The Development and Psychometric Evaluation of the Sexual Fantasy Experience Scale.

Clinicians and researchers consider sexual fantasies to be a central aspect of human sexuality. Although these are subjective experiences, most studies have assessed only their frequency and content. A measure that assesses individuals' subjective experience of sexual fantasies is therefore needed. The aim of this study was to evaluate the psychometric properties of a new measure, the Sexual Fantasy Experience Scale (SFES). In Study 1, the SFES was administered to 391 participants (240 defined themselves as women, 149 as men, and 2 as other). In Study 2, the SFES was administered to 426 participants (255 defined themselves as women, 167 as men, and 4 as other), along with a battery of questionnaires including the New Sexual Satisfaction Scale Short Form and the Global Measure of Sexual Satisfaction, both of which measure sexual satisfaction, as well as the Sexual Fantasy Checklist, which evaluates the content of sexual fantasies and their frequency. Five reliable SFES subscales emerged from Study 1: playfulness, limitlessness, functionality, intrusiveness, and shame. In Study 2, a confirmatory factor analysis confirmed the scale's underlying factor structure, which was obtained in Study 1. The subscales of the SFES contributed to the explained variance of the assessments of sexual satisfaction, beyond the contribution of the fantasies' content and frequency, demonstrating the incremental validity of the subscales. The results of the present analyses suggest that the SFES has good psychometric properties, making it useful as an assessment tool for future research, clinical practice, and sex education.

Peripartum dissociation, sense of control, postpartum posttraumatic stress disorder and emotional adjustment to motherhood in adult survivors of childhood maltreatment.

Survivors of childhood maltreatment (CM) may experience difficulties in the peripartum period and in adjustment to motherhood. In this study we examined a model wherein CM is associated with maternal self-efficacy and maternal bonding three months postpartum, through mediation of peripartum dissociation and reduced sense of control during childbirth and postpartum-posttraumatic-stress disorder (P-PTSD). Women were recruited in a maternity ward within 48 h of childbirth (T1, N = 440), and contacted three-months postpartum (T2, N = 295). Participants completed self-report questionnaires: peripartum dissociation, sense of control (T1), and CM, P-PTSD, postpartum-depression, maternal self-efficacy and bonding (T2). Obstetrical data were collected from medical files. Structural equation modeling was conducted to test the hypothesized model, controlling for mode of delivery and postpartum-depression. Reported CM included child emotional neglect (CEN; 23.5%), child emotional abuse (CEA; 16.3%), child sexual abuse (CSA; 12.9%) and child physical abuse (CPA; 7.1%). CM was positively associated with peripartum dissociation and P-PTSD (p < .001). Peripartum dissociation was positively associated with P-PTSD (p < .001). P-PTSD was negatively associated with maternal self-efficacy (p < .001) and maternal bonding (p < .001). Association between CM and maternal self-efficacy and bonding was serially mediated by peripartum dissociation and P-PTSD, but not by sense of control. Findings remained significant after controlling for mode of delivery and postpartum-depression. CM is a risk factor for adjustment to motherhood, owing to its effects on peripartum dissociation and P-PTSD. Implementation of a trauma-informed approach in obstetric care and recognition of peripartum dissociative reactions are warranted.

Sense of mastery among older adults and its relation to invalidating childhood experiences.

ObjectivesSense of mastery, a well-recognized resource for older adults, has been shown to be related to early life experiences, especially parent-child interactions. Yet while there are indications that a reduced sense of mastery is related to early experiences of child maltreatment, this association has not been studied among older adults. The aim of this study was to examine the relation between experiences of childhood parental invalidation and sense of mastery among older adults, through the mediation of self-objectification and perceived disrupted body boundaries.Methods: Three-hundred-and-sixteen older adults (Mean = 72.24; SD = 8.12 years; range: 60-94) filled out a battery of questionnaires assessing their levels of exposure to childhood parental invalidation experiences, sense of self-objectification, disrupted body boundaries, and sense of masteryResults: A structural equation modeling (SEM) analysis supported the hypothesized research model. More specifically, two significant indirect effects were observed, according to which the association between invalidating childhood experiences and sense of mastery was mediated by both self-objectification and by disrupted body boundaries.Conclusion: As these results suggest that early life experiences continue to affect individuals' sense of self in older age, they should be considered an important factor for evaluation and intervention.

