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.     

Mental health effects of adolescent trauma exposure in a female college sample: exploring differential outcomes based on experiences of unique trauma types and dimensions

Most studies on the psychological impact of trauma exposure focus on the response to a single type of trauma, with little or no attention paid to the contribution of prior traumatic experiences. The goal of this study was to disentangle some of the confounding effects of multiple trauma exposures by exploring the unique contribution to mental health outcomes made by specific types and dimensions of trauma. This report compares the psychological outcomes of college women who experienced different types of trauma during adolescence, including traumatic bereavement, sexual assault, and physical assault. Young women who had experienced a single event of one of these types were compared with peers who had experienced multiple single events, ongoing sexual and/or physical abuse, as well as those who had experienced no trauma. Results, based on structured clinical interviews, and self-report measures showed that there were some significant differences in mental health outcomes based on trauma type. However, trauma exposure versus no exposure and the cumulative effects of exposure versus one-time experiences played the key roles in differentiating the groups.     

Comparisons Between Young,Middle-Aged,and Older Adult Sexual and Gender Minority Male Sexual Assault Survivors

ObjectiveThis study compared sexual abuse histories and depressive symptoms between younger, middle-aged, and older sexual and gender minority (SGM) male survivors.DesignParticipants completed a brief, online screener as part of a large comparative effectiveness psychotherapy trial.SettingSGM males 18 years or older, residing in the U.S. or Canada, were recruited online.ParticipantsThis study included younger (aged 18–39; n = 1,435), middle-aged (aged 40–59; n = 546), and older (aged 60+; n = 40) SGM men who reported a history of sexual abuse/assault.MeasurementsParticipants were asked about their sexual abuse history, experience of other traumas, symptoms of depression, and past 60-day mental health treatment engagement.ResultsOlder SGM men reported a lower rate of occurrence of adult sexual assault, exposure to other traumas, and depression. However, older and younger groups did not differ on any childhood sexual assault variable, the frequency of or number of attackers for adult sexual assault, the frequency of accidents and other injury traumas, or the occurrence or frequency of mental health treatment. Trauma load, including childhood and adult sexual assault, were more strongly related to current depressive symptoms than age group.ConclusionWhile there were some age-based or cohort differences in the rates of sexual trauma, the clinical response of both groups was similar. Implications for working clinically with middle-aged and older SGM men with untreated sexual assault-related mental health difficulties are discussed, including outreach and availability of gender- and older-inclusive survivor treatment and resources.     

Mental Hygiene in Industry†

Objective: Approximately 30 million Americans present to acute care medical settings annually after incurring traumatic injuries. Posttraumatic stress disorder (PTSD) and depressive symptoms are endemic among injury survivors. Our article is a replication and extension of a previous report documenting a pattern of multiple traumatic life events across patients admitted to Level I trauma centers for an alcohol-related injury. Method: This study is a secondary analysis of a nationwide 20-site randomized trial of an alcohol brief intervention with 660 traumatically injured inpatients. Pre-injury trauma history was assessed using the National Comorbidity Survey trauma history screen at the six-month time point. Results: Most common traumatic events experienced by our population of alcohol-positive trauma survivors were having had someone close unexpectedly die, followed by having seen someone badly beaten or injured. Of particular note, there is high reported prevalence of rape/sexual assault, and childhood abuse and neglect among physically injured trauma survivors. Additional trauma histories are increasingly common among alcohol-positive patients admitted for a traumatic injury. Conclusions: Due to the high rate of experienced multiple traumatic events among acutely injured inpatients, the trauma history screen could be productively integrated into screening and brief intervention procedures developed for acute care settings.     

Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population

IntroductionConditional risk for PTSD is the risk of developing PTSD after exposure to traumatic events. This epidemiological study of the general urban population from the two largest cities in Brazil reports exposure to traumatic events; conditional risk for PTSD; and proportion/estimated number of PTSD cases secondary to each type of traumatic event.MethodCross-sectional study of general population (15–75 y.o.) from Rio de Janeiro and São Paulo. PTSD was assessed through Composite International Diagnostic Interview 2.1.ResultsOur main findings, from 3744 participants, were: 1) high prevalence of traumatic events (86%), urban violence being the most common; 2) conditional risk for PTSD was 11.1%; 3) women (15.9%) have overall conditional risk 3 times higher than men (5.1%); 4) war-related trauma (67.8%), childhood sexual abuse (49.1%) and adult sexual violence (44.1%) had the highest conditional risks; 5) 35% of PTSD cases (estimated 435,970 individuals) were secondary to sudden/unexpected death of a close person, and 40% secondary to interpersonal violence.ConclusionsBrazilian urban population is highly exposed to urban violence, and overall conditional risk for PTSD was 11.1%. Violence prevention and enhancement of resilience should be part of public policies, and mental health sequelae of trauma should be better recognized and treated.     

