Food allergy and attitudes to close interpersonal relationships: An exploratory study on attachment

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Food allergy is an adverse reaction to food in which immunologic mechanisms have been demonstrated. It can result in considerable morbidity and represents one of the most common causes of anaphylaxis.1 It affects nearly 5% of adults and 8% of children, with evidence of an increasing prevalence.2 Current management relies heavily on rigorous allergen avoidance and treatment in case of emergency.1
The limits imposed by the strict diet and the constant risk of fatal reactions make food allergy a burden for patients, impacting considerably on quality of life and psychologic well‐being.3 In particular, food allergy can affect social life including close interpersonal relationships. Intimate behaviour is increasingly described as a trigger of allergic reactions.9 A study on the occurrence of kiss‐induced allergic symptoms among patients with food allergy found that 12% experienced allergic symptoms when in close contact with a person who had eaten a not‐tolerated food.10
Attachment theory provides a theoretic framework to evaluate the quality of close interpersonal relationships in the context of chronic disorders.11 “Attachment behavioural system,” described as a species‐universal, biologically evolved neural programme, organizes behaviour in ways that increase the chances of an individual's survival, despite inevitable environmental dangers and demands. Lifelong patterns of response to threat are learned in the interaction between infants and primary caregivers. Attachment behaviours are designed to protect individuals from physical harm but also to help emotional adjustment. They serve the evolutionary goal of helping infants survive and enable individuals of any age who feel threatened to re‐establish emotional security through contact and comfort from an attachment figure (e.g. parents, partners).15 Threats, such as illness, pain or stressors, may activate attachment behaviours.17
According to attachment theory, individual differences arise in how the attachment system operates. “Attachment style” is a person's characteristic ways of relating in intimate caregiving and receiving relationships with close others. Measures of attachment either assign individuals to categories of attachment style or measure the degree to which various dimensions of attachment style are present. Taxometric analyses on multiple samples and measures suggest that variation in attachment is best modelled with dimensions rather than categories.20 Moreover, a dimensional approach avoids improper comparisons with psychopathologic categories and places attachment differences in perspective, to understand how individual personality characteristics may influence regular functioning.21
Dimensional models of attachment converge on two dimensions of insecurity: Attachment Anxiety (AAn) and Attachment Avoidance (AAv).22 AAn refers to a pattern of hyperactivation in the face of threat, including hypervigilance, worry about being abandoned, persistently seeking proximity and reassurance from others, dysfunctional stress and affect regulation. AAv refers to a pattern of deactivation in response to danger including denying attachment needs, minimizing distress, turning attention away from threat and being overly self‐reliant. Attachment security refers to the combination of low AAn and low AAv. It reflects a sense of safety and effective regulation of affect and is characterized by feeling comfortable with closeness and trusting that a partner will be available and responsive when needed.15 Attachment styles may be depicted linearly on a spectrum with high emotional expression and poor affect regulation at one end (AAn), and low emotional expression and over‐regulation of affect at the other (AAv). On this continuum, secure attachment is located at the mid‐point and is related with high psychologic functioning, effective coping strategies and resilience.18
The attachment style is believed to be a quite stable personality trait.15 Gender differences are also described: males tend to show higher AAv and lower AAn than females.

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