創傷症狀與依戀關係對於受暴婦女之自傷的影響：述情障礙的中介角色

Effects of posttraumatic stress symptoms and attachment on self-injury in battered women: Alexithymia as a mediator

宋佳樺(Jia-Hua Song)

指導教授 ： 洪福建

中原大學/理學院/心理學研究所/碩士(2017年)

https://doi.org/10.6840/cycu201700587

摘要

研究背景與目的：根據衛生福利部的調查，近10年來國內家庭暴力案件通報數有逐年增加的趨勢，婚姻/離婚/同居關係暴力約占一半以上，且其中8成的受害者皆為青壯年女性，國內外的研究均指出遭受親密關係暴力會對受害女性造成多種生理、情緒、行為、認知與人際方面的問題，涉及層面十分廣泛。親密關係暴力所導致之創傷症狀、成人不安全依戀模式可能會使受暴女性出現強烈的情緒反應，述情障礙更會加劇情緒調節的難度，增加後續以自傷作為調適與因應策略之風險，故研究者欲從情緒調節問題的角度，探討親密關係暴力是否會透過創傷後壓力症狀、成人不安全依戀去影響自傷想法/行為，並了解述情障礙在此關係中是否具有中介效果。

研究方法：本研究為一橫斷式研究，研究對象為90名向社會局或機構等求助之20至65歲受暴女性，使用自陳式量表蒐集資料。研究工具包括基本資料表、親密關係暴力量表、創傷後壓力診斷量表－DSM-5版、台灣多倫多述情量表、親密關係經驗量表－關係結構版、自我傷害量表等6個部分。

研究結果：結果顯示：(1) 焦慮依戀傾向最能顯著預測自傷想法與行為。(2) 在中介分析方面，創傷症狀與焦慮依戀傾向會部分中介影響親密關係暴力與自傷行為之間的關係；難以區辨與表達情緒(DIF+DDF)、難以確認與區辨情緒(DIF)、難以表達與溝通情緒(DDF)會完全中介影響創傷症狀與自傷行為之間的關係；DIF+DDF、DDF會部分中介影響焦慮依戀傾向與自傷行為之間的關係。(3) 在整體架構方面，親密關係暴力可顯著預測創傷症狀與焦慮依戀傾向，創傷症狀、焦慮依戀傾向皆可預測表達與溝通情緒困難(DDF)，創傷症狀與焦慮依戀傾向亦會透過難以表達情緒來間接影響自傷想法/行為，但雖然焦慮依戀傾向、難以表達情緒可直接預測自傷想法，難以表達情緒對自傷行為並無直接效果。

結論：過去研究多著重於親密關係暴力對自殺風險的影響，但本研究發現約有半數參與者曾出現自傷想法或行為，遠高於一般人，且結果指出親密關係暴力可直接預測自傷想法/行為，此關係會受到焦慮依戀特質、難以區辨與表達情緒等影響，特別是焦慮依戀傾向對自傷具有相當顯著的預測力，故當受害者遭遇到越嚴重的伴侶暴力、焦慮依戀傾向的程度越高、具有較多述情障礙特徵時，也會出現越多自傷想法/行為。上述結果均顯示受暴女性的自傷問題宜獲得更多學術與臨床關注，發展適當的介入方式與處遇措施，以避免其持續藉由自傷以調節情緒與壓力，另於文末討論研究結果、相關限制與未來之方向。

關鍵字

親密關係暴力 ； 創傷後壓力症狀 ； 成人不安全依戀 ； 述情障礙 ； 自傷

並列摘要

Background and purpose: According to Ministry of Health and Welfare’s data, the number of domestic violence has been increased over the last ten years, and intimate partner violence (IPV) accounts for more than 50% of the total number. Many researches indicate that IPV can cause many kinds of negative results in battered women. Trauma symptoms and insecure adult attachment may lead to intense negative emotions, and alexithymia will make it much more difficult to regulate emotion, increasing the risk for battered women to use self-harm as a coping strategy. Therefore, this study focuses on difficulties in emotion regulation, examines the relationship between IPV, trauma symptoms, insecure adult attachment, alexithymia and non-suicidal self-injury (NSSI).

Methods: The sample consists of 90 battered women between the ages of 20 to 65 years, recruited from domestic violence shelter or community agency. Measures of this study are the basic information questionnaire, Intimate partner violence questionnaire, the Posttraumatic Diagnostic Scale for DSM–5 (PDS–5), the Taiwan version of Toronto Alexithymia Scale-20, Experiences in close relationships – relationship structure questionnaire (ECR-RS), and Deliberate Self-Harm Inventory (DSHI).

Results: (1) Anxiety attachment was a significant predictor of NSSI. (2) According to mediation analyses, both trauma symptoms and anxiety attachment partially mediated the relationship between IPV and NSSI. Difficulty identifying feelings (DIF) and difficulty describing feelings (DDF) fully mediated the relationship between trauma symptoms and NSSI. Both DIF+DDF and DDF partially mediating the anxiety attachment-NSSI relationship. (3) Path analysis indicated that IPV could significantly predict trauma symptoms and anxiety attachment, both trauma symptoms and anxiety attachment could significantly predict DDF. An indirect path from trauma symptoms and anxiety attachment to NSSI was detected via DDF. Although anxiety attachment and DDF were significant predictors of NSSI thoughts, DDF couldn’t predict NSSI behaviors.

Conclusion: This study found that there’s about 50% of participants have engaged in NSSI, the prevalence of NSSI in battered momen is higher than general population. Results indicated that IPV, anxiety attachment and DDF were significant predictors of NSSI. Therefore, more severe IPV, higher level of attachment anxiety and alexithymia were related to more NSSI thoughts and behaviors in battered women. These findings highlighted the IPV-NSSI relationship, continued empirical investigations and intervention strategies are needed. Limitations of the study and future directions for IPV research were discussed.

並列關鍵字

Intimate partner violence ； Trauma symptoms ； Insecure adult attachment ； Alexithymia ； Non-suicidal self-injury

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