Gender as Potential Moderator of Associations Among Trauma Exposure,Posttraumatic Stress Disorder Symptoms,and Alcohol Use Disorder Symptoms in Young Adults

Traumatic events (TEs), posttraumatic stress disorder (PTSD) symptoms, and alcohol use disorder (AUD) symptoms can significantly impair functioning, yet little is known about whether associations among these variables differ between men and women within young adult samples. The current study conducted a path analysis of archival, longitudinal data from the Drug Use Trajectories: Ethnic/Racial Comparisons 1998–2002 (DUT) study (Turner, 2011) to examine gender differences as a possible moderator of the relations between TEs, PTSD symptoms, and AUD symptoms among 1,076 young adults (aged 18–23 years) residing in South Florida. The sample included 580 male (53.9%) and 496 female (46.1%) participants, whose ethnicity was self‐reported as African American (n = 280, 26.0%), non‐Hispanic White (n = 268, 24.9%), other Hispanic (n = 267, 24.8%), and Cuban (n = 261, 24.3%). Significant positive associations were found between TEs and PTSD symptoms, βs = .08–.30; PTSD and AUD symptoms, βs = .09 – .10; PTSD symptoms over time, β = .52; and AUD symptoms over time, β = .46. In addition, for male but not female participants, a higher frequency of PTSD symptoms at Wave I was related to more AUD symptoms at Wave II, β = .09. Findings build upon existing research to further elucidate the role of gender as a potential moderator of the associations among TEs, PTSD symptoms, and AUD symptoms for young adults and provide important implications for future research and clinical practice, including informing mental health prevention and treatment efforts.     

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.     

Alcohol‐involved assault and the course of PTSD in female crime victims

Although alcohol use has been associated with increased risk of victimization, little is known about how victim substance use at the time of assault may affect posttraumatic stress disorder (PTSD) symptom development. The present study is a longitudinal examination of substance use on PTSD symptom severity and course. A community sample of female crime victims (n = 60) were assessed within 5 weeks of sexual or physical assault with 3 and 6 month postassault follow‐ups. Twenty‐three participants had consumed alcohol or alcohol/drugs prior to the assault (38%) and 37 had consumed neither alcohol nor drugs. Analyses were conducted using hierarchical linear modeling. Participants who had consumed alcohol had lower initial intrusive symptoms, but their symptoms improved less over time.     

Early adult sexual assault and disordered eating: the mediating role of posttraumatic stress symptoms

Although adult sexual assault has been suggested to be a risk factor for disordered eating, little is known about the pathways leading to this disorder. This study aimed to examine the mediating effect of depressive symptoms and symptoms of posttraumatic stress disorder (PTSD), in the relationship between sexual assault and disordered eating among female students. A sample of 296 French female students completed a questionnaire assessing experiences of sexual assault from age 15, PTSD symptoms, depressive symptoms, and disordered eating. Results revealed that PTSD symptoms fully mediated the effect of early adult sexual assault on disordered eating (B = 1.10, SE = 1.64), and depressive symptoms were a partial mediator of this relationship (B = 2.64, SE = 1.28). When examining both mediators simultaneously the relationship was fully mediated and neither variable emerged as a significantly stronger mediator. Our findings highlight the complex relationship between PTSD symptoms, depressive symptoms, and disordered eating following sexual assault. Further investigation into the temporal relationships between these variables would contribute to inform prevention interventions for disordered eating.     

Exposure to interpersonal violence and risk for PTSD, depression, delinquency, and binge drinking among adolescents: data from the NSA-R

Interpersonal violence (IPV) is associated with a range of subsequent negative outcomes; however, research has yet to test whether IPV operates as a specific risk factor for separate psychopathology outcomes, such as posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, delinquent acts, or binge drinking. To address this, cumulative exposure to IPV and non-IPV-related traumatic events, PTSD symptoms, depressive symptoms, delinquent acts, and binge drinking were measured 3 times over approximately 3 years among a nationally representative sample of adolescents aged 12-17 (N = 3,614 at Wave 1). Results demonstrated that cumulative IPV exposure predicted subsequent PTSD, depression, delinquency, and binge drinking (βs = .07, .12, .10, and .09, respectively; all ps < .01) when all cross-relationships (e.g., the effect of delinquency on future binge drinking) were in the model. Exposure to non-IPV traumatic events generally did not confer vulnerability to subsequent psychopathology outcomes. Overall, findings from this study advance the literature in this area by exploring consequences for adolescents following cumulative IPV exposure.     

