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.
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...
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