The fearful-avoidant attachment is the lesser-known, fourth adult attachment style. Here, I explore what it is and what makes it unique and ultimately want to raise awareness of this attachment style.

For it is my view that it often goes under the radar of therapists when working with attachment. Fearful-avoidant attachment definitely deserves some TLC.

What is the fearful-avoidant attachment style?

The fearful-avoidant attachment style reminds me of the character Edward Scissorhands from the eponymous Tim Burton movie. He craves closeness and intimacy but is too wary and distrustful of humans to get closer. His scissor hands, which are meant to protect him, ultimately keep him at a distance from others.

There is sometimes confusion between this attachment style and disorganised attachment. Disorganised attachment is an infant attachment category, whereas fearful-avoidant attachment is an adult attachment style. These two concepts are distinct and it is unclear whether and to what extent this two attachment constructs overlap.

Not only is this attachment style the least known among therapists, but it is also the least researched.

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Conceptualising Fearful-Avoidant Attachment

To me, the best way to understand the concept of fearful-avoidant attachment is to shift how we think about attachment categories. Traditionally, attachment is viewed as a set of distinct, separate categories: Secure, Anxious, and Avoidant. However, more recently some researchers have proposed that attachment is better understood as a two-dimensional space with Avoidance and Anxiety axes—a perspective first introduced here.

I love this idea. It is elegant and makes sense clinically. If there were a Mendeleev-style periodic table for attachment, this model would be it. Just as the periodic table predicted the existence of yet-to-be-discovered elements, this model anticipates the presence of the fearful-avoidant attachment style.

Let’s take a closer look at this using the diagram below.

While fearful-avoidant attachment style can be seen as a combination of anxious and avoidant attachment style, it presents its own set of challenges in therapy. From my experience, establishing a relationship of trust is a major stumbling block.

I would also like to shine a light on some intriguing features of the fearful-avoidant attachment style that could help generate useful idea nuggets for therapy work.

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The Strange Situation Procedure

The ‘original’ way to assess attachment in infants was the Strange Situation Procedure (SSP). In this procedure, a 12 to 14 month-old infant and their mother are placed in a welcoming room with toys and a new person they haven’t met before. The mother and the stranger take turns leaving and returning, which creates different scenarios for the child. By observing the child's behaviour in a codified manner, researchers are able to determine one of four attachment styles: secure, anxious-avoidant, anxious-ambivalent or disorganised.

The first three categories correspond very broadly to the Secure, Avoidant and Anxious adult attachment categories, although the correspondence is far from being 100%. You can read more about the nitty-gritty of complexities of attachment classification and attachment continuity in Attachment Shadow.

Later studies have looked at the overt distress versus the physiological signs of distress while infants undergo the Strange Situation Procedure. One of the fascinating discoveries, evidenced from variations in their heart rate, was that the avoidant children experience as much physiological distress as secure children, despite the apparent composed and dismissing behaviour.

One possible interpretation: avoidant children experience as much emotional distress as other children when faced with attachment challenges, but they are already little masters at disguising their true feelings and reactions.

The story told by cortisol levels as a measure of physiological distress seems to be little more complicated.

Fearful-Avoidant Attachment And Emotion Regulation Strategies

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Attachment theory has become somewhat a victim of its own success and the misconceptions around attachment abound. We look into:

• The Barnum effect and attachment theory - where the theory gets so diluted that we can see in anyone and everyone

• Lost In Translation - how the attachment concepts are misunderstood and the mess with definitions

• Just Because Something Has the Word 'Attachment' Doesn't Mean That It’s Attachment Theory

• Principles of Attachment Theory Revisited

• Attachment Neurobollocks

The Barnum Effect and Attachment Theory

To me the shadow of attachment theory overlaps with the very reason why it is so popular.

In the language of cognitive biases it is called the Barnum effect. Basically, this applies to statements that appear personal yet are general enough to apply pretty much to everyone, at least some of the time. Like one of those magical mirrors from fairy tales that show us whatever we want to see.

Consider the following questions:

• Are you dependent on others?

• Do you feel an intense desire for intimacy or closeness?

• Are you sensitive to changes to how people feel, speak or behave?

• Do you have the tendency to feel or act jealous?

• Do you feel you are unworthy of love?

• Do you fear abandonment?

• Do you have low self-esteem?

• Do you overextend on work projects to please your coworkers?

• Are you frequently checking social media for information?

• Are you going along with whatever your friends want to do even if you don’t feel like it?

And what are your answers to these questions? If you find that you can relate to some of them in various aspects, then - drumroll, please - you might be anxiously attached.

Yet to me, all of the statements above apply to most people some of the time. Hence, the Barnum effect.

