Attachment & Human Development

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Trajectories of attachment in older age:

interpersonal trauma and its consequences

Rahel Bachem, Yafit Levin & Zahava Solomon

To cite this article: Rahel Bachem, Yafit Levin & Zahava Solomon (2019) Trajectories of
attachment in older age: interpersonal trauma and its consequences, Attachment & Human
Development, 21:4, 352-371, DOI: 10.1080/14616734.2018.1479871

To link to this article: https://doi.org/10.1080/14616734.2018.1479871

Published online: 04 Jun 2018.

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ATTACHMENT & HUMAN DEVELOPMENT
2019, VOL. 21, NO. 4, 352–371
https://doi.org/10.1080/14616734.2018.1479871

Trajectories of attachment in older age: interpersonal trauma

and its consequences
Rahel Bachema,b, Yafit Levina,b and Zahava Solomona,b
a
I-Core Research Center for Mass Trauma, Tel Aviv University, Tel Aviv, Israel; bBob Shapell School of Social
Work, Tel Aviv University, Tel Aviv, Israel

ABSTRACT ARTICLE HISTORY

Previous studies suggest that attachment insecurities may increase Received 8 January 2018
after trauma exposure, an effect documented only at a group level. Accepted 19 May 2018
This study explores the heterogeneity of changes over time and KEYWORDS
examines the associations of the nature of the traumatic event (inter- Attachment insecurities;
personal and nonpersonal), and its consequences (posttraumatic stress trajectories; war trauma; risk
disorder [PTSD] and loneliness) with attachment trajectories. Two factor; older age
groups of Israeli veterans participated: 164 former prisoners-of-war
and 185 combat veterans. Attachment was assessed at four points
(1991–2015). Risk factors were evaluated in 1991. Using latent growth
mixture modeling, trajectories of attachment insecurities were
explored. Three avoidance trajectories (stability, decrease, inverse
u-shaped) and two anxiety trajectories (stability, decrease) were iden-
tified. The inverse u-shaped avoidance trajectory was associated with
captivity, humiliation, loneliness, and PTSD, and stable avoidance was
associated with loneliness. Stable anxiety was associated with captivity
and loneliness. Attachment insecurities can change during aging and
persist decades after a trauma. Trauma-related risk factors are related
to more deleterious trajectories.

Introduction
According to attachment theory, interactions with significant others in childhood serve as
the basis for representations of self and others, which affect experiences in close relation-
ships over the life span (Bowlby, 1969, 1973). Positive experiences with attachment figures
characterized by sensitivity, availability, and responsiveness of the caretaker encourage the
development of positive internal working models regarding the self and others, while
negative experiences tend to evoke attachment insecurities (Bowlby, 1973; Mikulincer &
Shaver, 2016). It has been suggested that attachment insecurities can be described in two
dimensions: attachment-related anxiety and avoidance (Brennan, Clark, & Shaver, 1998).
Anxious attachment entails a constant worry that an attachment figure will not be available
to provide care and regulate emotions in times of need. To cope with such worries,
hyperactivating strategies, such as compulsively seeking proximity, protection, and
demanding approval, are employed. Contrarily, avoidant attachment indicates the extent
to which one distrusts the attachment figures’ goodwill to provide support and love and

CONTACT Rahel Bachem rahel.bachem@gmail.com

Rahel Bachem and Yafit Levin are shared first authorship.
© 2018 Informa UK Limited, trading as Taylor & Francis Group
 ATTACHMENT & HUMAN DEVELOPMENT 353

strives to maintain independence from others. Thus, deactivating attachment strategies

such as withdrawal and emotional distancing are adopted to regulate emotions (Mikulincer
& Shaver, 2003, 2016).

Stability versus change in middle adult attachment

According to Bowlby (1973), adult attachment patterns are rooted in childhood interac-
tions with attachment figures and thereafter are assumed to remain relatively stable
across the lifespan. Changes rarely occur, as individuals tend to assimilate new information
collected through life experiences in to existing working models, rather than updating
those models (Mikulincer & Shaver, 2016). From a theoretical perspective, this tendency
results in relative stability of attachment patterns over the lifespan.
Empirical studies investigating the stability of adult attachment, however, have revealed
a mixed picture. Most investigations on the development of adult attachment have exam-
ined stability over relatively short time periods (1 week–1 year; e.g. Davila & Cobb, 2003).
Studies covering longer periods in adulthood (2–31 years) demonstrated attachment to be
relatively stable, with test–retest correlations ranging between .35 and .61 (e.g. Chopik,
Edelstein, & Grimm, 2017; Chopik, Moors, & Edelstein, 2014; Davila, Karney, & Bradbury, 1999;
Klohnen & Bera, 1998; Zhang & Labouvie-Vief, 2004). Despite the significant degree of
stability, approximately half of the variance in later attachment ratings has not been
explained by earlier assessments (Zhang & Labouvie-Vief, 2004). Meta-analytic findings
revealed that attachment was stable mainly when time gaps up to 5 years were considered,
but not regarding intervals over 15 years (Pinquart, Feussner, & Ahnert, 2013).

Attachment and age

Several studies have indicated that age is likely related to attachment insecurities. Older
adults tend to experience less attachment anxiety (Klohnen & John, 1998; Mickelson, Kessler,
& Shaver, 1997) and more attachment avoidance (Diehl, Elnick, Bourbeau, & Labouvie-Vief,
1998; Magai et al., 2001) than younger adults. This trend may be related to the fact that with
maturation beyond young adulthood, individuals become more independent of immediate
social validation and support, which are signs of a better integrated and autonomous self
(e.g. Labouvie-Vief, Chiodo, Goguen, & Diehl, 1995). The vast majority of existing studies on
adult attachment, however, have focused on young populations from early to middle
adulthood; studies on attachment among the elderly are rare. One 6-year study that
included older adults (age range 15–87 years) confirmed that age was longitudinally related
to attachment change, with older participants reporting higher avoidant and lower anxious
attachment than younger ones (Zhang & Labouvie-Vief, 2004).
Despite the dearth of studies, older age may be a particularly interesting life stage
with regard to stability and change of attachment. It is a period characterized by an
exacerbation of potentially attachment-relevant life events, such as the loss of significant
others, as well as a higher dependence on others due to declining physical health
(Carstensen, Isaacowitz, & Charles, 1999; Rantakokko et al., 2014). At the same time,
interpersonal relationships have been shown to gain relevance with regard to emotion
regulation. According to the socioemotional selectivity theory (SST; Carstensen et al.,
1999), when older adults perceive their lifetime as limited, goals related to emotional
354 R. BACHEM ET AL.

