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What Is Attachment Theory?

The Importance of Early Emotional Bonds

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

• Attachment Theory
• Stages of Attachment

Attachment Styles

Attachment theory focuses on relationships and bonds (particularly long-term) between people, including those between a parent and child and between romantic partners. It is a psychological explanation for the emotional bonds and relationships between people.

This theory suggests that people are born with a need to forge bonds with caregivers as children. These early bonds may continue to have an influence on attachments throughout life.

History of the Attachment Theory

British psychologist John Bowlby was the first attachment theorist. He described attachment as a "lasting psychological connectedness between human beings." Bowlby was interested in understanding the anxiety and distress that children experience when separated from their primary caregivers.

Thinkers like Freud suggested that infants become attached to the source of pleasure. Infants, who are in the oral stage of development, become attached to their mothers because she fulfills their oral needs.

Some of the earliest behavioral theories suggested that attachment was simply a learned behavior. These theories proposed that attachment was merely the result of the feeding relationship between the child and the caregiver. Because the caregiver feeds the child and provides nourishment, the child becomes attached.

Bowlby observed that feedings did not diminish separation anxiety. Instead, he found that attachment was characterized by clear behavioral and motivation patterns. When children are frightened, they seek proximity from their primary caregiver in order to receive both comfort and care.

Understanding Attachment

Attachment is an emotional bond with another person. Bowlby believed that the earliest bonds formed by children with their caregivers have a tremendous impact that continues throughout life. He suggested that attachment also serves to keep the infant close to the mother, thus improving the child's chances of survival.

Bowlby viewed attachment as a product of evolutionary processes. While the behavioral theories of attachment suggested that attachment was a learned process, Bowlby and others proposed that children are born with an innate drive to form attachments with caregivers.

Throughout history, children who maintained proximity to an attachment figure were more likely to receive comfort and protection, and therefore more likely to survive to adulthood. Through the process of natural selection, a motivational system designed to regulate attachment emerged.

The central theme of attachment theory is that primary caregivers who are available and responsive to an infant's needs allow the child to develop a sense of security. The infant learns that the caregiver is dependable, which creates a secure base for the child to then explore the world.

So what determines successful attachment? Behaviorists suggest that it was food that led to forming this attachment behavior, but Bowlby and others demonstrated that nurturance and responsiveness were the primary determinants of attachment.

Ainsworth's "Strange Situation"

In her research in the 1970s, psychologist Mary Ainsworth expanded greatly upon Bowlby's original work. Her groundbreaking "strange situation" study  revealed the profound effects of attachment on behavior. In the study, researchers observed children between the ages of 12 and 18 months as they responded to a situation in which they were briefly left alone and then reunited with their mothers.

Based on the responses the researchers observed, Ainsworth described three major styles of attachment: secure attachment, ambivalent-insecure attachment, and avoidant-insecure attachment. Later, researchers Main and Solomon (1986) added a fourth attachment style called disorganized-insecure attachment based on their own research.

A number of studies since that time have supported Ainsworth's attachment styles and have indicated that attachment styles also have an impact on behaviors later in life.

Maternal Deprivation Studies

Harry Harlow's infamous studies on maternal deprivation and social isolation during the 1950s and 1960s also explored early bonds. In a series of experiments, Harlow demonstrated how such bonds emerge and the powerful impact they have on behavior and functioning.  

In one version of his experiment, newborn rhesus monkeys were separated from their birth mothers and reared by surrogate mothers. The infant monkeys were placed in cages with two wire-monkey mothers. One of the wire monkeys held a bottle from which the infant monkey could obtain nourishment, while the other wire monkey was covered with a soft terry cloth.

While the infant monkeys would go to the wire mother to obtain food, they spent most of their days with the soft cloth mother. When frightened, the baby monkeys would turn to their cloth-covered mother for comfort and security.

Harlow's work also demonstrated that early attachments were the result of receiving comfort and care from a caregiver rather than simply the result of being fed.

The Stages of Attachment

Researchers Rudolph Schaffer and Peggy Emerson analyzed the number of attachment relationships that infants form in a longitudinal study with 60 infants. The infants were observed every four weeks during the first year of life, and then once again at 18 months.

Based on their observations, Schaffer and Emerson outlined four distinct phases of attachment, including:

Pre-Attachment Stage

From birth to 3 months, infants do not show any particular attachment to a specific caregiver. The infant's signals, such as crying and fussing, naturally attract the attention of the caregiver and the baby's positive responses encourage the caregiver to remain close.

Indiscriminate Attachment

Between 6 weeks of age to 7 months, infants begin to show preferences for primary and secondary caregivers. Infants develop trust that the caregiver will respond to their needs. While they still accept care from others, infants start distinguishing between familiar and unfamiliar people, responding more positively to the primary caregiver.

Discriminate Attachment

At this point, from about 7 to 11 months of age, infants show a strong attachment and preference for one specific individual. They will protest when separated from the primary attachment figure (separation anxiety), and begin to display anxiety around strangers (stranger anxiety).

Multiple Attachments

After approximately 9 months of age, children begin to form strong emotional bonds with other caregivers beyond the primary attachment figure. This often includes a second parent, older siblings, and grandparents.

Factors That Influence Attachment

While this process may seem straightforward, there are some factors that can influence how and when attachments develop, including:

• Opportunity for attachment : Children who do not have a primary care figure, such as those raised in orphanages, may fail to develop the sense of trust needed to form an attachment.
• Quality caregiving : When caregivers respond quickly and consistently, children learn that they can depend on the people who are responsible for their care, which is the essential foundation for attachment. This is a vital factor.

There are four patterns of attachment, including:

• Ambivalent attachment : These children become very distressed when a parent leaves. Ambivalent attachment style is considered uncommon, affecting an estimated 7% to 15% of U.S. children. As a result of poor parental availability, these children cannot depend on their primary caregiver to be there when they need them.
• Avoidant attachment :   Children with an avoidant attachment tend to avoid parents or caregivers, showing no preference between a caregiver and a complete stranger. This attachment style might be a result of abusive or neglectful caregivers. Children who are punished for relying on a caregiver will learn to avoid seeking help in the future.
• Disorganized attachment : These children display a confusing mix of behavior, seeming disoriented, dazed, or confused. They may avoid or resist the parent. Lack of a clear attachment pattern is likely linked to inconsistent caregiver behavior. In such cases, parents may serve as both a source of comfort and fear, leading to disorganized behavior.
• Secure attachment : Children who can depend on their caregivers show distress when separated and joy when reunited. Although the child may be upset, they feel assured that the caregiver will return. When frightened, securely attached children are comfortable seeking reassurance from caregivers. This is the most common attachment style.

The Lasting Impact of Early Attachment

Children who are securely attached as infants tend to develop stronger self-esteem and better self-reliance as they grow older. These children also tend to be more independent, perform better in school, have successful social relationships, and experience less depression and anxiety.

Research suggests that failure to form secure attachments early in life can have a negative impact on behavior in later childhood and throughout life.

Children diagnosed with oppositional defiant disorder (ODD), conduct disorder (CD), or post-traumatic stress disorder (PTSD) frequently display attachment problems, possibly due to early abuse, neglect, or trauma. Children adopted after the age of 6 months may have a higher risk of attachment problems.

Attachment Disorders

In some cases, children may also develop attachment disorders. There are two attachment disorders that may occur: reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED).

• Reactive attachment disorder occurs when children do not form healthy bonds with caregivers. This is often the result of early childhood neglect or abuse and results in problems with emotional management and patterns of withdrawal from caregivers.
• Disinhibited social engagement disorder affects a child's ability to form bonds with others and often results from trauma, abandonment, abuse, or neglect. It is characterized by a lack of inhibition around strangers, often leading to excessively familiar behaviors around people they don't know and a lack of social boundaries.

Adult Attachments

Although attachment styles displayed in adulthood are not necessarily the same as those seen in infancy, early attachments can have a serious impact on later relationships. Adults who were securely attached in childhood tend to have good self-esteem, strong romantic relationships, and the ability to self-disclose to others.

A Word From Verywell

Our understanding of attachment theory is heavily influenced by the early work of researchers such as John Bowlby and Mary Ainsworth. Today, researchers recognize that the early relationships children have with their caregivers play a critical role in healthy development. 

Such bonds can also have an influence on romantic relationships in adulthood. Understanding your attachment style may help you look for ways to become more secure in your relationships.

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Main M, Solomon J. Discovery of a new, insecure-disorganized/disoriented attachment pattern. In: Brazelton TB, Yogman M, eds., Affective Development in Infancy. Ablex.

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Ainsworth MDS, Blehar MC, Waters E, Wall S.  Patterns of Attachment: A Psychological Study of the Strange Situation . Erlbaum.

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By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

What is Attachment Theory? Bowlby’s 4 Stages Explained

No matter what the “it” refers to, Sigmund Freud would have probably said yes to that question.

However, we now know a lot more about psychology, parenting, and human relationships than Freud did.

It’s clear now that not every issue can be traced back to one’s mother. After all, there is another person involved in the raising (or at least the creation) of a child.

In addition, there are many other important people in a child’s life who influence him or her. There are siblings, grandparents, aunts and uncles, godparents, close family friends, nannies, daycare workers, teachers, peers, and others who interact with a child on a regular basis.

The question posed above is tongue-in-cheek, but it touches upon an important discussion in psychology—what influences children to turn out the way they do? What affects their ability to form meaningful, satisfying relationships with those around them?

What factors contribute to their experiences of anxiety, avoidance, and fulfillment when it comes to relationships?

Although psychologists can pretty conclusively say that it’s not entirely the mother’s fault or even the fault of both parents, we know that a child’s early experiences with their parents have a profound impact on their relationship skills as adults.

Much of the knowledge we have on this subject today comes from a concept developed in the 1950s called attachment theory . This theory will be the focus of this article: We’ll explore what it is, how it describes and explains behavior, and what its applications are in the real world.

Before you continue, we thought you might like to download our three Positive Relationships Exercises for free . These detailed, science-based exercises will help you or your clients build healthy, life-enriching relationships.

This Article Contains:

What is attachment theory a definition, research and studies, erik erikson, attachment theory in babies, infants, and early childhood development, attachment theory in adults: close relationships, parenting, love, and divorce, attachment theory in grief and trauma, the attachment theory test, using attachment theory in the classroom (worksheet and pdf), attachment theory in social work, criticisms of attachment theory, recommended books, articles, and essays, a take-home message.

The psychological theory of attachment was first described by John Bowlby, a psychoanalyst who researched the effects of separation between infants and their parents (Fraley, 2010).

Bowlby hypothesized that the extreme behaviors infants engage in to avoid separation from a parent or when reconnecting with a physically separated parent—like crying, screaming, and clinging—were evolutionary mechanisms. Bowlby thought these behaviors had possibly been reinforced through natural selection and enhanced the child’s chances of survival.

These attachment behaviors are instinctive responses to the perceived threat of losing the survival advantages that accompany being cared for and attended to by the primary caregiver(s). Since the infants who engaged in these behaviors were more likely to survive, the instincts were naturally selected and reinforced over generations.

These behaviors make up what Bowlby termed an “attachment behavioral system,” the system that guides us in our patterns and habits of forming and maintaining relationships (Fraley, 2010).

Research on Bowlby’s theory of attachment showed that infants placed in an unfamiliar situation and separated from their parents will generally react in one of these ways upon reunion with the parents:

• Secure attachment: These infants showed distress upon separation but sought comfort and were easily comforted when the parents returned;
• Anxious-resistant attachment: A smaller portion of infants experienced greater levels of distress and, upon reuniting with the parents, seemed both to seek comfort and to attempt to “punish” the parents for leaving.
• Avoidant attachment: Infants in the third category showed no stress or minimal stress upon separation from the parents and either ignored the parents upon reuniting or actively avoided the parents (Fraley, 2010).
• In later years, researchers added a fourth attachment style to this list: the disorganized-disoriented attachment style, which refers to children who have no predictable pattern of attachment behaviors (Kennedy & Kennedy, 2004).

It makes intuitive sense that a child’s attachment style is largely a function of the caregiving the child receives in his or her early years. Those who received support and love from their caregivers are likely to be secure, while those who experienced inconsistency or negligence from their caregivers are likely to feel more anxiety surrounding their relationship with their parents.

However, attachment theory takes it one step further, applying what we know about attachment in children to relationships we engage in as adults. These relationships (particularly intimate and/or romantic relationships) are also directly related to our attachment styles as children and the care we received from our primary caregivers (Firestone, 2013).

The development of this theory gives us an interesting look into the study of child development.

Bowlby and Ainsworth: The History and Psychology of Attachment Theory

Bowlby’s interest in child development traces back to his first experiences out of college, in which he volunteered at a school for maladjusted children. According to Bowlby, two children sparked his curiosity and drive that laid the foundations of attachment theory.

There was an isolated and distant teenager who had no stable mother figure in his life and had recently been expelled from his school for stealing, and an anxious 7- or 8-year-old boy who followed Bowlby wherever he went, earning himself a reputation as Bowlby’s “shadow” (Bretherton, 1992).

Through his work with children, Bowlby developed a strong belief in the impact of family experiences on children’s emotional and behavioral wellbeing .

Early on in his career, Bowlby proposed that psychoanalysts working with children should take a holistic perspective, considering children’s living environments, families, and other experiences in addition to any behaviors exhibited by the children themselves.

This idea grew into a strategy of helping children by helping their parents, a generally effective strategy given the importance of the child’s relationships with their parents (or other caregivers).

At roughly the same time Bowlby was creating the foundations for his theory on attachment, Mary Ainsworth was finishing her graduate degree and studying security theory, which proposed that children need to develop a secure dependence on their parents before venturing out into unfamiliar situations.

In 1950, the two crossed paths when Ainsworth took a position in Bowlby’s research unit at the Tavistock Clinic in London. Her initial responsibilities included analyzing records of children’s behavior, which inspired her to conduct her own studies on children in their natural settings.

Through several papers, numerous research studies, and theories that were discarded, altered, or combined, Bowlby and Ainsworth developed and provided evidence for attachment theory.

Theirs was a more rigorous explanation and description of attachment behavior than any others on the topic at the time, including those that had grown out of Freud’s work and those that were developed in direct opposition to Freud’s ideas (Bretherton, 1992).

There were several groundbreaking studies that contributed to the development of attachment theory or provided evidence for its validity, including the study described earlier in which infants were separated from their primary caregivers and their behavior was observed to fall into a “style” of attachment.

Further findings on emotional attachment came from a surprising place: rhesus monkeys.

The Harlow Experiments

His work showed that motherly love was emotional rather than physiological, that the capacity for attachment is heavily dependent upon experiences in early childhood, and that this capacity was unlikely to change much after it was “set” (Herman, 2012).

Harlow discovered these interesting findings by conducting two groundbreaking experiments.

In the first experiment, Harlow separated infant monkeys from their mothers a few hours after birth. Each monkey was instead raised by two inanimate surrogate “mothers.” Both provided the infant monkeys with the milk they needed to survive, but one was made out of wire mesh while the other was wire mesh covered with soft terry cloth.

The monkeys who were given the freedom to choose which mother to associate with almost always chose to take milk from the terry cloth “mother.” This finding showed that infant attachment is not simply a matter of where they get their milk—other factors are at play.

For his second experiment, Harlow modified his original setup. The monkeys were given either the bare wire mesh surrogate mother or the terry cloth mother, both of which provided the milk the monkeys needed to grow.

Both groups of monkeys survived and thrived physically, but they displayed extremely different behavioral tendencies. Those with a terry cloth mother returned to the surrogate when presented with strange, loud objects, while those with a wire mesh mother would throw themselves to the floor, clutch themselves, rock back and forth, or even “scream in terror.”

This provided a clear indication that emotional attachment in infancy, gained through cuddling, affected the monkey’s later responses to stress and emotion regulation (Herman, 2012).

These two experiments laid the foundations for further work on attachment in children and the impacts of attachment experiences in later life.

Erikson’s work was based on Freud’s original personality theories and drew from his idea of the ego. However, Erikson placed more importance on context from culture and society than on Freud’s focus on the conflict between the id and the superego.

In addition, his stages of development are based on how children socialize and how it affects their sense of self rather than on sexual development.

The eight stages of psychosocial development according to Erikson are:

• Infancy—Trust vs. Mistrust : In this stage, infants require a great deal of attention and comfort from their parents, leading them to develop their first sense of trust (or, in some cases, mistrust);
• Early Childhood—Autonomy vs. Shame and Doubt : Toddlers and very young children are beginning to assert their independence and develop their unique personality, making tantrums and defiance common;
• Preschool Years—Initiative vs. Guilt : Children at this stage begin learning about social roles and norms. Their imagination will take off at this point, and the defiance and tantrums of the previous stage will likely continue. The way trusted adults interact with the child will encourage him or her to act independently or to develop a sense of guilt about any inappropriate actions;
• School Age—Industry (Competence) vs. Inferiority : At this stage, the child is building important relationships with peers and is likely beginning to feel the pressure of academic performance. Mental health issues may begin at this stage, including depression, anxiety, ADHD, and other problems.
• Adolescence—Identity vs. Role Confusion : The adolescent is reaching new heights of independence and is beginning to experiment and put together his or her identity. Problems with communication and sudden emotional and physical changes are common at this stage (Wells, Sueskind, & Alcamo, 2017).
• Young Adulthood—Intimacy vs. Isolation : At this stage (ages 18-40, approximately), the individual will begin sharing with others more, including people outside o the family. If the individual is successful in this stage of development, he or she will build satisfying relationships that have a sense of commitment, safety, and care; if not, they may fear commitment and experience isolation, loneliness, and depression (McLeod, 2017).
• Middle Adulthood—Generativity vs. Stagnation : In the penultimate stage (ages 40-65, approximately), the individual is likely established in his or her career, relationship, and family. If the individual is not established and contributing to society, he or she may feel stagnant and unproductive.
• Late Adulthood—Ego Integrity vs. Despair : Finally, late adulthood (ages 65 and above) usually brings reduced productivity, which can either be embraced as a reward for one’s contributions or be met with guilt or dissatisfaction. Successfully navigating this stage will protect the individual from feeling depressed or hopeless, and help the individual cultivate wisdom (McLeod, 2017).

Although it does not map completely onto attachment theory, Erikson’s findings are clearly related to the attachment styles and behaviors Bowlby, Ainsworth, and Harlow identified.

John Bowlby – Attachment Theory – Diana Simon Psihoterapeut

According to Bowlby and Ainsworth, attachments with the primary caregiver develop during the first 18 months or so of the child’s life, starting with instinctual behaviors like crying and clinging (Kennedy & Kennedy, 2004). These behaviors are quickly directed at one or a few caregivers in particular, and by 7 or 8 months old, children usually start protesting against the caregiver(s) leaving and grieve for their absence.

Once children reach the toddler stage, they begin forming an internal working model of their attachment relationships. This internal working model provides the framework for the child’s beliefs about their own self-worth and how much they can depend on others to meet their needs.

In Bowlby and Ainsworth’s view, the attachment styles that children form based on their early interactions with caregivers form a continuum of emotion regulation, with anxious-avoidant attachment at one end and anxious-resistant at the other.

Secure attachment falls at the midpoint of this spectrum, between overly organized strategies for controlling and minimizing emotions and the uncontrolled, disorganized, and ineffectively managed emotions.

The most recently added classification, disorganized-disoriented, may display strategies and behaviors from all across the spectrum, but generally, they are not effective in controlling their emotions and may have outbursts of anger or aggression (Kennedy & Kennedy, 2004).

Research has shown that there are many behaviors in addition to emotion regulation that relates to a child’s attachment style. Among other findings, there is evidence of the following connections:

• Secure Attachment: These children are generally more likely to see others as supportive and helpful and themselves as competent and worthy of respect. They relate positively to others and display resilience, engage in complex play and are more successful in the classroom and in interactions with other children. They are better at taking the perspectives of others and have more trust in others;
• Anxious-Avoidant Attachment : Children with an anxious-avoidant attachment style are generally less effective in managing stressful situations. They are likely to withdraw and resist seeking help, which inhibits them from forming satisfying relationships with others . They show more aggression and antisocial behavior, like lying and bullying, and they tend to distance themselves from others to reduce emotional stress;
• Anxious-Resistant Attachment : These children are on the opposite end of the spectrum from anxious-avoidant children. They likely lack self-confidence and stick close to their primary caregivers. They may display exaggerated emotional reactions and keep their distance from their peers, leading to social isolation.
• Disorganized Attachment : Children with a disorganized attachment style usually fail to develop an organized strategy for coping with separation distress, and tend to display aggression, disruptive behaviors, and social isolation. They are more likely to see others as threats than sources of support, and thus may switch between social withdrawal and defensively aggressive behavior (Kennedy & Kennedy, 2004).

It is easy to see from these descriptions of behaviors and emotion regulation how attachment style in childhood can lead to relationship problems in adulthood.

Attachment styles are primarily discussed in the context of our childhood and upbringing.

In the early stages of development, children develop different attachment patterns to their parents or caregiver. These attachment styles can be predictive of how children grow up. For example, anxious or avoidant attachment styles are often powerful predictors for psychopathology or maladjustment development in the later stages of life (Benoit, 2004).

On the contrary, children with secure attachment styles to their parents are also more likely to have secure attachments to their romantic partners. This being said, attachment styles from childhood play a significant role in all the relationships you will encounter.

From this image, you may notice that the secure attachment style is the only one with a “positive” connotation, whereas the other attachment styles seem to have more unfavorable consequences.

If you recognize yourself as displaying one of the more maladaptive attachment styles, don’t fret because this is 1. very common and 2. not set in stone. For example, if you identify with the fearful-avoidant attachment style, you may see that trust seems to be the biggest issue.

The purpose of this image is not to make you feel ashamed about having a particular attachment style, but the opposite. By accepting and embracing your weaknesses, you allow yourself to grow.

Indeed, it is clear how these attachment styles in childhood lead to attachment types in adulthood. Below is an explanation of the four attachment types in adult relationships.

Examples: The Types, Styles, and Stages (Secure, Avoidant, Ambivalent, and Disorganized)

The adult attachment styles follow the same general pattern described above (Firestone, 2013):

Secure Attachment

These adults are more likely to be satisfied with their relationships, feeling secure and connected to their partners without feeling the need to be together all the time. Their relationships are likely to feature honesty , support, independence, and deep emotional connections.

Dismissive-Avoidant (or Anxious-Avoidant) Attachment

One of the two types of adult avoidant attachments, people with this attachment style generally keep their distance from others. They may feel that they don’t need human connection to survive or thrive, and insist on maintaining their independence and isolation from others.

These individuals are often able to “shut down” emotionally when a potentially hurtful scenario arises, such as a serious argument with their partner or a threat to the continuance of their relationship.

Anxious-Preoccupied (or Anxious-Resistant) Attachment

Those who form less secure bonds with their partners may feel desperate for love or affection and feel that their partner must “complete” them or fix their problems.

While they long for safety and security in their romantic relationships, they may also be acting in ways that push their partner away rather than invite them in. The behavioral manifestations of their fears can include being clingy, demanding, jealous, or easily upset by small issues.

Fearful-Avoidant (or Disorganized) Attachment:

The second type of adult avoidant attachment manifests as ambivalence rather than isolation. People with this attachment style generally try to avoid their feelings because it is easy to get overwhelmed by them. They may suffer from unpredictable or abrupt mood swings and fear getting hurt by a romantic partner.

These individuals are simultaneously drawn to a partner or potential partner and fearful of getting to close. Unsurprisingly, this style makes it difficult to form and maintain meaningful, healthy relationships with others.

Each of these styles should be thought of as a continuum of attachment behaviors, rather than a specific “type” of person. Someone with a generally secure attachment style may on occasion display behaviors more suited to the other types, or someone with a dismissive-avoidant style may form a secure bond with a particular person.

Therefore, these “types” should be considered a way to describe and understand an individual’s behavior rather than an exact description of someone’s personality.

Based on a person’s attachment style, the way he or she approaches intimate relationships, marriage, and parenting can vary widely.

The number of ways in which this theory can be applied or used to explain behavior is compounded and expanded by the fact that relationships require two (or more) people; any attachment behaviors that an individual displays will impact and be influenced by the attachment behaviors of other people.

Given the huge variety of individuals, behaviors, and relationships, it is not surprising that there is so much conflict and confusion.

It is also not surprising, although no less unfortunate, that many relationships end up in divorce or dissolution, an event that may continue an unhealthy cycle of attachment in the children of these unions.

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Speaking of unfortunate situations, attachment theory also has applications in the understanding of the  grief and trauma associated with loss.

Although you may be most familiar with Kübler-Ross’s Five Stages of Grief, they were preceded by Bowlby’s Four Stages. During Bowlby’s work on attachment, he and his colleague Colin Murray Parkes noticed four stages of grief:

• Shock and Numbness: In this initial phase, the bereaved may feel that the loss is not real, or that it is simply impossible to accept. He or she may experience physical distress and will be unable to understand and communicate his or her emotions.
• Yearning and Searching: In this phase, the bereaved is very aware of the void in his or her life and may try to fill that void with something or someone else. He or she still identifies strongly and may be preoccupied with the deceased.
• Despair and Disorganization: The bereaved now accepts that things have changed and cannot go back to the way they were before. He or she may also experience despair, hopelessness, and anger, as well as questioning and an intense focus on making sense of the situation. He or she might withdraw from others in this phase.
• Reorganization and Recovery: In the final phase, the bereaved person’s faith in life may start to come back. He or she will start to rebuild and establish new goals, new patterns, and new habits in life. The bereaved will begin to trust again, and grief will recede to the back of his or her mind instead of staying front and center (Williams & Haley, 2017).

Of course, one’s attachment style will influence how grief is experienced as well. For example, someone who is secure may move through the stages fairly quickly or skip some altogether, while someone who is anxious or avoidant may get stuck on one of the stages.

We all experience grief differently, but viewing these experiences through the lens of attachment theory can bring new perspective and insight into our unique grieving processes and why some of us get “stuck” after a loss.

If you’re interested in learning about your attachment style, there are many tests, scales, and questionnaires out available for you to take.

