Elsevier

Brain, Behavior, and Immunity

Volume 41, October 2014, Pages 232-238
Brain, Behavior, and Immunity

Attachment anxiety is related to Epstein–Barr virus latency

https://doi.org/10.1016/j.bbi.2014.04.002Get rights and content

Abstract

Attachment theory provides a framework for understanding individual differences in chronic interpersonal stress. Attachment anxiety, a type of relationship insecurity characterized by worry about rejection and abandonment, is a chronic interpersonal stressor. Stress impacts cellular immunity, including herpesvirus reactivation. We investigated whether attachment anxiety was related to the expression of a latent herpesvirus, Epstein–Barr virus (EBV), when individuals were being tested for breast or colon cancer and approximately 1 year later. Participants (N = 183) completed a standard attachment questionnaire and provided blood to assess EBV viral capsid antigen (VCA) IgG antibody titers. Individuals with more attachment anxiety had higher EBV VCA IgG antibody titers than those with less attachment anxiety. The strength of the association between attachment anxiety and antibody titers was the same at both assessments. This study is the first to show an association between latent herpesvirus reactivation and attachment anxiety. Because elevated herpesvirus antibody titers reflect poorer cellular immune system control over the latent virus, these data suggest that high attachment anxiety is associated with cellular immune dysregulation.

Introduction

There are well-documented links between close relationships and physical health. People who have supportive close relationships have lower rates of morbidity and mortality than those who have unsupportive and conflict-ridden relationships (Berkman and Syme, 1979, Brummett et al., 2001, Gilbert et al., 2009, House, 1988, Orth-Gomer and Johnson, 1987, Repetti et al., 2002, Tomaka et al., 2006, Uchino et al., 1996). Attachment theory provides a framework for understanding individual differences in chronic interpersonal stress and thus may offer insight into the associations between close relationships and health (Diamond and Hicks, 2004, Shaver and Mikulincer, 2007, Uchino, 2009).

Attachment theory suggests that people who have responsive and supportive parents during childhood develop a sense of emotional security that lasts into adulthood, while those who have unresponsive and unsupportive parents develop a sense of emotional insecurity (Mikulincer and Shaver, 2009, Thompson, 1999). Different academic and theoretical traditions conceptualize attachment insecurity in slightly different ways (Fraley and Waller, 1998); according to adult attachment theory, there are two patterns or dimensions of attachment insecurity: attachment anxiety and attachment avoidance (Mikulincer and Shaver, 2007). These patterns have the potential to change throughout one’s lifespan but are thought to be relatively stable (Mikulincer and Shaver, 2007).

People with high attachment anxiety constantly worry about rejection and abandonment and use “hyperactivating” coping strategies, such as excessive rumination and preoccupation about stressful events (Brennan et al., 1998, Diamond and Fagundes, 2010, Diamond, 2001, Fraley and Shaver, 2000a). Indeed, people with higher attachment anxiety tend to have a more negative self-image and intense negative emotions than those with lower attachment anxiety (Mikulincer et al., 2006, Pietromonaco and Barrett, 1997).

People with high attachment avoidance are uncomfortable depending on others for support and use “deactivating” coping strategies that inhibit, exclude, or suppress distressing relational experiences (Brennan et al., 1998, Fraley and Shaver, 2000b). Individuals with higher attachment avoidance tend to denigrate and distrust support providers more than those with lower attachment avoidance (Mikulincer and Shaver, 2003, Shaver and Mikulincer, 2005). Furthermore, they keep negative emotions alive internally, while attempting not to express them externally (Mikulincer and Shaver, 2003, Shaver and Mikulincer, 2005).

Attachment anxiety has been reliably linked to many age-related health problems, while attachment avoidance has not (McWilliams and Bailey, 2010, Puig et al., 2012). The chronic social stress that is a feature of attachment anxiety may be an important mechanism underlying this link; chronic stress can impair vaccine responses, slow wound healing, promote inflammation, and dysregulate cellular immunity (Glaser and Kiecolt-Glaser, 2005a). Consistent with this argument, recent work in the field of psychoneuroimmunology demonstrated that people who had higher attachment anxiety had fewer numbers of CD3+ T-cells, CD45+ T-cells, CD3+CD4+ helper T-cells, and CD3+CD8+ cytotoxic T-cells compared with those who had lower attachment anxiety (Jaremka et al., 2013).

Chronic interpersonal stress can drive herpesvirus reactivation and replication by impairing cellular immune system control over viral latency through both autonomic and glucocorticoid pathways (Cacioppo et al., 2002, Glaser and Kiecolt-Glaser, 1994, Yang et al., 2010). Maladaptive alterations in cellular immune function can enhance herpesvirus reactivation and replication, resulting in elevated herpesvirus antibody titers (Glaser and Kiecolt-Glaser, 1994, Glaser and Kiecolt-Glaser, 2005b, Glaser et al., 2005, Steptoe et al., 2007). For example, organ transplant patients have dysregulated cellular immunity and elevated herpesvirus antibody titers (Gray et al., 1995). Although usually asymptomatic, elevated herpesvirus antibody titers reflect poorer cellular immune system control over viral latency (Glaser and Kiecolt-Glaser, 1994). Accordingly, people who are anxiously attached may be vulnerable to latent herpesvirus reactivation and replication due to their chronic interpersonal stress and corresponding cellular immune dysregulation.

Based on the argument that attachment anxiety is a chronic interpersonal stressor, we hypothesized that those who were more anxiously attached would have higher EBV VCA IgG antibody titers than those who were less anxiously attached. Because most studies have not shown a consistent association between attachment avoidance and health or stress sensitivity, we made no a priori hypothesis about attachment avoidance (Dewitte et al., 2010, Jaremka et al., 2013). However, we examined the possibility that those who were more avoidantly attached would have higher EBV VCA IgG antibody titers than those who were less avoidantly attached. We also explored whether the association between attachment anxiety/avoidance and herpesvirus reactivation differed over time.

Section snippets

Participants and procedure overview

Study participants (N = 183) were recruited from oncology clinics as they were being tested for breast or colon cancer as part of an ongoing longitudinal observational study investigating potential links between fatigue and immune dysregulation. Participants were being tested for breast or colon cancer because of a suspicious initial test; all participants completed their first visit after this initial suspicious test. Participants eventually received a benign diagnosis as the result of one or

Preliminary analyses

Table 1 reports descriptive sample information for all individuals who were EBV seropositive (i.e., the individuals included in the analysis). There was considerable variability in both attachment anxiety and EBV VCA IgG antibody titers. In addition, people who were higher on attachment anxiety were above the normal range for patient populations based on the extant literature using the ECR-M16 (Neel et al., 2013, Sockalingam et al., 2012, Sockalingam et al., 2013). Individuals who were lost to

Discussion

Individuals who were more anxiously attached had higher EBV VCA IgG antibody titers, reflecting poorer cellular immune system control of the latent virus, than their less anxiously attached counterparts. They also had higher levels of general anxiety than those who had lower attachment anxiety. Attachment avoidance was not associated with EBV VCA IgG antibody titers or general anxiety. This study is the first to show an association between latent herpesvirus reactivation and attachment anxiety.

Acknowledgments

Work on this project was supported in part by American Cancer Society Postdoctoral Fellowship Grants PF-11-007-01-CPPB and PF-12-040-01-CPPB and NIH grants CA131029, CA126857, and CA16058. Finally, the project was also supported by Award Number UL1TR000090 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Advancing Translational Sciences or the

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