Fibre and micronutrient intakes among fruit juice consumers and non-consumers in the UK and France: Modelling the effects of consumption of an orange pomace juice product.

BACKGROUND: Fruit intake, including consumption of 100% fruit juice, is generally associated with a better diet quality and overall health. However, fruit and vegetable intakes are below recommendations in many countries. METHODS: The present study examined fruit juice intake and total energy and nutrient intakes according to juice consumption or non-consumption in participants in the National Dietary and Nutrition Survey Rolling Programme 2014-2016 in the UK (n = 2723) and the Individual and National Study on Food Consumption 2006-2007 (n = 4079) in France. Total energy and nutrient intakes were also estimated for scenarios in which orange juice with pomace was either added to the daily diet or replaced 100% orange juice or beverages containing fruit juice. RESULTS: Fruit juice consumers had higher intakes of fruits and vegetables than non-consumers, were more likely to reach 5-a-day targets for fruit and vegetable consumption, and had significantly higher intakes of folate, vitamin C, potassium, magnesium, and fibre. Juice consumers also had higher total energy and sugar intakes, but lower body mass index than non-juice consumers. Modelling consumption of orange juice with pomace increased fibre and potassium intakes in orange juice consumers, and also increased fibre, most micronutrients, and 5-a-day achievements in non-juice consumers. CONCLUSIONS: These national survey results demonstrate that fruit juice consumers in the UK and France had higher intakes of fruits and vegetables than fruit juice non-consumers, and significantly higher intakes of several micronutrients and fibre. Furthermore, modelling of consumption of orange juice with pomace increased fibre and select micronutrient intakes, particularly among fruit juice non-consumers.

Victim selection patterns of community-residing child molesters identified by a nationwide youth-serving organization.

The current study examines data extracted from revocation files of a national youth-serving organization (YSO) involving 7819 revoked individuals and 12,254 alleged child victims to better understand victim selection patterns of community-residing child molesters. These data demonstrate consistent patterns of victim selection based upon the age, gender, and YSO affiliation of each victim. We created two variables to explore whether the revoked individual was "likely pedophilic (LP)" or a "mixed offender (MO)" based upon their behaviors and patterns of victim selection. Compared with the non-LPs and non-MOs, LPs and MOs had more known victims, were more often involved in other YSOs, and were more likely to have had contact with law enforcement. We utilized a public health perspective to interpret these findings, suggesting that child sexual abuse in YSOs reflects a societal problem that is not a unique phenomenon specific to programs offering services to youth.

The lethality of non-familial child abductions: Characteristics and outcomes of 565 incidents involving youth under the age of 18 years.

Offender motivation for child abduction determines both the nature and final outcome of the abduction. Research has identified victim characteristics, offender characteristics, and sexual motivations as factors influencing child abduction and child abduction homicide. We examine 565 child abductions identified through the Federal Bureau of Investigation (FBI) to determine the characteristics of victim, perpetrator, and crime and their influence on whether the child is murdered. Central to this research was the finding that 88.6% of the abductions involved a sexual motivation for the crime, and sexual motivation was significantly more likely when the victim was female and when the victim was post-pubescent. Of 581 child victims for whom the outcome of the abduction was known, 281 (48.3%) were found alive and 300 (51.7%) were found dead or presumed dead. There was a significant interaction between motive for the crime and the final abduction outcome, with victims abducted for sexual purposes being at higher risk of being murdered.

A systematic review of practices to promote vegetable acceptance in the first three years of life.

BACKGROUND: Although most children do not meet vegetable intake recommendations no clear universal guidelines exist on the best method of introducing and promoting vegetables in infants. OBJECTIVE: To identify strategies to promote vegetable acceptance in children from the start of complementary feeding until 3 years of age. DESIGN: A comprehensive search strategy was performed using the databases Scopus and Pubmed. Articles published before March 2018 measuring vegetable intake and/or liking were included. RESULTS: 46 papers, 25 experimental (intervention) studies, and 21 observational studies were included. Intervention studies revealed that repeated exposure increased acceptance of the target vegetable, whereas exposure to variety was found to be particularly effective in increasing acceptance of a new vegetable. Starting complementary feeding with vegetables increased vegetable acceptance, whereas starting with fruits did not. Visual exposure to an unfamiliar vegetable increased the acceptance of that vegetable even without consuming it, while visual exposure to a familiar vegetable did not. A stepwise introduction of vegetables resulted in better initial acceptance of vegetables than introducing vegetables directly. Observational studies showed that vegetable consumption was associated with frequency of exposure, exposure to variety, and modelling. A majority of studies found a positive association between breastfeeding and vegetable acceptance, but only two out of seven studies found an association between age of vegetable introduction and their acceptance. CONCLUSIONS: Based on the papers reviewed, we conclude that introducing vegetables at the beginning of complementary feeding, giving a different type of vegetable every day and ensuring repeated exposure to the same vegetable following an interval of a few days are the most promising strategies to promote vegetable intake in children starting complementary feeding until they are 3 years of age.