Feeny, Noller, and Hanrahan developed the Original Attachment Three-Category Measure in 1987 to test respondents’ adult attachment style. It contains only three items and is very simple, but it can still give you a good idea of which category you fall into: avoidant, anxious/ambivalent, or secure. You can complete the measure yourself or read more about it on page 3 of  this PDF .

Bartholomew and Horowitz’s Relationships Questionnaire added to The Three-Category Measure by expanding it to include the dismissive-avoidant category. You can find it on the same PDF as the Three-Category Measure, starting on page 3.

Fraley, Waller, and Brennan’s Experiences in Close Relationships Questionnaire-Revised (ECR-R) is a 32-item questionnaire that gives results measured by two subscales related to attachment: avoidance and anxiety (Fraley, Waller, & Brennan, 2000). Items are rated on a scale from 1 (strongly disagree) to 7 (strongly agree). You can find this questionnaire on the final three pages of the PDF mentioned above.

In addition to these scales, there are several less rigorous attachment style tests that can help you learn about your own style of connecting with others. These aren’t instruments often used in empirical research, but they can be helpful tools for learning more about yourself and your attachment style.

Diane Poole Heller developed an Attachment Styles Test, which contains 45 items rated on a three-point scale from “Rarely/Never” to “Usually/Often.” You can find it here , although after completing it you must enter an email to receive your results.

The Relationship Attachment Style Test is a 50-item test hosted on Psychology Today’s website. It covers the four attachment types noted earlier (Secure, Anxious-Ambivalent, Dismissive-Avoidant, Fearful-Avoidant) as well as Dependent and Codependent attachment styles .

If you are interested in taking this test, you can find it at this link . However, be aware that while you receive a free “snapshot report” at the end, you will need to pay to see your full results.

One of the ways in which the principles and concepts of attachment theory have been effectively applied to teaching is the practice of emotion coaching.

Emotion coaching is about helping children to become aware of their emotions and to manage their own feelings particularly during instances of ‘misbehavior.’ It enables practitioners to create an ethos of positive learning behavior and to have the confidence to de-escalate situations when behavior is challenging” (National College for Teaching and Leadership, 2014).

Emotion coaching is more about supporting children in learning about and regulating their own emotions and behavior than it is about “coaching” in the traditional sense. In emotion coaching, teachers are not required—or even encouraged—to promote proper behavior through rewards or punishments.

Instead, emotion coaching involves:

• Teaching students about the world of “in the moment” emotion;
• Showing students strategies for dealing with emotional ups and downs;
• Empathizing with and accepting negative or unpleasant emotions as normal, but not accepting negative behavior;
• Using moments of challenging behavior as opportunities for teaching;
• Building trusting and respectful relationships with the students (National College for Teaching and Leadership, 2014).

According to attachment theory expert Dr. John Gottman, there are five steps to emotion coaching, and they can be practiced by parents, teachers, or any significant adult in a child’s life:

• Tune in: Notice or become aware of your own and the child’s emotions. Make sure you are calm enough to practice emotion coaching, otherwise, you might want to give both of you a quick breather;
• Connect: Use this situation as an opportunity for you to practice and for the child to learn. State objectively (This is important!) what emotions you think the child is experiencing to help them connect their emotions to their behavior;
• Accept and Listen: Practice empathy. Put yourself in the child’s shoes, think about a situation when you felt a similar emotion, and try to remember what it felt like;
• Reflect: Once everyone is calm, go back over what the child said or did, mentioning only what you saw, heard, or understand of the situation. Reflect on what happened and why it happened;
• End with Problem Solving/Choices/Setting Limits: Whenever possible, try to end the situation by guiding or involving the child in problem-solving (Somerset Children & Young People, n.d.).

To learn more about emotion coaching and improve your skills as a parent or teacher, try the following activity.

What Would an Emotion Coach Do?

This short, two-page activity from the Somerset Emotion Coaching Project can help you enhance your understanding of what emotion coaching is—and what it is not.

There are five scenarios presented along with six potential responses. Your task is to read the scenario and decide which response(s) is/are the appropriate emotion coaching response(s).

The first scenario is: “Angry pupil over not wanting to attend a compulsory revision session.”

Your options include:

• Get cross with the pupil for the bad behavior;
• Tell the pupil they will have to complete an extra session due to the bad behavior;
• Help the pupil to think about what they can do about the problem;
• Tell the pupil not to make a big deal about staying after school;
• Validate the pupil’s expression of anger and frustration;
• Soothe the pupil.

This is an excellent activity to do in groups, as you can discuss each option with others and hear different perspectives from your own. In addition to identifying the emotion coaching response(s), you can also discuss which options are dismissive, avoidant, etc.

You can see the rest of the scenarios and try your hand at this activity by clicking here (an automatic download will start when you click on the link).

Emotion Coaching Scripts

Another great resource from the Somerset Emotion Coaching Project, this activity gives you a chance to practice brainstorming emotion coaching-appropriate responses.

As an added bonus, you can use the scripts you develop to guide you the next time you encounter a situation like those described.

There are six scenarios which you are instructed to create a script for:

• A pupil arrives late to class. She refuses to communicate with you and says “Don’t even start, just leave me alone”;
• A young person refuses to sit by her usual friends at a youth center and says that they have been saying unkind comments about her size;
• A boy regularly fails to complete work independently and will often sit passively and contribute little. He rarely presents with disruptive behavior but simply completes very little work. He appears isolated from his peers;
• A nursery child is crying at drop-off time and is clinging to her parent who has to go to work;
• An aggressive, confrontational parent is annoyed because she’s been asked to come in and talk about her son’s behavior. She approaches you and starts the conversation by saying, “You’re always having a go at us”;
• During recess, a group of young boys was fighting and one of them was hurt (not seriously). You approach them and they all look at you with worried expressions.

For each scenario, the instructions encourage you to:

• Recognize the emotion the child is displaying;
• Validate that emotion;
• Label the emotion the child is feeling;
• Empathize with the child;
• Set limits, if appropriate, and problem-solve.

Completing this worksheet provides you with an excellent opportunity to think, plan, and prepare for effective emotion coaching. You can download this activity for your own use here (an automatic download will start when you click on the link).

If you’re interested in learning more about applying attachment theory to teaching, check out Louis Cozolino’s book Attachment-Based Teaching: Creating a Tribal Classroom . He puts forth a simple but potentially game-changing idea: Relationships are the key to better performance rather than rigidly structured curricula.

In addition, our article Attachment Styles in Therapy: Worksheets & Handouts provides useful worksheets pertaining attachment styles.

Emotion coaching can also be used by social workers, to some extent. However, the application of attachment theory to social work is more significant in the three key messages that it espouses:

• It is vital for social workers to offer children and families a safe haven and secure base. This does not mean families should be forever comfortable and come to depend on the social worker, but families should know a social worker can provide a safe place when they are struggling as well as support for moving forward and outward;
• Social workers must be aware of children’s (and their families’) inner experiences and practice mentalization , or “bringing the inside out.” One of the most important factors in finding healing and improving family relations is to ensure that parents have an idea of what is going on in their children’s heads, including how they feel and think about their parents;
• Among the most effective tools in a social worker’s toolbox is the practice of recording parents as they interact with their child and using the videos to coach the parent. Valuable insights can be found in watching oneself parenting, and the social worker can provide in the moment coaching, offering praise for the parents’ strengths alongside suggestions for improvement (Shemmings, 2015).

Of course, there are many ways to apply attachment theory to working with children, especially those who are in the midst of family crises. However, if these three points are attended to, you’ll have the most important bases covered.

For social workers who work with adults, there are some different strategies and key points to keep in mind, specifically:

• Remember that attachment theory applies throughout the entire range of life, and many behaviors and processes are shaped by early attachment, including staying safe, seeking comfort, regulating proximity to the attachment figure, and seeking predictability;
• Keep in mind that attachment patterns are not based on a few key moments, but on thousands of moments throughout early life, and how an attachment figure responds (or does not respond) sets a template for the child’s attachment style in the future. This template affects how the child recognizes and responds to their own emotions and how they interact with attachment figures;
• This early template becomes deeply embedded in the brain and therefore has a significant impact on our ability to regulate our emotions and connect and relate to others in adulthood. This can lead an adult who was abused in childhood to fail to recognize that they are being abused in their intimate relationship, or even cause them to find comfort and stability in the predictability of their situation;
• Remember that attachment behaviors are adaptive to the context in which they were formed. Habits and behaviors that are adaptive in childhood, in an evolutionary sense at least, may become maladaptive and harmful in adulthood;
• Finally, social workers should never think that they are “treating” a set of behaviors and must recognize that the individual’s strategies were formed for a reason and likely helped him or her survive a difficult situation in childhood. The role of a social worker is to help clients avoid overapplying those strategies and to guide them in adding effective, new strategies to their toolboxes (Hardy, 2016).

As with any popular theory in psychology, there are several criticisms that have been raised against it.

Chief among them are the following criticisms:

• Overemphasis on Nurture: This criticism stems from psychologist J. R. Harris, who believes that parents do not have as much of an influence over their child’s personality or character as most people believe. She notes that much of one’s personality is determined by genetics rather than environment (Harris, 1998; Lee, 2003).
• The stressful situation criticism of attachment theory’s limitations notes that the model was based on a child’s reactions in momentary, stressful situations (being separated from one’s parent), and does not provide any insight into how children and parents interact in non-stressful situations;
• Further, the early model did not take into consideration the fact that children can have different kinds of attachments to different people; the attachment with the mother may not represent the attachments formed with others;
• Finally, the mother was viewed as the automatic primary attachment figure in the early model, when the father, stepparent, sibling, grandparent, aunt, or uncle may be the person that the child connects most strongly with (Field, 1996; Lee, 2003).

Although some of these criticisms have faded over time as the theory is injected with new evidence and updated concepts, it is useful to look at any theory with a critical eye.

17 Exercises for Positive, Fulfilling Relationships

Empower others with the skills to cultivate fulfilling, rewarding relationships and enhance their social wellbeing with these 17 Positive Relationships Exercises [PDF].

Created by experts. 100% Science-based.

A few of the most popular books on attachment theory can be found below:

• Attached: The New Science of Adult Attachment and How It Can Help You Find—and Keep—Love by Amir Levine and Rachel Heller ( Amazon );
• Attachment in Psychotherapy by David J. Wallin ( Amazon );
• Handbook of Attachment: Theory, Research, and Clinical Applications (3rd Edition) by Jude Cassidy and Phillip R. Shaver ( Amazon );
• Theories of Attachment: An Introduction to Bowlby, Ainsworth, Gerber, Brazelton, Kennell, & Klaus by Carol Garhart Mooney ( Amazon );
• Insecure in Love: How Anxious Attachment Can Make You Feel Jealous, Needy, and Worried and What You Can Do About It by Leslie Becker-Phelps ( Amazon );
• Wired for Love: How Understanding Your Partner’s Brain and Attachment Style Can Help You Defuse Conflict and Build a Secure Relationship by Dr. Stan Tatkin ( Amazon ).

There are also several great websites that host insightful essays and informative articles about attachment theory and its applications, including:

• www.communitycare.co.uk : The Community Care website calls itself “The heart of your social care career” and offers many interesting pieces on social work, attachment theory, and working with children and families who are struggling.
• “Attachment Theory” by Saul McLeod:  This article provides an excellent, brief introduction to attachment theory, as well as information on the Harlow experiments, the stages of attachment, and Lorenz’s imprinting theory.
• “A Brief Overview of Adult Attachment Theory and Research” by R. Chris Fraley:  This piece from attachment theory expert R. Chris Fraley also gives readers a thorough and academic introduction to familiarize them with the theory.
• “Attachment Styles at Work: Measurement, Collegial Relationships, and Burnout” by Michael P. Leiter, Arla Day, and Lisa Price:  This article , published in the journal Burnout Research in 2015, dives into the applications of attachment theory in the workplace, a subject we didn’t explore in this piece. The authors share some interesting insights about how one’s attachment style affects their relationships and performance in the workplace.

This piece tackled attachment theory, a theory developed by John Bowlby in the 1950s and expanded upon by Mary Ainsworth and countless other researchers in later years. The theory helps explain how our childhood relationships with our caregivers can have a profound impact on our relationships with others as adults.

Although attachment theory may not be able to explain every peculiarity of personality, it lays the foundations for a solid understanding of yourself and those around you when it comes to connecting and interacting with others.

What do you think about attachment theory? Do you think there are attachment styles not covered by the four categories? Are there any other criticisms of attachment theory you think are valid and worthy of discussion? We’d love to hear your thoughts in the comment section.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Relationships Exercises for free .

• Benoit, D. (2004). Infant-parent attachment: Definition, types, antecedents, measurement and outcome. Paediatrics & Child Health, 9(8) , 541-545.
• Bretherton, I. (1992). The origins of Attachment Theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 28, 759-775.
• Cherry, K. (2018). The story of Bowlby, Ainsworth, and Attachment Theory: The importance of early emotional bonds. Retrieved from https://www.verywellmind.com/what-is-attachment-theory-2795337
• Field, T. (1996). Attachment and separation in young children. Annual Review of Psychology, 47 , 541-561.
• Firestone, L. (2013). How your attachment style impacts your relationship.  Retrieved from https://www.psychologytoday.com/blog/compassion-matters/201307/how-your-attachment-style-impacts-your-relationship
• Fraley, R. C. (2010). A brief overview of adult attachment theory and research. Retrieved from https://internal.psychology.illinois.edu/~rcfraley/attachment.htm
• Hardy, R. (2016). Tips on applying attachment theory in social work with adults. Retrieved from http://www.communitycare.co.uk/2016/12/06/attachment-theory-social-work-adults/
• Harris, J. R. (1998). The nurture assumption: Why our children turn out the way they do. Free Press.
• Herman, E. (2012). Harry F. Harlow, monkey love experiments. Retrieved from http://pages.uoregon.edu/adoption/studies/HarlowMLE.htm
• Kennedy, J. H., & Kennedy, C. E. (2004). Attachment theory: Implications for school psychology. Psychology in the Schools, 41 , 247-259.
• Lee, E. J. (2003). The attachment system throughout the life course: Review and criticisms of attachment theory . Retrieved from http://www.personalityresearch.org/papers/lee.html
• McLeod, S. (2017). Erik Erikson. Retrieved from https://www.simplypsychology.org/Erik-Erikson.html
• National College for Teaching and Leadership (2014). An introduction to attachment and the implications for learning and behaviour [PDF Slide Presentation] . Retrieved from https://www.bathspa.ac.uk/media/bathspaacuk/education-/research/digital-literacy/education-resource-introduction-to-attatchment.pdf
• Shemmings, D. (2015). How social workers can use attachment theory in direct work. Retrieved from http://www.communitycare.co.uk/2015/09/02/using-attachment-theory-research-help-families-just-assess/
• Somerset Children & Young People Health & Wellbeing. (n.d.). Emotion coaching and self-regulation. Retrieved from http://www.cypsomersethealth.org/?ks=1&page=mhtk_secp_5
• Wells, J., Sueskind, B., & Alcamo, K. (2017). Child and adolescent issues. Retrieved from https://www.goodtherapy.org/learn-about-therapy/issues/child-and-adolescent-issues
• Williams, L., & Haley, E. (2017). Before the five stages were the FOUR stages of grief. Retrieved from https://whatsyourgrief.com/bowlby-four-stages-of-grief/

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What our readers think.

muchas gracias por la información

The linked surveys are problematic, when they refer to intimate or close relationships, particularly for persons who’ve only had one close adult relationship. Or none.

Article is defective (‘to’ instead of ‘too’ aside). Cannot – for the life of me – find the four stages of attachment declared at the outset; only four styles. For what’s it’s worth I experienced paternal absence and maternal rejection – prostitute mother and pimp father – which is to say, no parenting or attachment at all – leading to a hotch-potch of all three non-secure ‘styles’.

how does attachment influences personality development in adulthood.

Good question! We answer this question by linking the different attachment styles to adult behaviors traits in this article: https://positivepsychology.com/attachment-style-worksheets/ (see the subsection ‘Attachment Theory in Psychology: 4 Types & Characteristics’)

Hope this helps!

– Nicole | Community Manager

How do I reference this article

You can reference this article in APA 7th as follows: Ackerman, C. A. (2018, April 27). What is Attachment Theory? Bowlby’s 4 stages explained. PositivePsychology.com. https://positivepsychology.com/attachment-theory/

I think that a big limitation when discussing Attachment Theory, that I haven’t seen addressed, is the effect of trauma on a older child past the early defining stage, or an adult. Bullying, accidents and injury, severe illness, family upheaval, or other significant life events can significantly affect a person’s psychological state, and thus alter a Securely Attached style to one of the other types.

Thank you for an informative article! Do you happen to know of any non-profit organizations that focus on stopping the cycle of maladaptive attachment in families? I’m a student with some ideas for a program that I’d like to pitch to some organizations that serve at risk individuals.

Glad you found the article helpful — that sounds like an interesting idea! Your question’s a little tricky. It’s hard to know how explicitly existing services draw on Bowlby’s principles. However, I suspect that the messages of the framework are likely embedded in various parent support groups and educational opportunities. If you’re interested in the U.S. specifically, maybe check out some of the services listed here and inquire about any curriculums.

Thank you, Nicole!

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Attachment and child development

What is attachment theory and why is it important.

Attachment is a clinical term used to describe "a lasting psychological connectedness between human beings” (Bowlby, 1997) 1 . In particular, attachment theory highlights the importance of a child’s emotional bond with their primary caregivers. Disruption to or loss of this bond can affect a child emotionally and psychologically into adulthood, and have an impact on their future relationships.

Only specially trained and qualified professionals should assess a child’s attachment style. However, it’s important for all adults working with children to understand what attachment is and know how to help parents and carers become attuned to their child’s needs. You might do this by working with them directly, or by signposting families to other appropriate services. In the long term, this can help improve wellbeing and provide positive outcomes for both the child and their caregivers.

Understanding attachment in the early years

Children can form attachments with more than one caregiver, but the bond with the people who have provided close care from early infancy is the most important and enduring (Bowlby, 1997) 2 .

It’s important that parents and carers are attuned and responsive to their baby’s needs and are able to provide appropriate care. This includes recognising if their baby is hungry, feeling unwell or in need of closeness and affection (Howe, 2011) 3 .

Forming an attachment is something that develops over time for a child, but parents and carers can start to form an emotional bond with their child before they are born. Sometimes a parent or carer may have difficulty forming this bond, for example if they are experiencing mental health issues or don’t have an effective support network.

On this page, you’ll find information on:

• why attachment is important
• how children develop attachment
• attachment issues, insecure and secure attachment and behaviours to look out for
• how trauma can affect attachment
• how you can support parents and carers to develop a bond with their child.

Need specific information?

Our information specialists are here to help you find research, guidance and best practice.

Find out more

Stages of attachment

The first two years of a child’s life are the most critical for forming attachments (Prior and Glaser, 2006) 1 .

During this period, children develop an ‘internal working model’ that shapes the way they view relationships and operate socially. This can affect their sense of trust in others, self-worth and their confidence interacting with others (Bowlby, 1997) 2 .

When are attachments formed?

Attachments are formed in different ways during the phases of a child’s development.

Antenatal (before birth)

During the antenatal period, parents and carers can form a bond with their child. Any bonds formed before birth can have a positive impact on the relationship between babies and their caregivers once the child is born (Condon and Corkindale, 1997) 3 .

Birth until 6 weeks

This is sometimes referred to as the pre-attachment phase because the baby doesn’t appear to show an attachment to any specific caregiver. However, parents and carers who provide a nurturing environment and are responsive to their babies needs can lay the foundation for secure attachments to form (Bowlby, 1997) 4 .

6 weeks until 6-8 months

During this stage of their development, a baby might start to show a preference for their primary and secondary caregivers (often the mother and father).

6-8 months until 18 months-2 years

During this period a child begins to show a strong attachment to their primary caregivers. Babies start to develop separation anxiety during this phase and can become upset when their caregiver leaves, even for short periods (Bowlby, 1997) 5 .

18 months – 2 years onwards

At this point children are likely to become less dependent on their primary caregiver, particularly if they feel secure and confident the caregiver will return and be responsive in times of need (Bowlby, 1997) 6 .

Types of attachment

A child’s need for attachment is part of the process of seeking safety and security from their caregiver.

What does secure attachment look like?

In secure caregiver-child relationships, the caregiver is usually sensitive and tuned in to the child’s needs. They are able to provide care that is predictably loving, responsive and consistent.

Young children who have formed a secure attachment to their caregiver may display the following patterns of behaviour during times of stress or exploration:

• proximity maintenance – wanting to be near their primary caregiver
• safe haven - returning to their primary caregiver for comfort and safety if they feel afraid or threatened
• secure base – treating their primary caregiver as a base of security from which they can explore the surrounding environment. The child feels safe in the knowledge that they can return to their secure base when needed
• separation distress - experiencing anxiety in the absence of their primary caregiver. They are upset when their caregiver leaves, but happy to see them and easily comforted when they return

(Ainsworth et al, 2015) 1 .

Benefits of secure attachment

When caregivers react sensitively to ease their child’s distress and help them regulate their emotions, it has a positive impact on the child’s neurological, physiological and psychosocial development (Howe, 2011) 2 .

Children with secure attachments are more likely to develop emotional intelligence, good social skills and robust mental health (Howe, 2011) 3 .

Effects of insecure attachment

Not receiving comfort and security in the early years can have a negative effect on children’s neurological, psychological, emotional and physical development and functioning (Newman, 2015) 4 .

Babies and young children who have attachment issues may be more likely to develop behavioural problems such as attention deficit hyperactivity disorder (ADHD) or conduct disorder (Fearon et al, 2010) 5 .

Children who have attachment issues can have difficulty forming healthy relationships when they grow up. This may be because their experiences have taught them to believe that other people are unreliable or untrustworthy (Bowlby, 1997) 6 .

Adults with attachment issues are at a higher risk of entering into volatile relationships and having poor parenting skills, behavioural difficulties and mental health problems (Howe, 2011) 7 .

> Find out more about how trauma affects child brain development

Further reading

Take a look at our reading list on child attachment.

> View the reading list on the NSPCC Library catalogue

Attachment issues

Factors affecting attachment.

Some circumstances can make it more challenging for a child and their caregivers to form a pattern of secure attachment. These may include:

• abuse, maltreatment and trauma experienced by the parent or child
• parental mental health difficulties
• parental substance misuse
• the child having multiple care placements
• parents being separated from their baby just after birth, for example if the baby is receiving neonatal care
• stress such as having a low income, being a single parent, or being a young parent
• bereavement or loss of another caregiver that a child had an attachment with

(Bowlby, 1989) 1 .

Signs that a child may have attachment issues

Children’s behaviour can be influenced by a wide range of circumstances and emotions. 

Indicators that a baby or toddler might not have a secure attachment with their caregiver will emerge as a pattern of behaviour over time, particularly during moments of stress or exploration. This pattern might include:

• being fearful or avoidant of a parent or carer
• becoming extremely distressed when their carer leaves them, even for a short amount of time
• rejecting their caregiver’s efforts to calm, soothe, and connect with them
• not seeming to notice or care when their caregiver leaves the room or when they return
• being passive or non-responsive to their carer
• seeming to be depressed or angry
• not being interested in playing with toys or exploring their environment

(Howe, 2011) 2 .

As children with attachment issues get older, these behaviour patterns might evolve. As well as being evident during times of stress, some behaviours may start to become obvious at other times. These may include the child:

• finding it difficult to ask for help
• struggling to form positive relationships with adults and peers
• struggling to concentrate
• struggling to calm themselves down
• both demanding and rejecting attention or support at the same time
• becoming quickly or disproportionately angry or upset, at times with no clear triggers
• appearing withdrawn or disengaged from activities
• daydreaming, being hyperactive or constantly fidgeting or moving

(Mentally Healthy Schools, 2020) 3 .

If you think a child may have attachment issues, you should refer them to a suitably trained health and social care professional for a full assessment. You should follow your organisation’s procedures to make a health and social care referral, or contact your local authority children’s social care services.

Trauma and attachment

The signs of attachment issues can be similar to indicators that a child is experiencing other challenges, such as:

• mental health problems
• additional needs
• abuse and neglect .

This means it’s important to consider everything that’s going on in a child’s life and make sure they and their family are provided with appropriate support.

Think about all your previous experiences with the child and their caregivers, to help you build a clear picture of their relationships and recognise any concerning patterns of behaviour.

The impact of trauma and attachment

Children who have experienced abuse, neglect and trauma might develop coping strategies that can make it more complicated to recognise attachment issues.

For example, one sign of secure attachment is that children see their caregiver as a secure base to explore from. But children who have experienced neglect , for example, might display independent behaviour in order to protect themselves from the emotional pain of not having their needs met (Marvin et al, 2002) 1 .

It is also possible for a child to develop an attachment to someone who is maltreating them (Blizard & Bluhm, 1994) 2 .

As well as affecting attachment, experiencing trauma can have an impact on a child’s brain development. Children might need extra support to help strengthen the architecture of their brain.

What to do if you’re worried that a child is experiencing or at risk of abuse or neglect

If a child is in immediate danger, call the police on 999.

If you’re worried about a child but they are not in immediate danger, you should share your concerns.

• Follow your organisation’s child protection procedures without delay . These should provide clear guidelines on the steps you need to take if a child discloses abuse. They will state who in your organisation has responsibility for safeguarding or child protection and who you should report your concerns to.
• Contact your local child protection services . Their contact details can be found on the website for the local authority the child lives in.
• Contact the police . They will assess the situation and take the appropriate action to protect the child.
• Contact the NSPCC Helpline on 0808 800 5000 or by emailing [email protected] . Our child protection specialists will talk through your concerns with you, give you expert advice and take action to protect the child as appropriate. This may include making a referral to the local authority.

> Find out more about recognising and responding to abuse

If your organisation doesn't have a clear safeguarding procedure or you're concerned about how child protection issues are being handled in your own, or another, organisation, contact the Whistleblowing Advice Line to discuss your concerns.

