Role of attachment style in the association between childhood adversities and non-suicidal self-injury among young adults: a multigroup structural equation study

Background Non-suicidal self-injury (NSSI) is a significant health concern among adolescents and young adults, often resulting from adverse childhood experiences (ACEs). Dissociation, post-traumatic symptoms and attachment style may have a role in shaping such associations. Aims This study aims to provide a unified model of the impact of ACEs on NSSI, exploring complex post-traumatic stress disorder (cPTSD) symptoms and dissociation as potential mediators and the role of the predominant attachment style in affecting such associations. Methods 1010 young individuals attending the last year of high school participated in this cross-sectional study. ACEs, cPTSD, dissociation and NSSI were evaluated using self-report questionnaires. We fitted a path model of NSSI, with ACEs as exogenous variables and cPTSD and dissociation as sequential mediators. Secure, fearful and preoccupied attachment styles were modelled as grouping variables. Results Our findings showed that dissociation mediated the impact of ACEs on NSSI in subjects with a fearful attachment style, as opposed to those with a preoccupied attachment for whom cPTSD symptoms mediated the ACEs-NSSI association. Conclusions Attachment styles moderate the relationship between ACEs and NSSI, with either dissociation or post-traumatic symptomatology mediating the impact of ACEs on NSSI, depending on the predominant attachment style. Our results highlight the importance of attachment as a pathway modifier in the relationships between different psychopathology dimensions, providing a useful framework to better conceptualise the ACEs-NSSI association.