CHICAGO -- Individual differences in attachment style have a bearing on mental and physical health in the workplace, according to Dr. Josh B. Gibson.
When Dr. John Bowlby first developed attachment theory in the 1960s based on observations of separation anxiety in children, he proposed that early experiences with caregivers are internalized and form enduring cognitive schemas of relationships that influence the type of interactions individuals will have with others and the interpretation of these interactions.
These schemas, or "internal working models," generally are classified into three adult attachment styles: secure, anxious/preoccupied, and avoidant. Roughly 60% of individuals have a secure attachment style, said Dr. Gibson of the department of psychiatry at the University of California, San Francisco. They generally feel the world is safe and stable, and are trusting of other people and able to ask for help.
Slightly less than 20% of people have an anxious/preoccupied style and feel the world is an unpredictable, unsafe place. They need proximity and reassurance to feel secure, and as a result are preoccupied with being connected to others. Individuals with avoidant attachment feel people will mostly let them down, and so must be independent and take care of themselves. The model of Kim Bartholomew, Ph.D., and Leonard M. Horowitz, Ph.D., also includes fearful attachment, a less common insecure attachment style marked by negative internal working models of both self and other.
In the workplace, workers with secure attachment have high satisfaction and good balance between work, family, and self, Dr. Gibson said. Those with preoccupied attachment have job insecurity, feel they are not being recognized for their contributions, and have worse job performance, leading to lower pay overall and more frequent dismissals. Workers with avoidant attachment tend to be dissatisfied with coworkers, to prefer to work alone, and to have a poor work/life balance, in part because they are drawn to work in an effort to turn off and suppress the attachment system.
"I think it's important to think about attachment styles as representing vulnerability rather than pathology," he said.
Increasingly, researchers are focusing on how attachment styles influence health and health care utilization. As a general rule, patients with insecure attachment are at greater risk for depression and other physical morbidities, he said.
A recent population-based study involving 2,509 individuals, median age 49.9 years, found that those who self-reported chronic widespread pain were more likely to report a preoccupied (relative risk 2.6), dismissive (RR 2.8), or fearful attachment style (RR 1.4) than were those without pain (Pain 2009;143:200-5).
Attachment style was significantly associated with physical symptoms, but also primary care visits and primary care costs in a study of 701 women enrolled in the same HMO. This was true even after adjustment for age, marital status, income, ethnicity, and depression (Psychosom. Med. 2002;64:660-7).
Women with preoccupied attachment had the highest health care utilization, visiting their primary care physicians a mean of 3.95 times each year, compared with 3.41 times for dismissive attachment, 3.32 times for secure attachment, and 2. …