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Attachment and Posttraumatic Stress Disorder in Multiple Trauma Samples
Abstract
Introduction: Attachment orientations are associated with the severity of posttraumatic stress disorder (PTSD).
However, the mediator role of trauma type in the association between attachment orientation and PTSD remains
unknown.
Method: The relationship between trauma type, attachment, and PTSD was investigated in a large multiple
trauma sample (n=3735). All participants were assessed for PTSD using the Harvard Trauma Questionnaire (HTQ)
and for attachment orientations utilizing the Revised Adult Attachment Scale (RAAS).
Results: Overall, a secure attachment style was related to lower PTSD severity, while insecure attachment
styles were related to higher PTSD severity. Although both attachment dimensions were related to PTSD severity,
attachment anxiety had greater contribution in predicting PTSD. PTSD symptom clusters were not found to depend on
attachment dimensions. Finally, type of traumatic event moderated the association between attachment dimensions
and PTSD severity. While among trauma survivors of family illness, the securely attached group showed the lowest
PTSD severity, among trauma survivors of disease and physical health, the dismissively attached individuals showed
the lowest level of PTSD severity, compared to other attachment groups.
Conclusion: The results underscore the importance of taking into account the nature of the traumatic event
while assessing the effects of attachment in posttraumatic reactions. Moreover, dismissing attachment style might
be adaptive when facing the trauma of disease.
... A third possible explanation concerns the differential involvement of attachment anxiety and avoidance in the self-amplifying PTSD-attachment cycle. Several studies (Elklit, Karstoft, Lahav, & Andersen, 2016;Ogle, Rubin, & Siegler, 2015) and a meta-analysis of 46 studies (Woodhouse et al., 2015) found that attachment anxiety is more strongly related to PTSD symptoms than attachment avoidance. In addition, there are differences between thw two secondary attachment strategies in regulation of emotions (Mikulincer & Shaver, 2016). ...
Background: War captivity is one of the most severe human-made traumatic events which lead to self-amplifying cycle of post-traumatic stress disorder (PTSD) symptoms and attachment insecurities. Solid evidence in the literature pointed out on the intergenerational transmission of PTSD symptoms. However, no research has been conducted on the intergenerational transmission of attachment insecurities and the effect of the self-amplifying cycle among former prisoners of war (ex-POWs) and their offspring attachment insecurities.
Objective: This research aims to explore the intergenerational impact of a self-amplifying cycle of PTSD and attachment insecurities among ex-POWs on their offspring’s attachment orientations.
Method: We sampled dyads of Israeli ex-POWs of the Yom Kippur war and their adult offspring (ex-POW group) (n = 80) as well as dyads of Israeli veterans who fought in the Yom Kippur war, but were never held captive, and their adult offspring (control group) (n = 40). Veterans reported on PTSD severity and attachment orientations (anxiety, avoidance). Offspring reported on attachment orientations. We conducted (a) hierarchical regressions to predict offspring attachment orientations as a function of veterans’ attachment orientations, and (b) moderated mediation analyses examining the role of veterans’ PTSD in the intergenerational transmission of attachment orientations.
Results: Ex-POWs’ attachment anxiety was associated with offspring’s reports of higher attachment anxiety and avoidance, and this intergenerational transmission of attachment was mediated by ex-POWs’ PTSD severity. These effects were not significant in the control group.
Conclusions: Decades after the war end, the intergenerational sequelae of war captivity are evident by the impact of the self-amplifying cycle of PTSD and attachment insecurities among ex-POWs and their offspring’s attachment insecurities. Therefore, it is imperative for clinicians to recognize the intergenerational transmission and to focus not only on the trauma but also on the traumatized person’s attachment injuries and the shattering of core beliefs about the world, self, and others, in the context of attachment-based therapies.
... Furthermore, adapted versions of mental distress tests for Malaysian use are very few [4]. Most of the tests also use paper and pencil form [5]- [12]. The major weakness of paper and pencil method is the test score cannot be obtained immediately. ...
... Furthermore, adapted versions of mental distress tests for Malaysian use are very few [4]. Most of the tests also use paper and pencil form [5]- [12]. The major weakness of paper and pencil method is the test score cannot be obtained immediately. ...
... In Renaud (2008), the majority of the male veterans endorsed avoidant attachment styles, which was found to be associated with higher levels of PTSS. However, it is important to note that studies examining NIPT, IPT, or both have produced varied findings regarding the avoidant attachment-PTSS link (e.g., Elklit, Karstoft, Lahav, & Andersen, 2016;Gore-Felton et al., 2013;Huang, Chen, Su, & Kung, 2016). ...
