Complex trauma of war captivity: a prospective study of attachment and post-traumatic stress disorder

BACKGROUND: 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.MethodThe 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. RESULTS: 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. CONCLUSIONS: 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.     

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 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.     

Secondary traumatization and attachment among wives of former POWs: a longitudinal study

The aim of the present study was to examine the directionality of the association between post-traumatic stress symptoms (PTSS) and attachment insecurities across time among indirect trauma survivors. Wives of former prisoners of war (ex-POWs), with and without post-traumatic stress disorder (PTSD), and comparable controls were assessed 30 (T1) and 38 (T2) years after the Yom Kippur War. As expected, wives of ex-POWs endorsed higher PTSS compared to wives of controls. Wives of ex-POWs with PTSD endorsed higher PTSS and higher attachment avoidance compared to wives of ex-POWs without PTSD and controls. There were significant associations between PTSS and attachment insecurities. Contrary to the hypothesis, the relationship between PTSS and attachment insecurities among wives of ex-POWs was unidirectional, with attachment anxiety at T1 predicting PTSS at T2, and not vice versa. Results indicate that attachment anxiety might act as a risk factor for secondary traumatic reactions.     

Two subjective factors as moderators between critical incidents and the occurrence of post traumatic stress disorders: Adult attachment and perception of social support

This paper presents the result of a research which investigated the influence of the subjective factors ‘adult attachment style’ and ‘perception of social support’ in the occurrence of post traumatic stress disorders (PTSD) in a population of 544 subjects working for a security company and the Belgian Red Cross. The analysis of the results suggests that ‘adult attachment style’ and ‘perception of social support’ moderate between a critical incident and the occurrence of a PTSD. In other words, these independent variables differentiate between individuals who are more, and who are less prone, to suffer from a PTSD after having experienced a critical incident. The results of this research shed light on subjective risk factors related to PTSD. The findings can also suggest guidelines for the treatment of individuals suffering from a PTSD.     

Who stays in addiction treatment groups? Anxiety and avoidant attachment styles predict treatment retention and relapse

Attachment styles have been shown to be an important predictor of relationship quality and well‐being. They have also been linked with ability to function well in groups. Insecure attachment styles are thought to be an underlying cause of addiction and represent a target for change in one‐to‐one therapy. How attachment styles themselves affect group therapy for addiction is understudied. The current study addresses this gap by examining the effects of attachment styles on relapse and treatment retention amongst a population of people attending addiction therapy groups. Fifty‐eight individuals in such groups completed measures of attachment anxiety and avoidance. Participants were followed up 4 weeks later, and their continued treatment attendance and relapse status were recorded. In terms of treatment retention, high anxiety/high avoidant participants had the highest retention. In terms of relapse, low anxiety/high avoidant participants had the lowest rates. These results are discussed in terms of the potentially protective effects of avoidant attachment styles during group therapy and the role of anxiety attachment in the continued maintenance of both protective and risky personal relationships.     

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.     

Trajectories of attachment in older age: interpersonal trauma and its consequences

ABSTRACT

Previous studies suggest that attachment insecurities may increase after trauma exposure, an effect documented only at a group level. This study explores the heterogeneity of changes over time and examines the associations of the nature of the traumatic event (interpersonal and nonpersonal), and its consequences (posttraumatic stress disorder [PTSD] and loneliness) with attachment trajectories. Two groups of Israeli veterans participated: 164 former prisoners-of-war and 185 combat veterans. Attachment was assessed at four points (1991–2015). Risk factors were evaluated in 1991. Using latent growth mixture modeling, trajectories of attachment insecurities were explored. Three avoidance trajectories (stability, decrease, inverse u-shaped) and two anxiety trajectories (stability, decrease) were identified. The inverse u-shaped avoidance trajectory was associated with captivity, humiliation, loneliness, and PTSD, and stable avoidance was associated with loneliness. Stable anxiety was associated with captivity and loneliness. Attachment insecurities can change during aging and persist decades after a trauma. Trauma-related risk factors are related to more deleterious trajectories.     

