The influence of attachment on perceived stress and cortisol response to acute stress in women sexually abused in childhood or adolescence

https://doi.org/10.1016/j.psyneuen.2009.01.006Get rights and content

Summary

The long-term implications of sexual abuse in childhood or adolescence (CSA) have been relatively well documented regarding attachment (disorganized attachment in childhood, unresolved trauma in adulthood), stress reactions (altered patterns of stress reactivity under experimental conditions), and psychopathology. Attachment has been shown to mediate the implications of CSA, namely on psychopathology. The implication of attachment on stress responses of abused persons has not been documented. Twenty-seven 20–46 years old women who had experienced episodes of CSA, and 17 controls have been interviewed using the Adult Attachment Interview. Sixty-three percent of abused women presented an unresolved trauma (12% for the controls). Thirty-six women (14 controls and 22 abused) came again to the laboratory for a session involving an experimental stress challenge (TSST). Subjects provided repeated appreciations of perceived stress on visual analogue scales and saliva samples were collected to assay cortisol levels. Whereas abused women with unresolved trauma showed the highest levels of perceived stress, they simultaneously presented the most suppressed cortisol reactions (there were significant post hoc differences between “unresolved abused” and controls on the increase of perceived stress and on cortisol recovery after the acute stress). It is suggested that important stressful experiences (such as CSA), especially when they have not been psychologically assimilated, may cause a disconnection, during subsequent mildly stressful circumstances, between the perception of stress and natural defensive body reactions.

Section snippets

Background

The rate of women who have experienced sexual abuse in childhood and/or adolescence (CSA) can be approximated to one in seven women, or 16% (Molnar et al., 2001). Girls are at higher risk (around 2.5–3 times) than boys (Finkelhor, 1993, Fergusson et al., 1996, Sobsey et al., 1997).

Most studies on the risk factors of CSA point to the family environment and family dysfunction as important influential variables (Finkelhor, 1993, Mullen et al., 1993, Briere and Elliot, 1994, Fergusson et al., 1996,

Objectives

A network of relationships has been documented between child abuse (namely CSA), cortisol response to an acute stress (HPA), attachment, and psychopathology; more specifically, associations have been shown between CSA and HPA (e.g. Heim and Nemeroff, 1999), attachment and HPA (e.g. Quirin et al., 2008), psychopathology and HPA (e.g. Soravia et al., 2006), CSA and attachment (e.g. Neufeld Bailey et al., 2007), CSA and psychopathology (e.g. Barker-Collo and Read, 2003); moreover, several

Participants

Two groups of adult female subjects were included in the study: a clinical group (women with an experience of CSA) and a control group. In order to recruit the clinical group, several centers, which provide anonymous assistance to adult victims of sexual abuse, were contacted; they systematically distributed brochures to their clients, describing the study and proposing to contact the research unit; participation was voluntary and anonymous. Otherwise, the centers did not intervene in the

Abuse

All subjects included in the abused group reported several positive responses on the STI items, some expressing an experience of relatively moderate abuse (e.g. provocative touching) and others an experience of more severe abuse (e.g. genital rape). The STI scores derived from the ETI ranged between 0 and 22 for the control group (mean = 5.71, S.D. = 8.53) and between 4 and 618 (mean = 67.92, S.D. = 72.48) for the clinical group. The small overlap is due to the 6 control subjects who reported some

Discussion

We evaluated the perceived stress as well as the endocrine responses to an experimental psychosocial stress session (TSST) of 44 women, a part of them having been exposed to sexual abuse in their childhood and/or adolescence. Overall, the average scores of the whole group of participants showed a coherent pattern of activation and deactivation of both kinds of indicators. The visual examination of the data showed a trend (not statistically significant) of abused women to present a higher

Role of the funding source

Funding for the study was provided by from the Swiss National Science Foundation (SNF) No. 3200B0-100676/1 awarded to B. Pierrehumbert. The SNF had no further role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication.

