Attachment, Social Cognition, and Posttraumatic Stress Symptoms in a Traumatized, Urban Population: Evidence for the Mediating Role of Object Relations

Abstract

Research has linked multiple risk and resiliency factors to developing posttraumatic stress disorder (PTSD). One potentially important construct for understanding connections between trauma and PTSD is attachment. Although relationships between attachment and risk for PTSD have been described theoretically, limited research has addressed these relationships empirically. Furthermore, aspects of object relations overlap with attachment and PTSD, but have not been adequately incorporated in empirical research. One proposed pathway between attachment and PTSD involves the mediating role of object relations, particularly views of self and others. Present data were from a larger study investigating environmental and genetic risk factors for PTSD in an impoverished, primarily African American sample seeking care at a public urban hospital. Correlations indicated that adult attachment (with the exception of dismissing) and object relations relate to childhood traumas, (|r|s = .19-.29), adult traumas (|r|s = .14-.20), and self-reported PTSD symptoms (|r|s = .20-.36). Analyses also found support for mediational roles of object relations in relationships between attachment and PTSD symptoms (Model R(2) range = .136-.160). These data have theoretical, clinical, and research implications for understanding how particular aspects of attachment, specifically its effects on object relations, may protect against or predispose one to develop PTSD.

The role of attachment characteristics in dialectical behavior therapy for patients with borderline personality disorder

“…BPD patients and HC did not differ in the number of extrafamilial but in the number of intrafamilial trauma, including emotional neglect, physical, or sexual violence. These results correspond with studies demonstrating the relevance of intrafamilial traumatization for the development of unresolved attachment in the context of BPD (Fonagy & Bateman, 2008;Ortigo, Westen, DeFife, & Bradley, 2013). As expected, patients exhibited a significantly greater borderline and global symptom severity (BSL-23, BPI, and BSI) than HC subjects.…”

The relationship between adult attachment style and post-traumatic stress symptoms: A meta-analysis

“…The relationship between adult attachment styles and PTSD symptoms has been examined in many populations, including prisoners of war (Ein-dor, Doron, Mikulincer, Solomon & Shaver, 2010;Mikulincer, Ein-dor, Solomon & Shaver, 2011), veterans (Harari et al, 2009;Nye, Katzman, Bell, Kilpatrick et al, 2008), security workers (Bogaerts, 2009), those experiencing child abuse (Elklit, 2009;Sandberg, 2010), incest (Alexander, 1998), terrorist attacks (Fraley et al, 2006), childbirth (Iles, Slade & Spiby, 2011), and domestic violence (Scott & Babcock, 2010). Results suggest that secure attachment is associated with low PTSD symptoms (Alexander, 1993;Ghafoori, Hierholzer, Howsepian & Boardman, 2008;Ortigo, Westen, DeFife & Bradley, 2013), and insecure attachment is associated with higher PTSD symptoms (Clark & Owens, 2012;Scheidt et al, 2012;Solomon, Dekel & Mikulincer, 2008). However, a few studies do not find this (Elklit, 2009;Guðmundsdóttir, Guðmundsdóttir & Elklit, 2006) and publication bias may mean other null results have not been published.…”

Ontological insecurity II: Relationship to attachment, childhood trauma, and subclinical psychotic‐like experiences

“…Similar developmental models have been proposed in relation to anxiety (Bifulco et al 2006;Warren, Huston, Egeland, & Sroufe, 1997), depression (Bifulco et al, 2006;Fowler, Allen, Oldham, & Frueh, 2013), bipolar disorder (Morriss, van der Gucht, Lancaster, & Bentall, 2009), posttraumatic stress disorder (Ortigo, Westen, Defife, & Bradley, 2013) and personality disorders (Ma, 2006), particularly the borderline (Choi-Kain, Fitzmaurice, Zarnarini, Laverdiere, & Gunderson, 2009;Fongay & Luyten, 2009) and avoidant (Eikenaes, Pedersen, & Wilberg, 2016;Hageman, Francis, Field, & Carr, 2015) types. Furthermore, the utility of attachment theory is demonstrated by a recent meta-analysis of 36 studies involving a total of 3,158 patients with a range of Axis I and Axis II diagnoses: Significantly better outcomes were observed for those with secure (as against insecure) attachment styles, on data collected across various psychotherapeutic orientations (Levy, Kivity, Johnson, & Gooch, 2018).…”