Some obvious manifestations of the Barnum effect in action include the success of astrology and fortune-telling. The lasting and continuous success of these arcane arts is a testament to the incredible power of this effect.

Therefore, to me, the remarkable success of attachment theory overlaps somewhat with its shadow, the Barnum effect, a factor incidentally amplifying its broad appeal.

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The Shadow of Attachment

Dr. Pascal Vrticka, a social neuroscientist working on attachment breaks down what he sees as the shadow of attachment into four categories.

Shadow 1. Lost In Translation

I think that one very large shadow is attachment theory’s popularity and its widespread use. Everybody seems to be talking about attachment nowadays, especially on social media. The problem thereby is that people either use the same terms to describe different things, or link the same process to different terms. Both of these issues cause a lot of confusion – we are currently literally “lost in translation”.

One example is that many people keep saying that they have an “insecure-disorganised adult attachment style”. This is inaccurate in two ways.

• First, attachment disorganisation is a category that only exists in childhood attachment measures derived from behavioural observations. Attachment self-reports, which are predominantly used in adulthood, do not have a disorganised category. Instead, they include a description of individuals in whom there is a co-occurrence of insecure-avoidant and -anxious attachment tendencies – i.e., how they think about the availability and responsiveness of others, as well as their own ability to depend on and be close to them. Thus, disorganised and fearful(-avoidant) attachment are two different things.

• Second, attachment disorganisation (in childhood) is a separate category, not another type of insecure attachment. There are the three organised categories of secure, insecure-avoidant and insecure-anxious attachment, plus a separate category of disorganised attachment.

Taken together, there is no such thing as an “insecure-disorganised adult attachment style”.

I see two things in play here...

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Mess With Vernacular

The problem being that, when it comes to psychology, the categories used to designate the formal concepts often originate from words of everyday use - the vernacular.

This general issue was highlighted in a recent paper which focuses on how the word 'fear' is used in neuroscience. A scientist might study fear conditioning in animals or fear-related brain circuitry, but when neuroscientists talk about 'fear,' they’re actually referring to the relationship between a threatening stimulus and the animal's defensive response.

The same goes for words like pleasure, motivation, love, bonding, learning, and of course, attachment. In everyday language, attachment means two people being emotionally connected. So, it's no surprise that people feel they already understand what attachment is, even within the context of attachment theory, because some of that everyday meaning inevitably sneaks in.

Mess With Definitions

The second problem comes from how confusing the definitions in attachment theory can be. Think about it: for infant attachment in the Strange Situation Procedure (SSP), there's a ‘secure’ category, but when you move to the Adult Attachment Interview (AAI), it’s called ‘autonomous’ - only for it to be called ‘secure’ again when discussing adult attachment styles. Not confusing at all.

Another example: the infamous (and nonexistent – see above) 'insecure-disorganised adult attachment style' derived from self-report questionnaires. Yet, the 'unresolved/disorganised' adult attachment category derived from the AAI does seem to exist, but it's not exactly a category on its own. Again, not confusing at all, right? And it gets better.

Take insecure-ambivalent/resistant/preoccupied or -anxious attachment - they all refer to the same thing, yet for some reason they go by different names. And I am pretty sure I’ve seen terms like ‘anxious-avoidant attachment’, which totally throws me off balance. At this point, I have no idea what is going on.

It is a definitions mayhem!

Here is what Pascal says on the origins of this messy situation:

Different attachment measures were independently developed for different ages (mainly children vs. adults), are based on different measurement tools (behavioural observations vs. interviews vs. self-report questionnaires), have different objectives in mind (infant behaviour towards caregivers and strangers vs. verbal recollections of previous attachment experiences with one’s parents vs. self-reported thoughts and emotions within romantic relationships), and they furthermore stem from two different attachment traditions (developmental vs. social psychology).

However, the modern community of attachment researchers is actively trying to address the current state of widespread confusion. Please make sure to check this website of the Society for Emotion and Attachment Studies if you wish to get up-to-date and reliable definitions and explanations of attachment theory concepts.

To clear things up, here is an attempt to provide an overview with some examples of attachment orientations as assessed by three different attachment measures.

Please note that the unresolved attachment category – derived from the AAI (row 2 of the table above) – refers to a specific difficult event of loss or trauma, rather than being a person’s overall attachment orientation. Thus, for instance, a person can be overall securely attached, yet also have an unresolved attachment narrative when it comes to a specific person and/or event in their life.Therefore, the unresolved attachment category is not included in the table as a separate category.

And to be even clearer:

• Disorganised attachment is an attachment orientation attributed to infants derived from the SSP (see first row in the table). It is assigned if there is conflicted, confused, and/or apprehensive child behaviour towards their caregiver, or a complete lack of an organised child behavioural attachment strategy.