It is well-documented that insecure attachment poses substantial risks to post-trauma recovery. Although attachment anxiety reliably predicts and is associated with elevated post-traumatic stress symptoms (PTSS), the attachment avoidance–PTSS link has been far less consistent. This suggests both attenuating and enhancing connections between attachment difficulties and post-trauma outcomes. The goal of this study is 2-fold: (a) to review and summarize extant evidence concerning the relation between insecure attachment and PTSS and (b) to review mechanism(s) underlying attachment anxiety and attachment avoidance that may explain the development of PTSS. Following a systematic review of the empirical literature investigating attachment, trauma, and post-trauma reactions, a total of 138 studies were identified and summarized. The review further identifies explanatory mechanisms underlying the association between insecure attachment and PTSS, including stress appraisals, cognitive factors, self-esteem, emotion regulation strategies, social factors, and trauma-specific factors (i.e., type of trauma, extreme stress). Implications for practice, policy, and research are discussed.
... Nonetheless, other evidence calls into question the role of trauma type in explaining the effects of attachment avoidance. For example, a recent study that included various types of traumatic events suggested that the protective effects of attachment avoidance might be applicable to impersonal traumatic events as well, such that attachment avoidance was related to lower levels of PTSD symptoms among survivors of physical illness (Elklit, Karstoft, Lahav, & Andersen, 2016). Furthermore, a previous study conducted among part of the present sample of survivors of the interpersonal trauma of war captivity indicated attachment avoidance to be associated with higher levels of PTSD symptoms (Ein-Dor, Doron, Solomon, Mikulincer, & Shaver, 2010). ...
Spouses of traumatized war veterans might suffer from distress following indirect exposure to combat and direct exposure to domestic abuse. Yet the effect of this twofold trauma exposure is far from being fully understood. Theory views attachment security as a personal resource mitigating adversity, whereas attachment insecurities intensify distress. Nevertheless, there are mixed results concerning the effects of attachment in the aftermath of trauma. Furthermore, the role of trauma exposure levels regarding the effects of attachment remains largely unin-vestigated. Filling these gaps, this study assessed female military spouses 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. Direct (domestic abuse) and indirect (veteran part-ners' posttraumatic stress symptoms) trauma exposure, attachment , depression, and anxiety were assessed. Findings indicated an interaction between the trauma types in predicting spouses' anxiety. Domestic abuse moderated the relations between attachment and distress. Although attachment anxiety had non-significant effects on anxiety among low-level domestic abuse sufferers, it predicted elevated anxiety among high-level domestic abuse sufferers. Furthermore, while attachment avoidance predicted elevated distress among low-level domestic abuse sufferers, its effects dissolved or became positive in nature among high-level domestic abuse sufferers. Discussion focuses on evolutionary explanations of the functions of attachment under different conditions of threat.
... Coaccioli et al. in their research article reported that meditation is the best non-pharmacological approach for almost any types of chronic pains [4]. Elklit et al. described the importance of considering even the traumatic events for assessing the effects of posttraumatic reactions [6]. Abebe et al. found that the prevalence of anxiety was high in people living skin problems [7]. ...
Background
Despite the fact that childhood sexual abuse can affect a survivor's sexual functioning in adulthood, few studies have examined survivors' adult sexual functioning from the perspective of attachment theory.
Aim
The present study sought to examine how sexual abuse in childhood might shape the associations between attachment insecurities and sexual functioning among adults.
Methods
The study sample consisted of 265 participants (166 women and 99 men), 45 (16.9%) of whom were classified as survivors of childhood sexual abuse. Participants completed an online questionnaire about their history of childhood sexual abuse, attachment insecurities, and sexual functioning over the past 6 months.
Outcomes
The findings of the present study suggest that attachment insecurities may have unique implications for sexual functioning among survivors of childhood sexual abuse.
Results
Findings indicated that a history of childhood sexual abuse significantly moderated the associations between attachment insecurities and sexual functioning. Whereas the effect of attachment avoidance in predicting sexual desire was not significant among nonabused participants, it was significant among survivors; specifically, higher levels of attachment avoidance predicted lower levels of sexual desire. A different pattern was found for attachment anxiety. Although attachment anxiety did not predict vaginal lubrication/penile erection among nonabused participants, it had significant effects among survivors; specifically, higher levels of attachment anxiety predicted higher levels of vaginal lubrication/penile erection.
Clinical Translation
Findings from the present study may help facilitate sex therapy interventions for childhood sexual abuse survivors, from an attachment theory perspective.
Strengths & Limitations
The study included a nonclinical, convenience sample and used self-report measures, which are highly subjective and increase the possibility of social-desirability biases. However, on the plus side, it relied on simple, short, self-report questionnaires that are accessible and can be easily used by professionals to examine a survivor's current condition relative to any of the variables, establish intervention goals, and evaluate treatment.
