Attachment and psychosomatic medicine: Developmental contributions to stress and disease

Objective: The object of this study was to evaluate the evidence linking at tachment insecurity to illness. Attachment theory describes lifelong patter ns of response to threat that are learned in the interaction between an inf ant and his or her primary caregiver. Despite its biopsychosocial domain, a ttachment theory has only recently been applied to psychosomatic medicine. Method: MEDLINE and PsychInfo databases were searched from 1966 to 2000 for English language papers with key words "attachment" and "object relations. " Papers and their cited references were reviewed if they were directly rel ated to physical illness, symptoms, or physiology. A hypothetical causal mo del was developed. Results: Direct and indirect evidence from survey studie s supports an association between attachment insecurity and disease. Animal studies and human experiments suggest that attachment contributes to indiv idual differences in physiological stress response. There is also less robu st support for insecure attachment leading to symptom reporting and to more frequent health risk behaviors, especially substance use and treatment non adherence. Evidence supports the prediction from attachment theory that the benefits of social support derive more from attachment relationships than nonattachment relationships. Conclusions: Although the available data are s uggestive rather than conclusive, the data can be organized into a model th at describe attachment insecurity leading to disease risk through three mec hanisms. These are increased susceptibility to stress, increased use of ext ernal regulators of affect, and altered help-seeking behavior. This model w arrants further prospective investigation.