Anxious-preoccupied attachment, classified as the "C" pattern (ambivalent/resistant) in Ainsworth's Strange Situation paradigm (Ainsworth et al., 1978), describes a relational orientation characterized by heightened sensitivity to perceived threats to closeness, a persistent desire for reassurance about a partner's availability, and difficulty achieving felt security even within stable relationships. In Bowlby's theoretical framework (1969/1982), this pattern is understood to develop when caregiving is inconsistently responsive — available and attuned at times, but unpredictably unavailable or misattuned at others. The developing child learns that attachment needs are legitimate and sometimes met, but that vigilance and escalated signaling are necessary to maintain the caregiver's attention. This early template creates internal working models characterized by a positive view of others as desirable but unreliable, and a negative view of the self as insufficient to guarantee love without effort.
Hazan and Shaver (1987) extended this pattern to adult romantic relationships, finding that approximately 19% of their sample endorsed the anxious-ambivalent attachment description, reporting love experiences marked by obsessive preoccupation, emotional highs and lows, a strong desire for reciprocation and union, and persistent jealousy. Bartholomew and Horowitz (1991) refined the adult model, placing anxious-preoccupied attachment in the quadrant defined by a positive model of others (others are valued and desired) and a negative model of self (the self is seen as unworthy or inadequate). This configuration produces a characteristic relational stance in which the individual seeks closeness and validation from others to compensate for deficits in self-regard — a dependency that Bartholomew described as reflecting a "preoccupied" orientation toward attachment relationships.
In dimensional terms (Brennan, Clark, & Shaver, 1998; Fraley, Waller, & Brennan, 2000), anxious-preoccupied attachment corresponds to high attachment anxiety combined with low to moderate attachment avoidance. The anxiety dimension captures worry about abandonment, sensitivity to rejection cues, and a chronic need for reassurance, while the relatively low avoidance reflects the individual's strong desire for closeness rather than independence. Levine and Heller (2010) popularized the concept of activating strategies to describe the behavioral manifestations of this pattern — escalated attempts to reestablish contact and proximity with an attachment figure who is perceived as insufficiently available, including excessive calling, emotional protests, monitoring behaviors, and difficulty disengaging from relationship-related thoughts.
It is essential to approach anxious attachment with nuance and avoid pathologizing what may, in certain contexts, represent an adaptive response to genuinely unreliable relational environments. Cross-cultural research (van IJzendoorn & Sagi-Schwartz, 2008) has found that the prevalence of anxious attachment varies across cultures, with higher rates in some East Asian and Israeli samples where interdependence and proximity-seeking are more culturally normative. Furthermore, Ein-Dor, Mikulincer, Doron, and Shaver (2010) have proposed a social defense theory suggesting that anxious individuals may serve an adaptive function in groups by serving as early-warning "sentinel" detectors of threat, contributing to group survival through their hypervigilance. These perspectives complicate simplistic narratives that frame anxious attachment as purely dysfunctional.
Common Patterns
Researchers have identified these characteristic patterns in individuals with anxious-preoccupied attachment:
- Heightened vigilance toward signs of a partner's emotional withdrawal or disinterest
- Strong need for reassurance about the relationship's stability and partner's feelings
- Tendency to replay interactions and analyze them for signs of rejection or abandonment
- Difficulty self-soothing during periods of perceived distance from a partner
- Quick emotional activation in response to delayed texts, canceled plans, or ambiguous signals
- Protest behaviors such as excessive calling, emotional escalation, or withdrawing to provoke a response
- Tendency to prioritize the relationship above personal boundaries or needs
Research Foundation
The research foundation for anxious-preoccupied attachment spans developmental observation, self-report measurement, experimental social psychology, and clinical intervention research. From Ainsworth's original identification of the "C" pattern through contemporary neuroscience studies examining the neural correlates of attachment anxiety, the anxious attachment construct has been extensively investigated. However, the field continues to grapple with important methodological and conceptual questions, including the cultural specificity of attachment categories, the relationship between infant and adult attachment classifications, and the extent to which attachment anxiety is a stable trait versus a context-dependent state.
Ainsworth, Blehar, Waters, & Wall (1978)
Identified the ambivalent/resistant ("C") classification in infants. These infants showed heightened distress during separation, were difficult to soothe upon reunion, and displayed a mixture of proximity-seeking and angry resistance toward the caregiver. They explored less in the presence of the caregiver compared to secure infants, suggesting the caregiver was not functioning effectively as a secure base.
