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.     

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.     

Childhood Maltreatment and Psychiatric Morbidity in Bariatric Surgery Candidates

Background This study used standardized assessments to evaluate the association between childhood maltreatment (i.e., emotional, physical, and sexual abuse and emotional and physical neglect) and Axis I and II psychiatric disorders in patients presenting for bariatric surgery. Methods Participants (N = 230) provided demographic information and completed the Childhood Trauma Questionnaire, short form. The Structured Clinical Interview for the DSM-IV was used to assess Axis I clinical disorders and Axis II personality disorders. Results Approximately 66% of participants had a history of childhood maltreatment. Individuals reporting childhood maltreatment had a greater number of lifetime Axis I diagnoses than did those without, although the effect for physical neglect was no longer significant after controlling for multiple comparisons. With respect to specific Axis I diagnoses, a history of emotional or sexual abuse was associated with increased rates of lifetime mood and anxiety disorder diagnoses. Emotional neglect also was associated with increased rates of mood disorder diagnoses, and physical abuse was associated with increased rates of substance use disorders. There was no significant association between childhood maltreatment and personality psychopathology. Conclusion This study confirms high rates of childhood maltreatment in patients presenting for bariatric surgery that are associated with increased prevalence of lifetime mood, anxiety, and substance use disorders. Future prospective studies should include evaluation of a broad range of mental health and childhood experiences to tease apart the nature of the relationships between these factors and their potential impact on post-surgical outcomes.     

Comorbid Anxiety Disorders in Civilians Seeking Treatment for Posttraumatic Stress Disorder

Research indicates that posttraumatic stress disorder (PTSD) is associated with high rates of comorbid psychiatric diagnoses. Yet, it remains unknown whether PTSD is associated with greater comorbidity relative to patients with other anxiety disorders. This study examined prevalence of comorbid anxiety disorders with PTSD relative to other disorders among a treatment-seeking population. Patients with PTSD (n = 83) evidenced greater overall comorbidity as compared to patients with other anxiety (n = 151) or Axis I (n = 73) disorders. Compared to patients with panic disorder, patients with PTSD were more likely to be diagnosed with depression and social phobia, but not other anxiety disorders. Extent of anxiety disorder comorbidity was not related to PTSD severity. These findings are discussed in terms of their relevance for treatment of PTSD.     

Revictimization and Interpersonal Resource Loss Predicts PTSD Among Women in Substance-Use Treatment

Child physical abuse (CPA) and child sexual abuse (CSA) were hypothesized to be associated with revictimization and interpersonal resource loss in adulthood. These adulthood experiences were, in turn, hypothesized to increase risk for current posttraumatic stress disorder (PTSD). High-risk women were recruited from an innercity drug and alcohol treatment center (N = 105). Interpersonal resource losses, partner-produced physical assault, adulthood rape, CPA, and CSA had direct effects on PTSD. CPA and CSA also had indirect effects on PTSD through rape, which, in turn, predicted PTSD. Results suggest that the traumatic origins of current PTSD among substance-using women are multifaceted and support the importance of considering interpersonal coping resources in evaluating and treating female substance users.     

The impact of childhood abuse and combat‐related trauma on postdeployment adjustment

This retrospective study examined the effects of childhood physical abuse (CPA) and combat‐related trauma on postdeployment psychiatric symptoms in an outpatient clinical sample of 1,045 U.S. service members. The authors conducted hierarchical multiple regression analyses to examine the impact of CPA and combat‐related trauma on alcohol use, anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms. Analyses revealed significant main effects for CPA and combat‐related trauma on anxiety, depression, and PTSD. In contrast, no interactive effects were observed. Findings support and expand current knowledge about the roles that CPA and combat trauma play in the development of psychiatric symptoms and suggest a more complex etiology for postdeployment symptomatology. Clinical implications and future research opportunities are discussed.     

Childhood Abuse and Sexual Revictimization in a Female Navy Recruit Sample

To examine effects of childhood abuse on adult rape, 1,887 female Navy recruits were surveyed. Overall 35% of recruits had been raped and 57% had experienced childhood physical abuse (CPA) and/or childhood sexual abuse (CSA). Controlling for CPA, rape was significantly (4.8 times) more likely among women who had experienced CSA than among women who had not. In contrast, CPA (controlling for CSA) was unrelated to likelihood of adult rape. Alcohol problems and number of sex partners were examined as mediators. Although both variables predicted rape, their effects were independent of the effects of CSA. Finally, despite ethnic group differences in the prevalence of victimization, the predictors of rape did not differ significantly across ethnic groups.     

