How Relationships Can Affect your Health
Learning Goals:
Secure versus insecure attachment
Attachment and health
The healing power of attachment
My favourite resources to improve relationships
Reading time 15 minutes.
Supportive relationships protect our health, but some relationships have a more powerful effect on our health than others. These are called our attachment relationships and we experience the first of these in our parents/caregivers, then our close adult relationships - including our romantic partner. The reason for an attachment system is that it promotes survival by enabling our infants and children to be safe until they grow capable of fending for themselves. This system uses strategies to ensure offspring and their caregivers are bonded to promote who keep them safe and alive.
Attachment serves the evolutionary goal of helping offspring survive and enables individuals of any age who feel threatened to re-establish physical and emotional security through contact and comfort. I have written about adult attachment styles in a previous blog here which describes secure attachment and the three insecure attachment templates – preoccupied (amplification), dismissing (minimisation), and disorganised (fluctuation). Our default template occurs through our repeated relationship experiences which, while is most significant in infancy and childhood, can also be altered by relationships across the lifespan. We naturally develop adaptive strategies to cope with inconsistent, unavailable, or abusive attachment relationships.
To summarise the attachment styles in a nutshell, secure attachment is characterised by these nice experiences:
Feeling worthy of care and love.
Being trusting of close others to care for us.
Gaining ‘mentalising’ skills (i.e., imagining the mental/emotional perspective of others - related to empathy skills).
Gaining the ability to self-soothe when in distress or pain.
Having good boundaries and assertiveness skills.
Forming the ability to delay gratification.
In contrast, insecure attachment is characterised by some less easy experiences such as:
Reduced self-regulation of stress/emotions.
Difficulties seeking effective social support.
Amplifying and/or Minimising techniques (see below).
Effects on the gut-brain-axis and a less calm autonomic nervous system ("jumpy" vagus nerve, over or under-activated HPA axis, and effects on the gut including dysbiosis/intestinal permeability/impaired nutrient absorption).
Preoccupied Attachment (Amplification):
Relationships have been inconsistent.
Connection has been unreliable.
Feelings of vulnerability and unlovability.
Increased behaviours to obtain closeness (e.g., approval/reassurance and heightened distress).
Struggles with anxiety, emotional distress and calming down.
Heightened protest at separation from loved ones.
Dismissing Attachment (Minimisation):
Relationships have been unavailable or rejecting.
Connection has been unavailable/distracted/disconnected.
Protective mechanisms are to become independent (i.e.., "I don't need others").
Denial of closeness needs, avoid relationships (to avoid rejection/hurt), under-report distress.
May seek out external self-soothing methods (e.g., sex, alcohol, gambling, work).
Compulsive independence.
Do you see yourself in any of these descriptions? Perhaps you identify with both - the third insecure “disorganised” attachment pattern fluctuates between Amplification and Minimisation strategies with the internal conflict of wanting to approach closeness but avoiding danger. This usually forms where early relationships have been abusive in some way and the attachment bond has not been safe.
Whichever way it develops, your attachment system is a complex “meta-system.” This implicates multiple physiological systems, hormones, and neurotransmitters when it is activated ranging from oxytocin and vasopressin (bonding and commitment hormones), adrenalin and cortisol (stress and threat hormones), and those implicated in reward (dopamine and endogenous opiates – endorphins), relaxation (GABA), and contentment (serotonin). Illness, pain, separation, loss, and distress can each activate this meta-system, and trigger your default attachment behaviour (whichever pattern you developed for different circumstances).
In the literature, insecure attachment is associated with diabetes, cardiovascular issues, inflammatory diseases, ‘medically unexplained symptoms’, psychological concerns, and can drive chronic stress. Chronic stress is associated with raised inflammatory cytokines (Interleukin IL-1 and IL-6, and tumour necrosis factor,) and less anti-inflammatory cytokines that terminate the inflammatory response. This relates to the cytokine theory of mental health concerns, whereby a combination of chronic psychological, dietary, lifestyle and interpersonal stressors contribute to an inflammatory response and mental health symptoms like anxiety or depression.
“Supportive relationships protect health. But some have a more powerful effect on health than others. These are our attachment relationships. ”
— Hunter & Maunder (2015). Love, fear and health.
