A Longitudinal Examination of Posttraumatic Stress Disorder Symptoms and Risky Sexual Behavior: Evaluating Emotion Dysregulation Dimensions as Mediators.

Posttraumatic stress disorder (PTSD) has been linked to a wide array of risky and health-compromising behaviors, including risky sexual behavior (RSB). Cross-sectional studies reveal positive associations between emotion dysregulation and both PTSD and RSB. This study extended that work by exploring whether intermediate levels of emotion dysregulation across multiple dimensions account for the relation between baseline PTSD symptoms and RSB (i.e., number of vaginal sex partners, number of instances of condomless sex, and number of instances of risky/impulsive sex) 16 months later. Participants were 447 trauma-exposed young adult women from the community (60.0% White; M age = 21.80 years) who completed five assessments (separated by 4-month increments) over a 16-month period. Baseline PTSD symptoms were significantly positively associated with all emotion dysregulation dimensions at 8 months and the number of instances of risky/impulsive sex at 16 months. Further, results revealed significant indirect effects of baseline PTSD symptoms on (1) 16-month vaginal sex partners through both the nonacceptance of negative emotions and difficulties controlling impulsive behaviors when distressed at 8-month and (2) 16-month risky/impulsive sex through difficulties engaging in goal-directed behaviors when distressed at 8 months. Results provide support for the mediating roles of nonacceptance of negative emotions and difficulties controlling behaviors when distressed in the relation between PTSD symptoms and later RSB.

Risk for Revictimization Following Interpersonal and Noninterpersonal Trauma: Clarifying the Role of Posttraumatic Stress Symptoms and Trauma-Related Cognitions.

One victimization experience can increase the risk for subsequent victimization, which is known as revictimization. The aims of this study were to build on sexual revictimization research by (a) broadening the understanding of revictimization to interpersonal (and potentially noninterpersonal) trauma generally and (b) gaining specificity in the mechanisms that underlie revictimization. Using a prospective multisite design, an ethnically and racially diverse sample of 453 young women from the community (age range: 18-25 years, 60.7% European American) completed an initial survey and at least one follow-up survey within the subsequent year. Participants completed self-report measures of trauma history, posttraumatic stress symptoms, and maladaptive posttraumatic cognitions. Structural equation models revealed that interpersonal revictimization was observed when controlling for past noninterpersonal trauma, odds ratio (OR) = 2.27, 95% CI [1.23, 4.18], and supported the role of posttraumatic stress symptoms as a mechanism underlying such revictimization, 95% CI of indirect effect (IE) [0.08, 0.51]. Additionally, a history of noninterpersonal trauma (controlling for past interpersonal trauma) increased risk of subsequent interpersonal victimization via posttraumatic stress symptoms, 95% CI of IE [0.01, 0.38]. Notably, however, when maladaptive cognitions were included as mediators in addition to posttraumatic stress symptoms, the only unique indirect effect was for the association between interpersonal trauma and risk of revictimization specifically through perceived threat of harm, 95% CI of IE [0.05, 0.20]. These findings suggest that efforts to reduce interpersonal revictimization should target maladaptive posttraumatic cognitions, particularly perceptions of threat in the environment.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Riesgo de revictimización luego de trauma interpersonal y no interpersonal: Aclarando el rol de los Síntomas de Estrés postraumático y las Cogniciones relacionadas con el Trauma REVICTIMIZACIÓN, TEPT Y COGNICIONES Una experiencia de victimización puede aumentar el riesgo de una subsiguiente victimización, conocida como revictimización. Los objetivos de este estudio fueron desarrollar una investigación sobre la revictimización sexual mediante (a) una comprensión más amplia de la revictimización al trauma interpersonal (y potencialmente no interpersonal) en general, y (b) la obtención de especificidad en los mecanismos que subyacen a la revictimización. Utilizando un diseño multisitio prospectivo, una muestra étnica y racialmente diversa de 453 mujeres jóvenes de la comunidad (rango de edad: 18-25 años, 60.7% europeo-estadounidense) completaron una encuesta inicial y al menos una encuesta de seguimiento dentro del año siguiente. Las participantes completaron medidas de auto reporte del historial de traumas, síntomas de estrés postraumático y cogniciones postraumáticas no adaptativas. Los modelos de ecuaciones estructurales revelaron que se observó una revictimización interpersonal al controlar traumas no interpersonales pasados, odds ratio (OR) = 2.27, IC 95% [1.23, 4.18], y apoyaron el rol de los síntomas de estrés postraumático como un mecanismo subyacente a dicha revictimización, IC del 95% de efecto indirecto (IE) [0.08, 0.51]. Además, un historial de trauma no interpersonal (controlando el trauma interpersonal pasado) incrementó el riesgo de subsecuente victimización interpersonal mediante síntomas de estrés postraumático, IC del 95% de IE [0.01, 0.38]. Sin embargo, notablemente, cuando se incluyeron las cogniciones no adaptativas como mediadores además de los síntomas de estrés postraumático, el único efecto indirecto fue la asociación entre el trauma interpersonal y el riesgo de revictimización, específicamente a través de la percepción de la amenaza de daño, IC del 95% de IE [0.05, 0.20]. Estos hallazgos sugieren que los esfuerzos para reducir la revictimización interpersonal deben dirigirse a las cogniciones postraumáticas no adaptativas, en particular las percepciones de amenaza en el medio ambiente.

