Public Mental Health Clients with Severe Mental Illness and Probable Posttraumatic Stress Disorder: Trauma Exposure and Correlates of Symptom Severity

Individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure and for the development of posttraumatic stress disorder (PTSD). This study reports findings from a large, comprehensive screening of trauma and PTSD symptoms among public mental health clients in a statewide community mental health system. In 851 individuals with SMI and probable PTSD, childhood sexual abuse was the most commonly endorsed index trauma, followed closely by the sudden death of a loved one. Participants had typically experienced an average of 7 types of traumatic events in their lifetime. The number of types of traumatic events experienced and Hispanic ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relation to events that occurred on average 20 years earlier, suggesting the clinical need to address trauma and loss throughout the lifespan, including their prolonged after‐effects.     

ICD‐11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the United States: A Population‐Based Study

The primary aim of this study was to provide an assessment of the current prevalence rates of International Classification of Diseases (11th rev.) posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) among the adult population of the United States and to identify characteristics and correlates associated with each disorder. A total of 7.2% of the sample met criteria for either PTSD or CPTSD, and the prevalence rates were 3.4% for PTSD and 3.8% for CPTSD. Women were more likely than men to meet criteria for both PTSD and CPTSD. Cumulative adulthood trauma was associated with both PTSD and CPTSD; however, cumulative childhood trauma was more strongly associated with CPTSD than PTSD. Among traumatic stressors occurring in childhood, sexual and physical abuse by caregivers were identified as events associated with risk for CPTSD, whereas sexual assault by noncaregivers and abduction were risk factors for PTSD. Adverse childhood events were associated with both PTSD and CPTSD, and equally so. Individuals with CPTSD reported substantially higher psychiatric burden and lower levels of psychological well‐being compared to those with PTSD and those with neither diagnosis.     

Psychiatric and Physical Sequelae of Childhood Physical and Sexual Abuse and Forced Sexual Trauma Among Individuals With Serious Mental Illness

Trauma and posttraumatic stress disorder (PTSD) frequently co‐occur with serious mental illness, yet the unique mental and physical health influences of childhood physical abuse (CPA), childhood sexual abuse (CSA), and forced sexual trauma on individuals with serious mental illness remain unevaluated. The present study of 172 individuals with serious mental illness investigated the adverse effects of CPA, CSA, and forced sexual trauma on severity of PTSD and depression, and overall mental and physical health functioning. Data analysis consisted of chi‐square tests, independent t tests, bivariate odds ratios, and linear regressions. Prevalence of CPA (44.8%), CSA (29.1%), and forced sexual trauma (33.1%) were elevated, and nearly one third of participants (31.4%) reported clinical PTSD. Participants exposed to CSA or forced sexual trauma evidenced bivariate ORs ranging from 4.13 to 7.02 for PTSD, 2.44 to 2.50 for major depression, and 2.14 to 2.31 for serious physical illness/disability. Sexual trauma exposure associated with heightened PTSD and depression, and reduced mental and physical health functioning, with CSA uniquely predicting PTSD, depression, and physical health difficulties. CPA less significantly affected these clinical domains. Sexual traumas have profound negative effects on mental and physical health outcomes among individuals with serious mental illness; increased screening and treatment of sexual traumas is needed.     

Chronicity in Posttraumatic Stress Disorder (PTSD) and Predictors of Course of PTSD in Patients with Anxiety Disorders

The purpose of this study was to examine the course of comorbid posttraumatic stress disorder (PTSD) in 54 patients with another anxiety disorder. Using a prospective longitudinal design, the present study found that during the first 5 years of follow-up the probability of full remission from a chronic episode of PTSD was .18. Findings from this and other research confirm clinical impressions that a substantial number of people never fully remit from their PTSD even after many years. Variables associated with a longer time to remit from an episode of chronic PTSD were a history of alcohol abuse and a history of childhood trauma.     

Memory Functioning in Adult Women Traumatized by Childhood Sexual Abuse

Memory impairment has been reported in some studies of patients with combat-related posttraumatic stress disorder (PTSD) and in rape victims with PTSD. The authors tested whether explicit memory impairment was evident in adult women who were traumatized by severe sexual abuse in childhood. The California Verbal Learning Test (Delis, Kramer, Kaplan, & Ober, 1987) and the Benton Visual Retention Task (Benton, 1974) were administered to 22 female adult survivors of childhood sexual trauma and to 20 demographically and educationally similar nonvictimized women. No evidence was found of explicit memory impairment in the abuse survivors. Furthermore, neither PTSD severity, dissociative symptom severity, nor extent of preexisting amnesia for childhood trauma contributed to the variance in memory functioning. Additional studies are needed to determine the extent to which impaired explicit memory functioning is a common feature of posttraumatic stress syndromes.     

