Unresolved Attachment, Ptsd, and Dissociation in Women with Childhood Abuse Histories

Topics: Psychological trauma, Child abuse, Attachment theory Pages: 33 (9992 words) Published: September 1, 2011
Unresolved Attachment, PTSD, and Dissociation in Women With
Childhood Abuse Histories
K. Chase Stovall-McClough and Marylene Cloitre
New York University
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.

Keywords: attachment, unresolved attachment, childhood abuse, posttraumatic stress disorder Until recently, trauma theory and attachment theory have de- veloped along relatively independent lines. Trauma theory and research have proliferated primarily within a cognitive–behavioral framework, whereas attachment theory and research have flour- ished within psychodynamic and developmental disciplines. A

shared dialogue is needed between these scientific communities, however, as there is no empirical work addressing the conse- quences of childhood abuse for both adult attachment organization and psychopathology, particularly traumatic stress symptoms. This is surprising given that a number of studies have begun to suggest an association between childhood trauma, disorganized infant at- tachment, unresolved adult attachment, and clinical symptoms in childhood, adolescence, and early adulthood (e.g., E. A. Carlson, 1998; V. Carlson, Cicchetti, Barnett, & Braunwald, 1989; Lyons- Ruth, Easterbrooks, & Cibelli, 1997). Borrowing from a cognitive model of posttraumatic stress disorder (PTSD) and attachment research on unresolved childhood trauma, this study examines the distribution of unresolved attachment representations in adults with histories of abuse and attempts to promote an integrated understanding of unresolved attachment representations and the potential connection to traumatic stress symptoms.

Background
Childhood abuse has been linked with a variety of poor out-
comes, both in terms of psychiatric symptoms and problematic attachment representation. From a trauma theory perspective, abuse by a caretaker during childhood is a particularly devastating trauma because it occurs during crucial developmental years, when basic capacities for emotion regulation and identity formation are taking shape. In addition, children must cope, often by themselves, with the overwhelming nature of abuse in the context of limited cognitive and psychological resources (e.g., Briere, 1988). In such a setting, psychiatric symptoms, such as PTSD, often develop and endure through adolescence and into adulthood (e.g., Briere, 1988; Browne & Finkelhor, 1986). Without clinical attention, childhood abuse can be associated with lifelong struggles with trauma-related symptoms, including poor affect regulation, hyperarousal, intru- sive reexperiencing, and interpersonal struggles (e.g., van der Kolk & McFarlane, 1996). For instance, as many as 48%–85% of

survivors of childhood abuse show a lifetime prevalence of PTSD (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Roth, New- man, Pelcovitz, van der Kolk, & Mandel, 1997).
It has also been well established in the attachment literature that exposure to childhood abuse has detrimental effects on the attach- ment of children. For instance, maltreated children are more likely to be classified as having a disorganized attachment, with as many as 80% of maltreated children classified as disorganized (V. Carl- son et al., 1989). In turn, disorganized...

References: Adam, K. S., Sheldon-Keller, A. E., & West, M. (1996). Attachment
organization and history of suicidal behavior in clinical adolescents.
American Psychiatric Association. (1994). Diagnostic and statistical man-
ual of mental disorders (4th ed.)
Amir, N., Stafford, J., Freshman, M. S., & Foa, E. B. (1998). Relationship
between trauma narratives and trauma pathology
Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (1993). A psy-
chometric study of the adult attachment interview: Reliability and dis-
Briere, J. (1988). The long-term clinical correlates of childhood sexual
victimization
Briere, J., Elliott, D. M., Harris, K., & Cotman, A. (1995). Trauma
Symptom Inventory: Psychometrics and association with childhood and
Browne, A., & Finkelhor, D. (1986). Impact of child abuse: A review of the
research
Bryant, R. A., & Harvey, A. G. (1995). Avoidant coping style and post-
traumatic stress following motor vehicle accidents
Carlson, E. A. (1998). A prospective longitudinal study of attachment
disorganization/disorientation
Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. G. (1989). Finding
order in disorganization: Lessons from research on maltreated infants’
Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training
in affective and interpersonal regulation followed by exposure: A phase-
based treatment for PTSD related to childhood abuse. Journal of Con-
sulting and Clinical Psychology, 70, 1067–1074.
Cloitre, M., Scarvalone, P., & Difede, J. (1997). Posttraumatic stress
disorder, self- and interpersonal dysfunction among sexually re-
Creamer, M., Burgess, P., & Pattison, P. (1992). Reaction to trauma: A
cognitive processing model
Dozier, M., Stovall, K. C., & Albus, K. E. (1999). Attachment and
psychopathology in adulthood
Dubner, A. E., & Motta, R. W. (1999). Sexually and physically abused
foster care children and posttraumatic stress disorder
Fearon, R., & Mansell, W. (2001). Cognitive perspectives on unresolved
loss: Insights from the study of PTSD
Foa, E. B., & Hearst-Ikeda, D. (1996). Emotional dissociation in response
to trauma: An information-processing approach
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure
to corrective information
Foa, E. B., Molnar, C., & Cashman, L. (1995). Change in rape narratives
during exposure therapy for posttraumatic stress disorder
Fonagy, P., Steele, H., & Steele, M. (1991). Maternal representations of
attachment during pregnancy predict the organization of infant–mother
Frodi, A., Dernevik, M., Sepa, A., Philipson, J., & Bragesjo, M. (2001).
George, C., Kaplan, N., & Main, M. (1996). Attachment Interview for
Adults
community population of older adolescents. Journal of the American
Academy of Child & Adolescent Psychiatry, 34, 1369–1380.
Gray, M. J., & Lombardo, T. W. (2001). Complexity of trauma narratives
as an index of fragmented memory in PTSD: A critical analysis
Halligan, S. L., Michael, T., Clark, D. M., & Ehlers, A. (2003). Posttrau-
matic stress disorder following assault: The role of cognitive processing,
Harvey, A. G., & Bryant, R. A. (1999). Predictors of acute stress following
motor vehicle accidents
Hesse, E. (1996). Discourse, memory, and the Adult Attachment Interview:
A note with emphasis on the emerging cannot classify category
Hesse, E., & van IJzendoorn, M. H. (1998). Parental loss of close family
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