Attachment-Related Issues: How to Manage Depression

Mood disorders commonly occur alongside difficult early experiences, so how to manage depression is a concern that crosses the minds of many people with insecure attachment.

Days when we experience feelings of being “low” or “down” are common for us all, but some of us endure periods of a persistently sad mood for weeks, months – or more – at a time. These people may be experiencing depression or major depressive disorder, which is a serious mental health condition that impacts people’s thoughts, feelings, actions, and overall quality of life.

According to the World Health Organization (WHO), depression affects over 5% of the world’s adult population. Yet, despite this high percentage, depression is often misperceived by many as not being a life-affecting illness. This perception could not be less accurate: Depression can lead to a range of emotional and physical issues, a loss of interest in activities that were previously enjoyed, a decreased ability to perform tasks both at work and home, and an overall severe reduction in quality of life.

Fortunately, with effective treatment and support, it is possible to manage depression in a way that allows people suffering from it to lead a full, emotionally fulfilling life. To help answer any questions you may have about depression, as well as how depression and attachment relate, we cover the following topics in this article:

• The signs of depression
• Insecure attachment and depression
• Types of depression
• How to manage depression

Signs/Symptoms of Depression

The symptoms of depression vary according to the specific type, afflicted person, and distinct circumstances. Therefore, how to best manage depression can differ from person to person – especially if attachment and depression is a factor.

Having said as much, developing an awareness of the more common signs of depression may help you to communicate your concerns or difficulties with the necessary medical or mental health professionals should you need to.

The emotional and mental symptoms of depression can range from mild to severe. These symptoms typically include:

• continuous low mood or sadness
• feelings of worthlessness or hopelessness
• low self-esteem
• loss of joy from once pleasurable activities
• extreme worry or anxiety

Furthermore, the symptoms of depression aren’t purely emotional or mental; common physical signs of depression include:

• constant fatigue,
• insomnia,
• irritability,
• oversleeping,
• loss of appetite,
• loss of sex drive
• various physical aches and pains.

Depression in any form can affect your home, social, and work life. Furthermore, if depression is a result of attachment issues, it can particularly impact interpersonal relationships.

As a note, the more severe forms of depression may include suicidal ideations or an attitude that life “isn’t worth living.” If this is the case for you or someone you know, it is imperative that you immediately contact your local mental or medical health professional or emergency services.

Insecure Attachment and Depression

Bowlby’s attachment theory (1969) was originally developed to describe the proximal relationship between caregivers and their children and how this relationship functions to create feelings of care and security. “Felt security” occurs after repeated interactions in which the child feels as though their physical and emotional needs are consistently and adequately met.

However, if the child feels as though their physical and emotional needs are not met consistently and adequately, the child may view themself as less competent; they are unable to communicate their needs adequately enough to have them met. As a consequence of this self-view, as well as a lack of a secure relationship with primary caregivers – which promotes healthy self-esteem – the child is more vulnerable to mood disorders such as depression as they develop into adolescence.

In other words, from an attachment theory perspective, the less success a child experiences in getting their caregivers to meet their needs for security, the more likely they are to develop a depressive disorder.

Studies have demonstrated that the form of depression someone with attachment issues may be prone to experiencing may depend on the dimension of attachment they fall on. For instance, those who fall high on the dimension of anxious attachment (anxious and fearful-avoidant or disorganized attachment) may develop depression which focuses on issues of loss and abandonment, as well as dependence on others. In contrast, those who fall high on the dimension of avoidant attachment (avoidant and fearful-avoidant or disorganized attachment) may be more prone to depression which targets issues of self-worth.

Types of Depression

When considering how to manage depression, it is important to recognize that not all forms of depression are the same – and may manifest differently depending on attachment styles – therefore their symptoms and treatment vary. The following are some of the more common forms of depression:

Clinical or Major Depression

Clinical depression is medically diagnosed, meaning that it is assessed and treated by a doctor. Clinical depression is relatively common, as in the United States alone, approximately 16.2 million people have experienced it.

The symptoms of clinical depression tend to be severe and people tend to experience symptoms for most of the day, almost every day. These symptoms include continuous low mood, despondency, dread, over or under-sleeping, fatigue, over or under-eating, anxiety, loss of interest in previously enjoyed activities, low self-worth, lack of motivation, difficulty concentrating, and suicidal ideation.

If you think you (or someone you care about) may have clinical depression, it’s imperative to speak to your mental health specialist.

Attachment-Related Depression

Although attachment-related depression isn’t a commonly known form of depression, people with attachment issues have low self-views, difficulties trusting others, and problems feeling safe and secure in relationships. As a result, mood disorders such as depression and loneliness are common in people with insecure attachment styles – a fact that is backed up by many studies on attachment theory.

Dysthymia or Persistent Depression

Persistent depression or dysthymia is also known as “chronic depression,” and tends to last for more than two years. The symptoms of this form of depression are outwardly similar to major depression, but they might not be quite as intense.

Seasonal Affective Disorder (SAD)

As the name suggests, this form of depression tends to be seasonal or is associated with certain types of weather. People with SAD typically notice a reduction in their energy, mood, and sleeping patterns when the weather turns cold (or, in some instances, warm). For obvious reasons, this form of depression is more common in winter or more northerly countries.

Bipolar Disorder

Bipolar disorder is associated with periods of extreme highs and depressive lows. The low episodes of bipolar disorder tend to appear similar to depressive periods and share many of the same symptoms. The high episodes are sometimes referred to as “manic episodes” as they are associated with elation, speaking rapidly, high energy, and self-importance.

Pre- or Postnatal Depression

These forms of depression occur during and after pregnancy. Prenatal depression occurs before birth, and postnatal occurs after birth. Although more common in women, these forms of depression can also affect men due to lifestyle changes. These types of depression are often attributable to hormonal changes during pregnancy and childbirth, as well as a lack of sleep after having the child.

