The implications of attachment style in the relationship between caregivers and patients with dementia

Attachment theory helps to understand the relationship between patients with dementia and family and understand how attachment affects caregivers.

In the literature attachment theory, it is used as a basis for understanding the dynamics subordinated to the care of people with dementia and their families, looking like attachment influence the experience in the role of caregiver.

The assistance to the elderly with a degenerative disease such as dementia involves very complex issues and requires specific responses for both the sick person needs, but also for those who care for them, the so-called caregivers.

The role of the caregiver becomes crucial early stage of the disease and it is common that the same family can develop a stress condition, both physically and emotionally, due to the onerous task of care and nurture, both the physical load and the presence of behavioral disturbances that the disease involves, both for the inevitable changes in the relationship between the caregiver and the patient.

The implications of attachment style in the relationship between caregivers and patients with dementia

There are numerous works and studies that confirm the importance of the role of caregiver in the care process and the need to support this figure to learn the knowledge and resources needed to cover the new role; to process and overcome feelings of guilt and psycho-emotional discomfort that the disease brings.

Advertising message in the literature attachment theory is used as a basis for understanding the dynamics subordinated to the care of people with dementia and their families, noting that attachment influences the experience in the role of caregiver. In general attachment theory can be considered as an approach with multiple and complex conceptual roots that highlights as an essential aspect of the presence in man of an innate need to search throughout the whole of life the protective proximity of a significant figure each once that is in danger, suffering, needs or is in trouble. But this innate need right away is integrated with the experiences arising from the environment in which the individual finds himself. So the tendency of man to seek the closeness of attachment figures corresponds to a knowledge that is based on an innate scheme, but to become fully operational must be integrated with the concrete relationship experiences, in this sense, in fact, the quality of early relationships with caregivers during childhood influence the development of internal working models, the expectations towards self and others and provide the foundation for new experiences and social interactions.

In childhood, during the first year of life, children, within the relationship with the caregiver, you create expectations about the relationship with the attachment figure, so organizing the internal working models, formed by the set of episodic memories and semantics, so that both of the emotional cognitive, and self-representations and significant other. These templates determine those that are the attachment behaviors and that were divided into…

  • Secure attachment (lovable self, accepted; more accepting, provides care and protection, stable, episodic memory and integrated semantics; strategies used in the report and in the exploration of the environment are the most diverse, in general, approach to the attachment figure if c ‘is dangerous and exploration if there is no danger)
  • Avoidant insecure attachment (self-declined, not worthy of love, rejecting another, semantic memory and episodic non-integrated; most used strategy in the report is avoidance)
  • Ambivalent insecure attachment (self-worthy / unworthy of love, more accepting / rejecting, semantic memory and episodic uninterrupted; strategy most used in the report is an attempt to keep the relational control with seductive behaviors and / or aggressive mode)

The attachment theory does not provide an absolute stability throughout the lifespan, the attachment style learned in childhood although the internal working models are very resistant to change; the ability to change is linked to the ability to reflect on their internal models and the possibility of corrective relational experiences.

Attachment theory has been widely used as a basis for understanding the dynamics underlying the care of people in need, particularly of people with dementia and the differences that different styles of attachment to caregivers may result in the new relationship created. Dementia, in fact, threatens the attachment bond, with the progression of cognitive and functional disability, you can activate feelings of attachment, such as the search for security and closeness, dependency needs, required to caregivers.

This new relationship allows the child to restore the primary attachment bond to the parent, as a result the child is working in protective behaviors and helps to maintain the closeness and convey a sense of security to the fragile parent. In the context of care and activation of the welfare system, the ‘secure attachment appears to be related to a series of responses, including:

  • Knowledge of the patient life choices;
  • Feeling prepared to take on the role of caregiver;
  • The probability of providing support and assistance;
  • Be prepared for aid;
  • The quality of care provided to the sick person.