Echoes from the past: adjustment of aging former prisoners of war to the COVID-19 pandemic.

BACKGROUND: The aim of this study was to examine whether exposure to previous traumatic events is a risk factor for stress reactions during this pandemic. Capitalizing on a 29-year longitudinal study of Israeli ex-prisoners of war (ex-POWs) and combat veterans, we examined whether captivity is a risk factor for fear of coronavirus disease 2019 (COVID-19) and COVID-19-induced acute stress disorder (COVID-19 ASD) beyond the effects of combat exposure and other stressful life events. In addition, we examined the contribution of captivity experiences (severity of captivity, experience of solitary confinement, and suffering during captivity) and veterans' appraisal of the impact of their war-related experiences on adjustment to the current quarantine and isolation to fear of COVID-19 and COVID-19 ASD. METHODS: One-hundred-and-twenty Israeli ex-POWs from 1973 Yom Kippur War and 65 matched controls (combat veterans from the same war) filled out self-report questionnaires 18 (T1), 35 (T2), 42 (T3), and 47 (T4) years after the war. RESULTS: Findings revealed that although ex-POWs and controls did not differ in their level of exposure to COVID-19, ex-POWS reported higher levels of fear of COVID-19 and COVID-19 ASD than controls. Suffering during captivity, measured at 1991, and participants' appraisal of the extent to which their war-related experiences affected adjustment to COVID-19 were significantly associated with fear of COVID-19 and COVID-19 ASD. CONCLUSIONS: The findings of the study demonstrate the long-term effects of exposure to traumatic experiences (captivity) during young adulthood on adjustment to an unrelated collective stress, such as COVID-19, 40 years later.

Transactional Model of Parental Adjustment and Caregiving Burden Following a Children's Acquired Disability.

OBJECTIVES: Pediatric-acquired disability is often a crossroads in the lives of children and their parents, as they set out to adjust to a new physical impairment. This longitudinal study examined associations between the severity of children's-acquired disability, their parents' caregiver burden and adjustment, and parents' perception of the children's adjustment over time. METHODS: Participants were parents and medical staff of 140 children with acquired disability, aged 1-18, hospitalized in pediatric or rehabilitation departments. Data were collected about 1 month after diagnosis (T1) and about 4 months later (T2). Parents completed background information, caregiver burden, child, and parental adjustment questionnaires. Medical staff contributed the disability severity indices. RESULTS: The severity of the child's disability was negatively associated with parents' adjustment and perception of the child's adjustment. Caregiver burden was positively associated with the severity of the disability, and negatively with parents' adjustment and perception of their child's adjustment, at both time points. Over time, the severity of the disability and caregiver burden decreased, and parents' adjustment and perception of the child's adjustment improved. At T2, parents' and children's adjustment were strongly associated. CONCLUSIONS: The findings revealed the relationship between objective severity indices and caregiver burden. They suggest that parents' adjustment may affect their perception of the child's adjustment to disability, and emphasize the role of parental perceptions over time. Therefore, parents who are less likely to adjust effectively should be identified early on to facilitate professional intervention.

Reenacting Past Abuse - Identification with the Aggressor and Sexual Revictimization.

