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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Attachment and health | 2/4 | https://en.wikipedia.org/wiki/Attachment_and_health | reference | science, encyclopedia | 2026-05-05T15:31:25.364716+00:00 | kb-cron |
=== Insecure attachment styles in healthcare settings === Anxious-preoccupied people with anxious-preoccupied attachment tend to be hypervigilant to signs of danger and worry or catastrophize about symptoms. In health care appointments, their narrative is full of intense negative emotion but is relatively sparse in the specific detail desired by health care providers. This presentation can readily be perceived as "needy" or "dramatic". If the healthcare provider pulls away in response it may reinforce the patient's need to articulate their distress, creating a cycle of distress-withdrawal-distress. Avoidant-dismissive people with avoidant dismissive attachment emphasize their independence and minimizing expressing distress. They may delay seeking healthcare (see healthcare utilization), minimize reporting symptoms and disclose limited personal information. Fearful-disorganized people with fearful attachment often avoid routine healthcare, but present in a crisis with volatile, intense, negative emotions. Due to their degree of distress, they can present a disorganized narrative that is difficult for providers to follow and interpret diagnostically.
== Working model == Working models are representatives of the cognitive schema, or psychological structure (often unconscious), which underlie the different attachment classifications. Working models develop in children over time based on their experiences with their attachment figures. The cognitive schema for attachment consists of views of the efficacy of self and other to create security in times of distress.
=== Bartholomew and Horowitz model === Bartholomew and Horowitz proposed and verified a working model based on two dimensions; the view of the self (self-esteem) and the view of others (sociability)
Secure: Positive view of self, Positive view of other Dismissive: Positive view of self, Negative view of other Preoccupied: Negative view of self, Positive view of other Fearful: Negative view of self, Negative view of other
=== Prototype-insecurity classification model === In 2012 Maunder and Hunter combined the internal working model with the attitudes, behaviours and emotional expression of the different styles to create a prototype based classification that included severity of insecurity. This model was designed to be clinically useful, allowing healthcare providers to identify and predict the behaviours of patients whose attachment systems were activated by pain and illness. They distinguish the different attachment styles by; 1) attachment anxiety, the discomfort someone feels when separated, 2) attachment avoidance, which is discomfort associated with closeness and 3) severity of insecurity
Secure: Low anxiety, low avoidance, low severity of insecurity Dismissive: Low anxiety, high avoidance, moderate insecurity Preoccupied: High anxiety, low avoidance, moderate insecurity Fearful: High anxiety, high avoidance, high insecurity Disorganized: High anxiety, high avoidance, high insecurity. The difference between disorganized and fearful is that people with disorganized attachment do not use a consistent strategy to find security.
== Attachment and health outcomes == Attachment and health interact on multiple levels. Attachment is a biologically based system tied to our response to distress and attachment styles appear to confer differences in stress physiology. Illness and pain themselves act as an "activating signal" for attachment systems, and health care providers act as attachment figures in their role addressing illness and pain. Accordingly, attachment styles influence patient perception of illness, health care utilization, medication compliance and treatment response.
=== Physical health === While strong social support has been linked to greater resilience to stress and lower medical morbidity and mortality, the mechanism behind this association is poorly understood. In the late 1990s, Paul Ciechanowski investigated the role of attachment styles in patients managing diabetes, finding that individuals with an avoidant-dismissive style were less likely to be compliant with treatment recommendations and had less well-controlled disease as measured by glycated hemoglobin. Larger scale evidence comes from a large American survey of self-reported attachment styles and physical illness conducted by McWilliams and Bailey. They found that those with insecure attachment reported more physical illness than securely attached individuals. Specifically, they found preoccupied individuals reported more heart disease, and dismissive individuals more pain conditions. A prospective study followed children until the age of 32 and found a similar pattern of results. They found that people with anxious-resistant (dismissive) styles of attachment reported vague, non-specific symptoms more often, and those with anxious-preoccupied classification had a higher rate of inflammation-based illnesses. This prospective study was particularly important because of the difficulty assigning causation in the often observed relationship between chronic pain and insecure attachment. Further support is derived from experimental pain studies that have demonstrated numerous risk factors for the development of a chronic pain disorder associated with insecure adult attachment including lower perceived control of pain, higher pain catastrophizing and higher perceived pain intensity.
=== Mental health === Attachment theory can be conceptualized as a theory of emotional regulation. Bowlby predicted that insecure attachment would be a risk factor for mental health difficulties based on ineffective, or overly rigid, strategies for reducing distress and maintaining psychological resilience. There is a substantial body of literature that supports an association between adult insecure attachment and a wide variety of mental health disorders including depression, anxiety, eating, psychotic and personality disorders. Prospective evidence (research starting with infant attachment and following up over time) is mostly limited to studies following infants into childhood or adolescence as opposed to adulthood, but does demonstrate that insecure attachment is a general risk factor for both internalizing and externalizing symptomatology. Of the handful of studies that have followed infants to adulthood, the only two clear relationships that exist are between (1) disorganized attachment and dissociative symptoms and (2) resistant attachment and anxiety disorders in late adolescence. Causal relationships between insecure attachment and mental illness may be complex. Some risk factors for insecure attachment such as loss of parental figure, and sexual or physical abuse, are also risk factors for mental health disorders. Self-report measures of attachment may be biased by mental health conditions. For example, clinical depression is often associated with negative thoughts about the self, and this cognitive bias may influence the self-report in attachment questionnaires. There may be interpersonal consequences from untreated mental health conditions. Pre-existing psychological problems can increase the likelihood of secure attachment changing to insecure attachment over time.