Secure Attachment Moderates the Relation of Sexual Trauma With Trauma Symptoms Among Adolescents From an Inpatient Psychiatric Facility

Environmental and Genetic Contributions to Attachment in Late Adolescence and Young Adulthood

Adverse childhood experiences (ACEs) have been linked with attachment insecurity and psychopathology. However, some individuals remain securely attached and resilient following ACEs. Researchers have examined polymorphisms in the oxytocin receptor gene (OXTR), particularly rs53576, as a source of resilience, though examination of the biological mechanism by which rs53576 buffers the relation that would otherwise exist between ACEs and attachment insecurity is absent. The aim of the current study was to examine how ACEs interact with individual genetic and immune vulnerability to shape attachment security in older adolescents and young adults (n = 201). Moderated mediational models were tested in which ACEs acted as independent variables, attachment security acted as a dependent variable, inflammation (i.e., IL-6) was tested as a mediator, and rs53576 (i.e., AA, AG, GG genotypes) was tested as a moderator. Results indicated that physical abuse was significantly associated with decreased attachment security, with moderation by rs53576. A significant main effect of rs53576 on IL-6 was also noted. A similar pattern of results was evident across other ACEs and suggests that the effects of ACEs on attachment are buffered by the GG genotype. Association between GG and lower IL-6 suggests inflammation plays some role, though more research is needed.

Trauma-related symptoms in adolescents: the differential roles of sexual abuse and mentalizing

Introduction

Major gaps remain in our knowledge regarding childhood sexual abuse (CSA) related symptoms in adolescent psychiatric inpatients, as well as potential resilience factors like mentalizing. CSA is a risk factor for the early emergence of borderline personality features, posttraumatic stress, and sexual concerns. Mentalizing, which involves the capacity to understand our reactions and that of others in psychological terms, is a resilience factor for self and interpersonal functioning. The aim of this study was to address knowledge gaps by examining the contributions of CSA and mentalizing in a latent factor composed of borderline personality features, posttraumatic stress, and sexual concerns in a sample of adolescent psychiatric inpatients. We hypothesized that CSA and mentalizing would independently explain the variance in this latent factor.

Method

Participants were 273 adolescents aged 12-17 recruited from an adolescent inpatient psychiatric clinic. They completed the Reflective Function Questionnaire for Youth (RFQ-Y), the Trauma Symptom Checklist for Children (TSCC), and the Borderline Personality Features Scale for Children (BPFS-C). CSA was assessed using the Child Attachment Interview (CAI), the Computerized Diagnostic Interview Schedule for Children (C-DISC), as well as the Childhood Trauma Questionnaire (CTQ).

Results

27.5% of adolescent psychiatric inpatients reported CSA. CSA and mentalizing were independently associated with a latent factor consisting of posttraumatic stress, borderline personality features, and sexual concerns. CSA explained 5.0% and RF explained 16.7% of the variance of the latent factor. When we consider both the unique and the shared contribution of CSA and mentalizing, the model explained 23.0% of the variance of this factor.

Discussion

CSA and mentalizing independently explained variance in a latent factor constituted of borderline personality features, posttraumatic stress, and sexual concerns. The direct effect of mentalizing was stronger and mentalizing explained comparatively more variance of trauma-related symptoms in adolescent psychiatric inpatients. The findings are consistent with the theory that mentalizing is an internal resilience factor in adolescent psychiatric inpatients. By implication, clinical interventions focused on promoting the development of mentalizing, such as Mentalization Based Treatment, may palliate mental health difficulties manifested by adolescent psychiatric inpatients including those associated with CSA.

Post-traumatic-stress in the context of childhood maltreatment: pathways from attachment through mentalizing during the transition to parenthood

Introduction

This study aimed to clarify the role of mentalizing in pathways from attachment to Post Traumatic Stress Symptoms (PTSS) in survivors of childhood maltreatment (CM). We focused on the transition to parenting, a critical period for reworking parenting representations to reduce intergenerational maltreatment cycles.

Method

Study participants included 100 pregnant CM survivors. We assessed PTSS with the SCID and attachment and mentalizing with the Adult Attachment Interview (AAI), which was rated for Attachment and Reflective Functioning (RF).

Results

Regarding Re-experiencing trauma symptoms, the results of the path analysis were consistent with mediation. CM survivors' mentalizing about their early relationships with their parents (RF-Other) directly impacted Re-experiencing trauma symptoms, and attachment had an effect on Re-experiencing trauma symptoms through mentalizing (RF-Other). Regarding Arousal/Reactivity symptoms, the results of the pathways analysis were consistent with partial mediation by mentalizing about early relationships with parents (RF-Other). In addition to the pathway from attachment via mentalizing (RF-Other) to Arousal/Reactivity, the pathway between attachment and Arousal/Reactivity also remained significant.

