FEAR OF RELATIONSHIP LOSS: ATTACHMENT STYLE AS A 
VULNERABILITY FACTOR IN JOB BURNOUT
Andreja PŠENIČNY
1*
, Mitja PERAT
1
1
Institute for Human Resource Development, Psychotherapy, Gasilska 19, 1000 Ljubljana, Slovenia
Received: Feb 11, 2020
Accepted: May 19, 2020 
Original scientific article
*Corresponding author: Tel. + 386 31 711 421; E-mail: apsenicny@burnout.si
10.2478/sjph-2020-0019 Zdr Varst. 2020;59(3):146-154
STRAH PRED IZGUBO ODNOSA: STIL NAVEZANOSTI KOT DEJAVNIK 
RANLJIVOSTI ZA IZGOREVANJE NA DELOVNEM MESTU
Pšeničny A, Perat M. Fear of relationship loss: attachment style as a vulnerability factor in job burnout. 
Zdr Varst. 2020;59(3):146-154. doi: 10.2478/sjph-2020-0019.
ABSTRACT
Keywords: 
burnout, wornout, 
performance-
based self-esteem, 
workaholism, 
attachment styles
IZVLEČEK
Ključne besede: 
izgorelost, delovna 
izčrpanost, storilnostno 
samovrednotenje, 
deloholizem, stili 
navezanosti
Objective: To investigate the correlation between attachment styles and various burnout risk groups (“relaxed”, 
“wornout”, “challenged” and “burnout”) and whether attachment styles suitably discriminate between individual 
burnout risk groups.
Method: The study involved 2,320 participants (1,668 women and 652 men), who completed an adrenal burnout 
syndrome questionnaire, a performance-based self esteem scale, a work addiction risk test and a relationship 
questionnaire.
Results: A one-way analysis of variance confirmed attachment style differences between burnout risk groups. 
The challenged and burnout groups differed from the relaxed and wornout groups by having a significantly lower 
secure attachment style score and a higher insecure (avoidant and preoccupied) attachment style score. The 
canonical discriminant analysis showed that the predictors (secure, preoccupied and avoidant attachment styles) 
can be used to appropriately classify 85.4% of respondents in the predicted burnout risk groups.
Conclusion: The study confirmed the hypothesis that two insecure attachment styles (i.e. avoidant and preoccupied) 
predominate in the challenged and burnout groups, and that a secure attachment style predominates in the 
relaxed and wornout groups. Burnout syndrome can thus be conceived as the result of excessive and compulsive 
efforts to retain a relationship that is perceived as insecure or to reduce (excessive) fear of losing this relationship.
Namen: Ugotavljali smo, kako se stili navezanosti povezujejo z različnimi skupinami tveganja za izgorelost 
(neogroženi, delovno izčrpani, kandidati, izgoreli) in ali stili navezanosti ustrezno diskriminirajo med skupinami 
ogroženosti za izgorelost.
Metoda: V raziskavi je sodelovalo 2320 udeležencev (1668 žensk, 652 moških), ki so izpolnili vprašalnik sindroma 
adrenalne izgorelosti, vprašalnik storilnostno pogojenega samovrednotenja, vprašalnik deloholizma ter vprašalnik 
stila navezanosti.
Rezultati: Z enosmerno analizo variance smo potrdili razlike v stilih navezanosti med skupinami ogroženosti 
za izgorelost. Kandidati za izgorelost in izgoreli so se od neogroženih in delovno izčrpanih po stilu izgorelosti 
razlikovali, tako da so dosegli pomembno nižjo oceno varnega stila navezanosti in hkrati višjo oceno nevarnih 
stilov navezanosti (izogibajočega in preokupiranega). S kanonično diskriminantno analizo smo ugotovili, da se 
glede na prediktorje (varen, preokupiran in izogibajoč stil navezanosti) 85,4 odstotka udeležencev ustrezno 
razvršča v predpostavljene skupine ogroženosti za izgorelost.
Sklep: Raziskava je potrdila domnevo, da pri kandidatih in izgorelih prevladujeta dva nevarna stila navezanosti 
(izogibajoči in preokupirani), medtem ko pri neogroženih in delovno izčrpanih prevladuje varni stil navezanosti. 
Izgorevanje in izgorelost lahko torej razumemo kot posledico pretiranega, kompulzivnega prizadevanja, da bi 
ohranili odnos, ki ga doživljajo kot nevarnega, in tako ublažili svoj (pretirani) strah pred izgubo tega odnosa.
