Attachment is an emotional bond that is built over time with another person. The earliest bonds of connection are formed between children and their parents.
- What Is Attachment?
- Understanding Attachment
- Attachment At A Glance
- Attachment Theory
- Attachment Styles
- Importance Of Attachment Styles
- Impact Of Attachment
- Attachment Disorders
- Stages Of Attachment
- Childhood Attachment Patterns & Adult Relationships
- Attachment And Mental Health
- How To Develop A Secure Attachment Style
- Coping With Attachment
What Is Attachment?
Attachment is a special and deep emotional connection between two individuals. It is referred to as a lasting affectional bond and psychological connectedness between two people. It is typically formed by repeated emotional transactions or behaviors which helps in maintaining a particular proximity level to a specific person, identified as the attachment figure. People who feel attached to each other seek closeness with the other person, especially when feeling afraid or sad, as they feel safe and secure in their presence. A person may feel relieved and comforted when their attached figure responds to them and meets their emotional needs. This can also reduce feelings of distress in a person and make them rely on their attached figure. However, when the response from the attachment figure fails to meet their emotional needs, the person may feel neglected, foolish and stressed. It can also make the person suppress their emotions and feel isolated. It is considered a primal need and is associated with the hormone oxytocin.
According to a 2012 study 1 , it is “a basic human need for a close and intimate relationship,” between two individuals, especially between infants & caregivers. It is believed to be the means by which an infant asks their caregiver to meet their primary needs. Eventually, this becomes a driving force for the infant’s cognitive, emotional & social development. It also helps to develop a child’s coping system, stimulates brain development and impacts their ability to build relationships with others. “Attachment can be understood as being the enduring emotional closeness which binds families in order to prepare children for independence and parenthood,” explains a 2007 study 2 .
It is believed to be a psychobiological principle firmly based on evolutionary development. Not only is it a driving factor in individual development but also significantly contributes in ensuring the survival of our community. Apart from encouraging and guiding the primary transactions between the infant and the parents, it also motivates attunement & regulation of moods, feelings, and attitudes. Depending on the pattern of the bonding, a relational context is formed which determines the cognitive, emotional and social development of the infant in later life. It can greatly affect the psychological functions of mentalization & empathy and personal relationships of the child well into adulthood.
Parents have a significant impact on a child’s life because humans form their first emotional bond as a child with their parents. When children have close proximity to their parents they tend to seek comfort and protection from them. These bonds can also occur between two adults. As humans, our biological aim is survival and our psychological aim is security. Our ability to get attached stems from our intense desire for security. A 1990 study 3 pointed out that attachment is a product of evolutionary processes. Early childhood experiences largely influence the development of the brain and the ability to form stable relationships with others. Experts believe that it is a primary need for every individual. The network of neurons in the brain is dedicated to set our emotional bonding in motion and a hormone, oxytocin that accelerates the process.
According to a 2004 study 4 , it is a particular and limited aspect of the infant-parent/caregiver relationship which is characterized by making the infant feel protected, secure and safe. However, it should be noted that it is different from ‘bonding’. Bonding doesn’t affect an infant’s later emotional and social outcomes, but attachment can predict various facets of the child’s future. “Attachment is where the child uses the primary caregiver as a secure base 5 from which to explore and, when necessary, as a haven of safety and a source of comfort,” explains the study. Hence, it is imperative that parents focus on building a positive and healthy relationship with their child as disordered parental relationships 6 can result in behavior problems, poor performance, low self-esteem and relationship difficulties when the child grows up. In fact, research 7 shows that serious emotional neglect or adverse & traumatic experiences in early life “may lead to different levels of security versus insecurity or disorientation-disorganization of the attachment pattern,” which can affect neurobiological regulation.
Attachment At A Glance
- Attachment is an emotional bond that is built over time with another person. The earliest bonds of connection are formed between children and their parents.
- Attachment theory explains positive maternal-infant attachment as a dyadic relationship between the infant and mother that provides the infant with a secure base from which to explore the world.
