PCOS and Attachment Theory
We need to talk about the link between PCOS and difficulty with relationships. Yes, you guessed it, this is linked once again to childhood trauma, adverse childhood events, chronic stress, and being locked into a toxic stress response.
Up until recently, I thought connection was not in the cards for me
For most of my life, I was conditioned to believe I was incapable of deep, meaningful connection with others. Growing up in a turbulent household, I shut down my emotions from a young age. When conflict arose, I could feel all the oxygen in my body get trapped in my throat. It felt like paralysis. I couldn’t move, I couldn’t speak. All I knew to do was remain still, subconsciously hoping the conflict would resolve if I didn’t engage. I couldn’t think, I couldn’t feel. Just stay quiet. Behave. Do as well as you can in school. Be someone that will make the yelling stop.
Epigenetics, Childhood Trauma and PCOS
If you’ve read our posts on Childhood Trauma and PCOS, or how epigenetics play a key role in the manifestation of PCOS, you know about the link between our early relationships and experiences and our neuro-endocrine-immune systems. This is all interrelated. Our early relationships not only shape the way our bodies develop, but also how our view of love and connection develops. As I grew up, I had a lot of people around me. Plenty of wonderful friends who were there for me during some of the most difficult times of my life. On the surface, it seemed like my family was present. But secretly I felt like a stranger to everyone around me. I was a stranger to my family in particular, hiding any detail of my life that I could, even from my older sisters. I was conditioned to view my emotions and feelings as a burden not only to the people around me, but also to myself. Emotions and feelings were my weakness. A desire for connection and vulnerability was dangerous.
Overextending myself as a means to maintain emotional distance
Romantically, I distanced myself from connection and vulnerability as much as possible. In the beginning, it was always easier. I could engage, and I wanted to engage. I would foolishly become hopeful, as if I hadn’t read this narrative before. Finally the emotional closeness I had secretly craved since childhood could be fulfilled…until either that person got too close, or they revealed their true colors. Habitually I found myself attracted to people I thought needed my help, people I could “fix” or “rescue”, subconsciously attempting to rewrite the ending to the story of parent-child emotional inconsistency. Men, even a few friends, consistently told me I was the motivation they needed in their lives, and I thought that somehow made me special. But it didn’t. What it did was put an unequal relationship burden on my shoulders. I was parentified, I was not a partner. They, consciously or unconsciously, wanted me to help shield them from their unresolved wounds and pain. They promised to change, they promised to take action and be intentional. Promised to stop lying. Promised to communicate. Promised to be consistent. But their promises were as reliable as the MTA.
All the while I “managed” everything, badgering them on the items they needed to address. I worked on myself, and our relationship, for the both of us, like a fool. I had my own therapist, I read books, and I even took classes to address my own issues. I found couples’ counselors and apps to help us reconnect, outlining what I believed we needed to do to course correct the relationship. I read more books on relationship psychology than I can count. Now, listen, I knew and know I have plenty, PLENTY, of my own flaws. I’m not blind to that. But the idea that it’s all me? That the other person had nothing they should be working on for their own desire to grow? The idea that I was supposed to be the one doing all of the work without the help of my “partner”? Um, no. Immediate no. It takes two, baby. So what was I covering up by trying to give so much of myself to others, letting them disappoint me, and turning into the dreaded “nag”?
Why did it feel nearly out of my control to consistently go after people who would inevitably disappoint me?
Logically I knew what was happening, I can intellectualize my way out of a paper bag.
But there was something more at play that wasn’t in my conscious understanding.
PCOS Meets Attachment Theory
I started to read up on attachment theory, and the idea that if your primary caregivers did not meet a minimum of 30% of your emotional needs during your formative years, you would likely grow up with what’s known as an “insecure attachment style”. Insecure attachment styles make it much more difficult to find healthy relationships. They not only affect our ability to operate healthily in the context of a romantic relationship, they also harm our ability to choose healthy partners in the first place. Given the epigenetic influence on PCOS, my theory is that if you have PCOS and believe adverse childhood experiences may have contributed to its manifestation, you might have developed an insecure attachment style. This might be your sign to evaluate the close relationships in your life. If you believe your PCOS was influenced by persistent exposure to harmful situations at any point in life, there’s a good chance those experiences have creeped into your love life, connections with friends, family and even coworkers.
