Objective The present study examined the relationship between attachment and premenstrual symptoms, and the mediating role of maladaptive emotion regulation.

Method Attachment orientation, maladaptive emotion regulation, and premenstrual symptom severity were measured using a cross-sectional design among female university students who were naturally cycling (n = 165) or currently using hormonal contraception (HC) (n = 124).

Results Partial correlations, controlling for age, cycle regularity, and general symptoms of psychopathology (depression, anxiety, and stress), revealed positive associations between maladaptive emotion regulation and premenstrual symptoms, and between anxious attachment and maladaptive emotion regulation for both groups of women. Moreover, among women who were naturally cycling, maladaptive emotion regulation positively mediated the relationship between anxious (but not avoidant) attachment and premenstrual symptom severity; anxious attachment was associated with more severe premenstrual symptoms via increased maladaptive emotion regulation. This same mediation pathway was not observed for participants currently using HC.

Conclusions The findings highlight that a negative model of the self, which is characteristic of an anxious attachment style, may be a useful psychotherapeutic target for naturally cycling women who experience premenstrual symptoms. Further research and replication are required to confirm the potential moderating effect of HC and hormonal changes on these relationships.