Adult Attachment Style, Emotion Regulation and Obsessive-Compulsive Disorder-A Preliminary Cross-Sectional Mediational Investigation of an Attachment-Based Model

There is evidence that emotion regulation plays a role in the aetiology and maintenance of OCD, but knowledge about what impacts emotion dysregulation is limited. Attachment style is related to both emotion regulation and OCD symptoms, but the link between them has not been thoroughly studied. Examining emotion dysregulation within the context of OCD through an attachment theory framework may lead to a better understanding of the aetiology and maintenance of OCD. In the present study, we combined theoretically and empirically derived knowledge to examine the mediating role of emotion regulation between attachment dimensions (avoidance and anxiety) and OCD symptoms. One-hundred seventy-nine individuals with OCD were assessed with Experiences in Close Relationships-Revised (ECR-R), Difficulties in Emotion Regulation Scale (DERS) and Yale-Brown Obsession Compulsion Scale (Y-BOCS), and mediation analyses were conducted. Our results indicate that the association between OCD and attachment anxiety/avoidance was mediated by emotion dysregulation. The primary limitation of our study is that data are cross-sectional and, therefore, we cannot infer anything about the causal direction of these relationships. A second limitation of the study is that two of the three measures were derived from self-reported questionnaires, which may be prone to biassed reporting. Our results suggest that insecure attachment is important in OCD when taking emotion regulation into account. Thus, clinical interventions for OCD may improve by targeting attachment and difficulties related to emotion regulation. However, our findings are based on cross-sectional data that preclude conclusions relating to causal influence.