Attachment styles, traumatic events, and PTSD: a cross-sectional investigation of adult attachment and trauma

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.     

Attachment insecurity as a mediator of the relationship between childhood trauma and adult dissociation

This study aimed to investigate whether attachment insecurity mediates the relationship between childhood trauma and adult dissociation, specifically with regard to individual forms of childhood maltreatment. Psychiatric outpatients who visited a specialized trauma clinic (n = 115) participated in the study. Data were collected via the Childhood Trauma Questionnaire, Revised Adult Attachment Scale, and Dissociative Experience Scale. Structural equation modeling and path analysis were performed to analyze the mediating effects of attachment insecurity on the relationship between childhood trauma and adult dissociation. Greater childhood trauma was associated with higher dissociation, and the relationship between them was fully mediated by attachment anxiety. In path analysis of trauma subtypes, the effects of emotional abuse, physical abuse, and physical neglect as a child on adult dissociation were found to be fully mediated by attachment anxiety. The effect of sexual abuse on dissociation was mediated by a synergistic effect from both attachment anxiety and attachment avoidance. Regarding emotional neglect, a countervailing interaction was discovered between the direct and indirect effects thereof on dissociation; the indirect effect of emotional neglect on dissociation was partially mediated by attachment insecurity. Specific aspects of attachment insecurity may help explain the relationships between individual forms of childhood trauma and adult dissociative symptoms. Tailored treatments based on affected areas of attachment insecurity may improve outcomes among patients with dissociative symptoms and a history of childhood trauma.     

Attachment styles,earlier interpersonal relationships and schizotypy in a non‐clinical sample

Objectives . This paper investigates associations between adult attachment style, relationships with significant others during childhood, traumatic life‐events and schizotypy. Design . Relationships between attachment and hypothesized correlates were investigated in a cross‐sectional design using an analogue sample. The reliability of the attachment and trauma measures was investigated using a test‐retest design. Methods . Three hundred and four students completed the self‐report version of the Psychosis Attachment Measure (PAM), maternal and paternal versions of the Parental Bonding Instrument, the Attachment History Questionnaire, a measure of trauma and the Oxford‐Liverpool Inventory of Feelings and Experiences scale through an internet website. Results . As predicted, there were statistically significant associations between insecure attachment in adult relationships and experiences of negative interpersonal events. Both earlier interpersonal experiences and adult attachment style predicted schizotypy, and adult attachment style emerged as an independent predictor of positive schizotypal characteristics. Conclusions . The findings support associations between adult attachment style and previous interpersonal experiences and between adult attachment and schizotypy. The PAM is a reliable and valid instrument that can be used to explore attachment styles in analogue samples and associations between attachment styles and psychotic symptoms in clinical samples.     

童年期虐待、依恋与青少年B群人格障碍倾向关系的结构方程模型

目的:探讨儿童期虐待经历和依恋与青少年B群人格障碍倾向的关系模型。方法:采用儿童期虐待问卷(CTQ)、成人依恋问卷(AAQ3.1)和人格诊断问卷(PDQ)B群人格分量表对350名青少年进行调查。结果:相关分析表明除情感忽略与表演型、自恋型,躯体忽略与表演型,情感忽略与父亲依恋无显著相关,其余各因子、各变量间都有不同程度的显著正相关。结构方程模型结果显示,儿童期虐待和依恋对B群人格障碍倾向有显著正向预测作用,儿童期虐待除直接影响B群人格障碍倾向外,还通过依恋间接影响B群人格障碍倾向。结论:儿童期虐待和不安全依恋对B群人格障碍的形成有重要影响。不安全依恋在儿童虐待对B群人格障碍倾向的影响中起部分中介作用。     

Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories

The primary objective of this study was to examine unresolved trauma as assessed by the Adult Attachment Interview and current psychiatric symptoms, focusing on posttraumatic stress disorder (PTSD) and dissociation, in a group of adult female childhood abuse survivors. The authors examined psychiatric symptoms and attachment representations in a group with (n = 30) and without (n = 30) abuse-related PTSD. The findings revealed that unresolved trauma carried a 7.5-fold increase in the likelihood of being diagnosed with PTSD and was most strongly associated with PTSD avoidant symptoms rather than dissociative symptoms. The utility of a PTSD framework for understanding unresolved trauma and the role of intentional avoidance of trauma cues in the maintenance of traumatized states of mind are discussed.     

