Volume 28, Issue 3 (Autumn 2022)                   IJPCP 2022, 28(3): 304-321 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Naji Meydani F, Doos Ali Vand H, Abasi I, Noori M. Mediating Role of Difficulties in Emotion Regulation and Experiential Avoidance in the Relationship between Attachment Styles and Severity of Relationship Obsessive -compulsive Disorder Symptoms. IJPCP 2022; 28 (3) :304-321
URL: http://ijpcp.iums.ac.ir/article-1-3660-en.html
1- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. , doosalivand.h@sbmu.ac.ir
Full-Text [PDF 7632 kb]   (1132 Downloads)     |   Abstract (HTML)  (1896 Views)
Full-Text:   (879 Views)
1. Introduction
Relationship obsessive-compulsive disorder (ROCD) is a form of obsessive-compulsive disorder (OCD), which focuses on intimate relationships [1]. ROCD includes the feelings towards the partner, the partner’s feelings towards oneself, and the rightness of the relationship [2]. Identifying the mechanisms contributed to the severity of ROCD symptoms can significantly enhance our understanding of this disorder and expand our knowledge of the factors related to its development and exacerbation. Although the leading cause of ROCD is not known yet, factors such as attachment styles [1, 2, 5, 4], difficulty in emotion regulation [15, 20, 17], and experiential avoidance [13, 21, 65] may have a significant role. Previous studies have shown that insecure attachment styles are related to ROCD symptoms [1, 2], and difficulties in emotion regulation and experiential avoidance are associated with insecure attachment styles [6, 5, 242526]. On the other hand, difficulties in emotion regulation and experiential avoidance are associated with ROCD symptoms [6061626364, 70, 7172]. However, the mediating role of difficulties in emotion regulation and experiential avoidance in the relationship between attachment styles and severity of ROCD symptoms has not yet been investigated. Hence, this study aims to identify the mediating role of difficulties in emotion regulation and experiential avoidance in the relationship between attachment styles and ROCD symptoms. 
Method
This cross-sectional study conducted in the general population of Iran. A sample consisting of 531 individuals (455 females and 76 males (aged 18 or over were recruited through convenience sampling. Structural equation modeling (SEM) was employed to analyze the data. The used instruments included: (a) Experiences in Close Relationships-revised (ECR-R), designed in 1998 by Brennan et al. [29] with 36 items and two subscales of avoidance and anxiety; (b) difficulties in emotion regulation scale difficulties in emotion regulation scale (DERS), developed in 2004 by Gratz and Roemer (33) as 36 items self-report scale to assess six facets of emotion regulation; (c) Acceptance and Action Questionnaire-II (AAQ-II), designed in 2011 by Hayes et al. (36) as a self-report instrument to assess experiential avoidance and psychological inflexibility; (d) Relationship Obsessive-Compulsive Inventory (ROCI), designed in 2012 by Doron et al. [41]as a 12-item self-report instrument to assess the severity of ROCD in three domains.
For data analysis, first the assumptions of SEM were examined. After confirmation of the assumptions, Pearson’s correlation test was used. The structural equation model was used to test the hypothetical model using SPSS version 22 and AMOS version 24 software.
Results
Table 1 shows the values of the fitness indices for the study model. This model is illustrated in Figure 1

According to Figure 1, the direct and standardized effect of attachment styles on difficulties in emotion regulation was positive and significant (P <0.001, β= 0.82) and the direct and standardized effect of attachment styles on experiential avoidance was negative and significant (P<0.001, β= -0.79). In addition, the direct and standardized effect of difficulties in emotion regulation on ROCD symptoms was positive and significant (P<0.001, β= -0.57), and the direct and standardized effect of experiential avoidance on ROCD symptoms was significant and negative (P<0.001, β = -0.48). Therefore, two variables of difficulties in emotion regulation and experiential avoidance had a mediated the relationship between attachment styles and ROCD symptoms.
Discussion 
The purpose of the current study was to examine the mediating role of difficulties in emotion regulation and experiential avoidance in the relationship between attachment styles and ROCD symptoms. The results indicated that the study model perfectly fitted to data, and two variables of difficulties in emotion regulation and experiential avoidance had a mediatory role in the relationship between attachment styles and ROCD symptoms.