146
© National Institute of Public Health, Slovenia. 

1 INTRODUCTION
1.1 Burnout and Wornout
Burnout can be conceived of as a process resulting from 
unsuccessful (workaholic) efforts to maintain a stable self-
image through achievements, which are a component part 
of one’s self-esteem. Burnout is a decompensation, which 
is the final result of the process of self-exhaustion through 
overcompensated activity (1).
“Wornout” is an expression denoting a feeling of cognitive 
and physical exhaustion, and emotional reactions to this 
condition without the associated signs of anxiety and fear 
(2), or exhaustion that does not result from attempts to 
create or maintain self-esteem (3).
In terms of burnout risk, a distinction can be made between 
the following four groups: “relaxed”, “challenged”, 
“wornout” and “burnout”. Hallsten et al. (3) distinguished 
between these groups based on the following two 
criteria: a high or low level of burnout and high or low 
performance-based self-esteem. Pšeničny and Perat (4) in 
turn use three criteria: a high or low level of burnout, high 
or low performance-based self-esteem, and workaholism.
repeating patterns of behaviour in interaction with 
the caregiver transform into mental representations. 
These specific mental representations are referred to as 
attachment styles, which constitute one’s basic mental 
model for understanding the social world. Moreover, an 
attachment style is an implicit and automated method of 
organising stimuli. However, it is subject to perceptual 
and cognitive errors.
Bartholomew and Horowitz (7) empirically validated 
four attachment styles and categorised them into 
a secure attachment style (representations of both 
the self and the other are predominantly positive) 
and three insecure attachment styles: a preoccupied 
attachment style (a negative representation of self and 
a positive representation of the other), a fearful-avoidant 
attachment style (the representations of self and of the 
other are relatively negative) and a fearful-dismissing 
attachment style (the representation of self is positive 
and the representation of the other is negative). 
Adult attachment styles and mental representations both 
influence the formation of the models of self, of other and 
of relationships with others - that is, they also influence 
the (subconscious) expectations about relationships with 
others and our understanding of the social environment. 
Individuals with an implicit insecure attachment style in 
general experience relationships as less secure and stable 
(8, 9). 
According to the sociometer theory (10), threats to 
one’s relational value, such as social rejection, exclusion 
and criticism, are the most acute modern-day stressors 
because they undermine the feeling of social value, 
esteem and status (11). Research confirms the correlation 
between social stressors and job burnout (12), between 
burnout and hypersensitivity to rejection and criticism 
(4), and between an insecure attachment style and 
hypersensitivity to rejection and abandonment as a 
predictor of burnout (13).
1.3 Attachment Style, Regulation of Stress Response 
and Work Environment
Early experiences of secure or insecure emotional 
attachment play a crucial role in the development of an 
individual’s personality. Among other things, they are key 
to an individual’s ability to regulate emotions and cope 
with stressful situations, and have a significant effect 
on how an individual responds to the threat of losing an 
important attachment object (14).
The experience of insecure attachments results in a 
higher level of neuroticism or a generally weaker ability 
to regulate stress responses (15), and in various forms of 
personality traits that increase personal vulnerability, 
such as perfectionism, emotional lability, etc. (16) and 
workaholism (1, 17).
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147
Table 1. Burnout risk groups.
Low
High
Relaxed
Wornout
Challenged
Burnout
Performance-based self-esteem 
and/or workaholism
High Low Burnout risk
Compulsive motivation that ultimately leads to exhaustion 
and burnout originates from a deficit in self-esteem that 
is labile and dependent on achievements and external 
validation (performance-based self-esteem). The fear 
of losing self-esteem can be so strong that it leads to 
excessive working (and emotional) over-investment. 
This over-investment is also an indicator of poorer self-
regulation when it exceeds all limits and hard work is 
replaced by its compulsive form (i.e. workaholism), which 
ultimately poses a threat to physical and mental health. 
These two traits, which may also indicate a personality 
disorder in most individuals at risk of burnout, can 
therefore be considered a risk factor for the development 
of burnout syndrome. These risk-posing traits are only 
weakly expressed in relaxed and wornout individuals (4).
1.2 Attachment Styles and Fear of Relationship Loss
In his attachment theory, Bowlby (5, 6) explains that 
feelings of (in)security are the consequence of (un)
successful interactions between a child and his/her 
primary caregiver (most often the mother). These 

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148
Compared to those with an insecure attachment style, 
employees with a secure attachment style express higher 
general satisfaction, enjoy their work more, and are less 
worried about relationships at work. They experience less 
stress and cope with it more successfully, create a better 
work-life balance, and know how to seek help. Insecurely 
attached individuals are more afraid of rejection and poor 
performance, tend to be more over-involved, and feel less 
important and valued at work. Some avoid social contact 
(18-21). 
