Running Head: INSECURE ATTACHMENT AND INTERNALIZING SYMPTOMS A Lifespan Development Theory of Insecure Attachment and Internalizing Symptoms: Integrating Meta-Analytic Evidence via a Testable Evolutionary Mis/Match Hypothesis Or Dagan1, Ashley M. Groh2, Sheri Madigan3, and Kristin Bernard1 1 Department of Psychology, Stony Brook University, Stony Brook, NY 2 Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO 3 Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Canada Correspondent author: Or Dagan, Ph. Department of Psychology, Stony Brook University Stony Brook, NY, 11794 or.edu +1- 646-270-1100 ORCID iD: https://orcid.org/0000-0002-4674-5425 INSECURE ATTACHMENT AND INTERNALIZING SYMPTOMS 2 Abstract Attachment scholars have long argued that insecure attachment patterns are associated with vulnerability to internalizing symptoms such as depression and anxiety symptoms. However, accumulating evidence from the past four decades, summarized in four large meta- analyses evaluating the link between insecure attachment subtypes and internalizing symptoms provide divergent evidence for this claim.
This divergent evidence may be accounted for, at least in part, by the developmental period under examination. Specifically, children with histories of deactivating (i., insecure-avoidant) but not hyperactivating (i., insecure-resistant) attachment patterns in infancy and early childhood showed elevated internalizing symptoms. In contrast, adolescents and adults with hyperactivating (i., insecure-preoccupied) but not deactivating (i., insecure-dismissing) attachment classifications showed elevated internalizing symptoms. In this paper, we summarize findings from four large meta-analyses and highlight the divergent meta- analytic findings that emerge across different developmental periods.
We first present several potential methodological issues that may have contributed to these divergent findings. Then, we leverage clinical, developmental, and evolutionary perspectives to propose a testable lifespan development theory of attachment and internalizing symptoms that integrates findings across meta-analyses. According to this theory, subtypes of insecure attachment patterns may be differentially linked to internalizing symptoms depending on their mis/match with the developmentally appropriate orientation tendency toward caregivers (in childhood) or away from them (i., toward greater independence in post-childhood). Lastly, we offer future research directions to test this theory.
Keywords: Attachment, deactivating, hyperactivating, internalizing symptoms, lifespan, orientation tendency INSECURE ATTACHMENT AND INTERNALIZING SYMPTOMS 3 A Lifespan Development Theory of Insecure Attachment and Internalizing Symptoms: Integrating Meta-Analytic Evidence via a Testable Evolutionary Mis/Match Hypothesis Introduction Internalizing disorders of depression and anxiety are the most prevalent diagnosed mental illnesses in children (Graczyk et al., 2016; Maughan et al., 2013), adolescents (Canals et al., 2019; Thapar et al., 2012), and adults (Greenberg et al., 2015; Steel et al. Moreover, the prevalence of depression and anxiety symptoms across all age groups has been increasing over the past few decades (Hidaka, 2012; Mojtabai et al., 2016), and they are the most disruptive disorders in terms of disease burden (Mathers & Loncar, 2006; Rehm & Shield, 2019). Accordingly, internalizing symptoms, their etiology, treatment, and ultimately prevention are of high public health importance (Collins et al. Thus, a better understanding of which factors contribute to internalizing symptoms vulnerability is essential for research concerning the development and persistence of these symptoms across the lifespan.
One robust characteristic and potential cause of internalizing symptoms across all developmental stages is real or perceived loss of emotional ties to close others, which tend to increase interpersonal distress with close others (e., over-dependency, worrying, and feelings of loss and abandonment; Hames et al. This comes as no surprise, given the evolutionary adaptive benefits of maintaining close social bonds (Baumeister & Leary, 1995; Slavich et al. Strategies of managing interpersonal distress are reflected, among others, in an individual’s attachment pattern. An attachment pattern is commonly referred to as an emotional bond with a caregiver (and later, with close peers and/or romantic partners) that when optimized, can provide an individual with a ‘secure base’ to rely on in times of need.
