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Psychological Trauma: Theory, Research, Practice, and Policy - Vol 9, Iss 5

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Psychological Trauma: Theory, Research, Practice, and Policy Official Journal of APA Division 56. Psychological Trauma: Theory, Research, Practice, and Policy publishes empirical research on the psychological effects of trauma. The journal is intended to be a forum for an interdisciplinary discussion on trauma, blending science, theory, practice, and policy.
Copyright 2017 American Psychological Association
  • Trauma and deliberate self-harm among inpatient adolescents: The moderating role of anxiety sensitivity.
    Objective: Youth with posttraumatic stress disorder (PTSD) symptoms have significant difficulties regulating affective experiences; as a result, many engage in nonadaptive coping behaviors including deliberate self-harm (DSH). To identify youth with PTSD symptoms who may be most at risk for DSH, this study examined anxiety sensitivity (AS) as a moderator of the relationship between PTSD symptoms and DSH in a diverse sample of psychiatric inpatient youth with a history of potentially traumatic events (PTE). Method: Participants (N = 50; 52.0% female; Mage = 15.1 years, SD = .51; 44% White) completed a test battery that included measures of DSH frequency, depression, AS and PTSD symptomatology. Results: The proposed model accounted for 53.6% of variance in DSH, with PTSD symptoms being a significant predictor (sr2 = .11). The interaction of PTSD symptoms and AS accounted for an additional 4.5% of variance above and beyond covariates and main effects. Simple slopes revealed that the association between PTSD symptoms and DSH was significant for individuals scoring high (b = .25, SE = .06; t(50) = 3.83, p <.01) but not low (b = .03, SE = .10; t(50) = 0.30, p = .765) on the AS. Conclusions: Findings are consistent with theoretical and empirical work suggesting that DSH may be used to reduce emotional distress in the presence of maladaptive cognitive and emotional processes. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Gendered role of appraisals of safety in psychological outcome in relation to trauma.
    Objective: This study investigated gender differences in the role of appraisals of safety in the relationship between exposure to violence and trauma-related symptoms among South African adolescents living in low socioeconomic settings. Limited research exists in developing contexts on the role of cognitive appraisals in mitigating outcome following exposure to violence. Given the prevalence of violence in South Africa and the vulnerability of youth, this type of research is valuable in identifying adolescents at risk of negative psychological outcome following exposure, and in informing intervention efforts. Method: Adolescents (N = 498) completed an adapted version of the Harvard Trauma Questionnaire (Mollica et al., 1992) and the Safety Index (Ward, Flisher, Zissis, Muller, & Lombard, 2001). Results: The results indicate a significant positive relationship between all violence subscales and trauma-related symptoms, whereas a significant negative relationship was found between sense of safety and trauma-related symptoms. Important gender differences were identified in the role of appraisals of safety, with more effects noted for women than men. For men, the obtained results only demonstrated a health-sustaining role. For women, the results indicated a health-sustaining role, an indirect effect, and a stress-reducing role. Conclusion: These findings stress the necessity of gender-specific interventions. Assessment of psychological trauma, particularly among female adolescents, needs to include measures of cognitive appraisals related to safety. Therapeutic techniques that may be particularly beneficial to adolescent girls are those focusing on promoting sense of safety and targeting dysfunctional threat appraisals. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Relating dispositional mindfulness, contemplative practice, and positive reappraisal with posttraumatic cognitive coping, stress, and growth.
    Objective: A growing body of theoretical and empirical work suggests that mindfulness may support more positive posttraumatic outcomes by reducing posttraumatic stress (PTS) and encouraging posttraumatic growth (PTG). Positive reappraisal (PR), a cognitive coping correlate of dispositional mindfulness (DM) has also been linked with greater PTG. However, neither DM nor PR have been modeled in relation to core posttraumatic constructs such as core belief disruption, intrusive rumination, deliberate rumination, PTS and PTG. Method: This study explored associations between these constructs in a sample of college students (N = 505), also investigating the impact of contemplative practice involvement on the relationships between the constructs. Results: Results indicate that including DM and PR into established models of PTG increases the model’s explanatory power, which distinct cognitive coping pathways connect DM and core belief disruption with PTS as well as PTG, and that contemplative practice involvement substantially alters relationships between the core PTG variables. Conclusions: The present study contributes to the growing reconceptualization of trauma as linked with both positive and pathogenic outcomes, emphasizing the need to better understand how posttraumatic cognitive coping strategies contribute to more positive outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • PTSD symptoms and perception of cognitive problems: The roles of posttraumatic cognitions and trauma coping self-efficacy.