Adult sexual abuse is associated with elevated neurohormone levels among women with PTSD due to childhood sexual abuse

Posttraumatic stress disorder (PTSD) has been associated with reduced, similar, or increased urinary cortisol levels. The authors identified a factor that might contribute to such variability when they obtained 24-hour urinary neurohormone profiles on 69 women with PTSD due to childhood sexual abuse. Half (n = 35) had subsequently experienced adult sexual abuse (ASA) while the other half (n = 34) had not. The ASA group had significantly elevated urinary cortisol, norepinephrine and dopamine levels in comparison to the non-ASA group. Neither a history of childhood or adult physical abuse nor other variables contributed to this finding. The results suggest that the psychobiological consequences of exposure to the same traumatic event may differ as a result of an interaction between age and the composite history of trauma exposure.     

Age at trauma exposure and PTSD risk in young adult women

The aim of the current study was to test the independent and joint contributions of 8 different types of trauma to posttraumatic stress disorder (PTSD) risk using data from a young adult female cohort. Associations of traumatic events with PTSD onset were examined using Cox proportional hazards models. Differences in risk as a function of age at trauma were tested. Childhood sexual assault, physical abuse, and neglect were stronger predictors of PTSD onset than adolescent and early adult occurrence of these events in individual models. In a model including all traumatic events, differential risk by age remained for sexual assault and physical abuse. Early sexual assault was the strongest predictor of risk, but additional traumatic events increased risk even in its presence.     

An Affect-Management Group for Women with Posttraumatic Stress Disorder and Histories of Childhood Sexual Abuse

Systematic research on effective treatment for survivors of childhood sexual abuse with posttraumatic stress disorder (PTSD) is virtually non-existent. The aim of the present study was to compare the effectiveness of an affect-management treatment (AM) group to a wait list control condition for female survivors of childhood sexual abuse with PTSD. Forty-eight female survivors of childhood sexual abuse with PTSD were randomly assigned to either a 15-week affect-management treatment group or to a wait list control condition. All subjects received individual psychotherapy and pharmacotherapy for the duration of the study, and for at least 1-month prior to the study. Controlling for pretreatment scores, subjects who completed the affect-management treatment group (n = 17) reported significantly fewer posttreatment symptoms of PTSD and dissociation than subjects in the wait list control condition (n = 16). Our findings suggest that an affect-management group treatment is beneficial as an adjunct to individual psychotherapy and pharmacotherapy for survivors of childhood sexual abuse with PTSD.     

PTSD as a mediator of sexual revictimization: the role of reexperiencing, avoidance, and arousal symptoms

Theory and research suggest that posttraumatic stress disorder (PTSD) may mediate the relationship between child sexual abuse and adult sexual assault. However, little empirical research has examined the mediational role of PTSD. In the present study, the authors use structural equation modeling to examine the degree to which the three symptom clusters that define PTSD (reexperiencing, avoidance, and hyperarousal) contribute to sexual revictimization. To assess PTSD symptomatology, undergraduate women completed questionnaires (N = 1,449), which detailed the history and severity of childhood and adult sexual assault experiences. Results indicated that PTSD mediated sexual revictimization. When PTSD symptom clusters were examined individually, only the hyperarousal cluster was a significant mediator. Results are discussed in terms of information-processing mechanisms that may underlie sexual revictimization.     

Posttraumatic Stress Disorder Among Incarcerated Battered Women: A Comparison of Battered Women Who Killed Their Abusers and Those Incarcerated for Other Offenses

The present study examined differences in the amount and severity of spousal violence and posttraumatic stress symptoms between incarcerated battered women who killed/seriously assaulted their abusers and battered women incarcerated for other offenses. Additionally, several risk and buffering variables suggested by trauma research were tested to determine their ability to predict present posttraumatic stress disorder (PTSD) symptomatology. Findings revealed that battered women who killed/seriously assaulted their batterers experienced more frequent and severe spousal abuse than those in the comparison group. No significant group differences were found for present PTSD symptom levels. Predictors of present PTSD symptomatology included: childhood sexual abuse, childhood physical abuse, past PTSD symptomatology, length of time elapsed since living with partner and receiving counseling in prison. The implications of the findings are discussed.     

