Influence of Attachment on Adult Affective Disorders

Katherine Rogers Rosinsky

HD 300 - Early Childhood Themes and Life Cycle Issues

April 19, 2016

Influence of Attachment on Adult Affective Disorders


Depression and anxiety are the most common affective disorders afflicting

American adults today. An estimated 16 million have suffered an episode of depression

and approximately 40 million will experience an anxiety disorder at some point. What’s

more, the two disorders often occur together (NAMI, 2015). Slightly less common is

bipolar disorder, another affective disorder affecting close to 2.6 million Americans

(NAMI, 2015). Among the many possible causes of anxiety, depression, and bipolar

disorder are trauma (both physical head trauma and emotional trauma), environment, and

genetics (NAMI, 2015). Additionally, research correlates insecure attachment styles with

affective disorders, drawing a clear path to early parental and caregiver relationships

(Gerhardt, 2015; Mileva-Seitz 2015).

Attachment styles are learned from early childhood interactions with primary

caregivers. Infants are born with the innate ability to search for meaning in the facial

expressions of their doting parents. These intimate moments pave the way for the

complex neural connections necessary for optimal brain development. Without these

moments, as in cases of neglect or abuse, the connections are not made. These early

experiences create a template in the brain—an internal working model—that dictates how

we behave and interact with others later in life. In other words, parents and caregivers

are, quite literally, shaping infants brains by how they interact--or don’t interact--with


The following literature review will discuss the significant role early attachment

relationships have in the development of adult affective disorders, such as depression,

anxiety and bipolar disorder, as well as highlight the importance of fostering security in

young children. In particular, the focus will be on the two more common affective

disorders: depression and anxiety.

Review of Literature

The Evolution of the Social Brain

When humans became bipedal, the size of the newborn brain had to shrink to

allow the head to pass through the narrower opening in the female pelvis. Consequently,

human babies are born much less developed than other animals and are dependent on

other humans to care for them (Small, 1999). Some go as far as calling this period of time

after birth the fourth trimester. As a result of this extra gestational period, mothers

evolved to become more attuned to their offspring and the human brain had more time to

develop. More time to develop meant smarter brains which allowing humans to form

more sophisticated survival techniques and conquer their environment (Cozolino, 2016).

It can be said then, that nurturing is what advanced our species to the top of the food

chain. However, the neurological and physiological mechanics involved in the nurturing

process have evolved far past mere survival.

Humans are born with a primitive brain that ensures basic function such as simple

reflexes that allow infants to nurse, grasp, startle, etc. The social brain (the prefrontal

cortex) develops later through interactions with other individuals. Without appropriate

close relationships, these parts of the brain are unlikely to develop properly and will also

be physically smaller. Because the orbital frontal cortex grows and connects to the other

parts of the brain through social stimulation (play, touch, and interaction), the unique

brain and emotional structure that each baby develops, is shaped by his or her own

environment and social relationships (Gerhardt, 2015). The relationships that form during

early childhood make humans a highly social species. We nurture our children so they

will survive infancy and in doing so, give them the skills to survive adulthood. However,

it is one thing to survive; it’s an entirely different thing to thrive.

The Bonding Cycle

In the 1960s, psychologist Harry Harlow conducted a series of monkey

experiments, which proved primates require nurturing in order to achieve full and healthy

brain development. The study took newborn rhesus monkeys, and replaced their natural

mothers with two artificial ‘mothers’ made of wood and wire. One of the ‘mothers’ was

equipped with rubber nipples that supplied milk and the other was covered in soft cloth.

While the infant monkeys would repeatedly visit the milk ‘mother’ for food, they spent

the majority of the day and night clinging to the cloth ‘mother.’ What’s more, these infant

monkeys grew up to exhibit symptoms of mental illness and were incompetent mothers

themselves (Harlow & Harlow, 1965 as cited in Small, 1998). With these controversial

experiments, Harlow was able to prove that, although nursing is necessary for survival,

comfort was what the infant monkeys preferred. Additionally, without the bond from

their natural mothers, they were not able to bond with their own offspring. The same is

true for us; human babies are born with many incomplete systems that can only develop

through interactions with other humans (Gerhardt, 2015). Parents and primary caregivers

not only provide physical nourishment needed to survive early childhood, but also the

emotional nourishment needed to thrive.