Methodology: Strange Situation laboratory observation with mother-infant dyads. Infant behavior was coded for proximity-seeking, contact maintenance, resistance, and avoidance across separation and reunion episodes.
Honest Assessment: The "C" classification was the least common in Ainsworth's original sample (approximately 12%), raising questions about statistical power for characterizing this group. The Strange Situation captures behavior in a single brief laboratory episode, which may not adequately represent the full range of the child's attachment behaviors across contexts. Additionally, some researchers (Lamb, Thompson, Gardner, & Charnov, 1985) have questioned whether the Strange Situation procedure is equally stressful — and therefore equally valid as a measure — across different temperamental profiles.
Bartholomew & Horowitz (1991)
Proposed the four-category model of adult attachment, distinguishing the preoccupied style (positive other-model, negative self-model) from both secure, dismissive, and fearful patterns. Preoccupied individuals were characterized by excessive reliance on others for self-validation, high emotional expressiveness, and a tendency to idealize others while devaluing the self.
Methodology: Combined self-report measures and semi-structured interview ratings in a sample of 77 university students. Attachment was assessed using both self-classification and continuous rating scales, with additional peer and friend ratings to provide external validation.
Honest Assessment: The sample was small, young, and drawn from a single university, limiting generalizability. The four-category model, while influential, imposes categorical distinctions on what Fraley and Waller (1998) later demonstrated to be a dimensional structure. The distinction between "preoccupied" and "fearful" attachment — both involving negative self-models — can be difficult to operationalize reliably, and some individuals may shift between these patterns depending on context.
Levine & Heller (2010)
Synthesized and popularized the concept of activating strategies — behavioral and cognitive patterns through which anxiously attached individuals attempt to reestablish proximity with an attachment figure perceived as insufficiently available. These include excessive contact attempts, difficulty concentrating on other activities, hypervigilance to partner cues, and protest behaviors designed to elicit a response.
Methodology: Popular science synthesis drawing on published attachment research, clinical case studies, and the authors' professional experience in psychiatry and neuroscience. Not a primary empirical study.
Honest Assessment: As a popular rather than academic work, Attached necessarily simplifies complex research findings and may overstate the stability and distinctness of attachment categories. The activating/deactivating framework, while clinically intuitive, has not been as rigorously validated as the underlying dimensional model. Critics have noted that the book's self-help framing may inadvertently reinforce the categorical thinking ("I am anxious") that dimensional research has challenged, and may underemphasize the role of relationship context in eliciting attachment behaviors.
Fraley & Shaver (2000)
Provided a comprehensive review of adult romantic attachment research, noting that attachment anxiety is associated with heightened emotional reactivity in relationships, greater jealousy, more frequent conflict, and lower relationship satisfaction. They also highlighted unresolved questions about the stability of attachment orientations and the mechanisms through which early attachment experiences influence adult functioning.
Methodology: Theoretical review and integration of empirical literature spanning developmental, social, and clinical psychology.
Honest Assessment: The review acknowledged a persistent tension in the field regarding stability versus change in attachment orientations. While some longitudinal studies show moderate stability from infancy to adulthood (Waters, Merrick, Treboux, Crowell, & Albersheim, 2000), others demonstrate significant discontinuity, particularly when life circumstances change. This raises the question of whether anxious attachment is best understood as a stable trait-like disposition or as a context-sensitive state that emerges in response to specific relational conditions — a question that remains unresolved.
Johnson (2008)
Documented that Emotionally Focused Therapy (EFT), an approach grounded explicitly in attachment theory, is effective in helping individuals with anxious attachment patterns identify the underlying attachment needs beneath their protest behaviors and communicate those needs more directly and vulnerably. EFT frames anxious behaviors as understandable responses to perceived threats to the attachment bond rather than as pathological symptoms.
Methodology: Clinical framework and case studies presented within a therapeutic model that has been validated through multiple randomized controlled trials. Johnson draws on her own extensive clinical and research experience with couples.
Honest Assessment: While EFT has strong empirical support as a couples therapy modality, Johnson's presentation in Hold Me Tight is oriented toward a general audience and may oversimplify the therapeutic process. The attachment-based framing of EFT, while theoretically coherent, has been critiqued for potentially underemphasizing other important relational factors such as power dynamics, cultural context, and individual psychopathology that may contribute to relationship distress independently of attachment patterns.
