The role of Dysfunctional Personality Features and Adult Attachment Style in Predicting ICD-11 Trauma Related Disorders in a Community- dwelling Sample.

Serena Borroni, Giulia Ruotolo, Elisabetta Masci, Chiara Franzoni, Giulia Vassena, Andrea Fossati


Background. General population studies have shown that a large portion of people in developed countries have been exposed to at least one traumatic event in their lifetime. However, the development of trauma-related disorders (Post Traumatic Stress Disorder/Complex Post Traumatic Stress Disorder) is relatively rare. Thus, the evaluation and the early identification of trauma related disorders risk factors represent a relevant topic. The present study was aimed at investigating if dysfunctional personality traits and attachment styles represent risk factors for meeting the criteria of trauma-related disorders.

Methodology. In a sample of 552 Italian community-dwelling adult participants we administered the International Trauma Questionnaire, the Personality Inventory for DSM-5-BF and the Attachment Style Questionnaire. Three hundred-sixty-five participants reported one or more traumatic experiences according to ICD-11 operationalization.

Results. In our sample, the prevalence of trauma related disorders was 14.5%. Females and younger participants were significantly more likely to develop trauma related disorders. Moreover, the hierarchical logistic regression models showed that high level of Negative Affectivity and an anxious/ambivalent adult attachment style (Preoccupation with Relationship) increased the risk to meet trauma related disorders criteria. Finally, when we considered as covariates Negative Affectivity and Preoccupation with Relationship, only Negative Affectivity remained a significant predictor.

Conclusion. As a whole, these results suggested the importance of dysfunctional personality features in trauma related disorders risk. In addition, an insecure attachment style characterized by an anxious and dependent approach to relationships represents a relevant aspect in order to prevent trauma related disorders.


Attachment; Clinical Psychology, Personality; Trauma related Disorder; ICD-11.

Full Text:



American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

Bach, B., Markon, K., Simonsen, E., & Krueger, R. F. (2015). Clinical utility of the DSM-5 alternative model of personality disorders: Six cases from practice. Journal of Psychiatric Practice, 21(1), 3-25.

Barazzone, N., Santos, I., McGowan, J., & Donaghay‐Spire, E. (2019). The links between adult attachment and post‐traumatic stress: A systematic review. Psychology and psychotherapy: theory, research and practice, 92(1), 131-147.

Bartholomew, K. (1990). Avoidance of intimacy: An attachment perspective. Journal of Social and Personal relationships, 7(2), 147-178.

Ben‐Ezra, M., Karatzias, T., Hyland, P., Brewin, C. R., Cloitre, M., Bisson, J. I., ... & Shevlin, M. (2018). Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD‐11 proposals: A population study in Israel. Depression and anxiety, 35(3), 264-274.

Benjet, C., Bromet, E., Karam, E. G., Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., ... & Koenen, K. C. (2016). The epidemiology of traumatic event exposure worldwide: Results from the World Mental Health Survey Consortium. Psychological medicine, 46(2), 327-343.

Besser, A., Neria, Y., & Haynes, M. (2009). Adult attachment, perceived stress, and PTSD among civilians exposed to ongoing terrorist attacks in Southern Israel. Personality and Individual Differences, 47(8), 851-857.

Bowlby, J. (1980). Attachment and loss: Volume III: Loss, sadness and depression. In Attachment and Loss: Volume III: Loss, Sadness and Depression, pp. 1-462. London: The Hogarth press and the institute of psycho-analysis.

Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., ... & Reed, G. M. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical psychology review, 58, 1-15.

Brodaty, H., Joffe, C., Luscombe, G., & Thompson, C. (2004). Vulnerability to post‐traumatic stress disorder and psychological morbidity in aged holocaust survivors. International Journal of Geriatric Psychiatry, 19(10), 968-979.

Campbell-Sills, L., Cohan, S. L., & Stein, M. B. (2006). Relationship of resilience to personality, coping, and psychiatric symptoms in young adults. Behaviour Research and Therapy, 44(4), 585-599.

