Avoidant Attachment Style Research Articles

Sexuality, Sexual Behavior, and Relationships of Asexual Individuals: Differences Between Aromantic and Romantic Orientation.

Asexuality is a complex construct with a considerable lack of research until recently. Building upon available findings, we examined the extent to which romantic orientation shapes individual and relationship experiences, and expectations of asexual individuals. Specifically, our research focused on the distinction between romantic asexual individuals, who experience romantic attraction, and aromantic asexual individuals, who do not experience romantic attraction. A cross-sectional study with members of different asexual online communities (N = 447, 55.02% women; Mage = 24.77 years, SD = 7.21) aimed at examining how both groups differ in their identification with the asexuality construct as measured by the Asexuality Identification Scale (Yule et al., 2017), individual perspectives on sexuality, sexual behavior and relationships, concerns about commitment and sexual performance in a relationship, and attachment style. Results showed that aromantic asexual individuals identified more with asexuality, reported a more avoidant attachment style, and were more concerned with relationship commitment. In contrast, romantic asexual individuals reported less sex aversion, more sexual experiences (both past and current), and more sexual partners in the past. These individuals also engaged in romantic relationships more frequently in the past, had a stronger desire to engage in a romantic relationship in future (either with or without sexual intimacy), and were more concerned with sexual performance. Overall, our findings contribute to the literature by highlighting the need to consider romantic orientation when examining asexuality and its interpersonal outcomes.

Relationships between Theory of Mind and Attachment Styles in Emerging Adulthood

Several studies have highlighted a relationship between attachment and theory of mind (ToM) in childhood and in clinical populations. However, little is known about the link between attachment and ToM in the general adult population. The aim of this study was, therefore, to explore how differences in attachment styles influence ToM skills in a nonclinical population of young adults. 69 young adults performed the Reading the Mind in the Eyes test, Movie for the Assessment of Social Cognition test (MASC), and an adult attachment Q-sort questionnaire. Findings revealed that dimensions of avoidant and ambivalent attachment were, respectively, related to undermentalizing and overmentalizing tendencies. Insecure participants performed significantly more poorly than secure ones on the MASC. More specifically, participants with an avoidant attachment style made significantly more responses classified as undermentalizing than those with a secure attachment style. A statistical trend was observed for the MASC no-ToM score (answer with complete lack of ToM or literal understanding), with lower scores for the insecure ambivalent group than for the secure group. These results suggest that the individuals with avoidant insecure attachment are more likely to under-attribute mental states to others, while those with ambivalent insecure attachment tend not to make attributions when the situation requires it. Implications for future research are discussed.

The Moderating Role of the FKBP5 Gene Polymorphisms in the Relationship between Attachment Style, Perceived Stress and Psychotic-like Experiences in Non-Clinical Young Adults.

Numerous studies have reported that stressful life experiences increase the risk of psychosis and psychotic-like experiences (PLEs). Common variations of the FKBP5 gene have been reported to impact the risk of psychosis by moderating the effects of environmental exposures. Moreover, anxious and avoidant attachment styles have been shown to increase both the level of perceived stress and the risk for psychosis development. In the present cross-sectional study, we aimed to investigate whether variants of the FKBP5 gene moderate the effects of attachment styles and the level of perceived stress on the development of PLEs. A total of 535 non-clinical undergraduates were genotyped for six FKBP5 single nucleotide polymorphisms (SNPs) (rs3800373, rs9470080, rs4713902, rs737054, rs1360780 and rs9296158). The Psychosis Attachment Measure (PAM), the Perceived Stress Scale-10 (PSS-10) and the Prodromal Questionnaire 16 (PQ-16) were administered to assess attachment styles, the level of perceived stress and PLEs, respectively. Anxious attachment style, lower levels of perceived self-efficacy and higher levels of perceived helplessness were associated with a significantly higher number of PLEs. The main effects of attachment style on the severity of PLEs were significant in models testing for the associations with perceived self-efficacy and three FKBP5 SNPs (rs1360780, rs9296158 and rs9470080). The main effect of rs38003733 on the number of PLEs was observed, with GG homozygotes reporting a significantly higher number of PLEs in comparison to T allele carriers. In individuals with dominant anxious attachment style, there was a significant effect of the interaction between the FKBP5 rs4713902 SNP and self-efficacy on the severity of PLEs. Among rs4713902 TT homozygotes, a low level of perceived self-efficacy was associated with higher severity of PLEs. In subjects with non-dominant anxious attachment, a low level of perceived self-efficacy was associated with a higher number of PLEs, regardless of the genotype. Our results indicate that the FKBP5 gene might moderate the relationship between attachment, perceived stress and PLEs.

