Attachment dimensions and adolescent gambling: The mediating role of mentalization

Marina Cosenza, Maria Ciccarelli, Mariagiulia Sacco, Giovanna Nigro, Barbara Pizzini


Background: Several studies demonstrated that insecure attachment style represents a risk factor for gambling behavior. The recent literature strongly argues that attachment could be better described as a dimensional construct, in as much as variations in attachment seem to exist on a graded continuum rather than in categories, better grasped by dimensional models. However, only a few studies have investigated the role of specific attachment dimensions in adolescent gambling. Moreover, even if the role of attachment style on mentalization abilities and their influence on gambling are well established, no studies have so far investigated how attachment dimensions and mentalization interact each other in influencing gambling behavior. The present study was aimed to clarify the role of specific dimensions of attachment in adolescent gambling and to explore, for the first time, the causal relationships between attachment, mentalization, and adolescent gambling.

Methods: Four hundred and eighty-two adolescents aged 16-20 years were administered the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Attachment Style Questionnaire (ASQ), and the Reflective Functioning Questionnaire (RFQ-8).

Results: The results of the hierarchical linear regression analysis showed that high scores on Uncertainty about mental states (RFQ-8) and Preoccupation with relationships (ASQ) were significant predictors of gambling severity. Moreover, mediational analysis revealed that the effect of Preoccupation with relationships on gambling severity was totally mediated by Uncertainty about mental states.

Conclusion: The present study provided, for the first time, insight into the interrelationships between attachment dimensions, mentalization, and gambling severity, and suggested that preoccupation with relationships may be an important precursor to gambling and support the hypothesis that adolescents preoccupied with relationships have more severe gambling involvement due to poor mentalization abilities. Theoretical and clinical implications are discussed.


Gambling; Adolescent gambling; Mentalization; Attachment dimensions; Mediation analysis; Clinical Psychology.

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Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of Attachment. Erlbaum Associates, Inc.

Allen, J. G., Fonagy, P., & Bateman, A. (2008). Mentalizing in clinical practice. Washington, DC: APPI.

Andrie, E. K., Tzavara, C. K., Tzavela, E., Richardson, C., Greydanus, D., Tsolia, M., & Tsitsika, A. K. (2019). Gambling involvement and problem gambling correlates among European adolescents: results from the European Network for Addictive Behavior study. Social Psychiatry and Psychiatric Epidemiology, 54, 1429-1441.

Badoud, D., Luyten, P., Fonseca-Pedrero, E., Eliez, S., Fonagy, P., & Debbané, M. (2015). The French version of the Reflective Functioning Questionnaire: Validity data for adolescents and adults and its association with non-suicidal self-injury. PLoS ONE, 10(12), e0145892.

Bartholomew, K. (1990). Avoidance of Intimacy: An Attachment Perspective. Journal of Social and Personal Relationships, 7(2), 147-178.

Bartholomew, K., & Horowitz, L. M. (1991). Attachment styles among young adults: a test of a four-category model. Journal of Personality and Social Psychology, 61(2), 226-244.

Bateman, A. W., & Fonagy, P. (2004). Mentalization-Based Treatment of BPD. Journal of Personality Disorders, 18(1), 36-51.

Beauchaine, T.P., & Cicchetti, D. (2019). Emotion dysregulation and emerging psychopathology: A transdiagnostic, transdisciplinary perspective. Development and Psychopathology, 31, 799–804.

Beauchaine, T.P., & Crowell, S.E. (eds.) (2019). The Oxford Handbook of Emotion Dysregulation: Oxford: Oxford Handbooks Online.

Bizzi, F., & Pace, C. S. (2019). Attachment Representations and Emotion Regulation Strategies in Parents of Children with Disruptive Behaviour Disorders. Mediterranean Journal of Clinical Psychology, 7(3).

Black-Hughes, C., & Stacy, P. D. (2013). Early childhood attachment and its impact on later life resilience: a comparison of resilient and non-resilient female siblings. Journal of Evidence-based Social Work, 10(5), 410-420.

