Insecure early attachment might explain why people with social anxiety tend to suppress their anger

According to findings published in the journal BMC Psychiatry, people with social anxiety demonstrate higher levels of trait anger accompanied by a stronger tendency to suppress anger. The analysis further suggested that these anger regulation difficulties might have something to do with insecure early attachment.

Social anxiety disorder (SAD) is defined by an unrelenting fear of social interaction that is characterized by worry that one’s behavior will be negatively judged by others. Some studies have suggested that people with social anxiety are more likely to feel anger and also more likely to hold it in, likely because demonstrating one’s anger risks eliciting negative judgment from others. There is also evidence that people with social anxiety demonstrate higher levels of preoccupied attachment — an insecure attachment style defined by an ill-fated combination of worry about rejection and desire for connection.

A team of researchers led by Rupert Conrad wondered whether there might be a connection between the tendency for people with SAD to conceal their anger and their tendency toward insecure attachment. Young children learn to manage their stress and emotions through their relationships with primary caregivers, and Conrad and his team proposed that anger management issues might be the result of an insecure early attachment bond.

To explore this, the researchers recruited a sample of 321 adults with SAD and 94 control subjects with no mental health diagnoses. All participants completed questionnaires that included assessments of social phobia, depression, attachment style, state and trait anger, and anger expression.

When the researchers compared the adults with SAD to the controls, they found that those with SAD were less likely to have a secure attachment style — a type of attachment that involves a positive view of oneself and others. They were instead more likely than controls to have a fearful attachment style — a style of attachment defined by a negative self-view and avoidance of intimacy. In line with previous studies, respondents with SAD were also more likely to have a preoccupied attachment style — again, an attachment style characterized by worry about rejection and a dependency on others.

Next, respondents with social anxiety had higher levels of trait anger, suggesting a higher general tendency to show anger in a given situation. They also showed an anger expression style that involved holding in and concealing their anger. Furthermore, secure attachment, preoccupied attachment, and anger suppression were all predictors of SAD. Together, these three variables explained roughly 21% of the variation in social phobia scores.

Finally, anger suppression partly mediated the link between preoccupied attachment and social anxiety, providing support for the researchers’ initial hypothesis. The study authors note that preoccupied attachment often comes alongside inconsistent parenting, and people with this attachment style tend to believe that the lack of affection they receive is the result of their own inadequacies. The inability to properly regulate anger among people with SAD may stem from insensitive parenting where the caregiver failed to teach the child how to regulate their stress.

Conrad and his colleagues say their study highlights the importance of teaching patients with SAD healthy strategies for regulating their anger. Concealing emotions can be mentally exhausting in addition to holding patients back during therapy.

Both anger suppression and attachment styles have been found to influence treatment outcomes among patients with SAD. In light of evidence that attachment can be modified through cognitive behavioral therapy, therapeutic outcomes might be improved by educating patients on attachment styles and teaching positive anger management skills.

The study, “Significance of anger suppression and preoccupied attachment in social anxiety disorder: a cross-sectional study”, was authored by Rupert Conrad, Andreas J. Forstner, Man-Long Chung, Martin Mücke, Franziska Geiser, Johannes Schumacher, and Friederike Carnehl.