An Exploratory Study of Attachments and Posttraumatic Stress in Combat Veterans (original) (raw)
Shura et al (2015) attachments and PTSD (1).pdf
The purpose of this exploratory study was to evaluate the potential value of comparing specific attachments to posttraumatic stress disorder (PTSD) symptomatology in combat veterans with a new measure of attachments. A case series of 22 combat veterans in a Veterans Affairs Medical Center clinic completed PTSD Checklist -Military Version (PCL-M), Trauma Symptom Inventory -2nd Edition, and the Attachment and Clinical Issues Questionnaire (ACIQ) as part of a pilot study for a larger project. Descriptive statistics and Pearson correlations were used to examine the data. Although there were significant negative correlations between self-rated PTSD symptoms and avoidant (r = −0.44) and ambivalent (r = −0.55) attachment scores towards their mothers, suggesting a novel type of enmeshment, positive correlations were found between PTSD symptoms and avoidant partner attachments scores (r = 0.47). There were no significant correlations between the attachment scales to father and PTSD symptoms. The ACIQ Ambivalent Partner scale was only related to TSI-2 scales Intrusive Experiences (r = −0.44) and Defensive Avoidance (r = −0.44). An exploratory regression model using attachment variables identified from correlations and predicting PCL scores was significant (R 2 = 0.48); however, only Avoidant Partner scale contributed significant variance (β = 0.42, p = 0.024). The potency of the partner scale suggests a potential target for future research and intervention. These data point to new questions to be explored with larger samples and more sophisticated statistical techniques, and further highlighting the complexity of attachment and PTSD. Research suggests that the prevalence rate of posttraumatic stress disorder (PTSD) in combat veterans is approximately 16 % (Gates et al. 2012). Between 2004 and 2009, the Veterans Health Administration spent approximately 1.4billiononPTSDtreatment(CongressionalBudgetOffice2012),PTSDresearchexpendituresbytheUSgovernmentwere1.4 billion on PTSD treatment (Congressional Budget Office 2012), PTSD research expenditures by the US government were 1.4billiononPTSDtreatment(CongressionalBudgetOffice2012),PTSDresearchexpendituresbytheUSgovernmentwere24.5 million in 2009 (Monegain 2011), and $45 million in research funding was more recently awarded to form the Consortium to Alleviate PTSD in a joint effort by the Department of Veterans Affairs and the Department of Defense (U.S. Department of Veterans Affairs, National Center for PTSD 2015)
U.S. Army Medical Department journal
This study examined the effects of attachment style on self-reported posttraumatic stress disorder (PTSD) symptoms in a population of service members (N=561). Active duty, postdeployment service members completed anonymous questionnaires including 2 measures of adult attachment and the PTSD checklist-military as a measure of PTSD symptoms. Results confirmed the central hypothesis that attachment style was related to reported PTSD symptoms. Secure attachment style was associated with less reported PTSD symptoms and therefore may be involved in mechanisms associated with protection from developing PTSD after experiencing wartime trauma. Results were consistent when tested across continuous and dichotomous assessments that captured diagnostic criteria. This study demonstrates a significant relationship between attachment style and PTSD symptoms within a military population, potentially providing the basis for future research in this area.
Journal of Traumatic Stress
Samples in prior studies examining attachment theory in the military have been predominantly composed of male combat veterans. Given the rates of sexual trauma among female veterans and differences in the association between attachment and posttraumatic stress disorder (PTSD) severity for sexual trauma survivors, it was necessary to consider the attachment characteristics of veterans within a mixed-sex sample. Participants were a mixed-sex veteran sample seeking inpatient trauma-related treatment (N = 469). Using independent samples t tests, we examined sex differences in attachment. Consistent with our hypothesis, women reported a higher level of attachment anxiety than did men, t(351) = −2.12, p = .034. Women also reported a higher level of attachment avoidance, t(351) = −2.44, p = .015. Using hierarchical regression, we examined the contribution of attachment anxiety and avoidance to PTSD severity, partialing out variance accounted for by demographic variables and traumatic experiences. Consistent with our hypotheses, attachment avoidance predicted PTSD severity on the Clinician-Administered PTSD Scale for DSM-IV (CAPS), β = .20, p < .001, and the PTSD Checklist-Civilian Version (PCL-C), β = .18, p < .001. Attachment anxiety did not predict CAPS severity but did predict PCL-C severity, β = .11, p = .020. These results suggest the association between attachment avoidance and PTSD is not exclusive to combat trauma and may apply more generally to the larger veteran population. Higher levels of attachment anxiety and avoidance among female veterans potentially implicate the presence of greater attachment fearfulness among this particular subpopulation of veterans. Posttraumatic stress disorder (PTSD) is prevalent among veterans of the U.S. military (Sundin, Fear, Iversen, Rona, & Wessely, 2009). However, only a fraction of people exposed to trauma subsequently meet the diagnostic criteria for PTSD (Kessler et al., 1995). Attachment theory provides a useful framework for understanding vulnerabilities to developing PTSD as there is an inverse association between attachment security and PTSD severity following a traumatic experi
Anxiety Stress & Coping
This study examines the role of attachment in the long-term adjustment of Israeli veterans. The sample of participants comprised three groups of Israeli veterans who fought in the 1973 Yom Kippur War: 112 combat stress reaction (CSR) casualties, 98 veterans who received medals for bravery, and 189 controls. The CSR casualties reported higher levels of emotional distress than did participants in the two other groups. CSR veterans also showed the lowest levels of secure attachment characteristics. Additionally, the findings revealed different relationships between the avoidant style of attachment and emotional distress measures across the research groups. The implications of these findings are discussed according to two theoretical models of attachment.
