Attachment in medical care: A review of the interpersonal model in chronic disease management

Abstract

Objective

Patient–physician interaction is continually examined in an era prioritizing patient-centered approaches, yet elaboration beyond aspects of communication and empathy is lacking. Major chronic conditions would benefit tremendously from understanding interpersonal aspects of patient–physician encounters. This review intends to provide a concise introduction to the interpersonal model of attachment theory and how it informs both the patient–physician interaction and medical outcomes in chronic care.

Methods

A narrative review of the theoretical, neurobiological, epidemiological, investigational, and clinical literature on attachment theory and its impact on medical outcomes was conducted, utilizing a variety of key words as searched on PubMed database. Studies and reviews included were of a variety of sources, including textbooks and peer-reviewed journals. Reports in languages other than English were excluded.

Results

Measurable, discrete attachment styles and behavioral patterns correlate with poor medical outcomes, including nonadherence in insecure dismissing attachment and care overutilization in insecure preoccupied attachment. Furthermore, insecure dismissing attachment is associated with significant mortality. These variables can be easily assessed, and their effects are reversible, as evidenced by collaborative care outcome data.

Discussion

Attachment theory is useful a model with application in clinical and investigational aspects of chronic illness care. Implications and guidelines are explored.