• Suicidal ideation or self-harm in response to rejection
• Stalking, hypervigilance, or boundary violations in interpersonal relationships
• Substance use as a means of regulating emotional intensity after breakups or perceived abandonment
• Emotional dysregulation in the context of ambiguous romantic dynamics (e.g., “situationships”)

“Trauma doesn’t have to mean a dramatic event. Sometimes it’s the emotional needs that weren’t met. Those are the invisible wounds we work to heal in therapy.”
— Amy Fresch, MA, LPC, Clinical Director, River’s Bend

Limerence vs. Love: Neurobiology and Clinical Risk

Limerence, the obsessive, infatuated “high” often mistaken for love, has striking neurological similarities to addiction.³ The reward system becomes dysregulated, with clients seeking dopamine bursts through text messages, romantic fantasies, or intermittent reinforcement from avoidant partners.

For clients with a history of SUD, limerence can function as a substitute addiction.⁴ Clinicians often note that the emotional withdrawal from romantic loss mimics the withdrawal process from substances.

“In group, we often explore how relationship patterns can mimic substance use. The highs, the withdrawals, the obsessing, it’s all part of the same emotional cycle.”
— Amy Fresch

Key Differentiator:

Infatuation (Limerence)	Secure Connection
Obsessive preoccupation	Mutual respect
Fear-driven attachment	Emotional safety
Withdrawal-like symptoms	Co-regulation during conflict
Self-worth tied to validation	Self-worth remains intact

When Weekly Therapy Isn’t Enough

Most clients can explore attachment wounds in outpatient therapy. However, some reach a point where weekly therapy lacks the structure or intensity to keep them safe or moving forward.⁵

Consider referring to IOP/PHP when:

• Attachment trauma is co-occurring with SUD, mood disorders, or suicidal ideation
• The client’s relational instability leads to risk behaviors (e.g., impulsive sex, stalking, relapse)
• The client’s support system is unable to de-escalate attachment-based distress
• Therapeutic progress stalls due to repeated reenactments or inability to self-regulate

Download our FREE Attachment Styles in SUD and Mental Health Treatment: What to Look For

A Quick-Reference Guide for Therapists, Counselors, and Referral Partners

What Makes River’s Bend Different?

River’s Bend offers trauma-informed, attachment-sensitive care across multiple levels of treatment. Our Mental Healthand Substance Use Disorder IOP and Partial Hospitalization Program (PHP) support clients with relational dysregulation through:

Trauma-Informed IOP:

• 3x/week group therapy focused on emotional regulation, trauma processing, and relational dynamics
• Tracks for co-occurring disorders, including anxiety, depression, and SUD
• Attachment education and skills-based interventions

Group-Based Processing:

• Clients engage in facilitated group work where patterns are reflected and reworked in real-time
• Focus on trigger identification, boundary setting, and core belief restructuring

Family Engagement:

• Family involvement is encouraged to rebuild emotional safety and model secure attachment
• Psychoeducation on how trauma and attachment wounds manifest in relationships

“We see clients who once had stable relationships, but after trauma or during active addiction, they no longer feel safe connecting with others. They’re in survival mode—and survival mode isn’t where intimacy thrives.”
— Amy Fresch

Clinical Consultation & Resources

At River’s Bend, we welcome consultations with therapists, psychiatrists, and medical providers who are unsure if their client may benefit from a higher level of care.

We offer:

• Collaborative care planning
• Streamlined referral pathways
• Insurance-covered PHP/IOP for mental health and dual diagnosis
• Immediate availability for clinical assessments

Call to Action for Referral Partners

If you’re seeing signs of relational distress that exceed the scope of weekly therapy, River’s Bend is here to support your clinical decision-making and your clients’ recovery.

References

1. Eilert, D. W., & Buchheim, A. (2023). Attachment-Related Differences in Emotion Regulation in Adults: A Systematic Review on Attachment Representations. Brain Sciences, 13(6), 884. https://doi.org/10.3390/brainsci13060884  ↩︎
2. Wadsworth, M. E. (2015). Development of maladaptive coping: a functional adaptation to chronic, uncontrollable stress. Child Development Perspectives, 9(2), 96–100. https://doi.org/10.1111/cdep.12112  ↩︎
3. Clinic, C. (2025, November 12). Limerence: the Science of Obsessive Attraction. Cleveland Clinic. https://health.clevelandclinic.org/limerence  ↩︎
4. Blanco, C., Okuda, M., Wang, S., Liu, S., & Olfson, M. (2014). Testing the Drug Substitution Switching-Addictions hypothesis. JAMA Psychiatry, 71(11), 1246. https://doi.org/10.1001/jamapsychiatry.2014.1206  ↩︎
5. Wyant, B. E. (2021). Treatment of limerence using a Cognitive Behavioral approach: a case study. Journal of Patient Experience, 8, 23743735211060812. https://doi.org/10.1177/23743735211060812  ↩︎