Insecure Attachment Research Articles

The Effects of Insecure Attachment on Compulsive Sexual Behavior: The Mediating Effects of Loneliness and Acceptance

The Effects of Insecure Attachment on Compulsive Sexual Behavior: The Mediating Effects of Loneliness and Acceptance

Control in Intimate Relationships: An Exploration of Insecure Attachment Styles, Emotion Dysregulation, and Shame-Proneness

Control in Intimate Relationships: An Exploration of Insecure Attachment Styles, Emotion Dysregulation, and Shame-Proneness

The role of empathy and emotional regulation self-efficacy in adult attachment type and marital adjustment in breast cancer patients–a moderated mediation model

ABSTRACT To date, previous research has elucidated the impact of adult attachment type on marital relationships. However, the mechanisms underpinning the relationship between attachment type and marital adjustment in breast cancer patients remain unclear. In this study, a cohort of 272 breast cancer patients was surveyed using several instruments: the General Information Questionnaire, Revised Marital Adjustment Scale (RDAS), Adult Attachment Scale (AAS), Interpersonal Reactivity Indicator Scale (IRI), and Regulated Emotional Self-Efficacy Scale (RESS). We conducted moderated mediation analyses using the SPSS macro program PROCESS plug-in. Empathy was found to mediate the association between attachment type (attachment anxiety/attachment avoidance) and marital adjustment, with indirect effects of −0.141 (95% CI [−0.260, −0.063]) and 0.157 (95% CI [0.073,0.289]), respectively. Additionally, affect regulation self-efficacy was found to mediate the subsequent impact of attachment type (attachment anxiety/attachment avoidance) on marital adjustment via empathy, with moderated effects of 0.380 (95% CI [0.236, 0.525]) and 0.374 (95% CI [0.240, 0.509]), respectively. Consequently, the presence of insecure attachment in breast cancer patients appears to influence their empathy levels, thereby negatively impacting marital adjustment. Encouragingly, enhancing emotional regulation self-efficacy in patients holds the potential to mitigate these adverse effects. These findings contribute not only to a deeper theoretical understanding but also lay a solid foundation for practical interventions aimed at enhancing marital relationships among breast cancer patients.

Research on the Relationship Between Attachment Styles and Mental Health (Depression and Anxiety) among Chinese University Students

Abstract: Mental health problems are becoming more serious globally. Relevant literature suggests that insecure attachment has the potential to lead to a range of mental health problems. And increasing attachment security can greatly improve psychological resilience and overall mental health. In this study, 103 Chinese university students were selected to investigate the relationship between their attachment styles and their mental health, especially depression and anxiety. A structured questionnaire based on the Experiences in Close Relationships Scale (ECR-R) was used to assess participants' attachment-related anxiety and avoidance, and the PHQ-9 and GAD-7 were used to assess mental health indicators. The findings reveal that significant differences in depression and anxiety levels between attachment types. Individuals with secure attachment styles exhibit significantly lower levels of depression and anxiety compared to those with insecure attachment styles, such as preoccupied, dismissive. In addition, attachment-related anxiety and avoidance scores could predict depression and anxiety levels. These results underscore the protective nature of secure attachment and highlight the importance of considering attachment styles in mental health interventions.

Evaluating attachment-based family therapy in residential treatment in the United States: does adolescents’ increased attachment security to caregivers lead to decreases in depressive symptoms?