Conclusion
A history of childhood sexual abuse is related to 2 opposite patterns of association between attachment insecurity (depending on type) and sexual functioning.
Gewirtz-Meydan A, Lahav Y. Sexual Functioning Among Childhood Sexual Abuse Survivors From an Attachment Perspective. J Sex Med 2020;XX:XXX–XXX.
This study examines the association between adult attachment style and the way people reacted to the Iraqi missile attack on Israel during the Gulf War. One hundred forty Israeli students were interviewed 2 weeks after the war and classified according to their attachment style (secure, avoidant, or ambivalent) and residence area (dangerous vs. less dangerous). Ambivalent people reported more distress than secure people. Avoidant persons reported higher levels of somatization, hostility, and trauma-related avoidance than secure persons. These results characterized Ss living in dangerous areas. In addition, secure people used relatively more support-seeking strategies in coping with the trauma, ambivalent people used more emotion-focused strategies, and avoidant people used more distancing strategies. Findings are discussed in terms of attachment working models.
Introduction: Attachment orientations are associated with the severity of posttraumatic stress disorder (PTSD). However, the mediator role of trauma type in the association between attachment orientation and PTSD remains unknown. Method: The relationship between trauma type, attachment, and PTSD was investigated in a large multiple trauma sample (n=3735). All participants were assessed for PTSD using the Harvard Trauma Questionnaire (HTQ) and for attachment orientations utilizing the Revised Adult Attachment Scale (RAAS). Results: Overall, a secure attachment style was related to lower PTSD severity, while insecure attachment styles were related to higher PTSD severity. Although both attachment dimensions were related to PTSD severity, attachment anxiety had greater contribution in predicting PTSD. PTSD symptom clusters were not found to depend on attachment dimensions. Finally, type of traumatic event moderated the association between attachment dimensions and PTSD severity. While among trauma survivors of family illness, the securely attached group showed the lowest PTSD severity, among trauma survivors of disease and physical health, the dismissively attached individuals showed the lowest level of PTSD severity, compared to other attachment groups. Conclusion: The results underscore the importance of taking into account the nature of the traumatic event while assessing the effects of attachment in posttraumatic reactions. Moreover, dismissing attachment style might be adaptive when facing the trauma of disease.
There are no valid and reliable cross-cultural instruments capable of measuring torture, trauma, and trauma-related symptoms associated with the DSM-III-R diagnosis of posttraumatic stress disorder (PTSD). Generating such standardized instruments for patients from non-Western cultures involves particular methodological challenges. This study describes the development and validation of three Indochinese versions of the Harvard Trauma Questionnaire (HTQ), a simple and reliable screening instrument that is well received by refugee patients and bicultural staff. It identifies for the first time trauma symptoms related to the Indochinese refugee experience that are associated with PTSD criteria. The HTQ's cultural sensitivity may make it useful for assessing other highly traumatized non-Western populations.
TSaChi eiN-Dor Interdisciplinary Center (IDC) Herzliya attachment security contributes to resilience in times of stress, but it can be disrupted by traumatic events that shatter positive views of self and others. We followed israeli ex-PoWs of the Yom kippur War over 17 years and examined associations between trajectories of posttraumatic stress disorder (PTSD) and dis-ruptions in the regulatory functions of the attachment system. Fifty-nine ex-PoWs and 39 control veterans from the same war who had reported on PTSD 18, 30, and 35 years after the war performed laboratory cognitive tasks assessing activa-tion of mental representations of security in response to threat and the ability of these representations to color neutral stimuli with positive affect and reduce ac-cess to trauma-related thoughts. as compared to controls, ex-PoWs with persis-tent PTSD over the 17-year period exhibited dramatic disruptions in the soothing and healing functions of attachment security representations. These disruptions
Attachment patterns are especially salient in facing danger and threats to one’s life. Earlier research has suggested that secure persons are protected and insecure persons vulnerable in conditions of traumatic stress. We argued that the general view may not apply to the complex person–trauma interaction that is characteristic to torture and ill-treatment. Rather, as Crittenden maintains, each attachment pattern involves a unique strategy that is the most adaptive solution, depending on the nature of the trauma. We hypothesized that the general view of the secure attachment pattern being protective, and the insecure patterns being unprotective, would apply when political prisoners are exposed to physical torture and ill-treatment. Whereas, when exposed to psychological torture involving interpersonal cruelty, securely attached persons would be more vulnerable than insecure. The hypotheses were examined among 176 Palestinian male former political prisoners living in the Gaza Strip. Their mental health was assessed by posttraumatic (PTSD) and somatic symptoms, and adult attachment patterns by an applied AAI-method. The results confirmed that among insecure (both dismissing and preoccupied) men, the exposure to a high level of physical torture and ill-treatment was associated with increased levels of PTSD and somatic symptoms. On the other hand, exposure to psychological torture and ill-treatment was associated with an increased level of somatic symptoms among secure–autonomous, but not insecure, persons. The secure and insecure victims thus differed in their strengths and vulnerabilities depending on whether the torture was psychological and interpersonal or physical in nature. Both personality and the meaning of the trauma should thus be considered when helping victims of human rights abuse.
