Insecure Attachment Orientations After Sexual Abuse

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The Article Information

Title of the Article and Journal Reference

Murphy, S., Elklit, A., Hyland, P., & Shevlin, M. (2016). Insecure attachment orientations and posttraumatic stress in a female treatment-seeking sample of survivors of childhood sexual abuse: A cross-lagged panel study. Traumatology, 22(1), 48-55. Web.

Abstract of the Study

Adult attachment theory is increasingly being conceptualized within a traumatic framework. However, few studies have examined temporal relationships between insecure attachment orientations (attachment anxiety and attachment avoidance) and symptoms of posttraumatic stress (PTS). PTS refers to symptoms associated with posttraumatic stress disorder (PTSD) in the absence of a clinical diagnosis of PTSD. This prospective study assesses the temporal relations between the 2 attachment dimensions of anxiety and avoidance and PTS among a treatment-seeking sample of female survivors of childhood sexual abuse (CSA). Cross-lagged panel analysis was employed to assess the temporal relations between insecure attachment orientations and PTS using the Revised Adult Attachment Scale (RAAS) and the Harvard Trauma Questionnaire (HTQ). Initial assessment was on average 23 years after the onset of abuse (N 405), and participants were followed up after 6 months (N 245) and 12 months (N 119). PTS levels and insecure attachment declined over the 12-month period. Cross lagged panel analyses indicated that over the longer-term course of PTS, insecure attachment orientations are significantly related to PTS. While these associations were relatively weak in magnitude, temporal relations nevertheless remain. Specifically, attachment avoidance appears to be the more relevant orientation in PTS across the 3 time points in the study. Current results provide insight into the temporal relations between insecure attachment orientations and symptoms of PTS. The findings are discussed in terms of the existing trauma literature.

Literature Review

Past studies which provide the rationale for the current study include studies on attachment theory and traumatic syndrome following childhood sexual abuse. In particular, the researchers note that the quality of the early attachment pattern greatly influences the internal working models (IWM) of self and others, proposed by Bowlby (1973). More recent research supports the notion that early relationships with caregivers and the established attachment pattern are key to emotion regulation and close relationships of individuals in adulthood (Ainsworth, 1978; Collins et al., 2004; Mikulincer & Shaver, 2007). Although attachment patterns are, for the most part formed in childhood, they can also be transformed by later experiences in an individual’s life (Alexander et al., 1998; Mikulincer & Shaver, 2007). The researchers note that survivors of childhood sexual abuse have a 48% to 85% chance of developing PTSD symptoms in their lifetime (Kessler et al., 1995; Roth et al., 1997). Insecure attachment patterns may influence the development of negative IWM’s of self and others, which may also reduce the effectiveness of coping strategies and increase the chance of developing PTSD symptoms (Ein-Dor et al., 2010). The researchers also found that secure attachment has a protective effect on a range of trauma-related symptomatology (Carton-Cortes et al., 2015; Lowell et al., 2014). These findings from the past research became the basis for formulating the research question of the current study.

Adult attachment is considered developmental and social/personality research. The developmental perspective focuses on the adult-child relationship and is measured using the Adult Attachment Interview (AAI), which allows PTSD to be viewed through the category of unresolved trauma (George et al., 1984; Hesse, 2008). The social/personality perspective is measured on the basis of self-reported feelings and emotions regarding an individual’s attachment to current romantic or close relationships. The Harvard Trauma Questionnaire Part 4 (HTQ) designed to measure PTSD symptoms is used as a means of identifying the presence of psychological and physiological reactions to traumatic events (Mollica et al., 1992). Based on the analysis of data obtained from the AAI and HTQ, the researchers identified temporal relations between the attachment patterns and PTSD symptoms.