Childhood sexual abuse (CSA) poses a risk for sexual revictimization. Additionally, according to theory CSA may lead to identification with the aggressor, expressed by adopting the perpetrator's experience concerning the abuse; identifying with the perpetrator's aggression; replacing one's agency with that of the perpetrator; and becoming hyper-sensitive to the perpetrator. Although clinical impressions suggest that identification with the aggressor underlies reenactment of trauma, this linkage between identification with the aggressor and sexual revictimization remains largely uninvestigated. This study assessed (a) the relationship between identification with the aggressor (total score and four subscales) and sexual revictimization; (b) the unique associations between identification with the aggressor (total score and four subscales) and sexual revictimization, above and beyond chronicity of abuse and PTSD symptoms. Participants were Israeli women students who reported a history of CSA (n = 174). Analyses indicated significant correlations between two subscales of identification with the aggressor - replacing one's agency with that of the perpetrator and becoming hyper-sensitive to the perpetrator - and sexual revictimization. These subscales of identification with the aggressor were associated with sexual revictimization, above and beyond the effects of chronicity of the abuse and PTSD symptoms. Nevertheless, these associations were in opposite directions - while replacing one's agency with that of the perpetrator was related with higher occurrence of sexual revictimization, becoming hyper-sensitive to the perpetrator was related with lower levels of revictimization. These results imply that identification with the aggressor may serve as a multifaceted phenomenon in the context of sexual revictimization, comprised of both adaptive and maladaptive aspects.

Posttraumatic Stress Disorder, Orientation to Pain, and Pain Perception in Ex-Prisoners of War Who Underwent Torture.

OBJECTIVE: Studies suggest that torture survivors often experience long-term chronic pain and increased pain perception. However, it is unclear whether the actual experience of torture or rather the subsequent posttraumatic stress disorder (PTSD) explains these pain problems. Furthermore, although catastrophic and fearful orientations to pain have been suggested to play a significant role in the association between trauma and pain, the underlying mechanisms remain unclear. This study examined whether chronic pain and pain perception among torture survivors are associated with torture experience or PTSD and whether catastrophic and fearful orientations mediate or moderate these associations. METHODS: Fifty-nine ex-prisoners of war who underwent torture and 44 matched veterans participated in this study. Pain perception was evaluated by assessing pain threshold and reactivity to experimental suprathreshold noxious stimuli. Participants completed self-administered questionnaires assessing PTSD, chronic pain, pain catastrophizing, and fear of pain. RESULTS: Although chronic pain was associated with PTSD (0.44 < ß < 0.49, p < .002), increased pain perception was correlated with torture (0.33 < ß < 0.65, p < .05). Pain catastrophizing was found to mediate the association between PTSD and chronic pain (ß = 0.18 and 0.19, respectively; p < .05). Fear of pain moderated the association between torture and pain perception (ß = 0.41 and 0.42, respectively; p < .017). CONCLUSIONS: The findings suggest that chronic pain is contingent upon the psychological toll of torture, that is, PTSD. This study also indicates that PTSD exacerbates catastrophic orientation, which in turn may amplify chronic pain. Reactivity to experimental noxious stimuli was related to previous experiences of torture, which enhances perceived pain intensity when interacting with a fearful pain orientation. These findings highlight the significance of orientation to bodily experiences after trauma.

Acute Stress Disorder Symptoms Predict All-Cause Mortality Among Myocardial Infarction Patients: a 15-Year Longitudinal Study.

BACKGROUND: Studies have recognized myocardial infarction (MI) as a risk for acute stress disorder (ASD), manifested in dissociative, intrusive, avoidant, and hyperarousal symptoms during hospitalization. PURPOSE: This study examined the prognostic role of ASD symptoms in predicting all-cause mortality in MI patients over a period of 15 years. METHODS: One hundred and ninety-three MI patients filled out questionnaires assessing ASD symptoms during hospitalization. Risk factors and cardiac prognostic measures were collected from patients' hospital records. All-cause mortality was longitudinally assessed, with an endpoint of 15 years after the MI. RESULTS: Of the participants, 21.8 % died during the follow-up period. The decedents had reported higher levels of ASD symptoms during hospitalization than had the survivors, but this effect became nonsignificant when adjusting for age, sex, education, left ventricular ejection fraction, and depression. A series of analyses conducted on each of the ASD symptom clusters separately indicated that-after adjusting for age, sex, education, left ventricular ejection fraction, and depression-dissociative symptoms significantly predicted all-cause mortality, indicating that the higher the level of in-hospital dissociative symptoms, the shorter the MI patients' survival time. CONCLUSION: These findings suggest that in-hospital dissociative symptoms should be considered in the risk stratification of MI patients.

