Attachment-related consequences of war captivity and trajectories of posttraumatic stress disorder: A 17-year longitudinal study

Attachment security contributes to resilience in times of stress, but it can be disrupted by traumatic events that shatter positive views of self and others. We followed Israeli ex-POWs of the Yom Kippur War over 17 years and examined associations between trajectories of posttraumatic stress disorder (PTSD) and disruptions in the regulatory functions of the attachment system. Fifty-nine ex-POWs and 39 control veterans from the same war who had reported on PTSD 18, 30, and 35 years after the war performed laboratory cognitive tasks assessing activation of mental representations of security in response to threat and the ability of these representations to color neutral stimuli with positive affect and reduce access to trauma-related thoughts. As compared to controls, ex-POWs with persistent PTSD over the 17-year period exhibited dramatic disruptions in the soothing and healing functions of attachment security representations. These disruptions were not evident among ex-POWs with a worsening PTSD trajectory or a stable resilience trajectory. The implications of attachment-system functioning for understanding posttraumatic processes are discussed.