Differential relationships of childhood abuse and neglect subtypes to PTSD symptom clusters among adolescent inpatients

This article investigates whether childhood abuse and neglect subtypes (i.e., physical, sexual, and emotional abuse, and physical and emotional neglect) differentially predict the severity of individual posttraumatic stress disorder (PTSD) symptom clusters and overall posttraumatic stress. Eighty-nine patients admitted to the short-term adolescent treatment unit of a psychiatric hospital completed a battery of psychological assessments. Findings of multiple regression analyses showed that emotional and sexual abuse rather than physical abuse, emotional neglect, or physical neglect is related to individual symptom cluster severity and overall posttraumatic stress. Results suggested that a greater level of specificity is necessary when assessing child abuse and posttraumatic stress because each level provides more specific information about how to intervene to reduce the risk of negative outcomes.     

Exposure to traumatic events among treatment‐seeking,alcohol‐dependent women and men without PTSD

The authors examined lifetime exposure to a range of traumatic events in 106 abstinent, treatment‐engaged (85% residential; 15% outpatient), alcohol‐dependent women (n = 53) and men without current or lifetime posttraumatic stress disorder. Alcohol‐dependent women reported greater severity of childhood trauma, but similar lifetime exposure to traumatic events compared with men. Alcohol‐dependent women without cocaine abuse or TB (n = 10) reported greater severity of childhood trauma than women with (n = 43), and men with (n = 21) or without (n = 32) cocaine abuse or dependence. Results extend previously observed gender differences in trauma histories among alcohol‐dependent adults and point to potential gender‐ and substance‐specific drug coaddiction effects that may have been influenced by trauma exposure.     

Early Childhood Trauma and Disorders of Extreme Stress as Predictors of Treatment Outcome with Chronic Posttraumatic Stress Disorder

History of early childhood trauma was prevalent and highly correlated with Disorders of Extreme Stress Not Otherwise Specified (DESNOS) in a sample of veterans in inpatient treatment for chronic posttraumatic stress disorder (PTSD). DESNOS predicted reliable change on a variety of measures of psychiatric symptomatology (including PTSD) and psychosocial functioning independently of the effects of PTSD diagnosis and early childhood trauma history. DESNOS also predicted treatment outcome on PTSD and quality of life measures after controlling for the effects of ethnicity, war zone trauma exposure severity, initial level of symptomatic severity or quality of life, Axis I (PTSD and major depression) and Axis II (personality disorder) diagnostic status, and early childhood trauma history. Early childhood trauma was not predictive of outcome. DESNOS appears to play an important role in assessment and treatment planning for psychotherapeutic rehabilitation of chronic PTSD.     

Child physical abuse and adult mental health: A national study

This study characterizes adults who report being physically abused during childhood, and examines associations of reported type and frequency of abuse with adult mental health. Data were derived from the 2000-2001 and 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions, a large cross-sectional survey of a representative sample (N = 43,093) of the U.S. population. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between child physical abuse and adult psychiatric disorders adjusted for sociodemographic characteristics, other childhood adversities, and comorbid psychiatric disorders. Child physical abuse was reported by 8% of the sample and was frequently accompanied by other childhood adversities. Child physical abuse was associated with significantly increased adjusted odds ratios (AORs) of a broad range of DSM-IV psychiatric disorders (AOR = 1.16-2.28), especially attention-deficit hyperactivity disorder, posttraumatic stress disorder, and bipolar disorder. A dose-response relationship was observed between frequency of abuse and several adult psychiatric disorder groups; higher frequencies of assault were significantly associated with increasing adjusted odds. The long-lasting deleterious effects of child physical abuse underscore the urgency of developing public health policies aimed at early recognition and prevention.     

Subjective distress from stressful events and high-risk behaviors as predictors of PTSD symptom severity in clients with severe mental illness

Survey data collected from 257 community mental health center clients tested direct and indirect relationships among subjective distress associated with stressful/traumatic events and high-risk behaviors, substance abuse, and posttraumatic stress disorder (PTSD) symptoms. Structural equation modeling (SEM) revealed substantial direct effects of subjective distress associated with lifetime physical and sexual abuse on PTSD symptom severity. Subjective distress related to high-risk behaviors (e.g., suicide attempts) mediated subjective distress and PTSD symptom severity. Subjective distress from physical and sexual abuse was also strongly related to problem drinking. Adding gender to the model revealed greater subjective distress from physical and sexual abuse for women and greater drinking problems for men. Otherwise, gender had little effect on the model overall.     

Predictors of rape: findings from the National Survey of Adolescents

The current report examines data for 872 female adolescents obtained during the initial and follow-up interviews of the National Survey of Adolescents, a nationally representative sample. Lifetime prevalence of violence exposure reported was 12% and 13% for sexual assault, 19% and 10% for physical assault/punishment, and 33% and 26% for witnessing violence at Waves I and II, respectively. Racial/ethnic status, posttraumatic stress disorder (PTSD), childhood sexual abuse (CSA), and family drug problems emerged as significant predictors of new rape. Each of the PTSD symptom clusters significantly predicted new rape and analyses supported the mediational role of PTSD between CSA and new rape. African American or other racial identity was associated with lower risk.     

