Secure Attachment despite Childhood Maltreatment: Behavioral and Neural Correlates of Interpersonal Resilience

Katharina Brosch, Vincent Hammes, Paula Usemann, Frederike Stein, Sunny X. Tang, Rebecca M. Schwartz, Florian Thomas‐Odenthal, Lea Teutenberg, Nooshin Javaheripour, Susanne Meinert, Dominik Grotegerd, Elisabeth J. Leehr, Tiana Borgers, Kira Flinkenflügel, Janik Goltermann, Anne Sophie Hildebrand, Sabrina Teckentrup, Roman Vogler, Tim Hahn, Udo Dannlowski, Philipp Kanske, Benjamin Straube, Hamidreza Jamalabadi, Andreas Jansen, Igor Nenadić, Tilo Kircher, Nina Alexander

Background: Childhood maltreatment is a traumatic interpersonal stressor that increases vulnerability for depression in adulthood. However, some individuals show secure attachment despite childhood maltreatment, a pattern that can be described as interpersonal resilience. The present study examined the behavioral and neural correlates of interpersonal resilience, defined as secure attachment in adults exposed to childhood maltreatment. Methods: We analyzed structural 3T MRI data from 1,317 adults, including healthy participants and individuals with partially or fully remitted major depression. Gray matter volume was estimated from structural MRI data using voxel-based morphometry. Attachment style and childhood maltreatment were assessed using the Relationship Scales Questionnaire and the Childhood Trauma Questionnaire, respectively. A 2x2 design (childhood maltreatment by attachment style) tested main and interaction effects on behavioral outcomes and brain structure. Results: Interpersonally resilient individuals with secure attachment and maltreatment reported significantly better mental health outcomes compared to insecurely attached adults with maltreatment. Differences included lower self-reported and rater-based depressive symptoms, lower global symptom severity, and higher global functioning. In the neuroimaging analyses, we identified a significant childhood maltreatment by attachment style interaction in the left supramarginal gyrus, with larger gray matter volume in resilient individuals compared to all other groups. This effect remained robust across multiple sensitivity analyses, controlling for medication load, antidepressant intake, diagnosis group, as well as in a complementary dimensional analysis. Conclusions: The results identify a potential neural correlate of interpersonal resilience. Larger gray matter volume in the left supramarginal gyrus, a region previously implicated in perspective taking and self-other distinction among other functions, may be relevant to more adaptive interpersonal functioning after early adversity. Together with the robust behavioral effects, these findings are consistent with secure attachment as a protective factor that may be associated with attenuated effects of childhood maltreatment on mental health.