Secure Attachment Style
This is the attachment style we should all target. A secure attachment style is marked by an ability to pursue healthy partners, as well as openness to love and connection. It means that developing closeness with a person at a steady or manageable pace is not scary, it’s welcome, warm, and inviting. It feels safe. A secure attachment style signals that you can be intimate with someone, trust them, and generally respect a need for independence and autonomy. It’s not about codependency, it’s about healthy interdependence between you and your partner. Secure attachment means factoring your partner into your decision-making process, and remaining flexible in what relationships look like. Securely attached individuals are reliable and consistent. They communicate and face conflict maturely, not in anger, but in a balanced way with resolution as the goal. Compromise is possible, and they avoid game playing. They express themselves, and their feelings for you. I remember reading about secure attachment for the first time, and genuinely having zero idea that people could be like this. “You mean, some people actually feel this way in relationships? Like, without faking it? Or suppressing every fiber of their being?” Woah….
And then there’s Insecure Attachment…
which may be more common in those of us with PCOS
For those of us whose emotional needs may not have been entirely attended to in childhood, we are much more likely to develop an insecure attachment style. There are three insecure attachment styles, and they are: anxious, avoidant and fearful avoidant. Keep in mind that there are different spectrums or degrees to which you might display these behaviors.
Anxious Attachment Style
An anxious attachment style is characterized by people pleasing, attempted perfectionism, trying to control the uncontrollable, and sometimes a disrespect for the boundaries of others. The media will portray this as what we typically deem “clingy” behaviors. Think: feeling frantic or out of control when someone is not texting back. An incessant need to resolve conflict the second it arises, even if your partner asks for space. A fear that everything is going to crumble after the first argument. Think codependency. Because of the fear of not being in relationship, you let the other party set the tone, pace, etc., of the relationship without considering your needs. A sometimes intense fear of dying alone. In general, terrified of rejection and overall insecure over the relationship. You might feel you have to “play games” to keep someone’s attention - if they don’t respond for 2 hours, you won’t respond for 4 hours. Difficulty identifying what is at the root of why you feel upset, and even if you can identify it, you don’t want to articulate it, you want your partner to mind-read. You might personalize everything and automatically assume that any disruption to your partner’s behavior is about you/the relationship.
Avoidant Attachment Style
An avoidant attachment style moves in the opposite direction of the anxious attachment style (hint: if you’re thinking opposites attract, you’re right. These two attachment styles often find each other and date, and the outcome is usually…not great). Avoidants deeply fear losing their independence. They have learned that to survive, you can only rely on yourself. Intimacy is dangerous and something to avoid. You might consistently seek out long distance relationships, or seek unavailable partners, whether they are already in a relationship with someone else or are otherwise emotionally unavailable. You also might jump from relationship to relationship, constantly thinking there must be someone better out there. You tend to have a negative comparison bias of your current partner with either your previous partners or someone else you know. You send mixed signals, getting a touch closer to someone, then regressing. You have strict boundaries you don’t let your partner violate, and you tend to distance yourself from your partner. Distancing can look like shutting down emotionally and beginning to outsource your emotional needs to someone else, disallowing physical affection, or stonewalling. You tend not to trust others and fear being taken advantage of. You often have an intense need to protect yourself and your resources. You may have an unrealistic view of what a romantic relationship should be like. During conflict, you run, or you may explode. You often want to leave your intentions as murky, and fear commitment.
Anxious-Avoidant Attachment Style (AKA Fearful Avoidant)
Lastly is fearful avoidant. This is thought to be the rarest attachment style, and is a combination of both our anxious attachment and avoidant attachment styles. If you’re blessed like I am (plz sense my sarcasm) you fall into this lovely combo group. Hooray for being unique, am I right?! You display characteristics of both attachment styles, and different people or situations may bring out either your avoidant traits or your anxious traits. It’s a fun rollercoaster ride.