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.     

Addressing psychological trauma in dementia sufferers

Research has demonstrated that dementia sufferers may be victims of recent physical assault by family caregivers and other patients and staff in long-term care facilities. Some dementia sufferers have also been victims of violence at other points in their lives from events such as combat, physical and sexual abuse, natural and manmade disasters, and the like. These violent events may result in psychological trauma and the psychological aftermath of these violent incidents may last until death, if it is not treated. The purpose of this paper is to outline some intervention strategies regarding restraints for dementia sufferers who have a history of violence andfor whom little or no treatment has been provided. This paper is not intended to train trauma counseling specialists but to present common intervention strategies that may be fielded by long-term care staff to relieve unnecessary suffering.     

Patients' reports of traumatic or harmful experiences within the psychiatric setting

OBJECTIVE: This study examined the frequency and associated distress of potentially traumatic or harmful experiences occurring within psychiatric settings among persons with severe mental illness who were served by a public-sector mental health system. METHODS: Participants were 142 randomly selected adult psychiatric patients who were recruited through a day hospital program. Participants completed a battery of self-report measures to assess traumatic and harmful events that occurred during the course of their mental health care, lifetime trauma exposure, and symptoms of posttraumatic stress disorder. RESULTS: Data revealed high rates of reported lifetime trauma that occurred within psychiatric settings, including physical assault (31 percent), sexual assault (8 percent), and witnessing traumatic events (63 percent). The reported rates of potentially harmful experiences, such as being around frightening or violent patients (54 percent), were also high. Finally, reported rates of institutional measures of last resort, such as seclusion (59 percent), restraint (34 percent), takedowns (29 percent), and handcuffed transport (65 percent), were also high. Having medications used as a threat or punishment, unwanted sexual advances in a psychiatric setting, inadequate privacy, and sexual assault by a staff member were associated with a history of exposure to sexual assault as an adult. CONCLUSIONS: Findings suggest that traumatic and harmful experiences within psychiatric settings warrant increased attention.     

Impact of trauma on children

Millions of children are affected by physical and sexual abuse, natural and technological disasters, transportation accidents, invasive medical procedures, exposure to community violence, violence in the home, assault, and terrorism. Unfortunately, the emotional impact of exposure to trauma on children is often unappreciated and therefore untreated, and yet the impact of exposures to disaster and violence is profound and long-lasting. This article first briefly discusses the epidemiology of trauma in children, and then reviews the psychiatric and neurodevelopmental impact of trauma on children as well as the effects of trauma on children's emotional development. Trauma in children can lead to the development of posttraumatic stress disorder as well as to a variety of other psychiatric disorders, including depression, generalized anxiety disorder, panic attacks, borderline personality disorder, and substance abuse in adult survivors of trauma. Research has found that early exposure to stress and trauma causes physical effects on neurodevelopment which may lead to changes in the individual's long-term response to stress and vulnerability to psychiatric disorders. Exposure to trauma also affects children's ability to regulate, identify, and express emotions, and may have a negative effect on the individual's core identity and ability to relate to others. The authors also discuss what has been learned, based on recent experiences such as the World Trade Center catastrophe, about the role of television viewing in increasing the effects of traumatic events. The last section of the article provides guidance concerning the identification and clinical treatment of children and adolescents who are having emotional problems as a result of exposure to trauma.     

Relationship of sexual assault history to somatic symptoms and health anxiety in women

Prior reports have pointed to a link between traumatic experiences and health consequences in women. The objective of this study was to determine whether there is an association between sexual assault history and measures of somatic symptoms and illness attitudes in a sample of female Veterans Affairs primary care patients, a group in whom high rates of sexual trauma have been reported. We conducted a cross-sectional study of a representative sample of 219 women in a Veteran's Affairs primary care outpatient clinic. Sexual assault history, somatic symptoms and health anxiety were assessed by self-report questionnaire. Multivariate analyses were used to examine relationships between sexual assault exposure and these outcomes. Ninety-seven women (43.9%) reported experience(s) of sexual assault (i.e., rape, attempted rape or being made to perform any type of sexual act through force or threat of harm). Sexual assault was associated with a significant increase in somatization scores, physical complaints across multiple symptom domains and health anxiety. Sexual assault was also a significant statistical predictor of having multiple sick days in the prior 6 months and of being a high utilizer of primary care visits in the prior 6 months. These data confirm a strong association between sexual trauma exposure and somatic symptoms, illness attitudes and healthcare utilization in women. Causal mechanisms cannot be inferred from these data. Studies in other cohorts are warranted.     

