Self-Worth as a Mediator Between Attachment and Posttraumatic Stress in Interpersonal Trauma

Abstract

It is well documented that most trauma survivors recover from adversity and only a number of them go on to develop posttraumatic stress disorder (PTSD). In addition, survivors of interpersonal trauma (IPT) appear to be at heightened risk for developing PTSD in comparison to survivors of noninterpersonal trauma (NIPT). Despite a robust association between IPT exposure and attachment disruptions, there is a dearth of research examining the role of attachment-related processes implicated in predicting PTSD. Using a sample of college undergraduates exposed to IPT and NIPT, this study explores the mediating effect of self-worth in the relationship between attachment and PTSD. It is hypothesized that insecure attachment will be related to posttraumatic symptomatology via a reduced sense of self-worth in IPT survivors but not in NIPT survivors. Mediation analyses provide support for this hypothesis, suggesting the importance of considering negative cognitions about the self in therapeutic interventions, particularly those offered to IPT survivors.

Keywords

interpersonal trauma attachment self-worth posttraumatic stress disorder

Get full access to this article

View all access options for this article.

References

Ainsworth

M. S.

Blehar

M. C.

Waters

Wall

(1978). Patterns of attachment: A psychological study of the strange situation. Mahwah, NJ: Lawrence Erlbaum.

Alexander

P. C.

(1993). The differential effects of abuse characteristics and attachment in the prediction of long-term effects of sexual abuse. Journal of Interpersonal Violence, 8, 346-362. doi:10.1177/08862609300800300410.1177/088626093008003004

Bartholomew

(1990). Avoidance of intimacy: An attachment perspective. Journal of Social and Personal Relationships, 7, 147-178. doi:10.1177/026540759007200110.1177/0265407590072001

Benight

C. C.

Bandura

(2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behavior Research and Therapy, 42, 1129-1148. doi:10.1016/j.brat.2003.08.00810.1016/j.brat.2003.08.008

Bifulco

Moran

P. M.

Ball

Lillie

(2002). Adult Attachment Style-II: Its relationship to psychosocial depressive-vulnerability. Social Psychiatry and Psychiatric Epidemiology, 37, 60-67. doi:10.1007/s127-002-8216-x10.1007/s127-002-8216-x

Bowlby

(1982). Attachment and loss. Vol. 1: Attachment. New York, NY: Basic Books. (Original work published 1969)

Bradley

Schwartz

A. C.

Kaslow

N. J.

(2005). Posttraumatic stress disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: Self-esteem, social support, and religious coping. Journal of Traumatic Stress, 18, 685-696. doi:10.1002/jts.2007710.1002/jts.20077

Breslau

Davis

G. C.

Andreski

Peterson

(1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48, 216-222. Retrieved from http://archpsyc.ama-assn.org/

Brewin

C. R.

Andrews

Valentine

J. D.

(2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 5, 748-766. doi:10.1037//0022-006X.68.5.74810.1037//0022-006X.68.5.748

10.

Briere

J. N.

Elliott

D. M.

(1994). Immediate and long-term impacts of child sexual abuse. Future of Children, 4, 54-69. doi:10.2307/160252310.2307/1602523

11.

Browne

Winkelman

(2007). The effect of childhood trauma on later psychological adjustment. Journal of Interpersonal Violence, 22, 684-697. doi:10.1177/088626050730020710.1177/0886260507300207

12.

Carlson

Cicchetti

Barnett

Braunwald

(1989). Disorganized/disoriented attachment relationships in maltreated infants. Developmental Psychology, 24, 525-531.

13.

Cicchetti

Cummings

E. M.

Greenberg

M. T.

Marvin

R. S.

(1990). An organizational perspective on attachment beyond infancy: Implications for theory, measurement, and research. In Greenberg

M. T.

Cicchetti

Cummings

E. M.

(Eds.), Attachment in the preschool years: Theory, research and intervention (pp. 3-49). Chicago, IL: University of Chicago Press.

14.

Cicchetti

Toth

S. L.

(1995). Child maltreatment and attachment organization: Implications for intervention. In Goldberg

Muir

Kerr

(Eds.), Attachment theory: Social, developmental, and clinical perspectives (pp. 279-308). Hillsdale, NJ: Analytic Press.

