Attachment representations in Afghan refugees undergoing psychological treatment: a pilot study

Background: Refugees are at elevated risk of trauma-related disorders. Unresolved attachment is a vulnerability factor for post-traumatic stress, yet its role in Afghan refugees remains underexplored. This is the first study to assess attachment representations in this group using a validated narrative-based instrument.Objective: To examine attachment representations and their associations with psychological distress in a clinical sample of Afghan refugees.Method: Forty Afghan refugees (25% female; mean age = 25.4, SD = 7.2) receiving outpatient treatment at a specialised centre for displaced persons in southern Germany completed the Adult Attachment Projective Picture System (AAP). Psychological distress was assessed with the HSCL-25 and PCL-5, and traumatic events with the Essen Trauma Inventory. Interpreter support and cultural adaptations were applied. Attachment classifications were compared with published reference data. Exploratory analyses examined pre-post symptom change.Results: Unresolved attachment was found in 45% of participants - more frequent than in a non-clinical Middle Eastern group (p < .001), but not significantly different from a Western clinical group (p = .295) or an Arabic-speaking PTSD sample (p = .028, ns). Rates were significantly lower compared to a Western PTSD sample (p < .001). Unresolved attachment was not linked to higher baseline symptom severity (Mann-Whitney tests ns). Exploratory Wilcoxon tests showed significant symptom reductions across all attachment groups (all p < .05, large effects).Conclusions: Unresolved attachment is common in Afghan refugees but may not predict symptom burden in chronic trauma contexts. Defensive processes related to CPTSD and cultural norms may shape how unresolved states present in narrative assessments. Findings highlight the need for culturally responsive, attachment-informed care that may inform clinical adaptation in refugee mental health.