Beyond Clinical Outcomes: Posttraumatic Stress Symptoms Favor Attentional and Memory Control Abilities for Trauma-Related Words

Memory alterations and biases are core features of posttraumatic stress symptoms (PTSS). Although a large number of studies have investigated memory biases associated with PTSS, some inconsistencies remain regarding the nature of the mechanisms behind the threat-related biases observed in prior findings. The present study explored the extent to which inhibitory deficits, both for automatic and controlled processes, can account for these biases. Participants (N = 64) took part in a remember/know recognition procedure for positive, neutral, negative, and trauma-related words associated with negative priming and directed forgetting encoding. Half of the participants had high levels of PTSS (i.e., PCL-5 score > 40) and half had low levels (i.e., total PCL-5 score < 20). As both negative priming and directed forgetting effects are posited to depend on inhibitory abilities, we expected these effects to be absent for trauma-related words in participants with more severe PTSS. Replicating classic memory biases, participants with high levels of PTSS produced more “remember” recognition responses for trauma-related words, η_p² = .10. However, contrary to our expectations, directed forgetting, η_p² = .26; and negative priming effects were observed for trauma-related words but not for words of other valences, η_p² = .07 and .06, respectively. Hence, rather than the expected inhibitory deficits, our results suggest that PTSS preserve the ability to inhibit trauma-related information in both attentional and memory processes. As it appears to occur at the expense of other information, this preserved cognitive functioning for trauma-related stimuli is discussed with regard to resource reallocation theories.     

Sexual Assault,Posttraumatic Stress Symptoms,and Indices of Aggression Among Women

Sexual assault is associated with many adverse outcomes, including a higher risk for developing posttraumatic stress symptoms (PTSS). Although nonsexual trauma exposure has been linked to aggression, the associations between sexual assault and aggression are understudied. Further, the DSM-5 conceptualization of posttraumatic stress disorder (PTSD) includes a symptom related to aggression, and associations between symptom clusters and aggression with regard to the new criteria are underexplored. The present study aimed to (a) examine the relations between sexual assault and indices of aggression (i.e., physical/verbal aggression, anger, and hostility) after accounting for PTSS and (b) investigate PTSD symptom clusters in relation to aggression among 263 women (M_age = 29.03 years, SD = 11.71; 67.6% white). Path analysis revealed that sexual assault was unrelated to indices of aggression, βs = .003–.08; however, PTSS was consistently linked with increased aggression, βs = .22–.49. Results indicated specificity in the associations between the symptom clusters and aspects of aggression. Negative alterations in cognitions and mood corresponded with increased physical aggression, β = .28, and hostility, β = .38, and avoidance was related to verbal aggression, β = .19. Hyperarousal was also tied to higher levels of anger, hostility, and verbal aggression, βs = .21–.33. Nonetheless, lower levels of intrusion symptoms were associated with increased anger and hostility, β = -.26. With regard to understanding women's risk for aggression, PTSS may be more relevant than sexual assault. Further, there may be specificity related to the type of PTSD symptoms and aspects of aggression.     

Secondary Traumatization and Differentiation Among the Wives of Former POWs: A Reciprocal Association

Repercussions of war captivity may transmit to spouses of former prisoners of war (POW) via posttraumatic stress symptoms (PTSS). Overidentification with their partners underlies the PTSS experienced by former wives of POWs, thus implying impaired self‐differentiation. Although wives’ indirect exposure to their husbands' captivity and subsequent PTSS has been associated with the wives' PTSS and differentiation, the combined effects remain unclear. Furthermore, previous cross‐sectional studies could not illuminate directionality. This prospective study investigates (a) the moderating role of indirect exposure to captivity in the association between husbands’ PTSS and wives’ PTSS and differentiation; and (b) the directionality of the association between wives' differentiation and PTSS over time. The wives of both former POWs (n = 143) and combatants (n = 102) were assessed 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. The wives of former POWs endorsed higher PTSS and fusion differentiation, η²_p = .06 to .14. Indirect exposure to captivity moderated the associations between husbands' PTSS and wives' PTSS, Cohen's f ² = .01 to .03. The association between the wives' differentiation and PTSS over time was bidirectional, β = −0.18 to 0.68; R ² = .54 to .73. Results suggest a vicious cycle between PTSS and differentiation, and the need for clinical interventions that further differentiation for spouses of prolonged trauma victims.     

