The Effect of Developmental Trauma on the Manifestation of Internalizing and Externalizing Problems in Youth: A Mediator-moderator Model

Author : Bogdanovic Aleksandra, Tatjana Stefanovic Stanojevic, Milica Tosic Radev

Abstract : This research was conducted with the aim of empirically examining the effect of early traumatic experiences on the development of mental health problems by analyzing the roles of attachment, mentalization, and dissociation in this relationship. The sample included 121 participants, users of the child protection system for children and young people without adequate parental care, in temporary foster care in Serbia, aged between 11 and 18 years. The Childhood Trauma Questionnaire – CTQ (Bernstein & Fink, 1998), Clinical Version of the Relationship Questionnaire – RQ-CV (Holmes & Lyons Ruth, 2006), Reflective Function Questionnaire – RFQ (Fonagy et al., 2016), Adolescent Dissociative Experiences Scale – A-DES (Armstrong et al., 1997), and the Child Behavior Checklist, CBCL-YSR (Achenbach & Rescorla, 2001) were used. The results confirmed that dissociation has a mediating role in the relationship between trauma and mental health problems: both internalized (b = 1.81, SE = .04, p < .001) and externalized (b = 2.86, SE = .49, p < .000). Further results indicate a significant effect of the interaction between trauma and attachment on internalized and between trauma and mentalization on externalized mental health problems. These findings highlight the attachment security and certainty about mental states as resilience factors, while profound-distrust and uncertainty about mental states are vulnerability factors. These findings demonstrate that dissociative experiences mediate the relationship between trauma and emotional and behavioral difficulties in young people. Furthermore, they suggest that dimensions of attachment and mentalization can moderate the effects of trauma on the emergence of emotional and behavioral difficulties, helping to understand why some young people with early trauma experiences do not develop mental health problems. The practical implications of these results are discussed.

Keywords : Developmental trauma, Dissociation, Attachment, Mentalization, Externalization, Internalization.

Conference Name : International Conference on Child and Adolescent Psychiatry and Psychology (ICCAPP - 26)

Conference Place : Istanbul, Turkey

Conference Date : 3rd Apr 2026