Attachment and posttraumatic stress disorder in multiple trauma samples

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. Method: 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. Conclusion: 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.