Post-traumatic-stress in the Context of Childhood Maltreatment: Pathways from Attachment Through Mentalizing During the Transition to Parenthood

Overview

Journal Front Psychol

Date 2023 Jun 26

PMID 37359870

Authors

Karin Ensink

Michael Begin

Gabriel Martin-Gagnon

Marko Biberdzic

Nicolas Berthelot

Lina Normandin

Peter Fonagy

Odette Bernazzani

Jessica L Borelli

Affiliations

Soon will be listed here.

Abstract

Introduction: This study aimed to clarify the role of mentalizing in pathways from attachment to Post Traumatic Stress Symptoms (PTSS) in survivors of childhood maltreatment (CM). We focused on the transition to parenting, a critical period for reworking parenting representations to reduce intergenerational maltreatment cycles.

Method: Study participants included 100 pregnant CM survivors. We assessed PTSS with the SCID and attachment and mentalizing with the Adult Attachment Interview (AAI), which was rated for Attachment and Reflective Functioning (RF).

Results: Regarding Re-experiencing trauma symptoms, the results of the path analysis were consistent with mediation. CM survivors' mentalizing about their early relationships with their parents (RF-Other) directly impacted Re-experiencing trauma symptoms, and attachment had an effect on Re-experiencing trauma symptoms through mentalizing (RF-Other). Regarding Arousal/Reactivity symptoms, the results of the pathways analysis were consistent with partial mediation by mentalizing about early relationships with parents (RF-Other). In addition to the pathway from attachment via mentalizing (RF-Other) to Arousal/Reactivity, the pathway between attachment and Arousal/Reactivity also remained significant.

Discussion: This study provides new evidence of a mentalizing and attachment model of PTSS in CM survivors. The findings indicate that increased mentalizing about early relationships with parents is an important process associated with lower PTSS. Finally, we discuss the implications of developing interventions for CM survivors to reduce PTSS. Scaffolding the development of mentalizing regarding attachment relationships in which CM occurred may help CM survivors reduce the intrusion of traumatic memories and decrease trauma-related arousal and reactivity symptoms. Interventions to help CM survivors mentalize regarding parents and attachment relationships in which trauma occurred may be particularly important during the transition to parenting when activation of representations of parenting can trigger PTSS.

Citing Articles

Wais M, Begin M, Sharp C, Ensink K Front Psychol. 2024; 15:1364001.

PMID: 39021654 PMC: 11252049. DOI: 10.3389/fpsyg.2024.1364001.

The mediating role of mentalization and integrative self-knowledge in the relationship between childhood trauma and fear of intimacy.

Riazi S, Manouchehri M Front Psychol. 2024; 15:1384573.

PMID: 39006548 PMC: 11239571. DOI: 10.3389/fpsyg.2024.1384573.

Dimensional model of adolescent personality pathology, reflective functioning, and emotional maltreatment.

Ensink K, Deschenes M, Begin M, Cimon L, Gosselin T, Wais M Front Psychiatry. 2024; 14:1302137.

PMID: 38268556 PMC: 10806145. DOI: 10.3389/fpsyt.2023.1302137.

References

OConnor M, Elklit A . Attachment styles, traumatic events, and PTSD: a cross-sectional investigation of adult attachment and trauma. Attach Hum Dev. 2008; 10(1):59-71. DOI: 10.1080/14616730701868597. View

ODonovan A, Epel E, Lin J, Wolkowitz O, Cohen B, Maguen S . Childhood trauma associated with short leukocyte telomere length in posttraumatic stress disorder. Biol Psychiatry. 2011; 70(5):465-71. PMC: 3152637. DOI: 10.1016/j.biopsych.2011.01.035. View

Ortigo K, Westen D, DeFife J, Bradley B . Attachment, social cognition, and posttraumatic stress symptoms in a traumatized, urban population: evidence for the mediating role of object relations. J Trauma Stress. 2013; 26(3):361-8. DOI: 10.1002/jts.21815. View

Berthelot N, Ensink K, Bernazzani O, Normandin L, Luyten P, Fonagy P . Intergenerational transmission of attachment in abused and neglected mothers: the role of trauma-specific reflective functioning. Infant Ment Health J. 2015; 36(2):200-12. DOI: 10.1002/imhj.21499. View

