Entropy Rules

Parenting With PTSD:

Childhood Trauma Effects Inter-Transmission

    As detailed previously, it has been found that individuals who are maltreated as children tend to show negative biases in attention and memory, as well as difficulties in the regulation of attention, emotions, and behavioral impulses (e.g., Bremner et al., 1993; Fearon, Bakersmans-Kranenburg, van Ijzendoorn, Lapsley, & Roisman, 2010; Noll-Hussong et al, 2010; Siegel, 2012). Individuals who are maltreated as children tend to experience consistently high negative affect and simultaneously have reduced impulse control and empathic capacities (Becker-Blease & Kerig, 2016; Hess & Main, 2006). These traits in and of themselves, as well as problematic states of mind with respect to attachment (e.g., unresolved), influences thoughts, beliefs, behavioral urges, and emotional states that impact the quality of caregiving.
    Adults with a history of unresolved traumatic attachment are likely to be reminded, both implicitly and explicitly, of their insecure status by a variety of stimuli. A phenomenon termed "ecphory" refers to the degree of match between a memory and a retrieval cue; it is related to the observation that it is easier to recall memories when the conditions at time of recall resemble conditions of original encoding (Lang, Craske, Brown, & Ghaneian, 2001; Siegel, 2012; Steinvorth, Corkin, & Halgren, 2006). Ecphorous memory cues include external context (e.g., sights, sounds, smells) as well as internal context (e.g., emotional states, physical arousal). Unresolved memories of difficult maltreatment experiences involve a residue of implicit memories, as well as explicit memories, which can be triggered in the parent's new role as caregiver (e.g., such as when a parent is unable to soothe or effect a desired outcome with a child). Implicit memories resembling these experiences in the parent's history may be tinged with extreme emotional states, such as terror or rage. Thus, through a potentially innocuous ecophorous memory cue, these same states may be reproduced in the survivor-parent, influencing them to act impulsively in an effort to express, reduce, or avoid these emotions (Siegel & Hartzell, 2014). Additionally, intrusive thoughts, feelings, and memories can potentially lead to depressive or dissociative states, that can also interfere with sensitive parenting (Levendosky & Graham-Bermann, 2001; DiGiuseppe et al., 1996; Shaver & Fraley, 2008). A triggered parent may act in ways that include frightened or frightening behavior, disturbances in effective parental communication (e.g., contradictory cues), role confusion, and/or withdrawal in the parent, all of which have been associated with the risk of disorganized attachment (Abrams, Rifkin, & Hesse, 2006; Jacobvitz, Leon, & Hazen, 2006; Ehrensaft, Knous-Westfall, Cohen, & Chen, 2015; Siegel 2012; Siegel & Hartzell, 2014).
    Bailey and colleagues (2007) investigated the parenting styles of a sample of at-risk adolescent mothers (50% of whom were maltreated themselves as children) and their infants. Two common, problematic patterns of interaction were observed: (1) a withdrawn, inattentive, socioemotionally disengaged style, and (2) a nonsynchronous style where mothers interacted with their babies but according to their own agenda rather than being attentive and responsive to the signaled needs of the infant (Bailey et al., 2007). These interactive styles mediated the association between unresolved attachment status in the mother and disorganized attachment in the infant. Infants with disengaged or nonsynchronous mothers tended to prefer to interact with a stranger (i.e., in this case, the visiting researcher) or behaved in a sad and withdrawn manner as compared to infants of sensitive mothers who interacted harmoniously (Bailey et al., 2007). Disengaged and nonsynchronous styles seem to be found mostly in at-risk samples whereas attachment within low risk samples tends to be distinguishable based on variations in the sensitivity or insensitivity of the caregiver (Field, Healy, Goldstein, & Guthertz, 1990; Oldershaw, Walters, & Hall, 1989).
    From an attachment perspective, a parent's use of avoidant coping is likely to have adverse consequences on the developing child, since the avoidant caregiver is unable and/or unwilling to serve as a secure base for the child during times of distress (Siegel & Hartzell, 2014). Ehrensaft et al. (2015) investigated three generations of people who were physically and sexually-abused as children and subsequent parenting practices. Sexual abuse was associated with spending less time with the child and being less available, being less satisfied with the child, and perceiving one's own parenting as ineffective. Physical abuse was also associated with perceived parenting ineffectiveness. Parents who had experienced both kinds of abuse tended to be unavailable to their children and use more harsh discipline. Adult psychopathology and conduct disorder mediated the effect between abuse as a child and parenting strategies. This highlights the role of unmanaged emotional and behavioral dysregulation in creating a dynamic where parents may over rely on withdrawal as a means of coping with parenting responsibilities. Parents who were maltreated as children may need assistance learning emotion regulation strategies that allow them to stay connected to and present with their child, especially during times of distress (Ehrensaft et al., 2015).
    Disorganized attachment in childhood has also been strongly linked to parental behavior that is characterized as either frightening or frightened (Bailey et al., 2007; Hess & Main, 2006). Frightening behavior is likely related to sympathetic overarousal (i.e., the fight or flight response), while behavior consistent with a "freeze" response (e.g., dissociation), as well as timid or deferential behavior, sexualized behavior, and disorganized behavior indicates fear in the parent, which in turn influence fear states in the child. An example of deferential behavior that can be frightening to a child includes role-inversion, such as when a parent utilizes the child as a source of comfort when the parent is distressed. Even in the absence of overt abuse or neglect, dissociative behavior (e.g. "spacing out" and becoming unresponsive to a child's bids for connection) falls into the category of frightened behavior, and can lead to emotional neglect. Some studies have shown that parents with unresolved trauma are more easily triggered by a wide-variety of even vaguely trauma-related stimuli, which could trigger a frightened or frightening response in the parent (Hesse & Main, 2006). One study showed that women with an unresolved/disorganized attachment status did not differ from secure women in terms of emotionally sensitive parenting, but they did display more frightening behaviors than those who were not unresolved; it was the unresolved status of a childhood loss that was most predictive of frightening behavior (Jacobvitz et al., 2006). Other studies (e.g., Abrams, Rifkin, & Hesse, 2006) have replicated significant associations among unresolved adult state of mind with respect to attachment, frightened/frightening parenting behavior, and disorganized attachment.
