In This Article Expand or collapse the "in this article" section Attachment as a Health Determinant

  • Introduction
  • General Overviews
  • Theoretical Works
  • Journals
  • Internal Working Models
  • Longitudinal Studies
  • Ecological Model
  • Sensitivity
  • Adolescence and Adulthood
  • Deprivation of Care Studies
  • Biological Findings
  • Measures

Public Health Attachment as a Health Determinant
Maria Isabel Loureiro, Teresa Maia
  • LAST REVIEWED: 05 May 2017
  • LAST MODIFIED: 23 February 2011
  • DOI: 10.1093/obo/9780199756797-0120


Attachment theory was first formulated by John Bowlby. This theory is about how relationships are established between humans early in life, and has multiple evolutionary and ethological implications. Its importance today to public health relates to the growing recognition of the extreme importance of early-infant and child development to the lifetime trajectory of health, and it is strongly associated with other social determinants of population health. One fundamental aspect of this theory is the focus on the biological bases of attachment behavior. This behavior has the predictable outcome of increasing the child’s proximity to the attachment figure. The infant’s repertoire of proximity-promoting behaviors (vocalizing and cries, approaching and clinging) becomes organized into a behavior system (the attachment system) focused on a specific caregiver, usually the mother. The attachment system includes the form of attachment itself, the exploratory system, the social system, and the caregiver system. The caregiver system is the complementary system developed by the attachment figure. Each individual experiences emotional ties to the other and forms an internal representation—what Bowlby called an “internal working model”—of the relationship and its participants. This will influence the child’s later development and his future relationships. Mary Ainsworth had a relevant contribution to the development of methodological aspects, creating a standardized interview to assess the quality of attachment in infancy: the “Strange Situation.” Other relevant contributions to the development of this theory were the longitudinal studies that allowed researchers to understand the implications of attachment, the deprivations of care, or foster situations in development and future relationships and attachment. multiple evolutions in the development of evaluation procedures on babies, caregivers, and the type of relationship have emerged. Biological research brought new inputs and opened an area of understanding. All this information allowed researchers and clinicians to design and implement multiple intervention programs that have been evaluated. Attachment theory is today a complex and rich field of knowledge with multiple scientific and clinical implications.

General Overviews

In his first books, John Bowlby describes the fundamental ideas of attachment theory (see Bowlby 1969, Bowlby 1973, and Bowlby 1980, cited under Theoretical Works). Mary Ainsworth explains the “Strange Situation” theory that allows research to characterize the types of attachment (see Ainsworth, et al. 1978, cited under Theoretical Works). Cassidy and Shaver 2008 covers the origins and development of attachment theory, biological perspectives, measurement across the lifespan, clinical applications, and emerging topics. Zeanah 2009 follows the transactional approach in discussions of the impact of relational, experiential, and individual factors on pregnancy, neurological development, and early social emotional milestones. Gerhardt 2004 offers an overview of the latest scientific research on attachment. Other fundamental books include Grossmann 2005, where the longitudinal studies are described. Mikulincer 2006 examines romantic love using attachment theory. Finally Berlin 2005 highlights various programs, some of which focus exclusively on the attachment relationship, while others include an attachment focus as part of a broader intervention.

  • Berlin, L. J., Y. Ziv, L. Amaya-Jackson, and M. T. Greenberg, eds. 2005. Enhancing early attachments: Theory, research, intervention, and policy. Duke Series in Child Development and Public Policy. New York: Guilford.

    Addresses theoretical and empirical bases for interventions to improve attachment relationships between mothers and children; describes various programs, some of which focus exclusively on the attachment relationship, while others include an attachment focus as part of a broader intervention. Offers commentaries by known luminaries in the field with discussions about current research questions, such as short-term focused versus more broadly focused programs, and implications for public policy.

  • Cassidy, J., and P. R. Shaver, eds. 2008. Handbook of attachment: Theory, research, and clinical applications. 2d ed. New York: Guilford.

    This book Includes chapters like the origins and development of attachment theory, biological and evolutionary perspectives, and the role of attachment processes in personality, relationships, and mental health across the lifespan.

  • Gerhardt, S. 2004. Why love matters: How affection shapes a baby’s brain. New York: Brunner-Routledge.

    Gerhardt, a psychotherapist cofounder of the Oxford Parent Infant Project, has accomplished the task of linking the language of neurochemistry to the more abstract area of attachment theory. In so doing, she has greatly clarified the nature-nurture argument, while establishing the critical importance of parental love for optimum brain development in childhood and the subsequent capacity for love and trust in adulthood.

  • Grossmann, K. E., K. Grossmann, and E. Waters, eds. 2005. Attachment from infancy to adulthood: The major longitudinal studies. New York: Guilford.

    This book overviews longitudinal studies, particularly studies where infants, assessed using the Strange Situation Procedures twenty or more years ago, have been reassessed using the Adult Attachment Interview, providing insight into the stability of attachment between infancy and early adulthood.

  • Mikulincer, M., and G. S. Goodman, eds. 2006. Dynamics of romantic love: Attachment, caregiving, and sex. New York: Guilford.

    This book examines the interplay among distinct behavioral systems involved in romantic love. Interdependence theory and self-expansion theory are described to review the current state of knowledge in the field. Studies that address intimacy, jealousy, self-disclosure, sexual behavior, partner violence, and other processes in both satisfying and dysfunctional relationships are presented. Special topics include gender differences as well as attachment dynamics within same-sex couples.

  • Zeanah, C. H., ed. 2009. Handbook of infant mental health. 3d ed. New York, Guilford.

    The book describes the context of infant mental health; risk and protective factors; assessment; psychopathology; intervention; and applications to infant mental health. The challenges and inherent strengths of using a transactional model of developmental risk are discussed, where the outcomes are the product of a continuous and dynamic interplay between individual, social, economic, educational, and relational factors.

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