Polytraumatization,Mental Health,and Delinquency Among Adolescent Gang Members

Adolescent gang members are at high risk for polytraumatization (i.e., experiencing two or more types of trauma), which may contribute to behavioral problems, such as delinquency or drug distribution, and mental health symptoms, such as posttraumatic stress disorder (PTSD) and depression. The present study examined the associations between polytraumatization and these behavioral and mental health outcomes. We hypothesized that increased polytraumatization would lead to increased (b) mental health symptoms, (b) delinquency, and (c) drug distribution. Participants included 441 adolescent gang members (57.8% male; age range: 14–19 years) from a midsized city in the Midwestern United States. A path model was used to test hypotheses. A total of 88.0% of participants experienced polytraumatization, such as physical and sexual assault, involvement in accidents, or witnessing a death or injury. Polytraumatization was uniquely and positively associated with depressive and PTSD symptoms, delinquency, and drug distribution, βs = .25–.50, ps < .001, explaining an additional 5.9%–22.5% of the variance in these outcomes beyond covariates. Untreated traumatic exposure among adolescent gang members may subsequently lead to poor behavioral and mental health outcomes. These results may inform prevention and intervention efforts focused on mental health and social justice among a high‐risk adolescent population.     

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.     

Psychosocial correlates of PTSD symptom severity in sexual assault survivors

This study's goal was to assess the effects of preassault, assault, and postassault psychosocial factors on current posttraumatic stress disorder (PTSD) symptoms of sexual assault survivors. An ethnically diverse sample of over 600 female sexual assault survivors was recruited from college, community, and mental health agency sources (response rate = 90%). Regression analyses tested the hypothesis that postassault psychosocial variables, including survivors' responses to rape and social reactions from support providers, would be stronger correlates of PTSD symptom severity than preassault or assault characteristics. As expected, few demographic or assault characteristics predicted symptoms, whereas trauma histories, perceived life threat during the assault, postassault characterological self-blame, avoidance coping, and negative social reactions from others were all related to greater PTSD symptom severity. The only protective factor was survivors' perception that they had greater control over their recovery process in the present, which predicted fewer symptoms. Recommendations for intervention and treatment with sexual assault survivors are discussed.     

PTSD Symptomatology and Hazardous Drinking as Risk Factors for Sexual Assault Revictimization: Examination in European American and African American Women

A sexual victimization history is a risk factor for experiencing further sexual victimization. Posttraumatic stress disorder (PTSD) symptoms have been posited as predictors of revictimization through multiple pathways, including through their association with risk recognition and alcohol use. There is, however, limited longitudinal research examining these revictimization risk factors, including the extent to which they predict risk for forcible rape (rape involving threat or force) and incapacitated rape (rape of a victim incapacitated by substances). Additionally, there is no research evaluating ethnic differences in revictimization risk pathways. The current study examined PTSD symptoms and hazardous drinking as predictors of new forcible and incapacitated rape over 1 year in a community sample of European American (n = 217) and African American (n = 272) sexual assault victims (M = 34 years; 84% high school education or above). We hypothesized that PTSD symptoms would predict both types of revictimization and hazardous drinking would predict incapacitated rape. Results supported that PTSD symptoms predicted both types of rape (forcible rape, β = .34; incapacitated rape, β = .20), and hazardous drinking predicted incapacitated rape (β = .24). PTSD symptoms predicted hazardous drinking in African American women only (β = .20). Thus, there is a need to evaluate risk pathways for specific types of victimization among diverse samples.     

Changes in coping strategies, relationship to the perpetrator, and posttraumatic distress in female crime victims

This study examined the relationship between changes in coping and posttraumatic stress disorder (PTSD) symptomatology among recent female rape and physical assault victims as a function of assault type and perpetrator status. Participants were assessed within 1 month after trauma and again at 3 months after trauma. Results indicate that changes in coping strategies over time are associated with the severity of the PTSD symptoms. Assault type was not a significant factor in the association between changes in coping and PTSD, but perpetrator status was. Victims with known perpetrators, who coped more by social withdrawal, had more severe PTSD symptoms over time. The importance of examining the dynamic nature of coping in the development of PTSD is discussed.     

