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Complex trauma of war captivity: a prospective study of attachment and post-traumatic stress disorder

Published online by Cambridge University Press:  07 February 2008

Z. Solomon ,
R. Dekel  and
M. Mikulincer
Z. Solomon*
Affiliation:
The Adler Research Center for Child Welfare and Protection, Tel Aviv University, Israel
R. Dekel
Affiliation:
School of Social Work, Bar Ilan University, Israel
M. Mikulincer
Affiliation:
Department of Psychology, Bar Ilan University, Israel
*
*Address for correspondence: Professor Z. Solomon, Bob Shappell School of Social Work, Tel Aviv University, Tel Aviv 69978, Israel. (Email: [email protected])
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Abstract

Background

Victims of war captivity sometimes suffer from complex post-traumatic stress disorder (PTSD), a unique form of PTSD that entails various alterations in personality. These alterations may involve changes in attachment orientation.

Method

The sample comprised two groups of veterans from the 1973 Yom Kippur War: 103 ex-prisoners of war (ex-POWs) and 106 comparable control veterans. They were assessed at two points in time, 18 years and 30 years after the war.

Results

Ex-POWs suffered from more post-traumatic symptoms than controls at both measurements points and these symptoms increased only among ex-POWs from Time 1 to Time 2. In addition, both attachment anxiety and attachment avoidance increased with time among ex-POWs, whereas they decreased slightly or remained stable among controls. Finally, the increases in attachment anxiety and avoidance were positively associated with the increase in post-traumatic symptoms among both study groups. Further analyses indicated that early PTSD symptoms predicted later attachment better than early attachment predicted later PTSD symptoms.

Conclusions

The results suggest that: (1) complex traumas are implicated in attachment orientations and PTSD symptoms even many years after captivity; (2) there is an increase in attachment insecurities (anxiety, avoidance) and an increase in PTSD symptoms decades after the captivity; (3) and post-traumatic stress symptoms predict attachment orientations better than attachment orientations predict an increase in PTSD symptoms.

Keywords

Attachmentcomplex traumapost-traumatic symptomsPOWs
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 10 , October 2008 , pp. 1427 - 1434
Copyright
Copyright © 2008 Cambridge University Press