Borroni, S., Ruotolo, G., Masci, E., Franzoni, C., Vassena, G., & Fossati, A. (2022). The role of Dysfunctional Personality Features and Adult Attachment Style in Predicting ICD-11 Trauma Related Disorders in a Community-dwelling Sample. Mediterranean Journal of Clinical Psychology, 10(1).

Brennan, K. A., Clark, C. L., & Shaver, P. R. (1998). Self-report measurement of adult attachment: An integrative overview. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 46-76). Guilford Press.

Brevers, D., Cleeremans, A., Bechara, A., Greisen, M., Kornreich, C., Verbanck, P., & Noel, X. (2013). Impaired self-awareness in pathological gamblers. Journal of Gambling Studies, 29(1), 119–129.

Brevers, D., Cleeremans, A., Bechara, A., Greisen, M., Kornreich, C., Verbanck, P., & Noel, X. (2014). Impaired metacognitive capacities in individuals with problem gambling. Journal of Gambling Studies, 30(1), 141–152.

Calado, F., Alexandre, J., & Griffiths, M. D. (2017a). Prevalence of Adolescent Problem Gambling: A Systematic Review of Recent Research. Journal of Gambling Studies, 33, 397-424.

Calado, F., Alexandre, J., & Griffiths, M. D. (2017b). How coping styles, cognitive distortions, and attachment predict problem gambling among adolescents and young adults. Journal of Behavioral Addictions, 6(4), 648-657.

Casey, D. M., Williams, R. J., Mossière, A. M., Schopflocher, D. P., el-Guebaly, N., Hodgins, D. C., Smith, G. J., & Wood, R. T. (2011). The role of family, religiosity, and behavior in adolescent gambling. Journal of Adolescence, 34(5), 841- 851.

Chimienti, V., & De Luca R. (2012). Impulsivity, alexithymia and attachment styles in pathological gamblers and their relatives. Italian Journal on Addiction, 2, (3-4).

Ciccarelli, M., Cosenza, M., Nigro, G., Griffiths, M., & D’Olimpio, F. (2022). Gaming and gambling in adolescence: the role of personality, reflective functioning, time perspective and dissociation. International Gambling Studies, 22(1), 161-179.

Ciccarelli, M., Nigro, G., D’Olimpio, F., Griffiths, M., & Cosenza, M. (2021). Mentalizing Failures, Emotional Dysregulation, and Cognitive Distortions Among Adolescent Problem Gamblers. Journal of Gambling Studies, 37, 283-298.

Colasante, E., Gori, M., Bastiani, L., Scalese, M., Siciliano, V., & Molinaro, S. (2014). Italian adolescent gambling behaviour: Psychometric evaluation of the South Oaks Gambling Screen: Revised for Adolescents (SOGS-RA) among a sample of Italian students. Journal of Gambling Studies, 30(4), 789-801.

Cosenza, M., Ciccarelli, M., & Nigro, G. (2019). The steamy mirror of adolescent gamblers: Mentalization, impulsivity, and time horizon. Addictive Behaviors, 89, 156-162.

Craparo, G., Magnano, P., Zapparrata, M. V., Gori, A., Costanzo, G., Pace, U., & Pellerone, M. (2018). Coping, attachment style and resilience: the mediating role of alexithymia. Mediterranean Journal of Clinical Psychology, 6(1).

Di Trani, M., Renzi, A., Vari, C., Zavattini, G. C., & Solano, L. (2017). Gambling Disorder and Affect Regulation: The Role of Alexithymia and Attachment Style. Journal of Gambling Studies, 33(2), 649-659.

Dowling, N. A., Merkouris, S. S., Greenwood, C. J., Oldenhof, E., Toumbourou, J. W., & Youssef, G. J. (2017). Early risk and protective factors for problem gambling: A systematic review and meta-analysis of longitudinal studies. Clinical psychology review, 51, 109-124.

ESPAD Group (2020). ESPAD Report 2019: Results from the European School Survey Project on Alcohol and Other Drugs. European Monitoring Centre for Drugs and Drug Addiction.

Estévez, A., Jáuregui, P., Sánchez-Marcos, I., López-González, H., & Griffiths, M. D. (2017). Attachment and emotion regulation in substance addictions and behavioral addictions. Journal of Behavioral Addictions, 6(4), 534-544.

