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

Graeme Grandison,Mark Shevlin,Julian D Ford,Claire Fyvie,Philip Hyland,Thanos Karatzias,Marylene Cloitre

doi:10.1017/s0954579420001509

Abstract

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.

Highlights

Attachment describes the quality of the interaction between an infant and their primary caregivers
Childhood Trauma Questionnaire (CTQ) scores were associated only with disturbances of self–organization (DSO) symptoms and not posttraumatic stress disorder (PTSD), with higher CTQ scores correlated with higher DSO symptom severity
Preoccupied attachment was not significantly associated with either PTSD or DSO symptoms, and the Wald test indicated that both coefficients did not differ

Summary

Introduction

Attachment describes the quality of the interaction between an infant and their primary caregivers. These early interactions provide the basis for the formation of a secure bond, which when it is internalized can provide a sense of safety at times of distress (Bowlby, 1988). Bartholomew conceptualized adult attachment style in terms of viewing self and others in a positive or negative way based on dimensions of dependency and avoidance. Different combinations of these elements provide four attachment orientation styles including secure, dismissing, preoccupied, and fearful attachment styles (Bartholomew, 1990).

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