Childhood trauma in borderline personality disorder

Subjects with borderline personality disorder (N = 21) or borderline traits (N = 11) and nonborderline subjects with closely related diagnoses (N = 23) were interviewed in depth regarding experiences of major childhood trauma. Significantly more borderline subjects (81%) gave histories of such trauma, including physical abuse (71%), sexual abuse (68%), and witnessing serious domestic violence (62%); abuse histories were less common in those with borderline traits and least common in the subjects with no borderline diagnosis. These results demonstrate a strong association between a diagnosis of borderline personality disorder and a history of abuse in childhood.     

Moderators and mediators of a maternal depression treatment study: Impact of maternal trauma and parenting on child outcomes

ObjectiveTreatment of maternal depression with psychotherapy has been shown to confer indirect benefits to school-age offspring with psychiatric disorders. The current study sought to understand mechanisms by which improvement in depressed mothers, with and without histories of trauma and treated with psychotherapy, produce changes in children who struggle with psychiatric illnesses themselves. We hypothesized that maternal history of childhood trauma would moderate the relationship between maternal and child outcomes and that increased positive and decreased negative parenting behaviors would mediate the relationship between maternal and child outcomes. We also examined whether maternal history of trauma would moderate the mediational effects of parenting behaviors.MethodsParticipants were dyads (n = 62) of mothers with major depressive disorder and their children, ages 7–18, with at least one internalizing disorder. Mothers were treated with nine sessions of psychotherapy and children were treated openly in the community. Dyads were evaluated every three months over one year.ResultsMaternal improvement in depressive symptoms was associated, in a lagged fashion, with child improvement in functioning six months later. There was a significant interaction of time and change in maternal symptoms [F(1, 45) = 5.84, p = 0.02], where change in maternal depressive symptoms from baseline to six months was robustly associated with change in child functioning from baseline to 12 months (β = 0.49, p = 0.0002). Maternal history of childhood sexual abuse moderated the association between change in maternal and child depressive symptoms [F(1,87) = 5.8, p = 0.02], and maternal history of physical neglect moderated the relationship between improvement in maternal depression and improvement in child functioning [F(1,36) = 4.34, p = 0.04], where significant associations between maternal and child outcomes were only found in mothers without histories of sexual abuse or physical neglect. Increase in positive parenting strategies (acceptance) by mothers mediated 6-month lagged associations between maternal and child outcomes, but reduction in negative parenting strategies (psychological control) did not. Maternal history of childhood emotional neglect moderated the mediational model, such that improved positive parenting did not explain lagged improvement in child depression among the subset of mothers with childhood histories of emotional neglect.ConclusionsIn dyads comprised of depressed mothers and school-age children with internalizing disorders, children improved when mothers improved, but not among those whose mothers who had histories of sexual abuse or physical neglect. Increased use of positive parenting strategies among mothers accounted for lagged relationships between improvement in maternal depressive symptoms and improvement in child functioning. This pattern was not, however, observed among mothers with childhood histories of emotional neglect. Interventions that directly enhance positive parenting and more rapidly change these behaviors may hasten improvement in offspring. Offspring of depressed mothers with histories of early trauma are at high risk for poor outcomes, even when their mothers receive depression treatment.     

Development of posttraumatic stress disorder in adult bipolar patients with histories of severe childhood abuse

Little is known about the nature and extent of posttraumatic stress disorder (PTSD) in adults with bipolar disorder, particularly in relation to the presence of past childhood or adult forms of abuse, and its impact on course of illness. The authors studied 100 consecutive DSM-IV bipolar patients who were evaluated for childhood physical, sexual and emotional abuse, traumatic events in adulthood, and lifetime PTSD. Adult comorbid PTSD was evident in 24% of subjects and was significantly associated with childhood sexual abuse, adult sexual assault, and adult survival of the suicide, homicide, or accidental death of a close friend or relative. Severe childhood abuse was reported by about half of bipolar patients, but only one-third of abused patients developed PTSD. Risk for PTSD rose in linear fashion to the number of childhood abuse subtypes present. Adult sexual assault was significantly more likely to be associated with PTSD if childhood sexual abuse was present rather than absent. The findings suggest that about one-third of bipolar patients with severe childhood abuse histories, particularly sexual abuse, manifest comorbid adult PTSD. Childhood sexual abuse, as well as severe interpersonal loss, may sensitize individuals who are predisposed to bipolar disorder also to develop eventual PTSD.     