Body awareness and pain habituation: the role of orientation towards somatic signals.

Although body awareness and pain perception are considered to be parts of the interoceptive system, the relationship between them is unclear. This study examines the association between body awareness and pain habituation, hypothesizing that this association is moderated by pain catastrophizing and mindfulness. Sixty subjects received a mildly aversive electrical stimulus for 60 s, during which they were requested to rate the amount of perceived pain. Complete habituation was indicated by abolition of pain sensation; partial habituation was indicated by a decrease in pain sensation. Individuals who demonstrated complete habituation had lower levels of pain catastrophizing and lower levels of mindfulness. As hypothesized, the association between body awareness and pain habituation was moderated by pain catastrophizing: Among low pain catastrophizers, the higher the body awareness, the stronger the tendency to exhibit complete habituation. Among high pain catastrophizers, the higher the body awareness, the greater the likelihood to present partial habituation.

Body awareness: differentiating between sensitivity to and monitoring of bodily signals.

Sensitivity to bodily signals is the tendency to be aware of bodily states and to identify subtle bodily reactions to internal and environmental conditions. Monitoring these signals is a top-down process, describing individuals' tendency to actively scan their bodies in order to detect cues for their physical condition. Two studies examined the relations between these constructs and their adaptivity among young adults. In Study 1, 180 young adults completed questionnaires assessing sensitivity, monitoring, and hypochondriac tendency. In Study 2, 205 students reported their levels of sensitivity, monitoring, pain catastrophizing, and trait anxiety. Although monitoring and sensitivity were correlated, when controlling for their shared variance, only monitoring was associated with high hypochondriac tendency and anxiety. In addition, the adaptivity of sensitivity to bodily signals was dependent on both level of monitoring of bodily signals and pain catastrophizing. That is, pain catastrophizing moderated the effect of sensitivity and monitoring on anxiety. These findings suggest that the adaptivity of sensitivity is determined by the mode of attention characterizing the individual engaged in this process.

Predicting chronic pain two years following a spinal cord injury: Longitudinal study on the reciprocal role of acute pain and PTSD symptoms.

OBJECTIVES: To examine a) the development of PTSD symptoms and pain over five months post-spinal cord injury (SCI); b) the directional effects of PTSD symptoms and pain across five months post-SCI; and c) the prediction of chronic pain two-years post-SCI by PTSD symptoms and pain severity in the first five months post-SCI. STUDY DESIGN: Two-year longitudinal study. SETTING: : Individuals with an SCI admitted to the Department of Neurological Rehabilitation (N = 65). OUTCOME MEASURES: : PTSD symptoms and pain were evaluated at 1.5 months (T1), three months (T2), and five months (T3) post-SCI. Chronic pain was evaluated at 24 months post-SCI (follow-up). RESULTS: Seventy-five percent of participants reported chronic pain at follow-up. Pain severity at T1 and T2 predicted PTSD symptoms at T2 and T3, respectively. PTSD symptoms at T2 predicted pain severity at T3. Individuals with chronic pain at follow-up had reported more PTSD symptoms at T1, T2, and T3 than those without pain. A multivariate model yielded two significant indirect paths: a) PTSD symptoms at T1 predicted chronic pain severity at follow-up through PTSD symptoms at T2 and T3, and b) pain severity at T1 predicted chronic pain severity at follow-up through pain severity at T2 and T3. CONCLUSIONS: Both pain and PTSD in the acute post-SCI phase are markers for chronic pain two years later. PTSD and chronic pain exhibit a complex, reciprocal relationship across time that contributes to pain chronicity. Identifying individuals at risk and implementing interventions targeting both pain and PTSD symptoms during the acute phase may prevent their chronification.

To reappraise or not to reappraise? Emotion regulation strategies moderate the association of loneliness during COVID-19 with depression and anxiety.