In this study, we assessed the 17-year trajectories of attachment insecurities (anxiety and avoidance) and examined their relations to having been a prisoner of war and suffering from Posttraumatic Stress Disorder (PTSD). The sample included two groups of Israeli veterans from the 1973 Yom Kippur war: ex-prisoners of war and comparable control individuals who had not been held captive. They completed self-report measures of anxious and avoidant attachment and PTSD at three time points: 18, 30, and 35 years after the war. Ex-POWs were less secure with respect to attachment than the controls at the initial assessment, and although the controls experienced a decline in attachment insecurity over the 17-year period, the anxiety and avoidance scores of the ex-POWs increased over time. We also found that PTSD was associated with higher attachment insecurity scores at each time point, beyond the effect of war captivity. Implications of the findings for both attachment theory and the psychological effects of trauma are discussed.
In more than 90% of whiplash accidents a good explanation regarding the association between trauma mechanism, organic pathology, and persistent symptoms has failed to be provided.
We predicted that the severity of chronic whiplash-associated disorder (WAD), measured as number of whiplash symptoms, pain duration, pain-related disability, and degree of somatisation would be associated with the number of post-traumatic stress disorder symptoms (PTSD). Secondly, we expected attachment-anxiety to be a vulnerability factor in relation to both PTSD and WAD.
Data were collected from 1,349 women and 360 men suffering from WAD from the Danish Society for Polio, Traffic, and Accident Victims. The PTSD symptoms were measured by the Harvard Trauma Questionnaire. All three core PTSD clusters were included: re-experiencing, avoidance, and hyperarousal. Attachment security was measured along the two dimensions, attachment-anxiety and attachment-avoidance, by the Revised Adult Attachment Scale.
PTSD symptoms were significantly related to the severity of WAD. In particular, the PTSD clusters of avoidance and hyperarousal were associated with the number of whiplash symptoms, disability, and somatisation. Attachment-anxiety was significantly related to PTSD symptoms and somatisation but not to pain and disability. A co-morbidity of 38.8% was found between the PTSD diagnosis and WAD, and about 20% of the sample could be characterised as securely attached.
The PTSD clusters of avoidance and hyperarousal were significantly associated with severity of WAD. The study emphasises the importance of assessing PTSD symptomatology after whiplash injury. Furthermore, it highlights that attachment theory may facilitate the understanding of why some people are more prone to develop PTSD and WAD than others.
Bartholomew (1990) proposed a four category adult attachment model based on Bowlby's (1973) proposal that attachment is underpinned by an individual's view of the self and others. Previous cluster analytic techniques have identified four and two attachment styles based on the Revised Adult Attachment Scale (RAAS). In addition, attachment styles have been proposed to meditate the association between stressful life events and subsequent psychiatric status.
The current study aimed to empirically test the attachment typology proposed by Collins and Read (1990). Specifically, LPA was used to determine if the proposed four styles can be derived from scores on the dimensions of closeness/dependency and anxiety. In addition, we aimed to test if the resultant attachment styles predicted the severity of psychopathology in response to a whiplash trauma.
A large sample of Danish trauma victims (N=1577) participated. A Latent Profile Analysis was conducted, using Mplus 5.1, on scores from the RAAS scale to ascertain if there were underlying homogeneous attachment classes/subgroups. Class membership was used in a series of one-way ANOVA tests to determine if classes were significantly different in terms of mean scores on measures of psychopathology.
The three class solution was considered optimal. Class one was termed Fearful (18.6%), Class two Preoccupied (34.5%), and Class three Secure (46.9%). The secure class evidenced significantly lower mean scores on PTSD, depression, and anxiety measures compared to other classes, whereas the fearful class evidenced significantly higher mean scores compared to other classes.
The results demonstrated evidence of three discrete classes of attachment styles, which were labelled secure, preoccupied, and fearful. This is in contrast to previous cluster analytic techniques which have identified four and two attachment styles based on the RAAS.In addition, Securely attached individuals display lower levels of psychopathology post whiplash trauma.
