Adult attachment, death anxiety, representation of death, and depression, anxiety, obsessive-compulsive, and somatic symptoms in early emerging adulthood: a moderated mediation model

Abstract

Death anxiety has been increasingly recognized as a transdiagnostic factor associated with a wide range of internalizing symptoms, yet the psychological mechanisms linking existential concerns to psychopathology remain incompletely understood. Drawing on attachment theory and existential perspectives, this study examined whether death anxiety mediates the association between adult attachment styles and depressive, anxiety, obsessive-compulsive, and somatic symptoms, and whether this indirect association is moderated by individuals’ ontological representation of death. A sample of 640 Italian early emerging adults completed self‑report measures of attachment styles, death anxiety, ontological death representation, and internalizing symptoms. Conditional process analyses showed that preoccupied and dismissing attachment styles were indirectly associated with anxiety, obsessive-compulsive, and somatic symptoms through death anxiety among individuals who represented death as annihilation rather than as a passage to another form of existence. Death anxiety also mediated the association between preoccupied attachment and depressive symptoms, regardless of death representation. These findings suggest that insecure attachment configurations may increase vulnerability to psychopathology through heightened death anxiety, particularly when personal continuity is threatened by annihilationist beliefs. By integrating attachment‑related and existential dimensions, the study offers a transdiagnostic perspective on internalizing symptoms in early emerging adulthood and highlights the clinical relevance of addressing both relational insecurity and existential meaning in psychological assessment and intervention.