Attachment Representation and Sensitivity: The Moderating Role of Posttraumatic Stress Disorder in a Refugee Sample

• Author: Niels Aa,Elisa Ee,Marian J. Jongmans,Rolf J. Kleber
• Published date: 01 September 2017
• DOI: http://doi.org/10.1111/famp.12228
• Date: 01 September 2017

Attachment Representation and Sensitivity: The

Moderating Role of Posttraumatic Stress Disorder in

a Refugee Sample

ELISA VAN EE*

,†

MARIAN J. JONGMANS

‡

NIELS VAN DER AA*

,†

ROLF J. KLEBER

†,‡

It has been hypothesized that adult attachment representations guide care giving

behavior and influence parental sensitivity, and thus affect the child’s socio-emotional

development. Several studies have shown a link between posttraumatic st ress disorder

(PTSD) and reduced parental sensitivity, so it is possible that PTSD moderates the rela-

tionship between insecure attachment representations and insensitivity. In this study

symptoms of PTSD (Harvard Trauma Questionnaire), parental sensitivity (Emotional

Availability Scales), and attachment representations (Attachment Script Assessment)

were assessed in 53 parents who were asylum seekers or refugees. Results showed that

when parents were less able to draw on secure attachment representations, symptoms of

PTSD increased the risk of insensitive parenting. These findings suggest that parental

sensitivity is affected not just by attachment representations, but by a conjunction of risk

factors including symptoms of PTSD and insecure attachment representations. These

parents should therefore be supported to establish or confirm secure models of attach-

ment experiences, to facilitate their ability interact sensitively and form a secur e relation-

ship with their children.

Keywords: Attachment Representations; Trauma; Posttraumatic Stress Disorder;

Sensitivity; Refugee

Fam Proc 56:781–792, 2017

INTRODUCTION

It is well-established that a healthy parent–child relationship is important if children

are to prosper in their development. Bowlby (1973) developed attachment theory to

explain the relationship between parent and child from a biological perspective. Bowlby

proposed that, with age and cognitive development, sensorimotor representations of

*Centrum ’45, Diemen, The Netherlands.

†

Foundation Arq, Diemen, The Netherlands.

‡

Utrecht University, Utrecht, The Netherlands.

Correspondence concerning this article should be addressed to Elisa van Ee, Psychotraumacentrum

Zuid Nederland, Postbus 70058, 5201 DZ, ‘s-Hertogenbosch, The Netherlands. E-mail: e.van.ee@

reiniervanarkel.nl.

We thank all parents who were willing to trust our staff and participate in this study. Special thanks

also to M. J. van IJzendoorn and M. H. Bakermans-Kranenburg for their valuable contribution to the

design of the study and the selection of measurements, to N. van der Waal for her assistance in the project,

and H. Waters for her training in the SBS. This study was supported by a ZonMw grant (100002037) from

the Netherlands organization for scientific research.

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Family Process, Vol. 56, No. 3, 2017 ©2016 Family Process Institute

doi: 10.1111/famp.12228