Does attachment disorganization explain the posttraumatic symptoms in maltreated children?

Journal title MALTRATTAMENTO E ABUSO ALL’INFANZIA
Author/s Elena Camisasca, Sarah Miragoli, Paola Di Blasio
Publishing Year 2024 Issue 2023/3 Suppl. Language Italian
Pages 21 P. 111-131 File size 246 KB
DOI 10.3280/MAL2023-003-S1007
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Child maltreatment is a chronic relational trauma with maladaptive outcomes in terms of both attachment of posttraumatic symptomatology. Many studies show that disorganized attachment is an important risk factor for the onset of externalizing, dissociative and PTSD symptoms. The Internal Working Models (IWM) of attachment disorganization could be a psychological mechanism key to understand the effect of child maltreatment on post-traumatic symptoms. The study aims to: 1) check for any differences in the IWM and post-traumatic symptomatology in a group of 47 of maltreated children and a group of 59 chil-dren from disadvantaged families; 2) explore, in maltreated children, if the disorganization mediates the association between type of violence and posttraumatic symptomatology. Re-sults show that maltreated children have more severe maladaptive outcomes than the other group. Moreover, attachment disorganization is the only predictor of depressive symptoms; totally mediates the anger and dissociative symptoms; and partially mediates the anxiety and PTSD symptoms.

Keywords: child abuse, disorganized attachment, posttraumatic symptoms, children.

  1. Liotti, G. (2006). A model of dissociation based on attachment theory and research. Journal of Trauma & Dissociation, 7, 4, 55-73.
  2. Adam, K. S., Sheldon-Keller, A. E., & West, M. (1996). Attachment organization and history of suicidal behavior in adolescents. Journal of Consulting and Clinical Psychology, 64, 264-292. DOI: 10.1037/0022-006X.64.2.264
  3. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5. Arlington, VA: American Psychiatric Publishing.
  4. Agrawal, H. R., Gunderson, J., Holmes, B. M., & Lyons-Ruth, K. (2004). Attachment studies with borderline patients: A review. Harvard Review of Psychiatry, 12, 94-104. DOI: 10.1080/10673220490447218
  5. Attili, G. (2001a). Maltrattamento infantile ed attaccamento: l’organizzazione filogenetica del pattern disorganizzato. Maltrattamento e abuso all’infanzia, 3, 3, 49-61.
  6. Attili, G. (2001b). Ansia da separazione e misura dell’attaccamento normale e patologico: Versione modificata e adattamento italiano del Separation Anxiety Test (SAT) di Klagsbrun e Bowlby. Milano: Unicopli.
  7. Attili, G. (2007). Attaccamento e costruzione evoluzionistica della mente: normalità, patologia, terapia. Milano: Cortina Editore.
  8. Attili, G., Di Pentima, L., & Toni, A. (2013). Abuso, trascuratezza e il controllo degli eventi: il paradosso dell’attaccamento. Maltrattamento e abuso all’infanzia, 15, 3, 89-108. DOI: 10.3280/MAL2013-003005
  9. Baer, J. C., & Martinez, C. D. (2006). Child maltreatment and insecure attachment: A meta-analysis. Journal of Reproductive and Infant Psychology, 24, 187-197. DOI: 10.1080/02646830600821231
  10. Bailey, H. N., Moran, G., & Pederson, D. R. (2007). Childhood maltreatment, complex trauma symptoms, and unresolved attachment in an at-risk sample of adolescent mothers. Attachment and Human Development, 9, 139-161. DOI: 10.1080/14616730701349721
  11. Baker, A. J. L., & Verrocchio, M. C. (2013). Italian college student-reported exposure to parental alienation: Correlates with well-being. Journal of Divorce and Remarriage, 54, 8, 609-628. DOI: 10.1080/10502556.2013.837714
  12. Barnett, D., Ganiban, J., & Cicchetti, D. (1999). Maltreatment, negative expressivity, and the development of Type D attachments from 12 to 24 months of age. Monographs of the Society for Research in Child Development, 64, 3, 97-118.
  13. Bifulco, A., Kwon, J., Jacobs, C., Moran, P. M., Bunn, A., & Beer, N. (2006). Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Social Psychiatry and Psychiatric Epidemiology, 41, 796-805.
