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A cascade model of complex posttraumatic stress disorder centered on childhood trauma and maltreatment, attachment, and socio-interpersonal factors.

ABSTRACT: The present study proposes and tests a cascade model of complex posttraumatic stress disorder (CPTSD) focusing on childhood trauma and maltreatment, attachment, and socio-interpersonal factors. Multigroup path analysis was used to examine data from 126 individuals formerly affected by compulsory social measures and placements (CSMP) in their childhood and/or adolescence (i.e., risk group [RG]; M age = 70.8 years) and an age-matched control group (CG; n = 125; M age = 70.6 years). The final model confirmed the cascade structure, with stronger associations emerging in the RG. Childhood trauma and maltreatment were associated with attachment anxiety, β = |.20|-.30, which was related to all socio-interpersonal factors (i.e., disclosure of trauma, social acknowledgment, and social support), β = .27-|.54|; the latter were associated with substantial aspects of the CPTSD symptoms as well as life satisfaction, β = |.21|-.42. Among participants in the CG, we observed more direct, rather than mediated, paths to CPTSD symptoms. Adulthood trauma exposure did not follow the full cascade pattern but was associated with the socio-interpersonal factors. Nevertheless, more in-depth clinical knowledge of CPTSD and potential targets for psychological treatment may be gained from the confirmation of this newly proposed cascade model of CPTSD.

SUBMITTER: Maercker A

PROVIDER: S-EPMC9299117 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundExisting survey measures of childhood trauma history generally fail to take into account the relational-socioecological environment in which childhood maltreatment occurs. Variables such as the relationship between the perpetrator and the victim, the emotional availability of caregivers, witnessing the abuse of others, and the respondent's own thoughts, feelings, and actions in response to maltreatment are rarely assessed by current measures.MethodsTo address these concerns, the current study further investigated the family dynamics of childhood maltreatment using the Childhood Attachment and Relational Trauma Screen (CARTS) in 1,782 persons assessed online.ResultsPaired differences in means between item-rated descriptiveness of self, mothers, and fathers suggested that respondents' relationship with their biological fathers was less positive and secure than their relationship with their biological mothers, and that biological fathers were more often the perpetrator of emotional, physical, and sexual abuse than biological mothers. However, results further suggested that ratings between self, mothers, and fathers were positively correlated such that, for example, reports of a mother's or a respondent's own abusive behavior were more likely in the presence of reports of a father's abusive behavior. In addition, analyses evaluating witnessing violence demonstrated that fathers were rated as more often violent toward mothers than the reverse, although intimate partner violence was also frequently bidirectional. Analyses of sibling ratings further demonstrated that older brothers were either as or more frequently abusive when compared with parents. Finally, results suggested that childhood emotional, physical, and sexual abuse were much more often perpetrated by family members than extra-familial and non-family members.ConclusionsIn so far as these findings are consistent with the prior childhood trauma and attachment literature, the current study further supports the utility of the CARTS as a means of assessing the family dynamics of childhood attachment and maltreatment within a relational-socioecological framework.

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A cascade model of complex posttraumatic stress disorder centered on childhood trauma and maltreatment, attachment, and socio-interpersonal factors.

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