Staff attachment styles: a pilot study investigating the influence of adult attachment styles on staff psychological mindedness and therapeutic relationships

The attachment styles of psychiatric staff are likely to impact on their capacity to form positive therapeutic relationships with patients with psychosis. Twenty staff completed a measure assessing levels of attachment anxiety and avoidance. Staff and patients completed a measure of patients' interpersonal problems and staff completed the Five-Minute Speech Sample, which was used to derive ratings of psychological mindedness and therapeutic relationships. Higher staff avoidance was associated with greater discrepancies in staff and patient ratings of patients' interpersonal problems and poorer staff psychological mindedness. Lower staff anxiety and avoidance were associated with positive therapeutic relationships. Findings warrant replication in larger samples, but suggest that staff attachment style may be important in the development of better quality staff and patient relationships.     

Psychological adjustment in caregivers of school-age children infected with HIV: stress, coping, and family factors

OBJECTIVE: To assess for significant differences in psychological functioning between caregivers of HIV-infected children and caregivers of healthy children, and to examine the utility of applying a stress and coping model to caregivers of children with HIV disease. METHODS: Participants included caregivers of HIV-infected children (n = 36) and caregivers of a demographically matched control group of healthy children (n = 32). During their child's pediatric clinic visits, caregivers completed measures of psychological adjustment, stress, coping style, and family resources and support. They also completed a measure of their child's psychological adjustment. RESULTS: Caregiver psychological distress scores did not significantly differ between the HIV and control groups, and clinically significant rates of psychological distress were reported by more than a third of caregivers in both groups. Hierarchical multiple regression analyses revealed that independent of their child's illness status, stress and coping style were significant predictors of caregiver's psychological adjustment. In addition, caregiver psychological distress was a significant predictor of children's maladjustment. CONCLUSIONS: High rates of psychological distress were observed in caregivers of children with HIV disease; however, similarly high rates of psychological adjustment problems were found in caregivers of healthy children. Caregivers who reported high levels of daily stress and emotion-focused coping styles tended to report more psychological distress. Further, caregivers who reported more psychological distress also reported more internalizing and more externalizing behavior problems in their children, regardless of the child's illness status. These findings reflect the impact of poverty and environmental stress on caregivers' adjustment.     

Physical fitness and the stress process

In the current paper we focus on the role of physical fitness in the life stress process for both psychological and physical well‐being. The major research question posed in the current study is: Does physical fitness deter distress in a model containing the major components of the life stress process? That is, do individuals who exercise show higher levels of well‐being than those that do not exercise? Is this relationship independent of the stress they experience and the resources they possess? Using data from a representative community sample, the current study finds that physical fitness is directly related to both psychological and physical distress. The more a person exercises, the less psychological and physical symptoms he or she manifests. Physical fitness is associated with decreased distress. This finding holds up, even when stressors and psychosocial resources are included in the model. While physical fitness was not found to mediate the effects of stressors on distress, there was some evidence of a moderating effect of fitness in the stressor–distress relationship, both for psychological and for physical distress. That is, fitness served to buffer the effects of stressors on both psychological and physical distress. In addition, physical fitness is associated with psychological resources that, in turn, are associated with lower levels of distress. The more a person exercises, the greater the self‐esteem. Thus, in addition to directly deterring distress, physical fitness was found to have the potential to indirectly deter distress through its positive association with the level of psychological resources (i.e., self‐esteem) that individuals possess. These and other findings are discussed in the context of the life stress paradigm. Implications for future stress research are presented. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 81–101, 2004.     

Communication avoidance,coping and psychological distress of women with breast cancer

This study examined the relationship between communication avoidance of cancer-related topics with psychological distress, and the mediating role of coping strategies, in women with breast cancer. Women diagnosed with breast cancer (N = 338) completed an online survey including measures of self- and perceived-partner communication avoidance, psychological distress (depression, anxiety and stress), and coping strategies. Linear regression analyses indicated that women’s and perceived-partner’s communication avoidance was associated with anxiety, depression, and stress in the cancer-affected women. Bootstrapping analyses showed significant mediation effects of self- and perceived-partner communication avoidance on all distress outcomes through greater disengagement coping, and on anxiety through lower engagement coping. Emotionally valenced topics (i.e., disease progression and sexuality) were most avoided and practical issues were least avoided. Enhancing couple communication about cancer and women’s adaptive coping skills (i.e., discourage use of disengagement coping strategies and promote use of engagement coping strategies) may be important targets for psychosocial intervention.     