> Find out about the Whistleblowing Advice Line on the NSPCC website

When you're not sure

The NSPCC Helpline can help when you’re not sure if a situation needs a safeguarding response. Our child protection specialists are here to support you whether you’re seeking advice, sharing concerns about a child, or looking for reassurance.

Whatever the need, reason or feeling, you can contact the NSPCC Helpline on 0808 800 5000 or by emailing [email protected]

Our trained professionals will talk through your concerns with you. Depending on what you share, our experts will talk you through which local services can help, advise you on next steps, or make referrals to children’s services and the police.

> Find out more about how the NSPCC Helpline can support you

Supporting children and families

Building positive relationships.

It’s important for anyone who works with children and families to support parents and carers in building positive relationships with their child. Having positive interaction and play with caregivers can help a child’s brain to develop healthily.

> See our early years resources which you can share with parents and caregivers

Video feedback programmes can also be used by specially trained social care professionals to help caregivers improve their interactions with their child. This involves caregivers being filmed when they are interacting with their child and then watching the recording with a trained practitioner, who gives them feedback and helps them build on their strengths.

Support for parents and carers

If parents are struggling with their own issues, it may make it harder for them to bond with their child and provide consistant and responsive care. They may have:

• experienced abuse of trauma themselves
• drug and/or alcohol dependencies
• mental health issues.

> Find out more about parental mental health

> Learn more about parental substance misuse

Services for children and families

The NSPCC has many services that children and families can be referred to, from supporting parents and carers in taking care of their children to preventing sexual abuse and overcoming abuse.

Our services might be suitable for children and families you are working with:

• Pregnancy in Mind helps parents who are at risk of or experiencing mild to moderate anxiety and depression during pregnancy. The service helps build parents’ capacity to provide sensitive, responsive care to their babies and keep these skills developed postnatally and as their children develop

Browse for more services

Take a look at our reading list about child attachment interventions, support and treatment.

> View the list on the NSPCC Library catalogue

Supporting children’s mental health

Children with attachment issues may have problems expressing or controlling their emotions and forming positive relationships, which might affect their mental health.

It’s important to make sure children and young people have access to mental health support.

> Find out more about child mental health

> See the NSPCC’s advice for parents and carers on how to support their child’s mental health

If a child or young person needs confidential help and advice you can always direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online . Children under the age of 12 can be directed to the Childline Kids website .

We also have a series of posters and wallet cards you can download for free. These can be printed and displayed in your setting to encourage children to contact Childline if they need to talk.

Understanding child brain development

Learn more about trauma-informed approaches and how you can help children overcome adverse childhood experiences.

Child mental health

Explores different mental health issues and risk and vulnerability factors as well as how to recognise when a child needs help and how to respond.

Protecting children from neglect

Understand more about neglect, how to recognise it and how to protect children and young people from it.

Services for children & families

Discover our current services for children and families across the UK and Channel Islands.

John Bowlby’s Attachment Theory

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

John Bowlby (1907 – 1990) was a psychoanalyst (like Freud) and believed that mental health and behavioral problems could be attributed to early childhood.

Key Takeaways

• Bowlby’s evolutionary theory of attachment suggests that children come into the world biologically pre-programmed to form attachments with others, because this will help them to survive.
• Bowlby argued that a child forms many attachments, but one of these is qualitatively different. This is what he called primary attachment, monotropy.
• Bowlby suggests that there is a critical period for developing attachment (2.5 years). If an attachment has not developed during this time period, then it may well not happen at all. Bowlby later proposed a sensitive period of up to 5 years.
• Bowlby’s maternal deprivation hypothesis suggests that continual attachment disruption between the infant and primary caregiver could result in long-term cognitive, social, and emotional difficulties for that infant.
• According to Bowlby, an internal working model is a cognitive framework comprising mental representations for understanding the world, self, and others, and is based on the relationship with a primary caregiver.
• It becomes a prototype for all future social relationships and allows individuals to predict, control, and manipulate interactions with others.

Evolutionary Theory of Attachment

Bowlby (1969, 1988) was greatly influenced by ethological theory, but especially by Lorenz’s (1935) study of imprinting .  Lorenz showed that attachment was innate (in young ducklings) and therefore had a survival value.

During the evolution of the human species, it would have been the babies who stayed close to their mothers that would have survived to have children of their own.  Bowlby hypothesized that both infants and mothers had evolved a biological need to stay in contact with each other.

Bowlby (1969) believed that attachment behaviors (such as proximity seeking) are instinctive and will be activated by any conditions that seem to threaten the achievement of proximity, such as separation, insecurity, and fear.

Bowlby also postulated that the fear of strangers represents an important survival mechanism, built-in by nature.

Babies are born with the tendency to display certain innate behaviors (called social releases), which help ensure proximity and contact with the mother or attachment figure (e.g., crying, smiling, crawling, etc.) – these are species-specific behaviors.

These attachment behaviors initially function like fixed action patterns and share the same function. The infant produces innate ‘social releaser’ behaviors such as crying and smiling that stimulate caregiving from adults.

The determinant of attachment is not food but care and responsiveness.

Bowlby’s monotropic theory

A child has an innate (i.e., inborn) need to attach to one main attachment figure (i.e., monotropy).

Bowlby’s monotropic theory of attachment suggests attachment is important for a child’s survival.

Attachment behaviors in both babies and their caregivers have evolved through natural selection. This means infants are biologically programmed with innate behaviors that ensure that attachment occurs.

Although Bowlby did not rule out the possibility of other attachment figures for a child, he did believe that there should be a primary bond which was much more important than any other (usually the mother).

Other attachments may develop in a hierarchy below this. An infant may therefore have a primary monotropy attachment to its mother, and below her, the hierarchy of attachments may include its father, siblings, grandparents, etc.

Bowlby believes that this attachment is qualitatively different from any subsequent attachments.  Bowlby argues that the relationship with the mother is somehow different altogether from other relationships.

The child behaves in ways that elicit contact or proximity to the caregiver.  When a child experiences heightened arousal, he/she signals to their caregiver.

Crying, smiling, and locomotion are examples of these signaling behaviors.  Instinctively, caregivers respond to their children’s behavior, creating a reciprocal pattern of interaction.

Critical Period

A child should receive the continuous care of this single most important attachment figure for approximately the first two years of life.

Bowlby (1951) claimed that mothering is almost useless if delayed until after two and a half to three years and, for most children, if delayed till after 12 months, i.e., there is a critical period.

If the attachment figure is broken or disrupted during the critical two-year period, the child will suffer irreversible long-term consequences of this maternal deprivation.  This risk continues until the age of five.

Bowlby used the term maternal deprivation to refer to the separation or loss of the mother as well as the failure to develop an attachment.

The underlying assumption of Bowlby’s Maternal Deprivation Hypothesis is that continual disruption of the attachment between infant and primary caregiver (i.e., mother) could result in long-term cognitive, social, and emotional difficulties for that infant.

The implications of this are vast – if this is true, should the primary caregiver leave their child in daycare, while they continue to work?

Maternal Deprivation

Bowlby’s maternal deprivation hypothesis suggests that continual attachment disruption between the infant and primary caregiver (i.e., mother) could result in long-term cognitive, social, and emotional difficulties for that infant.

Bowlby (1988) suggested that the nature of monotropy (attachment conceptualized as being a vital and close bond with just one attachment figure) meant that a failure to initiate or a breakdown of the maternal attachment would lead to serious negative consequences, possibly including affectionless psychopathy.

Bowlby’s theory of monotropy led to the formulation of his maternal deprivation hypothesis.

John Bowlby (1944) believed that the infant’s and mother’s relationship during the first five years of life was crucial to socialization.

According to Bowlby, if separation from the primary caregiver occurs during the critical period and there is no adequate substitute emotional care, the child will suffer from deprivation.

This will lead to irreversible long-term consequences in the child’s intellectual, social, and emotional development.

Bowlby initially believed the effects to be permanent and irreversible:

• delinquency,
• reduced intelligence,
• increased aggression,
• depression,
• affectionless psychopathy

Bowlby also argued that the lack of emotional care could lead to affectionless psychopathy,

Affectionless psychopathy is characterized by a lack of concern for others, a lack of guilt, and the inability to form meaningful relationships.

Such individuals act on impulse with little regard for the consequences of their actions.  For example, showing no guilt for antisocial behavior.

The prolonged deprivation of the young child of maternal care may have grave and far-reaching effects on his character and so on the whole of his future life (Bowlby, 1952, p. 46).

Bowlby believed that disrupting this primary relationship could lead to a higher incidence of juvenile delinquency, emotional difficulties, and antisocial behavior. To test his hypothesis, he studied 44 adolescent juvenile delinquents in a child guidance clinic.

Bowlby 44 Thieves

To investigate the long-term effects of maternal deprivation on people to see whether delinquents have suffered deprivation.

According to the Maternal Deprivation Hypothesis, breaking the maternal bond with the child during their early life stages is likely to affect intellectual, social, and emotional development seriously.

Between 1936 and 1939, an opportunity sample of 88 children was selected from the clinic where Bowlby worked. Of these, 44 were juvenile thieves (31 boys and 13 girls) who had been referred to him because of their stealing.

Bowlby selected another group of 44 children (34 boys and 10 girls) to act as ‘controls (individuals referred to the clinic because of emotional problems but not yet committed any crimes).

On arrival at the clinic, each child had their IQ tested by a psychologist who assessed their emotional attitudes toward the tests. The two groups were matched for age and IQ.

The children and their parents were interviewed to record details of the child’s early life (e.g., periods of separation, diagnosing affectionless psychopathy) by a psychiatrist (Bowlby), a psychologist, and a social worker.  The psychiatrist, psychologist, and social worker made separate reports.

Bowlby found that 14 children from the thief group were identified as affectionless psychopaths (they were unable to care about or feel affection for others); 12 had experienced prolonged separation of more than six months from their mothers in their first two years of life.

In contrast, only 5 of the 30 children not classified as affectionless psychopaths had experienced separations.

Out of the 44 children in the control group, only two experienced prolonged separations, and none were affectionless psychopaths.

The results support the maternal deprivation hypothesis as they show that most of the children diagnosed as affectionless psychopaths (12 out of 14) had experienced prolonged separation from their primary caregivers during the critical period, as the hypothesis predicts

Bowlby concluded that maternal deprivation in the child’s early life caused permanent emotional damage.

He diagnosed this as a condition and called it Affectionless Psychopathy. According to Bowlby, this condition involves a lack of emotional development, characterized by a lack of concern for others, a lack of guilt, and an inability to form meaningful and lasting relationships.

Bowlby directly observed parental separation’s harm in evacuating children from bombing during WWII, strengthening his hospital research indicating it profoundly impacts children’s emotional and behavioral development.

Limitations

The supporting evidence that Bowlby (1944) provided was in the form of clinical interviews of, and retrospective data on, those who had and had not been separated from their primary caregiver.

This meant that Bowlby asked the participants to look back and recall separations.  These memories may not be accurate.

A criticism of the 44 thieves study was that it concluded affectionless psychopathy was caused by maternal deprivation.  This is correlational data and only shows a relationship between these two variables. It cannot show a cause-and-effect relationship between separation from the mother and the development of affectionless psychopathy.

Other factors could have been involved, such as the reason for the separation, the role of the father, and the child’s temperament. Thus, as Rutter (1972) pointed out, Bowlby’s conclusions were flawed, mixing up cause and effect with correlation.

Many of the 44 thieves in Bowlby’s study had been moved around a lot during childhood, and had probably never formed an attachment.  This suggested that they were suffering from privation, rather than deprivation, which Rutter (1972) suggested was far more deleterious to the children. This led to a very important study on the long-term effects of privation, carried out by Hodges and Tizard (1989).

The study was vulnerable to researcher bias. Bowlby conducted the psychiatric assessments himself and made the diagnosis of Affectionless Psychopathy. He knew whether the children were in the ‘theft group’ or the control group. Consequently, his findings may have been unconsciously influenced by his own expectations. This potentially undermines their validity.

Bowlby struggled to apply his new maladaptation model to retrospective research on adolescents with conduct problems, as such studies prejudice outcomes by selecting for problems and then looking backward.

Cautious of this, in 1950, Bowlby, Robertson, and new researcher Mary Ainsworth (1956) began a forward-looking “follow-up study” on whether preschoolers who were hospitalized long-term subsequently developed conduct issues.

Assessing 60 such children aged 6-13 and controls, contrary to maternal deprivation hypotheses, they found more emotional apathy, withdrawal, and poor control than criminality.

So, while early prolonged separation impacted some children’s later adjustment, outcomes proved far more varied than Bowlby’s theory initially predicted. The improved prospective methodology highlighted limitations in Bowlby’s previous retrospective approaches.

In the conclusions of the paper Bowlby admitted that his theory regarding the development of conduct problems may be wrong:

It is clear that some of the workers, including the present senior author, in their desire to call attention to dangers which can often be avoided have on occasion overstated their case. In particular, statements implying that children who are brought up in institutions or who suffer other forms of serious privation and deprivation in early life commonly develop psychopathic or affectionless characters (e.g., Bowlby, 1944) are seen to be mistaken. (Bowlby et al., 1956, p. 240)

Short-Term Separation

When WWII ended in 1945, Bowlby had to choose between completing child psychoanalysis training or researching parental separation’s impact on children. He chose the latter, joining colleagues at London’s Tavistock Clinic.

Robertson and Bowlby (1952) believe that short-term separation from an attachment figure leads to distress.

John Bowlby spent two years working alongside a social worker, James Robertson (1952), who observed that children experienced intense distress when separated from their mothers. Even when other caregivers fed such children, this did not diminish the child’s anxiety.

They found three progressive stages of distress:

• Protest : The child cries, screams, and protests angrily when the parent leaves. They will try to cling to their parents to stop them from leaving. Protest could last from a few hours to several days.
• Despair : The child’s protesting gradually stops, and they appear calmer, although still upset. The child refuses others’ attempts for comfort and often seems withdrawn and uninterested in anything. In the despair stage, children become increasingly withdrawn and hopeless.
• Detachment : If separation continues, the child will engage with other people again. All emotions are suppressed, and children live moment-to-moment by repressing feelings for their mother. On the surface, children were seen to be happy and content, but when the mother visited, they frequently ignored her and hardly cried when she left. If this state continues, children become so withdrawn as to seek no mothering at all – a sign of major psychological trauma.

Controversy arose between Bowlby and Robertson regarding the stages of separation, particularly the third stage, which Robertson termed denial, but Bowlby called detachment.

However, both powerfully influenced attitudes and practices around keeping mothers and children together. This led to advocacy for allowing parental presence and major reforms in hospital policies.

A Two-Year-Old Goes to Hospital

Though doctors saw the despair phase as adjustment, Bowlby felt it showed distress’s harm.

To demonstrate this, Robertson filmed two-year-old Laura’s distress when hospitalized for eight days for minor surgery in “ A Two-Year-Old Goes to Hospital ” (1952).

Time series photography showed the stages through which a small child, Laura, passed during her 8-day admission for umbilical hernia repair. The film graphically depicted Laura’s behavior while separated from her mother for a period of time in strange circumstances” (Alsop-Shields & Mohay, 2001).

Laura cries out for her mother from admission onward, pleading in anguish to go home when visited the second day. As the week progresses, her initial constant distress gives way to listlessness and detachment during the parents’ increasingly ambivalent visits.

However, when approached by hospital staff, Laura startles out of her trance to suddenly burst into tears and fruitlessly call for her mother once more.

The raw behaviors captured on film revealed the three-phase separation response of protest, despair, and detachment observed in Bowlby and Robertson’s prior research.

Laura’s suffering starkly contradicts expectations of childrens’ ready hospital adjustment, instead demonstrating their deep distress from both physical separation and the hospital environment itself.

These findings contradicted the dominant behavioral theory of attachment (Dollard and Miller, 1950), which was shown to underestimate the child’s bond with their mother.  The behavioral theory of attachment states that the child becomes attached to the mother because she feeds the infant.

Implications for nursing include the development of family-centered care models keeping parents integral to a child’s hospital care in order to minimize trauma, principles now widely implemented as a result of this pioneering work on attachment.

Internal Working Model

The child’s attachment relationship with their primary caregiver leads to the development of an internal working model (Bowlby, 1969).

This internal working model is a cognitive framework comprising mental representations for understanding the world, self, and others.

The social and emotional responses of the primary caregiver provide the infant with information about the world and other people, and also how they view themselves as individuals.

For example, the extent to which an individual perceives himself/herself as worthy of love and care, and information regarding the availability and reliability of others (Bowlby, 1969).

Bowlby referred to this knowledge as an internal working model (IWM), which begins as a mental and emotional representation of the infant’s first attachment relationship and forms the basis of an individual’s attachment style.

A person’s interaction with others is guided by memories and expectations from their internal model which influence and help evaluate their contact with others (Bretherton & Munholland, 1999).

Working models also comprise cognitions of how to behave and regulate affect when a person’s attachment behavioral system is activated, and notions regarding the availability of attachment figures when called upon.

Bowlby (1969) suggested that the first five years of life were crucial to developing the IWM, although he viewed this as more of a sensitive period rather than a critical one.

Around the age of three, these seem to become part of a child’s personality and thus affect their understanding of the world and future interactions with others (Schore, 2000).

According to Bowlby (1969), the primary caregiver acts as a prototype for future relationships via the internal working model.

There are three main features of the internal working model: (1) a model of others as being trustworthy, (2) a model of the self as valuable, and (3) a model of the self as effective when interacting with others.

It is this mental representation that guides future social and emotional behavior as the child’s internal working model guides their responsiveness to others in general.

The concept of an internal model can be used to show how prior experience is retained over time and to guide perceptions of the social world and future interactions with others.

Early models are typically reinforced via interactions with others over time, and become strengthened and resistant to change, operating mostly at an unconscious level of awareness.

Although working models are generally stable over time they are not impervious to change and as such remain open to modification and revision.  This change could occur due to new experiences with attachment figures or through a reconceptualization of past experiences.

Although Bowlby (1969, 1988) believed attachment to be monotropic, he did acknowledge that rather than being a bond with one person, multiple attachments can occur arranged in the form of a hierarchy.

A person can have many internal models, each tied to different relationships and different memory systems, such as semantic and episodic (Bowlby, 1980).

Collins and Read (1994) suggest a hierarchical model of attachment representations whereby general attachment styles and working models appear on the highest level, while relationship-specific models appear on the lowest level.

General models of attachment are thought to originate from early relationships during childhood, and are carried forward to adulthood where they shape perception and behavior in close relationships.

Attachment & Loss Trilogy

The attachment books trilogy developed key concepts regarding attachment, separation distress, loss responses, and clinical implications over the course of the three volumes.

Attachment (1969/1982)

• Provided evidence for the importance of early parent-child relationships.
• Analyzed the systemic and “goal-corrected” nature of behavior.
• Introduced the concept of an “environment of adaptedness” that organisms inherit a potential to develop systems suited for.
• Discussed how attachment behaviors in infants are components of an attachment system designed to achieve security.
• Explained how attachment behaviors change via feedback from caregivers, becoming oriented toward discriminated figures.
• Posited attachment as a foundational system for survival that interacts with other systems like exploration.

Separation (1973)

• Focused on the negative impacts of separation from attachment figures.
• Outlined phases of separation responses in infants and children.
• Analyzed short- and long-term pathological effects of loss or deprivation.
• Studied how mourning progresses in relation to attachment bonds.
• Linked separation distress and avoidance to later issues of delinquency.

Loss (1980)

• Explored the concept of “loss” in relation to attachment theory.
• Proposed stages of the mourning process.
• Studied outcomes following the loss of an attachment figure.
• Examined detachment and defense processes resulting from loss.
• Applied attachment theory understanding to treatment approaches.

Critical Evaluation

Implications for children’s nursing.

• During Robertson and Bowlby’s research, the British government established a parliamentary committee investigating children’s hospital conditions. This resulted in the 1959 Platt Report, containing 55 recommendations, including allowing parental presence and provisions for their accommodation and children’s education/recreation (Alsop-Shields & Mohay, 2001).
• Robertson also specifically critiqued task-oriented nursing and childcare institutions (Robertson, 1955, 1968, 1970) as emotionally neglectful. He and Bowlby suggested dysfunctional families be kept together but supported (Robertson & Bowlby, 1952) – principles now accepted but decades ahead of their time.
• Robertson and Bowlby’s work has greatly influenced the development of family-centered pediatric nursing models like partnership-in-care and family-centered care in the 1990s. By planning care around the whole family unit rather than just the hospitalized child, and involving parents closely in care, these models aim to reduce emotional trauma for children.

Bifulco et al. (1992) support the maternal deprivation hypothesis. They studied 250 women who had lost mothers, through separation or death, before they were 17.

They found that the loss of their mother through separation or death doubles the risk of depressive and anxiety disorders in adult women. The rate of depression was the highest in women whose mothers had died before the child reached 6 years.

Mary Ainsworth’s (1971, 1978) Strange Situation study provides evidence for the existence of the internal working model. A secure child will develop a positive internal working model because it has received sensitive, emotional care from its primary attachment figure.

An insecure-avoidant child will develop an internal working model in which it sees itself as unworthy because its primary attachment figure has reacted negatively to it during the sensitive period for attachment formation.

Bowlby’s Maternal Deprivation is supported by Harlow’s (1958) research with monkeys .  Harlow showed that monkeys reared in isolation from their mother suffered emotional and social problems in older age.  The monkey’s never formed an attachment (privation) and, as such grew up to be aggressive and had problems interacting with other monkeys.

Konrad Lorenz (1935) supports Bowlby’s maternal deprivation hypothesis as the attachment process of imprinting is an innate process.

Bowlby’s (1944, 1956) ideas had a significant influence on the way researchers thought about attachment, and much of the discussion of his theory has focused on his belief in monotropy.

Although Bowlby may not dispute that young children form multiple attachments, he still contends that the attachment to the mother is unique in that it is the first to appear and remains the strongest.  However, the evidence seems to suggest otherwise on both of these counts.

• Schaffer & Emerson (1964) noted that specific attachments started at about eight months, and very shortly thereafter, the infants became attached to other people. By 18 months, very few (13%) were attached to only one person; some had five or more attachments.
• Rutter (1972) points out that several indicators of attachment (such as protest or distress when an attached person leaves) have been shown for various attachment figures – fathers, siblings, peers, and even inanimate objects.

Critics such as Rutter have also accused Bowlby of not distinguishing between deprivation and privation – the complete lack of an attachment bond, rather than its loss.  Rutter stresses that the quality of the attachment bond is the most important factor, rather than just deprivation in the critical period.

Bowlby used the term maternal deprivation to refer to the separation or loss of the mother as well as the failure to develop an attachment.  Are the effects of maternal deprivation as dire as Bowlby suggested?

Michael Rutter (1972) wrote a book called Maternal Deprivation Re-assessed .  In the book, he suggested that Bowlby may have oversimplified the concept of maternal deprivation.

Bowlby used the term “maternal deprivation” to refer to separation from an attached figure, loss of an attached figure and failure to develop an attachment to any figure.  These each have different effects, argued Rutter.  In particular, Rutter distinguished between privation and deprivation.

Michael Rutter (1981) argued that if a child fails to develop an emotional bond , this is privation, whereas deprivation refers to the loss of or damage to an attachment.

Deprivation might be defined as losing something that a person once had, whereas privation might be defined as never having something in the first place.

From his survey of research on privation, Rutter proposed that it is likely to lead initially to clinging, dependent behavior, attention-seeking, and indiscriminate friendliness, then as the child matures, an inability to keep rules, form lasting relationships, or feel guilt.

He also found evidence of anti-social behavior, affectionless psychopathy, and disorders of language, intellectual development and physical growth.

Rutter argues that these problems are not due solely to the lack of attachment to a mother figure, as Bowlby claimed, but to factors such as the lack of intellectual stimulation and social experiences that attachments normally provide.  In addition, such problems can be overcome later in the child’s development, with the right kind of care.

Bowlby assumed that physical separation on its own could lead to deprivation, but Rutter (1972) argues that it is the disruption of the attachment rather than the physical separation.

This is supported by Radke-Yarrow (1985), who found that 52% of children whose mothers suffered from depression were insecurely attached. This figure raised to 80% when this occurred in a context of poverty (Lyons-Ruth,1988). This shows the influence of social factors. Bowlby did not take into account the quality of the substitute care. Deprivation can be avoided if there is good emotional care after separation.

Is attachment theory sexist?

Feminist critics argue Bowlby’s attachment theory is sexist for overly emphasizing mothers as ideal caregivers while neglecting other influences like fathers (e.g., Vicedo, 2017).

His popular 1950s parenting articles reinforced gender roles by proclaiming mothers uniquely important and always available. Critics also attacked his concept “monotropy” – instincts focused on one caregiver, presumably the mother.

However, Bowlby’s academic writings use phrases like “mothers or foster-mothers,” adoptive mothers, and “mother substitutes,” acknowledging many can serve as primary caregiver.

He never scientifically stated only biological mothers suffice. While “monotropy” poorly implies a singular caregiver, Bowlby meant children form one main attachment, not only to mothers. So academically, Bowlby did not limit caregivers to mothers, though his public emphasis on maternal deprivation and parenting did reinforce gender biases.

There are implications arising from Bowlby’s work.  He reinforced the idea that a mother should be the most central caregiver and that this care should be given continuously. An obvious implication is that mothers should not go out to work.  There have been many attacks on this claim:

• Mothers are the exclusive carers in only a very small percentage of human societies; often there are a number of people involved in the care of children, such as relations and friends (Weisner, & Gallimore, 1977).
• Van Ijzendoorn, & Tavecchio (1987) argue that a stable network of adults can provide adequate care and that this care may even have advantages over a system where a mother has to meet all a child’s needs.
• There is evidence that children develop better with a mother who is happy in her work, than a mother who is frustrated by staying at home (Schaffer, 1990).

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Robertson, J. (1955). Young children in long-term hospitals.  Nursing Times ,  23 (9).

Robertson, J. (1958).  Going to Hospital with Mother: A Guide to the Documentary Film . Tavistock Child Development Research Unit.

