Anxious Attachment Style: How It Can Impact Relationships

Anxious attachment is not just limited to romantic partners. We can be anxious to please and clingy with family members and friends, students, employees and even colleagues. When we really value intimacy with others, seemingly minor daily interactions – such as a late response, a sharp tone, an over-packed schedule or overwhelming environment – can come across as life-threatening. This video teaches the anxious attachment style in light of increasing relationship conflict and suboptimal mental health, and how the normal daily stress of chronically activating anxious individuals can interfere with both their daily life and relationships. Clinicians, supervisors, managers, educators, parents, family members, and caregivers of anxious individuals want to know: How can I support this individual to move from a troubled or avoidant interaction style to a healthy and adaptive one?

Why It Matters

Anxious attachment is more than a personality trait – it fundamentally shapes a person’s interpretation of interactions, their management of conflict, and their sense of safety. A neutral communication can be perceived as aggressive, a brief response as rejecting, and normal periods of separation as abandonment. Persistent reassurance requests, ‘testing’ behaviors, and feelings of regret and self-criticism then become characteristic of anxious attachment.

In my anxious attachment style relationships, I often found myself caught in a cycle of push and pull – seeking closeness and intimacy, yet at the same time, doubting that it would last. I often found myself to be emotionally exhausted and burned out because individuals with an anxious attachment style can drive their partners to the point of exhaustion through their need for increased intimacy and their demands for immediate resolution of conflict. They often ask the same questions repeatedly in search of assurance of love, commitment, and care, demand frequent contact, become angry and upset when their partner is not available, and demand constant reassurance to help them feel secure in the relationship.

How it can shape everyday relationship patterns

Do you get nervous and reach out for the other to soothe you? Want more intimacy or contact? Get intensely angry and resistant when your partner doesn’t comply with your needs right now? Then push them to be responsible for your feelings and tell them they were overreacting when you’ve calmed down?

• Frequent reassurance requests that temporarily calm anxiety but return quickly.
• Hypervigilance to tone, timing, and micro-signals, especially during stress.
• Difficulty tolerating uncertainty, such as waiting for a call back or a decision.
• Protest behaviors, like escalating conflict, withdrawing to provoke pursuit, or threatening to leave to get closeness.
• Rumination after conflict, replaying conversations and searching for proof of rejection.

Commonly, such patterns are seen as “neediness” but in reality they stem from a fear of rejection driven by an attachment orientation of threat. This orientation leads partners to fight for connection even as their behavior drives a distance between them, escalating the conflict.

Clinical relevance for mental health and physical health

Anxious attachment is an important concept for clinicians to understand. Chronic interpersonal stress caused by anxious attachment can increase anxiety and depression as well as cause a host of other stress-related physical and emotional symptoms. Patients with anxious attachment may report having “attachment anxiety.” However, they more commonly report insomnia, worry, changes in appetite and sleep, irritability, panic-like episodes, headaches, gastrointestinal problems, and a persistent low mood that gets worse when there are stressors in their relationship.

Instead of viewing the tension, anger and hurt between a couple through the distorting lens of blame and moralizing, the therapist views their interaction through the lens of attachment and asks questions about patterns, needs and the triggers of threat that set off a cascade of reactions. What triggers a sense of threat in each partner? What strategies do they use to try to regulate their partner’s reactions? Together they can work towards developing a safe connection and a more adaptive and healthy way of regulating each other’s nervous systems. This frame for viewing couples’ interaction increases motivation for change as patients experience decreasing shame and gain a sense that change is possible and is achieved through learning skills rather than moral improvement.

When anxious attachment overlaps with other conditions

Anxious attachment is not a formal clinical diagnosis; rather it is a pattern of relating to others that differs from secure attachment and from the symptoms associated with anxiety disorders such as Generalized Anxiety Disorder, Panic Disorder and Social Phobia. However, these anxious attachment patterns can be active and driving much of the behavior in a person’s life. The anxious attachment pattern is often closely tied to a person’s history of trauma. This pattern can emerge during the normal transitions of life such as pregnancy, postpartum, moving, illness, job loss, etc. and make it difficult to distinguish the impact of anxious attachment from the situation itself.

