Associations among symptoms of depression and posttraumatic stress disorder and self-reported health in sexually assaulted women

Symptoms of depression and posttraumatic stress disorder (PTSD) were examined for their association with health status in a sample of sexual assault victims. Hypotheses were that symptoms of each disorder would account for unique variance in health status among individuals exposed to traumatic stressors. Fifty-seven sexually assaulted college women were assessed for prior victimization history, assault characteristics, and depressive and PTSD symptoms. When prior history of sexual victimization, assault severity, and physical reactions during the assault were controlled, hierarchical multiple regression models indicated that symptoms of PTSD and depression were significantly associated with global health perceptions and severity of self-reported health symptoms. Only PTSD symptoms were significantly associated with reproductive health symptoms. The results suggest that both symptoms of PTSD and depression account for the relationship between exposure and health impairment among sexual assault victims.     

Posttraumatic stress disorder and social support in female victims of sexual assault: the impact of spousal involvement on the efficacy of cognitive-behavioral therapy

The goal of this study is to enhance the efficacy of CBT with victims of sexual assault suffering from PTSD by getting the spouse involved. Thus, in addition to attempting to reduce PTSD symptoms, the therapy focuses on improving the support offered by the spouse and favors management of the impact of the traumatic event within the couple. A single-case, multiple-baseline across-subjects design is used. Three victims of sexual assault with a diagnosis of PTSD participated in the study. Results at posttreatment and at 3-month follow-up are promising. None of the participants presents a diagnosis of PTSD, and all report a significant improvement in their satisfaction with the support received from their spouses.     

Relationship between symptom over-reporting and pre- and post-combat trauma history in veterans evaluated for PTSD

We examined the prevalence of pre- and post-combat traumatic events in the histories of 129 combat veterans referred to be evaluated for PTSD and examined the impact of these non-combat traumatic events on self-reported psychiatric symptoms. Participants were consecutive referrals to a Veterans Affairs outpatient post-traumatic stress disorder (PTSD) clinic who completed structured interviews, self-report measures (e.g., Minnesota Multiphasic Personality Inventory-2; MMPI-2), and a trauma history questionnaire as part of their routine clinical evaluations. Findings show that non-combat trauma was prevalent in this sample, with 65% (21% pre-combat) reporting physical assaults and 12% (11% pre-combat) reporting sexual assaults. Overall, history of sexual or physical assaults did not appear to be systematically related to reported symptom level. However, chi square analyses revealed a consistent over-representation of veterans who reported sexual trauma in the category suggestive of response exaggeration (i.e., MMPI-2 F-K validity index > or = 13). Finally, a hierarchical regression equation predicting F-K scores was computed, but accounted for only 15.9% of the variance in F-K. Presence of sexual assault history was the only predictor associated with a more pronounced response set suggestive of exaggeration or deception. These findings tentatively indicate that if history of sexual or physical assault has an impact on symptom reporting in combat veterans evaluated for PTSD, it is of modest magnitude.     

Anxiety sensitivity and breath-holding duration in relation to PTSD symptom severity among trauma exposed adults

The present investigation examined the main and interactive effects of anxiety sensitivity and behavioral distress tolerance, indexed using the breath-holding task, in relation to PTSD symptom severity among trauma-exposed adults. Participants were 88 adults (63.6% women; M(age)=22.9, SD=9.1, range=18-62), recruited from the community, who met DSM-IV-TR PTSD Criterion A for lifetime trauma exposure. Covariates included number of potentially traumatic events, nonclinical panic attack history, and participant sex. Anxiety sensitivity was significantly incrementally associated with PTSD total symptom severity, as well as Avoidance and Hyperarousal symptom severity (p's<.01). Breath-holding duration was not significantly related to PTSD symptom severity (p's>.05). However, breath-holding duration emerged as a significant moderator of the association between anxiety sensitivity and PTSD Avoidance symptom severity, such that lower breath-holding duration exacerbated the effect of heightened anxiety sensitivity with regard to PTSD Avoidance symptom severity.     

Psychopathology of sexual abuse in young people with intellectual disability

The present study addressed two issues using a sample of child and adolescent victims and perpetrators of sexual abuse: (1) the extent of post‐traumatic stress disorder (PTSD) in the sample; and (2) the possible distinction between perpetrators whose motivations were sexually impulsive, and those who were controlling and abuse‐reactive. Retrospective case material from 43 cases (21 victims only, and 22 perpetrators, of whom 16 were also victims) provided the data. Post‐traumatic symptomatology was not common. Only one case of PTSD was found. Perpetrators could be distinguished by whether they had suffered sexual abuse alone, sexual and physical abuse, or neither. The proposed distinction between perpetrators received support. Sexual abuse directed at younger victims was associated with earlier experience of multiple forms of abuse. The present data does not support the view that post‐traumatic symptoms following victimization are a mediator of sexual abuse perpetration. It is argued that an elaboration of the Williams & New developmental model of perpetration better fits the data.     