    Objective: Posttraumatic stress disorder (PTSD) is associated with mild neurocognitive deficits, yet clients often complain of cognitive problems that exceed what their objective performance demonstrates. In addition, PTSD is associated with negative appraisals about the self, traumatic event, and one’s ability to cope. This study examined posttraumatic cognitions as a moderator, and trauma coping self-efficacy as a mediator, of the relationship between PTSD symptoms and self-report of cognitive problems. Method: A sample of 268 trauma-exposed adults completed the PTSD Checklist for DSM–5, the Posttraumatic Cognitions Inventory, the Trauma Coping Self-Efficacy Scale, the Cognitive Self-Report Questionnaire, and the Quality of Life Scale. Results: Negative self-appraisals was a significant moderator in the relationship between PTSD symptoms and perception of cognitive problems (β = −.252, p = .001). In participants with high levels of negative posttraumatic cognitions, perception of cognitive problems was high regardless of PTSD symptom level. In a mediator analysis, there was a significant indirect effect of trauma coping self-efficacy (b = .125, 95% CI [.088, .172]). Finally, there was evidence of moderated mediation, such that trauma coping self-efficacy was a mediator only when posttraumatic cognitions were low or average. Conclusions: Results indicate that posttraumatic appraisals and coping self-efficacy play significant roles in perception of cognitive problems following trauma. Clinically, in patients for which there is a perception of cognitive impairment that is not borne out in neuropsychological testing, cognitive–behavioral therapy focused on altering negative self-perceptions and appraisals may be beneficial. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Symptoms and beyond: Self-concept among sexually assaulted women.
    Objective: The unique characteristics of sexual assault (SA)—a toxic mix of an interpersonal harm, a violent exploitation of one’s body, and a transformation of an act of connectedness into an act of submission—are postulated to negatively affect the self-concept. We sought to deepen the understanding of self-concept impairments among sexually assaulted women with varying levels of posttraumatic distress. To this end, we compared women with a main trauma of SA to women with a main trauma of motor-vehicle accident (MVA) and to nontraumatized (NT) women on several self-concept aspects. Our main hypotheses were (a) sexually assaulted women without PTSD exhibit impaired self-concept as compared with NT women and (b) SA is related to greater self-concept impairments as compared with MVA, even when posttraumatic distress is statistically controlled. Method: Women (N = 235: NT = 69, MVA = 87, SA = 79) completed a web-based survey including measures designed to assess the global and domain-specific contents and structure of the self-concept as well as background and clinical questionnaires. Results: Sexually assaulted women without PTSD reported impaired self-concept as compared with NT women. Furthermore, SA was related to greater self-concept impairments as compared with MVA, even when considering participants’ levels of posttraumatic distress. Conclusions: SA is related to unique self-concept impairments that extend beyond symptoms, emphasizing the need to assess and address self-concept impairments in sexually assaulted women. The importance of adopting a multifaceted conceptualization of the self to gain a deeper understanding of the aftermath of trauma is highlighted. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Is posttraumatic growth trauma-specific? Invariance across trauma- and stressor-exposed groups.
    Objective: Posttraumatic growth (PTG), or multidimensional positive change following a traumatic event (TE), is conceptualized as qualitatively distinct from growth following a nontraumatic stressful event (NTSE; Tedeschi & Calhoun, 2004; Zoellner & Maercker, 2006). However, the degree to which PTG is a trauma-specific phenomenon has yet to be established. Although research indicates that individuals who experience TEs endorse greater PTG than those who experience NTSEs (Kastenmüller et al., 2012; Tedeschi & Calhoun, 1996), factorial invariance and latent mean differences in PTG between these groups have yet to be examined. Accordingly, the aim of the present study was to extend previous findings by examining the factorial invariance of the Posttraumatic Growth Inventory (PTGI) across groups whose worst stressor was a Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013) Criterion A event or a non-Criterion A event. Method: Participants were 644 undergraduates who reported experiencing a stressful event and completed the Life Events Checklist for DSM–5 (LEC-5) and PTGI. Results: Results indicated that the previously identified 5-factor model of the PTGI provided the best fit, although fit was mediocre. A higher order model significantly worsened model fit and thus was rejected. Unexpectedly, strong factorial invariance and equivalence of latent means were found, indicating that the factor structure and latent means of PTG were identical across groups. Conclusions: Findings indicate that PTG might not be qualitatively or quantitatively distinct from growth due to NTSEs, and TEs and NTSEs elicit similar levels of PTG. Limitations include cross-sectional design. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • When traumatic event exposure characteristics matter: Impact of traumatic event exposure characteristics on posttraumatic and dissociative symptoms.