Attachment style and coping in relation to posttraumatic stress disorder symptoms among adults living with HIV/AIDS

Research indicates that a significant proportion of people living with HIV/AIDS report symptoms of posttraumatic stress disorder (PTSD). Moreover, attachment style has been associated with psychological and behavioral outcomes among persons living with HIV/AIDS. Attachment style may influence the ability to cope with traumatic stress and affect PTSD symptoms. To examine the association between attachment style and coping with PTSD symptoms, we assessed 94 HIV-positive adults on self-report measures of posttraumatic stress, coping, and attachment style. In multiple regression analysis, avoidant attachment and emotion-focused coping were positively and significantly associated with greater PTSD symptomatology. Support was also found for the moderating effects of avoidant and insecure attachment styles on emotion-focused coping in relation to greater PTSD symptoms. Taken altogether, these results suggest that interventions that develop adaptive coping skills and focus on the underlying construct of attachment may be particularly effective in reducing trauma-related symptoms in adults living with HIV/AIDS.     

父母的成人依恋、应对方式与教养方式的关系

目的探讨父母的成人依恋、应对方式与教养方式的关系。方法采用关系问卷、亲密关系经历量表、应对方式量表和教养方式问卷测查某企业233名已为人父母的员工。结果1不同依恋类型的父母在教养方式的过分干涉[F(3,224)=5.09,P0.01]、拒绝和否认[F(3,224)=5.47,P0.01]、惩罚和严厉[F(3,224)=4.54,P0.01]、偏爱孩子[F(3,224)=4.78,P0.01]维度上差异显著,且安全型父母的得分低于不安全型父母;2经回归分析发现,成人依恋和应对方式对教养方式的5个维度有不同的预测作用。结论父母的成人依恋、应付方式对教养方式有一定的影响。     

The transmission of trauma in refugee families: associations between intra-family trauma communication style,children’s attachment security and psychosocial adjustment

This study explores the transmission of trauma in 30 Middle Eastern refugee families in Denmark, where one or both parents were referred for treatment of PTSD symptoms and had non-traumatized children aged 4–9 years. The aim of the study was to explore potential risk and protective factors by examining the association between intra-family communication style regarding the parents’ traumatic experiences from the past, children’s psychosocial adjustment and attachment security. A negative impact of parental trauma on children might be indicated, as children’s Total Difficulties Scores on the Strengths and Difficulties Questionnaire (SDQ) were significantly higher than the Danish norms. A negative association between children’s attachment security as measured by the Attachment and Traumatization Story Task and higher scores on the SDQ Total Difficulties Scale approached significance, suggesting that the transmission of trauma may be associated with disruptions in children’s attachment representations. Furthermore a significant association between parental trauma communication and children’s attachment style was found.     

Attachment organization in Vietnam combat veterans with posttraumatic stress disorder

Attachment organization in a combat-related PTSD sample was investigated and compared with previously published clinical and non-clinical samples. The association between insecure attachment and unresolved mourning classification (U-loss) and between U-loss and PTSD symptoms was investigated. Vietnam combat veterans diagnosed with PTSD and in treatment (N = 48) were administered the Adult Attachment Interview, the SCID-IV, and CAPS. The PTSD sample was like non-clinical samples in the incidence of secure attachment (50%), but were more commonly unresolved. Veterans with insecure attachment organizations were more likely than those with secure attachment to be classified U-loss. U-loss classification was associated with greater likelihood of comorbid anxiety disorders and PTSD avoidance/numbing symptoms. The results suggest that while insecure attachment organization is associated with unresolved mourning in response to loss, it is not differentially associated with combat-related PTSD. The relationship between U-loss and PTSD is discussed in light of current literature.     