meaning and well-being become more prominent. Empirical studies have shown that
older adults prefer intimate social partners who may address their emotional needs,
whereas younger adults more frequently focus on social partners from whom they may
gain new information (Fredrickson & Carstensen, 1990; Fung, Carstensen, & Lutz, 1999).
This developmental change in goal striving characteristic of older age may also be
related to changes in the attachment system. Based on assumptions of the SST, one
could hypothesize that the main trajectory of attachment avoidance would show
decreases in older age, as proximity to others becomes more central for emotional
well-being and individuals have higher motivation to strengthen close relationships
(Fredrickson & Carstensen, 1990; Fung et al., 1999).
Regarding attachment anxiety, different trajectories may be expected. Individuals
high in attachment anxiety could be assumed to experience an increase in anxiety as
they age and more strongly depend on proximity to others to regulate emotions. To
obtain closeness, they are likely to employ hyperactivating strategies such as demanding
or forcing an attachment figure’s attention, love, and support. An intensification of these
behaviors would likely result in heightened relational conflicts and disappointment of
attachment needs. On the other hand, those with lower attachment anxiety may have
positive interpersonal experiences as a consequence of heightened investment in family
bonds and friendships; thus, attachment anxiety would likely diminish. The first aim of
this study is to examine the heterogeneity in the changes of anxious and avoidant
attachment among aging individuals across time.

Interpersonal correlates of attachment change

There is a general consensus in the attachment literature that the force behind attach-
ment change in adulthood is significant interpersonal experiences (Bowlby, 1969;
Mikulincer & Shaver, 2016). Thus, the current study was conducted with a trauma-exposed
sample, consisting of combat veterans and former prisoners of war (ex-POWs). Four
interpersonal factors related to combat and captivity were chosen, of which the former
two assess the severity of trauma exposure whereas the latter two represent potential
interpersonal consequences of the traumatic experience: (1) status of ex-POW versus
combat veteran, (2) degree of humiliation during war captivity, (3) loneliness after the
war, and (4) symptoms of posttraumatic stress disorder (PTSD).
Participation in combat is a traumatic experience that can have severe and adverse
psychological consequences over the lifespan of a veteran (e.g. Horesh, Solomon,
Keinan, & Ein-Dor, 2013). During war, combatants often experience intense helpless-
ness, uncertainty, and dread (Stein, Snir, & Solomon, 2015). However, as the violence
during combat is not personally directed against the soldier, the relational working
models of the veteran may not be challenged to a degree that would initiate a
change in the attachment system. War captivity, on the other hand, is a traumatic
experience that is distinctly interpersonal, deliberately perpetuated by one human to
another. A POW finds him- or herself under total domination by the perpetrator and
experiences repeated exposure to various deliberate assaults, including torture.
Psychological tactics of captors involving the attachment system include developing
a close relationship with the captive and establishing the captor as the omnipotent
source of approval and relief (Herman, 1992). In such constellations where one
 ATTACHMENT & HUMAN DEVELOPMENT 355

attachment partner (the captor) is the sole source of both suffering and relief, the
other attachment partner (the POW) may develop an attachment style characterized
by ambivalence. Abuse by the captor then can become an attachment-related trauma
and may elicit long-lasting changes in attachment insecurities, including general
difficulties to trust and rely on others who offer help in times of need, even bene-
volent individuals (Mikulincer, Ein-Dor, Solomon, & Shaver, 2011). Using the same
dataset as the current study, Mikulincer et al. (2011) found increased attachment
anxiety and avoidance over a 17-year period among ex-POWs, across three measure-
ments. It is hypothesized that captivity, as opposed to combat participation, is
associated with trajectories of higher attachment insecurity.
Furthermore, the war captive may be subjected to profound humiliation, evoked
through actions such as denying sanitary facilities or verbal devaluation (Stein et al.,
2015). Humiliation is a self-conscious emotion of high intensity that arises as a result of
experiencing a loss of value as a person, caused by a perpetrator who is in the necessary
position to inflict such damage (Fernandez, Saguy, & Halperin, 2015). Importantly, in the
process of humiliation, the victim accepts or internalizes the devaluation of his or her
identity (Klein, 1991) and thus, internal working models of the self in interpersonal
relationships are likely challenged. A study by Dekel, Solomon, and Ein-Dor (2016)
showed that the humiliation experienced in captivity continues to affect the veteran’s
mental state decades after repatriation. However, humiliation has not been researched
with respect to attachment development over time. Given its aversive interpersonal
characteristics, we hypothesize that more severe humiliation during captivity will be
associated with higher attachment insecurity.
An interpersonal outcome of trauma addressed in this study, likely related to attach-
ment insecurities across time, is PTSD. PTSD is characterized by intrusive thoughts,
hyperarousal, and avoidance (American Psychiatric Association, 2013). These symptoms
are related to a range of interpersonal difficulties. Veterans’ hyperarousal and irritability
give rise to emotional outbursts, which may generate conflicts with significant others
(Miller et al., 2013), whereas emotional numbing and detachment impede intimacy and
communication in intimate relationships (Monson, Taft, & Fredman, 2009). Moreover,
PTSD entails negative beliefs regarding others, which could further undermine basic
relational working models of attachment, particularly in individuals with antecedent
attachment-related doubts (Mikulincer & Shaver, 2016).
Past decades have seen a plethora of research on attachment insecurities as a risk
factor for PTSD after traumatic events (e.g. Dieperink, Leskela, Thuras, & Engdahl, 2001;
Fraley, Fazzari, Bonanno, & Dekel, 2006; Franz et al., 2014). However, there has been little
research on how PTSD may affect the attachment system across the life span, especially
with regard to older age. Results from an experimental study with the current popula-
tion of veterans and ex-POWs, assessing cognitive accessibility of trauma-related mental
representations in a Stroop color-naming task, propose that a reciprocal, recursive, and
amplifying cycle of PTSD and attachment insecurity may exist over time (Mikulincer,
Solomon, Shaver, & Ein-Dor, 2014). However, previous research on the longitudinal
dynamics of PTSD and attachment insecurities has assumed that individuals follow
one linear trajectory instead of identifying subgroups of participants that follow specific
pattern changes, as the current study intends. We thus hypothesize that more PTSD
symptoms will be associated with trajectories of higher attachment insecurity.
356 R. BACHEM ET AL.