Insecure attachment styles are associated with hypo-regulation strategies (i.e., disengaging from close others) and hyper-regulation strategies (i.e., exaggerating emotional expressions) [11, 6364, 65]. These strategies and difficulties in emotion regulation (i.e., lack of emotional clarity) can lead to compulsive behaviors in different domains of OCD, including ROCD [26]. 
Regarding experiential avoidance, insecure attachment styles can lead to the avoidance of unwanted experiences in intimate relationships and the avoidance of experience in general [8]. Avoidance from different involvements in intimate relationships activated by anxious and avoidant attachment styles, can lead to obsessions in interpersonal relationships and affect people’s intimate relationships through ROCD symptoms [8].
Our results should be considered in light of several limitations. First, the study had a cross-sectional design and, hence, causal conclusions cannot be reached. Future studies using longitudinal design are recommended to examine the relationship between attachment styles, difficulties in emotion regulation, experiential avoidance, and ROCD symptoms over a longer period. Moreover, the present study used self-report tools. Therefore, there may be a response bias. Clinical interviews or other assessment methods should be used in future studies. Most of participants in our study were female, limiting the generalizations of the results to the male population. Future studies should benefit from a more representative sample of both genders. Furthermore, the questionnaires were completed online, limiting the study to those who had access to the internet. Finally, the study population of this study was the general population. Future studies should be conducted on other population, including clinical population
As difficulty in emotion regulation and experiential avoidance mediate the relationship of attachment styles with ROCD symptom severity, targeting these variables in treatments can help reduce the problems in people who suffer from ROCD.

Ethical Considerations
Compliance with ethical guidelines

The study was approved by the Research Ethics Committee of School of Medicine, Shahid Beheshti University of Medical Sciences (Code: IR.SBMU.MSP.REC.1398.848). 

Funding
This article is a part of MSc. thesis of the Fatemeh Naji Meydani, Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences. The authors received no financial support for the research.

Authors contributions
Conceptualization, Project Administration, Research, Writing-original draft, Review, Validation and finalization: Fatemeh Naji Meydani; Conceptualization, validation, Supervision, Writing-review and editing: Hoda Doos Ali Vand; Methodology: Imaneh Abbasi and Mohammad Noori.

Conflicts of interest
The authors declare no conflict of interest.

References
  1. Doron G, Derby DS, Szepsenwol O, Talmor D. Tainted love: Exploring relationship-centered obsessive-compulsive symptoms in two non-clinical cohorts. Journal of Obsessive-Compulsive and Related Disorders. 2012; 1(1):16-24. [DOI:10.1016/j.jocrd.2011.11.002]
  2. Doron G, Derby D, Szepsenwol O, Nahaloni E, Moulding R. Relationship obsessive-compulsive disorder: Interference, symptoms, and maladaptive beliefs. Frontiers in Psychiatry. 2016; 7:58. [PMID] [PMCID]
  3. Doron G, Derby DS, Szepsenwol O, Talmor D. Flaws and all: Exploring partner-focused obsessive-compulsive symptoms. Journal of Obsessive-Compulsive and Related Disorders. 2012; 1(4):234-43. [DOI:10.1016/j.jocrd.2012.05.004]
  4. Bowlby J. Attachment and loss: Retrospect and prospect. The American Journal of Orthopsychiatry. 1982; 52(4):664-78. [DOI:10.1111/j.1939-0025.1982.tb01456.x] [PMID]
