The effects of IPV and mental health symptoms on HPA axis functioning during early pregnancy.

Maternal HPA axis dysregulation during early pregnancy can negatively affect maternal functioning. However, findings are mixed regarding how intimate partner violence (IPV), a common traumatic stressor, impacts HPA axis regulation during pregnancy. Interactions between IPV and mental health symptoms as they influence cortisol production are rarely examined, especially among pregnant women. Therefore, this study examined the impact of IPV, mental health symptoms, and their interactions on the maternal HPA axis during early pregnancy; 255 pregnant women, oversampled for experiences of IPV, completed a laboratory stressor and measures of depressive and post-traumatic stress symptoms (PTSS) at 15-18 weeks of pregnancy. Participants provided saliva samples following the Trier Social Stress Test that were assayed for cortisol; the area under the curve with respect to ground (AUCg) was computed as a measure of cortisol reactivity. The interactive effects of IPV, depressive symptoms, and PTSS on AUCg were significant, but the main effects were not. At low levels of depressive symptoms, the association between IPV and AUCg was negative; at moderate levels of depressive symptoms, it was not significant, and at high levels, it was positive. At low and moderate levels of PTSS, the effects of IPV on cortisol AUCg were not significant, but at high levels, the association was positive. IPV during early pregnancy was associated with both hyperactive and blunted stress reactivity, depending on the type and severity of mental health symptoms. These patterns of dysregulation of the HPA axis may have differential effects both for women's functioning throughout pregnancy as well as for the offspring.

Association Between Betrayal Trauma and the PAI Traumatic Stress Scale.

The Personality Assessment Inventory (PAI) is among the most commonly used broadband inventories of psychological functioning. For the purposes of assessing trauma specifically, the most relevant aspect of the PAI is the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T), which measures the degree to which a person feels wounded by something in their past. Research suggests that ARD-T is associated with exposure to a variety of different traumatic stressors. However, there is little research on the degree to which traumatic stressors that entail a component of interpersonal betrayal (i.e. betrayal trauma) are associated with higher scores on ARD-T relative to other stressors. In this study, we evaluated the relative associations between traumas with varying degrees of betrayal and scores on ARD-T in a secondary analysis of two non-clinical samples (college sample N = 494; crowdsourced sample N = 364) using a Bayesian approach to multiple regression. In both samples, traumas with both high and medium (but not low) degrees of betrayal were associated with elevated ARD-T scores. Findings suggest that ARD-T scores are associated with interpersonal trauma regardless of betrayal, which has implications for interpretation of the ARD-T scale in practice.

Developmental Consequences of Intimate Partner Violence on Children.

Numerous studies associate childhood exposure to intimate partner violence (IPV) with adverse adjustment in the domains of mental health, social, and academic functioning. This review synthesizes this literature and highlights the critical role of child self-regulation in mediating children's adjustment outcomes. We discuss major methodological problems of the field, including failure to consider the effects of prenatal IPV exposure and the limitations of variable-oriented and cross-sectional approaches. Finally, we present a comprehensive theoretical model of the effects of IPV on children's development. This model includes three mechanistic pathways-one that is unique to IPV (maternal representations) and two that are consistent with the effects of other stressors (maternal mental health and physiological functioning). In our model, the effects of these three pathways on child adjustment outcomes are mediated through parenting and child self-regulation. Future research directions and clinical implications are discussed in the context of the model.

A re-introduction of the psychodynamic approach to the standard clinical psychology curriculum.

OBJECTIVE: There is a strong evidence-base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence-base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence-based approaches. METHODS: We use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development-from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change. RESULTS/CONCLUSIONS: Based on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.

Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic.

Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.

Idiographic and nomothetic relationships between momentary interpersonal behaviors, interpersonal complementarity, and alliance ruptures in psychotherapy.

In this study, we aimed to examine how moment-to-moment interpersonal behaviors of warmth and dominance in patients and therapists, as well as interpersonal complementarity, are related to withdrawal and confrontation ruptures as sessions unfold. Sixteen psychotherapy sessions from eight independent therapeutic dyads were sampled for the highest level of alliance ruptures from a naturalistic psychotherapy data set featuring evidence-based psychodynamic psychotherapy for patients with interpersonal problems and personality pathology. Interpersonal behaviors, complementarity, and alliance ruptures were generated every 30 s within each session. Subgrouping within group iterative multiple model estimation (S-GIMME) was used to identify an idiographic network structure for each session and examine generalizability at the nomothetic and subgroup levels. Nomothetically, patients' dominance negatively predicted therapists' dominance concurrently, but positively predicted therapists' dominance with a 30-s lag; additionally, therapists' dominance predicted their own concurrent warmth. At the subgroup level, therapists being less dominant than typical predicted more concurrent withdrawal ruptures. Idiographic modeling revealed a high degree of heterogeneity in how interpersonal behaviors are associated with ruptures. More confrontation ruptures concurrently predicted higher dominance complementarity in one subgroup. This study demonstrated the interconnection between patients' and therapists' in-session behaviors as well as the role of therapists' behaviors in momentary rupture development. This study highlights the importance of attuning and responding to individualized, momentary therapeutic contexts in navigating ruptures, and emphasizes the value of idiographic relational network approaches to aid in psychotherapy research and case conceptualization. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Conflict Appraisals and Trauma Symptoms in Children Exposed to Intimate Partner Violence.

