When two people sustain nearly identical concussions, their recoveries often look remarkably different. One person steadily improves over a few months. Another develops persistent brain fog, anxiety, dizziness, fatigue, insomnia, or dysautonomia that lingers for years.
Certainly, the severity of the injury matters. Age matters. Hormones matter. Sleep matters. Rehabilitation matters. But what if another piece of the puzzle has been quietly shaping how your nervous system responds to stress — long before the concussion ever happened? In my recent conversation with psychotherapist, somatic therapist, and Chinese medicine practitioner Dr. Matthew Tolstoy, we explored a topic that has received surprisingly little attention in concussion rehabilitation: attachment theory — and how the relationship patterns we develop in early childhood may influence our autonomic nervous system throughout life.
Attachment Theory Isn't Just About Relationships
Many people first encounter attachment theory through books or social media discussing dating and romantic relationships. But that's only a small piece of a much bigger story.
Attachment theory began as a way of understanding how infants learn to survive. Unlike many animals, humans are born almost completely dependent on caregivers — we cannot feed ourselves, protect ourselves, or regulate many aspects of our physiology on our own. For years, our survival depends entirely on another human being.
Because of that dependence, the developing brain pays extraordinary attention to one question: "When I need help, what happens?" The answer to that question becomes encoded not only psychologically — but physiologically.
Your Nervous System Is Always Learning
As infants, our brains constantly monitor subtle cues: facial expressions, voice tone, touch, eye contact, comfort, separation, and responsiveness. Over thousands of interactions, the brain begins developing predictions about safety.
Do people come when I need them? Am I comforted when I'm distressed? Is it safe to express my emotions? Do I need to handle everything on my own?
These repeated experiences help shape how the autonomic nervous system responds to stress. Long before we're capable of conscious thought, the brain is learning how to survive — and how to do that in relationship with others around us.
What Happens After a Concussion?
A concussion doesn't simply affect memory or balance. It can also disrupt communication between the prefrontal cortex, limbic system, and brainstem — the very regions involved in emotional regulation, autonomic control, and our ability to accurately interpret safety versus threat.
For many people, that means coping strategies that were once largely automatic become much more visible. It's almost as though the brain's "executive control" becomes less able to regulate older, deeply ingrained autonomic patterns.
The concussion didn't necessarily create those patterns. It may simply have made them harder to compensate for.
The Four Attachment Styles
One of the most practical parts of my conversation with Dr. Tolstoy was learning how these patterns often organize into four broad attachment styles. These are not labels. They are not personality types. They are learned strategies for navigating stress and relationships.
Secure Attachment
People with a secure attachment style generally expect that others will be available when needed. They can ask for help, tolerate conflict without feeling overwhelmed, and trust both themselves and other people. When stress occurs, their nervous system is usually able to return to baseline relatively efficiently.
Avoidant Attachment
People with an avoidant attachment style often learned early in life that expressing distress did not reliably bring comfort. As a result, their nervous system developed a different strategy: deactivate, become self-reliant, need less, ask for less.
One fascinating finding discussed during our interview is that research has shown people with avoidant attachment often demonstrate significant physiological signs of stress while reporting that they don't feel particularly stressed at all. Their body is highly activated, but their conscious awareness of that activation may be surprisingly limited. This disconnect may have important implications for concussion recovery, where autonomic regulation is already under strain.
Anxious Attachment
For people with an anxious attachment style, the nervous system often learned that expressing distress increased the likelihood of receiving attention or care. The strategy became: amplify, reach out, seek reassurance, stay close.
Dr. Tolstoy describes this as a more sympathetic-dominant pattern, where stress fuels an increased drive for connection. Even when support arrives, the nervous system may have difficulty fully settling because maintaining distress has become unconsciously associated with maintaining connection.
Disorganized Attachment
Perhaps the most challenging pattern is disorganized attachment. Instead of having one consistent strategy, the nervous system alternates between conflicting responses: move closer, pull away, seek connection, fear connection.
