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Anxiety and depression, typically labeled as internalizing symptoms/disorders, are among the most common forms of psychopathology affecting children and adolescents (Costello et al., 1996; Last, Perrin, Hersen, & Kazdin, 1996), and therefore, it is important to understand factors that may give rise to these conditions. With origins in the study of clinical issues, attachment theory provides one framework for understanding the development of anxiety and depression (Bowlby, 1969, 1973). Although studies assessing these associations have begun to emerge in the last decade, a comprehensive review of empirical findings is missing from the literature. One review focused exclusively on family factors in anxiety, but not depression (Bögels & Brechman-Toussaint, 2006), and other reviews (e.g., DeKlyen & Greenberg, 2008; Ranson & Urichuk, 2008) have assessed the relations of attachment with a broad range of symptomatology, all with a limited focus on empirical evidence regarding the associations of parent-child attachment with internalizing problems or, more specifically, anxiety and depression. The purpose of this paper is to review theoretical approaches and to evaluate the empirical evidence for the links between attachment and the development of internalizing problems in childhood and adolescence. In addition, we propose two models that might explain how attachment, in combination with other factors, may relate to anxiety or depression.
Anxiety and Depression: Conceptual Definitions
Internalizing problems are characterized by covert, inner-directed symptoms (e.g., distress) and overcontrolled behaviors (Achenbach & McConaughy, 1992), and are operationalized in the child and adult literatures as symptoms, syndromes, or diagnoses (Compas, Ey, & Grant, 1993; Fonseca & Perrin, 2001). Anxiety disorders include: generalized anxiety disorder, social phobia, specific phobia, obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder, and separation anxiety disorder, with the latter the only anxiety disorder specific to childhood (American Psychiatric Association [APA], 2000). The common denominator of anxiety disorders is an intense fear or worry associated with avoidant behavior (Kendall, Hedtke, & Aschenbrand, 2006). The most common depressive disorders in children are major depressive disorder and dysthymic disorder, marked by feelings of sadness, diminished energy, and sleep and appetite disturbances (APA, 2000). Diagnostic criteria for depression are similar for children and adults, with two exceptions: irritability may substitute for depressed mood, and the required duration of dysthymic disorder is shorter in childhood. Bipolar disorders are also included...