• There is NO such thing as an “insecure-disorganised adult attachment style”.

• Fearful-avoidant attachment is NOT another name for disorganised attachment.

• Insecure-avoidant and -dismissive attachment are different terms that designate essentially the same attachment orientation. The same logic goes for insecure-ambivalent/resistant/preoccupied/anxious attachment. And for autonomous and secure attachment.

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Shadow 2. Just Because Something Has the Word 'Attachment' Doesn't Mean That It is Based On Attachment Theory

Another example is the parenting philosophy of “attachment parenting”, which many people believe to be based on attachment theory. Simply because of the word “attachment” in its name. But this is also inaccurate. Attachment parenting was developed by two paediatricians in the 1980s independent of the considerations that inspired attachment theory several decades earlier, and initially called “the new continuum concept” or “immersion mothering”. It was only later on renamed into “attachment parenting”, although its core assumptions always remained independent from attachment theory. Crucially, there is very little scientific evidence that “attachment parenting” practices – such as the seven Baby Bs – yield secure child attachment development.

This, too, underlines the fundamental point that just because someone adds the word 'attachment', it doesn’t automatically mean that it is supported by attachment research. In the same way that just because someone prefixes their method with 'quantum', it doesn't automatically mean it is supported by quantum physics (e.g., quantum healing), or the prefix 'neuro' that it is backed by neuroscience.

Shadow 3. Fundamentals of Attachment Theory Revisited

Another growing shadow is that many people are unaware of how much attachment theory has changed over the years. Since John Bowlby and Mary Ainsworth first described and developed attachment theory about 70 years ago, a lot of new scientific evidence has emerged that strongly changed or even replaced many of its initial claims. For example, we nowadays appreciate that attachment can and does change across the life span, that both mums and dads (and other caregivers) are important attachment figures for their children, and that constantly being “tuned in” with one’s children is not always a good thing.

So what are some of these fundamental attachment theory tenets, and have they stood the test of accumulated empirical evidence over 70 years?

Some of the original tenets of attachment theory

1. The main attachment figure always is the mother

2. Attachment is due to nurture (environment), not to nature (genetics)

3. Attachment is stable over the lifetime

4. There is an intergenerational continuity of attachment

Tenets revisited (according to empirical evidence available today)

1. Fathers are attachment figures, too, as well as are any other caregivers who are reliably present in a child's life

2. Attachment is due to a nature (genetics) by nurture (environment) interaction

3. Attachment can and does change over the lifetime (albeit not that easily)

4. There is intergenerational continuity of attachment, but its effect is weak - in other words, it is far from deterministic and there are no fixed rules for attachment transmission

Overall, it’s fair to say that the fundamental assumptions of attachment theory are nowhere near as deterministic and immutable as originally thought. Instead, it seems there’s a lot more 'noise in the signal' when it comes to attachment. This is actually good news for therapy - no matter what happens to us, who our parents are, or what starting position we are given in life, we can always change for the better.

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Shadow 4. Attachment Neurobollocks

The same holds true for the initial claims made about the underlying neurobiology of attachment. At the time when these claims first emerged, we had a very different view of the human brain, its organisation and functioning. We believed in things like people being either left- or right-brained, the brain consisting of three separate layers called the “reptile brain”, “mammal brain” and “human brain” (as part of the triune brain model), or the existence of a separate dorsal and a ventral vagal pathway (as part of polyvagal theory). Unsurprisingly, such views of human brain organisation and functioning also influenced the formulation of particular therapeutic approaches in the context of attachment. Recent scientific evidence, however, clearly shows that the human brain works very differently and that such views are no longer valid. This not only has many implications on how the neurobiology underlying attachment should be described, but also how such a neuroscience-based view informs therapy. In short, while we absolutely need social neuroscience data to fully understand human attachment, it is only helpful when applied properly and based on state-of-the-art scientific evidence.

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These are the five main shadows of attachment, as we see them. Do you have a favourite attachment shadow of your own? I would love to hear.

As always, thank you so much for reading …🙏

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There is no question: the anxious–avoidant trap is trouble. It describes what happens when two opposing adult attachment styles collide within a relationship.

When Charles Dickens wrote: “It was the best of times, it was the worst of times”, could he have been describing an anxious–avoidant relationship?

You might be wondering: do I have a confession to make or a relationship pattern of my own to work through? You will be disappointed. Yes, I might have had my fair share of Mr Bigs – the quintessential avoidantly attached man – but those days are behind me now. There will be nothing like it here. Instead, I am merely following my co-author on many pieces here, Pascal Vrticka, down this rabbit hole, explored in his recent post The Anxious–Avoidant Trap: Fact or Fiction? Pascal has done all the legwork and I am just offering a more narrative and therapeutically tuned version of what he found out.