PTSD and alcohol use after the World Trade Center attacks: a longitudinal study

Research suggests that posttraumatic stress disorder (PTSD) is associated with increased alcohol use, but the findings have not been consistent. We assessed alcohol use, binge drinking, and psychotropic medication use longitudinally in 1,681 New York City adults, representative of the 2000 census, 2 years after the World Trade Center attacks. We found that, with the exception of a modified CAGE Questionnaire index for alcohol, alcohol use showed a modest increase over time and was related to PTSD symptoms, with an increase of about 1 more drink per month for those with PTSD, even though overall levels appeared to be within the National Institute on Alcohol Abuse and Alcoholism's safe range. Psychotropic medication use followed a similar trend; those with PTSD used psychotropics about 20 more days over the past year than those without. Because the study analyses adjusted for key psychosocial variables and confounders, it is not clear if the increased alcohol use following trauma exposure is associated with self-medication of PTSD symptoms, whether increased alcohol use prior to exposure is a risk for delayed-onset PTSD, or whether a third unmeasured variable is involved. Further research is warranted.     

An evaluation of three brief programs for facilitating recovery after assault

Ninety female recent assault survivors who met symptom criteria for posttraumatic stress disorder (PTSD) were randomized to one of three interventions: Brief Cognitive Behavioral Intervention, which focused on processing the traumatic event (B-CBT); assessment condition (AC); or supportive counseling (SC). Within 4 weeks of an assault, participants met weekly with a therapist for four 2-hr sessions. Across all interventions, participants reported decreases in PTSD symptoms, depression, and anxiety over time. At postintervention, participants in B-CBT reported greater decreases in self-reported PTSD severity and a trend toward lower anxiety than those in SC. At 3-month follow-up, participants in B-CBT evidenced lower general anxiety than those in SC and a trend toward lower self-reported PTSD severity. At last available follow-up (on average, 9-months postassault), all three interventions were generally similar in outcome. These findings suggest that a trauma-focused intervention aimed at those with severe PTSD symptoms after an assault can accelerate recovery.     

Assault, psychiatric diagnoses, and sociodemographic variables in relation to help-seeking behavior in a national sample of women

Using a national probability household sample of 4,008 women, we estimated the prevalence and correlates of formal and informal help seeking. One-year prevalences of formal help seeking (e.g., seeking help from professional) and informal help seeking (e.g., seeking help from a relative or friend) were 10.6 and 6.6%, respectively. In the final multivariable model, increased likelihood of informal help seeking was associated with younger age, history of sexual assault, and past-year diagnoses of posttraumatic stress disorder (PTSD) and major depressive episode (MDE). Similarly, increased likelihood of formal help seeking was associated with younger age, Caucasian racial/ethnic status, history of sexual assault, history of physical assault, and past-year diagnoses of PTSD and MDE. Implications for helping professionals and public education programs are discussed.     

Efficacy of Imagery Rehearsal Therapy and Cognitive Behavioral Therapy in Sexual Assault Victims With Posttraumatic Stress Disorder: A Randomized Controlled Trial

Sleep disturbances are common among sexual assault victims with posttraumatic stress disorder (PTSD), but cognitive behavioral therapy (CBT) for PTSD does not directly address sleep‐related symptoms. Trauma‐related sleep disturbances are associated with more impairment and contribute to the maintenance of PTSD. In this study, we evaluated the efficacy of a combination of CBT and nightmare therapy (imagery rehearsal therapy; IRT) compared to CBT alone for the treatment of PTSD. We recruited 42 adult victims of sexual assault who were suffering from PTSD and randomly assigned them to either the experimental (IRT + CBT) or control condition (waiting period followed by CBT). After CBT, both groups demonstrated significant decreases in nighttime symptoms (except nightmare frequency) and PTSD symptoms and showed improvements in functional impairment and mental health, ds = 0.13–0.83, ps = .005–.008. Outcomes between the two groups did not differ significantly after CBT; however, we observed medium to medium‐large differences between the control group and experimental group in terms of nighttime symptoms, ds = 0.45–0.63. Although results did not clearly establish the superiority of IRT + CBT over CBT alone, they demonstrated that IRT yielded greater improvement in nighttime symptoms than the waiting period, ds = 0.72–1.13, ps = .006–.047 for all interaction effects. Findings suggest that targeting nightmares at the beginning of treatment for PTSD may yield rapid improvement in nighttime symptoms. This strategy could be useful for patients with time or resource constraints or those for whom nightmares are the primary complaint.     

