Social maltreatment as trauma: Posttraumatic correlates of a new measure of exposure to sexism, racism, and cisheterosexism.

OBJECTIVE: Maltreatment based on race, sex, or lesbian, gay, bisexual, transgender, queer, or other sexual and gender minorities (LGBTQ+) status is a significant life stressor, potentially independent of whether it can be categorized as a Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) trauma. Yet there is a relative lack of research systematically examining these events, their intersectionality, and links to posttraumatic stress (PTS). The purpose of this study was to develop a comprehensive measure of social discrimination and maltreatment (SDM) and to examine whether these events can serve as potential traumatic stressors, above-and-beyond classic trauma exposure. METHOD: A 36-item Social Discrimination and Maltreatment Scale (SDMS), consisting of three subscales (sexism, racism, and cisheterosexism) and a total score, was developed and validated in a sample of 528 adults. RESULTS: The SDMS and its subscales were internally consistent (αs from .95 to .97) and demonstrated factorial validity in two subsamples (ns = 265 and 263). Marginalized groups each endorsed the most relevant SDMS subscale (e.g., people of color reporting more racism and women reporting more sexism). The total SDM score was associated with PTS even when controlling for general trauma exposure, and there was a linear relationship between the number of elevated SDMS subscales and PTS scores. CONCLUSIONS: Although not considered traumatic in the DSM-5-TR, exposure to sexism, racism, and cisheterosexism may be significant sources of PTS. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Child and Adolescent Exposure to Sexual Harassment: Relationship to Gender, Contact Sexual Abuse, and Adult Psychological Symptoms.

In contrast to adults, there is considerably less research on childhood or adolescent exposure to sexual harassment (CAESH), its lasting psychological correlates, and whether such experiences should be included in definitions of childhood sexual abuse. The current study examined the prevalence and symptomatic sequels of unwanted flirting, being "checked out" sexually, unwanted sexual attention, sexual comments, propositions, and related noncontact behaviors that occurred before age 18, as well as the multivariate relationship between CAESH and contact child sexual abuse (C-CSA) in a diverse online sample of 528 individuals. CAESH was very common, with over 95% of women and 64% of men reporting at least one experience of noncontact sexual harassment before age 18. When childhood sexual abuse was operationalized as the presence of either C-CSA or a total CAESH score of 18 or higher (corresponding to an average score of "3-5 times" prior to age 18), the prevalence was 67% for women and 26% for men, more than three times higher than C-CSA alone. This expanded definition was associated with significantly more anxiety, depression, and posttraumatic stress relative to C-CSA alone. These results suggest that CAESH is a significant source of symptoms in adults and support the emerging perspective that childhood sexual abuse may be best understood as including both contact and noncontact events.

Police in the rearview mirror: Social marginalization, trauma, and fear of being killed.

An online sample of 528 people was asked to respond to a hypothetical scenario: If a police car came up right behind you with its lights flashing, how much would you worry that you would be killed? Participants also reported on whether they experienced aggressive behavior by police in the past (provoked or otherwise) and, if so, completed a measure of associated posttraumatic stress. At least some fear of being killed by police (FKP) in the rearview mirror scenario was reported by the majority (56%) of Black participants, 39% of those self-describing as "other or mixed" race, and 31% of Hispanic participants, as compared to 26% of those of Asian descent and 19% of those identifying as White. When the highest level of FKP was considered, Black participants were 12 times more likely than White participants to report "extreme" fear of death at the hands of police. Lesbian, gay, bisexual, transgender, queer, and more participants were also more likely than cisgender/heterosexual respondents to report both FKP (35% vs. 20%) and "extreme" FKP (8% vs. 3%). FKP was also more prevalent among those self-reporting unprovoked police aggression in the past and those for whom police aggression had led to posttraumatic stress disorder. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Impact of Peer Support Group Programs on Psychosocial Outcomes for Burn Survivors and Caregivers: A Review of the Literature.