Social Support,Coping, and Posttraumatic Stress Symptoms in Female Sexual Assault Survivors: A Longitudinal Analysis

Social support and coping affect each other after stressful life events, including sexual assault (Taylor & Stanton, 2007). The present study examined the associations among assault‐specific support, maladaptive coping, and posttraumatic stress symptoms (PTSS) over 3 years in a sample of female sexual assault survivors from a large metropolitan area (N = 1,863). A 3‐wave cross‐lagged panel model revealed significant weak‐to‐moderate reciprocal associations between maladaptive coping and PTSS (βs = .09 to .21), significant weak reciprocal associations between turning against social reactions and PTSS (βs = .07 to .10), and inconsistent weak reciprocal associations between maladaptive coping and unsupportive acknowledgment reactions (βs = .06 to .14). We conclude with implications regarding treatment and intervention for survivors and their support networks.     

Gender Differences in Threat Biases: Trauma Type Matters in Posttraumatic Stress Disorder

Women are diagnosed with posttraumatic stress disorder (PTSD) at twice the rate of men. This gender difference may be related to differences in PTSD experiences (e.g., more hypervigilance in women) or types of trauma experienced (e.g., interpersonal trauma). We examined whether attentional threat biases were associated with gender, PTSD diagnosis, and/or trauma type. Participants were 70 civilians and veterans (38 women, 32 men; 41 with PTSD, 29 without PTSD) assessed with the Clinician Administered PTSD Scale for DSM‐IV who completed a facial dot‐probe attention bias task and self‐report measures of psychiatric symptoms and trauma history. Factorial ANOVA and regression models examined associations between gender, PTSD diagnosis, index trauma type, lifetime traumatic experiences, and attentional threat biases. Results revealed that compared to women without PTSD and men both with and without PTSD, women with PTSD demonstrated attentional biases toward threatening facial expressions, d = 1.19, particularly fearful expressions, d = 0.74. Psychiatric symptoms or early/lifetime trauma did not account for these attentional biases. Biases were related to interpersonal assault index traumas, η_p² = .13, especially sexual assault, d = 1.19. Trauma type may be an important factor in the development of attentional threat biases, which theoretically interfere with trauma recovery. Women may be more likely to demonstrate attentional threat biases due to higher likelihood of interpersonal trauma victimization rather than due to gender‐specific psychobiological pathways. Future research is necessary to clarify if sexual assault alone or in combination with gender puts individuals at higher risk of developing PTSD.     

Dangerous Safe Havens: Institutional Betrayal Exacerbates Sexual Trauma

Research has documented the profound negative impact of betrayal within experiences of interpersonal trauma such as sexual assault (Freyd, 1994, 1996; Freyd, DePrince, & Gleaves, 2007). In the current study of college women (N = 345, 79% Caucasian; mean age = 19.69 years, SD = 2.55), we examined whether institutional failure to prevent sexual assault or respond supportively when it occurs may similarly exacerbate posttraumatic symptomatology—what we call “institutional betrayal.” Almost half (47%) of the women reported at least one coercive sexual experience and another 21% reported no coercion, but at least one unwanted sexual experience (total reporting unwanted sexual experiences, N = 233). Institutional betrayal (e.g., creating an environment where these experiences seemed more likely, making it difficult to report these experiences) was reported across different unwanted sexual experiences (47% and 45% of women reporting coercion and no coercion, respectively). Those women who reported institutional betrayal surrounding their unwanted sexual experience reported increased levels of anxiety (R² = .10), trauma‐specific sexual symptoms (R² = .17), dissociation (R² = .11), and problematic sexual functioning (R² = .12). These results suggest that institutions have the power to cause additional harm to assault survivors.     