Children exposed to intimate partner violence (IPV) are at risk for posttraumatic stress symptoms (PTSS) and alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning. The current study investigated children's threat and self-blame appraisals about parental conflict as potential mechanisms leading to these adverse outcomes. Parent-child relationships were also examined. The sample consisted of 119 10-year-olds and their mothers who were recruited from the community as part of a larger study of IPV. Children's reports of IPV directed at their mother in the past year were not associated with PTSS; however, IPV exposure was associated with attenuated cortisol output in response to a social stressor. IPV exposure was also associated with greater threat appraisals and poorer quality parent-child relationships. These results provide further evidence that witnessing IPV is threatening for children, has negative consequences for parent-child relationships, and can impact children's HPA axis functioning.

Incremental Influence of Betrayal Trauma and Personality Traits on PTSD Symptoms.

Symptoms of posttraumatic stress disorder (PTSD) are common reactions to trauma. One factor that influences the manifestation of PTSD symptoms is the type of trauma experienced. Traumas perpetrated by someone on whom the trauma survivor trusts and relies on for support (i.e., betrayal traumas) are especially predictive of PTSD symptoms. However, the degree to which this is true differs somewhat across men and women. Another factor that influences PTSD symptoms is personality, which is most often operationalized in terms of discrete personality traits. Among these traits, Neuroticism (the tendency to experience negative affect) is linked to a wide range of psychological dysfunction in general and to PTSD symptoms in particular. However, there is little research on how trauma type and personality differentially influence PTSD symptoms. To address this gap, in this study we examined the incremental effects of traumas with varying degrees of betrayal and personality traits on PTSD symptoms in a sample of college students (N = 276) using a Bayesian approach to multiple regression. Results suggest that Neuroticism and trauma at all levels of betrayal were associated with higher levels of PTSD symptoms, although this differed across sex. These results are consistent with previous research that identifies Neuroticism as a risk factor for a wide range of mental health problems and clarifies earlier findings on betrayal trauma.

Maternal parentification history impacts evaluative cognitions about self, parenting, and child.

Parentification occurs when children are unfairly charged with fulfilling parental instrumental and emotional needs. Parentification is associated with risk to evaluative self cognitions from childhood to emerging adulthood, but this association has not yet been studied among parents. The transition to parenthood is typically characterized by declines in self-esteem, suggesting it is a critical period for understanding the risk parentification history poses to evaluative self-cognitions and evaluative cognitions about children. The present study addresses these gaps using longitudinal data (N = 374 first-time mothers) to examine the influence of maternal parentification history domains (emotional and instrumental caregiving, role unfairness) on trajectories of maternal evaluative cognitions about the self (self-esteem, parenting self-efficacy) and about the child (difficult child temperament, dissatisfaction with child contributions to relationships) in early parenthood. A spillover model was also examined such that evaluative cognitions about the self were examined as potential mediators between parentification history and evaluative cognitions about children. Results support associations between the role unfairness domain of parentification and each domain of maternal evaluative cognitions and a significant indirect effect of unfairness on risk to maternal evaluative cognitions about child contributions via parenting self-efficacy. Implications for mother-child relationships and processes of intergenerational transmission of parentification are discussed.