Peer support group programs are often recommended for burn survivors as a way to facilitate their psychosocial recovery and reintegration into the community. Such programs provide opportunities for burn patients and their caretakers to access emotional and informational support from healthcare providers and other survivors in inpatient or outpatient settings. Despite their popularity, however, there is little information currently available on the efficacy of these groups. In response, we reviewed the existing literature on peer support group programs and their impacts on psychosocial outcomes for burn survivors and their caregivers. A systematic review of the literature utilizing PubMed, PsycINFO, and Medline databases was conducted for articles published between 1990 and 2018. Twenty-five articles including inpatient, outpatient, integrative peer support groups, and burn camps met our inclusion criteria. All inpatient peer support group program articles (n = 4) reported associations with psychosocial improvements. Integrative peer support group program articles (n = 2) reported associations with social integration and reduction in post-traumatic stress and anxiety. All outpatient peer support group program articles (n = 8) demonstrated associations with psychosocial outcomes involving life satisfaction, acceptance of self, and reduced levels of isolation. Findings were less consistent for burn camps: eight articles suggested improvements in psychological outcomes while three articles reported no significant psychosocial effects. Although these results are encouraging, further study is indicated both to replicate these findings, and to determine the optimal implementation of inpatient and outpatient peer support programs.

Sexual assault trauma: Does prior childhood maltreatment increase the risk and exacerbate the outcome?

BACKGROUND: Some individuals who have been sexually assaulted as adolescents or adults have also been abused in childhood, although it is not clear how different forms of childhood maltreatment are related to adolescent/adult sexual assault, and how earlier abuse alters the relationship between sexual assault and current symptomatology. OBJECTIVE: We sought to determine which types of child maltreatment are associated with adolescent or adult sexual assault, whether such child maltreatment interacts with sexual assault to predict more severe symptoms, and if sexual assault has unique symptom correlates after controlling for prior child maltreatment. PARTICIPANTS AND SETTING: Participants were 398 women recruited online. RESULTS: A total of 36 % of women had experienced unwanted sexual contact at age 13 or younger (childhood sexual abuse [CSA]), 32 % had experienced unwanted sexual contact at age 14 or later (adolescent/adult sexual assault), and 24.4 % had experienced both. Of all forms of child maltreatment, only CSA was associated with sexual assault, doubling the risk relative to those without a history of CSA. CSA and sexual assault were each uniquely associated with current symptomatology, however there was no interaction between sexual assault and CSA on psychological symptoms. CONCLUSIONS: CSA is associated with a greater risk of later sexual assault, and both CSA and sexual assault have additive effects on adult symptomatology. However, prior sexual abuse does not appear to exacerbate the effects of sexual assault, and sexual assault is associated with lasting psychological sequelae even when controlling for sexual abuse.

Recent Suicidal Ideation and Behavior in the General Population: The Role of Depression, Posttraumatic Stress, and Reactive Avoidance.

The multivariate relationship between suicidality and three potential etiologic variables (depression, posttraumatic stress, and reactive avoidance) was examined in a stratified sample of 679 individuals from the general population. Lifetime exposure to a trauma or another very upsetting event was prevalent among those reporting suicidal behavior in the previous 6 months (58%) and those reporting recent suicidal ideation alone (40%), relative to those with no recent suicidal thoughts or behaviors (26%). Canonical correlation analysis indicated two independent sources of variance: the first loading on both suicidal ideation and behavior, predicted by depression, posttraumatic stress, and reactive avoidance, and the second indicating a unique relationship between suicidal behavior and reactive avoidance alone. Results indicate that the etiology of suicidality is likely multidimensional, and point to a significant variant of suicidal behavior that is unrelated to depression or posttraumatic stress, but may reflect emotional dysregulation and subsequent distress reduction behaviors.

Intimate Partner Violence in Male Survivors of Child Maltreatment: A Meta-Analysis.

Intimate partner violence (IPV) is a major public health concern. Yet, despite an increasingly extensive literature on interpersonal violence, research on male victims of IPV remains sparse and the associations between different forms of child maltreatment (CM) and IPV victimization and perpetration in men remains unclear. The present meta-analysis evaluated five different forms of CM (sexual, physical, and psychological abuses, neglect, and witnessing IPV) as they predicted sexual, psychological, and physical IPV perpetration and victimization in men. Overall, most available studies examined men as perpetrators of IPV, whereas studies of victimization in men were relatively scarce. Results reveal an overall significant association ( r = .19) between CM and IPV. The magnitude of this effect did not vary as a function of type (perpetration vs. victimization) or form (sexual, psychological, or physical) of IPV. Although all forms of CM were related to IPV, with effect sizes ranging from .05 (neglect and IPV victimization) to .26 (psychological abuse and IPV victimization), these associations varied in magnitude according to the type of CM. Findings suggest the importance of expanding research on CM and IPV to include a range of different kinds of abuse and neglect and to raise concerns about the experience of men as both victims and perpetrators of IPV.

The Disorganized Response Scale: Construct validity of a potential self-report measure of disorganized attachment.