    Objective: Traumatic events can lead to posttraumatic (posttraumatic stress disorder [PTSD] specific symptoms) and dissociative symptoms (PTSD nonspecific symptoms). However, the trauma exposure characteristics (type of exposure, categorical form, number of exposures and the age of the exposure) are rarely studied. We hypothesized that the characteristics of a traumatic event are the only predictors of specific posttraumatic symptoms (intrusion, avoidance, negative cognitive impairment) and nonspecific symptoms (dissociation). We also hypothesized that some characteristics of a traumatic event are specific predictors of posttraumatic symptoms, whereas other characteristics are predictors of nonspecific symptoms. Method: Three hundred nine university students participated in the study (201 men, 108 women; mean age : 19.32 years). Students completed questionnaires assessing trauma exposure characteristics, PTSD, dissociation, and burnout. Multiple linear regressions were conducted to identify predictive factors for elevated specific PTSD symptoms and elevated nonspecific PTSD symptoms. Results: A different impact of the characteristics of 1 or more traumatic events was observed on specific posttraumatic symptoms. In men, the model was significant, with 6 predictors explaining 14% to 23% of the variance of specific posttraumatic symptoms. In women, 2 predictors explaining 15% to 28% of the variance of posttraumatic symptoms were found. The characteristics of the traumatic event were not the only predictors of posttraumatic symptoms (specific and nonspecific), with emotional exhaustion playing an unexpected predictive role. Conclusions: Burnout and PTSD might share emotional exhaustion as a common risk factor for PTSD. Further studies in this area are warranted, noteworthy focusing on clinical populations. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Trauma, posttraumatic stress disorder symptoms, and dissociative experiences during men’s intimate partner violence perpetration.
    Objective: Research with partner-violent men has found that a subset of this population reports dissociative experiences during their violence (e.g., inability to remember violence [despite admission that it had occurred]; flashbacks during violence). However, the literature examining this phenomenon has been primarily limited to clinical observations and case studies, and there is a need for more thorough empirical investigation regarding the prevalence and correlates of dissociative violence among individuals in intimate partner violence (IPV) intervention programs. The primary goals of this study were to provide descriptive information about the rates of endorsement of dissociative experiences during IPV perpetration and to examine their associations with trauma exposure and posttraumatic stress disorder (PTSD) symptoms. Method: Participants were 302 men presenting for services at a community-based IPV intervention program. All variables were assessed via self-report and clinician interview at program intake. Results: Results indicated that 22.2% of participants reported 1 or more dissociative experiences during partner violence perpetration. Additionally, frequency of dissociative IPV perpetration showed significant positive correlations with the total number of potentially traumatic events (PTEs) reported and PTSD symptoms, with effect sizes in the small and medium ranges of magnitude, respectively. Finally, PTSD symptoms significantly mediated the relationship between total number of PTEs and dissociative IPV perpetration. Conclusions: Findings indicate a potentially meaningful relationship between trauma, PTSD symptoms, and dissociative experiences during IPV perpetration. Further qualitative and quantitative investigation is needed to better understand this phenomenon and how it can be addressed in IPV treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Sex differences in the appraisal of traumatic events and psychopathology.
    Objective: The current study is an investigation of the relationship between the appraisal of traumatic events and mental disorder symptoms: internalizing symptoms and externalizing/substance-abuse symptoms. Cumulative trauma over the lifetime was taken into account. Also, specific effects related to traumatic events of various types (i.e., betrayal trauma, accident involving a family member, physical violence, and natural disaster) were assessed. Participants, 190 young men and 277 young women, were asked to evaluate the strength with which the traumatic event impacted their lives. Method: It was hypothesized that the relationship between traumatic experiences and mental disorder symptoms would be stronger in women than in men, and also that cognitive appraisal, in interaction with gender, would be related to the severity of the symptoms. Results: Women showed higher levels of internalizing symptoms, but lower levels of externalizing/substance-abuse symptoms than men. Still, the correlation between cumulative trauma and both types of symptoms was stronger in women. For all types of trauma, women reported a stronger negative appraisal of the event than men. Interaction of sex and cognitive appraisal was demonstrated to be related to the severity of internalizing disorders. Conclusion: In the present study, women, as compared with men, evaluated traumatic events more negatively (for all types of trauma) and the relationship between trauma and mental disorder symptoms was also stronger in women. These results show the importance of the appraisal of trauma in the development of psychiatric symptoms in women and men following trauma. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Adverse childhood experiences and risk for suicidal behavior in male Iraq and Afghanistan veterans seeking PTSD treatment.
