Maladaptive trauma appraisals mediate the relation between attachment anxiety and PTSD symptom severity

Attachment, Mental Health, and Alcohol Use by Men: The Mediating Role of Cumulative Lifetime Violence Severity

Cumulative lifetime violence (CLV) encompasses many different types and contexts of violence that occur across the lifespan and is associated with negative mental health outcomes in men; however, little attention has been paid to other factors that can influence these relationships such as attachment style. In this analysis, our focus is to understand how attachment styles directly and indirectly through CLV affect men's mental health, specifically depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol use. Data from 597 Canadian men with lifetime experiences of violence who participated in our national online survey focusing on violence and health were used for mediation analysis. Results indicated that CLV severity mediated the relationship between attachment anxiety (but not attachment avoidance) and depression, anxiety, PTSD, and alcohol use. Although attachment anxiety and attachment avoidance each directly affected depression, anxiety, and PTSD, neither directly affected alcohol use. Importantly, these findings provide the first evidence that the mechanism by which anxious attachment affects alcohol use is through CLV severity. These findings highlight the importance of anxious attachment on mental health outcomes for men who have experienced CLV.

The Revised Pathogenic Beliefs Scale: A Transtheoretical Measure of Maladaptive Beliefs That Are Associated with Psychological Distress

Pathogenic beliefs are maladaptive cognitive schema that may obstruct a person's ability to achieve meaningful goals in their life. This study sought to revise a previously existing measure of pathogenic beliefs (the Pathogenic Beliefs Scale) by improving the quality of items and separating the ratings of the presence of a pathogenic belief from the distress associated with it. In Study 1 (n = 272), we used item-response theory to identify 21 items from an initial pool of 44 items. In Study 2 (n = 422), we tested the items from Study 1 using confirmatory factor analysis. Study 3 used the combined samples from Study 1 and Study 2 (total n = 528) to compare the revised measure to the Experiences in Close Relationships and the Measure of Parental Style. Results indicate that the revised 21-item PBS has good reliability and convergent validity with related measures, consistent with previous studies of the longer version of the PBS. The 21-item revised PBS is included as supplemental material, and freely available to clinicians and researchers.

Attachment processes in posttraumatic stress disorder: A review of mechanisms to advance theories and treatments

Current conceptualisations of posttraumatic stress disorder (PTSD) are driven by biological, learning, and cognitive models that have shaped current treatments of the disorder. The strong influence of these models has resulted in a relative neglect of social mechanisms that can influence traumatic stress. There is abundant evidence from experimental, observational, and clinical studies that social factors can moderate many of the mechanisms articulated in prevailing models of PTSD. In this review it is proposed that attachment theory provides a useful framework to complement existing models of PTSD because it provides explanatory value for social factors can interact with biological, learning, and cognitive processes that shape traumatic stress response. The review provides an overview of attachment theory in the context of traumatic stress, outlines the evidence for how attachment factors can moderate stress responses and PTSD, and considers how harnessing attachment processes may augment recovery from and treatment of PTSD. This review emphasizes that rather than conceptualizing attachment theory as an independent theory of traumatic stress, there is much to gain by integrating attachment mechanisms into existing models of PTSD to accommodate the interactions between cognitive, biological, and attachment processes.

Perceived parental depression and PTSD in adolescents: mediating roles of attachment insecurity and coping style

Background: Earthquakes can cause negative psychological states in adolescents and their parents, such as post-traumatic stress disorder (PTSD) and depression. Previous cross-sectional studies have shown that adolescents who perceive parental depression after an earthquake are more likely to experience PTSD. However, the mechanism underlying this process remains unclear and previous studies have not examined the association between these factors.Objective: The current study explored the mediating roles of attachment insecurity and coping style in the association between perceived parental depression and PTSD in adolescents after the Jiuzhaigou earthquake.Method: In total, 391 participants completed follow-up questionnaires at 12, 21, and 27 months (T1-T3, respectively) after the Jiuzhaigou earthquake.Results: T1 perceived parental depression was not a direct predictor of T3 PTSD in adolescents. In the full mediation model, T1 perceived parental depression predicted T3 PTSD in adolescents indirectly via T2 attachment insecurities through T2 emotion-focused coping.Conclusion: The findings highlight that attachment insecurity and emotion-focused coping mediated the relationship between perceived parental depression and PTSD in adolescents following an earthquake. To alleviate PTSD in adolescents, efforts should be directed toward reducing perceived parental depressive symptoms and emotion-focused coping, and promoting the formation of secure attachment styles.