Posttraumatic stress disorder symptom severity predicts aggression after treatment

This study examined the relation between posttraumatic stress disorder (PTSD) severity and aggression (verbal, psychological, and physical aggression) in a longitudinal dataset. Participants were 175 males in PTSD residential treatment who were assessed at pre-treatment, post-treatment, and at 4-month follow-up. Post-treatment PTSD severity predicted aggression at post-treatment and 4-month follow-up, adjusting for age, pre-treatment PTSD severity, and pre-treatment aggression. When examining the relation between aggression and specific PTSD symptom clusters, post-treatment Reexperiencing, Avoidance/Numbing and Hyperarousal symptoms predicted aggression at posttreatment and 4-month follow-up. These results support the hypothesis that post-treatment PTSD severity may be an important marker of post-treatment aggression risk and may offer unique information important to clinicians and patients focused on the development and maintenance of adaptive, non-aggressive relationships after intensive PTSD treatment.     

PTSD in victims of sexual assault: test of a major component of the Ehlers-Clark theory

We investigated a major component of the Ehlers-Clark theory of post-traumatic stress disorder (PTSD) in a sample of 50 female victims of sexual assault. In particular, we tested the hypothesis that the victims' appraisals of the trauma and its consequences contribute significantly to the persistence of PTSD symptoms. The results indicated that the victims' appraisals of the sexual assault and its sequelae are strongly and positively related to PTSD symptoms. This finding remained significant after statistically controlling for the perceived severity of the assault. Most of the results are consistent with the Ehlers-Clark theory.     

Peritraumatic dissociation, acute stress, and early posttraumatic stress disorder in victims of general crime.

OBJECTIVE: To compare the relation between peritraumatic dissociation and acute stress and the early development of posttraumatic stress disorder (PTSD) in victims of general crime. METHOD: A total of 48 subjects were assessed within 24 hours of the trauma, using the Peritraumatic Dissociative Experiences Questionnaire Self-Report Version (PDEQ-SRV). They were followed longitudinally to assess acute stress (2 weeks after the assault,) using the Standford Acute Stress Reaction Questionnaire (SASRQ), and posttraumatic stress (at 5 weeks), using the Clinician-Administered PTSD Scale (CAPS) and the Impact of Event Scale (IES). RESULTS: Among PTSD subjects mean PDEQ scores were significantly higher (mean 3, SD 0.9) than in those without PTSD (mean 2.3, SD 0.7) (t = 2.78, df 46, P = 0.007). Among PTSD subjects, mean SASRQ scores were significantly higher (mean 97.9, SD 29.2) than in those without PTSD (mean 54.8, SD 28.2) (t = 4.9, df 46, P = 0.00007). CONCLUSIONS: High levels of peritraumatic dissociation and acute stress following violent assault are risk factors for early PTSD. Identifying acute reexperiencing can help the clinician identify subjects at highest risk.     

The predictive power of peritraumatic dissociation and acute stress symptoms for posttraumatic stress symptoms: a three-month prospective study

OBJECTIVE: The authors prospectively examined the power of peritraumatic dissociation and acute stress symptoms in predicting posttraumatic stress disorder (PTSD) symptoms. METHOD: Thirty-five assault victims were assessed with the Peritraumatic Dissociative Experiences Questionnaire within 24 hours of the assault. Participants were reassessed 2 weeks after the trauma with the Stanford Acute Stress Reaction Questionnaire and 3 months after the trauma with the Clinician-Administered PTSD Scale and the Impact of Event Scale. Correlational analyses and a hierarchical multiple regression were conducted. RESULTS: Peritraumatic dissociation and acute stress symptoms were correlated with later PTSD symptoms and diagnosis. Together, peritraumatic dissociation and acute stress symptoms accounted for 33% of the variance in PTSD symptoms. CONCLUSIONS: These results support earlier findings that peritraumatic dissociative experiences and acute stress are robust predictors of PTSD. Such symptoms may be of use for identifying at an early stage individuals at highest risk of remaining symptomatic. Future studies should investigate the predictive power of specific peritraumatic and acute stress disorder symptom clusters.     