  14. Briere, J. (1996). Trauma Symptom Checklist for Children (TSCC) professional manual. Odessa, FL: Psychological Assessment Resources.
  15. Bureau, J. F., Easterbrooks, M. A., & Lyons-Ruth, K. (2009). Maternal depressive symptoms in infancy: Unique contribution to children’s depressive symptoms in childhood and adolescence? Development and Psychopathology, 21, 519-537. DOI: 10.1017/S0954579409000285
  16. Camisasca, E. (2008). Traumi irrisolti, comportamento genitoriale atipico e attaccamento disorganizzato: una rassegna della letteratura. Maltrattamento e abuso all’infanzia, 2, 77-99.
  17. Camisasca, E. (2009). Traiettorie di internalizzazione ed esternalizzazione in bambini maltrattati: il ruolo dell’attaccamento. Maltrattamento e abuso all’infanzia, 3, 65-82. DOI: 10.3280/MAL2009-003007
  18. Cassidy, J., & Marvin, R. S. (with the MacArthur Working Group on Attachment). (1992). Attachment organization in three and four year olds: Procedures and coding manual. Unpublished manuscript, University of Virginia.
  19. Liotti, G., & Farina, B. (2011). Sviluppi traumatici. Eziopatogenesi, clinica e terapia della dimensione dissociativa. Milano: Cortina Editore.
  20. Cicchetti, D., & Toth, S. L. (1995). A developmental psychopathology perspective on child abuse and neglect. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 541-565. DOI: 10.1097/00004583-199505000-00008
  21. Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2006). Fostering secure attachment in infants in maltreating families through prevention interventions. Development and Psychopathology, 18, 623-649. DOI: 10.1017/S0954579406060329
  22. Cole, P. M., & Putnam, F. W. (1992). Effects 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.60.2.174
  23. Courtois, C. A. (2008). Complex trauma, complex reactions: Assessment and treatment. Psychotherapy: Theory, Research, Practice, Training, 1, 86-100. DOI: 10.1037/1942-9681.S.1.86
  24. Cyr, C., Euser, E. M., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. (2010). Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses. Development and Psychopathology, 22, 87-108. DOI: 10.1017/S0954579409990289
  25. Di Blasio, P., Camisasca, E., & Procaccia, R. (2007). Fattori di mediazione dell’esperienza traumatica nei bambini maltrattati. Maltrattamento e abuso all’infanzia, 2, 33-59
  26. Di Blasio, P., Piccolo, M., & Traficante Valvassori, D. (2011). TSCC - Trauma Symptom Checklist for Children. Valutazione delle conseguenze di esperienze traumatiche. Trento: Erickson.
  27. Di Blasio, P., Miragoli, S., & Procaccia, R. (2011). Understanding children’s sexual abuse through their allegations. In Ardino V. (Ed.), Post-traumatic syndromes in children and adolescents (pp. 177-198). London: Wiley and Sons Publications.
  28. Fearon, R. P., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., Lapsley, A., & Roisman, G. I. (2010). The significance of insecure attachment and disorganization in the development of children’s externalizing behavior: A meta-analytic study. Child Development, 81, 435-456.
  29. Groh, A. M., Roisman, G. I., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., & Fearon, R. M. (2012). The significance of insecure and disorganized attachment for children’s internalizing symptoms: A meta-analytic study. Child Development, 83, 591-610.
  30. Hankin, B. (2005). Childhood maltreatment and psychopathology: Prospective tests of attachment, cognitive vulnerability, and stress as mediating processes. Cognitive Therapy and Research, 29, 645-671.
  31. Hesse, E., & Main, M. (2000). Disorganized infant, child, and adult attachment: Collapse in behavioral and attentional strategies. Journal of the American Psychoanalytic Association, 48, 1097-1127. DOI: 10.1177/00030651000480041101
  32. Hesse, E., & Main, M. (2006). Frightened, threatened, and dissociative parental behavior in low risk samples: Description, discussion, and interpretation. Development and Psychopathology, 18, 309-343. DOI: 10.1017/S0954579406060172
  33. Howell, E. F. (2005). The dissociative mind. London: The Analytic Press.
  34. Kearney, C. A., Wechsler, A., Kaur, H., & Lemos-Miller, A. (2010). Posttraumatic stress disorder in maltreated youth: A review of contemporary research and thought. Clinical Child and Family Psychology Review, 13, 46-76.