Safety issues should not be diagnosed as an attachment style. Instead, partners experiencing coercion, intimidation, stalking, or violence should receive safety planning and appropriate referral for emergency services.

What appears to be “fear of abandonment” may actually be a valid fear for the partner, based on real danger in the relationship.

System level impact

Anxious individuals with anxious attachment typically require relationship focused care that is preventative in nature. Psychotherapy, couples therapy, and skills training are often a time-intensive, long-term process for this population. As a result, anxious individuals are often further disadvantaged by long wait times, inconsistent access to needed services, and lack of trained therapists.

We shouldn’t think that all the work of therapy happens through “telehealth”– even digital means don’t entirely substitute for relational attachment work. There are some very cool apps that help people learn breathing, relaxation, and even guided journaling and coping-skills training. However, even these tools don’t begin to substitute for the safe, reliable connection with another human that is necessary for attachment work. This skill set is practiced and consolidated through engagement in relationships. There are a host of privacy concerns, variability in engagement, and a serious lack of adequate crisis support across platforms and apps, which means that many individuals will find these tools to be less effective when they are most distressed (at the highest level of distress).

Attachment distress can impact a person’s way of engaging in performance and learning. For adults with attachment distress, this can mean experiencing increased sensitivity to criticism, being hurt by rejection by colleagues or supervisors, pushing themselves to exhaustion in pursuit of validation, or being extremely vigilant to others’ reactions at work. In schools, we may observe separation distress in preschoolers (e.g., throwing a tantrum when dropped off at school), aggressive peer behavior, trouble trusting school staff, or an extreme reaction when they feel they are being left out. This emerging field requires integrated behavioral health and academic supports and early intervention with families as well as programs that teach relationship literacy.

Who It Affects

Anxious attachment styles are not exclusive to the young. People of all ages, genders, and backgrounds can exhibit anxious attachment behaviors. Inconsistent or unpredictable caregiver/couples behavior is often the precursor to the development of anxious attachment in children and adolescents. Because their caregivers were often inconsistent in their comfort and availability, adults with anxious attachment styles experience significant uncertainty with respect to the reliability of closeness with their partner. They may show their anxious attachment in their motivations to maintain a romantic relationship, for example by frequent texting, by going to great lengths to repair conflicts, or by being overly vigilant in monitoring their partner’s behavior in order to assess whether or not he or she is safe.

How it can develop across the lifespan

Anxious attachment is often considered innate, something we are born with, but it isn’t. Adults develop anxious attachment strategies after experiencing betrayal, repeated loss (i.e. break-ups) and/or infertility; serious or chronic illness; complicated grief; or an unreliable and unpredictable partner. After experiencing these painful traumas, our minds and bodies develop hypervigilance strategies in an attempt to protect us from future abandonment, even when our partner is deeply invested and committed to the relationship.

Despite possessing secure and securely attached traits, even the most grounded individuals can be driven to extreme attachment anxiety by change. Being in the midst of a life transition such as pregnancy and the postpartum period, moving to a new house, experiencing stress related to immigration, financial threats, or the stress of caring for an aging parent all push threat-sensitive individuals to expect the worst and to require a lot of reassurance. With dwindling resources, the nervous system becomes less able to tolerate ambiguity and uncertainty, and increasingly in need of consistency and reassurance.

How it shows up in romantic partnerships

In romantic relationships, anxious attachment is characterized by high closeness needs and much anxiety about those needs not being met. This can play out in a partner’s insatiable need for proximity, as well as a lot of distress when those needs aren’t immediately met, including misinterpreting normal space as rejection. Anxious attachment often manifests as overfunctioning in a relationship. People with an anxious attachment style tend to say please be with me, I’m sorry, and yes, I’ll do that. They tend to prioritize their partner’s needs before their own.

The emotionally focused approach can be very helpful to the anxiously attached person, but it is also beneficial to the more securely attached partner. The approach helps the couple understand the original development of the pursue/withdraw pattern between them. The testy and pushy pursuit by the anxious individual can push the avoidant or dismissive individual to push them away even more. The withdrawal can then escalate the anxious individual’s fears and prompt even greater pursuit. This pursue/withdraw pattern can become the couple’s most intractable pattern of conflict. However, it can also be the first intractable pattern addressed in couple therapy, as each partner comes to understand his or her role in the repetitive cycle.

