INVESTIGATIVE REPORT
813 Advances in dermatology and venereology ActaDV Acta Dermato-Venereologica ActaDV
Attachment Styles of Dermatological Patients in Europe : A Multicentre Study in 13 Countries
Csanád SZABÓ 1 , Anita ALTMAYER 1 , Lars LIEN 2 , Francoise POOT 3 , Uwe GIELER 4 , Lucia TOMAS-ARAGONES 5 , Jörg KUPFER 6 , Gregor B . E . JEMEC 7 , Laurent MISERY 8 , Dennis LINDER 9 , Francesca SAMPOGNA 10 , Henriët VAN MIDDENDORP 11 , Jon Anders HALVORSEN 12 , 13 , Flora BALIEVA 14 , Jacek C . SZEPIETOWSKI 15 , Dmitry ROMANOV 16 , Servando E . MARRON 17 , Ilknur K . ALTUNAY 18 , Andrew Y . FINLAY 19 , Sam S . SALEK 20 and Florence DALGARD 2 , 21
1
Department of Dermatology and Allergology , University of Szeged , Szeged , Hungary , 2 National Center for Dual Diagnosis , Innlandet Hospital Trust , Brumunddal , Norway , 3 Department of Dermatology , Universite Libre de Bruxelles Erasme Hospital , Brussels , Belgium , 4 Department of Dermatology , Justus Liebig University , Giessen , Germany , 5 Department of Psychology , University of Zaragoza , Aragon Health Sciences Institute , Zaragoza , Spain , 6 Institute of Medical Psychology , Justus Liebig University , Giessen , Germany , 7 Department of Dermatology , Zealand University Hospital , Roskilde , Denmark , 8 Department of Dermatology , University Hospital of Brest , Brest , France , 9 Oslo Center for Biostatistics and Epidemiology , University of Oslo , Oslo , Norway , 10 Clinical Epidemiology Unit , Istituto Dermopatico dell ’ Immacolata ( IDI ) - IRCSS FLMM , Rome , Italy , 11 Health , Medical and Neuropsychology unit , Faculty of Social and Behavioural Sciences , Leiden University , Leiden , The Netherlands , 12 Department of Dermatology , Oslo University Hospital , 13 Institute of Clinical Medicine , University of Oslo , Oslo , Norway ,
14
Department of Dermatology , Stavanger University Hospital , Stavanger , Norway , 15 Department of Dermatology , Venereology and Allergology , Wroclaw Medical University , Wroclaw , Poland , 16 Department of Psychiatry and Psychosomatics , I . M . Sechenov First Moscow State Medical University , Moscow , Russia , 17 Department of Dermatology , Alcaniz Hospital , Alcaniz , Spain , 18 Department of Dermatology and Venereology , Sisli Hamidiye Etfal Teaching and Research Hospital , Health Sciences University , Şişli-Istanbul , Turkey , 19 Department of Dermatology , Cardiff University School of Medicine , Heath Park , Cardiff , UK , 20 Department of Pharmacy , Pharmacology and Postgraduate Medicine , The School of Life and Medical Sciences , University of Hertfordshire , Hatfield , UK , and 21 Department of Dermatology and Venereology , Skåne University Hospital , Lund University , Malmö , Sweden
Attachment styles of dermatological outpatients and satisfaction with their dermatologists were investigated within the framework of a multicentre study conducted in 13 European countries , organized by the European Society for Dermatology and Psychiatry . Attachment style was assessed with the Adult Attachment Scale . Patient satisfaction with the dermatologist was assessed with an 11-degree scale . A total of 3,635 adult outpatients and 1,359 controls participated in the study . Dermatological outpatients were less able to depend on others , were less comfortable with closeness and intimacy , and experienced similar rates of anxiety in relationships as did the controls . Participants who had secure attachment styles reported stressful life events during the last 6 months significantly less often than those who had insecure attachment styles . Patients with secure attachment styles tended to be more satisfied with their dermatologist than did insecure patients . These results suggest that secure attachment of dermatological outpatients may be a protective factor in the management of stress .
Key words : psychodermatology ; attachment styles ; satisfaction . Accepted Jan 24 , 2017 ; Epub ahead of print Jan 25 , 2017 Acta Derm Venereol 2017 ; 97 : 813 – 818 .
Corr : Csanád Szabó , Department of Dermatology and Allergology , University of Szeged , Korányi fasor 6 , HU-6720 Szeged , Hungary . E-mail : szabo . csanad @ med . u-szeged . hu
Attachment can be defined as an emotional bond that develops within the context of the early interactions between infants and their primary caregivers ( 1 ). Attachment towards caregivers has an effect on later interpersonal expectations , emotions , and behaviours towards significant others ( 2 ). Attachment style relates to the way people behave in close relationships , which , in turn , is linked to well-being , due to a positive association between social support and health ( 3 – 5 ).
Three different attachment styles were categorized by Ainsworth et al . ( 6 ); secure attachment , and 2 types of insecure attachment : anxious-ambivalent , and avoidant . These different attachment styles can be defined by attributes of 3 dimensions of attachment : comfort with closeness ( closeness ), capacity to depend on others ( dependency ), and fear of being abandoned ( anxiety in relationships ) ( 7 ). Securely attached people find it relatively easy to get close to others and are comfortable depending on them ; they do not often worry about being abandoned . Individuals with avoidant attachment style are somewhat uncomfortable being close to others ; they find it difficult to allow themselves to depend on others , and they are nervous when anyone gets too close to them . People who have an anxious-ambivalent attachment style find that others are reluctant to get as close as they would like , and they often worry that their partner “ does not really love them ” or does not want to stay with them ( 2 ). In a large representative sample of American adults the distribution of adult attachment styles was 59 % secure , 25 % avoidant , and 11 % anxious ( 8 ).
Secure attachment probably results in beneficial psychological health attributes . Patients with insecure attachment styles tend to report a greater number of physical symptoms compared with secure individuals ( 9 ). A secure attachment style might be an important inner resource in emotional adaptation to chronic diseases ( 10 ). The prototype of secure attachment is characterized by a valuing of intimate friendships , the capacity to maintain close relationships without losing personal autonomy , and a coherence and thoughtfulness in discussing relationships and related issues ( 11 ). Insecure attachment has been linked to higher depressive and anxiety scores compared with secure individuals ( 12 ). Avoidant at-
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2017 Acta Dermato-Venereologica . doi : 10.2340 / 00015555-2619 Acta Derm Venereol 2017 ; 97 : 813 – 818