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Attachment-related trauma and posttraumatic stress disorder: Implications for adult adaptation
... Attachment theory identifies infancy as a critical period for developing a secure attachment, suggesting that infants are more vulnerable to attachment disruption (Bowlby, 1973). It is proposed that as infants are more reliant on their parents for survival, they are more likely to perceive IPV as a threat (Kobak, Cassidy, & Zir, 2014). In addition, infants are likely to spend more time with caregivers and have closer proximity to them, compared to children and adolescents. ...
... As children become older, they are likely to spend more time at school or away from their parents, which may buffer the risk of an insecure attachment (Kalil, Ryan, & Corey, 2012). In addition, older children are likely to have an established attachment with their caregivers, alongside having likely developed the cognitive capacity to distinguish between IPV as a threat to their caregiver, and a threat to the self (Kobak et al., 2014). These factors may therefore decrease their risk of an insecure attachment developing in the context of IPV. ...
... This is consistent with attachment theory identifying infancy as a critical period for developing attachment (Bowlby, 1973). It is also consistent with the notion that infants are more dependent on primary caregivers and therefore more likely to experience IPV as a threat (Kobak et al., 2014). It is likely that older children have developed the cognitive ability to distinguish between a threat to a primary caregiver and a threat to the self, thus having a lower risk for attachment disruption. ...
Background: Intimate Partner Violence (IPV) is associated with increased risk of impairment to a child’s emotional, behavioural, and psychological functioning. Further, the presence of IPV is negatively associated with a child’s attachment to their primary caregivers, which is an additional risk factor for social, emotional, and psychological impairment.
Objective: The aim of this systematic review and meta-analysis was to synthesise the evidence on the association between IPV and the attachment of infants, children, and adolescents to their primary caregiver/s.
Method: A systematic review was completed, in accordance with the PRISMA statement, on IPV and the parent-child attachment of infants, children, and adolescents (18 years and younger). Meta-analyses were conducted to estimate the magnitude of these associations.
Results: A total of 15 studies were included. IPV was significantly associated with less secure child attachment. The pooled effect sizes (Pearson’s r) for both longitudinal studies (n=5) and cross-sectional and retrospective studies combined (n=10) were small (r=-.22, 95% CI [-.32,-.12], p<.001; r=-.10, 95% CI [-.203, -.001], p=.048). Subgroup analyses identified that the effect size was larger when IPV and attachment were measured during infancy compared to childhood, and when attachment was measured via observational methods compared to self-report.
Conclusion: While the current literature base is limited, findings can inform further research alongside clinical assessment and intervention. It can also help guide attachment- and family-based intervention for families impacted by IPV.
... As such, an emerging body of research suggests that within the context of caregiving relationships, both Criterion A events that involve an immediate threat of danger (e.g., physical or sexual maltreatment) and non-Criterion A events (e.g., extended separation from a caregiver, loss of a caregiver, perceived emotional abandonment by a caregiver when in need of comfort) may be perceived as overwhelming, dysregulating, and traumatic to youth (Kobak et al., 2004;Spinazzola et al., 2021). Both sets of events are defined by a perceived threat to the availability or trustworthiness of an attachment figure, which may be experienced as a threat to psychological survival through the eyes of children due to their ultimate reliance on that attachment figure for resources and support (Kerig, 2017;Kobak et al., 2004;. ...
... As such, an emerging body of research suggests that within the context of caregiving relationships, both Criterion A events that involve an immediate threat of danger (e.g., physical or sexual maltreatment) and non-Criterion A events (e.g., extended separation from a caregiver, loss of a caregiver, perceived emotional abandonment by a caregiver when in need of comfort) may be perceived as overwhelming, dysregulating, and traumatic to youth (Kobak et al., 2004;Spinazzola et al., 2021). Both sets of events are defined by a perceived threat to the availability or trustworthiness of an attachment figure, which may be experienced as a threat to psychological survival through the eyes of children due to their ultimate reliance on that attachment figure for resources and support (Kerig, 2017;Kobak et al., 2004;. Given the salience of parent-child relationship quality on moral development (i.e., moral emotions and behavior), AT may also have moral implications as well; research suggests that youth exposed to ATs involving Criterion A events (e.g., physical abuse) as well as those that do not fit Criterion A (e.g., neglect) subsequently exhibit maladaptive alterations in moral development and behavior (Koenig et al., 2004). ...