Robertson, J. (1968). The long-stay child in hospital.  Maternal Child Care ,  4 (40), 161-6.

Robertson, J., & Robertson, J. (1968). Jane 17 months; in fostercare for 10 days.  London: Tavistock Institute of Human Relations. Film .

Robertson, J., & Robertson, J. (1971). Young children in brief separation: A fresh look.  The psychoanalytic study of the child ,  26 (1), 264-315.

Rutter, M. (1972). Maternal deprivation reassessed. Harmondsworth: Penguin.

Rutter, M. (1979). Maternal deprivation, 1972-1978: New findings, new concepts, new approaches. Child Development , 283-305.

Rutter, M. (1981). Stress, coping and development: Some issues and some questions. Journal of Child Psychology and Psychiatry, 22(4) , 323-356.

Schaffer, H. R. & Emerson, P. E. (1964). The development of social attachments in infancy. Monographs of the Society for Research in Child Development , 29 (3), serial number 94.

Schore, A. N. (2000). Attachment and the regulation of the right brain. Attachment & Human Development, 2(1) , 23-47.

Tavecchio, L. W., & Van Ijzendoorn, M. H. (Eds.). (1987). Attachment in social networks: Contributions to the Bowlby-Ainsworth attachment theory . Elsevier.

Vicedo, M. (2020). Attachment Theory from Ethology to the Strange Situation. In  Oxford Research Encyclopedia of Psychology .

Weisner, T. S., & Gallimore, R. (1977). My brother’s keeper: Child and sibling caretaking. Current Anthropology, 18(2) , 169.

Further Reading

• The Internal Working Models Concept: What Do We Really Know About the Self in Relation to Others?
• The Effects of Maternal Deprivation
• Davies, R. (2010). Marking the 50th anniversary of the Platt Report: from exclusion, to toleration and parental participation in the care of the hospitalized child .  Journal of Child Health Care ,  14 (1), 6-23.
• Bowlby, J. (1963). Pathological mourning and childhood mourning .  Journal of the American Psychoanalytic Association ,  11 (3), 500-541.

Related Articles

Child Psychology

Vygotsky vs. Piaget: A Paradigm Shift

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Attachment Theory In Psychology

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In This Article Expand or collapse the "in this article" section Attachment in Social and Emotional Development across the Life Course

Introduction, general overviews.

• Historical Origins of Attachment Theory
• Normative Development of Attachment
• Caregiving Antecedents of Individual Differences in Attachment
• Attachment Variation and Children’s Endogenous and Temperamental Characteristics
• Infant and Child Behavioral Measures of Attachment
• Child Representational Measures of Attachment
• Adolescent and Adult Representational Measures of Attachment
• Theoretical Background and Reviews of the Literature
• Social Competence
• Externalizing Problems
• Internalizing Problems
• Continuity and Lawful Change in Attachment
• Engagement in and Quality of Romantic Relationships
• Attachment and Secure Base Behavior in Romantic Relationships
• Attachment and Conflict and Conflict Resolution in Romantic Relationships
• Intergenerational Transmission of Attachment and the Transmission Gap

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• Turning Points in the Assessment and Clinical Applications of Individual Differences in Attachment

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Attachment in Social and Emotional Development across the Life Course by Ashley M. Groh LAST REVIEWED: 29 November 2017 LAST MODIFIED: 29 November 2017 DOI: 10.1093/obo/9780199828340-0201

Attachment theory is one of the few remaining grand theories in psychology, providing an account of personality development from infancy to adulthood. Thus, it is not surprising that the influence of attachment theory spans several disciplines of psychology, including developmental psychology, clinical psychology, social-personality psychology, and behavioral neuroscience. Attachment theory provides a theoretical framework for understanding the nature of the child’s tie to parents and the legacy of children’s early experiences with parents for socioemotional (mal)adjustment across the lifespan. It has been an especially generative theoretical framework for investigating the significance of early parent–child relationships for children’s subsequent close interpersonal relationships, helping to establish it as one of the main theoretical frameworks guiding research in developmental science. The aim of this overview is to provide an account of attachment theory and research in developmental psychology. Specifically, this overview will first lay the theoretical and methodological groundwork, covering the topics of the history and inception of attachment theory, the origins of individual differences in infant attachment, and the measures used in developmental psychology for assessing individual differences in attachment in childhood and adulthood. Next, the overview will focus on the more substantive questions that have guided developmental research on attachment, including the significance of early parent–child attachment for children’s social and emotional development, the stability of attachment across the early life course, the significance of attachment for romantic relationships in adolescence and adulthood, and finally the intergenerational transmission of attachment.

An understanding of the significance of attachment for close interpersonal relationships across the lifespan must first begin with knowledge of attachment theory. For a thorough understanding of attachment theory, a must-read is the attachment trilogy Bowlby 1973 , Bowlby 1980 , and Bowlby 1982 , in which John Bowlby lays out his theory of attachment. In the first volume, Bowlby 1982 draws on insights from evolutionary theory, systems theory, ethology, and cognitive psychology to provide an integrative theoretical account of the nature of the child’s tie to parents, the normative development of attachment relationships, and the significance of attachment relationships for development. In the latter two volumes, Bowlby 1973 and Bowlby 1980 provide a theoretical account of the negative interpersonal and mental health implications that disruptions in attachment relationships, such as separations from or loss of attachment figures, might have on the developing child. Most research on attachment concerns the antecedents and sequelae of individual differences in the quality of attachment relationships. Thus, another important primary source is Ainsworth, et al. 2015 , which provides an overview of Ainsworth’s groundbreaking research in which she identified individual differences in the quality of mother–infant attachment relationships and their caregiving antecedents, a characterization of patterns of infant attachment, and an overview of the most widely used measure of infant attachment, the Strange Situation procedure. In addition to these theoretical accounts of attachment, there are several resources available that provide both relatively brief summaries of attachment theory and survey the vast body of developmental research on the legacy of children’s early attachment-relevant experiences with parents for interpersonal functioning in childhood, adolescence, and adulthood. Cassidy and Shaver 2016 is the most comprehensive source on attachment research. The handbook is divided into chapters that span developmental periods from infancy to adulthood and are written by leading scholars in the specific subfield of attachment research. The chapters serve to orient the reader to the major questions guiding work in the specific area of attachment research and provide a review of the research conducted to date. The chapter Belsky and Cassidy 1994 provides an approachable overview of attachment theory and research for graduate and undergraduate students who are new to attachment theory and research. Roisman and Groh 2011 is another chapter targeted at the level of graduate and undergraduate students that provides an overview of attachment theory, appreciative critique of research conducted to date, and suggestions for future research. Attachment and Human Development is a journal that provides a forum for the presentation and discussion of attachment theory and research. It is the official journal of both the International Attachment Network and the Society for Attachment and Emotion Studies.

Ainsworth, M. D. S., M. C. Blehar, E. Waters, and S. N. Wall. 2015. Patterns of attachment: A psychological study of the strange situation . 2d ed. New York: Psychology Press.

This book focuses on Ainsworth’s research leading to the identification of individual differences in the quality of mother–infant attachment relationships. The first edition of this book was released in 1978 and is no longer in circulation. This second edition of the book includes a new preface and new appendices. This source is best suited for graduate students who are primarily interested in attachment and parenting research. Also see Individual Differences in Attachment , Caregiving Antecedents of Individual Differences in Attachment , and Infant and Child Behavioral Measures of Attachment .

Attachment and Human Development . 1999–.

Attachment and Human Development is the official journal of the International Attachment Network and the Society for Attachment and Emotion Studies. This journal is the leading forum for the presentation of empirical research, reviews, and clinical case studies that reflect contemporary advances in attachment theory and research.

Belsky, J., and J. Cassidy. 1994. Attachment theory and evidence. In Development through life . Edited by M. Rutter and D. Hay, 373–402. London: Blackwell.

This chapter is relevant for undergraduate and graduate students who are just becoming familiar with attachment theory and research. This chapter provides a concise summary of attachment theory that discusses the main points of attachment theory. The chapter reviews some of the classic studies in the attachment field. However, the reader should be aware that there is much new research on the topics surveyed in this chapter. Also see Theoretical Background and Reviews of the Literature .

Bowlby, J. 1973. Attachment and loss . Vol. 2, Separation: Anxiety and anger . London: Hogarth.

This is the second volume of Bowlby’s attachment trilogy. It focuses on the negative impact that separations from the parent might have on children’s mental health and interpersonal functioning. This volume is best suited for graduate students, especially those with particular interest in atypical development.

Bowlby, J. 1980. Attachment and loss . Vol. 3, Loss: Sadness and depression . London: Hogarth.

This is the third volume of Bowlby’s attachment trilogy. It focuses on the negative impacts that loss of parents can have on children’s mental health and interpersonal functioning. This volume is best suited for graduate students, especially those with particular interest in atypical development.

Bowlby, J. 1982. Attachment and loss . Vol. 1, Attachment . 2d ed. London: Hogarth.

This is the first volume of Bowlby’s attachment trilogy in which he lays out his theory of attachment. This volume focuses on the functions of attachment relationships and the role they play in promoting mental health and interpersonal functioning. The first version of this book was published in 1969, but the second edition released in 1982 is recommended because it contains two new chapters that were added in light of research conducted since the release of the first edition. Also see Historical Origins of Attachment Theory and Normative Development of Attachment .

Cassidy, J., and P. R. Shaver, eds. 2016. Handbook of attachment: Theory, research, and clinical applications . 3d ed. New York: Guilford.

This handbook is the most comprehensive source for research on attachment. If one is interested in a particular area of attachment research, specific chapters written by leading scholars in the field provide an excellent way to orient oneself to the area. Of note, the first edition of the handbook was released in 1999 and the second edition was released in 2008. The third edition, released in 2016, is recommended because it comprises the latest research findings.

Roisman, G. I., and A. M. Groh. 2011. Attachment theory and research in developmental psychology: An overview and appreciative critique. In Social development: Relationships in infancy, childhood, and adolescence . Edited by M. K. Underwood and L. H. Rosen, 101–126. New York: Guilford.

This chapter is relevant for undergraduate and graduate students who are just becoming familiar with attachment theory. It provides an historical overview of attachment theory, a brief summary of the key points of attachment theory, and an overview of the main measures used in attachment research in developmental psychology. In addition, the authors evaluate support for attachment theory in light of extant evidence and offer suggestions for future research.

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Chapter 10: Emotional Development and Attachment

Psychosocial development occurs as children form relationships, interact with others, and understand and manage their feelings. In social and emotional development, forming healthy attachments is very important and is the major social milestone of infancy. Attachment is a long-standing connection or bond with others. Developmental psychologists are interested in how infants reach this milestone. They ask such questions as: How do parent and infant attachment bonds form? How does neglect affect these bonds? What accounts for children’s attachment differences?

Early Attachment Research

Researchers Harry Harlow, John Bowlby, and Mary Ainsworth conducted studies designed to answer these questions. In the 1950s, Harlow conducted a series of experiments on monkeys. He separated newborn monkeys from their mothers. Each monkey was presented with two surrogate mothers. One surrogate mother was made out of wire mesh, and she could dispense milk. The other surrogate mother was softer and made from cloth: This monkey did not dispense milk. Research shows that the monkeys preferred the soft, cuddly cloth monkey, even though she did not provide any nourishment. The baby monkeys spent their time clinging to the cloth monkey and only went to the wire monkey when they needed to be fed. Prior to this study, the medical and scientific communities generally thought that babies become attached to the people who provide their nourishment. However, Harlow (1958) concluded that there was more to the parent-child bond than nourishment. Feelings of comfort and security are the critical components of parental-infant bonding, which leads to healthy psychosocial development.

Building on the work of Harlow and others, John Bowlby developed the concept of attachment theory. He defined attachment as the affectional bond or tie that an infant forms with the mother (Bowlby, 1969). He believed that an infant must form this bond with a primary caregiver in order to have normal social and emotional development. In addition, Bowlby proposed that this attachment bond is very powerful and continues throughout life. He used the concept of a secure base to define a healthy attachment between parent and child (1988). A secure base is a parental presence that gives children a sense of safety as they explore their surroundings. Bowlby said that two things are needed for a healthy attachment: The caregiver must be responsive to the child’s physical, social, and emotional needs; and the caregiver and child must engage in mutually enjoyable interactions (Bowlby, 1969).

Ainsworth’s Strange Situation

While Bowlby thought attachment was an all-or-nothing process, Mary Ainsworth’s (1970) research showed otherwise. Ainsworth wanted to know if children differ in the ways they bond, and if so, how. To find the answers, she devised the Strange Situation procedure to study attachment between mothers and their infants (1970). In the Strange Situation, the mother (or primary caregiver) and the infant (age 12-18 months) are placed in a room together.  There are toys in the room, and the caregiver and child spend some time alone in the room. After the child has had time to explore their surroundings, a stranger enters the room. The caregiver then leaves their baby with the stranger. After a few minutes, they return to comfort their child.

Video 10.3 Secure and Insecure Attachment. 

Types of Attachment

Based on how the toddlers responded to the separation and reunion, Ainsworth identified three types of parent-child attachments: secure, avoidant, and resistant (Ainsworth & Bell, 1970). A fourth style, known as disorganized attachment, was later described (Main & Solomon, 1990).

Secure Attachment

The most common type of attachment—also considered the healthiest—is called secure attachment . The secure child feels confident that their needs will be met in a timely and consistent way. The child prefers their caregivers over others. A young child will use the caregiver as the base for exploration, providing assurance and enabling discovery. In the Strange Situation, securely attached children were distressed when their caregivers left the room, but when their caregivers returned, the securely attached children were happy to see them.

Securely attached children have caregivers who are sensitive and responsive to their needs. In North America, this interaction may include an emotional connection in addition to adequate care. However, even in cultures where mothers do not talk, cuddle, and play with their infants, secure attachments can develop (LeVine et. al., 1994). Secure attachments can form provided the child has consistent contact and care from one or more caregivers. Consistency of contacts may be jeopardized if the infant is cared for in a daycare with a high turn-over of caregivers or if institutionalized and given little more than basic physical care. And while infants who have not had the opportunity to attach in infancy, perhaps because of being in orphanages with inadequate care, can form initial secure attachments several years later, they may have more emotional problems of depression or anger, or be overly friendly as they make adjustments (O’Connor et. al., 2003).

Video 10.4 This video demonstrates Ainsworth’s protocol for assessing the quality of a child’s attachment to their caregiver and the typical response of a securely attached child.

Avoidant Attachment

Avoidant attachment,  a  s tyle marked by insecurity, is characterized by a tendency to avoid contact with the caregiver and with others. This child may have learned that needs typically go unmet and learns that the caregiver does not provide care and cannot be relied upon for comfort, even sporadically. An insecure-avoidant child learns to be more independent and disengaged. Such a child might sit passively in a room filled with toys until it is time to go.

During the Strange Situation, the child is unresponsive to the parent, does not use the parent as a secure base, and does not care if the parent leaves. The toddler reacts to the parent the same way they react to a stranger.  When the parent does return, the child is slow to show a positive reaction. Ainsworth theorized that these children were most likely to have a caregiver who was insensitive and inattentive to their needs (Ainsworth, Blehar, Waters, & Wall, 1978).

Video 10.5 This video depicts a child with the avoidant attachment style.

Resistant Attachment

Resistant attachment is another insecure attachment style. These children tend to show clingy behavior and are hesitant to engage in activities or play aware from the caregiver. It is as if the child fears that the caregiver will abandon them and clings accordingly.  The child may cry if separated from the caregiver and also cry upon their return. They seek constant reassurance that never seems to satisfy their doubt. This type of insecure attachment might be a result of not having their needs met in a consistent or timely way. Consequently, the infant is never sure that the world is a trustworthy place or that they can rely on others without some anxiety. A caregiver who is unavailable, perhaps because of marital tension, substance abuse, or preoccupation with work, may send a message to the infant they cannot rely on having their needs met. A caregiver who attends to a child’s frustration can help teach them to be calm and to relax. But an infant who receives only sporadic attention when experiencing discomfort may not learn how to calm down.

During the Strange Situation, these children do not explore the toys in the room, appearing too fearful. When the caregiver leaves, the child becomes extremely disturbed and angry with the parent. Furthermore, when the caregiver returns, the children are difficult to comfort. Resistant attachment is thought to be the result of the caregivers’ inconsistent level of response to their child (Ainsworth & Bell, 1970).

Video 10.6 The final segment of this video demonstrates the behavior of a child with a resistant attachment style.

Disorganized Attachment

Finally, the  disorganized   attachment  represents the most insecure style of attachment and occurs when the child is given mixed, confused, and inappropriate responses from the caregiver. For example, a mother who suffers from schizophrenia may laugh when a child is hurting or cry when a child exhibits joy. The child does not learn how to interpret emotions or to connect with the unpredictable caregiver.   This type of attachment is seen most often in kids who have been abused or severely neglected. Research has shown that abuse disrupts a child’s ability to regulate their emotions.  These children behave oddly in the Strange Situation. They freeze, run around the room in an erratic manner, or try to run away when the caregiver returns (Main & Solomon, 1990), and their behavior tends to be unpredictable in response to the protocol.

How common are the attachment styles among children in the United States? It is estimated that about 65 percent of children in the United States are securely attached. Twenty percent exhibit avoidant styles and 10 to 15 percent are resistant. Another 5 to 10 percent may be characterized as disorganized.

Influences on Attachment Formation

While Ainsworth’s research has found support in subsequent studies, it has also met criticism. Some researchers have pointed out that a child’s temperament (which we discuss next) may have a strong influence on attachment (Gervai, 2009; Harris, 2009), and others have noted that attachment varies from culture to culture, a factor that was not accounted for in Ainsworth’s research (Rothbaum, Weisz, Pott, Miyake, & Morelli, 2000; van Ijzendoorn & Sagi-Schwartz, 2008).

Attachment styles vary in the amount of security and closeness felt in the relationship and they can change with new experiences. The type of attachment fostered in parenting styles varies by culture as well. For example, German parents value independence and Japanese mothers are typically by their children’s sides. As a result, the rate of insecure-avoidant attachments is higher in Germany and insecure-resistant attachments are higher in Japan. These differences reflect cultural variation rather than true insecurity, however (van Ijzendoorn and Sagi, 1999).  Keep in mind that methods for measuring attachment styles have been based on a model that reflects middle-class, US values and interpretation. Newer methods for assessing attachment styles involve using a Q-sort technique in which a large number of behaviors are recorded on cards and the observer sorts the cards in a way that reflects the type of behavior that occurs within the situation.

Child and Adolescent Development Copyright © 2023 by Krisztina Jakobsen and Paige Fischer is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Attachment theory and research.

• Pehr Granqvist Pehr Granqvist Stockholm University
•  and  Robbie Duschinsky Robbie Duschinsky Sidney Sussex College Cambridge
• https://doi.org/10.1093/acrefore/9780190236557.013.51
• Published online: 31 August 2021

Attachment theory was founded by John Bowlby (1907–1990), a British child psychiatrist and psychoanalyst. The theory builds on an integration of evolutionary theory and ethology, cybernetics and cognitive science, as well as psychoanalytic object relations theory. The theory postulates that an attachment behavioral system evolved via natural selection processes. Bowlby conceived of the attachment system as a behavioral control system that continuously monitors the offspring’s proximity to caregivers, which has in turn been associated with protection from dangers and thus increased chances of survival and reproduction in humans’ and many other mammals’ ancestral environments. Attachment is a species-wide phenomenon denoting the strong bonds that children form to their caregiver(s), seeking to maintain proximity and communication, protesting separations, and using the caregiver(s) as a safe haven to return to for comfort and protection and as a secure base to explore the environment from. Attachments take time, maturation, and repeated sequences of interaction to form and are typically observed from the second half of children’s first year of life onward. According to the theory, attachment-related experiences with the caregiver(s) become internalized in the form of cognitive-affective representations of self and others (internal working models [IWMs]) that organize the child’s behavior and displays of affect in relation to the caregiver(s). Although malleable, such IWMs display a certain measure of continuity across time and situations and may generalize to affect the individual’s expectancies and behavioral inclinations in other and later interpersonal relationships. As pioneered by Mary Ainsworth and colleagues, attachments vary in quality, largely depending on the caregiver’s behaviors (e.g., responsivity and sensitivity to the child’s signals), whereas evidence for a direct influence of genetic heritability is limited. Variations in attachment are typically described using two dimensions (secure–insecure, organized–disorganized) subsuming four categories (secure, insecure–avoidant, insecure-resistant–ambivalent, disorganized–disoriented). Much of the empirical research regarding attachment has focused on these variations and their measurement. Ainsworth and colleagues’ Strange Situation Procedure (SSP), applicable for children aged 10–18 months, is often heralded as the “gold standard” attachment measurement tool. The concerted body of research indicates that secure attachment (or associated factors), marked by confidence in the caregiver’s availability, is generally a protective factor in socioemotional development. In contrast, insecure (avoidant and resistant) attachment, characterized by lack of confidence in the caregiver’s availability, is generally a vulnerability factor in development. Disorganized attachment, reflecting confused, conflicted, or apprehensive child behaviors in the presence of the caregiver (in the SSP), is a risk factor in development, most notably for externalizing behavior problems. Notably, the effect sizes observed have typically been small to moderate, and much is unknown about linking mechanisms and moderating influences. Although most readily observed in early childhood, humans form attachments throughout the lifespan. Accordingly, much research has also focused on adult (e.g., spousal) attachment and the intergenerational transmission of attachment from caregivers to their children.

• attachment quality
• development

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Anxious Attachment

How does it develop in childhood?

Avoidant Attachment

What are symptoms in adult relationships?

Disorganized Attachment

What is it like to date a disorganized adult?

Secure Attachment

The 5 conditions for secure attachment

What Is Attachment Theory?

Do you know your attachment style take our attachment quiz and find out now – fast, easy, free., in this page you’ll find:.

• The foundation of attachment theory
• The attachment classification system
• The stages of attachment
• The emotional skills we learn from attachment
• Relationships from an attachment perspective
• rief overview of our guidelines for attachment classification
• Influence on other fields and future directions

The History of Attachment Theory

Attachment theory owes its inception primarily to John Bowlby (1907-1990). Trained in psychoanalysis in the 1930s, Bowlby was not entirely satisfied with his studies. From his perspective, psychoanalysis focused too much on our internal world, and consequently ignored the environment we are immersed in [1].

During the early years of his career, Bowlby worked in a psychiatric hospital as he was also trained in developmental psychology and child psychiatry. In fact, it was in this hospital where he found the inspiration for his subsequent innovative work on attachment.

He observed that two children under his care displayed marked differences in behaviors. One child was notably distant and emotionless, while the other was constantly in his vicinity – so much so, that others started to refer to the child as Bowlby’s “shadow” [1].

Bowlby was later mentored by Melanie Klein, a highly influential name in the field, whom he later publicly disagreed with theoretically. The basis of this disagreement centered on Klein’s belief that children’s emotional problems arise solely from internal processes. In contrast to this belief, Bowlby postulated that children’s emotional problems actually arise from how they interact with their environment growing up [1].

A principal aspect of Bowlby’s later career was his focus on mother-child separation issues. He was strongly influenced by Konrad Lorenz’s work, which showed how attachment is instinctual. From Lorenz’s theory, Bowlby gleaned that a newborn baby does not solely need their mother for food, but instead desires the caregiver-child connection that builds between them [2]. Therefore, Bowlby sought to understand what would happen to children when this essential need was not met.

Bowlby’s Attachment Theory

In essence, Bowlby’s attachment theory posits that attachment bonds are innate [1]. When a child’s immediate need for a secure attachment bond is not met, the child feels threatened and will react accordingly, such as by crying or calling out for their caregiver. Moreover, if the need for a stable bond is not met consistently, the infant can develop social, emotional, and even cognitive problems.

This need for attachment has catalyzed our understanding of human nature, leading up to Roy Baumeister and Mark Leary’s claim that belongingness is an essential human need, much like shelter or water [3].

The Anxious-Avoidant Spectrum

From Bowlby’s initial observations of the children with two highly distinctive behaviors at the psychiatric hospital, a spectrum of attachment behaviors came to life. We can visualize this spectrum holding attachment anxiety on one side and attachment avoidance on the other.

Given certain triggers and subsequent behaviors, one can gravitate toward either side of the spectrum. For example, an anxious attacher who hasn’t heard from their partner for a couple of hours is likely to trigger anxious attachment behaviors such as texting or calling their partner incessantly. In this case, they have demonstrated to be most certainly on the anxious side of the spectrum.

However, as was to be soon discovered through research, this anxious-avoidant spectrum didn’t fully account for the behavioral differences observed in children. There was still some information missing. Let’s dive into how attachment theory developed further.

Ainsworth and Attachment Theory: The Strange Situation

Mary Ainsworth (1913-1999) – considered to be the second founder of the field of attachment – furthered the development of Bowlby’s theory. Ainsworth crucially contributed to attachment theory with the concept of a secure base [1]. In her view, a child needs an established secure base, or dependence, with their caregivers before venturing into the exploration of the world around them.

The Strange Situation is perhaps the most well-known of Ainsworth’s main contributions [4]. The study was designed to look at the association between attachment and infants’ exploration of their surroundings.

• Children between the ages of 12 and 18 months from a sample of 100 typical American families were observed in the Strange Situation.
• A small room was set up with a one-way glass window designed to covertly observe the actions of the child. The room was filled with toys, and at first, it was just the infant and their mother.
• The Strange Situation consisted of eight steps, each of which lasted approximately 3 minutes:
• Mother and infant alone.
• A stranger enters the room.
• The mother leaves the baby and stranger alone.
• The mother returns.
• The stranger leaves.
• The mother leaves and the child is left alone.
• The stranger returns.
• Mother returns and the stranger exits.

The aim of the Strange Situation was to observe the infant’s exploratory behavior with their mother, in her absence, as well as in the presence of a stranger. This was one of the main experiments to drive the establishment of an attachment classification system. It allowed for the distinction between a child’s ambivalent and dismissing behaviors upon reuniting with their mother [1,5].

