A fearful adult attachment style is associated with double the presence of chronic pain compared to secure attachment: A national survey of a South African population

Insecure attachment style is associated with chronic widespread pain

There has been little prospective investigation of the relationship between adult attachment style and clinical levels of anxiety and major depression. This paper seeks to address this, as well as examining the potentially mediating role of adult insecure attachment styles in the relationship between childhood adverse experience and adult disorder. 154 high-risk community women studied in 1990-1995, were followed-up in 1995-1999 to test the role of insecure attachment style in predicting new episodes of anxiety and/or major depressive disorder. The Childhood Experience of Care and Abuse (CECA) and the Attachment Style Interview (ASI) were administered at first interview and the Structured Clinical Interview for DSM-IV (SCID) administered at first and follow-up interview. Major depression and clinical level anxiety disorders (GAD, Social Phobia or Panic and/or Agoraphobia) were assessed at first contact and for the intervening follow-up period. 55% (85/154) of the women had at least one case level disorder in the follow-up period. Only markedly or moderately (but not mildly) insecure attachment styles predicted both major depression and case anxiety in follow-up. Some specificity was determined with Fearful style significantly associated both with depression and Social Phobia, and Angry-Dismissive style only with GAD. Attachment style was unrelated to Panic Disorder and/or Agoraphobia. In addition, Fearful and Angry-Dismissive styles were shown to partially mediate the relationship between childhood adversity and depression or anxiety. In order to correctly interpret lifespan models of adult psychiatric disorder, it is necessary to test for mediating factors. Attachment theory provides a framework for explaining how dysfunctional interpersonal style arising from early childhood perpetuates vulnerability to affective disorders. This has implications for intervention and treatment to break cycles of risk.

Research shows that insecure attachment styles and failures in mentalizing are associated with increased problematic social media use (PSMU). This study aimed to investigate the mediating role of failures in mentalizing in the relationships between attachment styles and PSMU within a large sample of individuals from the community. The study involved the participation of 3600 adult volunteers (2312 females, 64.2%) aged between 18 and 60 years old (M = 29.92; SD = 10.68). Participants completed measures to assess socio-demographics, adult attachment styles, mentalization, and PSMU. Findings showed that secure and dismissing attachment styles predicted reduced levels of PSMU, and that preoccupied and fearful attachment styles predicted increased levels of PSMU. The relationships between adult attachment styles and PSMU were mediated by failures in mentalizing. Thus, individuals with preoccupied and fearful attachment styles may excessively resort to social media as a means of coping with unprocessed mental states. Clinical interventions that focus on improving mentalizing abilities and promoting the adoption of appropriate self-regulation strategies might reduce maladaptive engagement in social media.

The present study investigated the relationship between adult attachment style and unprotected sex among women living with HIV-positive in Ibadan. HIV-positive participants (N = 60) completed questionnaires assessing consistent condom use three months preceding study, multiple sexual partners, adult attachment, self-esteem, and depressive symptoms. Results revealed that insecure attachment styles (particularly negative attachment representations of self) and fearful attachment were associated with both number of none condom use in the past three months and having multiple sexual partners in the same period. Similarly negative self esteem and depressive symptoms were related to these high risk sexual practices. These relationships remained significant after controlling for self-esteem, and depressive symptoms. These results suggest the inclusion of relational factors such as attachment in HIV prevention.

Copious studies have identified a link between disorganised attachment and engagement in controlling caregiving or controlling punitive behaviours. Studies have suggested that consistently engaging in these behaviours can cause difficulties within relationships and contribute to the development of a personality disorder. Most of the literature thus far has focused on engagement in controlling behaviours by children with a disorganised attachment style, despite there being theoretical grounds to suggest they may also be used by adults and across all types of insecure attachment. This study aimed to address these gaps by looking at adult attachment style and engagement in controlling behaviours in romantic relationships, across all insecure attachment styles; avoidant, anxious and disorganised. The current study recruited a non-clinical sample; specifically, 149 English-speaking adults, living in the UK, between the ages of 18 and 77 years old (M = 34.28, SD = 14.90). The participants answered an anonymous online questionnaire containing four self-report measures which assessed the participants' attachment security and organisation, caregiving style and engagement in punitive behaviours. The results indicated that participants who scored higher in disorganised attachment were more likely to use controlling punitive behaviours in their romantic relationships. Moreover, participants who reported a more insecure-anxious attachment style were more likely to use compulsive caregiving behaviours in their romantic relationships. In contrast, participants who reported a higher insecure avoidant attachment style were less likely to use compulsive caregiving behaviours in their romantic relationships. These results have implications for adult attachment theory and aid the understanding of some of the behaviours that can be harmful within romantic relationships. The findings could be used to help at-risk individuals develop healthy interpersonal relationship going forward.

Disruptive mood dysregulation disorder (DMDD) is a relatively new diagnostic entity concerning children with chronic irritability and severe anger outbursts. Currently, there is limited knowledge about the parental factors associated with the disorder. The aim of this study was to compare stress levels and attachment styles in parents of children with DMDD with those of parents of children with other diagnoses. Our sample consisted of 218 children (6-12 years, M age = 9.68 years) referred to child mental health outpatient clinics. Clinicians used a standardized semi-structured diagnostic interview to identify diagnoses. Parental stress levels and attachment styles were assessed using parent reports. We found that parents of children with DMDD experience significantly higher levels of parenting stress related to factors in the child than parents of children with other diagnoses. Furthermore, parents of children with DMDD show a higher association with insecure adult attachment styles than parents of children without DMDD. Finally, an adult preoccupied-ambivalent attachment style explains the variability in parental stress in the DMDD group to a large degree. We discuss how parental stress and an insecure attachment style can be associated with negative parenting practices. An implication from this study could be that treatment results might be improved by involving parents more in treatment programs for children with DMDD.

Therapists’ adult attachment style may affect their ability to form effective therapeutic alliances. An analysis of semi‐structured interviews with eleven family therapists explored the relationship between their adult attachment styles, as assessed using a self‐report measure, and their perceptions of the therapeutic alliance. A framework analysis was employed, using four dimensions of the therapeutic alliance: engagement in the therapeutic process, emotional connection to the therapist, safety within the therapeutic system and shared sense of purpose within the family. Responses were compared between therapists with secure and insecure attachment styles according to different dimensions of the therapeutic alliance. There were no substantial differences in therapists’ accounts of their approach to engagement and creating a sense of safety; however they differed in their approaches to managing clients’ hostility. Secure and insecure therapists differed in one of the dimensions of therapeutic alliance; emotional connections to family members. Training and supervision could incorporate an understanding of attachment style. Suggestions are made for future research based on this exploratory study.Practitioner Points The ability to co‐create a secure base may be related to the therapist's adult attachment style. Therapists with insecure attachment styles appear to have difficulty in managing clients’ hostility and close emotional connections. Trainees may benefit from understanding their own adult attachment styles and resolving outstanding family‐of‐origin issues. Clinical supervision could reflect on the interaction between the therapist's and family attachment styles.

Adverse childhood experiences (ACEs) refer to any stressful or potentially traumatic events that happen before age 18 years. Early neglect and an early high–emotional environment seem to impair the normal acquisition of the understanding of the self and others (mentalization) and have an impact on the attachment relationship that persists into adulthood. Few studies have evaluated the associations between ACEs, attachment and mentalization in adult community samples. The present study aims to evaluate the associations among ACEs, adult attachment style in peer relationships and mentalization in a sample of 403 community–dwelling adults. Participants were administered the Childhood Abuse and Trauma Scale, the Attachment Style Questionnaire, and the Mentalization Questionnaire. The results showed significant associations between ACEs, mentalization, and adult insecure attachment style. Moreover, the insecure attachment styles Discomfort with Closeness and Need for Approval fully mediated the observed associations between ACEs and mentalization deficit. These data suggested that ACEs impact on mentalization via its effect on avoidant and preoccupied attachment style and that an adult insecure attachment style in individuals who experienced early adverse events could impair mentalization ability. Furthermore, they seem to present relevant clinical implications highlighting the importance of the development of a secure attachment relationship in the therapeutic context.

The present study investigated the relationship between adult attachment style and depressive symptomatology in patients with HIV. Moreover, perceived social support was investigated as a potential mediator between adult attachment and depressive symptoms. A sample of 233 HIV-infected patients (90% male) completed questionnaires assessing adult attachment style (Relationship Questionnaire), depressive symptoms (Beck Depression Inventory), and perceived social support (Medical Outcomes Study Social Support Survey). After controlling for demographic and medical variables, an insecure adult attachment style was found to be strongly related with depressive symptoms. Half of the insecurely attached patients reported clinically elevated levels of distress, while one in nine securely attached patients reported elevated levels of distress (χ2=32.25, p=0.001). Moreover, the association between attachment style and depressive symptomatology was found to be partly mediated through perceived social support. This study strongly supports the notion that an insecure attachment style is a vulnerability factor for developing depressive symptoms that would warrant clinical attention when confronted with a chronic illness such as HIV. The clinical implications of these findings are discussed.

This study examines the relationship between attachment style and love relationships and friendships in a group of women (N = 40) known to be at risk of experiencing relationship problems. The association between attachment style and measures of self-esteem and depression were also investigated. Women with a secure attachment style had more positive ratings in the domain of adult love relationships than women with insecure attachment style (avoidant and ambivalent) and difficulties in adult love relationships were found to be particularly related to an avoidant attachment style. Insecure attachment style was also related to having cohabited with a deviant partner. Adult attachment style was not found to be related to ratings of current mood but was significantly related to self-esteem and to ratings of functioning in the domain of adult friendships. In particular, participants with an anxious-ambivalent attachment style had more negative self-esteem than secure participants. Secure participants had more positive ratings in the domain of adult friendships than insecure participants and a moderately significant association was also found between difficulties in the domain of adult friendships and an anxious-ambivalent attachment style. In addition, 20% (N = 8) of the women also reported attachment styles characterized by high levels of avoidance and ambivalence: this group was found to have more pervasive difficulties in their close relationships than women who endorsed a single dominant attachment style.