Effects of Group Narrative Therapy on Feeling of Inferiority and Attachment Styles in Married Women Experienced Marital Infidelity

Background: Marital infidelity damages marriage and increases the tensions between couples. The present study aims to evaluate the effect of group narrative therapy on feeling of inferiority and attachment styles in married women experienced marital infidelity. Methods: This is a quasi-experimental study with a pretest/posttest design using a control group. The study population consists of all women experienced marital infidelity referred to Peidayesh Counseling Center in Mashhad, Iran. Of these, 40 eligible women were selected using a convenience sampling method and assigned into intervention (n=20) and control (n=20) groups. Data collection tools were Hazan and Shaver (1986)’s Adult Attachment Questionnaire and Eysenck (1988)’s Inferiority Questionnaire. Group narrative therapy was performed in the intervention group at 7 sessions while the control group did not receive any intervention. Data analysis was performed by univariate and multivariate analysis of covariance in SPSS software, v. 22. Results: Group narrative therapy had significant effects on feeling of inferiority and all three secure, avoidant and ambivalent attachment styles (P=0.001). Conclusion: Group narrative therapy can reduce feelings of inferiority and avoidant and ambivalent attachments and increase secure attachment in women experienced marital infidelity. This method can be used to improve psychological problems of these women.

Anxious attachment improves and is predicted by anxiety sensitivity in internet-based, guided self-help cognitive behavioral treatment for panic disorder.

The purpose of this study was to examine whether anxious and avoidant attachment styles improve during guided internet-based cognitive behavioral treatment (ICBT) for panic disorder, and if so, to identify potential theoretically driven mechanisms related to the change. We examined changes in anxious and avoidant attachment and their time-lagged (1 week), longitudinal relationship with panic-related constructs in patients participating in ICBT (n = 79) in an open trial. Anxious attachment scores improved significantly with a medium effect during ICBT, d = 0.76 [0.45, 1.08]. According to benchmark analyses, changes were similar to the magnitude of change in face-to-face CBT and final scores to values of a nonclinical sample. Additionally, similar to findings in face-to-face CBT for panic disorder, longitudinal time analyses revealed that anxiety sensitivity scores predicted later improvement in anxious attachment scores, but not vice versa. Counter to our hypothesis, avoidant attachment did not significantly change during treatment, d = 0.15 [0.02, 0.46]; however, pretreatment level of avoidant attachment in ICBT was similar to the nonclinical sample. Also counter to our hypotheses, agoraphobic avoidant behaviors when alone did not predict changes in anxious attachment. These results suggest that anxious attachment can improve in ICBT for panic disorder even though the focus of the treatment is not on interpersonal relationships. These changes appear to follow changes in anxiety sensitivity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Contribution of Attachment Styles and Reassurance Seeking to Trust in Romantic Couples.

The current daily diary study examined the moderating impact of attachment style on the association between excessive reassurance seeking (ERS) behavior and trust in romantic dyads. A sample of 110 heterosexual couples completed measures of attachment, ERS, and relationship trust. In line with prior research, an anxious attachment style was associated with higher daily ERS, and an avoidant attachment style with lower daily ERS. Lower levels of trust were also associated with greater daily ERS. Moreover, analyses remained significant while controlling for symptoms of depression. This study extended the literature by demonstrating that for women with an anxious attachment style, and men with an avoidant attachment style, ERS was related to lower next day trust. In contrast, the partners of men with an avoidant attachment style, who also engaged in ERS, reported higher levels of next day trust. This study was also the first to examine how individual attachment styles influenced the perception of, and reactions to, ERS. Women with an anxious attachment style liked when their male partners engaged in ERS, as illustrated by higher levels of reported trust. These results support the idea that attachment styles play an important role in determining whether or not ERS leads to negative interpersonal consequences. They also suggest that it is the combination of relationship insecurities and ERS that leads to negative interpersonal consequences.