In the last post we looked at Control, Obsession, and Apathy in relation to romantic relationships. Today we’re going to explore how these same attachment styles manifest in other domains: Business, Friendships, and even our connection with Spirit.

Attachment anxiety isn’t confined to romantic partners. Many people struggle with anxious attachment in their friendships. They may worry about being cast out of a friend group or be worried that they will be replaced by another person. We may display the same obsessions with checking in and getting immediate responses from our friends that we do with our partners. Conversely, we may go to unreasonable lengths to show our appreciation and care for our friends in hopes of getting attachment in return, and we may be left feeling confused, angry, and deeply sad when our gestures are completely ignored.

Anxious attachment can also impact a parent’s response to their child’s pursuit of independence. Parents with an anxious attachment may feel threatened by their child’s growing independence, take their child’s desire for independence personally, or need their child to reassure them of their love. Many parents find that having their own regulation needs met is key to being a source of comfort and setting healthy boundaries for their child.

Clinicians and stakeholders

Attachment-related distress takes many different forms and is seen in a variety of clinical settings. While mental health professionals may not use the word “attachment” when describing their clients’ presenting problems, the resulting distress is familiar to most clinicians. Patients in primary care may report a range of stress-related symptoms, such as sleep disturbance and fatigue, or experience illness that is related to difficult interpersonal experiences. Many mental health professionals see patients who experience chronic worry, fluctuating moods, panic, or a repeated pattern of difficult interactions with others. Couples and family therapists are particularly able to observe the patterns of interaction between partners, especially during periods of conflict.

Payers and health care system administrators are important stakeholders as their decisions regarding coverage of treatments for the publically insured have a profound impact on the quality of life for the individuals and families for whom they care. Reimbursement policies that support brief, symptom focused treatments to help individuals reduce depressive and anxiety symptoms may not be sufficient to address the attachment related drivers of these symptoms. Programs to support the health and well-being of caregivers, parental mental health, and early parenting and bonding are important from a public health perspective as they have the indirect effect of reducing attachment insecurity in children.

What Changes

Practice becomes much more effective “medicine” if we recognize how attachment patterns, as well as the overall impact of chronic interpersonal stress and repeated relationship break-downs, affect the body and mind. You don’t have to become learned in the diagnosis of attachment disorders. Simply ask yourself and your students: What happens in your body when you feel pushed away or physically very close to another and can’t get away? What do you do? What would you say to another person in order to get them to stay with you or not to push you away? What would be the worst thing that could happen if the other person were to push you away?

Assessment and early identification

• High distress during ordinary separations and strong urgency to reconnect.
• Frequent reassurance-seeking that brings only short relief.
• Conflict escalation when closeness feels threatened, followed by shame.
• Strong fear of being replaced, forgotten, or abandoned, even with evidence of care.
• Difficulty self-soothing, relying primarily on partner availability to calm down.

A more meaningful way to look for triggers is to consider patterns over time and how things relate to each other as well as specific events. Some useful clinical clues are:

One must also rule out other conditions that might mimic attachment anxiety such as thyroid issues, substance use, and untreated mood disorders. How a person processes trauma and their personality structure can also cause problems in relationships. Knowing the structure of the individual’s personality and how they process trauma will allow the clinician to give the most appropriate treatment.

Stepped care treatment options

Stepped-care approaches offer the promise of providing effective treatment to individuals at all stages of change, and can reduce dropout. Often, treatment is most effective when it begins with a focus on skill-building, and then gradually steps up to more intense and personally revealing work as individuals become ready for it.

Helping individuals and groups to learn Skills such as Emotion Regulation, Distress Tolerance, Interpersonal Communication and Cognitive Flexibility can quickly and effectively reduce current suffering. Short Skills for the Task at Hand-based therapies and psycho-educational sessions can also immediately teach patients to slow down, think more slowly and clearly, identify life limiting and catastrophic interpretations of reality and replace them with more helpful and life enhancing responses, and move from avoidance-oriented behaviors to more secure responses.

