Self-compassion and rumination mediate the relationship between attachment styles and sleep quality in patients with gastrointestinal disorders

Sleep disturbances are highly prevalent among patients with gastrointestinal (GI) disorders, yet the psychological mechanisms underlying this vulnerability remain poorly understood. Attachment theory offers a valuable framework for examining how early relational patterns, through cognitive-affective pathways involving self-compassion and rumination, ultimately influence sleep outcomes. This study investigated the mediating roles of self-compassion and rumination in the relationship between attachment styles and sleep quality in patients with GI disease. A cross-sectional study was conducted with 348 adult patients diagnosed with GI disorders at a tertiary referral center in Tehran, Iran. Participants completed validated self-report measures, including the Adult Attachment Scale (AAS), the Self-Compassion Scale (SCS), the Ruminative Response Scale (RRS), and the Pittsburgh Sleep Quality Index (PSQI). Structural equation modeling with bias-corrected bootstrapping (5000 resamples) was used to test mediation hypotheses. Secure attachment was positively associated with sleep quality, while insecure attachment showed a negative association. Both mediation models demonstrated good fit to the data. Self-compassion and rumination each significantly and partially mediated the relationship between attachment styles, both secure and insecure, and sleep quality. Attachment styles influence sleep quality in GI patients through cognitive-affective pathways involving self-compassion and rumination. These findings highlight the clinical utility of attachment-informed, psychologically integrated interventions, targeting rumination and self-compassion, to improve sleep outcomes in this population.