Internal working model of attachment
Internal working model of attachment is a psychological approach that attempts to describe the development of mental representations, specifically the worthiness of the self and expectations of others' reactions to the self. This model is a result of interactions with primary caregivers which become internalized, and is therefore an automatic process. John Bowlby implemented this model in his attachment theory in order to explain how infants act in accordance with these mental representations. It is an important aspect of general attachment theory.
Attachment and Health
While strong social support has been linked to greater resilience to stress and lower medical morbidity and mortality, the mechanism behind this association is poorly understood. In the late 1990s, Paul Ciechanowski investigated the role of attachment styles in patients managing diabetes, finding that individuals with an avoidant-dismissive style were less likely to be compliant with treatment recommendations and had less well-controlled disease as measured by glycosylated hemoglobin. Larger scale evidence comes from a large American survey of self-reported attachment styles and physical illness conducted by McWilliams and Bailey. They found that those with insecure attachment reported more physical illness than securely attached individuals. Specifically, they found preoccupied individuals reported more heart disease, and dismissive individuals more pain conditions. A prospective study followed children until the age of 32 and found a similar pattern of results. They found that people with anxious-resistant (dismissive) styles of attachment reported vague, non-specific symptoms more often, and those with anxious-preoccupied classification had a higher rate of inflammation-based illnesses. This prospective study was particularly important because of the difficulty assigning causation in the often observed relationship between chronic pain and insecure attachment. Further support is derived from experimental pain studies that have demonstrated numerous risk factors for the development of a chronic pain disorder associated with insecure adult attachment including lower perceived control of pain, higher pain catastrophizing and higher perceived pain intensity.