Latent Profiles of Disordered Eating Among Veterans: Associations With Mental Health Concerns.

BACKGROUND: Varying patterns in eating disorder (ED) classification are evident and may impact ED treatment and prevention. However, investigations of patterns of heterogeneity in ED presentations have been limited to civilian samples, despite the high prevalence of EDs in military personnel and veterans. The present study aimed to explore ED-related symptom patterns, including emotional overeating, in women veterans. METHODS: Participants were 407 women veterans using health care services at a large Veterans Affairs health care system who completed mental health measures via surveys. Latent profile analyses were used to explore distinct ED symptom patterns (binge eating, purging, heavy exercise, positive and negative emotional overeating, dietary restraint, and shape/weight concerns). Subsequent auxiliary models explored associations with mental health concerns (depressive symptoms, posttraumatic stress disorder, anxiety, alcohol misuse, substance misuse), adjusting for age, race and ethnicity, and service branch. RESULTS: A four-class solution demonstrated the best model fit, characterized as follows: 1) Low ED Concerns, 2) Moderate Dietary Restraint/Negative Emotional Eating, 3) High Binge/Emotional Eating, and 4) High ED Concerns. Although all profiles had moderate or higher levels of negative emotional overeating, the High Binge/Emotional Eating and High ED Concerns profiles were distinct in levels of dietary restraint and had the highest probabilities of positive emotional overeating. The High ED Concerns profile also had the most severe mental health concerns relative to the other profiles. CONCLUSIONS: The identification of unique ED symptom patterns in women veterans can inform prevention and intervention efforts.

Associations of humor, morale, and unit cohesion on posttraumatic stress disorder symptoms.

Military personnel experience many stressors during deployments that can lead to symptoms of posttraumatic stress disorder (PTSD). However, not all military personnel who are exposed to deployment stressors develop PTSD symptoms. Recent research has explored factors that contribute to military personnel resilience, a multifaceted and multidetermined construct, as a means to mitigate and prevent PTSD symptoms. Much of this research has focused on the effects of individual-level factors (e.g., use of coping strategies like humor, the morale of individual unit members), with some research focusing on unit-level factors (e.g., the cohesiveness of a unit). However, there is little research exploring how these factors relate to each other in mitigating or reducing PTSD symptoms. In this study, we examined the association between deployment stressors, perceived unit cohesion, morale, humor, and PTSD symptoms in a sample of 20,901 active-duty military personnel using structural equation modeling. Results indicated that perceived unit cohesion, humor, and morale were positively associated with each other and negatively associated with PTSD symptoms over and above the effect of deployment stressors. These findings highlight the influence of resilience factors on PTSD symptoms beyond their substantial overlap and have implications for future research as well as the potential development of interventions for military personnel.

Dimensional approaches to studying, assessing, and treating traumatic stress: Introduction to the Special Section.

Dimensional models of psychopathology are gaining empirical support and are, thus, increasingly common in research and clinical practice. This is true for traumatic stress studies, although the movement toward dimensional conceptualizations of traumatic stress may be somewhat slower, perhaps due at least in part to how trauma is diagnosed. The purpose of this special section is to collect and showcase cutting-edge basic, applied, and conceptual work on dimensional models of traumatic stress. Its goal is to highlight the utility of such models and to facilitate greater connection between traumatic stress studies and the broader dimensional movement in psychopathology.

Influence of Betrayal Trauma on Schizoid Personality Pathology.

Schizoid personality pathology is among the most debilitating and enigmatic forms of personality pathology. Some have suggested that a potential etiological influence on schizoid pathology is trauma. Thus far, research on the association between trauma and schizoid pathology has focused primarily on type of trauma (e.g., abuse vs. neglect during childhood) rather than who perpetrated the trauma. This contrasts with recent research on trauma perpetrated by someone upon whom the survivor relies and/or trusts (i.e. betrayal trauma), which many studies show has a uniquely pernicious association with several forms of personality pathology. However, this has not yet been examined with respect to schizoid pathology specifically. In this study, we examined the relative associations between trauma varying degrees of betrayal and schizoid personality pathology in a sample recruited from Amazon's Mechanical Turk (N = 300) using a Bayesian approach to structural equation modeling. Results suggest that interpersonal trauma in general was associated with higher levels of schizoid pathology. Findings further indicate that for men but not women, trauma with a high degree of betrayal was uniquely associated with schizoid pathology. These findings contribute to the growing body of research suggesting the influence of interpersonal trauma in general and betrayal trauma in particular on personality pathology and have implications for future research on and intervention with people with high levels of schizoid pathology.

