Adult Attachment Orientations, Depressive Symptoms, Anger, and Self-Directed Aggression by Psychiatric Patients

This study applied adult attachment theory to better understand self-directed aggression, defined as suicide attempts and nonsuicidal self-injury, reported by 109 hospitalized psychiatric patients. As expected, patients with higher levels of adult attachment anxiety were more likely to report suicide attempts and self-injury. We tested depressive symptoms and anger as mediators of the relationship between attachment orientations and self-directed aggression. As hypothesized, depressive symptoms partially mediated the relationship between attachment anxiety and self-directed aggression, but unexpectedly, anger did not. The results support that levels of depression partially explain the associations between attachment anxiety and self-directed aggression. Subsidiary analyses suggested that patients with higher levels of adult attachment avoidance were more likely to report histories of nonsuicidal self-injury but not suicide attempts. Implications for research and practice are discussed.