  35. Klagsbrun, M., & Bowlby, J. (1976). Responses to separation from parents: A clinical test for young children. British Journal of Projective Psychology, 21, 7-21.
  36. Liotti, G. (2004). Trauma, dissociation and disorganised attachment: Three strands of a single braid. Psychotherapy: Theory, Research, Practice, Training, 41, 472- 486. DOI: 10.1037/0033-3204.41.4.472
  37. Lopez, M. A., & Heffer, R. W. (1998). Self-concept and social competence of university student victims of childhood physical abuse. Child Abuse & Neglect, 22, 183-195. DOI: 10.1016/S0145-2134(97)00136-1
  38. Lowell, A., Renk, K., & Adgate, A. H. (2014, in press). The role of attachment in the relationship between maltreatment and later emotional and behavioral functioning. Child Abuse & Neglect.
  39. Lyons-Ruth, K., Bronfman, E., & Atwood, G. (1999). A relational diathesis model of hostile-helpless states of mind: Expressions in mother-infant interaction. In J. Solomon & C. George (Eds.), Attachment disorganization (pp. 33-70). New York: Guilford Press.
  40. Lyons-Ruth, K., Bronfman, E., & Parsons, E. (1999). Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns. Monographs of the Society for Research in Child Development, 64, 67-96.
  41. Lyons-Ruth, K., Yellin, C., Melnick, S., & Atwood, G. (2003). Childhood experiences of trauma and loss have different relations to maternal unresolved and hostile-helpless states of mind on the AAI. Attachment and Human Development, 5, 330-352. DOI: 10.1080/14616730310001633410
  42. Macfie, J., Cicchetti, D., & Toth, S. L. (2001). Dissociation in maltreated versus non-maltreated preschool-aged children. Child Abuse and Neglect, 25, 1253-1267. DOI: 10.1016/S0145-2134(01)00266-6
  43. Madigan, S., Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., Moran, G., Pederson, D. R., & Benoit, D. (2006). Unresolved states of mind, anomalous parental behavior, and disorganized attachment: A review and meta-analysis of a transmission gap. Attachment & Human Development, 8, 89-111. DOI: 10.1080/14616730600774458
  44. Main, M. & Cassidy, J. (1988). Categories of response to reunion with the parent at age six: Predicted from infant attachment classification and stable over a one-month period. Developmental Psychology, 24, 415-426. DOI: 10.1037/0012-1649.24.3.415
  45. Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behaviour the linking mechanism? In M. T. Greenberg, D. Cicchetti & E. M. Cummings (Eds.), Attachment in the preschool years (pp. 161-182). Chicago, IL: Chicago University Press.
  46. Marvin, R. S., & Whelan, W. F. (2003). Disordered attachments: Toward evidence-based clinical practice. Attachment & Human Development, 5, 283-288. DOI: 10.1080/14616730310001596106
  47. Maughan, A., & Cicchetti, D. (2002). The impact of child maltreatment and inter-adult violence on children’s emotion regulation abilities. Child Development, 73, 1525-1542. DOI: 10.1111/1467-8624.00488
  48. MacDonald, H. Z., Beeghly, M., Grant-Knight, W., Augustyn, M., Woods, R. W., Cabral, H., et al. (2008). Longitudinal association between infant disorganized attachment and childhood posttraumatic stress symptoms. Development and Psychopathology, 20, 493-508. DOI: 10.1017/S0954579408000242
  49. Moss, E., Cyr, C., Bureau, J. F., Tarabulsy, G. M., & Dubois-Comtois, K. (2005). Stability of attachment during the preschool period. Developmental Psychology, 41, 773-783. DOI: 10.1037/0012-1649.41.5.773
  50. Moss, E., Dubois-Comtois, K., Cyr, C., St-Laurent, D., Tarabulsy, G. M., Bernier, A., et al. (2007). Can caregiving behavior of maltreating mothers be changed? Paper presented at the biennial meeting of the Society for Research in Child Development, Boston.
  51. Muller, R. T., Thornback, K., & Bedi, R. (2012). Attachment as a mediator between childhood maltreatment and adult symptomatology. Journal of Family Violence, 27, 243-255.