Psychological Medicine, 2008
BackgroundVictims of war captivity sometimes suffer from complex post-traumatic stress disorder (PTSD), a unique form of PTSD that entails various alterations in personality. These alterations may involve changes in attachment orientation.MethodThe sample comprised two groups of veterans from the 1973 Yom Kippur War: 103 ex-prisoners of war (ex-POWs) and 106 comparable control veterans. They were assessed at two points in time, 18 years and 30 years after the war.ResultsEx-POWs suffered from more post-traumatic symptoms than controls at both measurements points and these symptoms increased only among ex-POWs from Time 1 to Time 2. In addition, both attachment anxiety and attachment avoidance increased with time among ex-POWs, whereas they decreased slightly or remained stable among controls. Finally, the increases in attachment anxiety and avoidance were positively associated with the increase in post-traumatic symptoms among both study groups. Further analyses indicated that early ...
Journal of Social and Clinical Psychology, 2014
Interdisciplinary Center (IDC) Herzliya attachment security contributes to resilience in times of stress, but it can be disrupted by traumatic events that shatter positive views of self and others. We followed israeli ex-PoWs of the Yom kippur War over 17 years and examined associations between trajectories of posttraumatic stress disorder (PTSD) and disruptions in the regulatory functions of the attachment system. Fifty-nine ex-PoWs and 39 control veterans from the same war who had reported on PTSD 18, 30, and 35 years after the war performed laboratory cognitive tasks assessing activation of mental representations of security in response to threat and the ability of these representations to color neutral stimuli with positive affect and reduce access to trauma-related thoughts. as compared to controls, ex-PoWs with persistent PTSD over the 17-year period exhibited dramatic disruptions in the soothing and healing functions of attachment security representations. These disruptions
Attachment and Posttraumatic Stress Disorder in Multiple Trauma Samples
Journal of Psychiatry, 2016
Introduction: Attachment orientations are associated with the severity of posttraumatic stress disorder (PTSD). However, the mediator role of trauma type in the association between attachment orientation and PTSD remains unknown. The relationship between trauma type, attachment, and PTSD was investigated in a large multiple trauma sample (n=3735). All participants were assessed for PTSD using the Harvard Trauma Questionnaire (HTQ) and for attachment orientations utilizing the Revised Adult Attachment Scale (RAAS). Results: Overall, a secure attachment style was related to lower PTSD severity, while insecure attachment styles were related to higher PTSD severity. Although both attachment dimensions were related to PTSD severity, attachment anxiety had greater contribution in predicting PTSD. PTSD symptom clusters were not found to depend on attachment dimensions. Finally, type of traumatic event moderated the association between attachment dimensions and PTSD severity. While among trauma survivors of family illness, the securely attached group showed the lowest PTSD severity, among trauma survivors of disease and physical health, the dismissively attached individuals showed the lowest level of PTSD severity, compared to other attachment groups. The results underscore the importance of taking into account the nature of the traumatic event while assessing the effects of attachment in posttraumatic reactions. Moreover, dismissing attachment style might be adaptive when facing the trauma of disease.
Stressful Life Events Across the Life Span and Insecure Attachment Following Combat Trauma
Clinical Social Work Journal, 2014
Attachment orientations are mostly considered to be stable interpersonal patterns. Still, a growing body of literature shows changes in attachment orientations following stressful and traumatic events. This study examined the implications of stressful life events (SLEs) throughout the life cycle in insecure attachment orientations (anxious attachment and avoidant attachment). The sample included 664 Israeli war veterans from the 1982 Lebanon War, of whom 363 suffered from acute combat stress reaction (CSR) on the battlefield, and 301 comprised a matched control group without antecedent CSR. The findings reveal a positive correlation between insecure attachment and both acute (CSR) and chronic (post-traumatic stress disorder) stress reactions. In addition, post-war SLEs were more powerful predictors of insecure attachment than other types of SLEs. Combat exposure, as well as pre-war SLEs in childhood and adulthood, made differential contributions to both types of insecure attachment orientations. Theoretical and practical implications of these findings are discussed.
Long-term adjustment among Israeli war veterans: the role of attachment style
Anxiety, Stress & Coping, 2004
This study examines the role of attachment in the long-term adjustment of Israeli veterans. The sample of participants comprised three groups of Israeli veterans who fought in the 1973 Yom Kippur War: 112 combat stress reaction (CSR) casualties, 98 veterans who received medals for bravery, and 189 controls. The CSR casualties reported higher levels of emotional distress than did participants in the two other groups. CSR veterans also showed the lowest levels of secure attachment characteristics. Additionally, the findings revealed different relationships between the avoidant style of attachment and emotional distress measures across the research groups. The implications of these findings are discussed according to two theoretical models of attachment.