Individuals who are insecurely attached, such that their ability to use the caregiver as a secure base is compromised, often have close interpersonal relationships devoid of effective soothing INSECURE ATTACHMENT AND INTERNALIZING SYMPTOMS 4 capacities (Dykas & Cassidy, 2011), and can have difficulties regulating their emotional and psychological stress reactivity (Brumariu, 2015; Dozier & Kobak, 1992; Groh & Narayan, 2019; Roisman et al. Compromised processing and management of interpersonal distress, in turn, is linked to internalizing symptoms across the lifespan (Hammen, 2009; Shapero et al., 2016; Zeman et al. These links between insecure attachment patterns and internalizing symptoms across the lifespan have been extensively explored in the past four decades. In this paper, we review results from four meta-analyses that assessed the link between specific patterns of insecure attachment and internalizing symptoms in childhood, adolescence, and adulthood.
We first provide an overview of how behavioral and representational attachment patterns throughout the lifespan are most commonly assessed in the developmental psychology research culture. We then review the conceptual links previously offered between attachment and internalizing symptoms and summarize the meta-analytic evidence for this link across the lifespan. Finally, we provide a critical analysis of the results. We first offer methodological explanations for the divergent findings.
Then, we draw upon the developmental-evolutionary mismatch hypothesis to develop a testable theory that may advance our understanding of the association between insecure attachment patterns and internalizing symptoms across human development (Dagan & Bernard, 2021). The theory, which we here refer to as “the lifespan developmental theory of attachment and internalizing symptoms,” predicts that one’s risk for developing internalizing symptoms in a specific developmental stage (i., childhood versus adolescence and adulthood) depends on the match or mismatch (hereafter, mis/match) between one’s insecure attachment pattern subtype and the developmentally appropriate orientation tendency toward or away from caregivers (i., avoiding proximity in childhood or pursuing INSECURE ATTACHMENT AND INTERNALIZING SYMPTOMS 5 greater independence in post-childhood). In the end, we propose a manner in which future research can test our proposed theory. Attachment Assessment Across the Lifespan Attachment in infancy and early childhood.
Attachment behavior has been conceptualized as characterizing human beings “from the cradle to the grave” (Bowlby, 1969); as such, attachment patterns have been assessed throughout human development. In infancy, the gold standard assessment of attachment is an observational paradigm of infant-parent interactions: the Strange Situation Procedure (SSP; Ainsworth et al. The SSP is designed to activate the infant’s attachment system through brief separations from the parent; expectations of the parent’s availability are assessed by observing the infant’s behavior when reunited with the parent following brief separations (Ainsworth et al. Infants who are classified as securely attached are thought to have experienced repeated interactions with an emotionally available caregiver (Ainsworth et al.
Thus, following separations in the SSP, securely attached infants tend to quickly reestablish and maintain contact with the parent until comforted, and show readiness to return to play (Sroufe, 1979). Unlike securely attached infants, insecurely attached infants have likely experienced caregivers that are unavailable or inattentive in times of distress, leading them to develop alternative strategies to regulate their distress (Belsky, 1997; Main, 1981). Ainsworth and colleagues (1978) identified two patterns of insecure attachment, insecure-avoidant and insecure-resistant. Infants classified as insecure-avoidant tend to limit proximity seeking upon reunion with the parent; these infants tend to exhibit distant, self-reliant behaviors and expressions and direct attention away from the caregiver upon reunion (Ainsworth et al.
Insecure-resistant infants tend to exhibit strong proximity seeking behavior prior to INSECURE ATTACHMENT AND INTERNALIZING SYMPTOMS 6 separation from the caregiver, become increasingly distressed during separations, and upon reunion, exhibit simultaneous proximity seeking (e., crying or clinginess) with passivity or anger outbursts (e., hitting or tantrums; Cassidy & Berlin, 1994; Main, 2000). In addition to being classified as secure, insecure-avoidant, or insecure-resistant based on observed behavior in the SSP, an infant may also be classified as disorganized (Main & Solomon, 1990). Attachment disorganization is thought to develop either in harsh rearing environments (Cyr et al., 2010), in the context of disrupted, frightening, or frightened parental behavior (Main & Hesse, 1990; Lyons-Ruth et al., 1999), and/or when parents have failed to resolve past histories of trauma or grief (Madigan et al. Infants with disorganized attachment tend to exhibit fleeting disoriented and anomalous behaviors (e., misdirected, incomplete and interrupted movements and expressions) in the context of the SSP.
