Experiencing sexual trauma has been linked to internalizing and externalizing psychopathologies. Insecure attachment has been shown to moderate the relation between sexual trauma and trauma symptoms among adults. However, few studies have explored relations among sexual trauma, attachment insecurity, and trauma symptoms in adolescence, and none have used developmentally appropriate measures. The present study sought to examine attachment security as a potential moderator of the relation between having a history of sexual trauma (HST) and trauma symptoms among adolescents at an inpatient psychiatric facility. Attachment to caregivers was measured by the Child Attachment Interview (CAI) and trauma symptoms by the Trauma Symptoms Checklist for Children (TSCC). HST was assessed with responses to two separate interviews that asked about traumatic experiences: the Computerized Diagnostic Interview Schedule for Children (C-DISC) and the CAI. Moderation analyses were conducted using univariate General Linear Modeling (GLM). Of the 229 study participants, 50 (21.8%) had a HST. The relation between HST and trauma symptoms was significantly moderated by insecure attachment with both mother, F(1, 228) = 4.818, p = .029, and father, F(1, 228) = 6.370, p = .012. Specifically, insecurely attached adolescents with a HST exhibited trauma symptoms at levels significantly greater than securely attached adolescents with a HST and adolescents with no HST. Results are consistent with previous research that suggests secure attachment may protect against the development of trauma symptoms among those who have experienced a sexual trauma.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
2.
AspelmeierJ. E.ElliottA. N.SmithC. H. (2007). Childhood sexual abuse, attachment, and trauma symptoms in college females: The moderating role of attachment. Child Abuse & Neglect, 31, 549-566. doi:10.1016/j.chiabu. 2006.12.002
3.
BaileyH.MoranG.PedersonD. R. (2007). Childhood maltreatment, complex trauma symptoms, and unresolved attachment in an at-risk sample of adolescent mothers. Attachment & Human Development, 9, 139-161. doi:10. 1080/14616730701349721
4.
BernsteinD. P.FinkL.HandelsmanL.FooteJ. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. The American Journal of Psychiatry, 151, 1132-1136.
5.
BriereJ. (1996). Trauma Symptoms Checklist for Children: Professional manual. Odessa, FL: Psychological Assessment Resources.
6.
BriereJ. (2004). Psychological assessment of child abuse effects in adults. In WilsonJ. P.KeaneT. M. (Eds.), Assessing psychological trauma and PTSD (2nd ed., pp. 538-564). New York, NY: Guilford Press.
7.
BriereJ.KaltmanS.GreenB. L. (2008). Accumulated childhood trauma and symptom complexity. Journal of Traumatic Stress, 21, 223-226. doi:10.1002/jts.20317
8.
CarrettaC. M.BurgessA. W. (2013). Symptom responses to a continuum of sexual trauma. Violence and Victims, 28, 248-258.
9.
CicchettiD. (2006). Development and psychopathology. In CicchettiD.CohenD. J. (Eds.), Developmental psychopathology, Vol. 1: Theory and method (2nd ed., pp. 1-23). Hoboken, NJ: John Wiley.
10.
CicchettiD.RogoschF. A. (1997). The role of self-organization in the promotion of resilience in maltreated children. Development and Psychopathology, 9, 797-815. doi:10.1017/S0954579497001442
11.
CicchettiD.TothS. L. (2005). Child maltreatment. Annual Review of Clinical Psychology, 1, 409-438. doi:10.1146/annurev.clinpsy.1.102803.144029
12.
CicchettiD. V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6, 284-290. doi:10.1037/1040-3590.6.4.284
13.
CohenJ. (1977). Statistical power analysis for the behavioral sciences (Rev. ed.). Hillsdale, NJ: Lawrence Erlbaum.
14.
CohenJ. A.MannarinoA. P.DeblingerE. (2006). Treating trauma and traumatic grief in children and adolescents. New York, NY: Guilford Press.
15.
CorcoranJ.PillaiV. (2008). A meta-analysis of parent-involved treatment for child sexual abuse. Research on Social Work Practice, 18, 453-464. doi:10.1177/1049731507313980
16.
CougleJ. R.TimpanoK. R.Sachs-EricssonN.KeoughM. E.RiccardiC. J. (2010). Examining the unique relationships between anxiety disorders and childhood physical and sexual abuse in the National Comorbidity Survey-Replication. Psychiatry Research, 177, 150-155. doi:10.1016/j. psychres.2009.03.008
17.