Forming My Fearful Avoidant Attachment
Now, your attachment style is thought to form very early in your life. Some researchers claim it forms when you are a baby, with others saying that is where it starts, and continues to develop into your childhood and adolescence. Hello, epigenetics! We love talking about you here, thanks for joining us again. So, how did my environment shape my attachment style? Why, even though I’m out of my childhood environment, am I consistently attracted to the same behaviors in men? Why do I end up as Chief Relationship Officer over and over again? Why do I overextend, only to grow resentful and then shut down and push/pull away?
PCOS and the Learned Behavior of the Autonomic Nervous System
To answer this question, we need to discuss our autonomic nervous system. It comprises the sympathetic, parasympathetic and enteric nervous systems. The ANS responds to external and internal cues from our body and environment to produce physiological responses. Think: any sort of stimuli, ranging from a particle of dust landing on your eye, to a giant bear in front of you exposing its teeth. It dictates our automatic physiological response. We don’t think, it simply does. Our ANS dictates the state we are in, meaning whether we are in a state of relaxation, hypervigilance, connection, or mobilized for fight or flight, to name a few. The sympathetic nervous system is omnipresent in our body’s tissues, and is associated with the fight or flight response, where blood pressure and heart rate increase and glucose enters the blood. The parasympathetic nervous system is responsible for our “rest and digest” functions, including reproductive health, immune function and more. The enteric nervous system is a connecting system and helps with immune and endocrine system modulation.
We’re doing so much unconsciously
Now, let’s return to the fact that our nervous system response to our environment is automatic. If you recall, we said the autonomic nervous system dictates our state: whether we are hypervigilant to the environment around us, are running from an active or perceived threat, or whether we are open to safety and connection. That means it is only after our body has produced a physiological response to something that we bring that response to our mind’s eye. Our body is processing a lot more of our response to the threat than we are consciously aware of. So, in other words, “story follows state”, a phrase borrowed from Deb Dabna. And quite frankly, sometimes a story never forms. Sometimes our nervous system subconsciously adapts to something and it never reaches a point where we perceive it.
But stop viewing it as something that’s “wrong” with you
Over time, our nervous system becomes wired to operate a certain way. This means that if we are trapped in a toxic stress response, our nervous system becomes more fragile. We are susceptible to dramatic shifts from a state of safety and openness, to a state of immobilization or fear. We become so accustomed to residing in immobilization or fear that it becomes our comfort zone. Our autonomic nervous system effectively “learns” the way we’ve survived thus far is in this state of immobilization, fear, or fight/flight mode. This becomes our body’s idea of what is safe. It’s familiar and we know what to expect, and humans are famously creatures of habit, skeptical and even terrified of change. If this resonates with you and you are frequently trapped in a state of immobilization, fear, fight or flight, or connection and openness feels dangerous, you are not broken. There is nothing wrong with you. Your body adapted to a survival response, and technically it is working exactly the way it’s supposed to. This was really hard for me to grasp and fully understand because I have a tendency to place blame inwards, as I’m sure many of you do.
How does the shaping of the ANS impact my relationships?
Now that we have an understanding of our autonomic nervous system, as well as the potential for us to become accustomed to a state of fight, flight, freeze, or fawn, we can discuss Polyvagal Theory. Polyvagal Theory looks at the autonomic nervous system response to external stimuli according to three evolutionary pathways - the dorsal vagus, the sympathetic nervous system, and the ventral vagus. Our dorsal vagus is the most primitive and is associated with a freeze or fawn response to a threat. This can look like immobilization, or attempting to placate the threatening stimuli. Out of evolutionary necessity, our sympathetic nervous system developed next. Think: fight or flight. Blood pressure and heart rate increase, pupils dilate, our body floods with glucose to mobilize us to confront the threat or flee. Last to develop was the ventral vagal system, the portion of the nervous system that allows for social engagement and connection (bing, bing: relationship with others!). Every social interaction we have, all of our relationships, effectively mold our autonomic nervous system, from the time we enter this world. They mold the automatic response we have to stimuli.