In the wake of traumatic events, survivors often report experiencing distinct feelings of
loneliness that are associated with symptoms of PTSD (Macleod, 1994; Solomon & Dekel,
2008). Loneliness connotes emotional isolation evoked by the absence of close attachment
partners and socially integrative relationships (Weiss, 1973). The experience of loneliness
contradicts attachment security as the individual feels that he or she cannot rely on others in
times of need. Attachment insecurities have been associated with more feelings of family-,
social-, and romantic loneliness (Bemardon, Babb, Hakim-Larson, & Gragg, 2011), as well as
with lower levels of self-rated intimacy, self-disclosure, responsiveness, and relationship
satisfaction (Bippus & Rollin, 2003; Grabill & Kerns, 2000; Kafetsios & Nezlek, 2002). In the
context of trauma, loneliness and estrangement from others may thus prevent a trauma-
tized individual from restructuring the damaged attachment system. However, most
research concerning the relation of attachment insecurities and loneliness has been cross-
sectional or covered only a short period of time in prospective studies (e.g. Shallcross,
Frazier, & Anders, 2014; Wei, Russell, & Zakalik, 2005). To the best of our knowledge, the
current study is the first to evaluate loneliness as a correlate of trajectories of attachment
insecurities over an extended period of time. It is hypothesized that higher levels of lone-
liness after the war will be associated with trajectories of higher attachment insecurities.

The current study

To date, research has assessed longitudinal changes in attachment in terms of the mean
of a group over several measurement points (Chopik et al., 2017; Mikulincer et al., 2014;
Zhang & Labouvie-Vief, 2004). However, given the heterogeneous findings regarding
stability and change of attachment over the life course, the question arises whether the
group mean overlooks the complexity of attachment over time. Age-related changes in
the social-emotional goal structure (Carstensen et al., 1999) may be associated with
changes in attachment insecurities in older age. Moreover, individual constellations of
trauma-related interpersonal risk factors may be implicated in different developmental
trajectories of attachment insecurities. Employing a data-driven approach, the first goal
of this study is to reveal potentially latent trajectories of attachment insecurities (latent
growth mixture modeling; LGMM) among aging survivors of traumatic events. The
second goal is to examine the association of interpersonal trauma (i.e. war captivity vs.
combat stress, humiliation in captivity) and its consequences (PTSD and loneliness) with
these trajectories.

Methods
Participants and procedure
Two groups of Israeli veterans who participated in the 1973 Yom Kippur War were measured
at four time points: 1991 (T1), 2003 (T2), 2008 (T3), and 2015 (T4). Participants signed
informed consent after receiving a detailed explanation of the study’s aims and procedures.
The study was approved by the institutional review board of Tel-Aviv University.
 ATTACHMENT & HUMAN DEVELOPMENT 357

Ex-POWs
According to Israel’s Ministry of Defense, 240 soldiers from the Israeli Army land forces were
captured during the Yom Kippur War. Two hundred seventeen ex-POWs who were residing in
Israel at T1 were approached, and 164 participated in the study at T1; 144 ex-POWs partici-
pated in T2 (10 could not be located/refused, 6 could not participate due to mental deteriora-
tion, and 4 had died), and 183 participated in T3 (29 could not be located/refused, 6 could not
participate due to mental deterioration, and 20 had died). T3 included 109 ex-POWs who
participated at T1, and 74 ex-POWs from the original sampling list, who did not participate
previously. In T4, 158 ex-POWs took part (36 declined to participate, 8 could not be located, 5
did not participate due to mental deterioration or other medical reasons, 5 were abroad, and
30 had died).

Combat veterans
A group of 280 combat veterans of the Yom Kippur War, matched to the ex-POWs in
demographic and military background, were drawn from the Israel Defense Forces data-
banks. Two hundred fifty-five veterans who were residing in Israel at T1 were approached,
and 185 of them participated in the study; 143 participated at T2 (41 could not be located
and 1 had died), and 118 took part at T3 (20 could not be located/refused, and 5 had
died). At T4, 101 veterans participated (34 declined to participate, 14 could not be located,
2 did not return the questionnaire, 1 was abroad, and 18 had died).
The age of the participants at T1 was M = 39.8, SD = 3.3, min = 36, max = 50; T2:
M = 53.5, SD = 4.6, min = 49, max = 80; T3: M = 56.8, SD = 5, min = 52 max = 83; T4:
M = 65.1, SD = 4.3, min = 59, max = 80. No significant differences were found between
ex-POWs and combat veterans in background variables such as age, education, or
military assignment during the war (for detailed information, see Solomon, Horesh,
Ein-Dor, & Ohry, 2012).
In T3, participants were asked to report any change in their marital status compared
to T1. The majority of both groups (83.3% in ex-POWs and 87.9% in controls) reported
still being in their first marriage (χ 2ð3Þ ¼ 1:92, p = .59), while 13.2% of ex-POWs and 11.1%
of controls were divorced (none widowed). In T4, the proportions of the reports of
change in marital status since T3 were also similar in both groups, χ 2ð1Þ ¼ :69, p = .41. Of
the controls, 9.8% and 13.4% of ex-POWs reported a change in their marital status. Four
ex-POWs got married, three widowed, three separated, and nine divorced, whereas one
control veteran got married, three separated, four divorced, and none were widowed.
Consequently, marital status in both groups did not change significantly over time and
its potential association for attachment trajectories was not further explored.