  5. Mikulincer M, Shaver PR. Attachment in adulthood: Structure, dynamics, and change. New York City: The Guilford Press; 2007. [Link]
  6. Mikulincer M, Shaver PR. The attachment behavioral system in adulthood: Activation, psychodynamics, and interpersonal processes. Advances in Experimental Social Psychology. 2003; 35:56-152. [DOI:10.1016/S0065-2601(03)01002-5]
  7. Doron G, Derby DS, Szepsenwol O. Relationship obsessive-compulsive disorder (ROCD): A conceptual framework. Journal of Obsessive-Compulsive and Related Disorders. 2014; 3(2):169-80. [DOI:10.1016/j.jocrd.2013.12.005]
  8. Doron G, Szepsenwol O, Karp E, Gal N. Obsessing about intimate-relationships: Testing the double relationship-vulnerability hypothesis. Journal of Behavior Therapy and Experimental Psychiatry. 2013; 44(4):433-40. [PMID]
  9. Pascuzzo K, Moss E, Cyr C. Attachment and emotion regulation strategies in predicting adult psychopathology. Sage Open. 2015; 5(3):2158244015604695. [DOI:10.1177/2158244015604695]
  10. Mohammadkhani S, Hasani J, Akbari M, Yazdan Panah N. [Mediating role of emotion regulation in the relationship of metacognitive beliefs and attachment styles with risky behaviors in children of Iran-Iraq war veterans with psychiatric disorders (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2020; 25(4):396-411. [DOI:10.32598/ijpcp.25.4.2]
  11. Girme YU, Jones RE, Fleck C, Simpson JA, Overall NC. Infants’ attachment insecurity predicts attachment-relevant emotion regulation strategies in adulthood. Emotion. 2021; 21(2):260-272. [DOI:10.1037/emo0000721] [PMID] [PMCID]
  12. Shear MK. Exploring the role of experiential avoidance from the perspective of attachment theory and the dual process model. Omega (Westport). 2010; 61(4):357-69. [DOI:10.2190/OM.61.4.f] [PMID]
  13. Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K. Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology. 1996; 64(6):1152–1168. [DOI:10.1037/0022-006X.64.6.1152] [PMID]
  14. Vanwoerden S, Kalpakci AH, Sharp C. Experiential avoidance mediates the link between maternal attachment style and theory of mind. Comprehensive Psychiatry. 2015; 57:117-24. [DOI:10.1016/j.comppsych.2014.11.015] [PMID]
  15. Mikulincer M, Shaver PR. Adult attachment and affect regulation. In: Cassidy J, Shaver PR, editors. Handbook of attachment: Theory, research, and clinical applications. New York: The Guilford Press; 2008. [Link]
  16. Yap K, Mogan C, Moriarty A, Dowling N, Blair-West S, Gelgec C, et al. Emotion regulation difficulties in obsessive-compulsive disorder. Journal of Clinical Psychology. 2018; 74(4):695-709. [DOI:10.1002/jclp.22553] [PMID]
  17. Stern MR, Nota JA, Heimberg RG, Holaway RM, Coles ME. An initial examination of emotion regulation and obsessive-compulsive symptoms. Journal of Obsessive-Compulsive and Related Disorders. 2014; 3(2):109-14. [DOI:10.1016/j.jocrd.2014.02.005]
  18. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment. 2004; 26(1):41-54. [DOI:10.1023/B:JOBA.0000007455.08539.94]
  19. Fernández de la Cruz L, Landau D, Iervolino AC, Santo S, Pertusa A, Singh S, et al. Experiential avoidance and emotion regulation difficulties in hoarding disorder. Journal of Anxiety Disorders. 2013; 27(2):204-9. [DOI:10.1016/j.janxdis.2013.01.004] [PMID]
  20. Fergus TA, Bardeen JR. Emotion regulation and obsessive-compulsive symptoms: A further examination of associations. Journal of Obsessive-Compulsive and Related Disorders. 2014; 3(3):243-8. [DOI:10.1016/j.jocrd.2014.06.001]
  21. Eifert GH, Forsyth JP. Acceptance and commitment therapy for anxiety disorders: A practitioner’s treatment guide to using mindfulness, acceptance, and values-based behavior change strategies.Journal of Contemporary Psychotherapy. 2006; 36:191–2. [Link]
