Behavioral markers of coping and psychiatric symptoms among sexually abused children

The current study examined coping and psychiatric symptoms in a longitudinal sample of sexually abused children. Coping was behaviorally coded from children's forensic interviews in the aftermath of sexual abuse. Using principal components analysis, coping behaviors were found to cluster into 3 categories: avoidant, expressive, and positive affective coping. Avoidant coping had predictive utility for a range of psychiatric symptoms, including depressive, posttraumatic stress, anxiety, and dissociative symptoms as well as aggression and attention problems measured 8-36 months following the forensic interview. Specific behaviors, namely fidgetiness and distractibility, were also found to be associated with future symptoms. These findings suggest the predictive utility of avoidant behaviors in general, and fidgetiness and distractibility in particular, among sexually abused children.     

The relationship between acute stress disorder and posttraumatic stress disorder in injured children

This study indexed the relationship between acute stress disorder (ASD) and subsequent posttraumatic stress disorder (PTSD) in injured children. Consecutive children between 7-13 years admitted to a hospital after traumatic injury (n = 76) were assessed for ASD. Children were followed up 6-months posttrauma (n = 62), and administered the PTSD Reaction Index. Acute stress disorder was diagnosed in 10% of patients, and 13% satisfied criteria for PTSD. At 6-months posttrauma, PTSD was diagnosed in 25% of patients who were diagnosed with ASD. Acute stress reactions that did not include dissociation provided better prediction of PTSD than full ASD criteria. These findings suggest that the current ASD diagnosis is not optimal in identifying younger children who are high risk for PTSD development.     

Avoidant coping as a mediator between peritraumatic dissociation and posttraumatic stress disorder symptoms

Peritraumatic dissociation consistently predicts posttraumatic stress disorder (PTSD). Avoidant coping may serve as a mechanism through which peritraumatic dissociation contributes to PTSD symptoms. Path analysis was used to examine whether avoidant coping assessed 6 weeks following a motor vehicle accident mediated the relationship between in-hospital peritraumatic dissociation and 6-month (n = 193) and 12-month (n = 167) chronic PTSD symptoms. Results revealed that, after controlling for age, gender, depression, and 6-week PTSD symptoms, avoidant coping remained a partial mediator between peritraumatic dissociation and chronic PTSD symptoms 6- and 12-months postaccident. Post-hoc multigroup analyses suggested that at 6-months posttrauma, the mediation was significant in women, but not in men. Gender-specific results were not significant at 12-months posttrauma. Interventions targeted at reducing avoidant coping in high dissociators may aid in reducing PTSD symptoms.     

Acute stress disorder and posttraumatic stress disorder in parents of injured children

Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) were examined in 334 parents of children with traffic‐related injuries. In the first month after their child's injury, 12% of parents had ASD and another 25% had partial ASD. Among 251 parents assessed again approximately 6 months postinjury, 8% had PTSD and another 7% had partial PTSD. The ASD and PTSD severity were associated (r = .54), but ASD status was not a sensitive predictor of later PTSD. Independent predictors of ASD severity included prior trauma exposure, peritrauma exposure and perceptions of the child's pain and life threat, and child ASD severity. Independent predictors of PTSD severity included prior trauma exposure, parent ASD severity, and parent‐rated child physical health at follow‐up.     

Traumatic brain injury, dissociation, and posttraumatic stress disorder in road traffic accident survivors

This study investigated the symptom profiles of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in participants who did and did not sustain traumatic brain injury (TBI), following a road traffic accident. The participants were assessed at three time points: as soon as possible posttrauma as well as at 6 weeks and 3 months posttrauma. At the first assessment, fewer participants from the TBI group recalled feeling fear and helplessness at the time of the trauma, fewer TBI participants reported recurrent intrusive thoughts and images, and more TBI participants reported dissociation since the trauma, relative to the non-TBI group. At the second assessment, fewer participants from the TBI group recalled feeling intense helplessness at the time of the trauma. Fewer TBI participants also reported reliving and physiological reactions on trauma reminders relative to the non-TBI group. At 3 months posttrauma, there was no difference in PTSD symptom profile between non-TBI and TBI groups. Our findings indicate that the presence of TBI is likely to influence the distribution of certain symptoms, but need not be a significant barrier to diagnosing ASD and PTSD.     