Blackout Drinking Predicts Sexual Revictimization in a College Sample of Binge‐Drinking Women

Sexual victimization is prevalent on U.S. college campuses. Some women experience multiple sexual victimizations with heightened risk among those with prior victimization histories. One risk factor for sexual revictimization is alcohol use. Most research has focused on associations between alcohol consumption and revictimization. The current study's objective was to understand potential mechanisms by which drinking confers risk for revictimization. We hypothesized that specific drinking consequences would predict risk for revictimization above and beyond the quantity of alcohol consumed. There were 162 binge‐drinking female students (mean age = 20.21 years, 71.3% White, 36.9% juniors) from the University of Washington who were assessed for baseline victimization (categorized as childhood vs. adolescent victimization), quantity of alcohol consumed, and drinking consequences experienced, then assessed 30 days later for revictimization. There were 40 (24.6%) women who were revictimized in the following 30 days. Results showed that blackout drinking at baseline predicted incapacitated sexual revictimization among women previously victimized as adolescents, after accounting for quantity of alcohol consumed (OR = 1.79, 95% CI [1.07, 3.01]). Other drinking consequences were not strongly predictive of revictimization. Adolescent sexual victimization was an important predictor of sexual revictimization in college women; blackout drinking may confer unique risk for revictimization.     

Adults with Comorbid Posttraumatic Stress Disorder,Alcohol Use Disorder,and Opioid Use Disorder: The Effectiveness of Modified Prolonged Exposure

Opioid use disorders (OUDs) are a growing problem in the United States. When OUDs co‐occur with problematic drinking and posttraumatic stress disorder (PTSD), negative drug‐related mental and physical health outcomes may be exacerbated. Thus, it is important to establish whether PTSD treatments with established efficacy for dually diagnosed individuals also demonstrate efficacy in individuals who engage in problematic drinking and concurrent opioid misuse. Adults who met DSM‐IV‐TR criteria for PTSD and alcohol dependence were recruited from a substance use treatment facility and were randomly assigned to receive either modified prolonged exposure (mPE) therapy for PTSD or a non‐trauma‐focused comparison treatment. Compared to adults in a non‐OUD comparison group (n = 74), adults with OUD (n = 52) were younger, reported more cravings for alcohol, were more likely to use amphetamines and sedatives, were hospitalized more frequently for drug‐ and alcohol‐related problems, and suffered from more severe PTSD symptomatology, depressive symptoms, and anxiety, standardized mean differences = 0.36–1.81. For participants with OUD, mPE was associated with large reductions in PTSD symptomatology, sleep disturbances, and symptoms of anxiety and depression, ds = 1.08–2.56. Moreover, participants with OUD reported decreases in alcohol cravings that were significantly greater than those reported by the non‐OUD comparison group, F(1, 71.42) = 6.37, p = .014. Overall, our findings support the efficacy of mPE for PTSD among individuals who engage in problematic drinking and concurrent opioid misuse, despite severe baseline symptoms.     

An Evaluation of Stress Symptoms Associated with Academic Sexual Harassment

It is clear that sexual assault can precipitate posttraumatic stress disorder. Some theorists have suggested that less severe sexually harassing behaviors may also have trauma-like sequelae. In a study evaluating this hypothesis, 69 female participants completed self-report measures of instances of sexual harassment, basic beliefs, psychological distress/symptoms, and PTSD symptoms. Participants watched videotapes depicting sexual harassment, emotional arousal (not sexual in nature), and a neutral interaction while their heart rate was monitored, and they were interviewed using the SCID for PTSD. Results revealed that those who had been sexually harassed reported more negative basic beliefs, more general distress, and more negative state mood after watching the sexual harassment video, relative to those who had not been harassed. The severity of sexual harassing behaviors experienced was positively correlated with PTSD symptoms. Heart rate reactivity to the videotapes did not differ across groups defined by sexual harassment status.     

