Multiple traumatic experiences and the development of posttraumatic stress disorder

This study assesses the differential and combined impacts of multiple lifetime stressors in the development and severity of posttraumatic stress disorder (PTSD) symptoms. One hundred and four clinical and 64 nonclinical participants were assessed for their exposure to four types of interpersonal trauma: physical and sexual abuse in childhood, lifetime community violence, and domestic violence in adulthood. PTSD symptomatology was assessed using the Los Angeles Symptom Checklist (LASC). Results indicated that exposure to lifetime multiple traumatic experiences was positively correlated with severity of PTSD symptoms. Clinical participants had experienced significantly more multiple traumas and had a higher rate of PTSD than the nonclinical participants. Results also suggested that adults who had experienced childhood sexual abuse were at higher risk for the development of PTSD related to interpersonal violence than adults who were not sexually abused as children.     

Isolating Adult Psychological Correlates of Witnessing Parental Violence: Findings from a Predominantly Latina Sample

This study examined the relationship between childhood exposure to parental violence and adult psychological functioning in a sample of predominantly Mexican American participants. Questionnaires assessing childhood maltreatment, family environment, and current psychological symptomatology were completed by 142 female undergraduates. Findings revealed that witnessing parental violence in childhood was associated with depressive symptoms, low self-esteem, and trauma symptoms in adulthood, even after controlling for child physical and sexual abuse. However, in subsequent analyses, also controlling for levels of nonphysical family conflict, previous associations between exposure to parental violence and adult symptomatology were reduced, such that trauma-related symptoms remained the sole outcome still predicted by a history of witnessing parental violence. Implications of these findings, issues related to the use of statistical control procedures in abuse effects research, and directions for future investigation are discussed.     

Is Domestic Violence Learned? The Contribution of Five Forms of Child Maltreatment to Men's Violence and Adjustment

On the basis of a learning-theory approach to the intergenerational transmission of violence, researchers have focused almost exclusively on violent men's childhood experiences of physical abuse and witnessing family violence. Little consideration has been given to the coexistence of other forms of child maltreatment or the role of family dysfunction in contributing to violence. This study shows the relationships between the level of child maltreatment (physical abuse, psychological maltreatment, sexual abuse, neglect, and witnessing family violence), childhood family characteristics, current alcohol abuse, trauma symptomatology, and the level of physical and psychological spouse abuse perpetrated by 36 men with a history of perpetrating domestic violence who had attended counseling. As hypothesized, a high degree of overlap between risk factors was found. Child maltreatment, low family cohesion and adaptability, and alcohol abuse was significantly associated with frequency of physical spouse abuse and trauma symptomatology scores, but not psychological spouse abuse. Rather than physical abuse or witnessing family violence, childhood neglect uniquely predicted the level of physical spouse abuse. Witnessing family violence (but not physical abuse) was found to have a unique association with psychological spouse abuse and trauma symptomatology. These results present a challenge to the understanding of domestic violence obtained from learning theory.     

Domestic violence in Puerto Rican gay male couples: perceived prevalence, intergenerational violence, addictive behaviors, and conflict resolution skills

Domestic violence (DV) is a pattern of behaviors in the context of an intimate relationship, which can be manifested in emotional, physical, or sexual abuse. DV currently represents a social and a public health issue. This study is an effort to foster a better understanding of DV among same-sex couples. In it, the authors included the participation of 199 Puerto Rican gay males to identify prevalence of DV, violence in their family of origin, participants' addictive behaviors and exposure to violence at childhood, and their conflict resolution skills. Participants were relatively young, highly educated Puerto Rican gay men who reported a high level of domestic violence in their relationships. This violence was identified as emotional violence by 48% of the participants. This sample reported high levels of violence among their families of origin and low conflict resolution skills.     

Relationship between type of trauma exposure and posttraumatic stress disorder among urban children and adolescents

This study examines the association between trauma exposure and posttraumatic stress disorder (PTSD) among 157 help-seeking children (aged 8-17). Structured clinical interviews are carried out, and linear and logistic regression analyses are conducted to examine the relationship between PTSD and type of trauma exposure controlling for age, gender, and ethnicity. Confrontation with traumatic news, witnessing domestic violence, physical abuse, and sexual abuse are each significantly associated with PTSD. Witnessing a crime, being the victim of a crime, and exposure to accidents, fire, or disaster are not associated with PTSD. These findings underscore the association between interpersonal violence and childhood PTSD.     

