Attachment organization in Arabic-speaking refugees with post traumatic stress disorder

ABSTRACT

As a part of an ongoing clinical study of refugees with post traumatic stress disorder (PTSD), the primary objective of the current study was to examine and describe the distribution of adult attachment patterns as assessed by the Adult Attachment Interview (AAI) in Arabic-speaking refugees. A total of 43 adult male and female refugees with Iraqi and Palestinian backgrounds completed the AAI. Sixty-seven percent of the sample was classified as Unresolved with respect to loss or trauma and a substantial proportion of insecure attachment representations (14% Secure-Autonomous, 39% Dismissing, 42% Preoccupied, 5% Cannot Classify) was found, in addition to high intake levels of post traumatic stress symptoms and comorbidity. Findings are compared with AAI studies of other PTSD or trauma samples, and the paper elaborates upon the methodological challenges in administering the AAI in a context of simultaneous translation.

KEYWORDS:

• Adult attachment patterns
• unresolved trauma
• AAI
• complex refugee trauma
• post traumatic stress disorder

Acknowledgements

In the hope that this research may lead to better a psychological understanding of the developmental experiences and vulnerabilities of living through war that may influence adult refugees’ trauma-related mental illnesses and trauma treatment models, the author wishes to thank the participating refugees who agreed to share their attachment experiences and life stories in the context of the Adult Attachment Interview. I thank my two irreplaceable, conscientious interpreters, Zeinab Hashemi and Nasir Hasan, and the sponsor-investigator for the clinical trial the study was nested in Jessica Carlsson Lohmann MD PhD. Finally, appreciation of the following psychology students’ contribution to this project with thorough AAI transcriptions: Anna Thorlacius-Ussing, Cecilie Hedegaard, Esben Nedergård Olsen, Freja Rose Enevoldsen, Henrik Bayer Elming, Ida Lohse, Julie-Astrid Galsgaard, Kamilla Julie Lauenborg, Katrine Schneekloth Friis Nielsen, Laura Gaun, Mette Fonsø, Nana Marie Jespersen, Nina Friser Holst, and Signe Pertou Ringkøbing. The present research with adult refugees was approved by the Danish Scientific Ethics Committee and The Danish Data Protection Agency. The author was responsible for conducting all of the Adult Attachment Interviews and for administration of transcripts. The author participated at the 2011 Nordic Adult Attachment Institute at Göteborg, Sweden, and was trained by certified AAI trainers Anders Broberg, PhD, and Tord Ivarsson, MD, in the AAI Coding and Classification System. The AAI transcripts were scored by blinded certified AAI coders Gitte Jönsson and Renate Sommerstad.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

This research was supported by The Health Foundation [grant number 2012B160], Department of Psychology, University of Copenhagen, Competence Centre for Transcultural Psychiatry, and Trygfonden [grant number 7-10-1002].