Insecure Attachment Orientations Research Articles

Disinhibited eating mediates differences in attachment insecurity between bariatric surgery candidates/recipients and lean controls

Previous research has shown that attachment anxiety is a good predictor of body mass index. This relationship is significantly mediated by disinhibited (over-) eating and is likely to reflect a specific form of affect regulation. This study explored whether obese bariatric surgery candidates (BSC; N=34) and bariatric surgery recipients (BSR; N=15) would show higher levels of attachment insecurity (higher attachment anxiety and/or higher attachment avoidance) than a group of age and gender-matched lean controls (N=54). Mediation analyses showed that compared to lean controls (M=2.96, SE=0.1), both BSC (M=3.5, SE=0.2) and BSR (M=3.4, SE=0.2) groups had a more insecure attachment orientation. These relationships were significantly mediated by disinhibited eating (BSC: lower limit confidence interval (LLCI)=0.06 and upper limit confidence interval (ULCI)=0.62; BSR: LLCI=0.02 and ULCI=0.76). There was no such relationship when the BSC and BSR groups were compared (LLCI=−0.15 & ULCI=0.3). These observations suggest that attachment insecurity may be a risk factor for obesity and bariatric surgery because of associated disinhibited eating. Moreover, these factors may be important to consider when bariatric surgery results in poor outcomes.

Direct and indirect effects of attachment orientation on relationship quality and constraint commitment in married couples

ABSTRACTThis study examined the associations between attachment orientation, relationship quality, and constraint commitment. It tested the prediction that insecure attachment would be negatively associated with constraint commitment, that relationship quality would be positively associated with constraint commitment, and that there would be an indirect effect of attachment insecurity on lower constraint commitment through lower relationship quality. Parallel research questions were advanced to examine if there were corresponding partner effects. Predictions were tested on 628 married couples. Tests of actor-partner interdependence revealed that attachment insecurity was associated with lower constraint commitment for both husbands and wives, and that husbands’ attachment insecurity was associated with wives’ lower constraint commitment. These same tests revealed a positive association between relationship quality and constraint commitment for husbands and wives. Tests of actor-partner interdependence mediation models revealed that attachment insecurity was indirectly associated with lower constraint commitment through lower relationship quality for both husbands and wives, and that husbands’ attachment insecurity was associated with wives’ lower constraint commitment through wives’ lower relationship quality. This study extends previous research on attachment and commitment by demonstrating that an insecure attachment orientation is associated with perceptions of lower constraint commitment through lower relationship quality, suggesting that relationship quality plays an important role in explaining the association between attachment orientation and constraint commitment.

Gender, attachment orientations, rumination, and symptomatic distress: Test of a moderated mediation model

The present study examined rumination as a fundamental cognitive mechanism mediating the risk factors in insecure attachment orientations to symptomatic distress, and gender was tested as moderator of this mediation mechanism. A sample of Turkish university students composed of 278 females and 308 males (N=586, Mage=22.43i SDage=2.21) completed the self-report measures. Mediation and moderation analyses performed based on linear regression models partially supported the research hypotheses. Attachment orientations and rumination significantly predicted an increase in symptomatic distress. Rumination fully mediated the effect of secure and preoccupied attachment orientations, and partially mediated the effect of fearful-avoidant attachment on distress. Dismissive-avoidant attachment was related neither to rumination nor to symptomatic distress. Nonsignificant moderator findings supported equivalent mediation models for women and men, despite significant gender differences in levels of attachment, rumination, and distress. Rumination is a significant feature of preoccupied and fearful-avoidant attachment, and mediates their effects on distressed moods in the Turkish cultural context.

Insecure attachment orientation and well-being in emerging adults: The roles of perceived social support and fatigue

Attachment theory posits that insecure attachment orientations reflect activation of the attachment behavioural system, and therefore deactivation of its complementary counterpart the exploration system, which is associated with feeling less energized. We hypothesized that less perceived social support and higher fatigue would prospectively explain the link between insecure attachment and well-being in emerging adulthood (ages 18–25), a period in which exploration and social relationships are critical. Participants aged 18–25 completed surveys initially and two weeks later (N=153). Temporal multiple mediation revealed that, at T1, both forms of insecure attachment (anxious and avoidant) were associated with lower T2 well-being, with less perceived social support and higher levels of fatigue each uniquely explaining these associations, after controlling for the effects of each form of attachment on the other. Our findings suggest that deactivation of the exploration system and information processing biases regarding the availability and trustworthiness of others may compromise well-being for emerging adults with an insecure attachment orientation.