In this study we tested for a protective effect of secure attachment representations in the development of posttraumatic stress disorder (PTSD). In a design with a control group, we replicated and extended a recent study that found no underrepresentation of secure attachment representations in veterans with PTSD (Nye, Katzman, Bell, Kilpatrick, Brainard, & Haaland, 200863.
Nye , E. C. ,
Katzman , J. ,
Bell , J. B. ,
Kilpatrick , J. ,
Brainard , M. and
Haaland , K. Y. 2008. Attachment organization in Vietnam combat veterans with posttraumatic stress disorder. Attachment & Human Development, 10(1): 41–57. [Taylor & Francis Online], [PubMed], [Web of Science ®]View all references). Furthermore, we examined the association of the Adult Attachment Interview (AAI) classification of unresolved loss or trauma and PTSD symptomatology. The Adult Attachment Interview and the Clinician Administered PTSD Scale (CAPS) were administered with 31 veterans with PTSD and 29 trauma-exposed veterans without PTSD of similar age and country of deployment. Patient and control groups did not differ in the prevalence of secure attachment representations, neither did unresolved and not unresolved subjects differ in prevalence of secure attachment representations. Unresolved state of mind with respect to deployment related trauma was found to correlate strongly with total CAPS score. This study shows no protective effect of secure attachment representations in the development of PTSD. AAI unresolved state of mind with respect to deployment related trauma and PTSD correlate strongly, due to the common core phenomenon of lack of integration.
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.
Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.
The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.
Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
This study examines the association between adult attachment style and the way people reacted to the Iraqi missile attack on Israel during the Gulf War. One hundred forty Israeli students were interviewed 2 weeks after the war and classified according to their attachment style (secure, avoidant, or ambivalent) and residence area (dangerous vs. less dangerous). Ambivalent people reported more distress than secure people. Avoidant persons reported higher levels of somatization, hostility, and trauma-related avoidance than secure persons. These results characterized Ss living in dangerous areas. In addition, secure people used relatively more support-seeking strategies in coping with the trauma, ambivalent people used more emotion-focused strategies, and avoidant people used more distancing strategies. Findings are discussed in terms of attachment working models.
Meta-analyses were conducted on 14 separate risk factors for posttraumatic stress disorder (PTSD), and the moderating effects of various sample and study characteristics, including civilian/military status, were examined. Three categories of risk factor emerged: Factors such as gender, age at trauma, and race that predicted PTSD in some populations but not in others; factors such as education, previous trauma, and general childhood adversity that predicted PTSD more consistently but to a varying extent according to the populations studied and the methods used; and factors such as psychiatric history, reported childhood abuse, and family psychiatric history that had more uniform predictive effects. Individually, the effect size of all the risk factors was modest, but factors operating during or after the trauma, such as trauma severity, lack of social support, and additional life stress, had somewhat stronger effects than pretrauma factors.
Previous research has found that avoidant adults have more difficulty recalling emotional experiences than do less avoidant adults. It is unclear, however, whether such findings reflect differences in the degree to which avoidant adults (a) attend to and encode emotional information, (b) elaborate emotional information they have encoded, or (c) do both. Two studies were conducted to distinguish between the effects of these processes. Participants listened to an interview about attachment-related issues and were asked to recall details from the interview either immediately or at variable delays. An analysis of forgetting curves revealed that avoidant adults initially encoded less information about the interview than did nonavoidant adults, although avoidant and nonavoidant adults forgot the information they did encode at the same rate. The implications of these findings for current views on the nature and efficacy of defenses are discussed.
Adult attachment style and post-traumatic stress disorder (PTSD) symptomatology were investigated in 107 former prisoner of war veterans. Those with secure attachment styles scored significantly lower on measures of PTSD than did those with insecure styles, and attachment style was a stronger predictor of PTSD symptom intensity than was trauma severity. The suggested association between attachment style and PTSD's development and persistence are discussed in relation to research and clinical practice.
It is widely assumed that emotionally avoidant or defensive individuals will have a difficult time adjusting to the loss of a loved one. However, recent research suggests that defensive individuals tend to adapt quite well to loss. Such findings pose a number of challenges to attachment theory--a theory that has traditionally held that emotional avoidance is indicative of poor psychological adjustment. In this article, the authors argue that contemporary models of individual differences in adult attachment allow the derivation of at least three competing hypotheses regarding the relationship between avoidant attachment and adaptation to loss. These hypotheses are tested using two-wave data on 59 bereaved adults. Results indicate that whereas some avoidant individuals (i.e., those who are fearfully avoidant) have a difficult time adapting to the loss of a loved one, other avoidant adults (i.e., those who are dismissingly avoidant) show a pattern of resilience to loss.
