Adult Attachment as a Mediator of the Link Between Interpersonal Trauma and International Classification of Diseases (ICD)-11 Complex Posttraumatic Stress Disorder Symptoms Among College Men and Women.

Previous research indicates that insecure attachment patterns are associated with interpersonal trauma and posttraumatic symptomatology, and that they mediate various trauma-related symptoms. However, no study to date has examined whether these patterns mediate the link between interpersonal trauma and the newly recognized diagnostic features of complex posttraumatic stress disorder (CPTSD), as published by the World Health Organization (2019) in the 11th version of the International Classification of Diseases (ICD-11). Mediators of CPTSD are important to identify because they can provide a deeper understanding of the condition's etiology. Moreover, if amenable to clinical intervention, they can be targeted to improve treatment effectiveness. The purpose of the present study was to formally test our hypothesis that two underlying dimensions of adult attachment insecurity (i.e., attachment anxiety and avoidance) would mediate the link between interpersonal trauma and ICD-11 CPTSD symptoms. Participants were a culturally diverse sample of 169 college men and women. They completed a modified version of the Life Events Checklist (LEC-5), the revised Experiences in Close Relationships (ECR-R) scale, and the International Trauma Questionnaire (ITQ). Results of path analysis partially supported our hypothesis, indicating that attachment anxiety, but not avoidance, partially mediated the link between interpersonal trauma and PTSD and DSO ("Disturbances in Self-Organization") features of CPTSD. Although longitudinal research is needed, findings suggest that attachment anxiety may contribute to the development and maintenance of CPTSD symptoms following interpersonal trauma. Clinical interventions that help individuals rework and integrate representations of attachment that involve a fear of not being able to access adequate care and protection, and a negative view of self may be particularly useful in ameliorating the symptoms of CPTSD.

Attachment Anxiety as a Risk Factor for Subsequent Intimate Partner Violence Victimization: A 6-Month Prospective Study Among College Women.

Recent research suggests that individuals with attachment difficulties are at increased risk for experiencing intimate partner violence (IPV) victimization. However, most studies conducted on this topic have been cross-sectional, leaving it unclear whether attachment difficulties actually precede this type of violence. The current 6-month prospective study examined the relation between adult attachment and subsequent IPV victimization in a sample of 133 college women. At Time 1, participants completed the Experiences in Close Relationships (ECR) questionnaire to assess the two underlying orthogonal dimensions of adult attachment (anxiety and avoidance) and the Traumatic Life Events Questionnaire (TLEQ) to assess prior exposure to interpersonal traumatic events. At follow-up, participants completed a modified version of the Revised Conflict Tactics Scale (CTS-2) to assess IPV victimization. Results indicated that attachment anxiety was associated with an increased risk for experiencing physical assault during the 6-month follow-up period, even after statistically adjusting for prior interpersonal trauma. In contrast, attachment avoidance was unrelated to subsequent IPV victimization.

Gender differences in attitudinal acceptance of intimate partner violence perpetration under attachment-relevant contexts.

Attachment theory has been one of the leading theoretical frameworks in the last few decades for explaining physical violence within romantic relationships. In this study, the authors examined differences in attachment patterns and attitudinal acceptance of violence perpetrated in romantic relationships among men and women. The Attitudinal Acceptance of Intimate Partner Violence questionnaire was developed to measure acceptance of intimate partner violence (IPV) under attachment-relevant contexts of abandonment, as well as other contexts identified in the literature. Results indicated that men with higher degrees of attachment anxiety were more accepting of both male- and female-perpetrated IPV under contexts of abandonment, and men with higher degrees of attachment avoidance were more accepting of female-perpetrated IPV under contexts of abandonment. Implications for research and treatment are discussed.

Adult attachment as a predictor of posttraumatic stress and dissociation.

This study examined whether K. Bartholomew's (1990) self-report dimensions of adult attachment (secure, dismissing, preoccupied, and fearful) mediate or moderate links from victimization/abuse to posttraumatic stress and dissociation. Participants were 199 college women with and without a history of childhood physical abuse, childhood sexual victimization, and adolescent/adult sexual victimization. Path analysis revealed no significant mediation effects for attachment; however, hierarchical multiple linear regression indicated that dismissing attachment moderated the link between victimization/abuse and posttraumatic stress (i.e., the relationship was strongest for women with high dismissing scores). All 4 attachment dimensions uniquely predicted posttraumatic stress, whereas only fearful attachment uniquely predicted dissociation.

Attachment anxiety as a mediator of the relationship between interpersonal trauma and posttraumatic symptomatology among college women.

The identification of variables that mediate the relationship between traumatic life events and posttraumatic symptomatology could help elucidate underlying causal mechanisms and improve therapeutic intervention offered to individuals suffering from posttraumatic stress. The authors examined whether adult attachment, as measured by Brennan, Clark, and Shaver's Experiences in Close Relationships Inventory, mediates the relationship between a broad range of traumatic life events and posttraumatic symptomatology. Participants were 224 ethnically diverse college women. Path analysis indicated that attachment anxiety partially mediated the link between intimate partner violence and posttraumatic symptomatology, as well as the link between adolescent or adult sexual victimization and posttraumatic symptomatology. Attachment avoidance, although associated with posttraumatic stress, did not mediate the relationship between traumatic life events and PTSD symptoms.

Stalking, threatening, and harassing behavior by psychiatric patients toward clinicians.

The authors surveyed hospital staff to determine how often they had been the target of stalking, threatening, or harassing behavior (STHB) by patients, what strategies they had used to manage the behavior, and their evaluation of various interventions. A written survey about STHB by patients was sent to all clinical staff (N = 82) of the adult inpatient psychiatric service of an urban university hospital. Clinicians who had been the target of such behavior were interviewed about their experiences. Of the 62 staff members who completed the survey, 33 (53%) had experienced some type of STHB during their career. Seventeen of these 33 individuals agreed to be interviewed and provided information about 28 cases of STHB. Staff often rated the behavior as upsetting and disruptive. The frequency with which staff used various management strategies and their perceived effectiveness are described. The results suggest that although severe cases are relatively rare, milder forms of STHB are experienced by a substantial proportion of clinicians and have significant adverse consequences. A variety of management options are available to the clinician when confronted with this situation.