- Attachment styles help a child to increase their independence when they are securely attached to their parents.
- Parents play a significant role in shaping the child’s attachment behaviors.
- Attachment disorder is a condition characterized by the inability to form meaningful relationships and an emotional connection with others.
- Our attachment styles dictate how we bond with other people and how we respond when we separate from them.
- Abuse and neglect in childhood can affect attachment styles in adulthood.
- Attachment is an infant’s first coping mechanism because it sets up a mental representation of the caregiver in the infant’s mind.
It is an evolutionary and psychological theory that is concerned with the bonds and relationships people share with others. This can be either between romantic partners or parents and children. Originally developed by British psychologist John Bowlby, the notion indicates that children must form a close bond with at least one parent or primary caregiver for effective cognitive, emotional and social development. Considered as “one of the most important achievements 8 of contemporary psychology,” the concept is described as “lasting psychological connectedness between human beings,” by Bowlby. He proposed that the attached behaviors of children are part of an evolved behavioral system that helps to ensure that they are cared for.
“Attachment theory explains positive maternal-infant attachment as a dyadic relationship between the infant and mother that provides the infant with a secure base from which to explore the world,” states a 2010 study 9 . According to this theory, an infant would primarily seek proximity to an attachment figure during stressful situations. Infants tend to become attached to adults who are sensitive and responsive as parents consistently attend to their child’s needs from six months to two years of age. After this period, children begin to view their parents as a secure source. As they grow older, they tend to explore and return to their secure base. Parental responses are largely responsible for the development of patterns of such behavior. These responses will guide the child’s feelings, thoughts, and expectations in later relationships.
It refers to the way we relate to others, especially our attachment figures. It is how we interact, react, respond and behave in relationships. The styles are associated with the expectations we have from relationships with loved ones and depend on the initial bonding we shared with our primary caregivers or parents as infants. These patterns or styles tend to develop from an early age. However, it tends to remain the same even in adulthood and influences intimate & social relationships as well as our own parenting styles. According to a 2016 study 10 , “An attachment style refers to the relational behaviors that occur between the individuals and their primary caregivers to get their basic needs met (initially) and then to develop a schema (or response set) for interacting with the world (and others) around them.”
There are four major styles that people tend to form early in life and continue to engage in it even during adulthood. These include –
Secure attachment is the emotional bond that is formed when a parent constantly responds to their child’s every need and ensures that the child feels secure, understood, and calm. They often get upset when their parents leave and tend to be happy when they return. When a child forms this connection they become certain that their parents will be responsive to their needs and desires. The child feels more secure and confident to interact with the outside world. It is considered as the most adaptive style. In a 2004 study 11 , researchers Marlene M Moretti, PhD and Maya Peled, MA explain that “Secure attachment is associated with less engagement in high risk behaviours, fewer mental health problems, and enhanced social skills and coping strategies.”
2. Dismissive avoidant
The dismissive avoidant bond is formed when a parent fails to meet their child’s needs emotionally. Parents who are unreliable tend to leave a deep subconscious fear of intimacy in their child’s mind. Children with dismissive avoidant parents tend to see an emotional connection as unnecessary. They don’t have access to emotional memories due to their defensive shield of self-esteem and self-sufficiency that makes them believe that they don’t need others. This also makes them suppress their negative memories. According to a recent scientific analysis 12 , “Children who develop an ‘avoidant’ attachment pattern are thought to maintain proximity to their caregiver by ‘down-regulating’ their attachment behaviour: they appear to manage their own distress and do not strongly signal a need for comfort”
3. Anxious/ Preoccupied
The development of an anxious/preoccupied style is associated with an inconsistent parenting style. The child receives mixed signals and ends up getting confused about their relationship with their parents. A child with this style of bond with their parents tends to be anxious when they are separated from their parents. They are hard to console even after the caregiver has returned. As they grow into adulthood, they tend to develop anxiety and may need constant reassurance and affection from their partner. Adults growing up with this pattern tend to think highly of others but often suffer from low self-esteem. A 2009 study 13 suggested that this pattern may contribute to cognitive vulnerability to depression. “Anxious-avoidant children are reluctant to approach their parents even when distressed, because they fear their overtures for comfort will be rejected or punished,” add researchers Moretti and Peled.