This study examined the relationship between individual differences in adult attachment and psychological adaptation in a sample of high-exposure survivors of the terrorist attacks on the World Trade Center on September 11, 2001. Symptoms of posttraumatic stress disorder (PTSD) and depression were assessed via self-report 7 and 18 months after the attacks. In addition, friends and relatives were asked to provide evaluations of participants' adjustment before and after the attacks. Findings indicate that securely attached individuals exhibited fewer symptoms of PTSD and depression than insecurely attached individuals and were viewed by friends and relatives as showing an increase in adjustment following the attacks. Highly dismissing adults were viewed by their friends and family as showing neither increments nor decrements in adjustment, despite the fact that highly dismissing people self-reported relatively high levels of PTSD and depression.
Although 10 studies have been published on the empirical overlap of the Adult Attachment Interview (AAI) and measures of self-reported attachment style, results in this literature have been inconsistently interpreted in narrative reviews. This report was designed as a rapprochement of the AAI and attachment style literatures and includes 3 studies. Study 1 (combined N = 961) is a meta-analytic review showing that by J. Cohen's (1992) criteria (mean r = .09), the association between AAI security and attachment style dimensions is trivial to small. Study 2 (N = 160) confirms meta-analytic results with state-of-the-art assessments of attachment security and also examines attachment dimensions in relation to the Big 5 personality traits. Finally, Study 3 is an investigation of 50 engaged couples that shows that developmental and social psychological measures of attachment security predict somewhat distinct--though theoretically anticipated--aspects of functioning in adult relationships.
Victims of war captivity sometimes suffer from complex post-traumatic stress disorder (PTSD), a unique form of PTSD that entails various alterations in personality. These alterations may involve changes in attachment orientation.
The sample comprised two groups of veterans from the 1973 Yom Kippur War: 103 ex-prisoners of war (ex-POWs) and 106 comparable control veterans. They were assessed at two points in time, 18 years and 30 years after the war.
Ex-POWs suffered from more post-traumatic symptoms than controls at both measurements points and these symptoms increased only among ex-POWs from Time 1 to Time 2. In addition, both attachment anxiety and attachment avoidance increased with time among ex-POWs, whereas they decreased slightly or remained stable among controls. Finally, the increases in attachment anxiety and avoidance were positively associated with the increase in post-traumatic symptoms among both study groups. Further analyses indicated that early PTSD symptoms predicted later attachment better than early attachment predicted later PTSD symptoms.
The results suggest that: (1) complex traumas are implicated in attachment orientations and PTSD symptoms even many years after captivity; (2) there is an increase in attachment insecurities (anxiety, avoidance) and an increase in PTSD symptoms decades after the captivity; (3) and post-traumatic stress symptoms predict attachment orientations better than attachment orientations predict an increase in PTSD symptoms.
The aim of the present study was to examine the association between post-traumatic stress disorder (PTSD) and adult attachment in a young adult population. A sample of 328 Danish students (mean age 29.2 years) from four different schools of intermediate education level were studied by the Harvard Trauma Questionnaire (HTQ), the Revised Adult Attachment Scale (RAAS), the Trauma Symptom Checklist (TSC), the Crisis Support Scale (CSS), the Coping Style Questionnaire (CSQ), and the World Assumption Scale (WAS). Attachment styles were associated with number of PTSD symptoms, negative affectivity, somatization, emotional coping, attributions, and social support. The distribution of attachment styles in relation to PTSD symptoms could be conceived as uni-dimensional.
The purpose of this study was to evaluate whether children with a history of disorganized attachment in infancy were more likely than children without a history of disorganized attachment to exhibit symptoms of posttraumatic stress disorder (PTSD) at school age following trauma exposure. The sample consisted of 78 8.5-year-old children from a larger, ongoing prospective study evaluating the effects of intrauterine cocaine exposure (IUCE) on children's growth and development from birth to adolescence. At the 12-month visit, children's attachment status was scored from videotapes of infant-caregiver dyads in Ainsworth's strange situation. At the 8.5-year visit, children were administered the Violence Exposure Scale-Revised, a child-report trauma exposure inventory, and the Diagnostic Interview for Children and Adolescents by an experienced clinical psychologist masked to children's attachment status and IUCE status. Sixteen of the 78 children (21%) were classified as insecure-disorganized/insecure-other at 12 months. Poisson regressions covarying IUCE, gender, and continuity of maternal care indicated that disorganized attachment status at 12 months, compared with nondisorganized attachment status, significantly predicted both higher avoidance cluster PTSD symptoms and higher reexperiencing cluster PTSD symptoms. These findings suggest that the quality of early dyadic relationships may be linked to differences in children's later development of posttraumatic stress symptoms following a traumatic event.
