Military Service Records: Searching for the Truth

In conducting Compensation and Pension (C&P) examinations, one of the most significant sources of evidence supporting a veteran’s claim for service connection are found in the veteran’s service medical records and service personnel records. Although specific numbers are unknown, a majority of mental health providers who conduct C&P examinations are not veterans and have limited knowledge and understanding of the records they are being asked to review. In cases of an initial posttraumatic stress disorder (PTSD) examination, the Federal Register requires C&P examiners to determine if the veteran’s claim is consistent with the places, types, and circumstances of the veteran’s service. This article reviews specific data within personnel records to help verify those elements. Additionally, perhaps one of the most difficult types of evaluations faced by any C&P examiner is a PTSD claim for personal assault (e.g., military sexual trauma). This article reviews the types of information within the records to help identify specific “Markers” associated with personal trauma.     

Posttraumatic Stress Disorder Symptoms,Traumatic Reminders,and Partner Aggressive Tendencies Among Veterans

This study examined whether laboratory exposure to traumatic reminders potentiated the relationship between veterans’ posttraumatic stress disorder (PTSD) symptoms and intimate partner aggression (IPA) articulations elicited during an anger-induction task. The sample included 82 male Operation Iraqi Freedom/Operation Enduring Freedom veterans. The Articulated Thoughts in Simulated Situations (ATSS) procedure was used to assess physical IPA articulations (i.e., expressions of physically aggressive intentions toward the partner) and verbal IPA articulations (i.e., statements intended to insult or demean the partner) made during “relationship anger” provoking scenarios. Participants were administered versions of the ATSS both with and without trauma cue presentation. Results indicated that trauma cue exposure potentiated the relationship between veterans’ PTSD symptoms and physical IPA articulations, but did not strengthen the significant relationship between PTSD symptoms and verbal IPA articulations. Findings contribute to the literature on veterans’ PTSD symptoms and IPA perpetration by highlighting the influence of traumatic reminders.     

Empirical Limits for the Forensic Assessment of PTSD Litigants

This paper discusses the limits of expert opinion on posttraumatic stress disorder (PTSD) in personal injury claims. The construct of PTSD is hampered by several empirical limitations. Multiple reliable measures of PTSD exist, but have not been evaluated sufficiently within litigating samples and are infrequently used by forensic assessors. Common methods for trauma screening appear insensitive. Opinions about causation of PTSD and disability are complicated by retrospective memory biases, as well as the failure of most anxiety disorders to be detected within primary medical care. PTSD appears to have a steep spontaneous remission curve during the first year, but at least 10% of trauma-exposed people suffer chronic distress. Little is known about the course beyond 1 year. Efficacious psychological treatments have been developed for PTSD, but are not in common use limiting claimants access to rehabilitative treatments. Research on functional disability associated with PTSD is in its infancy, but it seems likely that PTSD will account for only a part of the variance in work disability. We provide suggestions for improving forensic practice, advising the courts about the limitations of forensic opinions, and necessary research.     

Traumatic Event Exposure and Behavioral Health Disorders among Incarcerated Females Self-Referred to Treatment

At least half of the women inside prison have mental health problems, have experienced physical, sexual, or emotional abuse during their formative years and often in adulthood, and have addiction problems. Only a minority of these women receive treatment for their behavioral health problems associated with trauma while incarcerated, even though these problems are risk factors for returning to prison after release. This study focuses on the traumatic experiences and behavioral health problems of a group of female inmates who volunteered in August 2009, to be screened for admission into an integrated trauma-reentry program implemented at an adult female correctional facility. Of the 278 women who self-referred for screening, 196 preliminarily met the time eligibility criterion of residing at the prison for eight to 24 more months. Half of these women (n?=?97) were actually time-eligible for screening and agreed to be screened. Of this sample of treatment-seeking soon-to-be-released female prisoners, the vast majority (93%) reported significant and complex histories of traumatic event exposure and high rates of either posttraumatic stress disorder (PTSD) or sub-threshold PTSD, past alcohol and other substance abuse or dependence, other axis I psychiatric disorders, and subjective distress. Identifying trauma exposure histories and associated behavioral health problems within this population and providing effective interventions holds potential promise for preparing incarcerated women to manage their post-release lives in ways that will keep them safe, healthy, and in the community.     

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.     

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.     

Prisoners,pups, and PTSD: the grass roots response to veterans with PTSD

As the human–animal bond is increasingly recognized as therapeutic, the role of animals, most frequently canines, grows. A contemporary pairing of animals and humans can be found inside prisons. While the dogs trained by inmates are most frequently adopted out to the community, today dogs are being trained to assist veterans with post-traumatic stress disorder (PTSD) as part of a grass roots effort to fulfill the mental health needs of veterans. The growing number of veterans with PTSD and concomitant issues including addiction, unemployment, homelessness, and crime, makes the mental healthcare issues of veterans a social problem. The civilian-led effort to provide veterans with dogs is a continuation of the public’s involvement with the proliferation of prison-based animal programs. While this next generation of animal programs has overwhelming community support, it also suffers from similar limitations as its predecessors. With no universal agreement as to the training methods or level of skills needed by the dogs, their efficacy at lessening the symptoms of veterans’ PTSD remains largely unknown.     

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.     

Victimization and perpetration among perinatal substance abusers

This study examined associations between demographic, psychiatric, substance abuse, and childhood abuse variables and past 30-day victimization and perpetration among 77 perinatal substance abusers. Victimization rates were 70% emotional, 34% physical, 29% sexual, and 42% personal freedom violations. For perpetration, incidence was 71% emotional, 25% physical, 5% sexual, and 9% personal freedom violations. Through univariate regression, Addiction Severity Index (ASI) psychiatric and drug composite scores, childhood physical abuse, borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) were found to significantly predict victimization. In contrast, ASI psychiatric and drug composite scores, BPD, PTSD, and aggressive-sadistic and antisocial personality disorders were found to significantly predict perpetration. In multiple regression models, ASI drug and psychiatric composite scores accounted for the majority of the variance for both victimization and perpetration, suggesting that women with high ASI scores should be queried about their involvement in abusive acts at time of admission to drug treatment.     