Insecure attachment orientations and posttraumatic stress in a female treatment-seeking sample of survivors of childhood sexual abuse: A cross-lagged panel study.

Adult attachment theory is increasingly being conceptualized within a traumatic framework, however, few studies have examined temporal relationships between the insecure attachment orientations (attachment anxiety and attachment avoidance) and symptoms of posttraumatic stress (PTS). PTS refers to symptoms associated with posttraumatic stress disorder (PTSD) in the absence of a clinical diagnosis of PTSD. This prospective study assesses the temporal relations between the 2 attachment dimensions of anxiety and avoidance and PTS among a treatment-seeking sample of female survivors of childhood sexual abuse (CSA). Cross-lagged panel analysis was employed to assess the temporal relations between insecure attachment orientations and PTS using the Revised Adult Attachment Scale (RAAS) and the Harvard Trauma Questionnaire (HTQ). Initial assessment was on average 23 years after the onset of abuse (N = 405), and participants were followed-up after 6 months (N = 245) and 12 months (N = 119). PTS levels and insecure attachment declined over the 12-month period. Cross lagged panel analyses indicated that over the longer-term course of PTS, insecure attachment orientations are significantly related to PTS. While these associations were relatively weak in magnitude, temporal relations nevertheless remain. Specifically attachment avoidance appears to be the more relevant orientation in PTS across the 3 time points in the study. Current results provide insight into the temporal relations between insecure attachment orientations and symptoms of PTS. The findings are discussed in terms of the existing trauma literature.

Doctors’ Attachment Orientations, Emotion Regulation Strategies, and Patient Satisfaction: A Multilevel Analysis

Extending recent research on emotion regulation in doctor–patient interaction, the present study examined relationships between doctors’ attachment orientations, their emotion regulation strategies, and patients’ satisfaction with the encounter. Forty doctors completed scales of attachment orientations and emotion regulation strategies, and 160 of their patients reported on a standard measure of satisfaction with their doctor. Results from multilevel analyses showed that doctors’ avoidant and anxious attachment orientations were independently associated with lower satisfaction for patients higher on serious illness perceptions. Doctors’ emotion regulation strategies did not mediate insecure attachment orientation relationships with patients’ satisfaction as anticipated, but these regulatory strategies were an independent factor associated with satisfaction levels of patients with higher illness severity perceptions. The study confirms predictions based on attachment theory that doctors’ insecure attachment can have adverse effects for doctor–patient interaction.

Development of the Fear of Intimacy Components Questionnaire (FICQ)

Abstract. We developed a new instrument designed to measure fear of intimacy in romantic relationships. We suggest assessing fear of intimacy through two dimensions: self-revelation and dependence. The Fear of Intimacy Components Questionnaire (FICQ) was validated across three studies in which a 10-item solution systematically emerged. Consistently with a two component perspective, a two-factor solution fitted data the best: fear of losing the self (FLS) and fear of losing the other (FLO). Qualitative analyses verified content validity. Exploratory and confirmatory factor analyses tested the factor structure. Multigroup analyses supported the structural invariance across gender, age, and relationship status. Both factors showed adequate discriminant validity and internal consistency, and good 3-week period test-retest reliability. Associations between the FICQ and insecure attachment orientations demonstrated convergent validity. The association between the FICQ and relationship satisfaction above and beyond a preexisting measure offered criterion validity. By going beyond traditional self-revelation-focused conception of fear of intimacy, that is, by proposing a bi-dimensional structure to fear of intimacy, we believe that this new measure will contribute to future research on fear of intimacy.

Do episodic self- and partner-uncertainty mediate the association between attachment orientations and emotional responses to relationship-threatening events in dating couples?

This study examined relational-uncertainty perceptions (a form of cognitive appraisal) to investigate how partners in 272 heterosexual couples responded emotionally to a relationship-challenging event. Participants rated themselves on attachment anxiety and avoidance. Then, after listing a challenging event, they rated how uncertain it made them about their own and their partner's continued involvement in the relationship. Participants also rated how angry and fearful the event made them. An Actor-Partner Interdependence Model yielded three sets of results. First, actor effects from insecure attachment orientations to episodic relational uncertainty emerged. Second, proposed mediation between attachment orientations and emotional reactions by uncertainty was partially supported (perceived partner-uncertainty partially mediated the positive association of anxious attachment and fear, and self-uncertainty partially mediated the positive relation between avoidant attachment and anger). Finally, a partner effect was found between one couple member's avoidant attachment and the other's perceived partner uncertainty. Men and women exhibited similar findings.

Serotonin receptor gene (5-HT1A) modulates alexithymic characteristics and attachment orientation.

