Attachment styles and PTSD in adolescents in three Nordic Countries

Abstract

Studies of possible variables influencing development of posttraumatic stress (PTSD) are of great importance in the effort to enhance preventive and interventional methods in the aim to prevail this devastating condition. Despite the vast research in adults, little is still known of adolescents. Although research is scarce, attachment style has been identified to be an influencing factor in adults, and still research in adolescent is almost non-existent. To our knowledge, no prior study has been conducted, looking at the relationship between attachment style, exposure to a broad range of potentially traumatic events, and subsequent PTSD symptoms in a cross cultural perspective. This is the aim of the present study. Procedure: Data was collected from questionnaire surveys of 1283 adolescents (mean age 14.1 years). Measures: PTSD was measured with The Harvard Trauma Questionnaire-Part IV (HTQ); and attachment style was studied using the Revised Adult Attachment Scale (RAAS). Potentially traumatic events were examined using a broad event list of 19 events. Results: Contrary to what was expected, significant cross cultural differences were found in the distribution of securely, preoccupied, and dismissive attached. Around half of the Faroese population was securely attached, contrary to the Danish and Icelandic population, where the majority was dismissive attached. Cross cultural differences were also found in the distribution of attachment style among those adolescents with PTSD. The majority of the Danish adolescent population with PTSD was dismissive attached; the majority of the Faroese adolescent population with PTSD was securely attached, and in the Icelandic adolescents with PTSD were distributed somewhat even between the four attachment styles. Finally, cross cultural differences were identified in which potentially traumatic events had a significant contribution to the variation in PTSD. The results are discussed and clinical recommendations are presented.

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Petersen, T. and Elklit, A. (2013) Attachment styles and PTSD in adolescents in three Nordic Countries. Open Journal of Epidemiology, 3, 62-69. doi: 10.4236/ojepi.2013.32010.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders. 3rd Edition, American Psychiatric Association, Washington DC.
[2] Caffo, E., Forresi, B. and Lievers, L.S. (2005) Impact, psychological sequelae and management of trauma affecting children and adolescents. Current Opinion in Psychiatry, 18, 422-428. doi:10.1097/01.yco.0000172062.01520.ac
[3] Boney-McCoy, S. and Finkelhor, D. (1995) Psychosocial sequelae of violent victimization in a national youth sample. Journal of Consulting and Clinical Psychology, 63, 726-736. doi:10.1037/0022-006X.63.5.726
[4] Broberg, A.G., Dyregrov, A. and Lilled, L. (2005) The Göteborg discotheque fire: Posttraumatic stress and school adjustment as reported by the primary victims 18 months later. Journal of Child Psychology and Psychiatry, 46, 1279-1286. doi:10.1111/j.1469-7610.2005.01439.x
[5] Edgardh, K. and Ormstad, K. (2000) Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen-year-old boys and girls. Acta Paediatrica, 88, 310-319. doi:10.1111/j.1651-2227.2000.tb01333.x
[6] Evans, L.G. and Oehler-Stinnett, J. (2006) Structure and prevalence of PTSD symptomology in children who have experienced a severe tornado. Psychology in the Schools, 43, 283-295. doi:10.1002/pits.20150
[7] Khamis, V. (2005) Post-traumatic stress disorder among school age Palestinian children. Child Abuse & Neglect, 29, 81-95. doi:10.1016/j.chiabu.2004.06.013
[8] Bödvarsdóttir, í. and Elklit, A. (2007) Victimization and PTSD-like states in an Icelandic youth probability sample. BMC Psychiatry, 7, 51.
[9] Elklit, A. and Petersen, T. (2008) Exposure to traumatic events among adolescents in fournations. Torture, 18, 2-11.
[10] Petersen, T., Elklit, A. and Olesen, J.G. (2010) Victimization and PTSD in a Faroese youth total-population sample. Scandinavian Journal of Psychology, 51, 56-62. doi:10.1111/j.1467-9450.2009.00728.x
[11] Lyons-Ruth, K. and Jacobvitz, D. (2008) Attachment disorganization: Genetic factors, parenting contexts, and developmental transformations from infarncy to adulthood. In: Cassidy, J. and Shaver, P.R., Eds., Handbook of Attachment. Theory, Research, and Clinical Applications. Guilford Press, New York, 666-697.