Anxious and status signaling: Examining the link between attachment style and status consumption and the mediating role of materialistic values

Attachment theory has recently been recognized as a potentially fruitful avenue for studying consumer behavior. However, few studies have examined the relationship between attachment styles and consumer preferences. Based on literature suggesting that individuals with an anxious attachment style have a particularly strong need for attention, we conducted two studies with a total sample of over 2000 participants, which tested and found that anxiously attached consumers displayed a higher propensity to purchase status-signaling goods than their counterparts with secure attachment styles. This effect was mediated by materialistic values, such that participants with an anxious attachment style reported the highest materialistic values. Additionally, we found mixed evidence for the relationship between an avoidant attachment style, materialism, and status consumption. Together, these findings highlight the importance of attachment theory in the study of status consumption and offer potential implications for research on social status and related research areas.

Daughter-to-Father Attachment Style and Emerging Adult Daughter's Psychological Well-Being: Mediating Role of Interpersonal Communication Motives.

This study investigated insecure attachment of emerging adult daughters with their fathers and how it affects daughter's psychological well-being, with interpersonal communication motives taken as mediating variables. A sample of daughters (N = 243) ranging from 18 to 25 years was collected through purposive sampling from Islamabad and Rawalpindi. For this cross-sectional study, data were collected using psychometrically sound tools along with a demographic data sheet. Results revealed that anxiety and avoidance attachment style negatively correlate to young adult daughters' psychological well-being as hypothesized. Moreover, this relationship is partially mediated by interpersonal communication motives. Among communication motives, affection motive is a stronger predictor of psychological well-being scores (β = .31, p < .01). Other motives, i.e., pleasure, relaxation, inclusion, escape, and control did not show significant results in mediation. These findings have practical implications for parents, mental health professionals, and family counselors.

Predicting Students' Social Adjustment and Academic Achievement based on Parenting Attachment Styles

Aim: The purpose of this study was to predict social adjustment and academic achievement based on parental attachment styles in students. Methods: The method of this research was descriptive-correlational. The study population included 18,000 male and female first year high school students in Lorestan province in the academic year of 2014-15, which was conducted on a sample of 364 students (200 girls, 164 boys). Multi-stage cluster sampling method was selected. The California Social Adjustment Questionnaire (Klako et al., 1953) and the Hazen and Shaver Adult Attachment Styles Questionnaire (1897) were used to collect data, and the students' final grade point average was used to assess academic performance. Data were analyzed using Pearson correlation and multiple regression analysis (stepwise). Findings: The results of Pearson correlation coefficient showed that there was a meaningful negative relationship between avoidant attachment style (P=0.001, r=-0.35), anxiety attachment style (P=0.001, r=-0.29) with adaptation. Also, between secure attachment style (P≥0.001, r=0.41), attachment to mother (P≥0.001, r=0.35), attachment to father (P≥0.001, r=0.37) and attachment to friends (P=0.001, r=0.38) has a significant positive relationship with adaptation. Multiple regression results showed 31% of the total variance of students' academic adjustment by avoidant attachment style (β=-0.16), anxiety attachment style (β=-0.14), secure attachment (β=0.23), attachment to mother (β=0.10), attachment to father (β=0.15), and attachment to friends (β=0.09) are explained. Also, 14% of the variance of academic achievement is explained by the style of secure attachment (β=0.17), attachment to father (β=0.10) and attachment to friends (β=0.11). Conclusion: The present study showed that the first emotional bonds between child and mother play a fundamental role in the formation of social trust and the continuation of emotional relationships in the later period of growth, promoting it positively. Thus, with success in this field, social adjustment is achieved.