La parentalización ocurre cuando a los niños se les hace asumir injustamente las necesidades instrumentales y emocionales de los padres. Se asocia la parentalización con el riesgo de auto cognición evaluativa de la niñez al naciente estado de adultez, pero esta asociación no ha sido aún estudiada entre los padres. La transición a la condición de ser padres se caracteriza típicamente por las bajas en la auto estima, lo cual sugiere que se trata de un período crítico para comprender el riesgo que el historial de la parentalización presenta para la auto cognición evaluativa y las cogniciones evaluativas sobre los niños. El presente estudio trata de estos vacíos usando datos longitudinales (N = 374 madres primerizas) para examinar la influencia de los campos del historial de la parentalización materna (el cuidado emocional e instrumental, el papel de lo que es injusto) sobre las trayectorias de las cogniciones evaluativas maternas acerca de ellas mismas (auto estima, auto efectividad en la crianza) y acerca del niño (el difícil temperamento del niño, la insatisfacción con las contribuciones del niño a las relaciones) en la temprana etapa de la maternidad. Se examinó un modelo de efectos secundarios de tal manera que se examinaron las cogniciones evaluativas acerca del yo como posibles factores de mediación entre el historial de parentalización y las cogniciones evaluativas acerca de los niños. Los resultados apoyan las asociaciones entre el papel del ámbito de lo injusto de la parentalización y cada ámbito de cogniciones evaluativas maternas y un efecto indirecto significativo de lo injusto sobre el riesgo de cogniciones evaluativas maternas sobre las contribuciones del niño por medio de la auto efectividad de la crianza. Se discuten las implicaciones de las relaciones madre-niño y los procesos de transmisión intergeneracional de la parentalización.

La parentification prend place lorsque on exige injustement des enfants qu'ils remplissent les besoins instrumentaux et émotionnels parentaux. La parentification est liée au risque d'auto-cognitions évaluatives de l'enfance au début de l'âge adulte, mais cette association n'a pas encore été étudiée chez les parents. La transition à la parenté est typiquement caractérisée par des déclins dans la confiance, suggérant que c'est une période critique pour comprendre l'histoire de risque que la parentification pose aux auto-cognitions évaluative et aux cognitions évaluatives sur les enfants. Cette étude porte sur ces écarts en utilisant des données longitudinales (N = 374 mères dont c'était la première grossesse) afin d'examiner l'influence des domaines de l'histoire de la parentification maternelle (soins émotionnels et instrumentaux, injustice du rôle) sur des trajectoires de cognition évaluative maternelle sur le moi (confiance en soi, auto-efficacité de parentage) et sur l'enfant (tempérament difficile de l'enfant, insatisfaction avec les contributions de l'enfant à la relation) au début de la parenté. Un modèle de débordement a aussi été examiné de telle manière que les cognitions évaluatives sur le self ont été examinées en tant que médiatrices potentielles entre l'histoire de parentification et les cognitions évaluatives sur les enfants. Les résultats soutiennent les liens entre le domaine de parentification de l'injustice du rôle et chaque domaine de cognitions évaluatives maternelles et un effet indirect important de l'injustice sur le risque aux cognitions évaluatives maternelles sur les contributions de l'enfant au travers de l'auto-efficacité de parentage. Les implications pour les relations mère-enfant et les processus de transmission intergénérationnelle de la parentification sont discutés.

Influence of personality traits on college women's appraisals of intimate partner violence.

Intimate partner violence (IPV) is a common traumatic stressor for young adult women and results in a number of problems for those who experience it. The appraisals women make of IPV influence the degree of distress they experience in the aftermath of IPV. Research suggests that personality traits may influence IPV appraisals, although there are relatively few studies of this. In this study, we examine the association between Five Factor Model personality traits (i.e., Agreeableness, Conscientiousness, Extraversion, Neuroticism, and Openness) and appraisals of IPV in a sample of young adult women in college who experienced IPV (N = 241) using a Bayesian approach to multiple regression. Results suggest that Agreeableness, Extraversion, and Neuroticism predicted different styles of appraisals over and above the effect of IPV severity. Study findings clarify previous research on the role of personality traits in the response to IPV and suggest directions for future research.

Introduction to the Special Section on Complex Posttraumatic Stress Disorder (CPTSD): The Evolution of a Disorder.

The inclusion of complex posttraumatic stress disorder (CPTSD) in the 11th revision of the International Classification of Diseases is an important development in the field of psychotraumatology. Complex PTSD was developed as a response to a clinical need to describe difficulties commonly associated with exposure to traumatic stressors that are predominantly of an interpersonal nature. With this special section, we bring attention to this common condition following exposure to traumatic stressors that only recently has been designated an official diagnosis. In this introduction, we review the history of CPTSD as a new condition and we briefly introduce the papers for the special section in the present issue of the Journal of Traumatic Stress. It is our hope that the work presented in the special section will add to an ever-expanding evidence base. We also hope that this work inspires further research on the cultural validity of CPTSD, its assessment, and treatment.

Interpersonal Style and Posttraumatic Stress Disorder Symptoms in Female Victims of Dating Violence.

