Attachment style and premenstrual symptom severity: the mediating role of maladaptive emotion regulation

ABSTRACT

Objective

The present study examined the relationship between attachment and premenstrual symptoms, and the mediating role of maladaptive emotion regulation.

Method

Attachment orientation, maladaptive emotion regulation, and premenstrual symptom severity were measured using a cross-sectional design among female university students who were naturally cycling (n = 165) or currently using hormonal contraception (HC) (n = 124).

Results

Partial correlations, controlling for age, cycle regularity, and general symptoms of psychopathology (depression, anxiety, and stress), revealed positive associations between maladaptive emotion regulation and premenstrual symptoms, and between anxious attachment and maladaptive emotion regulation for both groups of women. Moreover, among women who were naturally cycling, maladaptive emotion regulation positively mediated the relationship between anxious (but not avoidant) attachment and premenstrual symptom severity; anxious attachment was associated with more severe premenstrual symptoms via increased maladaptive emotion regulation. This same mediation pathway was not observed for participants currently using HC.

Conclusions

The findings highlight that a negative model of the self, which is characteristic of an anxious attachment style, may be a useful psychotherapeutic target for naturally cycling women who experience premenstrual symptoms. Further research and replication are required to confirm the potential moderating effect of HC and hormonal changes on these relationships.

Key Points

What is already known about this topic:

1. Premenstrual symptoms affect approximately 70–90% of reproductive-age women.

2. Elevated premenstrual symptoms are associated with adverse psychological outcomes including lower health-related quality of life and increased risk of suicide.

3. Maladaptive emotion regulation has been implicated in heightened premenstrual symptom severity; however, the role of attachment style has been underexplored.

What this topic adds:

1. Anxious attachment was associated with elevated premenstrual symptoms via maladaptive emotion regulation among women who were naturally cycling.

2. A negative model of the self may be the theoretical mechanism underlying the link between anxious attachment and premenstrual symptoms.

3. Psychotherapies that address underlying attachment insecurity may improve emotion regulation and, thus, reduce premenstrual symptom severity.

KEYWORDS:

• Anxious attachment
• avoidant attachment
• emotion regulation
• menstruation
• women’s health

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.