Previous studies have indicated that alexithymia is associated with the availability of serotonin in the brain and with the insecure attachment orientation. Inspired by the finding that the receptor 5-HT1A modulates the level of serotonin in the brain, this study investigated to what extent a polymorphism (C-1019G, rs6295) of 5-HT1A gene modulates individuals' alexithymic characteristics and attachment orientation in 504 Chinese Han people. Results showed significantly higher total scores on the 20-item Toronto Alexithymia Scale (TAS-20) for individuals carrying the CG/GG genotype than for individuals carrying the CC genotype. Specifically, individuals with the CG/GG genotype reported greater difficulty in identifying own feelings than individuals with the CC genotype. Results also showed that individuals carrying the CG/GG genotype seemed to be less comfortable with having close relationships to others than individuals with the CC genotype. These findings provide the first evidence for the link between 5-HT1A and the development of alexithymic characteristics and attachment orientation.

Stressful Life Events Across the Life Span and Insecure Attachment Following Combat Trauma

Attachment orientations are mostly considered to be stable interpersonal patterns. Still, a growing body of literature shows changes in attachment orientations following stressful and traumatic events. This study examined the implications of stressful life events (SLEs) throughout the life cycle in insecure attachment orientations (anxious attachment and avoidant attachment). The sample included 664 Israeli war veterans from the 1982 Lebanon War, of whom 363 suffered from acute combat stress reaction (CSR) on the battlefield, and 301 comprised a matched control group without antecedent CSR. The findings reveal a positive correlation between insecure attachment and both acute (CSR) and chronic (post-traumatic stress disorder) stress reactions. In addition, post-war SLEs were more powerful predictors of insecure attachment than other types of SLEs. Combat exposure, as well as pre-war SLEs in childhood and adulthood, made differential contributions to both types of insecure attachment orientations. Theoretical and practical implications of these findings are discussed.

Changes in Attachment Representations During an Open Trial of a Psychological Intervention for Adolescents with Learning Disorders

Background: Most of the interventions developed for adolescents with learning disorders (LDs) focus on enhancing cognitive and learning skills. However, these adolescents have been usually found to score high on measures of insecure attachment orientations. Objectives: The purpose of the current analysis was to examine changes in attachment orientations towards parents, attachment- related representations of teachers, and feelings of loneliness among adolescents with LD during an open trial of a psychological intervention for adolescents diagnosed with learning disorders (the “I Can Succeed” program, or ICS). ICS aims to target both academic and emotional functioning. Methods: Participants included 40 adolescents with LD and their parents. Measures included Attachment to parents (Kerns); Attachment representations of teachers (Children’s Appraisal of Teacher as a Secure Base (CATSB); and Loneliness (Peer-Network Loneliness and Peer-Dyadic Loneliness Scale (PNDLS). Adolescents completed questionnaires before the ICS Intervention (baseline), at the end of the acute phase (end of treatment) and at a six months follow-up meeting (follow-up). Results: The main results of the current study indicate that 6 months after the “I Can Succeed” intervention, there was improvement in LD students’ attachment security to mothers, appraisals of homeroom teacher as a security-enhancing figures (more acceptance and less rejection), and satisfaction with relationships with peers and friends (lower dyadic loneliness scores). One practical implication concerns the use of attachment theory as a foundation upon which to develop interventions among adolescents with LD.

Leaders' and subordinates' attachment orientations, emotion regulation capabilities and affect at work: A multilevel analysis

Two studies examined relationships between leaders' and subordinates' attachment orientations, emotion regulation capabilities, and affective experience and satisfaction at work. As expected, supervisors' and subordinates' insecure attachment orientations (higher anxiety and avoidance) were associated with own positive affect and satisfaction at work. Supervisors' anxious attachment orientation was associated with subordinates' lower positive affect and satisfaction at work. Contrary to hypotheses, supervisors' higher avoidance was associated with subordinates' lower negative affect and higher job satisfaction. Supervisors' emotion regulation capabilities did not mediate relationships between supervisors' insecure attachment orientations and supervisors' own or subordinates' affect and job satisfaction as expected. However, subordinates' emotion regulation capabilities interacted with supervisors' attachment orientations to predict subordinates' emotion experience at work. The results contribute to an understanding of attachment orientations' emotion dynamics in leader–follower interaction, pointing in particular to perceptual and affect-related processes at different levels of analysis.