In Relationships
In romantic partnerships, individuals with anxious-preoccupied attachment often bring an intensity of emotional investment that reflects the depth of their desire for connection. Research consistently documents that anxiously attached individuals report stronger desires for closeness, higher emotional reactivity to relationship events, and greater preoccupation with their partner's availability compared to individuals with other attachment orientations (Mikulincer & Shaver, 2007). This heightened relational focus can manifest as passionate attentiveness and devotion in the early stages of a relationship, but it can also create distress when the intensity of the individual's needs exceeds what the partner can or is willing to provide. Levine and Heller (2010) observe that anxiously attached individuals are particularly susceptible to the anxious-avoidant trap — a relational dynamic in which they are disproportionately drawn to avoidant partners, whose withdrawal triggers their attachment alarm and intensifies their pursuit behavior.
A defining feature of anxious attachment in relationships is the deployment of what Mikulincer and Shaver (2007) term hyperactivating strategies. These are intensified attempts to gain proximity, attention, and reassurance from an attachment figure, and they include behaviors such as excessive calling or texting, emotional escalation during disagreements, monitoring a partner's activities, expressing distress in exaggerated ways to elicit a caregiving response, and difficulty self-soothing during periods of perceived distance. These behaviors are not manipulation in the conventional sense; rather, they represent the attachment system's alarm response operating at high intensity. From the perspective of the anxiously attached individual, these behaviors feel necessary and proportionate to the perceived threat of abandonment, even when an outside observer might view the situation as stable.
Importantly, the relational outcomes associated with anxious attachment are not fixed. Johnson (2008) demonstrates through Emotionally Focused Therapy that when anxiously attached individuals learn to identify and articulate the primary emotions beneath their protest behaviors — typically fear, sadness, and a deep longing to feel valued — their partners are often able to respond with greater empathy and accessibility. This shift from secondary reactive emotions (anger, accusation, withdrawal) to primary attachment emotions (vulnerability, need, fear of loss) frequently transforms the relational dynamic, allowing the anxious individual to receive the reassurance they need in a way that draws the partner closer rather than pushing them away. Levine and Heller (2010) add that pairing with a securely attached partner is one of the most consistently documented pathways toward reduced attachment anxiety over time.
Communication Patterns
Communication research documents that individuals with anxious-preoccupied attachment exhibit patterns characterized by high emotional expressiveness, frequent bids for reassurance, and difficulty tolerating ambiguity in their partner's communications. Mikulincer and Shaver (2007) describe a tendency toward what they call "communication escalation" — progressively intensifying emotional signals when initial bids for connection are not met with the desired response. This escalation is driven by the attachment system's alarm: when the anxiously attached individual perceives that their partner is not sufficiently engaged, the system amplifies the distress signal in an effort to recapture attention. In practice, this can manifest as repeated requests for clarification of a partner's feelings, emotional outbursts during text-based communication where tone is ambiguous, and difficulty letting a topic drop once activated.
Levine and Heller (2010) emphasize that anxiously attached individuals can develop more effective communication by learning to express attachment needs directly and vulnerably rather than through protest behaviors. This involves identifying the specific need underlying the escalation — such as "I need to know that you still want to be with me" or "I feel scared when I do not hear from you" — and communicating it in a straightforward manner. Johnson (2008) frames this skill development as the core therapeutic task in EFT with anxious clients, noting that when protest behaviors are translated into attachment language, partners are far more likely to respond with empathy and reassurance. The shift from accusation ("You never pay attention to me") to vulnerability ("I feel frightened when I cannot reach you") represents a fundamental change in the communication pattern that research links to improved relationship outcomes.
Under Stress
Under conditions of stress — whether relationship-specific or general life stress — individuals with anxious-preoccupied attachment tend to experience an intensification of their attachment system's activation. Mikulincer and Shaver (2007) document that attachment anxiety is associated with heightened physiological arousal during threatening situations, greater difficulty down-regulating negative emotions, and a strong tendency to seek proximity and reassurance from attachment figures as the primary coping strategy. When the attachment figure is available and responsive, this proximity-seeking can be effective: the anxious individual's distress is soothed through contact and reassurance. However, when the attachment figure is unavailable, unresponsive, or is the source of the stress, the anxious individual may become caught in a loop of escalating distress without effective means of self-regulation.
Simpson, Rholes, and Phillips (1996) demonstrated in a laboratory study that anxiously attached individuals reported more distress and engaged in more support-seeking behavior when anticipating a stressful event. However, their support-seeking was often perceived by partners as more intense and less effective than that of securely attached individuals, sometimes eliciting withdrawal rather than the desired comfort. This finding highlights a paradox of anxious attachment under stress: the very behaviors designed to recruit caregiving — heightened emotionality, persistent reassurance-seeking, difficulty being soothed — can overwhelm a partner's capacity to respond, particularly if that partner has avoidant tendencies. Levine and Heller (2010) recommend that anxiously attached individuals develop co-regulation awareness, learning to recognize when their stress response is escalating and to communicate needs in ways that make it easier for their partner to provide effective support.
