Community violence victimization and symptoms of posttraumatic stress disorder: the moderating effects of coping and social support

This study tested the relationship of community violence (CV) victimization to severity of posttraumatic stress disorder (PTSD), and the roles of coping style and perceived social support in moderating that relationship. Three-hundred seventy-two men and women (age 18 to 22 years) self-reported on CV exposure, traumatic experiences, PTSD symptoms, perceived support from family and friends, and coping strategies. Results indicated that high CV victimization, high disengagement coping (i.e., avoidant styles), and low perceived social support from family and friends significantly predicted increased PTSD scores. Significant moderating effects indicated that the relationship between victimization and heightened PTSD severity was stronger at high levels of perceived friend support and disengagement. Thus, the protective function of friend support seemed to break down at increasing levels of victimization, whereas, as expected, avoidant styles of coping increased the risk for negative outcome. Findings are discussed in terms of event controllability, negative social reactions, and coping resources.     

Exposure to interpersonal violence as a predictor of PTSD symptomatology in domestic violence survivors

This study examines the interrelationships between childhood abuse, exposure to maternal domestic violence, and posttraumatic stress disorder (PTSD) symptomatology in a multiethnic sample of 111 adult female residents of a domestic violence (DV) shelter. Participants completed structured interviews about the DV and their prior violence exposure, as well as the Impact of Event Scale-Revised. As hypothesized, there was high co-occurrence between exposure to maternal DV and childhood physical and sexual abuse, and the frequency of lifetime violence exposure predicted PTSD symptomatology. A series of multiple regressions indicated a more complex pattern of relationships, in which specific forms of prior violence exposure predicted different PTSD symptom dimensions. A history of witnessing maternal DV predicted intrusion symptoms, and a history of childhood sexual abuse predicted hyperarousal symptoms. Ethnicity was not related to levels of violence exposure or to PTSD symptoms. Clinical implications of the findings are discussed.     

The Minnesota Multiphasic Personality Inventory-2 Restructured Form and Posttraumatic Stress Disorder: Forensic Applications and Considerations

This paper reviews the empirical literature on the use of the Minnesota Multiphasic Personality Inventory-2 Restructured Form (RF; Ben-Porath and Tellegen 2008; Tellegen and Ben-Porath, 2008) scales for the assessment of posttraumatic stress disorder (PTSD) and PTSD comorbidity and discusses the use of the instrument in forensic contexts. We focus on prior work that has examined the association between the RF scales and PTSD, PTSD comorbidity, and the utility of the RF validity scales for detecting feigned symptoms of PTSD. We conclude that though the MMPI-2 RF scales show expected patterns of association with PTSD, their most useful application in the forensic arena may be in the identification of comorbid personality-based psychopathology, and in detecting symptom overreporting. We recommend that the MMPI-2 RF be used in the context of a comprehensive assessment that includes an exhaustive record review, detailed history with an emphasis on past trauma, and structured diagnostic interviews.     

Posttraumatic Stress Disorder and Removal from Home as a Primary, Secondary, or Disclaimed Trauma in Maltreated Adolescents

Posttraumatic stress disorder (PTSD) is common among maltreated youth but it remains unclear as to whether removal from home is as traumatizing as the maltreatment. This study examined 250 maltreated adolescents aged 11–17?years who were grouped on the basis of whether they (1) endorsed removal from home as their primary traumatic event, (2) endorsed removal from home as a secondary traumatic event, but not their primary traumatic event, or (3) did not endorse removal from home as traumatic. PTSD diagnoses as well as symptoms of PTSD, dissociation, depression, posttraumatic cognitions, and anger expression were measured. Adolescents who endorsed removal from home as their primary traumatic event reported significantly lower levels of PTSD and related symptoms than adolescents in the other groups. The findings are discussed within the context of transactions surrounding removal from home and support previous work that PTSD is a critical concern regarding many maltreated youth.     

Personality Disorder Symptoms in Women as a Result of Chronic Intimate Male Partner Violence

This study explores the personality disorder symptoms of women victims of intimate male partner violence (IPV), after controlling for the contribution of experiences of childhood abuse. Victims of both physical and psychological violence (n = 73) or psychological violence alone (n = 53) were compared with non-abused control women (n = 52). Information about sociodemographic characteristics, childhood abuse, and personality characteristics (MCMI-II) was obtained through face-to-face structured interviews. Women victims of IPV had higher scores than controls in schizoid, avoidant, self-defeating personality scales, as well as in the three pathological personality scales (schizotypal, borderline and paranoid). Both physical and psychological IPV were strongly associated with personality disorder symptomatology, regardless of the effects of childhood abuse. These findings underscore the need to screen for personality disorder symptoms in women victims of IPV when dealing with therapeutic interventions.     