Cross-Lagged Associations of Insecure Attachment Style, Alcohol Use, and Sexual Behavior During Emerging Adulthood.

Insecure romantic attachment style has been associated with greater substance use and higher risk sexual behavior, but the temporal nature of these associations is not well-understood. This study examined whether having a more insecure attachment style was associated with greater engagement in higher-risk sexual behavior over time and, if so, whether this was mediated by more frequent alcohol use. We used three annual waves of survey data from a diverse California cohort (N = 2371) who were assessed from ages 19 to 21-22 years. Separate cross-lagged models examined temporal associations of insecure romantic attachment style (anxious and avoidant), past month alcohol use frequency, and sexual behavior (number of sex partners, condomless sex with casual and steady partners). Attachment anxiety was not directly associated with sexual behavior. Rather, a consistent pattern across waves showed that greater attachment anxiety was associated with more frequent alcohol use at the next wave, which, in turn, was associated with having more sex partners and condomless sex with casual and steady partners one year later. In contrast, greater attachment avoidance was directly associated with having fewer sex partners, and its associations with condomless sex differed across partner type and assessment waves. Attachment avoidance was unrelated to alcohol use frequency. Results indicated that both anxious and avoidant attachment styles were associated with higher-risk sexual behavior, but in different ways and through different mechanisms. Future research may want to examine whether the effectiveness of sexual risk reduction programs for young people is enhanced by discussing attachment style and tailoring the curriculum accordingly.

The influence of attachment style on interpersonal learning in substance use psychotherapy groups

Substance Use Disorders (SUDs) are prevalent, long-term conditions, commonly treated via group intervention. Additionally, interpersonal learning (IL) is a therapeutic factor unique to group treatment programs, which has been associated with successful group therapy outcomes. While previous research has suggested attachment styles may predict experiences of IL within groups, research in this area is limited. Therefore, this study aims to investigate if attachment style impacts IL, within SUD group treatment programs and specifically, if anxious and avoidant attachment styles influence IL. Participants (N = 38) were recruited voluntarily from an outpatient SUD open group therapy program at a private mental health hospital in Sydney. All participants completed paper-based self-report questionnaires to assess attachment style and IL. Two separate Multiple Linear Regressions (MLRs) revealed anxious attachment was not a significant predictor of IL and avoidant attachment was a significant, negative predictor of IL. Additionally, thematic analysis of qualitative data revealed themes and behaviours which may improve IL. Thus, future directions and implications of the study’s findings indicate the need to conduct additional research into members attachment-based needs to enhance SUD group treatment outcomes.

Factors associated with parenting stress in parents of 18-month-old children: Parenting stress in parents of toddlers.

Parenting stress is associated with less optimal outcomes for children. Risk factors contributing to parenting stress in healthy toddlers have received little empirical attention. This study sought to determine the factors that are associated with parenting stress in parents of 18-month-old children. We analysed cross-sectional survey data from a prospective cohort study focused on parent-child mealtime interactions. Families with an 18-month-old child were recruited in Columbus, Ohio, USA, between December 2017 and May 2019. Adjusted stepwise linear regression models estimated associations between child factors (e.g., temperament), parental factors (e.g., depressive symptoms), quality of romantic relationship factors (e.g., adult attachment style) and home environment factors (e.g., household income) and parenting stress (Parental Distress subscale of the Parenting Stress Index-4 Short Form). The 299 children included 129 (43%) females. Parents were on average 30.6 (SD 6.1) years old and included a diverse racial/ethnic cohort. Mean Parental Distress score was 24.3 (SD 6.8; score range 12-60). Higher Parental Distress scores were associated with greater parental depressive symptoms (B = 5.1 [95% CI: 2.4, 7.7]) and avoidant (B = 2.8 [95% CI: 0.9, 4.6]) attachment style. Other child, parental and home environment factors did not demonstrate statistically significant relationships with parental distress in the final model. Our findings align with recommendations for paediatric providers to screen for parenting stress and mental health.