Long-term exposure to stress can also result in desensitised glucocorticoid receptors to cortisol (cortisol resistance), chronic low-grade inflammation with a reduced immune response, and changes to brain-derived neurotrophic factor (BDNF; which aids brain growth and plasticity, insulin sensitivity, and parasympathetic/relaxation system tone). Long-term exposure to stress can also churn through vital nutrients needed for optimal functioning, and can adversely impact the gut lining via impaired digestion/stomach acid, contributing to gut permeability (“leaky gut”). This places the individual at risk of nutritional deficiencies that further worsen the problem and cause more symptoms and a vicious cycle, as the physical foundations are compromised. In addition, when chronically stressed we are more likely to use health detracting behaviour to numb, avoid, or change how we feel, such as alcohol/smoking/caffeine, poor nutritional choices, overworking, and reducing our health-enhancing behaviours like getting seeking social support, quality sleep, nutritious food, and movement.
There are various interesting studies looking at attachment and immune functioning that I find fascinating. Chronic social stress has been found to impair vaccine responses, delay wound healing speed, and dysregulate cellular immunity. EBV virus (glandular fever) latency has been found to be higher in “amplifiers“ with preoccupied attachment (but not dismissing). Those with preoccupied attachment had delayed or impaired recovery from glandular fever compared to those with other attachment styles. Gut microbiota disruption during critical developmental windows has also been found to occur, with effects on the modulation of the immune system and changes in hormones and neurotrophins (proteins that determine neuronal outcomes). There are also epigenetic changes found. For example, some genes seem to be “socially sensitive” and may switch on or off depending on the quality of attachment experiences. Those with preoccupied attachment experience a significantly greater number of physical symptoms compared to other patients (Liechanowski, 2002). With preoccupied attachment there is more stress and anxiety, vagal tone is poor so it's harder to calm down, and the gut is impacted by chronic relational stress and all the things going on above. Over time immune functioning can be impaired causing further health issues, especially chronic types such as autoimmunity.
The Healing Power of Attachment
When illness or injury activates the attachment system through distress and vulnerability it is relationally attuned responses that help to soothe and calm the “metasystem”.
This might vary depending on the attachment style - so a first step is to develop self-awareness of your own style and that of your close other/s.
being predictable, attentive, supportive. To be soothing of distress and anxiety through facial expressions, voice tone, and body language. To listen compassionately, believe the experience, and to focus on distress rather than content (initially).
We are not just a mind or a body, or even a mind-body, we are a mind-body-other. Your health is always in the context of your relationships which can either be a driving factor in chronic health and mental health concerns or a healing resource that enhances your physical and emotional wellbeing.
If healing relationships are not currently something you have access to, the good news is that there are so many resources and supports to develop more earnt secure attachment strategies and cultivate the types of relationships that will support your wellbeing in the future.
Two of my favourite recommended resources to learn how to improve your attachment skills and relationships:
Listen:
https://therapistuncensored.com/
Read:
References
Cassidy, J., & Shaver, P.R. (Eds.). (2016). Handbook of attachment. Theory, research and clinical applications. (3rd Ed). New York: Guilford Press.
Cirulli, F. (2014). Interactions between early life stress and metabolic stress in programming of metal and metabolic health. Current Opinion in Behavioral Sciences, 14, 65-71. https://doi.org/10.1016/j.cobeha.2016.12.009
Dean, J. & Keshavan, M. (2017). The neurobiology of depression: An integrated view. Asian Journal of Psychiatry, 27, 101-111.
Fagundes, C.P., et al. (2014). Attachment anxiety is related to Epstein-Barr virus latency. Brain, Behavior, and Immunity, 41, 232-238. https://doi.org/10.1016/j.bbi.2014.04.002
Greenblatt, J. M., & Brogan, K. (Eds.). (2016). Integrative Therapies for Depression: Redefining Models for Assessment, Treatment and Prevention. CRC Press.
Hunter, J., & Maunder, R. (Eds.). (2016). Improving patient treatment with attachment theory. A guide for primary care practitioners and specialists. Springer Publishing.
Maunder, R., & Hunter, J. (2015). Love, fear and health: How our attachments to others shape health and healthcare. University of Toronto Press.
McEwen, B. S., & Lasley, E. N. (2002). The end of stress as we know it. Joseph Henry Press.