Emotion Dysregulation Prospectively Predicts Posttraumatic Stress Disorder Symptom Severity 3 Months After Trauma Exposure

Despite growing evidence in support of emotion dysregulation as a risk factor for the development of posttraumatic stress disorder (PTSD) following trauma exposure, few studies have examined temporal relations between emotion dysregulation and the onset and/or worsening of PTSD symptoms over time. The aim of the present study was to extend research on temporal associations between emotion dysregulation and PTSD in a sample of individuals recruited from hospital emergency departments soon after a traumatic event. Adult participants (N = 85; 62.4% female) completed self-report measures of emotion dysregulation and PTSD symptoms within 2 weeks of experiencing a traumatic event. Symptoms of PTSD were assessed approximately 3 months posttrauma. The results of a hierarchical linear regression analysis demonstrated that the inclusion of emotion dysregulation accounted for a significant amount of unique variance, β = .23, ΔR² = .04, p = .042, in 3-month PTSD symptom severity over and above other risk factors and baseline PTSD symptoms. No specific facet of emotion dysregulation emerged as a significant predictor of 3-month PTSD symptoms when all facets were included on the same step of the model, βs = −.04–.33, ps = .133–.954. These results demonstrate that posttraumatic emotion dysregulation may predict PTSD symptoms 3 months after trauma exposure. These findings are consistent with a growing body of literature that speaks to the relevance of emotional processes to the onset and maintenance of PTSD following exposure to a traumatic event.     

Posttraumatic Stress Disorder,Functional Impairment,and Subjective Distress in World Trade Center Disaster Workers

Posttraumatic stress disorder (PTSD) is associated with functional deficits, poor physical health, and diminished quality of life. Limited research has examined PTSD symptom clusters and their associations with functioning and distress among disaster recovery workers, a population at high risk for PTSD due to potential for repeated trauma. The purpose of this study was to investigate associations between overall PTSD severity, as well as PTSD symptom clusters, and social and occupational functioning and subjective distress in World Trade Center (WTC) disaster workers after the terrorist attacks on September 11, 2001 (9/11). Disaster workers deployed to the site of the attacks completed assessments at three time points over approximately 5 years post‐9/11. Our sample consisted of participants who met criteria for PTSD or subthreshold PTSD at baseline (n = 514), 1‐year (n = 289), and 2‐year follow‐up (n = 179). Adjusted linear regression indicated that Clinician Administered PTSD Scale (CAPS)‐rated PTSD severity was positively associated with subjective distress, and deficits in social and occupational functioning, over time, CAPS Criterion F items; βs = .20 to .62, ps < .001. The reexperiencing and avoidance/numbing symptom clusters were associated with increased subjective distress, the avoidance/numbing and hyperarousal clusters were associated with deficits in social functioning, and the reexperiencing and hyperarousal clusters were associated with worse occupational functioning. These associations were consistent across the study period. Findings point to the importance of targeting PTSD symptom clusters associated with specific areas of functional impairment, with the goal of improving global outcomes.     

Associations among psychosis,mood, anxiety,and posttraumatic stress symptoms: A network analysis

The associations among psychotic experiences (i.e., hallucinations and delusions), trauma exposure, and posttraumatic stress symptoms are complex and multidirectional. Using network analysis to understand how psychotic experiences and symptoms of posttraumatic stress disorder (PTSD) relate to one another may identify new interventional targets to treat comorbidity and its underlying pathological processes. This study aimed to use network analysis to examine the associations among psychotic experiences; negative symptoms of psychosis; and symptoms of PTSD, anxiety, and depression. In this population-based cohort study, 4,472 participants (36.7% male) were assessed for psychotic experiences, negative symptoms of psychosis, PTSD, anxiety, and depression at age 23 (M = 23.86 years, SD = 0.520) or 24 years (M = 24.03, SD = 0.848). Associations among symptoms were assessed via network analysis. Exploratory graph analysis identified three clusters of densely connected symptoms within the overall network: psychotic experiences; PTSD symptoms; and depressive and anxiety symptoms and negative symptoms of psychosis. Psychotic experiences had the strongest associations with other symptoms in the network, and symptoms of anxiety played a key role in bridging psychotic experiences, symptoms of PTSD, and depressive symptoms. Consistent with the stress reactivity and affective models for psychotic experiences, the results suggest that symptoms of anxiety and emotional distress (e.g., hyperarousal, panic) may have a key role in the development and maintenance of psychotic experiences and symptoms of PTSD. Targeting these symptoms may ameliorate symptom burden transdiagnostically.