A review of the neurobehavioral mechanisms linking insecure attachment and anxiety disorders

Attachment processes during early childhood shape the development of basic emotional regulation skills that can impact how individuals cope with trauma and stress through their ontogeny. As a result, insecure attachment styles impact mental health by facilitating inadequate emotional regulation such as hypervigilance and negative affect, ultimately increasing the risk of both internalizing symptoms, such as depression and anxiety, and externalizing symptoms, such as harmful substance use and antisocial behavior. In this review, we focus on pathways linking insecure attachment (especially anxious-insecure styles) and anxiety disorders throughout development, summarizing cross-species data on the impacts of attachment issues on neurobehavioral systems involved in anxiety and defense. Data from animal research, gene variant and epigenetic human studies, and clinical research suggest an interplay between oxytocin, dopamine, serotonin, and glucocorticoids in shaping the responsiveness of neural circuits involved in social behavior, reward, and defensive behavior, resulting in maladaptive behavior in later stages of life. These findings underscore the multifaceted biological underpinnings of insecure attachment and its long-term psychological consequences.