The Attachment Classification System

From the Strange Situation, Ainsworth developed the Strange Situation Classification (SSC) , which is the cornerstone of how we categorize attachment styles today. Ainsworth distinguished three attachment styles:

Secure – the child displays distress when separated from the mother, but is easily soothed and returns their positive attitude quickly when reunited with them.

Resistant – the child displays intense distress when the mother leaves but resists contact with them when reunited.

Avoidant – the child displays no distress when separated from their mother, as well as no interest in the mother’s return.

Adding Disorganized Attachment

Ainsworth had several Ph.D. students working with her – one of whom became notorious for their significant contributions to attachment theory .

Namely, Mary Main observed a unique behavior in one infant: in a moment when the infant was frightened by thunder, they surprisingly ran towards the experimenter instead of their own mother.

Based on this interaction, Main decided to focus her research on identifying peculiar behaviors such as this, leading to the identification of the fourth element in the classification of attachment: the disorganized attachment style – which incorporated both resistant and dismissing behaviors [6,7,8].

The attachment spectrum (Figure 1) stemmed from both Bowlby’s and Ainsworth’s contributions to the theory.

The Stages of Attachment

In the 1960s, Rudolph Schaffer and Peggy Emerson identified that human social connections start at birth, and that the bond between an infant and caregiver only grows stronger over time. Furthermore, attachment styles also develop over time, and this was illustrated in the four stages that Schaffer and Emerson developed in 1964 [9].

Their study was conducted in such a way that babies were followed-up through interviews with their mothers, every 4 weeks throughout their first year after birth, and then one more time at 18 months. Their research resulted in the development of the following stages:

Asocial Stage 0-6 weeks. Babies don’t distinguish between humans, although there is a clear preference for humans over non-humans. The infants form attachment with anyone who comes their way.

Indiscriminate Stage 6 weeks – 6 months. The bonds with their caregivers start to grow stronger. Infants begin to distinguish people from one another, and they do not have a fear of strangers.

Specific Attachment Stage 7+ months. This is when separation anxiety becomes prevalent, particularly from their main caregivers or close adults. At this point, infants develop a feeling of distress when surrounded by strangers.

Multiple Attachments Stage 10+ months. Attachment with the infant’s primary caregiver grows even stronger. The infant is increasingly interested in creating bonds with others that are not their caregivers.

Learning Relationship Skills From Attachment

Our main attachment relationships , especially those in our earliest stages of life, have a unique influence on how we handle other relationships later on [10]. An important role that these attachment relationships have is to teach us healthy affect regulation.

Affect regulation, or emotion regulation, is the extent to which we can experience emotions and process these in a healthy way.

Emotion regulation is especially important when we encounter negative experiences. As infants, these negative experiences are a key opportunity to cultivate this skill. It is also in these moments that we learn how, or to what extent, we can rely on our caregivers to support us [11]. Thus, if we don’t feel protected or understood by our caregivers, this can teach us that they are not reliable sources of safety or love.

Moreover, we learn emotion regulation and relationship skills directly through our caregivers’ behaviors. Basically, we mirror our caregivers’ actions; for instance, if we notice that our cries bring about distress in our caregiver, we feel greater distress in return [12]. Thus, an infant develops a sense of self by assessing their impact on their surroundings. If their caregivers consistently react to the child negatively or neglect them in some way, the child will develop a distorted version of themselves and their capacity to interact with their environment [12].

Relationships Through the Lens of Attachment Theory

Today, attachment theory is regularly applied to a vast array of relationships, but this was not always the case. In the 1980s, Cindy Hazan and Philip Shaver introduced their views on attachment, arguing that its classification system could be applied to romantic relationships as well as the original caregiver-child format [10]. Their argument relied on the premise that relationships/love take many shapes and forms, and an attachment reaction typically follows.

With this perspective in mind, we can begin to see how attachment is not a static aspect of ourselves – it fluctuates depending on a specific relationship and situation. While we do have our first encounter with an attachment relationship at birth, with our caregivers, this is not the only relationship that will influence how we relate to others. From childhood onwards, the people closest to us all have an impactful role in our development.

What Is an Attachment Bond?

An attachment bond is one that we establish with the closest people in our lives, typically, our caregivers, close family, or intimate partners.

Therefore, not every relationship we have will have an attachment bond. Instead, these bonds form in the relationships with people that we need, such the ones that fulfill basic physical needs (e.g. food and shelter), or emotional needs (e.g. the need to belong).

Attachment bonds or attachment figures are the connections whose absence causes us the most suffering. For this reason, losing an attachment bond is a highly distressing experience, which is usually marked by anxiety and sadness.

However, loss can feel very different depending on the type of relationship and bond that was developed. On the flip side, reuniting with an attachment figure after some time apart can bring about immense happiness and joy, and even a sense of relief.

Our Classification of Attachment

From the inception of attachment theory onwards, vast amounts of research and studies have been conducted and published by renowned professionals. At The Attachment Project, we endeavor to keep abreast of this work and the most recent findings in the field, and use it to guide us in delivering scientifically and theoretically sound information.

Having said as much, and recognizing the evolution of attachment theory, we’ll leave you with a very brief overview of the classification of attachment as we understand it, entirely based on previous work and research:

Secure attachment is characteristic of people who easily trust others. These individuals are attuned to their own emotions and can easily attune to those of others. They are comfortable with intimacy and can easily communicate their thoughts and feelings. The secure attachment is characterized by the ability to:

• Handle conflict calmly
• Feel comfortable both in relationships and on your own
• Differentiate thoughts from feelings
• Maintain a balanced sense of self and confidence

The Conditions for Secure Attachment

Recently, a study designed to specifically examine secure attachment identified the conditions necessary to raise a securely attached child [13].

If these conditions are not met, an insecure attachment style is likely to develop. The five conditions for secure attachment are as follows:

• The child feels safe.
• The child feels seen and known.
• The child feels comfort, soothing, and reassurance.
• The child feels valued.
• The child feels supported to explore.

On the other hand, the following experiences can lead to an insecure attachment to form during childhood:

• Perceived inconsistency: The child feels incoherence in whether their needs are met. This inconsistency can be confusing for the child, who will feel that their caregiver(s) are ultimately unreliable.
• Felt rejection or neglect: Even though the caregiver(s) may not do so purposefully or knowingly, the child feels that their needs, particularly their emotional needs, are not being met. They may feel that they are not appreciated or understood for who they are.
• Sense of fear: A sense of fear can come from truly alarm-inducing situations, such as a traumatic event. However, a sense of fear also arise from seemingly simple situations that induce feelings of rejection, neglect, or that result in the sense of being unloved.

Anxious attachment (or preoccupied) can often be identified in people who essentially have an extra-sensitive nervous system. These individuals may struggle with hyperactivation of emotions, as well as hypervigilance for something going wrong. The scariest thing they can imagine is being abandoned by their loved ones.

Most likely, their attachment anxiety stems from an inconsistent parent who would be attentive at times yet misattuned at other times.

The main signs of anxious attachment are the following:

• Catastrophic thinking, such as picturing things going very wrong, very easily
• A positive view of others, but a negative view of themselves
• Putting great effort into relationships, to the extent of self-sacrifice
• Immense difficulty with receiving criticism and rejection

Avoidant attachment (or dismissive) is often present in individuals who tend to downplay their emotions or dismiss them completely. These people are typically highly independent and self-reliant, and their greatest fear is usually intimacy and vulnerability.

This attachment style tends to develop when caregivers were not emotionally attuned to their child or who were generally emotionally distant.

The main tell-tale signs of an avoidant attacher are:

• Difficulty seeking support and admitting they need help
• Extreme self-reliance and independence
• A tendency to have a positive self-view yet a negative or critical view of others
• Maintaining or increasing distance when others try to connect emotionally

Disorganized attachment (or fearful-avoidant) is typically identified in individuals who have experienced childhood trauma or abuse. [8]. The disorganized attachment style is characterized by demonstrating inconsistent behaviors and having a hard time trusting others.

This style develops in children whose caregivers were a source of perceived fear, instead of safety and connection.

Disorganized attachment can be identified from:

• Inconsistency and unpredictability
• Oscillating between avoidant and anxious behaviors
• Their caregiver, or their main source of safety as infants, was also their main source of fear
• Struggles with intimacy and building trust in others

The Attachment Style Quiz

You may have come across the Attachment Style Quiz on our website – it is our preferred method of individual assessment on attachment styles. The Experiences in Close Relationships – Relationship Structures (ECR-RS) Questionnaire, was originally developed by R. Chris Fraley and is scientifically tested and validated [14,15].

The quiz is free and easy to complete, and you can find out your attachment style in just 5 minutes. There are other assessment alternatives you may want to opt for, which we’ve outlined in our blog post on commonly used attachment style tests. One such recommended measurement is the Adult Attachment Interview (AAI), which must be conducted by a trained professional. If you want to further explore your attachment style, we suggest bringing the materials from our website (your quiz results and any relevant articles) to a mental health practitioner.

Discover your attachment style in just 5 minutes. Receive your report straight away. Totally free!

Influence and Future Directions

Attachment theory has influenced developmental psychopathology, especially the investigation of family relationships, and even the cross-cultural aspects of attachment [1].

At The Attachment Project, we seek to increase mental health awareness through informing our audience about the multiple influences of attachment on various areas of life.

For instance, there is a growing body of work on the association between organizational psychology and attachment theory psychology [20], and that line of research deals with how attachment impacts our behaviors and emotions in the workplace. Moreover, there are multiple links between attachment and a number of mental health concerns, such as eating disorders, addiction, ADHD, ASD, and issues with language development.

Another interesting connection is to be found between attachment and early maladaptive schemas. Maladaptive schemas are, in a nutshell, limiting beliefs that are formed based on repeated patterns of trauma in early childhood. Last but not least, attachment has a profound influence on many aspects of our personal relationships, such as jealousy, loneliness, and compassion.

We are eager to continue exploring the field, with the aim to help you, our readers, learn more about yourselves and gain the necessary insights to build the relationships and lives you truly want and deserve.

Curious to learn more about your attachment style?

Get your digital Attachment Style Workbook to gain a deeper understanding of…

• how your attachment style developed
• how it influences different aspects of your daily life, such as your self-image, romantic relationships, sexual life, friendships, career, and parenting skills
• how you can use the superpowers associated with your attachment style
• how you can begin cultivating a secure attachment

[1] Bretherton, I. (1992). The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental Psychology, 28 (5), 759–775. [2]Bowlby, J. (1982). Attachment and loss: Retrospect and prospect. American Journal of Orthopsychiatry, 52 (4), 664–678. [3] Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117 (3), 497–529. [4] Ainsworth, M. D. S., Wittig, B. A. (1969). Attachment and the exploratory behavior of one-year-olds in a strange situation. In B. M. Foss (Ed.), Determinants of infant behavior (Vol. 4, pp. 113-136). London: Methuen. [5] Ainsworth, M. D. S., Blehar, M. C, Waters, E., Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum [6] Main, M. & Weston, D.R. (1981) The quality of the toddler’s relationship to mother and to father: related to conflict behavior and the readiness to establish new relationships. Child Development, 52(3), 932–40. [7] Main, M. (1999) Disorganized Attachment in Infancy, Childhood, and Adulthood: An Introduction to the Phenomena. Unpublished manuscript, Mary Main & Erik Hesse personal archive; Hinde, R. (1966, 1970) Animal Behavior, 2nd edn. New York: McGraw. [8] Main, M. & Solomon, J. (1986) Discovery of a new, insecure-disorganized/disoriented attachment pattern. In M. Yogman & T.B. Brazelton (eds) Affective Development in Infancy (pp.95–124.) Norwood, NJ. [9] Schaffer, H.R., Emerson, P.E. (1964). The development of social attachments in infancy. Monograph of the Society for Research in Child Development, 29(3), 1-77. [10] Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511–524. [11] Buckholdt, K.E., Parra, G.R., Jobe-Shields, L. (2013). Intergenerational Transmission of Emotion Dysregulation Through Parental Invalidation of Emotions: Implications for Adolescent Internalizing and Externalizing Behaviors. Journal of Child and Family Studies, 23, 324-332. [12] Winnicott, D.W. (1971). Mirror-role of Mother and Family in Child Development. Chapter 9 in Winnicott, D.W. (ed.) Playing & Reality. Tavistock Publications. [13] Brown, D. P., & Elliott, D. S. (2016). Attachment disturbances in adults: Treatment for comprehensive repair. WW Norton & Co. [14] Fraley, R. C., Heffernan, M. E., Vicary, A. M., & Brumbaugh, C. C. (2011). The Experiences in Close Relationships—Relationship Structures questionnaire: A method for assessing attachment orientations across relationships. Psychological Assessment, 23(3), 615–625. [15] Fraley, R. C., Niedenthal, P. M., Marks, M. J., Brumbaugh, C. C., & Vicary, A. (2006). Adult attachment and the perception of emotional expressions: Probing the hyperactivating strategies underlying anxious attachment. Journal of Personality, 74, 1163-1190. [16] Keller, H. (2018). Universality claim of attachment theory: Children’s socioemotional development across cultures. PNAS, 115(45), 11414-11419. [17] Bakermans-Kranenburg, M., van Ijzendoorn, M.H. (2009). The fist 10,000 Adult Attachment Interviews: Distributions of adult attachment representations in clinical and non-clinical groups. Attachment & Human Development, 11(3), 223-263. [18] Sprecher, S. (2020). Trends Over Time in Emerging Adults’ Self-Reports on Attachment Styles. Emerging Adulthood, 1-6. [19] Cullen, W., Gulati, G., Kelly, B.D. (2020). Mental health in the COVID-19 pandemic. QJM: An International Journal of Medicine, 113(5), 311-312. [20] Yip, J., Ehrhardt, K., Black, H., Walker, D.O. (2017). Attachment theory at work: A review and directions for future research. Journal of Organizational Behavior, 39(2), 185-198.

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Parent-Child Attachment: A Principle-Based Concept Analysis

Introduction.

Extensive evidence indicates that the quality of parent-child attachment is related to later socio-emotional and physical health outcomes. Yet, despite its clinical relevance, the parent-child attachment concept has been inconsistently applied across the disciplines of nursing, medicine and psychology and is often conflated with parent-child bonding in nursing literature.

To provide readers with a critical analysis of the concept of parent-child attachment. Using a principle-based concept analysis, we clarify how parent-child attachment is understood from a multidisciplinary perspective to advance the use of this concept in nursing practice.

Concept Description: Attachment is an affectionate, mutually satisfying relationship between a child and a caregiver that serves the purpose of making the child feel safe, secure, and protected.

In this principle-based concept analysis, each definitional (i.e., epistemological, pragmatic, linguistic, and logical) principle contributes to an understanding of the strengths and limitations of the state of science about this concept. The discussion highlights how applying the concept of parent-child attachment security may offer exciting and promising opportunities for nursing clinical work with families.

The understanding of the concept of parent-child attachment differs among disciplines of nursing, medicine and psychology and offers exciting and promising opportunities for clarity and collaborative, multi-disciplinary work.

Attachment is an affectionate, mutually satisfying relationship between a child and a caregiver (e.g., a parent) who is involved in making the child feel safe, secure, and protected (Bowlby, 1969/1982). According to attachment theory, a child who consistently experiences responsive and sensitive caregiving develops an expectation that others will be supportive and available in times of need (Fraley, 2002). The founder of attachment theory, British psychoanalyst John Bowlby (1944, 1951 ), studied how the child’s early experiences with the caregiver impacted the child’s future mental health. Based on his work with hospitalized and institutionalized children, Bowlby (1951) concluded that to thrive emotionally and grow up mentally healthy, a child must experience a mutually affectionate relationship with the primary caregiver. Bowlby contended that when distressed or alarmed, infants were disposed to attain closeness with their caregiver through signals and movements, such as crying, smiling, sucking, clinging, and crawling. This disposition towards a caregiver was described as an “attachment system”, with the actions of the infant being termed “attachment behavior” (Bowlby, 1969/1982). Bowlby identified the emotional and physical availability of the caregiver as a “set-goal” of attachment in infancy. According to Bowlby (1982), attachment behaviors are rooted in evolution and increase the likelihood of survival by increasing caregiver-child proximity.

The attachment system serves to keep the caregiver close to protect the infant in case of a physical or psychological threat (Bowlby, 1982). Bowlby claimed that a well-loved infant will protest separation from parents, but will later develop more self-reliance ( Bretherton, 1992 ). In the first volume of his trilogy, Attachment, and Loss , Bowlby (1969) considered the antecedents of attachment, such as maternal sensitivity to an infant’s cues. Bowlby’s (1951) discovery of just how much children depend on their parents for support led to his famous quote that still rings true to this day: “if a community values its children it must cherish their parents” (p. 84). Bowlby’s collaboration with the Canadian psychologist Mary Ainsworth led to the development of attachment theory. Parent-child attachment (PCA) security is one of the factors in determining future socio-emotional functioning and mental and physical health ( Ranson & Urichuk, 2008 ). Insecure PCA may increase the risk for later behavior problems, psychopathology, and physical illnesses, especially in the presence of other risk factors, such as poverty or abuse (Anderson et al., 2012; Cassidy et al., 2014; Puig et al., 2012; Sroufe et al., 1999).

The discipline of nursing has a strong interest in promoting child health ( Fuemmeler et al., 2017 ). Nurses work closely with families of young children, and parents often approach nurses for advice on their children’s health ( Ordway et al., 2014 ). Thus, nurses have a unique opportunity to promote secure PCA, especially among families where children are at increased risk for developing insecure attachments (e.g., families affected by poverty, intimate partner violence, stress, parental mental health problems, and substance use). However, descriptions of the PCA concept have been inconsistent in nursing literature, slowing the advancement of nursing practice in this area. For example, a previous concept analysis on maternal-infant attachment ( Goulet et al., 1998 ) and practice guidelines (Schenck et al., 2005) included several statements that described maternal-infant bonding, thus confusing the distinction between attachment and bonding in the nursing literature. We assert that nursing practice will be enhanced by a clearer understanding of attachment theory and that nurses will be better positioned to support parents, increasing the likelihood of secure attachment development, and subsequently, improving long-term child’s health outcomes.

Aims of Analysis

We aimed to review how PCA is described across the disciplines of psychology and nursing to advance the use of this concept for nursing practice. A multidisciplinary perspective is important for nursing because other disciplines can add to the understanding of a concept of interest ( McCrae, 2012 ). While the concept of PCA originated in the discipline of psychology, a clear definition and careful use of terminology are critical for this concept to be successfully adopted in nursing practice.

Literature searches were conducted in MEDLINE, EMBASE, CINAHL, ERIC, and PsycINFO databases using combination sets of keywords (1: child; 2: parent; 3: attachment) in titles and abstracts of the articles ( Table 1 ). Search terms were pilot-tested with an academic librarian at the University of Calgary and refined for each database. No time limits were set. The literature searches were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( Figure 1 , Moher et al., 2009 ). Articles were included if they met the following criteria: (1) published in English, (2) literature reviews or conceptual papers, (3) included children ≤ 18 years of age and their parents (mother or father), and (4) parent-child attachment identified as a focus. Articles were excluded if they were (1) primary studies, (2) focused on parental-fetal attachment, (3) focused on attachment disorders, and (4) editorials, letters, books, abstracts, and grey literature ( Table 2 ). Reference lists of publications were examined for further potentially relevant sources. A data file using an Excel spreadsheet was created to aid in the screening and synthesis of the literature. The data file captured the following: authors’ names, publication year, authors’ field of discipline, abstract, PCA definition, children’s age in the publication, attachment to mother/father/both parents.

Search Strategy Key Words.

PRISMA 2009 Flow Diagram ( Moher et al., 2009 ).

Inclusion/Exclusion Criteria.

Two reviewers (first author and the scientific writer/methodologist at the Faculty of Nursing, University of Calgary) conducted an inter-rater reliability check ( McHugh, 2012 ) with 97% agreement, and independently screened 1013 abstracts. Ninety-nine abstracts were selected for full-text review. A total of 26 articles were identified as meeting the inclusion criteria of this analysis. The majority of included articles were from the discipline of psychology ( n  = 22), three were from the discipline of nursing, and one article was from the medical discipline of medicine. Most of the articles were written in North America ( n  = 20). Four articles focused on father-child attachment, while the rest examined either mother-child attachment ( n  = 8), attachment between both parents and a child ( n  = 5), or did not specify which parent was the focus ( n  = 9) ( Table 3 ). Using the principle-based concept analysis method (Morse, 1995; Penrod & Hupcey, 2005), the articles were examined to clarify the definition of the PCA concept (epistemological principle), appraising its applicability in practice (pragmatic principle), evaluating consistency in use within literature (linguistic principle), and differentiating it from related concepts (logical principle). See Table 4 for the description of the application of guiding principles to the analysis.

Included Studies.

Guiding Principles (Penrod & Hupcey, 2013) and Application to Concept of PCA.

Epistemological Principle: Is the Concept Clearly Defined?

The PCA is a “psychological tether which binds infant and caregiver together” (L. Sroufe & Waters, 1977 , p. 1186). Bowlby (1951) argued that to thrive emotionally and grow up mentally healthy, a child must experience a mutually affectionate relationship with the primary caregiver (attachment figure). When distressed or alarmed, children are disposed to attain closeness with their attachment figure through cues and movements, such as crying, smiling, sucking, clinging, and crawling. This disposition towards an attachment figure is described as an attachment system, with the actions of the child being termed attachment behaviors (Bowlby, 1969/1982). Attachment behaviors are influenced by situational context (e.g., setting, preceding events) and the child’s mood, and are not constant across situations (L. Sroufe & Waters, 1977 ). Attachment behaviors are differentiated from affiliative behaviors because they involve seeking proximity when experiencing distress ( Zeanah et al., 2011 ). Reciprocity of the behaviors between caregiver and child is the key factor in Bowlby and Ainsworth’s descriptions of attachment. Bowlby (1969) described attachment figure-child proximity as a set- goal of the attachment system, with attachment behaviors (smiling, clinging) serving to achieve this goal. Attachment behaviors change as children mature. For example, infants who seek proximity by crawling towards the caregiver at 12 months of age may smile and speak when they are older. Thus, multiple attachment behaviors can have a similar meaning, and serve as means of re-establishing contact ( Sroufe & Waters, 1977 ). The child decides which behaviors to use to maintain the proximity to the caregiver based on the situational context ( Sroufe & Waters, 1977 ). Sroufe and Waters (1977) suggested that the set- goal of the attachment system is “felt security”, where the child feels affection for the caregiver. There is a decreased need for proximity to the attachment figure in the absence of distress as the child grows and develops.

Two hallmark ideas of attachment theory are “secure base” and “internal working models”. The concept of the secure base contains two interconnected phenomena: a “base” from which to explore and a “haven of safety” to which the child may return in times of distress ( Waters & Cummings, 2000 ). The attachment figure for the child is regarded as a "secure base", a stronger and wiser person to turn to when the attachment system is activated (such as when a child is frightened or ill). Once comfort and reassurance in the presence of distress-inducing stimuli are achieved, the attachment figure “shifts from being a safe haven to being a secure base from which to explore” (Ainsworth et al., 1978, p. 265). The feeling of security promotes the child’s return to play ( Sroufe & Waters, 1977 ). Bowlby (1988) proposed that across the lifespan “all of us…are happiest when life is organized as a series of excursions, long or short, from the secure base provided by our attachment figure” (p. 62). A child’s committed relationship with at least one attachment figure is central to healthy development ( Bretherton, 1992 ). An attachment figure is someone who provides “physical and emotional care, continuity and consistency in a child’s life, and emotional investment in the child” (Howes, 1999, p. 675). Bowlby used the term “attachment figure” rather than “mother” presuming that the nature of the interaction rather than the category of the individual (e.g., adoptive mothers, siblings, grandparents, fathers, childcare providers) would be of most importance to the child ( Ainsworth et al., 2015 ). Sir Richard Bowlby (2010) suggested that children can have a network of multiple attachment figures. All four attachment patterns are relationship-specific, such that a child may show secure attachment towards the mother, be avoidantly attached to the father, and display disorganized attachment behaviors towards the daycare worker.

The attachment figure needs to be accessible and available to the child, along with being perceptive of the child's emotional needs. Parents function as attachment figures to children across the early years, preadolescence, and adolescence (Kerns & Brumariu, 2014). As children grow, they venture further from the secure base, and for an increasingly extended period of time (Bowlby, 1988). Thus, a parent's behavior is expected to shift from a protective role in the early years of a child's life to autonomy-support and encouragement of self-regulation as the child gets older ( Koehn & Kerns, 2018 ).

The responsiveness of the attachment figure to the child’s signals of a need to explore is as important as the sensitivity to signals of proximity needs ( Grossmann et al., 2002 ). Children trust that their attachment figures will notice and respond to their needs ( Benoit, 2004 ). This trust facilitates the exploration of the environment and supports the development of social and cognitive competence ( Ainsworth et al., 2015 ). Ainsworth used the term “organization” to describe the way a child’s attachment behaviors are brought together to form a coherent pattern of security or insecurity ( Duschinsky & Solomon, 2017 ). Quality of PCA is best assessed by reference to organization of attachment behaviors concerning the attachment figure and in consideration of the situational context (L. Sroufe & Waters, 1977 ). Children with secure attachment (Type B) openly express their emotional needs and can accurately predict responses from their caregivers. Children with insecure/avoidant attachment (Type A) mask their emotional needs, typically after being consistently rejected by their caregivers in times of past distress. In insecure/ambivalent (Type C) attachment relationships, children exaggerate the display of their emotional needs in a desperate attempt to get the attention of the caregiver, who has typically demonstrated inconsistency in their past responses. Children with secure and insecure/avoidant and insecure/ambivalent patterns use organized strategies to maintain interaction with their attachment figure, such that children know how to deal with distress ful situations to maintain a satisfying interaction with their attachment figure ( Benoit, 2004 ). Children with insecure/disorganized (D) attachment, fail to develop and organized pattern and display contradictory and incoherent behaviors with caregivers. Secure attachment is the most prevalent and preferred pattern of PCA across cultures. See Table 5 for the description of patterns of attachment.

