The links between adult attachment and post-traumatic stress: A systematic review

Purpose The theory of attachment has informed our understanding of survival and well-being throughout the lifespan. There is a growing interest in the relationship between attachment and symptoms of post-traumatic stress (PTS). Emerging evidence points to important links between attachment and PTS, yet current theoretical and clinical understandings of PTS symptoms and attachment remain relatively disparate. The current systematic review aimed to synthesize, describe, and critique evidence demonstrating the links between attachment and PTS in adults. It also aimed to explore whether the relationship between attachment and PTS differs according to the nature of the traumatic event. Methods Searches were conducted using PsycINFO, the Cochrane Library, Medline, and Google Scholar to identify empirical studies focusing on PTS in adults. Results Twenty-one papers were identified. Attachment was shown to have moderating and mediating influences on the relationship between trauma and PTS. This varied according to the type of trauma, and how symptoms of PTS were reported across the different attachment styles. Methodological rigour varied across studies. Clinical and research implications are discussed, including the consideration of attachment security in assessment and formulation. Conclusions Although findings were mixed, this review suggests that there is an important link between attachment and PTS. It supports the current emerging evidence demanding the development of a more unified theoretical framework for attachment, types of trauma, and symptoms of PTS. Practitioner points The findings discussed in this review have important implications for the treatment of PTS symptoms. Consideration of attachment styles in formulations is likely to inform treatment plans. There is increasing evidence to suggest that assessing and accounting for attachment style in therapy may improve the chances of successful treatment.