The dietary intake of two groups of lactating women in Shanghai during the puerperium.

BACKGROUND AND OBJECTIVES: Lactation is a time of increased nutritional requirements for mothers, and inadequate nutrient intake may have a detrimental effect on a woman's nutritional status. To investigate the dietary intake of two groups of women in Shanghai during the traditional confinement period. METHODS AND STUDY DESIGN: Two groups of women (1) a community dwelling sample (n=92); (2) residents in a Maternity Care Centre (MCC) (n=30), kept a prospective dietary record which was complemented by photographing. This data collection was done on a single day on three occasions in the community group, and for three days on five occasions in the MCC one. The mean nutrient intakes of the two groups were compared at common time points to dietary reference intakes, and the food intake was compared to dietary guidelines. RESULTS: Over half of this population had high body mass indices (BMIs) which reported that an excessive proportion of calories had come from fat intake. The mean intakes of sodium were higher than the recommended. Fruit, vegetable, bean, tuber, and milk intakes were lower than the recommendations. Over 70% of the women failed to meet the Estimated Average Requirement (EAR) for calcium. A notable proportion of all women failed to meet the EAR for vitamin C, thiamin, and riboflavin. Dietary fiber intakes were low, with a group mean intake value less than half the Adequate Intake (AI). CONCLUSIONS: This study on dietary intakes indicates nutritional intake issues may exist among lactating women in Shanghai, particularly in community-dwelling women.

Correction to: Challenges in the assessment of total fluid intake in children and adolescents: a discussion paper.

In the original publication of the article, a mistake was introduced in affiliation of Dr. Michael Nelson.

Challenges in the assessment of total fluid intake in children and adolescents: a discussion paper.

PURPOSE: In recent years, evidence has emerged about the importance of healthy fluid intake in children for physical and mental performance and health, and in the prevention of obesity. Accurate data on water intake are needed to inform researchers and policymakers and for setting dietary reference values. However, to date, there are few published data on fluid or water intakes in children. This is due partly to the fact that drinking water is not always reported in dietary surveys. The aim of this paper is to review the current status of the literature and highlight the challenges of assessing total fluid intake in children and adolescents. RESULTS: From the dietary assessment literature it is apparent that children present unique challenges to assessing intake due to ongoing cognitive capacity development, limited literacy skills, difficulties in estimating portion sizes and multiple caregivers during any 1 day making it difficult to track intakes. As such, many issues should be considered when assessing total fluid intakes in children or adolescents. Various methods to assess fluid intakes exist, each with its own strengths and weaknesses; the ultimate choice of method depends on the research question and resources available. Based on the literature review, it is apparent that if the research focus is to assess only fluid intake, a fluid-specific method, such as a diary or record, appears to be a feasible approach to provide an accurate estimate of intakes.

A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms.

The role of mindfulness, mindful eating and a newer concept of intuitive eating in modulating eating habits is an area of increasing interest. In this structured literature review, a summary of the current evidence is presented, together with details of interventions undertaken and the tools to measure outcomes. It is broad in scope given the emerging evidence base in this area. The review yielded sixty-eight publications: twenty-three interventions in obese/overweight populations; twenty-nine interventions in normal-weight populations; sixteen observational studies, three of which were carried out in overweight/obese populations. Mindfulness-based approaches appear most effective in addressing binge eating, emotional eating and eating in response to external cues. There is a lack of compelling evidence for the effectiveness of mindfulness and mindful eating in weight management. Mindfulness-based approaches may prevent weight gain. Reduced food intake was seen in some of the studies in overweight and obese populations, but this was less apparent in the studies in normal-weight populations. The evidence base for intuitive eating is limited to date and further research is needed to examine its potential in altering eating behaviours. Mindfulness appears to work by an increased awareness of internal, rather than external, cues to eat. Mindfulness and mindful eating have the potential to address problematic eating behaviours and the challenges many face with controlling their food intake. Encouraging a mindful eating approach would seem to be a positive message to be included in general weight management advice to the public.

