Linking childhood maltreatment to ICD-11 PTSD and CPTSD: Differential roles of insecure attachment and emotion dysregulation.

INTRODUCTION

Accumulating evidence suggests that childhood maltreatment (CM) increases risk for ICD-11 PTSD and CPTSD. Insecure attachment and emotion dysregulation (ED) may serve as key pathways linking CM to trauma-related symptoms. This study examined whether specific dimensions of insecure attachment (anxious, avoidant, disorganized) and ED mediate the links between overall CM and ICD-11 PTSD and CPTSD symptoms.

METHOD: Between July and December 2022, 669 Taiwanese community-dwelling adults (53.5% female) meeting the ICD-11 trauma exposure criterion participated. Simple, parallel, and parallel-serial mediation analyses were performed to examine the hypothesized indirect associations.

RESULTS

Overall CM was strongly associated with ICD-11 PTSD/CPTSD symptoms. Simple mediation analyses showed that all dimensions of insecure attachment and ED significantly mediated the associations between overall CM and ICD-11 PTSD/CPTSD symptoms. In parallel mediation, only anxious and disorganized attachment remained significant mediators. Anxious attachment showed small-to-medium effects, while disorganized attachment yielded medium-to-large effects for both outcomes. Among ED dimensions, impulse control difficulties and limited access to regulation strategies significantly mediated the effects of overall CM on both outcomes, with impulse control exerting a stronger influence on PTSD symptoms, and limited regulation strategies showing a stronger effect on CPTSD symptoms. In parallel-serial mediation, significant sequential indirect pathways emerged from overall CM to PTSD/CPTSD symptoms through all insecure attachment dimensions followed by general ED.

CONCLUSIONS

Insecure attachment and ED are central to understanding the links between CM and symptoms of ICD-11 PTSD and CPTSD, particularly highlighting the role of disorganized attachment and limited emotion regulation strategies in CPTSD development.