The Relationships Between Childhood Sexual Abuse,Social Anxiety,and Symptoms of Posttraumatic Stress Disorder in Women

The relationships between childhood sexual abuse, social anxiety, and symptoms of posttraumatic stress disorder were examined in a sample of 313 undergraduate women. Thirty-one percent of the women reported some form of sexual abuse in childhood. Women with a history of sexual abuse reported more symptoms of anxiety, distress in social situations, and posttraumatic stress disorder than other women. Women who experienced attempted or actual intercourse reported more avoidance than women with no history of abuse and women with exposure only, and more PTSD symptoms than all other groups of women. Women who experienced fondling reported more PTSD symptoms than women with no history of abuse. Pressure, age of onset of abuse, abuse by a family friend, and abuse by other perpetrators were all significant abuse characteristics in predicting adult social anxiety. Implications of these results for research and interventions are discussed.     

Cumulative experiences of violence among high-risk urban youth

This study examines type-specific and cumulative experiences of violence among a vulnerable population of youth. Sixty high-risk, shelter-dwelling, urban youth were interviewed regarding their history of childhood maltreatment, exposure to community violence (ECV), and experience with intimate partner violence (IPV). Results show a high prevalence and high degree of overlap among multiple types of violence exposure. Childhood physical, sexual (CSA), and emotional (CEA) abuse were interrelated and were associated with ECV. Cumulative experiences of childhood abuse (CCA) had a graded association with IPV victimization. In multivariate analyses, CCA and ECV were independently associated with IPV victimization. Gender moderated the effect of one association: CEA raised the risk of IPV victimization for girls but not for boys. Only CSA predicted IPV perpetration. Findings suggest that cumulative exposures to violence create cumulative risk for experiencing more violence. Shelter-dwelling, urban youth may be particularly vulnerable to this additive effect.     

Sexual Harassment and Posttraumatic Stress Disorder: Damages Beyond Prior Abuse

This study examined the extent to which harassment experiences correlate with posttraumatic stress disorder (PTSD) symptoms, and whether diagnosable PTSD on the basis of sexual harassment occurs after accounting for prior PTSD, prior sexual abuse, and prior psychological dysfunction. The sample consisted of a two-wave panel of 445 women who had received a domestic violence protective order from a Kentucky court. Hierarchical linear and logistic analyses confirmed that sexual harassment experiences were significantly correlated with PTSD symptoms after controlling for an extensive set of trauma variables measured in both the baseline and follow up interviews. Our findings lend further evidence that claims of PTSD from sexual harassment may be credible even if claimants have been victims of other forms of trauma.     

Factors Associated with Domestic Violence and Sexual Assault Victimization

This study explored factors associated with a lifetime history of domestic violence and sexual assault in a sample of welfare recipients in Illinois. Results indicate that childhood exposure to domestic violence is a risk factor for both sexual assault and domestic violence victimization, but that childhood physical abuse is only a risk factor for domestic violence. Increased education and employment skills and having more children were also risk factors for domestic violence victimization. Domestic violence was significantly associated with depression, while sexual assault was associated with low social support and a greater perceived need for mental health services. Frequent alcohol and drug use were not associated with either type of victimization. Research implications are discussed.     

The Impact of Child Abuse History, PTSD Symptoms, and Anger Arousal on Dating Violence Perpetration Among College Women

Preliminary research suggests that child abuse is indirectly associated with female-perpetrated intimate partner violence via posttraumatic stress disorder (PTSD) symptoms and anger. To date, however, no known studies have investigated these relationships for physical and psychological dating violence within a female college sample. Therefore, the purpose of the current study was to examine the impact of child abuse history, PTSD symptoms, and anger arousal on female-perpetrated physical and psychological dating violence. Female undergraduates (N = 496) completed measures of child abuse, PTSD symptoms, anger arousal, and dating violence perpetration as part of a larger trauma and violence study. Results indicated that child abuse directly predicted female-perpetrated physical and psychological dating violence and indirectly impacted female-perpetrated physical and psychological dating violence via PTSD symptoms and anger arousal. The direct relationships between PTSD symptoms and female-perpetrated physical and psychological dating violence were nonsignificant after controlling for the effect of anger arousal.     

Psychopathology in women arrested for domestic violence

This study examined the prevalence of psychopathology among women arrested for violence and whether the experience of intimate partner violence (IPV) was associated with Axis I psychopathology. Women who were arrested for domestic violence perpetration and court referred to violence intervention programs (N= 103) completed measures of IPV victimization, perpetration, and psychopathology. Results revealed high rates of posttraumatic stress disorder (PTSD), depression, generalized anxiety disorder (GAD), panic disorder, substance use disorders, borderline personality disorder, and antisocial personality disorder. Violence victimization was significantly associated with symptoms of psychopathology. Logistic regression analyses showed that sexual and psychological abuse by partners were associated with the presence of PTSD, depression, and GAD diagnoses. Results highlight the potential importance of the role of violence victimization in psychopathology. Results suggest that Axis I and Axis II psychopathology should routinely be assessed as part of violence intervention programs for women and that intervention programs could be improved by offering adjunct or integrated mental health treatment.     

