Anna Sophie Herrmann – Complex Childhood Trauma

Tracing Trauma in Narrative: The Effects of Complex Childhood Trauma on Mentalization


Theoretical Background: Complex childhood trauma refers to aversive childhood experiences such as emotional, physical, and sexual abuse or neglect by primary caregivers. Such experiences are accompanied by intense feelings of existential threat, fear, helplessness, and horror, disrupting the emotion regulation system. Mentalization refers to a set of social-cognitive skills that enable us to develop a mental representation of ourselves and others as feeling, thinking, and acting intentionally. Being able to mentalize is essential for emotion regulation and flexible, adequate interaction in interpersonal relationships. In order to acquire these skills, children depend on caring, non-threatening adults to mirror their mental states in a relationship characterized by secure attachment. In case of complex childhood trauma, a childs primary caregivers become a source of danger instead of representing psychological safety, undermining this process and resulting in mentalization deficits. Consequently, attachment-relevant interpersonal situations are associated with danger and therefore easily trigger anxiety in traumatized individuals, further compromising their already limited mentalization capacities. This results in states of psychic dysregulation, which may be pathological to a degree that the criteria of a mental health disorder such as Borderline personality disorder are fulfilled. 1

Objective: This thesis explores whether patients who have experienced complex childhood trauma are more limited in their mentalization capacities when they experience attachment anxiety than patients who have not. By analyzing patient narratives on interpersonal situations, it seeks to retrace mentalization deficits in attachment-relevant situations as a consequence of complex trauma in traumatized patients language: are the traumatized patients narratives of inferior quality in terms of mentalization markers when the situations are attachment-relevant and may therefore trigger attachment anxiety? Furthermore, it investigates whether inpatient psychotherapy has a positive effect on mentalization.

Method: The study is based on a sample of n=155 patients in inpatient treatment at the University Medical Centers Department of Psychosomatic Medicine and Psychotherapy in Mainz. Childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ)2, a screening tool for a history of child abuse and neglect. The patients CTQ scores will allow dividing the sample into traumatized and non-traumatized patients. Furthermore, all patients filled out the Levels of Emotional Awareness Scale (LEAS)3, and the Adult Attachment Projective Picture System (AAP)4 at the onset and at the end of inpatient treatment. The LEAS is a free-response assessment of emotional awareness, employing descriptions of interpersonal situations as stimuli for patients narratives. It is a tool for measuring emotion-focused mentalization using a specific scoring system. The AAP is a free-response assessment of adult attachment, employing pictures of interpersonal situations as stimuli for patients narratives. Unlike the LEAS, a mental performance measure, the AAP is specifically designed to trigger attachment-related anxiety. Analyzing the traumatized and non-traumatized patients narratives on the interpersonal situations described or shown to them in LEAS and AAP, using the LEAS scoring system, will thus allow for a comparison of the two groups ability to mentalize in attachment-relevant (AAP) vs. non-attachment-relevant (LEAS) interpersonal situations. Finally, all patients mentalization scores in LEAS and AAP pre- and post-treatment will be compared.

Relevance: This dissertation aims to deepen our understanding of the consequences of complex childhood trauma, and to contribute to the ongoing discussion about the diagnostic implications of their complexity. Furthermore, it may be seen as a pilot study for the practicability of a qualitative measure of therapeutic success with regard to patients capabilities to handle attachment-related anxiety. Supervisor: PD Dr. Claudia Subic-Wrana


1 Fonagy, P., Gergely, G., Jurist, E. & Target, M. (2002): Affect Regulation, Mentalization and the Development of the Self. New York: Other Press.
2 Bernstein, D.P. & Fink, L. (1998): Childhood Trauma Questionnaire: A retrospective self-report manual. San Antonio: The Psychological Corporation.
3 Lane, R., Quinlan, D., Schwartz, G., Walker, P. & Zeitlin, S. (1990): The levels of emotional awareness scale: A cognitive-developmental measure of emotion. Journal of Personality Assessment 55, 124-134.
4 George, C. & West, M. (2012): The Adult Attachment Projective Picture System. Attachment Theory and Assessment in Adults. New York: The Guilford Press.

Author: Anna Sophie Herrmann