Path Toward Growth
Growth for individuals with anxious-preoccupied attachment typically involves developing greater capacity for self-regulation and self-validation alongside, rather than as a replacement for, relational connection. Mikulincer and Shaver (2007) describe a process in which anxiously attached individuals gradually internalize experiences of reliable, responsive care — whether from a partner, therapist, or other attachment figure — building what Bowlby (1969/1982) called a more positive internal working model of both self and other. This internalization does not require suppressing attachment needs, which would represent a shift toward avoidance rather than security. Instead, it involves developing confidence that needs will be met, which paradoxically reduces the urgency and intensity with which those needs are expressed.
Johnson (2008) identifies several specific growth tasks for anxiously attached individuals within the Emotionally Focused Therapy framework. Central among these is learning to differentiate between primary attachment emotions (genuine fear, sadness, longing for connection) and secondary reactive emotions (anger, blame, accusation) that often overlay them. When anxious individuals can access and express their vulnerability directly — saying "I am afraid you will leave me" rather than "You always put everything else before me" — their partners are far more likely to respond with empathy and closeness. This shift does not occur automatically; it typically requires sustained practice within a relational context that is safe enough to risk vulnerability without the protective armor of protest behaviors.
Levine and Heller (2010) offer a practical growth framework centered on partner selection awareness and activating strategy recognition. They observe that anxiously attached individuals often mistake the intense emotional activation triggered by an avoidant partner for passion or chemistry, interpreting the anxiety of insecure attachment as evidence of deep love. Learning to distinguish between genuine emotional connection and attachment system alarm — and developing a preference for partners who provide consistent, reliable responsiveness — represents a significant developmental achievement. The research on earned security (Roisman et al., 2002) provides empirical support for the possibility of this kind of growth, demonstrating that individuals can move from anxious to secure functioning through corrective relational experiences, though the process is typically gradual and requires sustained engagement with secure relational environments.
Frequently Asked Questions
Is anxious attachment the same as codependency?
While anxious attachment and codependency share surface features — including excessive focus on a partner, difficulty with autonomy, and a tendency to prioritize the relationship above personal well-being — they are conceptually distinct. Anxious attachment is a construct rooted in attachment theory (Bowlby, 1969/1982; Ainsworth et al., 1978) and describes a relational orientation that develops in response to inconsistent early caregiving. Codependency, by contrast, originated in addiction treatment contexts and refers more broadly to patterns of enabling and excessive caretaking. An individual with anxious attachment may or may not exhibit codependent behaviors, and codependency can arise from dynamics unrelated to attachment. However, Levine and Heller (2010) note that anxiously attached individuals are more vulnerable to codependent relational patterns because their intense need for closeness can lead them to tolerate unhealthy relationship dynamics in exchange for proximity.
Are activating strategies always unhealthy or problematic?
Activating strategies — the heightened proximity-seeking, reassurance-seeking, and emotional signaling behaviors associated with anxious attachment — are not inherently pathological. They represent the attachment system functioning at high intensity, which in some contexts may be an appropriate and adaptive response. When a partner is genuinely withdrawing, being unfaithful, or otherwise threatening the attachment bond, the anxious individual's alarm may be accurately calibrated to a real relational threat. Ein-Dor et al. (2010) propose that anxious individuals' hypervigilance to threat may serve a protective function at the group level, functioning as an early warning system. The clinical concern arises when activating strategies are deployed indiscriminately — in response to minor or imagined threats — and when they consistently produce the opposite of their intended effect by pushing partners away rather than drawing them closer.
Is anxious attachment more common in certain cultures?
Cross-cultural research by van IJzendoorn and Kroonenberg (1988) and van IJzendoorn and Sagi-Schwartz (2008) documents meaningful cultural variation in the distribution of attachment classifications, including anxious attachment. Cultures that emphasize interdependence, close physical proximity between caregiver and child, and communal rather than individual identity tend to show higher rates of anxious-ambivalent classifications in infancy. However, it is essential to recognize that the meaning of these classifications may differ across cultural contexts — behaviors coded as "resistant" in Ainsworth's American-normed paradigm may reflect culturally normative expectations about closeness in other settings. Rothbaum, Weisz, Pott, Miyake, and Morelli (2000) have argued that attachment theory's emphasis on autonomy and exploration as markers of security reflects Western cultural values that are not universally shared.