Childhood Sexual Abuse and Fear of Abandonment Moderate the Relation of Intimate Partner Violence to Severity of Dissociation.

Betrayal trauma theory proposes a relation between intimate partner violence (IPV) and dissociation, suggesting that dissociation among victims of IPV may function to restrict awareness of abuse in order to preserve attachments perceived as vital. We investigated two factors that may moderate the relation between IPV and dissociation-childhood sexual abuse (CSA) severity and fear of abandonment-among 348 women currently in a relationship. The relation between frequency of IPV (sexual and physical) and dissociation (amnesia and depersonalization) was moderated by CSA severity and fear of abandonment. Specifically, among women with clinically relevant fear of abandonment, the strength of the relation between IPV and dissociation became stronger as CSA severity increased. This study is the first to demonstrate the moderating roles of fear of abandonment and CSA history in the relation between IPV and dissociation among women. Findings suggest that it may be important to target fear of abandonment in interventions with IPV victims who have a CSA history. Results suggest that fear of abandonment warrants greater attention in research on IPV revictimization.

Victim Alcohol Intoxication During a Sexual Assault: Relations With Subsequent PTSD Symptoms.

This study examines associations between women's alcohol intoxication at the time of sexual assault and posttraumatic stress disorder (PTSD) symptoms. Drawing on the dual representation theory (Brewin, Gregory, Lipton, & Burgess, 2010), we hypothesized that intoxication at the time of assault would be positively associated with both overall symptoms of PTSD and PTSD reexperiencing symptoms in particular. A total of 143 community women (ages 18-26 years; 71.3% European American) reporting sexual victimization completed questionnaires assessing severity of coercion involved in the assault, perceived level of intoxication at the time of assault, and current PTSD symptoms. Overall, results suggested that greater alcohol intoxication (but not alcohol use alone) was associated with more severe PTSD symptoms when controlling for severity of coercion. Furthermore, higher levels of victim intoxication at the time of the assault were most predictive of reexperiencing symptoms relative to the other symptom clusters.

Contributions of Child Sexual Abuse, Self-Blame, Posttraumatic Stress Symptoms, and Alcohol Use to Women's Risk for Forcible and Substance-Facilitated Sexual Assault.

