The Roots of Chronic Posttraumatic Stress Disorder: Childhood Trauma, Information Processing, and Self-protective Strategies

Abstract

Background: Although childhood endangerment often precedes adult posttraumatic stress disorder (PTSD), the mechanism from danger to disorder is unclear. We proposed a developmental process in which unprotected and uncomforted danger in childhood would be associated with ''shortcuts'' in information processing that, in adulthood, could result in PTSD if the adult experienced additional exposure to danger. Information processing was defined as the basic associative, dissociative, and integrative processes used by all humans. Individual differences in parents' (or primary caregivers') protective and comforting behavior were expected to force unprotected children to use psychological shortcuts that linked early trauma to later vulnerability for PTSD. Method: We compared 22 adults with chronic PTSD to (a) 22 adults with other psychiatric diagnoses and (b) 22 normative adults without any diagnosis, in terms of information processing around childhood danger. The Adult Attachment Interview was used to derive information processing variables, including self-protective strategies, childhood traumas, and depression. Results: The two patient groups differed from the normative group on all variables. Adults with chronic PTSD differed from other psychiatric patients in having more childhood traumas and using more transformations of associative and dissociative processes. Within the PTSD group, there were three psychologically different subgroups. Conclusion: Our findings suggest that (1) prediction of risk for adult PTSD may be possible, (2) treatment might be facilitated by provision of a protective and supportive therapist, (3) who included a focus on correction of information processing errors and use of more adaptive strategies, and (4) subgroups of adults with PTSD may require different forms of treatment.

Can Attachment Inform Decision‐making in Child Protection and Forensic Settings?

“…However, where the ABC+D method uses markers of confusion, irrational thinking, disorientation, incoherence, and continuing fear and guilt as indices of unresolved/disorganized responses to trauma, the DMM currently identifies 12 forms of psychological trauma (dismissed, displaced, denied, blocked from recall, preoccupied, vicarious, hinted, suggested, imagined, delusional, depressed, and disorganized). In research using the AAI with DMM classificatory guidelines (Crittenden & Landini, ), preoccupied psychological trauma has been associated with normative functioning and mild anxieties (e.g., Hughes, Hardy, & Kendrick, ; Landini, Crittenden, & Landi, ; Shah et al., ) whereas other forms of psychological trauma were associated with specific psychiatric disorders (e.g., dismissed‐and‐preoccupying trauma and disorganized trauma in PTSD: Crittenden & Heller, ; imagined trauma in eating disorders: Ringer & Crittenden, ; denied, blocked, delusional, depressed, and disorganized forms of psychological trauma in borderline personality disorder: Crittenden & Newman, ). We think that psychological trauma, more than unresolved loss, is relevant to parental maltreatment of children, and that it can be assessed in a nuanced way.…”

Comparing Main, Goldwyn, and Hesse (Berkeley) and Crittenden (DMM) coding systems for classifying Adult Attachment Interview transcripts: an empirical report

“…In this context, patterns of attachment are considered self-protective strategies that vary dimensionally in different uses of cognitive-contingent information and affect-arousing information to organize behavior. For the analysis and classification of AAI transcripts, the DMM considers several self-protective attachment strategies, unresolved psychological trauma and loss, and modifiers (Crittenden & Heller, 2017;Crittenden & Landini, 2011). The three basic groups of self-protective attachment strategies (Types A, B, and C), each subdivided into specific subcategories, are defined in terms of the degree of integration of cognitive and affective information.…”

“…Adults maltreated or neglected in childhood may show high-risk attachment strategies that reflect high-index Type A+ (A3-A8) or Type C+ (C3-C8) patterns, sometimes organized as mixed patterns (A+/C+, A+C+). Such high-index patterns refer to A and/or C strategies with increasingly distorted levels of affect and cognition, respectively, and are often associated with clinical disorders (Crittenden & Heller, 2017;Crittenden & Newman, 2010;Landini, Crittenden, & Landi, 2016;Zachrisson, Sommerfeldt, & Skårderud, 2011). Table 1 summarizes the Berkeley and the DMM classification systems.…”

Diagnostic Use of Crittenden's Attachment Measures in Family Court Is Not Beyond a Reasonable Doubt

“…We agree with Spieker and Crittenden that because the samples were small and “Crittenden supervised … classifications” (p. 635), the studies require larger scale replications. When we combine various small studies, the aggregate sample comprises substantial numbers of maltreated ( n = 187) and “adequately reared,” typical, or normative ( n = 124) children (Crittenden , ; Crittenden et al., ; Crittenden & Heller, ; Crittenden, Robson, & Tooby, ; Shah, Fonagy, & Strathearn, ). In the typical group, there were 25% children (31/124) with an atypical DMM attachment classification.…”