  22. Twohig MP, Hayes SC, Masuda A. Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy. 2006; 37(1):3-13. [DOI:10.1016/j.beth.2005.02.001] [PMID]
  23. Wetterneck CT, Steinberg DS, Hart J. Experiential avoidance in symptom dimensions of OCD. Bulletin of The Menninger Clinic. 2014; 78(3):253-69. [DOI:10.1521/bumc.2014.78.3.253] [PMID]
  24. Cowie H. Handbook of attachment: Theory, research, and clinical applications. Oxfordshire: Taylor & Francis; 2018. [DOI:10.1080/02643944.2018.1429117]
  25. Shaver PR, Mikulincer M. Attachment-related psychodynamics. Attachment & Human Development. 2002; 4(2):133-61. [DOI:10.1080/14616730210154171] [PMID]
  26. Mikulincer M, Shaver PR. Attachment orientations and emotion regulation. Current Opinion in Psychology. 2019; 25:6-10. [DOI:10.1016/j.copsyc.2018.02.006] [PMID]
  27. Kline RB. Principles and practice of structural equation modeling. New York, NY: Guilford Press; 2015. [Link]
  28. Jackson DL. Revisiting sample size and number of parameter estimates: Some support for the N: q hypothesis. Structural Equation Modeling. 2003; 10(1):128-41. [DOI:10.1207/S15328007SEM1001_6]
  29. Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: An integrative overview. In: Simpson JA, Rholes S, editors. Attachment theory and close rela-tionships. New York: The Guilford Press; 1998. [Link]
  30. Alonso-Arbiol I, Balluerka N, Shaver PR. A Spanish version of the Experiences in Close Relationships (ECR) adult attachment questionnaire. Personal Relationships. 2007; 14(1):45-63. [DOI:10.1111/j.1475-6811.2006.00141.x]
  31. Fraley RC, Waller NG, Brennan KA. An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology. 2000; 78(2):350-65 [DOI:10.1037/0022-3514.78.2.350] [PMID]
  32. Panaghi L, Maleki G, Zabihzadeh A, Poshtmashhadi M, Soltaninezhad Z. [Validity, reliability, and factor analysis of Experiences in Close Relationship (ECR) Scale (Persian)]. Iranian Journal of Psychiatry and Clinical Psychology. 2014; 19(4):305-13. [Link]
  33. Dan-Glauser ES, Scherer KR. The difficulties in emotion regulation scale (DERS). Swiss Journal of Psychology. 2013; 72(1):5-11.  [DOI:10.1037/t38610-000]
  34. Azizi A, Mirzaei A, Shams J. [Correlation between distress tolerance and emotional regulation with students smoking dependence (Persian)]. Hakim Research Journal. 2010; 13(1):11-8. [Link]
  35. Shams J, Azizi A, Mirzaei A. [Correlation between distress tolerance and emotional regulation with students smoking dependence (Persian)]. Hakim Research Journal. 2010; 13(1):11-8. [Link]
  36. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy. 2011; 42(4):676-88.  [DOI:10.1016/j.beth.2011.03.007] [PMID]
  37. Hayes SC, Strosahl K, Wilson KG, Bissett RT, Pistorello J, Toarmino D, et al. Measuring experiential avoidance: A preliminary test of a working model. The Psychological Rec-ord. 2004; 54(4):553-78. [DOI:10.1007/BF03395492]
  38. Monestès JL, Villatte M, Mouras H, Loas G, Bond FW. Traduction et validation française du questionnaire d’acceptation et d’action (AAQ-II). European Review of Applied Psychology. 2009; 59(4):301-8.  [DOI:10.1016/j.erap.2009.09.001]
  39. Abasi E, Fati L, Molodi R, Zarabi H. [Psychometric properties of Persian Version of Acceptance and Action Questionnaire -II (Persian)]. Psychological Methods and Models. 2012; 2(10):65-80.[Link]
  40. Doron G, Mizrahi M, Szepsenwol O, Derby D. Right or flawed: Relationship obsessions and sexual satisfaction. The Journal of Sexual Medicine. 2014; 11(9):2218-24. [DOI:10.1111/jsm.12616] [PMID]
  41. Hulland J. Use of partial least squares (PLS) in strategic management research: A review of four recent studies. Strategic Management Journal. 1999; 20(2):195-204. [DOI:10.1002/(SICI)1097-0266(199902)20:23.0.CO;2-7]