BACKGROUND: The COVID-19 pandemic resulted in heightened feelings of loneliness due to lockouts and social restrictions. OBJECTIVE: In the present study, we examined the association of loneliness during the pandemic with anxiety and depression, while exploring the moderating role of the tendency to use two emotion-regulation strategies (expressive suppression, cognitive reappraisal). DESIGN: We chose to examine these associations in a sample of older adults, because they faced higher risk for loneliness and health problems during the COVID-19 pandemic. METHODS: Specifically, 174 Israeli veterans and ex-prisoners of wars from the 1973 Yom Kippur war (mean age = 69) completed self-report scales tapping loneliness, depression, anxiety, and emotion regulation strategies at the beginning of the COVID-19 outbreak (April-May 2020). RESULTS: Findings revealed a stronger association between loneliness and depression among participants who had a greater tendency of using suppression. The tendency to use suppression did not significantly moderate the link between loneliness and anxiety. Additionally, a weaker association between loneliness and depression was found among participants who has a greater tendency of using reappraisal. However, these participants showed a stronger association between loneliness and anxiety. CONCLUSIONS: These findings highlight the complexity of reappraisal and adds to the growing body of work on emotion regulation.

Attachment style and coping in relation to posttraumatic stress disorder symptoms among adults living with HIV/AIDS.

Research indicates that a significant proportion of people living with HIV/AIDS report symptoms of posttraumatic stress disorder (PTSD). Moreover, attachment style has been associated with psychological and behavioral outcomes among persons living with HIV/AIDS. Attachment style may influence the ability to cope with traumatic stress and affect PTSD symptoms. To examine the association between attachment style and coping with PTSD symptoms, we assessed 94 HIV-positive adults on self-report measures of posttraumatic stress, coping, and attachment style. In multiple regression analysis, avoidant attachment and emotion-focused coping were positively and significantly associated with greater PTSD symptomatology. Support was also found for the moderating effects of avoidant and insecure attachment styles on emotion-focused coping in relation to greater PTSD symptoms. Taken altogether, these results suggest that interventions that develop adaptive coping skills and focus on the underlying construct of attachment may be particularly effective in reducing trauma-related symptoms in adults living with HIV/AIDS.

Child abuse and eating disorder symptoms: Shedding light on the contribution of identification with the aggressor.

BACKGROUND: Childhood abuse has been increasingly recognized as a risk factor for eating disorder symptoms. Additionally, it has been demonstrated that childhood abuse may lead to identification with the aggressor, an automatic defensive process, to survive the abuse. Although it has been clinically implied, the role of identification with the aggressor as a potential mechanism underlying the relation between childhood abuse and eating disorder symptoms has not yet been empirically explored. OBJECTIVE: This study examines the role of identification with the aggressor as mediator in the association between history of childhood abuse and eating disorder symptoms among adults. PARTICIPANTS AND METHODS: A convenience sample of 198 participants completed self-report questionnaires assessing history of childhood abuse, eating disorder symptoms, and the various facets of identification with the aggressor. RESULTS: Severity of childhood abuse was significantly associated with shape and weight overevaluation, body dissatisfaction, and binge eating, as well as with all components of identification with the aggressor. In addition, almost all components of identification with the aggressor were significantly associated with eating disorder symptoms. Finally, identifying with the perpetrator's aggression mediated the association between childhood abuse and eating disorder symptoms. CONCLUSIONS: The findings may contribute to future clinical interventions by illuminating identification with the aggressor as an important aspect in treating eating disorders. Understanding the pervasive effects of identification with the aggressor on survivors' self and their interactions with others may point to the significance of the therapeutic relationship, through which survivors can reprocess and weaken its detrimental effects.

Vulnerability reawakened: Increased substance use among aging traumatized veterans during COVID-19 pandemic.

