Attachment has been defined as an affectionate bond between two people that endures through time and space and serves to join them emotionally (Klaus & Kennell, 1976). The concept of attachment theory was initially formulated by psychiatrist John Bowlby, and became more widely known following a report to the World Health Organisation (Bowlby, 1951) in which Bowlby stated:
What is believed to be essential for mental health is that the infant and young child should experience a warm, intimate and continuous relationship with his mother. The long period of helpless infancy of the human species entails serious risks, so it is of crucial importance to survival, that the child and its mother should become attached.
Attachment is an evolutionary, lifespan model of social behaviour. It proposes that infants will instinctively attach to a caregiver for the purpose of survival and ultimately genetic replication. The establishment of at least one attachment relationship is necessary for biological, emotional and cognitive development to occur optimally. Early experiences of attachment relationships will later determine how the individual regulates their own cognitive and affective states, and their interpersonal relationships with others throughout the lifespan.
Although the biological mother is usually the primary caregiver who provides most of the child care and related social interaction, infants will instinctively attach to anyone who is consistently available and accessible (Bowlby 1969, 1982). Attachment figures are thought to be arranged hierarchically, with the primary caregiver being targeted as the principal attachment figure and the others (siblings, grandparents, aunts and uncles) as subsidiary attachment figures who can provide safety and security in the absence of the principal figure (Bretherton, 1985).
Attachment figures are thought to be unique in that they are not just close relationships. They are special individuals to whom a person turns when protection and support are needed (Mikulincer & Shaver, 2007). According to the theory (Ainsworth, 1991; Hazan & Shaver, 1994; Hazan & Zeifman, 1994) an attachment figure serves three purposes. First, he or she is a target for proximity seeking – people seek out and benefit from proximity to their attachment figures in times of need. Second, an attachment figure serves as a safe haven – providing comfort and protection in times of need. Third, an attachment figure provides a secure base – allowing a child to explore safely and freely in their environment and to return when necessary, for example when frightened, hungry or distressed.
The Attachment System
The attachment system can be thought of as comprising (1) a set of behaviours activated by threat; (2) a response to those behaviours by the caregiver; and (3) a psychophysiological state that is the end result of those behaviours (Holmes, 2001).
Attachment behaviours are any behaviours designed to get the infant into a close and protective relationship with their attachment figure when they experience anxiety. Infants are born with a repertoire of behaviours for seeking proximity to a caregiver such as smiling, crying and babbling. By the end of the first two years the infant is able to display a range of behaviours designed to attract and maintain attention including shouting, following and clinging. If the caregiver is inaccessible or unresponsive, attachment behaviour is more strongly exhibited (Ainsworth, 1967). Anxiety, fear, illness and fatigue will also cause a child to increase attachment behaviours.
The Development of Attachment Relationships
Bowlby (1969, 1982) and Ainsworth (1973) proposed four phases in the development of attachments. In the pre-attachment phase (between birth to 2 months of age) it is thought that the infant begins to develop social behaviours. Infants are responsive to social interaction with anyone, demonstrating interest by visual tracking and listening. The next phase is attachment in the making (occurring between 2 to 6 months of age). The infant is able to discriminate between adults and will show a preference for particular adults, by demonstrating greater vocalization and smiling. In the clear-cut attachment phase (between 6 to 7 months of age) the child will actively seek out and maintain proximity with the primary caregiver, using him/her as a safe haven and secure base, reacting to separation with extreme distress.
As children develop the secure base becomes internalised. This is because mental representations of attachment-related interactions are gradually laid down. Bowlby called these mental representations ‘internal working models’ which consist of generalised thoughts, feelings, memories and expectations regulating the way that an individual engages in close relationships (Rholes & Simpson, 2004). The older child’s sense of security is maintained not only by seeking physical proximity to the attachment figure but increasingly by reference to the internal working model of the attachment figure as part of affect regulation. This is reflected in the fourth phase, goal corrected partnership (beyond 2 years of age) in which there is less need for physical proximity as the child gains increased emotional security.
