Attachment Relationships as Determinants of Physical Health (Maunder and Hunter, 2008)

In 2008, “Attachment Relationships as Determinants of Physical Health” synthesized evidence regarding the role of two-person relationships, and particularly of insecure patterns of attachment, in the development and course of physical disease. Since that time, evidence has continued to accrue to validate and expand the framework described there, which Jon Hunter and I reviewed in more depth in 2015, in the book Love, Fear, and Health: How Our Attachments to Others Shape Health and Health Care.

The impact of close relationships on physical health, for better and worse, is most starkly evident when early development is complicated by abuse, neglect, and other forms of severe relational adversity. In the time since this paper was written, the general public has become much more knowledgeable about how very common these harmful experiences are, especially through growing awareness of the concept of adverse childhood experiences (ACEs), which was introduced by Vincent Felitti and his colleagues. Insecure patterns of attachment, including disorganized attachment, are a common mediator between ACEs and adult illness, making the framework described in this article both relevant and helpful for health care providers trying to provide trauma-informed care.

Theory and evidence-based causal models should alter practice in health care, and ultimately improve patient outcomes. One of the most fundamental barriers to providing treatment relationships in medicine that foster effective treatment and healing for patients who have a history of childhood adversity is that these experiences are usually not even part of the health care conversation. Doctors don't ask, even though most patients wouldn't mind if they did. Furthermore, few health care professionals outside of mental health settings appreciate