4. Fearful avoidant
Fearful avoidant style, also known as disorganized pattern, is a blend of anxious preoccupied and dismissive-avoidant features. Individuals belonging to this pattern believe that they are unworthy of love. This is mostly due to severe childhood trauma, emotional neglect, or abuse. Exposure to such trauma can have long-term damaging effects that can change the sensitivity and emotional regulation of the brain. The parents of such children may have been physically violent, abusive, suffering from PTSD, or been severely depressed.
When the child sought comfort they were met with a frightened or abusive parent. Due to this, the children often go through extreme highs or lows, and as adults, they become unpredictable, erratic, or bizarre. They may also resort to dissociation as a coping strategy. Studies 14 have found that inconsistent behavior from parents can be a crucial factor that leads to the development of this attachment style.
Read More About Attachment Styles Here
Importance Of Attachment Styles
Babies and young children are entirely reliant on their parents for attending to all their needs. The bonding formed in the early years play a significant role in future relationships. Since forming an emotional bond is a survival need, every child forms some sort of attachment with their parents. It plays a critical role in establishing a mental foundation that will dictate how the child feels about themselves. According to a 2019 study 15 , “For the growth of mentally and physically healthy individuals, the mother is expected to create a suitable attachment starting before the birth and to maintain it afterwards. It is also necessary for the baby to establish appropriate and safe attachment towards the mother in a similar manner.”
This can help a child to increase their independence when they are securely attached to their parents. This connection allows the child to be more confident and self-reliant. It is an essential element that can have a significant impact on the way a child forms bonds and interacts with others as adults. Children with secure attachments are best equipped to form strong emotional bonds as adults. The child is reaffirmed by their parents that they are worth being cared for. Hence, they develop a sense of confidence and feel comfortable that their needs will be met.
Impact Of Attachment
A young child lacks the ability to express their needs to their caregivers. So children often communicate through behavior. Parents play a significant role in shaping the child’s attachment behaviors. According to John Bowlby’s theory 1 , a child is “attached” to someone when he or she is “strongly disposed to seek proximity to and contact with a specific figure and to do so in certain situations, notably when he is frightened or ill”. Research suggests that most infants have secure attachments with their mothers. A child’s behaviors largely depend on how parents comfort and communicate with them when they are upset or ill. Parental attachment styles also have a crucial impact on the development of psychiatric manifestations in school-aged children. One 2006 study 16 found that “Parental insecure attachment was associated with the development of the psychopathologies and psychiatric illness of their children.”
A child who is ignored by their parents often misbehaves as a way to seek attention. When parents respond to those attention-seeking misbehaviors with anger or screams, it inadvertently reinforces that behavior. Instead of this, rewarding the child’s appropriate behaviors with praise and hugs can be more effective. Hence, it is important to pay attention when the child displays different behavior to communicate their needs. Children who are diagnosed with oppositional defiant disorder, conduct disorder or post-traumatic stress disorder often display attachment issues due to abuse, neglect, or trauma. Researchers 17 suggest that children adopted after the age of six months are at greater risk for developing these conditions.
The quality of how a child gets attached early in life can also have a serious impact on future relationships that the child may have. Children who are securely attached tend to have high self-esteem and have strong romantic relationships. A 2019 study 18 found that children who were securely attached tend to be more independent, have better academic performance, successful social relationships, and tend to experience less depression and anxiety.