Around the same time, psychologists John Bowlby was making the connection

between the mothering urge and evolution, finding that the two were indeed related. He

argued that attachment is an instinctual or biological drive that keeps children close to

their mothers to ensure safety (Unger, 2014). His research led to the idea that a primary

caregiver, typically the mother, serves as the ‘secure base’ from where an infant can feel

safe to explore his environment. This tendency develops around the age of eight months,

when a child is learning to crawl (Bowlby, 1969). Bowlby’s work, along with the work of

psychologists Mary Ainsworth and Mary Main, lead to the discovery that children

display a number of different behaviors when separated from, and reunited with, their

primary caregivers. These behaviors are considered attachment styles and were classified

as secure, avoidant, ambivalent, and (some years later) disorganized (Gerhardt, 2015).

Ainsworth developed an experiment, known as the Strange Situation, which

observed parents and infants in a laboratory. Later versions of the experiment involved

also observing the parents and infants in their own home. In the home, they observed the

parenting style of the mother, noting her level of availability in attending to the infants

needs. In the laboratory, they measured the distress response of infants in a room under

different circumstances: with their mother, alone, with mother and stranger, and with

stranger (Ainsworth, 1978; Cozolino, 2016)). The experiment showed that infants quite

typically react negatively when the mother leaves the room, but what’s perhaps more

interesting was the infant's reaction upon the mother’s return.

Some years later, Main developed the adult attachment interview, which asks

adults fifteen questions to determine their own attachment style: secure-autonomous,

preoccupied, dismissing, and preoccupied (Main, 2000).

Data from Strange Situation experiments, combined with the results from the

adult attachment interviews, verify that the quality of parent-infant relationships, largely

determines the attachment style a child will develop (Ainsworth, 1978; Main, 2000). This

correlation also confirms the cyclical nature of attachment mentioned earlier in Harlow’s

monkey experiments. The table below illustrates the connectedness of parental

attachment style and infant attachment styles.

Main, M. (2000). Journal of the American Psychoanalytic Association

Attachment Style in Infants

The strange situation experiment allowed researchers to determine the difference

between attachment styles, by observing the reunion behavior of the infants. This was

observed when the mother returned after leaving the child alone or with the stranger.

Upon entering the room, the infant would seek proximity and make contact with the

mother. Once soothed, however, the infant would leave the mother to go play again. In

these situations, the child knows that the mother is a source for autonomic regulation.

Developing children need an adult figure who they can trust to serve as a sociostatic

regulator; someone who can regulate their anxiety and emotional responses through their

presence and touch (Cozolino, 2016).

Avoidant children ignored the mothers when they returned to the room

(Ainsworth, 1978). Although it appeared that the infants were indifferent to their

mother’s absence, their sympathetic nervous system was actually aroused, which tells

researchers that the infant was indeed afraid to be left alone or with the stranger, but the

mother is not a sociostatic regulator so the child had learned not to seek her out for

comfort (Cozolino, 2016). Children who were categorized as disorganized, were

extremely difficult to sooth and displayed contradictory behavioral reactions upon the

mothers return—clinging and pushing away (Gerhardt, 2015).

The securely attached children exhibited an appropriate amount of distress when

the mother left the room, and were easily calmed when she returned, because of their

trust in their mother's ability to help regulate their nervous system. When children grow

up with consistent and reliable parenting, they develop positive working models, which

inform their ability to regulate stress as an adult (Swanson and Mallinckrodt,

2001). Insecurely attached children on the other hand, lack the ability to easily regulate

their autonomic nervous system (Cozolino, 2016). When faced with a stressful situation,

they tend to remain in a state of sympathetic arousal beyond what is considered normal.

Attachment Style in Adults

In a perfect world, mothers and fathers would be automatically equipped with the

emotional tools for raising children. They would intuitively know the right way to

comfort a distressed baby and support her through her difficulties. It just so happens that

humans do have built in mechanisms for nurturing, but whether a person is able to access

these innate abilities, largely has to do with the way they themselves were parented.

According to Mileva-Seitz and colleagues (2013), mothers who have early negative

experiences tend to have lower levels of oxytocin, an important biochemical in the

bonding process. Many mothers, who lacked the fundamental building blocks of early

attachment, become depressed during pregnancy. Furthermore, research shows that high

levels of depression or anxiety during pregnancy, will lead to an increased risk of the

infant later having difficulty coping with stress and new stimuli (Sandman & Davis, 2012

as cited in Gerhardt, 2015). This is due to prolonged exposure to high levels of the stress

hormone, cortisol, coming from the mother while pregnant.

At a recent infant-toddler conference, psychologist Lou Cozolino said, “Love

becomes flesh” (Cozolino, 2016). What allows this to happen is something known as

epigenetics. This is an organism's ability to alter its DNA based on environmental

elements and experiences. When a parent expresses love to an infant in the way of

nurture, the infant’s brain will grow accordingly. The feelings of fear, stress, love, and

security all get programmed into the brain by way of cortisol (stress) and oxytocin (love),

and create the internal working model mentioned earlier. These hormones are triggered

by the facial expressions of the parents and their responsiveness to the infants needs.