OBJECTIVE: Based on the paucity of self-report measures of disorganized attachment (DA), we developed and tested a scale examining adults' self-reported disorganized verbalizations, cognitions, and behaviors when discussing their childhoods. METHOD: The Disorganized Response Scale (DRS) was created and administered to 640 university students, and its associations with variables known to covary with DA, such as childhood maltreatment, insecure attachment, and psychological symptoms, were examined. RESULTS: Factor analysis of DRS items revealed a single 15-item dimension that reflected participants' self-reported disorganized responses when discussing their childhoods. Structural equation modeling indicated a good fit to a model in which fearful caretaking and childhood abuse and neglect were associated with the DRS. In turn, the DRS, along with anxious and avoidant attachment, was independently related to symptoms and partially mediated the relationship between child maltreatment and symptomatology. Hierarchical multiple regression indicated that the DRS accounted for significant additional variance in posttraumatic stress, externalization, somatization, and, especially, dissociation, even after demographics and both anxious and avoidant attachment were taken into account. CONCLUSIONS: Analyses support the construct validity of the DRS as a measure of disorganized attachment-related responses in adults. Further research is indicated to replicate these findings and to evaluate their convergence with interview measures of DA. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Childhood maltreatment, attachment, and borderline personality-related symptoms: Gender-specific structural equation models.

OBJECTIVES: Survivors of early interpersonal trauma may experience relational problems, anger, impulsive and self-destructive behaviors, identity disturbance, and other difficulties that are associated with borderline personality disorder. Insecure attachment also has been documented in survivors and may be related to borderline personality-related symptoms (BPRS). The goal of the current study was to examine an integrative model of maternal and paternal childhood maltreatment and insecure attachment as they predict BPRS. METHOD: The sample was composed of 954 participants who completed self-report measures of parental maltreatment during childhood, attachment security, and trauma-related symptoms. RESULTS: Structural equation modeling suggested differential impacts of maternal and paternal maltreatment on male and female participants. Both maternal and paternal maltreatment were directly associated with BPRS in women, whereas in men, only paternal maltreatment was directly related to BPRS. In women, paternal maltreatment was indirectly associated with BPRS through attachment anxiety but not through attachment avoidance. In men, maternal maltreatment was indirectly associated with BPRS through attachment anxiety but not through attachment avoidance. CONCLUSION: These findings have implications for the understanding of gender-specific etiologies of borderline personality symptoms and underscore attachment security as an important intervention target. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Acute Stress Symptoms in Seriously Injured Patients: Precipitating Versus Cumulative Trauma and the Contribution of Peritraumatic Distress.

The relationship between type of trauma exposure, cumulative trauma, peritraumatic distress, and subsequent acute stress disorder (ASD) symptoms was examined prospectively in 96 individuals presenting with acute medical injuries to a Level 1 emergency/trauma department. Common precipitating traumas included motor vehicle-related events, stabbings, shootings, and physical assaults. At 2 to 3 weeks follow-up, 22.9% of participants had developed ASD. Univariate analysis revealed no relationship between type of precipitating trauma and ASD symptoms, whereas robust path analysis indicated direct effects of gender, lifetime cumulative trauma exposure, and peritraumatic distress. Peritraumatic distress did not mediate the association between cumulative trauma and symptoms, but did mediate the association between gender and symptomatology. These results, which account for 23.1% of the variance in ASD symptoms, suggest that ASD may be more due to cumulative trauma exposure than the nature of the precipitating trauma, but that cumulative trauma does not exert its primary effect by increasing peritraumatic distress to the most recent trauma.

Disengaged parenting: Structural equation modeling with child abuse, insecure attachment, and adult symptomatology.

Based on attachment theory, we hypothesized that self-reported childhood experiences of disengaged parenting (DP) would predict adults' psychological symptoms even more than, on average, childhood sexual, physical, or psychological abuse. In a large (N=640) university sample, bootstrapped multiple regression analyses indicated that although various forms of child maltreatment were correlated with symptomatology at the univariate level, DP was the primary multivariate predictor. Structural equation modeling indicated significant direct paths from (a) DP to both nonsexual child maltreatment and sexual abuse, (b) DP and nonsexual child maltreatment to insecure attachment, and (c) sexual abuse and insecure attachment to symptomatology. There were significant indirect effects of DP on psychological symptoms through sexual and nonsexual abuse, as well as through attachment. These results suggest that although child abuse has direct and indirect impacts on psychological symptoms, exposure to DP may be especially detrimental, both by increasing the risk of child abuse and by virtue of its impacts on attachment insecurity. They also support the potential use of attachment-oriented intervention in the treatment of adults maltreated as children.

