HOW WOULD ATTACHMENT STYLES EFFECT MENTAL HEALTH PRESENTATIONS

It is generally agreed that people with an insecure attachment style (especially disorganised) are more like to develop mental health difficulties. The flavour of the mental health difficulty might differ according to the attachment style

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Anxiety and Depression

For example, someone with an ambivalent attachment style or using coercive strategies (according to the DMM model) might be most anxious about relationships. They might find themselves constantly worrying about what a friend they were talking earlier on that day was thinking of them, and whether they might have said something that upset them. They find themselves constantly sending text messages seeking reassurance. The fear of abandonment can become intense, and so they may be more prone to depression if they find that a relationship has broken down.

Those with an avoidant attachment style, or who uses compulsive strategies, might get anxious about their compulsive strategies not working. For example, someone who has learnt to obey others in order to get along, might be especially about getting into trouble. Someone who has developed strategies of impressing others through achievement might become anxious about not achieving. If for example a high achiever does not meet his or her own expectations, then he could become prone to depression.

Johnson, S. M. (2019). Attachment Theory in Practice: Emotionally Focused Therapy (EFT) with Individuals, Couples, and Families. United States: Guilford Publications. Pg 11.

Personality Disorders

There has been a lot of talk as to whether the term ‘personality disorder’ is a helpful term. Some people don’t mind the diagnosis, whereas others don’t like to be told that their personality is ‘disordered’. In fact, when we look at people with a diagnosis of ‘personality disorder’, you could actually say that the way their personality is actually makes complete sense given the circumstances they had to endure.

Regardless of the term, those people who tend to stick to themselves, or who on the surface appear to be more concerned about order and routine than relationships, may be more likely to have an avoidant attachment style. Those people who are more often thinking about what others think of them and who are often worried about being rejected may be more likely to have an ambivalent attachment style.

Psychosis

Psychosis is what is most commonly associated with severe mental illness. These are people whose idea of reality becomes distorted. They almost always need medication and a stay in hospital. Some researchers have suggested that the type of attachment someone has effects the type of psychosis they may develop.

Let’s imagine someone with an avoidant attachment style, or who according to the DMM model uses compulsive strategies. I mentioned before that these people may suppress negative emotions. One of those could be for example anger. Let’s say they have had an abusive parent. They start to have feelings of anger, but they have learnt that it wasn’t safe to express those or to even feel those, so they learnt to suppress those feelings and their associated thoughts. In extreme cases, they may completely disown those thoughts or feelings as belong to them. Meanwhile, the more they suppress them, the more those thoughts intensify in the background. Gradually, a thought such as “I hate my parent” can grow in intensity, so that it eventually transforms into a thought ‘kill your parent’. The person by this stage is unable to accept that the thought come from within themselves, so the thought is instead experienced as a voice as coming from outside of them which causes great distress. For this reason, some have associated hearing voices with an avoidant attachment or compulsive attachment strategies.

On the other side, let’s reconsider those with an ambivalent attachment style or who uses coercive attachment strategies. From their childhood, these people have found it hard to trust that others will be available for them. As they grow older, they may have more experiences of being let down by others, or even of others taking advantage of them. They may start to develop paranoid thoughts, which can become paranoid delusions, or fixed beliefs about people being out to hurt them.

These ideas are more ideas than established facts at this point, but if you are interested, you can read more in this very in depth article:

A Dynamic-Maturational Framework for the Study of Psychosis and Attachment Theory - Alexander H. Jack, Stephanie Wilson, 2022 (sagepub.com)

APPLICATION TO TREATMENT

When someone with a mental illness comes to treatment, understanding their attachment can help make sense of how the mental illness came to be. This can help fine tune the type of treatment they receive, especially in regards to helping the families of the client provide what the client needs the most to both help the client in the present situation as well as to reduce the chances of relapse in the future.