Stability of attachment‐related anxiety and avoidance and their relationships with the five‐factor model and the psychobiological model of personality

Objectives. The stability of attachment‐related anxiety and avoidance and their relationship with influential personality models are issues worth further investigation. Studying discriminant validity with respect to aspects of personality deemed as prevalently heritable, such as temperament, is particularly important. Our aims were to examine the stability of attachment dimensions and to study their relationship with psychological distress, the Big Five factors, and temperament and character dimensions. Methods. The Experiences in Close Relationships (ECR) questionnaire, the State‐Trait Anxiety Inventory (STAI), the Zung depression scale (ZDS), the Temperament and Character Inventory (TCI‐125), and the Big Five Questionnaire (BFQ) were administered to 222 undergraduate and graduate students. After 1 month, 115 participants completed again the ECR, the STAI, and the ZDS. Results. Attachment‐related anxiety was modestly correlated with depression and anxiety, while attachment‐related avoidance was modestly correlated with depression. The test–retest reliability of ECR scores was high. Changes in attachment‐related anxiety were not related to changes in depression or anxiety, and changes in attachment‐related avoidance were modestly correlated with changes in depression. In separate multiple regression models also including gender and age, attachment‐related anxiety was correlated with harm avoidance, reward dependence, low novelty seeking, low self‐directedness and low cooperativeness; low energy/extraversion and low emotional stability; attachment‐related avoidance was correlated with low reward dependence and tended to be correlated with low self‐directedness. Conclusions. These findings corroborate the reliability and the convergent and discriminant validity of the ECR, and support the notion that the attachment dimensions are only modestly related to psychological distress and are not redundant with constructs developed within influential personality models such as the five‐factor model and the psychobiological model.     

Attachment and interpersonal distress: examining the relationship between attachment styles and interpersonal problems in a clinical population

The present study examined the relationship between self‐perceived attachment styles and interpersonal problems. Specifically, we utilized a clinical sample from an outpatient university‐based community clinic who completed the Experiences in Close Relationships Scale‐Revised, the Relationship Questionnaire and Inventory of Interpersonal Problems Circumplex Scales (IIP‐64) as part of a psychological assessment process. The results showed a significant positive correlation between the IIP‐64 total score and both attachment anxiety and attachment avoidance. Findings revealed significant negative relationships between a secure attachment and the dominant, vindictive, cold, socially inhibited and non‐assertive subscales of the IIP‐64. Findings also revealed a significant positive relationship between a fearful attachment and the dominant, vindictive, cold, socially inhibited and non‐assertive subscales of the IIP‐64. Finally, results showed a significant relationship between a dismissive attachment and the dominant subscale of the IIP‐64. Copyright © 2008 John Wiley & Sons, Ltd.     

唐山大地震孤儿远期心身健康的调查研究

目的：探讨遭受唐山大地地震严重精神创伤的孤儿远期心身健康状况。方法：以经受唐山大地震且父母在地震中震亡的孤儿５７例为研究组,对照组断经历唐山大地震的非孤儿４７例,两组之间均完成了唐山大地震童心身健康调查问卷和标准化评定工具的调查、评定和诊断。结果：５７例孤儿中目前有１３例诊断为心理创伤后应激障碍（ＰＴＳＤ）,而对照组中仅有１例,孤儿组ＳＡＳ总分和标准分。ＳＤＳ总分和标准分、ＳＣＬ－９０中阳性项目数     

Predictors of posttraumatic stress disorder symptomatology following bone marrow transplantation for cancer

This study examined the prevalence and predictors of posttraumatic stress disorder (PTSD) symptoms in 70 men and women treated with bone marrow transplantation for cancer. Findings indicated that the number of symptoms present ranged from 0 to a possible high of 17 (M = 3.0, SD = 3.9). As predicted. lower social support and higher avoidance coping I month pretransplant predicted greater PTSD symptom severity an average of 7 months posttransplant. These variables remained significant predictors of symptom severity even after accounting for pretransplant levels of psychological distress. Additional analyses indicated the presence of a significant interaction between social support and avoidance coping, with patients high in avoidance coping and low in social support reporting the most severe symptoms. These findings identify patients at risk for psychological disturbance posttransplant and can serve to guide future intervention efforts.     

