Imagine—you are living with a chronic physical illness or condition for a year or two and you are doing relatively well. You take medication daily, your physical health is stable, and you have never been hospitalized. You read about support groups and ways that you can maintain a good quality of life by eating right and exercising. You never really forget that you have a condition, but after a while you feel that your life can be normal and that everything is going to be ok. You experience months of symptom-free living, you feel good and strong, and you are proud of your healthy lifestyle.

It is possible to imagine how anyone having the experience just described would feel confident in the future of his or her health and secure in the relationships with his or her self, with loved ones, and with the surrounding environment. Somehow it is easy to overlook how the progress of others living with the same illness affects the sense of security and identity just described. It does.

Now imagine that this secure and confident person hears about another individual who has the same chronic illness, and who unexpectedly ends up in the hospital with complications. This person admitted to the hospital was also someone who was doing “relatively well,” who was also stable on medication, and who was maintaining a healthy quality of life. How does hearing this news affect the person who is still functioning quite well despite having a chronic condition? Some could say this person may feel lucky that they are not in the hospital. Others may worry about their comrade. Many may experience fear; a rattling of the security previously felt and a plunge into a chaotic unpredictability. This unknown does not only alter the confidence in one’s health but may also destabilize a previously secure way of relating to one self and others. Attachment theory can help shed light on what occurs when one’s sense of security is threatened.

Attachment theory describes how emotional bonds to others are formed in early childhood between a child and his or her parent. Broadly speaking, when a parent is dependable, consistent, and responsive to a child’s physical and emotional needs, a sense of security develops in the child. Children with secure attachments will be upset when a parent leaves but experience enough confidence in their emotional bonds with their parent that they feel confident that the parent will return, and therefore are able to relax and explore their surrounding environment until they are reunited with the parent. Children whose parent is persistently emotionally unavailable, emotionally overinvolved, rejecting, neglectful, or abusive are likely to develop insecure attachments. These children will either have no interest in a relationship with their parent, or will excessively cling to their parent and become extremely distressed in their parent’s absence. Following these insecurities, these children may feel less comfortable exploring their surrounding environment and new relationships. It is postulated that the attachments formed in early childhood usually persist in later life, so that a child with a secure attachment style grows into an adult with a secure attachment style.

You may be wondering what this has to do with chronic physical illness. Imagine—a person living with chronic physical illness, who has felt secure in his or her relationships for the majority of life, is suddenly hit with the unpredictability brick. At first you wonder, “will I die, will my friends abandon me, will I disappoint others?” After some time you experience a period of fairly good health and your foundation of security in relationships allows you to maintain trust in the strength of your relational bonds. Then one day this person finds out that someone with the same condition becomes very sick and is hospitalized. There is an earthquake. The secure attachment style starts to crack. This person starts to wonder, “what if this happens to me” and “anyone could go at any time, I could go at any time.” The previously secure emotional bonds begin to feel more tenuous and fluid. The sense of stability and consistency, originally provided by a parent during childhood becomes threatened. Maybe some react by isolating themselves, or others may fluctuate between clinging to their loved ones out of fear of losing them and becoming very angry with their loved ones for not always being able to be perfectly present. A person who once had a secure attachment style may appear as someone with an insecure attachment style. Trauma—trauma shakes up one’s sense of security in self and in others—the trauma of living with chronic illness and witnessing what happens to others with the same illness, is no exception.

Does one ever really lose their secure base or is it temporarily challenged in the face of trauma? Perhaps people with a secure attachment style who are diagnosed with a chronic illness cope better and maintain healthy relationships with more ease than people with fundamentally insecure attachments. Can the original attachment style really change or does the person living with a chronic illness at times struggle with so much that their underlying security is temporarily forgotten and with time once again remembered? I would think that the attachments formed early on with one’s parents are the most powerful bonds experienced in life and that a secure emotional relationship with the parent will remain and carry a person living with chronic illness through difficult times. On the other hand, I do believe in the possibility of change through new relationships, such as the change that occurs in psychotherapy when previously insecure styles can evolve into more secure ones. That is the positive spin, but if that can occur it could be possible to conceive of the opposite occurring as well—secure to insecure. Maybe in the end it does not really matter whether or not the attachment style really changes, but rather the importance lies in understanding the experience of what occurs to one’s world and one’s sense of security in relationships with self and others when living with a chronic illness.