I want to talk about this because, in my experience, out all attachment combinations, the anxious-avoidant combination takes up the most airtime. So I am wondering whether there really is such an extraordinary gravitational pull between the anxious and the avoidant attachment styles, as pop-psychology wisdom would have it. After all, if such a pull does exist, it is important to understand it and unpack it in therapy.

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Adult Attachment Styles In A Nutshell

Attachment is a biological mechanism that compels children to seek care from reliable and close others in times of real or perceived threat. These reliable others are referred to as attachment figures.

More recently, attachment has also been described as our primary mechanism for social allostasis. In other words, it is the process through which we rely on others to maintain our homeostasis – our state of physical and psychological equilibrium, the sine qua non of every form of life.

Attachment is prominent in childhood but while it takes different, maybe sometimes more subtle or even symbolic forms, attachment persists throughout our lifetime. In adulthood, perhaps unsurprisingly, it is the romantic partners that often take on the role of attachment figures.

Research in social psychology generally defines four adult attachment categories: secure, avoidant, anxious, and fearful-avoidant. The three latter attachment styles - avoidant, anxious and fearful-avoidant - are said to be insecure attachment styles.

A Word About Neurobiology of Attachment

Attachment is not only evident in relational patterns and behaviour. Today we know that attachment leaves a deep imprint on a person’s biology, including patterns of brain activation and connectivity, physiology, endocrinology and even epigenetics. Each attachment style does so in its own idiosyncratic way, making it possible to define a neural signature for each attachment style (that is pretty cool, right?). In other words, attachment patterns run deep permeating our biological make up and defining who we are beyond just our behaviour in relationships.

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Attachment System Activation and Anxious-Avoidant Dynamic

The biological system that is activated when we perceive a threat, whether physical or psychological, and that compels us to seek the help of close others, our attachment figures, is called the attachment system. Because ultimately it is about survival, the attachment system, particularly when “felt security” is not attained quickly, carries tremendous power.

In the case of anxious–avoidant couples, these attachment energies, once activated, push in opposite directions. Having worked with people in therapy on both ends, anxious and avoidant alike, I can attest that it can at times resemble a Molotov cocktail of a relationship. It is the attachment big bada boom.

Indeed, the two attachment styles employ opposing strategies in pursuit of their “attachment goals” (see the diagram about attachment styles above). When perceiving threat, an individual with an anxious attachment style will typically employ hyperactivating strategies. This means that they will often escalate and intensify their attempts to receive attention, reassurance, proof that the other cares. They may be perceived as “clingy” or “needy” and might even resort to protest behaviours (strategies such as sulking, acting out or looking for attention outside of the relationship).

In contrast, an individual with an avoidant attachment style is more likely to resort to deactivating strategies. Under pressure, they tend to require space, distance themselves from others (including their attachment figures) and rely on their own strategies for emotional regulation, most often through emotional suppression. In such moments, empathy is not a forte and they are unlikely to be receptive to the distress of others. In fact, a requests for emotional support is likely to drive them even further away.

Such is, in a nutshell, the infamous anxious-avoidant dynamic.

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Trap or Vortex?

So what's the deal with the anxious–avoidant trap? I first came across the idea in the book Attached – the same book that helped propel attachment theory into stardom ( I like the book, by the way, it is really what got me into attachment in the first place).

A considerable portion of Attached is dedicated to this idea of inexorable pull of the anxious and avoidant attachment. The word “trap” refers to the idea that we do not see it coming, but once we are in it, it is difficult to escape. According to the book, this is how we end up being drawn into and stuck in an anxious–avoidant relationship. While the authors never state it explicitly, I feel as though the concept has been taken to mean that these relationships are somehow common 'trap' we fall into. And to be sure, given the intensity of the dynamic, “anxious–avoidant vortex” might be an even better descriptor.

At any rate, at this point the anxious-avoidant trap (or vortex) has become part of attachment lore.

Internal Working Models of Attachment

According to Attached, these couples are formed and endure, despite their incompatible needs – one partner consistently seeking more intimacy, the other consistently seeking less – because they confirm each other’s deeply embedded beliefs about the self and the world.

What is really being referred to here are the internal working models (IWMs) of attachment: a set of internalised rules and expectations about others that, according to attachment theory, are forged in the crucible of early relationships. These are deeply held beliefs, often sitting partially or entirely outside awareness. The idea is similar to the script in Transactional Analysis.

And they are funny things, the deeply held beliefs. Even if they are negative or painful, there is still comfort in seeing them confirmed. It is almost like saying: “I knew it all along”. Like touching or poking a sore spot, it is, strangely, soothing. It is the devil you know.

