The Relationship Between Sexual Trauma,Peritraumatic Dissociation,Posttraumatic Stress Disorder,and HIV-Related Health in HIV-Positive Men

This study tested a novel extension of P. P. Schnurr and B. L. Green’s (2004) model of the relationships between trauma symptoms and health outcomes with specific application to HIV-positive men. A diverse sample of 167 HIV-positive men recruited from San Francisco Bay Area HIV clinics completed demographic, medical, trauma history, and symptom questionnaires. Mediation analyses were conducted using the method proposed by R. Baron and D. Kenny (1986). Regression analyses found that sexual revictimization (SR) significantly mediated the relationship between child sexual abuse and peritraumatic dissociation (PD), and PD mediated the relationship between SR and current posttraumatic stress (PTS) symptom severity. PTS symptoms partially mediated the relationship between SR and current HIV symptom severity. The findings indicate that among HIV-positive men, sexually revictimized men constitute a vulnerable group that is prone to PD, which places them at risk for posttraumatic stress disorder (PTSD) and worsened HIV-related health. Furthermore, traumatic stress symptoms were associated with worse HIV-related symptoms, suggesting that PTS symptoms mediate the link between trauma and health outcomes. This study highlights the need for future research to identify the biobehavioral mediators of the PTSD–health relationship in HIV-positive individuals.     

Attachment and coping as facilitators of posttraumatic growth in Turkish university students experiencing traumatic events

This study was designed to explore the role of attachment and coping as facilitators of posttraumatic growth (PTG) in a sample of Turkish university students who experienced traumatic life events. Participants who reported a traumatic event from a list were asked to choose the most distressing one; to answer questions related to the impact of the trauma; and to fill out measures of attachment styles, ways of coping, and PTG. PTG was regressed on gender, trauma-related factors, attachment styles, and coping styles in order to examine the associations with PTG. Felt helplessness and horror, fatalistic coping, and optimistic coping were significant predictors of PTG. Fatalistic coping partially mediated the relationship between attachment anxiety and PTG.     

Posttraumatic growth in accident survivors: openness and optimism as predictors of its constructive or illusory sides

Posttraumatic growth (PTG), the phenomenon of self-reported positive outcomes of trauma, is assumed to consist of two sides: a constructive and an illusory side. This study investigates the relationship between PTG and its possible illusory and constructive predictors, as well as the moderating role of posttraumatic stress disorder (PTSD) severity. One-hundred two motor vehicle accident (MVA) survivors with full, subsyndromal, and without PTSD were assessed by multiple psychometric measures targeting PTSD severity, posttraumatic growth, optimism, and openness to experience. Hierarchical regression analysis yielded differential interaction effects between PTSD severity and optimism, as well as openness facets pointing to the moderating role of PTSD severity in the prediction of an illusory and a constructive factor in PTG.     

DYNAMICS AMONG POSTTRAUMATIC STRESS SYMPTOMS,FORGIVENESS FOR THE PERPETRATOR,AND POSTTRAUMATIC GROWTH FOLLOWING COLLECTIVE TRAUMA

Theory highlights forgiveness as a dynamic process that unfolds over time, as well as a potential target for posttrauma therapy. Longitudinal research, however, is nonexistent in the trauma literature. Further, the adaptation of forgiveness for understanding mass violent events has yet to be tested. The current study examined a theory‐based hypothesis posing forgiveness as a mediator between posttraumatic stress (PTS) symptoms and posttraumatic growth (PTG) in the context of a mass university campus shooting. Results showed that forgiveness was a significant mediator of the indirect, positive relationship between Time 1 PTS and Time 1 and Time 2 PTG. Implications include considering mechanisms (e.g., forgiveness) that link PTS and PTG for application in future research and practice.     