In attachment-informed psychotherapy, patients strive to achieve an “earned secure” experience of and with their caregiver/primary relationship. An evidence-based, attachment-informed therapy is used to increase patients’ awareness of their emotional experiences, acceptance, trust, and compassion of self, processing and integration of traumatic experiences when present, and repair and reorganization of the relationship with their caregiver. Depending on patient history and needs, one important aspect of attachment-informed work is gaining understanding of early experiences and relationship patterns. However, growth and understanding must be processed and achieved at a slow and individualized pace, and in a manner that does not overwhelm the patient.

Partners therapy is most effective when both partners are motivated to make changes, and are working together to change. By identifying a negative pursue-withdraw cycle, creating a safe, emotional space for each other, and learning how to repair and recover from conflict, the couple can reduce their attachment anxiety by learning to respond to each other’s fear more clearly, warmly and less defensively.

Concrete tools patients can use

• A pause plan: Stop, breathe, name the feeling, and delay texting or confronting for 20 minutes when triggered.
• A clarity script: “I am feeling unsure and could use reassurance. Are we okay, and can we talk later today?”
• A boundary script: “I want closeness, but I cannot keep checking. I will message once and then return to my tasks.”
• Self-soothing routines: paced breathing, grounding, short walks, muscle relaxation, journaling, and sleep consistency.
• Repair rituals: a brief daily check-in, a weekly planning talk, and a clear apology format after conflict.

Incorporating tools into your treatment that you can practice in between sessions is very helpful to patients. For example:

As mentioned previously, there is typically an initial period of discomfort or unpleasantness prior to the individual arriving at a place of improvement. Importantly, if individuals do not experience an increase in anxiety when they attempt to reduce their intolerance of uncertainty-based reassurance-seeking behaviour, then it is likely that nothing is actually changing and thus improvement is unlikely to occur. It can be very difficult for individuals to tolerate some degree of discomfort while engaged in the change process; however, it is a critical component of the adherence to treatment and avoidance of feelings of failure.

Medication as part of a broader plan

While there may be times when a client’s severe anxiety or depression requires the addition of medication to an already established treatment plan, in general it is most effective when used in conjunction with an emotionally relational stance, rather than as the sole mode of treatment. This is because medication can take the edge off of the most severe symptoms, thereby allowing the client to start to learn new skills and to once again obtain necessary sleep. However, once the client is no longer taking the medication, the triggers to anxiety or depression that relate to a client’s attachment patterns, their ways of communicating, and their patterns of emotion regulation will likely once again become active unless these are addressed in the therapeutic relationship.

Care delivery and policy

Integrating behavioral health into primary care and scaling up evidence-based practices to reach more people is critical to improving care delivery. This can be achieved by improving referral processes, utilizing telehealth, scaling up group skills training, and building a more robust workforce able to deliver relationship-based therapies.

Prevention and policy/training is most cost-effective in the long run. Supports for young children and their caregivers as well as for mental health of parents of young children can prevent problems. Later problems in insecurely attached children can be prevented or ameliorated. Clinicians can become more effective and decrease stigma by learning about adult attachment and its effects on children.

Safety and ethics

Anxiously attached should not be used as a final mental health diagnosis or treatment goal. Rather, safe practice with couples would begin with a safety assessment to identify any potential for coercion, threats, excessive monitoring, and/or violence. Following the assessment, treatment and referrals for resources and other therapeutic interventions would be pursued. Additionally, “reassurance” is not and should never be treatment for any pattern of adult attachment, and certainly not for an anxiously attached way of relating. Under rare circumstances, contraindication of couples therapy for individuals suffering from anxious attachment could also occur. It is the job of the mental health professional to be certain that they are not inadvertently pathologizing or putting the couples in danger by engaging in therapy that could possibly go awry.

Measuring progress

Tracking a few indicators of progress can be helpful. Some indicators that might be useful to track are sleep quality/hypervigilance, mood, frequency of requests for reassurance/reassuring behaviors, frequency/intensity of negative conflict, frequency of repairs, and self reported safety in the relationship. Small increments of safety (i.e. less waking up at night for urgent texts, a faster recovery from conflict) can mean a lot.

References:

https://www.simplypsychology.org/anxious-attachment-style.html https://www.attachmentproject.com/anxious-attachment-relationships/