“How a bad relationship can make you ill – by damaging your immune system” reports the Mail Online.
Generations of poets and songwriters have told us how love can break our hearts, but the study covered by the Mail suggests that being in an emotionally unhealthy relationship can also impact on physical health.
The study analysed 85 couples who had been married for at least two years to investigate the link between:
- attachment anxiety (a psychological term characterised by fear of rejection, dependency on others and anxiety about close relationships)
- levels of a hormone called cortisol which is known to be associated with stress
- levels of immune cells called T cells – the lower your T cell count, the weaker your immune system tends to be, making your more vulnerable to infection
This small study has found that participants with higher attachment anxiety had increased levels of the stress hormone cortisol and lower levels of subtypes of T-cells.
However, the study design means that a cause-and-effect relationship cannot be proven, so we don’t know what came first. Does having attachment anxiety weaken the immune system and increase levels of stress hormones? Or do people with high stress hormone levels and a weakened immune system have a predisposition to end up with attachment anxiety?
If attachment anxiety does cause the changes seen, this study suggests how social relationships can affect health and wellbeing. While the results of this study are interesting, the researchers do not suggest how attachment anxiety could be treated.
Where did the story come from?
The study was carried out by researchers from American universities: The Ohio State University College of Medicine, The University of Texas at Austin, and Eastern Illinois University.
It was funded by the American Cancer Society, a Pelotonia Fellowship, and the US National Institutes of Health.
The study was published in the peer-reviewed journal, Psychological Science.
The Mail Online’s coverage of the study is good, although the headline is misleading.
The study did not look at ‘illness’ as suggested in the headline. In fact, to be included in the study, participants had to be in good health.
So while there may be a potential association between a lower T cell count, increased cortisol levels and an increased risk of illness, this cannot be shown by the study in question.
What kind of research was this?
This cross-sectional study aimed to investigate the link between attachment anxiety, cortisol (‘stress-hormone’) production, and the levels of different subtypes of a group of immune cells called T cells.
Attachment anxiety is characterised by:
- fear of rejection
- dependency on others
- anxiety about close relationships
Individuals with high attachment anxiety readily perceive social threats, react strongly to stressful experiences, and dwell on negative rather than positive aspects of their relationship.
The researchers report that previous studies have indicated that people with high attachment anxiety may be at increased risk of health problems.
People with attachment anxiety have also been found to have higher levels of the stress hormone cortisol. Both stress and cortisol can influence the immune system. In this study, the researchers predicted that people with attachment anxiety would have higher levels of cortisol in their blood and would have fewer CD T cells.
An inherent limitation of cross-sectional studies is that they cannot show a cause-and-effect relationship, and because participants are not followed-up over time, they cannot prove what came first.
What did the research involve?
The researchers recruited 85 couples in good health who had been married for a minimum of two years (average duration of marriage was 12.26 years).
Blood and saliva samples were collected at defined times over three days. Levels of cortisol were measured in saliva, and levels of T-cells were measured in blood.
Participants completed the Experiences in Close Relationships questionnaire, which is used to measure attachment disorders in adults on two sub-scales, one for attachment anxiety and one for attachment avoidance. Attachment avoidance is another dimension of attachment disorder, in which people are excessively self-reliant and are uncomfortable with closeness and intimacy.
To distinguish between people who were anxious in general and those with attachment anxiety, participants completed the Beck Anxiety Inventory (a standardised questionnaire used to assess anxiety).
Finally, as sleep influences cortisol production and immune function, participants also completed a related questionnaire used to assess sleep quality (the Pittsburgh Sleep Quality Index).
The researchers analysed whether there was an association between attachment anxiety and levels of cortisol and T cells taking into account that participants were husband and wife pairs, and including body mass index (BMI), age, gender, attachment avoidance and general anxiety symptoms as control variables.
What were the basic results?
The Experiences in Close Relationships questionnaire scores for participants ranged from 1.00 to 5.39 for attachment anxiety and 1.00 to 5.94 for attachment avoidance (scores can range from one to seven, with higher numbers reflecting more attachment anxiety and attachment avoidance, respectively).
Participants with higher attachment anxiety had higher levels of cortisol (marginal on day one and significant on days two and three). Participants with an attachment anxiety level one standard deviation above the mean value had 11% more cortisol than those with attachment anxiety one standard deviation below the mean on days two and three.
In addition, participants who were more anxiously attached had fewer T cells. (Higher levels of cortisol were associated with lower levels of the subtypes of T cells investigated).
The association between attachment anxiety and levels of cortisol and T cells remained after health behaviours, including sleep quality, were accounted for.
How did the researchers interpret the results?
“People with higher attachment anxiety produced more cortisol and had fewer numbers of CD3+ T cells, CD45+ T cells, CD3+CD4+ helper T cells, and CD3+CD8+ cytotoxic T cells than those with lower attachment anxiety, independent of their general anxiety levels." They go on to say that ‘the current results are thus consistent with theoretical speculation that anxiety about close relationships enhances risk for mental and physical health problems.”
This small study has found that participants with higher attachment anxiety had increased levels of the stress hormone cortisol and lower levels of subtypes of T-cells, part of the immune system.
This study suggests that attachment anxiety may cause physiological changes in the body, although the study design means that a cause-and-effect relationship cannot be proven.
Also, we don’t know what came first: whether people with attachment anxiety have higher levels of cortisol and lower levels of T cells, or people with higher levels of cortisol have higher attachment anxiety.
If attachment anxiety causes the changes seen, this study suggests how social relationships can affect health and wellbeing. Although the results of this study are interesting, the researchers do not suggest how attachment anxiety could be treated.
Despite these limitations, this study would seem to reinforce the theory that our emotional wellbeing can have a significant impact on our physical wellbeing.
Read more advice about improving your emotional wellbeing.
Analysis by Bazian
Edited by NHS Website
Links to the science
Psychological Science. Published online January 10 2013