Child sexual abuse and adult sexual assault have been linked to increased self-blame, posttraumatic stress symptoms, and alcohol use. The current study aims to examine (a) whether these constructs explain women's risk for later adult sexual assault and revictimization, (b) whether such factors differentially confer risk for specific types of adult sexual assault (i.e., substance-facilitated and forcible), and (c) if self-blame confers risk indirectly through other risk factors. Multiple types of self-blame, posttraumatic stress, and alcohol use were examined among 929 female college students as serial mediators of the relationship between child sexual abuse and adult sexual assault and as risk factors for sexual revictimization among child sexual abuse survivors. In the model predicting risk for substance-facilitated adult sexual assault, child sexual abuse indirectly predicted greater risk for substance-facilitated adult sexual assault mediated through two separate paths: global blame-to-posttraumatic-stress and global blame-to-alcohol use. In the model predicting risk for forcible adult sexual assault, child sexual abuse directly predicted greater risk for forcible adult sexual assault, and this relation was mediated by the global blame-to-posttraumatic-stress path. Among child sexual abuse survivors, child sexual abuse specific characterological and behavioral self-blame directly predicted greater risk for forcible and substance-facilitated revictimization, but the pathways were not mediated by posttraumatic stress or alcohol use. Results emphasize the importance of assessing different types of self-blame in predicting posttraumatic stress symptoms as well as examining risk for sexual victimization and revictimization. Findings did not support hypotheses that increased posttraumatic stress would predict increased alcohol use but did indicate that heightened self-blame is consistently associated with heightened posttraumatic stress and that heightened global self-blame predicts increased alcohol use. Implications for future research and intervention are discussed.

Number of sexual partners and sexual assertiveness predict sexual victimization: do more partners equal more risk?

In previous studies, number of sexual partners and sexual assertiveness were examined as independent risk factors for sexual victimization among college women. Using a sample of 335 college women, this study examined the interaction of number of sexual partners and sexual assertiveness on verbal sexual coercion and rape. Approximately 32% of the sample reported unwanted sexual intercourse, 6.9% (n = 23) experienced verbal sexual coercion, 17.9% (n = 60) experienced rape, and 7.2% (n = 24) experienced both. As number of sexual partners increased, instances of verbal sexual coercion increased for women low in relational sexual assertiveness but not for women high in relational sexual assertiveness. A similar relationship was not found for rape. Among women who experienced both verbal sexual coercion and rape, increases in number of partners in the context of low refusal and relational assertiveness were associated with increases in verbal sexual coercion and rape. Findings suggest sexual assertiveness is related to fewer experiences of sexual coercion.

Child abuse, early maladaptive schemas, and risky sexual behavior in college women.

Previous research suggests that individuals abused as children are more likely to engage in risky sexual behavior during adulthood. The present study examined early maladaptive schemas as mediators of the child abuse-risky sexual behavior relationship among 653 college women. Self-report surveys assessed three forms of child abuse: Sexual, physical, and emotional, and assessed early maladaptive schemas within two domains: Disconnection/rejection and Other-Directedness. Disconnection/rejection schemas fully mediated the relation between child emotional abuse and number of sexual partners and partially mediated the relationship for sexual and physical abuse. However, when frequency of specific risky sexual acts (e.g., sex without contraception) was examined in the previous six months, only abandonment was a partial mediator. Implications for intervention and future research are discussed.

Characterizing Sexual Violence in Intimate Relationships: An Examination of Blame Attributions and Rape Acknowledgment.

Rape by an intimate partner frequently involves a precedence of sexual consent between victim and perpetrator, often does not include the use of physical force, and may not fit societal definitions of rape. Given these unique characteristics, women who are assaulted by an intimate partner may be less likely to acknowledge the experience as a rape. In turn, they might make fewer blame attributions toward themselves and their perpetrators than victims of rape by a nonpartner. Consistent with these expectations, results from 208 community women reporting rape in adulthood revealed the presence of indirect effects of perpetrator type (nonpartner vs. intimate partner) on both behavioral self-blame and perpetrator blame through rape acknowledgment, even when controlling for both victim substance use at the time of the assault and coercion severity. Compared with women who experienced a rape by a nonpartner, women who experienced rape in the context of a marital or dating relationship were less likely to blame themselves or the perpetrator for the assault, in part because they were less likely to label their experience as a rape. Overall, these findings highlight the unique nature of intimate partner rape and provide further information about the relatively underresearched area of sexual violence in intimate relationships.

Beyond the Force-Substance Dichotomy: Examining the Experience of Combined and Incapacitated Type Rapes and Their Relation to PTSD Symptoms.

