The impact of attachment style on posttraumatic stress symptoms and treatment response in survivors of sexual assault

<b>Background:</b> Sexual assault (SA) is associated with a high risk of posttraumatic stress disorder (PTSD), and delayed disclosure of SA may exacerbate psychological distress. Attachment theory provides a useful framework for understanding individual differences in trauma response. However, little is known about how attachment styles impact symptom severity and psychotherapy outcomes in late disclosers of SA. This study aimed to examine the relationship between adult attachment styles, posttraumatic stress symptoms, and psychotherapy outcomes in a clinical sample of adult survivors of SA.<b>Objectives:</b> This study investigated (1) the association between attachment styles and posttraumatic stress symptoms prior to treatment, (2) whether attachment style at baseline predicted treatment outcomes, and (3) whether changes in attachment security were associated with symptom reduction.<b>Methods:</b> Sixty-seven adult survivors of SA (66 women, 1 man) seeking treatment an average of 47.5 months after the assault completed the Revised Adult Attachment Scale and the Posttraumatic Diagnostic Screening at baseline and post-treatment. General linear models were used to assess relationships between attachment dimensions and symptom severity.<b>Results:</b> Attachment avoidance, but not attachment anxiety, was significantly associated with posttraumatic stress symptoms at baseline, accounting for 23% of the variance in overall post-traumatic distress. Neither attachment avoidance nor attachment anxiety predicted treatment outcomes. However, greater reductions in attachment avoidance during therapy were significantly correlated with improvement in posttraumatic stress symptoms, accounting for 10% of the variance in post-treatment symptoms.<b>Conclusions:</b> These findings suggest attachment avoidance is associated with posttraumatic stress symptoms among late disclosers of SA and that reduction in avoidance during therapy is related to improved outcomes. Given the interpersonal nature of SA, addressing attachment avoidance in psychotherapy may enhance recovery.