    Another category of behavior, which also contributes to the development of problematic attachment, has been labeled by researchers as "atypical" (Lyons-Ruth et al., 1999). Atypical behaviors include those already discussed (i.e., withdrawn, frightening, and frightened behaviors), and also intrusive or otherwise misattuned behavior that has also been associated with maltreatment and disorganized attachment. These behaviors include "affective errors", such as not comforting an obviously distressed child, or laughing at an embarrassed child. Atypical maternal behavior has been shown to be associated with unresolved childhood trauma and predicted disorganized infant behavior in the strange situation (Goldberg, Benoit, Blockland, & Madigan, 2003; MacDonald et al., 2008). Although all parents may display these problematic behaviors from time to time, parents with a history of maltreatment are at greater risk of enacting such behaviors more frequently and more often in response to internal cues (e.g., implicit memory flashbacks) as opposed to external cues. When the parents behavior is driven by internal versus external cues, it confuses the child who may lack the psychological sophistication involved in mind-mindedness that would allow them to guess the cause of the parent's behavior. At any rate, the child cannot observe the internal causes of the parent's atypical behavior, and thus is not capable of stopping or altering the parental behavior through adjustments in their own behavior, thus leaving the child with a feeling of being confused and out of control. If such parental behavior is based in unresolved traumatic maltreatment, it is also likely the maltreated parent will display such problematic behaviors more frequently and for more prolonged periods of time (Hesse & Main, 2006). Failure to resolve early life trauma such as that associated with maltreatment greatly increases the risk of intergenerational transmission (Hesse & Main, 1999). Additionally, the link between a history of maltreatment and acting in frightened/frightening ways suggests that it is unresolved trauma in the parents that is a primary risk factor for child maltreatment and disorganized attachment, indicating the necessity of the parent's work in resolving these difficult early life experiences (Schuengel, Bakermans-Kranenburg, & Van IJzendoorn 1999).
    Finally, another aspect of parenting that influences attachment is parenting sensitivity. Maternal sensitivity encompasses positive behavior, such as cooperation, contingent responsiveness, acceptance, and pleasurable affectivity. At its extreme, insensitivity may refer to emotional abuse, including overt hostility, and punitive and retaliatory behavior. Across parenting populations, there is only modest support for the mediating role of maternal sensitivity in the association between maternal attachment representations and the attachment status of their children (Atkinson et al., 2000; Pederson et al., 1998; Raval et al., 2001). However, Van Ijzendoorn et al.'s (1999) meta-analysis suggests that in high-risk, low-SES populations, maternal insensitivity alone (excluding pathological and atypical behavior) contributed significantly to the development of disorganized attachment. High-risk environments place high demands on maternal sensitivity in that the greater degree of threat and stress is likely to lead to attachment needs being triggered more frequently and with higher consequences given lack of resources. The contribution of an impoverished environment to the intergenerational transmission of child maltreatment cannot be understated. Other common risk factors that exacerbate these situations include parental substance abuse, heightened physiological reactivity, and the presence of domestic violence (Bernier & Meins, 2008). However, in lower risk samples, a mere lack of sensitivity does not appear sufficient to produce attachment disorganization. Rather, it appears that overtly negative or withdrawn parental behavior plays a more influential role in attachment security in low-risk populations, perhaps because attachment is more relevant in contexts where mothers and children must frequently navigate objectively stressful experiences together (Kelly, Slade, & Grienenberger, 2005).
    This section has highlighted the roles of frightening, withdrawn, atypical, and (in)sensitive behavior in affecting attachment. A recent meta-analysis found moderate effect sizes for the links between unresolved states of mind with respect to attachment and (1) frightening, threatening, or dissociative behavior, and (2) disorganized attachment, as well as a moderate association between these types of behavior and disorganized attachment (Bailey et al., 2007). However frightening, threatening, or dissociative behavior did not mediate the link between unresolved attachment status and disorganized attachment (Bailey et al., 2007). Some studies have found that frightened, frightening, or anomalous behaviors explain approximately 25% of variance in disorganized attachment indicating other factors also influence this developmental trajectory (Bernier & Meins, 2008; Madigan et al., 2007). Another study showed the expected associations of frightening, insensitive, or unskillful parenting behavior and attachment variables, but parenting behavior did not mediate the associations between maternal Unresolved status and infant disorganized attachment, again indicating other factors must contribute to disorganization in the infant (Goldberg et al., 2003). Given the limited portion of the variance explained by atypical or frightening behavior, this calls into question other potential factors that could contribute to disorganized attachment, such as a lack of reflective functioning (i.e., mind-mindedness), a cognitive factor that may underlie a parent's affective errors, withdrawal, aggression, and/or intrusion.

⇲ About The Author

Robin Hertz, MA is currently in the process of completing a PhD in Clinical Psychology at the University of Oregon.