Childhood trauma and suicide risk: Investigating the role of adult attachment.

BACKGROUND: Suicide is a leading cause of death globally and a serious public health concern. Childhood trauma has been found to be associated with adult suicide vulnerability. Recent research has turned attention to investigating the role of attachment in the context of the childhood trauma-adult suicide relationship. The current study investigated for the first time whether attachment influences and moderates the childhood trauma-suicidality relationship, using a daily diary design, in the general population. METHODS: 481 participants completed questionnaires assessing experiences of childhood trauma, attachment patterns, and history of suicidality. 243 participants continued to a daily diary phase where measures of daily stress, defeat and entrapment were completed for 7 consecutive days. RESULTS: Higher levels of childhood trauma were associated with a history of suicide ideation and attempt and also higher levels of daily defeat, entrapment and stress during the 7 day study. Similarly, higher levels of attachment anxiety and avoidance were associated with a history of suicide ideation and attempt together with higher levels of daily defeat, entrapment and stress. However, the effects of childhood trauma on suicide history and on daily suicide vulnerability factors were not moderated by attachment anxiety or avoidance. LIMITATIONS: The measure of childhood trauma was a retrospective self-report tool that may be influenced by memory biases. CONCLUSIONS: Childhood trauma and insecure attachment are implicated in adult suicide risk. Interventions aimed at mitigating the negative effects of childhood trauma and insecure attachment should also incorporate components that target modifiable risk factors such as defeat, entrapment and stress.

Adverse childhood experiences and aggression in adulthood: The moderating role of positive childhood experiences.

BACKGROUND: Adverse childhood experiences (ACEs) have a significant impact on a person's psychological development and predispose them to various harmful consequences in adulthood, such as different forms of aggression. Contrarily, positive childhood experiences (PCEs) operate as protective factors, buffering against the adverse effects of ACEs and promoting adaptive behaviors and psychological well-being. However, the role of PCEs in the relationship between ACEs and aggression remains relatively unexplored. OBJECTIVE: To explore the moderation role of PCEs in the relationship between ACEs and aggression and its different components across sexes in a community sample. METHODS: A sample of 1541 Portuguese adults answered an online protocol with a sociodemographic questionnaire, the Benevolent Childhood Experiences Scale, the Childhood History Questionnaire, and the Buss-Perry Aggression Questionnaire. RESULTS: ACEs were positively correlated with aggression, including physical and verbal aggression, anger, and hostility, with women reporting a higher prevalence of ACEs and higher levels of anger. Men revealed higher scores in physical and verbal aggression. Furthermore, moderation analyses clarified the moderating effect of PCEs on the relationship between ACEs and aggression in women and between ACEs and anger in both sexes. PCEs attenuate the adverse impact of ACEs, reducing aggression and anger levels. CONCLUSIONS: This study stresses the complex interplay between childhood experiences and adult aggression, highlighting the differential effects of ACEs and PCEs across men and women. By clarifying these dynamics, interventions can be tailored to bolster protective factors like PCEs. This will ultimately foster healthier developmental trajectories and reduce the prevalence of aggression in adulthood.

Childhood trauma associated with psychotic-like experiences among people living with HIV: The chain mediation effect of stigma and resilience.

BACKGROUND: Previous research established the associations between childhood trauma and psychosis, but the effects of childhood trauma on psychotic-like experiences (PLEs) among people living with HIV (PLWH) and the potential mediation mechanisms in these associations remain unclear. OBJECTIVE: This study aimed to investigate the effects of childhood trauma on PLEs, as well as the chain mediation roles of stigma and resilience in this relationship. Furthermore, we explored whether the aforementioned associations differed when hallucinatory experiences (HEs) and delusional experiences (DEs) were separately modeled. PARTICIPANTS AND SETTING: The sample included 333 outpatients participants (95.2 % males, Mage = 28.24 ± 7.12) living with HIV recruited from Hunan Province, China; and data were collected with a cross-sectional survey. METHOD: The hypothesized chain mediation models were examined using SPSS PROCESS macro 3.3 software. RESULTS: Various influencing mechanisms of childhood trauma on HEs and DEs were examined in this study. Our results showed that, (a) childhood trauma directly exerted negative effect on HEs, while the chain mediation effect of stigma and resilience were not statistically significant. Conversely, (b) childhood trauma exerted no direct influence on DEs but rather through the chain mediation effect of stigma and resilience. CONCLUSIONS: The identification of two different routes between that childhood trauma can have on HEs and DEs highlighted the importance of tailored prevention and intervention among PLWH with a history of childhood trauma.