Posttraumatic growth in clinical psychology - a critical review and introduction of a two component model

Positive psychological or personal changes in the aftermath of trauma, defined as the result of the struggle with highly stressful events, have recently elicited heightened attention by trauma researchers. This article aims at summarizing the most important theoretical models and conceptualizations of posttraumatic growth (PTG) and addresses the issue of the adaptive significance of this phenomenon. It further renders a thorough empirical review of the relationship between PTG and psychological adjustment. European findings are specifically incorporated. As a conclusion, a two component cognitive model of PTG will be proposed that may explain the contradicting empirical findings in regard to the relationship between mental health and PTG. The Janus-Face model of PTG [Maercker, A. and Zoellner, T. (2004). The Janus face of self-perceived growth: Toward a two-component model of posttraumatic growth. Psychological Inquiry, 15, 41-48.] incorporates a constructive and an illusory aspect. On this basis, findings regarding relevant cognitive factors as predictors of PTG are summarized and evaluated. The article ends with a discussion of fruitful future research directions and how PTG can add a new perspective into trauma therapy.     

Rates of traumatization and psychopathology in criminal justice-involved women

Prior research has consistently found disproportionate rates of traumatization and psychopathology in criminal justice-involved women. The current study aimed to characterize rates of traumatization, psychopathology, and diagnostic comorbidity in women involved with the justice system. Furthermore, this study examined the role of posttraumatic stress symptoms in the association between traumatic events and levels of self-esteem. Participants were 185 women from the Chicagoland area with current or previous (past 2 years) involvement with the criminal justice system. Results confirmed disproportionate rates of trauma experiences and psychopathology in this population, and logistic regression analyses indicated that rates of traumatization predicted diagnostic comorbidity. Analyses indicated an indirect effect of posttraumatic stress in the association between traumatic experiences and self-esteem. Findings highlight the importance of assessing and targeting both trauma experiences and posttraumatic stress in justice-involved women to optimize prevention and intervention efforts.     

Traumatic Memories: Empirical Foundations, Forensic and Clinical Implications

This article reviews empirical research on memories for negative personal experiences among adults. It examines basic concepts (including neural underpinnings), theoretical models of the affect-memory relationship, and data from three sources: victims or witnesses to crimes and atrocities, "flashbulb memories" for traumatic events, and laboratory simulations of shocking experiences. Evidence suggests that memories for traumatic experiences contain more central than peripheral detail, are reasonably accurate and well-retained for very long periods, but are not completely indelible. Assertions of eyewitness memory's vulnerability to change through suggestion have overstated the evidence. Forensic and clinical implications are discussed and a plea issued for more study of the memory phenomena that characterize posttraumatic stress disorder (PTSD) and are the focus of trauma survivors' treatment.     

The Relationship of Psychological Trauma and Dissociative and Posttraumatic Stress Disorders to Nonsuicidal Self-Injury and Suicidality: A Review

We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.     

Sense of coherence moderates late effects of early childhood Holocaust exposure

This study evaluated child Holocaust survivors with an emphasis on potential protective factors facilitating participants' adaptation to post-Holocaust life. We examined Antonovsky's (1979, 1987) salutogenic paradigm, testing the mediating and moderating effect of participants' sense of coherence (SOC) on the association between early childhood deprivation due to Holocaust persecution and posttraumatic stress later in life. The nonclinical sample, composed of 203 child Holocaust survivors born between 1935 and 1944 completed questionnaires on Holocaust survival exposure, inventories on current health, posttraumatic stress, and SOC. The results indicated that SOC moderates the association between traumatic experiences during the war and posttraumatic stress, and SOC acts as a protective factor, buffering the impact of traumatic Holocaust experiences on child survivors in old age. Survivors with a less coherent perspective on the meaning of their life showed greater vulnerability for posttraumatic complaints. The moderating role of the SOC may suggest promising avenues of therapeutic interventions for child Holocaust survivors and other adults with early childhood trauma.     

