Using path analysis to determine the relationship between attachment styles and severity of menopausal symptoms: survey mediation role of sex guiltiness feeling and defense mechanisms

As a complex phenomenon, menopause is accompanied by simultaneous biological, psychic and social changes in life. Attachment styles have critical role in determining the way a woman behave to her body. Researches have shown that there is a relation between unsecure attachment and somatization. They are more vulnerable and tolerate more anxiety. Most of them use psychical mechanism to reduce their anxiety. Moreover, reduction of sexual desire is one of the widespread symptoms of menopause that is related to attachment styles, too. Sex guiltiness is the most important reason of reduction in sexual desire in women and it is related to somatization. Therefore, this study was conducted to investigate the relation between severity of menopausal symptoms with attachment styles based on the mediation role of defense mechanism and sex guiltiness feel. 

According to Morgan table, 388 individuals was participated to study, menopause women ranging from 45 to 65 years old in the city of Mashhad (Khorasan Razavi province, Northeast of Iran). They were selected by using convenience sampling. Inclusion criteria included to be in menopausal period, consent to participate in research, between 45 to 65 years old, Mashhad inhabitant, at least elementary literacy, no background of chronic psychical or physical disease, hysterectomy or artificial menopause and not using replacement therapy like hormone therapy. For data collection, different questionnaire including that of Greene questionnaire of severity of menopausal symptoms, Hazan and Shaver's adult attachment style, Andrews' defense style and Mosher's sex guilt were used. These questionnaires were spread in parks and recreation centers of five main districts of Mashhad. Mean, standard deviation and Pearson correlation accounted by the use of SPSS Ver.21 and data were analyzed by using path analysis in Lisrel software.  

Correlation between severity of menopausal symptoms, attachment styles, defense mechanisms and sex guilt were significant (p<0.01). In another words, with an increase in severity score of menopausal symptoms, participant’s scores in sex guilt, immature and neurotic defense mechanism, avoidant, and ambivalence attachment styles were augmented. Fitness parameters of path analysis indicated that the model was generally fitted. The results of path analysis also showed that insecure attachment styles (avoidant and ambivalent) through sex guilt, immature and neurotic defense mechanism, can affect the severity of menopausal symptoms. The effect of avoidant attachment on severity of menopausal symptoms was 0.23, through sex guiltiness feel was 0.26 and through immature and neurotic defense mechanism was 0.24 and they were significant (p<0.01). The effect of ambivalent attachment on severity of menopausal symptoms was 0.18, through sex guilt was 0.21 and through immature and neurotic defense mechanism was 0.20 and they were significant, too (p<0.01). Women with avoidant or ambivalent attachments experience more severe symptoms. In addition, women with high score in menopausal symptoms scale, have higher score in immature and neurotic defense mechanism and sex guilt. 

According to findings, conceptual model of the research confirmed and the results of path analysis, indicated that insecure attachment styles (avoidant and ambivalence) with more sex guilt and by the use of immature and neurotic defense mechanisms, affect the severity of menopausal symptoms. Thus, effects and relations of attachment styles on the severity of menopausal symptoms are mediated by sex guilt and defense mechanism. Insecure women experience more anxiety, therefore they use more immature and neurotic defense mechanism that it results in the increase of severity of menopausal symptoms. Moreover, when women feel sexual guilt, it also may cause the increase in severity of menopausal symptoms.