What your attachment style has to do with physical pain
In my doctoral training, I studied a question at the intersection of mind and body: why do early relationships seem to shape physical pain decades later? My dissertation at Pepperdine University was a systematic review of 29 studies on attachment styles and chronic pain. Here is what I found, in plain language.
What is an attachment style — and where does it come from?
An attachment style is the pattern we develop, beginning in our earliest relationships, for how we connect with others — how comfortable we are with closeness, how we handle distress, whether we reach for people or brace ourselves when things go wrong. Researchers describe a secure style and several insecure ones: anxious (preoccupied with closeness and fearful of rejection), avoidant (self-reliant, uncomfortable depending on anyone), and fearful (wanting closeness and fearing it at once). These are not diagnoses or fixed categories — they are tendencies, and they can shift over a lifetime, including through therapy.
What does attachment have to do with physical pain?
More than most people expect. The systems that process physical pain and the systems that manage emotion and stress are deeply intertwined — and those stress-regulation systems are shaped in part by our earliest relationships. Attachment influences how the body responds to threat, how we interpret symptoms, and whether we seek comfort or go it alone when something hurts. None of this means pain is imagined. It means the nervous system doing the hurting is the same one that learned, long ago, what to expect from other people.
You reviewed 29 studies. What did you find?
Three findings stood out. First, insecure attachment is consistently more common among people living with chronic pain than among healthy comparison groups — in one study of chronic widespread pain, it was nearly twice as prevalent. Second, attachment insecurity appeared to act as a predisposing factor across many dimensions of the pain experience: pain-related disability, coping, catastrophizing, depression, even how people engaged with treatment programs. Third — and this is the hopeful one — secure attachment appeared to function as a protective factor: people with secure styles showed less catastrophizing, more effective coping, and protection against depression in the context of pain.
Did anything in the research change how you practice?
Yes. Several of the studies I reviewed pointed toward the same clinical implication: that treatment may be more effective when it takes attachment into account, and that the therapeutic relationship itself can serve as a secure base — a steady relationship in which old patterns can safely change. That is the heart of how I work. It is also why I pay attention to the whole person: mind and body are one system, and that includes the physical symptoms of anxiety, as well as sleep and pain.
What should someone living with pain — or unexplained physical symptoms — take from this?
Three things. Your pain is real — nothing in this research says otherwise. Your history matters — the body keeps score of our earliest lessons about safety and connection, and understanding those lessons is clinically relevant. And patterns are not fate — attachment styles can change, and therapy is one of the places where that change happens. If you live with chronic pain, psychotherapy belongs alongside your medical care.
This article is for general information and is not medical or psychological advice. If you are living with chronic pain, please work with your physician alongside any psychological care. Research citation: Cohen, S. M. (2023). A Systematic Review on the Relationship Between Attachment Styles and Chronic Pain. Pepperdine University.