Association Between Betrayal Trauma and the PAI Traumatic Stress Scale.

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

The influence of betrayal trauma on complex posttraumatic stress disorder symptoms.

OBJECTIVE: Complex posttraumatic stress disorder (complex PTSD) is characterized by symptoms of PTSD combined with disturbance in self-organization and is distressing for many people who have experienced chronic and repetitive interpersonal trauma. Studies on the precursors to complex PTSD have thus far focused on the forms of trauma perpetrated rather than who perpetrated the trauma. Traumas that are associated with complex PTSD (i.e., chronic and repetitive interpersonal traumas) are often perpetrated by someone that is close to the victim and thus involve an element of betrayal. However, there is little research on whether traumas high in betrayal are more associated with complex PTSD symptoms than traumas lower in betrayal. The aim of this study is to examine the association between traumas with varying degrees of betrayal and complex PTSD symptoms. METHOD: We examined this association in a sample of adults (N = 364) recruited using Amazon's Mechanical Turk using a Bayesian approach to multiple regression. RESULTS: Results suggest that interpersonal traumas both with and without a component of betrayal were associated with complex PTSD symptoms for both women and men. We further found that for men, noninterpersonal trauma was also associated with complex PTSD symptoms. CONCLUSION: Study findings highlight the role of interpersonal trauma on complex PTSD symptoms, especially for women. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Impact of Cognitive Behavioral Therapy for Substance Use Disorders on Veterans' Interpersonal Difficulties.

Background: Substance use disorders (SUDs) negatively impact veterans and their relationships with others. Although there are several evidence-based treatments for SUD symptoms, there is less research on whether reduction in SUD symptoms coincides with reduction in interpersonal difficulties. Methods: In this study we examined the relationship between SUD and relationships in a national sample of 458 veterans who received approximately 12 sessions of Cognitive Behavioral Therapy for Substance Use Disorders (CBT-SUD) through the Veterans Health Administration (VHA). Results: Parallel latent growth curve modeling (LGCM) indicated that self-reported alcohol use, drug use, and interpersonal difficulties decreased over the course of treatment. Alcohol and drug use were positively associated with each other and with interpersonal difficulties at each time point, and baseline alcohol and drug use were negatively associated with the reduction of use over time. However, there was little evidence that reductions in substance use led to a reduction in interpersonal difficulties (or vice-versa). Conclusions: Findings highlight promising strategies to further understand how CBT-SUD may enhance reductions in substance use as well as improve relationships with family and friends.

Influence of betrayal trauma on obsessive-compulsive personality pathology.

OBJECTIVE: Obsessive-compulsive personality disorder (OCPD) is among the most common forms of personality pathology. Research suggests that among the risk factors for OCPD pathology is trauma, although it is unclear which kinds of trauma are most influential. Of particular relevance may be trauma high in interpersonal betrayal, which research suggests has a unique association with many different forms of personality pathology. However, this has not yet been examined for OCPD specifically. METHOD: In this study, we examined the differential associations between trauma with varying levels of betrayal and OCPD pathology in a sample of women and men recruited online (N = 300) using a Bayesian approach to structural equation modeling. RESULTS: Results suggest that although general interpersonal trauma was associated with OCPD across the sample, interpersonal trauma high in betrayal was uniquely associated with OCPD for men. CONCLUSION: These findings have implications for future research on the influence of trauma and personality pathology as well as for the treatment of OCPD specifically. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Virtual Worlds Technology to Enhance Training for Primary Care Providers in Assessment and Management of Posttraumatic Stress Disorder Using Motivational Interviewing: Pilot Randomized Controlled Trial.

