臺灣博碩士論文加值系統

背景：童年不當對待是影響身心健康問題的風險因子，亦可能提高個體罹患ICD-11複雜性創傷後壓力症的風險。主要照顧者的不當對待可能影響個體產生不安全依戀，進而影響在面對威脅和壓力下的情緒調節困難，而不安全依戀與情緒調節困難可能影響複雜性創傷後壓力症狀 (complex post-traumatic stress symptom ; CPTSS) 的嚴重度。本研究首先探討在童年不當對待對ICD-11 CPTSS的預測上，不安全依戀和情緒調節困難之序列中介效果，接著探討台灣成人的童年不當對待樣態類型，以及上述類型在ICD-11創傷後壓力症狀和CPTSS嚴重度上之差異。
方法：本研究採用橫斷性設計與網路匿名調查，參與者為741位曾經歷童年不當對待的社區成人，平均年齡為35.7歲（SD = 8.98） ，男性佔49.4％。本研究使用結構方程模型檢驗不安全依戀和情緒調節困難的序列中介效果，再以潛在剖面分析對童年不當對待進行分類並比較各類別的症狀嚴重度。
結果：序列中介分析指出，童年不當對待依序經由不安全依戀和情緒調節困難，顯著預測ICD-11 CPTSS嚴重度。潛在剖面分析結果發現，台灣成人的童年不當對待樣態可分為四類，分別是低不當對待（類別一）、中等心理不當對待（類別二）、多重不當對待－低性虐待（類別三）以及多重不當對待－高性虐待（類別四）。類別三和四在ICD-11創傷後壓力症狀和CPTSS嚴重度相當，並顯著高於其他兩類。類別一和二在ICD-11創傷後壓力症狀和CPTSS嚴重度上無顯著差異。在自我組織障礙上，類別二、三以及四之間無顯著差異，但顯著高於類別一。
結論：不安全依戀和情緒調節困難在童年不當對待與ICD-11 CPTSS之關係上扮演重要中介角色。台灣成人的童年不當對待樣態可大致分為四類，其中經歷多重不當對待－無論性虐待高低與否－的創傷心理困難最為嚴重。

Background: Childhood maltreatment is a risk factor for mental and physical health problems and may increase the risk of ICD-11 complex posttraumatic stress disorder. Maltreatment from main caregivers may result in insecure attachment, which then leads to one’s difficulties in emotion regulation while facing threat and stress. Insecure attachment and emotion regulation difficulties might both result in increasing levels of complex post-traumatic stress disorder symptoms (CPTSS). This study investigated the serial mediating effects of insecure attachment and emotion regulation difficulties in the relationship between childhood maltreatment and ICD-11 CPTSS. Moreover, the study investigated classes of childhood maltreatment among Taiwanese adults and the differences in PTSS and CPTSS severity across classes.
Method: A cross-sectional design was used with an online anonymous survey completed by 741 community adults who had experienced childhood maltreatment. Participants averaged 35.7 years of age (SD = 8.98) and was composed of 49.4% men. Structural equation modeling was used to examine the serial mediating effects of insecure attachment and emotional regulation difficulties. Latent profile analysis was applied to classify childhood maltreatment into classes, allowing for comparisons of symptom severity scores across classes.
Results: A serial mediation analysis showed that childhood maltreatment significantly predicted ICD-11 CPTSS sequentially through insecure attachment and emotional regulation difficulties. Latent profile analysis revealed four classes of childhood maltreatment among Taiwanese adults: low maltreatment (Class 1), moderate psychological maltreatment (Class 2),multiple maltreatment－low sexual abuse (Class 3), and multiple maltreatment－high sexual abuse (Class 4). Both Class 3 and 4 exhibited significantly higher PTSS and CPTSS severity than Class 1 and 2, while Class 3 and 4 were comparable in PTSS and CPTSS severity. Class 1 and 2 did not significantly differ in PTSS and CPTSS severity. Regarding DSO severity, Class 2, 3 and 4 showed no significant difference, but all Classes were significantly higher than Class 1.
Conclusion: Insecure attachment and emotional regulation difficulties play crucial mediating roles in the relationship between childhood maltreatment and ICD-11 CPTSS. Taiwanese adults' experiences of childhood maltreatment can be categorized into four distinct classes, with multiple maltreatment－either with high or low sexual abuse－showing most severe traumatic psychological difficulties.

目錄
摘要 i
Abstract iii
第一章　緒論 1
第一節　童年不當對待的現況與身心影響 1
壹、童年不當對待在全球及台灣的現況 1
貳、童年不當對待之身心影響 4
第二節　複雜性創傷與複雜性創傷後壓力症狀 5
壹、複雜性創傷與複雜性創傷後壓力症之現象 5
貳、童年不當對待與複雜性創傷後壓力症狀 8
第三節　依戀型態與情緒調節 8
壹、依戀型態 8
貳、情緒調節與情緒調節困難 10
參、不安全依戀與情緒調節困難之間的關聯 12
第四節　不安全依戀、情緒調節困難及複雜性創傷後壓力症狀 13
第五節　研究目的與假設 15
壹、研究缺口 15
貳、研究目的與假設 16
第二章　研究方法 19
第一節　參與者與研究程序 19
第二節　研究工具 22
壹、人口統計變項 22
貳、童年不當對待 22
參、複雜性創傷後壓力症狀 23
肆、不安全依戀 23
伍、情緒調節困難 24
第三節　統計分析 24
第三章　研究結果 27
第一節 各變項之描述統計與相關 27
壹、童年不當對待之描述統計 27
第二節 童年不當對待、不安全依戀、情緒調節困難及複雜性創傷症狀之結構方程模型 30
壹、測量模型檢驗 30
貳、結構模型檢驗：整體適配度 32
參、個別路徑之參數檢驗：序列中介效果 34
第三節　童年不當對待之潛在剖面分析 37
壹、潛在剖面分析檢驗 37
貳、潛在類別與複雜性創傷症狀嚴重度之檢驗 38
第四節　額外分析：不安全依戀之多重平行中介效果 42
第四章　討論 44
第一節　童年不當對待與複雜性創傷後壓力症狀之關聯 44
第二節　台灣成人的童年不當對待樣態及差異 47
第三節　研究限制與未來方向 50
參考文獻 52

圖目錄
圖1 不安全依戀與情緒調節困難中介童年不當對待與複雜性創傷後壓力症狀之關係：序列多重中介模型 18
圖2 結構模型 33
圖3 不安全依戀與情緒調節困難中介童年不當對待與複雜性創傷後壓力症狀之關係：序列中介模型 35
圖4 潛在類別模型折線圖 40
圖 5 童年不當對待經由不安全依戀預測複雜性創傷後壓力症狀之中介分析 43

表目錄
表1 參與者人口統計學變項 21
表2 童年不當對待之描述統計 28
表3 各研究變項之平均值、標準差及相關矩陣表 29
表4 測量模型之驗證性因素分析 31
表5 序列中介模型之檢驗結果 36
表6 潛在剖面分析之模型適配性比較表 39
表7 各潛在類別之童年不當對待描述分析 39
表8 各潛在類別之變異數分析 41

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