Several studies have confirmed a correlation between 
attachment styles and stress and burnout at work. Their 
authors report a negative correlation between a secure 
attachment style and burnout symptoms, and positive 
correlations between burnout and insecure attachment 
styles (i.e. preoccupied and avoidant) (15, 22-24). These 
correlations are understandable because people become 
attached to their work and the workplace, as well as 
to the people they encounter in this important living 
environment. The same notions and emotional responses, 
including expectations and fears, as exist in any other 
attachment relationship therefore come to the fore within 
this social context. Hence, for most people work and the 
work environment are important sources of security or 
insecurity. People who grew up experiencing insecure 
attachment, however, have at-risk personality traits 
that, in certain conditions, drive them into a process of 
exhaustion and may increase their work-related or other 
engagements endlessly (1, 4).
2 RESEARCH PROBLEM
We explored whether the relaxed and wornout groups 
differ from the challenged and burnout groups in terms of 
attachment style.
2.1 Hypotheses
This study’s basic premise was that insecure attachment 
affects the development of traits that pose a risk 
of burnout (i.e. performance-based self-esteem and 
workaholism). Individuals with a higher level of at-
risk traits were therefore also expected to have more 
pronounced insecure attachment styles. The following 
working hypotheses can be specified based on these 
premises:
H
1a
: The average score on various attachment styles 
(secure, preoccupied, avoidant and dismissing) differs 
significantly by burnout risk group (independent variable: 
relaxed, challenged, wornout and burnout).
H
1b
: A significant correlation is expected between various 
attachment styles (secure, preoccupied, avoidant and 
dismissing) and burnout risk groups (relaxed, challenged, 
wornout and burnout).
H
2
: The set of attachment styles (secure, preoccupied, 
avoidant and dismissing) produces a suitable distinction 
between the burnout risk groups.
3 METHOD
3.1 Participants and Instruments
3.1.1 Participants
The convenience sample included participants that 
completed the questionnaires posted on the website of 
the Institute for Human Resource Development between 
January 2018 to April 2019. A total of 2,320 individuals 
(1,668 women and 652 men) completed the questionnaires. 
Fourteen per cent of them were unemployed (including 
students and seniors), 69% were in employment, 7% were 
self-employed and 10% held managerial positions. The 
youngest respondent was 18 years old and the oldest was 
69 (M=38.50, SD=11.33).
3.1.2 Instruments
The Adrenal Burnout Syndrome Questionnaire or ABSQ 
(25) comprises four scales: body symptoms (45 items), 
emotional symptoms (94 items), behavioural symptoms 
(61 items) and cognitive symptoms (46 items). Cronbach’s 
α=0.962. The outcomes are the variable “average adrenal 
burnout syndrome rate” or ABSRa (with scores from 0 to 3), 
hereinafter referred to as “burnout,” and the categorical 
variable “burnout classes” or ABSCl (0=no symptoms; 
1=mild; 2=medium; 3=strong burnout). The latter was 
further converted into the dichotomous variable “burnout 
categories” or ABSCat (low level=no symptoms; high 
level=1, 2, 3).
The participants were then further divided into four 
burnout risk groups, whereby the variable “risk” (ABSRi) 
was obtained. The classification procedure is described 
below under “H1 testing.”
The Performance-Based Self-Esteem Scale or PBSE Scale 
(3) comprises four statements and measures performance-
based self-esteem. The responses were rated on a five-
point Likert scale (1=Fully disagree, 2=Somewhat disagree, 
3=Neither agree nor disagree, 4=Somewhat agree, 5=Fully 
agree). The questionnaire’s reliability measured using 
Cronbach’s alpha was 0.872. The outcome is the variable 
“average test score” or, as we called it, “performance-
based self-esteem” or PBS (with scores from 1 to 5). This 
variable was further converted into the dichotomous 
variable “performance-based self-esteem categories” or 
PBSCat (low level=1-2.45; high level =2.46-5). The criterion 
used was the average score reported by the authors of 
this scale.