Prior research has examined how posttraumatic stress disorder (PTSD) symptoms are influenced by the experience of different types of rape, defined according to the method of coercion used. This work, which classifies rape experiences as either forcible or substance-involved, has yielded mixed findings regarding differences in PTSD symptoms as a function of rape type. Based on recent evidence indicating significant heterogeneity within substance-involved rapes, the present study utilized a novel four-group conceptualization of rape type to examine differences in PTSD symptom severity and associated factors across rape type. Using a sample of 161 community women with experiences of adult rape, we examined four rape types based on method of coercion: forcible-only rape (i.e., involving only force/threat of force; n = 48), impaired rape (i.e., substance-related impairment was present, but the participant remained conscious; n = 56), combined rape (i.e., both force/threat of force and substance-related impairment were present; n = 29), and incapacitated rape (i.e., the participant was intoxicated to the point of unconsciousness; n = 28). We compared these groups on PTSD symptom severity within each symptom cluster, as well as on assault characteristics and consequences, including peritraumatic fear and injury, acknowledgment, and self-blame. Combined type rapes were associated with significantly more severe PTSD symptoms than forcible-only and impaired type rapes. Differences among the groups were also found for peritraumatic fear and injury, and rape acknowledgment. Utilizing a dichotomous approach to rape type overlooks the complexity of women's experiences. Differences in PTSD symptom severity as a function of the proposed four-group conceptualization of rape type highlight the importance of assessing method of coercion when treating rape-related PTSD. Likewise, differences across rape types in peritraumatic fear and rape acknowledgment highlight the potential utility of type-specific targets of intervention.

Substance use and PTSD symptoms impact the likelihood of rape and revictimization in college women.

The present study utilized a mixed retrospective and prospective design with an 8-month follow-up period to test a model of revictimization that included multiple childhood (i.e., child sexual, physical, and emotional abuse) and situational variables (i.e., substance use, sexual behavior) for predicting rape among 276 college women. It was of particular interest to determine whether traumatic responses (e.g., posttraumatic symptomatology or risky behavior) increased vulnerability for revictimization. During the 8-month follow-up period, 9% of participants were raped; 88% of assaults involved substance use by the victim. Posttraumatic stress disorder (PTSD) symptomatology predicted rape, substance use, and sexual behavior. Substance use, but not sexual behavior, mediated the relation between PTSD symptomatology and rape during the follow-up period. Sexual behavior indirectly impacted risk for rape via substance use. Results suggest that college women with PTSD symptomatology may be at greater risk for rape if they use substances to reduce distress.

Psychological consequences of sexual victimization resulting from force, incapacitation, or verbal coercion.

Recently, incapacitated rape has emerged as a distinct type of sexual victimization. However, little is known about its longer-term psychological consequences. Two studies compare the psychological consequences of incapacitated rape to those of forcible rape and verbal coercion. Generally, the traumatic impact of incapacitated rape was intermediate to that of verbal coercion and forcible rape; however, there were domains (e.g., current perceived trauma and emotional impact) in which incapacitated and forcible rape had a similar impact and other domains (e.g., attributions of responsibility) in which incapacitated rape was similar to verbal coercion. This research suggests that sexual assault researchers might benefit from separately examining forcible and incapacitated rape.

Effects of childhood emotional maltreatment on depressive symptoms through emotion dysregulation in treatment-seeking patients with heroin-dependence.

BACKGROUND: Although individuals who experience childhood emotional maltreatment (CEM) are more likely to use maladaptive emotion regulation strategies, resulting in vulnerability to depression, no research has examined whether emotion dysregulation may explain the association between CEM and current depressive symptoms in a clinical sample of heroin-dependent individuals. OBJECTIVES: The current study aimed to assess the direct effect of CEM on current depressive symptoms and its indirect effect via emotion dysregulation in a treatment-seeking sample of males with heroin dependence. In a cross-sectional design, participants (N = 350) completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale (OCDUS), and the Beck Depression Inventory-II (BDI-II). RESULTS: Emotional abuse and neglect severity had significant direct effects on current depressive symptoms and significant indirect effects through emotion dysregulation after controlling for clinical factors related to heroin use. LIMITATIONS: Study limitations include the cross-sectional design and use of self-report scales. CONCLUSIONS: Findings suggest emotion dysregulation may increase depressive symptoms in heroin users who experienced CEM. Training in emotion regulation strategies may decrease depressive symptoms in heroin-dependent individuals with CEM. Additional research with a longitudinal design to confirm these results is warranted.