Methodology

To collect data for the study, the authors used questionnaires and interviews of study participants. They include a questionnaire of 18 questions related to sexual abuse experiences, a list of perpetrators, and the age at which the abuse occurred. Additionally, researchers used the AAI to investigate attachment patterns, and the HTQ was used to identify symptoms of PTSD. The study design is a cross-lagged panel analysis that allows to determine the temporal relations between the two attachment dimensions (anxiety and avoidance) and PTSD symptoms across three time points. The study was correlational as it did not include elements of an experimental study. The independent variable in the study is the two attachment dimensions (anxiety and avoidance); the dependent variable is the manifestation of PTSD symptoms. As part of the study, random assignment was not used, since the participants were not divided into groups. The study did not use experimental control. The study presents correlation coefficients for attachment dimensions and PTSD symptoms. The sample of the study includes 405 consecutive female outpatients at four (now three regional) treatment centers in Denmark that exist for individuals who were sexually abused in childhood. The study population includes child sexual abuse survivors with an active alcohol or drug abuse, psychotic state, massive self-destructive behavior, current treatment elsewhere, or a personality disorder that undergoes childhood sex abuse trauma treatment.

Major Findings of the Study

The main finding of the study was that both the signs of insecure attachment and the symptoms of PTSD decrease over time. Additionally, avoidant attachment individuals have been found to be more vulnerable to the persistence and severity of PTSD symptoms than anxious attachment individuals.

Limitations of the Study

The sample of the study consists of participants undergoing special treatment, which does not allow the generalization of the results to a wider population. Additionally, participants with a number of mental health disorders and substance abuse were excluded from the sample, which further reduces the possibility of generalization. It is not possible within the study to determine the extent to which clinical interventions affect changes in participants’ PTSD symptom presentation. An average of 23 years has elapsed since the episode of childhood sexual abuse in participants, which does not allow us to judge the acute stages of PTSD. Finally, the study did not include studies on the effect of other variables on the presentation of PTSD symptoms in participants.

Credibility

The study is highly credible because it uses a valid research design, reliable sources, and is conducted by current members of the scientific community.

Future Implications

Future research is needed to identify a correlation between attachment type and PTSD symptoms in other traumatized populations. Consideration should also be given to the impact of attachment on PTSD symptoms during more acute stages of the development of the disorder.

Psychological Concepts

This article is important for the field of psychology as it sheds light on the possible influence of attachment type on the development of PTSD symptoms. Additionally, it highlights that avoidant attachment may be a vulnerable factor for the development of PTSD following an experience of childhood sexual abuse.

References

Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum.

Alexander, P. C., Anderson, C. L., Brand, B., Schaeffer, C. M., Grelling, B. Z., & Kretz, L. (1998). Adult attachment and long-term effects in survivors of incest. Child Abuse & Neglect, 22, 45– 61.

Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation, anxiety and anger. New York, NY: Basic Books.

Canton-Cortes, D., Cortes, M. R., & Canton, J. (2015). Child sexual abuse, attachment style, and depression: The role of the characteristics of abuse. Journal of Interpersonal Violence, 30, 420 – 436.

Collins, N. L., Guichard, A. C., Ford, M. B., & Feeney, B. C. (2004). Working models of attachment: New developments and emerging themes. In W. Rholes & J. A. Simpson (Eds.), Adult attachment: Theory, research, and clinical implications (pp. 196 –240). New York, NY: Guilford Press Publications.

George, C., Kaplan, N., & Main, M. (1984). Attachment interview for adults. Unpublished manuscript, University of California, Berkeley.

Hesse, E. (2008). The adult attachment interview: Protocol, method of analysis, and empirical studies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications. Second Edition (pp. 552–598). New York, NY: Guildford Press Publications.

Ein-Dor, T., Doron, G., Solomon, Z., Mikulincer, M., & Shaver, P. R. (2010). Together in pain: Attachment-related dyadic processes and posttraumatic stress disorder. Journal of Counseling Psychology, 57, 317– 327.

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048 –1060.

Lowell, A., Renk, K., & Adgate, A. H. (2014). The role of attachment in the relationship between child maltreatment and later emotional and behavioral functioning. Child Abuse & Neglect, 38, 1436 –1449.

Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York, NY: Guilford Press.

Mollica, R. F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S., & Lavelle, J. (1992). The Harvard trauma questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous and Mental Disease, 180, 111–116.

Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM–IV field trial for posttraumatic stress disorder. Journal of Traumatic Stress, 10, 539 –555.

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