Attachment mediates the link between childhood maltreatment and loneliness in persistent depressive disorder
Abstract
Background A central concept of attachment theory is that early experiences with close attachment figures shape the way we interact with and relate to other social partners throughout life. As such, early experiences of childhood maltreatment (CM) have been suggested as a key precursor of adult insecure attachment representations. As CM has been linked to feelings of loneliness in adulthood, this study examines whether insecure attachment could explain the relationship between CM and loneliness. Also, the moderating role of a diagnosis of persistent depressive disorder (PDD) is investigated, a disorder characterized by high levels of CM and loneliness. Method 60 patients with PDD (DSM-5) and 60 gender- and age-matched non-clinical control participants (NC) completed self-report questionnaires measuring attachment, loneliness, and CM. Mediation analyses (PDD as a moderator) were performed. Results PDD patients reported higher levels of CM, attachment anxiety, attachment avoidance, and loneliness than NC. CM was positively associated with loneliness in both groups. Mediation analyses demonstrated that the relationship between CM and loneliness was mediated by avoidant, but not anxious attachment, regardless of a diagnosis of PDD. Limitations Caution when interpreting these results is crucial as the study lacked a clinical control group, relied on self-report measures, and the cross-sectional design limits the ability to draw causal inferences. Conclusions All constructs studied…
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Anxious attachment appears more strongly linked to depressive symptoms than attachment avoidance.
“Anxious attachment appears more strongly linked to depressive symptoms than attachment avoidance (Sabaß et al. 2022; Zheng et al. 2020), and is particularly associated with persistent forms of depression (Mikulincer and Shaver 2003).”
From Reciprocal Dynamics of Therapeutic Alliance and Depressive Symptoms in Inpatient Cognitive Behavioural Analysis System of Psychotherapy: The Role of Attachment Insecurity. (2025) · cites this paper as Sabaß et al. 2022
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Loneliness in Personality Disorders
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“Like previous studies, we found that childhood abuse was significantly positively related to depression (Sabaß et al., 2022).”
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“Anxious attachment appears more strongly linked to depressive symptoms than attachment avoidance (Sabaß et al. 2022; Zheng et al. 2020), and is particularly associated with persistent forms of depression (Mikulincer and Shaver 2003).”
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“…and foster negative internal working models marked by distrust and diminished self-worth (Diamond et al., 2021; Fuchshuber et al., 2019), relational schemas that persist into later life and erode the capacity to form and maintain the close bonds that buffer against loneliness (Sabaß et al., 2022).”
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“…in both a population-based and a clinical sample including PDD, trait loneliness was more closely tied to early adversity, here operationalized as childhood mal-treatment, than the objective size of the social network was, and most strongly to emotional neglect and emotional abuse [ 23, 29 ].”
Self-citationTherapie der chronischen Depression mit CBASP
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“Hierbei konnte außerdem gezeigt werden, dass der Zusammenhang zwischen Kindheitstraumatisierungen und Einsamkeit über einen vermeidenden Bindungsstil und eine grö-ßere Zurückweisungssensitivität vermittelt ist [17, 20].”
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- Authors
- Sabaß, L., Buchenrieder, N., Rek, S. V., Nenov-Matt, T., Lange, J., Barton, B. B., Musil, R., Jobst, A., Padberg, F., & Reinhard, M. A.
- Affiliations
- LMU Klinikum (DE)
- Hochschule Fresenius (DE)
- Corresponding author
- Sabaß, L.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2022-09
- Volume
- 312
- Pages
- 61-68
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W4283073155
- Cited by
- 22
- References
- 0
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 2 · 2023: 4 · 2022: 3
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- child abuse, loneliness, dysthymia, insecure attachment, attachment avoidance, attachment anxiety, mediation
- MeSH terms
- Adult, Child, Child Abuse, Chronic Disease, Cross-Sectional Studies, Depression, Depressive Disorder, Humans, Loneliness, Object Attachment
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