Since Bowlby’s original formulation of attachment theory, the pioneering work of Mary Ainsworth (1978) has been of great importance in the field. Her research demonstrated that by twelve months infants develop a distinct and organised pattern of either secure or insecure attachment behaviour towards a caregiver. This is consistent with the response they received to their requests for comfort, soothing and protection. This was measured using a now widely used protocol named the Strange Situation Test (SST: Ainsworth et al, 1978). This observes infant and caregiver responses to short periods of separation and reunion, in addition to the infant’s reaction to the presence of a stranger.
Infant responses associated with secure attachment include protest on separation but easily comforted on return. The caregiver responds promptly, sensitively and consistently to the infant’s needs. The corresponding psychophysiological state of the child includes feeling soothed, steady breathing and reduced pulse rate. Children with secure attachment experiences are more likely to develop internal working models in which they see themselves as lovable, worthy and effective, and others as available, loving and interested. Approximately 65-75% of one year old infants are classified as secure on the SST (Fox et al, 1991; Waters et al, 2000).
Conversely, if caregivers are dismissive and therefore unresponsive to the child’s distress, the child learns to keep near enough to a rejecting parent to ensure some measure of protection, but not so close as to risk being rejected. The child deactivates affect and avoids closeness (insecure avoidant attachment). If caregivers are insensitive and therefore inconsistent in their response to the child’s distress, the child learns to cling to the caregiver in the hope of extracting as much nurturance as s/he can in as short a time as possible. The child amplifies affect and clings to the caregiver (insecure-ambivalent attachment). In both insecure attachment patterns the child experiences increased physiological arousal and an associated increase in distress. Insecure children often feel unloved and ineffective, perceiving others as unavailable, unreliable and disinterested. Using the SST, approximately 25% of infants are classified as insecure-avoidant and 10% as insecure-ambivalent (Fox et al, 1992).
Approximately 15% of children fail to develop an organised response to their caregiver (van Ijzendoorn et al, 1999). Such children were later categorised as insecure-disorganised (Main & Soloman, 1986). Disorganisation of infant attachment behaviour has been correlated with unresolved traumas or losses in the caregiver (Main & Hesse, 1990; van Ijzendoorn et al, 1999). The caregiver is perceived as frightening to the child, either because they are hostile or helpless. Care is grossly inconsistent, haphazard, over-anxious, incorrectly timed, harsh, rigid and/or deficient. In incoherent attachment there is an approach-avoidance oscillation, with no secure resting point. The child is torn between a longing to have his needs met, and a fear of the consequences of doing so (Holmes, 2001).
In sum, the hypothesised attachment behavioural system causes children to become attached to caregivers even if the caregiver does not provide security and comfort. If the caregiver is unreliable or even maltreating, the child will modify its attachment behaviour in order to obtain whatever security is possible in that particular relationship (Bowlby, 1988; Main, 1995).
Attachment in Adolescence and Adulthood
In the early years attachment literature mostly focused on early relationships between children and their parents. However, although the attachment system is most critical during the early years of life, Bowlby (1988) assumed that it is active over the entire lifespan. Attachment figures in infancy are normally parents, but as development progresses, the most important attachment figures become close friends or romantic partners, and in old age sometimes one’s own children (Ainsworth, 1989). There is now a significant amount of research that has been carried out on adult relationships and the way they are influenced by attachment patterns (Cassidy & Shaver, 1999).
Threats to security in older children and adults arise from prolonged absence, breakdowns in communication, emotional unavailability or signs of rejection or abandonment (Kobak & Madson, 2008). Although the same kinds of processes occur, the threshold for activation of the attachment system is generally higher in adulthood than in childhood, because most adults have developed an array of coping and problem-solving abilities that can be exercised autonomously.
The internal secure base may be accessed through comforting thoughts, images or behaviours such as hot baths, favourite foods, music or alcohol. These abilities to self soothe and regulate emotions enable adults to imagine being calmed by an attachment figure or to postpone comfort seeking until such support is available (Mikulincer & Shaver, 2007). Pathological variants of secure base behaviour may include binge eating, substance abuse and deliberate self harm (Holmes, 2001).