Direct and indirect effects of attachment orientation on relationship quality and loneliness in married couples

This study tested the prediction that spouses’ insecure attachment orientation would be negatively associated with relationship quality. It was further predicted that there would be indirect effects of attachment orientation on spouses’ relationship quality through interpersonal trust as well as indirect effects of attachment orientation on loneliness through spouses’ relationship quality. Predictions were tested on 225 married couples that completed measures of attachment orientation, personal commitment, dedication commitment, interpersonal trust, loneliness, and marital satisfaction. Tests of actor–partner interdependence revealed that insecure attachment (i.e., anxious and avoidant) was associated with lower relationship quality and that one partner’s insecure attachment was associated with his/her spouse’s report of lower relationship quality. Actor–partner mediator models revealed that interpersonal trust mediated the relationship between attachment orientation and relationship quality; insecure attachment was associated with lower levels of interpersonal trust and, in turn, lower relationship quality, both individually and dyadically. Similarly, relationship quality mediated the relationship between attachment orientation and loneliness; insecure attachment was associated with lower relationship quality and, in turn, higher levels of loneliness both individually and dyadically.

Attachment and dysfunctional rumination: The mediating role of Emotional Intelligence abilities

Integrating theories of attachment and maladaptive rumination, the present study tested the hypothesis that Emotional Intelligence (EI) abilities mediate relationships between insecure adult attachment orientations (Anxiety and Avoidance) and dysfunctional rumination (Brooding and Depression-related). The results showed that attachment anxiety and avoidance were positively associated with brooding and depression-related rumination, and EI abilities mediated these associations. Emotion perception and management abilities partially mediated the relationship of anxious attachment with brooding rumination, and fully mediated the relationship between avoidant attachment and brooding rumination. Using and understanding emotion abilities fully mediated links between anxious and avoidant attachment and depression related rumination. The results highlight the role of emotion-information processing in the adoption of maladaptive rumination in insecure attachment.

Disentangling the effects of depression symptoms and adult attachment on emotional disclosure.

Individuals with high levels of depression symptoms and individuals with insecure attachment orientations have been shown to limit their use of emotional disclosure as a means of emotion regulation. However, little is known about how depression symptoms and insecure attachment orientations might jointly predict whether individuals engage in emotional disclosure. The authors addressed this question using both inter- and intraindividual approaches. College students (N = 121) completed measures of depression symptoms, adult attachment orientation, and generalized disclosure tendencies. To obtain an intraindividual measure of emotional disclosure, participants also completed an online daily diary in which they rated the intensity of the day's most unpleasant event and their disclosure of that event for 7 days. Results indicated that depression symptoms were negatively related to generalized disclosure tendencies and to intraindividual daily intensity-disclosure slopes. Attachment avoidance was negatively related to both generalized disclosure tendencies and to daily disclosure, and attachment anxiety moderated the relation between daily event intensity and disclosure. The authors discuss the implications for theory and counseling psychology practice.

Does attachment insecurity affect the outcomes of a multidisciplinary pain management program? The association between attachment insecurity, pain, disability, distress, and the use of opioids

Cognitive and behavioural treatments have been shown to be effective for the management of chronic pain. However, not all patients succeed at such a treatment. Attachment insecurity has recently been proposed as an individual vulnerability factor that may have a negative impact on pain, disability, psychological distress, and compliance with treatment, resulting in a poorer outcome. Furthermore, attachment avoidance has been associated with opioid abuse. We hypothesised that attachment anxiety would be associated with higher levels of pain intensity and disability, and that both attachment dimensions would be associated with anxiety and depression. Moreover, we hypothesised that attachment avoidance would be positively associated with the use of opioids. Finally, we predicted that patients with an insecure attachment orientation would profit less from a routine pain management program. Data were collected from 72 patients referred consecutively from December 2008 to August 2009 to a 13-week pain management program at a Danish multidisciplinary pain centre. Both attachment dimensions were positively associated with anxiety and depression. Moreover, the insecurely attached patients used significantly more opioids compared to the securely attached. None of the attachment dimensions was associated with pain and disability, and the pain management program was equally effective for both the secure and insecure groups. However, the level of anxiety and depression for insecurely attached patients did not decline below a clinical level post-treatment. The present study suggests that attachment insecurity plays an important role in the context of chronic pain management. With regards to the management of pain related anxiety, depression, and the use of opioids, the current results suggests that practitioners should keep attachment insecurity in mind.

