#1: Attachment Language

Answer

Yes, unfortunately, we do get lost in translation quite a bit these days when we talk about attachment. This not only comes from the fact that there are two different attachment traditions (i.e., developmental psychology, social psychology) that often use different attachment terms for similar concepts, but also because the technical meanings used by attachment theory and research may not always be reflected in everyday language.

The Society for Emotion and Attachment Studies (SEAS) has recently collated a freely accessible online list of attachment terms and concepts that mentions both common misconceptions and accessible technical explanations of attachment. I find this list very useful and visit it regularly by myself. On this page as part of my website, and particularly in section 1. A Cautionary Note on Attachment Language, you can find additional resources in the form of scientific articles on this very important topic.

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#2: Attachment & Sleep

Answer

Sleep training refers to parents using a wide range of strategies to encourage their infant to sleep at night. More recently, however, sleep training is often associated with letting infants “cry-it-out”.

Scientific evidence on possible benefits of sleep training as such is inconsistent and there are problems with the experimental design and data analysis used in many studies – e.g., non-randomisation, strong reliance on parent reports encouraging confirmation bias, small sample size, etc. For a great summary, see here.

Similarly, (direct) scientific evidence on the association between sleep training and infant attachment development remains mixed and controversially discussed – for more information, see here. Importantly, the absence of any “detrimental” effects of letting an infant “cry-it-out” on later attachment when assessed as part of a single study should not be generalised to predict no correlation overall.
Speaking from an attachment theoretical perspective – and supported by indirect research on parents’ response to infant crying -, caregiver availability and sensitivity is likely to be more helpful for both sleep training and infant attachment development as such, as well as for the link between sleep training and infant attachment development.

This is a complex issue and more research is definitely needed before we can reach any firm conclusions.

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#3: Attachment on Instagram & SoNeAt

Answer

Usually, the terms “secure”, “avoidant” and “anxious” are used quite accurately on social media. However, one needs to keep in mind that there are two main traditions in attachment theory and research: developmental psychology and social psychology. The attachment terms and their underlying concepts used by these two traditions are similar, but not always identical. This can and does lead to some confusion, including on social media.

The term “disorganised” is more difficult. It stems from a developmental attachment theory background, and means that there has been some degree of systematic disruption in the functioning of children’s attachment system. Importantly, however, it is not the same as an attachment disorder and does not necessarily result from child maltreatment.

Furthermore, disorganisation in childhood is often confused with fearful (or fearful-avoidant / anxious-avoidant) attachment in adulthood. There is no evidence of empirical associations between fearful attachment in self-report measures and disorganised attachment when assessed by developmental attachment researchers; they are distinct constructs.

For more information, I always recommend these excellent Explanations of Attachment Theoretical Concepts provided by the Society for Emotion and Attachment Studies (SEAS). And there also is some more information on attachment disorganisation available on my website.

Another example for a common misconception is attachment parenting. Attachment parenting was inspired by attachment theory somewhere along the way and does integrate some of its terms and concepts. However, it builds to a large degree on constructs that are not supported by current attachment theory and research. Maybe we can discuss this in another Attachment Q & A.

The social neuroscience approach to attachment (SoNeAt) aims at describing the neurobiological basis of human attachment behaviour. SoNeAt complements the traditional behavioural observation, interview and self-report measures with objective neuroscientific data.

So far, this endeavour has led to the development of two functional neuro-anatomical models of human attachment, one for organised (i.e., secure and insecure) and one for disorganised / disrupted attachment (NAMA and NAMDA, respectively).

SoNeAt integrates the two developmental and social psychology attachment traditions to explore both commonalities and differences on the neurobiological level. Most recently, SoNeAt proposes a tight link between attachment and energy conservation through co-regulation / social allostasis as one possible neurobiological basis of human attachment.

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#4: Attachment & Neurodiversity

Answer

In my SoNeAt Lab, we have so far only assessed neurotypical children, adolescents and adults. However, as part of a collaboration with the East Suffolk and North Essex NHS Foundation Trust and the Synapse Centre for Neurodevelopment, we are currently setting up a new line of research in families with neurodiverse children by looking at bio-behavioural synchrony from an attachment perspective. Hopefully, the first results will become available soon.