Discussion

This study provides new evidence of a mentalizing and attachment model of PTSS in CM survivors. The findings indicate that increased mentalizing about early relationships with parents is an important process associated with lower PTSS. Finally, we discuss the implications of developing interventions for CM survivors to reduce PTSS. Scaffolding the development of mentalizing regarding attachment relationships in which CM occurred may help CM survivors reduce the intrusion of traumatic memories and decrease trauma-related arousal and reactivity symptoms. Interventions to help CM survivors mentalize regarding parents and attachment relationships in which trauma occurred may be particularly important during the transition to parenting when activation of representations of parenting can trigger PTSS.

Patterns of Mother, Father, and Peer Attachment Quality as Moderators of Child Maltreatment Risk for Depression and PTSD Symptoms in Adolescent Females

Child maltreatment (CM) is a robust risk factor for adolescent depressive and post-traumatic stress disorder (PTSD) symptoms. Quality attachment relationships have been posited as a protective factor but findings are equivocal and studies have not adequately considered the complex network of interpersonal relationships that adolescents rely on. The current study applied a person-centered approach to (a) identify subgroups of adolescent females characterized by distinct patterns of attachment quality with peers, fathers, and mothers and (b) determine if the effect of maltreatment on depressive and PTSD symptoms varied as a function of distinct patterns of attachment quality. Data came from a prospective, longitudinal cohort study of 464 racially diverse and adolescent females designed to examine the developmental sequelae of substantiated CM (260 maltreated and 204 demographically matched, nonmaltreated comparisons). Latent profile analysis (LPA) revealed four profiles of attachment characterized by: (a) above-average attachment quality across all three relationships (N = 207, 44.6%); (b) below-average quality with father and friends and above-average quality with mothers (N = 128, 27.6%); (c) below-average quality across all three relationships (N = 106, 22.9%); and (d) very low-(-1 SD) quality with mothers and above-average quality with fathers and friends (N = 23, 5.0%). Moderation models revealed that cumulative maltreatment exposure resulted in greater adolescent depressive symptoms only for those with a profile of attachment consisting of very low-quality maternal attachment and high-quality father and friend attachments. Profiles did not significantly moderate the effect of maltreatment on PTSD symptoms. Results identify subgroups of maltreatment survivors most vulnerable to the development of depression in adolescence. Such groups should be targets for the provision of finite clinical resources with clinical interventions that seek to promote healthy maternal attachment relationships to mitigate the impact of maltreatment on depression.

Testing the role of inflammation in the relation of childhood maltreatment and suicidal ideation among young adults

BACKGROUND

In recent years, the prevalence of suicidal ideation among young adults has been on the rise, with childhood maltreatment thought to partially explain this disparity. Systemic inflammation-a product of over-activation of the body's stress response system-has been hypothesized to play a predictive role in the development of suicidal ideation. Enduring childhood maltreatment can lead to systemic inflammation, possibly accounting for suicidal ideation's increased prevalence among young adults who have a history of childhood maltreatment.

METHODS

The current study sought to investigate the importance of childhood maltreatment as a static risk factor for downstream suicidal ideation in young adulthood with the immunological response (i.e., systemic inflammation) to childhood maltreatment serving as a mediating factor.

RESULTS

Systemic inflammation was found to be positively associated with suicidal ideation, supporting the unique role systemic inflammation may play in the pathogenesis of suicidal ideation, though hypotheses regarding childhood maltreatment were not supported.

CONCLUSION

This study provides novel insight into a potential immunobiological model for suicidal ideation development in young adult populations.

Advancement in the child attachment interview and the child and adolescent reflective functioning scale using a PDM-2 framework: case reports

The Child Attachment Interview (CAI) is a well-established semi-structured interview, widely used to identify attachment representations in middle childhood and adolescence. The application of the Child and Adolescent Reflective Functioning Scale (CRFS) to CAI narratives allows for an assessment of child mentalization, considered a strong predictor of attachment security. The 2^nd edition of the Psychodynamic Diagnostic Manual (PDM-2) includes CAI and CRFS as valid and reliable assessment measures in order to assess the dominion of the Mental Functioning axis. The aim of the present paper is to investigate the informative power of CAI and CRFS for the overall understanding of mental functioning and personality in a PDM-2 framework. The present report includes the discussion of two clinical cases of school-aged children in applying the Psychodiagnostic Chart-Second Edition (PDC-2) to the CAI transcript. The first case concerns a young male, aged 10, suffering from Oppositional-Provocative Disorder (externalizing disorder), while the second case concerns a young female, aged 15, suffering from Somatic Symptoms Disorder (internalizing disorder). PDC-2 for children and adolescents was used. Data from the scoring of CAI and CRFS were combined with a systematic evaluation of the qualitative contents emerging from CAI transcripts. A detailed analysis suggests that both the CAI and CRFS are useful attachment-oriented measures, able to explore child’s mental states, and together with the application of PDC-2 they provide an essential contribution in the understanding of developmental psychopathology. Implications of this innovative approach for clinical assessment, treatment design, and interventions are further discussed.