Nietlisbach G, Maercker A, Rossler W, Haker H . Are empathic abilities impaired in posttraumatic stress disorder?. Psychol Rep. 2010; 106(3):832-44. DOI: 10.2466/pr0.106.3.832-844. View

Ensink K, Normandin L, Target M, Fonagy P, Sabourin S, Berthelot N . Mentalization in children and mothers in the context of trauma: An initial study of the validity of the Child Reflective Functioning Scale. Br J Dev Psychol. 2014; 33(2):203-17. DOI: 10.1111/bjdp.12074. View

Weertman A, Arntz A, Dreessen L, van Velzen C, Vertommen S . Short-interval test-retest interrater reliability of the Dutch version of the Structured Clinical Interview for DSM-IV personality disorders (SCID-II). J Pers Disord. 2004; 17(6):562-7. DOI: 10.1521/pedi.17.6.562.25359. View

Stacks A, Muzik M, Wong K, Beeghly M, Huth-Bocks A, Irwin J . Maternal reflective functioning among mothers with childhood maltreatment histories: links to sensitive parenting and infant attachment security. Attach Hum Dev. 2014; 16(5):515-33. PMC: 4146668. DOI: 10.1080/14616734.2014.935452. View

Macpherson J, Gray S, Ip P, McCallum M, Hanlon P, Welsh P . Child maltreatment and incident mental disorders in middle and older ages: a retrospective UK Biobank cohort study. Lancet Reg Health Eur. 2021; 11():100224. PMC: 8642708. DOI: 10.1016/j.lanepe.2021.100224. View

10.

Fonagy P, Target M . The mentalization-focused approach to self pathology. J Pers Disord. 2006; 20(6):544-76. DOI: 10.1521/pedi.2006.20.6.544. View

11.

Ensink K, Begin M, Normandin L, Godbout N, Fonagy P . Mentalization and dissociation in the context of trauma: Implications for child psychopathology. J Trauma Dissociation. 2016; 18(1):11-30. DOI: 10.1080/15299732.2016.1172536. View

12.

Borelli J, Ensink K, Gillespie M, Falasiri E, Bernazzani O, Fonagy P . Mothers' Self-focused Reflective Functioning Interacts with Childhood Experiences of Rejection to Predict Current Romantic Relationship Quality and Parenting Behavior. Fam Process. 2020; 60(3):920-934. DOI: 10.1111/famp.12603. View

13.

Zanarini M, Frankenburg F . Attainment and maintenance of reliability of axis I and II disorders over the course of a longitudinal study. Compr Psychiatry. 2001; 42(5):369-74. DOI: 10.1053/comp.2001.24556. View

14.

Ensink K, Begin M, Normandin L, Fonagy P . Maternal and child reflective functioning in the context of child sexual abuse: pathways to depression and externalising difficulties. Eur J Psychotraumatol. 2016; 7:30611. PMC: 4731426. DOI: 10.3402/ejpt.v7.30611. View

15.

Shai D, Belsky J . Parental embodied mentalizing: how the nonverbal dance between parents and infants predicts children's socio-emotional functioning. Attach Hum Dev. 2016; 19(2):191-219. DOI: 10.1080/14616734.2016.1255653. View

16.

Katznelson H . Reflective functioning: a review. Clin Psychol Rev. 2014; 34(2):107-17. DOI: 10.1016/j.cpr.2013.12.003. View

17.

Narayan A, Rivera L, Bernstein R, Harris W, Lieberman A . Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: A pilot study of the benevolent childhood experiences (BCEs) scale. Child Abuse Negl. 2017; 78:19-30. DOI: 10.1016/j.chiabu.2017.09.022. View

18.

Cloitre M, Scarvalone P, Difede J . Posttraumatic stress disorder, self- and interpersonal dysfunction among sexually retraumatized women. J Trauma Stress. 1997; 10(3):437-52. DOI: 10.1023/a:1024893305226. View

19.

Ensink K, Berthelot N, Bernazzani O, Normandin L, Fonagy P . Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale. Front Psychol. 2015; 5:1471. PMC: 4269108. DOI: 10.3389/fpsyg.2014.01471. View

20.

Friedman M . Finalizing PTSD in DSM-5: getting here from there and where to go next. J Trauma Stress. 2013; 26(5):548-56. DOI: 10.1002/jts.21840. View