More generally, research on attachment and neurodiversity is still rather sparse and the results quite mixed. This is nicely illustrated by the example of autism spectrum disorder (ASD). A recent systematic review identified only forty papers investigating attachment in children with ASD, and only 7 of them (N=186) were found to have used the Strange Situation Paradigm (SSP) to classify children’s attachment. Within this small sample, 47% of children with ASD classified as secure.

Despite the small sample, this is an important finding, which demonstrates that children with ASD do form selective, secure attachments – contrary to the historical perception that social communication difficulties of children with an ASD diagnosis impair them to do so. At the same time, such results also suggest that children with ASD may be more likely to form an insecure attachment with their caregiver(s). 

Yet, some questions regarding attachment in children with ASD remain. One of them is whether children with ASD form an attachment relationship with both their mother and their father. Relatedly, it remains to be tested whether the SSP is a good and valid measure to assess attachment in children with ASD to both parents. Another question is whether attachment-based interventions may benefit the parent-child relationship in families with children with ASD. More research is clearly needed.

Please refer to this very helpful article by Harvard Health Publishing on the definition of the terms “neurodiversity” and “neurodiverse”.

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#5: Attachment & Parental Depression

Answer

There is converging scientific evidence for a link between parental (postnatal) depression and both parental and child attachment. 

One systematic review (20 studies) looked at associations between maternal attachment (self-reports, interviews) and postnatal depression symptoms (until 12 months postpartum). In 19 studies, there was a significant link between maternal attachment and postnatal depression symptoms. In 7 studies, there was a more specific link between maternal attachment anxiety and postnatal depression symptoms, whereas only 3 studies showed such a link for avoidance. 

Another systematic review (29 studies) looked at associations between child attachment (mainly Strange Situation Paradigm – SSP) and maternal (postnatal) depression (self-reports, clinical interviews). There was an equivocal association between maternal depression and child attachment security. However, depression and child attachment were almost only significantly associated when depression was diagnosed by structured interview and not by self-descriptive questionnaires. Furthermore, effects for postpartum depression were only significant when measured up to six months after childbirth.

But what about fathers? I could not find any systematic research – although paternal depression is meta-analytically associated with an increased risk of depression in offspring and fathers’ positive and negative parenting behaviours.

More comprehensive longitudinal research is crucially needed to examine possible cause-effect associations in both mothers and fathers.

Also, please note that attachment can and does change across the life span. Having an insecure attachment during childhood does not predetermine all subsequent attachments.

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#6: Attachment & Pain

Answer

After quite a long literature search, I must admit that I did not find enough meta-analytic evidence for specific associations between individual differences in attachment and pain (sensitivity).

However, I am aware of several social neuroscience studies showing that subjective pain experience (i.e., unpleasantness ratings) and pain-related brain activation is reduced by the real or imagined presence of a significant other with whom one has a secure-like relationship (e.g., Coan et al., 2006; Eisenberger et al., 2011). As we argue in our latest SoNeAt theoretical account (White, Kungl, Vrticka, 2023), such evidence suggests that attachment security may be associated with better access to, and more efficient co-regulation through social allostasis under distress, including when in pain.

There is another theoretical account of a possible link between (adult) attachment and pain – in this case chronic pain (Meredith et al., 2008). This theoretical account, also known as the Attachment-Diathesis Model of Chronic Pain (ADMoCP), not only suggests that attachment insecurity may represent a diathesis – or predisposition – for developing chronic pain (and associated disability), but also a vulnerability factor for poor outcome in the face of chronic pain. Discussed contributors are, amongst others, perceptions of pain as more threatening, more negative perceptions of the availability and adequacy of social support, less support-seeking, and less adaptive coping strategies. 

Taken together, the available social neuroscience evidence and attachment theory does indicate a link between attachment and pain. Yet, more research is necessary to better understand the exact mechanisms mediating such a relationship.

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#7: Attachment to Partner versus Parents

Answer

I am not aware of any SoNeAt studies that assessed participants’ attachment to more than one attachment figure. It would be very interesting and timely to see such research carried out in the near future. 

