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Learn More. This article examines how individual differences in adult attachment shape regulatory strategies and relationship behaviors, which in turn influence health-related responses, behaviors, and outcomes. We review links between attachment and physiological responses to stress e.

Supportive, high quality close relationships, including marital relationships, have been consistently linked to better health [ 12 ]. This article focuses on how individual differences in adult attachment shape regulatory strategies and relationship functioning in ways that impact health-related biological responses to stress and health behavior, which, in turn, contribute to downstream physical health outcomes.

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The attachment system is closely tied to how people regulate affect, particularly when they are threatened [ 3 ]. Under threat, people often seek a close partner for comfort and support, which can help them cope with distress and return to a calmer state. This pattern is typical for individuals who are securely attached and expect that partners will be available and responsive to their needs.

In contrast, individuals who are avoidantly attached expect that partners will be less available and less responsive, and they tend to cope by minimizing distress and retreating from others. Individuals who are anxiously attached desire excessive closeness and worry that partners Attached wf seeking attached bm not be sufficiently responsive, and they tend to cope by persistently aling their distress and seeking excessive reassurance. Figure 1 includes two partners to highlight the dyadic nature of attachment relationships, and to illustrate that partners can influence each other at any point in the process.

For example, during difficult interactions e. Our review focuses on connections between adult attachment and health-related biological responses to stress, health behavior, and physical health endpoints. As shown in the figure, earlier experiences e. Thus, the link between adult attachment and health may be partially molded by earlier experiences and their influence on biological mediators and physical health.

Attachment styles promote strategies for regulating affect and the self, as well as behavior patterns in close relationships, which in turn, influence how individuals respond to stress at a physiological level e. Physiological responses to stress and health behavior contribute to subsequent health outcomes over time.

Two components may contribute to the attachment—health link but are outside the scope of this article: a early experiences such as childhood attachment may shape adult attachment, as well as other variables and links in the model, and b attachment insecurity is associated with greater negative affect, including dysphoria, depression, and anxiety, which in turn is associated with greater inflammation and disease risk. Pietromonaco, C. DeVito, F. Lembke, Rholes Eds.

NY: Guilford. Reprinted with permission of Guilford Press. We focus on three types of biological responses to stress that have been linked to adult attachment: hypothalamic-pituitary-adrenal HPA axis responses, cardiovascular responses, and immune responses.

Cortisol is a steroid hormone released via the HPA axis, and its release affects metabolic, immune, and nervous systems. Although the release of cortisol prepares the body to respond to acute demands, the repeated release of cortisol in response to chronic stressors can disrupt the normal functioning of the HPA axis and associated biological systems [ 1011 ] in ways that potentially influence longer-term health outcomes. Recent Attached wf seeking attached bm suggests that cortisol responses to acute stressors also predict later health: A study of over adults found that cortisol reactivity to acute cognitive stress tasks predicted increased coronary artery calcification over time [ 12 ] and decreased leukocyte telomere length over 3 years [ 13 ].

This evidence suggests that cortisol responses to chronic stress and to acute stress may have downstream implications for health. Findings generally indicate that anxiously attached individuals show exaggerated cortisol reactivity [ 14 — 17 ], although exceptions exist [ 18 ], as well as higher daily levels of cortisol [ 19 ]. Findings for attachment avoidance are inconsistent; avoidance has been associated with higher cortisol in response to conflict discussions [ 15 ], but other work has not found this association [ 14 ]. For example, newly-married wives who were more anxiously attached who had husbands who were more avoidantly attached showed exaggerated cortisol reactivity in anticipation of a conflict discussion [ 20 ].

This work suggests that anxiously attached individuals may be more physiologically taxed under some conditions. An important question for future work is whether the cumulative effects of attachment-related cortisol patterns influence later health outcomes. Chronic patterns of cardiovascular reactivity to stress are associated with increased risk for cardiovascular disease [ 21 ]. Meta-analytic evidence indicates that even cardiovascular reactivity to acute cognitive stressors in the lab predicts increased cardiovascular risk e.

Insecure attachment has been associated with distinctive cardiovascular responses to stress.

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In one study, dating partners viewed a distressing film and then prepared for and later had a discussion about the film [ 23 ]. Cardiovascular threat responses sympathetic arousal together with increased vascular resistanceindexed as total peripheral resistance TPRwere assessed throughout the procedure. During the conversation, avoidant individuals showed blunted cardiovascular threat responses. Furthermore, individuals with more avoidant partners showed increased TPR greater threat when preparing for the conversation if they had been instructed to suppress their emotions, compared to individuals instructed to express their emotions.

These findings suggest that individuals with more avoidant partners experience greater physiological threat Attached wf seeking attached bm conditions e. Other studies, however, using different measures and methods have found somewhat different findings. For example, married or cohabiting romantic partners with a more avoidant partner showed less cardiovascular reactivity assessed as a composite of 5 cardiovascular indicators when discussing a relationship conflict, especially when one member of the couple was instructed to suppress emotions; those with an anxious partner showed more cardiovascular reactivity, regardless of emotion regulation condition [ 24 ].

In another study of married or cohabiting couples, more avoidantly attached individuals showed less reduction in autonomic nervous system ANS arousal indexed via inter-beat-intervals from heart rate assessments when they received support during a support-seeking interaction unrelated to the relationship or partner [ 25 ]. In contrast, anxiously attached men but not women showed reduced ANS arousal when they received more support. Women with more anxiously attached partners also showed reduced ANS arousal when they received more support, perhaps because anxiously attached men were more engaged when providing support.