The Moderating Effect of Childhood Maltreatment on the Relations Among PTSD Symptoms,Positive Urgency,and Negative Urgency

Childhood maltreatment increases the risk for posttraumatic stress disorder (PTSD) and comorbid substance use disorder (SUD). One pathway by which this occurs is through impaired emotion regulation. Past research has shown that negative urgency, a deficit in the regulation of negative emotions, is strongly related to PTSD in those with comorbid SUD. However, there is minimal research on the relation between positive urgency and PTSD in those with comorbid SUD. The current study investigated the association between childhood maltreatment, positive urgency, negative urgency, and PTSD symptoms among those with SUD. Results suggested that PTSD was associated with negative urgency and positive urgency overall. Childhood maltreatment did not moderate the association between negative urgency and PTSD. Childhood emotional abuse, emotional neglect, and sexual abuse moderated the relation between positive urgency and PTSD (ΔR ² = .04 to .10). The association between PTSD and positive urgency was only significant at lower levels of emotional abuse and neglect. Future research should further examine the processing of positive emotions in those with PTSD and comorbid SUD. Findings might inform clinical interventions among populations exposed to childhood maltreatment to reduce or prevent the development of psychopathology.     

Assessing risk of violent behavior among veterans with severe mental illness

Although empirical research has examined factors associated with increased violence risk among individuals with severe mental illness (SMI) and among veterans without SMI, less attention has been devoted to identifying violence risk factors among veterans with SMI. Using multivariable analysis of a large pooled sample of individuals with SMI, this study examines violence risk factors of N = 278 veterans with SMI. In multivariate modeling, violence by veterans with SMI was associated with head injury, posttraumatic stress disorder (PTSD), substance abuse, and homelessness. Results support the view clinicians assessing violence risk among veterans with SMI should consider a combination of characteristics empirically related to violence by non-veterans with SMI (e.g., homelessness) and veterans without SMI (e.g., PTSD).     

The Impact of Childhood Abuse Among Women With Assault‐Related PTSD Receiving Short‐Term Cognitive–Behavioral Therapy

This study examined the effect of child sexual or physical abuse on brief cognitive–behavioral therapy treatments with adults with posttraumatic stress disorder (PTSD). We analyzed secondary data from two randomized controlled trials (Resick, Nishith, Weaver, Astin, & Feuer, 2002; Resick et al., 2008) that included women with PTSD who did or did not have child sexual abuse (CSA) or child physical abuse (CPA) histories to determine whether childhood abuse impacted dropout rate or reduction in PTSD symptoms. In Study 1, presence, duration, or severity of CSA was not associated with dropout; however, frequency of CSA significantly predicted dropout (OR = 1.23). A significant CPA Severity × Treatment Group interaction emerged such that CPA severity was associated with greater dropout for prolonged exposure (PE; OR = 1.45), but not cognitive processing therapy (CPT; OR = 0.90). Study 2 found no differences in dropout. Study 1, comparing CPT and PE among women who experienced at least 1 rape found no differences in outcome based on childhood abuse history (r_p²s = .000–.009). Study 2, a dismantling study of CPT with women seeking treatment for adult or child sexual or physical abuse found that for those with no childhood abuse, CPT‐C, the cognitive‐only version of CPT, had an advantage, whereas both forms of CPT worked best for those with higher frequency of childhood abuse; the effect size was small.     

Psychopathology and sexual trauma in childhood and adulthood

This study evaluates the occurrence of psychopathology among 97 women who (1) experienced sexual abuse in childhood only, (2) were raped in adulthood only, (3) experienced both childhood sexual abuse and rape in adulthood, or (4) experienced no sexual trauma. Women were recruited from advertisements and assessed using the Structured Clinical Interview for DSM-IV (SCID-I/P) and the Modified PTSD Symptom Scale Self-Report. Women who reported sexual trauma were significantly more likely to exhibit psychopathology than controls. Being sexually victimized in childhood and raped in adulthood was associated with a particular risk for substance dependence.     