Combined evaluations of competency to stand trial and mental state at the time of the offense: An overlooked methodological consideration?

Combined evaluations of competency to stand trial (CST; competency) and mental state at the time of the offense (MSO; sanity) frequently co-occur. However, most research examines the 2 as discrete constructs without considering 4 potential combined evaluation outcomes: competent-sane, incompetent-sane, competent-insane, and incompetent-insane. External validity can be improved if research more closely mirrored practice. It may be incorrect to assume incompetent defendants are similar across CST-only and combined evaluations, and insane defendants are similar across MSO-only and combined evaluations. Using a sample of 2,751 combined evaluations, we examined demographic, clinical, offense, evaluation, and psycholegal characteristics associated with evaluators' combined evaluation opinions. Multinomial regression analyses revealed older defendants were more likely to be opined incompetent-insane. Defendants with psychotic disorders were more often opined insane, regardless of competency status. Affective diagnoses predicted competent-insane opinions. Developmental disorders were closely related to incompetence, regardless of sanity status. Defendants with organic disorders tended to have global psycholegal impairment, in that they were more often opined incompetent-insane, incompetent-sane, or competent-insane, relative to competent-sane. Prior hospitalization predicted competent-insane relative to competent-sane opinions. Defendants not under the influence of a substance during the offense or with no prior convictions were more likely to be opined insane, regardless of competency status. We interpret these findings in light of psycholegal theory and provide recommendations for research and practice. Collectively, results suggest incorporation of combined evaluations into CST and MSO research is an important methodological consideration not to be overlooked. (PsycINFO Database Record

Young Carers' Needs and Changing Experiences during an Era of Austerity.

Many children caring for ill or disabled family members remain 'hidden' and 'invisible' in our communities. This study is the first to explore patterns of change, over time and throughout austerity, for children with caregiving roles to better understand how their lives differ from those of their non-caregiving peers. A survey of 2154 children, aged 9-18 years in the general population, and a further 21 children, aged 8-18 years and known to be young carers from the same English unitary authority, was conducted to gain an in-depth understanding of children's perceptions and experiences of what they do to help at home. This study shows that children with caregiving roles remain a distinctive group who assume more domestic and caring responsibilities than their peers, and who also perform many of these activities more frequently than young caregivers in 2001. Approximately 19% of the respondents in the general population showed signs of being in a caring role, double the percentage identified by the author in 2001, 72% of whom were from Black and Minority Ethnic backgrounds. Indicating over time higher levels of unmet needs among parents and other family members who are ill or disabled, these findings have important implications for professional policy, planning and practice across adult and children's services.

A systematic review of reliability and objective criterion-related validity of physical activity questionnaires.

Physical inactivity is one of the four leading risk factors for global mortality. Accurate measurement of physical activity (PA) and in particular by physical activity questionnaires (PAQs) remains a challenge. The aim of this paper is to provide an updated systematic review of the reliability and validity characteristics of existing and more recently developed PAQs and to quantitatively compare the performance between existing and newly developed PAQs.A literature search of electronic databases was performed for studies assessing reliability and validity data of PAQs using an objective criterion measurement of PA between January 1997 and December 2011. Articles meeting the inclusion criteria were screened and data were extracted to provide a systematic overview of measurement properties. Due to differences in reported outcomes and criterion methods a quantitative meta-analysis was not possible.In total, 31 studies testing 34 newly developed PAQs, and 65 studies examining 96 existing PAQs were included. Very few PAQs showed good results on both reliability and validity. Median reliability correlation coefficients were 0.62-0.71 for existing, and 0.74-0.76 for new PAQs. Median validity coefficients ranged from 0.30-0.39 for existing, and from 0.25-0.41 for new PAQs.Although the majority of PAQs appear to have acceptable reliability, the validity is moderate at best. Newly developed PAQs do not appear to perform substantially better than existing PAQs in terms of reliability and validity. Future PAQ studies should include measures of absolute validity and the error structure of the instrument.

Men participating in a weight-loss intervention are able to implement key dietary messages, but not those relating to vegetables or alcohol: the Self-Help, Exercise and Diet using Internet Technology (SHED-IT) study.