Life stress related to child bearing has been suggested to increase the risk of maternal depression in vulnerable women who have an insecure relationship. This study examined the relationship between adult attachment security and maternal depression in postpartum women as compared to nonpostpartum women. A total of 254 Korean women were recruited from pediatric hospitals, of whom 119 were in the postpartum period. Participants completed the Relationship Questionnaire, the Beck Depression Inventory, and the Rosenberg Self‐Esteem Scale. Both preoccupied and fearful attachment styles were associated with low self‐esteem and higher levels of depressive symptoms, but a dismissing attachment style was not related to self‐esteem and depression severity. Low self‐esteem was found to mediate the relation between insecure attachment and depression severity; however, this mediating effect differed depending on the insecure attachment style. For preoccupied attachment, the role of self‐esteem as a mediator was observed only in postpartum women, not in nonpostpartum women (moderated mediation). In contrast, for fearful attachment, the mediating effects emerged in both groups. The results highlight the fact that there is a complex mechanism behind the link between interpersonal relationships and risk of maternal depression.

Background: Both childhood abuse and chronic pain are common in people with substance use disorders (SUDs). Studies have found that exposure to childhood abuse is associated with chronic pain in adulthood; however, few studies have examined this association in people with SUDs. Objectives: This study aimed to characterize the association between childhood abuse and chronic pain presence and severity in adults with SUDs. Methods: Data were obtained from 672 treatment-seeking participants with SUDs on an inpatient detoxification unit. Regression models evaluated whether childhood physical or sexual abuse was associated with the likelihood of chronic pain and severity of several pain-related characteristics: pain catastrophizing, pain severity, and pain interference. Results: Childhood physical and sexual abuse were significantly associated with a greater likelihood of chronic pain in adulthood. In the adjusted analyses, childhood physical abuse was associated with worse pain severity, whereas childhood sexual abuse was associated with greater pain catastrophizing and worse pain interference. Conclusions: Childhood physical and sexual abuse were associated with a greater likelihood of chronic pain in adults with SUDs. Among those with chronic pain, exposure to childhood abuse was associated with a more severe symptom profile, characterized by greater pain severity, more catastrophic interpretations of pain, and more pain-related interference with daily life. People with SUDs and a history of childhood abuse may benefit from screening for pain and interventions to reduce pain catastrophizing. These findings highlight the importance of longitudinal research to understand mechanisms linking childhood abuse exposure to later pain and substance misuse.

Insecure attachment styles have been linked to an increased risk for suicidality, functioning as a distal risk factor for suicide behaviors in adulthood. Studies on the subject are numerous, but heterogeneous in methodology. This study aimed to sensibly group study findings and quantify the magnitude of this relationship. We performed a systematic literature search to select studies investigating insecure adult attachment styles and suicidal ideation and attempt, and present quantitative data that could be pooled into a meta-analysis. Six random-effect meta-analyses were performed, comprising 47 studies with 50,214 individuals. A small effect size association was found for the relationship between suicidal ideation and insecure attachment styles (anxious, avoidant, and fearful); similar findings were found for the relationship between suicide attempt and insecure attachment (Pearson’s r ranged from 0.16 to 0.26, all ps <0.05). The type of attachment measure moderated the association of suicidal ideation with anxious and avoidant attachment. This review has been preregistered at The International Prospective Register of Systematic Reviews (PROSPERO) – Registration number CRD42023401459.

Adult attachment style, perceived social support, and post-traumatic stress among female victims of sexual assault

Impaired Theory of Mind (ToM) and insecure (adult) attachment styles have been found in persons with schizophrenia as well as in their healthy siblings. ToM refers to the ability to infer mental states of self and others including beliefs and emotions. Insecure attachment is proposed to underlie impaired ToM, and comprises avoidant (discomfort with close relationships, high value of autonomy) and anxious (separation anxiety, dependency on others) attachment. Insight into the association between attachment style and ToM is clinically relevant, as it enhances our understanding and clinical approach to social dysfunction in schizophrenia. Therefore, we studied the association between insecure attachment styles and ToM in patients with schizophrenia, their siblings, and healthy controls. A total of 111 patients with a diagnosis in the schizophrenia spectrum, 106 non-affected siblings and 63 controls completed the Psychosis Attachment Measure, the Conflicting Beliefs and Emotions, a subsection of the Wechsler Adult Intelligence Scale, and the Childhood Trauma Questionnaire-Short Form. Severity of symptoms was assessed with the Community Assessment of Psychic Experiences and the Positive and Negative Syndrome Scale. After controlling for sex, intelligence, history of trauma and symptom severity, avoidant attachment was significantly associated with cognitive as well as with affective ToM, showing U-shaped associations, indicating better ToM performance for patients with lower or higher levels of avoidant attachment compared to medium levels. Anxious attachment in patients was associated with more problems in cognitive ToM. The results from this study support the idea that an anxious attachment style is associated with worse ToM performance in patients. Results also suggested a potential protective role of higher levels of avoidant attachment on ToM. These findings bear clinical relevance, as activation of (insecure) attachment mechanisms may affect interpersonal relations, as well as therapeutic working alliance. Further clarification is needed, especially on associations between ToM and avoidant attachment.