Adult attachment and how it is related to health

We have been writing about the ways in which humans find security in our most important relationships (or fail to) and how these affect physical health and health care since 2001. It goes both ways. On one hand being sick is one of the most fundamental threats that any organism faces, so it triggers all of our insecurities. The way we manage feeling stressed and insecure often has an impact on our relationships with health care providers. On the other hand, chronic feelings of insecurity contribute to a whole host of things that subtly (and not so subtly) increase the risk that we will get sick. So attachment insecurity shapes both our risk of disease and our illness behaviour. Understanding how this works changes the way you look  at many of the human interactions that occur in hospitals, clinics and waiting rooms.

  • Maunder RG, Hunter JJ. Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosom Med. 63 (4), 2001, 556-567.
  • Hunter J, Maunder RG. Using attachment theory to understand illness behavior. Gen Hosp Psychiatry. 23 (4), 2001, 177-182.
  • Maunder R, Lancee, W, Greenberg, G, Hunter, J, Fernandes, B. Insecure attachment in a subgroup of ulcerative colitis defined by ANCA status. Dig Dis Sci. 45, 2000, 2127-2132.
  • Maunder, RG, Hunter, JJ. An integrated approach to the formulation and psychotherapy of medically unexplained symptoms: Meaning- and attachment-based intervention. Am J Psychotherapy. 2004, 58(1), 17 -33.
  • Maunder RG, Lancee WJ, Hunter, JJ, Greenberg, GR, Steinhart, AH. Attachment insecurity moderates the relationship between disease activity and depressive symptoms in ulcerative colitis. Inflamm Bowel Dis. 2005; 11(10): 919-926.
  • Maunder, RG, Lancee, WJ, Nolan, RP, Hunter, JJ, Tannenbaum, D. The relationship of attachment insecurity to subjective stress and autonomic function during standardized acute stress in healthy adults. J Psychosom Res. 2006; 60: 283-290.
  • Maunder RG, Panzer A, Viljoen M, Owen R, Schalk AA, Hunter JJ. Physician’s difficulty with Emergency Department patients is related to patient’s attachment style. Soc Sci Med. 2006; 63(2):552-62.
  • Sloan E, Maunder R, Hunter J, Moldofsky, H. The α-EEG anomaly during sleep is associated with insecure attachment. BioPsychoSocial Med. 2007, 1:20.
  • Ravitz P, Maunder R, McBride C. Attachment, contemporary interpersonal theory and IPT: An integration of theoretical, clinical and empirical perspectives. Journal of Contemporary Psychotherapy. 38:11-21, 2008.
  • Maunder RG, Hunter JJ. Attachment relationships as determinants of physical health. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry. 36: 11-32, 2008.
  • Maunder RG, Hunter JJ. Assessing patterns of adult attachment in medical patients. Gen Hosp Psychiatry. 31:123-130, 2009.
  • Ravitz P, Maunder RG, Hunter JJ, Sthankiya B, Lancee, WJ. Adult Attachment Measures – a 25 year review. J Psychosom Res. 69 (4): 419-32, 2010.
  • Maunder RG, Hunter JJ, Lancee WJ. The impact of attachment insecurity and sleep disturbance on symptoms and sick days in hospital-based healthcare workers. J Psychosom Res. 70 (1): 11-17, 2011.
  • Maunder RG, Hunter JJ. A prototype-based model of attachment for healthcare providers. Psychodynamic Psychiatry. 40(4):549-73, 2012.
  • RG Maunder, RP Nolan, JS. Park, R James, G Newton. Social support and the consequences of heart failure compared to other cardiac diseases: The contribution of support received within an attachment relationship. Archives of Cardiovascular Disease, 2015 108(8-9), 437-45.
  • RG Maunder, L Wiesenfeld, S Rawkins, J Park. Development of the C4 Inventory: A Measure of Common Characteristics of Complicated Care in Outpatient Psychiatry. Journal of Comorbidity. 2016 May 11;6(2):56–64. Get free open-access pdf here.
  • RG Maunder, JJ Hunter. Can patients be “attached” to healthcare providers? An observational study to measure attachment phenomena in patient-provider relationships. BMJ Open. 2016 Apr 27;6. Get free open-access pdf here.
  • Feldcamp L, Doucet JS, Pawling J, Fadel MP, Fletcher PJ, Maunder R, Dennis JW, Wong AH. Mgat5 modulates the effect of early life stress on adult behavior and physical health in mice. Behavioural Brain Research. 2016 Oct 1;312:253-64.
  • Le TL, Mann RE, Levitan RD, George TP, Maunder RG. Sex differences in the relationships between childhood adversity, attachment anxiety and current smoking. Addiction Research & Theory. 2016 Oct 31:1-8.
  • Maunder RG, Hunter JJ, Le TL. Insecure Attachment and Trauma in Obesity and Bariatric Surgery. In Psychiatric Care in Severe Obesity 2017 (pp. 37-48). Springer International Publishing.
  • Maunder RG, Hunter JJ, Atkinson L, Steiner M, Wazana A, Fleming AS, Moss E, Gaudreau H, Meaney MJ, Levitan RD. An Attachment-Based Model of the Relationship Between Childhood Adversity and Somatization in Children and Adults. Psychosomatic Medicine. 2017 Jun 1;79(5):506-13.
  • Le TL, Levitan RD, Mann RE, Maunder RG. Childhood Adversity and Hazardous Drinking: The Mediating Role of Attachment Insecurity. Subst Use Misuse. 2018 Jan 15:1-12.
  • J Hunter RG Maunder. Using Attachment Theory to Understand and Support Healthcare Workers under Stress. Canadian Journal of Physician Leadership 2019;6(1), 30-35.
  • Le TL, Conklin CA, George TP, Levitan RD, Mann RE, Maunder RG, Exposure to attachment figure cues reduces cigarette craving. Experimental and Clinical Psychopharmacology. 28 (1):  81-86, FEB 2020
  • TL Le, R Geist, JJ Hunter, RG Maunder. Relationship between insecure attachment and physical symptom severity is mediated by sensory sensitivity. Brain and Behavior 2020;10(8):1-5.
  • Godoy LC, Frankfurter C, Cooper M, Lay C, Maunder R, Farkouh ME. Association of Adverse Childhood Experiences With Cardiovascular Disease Later in Life: A Review. JAMA Cardiol. 2021 Feb 1;6(2):228-235.
  • Le TL, Mylopoulos M, Bearss E, Geist R, Maunder R. Multiple symptoms and health anxiety in primary care: a qualitative study of tensions and collaboration between patients and family physicians. BMJ Open. 2022 Apr 15;12(4):e050716.
  • RG Maunder, ND Heeney, JJ Hunter. Adult attachment insecurity and responses to prolonged severe occupational stress in hospital workers during the COVID-19 pandemic, Health Psychology and Behavioral Medicine, 2022, 10:1, 871-887, DOI: 10.1080/21642850.2022.2123806