Research on trauma- and stressor-related disorders has recently expanded to consider moral injury, or the harmful psychological impact of profound moral transgressions, betrayals, and acts of perpetration.
Largely studied among military populations, this construct has rarely been empirically extended to children and adolescents despite its relevance in the early years, as well as youths’ potentially heightened
susceptibility to moral injury due to ongoing moral development and limited social resources relative to adults. Application of the construct to young persons, however, requires theoretical reconceptualization
from a developmental perspective. The present paper brings together theory and research on developmentally-oriented constructs involving morally injurious events, including attachment trauma, betrayal trauma, and perpetration-induced traumatic stress, and describes how they may be integrated and extended to inform a developmentally-informed model of moral injury. Features of such a model include identification of potentially morally injurious events, maladaptive developmental meaning-making processes that underlie moral injury, as well as behavioral and emotional indicators of moral injury among youth. Thus, this review summarizes the currently available developmental literatures, identifies the major implications of each to a developmentally-informed construct of moral injury, and presents a conceptual developmental model of moral injury for children and adolescents to guide future empirical research. https://rdcu.be/ct2b5
... In both studies the ACE scale did not include physical or sexual abuse to avoid overlapping of events in the assessment of the number of negative events. A similar level of association may also be due to the fact that the items considered on the ACEs questionnaire include extremely threatening experiences, which can be simultaneously and highly associated with both PTSD and DSO symptoms (Cicchetti, 2016;Kobak et al., 2004). Effects such as those mentioned are consistent with the conceptualisation of CPTSD (Cloitre, 2021;Courtois & Ford, 2009;Maercker et al., 2013) and the available evidence showing an association between these experiences and the DSO symptoms of CPTSD Karatzias et al., 2017Karatzias et al., , 2021. ...
Background
ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) are stress-related disorders. The International Trauma Questionnaire (ITQ) is a widely used instrument to assess PTSD and CPTSD. To date, there is no evidence of the psychometric characteristics of the ITQ in Latin American countries.
Objective
The aim of this study was to assess the construct and concurrent validity of the Latin American Spanish adaptation of the ITQ in a sample of Chilean adults.
Methods
A sample of 275 Chilean young adults completed the ITQ, a traumatic life events checklist, the Adverse Childhood Experiences Questionnaire, the Depression Anxiety Stress Scales-21, and the Columbia-Suicide Severity Rating Scale short version. Four alternative confirmatory factor analysis models were tested. Correlation analyses were performed to determine concurrent validity with associated measures (number of reported traumatic events, number of adverse childhood experiences, anxiety, depression, and suicidal risk).
Results
The second-order two-factor (PTSD and DSO) and the correlated first-order six-factor model provided acceptable fit; however, the first model showed a better fit based on the BIC difference. The PTSD and DSO dimensions, as well as the six ITQ clusters showed positive correlations with reported number of traumatic life-events, reported number of adverse childhood experiences, levels of anxiety, depression, and suicidal risk.
Conclusions
The ITQ Latin American Spanish adaptation provides acceptable psychometric evidence to assess PTSD and CPTSD in accordance with the ICD-11.
... However, the present study is guided by the theory that these associations may be especially evident among pregnant people who experienced attachment-related traumas. Attachment trauma is defined broadly as any traumatic experience that is perpetrated by someone close or trusted and threatens the integrity of the attachment relationship (George & West, 2012;Kobak et al., 2004). Attachment trauma is not isolated to childhood but can occur across the lifespan, such as with close and trusted individuals during adulthood. ...