These individuals may experience both sympathetic activation and parasympathetic shutdown occurring in ways that feel confusing and unpredictable. Relationships often feel simultaneously comforting and threatening.
Why This Matters for Dysautonomia
One of the most important ideas from our conversation is this: two people can have the same concussion, but arrive at that injury with two very different nervous systems. One person's autonomic response to stress may naturally involve shutting down. Another's may involve becoming highly activated. Another may fluctuate between both.
This may help explain why there is no single protocol that works for every person with dysautonomia or persistent post-concussion symptoms. The nervous system isn't responding only to the injury — it's also responding according to patterns that may have been developing for decades.
"Your attachment style is not your destiny. It is a learned pattern of autonomic regulation — and the brain remains capable of change throughout life."
Awareness Changes Everything
This is the part of attachment theory I find most hopeful. The goal is not to diagnose yourself. Nor is it to blame your parents. Instead, it's to develop awareness.
When you begin recognizing your automatic responses to stress, something remarkable happens. You create space between the stimulus and your response. That space is where change becomes possible. Without awareness, our nervous system simply repeats the same patterns it has always relied upon. With awareness, we gain the opportunity to choose differently.
Neuroplasticity Doesn't End in Childhood
One concern people often have when learning about attachment theory is: "If these patterns formed when I was an infant, am I stuck with them?" Fortunately, no.
While the earliest years of life are incredibly influential, the brain remains capable of change throughout adulthood. Every healthy relationship, every therapeutic interaction, every moment of emotional safety, every opportunity to experience stress differently — all of it provides new information to the nervous system.
That is neuroplasticity. Not simply learning new facts. Learning new ways of being.
Why This Matters for Concussion Recovery
As clinicians, we often focus on the physical aspects of concussion rehabilitation: vision, balance, vestibular function, exercise, sleep, nutrition. Those are all incredibly important. But Dr. Tolstoy reminds us that the nervous system does not separate physiology from psychology as neatly as medicine often does. The brain experiences them together.
When we acknowledge that reality, we open the door to a more complete understanding of recovery — one that honors both the biology of brain injury and the lived experiences that shaped the nervous system long before the injury occurred.
Dr. Wolf's Perspective
One of the reasons this conversation resonated with me so deeply is because it reinforces something I've observed clinically for years: two people can have nearly identical injuries and dramatically different recoveries. Traditionally, we've looked to factors like age, hormones, sleep, vestibular dysfunction, cervical injury, inflammation, or genetics to explain those differences. Those factors absolutely matter. But Dr. Tolstoy introduced another layer that I think deserves far more attention — the possibility that our nervous system's earliest "operating system" influences how we respond to the enormous physiological stress of a concussion.
What I find most hopeful about attachment theory is that it isn't a story about being permanently shaped by your past. It's a story about awareness. Once we begin to recognize these deeply ingrained autonomic patterns, we are no longer completely governed by them. Awareness becomes the bridge between unconscious survival strategies and intentional healing. And from a functional neurology perspective, that bridge is built on neuroplasticity. The brain that learned these patterns is also capable of learning new ones.
Work with Dr. Matthew Tolstoy
Dr. Matthew Tolstoy is a psychotherapist, somatic therapist, and Chinese medicine practitioner specializing in the intersection of psychology, physiology, and healing. Learn more about his work and approach.
Listen to the Full Episode
In this conversation with Dr. Matthew Tolstoy, we take a much deeper dive into attachment theory, autonomic regulation, dysautonomia, concussion recovery, and the fascinating overlap between psychology, physiology, and functional neurology. If you've ever wondered why your nervous system seems to react in ways you can't fully explain, this episode offers a thoughtful framework that may change how you understand both stress and healing.
Episode 69
How Early Attachment Shapes Dysautonomia and Stress Responses with Dr. Matthew Tolstoy
Listen to Episode 69If you've been wondering why your nervous system seems to respond differently than expected — even after doing all the “right” things in recovery — you're not alone, and there may be more to the story. A qualified healthcare professional can help you explore what might be happening and which next steps may be appropriate.