Correlates of posttraumatic stress disorder in forensic psychiatric outpatients in the Netherlands

Using a sample of 154 Dutch forensic psychiatric outpatients aged 18-62 years, this study investigated whether risk factors of posttraumatic stress disorder (PTSD), mainly identified in nonforensic research, forensic psychiatric factors, and potential comorbid mental disorders were associated with PTSD. Data on demographics, victimization during childhood or adolescence, and forensic psychiatric factors were derived from electronic medical records. Mental disorders were assessed using structured psychiatric interviews and consensus diagnoses were established during weekly case consultations. The PTSD rate was 75% in the sample. Whereas the PTSD group was significantly more likely to be older, female, not Dutch, and to have a history of victimization, previously perpetrated family violence, and lower psychosocial and occupational functioning than the non-PTSD group, the latter group had significantly higher rates of psychiatric history, attention-deficit/hyperactivity disorder (ADHD), antisocial personality disorder, drug abuse, and previous repeated nonfamily violence perpetration. Effect sizes ranged from Nagelkerke R(2) = .04 for psychosocial and occupational functioning to Nagelkerke R(2) = .70 for ADHD. This study demonstrated differences between those with and without PTSD in demographic, victim, forensic, and psychological characteristics. Future studies should examine the complexity between early victimization, delinquency patterns, and psychopathology regarding the prediction of PTSD among forensic psychiatric outpatients.     

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.     

Attention,arousal, and memory in posttraumatic stress disorder

Vietnam combat veterans with current posttraumatic stress disorder (PTSD), with other Axis-I disorders, or with no Axis-I disorders completed a series of tasks designed to elucidate the psychophysiological parameters of information-processing in PTSD. These tasks included a modified Stroop procedure (MSP), a standard Stroop procedure, a recognition memory task, and a threat rating task. Physiological responses were recorded throughout the study. Our data supported several predictions derived from information-processing models of PTSD. PTSD subjects exhibited greater MSP interference to high threat words than both comparison groups, and a liberal response bias toward recognizing military-related words. PTSD symptoms and threat reactions contributed to MSP interference effects for high-threat words after controlling for medications, depression, and baseline physiological activity.     

Peritraumatic distress,posttraumatic stress disorder symptoms,and posttraumatic growth in victims of violence

This study explored whether peritraumatic distress and posttraumatic stress disorder (PTSD) symptoms are curvilinearly related to posttraumatic growth in victims of violence several years after victimization (Time 1; n = 678) and 6 months later (Time 2, n = 205). At both time points, curve estimation revealed linear and quadratic associations between peritraumatic distress and posttraumatic growth and quadratic associations between PTSD symptoms and posttraumatic growth. In multivariate regressions controlling for background variables, the linear peritraumatic distress and quadratic PTSD symptom terms remained significant predictors of posttraumatic growth Time 1 scores. For Time 2, the linear peritraumatic distress term remained significant, though only prior to controlling for posttraumatic growth Time 1 scores. The results suggest that peritraumatic distress enables growth after substantial time has elapsed since victimization.     

Educational,occupational, and relationship histories of men who were sexually and/or physically abused as children

Ninety men (mean age 26) at an urban Northeastern university were administered a self-report assessment of their early sexual and physical abuse experiences, and their educational, occupational, relationship, and substance abuse histories. Subjects were classified as sexually abused according to criteria used by Wyatt (1985) and Finkelhor (1979). Sixteen men (17.8%) experienced sexual abuse alone, 22 men (24.4%) physical abuse alone, 15 men (16.7%) both sexual and physical abuse, and 37 men (41.1%) were classified as nonabused. Of the 31 men who reported sexual abuse, 24 (77.4%) were contact, the rest noncontact. Sexually abused men reported significantly greater difficulties than nonabused men at all levels of education: grade school, high school and college. They also reported more negative job experiences and more negative experiences in relationships. Physically abused men showed a similar but less pervasive pattern of difficulties. Substance abuse was significantly more prevalent among both sexually and physically abused men than among nonabused subjects.     

Conduct disorder, war zone stress, and war-related posttraumatic stress disorder symptoms in American Indian Vietnam veterans

This study examined whether conduct disorder (CD) was associated with war zone stress and war-related post-traumatic stress disorder (PTSD) symptoms in American Indian (AI) Vietnam veterans. Cross-sectional lay-interview data was analyzed for 591 male participants from the American Indian Vietnam Veterans Project. Logistic regression evaluated the association of CD with odds of high war zone stress and linear regression evaluated the association of CD and PTSD symptom severity. Childhood CD was not associated with increased odds of high war zone stress. Conduct disorder was associated with elevated war-related PTSD symptoms among male AI Vietnam Veterans independent of war zone stress level and other mediators. Future efforts should examine reasons for this association and if the association exists in other AI populations.     