Interparental conflict and relational attitudes within romantic relationships: The mediating role of attachment orientations

Early experiences and childhood perceptions of interparental conflict (IPC) have consistently been shown to have detrimental consequences for future psychological adjustment, in particular for attachment and couple relationships during adolescence and adulthood. We hypothesized that 1. IPC would predict anxious and avoidant attachment styles, and three relational attitudes associated with couple relationships: sense of relational entitlement, pathological concern, and authenticity; and 2. Attachment style would mediate the associations between IPC and these three relational attitudes. Measures of perceived IPC, attachment orientations, relational entitlement, pathological concern, and authenticity in romantic relationships were completed online by 280 young adults aged 19–32. IPC was positively correlated with anxious and avoidant attachment styles, restricted and inflated sense of entitlement, and pathological concern and negatively with authenticity. A structural equations model showed that IPC predicted avoidant and anxious attachment styles, which positively predicted an inflated and restricted sense of relational entitlement and pathological concern and negatively predicted authenticity. Attachment styles fully mediated the relationships between IPC and the relational attitudes. IPC therefore seems to be related to imbalanced attitudes in romantic relationships, due in part to a propensity toward insecure attachment orientations. Children with insecure attachment who are exposed to significant levels of IPC may be at high risk for relationship problems later in life because of difficulties exposing their vulnerability, assessing need fulfillment realistically, and caring for themselves as well as others. They should therefore be helped to communicate their relational needs to significant others, in particular to their partners.

Avoidant Attachment Style Moderates the Recovery of Healthy Sexuality in Women With Anorexia Nervosa Treated With Enhanced Cognitive Behavior Therapy (CBT-E): A 2-Year Follow-Up Study

Insecure Attachment style has been associated with interpersonal problems in persons with Anorexia Nervosa (AN), and it might moderate the recovery of healthy sexuality in these subjects. The aim of the present 2-year follow-up study was to evaluate the role of insecure attachment style as a moderator of the recovery of healthy sexuality in women with AN. 63 Italian women with AN treated with a multidisciplinary approach including Enhanced Cognitive Behavior Therapy were evaluated by means of a clinical interview and self-administered questionnaires. Individual psychotherapy sessions were administered by experienced psychotherapists over the course of at least 40 weeks (median number of sessions=43, range: 38-50); trained dieticians provided personalized nutritional counselling to facilitate weight recovery. The assessment was performed at baseline (T0) and after 1 (T1) and 2 (T2) years. The administered questionnaires investigated general psychopathology (SCL-90-R), eating disorder-specific psychopathology (EDE-Q), female sexuality (FSFI) and adult attachment style (ECR). At baseline, avoidant attachment style was associated with all domains of sexual dysfunction. Longitudinal analysis showed a significant decrease in both eating disorder-specific psychopathology and sexual dysfunctions at follow-up evaluations. However, only 45% of remitted subjects also recovered healthy sexuality: these women reported significantly lower avoidance scores than those who only recovered from AN. Moderation analysis indicated that sexual desire did not increase in participants with higher levels of avoidant attachment. These novel findings highlighted the importance of the assessment of adult attachment in the clinical setting, for better characterization and treatment of persons suffering from AN. The long follow-up duration, the multidisciplinary nature of the treatment, and the novelty of the topic were major strengths of the study, whereas the limited sample size and the absence of biological data were the main limitations. This study highlighted the crucial role of avoidant attachment in the relationship between AN and sexual dysfunctions, underlining the importance of integrating treatments with attachment-focused interventions. Cassioli E, Rossi E, Vizzotto C, et al. Avoidant Attachment Style Moderates the Recovery of Healthy Sexuality in Women With Anorexia Nervosa Treated With Enhanced Cognitive Behavior Therapy (CBT-E): A 2-Year Follow-Up Study. J Sex Med 2022;19:347-355.