Adoption and trauma: Risks, recovery, and the lived experience of adoption

BACKGROUND

Although a very heterogeneous group, adopted persons may present developmental and mental health problems of varying severity. Pre-placement adversity and trauma have often been linked to these problems. It has been also suggested that adoption itself is a psychological trauma, predisposing the individual to emotional difficulties.

OBJECTIVES

This article examines the links between early adversity, trauma, and adoption. We begin by defining trauma and then describe the way in which pre-placement adversity can undermine neurobehavioral and interpersonal functioning, increasing the risk for long-term psychological difficulties. Next, we examine children's recovery when placed in a stable adoptive home. Finally, we explore adoption as a lived experience, highlighting contextual and developmental factors that facilitate the person's positive or negative attributions about being adopted, leading to varying patterns of emotional adjustment.

CONCLUSIONS

Although pre-placement adversity increases adopted individuals' risk for maladjustment, the human brain and behavior are malleable, and placement in a nurturing adoptive home often facilitates recovery from early adversity, with significant heterogeneity in the extent of recovery within and across domains of functioning. While there is no evidence that early adoption is a trauma for the individual, ongoing negative life circumstances, attachment difficulties, and developmentally-mediated attributions about adoption can undermine the person's self-esteem, identity, relationships, and sense of well-being. Conclusions and suggestions for future research are offered.

Childhood trauma, attachment orientation, and complex PTSD (CPTSD) symptoms in a clinical sample: Implications for treatment

Although there has been significant work on the association between posttraumatic stress disorder (PTSD) and attachment orientation, this is less the case for complex PTSD (CPTSD). The primary aim of this paper was to assess the strength of the association between the four adult attachment styles (i.e., secure, dismissing, preoccupied, and fearful) and severity of CPTSD symptoms (i.e., symptoms of PTSD and disturbances in self-organization [DSO]). We hypothesized that attachment orientation would be more strongly associated with DSO symptoms compared to PTSD symptoms. A trauma exposed clinical sample (N = 331) completed self-report measures of traumatic life events, CPTSD symptoms, and attachment orientation. It was found that secure attachment and fearful attachment were significantly associated with DSO symptoms but not with PTSD symptoms. Dismissing attachment style was significantly associated with PTSD and DSO symptoms. Preoccupied attachment was not significantly associated with CPTSD symptoms. Treatment implications for CPTSD using an attachment framework are discussed.

Insecure attachment styles as predictors of posttraumatic growth in a South African student sample

South Africa, as a developing country, is characterized by high levels of crime, partner violence, and other traumatic experiences. Exposure to these traumas may lead to the development of post-traumatic stress disorder or, conversely, post-traumatic growth. Citizens in developing African countries appear to be at risk for the development of insecure attachment styles due to the cumulative effects of socio-economic risk factors. The prevalence of many possible traumatic experiences along with the risk of more insecure attachments set the stage for investigating the impact of insecure attachment on post-traumatic growth. The aim of this study was thus to determine whether two insecure attachment styles, namely anxious and avoidant attachment, were significant predictors of post-traumatic growth. The sample consisted of 233 undergraduate students from a South African university who had experienced a traumatic event. Participants’ ages ranged from 18 to 33 years ( M = 21 years) and were from various ethnic backgrounds (81.5% Black African, 7.7% White, 9% Coloured, and 3.9% Asian/Indian). Two self-report measures were administered via an online survey to assess attachment styles and post-traumatic growth. Results showed that an anxious attachment style was a significant negative predictor of post-traumatic growth. Furthermore, individuals with an avoidant attachment style were significantly less likely to experience post-traumatic growth through relating to others, than along the other domains of post-traumatic growth. The findings contribute by highlighting the importance of considering how insecure attachment styles may impact post-traumatic growth, as this could inform the treatment of trauma victims.

Insecure Attachment to Parents and PTSD among Adolescents: The Roles of Parent-Child Communication, Perceived Parental Depression, and Intrusive Rumination

Based on attachment theory and a social-cognitive model of posttraumatic stress disorder (PTSD), this study examined the roles of parent-child communication, perceived parental depression, and intrusive rumination in the association between insecure attachment to parents and PTSD among adolescents following the Jiuzhaigou earthquake. In this study, 620 adolescents were recruited to complete self-report questionnaires. The results showed that the direct association between anxious attachment and PTSD was significant, but that between avoidant attachment and PTSD was non-significant. In addition, both anxious and avoidant attachment had indirect associations with PTSD via the mediating effects of parent-child communication openness and problems, perceived parental depression, and intrusive rumination. However, the specific paths between anxious and avoidant attachment and PTSD were different. The findings indicated that insecure attachment among adolescents following the earthquake was predictive for their PTSD, and the mechanisms underlying the association between anxious attachment and PTSD and the association between avoidant attachment and PTSD were distinct. To alleviate PTSD, more attention should be paid to improving the quality of parent-child communication for adolescents with avoidant attachment to parents, and to reducing negative cognition in adolescents with anxious attachment.