The Relationship Between Posttraumatic Stress Disorder, Childhood Trauma and Alexithymia in an Outpatient Sample

One aim of this study was to examine the strength of association between posttraumatic stress disorder (PTSD) and alexithymia relative to other psychiatric disorders in a sample of 252 treatment-seeking psychiatric patients. The other aim of this study was to explore which type of childhood trauma was associated with a greater level of adult alexithymia. The study found that PTSD and borderline personality disorder (BPD) were the two disorders among selected psychiatric disorders to contribute independently to a higher degree of alexithymia. Another finding was that a greater severity of emotional neglect and physical neglect, rather than abuse, was significantly related to higher levels of alexithymia. In addition, the study found that among these variables, BPD had the strongest relationship to alexithymia.     

The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder

This study examined the relationship between childhood sexual abuse and symptoms of a newly proposed complex posttraumatic stress disorder or disorder of extreme stress not otherwise specified (DESNOS). Compared to 34 women without histories of sexual abuse, 74 survivors of sexual abuse showed increased severity on DESNOS symptoms of somatization, dissociation, hostility, anxiety, alexithymia, social dysfunction, maladaptive schemas, self-destruction, and adult victimization. In addition, a logistic regression found that a complex of symptoms representing DESNOS was significantly related to a history of sexual abuse. Consistent with other studies, the results of this study provide support for the idea that symptoms of DESNOS characterize survivors of sexual abuse.     

Intimate Partner Violence Among Women Veterans: Previous Interpersonal Violence as a Risk Factor

Experiences of abuse during childhood or military service may increase women veterans’ risk for intimate partner violence (IPV) victimization. This study examined the relative impact of 3 forms of interpersonal violence exposure (childhood physical abuse [CPA], childhood sexual abuse [CSA], and unwanted sexual experiences during military service) and demographic and military characteristics on past‐year IPV among women veterans. Participants were 160 female veteran patients at Veterans Afffairs hospitals in New England who completed a paper‐and‐pencil mail survey that included validated assessments of past‐year IPV and previous interpersonal violence exposures. Women who reported CSA were 3.06 times, 95% confidence interval (CI) [1.14, 8.23], more likely to report past‐year IPV relative to women who did not experience CSA. Similarly, women who reported unwanted sexual experiences during military service were 2.33 times, 95% CI [1.02, 5.35], more likely to report past‐year IPV compared to women who did not report such experiences. CPA was not associated with IPV risk. Having less education and having served in the Army (vs. other branches) were also associated with greater risk of experiencing IPV in the past year. Findings have implications for assisting at risk women veterans in reducing their risk for IPV through detection and intervention efforts.     

Interrelationships between crime, substance abuse, and aggressive behaviours among persons with traumatic brain injury

Professionals have suggested that aggressiveness, substance abuse, and criminality contribute to poor outcomes after brain injury. There is considerable research regarding post-injury aggressive behaviour, but limited information concerning criminal behaviour and alcohol use patterns. With a sample of 327 patients varying in severity of traumatic brain injury, the present investigation examined alcohol use patterns, arrest histories, behavioural characteristics, and psychiatric treatment histories. Relative to the uninjured population, analysis revealed relatively high incidence of heavy drinking, both pre- and post-injury, among patients with a history of arrest. Increases in abstinence rates were found regardless of arrest history. In addition, a history of arrest was associated with a greater likelihood of psychiatric treatment. Findings also indicated relatively high levels of aggressive behaviours. Discussion focuses on implications for evaluation, rehabilitation, and future research.     

The relationship between childhood maltreatment and psychopathology in adults undergoing bariatric surgery

Background

A history of childhood maltreatment and psychopathology are common in adults with obesity.

Post-traumatic stress and associated disorders among vietnam veterans: The significance of combat exposure and social support

The hypothesis is tested that individuals exposed to traumatic stress who currently have lower social support have higher rates of post-traumatic stress and associated disorders. To test this, the current prevalence of five psychiatric disorders, including post-traumatic stress, generalized anxiety, depression, alcohol abuse, and drug abuse, were studied among a random sample of veterans who served in Vietnam (N=2,490) and a random sample of era veterans who did not (N=1,972). Logistic regression was used to analyze each disorder, controlling for past combat exposure, current social status, childhood delinquency, military adjustment, and current social support. Combat exposure was the best predictor of post-traumatic stress and was also associated with anxiety and depression, but not alcohol or drug abuse. Substance abuse was associated with childhood delinquency, and the best predictor of drug abuse was illicit Army drug use. Lower social support was associated with all disorders, except drug abuse. Although the causal nexus is not clear in this case, this study suggests that future research and clinical interventions should not overlook the significance of social support among victims of traumatic stress.