Missing values handling

We used MPlus 7 (Muthén & Muthén, 2012), which employs a robust full-information
maximum-likelihood (Robust FIML) estimation procedure for handling missing data and
for dealing with non-normal distributions. The appropriateness of FIML is widely endorsed
(Enders, 2001; Schafer & Graham, 2002). Subjects were included in the study (n = 349, 93.3%)
provided they participated in at least two of the four assessments in T1, T2, T3, and T4.
Seventy-seven participated in 2 time points (22.7%), 130 participated in 3 time points
358 R. BACHEM ET AL.

(37.2%), and 142 (40.1%) participated in 4 assessments. Subjects who participated at only
one time point (n = 25) were excluded. To diagnose the impact of missing data, MPlus
provides estimates of covariance coverage for each pair of variables in the analysis. In the
present study, covariance coverage for each pair of variables did not fall below .4, which is
above the minimum threshold of .10 for model convergence. In addition, Little’s missing
completely at random test revealed that the data were not missing completely at random,
χ 2ð407Þ ¼ 687:8, p < .001, which rendered analyses consisting only of data which were
complete somewhat biased. Supplementary t-tests between missing and present data in
all possible combinations of variables were calculated. Veterans with missing data in T3
attachment avoidance reported lower attachment avoidance in T2 (M = 3.03, SD = .68)
compared to those with existing data in T3 (M = 3.86, SD = .69, t = 4.2). Additionally, veterans
with missing data in T3 attachment avoidance also reported higher attachment anxiety in
T2 (M = 3.01, SD = .54) compared to those with existing data in T3 (M = 2.45, SD = 1.16,
t = 3.2). Veterans with missing data in attachment anxiety in T1 reported lower PTSD levels in
T2 (M = 5.38, SD = 1.98) compared to veterans with existing data in T1 (M = 7.14, SD = 2.01,
t = 3.8). Veterans with missing data in attachment avoidance in T1 reported higher attach-
ment avoidance in the subsequent measurements of T2 (t = 3.2), T3 (t = 2.2), and T4 (t = 2.5)
(T2: M = 4.57, T3: M = 4.00, T4: M = 3.93) compared to those with existing data in T1
attachment avoidance (T2: M = 3.54, T3: M = 3.61, T4: M = 3.44). All p values presented are
below .001.

Measures
Attachment insecurities
Attachment anxiety and avoidance were assessed with a 10-item scale developed by
Mikulincer, Florian, and Tolmacz (1990), who adapted Hazan and Shaver (1987) descriptions
of avoidant and anxious attachment styles and constructed five items to represent each
dimension. The five anxiety items (e.g. “I worry about being abandoned”) correspond to
items in Brennan et al.’s (1998) anxiety subscale of the Experiences in Close Relationships
measure. The five avoidance items (e.g. “I feel uncomfortable when others get close to me”)
correspond to items in the avoidance subscale. Participants rated the extent to which an
item described them using a 7-point scale ranging from 1 (not at all) to 7 (very much).
Numerous studies by Mikulincer have demonstrated the measure’s high construct and
predictive validity (see Mikulincer & Shaver, 2016, for a review). It is associated in theoreti-
cally predictable ways with measures of attachment-related cognitive processes, emotion-
regulation, personal adjustment, and relationship quality. A similar questionnaire has been
found to be valid, reliable, and with significant links to biobehavioral markers (Ein-Dor,
Verbeke, Mokry, & Vrtička, n.d.). In the present study, Cronbach’s α for the anxiety and
avoidance items was adequate at each time point, .70, .74, .72, and .70 for attachment
anxiety; .72, .69, .75, and .72 for avoidance. Two scores for each participant were computed
by averaging items from each subscale.
 ATTACHMENT & HUMAN DEVELOPMENT 359

PTSD symptoms
PTSD was measured at T1 using the PTSD Inventory (Solomon et al., 1993). This is a self-
report scale based on the criteria of the Diagnostic and Statistical Manual of Mental
Disorders, Third Edition Revised (DSM-III-R; American Psychiatric Association, 1987). The
inventory consists of 17 statements corresponding to the 17 PTSD symptoms listed in
the DSM-III-R. In the present study, changes between DSM editions were accounted for
(e.g. DSM-IV moved the physiological reactivity to resembling events from the hyperar-
ousal cluster to the intrusion cluster). Participants were asked to indicate whether they
experienced a symptom in the past month, using a 4-point scale ranging from 1 (“not at
all”) to 4 (“I usually did”). For each participant, an answer of three or above (i.e. “often” or
“I usually did”) was considered a positive symptom endorsement. The intensity of PTSD
was calculated as the sum of the endorsed symptoms.
The inventory has proven psychometric properties in terms of both high test–retest
reliability and concurrent validity compared to clinical diagnosis (Solomon et al., 1993).
Reliability values for total and subscale scores were high at all assessments (Cronbach’s α
was .90 at each assessment).

Loneliness
Loneliness at T1 was measured using the UCLA Loneliness Scale (Russell, Peplau, &
Cutrona, 1980). This scale consists of 20 items, 10 reflecting satisfaction with social
relationships and 10 reflecting dissatisfaction. Subjects were asked to indicate how
often they had experienced these feelings on a 4-point Likert scale (1 = “not at all”,
4 = “very often”). The total score of the scale is the mean of all 20 items after having
reversed the positively worded items. High scores reflected more feelings of loneliness.
The Cronbach’s α in the current sample was .87, indicating high internal consistency.

Humiliation in captivity
To quantify the subjective experience of humiliation, at T1, ex-POWs were asked to rate how
humiliated they felt during captivity using a 5-point Likert scale (from 1 = “not at all” to
4 = “to a high degree”).

