Adult attachment styles as predictors of posttraumatic stress severity and PTSD among U.S. Army soldiers

This study examined the relationships between adult attachment style and posttraumatic stress in a large sample of U.S. Army soldiers recently returned from a combat deployment. Results from responses to the Relationship Style Questionnaire and the Posttraumatic Stress Checklist (n=742) showed that soldiers with an insecure attachment style (preoccupied, fearful avoidant, dismissing avoidant) had statistically significantly higher rates of PTSD than soldiers with a secure attachment style: Secure, 6%; Preoccupied, 25.6%; Fearful Avoidant, 23.6%; Dismissing Avoidant, 1 1.9%. Soldiers with insecure attachment styles also had statistically significantly higher posttraumatic stress severity (PSS) than soldiers with secure attachment styles. Soldiers with insecure attachment styles that are higher on the anxiety dimension (preoccupied and fearful avoidant) had statistically significant higher intrusion symptom severity than other styles. Soldiers with insecure attachment styles that are higher on the avoidance dimension (fearful avoidant and dismissing avoidant) had statistically significant higher avoidance symptom severity than soldiers with a secure attachment style but not soldiers with a preoccupied style.

This study also examined the associations between adult attachment dimensions and PSS. Results from simple linear regressions (n=759) showed higher attachment anxiety and attachment avoidance independently predicted higher PSS. Results from hierarchical multiple regressions (n=737) showed adult attachment dimensions, anxiety and avoidance, were stronger predictor of PSS than combat exposure, perceived danger, and demographic risk factors. Two cumulative R2 series showed similar results. In a regression model that assigned causal priority to the attachment dimensions, attachment anxiety and attachment avoidance collectively accounted for a statistically significant greater amount of variance in PSS than combat exposure, 20% versus 7%. Data show perceived danger and being female were also significant predictors of PSS in this sample. The overall hierarchical regression model accounted for 31% of the variance in PSS. This study suggests attachment insecurity and attachment security are risk and resilience factors of PTSD, respectively. The study also suggests contemporary attachment theory is an important theoretical framework with broader implications for the Army. A discussion of implications included Army medicine, the human dimension and capabilities development, leadership, comprehensive soldier fitness, and counseling. The study proposed specific recommendations to use or accelerate attachment research in these areas.