Diabetes, Relationships, and Attachment Styles

Alexandria Ambrose, PsyD

Dr. Alexandria Ambrose is a licensed psychologist in Colorado, while also offering teletherapy to residents in over 30 states. She currently owns a private practice providing individual and couples therapy to those coping with chronic medical illness, relationship concerns, anxiety, depression, trauma, grief and loss, and disordered eating patterns. Living with type 1 diabetes since 2004, Alexandria approaches her work compassionately and genuinely. Alexandria published an e-book in 2022 entitled: My Diabetes and Me: A Psychoeducational Guidebook for Adolescents and Parents Coping with Type 1 Diabetes that was originally part of her dissertation in graduate school. In her free time, she can usually be found online shopping for new CGM stickers, hanging out with her cats, and exploring new spots to take nature walks. Website: https://dralexandriaambrose.com/ Instagram: dralexandriaambrose

Any chronic illness, especially diabetes, can be incredibly present in relationships, almost like a “third wheel” in monogamous relationships. This shows up in a variety of ways:

Tricky Balances
• Prioritizing both your health needs AND the needs of your partner.
• Wanting to share your experiences but NOT wanting to feel the burden of having to educate (partners need to do some of their research too!).
• Balancing receiving support in a romantic relationship while NOT feeling like it is a caregiving relationship.

Emotional Vulnerability
• Not only sharing with partners about the literal parts of the disease, but also the emotional impact on both yourself AND your relationship

Sharing & Understanding
• Deciding how much you want your partner involved in your diabetes.
• Helping partners understand the difficulties that come with having a chronic illness while also holding emotional space for THEM while they process THEIR own emotions… whew! Lots of feelings everywhere.

So much of how we operate in relationships stem from our understanding of ourselves in relation to others.

Translation: we learned a whole lot from not just our upbringing and caregiver relationships but our understanding of the world comes from MANY different relationships… family, friends, romantic partners.

It impacts the type of partners we seek in addition to how we respond to various interactions within our relationships. The science of attachment styles can help us understand perhaps why we do the things we do in relationships.

ATTACHMENT STYLES 101

What are “attachment styles”?
Our attachment styles stem from really early-in-life relationship patterns that taught us how to connect with other humans and how much to depend on others. It informs the way we function in relationships and how we respond to various events that occur in relationships. How reliable your relationships are early on teaches you how to assess or guess in future relationships. What happens to us when we are younger can be ingrained at a neurobiological level, which absolutely impacts our responses and behaviors.

The not-so-great part is that sometimes our inner attachment system alarms go off EVEN when a present relationship may be secure or safe.

Some questions to reflect on to discover your attachment style:
• How were needs expressed growing up? How were needs met?
For example, do you remember caregivers asking how your day was or how you felt about your diagnosis or when your A1C was not quite what your doctor wanted?

• What were your models of relationships?
Did you grow up with caregivers who were married? Divorced? Together but should have divorced? Did you see parents or caregivers be affectionate and talk about emotions? How did they take care of each other and how did they take care of you?

• Did you talk about emotions?
Were there conversations about anger, sadness, joy, embarrassment, shame, guilt?

• Did you learn how to communicate what you are needing?

• Did you feel emotionally safe?
Were you able to express yourself without being ignored or invalidated? Did relationships ever feel conditional? As if you did not do/act a certain way, your person would not be as attentive or show care.

What are the types of “attachment styles”?

Anxious
• Preoccupied
• Fear of abandonment
• Worrisome
• Struggles to communicate needs directly

When we feel anxious, fearful, and feeling likely to be abandoned (anxious attachment), it can lead to overthinking when it comes to receiving support from a partner. Or this type of attachment style keeps your worry alarms going even when perhaps something objectively insignificant happens (think about the last time your partner did not text you back when you really needed them… did you go into panic mode? Or fearful that they are not committed?)

Avoidant
• Downplays importance of relationship
• Equates relationships with loss of independence
• Tend to withdraw

When we have an avoidant attachment style, we tend to isolate more, perhaps avoid “being a burden” all together and refuse to let our partner into our diabetes world. Think about the times of just doing it all on your own and not wanting to even pursue dating because it would mean inviting someone into life and being vulnerable.

Secure
• Feeling comfortable with closeness while valuing alone time
• Can communicate directly when feeling upset
• Cooperative & flexible

When we feel secure or safe (aka a secure attachment style), we lean more into being open and vulnerable. With this type of attachment style, there is a balance of asking for what we need alongside maintaining our independence.

And what do attachment styles have to do with diabetes?

Attachment styles very much impact how we operate in relationships. Diabetes includes so much receiving care that sometimes it helps to understand HOW we receive that love and care.

Thinking about attachment styles can help us understand how we tolerate relational misunderstandings, miscommunications, and fears as they relate to diabetes.
• Do you ever feel like a partner will abandon you if they feel like your diabetes is “too much?”
• Does it bother you when a partner does not respond how you want or expect them to respond when you talk about the emotional toll of diabetes?
• Are you fearful that your partner doesn’t love you if they don’t help you order supplies or pick up prescriptions?
• Do you avoid seeking companionship at all because it is just too much work to have to explain your broken pancreas?

That’s your attachment style talking!

Our attachment styles may impact how much we want our partner to be involved in our diabetes, how we communicate what types of help we do OR don’t want, or even how we emotionally respond when our partner attempts to provide support in their own way. Identifying what style(s) we formed early on aid us in figuring out why we feel anxious or stressed in times of relationship conflict. Attachment styles may shape the type of desire we have for our partners to take care of us, especially when it comes to diabetes.

How to incorporate the science of attachment styles into practice
(While this is not a comprehensive list, here are some tips now that you have are beginning to reflect on attachment styles, relationships, and diabetes):

• Nonjudgmentally reflect on what your attachment style may be.
Keyword here is nonjudgmentally. While having a secure attachment makes life easier, this takes practice, intentionality, awareness (both of self and partners), and some non-intuitive work. If you grew up with unreliable and emotionally distant caregivers, you will assume partners will be unreliable and emotionally distant! Be a compassionate observer (or even a neutral one!) when reflecting on these questions posed. There are also types of quizzes in books and online to see what style you gravitate towards. It is also helpful for you partner to see what their style may be.
• Communicate with your partner.
Throwing diabetes management into the mix of humans relating to and communicating with one another can be really incredibly hard. Being aware of attachment style tendencies can help you and your partner understand how to communicate your needs. Listen to understand and use “I” statements.
• Be aware, patient, and self-compassionate.
Tuning into when you feel significant emotional responses to your partner can give you a lot of data on navigating attachment style patterns. Again, this is a time to be a neutral observer. No need to judge yourself for patterns that have been there for most of your life. Remember to hold patience for both yourself and your partner.

References:
Ainsworth, M.D.S., & Bell, S.M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41, 49-67.
Bowlby J. (1969). Attachment. Attachment and loss: Vol. 1. Loss. New York: Basic Books.
Johnson, S. (2008). Hold me tight: Seven conversations for a lifetime of love. Little, Brown and Company, Hachette Book Group.
Levine, A., & Heller, R.S.F., (2010). Attached: The new science of adult attachment and how it can help you find—and keep—love. TarcherPerigee.