Psychotic Depression

Psychotic depression or “depressive psychosis” are episodes of extreme low mood which is accompanied by hallucinations or delusions. The hallucinations may involve auditory, visual, or olfactory visions or apparitions. The delusions may include believing in untrue or fantastical stories or opinions.

This list includes the more commonly known forms of depression, but other forms comprise premenstrual syndrome, atypical depression, situational depression, subsyndromal depression, cyclothymia, and disruptive mood dysregulation disorder.

Depression Treatment

When treating depression, promoting psychological well-being is key. Psychological well-being involves promoting meaning, mastery, purpose in life, and positive relationships. However, managing depression relating to attachment issues may be more complicated, as the research on promoting psychological well-being for attachment-related mood disorders is limited.

Furthermore, if you are wondering how to manage depression and attachment, then you might be considering the most appropriate form of treatment for your symptoms. Yet, the best form of treatment for you will depend on the type of depression that you have. Of utmost importance is discussing your concerns with a trained mental health professional, such as your GP.

Mild depression can often be helped through establishing healthier lifestyle habits, such as eating a nutrient-rich diet, exercising, and meditation. There is also a range of mental health apps that can guide people through their symptoms or episodes.

Moderate or severe depression requires a different approach to mild depression, however, as the symptoms may be more severe or well-established. If you are experiencing more severe signs of depression, then your doctor may discuss the option of medication with you as it is often necessary to get the symptoms of the illness under control.

Attachment-Related Depression Strategies

Speaking to a trained mental health professional is highly important when treating and managing depression, however, there are a couple of strategies you can put in place in the interim. Often, considering the traits of your specific attachment style can help during this process.

Talk Therapy

Talk therapies such as Cognitive Behavioral Therapy (CBT), Psychodynamic Therapy, and Attachment Therapy are effective ways of managing the depressive cycle of thoughts, feelings, and actions. CBT is present-focused, so it can help manage current thoughts and beliefs that maintain depression. In contrast, psychodynamic and attachment therapy focus on formative years and how the beliefs associated with our childhoods can impact our current outlooks. However, there are a range of different therapies that may suit the specific forms of depression in distinct ways.

Moreover, a combination approach may be necessary for people with more severe forms of depression. This approach often involves both therapy and medication, so it’s important to consult your GP if this is something you would like advice on.

Regulate Emotion Expression

People high on the dimension of anxious attachment tend to overly express their distress, which can further dysregulate their mood. Over-expression of distress is associated with negative self-views and low control over actions, which results from attempts to avoid or reject the true nature of negative feelings.

In contrast, people high on the dimension of avoidant attachment are prone to under-regulation of emotions in an attempt to suppress negative feelings. However, suppression of negative feelings is also related to increased depression symptomatology.

Tuning into our emotions can help us experience them in healthier, more balanced ways – which, in turn, can impact our mood in positive ways. Our previous article on emotion regulation can help you with this process.

Challenge and replace negative self-thoughts

Depression can be caused and maintained by negative self-thoughts such as, Deep down I know that everyone is better than me. Thoughts like this are indicative of low self-esteem, which can result from an insecure attachment style – how our needs were met in our early years can cause negative self-perceptions. Furthermore, the activation of insecure attachment-related thoughts (for example, I’m not worthy of love and affection) is related to low levels of self-acceptance and increased depression.

Although targeting low self-esteem is a process that involves developing awareness around why we have negative self-views-such as understanding our attachment styles, we can still overcome an internal self-critic through some metacognition work.
The following activity can help you challenge and replace negative self-talk.

• Every day for the next couple of weeks spend some time noting any negative thoughts that you had about yourself that day in the table below.
• Analyze how your negative thoughts are distorted or inaccurate by answering each of the “challenging questions” in the table.
• With practice, you will likely start to recognize how much of your inner narrative is negative. Continue to challenge these negative beliefs and replace them with more realistic and positive ones.

Try rational affirmations

Rational or “neutral” affirmations are particularly helpful for people with depression symptomatology. This is because positive affirmations can feel too absurd or unrealistic for those of us who struggle to see our worth. In general, affirmations can target negative self-beliefs and subsequent negative emotions and actions through consciously challenging our subconscious. Plus, the more realistic and reasonable they are, the more effective they’re likely to be. Instead of using affirmations to express self-love, use them to express self-neutrality. After all, if you have an inferiority complex, being neutral towards yourself is a radical change from being consistently critical towards yourself.

Use the negative thoughts you identified in the previous tip to help you create your neutral affirmations. For example, if your thought is I fail at everything that I do, you can create an affirmation such as “I’m not going to give up.” Furthermore, make sure your affirmations tap into your sense of self by using “I” statements. The following are more examples of rational affirmations.

• Today I’m doing OK.
• I am working hard to accept myself for who I am.
• With effort and time, I am getting better each day.
• I am capable of handling things that come my way.

Practice your rational or neutral affirmations daily by keeping them accessible to you, such as in a notebook or stored on your phone. In time, your mind will start going to these affirmations as natural thoughts rather than concentrated effort.

Final Words on Attachment and Depression

Depression is a global mental health problem that affects approximately 5% of the world’s population. However, the symptoms of depression vary largely depending on the etiology, form, and specific individual affected. Furthermore, those of us who experienced challenges in our early years – such as developing an insecure attachment style – may be more at risk of forming depressive symptomatology.

Although we can take steps to improve our overall mood, if you or someone you know is struggling with depression, it is imperative that you speak to a mental health or medical professional. With the right care and strategies, depression can improve to the extent that it no longer dominates someone’s life. And, as always, if you need more advice on the steps you can take, we at The Attachment Project are always at hand.