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References

Apa (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised (DSM-III-R). American Psychiatric Association: Washington, DC.Google Scholar
Apa (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). American Psychiatric Association: Washington, DC.Google Scholar
Baldwin, MW, Keelan, JPR, Fehr, B, Enns, V, Koh-Rangarajoo, E (1996). Social-cognitive conceptualization of attachment working models: availability and accessibility effects. Journal of Personality and Social Psychology 71, 94–109.CrossRefGoogle Scholar
Bowlby, J (1973). Attachment and Loss: Separation, Anxiety and Anger. Basic Books: New York.Google Scholar
Brennan, KA, Clark, CL, Shaver, PR (1998). Self-report measurement of adult attachment: an integrative overview. In Attachment Theory and Close Relationships (ed. Simpson, J. A. and Rholes, W. S.), pp. 46–76. Guilford Press: New York.Google Scholar
Brewin, CR, Dalglish, T, Joseph, SA (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review 103, 670–686.CrossRefGoogle ScholarPubMed
Collins, NL, Read, SJ (1994). Cognitive representations of attachment: the structure and function of working models. In Attachment Processes in Adulthood (ed. Perlman, D. and Bartholomew, K.), pp. 53–90. Jessica Kingsley Publishers: Philadelphia.Google Scholar
Davila, J, Cobb, RJ (2004). Predictors of change in attachment security during adulthood. In Adult Attachment (ed. Rholes, W. S. and Simpson, J. A.), pp. 133–156. Guilford Press: New York.Google Scholar
Diehl, M, Elnick, AB, Bourbeau, LS, Labouvie-Vief, G (1998). Adult attachment styles: their relations to family context and personality. Journal of Personality and Social Psychology 74, 1656–1669.CrossRefGoogle ScholarPubMed
Fraley, RC, Fazzari, DA, Bonanno, GA, Dekel, S (2006). Attachment and psychological adaptation in high exposure survivors of the September 11th attack on the World Trade Center. Personality and Social Psychology Bulletin 32, 538–551.CrossRefGoogle ScholarPubMed
Hazan, C, Shaver, P (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology 52, 511–524.CrossRefGoogle ScholarPubMed
Herman, JL (1992). Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress 5, 377–391.CrossRefGoogle Scholar
Janoff-Bulman, R (1992). Shattered Assumptions. The Free Press: New York.Google Scholar
Kobak, RR, Hazan, C (1991). Attachment in marriage: effects of security and accuracy of working models. Journal of Personality and Social Psychology 60, 861–869.CrossRefGoogle ScholarPubMed
Long, N, Chamberlain, K, Vincent, C (1994). Effect of the Gulf War on reactivation of adverse combat-related memories in Vietnam veterans. Journal of Clinical Psychology 50, 138–144.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Mikulincer, M, Florian, V (2000). Exploring individual differences in reactions to mortality salience: does attachment style regulate terror management mechanisms? Journal of Personality and Social Psychology 79, 260–273.CrossRefGoogle ScholarPubMed
Mikulincer, M, Florian, V, Tolmacz, R (1990). Attachment styles and fear of personal death: a case study of affect regulation. Journal of Personality and Social Psychology 58, 273–280.CrossRefGoogle Scholar
Mikulincer, M, Shaver, PR (2007). Attachment Patterns in Adulthood: Structure, Dynamics, and Change. Guilford Press: New York.Google Scholar
Opp, L (1987). Normative mid-life concerns among Vietnam veterans with post-traumatic stress disorders: some preliminary empirical findings. Journal of Contemporary Psychotherapy 17, 174–194.CrossRefGoogle Scholar
Pozgain, I, Mandic, N, Filakovic, P, Antolovic-Pozgain, A (2003). The relation between personality disorder and posttraumatic stress disorder. Socijalna Psihijatrija 31, 173–179.Google Scholar
Schnurr, PP, Lunney, CA, Sengupta, A, Spiro, A (2005). A longitudinal study of retirement in older male veterans. Journal of Consulting and Clinical Psychology 73, 561–566.CrossRefGoogle ScholarPubMed
Solomon, Z, Benbenishty, R, Neria, Y, Abramowitz, M, Ginzburg, K, Ohry, A (1993). Assessment of PTSD: validation of the revised PTSD inventory. Israel Journal of Psychiatry and Related Sciences 30, 110–115.Google ScholarPubMed
Solomon, Z, Neria, Y, Ohry, A, Waysman, M, Ginzburg, K (1994). PTSD among Israeli former prisoners of war and soldiers with combat stress reaction: a longitudinal study. American Journal of Psychiatry 151, 554–559.Google ScholarPubMed
Terr, LC (1991). Childhood traumas: an outline and overview. American Journal of Psychiatry 148, 10–20.Google ScholarPubMed
Ursano, RJ, Rundell, JR, Fragala, MR, Larson, SG, Wain, HJ, Brandt, GT, Beach, BL (1996). The prisoner of war. In Emotional Aftermath of the Persian Gulf War (ed. Ursano, R. J. and Norwood, E.), pp. 443–476. American Psychiatric Press: Washington, DC.Google Scholar
Van der Kolk, Bessel A (2002). Assessment and treatment of complex PTSD. In Treating Trauma Survivors with PTSD (ed. Yehuda, R.), pp. 127–156. American Psychiatric Press: Washington, DC.Google Scholar
Waters, E, Hamilton, CE, Weinfield, NS (2000). The stability of attachment security from infancy to adolescence and early adulthood. Child Development 71, 678–683.CrossRefGoogle ScholarPubMed
Wickie, SK, Marwit, SJ (2000). Assumptive world views and the grief reactions of parents of murdered children. Omega Journal of Death and Dying 42, 101–113.CrossRefGoogle Scholar
Zakin, G, Solomon, Z, Neria, Y (2003). Hardiness, attachment style, and long-term psychological distress among Israeli POWs and combat veterans. Personality and Individual Differences 34, 819–829.CrossRefGoogle Scholar
Zhang, F, Labouvie-Vief, G (2004). Stability and fluctuation in adult attachment style over a 6-year period. Attachment and Human Development 6, 419–437.CrossRefGoogle Scholar