Conflict of interest

None of the authors have any conflicts of interest.

Acknowledgements

Swiss National Science Foundation (SNF) No. 3200B0-100676/1.

Association “Faire le Pas”, Lausanne.

We thank the psychologists and psychiatrists who conducted the interviews, ran the experiments, or provided support for the study: Clelia Argenziano, Catherine Badertscher, Maria Bayoi, Olivier Chouchena, Emmanuelle Cohin, Elisabetta Constantino, Giusi Daniele, Céline Dessarzin, Nevena Dimitrova, Daniela Equestre, Carol Gachet, Nathalie Glatz, Olivier Halfon, Markus Heinrichs, Dominique Laufer,

References (113)

  • C. Heim et al.

    The impact of early adverse experiences on brain systems involved in the pathophysiology of anxiety and affective disorders

    Biol. Psychiatry

    (1999)
  • C. Heim et al.

    The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders

    Psychoneuroendocrinology

    (2000)
  • C. Heim et al.

    The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies

    Biol. Psychiatry

    (2001)
  • C. Heim et al.

    The dexamethasone/corticotropin-releasing factor test in men with major depression: role of childhood trauma

    Biol. Psychiatry

    (2008)
  • M. Heinrichs et al.

    Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress

    Biol. Psychiatry

    (2003)
  • J.W. Kasckow et al.

    Corticotropin-releasing hormone in depression and posttraumatic stress disorder

    Peptides

    (2001)
  • B.S. McEwen et al.

    Stress and cognitive function

    Curr. Biol.

    (1995)
  • B.S. McEwen

    Effects of adverse experiences for brain structure and function

    Biol. Psychiatry

    (2000)
  • G. Meinlschmidt et al.

    Decreased cortisol awakening response after early loss experience

    Psychoneuroendocrinology

    (2005)
  • P. Pervanidou et al.

    Elevated morning serum interleukin (IL)-6 or evening salivary cortisol concentrations predict posttraumatic stress disorder in children and adolescents six months after a motor vehicle accident

    Psychoneuroendocrinology

    (2007)
  • P.M. Plotsky et al.

    Early postnatal experience alters hypothalamic corticotropin-releasing factor (CRF) mRNA, median eminence CRF content and stress-induced release in adult rats. Mol

    Brain Res.

    (1993)
  • J.C. Pruessner et al.

    Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change

    Psychoneuroendocrinology

    (2003)
  • M. Quirin et al.

    HPA system regulation and adult attachment anxiety: individual differences in reactive and awakening cortisol

    Psychoneuroendocrinology

    (2008)
  • D.L. Shapiro et al.

    Adolescent survivors of childhood sexual abuse: the mediating role of attachment style and coping in psychological and interpersonal functioning

    Child Abuse Neglect.

    (1999)
  • D. Simeon et al.

    Hypothalamic–pituitary–adrenal axis function in dissociative disorders, post-traumatic stress disorder, and healthy volunteers

    Biol. Psychiatry

    (2007)
  • D. Sobsey et al.

    Gender differences in abused children with and without disabilities

    Child Abuse Neglect.

    (1997)
  • R. Stam et al.

    Long-lasting stress sensitisation

    Eur. J. Pharmacol.

    (2000)
  • L. Ahnert et al.

    Transition to child care: associations with infant–mother attachment, infant negative emotion, and cortisol elevations

    Child Dev.

    (2004)
  • M. Ainsworth

    Attachments beyond infancy

    Am. Psychol.

    (1989)
  • M.D. Ainsworth et al.

    Patterns of Attachment: A Psychological Study of the Strange Situation

    (1978)
  • P.C. Alexander

    Application of attachment theory to the study of sexual abuse

    J. Consult. Clin. Psychol.

    (1992)
  • American Psychiatric Association

    Diagnostic and Statistical Manual for the Mental Disorders

    (1994)
  • K.J.S. Anand

    Relationships between stress responses and clinical outcome in newborns, infants, and children

    Crit. Care Med.

