Attachment Style and Mentalization Impact Among Women Victims of Domestic Violence

Study Overview
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Brief Summary
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Attachment and mentalization with a population of domestic violence victims Domestic violence is one of the most common forms of domestic violence. Multiform and complex, it affects all backgrounds and all ages. According to a survey instituted by the government of Emmanuel Macron, 219,000 women were recognized as victims of domestic violence in 2017. This phenomenon is not without questioning the scientific scene. Also, this study focus on the quality of the attachment because if this bond is insecure, it can constitute a point of vulnerability in self-construction and impact on future relational modalities.

Detailed Description
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The security of the bond of attachment depends on the capacity of the maternal figure, or her substitute, to understand and respond in an adapted and consistent manner to her baby. In addition, it has also been established that when disruptions occur in the security of attachment bond, the quality of mentalization is impacted. But, mentalization is the quality and quantity of psychic representations available to allow someone understanding and thinking about his links to others and to himself. This is an essential asset in the release of situations of violence and in overcoming trauma because it participates in psychic development. That's why this research focuses on early relationships and the quality of mentalization with a cohort of thirty women victims of domestic violence, consultant within the Legal Medicine department of the CHU of Besançon. This research focuses on two groups of subjects: women who managed to get out of violent relationship (15 subjects) and others who did not (15 subjects). The research methodology includes several tools: two projective tests (Rorschach and TAT), ten self-questionnaires (which assess attachment, stress, social support, relational quality with the main attachment figures, the image of the Self-body, quality of mentalization), a clinical research interview and presentation of the AAI. The observation of this population will highlight the impact of the early environment in the psychic construction of the subject and the victim's destiny. Moreover, this study will look at the role of psychotherapeutic follow-up in the quality of mentalization.

Official Title
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Attachment Style and Mentalization Impact Among Women Victims of Domestic Violence

Conditions
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Violence, Domestic

Intervention / Treatment
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* Behavioral: Semi-structured interviews
* Behavioral: Projective methode
* Behavioral: Selfreported


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women over 20 years old, victims of domestic violence With european culture Separated from their abusive partner Consulting the Legal Medicine Department in Besançon University Hospital Exclusion Criteria: Refusal to participate

Ages Eligible for Study
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Minimum Age: 20 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: First group : women following a psychotherapy Second group : women unfollowing a psychotherapy
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Subjects following a psychotherapy<br>Domestic violence victims following a psychotherapy 15 subjets Aged from 20 to 55 | Behavioral: Semi-structured interviews<br>* Interview<br>Behavioral: Projective methode<br>* Rorschach + thematic aperception test<br>Behavioral: Selfreported<br>* RSQ - PBI - RFQ - QSCPGS - SSQ6 - ÉCHELLES DE CUNGI - STAI - PCL-S - IES-R<br>|
| Experimental: Subjects unfollowing a psychotherapy<br>Domestic violence victims unfollowing a psychotherapy 15 subjects Aged from 20 to 55 | Behavioral: Semi-structured interviews<br>* Interview<br>Behavioral: Projective methode<br>* Rorschach + thematic aperception test<br>Behavioral: Selfreported<br>* RSQ - PBI - RFQ - QSCPGS - SSQ6 - ÉCHELLES DE CUNGI - STAI - PCL-S - IES-R<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Security of the current attachment | Relationship Scale Questionary (RSQ) Description : 30 questions Answers : - 5 (not like me at all to) + 5 (very like me) Cotation : self-model scale : - 4 to + 4 model of others : - 4 to + 4 positive self-model and positive model of others = secure positive self-model and negative model of others = insecure detached negative self-model and positive model of others = insecure worried negative self-model and negative model of others = insecure fearful | Month 12 | 
| Security of the early attachment | Adult Attachment Interview (AAI : Main, George & Kaplan, 1984 ; Pierrehumbert et al., 1999) Description : 20 questions Free answers Cotation : Edicode, Pierrehumbert Fluidity = 1 to 9 Coherence = 1 to 9 Reflexive = 1 to 9 Authentic = 1 to 9 Scores have to be high | Month 12 | 
| Mentalization | The Reflective Functioning Questionnaire (RFQ : Fonagy & al., 2016) The 8-item RFQ Reflective Functioning Questionnaire comprises two subscales each of 6 items (Uncertainty and Certainty about mental states) The two scales operate with a Likert scale of 7 points that evaluate the degree of agreement of the subject with the sentences presented in each item. The items of Uncertainty or RFQ_U correspond to statements such as Often very strong feelings cloud my thinking, they are recorded to detect extreme levels of uncertainty about mental states, in the following way 0, 0, 0, 0, 1, 2, 3, so that high scores reflect hypomentalization. Scores have to be medium The items corresponding to Certainty of mental states or RFQ_C contemplate statements such as When I get angry I say things without really knowing why I say them which are recorded as 3, 2, 1, 0, 0, 0, 0, in such a way that a 6 low degree of agreement reflects Hypermentalization. Scores have to be medium | Month 12 | 
| Quality of early relationship | Parental Bonding Instrument (G. Parker, H. Tupling and R.B. Brown) Two scales termed 'care' and 'overprotection' or 'control', measure fundamental parental styles as perceived by the child. 25 item questions, including 12 'care' items and 13 'overprotection' items. Likert scale : very like (+3) or very dislike (-3). In addition to generating care and protection scores for each scale, parents can be effectively assigned to one of four quadrants: Mothers : care score = 27.0 / protection score = 13.5. Fathers :care score = 24.0 / protection score = 12.5. High care and high protection means affectionate constraint. High protection and low care means affectionless control. High care and low protection means optimal parenting. Low care and low protection means neglectful parenting. | Month 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PTSD | Cungi's Scale 8 items Subject evaluates the importance for him of each of the items with a rating ranging from 1, very little impact at 6, extremely high impact. Score have to be low State-Trait Anxiety Inventory (STAI : Spielberg, 1983) Measures how the subject feels right now on 40 items with answer choices of 1 = not at all / almost never, 2 = somewhat/sometimes, 3 = moderately so / often, and 4 = very much so / almost always. Item scores are added to obtain subtest total scores. The score range for each subtest is 20-80, the higher score indicating anxiety. The cut point of 39-40 has been suggested to detect clinically significant symptoms. Impact of Event Scale Revisited (IES-R : Horowitz, Wilner, & Alvarez, 1979) 7 additional questions and a scoring range of 0 to 88. Scores that exceed 24 can be quite meaningful 33 and above : PTDS | Month 12 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Domestic violence, Attachment, Mentalization, Victimization, Psychic elaboration of the trauma