CHICAGO (EGMN) – Individual differences in attachment style have a bearing on mental and physical health in the workplace, Dr. Josh B. Gibson said at the annual conference of the Academy of Organizational and Occupational Psychiatry.
When Dr. John Bowlby first developed attachment theory in the 1960s based on observations of separation anxiety in children, he proposed that early experiences with caregivers are internalized and form enduring cognitive schemas of relationships that influence the type of interactions individuals will have with others and the interpretation of these interactions.
These schemas, or “internal working models,” generally are classified into three adult attachment styles: secure, anxious/preoccupied, and avoidant. Roughly 60% of individuals have a secure attachment style, said Dr. Gibson of the department of psychiatry at the University of California, San Francisco. They generally feel the world is safe and stable, and are trusting of other people and able to ask for help.
Slightly less than 20% of people have an anxious/preoccupied style and feel the world is an unpredictable, unsafe place. They need proximity and reassurance to feel secure, and as a result are preoccupied with being connected to others. Individuals with avoidant attachment feel people will mostly let them down, and so must be independent and take care of themselves. The model of Kim Bartholomew, Ph.D., and Leonard M. Horowitz, Ph.D., also includes fearful attachment, a less common insecure attachment style marked by negative internal working models of both self and other.
In the workplace, workers with secure attachment have high satisfaction and good balance between work, family, and self, Dr. Gibson said. Those with preoccupied attachment have job insecurity, feel they are not being recognized for their contributions, and have worse job performance, leading to lower pay overall and more frequent dismissals. Workers with avoidant attachment tend to be dissatisfied with coworkers, to prefer to work alone, and to have a poor work/life balance, in part because they are drawn to work in an effort to turn off and suppress the attachment system.
“I think it’s important to think about attachment styles as representing vulnerability rather than pathology,” Dr. Gibson said.
Increasingly, researchers are focusing on how attachment styles influence health and health care utilization. As a general rule, patients with insecure attachment are at greater risk for depression and other physical morbidities, he said.
A recent population-based study involving 2,509 individuals, median age 49.9 years, found that those who self-reported chronic widespread pain were more likely to report a preoccupied (relative risk 2.6), dismissive (RR 2.8), or fearful attachment style (RR 1.4) than were those without pain (Pain 2009;143:200-5).
Attachment style was significantly associated with physical symptoms, but also primary care visits and primary care costs in a study of 701 women enrolled in the same HMO. This was true even after adjustment for age, marital status, income, ethnicity, and depression (Psychosom. Med. 2002;64:660-7).
Women with preoccupied attachment had the highest health care utilization, visiting their primary care physicians a mean of 3.95 times each year, compared with 3.41 times for dismissive attachment, 3.32 times for secure attachment, and 2.84 times for fearful attachment. Not surprisingly, mean annual primary care costs were significantly higher for women with preoccupied attachment at $519, compared with $428, $451, and $363, respectively.
Despite being at opposite ends of the utilization and cost spectrums, however, women with preoccupied and fearful attachment styles reported the highest number of symptoms. This is likely because they have internalized a negative sense of self, and that leads to more focus on negative affects and increased somatization, Dr. Gibson said. Depression was reported in 4% of the 239 patients with secure attachment, reaching a high of 14% in the 145 patients with fearful attachment.
It has been suggested that treatment strategies, including support and education, should be based on knowledge of attachment styles. As for attachment style testing in the workplace, Dr. Gibson said in an interview that it could be helpful in situations where interpersonal relatedness has significant impact on productivity. Examples would include initial hiring, forming project teams, or assessing fitness for particular job roles or promotions. As with any type of employment testing, however, there are pros and cons, and there needs to be quite a bit of thoughtfulness behind its use, he cautioned.
“As a physician, I’m wary of using these tests in a way that would benefit the company and not the worker,” he said. “For example, a company seeking to wring every last ounce of work from its employees could select purely for avoidantly attached people, those most likely to give up personal health and relationships in order to work.
“The physical and emotional health of those people would suffer, and that’s not what I believe in.”
If the goal is to reduce health care costs or improve job performance/satisfaction, knowledge of attachment style might be useful, as employees need different things from their managers based on attachment style. A manager who gives the preoccupied worker frequent, consistent check-ins and praise for a job well done should see better job performance, Dr. Gibson said. That approach would backfire with the avoidant worker in many cases, as that person more likely needs large work assignments that have meaning and to be given feedback about how peers view his or her performance.
“Improved job satisfaction and improved job performance go hand-in-hand,” he said. “When work serves to lower activation of the attachment system, improved health follows.”
Still, it’s no guarantee that lower health costs will necessarily follow. Attachment styles are thought to remain relatively consistent over time. One longitudinal study showed that 72% of adults had the same style at 1 year of age as they did at age 20 years (Child Dev. 2000;71:684-9). Those who changed had a higher likelihood of experiencing abuse, parental loss or divorce, or a parent developing a life-threatening or mental illness.
“Attachment style is a powerful and predictive lens that shows the importance of relationships to our emotional and physical health,” Dr. Gibson said. “We must focus on improving our relationships – at work, at home, and in psychotherapy – in order to improve our health and our lives.”
Dr. Gibson reported no conflicts of interest.