Patterns of Attachment, Distribution, and Corresponding Responses.

Note. Adapted from Benoit (2004) and Golding (2007).

Another key idea of attachment theory, internal working models (IWMs), is defined as cognitive mental structures or mental schemas. IWMs summarize early caregiving experiences and shape expectations about future interactions with significant others ( Bretherton, 1992 ). IWMs are thought to develop as early as 12 months of age, constructed from a child’s actual experiences with the parent ( George, 1996 ), and influence how the children view themselves in relationships with others ( Rosmalen et al., 2014 ). The concept of IWMs has received much attention in explaining the link between early caregiving experiences and children’s later health outcomes. For example, securely attached children develop IWMs of available care and self-worth and tend to be more empathetic and responsive to others ( Sroufe et al., 1993 ). Children with insecure attachments develop IWMs of the self as unworthy and expectations of others as unavailable or insensitive. These children are more likely to inadequately cope with stress and behave in ways that bring about more adverse experiences ( Sroufe et al., 1993 ). As children grow, they begin to rely more on IWMs than on the actual presence of the attachment figure to guide their daily social interactions (Bowlby, 1982).

To conclude, the concept of PCA is well-defined within the psychology literature. Most articles in this review employed Ainsworth et al. (1978) and/or Bowlby’s (1988) definitions of PCA (see Table 3 ), with an exception of a nursing article by Goulet (1998) , where the definition of PCA by Bowlby (1996) was mixed with the definition of maternal-infant bonding by Klaus and Kennell (1983) . The definitions of PCA in the nursing literature were mostly focused on infants, and not on older children.

Pragmatic Principle: Is the Concept Applicable and Useful?

An extensive amount of literature focused on the measurement of attachment in infancy and childhood. The development of a standardized procedure to observe and study attachment behavior was a major step in the establishment of an empirical knowledge base regarding the developmental significance of attachment (Ainsworth et al., 1978). A study of individual differences in child attachment in home- and laboratory-based observations in 26 middle-class families in Baltimore led to the development of the Strange Situation procedure (SSP) (Ainsworth et al., 1978; Bell & Ainsworth, 1972) to classify patterns of attachment. The SSP was designed to use cues of unfamiliarity and separation from a caregiver to elicit attachment behaviors. The SSP aimed to activate the child's expectations about what happens when the caregiver was not available in the past and allowed the observer to interpret these expectations from the child’s behavior ( Duschinsky, 2015 ). The first report on the use of SSP described 14 children from the Baltimore study who were divided into three groups based on their behavior during the procedure ( Ainsworth & Bell, 1970 ). The SSP consists of eight episodes (see Table 6 ). During SSP, a caregiver leaves the child twice in an unfamiliar environment (a laboratory room decorated as a playroom) with enticing toys, first with a stranger (an unknown female experimenter) and then alone, before returning (Ainsworth et al., 1978). Being separated twice in an unfamiliar ( strange ) environment activates the child’s attachment system and allows for observation of individual differences in attachment patterns ( Rosmalen et al., 2014 ). The decisive factor for attachment classification is the child's behavior at the reunion with the caregiver. The SSP is videotaped and the child's behaviors concerning the caregiver are coded on a 7-point Likert scale for the presence of proximity and contact-seeking, maintaining contact, resistance, avoidance, distance interaction, and search behaviors ( Shah & Strathearn, 2014 ).

The Strange Situation Procedure Episodes (Ainsworth et al., 1978; Rosemalen et al., 2014).

In 1986, Main and Solomon reviewed 200 cases from the early SSP tapes and added a fourth category (D) to describe a child’s inexplicable and fragmentary behaviors that were discrepant with the original ABC classification. A child’s behaviors coded as D were based on the following indices: (a) sequential and (b) simultaneous display of contradictory behavior, (c) misdirected or incomplete movements, (d) stereotypes and anomalous postures, (e) freezing or stilling, (f) display of apprehension of the caregiver, and (g) signs of disorganization ( Granqvist et al., 2017 ). A 9-point scale for coding disorganization is used, where observation of five or more disorganized behaviors is sufficient to place a child into the D category ( Duschinsky & Solomon, 2017 ). Combined with Ainsworth’s original attachment patterns, this discovery culminated in the ABC+D attachment classification model. The SSP remains one of the most widely used standardized, laboratory-based assessments of young children's attachment behaviors (Fearon et al., 2010).

The SSP is normally only used during infancy and toddlerhood because as the children grow, the goals of attachment shift from proximity-seeking to co-constructing of cooperative partnerships with their attachment figure to ensure parents' ability and availability to act in child's best interests ( Fernandes et al., 2020 ). To account for the change in the attachment goal and behaviors, different measures of PCA are used during middle childhood and adolescence. Some of the examples of these measures include Maternal Behavior Q-Set ( Pederson & Moran, 1995 ), Attachment Story Completion Task ( Bretherton et al., 1990 ), Adult/Adolescent Attachment Interview ( George et al., 1996 ), Security Scale ( Kerns et al., 2001 ), and separation-reunion procedures ( Solomon & George, 1999 ).

The SSP is validated against home observations of mother-child interactions, and some suggest that it may not capture the quality of attachment to fathers ( Bretherton, 2010 ; Grossmann et al., 2002 ). The mechanisms involved in the development of attachment relationships may differ for mothers and fathers, with a mother’s interactions with her child typically involving caregiving, while a father’s interactions typically involve play ( Lamb, 2000 ). Paquette (2004) proposed a new theory of father-child attachment, called activation relationship. The activation relationship theory stipulates that limit-setting and discipline are important in helping children feel safe when exploring their environment ( Paquette, 2004 ). The Risky Situation (RS) procedure has been developed to test the following dimensions of father-child attachment in children aged 12-18 months: stimulation (encourage the child to be open to the outside world), and discipline (setting limits for the child’s safety). According to the activation relationship theory, children are classified as activated (explore environment appropriately, and obey limits set by the father for their protection), under activated (fearful to explore, cautious and obedient), or overactivated (showing no hesitation or fear in exploration, even in the presence of risk, and are disobedient) ( Paquette, 2004 ).

One of the central notions of attachment theory is that the quality of early caregiving is crucial to child development, especially how the parent is sensitive and responsive to the child’s cues (Ainsworth et al., 1978; Bell & Ainsworth, 1972). Attachment-based interventions are usually aimed at helping parents become more sensitive, responsive, and reflective. Sensitivity is the parental ability to perceive and appropriately interpret the cues implicit in the child's behavior, verbalization, and words, and correctly respond to these signals (Ainsworth et al., 1978). Individual differences in the child’s attachment security were attributed to variations in maternal sensitivity, and mothers of securely attached children were deemed more consistent and sensitive than mothers of insecurely attached children (De Wolff & van Ijzendoorn, 1997). Numerous studies have replicated these findings, exploring how maternal capacity to organize thoughts was linked to the ability to sensitively respond to her infant (van Ijzendoorn, 1995). Reviews by Goldsmith and Alansky (1987) , van Ijzendoorn (1995), De Wolff and van Ijzendoorn (1997), and Madigan et al. (2006) supported the notion that maternal sensitivity was linked to attachment security. A review of interventions to increase infant security by enhancing parental sensitivity concluded that short-term interventions were more effective than long-term, and increase in parental sensitivity did not always impact an infant’s attachment security, and in some studies improvement in infant security was noted without an increase in parental sensitivity ( Mountain et al., 2017 ).

The security of a child's attachment is also associated with the parent’s reflective functioning (RF) ( Katznelson, 2014 ; Slade, 2005 ). Parental RF refers to a parent's capacity to reflect on their own childhood experiences, and make meaning of their child’s thoughts, feelings, and behaviors ( Slade, 2005 ). It is theorized that RF promotes the parental capacity to regulate their emotions, and enables them to respond sensitively to their children’s emotional and physical needs ( Fonagy & Target, 1997 ). Higher levels of maternal ( Stacks et al., 2014 ) and paternal ( Fonagy et al., 1991 ) RF have been linked to sensitive behavior and a child’s attachment security. Studies that have assessed maternal reflective functioning capacity have shown that mothers with moderate to high RF scores were more likely to respond to their children sensitively, and were more likely to have children with secure attachment, compared to mothers with lower RF scores ( Bakermans-Kranenburg et al., 2003 ; Sadler et al., 2013 ).

To conclude, the concept of PCA can be measured by validated tools and is useful to nursing practice because nursing practice is concerned with child mental health ( Gordon et al., 2020 ).

Linguistic Principle: Is the Concept Used Consistently and Appropriately Within the Scientific Literature?

The most outstanding linguistic issue pertained to how PCA differs from maternal-child bonding. In the nursing literature, PCA is often conflated with parent-child bonding ( Bicking Kinsey & Hupcey, 2013 ; Klaus & Kennell, 1983 ). While screening abstracts to determine inclusion eligibility for this concept analysis, we noted that many nursing articles that included the term “attachment” in the title and/or abstract used the terms “attachment” and “bonding” interchangeably. Maternal-infant bonding is emotional affection experienced by the mother toward her infant emerging in the immediate postpartum period ( Condon & Corkindale, 1998 ). Bonding is not attachment ( Benoit, 2004 ; Redshaw & Martin, 2013 ). Unlike PCA, bonding does not predict socio-emotional and physical health outcomes later in life. Blurred distinctions between the concepts of bonding and PCA and the subsequent practice recommendations from nursing articles ( Goulet et al., 1998 ; Hill & Flanagan, 2020 ; Schenk et al., 2005 ) suggest that a clarification of PCA concept is needed.

There is a discrepancy in the description of the patterns of attachment within the psychology and nursing literature, indicating that nurses and psychologists may think differently about PCA. The conventional terms (developed by Bowlby & Ainsworth) used in the psychology literature for quality of attachment are “secure”, “insecure”, or “disorganized”. In the nursing literature, terms such as “positive” or “negative” are used when referring to the quality of PCA ( Schenk et al., 2005 ). Further, the terms “attachment” and “bonding” are used interchangeably in nursing original research and conceptual articles ( Karl et al., 2006 ; Kearvell & Grant, 2010 ; Zauderer, 2008 ). From the nursing perspective, attachment begins immediately after birth (do Vale et al., 2006; Goulet et al., 1998 ; Schenk et al., 2005 ). For example, a descriptive nursing study suggested that “attachment initially occurs soon after birth in a very important manner through eye contact” ( do Vale et al., 2005 , p. 71). From the psychology perspective, this statement is problematic, because attachment is not an instantaneous process, and only develops by the age of six or eight months ( Zeanah et al., 2000 ).

The scales frequently used by nurses to assess bonding have the term “attachment” in the title, such as the Maternal-Postnatal Attachment Scale ( Beirami et al., 2017 ; Ghadery-Sefat et al., 2016 ), which may also contribute to differences in how PCA is understood in the nursing and psychology literature.

Schenk et al. (2005) claimed that the nature of maternal-child attachment “from birth” (p. 516) is associated with the child’s behavioral disorders. The latest research suggests that maternal mental health problems and perception of family support, not the quality of bonding at birth, may influence the development of a child's behavior problems ( Maia et al., 2020 ). The discrepancy between how bonding and attachment are understood is not just a “harmless misunderstanding” (Eyer, 1994, p. 90). New parents who have been separated from their newborn often feel anxiety about not being able to establish “bonding” early on ( Redshaw & Martin, 2013 ), but bonding has not been shown to impact long term emotional and physical health.

In sum, PCA is not bonding. The implied meaning of the PCA concept in nursing literature is inconsistent with that of psychology and medicine. PCA does impact health and development over the life span ( Puig et al., 2013 ; Sroufe, 2005 ; Weinfield et al., 2000 ). Claims regarding the effects of maternal-infant bonding on long-term child health outcomes are not supported by current evidence.

Logical Principle: Does the Concept Hold Its Boundaries When Integrated With Other Concepts?

In applying the logical principle, we considered PCA in the context of related concepts, such as “parenting” and “parent-child relationship”. There is often an overlap between concepts of “attachment” and “parenting” in the scientific literature ( Koehn & Kerns, 2018 ). There is much more to parenting than attachment ( Lyons-Ruth, 1996 ). Attachment is only one specific aspect of a relationship between a parent and a child. The purpose of an attachment figure is to make the child feel safe, secure, and protected. Attachment is different from other aspects of parenting such as feeding, teaching, playing, and disciplining ( Benoit, 2004 ). However, attachment-based research has been used to identify parenting practices that can impact a child's socio-emotional health, such as frightening or frightened parental behavior that may contribute to attachment disorganization (Kindsvatter & Tansey, 2018; Lyons-Ruth, 1996 ; Ranson & Urichuk, 2008 ).

The parent-child relationship is another concept that frequently emerged during our review of the literature for this concept analysis. The relationship is defined as the state of being related or interrelated ( Merriam-Webster Dictionary, 2019 ). Parent-child relationships influence the social and emotional development of the child ( Koehn & Kerns, 2018 ). Nonetheless, PCA is not the same as the concept of a parent-child relationship. Rather, attachment theory provides a framework for studying parent-child relationships ( Van IJzendoorn, Goldberg et al., 1992 ). Attachment is a specific type of relationship with distinct goals and behaviors. Additionally, PCA can function outside of parent-child relationships, as in cases of securely attached children shown to have less difficulty in building and maintaining social relationships with peers ( Sroufe, 1988 ). To conclude, there are conceptually distinct boundaries between PCA, parenting, and the parent-child relationship.

Recommendations for Nursing Practice

The concept of PCA is useful and relevant to nursing practice. A child's mental health is one of the top national priorities for nursing ( Eckardt et al., 2017 ). The nurse may be the first healthcare professional who comes in contact with parents and their children. Nurses in all areas of healthcare should be able to observe the interaction between a parent and a child (e.g., attachment behaviors), and assess the quality of PCA. Nurse leaders must continue to advocate for the inclusion of attachment theory knowledge in formal nursing programs to help ensure the implementation and sustainability of attachment-based interventions that support optimal child development. Nurses need to identify factors that interfere with PCA, assess available supports, and provide necessary referrals. Specifically, the assessment of the PCA should include an assessment of the family context (e.g., parental mental health, social support, socio-economic status) because children are highly dependent on their immediate family environment for their health and development.

Even maltreated and neglected children become attached, although usually in an insecure or disorganized way ( Benoit, 2004 ). When assessing PCA, the question should be what is the quality of PCA instead of is there a PCA ( Benoit, 2004 ). PCA can be disrupted by conditions that limit children’s behavior, such as neurological disorders, illness, and fatigue, or conditions that can interfere with the parent’s ability to provide care, such as poverty and mental health problems. However, the parent plays a more important role than the child in shaping the quality of attachment ( O'Connor et al., 2019 ). This is important to know because attachment outcomes can be altered by changes in the immediate environment, such as changes in parenting behaviors ( Belsky & Fearon, 2002 ).

Attachment behaviors are most likely to be evident when the child is in an unfamiliar environment or feeling ill or in pain ( Feeney, 2000 ). During the visit to a healthcare setting, a frightened child may crawl to the parent, looking to be picked up and comforted ( George, 1996 ). Nurses can point out the child's attachment behaviors, such as clinging to the parent when upset, resisting separation, and calming when held by the parent. In toddlers, controlling behaviors (e.g., being punitive, bossy, assuming inappropriate caregiving behaviors towards a parent) can be noted as possible signs of attachment insecurity/disorganization ( Zeanah et al., 2011 ). It is important to note that a secure or insecure attachment quality cannot be inferred from any single behavior (e.g., crying, resistance), but needs to be inferred from the pattern of behavior within situational context (separating or reuniting with a parent) ( Sroufe & Waters, 1977 ). Parenting behaviors that encourage autonomy and maintain relatedness (e.g., respecting that children have their own thoughts and feelings) are important indicators of attachment security in parents with adolescents. To enhance PAC, nurses can use positive reinforcement of parenting skills, such as modeling appropriate responses (e.g., warm, supportive, sensitive, responsive, and prompt) to the child’s behaviors to encourage parents to assume similar responses to promote feelings of security in a child. Nurses should provide education on ways to increase parental sensitivity and responsiveness (child cue-based interactions, normal child growth, and development).

Both mother and father are important in fostering secure attachment ( Bretherton, 2010 ). Fathers are still marginal to the majority of parenting interventions to enhance PCA ( Panter-Brick et al., 2014 ), and more research that evaluates parenting programs that include the participation of fathers is needed to better understand the impact of fathering on a child's attachment security. Because attachment-based intervention programs have primarily targeted the mother-child relationship, there are no guidelines for effective father-child attachment programs to date ( Henry et al., 2020 ). Adverse socio-demographic factors have been shown to have a more negative impact on the fathering role, compared to the mothering role ( Bretherton, 2010 ; Palm, 2014 ; Paquette, 2004 ). Thus, the most effective programs to support fathers should include efforts to access and minimize socio-demographic barriers (e.g., lack of social support and unemployment, marital discord, mental illness, lack of education) along with parenting skills (e.g., sensitivity, responsiveness towards their children) and knowledge of child development ( Bretherton, 2010 ; Palm, 2014 ). With the support of nurses, fathers can develop parenting competencies and confidence in both play and caregiving contexts which can enhance father-child attachment security.

To advance the use of the PCA concept for nursing practice, we propose the definition of the PCA as a bi-directional relationship between a child of 0 to 18 years of age and a primary caregiver, where a child uses the caregiver as a secure base from which to explore and as a haven of safety and source of comfort in times of distress (Ainsworth et al., 1978; Bowlby, 1988).

Conclusions

This article aimed to describe how the concept of PCA is understood from a multidisciplinary perspective. Attachment theory offers nurses promising practice opportunities to provide an umbrella of supports that embraces and promotes life-long emotional and physical health of children and their families. The concept of PCA is poorly understood in nursing literature due to inconsistencies and confusion of this concept with the concept of bonding.

Acknowledgement: The authors would like to acknowledge the assistance of Jason Novick in preparation of the manuscript.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article: This work was supported by Canadian Institutes of Health Research Doctoral Award (394652).

ORCID iDs: E. Ali https://orcid.org/0000-0002-2104-7145

K. Benzies https://orcid.org/0000-0002-9090-2395

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Disorganized Attachment: The Childhood Environment

What kind of childhood environment creates disorganized attachment.

Posted March 28, 2024 | Reviewed by Tyler Woods

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Welcome back to the second part of my series on disorganized attachment . In the first article , I explored how children with anxious, avoidant, and secure attachment styles each have predictable strategies for trying to get their needs for emotional comfort and care met by their caregivers. Another group of children identified by early researchers as having strategies that were neither consistent nor predictable were classified as having a "disorganized attachment style.” (2)

Attachment styles aren’t set in stone and can adapt to the health of a given relationship. They can also shift with therapeutic intervention via professional help or self-help . (3) However, research is clear that attachment styles are initially formed between a child and early caregivers and that people are prone to replicating experiences from their childhoods throughout their adulthoods in ways that reinforce the attachment style they developed with early caregivers. (4) In this sense, attachment style consistency is often the path of least resistance for a given individual. According to research, children identified as having disorganized attachment were likely to carry the attachment style into adulthood. (5)

Children with disorganized attachment face a painful challenge when seeking emotional care from their caregivers. (6) Like children with anxious and avoidant attachment styles, disorganized children can’t be sure whether they will receive a positive response. They also have good reason to believe, based on experience, that their attempts to connect will be met with intensified levels (compared to the other attachment styles) of rejection, non-responsiveness, punishment , abuse, or fear -inducing tactics, all of which will leave them feeling significantly worse than the emotional loneliness which compelled them to seek connection in the first place. The parents they depend on for care and support are also a source of threat, creating a complex and distressing emotional landscape.

Disorganized children feel more than just insecure in their most important relationships; they feel unsafe. While the emotional environment of children with anxious and avoidant attachment is considered "emotionally insensitive," the emotional environment of children with disorganized attachment is considered "emotionally threatening." (6) There is a strong association between childhood physical and/or sexual trauma and disorganized attachment, but children need not be physically harmed to develop disorganized attachment. (6) Research shows that neglect, overwhelming exposure to violence between adults in the home, and emotional unsafety are also heavily associated with disorganized attachment.

All children equate emotional safety with physical safety, believing that being treated with emotional care signifies being lovable, which they unconsciously interpret as being worthy of protection from physical harm. Consequently, even chronic emotional invalidation (conveying that the child's emotions are wrong, shameful, excessive, or deserving of rejection) can distress a child enough to result in disorganized attachment. (8) This can create a particular challenge for adults struggling with disorganized attachment who are unable to pinpoint anything in their childhood that was obviously abusive.

Parents of children with disorganized attachment commonly share a key factor: unresolved grief and trauma from their own past experiences, which manifests as any block to their ability to provide sufficient emotional support to their children. (9) While not all parents with unresolved issues will parent in a way that creates disorganized attachment in their children, it’s essential to recognize that any unresolved trauma or high stress a parent struggles with can play a significant role.

Children with disorganized attachment experience heightened levels of anxiety , surpassing those with anxious and avoidant attachment. Their craving for emotional fulfillment without having a way to achieve it leads to a persistent state of yearning that keeps their nervous system in a chronic state of agitation. (6) Alongside this yearning, they grapple with feelings of deprivation and grief and must face these feelings alone. (5) Without support, they feel emotionally isolated, intensifying their struggle beyond the original pain. The longer this pattern continues, the more reasons they accumulate to believe that others cannot be trusted to be emotionally safe and available, and that relationships require a constant choice between loneliness and emotional hurt.

During moments of overwhelming stress, children with disorganized attachment are prone to losing themselves to uncontrollable emotional outbursts. Psychologists refer to this nervous system breakdown as “emotional dysregulation,” and while most young children experience dysregulation as a normal part of their development, disorganized children continue getting dysregulated even as they get older. (10)

Some disorganized children will cope with overwhelming emotions by suppressing them to the extent that they aren’t apparent to others or even to themselves. While they may appear “flat” on the outside, on the inside, they are expending significant psychic energy to prevent themselves from emotionally dysregulating. (11)

These coping strategies demand significant energy and are likely to impede their social, emotional, and/or educational development. When these areas of development are hindered, children with disorganized attachment run a high risk of encountering even more challenges in life, compounding existing problems. (5)

As mentioned earlier, there is a correlation between children with disorganized attachment and one or both parents harboring unresolved grief or trauma from their past. Given that intergenerational trauma often manifests in the most subtle of ways, it is impossible to outline all the factors that can tip a child toward a disorganized attachment style. Additionally, it’s important to acknowledge that some children with abusive or neglectful parents do not develop disorganized attachment. Children exist within an environment beyond their home, wherein the presence of supportive extended family members or a safe community can positively impact their self-views and emotional coping mechanisms.

A core principle of attachment theory emphasizes that children thrive when they have a "safe haven” to retreat to amidst life's external challenges. For a child with a strained family life, this could be provided by a loving grandparent, faith community, school system, or anywhere they have exposure to emotional safety and healthy boundaries . These environments won’t be enough to eliminate the effects of a threatening home life, but they can provide comfort, and plant seeds of awareness that they are worthy of care and that safe people do exist.

Lastly, disorganized attachment falls on a spectrum. The environmental factors which contribute to its development also range on a spectrum. Most individuals have childhood experiences that defy simple categorization as either "good" or "bad,” and it’s important not to oversimplify our childhoods in such terms. Instead, reflecting on what aspects went well and what didn't, understanding the ongoing impact of our past experiences on our present life, and identifying areas for growth are essential steps. Fortunately, there is much hope for healing.

If you’re reading this article and relating to the information from the perspective of a parent and recognizing these patterns in your own behaviors, all is not lost. Attachment styles are malleable, and you can learn how to create the necessary shifts (including doing your own self-work) to create the type of safe environment that fosters your child’s growth toward secure attachment. For more guidance on parenting with emotional safety, I highly recommend the work of Gabor Mate, particularly his book Scattered Minds .

To find a therapist near you, visit the Psychology Today Therapy Directory .

(1) Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Strange Situation Procedure (SSP) [Database record]. APA PsycTests.

(2) Main, M., & Solomon, J. (1990). Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation.

(3) Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. The Guilford Press.

(4) Cassidy, J., & Shaver, P. R. (Eds.). (2008). Handbook of attachment: Theory, research, and clinical applications (2nd ed.). The Guilford Press.

(5) Paetzold RL, Rholes WS. The Link from Child Abuse to Dissociation: The Roles of Adult Disorganized Attachment, Self-Concept Clarity, and Reflective Functioning. J Trauma Dissociation. 2021 Oct-Dec;22(5):615-635.

(6) Main, M., & Hesse, E. (1990). Parents' unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In M. T. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention (pp. 161–182). The University of Chicago Press.

(8) Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder . Guilford Publications.

(10) Fonagy, P., Target, M., Gergely, G., Allen, J. G., & Bateman, A. W. (2003). The developmental roots of borderline personality disorder in early attachment relationships: A theory and some evidence. Psychoanalytic Inquiry, 23 (3), 412–459.

(11) Lyons-Ruth, K., & Jacobvitz, D. (1999). Attachment disorganization: Unresolved loss, relational violence, and lapses in behavioral and attentional strategies. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 520–554). The Guilford Press.

Julie Menanno, M.A., LMFT, LCPC , is a licensed marriage and family therapist specializing in Emotionally Focused Therapy for couples.

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At any moment, someone’s aggravating behavior or our own bad luck can set us off on an emotional spiral that threatens to derail our entire day. Here’s how we can face our triggers with less reactivity so that we can get on with our lives.

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Synced brains: Why being constantly tuned in to your child’s every need isn’t always ideal

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Current advice says parents should be "in sync" with their kids as often as possible - but is this outdated? Photo / 123RF

For healthy child development , it’s crucial children can form secure attachment bonds with their parents. Decades of research identified one key ingredient for this process: the co-ordination of parents’ and children’s brains and behaviour during social interactions.

Humans connect with each other by synchronising in many ways. Called bio-behavioural synchrony , this involves imitation of gestures and the alignment of heartbeats and hormone secretion (like cortisol and oxytocin). Even brains can synchronise - with brain activity decreasing and increasing in the same areas at roughly the same time when we spend time with others.