BACKGROUND: Many individuals with posttraumatic stress disorder (PTSD) first present to primary care rather than specialty mental health care. Primary care providers often lack the training required to assess and treat patients with PTSD. Virtual trainings have emerged as a convenient and effective way of training primary care providers in PTSD assessment and communication methods (ie, motivational interviewing [MI]). OBJECTIVE: The aim of this study was to conduct a pilot randomized controlled trial of a synchronous Virtual Worlds (VW; a virtual world where learners were immersed as avatars) training versus an asynchronous web-based training on PTSD and MI, comparing the feasibility, acceptability, usability, and preliminary efficacy of 2 different training platforms among primary care providers. METHODS: Participating primary care providers were randomized to a VW and a web-based PTSD training. Outcomes were collected at baseline, posttraining, and 90-days follow-up. Standardized patient interviews measured participants' communication skills in assessing and managing patients with PTSD symptoms. RESULTS: Compared to the web-based training, the VW training platform achieved larger learning gains in MI (ie, partnership and empathy) and in discussing pharmacotherapy and psychotherapy for PTSD. Both VW and web-based trainings led to increases in PTSD knowledge and primary care providers' self-confidence. CONCLUSIONS: The asynchronous web-based PTSD training improved PTSD-related knowledge and self-confidence but was not as effective as the VW immersive experience in teaching MI or clinical management. Because VW training is synchronous and new for many learners, it required more time, facilitation, and technical support. As computer technology improves, VW educational interventions may become more feasible, particularly in teaching clinical skills. TRIAL REGISTRATION: ClinicalTrials.gov NCT03898271; https://tinyurl.com/mu479es5.

N-acetylcysteine for smoking cessation among dual users of tobacco and cannabis: Protocol and rationale for a randomized controlled trial.

BACKGROUND: Tobacco and cannabis co-use is a growing public health problem. The synergistic effects of cannabis and nicotine on neurobiological systems that mediate reward and shared environmental cues reinforcing use may make tobacco smoking cessation more difficult. N-acetylcysteine (NAC), an FDA-approved medication and over-the-counter supplement, has shown promise in animal studies and randomized controlled trials (RCTs) in reducing tobacco and cannabis craving and use. NAC's potential efficacy in treating addiction may be attributable to its central nervous system effects in reducing excessive glutamatergic activity, oxidative stress, and inflammation. To date, no RCT has examined NAC for smoking cessation among dual users of tobacco and cannabis. METHOD: In a double-blind, placebo-controlled RCT, we will examine NAC for smoking cessation among dual users of tobacco and cannabis. Sixty adult cigarette-cannabis co-users are randomized to receive NAC 3600 mg per day or placebo over 8 weeks. Participants in both groups receive 8 weekly cognitive behavioral therapy sessions addressing smoking cessation and cannabis reduction. Outcomes are assessed at Weeks 0, 4, 8, and 12. Primary aims are to determine NAC's efficacy in decreasing cigarette craving, nicotine dependence, and use; and cannabis craving and use. Exploratory aims include examination of changes in neurocognition with NAC and their potential mediational effects on cigarette and cannabis use outcomes. CONCLUSION: Results will inform smoking cessation treatment among dual users of tobacco and cannabis. CLINICALTRIALS: gov Identifier: NCT04627922.

Relative Effects of Sexual Assault and Temperament Traits on Cognitive Characteristics of Histrionic Personality Disorder.

Histrionic personality disorder (HPD) is a common and problematic form of personality pathology involving excessive attention-seeking, often through overly sexualized means. Much of the research on HPD has involved the association between HPD characteristics and basic temperament traits. Given the sometimes hypersexualized presentation of HPD, another potential influence on HPD characteristics may be exposure to sexual assault. However, there is little research on the association between sexual assault and HPD in general or with respect to temperament traits in particular. In this study, we examine the relative associations of sexual assault and temperament traits with the cognitive characteristics of HPD in a large sample of college students (N = 965) using a Bayesian approach to the analysis of covariance. Results suggest that sexual assault is associated with HPD cognitive characteristics over and above the robust influence of temperament traits. The study findings have implications for future research on and clinical intervention with people with HPD.

Applying Bayesian statistics to research on psychological trauma: Introduction to the special section.

Use of Bayesian statistics is increasingly common in research in general and in psychological research in particular. This is especially the case for research on psychological trauma, in which the strengths of Bayesian statistics are particularly pronounced. The goals of this introduction to the special section on applying Bayesian statistics to research on psychological trauma are two-fold: first, to overview and discuss the benefits of Bayesian statistics and, second, to introduce the articles in this special section. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Rumination influences the relationship between trauma and depression over time among youth living with HIV.