The Work Addiction Risk Test or WART (26) comprises 25 
items and measures the tendency for compulsive hard 
work or workaholism. Cronbach’s α=0.966. The responses 

were rated on a four-point Likert scale (1=Never true, 
2=Sometimes true, 3=Often true, 4=Always true). The 
outcome of the test is the variable “workaholism” or 
WORKHL (with scores ranging from 25 to 100). The average 
score reported by Robinson is 47, which was used as the 
criterion for converting this variable into the dichotomous 
variable “workaholism categories” or WORKCat (low level: 
25-47; high level=48-100). 
Based on the results of these three questionnaires, the 
respondents were divided into four burnout risk groups: 
relaxed, challenged, wornout and burnout. Three 
classification criteria were used: a low or high level of 
burnout (ABSCat), low or high performance-based self-
esteem (PBS Cat), and a low or high level of workaholism 
(WORKCat), as the last two variables are the main 
predictors of burnout (1).
The variable “risk” (ABSRi) was thus obtained, with 
four groups of respondents at various risk of burnout: 
the relaxed group (a low level of performance-based 
self-esteem, workaholism and burnout), challenged (a 
high level of performance-based self-esteem and/or 
workaholism and/or a low level of burnout), the wornout 
group (a low level of performance-based self-esteem 
and workaholism, and a high level of burnout), and the 
burnout group (a high level of performance-based self-
esteem and/or workaholism and burnout).
The Relationship Questionnaire or RQ (7) comprises four 
short paragraphs describing a prototypical attachment 
pattern as it applies in close adult peer relationships 
(Bartholomew & Horowitz, 1991). Participants first select 
(forced choice) one of the four attachment styles (secure, 
preoccupied, avoidant and dismissing) and then rate each 
one on a seven-point Likert scale. These scores form the 
profile of an individual’s attachment style. The outcome is 
the categorical variable “attachment style” (STYLE) and 
four continuous variables: “secure attachment style” (SEC-
AS), “preoccupied attachment style” (PRE-AS), “avoidant 
attachment style” (AVO-AS), and “dismissing attachment 
style” (DIS-AS; scores for all these ranging from 1 to 7). 
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149
The last four variables were combined into an aggregate 
variable “attachment styles” (ASTYLES).
3.2 Procedure
The PBSE scale and WART test were translated into 
Slovenian by Andreja Pšeničny and Mitja Perat with the 
author’s permission, after which they were back-translated 
by an English specialist. 
Participants completed the questionnaires posted on the 
website of the Institute for Human Resource Development 
between January 2018 and April 2019. Their personal data 
was protected in accordance with the Slovenian Personal 
Data Protection Act.
4 RESULTS
4.1 Descriptive Sample Statistics
Table 2.
Table 3.
Descriptive statistics for the testing results (mean 
scores and standard deviations).
Frequencies, descriptive statistics and differences in test scores by category “low level” and “high level” for burnout, 
performance-based self-esteem and workaholism.
**Statistically significant difference p<0.01
Notes: ABSCat=adrenal burnout syndrome categories; PBSCat=performance-based self-esteem categories; WORKCat=workaholism categories
Burnout (ABSRa)
Performance-based self-esteem (PBS)
Workaholism (WORKHL)
Secure style (SEC-AS)
Preoccupied style (PRE-AS)
Avoidant style (AVO-AS)
Dismissing style (DIS-AS)
ABSCat
PBSCat
WORKCat
Low 
High 
Low 
High 
Low 
High 
0.65
34.21
56.59
4.12
3.29
3.63
3.59
1,130
1,190
431
2,694
335
1,225
0.06
1.22
1.69
3.74
37.84
67.85
0.11
0.58
0.41
0.66
7.28
12.77
−66.19
−60.15
−41.21
1778.04
120.50
133.521
0.00**
0.00**
0.00**
0.72
14.09
17.98
2.19
2.05
2.24
2.01
Variable M
N M SD t t-test df p
SD
Attachment styles by category (forced choice): the secure 
attachment style was selected by 31.1% of participants, 
the preoccupied style by 19.3%, the avoidant by 27.5% and 
the dismissing by 22%. The differences were statistically 
significant ( χ
2
 (3)=79.02, p<0.01)
The differences in the test scores between the low- and 
high-level categories (see the Methods section for the 
variables used) are shown in Table 3.

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150
Based on the results shown in Table 3, participants were 
divided into four burnout risk groups. Table 4 shows the 
descriptive statistics for the selected parameters by 
individual ABSRi category.
Table 4. Descriptive statistics (mean scores and standard deviations) for performance-based self-esteem, workaholism and burnout 
by burnout risk group (ABSRi), and the results of the one-way analysis of variance.