CrowellJ. A.FraleyR.ShaverP. R. (2008). Measurement of individual differences in adolescent and adult attachment. In CassidyJ.ShaverP. R. (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 599-634). New York, NY: Guilford Press.
18.
ElliottD. M.BriereJ. (1992). Sexual abuse trauma among professional women: Validating the Trauma Symptom Checklist-40 (TSC-40). Child Abuse & Neglect, 16, 391-398. doi:10.1016/0145-2134(92)90048-V
19.
EybergS. M.RobinsonE. A. (1982). Parent-child interaction training: Effects on family functioning. Journal of Clinical Child Psychology, 11, 130-137. doi:10.1080/15374418209533076
20.
FinkL. A.BernsteinD.HandelsmanL.FooteJ. (1995). Initial reliability and validity of the Childhood Trauma Interview: A new multidimensional measure of childhood interpersonal trauma. The American Journal of Psychiatry, 152, 1329-1335.
21.
FinkelhorD. (1998). A comparison of the responses of preadolescents and adolescents in a national victimization survey. Journal of Interpersonal Violence, 13, 362-382. doi:10.1177/088626098013003004
22.
ForbesD.ParslowR.FletcherS.McHughT.CreamerM. (2010). Attachment style in the prediction of recovery following group treatment of combat veterans with post-traumatic stress disorder. Journal of Nervous and Mental Disease, 198, 881-884. doi:10.1097/NMD.0b013e3181fe73fa
23.
FortierM. A.DiLilloD.Messman-MooreT. L.PeughJ.DeNardiK. A.GaffeyK. J. (2009). Severity of child sexual abuse and revictimization: The mediating role of coping and trauma symptoms. Psychology of Women Quarterly, 33, 308-320. doi:10.1111/j.1471-6402.2009.01503.x
24.
GrossmannK.GrossmannK. E.KindlerH.ZimmermannP. (2008). A wider view of attachment and exploration: The influence of mothers and fathers on the development of psychological security from infancy to young adulthood. In CassidyJ.ShaverP. R. (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 857-879). New York, NY: Guilford Press.
25.
HinshawS. P. (2013). Developmental psychopathology as a scientific discipline: Relevance to behavioral and emotional disorders of childhood and adolescence. In BeauchaineT. P.HinshawS. P. (Eds.), Child and adolescent psychopathology (pp. 3-28). Hoboken, NJ: John Wiley.
26.
JohnsonL. N.KetringS. A.RohacsJ.BrewerA. L. (2006). Attachment and the therapeutic alliance in family therapy. American Journal of Family Therapy, 34, 205-218. doi:10.1080/01926180500358022
27.
JohnsonN. L.JohnsonD. M. (2013). Factors influencing the relationship between sexual trauma and risky sexual behavior in college students. Journal o Interpersonal Violence, 28, 2315-2331. doi:10.1177/0886260512475318
28.
JohnsonS. D.CottlerL. B.Ben AbdallahA.O’LearyC. (2011). History of sexual trauma and recent HIV-risk behaviors of community-recruited substance using women. AIDS and Behavior, 15, 172-178. doi:10.1007/s10461-010-9752-6
29.
KaltmanS.KrupnickJ.StocktonP.HooperL.GreenB. L. (2005). Psychological impact of types of sexual trauma among college women. Journal of Traumatic Stress, 18, 547-555. doi:10.1002/jts.20063
30.
KimS.SharpC.CarboneC. (2014). The protective role of attachment security for adolescent borderline personality disorder features via enhanced positive emotion regulation strategies. Personality Disorders: Theory, Research, and Treatment, 5, 125-136. doi:10.1037/per0000038
31.
LestradeK. N.TalbotN. L.WardE. A.CortN. A. (2013). High-risk sexual behaviors among depressed Black women with histories of intrafamilial and extrafamilial childhood sexual abuse. Child Abuse & Neglect, 37, 400-403. doi:10.1016/j.chiabu.2013.01.007
32.
LimkeA.ShowersC. J.Zeigler-HillV. (2010). Emotional and sexual maltreatment: Anxious attachment mediates psychological adjustment. Journal of Social & Clinical Psychology, 29, 347-367. doi:10.1521/jscp.2010.29.3.347
33.
LutharS. S.CicchettiD. (2000). The construct of resilience: Implications for interventions and social policies. Development and Psychopathology, 12, 857-885. doi:10.1017/S0954579400004156
34.