OBJECTIVE: To describe dietary changes in men participating in an obesity intervention as part of the Self-Help, Exercise and Diet using Information Technology (SHED-IT) study. DESIGN: An assessor-blinded randomized controlled trial comparing Internet (n 34) v. information-only groups (n 31) with 6-month follow-up. Dietary intake assessed by FFQ, reporting usual consumption of seventy-four foods and six alcoholic beverages using a 10-point frequency scale. A single portion size (PSF) factor was calculated based on photographs to indicate usual serving sizes. SETTING: The campus community of the University of Newcastle, New South Wales, Australia. SUBJECTS: Sixty-five overweight/obese men (43 % students, 42 % non-academic general staff, 15 % academic staff; mean age 35.9 (sd 11.1) years, mean BMI 30.6 (sd 2.8) kg/m2). RESULTS: The average PSF decreased significantly over time (χ2 = 20.9, df = 5, P < 0.001) with no differences between groups. While both groups reduced mean daily energy intake (GLM χ2 = 34.5, df = 3, P < 0.001), there was a trend towards a greater reduction in the Internet group (GLM χ2 = 3.3, P = 0.07). Both groups reduced percentage of energy from fat (P < 0.05), saturated fat (P < 0.001) and energy-dense/nutrient-poor items (P < 0.05), with no change in dietary fibre or alcohol (P > 0.05). CONCLUSIONS: Although men reported some positive dietary changes during weight loss, they did not increase vegetable intakes nor decrease alcohol consumption, while saturated fat, fibre and Na intakes still exceeded national targets. Future interventions for men should promote specific food-based guidelines to target improvements in their diet-related risk factor profile for chronic diseases.

Adolescents seeking weight management: who is putting their hand up and what are they looking for?

We describe the characteristics of adolescents seeking treatment for obesity via the 'Eat Smart' feasibility study; an intensive 12 week dietitian-led weight management programme with an emphasis on lifestyle change. It was designed to test the feasibility of a structured low-fat diet compared with a semi-structured reduced carbohydrate plan compared with a model of 'standard care'- an unstructured low fat approach. When compared with non-participants, participants were predominantly female and lived in lower socioeconomic areas. When given the choice of dietary approach, 50% elected reduced dietary carbohydrate, 43% structured low fat and 7% chose 'standard care'. Modest weight loss was achieved over 12 weeks, with both the structured low fat and reduced carbohydrate formats. Families showed a strong preference for structured eating plans, in particular seeking assistance with correct portion size. The current standard model of unstructured advice was both unpopular and relatively unsuccessful.

Multi-site randomized controlled trial of a child-centered physical activity program, a parent-centered dietary-modification program, or both in overweight children: the HIKCUPS study.

OBJECTIVE: To evaluate whether a child-centered physical activity program, combined with a parent-centered dietary program, was more efficacious than each treatment alone, in preventing unhealthy weight-gain in overweight children. STUDY DESIGN: An assessor-blinded randomized controlled trial involving 165 overweight/obese 5.5- to 9.9- year-old children. Participants were randomly assigned to 1 of 3 interventions: a parent-centered dietary program (Diet); a child-centered physical activity program (Activity); or a combination of both (Diet+Activity). All groups received 10 weekly face-to-face sessions followed by 3 monthly relapse-prevention phone calls. Analysis was by intention-to-treat. The primary outcome was change in body mass index z-score at 6 and 12 months (n=114 and 106, respectively). RESULTS: Body mass index z-scores were reduced at 12-months in all groups, with the Diet (mean [95% confidence interval]) (-0.39 [-0.51 to 0.27]) and Diet + Activity (-0.32, [-0.36, -0.23]) groups showing a greater reduction than the Activity group (-0.17 [-0.28, -0.06]) (P=.02). Changes in other outcomes (waist circumference and metabolic profile) were not statistically significant among groups. CONCLUSION: Relative body weight decreased at 6 months and was sustained at 12 months through treatment with a child-centered physical activity program, a parent-centered dietary program, or both. The greatest effect was achieved when a parent-centered dietary component was included.

Assessment of physical activity - a review of methodologies with reference to epidemiological research: a report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation.