So in terms of these IWMs or script, anxious and avoidant attachment are essentially each other’s worst nightmare come true.

For the anxious partner, the avoidant confirms their deepest fear and script belief: I am unlovable and others are distant, indifferent, and might abandon me.

For the avoidant, it works the other way round: the anxious partner seems to prove the belief that others are clingy, needy, and not competent enough to cope with problems.

Which is exactly how hyperactivating the attachment system might look like. It sure does look like trouble.

This dynamic epitomises the opposites attract hypothesis when it comes to how couples are formed attachment-wise (aka complementarity hypothesis).

The idea that the opposites attract has something narratively satisfying about it, don't you think? In fact, many works of fiction have made use of this. Think of Jane Eyre, Pride and Prejudice or Sex and the City, to name just a few.

But then again satisfying narratives can be so treacherous. In fact, let me present an alternative narrative, that is, in my opinion as seductive. It goes like this:

We are attracted to what is similar to us. We see beyond the surface and recognise the deep imprints that our relationship experiences have left upon us. Shared formative experiences are more likely to lead us to see the world in the same way and to understand each other's emotional needs and reactions. Ultimately, it is trauma bonding meets kindred spirit type of thing.

This nifty competing narrative too that also has some empirical support. It is referred to as the similarity hypothesis.

There is also a third hypothesis: everybody wants to be with a secure person. It is the attachment security hypothesis.

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So Is Anxious-Avoidant Trap Really A Thing?

So is this combination really common, as pop-wisdom would have us think? In other words what is the prevalence of different combinations of attachment styles in couples?

The information here is scarce. One study found that secure-secure combination to be around 56.9% of all couples. For simplicity purposes, let's go with very rough estimates of how distributed is each attachment style in the population. That would be 60% for secure attachment, let's go for 15% for avoidant, 15% for anxious and the remaining 10% for the fearful-avoidant. Let's do little maths now.

With 56.9% of all the couples being secure-secure combination (vs 36% expected by chance) we can see is that secure-secure couples are over-represented in this sample. In other words, the most likely combination, by far, even if taking into account that secure attachment is the most common attachment, is a relationship between two secure people.

And what about anxious-avoidant combinations. Well, according to simple statistic combination outlined in the figure above we would expect 4.5% of all couples to be anxious-avoidant combination. Is that estimates accurate(ish) or is it that these couples are over-represented? Well, it is impossible to say - we simply don't have the numbers yet.

It Is a Thing: Real vs Hypothetical Relationships

Another study looked at the attachment structure of couples and hypothetical couples, trying to crack this puzzle (this study was a meta-analysis - meaning that it combined the findings from several other studies).

A hypothetical couple is essentially an experimental set-up in which a participant is presented with descriptions of hypothetical partners and asked to rate how much they think they would fancy them, based on those descriptions.

Like the previous study, they found that the secure people have a preference for secure partners.

Now going back to 'insecure' couples, an interesting picture starts to emerge.

When asked hypothetically, people appeared to believe that they would be more attracted to those who displayed similar attachment traits to their own. This seems to lend support to the similarity hypothesis. In other words, in theory we believe that we are attracted to those who show attachment traits akin to ours.

Yet, in real couples, the 'opposites attract' hypothesis seemed to prevail. In other words, in real-life couples, the insecure couples tended to go for their opposites. And this lends some support to the 'anxious-avoidant trap' narrative, with the caveat that the results are not consistent over all studies and no definitive conclusion can be confidently made.

Additionally, this provides an interesting idea to chew on: if true, this results make us look like we are not particularly proficient at knowing what we are genuinely attracted to, as indicated by the discrepancy between hypothetical partners and real-life partners. To be taken with a pinch of salt (as other factors might explain it).

But overall, yes, it appears that this meta-analysis provides some support for the concept of the 'anxious-avoidant trap'.

Relationship Satisfaction And Relationship Stability

Now that we have established that the anxious-avoidant trap might indeed be a thing, how do people actually fare when they are in such relationships? Are they happy? Are these relationships stable?

Although this is not specific to the anxious-avoidant combination, there is evidence that couples in which one or both partners have insecure attachment are less stable and experience lower relationship satisfaction.

Another study concludes that "the results for anxious-avoidant pairings suggests that this is a particularly dissatisfying combination for both individuals". Damn, no arguing with that…

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So What Is the Upshot (Including For Therapy)

When I teach the neuroscience of attachment workshops, I will always cover the anxious-avoidant trap. Not because it is the most common pattern in couples (we have seen that the secure-secure is) but because it does happen. And now we know that the research seems to support the idea that there is indeed something to this anxious-avoidant gravitational pull.