  42. Magner N, Welker RB, Campbell TL. Testing a model of cognitive budgetary participation processes in a latent variable structural equations framework. Accounting and Busi-ness Research. 1996; 27(1):41-50. [DOI:10.1080/00014788.1996.9729530]
  43. Henseler J, Ringle CM, Sinkovics RR. The use of partial least squares path modeling in international marketing. In: Cavusgil T, editor. New challenges to international market-ing. Bingley: Emerald Group Publishing Limited; 2009. [DOI:10.1108/S1474-7979(2009)0000020014]
  44. Doron G, Kyrios M. Obsessive-compulsive disorder: A review of possible specific internal representations within a broader cognitive theory. Clinical Psychology Review. 2005; 25(4):415-32.  [DOI:10.1016/j.cpr.2005.02.002] [PMID]
  45. Doron G, Kyrios M, Moulding R. Sensitive domains of self-concept in obsessive-compulsive disorder (OCD): Further evidence for a multidimensional model of OCD. Journal of Anxiety Disorders. 2007; 21(3):433-44. [DOI:10.1016/j.janxdis.2006.05.008] [PMID]
  46. Cooper ML, Shaver PR, Collins NL. Attachment styles, emotion regulation, and adjustment in adolescence. Journal of Personality and Social Psychology. 1998; 74(5):1380-97.  [DOI:10.1037/0022-3514.74.5.1380] [PMID]
  47. Vogel PA, Stiles TC, Nordahl HM. Cognitive personality styles in OCD outpatients compared to depressed outpatients and healthy controls. Behavioural and Cognitive Psycho-therapy. 2000; 28(3):247-58.  [DOI:10.1017/S1352465800003052]
  48. Fennell D, Liberato AS. Learning to live with OCD: Labeling, the self, and stigma. Deviant Behavior. 2007; 28(4):305-31.  [DOI:10.1080/01639620701233274]
  49. Nice J. Obsessive-Compulsiveness and Sense of Self: Self-ambivalence, attachment insecurity, shame and self-compassion [PhD thesis]. Guildford: University of Surrey; 2013.[Link]
  50. Bowlby J. Attachment and loss. New York: Basic Books; 1969.
  51. Bartholomew K, Horowitz LM. Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology. 1991; 61(2):226-44.  [DOI:10.1037/0022-3514.61.2.226] [PMID]
  52. Bowlby J. A secure base: Clinical applications of attachment theory. London: Routledge; 1988. [Link]
  53. Khosravani V, Samimi Ardestani SM, Sharifi Bastan F, Malayeri S. Difficulties in emotion regulation and symptom dimensions in patients with obsessive-compulsive disorder. Current Psychology. 2020; 39(5):1578-88. [DOI:10.1007/s12144-018-9859-x]
  54. Berant E, Mikulincer M, Florian V. Attachment style and mental health: A 1-year follow-up study of mothers of infants with congenital heart disease. Personality and Social Psychology Bulletin. 2001; 27(8):956-68. [DOI:10.1177/0146167201278004]
  55. Contreras JM, Kerns KA, Weimer BL, Gentzler AL, Tomich PL. Emotion regulation as a mediator of associations between mother-child attachment and peer relationships in middle childhood. Journal of Family Psychology. 2000; 14(1):111-24.  [DOI:10.1037/0893-3200.14.1.111] [PMID]
  56. Gilliom M, Shaw DS, Beck JE, Schonberg MA, Lukon JL. Anger regulation in disadvantaged preschool boys: Strategies, antecedents, and the development of self-control. Devel-opmental Psychology. 2002; 38(2):222-35. [DOI:10.1037/0012-1649.38.2.222] [PMID]
  57. Mikulincer M, Birnbaum G, Woddis D, Nachmias O. Stress and accessibility of proximity-related thoughts: Exploring the normative and intraindividual components of attachment theory. Journal of Personality and Social Psychology. 2000; 78(3):509-23. [DOI:10.1037/0022-3514.78.3.509] [PMID]
  58. Mikulincer M, Shaver PR, Pereg D. Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies. Motivation and Emotion. 2003; 27(2):77-102. [DOI:10.1023/A:1024515519160]
  59. Roisman GI, Padrón E, Sroufe LA, Egeland B. Earned-secure attachment status in retrospect and prospect. Child Development. 2002; 73(4):1204-19. [DOI:10.1111/1467-8624.00467] [PMID]