A longitudinal study of the impact of childhood adversity dimensions on social and psychological factors and symptoms of psychosis, depression, and anxiety.

The present study examined three empirically-derived childhood adversity dimensions as predictors of social, psychological, and symptom outcomes across three prospective assessments of a young adult sample. Participants were assessed five times over eight years with semi-structured interviews and questionnaires. The analyses used the dimensions underlying multiple subscales from well-established childhood adversity measures administered at the first two assessment waves (described in a previous report). Outcome data pertain to the last three assessment waves, with sample sizes ranging from 89 to 169. As hypothesized, the childhood adversity dimensions demonstrated overlapping and differential longitudinal associations with the outcomes. Deprivation predicted the negative (deficit-like) dimension of psychosis, while Threat and Intrafamilial Adversity predicted the positive (psychotic-like) dimension. Depression and anxiety symptoms were predicted by different childhood adversity dimensions over time. Furthermore, Threat predicted a smaller and less diverse social network, Intrafamilial Adversity predicted anxious attachment, and Deprivation predicted a smaller social network, anxious and avoidant attachment, perceived social support, and loneliness. The three adversity dimensions combined accounted for moderate to large proportions of variance in several outcomes. These results extend prior work by identifying associations of three meaningful dimensions of childhood adversity with different risk profiles across psychological, social, and psychopathological domains. The findings enhance our understanding of the impact of childhood adversity across young adulthood.

Childhood adversity, accelerated GrimAge, and associated health consequences.

Childhood adversity is linked to psychological, behavioral, and physical health problems, including obesity and cardiometabolic disease. Epigenetic alterations are one pathway through which the effects of early life stress and adversity might persist into adulthood. Epigenetic mechanisms have also been proposed to explain why cardiometabolic health can vary greatly between individuals with similar Body Mass Index (BMIs). We evaluated two independent cross-sectional cohorts of adults without known medical illness, one of which explicitly recruited individuals with early life stress (ELS) and control participants (n = 195), and the other a general community sample (n = 477). In these cohorts, we examine associations between childhood adversity, epigenetic aging, and metabolic health. Childhood adversity was associated with increased GrimAge Acceleration (GAA) in both cohorts, both utilizing a dichotomous yes/no classification (both p < 0.01) as well as a continuous measure using the Childhood Trauma Questionnaire (CTQ) (both p < 0.05). Further investigation demonstrated that CTQ subscales for physical and sexual abuse (both p < 0.05) were associated with increased GAA in both cohorts, whereas physical and emotional neglect were not. In both cohorts, higher CTQ was also associated with higher BMI and increased insulin resistance (both p < 0.05). Finally, we demonstrate a moderating effect of BMI on the relationship between GAA and insulin resistance where GAA correlated with insulin resistance specifically at higher BMIs. These results, which were largely replicated between two independent cohorts, suggest that interactions between epigenetics, obesity, and metabolic health may be important mechanisms through which childhood adversity contributes to long-term physical and metabolic health effects.

The Relationship Between Childhood Traumatic Experiences and Bodily Distress Syndrome: The Mediating Role of Somatoform Dissociation.

This research aimed to investigate the relationship between childhood traumatic experiences and bodily distress syndrome, and the mediating role of somatoform dissociation. A total of 241 individuals living in Iran aged 20-40 years (M = 26.41 years, SD = 6.30; 74.7% females) were selected by convenience sampling to participate online in the research in March 2023. They answered the Childhood Trauma Questionnaire (CTQ-SF), the Bodily Distress Syndrome Checklist (BDS-25), and the Somatoform Dissociation Questionnaire (SDQ-20). The results of the structural equation modeling showed that the model had a good fit, and significant relationships were observed between childhood traumatic experiences and bodily distress syndrome, between childhood traumatic experiences and somatoform dissociation, and also between somatoform dissociation and bodily distress syndrome. The results indicated that somatoform dissociation partially mediates the relationship between childhood traumatic experiences and bodily distress syndrome. Furthermore, the prevalence of bodily distress syndrome was higher in the female than the male participants. The results thus highlight the role of childhood traumatic experiences and somatoform dissociation in creating bodily distress syndrome.

The Effects of Childhood Adversity and Self-Regulation on the Well-Being of Adults with Delinquency Histories: A Mediation Model.

