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研究生:宋佳樺
研究生(外文):Jia-Hua Song
論文名稱: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
論文名稱(外文):Effects of posttraumatic stress symptoms and attachment on self-injury in battered women: Alexithymia as a mediator
指導教授:洪福建洪福建引用關係
指導教授(外文):Fu-Chien Hung
學位類別:碩士
校院名稱:中原大學
系所名稱:心理學研究所
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:122
中文關鍵詞: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
外文關鍵詞:Intimate partner violenceTrauma symptomsInsecure adult attachmentAlexithymiaNon-suicidal self-injury
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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。
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.
目錄
摘要 I
Abstract III
謝誌 V
目錄 VI
圖目錄 IX
表目錄 X
第一章 緒論 1
第一節 研究背景與動機 1
第二章 文獻探討 5
第一節 親密關係暴力 5
第二節 自傷行為與述情障礙 8
一、自傷行為 8
二、述情障礙 10
三、自傷與述情障礙的情緒調節功能 11
第三節 創傷後壓力症狀對自傷的影響 14
一、創傷後壓力症 14
二、親密關係暴力與創傷後壓力症 14
三、創傷對情緒調節問題與自傷的影響 16
第四節 成人依戀關係對自傷的影響 18
一、成人依戀關係 18
二、親密關係暴力與成人依戀關係 21
三、成人依戀關係對情緒調節問題與自傷的影響 24
第五節 研究目的與架構 27
第三章 研究方法 29
第一節 研究對象 29
第二節 研究工具 31
一、個案基本資料表 31
二、親密關係暴力量表 31
三、創傷後壓力診斷量表 31
四、多倫多述情障礙量表 32
五、親密關係經驗量表-關係結構版 33
六、自我傷害量表 34
第三節 研究程序與資料分析 35
一、研究程序 35
二、資料分析 35
第四章 研究結果 37
第一節 參與者特性分析 37
第二節 基本人口變項、受暴相關經驗在各研究變項的差異分析 39
一、基本人口變項在各研究變項的差異分析 39
二、受暴相關變項在各研究變項的差異分析 41
三、有無自傷想法/行為在各研究變項的差異分析 43
第三節 年齡、相處與受暴年數及各研究變項的相關分析 45
一、親密關係暴力:與創傷症狀、成人不安全依戀、述情障礙、自傷想法/行為之相關 47
二、創傷症狀:與成人不安全依戀、述情障礙、自傷想法/行為之相關47
三、成人不安全依戀:與述情障礙、自傷想法/行為之相關 48
四、述情障礙:與自傷想法/行為之相關 48
五、自傷想法與自傷行為之相關 49
第四節 自傷行為之中介效果檢驗 50
一、以親密關係暴力預測自傷行為:創傷後壓力症狀之中介效果 51
二、以親密關係暴力預測自傷行為:成人不安全依戀之中介效果 51
三、以創傷症狀預測自傷行為:述情障礙之中介效果 52
四、以焦慮依戀預測自傷行為:述情障礙之中介效果 54
第五節 路徑分析 57
一、親密關係暴力、創傷症狀、焦慮依戀傾向、DIF+DDF與自傷想法/行為之間的關係 57
二、親密關係暴力、創傷症狀、焦慮依戀傾向、DDF與自傷想法/行為之間的關係 59
第五章 討論與建議 62
第一節 研究目的與結果摘述 62
第二節 主要研究結果討論 64
一、親密關係暴力、創傷症狀與自傷行為之間的關係 64
二、親密關係暴力、焦慮依戀傾向與自傷行為之間的關係 65
三、創傷症狀、難以區辨與表達情緒、自傷行為之間的關係 67
四、焦慮依戀傾向、難以表達情緒與自傷行為之間的關係 68
五、親密關係暴力、創傷症狀、焦慮依戀傾向與難以表達情緒、自傷之間的關係 69
第三節 其他研究結果討論 71
一、受暴女性的基本人口變項在各研究變項上的差異 71
二、焦慮依戀傾向與逃避依戀傾向的關係 72
三、DIF、DDF與EOT在各主要研究變項上的差異 73
第四節 研究貢獻 75
第五節 研究限制與建議 76
一、研究方法限制 76
二、研究結果推論限制 76
三、未來建議與研究方向 77
參考文獻 79
附錄一 研究倫理審查核可證明 90
附錄二 量表授權同意書 91
附錄三 研究問卷 95
附錄四 心理衛教單 105
附錄五 自傷想法之中介效果檢驗 107

圖目錄
圖2-5-1 研究架構圖 28
圖4-5-1 親密關係暴力、創傷症狀、焦慮依戀傾向、難以區辨與表達情緒(DIF+DDF)與自傷想法之路徑分析圖 58
圖4-5-2 親密關係暴力、創傷症狀、焦慮依戀傾向、難以區辨與表達情緒(DIF+DDF)與自傷想法之路徑分析圖 59
圖4-5-3 親密關係暴力、創傷症狀、焦慮依戀傾向、難以表達情緒(DDF)與自傷想法之路徑分析圖 60
圖4-5-4 親密關係暴力、創傷症狀、焦慮依戀傾向、難以表達情緒(DDF)與自傷行為之路徑分析圖 61

表目錄
表3-1-1 參與者分布情形 29
表3-1-2 基本人口變項特性 30
表4-1-1 受暴相關變項特性 37
表4-1-2受暴相關變項特性(續) 38
表4-2-1 基本人口變項在各研究變項的差異分析結果 40
表4-2-2 受暴相關變項在各研究變項的差異分析結果 42
表4-2-3 受暴相關變項在各研究變項的差異分析結果(續) 43
表4-2-4 有無自傷想法/行為在各研究變項的差異分析結果 44
表4-3-1 年齡、相處與受暴年數及各研究變項的相關性分析結果 46
表4-4-1 以親密關係暴力預測自傷行為之拔靴法結果:創傷症狀之中介效果 51
表4-4-2 以親密關係暴力預測自傷行為之拔靴法結果:焦慮依戀傾向之中介效果 52
表4-4-3 以創傷症狀預測自傷行為之拔靴法結果:DIF+DDF之中介效果 53
表4-4-4 以創傷症狀預測自傷行為之拔靴法結果:DIF之中介效果 53
表4-4-5 以創傷症狀預測自傷行為之拔靴法結果:DDF之中介效果 54
表4-4-6 以焦慮依戀傾向預測自傷行為之拔靴法結果:DIF+DDF之中介效果 55
表4-4-7 以焦慮依戀傾向預測自傷行為之拔靴法結果:DIF之中介效果 55
表4-4-8 以焦慮依戀傾向預測自傷行為之拔靴法結果:DDF之中介效果 56
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