Emotion Regulation Mediates the Relationship between a History of Child Abuse and Current PTSD/Depression Severity in Adolescent Females

Although experiencing child abuse (i.e., physical abuse, sexual abuse, exposure to violence) is associated with a variety of mental health difficulties, simple exposure to abuse does not produce symptoms in every individual. The current study explored emotion regulation as a mediator in the relationship between a history of child abuse and symptoms of posttraumatic stress and depression. Adolescent females (ages 11–17 years) were asked to retrospectively report on their exposure to child abuse, current symptoms of PTSD/depression, and emotion regulation abilities. Caregiver report of adolescent emotional difficulties was also obtained. Analyses revealed that child abuse-exposed females, when compared to females without a trauma history, had worse emotion regulation abilities and increased mental health difficulties. Moreover, emotion regulation significantly mediated the relationship between child abuse and all assessed mental health symptoms. These findings extend previous work from adult samples, underscoring the importance of assessing emotion regulation abilities in abuse-exposed youth.     

Posttraumatic Stress Disorder and Depression in Battered Women: The Mediating Role of Learned Helplessness

Learned helplessness (LH) may mediate the link between violence exposure and mental disorders in battered women. This study evaluated the contribution of LH to Posttraumatic Stress Disorder (PTSD) and major depression (MDD) in women with prolonged exposure to partner violence in 101 residents of shelters for battered women in Israel. DSM-IV axis-I disorders were assessed by a structured clinical interview. Self-report questionnaires evaluated exposure to violence, symptoms of PTSD and depression, LH, history of child abuse, SES and the extent of male-dominance and prejudice against women in the participants prior socialization background. LH significantly mediated the effect of violence on PTSD and depression symptoms. Male-dominated background contributed to LH. Thus, LH may increase the risk of mental disorders in battered women and should be addressed in interventions designed to reduce the burden of mental illness in this population.     

Revictimization and self-harm in females who experienced childhood sexual abuse: results from a prospective study

Lifetime trauma histories were ascertained for females with confirmed histories of childhood sexual abuse and comparison females participating in a longitudinal, prospective study. Abused participants reported twice as many subsequent rapes or sexual assaults (p = .07), 1.6 times as many physical affronts including domestic violence (p = .01), almost four times as many incidences of self-inflicted harm (p = .002), and more than 20% more subsequent, significant lifetime traumas (p = .04) than did comparison participants. Sexual revictimization was positively correlated with posttraumatic stress disorder symptoms (PTSD), peritraumatic dissociation, and sexual preoccupation. Physical revictimization was positively correlated with PTSD symptoms, pathological dissociation, and sexually permissive attitudes. Self-harm was positively correlated with both peritraumatic and pathological dissociation. Competing theoretical explanations for revictimization and self-harm are discussed and evaluated.     

Adult psychopathology and intimate partner violence among survivors of childhood maltreatment

Childhood maltreatment is associated with psychopathology and revictimization in adulthood. Whether different types of childhood maltreatment have different long-term consequences, however, is largely unknown. The participants in this study included 42 female victims of intimate partner violence and 30 women with no history of serious trauma. These women completed measures of their trauma history, current psychological symptoms, and severity of current abuse. Regression-based techniques were used to assess the relationships among these constructs. Childhood maltreatment was associated with current distress and current conflict in relationships. There was a positive relationship between number of types of childhood traumatization and psychopathology. Symptoms of post-traumatic stress disorder (PTSD) and depression were negatively associated with current relationships involving physical assault. This work underscores the importance of assessing multiple types of childhood maltreatment and of considering the cumulative effects of such experiences.     

Self-injurious behaviors, PTSD arousal, and general health complaints within a treatment-seeking sample of sexually abused women

Eighty-nine adult female survivors of childhood sexual abuse, presenting for psychological treatment, were assessed for self-reported rates of self-injurious behaviors (SIB), health complaints, and posttraumatic stress disorder (PTSD) symptoms of physiological arousal. A composite measure of current SIB was significantly and positively associated with health complaints, PTSD arousal, and three measures of sexual abuse severity: age of onset for sexual abuse, injury experienced during the sexual abuse, and perceived life threat. Tests of mediation revealed that symptoms of PTSD arousal mediated the relationship between earlier age of onset for sexual abuse and SIB. PTSD arousal moderated the relationship between sexual-abuse-related injury and SIB. SIB was a unique predictor of health complaints, even after controlling for sexual abuse severity and PTSD arousal.     