15.

Coffey

S. F.

Dansky

B. S.

Falsetti

S. A.

Saladin

M. E.

Brady

K. T.

(1998). Screening for PTSD in a substance abuse sample: Psychometric properties of a modified version of the PTSD Symptom Scale Self-Report. Journal of Traumatic Stress, 11, 393-399. doi:10.1023/A:102446750756510.1023/A:1024467507565

16.

Cole

P. M.

Putnam

F. W.

(1992). Effect of incest on self and social functioning: A developmental psychopathology perspective. Journal of Consulting and Clinical Psychology, 60, 174-184. doi:10.1037//0022-006X.60.2.17410.1037//0022-006X.60.2.174

17.

Collins

N. L.

Read

S. J.

(1990). Adult attachment, working models, and relationship quality in dating couples. Journal of Personality and Social Psychology, 58, 644-663. doi:10.1037/0022-3514.58.4.64410.1037/0022-3514.58.4.644

18.

Cook

Spinazzola

Ford

Lanktree

Blaustein

Cloitre

. . . van der Kolk

(2005). Complex trauma in children and adolescence. Psychiatric Annals, 35, 390-398. Retrieved from http://www.psychiatricannalsonline.com/

19.

Crittenden

P. M.

(1997). Patterns of attachment and sexual behavior: Risk of dysfunction versus opportunity for creative integration. In Atkinson

Zucker

(Eds.), Attachment and psychopathology (pp. 47-93). New York, NY: Guilford.

20.

Cuneo

K. M.

Schiaffino

K. M.

(2002). Adolescent self-perceptions of adjustment to childhood arthritis: The influence of disease activity, family resources, and parent adjustment. Journal of Adolescent Health, 31, 363-371. doi:10.1016/S1054-139X(01)00324-X10.1016/S1054-139X(01)00324-X

21.

Ehlers

Clark

D. M.

(2000). A cognitive model of posttraumatic stress disorder. Behavior Research and Therapy, 38, 319-345. doi:10.1016/S0005-7967(99)00123-010.1016/S0005-7967(99)00123-0

22.

Elwood

L. S.

Williams

N. L.

(2007). PTSD-related cognitions and romantic attachment style as moderators of psychological symptoms in victims of interpersonal trauma. Journal of Social and Clinical Psychology, 26, 1189-1209. doi: 10.1521/jscp.2007.26.10.118910.1521/jscp.2007.26.10.1189

23.

Fairchild

A. J.

Finney

S. J.

(2006). Investigating validity evidence for the Experiences in Close Relationships-Revised Questionnaire. Educational and Psychological Measurement, 66, 116-135. doi:10.1177/001316440527856410.1177/0013164405278564

24.

Feeney

J. A.

Noller

(1990). Attachment style as a predictor of adult romantic relationships. Journal of Personality and Social Psychology, 58, 281-291. doi:10.1037//0022-3514.58.2.28110.1037//0022-3514.58.2.281

25.

Foa

E. B.

(1995). Posttraumatic Stress Diagnostic Scale–manual. Minneapolis, MN: National Computer Systems.

26.

Foa

E. B.

Feske

Murdock

T. B.

Kozak

M. J.

McCarthy

P. R.

(1991). Processing of threat-related information in rape victims. Journal of Abnormal Psychology, 100, 156-162. doi:10.1037/0021-843X.100.2.15610.1037/0021-843X.100.2.156

27.

Foa

E. B.

Steketee

Rothbaum

B. O.

(1989). Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behavior Therapy, 20, 155-176. doi:10.1016/S0005-7894(89)80067-X10.1016/S0005-7894(89)80067-X

28.

Fraley

R. C.

Shaver

P. R.

(2000). Adult romantic attachment: Theoretical developments, emerging controversies, and unanswered questions. Review of General Psychology, 4, 132-154. doi:10.1037/1089-2680.4.2.13210.1037/1089-2680.4.2.132

29.

Fraley

R. C.

Waller

N. G.

Brennan

K. A.

(2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350-365. doi:10.1037//0022-3514.78.2.35010.1037//0022-3514.78.2.350

30.