Physical activity has a fundamental role in the prevention and treatment of chronic disease. The precise measurement of physical activity is key to many surveillance and epidemiological studies investigating trends and associations with disease. Public health initiatives aimed at increasing physical activity rely on the measurement of physical activity to monitor their effectiveness. Physical activity is multidimensional, and a complex behaviour to measure; its various domains are often misunderstood. Inappropriate or crude measures of physical activity have serious implications, and are likely to lead to misleading results and underestimate effect size. In this review, key definitions and theoretical aspects, which underpin the measurement of physical activity, are briefly discussed. Methodologies particularly suited for use in epidemiological research are reviewed, with particular reference to their validity, primary outcome measure and considerations when using each in the field. It is acknowledged that the choice of method may be a compromise between accuracy level and feasibility, but the ultimate choice of tool must suit the stated aim of the research. A framework is presented to guide researchers on the selection of the most suitable tool for use in a specific study.

The impact of nutrition education with and without a school garden on knowledge, vegetable intake and preferences and quality of school life among primary-school students.

OBJECTIVE: To investigate the impact of school garden-enhanced nutrition education (NE) on children's fruit and vegetable consumption, vegetable preferences, fruit and vegetable knowledge and quality of school life. DESIGN: Quasi-experimental 10-week intervention with nutrition education and garden (NE&G), NE only and control groups. Fruit and vegetable knowledge, vegetable preferences (willingness to taste and taste ratings), fruit and vegetable consumption (24 h recall × 2) and quality of school life (QoSL) were measured at baseline and 4-month follow-up. SETTING: Two primary schools in the Hunter Region, New South Wales, Australia. SUBJECTS: A total of 127 students in Grades 5 and 6 (11-12 years old; 54 % boys). RESULTS: Relative to controls, significant between-group differences were found for NE&G and NE students for overall willingness to taste vegetables (P < 0·001) and overall taste ratings of vegetables (P < 0·001). A treatment effect was found for the NE&G group for: ability to identify vegetables (P < 0·001); willingness to taste capsicum (P = 0·04), broccoli (P = 0·01), tomato (P < 0·001) and pea (P = 0·02); and student preference to eat broccoli (P < 0·001) and pea (P < 0·001) as a snack. No group-by-time differences were found for vegetable intake (P = 0·22), fruit intake (P = 0·23) or QoSL (P = 0·98). CONCLUSIONS: School gardens can impact positively on primary-school students' willingness to taste vegetables and their vegetable taste ratings, but given the complexity of dietary behaviour change, more comprehensive strategies are required to increase vegetable intake.

The SHED-IT community trial study protocol: a randomised controlled trial of weight loss programs for overweight and obese men.

BACKGROUND: Obesity is a major cause of preventable death in Australia with prevalence increasing at an alarming rate. Of particular concern is that approximately 68% of men are overweight/obese, yet are notoriously difficult to engage in weight loss programs, despite being more susceptible than women to adverse weight-related outcomes. There is a need to develop and evaluate obesity treatment programs that target and appeal to men. The primary aim of this study is to evaluate the efficacy of two relatively low intensity weight loss programs developed specifically for men. METHODS AND DESIGN: The study design is an assessor blinded, parallel-group randomised controlled trial that recruited 159 overweight and obese men in Newcastle, Australia. Inclusion criteria included: BMI 25-40 (kg/m2); no participation in other weight loss programs during the study; pass a health-screening questionnaire and pre-exercise risk assessment; available for assessment sessions; access to a computer with e-mail and Internet facilities; and own a mobile phone. Men were recruited to the SHED-IT (Self-Help, Exercise and Diet using Internet Technology) study via the media and emails sent to male dominated workplaces. Men were stratified by BMI category (overweight, obese class I, obese class II) and randomised to one of three groups: (1) SHED-IT Resources - provision of materials (DVD, handbooks, pedometer, tape measure) with embedded behaviour change strategies to support weight loss; (2) SHED-IT Online - same materials as SHED-IT Resources plus access to and instruction on how to use the study website; (3) Wait-list Control. The intervention programs are three months long with outcome measures taken by assessors blinded to group allocation at baseline, and 3- and 6-months post baseline. Outcome measures include: weight (primary outcome), % body fat, waist circumference, blood pressure, resting heart rate, objectively measured physical activity, self-reported dietary intake, sedentary behaviour, physical activity and dietary cognitions, sleepiness, quality of life, and perceived sexual health. Generalised linear mixed models will be used to assess all outcomes for the impact of group (Resources, Online, and Control), time (treated as categorical with levels baseline, 3-months and 6-months) and the group-by-time interaction. These three terms will form the base model. 'Intention-to-treat' analysis will include all randomised participants. DISCUSSION: Our study will compare evidence-based and theoretically driven, low cost and easily disseminated strategies specifically targeting weight loss in men. The SHED-IT community trial will provide evidence to inform development and dissemination of sustainable strategies to reduce obesity in men. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12610000699066).