Attachment organization in Vietnam combat veterans with posttraumatic stress disorder

Attachment organization in a combat-related PTSD sample was investigated and compared with previously published clinical and non-clinical samples. The association between insecure attachment and unresolved mourning classification (U-loss) and between U-loss and PTSD symptoms was investigated. Vietnam combat veterans diagnosed with PTSD and in treatment (N = 48) were administered the Adult Attachment Interview, the SCID-IV, and CAPS. The PTSD sample was like non-clinical samples in the incidence of secure attachment (50%), but were more commonly unresolved. Veterans with insecure attachment organizations were more likely than those with secure attachment to be classified U-loss. U-loss classification was associated with greater likelihood of comorbid anxiety disorders and PTSD avoidance/numbing symptoms. The results suggest that while insecure attachment organization is associated with unresolved mourning in response to loss, it is not differentially associated with combat-related PTSD. The relationship between U-loss and PTSD is discussed in light of current literature.     

Reliability and validity of the Dutch version of the maternal antenatal attachment scale

In this study, we investigated the psychometric qualities of the Dutch version of the Maternal Antenatal Attachment Scale (MAAS). In a monocentric prospective observational cohort study, 403 expectant mothers completed a booklet with questionnaires in the first (T1), second (T2), and third (T3) pregnancy trimesters. In addition to the MAAS (T1-T3), the following measures were used: the Marlowe-Crowne Social Desirability Scale (T1), the Parental Bonding Inventory (T1), the Relationship Questionnaire (T1) the Facilitator scale and the Regulator scale (T3), the Edinburgh Postnatal Depression Scale (T1-T3) and the Pregnancy Related Anxiety Questionnaire (T1-T3). In this study, the mean of the MAAS scales increased as the pregnancy progressed. Good internal reliabilities were found for the Total MAAS scale, the Quality subscale and the Preoccupation subscale. Small-to-moderate correlations were found with social desirability, maternal orientation, parental care and adult attachment. Maternal mood was weakly associated with the quality but not with the intensity of the maternal attachment feelings. Overall, our findings suggest that the Dutch version of the Maternal Antenatal Attachment Scale is a reliable and valid measure of the early emotional tie between a pregnant woman and her unborn child.     

Erratum to: Reliability and validity of the Dutch version of the Maternal Antenatal Attachment Scale

In this study, we investigated the psychometric qualities of the Dutch version of the Maternal Antenatal Attachment Scale (MAAS). In a monocentric prospective observational cohort study, 403 expectant mothers completed a booklet with questionnaires in the first (T1), second (T2), and third (T3) pregnancy trimesters. In addition to the MAAS (T1-T3), the following measures were used: the Marlowe-Crowne Social Desirability Scale (T1), the Parental Bonding Inventory (T1), the Relationship Questionnaire (T1) the Facilitator scale and the Regulator scale (T3), the Edinburgh Postnatal Depression Scale (T1-T3) and the Pregnancy Related Anxiety Questionnaire (T1-T3). In this study, the mean of the MAAS scales increased as the pregnancy progressed. Good internal reliabilities were found for the Total MAAS scale, the Quality subscale and the Preoccupation subscale. Small-to-moderate correlations were found with social desirability, maternal orientation, parental care and adult attachment. Maternal mood was weakly associated with the quality but not with the intensity of the maternal attachment feelings. Overall, our findings suggest that the Dutch version of the Maternal Antenatal Attachment Scale is a reliable and valid measure of the early emotional tie between a pregnant woman and her unborn child.     

An investigation into the relationship between attachment,gender and recovery from psychosis in a stable community‐based sample

The current study sought to investigate how men and women who experience psychosis represent early bonding experiences, current attachment style and the recovery style adopted. Seventy‐three participants (18 women and 55 men) with a diagnosis of psychosis completed the Parental Bonding Instrument, the Attachment Style Questionnaire and the Recovery Style Questionnaire. Differences were observed between men and women in relation to the nature of insecure attachment styles demonstrated. Significant associations were found between perceptions of parents as uncaring and insecurity in adult attachment style. A greater number of significant associations were found between recollections of early bonding and attachment styles amongst women than men. Men and women did not differ significantly in terms of the recovery style adopted, nor were significant differences found in relation to perceptions of early bonding experiences. Methodological and theoretical issues were considered and directions for future research were suggested. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• Individuals with psychosis are more likely to have lower levels of parental care than the general population.
• This lower parental care is likely to be associated with insecure adult attachment relationships but not recovery style.