Providing a Model for Marital Burnout based on attachment styles in married people: Differentiation with mediating role

Aim: The aim of this study was to develop a model of marital boredom based on attachment styles in married people: with a mediating role of differentiation. Methods: In terms of the applied purpose of the research, the research design was descriptive and the type of correlation was modeling. The statistical population of the present study included all young married men and women between the ages of 20-35 who referred to psychology and counseling clinics in Tehran using the sampling method available to 480 people (289 females, 191 males) as a sample were chosen. Data were collected using the Pinner Marital Boredom Scale (1996), the Scorne and Friedlander (1998) Differentiation Questionnaire, and the Collins and Reed Adult Attachment Style Questionnaire (1990). Results: The results showed that there was a significant negative relationship between marital differentiation and boredom, Also, differentiation has a negative relationship with insecure attachment styles (ambiguous / avoidant) and on the other hand has a positive and significant relationship with insecure attachment style and has a mediating role in the relationship between avoidant attachment style and marital boredom (P&lt;0.05). Conclusion: According to the relationship between attachment styles and marital heartbreak, and also regarding the mediating role of differentiation in the relationship between attachment styles and marital heartbreak, it is concluded that paying attention to these two variables in premarital and couple interventions by family counselors and psychologists is effective in preventing couple relationship damage.

The Effect of Embodied Temperature and Avoidant Attachment Styles on Retro Product Preference

Purpose This paper analyzes the effect of embodied temperature and avoidance attachment styles on retro product preference and the moderating effect of avoidance attachment styles. Design/Methodology/Approach To find the extent of the effect above, this study utilized an experimental study design, and conducted experiments two times when outdoor temperatures were cool (15 degrees average) and hot (30 degrees average). Findings According to the analysis, retro products are preferred when consumers feel temperatures are lower. Furthermore, consumer retro product preferences were higher among participants with weaker avoidance attachment. Finally, the study found that the effect of embodied temperature on retro product preference was attenuated when consumers had lower avoidance attachment. In comparison, the effect was maintained when consumer avoidance attachment was stronger. Research Implications As a first study approaching retro marketing from a nostalgia perspective through embodied temperature and avoidance attachment, this study contributes to the development of an academic relationship between embodied cognition and consumer behavior by highlighting the process of how embodied temperature intervenes in retro marketing. Furthermore, this study may give strategic implications to companies that plan to launch retro products in the future as to product launch scheduling and consumer targeting.

What Happened to Children with Avoidant Attachment? A Study of Social Relations-Based Behaviours of Avoidant Children from the Age of 3 to 19

The purpose of this study is to assess the social relationship-based behaviors of 19-year-old children who are in the early stages of adulthood and had an avoidant attachment style at age 6. Based on criterion sampling, a purposive sampling method used in qualitative research, the study group of this research was selected from children whose attachment security had been previously identified. The study was conducted with 5 girls and 5 boys with avoidant attachment styles selected from the 26 available children who participated in the 2006 study that identified the attachment patterns of 110 children. The data collection instruments of the study are the IDFSS attachment scale used in 2006 and a semi-structured interview form and a student data form used in 2019. The study concludes that children who exhibited avoidant attachment at age 6 maintained their attachment patterns. They were found to fail in perceiving academic achievement, coping with emotional problems, relationships with parents and others, and trust in others.

OCD, death anxiety, and attachment: what's love got to do with it?

Death anxiety has been empirically implicated in obsessive compulsive disorder (OCD). Research has shown that secure attachments appear to protect against fear of death, and are also associated with reduced risk of mental illness. However, few studies have investigated the moderating effect of attachment style in the relationship between death anxiety and OCD. The present study sought to explore whether attachment style moderates the relationship between death anxiety and OCD symptoms among a treatment-seeking sample of individuals diagnosed with OCD. Following a structured diagnostic interview, a number of measures were administered to 48 participants. These included the Multidimensional Fear of Death Scale, Vancouver Obsessive Compulsive Inventory, and Experiences in Close Relationships-Revised. As expected, death anxiety was a strong predictor of OCD severity, and other markers of psychopathology. However, contrary to hypotheses, neither anxious nor avoidant attachment style moderated the association between fear of death and OCD severity. The current findings add further support to the role of death anxiety in OCD. Given the absence of a moderating effect of attachment between death fears and OCD severity, it is possible that this proposed buffer against death anxiety may potentially be insufficient in the presence of this disorder. Further research is needed to clarify whether attachment style may moderate the relationship between death anxiety and symptom severity in other disorders.