Prevalence and characteristics of trauma and posttraumatic stress disorder in female prisoners in China

OBJECTIVE: Posttraumatic stress disorder (PTSD) and its relationship with a range of traumatic events have previously been documented within various traumatized groups in Western countries. In the present study, the authors investigated the relationship between the frequency and type of traumatic events and the prevalence of PTSD among female prisoners in China. METHOD: A structured psychiatric interview, the self-report Traumatic Life Events Questionnaire, and Symptom Checklist-90-Revised were administered to a subset of 471 female members who were randomly selected from Hunan female prison, China. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses were assigned by consensus after the interviews were evaluated by independent raters. RESULTS: The prevalences of lifetime and current PTSD were 15.9% (n = 75) and 10.6% (n = 50), and 82% (n = 386) of the subjects had experienced at least 1 traumatic event. The whole sample was divided into 2 groups according to age: the younger group (age < or =25 years) and the older group (age >25 years) .The most predictive factor for lifetime PTSD among the younger age group was the experience of sudden death of a close friend or a loved one, childhood physical abuse, intimate partner abuse, and sexual abuse before the age of 13 years by someone at least 5 years older. For the older group, the most predictive factors were a history of motor traffic accident, sudden death of a close friend or a loved one, severe assault by acquaintance or stranger, witness to family violence, having experienced more than 5 traumatic events, intimate partner abuse, and sexual abuse before the age of 13 years by someone at least 5 years older. Those females with PTSD tended to demonstrate higher levels of anger/hostility or interpersonal sensitivity than those without either partial or full diagnosis. CONCLUSIONS: In this sample of female prisoners in China, although exposure to traumatic events was common and the rate is nearly as high as that in western countries, the prevalences of lifetime and current PTSD were relatively lower. Moreover, the prevalence of current PTSD among younger prisoners was significantly higher than that among older prisoners. The risk of developing lifetime PTSD was significantly greater only for older prisoners with a history of more than 5 traumatic events, whereas the types of specific traumatic events with the risk of developing lifetime PTSD among younger prisoners were similar to that among older prisoners. Administering specialized treatments for anger dyscontrol and interpersonal sensitivity may be useful for rehabilitation and reform of female prisoners.     

Associations between traumatic events and suicidal behavior in South Africa

Research conducted predominantly in the developed world suggests that there is an association between trauma exposure and suicidal behavior. However, there are limited data available investigating whether specific traumas are uniquely predictive of suicidal behavior or the extent to which traumatic events predict the progression from suicide ideation to plans and attempts. A national survey was conducted with 4351 adult South Africans between 2002 and 2004 as part of the World Health Organization World Mental Health Surveys. Data on trauma exposure and subsequent suicidal behavior were collected. Bivariate and multivariate survival models tested the relationship between the type and number of traumatic events and lifetime suicidal behavior. A range of traumatic events are associated with lifetime suicide ideation and attempt; however, after controlling for all traumatic events in a multivariate model, only sexual violence (odds ratio = 4.7; confidence interval, 2.3 to 9.4) and having witnessed violence (odds ratio = 1.8; confidence interval, 1.1 to 2.9) remained significant predictors of lifetime suicide attempts. The disaggregation of the associations between traumatic events and suicide attempts indicates that they are largely caused by traumatic events predicting suicide ideation rather than by the progression from suicide ideation to attempt. This article highlights the importance of traumatic life events in the occurrence of suicidal thoughts and behaviors and provides important information about the nature of this association. Future research is needed to better understand how and why such experiences increase the risk of suicidal outcomes.     