Frazier

P. A.

Tix

A. P.

Barron

K. E.

(2004). Testing moderator and mediator effects in counseling psychology research. Journal of Counseling Psychology, 51, 115-134. doi:10.1037/0022-0167.51.1.11510.1037/0022-0167.51.1.115

31.

Freyd

(1994). Betrayal trauma: Traumatic amnesia as an adaptive response to childhood abuse. Ethics & Behavior, 4, 307-329. doi:10.1207/s15327019eb0404_110.1207/s15327019eb0404_1

32.

Freyd

J. J.

(2009). What is a betrayal trauma? What is betrayal trauma theory? Retrieved from http://dynamic.uoregon.edu/~jjf/defineBT.html

33.

Gold

S. R.

Sinclair

B. B.

Bulge

K. A.

(1999). Risk of sexual revictimization: A theoretical model. Aggression and Violent Behavior, 4, 457-470. doi:10.1016/S1359-1789(98)00024-X10.1016/S1359-1789(98)00024-X

34.

Griffin

Bartholomew

(1994). Models of the self and other: Fundamental dimensions underlying measures of adult attachment. Journal of Personality and Social Psychology, 67, 430-445. doi:10.1037/0022-3514.67.3.43010.1037/0022-3514.67.3.430

35.

Hazan

Shaver

(1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511-524. doi:10.1037/0022-3514.52.3.51110.1037/0022-3514.52.3.511

36.

Huth-Bocks

A. C.

Levendosky

A. A.

Theran

S. A.

Bogat

G. A.

(2004). The impact of domestic violence on mothers’ prenatal representations of their infants. Infant Mental Health Journal, 25, 79-98. doi:10.1002/imhj.1009410.1002/imhj.10094

37.

Janoff-Bulman

(1989). Assumptive worlds and the stress of traumatic events: Applications of the schema construct. Social Cognition, 7, 113-136. doi:10.1521/soco.1989.7.2.11310.1521/soco.1989.7.2.113

38.

Janoff-Bulman

(1992). Shattered assumptions: Towards a new psychology of trauma. New York, NY: Free Press.

39.

Kessler

R. C.

Sonnega

Bromet

Hughes

Nelson

C. B.

(1995). Posttraumatic stress disorder in a national comorbidity survey. Archives of General Psychiatry, 52, 1048-1060. Retrieved from http://archpsyc.ama-assn.org

40.

Kubany

E. S.

(2004). Traumatic Life Events Questionnaire (TLEQ). Los Angeles, CA: Western Psychological Services.

41.

Kubany

E. S.

Haynes

S. N.

Leisen

M. B.

Owens

J. A.

Kaplan

A. S.

Watson

S. B.

Burns

(2000). Development and preliminary valiation of a brief broad-spectrum measure of trauma exposure: The Traumatic Life Events Questionnaire. Psychological Assessment, 12, 210-224. doi:10.1037//1040-3590.I2.2.21010.1037//1040-3590.I2.2.210

42.

Lilly

M. M.

(2011). The contributions of interpersonal trauma exposure and world assumptions in predicting dissociation in undergraduates. Journal of Trauma & Dissociation, 12, 375-392. doi:10.1080/15299732.2011.57376110.1080/15299732.2011.573761

43.

Macdonald

H. Z.

Beeghly

Grant-Knight

Augustyn

Woods

R. W.

Carbral

. . . Frank

D. A.

(2008). Longitudinal association between infant disorganized attachment and childhood posttraumatic stress symptoms. Development and Psychopathology, 20, 493-508. doi:10.1017/S095457940800024210.1017/S0954579408000242

44.

Mikulincer

Florian

Weller

(1993). Attachment styles, coping strategies, and posttraumatic psychological distress: The impact of the Gulf War in Israel. Journal of Personality and Social Psychology, 64, 817-826. doi:10.1037/0022-3514.64.5.81710.1037/0022-3514.64.5.817

45.

Muller

R. T.

Sicoli

L. A.

Lemieux

K. E.

(2000). Relationship between attachment style and posttraumatic stress symptomatology among adults who report the experience of childhood abuse. Journal of Traumatic Stress, 13, 321-332. doi:10.1023/A:100775271955710.1023/A:1007752719557

46.

