{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T20:54:59Z","timestamp":1793393699074,"version":"4.5.0"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T00:00:00Z","timestamp":1627344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:p>The aim of the present study was to examine the hypothesis that attachment and childhood sexual abuse (CSA) interacted such that school aged CSA survivors with insecure attachment to parents would be at an elevated risk of developing post-traumatic stress disorder (PTSD) and trauma symptoms. Participants (<jats:italic>n<\/jats:italic>= 111, ages 7\u201312) comprised two groups, child CSA survivors (<jats:italic>n<\/jats:italic>= 43) and a matched comparison group of children (<jats:italic>n<\/jats:italic>= 68) recruited from the community. Children completed the Child Attachment Interview (CAI) as well as the Trauma Symptom Checklist for Children (TSCC). There was a significant interaction between sexual abuse history and attachment security, such that sexually abused children with insecure attachment representations had significantly more PTSD and trauma symptoms than sexually abused children with secure attachment to parents. The findings show that using a dual lens of attachment and CSA can facilitate the identification of children most at risk and has important implications for understanding risk and resilience processes.<\/jats:p>","DOI":"10.3389\/fpsyg.2021.646680","type":"journal-article","created":{"date-parts":[[2021,7,27]],"date-time":"2021-07-27T08:40:51Z","timestamp":1627375251000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":24,"title":["Post-traumatic Stress Disorder in Sexually Abused Children: Secure Attachment as a Protective Factor"],"prefix":"10.3389","volume":"12","author":[{"given":"Karin","family":"Ensink","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Fonagy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Normandin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abby","family":"Rozenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Marquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natacha","family":"Godbout","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Borelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/j.chiabu.2006.12.002","article-title":"Childhood sexual abuse, attachment, and trauma symptoms in college females: the moderating role of attachment","volume":"31","author":"Aspelmeier","year":"2007","journal-title":"Child Abuse Negl."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1111\/papt.12181","article-title":"The links between adult attachment and post-traumatic stress: a systematic review","volume":"92","author":"Barazzone","year":"2019","journal-title":"Psychol. Psychother. Theory Res. Pract."},{"key":"ref201","first-page":"34","author":"Besser","year":"2012"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1037\/0003-066X.59.1.20","article-title":"Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events?","volume":"59","author":"Bonanno","year":"2004","journal-title":"Am. Psychol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1037\/a0018490","article-title":"Attachment and emotion in school-aged children","volume":"10","author":"Borelli","year":"2010","journal-title":"Emotion"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"196","DOI":"10.3389\/fmed.2018.00196","article-title":"School-aged children with higher reflective functioning exhibit lower cardiovascular reactivity","volume":"5","author":"Borelli","year":"2018","journal-title":"Front. 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Stress."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"284","DOI":"10.2307\/1166150","article-title":"A functionalist perspective on the nature of emotion","volume":"59","author":"Campos","year":"1994","journal-title":"Monogr. Soc. Res. Child Dev."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1111\/j.1540-5834.1994.tb01287.x","article-title":"Emotion regulation: influences of attachment relationships","volume":"59","author":"Cassidy","year":"1994","journal-title":"Monogr. Soc. Res. Child Dev."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"327","DOI":"10.4088\/JCP.10m06293","article-title":"Neural correlates and predictive power of trait resilience in an acutely traumatized sample: a pilot investigation","volume":"73","author":"Daniels","year":"2012","journal-title":"J. Clin. Psychiatry"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1108\/14636646200600015","article-title":"Inducing traumatic attachment in adults with a history of child abuse: forensic applications","volume":"8","author":"de Zulueta","year":"2006","journal-title":"Br. J. Forensic Pract."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1002\/jts.20062","article-title":"Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects?: a survey of traumatic stress professionals","volume":"18","author":"Elhai","year":"2005","journal-title":"J. Trauma. Stress"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"30611","DOI":"10.3402\/ejpt.v7.30611","article-title":"Maternal and child reflective functioning in the context of child sexual abuse: pathways to depression and externalising difficulties","volume":"7","author":"Ensink","year":"","journal-title":"Eur. J. 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Orthop."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1111\/infa.12263","article-title":"Costs of not getting to know you: lower levels of parental reflective functioning confer risk for maternal insensitivity and insecure infant attachment","volume":"24","author":"Ensink","year":"2019","journal-title":"Infancy"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1037\/cbs0000030","article-title":"Intergenerational pathways from reflective functioning to infant attachment through parenting","volume":"48","author":"Ensink","year":"","journal-title":"Can. J. Behav. Sci."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1046\/j.1365-2214.2000.00146.x","article-title":"Implications of attachment style for patterns of health and illness","volume":"26","author":"Feeney","year":"2000","journal-title":"Child Care Health Dev."