The cycle of healing - dissociation and attachment during treatment of CSA survivors.

Childhood sexual abuse (CSA) is an extreme traumatic event associated with numerous long lasting difficulties and symptoms (e.g., Herman, 1992). These include, among other things, the impediment of basic interpersonal structures of attachment (Rumstein-McKean & Hunsley, 2001), as well as impairment of mental integration manifested in dissociation (Van Den Bosch et al., 2003). Theoretically, attachment insecurities and dissociation are closely linked, since dissociation is generated as a way to resolve the conflicted attachment demands faced by the abused child (e.g., Liotti, 1992). Nevertheless, the directionality of association between attachment insecurities and dissociation during treatment of adult CSA survivors remains largely uninvestigated. Filling this gap, the present prospective study assessed female adult survivors of CSA who were outpatients at four treatment centers in Denmark (n=407), at the start of treatment (T1), 6 months after starting treatment (T2) and 12 months after starting treatment (T3). Results indicated that both attachment insecurities and dissociation reduced over time during treatment. Elevated attachment insecurities were associated with elevated dissociation at each of the measurements. Moreover, there was a reciprocal association between attachment avoidance and dissociation during treatment. Low levels of attachment avoidance predicted a decline in dissociation and vice versa. Findings suggest that treatment creates a cycle of healing in which rehabilitation of attachment fosters reintegration, which in turn deepens the restoration of attachment.