MarriottC.Hamilton-GiachritsisC.HarropC. (2014). Factors promoting resilience following childhood sexual abuse: A structured, narrative review of the literature. Child Abuse Review, 23, 17-34. doi:10.1002/car.2258
35.
MikulincerM.ShaverP. R. (2008). Adult attachment and affect regulation. In CassidyJ.ShaverP. R. (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 503-531). New York, NY: Guilford Press.
36.
MilotT.ÉthierL. S.St-LaurentD.ProvostM. A. (2010). The role of trauma symptoms in the development of behavioral problems in maltreated preschoolers. Child Abuse & Neglect, 34, 225-234. doi:10.1016/j.chiabu.2009.07.006
NilssonD.GustafssonP. E.SvedinC. (2012). Polytraumatization and trauma symptoms in adolescent boys and girls: Interpersonal and noninterpersonal events and moderating effects of adverse family circumstances. Journal of Interpersonal Violence, 27, 2645-2664. doi:10.1177/0886260512436386
39.
RocheD. N.RuntzM. G.HunterM. A. (1999). Adult attachment: A mediator between child sexual abuse and later psychological adjustment. Journal of Interpersonal Violence, 14, 184-207. doi:10.1177/088626099014002006
40.
SadowskiC. M.FriedrichW. N. (2000). Psychometric properties of the Trauma Symptom Checklist for Children (TSCC) with psychiatrically hospitalized adolescents. Child Maltreatment, 5, 364-372. doi:10.1177/1077559500005004008
41.
ScottS.BriskmanJ.WoolgarM.HumayunS.O’ConnorT. G. (2011). Attachment in adolescence: Overlap with parenting and unique prediction of behavioural adjustment. Journal of Child Psychology and Psychiatry, 52, 1052-1062. doi:10.1111/j.1469-7610.2011.02453.x
42.
ShafferD.FisherP.LucasC. P.DulcanM. K.Schwab-StoneM. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 28-38. doi:10.1097/00004583-200001000-00014
43.
ShapiroD. L.LevendoskyA. A. (1999). Adolescent survivors of childhood sexual abuse: The mediating role of attachment style and coping in psychological and interpersonal functioning. Child Abuse & Neglect, 23, 1175-1191. doi:10.1016/S0145-2134(99)00085-X
44.
Shmueli-GoetzY.TargetM.FonagyP.DattaA. (2008). The Child Attachment Interview: A psychometric study of reliability and discriminant validity. Developmental Psychology, 44, 939-956. doi:10.1037/0012-1649.44.4.939
45.
TargetM.FonagyP.Shmueli-GoetzY. (2003). Attachment representations in school-age children: The development of the Child Attachment Interview (CAI). Journal of Child Psychotherapy, 29, 171-186. doi:10.1080/0075417031000138433
46.
TargetM.FonagyP.Shmueli-GoetzY.DattaA.SchneiderT. (2007). The Child Attachment Interview (CAI) protocol. Unpublished manuscript, University College London, London, England.
47.
TascaG. A.RitchieK.ConradG.BalfourL.GaytonJ.LybanonV.BissadaH. (2006). Attachment scales predict outcome in a randomized controlled trial of two group therapies for binge eating disorder: An aptitude by treatment interaction. Psychotherapy Research, 16, 106-121. doi:10.1080/10503300500090928
48.
VentaA.SharpC.NewlinE. (2014). A descriptive study of symptom change as a function of attachment and emotion regulation in a naturalistic adolescent inpatient setting. European Child & Adolescent Psychiatry, 24, 95-104. doi:10.1007/s00787-014-0532-0
49.
VentaA.Shmueli-GoetzY.SharpC. (2014). Assessing attachment in adolescence: A psychometric study of the Child Attachment Interview. Psychological Assessment, 26, 238-255. doi:10.1037/a0034712
50.
WeinfieldN. S.SroufeL.EgelandB.CarlsonE. (2008). Individual differences in infant-caregiver attachment: Conceptual and empirical aspects of security. In CassidyJ.ShaverP. R. (Eds.), Handbook of attachment: Theory, research, and clinical applications (2nd ed., pp. 78-101). New York, NY: Guilford Press.
51.
ZachrissonH.RøysambE.OppedalB.HauserS. (2011). Factor structure of the Child Attachment Interview. European Journal of Developmental Psychology, 8, 744-759. doi:10.1080/17405629.2011.631293
