Adult Attachment as a Mediator of the Link Between Interpersonal Trauma and International Classification of Diseases (ICD)-11 Complex Posttraumatic Stress Disorder Symptoms Among College Men and Women

Previous research indicates that insecure attachment patterns are associated with interpersonal trauma and posttraumatic symptomatology, and that they mediate various trauma-related symptoms. However, no study to date has examined whether these patterns mediate the link between interpersonal trauma and the newly recognized diagnostic features of complex posttraumatic stress disorder (CPTSD), as published by the World Health Organization (2019) in the 11th version of the International Classification of Diseases (ICD-11). Mediators of CPTSD are important to identify because they can provide a deeper understanding of the condition’s etiology. Moreover, if amenable to clinical intervention, they can be targeted to improve treatment effectiveness. The purpose of the present study was to formally test our hypothesis that two underlying dimensions of adult attachment insecurity (i.e., attachment anxiety and avoidance) would mediate the link between interpersonal trauma and ICD-11 CPTSD symptoms. Participants were a culturally diverse sample of 169 college men and women. They completed a modified version of the Life Events Checklist (LEC-5), the revised Experiences in Close Relationships (ECR-R) scale, and the International Trauma Questionnaire (ITQ). Results of path analysis partially supported our hypothesis, indicating that attachment anxiety, but not avoidance, partially mediated the link between interpersonal trauma and PTSD and DSO (“Disturbances in Self-Organization”) features of CPTSD. Although longitudinal research is needed, findings suggest that attachment anxiety may contribute to the development and maintenance of CPTSD symptoms following interpersonal trauma. Clinical interventions that help individuals rework and integrate representations of attachment that involve a fear of not being able to access adequate care and protection, and a negative view of self may be particularly useful in ameliorating the symptoms of CPTSD.