Current attachment theory supports the notion that attachment can and does change over time. And with such change comes the opportunity for more secure attachment bonds (e.g., to one’s romantic partner) to “buffer” against other, more insecure bonds (e.g., to one’s parents).  

Changes in one’s attachment style in adulthood have been associated with several events and factors, including the transition to parenthood, formation of new relationships or breakups, stable resilience/vulnerability factors and therapy (Fraley, 2019).

One model that could help understand such plasticity is the Attachment Security Enhancement Model (ASEM; Arriga et al., 2017). ASEM not only explains why people may experience attachment insecurity in the context of close relationships (e.g., partner experienced as inaccessible or unresponsive, perceived threats to one’s autonomy/independence). It also explains how relationship partners can buffer attachment insecurity in day-to-day interactions and thereby provide the scaffolding for successful relationship development (e.g., partner using safe strategies of soothing and calming, respecting need for autonomy). 

Current attachment theory also supports the notion that we can have multiple different attachments at the same time. What remains unclear is what exactly happens to the structure and hierarchy of existing attachment bonds when we develop new ones (Fraley, 2019; Fraley & Roisman, 2019).

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#8: Attachment & Sex Differences

Answer

From my reading of the attachment literature, findings on the topic of sex differences are mixed and researchers do not seem to always agree on their robustness and prevalence (see Del Guidice, 2019; Del Guidice, 2011; Bakermans-Kranenburg & van IJzendoorn, 2008; Bakermans-Kranenburg & van IJzendoorn, 2009). 

There is some indication that sex differences in attachment start emerging in middle childhood (ages 6-11) and remain similar thereafter. Usually, boys/men are found to be less secure and more avoidant, and girls/women more anxious. Furthermore, some studies indicate that there are more disorganised boys than girls.

The above said, a variety of factors can influence not only the detection of sex differences in attachment but also their magnitude. These factors include the age (beyond middle childhood) at which sex differences are assessed, the attachment measure used (i.e., narrative methods – interviews, story completion tasks – versus self-reports), the participant populations tested (e.g., students, community samples, online samples) as well as geographic location/culture. Sex differences in attachment, particularly when assessed with narrative methods during childhood, could also be confounded by cognitive/verbal abilities, which tend to develop earlier in girls than in boys. 

What is concerning possible sex differences in the neural underpinning of attachment, I do not feel that there is enough evidence to make any statements as of yet. Social neuroscience studies usually have a relatively small sample size, which often precludes testing sex differences in relation to attachment. Furthermore, even if sex differences are observed, meaningfully interpreting them is no trivial task. And I am not aware of any meta-analyses looking at reliable and replicable patterns across many studies.

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#9: Attachment Parenting

Answer

Attachment theory and research and attachment parenting are two different constructs.

Attachment theory (AT) was developed by John Bowlby and Mary Ainsworth from the 1950s. It has a long and rich research tradition relying upon behavioural observation, semi-structured narrative procedures and self-reports, and more recently social neuroscience methods

Attachment parenting (AP) is a parenting philosophy developed by paediatrician William Sears and registered nurse Martha Sears during the 1980s. Its central ideas are based on the Sears’ own parenting experiences and observations from their paediatric practice. There originally was no direct link to AT and research, and the name “attachment parenting” only emerged later – initially, the parenting philosophy was called “the new continuum concept” and “immersion mothering”. 

There is quite some confusion between AT and AP, mainly caused by the use of similar language that refers to distinct concepts. 

Although AP advocates for parents’ emotional responsiveness towards their infants, it does so in a strongly prescriptive way linked to its seven “Baby Bs”. For example, AP proposes to breastfeed only, wearing infants on the body as much as possible and always sleeping very close to the baby. Crucially, these prescriptions as such are often understood to yield secure attachment development in infants. Yet, little research and scientific evidence exist that would support such claims.

Conversely, AT and research emphasise that infants’ attachment development does not necessitate parents to always do things in a particular way. Every child is different and every parent-child interaction unique. What counts from an AT and research perspective is how the parent-infant relationship functions overall and whether infants can develop trust in their caregiver(s) and their own capacity to elicit help and support when needed.

