Attachment and Health

Attachment and Health is psychological model which considers how attachment theory pertains to people’s preferences and expectations for the proximity of others when faced with stress, threat, danger or pain. In 1982 the American Psychiatrist, Lawrence Kolb, noticed that patients with chronic pain displayed behaviours with their healthcare providers akin to what children might display with an attachment figure, thus marking one of the first applications of attachment theory to physical health. Development of adult attachment theory and adult attachment measures in the 1990s provided researchers with the means to apply attachment theory to health in a more systematic way. Since that time it has been used to understand variation in stress response, health outcomes and health behaviour. Ultimately, the application of attachment theory to health care may enable health care practitioners to provide more personalized medicine by creating a deeper understanding of patient distress and allowing clinicians to better meet their needs and expectations.

John Bowlby and Mary Ainsworth developed attachment theory in the 1960s while investigating the effects of maternal separation on infant development. The development of the Strange Situation task in 1965 by Ainsworth and Wittig allowed researchers to systematically investigate the attachment system operating between children and their parents. The Strange Situation involves separating infant-parent dyads and observing infant behaviours upon reunion. Infant behaviour tended to follow patterns, leading to the development of three attachment categories: Secure, Anxious-Avoidant, and Anxious-Resistant. In 1990, Ainsworth added a new category, championed by Mary Main, called Disorganized/Disoriented attachment, characterized by its less reliable pattern of behaviour.

Bowlby believed attachment to be a primary biological drive to achieve proximity with a caregiver that transforms across child development to also encompass a psychological drive to find security by achieving a preferred interpersonal distance with an important caregiver he called an attachment figure. Insecure attachment patterns develop when caregivers are experienced as inconsistent or unpredictable, which necessitates the development of different strategies to achieve a sense of comfort and safety within an interpersonal setting. Furthermore, he posited that attachment figures function as a secure base that facilitate environmental eexploration and that attachment behaviours are triggered by perceived stress, danger or pain, and are thus state dependent.

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