Posttyphoon prevalence of posttraumatic stress disorder,major depressive disorder,panic disorder,and generalized anxiety disorder in a Vietnamese sample

In 2006, typhoon Xangsane disrupted a multiagency health needs study of 4,982 individuals in Vietnam. Following this disaster, 798 of the original participants were reinterviewed to determine prevalence and risk factors associated with posttraumatic stress disorder (PTSD), major depressive disorder (MDD), panic disorder (PD), and generalized anxiety disorder (GAD). Posttyphoon prevalences were PTSD 2.6%, MDD 5.9%, PD 9.3%, and GAD 2.2%. Of those meeting criteria for a disorder, 70% reported only one disorder, 15% had two, 14% had three, and 1% met criteria for all four disorders. Risk factors for posttyphoon psychopathology differed among disorders, but generally were related to high typhoon exposure, prior trauma exposure, and in contrast to Western populations, higher age, but not gender.     

Brain, skull, and cerebrospinal fluid volumes in adult posttraumatic stress disorder

Children and adolescents with maltreatment-related posttraumatic stress disorder (PTSD) exhibit smaller intracranial tissue volume than controls. Linear relationships have also been observed between intracranial tissue volume and the age of maltreatment onset. The authors explored associations among adult PTSD, early trauma, and cerebral volumes in 99 combat veterans. A bone-based estimate of cranial volume was developed to adjust for variation in body size. Posttraumatic stress disorder was not associated with smaller cerebral tissue volume, but rather with smaller cerebrospinal fluid (CSF) and cranial volumes. These findings co-occurred with expected effects of alcoholism and aging on cerebral tissue and CSF volumes. The results point to early developmental divergences between groups with and without PTSD following adult trauma.     

The relationship among cognitive schemas,job-related traumatic exposure,and posttraumatic stress disorder in journalists

American newspaper journalists (N = 906) participated in a study examining a cognitive mediational model for explaining the relationship between exposure to work-related traumatic events and work-related posttraumatic stress disorder (PTSD). Results indicated (a) greater exposure to work-related traumatic events was associated with work-related PTSD symptoms, as well as negative cognitive schemas; (b) cognitive beliefs partially accounted for PTSD symptoms, but the full cognitive mediational model was not supported. Implications include targeting interventions for journalists who experience traumatic stress and modifying theories about PTSD symptoms in journalists.     

Diagnosis and management of posttraumatic stress disorder in returning veterans

As the conflict in Iraq continues, public health authorities in the United States anticipate that many returning soldiers will suffer from posttraumatic stress disorder (PTSD). Initially, most of these veterans are likely to consult their primary care physicians about health problems. However, the diagnosis of PTSD is often missed in primary care settings. The author encourages physicians to become better prepared to recognize this disorder in their patients and initiate proper treatment or appropriate referral. Current diagnostic approaches and treatment modalities for combat-related PTSD are reviewed-with an emphasis on clinical procedures for the primary care physician.     

Coping, symptoms, and functioning outcomes of patients with posttraumatic stress disorder

This study examines the association between approach coping and better functioning outcomes and the reciprocal relationships between coping and posttraumatic stress disorder (PTSD) symptoms in patients diagnosed with PTSD. Posttraumatic stress disorder patients receiving services in five VA health care systems were randomly selected and surveyed at baseline and followed 10 months later. Analyses of longitudinal data using structural equation modeling techniques showed that more approach coping predicted better family and social functioning. Cognitive avoidance coping predicted more PTSD symptoms, and more PTSD symptoms predicted more approach coping and more behavioral avoidance coping. Approach coping may enable patients with chronic PTSD to establish and maintain better relationships with family and friends, despite continuing PTSD.     

The Sydney Holocaust study: posttraumatic stress disorder and other psychosocial morbidity in an aged community sample

We investigated the psychological status and social functioning of Holocaust survivors. From 814 responses to a community survey of Jewish elders (aged 60 years or older), survivors (n = 100), refugees who had not experienced the Holocaust (n = 50), and Australian/English-born persons (n = 50), were randomly selected for semistructured interview, which included Posttraumatic Stress Disorder (PTSD) assessment, ratings on the General Health Questionnaire, Brief Psychiatric Rating Scale, Impact of Event Scale, Mini-Mental Status Examination, and Instrumental Activities of Daily Living and Social Functioning. On all psychological measures, survivors were functioning worse than refugees and Australian/English-born persons. The 3 groups were similar in social and instrumental functioning. The more severe the trauma the greater the level of psychological morbidity. Despite normal social and daily functioning, psychological morbidity following massive trauma endures.