Symptoms of posttraumatic stress disorder (PTSD) are some of the most common mental health symptoms women experience following exposure to dating violence (DV). However, not all women who experience DV exhibit PTSD symptoms. One factor that may influence whether or not women exhibit PTSD symptoms in the aftermath of DV exposure is interpersonal style, often operationalized in terms of two orthogonal dimensions, warmth and dominance. In this study, we examined the main and moderating effects of warmth and dominance on the association between DV and PTSD symptoms using latent moderating structural equation modeling in a sample of 303 female college students who reported DV exposure in the past year. Results indicated that warmth exerted a main effect predicting fewer PTSD symptoms. In addition, dominance moderated the association between DV and PTSD symptoms such that at high levels of DV, women who were high on dominance reported fewer PTSD symptoms than did women who were low on dominance. These findings suggest that aspects of interpersonal style may promote resilience to symptoms of posttraumatic stress following DV exposure. Directions for future research are also discussed.

Influence of betrayal trauma on borderline personality disorder traits.

Recent research has linked traumatic experiences with a high degree of betrayal with symptoms of borderline personality disorder (BPD). Much of this research has operationalized BPD in terms of diagnostic symptoms, which contrasts with recent approaches to understanding personality disorders (PDs) in terms of maladaptive personality traits. In this study we examine the influence of traumatic experiences with varying levels of betrayal on BPD assessed via maladaptive personality traits in a sample of college students (N = 915) using a Bayesian approach to structural equation modeling. Results suggest that trauma with a high degree of betrayal (high betrayal trauma) was the only credible predictor of BPD traits when other traumatic experiences (medium and low betrayal trauma) were taken into account, and that this effect did not vary across sex. Future research directions and clinical implications are also discussed.

Do different data analytic approaches generate discrepant findings when measuring mother-infant HPA axis attunement?

Attunement between mothers and infants in their hypothalamic-pituitary-adrenal (HPA) axis responsiveness to acute stressors is thought to benefit the child's emerging physiological and behavioral self-regulation, as well as their socioemotional development. However, there is no universally accepted definition of attunement in the literature, which appears to have resulted in inconsistent statistical analyses for determining its presence or absence, and contributed to discrepant results. We used a series of data analytic approaches, some previously used in the attunement literature and others not, to evaluate the attunement between 182 women and their 1-year-old infants in their HPA axis responsivity to acute stress. Cortisol was measured in saliva samples taken from mothers and infants before and twice after a naturalistic laboratory stressor (infant arm restraint). The results of the data analytic approaches were mixed, with some analyses suggesting attunement while others did not. The strengths and weaknesses of each statistical approach are discussed, and an analysis using a cross-lagged model that considered both time and interactions between mother and infant appeared the most appropriate. Greater consensus in the field about the conceptualization and analysis of physiological attunement would be valuable in order to advance our understanding of this phenomenon.

Infant adrenocortical reactivity and behavioral functioning: relation to early exposure to maternal intimate partner violence.

Prenatal stress negatively affects fetal development, which in turn may affect infant hypothalamic-pituitary-adrenal (HPA) axis regulation and behavioral functioning. We examined effects of exposure to a traumatic stressor in families [intimate partner violence (IPV)] on both infants' HPA axis reactivity to stress and their internalizing and externalizing behaviors. Infants (n = 182, 50% girls, x age = 11.77 months) were exposed to a laboratory challenge task designed to induce frustration and anger (i.e. arm restraint). Saliva samples were taken pre-task and 20 and 40 min post-task and then assayed for cortisol. Mothers reported on their pregnancy and postpartum IPV history, current mental health, substance use and their infants' behaviors. Structural equation modeling revealed that prenatal, but not postnatal, IPV was independently associated with infant cortisol reactivity and problem behavior. Maternal mental health predicted infant behavioral functioning but not infant HPA axis reactivity. These findings are consistent with the prenatal programing hypothesis; that is, early life stress affects later risk and vulnerability for altered physiological and behavioral regulation.

The influence of prenatal intimate partner violence exposure on hypothalamic-pituitary-adrenal axis reactivity and childhood internalizing and externalizing symptoms.