BackgroundThe inclusion of family therapy in residential treatment centers (RTCs) has increased over time. However, there is little data on whether empirically-supported family therapies (ESFTs) are being adopted and if they contribute to treatment effectiveness. This study aimed to test whether Attachment-Based Family Therapy (ABFT), an ESFT integrated into a large residential psychiatric system, would improve perceived attachment insecurity (anxiety and avoidance) and contribute to decreases in depression for adolescents.MethodABFT was integrated into the clinical program of a large, residential psychiatric system. All family therapists were trained to a level of certification. Improvement was measured by changes in adolescent’s perceived attachment to caregivers and reduction in depressive symptoms. The sample included 4786 patients. Attachment insecurity and depressive symptoms were measured at intake, week 3, and week 5. A random-intercept, cross-lagged panel model was used to examine the relationships between attachment and depression over time.ResultsThe results generally supported hypotheses. Attachment insecurity and depressive symptoms improved over the five weeks of treatment. Improvements in attachment avoidance preceded improvements in depressive symptoms within subjects, over time. Simultaneously, improvements in depressive symptoms preceded those in both dimensions of attachment. Thus, improvement in perceived attachment was associated with a reduction in depressive symptoms.ConclusionRTCs that can generate improvements in attachment insecurity and depressive symptoms, via ABFT or other ESFTs, might improve treatment outcomes, and ideally, adolescents’ successful transition back home to families. More research is needed to disentangle the contribution of ABFT and other treatment elements in a multimodal, residential treatment program. The study supports the call for increased incorporation of families into the RTC treatment process.

Disturbances in eating behavior and body image: The role of attachment, media internalization, and self-objectification

ObjectiveResearch has increasingly demonstrated the need to conceptualize the etiology of eating disorders beyond a sole focus on body image disturbance. Attachment patterns, media internalization, and self-objectification have been previously found to play a potential role in the development and maintenance of eating psychopathology. MethodThis study 1) examined the associations between eating behavior, body dissatisfaction, attachment, media internalization, and self-objectification, 2) evaluated media internalization and self-objectification as mediators of the relationship between insecure attachment patterns and both eating disorder symptomatology and body dissatisfaction, and 3) explored predictors of eating behavior in a sample of 252 Lebanese individuals between the ages of 18 and 25. ResultsEating disorder symptomatology was positively correlated with body dissatisfaction, insecure attachment patterns, media internalization, and self-objectification. Positive associations between attachment anxiety and avoidance and eating disorder symptomatology were mediated by media internalization and self-objectification. Positive associations between attachment anxiety and avoidance and body dissatisfaction were also mediated by media internalization and self-objectification. Body dissatisfaction, media internalization, attachment anxiety and avoidance, and self-objectification were identified as predictors of eating behavior, with media internalization accounting for the highest variance in eating behavior. ConclusionsInsecure attachment, heightened susceptibility to internalizing unrealistic media portrayals, and an objectifying self-concept were found to be associated with eating disorder symptomatology and body image dissatisfaction. Findings were interpreted in light of suggested directions and considerations for the design of prevention and intervention programs.

Childhood Unpredictability is Associated With Religious Coping Through Attachment to God and Divine Forgiveness.

Because a majority of the world's population is religious and believes in some higher power, it is important to understand what may facilitate or hinder religious psychological processes that give rise to well-being. The current work therefore threads together behavioral ecological, attachment, and forgiveness theoretical perspectives to assess candidate correlates of divine forgiveness and religious coping. Study 1 (N = 441) showed, via a single path model, that childhood unpredictability was positively associated with avoidant attachment to God, which was in turn negatively associated with divine forgiveness, such that avoidant attachment to God fully mediated the association between childhood unpredictability and divine forgiveness. Study 2 (N = 417) extended the investigation to religious coping, again analyzing data via a single path model. Childhood unpredictability was associated with positive (but not negative) coping through a mediation sequence of insecure attachment (avoidant and anxious) and, in turn, divine forgiveness. For avoidance, unpredictability was positively associated with avoidant attachment, which was negatively associated with divine forgiveness, which was positively associated with positive religious coping. For anxious attachment, unpredictability was positively associated with anxious attachment, which was positively associated with divine forgiveness, which was positively associated with positive religious coping. Notably, avoidant attachment was also curvilinearly associated with anxious attachment and coping, such that people high and low (vs. average) in avoidance are high in anxious attachment as well as positive and negative religious coping. Thus, the work provides insights important to both the study of early childhood environments and the study of religious psychological processes.