[12] Declercq, F. and Palmans, J. (2006) Two subjective factors as moderatorsnetween critical incidents and the occurrence of posttraumatic stress disorders: “Adult attachment” and “perception of social support”. Psychology and Psychotherapy: Theory, Research and Practice, 79, 232-337. doi:10.1348/147608305X53684
[13] Sandberg, D.A., Suess, E.A. and 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:10.1177/0886260508329126
[14] Solomon, Z., Dekel, R. and Mikulincer, M. (2008) Complex trauma of war captivity: A prospective study of attachment and post-traumatic stress disorder. Psychological Medicine, 38, 15-28. doi:10.1017/S0033291708002808
[15] Ainsworth, M.S., Blehar, M.C., Waters, E. and Wall, S. (1978) Patterns of attachment: A psychological study of the strange situation. Lawrence Erlbaum, Oxford.
[16] Bowlby, J. (1988) A secure base. Clinical applications of attachment theory. Routledge, London.
[17] Bretherton, I. (1991) The roots and growing points of attachment theory. In: Parkes, C.M., Stevenson-Hinde, J. and Marris, P., Eds., Attachment across the Life Cycle, Tavistock/Routledge, New York, 9-32.
[18] Bartholomew, K. and Horowitz, L.M. (1991) Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61, 226-244. doi:10.1037/0022-3514.61.2.226
[19] Stein, H., Jacobs, N.J., Ferguson, K.S., Allen, J.G. and Fonagy, P. (1998) What do adult attachment scales measure? Bulletin of the Menninger Clinic, 62, 33-82.
[20] Van Ijzendoorn, M.H. and Sagi-Schwartz, A. (2008) Cross-cultural patterns of attachment: Universal and contextual dimentions. In: Cassidy, J. and Shaver, P.R., Eds., Handbook of Attachment. Theory, Research, and Clinical Applications. Guilford Press, New York, 880-905.
[21] Freidlmeier, W. and Granqvist, P. (2006) Attachment transfer among Swedish and German adolescents: A prospective longitudinal study. Personal Relationships, 13, 261-279. doi:10.1111/j.1475-6811.2006.00117.x
[22] Finzi-Dottan, R., Dekel, R., Lavi, T. and Su’ali, T. (2006) Posttraumatic stress disorder reactions among children with learning disabilities exposed to terror attacks. ComprehensivePsychiatry, 47, 144-151. doi:10.1016/j.comppsych.2005.05.001
[23] Lindberg, N.M. (1998) Attachment cognitions as moderators of posttraumatic stress disorder symptomatology in adolescents exposed to community violence. Dissertation Abstracts International: Section B: The Sciences and Engineering, 58, 6815.
[24] Campini, C. (2006) Attachment style stability, life events, and adjustment across adolescence: A longitudinal study. Dissertation Abstracts International: Section B: The Sciences and Engineering, 66, 6310.
[25] Tobey, C.P. (2001) Parental attachment, adolescent sexual behaviour, and stressful life events. Dissertation Abstracts International: Section B: The Sciences and Engineering, 62, 1602.
[26] Elklit, A. (2002) Victimization and PTSD in a Danish national youth probability sample. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 174-181. doi:10.1097/00004583-200202000-00011
[27] O’Connor, M. and Elklit, A. (2008) Attachment styles, traumatic events and PTSD: A cross-sectional investigation of adult attachment and trauma. Attachment and Human Development, 10, 59-71. doi:10.1080/14616730701868597
[28] Dieperink, M., Leskela, J., Thuras, P. and Engdahl, B. (2001) Attachment style classification and posttraumatic stress disorder in former prisoners of war. American Journal of Orthopsychiatry, 71, 374-378. doi:10.1037/0002-9432.71.3.374
[29] Howard, M.S. and Medway, F.J. (2004) Adolescents’ attachment and coping with stress. Psychology in the Schools, 41, 391-402. doi:10.1002/pits.10167
[30] Dekel, R., Solomon, Z., Ginzburg, K. and Neria, Y. (2004) Long-term adjustment among Israeli war veterans: The role of attachment style. Anxiety, Stress & Coping: An International Journal, 17, 141-152. doi:10.1080/10615800410001721184
[31] Mollica, R.F., Caspi-Yavin, Y., Bollini, P., Truong, T., Tor, S. and Lavelle, J. (1992) The Harvard trauma questionnaire: Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in indochinese refugees. Journal of Nervous and Mental Disease, 180, 111-116. doi:10.1097/00005053-199202000-00008
[32] Collins, N.L. and Read, S.J. (1990) Adult attachment, working models, and relationship quality in dating couples. Journal of Personality and Social Psychology, 58, 644-663. doi:10.1037/0022-3514.58.4.644
[33] Collins, N.L. (1996) Working models of attachment: Implications for explanation, emotion, and behaviour. Journal of Personality and Social Psychology, 71, 810-832. doi:10.1037/0022-3514.71.4.810
[34] Hamilton, C.E. (2000) Continuity and discontinuity of attachment from infancy through adolescence. Child Development, 71, 690-694. doi:10.1111/1467-8624.00177
[35] Jackson, S. and Goossens, L. (2008) Handbook of adolescent development. Psychology Press, East Sussex.
