kb/data/en.wikipedia.org/wiki/Attachment_and_health-2.md

title	chunk	source	category	tags	date_saved	instance
Attachment and health	3/4	https://en.wikipedia.org/wiki/Attachment_and_health	reference	science, encyclopedia	2026-05-05T15:31:25.364716+00:00	kb-cron

== Mechanisms by which attachment influences health == Maunder and Hunter outlined three ways in which insecure attachment can serve as a risk factor for health problems:

1. It may increase one's susceptibility to stress by changing stress physiology
2. It may be related to potentially harmful behaviours undertaken to regulate affect, and
3. It may change the way people interact with the healthcare system

=== Attachment and stress ===

The stress response in humans is largely governed by the hypothalamic-pituitary-adrenal axis (HPA) and sympathetic nervous system. The HPA axis has garnered particular attention from attachment researchers because it is known to be activated by social stressors. The normal response for this system is to release stress hormones, particularly cortisol, for a brief duration and then shut itself off due to negative feedback, resulting in a short, strong release of cortisol. The HPA axis also follows a circadian rhythm, with highest release within about 30 minutes to 1 hour upon awakening, called the cortisol response to awakening (CRA), and a slow taper throughout the day. Researchers have looked at both cortisol response to stress (CRS) and CRA to determine if attachment anxiety and avoidance underlie individual differences in HPA activity. Findings in the field have inconsistent. The evidence suggests that (a) individuals with high attachment anxiety perceive a higher degree of distress when faced with a stressor and have higher baseline anxiety compared to those low in attachment anxiety, (b) most studies suggest higher cortisol reactivity to stress in anxiously attached individuals, while two studies did not support this trend(c) avoidant-dismissive attachment has been less consistent, with some studies showing an increase in cortisol produced in response to a stressor, and others not finding any differences in comparison to securely attached individuals(d) fearful attachment is associated with lower cortisol both upon awakening and in response to a stressor although one study in pregnant women found less diurnal variation in those fearfully versus securely attached, leading to a higher bedtime cortisol level in the fearful group. The finding that those with fearful attachment would show small cortisol reactivity in response to a stressor may seem counterintuitive but is in line with the predictions of stress researcher Bruce McEwen, who hypothesized that frequent early stressors in life would cause an initial hyper-reactivity in the HPA axis that would over time become pathologically sluggish as the individual ages, leading to greater overall cortisol release and less adaptive responsivity. Another related biological system that regulates stress response is the autonomic nervous system. In general, the sympathetic system is activated during times of stress and the parasympathetic system acts to decrease physical readiness for stress. These systems are sometimes called the "fight-or-flight" and "rest-or-digest" systems, respectively, and operate in a balance, as opposed to being totally on or off. Researchers can approximate the relative balance by looking at skin conductance, blood pressure and heart rate. Studies of this kind provided hard evidence that avoidant infants were truly distressed during the strange situation task despite their minimally distressed appearance as they showed elevations in heart rate when caregivers were away and took longer to return to baseline when the caregiver returned in comparison to securely attached infants. Studies of skin conductance and heart rate in adults have shown that those with avoidant attachment and anxious attachment will show markers of increased distress during attachment and non-attachment stressors compared to those securely attached.

=== Health behaviours === According to the attachment theory, people with insecure attachments have less effective strategies for dealing with negative emotions compared to people with secure attachments. One way which insecurely-attached individuals may try to regulate their distress is by using strategies or behaviours that are attractive for their short term relief, but may have deleterious risks over years like eating, drug use or risky sex. In a survey of 356 primary care patients in Toronto, rates of smoking, harmful drinking, and obesity, were all found to be highest in those with the most severe anxious and avoidant attachment. Both attachment anxiety and attachment avoidance have been linked in separate studies to increasing the risk of eating disorders and substance use in adolescents.

=== Eating === A review of attachment and eating disorder literature in 2010 showed rates of insecure attachment to be approximately 70% in eating disorder populations in contrast to the 30-40% prevalence in the normal population. These rates are similar to those found in other mental health populations. The review noted small trends for anxious attachment to be more highly associated with binge-purging symptomatology and avoidant attachment to be more highly associated with restrictive. The relationship between high attachment anxiety and disinhibited eating, or binge eating, has also been found in non-clinical and pre-bariatric surgery populations. The disordered eating in insecure attachment does seem to have implications for overall health as well, with one study demonstrating a relationship with higher body mass index and another demonstrating a higher risk for metabolic syndrome at midlife.