Measurement and Classification of Attachment in Adolescence and Adulthood
The measurement of attachment in adulthood has primarily been carried out using the Adult Attachment Interview (AAI: George et al, 1984). This method assesses an individual’s state of mind regarding their attachment relationships within the family. These ‘attachment representations’ are determined by the coherence and quality of the narrative constructed by the individual when recalling attachment-related memories. Individuals are classified as secure-autonomous, dismissing (similar to insecure-avoidant category on the SST) and preoccupied (similar to insecure-ambivalent). There is also an unresolved category, which is similar to the disorganised category on the SST. Meta-analytic evidence suggests that 55% of mothers in a non-clinical sample are categorised as secure, 16% dismissing, 9% preoccupied and 19% unresolved. A similar result was found for non-clinical fathers (van Ijzendoorn & Bakermans-Kranenburg, 1996).
Table 4.1: Correspondence of Strange Situation Test patterns to Adult Attachment Interview Categorisations (adapted from Hesse, 1999)
Infant Strange Situation Test
State of Mind with regard to
Explores room and toys with interest prior to separation from attachment figure. Signs of missing attachment figure during separation episodes. Clear preference for attachment figure over stranger. Actively greets parent on reunion, initiating physical contact. Settles after contact with attachment figure, returning to exploration/play.
Secure/Freely autonomous (“F”):
Discourse is collaborative and coherent.
Valuing of attachment, but objective in discussion of experiences. Recall of and reflection upon attachment related experiences is consistent, regardless of positive/negative content of experiences. Few violations of Gricean maxims.
Unlikely to cry on separation from attachment figure. Actively avoids and ignores attachment figure on reunion (e.g. moving or turning away, leaning out). Minimal proximity seeking, distress or anger. Interaction with attachment figure unemotional. Focus on toys or surroundings throughout SST.
Attachment related experiences minimised or dismissed. Relationships normalised, with generalised descriptions and poor autobiographical recall, or memories recounted contradict semantic account offered. Violations of Gricean maxim of quality via above, and frequent violations of quantity through excessive succinctness.
Appears wary and/or distressed prior to separation. Unlikely to explore. Preoccupied with attachment figure throughout SST, either passively or angrily. Slow to settle on reunion with attachment figure. Continued focus on attachment figure, crying and expressing distress.
Preoccupation with attachment related experiences expressed via passive, angry or fearful discourse. Sentences and passages overlong, grammatically enmeshed, and replete with vague identifiers (“this and that”). Frequent violations of Gricean maxims of manner, relevance and quantity.
Behaviour of infant is with attachment figure disorganised/disoriented, indicative of collapse of coherent attachment strategy – e.g. freezing; rising then falling prone, clinging to attachment figure while crying.
Striking lapses of monitoring or reasoning in the specific instance of discussing loss and/or abuse. Indicated through speech such as belief that deceased is still alive or eulogising discourse, absorption into sensory memories, and/or subtle dissociation.
Self Report Methods
Hazan and Shaver (1987) created the first questionnaire to measure attachment in adults. Their questionnaire was designed to classify adults into the three attachment styles identified by Ainsworth. The questionnaire consisted of three sets of statements, each set of statements describing an attachment style. People participating in their study were asked to choose which set of statements best described their feelings:
Secure – I find it relatively easy to get close to others and am comfortable depending on them and having them depend on me. I don’t often worry about being abandoned or about someone getting too close to me.
Avoidant – I am somewhat uncomfortable being close to others; I find it difficult to trust them completely, difficult to allow myself to depend on them. I am nervous when anyone gets too close, and often, love partners want me to be more intimate than I feel comfortable being.
Anxious/Ambivalent – I find that others are reluctant to get as close as I would like. I often worry that my partner doesn’t really love me or won’t want to stay with me. I want to merge completely with another person, and this desire sometimes scares people away.