BACKGROUND: Traumatizing events often result in long-term mental health symptoms. Identifying the features of the post-trauma experiences that can impact mental health symptoms is key to designing effective interventions. METHODS: Youth living with HIV (YLH),1 predominantly sexual and gender minorities (SGM;2 84 % gay, bisexual, transgender, queer, pansexual identities), 78 % Black and Latino, (N = 170) were recruited in New Orleans, LA and Los Angeles, CA from 13 youth-serving agencies. They were assessed for trauma, rumination and depression, with 78 % reassessed for depression at 4 and 74 % at 8 months later. Relationships between these variables were examined using a Bayesian approach to structural equation modeling. RESULTS: At recruitment, 78 % of YLH reported at least one traumatic event, and 21 % met the cut-off score indicating depression on the PHQ-9. Ruminations were reported by 41 % of YLH. While associations between trauma and depression were modest (rmean = 0.19), ruminations were moderately associated with depressive symptoms over time (rmean = 0.34). Ruminations were only modestly associated with trauma (rmean = 0.19) but had a robust negative association (λSTD = -0.29) with the slope of depressive symptoms such that the more ruminations YLH experienced, the smaller the decline in depression over time. The associations between trauma and depression were more modest (λSTD ≤ 0.12). Limitations The main limitations of this study are the lack of a scale to measure trauma and the use of a single item measure of rumination. CONCLUSION: Ruminations appear to be associated with traumatic events for a large subset of young people, suggesting that future interventions should consider including components addressing ruminations. CLINICALTRIALS: gov registration NCT03109431.

Influence of maladaptive personality traits on women's posttraumatic cognitions of IPV.

OBJECTIVE: Intimate partner violence (IPV) is a problem for women worldwide. One factor that affects the severity of women's distress in the aftermath of IPV is how they make meaning of the violence they experienced. Posttraumatic meaning-making takes the form of 3 distinct posttraumatic cognitions: self-blame, other negative thoughts about oneself, and negative thoughts about the world. Women's posttraumatic cognitions in the aftermath of IPV are in part a function of personality. Research on personality and posttraumatic cognitions has focused primarily on the influence of normative personality traits, although maladaptive personality traits are more common in clinical assessment. One of the most common models of maladaptive traits is DSM-5's Alternative Model of Personality Disorder (AMPD), which contains 5 maladaptive variants of normative personality traits (Antagonism, Detachment, Disinhibition, Negative Affect, and Psychoticism). Although there is increasing research on the AMPD traits in general, there is limited research on the influence of these traits on women's response to IPV specifically. METHOD: In this study we examine the association between AMPD traits and posttraumatic cognitions of IPV in a sample of women exposed to IPV (N = 199) using a Bayesian approach to multiple regressions. RESULTS: Results suggest that IPV and Negative Affect were the primary influences on all 3 IPV-related posttraumatic cognitions and that other traits had differential effects depending on the type of posttraumatic cognition under analysis. CONCLUSIONS: These findings clarify our understanding of individual differences in posttraumatic response and have implications for the treatment of women exposed to IPV. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Influence of Child Abuse and Neglect on Histrionic Personality Pathology.

Histrionic personality pathology is among the most common forms of personality pathology, although little is known about its potential risk factors. One possible factor that may influence histrionic personality pathology is childhood trauma, most notably sexual abuse and physical/emotional neglect. However, there is little research on how these and other forms of childhood trauma may influence histrionic personality pathology relative to each other. To address this, in this study we examined the relative effects of different forms of child abuse and neglect on histrionic personality pathology in a sample of women and men from Amazon's Mechanical Turk (N = 399) using a Bayesian approach to structural equation modeling. Results suggest that child sexual abuse is the strongest predictor of histrionic personality pathology in adulthood. However, this differs between women and men such that physical neglect also predicts histrionic personality pathology for women, whereas physical and emotional abuse as well as emotional neglect predict histrionic personality pathology for men. These findings provide insight into the developmental precursors to histrionic personality pathology and have implications for research on and clinical intervention with people exhibiting histrionic personality pathology.

Longitudinal Association Between Intimate Partner Violence and Alcohol Use in a Population Cohort of South African Women.

Intimate partner violence (IPV) is a common traumatic stressor for women worldwide, especially for women living in low-and-middle-income countries. One of the most common correlates of IPV victimization is alcohol use, but the dynamics of IPV and drinking among women are not well understood. Although some research suggests that women drink in the aftermath of IPV to cope with distress related to the violence they experienced, other studies imply that higher levels of alcohol use among one or both partners in a relationship make violence more likely. In this study, we examine this question in a secondary analysis of a longitudinal study of a population cohort of pregnant women in South Africa (N = 1238) using a Bayesian approach to latent growth curve structural equation modeling. Results indicate that on average, IPV decreases and alcohol use increases over time and that these trajectories are associated with each other. Further, results suggest that although IPV drives drinking (rather than the other way around), higher average levels of alcohol use are associated with a slower decrease in IPV. Findings have implications for future research on the association between IPV and alcohol use, as well as for clinical intervention for women who experienced IPV.

