Posttraumatic anger, recalled peritraumatic emotions, and PTSD in victims of violent crime

A mixed cross-sectional and longitudinal design was employed to explore the association between posttraumatic anger and posttraumatic stress disorder (PTSD; symptoms) in victims of civilian violence. It was speculated that this relationship is mainly due to concurrent recalled peritraumatic emotions. Such emotions may be interpreted to result from anger-rooted threat perceptions and to share similarities with posttraumatic intrusion symptoms. In addition, predictors of PTSD maintenance were investigated. Cross-sectional data indicated that posttraumatic anger and several indices of PTSD were highly interconnected. Recalled peritraumatic emotions partly accounted for the relation between posttraumatic anger and posttraumatic intrusions (n = 177). Only posttraumatic intrusions were associated with PTSD symptom persistence at follow-up (n = 56). Findings were discussed in light of study limitations and directions for future research.     

Associations between expectancies of alcohol and drug use, severity of partner violence, and posttraumatic stress among women

Women who experience recurrent intimate partner violence (IPV) may use alcohol or drugs because they expect that these substances will help them cope with the negative physical and psychological sequelae of IPV. However, expectancies for alcohol and drug use have not been explored among this population of women. We used the Relaxation and Tension-Reduction Scale, Arousal and Aggression Scale, and Social Assertion Scale of the Alcohol Expectancy Questionnaire and modified its items to assess both alcohol and drug expectancies of 212 community-based, IPV-exposed women. Results of bivariate correlations showed that greater alcohol and drug expectancies were significantly correlated with greater alcohol problems and greater posttraumatic stress total and symptom severity scores. Results of a multivariate regression model showed that after controlling for demographic characteristics and history of childhood trauma, Relaxation and Tension- Reduction expectancies were associated with number of days of alcohol use, alcohol problems, physical and sexual IPV severity scores, and posttraumatic stress total and reexperiencing symptom severity scores. Expectancies do not significantly moderate the relationships between IPV, posttraumatic stress, and problematic alcohol and drug use. Given the strong relationships of expectancies with IPV severity, posttraumatic stress, and alcohol problems, expectancies may serve as targets for interventions to reduce alcohol use and problems and improve health-related outcomes in IPV-exposed women.     

Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth

This study examined childhood gender atypicality, lifetime victimization based on sexual orientation, and current mental health, including trauma symptoms and posttraumatic stress disorder (PTSD), among 528 lesbian, gay, and bisexual youth. Nearly 80% reported verbal victimization, 11% physical, and 9% sexual, with males reporting significantly more victimization. Victimization began, on average, at age 13. Verbal attacks occurred as early as age 6, physical attacks at 8, and sexual attacks at 9. Youth who were considered gender atypical in childhood reported more victimization and more current mental health symptoms. PTSD was found in 9% of youth and was associated with past physical victimization.     

Posttraumatic stress disorder following ethnoreligious conflict in Jos, Nigeria

In September 2001, ethnoreligious rioting occurred in Jos, Nigeria. Using a multistage cluster sampling technique, 290 respondents were recruited in Jos 7 to 9 months after the riot. Data were collected regarding demographics, exposure to traumatic events, and psychological symptoms. Resting pulse and blood pressure were recorded. A total of 145 (52.5%) witnessed or were victims of personal attacks, 165 (59.6%) lost their possessions, 56 (20.7%) had their homes burned, 44 (16.2%) witnessed relatives' deaths, and 8 (2.9%) were robbed. A total of 252 (89.7%) of the respondents met reexperiencing criteria, 138 (49.1%) met avoidance criteria, and 236 (84.0%) met arousal criteria for posttraumatic stress disorder (PTSD). A total of 116 (41%, 95% confidence interval [CI] = 36% to 47%) met all three categories for PTSD. Only personal attacks (adjusted odds ratio = 2.8, 95% CI = 1.7 to 4.7) and a heart rate of 90 beats/min or more (adjusted odds ratio = 2.8, 95% CI = 1.4 to 5.8) were significantly related to PTSD in a multivariate model.     

Psychological abuse and posttraumatic stress symptoms in college students

Research suggests that among college students, physical and sexual abuse in intimate relationships are associated with posttraumatic stress. Psychological abuse occurs in intimate relationships among college students, and though there is evidence that such abuse has a negative emotional impact, posttraumatic stress has not been extensively researched as an outcome in this population. The purpose of this study is to determine the associations of past-year psychological abuse with posttraumatic stress symptoms while controlling for other types of past-year relationship abuse and lifetime trauma history. The sample consists of 191 college men and women (81.7% women and 89.5% White). Linear regression analyses demonstrate that trauma history, but not past year relationship violence, is a significant predictor of PTSD symptom severity for women, and neither set of variables significantly predicts PTSD symptom severity for men. Implications for future research are discussed.     