    (1993)
  • J. Axelrod et al.

    Stress hormone: their interaction and regulation

    Science

    (1984)
  • S. Barker-Collo et al.

    Models of response to childhood sexual abuse: their implications for treatment

    Trauma Violence Abuse

    (2003)
  • E. Bernstein et al.

    Development, reliability, and validity of a dissociation scale (DES)

    J. Nerv. Ment. Dis.

    (1986)
  • K. Bevans et al.

    Advances and future directions in the study of children's neurobiological responses to trauma and violence exposure

    J. Interpers. Violence

    (2005)
  • J. Bowlby

    Attachment and loss: Vol. 1. Attachment

    (1969)
  • J. Bowlby

    Attachment and Loss: Vol. 2. Separation

    (1973)
  • J. Bowlby

    Attachment and Loss: Vol. 3. Loss

    (1980)
  • J.D. Bremner et al.

    MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder

    Am. J. Psychiatry

    (1995)
  • J. Bremner et al.

    Development and preliminary psychometric properties of an instrument for the measurement of childhood trauma : The Early Trauma Inventory

    Depress. Anxiety

    (2000)
  • J. Bremner et al.

    Psychometric properties of the Early Trauma Inventory-Self Report

    J. Nerv. Ment. Dis.

    (2007)
  • D. Bremner et al.

    Cortisol, dehydroepiandrosterone, and estradiol measured over 24 h in women with childhood sexual abuse-related posttraumatic stress disorder

    J. Nerv. Ment. Dis.

    (2007)
  • J.D. Briere et al.

    Immediate and long-term impacts of child sexual abuse victims

    Future Child.

    (1994)
  • A. Browne et al.

    The impact of child sexual abuse: a review of the research

    Psychol. Bull.

    (1986)
  • V. Carlson et al.

    Disorganized/disoriented attachment relationships in maltreated infants

    Dev. Psychopathol.

    (1989)
  • E.B. Carlson et al.

    Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study

    Am. J. Psychiatry

    (1993)
  • G.P. Chrousos et al.

    The concepts of stress and stress system disorders: overview of physical and behavioral homeostasis

    J. Am. Med. Assoc.

    (1992)
  • S.S. Dickerson et al.

    Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research

    Psychol. Bull.

    (2004)
  • Cited by (64)

    • Stress-elicited neural activity in young adults varies with childhood sexual abuse

      2021, Cortex
      Citation Excerpt :

      Childhood physical and sexual abuse are prevalent issues (lifetime prevalence of physical abuse is 28% and lifetime prevalence of sexual abuse is 21%) in the United States and are associated with increased risk of future psychopathology (Dong et al., 2003; Felitti et al., 1998; Gilbert et al., 2009). Specifically, abuse during childhood is linked to emotional dysfunction (e.g., symptoms of anxiety, depression, and posttraumatic stress disorder; PTSD) as well as changes in the psychophysiological response to stress (e.g., blunted cortisol response to stress) that often persists into adulthood (Anda et al., 2006; Chen et al., 2010; Gilbert et al., 2009; Linares et al., 2013; Pierrehumbert et al., 2009; Trickett et al., 2014). The impact of childhood abuse is significant; these experiences are linked to approximately 45% of childhood-onset psychiatric disorders (e.g., mood, anxiety, substance use, and disruptive behavior disorders) and 80% of childhood and adolescent suicide attempts (Dube et al., 2001; Green et al., 2010).

    View all citing articles on Scopus
    1

    Tel.: +41 21 314 74 93; fax: +41 21 314 74 81.

    2

    Tel.: +41 21 692 32 60.

    3

    Tel.: +41 44 635 7363; fax: +41 44 635 7159.

    4

    Tel.: +41 21 314 19 60.

    View full text