Carmassi, C., Stratta, P., Massimetti, G., Bertelloni, C. A., Conversano, C., Cremone, I. M., ... & Dell'Osso, L. (2014). New DSM-5 maladaptive symptoms in PTSD: gender differences and correlations with mood spectrum symptoms in a sample of high school students following survival of an earthquake. Annals of general psychiatry, 13(1), 1-9.

Clark, L. A. (2007). Assessment and diagnosis of personality disorder: Perennial issues and an emerging reconceptualization. Annual Review of Psychology, 58, 227-257.

Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. European Journal of Psychotraumatology, 4(1), 20706.

Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5(1), 25097.

Cloitre, M., Hyland, P., Bisson, J. I., Brewin, C. R., Roberts, N. P., Karatzias, T., & Shevlin, M. (2019). ICD‐11 posttraumatic stress disorder and complex posttraumatic stress disorder in the United States: A population‐based study. Journal of Traumatic Stress, 32(6), 833-842.

Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., ... & Hyland, P. (2018). The International Trauma Questionnaire: Development of a self‐report measure of ICD‐11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 138(6), 536-546.

Collimore, K. C., McCabe, R. E., Carleton, R. N., & Asmundson, G. J. (2008). Media exposure and dimensions of anxiety sensitivity: Differential associations with PTSD symptom clusters. Journal of Anxiety Disorders, 22(6), 1021-1028.

Contractor, A. A., Armour, C., Shea, M. T., Mota, N., & Pietrzak, R. H. (2016). Latent profiles of DSM-5 PTSD symptoms and the “Big Five” personality traits. Journal of anxiety disorders, 37, 10-20.

Fauerbach, J. A., Lawrence, J. W., Schmidt Jr, C. W., Munster, A. M., & Costa Jr, P. T. (2000). Personality predictors of injury-related posttraumatic stress disorder. The Journal of Nervous and Mental Disease, 188(8), 510-517.

Feeney, J. A., Noller, P., & Hanrahan, M. (1994). Assessing adult attachment. In M. B. Sperling & W. H. Berman, Attachment in adults: Clinical and developmental perspectives, pp. 128–152. New York, NY: Guilford Press.

Ferrajão, P. C., Badoud, D., & Oliveira, R. A. (2017). Mental strategies as mediators of the link between attachment and PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 9(6), 731.

Fossati, A., Feeney, J. A., Donati, D., Donini, M., Novella, L., Bagnato, M., ... & Maffei, C. (2003). On the dimensionality of the Attachment Style Questionnaire in Italian clinical and nonclinical participants. Journal of Social and Personal Relationships, 20(1), 55-79.

Ghazinour, M., Richter, J., Emami, H., & Eisemann, M. (2003). Do parental rearing and personality characteristics have a buffering effect against psychopathological manifestations among Iranian refugees in Sweden?. Nordic Journal of Psychiatry, 57(6), 419-428.

Gil, S. (2005). Pre-traumatic personality as a predictor of post-traumatic stress disorder among undergraduate students exposed to a terrorist attack: A prospective study in Israel. Personality and Individual Differences, 39(4), 819-827.). Depression and Anxiety, 6(2), 70-77.

Glück, T. M., Knefel, M., Tran, U. S., & Lueger-Schuster, B. (2016). PTSD in ICD-10 and proposed ICD-11 in elderly with childhood trauma: Prevalence, factor structure, and symptom profiles. European Journal of Psychotraumatology, 7(1), 29700.

Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of personality and social psychology, 52(3), 511.

Heinrichs, M., Wagner, D., Schoch, W., Soravia, L. M., Hellhammer, D. H., & Ehlert, U. (2005). Predicting posttraumatic stress symptoms from pretraumatic risk factors: A 2-year prospective follow-up study in firefighters. American Journal of Psychiatry, 162(12), 2276-2286.

Hensley, L., & Varela, R. E. (2008). PTSD symptoms and somatic complaints following Hurricane Katrina: The roles of trait anxiety and anxiety sensitivity. Journal of Clinical Child & Adolescent Psychology, 37(3), 542-552.

Holeva, V., & Tarrier, N. (2001). Personality and peritraumatic dissociation in the prediction of PTSD in victims of road traffic accidents. Journal of psychosomatic research, 51(5), 687-692.