For further reading, please refer to this nice article by the Greater Good Magazine from 2018.

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#10: Child-Father Attachment

Answer

Attachment theory initially mainly focussed on mothers and the mother-child relationship. Luckily, this has started to change, as nicely summarised by Inge Bretherton in her 2010 review paper “Fathers in attachment theory and research”. The same applies for social neuroscience research on the neurobiological substrates of parenting and caregiving, where studies on fathers are steadily increasing but are still strongly lagging behind studies on mothers. 

There are several important messages from the available theory and research on fathers from both a social neuroscience and an attachment perspective.

First, converging neurobiological data shows that there is no “maternal” or “paternal” brain, but an overall caregiving brain. All adults – regardless of their gender, sexual orientation, biological relatedness, role as primary or secondary caregivers, etc. – are neurobiologically wired to become parents. Changes in hormones as well as brain activation and structure occur in all adults who become parents – naturally with some differences.

Second, despite all adults being neurobiologically wired to become parents, parents are made not born. Practice is key. The amount of neurobiological changes that happen during the transition to parenthood (and that persist later on) crucially depends on the time spent involved in childcare activities and the quality of such parenting time. 

Third, current attachment research is revealing that attachment to both mothers and fathers influences several child developmental outcomes – for example child language competence or behavioural problems. This underscores the importance of fathers as attachment figures for their children.

For more information, please check out my Caring Dads website and many helpful resources provided by the Special Interest Research Group on Father-Child Attachment (SIRG FCAR) within SEAS. 

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#11: The Social Neuroscience of Attachment (SoNeAt)

Answer

Human attachment arises from a complex interplay between psychological, behavioural, biological and brain processes. 

Traditional attachment measurement tools derived from developmental and social psychology are behavioural observation (e.g., Strange Situation Procedure – SSP), semi-structured narrative procedures/interviews (e.g., story completion tasks, Adult Attachment Interview) and self-report questionnaires (e.g., Experiences in Close Relationships). 

SoNeAt crucially extends these tools by adding objective measures of physiology (e.g., heart rate, skin conductance), endocrinology (e.g., oxytocin, cortisol), genetics and epigenetics (i.e., genetic makeup and expression) and neuroimaging (e.g., brain activation, structure and connectivity.  

SoNeAt postulates that human attachment’s complex nature can only be fully understood when combining both traditional and modern attachment tools. 

A classical example of the necessity to include SoNeAt methods to study attachment are the results on avoidant attachment emerging from Spangler and Grossmann’s seminal study (1993). In this study, the authors for the first time measured heart rate and salivary cortisol in children while they underwent behavioural observation during the SSP.

In their behaviour, avoidant children showed less overt distress after short separations from their mother – as expected. However, heart rate and cortisol data revealed increased distress and thus the lack of an appropriate coping strategy. In other words, the objective physiological data was different from the behaviourally observed data!

Since then, SoNeAt has been continuously refined and extended. Most recent SoNeAt accounts include the functional neuro-anatomical models of organised and disorganised attachment (NAMA and NAMDA) and the link between attachment, social connection and energy conservation through co-regulation/social allostasis.

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#12: Disorganised Attachment & Attachment Disorder

Answer

This is a very important question as there is extensive confusion surrounding these two terms. Again, please refer to the really helpful SEAS guidance. 

The term disorganised attachment is used in a developmental context. It is an attachment classification coded on the basis of children’s relationship-specific behaviour that indicates conflict (expression of different behavioural patterns towards the caregiver, e.g. approach and avoidance), confusion and/or apprehension towards the attachment figure when a child is distressed and the attachment system activated.

The above behaviours in different ways suggest disruption of the attachment system brought about by a state of “fright without solution” caused by alarming or inexplicable caregiver behaviour in response to child distress.

Two very important things to keep in mind. 1) Disorganised attachment does not necessarily imply that a child has been maltreated. It can also arise due to multiple socio-economic adversities, including parental mental health issues (e.g., depression) or substance abuse. See here for more information. 2) Disorganisation is not the same as “fearful” or “fearful-avoidant” attachment derived from adult self-report questionnaires. They are very different constructs. Please be wary if you read about disorganised attachment in adults. 