Analytic plan
All analyses were conducted in Mplus version 7 (Muthén & Muthén, 2012). We used
LGMM, which is a person-centered approach, to identify trajectories of attachment
insecurities over time (Muthén & Muthén, 2004); it combines latent class analysis and
growth modeling. Hence, LGMM expects subpopulations with unique growth trajec-
tories across time (Jung & Wickrama, 2008). This method enables identification of
heterogeneous progressive patterns of change in attachment insecurities following
trauma. We examined conditional LGMM models of attachment avoidance and anxiety
ranging from one to four classes, while also regressing class membership and slopes on
group (ex-POWs = 1, combat veterans = 0) and initial PTSD at T1.
360 R. BACHEM ET AL.

To account for the differences in time between the assessments, we used correspond-
ing time scores in determining the slope of the model (0, 12, 17, and 24). Given the
theoretical assumption that posttraumatic outcomes entail curvilinear patterns of
change (Bonanno, 2004), and given the connection of PTSD and attachment insecurities
(Solomon, Dekel, & Mikulincer, 2008), we chose to include a quadratic factor in our latent
growth models. This enables detection of curvilinear trajectories in addition to a linear
pattern. Hence, three latent factors were estimated, the intercept as well as the slope of
both linear and quadratic models. To avoid multicollinearity between the linear and
quadratic slopes, we centered the time scores and divided them by 10 to avoid
problems of convergence (Wang & Wang, 2012). We first examined whether the fit
indices improved from only-linear to both linear and quadratic models with the same-
number of trajectories, that is lower Bayesian information criterion (BIC), sample size
adjusted Bayesian Information Criterion (ssBIC), and Akaike information criterion(AIC),
and better entropy. We favored the model with both linear and quadratic slopes only if
it had a significant bootstrap likelihood ratio test (BLRT). We used the log-likelihood ratio
chi-square tests to assess whether a model with quadratic effects provided superior fit
over a linear-only model.
Following Jung and Wickrama (2008), the optimal model was selected based on fit
indices, theoretical soundness, and parsimony. The models were compared using the
following indices: BIC, the adjusted BIC, and the AIC. Furthermore, we used the BLRT,
entropy score, and average latent class probabilities of group membership (e.g. Jung &
Wickrama, 2008). More specifically, the optimal number of classes was chosen based on
(a) the lowest BIC, sample size-adjusted BIC, and AIC scores; (b) significant BLRT test; and
(c) high latent class membership probabilities, as indicated by an entropy value
approaching 1 (Jung & Wickrama, 2008).
Subsequently, to predict class membership and the slopes by captivity and PTSD
at the initial assessment, we examined the logistic regressions generated in the
analyses. The slopes of the classes and the classes’ membership were regressed on
group (ex-POWs vs. combat veteran) and PTSD. Next, we aimed to test the role of
humiliation in captivity and loneliness in the trajectories found. We did not use the
three-step procedure developed by Vermunt (2010) that includes these two factors in
the LGMM model, as it could not be applied due to missing data on combinations of
the variables; we would have lost more than half of the participants for these
analyses (valid N listwise = 122). As humiliation in captivity and loneliness would
interfere with the mixture solution, they were kept outside the mixture part of the
model. We exported most likely class membership information to SPSS version 24.
Simulation studies found that, for models with high Entropy, i.e. higher than .80,
covariates estimation based on the most likely class membership is a viable alter-
native to including covariates in the model. Since our model had a medium and high
entropy (.77 and .96), we used the variable of most likely class membership on SPSS.
We assessed the differences between groups of trajectories of attachment insecu-
rities for humiliation and loneliness using analyses of variance (ANCOVAs) controlling
for age, p < .05. Bonferroni post hoc analyses were implemented to test which groups
were different.
 ATTACHMENT & HUMAN DEVELOPMENT 361

Results
Trajectories of attachment avoidance (conditional model)
To examine the attachment avoidance trajectories, we assessed the model fit of the linear
and linear + quadratic conditional models (regressed on group and PTSD at T1). Based on
the AIC, ssBIC, and BLRT, we found that successive models continued to demonstrate
improved fit from one to three classes in linear + quadratic parameters (except for the BIC)
and increased accuracy from .67 to .77. However, in a linear-only model, the fit improved
only from one to two classes, with no significant BLRT from one to two class models.
Importantly, the linear + quadratic parameters consistently outperformed the linear ones
(Table 1). As a result, the three-class model of the linear + quadratic model was accepted
for being parsimonious and interpretable. The solutions in the linear model were not
indicative and overlooked quadratic terms. The four-class solution in the linear + quadratic
model was rejected as the additional class was merely a split of the third class and
contained only 2% of the sample.
The final model identified three substantively distinct classes (see Figure 1(a)). The largest
class (stable avoidance trajectory: n = 149, 43.7%) was characterized by high initial

Table 1. Linear and quadratic change over time in attachment insecurities.

Linear weights only Linear + quadratic weights
Model AIC BIC Adj. BIC Entropy BLRT AIC BIC Adj. BIC Entropy BLRT
Avoidance
1 class 2869.2 2907.5 2875.8 – – 2916.5 2974.01 2926.4 – –
2 classes 2848.3 2905.8 2858.3 .58 .00 2805.1 2885.6 2818.9 .67 .00
3 classes 2833.8 2910.5 2847.1 .72 .00 2786.3 2874.7 2804.1 .77 .00
4 classes 2829.7 2925.5 2846.2 .90 .15 2774.3 2900.7 2796.1 .67 .24
Anxiety
1 class 2507.8 2546.1 2514.4 – – 2566.5 2623.9 2576.3 – –
2 classes 2466.8 2524.3 2476.7 .96 .00 2480 2560.1 2493.4 .72 .00
3 classes 2460.6 2537.7 2473.8 .83 .33 2472.4 2575.8 2490.2 .73 .66
4 classes 2418.4 2514.1 2434.8 .90 .24 – – – – –
Note. Fit indices of the selected conditional model are marked in bold. In these models, the classes are regressed on
captivity and PTSD symptoms; adj. BIC: sample size-adjusted Bayesian Information Criterion; AIC: Akaike Information
Criterion; BIC: Bayesian Information Criterion.

