Childhood Maltreatment and Psychopathology: The Mediating Roles of Mentalizing and Attachment Styles

Evidence suggests that childhood maltreatment is associated with adult psychopathology, including borderline personality disorder (BPD). Mentalizing and attachment styles (anxiety and avoidance) are implicated in psychopathology development and maintenance of psychopathology, and may serve as treatment targets.

This study investigated (1) associations between childhood maltreatment (severity and multiplicity) and adult psychopathology (psychological distress and BPD symptoms), and (2) indirect effects of mentalizing, anxious attachment style, and avoidant attachment style. Using structural equation modeling and network analysis, we tested these relationships in a cross-sectional sample of 340 participants.

Results supported a dose-response relationship between maltreatment and adult psychopathology, with both severity and multiplicity significantly associated with increased psychological distress. Mentalizing exhibited a partial indirect effect in this association, as lower mentalizing was related to higher levels of psychopathology. Attachment anxiety demonstrated an indirect effect across the maltreatment-psychopathology relationship, whereas attachment avoidance was not found to be a meaningful indirect pathway. Notably, mentalizing difficulties emerged as the strongest indirect pathway across all models, highlighting mentalizing interventions as promising transdiagnostic approaches for mitigating the psychological impacts of childhood trauma. Exploratory network analysis broadly converged with these findings, showing that mentalizing and attachment anxiety were uniquely associated with psychopathology after controlling for all other variables in the network, whereas attachment avoidance occupied a peripheral position.

Overall, these results enhance understanding of mechanisms linking early adversity to adult psychopathology, emphasizing the importance of interventions addressing transdiagnostic risk factors such as mentalizing difficulties and heightened attachment anxiety.