PURPOSE: Most youth with delinquency histories experience childhood adversity leaving them vulnerable to poor adult well-being. Previous research indicates that self-regulation difficulties could explain how childhood adversity affects adult well-being. Yet, very few studies target adult self-regulation intervention. Therefore, this study examined the intervening effects of emerging adult self-regulation on the association between childhood adversity and adult well-being. METHOD: Using data from the first four waves of the Add Health Study, the researchers conducted structural equation modeling for mediation with bootstrapping. The researchers tested the mediation effects of emerging adult self-regulation on the association between childhood adversity (child maltreatment and violent victimization) and later adult well-being (mental health problems, alcohol and drug use, criminal behaviors) among people with delinquency histories and/or arrest prior to age 18 (N = 1,792). RESULTS: Several significant direct effects and one partial mediation effect were found. For example, child maltreatment significantly predicted adult mental health problems and criminal behaviors. Self-regulation (via the dissatisfaction with life and self subscale) mediated the association between child maltreatment and adult mental health problems. DISCUSSION: Findings highlight the need for social workers to focus on prevention services and trauma-informed treatment for people with delinquency histories. In addition, evidence-based practice requires self-regulation interventions for adults with histories of childhood adversity and delinquency to focus on their emotional and cognitive functioning as well as self-esteem. CONCLUSION: Implementing self-regulation interventions during emerging adulthood can be useful to mitigate later adult mental health problems among people with histories of childhood adversity and delinquency.

Lifetimes of Vulnerability: Childhood Adversity, Poor Adult Health, and the Criminal Legal System.

On average, incarcerated people have higher rates of poor health, mental illness, and histories of adverse childhood experiences (ACEs) than the general population. This mixed-methods analysis examines the relationship between ACEs and poor adult health among a sample of formerly incarcerated people. The quantitative analysis (N = 122) shows childhood adversity is associated with various health conditions in adulthood, although the strength of this relationship varies by the kinds of ACEs respondents encountered. The qualitative analysis of life history timelines (N = 42) reveals two pathways relating ACEs to poor health and legal system involvement: (1) violence and victimization and (2) drug use as a coping mechanism. Unaddressed mental health challenges in the aftermath of adversity emerged as an important precursor to both pathways. Prisons lack a meaningful consideration of these early life events and the social structures that result in the high rates of vulnerable people in its care.

Cumulative childhood trauma and complex psychiatric symptoms in pregnant women and expecting men.

BACKGROUND: Women and men having been exposed to childhood trauma would be at high risk of various mental health symptoms while awaiting a child. This study aimed to evaluate the association between cumulative childhood trauma and the accumulation of symptoms belonging to different psychiatric problems in pregnant women and expecting men. METHODS: We first examined prevalence rates of childhood trauma across our samples of 2853 pregnant women and 561 expecting men from the community. Second, we evaluated the association between cumulative childhood trauma and symptom complexity (i.e., the simultaneous presentation of symptoms belonging to multiple psychiatric problems) using subsamples of 1779 pregnant women and 118 expecting men. Participants completed self-reported measures of trauma (Childhood Trauma Questionnaire) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; State-Trait Anger Expression Inventory-2; Self and Interpersonal Functioning Scale). RESULTS: Trauma was more frequent in pregnant women than in expecting men and in participants reporting sociodemographic risk factors than in those not reporting any. A dose-response relationship was observed between the number of different traumas reported by pregnant women and expecting men and the complexity of their psychiatric symptoms, even when controlling for the variance explained by other risk factors. Women having been exposed to cumulative childhood trauma were 4.95 times more at risk of presenting comorbid psychiatric problems during pregnancy than non-exposed women. CONCLUSIONS: Childhood trauma is frequent in the general population of pregnant women and expecting men and is associated with symptom complexity during the antenatal period. These findings call for delivering and evaluating innovative trauma-informed antenatal programs to support mental health and adaptation to parenthood in adults having been exposed to childhood trauma.

Emotion regulation deficits mediate childhood sexual abuse effects on stress sensitization and depression outcomes.

Child sexual abuse (CSA) is a notable risk factor for depressive disorders. Though multiply determined, increased sensitivity to stress (stress sensitization) and difficulty managing distress (emotion regulation) may reflect two pathways by which CSA confers depression risk. However, it remains unclear whether stress sensitization and emotion regulation deficits contribute to depression risk independently or in a sequential manner. That is, the frequent use of maladaptive emotion regulation responses and insufficient use of those that attenuate distress (adaptive emotion regulation) may lead to stress sensitization. We tested competing models of CSA, stress sensitization, and emotion regulation to predict depression symptoms and depressive affects in daily life among adults with and without histories of CSA. Results supported a sequential mediation: CSA predicted greater maladaptive repertoires that, in turn, exacerbated the effects of stress on depression symptoms. Maladaptive responses also exacerbated the effects of daily life stress on contemporaneous negative affect (NA) levels and their increase over time. Independent of stress sensitization, emotion regulation deficits also mediated CSA effects on both depressive outcomes, though the effect of maladaptive strategies was specific to NA, and adaptive responses to positive affect. Our findings suggest that emotion regulation deficits and stress sensitization play key intervening roles between CSA and risk for depression.