Factors that contribute to the improvement in maternal parenting after separation from a violent husband or partner

The authors test the hypothesis that separation from a violent husband or partner improves maternal parenting in Japan and examine how childhood abuse history (CAH), experience of domestic violence (DV), mental health problems, husband or partner's child maltreatment, and other demographic factors affect maternal parenting after such separation. A self-administered questionnaire survey is conducted for mothers (n = 304) and their children (n = 498) staying in 83 mother-child homes in Japan to assess the mothers' CAH, DV experiences, current mental health problems, and exposure to a husband or partner's child maltreatment. The authors also assess maternal poor parenting (physical and psychological abuse, neglect, no playing, and no praise) before and after admission into the mother-child homes. The total poor parenting score (specifically for neglect, no playing, and no praise) significantly reduces after separation from a violent husband or partner (p = .001, paired t test). However, scores for psychological abuse significantly increase after admission (p < .001, paired t test). CAH, DV, and mental health problems are not associated with a reduced total poor parenting score after admission. Husband or partner's child maltreatment is independently significantly associated with a reduced maternal poor parenting score: A 10% increase in such maltreatment is associated with a 5% reduction in the poor parenting score after separation. Marital status also contributes to the score reduction: The reduction is less in married or divorced mothers than in those who did not marry the partner. Mother-child homes might be useful for improving maternal parenting. Further study is needed to elucidate the mechanism of the impact of separation from a violent husband or partner on maternal parenting.     

Childhood Sexual Abuse and Intimate Partner Violence among Women in Methadone Treatment: A Direct or Mediated Relationship?

Women in substance use treatment report rates of childhood sexual abuse and intimate partner violence that far exceed those reported by women in the general population. Previous research with nonrandom samples of women in substance use treatment suggests that there is a statistically significant relationship between childhood sexual abuse and intimate partner violence; however, little is known about the mechanisms of risk between these two public health concerns among this population of women. To address this gap in knowledge and to inform intervention strategies, this study examined direct and mediated relationships between childhood sexual abuse and intimate partner violence risk among a random sample of 416 women in methadone treatment. In addition to high rates of childhood sexual abuse (57.9%), intimate partner violence (lifetime prevalence, 89.7%; 6-month prevalence, 78.4%), posttraumatic stress disorder (PTSD, 28.6%), and global psychological distress (19.5%), findings suggest that the relationship between childhood sexual abuse and intimate partner violence is mediated by mental health problems and that women experiencing PTSD or global psychological distress are 2.7 and 2.4 times more likely to experience intimate partner violence than women without such experiences, respectively. Although not a mediator in this relationship, financial independence reduced women's risk of partner violence by two-thirds. The paper includes discussion of social learning and stress and coping theories to explicate the findings and to inform intervention strategies. This study is based, in part, on the first author's dissertation. A previous version of this paper was presented at the Society for Social Work and Research Annual Conference held in January 2005 in New Orleans, Louisiana. The following grants provided funding for this study: R01DA11027 and 3T32MH014623-22S1.     

Substance use and PTSD symptoms impact the likelihood of rape and revictimization in college women

The present study utilized a mixed retrospective and prospective design with an 8-month follow-up period to test a model of revictimization that included multiple childhood (i.e., child sexual, physical, and emotional abuse) and situational variables (i.e., substance use, sexual behavior) for predicting rape among 276 college women. It was of particular interest to determine whether traumatic responses (e.g., posttraumatic symptomatology or risky behavior) increased vulnerability for revictimization. During the 8-month follow-up period, 9% of participants were raped; 88% of assaults involved substance use by the victim. Posttraumatic stress disorder (PTSD) symptomatology predicted rape, substance use, and sexual behavior. Substance use, but not sexual behavior, mediated the relation between PTSD symptomatology and rape during the follow-up period. Sexual behavior indirectly impacted risk for rape via substance use. Results suggest that college women with PTSD symptomatology may be at greater risk for rape if they use substances to reduce distress.     

A prospective analysis of the relationship between childhood sexual victimization and perpetration of dating violence and sexual assault in adulthood

The majority of studies evaluating the relationship between childhood sexual assault and subsequent sexual assault perpetration by men have been conducted retrospectively and with incarcerated populations. The present study seeks to improve on previous research by prospectively investigating the relationship between childhood sexual assault and subsequent perpetration of dating violence in adulthood in men. Although there is a significant relationship between childhood sexual abuse and history of sexual assault perpetration at baseline, prospective analyses indicate that childhood sexual assault is not predictive of perpetration during the follow-up period. The role of family factors, including parental conflict resolution, is implicated in subsequent sexual aggression. These results are supportive of the idea that the effects of childhood sexual abuse may be mediated by a variety of factors.