**Statistically significant difference p<0.01
Performance-based 
self-esteem 
Workaholism
Burnout
Relaxed
Challenged
Wornout
Burnout
Relaxed
Challenged
Wornout
Burnout
Relaxed
Challenged
Wornout
Burnout
19.16
41.55
20.49
43.82
39.24
63.37
44.50
67.47
.03
.03
.81
1.29
5.60
10.50
4.47
9.11
8.91
17.46
7.22
13.75
.08
.02
.29
.60
1,489.78
712.45
1,686.04
0.00**
0.00**
0.00**
M M
F
df(3.3389)
p
Table 5 shows the final classification of participants into 
ABSRi categories.
Table 5.
Figure 1. 
Participant classification into burnout risk groups 
(ABSRi variable).
Comparison of attachment style mean scores (secure, 
preoccupied, avoidant and dismissing) between 
burnout risk groups (relaxed, challenged, wornout 
and burnout).
Notes: ABSCat=adrenal burnout syndrome categories; 
PBSCat=performance-based self-esteem categories; 
WORKCat=workaholism categories
Low PBSCat 
and WORKCa
High PBSCat 
and WORKCat
Relaxed 
832 (35.9%)
Challenged 
258 (11.1%)
Wornout 
328 (14.1%)
Burnout 
902 (38.9%)
Low ABSCat High ABSCat
4.2 H
1
 Testing
Proceeding from the assumption that an insecure 
attachment style is associated with burnout risk, the 
challenged and burnout group ought to have a higher score 
for insecure attachment styles (preoccupied, avoidant 
and dismissing) and a lower secure attachment style score 
than the relaxed and wornout groups.
To check this, we carried out a repeated measures analysis 
of variance. Because Mauchly’s test showed that sphericity 
( χ
2
(2)=189.60, p<0.01) was violated, we corrected the 
degrees of freedom using Greenhouse–Geisser sphericity 
estimates.

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151
Table 6.
Table 7.
Summary of one-way repeated measures analysis of variance: attachment style mean score (ASTYLES variable) by group 
(relaxed, challenged, wornout and burnout; (ABSRi variable).
Comparison of the percentage of participants with secure and insecure attachment styles (ASTYLES variable) between 
burnout risk groups (ABSRi variable).
Note: No cells (0.0%) have an expected number below 5. The minimum expected number is 49.82
**Statistically significant difference p<0.01
Between individuals
     Cross section
     Error
Within individuals
     ASTYLES
     ASTYLES*ABSRi
     Error
Burnout risk groups
 
3
2,316
2.627
7.882
6,084.654
446
53.6%
53
20.5%
193
58.8%
30
3.3%
 
464.632
6,380.744
1,482.684
3321.341
31,787.110
Relaxed
Challenged
Wornout
Burnout
N
%
N
%
N
%
N
%
 
154.877
2.755
564.354
421.400
5.224
34
4.1%
102
39.5%
15
4.6%
488
54.1%
56
6.7%
49
19.0%
48
14.6%
295
32.7%
 
56.215
 
108.028
80.664
296
35.6%
54
20.9%
72
22.0%
89
9.9%
 
0.00**
0.00**
0.00**
df
Preoccupied
Attachment styles (ASTYLES)
SS
Secure 
Variability source MS
Avoidant
F
Dismissing
p
The results confirmed our hypothesis for two insecure 
attachment styles (i.e. preoccupied and avoidant) and the 
secure attachment style.
The challenged and burnout group showed a significantly 
lower secure attachment style score and a significantly 
higher score for two insecure attachment styles (i.e. 
preoccupied and avoidant) than the relaxed and wornout 
(Figure 1, Table 6). A post-hoc comparison of difference 
also shows no statistically significant differences between 
the relaxed and wornout groups in any attachment style. 
The dismissing attachment style is significantly lower 
among the relaxed group than among the burnout group 
(p<0.05), whereas no significant differences in this style 
can be observed between the other groups. The first 
part of the hypothesis that burnout risk groups also 
differ by the degree of expression of secure and insecure 
attachment styles can be confirmed for the secure and 
two insecure attachment styles (i.e. preoccupied and 
avoidant), whereas it can only partly be confirmed for the 
dismissing style.
If it is primarily insecurely attached individuals who burn 
out, one would expect a considerably higher percentage 
of those that chose an insecure attachment style among 
the challenged and burnout group than among the relaxed 
and wornout groups.