One important advance in the development of attachment questionnaires was the addition of a fourth style of attachment. Bartholomew and Horowitz (1991) proposed a model that identified four categories or styles of adult attachment. Their model was based on the idea that attachment styles reflected people’s thoughts about their partners and thought about themselves. Using their ‘Relationships Questionnaire (RC), they identified four categories based on positive or negative thoughts about partners and on positive or negative thoughts about self.
Fig X: Bartholomew and Horowitz (1991) Model
Factor analyses have since revealed that two dimensions underlie self -report measures, which can be conceptualised in affective-behavioural terms (anxiety versus avoidance) or cognitive terms (model of self versus model of others) (Crowell et al, 1999).
Stability of Attachment Patterns throughout the Lifespan
There is evidence that there is a strong continuity between infant attachment patterns, child and adolescent patterns and adult attachment patterns. The stability of attachment patterns is illustrated by longitudinal studies of infants assessed with the Strange Situation and followed up in adolescence or young adulthood with the AAI. Two studies (Hamilton, 2000; Waters, et al., 2000) have shown a 68-75% correspondence between attachment classifications in infancy and classifications in adulthood. Similar findings have also been found using other measures of attachment in adults (Hazan & Zeifman, 1994).
This stability is hypothesised to be because internal working models continue to exist and exert a shaping influence on attachment patterns throughout the lifespan. Bowlby (1973) noted that people often attract relationship partners who fit their working models of others. The model is thus reinforced, which then continues to exert a strong influence on experiences in close relationships.
Contrary to this, other studies using the same methodology provide evidence of inconsistency between infant and adult attachment patterns (Lewis et al, 2000; Weinfield et al, 2000). Bowlby (1969, 1982) recognised that internal working models are subject to change and revision when various attachment related experiences (for example loss of an attachment figure or forming new attachment bonds) challenge the validity of the self and social schemas (Mikulincer & Shaver, 2007). There is evidence that life events are important factors in determining the stability of attachment style (Hamilton, 2000).
Hence, adult attachment patterns are rooted in early interactions with primary caregivers and later attachment experiences that challenge the validity of early working models. This is what makes personal development and successful psychotherapy possible (Mikulincer & Shaver, 2007).
Significance of the Attachment System
Holmes (2001) conceptualises the attachment system as a ‘psychological immune system’ in that secure attachment provides optimal immunity from threats to the psychological health of the self, through the ability to regulate affect and to draw on significant others for support. Secure children, with the benefit of well-regulated caregiver-infant relationships behind them, are expected to evolve positive expectations concerning their competence, to achieve a reliable capacity for modulation of arousal, a good capacity for communication within relationships and confidence in the ongoing availability of the caregiver (Fonagy, 1996). Consistent with this, research has shown that that attachment security is associated with higher self esteem, (Schmitt & Allik, 2005) a positive self-concept, (Verschueren & Marcoen, 1999), lower levels of distress and higher levels of psychological well-being in relation to stressful events (Birnbaum et al, 1997; Mikulincer et al, 1993) and relationship satisfaction (Shaver et al, 2005). In addition, secure attachment facilitates the recognition, labelling and evaluation of emotional and intentional states in the self and in others, a capacity known as reflective function or mentalisation (Fonagy et al, 2002).
Conversely, suboptimal immunity, which is synonymous with insecure attachment organisations, leaves the individual at heightened risk of developing mental health difficulties when faced with significant or salient stressors (MacBeth phd article).
Attachment and Psychopathology
The reliance of insecure attachment strategies renders individuals at heightened risk of developing psychological difficulties in adolescence and adulthood. Minimising attachment strategies (synonymous with avoidant attachment style for example deactivation of affect and avoidance of situations that are likely to be emotionally arousing) have been hypothesized to associate with externalizing pathologies for example substance abuse or conduct disorder (ref).Maximising strategies, on the other hand (synonymous with ambivalent attachment style for example amplification of affect and preoccupation with contact form a caregiver) are hypothesized to associate with internalizing pathologies such as anxiety and depression.