a. Attachment avoidance b. Attachment anxiety

6 6
5.0 5.2
5 5

4.1 4 3.4 3.5

4 3.6 3.2 3.3
3.6 3.5 3.7
3
3 3.1
2 2.5
2.8 2.3 2.1
2.7 2.5 2.0
2 2.4 1

1 0
1991 2003 2008 2015 1991 2003 2008 2015

Stable avoidance trajectory 43.7% Stable anxiety trajectory 31.8%

Decreasing avoidance trajectory 30.5% Decreasing anxiety trajectory 68.2%
Inverse u-shaped avoidance trajectory 25.%

Figure 1. Estimated means changes over time in attachment insecurities. (a) Attachment avoidance.
(b) Attachment anxiety.
362 R. BACHEM ET AL.

attachment avoidance (Est = 3.6, SE = .6, p < .001) and displayed stability over time, as
captured by nonsignificant linear (Est = −.00, SE = .1, p = .97) and quadratic (Est = .03, SE = .00,
p = .89) slopes. The second largest class (decreasing avoidance trajectory: n = 104, 30.5%)
demonstrated lower initial attachment avoidance (Est = 2.71, SE = 6, p < .001) and a linear
decrease over time (Est = −.2, SE = .1, p = .01) but no quadratic pattern (Est = .02, SE = .1,
p = .75). The third class (inverse u-shaped avoidance trajectory n = 88, 25.8%) demon-
strated the lowest initial level of attachment avoidance (Est = 5.13, SE = .6, p < .001) and was
characterized by a significant quadratic slope (Est = −1.33, SE = .45, p = .003). However, the
linear slope was not significant (Est = −.00, SE = .25, p = .99). This trajectory showed a sharp
increase from T1 to T2, then a smaller increase between T2 and T3, followed by a moderate
decrease between T3 and T4. Figure 1(a) presents attachment avoidance trajectories.

Trajectories of attachment anxiety (conditional model)

To examine the attachment anxiety trajectories, we assessed the model fit of the linear
and linear + quadratic conditional models (regressed on group and PTSD at T1). Based
on the AIC, BIC, SSBIC, and BLRT, we found that successive models continued to
demonstrate improved fit from one to two classes in linear + quadratic parameters
and in the linear-only parameters model. Importantly, the linear parameters consistently
outperformed the linear + quadratic parameters (Table 1). Thus, the two-class linear
model was accepted for being parsimonious and interpretable. Moreover, its entropy
improved to an excellent accuracy of .96.
The model identified two substantively distinct classes (see Figure 1(b)). The largest class
(decreasing anxiety trajectory n = 230, 68.2%) was characterized by medium-to-high
initial attachment anxiety (Est = 2.53, SE = .1, p < .001). This trajectory displayed a negative
linear decrease over time as captured by a significant linear slope (Est = −.02, SE = .00,
p < .001). The second class (stable anxiety trajectory: n = 110, 31.8%) demonstrated high
initial levels of attachment anxiety (Est = 3.19, SE = .12, p < .001) and was characterized by a
nonsignificant linear slope (Est = −.01, SE = .01, p = .4) (Figure 1(b)).

Relation of trauma type and attachment trajectories

Regressions of the slopes of the attachment avoidance trajectories on captivity of all
classes yielded no significant effects. Next, logistic regressions were conducted to assess
whether the trajectories were predicted by captivity. Compared to the decreasing
avoidance trajectory (reference group), ex-POWs were more likely to belong to the
inverse u-shaped avoidance trajectory than controls (OR = 6.3) but ex-POWs were as
likely to belong to the stable avoidance trajectory as controls were (OR = .2). Regarding
attachment anxiety, it was evident that for ex-POWs, the slopes were steeper compared
to combat veterans (Est = .02, p < .001), indicating less decrease and less stability in this
group compared to combat veterans. Results of the logistic regression with trauma type
predicting the trajectories showed that ex-POWs were at a higher risk to belong to the
stable anxiety trajectory than the decreasing anxiety trajectory (OR = .34).
 ATTACHMENT & HUMAN DEVELOPMENT 363

Relation of humiliation in captivity and attachment trajectories

Among ex-POWs, we found significant differences between attachment avoidance trajec-
tories in humiliation in captivity F(2, 338) = 4.04, p = .01. As can be seen in Table 2, ex-POWs in
the inverse u-shaped avoidance trajectory reported higher humiliation in captivity compared
to those in the decreasing avoidance trajectory. The stable avoidance trajectory did not differ
from the two other trajectories. We found no differences between attachment anxiety
trajectories in humiliation in captivity, F(2, 338) = 1.62, p = .2. Age was not significant (p = .70).

Relation of PTSD and attachment trajectories

The regressions of the attachment avoidance slopes on PTSD of all classes yielded no
significant effects. Next, logistic regressions were conducted to assess whether the
trajectories were predicted by PTSD. Compared to the decreasing avoidance trajectory
(chosen to be the reference group), veterans with higher PTSD (OR = 1.2) were more
likely to belong to the inverse u-shaped avoidance trajectory. However, veterans with
higher PTSD were not more likely to belong to the stable avoidance trajectory
compared to the decreasing avoidance trajectory (OR = .2). As for the attachment
anxiety trajectories, the slopes were marginally significantly predicted by PTSD, that is
there was less decrease and less stability in veterans with higher PTSD (Est = .01
p = .06). However, in predicting the classes, it was revealed that veterans with higher
PTSD were not at a higher risk (OR = 0).

Relation of loneliness and attachment trajectories

As can be seen in Table 2, there was a significant effect of avoidance trajectories on
loneliness, F(2, 338) = 6.35, p = .002. That is, participants of both the inverse
u-shaped avoidance trajectory and the stable avoidance trajectory reported higher
levels of loneliness, as compared to those in the decreasing avoidance trajectory.
Results also revealed significant differences between the anxiety attachment trajec-
tories regarding loneliness, F(2, 338) = 14.3, p < .001. Participants in the stable
anxiety trajectory reported higher levels of loneliness compared to the decreasing
anxiety trajectory. Age was not significant (p = .66).