The right hemisphere of the brain is associated with high levels of cortisol, and

also depression. Adults who had the opportunity to develop under normal nurturing

circumstances, have more left-brain activity and, as a result, have the ability to regulate

cortisol levels. Babies of depressed mothers do not develop the same left-brain

predominance, and in turn have a higher risk of becoming depressed as an adult. In fact,

about 40 percent of babies with less left-brain activity, have episodes of depression by the

age of 16. The correlation between depressed mothers and lack of left-brain activity in

their infants, suggests a physiological link. According to Gerhardt (2015), the connection

lies in the depressed mother’s inability to adequately respond to her baby’s needs.

Mikulincer et al evaluated the results of numerous self-report studies and found

that, without exception, adults with attachment anxiety (as described by the anxious-

preoccupied attachment style) also suffer from depression and anxiety and about half of

the studies confirmed that those with avoidant attachment styles (dismissive-avoidant or

fearful-avoidant) are also associated with depression and anxiety. Among the avoidant

individuals, depression and anxiety were more common with the fearful rather than

dismissing avoidance. These adults who suffer from anxiety and depression, often

describe their parents as being unsupportive, unavailable, or rejecting (Mikulincer et al.,

2007). When a child loses a parent to abandonment or death, he is more likely to develop

depression in adulthood. Furthermore, if he had insecure working models before the loss

or received inadequate comfort after the loss, their risk of depression increases (Harris et

al., 1990; Cummings & Cicchetti, 1990 as cited in Mikulincer et al., 2007).

As mentioned earlier, infants learn to regulate their autonomic nervous systems

and cortisol levels based on the responsiveness of the primary caregivers. Healthy

maternal interactions in infancy help develop the appropriate physiology in a child to

regulate their own stress levels later in life. These interactions include the facial

expressions of the mother or caregiver. The vagus nerve, being connected to our facial

muscles, pupils, and inner ear, allows humans to relate a physical representation of our

inner state. Low levels of attachment insecurity are associated with high levels of vagal

tone (Diamond, 2012). When infants look to their mothers for comfort under stress, and

they see the calming expression of a soft smile, their own nervous system responds by

switching to a parasympathetic state (Cozolino, 2016).

In Cozolino’s keynote address, he offered a grain of hope. Most insecurely

attached adults who enter an intimate and trusting relationship with a securely attached

adult, will become securely attached themselves within five years (Cozolino, 2016).

While attachment has been studied for many years and is widely accepted as an important

feature in early childhood development, further studies that connect insecure attachment

in children to adult affective disorders, could serve as a cautionary reminder to parents.

Nurturing interactions in childhood are much more than a series of positive moments;

they enable a person to be happy and healthy in adulthood.


Ainsworth, M. D. (1978). Patterns of attachment: A psychological study of the

strange situation. Hillsdale, NJ: Lawrence Erlbaum Associates.

Bowlby, J. (1969). Attachment. London, England. Pelican

Cozolino, L., (April 16, 2016). 27th Annual RIE Conference. Keynote address.

Diamond, L. M., Fagundes, C. P., & Butterworth, M. R. (2012). Attachment

Style, Vagal Tone, and Empathy During Mother-Adolescent Interactions. Journal Of

Research On Adolescence (Wiley-Blackwell), 22(1), 165-184. doi:10.1111/j.1532-


Gerhardt, S. (2015). Why love matters: How affection shapes a baby’s brain.

Hove, East Sussex, England: Brunner-Routledge.

Main, M. (2000). The organized categories of infant, child, and adult attachment:

Flexible vs. inflexible attention under attachment-related stress. Journal of the American

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Mileva-Seitz V, Steiner M, Atkinson L, Meaney MJ, Levitan R, Kennedy JL, et

al. (2013) Interaction between Oxytocin Genotypes and Early Experience Predicts

Quality of Mothering and Postpartum Mood. PLoS ONE 8(4): e61443.


Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure,

dynamics, and change. New York, NY: Guilford Press.

National Association of Mental Illness (NAMI)


Small, M. F. (1999). Our babies, ourselves: How biology and culture shape the

way we parent. New York, NY: Anchor Books.

Unger, J., & Luca, R. (2014). The Relationship Between Childhood Physical

Abuse and Adult Attachment Styles. Journal Of Family Violence, 29(3), 223-234.