A preliminary investigation of parent-child attachment relationship in toddlers with autism traits

Using a cross-sectional design, this study explored attachment insecurity and disorganization (assessed using the Strange Situation Procedure) in 90 toddlers (aged 14–24 months) with and without autism traits and assessed the associations between autism traits (severity and profiles) and both developmental level and attachment classification. Our findings showed no significant differences between the rates of attachment insecurity or attachment disorganisation among toddlers with, and toddlers without, autism traits. However, among the toddlers with autism traits, those with a disorganised attachment were more likely to have autism traits of greater severity. While greater autism trait severity was associated with attachment disorganisation, it remains unclear whether this association is the result of children with autism traits having higher rates of attachment disorganisation or whether autism traits are being misinterpreted as attachment disorganisation indices.

Male infertile couples: an actor-partner interdependence model of attachment styles and fertility pressure

BackgroundCouples undergoing artificial insemination by donor semen(AID) represent a unique group of infertility patients, the relationship between fertility pressure and attachment styles remains unclear. To investigate the fertility pressure and attachment dimensions in artificial insemination by donor semen(AID) couples, and develop an Actor-Partner Interdependence Model (APIM) for patient care.MethodsThis study is a cross-sectional study. From June to September 2021, couples who were about to receive AID treatment in our hospital were assessed using the Fertility Problem Inventory, and the Experiences in Close Relationships(ECR). Dyadic analysis applying the APIM was used.ResultsA total of 448 valid questionnaires were recovered, the effective response rate was 94.9%. The average score of men’s fertility pressure was higher than that of women’s(P = 0.021). The score of male attachment anxiety was higher than that of females(P = 0.038). Attachment avoidance(β = 0.46) and attachment anxiety(β = 0.33) in wives significantly impacted their fertility pressure. Attachment avoidance(β = 0.17) and attachment anxiety(β = 0.52) in husbands significantly impacted their fertility pressure. The attachment avoidance of wives’ had a significant impact on the husbands’ fertility pressure(β = 0.11).ConclusionOverall, the study revealed that in the couples who use donor sperm to expect pregnancy, the male has higher fertility pressure. Insecure attachment can cause more severe fertility pressure, fertility pressure is also affected by one’s partner.

Intergenerational Transmission of Posttraumatic Orientation to Bodily Signals Following Child Maltreatment.

Recent studies have indicated that CM (child maltreatment) may influence individuals' perception of their bodies, often resulting in a posttraumatic orientation to bodily signals (OBS). Given the intricate relationship between bodily and interpersonal experiences, it is hypothesized that posttraumatic OBS may be intergenerationally transmitted. However, knowledge regarding this phenomenon, and its underlying mechanisms, remains limited. Two studies tested (a) the link between CM and posttraumatic OBS, mediated by posttraumatic stress (PTS) symptoms and attachment security, and (b) the intergenerational transmission of a posttraumatic OBS following CM among dyads of parents and their young adult offspring. The first study included 445 young adults (mean age = 352, SD = 10.2), and the second study included 393 dyads (parents' mean age = 58, SD = 5.91; offspring's mean age = 27, SD = 3.91). The participants completed self-reported questionnaires. Study 1 found that posttraumatic OBS was associated with CM, through the mediation of PTS symptoms (indirect effect = 0.15, p = .005), and insecure attachment (indirect effects between 0.132 and 1.44, p < .006). The second study found two pathways of intergenerational transmission. The first pathway showed indirect paths between parents' CM exposure and offspring's posttraumatic OBS, through parents' reaction to CM (PTS symptoms, anxious attachment, and avoidant attachment) and posttraumatic OBS (indirect effects between 0.006 and 0.013, p < .039). The second pathway revealed indirect links between parents' CM exposure and offspring's posttraumatic OBS, through parents' and offspring's reaction to CM (indirect effects between 0.006 and 0.56, p < .015). The study's findings add empirical evidence that posttraumatic OBS is a significant implication of CM. The second study illuminates the intergenerational transmission of a posttraumatic OBS following parental CM exposure, uncovering PTS symptoms, and insecure attachment styles as potential underlying mechanisms.

Childhood Adversity and Engagement in Adulthood: The Role of Attachment as a Mediator.