Discussion
Attachment stability is a central topic in attachment research but has rarely been
examined among older adults and across several decades. The current study aimed to

Table 2. Descriptive statistics differences between attachment classes in humiliation and loneliness.
Avoidance classes M SD Anxiety classes M SD
Loneliness Inverse u-shaped course 1.90 .38 Stable course 1.97 .41
Decreasing course 1.75 .36 Decreasing course 1.80 .36
Stable course 1.92 .39
Humiliation in captivity Inverse u-shaped course 4.40 1.1 Stable course 4.31 .75
Decreasing course 4.09 .39 Decreasing course 4.18 .85
Stable course 4.26 .77
364 R. BACHEM ET AL.

(1) investigate heterogeneity in changes regarding attachment insecurities in older

adults who had experienced war trauma and (2) examine the relations between the
trajectories of attachment insecurities and four interpersonal risk factors related to war
trauma. In line with our hypotheses, results revealed that almost two-thirds of the
participants investigated in this study showed significant changes in attachment insecu-
rities during the study period. We thus propose that attachment develops and changes
at an older age and decades after a traumatic event. This contradicts the general view of
the attachment theory, which assumes that relational schemata are largely stable
throughout the adult lifespan (Bowlby, 1969). However, the extent of change we
found in trajectories of attachment insecurities varied between individuals and attach-
ment dimensions.

Stable and decreasing trajectories of attachment avoidance and anxiety

Based on the SST (Carstensen et al., 1999), we expected the decrease to be the most
prevalent trajectory of attachment avoidance. Contrary to our hypothesis, this trend was
observed in only 30.5% of the study participants, whereas 25.8% followed an inverse
u-shaped trajectory and 43.7% of the sample experienced stability. Thus, entering older
age, which is assumed to entail a goal shift toward achieving interpersonal closeness,
may affect attachment avoidance in a subgroup of individuals. However, it does not
seem to be the primary factor in determining attachment development during this life
stage. The largest trajectory group in this dimension was characterized by stability of
attachment avoidance, as predicted by attachment theory (e.g. Bowlby, 1969); never-
theless, this group represents less than half of the current sample. In conclusion,
attachment avoidance presented heterogeneous trajectories; no single theoretical per-
spective accounted for all of them. Importantly, individual attachment development may
be related to the constellation of interpersonal risk factors, which are discussed below.
Notably, the results of the current study differ from earlier longitudinal findings that
identified either a decrease (Chopik et al., 2017) or an increase in avoidant attachment in
older adults. This was assumed to be a defensive reaction to losses of attachment
relationships and declined self-capacity (Magai et al., 2001; Zhang & Labouvie-Vief,
2004). Potentially, participants of the current study had not yet advanced sufficiently
far in the aging process (M = 65.1 years, SD = 4.3 at T4) to suffer from age-related losses
to a degree that warranted defensive reactions in interpersonal relationships. However,
the abovementioned previous studies did not separately portray attachment trajectories;
thus, individual differences may have been masked in their samples. It is further possible
that the stable trajectory of the current study may develop into an increasing or
decreasing trajectory as the participants advance in the aging process. Future research
should evaluate the trajectories of attachment avoidance as individuals grow older.
We further proposed that age-related shifts in social-emotional goals (Carstensen
et al., 1999) may also be associated with trajectories of attachment anxiety. Individuals
with moderate or low attachment anxiety were expected to decrease in anxiety whereas
those with high attachment anxiety were expected to experience an increase in anxiety.
These hypotheses were partly confirmed as 68.2% of the participants indeed followed a
decreasing anxiety trajectory at a low-to-moderate level whereas 31.8% of the partici-
pants followed a stable trajectory at a medium-to-high level of attachment anxiety. The
 ATTACHMENT & HUMAN DEVELOPMENT 365

current results, however, present no indication that older adults with high anxiety at T1
would intensify their use of hyperactivating strategies as they enter older age, as only
stable and decreasing trajectories were found regarding attachment anxiety (Figure 1).
Interestingly, whereas the largest trajectory group on the avoidance dimension
represented stability, two-thirds of the participants reported change in the anxiety
dimension. It is possible that employing hyperactivating strategies that are characteristic
of attachment anxiety is more resource-consuming than employing deactivating strate-
gies that are characteristic of attachment avoidance. As individuals age and their
resources become limited, it may be economical to tone down the usage of hyperacti-
vationg strategies. In consequence, attachment anxiety may be more prone to change
than attachment avoidance during older age.

Inverse u-shaped trajectory of attachment avoidance

Of particular interest is the inverse u-shaped trajectory of attachment avoidance: it
represents the most deleterious course with peaks of attachment avoidance that
exceeded the avoidance described in the stable and decreasing trajectories. A contex-
tual factor that may account for the rise in attachment avoidance at the second
measurement (2003) could be Israel’s involvement in the Al-Aqsa Intifada, a violent
armed conflict with Palestine, posing a continuous life threat to the civilian population.
Similarly, during the third measurement (2008), a major exchange of war prisoners
caused a public discourse, and an armed operation accompanied by rocket attacks
also took place. In a context resembling the original trauma, traumatic memories and
posttraumatic symptoms can be reactivated (Green, Coupe, Fernandez, & Stevens, 1995).
Moreover, in such times of danger to oneself and significant others, an increase in
attachment avoidance is protective as avoidant individuals’ tendencies for affective
numbness and self-reliance may shield them from more intense negative emotions
(Kanninen, Punamäki, & Qouta, 2003). In contrast, the first (1991) and fourth assessment
(2015) were conducted during a time of relative peace and quiet. Consequently, parti-
cipants prone to attachment changes might have displayed relational working models
less characterized by avoidance.
The identification of an inverse u-shaped trajectory of attachment avoidance may also
lend support to Baldwin and Fehr’s (1995) perspective that attachment changes reflect a
momentary activation of different relational schemata available to a person rather than
an enduring change in a person’s internal relational landscape. Whereas a specific
relational schema may be dominant throughout the majority of contexts and social
interactions, individuals might nevertheless have a wider repertoire of relational sche-
mata available to them. The current findings add to this perspective by suggesting that
the tendency to actually experience shifts in schema activation is associated with
accumulated interpersonal risk factors.