Hovens, J. E., Op den Velde, W., Falger, P. R. J., De Groen, J. H. M., & Van Duijn, H. (1994). Posttraumatic stress disorder in male and female Dutch resistance veterans of World War II in relation to trait anxiety and depression. Psychological reports, 74(1), 275-285.

Huang, Y. L., Chen, S. H., Su, Y. J., & Kung, Y. W. (2017). Attachment dimensions and post‐traumatic symptoms following interpersonal traumas versus impersonal traumas in young adults in Taiwan. Stress and Health, 33(3), 233-243.

Huang, Y. L., Fonagy, P., Feigenbaum, J., Montague, P. R., Nolte, T., & Mood Disorder Research Consortium. (2020). Multidirectional pathways between attachment, mentalizing, and posttraumatic stress symptomatology in the context of childhood trauma. Psychopathology, 53(1), 48-58.

Hyatt, C. S., Maples-Keller, J. L., Crowe, M. L., Sleep, C. E., Carter, S. T., Michopoulos, V., ... & Powers, A. (2021). Psychometric properties of the Personality Inventory for DSM-5-Brief Form in a community sample with high rates of trauma exposure. Journal of personality assessment, 103(2), 204-213.

Hyland, P., Brewin, C. R., & Maercker, A. (2017a). Predictive validity of ICD‐11 PTSD as measured by the Impact of Event Scale‐Revised: A 15‐year prospective study of political prisoners. Journal of Traumatic Stress, 30(2), 125-132.

Hyland, P., Shevlin, M., Elklit, A., Murphy, J., Vallières, F., Garvert, D. W., & Cloitre, M. (2017b). An assessment of the construct validity of the ICD-11 proposal for complex posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 9(1), 1.

Hyland, P., Vallières, F., Cloitre, M., Ben-Ezra, M., Karatzias, T., Olff, M., ... & Shevlin, M. (2020). Trauma, PTSD, and complex PTSD in the Republic of Ireland: Prevalence, service use, comorbidity, and risk factors. Social Psychiatry and Psychiatric Epidemiology, 56(4), 649-658.

Jakšić, N., Brajković, L., Ivezić, E., Topić, R., & Jakovljević, M. (2012). The role of personality traits in posttraumatic stress disorder (PTSD). Psychiatria Danubina, 24(3), 256-266.

James, L. M., Anders, S. L., Peterson, C. K., Engdahl, B. E., Krueger, R. F., & Georgopoulos, A. P. (2015). DSM-5 personality traits discriminate between posttraumatic stress disorder and control groups. Experimental Brain Research, 233(7), 2021-2028.

Kajantie, E., & Phillips, D. I. (2006). The effects of sex and hormonal status on the physiological response to acute psychosocial stress. Psychoneuroendocrinology, 31(2), 151–178.

Karatzias, T., Shevlin, M., Ford, J. D., Fyvie, C., Grandison, G., Hyland, P., & Cloitre, M. (2021). Childhood trauma, attachment orientation, and complex PTSD (CPTSD) symptoms in a clinical sample: Implications for treatment. Development and Psychopathology, 1-6.

Karatzias, T., Shevlin, M., Fyvie, C., Hyland, P., Efthymiadou, E., Wilson, D., ... & Cloitre, M. (2017). Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) based on the new ICD-11 trauma questionnaire (ICD-TQ). Journal of Affective Disorders, 207, 181-187.

Karatzias, T., Shevlin, M., Hyland, P., Brewin, C. R., Cloitre, M., Bradley, A., ... & Roberts, N. P. (2018). The role of negative cognitions, emotion regulation strategies, and attachment style in complex post‐traumatic stress disorder: Implications for new and existing therapies. British Journal of Clinical Psychology, 57(2), 177-185.

King, L. A., King, D. W., Fairbank, J. A., Keane, T. M., & Adams, G. A. (1998). Resilience–recovery factors in post-traumatic stress disorder among female and male Vietnam veterans: Hardiness, postwar social support, and additional stressful life events. Journal of Personality and Social Psychology, 74(2), 420.

Klein, A. B., Dutra, S. J., Bovin, M. J., Keane, T. M., & Marx, B. P. (2021). The role of negative affect in differentiating posttraumatic stress disorder, depression, and their comorbidity among united states veterans. Journal of Traumatic Stress, 34(2), 322-332.

Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., & Skodol, A. E. (2013a). The Personality Inventory for DSM-5-Brief Form (PID-5-BF)-Adult. Washington, DC: American Psychiatric Association.

Kunst, M. J. J. (2011). Affective personality type, post‐traumatic stress disorder symptom severity and post‐traumatic growth in victims of violence. Stress and Health, 27(1), 42-51.

Lauterbach, D., & Vrana, S. (2001). The relationship among personality variables, exposure to traumatic events, and severity of posttraumatic stress symptoms. Journal of Traumatic Stress, 14(1), 29-45.

Madamet, A., Potard, C., Huart, I., El-Hage, W., & Courtois, R. (2018). Relationship between the big five personality traits and PTSD among French police officers. European Journal of Trauma & Dissociation, 2(2), 83-89.

Maercker, A., Brewin, C. R., Bryant, R. A., Cloitre, M., van Ommeren, M., Jones, L. M., ... & Reed, G. M. (2013). Diagnosis and classification of disorders specifically associated with stress: Proposals for ICD‐11. World Psychiatry, 12(3), 198-206.

Marais, A., & Stuart, A. D. (2005). The role of temperament in the development of post-traumatic stress disorder amongst journalists. South African Journal of Psychology, 35(1), 89-105.

Marshall, E. M., & Frazier, P. A. (2019). Understanding posttrauma reactions within an attachment theory framework. Current opinion in Psychology, 25, 167-171.

Mikulincer, M., Ein-Dor, T., Solomon, Z., & Shaver, P. R. (2011). Trajectories of attachment insecurities over a 17-year period: A latent growth curve analysis of the impact of war captivity and posttraumatic stress disorder. Journal of Social and Clinical Psychology, 30(9), 960-984.

Mikulincer, M., Shaver, P. R., & Horesh, N. (2006). Attachment bases of emotion regulation and posttraumatic adjustment. In D. K. Snyder, J. Simpson, & J. N. Hughes, Emotion regulation in couples and families: Pathways to dysfunction and health, pp. 77–99. Washington DC: American Psychological Association.

Miller, M. W. (2003). Personality and the etiology and expression of PTSD: A three-factor model perspective. Clinical Psychology: Science and Practice, 10(4), 373.

Miller, M. W. (2004). Personality and the development and expression of PTSD. PTSD Research Quarterly, 15, 1–3.

Miller, M. W., & Resick, P. A. (2007). Internalizing and externalizing subtypes in female sexual assault survivors: Implications for the understanding of complex PTSD. Behavior Therapy, 38(1), 58-71.

Miller, M. W., Fogler, J. M., Wolf, E. J., Kaloupek, D. G., & Keane, T. M. (2008). The internalizing and externalizing structure of psychiatric comorbidity in combat veterans. Journal of Traumatic Stress, 21(1), 58-65.

Miller, M. W., Greif, J. L., & Smith, A. A. (2003). Multidimensional Personality Questionnaire profiles of veterans with traumatic combat exposure: Externalizing and internalizing subtypes. Psychological Assessment, 15(2), 205.

Miller, M. W., Kaloupek, D. G., Dillon, A. L., & Keane, T. M. (2004). Externalizing and internalizing subtypes of combat-related PTSD: a replication and extension using the PSY-5 scales. Journal of abnormal psychology, 113(4), 636.

North, C. S., Hong, B. A., Suris, A., & Spitznagel, E. L. (2008). Distinguishing distress and psychopathology among survivors of the Oakland/Berkeley firestorm. Psychiatry: Interpersonal and Biological Processes, 71(1), 35-45.

O'Connor, M., & Elklit, A. (2008). Attachment styles, traumatic events, and PTSD: A cross-sectional investigation of adult attachment and trauma. Attachment & human development, 10(1), 59-71.

Olff, M., Langeland, W., Draijer, N., & Gersons, B. P. R. (2007). Gender differences in posttraumatic stress disorder. Psychological Bulletin, 133, 183–204.