My colleagues and I carried out research which showed brain-to-brain synchrony between parent and child can be helpful for children’s attachment, and tends to rise when a parent and child play, talk or solve problems together. However, we started wondering whether more synchrony is always better. Our recent study, published in Developmental Science , suggests it can sometimes be a sign of relationship difficulties.

Is current parenting advice up to date?

A lot of current parenting advice recommends parents be constantly “in sync” with their kids. It tells parents to be physically close and attuned to their children and anticipate and immediately respond to their every need.

The advice is building upon attachment theory and research which shows higher parental sensitivity and reflective functioning are beneficial for child development and secure attachment formation.

Yet, despite its good intentions, this advice misses several important details. For example, research revealed about 50-70 per cent of the time, parents and children are not “in sync”. During these times, they may be doing separate activities, such as a child exploring something on their own or a parent working. They rather engage in a constant “social dance” comprising being attuned to each other, failing to do so and repairing this disconnect.

And it’s this flow of connection, disconnection and reconnection which offers children an ideal mixture of parental support and moderate, useful stress that helps growing children’s social brains.

Researchers also agree that there can be negative consequences to parents and children constantly being tuned in to each other. For example, it can increase stress on the relationship and raise the risk of insecure child attachment. That is especially true if it is associated with parents overstimulating their child or being too responsive to their child’s every need.

For parent-child synchrony, there thus appears to be an “optimal midrange”. Or, in other words, more synchrony may not necessarily be better.

Brain-to-brain synchrony and attachment

Within a large international team of investigators from across Europe, my colleagues Trinh Nguyen, Melanie Kungl, Stefanie Hoehl, Lars White and I set out to investigate how exactly parent-child bio-behavioural synchrony is linked to attachment.

We invited parent-child pairs - 140 parents and their 5 to 6-year-old kids - to our SoNeAt Lab, where they solved tangram puzzles together.

We measured brain activity with functional near-infrared spectroscopy (fNIRS) “hyperscanning”, for which parents and children were asked to wear caps linked up with optical sensors. We also recorded videos of their interactions so we could assess how much behavioural synchrony they demonstrated - how attuned and attentive they were to each other. And finally, we assessed parents’ and children’s type of attachment - known as attachment representations.

We previously discovered increased neural synchrony in mother-child and father-child pairs during different tasks. In mother-child pairs, neural synchrony was linked to taking turns in solving puzzles or conversations. And in father-child pairs, synchrony during puzzling was linked to dads being confident about and enjoying their role as fathers. But does that mean higher parent-child neural synchrony is always a measure of a good relationship?

In our new study, we actually observed that mothers who had an insecure, anxious or avoidant attachment type showed more neural synchrony with their children. Interestingly, mothers’ attachment types were unrelated to how synced mothers and children were in terms of their behaviour. We also found increased neural but decreased behavioural synchrony in father-child pairs (compared to mother-child pairs) independent of attachment.

Our findings suggest higher neural synchrony may be the result of putting increased cognitive effort into the parent-child interaction. If mothers’ attachment representations are insecure, it may be more difficult for mums and kids to co-ordinate and help each other during activities such as puzzle solving.

A similar explanation may apply to neural synchrony during father-child problem-solving. Dads are more familiar with active, rough-and-tumble play. Engaging in structured and cognitively demanding activities such as puzzles may therefore be more challenging and require more neural synchrony for father-child pairs.

Lessons to be learned

What do our new findings mean? Most importantly, parents should not feel they must be “in sync” with their kids all the time and at all costs. High parent-child attunement can also reflect interaction difficulties and can often add up to parental burnout, further negatively impacting the parent-child relationship.

It is of course helpful if parents are emotionally available, skilled in reading their children’s cues and promptly and sensitively respond to their needs. Especially when children are young. However, it suffices for parents to be “good enough” - to be available when children need them rather than “always on”.

Children can also benefit from freedom and independence emotionally, socially and cognitively, especially as they get older.

What really counts is that the parent-child relationship functions well overall. That children can develop trust in their parents and that any mismatches, which naturally occur all the time, are successfully repaired. That’s the true essence of attachment theory, which is often missed and misrepresented in parenting advice.

To better navigate the challenging parenting path, parents need access to trustworthy and up to date sources of information. Together with the UK Charity Babygro, we therefore published the free-of-charge Babygro Book for Parents , which provides them with evidence-based knowledge on parenting and child development.

It is our hope the book can empower parents so they feel reassured and confident in their own parenting choices and can optimally support their children to grow and thrive.

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Attachment in Young Adults and Life Satisfaction at Age 30: A Birth Cohort Study

• Open access
• Published: 21 May 2024

Cite this article

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• Julie A. Blake   ORCID: orcid.org/0000-0002-8062-4029 1 , 2 , 5 ,
• Hannah J. Thomas 1 , 3 , 4 , 5 ,
• Anita M. Pelecanos 1 ,
• Jake M. Najman 4 &
• James G. Scott 1 , 2 , 3 , 4 , 5  

Satisfying close relationships are associated with higher levels of life satisfaction throughout the life course. Despite the fundamental role of attachment style in close relationships, few studies have longitudinally examined the association between attachment style in young adults with later life satisfaction.

Data from 2,088 participants in a longitudinal birth cohort study were examined. At 21-years, participants completed the Attachment Style Questionnaire which comprises five domains reflective of internal working models of interpersonal relationships and attachment style: confidence (security), discomfort with closeness and relationships as secondary (avoidance), need for approval and preoccupation with relationships (anxiety). At 30-years, participants self-reported their overall life satisfaction. Linear regression was used to longitudinally examine the association between attachment domains at 21-years and life satisfaction at age 30.

After adjustments, confidence was positively associated with life satisfaction (β = 0.41, 95% CI 0.25–0.56, p  < 0.001), while need for approval was negatively associated with life satisfaction (β = -0.17, 95% CI -0.30 – -0.04, p  < 0.001). Low income at 21, caring for a child by age 21, and leaving the parental home at 16-years or under were negatively associated with life satisfaction at 30-years.

Young adult attachment style is associated with later life satisfaction, particularly through confidence in self and others. Promoting positive internal working models of interpersonal relationships and fostering greater confidence in self and others in adolescence may be an effective strategy for improving life satisfaction later in life.

Avoid common mistakes on your manuscript.

Introduction

Social connection is a fundamental human need that plays a crucial role in promoting overall health and wellbeing across the lifespan (Martino et al., 2017 ) and serves as a protective factor against various adverse physical and mental health outcomes at different stages of life (Heinsch et al., 2022 ). Satisfying close relationships are consistently associated with higher levels of life satisfaction, happiness and overall quality of life (Gustavson et al., 2016 ; Kaufman et al., 2022 ). Attachment theory is an essential framework for understanding human relationships. An individual’s ability to connect with others and form healthy relationships is underpinned by their attachment style, which is commonly characterized by dimensions of security and insecurity . A growing body of literature suggests attachment style is important in life satisfaction. This paper provides a brief review of the current evidence for a relationship between attachment style and life satisfaction in adulthood. This study then addresses some of the gaps in the research using data from a longitudinal birth cohort and discusses the findings in the context of the existing literature.

Attachment Theory and Relationships

Attachment style plays a fundamental role in close relationships. Internal working models of attachment are shaped through bonding experiences with early caregivers which form a core mental representation of an individual and their relationships with others. Consistent and nurturing caregiving experiences contribute to the development of a positive or ‘secure’ internal working model, characterized by belief in one’s worthiness of love as well as trust in others’ availability during times of need (Bartholomew & Horowitz, 1991 ). Conversely, inconsistent, fearful, or rejecting caregiving experiences often lead to a negative or ‘insecure’ inner working model, marked by negative perceptions of self and others. These mental representations of self and others manifest as attachment styles and influence individuals’ thoughts and behaviours within close relationships (Sherman et al., 2015 ). An individual’s inner working model of attachment influences how they respond to their emotions, both positive and negative; for example, an individual with a more insecure inner working model is more likely to respond to negative emotions with greater intensity (i.e., hyperactivated response to perceived abandonment or rejection) and be less open to exploring positive emotions (Mikulincer et al., 2013 ). As such, individuals with a more insecure inner working model of attachment are likely to experience greater difficulties with interpersonal communication and emotion regulation (Kobak & Bosmans, 2019 ; Lewczuk et al., 2021 ) thereby making them vulnerable to social isolation, loneliness and poor mental health (Manning et al., 2017 ; Nottage et al., 2022 ) and negatively impact their satisfaction with life.

In contrast, having a more secure inner working model of attachment is found to moderate the relationship between positive life events and self-reported wellbeing (Spence et al., 2022 ). Individuals with a secure attachment style may be better able to recognise and appreciate positive events, therefore experiencing greater increases in wellbeing. These individuals are more likely to be in a romantic relationship than those with higher levels of attachment insecurity, although even for those not in a relationship, having a secure attachment style is associated with greater levels of psychological wellbeing and life satisfaction (MacDonald & Park, 2022 ; Sagone et al., 2023 ). Although long thought to be fixed in early childhood, attachment patterns remain somewhat dynamic and susceptible to change throughout adolescence (Jones et al., 2018 ; Theisen et al., 2018 ). This offers a powerful opportunity to positively influence lifelong trajectories. There are numerous attachment informed interventions that have been developed which adopt a variety approaches. Evidence of their efficacy, particularly with regards to sustained improvements; however, is lacking, and they currently remain underutilized (Gregory et al., 2020 ; Wright et al., 2023 ).

Life Satisfaction

Life satisfaction, defined as “the degree to which a person positively evaluates the overall quality of his / her life as a whole” Veenhoven ( 1996 ) (p.6), is tightly connected with the concepts of subjective wellbeing, happiness and quality of life (Medvedev & Landhuis, 2018 ; Pronk et al., 2016 ). Since it primarily relies on individuals’ personal assessments of their lives, it is inherently subjective, requiring individuals to evaluate their lives according to their personal values and priorities. However, research efforts which have sought to understand the relative influence of specific life domains on overall life satisfaction find that the quality of family and romantic relationships can have a greater impact on overall life satisfaction than other relationships (Badri et al., 2022 ; Milovanska-Farrington & Farrington, 2022 ; Nakamura et al., 2022 ). In Western societies, various factors are identified as significant predictors of life satisfaction. These include standards of living, household income, health status, relationship status, and mental wellbeing (Jarden et al., 2022 ; Kubiszewski et al., 2018 ; Lombardo et al., 2018 ; Park et al., 2020 ). Lower ratings of life satisfaction are associated with poorer levels of physical and mental health, chronic disease, health service utilization and premature mortality (Kim et al., 2021 ; Michalski et al., 2022 ; Rosella et al., 2018 ). Insights from a nationally representative study of Americans aged over 50 showed that higher ratings of life satisfaction predicted better future outcomes on a range of physical and mental health indicators (Kim et al., 2021 ). Improving the life satisfaction of populations is therefore an important public health objective.

National studies of life satisfaction show a U-shaped trajectory across the lifespan, characterised by declines during middle adulthood followed by a resurgence in older age. In a study of over 10,000 New Zealanders using data from the Gallup World Poll (2006 to 2017), Jarden et al. ( 2022 ) showed that life satisfaction is lowest at around 40-years of age, with living standards and household income being the strongest indicators of life satisfaction. Similarly, Park et al. ( 2020 ) demonstrated in their study of over 12,000 Australians, also using Gallup World Poll data (2005 to 2017) that life satisfaction is lowest during in the mid-thirties to mid-fifties. In another Australian study including over 30,000 participants from the Household, Income and Labour Dynamics in Australia survey (HILDA) between 2001 and 2016, Kubiszewski et al. ( 2018 ) found life satisfaction to be lowest during in the late forties, with health, living situation and marital status being important predictors of life satisfaction. Interestingly, a similar trend is observed for levels of satisfaction with a romantic partnership throughout adulthood. One meta-analysis using data from 165 unique samples concluded that relationship satisfaction reaches its lowest point around the age of 40 (Bühler et al., 2021 ); comparable to life satisfaction. While it’s important to acknowledge that these findings are correlational in nature, they provide further support to results of numerous studies which find relationship status to be an important factor in how an individual rates their personal life satisfaction. These patterns suggest that fostering and maintaining fulfilling relationships may play a pivotal role in enhancing individuals’ overall life satisfaction.

Brief Review of Life Satisfaction and Attachment Studies

A growing body of literature suggests attachment style is important in life satisfaction. In early adulthood, studies of student populations find life satisfaction is positively correlated with attachment security and negatively correlated attachment insecurity (Deniz & Işik, 2010 ; Dugan et al., 2023 ). Some evidence suggests that the attachment quality of romantic relationships is a stronger predictor of life satisfaction above attachment quality with parents or peers in this age group (Guarnieri et al., 2015 ). This study also found that romantic attachment quality fully mediated the relationship between the mother-offspring attachment relationship and offspring life satisfaction, suggesting that secure mother-child attachments lead to more secure romantic relationships which in turn, result in higher levels of life satisfaction. Higher rates of attachment insecurity and lower rates of life satisfaction are found among young adults who identify with a sexual or gender minority group compared to those of heterosexual identity (Kardasz et al., 2023 ). Similarly, secure attachment style is associated with greater life satisfaction in older adulthood during the ages of approximately 60 to 70 years. Religion and hope were found to fully mediate this relationship; however, in a study of older Israeli adults, although they only partially mediated the relationship between in secure attachment and life satisfaction (Pahlevan Sharif et al., 2021 ). Consistent with these findings, a German study of older adults found individuals with a secure attachment style were more hopeful towards the future (Wensauer & Grossmann, 1998 ). Another German study of older adults found that compared to individuals with a secure attachment style, medical burden and life satisfaction were more strongly correlated with an insecure attachment style (Kirchmann et al., 2013 ).

Throughout adulthood, other studies find similar links between attachment style and life satisfaction. Potential mechanisms for this relationship were explored in some of these studies; for example, an Israeli study of working adults found that insecure attachment style was associated with both life satisfaction and job satisfaction, with job burnout partially mediating the relationship between attachment style and life satisfaction (Reizer, 2014 ). A Turkish study found that self-efficacy, self-love and compassion were mediators of life satisfaction and avoidant and secure attachment styles in adulthood, although not for anxious attachment (Deniz & Yıldırım Kurtuluş, 2023 ). A multinational study found higher attachment insecurity was associated with lower life satisfaction and satisfaction with singlehood, with individuals higher in attachment anxiety having a stronger desire for a partner (MacDonald & Park, 2022 ). A case control study of Polish women with breast cancer found higher life satisfaction was reported in women with a secure attachment style, regardless of breast cancer status (Koziińska, 2012 ). Lastly, a Dutch study also found attachment style was related to life satisfaction and that attachment insecurity was predicted by a range of adverse childhood experiences (Hinnen et al., 2009 ). These studies indicate that attachment styles impact life satisfaction across different cultures and contexts, with various mediating factors playing a role in this relationship.

Numerous studies also report a significant relationship between attachment style and closely related constructs to life satisfaction such as quality of life (Brophy et al., 2020 ; Darban et al., 2020 ) and happiness (Moghadam et al., 2016 ; Momeni et al., 2022 ). The limitation of almost all of these studies however, is that they are cross-sectional by design, and often include small, non-generalizable samples. An exception is the study by Platts et al. ( 2022 ) that prospectively examined the influence of attachment style on quality of life in a sample of over 5,000 American adults in middle to older age. Their study found that insecure attachment style longitudinally predicted poorer quality of life at a five-year follow up. In addition, they also found that insecure attachment style predicted worse mental and physical health at a 14-year follow-up. There is a need for studies that prospectively examine the influence of early adult attachment on life satisfaction in adulthood, particularly in middle adulthood where life satisfaction typically declines.

The Present Study

While studies have begun to examine the link between attachment and life satisfaction, there is a notable gap in the literature in terms of understanding the influence of attachment styles in early adult life on life satisfaction in later adulthood. The significance of early adulthood in this context stems from the evidence that attachment styles are more malleable up to approximately this period in life (Jones et al., 2018 ; Theisen et al., 2018 ) and therefore potentially a critical period for attachment development that could have lifelong influences. Notably, existing studies have shown that life satisfaction tends to dip during mid-life, yet research efforts have typically paid greater attention to factors influencing life satisfaction in later adulthood (Cheng et al., 2022 ; Khodabakhsh, 2022 ). In contrast, a significant portion of research exploring the relationship between attachment and life satisfaction has centred primarily on early, or later adulthood. Much of the existing research has focused on specific demographic groups, such as students, which leaves questions about the generalisability of these findings. This study seeks to bridge these gaps by drawing upon data from a longitudinal birth cohort study to explore the relationship between attachment styles and life satisfaction over nearly a decade of follow-up. Given life satisfaction is closely connected to physical and mental health, it is vital to explore ways in which life satisfaction can be enriched earlier in adulthood.

This study seeks to address these gaps by drawing upon data from a longitudinal birth cohort. Its primary aim is to expand the current body of research on attachment and life satisfaction through a longitudinal investigation into how attachment patterns observed during emerging adulthood (at 21-years) is associated with life satisfaction in later adulthood (at 30-years) in a large community sample. The study will employ a multi-dimensional assessment of attachment to simultaneously account for both the degree of attachment security and insecurity across five distinct domains of attachment to potentially illuminate important elements of attachment that could be targeted through intervention.

Sample and Procedure

This study utilised data from a prospective birth cohort of mothers and their offspring who received antenatal care at an urban Australian hospital between 1981 and 1984. Around 50% of all births in the region during this time occurred at this facility. Pregnant women attending their first antenatal appointment were consecutively invited to participate in the study. Of the 8,556 private and public patient pregnant women invited to participate in the study, 8,458 (98.9%) consented. Participants enrolled into the study provided informed written consent (see Najman et al. ( 2005 ; 2015 ) for further details). Baseline data were collected on a total of 7,223 singleton, live-birth offspring and their mothers. Mothers and offspring were followed prospectively when offspring were six-months, five, 14, 21 and 30-years of age. The 21-year follow up occurred from 2001 to 2004. Ethical approval for the 21-year follow-up for this study was granted by the relevant university and hospital Human Research Ethics Committees.

Attachment Style Questionnaire (ASQ)

At the 21-year follow up, offspring attachment styles were assessed using the Attachment Style Questionnaire (ASQ) (Feeney et al., 1994 ). The ASQ is a 40 item self-report measure designed for young adults and/or those without experience of romantic relationships. Items are framed as statements such as “I find it hard to trust other people” and “I often feel left out or alone”, which participants responded to on a 6-point Likert scale (“totally disagree” to “strongly disagree”). Items were grouped into five subscales: (1) confidence (in self and others) (CON), (2) discomfort with closeness (DWC), (3) relationships as secondary (compared with achievements) (RAS), (4) need for approval (related to fear of rejection) (NFA), and (5) preoccupation with relationships (PWR). For each subscale a mean score was calculated. This study utilises a 33-item short form of the ASQ, which has been previously validated by confirmatory factor analysis in the study sample (see Supplementary Table 1 for a full list of items).

At the 30-year follow up, participants responded to three items: life satisfaction ( how satisfied are you with your life as a whole these days? ), happiness ( how would you say you feel these days? ) and quality of life ( how would you rate your overall quality of life these days?) on a 4-point Likert scale ranging from (4) (very satisfied / very happy / excellent) to (1) (very dissatisfied / very unhappy / poor). Responses to the three items were combined to yield an overall ‘satisfaction with life’ score ranging from a possible lowest score of 3 to a highest possible score of 12. High internal consistency was found for the three life satisfaction questions (Cronbach’s Alpha [α] = 0.89).

Potential covariates collected at the 21-year follow-up considered for inclusion in the analyses included sex (male / female), level of education (incomplete high school / complete high school / diploma or certificate / post high school education), relationship status (single / partner – living separately / partner – living together), living arrangement ((live with parents / own your accommodation [outright or with a mortgage] / rent / other), age of leaving the parental home ( ≤  16/ 17 / 18 / 19 / 20+), biological children in own care (yes / no), weekly income ([gross income including welfare benefits] no income / <$200 / $200 - $499 / $500 - $799 / $800+ [AUD]).

Statistical Analysis

Data were analysed using R v4.1.1 (R Core Team, 2023 ). A total sample of 2,088 participants (51.9% of the original 7,233 participants recruited at birth) had less than 10% missing data on the ASQ and no missing data for each of the three outcome variables at the 30-year follow up. Of these, 142 (6.8%) participants had between one and three missing items ( ≤  10%) on the ASQ. Little’s Missing Completely At Random (MCAR) test showed evidence of systematic missingness in our data (χ2 (1,480)  = 1,708, p  < 0.001). Data were imputed using a linear regression based simple imputation method whereby missing values are predicted using observed responses.

Differences in 21-year characteristics among those retained in the study and those lost to follow-up at the 30-year follow-up were examined using Welch’s two sample t-test for continuous variables and Pearson’s chi square tests for categorical variables. Univariable linear regressions were run for each variable individually against levels of life satisfaction at age 30-years. Multivariable linear regression​​ was used to assess the relationship between attachment domains of the ASQ at 21-years, adjusting for covariates. Collinearity was not detected between any of the five ASQ attachment domains and they were subsequently included within the one multivariate model.

Differences in 21-year characteristics between those retained in the current study ( n  = 2,088) compared with those lost to follow-up at 30-years ( n  = 1,627) are shown in Table  1 . Statistically significant differences were found between the two groups across all covariates, with those lost to follow up being more likely to be male (57.3% vs. 38.7%), have an incomplete high school education (27.8% vs. 15.0%), earn less than $200 per week (26.5% vs. 20.9%), have moved out of home at 16-years of age or younger (14.6% vs. 8.8%) and not have a partner (51.2% vs. 45.8%).

For participants included in the current study, the majority were female ( n  = 1,279, 61.3%), who had completed high school education ( n  = 1,777, 56.8%), and at 21-years were single ( n  = 953, 45.8%), had never left the parental home ( n  = 959, 46.1%), earned a weekly income of $200 to $499 AUD ( n  = 1,010, 49.5%) and had no biological children in their care ( n  = 1,925, 92.5%).

Figure  1 shows the distribution of total life satisfaction scores at age 30. A little over one-third of the 2,088 participants included in the current study reported a life satisfaction score of 9 out of a possible 12 ( n  = 752, 36.0%), and one-quarter of participants ( n  = 512, 24.5%) reported a maximum score of 12.

Life satisfaction scores at age 30. 12 = highest possible score. 3 = Lowest possible score

Linear Regression

Table  2 presents the results of the univariable and multivariable associations between each separate predictor and life satisfaction at age 30. In the univariable analyses, each of the five attachment domains at age 21 were individually associated with life satisfaction at age 30, with confidence being the domain that was most strongly associated (β = 0.79, 95% confidence interval [CI] 0.68–0.90, p  < 0.001). Of the seven covariates included in the analyses, participant sex and living arrangements were not independently statistically significantly associated with life satisfaction and were not included in the multivariate analysis.

After adjustments for all attachment domains and covariates, confidence remained the attachment domain most strongly associated with life satisfaction (β = 0.41, 95% CI 0.25–0.56, p  < 0.001). Need for approval was the only other attachment domain to remain statistically significantly associated with life satisfaction (β = -0.17, 95% CI -0.30 – -0.04, p  < 0.001).

Covariates which remained also significantly associated with life satisfaction included: having no income (compared to earning $200 - $499AUD per week) (β = -0.66, 95% CI -1.03 -0.29, p  < 0.001) or low income (β = -0.22, 95% CI -0.40 -0.04, p  < 0.018), leaving the parental home at 16-years or younger (compared to currently living in the parental home) (β = -0.43, 95% CI -0.74 to -0.12, p  = 0.007), caring for biological children (compared to not caring for biological children) (β =-0.49, 95% CI -0.49 to -0.18, p  = 0.002) and having a partner (compared to being single) (not cohabiting: β = 0.41, 95% CI 0.23–0.60, p  < 0.001; cohabiting: β = 0.26, 95% CI 0.05–0.47, p  < 0.014).

The current study examined the association between attachment style in young adults (21-years) and life satisfaction at age 30, utilising a dimensional measure of attachment, encompassing five attachment domains reflecting security, avoidance, and anxiety in a large community sample. The study has several key findings. First, confidence in self and others at 21 years emerged as a significant predictor of life satisfaction at age 30, even after accounting for the degree of endorsement on domains of attachment insecurity and important social-demographic factors such as relationship status, income and education. Second, greater need for approval increased the likelihood of reporting low life satisfaction, albeit to a lesser extent than confidence. Finally, preoccupation with relationships and insecure-avoidant attachment assessed by discomfort with closeness and relationships as secondary subscales, were not associated with future life satisfaction when accounting for other attachment domains.

While previous research has established a link between attachment and life satisfaction in university students (Tepeli Temiz & Tarı Cömert, 2018 ), and adults (Deniz & Yıldırım Kurtuluş, 2023 ), our findings suggest that attachment style in early adulthood is associated with life satisfaction a decade later. The current results underscore the importance of considering an individual’s level of confidence in self and others, for this is a component of attachment security and a secure internal working model of interpersonal relationships, regardless of the co-occurrence of patterns of attachment anxiety or avoidance. Higher scores on the confidence subscale reflects a positive internal working model characterised by high self-worth, trust in others and a general confidence in interpersonal relating. Our findings therefore suggest that having a positive representation of oneself and others is associated with later life satisfaction, independent of most features of attachment insecurity (discomfort with closeness, relationships as secondary and preoccupation with relationships). Need for approval was the only domain of attachment insecurity that was significantly associated with life later satisfaction. This finding aligns with previous research finding that individuals exhibiting a high need for approval by others is negatively correlated with life satisfaction in adulthood (Fowler et al., 2018 ). Importantly, early adult attachment remained independently associated with later life satisfaction even after accounting for a range of important social-demographic factors, suggesting that modification of attachment style in emerging adulthood could enhance life satisfaction further into adulthood.