Additional work is needed to determine whether the different patterns across studies result from differences in experimental contexts, cardiovascular measures, or both, or whether such differences might be explained by moderating variables e. For example, anxiously attached individuals who need greater responsiveness from their partner may show greater reactivity when their partner is avoidant [ 20 ].

Dysregulated immune function is associated with increased risk for chronic diseases, including cardiovascular disease and cancer, as well as earlier mortality, and offers a plausible pathway linking close relationships to health [ 26 ]. For example, spouses in more distressed marriages showed decreases in immune function over 2 years [ 27 ]. Relationship expectations and perceptions associated with attachment insecurity likely contribute to this link. Consistent with this idea, women with greater attachment avoidance but not attachment anxiety evidenced lower natural killer cell cytotoxicity NKCC, an immune marker across four timepoints during a one-year period, even after ing for factors such as smoking, alcohol use, and perceived social support [ 28 ].

Neither form of attachment was associated with a second immune marker, lymphocyte proliferative response, a functional test of the immune response [e. These findings align with work showing disrupted inflammatory responses assessed via Interleukin-6 among more avoidant spouses in relation to a conflict discussion [ 29 ], and slower wound healing among more avoidant women [ 30 ].

Anxiously attached individuals also have shown altered immune function, including fewer T-cells across 2 days [ 31 ], greater antibody titers to the Epstein-Barr virus indicating weaker cellular immune system control over the virus at two assessments [ 32 ], slower recovery from induced skin wounds for men but surprisingly faster recovery for women [ 30 ], and increases in the inflammation Attached wf seeking attached bm, Interleukin-6, after cardiac surgery, particularly among those with poorer sleep quality [ 33 ].

Insecure attachment has been linked to a variety of risky health and lifestyle behaviors, including increased drug and alcohol use, riskier sexual behavior, poorer eating habits, and less physical activity [ 34 — 36 ], and among diabetic patients, lower likelihood of following diet and exercise regimens [ 3738 ]. Avoidance is associated with less seat belt use [ 35 ] and less use of health care services among individuals with three or more chronic illnesses [ 38 ].

More needs to be known about how health behaviors unfold in attachment relationships, including identifying which types of partner behaviors are effective for people with which attachment styles [ 45 ]. Strong evidence linking adult attachment to physical health endpoints is scarce. Cross-sectional evidence from a nationally-representative sample of over 5, participants suggests that attachment anxiety but not avoidance predicts higher likelihood of self-reported chronic pain as well as stroke, heart attack, and high blood pressure, after controlling for the link between attachment and psychiatric disorders [ 3940 ].

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Prospective studies are needed, however, to clarify the direction of causality as well as to identify other factors that may for this association. Two additional studies suggest that attachment insecurity is associated with poorer disease outcomes, and that, under some conditions, avoidance may confer increased risk.

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One study of 96 breast cancer survivors indicated that attachment anxiety and avoidance were both associated with lower quality of life. The link between avoidance and quality of life, however, was more pronounced among avoidant breast cancer survivors who also showed poorer physiological emotion regulation capacity assessed via resting respiratory sinus arrhythmia [ 41 ].

Among women with inflammatory bowel disease IBDboth anxious and avoidant attachment were associated with greater disease severity [ 42 ]. Furthermore, women higher in avoidance who also had more severe IBD were more likely to experience negative affect, again suggesting greater vulnerability for some avoidant women. Other work suggests that more complex models may be needed when evaluating links between attachment and physical health.

A study of Attached wf seeking attached bm found that general stress mediated the links between attachment anxiety or avoidance and poorer self-reported health; childhood socioeconomic status also predicted attachment anxiety but not avoidance in these mediation models [ 43 ]. A growing literature indicates that adult attachment insecurity is associated with dysregulated physiological responses to stress, risky health behaviors, and susceptibility to serious physical illnesses. Findings vary in whether attachment anxiety, avoidance, or both are connected to relevant health outcomes, but it is clear that attachment insecurity is associated with greater health risks.

Furthermore, prospective studies in which attachment measured at earlier timepoints predicts potential mediators and health outcomes at later timepoints will help disentangle causal direction and identify key mediating pathways. For instance, findings suggest that couple-based interventions for pairs in which one or both partners are insecurely attached may need to be tailored differently from those in which both partners are securely attached [ 4 ].

Although the link between attachment and health involves a complex interplay among individual and partner characteristics as well as features of the situation, further work in this emerging area will open new avenues for health-promoting interventions. Relationship context e. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript.

The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Paula R. Pietromonaco, University of Massachusetts, Amherst. Lindsey A. Beck, Emerson College.

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National Center for Biotechnology InformationU. Curr Opin Psychol. Author manuscript; available in PMC Feb 1. Pietromonaco and Lindsey A. Author information Copyright and information Disclaimer. Pietromonaco, University of Massachusetts, Amherst. Contact: ude. Copyright notice. The publisher's final edited version of this article is available at Curr Opin Psychol.

See other articles in PMC that cite the published article. Abstract This article examines how individual differences in adult attachment shape regulatory strategies and relationship behaviors, which in turn influence health-related responses, behaviors, and outcomes.

Keywords: attachment, health, relationships, stress, physiology.

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Adult Attachment and Physical Health