Feeney, J. A. (1991). The attachment perspective on adult romantic relationships. [Unpublished doctoral dissertation]. University of Queensland, Australia.

Feeney, J. A., Noller, P., & Hanrahan, M. (1994). Assessing adult attachment. In M. B. Sperling & W. H. Berman (Eds.), Attachment in adults: Clinical and developmental perspectives (pp. 128-152). Guilford Press.

Fischer-Kern, M., Fonagy, P., Kapusta, N.D., Luyten, P., Boss, S., Naderer, A., et al. (2013). Mentalizing in female inpatients with major depressive disorder. Journal of Nervous and Mental Disease, 201, 202–207.

Flores, P. (2004). Addiction as an attachment disorder. Jason Aronson.

Floros, G. D. (2018). Gambling disorder in adolescents: prevalence, new developments, and treatment challenges. Adolescent health, medicine and therapeutics, 9, 43.

Fonagy, P., & Bateman, A. W. (2006). Mechanisms of change in mentalization-based treatment of BPD. Journal of Clinical Psychology, 62(4), 411-430.

Fonagy, P., Bateman, A., & Luyten, P. (2012). Introduction and overview. In A. Bateman & P. Fonagy (Eds.), Handbook of mentalizing in mental health practice (pp. 3-41). American Psychiatric Publishing Inc.

Fonagy, P., & Campbell, C. (2016). Attachment theory and mentalization. In A. Elliott & J. Prager (Eds.), The Routledge handbook of psychoanalysis in the social sciences and humanities (pp. 115-131). Routledge/Taylor & Francis Group.

Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect regulation, mentalization, and the development of the self. New York: Other Press.

Fonagy, P., Gergely, G., & Target, M. (2007). The parent-infant dyad and the construction of the subjective self. Journal of Child Psychology and Psychiatry, 48(3-4), 288-328.

Fonagy, P., Leigh, T., Steele, M., Steele, H., Kennedy, R., Mattoon, G., et al. (1996). The relation of attachment status, psychiatric classification, and response to psychotherapy. Journal of Consulting and Clinical Psychology, 64, 22–31.

Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y.-W., Warren, F., Howard, S., Ghinai, R., Fearon, P., & Lowyck, B. (2016). Development and validation of a self-report measure of mentalizing: The Reflective Functioning Questionnaire. PLoS ONE, 11(7), e0158678.

Fonagy, P., Steele, H., Steele, M., & Holder, J. (1997). Attachment and theory of mind: Overlapping constructs? Association for Child Psychollogy and Psychiatry, Occasional Papers, 14, 31-40.

Fonagy, P., & Target, M. (1997). Attachment and reflective function: Their role in self-organization. Development and Psychopathology, 9, 679-700.

Fossati, A., Feeney, J. A., Donati, D., Donini, M., Novella, L., Bagnato, M., Acquarini, E., & Maffei, C. (2003). On the dimensionality of the Attachment Style Questionnaire in Italian clinical and nonclinical participants. Journal of Social and Personal Relationships, 20(1), 55-79.

Fraley, R. C., Hudson, N. W., Heffernan, M. E., & Segal, N. (2015). Are adult attachment styles categorical or dimensional? A taxometric analysis of general and relationship-specific attachment orientations. Journal of Personality and Social Psychology, 109(2), 354-368.

Fraley, R. C., & Waller, N. G. (1998). Adult attachment patterns: A test of the typological model. In J. A. Simpson & W. S. Rholes (Eds.), Attachment theory and close relationships (pp. 77-114). Guilford Press.

Frisone, F. (2021). Problem gambling in phenomenological psychopathology. International Gambling Studies, 21(3), 537-541.

Frisone, F., Settineri, S., Sicari, P. F., & Merlo, E. M. (2020). Gambling in adolescence: a narrative review of the last 20 years. Journal of Addictive Diseases, 38(4), 438-457.

Gambin, M., Woźniak-Prus, M., Konecka, A., & Sharp, C. (2021). Relations between attachment to mother and father, mentalizing abilities and emotion regulation in adolescents. European Journal of Developmental Psychology, 18(1), 18-37.