Interpersonal trauma and its consequences

Ex-POWs were more likely than combat veterans to demonstrate a fluctuating trajectory
of attachment avoidance (inverse u-shaped trajectory) as well as a medium high stable
trajectory of attachment anxiety. Similarly, the results show that ex-POWs who
366 R. BACHEM ET AL.

experienced more humiliation in captivity showed a higher likelihood of belonging to

the inverse u-shaped trajectory of attachment avoidance. Thus, in accordance with our
hypotheses, interpersonal trauma was associated with more deleterious longitudinal
development on both dimensions. Given the highly interpersonal nature of the trauma
of captivity and humiliation in captivity, these findings are in line with the theoretical
assumptions of attachment theory. Notably, experiencing humiliation only appeared to
be related to attachment avoidance but not anxiety. To avoid future humiliation, it is
likely more effective to employ deactivating strategies, such as withdrawal, rather than
hyperactivating strategies, such as proximity-seeking.
Interestingly, PTSD symptoms were associated with the inverse u-shaped avoidance
trajectory but not with the stable and decreasing trajectories of both dimensions. This
finding is surprising as previous studies found PTSD to be related to both attachment
dimensions (e.g. O’Connor & Elklit, 2008). Possibly, the inverse u-shaped avoidance
trajectory represented more highly burdened individuals and thus may be understood
as a more likely proxy of pathology than the other trajectories. The stable and decreas-
ing trajectories, on the other hand, reflected lower levels of impairment. Consequently,
mechanisms other than PTSD might have been involved in their longitudinal
development.
Loneliness was associated with higher attachment insecurities on both dimensions. In
fact, loneliness was the one construct associated with all trajectories, representing the most
solid correlate of attachment insecurities in the current study. It has been proposed that
anxious individuals are more susceptible to loneliness than attachment-avoidant indivi-
duals, since the former focus on their unsatisfied need for interpersonal closeness while the
latter tend to deny it (Berlin, Cassidy, & Belsky, 1995; Mikulincer & Shaver, 2014). It seems
that despite the tendency to avoid closeness, these individuals experience the need for
contact with significant others, supporting Mikulincer and Shaver’s (2014) observation that
the attachment system of avoidant individuals is not deactivated to such an extent that
they would no longer care about the absence of supportive relationships. The dualism of
avoidant attachment and simultaneous loneliness likely represents a lack of integration
often observed in survivors of interpersonal trauma. On the one hand, their relationships
are characterized by avoidance and suspicion; on the other, they may be dependent and
clinging to their attachment partners (Herman, 1992).
All of the interpersonal risk factors investigated in the current study (captivity,
humiliation, loneliness, PTSD) were associated with a higher likelihood of belonging to
the inverse u-shaped group of attachment avoidance. It is possible that in the presence
of a number of accumulating risk factors, trauma survivors showed less relational work-
ing model stability and more readily revised them when confronted with new sources of
internal or external stress. The individual differences model of attachment (Davila et al.,
1997, 1999) proposes that certain stable vulnerability factors, typically early personal and
family dysfunction, could interfere with the development of coherent views of the self
and others and renders some individuals more prone to attachment changes than
others. The results of the current study suggest that such individual vulnerability may
also be acquired during adulthood under circumstances of severe interpersonal trauma.
The current study has several limitations. First, some of the variation in attachment
patterns across adulthood is likely due to measurement error, as the reliability of the
self-report attachment measure was adequate, though not excellent. Second, as our
 ATTACHMENT & HUMAN DEVELOPMENT 367

initial measurement took place 30 years after the war, we have no information on the
study variables in the time before, or in the first years following, the trauma. Third,
humiliation was assessed with only a single item. Fourth, the current study investigates a
specific age cohort of Israeli veterans and ex-POWs of the Yom Kippur War. Whether the
trajectories of attachment insecurities can be generalized to veterans of other cultural
backgrounds or non-traumatized populations should be subject to future research.
Further research also is needed to investigate trajectories of attachment in populations
that experienced interpersonal traumatic events other than war trauma. Importantly,
different interpersonal factors may be associated with longitudinal attachment devel-
opment in those cases. Finally, the veterans investigated in this study are of one age
group and thus, a possible cohort effect cannot be negated.
Despite these limitations, several implications for clinical practice may be drawn from
the above findings. The majority of the sample were in stable long-term marriages, which
suggests that the changes in attachment insecurities were not due to changes in marital
status but rather the trauma-related interpersonal factors. Identifying risk factors of
attachment insecurity trajectories can provide mental health professionals with specific
information on areas for intervention when working with individuals displaying attach-
ment insecurities. As aspects of trauma severity (e.g. humiliation in captivity) cannot be
reversed, therapists should support the survivors in mourning and working through their
traumatic interpersonal experience to prevent the experience from coloring the way they
perceive others. Importantly, besides the treatment of PTSD, which has effective, evi-
dence-based approaches described elsewhere (e.g. Briere & Scott, 2015), the present
investigation directs therapeutic attention toward a reduction of loneliness, the most
consistent risk-factor for attachment insecurities in the current study. Moreover, loneliness
has been identified as a significant mental health problem in the elderly (Beutel et al.,
2017), thus making it a particularly relevant treatment target for aging trauma survivors. A
meta-analytic evaluation of 50 loneliness interventions demonstrated that addressing
maladaptive social cognitions was a particularly effective component of these treatments
(Masi, Chen, Hawkley, & Cacioppo, 2011). This is a promising finding also in the context of
treatment of attachment insecurities, as exploring and reducing maladaptive social cogni-
tions may not only result in lower feelings of loneliness but might also allow the person to
explore attachment strategies less characterized by anxiety or avoidance.

Acknowledgments
We thank all study participants for their repeated collaboration and we thank Prof. K. Ginzburg for
her valuable advice in writing this manuscript.

Disclosure statement
The authors report no conflicts of interest.

Funding
This research was supported by the I-CORE Program of the Planning and Budgeting Committee
and The Israel Science Foundation: [Grant Number 1916/12].
368 R. BACHEM ET AL.

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