When Holding On Becomes Pathological — and Why I'm Seeing the Opposite Problem in My Clinic

MBC1 — SABAH AL KHAIR YA ARAB · January 6, 2021

Ms. Sarah El Nabulsi, M.Sc., M.A., M.A., DHA Licensed Clinical Psychologist, joined the hosts of MBC1's Sabah Al Khair Ya Arab to unpack one of the most misunderstood dynamics in psychological wellbeing: attachment. When does holding on become pathological? What are the warning signs? And what is actually driving this behaviour — in Arab culture specifically — right now?

The answers were not what the hosts expected.

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What Pathological Attachment Actually Looks Like

Attachment becomes pathological when it begins to erode a person's capacity to function independently. The markers are specific: a felt sense that you cannot exist without this person — that enjoyment is conditional on their presence, that the day has no real shape unless they are in it. When it comes to routines and objects, the signal is compulsion: a felt need to follow a specific ritual or return to a specific place that, when disrupted, produces genuine distress rather than mere inconvenience.

In its most extreme form, pathological attachment to objects overlaps significantly with the clinical picture of hoarding. In the DSM-5, Hoarding Disorder is defined as a persistent difficulty discarding possessions regardless of their actual value — including objects others would consider worthless, such as used packaging or worn-out containers — leading to the accumulation of clutter that compromises living spaces and daily functioning. While hoarding disorder was historically classified under Obsessive-Compulsive Disorder, the DSM-5 (2013) formally distinguished it as its own diagnostic category, reflecting growing research evidence that its underlying mechanisms are meaningfully distinct. What the two conditions share is the emotional weight attached to objects most people would release without thought — a weight that, from the outside, is almost impossible to understand, and from the inside, is entirely real.

What I Am Actually Seeing in My Clinic

Here is where I want to offer something that may surprise. The hosts framed this topic around excessive attachment — and it is a real clinical presentation. But when I reflect on what I am genuinely observing in my clinical work right now, the more prominent pattern is actually the opposite.

What I see increasingly is detachment. Clients who exit relationships the moment they require adjustment. Who interpret any friction as evidence that this is not the right relationship — rather than as the ordinary resistance that every meaningful connection produces at some point. Who move on with a speed and a lightness that, from the outside, can look like confidence, but which clinically often reflects something more fragile.

This is a significant cultural shift. In Arab culture traditionally, attachment has been one of our deepest and most defining features. Bonds are not provisional. Community is not optional. Connections to family, neighbours, and community are maintained across generations and across difficulty. This relational depth is one of the genuinely protective features of Arab culture — and it is under pressure in a way I find worth naming directly.

What we are absorbing from more individualistic cultural frameworks is the idea that a relationship that requires effort is a relationship that is wrong for you. That framing is, I would argue, one of the more psychologically damaging ideas of our era. Effort is not a red flag. It is what love and connection are actually made of.

Attachment Patterns — and Why One Person Can Look Very Different in Different Relationships

One of the most important things to understand about attachment is that it is not a fixed trait. The same person can show entirely different attachment patterns depending on who they are with — specifically, depending on what the other person's attachment style is doing to theirs.

The foundational framework here comes from John Bowlby, whose attachment theory — developed across three major volumes published between 1969 and 1980 — established that human beings are biologically driven to form close bonds, and that the quality of early attachment relationships shapes our internal working models: our unconscious templates for what relationships are, what we can expect from other people, and whether we fundamentally deserve to be loved. Mary Ainsworth's landmark Strange Situation research (1970) built on Bowlby's work to identify the basic attachment patterns — secure, anxious-preoccupied, and dismissive-avoidant — that continue to organise our relationships in adulthood.

A fourth pattern — disorganized attachment — was identified by Mary Main and Judith Solomon in 1986, and it is this pattern that helps explain something I see frequently: a person who bonds intensely with someone in the early stages of a relationship, then, once that bond is reciprocated and the other person has genuinely attached, withdraws. Becomes distant. Acts in ways that feel confusing and contradictory.

For someone with a secure or anxious-preoccupied attachment style on the receiving end of this, the experience is destabilising in a very specific way. The withdrawal feels like something they have done wrong — like the relationship requires more effort, more investment, more pursuit, to get back to the closeness that was there before. And so they chase. Not because their attachment is pathological in itself, but because they have been placed in a dynamic — by another person's disorganized pattern — that pulls for exactly this response. The problem is not always with the person who is attaching. It is sometimes with the dynamic.

Symptoms of Pathological Attachment

When attachment does become genuinely problematic on the individual level, the signs are consistent: an inability to move through the day without the other person occupying a disproportionate amount of mental and emotional space; a sense of self that has no stable independent foundation — no felt experience of being a complete person when alone; and patterns of anxious monitoring — checking in compulsively, worrying without objective cause, reading significance into small delays or changes in tone.