Separate literatures have demonstrated that mothers' experiences with trauma during childhood or pregnancy are associated with maternal prenatal health risks, adverse childbirth outcomes, and offspring internalizing and externalizing disorders. These literatures largely align with the intergenerational transmission or fetal programming frameworks, respectively. However, few studies have tested the effects of maternal childhood and prenatal trauma simultaneously on mothers' and infants' health outcomes, and no studies have examined these effects on newborn neurobehavioral outcomes. Thus, in the present study, we examined how the developmental timing of pregnant women's traumatic life experiences associated with their physical health and psychopathology (Aim 1) as well as their newborns' birth and neurodevelopmental outcomes (Aim 2; for pre-registered aims and hypotheses, see https://osf.io/ygnre/?view_only=cbe17d0ac7f24af5a4d3e37e24eebead). One hundred and fifty-two 3rd trimester pregnant women (Mage = 29 years; 17.1% Hispanic/Latina) completed measures of trauma history and psychopathology. Then, 24-48 h after birth, trained clinicians conducted newborn neurobehavioral exams (n = 118 newborns; 52.6% female). Results indicated that lifetime traumatic experiences associated with multiple prenatal maternal health outcomes, including depression, anxiety, emotion dysregulation, and pregnancy complications. Pregnant women's experiences with childhood trauma, but not adulthood or prenatal trauma, predicted higher neurobehavioral attention scores among female newborns. Our discussion highlights the importance of considering the developmental timing of maternal trauma on perinatal outcomes and contextualizes our findings within the intergenerational transmission and fetal programming literatures. DATA AVAILABILITY: Data pertaining to R01MH119070 (MPIs Crowell & Conradt) and that support these findings are uploaded to the NIMH repository.
... Kobak and colleagues (2004) describe four separate types of attachment-related trauma, including prolonged or unanticipated separation from an attachment figure, abuse or neglect perpetrated by an attachment figure, abandonment or isolation from an attachment figure, or losing an attachment figure through death. Although some attachment-related traumas may not appear to meet the definition of a potentially traumatic event according to the criteria outlined in the Diagnostic and Statistical Manual (DSM-5; American Psychiatric Association, 2013), when viewed from the perspective of a child or adolescent, many scholars have argued that attachment-related traumas may very well impose serious fear or perceived threat of bodily harm (Bowlby, 1973;Kerig, 2017;Kobak et al., 2004;van der Kolk et al., 2009). Attachment-related trauma exposures are common among youth involved in the CW system (Kisiel et al., 2014), as well as justice-involved populations. ...
Previous research has provided robust evidence demonstrating that a notable proportion of youth become involved in both the child welfare (CW) system and the juvenile justice (JJ) system, a population often referred to as crossover youth. Prior work has identified a number of risk factors associated with crossing over between these systems. However, there are limitations to the extant literature, key among which is a lack of systematic attention to the influence of trauma exposure and posttraumatic sequelae on the crossover trajectory. In contrast, viewing this research through a trauma-informed lens promises to enhance our ability to integrate findings across studies and to derive theoretically derived hypotheses about underlying mechanisms which will better inform future research and the development of effective prevention and intervention efforts. Accordingly, the purpose of this article is to present a trauma-informed research agenda that would strengthen future research in the field. After providing a brief critique of the existing studies that has documented known risk factors associated with the crossover population, we outline ways in which future research could apply relevant theoretical trauma-informed approaches, including developmental traumatology, to further advance our knowledge of risk factors and mechanisms associated with the crossover trajectory. We conclude by discussing policy and system-wide implications related to the proposed research agenda.
... An individual who experienced abusive or maltreating interactions or the death of a loved person, may be categorized as disorganized/unresolved through the AAI classification. The signs of reexperiencing the trauma, the increased arousal, the avoidance of memory, the indications of disbelief may show evidence of disorientation and disorganization during the AAI, even when the individual does not meet the criteria for a diagnosis of PTSD (Kobak, Cassidy, & Zir, 2004). ...
