Understanding the impact of attachment insecurity on PTSD symptoms among male Veterans and military personnel.

Attachment insecurity (i.e., attachment anxiety and attachment avoidance) has been found to contribute to PTSD symptom severity in Veterans. However, little is known of the unique contribution of attachment insecurity on individual PTSD symptom clusters. In a community sample of 106 combat-deployed Veterans, active duty service members, and reservists, this study examined: (1) the relationships between childhood family experience, combat experience, attachment insecurity, and PTSD symptom clusters, and (2) the influence of attachment insecurity on PTSD symptom clusters. Results revealed significant correlations between attachment anxiety and all PTSD symptom clusters (rs = .22 -.43) and attachment avoidance and PTSD symptom clusters, except the avoidance cluster (rs = .21 -.36). Four multiple regression analyses were employed to address the second study aim. Childhood family experiences predicted negative alterations in cognitions and mood (ß = -.30) and alterations in arousal and reactivity (ß = -.20). Further, combat experience significantly predicted each symptom cluster of PTSD (ßs = .03 -.44). In the second step, attachment anxiety and attachment avoidance were added to each model. Attachment anxiety and attachment avoidance predicted negative alterations in cognitions and mood (ßs = .22 and .35) and alterations in arousal and reactivity (ßs = .27 and .17). Inconsistent with previous research, attachment insecurity did not predict symptoms of avoidance. These results highlight the impact of attachment among a diverse sample of trauma exposed individuals and may provide insights for clinical implications and therapeutic approaches when working with Veterans and military personnel high in attachment insecurity.

Military and Premilitary Trauma, Attachment Orientations, and Posttraumatic Stress Disorder Severity Among Male and Female Veterans.

Samples in prior studies examining attachment theory in the military have been predominantly composed of male combat veterans. Given the rates of sexual trauma among female veterans and differences in the association between attachment and posttraumatic stress disorder (PTSD) severity for sexual trauma survivors, it was necessary to consider the attachment characteristics of veterans within a mixed-sex sample. Participants were a mixed-sex veteran sample seeking inpatient trauma-related treatment (N = 469). Using independent samples t tests, we examined sex differences in attachment. Consistent with our hypothesis, women reported a higher level of attachment anxiety than did men, t(351) = -2.12, p = .034. Women also reported a higher level of attachment avoidance, t(351) = -2.44, p = .015. Using hierarchical regression, we examined the contribution of attachment anxiety and avoidance to PTSD severity, partialing out variance accounted for by demographic variables and traumatic experiences. Consistent with our hypotheses, attachment avoidance predicted PTSD severity on the Clinician-Administered PTSD Scale for DSM-IV (CAPS), ß = .20, p < .001, and the PTSD Checklist-Civilian Version (PCL-C), ß = .18, p < .001. Attachment anxiety did not predict CAPS severity but did predict PCL-C severity, ß = .11, p = .020. These results suggest the association between attachment avoidance and PTSD is not exclusive to combat trauma and may apply more generally to the larger veteran population. Higher levels of attachment anxiety and avoidance among female veterans potentially implicate the presence of greater attachment fearfulness among this particular subpopulation of veterans.

Differential relationships of guilt and shame on posttraumatic stress disorder among veterans.

OBJECTIVE: Despite important conceptual differences between shame and guilt, literature distinguishing these emotions in relation to posttrauma functioning for veterans has been largely theoretical. This is the first study to concurrently examine trauma-related guilt and internalized shame in relation to PTSD severity as the dependent variable. Our primary aim was to examine guilt and shame on PTSD symptom severity within the same model. A secondary aim was to evaluate whether trauma-related guilt can occur independent of shame. METHOD: Participants were 144 veterans seeking PTSD treatment. Regression analysis was used for our primary aim. Chi-square was used for our secondary aim to examine the percentage of participants categorized one standard deviation above (high) and below (low) the mean for shame and guilt. RESULTS: Entered together, internalized shame (ß = .44, p < .001) and guilt-related distress (ß = .32, p < .001) were related to PTSD severity. Guilt cognitions and global guilt were unrelated to PTSD. Analyses showed significant differences in participants categorized as low/high shame and low/high global guilt (χ² = 14.22, p < .001), guilt-related distress (χ² = 15.09, p < .001), and guilt cognitions (χ² = 13.16, p < .001). Across guilt subscales, "shame-free" trauma-related guilt did not exist (0%). Conclusions Internalized shame and guilt distress were both related to PTSD severity; however, shame added variance not already accounted for by guilt. Tangney, Stuewig, and Mashek (2007) stipulate that guilt becomes maladaptive when fused with shame; however, our results indicate trauma-related guilt is possibly always fused with shame. (PsycINFO Database Record (c) 2018 APA, all rights reserved).