     

Profiles of Irish survivors of institutional abuse with different adult attachment styles

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.     

Longitudinal association between adolescent attachment,adult romantic attachment,and emotion regulation strategies

Attachment security towards parents and peers in adolescence, and romantic attachment styles and emotion regulation strategies in young adulthood, were evaluated using an eight-year longitudinal design. Fifty-six young adults completed the Inventory of Parent and Peer Attachment (IPPA) at age 14, and then, at age 22, the Experience in Close Relationships (ECR) and the Coping Inventory for Stressful Situations (CISS), an emotion regulation questionnaire concerning coping strategies, including task-oriented versus emotion-oriented foci. Results indicated that greater insecurity to parents and peers in adolescence predicted a more anxious romantic attachment style and greater use of emotion-oriented strategies in adulthood. Concurrently, anxious adult attachment style was related to more emotion-oriented strategies, whereas an avoidant attachment style was related to less support-seeking. Analyses also identified emotion-oriented coping strategies as a partial mediator of the link between adolescent attachment insecurity to parents and adult anxious attachment, and a complete mediator of the association between adolescent attachment insecurity to peers and adult anxious attachment. These findings support the core assumption of continuity in attachment theory, where relationships to parents influence close romantic relationships in adulthood.     

The Symptoms of Trauma Scale (SOTS): Psychometric evaluation and gender differences with adults diagnosed with serious mental illness

A new clinician rating measure, the Symptoms of Trauma Scale (SOTS), was administered to adult psychiatric outpatients (46 men, 47 women) with severe mental illness who reported a history of trauma exposure and had recently been discharged from inpatient psychiatric treatment. SOTS composite severity scores for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, posttraumatic stress disorder (PTSD), complex PTSD (cPTSD), and total PTSD/cPTSD severity had acceptable internal consistency reliability. SOTS scores’ construct and convergent validity was supported by correlations with self-report measures of childhood and adult trauma history and PTSD, dissociation, and anger symptoms. For men, SOTS scores were associated with childhood sexual and emotional abuse and self-reported anger problems, whereas for women SOTS scores were most consistently and strongly associated with childhood family adversity and self-reported PTSD symptoms. Results provide preliminary support for the reliability and validity of the SOTS with adults with severe mental illness and suggest directions for replication, measure refinement, and research on gender differences.     

Relationship between the Social Cognition and Object Relations Scale (SCORS) and attachment style in a clinical sample

This present study examined the relationship between the Social Cognition and Object Relations Scale (SCORS) and two measures of adult attachment: the Relationship Questionnaire (RQ) and the Experiences in Close Relationships Questionnaire‐Revised (ECR‐R). Forty‐five patients (76% female) at a university‐based outpatient treatment clinic participated in this study. We hypothesized that higher levels of attachment security would be associated with higher, more adaptive ratings on the SCORS variables. Results indicated that the SCORS Self‐Esteem (SE) variable was significantly positively related to the RQ's Secure Attachment ratings and negatively related with the ECR‐R's Anxious Attachment scale. Additionally, negative trends were noted between SE and the RQ's Fearful and Preoccupied Attachment scores. The SCORS Emotional Investments in Relationships and Affective Quality of Representations variables were associated with higher Secure scores and lower, more maladaptive Preoccupied scores on the RQ. It was also associated with greater attachment anxiety as measured by the ECR‐R. Using both clinician (SCORS) and participant‐rated measures (ECR‐R and RQ), this study provides further understanding on how object representations and attachment style relate within a clinical sample. Results are discussed in light of prior research examining relationships between object relations and adult attachments, and clinical implications are also reviewed. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? Individuals with higher levels of attachment anxiety may enter therapy with more self‐image problems. ? Individuals with higher levels of attachment anxiety may enter therapy with more maladaptive expectations about relationships. ? Patients who endorse high levels of attachment anxiety (e.g., fearful and preoccupied) may be more likely to present with Axis II complaints. ? Examining a patient's attachment style and object relations using different measures of assessment (e.g., explicit and implicit) can help gain a deeper and more comprehensive understanding of a patient.     