If working with someone who has an insecure attachment, whether anxious or avoidant, dating the attachment opposite is probably not the best idea, if the choice is available at all. Discussing this in therapy, and exploring in detail the reasons why (as I have attempted to do in this piece), is, I believe, a good idea.

On the other hand, if working with someone who is already engaged in an anxious–avoidant relationship dynamic, it is important to understand that the disagreements, arguments and tensions in the couple will not always be expressed in terms of optimal emotional distance, as we do, using the language of attachment theory. In their daily lives, people rarely speak about it in this way. Rather, the tensions are more likely to arise around seemingly mundane matters, at least at the surface level. The opposing attachment dynamic is nevertheless likely playing out underneath. In therapy, it is important to bring these invisible attachment undercurrents into awareness and help the client frame them as such, gradually unpicking how they underpin the day-to-day life of the couple.

Finally, I would like conclude the same way Pascal does in his post: attachment can and does change. And so, maybe no attachment combination has to be a 'trap' with no escape.

As always, thank you so much for reading🙏.

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Shoutout and a huge thanks to Dr. Pascal Vrticka for sharing his thinking and references on this topic. He has essentially done all the legwork for this piece, I am just a messager.

Some Solid Attachment References

1. Attachment definitions and concepts

2. Attachment Myth-busting

3. Attachment Q&A

4. Intro to attachment research

Related Posts

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In the 1997 sci-fi movie "The Fifth Element" the protagonists, a 23th century cabbie and a mysterious extraterrestrial, embark on the quest to find the fifth element. They don't know what the fifth element is but they know that it complements the four elements of fire, earth, water and air, and is needed to maintain harmony amongst humans (and save the world).

In this piece, we try to make the case for why attachment could just be that Fifth Element.

Social neuroscientist Dr Pascal Vrticka (his bio is at the end of this post) has agreed to play with the idea, explaining, amongst other things, why in his opinion attachment is as important for survival as any other fundamental biological need. We look into:

• Mismatch between the physiology and behaviour in avoidant attachment

• How social neuroscience captures the neurobiological signals of attachment

• Brain activation in relation to attachment

• Changes of brain structure and connectivity linked to attachment

• Epigenetics of attachment

• Attachment as a mechanism for social survival

• Concepts of 'individual fight' and 'social flight'

• Why insights from the social neuroscience of attachment is useful for therapy

• Depathologizing attachment

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So, is attachment the fifth element?

As we have seen last in ‘Attachment Shadow’, there currently is a lot of confusion and doubt about attachment theory. And, as we have also seen, some of this confusion and doubt is completely justified. Attachment theory is not a single and tidy framework. It is very diverse and quite messy. However, once we can look beyond this apparent untidiness and grasp its true essence, then I believe that attachment theory has an enormous potential to inform and transform our lives.

For me as a social neuroscientist, what makes me think that attachment could just be the fifth element – employing that cinematic metaphor to say that something is as essential for surviving and thriving as the material conditions for physical survival– is what I can observe when I objectively investigate its neurobiological underpinnings.

Why can attachment be confusing? Because it involves the entire body and brain, because it affects our feelings, thoughts and behaviours in multifaceted ways. And it often does so in ways that don't tell a coherent story. Such a discrepancy was already observed by Spangler & Grossmann in their seminal study (1993). In this study, the authors for the first time measured heart rate (i.e., physiology) and salivary cortisol (i.e., endocrinology) in 12-months old infants undergoing the Strange Situation Procedure to assess their attachment orientation. One of the main findings was that although insecure-avoidant infants showed no overt signs of stress in their behaviour, their physiology and endocrinology told a very different story – one of being stressed and having difficulty regulating such distress.

For the last (almost) twenty years, I have been working – together with many students and colleagues – on expanding such an investigation of the objectively measurable neurobiological correlates of human attachment. And in doing so, we discovered many novel neurobiological patterns that added substantially to our understanding of how attachment works and why it does what it does. For example, we can nowadays see how different attachment orientations are associated with distinct patterns of brain activation, structure and connectivity, how they are related to epigenetic modifications of genes involved in a range of biochemical pathways, and how they are linked to bio-behavioural and interpersonal neural synchrony.

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Are you saying that attachment is one of those psychological and behavioural characteristics of humans that are so strong that are able to produce their distinct neurobiological signals?

Everything we experience, do and think is based on neurobiological signals. Attachment is no exception. Attachment is orchestrated by many different players within the body and brain to give rise to the complex feelings, behaviours and thoughts we usually associate it with. The important thing is that nowadays, by combining the traditional attachment measures of behavioural observation, interviews and self-reports with state-of-the-art neuroimaging methods, we can actually see and quantify how all of this is unfolding within the body and brain and what it all means for our mental health and wellbeing.