The roles of attachment and emotion dysregulation in the association between childhood maltreatment and PTSD in an inner-city sample

BACKGROUND

Most people will experience a traumatic event in their lifetime, but only a subset (<10%) will develop posttraumatic stress disorder (PTSD).

OBJECTIVE

To facilitate prevention and intervention of PTSD, it is important to understand how risk and resilience factors interact with one another to explain individual differences in risk for PTSD, especially in underprivileged groups, who often experience greater burden of trauma and PTSD.

METHOD

The current study utilized multiple and moderated regression to examine the relation between childhood maltreatment and adulthood PTSD risk in the context of various attachment patterns and emotion dysregulation in a sample (n = 856) of mostly low-income, African American participants.

RESULTS

Moderation analysis indicated that the strongest association between self-reported childhood maltreatment and PTSD symptoms was manifest in participants reporting the highest levels of both attachment anxiety and attachment avoidance (b = 0.22, 95% CI [0.15, 0.29], p < .001), whereas, among those low on both these dimensions (i.e., more securely attached participants), there was no significant association between childhood maltreatment and current PTSD (b = 0.07, 95% CI [-0.01, 0.14], p = .07). Separately, multiple regression predicting current PTSD symptoms revealed an effect size for the two attachment dimensions similar to that of emotion dysregulation, while controlling for childhood maltreatment.

CONCLUSIONS

These findings suggest more secure attachment may buffer against the deleterious effects of childhood maltreatment, and both attachment difficulties and emotion dysregulation serve as robust correlates of adulthood PTSD.

Attachment Style Moderates Polygenic Risk for Posttraumatic Stress in United States Military Veterans: Results From the National Health and Resilience in Veterans Study

BACKGROUND

A polygenic risk score (PRS) derived from genome-wide association studies of posttraumatic stress disorder (PTSD) may inform risk for this disorder. To date, however, no known study has examined whether social environmental factors such as attachment style may moderate the relation between PRS and PTSD.

METHODS

We evaluated main and interactive effects of PRS and attachment style on PTSD symptoms in a nationally representative sample of trauma-exposed European-American U.S. military veterans (N = 2030). PRS was derived from a genome-wide association study of PTSD re-experiencing symptoms (N = 146,660) in the Million Veteran Program cohort. Using one-sample Mendelian randomization with data from the UK Biobank (N = 115,099), we evaluated the effects of re-experiencing PRS and attachment style on PTSD symptoms.

RESULTS

Higher re-experiencing PRS and secure attachment style were independently associated with PTSD symptoms. A significant PRS-by-attachment style interaction was also observed (β = -.11, p = .006), with a positive association between re-experiencing PRS and PTSD symptoms observed only among veterans with an insecure attachment style. One-sample Mendelian randomization analyses suggested that the association between PTSD symptoms and attachment style is bidirectional. PRS enrichment analyses revealed a significant interaction between attachment style and a variant mapping to the IGSF11 gene (rs151177743, p = 2.1 × 10^-7), which is implicated in regulating excitatory synaptic transmission and plasticity.

CONCLUSIONS

Attachment style may moderate polygenic risk for PTSD symptoms, and a novel locus implicated in synaptic transmission and plasticity may serve as a possible biological mediator of this association. These findings may help inform interpersonally oriented treatments for PTSD for individuals with high polygenic risk for this disorder.

Policymakers as safe havens: The relationship between adult attachment style, COVID-19 fear, and regulation compliance

The COVID-19 crisis has caused severe psychological distress. Governments have been trying to fight the outbreak, inter alia, by enacting various restrictions to maintain social distancing. However, compliance with restrictions depends upon different interpersonal variables. The present study focused on the relationship between attachment patterns, fear of COVID-19, and adherence to COVID-19 guidelines. Participants completed the ECR measure to assess their adult attachment style, in addition to a COVID-19 fear and guidelines compliance questionnaire. We suggest that anxious attachment patterns may be related to heightened fear of COVID-19. Although fear and guideline adherence were positively correlated, secure attachment patterns were correlated to higher adherence than insecure attachment patterns.

The Differential Effects of Insecure Attachment on Post-Traumatic Stress: A Systematic Review of Extant Findings and Explanatory Mechanisms

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.