A key assumption of occupational therapy is that engagement in meaningful activities is fundamental to one's health and well-being. Preliminary findings suggest a link between childhood adversity and engagement in meaningful activity. Childhood adversity is also linked to attachment insecurity in adulthood, and both represent barriers to health and well-being. It is unknown whether attachment insecurity is associated with meaningful activity engagement or how attachment insecurity influences the relationship between childhood adversity and meaningful activity engagement. To investigate the association between attachment insecurity and meaningful activity engagement and the role of attachment insecurity in the relationship between childhood adversity and engagement in meaningful activities in adulthood. Cross-sectional online survey. Community. Community-dwelling adults ages 18 yr or older, healthy, and able to understand standard English to complete the questionnaires. Participants were recruited through snowball sampling. Participants answered demographic questions and completed three questionnaires: the Engagement in Meaningful Activities Survey, Risky Families Questionnaire, and Experiences in Close Relationships-Short Form. Participants (N = 329) completed at least two of the three surveys, with most (n = 312) completing all three. More insecurely attached participants reported less engagement in meaningful activities. Both attachment avoidance and attachment anxiety mediated the relationship between childhood adversity and meaningful activity engagement. The findings offer support for interrelations among childhood adversity, attachment insecurity, and engagement in meaningful activity. Further research is required to support the application of these findings in clinical settings. Plain-Language Summary: To our knowledge, this is the first study to establish a connection between attachment insecurity in adults and lower levels of engagement in meaningful activities during adulthood. The findings highlight the heightened vulnerability of adults who have a history of childhood adversity. The findings also emphasize the significance of (1) considering clients' childhood adversity and attachment patterns when assessing for and providing occupational therapy services and (2) advocating for the inclusion of trauma-informed practices for those with lower levels of meaningful occupational engagement.

Binge eating, social media disorder and attachment in adolescence: Gender differences in the mediating role of alexithymia

IntroductionThere is a need for research investigating factors accounting for binge eating (BE) and social media disorder (SMD) in adolescence. ObjectiveDespite studies suggesting the role of both attachment and alexithymia in these disorders, there has been no investigation into the mediating role of alexithymia in the pathways linking the different types of attachment relationships to both BE and SMD. MethodsA total of 423 Italian adolescents (32.2% males, Mage=16.88) completed self-report questionnaires investigating attachment, alexithymia, binge eating, and social media disorder levels. Hypotheses were tested with Structural Equation Modelling including multigroup analyses. ResultsAlmost all the variables showed relationships with each other. BE was explained by attachment to the mother and peers in both genders, but the mediating effect of alexithymia was significant only among girls. SMD was explained only by attachment to peers among boys but by attachment to the parents among girls. Moreover, among girls, the role of attachment to the father in SMD was fully mediated by alexithymia levels. ConclusionsAttachment and alexithymia are two explaining variables associated with BE and SMD in adolescence. However, differentiating between attachment relationships appears crucial to reaching a nuanced understanding of the dynamics underlying both BE and SMD.

Longitudinal links from attachment with mothers and fathers to adolescent substance use: Internalizing and externalizing pathways.

The present study examined whether internalizing and externalizing symptoms may mediate the association between adolescent-mother and adolescent-father attachment and substance use. The sample included 167 adolescents (47% girls) who were assessed at five time points with approximately 1 year between each assessment, beginning in middle adolescence (Mage=14.07) and ending in the transition to young adulthood (Mage=18.39). The adolescents reported their perceived attachment with both their mother and father during middle adolescence (Times 1 and 2), their internalizing and externalizing symptoms during late adolescence (Times 3 and 4), and their alcohol use during the transition to young adulthood (Time 5). The results showed that less secure adolescent-father attachment, but not adolescent-mother attachment, was predictive of heightened externalizing and internalizing symptoms. In turn, heightened externalizing symptoms were predictive of heightened alcohol use. Despite the nonsignificant direct association between adolescent-father attachment and alcohol use, less secure adolescent-father attachment was indirectly predictive of greater alcohol use, mediated through heightened externalizing symptoms. The findings highlight the importance of close and trusting father-adolescent relationships in the development of psychopathology and substance use behaviors. The developmental cascade from a less secure adolescent-father attachment to greater externalizing symptoms and heightened substance use, as well as implications for prevention and intervention of young adult substance use, are discussed. RESEARCH HIGHLIGHTS: The differential pathways from adolescent-mother and adolescent-father attachment to substance use during the transition to young adulthood are not well known. Longitudinal data were used to test whether internalizing and externalizing symptoms may mediate the association between adolescent-mother and adolescent-father attachment and substance use. Less secure adolescent-father attachment predicted heightened internalizing and externalizing symptoms, and less secure adolescent-father attachment predicted greater alcohol use, mediated through heightened externalizing symptoms. The findings suggest that addressing insecure attachment with fathers during adolescence may reduce unhealthy substance use during the transition to young adulthood.