Rape Disclosure and Depression Among Community Women: The Mediating Roles of Shame and Experiential Avoidance.

Many women who disclose a rape encounter victim-blaming responses, which are associated with negative outcomes. The present study examined rape-related shame and experiential avoidance as mediators of the relation between victim-blaming responses to rape disclosure and depression among 103 rape survivors drawn from a community sample. Results revealed that victim-blaming responses were positively associated with depressive symptoms through rape-related shame and experiential avoidance, and shame was indirectly related to depression via avoidance. Findings suggest clinical interventions should focus on rape-related shame and experiential avoidance in targeting depression among rape survivors, and future research should continue to examine how victim-blaming responses to rape disclosure may be related to these factors.

Linking childhood emotional abuse and depressive symptoms: The role of emotion dysregulation and interpersonal problems.

Childhood abuse is a major public health problem that has been linked to depression in adulthood. Although different types of childhood abuse often co-occur, few studies have examined their unique impact on negative mental health outcomes. Most studies have focused solely on the consequences of childhood physical or sexual abuse; however, it has been suggested that childhood emotional abuse is more strongly related to depression. It remains unclear which underlying psychological processes mediate the effect of childhood emotional abuse on depressive symptoms. In a cross-sectional study in 276 female college students, multiple linear regression analyses were used to determine whether childhood emotional abuse, physical abuse, and sexual abuse were independently associated with depressive symptoms, emotion dysregulation, and interpersonal problems. Subsequently, OLS regression analyses were used to determine whether emotion dysregulation and interpersonal problems mediate the relationship between childhood emotional abuse and depressive symptoms. Of all types of abuse, only emotional abuse was independently associated with depressive symptoms, emotion dysregulation, and interpersonal problems. The effect of childhood emotional abuse on depressive symptoms was mediated by emotion dysregulation and the following domains of interpersonal problems: cold/distant and domineering/controlling. The results of the current study indicate that detection and prevention of childhood emotional abuse deserves attention from Child Protective Services. Finally, interventions that target emotion regulation skills and interpersonal skills may be beneficial in prevention of depression.

Sexuality, substance use, and susceptibility to victimization: risk for rape and sexual coercion in a prospective study of college women.

An 8-month prospective study examined behavioral, personality, and psychological variables thought to increase vulnerability for college women's experience of rape and verbal sexual coercion. Participants were 276 college women who completed self-report surveys. During 1 academic year, 9.5% of women were raped and 11.7% reported verbal sexual coercion. Elevated levels of sexual concerns, dysfunctional sexual behavior, and impaired self-reference were associated with both verbal sexual coercion and rape. Alcohol and marijuana use increased risk only for rape, whereas self-criticism and depression increased risk only for verbal coercion. Findings suggest that multiple aspects of sexuality, such as shame regarding sexuality and using sex to meet nonsexual needs, may increase risk for both types of sexual victimization. Results support conclusions that rape and verbal sexual coercion have both shared and unique risk factors. Implications for future research and intervention programs are discussed.

I Said No: The Impact of Voicing Non-Consent on Women's Perceptions of and Responses to Rape.

The current study explored the impact of voicing non-consent in relation to rape. Aims of the study included determining (a) the prevalence of voicing non-consent, (b) the relationship of voicing non-consent to verbal and physical resistance, and (c) whether voicing non-consent predicts distress and rape acknowledgment. Out of 262 college women who experienced rape, 81% voiced non-consent. Voicing non-consent was related to verbal and physical resistance, but was distinct in prevalence and prediction of distress. Voicing non-consent was associated with trauma-related symptoms in multivariate models. Women who voiced non-consent were more likely to acknowledge their experience as rape or sexual assault. Implications are discussed.

Latent Classes of Lifetime Sexual Victimization Characteristics in Women in Emerging Adulthood: Differential Relations with Emotion Dysregulation.