Moving Beyond “Sticks and Stones”: Chronic Psychological Trauma Predicts Posttraumatic Stress Symptoms

To date, trauma research has focused on the impact of physical trauma on posttraumatic stress (PTS) symptoms. Sometimes psychological trauma is measured with instances of physical trauma; however, less is known about solely psychological trauma. The current study addresses this by examining psychological trauma and PTS symptoms using the chronic relational trauma (CRT) model. The CRT model examines physical and possible concurrent psychological childhood, peer, and intimate partner trauma; however, psychological trauma alone has yet to be tested. A total of 232 female undergraduates (M age = 18.32, SD = 1.60) completed a series of questionnaires. Structural equation modeling indicated that childhood, peer, and intimate partner psychological trauma predict current PTS symptoms. Contributions of these findings are discussed.     

Social participation and posttraumatic growth: The serial mediation of hope,social support,and reappraisal

In light of the global crisis created by the outbreak of the coronavirus and the disease it causes, coronavirus disease 2019, the goal of the study was to detect factors that might enhance people's ability to experience positive psychological change during traumatic events. As such, this study examined the relationship between social participation and posttraumatic growth (PTG) during the coronavirus outbreak and tested the mediating role of hope, social support, and cognitive reappraisal in explaining this relationship. The sample consisted of 275 participants (21.8% male, and 78.2% female, with an average age of 33.42, SD = 13.63), subjected to social-distancing regulations during this period. Results demonstrated a serial mediation model in which social participation predicted PTG directly and indirectly through hope (pathways and agency), social support, and cognitive reappraisal. The importance of social participation in nourishing personal resources and practical implications including the need for prevention programs are discussed.     

Posttraumatic growth in adolescent survivors of cancer and their mothers and fathers

OBJECTIVE: To describe posttraumatic growth (PTG) following childhood cancer survival and its association with demographic and disease/treatment variables, perceived treatment severity and life threat, and posttraumatic stress symptoms (PTSS). METHOD: Adolescent survivors of cancer (N = 150, ages 11-19), at least 1 year after treatment, and their mothers (N = 146) and fathers (N = 107) completed self-report measures of perceived treatment intensity and PTSS and a semistructured interview designed to identify posttraumatic responses and indicators of PTG including perceived positive changes for self, relationships, and life goals. RESULTS: A majority of adolescents and their mothers and fathers reported PTG. Greater perceived treatment severity and life threat, but not objective disease severity, was associated with PTG. PTG and PTSS were positively associated for the adolescent cancer survivors. Diagnosis after age 5 resulted in more perceived benefit and greater PTSS for adolescent survivors. CONCLUSION: Clarification of the concept and measurement of PTG after childhood cancer is warranted, as are prospective studies of the association of PTG and PTSS and the role of demographic variables and illness-specific appraisals.     

‘A blessing and a burden’: Exploring posttraumatic growth in doctors with acquired invisible disability—An interpretative phenomenological analysis

Objectives

Qualitative studies of the relationship between acquired invisible disability (AcqID) and posttraumatic growth (PTG) are scant, especially in the context of healthcare professionals. This study aimed to explore in-depth accounts of the lived experience of PTG in doctors with AcqID arising from physical illness with cognitive dysfunction.

Design

Five doctors who had been diagnosed in the last decade with a physical illness with cognitive dysfunction resulting in an AcqID, and who self-reported at least one feature of PTG participated in this qualitative research study.

Methods

Semi-structured interviews were used to collect data, which were analysed using interpretative phenomenological analysis.

Results

This study recognized that AcqID supported a process of PTG for participants. Three superordinate themes were apparent across the sample: identity (The human left behind), self (Acceptance of the disabled self), and rebirth (The phoenix rises from the ashes). Human connection, service as a value, and the role of the body were found to be key facilitators of PTG in these participants. This study offers new perspectives on cognitive-embodied appreciation in facilitating PTG in doctors with AcqID.

Conclusions

While the participants perceived AcqID with cognitive dysfunction to be a trauma, they also experienced PTG, Corporeal PTG and a new considered domain, Cognitive-Embodied PTG. The unrealised potential of PTG can be harnessed if doctors with disability are viewed as assets to the medical profession, and diversity is promoted through the provision of appropriate support. Thus, there is potential to cultivate a flourishing, inclusive, and compassionate culture within medicine.     