As anticipated, more than a half of the relaxed and 
wornout individuals reported a secure attachment style, 
whereas only one-fifth reported the same among the 
challenged, and only every thirtieth among the burnout 
group. The avoidant attachment style predominated 
in these two groups (Table 7). The differences were 
statistically significant ( χ
2
(9)=1,208.619, p<0.01). Based 
on this, the second part of the hypothesis can also be 
confirmed.

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152
4.3 H
2
 Testing
In the final stage, we also explored whether the set of 
attachment styles studied also enabled appropriate 
classification of participants into the burnout risk groups 
defined based on three criteria (i.e. performance-based 
self-esteem, workaholism and burnout). A canonical 
discriminant analysis with a gradual inclusion of variables 
was used. The variable “dismissing attachment style” 
(DIS-AS) was excluded from the analysis.
Table 8.
Table 9.
Table 10.
Testing the equality of centroids by burnout class 
(ABSCl).
Relative influence of predictors on the functions’ values (standardised coefficients) and the correlation between the 
“ASTYLES” variables and functions (structural matrix).
Percentages of appropriately classified members of individual burnout risk groups.
*Maximum absolute correlations between each variable and individual discriminant function
**Statistically significant difference p<0.01
1 / 3
2 / 3
3
Secure style
Preoccupied style
Avoidant style
Dismissing style
Original group 
members
12
6
2
0.12
0.80
0.95
−0.42
0.88
0.94
−0.03
−0.38
0.34
0.57
−0.00
4.1%
91.1%
10.7%
15.9%
−0.92
0.35
0.40
0.06
0.92*
0.31
0.12
−0.01
9.6%
8.9%
89.3%
2.7%
0.15
−0.61
0.47
0.27
86.3%
0.0
0.0
0.0
Relaxed
Challenged
Wornout
Burnout
−0.05
−0.85*
0.78*
0.41*
0.0
0.0
0.0
81.5%
0.00**
0.00**
0.00**
4,921.07
507.64
11.53
Functions 
tested
df Wilks’s 
lambda
1 1
Challenged Relaxed
2 2
Wornout
3
Standardised coefficients
Functions
Structural matrix
Functions
Predicted group members
3
Burnout
p χ
2
All three functions are statistically significant (Table 8). 
The first function is moderately positively correlated with 
the preoccupied and avoidant attachment styles. The 
second function is very strongly positively correlated with 
secure attachment, and the third function is very strongly 
positively correlated with the remaining predictors, with 
the preoccupied style being inversely proportionate to 
this function (Table 9). Based on these three predictors, 
originally 85.4% of participants were classified into 
appropriate burnout risk groups (Table 10). The third 
hypothesis can thus be confirmed.
5 DISCUSSION
Like many previous studies, this study also confirmed that 
individuals who developed insecure attachment styles due 
to specific circumstances during their childhood burn out 
more often and more strongly than those that were securely 

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153
attached to their parents or caregivers. The new finding 
presented in this study is that a distinction can also be made 
between the wornout and burnout individuals based on their 
attachment styles. What the burnout and wornout groups 
have in common is a general feeling of overtiredness and 
exhaustion, but unlike the burnout group, the wornout do 
not show any significant psychopathological characteristics 
and symptoms (3, 4) argue that performance-based self-
esteem is the psychopathological characteristic that 
distinguishes the wornout from the burnout. Pšeničny and 
Perat (4) also added workaholism as the third criterion. The 
same criteria are used to distinguish between the relaxed 
and the challenged. Due to these risky personality traits, 
we consider the “challenged” to be potential candidates 
for burnout.
The study confirmed the hypothesis that a secure 
attachment style predominated among wornout and 
relaxed individuals and that insecure attachment styles 
were more common among the burnout and challenged. 
In addition, attachment styles proved to be an important 
predictor for classifying participants into these four 
categories (over 85% of participants were appropriately 
classified).
Even in more strenuous and stressful circumstances, more 
securely attached individuals will experience only (normal) 
signs of exhaustion (wornout). Unlike burnout, this does 
not lead to decompensation because these individuals 
will not neglect their needs due to excessive fear of 
losing an important relationship. In our opinion, securely 
attached individuals will respond reciprocally: they will 
take criticism, rejections and threats into consideration, 
and increase their investment only to a reasonable extent 
because they are able to emotionally cope with potential 
loss. 