Symptom Validity Testing in Claimants with Alleged Posttraumatic Stress Disorder: Comparing the Morel Emotional Numbing Test, the Structured Inventory of Malingered Symptomatology, and the Word Memory Test

In independent medical examinations, unjustified claims of posttraumatic stress disorder (PTSD) are to be expected at an increased rate. In a prospective study, consecutive cases of patients claiming PTSD who underwent independent neuropsychiatric evaluation were analyzed. For 61 adult patients, results of three symptom validity tests (Morel Emotional Numbing Test, Structured Inventory of Malingered Symptomatology, and Word Memory Test) were available. Seventy percent of all claimants showed probable negative response bias in at least one of the three tests, 25% in all three tests. High probability of negative response bias was associated with symptom overreporting and demonstration of cognitive deficits in performance tests. The results indicate that high rates of uncooperativeness must be expected in civil forensic patients with claimed PTSD. A multi-method approach to the assessment of response distortion in PTSD claimants is indicated.     

Treatment of human-caused trauma: attrition in the adult outcomes research

Attrition or dropout is the failure of a participant to complete, comply, or the prematurely discontinuation or discharge from treatment, resulting in lost data and affecting outcomes. This review of 10 years of adult posttraumatic stress disorder (PTSD) treatment outcome literature specific to Criterion A events of human origin examines how attrition is defined and addressed, methodologically and statistically. Of the 13 experimental or quasi-experimental studies, 11 report attrition information. Compared to treatment completers, attriters more often had elevated pretest scores on PTSD and other symptom measures. The characteristics of dropouts given the intentional nature of the traumatic events reviewed in this study are shared to inform clinical practice. Recommendations for consistent methods in examining, analyzing, and interpreting treatment outcome data are also discussed.     

Structural validity of the posttraumatic stress disorder checklist among college students with a trauma history

The authors conducted confirmatory factor analyses to test three-factor and four-factor models of posttraumatic stress disorder (PTSD) using the PTSD Checklist with college students reporting a traumatic event history. The authors found support for the three-factor DSM-IV-based PTSD diagnostic model including reexperiencing, avoidance/numbing, and hyperarousal symptom factors, with slightly better support for a four-factor model separating the avoidance and numbing factors. Results further attest to the PTSD Checklist's construct validity, and to research finding that PTSD avoidance and numbing constructs are distinct.     

Scale 8 Elevations on the MMPI-2 among Women Survivors of Childhood Sexual Abuse: Evaluating Posttraumatic Stress, Depression, and Dissociation as Predictors

This paper investigated elevations on Scale 8 of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) in women survivors of childhood sexual abuse (CSA) in order to assess whether symptoms of posttraumatic stress disorder, depression, or dissociation account for such elevations. Participants were 73 women seeking outpatient treatment for CSA after-effects at a university-based community mental health center. A stepwise multiple regression analysis was conducted, including measures of commonly reported symptoms in CSA survivors: depression, posttraumatic stress, and dissociation. Regression analyses revealed that the Beck Depression Inventory (BDI) and Dissociative Experiences Scale (DES) accounted for the most variance in Scale 8 scores (59%), with the BDI as the best predictor. The Impact of Event Scale (IES) did not predict Scale 8 scores significantly above that achieved by the model above. Cross-validation results indicated good generalizability. Results suggest that depression and dissociation contribute most to scores on Scale 8. Implications of these findings for the clinical and empirical use of the MMPI-2 with CSA survivors are discussed.     

Posttraumatic stress disorder symptom severity and fear of personal crime: exploring their interrelationship as a function of risk estimation

Both trauma psychology and criminology have studied the psychological correlates of crime victimization. While the former discipline has primarily focused on the development of posttraumatic stress disorder (PTSD) among crime victims, the latter has particularly studied the association between history of victimization and fear of crime. A major difference between both concepts is that PTSD is experienced in relation to previous victimization, while fear of crime does not necessarily follow from previous victimization and is primarily experienced in anticipation of possible future victimization. Despite their different orientations, both perspectives share one central tenet: they both argue that feelings of anxiety are accompanied by increased perceptions of risk for future victimization. Given this theoretical overlap, both types of anxiety may correlate with each other. The current study explored this topic in a sample of Dutch university students (N = 375) and found that PTSD symptom severity and fear of crime were significantly associated with each other, both in univariate and multivariate analyses. This association was stronger for participants who scored higher on perceived risk of personal crime victimization than for those who scored lower. Results were discussed in light of study limitations and directions for future research.     