Attributional style and anxiety sensitivity as maintenance factors of posttraumatic stress symptoms: A prospective examination of a diathesis–stress model

Diathesis–stress models of posttraumatic stress disorder (PTSD) assert that traumatic events function as stressors that interact with vulnerabilities to influence the development of PTSD. The present study prospectively examined negative attributional style (NAS) and anxiety sensitivity (AS) as maintenance factors for PTSD in female adult sexual assault victims. A diathesis–stress model was tested by examining interactions between the vulnerabilities and negative life events. The present study included both the traditional three-factor model of PTSD (re-experiencing, avoidance and emotional numbing, and arousal) and the dysphoria four-factor model of PTSD (re-experiencing, avoidance, arousal, and dysphoria). Robust regression analyses revealed that negative life events at Time 2 significantly predicted increases in all clusters of the three-factor model (i.e., re-experiencing, avoidance and numbing, and arousal) and the re-experiencing, arousal, and dysphoria clusters of the four-factor model (but not avoidance). Neither NAS nor AS significantly independently predicted any of the symptom clusters for either model. Both NAS and AS interacted with negative life events to predict increases in the avoidance and numbing symptoms. However, examination of the dysphoria four-factor model of PTSD revealed that the NAS and AS interactions with negative life events only predicted dysphoria symptoms.     

Genetic and environmental influences on trauma exposure and posttraumatic stress disorder symptoms: a twin study

OBJECTIVE: Posttraumatic stress disorder (PTSD) develops in only a subset of persons exposed to traumatic stress, suggesting the existence of stressor and individual differences that influence risk. In this study the authors examined the heritability of trauma exposure and PTSD symptoms in male and female twin pairs of nonveteran volunteers. METHOD: Scores on a traumatic events inventory and a DSM-IV PTSD symptom inventory were examined in 222 monozygotic and 184 dizygotic twin pairs. Biometrical model fitting was conducted by using standard statistical methods. RESULTS: Additive genetic, common environmental, and unique environmental effects best explained the variance in exposure to assaultive trauma (e.g., robbery, sexual assault), whereas exposure to nonassaultive trauma (e.g., motor vehicle accident, natural disaster) was best explained by common and unique environmental influences. PTSD symptoms were moderately heritable, and the remaining variance was accounted for by unique environmental experiences. Correlations between genetic effects on assaultive trauma exposure and on PTSD symptoms were high. CONCLUSIONS: Genetic factors can influence the risk of exposure to some forms of trauma, perhaps through individual differences in personality that influence environmental choices. Consistent with symptoms in combat veterans, PTSD symptoms after noncombat trauma are also moderately heritable. Moreover, many of the same genes that influence exposure to assaultive trauma appear to influence susceptibility to PTSD symptoms in their wake.     

Symptoms of posttraumatic stress disorder in adolescents with conduct disorder: sex differences and onset patterns.

OBJECTIVE: To examine sex differences in the rate and symptoms of posttraumatic stress disorder (PTSD), trauma exposure, and onset patterns in youth with conduct disorder (CD). METHOD: Youth admitted to a clinical facility for severe behaviour problems completed the Diagnostic Interview for Children and Adolescents--Revised (DICA-R) to assess the presence of CD and PTSD. RESULTS: Over one-half of CD youth reported exposure to trauma, yet only 17% met criteria for PTSD. PTSD was more frequent in CD girls (28%) than in boys (10%), and girls experienced greater symptom intensity and anhedonia, difficulty feeling love or affection, and disturbance of sleep and concentration. Girls more frequently reported sexual assault, while boys were more likely to report accidents, physical assaults, and witnessing the death of a loved one. Retrospective reports indicated that PTSD tended to develop subsequent to CD. CONCLUSIONS: Exposure to trauma is common among CD youth; however, diagnostic procedures should be adapted for increased sensitivity to PTSD. The development of CD may increase the risk for PTSD, particularly in girls, by exposing youth to situations in which they are traumatized. The role of trauma in CD should be routinely examined by clinicians and warrants further research.     