  52. Pollack, S. D., Cicchetti, D., Hornung, K., & Reed, A. (2000). Recognizing emotions in faces: Developmental effects of child abuse and neglect. Developmental Psychology, 36, 679-688. DOI: 10.1037/0012-1649.36.5.679
  53. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879-891. DOI: 10.3758/BRM.40.3.879
  54. Procaccia, R., Miragoli, S., & Di Blasio, P. (2013). L’utilizzo del Blacky Pictures’ Test nella valutazione dei minori vittime di abuso sessuale. Maltrattamento e abuso all’infanzia, 15, 3, 88-110. DOI: 10.3280/MAL2013-003006
  55. Quas, J. A., Goodman, G. S., & Jones, D. (2003). Predictors of attributions of self-blame in child sexual abuse victims. Journal of Child Psychology and Psychiatry and Allied Disciplines, 44, 723-746. DOI: 10.1111/1469-7610.00158
  56. Riggs, S. A., & Jacobvitz, D. (2002). Expectant parents’ representations of early attachment relationships: Associations with mental health and family history. Journal of Consulting and Clinical Psychology, 70, 195-204. DOI: 10.1037/0022-006X.70.1.195
  57. 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: 10.1177/088626099014002006
  58. Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trials for posttraumatic stress disorder. Journal of Traumatic Stress, 10, 539-555.
  59. 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, 1, 33-49. DOI: 10.1177/0886260508329126
  60. Schore, A. N. (2003). Affect dysregulation and disorders of the self. NewYork: Norton.
  61. Schuengel, C., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (1999). Attachment and loss: Frightening maternal behavior linking unresolved loss and disorganized infant attachment. Journal of Consulting and Clinical Psychology, 67, 54-63.
  62. Shapiro, D. L., & Levendosky, A. 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, 11, 1175-1191. DOI: 10.1016/S0145-2134(99)00085-X
  63. Sternberg, K. J., Baradaran, L. P., Abbott, C. B., Lamb, M. E., & Guterman, E. (2006). Type of violence, age, and gender differences in the effects of family violence on children’s behavior problems: A mega-analysis. Developmental Review, 26, 89-112,
  64. Stronach, E. P., Toth, S. L., Rogosch, F., Oshri, A., Manly, J. T., Cicchetti, D. (2011). Child maltreatment, attachment security, and internal representations of mother and mother-child relationships, Child Maltreatment, 16, 2, 137-145. DOI: 10.1177/1077559511398294
  65. Twaite, J., & Rodriguez-Srednicki, O. (2004). Childhood sexual and physical abuse and adult vulnerability to PTSD: The mediating effects of attachment and dissociation. Journal of Child Sexual Abuse, 13, 17-38.
  66. van der Kolk, B. A. (1996). The body keeps the score: Approaches to the psychobiology of posttraumatic stress disorder. In B. A. van der Kolk, A. C. McFarlane & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York: Guilford Press.
  67. van IJzendoorn, M. H., Schuengel, C., & Bakermans-Kranenburg, M. J. (1999). Disorganized attachment in early childhood: Meta-analysis of precursors, concomitants, and sequelae. Development and Psychopathology, 11, 225-249.
  68. Verrocchio, M. C., & Baker, A. J. L. (2013). Italian adults’ recall of childhood exposure to parental loyalty conflicts. Journal of Child and Family Studies,1-11.
  69. Walrath, C. M., Ybarra, M. L., Holden, E. W. (2006). Understanding the pre-referral factors associated with differential 6-month outcomes among children receiving system-of-care services. Psychological Services, 3, 35-50. DOI: 10.1016/S0145-2134(03)00035-8
  70. West, M., Adam, K., Spreng, S., & Rose, S. (2001). Attachment disorganization and dissociative symptoms in clinically treated adolescents. Canadian Journal of Psychiatry, 46, 627-631.
  71. Wright, J., Friedrich, W., Cinq-Mars, C., Cyr, M., & McDuff, P. (2004). Self-destructive and delinquent behaviors of adolescent female victims of child sexual abuse: Rates and covariates in clinical and nonclinical samples. Violence and Victims, 19, 627-643.

Elena Camisasca, Sarah Miragoli, Paola Di Blasio, La disorganizzazione dell’attaccamento spiega i sintomi post-traumatici nei bambini vittime di violenza intrafamiliare? in "MALTRATTAMENTO E ABUSO ALL’INFANZIA" 3 Suppl./2023, pp 111-131, DOI: 10.3280/MAL2023-003-S1007