Cumulative Childhood Trauma and Adult Sexual Satisfaction: Mediation by Affect Dysregulation and Sexual Anxiety in Men and Women.

Childhood cumulative trauma (CCT) refers to an amalgam of childhood maltreatment experiences that can lead to a range of symptoms and problems in adulthood. The current study examined an integrative model of CCT for its relevance to psychosexual adjustment in adult survivors. A total of 620 participants aged 18 years and over completed a questionnaire assessing early life experiences, affect dysregulation, sexual anxiety, and sexual satisfaction. Path analyses confirmed the hypothesis that CCT is associated with affect dysregulation and sexual anxiety that, in turn, predict lower levels of sexual satisfaction. The validity of this mediational model was demonstrated for different operationalizations of CCT. The results suggested that sex therapists, who are likely to encounter CCT survivors in their practice, should consider targeting affect dysregulation in their efforts to decrease sexual anxiety and increase sexual satisfaction.

Emotional and Sexual Correlates of Child Sexual Abuse as a Function of Self-Definition Status.

Among individuals defined as having been sexually abused based on legal criteria, some will self-report having been abused and some will not. Yet, the empirical correlates of self-definition status are not well studied. Different definitions of abuse may lead to varying prevalence rates and contradictory findings regarding psychological outcomes. The present study examined whether, among legally defined sexual abuse survivors, identifying oneself as having experienced childhood sexual abuse (CSA) was associated with more severe abuse, negative emotional reactions toward the abuse, and current sexual reactions. A convenience sample of 1,021 French-speaking Canadians completed self-report questionnaires online. The prevalence of legally defined CSA was 21.3% in women and 19.6% in men, as compared to 7.1% in women and 3.8% in men for self-defined CSA. Among legally defined sexual abuse survivors, those who identified themselves as CSA survivors had been abused more frequently, were more likely to report a male aggressor, and more often described abuse by a parental figure than those who did not self-identify as abused. Further, self-defined CSA was associated with more negative postabuse reactions and sexual avoidance, whereas those not identifying as sexually abused were more likely to report sexual compulsion.

Dissociative complexity: Antecedents and clinical correlates of a new construct.

OBJECTIVE: To the extent that dissociation is a multidimensional phenomenon, and given a growing literature on complex posttraumatic outcomes, we hypothesized a new construct: dissociative complexity (DC). DC is defined as the tendency to simultaneously endorse multiple, relatively independent dissociative dimensions into their clinical ranges, and therefore represents the overall breadth or complexity of an individual's dissociative response. METHOD: DC was evaluated in general population and prison participants using the Multiscale Dissociation Inventory (MDI; Briere, 2002). RESULTS: DC was higher among prisoners and women, and, as hypothesized, was associated with cumulative trauma and serious comorbidities (suicidality and substance abuse), even when controlling for generally elevated dissociation. CONCLUSIONS: DC appears to be a meaningful clinical construct that is phenomenologically and empirically different from a unidimensional index of dissociative severity. DC may serve as a clinical marker for multiple trauma exposures, complex dissociative outcomes, and risk of problematic comorbidities. (PsycINFO Database Record

Compensatory self-injury: Posttraumatic stress, depression, and the role of dissociation.

OBJECTIVE: Despite a number of studies, the reasons for self-injurious behavior (SIB) have yet to be clearly specified. Using path analysis, we sought to test the hypothesis that exposure to adverse events produces depression and posttraumatic stress, which in turn motivate dissociation that, when at high levels, supports the use of SIB. METHOD: A sample of 679 adults (54% female, mean age = 53 years) were recruited from the general population by a national survey company, and administered measures evaluating posttraumatic stress, depression, dissociation, and SIB. RESULTS: A total of 4.3% of participants reported some level of SIB within the prior 6 months. Younger age, exposure to adverse events, posttraumatic stress, depression, and dissociation were all related to SIB by univariate analyses. Path analyses revealed that although adverse events predicted posttraumatic stress and depression, which were then associated with SIB, these paths to SIB were no longer significant once dissociation was entered into the model, indicating full mediation. CONCLUSION: Rather than arising directly from posttraumatic stress or depression, SIB may occur most proximally in response to dissociation, with the pain associated with SIB potentially serving to interrupt or titrate unwanted hypoarousal and numbing. Clinicians should consider specifically targeting dissociation and its adversity-related antecedents when treating SIB. (PsycINFO Database Record

Cumulative trauma and current posttraumatic stress disorder status in general population and inmate samples.