And when you say brain activation, what does that mean, in layman’s terms?

It means that we can see where and how in the brain certain information is processed and how information processing differences are related to individual differences in attachment. For example, in a recent study, we used electroencephalography (in short EEG) to measure brain activity in 9-11 year old children while we showed them happy and angry faces of either their mother or a female stranger. We found that children classified as insecure-avoidant (and thus using deactivating attachment strategies) initially had higher brain activity to all angry faces, meaning that they very quickly detected and neurally processed angry, and thus potentially hostile, faces. However, in the same children, very shortly thereafter, brain activity strongly decreased to all faces, including to happy mother faces. We could thus see that an insecure-avoidant attachment orientation did not just ‘shut down’ the neural processing of attachment-related information from the beginning. Instead, attachment-related information was first processed more readily, only to thereafter be somehow ‘suppressed’. This so-called ‘two-stage processing model’ reveals crucial insights on how insecure-avoidant individuals process information from their surroundings.

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And when you talk about changes in structure and connectivity, can you also give us an idea of what that means?

Besides looking at associations between attachment and brain activation – i.e., how the brain responds to certain kinds of information, we can also investigate whether there are associations between attachment and brain structure and connectivity – i.e., how the brain is physically made up and how different brain parts are connected with one another. For example, in another recent study, we looked at the association between self-reported attachment and cortical thickness (i.e., the depth of the grey matter that is made up by cell bodies, dendrites and synapses) by means of magnetic resonance imaging (in short MRI) in almost 100 adolescents over a period of up to four years.

What usually happens during adolescence is so-called ‘neuronal pruning’, which is a natural process that involves the elimination of unnecessary or weak synapses between neurons. This process is essential for refining the brain's connections and optimising its function, and can be measured by a decrease of grey matter volume. What we observed in relation to attachment, was that those adolescents with more insecure-avoidant and -anxious attachment showed stronger grey matter volume decrease, and particularly so if they were younger at study onset. Our results thus revealed that individual differences in attachment were associated with brain maturation during adolescence, and that insecure attachment may have somewhat ‘accelerated’ it.

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You also mention attachment and epigenetic modifications. In the therapy world, we love epigenetics but mainly in the context of transgenerational transmission of trauma. Are you referring to that specific context when you talk about epigenetics of attachment?

Epigenetics is an umbrella term that refers to reversible changes in gene expression that happen without any alteration of the underlying DNA sequence itself. All cells in the body have the same DNA, yet they don’t express the same genes. For example, brain cells have the exact same DNA as, say, blood cells, but they look very different and have very different functions. Thus, the only difference between them is epigenetic, relating to which genes are ‘turned on’ and expressed and which genes are ‘turned off’ and silent. Epigenetic modifications also happen in response to external conditions and are essential to the capacity of the organism to adapt to a change in circumstances.

In our work on epigenetics, we don’t look at transgenerational transmission (yet). To do so, we would need to assess epigenetic changes in the first generation’s germline cells (i.e., cells that eventually develop into gametes – sperm or eggs) and then see whether the same changes are also present in the second generation’s cells throughout the body.

Instead, we investigate whether there is an association between individual differences in attachment and current epigenetic modifications in the periphery (i.e., cells from blood or saliva). For example, in a study that we published in 2018, we looked at epigenetic modification in the oxytocin receptor gene and glucocorticoid receptor gene – two genes important for the social regulation of stress – in the saliva of 109 young adults as a function of their attachment orientation. We found that there was epigenetic modification in both of these genes but only in participants who scored high on insecure-avoidant (and concomitantly low on insecure-anxious) attachment. This is interesting, because insecure-avoidant attachment most consistently shows links to diminished social responding and support-seeking under stress.

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A New Perspective On an Old Mechanism for Survival

Attachment is our primary social survival strategy. We depend on the support and co-regulation provided by others. This is because our brain and body treat our own bioenergetic resources and the resources provided by significant others interchangeably. If we have a strong and supportive social network of attachment figures, our own energy levels are not only conserved but they are literally increased.

This perspective seems systemic, as if there is an organism and a super-organism formed by the people around us. Attachment serving as a sort of invisible, non-physical connective tissue for that super-organism, if I understand correctly? If we can count on super-organism in times of need, it makes sense that our energy levels are heightened.

Yes, absolutely. Our primary attachment strategy associated with a secure attachment orientation is the one of proximity-seeking under stress. We naturally and automatically reach out to others for help and support if we face a significant challenge. Activation of our attachment system ensures that we can easily communicate when we need help and that our significant others, our attachment figures, can promptly and appropriately respond. Therefore, it is our brain’s and body’s ‘default’ or ‘baseline’ state to assume the presence and availability of others in times of distress.

