Dyadic adjustment in a clinical sample of adult victims of cumulative childhood interpersonal trauma: The role of complex posttraumatic stress and attachment insecurities

BACKGROUND: Cumulative childhood interpersonal trauma (CCIT) is highly prevalent and has been consistently associated with persistent relational difficulties in adulthood. Victims frequently report lower dyadic adjustment, a key determinant of health, well-being, and trauma recovery. However, the mechanisms linking CCIT to impaired couple functioning remain insufficiently understood. OBJECTIVE: This study examined a sequential model in which symptoms of complex posttraumatic stress disorder (C-PTSD) - including posttraumatic stress (PTS) and disturbances in self-organization (DSO) - and subsequent attachment insecurities (avoidance and anxiety) were tested as explanatory mechanisms in the association between CCIT and dyadic adjustment within a clinical sample. PARTICIPANTS AND SETTINGS: A total of 907 adults seeking therapy for sexual and relational difficulties completed validated measures as part of their intake assessment. RESULTS: Path analyses revealed significant sequential associations whereby CCIT was indirectly associated with lower dyadic adjustment through DSO then attachment avoidance (β = -0.034, 95% CI [-0.053, -0.020]), as well as through DSO then attachment anxiety (β = -0.008, 95% CI [-0.016, -0.003]). In contrast, CCIT was positively associated with dyadic adjustment through PTS alone (β = 0.060, 95% CI [0.032, 0.093]) but negatively associated with dyadic adjustment through the sequential association via PTS then attachment anxiety (β = -0.006, 95% CI [-0.013, -0.002]). Although statistically significant, the sequential indirect effects were small in magnitude and should not be interpreted as evidence of substantial clinical effects. The final model explained 24.8% of the variance in dyadic adjustment. CONCLUSION: These results point to the relevance of addressing self-organization impairments and attachment dynamics in clinical interventions aimed at improving relational functioning among CCIT victims.