Adult attachment, depression, and eating disorder symptoms: The mediating role of affect regulation strategies Giorgio A. Tasca a,b,c, * , Leah Szadkowski a , Vanessa Illing a , Anne Trinneer a , Renee Grenon c , Natasha Demidenko b , Valerie Krysanski a,b , Louise Balfour a,b , Hany Bissada a,b a University of Ottawa, 75 Laurier Avenue, East, Ottawa, ON, Canada K1N 6N5 b The Ottawa Hospital, 501 Smyth Road, Box 400, Ottawa, ON, Canada K1H8L6 c Carleton University, 1125 Colonel By Drive, Ottawa, ON, Canada K1S 5B6 article info Article history: Received 13 February 2009 Received in revised form 21 May 2009 Accepted 1 June 2009 Available online 21 June 2009 Keywords: Attachment Eating disorders Affect regulation Structural equation modeling abstract The study examined the role of affect regulation strategies in mediating the relationship between attach- ment dimensions and both depressive and eating disorder (ED) symptoms. Participants were 310 women seeking treatment for an ED. Structural equation modeling indicated that attachment anxiety contributed to both depressive symptoms and ED symptoms through emotional reactivity. In contrast, only the asso- ciation between attachment avoidance and depressive symptoms was mediated by emotional deactiva- tion; whereas attachment avoidance had a direct relationship with ED symptoms not mediated by emotional deactivation. The results suggest tailored clinical interventions that take into account attach- ment style and accompanying affect regulation strategies. Treatment of patients who experience attach- ment anxiety may emphasize impulse regulation, whereas treatment of ED patients with attachment avoidance could focus on gradual exposure to affective expression. Ó 2009 Elsevier Ltd. All rights reserved. 1. Introduction During the past 30 years, attachment theory (Bowlby, 1973) has become one of the most important conceptual frameworks for understanding affect regulation and human relationships (Mikul- incer & Shaver, 2007). Attachment is an inborn system that moti- vates an infant to seek proximity to a care-giving adult. The attachment system results in systematic patterns of interpersonal expectations, emotions, and behaviours that are associated with specific attachment-related strategies to regulate affect (Shaver & Mikulincer, 2002). Brennan, Clark, and Shaver (1998) argued that attachment can be characterized in terms of two orthogonal dimensions of attachment anxiety and attachment avoidance. Attachment anxiety may develop when attachment figures are inconsistent or unpredictable. In an attempt to maintain an engagement with inconsistent caregivers, these children ‘‘hyper- activate” their attachment systems. This involves excitatory path- ways that intensify negative emotional responses by keeping them active in working memory resulting in an up-regulation of emotion (Shaver & Mikulincer, 2002). Attachment avoidance may develop when individuals perceive their primary attachment figure as rejecting or unavailable. In response, these individuals ‘‘deactivate” their attachment systems and defensively devalue their need for relationships. Thus, affective experiences are cut off from working memory, and this is accompanied by a down-regulation of emotion (Shaver & Mikulincer, 2002). Researchers link these attachment dimensions to psychological distress, including depression (e.g., Wei, Vogel, Ku, & Zakalik, 2005) and eating disorders (e.g., O’Kearney, 1996). In a recent study, Tas- ca et al., 2006 tested a structural equation model of the association between attachment insecurity and eating disorder (ED) symp- toms. Attachment insecurity was directly related to body dissatis- faction and negative affect among a clinical sample of eating disordered women. EDs are considered to be among the most difficult to treat, and they have the highest rate of mortality among mental disorders (Agras, 2001). Treatments are not effective for 40% for those with bulimia nervosa (BN) in terms of reducing binge eating and purg- ing (Stice, 1999), and recovery from anorexia nervosa (AN) tends to be even lower due to very high attrition rates (Tasca, Taylor, Bissada, Ritchie, & Balfour, 2004). AN restricting subtype (ANR) is often characterized by severe food restriction, body dissatisfaction, body image distortion, and very low body weight. Binge eating and/or purging also occur in the binge or purge subtype of AN (ANB). BN symptoms include body dissatisfaction and binge eating followed by inappropriate compensatory behaviours (e.g., vomit- ing). Individuals with an ED often suffer from current or lifetime history of depression (Pike & Striegel-Moore, 1997). 0191-8869/$ - see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.paid.2009.06.006 * Corresponding author. Address: The Ottawa Hospital, 501 Smyth Road, Box 400, Ottawa, ON, Canada K1H8L6. Tel.: +1 613 737 8035; fax: +1 613 737 8085. E-mail address: gtasca@toh.on.ca (G.A. Tasca). Personality and Individual Differences 47 (2009) 662–667 Contents lists available at ScienceDirect Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid