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. This study is related to the project, From Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The language of this article has been edited and improved using AI tools (Claude Sonnet 5). The authors take full responsibility for its content. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Mental Health, Iran University of Medical Sciences, Tehran, Iran Student Research Committee, Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran The Research Ethics Committee of the Shahid Beheshti University of Medical Sciences, in Tehran, Iran approved the study (Approval ID: IR.SBMU.RETECH.REC.1402.810). All study procedures were performed in compliance with the Helsinki Declaration guidelines. Each participant or parents of participant provided signed informed consent before participation.