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.