OBJECTIVES: The aims of the present study were to investigate latent classes of sexual victimization among young adult women based on characteristics of their victimization experiences (e.g., relationship with the perpetrator, nature of act, frequency), and examine differences in dimensions of emotion dysregulation across these classes and among non-victims. METHOD: Participants were 491 women in the age range of 18-25 years from the United States; of these, 335 participants (M = 22.0, SD = 2.22) reported at least one experience of sexual victimization during their lifetime. Latent class analysis was employed to identify groups of women based on characteristics of their sexual victimization experiences. RESULTS: A three-class solution was found to be most parsimonious. The classes were labeled as High severity developmental revictimization (DRV; 43.3%), Low severity child/adolescent sexual abuse (CASA: 20.3%), and Low severity adult sexual assault (ASA; 36.4%). The DRV class reported higher rates of penetrative abuse and longer duration of abuse than the CASA class, and higher rates of injury during assault than the ASA class. Further, the DRV class reported greater difficulties in three dimensions of emotion regulation than the ASA class and greater deficits in emotional clarity than the CASA class. Finally, the three latent classes reported greater difficulties in at least four dimensions of emotion regulation than the non-victimized group. CONCLUSIONS: Findings of different classes of sexual victimization suggest the multidimensionality of these experiences. Results also highlight the potential utility of interventions aimed at improving emotion regulation among women with severe childhood sexual abuse.

Unique and combined contributions of multiple child abuse types and abuse severity to adult trauma symptomatology.

Studies have documented the co-occurrence and cumulative impact of multiple types of child maltreatment on later psychosocial difficulties. Other research suggests that child abuse characteristics indicative of severity may also increase risk of later adjustment problems. However, little effort has been made to examine the co-occurrence of both multiple types of maltreatment and abuse severity within a single study. The present investigation examines self-reported child maltreatment and adult functioning in a geographically diverse sample of 1,396 undergraduate students. Results indicate that experiencing multiple types of maltreatment is positively associated with more severe abuse. Although increased maltreatment types and more severe abuse are each associated with greater trauma symptomatology, abuse severity is the stronger of the two predictors. Finally, number of maltreatment types and severity of maltreatment interact to predict greater levels of trauma symptomatology. These results highlight the importance of considering both co-occurring abuse types and severity in research and clinical work with adult victims.

Sexual victimization in relation to perceptions of risk: mediation, generalization, and temporal stability.

There is evidence that personal experience with trauma is associated with increases in both personal and comparative risk perception. This study investigates this relation in terms of sexual victimization among women, focusing on three potential mediators: perceived control over sexual assault, perceived similarity to a typical sexual assault victim, and psychological distress. Mediational analyses were investigated using structural equation modeling. Although victimization experience was not related to comparative risk perception, it was associated with greater personal risk perception. This relation was mediated by perceived similarity to a typical sexual assault victim. Prospective analyses indicated that personal risk perception does change in response to sexual victimization but also indicated that heightened risk perception may be an accurate assessment of risk that actually precedes victimization experience. Implications for the meaning of perceived similarity and perceptions of risk for sexual assault victims are discussed.

The Importance of Substance-Related Sexual Victimization: Impact on Substance Use and Risk Perception in Female College Students.

Data on risk perception, sexual victimization, and substance use were obtained via surveys from 496 female college students to determine what factors influence risk perception using a written vignette in which participants make a hypothetical decision to leave a potentially risky situation. Experiences of substance-related (SR) victimization, rather than forcible victimization, were associated with significantly delayed risk perception. SR victimization victims reported feeling uncomfortable significantly later and leaving the scenario significantly later than non-victims. SR victimization victims also had significantly higher scores on heavy episodic drinking (HED), marijuana use, alcohol-related tolerance, and blackouts. Both substance use (HED and marijuana use) and alcohol-related problems (tolerance and blackouts) mediated the link between SR victimization and risk perception in the form of behavioral leave response. In contrast, only HED and tolerance mediated the link between SR victimization and risk recognition. Findings suggest the importance of differentiating types of victimization in predicting risk perception and of addressing substance use in sexual victimization risk reduction interventions.