Differences in intimate partner violence exposure across college, crowdsourced, and at-risk samples.

OBJECTIVE: Intimate partner violence (IPV) is a pervasive and common form of violence against women. IPV is multifaceted, with physical, sexual, and/or psychological means of perpetration, and has detrimental effects on women's mental health. IPV generally affects women; however, how IPV differentially affects different groups of women is less clear. Women who are socioeconomically vulnerable are often considered at risk for IPV, although women in college are also often the topic of IPV research due both to high rates of IPV and to ease of study recruitment. There is increasing research on the effects of IPV in a third group of women, those recruited through online platforms (i.e., crowdsourcing). How IPV differs across these three samples has yet to be examined. METHOD: In this study, we examined differences in IPV exposure across three samples of women, at risk (n = 144), college (n = 654), and crowdsourced (n = 168), using a Bayesian approach to general linear modeling. RESULTS: Results indicated that the majority of women in each sample experienced some IPV. Results further suggested that women in the crowdsourced sample had the highest exposure to IPV in general and to physical IPV, sexual IPV, and IPV-related injury in particular, whereas women in the at-risk sample had the highest rates of psychological IPV. CONCLUSION: These findings highlight the importance of sampling in studies of IPV and thus have ramifications for future research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Thinking hierarchically about posttraumatic response: Commentary on Lehinger et al. (2022).

Lehinger et al.'s (2022) study on the associations between posttraumatic stress symptoms, posttraumatic cognitions, and alcohol use in sexual assault survivors extends previous research on posttraumatic response to sexual trauma. The study is useful for these purposes but it also raises other interesting questions about the nature of posttraumatic response and the structure of psychopathology more generally. In this commentary, we describe Lehinger et al.'s (2022) study and its findings and discuss their potential relevance for emerging transdiagnostic, hierarchical models of psychopathology.

Influence of Betrayal Trauma on Schizotypal Personality Pathology.

Schizotypal personality pathology (SZP) is a persistent and debilitating problem for a substantial number of people. Research on SZP has typically emphasized its biological and more specifically genetic origins. However, recent research has highlighted the potential influence of trauma on SZP. This research is promising, although it has thus far focused primarily on type of trauma (e.g., different types of abuse vs. neglect in childhood) rather than who perpetrated the trauma. Previous studies on both personality pathology in general and psychotic-spectrum experiences characteristic of SZP in particular have highlighted the influence of trauma perpetrated by someone with whom the trauma survivor was close (i.e., betrayal trauma), although this has not yet been examined with respect to SZP specifically. In this study we examined this, evaluating the influence of trauma with varying degrees of betrayal on SZP in a sample of adults (N = 364) using structural equation modeling. Results suggest that interpersonal trauma in general was associated with higher levels of SZP. Findings further indicate that for women but not men, trauma with a high degree of betrayal was uniquely associated with SZP. These results underscore the potential role of trauma in SZP and have implications for future research on and intervention with people with high levels of SZP.

Posttraumatic stress disorder symptom expression in racially and ethnically diverse women veterans.

The number of racial/ethnic and women minorities entering the military continues to grow and more research is needed to properly assess, conceptualize, and treat posttraumatic stress disorder (PTSD) in diverse women. Recently, typological approaches have been useful in revealing distinct PTSD symptom presentations; however, existing research has not examined racial/ethnic differences among women veterans. We examined PTSD symptom expression and whether it differed by race/ethnicity in a sample of 407 women veterans that were recruited as part of a larger study on veterans' health. We conducted a series of model-based cluster analyses by race/ethnicity. Most racial/ethnic groups had between two- and four-group typologies that differed primarily in symptom severity. Latina veterans were found to have a unique eight-group PTSD typology differing not only in overall symptom severity but also in elevations of avoidance and hyperarousal symptoms. Racial and ethnic minority trauma survivors may present with a variety of posttraumatic symptom expressions. Better understanding these varying PTSD typologies will allow us to provide more tailored assessment and treatment for diverse women veterans with PTSD.