catastrophizing and higher perceived pain intensity. Mental health Attachment theory can be conceptualized as a theory of emotional regulation. Bowlby predicted that insecure attachment would be a risk factor for mental health difficulties based on ineffective, or overly rigid, strategies for reducing distress and maintaining psychological resilience. There is a substantial body of literature that supports an association between adult insecure attachment and a wide variety of mental health disorders including depression, anxiety, eating, psychotic and personality disorders. Prospective evidence (research starting with infant attachment and following up over time) is mostly limited to studies following infants into childhood or adolescence as opposed to adulthood, but does demonstrate that insecure attachment is a general risk factor for both internalizing and externalizing symptomatology. Of the handful of studies that have followed infants to adulthood, the only two clear relationships that exist are between (1) disorganized attachment and dissociative symptoms and (2) resistant attachment and anxiety disorders in late adolescence. Causal relationships between insecure attachment and mental illness may be complex. Some risk factors for insecure attachment such as loss of parental figure, and sexual or physical abuse, are also risk factors for mental health disorders. Self-report measures of attachment may be biased by mental health conditions. For example, clinical depression is often associated with negative thoughts about the self, and this cognitive bias may influence the self-report in attachment questionnaires. There may be interpersonal consequences from untreated mental health conditions. Pre-existing psychological problems can increase the likelihood of secure attachment changing to insecure attachment over time. Mechanisms by which Attachment Influences Health Maunder and Hunter outline 3 ways in which insecure attachment can serve as a risk factor for health problems: 1) it may increase one's susceptibility to stress by changing stress physiology, 2) it may be related to potentially harmful behaviours undertaken to regulate affect, and 3) it may change the way people interact with the healthcare system. Attachment and Stress See also: stress (biology), stress (psychological) The stress response in humans is largely governed by the hypothalamic-pituitary-adrenal axis (HPA) and sympathetic nervous system. The HPA axis has garnered particular attention from attachment researchers because it is known to be activated by social stressors. The normal response for this system is to release stress hormones, particularly cortisol, for a brief duration and then shut itself off due to negative feedback, resulting in a short, strong release of cortisol. The HPA