Adult Attachment Interview differentiates adolescents with Childhood Sexual Abuse from those with clinical depression and non-clinical controls

Abstract

Although attachment representation is considered to be disturbed in traumatized adolescents, it is not known whether this is specific for trauma, as comparative studies with other clinical groups are lacking. Therefore, attachment representation was studied by means of the Adult Attachment Interview in adolescents with Childhood Sexual Abuse (CSA) (N = 21), clinical depression (N = 28) and non-clinical controls (N = 28). Coherence of mind and unresolved loss or trauma, as well as the disorganized attachment classification differentiated the CSA group from the clinical depression group and controls, over and above age, IQ, and psychiatric symptomatology. In the current era of sustained criticism on criteria-based classification, this may well carry substantial clinical relevance. If attachment is a general risk or vulnerability factor underlying specific psychopathology, this may guide diagnostic assessment as well as treatment.

Keywords:

• attachment representation
• Childhood Sexual Abuse
• clinical depression
• dissociation
• unresolved loss or trauma
• coherence of mind

Acknowledgements

We thank all students, mental health professionals and personnel from Psychotraumacenter and GGZ Kinderen en Jeugd Rivierduinen, Curium-LUMC and KJTC Haarlem, who facilitated or helped with patient selection and inclusion or who helped with transcription of the AAI. We especially thank C.I. Gelderblom and B.G. van den Bulk for assisting with recruitment, data collection and database management, and C.I.G. also with transcription of AAI’s. G. Kuipers, S. den Hollander and M.J. Bakermans-Kranenburg we thank for AAI coding. M.J. van Hoof was generously sponsored by the Psychotraumacenter and GGZ Kinderen en Jeugd and WOP Rivierduinen, and the Hilly Roevers-Bonnet fonds of the Dutch Society of Female Doctors (VNVA). M.H. van IJzendoorn was supported by a SPINOZA award. Last but not least we thank participants and their parents for their trust and efforts without which this research could not have been done.