Differences among sexually abused and nonabused youth living with HIV

Risk behaviors were compared between sexually abused and nonabused youth living with HIV (YLH). Abused YLH were significantly more likely to have attempted suicide, to have been admitted into an alcohol and/or drug treatment program, and to have engaged in crack cocaine use than were nonabused YLH and had a greater number of sexual partners. A significantly higher proportion of abused YLH had been incarcerated in contrast to nonabused youth. There were also significantly greater conduct problems among abused YLH. Finally, abused YLH had significantly higher scores on positive action and social-support coping styles than nonabused youth. Consistent with previous research, abused youth are at higher risk for a variety of negative outcomes and are also similar in many respects to sexually abused youth who are not HIV-positive. The high frequencies of two positive styles of coping among abused YLH were also observed.     

Victimization, posttraumatic stress disorder symptomatology, and later nonsuicidal self-harm in a birth cohort

This longitudinal population-based study examined pathways to nonsuicidal self-harm (NSSH) in relation to childhood sexual abuse (CSA), assault victimization in early adulthood, posttraumatic stress disorder symptomatology (PTSD), and other mental disorders. At age 21, 476 men and 455 women completed interviews on assault victimization, PTSD, and other mental disorders. At age 26, they completed independent interviews on self-harm and childhood sexual abuse (CSA). Multivariate logistic regression analyses were conducted to determine predictors for NSSH at age 26. For men, anxiety and depressive disorders at age 21 were the only significant predictors of NSSH at age 26. For women, victimization, PTSD, and other anxiety disorders at age 21 all significantly predicted NSSH. CSA predicted later NSSH only indirectly, by increasing the risk of anxiety disorders among men and of assault victimization among women. In conclusion, pathways to nonsuicidal self-harm differed by sex. For women there were direct links with assault victimization and PTSD in early adulthood, whereas for men only internalizing disorders predicted future NSSH.     

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.     

Adult children of alcoholics: An exploration of Axis II disorders and replicated dysfunctional family patterns

This study examined Axis II personality disorders and replicated dysfunctional family patterns in adult children of alcoholics (ACAs). Parental and spousal confirming and disconfirming communication patterns, and replicated physical, sexual, and emotional abuses were explored. Sixty ACAs were assessed using structured clinical interviews and self-report measures. Sixty-five percent met DSM-IIIR criteria for one or more Axis II disorders. Failure to feel confirmed (valued) by one's alcoholic parent was significantly associated with ACA Axis II disorders and alcohol abuse. Significant relationships between physical and sexual abuses and Axis II pathology were found. Replication of childhood abuse and dysfunctional communication was also noted.     

Mental health correlates of the victim-perpetrator relationship among interpersonally victimized adolescents

This research examines mental health correlates of different victim-perpetrator relationships among adolescent victims of interpersonal violence. A large and nationally representative sample of adolescents (N = 4,023) responded to structured telephone interviews concerning mental health functioning (posttraumatic stress disorder-PTSD, major depressive disorder, substance abuse/dependence, and delinquency). Those reporting histories of sexual (n = 321) and/or physical (n = 688) assault were queried about specific aspects of their assaults, including their relationship with the perpetrator. After controlling for demographic and assault-related risk factors, the victim-perpetrator relationship remained a significant risk factor for mental health problems. Adolescents sexually assaulted by nonstrangers were at increased risk for PTSD; those sexually assaulted by acquaintances or people they did not know well were at increased risk for delinquency. Adolescents who were physically assaulted by a family member were at increased risk for PTSD. Explanations for the findings and the need for consistent assessment methods across related studies are discussed.     

Group Treatment for Spouse Abuse: Are Women with PTSD Appropriate Participants?

Eighty four abused women seeking therapy with their husbands were accepted into a group treatment program for spouse abuse. In the current study, we evaluated the treatment outcome of those women (n = 27) diagnosed with Posttraumatic Stress Disorder (PTSD). PTSD diagnosis, itself, did not differentiate those women who dropped out of treatment. Results indicated, however, that across all women, avoidance symptomatology significantly differentiated treatment completers from dropouts. Although women with PTSD began treatment in worse condition (lower marital satisfaction, higher depressive symptomatology, greater fear of spouse), post-assessment revealed they achieved positive treatment gains parallel to those of women without PTSD. Women with PTSD improved on each outcome variable measured, including a reduction in fear of spouse. Women with PTSD also did not differentially drop out of either treatment condition (men's/women's versus conjoint groups) which lends support to the appropriateness of conjoint treatment for spouse abuse.     