It is a condition characterized by the inability to form meaningful relationships and an emotional connection with others. It refers to an atypical assemblage of behaviors in children who are unable to build secure attachments with caregivers or parents. “Attachment disorders denote two very specific and rare forms of diagnosable mental disorders identified by the ICD-10 and DSM-5,” explains a 2019 study 19
The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) recognized the following two main types of such disorders:
1. Reactive Attachment Disorder (RAD)
This condition is identified 20 as “a trauma- and stressor-related condition of early childhood caused by social neglect and maltreatment.” It is a persistent pervasive behavior pattern marked by intensely withdrawn behavior from the child. It is characterized by a tendency to avoid any signs of attached behavior towards their parents or caregivers. Children with RAD rarely seek proximity or respond to comfort from parents even when they are upset. They are also typically unresponsive to others, experience irritability, fearfulness, extreme sadness and a lack of positive affect. Diagnosis of the condition requires clear evidence of neglect or constant change in caregivers, like different foster care placements. Moreover, the symptoms should be observed by the time the child is 5 years old.
2. Disinhibited Social Engagement Disorder (DSED)
Also known as disinhibited attachment disorder, this condition refers to an intense and persistent tendency to avoid displaying any appropriate cautiousness towards strangers or unfamiliar adults. The child may tend to show overfriendliness with unknown adults and may be unable to follow common social boundaries. Children with DSED 21 tend to approach strangers without any hesitation. They often wander off and hug or touch unknown adults easily. They may interact with a stranger, physically or verbally, without any inhibition and may even ignore their caregiver when in an unfamiliar location. Diagnosis requires clear evidence of pathogenic care. It is usually diagnosed in children between the ages of 9 months to 5 years.
One 2018 study 22 has found that limiting the amount of time a child spends in “institutions and preserving placements,” can help to cope with DSED symptoms among children who were institutionalized previously.
Stages Of Attachment
An emotional bond develops through everyday interactions as the parent attends to their infant’s needs. The bond is at its peak during the first year of the child’s life. It has been observed that a child goes through a few basic stages over the course of their childhood.
Based on a longitudinal study, the following stages have been identified:
1. Asocial or Pre-attachment stage (Birth to 3 months)
During this stage, children may not develop any attachment with their parents or primary caregivers. It usually spans from birth to the first 6 weeks of life. Infants tend to prefer looking at the faces and listening to voices of their primary caregivers and others. Although they may respond to different stimuli from different people, they may be unable to distinguish one person from the other. After the 6 week mark, smiling human faces may encourage babies to smile happily and make eye contact. Identified as ‘social smiling’ 23 by Bowlby, it increases the likelihood that the primary caregiver will respond to the needs of the baby with love and kindness, which will strengthen positive bonding and how they feel attached. The infant’s behavior, such as crying, jabbering and grasping their caregiver is directed at promoting bonding, attachment and emotional investment by the parent.
2. Indiscriminate Attachment (6 weeks to 7 months)
This phase, which lasts from 6 weeks to 6-8 months, is regarded as the ‘attachment in the making’ phase. When babies are around 3 months of age, they start to prefer human company and are able to distinguish between different people. Even though they are indiscriminately comforted, infants can display bonding behaviors specifically with their primary caregiver or those they recognize and prefer. However, they may behave differently around strangers. Their preferred people will be better able to comfort them when they are crying. According to Bowlby, the preferences of the baby may be limited to around 3 individuals, with a particular person being the favorite which in most cases is the mother. During this stage, infants tend to develop trust that the parents will respond to their needs. They also tend to get upset when their caregiver doesn’t interact with them.
3. Specific or Discriminate Attachment (7 months to 11 months)
Spanning from 6-8 months to 18-24 months, this stage marks the development of clear patterns of being attached. When an infant becomes 6 months old, their preference for a particular person becomes stronger. They can experience separation anxiety when that individual is not present nearby. Moreover, they may also attempt to follow that person around once they learn crawling. Once the child sees their favorite caregiver after being absent for some time, the child may appear enthusiastic and happy. They tend to seek security, comfort, and protection from their primary caregivers. During this stage, the child may also become cautious of strangers and may cry in unknown surroundings. When the infant becomes one year old, they may develop a clear attachment with their favorite person depending on how sensitively that person responds to the child’s needs.