Associations between Pittsburgh Sleep Quality Index factors and health outcomes in women with posttraumatic stress disorder

ObjectiveThe Pittsburgh Sleep Quality Index (PSQI) is a widely used measure of subjective sleep disturbance in clinical populations, including individuals with posttraumatic stress disorder (PTSD). Although the severity of sleep disturbance is generally represented by a global symptom score, recent factor analytic studies suggest that the PSQI is better characterized by a two- or three-factor model than a one-factor model. This study examined the replicability of two- and three-factor models of the PSQI, as well as the relationship between PSQI factors and health outcomes, in a female sample with PTSD.MethodsThe PSQI was administered to 319 women with PTSD related to sexual or physical assault. Confirmatory factor analyses tested the relative fit of one-, two-, and three-factor solutions. Bivariate correlations were performed to examine the shared variance between PSQI sleep factors and measures of PTSD, depression, anger, and physical symptoms.ResultsConfirmatory factor analyses supported a three-factor model with Sleep Efficiency, Perceived Sleep Quality, and Daily Disturbances as separate indices of sleep quality. The severity of symptoms represented by the PSQI factors was positively associated with the severity of PTSD, depression, and physical symptoms. However, these health outcomes correlated as much or more with the global PSQI score as with PSQI factor scores.ConclusionsThese results support the multidimensional structure of the PSQI. Despite this, the global PSQI score has as much or more explanatory power as individual PSQI factors in predicting health outcomes.     

Positive emotion dysregulation and posttraumatic stress disorder symptoms: Investigating the role of anxiety sensitivity

ObjectivePosttraumatic stress disorder (PTSD) symptoms are prevalent and deleterious among individuals who have experienced a sexual assault. Although an emerging field of research has established a link between positive emotion dysregulation and PTSD symptoms, there is a limited understanding of mechanisms underlying this relation. Individuals who have experienced a sexual assault may begin to fear any arousal-related sensations via stimulus generalization, including that associated with positive emotions, which, in turn, may amplify PTSD symptoms. Thus, the current study examined the role of anxiety sensitivity in the association between positive emotion dysregulation and PTSD symptoms.MethodsA sample of 500 community members reporting a history of sexual assault (M_age = 34.54, 54.4% male, 79.0% white) completed measures of positive emotion dysregulation, anxiety sensitivity, and PTSD symptoms.ResultsFindings detected a significant indirect effect of anxiety sensitivity in the relation between positive emotion dysregulation and PTSD symptoms (β = 0.28, SE = 0.03, 95% CI [0.22, 0.34]). Supplementary analyses revealed that effects held for subscales of anxiety sensitivity (i.e., cognitive, physical, social concerns) and PTSD symptom clusters (i.e., intrusions, avoidance, negative alternations in cognitions and mood, alternations in arousal and reactivity).ConclusionsThis study offers preliminary empirical support for the assertion that fear of arousal-related sensations associated with positive emotions may partially explain the link between positive emotion dysregulation and PTSD symptoms among those who have experienced a sexual assault. Information from this study could advance future research and treatment.     

Post-trauma symptoms following indirect exposure to the September 11th terrorist attacks: The predictive role of dispositional coping

Few data prospectively address the role of coping in the development of PTSD. In the present study, 308 undergraduates were assessed for coping prior to the 9/11 WTC attack and for PTSD symptomatology at one and three-months post-9/11. Multiple regression analyses indicated that emotion-focused coping was predictive of increased symptomatology at Month 1 and Month 3, whereas problem-focused and avoidance-focused coping were not. Specifically, analyses predicting PTSD symptom factors (Intrusions, Avoidance, Dysphoria, and Hyperarousal) indicated that greater emotion-focused coping predicted increased Dysphoria symptoms at both time points and, among females, increased levels of Hyperarousal symptoms at Month 1. The role of coping style in the development of PTSD symptomatology and its clinical implications are discussed.     

Risk factors and outcome in ambulatory assault victims presenting to the acute emergency department setting: implications for secondary prevention studies in PTSD

Prevention of post-traumatic stress disorder (PTSD) in trauma victims is an important public health goal. Planning for the studies required to validate prevention strategies requires identification of subjects at high risk and recruitment of unbiased samples that represent the larger high-risk population (difficult because of the avoidance of many trauma victims). This study recruited high-risk victims of interpersonal violence (sexual or physical assault) presenting to an urban emergency department for prospective 1- and 3-month follow-up. Of 546 victims who were approached about participating, only 56 agreed to be contacted and only 46 participated in either the 1- or 3-month interviews. Of the 46, 43 had been previously victimized with a mean of over six traumas in the group; 21% had prior PTSD, 85% had prior psychiatric illness, and 37% had prior substance abuse. Sixty-seven percent had positive urine for alcohol or drugs on presentation. Fifty-six percent developed PTSD at 1 or 3 months with the rate declining between 1 and 3 months. There was high use of medical and psychiatric services. These findings document both the difficulty of recruiting large samples of high-risk assault victims to participate in research, and the high rate of prior traumatization, PTSD, substance use, and psychiatric morbidity in these subjects which, if still active at the time of victimization, may complicate efforts to document preventive treatment effects.     