These behaviors are understood as manifestations of the confusion the infant experiences between the parent as a safe haven and simultaneously as a source of threat or fear (Hesse & Main, 2006). Attachment in adolescence and adulthood. By adolescence, early attachment-relevant experiences with caregivers are thought to become internalized in the form of cognitive-affective representations. In developmental psychology, attachment representations are most commonly assessed via the Adult Attachment Interview (AAI; George et al.
The AAI is a semi- structured interview in which individuals are asked about past experiences with their primary caregivers, and how these experiences may have affected their development and personality. Attachment classifications are derived based mainly on the coherence of individuals’ discourse in the AAI (Hesse, 2016). That is, the AAI is coded based on an individual’s manner of speech during the interview, with higher coherence codes denoting internally consistent but not INSECURE ATTACHMENT AND INTERNALIZING SYMPTOMS 7 emotionally overwrought manner of speech when describing early and current experiences and with caregivers and impacts on current functioning and relationships (e. The AAI reflects discursive behavior that mirrors the behavior of the corresponding infant attachment classifications.
Similar to infants who are classified as securely attached, adults who are classified as secure-autonomous in the AAI flexibly explore their environment. Whereas infants do so in the context of the physical environment, secure adults do so in the context of the ‘mental environment,’ such that they are able to evaluate past and present experiences with their caregivers without becoming emotionally caught up in or cut off from these experiences. Secure narratives are thus characterized by a coherent and collaborative manner of speech (Hesse, 2016). Like insecure-avoidant infants, adults with insecure-dismissing representations based on the AAI tend to exhibit physiological reactivity suggestive of inhibition of negative emotional arousal when confronted with stressful questions (i., about separation and rejection; Dozier & Kobak, 1992; Roisman, 2007).
During the AAI, insecure-dismissing attachment pattern is predominantly indicated by idealization of caregivers (i., characterization of past relationship with caregivers in a highly positive manner with the inability to support such characterizations with autobiographical memories) and/or insistence on lack of memory of childhood events (Hesse, 2016). Congruent with insecure-resistant infants’ exaggeration of proximity seeking behaviors upon separation and reunion with their caregivers during the SSP, insecure- preoccupied adolescents and adults become emotionally overwhelmed when discussing attachment relationships with one or more caregivers during the AAI. The insecure-preoccupied attachment pattern is reflected in AAI discourse via heightened expression of anger when INSECURE ATTACHMENT AND INTERNALIZING SYMPTOMS 8 discussing negative experiences in relation to one or more caregivers, and/or difficulty in finding words and focusing on such experiences (Hesse, 2016). Lastly, similar to disorganized infants, disorganized adults- commonly referred to as ‘unresolved’- tend to exhibit disorientation during the discussion of past abuse or traumatic grief via lapses in monitoring of reasoning or discourse (Hesse & Main, 2006).
Like disorganized attachment, an unresolved attachment classification is assigned in addition to a classification of secure-autonomous, insecure-dismissing, or insecure-preoccupied. Insecure Attachment and Internalizing Symptoms Across the Lifespan: Conceptual Links Infancy and childhood. Bowlby hypothesized about links between early insecure attachment and heightened vulnerability to depression and anxiety; his framework was that “the psychology and psychopathology of emotion is […] the psychology and pathology of affectional bonds” (Bowlby, 1979, p. He proposed that anxiety is rooted in early distress regarding the availability of attachment figures (Bowlby, 1973), a hallmark of insecure attachment.
Bowlby (1969, 1980) also proposed that prolonged separation or a loss of a primary caregiver early in life, or failure to form a consistent and satisfying emotional bond with a caregiver, would lead to negative representations of the self (e., ‘unlovable’) and other (e. These negative representations, in turn, are thought to enhance an experience of the relational world that is stressful, which may trigger depressive symptoms.