Correlation Between Insecure Attachment Style and Symptomatology in Patients With Bipolar Disorder: A Systematic Review

Abstract

Background: Attachment style describes the bond between a child and their caregivers, and its effect on subsequent relationships. Bipolar disorder (BD) is a mood disorder characterized by fluctuations in mood and energy levels. The aim of this work is to update the evidence on the relationship between two insecure attachment styles (anxious and avoidant) and the symptomatology of patients with BD.

Methods: To achieve the objectives of this systematic review, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines were followed. Searches were conducted from inception until July 24, 2025 in the PsycInfo, PubMed, Scopus, and Web of Science databases. A structured process was carried out for study selection, data extraction, and risk of bias assessment of the included studies.

Results: A total of six articles were included, five of which were cross-sectional and one was a case-control study. These six studies included a total of 466 patients, with a weighted mean age of 41.4 years old. The weighted mean age was calculated according to the sample size of each of the selected articles. The female-to-male ratio was 1.53:1. Patients with insecure attachment experienced depressive, anxiety, and somatization symptoms, as well as greater symptom severity (increased risk of suicidal behavior, greater number of hospitalizations, higher frequency of affective episodes, and greater substance use). 

Conclusions: In patients with BD, insecure attachment is associated with greater symptom severity. Future research should investigate the explanatory mechanisms underlying the relationship between insecure attachment and the symptomatology of these patients.