George, S., & Murali, V. (2005). Pathological gambling: An overview of assessment and treatment. Advances in Psychiatric Treatment, 11(6), 450-456.

Gori, A., Topino, E., Craparo, G., Bagnoli, I., Caretti, V., & Schimmenti, A. (2021). A Comprehensive Model for Gambling Behaviors: Assessment of the Factors that can Contribute to the Vulnerability and Maintenance of Gambling Disorder. Journal of Gambling Studies. Epub ahead of print.

Griffin, D. W., & Bartholomew, K. (1994). Models of the self and other: Fundamental dimensions underlying measures of adult attachment. Journal of Personality and Social Psychology, 67(3), 430-445.

Gupta, R., & Derevensky, J. L. (2000). Adolescents with gambling problems: From research to treatment. Journal of Gambling studies, 16(2), 315-342.

Gupta, R., & Derevensky, J. L. (2005). A treatment approach for adolescents with gambling problems. In Gambling problems in youth (pp.165-188). Springer, Boston, MA.

Handeland, T. B., Kristiansen, V. R., Lau, B., Håkansson, U., & Øie, M. G. (2019). High degree of uncertain reflective functioning in mothers with substance use disorder. Addictive behaviors reports, 10, 100193.

Hayes, A. F. (2018). Partial, conditional, and moderated moderated mediation: Quantification, inference, and interpretation. Communication Monographs, 85(1), 4-40.

Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511-524.

Höfler, D. Z., & Kooyman, M. (1996). Attachment transition, addiction and therapeutic bonding--an integrative approach. Journal of Substance Abuse Treatment, 13(6), 511-519.

Humfress, H., O'Connor, T. G., Slaughter, J., Target, M., & Fonagy, P. (2002). General and relationship-specific models of social cognition: explaining the overlap and discrepancies. Journal of Child Psychology and Psychiatry, 43(7), 873-83.

Hünefeldt, T., Laghi, F., Ortu, F., & Belardinelli, M. O. (2013). The relationship between 'theory of mind' and attachment-related anxiety and avoidance in Italian adolescents. Journal of Adolescence, 36(3), 613-621.

Imperatori, C., Corazza, O., Panno, A., Rinaldi, R., Pasquini, M., Farina, B., & Bersani, F. S. (2020). Mentalization impairment is associated with problematic alcohol use in a sample of young adults: A cross-sectional study. International journal of environmental research and public health, 17(22), 8664.

Jauregui, P., & Estévez, A. (2020). Predictive Role of Attachment, Coping, and Emotion Regulation in Gambling Motives of Adolescents and Young People. Journal of Gambling Studies, 36, 1283-1300.

Kalischuk, R. G., Nowatzki, N., Cardwell, K., Klein, K., & Solowoniuk, J. (2006). Problem gambling and its impact on families: A literature review. International Gambling Studies, 6(1), 31-60.

Keelan, J. P. R., Dion, K. L., & Dion, K. K. (1994). Attachment style and heterosexual relationships among young adults: A short-term panel study. Journal of Social and Personal Relationships, 11(2), 201-214.

Keough, M. T., Penniston, T. L, Vilhena-Churchill, N., Bagby, M. R, & Quilty, L. C. (2018). Depression symptoms and reasons for gambling sequentially mediate the associations between insecure attachment styles and problem gambling. Addictive Behaviors, 78, 166-172.

Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4(5), 231-244.

Kirkpatrick, L. A., &. Davis, K. E. (1994). Attachment Style, Gender and Relationship Stability: A Longitudinal Analysis. Journal of Personality and Social Psychology, 66, 502-512.

Magoon, M. E., & Ingersoll, G. M. (2006). Parental modeling, attachment, and supervision as moderators of adolescent gambling. Journal of Gambling Studies, 22(1), 1-22.

Marszał, M., & Jańczak, A. (2018). Emotion dysregulation, mentalization and romantic attachment in the nonclinical adolescent female sample. Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues, 37(4), 894-904.

McComb, J. L., & Sabiston, C. M. (2010). Family Influences on Adolescent Gambling Behavior: A Review of the Literature. Journal of Gambling Studies, 26(4), 503-520.