We aimed to assess changes in the attachment internal working model and reflective function (RF) as mechanisms of change in eye movement desensitization and reprocessing (EMDR) treatment for patients with traumatic memories. Twenty adult female patients with parenting and relational problems participated in the study. Attachment organization was assessed with the Adult Attachment Interview (AAI) and the RF coding scale pre- and posttreatment. We found that EMDR therapy increased patients' narrative coherence and RF. We noted a significant decrease in the number of participants classified as unresolved following the course of EMDR treatment in which loss and/or trauma were resolved. This article summarizes the changes after EMDR therapy regarding attachment status and its efficacy to reprocess early traumatic memories in a more adaptive way. Finally, our results also support the usefulness of the AAI as a tool for understanding the changing processes during a therapeutic treatment.
... Research also has implicated specific kinds of traumatic experiences in adolescent risk-taking. In particular, youth who have experienced attachment traumas (Kobak, Cassidy, & Zir, 2004) such as parental maltreatment, neglect, or abandonment are more likely than their peers to engage in risky sexual behaviors (Bornovalova et al., 2008;Puffer et al., 2012). For example, a longitudinal study by Hentges, Shaw, and Wang (2017) found that maternal rejection in early childhood was associated with elevated levels of risky sexual behavior and aggression at ages 15 and 22. ...
A substantial body of research confirms that trauma exposure predicts adolescent involvement in the justice system, although the mechanisms accounting for this association are not well understood. The most recent revision of the Diagnostic and Statistical Manual (DSM‐5; American Psychiatric Association, 2013, Washington, DC) diagnosis of posttraumatic stress disorder introduced a new symptom, that of
“self‐destructive or risky behavior,” which may have particular relevance to understanding posttraumatic reactions in the adolescent period and the processes by which trauma becomes associated with offending. The present article reviews evidence supporting the link between trauma exposure and self‐harming or recklessness and outlines
theories that propose biological and psychological functions of these behaviors, which can be understood as representing the proposed construct of posttraumatic risk‐seeking. Implications for future research and interventions with traumatized youth are discussed.
Attachment Trauma (AT) is a known clinical heuristic in Psychology. However, different perspectives on it have emerged, leading to heterogeneity and confusion. In pursuit of clarity, this paper aims to navigate the perspectives surrounding AT through an integrative review. The review identifies six distinct lines of research. The initial three, falling under the attachment research tradition, include 1. Infant disorganized attachment, 2. Unresolved/disorganized adult states of mind, and 3. Adult fearful attachment in personality Psychology. The subsequent three, falling under the trauma research tradition, encompass 4. Complex Post Traumatic Stress Disorder (cPTSD), 5. Early adverse experiences, and the 6. Biological correlates of trauma. By elucidating the commonalities and disparities between these research programs the paper underscores how they seem to converge on the core concept of AT. Ultimately, a new definition of AT is put forward: “varying and long-lasting biological, psychological, and relational consequences resulting from incomplete encoding and integration of emotionally overwhelming experiences within an attachment relationship”. The definition is explained in depth, highlighting how AT may be framed as a diverse set of adaptations, rather than a diagnosis, that may nevertheless lead to maladjustment and increased risk of psychopathology. Moreover, it is argued that the biological and evolutionary nature of the attachment bond is what distinguishes the AT concept from its alternatives (e.g.,relational trauma, betrayal trauma) in terms of solidity and explanatory power.
The exposure of children and adolescents to trauma is one of the most important public health challenges. These childhood experiences play a role in children’s attachment patterns with their parents and peers. The objective of this study was to examine the relationship between exposure to trauma and the degree of attachment representations in school-aged children in Burundi. One hundred thirteen vulnerable children aged 7 to 12 years were recruited and referred by their teachers. We used an event list including the post-traumatic reaction index to measure their exposure to traumatic events and the People in My Life instrument to measure attachment representations. The results revealed that the children had experienced or witnessed at least one traumatic event. The results indicated that secure attachment representations were highest among children with their parents and lowest among children with their peers. The relationship between trauma experiences and children’s attachment representations was significant with their parents and with their peers. Children’s attachment representations with their parents and peers predicted their traumatic experiences. Future research should focus on how attachment relationships can facilitate counselors and clinicians in providing preventive psycho-education to adults and children to develop healthier functioning, through better knowledge of the complex interplay between traumas.
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