4. Multiple Attachments (24 months+)
This stage is regarded as a goal-corrected partnership phase and may manifest when the child is around 24 months until the end of childhood. It was observed by Bowlby that when children are around 3 years of age, they begin to realize and understand that their primary caregivers or parents have their own needs, goals and life. Hence, the child may feel less anxious when their parents are not around for a period of time. Moreover, they may also start building bonds with other people they recognize and prefer, apart from their caregivers or parents. The infant may become increasingly independent and tends to form several attachments with others, like grandparents, siblings, peers or neighbors.
Childhood Attachment Patterns & Adult Relationships
Our childhood experiences are crucial to our emotional development. Our parents play a significant role in how we experience the world because our emotional foundation is formed during childhood. When a child grows up in an insecure environment, they become adults who struggle with feelings of low self-worth and confidence. They also fail to regulate their emotions in a given situation. A 2012 study 24 pointed out that children who are not securely attached to their parents have an increased risk of developing anxiety and depression.
According to a 2017 study 25 , highly avoidant & anxious people have been found to be less inclined to think, feel & behave in accordance with their insecure bonding models while they are dependent on their romantic partners or engaged with committed partners 26 . The researchers found that highly anxious individuals may not always behave in a demanding or clingy manner in relationships. Moreover, they may be less likely to use dysfunctional conflict resolution tactics. Instead, they may reveal anxiety symptoms in stressful situations, particularly those that threaten the quality or stability of their intimate relationships. Moreover, highly avoidant individuals are not necessarily withdrawn, unsupportive or uncooperative in relationships. The study explains that “the defining attributes of avoidance are elicited by certain types of stressful situations,” such as sharing deep personal emotions, being emotionally intimate or receiving or giving support.
Research has also found that there is a significant relationship between attachment style formed through early family environment and marital satisfaction. A 2016 study 27 revealed that avoidant insecure & ambivalent insecure styles can severely affect adult romantic relationships. The researchers identified “a meaningful negative relationship between insecure attachment avoidant and insecure attachment anxious-ambivalent styles and marital satisfaction.” Another 2019 study 28 indicates that our bonding with parents and others often plays a vital role in shaping our romantic relationships, based on gender. However, it can also affect our degree of aggressiveness. Childhood experiences lay the foundation of how we perceive our future relationships. Our attachment styles dictate how we bond with other people and how we respond when we separate from them. Hence, it is essential to understand how your childhood experiences have shaped your personality. This will help you to improve your relationships in the future.
Attachment And Mental Health
There is no doubt that childhood relationships are associated with the cognitive development of the child and can severely affect their behavior in adulthood. It has been observed that abuse and neglect in childhood can affect attachment styles in adulthood. Moreover, it can also have certain negative mental health outcomes and lead to a number of psychiatric disorders later in adulthood. According to a 2018 study 29 , secure attachment is related to positive mental health and psychological well-being. However, “children with insecure attachments, compared to those with secure attachments, were more likely to manifest psychopathology in adulthood and to engage in risky behaviors.” The insecure style is also associated with lower levels of self-esteem, a higher risk of developing depression, anxiety and other psychological issues among adults. It can also determine our personality development as well.
Some researchers 30 have found that the avoidant style can lead to major depression and post-traumatic stress disorder (PTSD). However, it was found that female partners are more likely to experience PTSD symptoms than male partners. Another 2014 study 31 found that individuals with securely attached relationships are “less likely to develop posttraumatic stress symptoms.” Studies 32 have also found that attachment style is associated with “suicide ideation and attempt” in adults.
How To Develop A Secure Attachment Style
It is possible to rewire your brain and find self-compassion if you had a difficult childhood. Some of the things you can do to develop a more secure attachment style are as follows:
1. Build your self-esteem
Changing your attachment style can be challenging. Hence, the best way to get started is by focusing on developing a stronger sense of self. Show kindness to yourself and practice self-forgiveness to overcome unhealthy patterns of the past. Rebuild your self-esteem by avoiding self criticism, shame and negative self-talk. It is also important to practice self-love by making yourself a priority. Tell yourself that you are worthy of all the love you receive from all your relationships.