Pathological personality traits from ICD-11 and attachment - Comparison of 10 models of attachment dimensions.

The aim of the study was to analyze the relationship between personality disorders according to the new ICD-11 dimensional approach and attachment. To do so, we examined ten models of attachment and employed seven questionnaires. The study was conducted online and involved a non-clinical group of N = 391 (68% women, 30% men, and 2% - people who marked the "gender - other" category, aged 16-65 yeas; M = 24.91; SD = 7.8). Attachment was measured using seven questionnaires, and the Polish adaptation of the PiCD Questionnaire was used to measure personality disorders according to ICD-11. The regression analysis revealed a consistent picture of the relationship between insecure attachment (regardless of model) and personality disorders. "Negative Affectivity" and "Disinhibition" are associated with Anxious attachment, while "Detachment" and "Dissociality" with Avoidant attachment. "Anankastia" showed only a sporadic association with attachment. Attachment (according to theoretical models formed in childhood) is significantly related to personality disorders in adults. In the conducted study, a coherent picture of this relationship was obtained thanks to the use of many conceptualizations and operationalizations of attachment.

Conceptualizing Couples Through Romantic Attachment and Love Language

Attachment theory posits that relationships developed in childhood between children and their parents or caregivers, impact the manner in which later relationships are developed in adulthood. John Bowlby described various attachment styles within the child-caregiver relationship. Some of these attachment styles are viewed today through the lens of romantic attachment styles that include secure (content and healthy relationships), avoidant (dismissive and unengaged in relationships), and anxious (insecurities and fear in relationships). Couples romantic attachment could be better understood in conjunction with love languages. Love languages, developed by Gary Chapman, include words of affirmation, quality time, gift giving, physical touch, receiving gifts, and acts of service. Applying love language techniques to mending insecure attachments, can lead to couples understanding of one another's needs, and improve relationship satisfaction. Thus, this article advocates for clinicians’ assessing romantic attachment and love languages in couples therapy, to promote stronger, affectionate, empathic, and satisifying relationships. Lay summary Understanding your partner's needs can improve relationship satisfaction in relationships. Insecure romantic attachments may be strengthened by speaking your partner's love language. This article advocates for clinicians to assess for romantic attachment and love languages in couples therapy.

The Association Between Adult Attachment Patterns, Attachment to Group and Mental Health in Israel Following the October 7th Attack: The Role of Emotion Regulation Strategies.

We examined the associations between attachment anxiety, attachment avoidance, and attachment to group (to Israel) and mental health scores. The study used a community sample of 434 participants in response to the October 7th attack on Israel. Additionally, we explored the potential mechanisms linking these attachment patterns to mental health scores. We focused on emotion regulation strategies, such as task-focused, emotion-focused, and distance-focused strategies, as potential mediators. The results indicated that the negative direct association between attachment anxiety and mental health is fully mediated by a high emotion-focused strategy and a low task-focused strategy. Attachment avoidance did not have a significant direct association with mental health scores. However, it had significant negative indirect associations through a high emotion-focused strategy and a low task-focused strategy. Attachment to the group (to Israel) showed both direct and indirect positive associations with mental health through a low emotion-focused strategy and a high task-focused strategy. The discussion highlights the role of internal representations of insecure attachment, group attachment, and emotion regulation strategies (especially emotion- and task-focused strategies) in how highly stressful external situations affect mental health.

Adult insecure attachment styles and suicidality: A meta-analysis

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.