[36] Erikson, E.H. (1968) Identity, youth and crisis. W. W. Norton, New York.
[37] Van IJzendoorn, M.H. and Kroonenberg, P.M. (1988) Cross-cultural patterns of attachment: A meta-analysis of the strange situation. Child Development, 59, 147-156. doi:10.1111/j.1467-8624.1988.tb03202.x
[38] Roche, D.N., Runtz, M.G. and Hunter, M.A. (1999) Adult attachment: A mediator between child sexual abuse and later psychological adjustment. Journal of Interpersonal Violence, 14, 184-207. doi:10.1177/088626099014002006
[39] Mikulincer, M. and Shaver, P.R. (2007) Attachment in adulthood: Structure, dynamics, and change. Guildford Press, New York.
[40] Fraley, R.C., Fazzari, D.A., Bonanno, G.A. and Dekel, S. (2006) Attachment and psychological adaptation in high exposure survivors of the September 11th attack on the World Trade Center. Personality and Social Psychology Bulletin, 32, 538-551. doi:10.1177/0146167205282741
[41] Tolin, D.F. and Foa, E.B. (2006) Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin, 132, 959-992. doi:10.1037/0033-2909.132.6.959
[42] Ditlevsen, D.N. and Elklit, A. (2010) The combined effect of gender and age on posttraumatic stress disorder: Do men and women show differences in the lifespan distribution of the disorder? Annals of General Psychiatry, 9, 32.
[43] Finzi-Dottan, R. and Karu, T. (2006b) From emotional abuse in childhood to psychopathology in adulthood—A path mediated by immature defense mechanisms and self-esteem. The Journal of Nervous and Mental Disease, 194, 616-621. doi:10.1097/01.nmd.0000230654.49933.23
[44] Bryant, R.A. and Guthrie, R.M. (2005) Maladaptive appraisals as a risk factor for posttraumatic stress—A study of trainee firefighters. American Psychological Society, 16, 749-752.
[45] Petersen, T., Armour, C. and Elklit, A. (Submitted) Modelling patterns of negative life experiences and mental health in Faroese adolescents.
[46] Costello, E.J., Erkanli, A., Fairbank, J.A. and Angold, A. (2002) The prevalence of potentially traumatic events in childhood andadolescence. Journal of Traumatic Stress, 15, 99-112. doi:10.1023/A:1014851823163
[47] Sroufe, L.A. (2005) Attachment and development: A prospective, longitudinal study from birth to adulthood. Attachment & Human Development, 7, 349-367. doi:10.1080/14616730500365928
[48] Shevlin, M. and Elklit, A. (2008) A latent class analysis of adolescent adverse life events based on a Danish national youth probability sample. Nordic Journal of Psychiatry, 60, 218-224. doi:10.1080/08039480801983992
[49] de Zulueta, F. (2006) The treatment of psychological trauma from the perspective of attachment research. Journal of Family Therapy, 28, 334-351. doi:10.1111/j.1467-6427.2006.00356.x
[50] Willis, G.B. and Gonzalez, A. (1998) Methodological issues in the use of survey questionnaires to assess the health effects of torture. Journal of Nervous and Mental Disease, 186, 283-289. doi:10.1097/00005053-199805000-00004

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