Lies, truths, and attachment orientations in late adolescence

In this paper we examine the association between adolescents’ attachment orientations and their perceived abilities to tell and detect lies and truths. The 121 adolescents who participated in this study (a) self-assessed their abilities to tell and detect lies and truths and (b) completed a measure of attachment orientations (ECR). Results indicated that participants overestimated their truth-related abilities (i.e., truth telling and truth detecting) and their lie detection abilities, but not their lie-telling abilities. Attachment anxiety predicted poor subjective abilities related to lies (i.e., telling and detecting lies) and poor subjective abilities related to delivering messages (i.e., telling lies and truths). Attachment avoidance predicted low self-ratings of truth-telling abilities. This is the first study to link insecure attachment orientations with perceived abilities to tell and detect lies and truths, and the first to link avoidance to lack of self-confidence in delivering truthful messages. The implications of these findings for interpersonal relationships, criminal interrogation, and court litigations are discussed. Suggestions for future studies examining broader implications of the results are offered.

When home isn't a safe haven: Insecure attachment orientations, perceived social support, and PTSD symptoms among Israeli evacuees under missile threat.

This study examined a theoretically based mediation model including intensity of trauma exposure, adult attachment, perceived social support, and posttraumatic stress disorder (PTSD) symptoms. The sample consisted of 135 Israeli students who were evacuated from a college campus located near the Israel–Gaza border in response to increased missile fire in the area. An Internet-based data collection procedure was used to survey the evacuees, who remained within the affected region. Individuals at different locations within the affected area were exposed to different levels of trauma intensity. Results indicated that intensity of trauma exposure did not affect levels of PTSD symptoms or perceived social support. Structural equation modeling showed that the link between attachment anxiety and PTSD symptoms is mediated by low levels of perceived social support. These findings underscore the role of interpersonal resources in the psychological sequelae of exposure to a continuous, life-threatening situation by highlighting the negative role played by low perceived social support among insecurely attached individuals exposed to missile attacks. Theoretical and clinical implications of the findings are discussed.

Caregiving styles and attachment orientations in couples facing advanced cancer

This study examines associations between caregiving styles and caregivers' and patients' attachment orientations among couples facing advanced cancer. Four caregiving styles were examined: proximate, sensitive, controlling, and compulsive. A total of 110 patients with advanced gastrointestinal or lung cancer and their spouse caregivers were recruited. Measures included: the Experiences in Close Relationships Inventory, the Caregiving Questionnaire, and the Demand Subscale from the Caregiving Burden Scale. Caregivers reported high levels of proximate and sensitive caregiving and moderate levels of controlling and compulsive caregiving. Hierarchical regressions were conducted to examine the contribution of caregivers' and patients' attachment orientations to each caregiving style while controlling for caregiving demands. Both caregiving proximity and sensitive caregiving were negatively associated with caregivers' avoidant attachment. Controlling caregiving was positively related to caregivers' avoidant and anxious attachment orientations. Compulsive caregiving was positively associated with caregiving demand and caregivers' attachment anxiety. In addition, compulsive caregiving was positively associated with patients' attachment avoidance and negatively associated with patients' attachment anxiety. The study demonstrated two clusters of ways to provide care: other-oriented and self-oriented. The study revealed that both patients' and caregivers' attachment orientations contributed to caregivers' patterns of caregiving. Insecure attachment orientations and resulting couple interaction patterns of 'demand-withdrawal' and 'avoidance-pursuit' are potential sources of distress that may benefit from exploration in psychotherapeutic interventions for couples facing advanced cancer. Copyright © 2011 John Wiley & Sons, Ltd.

Knowing loved ones' end-of-life health care wishes: Attachment security predicts caregivers' accuracy.

At times, caregivers make life-and-death decisions for loved ones. Yet very little is known about the factors that make caregivers more or less accurate as surrogate decision makers for their loved ones. Previous research suggests that in low stress situations, individuals with high attachment-related anxiety are attentive to their relationship partners' wishes and concerns, but get overwhelmed by stressful situations. Individuals with high attachment-related avoidance are likely to avoid intimacy and stressful situations altogether. We hypothesized that both of these insecure attachment patterns limit surrogates' ability to process distressing information and should therefore be associated with lower accuracy in the stressful task of predicting their loved ones' end-of-life health care wishes. Older patients visiting a medical clinic stated their preferences toward end-of-life health care in different health contexts, and surrogate decision makers independently predicted those preferences. For comparison purposes, surrogates also predicted patients' perceptions of everyday living conditions so that surrogates' accuracy of their loved ones' perceptions in nonstressful situations could be assessed. Surrogates high on either type of insecure attachment dimension were less accurate in predicting their loved ones' end-of-life health care wishes. It is interesting to note that even though surrogates' attachment-related anxiety was associated with lower accuracy of end-of-life health care wishes of their loved ones, it was associated with higher accuracy in the nonstressful task of predicting their loved ones' everyday living conditions. Attachment orientation plays an important role in accuracy about loved ones' end-of-life health care wishes. Interventions may target emotion regulation strategies associated with insecure attachment orientations.