    Objective: Adverse childhood experiences (ACEs) are associated with increased risk for suicide and appear to occur in disproportionately high rates among men who served in the U.S. military. However, research has yet to examine a comprehensive range of ACEs among Iraq/Afghanistan veterans with combat-related posttraumatic stress disorder (PTSD) or whether these premilitary stressors may contribute to suicidal behavior in this highly vulnerable population. Method: A sample of 217 men entering a residential program for combat-related PTSD completed measures for ACEs, combat exposure, and lifetime suicidal ideation and attempts. Results: The majority of patients had experienced multiple types of adversity or traumas during childhood/adolescence. In particular, 83.4% endorsed at least 1 ACE category and 41.5% reported experiencing 4 or more ACEs. When accounting for effects of deployment-related stressors, we further found that accumulation of ACEs was uniquely linked with thoughts of suicide or attempts among these patients. Namely, for every 1-point increase on the ACE Questionnaire, veterans’ risk of suicidal ideation and attempts increased by 23% and 24%, respectively. Conclusion: This brief report provides initial evidence that veterans seeking treatment for combat-related PTSD often have extensive histories of premilitary stressors that may increase suicide risk beyond probable deployment-related traumas. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Consequences of violence across the lifespan: Mental health and sleep quality in pregnant women.
    Objective: Research has demonstrated that exposure to violence and adversity has negative effects on both mental health and biobehavioral outcomes, such as sleep health. Research examining the relationship between past and recent violence exposure and mental health suggests that the effects of childhood adversity are especially pernicious, but to date, no studies have attempted to disentangle the direct, indirect and relative effects of past year versus childhood exposure to violence and adversity on sleep. The objective of the current study was to examine the direct effects of adverse childhood experiences (ACEs) and past year intimate partner violence (IPV) on different aspects of sleep health in pregnant women. Method: A sample of high-risk pregnant women (n = 101) were interviewed. Mediation analysis with bias-corrected, bootstrapped confidence intervals was used to evaluate direct and indirect effects. Results: Findings indicated that while ACEs had significant direct effects on mental health, past year IPV had stronger effects on sleep quality, latency, and efficiency. ACEs did, however, indirectly affect subjective sleep quality via past year psychological IPV. Conclusion: These findings suggest that sleep disturbance may be a regulatory stress response that is most clearly linked to past year violence and trauma. That is, though long-term sleep disturbance may be evident following childhood adversity, it is likely that this relationship is better explained by the role of childhood adversity in predicting adulthood revictimization or due to long-term mental health difficulties associated with early trauma. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Lifetime history of suicidal ideation and attempts among incarcerated women in israel.
    Background: Evidence indicates that rates of death by suicide are higher among female inmates compared with male inmates and the general population. Despite the high rate of lifetime suicidality, little is known about the predictors of suicidality for these women. Objective: The purpose was to examine sociodemographic, criminological, and psychological variables associated with a history of suicidal ideation and suicide attempts among incarcerated women. Method: This cross-sectional study investigated a history of suicidal ideation and suicide attempts in a sample of 46 Israeli incarcerated women. Participants completed a confidential interview that included the Addiction Severity Index, the Renard Diagnostic Interview, self-report measures of the Childhood Trauma Questionnaire, and the presence of symptoms of depression. Results: More than half of the women reported a history of suicidal ideation or attempts. Those who reported such a history were characterized by a high prevalence of childhood victimization, early onset of substance abuse, high prevalence of mental health problems, and high prevalence of mental health problems in the family. Child abuse, depression, and family mental health problems are related to suicidal ideation and attempts in incarcerated women. Conclusions: As the number of women with mental health concerns entering prison grows, corrections staff are faced with increasing challenges to provide services that mitigate the risk of death by suicide. Inquiring about childhood abuse and symptoms of depression and mental health problems, as well as providing treatment for the emotional impact of trauma exposure, may reduce the risk of suicidality in this population. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Longitudinal analysis of quality of life across the trauma spectrum.