Both PTSD-related cognitions and adult romantic attachment cognitions have been linked to level of symptomatology and can be conceptualized as interpersonal cognitive schemas that may increase vulnerability to the development of psychological symptoms. The present study examined PTSD-related cognitions and adult romantic attachment as moderators of symptom development after interpersonal trauma. Victims reported higher levels of PTSD-related cognitions and attachment anxiety, but not attachment avoidance, than nonvictims. Results suggest that the experience of trauma, high levels of insecure attachment, and high levels of PTSD-related cognitions are associated with higher levels of symptomatology. In addition, PTSD-related cognitions served as a unique predictor of PTSD symptoms, and moderated the relation between attachment anxiety and depressive symptoms.
Attachment theory (J. Bowlby, 1982/1969, 1973) is one of the most useful and generative frameworks for understanding both normative and individual-differences aspects of the process of affect regulation. In this article we focus mainly on the different attachment-related strategies of affect regulation that result from different patterns of interactions with significant others. Specifically, we pursue 3 main goals: First, we elaborate the dynamics and functioning of these affect-regulation strategies using a recent integrative model of attachment-system activation and dynamics (P. R. Shaver & M. Mikulincer, 2002). Second, we review recent findings concerning the cognitive consequences of attachment-related strategies following the arousal of positive and negative affect. Third, we propose some integrative ideas concerning the formation and development of the different attachment-related strategies.
This study examined the relationships among exposure to terrorism, individual differences in adult attachment dimensions, perceived stress, and posttraumatic stress disorder (PTSD). A representative sample of 254 adults who had experienced more than 7 years of ongoing exposure (OGE) to rocket and mortar fire in southern Israel was compared to 308 individuals with no exposure (NE) to terrorism. OGE individuals reported significantly elevated levels of insecure attachment, perceived stress, and PTSD-symptoms as compared to the NE individuals. The associations between perceived stress and PTSD-symptoms were significantly stronger in the OGE group, compared to the NE group. For OGE individuals, the elevated level of perceived stress mediated the association between Attachment Anxiety and PTSD-symptoms. Theoretical and clinical implications of the findings are discussed.
We used actor-partner interdependence modeling to explore associations among attachment-related dyadic processes, posttraumatic stress disorder (PTSD) in war veterans, and secondary traumatic stress (STS) in their wives. A sample of 157 Israeli couples (85 former prisoners of war and their wives and a comparison group of 72 veterans not held captive and their wives) completed self-report scales assessing attachment insecurities (anxiety, avoidance) and PTSD symptoms. For both groups of veterans and their wives, attachment anxiety was associated with the severity of their own and their spouses' PTSD and STS. Avoidant attachment was associated with PTSD and STS only in couples that included a former prisoner of war. A complex pattern of associations involving avoidant attachment was observed in the actor-partner analyses of these couples. The study demonstrates that attachment-related dyadic processes play a role in the development and maintenance of PTSD in traumatized veterans and STS in their wives.
Two hundred and forty seven survivors of institutional abuse in Ireland were classified with the Experiences in Close Relationships Inventory as having fearful (44%), preoccupied (13%), dismissive (27%), or secure (17%) adult attachment styles. The group with the secure adult attachment style had the most positive profile, while the most negative profile occurred for the fearful group in terms of DSM IV diagnoses and scores on the Trauma Symptom Inventory, the Global Assessment of Functioning Scale, the World Health Organization Quality of Life 100 scale, and the Kansas Marital Satisfaction Scale. The profile of the preoccupied group was more similar to that of the fearful group. The profile of the dismissive group was more similar to that of the secure group.
The identification of variables that mediate the relationship between traumatic life events and posttraumatic symptomatology could help elucidate underlying causal mechanisms and improve therapeutic intervention offered to individuals suffering from posttraumatic stress. The authors examined whether adult attachment, as measured by Brennan, Clark, and Shaver's Experiences in Close Relationships Inventory, mediates the relationship between a broad range of traumatic life events and posttraumatic symptomatology. Participants were 224 ethnically diverse college women. Path analysis indicated that attachment anxiety partially mediated the link between intimate partner violence and posttraumatic symptomatology, as well as the link between adolescent or adult sexual victimization and posttraumatic symptomatology. Attachment avoidance, although associated with posttraumatic stress, did not mediate the relationship between traumatic life events and PTSD symptoms.
