The role of adult attachment orientation and coping in psychological adjustment to living with skin conditions

Abstract

Background

Skin conditions can be associated with significant psychological distress. Investigation of attachment orientation and associated use of coping strategies is a promising perspective from which to investigate psychological adjustment to skin conditions.

Objectives

To examine the role of adult attachment orientation, conceptualised as two dimensions: attachment avoidance and attachment anxiety, in psychological adjustment (appearance related distress and skin related quality of life) and the mediating role of two coping strategies: defeatism and activity.

Methods

Attachment avoidance and attachment anxiety (ECR), use of coping strategies (COPE), appearance related distress (DAS 24) and skin related quality of life (Skindex-16) were assessed through a cross-sectional online survey in 207 adults with skin conditions. Multiple mediation analyses were performed using PROCESS path analysis.

Results

Overall, higher attachment avoidance and higher attachment anxiety were associated with higher appearance related distress and greater impact on emotions and functioning aspects of quality of life. For attachment anxiety, the relationship was fully explained by more frequent use of defeatism coping. For attachment avoidance, the relationship was partially explained by more frequent use of defeatism coping (and in the case of appearance related distress also more frequent use of activity coping), and higher attachment avoidance was also associated with poorer psychological adjustment in a way that could not be explained by use of assessed coping strategies.

Conclusions

Insecure attachment orientation (high attachment avoidance or high attachment anxiety) is linked to poorer adjustment. People with insecure attachment might benefit from psychological interventions that target underlying attachment orientation.

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