Dissociation as a Mediator of the Relationship Between Childhood Trauma and Nonsuicidal Self-Injury in Females: A Path Analytic Approach

New theoretical models of nonsuicidal self-injury (NSSI) postulate that symptoms subsequent to childhood maltreatment rather than childhood maltreatment itself may lead to engagement in NSSI. However, little is known concerning which specific syndromes serve as underlying mechanisms. In this study we sought to examine the mediating effects of dissociative, posttraumatic, and depressive symptoms, 3 often comorbid syndromes following childhood trauma. In addition, we aimed to assess differences between women with and without NSSI. A sample of 87 female inpatients with a history of childhood abuse and neglect was divided into 2 subgroups (NSSI: n = 42, no NSSI: n = 45). The assessment included measures of NSSI characteristics; adverse childhood experiences; and posttraumatic, dissociative, and depressive symptoms. The NSSI group reported significantly more cases of childhood maltreatment and higher levels of current dissociative, posttraumatic, and depressive symptoms than patients without NSSI. The results of a path analysis showed that only dissociation mediated the relationship between a history of child maltreatment and NSSI when all 3 psychopathological variables were included in the model. The findings point toward a strong and rather specific association between dissociative experiences and NSSI and therefore have important implications for clinical practice.     

Victims of war—Psychoendocrine evidence for the impact of traumatic stress on psychological well-being of adolescents growing up during the Israeli–Palestinian conflict

Violent conflicts are severe traumatic stressors with detrimental effects on physical and mental health, with children and adolescents being particularly at risk. For the hypothalamic–pituitary–adrenal (HPA) axis, characteristic patterns of dysregulation in trauma-exposed individuals have been shown. This study set out to investigate self-reported mental well-being in Palestinian adolescents growing up during the Israeli–Palestinian conflict. Hair cortisol concentrations (HCC) as a psychoendocrine marker for long-term HPA axis aberrations along with the potential protective factor sense of coherence (SoC; i.e., the global mindset to interpret the world and emerging stressors as comprehensible, manageable, and meaningful) were examined. Between 2014 and 2016, posttraumatic stress disorder (PTSD), depression, anxiety, HCC, and SoC were examined in 233 adolescents aged 11 to 16 from the West Bank. More than half of the participants reported trauma exposure, with 40% fulfilling the criteria of a preliminary PTSD diagnosis and a high prevalence of anxiety and depression. HCC was significantly elevated in the PTSD subgroup compared to the subgroup not exposed to any traumatic events (p = 0.046), with trauma-exposed individuals in between. HCC was further associated with typical sequelae of traumatic stress. Notably, SoC was inversely related to self-reported psychopathology, as well as to HCC in the trauma group. The results illustrate the situation of adolescents exposed to chronic traumatic stress and extend the literature on aberrant HPA axis functioning under such conditions. They also point out a central role of SoC, which may imply new strategies to aid individuals exposed to ongoing conflicts.     

Event-Related Household Discussions Following the Boston Marathon Bombing and Associated Posttraumatic Stress Among Area Youth

Despite research documenting the scope of disaster-related posttraumatic stress (PTS) in youth, less is known about how family processes immediately postdisaster might associate with child outcomes. The 2013 Boston Marathon bombing affords a unique opportunity to assess links between immediate family discussions about community trauma and child mental health outcomes. The present study examined associations between attack-related household discussions and child PTS among Boston-area youth ages 4 to 19 following the Marathon bombing (N = 460). Caregivers completed surveys 2 to 6 months postattack about immediate household discussions about the events, child exposure to potentially traumatic attack-related experiences, and child PTS. During the Marathon bombing and manhunt, there was considerable heterogeneity in household discussions across area families, and several discussion items were differentially predictive of variability in children’s PTS. Specifically, after controlling for children’s direct exposure to the potentially traumatic attack/manhunt events, children showed lower PTS when it was their caregivers who informed them about the attack and manhunt, and when their caregivers expressed confidence in their safety and discussed their own feelings about the manhunt with their child. Children showed higher PTS when their caregivers did not discuss the events in front of them, asked others to avoid discussing the events in front of them, and expressed concern at the time that their child might not be safe. Child age and traumatic attack/manhunt exposure moderated several links between household discussions and child PTS. Findings underscore the importance of family communication and caregiver modeling during times of community threat and uncertainty.     