Women's Sexual Desire,Trauma Exposure,and Posttraumatic Stress Disorder

Research suggests that posttraumatic stress disorder (PTSD) is associated with sexual dysfunction; however, there is a paucity of research examining the relations among trauma exposure, PTSD, and low sexual desire, specifically. Thus, the goal of the present study was to investigate whether women with hypoactive sexual desire disorder (HSDD; n = 132) were more likely to meet criteria for a diagnosis of current or lifetime PTSD relative to women with no sexual desire concerns (n = 137). We also sought to compare the type, frequency, and intensity of PTSD symptoms between the two groups. Finally, we examined whether women in the two groups were exposed to more, or different types of, potentially traumatic events. Compared to women with no sexual health concerns, women with HSDD were more likely to meet criteria for current PTSD, odds ratio (OR) = 5.50, 95% CI [1.18, 25.61]; and lifetime PTSD, OR = 2.78, 95% CI [1.56, 4.94]. Women in the HSDD group also had higher odds of meeting criteria for avoidance (5.10 times) and hyperarousal symptoms (4.48 times) and scored higher on measures of past-month PTSD symptom frequency, d = 0.62, and intensity, d = 0.57. No group differences were observed regarding reexperiencing symptoms, the associated features of PTSD, or type or frequency of exposure to potentially traumatic events. The findings indicate PTSD symptomatology may be a predisposing or perpetuating contributor to low sexual desire, and low sexual desire and PTSD may be related through an alteration in stress adaptability.     

Trauma and Posttraumatic Stress Disorder Among Transition‐Age Youth With Serious Mental Health Conditions

There is little information on trauma, posttraumatic stress disorder (PTSD), and associated risk factors in transition‐age youth with mental health conditions. This study aimed at understanding the correlates and predictors of PTSD in 84 transition‐age youth, between 16 and 21 years old, residing in supported community housing. Chi‐square analyses and t tests were used to compare youth with a diagnosis of PTSD to those without a PTSD diagnosis. Stepwise logistic regression analyses were performed to identify unique predictors of PTSD. Of the 84 individuals, 79 (94%) reported a history of trauma, of whom 30 (36%) had PTSD. Sexual abuse was significantly associated with a PTSD diagnosis (r = .47) and the only unique predictor of PTSD (Cox r² = .20). Transition‐age youth in supported community housing had higher rates of trauma exposure and PTSD than the general adolescent population, suggesting the need for routine assessment and treatment of PTSD in this population.     

The Role of Childhood Trauma and PTSD in Postpartum Sleep Disturbance

Despite robust associations between postpartum sleep difficulties and maternal psychopathology, little attention has been paid to the role of childhood trauma and posttraumatic stress disorder (PTSD). In the present study, we examined sleep complaints in postpartum women with a history of childhood trauma compared to postpartum women who were not exposed to childhood trauma. Participants (N = 173) completed questionnaires by telephone at 4‐months postpartum. After adjusting for nuisance variables, there were significantly higher rates of sleep disturbance (falling asleep and staying asleep) for women with a past history of neglect (OR = 4.84, p = .036 and 5.78, p = .006, respectively), physical abuse (OR = 9.20, p = .002 and 3.84, p = .044, respectively), and physical abuse with sexual abuse (OR = 5.95, p = .011 and 3.56, p = .045, respectively). Current PTSD was significantly associated with trouble staying asleep (OR = 4.21, p = .032) whereas recovery from PTSD was associated with trouble falling (OR = 4.19, p = .015) and staying asleep (OR = 3.69, p = .011). Our findings affirm the contribution of childhood trauma and PTSD to postpartum sleep.     

A prospective study of sex differences in the lifetime risk of posttraumatic stress disorder among abused and neglected children grown up

In the general population, women's lifetime risk of developing posttraumatic stress disorder (PTSD) is twice that of men's. However, evidence is contradictory as to whether this sex difference is present among child abuse/neglect victims. The authors examined sex differences in PTSD among a sample of 674 individuals with documented child abuse/neglect histories assessed for PTSD in adulthood. Across all types of abuse/neglect, women were more than twice as likely to develop PTSD as men. The sex difference was greatest among sexual abuse victims. Female victims' greater revictimization explained a substantial proportion (39%) of the sex differences in PTSD risk. Future research should identify mechanisms that make female victims particularly vulnerable to revictimization and the development of PTSD.