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.     

PTSD symptoms and sexual harassment: the role of attributions and perceived control

Researchers have compiled significant evidence demonstrating that sexual harassment leads to psychological harm, including the full symptom picture of PTSD, but few have examined the psychological processes involved. Research on attributions among trauma victims would suggest that causal attributions and perceptions of control may be important predictors of outcomes. The authors discuss a study involving a path model that used data from 189 women involved in sexual harassment litigation. Results indicate that both self-blame and harasser blame were positively related to PTSD symptoms. Control over recovery and the perception that future harassment is unlikely were both related to fewer PTSD symptoms. Unexpectedly, perceived control over future harassment is related to higher levels of PTSD symptoms. Implications for research and practice are discussed.     

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.     

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.     

Treating low-income and minority women with posttraumatic stress disorder: a pilot study comparing prolonged exposure and treatment as usual conducted by community therapists

Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD or treatment as usual (TAU; n = 12). Participants are predominantly low income and African American with complex trauma and psychiatric histories. Treatment is delivered by community therapists with no prior training in behavior therapy for anxiety disorders. Clients who completed PE show a greater improvement in PTSD symptoms, general anxiety, and depression than clients who completed TAU. These findings provide preliminary evidence suggesting that PE is an effective treatment for core PTSD symptoms, even when delivered by community therapists in a front-line services clinic.     

Advocate Safety Planning Training,Feedback, and Personal Challenges

Of all the advocacy services provided to partner violence and sexual assault victims, safety planning may be most central. However, unlike many community behavioral health or case management services, there is virtually no literature on standards of care in safety planning, ways to measure its effectiveness, or discussion of the challenges advocates face in their day-to-day practice of planning for victim safety. The purpose of this paper is to describe advocate perceptions of training and supervision, how they obtain feedback about their work with victims, and their personal challenges in safety planning with victims. Study results highlight the need for more guidance, training, and support as well as more coping strategies for the numerous personal challenges advocates face in their day-to-day safety planning work. Implications for research and practice are discussed.     

Violence between therapy-seeking veterans and their partners: prevalence and characteristics of nonviolent, mutually violent, and one-sided violent couples

Among male veterans and their female partners seeking therapy for relationship issues, three violence profiles were identified based on self-reports of physical violence: nonviolent, in which neither partner reported perpetrating physical violence (44%); one-sided violent, in which one partner reported perpetrating violence (30%); and mutually violent, in which both partners reported perpetrating physical violence (26%). Profiles were distinguished based on the veteran's psychiatric diagnosis, woman's age, and both partners' reports of the frequency and severity of violence. Men and women in mutually violent couples reported more verbal and physical aggression than did men or women in any other group. The three groups reported comparable rates of sexual aggression. Appraisals of marital satisfaction and intimacy were not different based on violence profile. No gender differences emerged in the self-reports of frequency and severity of verbal, physical, and sexual aggression.     

The PTSD Stressor Criterion as a Barrier to Malingering: DSM-5 Draft Commentaries

This commentary focuses on the proposed changes to the trauma stressor criterion for PTSD for DSM-5, specifically its likely impact on malingering. PTSD is particularly susceptible to malingering because the diagnosis relies so heavily on a patient’s subjective symptoms. Because the traumatic event that is the trigger of the PTSD syndrome is generally based on objective fact and thus often easily corroborated, this element of the diagnosis is usually more challenging to malinger than subjective reports of symptoms. Therefore, one of the main gateways for limiting the misuse of the PTSD diagnosis in forensic settings is the criterion defining the range of qualifying traumas. Proposed changes to criterion A of PTSD in the draft include modifying the types of qualifying trauma by replacing “threat to physical integrity” with “sexual violation,” and clarifying the modes of exposure by replacing the phrase “confronted with” with two criterion: “learning that the event occurred to a close relative or close friend” and “experiencing repeated or extreme exposure to aversive details of the event.” Each of these changes has the potential to significantly broaden the range of qualifying stressors and consequently expand the potential pool of individuals who might be in a position to malinger the disorder. Given the likelihood that the DSM-5 field trials will be unable to provide information relevant to assessing the impact of making these changes in forensic settings, it would be prudent to resist the inclination to tinker with the wording unless other mechanisms are available to ensure that the wording changes do more good than harm.     

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.     

Do Motivations for Malingering Matter? Symptoms of Malingered PTSD as a Function of Motivation and Trauma Type

Psychological disorders associated with traumatic events, such as post-traumatic stress disorder (PTSD), may be prone to malingering due to the subjective nature of trauma symptomology. In general, symptoms tend to be inflated when an external reward (i.e., compensation) is associated with the claim. The present study was designed to test whether malingered claims of PTSD symptoms differed as a function of the type of trauma being malingered (accident, disaster, sexual assault) and the motivation for malingering (compensation, attention, revenge, no motivation). Participants were randomly assigned into conditions, given malingering instructions, and then asked to complete three measures of trauma symptoms (Impact of Event Scale??Revised; Post-Traumatic Stress Disorder Checklist; Trauma Symptom Inventory). Results indicated that participants in the sexual assault condition produced higher symptom reports on nearly all scales. Revenge and compensation motivations yielded elevated symptom scores. Further, individuals rated high in fantasy proneness and dissociation produced elevated scores on atypical responding and most clinical scales. More research is needed to examine the extent to which different motivations and trauma types influence symptom reporting.