OBJECTIVE: This study prospectively assesses the implication of (a) exposure to distant trauma of war captivity, (b) stressful life events across the life span, and (c) posttraumatic stress disorder (PTSD) trajectories and current PTSD, on substance use during the COVID-19 pandemic. METHOD: One hundred and twenty Israeli ex-prisoners of war (ex-POWs) and 65 matched veterans of the 1973 Yom Kippur War filled out self-report questionnaires in 4 waves of assessment (T1-18, T2-30, T3-35, and T4-42 years after the war). A fifth wave of assessment (T5) was conducted in the midst of the COVID-19 pandemic, 47 years after the war. RESULTS: Whereas in the earlier assessments (T1-T4) war captivity was not related to substance use, during the COVID-19 pandemic (T5) ex-POWs reported higher increase of use of alcohol, tranquilizers, cannabis, and sleep medications than comparable veterans. War-induced PTSD trajectories that were prospectively measured between T1-T4, and concurrent PTSD during the pandemic (T5) were related to increase in substance use during the pandemic (T5). CONCLUSIONS: The findings demonstrate the long-term effects of both earlier experience of severe traumatic stress in young adulthood and the resultant PTSD trajectories, as reflected in increased substance use among the elderly, in the face of subsequent calamity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Obstetric outcome and emotional reactions to childbirth in women with dyspareunia: A cross-sectional study.

OBJECTIVE: To assess obstetrical outcomes, perceptions of childbirth experience and emotional adjustment, in women with dyspareunia. STUDY DESIGN: In this cross-sectional study, 440 women were recruited within 48 h postpartum in the maternity ward of a large medical center, during the period of April 2018- August 2020. Self-report questionnaires were administered which addressed demographic and reproductive background, dyspareunia, perceptions of control during labor (Labor Agentry Scale), perceived professional support (Intrapartum Care Scale), and maternal adjustment, implicated in perinatal dissociation (Peritraumatic Dissociative Experiences Questionnaire), acute stress disorder (ASD) symptoms (Stanford Acute Stress Reaction Questionnaire), bonding (Mother-to-Infant Bonding Scale), anticipated maternal self-efficacy (Maternal Self-Efficacy Scale) and well-being (Positive and Negative Affect Schedule, Edinburgh Postnatal Depression Scale). Obstetrical information was retrieved from clinical files and included pregnancy complications, week and mode of delivery, nature of labor onset, analgesia during delivery, birthweight, perineal tears. RESULTS: The dyspareunia group included 71 women (18.3%) and the comparison group 317 (81.7%). Demographic data were similar among groups. No difference was observed in nature of labor onset, type of analgesia, route of delivery, perineal tears. More participants with dyspareunia had premature delivery versus comparisons (14.1% vs 5.6%, p = 0.02). Women with dyspareunia reported lower levels of control (p = 0.01) and perceived support during childbirth (p < 0.001), higher levels of perinatal dissociation (p < 0.001) ASD symptoms (p < 0.001), depression (p = 0.02), negative affect (p < 0.001), and reported lower levels of maternal bonding (p < 0.001) and anticipated maternal self-efficacy (p = 0.01). CONCLUSION: Dyspareunia was associated with more premature deliveries, parameters of emotional distress during childbirth and poorer maternal adjustment following childbirth. Perinatal caregivers should be cognizant of such cognitive and emotional reactions in women with dyspareunia, so as to assess for a history of dyspareunia in pregnant women and provide adequate support during pregnancy and delivery.

The role of impulsivity in the association between childhood trauma and dissociative psychopathology: mediation versus moderation.

Previous studies on survivors of childhood trauma documented associations between psychological dysregulation, impulsivity, and both behavioral and emotional manifestations of distress. Yet, the mechanism that links these variables remains unclear. The current study aims to examine the pattern of relations between a history of child abuse, impulsivity and dissociation. More specifically, it examines whether impulsivity serves as a moderator or mediator in the association between childhood trauma and dissociation. Eighty-one inpatients from the acute wards of two psychiatric hospitals participated in this study. Data were collected by clinician-administered questionnaires. A highly significant linear hierarchical regression analysis revealed that both psychiatric comorbidity and childhood trauma made unique contributions to the variance of dissociation. Yet, the significant association between childhood trauma and dissociation decreased when impulsivity was entered into the regression model. Our findings suggest that impulsivity mediates the association between childhood trauma and dissociative psychopathology and imply that the identification and treatment of impulsivity could be a potentially valuable clinical target in individuals with dissociative disorders.

