The role of attachment and post-traumatic symptomatology in children and adolescents with defiant oppositional disorder

BACKGROUND: In line with a consistent literature, defiant oppositional disorder in childhood and adolescence have experienced some traumatic events, such as experiences of abuse, rejection, violence assisted. Recent studies are focusing the attention on the role of attachment and post-traumatic symptomatology for a better evaluation of this disorder. AIM(S): The following objectives are set by the present study: 1) to evaluate the post-traumatic stress and related psychological symptomatology in a group of children diagnosed with defiant oppositional disorder; 2) to evaluate their attachment models; 3) to test the extent of the association between post-traumatic symptomatology and attachment organization in defiant oppositional disorder. METHOD: Twenty consecutive Italian patients aged from 8 to 15 (m=11.4 ds=1.87), previously diagnosed with defiant oppositional disorder, were administered the Trauma Symptom Checklist for Children (TSCC-A) and the Child Attachment Interview (CAI). RESULTS: Post-traumatic symptomatology, evaluated in 9 subscales, showed clinically significant scores about anger and post-traumatic stress; dissociation symptomatology was seen in 20% of the patients. Insecure attachment was found in more than half of the patients diagnosed with defiant oppositional disorder; high levels of attachment disorganization were found. CONCLUSIONS: This study suggests that attachment organization may be a fundamental element to be assessed in the evaluation of defiant oppositional disorder in children and adolescents. Finally, methodological limitations restricting causal inferences between attachment and dissociation are discussed.