2. Become aware of yourself
Gain self-awareness and try to understand your own thoughts and feelings. Once you become aware of your own emotions, you will be able to accept them despite how difficult they may be. Self-acceptance is a crucial step and is directly related to stronger self-esteem and self-confidence. Assessing your innermost thoughts and feelings is essential to ensure that you don’t keep falling into the same patterns for the rest of your life.
3. Accept your attachment style
If you currently have an insecure pattern in your relationships, then start by acknowledging it. By identifying the drawbacks of your insecure style, you will be better able to realize what you need to change and shift your focus appropriately. It will also enable you to identify your own needs and find healthier ways to meet them and maintain more positive relationships. If you are avoidant, then take deliberate steps to strengthen relationships with loved ones and focus on meeting their emotional needs without compromising your own.
4. Do the things you love
Learn to work on the things you already love and gain mastery over them. Spend more time doing the things you love as it will help you develop a more positive mindset and experience self-love and passion. Once you enter a state of flow and be mindful, you will feel more in control of your life and your emotions.
5. Try things out of your comfort zone
Building self-esteem requires both patience and courage. You will only feel proud of yourself when you push yourself out of your comfort zone. You will feel stronger when you accomplish the task you set out to do. This will help you gain confidence in yourself and overcome toxic mental boundaries.
6. Focus on your physical wellness
When you work on your physical health, it strengthens your mind too. It nurtures your physical and emotional health and builds your confidence. Studies 33 have found that regular physical activity can enable people with lower self-esteem to boost their sense of self-worth. Researchers 34 have also found that “exercise has positive short-term effects on self-esteem in children and young people.” Focusing on self-care can significantly help to improve your emotional stability and strength.
7. Analyze your deeper self
Make sure to practice positive self-talk. Sometimes the way you speak to yourself in your head tends to be harsh and critical. It is important to be aware of your self-talk and inculcate new ideas. In case you are hard on yourself, try asking yourself whether you would speak to someone else in the same way. If not, then show yourself the same kindness and compassion you would give to someone else.
8. Talk to someone
If you have difficulty in connecting with people or if you are unable to overcome unhealthy patterns in your relationships, then find the courage to talk openly and honestly with someone. Withdrawing from others, isolating yourself or repressing your emotions can make things worse. Talking with a trusted loved one can not only help you open up but also enable you to gain new perspectives which is essential for developing a new, more secure attachment style. It can also help to consult a doctor or therapist, if needed.
Coping With Attachment
Attachment is an infant’s first coping mechanism because it sets up a mental representation of the caregiver in the infant’s mind. This allows the infant to separate from their caregiver and explore the world around them without being upset. Hence, it is essential for parents to pay attention to their child’s upbringing to ensure that they grow into responsible and secure adults.References:
- Hong, Y. R., & Park, J. S. (2012). Impact of attachment, temperament and parenting on human development. Korean journal of pediatrics, 55(12), 449–454. https://doi.org/10.3345/kjp.2012.55.12.449
- Rees C. (2007). Childhood attachment. The British journal of general practice : the journal of the Royal College of General Practitioners, 57(544), 920–922. https://doi.org/10.3399/096016407782317955
- Draper, P., & Beisky, J. (1990). Personality development in evolutionary perspective. Journal of Personality, 58(1), 141-161. https://doi.org/10.1111/j.1467-6494.1990.tb00911.x
- Benoit D. (2004). Infant-parent attachment: Definition, types, antecedents, measurement and outcome. Paediatrics & child health, 9(8), 541–545. https://doi.org/10.1093/pch/9.8.541
- Waters E, Cummings EM. A secure base from which to explore close relationships. Child Dev. 2000 Jan-Feb;71(1):164-72. doi: 10.1111/1467-8624.00130. PMID: 10836570.