Meins, E., Fernyhough, C., Russell, J., & Clark-Carter, D. (1998). Security of attachment as a predictor of symbolic and mentalising abilities: A longitudinal study. Social Development, 7(1), 1-24.

Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. The Guilford Press.

Morandotti, N., Brondino, N., Merelli, A., Boldrini, A., De Vidovich, G. Z., Ricciardo, S., Abbiati, V., Ambrosi, P., Caverzasi, E., Fonagy, P., & Luyten, P. (2018). The Italian version of the refective functioning questionnaire: Validity data for adults and its association with severity of borderline personality disorder. PLoS One, 13(11), e0206433.

Nigro, G., D'Olimpio, F., Ciccarelli, M., & Cosenza, M. (2019). The fuzzy future: Time horizon, memory failures, and emotional distress in gambling disorder. Addictive Behaviors, 97, 7-13.

Nigro, G., Matarazzo, O., Ciccarelli, M., D’Olimpio, F., & Cosenza, M. (2019). To chase or not to chase: A study on the role of mentalization and alcohol consumption in chasing behavior. Journal of Behavioral Addictions, 8(4), 743-753.

Pace, U., Schimmenti, A., Zappulla, C., & Di Maggio, R. (2013). Psychological variables characterizing different types of adolescent gamblers: A discriminant function analysis. Clinical Neuropsychiatry, 6(10), 253-259.

Raby, K. L., Fraley, R. C., & Roisman, G. I. (2021). Categorical or dimensional measures of attachment? In R. A. Thompson, J. A. Simpson, & L. J. Berlin (Eds.), Attachment: The Fundamental Questions (pp. 70-77). Guilford Press.

Schimmenti, A., & Caretti, V. (2010). Psychic retreats or psychic pits?: Unbearable states of mind and technological addiction. Psychoanalytic Psychology, 27(2), 115-132.

Schimmenti, A., Guglielmucci, F., Barbasio, C., & Granieri, A. (2012). Attachment disorganization and dissociation in virtual worlds: A study on problematic Internet use among players of online roleplaying games. Clinical Neuropsychiatry, 9, 195-202.

Schwarzer, N., Nolte, T., Fonagy, P., & Gingelmaier, S. (2021). Mentalizing and emotion regulation: Evidence from a nonclinical sample. International Forum of Psychoanalysis, 30(1), 34-45.

Sharp, C., Pane, H., Ha, C., Venta, A., Patel, A. B., Sturek, J., & Fonagy, P. (2011). Theory of mind and emotion regulation difficulties in adolescents with borderline traits. Journal of the American Academy of Child & Adolescent Psychiatry, 50(6), 563-573.

Simpson, J. A. (1990). Influence of attachment styles on romantic relationships. Journal of Personality and Social Psychology, 59(5), 971-980.

Stacy, P. D. (2004). Attachment as a protective factor: An intra-family design [Unpublished doctoral dissertation]. University of Montana.

Stacy, P. D. (2006). Early childhood attachment as a protective factor: Comparing resilient and non-resilient siblings. Journal of Evidence Based Social Work, 3, 49-65.

Sui, J. J., & Baloglu, S. (2003). The role of emotional commitment in relationship marketing: An empirical investigation of a loyalty model for casinos. Journal of Hospitality & Tourism Research, 27(4), 470-489.

Tabachnick, B. G., & Fidell, L. S. (2019). Using multivariate statistics (7th ed.). Boston, MA: Pearson.

Terrone, G., Gori, A., Topino, E., Musetti, A., Scarinci, A., Guccione, C., & Caretti, V. (2021). The Link between Attachment and Gambling in Adolescence: A Multiple Mediation Analysis with Developmental Perspective, Theory of Mind (Friend) and Adaptive Response. Journal of Personalized Medicine, 11, 228.

Walters, G. D. (1994). The gambling lifestyle: I. Theory. Journal of gambling studies, 10(2), 159-182.

Winters, K. C., Stinchfeld, R. D., & Fulkerson, J. (1993). Toward the development of an adolescent gambling problem severity scale. Journal of Gambling Studies, 9, 63-84.



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