These are not character flaws. They are the predictable outputs of an attachment system that has not had the security it needed, at some earlier point in development, to trust that connection does not require constant maintenance to survive.

Why We Stay Attached to Circumstances That Are Hurting Us

One of the more counterintuitive things I am asked about is why people remain attached to situations, relationships, or patterns that are clearly not good for them — sometimes long after they know, intellectually, that leaving would be better.

The answer lies in how the nervous system understands security. Predictability, to the nervous system, functions as safety. A situation that is difficult but familiar is, at the neurological level, more manageable than a situation that is uncertain and unknown — even if the uncertain situation holds the possibility of something genuinely better. For some people, the anxiety provoked by the unknown is more distressing than the pain of staying where they are. This is not weakness. It is a genuine fear response, with a genuine neurological basis — connected directly to what researchers including Dugas and colleagues have identified as intolerance of uncertainty, a well-documented cognitive vulnerability that underlies anxiety across its many presentations.

This is something I work with explicitly in therapy. Life is unpredictable by nature — and a life that was fully predictable would, I often point out to clients, be a very boring life indeed. The goal is not to eliminate that discomfort, but to build a strong enough internal foundation that the discomfort of uncertainty no longer has the power to hold us in place.

The Generational Shift — and What Mental Health Requires of Us Now

Healthy adaptation is one of the defining markers of good mental health — the capacity to adjust successfully to changing circumstances, rather than requiring circumstances to remain static in order to feel safe.

The circumstances of life in the Arab world have changed profoundly. Previous generations were structured around a single shared ambition: the father built, the family supported, children eventually contributed to what he had created. There was a natural complementarity in that model, and a natural depth of interdependence.

Today, every person in that family is chasing their own dream. The pace is faster, the demands are more individual, the geography is more dispersed. To function well in this world, we cannot afford to require another person's presence in order to feel complete. We need a strong enough internal sense of self — what I refer to clinically as self-referral consciousness — that our wellbeing is grounded in ourselves rather than in what other people are doing or not doing. We need healthy independence alongside healthy interdependence: genuine connection without dissolution.

Building Self-Referral Consciousness Through Transcendental Meditation

Self-referral consciousness is the capacity to know yourself through yourself — not through other people's opinions of you, not through their attention or validation, not through whether they call or don't call. It is the quality that allows a person to be fully present in their relationships without losing themselves in them.

One of the most effective tools I use with clients for developing this quality is Transcendental Meditation. The physiological basis for why TM is particularly suited to this work was first published in a landmark 1970 study by Robert Keith Wallace in Science — one of the first scientific investigations of TM's effects — which documented a distinct physiological state during TM practice that Wallace described as a fourth major state of consciousness: restful alertness. In this state, the body reaches levels of rest measurably deeper than deep sleep — metabolic rate drops significantly, oxygen consumption falls — while the mind, paradoxically, remains fully awake and alert. Alert, specifically, to its own inner nature rather than to external stimulation.

This is practised twice daily — once in the morning, once in the early afternoon. The effect, over time, is that the practitioner develops what might be described as an inner anchor: a stable connection to the deeper, quieter layers of their own consciousness that persists as a kind of background resource throughout the rest of the day. Decisions are made from a calmer place. Reactions are less automatic. The need for constant external validation — which is precisely what drives pathological attachment — becomes less urgent, because the internal foundation it was compensating for is genuinely stronger.

When we are deeply rooted in ourselves, other people become companions rather than necessities. We can connect, attach, and love — and also tolerate the natural distances and uncertainties that every relationship involves, without those distances threatening our sense of self.

About Ms. Sarah El Nabulsi

Ms. Sarah El Nabulsi, M.Sc., M.A., M.A. is a DHA Licensed Clinical Psychologist (License No. DHA-75083705) based in Dubai, and UAE Director of the Transcendental Meditation Organization. She has been featured on MBC, MBC1, Sky News Arabia, Dubai TV, and BBC Arabic, and is the founder of the online courses Anxiety 101 (Level 1) and Master Yourself (Level 2).

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Related reading: Why Do Arabs Repress Emotions? A Clinical Psychologist's Perspective

Citations :

• John Bowlby — attachment theory (1969–1980)

• Mary Ainsworth — Strange Situation, secure/insecure/avoidant patterns (1970)

• Mary Main & Judith Solomon — disorganized attachment (1986)

• DSM-5 (APA, 2013) — Hoarding Disorder as distinct from OCD

• Robert Keith Wallace (1970), Science — TM's fourth state of consciousness / restful alertness

• Dugas et al. — intolerance of uncertainty and anxiety