Emotion regulation as a mediator of the association between attachment security and skin picking disorder symptom severity

Skin picking disorder (SPD) constitutes a significant, but hidden, public health concern. The awareness of the condition is low and treatments are of limited effectiveness, specialisation, and accessibility. SPD remains poorly understood and under-researched. Links between SPD and emotion regulation have been noted; however, no research has yet looked at this in the context of attachment theory, despite the well-established literature connection between emotion regulation and attachment as well as between attachment and psychopathology. The aim of this study was to investigate the relationship between SPD, emotion regulation, and attachment. The study used a cross-sectional design. 186 participants were recruited from SPD-dedicated websites and administered measures of adult attachment security, emotion regulation, and SPD symptom severity. The study found that avoidant attachment and maladaptive emotion regulation accounted for 21% of variance in SPD symptom severity. Moreover, maladaptive emotion regulation partially mediated the relationship between avoidant attachment and SPD symptom severity. Demonstrating an association between SPD and insecure attachment highlights potential influences of developmental and relational factors on symptom severity. Furthermore, it offers support for psychological treatments addressing attachment and emotion regulation issues.