Hope, meaning, and growth following the September 11, 2001, terrorist attacks

Positive psychologists found the increase of seven character strengths that encompass the so-called theological virtues, including hope and spirituality, in Americans after the September 11, 2001, attacks. Little is known about how they may affect post-September 11, 2001, mental health. Using multivariate analysis, this study investigated the relationship of hope and spiritual meaning with depression and anxiety in a sample of 457 students 3 months after September 11, 2001. Both characters contributed to lower levels of symptoms. In qualitative analysis, of 313 answers to an open-ended question regarding personal change, four categories emerged. The first three were consonant with other studies on posttraumatic growth (PTG), including changes in the self or behavior, relationships, and worldviews. The fourth category unique to September 11, 2001, was changes in political views. These findings offer further credence to the study of positive aspects resulting from violence-related trauma and highlight the needs for addressing the nature of traumatic events and PTG.     

Prevalence and Predictors of Suicidal Ideation Among U.S. Law Enforcement Officers

Police officers have often been reported to experience high rates of suicide compared to the general population. Suicidal ideation (SI) is considered a strong predictor of suicidal acts. However, few studies have examined SI in U.S. law enforcement officers. This study investigated the prevalence of SI and the association between SI and amount of subjective work-related traumatic stress, personal relationship stress, work-related but non-traumatic stress, age, depression, posttraumatic stress disorder symptoms, alcohol use, and posttraumatic growth among law enforcement officers (N?=?193) from a Midwestern state. Multiple regression analysis demonstrated that greater depression symptoms significantly predicted greater SI among officers.     

Cutoff Scores for the Morel Emotional Numbing Test for PTSD: Considerations for Use in VA Mental Health Examinations

The use of cutoff scores on symptom validity measures has been applied to determine the authenticity of posttraumatic stress disorder (PTSD) in U.S. Department of Veterans Affairs compensation and pension examinations. This approach is controversial due to variations in the interpretation and application of cutoff scores from symptom validity testing. In response to the proposal that the cutoff score on the Morel Emotional Numbing Test for Posttraumatic Stress Disorder (MENT) be increased, the diagnostic accuracy of the standard cutting score for identifying simulated symptoms of PTSD was compared to the proposed alternate cutoff score. The results of decision matrix tables (true positive, true negative, false positive, and false negative) comparing the sensitivity and specificity and deriving confidence intervals for the standard cutoff score and proposed alternate cutoff score are presented. In addition, analyses using binomial probability theory to determine whether the outcome of increasing the cutoff score on the MENT meets reasonable standards for types I and II errors are presented.     

Recalled peritraumatic reactions, self-reported PTSD, and the impact of malingering and fantasy proneness in victims of interpersonal violence who have applied for state compensation

The present study explores the associations between three types of peritraumatic reactions (dissociation, distress, and tonic immobility) and posttraumatic stress disorder (PTSD) symptoms in a sample of 125 victims of interpersonal violence who had applied for compensation with the Dutch Victim Compensation Fund (DCVF). In addition, the confounding roles of malingering and fantasy proneness are examined. Results indicate that tonic immobility did not predict PTSD symptom levels when adjusting for other forms of peritraumatic reactions, whereas peritraumatic dissociation and distress did. However, after the effects of malingering and fantasy proneness had been controlled for, malingering is the only factor associated with increased PTSD symptomatology. Implications for policy practice as well as study strengths and limitations are discussed.     

Psychopathy, traumatic exposure, and lifetime posttraumatic stress

This study examined two theoretical models on the interaction between psychopathy, traumatic exposure, and lifetime posttraumatic stress in a sample of 81 male detainees. In Model 1, the interpersonal and affective features of psychopathy were assumed to protect against posttraumatic stress. In Model 2, the lifestyle and antisocial traits of psychopathy were assumed to lead to a lifestyle that increases the risk of traumatic exposure and subsequent posttraumatic stress. The authors found significant negative bivariate associations between Psychopathy Checklist-Revised (PCL-R) total, Interpersonal and Affective facet scores, and posttraumatic stress. Model 1 was confirmed, as they found the interaction between the Affective facet and traumatic exposure had a significant negative effect on posttraumatic stress. Model 2 was rejected. The authors' findings confirm that the interpersonal and affective features of psychopathy are associated with an emotional deficit and that the affective features of psychopathy are crucial for understanding the relationship between psychopathy and anxiety.     

Do trials of perpetrators retraumatize crime victims?

Attendance at trials of perpetrators could be retraumatizing for crime victims suffering from posttraumatic stress disorder. To investigate this hypothesis, two studies were conducted in which retraumatization was defined as a significant increase in posttraumatic stress reactions. A cross-sectional study of 137 victims of rape and nonsexual assault revealed that trial variables do virtually not predict posttraumatic stress reactionsat a time several years after trial. A longitudinal study of 31 victims of rape and nonsexual assault revealed intraindividual stability of posttraumatic stress reactions for the time interval from a few weeks before the trial to a few weeks after the trial; in addition, interindividual stability was high. The results of both studies do not support the retraumatization hypothesis, which should therefore be used with caution.     

