Adaptations to adult attachment and intimacy following spinal cord injury: a systematic review

Abstract

Purpose

Experiencing spinal cord injury (SCI) can be life-changing for individuals and their families. Previous reviews have focused on coping and psychological adjustment, sexual function and sexuality, or factors facilitating or impeding interpersonal relationships after SCI. However, there is a very little synthesis of research focusing on changes to adult attachment and emotional intimacy post-SCI. This review aims to examine the mechanisms of change in adult attachment and intimacy in romantic relationships following SCI.

Materials and methods

Four online databases (Psycinfo, Medline, CINAHL, and Scopus) were searched for qualitative papers concerning romantic relationships, attachments, and intimacy post-SCI. Sixteen of the 692 papers met the inclusion criteria. These were quality assessed and analysed using meta-ethnography.

Results

Three main themes emerged from the analysis: (a) strengthening and maintaining adult attachment; (b) changes in roles; and (c) changing views of intimacy.

Conclusion

Many couples face significant changes to adult attachment and intimacy following SCI. Systematic ethnographic analysis of their negotiations enabled the identification of underlying relational processes and adaptation strategies associated with changes to inter-dependence, communication, role revision, and re-definition of intimacy. The findings indicate that healthcare providers should assess and respond to challenges faced by couples post-SCI using evidence consistent with adult attachment theory.

IMPLICATIONS FOR REHABILITATION

• Professionals should support both partners to develop strategies to try to cope with spinal cord injury (SCI) and its associated stressors following injury.

• Information and support regarding both the physical and emotional impact of the injury on coupledom and romantic relationships should be provided after SCI.

• Support should be tailored to reflect an individual with SCI and their partner’s cultural and societal background and needs.

Keywords:

• Spinal cord injury
• couple relationships
• adult attachment
• intimacy
• adjustment
• qualitative research
• systematic review

Acknowledgments

The authors would like to thank Jonathan Jones, Psychology Subject Librarian, Cardiff University, for his support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The research was completed as a partial fulfilment of the requirements of the Doctorate in Clinical Psychology for the lead author and as such was partially funded by Health Education and Improvement Wales.