Predisposition to depression: the role of attachment

Objective: To examine the hypothesis that adverse early relational experiences causing activation of the hypophysial-pituitary-adrenal (HPA) axis during critical early stages of development can predispose to depression. Patients thus affected are likely to manifest insecure patterns of attachment in close relationships and are vulnerable to depression after adverse life events. Method: The literature pertaining to sensitization of the HPA axis in early life and the neurobiology of attachment is examined. Results: Adverse early relational experiences can result in activation of the HPA axis, causing sensitization of depression pathways in the brain. Secure attachment acts as a buffer against HPA activation in response to stress. Infants with insecure attachment lack this buffering effect and may be predisposed to depression and other psychiatric disorders in response to psychosocial stressors. Conclusions: There is a patient group predisposed to depression on the basis of adverse early life experience. In these cases, the neurobiology of attachment offers a means of integrating findings concerning sensitization of the HPA axis in infancy, the effects of early life experience on brain development, and predisposition to depression and other psychiatric disorders. These findings have important implications for the development of interventions aimed at prevention and treatment for this patient group.