In terms of covariates, not having an income at age 21 was most strongly negatively associated with life satisfaction at age 30, followed by caring for biological children at age 21 and leaving the parental home by age 16. One nationally representative Australian study found that life satisfaction decreases in the years following child-bearing, with declines in satisfaction with leisure, health and partnership explaining the overall decrease (Aassve et al., 2021 ). The finding that childbearing in early adulthood is associated with lower life satisfaction almost 10-years later in our study warrants exploration around the ways in which young people who enter parenthood can be better supported to have greater life satisfaction. Compared to those still living in the parental home, individuals who left the parental home by age 16 or younger were at a significant risk of lower life satisfaction at age 30. Interestingly however, the effect of leaving the parental home at age 17 or above was not significant. Research shows that young Australians who have experienced marginalization such as early life disadvantage, social isolation and financial hardship, are more likely to leave home prior to the age of 18, and that for those who do, this marginalization persists during the 10-years following (Cruwys et al., 2013 ). Another Australian study shows that for young people who leave home for reasons other than to live with a partner, are more likely to be less satisfied with the quality of the relationships with their parents (Qu & De Vaus, 2015 ). Experiences of childhood abuse and household dysfunction, for example, are significant predictors of lower life satisfaction in adulthood (Mosley-Johnson et al., 2019 ) and these adversities are also likely to contribute to an early departure from the parental home.

Individuals who reported having a partner but not cohabiting with their partner on the other hand, were more likely to report greater life satisfaction compared to those who were single, as too were those living with a partner, although the association of this relationship was weaker in magnitude. Where previous studies have found that being in a non-cohabiting relationship is associated with lower life satisfaction (Bucher et al., 2019 ), the positive effect of not cohabiting with a partner in the current study may be explained by factors relating to the age of participants who are more likely to be still living in the parental home and may benefit from maintaining the autonomy to independently navigate the transition into adulthood and pursue individual goals whilst simultaneously receiving support and companionship from a romantic partner. This finding suggests that consideration of the context of intimate relationship such as the underlying mechanisms and contextual factors (e.g. age, relationship quality and duration, desire for a partner) that might explain the relationship between relationship status and life satisfaction (Roy et al., 2023 ; Stahnke & Cooley, 2021 ), may be an important factor when examining the effects of relationships in the context of life satisfaction. The level of contentment with being single is also an important consideration of the relationship between attachment style and life satisfaction. MacDonald and Park ( 2022 ) found that secure attachment was a protective factor for life satisfaction for non-partnered individuals, suggesting that these people are better equipped to meet their needs for emotional connection through non-romantic relationships. Researchers should be encouraged to incorporate information on relationship context when examining relationship status in future studies on life satisfaction and attachment.

Incomplete high school education was negatively associated with later life satisfaction in the current study, although this relationship became non-significant after controlling for other variables, including income. A recent study examining data from 24 nations showed that income attenuated the relationship between higher education and life satisfaction (Araki, 2022 ), with similar results found in other studies which show that education is not a significant predictor of life satisfaction when accounting for income (Hennig & Laier, 2023 ; Jarden et al., 2022 ) suggesting that the association between education and with life satisfaction can be explained by the earning potential relevant to the level of education attainment. While higher income in early adulthood was not associated with later life satisfaction in the current study, having no income emerged as the strongest predictor in the model of life satisfaction almost 10-years later. The absence of contextual information regarding the financial and living circumstances of this group, such as whether they were being financially supported by parents, experienced a temporary lapse in employment or endured chronic poverty for example, makes it is difficult to draw clear interpretations. Regardless, these add to the literature base that evidence a strong link between income and life satisfaction by demonstrating a longitudinal adverse effect of having no income in early adult life on life satisfaction later into adulthood.

The link between attachment, interpersonal relationships, and life satisfaction is well established, yet the effectiveness of attachment informed interventions in increasing life satisfaction remains relatively unknown. Greenman and Johnson ( 2022 ) suggest that attachment is a valuable framework through which to understand links between loneliness, social disconnection and health, all of which are linked to life satisfaction. Currently, there exists a broad range of attachment-based interventions that aim to promote healthy attachment styles during adolescence (Kobak et al., 2015) that enhance close relationships, improve interpersonal communication, and foster a sense of connectedness more broadly (Greenman & Johnson, 2022 ; Kobak & Bosmans, 2019 ). Attachment is shown to be more stable in adulthood and therefore more difficult to modify (Fraley, 2019 ) thus, interventions targeting adolescence may be a critical window in which to intervene. Interventions with an attachment focus may have potential in improving life satisfaction in adulthood, given that improving interpersonal communication is associated with better psychological health and wellbeing (Mukherjee, 2017 ; Oliveira et al., 2022 ). Approaches to increasing relational confidence and attachment security can be implemented in a range of settings that extend beyond 1:1 therapy (Mikulincer & Shaver, 2020 ). Attachment style can affect educational outcomes (Wang et al., 2021 ), work performance (Greškovičová & Lisá, 2023 ) and health (Pietromonaco & Beck, 2019 )—all of which are important factors in life satisfaction.

In childhood education, teachers serve as an attachment figure by providing a supportive and reassuring environment to learn through taking risks and making mistakes (Mikulincer & Shaver, 2020 ). Preliminary evidence supports the use of attachment based interventions to enhancing teacher-child relationships (Spilt & Koomen, 2022 ). In healthcare, patient attachment style is associated with service utilization and treatment outcomes (Jimenez, 2016 ; Meng et al., 2015 ). Health providers serve attachment related functions through provision of a safe haven during times of distress and also as a secure base whereby they can facilitate increases in health related confidence (Maunder & Hunter, 2016 ). Attachment informed interventions are also recommended for the workplace. The use of security priming interventions for those who are in leadership roles for example, are suggested to increase secure base behaviours and create secure relationships in the workplace (Yip et al., 2018 ). Public health and policy initiatives also offer important opportunities to foster secure attachment trajectories. Cassidy et al. ( 2013 ) argue for example, that parental leave, child care and flexible work policies should “recognize child care as a prime societal concern” (p.15) based on a substantial literature base for the importance of attachment theory in parenting and child development.

Strengths and Limitations

This is the first longitudinal study to examine the associations between attachment styles in young adults with later life satisfaction. Furthermore, the large, community-based sample enhances the generalizability of the findings. The utilization of a dimensional measure of attachment that captures broad inner working models of interpersonal relationships, rather than focusing on a specific person of reference, allows the association between specific attachment styles and adult life satisfaction. However, it is important to note that the confidence subscale used in our study does not fully assess all dimensions of attachment security (Justo-Núñez et al., 2022 ), and therefore should be interpreted within this context. A further limitation of the study is the measurement of life satisfaction through a brief composite measure of happiness, quality of life, and satisfaction with life. Single item measures of life satisfaction; however, are shown to produce similar results to the use of longer validated scales (Cheung & Lucas, 2014 ). The current study used three items that demonstrated good internal consistency which have been used in previous studies (Lee et al., 2021 ). The lack of detailed insights and contextual factors that may have influenced the responses; however, is a potential limitation (Ruggeri et al., 2020 ). Another limitation is the considerable attrition rate, with approximately two-thirds of the original sample lost to follow up at age 30. Although significant differences were found between participants retained in the sample and those who were lost to follow-up, previous research suggests that differential attrition rarely affects estimates of associations (Saiepour et al., 2019 ). None the less, interpreting the findings of the current study within the context of the study sample is required.

Conclusions

In conclusion, this study identifies associations between young adult attachment styles and life satisfaction almost 10-years later. This study provides evidence that an inner working model of interpersonal relationships characterised by confidence in self and support from others in early adulthood is associated with an increased life satisfaction at age 30, while a higher need for approval was associated with lower life satisfaction. Having a low, or no income at age 21, leaving the parental home at 16-years of age or younger, and caring for children at age 21 were risk factors for lower life satisfaction at age 30, while having a partner at age 21 was associated with higher life satisfaction. Optimising life satisfaction is an important public health objective and is integral to overall health and wellbeing. Application of attachment-informed interventions that cultivate secure internal working models of interpersonal relationships and particularly increasing confidence in relating with others during adolescence and early adulthood is proposed as a potential strategy to improve life satisfaction in middle adulthood.

Conflict of interest

The authors do not have any competing interests to report.

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Blake, J.A., Thomas, H.J., Pelecanos, A.M. et al. Attachment in Young Adults and Life Satisfaction at Age 30: A Birth Cohort Study. Applied Research Quality Life (2024). https://doi.org/10.1007/s11482-024-10297-x

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"Baby Reindeer" and the Psychology of Attachment

Why we attach to abusive people..

Posted May 13, 2024 | Reviewed by Monica Vilhauer

• What Is Attachment?
• Find a therapist to strengthen relationships
• "Baby Reindeer" stages the conflict between authenticity and attachment needs.
• We often form negative or abusive attachments because we have learned to prioritize attachment at all costs.
• Getting in touch with our instinctive, protective needs can feel foreign and uncomfortable.

One of the strengths of the new Netflix show "Baby Reindeer" is the honest way that it depicts negative or abusive attachments.

In the series, the main character Donny develops two abusive relationships: one with a stalker and another with a groomer. In many cases where such relationships are represented, a film or TV show may provide hints or context clues as to how these dynamics happened, but in "Baby Reindeer," the character’s monologue presents an explicit and reflective take on the process through which Donny arrived to be in these situations. In so doing, it reveals a complex psychological tug of war between what Gabor Maté describes as the primal pull between “ authenticity ” and “ attachment ” needs.

Attachment Vs. Authenticity

In The Myth of Normal , Maté outlines a theory of attachment which, he argues, serves as our primary need as infants. Because we are dependent creatures from birth, we are “hard-wired” for attachment as a survival impulse; we have a need to be connected and interdependent with another human, usually a caretaker . When we are young and vulnerable, we do not have the option of selecting or discerning the quality of the attachment, since abandoning this would imperil our survival.

As a result, we often have to circumvent our authentic “gut” impulses about our attachment figures in order to stay attached. Better to have a bad attachment than none at all.

It is this struggle or conflict between an authentic “gut” impulse and an attachment need that is thematized so well in "Baby Reindeer," as we witness Donny in his inner monologue questioning and asking himself why he continued to go back to the abusive groomer’s apartment, or why he decided to “friend” a known stalker.

One answer to the question is that those weaned on negative attachments can lose the capacity or notion that they have agency or options in attachment situations. They are oriented primarily to what the other wants and become highly tuned in to accommodating the attachment under their terms. They lose touch with their inner radar system for the sake of the attachment.

This often translates into tolerating and accommodating a lot of bad behaviour from others, particularly under the fear of conflict, confrontation, and ultimately loss of the attachment. One of the common core beliefs experienced by those with negative early attachments is “I am responsible for other people’s feelings.” This often results in self-sacrificing behaviour for the sake of others and can make one vulnerable to abuse and manipulation.

This conflict-avoidance or people-pleasing is seen throughout "Baby Reindeer" as Donny works to manage and accommodate the bad moods experienced by his stalker. At the outset, he gets her a tea on the house instead of enforcing the rules of the bar. He takes personal and professional risks in order to smooth out the interpersonal situations and manage the feelings of Martha, instead of risking a scene that might be dramatic or conflict-laden. What might under some conditions look like a kind gesture, can be seen from Maté’s lens as a negation of his authentic, perhaps protective instinct to cast someone negative from the establishment.

The series then offers a working through and recalibration of his instincts and boundaries with the help (no surprise) of a girlfriend who is a therapist. The show, thus, reveals the importance of interpersonal relationships as a way to re-orient negative attachment patterns and re-draw healthy boundaries around abusive people.

It also shows the difficulty of re-training negative attachment, since what often feels familiar or comfortable is the abusive pattern, while what can feel foreign and strange is in fact the positive and healthy attachment, like the one Donny experiences with his new girlfriend Teri.

Maté, Gabor. The Myth of Normal. Toronto: Knopf, 2022.

Nicholas Balaisis is a Registered Psychotherapist in Ontario. He works with both individuals and couples and has specializations in CBT/ DBT, EFT couples therapy, trauma, CBT-I (insomnia), sex therapy, and existential psychotherapy.

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At any moment, someone’s aggravating behavior or our own bad luck can set us off on an emotional spiral that threatens to derail our entire day. Here’s how we can face our triggers with less reactivity so that we can get on with our lives.

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Secure attachment to both parents − not just mothers − boosts children’s healthy development

I magine a sudden rustle in the tall grass. A ripple of alarm passes through the group of early humans who live together amid ancient, rugged terrain. In the center of the encampment, a 3-year-old child – let’s call her Raina – stumbles and falls, her eyes wide with fear.

Without hesitation, her mother sweeps her up into her protective arms, while her grandmother quickly gathers herbs and leaves to create a pungent smokescreen to deter lurking predators. Simultaneously, Raina’s father and uncles move swiftly to the outskirts of the camp, their vigilant eyes scanning for signs of danger.

In this heart-pounding moment, Raina was enveloped in a web of care. Multiple caregivers worked seamlessly together, their collective efforts serving as a shield against the unknown threat that lurked beyond the safety of their campfire’s glow. It took a village to ensure Raina’s safety.

For at least 200,000 years, children grew up in a similar setting to Raina’s: a social environment with multiple caregivers . But 20th-century child psychologists placed almost exclusive importance on the mother-child bond. Research on children’s attachment relationships – the emotional ties they develop with their caregivers – and how they influence child development has had a mother-centric focus. Academic psychology’s emphasis on the child-mother relationship can be at least partly attributed to social norms about the appropriate roles of mothers and fathers . Whereas fathers have been characterized as the breadwinners, mothers have been thought of as more involved in the daily care of children.

We are clinical-developmental psychology and child and family researchers interested in studying how the quality of child-caregiver relationships affects children’s development. With 29 other researchers, we started a research consortium to study children’s attachment relationships. Together, we ask: How does having attachment relationships to both mothers and fathers affect children’s socioemotional and cognitive outcomes?

Mother-centric attachment research

Children develop attachment relationships with people whose presence around them is stable over time. For most children, these people are their parents.

Social scientists broadly classify attachment relationships as secure or insecure. A secure relationship with a specific caregiver reflects a child’s expectation that when they’re alarmed – as when emotionally or physically hurt – this caregiver will be available and emotionally supportive. In contrast, children who are uncertain about the availability of their caregivers in times of need are likely to form an insecure attachment relationship .

In the U.S. and Europe, where most attachment research has been conducted to date, the primary caregiver was frequently assumed to be the mother. Accordingly, researchers have almost exclusively focused on mothers as attachment figures. Mothers were also more accessible for researchers , and they more readily consented to participate in studies than fathers and nonparental caregivers such as grandparents and professional caretakers.

Furthermore, many researchers have assumed that there is a hierarchy within parental caregiving , wherein attachment with mothers is more important for understanding children’s development than attachment with caregivers considered “secondary,” such as fathers.

Already by the late 1980s, some scholars recognized the need to assess the joint impact of children’s attachment relationships with multiple caregivers on their developmental trajectories. But little research ensued. Recently, we revived such calls and proposed models that researchers can use to systematically assess the joint effects of children’s attachment to both mothers and fathers on an array of developmental outcomes.

Then, we recruited more than two dozen social scientists from eight countries who are interested in these questions around attachment relationships. Together, we formed the Collaboration on Attachment to Multiple Parents Synthesis consortium.

The more secure attachments the better

The first step our group took was compiling data collected by attachment researchers across the globe over the past 40 years. We identified previous research on the attachment relationships of more than 1,000 children with both their parents.

Instead of categorizing children as securely versus insecurely attached to one parent, we placed them into one of four groups:

• Children with secure attachment relationships to both mother and father.
• Children with secure attachment to mother and insecure attachment to father.
• Children with insecure attachment to mother and secure attachment to father.
• Children with insecure attachments to both parents.

In two separate studies, we assessed whether the children’s attachment to mother and father predicted mental health and language competence . In these studies, children’s attachment relationships were assessed by observing how they behaved during brief separations from each parent – for instance, in what psychologists call the strange situation procedure .

We found that children who simultaneously had secure attachment relationships with both mothers and fathers were likely to experience fewer symptoms of anxiety and depression and to exhibit better language skills than kids with one or no secure attachment relationships within their intact, two-parent families.

How might a child’s network of attachment relationships have these effects? While we couldn’t assess it in our study, there are various plausible mechanisms at play. For instance, think about a child with two secure attachment relationships to both mother and father who has trust in both parents that they will be there in challenging situations.

All children encounter sadness, anger and despair. But because a child with dual secure attachments can readily turn to their parents for help and support, negative emotions may be resolved quickly and not turn into defiance or depression. Because they have less of a need to monitor their parents’ whereabouts , this child may also be more adventurous and exploratory, giving them experiences to share and talk about. They might be exposed to a wider range and amount of verbal expression – helping expand their language skills.

Mothers aren’t the whole story

It is also important to note what we did not find: There was no hierarchy of importance in terms of which parent a child developed a secure attachment with. Children with secure attachment only to mothers (but not to fathers) and children with secure attachment only to fathers (but not to mothers) were not statistically different in their mental health and language competence outcomes.

These findings support an important takeaway: Mothers and fathers are equally important in raising children and setting them up for optimal developmental trajectories. In other words, it is the number of secure attachment relationships a child develops within the family network – not the specific gender of the adult with whom a secure relationship is developed – that matters.

Children have also been shown to thrive when developing secure attachment relationships in nontraditional families, such as those with same-sex parents . We thus expect that future studies will replicate our findings in nontraditional two-parent families.

Future research should also investigate other family networks that include nonparental caregivers, such as grandparents, who often take an active role in rearing children. In collectively oriented cultures, family households often comprise a wider network of attachment figures than the traditional two-parent households often found in the U.S., Canada and Europe. Studies in these cultures are likely to find that attachment networks may be more pertinent than research on single relationships when it comes to understanding children’s mental health and academic skills.

As the African proverb goes, it takes a village to raise a child. We are all descendants of children like Raina. Our findings highlight the critical need to adjust policy and early intervention efforts to support the parent couple and potentially other configurations of stable caregivers – not just mothers.

This article is republished from The Conversation , a nonprofit news site dedicated to sharing ideas from academic experts.

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Carlo Schuengel receives funding from the Netherlands Organisation for Health Research and Development (ZonMw) and from the Scientific Research Foundation (SWO)‘s Heeren Loo.

Or Dagan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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• About Adverse Childhood Experiences
• Risk and Protective Factors
• Program: Essentials for Childhood: Preventing Adverse Childhood Experiences through Data to Action
• Adverse childhood experiences can have long-term impacts on health, opportunity and well-being.
• Adverse childhood experiences are common and some groups experience them more than others.

What are adverse childhood experiences?

Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). Examples include: 1

• Experiencing violence, abuse, or neglect.
• Witnessing violence in the home or community.
• Having a family member attempt or die by suicide.

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding. Examples can include growing up in a household with: 1

• Substance use problems.
• Mental health problems.
• Instability due to parental separation.
• Instability due to household members being in jail or prison.

The examples above are not a complete list of adverse experiences. Many other traumatic experiences could impact health and well-being. This can include not having enough food to eat, experiencing homelessness or unstable housing, or experiencing discrimination. 2 3 4 5 6

Quick facts and stats

ACEs are common. About 64% of adults in the United States reported they had experienced at least one type of ACE before age 18. Nearly one in six (17.3%) adults reported they had experienced four or more types of ACEs. 7

Preventing ACEs could potentially reduce many health conditions. Estimates show up to 1.9 million heart disease cases and 21 million depression cases potentially could have been avoided by preventing ACEs. 1

Some people are at greater risk of experiencing one or more ACEs than others. While all children are at risk of ACEs, numerous studies show inequities in such experiences. These inequalities are linked to the historical, social, and economic environments in which some families live. 5 6 ACEs were highest among females, non-Hispanic American Indian or Alaska Native adults, and adults who are unemployed or unable to work. 7

ACEs are costly. ACEs-related health consequences cost an estimated economic burden of $748 billion annually in Bermuda, Canada, and the United States. 8

ACEs can have lasting effects on health and well-being in childhood and life opportunities well into adulthood. 9 Life opportunities include things like education and job potential. These experiences can increase the risks of injury, sexually transmitted infections, and involvement in sex trafficking. They can also increase risks for maternal and child health problems including teen pregnancy, pregnancy complications, and fetal death. Also included are a range of chronic diseases and leading causes of death, such as cancer, diabetes, heart disease, and suicide. 1 10 11 12 13 14 15 16 17

ACEs and associated social determinants of health, such as living in under-resourced or racially segregated neighborhoods, can cause toxic stress. Toxic stress, or extended or prolonged stress, from ACEs can negatively affect children’s brain development, immune systems, and stress-response systems. These changes can affect children’s attention, decision-making, and learning. 18

Children growing up with toxic stress may have difficulty forming healthy and stable relationships. They may also have unstable work histories as adults and struggle with finances, jobs, and depression throughout life. 18 These effects can also be passed on to their own children. 19 20 21 Some children may face further exposure to toxic stress from historical and ongoing traumas. These historical and ongoing traumas refer to experiences of racial discrimination or the impacts of poverty resulting from limited educational and economic opportunities. 1 6

Adverse childhood experiences can be prevented. Certain factors may increase or decrease the risk of experiencing adverse childhood experiences.

Preventing adverse childhood experiences requires understanding and addressing the factors that put people at risk for or protect them from violence.

Creating safe, stable, nurturing relationships and environments for all children can prevent ACEs and help all children reach their full potential. We all have a role to play.

• Merrick MT, Ford DC, Ports KA, et al. Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention — 25 States, 2015–2017. MMWR Morb Mortal Wkly Rep 2019;68:999-1005. DOI: http://dx.doi.org/10.15585/mmwr.mm6844e1 .
• Cain KS, Meyer SC, Cummer E, Patel KK, Casacchia NJ, Montez K, Palakshappa D, Brown CL. Association of Food Insecurity with Mental Health Outcomes in Parents and Children. Science Direct. 2022; 22:7; 1105-1114. DOI: https://doi.org/10.1016/j.acap.2022.04.010 .
• Smith-Grant J, Kilmer G, Brener N, Robin L, Underwood M. Risk Behaviors and Experiences Among Youth Experiencing Homelessness—Youth Risk Behavior Survey, 23 U.S. States and 11 Local School Districts. Journal of Community Health. 2022; 47: 324-333.
• Experiencing discrimination: Early Childhood Adversity, Toxic Stress, and the Impacts of Racism on the Foundations of Health | Annual Review of Public Health https://doi.org/10.1146/annurev-publhealth-090419-101940 .
• Sedlak A, Mettenburg J, Basena M, et al. Fourth national incidence study of child abuse and neglect (NIS-4): Report to Congress. Executive Summary. Washington, DC: U.S. Department of Health an Human Services, Administration for Children and Families.; 2010.
• Font S, Maguire-Jack K. Pathways from childhood abuse and other adversities to adult health risks: The role of adult socioeconomic conditions. Child Abuse Negl. 2016;51:390-399.
• Swedo EA, Aslam MV, Dahlberg LL, et al. Prevalence of Adverse Childhood Experiences Among U.S. Adults — Behavioral Risk Factor Surveillance System, 2011–2020. MMWR Morb Mortal Wkly Rep 2023;72:707–715. DOI: http://dx.doi.org/10.15585/mmwr.mm7226a2 .
• Bellis, MA, et al. Life Course Health Consequences and Associated Annual Costs of Adverse Childhood Experiences Across Europe and North America: A Systematic Review and Meta-Analysis. Lancet Public Health 2019.
• Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students — Adolescent Behaviors and Experiences Survey, United States, January–June 2021 | MMWR
• Hillis SD, Anda RF, Dube SR, Felitti VJ, Marchbanks PA, Marks JS. The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics. 2004 Feb;113(2):320-7.
• Miller ES, Fleming O, Ekpe EE, Grobman WA, Heard-Garris N. Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes. Obstetrics & Gynecology . 2021;138(5):770-776. https://doi.org/10.1097/AOG.0000000000004570 .
• Sulaiman S, Premji SS, Tavangar F, et al. Total Adverse Childhood Experiences and Preterm Birth: A Systematic Review. Matern Child Health J . 2021;25(10):1581-1594. https://doi.org/10.1007/s10995-021-03176-6 .
• Ciciolla L, Shreffler KM, Tiemeyer S. Maternal Childhood Adversity as a Risk for Perinatal Complications and NICU Hospitalization. Journal of Pediatric Psychology . 2021;46(7):801-813. https://doi.org/10.1093/jpepsy/jsab027 .
• Mersky JP, Lee CP. Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC pregnancy and childbirth. 2019;19(1). https://doi.org/10.1186/s12884-019-2560-8 .
• Reid JA, Baglivio MT, Piquero AR, Greenwald MA, Epps N. No youth left behind to human trafficking: Exploring profiles of risk. American journal of orthopsychiatry. 2019;89(6):704.
• Diamond-Welch B, Kosloski AE. Adverse childhood experiences and propensity to participate in the commercialized sex market. Child Abuse & Neglect. 2020 Jun 1;104:104468.
• Shonkoff, J. P., Garner, A. S., Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, & Section on Developmental and Behavioral Pediatrics (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663
• Narayan AJ, Kalstabakken AW, Labella MH, Nerenberg LS, Monn AR, Masten AS. Intergenerational continuity of adverse childhood experiences in homeless families: unpacking exposure to maltreatment versus family dysfunction. Am J Orthopsych. 2017;87(1):3. https://doi.org/10.1037/ort0000133 .
• Schofield TJ, Donnellan MB, Merrick MT, Ports KA, Klevens J, Leeb R. Intergenerational continuity in adverse childhood experiences and rural community environments. Am J Public Health. 2018;108(9):1148-1152. https://doi.org/10.2105/AJPH.2018.304598 .
• Schofield TJ, Lee RD, Merrick MT. Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment: a meta-analysis. J Adolesc Health. 2013;53(4 Suppl):S32-38. https://doi.org/10.1016/j.jadohealth.2013.05.004 .

Adverse Childhood Experiences (ACEs)

ACEs can have a tremendous impact on lifelong health and opportunity. CDC works to understand ACEs and prevent them.