- Rees CA. Thinking about children’s attachments. Arch Dis Child. 2005 Oct;90(10):1058-65. doi: 10.1136/adc.2004.068650. PMID: 16177163; PMCID: PMC1720124.
- Lahousen, T., Unterrainer, H. F., & Kapfhammer, H. P. (2019). Psychobiology of Attachment and Trauma-Some General Remarks From a Clinical Perspective. Frontiers in psychiatry, 10, 914. https://doi.org/10.3389/fpsyt.2019.00914
- Moghadam, M., Rezaei, F., Ghaderi, E., & Rostamian, N. (2016). Relationship between attachment styles and happiness in medical students. Journal of family medicine and primary care, 5(3), 593–599. https://doi.org/10.4103/2249-4863.197314
- Flaherty, S. C., & Sadler, L. S. (2011). A review of attachment theory in the context of adolescent parenting. Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners, 25(2), 114–121. https://doi.org/10.1016/j.pedhc.2010.02.005
- Mohammadi, K., Samavi, A., & Ghazavi, Z. (2016). The Relationship Between Attachment Styles and Lifestyle With Marital Satisfaction. Iranian Red Crescent medical journal, 18(4), e23839. https://doi.org/10.5812/ircmj.23839
- Moretti, M. M., & Peled, M. (2004). Adolescent-parent attachment: Bonds that support healthy development. Paediatrics & child health, 9(8), 551–555. https://doi.org/10.1093/pch/9.8.551
- National Collaborating Centre for Mental Health (UK). Children’s Attachment: Attachment in Children and Young People Who Are Adopted from Care, in Care or at High Risk of Going into Care. London: National Institute for Health and Care Excellence (UK); 2015 Nov. (NICE Guideline, No. 26.) 2, Introduction to children’s attachment. Available from: https://www.ncbi.nlm.nih.gov/books/NBK356196/
- Lee, A., & Hankin, B. L. (2009). Insecure attachment, dysfunctional attitudes, and low self-esteem predicting prospective symptoms of depression and anxiety during adolescence. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 38(2), 219–231. https://doi.org/10.1080/15374410802698396
- Reisz, S., Duschinsky, R., & Siegel, D. J. (2017). Disorganized attachment and defense: Exploring John Bowlby’s unpublished reflections. Attachment & Human Development, 20(2), 107-134. https://doi.org/10.1080/14616734.2017.1380055
- Karakaş, N. M., & Dağlı, F. Ş. (2019). The importance of attachment in infant and influencing factors. Turk pediatri arsivi, 54(2), 76–81. https://doi.org/10.14744/TurkPediatriArs.2018.80269
- Yoo HI, Kim BN, Shin MS, Cho SC, Hong KE. Parental attachment and its impact on the development of psychiatric manifestations in school-aged children. Psychopathology. 2006;39(4):165-74. doi: 10.1159/000092677. Epub 2006 Apr 11. PMID: 16612136.
- Niemann, S., & Weiss, S. (2011). Attachment Behavior of Children Adopted Internationally at Six Months Post Adoption. Adoption quarterly, 14(4), 246–267. https://doi.org/10.1080/10926755.2011.628262
- Spruit, A., Goos, L., Weenink, N. et al. The Relation Between Attachment and Depression in Children and Adolescents: A Multilevel Meta-Analysis. Clin Child Fam Psychol Rev 23, 54–69 (2020). https://doi.org/10.1007/s10567-019-00299-9
- Turner, M., Beckwith, H., Duschinsky, R., Forslund, T., Foster, S. L., Coughlan, B., Pal, S., & Schuengel, C. (2019). Attachment difficulties and disorders. InnovAiT, 12(4), 173. https://doi.org/10.1177/1755738018823817
- Ellis EE, Yilanli M, Saadabadi A. Reactive Attachment Disorder. [Updated 2020 Nov 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537155/
- Minnis H. What Happens to Disinhibited Social Engagement Disorder Over Time? J Am Acad Child Adolesc Psychiatry. 2018 May;57(5):304-305. doi: 10.1016/j.jaac.2018.03.001. PMID: 29706157.