Posttraumatic stress disorder in hospitalized adolescents: psychiatric comorbidity and clinical correlates

OBJECTIVE: To describe the diagnostic comorbidity and clinical correlates of posttraumatic stress disorder (PTSD) in adolescent psychiatric inpatients. METHOD: Seventy-four adolescent inpatients were given a structured diagnostic interview, the revised version of the Diagnostic Interview for Children and Adolescents, and a battery of standard self-report measures to assess general trauma exposure, posttraumatic stress symptoms, suicidal behavior, dissociation, and depression. RESULTS: Ninety-three percent of subjects reported exposure to at least one traumatic event such as being a witness/victim of community violence, witnessing family violence, or being the victim of physical/sexual abuse. Thirty-two percent of subjects met diagnostic criteria for current PTSD, with sexual abuse cited as the most common traumatic stressor in 69% of PTSD cases. Girls were significantly more likely to develop PTSD than boys, although the total number of types of trauma did not differ by gender. Compared with psychiatric controls, male youngsters with PTSD were significantly more likely to have comorbid diagnoses of eating disorders, other anxiety disorders, and somatization disorder. Furthermore, male and female youngsters with PTSD were significantly more likely to have attempted suicide and report greater depressive and dissociative symptoms. CONCLUSION: In clinical populations of hospitalized adolescents exposed to multiple forms of trauma, PTSD is a common, but highly comorbid disorder. Specific multimodal assessments and treatments targeted to both PTSD and its comorbidity profile are warranted.     

Panic following trauma: the etiology of acute posttraumatic arousal

Two studies examined the contributing factors for panic symptoms following trauma. In Study 1, survivors of sexual and nonsexual assaults (N=105) were assessed at 2 weeks postcrime. Prior trauma, psychiatric history, crime characteristics, and peritraumatic dissociation were assessed. Posttraumatic panic was modestly predicted by childhood sexual abuse (CSA) experiences, a history of Anxiety and Depression, and peritraumatic dissociation. Childhood physical abuse (CPA), Adult Victimization, crime variables, and a prior history of Substance Use disorders and posttraumatic stress disorder (PTSD) were not implicated. In Study 2, the role of peritraumatic panic in predicting later arousal was also examined in a similar sample who were assessed within 6 weeks of their trauma (N=93). Presence of significant arousal during trauma predicted frequency of posttrauma panic attacks, but not its severity. In contrast to Study 1, prior history of PTSD, perception of life threat, and the index trauma being a sexual assault all predicted posttrauma panic, whereas prior trauma exposure and depression did not. These findings are discussed in terms of cognitive and arousal factors that may influence posttrauma panic.     

Prevalence and correlates of dating violence in a national sample of adolescents

ObjectiveDating violence is an important but understudied public health concern in adolescents. This study sought to examine the lifetime prevalence of serious forms of dating violence in 12- to 17- year-olds, risk and protective factors associated with dating violence, and the relation between dating violence and mental health.MethodA nationally representative sample of adolescents (N = 3,614) completed a telephone-based interview that assessed serious forms of dating violence (i.e., sexual assault, physical assault, and/or drug/alcohol-facilitated rape perpetrated by a girlfriend, boyfriend, or other dating partner).ResultsPrevalence of dating violence was 1.6% (2.7% of girls, 0.6% of boys), equating to approximately 400,000 adolescents in the U.S. population. Risk factors included older age, female sex, experience of other potentially traumatic events, and experience of recent life stressors. Findings also suggested that dating violence is associated with posttraumatic stress disorder and major depressive episode after controlling for demographic variables, other traumatic stressors, and stressful events.ConclusionsThese findings indicate that dating violence is a significant public health problem in adolescent populations that should be addressed through early detection, prevention, and intervention. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(7):755–762.     

Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma.

OBJECTIVE: With the exception of a few reports of higher rates of childhood trauma in Vietnam veterans with posttraumatic stress disorder (PTSD), little is known about the influence of previous exposure to trauma on the PTSD effects of subsequent trauma. The authors examine interrelated questions about the effects of previous exposure to trauma. METHOD: A representative sample of 2,181 individuals in southeast Michigan were interviewed by telephone to record lifetime history of traumatic events specified in DSM-IV as potentially leading to PTSD. PTSD was assessed with respect to a randomly selected index trauma from the list of events reported by each respondent. RESULTS: History of any previous exposure to traumatic events was associated with a greater risk of PTSD from the index trauma. Multiple previous events had a stronger effect than a single previous event. The effect of previous assaultive violence persisted over time with little change. When they examined several features of the previous exposure to trauma, the authors found that subjects who experienced multiple events involving assaultive violence in childhood were more likely to experience PTSD from trauma in adulthood. Furthermore, previous events involving assaultive violence--single or multiple, in childhood or later on--were associated with a higher risk of PTSD in adulthood. CONCLUSIONS: Previous exposure to trauma signals a greater risk of PTSD from subsequent trauma. Although these results are consistent with a sensitization hypothesis, like the results from previous research on PTSD, they do not address the mechanism of increased responsivity to trauma. Long-term observational studies can further elucidate these observations.