To me, this perspective on attachment is really new. Sometimes, people can feel embarrassed or ashamed for needing help from others. However, viewing others as an extension of oneself to meet one’s needs seems to be a natural mechanism in light of this understanding of attachment. I am looking forward to seeing how we can leverage it in therapy.

I think this is a crucial point. We all need help when we are facing a significant challenge. There is nothing wrong with asking for help and no need to be ashamed for doing so. We are neurobiologically just not made for coping completely on our own. This can work for some time and to some degree if absolutely necessary, but in the long term, it uses too much energy and leads to wear-and-tear and thus the emergence of mental and physical health issues.

Modern attachment science can help us understand what happens if our social resources are decreased, or we feel as if they are decreased. Under such circumstances, we need to start employing compensation strategies to minimise the risk for the above-described wear-and-tear effects. Either we become more self-dependent and employ more self-regulation – what we call “individual fight” associated with attachment avoidance. Or we start signalling others more loudly that we want and need their help – what we call “social flight” associated with attachment anxiety.

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Can you say a bit more about concepts of 'individual fight' and 'social flight'?

As we point out in our just published ‘narrative on the neurobiological roots of attachment-system functioning’, attachment does involve some elements of a classical ‘fight-or-flight’ response.

Avoidantly attached people usually up-regulate their own defences and energy to fend for themselves – and thus ‘fight’. After all, if nobody is around to help, the only choice is to stand up and fight on one’s own. However, there also is an element of ‘running away from help’. Avoidance often involves an active decision not to ask for help and instead to face challenges alone. And this goes beyond a ‘simple’ fight response that is triggered by an immediate threat where there often is no other choice than to stand up and act alone.

For attachment anxiety, we could say that there is an element of a classical ‘flight’ response. However, this ‘flight’ has the special property to be directed towards one’s attachment figures. Therefore, we call it ‘social flight’. In other words, when anxiously attached people face a challenge, they don’t just run away from it, they run towards their attachment figures as their ‘safe haven’.

But can the strictly controlled and artificial conditions in a neuroscience lab tell us about the real life attachment or even inform the psychotherapy process?

In science, including the science of attachment, we want to be able to make generalisable predictions that apply to as many people as possible. To answer such questions, we need to obtain data from large groups of people, and the thereby obtained results can only say something about attachment on the level of these groups, not for separate individuals. In therapy, the story is very different, because the main focus is on one specific individual and one specific relational dynamic between the therapist and client. The central question thus is how an individual with a unique personality and personal circumstances, including attachment, can best be helped by the therapist. Unsurprisingly, these two approaches can easily feel miles apart.

I nonetheless think that attachment science can be very helpful in a therapeutic context.

For example, our results show that attachment is everywhere in the brain, that it affects activity in, as well as the structure and connectivity of, almost all brain areas that are organised into complex interdependent networks. Thus, when working on attachment with a client, there should be some elements that target emotions, both positive and negative, and other elements that target thoughts and mentalisation/mental representations. And the focus should be on restoring an optimal balance between all of these processes.

This is great news for therapy. Can you give us one more example of what you think can be useful for therapists to know from your research on neuroscience of human attachment?

Maybe that our body and brain is highly adaptive, and that our reactions to certain events should therefore always and foremost be understood as meaningful and appropriate. If there is nobody around to help us cope when we are stressed, it makes perfect sense to up-regulate our own and thus ‘individual fight’ responses. Conversely, if we need and want to obtain help from others but cannot really predict whether they will be available or not, it makes perfect sense to up-regulate our ‘social flight’ responses to signal them more loudly that they should come and assist us. In other words, there is nothing intrinsically ‘bad’ about the neurobiological patterns and the corresponding feelings, thoughts and behaviours associated with insecure-avoidant and -anxious attachment.

Very often, these mechanisms work well and help us function quite nicely within specific attachment relationships. Understanding the intricate ways in which attachment works within our body and brain thus has a healing and soothing element, because it makes us realise that insecure attachment is not some sort of disorder or a mental health condition. It helps us depathologize attachment insecurities. This does, of course, not mean that we should disregard the risks that come with high attachment insecurity, which still need to be attended to, ideally through professional help. But it can put some things into perspective by appreciating that our body and brain is responding in neurobiologically predictable and appropriate ways to specific, often challenging, environmental demands.

I appreciate, it’s a lot, so if attachment is your jam, maybe worth another read. And then … I am curious, can I just ask:

Have we convinced you? Could attachment be the Fifth Element?

As always, thank you for reading. 🙏

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For those interested in attachment (and who managed to read until the end): some time ago, we explored the ’attachment shadow’ – i.e., how the meaning of attachment concepts can get lost in translation and how they are often mingled with lots of neurobollocks.