Resilience in Men and Women Experiencing Sexual Assault or Traumatic Stress: Validation and Replication of the Scale of Protective Factors

The literature on sexual assault (SA) typically has been generalized to women and children. However, both men and women experience SA. Research shows that not all individuals experience the negative impacts of SA in the same way. The ability to buffer the negative effects of SA may lie in specific protective factors that determine resilience. Resilience scales used in adult populations have not been validated for use in SA samples. The purpose of the present study was to replicate the factor structure of a resilience scale, the Scale of Protective Factors (SPF), in a sample of emerging adults (n = 571) and to validate the replicated model on a subsample of the participants who reported SA (n = 173). Additionally, we sought to examine gender differences in mental health outcomes including depression and anxiety, and the availability of protective factors that determine resilience among those participants who reported experiencing SA (n = 173) as compared to other forms of traumatic stress (n = 132). The SPF achieved good model fit in the larger emerging adult sample and adequate model fit was achieved in the SA subsample. Results indicated significant gender differences in mental health outcomes with η² ranging between .03 and .21. Implications and future directions are discussed.     

Sexual Dysfunction in Postmenopausal Women with Breast Cancer on Adjuvant Aromatase Inhibitor Therapy

IntroductionThe aim of this study was to investigate whether postmenopausal women with breast cancer (BC) on adjuvant aromatase inhibitor (AI) therapy have a higher prevalence of female sexual dysfunction (FSD). Second, the aim was to determine the quality of life (QoL) and level of anxiety depending on whether or not they are AI users.MethodsA prospective cross-sectional study involving 168 patients was performed. Three questionnaires were carried out: sexual functioning was evaluated with the Female Sexual Function Index (FSFI), while the EORTC QLQ-BR23 measures to study QoL in patients with BC and the State-Trait Anxiety Inventory (STAI) questionnaire (trait and status) were used to assess anxiety status in patients under treatment with AIs or not.Results47.6% (80/168) of the postmenopausal BC survivors were not sexually active (mean time after surgery: 48.6 months) despite a relatively low mean age (56.43 years). Postmenopausal AI-treated women had significantly worse sexual function as measured by the FSFI (23.40 ± 5.26 vs. 30.16 ± 2.24; p = 0.000). There were significant differences between both groups in all domains, except orgasm. The QoL score was 37.67 ± 7.38 in AI users versus 39.00 ± 1.44 among nonusers (p = 0.053). Patients under endocrine treatment also presented STAI scores significantly higher (25.83 ± 4.99 vs. 19.00 ± 7.12; p = 0.000). Trait anxiety was high in both groups, but this was not statistically significant.ConclusionsWe observed a high prevalence of sexual inactivity among BC survivors regardless of AI use. Patients with AI use presented significantly higher prevalence of FSD, worse QoL, and greater anxiety.     

Encouraging Legal Help Seeking for Victims of Intimate Partner Violence: The Therapeutic Effects of the Civil Protection Order

Civil protective orders (CPOs) are the most widely used justice system remedy for intimate partner violence (IPV), and were implemented to ensure safety and increase victim participation in the justice system. Limited data exists regarding the effectiveness of CPOs; however, theories of therapeutic jurisprudence argue that legal interventions in and of themselves can improve mental health outcomes. To test this hypothesis, we examined the effectiveness of having a CPO issued against one's abuser at improving the psychological sequelae of exposure to trauma. We used a longitudinal sample of female residents of battered women's shelters who had experienced IPV (N = 106; 55% African American). One‐way analyses of variance using gain scores indicated that PTSD symptoms (effect size η_p² = .16) and incidents of sexual revictimization (effect size η_p² = .09) decreased from baseline to 6‐months postshelter for women who had a CPO against their most recent abuser compared to women without a CPO. These results support theories of therapeutic jurisprudence, suggesting that having a CPO can improve mental health outcomes. Limitations and clinical implications of our findings are discussed, including arguing for a coordinated service system that incorporates both legal and psychological assistance to improve the mental health of victims of IPV.     

Sexual Trauma and Combat During Deployment: Associations With Suicidal Ideation Among OEF/OIF/OND Veterans

Compelling evidence has emerged on the association between military sexual trauma and suicide attempt; however, research investigating how sexual trauma during deployment relates to suicidal ideation has received considerably less attention and has yielded mixed findings. Furthermore, such research has not accounted for other types of trauma that may occur during deployment. Our objectives were to examine whether sexual trauma during deployment was associated with recent suicidal ideation, adjusting for exposure to combat. Our sample included 199 Operation Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) veterans entering inpatient trauma‐focused treatment who completed the Beck Scale for Suicide Ideation (Beck & Steer, 1991) and the Deployment Risk and Resilience Inventory Sexual Harassment and Combat Experiences Scales (King, King, Vogt, Knight, & Samper, 2006). Deployment‐related sexual trauma was significantly associated with recent suicidal ideation, adjusting for age and gender (β = .18, η_p² = .03) and additionally for combat (β = .17, η_p² = .02). These findings underscore the importance of assessing for deployment‐related sexual trauma when assessing suicide risk in OEF/OIF/OND veterans in inpatient settings.     