The Vulnerable Attachment Style Questionnaire (VASQ): an interview-based measure of attachment styles that predict depressive disorder

BACKGROUND: The Vulnerable Attachment Style Questionnaire (VASQ) was developed to provide a brief self-report tool to assess adult attachment style in relation to depression and validated against an existing investigator-based interview (Attachment Style Interview--ASI). This paper describes the development and scoring of the VASQ and its relationship to poor support and major depression. METHOD: Items for the VASQ reflected behaviours, emotions and attitudes relating to attachment relationship style, drawn directly from the ASI. The VASQ was validated against the ASI for 262 community-based subjects. Test-retest was determined on 38 subjects. RESULTS: Factor analysis derived two factors, labelled 'insecurity' and 'proximity-seeking'. The VASQ insecurity dimension had highest mean scores for those with interview-based Angry-dismissive and Fearful styles and was significantly correlated with degree of interview-based insecurity. The proximity-seeking VASQ scores had highest mean for those with Enmeshed interview attachment style and was uncorrelated with ASI insecurity. VASQ scores were highly correlated with a well-known self-report measure of insecure attachment (Relationship Questionnaire) and text-retest reliability of the VASQ was satisfactory. The total VASQ score and the insecurity subscale proved highly related to poor support and to depressive disorder. This was not the case for the proximity-seeking subscale. CONCLUSION: The VASQ is a brief self-report measure that distinguishes individuals with attachment styles vulnerable for depressive disorder. The use of the measure for screening in research and clinical contexts is discussed.     

Attachment organization in Arabic-speaking refugees with post traumatic stress disorder

As a part of an ongoing clinical study of refugees with post traumatic stress disorder (PTSD), the primary objective of the current study was to examine and describe the distribution of adult attachment patterns as assessed by the Adult Attachment Interview (AAI) in Arabic-speaking refugees. A total of 43 adult male and female refugees with Iraqi and Palestinian backgrounds completed the AAI. Sixty-seven percent of the sample was classified as Unresolved with respect to loss or trauma and a substantial proportion of insecure attachment representations (14% Secure-Autonomous, 39% Dismissing, 42% Preoccupied, 5% Cannot Classify) was found, in addition to high intake levels of post traumatic stress symptoms and comorbidity. Findings are compared with AAI studies of other PTSD or trauma samples, and the paper elaborates upon the methodological challenges in administering the AAI in a context of simultaneous translation.     

Relationships among childhood trauma, posttraumatic stress disorder, and dissociation in men living with HIV/AIDS

This study examined the relationships among dissociation, childhood trauma and sexual abuse, and posttraumatic stress disorder (PTSD) symptoms in HIV-positive men. Data were collected from 167 men enrolled in a randomized clinical trial that examined a group therapy intervention to decrease HIV-related risk behavior and trauma-related stress symptoms. Participants completed the Trauma History Questionnaire, the Impact of Events Scale-Revised, and the Stanford Acute Stress Reaction Questionnaire. Overall, 35.3% of the participants reported having experienced childhood sexual abuse. A total of 55.7% of the sample met diagnostic criteria for PTSD. The intensity of dissociative symptoms that participants endorsed was positively associated with experience of childhood sexual abuse (r?=?.20, p < .01). Dissociative symptoms were also positively associated with specific PTSD symptoms, notably hyperarousal (r?=?.69, p < .001). Hierarchical regression indicated that hyperarousal symptoms accounted for more of the variance in dissociation than childhood sexual abuse. These results suggest that childhood sexual abuse may be involved in the development of dissociative symptoms in the context of adulthood stress reactions. Furthermore, the pattern of the association between dissociation and PTSD is consistent with the possibility of a dissociative PTSD subtype among HIV-positive men.