Childhood adversity, attachment and personality styles as predictors of anxiety among elderly caregivers

Correlates of self-rated attachment in patients with cancer and their caregivers: a systematic review and meta-analysis

BACKGROUND

This study aimed to evaluate the association between an anxious/avoidant attachment style and psychosocial variables in patients with cancer and their caregivers.

METHODS

PsycINFO, PubMed, Google Scholar, and SCOPUS were searched for empirical studies published in peer-reviewed journals between 1994 and 2015, and unpublished data from one cohort were added. Meta-analyses synthesized results from studies investigating the correlates of attachment styles, measured with validated scales, among patients with cancer or their caregivers.

RESULTS

Thirteen studies (k = 13) were included in the quantitative synthesis (including unpublished data from one cohort). Anxious attachment was associated with depression (r = 0.29, CI 0.19-0.38, I(2)  = 76%), anxiety (r = 0.34, CI 0.13-0.52, I(2)  = 69%), and social support (r = -0.39, CI -0.55-0.21, I(2)  = 87%). Avoidant attachment was associated with depressive symptoms (r = 0.20, CI 0.15-0.25, I(2)  = 16%), anxiety (r = 0.13, CI 0.01-0.24, I(2)  = 4%), and social support (r = -0.28, CI -0.42-0.14, I(2)  = 75%).

CONCLUSIONS

Patients with cancer and their caregivers showing high levels of insecure attachment are at risk of experiencing higher levels of depressive symptoms, anxiety, and poor social support. Findings suggest that clinicians' awareness of attachment styles may serve as important clinical insight to improve treatment outcomes. Large-scale studies and longitudinal studies are required to investigate distinct longitudinal pathways in cancer-related distress across different attachment styles Copyright © 2016 John Wiley & Sons, Ltd.

An analysis of early developmental trauma in social anxiety disorder and posttraumatic stress disorder

BACKGROUND

The early contributions of childhood trauma (emotional, physical, sexual, and general) have been hypothesized to play a significant role in the development of anxiety disorders, such as posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD). The aim of this study was to assess childhood trauma differences between PTSD and SAD patients and healthy controls, as measured by the Early Trauma Inventory.

METHODS

We examined individuals (N = 109) with SAD with moderate/severe early developmental trauma (EDT) (n = 32), individuals with SAD with low/no EDT (n = 29), individuals with PTSD with EDT (n = 17), and healthy controls (n = 31). The mean age was 34 years (SD = 11). Subjects were screened with the Mini-International Neuropsychiatric Interview (MINI), Liebowitz Social Anxiety Scale (LSAS), Clinician-Administered PTSD Scale (CAPS), and Childhood Trauma Questionnaire (CTQ). Analysis of variance was performed to assess group differences. Correlations were calculated between childhood traumas.

RESULTS

Although not statistically significant, individuals with PTSD endorsed more physical and sexual childhood trauma compared with individuals with SAD with moderate/severe EDT who endorsed more emotional trauma. For all groups, physical and emotional abuse occurred between ages 6 and 11, while the occurrence of sexual abuse in individuals with PTSD was at 6-11 years and later (13-18 years) in individuals with SAD with moderate/severe EDT. For emotional abuse in all groups, the perpetrator was mostly a primary female caregiver; for sexual abuse, it was mostly a nonfamilial adult male, while for physical abuse, it was mostly a caregiver (male in PTSD and female in SAD with moderate/severe EDT).

CONCLUSIONS

The contribution of childhood abuse to the development of PTSD and SAD and the differences between these groups and other anxiety disorders should not be ignored and attention should be given to the frequency and severity of these events. The relationship of the perpetrator(s) and the age of onset of childhood abuse are also important considerations as they provide a useful starting point to assess impact over the life course. This can, in turn, guide clinicians on the optimal timing for the delivery of interventions for the prevention of PTSD and SAD.

A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders

Empirical findings regarding childhood traumatic stress are placed within a developmental life-trajectory model that incorporates a tripartite etiology of posttrauma distress. This approach recognizes an intricate matrix of child-intrinsic factors, developmental maturation and experience, life events, and evolving family and social ecologies. Of central developmental importance in the field of traumatic stress is the ontogenesis of appraisal, emotional response, emotional and physiological regulation, and consideration of protective action with regard to danger. The complexity of traumatic situations and their aftermath suggests the relevance of multiple stress diatheses in understanding individual variability in proximal and distal effects. Neurobiological systems that subserve danger mature over childhood and adolescence. Neurophysiological and neurohormonal studies among traumatized children and adolescents suggest potential neurodevelopmental stage-related vulnerabilities within these systems. Advances in child development and traumatic stress provide tools for investigating proximal and distal interplay of psychopathology, disturbances in the acquisition and maintenance of developmental competencies, and life-trajectory outcomes. A developmental psychopathology model suggests different avenues by which dangerous circumstances, childhood traumatic experiences, and posttraumatic stress disorder (PTSD) can intersect with other anxiety disorders over the life span.