Adaptive style and symptoms of posttraumatic stress in children with cancer and their parents

OBJECTIVE: To examine symptom levels of posttraumatic stress (PTS) in children with cancer and their parents as a function of patient and parent adaptive style. METHOD: Participants included 162 pediatric cancer patients and their parents. Patients completed self-report measures of PTS and adaptive style. Parents reported on their own adaptive style and PTS, as well as levels of PTS in their child. RESULTS: Adaptive style was a significant correlate of PTS. Children identified as low anxious (LA) or repressors (REP) obtained lower levels of PTS than did high anxious (HA) children, both by self-report and parent report. Parents identified as LA or REP self-reported lower levels of PTS than HA and also reported lower levels of PTS in their children. CONCLUSIONS: Patient and parent adaptive style are significant determinants of PTS in the pediatric oncology setting. These findings, in combination with the generally low levels of PTS in the pediatric oncology population, raise questions about the utility of the posttraumatic stress model for understanding the experiences of children with cancer, although such a model may be more applicable to parental response.     

Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: application to operation enduring and Iraqi Freedom veterans

As the newest generation of veterans returns home from their duties abroad, many face the individual and interpersonal aftereffects of duty-related traumatic experiences. Despite the established association between posttraumatic stress disorder (PTSD) and relationship problems, there is a lack of evidence-based conjoint treatments that target both PTSD and relationship distress. Cognitive-behavioral conjoint therapy (CBCT) for PTSD was developed to address this need. The authors summarize knowledge on the association between PTSD and relationship functioning, as well as recent research on veterans and their partners. Following an overview of CBCT for PTSD, the authors present a case study to illustrate the application of CBCT to an Operation Enduring and Iraqi Freedom couple.     

The association between deployment-related posttraumatic growth among U.S. Army soldiers and negative behavioral health conditions

Objectives: This study assessed posttraumatic growth (PTG) in a sample of U.S. Army Soldiers using the Post‐Traumatic Growth Inventory (PTGI), and the relationship between PTG and negative behavioral health (BH) conditions. Design: A sample of Soldiers with prior combat deployment experience (n = 1,834) completed an anonymous survey including demographics, the PTGI, and negative BH conditions. Results: Among previously deployed Soldiers, those reporting the highest number of combat experiences also reported significantly higher overall PTG. A significant inverse relationship was observed between PTG and recent suicidal ideation, whereby Soldiers reporting recent suicidal ideation reported significantly lower overall PTG. Conclusions: This study quantified PTG resulting from deployment and demonstrated the degree to which combat experiences might result in PTG. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–10, 2011.     

Brief report: the impact of maternal posttraumatic stress disorder symptoms and child gender on risk for persistent posttraumatic stress disorder symptoms in child trauma victims

OBJECTIVE: To longitudinally examine the impact of maternal posttraumatic stress disorder symptoms (PTSS) on child adjustment following a child's traumatic injury, focusing on child gender differences. METHODS: Forty-one child traumatic injury victims aged 8-18 years and their biological mothers were interviewed over two follow-ups (6 weeks and 7 months). Children were administered the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for Children and Adolescents (CAPS-CA), whereas mothers completed the CAPS. RESULTS: Six weeks post trauma, maternal PTSS were significantly related to PTSS in boys but not in girls. However, at 7 months, maternal PTSS were strongly related to child PTSS in both boys and girls. Significant 6-week maternal distress-child gender interactions suggested that maternal PTSS, especially avoidance, predicted greater 7-month PTSS but that this was primarily because of a significant relationship in females. CONCLUSIONS: Maternal distress was found to negatively impact subsequent child adjustment, particularly in females. These results underscore the importance of considering family-centered interventions for child PTSD, especially in girls.