Norris

(1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 60, 409-418. doi:10.1037//0022-006X.60.3.40910.1037//0022-006X.60.3.409

47.

O’Connor

Elklit

(2008). Attachment styles, traumatic events, and PTSD: A cross-sectional investigation of adult attachment and trauma. Attachment & Human Development, 10, 59-71. doi:10.1080/1461673070186859710.1080/14616730701868597

48.

Owens

G. P.

Chard

K. M.

(2001). Cognitive distortions among women reporting childhood sexual abuse. Journal of Interpersonal Violence, 16, 178-191. doi:10.1177/08862600101600200610.1177/088626001016002006

49.

Ozer

E. J.

Best

S. R.

Lipsey

T. L.

Weiss

D. S.

(2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52-73. doi:10.1037/0033-2909.129.1.5210.1037/0033-2909.129.1.52

50.

Perkonigg

Kessler

R. C.

Storz

Wittchen

H.-U.

(2000). Traumatic events and post-traumatic stress disorder in the community: Prevalence, risk factors, and comorbidity. Acta Psychiatrica Scandinavica, 101, 46-59. doi:10.1034/j.1600-0447.2000.101001046.x10.1034/j.1600-0447.2000.101001046.x

51.

Renaud

E. F.

(2008). The attachment characteristics of combat veterans with PTSD. Traumatology, 14, 1-12. doi:10.1177/153476560831908510.1177/1534765608319085

52.

Resnick

H. S.

Kilpatrick

D. G.

Dansky

B. S.

Saunders

B. E.

Best

C. L.

(1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative sample of women. Journal of Counseling and Clinical Psychology, 61, 984-991. doi:10.1037//0022-006X.61.6.98410.1037//0022-006X.61.6.984

53.

Roberts

J. E.

Gotlib

I. H.

Kassel

J. D.

(1996). Adult attachment security and symptoms of depression: The mediating roles of dysfunctional attitudes and low self-esteem. Journal of Personality and Social Psychology, 70, 310-320. doi:10.1037/0022-3514.70.2.31010.1037/0022-3514.70.2.310

54.

Roche

D. N.

Runtz

M. G.

Hunter

M. A.

(1999). Adult attachment: A mediator between child sexual abuse and later psychological adjustment. Journal of Interpersonal Violence, 14, 184-207. doi:10.1177/08862609901400200610.1177/088626099014002006

55.

Sandberg

D. A.

Suess

E. A.

Heaton

J. L.

(2010). Attachment anxiety as a mediator of the relationship between interpersonal trauma and posttraumatic symptomatology among college women. Journal of Interpersonal Violence, 25, 33-49. doi:10.1177/088626050832912610.1177/0886260508329126

56.

Sibley

C. G.

Fischer

Liu

J. H.

(2005). Reliability and validity of the Revised Experiences in Close Relationships (ECR-R) self-report measure of adult romantic attachment. Personality and Social Psychology Bulletin, 31, 1524-1536. doi:10.1177/014616720527686510.1177/0146167205276865

57.

Silver

R. L.

Boon

Stones

M. H.

(1983). Searching for meaning in misfortune: Making sense of incest. Journal of Social Issues, 39, 81-101. doi:10.1111/j.1540-4560.1983.tb00142.x10.1111/j.1540-4560.1983.tb00142.x

58.

Stovall-McClough

K. C.

Cloitre

(2006). Unresolved attachment, PTSD, and dissociation in childhood abuse histories. Journal of Consulting and Clinical Psychology, 74, 219-228. doi:10.1037/0022-006X.74.2.21910.1037/0022-006X.74.2.219

59.

Sullivan-Hanson

J. M.

(1990). The early attachment and current affectional bonds of battered women: Implications for the impact of spouse abuse on children (Unpublished doctoral dissertation). University of Virginia, Charlottesville.

60.

van Buren

Cooley

E. L.

(2002). Attachment styles, view of self and negative affect. North American Journal of Psychology, 4, 417-430. Retrieved from http://najp.8m.com/

61.

van Oppen

Arntz

(1994). Cognitive therapy for obsessive-compulsive disorder. Behavior Research and Therapy, 32, 79-87. doi:10.1016/0005-7967(94)90086-810.1016/0005-7967(94)90086-8