Process evaluation of the Hunter Illawarra Kids Challenge Using Parent Support study: a multisite randomized controlled trial for the management of child obesity.

The purposes of this article are to (a) outline findings from secondary or process outcome data of the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) study and (b) inform the design and development of future research interventions and practice in the management of child obesity. Data were collected by means of facilitator evaluations, independent session observation, attendance records, and parent questionnaires. Internal validity and reliability of the program delivery were high. All parents reported positive changes in their children as a result of the physical activity program, the dietary modification program, or both. Most participants completed the home activities, but more than half reported that finding time to do them was problematic. Facilitator review indicated that future programs should specifically cater to children of similar age or same sex, allow adequate time for explanation of complex nutritional concepts, and use intrinsic motivators for participants. Recommendations for future interventions, specifically the implementation of subsequent HIKCUPS or other multisite effectiveness studies, are detailed.

Exploring the mechanisms of weight loss in the SHED-IT intervention for overweight men: a mediation analysis.

BACKGROUND: Statistical mediation analysis can be used to improve the design of obesity prevention and treatment programs by identifying the possible mechanisms through which an intervention achieved its effects. The aim of this study was to identify mediators of weight loss in an Internet-based weight-loss program specifically designed for overweight men. METHODS: The Self-Help, Exercise and Diet using Information Technology (SHED-IT) program was a 3-month randomized controlled trial (Internet-based intervention group vs information only control group) that was implemented in 2007 with baseline and 6-month follow-up assessment of weight, physical activity and dietary behaviors. Intention-to-treat and per-protocol mediation analyses were conducted using a product-of-coefficients test. RESULTS: Participants (N = 65) were overweight and obese male academic (n = 10) and non-academic (n = 27) staff and students (n = 28) from the University of Newcastle, Australia. Mean (SD) age = 35.9 (11.1) years and mean (SD) BMI = 30.6 (2.8). In the intention-to-treat analysis, both groups lost weight, but relative to the control group, the intervention did not have a statistically significant 'total effect' on weight, tau = -.507, p = .716 (95% CI = -3.277 to 2.263). In the per-protocol analysis, the intervention had a statistically significant 'total effect' on weight, tau = -4.487, p < .05 (95% CI = -8.208 to -.765). The intervention did not have a statistically significant effect on any of the hypothesized mediators and none of the behavioral variables mediated weight loss in the SHED-IT program. Although participants in the intervention group reduced their fat intake over the study period, the changes did not satisfy the criteria for mediation. CONCLUSION: Few studies have examined the mediators of weight loss in obesity treatment interventions. While none of the hypothesized mediators satisfied the criteria for mediation in the current study, there was some evidence to suggest that overweight men in the SHED-IT intervention reduced their fat intake over the study period. Future obesity treatment and prevention programs should explore behavioral mediators of weight loss using appropriate statistical methods. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry No: ANZCTRN12607000481471.

Symptom patterns related to traumatic exposure among female inmates with and without a diagnosis of posttraumatic stress disorder.

Our study examines the trauma-related experiences of 203 female prison inmates, most of whom had experienced chronic trauma throughout their lives but among whom only 51 percent met diagnostic criteria for PTSD. We used the two groups to study differences in trauma exposure and pre-existent psychopathology as they related to the emergence of full diagnostic criteria for PTSD. We also used the entire sample to explore the factor structure and endorsement frequencies of each symptom category as it related to trauma exposure. Our analyses indicated that the PTSD group differed from the non-PTSD group in the number of life traumas each group had experienced and the pre-existence of borderline personality disorder. Five symptoms accurately differentiated the two groups, with an 86 percent correct classification: recurrent thoughts, amnesia, loss of interest, difficulty concentrating, and a heightened startle response. An exploratory factor analysis further suggested two primary factors: intrusion and arousal. We apply our findings to the naturalistic versus interactional debate surrounding the disorder and reflect on the endorsement frequencies as they might inform our understanding of malingering as it occurs in legal and forensic settings.