Attachment and physical health: introduction to the special issue

ABSTRACT

Over the last 40 years, researchers have made considerable progress identifying the ways in which attachment security shapes individuals’ social and emotional functioning. In recent years, new investigations have shed light on connections between attachment and physiological systems in the body. The goal of this special issue is to focus attention on how attachment may be related to biological markers that relate to physical health, including inflammation, cortisol, and cardiometabolic risk. The papers in this special issue, highlighted in this introduction, demonstrate that these links may exist across the lifespan. We conclude with several examples of extensions of this work might emerge in the years to come.

KEYWORDS:

• Attachment
• physical health
• inflammation
• cortisol

Although the primary focus of attachment theory and research to date has centered on how individual differences in attachment shape individuals’ social and emotional functioning, an emerging literature suggests that attachment-related experiences may also have implications for physical health across the lifespan (see Ehrlich, Miller, Jones, & Cassidy, 2016, for a review). A robust literature examines social relationships broadly defined and markers of physical health, but only a handful of studies examine relationships that reflect attachment specifically.

As we have previously argued (Ehrlich, 2019; Ehrlich et al., 2016), we see considerable merit in examining links between attachment and markers of physical health (including disease morbidity as well as pre-disease risk markers). Attachment theory is particularly well suited to explain why certain qualities of close relationships could influence physiology, including the immune and neuroendocrine systems, in ways that could have downstream implications for physical health. Attachment theory provides a framework for understanding how individuals manage and regulate their stress. Individuals who have a close relationship partner who serves as a secure base on whom they can rely on for support may have better ways of managing their negative emotions, and this regulation might serve an important stress-buffering role that could minimize “wear and tear” on the body. Similarly, we have argued that attachment security may help children with a chronic disease better manage their symptoms (Ehrlich et al., 2018). For example, children with a chronic disease who have a secure base may be better able to seek care at appropriate times, attend to worsening disease symptoms before problems become urgent, and balance the challenges of their illness with other demands in their life.

The goal of this special issue is to highlight several new studies that illustrate insights into the connections between attachment relationships and physical health. Across five papers, researchers address novel questions about links between attachment and measures of inflammation, cortisol, and cardiometabolic risk. These papers also draw attention to the fact that we can test questions about links between attachment and physical health across the lifespan, including in early childhood (Bernard, Hostinar, & Dozier, 2019) adolescence (Harvey, Farrell, Imami, Carré, & Slatcher, 2019), emerging adulthood (Gouin & MacNeil, 2019), young adulthood (Ehrlich et al., 2019), and middle adulthood (Farrell et al., 2019). The papers also vary in sample characteristics, including low-risk and high-risk samples, samples of healthy individuals and individuals with chronic disease, and samples of participants living in typical circumstances and those experiencing major life changes. Participant race and ethnicity also vary across papers.

We are excited about this collection of papers and their contributions to the growing body of research on attachment and physical health. These studies test novel hypotheses and shed light on the ways in which attachment is linked to various biological markers and pre-disease risk factors. At the same time, we note that there remain many unanswered questions about the ways in which attachment-related experiences shape physiology and effect change on physical health. Below, we list a handful of questions that we hope future research will answer. We present this list with the hope that it will generate new ideas among researchers who are interested in examining variation in physical health as a consequence of attachment experiences.

1. To what extent do early attachment experiences leave a lasting residue on physical health in adulthood? There are several ongoing longitudinal studies that are well positioned to address this question. One sample, included in this special issue (Farrell et al., 2019), is the Minnesota Longitudinal Study of Risk and Adaptation. This impressive study includes assessments of attachment in infancy as well as parental sensitivity and other contextual factors, and the target children in the sample have now reached middle adulthood, which opens up numerous possibilities for identifying early life risk and protective factors for the onset of chronic disease. We are not aware of any longitudinal studies that include both assessments of attachment and markers of health starting in infancy or early childhood, but this will be an exciting gap to address in forthcoming large scale longitudinal studies.

2. Are there critical periods during which attachment-related experiences have a particularly large effect on children’s or adults’ physical health? Some preliminary evidence suggests that relative to attachment experiences in young adulthood, attachment experiences in adolescence may have stronger ties to systemic inflammation in adulthood (Jones et al., 2017). Large longitudinal studies that span developmental periods will be particularly important in helping to track attachment-related experiences and physical health to evaluate whether some developmental periods represent unique points of vulnerability or opportunity for shaping long-term health trajectories.

3. In what ways can secure attachment serve as a buffer from exposure to adverse environmental or contextual exposures? We (Ehrlich et al., 2016) and others (Chen, Brody, & Miller, 2017) have previously suggested that attachment security may play a stress-buffering role for children who are experiencing other forms of stress; it may be that the protective role of attachment security is more easily identified under conditions of high but not low stress.

4. What physiological systems are most directly related to attachment? A number of studies now link attachment to neuroendocrine activity (e.g. Gunnar, Brodersen, Nachmias, Buss, & Rigatuso, 1996; Hane & Fox, 2016) and brain function (Coan, 2016). Identification of the physiological systems that are most sensitive to attachment experiences will be important.

5. To what extent should attachment-health links be thought of as dyadic versus individualistic processes? Researchers often conceptualize attachment in terms of a trait-like component of individuals, but attachment relationships are dyadic in nature. Recently, Manczak, DeLongis, and Chen (2016) provided some intriguing evidence documenting the health “costs” associated with parental empathy; we can imagine there may be some circumstances wherein attachment security serves as a protective factor and perhaps other times when it may place individuals at greater risk for poor health (e.g. secure individuals caring for a terminally ill partner may be particularly vulnerable to health problems associated with the chronic stress of intensive caregiving).

6. Could attachment-based interventions improve children’s physical health? There is great promise in capitalizing on successful intervention programs to examine experimentally whether changes in parenting and attachment security could contribute to changes in physical health. Convincing evidence already suggests that these interventions change children’s physiology (e.g. Dozier, Peloso, Lewis, Laurenceau, & Levine, 2008); future studies could examine whether improving attachment security is associated with declines in low-grade inflammation, blood pressure, or obesity in children.

This list represents only a small selection of the many important and interesting research questions that could be pursued when examining the links between attachment and physical health. In addition, we note that many of the questions researchers are now routinely addressing in relation to various outcomes (e.g. relative contributions of attachment, sensitivity, and social support in predicting outcomes; moderating factors shaping the strength of associations between attachment and outcomes; differential susceptibility) could be examined within the proposed framework of attachment-physical health research. We look forward to the new and creative research questions that are sure to make a transformative impact on our understanding of the ways in which attachment “gets under the skin” in the years to come.

Acknowledgments

We are grateful to many people who made this special issue possible. First, we would like to thank the authors who contributed novel and important papers. In addition, we thank Kristin Bernard, Christopher Fagundes, Allison Farrell, Jean-Phillipe Gouin, Michael Harvey, Camelia Hostinar, Heidi Kane, Kharah Ross, Richard Slatcher, Jessica Stern, and Theodore Waters for their helpful reviews. We also thank Michael Murphy, who acted as Action Editor for our own paper, and two anonymous reviewers. We are especially grateful to Howard Steele, who encouraged us to pursue this special issue and provided us with guidance and flexibility along the way.

Disclosure statement

No potential conflict of interest was reported by the author.