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Cited by 43Personality Disorders and PsychopathologyPsychoanalysis and Psychopathology ResearchPersonality Traits and Psychology

Attachment anxiety as mediator of the relationship between childhood trauma and personality dysfunction in borderline personality disorder

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Erkoreka, Leire, Zamalloa, Iker, Rodriguez, Santiago, Muñoz, Pedro, Mendizabal, Imanol, Zamalloa, M. Isabel, Arrue, Aurora, Zumarraga, Mercedes +1 more·2022·Clinical Psychology & Psychotherapy
DOI 10.1002/cpp.2640
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Abstract

Insecure attachment has been described as mediating the relationship between childhood trauma and dysfunctional personality traits in different mental disorders. Despite the role insecure attachment and childhood trauma have independently demonstrated to play as determinants of borderline personality disorder, less is known about the mediating mechanisms explaining these associations. For the first time, we assessed adult attachment, childhood trauma and dimensional personality pathology in a sample of outpatients with borderline personality disorder and tested whether the association between childhood trauma and personality dysfunction was at least partially attributable to insecure attachment. The results showed that attachment anxiety fully mediated the relationship between specific types of trauma (emotional abuse and physical neglect) and emotional dysregulation. Further, emotional abuse was both directly associated with dissocial behaviour and indirectly via attachment anxiety (partial mediation). Emotional abuse has been described as an essential environmental factor for the development of borderline personality disorder and emotional dysregulation, on its part, as the core feature of the condition. Our results indicate that attachment anxiety explains the link between these central aspects of borderline personality disorder. Our findings are consistent with previous research and current etiological understanding of the condition and provide support for recommending a careful assessment of childhood traumatic experiences and adult attachment style to gain a more comprehensive insight into the symptoms and its heterogeneity. As a secondary aim, we assessed the effect parental mental illness may have in these mediation models, but no significant influence on childhood trauma, attachment or personality was found.

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  • Insecure attachment is robustly associated with impairments in affect regulation, heightened interpersonal reactivity, and poor stress tolerance.

    “Beyond its origins, insecure attachment has been robustly associated with impairments in affect regulation, heightened interpersonal reactivity, and poor stress tolerance [21] — all of which are central vulnerabilities in both maladaptive personality functioning and SUD.”

    From The link of adverse childhood experiences and attachment to maladaptive personality traits in adults diagnosed with substance use disorder (2025) · cites this paper as [21]

    The Introduction links insecure attachment to negative affectivity and describes affective lability and unstable relationships in extreme attachment anxiety. The Conclusions also report an association between attachment anxiety and emotional dysregulation in patients with borderline personality disorder. The copy does not establish poor stress tolerance as a separate association, and its specific findings concern attachment anxiety rather than insecure attachment broadly. (LLM, conf=0.86)

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  • Anxious attachment style is characterized by heightened sensitivity to rejection, difficulties with affect regulation, and persistent fears about the availability of close others.

    “Clinically, persons with a history of emotional abuse and neglect often develop an anxious (preoccupied) attachment style [42–45], characterized by heightened sensitivity to rejection, difficulties with affect regulation, and persistent fears about the availability of close others [21].”

    From The link of adverse childhood experiences and attachment to maladaptive personality traits in adults diagnosed with substance use disorder (2025) · cites this paper as [21]

    The Introduction describes affective lability and chronic abandonment fears as core features of extreme attachment anxiety, and §2.2 (Measures) characterizes anxious attachment by fear of abandonment and anger at separation. These support the claims about affect regulation and fears concerning close others, but our copy does not specifically characterize anxious attachment by heightened sensitivity to rejection. Page numbers were not available in the indexed passages. (LLM, conf=0.82)

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1 of the 89 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Livesley, W. J., & Jackson, D. N. (2009). Manual for the dimensional assess- ment of personality pathology-basic questionnaire. Sigma Press.

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Authors
Erkoreka, L., Zamalloa, I., Rodriguez, S., Muñoz, P., Mendizabal, I., Zamalloa, M. I., Arrue, A., Zumarraga, M., & Gonzalez‐Torres, M. A.
Affiliations
  • University of the Basque Country (ES)
  • AVATI‐TLP Bilbao Spain
  • Osakidetza (ES)
  • BioCruces Health research Institute (ES)
  • Biocruces Bizkaia Health Research Institute Barakaldo Spain
  • Department of Neurosciences University of the Basque Country UPV/EHU Leioa Spain
Corresponding author
Erkoreka, Leire
ORCID
Venue
Clinical Psychology & Psychotherapy
Publisher
Wiley
Published
2021-07-16
Volume
29
Issue
2
Pages
501-511
ISSN
  • 1063-3995 (ISSN-L)
  • 1099-0879
DOI
10.1002/cpp.2640
OpenAlex
W3177553951
Cited by
43
References
89
Citations by year
2026: 12 · 2025: 12 · 2024: 10 · 2023: 6 · 2022: 3
FWCI
3.24
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Psychology & Psychotherapy (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Communities in ADDI (University of the Basque Country) (submittedVersion, cc-by-nc-nd)
  • Hispana (submittedVersion, cc-by-nc-nd)
Funders
Euskal Herriko Unibertsitatea
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
  • Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
Keywords
borderline personality disorder, attachment anxiety, insecure attachment, childhood trauma, emotional abuse, physical neglect, emotional dysregulation, mediation, parental mental illness, adult attachment styles
MeSH terms
Adverse Childhood Experiences, Adult, Anxiety, Borderline Personality Disorder, Child, Child Abuse, Humans, Personality

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