This prospective longitudinal study examines the long-term influence of intimate partner violence (IPV) exposure in utero. We hypothesized that (a) prenatal IPV increases risk for internalizing and externalizing problems as well as for a profile of dysregulated cortisol reactivity, and (b) patterns of cortisol hyper- and hyporeactivity are differentially associated with internalizing and externalizing problems. The participants were 119 10-year-old children. Their mothers reported their IPV experiences and distress during pregnancy. Child and maternal reports of internalizing and externalizing problems as well as lifetime IPV exposure were obtained. Salivary cortisol was assessed at baseline, 20 min, and 40 min after challenge. The results partially supported our hypotheses: Exposure to IPV during pregnancy predicted child-reported internalizing and externalizing problems, mother ratings of child externalizing problems, and a profile of high cortisol secretion before and after stress challenge. The results were significant above and beyond the influence of maternal distress during pregnancy and IPV that occurred during the child's life. In addition, a profile of high cortisol secretion was associated with maternal reports of child internalizing behaviors. Findings support the growing consensus that prenatal stress can lead to lasting disruptions in adaptation and highlight the need for more longitudinal examinations of prenatal IPV exposure.

Personality constellations of adolescents with histories of traumatic parental separations.

Consistent with attachment theory and a developmental psychopathology framework, a growing body of research suggests that traumatic parental separations may lead to unique pathways of personality adaptation and maladaptation. The present study both examined personality characteristics and identified personality subtypes of adolescents with histories of traumatic separations. Randomly selected psychologists and psychiatrists provided data on 236 adolescents with histories of traumatic separations using a personality pathology instrument designed for use by clinically experienced observers, the Shedler-Westen Assessment Procedure. Using a Q factor analysis, five distinct personality subtypes were identified as follows: internalizing/avoidant, psychopathic, resilient, impulsive dysregulated, and immature dysregulated. Initial support for the validity of the subtypes was established on the basis of axis I and axis II pathology, adaptive functioning, developmental history, and family history variables. The personality subtypes demonstrated substantial incremental validity in predicting adaptive functioning, above and beyond demographic variables and histories of other traumatic experiences.

Betrayal trauma and dimensions of borderline personality organization.

Borderline personality pathology can be conceptualized as one of many conditions within a broader spectrum of borderline personality organization (BPO). This spectrum is composed of several specific dimensions of psychological functioning (primitive psychological defenses, identity diffusion, and reality testing). Although several theories associate trauma with borderline pathology, betrayal trauma theory specifies that trauma with a high degree of betrayal has an especially pernicious influence on borderline pathology. In addition, betrayal trauma theorists propose that constructs related to each BPO dimension are influenced by traumatic betrayal, but this has not yet been tested within the context of borderline pathology specifically. In this article, we examine the relation between trauma with varying levels of betrayal and the specific dimensions of BPO using a Bayesian approach to multiple regression. Results indicated that trauma with a high degree of betrayal was associated with each dimension of BPO, that medium betrayal trauma was associated with problems in reality testing, and that low betrayal trauma was associated with primitive psychological defenses. These effects differed by gender. Limitations of the study and directions for future research are also discussed.

Economic Hardship Predicts Intimate Partner Violence Victimization During Pregnancy.

Objective: Intimate partner violence (IPV) during pregnancy is associated with negative physical and mental health consequences for both mothers and infants. Economic hardship is often exacerbated during pregnancy and is associated with increased rates of IPV in non-pregnant samples. However, temporal associations between economic hardship and IPV victimization have not been well characterized during pregnancy. The present study used data collected at the weekly level to examine the interindividual and intraindividual effects of economic hardship on IPV victimization during pregnancy and determine whether longitudinal changes in IPV across pregnancy vary based on level of economic hardship. Method: Two hundred ninety-four women reported on weekly experiences of IPV and economic hardship (i.e., food insecurity and other money problems) during weeks 17-40 of pregnancy. Participants were oversampled for low income and IPV exposure. Binary logistic multilevel models were used to test study hypotheses. Results: Greater economic hardship on average during pregnancy predicted increased odds of IPV victimization. Within-person increases in economic hardship also predicted increased odds of IPV victimization in the same week. Although IPV victimization tended to decrease on average over the course of pregnancy, there was a significant time by economic hardship interaction such that IPV decreased more gradually for women reporting high levels of economic hardship. Conclusions: The present study examined weekly patterns of IPV victimization across pregnancy in a low-income community sample. Results suggest that policies aimed at increasing families' economic security during the perinatal period may reduce the individual and societal burden of IPV.

Dating violence: mental health consequences based on type of abuse.

This study aims to determine the relationship between psychological, physical, and sexual abuse, and mental health symptoms. Female college students (N = 499) completed anonymous online surveys to report experiences of abuse, as well as symptoms of depression, posttraumatic stress disorder (PTSD), and physical injuries. Five groups of participants were found: no abuse; psychological abuse; physical abuse; psychological and physical abuse; and psychological, physical, and sexual abuse. The multiple abuse groups showed the highest rate of mental health symptoms. In addition, increased frequency of abuse was related to more mental health symptoms and more physical injuries.