Post-traumatic Stress Disorder in Older U.S. Military Veterans: Prevalence,Characteristics, and Psychiatric and Functional Burden

ObjectiveTo characterize the prevalence, characteristics, and comorbidities of subthreshold and full post-traumatic stress disorder (PTSD) in older U.S. military veterans.Design and SettingA nationally representative web-based survey of older U.S. military veterans who participated in the National Health and Resilience in Veterans Study (NHRVS) between November 18, 2019 and March 8, 2020.ParticipantsU.S. veterans aged 60 and older (n = 3,001; mean age = 73.2, SD: 7.9, range: 60–99).MeasurementsPTSD was assessed using the PTSD Checklist for DSM-5. Self-report measures assessed sociodemographic characteristics, trauma exposures, suicidal behaviors, psychiatric and substance use disorders, as well as mental, cognitive, and physical functioning. Multivariable analyses examined correlates of subthreshold and full PTSD.ResultsThe vast majority of the sample (n = 2,821; 92.7%) reported exposure to one or more potentially traumatic events. Of those exposed to such events, 262 (9.6%, 95% confidence interval [CI]: 8.4%–10.9%) and 68 (1.9%, 95% CI: 1.3%–2.6%) screened positive for subthreshold and full PTSD, respectively. The prevalence of subthreshold and full PTSD was significantly higher in female veterans and veterans who use VA as their primary healthcare. Subthreshold and full PTSD groups endorsed more adverse childhood experiences and total traumas than the no/minimal PTSD symptom group, the most common traumatic experiences endorsed were combat exposure, physical or sexual assault, and life-threatening illness or injury. Veterans with subthreshold and full PTSD were also more likely to screen positive for depression, substance use disorders, suicide attempts, nonsuicidal self-injury, and suicidal ideation, and reported lower mental, cognitive, and physical functioning.ConclusionSubthreshold PTSD and full PTSD are prevalent and associated with substantial clinical burden in older U.S. veterans. Results underscore the importance of assessing both subthreshold and full PTSD in this population.     

The aftermath of rape. Profiles of immediate and delayed treatment seekers

Seventy-eight sexual assault victims who sought treatment within 1 month of their assaults were compared with 40 victims who delayed seeking treatment. Demographic, rape situation, and psychiatric history characteristics were examined as were postrape symptom profiles and responses to treatment. More of the delayed treatment seekers were raped by a "friend," and fewer used physical means to defend themselves against the assailant. With respect to symptomatology, delayed treatment seekers reported considerable rape-related distress and were more anxious and significantly more fearful than were recent rape victims. Implications for clinical practice and for the tailoring of services for victims of sexual assault are suggested.     

Correlates of community violence exposure in hospitalized adolescents.

To examine psychological and behavioral correlates of community violence exposure in psychiatrically hospitalized adolescents, 89 inpatients were administered a battery of psychometrically well-established self-report instruments. Violence exposure was assessed using the Child's Exposure to Violence Checklist (CEVC). Half of the patients reported exposure to multiple incidents violence in their community (52%) and home (53%). Sixty-one percent were victims of physical assault, and 39% were victims of sexual assault. Patients who had witnessed community violence reported significantly more post-traumatic stress disorder (PTSD) symptoms, drug use, and violence potential than patients without a history of witnessing community violence. Patients exposed to community violence were also more likely to be the victim of childhood maltreatment, as well as a perpetrator of violence. In conclusion, traumatization via exposure to community violence may serve as one important determinant in the development of mixed internalizing and externalizing psychopathology in adolescent inpatients, thus necessitating accurate assessment and treatment planning.     

Effects of adolescent trauma exposure on risky behavior in college women

Individuals with sexual assault or abuse histories are likely to engage in risky sexual and other self-destructive behaviors. Studies of these behaviors, however, have focused on target traumatic events without accounting for other events in the participant's history, recency of the events, and/or developmental level at time of occurrence. The present study addressed some of these confounds by creating groups with unique and non-overlapping trauma histories among adolescent participants whose first trauma occurred at age 12 or older. Sophomore women from six regional campuses were screened in a two-stage procedure, and 209 of 363 final interviewees were included in the present report. These were assigned to a no trauma group, or to one of five groups with a unique trauma history: a single traumatic loss, a single physical assault, a single sexual assault, ongoing sexual or physical abuse, or multiple single traumas. Risky sexual behavior, suicidal ideation, and elevated perpetration of violence were most prominent among those with ongoing abuse exposure, although a single exposure to interpersonal violence during adolescence was sufficient for some risky behaviors. Major depression (MDD) and posttraumatic stress disorder (PTSD) were associated with many of the behaviors, and may serve to heighten risk.