The influence of childhood abuse and adult attachment style on clinical relationships in breast cancer care

Objective: In a previous report, breast cancer patients reporting a history of childhood abuse were less likely to feel fully supported in their relationships with clinical staff than were patients who did not report an abuse history. Our aims were to replicate this effect, to test whether surgeons' difficulties in these relationships mediated the relationship of abuse to patients feeling less supported, and to test whether patients' attachment style mediates the influence of abuse on patients' or surgeons' experience of the relationship.

Method: Women with primary breast cancer (N = 100) completed self-report questionnaires around the time of surgery to assess: emotional distress; adult attachment (models of self and other); sexual, physical and emotional abuse before age 16; and childhood parental care. After consultation three weeks post-operatively patients and surgeons completed self-report questionnaires to measure, respectively, patients' perceptions of support from the surgeon, and surgeons' perceptions of difficulty in their relationship with the patient.

Results: Patients recalling abuse were more than seven times more likely to feel incompletely supported by the surgeon than those not recalling abuse, after controlling for emotional distress. Surgeons reported greater difficulty in relationships with patients recalling abuse than with non-abused patients. Attachment (poor model of self) mediated the relationship of abuse with patient perceptions of incomplete support, but not the relationship with surgeon ratings of difficulty.

Conclusion: The damaging effects of childhood abuse on adult relationships extend to relationships with surgeons in cancer care. While effects of abuse on attachment can explain the damage that patients experience, mediators of the difficulty that surgeons experience need further research.