In individuals with preoccupied and avoidant attachment 
styles, the fear of losing an important relationship, 
including interpersonal relationships at work and 
employment itself, may be such a strong stressor that 
it can function as compulsive motivation and trigger 
over-investment (workaholism) or a search for constant 
validation through performance (performance-based 
self-esteem) with a single goal in mind: to retain this 
relationship. Adverse psychological as well as objective 
work circumstances and inappropriate interpersonal 
relationships in the workplace can be a real trigger for this 
fear for all employees, except that it is disproportionately 
strong in those who carry an insecure attachment style 
and triggers defensive over-engagement. Burning out and 
burnout can thus be conceived as the result of excessive 
and compulsive efforts to retain a relationship that is 
perceived as insecure, or to reduce (excessive) fear of 
losing this relationship. 
Because the burnout group shows characteristics 
indicating the presence of psychopathological factors, and 
hence differs from the wornout group in this regard, this 
finding should be taken into account in selecting measures 
for preventing and treating these conditions. In addition 
to measures aimed at improving work conditions and 
acquiring more suitable skills and knowledge (which can 
successfully reduce wornout), individuals who are burning 
out also require professional help. 
Long-term (development-oriented) psychotherapy has a 
beneficial effect on changing a person’s attachment style 
by simultaneously and inversely proportionately increasing 
the secure attachment style and reducing insecure 
attachment (27). Various forms of training, coaching and 
counselling, as well as shorter forms of therapy (e.g. 
cognitive behavioural therapy) may also be helpful for 
managing the symptoms and constructing short-term 
coping strategies for better functioning in difficult work 
situations.
This information is also important for employers in 
managing burnout. Specifically, burnout risk can be 
reduced in individuals identified as challenged (burnout 
candidates) by taking into account their specific 
vulnerabilities and taking appropriate action, increase 
their feelings of secure employment and decrease burnout 
triggers.
5.1 Limitations
This study’s limitations lie in the unrepresentative nature 
of the sample and the instruments used. The convenience 
sample included in the study does not necessarily reflect 
the percentage of burnout, wornout and challenged 
individuals within a population. The Relationship 
Questionnaire used has its own limitations, particularly in 
terms of the validity of its content. Therefore, it cannot 
be used reliably in clinical practice.
6 CONCLUSION 
The study confirmed the hypothesis that two insecure 
attachment styles (i.e. avoidant and preoccupied) 
predominate in the challenged and burnout groups, and 
that a secure attachment style predominates in the 
relaxed and wornout groups. Burnout syndrome can thus 
be conceived as the result of excessive and compulsive 
efforts to retain a relationship that is perceived as insecure 
or to reduce (excessive) fear of losing this relationship.
CONFLICTS OF INTEREST
The authors have no conflicts of interest to declare. 

10.2478/sjph-2020-0019 Zdr Varst. 2020;59(3):146-154
154
FUNDING
The study was financed by the Institute for Human 
Resource Development, Ljubljana.
ETHICAL APPROVAL
Data confidentiality: Data was collected anonymously 
through the website. Informed consent and volunteering: 
Participants were informed in writing of the purpose of 
the survey and that they agreed to the use of their survey 
data by completing the questionnaires. The research 
carried no risk of the violation of ethical principles.
REFERENCES
1. Pšeničny, A. Recipročni model izgorelosti: povezava med 
interpersonalnimi in intrapersonalnimi dejavniki nastanka sindroma 
izgorelosti: doctoral dissertation. Ljubljana: University of Ljubljana, 
2009.
2. Cox T, Kuk G, Leiter M. Burnout, health, work stress, and organizational 
healthiness. In:  Schaufeli WB, editor. Professional burnout: recent 
developments in theory and research. Philadelphia, PA: Taylor & 
Francis, 1993:177-93.
3. Hallsten L, Josephson M, Torgén M. Performance-based self-esteem: a 
driving force in burnout process and its assessment. Arbete och Hälsa. 
2005;4:117-39.
4. Pšeničny A, Perat M. Can burnout result from personality disorders? 
Anthrophos. 2016;1-2:27-49.
5. Bowlby J. Attachment and loss. Volume II. Separation: anger and 
anxiety. New York: Basic Books, 1973.
6. Bowlby J. A secure base: parent-child attachment and healthy human 
development. New York: Basic Books, 1988.
7. Bartholomew K, Horowitz L. Attachment styles among young adults: a 
test of a four-category model. J Pers Soc Psychol. 1991;61:226-44. doi: 
10.1037/0022-3514.61.2.226.