A new 4-group model of attachment styles in adulthood is proposed. Four prototypic attachment patterns are defined using combinations of a person's self-image (positive or negative) and image of others (positive or negative). In Study 1, an interview was developed to yield continuous and categorical ratings of the 4 attachment styles. Intercorrelations of the attachment ratings were consistent with the proposed model. Attachment ratings were validated by self-report measures of self-concept and interpersonal functioning. Each style was associated with a distinct profile of interpersonal problems, according to both self- and friend-reports. In Study 2, attachment styles within the family of origin and with peers were assessed independently. Results of Study 1 were replicated. The proposed model was shown to be applicable to representations of family relations; Ss' attachment styles with peers were correlated with family attachment ratings.
Two studies examined attachment style differences in social perception. In Study 1, participants wrote open-ended explanations for hypothetical relationship events and described how they would feel and behave in response to each event. Compared with secure participants, preoccupied participants explained events in more negative ways; they also reported more emotional distress and behaviors that were likely to lead to conflict. Avoidant participants also provided negative explanations, but did not report emotional distress. Path analysis indicated that attachment style differences in behavior were mediated by explanation patterns and emotional distress. Study 2 was designed to replicate Study 1 and test the relative importance of attachment style and relationship quality to predicting each outcome. Results indicated that both variables were significant predictors of explanations, but only attachment style predicted emotional responses. These findings are consistent with the idea that adults with different working models of attachment are predisposed to think, feel, and behave differently in their relationships.
This study examines the relationship between adult attachment style and posttraumatic stress symptomatology in a volunteer sample of adults who reported the experience of childhood abuse. Sixty-six individuals completed measures of abuse history, attachment style, and posttraumatic stress symptomatology. Results indicated that 76% of participants endorsed one of the three insecure attachment styles (dismissing, fearful, or preoccupied). Analyses of variances revealed that those who displayed fearful and preoccupied attachment styles, which represent a negative view of the self, had the highest mean scores on posttraumatic symptoms. Correlational analyses revealed a significant positive relationship between negative view of self and posttraumatic stress symptomatology, but not between negative view of other and posttraumatic stress symptomatology. Regression analyses indicated that having a negative view of self was most highly associated with posttraumatic stress symptoms, followed by a history of physical abuse. The regression analysis further indicated that negative view of other was unrelated to posttraumatic stress symptoms.
The aim of this study was to examine the relationships among social support, attachment security, and psychopathology in an adult sample of high risk abuse survivors. Attachment security was conceptualized in terms of two underlying dimensions, the working models of self and other.
Sixty-six participants (24 men and 42 women) who met conditions for physical or sexual abuse were recruited from the greater Boston area. They completed the "Record of Maltreatment Experiences." the "Relationship Scales Questionnaire," the "Norbeck Social Support Questionnaire," and multiple measures of psychopathology.
When multiple risk and protective factors were examined concurrently (e.g., social support, attachment, abuse history, IQ, SES), a negative view of self (one of the attachment poles) was the strongest predictor of overall psychopathology. Social support did not emerge as a significant direct predictor of psychopathology, once the effects of negative view of self were accounted for. However, among participants low on social support, in comparison to those who are high, a negative view of self was more highly correlated with some psychopathology measures.
These findings indicate that among maltreatment survivors, negative view of self emerges as the most substantial predictor of psychopathology when examined in combination with other relevant risk factors.
Numerous languages characterize 'social pain', the feelings resulting from social estrangement, with words typically reserved for describing physical pain ('broken heart', 'broken bones') and perhaps for good reason. It has been suggested that, in mammalian species, the social-attachment system borrowed the computations of the pain system to prevent the potentially harmful consequences of social separation. Mounting evidence from the animal lesion and human neuroimaging literatures suggests that physical and social pain overlap in their underlying neural circuitry and computational processes. We review evidence suggesting that the anterior cingulate cortex plays a key role in the physical-social pain overlap. We also suggest that the physical-social pain circuitry might share components of a broader neural alarm system.
Issue 3 • 1000370` 1000370`J Psychiatry ISSN: 2378-5756 Psychiatry, an open access journal Citation Attachment and Posttraumatic Stress Disorder in Multiple Trauma Samples
- A Elklit
- Ki Karstoft
- Y Lahav
- Te Andersen
Volume 19 • Issue 3 • 1000370` 1000370`J Psychiatry
ISSN: 2378-5756 Psychiatry, an open access journal
Citation: Elklit A, Karstoft KI, Lahav Y, Andersen TE (2016) Attachment and Posttraumatic Stress Disorder in Multiple Trauma Samples. J Psychiatry
19: 370 doi:10.4172/2378-5756.1000370
An empirical lighting and analysis of "emotional numbing" as a possible independent factor in PTSD
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Attachment in Adulthood: Structure, Dynamics, and Change
- M Mikulincer
- Pr Shaver
Mikulincer M, Shaver PR (2007) Attachment in Adulthood: Structure, Dynamics,
and Change. The Guilford Press, New York.
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