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Resilience Among Childhood Abuse Survivors with
Posttraumatic Stress Disorder Attachment Status
Moderates Depression Risk and Severity Following
Adversity Anthony Charuvastra MD, Patty Zorbas
MA, Marylene Cloitre PhD NYU Child Study Center
Nathan Kline Institute
DISCLOSURE Supported by the Leon Levy Foundation
Objective
Methods
Results
Conclusions
To evaluate whether Adult Attachment status was
predictive of comorbid depression in women with
PTSD and investigate whether attachment status
was a moderator of the depressogenic cumulative
impact of subsequent traumatic life events.

• Participating women were part of a randomized
  controlled trial for the treatment of childhood
  abuse related PTSD (n89).
• Inclusion criteria female, a history of sexual
  or physical abuse by a caretaker or person in
  authority before the age of 18, literate in
  English, age 18 to 65 years.
• Exclusion criteria current bipolar disorder,
  moderate to severe substance dependence,
  psychotic symptoms, severe eating disorder, acute
  suicidality requiring immediate clinical
  attention.
• Measures Structured Clinical Interview for
  DSM-IV (SCID-IV), Clinician-Administered PTSD
  Scale (CAPS), Beck Depression Inventory (BDI),
  Adult Attachment Interview (AAI), Life Events
  Checklist (LEC). Traumatic life events were
  defined as events that were significant at the
  time and continued to impact the person within
  the year prior to assessment.
• Statistical Analyses
• Data was analyzed using SPSS (version 15.0).
  Associations between attachment status, early
  environment variables, and depressive disorders
  were measured using Chi-square analysis for
  categorical variables and Pearson correlation
  coefficients for continuous variables.
  Hierarchical regression analyses examined whether
  attachment status interacted with cumulative
  traumatic life events to predict depression
  severity.

• In this population, we propose that
• Adult attachment security moderates the risk of
  chronic depression
• Adult attachment security mediated the
  relationship between the cumulative traumatic
  life events and severity of depression.
• Adult attachment states of mind appear to
  function independently in their impact on risk of
  depression, as no other abuse related variables
  were associated with chronic depression.
• Children with post-traumatic stress symptoms
  are at the highest risk of developing chronic
  depression, highlighting the need to address this
  aspect of abuse related developmental
  psychopathology.(Copeland et al., 2007)
  Survivors of childhood abuse are at elevated risk
  for subsequent adverse life events.
• Clinically, interventions that influence
  attachment states of mind may be important for
  children and adults who have experienced abuse
  from caretakers. Promoting secure attachment may
  reduce risk for depressive reactions to
  cumulative life traumas and the risk for chronic
  and complex depressive disorders such as
  dysthymia and double depression.

Attachment Associated With Chronic Depression
Background
28 of adults report being victims of childhood
physical or sexual abuse.(Anda et al., 2006)
Childhood abuse is associated with compromised
attachment in children and adults, and higher
rates of psychiatric disorders. Little is known
about the relationship between childhood abuse,
the development of attachment states of minds
into adulthood, and adult psychopathology.
Studies have shown that insecure attachment
status is related to depressive disorders. One
goal of this study was to determine whether this
relationship was maintained in the context of
PTSD. In addition, the accumulation of life
stressors is associated with increasing severity
of depressive symptoms and this relationship is
particularly strong among women with histories of
childhood abuse.(Kendler et al, 2004) We assessed
whether attachment status among women with PTSD
would mediate the relationship between
accumulating life traumas and depression.
Attachment Insecurity Predicts Depressogenic
Sensitivity to Traumatic Life Events
Attachment Status Secure R2 0.00 Insecure R2
0.44
BDI
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References
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Anda, R. F., V. J. Felitti, et al. (2006). "The
enduring effects of abuse and related adverse
experiences in childhood. A convergence of
evidence from neurobiology and epidemiology." Eur
Arch Psychiatry Clin Neurosci 256(3)
174-86. Copeland, W. E., G. Keeler, et al.
(2007). "Traumatic events and posttraumatic
stress in childhood." Arch.Gen.Psychiatry 64(5)
577-584. Kendler, K. S., J. W. Kuhn, et al.
(2004). "Childhood sexual abuse, stressful life
events and risk for major depression in women."
Psychol.Med. 34(8) 1475-1482. Sroufe, L. A.
(2005). "Attachment and development a
prospective, longitudinal study from birth to
adulthood." Attach.Hum.Dev. 7(4) 349-367.
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1-2
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Criterion A Life Events