8. Byrne Z, Albert L, Manning S, Desir R. Relational models and 
engagement: an attachment theory perspective. J Manag Psychol. 
2017;32:30-44. doi: 10.1108/JMP-01-2016-0006.
9. Fraley R, Waller N, Brennan, K. An item response theory analysis 
of self-report measures of adult attachment. J Pers Soc Psychol. 
2000;78:350-65. doi: 10.1037/0022-3514.61.2.226.
10. Leary M, Tambor E, Terdal S, Downs D. Self-esteem as an interpersonal 
monitor: the sociometer hypothesis. J Pers Soc Psychol. 1995;68:518-
30. doi: 10.1037/0022-3514.68.3.518.
11. Dickerson S, Keneny M. Acute stressors and cortisol responses: a 
theoretical integration and synthesis of laboratory research. Psychol 
Bull. 2004;130:355-91. doi: 10.1037/0033-2909.130.3.355.
12. Dormann C, Zapf D. Customer-related social stressors and burnout. 
J Occup Health Psychol. 2004;9:61-82. doi: 10.1037/1076-8998.9.1.61.
13. Ronen S, Baldwin M. Hypersensitivity to social rejection and perceived 
stress as mediators between attachment anxiety and future burnout: 
a prospective analysis. Appl Psychol. 2010;59:380-403. doi: 10.1111/
j.1464-0597.2009.00404.
14. Shore J, Shore A. Modern attachment theory: the central role of affect 
regulation in development and treatment. Clin Soc Work J. 2007;36:9-
20. doi: 10.1007/s10615-007-0111-7.
15. Pines AM. Adult attachment styles and their relationship to burnout: 
a preliminary, cross-cultural investigation. Work & Stress. 2004;18:66-
80. doi. 10.1080/02678370310001645025.
16. Lorente L, Salanova M, Martinez I, Schaufeli W. Extension of the 
job demands-resources model in the prediction of burnout and 
engagement among teachers over time. Psicothema. 2008:345-60.
17. Guglielmi D, Simbula S, Schaufeli W, Depolo M. Self-efficacy and 
workaholism as initiators of the job demands-resources model. Career 
Dev Int. 2012;17:375-89. doi: 10.1108/13620431211255842.
18. Hazan C, Shaver P. Love and work: an attachment-theoretical 
perspective. J Pers Soc Psychol. 1990;59:270-80. doi: 10.1037/0022-
3514.59.2.270.
19. Harms P. Adult attachment styles in the workplace. Hum Resource 
Manage Rev. 2011;21:285-96. doi: 10.1016/j.hrmr.2010.10.006.
20. Richards D, Schat A. Attachment at (not to) work: applying attachment 
theory to explain individual behavior in organizations. J Appl Psychol. 
2011;96:169-82. doi: 10.1037/a0020372.
21. Meredith P , Poulsen A, Khan A, Handerson J, Castrisos V . The relationship 
between adult attachment styles and work-related self-perceptions 
for Australian paediatric occupational therapists. Br J Occup Ther. 
2011;74:160-7. doi: 10.4276%2F030802211X13021048723138.
22. Allison LW. Associations among attachment style, burnout, and 
compassion fatigue in health and human service workers: a 
systematic review. J Hum Behav Soc Environ. 2015:571-90. doi: 
10.1080/10911359.2014.988321
23. Pickar S. How attachment style correlates to symptoms of burnout for 
direct care staff in a company that serves people with developmental 
and/or intellectual disabilities: master’s thesis. Saint Paul, MN: 
Hamline University, 2015.
24. Vîrgă D, Schaufeli W, Taris T, van Beek I, Sulea C. Attachment styles 
and employee performance: the mediating role of burnout. J Psychol. 
2019;153:383-401. doi: 10.1080/00223980.2018.1542375.
25. Pšeničny A. Razvoj vprašalnika sindroma adrenalne izgorelosti (SAI) 
in preverjanje izhodišča Recipročnega modela izgorelosti. Psihološka 
Obzorja. 2007:47-82.
26. Robinson BE. (2014). Chained to the desk: a guidebook for workaholics, 
their partners and children and the clinicians who treat them. New 
York: University Press, 2014.
27. Buchheim A, Horz-Sagstetter S, Doering S, Rentrop M, Schuster P, 
Buchheim P, et al. Change of unresolved attachment in borderline 
personality disorder: RCT study of transference-focused psychotherapy. 
Psychother Psychosom. 2017;86:314-6. doi:10.1159/000460257.