Multiple Deployments and Combat Trauma: Do Homefront Stressors Increase the Risk for Posttraumatic Stress Symptoms?

Multiple deployments are common among military personnel who served in Operation Enduring Freedom and Operation Iraqi Freedom and are associated with greater posttraumatic stress symptoms (PTSS). Homefront stressors (i.e., family, occupational problems) resulting from deployments may increase the risk of PTSS. Moreover, with multiple deployments, a new deployment may occur while still experiencing homefront stressors from previous tours. This prospective study assessed whether homefront stressors from a previous tour increased the risk of PTSS after a new deployment. It also examined the effects of homefront stressors at postdeployment. Survey data were obtained from U.S. National Guard soldiers with previous deployments prior to (Wave 1) and after (Wave 2) a new deployment to Iraq (N = 196). Homefront stressors reported at Wave 1 (β = .154, p = .015) and Wave 2 (β = .214, p = .002) were both significantly predictive of PTSS at postdeployment, even after adjusting for warzone stressors, predeployment PTSS, and other variables. A pattern of chronic homefront stressors (i.e., homefront stressors at pre‐ and postdeployment) was associated with higher levels of PTSS at postdeployment (β = .220, p = .002). Service members with multiple deployments are at greater risk for PTSS if deployed with homefront stressors from previous tours and/or face these stressors at postdeployment.     

Validating a Virtual Environment for Sexual Assault Victims

Virtual reality has shown promising results in the treatment of posttraumatic stress disorder (PTSD) for some traumatic experiences, but sexual assault has been understudied. One important question to address is the relevance and safety of a virtual environment (VE) allowing patients to be progressively exposed to a sexual assault scenario. The aim of this study was to validate such a VE. Thirty women (victims and nonvictims of sexual assault) were randomly assigned in a counter‐balanced order to 2 immersions in a virtual bar: a control scenario where the encounter with the aggressor does not lead to sexual assault and an experimental scenario where the participant is assaulted. Immersions were conducted in a fully immersive 6‐wall system. Questionnaires were administered and psychophysiological measures were recorded. No adverse events were reported during or after the immersions. Repeated‐measures analyses of covariance revealed a significant time effect and significantly more anxiety (Cohen's f = 0.41, large effect size) and negative affect (Cohen's f = 0.35, medium effect size) in the experimental scenario than in the control condition. Given the safety of the scenario and its potential to induce emotions, it can be further tested to document its usefulness with sexual assault victims who suffer from PTSD.     

The Effects of Posttraumatic Stress and Trauma-Focused Disclosure on Experimental Pain Sensitivity Among Trauma-Exposed Women

Previous studies evaluating the impact of trauma history and posttraumatic stress disorder (PTSD) on pain sensitivity have yielded inconsistent findings. The presence of trauma-related negative affective states may account for these discrepancies. The current study aimed to evaluate the effect of PTSD and trauma-related negative affect on sensory, affective, physiological, and neuroendocrine responses to an experimental pain task. Trauma-exposed adult women (N = 87) with or without probable PTSD underwent an emotional disclosure paradigm during which they wrote about a traumatic event or a neutral topic. Participants then completed a pain induction procedure. Sensory and affective reports of pain, as well as physiological and neuroendocrine reactivity, were assessed. Compared to women without PTSD, those with PTSD demonstrated decreased sensory pain responses, η_p² = .11, including increased time to pain detection (i.e., threshold) and ability to withstand the pain stimuli (i.e., tolerance) after accounting for relevant covariates. Women with PTSD also demonstrated increased cortisol reactivity following the pain stimulus, η_p² = .06. The main and interactive effects of PTSD group and writing condition did not significantly predict alterations in affective reports of pain or heart rate reactivity. The results suggest that PTSD symptoms may contribute to alterations in pain sensitivity in trauma-exposed women, but this association is complex and requires further exploration.     