OBJECTIVE: This research was undertaken to examine the role between cumulative exposure to different types of traumatic events and posttraumatic stress disorder (PTSD) status in general population and prison samples. METHODS: Two archival datasets were examined: the standardization sample for the Detailed Assessment of Posttraumatic States (DAPS; Briere, 2001), and data from a study on trauma and posttraumatic sequelae among inmates and others. RESULTS: PTSD was found in 4% of the general population sample and 48% of the prison sample. Trauma exposure was very common among prisoners, including a 70% rate of childhood sexual abuse for women and a 50% rate for men. Lifetime number of different types of trauma was associated with PTSD in both the general population and prison samples, even when controlling for the effects of sexual trauma. Cumulative interpersonal trauma predicted PTSD, whereas cumulative noninterpersonal trauma did not. In the general population sample, participants who had only 1 type of trauma exposure had a 0% likelihood of current PTSD, whereas those with 6 or more other trauma types had a 12% likelihood. In the prison sample, those with only 1 type of trauma exposure had a 17% percent likelihood of current PTSD, whereas those exposed to 6 or more other trauma types had a 64% chance of PTSD. CONCLUSION: Cumulative trauma predicts current PTSD in both general population and prison samples, even after controlling for sexual trauma. PTSD appears to develop generally as a function of exposure to multiple types of interpersonal trauma, as opposed to a single traumatic event. (PsycINFO Database Record

Adult Sexual Outcomes of Child Sexual Abuse Vary According to Relationship Status.

This study tested a moderation model in which the association between child sexual abuse severity and negative sexual outcomes (i.e., sexual avoidance and compulsivity) differed as a function of relationships status (i.e., single, cohabiting, and married individuals). A sample of 1,033 adults completed self-report questionnaires online, and 21.5% reported childhood sexual abuse. Path analyses indicated that child sexual abuse severity was associated with higher sexual compulsivity in single individuals, both higher sexual avoidance and compulsivity in cohabiting individuals, and higher sexual avoidance in married individuals. The moderation model was invariant across men and women. These results suggest that the time course of negative sexual outcomes associated with child sexual abuse may follow distinct patterns of expression according to relationship status.

Extradyadic Sexual Involvement and Sexual Compulsivity in Male and Female Sexual Abuse Survivors.

We tested a mediation model in which the relationship between child sexual abuse (CSA) severity and extradyadic sexual involvement (ESI) is explained through sexual compulsivity. Participants were 669 adults currently involved in an intimate relationship who completed self-report questionnaires. Prevalence of ESI was 32% in women and 57% in men survivors, more than twice the rates among participants with no CSA history. Sexual compulsivity was significantly higher in participants with multiple extradyadic partners as compared to participants reporting only one extradyadic relationship, who nevertheless scored higher than participants reporting no extradyadic partner. The hypothesized structural equation model (SEM) was invariant across men and women and indicated CSA severity was positively and significantly associated with sexual compulsivity, which, in turn, predicted ESI. However, there was also a direct association between CSA and ESI. High CSA severity, directly and through high sexual compulsivity, led to the highest probability of ESI.

Recent Suicidality in the General Population: Multivariate Association With Childhood Maltreatment and Adult Victimization.

Three hundred and eighty-seven participants from the general population completed the Suicidality scale of the Detailed Assessment of Posttraumatic Stress (DAPS) and the Traumatic Events Survey (TES). Within the prior month, 14% of adults reported some degree of suicidal ideation and 2% reported an active or passive suicide attempt. Multinomial logistic analysis indicated that, as compared with nonsuicidal participants, age, childhood physical abuse, childhood sexual abuse, and childhood emotional abuse were associated with recent suicide attempts, whereas recent suicidal ideation without attempts was predicted solely by emotional abuse. In contrast, adult sexual or physical assaults were not associated with recent suicidality in any form.

Complex Trauma in Adolescents and Adults: Effects and Treatment.

Complex trauma involves multiple exposures to adverse events over the lifespan. Such experiences are associated with a variety of psychological outcomes, including a decreased threshold for the development of posttraumatic stress disorder as well as self-capacity problems and dysfunctional behaviors. Psychological interventions that increase affect regulation, support titrated processing of memories and cognitions, and emphasize the therapeutic relationship seem to be most helpful for complex trauma effects. Pharmacologic treatments have some efficacy in the treatment of the posttraumatic stress components of complex posttraumatic outcomes but are generally less successful in reducing self-related problems and symptoms.