A multi-modal approach to the study of attachment-related distress

The present study aimed at providing a comprehensive analysis of individual differences in the regulation of attachment distress as measured through different components of the emotional response, including neuroendocrine reactions, subjectively experienced affect, and proximity seeking behaviour. Emotional responses were measured before, during, and after the induction of attachment distress in a sample of couples. Analyses using multi-level modelling revealed that, in both men and women, attachment anxiety was related to physiological (i.e., cortisol) and subjective emotional distress responses, whereas attachment avoidance most consistently predicted subjective and behavioural responses to distress. In addition to one's own attachment style, partner's attachment style was also found to modulate emotional and behavioural responses to relational stress, in both couple members. Attachment style was also found to moderate the interrelations between emotional indices, revealing interesting information on the regulatory strategies underlying attachment anxiety and avoidance.     

Peritraumatic dissociation as a mediator of peritraumatic distress and PTSD: a retrospective, cross-sectional study

The objective of the present article was to examine the mediational significance of peritraumatic dissociation in the relationship between peritraumatic distress and posttraumatic stress disorder (PTSD). A total of 71 individuals with spinal cord injuries completed interviews and questionnaires measuring PTSD symptomatology, peritraumatic dissociation, and peritraumatic distress. Peritraumatic dissociation was found to partially mediate the relationship between peritraumatic distress and PTSD symptomatology. These findings provide support for the hypothesis that peritraumatic distress and peritraumatic dissociation significantly impact PTSD severity. The findings also support the hypothesis that peritraumatic dissociation is provoked by peritraumatic distress. The results further indicate that although peritraumatic dissociation seems to be a significant risk factor for PTSD, it is not necessary for the development of PTSD; the presence of peritraumatic distress may be sufficient. These findings highlight the importance of investigating peritraumatic reactions after a traumatic event in order to identify individuals at risk for developing PTSD. Such a practice may help prevent the development of chronic conditions.     

Main and Interactive Effects of Anxiety Sensitivity and Physical Distress Intolerance with Regard to PTSD Symptoms Among Trauma-Exposed Smokers

The present study examined the roles of anxiety sensitivity (AS; the tendency to misinterpret physical internal sensations of harmful) and distress tolerance (the capacity to tolerate aversive stimuli) in terms of the expression of posttraumatic stress disorder (PTSD) symptoms among a sample of trauma-exposed, treatment-seeking tobacco smokers (n = 137; M_age = 37.7 years, 48.2% female). It was hypothesized that higher AS and lower physical distress tolerance would interact to predict greater PTSD avoidance and hyperarousal symptoms. Results were partially consistent with this prediction. Specifically, there was a significant interactive effect of AS by physical distress tolerance in terms of PTSD hyperarousal symptom cluster severity. The form of the interaction was in the expected direction, with the highest levels of PTSD hyperarousal symptoms reported among smokers with higher levels of AS and a lower capacity to tolerate physical distress. Findings underscore the importance of considering AS and physical distress tolerance in terms of better understanding mechanisms underlying the expression of PTSD symptoms among trauma-exposed smokers.     

突发公共卫生事件下青少年应激反应与应对方式

目的:分析一起突发公共卫生事件下青少年应激反应的状况及特点,并考察了应对方式对应激反应的作用机制,为开展心理危机干预提供科学依据。方法:采用分层整群抽样,对642名青少年进行应激反应和应对方式调查。结果:青少年应激反应以疑病和焦虑为主,高中生的焦虑显著高于初中生(t=-3.259,P0.05),女生的疑病、焦虑和总分均显著高于男生(t=-3.585,-2.651,-2.266;P0.05),病例多类型学生的焦虑显著高于病例少类型学生(t=-2.591,P0.05);应对方式以处理问题和期望为主,高中生的处理问题、期望、逃避、控制情绪、积极应对和消极应对得分均显著高于初中生(P0.05),女生寻求支持、控制情绪的得分显著高于男生(t=-2.339,-2.121;P0.05),病例多类型学生期望的得分显著高于病例少类型学生(t=2.055,P0.05)。积极应对、消极应对与应激反应之间均呈显著正相关(r=0.140,0.372;P0.001),消极应对对应激反应有显著预测效应(β=0.373,P0.001)。结论:在突发公共卫生事件中应侧重女性青少年的心理状况和低年龄青少年的不良应对方式,心理干预应将消极应对方式的调整和改变作为重点。