Multidirectional Pathways between Attachment, Mentalizing, and Posttraumatic Stress Symptomatology in the Context of Childhood Trauma

Abstract

Introduction: Exposure to traumatic stressful events in childhood is an important risk factor for the development of posttraumatic symptomatology. From a mentalization-based developmental perspective, childhood adversity can affect attachment in children and may result in insecure attachment and impaired mentalizing abilities, which increase the lifetime risk for psychopathology. The present cross-sectional study examined the potential mediating role of attachment insecurity and impaired mentalizing on the relationship between childhood trauma and posttraumatic symptomatology. Method: Adults who had experienced childhood neglect and abuse (n = 295, 184 patients with personality disorder and 111 community controls) completed self-report measures of posttraumatic stress disorder (PTSD) symptoms, dissociative experiences, adult attachment insecurity, and mentalizing. Results: Structural equation modelling results revealed that attachment insecurity together with lower mentalizing mediated the link between childhood trauma and PTSD symptoms, and lower mentalizing mediated the link between childhood trauma and dissociative experiences. Conclusion: The findings show that attachment insecurity and lower mentalizing play significant mediating roles in the reporting of posttraumatic symptomatology among survivors of childhood abuse and neglect, with treatment implications for mentalization-based therapy as beneficial for individuals with a history of childhood trauma.

Self-Rated Mentalizing Mediates the Relationship Between Stress and Coping in a Non-Clinical Sample

“…Moreover, several mediation models (e.g. Huang et al, 2020;Chiesa & Fonagy,2014) showed a partial mediating effect of adverse childhood experiences on general psychopathology via mentalizing. In detail mentalizing had a protective, buffering effect which leads to a decrease in general psychopathology.…”

A Critical Evaluation of the Reflective Functioning Questionnaire

“…The aim of the present research is to replicate and extend previous findings from Spitzer and colleagues, while also comprehensively presenting our concerns regarding the measure. A critical reexamination and discussion of the RFQ-8 appears to be of particular importance given that researchers are increasingly adopting the measure for primary investigations of the mentalizing construct (e.g., Agostini et al, 2019;Badoud et al, 2018;Berthelot et al, 2019;Brugnera et al, 2020;Carlone & Milan, 2020;Cosenza et al, 2019;de Meulemeester et al, 2017de Meulemeester et al, , 2018Euler et al, 2019;Gambin et al, 2020;Huang et al, 2020;Li et al, 2020;Macfie et al, 2020;Morosan et al, 2019Morosan et al, , 2020Perroud et al, 2017;Sacchetti et al, 2019;Salaminios et al, 2020;Scandurra et al, 2020) or as an outcome measure for evaluating psychotherapy effectiveness (e.g., Arnfred et al, 2017;Derks et al, 2019).…”

Mentalization and Dissociation after Adverse Childhood Experiences

“…Social embedded stress response may enforce the pathway between dissociation and mentalization in patients with attachment insecurity. This theory is supported by recent a recent study, which showed that attachment insecurity in combination with lower mentalizing mediated the link between childhood trauma and PTSD symptoms in adults who had experienced childhood neglect and abuse (24). Early maltreatment may increase the risk for the development of attachment insecurity with long-lasting effects.…”

“…Sharp et al describe a socialcognitive model of PTSD and attachment insecurity with impaired mentalizing abilities mediated associations with dissociative experiences (26). Individuals with lower mentalizing predict dissociation after exposure to childhood trauma (24). There may be a link between related mentalizing process early maltreatment and later posttraumatic symptoms such as dissociative experience.…”