Trajectories analysis of comorbid depression and anxiety among Israeli veterans: The implications on cognitive performance.

BACKGROUND: Among war veterans, research has indicated high rates of depression, anxiety, and comorbidity of these disorders, with even higher rates among prisoners-of-war. However, little is known about the longitudinal effects of comorbidity profiles on cognitive performance, particularly in the case of aging war veterans. METHOD: This longitudinal study focuses on Israeli veterans from the 1973 Yom Kippur War, with assessments at four time-points: 1991 (T1), 2003 (T2), 2008 (T3), and 2015 (T4). Two groups were included: veterans who were held captive (ex-POWs; n = 196), and veterans who were not (war veterans; n = 159). Participants completed validated self-report measures, and their cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA). RESULTS: Three distinct profiles of comorbidity were identified: resiliency (57.5%, n = 204); delayed-onset (29.6%, n = 105), and chronic (13.00%, n = 46). The chronic profile identified mostly among ex-POW (91.3%, n = 42), veterans with lower education at T1, and with more cognitively impaired compared to the other profiles (p < .0001). No differences were found between the profiles in age and family status at T1. CONCLUSIONS: The findings highlight the importance of viewing aging veterans as a high-risk population for cognitive impairments, particularly those suffering from chronic comorbidity of depression and anxiety. Therefore, the appropriate diagnosis and cognitive treatment are required to preserve cognitive abilities and prevent decline.

Identification With the Aggressor and Inward and Outward Aggression in Abuse Survivors.

Childhood abuse survivors may display both inward and outward aggression manifested in self-injurious behavior (SIB) and violent acts toward others. Scrutinizing the literature reveals that the relational dynamics between victims and their perpetrators might be involved in these phenomena. Yet, research on this subject matter has been sparse. Filling this gap, this study investigated the contribution of the singular bonds between victims and their perpetrators, known as identification with the aggressor, in explaining survivors' aggression. The study was conducted among 306 Israeli college/university students who reported a history of childhood abuse. Results revealed that levels of adopting the perpetrator's experience, identifying with the perpetrator's aggression, and replacing one's agency with that of the perpetrator were significantly associated with survivors' inward and outward aggression. Moreover, profile type-that is, having high versus low levels of identification with the aggressor-was implicated in participants' SIBs, urge to harm others, and violent acts toward others, above and beyond the effects of gender and posttraumatic stress disorder (PTSD) symptoms. The present findings suggest that identification with the aggressor might make survivors prone to the re-enactment of past abusive dynamics, which, in turn, could eventuate in aggression toward themselves and others.

The Differential Role of Narcissism in the Relations Between Childhood Sexual Abuse, Dissociation, and Self-Harm.

Childhood sexual abuse (CSA) is considered a risk factor for self-harm behaviors. According to the anti-dissociation model of self-harm, the relation between CSA and self-harm is mediated by dissociation. However, inconclusive evidence supporting this model suggests that this association may be moderated by vulnerability factors. Grandiose and vulnerable narcissism represent distinct patterns of behaviors intended to deal with unmet needs of recognition. The aim of the study was to examine a model in which the relation between CSA and self-harm is mediated by dissociation, and the relation between dissociation and self-harm is moderated by grandiose narcissism and vulnerable narcissism. A battery of self-reported questionnaires including the Childhood Trauma Questionnaire, Dissociative Experiences Scale, Deliberate Self-Harm Inventory, and Brief-Pathological Narcissism Inventory were filled out by 766 college/university students. Results indicated that self-harm was related to CSA through the mediation of dissociation. Moreover, the analyses yielded significant interactions of both vulnerable and grandiose narcissism with dissociation in predicting self-harm; the relation between dissociation and self-harm was significant among individuals with high levels of vulnerable narcissism, as well as among individuals with low levels of grandiose narcissism. These findings support the anti-dissociation model of self-harm. The findings also highlight the complex and ambiguous role of narcissism in the long-term adjustment of CSA survivors.