Strong Link Between Insecure Adult Attachment Style and Primary Care Attendance
Mar 18, 2005 - 4:07:00 PM, Reviewed by: Dr.
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The researchers suggest that a possible explanation for the relationship between insecure attachment style and frequent attendance is that those who are insecurely attached may lack emotional care and support because of their problems in maintaining close relationships.
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By Royal College of Psychiatrists, UK,
There is a strong link between an insecure adult attachment style and frequent GP attendance, a new study has found.
The aim of the research was to test the hypothesis that among primary care patients who have a medically unexplained symptom (MUS), those with an insecure adult attachment style have a pattern of excessive medical care seeking.
Insecure adult attachment style is a way of relating to close others (e.g. partners or close friends) in which the insecure person has difficulty feeling comfortable being close to and relying on others.
The person with insecure attachment will tend either to be very clingy and dependent, fearing that the other will leave them, or the opposite extreme of finding it very difficult to get close to others and always keeping people at a distance. The pattern of relating to others arises from disruption to attachment to the primary care giver (usually mother) during childhood.
In this study 2337 consecutive attenders at 10 London general practices were screened. 586 had symptoms that were rated by the GP as either unexplained, or of uncertain origin.
At one-year follow-up, 72 were excluded as no longer registered, and 102 were excluded because an organic cause had been found for the initial symptom. The final sample was therefore 410 patients who had an initial MUS and for whom one-year follow-up information was available.
All participants completed a baseline questionnaire before they were interviewed by a GP to assess levels of psychological distress, beliefs about the symptom, levels of unexplained physical symptoms, and degree of physical functioning.
A telephone call after this appointment assessed the level of symptom worry and health worry, their views on GP management of their case, and their satisfaction with the GP consultation. The main outcome of the study was the number of self-initiated GP consultations over one year.
It was found that there was a significant association between a self-rated insecure attachment style at baseline and frequent attendance. This association was particularly strong in those patients who believed that there was a physical cause for their initial unexplained complaint.
The researchers suggest that a possible explanation for the relationship between insecure attachment style and frequent attendance is that those who are insecurely attached may lack emotional care and support because of their problems in maintaining close relationships. They may therefore seek care excessively from professional caregivers, such as the GP.
Although they are not necessarily aware of it, they have a need to confide in someone and to feel looked after which is met by the doctor because of the lack of close others in their lives.
People with some types of insecure attachment (insecure anxious attachment) find it difficult to accept reassurance and to trust caregivers. Therefore, they may repeatedly see the GP with a symptom, being unable to accept the GP's reassurance that the symptoms is not a sign of serious disease.
The findings of this study may help towards developing strategies to manage frequent attenders at GP surgeries. 
- Faculty of liaison psychiatry annual conference - 16th - 18th March 2005. Catalonia Barcelona Plaza, Barcelona, Spain
www.rcpsych.ac.uk
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