},{"key":"ref29","volume-title":"Affect Regulation, Mentalization, and the Development of the Self","author":"Fonagy","year":"2002"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1111\/j.1469-7610.2007.01727.x","article-title":"The parent-infant dyad and the construction of the subjective self","volume":"48","author":"Fonagy","year":"2007","journal-title":"J. Child Psychol. 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Psychopathol."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1007\/s10802-009-9300-x","article-title":"Posttraumatic stress symptoms and trajectories in child sexual abuse victims: an analysis of sex differences using the national survey of child and adolescent well-being","volume":"37","author":"Maikovich","year":"2009","journal-title":"J. Abnorm. Child Psychol."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1097\/00006842-200107000-00006","article-title":"Attachment and psychosomatic medicine: developmental contributions to stress and disease","volume":"63","author":"Maunder","year":"2001","journal-title":"Psychosom. Med."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1097\/00004583-199209000-00015","article-title":"Sexually abused children at high risk for post-traumatic stress disorder","volume":"31","author":"McLeer","year":"1992","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.6092\/2282-1619\/mjcp-2418","article-title":"Childhood trauma, attachment and psychopathology: a correlation network approach","volume":"8","author":"Midolo","year":"2020","journal-title":"Mediterr. J. Clin. Psychol."},{"key":"ref49","first-page":"503","article-title":"Adult attachment and affect regulation","volume-title":"Handbook of Attachment: Theory, Research, and Clinical Applications","author":"Mikulincer","year":"2008"},{"key":"ref50","first-page":"77","volume-title":"Attachment Bases of Emotion Regulation and Posttraumatic Adjustment Emotion Regulation in Couples and Families: Pathways to Dysfunction and Health","author":"Mikulincer","year":"2006"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1023\/A:1024515519160","article-title":"Attachment theory and affect regulation: the dynamics, development, and cognitive consequences of attachment-related strategies","volume":"27","author":"Mikulincer","year":"2003","journal-title":"Motiv. Emot."},{"key":"ref52","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/978-1-4899-7522-5_4","article-title":"An attachment perspective on traumatic and posttraumatic reactions","volume-title":"Future Directions in Post-Traumatic Stress Disorder","author":"Mikulincer","year":"2015"},{"key":"ref203","doi-asserted-by":"publisher","first-page":"e1001349","DOI":"10.1371\/journal.pmed.1001349","article-title":"The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis.","volume":"9","author":"Norman","year":"2012","journal-title":"PLoS Med."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1080\/14616730701868597","article-title":"Attachment styles, traumatic events, and PTSD: a cross-sectional investigation of adult attachment and trauma","volume":"10","author":"O\u2019Connor","year":"2008","journal-title":"Attach Hum. Dev."},{"key":"ref55","first-page":"27","article-title":"Attachment and emotion in middle childhood and adolescence","volume":"24","author":"Parrigon","year":"2015","journal-title":"Psihologijske Teme"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1037\/a0029349","article-title":"Close relationship processes and health: implications of attachment theory for health and disease","volume":"32","author":"Pietromonaco","year":"2013","journal-title":"Health Psychol."},{"key":"ref57","doi-asserted-by":"publisher","first-page":"384","DOI":"10.3389\/fpsyg.2017.00384","article-title":"The child attachment interview: a narrative review","volume":"8","author":"Privizzini","year":"2017","journal-title":"Front. Psychol."},{"key":"ref58","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1097\/00004583-200303000-00006","article-title":"Ten-year research update review: child sexual abuse","volume":"42","author":"Putnam","year":"2003","journal-title":"J. Am. Acad. 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Psychiatry"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1111\/j.1750-8606.2011.00181.x","article-title":"When words just won\u2019t do: Introducing parental embodied mentalizing","volume":"5","author":"Shai","year":"2011","journal-title":"Child Dev. Perspect."},{"key":"ref62","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1080\/14616734.2016.1255653","article-title":"Parental embodied mentalizing: how the nonverbal dance between parents and infants predicts children\u2019s socio-emotional functioning","volume":"19","author":"Shai","year":"2017","journal-title":"Attach Hum. Dev."},{"key":"ref63","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1037\/0012-1649.44.4.939","article-title":"The child attachment interview: a psychometric study of reliability and discriminant validity","volume":"44","author":"Shmueli-Goetz","year":"2008","journal-title":"Dev. Psychol."},{"key":"ref65","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1080\/0075417031000138433","article-title":"Attachment representations in school-age children: the development of the child attachment interview (CAI)","volume":"29","author":"Target","year":"2003","journal-title":"J. Child Psychother."},{"key":"ref67","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1037\/a0034712","article-title":"Assessing attachment in adolescence: a psychometric study of the child attachment interview","volume":"26","author":"Venta","year":"2014","journal-title":"Psychol. Assess."},{"key":"ref68","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.janxdis.2015.07.002","article-title":"The relationship between adult attachment style and post-traumatic stress symptoms: a meta-analysis","volume":"35","author":"Woodhouse","year":"2015","journal-title":"J. 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