Disorganized attachment and emotion dysregulation as mediators of the association between sexual abuse and dissociation in preschoolers

Background: Child sexual abuse (CSA) is a prevalent social problem associated with a plethora of difficulties in preschool children. Young victims are likely to show dissociation symptoms that may significantly impede their adaptation. Yet, mechanisms linking CSA with later dissociative symptoms remain unclear. The aim of the present study was to explore whether disorganized attachment and emotion dysregulation could act as mediators of the association between CSA and dissociation.

Methods: A sample of 424 preschool children (274 CSA victims, 150 comparison group children; 3.5-6 years old) and their parents were recruited. Parents reported on children's emotion dysregulation at initial assessment while attachment representations were assessed through children's narratives using the Attachment Story Completion Task (Bretherton et al., 1990) coded with the Q-Sort (Miljkovitch et al., 2004). Parents reported on children's dissociative symptoms one year later.

Results: Mediation analysis showed that disorganized attachment and emotion dysregulation mediated the association between CSA and dissociation. CSA was linked to greater disorganization scores that were associated with higher scores of emotion dysregulation. Emotion dysregulation was in turn associated with increased severity of dissociation symptoms in preschool children one year later.

Limitations: Given that attachment and emotion dysregulation were both assessed at T1, the temporal sequencing of mediators remains to be validated in a longitudinal design.

Conclusions: Findings highlight the relevance of fostering healthy parent-child relationships, as well as the development of optimal emotion regulation skills in young CSA victims to prevent the emergence of dissociation symptoms in this vulnerable population.