Adolescent Girls’ Use of Avoidant and Approach Coping as Moderators Between Trauma Exposure and Trauma Symptoms

High rates of child maltreatment demand attention, as exposure to child maltreatment substantially increases the risk of developing PTSD. Some evidence exists that the presence of coping skills may reduce the likelihood that victims of childhood maltreatment will develop PTSD (Agaibi & Wilson, Trauma Violence Abuse 6:195–216, 2005). This study examined whether avoidant and/or approach coping skills moderated the relationship between childhood trauma exposure and trauma symptoms among adolescent females with a history of complex trauma. Results suggest that the use of avoidant coping moderates the relationship between trauma exposure and trauma symptoms. More specifically, girls with higher levels of trauma exposure demonstrated lower levels of trauma symptoms if they reported using higher levels of avoidant coping. Clinical implications for these results are discussed.     

Family Context and Childhood Adjustment Associated with Intrafamilial Unwanted Sexual Attention

Unwanted sexual attention (UWSA) encompasses unsolicited verbal comments, gestures, stares, and other noncontact behaviors made regarding one's sexuality and physical appearance. The present study examined the correlates and impact of such UWSA perpetrated toward girls by family members. The first objective of the study was to explore whether family climate is associated with intrafamilial UWSA. This included looking at three types of dysfunctional parenting styles (unaffectionate, unavailable, and patriarchal) as well as exploring the co-occurrence of UWSA by adult and child relatives. The second objective was to then measure the impact of such intrafamilial UWSA on childhood emotional health, after controlling for parenting style and the experience of more traditional forms of child sexual abuse (CSA). Of the 296 university women (mean age = 19) who participated in the study, 70% (N = 206) reported UWSA from a family member prior to age 18. Whereas each dysfunctional parenting style was related to presence of UWSA, a simultaneous multiple regression analysis indicated that two of the parenting styles, patriarchal and parental unavailability, also predicted frequency of nonphysical UWSA within the family. Presence of UWSA from a child relative was significantly correlated with presence of UWSA from an adult relative. Additionally, a hierarchical multiple regression, entering the three parenting styles simultaneously in the first step, childhood sexual abuse in the second step, and familial UWSA in the last step, indicated that the frequency of UWSA by family members significantly predicted poorer childhood mental health when controlling for the other variables. Overall, results indicate that while the specific parenting styles which co-occur with UWSA may be detrimental in their own right, the impact of UWSA on girls appears to be above and beyond that of either parenting styles or CSA. Clinical implications are discussed.     

Intimate partner violence and miscarriage: examination of the role of physical and psychological abuse and posttraumatic stress disorder

Despite research documenting high rates of violence during pregnancy, few studies have examined the impact of physical abuse, psychological abuse, and posttraumatic stress disorder (PTSD) on miscarriage. Secondary analysis of data collected by the Chicago Women's Health Risk Study permitted an exploration of the relationships among physical abuse, psychological abuse, PTSD, and miscarriage among 118 primarily ethnic minority women. The interaction between maximum severity of abuse and age provided the best multivariate predictor of miscarriage rate, accounting for 26.9% of the variance between live birth and miscarriage outcome. Mean scores of psychological abuse, physical violence, forced sex, and PTSD were significantly higher in the miscarriage group than in the live birth group. Women who experience physical violence and psychological abuse during pregnancy may be at greater risk for miscarriage. Prospective studies can confirm findings and determine underlying mechanisms. Routine screening for traumatic stress and PTSD may reduce rates of miscarriage.     

Child sexual abuse, coping responses, self-blame, posttraumatic stress disorder, and adult sexual revictimization

The present study examined the psychological sequelae of child sexual abuse (CSA) and the factors that contributed to revictimization in the form of adult sexual assault (ASA) using a survey of 577 female college students. CSA characteristics, maladaptive coping in response to CSA, degree of self-blame at the time of the abuse and currently, and posttraumatic stress disorder (PTSD) symptoms were examined as predictors of revictimization. Results indicated that individuals who reported both CSA and ASA had more PTSD symptoms, were more likely to use drugs or alcohol to cope, act out sexually, withdraw from people, and seek therapy services. In addition, the revictimized group reported more self-blame at the time of the abuse and currently. The only factor that predicted revictimization in this study was the number of maladaptive coping strategies used. Implications of these findings are discussed.     

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.     

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.     

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.     

An Investigation of Posttraumatic Stress Disorder and Depressive Symptomatology among Female Victimsof Interpersonal Trauma

This study examined factors associated with PTSD-depression comorbidity among a sample of 162 adult female rape or assault victims with PTSD, as well as potential differential predictors of PTSD and depression severity. PTSD-only participants reported higher levels of childhood sexual abuse than those with comorbid PTSD and depression, and the PTSD/MDD group reported relatively more distorted trauma-related beliefs, dissociation, PTSD severity, and depression severity. Distorted trauma-related beliefs and dissociation were the strongest unique predictors of higher PTSD and depressive symptoms. Rates of PTSD and depression comorbidity did not appear to be a function of symptom overlap. Study findings suggest possible explanations for the high PTSD and depression comorbidity rates commonly found among victims of interpersonal violence. This research was supported in part by a grant to Patricia A. Resick from the National Institute of Mental Health (R02-MH51509).