Attachment orientation, adherence to treatment, and psychological adjustment in individuals with skin conditions

Abstract

Background: It has increasingly been recognised that attachment orientation is associated with adjustment to chronic health conditions. This study aimed to test the mediating role of coping in the link between attachment and adjustment (indicated by appearance concern and adherence to treatment), in people with skin conditions. Method: Attachment orientation (ECR), coping (Brief COPE), appearance concern (DAS 24) and adherence to treatment were assessed through a cross-sectional online survey in 207 adults with skin conditions. Moderated-mediation model was used to test the hypotheses. Findings: Defeatism coping partially mediated the link between attachment and appearance concern; insecure attachment was associated with use of defeatism coping and greater appearance concern. Additionally, higher attachment avoidance was directly associated with greater appearance concern. High attachment avoidance was linked to lower adherence to treatment but this association was not mediated by coping. Discussion: An insecure attachment orientation is linked to poorer adjustment to skin conditions which can be partially explained by the use of defeatism coping strategies. Future interventions to improve adjustment in skin conditions should focus on the needs of people with insecure attachment.