Use of sexual intercourse to reduce negative affect as a prospective mediator of sexual revictimization

Increased risk of adult sexual assault (ASA) among women who experienced child sexual abuse (CSA) is well established. The strategies these women use to reduce negative affect secondary to CSA, such as sexual contact, may mediate the link between CSA and later ASA. Two waves of data from a racially diverse sample (i.e., 46% Black, 46.1% White, 7.9% other) of community women (N = 776) were analyzed using structural equation modeling. A history of CSA was associated with a twofold increase in the likelihood of experiencing ASA between the two measurement occasions (approximately 6 years). Psychological distress (i.e., depression, anxiety) and use of sex to reduce negative affect partially mediated the relation between CSA and prospective ASA. Implications for the treatment of CSA and prevention of sexual assault are discussed.     

Posttraumatic Stress Disorder and Childhood Traumatic Loss: A Secondary Analysis of Symptom Severity and Treatment Outcome

Loss is a commonly experienced traumatic event among children. Although the experience of loss can potentially lead to posttraumatic stress symptoms (PTSS), little is known about PTSS levels after traumatic loss versus other traumatic events. We investigated data from a randomized controlled trial (RCT) on trauma-focused cognitive behavioral therapy (TF–CBT) versus a waitlist condition for children with PTSS. In a secondary analysis, we compared participants who reported traumatic loss as their index event (n = 23) to those who reported the two most frequently reported index events in the RCT: sexual abuse (SA; n = 59) and physical violence (PV; n = 55). The index event was rated according to the participants’ most distressing traumatic event reported on the Clinician-Administered PTSD Scale for Children and Adolescents. Participants who experienced traumatic loss reported fewer PTSS and better general functioning than those who reported SA. A subgroup RCT (n = 19) revealed TF–CBT to be highly effective in reducing PTSS in cases of traumatic loss, d = 1.69. The effect sizes for PTSS indicated that all three trauma groups benefited from TF–CBT. In the waitlist group, PTSS symptoms improved for SA and PV, ds = 0.76 and 0.98, respectively, but not for traumatic loss, d = 0.23. These findings suggest that TF–CBT is a feasible and promising treatment for children who experience PTSS after traumatic loss. The results are limited by the post hoc quality of the analyses and lack of a measure of grief in the RCT.     

Emotional adjustment in survivors of sexual assault living with HIV-AIDS

This study examined history of sexual assault in 357 men and women living with HIV-AIDS. Participants completed measures of demographic characteristics, sexual assault history, emotional distress and psychiatric symptoms, substance use, and sexual behaviors. Results showed that 68% of women and 35% of men living with HIV-AIDS reported a history of sexual assault since age 15. History of sexual assault was related to history of substance use and mental health treatment. Sexual assault survivors reported greater anxiety, depression, and symptoms of borderline personality and were significantly more likely to report recent unprotected intercourse than persons who had not been sexually assaulted. Results suggest tailoring secondary prevention interventions to meet the needs of HIV-positive survivors of sexual assault.     

Bariatric Surgery is Associated with Reduced Depressive Symptoms and Better Sexual Function in Obese Female Patients: A One-Year Follow-Up Study

Bariatric surgery is an effective treatment for obesity; few studies, however, have investigated its impact on patients’ sexuality. We aimed to determine bariatric surgery’s effect on female patients’ body mass index (BMI), anxiety and depressive symptoms, and sexual function and delineate predictors of treatment outcomes. Fifty-nine obese female bariatric candidates were administered the Hospital Anxiety and Depression Scale and the Female Sexual Function Index 1 week before surgery (T1) and 1 year after (T2). Statistical analysis revealed significant reductions in BMI (p < 0.001), depression (p < 0.001), and sexual pain levels (p = 0.014) and significant improvements in sexual desire (p = 0.005), arousal (p = 0.001), lubrication (p = 0.003), satisfaction (p = 0.012), and total sexual function (p = 0.003) postoperatively. Postoperative total sexual function was independently predicted by baseline sexual function and low baseline BMI. Bariatric surgery is an effective way to reduce weight, manage depression, and improve sexual function in female obese patients.     