PTSD symptom clusters, feelings of revenge, and perceptions of perpetrator punishment severity in victims of interpersonal violence

Feelings of revenge have often been found to correlate with symptoms of posttraumatic stress disorder (PTSD). Which PTSD symptom cluster prevails in this association is, however, unknown. Furthermore, previous studies suggest that revenge may be satisfied by perceptions of perpetrator punishment severity, but did not control for concurrent symptoms of PTSD. Therefore, this study explored associations between PTSD symptom clusters, feelings of revenge, and perceived perpetrator punishment severity in a sample of victims of interpersonal violence. Results indicated that the re-experiencing/intrusion symptom cluster was the only index of PTSD which was related to victims' feelings of revenge (n = 207). Revenge correlated negatively with perceptions of punishment severity in victim who knew that the perpetrator had been sentenced, but not after adjustment for PTSD symptoms (n = 96).     

The Detection of Feigned Psychiatric Disorders Using the MMPI-2-RF Overreporting Validity Scales: An Analog Investigation

Individuals who are motivated to feign psychological problems to achieve a desired outcome (e.g., insanity defense) may overreport symptoms of psychopathology, with type of pathology being dependent on the setting. In the current investigation, we examined the utility of the overreporting validity scales (infrequent responses [F-r], infrequent psychopathology responses [F_P-r], infrequent somatic responses [Fs], and symptom validity [FBS-r]) on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath and Tellegen 2008) to detect research participants instructed to simulate one of three mental disorders: major depressive disorder (MDD), schizophrenia (SCH), or post-traumatic stress disorder (PTSD). The restructured clinical (RC) and overreporting validity scale scores of bona fide psychiatric patients with a primary diagnosis of either MDD, SCH, or PTSD were compared to two groups of simulators—naïve (i.e., undergraduate students with no training in mental disorders) and sophisticated (i.e., individuals with advanced training in psychopathology or personal experience with the disorder asked to overreport symptoms). Examination of the RC Scale profiles revealed that the sophisticated simulators produced symptom profiles more similar to the profiles of the psychiatric patients than did the naïve simulators. For the overreporting validity scales, the sophisticated simulators were less likely to be detected as feigning compared to the naïve simulators; overall, the validity scales were able to distinguish patients from simulators and accurately classify most of the simulators regardless of their level of “symptom” sophistication. Examination and comparison of the validity scales revealed that across disorders and level of research participant symptom sophistication, the F_P-r scale best differentiated simulators from patients.     

Feelings of revenge, retaliation motive, and posttraumatic stress reactions in crime victims

Individuals with posttraumatic stress disorder (PTSD) are often said to experience strong feelings of revenge. However, there is a need for confirmatory empirical studies. Therefore, in a study of 174 victims of violent crimes, the relation between feelings of revenge and posttraumatic stress reactions was investigated. Feelings of revenge were correlated with intrusion and hyperarousal but not with avoidance. Feelings of revenge explained incremental variance of intrusion and hyperarousal when the variance explained by victimological variables was controlled. The retaliation motive implied in feelings of revenge did not account for the relation between feelings of revenge and posttraumatic stress reactions. However, the relation was moderated by the time since victimization. Therefore, feelings of revenge must presumably be regarded as a maladaptive coping reaction to experienced injustice, but not in the first period after victimization.     

The Delayed and Cumulative Consequences of Traumatic Stress: Challenges and Issues in Compensation Settings

Delayed onset posttraumatic stress disorder has been a challenging issue in medico-legal settings. Prospective studies have done much to characterise the validity of this construct and the prevalence in various populations. The delayed impact of these events places significant challenges on a plaintiff in establishing a causal link to some distal exposure. Furthermore, the literature highlights that depression is a frequent independent outcome from posttraumatic events, independent of the frequent comorbidity for posttraumatic stress disorder. To date, there has been little examination of the commonality of the underlying mechanisms of aetiology between depression and posttraumatic stress disorder. The concepts of sensitisation and kindling have been extensively discussed as underlying mechanisms relevant to a range of psychiatric disorders. This idea of increasing sensitisation of individuals who have multiple traumatic stress exposures is of critical importance to understanding the shared aetiology of major depressive disorder and posttraumatic stress disorder. Furthermore, the neural circuitry involved in these conditions particularly involves the amygdala, medial prefrontal cortex and anterior cingulate. Given the shared aetiological mechanisms, it is probable that the delays in treatment which have been demonstrated to be important factors for decreasing the probability of a full treatment response in depression are equally relevant to posttraumatic stress disorder. This raises important issues about the liability of employers particularly in the emergency services for vetting individuals where there is a foreseeable risk. A further challenge in litigation settings is the increasing body of evidence linking posttraumatic stress disorder and depression to cardiovascular disease and hypertension.