Trauma and social pathways to psychosis: Examining the role of attachment, social rank and dissociation in a clinical sample.

The trauma and social pathways model of psychosis proposes interactions between trauma, attachment, social rank and dissociation in pathways to psychosis, though this model has yet to be empirically investigated. The primary aim of this study was to examine the overall predictive value of the trauma and social pathways model using regression analysis. A secondary aim was to delineate hypothesized pathways between trauma and positive symptoms of psychosis using serial mediation analysis. This was a cross-sectional study of people attending mental health services for a psychosis-related diagnosis (N = 71). Measures of trauma, positive symptoms of psychosis, attachment, social comparison and dissociation were completed. A model of recurrent trauma, insecure attachment, social rank and dissociation predicted 23.2% of the variance in positive symptoms of psychosis. Recurrent trauma, attachment and dissociation contributed significantly to the model, while social rank did not. Further, serial mediation analysis indicated that the sequence of disorganized attachment and dissociation fully mediated the relationship between recurrent trauma and positive symptoms. Results provide preliminary support for the trauma and social pathways model of psychosis, specifically as it relates to recurrent trauma, insecure attachment and dissociation. Results did not support the social rank component of this model, however. These findings provide clear targets for the development of next-wave psychological interventions that focus on trauma-related variables in psychosis. Future studies should replicate these findings with a larger clinical sample, and consider a measure of shame to further elucidate social processes in pathways to psychosis.

Preterm infant attachment is independent of breast milk intake during neonatal care

Background Following preterm birth, breast milk feeding is recommended because it confers broad health benefits to preterm infants. Breast milk has been suggested to promote secure attachment in infancy, but this is uncertain. Elucidating the relationship between breast milk intake and infant attachment is crucial for supporting parents of preterm infants to make feeding choices and providing accurate counselling when breast milk is not available. We aimed to investigate if breast milk exposure during neonatal care associates with attachment outcomes derived from infants’ responses to the Still-Face Paradigm (SFP) at nine months of age. Methods We studied 77 preterm (&lt; 33 weeks’ gestation) and 71 term infants. Preterm infant feeding data were collected from birth until hospital discharge. Infant responses to the SFP were videocoded at nine months corrected age. Infants’ distress, fretfulness, attentiveness to caregivers and attachment classification were compared between preterm infants who received exclusive breast milk for ≥ 75% of inpatient days, those who received exclusive breast milk for &lt; 75% of inpatient days, and term infants. Milk intake thresholds were chosen based on our previous work demonstrating positive associations between breast milk intake and MRI markers of brain maturation. Results There were no significant differences in infant distress, fretfulness, attentiveness to caregivers (p-values &gt; 0.19), or in the odds of secure versus insecure attachment classification (relative risk ratio = 0.57–0.89, p-values = 1.00) between preterm infants with high or low breast milk exposure, or term comparators. Conclusions Attachment outcomes at nine months were similar between term and preterm infants, and breast milk exposure did not associate with attachment in the preterm group. Although breast milk feeding has clear benefits, these findings may alleviate some of the pressures experienced by parents who are unable to provide breast milk for infants cared for in the neonatal unit.

Attachment goes to court in Sweden: perception and application of attachment concepts in child removal court decisions

ABSTRACT Concerns have been raised regarding misconceptions about attachment theory in child protection settings, but the application of attachment concepts in judicial child protection decisions has not been systematically explored. This study therefore examined the perception and application of attachment concepts in Swedish judicial decision protocols concerning involuntary removals of children (aged 0–2 years) where emotional neglect was a notable concern (n=28). Attachment concepts were frequently misunderstood, and imprecisely articulated. Unsystematic observations of child behavior were used to infer attachment insecurity and, by extrapolation, caregiving deficiencies. Attachment concepts were primarily used to support child removal, and insecure attachment seemed to be viewed as meeting the legally required level of risk to warrant involuntary child out–of–home placement. Our results indicate that misconceptions about attachment theory may be prevalent in judicial decision protocols. We emphasize the need to elaborate on risks in legally relevant ways without incorrect appeals to attachment theory.