Investigating the Association Between Parental Absence and Developmental Trauma Disorder Symptoms

The importance of parent‐child relationships in social and emotional development is well established. The current study examined the vulnerability to developmental trauma disorder (DTD) symptoms for children who were left behind by their parents due to migration. Using samples from China, we investigated the change pattern of DTD symptoms with respect to scales for affect–physical dysregulation, self‐dysregulation, and behavioral dysregulation among left‐behind children in comparison to their peers. The results of a hierarchical linear model analysis indicated that there were no statistically significant differences in affect‐physical dysregulation, self‐dysregulation, or behavioral dysregulation between left‐behind children and their counterparts at age 13, η_p² = .00–.013. However, DTD symptoms worsened over time for left‐behind children, with a larger mean score difference in DTD symptoms at 18 years of age, η_p² = .24–.43. The results suggest a possible link between impaired caregiving systems and DTD symptoms. Early prevention efforts would benefit these children before they develop more serious psychosocial problems in the future.     

Parent and Child Trauma Symptoms During Child–Parent Psychotherapy: A Prospective Cohort Study of Dyadic Change

Five randomized controlled trials have shown that child–parent psychotherapy (CPP) improves trauma symptoms in children. Less is known about parent symptoms or moderators of symptom change. In a sample of 199 parent (81% biological mother; 54% Latina/o) and child (aged 2 to 6 years; 52% male; 49% Latina/o) dyads who participated in an open treatment study of CPP, this study investigated whether parent and child symptoms similarly decreased during treatment and whether improvement was moderated by parent, child, and treatment characteristics. Parents completed baseline and posttreatment interviews regarding exposure to traumatic events, posttraumatic stress symptomatology (PTSS), and other mental health indices. Latent difference score analysis showed that PTSS significantly decreased by more than 0.5 SD for parents and children. The PTSS improvement in parents was associated with reductions in child avoidance, r = .19, p = .040, and hyperarousal, r = .33, p < .001. Girls showed a greater reduction than boys in reexperiencing, β = −.13, p = .018, and hyperarousal, β = −.20, p = .001. Contrary to expectations, parent and child improvement in PTSS was greater for those with fewer parental lifetime stressors, β_range = .15 to .33, and for those who participated in fewer treatment sessions, β_range = .15 to .21. The extent of improvement in parent PTSS varied based on clinician expertise, β = −.20, p = .009. Significant reductions in parent and child PTSS were observed during community-based treatment, with CPP and symptom improvement varying according to child, parent, and treatment characteristics.     

Trajectories of mental health symptoms predict long-term quality of life among Wenchuan adolescent survivors: A 10-year follow-up study

Purpose: Previous studies usually examine the associations between psychological distresses and quality of life (QOL) with a variable-centred approach, while little is known about the effect of the individual variance in time-varying changes of psychological distresses on QOL. Therefore, this study aimed to examine whether individual variance in psychological distresses during the early phases postearthquake would develop different QOL’s levels among adolescent survivors 10-year after the Wenchuan earthquake. Methods: Data were extracted from the Wenchuan Earthquake Adolescent Health Cohort Study. The current study included 744 adolescent survivors who effectively completed surveys at 6 months, 24 months, and 10 years after the earthquake. Self-report questionnaires were administered to collect information on socio-demographic characteristics, earthquake exposure, life events, anxiety symptoms, depressive symptoms, posttraumatic stress symptoms (PTSS), and QOL. Data were analysed using hierarchical multiple regression. Results: Trajectories of psychological distresses were classified as follow: resistance (anxiety 40.73%; depression 54.70%; PTSS 74.46%), recovery (anxiety 17.20%; depression 9.27%; PTSS 10.35%), delayed dysfunction (anxiety 10.35%; depression 18.15%; PTSS 6.18%), and chronicity (anxiety 31.72%; depression 17.88%; PTSS 9.01%). After controlling covariates, hierarchical multiple regression only revealed that the anxiety trajectory with delayed dysfunction remained significantly predictive for four domains of QOL (physical health, psychological health, social relationships, and environment). Conclusion: The current study highlights the importance of focusing on the variations in trajectories of anxiety symptoms among disaster survivors and providing individualized mental health services to improve survivors'' QOL.