Ouimette, P., Cronkite, R., Prins, A., & Moos, R. H. (2004). Posttraumatic stress disorder, anger and hostility, and physical health status. The Journal of Nervous and Mental Disease, 192(8), 563-566.

Parslow, R. A., Jorm, A. F., & Christensen, H. (2006). Associations of pre-trauma attributes and trauma exposure with screening positive for PTSD: Analysis of a community-based study of 2085 young adults. Psychological Medicine, 36(3), 387-395.

Reis, A. M., de Francisco Carvalho, L., & Elhai, J. D. (2016). Relationship between PTSD and pathological personality traits in context of disasters. Psychiatry research, 241, 91-97.

Richman, H., & Frueh, B. C. (1997). Personality and PTSD II: Personality assessment of PTSD‐diagnosed Vietnam veterans using the Cloninger Tridimensional Personality Questionnaire (TPQ). Depression and Anxiety, 6(2), 70-77.<70::AID-DA3>3.0.CO;2-9

Sleep, C. E., Hyatt, C. S., Lamkin, J., Maples-Keller, J. L., & Miller, J. D. (2018). Examining the relations among the DSM–5 alternative model of personality, the five-factor model, and externalizing and internalizing behavior. Personality Disorders: Theory, Research, and Treatment, 9(4), 379.

Somma, A., Maffei, C., Borroni, S., Gialdi, G., & Fossati, A. (2019). Post traumatic reactions as individual differences: Latent structure analysis of the international trauma questionnaire in Italian trauma-exposed and non-trauma exposed adults. Mediterranean Journal of Clinical Psychology, 7(1).

Thomas, J. L., Britt, T. W., Odle‐Dusseau, H., & Bliese, P. D. (2011). Dispositional optimism buffers combat veterans from the negative effects of warzone stress on mental health symptoms and work impairment. Journal of Clinical Psychology, 67(9), 866-880.

Thomas, K. M., Hopwood, C. J., Donnellan, M. B., Wright, A. G., Sanislow, C. A., McDevitt-Murphy, M. E., ... & Morey, L. C. (2014). Personality heterogeneity in PTSD: distinct temperament and interpersonal typologies. Psychological assessment, 26(1), 23.

van Zuiden, M., Kavelaars, A., Rademaker, A. R., Vermetten, E., Heijnen, C. J., & Geuze, E. (2011). A prospective study on personality and the cortisol awakening response to predict posttraumatic stress symptoms in response to military deployment. Journal of Psychiatric Research, 45(6), 713-719.

Widiger, T. A., Simonsen, E., Krueger, R., Livesley, W. J., & Verheul, R. (2005). Personality disorder research agenda for the DSM–V. Journal of Personality Disorders, 19(3), 315-338.

Wolf, E. J., Miller, M. W., Harrington, K. M., & Reardon, A. (2012). Personality-based latent classes of posttraumatic psychopathology: Personality disorders and the internalizing/externalizing model. Journal of Abnormal Psychology, 121(1), 256.

Wolf, E. J., Miller, M. W., Krueger, R. F., Lyons, M. J., Tsuang, M. T., & Koenen, K. C. (2010). Posttraumatic stress disorder and the genetic structure of comorbidity. Journal of Abnormal Psychology, 119(2), 320.

Woodhouse, S., Ayers, S., & Field, A. P. (2015). The relationship between adult attachment style and post-traumatic stress symptoms: A meta-analysis. Journal of Anxiety Disorders, 35, 103-117.

World Health Organization (2018). International Classification of Diseases (ICD-11). Geneva, Switzerland: World Health Organization.

Wu, D., Yin, H., Xu, S., & Zhao, Y. (2011). Risk factors for posttraumatic stress reactions among Chinese students following exposure to a snowstorm disaster. BMC Public Health, 11(1), 1-7.

Yin, Q., Wu, L., Yu, X., & Liu, W. (2019). Neuroticism predicts a long-term PTSD after earthquake trauma: The moderating effects of personality. Frontiers in Psychiatry, 10, 657.

Zerach, G., & Elklit, A. (2020). Attachment and social support mediate associations between Polyvictimization and psychological distress in early adolescence. International Journal of Psychology, 55(3), 380-391.



  • There are currently no refbacks.