Attachment disorders are rare diagnosable mental disorders identified by the ICD-10 and DSM-5 in children. There are two forms of attachment disorders: “reactive” and “disinhibited”. They are associated with a history of grossly inadequate and/or unstable care.

A critical difference between insecure (and to some degree disorganised) attachment and attachment disorders is that the former is relationship-specific, whereas the latter are not. Instead, attachment disorders characterise behaviours that persist across different caregiving relationships.

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#13: Bio-Behavioural Synchrony & Attachment

Answer

Bio-behavioural synchrony (BBS) describes how the behaviour and neurobiology of interacting individuals becomes aligned or coordinated with one another.

On the behavioural level, this can be observed, for example, in patterns of eye gaze, touch and speech / vocalisations. On the neurobiological level, BBS is reflected in our physiology (e.g., heart rate), endocrinology (i.e., secretion of hormones like oxytocin and cortisol) and brain activity. A great summary can be found here. 

BBS during social interaction usually is strongest among individuals who are in a close relationship with one another – e.g., parents (both mums and dads) with their children or romantic partners. However, there can be quite extensive interindividual differences in BBS within a given relationship category that reflect interaction and relationship quality. We are investigating such interindividual differences within our CARE studies and beyond. 

But why do we get “in sync” during social interaction? Current theory suggests that BBS has two main functions. The first function is to help us make predictions about what is going to happen next. During social interactions with others, such “mutual prediction” is easiest if we behave, feel and think similarly at the same time. The second function is to create a “social glue” that makes us stick together and enjoy being part of small groups and larger communities. For more details, check this nice review paper. 

BBS is vital for attachment formation and maintenance due to its two main functions just mentioned above. It binds the caregiver and child together, thereby allowing the child to start forming predictions about their own feelings and behaviours as well as their caregivers’ feelings and behaviours. BBS furthermore is one of the main forces for co-regulation or social allostasis and underlying the emergence of children’s internal working models (IWMs) of attachment.

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#14: Attachment System De- and Hyperactivation

Answer

Attachment theory often talks about an “attachment behavioural system” (ABS). A behavioural system like the ABS is defined as a species-universal program that organises an individual’s behaviour in functional ways and that follows a particular predictable pattern of activation and termination. The biological function of the ABS is to protect individuals (especially children) from danger by ensuring that they maintain proximity to caring and supportive others (attachment figures).

ABS activation occurs most reliably and strongly by the combination of a threat and lack of access to attachment figures. This initiates proximity-seeking behaviour as the natural and primary attachment strategy under distress. If protection and support is attained, ABS activation is usually terminated. Such a pattern is linked with the emergence of attachment security. 

However, when distress prevails and no attachment figures are available / their availability unpredictable, emerging attachment insecurity entails the employment of secondary attachment strategies.

If further proximity-seeking is not seen as viable, the ABS will be deactivated – resulting in distancing from threat- and attachment-related cues to prevent the need for proximity-seeking in the first place. This strategy is associated with attachment avoidance. 

Conversely, if further proximity-seeking is regarded as feasible, the ABS will be hyperactivated – i.e., resulting in hypervigilance regarding threat- and attachment-related cues to enhance the chances of proximity-seeking yielding the desired protection and support. This strategy is associated with attachment anxiety. 

Our NAMA & NAMDA link the above behavioural processes to brain activity, structure and connectivity patterns as well as physiology, endocrinology and genetics/epigenetics.

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#15: Attachment in the Brain

Answer

There is a neurobiological attachment system that is comparable to the attachment behavioural system (see Attachment Q and A 14).

Crucially, however, there is no single attachment brain region or network. Attachment is literally everywhere in the brain!

In our functional neuro-anatomical model of attachment (NAMA), we associate attachment with four large and interconnected neural networks, which we call approach, aversion, emotion regulation and mental state representation / mentalising.

We furthermore propose a prototypical attachment pathway that explains the involvement of these four networks.

The neurobiological attachment system is usually activated by a threat that triggers an appropriate fear response and a deviation from homeostasis. This is neurobiologically maintained by the aversion module.