- Guyon-Harris, K. L., Humphreys, K. L., Fox, N. A., Nelson, C. A., & Zeanah, C. H. (2018). Course of Disinhibited Social Engagement Disorder From Early Childhood to Early Adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 57(5), 329–335.e2. https://doi.org/10.1016/j.jaac.2018.02.009
- Field, C. (2011). Bowlby’s stages of attachment. Encyclopedia of Child Behavior and Development, 275-277. https://doi.org/10.1007/978-0-387-79061-9_398
- Mikulincer, M., & Shaver, P. R. (2012). An attachment perspective on psychopathology. World psychiatry : official journal of the World Psychiatric Association (WPA), 11(1), 11–15. https://doi.org/10.1016/j.wpsyc.2012.01.003
- Simpson, J. A., & Steven Rholes, W. (2017). Adult Attachment, Stress, and Romantic Relationships. Current opinion in psychology, 13, 19–24. https://doi.org/10.1016/j.copsyc.2016.04.006
- Tran S, Simpson JA. Prorelationship maintenance behaviors: the joint roles of attachment and commitment. J Pers Soc Psychol. 2009 Oct;97(4):685-98. doi: 10.1037/a0016418. PMID: 19785486.
- Mohammadi, K., Samavi, A., & Ghazavi, Z. (2016). The Relationship Between Attachment Styles and Lifestyle With Marital Satisfaction. Iranian Red Crescent medical journal, 18(4), e23839. https://doi.org/10.5812/ircmj.23839
- Santona, A., De Cesare, P., Tognasso, G., De Franceschi, M., & Sciandra, A. (2019). The Mediating Role of Romantic Attachment in the Relationship Between Attachment to Parents and Aggression. Frontiers in psychology, 10, 1824. https://doi.org/10.3389/fpsyg.2019.01824
- Widom, C. S., Czaja, S. J., Kozakowski, S. S., & Chauhan, P. (2018). Does adult attachment style mediate the relationship between childhood maltreatment and mental and physical health outcomes?. Child abuse & neglect, 76, 533–545. https://doi.org/10.1016/j.chiabu.2017.05.002
- Gallagher HC, Lusher D, Gibbs L, Pattison P, Forbes D, Block K, Harms L, MacDougall C, Kellett C, Ireton G, Bryant RA. Dyadic effects of attachment on mental health: Couples in a postdisaster context. J Fam Psychol. 2017 Mar;31(2):192-202. doi: 10.1037/fam0000256. Epub 2016 Nov 21. PMID: 27869452.
- Okello, J., Nakimuli-Mpungu, E., Musisi, S., Broekaert, E., & Derluyn, I. (2014). The association between attachment and mental health symptoms among school-going adolescents in northern Uganda: the moderating role of war-related trauma. PloS one, 9(3), e88494. https://doi.org/10.1371/journal.pone.0088494
- Palitsky D, Mota N, Afifi TO, Downs AC, Sareen J. The association between adult attachment style, mental disorders, and suicidality: findings from a population-based study. J Nerv Ment Dis. 2013 Jul;201(7):579-86. doi: 10.1097/NMD.0b013e31829829ab. PMID: 23817155.
- Zamani Sani, S. H., Fathirezaie, Z., Brand, S., Pühse, U., Holsboer-Trachsler, E., Gerber, M., & Talepasand, S. (2016). Physical activity and self-esteem: testing direct and indirect relationships associated with psychological and physical mechanisms. Neuropsychiatric disease and treatment, 12, 2617–2625. https://doi.org/10.2147/NDT.S116811
- Ekeland E, Heian F, Hagen KB, Abbott J, Nordheim L. Exercise to improve self-esteem in children and young people. Cochrane Database Syst Rev. 2004;(1):CD003683. doi: 10.1002/14651858.CD003683.pub2. PMID: 14974029.