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