Bağlanma Teorisi ve Bağlanma Bozukluklarına Genel Bir Bakış

Bağlanma sistemi, bebeğin hayatta kalması için hayati önemi olan, sadece insana özgü olmayıp doğada bütün memeli türlerinde görülen evrimsel bir sistemdir. Anne-çocuk ilişkisinden başlayarak kişinin hayatı boyunca kurduğu bütün ilişkiler için bir taslak arz eden bağlanma biçimi, kronik hastalık durumlarında kişinin tedavi ekibi ile kurduğu ilişkide de belirleyici olabilmektedir. Bağlanma temelde güvenli ve güvensiz bağlanma olarak ikiye ayrılır; güvensiz bağlanma ise kendi içinde kaygılı, kaçıngan, ve dezorganize güvensiz bağlanma olmak üzere üç tiptir. Güvenli bağlanma özellikleri göstermeyen kişiler, bazen sorunlu ilişki kurma biçimleri nedeniyle "zor hasta" olarak tanımlanarak klinik ilgi odağı olmaktadırlar. Bağlanma biçimleri ve bunlardan kaynaklanabilecek sorunlar literatürdeki bilgiler ışığında incelendiğinde, basit birtakım girişimlerin doktor-hasta ilişkisindeki bazı zorluklara çözüm olabileceği görülmektedir. Hastaların farklı bağlanma biçimleri dikkate alınarak ve tedaviler hastalar ile işbirliği içinde planlanarak, hastalara kişiye özgü ve daha başarılı bir bakım sağlanabilir. John Bowlby tarafından temelleri atılan bağlanma teorisi ile ilgili bilgi sahibi olmak ve hastaların farklı bağlanma biçimlerini tanıyabilmek terapötik işbirliğinde nerede olduğumuzu görmemize ve doğabilecek sorunları öngörerek daha iyi sağlık hizmetleri vermemize yardımcı olabilir.

Attachment Theory and an Overview of Attachment Disorders

Attachment system is an evolutionary system that is seen in all mammals in nature and vitally important for the baby's survival. The attachment pattern developed in the infancy functions as a template for all relationships in life beginning with the first interaction between the mother and baby, and may play a decisive role in the relationship that one forms with healthcare professionals in case of chronic illness as well. Attachment patterns can be distinguished as secure and insecure attachment; and insecure attachment can be further categorized into three patterns: anxious, avoidant, and disorganized insecure attachment. Patients who do not exhibit a secure attachment pattern sometimes become the focus of clinical attention as "difficult patients" due to their problematic forms of developing relationships. When attachment patterns and the related problems are investigated in the light of the literature, it is seen that solutions for such problems in the doctor-patient relationship are possible by certain simple interventions. Individualized, more successful healthcare can be achieved by considering patients' distinct attachment patterns and cooperating with the patient in planning the treatment. Being knowledgeable with the attachment theory founded by John Bowlby and able to recognize patients' distinctive attachment patterns might help us realize where we stand in the therapeutic collaboration with the patient and, enabling us to anticipate potential problems, can result in better healthcare.

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1. Bowlby J. The making and breaking of affectional bonds. II. Some principles of psychotherapy. The fiftieth Maudsley lecture. Br J Psychiatry. 1977;130:421-31.
2. Bowlby J. Attachment. New York: Basic Books; 1969.
3. Bowlby J. Separation: Anxiety and Anger. New York: Basic Books; 1973.
4. Bowlby J. Loss: Sadness and Depression. New York: Basic Books; 1980.
5. Kraemer GW. A psychobiological theory of attachment. Behav Brain Sci. 1992;15(3):451-93.
6. Bretherton I, Munholland KA. Internal working models in attachment relationships: a construct revisited. Handbook of Attachment, ed. Cassidy J, Shaver PR. New York: Guilford; 1999:89-111.
7. Hazan C, Shaver PR. Romantic love conceptualized as an attachment process. J Personality Social Psychol. 1987;52(3):511-24.
8. Mickelson KD, Kessler RC, Shaver PR. Adult attachment in a nationally representative sample. J Pers Soc Psychology. 1997;73(5):1092-106.
9. West ML, Sheldon-Kellor AE. Patterns of Relating: An Adult Attachment Perspective. New York: Guilford Press; 1994.
10. Klohnen EC, John OP. Working models of attachment: a theory-based prototype approach. Attachment Theory and Close Relationships, ed. Simpson JA, Rholes WS. New York: Guilford; 1998:115-40.
11. Özer Ü, Yıldırım EA, Erkoç ŞN. Major depresyon olgularında intihar düşünce ve davranışının bağlanma biçimi ile ilişkisi. Arch Neurosciatr. 2015;52(3):283-8.
12. Bartolomew K, Horowitz LM. Attachment styles among young adults: a test for four-category model. J Pers Soc Psychol. 1991;61(2):226-44.
13. Wilhelm K, Tietze T. Difficult doctor-patient interactions: applying principles of attachment-based care. Medicine Today. 2016;17(1-2):36-44 . 14. Main M. Metacognitive knowledge, metacognitive monitoring, and singular (coherent) vs. multiple (incoherent) model of attachment: findings, and directions for future research. Attachment Across the Life Cycle, ed. Parkes CM, Stevenson-Hinde J, Marris P. Londra: Routledge; 1991:127-60.
15. Fonagy P, Steele H, Moran GS, Higgett AC. The capacity for understanding mental states: the reflective self in parent and child and its significance for security of attachment. Infant Ment Health J. 1991;12(3):201-18.
16. Lyons-Ruth K, Block D. The disturbed caregiving system: relations amongst childhood trauma, maternal caregiving, and infant affect, and attachment. Infant Mental Health J. 1996;17:257-75.
17. Adshead G. Psychiatric staff as attachment figures. Br J Psychiatry. 1998;172:64-9.
18. Blackwell B. Sick-role susceptibility. Psychother Psychosom. 1992;58:79-90.
19. Groves JE. Taking care of the hateful patient. N Engl J Med. 1978;298(16):883-7.
20. Lipowski ZJ, Somatization: the concept, and its clinical application. Am J Psychiatry. 1988;145(11):1358-68.
21. Dozier M. Attachment organization, and treatment use for adults with serious psychopathological disorders. Dev and Psychopathol. 1990;2(1):47-60.
22. Ciechanowski P, Katon W, Hirsch I. Attachment style and adherence in the diabetic patient. Psychosom Med. 1999;61(1):110.
23. Yılmaz Özpolat AG, Ayaz T, Konağ Ö, Özkan A. Attachment style and perceived social support as predictors of biopsychosocial adjustment to cancer. Turk J Med Sci. 2014;44(1):24-30.
24. Maunder RG, Hunter JJ. Attachment and psychosomatic medicine: developmental contributions to stress and disease. Psychosom Med. 2001;63(4):556-67.