get too close. They tend to agree with statements such as "I am somewhat uncomfortable getting close to others. I want emotionally close relationships, but I find it difficult to trust others completely, or to depend on them. I sometimes worry that I will be hurt if I allow myself to become too close to others." People with loss or trauma in childhood are at greater risk of developing this style of attachment. Insecure Attachment Styles in Healthcare Settings Anxious-Preoccupied People with anxious-preoccupied attachment tend to be hypervigilant to signs of danger and worry or catastrophize about symptoms. In health care appointments, their narrative is full of intense negative emotion but is relatively sparse in the specific detail desired by health care providers. This presentation can readily be perceived as "needy" or "dramatic". If the healthcare provider pulls away in response it may reinforce the patient's need to articulate their distress, creating a cycle of distress-withdrawal-distress. Avoidant-Dismissive People with avoidant dismissive attachment emphasize their independence and minimizing expressing distress. They may delay seeking healthcare (see healthcare utilization), minimize reporting symptoms and disclose limited personal information. Fearful-Disorganized People with fearful attachment often avoid routine healthcare, but present in a crisis with volatile, intense, negative emotions. Due to their degree of distress, they can present a disorganized narrative that is difficult for providers to follow and interpret diagnostically. Working Model Working models are representatives of the cognitive schema, or psychological structure (often unconscious), which underlie the different attachment classifications. Working models develop in children over time based on their experiences with their attachment figures. The cognitive schema for attachment consists of views of the efficacy of self and other to create security in times of distress. Bartholomew and Horowitz Model Bartholomew and Horowitz proposed and verified a working model based on two dimensions; the view of the self (self-esteem) and the view of others (sociability) Secure- Positive view of self, Positive view of other Dismissive- Positive view of self, Negative view of other Preoccupied- Negative view of self, Positive view of other Fearful- Negative view of self, Negative view of other Prototype-Insecurity Classification Model In 2012 Maunder and Hunter combined the internal working model with the attitudes, behaviours and emotional expression of the different styles to create a prototype based classification that included severity of insecurity. This model was designed to be clinically useful, allowing healthcare providers to identify and predict the