behaviours of patients whose attachment systems were activated by pain and illness. They distinguish the different attachment styles by; 1) attachment anxiety, the discomfort someone feels when separated, 2) attachment avoidance, which is discomfort associated with closeness and 3) severity of insecurity Secure- Low anxiety, low avoidance, low severity of insecurity Dismissive- Low anxiety, high avoidance, moderate insecurity Preoccupied- High anxiety, low avoidance, moderate insecurity Fearful- High anxiety, high avoidance, high insecurity Disorganized- High anxiety, high avoidance, high insecurity. The difference between disorganized and fearful is that people with disorganized attachment do not use a consistent strategy to find security. Attachment and health outcomes Attachment and health interact on multiple levels. Attachment is a biologically based system tied to our response to distress and attachment styles appear to confer differences in stress physiology. Illness and pain themselves act as an "activating signal" for attachment systems, and health care providers act as attachment figures in their role addressing illness and pain. Accordingly, attachment styles influence patient perception of illness, health care utilization, medication compliance and treatment response. Physical health While strong social support has been linked to greater resilience to stress and lower medical morbidity and mortality, the mechanism behind this association is poorly understood. In the late 1990s, Paul Ciechanowski investigated the role of attachment styles in patients managing diabetes, finding that individuals with an avoidant-dismissive style were less likely to be compliant with treatment recommendations and had less well-controlled disease as measured by glycated hemoglobin. Larger scale evidence comes from a large American survey of self-reported attachment styles and physical illness conducted by McWilliams and Bailey. They found that those with insecure attachment reported more physical illness than securely attached individuals. Specifically, they found preoccupied individuals reported more heart disease, and dismissive individuals more pain conditions. A prospective study followed children until the age of 32 and found a similar pattern of results. They found that people with anxious-resistant (dismissive) styles of attachment reported vague, non-specific symptoms more often, and those with anxious-preoccupied classification had a higher rate of inflammation-based illnesses. This prospective study was particularly important because of the difficulty assigning causation in the often observed relationship between chronic pain and insecure attachment. Further support is derived from experimental pain studies that have demonstrated numerous risk factors for the development of a chronic pain disorder associated with insecure adult attachment including lower perceived control of pain, higher pain