  60. Gerhart JI, Baker CN, Hoerger M, Ronan GF. Experiential avoidance and interpersonal problems: A moderated mediation model. Journal of Contextual Behavioral Science. 2014; 3(4):291-8. [DOI:10.1016/j.jcbs.2014.08.003]
  61. Cordon SL, Finney SJ. Measurement invariance of the Mindful Attention Awareness Scale across adult attachment style. Measurement and Evaluation in Counseling and Development. 2008; 40(4):228-45. [DOI:10.1080/07481756.2008.11909817]
  62. Wilson VR. Attachment, experiential avoidance, and mindfulness in the narrative disclosure task [PhD thesis]. Boston: Boston University; 2012. [Link]
  63. Shaver PR, Lavy S, Saron CD, Mikulincer M. Social foundations of the capacity for mindfulness: An attachment perspective. Psychological Inquiry. 2007; 18(4):264-71. [DOI:10.1080/10478400701598389]
  64. Ryan RM, Brown KW, Creswell JD. How integrative is attachment theory? Unpacking the meaning and significance of felt security. Psychological Inquiry. 2007; 18(3):177-82. [DOI:10.1080/10478400701512778]
  65. Abramowitz JS, Lackey GR, Wheaton MG. Obsessive-compulsive symptoms: The contribution of obsessional beliefs and experiential avoidance. Journal of Anxiety Disorders. 2009; 23(2):160-6. [DOI:10.1016/j.janxdis.2008.06.003] [PMID]
  66. Chawla N, Ostafin B. Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology. 2007; 63(9):871-90. [DOI:10.1002/jclp.20400] [PMID]
  67. Rachman S, Radomsky AS, Shafran R. Safety behaviour: A reconsideration. Behaviour Research and Therapy. 2008; 46(2):163-73. [DOI:10.1016/j.brat.2007.11.008] [PMID]
  68. Stasik SM, Naragon-Gainey K, Chmielewski M, Watson D. Core OCD symptoms: Exploration of specificity and relations with psychopathology. Journal of Anxiety Disorders. 26(8):859–70. [PMID] [PMCID]
  69. Abramowitz JS, McKay D, Storch EA. The Wiley handbook of obsessive-compulsive disorders. New Jersey: John Wiley & Sons; 2017. [DOI:10.1002/9781118890233]
  70. Robinson LJ, Freeston MH. Emotion and internal experience in obsessive-compulsive disorder: Reviewing the role of alexithymia, anxiety sensitivity and distress tolerance. Clinical Psychology Review. 2014; 34(3):256-71. [DOI:10.1016/j.cpr.2014.03.003] [PMID]
  71. Smith AH, Wetterneck CT, Hart JM, Short MB, Björgvinsson T. Differences in obsessional beliefs and emotion appraisal in obsessive-compulsive symptom presentation. Journal of Obsessive-Compulsive and Related Disorders. 2012; 1(1):54-61. [DOI:10.1016/j.jocrd.2011.11.003]
  72. Doron G, Talmor D, Szepsenwol O, Derby DS. Relationship-centered obsessive-compulsive phenomena. Psicoterapia Cognitiva e Comportamentale. 2012; 18(1):79–90. [Link]
  73. Bowlby J. Attachment and loss. Volume II. Separation, anxiety and anger. London: The Hogarth press; 1973. [Link]
  74. Doron G, Moulding R, Kyrios M, Nedeljkovic M, Mikulincer M. Adult attachment insecurities are related to obsessive-compulsive phenomena. Journal of Social and Clinical Psychology. 2009; 28(8):1022-49. [DOI:10.1521/jscp.2009.28.8.1022]
  75. Hall BJ, Hobfoll SE, Canetti D, Johnson RJ, Galea S. The defensive nature of benefit finding during ongoing terrorism: An examination of a national sample of Israeli Jews. Journal of social and Clinical Psychology. 2009; 28(8):993-1021. [DOI:10.1521/jscp.2009.28.8.993] [PMID] [PMCID]
  76. Doron G, Sar-El D, Mikulincer M. Threats to moral self-perceptions trigger obsessive-compulsive contamination-related behavioral tendencies. Journal of Behavior Therapy and Experimental Psychiatry. 2012; 43(3):884-90. [DOI:10.1016/j.jbtep.2012.01.002] [PMID]
Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2022/01/9 | Accepted: 2022/10/17 | Published: 2022/12/22

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Iranian Journal of Psychiatry and Clinical Psychology

Designed & Developed by : Yektaweb