The data on the scientific landscape, leading in the direction of which a safe caregiver can be seen as not only able to take advantage of existing social media and, above all, to confront and integrate the emotions about a spouse, being able to be emotionally unavailable and decreasing the load subjective feeling that the disease involves the ‘burden’.

Faced with events such as the diagnosis of a chronic illness, a safe caregiver can have a better adaptation in stressful situations. In contrast, attachment styles of insecure in a caregiver can pour into situations of increasing conflict, ambivalent feelings, and difficulty in facing and regulate emotions. The unresolved disagreements but also the present, never faced in its history of life, affecting the difficult moments of the nursing situation; caregivers with secure attachment style, are comfortable in how to provide comfort and support, while caregivers with insecure attachment styles, are struggling to support the sick or tend to avoid situations in which the support or in situations where the need is required to dependency on the part of the patient is high.

In several studies, such as Carpenter, was viewed as attachment style, the daughters who deal with older mothers, was related to the type of care provided; daughters with a secure attachment are able to provide more emotional care (proximity, protection, safety) compared insecure attachment. Also in the same study, also confirmed in other studies, the secure attachment style is related to a lower perception of the burden of care, whereas insecure attachment styles are more related to a perception of load increased and the presence of depressive symptoms. As pointed out by Carpenter, in difficult conditions an adult with insecure attachment style may have difficulty finding the resources to provide sensitive and effective care to other people; a relatively safe person can instead perceive others, not only as a source of security and support but also be able to understand the needs of others and provide support.

The insecure caregiver also seems less able to work concretely in the call for help when difficulties arise, such as turn to services in the area. In the study by Markiewicz and colleagues addressed to the exploration of attachment styles and personality traits of caregivers, showed how a style of attachment Safe monsters healthy relationships in which people wants to be available and reliable. The anxious-ambivalent style instead reflects an attachment of dependence, accompanied by emotions of anger and disappointment, while avoidant style reflects those who avoid or stand apart from the other. Markiewicz and colleagues also found that the caregiver anxious – ambivalent reported more often negative emotional reactions related to their caring role, and less likely to require external support and contact services. Avoiding caregiver is more likely to entrust the care for outside help.

In the United Kingdom, as part of a longitudinal study of people with Alzheimer’s, attachment style of the caregiver and the coping strategies put into practice in the care and assistance of the sick, were examined as potential predictors of emotional and psychological aspects as well as the degree subjective burden experienced by the caregiver. The results show that caregivers with insecure attachment signaled anxiety-depressive symptoms, it has also highlighted how these people used dysfunctional coping strategies accordingly to feel the greater load.

Magai and Cohen (1998) in their study analyzed the impact of attachment style of patients with dementia, about who is taking care of these people. Noting that attachment style of people with dementia, it was a significant predictor of caregiver burden. Those who take care of an elderly suffering from dementia showing a secure attachment style, sagger an no less load the care. For people with dementia, one secure attachment style was associated with a lower occurrence of emotional symptoms (anxiety, frustration, agitation) and a positive self-concept, with lower anxiety and a more positive self-concept.

In addition, having this attachment style in both the person with dementia and their family is considered important to the welfare of both members.

In clinical practice, it is, therefore, important to consider the potential implications of attachment relationships. The presented evidence showing how important it is to keep in mind the attachment construct. In fact, specifically a secure attachment style allows you to seamlessly integrate emotions and cognitions that can lead to elder care where even the latter is co-relational-structures of the new dynamics that are initiated; while an insecure attachment styles, so not very functional to the construction of meanings of the self and the world, the discrepancies and subjective suffering can be a risk factor for the welfare of those who take care of a sick family member.

Psychotherapeutic interventions should focus more on solving negative psychological and emotional symptoms, educate and teach appropriate coping strategies, and the evaluation of the burden, rather than on attachment, which is considered stable and not easily susceptible to change through the intervention.

In conclusion, while the style of attachment cannot be open to change, recognition of attachment dynamics is important in terms of support and care for those living with dementia.