İlk Yetişkinlik Dönemindeki Bireylerde Bağlanma Stilleri Üzerinde Benlik Saygısının Etkisinin İncelenmesi: Duygusal Bağımlılığın ve Yalnızlığın Aracı Rolü

Investigating the concepts affecting individuals' attachment styles in early adulthood is essential for healthy and satisfying social and emotional/romantic relationships. The purpose of this study was to examine the direct effects of self-esteem, loneliness, and emotional dependency on university students’ attachment styles. In addition, this study investigated the mediating roles of emotional dependency and loneliness on the relationships between attachment styles and self-esteem. The research group consisted of 518 volunteer university students in their first adulthood. Demographic Information Form, Rosenberg Self- Esteem Scale (RSES), Experiences in Close Relationships- Revised (ECR- R), Emotional Dependency, and UCLA Loneliness Scale were used to collect the data. Pearson moments correlation coefficients, hierarchical regression analyses, and bootstrapping methods were performed to test the hypotheses. The results of hierarchical regression analysis showed that self-esteem negatively and loneliness positively predicted anxious and avoidant attachment styles. Emotional dependency positively predicted anxious attachment and negatively predicted avoidant attachment styles. In addition, the bootstrapping analysis showed that loneliness played a significant partial mediator role on the relationships between self-esteem and avoidant and anxious attachment, while emotional dependency was not a significant mediator. The findings were discussed along with the theoretical basis and the previous findings, and suggestions were presented for future studies.

Attachment Style and Reality-Testing Impairment Among Patients with Schizophrenia: A Descriptive Correlational Study

Background: Insecure attachment styles are an area of research that is currently receiving much attention because it has an important role in developing many psychological disorders and might have an effect on an individual's perception of his outer reality. In this respect, assessment of attachment styles among patients with schizophrenia can be informative in indicating how well the patients perceive their reality accurately. Aim: This study aimed to determine the attachment style and reality testing impairment among patients with schizophrenia. As well, investigate the relationship between them among those patients. Setting: This study was conducted at El-Maamoura hospital for Psychiatric Medicine in Alexandria. Subjects: A representative sample of 200 randomly recruited patients with schizophrenia were the subjects of the present study. Tools: A Socio-Demographic and Clinical Data Sheet, Bell Reality Testing Inventory (BRTI), and The Psychosis Attachment Measure (PAM). Results: The study showed that 54.5% of the studied patients exhibited an avoidant attachment style and the patients who exhibited an anxious attachment style constitute 40%. Moreover, 60% of the studied patients had a moderate level of reality-testing impairment and 36.5% had severe impairment. A statistically significant positive correlation between psychotic attachment styles and reality-testing impairment was found (r=0.394, p=0.000). More specifically, there was a statistically significant positive correlation between the avoidant attachment style and the three domains of reality-testing impairment as well as the total scores (r= 0.577, 0.179, 0.278, 0.501 respectively, were p=0.000). Meanwhile, a statistically significant positive correlation between the anxious attachment style was found only with the Hallucinations & Delusions domain of reality-testing impairment (r =0.291, p=0.000). Conclusion: It can be concluded that almost all patients with schizophrenia exhibit insecure attachment styles, with avoidant attachment style being the most prevalent, usually at a severe level in the majority of cases. On the other hand, the great majority of these same patients present with reality-testing impairment reflected in its three domains: reality distortion, the uncertainty of perception, and hallucinations & delusions. Evidence of a correlation between attachment styles and reality testing impairment, (both of the total and sub total domains) in these patients usually and frequently there. Recommendations: Building up a secure, structured, and consistent environment for patients with schizophrenia to modify their insecure attachment styles and hope to become more reality-oriented.