Inflammatory and environmental contributions to social information processing

It appears that social information processing is negatively affected by inflammation, but extant research is primarily experimental and comes from laboratory-based manipulations of inflammatory states. We aimed to examine interactions between inflammation, stressful life events, and positive memories of childhood relations with parents in relation to social information processing in 201 adults. We hypothesized that increased inflammation and stressful life events would be associated with greater hostile social information processing, but that positive memories of childhood relations with parents would moderate both relations. Results indicated that high IL-6 levels and stressful life events were significantly associated with direct and hostile social information processing. Positive memories of childhood relations with parents attenuated the link between stressful life events and social information processing. Findings suggest that both immune function and environmental stressors are related to social information processing and that positive memories of childhood relations exert some buffering effect.

Post-traumatic Stress Disorder in Sexually Abused Children: Secure Attachment as a Protective Factor

The aim of the present study was to examine the hypothesis that attachment and childhood sexual abuse (CSA) interacted such that school aged CSA survivors with insecure attachment to parents would be at an elevated risk of developing post-traumatic stress disorder (PTSD) and trauma symptoms. Participants (n = 111, ages 7-12) comprised two groups, child CSA survivors (n = 43) and a matched comparison group of children (n = 68) recruited from the community. Children completed the Child Attachment Interview (CAI) as well as the Trauma Symptom Checklist for Children (TSCC). There was a significant interaction between sexual abuse history and attachment security, such that sexually abused children with insecure attachment representations had significantly more PTSD and trauma symptoms than sexually abused children with secure attachment to parents. The findings show that using a dual lens of attachment and CSA can facilitate the identification of children most at risk and has important implications for understanding risk and resilience processes.

Child Sexual Abuse as a Unique Risk Factor for the Development of Psychopathology: The Compounded Convergence of Mechanisms

Meta-analytic, population cohort, prospective, and clinical studies provide systematic evidence that child sexual abuse accounts for unique variation in several deleterious outcomes. There is strong evidence for psychiatric disorders, including posttraumatic stress disorder and mood, anxiety, and substance use disorders, and mixed evidence for personality disorders. Evaluation of sex-specific outcomes shows strong evidence for teenage childbearing, sexual revictimization, and sexual dysfunction and mixed evidence for heightened sexual behaviors and sexual offending. This review further demonstrates not only that survivors suffer the noxious impact of traumatic sexualization but that additional transdiagnostic mechanisms, including the biological embedding of stress, emotion dysregulation, avoidance, and insecure attachment, converge to compound risk for deleterious outcomes. A road map to enhance the rigor of future research is outlined, and specific recommendations for evidence-based policy making to boost prevention efforts and increase access to treatment are discussed.

Get secure soon: attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy

Severe posttraumatic stress symptoms (PTSS) are connected to a variety of health-related and interpersonal problems, among them are the insecure attachment orientations. However, psychotherapy seems to improve not only PTSS but also attachment insecurities. In a large multicenter, randomized clinical trial, the attachment characteristics and PTSS of 85 adolescents and young adults (aged 14-21 years) with clinically relevant abuse-related PTSS were assessed at study entry, at the end of treatment, and 3 months after the end of treatment. Participants were randomized either to a developmentally adapted cognitive processing therapy (D-CPT) or to a wait-list with treatment advice (WL/TA). The purpose of the study was to analyze the association between PTSS and attachment at study entry as well as changes in attachment during the trial. We found that attachment-related avoidance (AR avoidance) was positively associated with PTSS from both self-reports and clinician ratings, whereas attachment-related anxiety (AR anxiety) was only related to self-reported PTSS (Pearson correlation coefficients between 0.37 and 0.46). Changes in AR anxiety occurred in both conditions at some point during the study (baseline to 3-month follow-up effect size was d = 0.60 for D-CPT and d = 0.44 for WL/TA) whereas for AR avoidance, only participants in D-CPT improved significantly (baseline to 3-month follow-up effect size was d = 0.75). The results indicate that PTSS and attachment are connected. Positive changes in attachment insecurities brought about by trauma-focused psychotherapy seem possible.Trial registration: German Clinical Trials Register (DRKS); Germanctr.de; identifier: DRKS00004787; date of registration: 18 March 2013.