What follows is an automatic proximity seeking response maintained by the approach module that encodes social connection and closeness as innately rewarding.

If proximity-seeking is successful, co-regulation / social allostasis can take place, followed by a return to homeostasis. This helps shape the emotion regulation network so that in the future, self-regulation (and the co-regulation of others) will be possible.

Finally, predictions about others’ availability and one’s ability to elicit help when needed (i.e., IWMs) are encoded in the mental state representation module.

Once secure, insecure-avoidant or -anxious attachment emerges, it will associate with different de- and hyper-activation patterns as modifications of the above (initial) prototypical attachment pathway.

Attachment in the brain can be measured by linking individual differences in attachment patterns derived from interviews, behavioural observation or self-reports with brain activation, structure or connectivity patterns. Results from different studies can then be compared to reveal commonalities and differences between attachment derived by different assessment tools.

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#16: Oxytocin & Attachment

Answer

In the press and on social media, oxytocin (OT) is often labelled the “love hormone”. Although OT undoubtedly plays an important role in love, sex, childbirth, bonding, attachment and caregiving, such an account unfortunately is too simplistic.   

The main problem is an overemphasis on OT’s prosocial and relationship-promoting effects. This tendency goes back to a 2005 study in humans that reported increased trust after a single dose of OT given by nasal spray. 

However, many subsequent studies using a similar procedure were inconclusive and often failed to show the same results. What is more, many studies found OT to have negative effects. For example, OT administration increased dishonesty / lying, increased the inclination for aggression and made more anxiously attached participants remember their mother as less caring and close. 

How can we reconcile these opposite roles of OT for human social behaviour? 

One way is to conceptualise OT’s function as regulating the saliency of many different cues – positive, negative, social, non-social – depending on a variety of contextual factors. For example, for social relationships, it is beneficial to show both prosocial behaviour towards one’s friends but more wary or even hostile behaviour towards strangers – also known as “tend-and-defend”.

A related but slightly different approach suggests that OT is importantly involved in “tend-and-befriend”, which enhances the desire for social contact in response to stress (which is more prominent in individuals with attachment anxiety versus avoidance). 

Extending this approach, a recent theory describes OT as an allostatic hormone that modulates both social and non-social behaviour by maintaining stability through changing environments. This account overlaps nicely with our latest thoughts on the link between attachment, social connection and energy conservation through co-regulation (i.e., social allostasis). 

When you read about OT the next time, try to keep these different accounts in mind.

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#17: ACEs & Attachment

Answer

It is well established that ACEs can leave long-lasting neurobiological scars and increase the risk of developing mental disorders. A first meta-analysis showed several neurobiological markers of ACEs, including blunted cortisol response to stress, low-grade inflammation, stronger amygdala response to negative cues and diminished hippocampus size. These combined findings point to a dysregulation of the HPA-stress axis. 

Although we agree with a strong link between ACEs and altered neurobiology of stress overall, we wish to point out strong differences pertaining to the onset/chronicity as well as type of ACEs. 

As we summarise in our functional neuro-anatomical model of disrupted and disorganised attachment (NAMDA), ACEs’ neurobiological signature strongly differs in individuals who were exposed to maltreatment characterised by neglect vs abuse. 

Neglect yields a pattern of rigidly independent self-regulation with an apparent absence of distress, passivity and resignation and thus overall hypo-activation. This is due to prolonged unavailability of others for co-regulation / social allostasis, representing a protective shutdown since constant self-regulation becomes unsustainable.

Abuse yields a pattern of harm-avoidance and rigid control marked by an approach-avoidance conflict linked with global hyper-activation. This is due to conflicting information between safety and danger as caregivers become a source of fear and threat.

Importantly, emerging data suggests that a further dissociation between emotional vs physical maltreatment may be necessary, because emotional maltreatment involves a specific set of experiences (e.g., role reversal of child and caregiver, restricting the child’s age-expected need for autonomy, caregiver threats of abandonment or suicide). 

Likewise, ACEs’ age of onset/chronicity needs to be considered, with earlier onset/longer exposure more likely to leave larger and lasting neurobiological scars.

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#18: Your question could be next!

Question

Stay tuned

Answer

Stay tuned!