Exploring the associations between parental exposure to childhood adversity, post-traumatic stress symptoms and prenatal attachment

Fflur, Siana 2024. Exploring the associations between parental exposure to childhood adversity, post-traumatic stress symptoms and prenatal attachment. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

Exposure to childhood adversity can have a profound and long-lasting harmful impact on various aspects of people’s lives and can often influence mental and relational health. Parents’ exposure to childhood maltreatment can later have an adverse impact on their relationship with their own children. This Thesis examines the association between expectant parents’ exposure to childhood adversity and their prenatal attachment towards their developing baby during pregnancy, with a particular focus on exposure to childhood maltreatment. The aim is to better understand this association and contribute towards the development of clinical interventions to support expectant parents who have been exposed to childhood adversity who are experiencing difficulties in their prenatal attachment towards the developing baby. The existing evidence assessing whether there is an association between parents’ experience of childhood adversity and prenatal attachment is synthesised and appraised in the systematic review. This is a clinically relevant issue, as prenatal attachment is a predictor of maternal health-related behaviour during pregnancy, as well as the quality of the parent-child attachment relationships postnatally. The review also aims to explore whether the association between different types of childhood adversity and prenatal attachment may vary in strength. Namely, the review explored whether childhood maltreatment is more strongly associated with prenatal attachment, compared to other forms of childhood adversity: household dysfunction and ACEs (where maltreatment and household dysfunction are combined). Relevant studies were found to include in the systematic review by searching databases. Thirteen studies, reported across 15 papers, met the review’s inclusion criteria. Relatively consistent evidence was found for an association between maternal experiences of childhood maltreatment, in particular emotional abuse and neglect, with lower levels of prenatal attachment. The evidence for an association between prenatal attachment and both household dysfunction and combined ACEs was mixed. However, it is important to note that fewer studies explored these associations, and the methodology was generally weaker in these studies. A current limitation highlighted by the review is that research on the association between childhood adversity and prenatal attachment in fathers and other non-birthing parents is lacking. The empirical paper builds on the findings of the systematic review by proposing and exploring a possible mechanism which may underly the association between maternal childhood maltreatment and prenatal attachment. The study examined whether the two clusters of post-traumatic stress symptoms (post-traumatic stress disorder (PTSD) symptoms, and disturbances in self-organisation (DSO) symptoms) may explain part of the association found between expectant mothers’ and birthing-parents’ experiences of childhood maltreatment and prenatal attachment. The study is guided by attachment theory and theories of intergenerational trauma. Attachment theory emphasises the importance of early relationships in shaping later emotional and social development. Theories of intergenerational trauma highlight that trauma experienced by an individual can affect future generations through environmental and biological mechanisms. These theories guided the aims of the present study, which were to better understand one of the possible environmental and emotional/relational mechanisms underlying the association between maternal maltreatment and prenatal attachment. Specifically, the aims were to examine whether ongoing trauma symptoms may, in part, explain why some individuals exposed to childhood maltreatment go on to experience difficulties in attachment relationships, whilst others do not. Expectant mothers and birthing-parents completed an online survey, answering questions about their own experiences of childhood adversity, posttraumatic stress symptoms and prenatal attachment towards the developing baby. One-hundred and fifty trauma-exposed participants from the Maternal Wellbeing, Mental Health & Life Experiences study were included in the study. A negative association was found between DSO symptoms and prenatal attachment in this group, but no significant association was found between PTSD symptoms and prenatal attachment. DSO symptoms were also found to fully mediate the association between participants’ exposure to childhood maltreatment and prenatal attachment towards their developing baby. This suggests that DSO symptoms in adulthood may play an important role in explaining how mothers’ and birthing parents’ exposure to childhood maltreatment affect prenatal attachment. Furthermore, the findings suggest that DSO symptoms may be a suitable target for interventions aiming to strengthen prenatal attachment in this population. Experiencing DSO symptoms alone, without PTSD symptoms, does not currently meet criteria for any post-traumatic stress diagnosis. Whilst DSO symptoms form part of the ICD-11 Complex-PTSD (C-PTSD), this is only met when the symptoms are paired with clinically significant levels of PTSD symptoms. There is therefore a risk that mothers and birthing parents who experience DSO symptoms alone may not meet the criteria for some services that could otherwise offer support. This Thesis contributes to the limited existing evidence base exploring the association between parents’ experiences of childhood adversity and prenatal attachment. Methodological issues and gaps in the evidence base are highlighted, and suggestions are made for future research. These studies contribute towards the development of interventions to support expectant parents and their relationships with their unborn child.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	17 September 2024
Last Modified:	17 Sep 2024 08:54
URI:	https://orca.cardiff.ac.uk/id/eprint/172155

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