One of the subjects that I have spoken on extensively on over the last few years is the topic of attachment. By attachment, I am referring to the style of interpersonal relating that we have learned and internalized from childhood experiences. According to decades of research, started by psychoanalyst John Bowlby and extended by Mary Ainsworth, among many others, psychologists have identified four main types of attachment styles- secure, anxious/ambivalent, avoidant, and disorganized. The secure attachment style, prevalent in 65% of the population is marked by emotional stability and a childhood featuring stable and nurturing caregiving. Anxious/ambivalent attachment is characterized by obsessive preoccupations about the object of the intimate relationship and intense fear of abandonment. People with this attachment style typically have experienced inconsistent caregiving, and so have grown to feel unsafe in the stability of close relationships. Avoidant attachment is marked by the avoidance of intimacy, as well as of experiencing feeling and emotions. These folks have typically experienced more neglectful caregiving as kids. I will put aside the disorganized attachment for the moment, as it is not very common, and is typically a byproduct of more severe abuse.

At this point, I want to make an important note about what I mean by “intimacy.” I think sometimes folks get caught up in some kind of a rigid idea about what intimacy means, one that is cooked up in harlequin romance books, soap operas, and Hollywood Happy Endings. This involves the kind of romantic closeness, actually known as partner engagement, which involves the typical aspects of what we would all consider as deep and meaningful love making– the pillow talk, the eye gazing, the deep kissing, the sensual touching, and so on. However, based on my experience as a sexologist and sex therapist, working with numerous individuals and couples, I do not define intimacy in that way. To me, intimacy simply means being able to be emotionally vulnerable and transparent with another person. In that sense, two friends can be extremely intimate, a mentoring relationship can be intimate, and sexual exploration can be intimate, while eye gazing and pillow talk may not. It’s all about the context.

Anyway, let’s get back to how attachment styles start to interact with and affect sexuality. Taking the above childhood attachment styles, psychologist Kim Bartholomew applied them to adult behavior and created a new matrix of terms. In her conceptualization, secure childhood attachment remains as secure adult attachment, while anxious/ambivalent childhood attachment is now termed Preoccupied, and avoidant childhood attachment is divided into two new categories- Fearful and Dismissive. The chart below illustrates this concept:


It is with these four adult attachment styles that we start to see a pattern of sexual behavior. Secure adults are able to feel comfortable being emotionally vulnerable and dependent on others. These are not the kinds of folks who are typically prone to experiencing sexual difficulties. Preoccupied attachment, in the upper right hand corner, typically involves obsessive thoughts revolving around the fear of abandonment. These are the kinds of folks who may appear to be overly needy, dependent, or overbearing very early on in relationships. The last two– Dismissive and Fearful– are probably the most common attachment styles that I see in my office. They crave love just like everyone else, but are so uncomfortable in the face of closeness, that they seek to escape and create as much safe distance as possible. This kind of discomfort with closeness can play out in sexual dysfunctions such as erectile dysfunction and premature ejaculation as well as sexual compulsivity and/or infidelity. My colleague, Dr. Crocker and I, have spoken at length at numerous events about how frequent infidelity or paying for sex workers may actually be an attempt for some to enjoy sex at distances far enough to actually feel safe.  Indeed, it is far less likely to feel emotionally vulnerable with a stranger than with a long-term partner.

I’ll end this topic here for now. The main takeaway is that we all want to enjoy life, be happy, and be loved, but sometimes, depending on our attachment style (which we’ve picked up from childhood) it just feels too overwhelming to be able to experience that with someone who is “too” close. A myriad of sexual problems can creep up as a result, preventing us from experiencing sexual satisfaction within close relationships. The good news is that research shows that through a commitment to consistent therapy with a well-trained clinician, attachment patterns can and do change. Learning to tolerate the higher levels of anxiety that emotional closeness produces allows us to eventually change our patterns of relating, finally giving us the freedom to experience our natural full range of sexual pleasure.