We’re on autopilot with how we choose partners and operate in relationships
According to Polyvagal Theory, the absence or lack of relationships where we learn that connection and vulnerability with a trusted source is safe shapes the nervous system to associate closeness with danger. We AUTOMATICALLY retreat into a more primitive state because of our hypervigilance and lived experiences. We might at our heart of hearts deeply crave connection, but our nervous system has been trained to see it as a threat. We may self-sabotage in relationships, isolate ourselves, pick fights or arguments, or run away. We may not even engage in relationships at all because our safety zone is one of sheer isolation. A deep craving for that connection may lead us to settle for an artificial one. We may hide parts of ourselves out of fear that if people see the whole us, we’ll be rejected. We may shut down our needs and make excuses for behavior we are extremely uncomfortable with, or we said were dealbreakers. We may hold on with all our might to a connection that does not serve us and is not for us, fearing otherwise we will be alone. Or because we believe this is what a relationship is supposed to be like, or believe it’s the best we can get.
I started to put the pieces together
Suddenly this idea of attachment theory started to make a lot more sense. I could try to rationalize my way through every relationship, but at the end of the day my nervous system was not my friend. She had adapted in childhood to help me survive, but the way she adapted was hurting me in adulthood and in my romantic relationships. She became addicted to inconsistency in words and actions, chaos, and highs and lows. She was wired to expect and accept disappointment. And she was wired to run away from safe closeness when it did appear. She was also wired to learn she wasn’t in control- that it wasn’t about choosing, it was about being chosen. She overextended herself to prove her worth, why she was so deserving of love, only to receive little in return. She sought to fix, to repair, to prove she was so worthy that someone else wanted to fix themselves.
Your relationship issues may be about someone you didn’t expect
And suddenly with words down on the page, everything illuminated. My attachment behaviors in my adult relationships were rooted in a broken relationship with the one person who I wanted to choose me more than anyone in the world - my mother. My mother’s emotional instability caused a rift in the most love I had ever received from someone. She loved me so much, but she was wildly unpredictable and unstable. She could be deeply affectionate in one moment, and entirely withdrawn in the next. She could be emotionally reactive in one moment, and numb in the next. She ran from conflict and had a severe victim mentality where she was often blind to herself. She was plagued by her own demons, her own traumas, her own mental illness and insecurities, and the adult version of me knows that. But for the little girl inside of me, it was personal. My mom would not get better or even try to get better because of me - I wasn’t good enough for her to want to get better.
Your autonomic nervous system response explains your attachment style
Attachment theory tells us that we will subconsciously recreate the relationship with the caregiver that hurt us most during childhood in our adult relationships, especially our romantic relationships. I wasn’t doing this on purpose, everything was happening at an unconscious level. The autonomic nervous system makes us attracted to what is familiar. Again, this feels good to us because it’s comfortable, we know what to expect. I set myself up for disappointment. I believed so deeply (at an unconscious level) that if I was good enough, and got a man to love me enough, he would adjust to who I needed him to be. He would do the work, he would go to therapy, deal with his wounds, and be his own source of motivation. I fell in love with who I thought they were at their heart of hearts, rather than who they showed me they were. It was unfair to me, and it was unfair to them. It prevented true emotional intimacy, and allowed me to maintain the distance I needed to feel safe.
Well…what the heck do I do now?
So what do we do? How do we even begin to address this? We have to reparent our inner child. It has nothing to do with fixing our caregiver - believe me, I tried that. It leads to more heartbreak and is a waste of time. You will not change the person who hurt you. It simply will not happen, and you have to let go of that lingering hope. I love my mom dearly, but I had to let go of the idea that she could change for me. I had to release the idea that she could go back in time and be who I wanted her to be. Remember this, internalize this: people do not change for other people. People change when they want to change for themselves. We can only control ourselves, nothing else. We have to show up for ourselves as adults, and show the little one inside of us that we can provide what she needs, that she is safe, and she was always good enough. It had nothing to do with her. This is a process that takes time. You’re rewiring your nervous system, and you have to be patient with yourself. I’ll be back next time with more information on what this has looked like for me. Until then, take care of yourself. You are brave, and you are strong.