A cascade model of complex posttraumatic stress disorder centered on childhood trauma and maltreatment, attachment, and socio-interpersonal factors

Abstract

The present study proposes and tests a cascade model of complex posttraumatic stress disorder (CPTSD) focusing on childhood trauma and maltreatment, attachment, and socio-interpersonal factors. Multigroup path analysis was used to examine data from 126 individuals formerly affected by compulsory social measures and placements (CSMP) in their childhood and/or adolescence (i.e., risk group [RG]; M age = 70.8 years) and an age-matched control group (CG; n = 125; M age = 70.6 years). The final model confirmed the cascade structure, with stronger associations emerging in the RG. Childhood trauma and maltreatment were associated with attachment anxiety, β = |.20|-.30, which was related to all socio-interpersonal factors (i.e., disclosure of trauma, social acknowledgment, and social support), β = .27-|.54|; the latter were associated with substantial aspects of the CPTSD symptoms as well as life satisfaction, β = |.21|-.42. Among participants in the CG, we observed more direct, rather than mediated, paths to CPTSD symptoms. Adulthood trauma exposure did not follow the full cascade pattern but was associated with the socio-interpersonal factors. Nevertheless, more in-depth clinical knowledge of CPTSD and potential targets for psychological treatment may be gained from the confirmation of this newly proposed cascade model of CPTSD.