    Objective: Few longitudinal studies have examined the relationship between trauma exposure and posttraumatic stress disorder (PTSD) in relation to quality of life or have been designed to consider the relationships between trauma, PTSD diagnosis, and quality of life in terms of both global scores and specific domains. This article aims to provide an essential longitudinal examination of the effects of trauma and PTSD diagnosis on global as well as specific domains of quality of life in a Canadian sample to better understand the diagnosis and unveil possible routes of research and successful treatment methods for the future. Method: Data were drawn from the initial two waves of the Zone d’étude en épidémiologie sociale et psychiatrique du sud-ouest de Montréal (ZEPSOM), an epidemiological catchment area study based in southwest Montréal (N = 2,433 at Wave 1 and N = 1,823 at Wave 2). PTSD diagnosis and global and subscale scores of quality of life outcomes were established by face-to-face structured interviews using standardized instruments. Outcomes were compared among 3 trauma/PTSD categories and healthy controls. Results: This study extends previous cross-sectional findings within the catchment area by demonstrating that the effects of current PTSD diagnosis on quality of life endure with time. Specifically, the negative impact of current diagnosis of PTSD on Wave 2 quality of life is expressed through its influence on Wave 1 quality of life. Subscale findings are discussed. Conclusion: Research needs to focus on understanding more than just global indices of quality of life when it comes to the trauma spectrum. Additional research remains necessary to fully understand these complex relationships over time. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • The relationship between childhood abuse and violent victimization in homeless and marginally housed women: The role of dissociation as a potential mediator.
    Objective: Previous studies have established a link between childhood abuse and dissociation. Other work has shown childhood abuse increases the likelihood of violent victimization in adulthood. Although it has been posited that dissociation may mediate childhood abuse and adult violent victimization, research investigating this hypothesis is sparse, particularly for extremely vulnerable populations such as homeless and unstably housed individuals. investigated the relationship between childhood abuse and dissociation on violent victimization in a cohort of homeless and unstably housed women. We also assessed whether dissociation mediated childhood abuse and violent victimization in this sample. Method: Participants were asked at an initial assessment and a 6-month follow-up to report any physical or sexual violence experienced in the previous 6 months. Questionnaires recording history of specific types of childhood abuse, dissociation, and other factors were also recorded at the initial assessment. Results: Hierarchical logistic regression models revealed that childhood sexual abuse (Odds ratio [OR] = 3.10, p <.01) and severe dissociation (OR = 1.99, p <.01) were significantly associated with recent physical violence, and childhood sexual abuse (OR = 3.88, p <.01) and dissociation (OR = 1.87, p <.05) were also associated with recent sexual violence. Dissociation mediated neither childhood abuse on recent physical violence or recent sexual violence. Conclusion: Developing approaches that effectively identify and treat dissociation as a part of an overall framework of trauma-informed care in homeless and unstably housed women may be an effective way to decrease future physical violence in this vulnerable population. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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  • Mother–child interactions at six months postpartum are not predicted by maternal histories of abuse and neglect or maltreatment type.
    Objective: A history of childhood maltreatment (CM) is associated with increased rates of maternal psychiatric symptoms and other adverse outcomes in adulthood among postpartum women. However, to date only a few studies have examined associations between CM and mother–child interactions among a nonclinical sample of postpartum women, and the specific potential influence of the type of abuse or neglect is poorly understood. This study was an aim to examine the relationships between CM types and observed parenting in a nonclinical group of recently postpartum mothers with maltreatment histories. Method: Participants were 173 postpartum, nonclinically referred mothers oversampled in the community for CM histories (n = 123, 72%) and their infants who underwent high- and low-stress interactive tasks during their 6-month postpartum visits, which were videotaped for later independent coding on hostile, controlling, and positive parenting. Mothers also provided information on demographics and type of CM they had experienced (i.e., emotional, sexual, physical abuse, and neglect). Differences of maternal parenting by history of CM and specific type were analyzed via 2-way univariate general linear models. Results: Inconsistent with a priori hypotheses, no significant differences emerged between overall CM severity or exposure to any particular CM type and hostile, controlling, or positive parenting in the high- or low-stress tasks. Conclusion: Findings suggest that nonclinical postpartum women with CM histories show resilience regarding postpartum parenting quality and do not differentiate from non-CM maltreated postpartum mothers. We discuss the potential influence of resilience, moderating factors, clinical implications, and recommendations based on our findings. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
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