Convergence in Reports of Adolescents' Psychopathology: A Focus on Disorganized Attachment and Reflective Functioning

Although convergence in parent-youth reports of adolescent psychopathology is critical for treatment planning, research documents a pervasive lack of agreement in ratings of adolescents' symptoms. Attachment insecurity (particularly disorganized attachment) and impoverished reflective functioning (RF) are 2 theoretically implicated predictors of low convergence that have not been examined in the literature. In a cross-sectional investigation of adolescents receiving inpatient psychiatric treatment, we examined whether disorganized attachment and low (adolescent and parent) RF were associated with patterns of convergence in adolescent internalizing and externalizing symptoms. Compared with organized adolescents, disorganized adolescents had lower parent-youth convergence in reports of their internalizing symptoms and higher convergence in reports of their externalizing symptoms; low adolescent self-focused RF was associated with low convergence in parent-adolescent reports of internalizing symptoms, whereas low adolescent global RF was associated with high convergence in parent-adolescent reports of externalizing symptoms. Among adolescents receiving inpatient psychiatric treatment, disorganized attachment and lower RF were associated with weaker internalizing symptom convergence and greater externalizing symptom convergence, which if replicated, could inform assessment strategies and treatment planning in this setting.

Linguistic Analysis as a Method for Assessing Symptoms After Sexual Trauma Among Female Adolescent Psychiatric Inpatients

Using a sample of female psychiatric inpatient adolescents, the current study aimed to extend this literature to an adolescent sample for the first time by examining if linguistic markers and their subcategories (cognitive process words, pronoun use, and somatosensory detail) in a trauma account are related to trauma symptomology and recovery during inpatient care. Results indicated that greater use of body words and fewer insight words were related to increased trauma symptoms at admission. In addition, use of fewer cognitive process words at admission predicted greater symptom change at discharge, extending previous research findings to an adolescent sample. Findings suggest that linguistic analysis may be an important component of adolescent trauma symptom assessment and treatment monitoring.

Artificial neural network coding of the child attachment interview using linguistic data

Assessing attachment in adolescents is important due to relations between insecurity and psychopathology. The child attachment interview (CAI) holds promise in this regard, but is time-consuming to code, which may render it inaccessible. The aim of this study was to develop computerized neural network models to predict attachment classifications on the CAI and to determine whether the models could achieve the CAI's benchmark qualification of 80% on reliability training cases. Four hundred and ninety interviews from inpatient adolescents served as model training and testing samples. The CAI's 30 standard reliability cases were treated as the independent holdout sample, in which the performance of the final models was evaluated against the 80% benchmark. Models demonstrated moderate accuracy and high correct classification rates, as compared to human coders. Performance was poorer when models were applied to the reliability training cases, but automated coding of the CAI holds promise for future development.

The Child Attachment Interview: A Narrative Review

Attachment theory promoted an impressive body of research on the psychic developmental processes, resulting in studies on both typical and atypical development. Much of the diffusion of the attachment theory in the clinical field was related to the design of reliable instruments to evaluate the organization of attachment in infancy as well as in adulthood. Until recently, the lack of a suitable instrument to assess attachment in middle childhood as well as in adolescence hindered the expansion of research in these developmental phases during which the parent-child relationship takes on a different, albeit still crucial, role. The Child Attachment Interview (CAI), a measure that was recently designed to assess attachment at a representational level in middle childhood and adolescence, filled the measurement gap. The aim of the current review was to summarize previous empirical investigations concerning CAI in order to (a) provide an overview of the state of current research, (b) identify unanswered questions, and (c) propose future research directions. A narrative review was conducted to map the current research findings by searching for the term “Child Attachment Interview” in the Medline, Scopus, Web of Science, and PsychINFO databases, followed by a search in Mendeley. Limits were set to exclude dissertations, chapters in books, and qualitative or theoretical papers, while empirical studies were included if they used the CAI and were published in English language, peer-reviewed journals by July, 2016. The review, which ultimately included 39 studies meeting the criteria, showed that the CAI is a reliable instrument to assess attachment organization in clinical and non-clinical samples, thus providing a worthwhile contribution to the investigation of the influence of the parent-child relationship beyond infancy and early childhood. Nevertheless, the review pointed out a number of relevant open issues, the most critical of which concerned the CAI coding and classification system. In particular, some relevant questions arose about (a) how opportune it would be to maintain a distinct classification for mother and father, (b) coding challenges regarding both the father and the Preoccupied and Disorganized classification, and finally (c) the advantage of a dimensional vs. a categorical approach.