The relationship between posttraumatic stress disorder, trauma centrality, interpersonal sensitivity and psychiatric co-morbidity among students in Kazakhstan: a Latent Class Analysis

BACKGROUND

Trauma can lead to trauma centrality and affect levels of interpersonal sensitivity and psychiatric co-morbidity. Whether a coexisting relationship between posttraumatic stress disorder (PTSD) and trauma centrality can influence levels of interpersonal sensitivity and psychiatric co-morbidity among university students from Kazakhstan is unknown.

AIM

To investigate the impact of the aforementioned co-existing relationship on interpersonal sensitivity and psychiatric co-morbidity among Kazakh university students.

METHODS

597 students (F = 428, M = 169) completed questionnaires measuring PTSD, psychiatric co-morbidity, interpersonal sensitivity, and trauma centrality.

RESULTS

28%, 32% and 40% met the criteria for full, partial and no-PTSD, respectively. Latent Class Analysis revealed a three-class solution: Class 1 (the altered-self group) with a low level of PTSD but a high level of trauma centrality, Class 2 (the traumatized-self group) with high levels of PTSD and trauma centrality and Class 3 (the low symptom group) with low levels of PTSD and trauma centrality. There were significant differences in the levels of interpersonal sensitivity and psychiatric co-morbidity across three classes.

CONCLUSION

There are individual differences in the display of posttraumatic stress disorder symptoms, and trauma centrality. These differences can influence interaction with others and psychological distress.

Attachment and social support mediate associations between Polyvictimization and psychological distress in early adolescence

The current study assesses associations between multiple experience of traumatic events (polyvictimization), PTSD symptoms (PTSS) and psychiatric symptoms in early adolescence, and explores the mediating roles of attachment orientations and perceived social support in the associations between polyvictimization, PTSS and psychiatric symptoms. In 2001, a representative national sample of 390 Danish eighth-graders (M = 13.95, SD = .37) completed validated self-report questionnaires. Polyvictimization was related to higher PTSS and psychiatric symptoms. Importantly, polyvictimization was significantly linked to high attachment anxiety, which was linked with low perceived social support, which in turn was linked with high PTSS levels and psychiatric symptoms. Polyvictimization might have dire consequences in early adolescence. An individual's high attachment anxiety might be connected with lack of perceived social support, which should be seen as a possible psychological distress mechanism subsequent to exposure to a number of potentially traumatic events.

Posttraumatic Stress Disorder and Psychiatric Co-morbidity among Syrian Refugees of Different Ages: the Role of Trauma Centrality

It has been documented that trauma centrality is associated with posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among Syrian refugees. Whether age would influence the levels of the above constructs and the association between trauma centrality and distress outcomes is unclear. This study compared age differences in 1) the levels of trauma centrality, posttraumatic stress disorder and psychiatric co-morbidity, and 2) models depicting the association between trauma centrality and distress outcomes among Syrian refugees. One thousand one hundred and ninety-seven refugees completed the Centrality of Event Scale, Harvard Trauma Questionnaire and General Health Questionnaire-28. Age groups were divided into young, middle-aged adults and adults of 45 or above. No significant group differences were found in the proportion of refugees meeting the diagnostic criteria for PTSD. Controlling for demographic variables, all subscales of trauma centrality and psychiatric co-morbidity were significantly different between groups. Young adults reported significantly less trauma centrality and psychiatric co-morbidity than the other groups. Multiple-indicator multiple-cause modelling showed that trauma centrality was significantly correlated with PTSD and psychiatric co-morbidity. Multi-group analysis showed the model for the young adult group to be significantly different from the middle-aged group model. To conclude, age did not seem to influence the severity of PTSD among Syrian refugees. The war had a less severe impact on young adults' sense of self and other psychological problems than those who were older. The way in which young and middle-aged adults responded to distress varied depending on environment and personal characteristics.

Posttraumatic stress disorder and relationship functioning: A comprehensive review and organizational framework

Posttraumatic stress disorder (PTSD) is associated with impairments in relationship functioning. Beyond the abundance of research that has demonstrated this basic link, more recent research has begun to explore possible mediators and moderators of this association. The present paper reviews and synthesizes existing literature in the context of an overarching organizational framework of potential ways in which PTSD impacts relationship functioning. The framework organizes findings in terms of specific elements of PTSD and comorbid conditions, mediators (factors that are posited to explain or account for the association), and moderators (factors that are posited to alter the strength of the association). Specific symptoms of PTSD, comorbid symptoms, and many of the potential mediators explored have extensive overlap, raising questions of possible tautology and redundancy in findings. Some findings suggest that non-specific symptoms, such as depression or anger, account for more variance in relationship impairments than trauma-specific symptoms, such as re-experiencing. Moderators, which are characterized as individual, relational, or environmental in nature, have been the subject of far less research in comparison to other factors. Recommendations for future research and clinical implications of the findings reviewed are also presented.

Understanding posttrauma reactions within an attachment theory framework

The purpose of this paper is to review recent research on posttrauma reactions (i.e., posttraumatic stress disorder [PTSD] symptoms and self-reported posttraumatic growth [PTG]) using attachment theory as a framework. Attachment orientations are significantly related to PTSD symptoms: insecure attachment orientations (particularly attachment anxiety) are positively associated with PTSD symptoms whereas attachment security is negatively associated with PTSD symptoms. Although associations appear to be reciprocal, research typically focuses on insecure attachment orientations predicting PTSD symptoms and the possible mechanisms of those relations, particularly a lack of social support. Some trauma characteristics (e.g., trauma severity) also appear to moderate the association between attachment and PTSD symptoms. Research on attachment orientations and PTG, however, has yielded mixed results. More rigorous methods are needed to better understand the role of attachment orientations in actual growth from pre to post-trauma.

Psychological and clinical correlates of the Centrality of Event Scale: A systematic review

The Centrality of Event Scale (CES) was introduced to examine the extent to which a traumatic or stressful event is perceived as central to an individual's identity and life story, and how this relates to Posttraumatic Stress Disorder (PTSD) symptoms. In addition, the CES has been examined in relation to a range of other conditions and dispositions. We present a systematic review of the correlates of the CES. Results from 92 publications resulted in 25 measurement categories in the six theoretical domains of trauma, negative affect and distress, autobiographical memory, personality, positive affect, and gender. The mean weighted correlations of the 25 measurement categories ranged from -.17 to .55, with standard errors from .01 to .02, allowing us to distinguish empirically among effects. Consistent with the theoretical motivation for the CES and predictions predating the review, the CES correlated positively with a range of measures, correlating most highly with measures related to trauma, PTSD, grief, and autobiographical memory. The findings show that the CES probes aspects of autobiographical memory of broad relevance to clinical disorders, and with specific implications for theories of PTSD.

Posttraumatic Stress Among Syrian Refugees: Trauma Exposure Characteristics, Trauma Centrality, and Emotional Suppression

OBJECTIVES

This study revisited the prevalence of posttraumatic stress disorder (PTSD) and examined a hypothesized model describing the interrelationship between trauma exposure characteristics, trauma centrality, emotional suppression, PTSD, and psychiatric comorbidity among Syrian refugees.

METHODS

A total of 564 Syrian refugees participated in the study and completed the Harvard Trauma Questionnaire, General Health Questionnaire (GHQ-28), Centrality of Event Scale, and Courtauld Emotional Control Scale.

RESULTS

Of the participants, 30% met the cutoff for PTSD. Trauma exposure characteristics (experiencing or witnessing horror and murder, kidnapping or disappearance of family members or friends) were associated with trauma centrality, which was associated with emotional suppression. Emotional suppression was associated with PTSD and psychiatric comorbid symptom severities. Suppression mediated the path between trauma centrality and distress outcomes.

CONCLUSIONS

Almost one-third of refugees can develop PTSD and other psychiatric problems following exposure to traumatic events during war. A traumatized identity can develop, of which life-threatening experiences is a dominant feature, leading to suppression of depression with associated psychological distress.

The relationship between trauma centrality, self-efficacy, posttraumatic stress and psychiatric co-morbidity among Syrian refugees: Is gender a moderator?

This study examined the inter-relationship between trauma centrality, self-efficacy, posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among a group of Syrian refugees living in Turkey, and whether gender would moderate the mediational effect of self-efficacy on the impact of trauma centrality on distress. Seven hundred and ninety-two Syrian refugees completed the Harvard Trauma Questionnaire, General Health Questionnaire-28, Centrality of Event Scale and Generalized Self-Efficacy Scale. The results showed that 52% met the cutoff for PTSD. Trauma centrality was positively correlated with PTSD, psychiatric co-morbidity and self-efficacy. Self-efficacy was negatively correlated with PTSD only. Gender did not moderate the mediational effect of self-efficacy on the path between trauma centrality and distress outcomes. To conclude, following exposure to traumatic events, more than half reported PTSD. Perception of the future and identity construction was affected. Signs of psychological distress were evident, alongside resilience, regardless of gender.