Violencia intrafamiliar: un riesgo para el desarrollo de la primera infancia / Domestic violence. A risk to early childhood development

Los padres y cuidadores son los adultos que apoyan a los niños y niñas para el desarrollo de los aspectos que constituyen la naturaleza humana, les proporcionan los significados y las nociones que concretan la dignidad de la persona en la familia y en los otros escenarios fuera de esta, por tanto, la exposición a la violencia intrafamiliar se constituye un riesgo para el desarrollo integral de los niños y las niñas. Objetivo: identificar tipos y formas de violencia intrafamiliar que sufren las madres y cuidadoras como un factor de riesgo en el desarrollo integral de los niños y niñas de un programa de primera infancia. Metodología: estudio cuantitativo, descriptivo transversal mediante cuestionario. Participaron 308 mujeres. Resultados: las participantes son víctimas de violencia psicológica, física, económica y sexual por parte de los miembros de sus familias de origen, política y propia. Conclusiones: es evidente el riesgo para el desarrollo integral de los niños y las niñas sobre reproducir los modelos de trato violento, dado que los actos de violencia son repetitivos en la historia familiar.

Parents and caregivers are adults who support children for the development of the aspects that constitute human nature, provide them with meanings and notions that concretize the dignity of the person in the family and in other scenarios outside it, therefore, exposure to domestic violence is a risk to the integral development of children. Objective: to identify types and forms of domestic violence suffered by mothers and caregivers as a risk factor in the integral development of children in an early childhood program. Methodology: a quantitative, descriptive cross-sectional study by questionnaire. 308 women participated. Results: the participants are victims of psychological, physical, economic, and sexual violence by their family members, of origin, politics, and their own. Conclusions: the risk to the integral development of children of reproducing models of violent treatment is evident, given that acts of violence are repetitive in family history

Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes.

OBJECTIVE: To examine the association between adverse childhood experiences and adverse pregnancy outcomes. METHODS: This cohort study included individuals who enrolled in a perinatal collaborative mental health care program (COMPASS [the Collaborative Care Model for Perinatal Depression Support Services]) between 2017 and 2021. Participants completed psychosocial self-assessments, including an adverse childhood experiences screen. The primary exposure was adverse childhood experiences measured by the ACE (adverse childhood experience) score, which was evaluated as a dichotomized variable, with a high ACE score defined as greater than three. Secondary analyses used the ACE score as a continuous variable. Adverse pregnancy outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age (SGA) births were abstracted from the electronic health record. Bivariable and multivariable analyses were performed, including mediation analyses. RESULTS: Of the 1,274 women with a completed adverse childhood experiences screen, 904 (71%) reported one or more adverse childhood experiences, and 290 (23%) reported a high ACE score (more than three adverse childhood experiences). Adverse childhood experience scores were not associated with gestational diabetes or SGA births. After controlling for potential confounders, individuals with high ACE score had 1.55-fold (95% CI 1.06-2.26) increased odds of having hypertensive disorders of pregnancy and 2.03-fold (95% CI 1.38-2.99) increased odds of preterm birth. Each point increase in ACE score was not associated with a statistically increased odds of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.07, 95% CI 0.99-1.15); however, each additional point on the adverse childhood experiences screen was associated with increased odds of preterm birth (aOR 1.13, 95% CI 1.05-1.22). Mediation analyses demonstrated tobacco use, chronic medical problems, and obesity each partially mediated the observed association between high ACE scores and hypertensive disorders of pregnancy. Having chronic medical comorbidities partially mediated the observed association between high ACE scores and preterm birth. CONCLUSION: One in four individuals referred to a perinatal mental health program who were pregnant or postpartum had a high ACE score. Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.

Childhood Trauma and Perinatal Depression: Data From the IGEDEPP Cohort.

Background: Childhood trauma (CT) is associated with an increased risk of major depressive disorder, but little is known about the impact of CT on depression during pregnancy and the early and late postpartum period. The present study assesses whether CT is associated with perinatal depression, considering different types of CT.Methods: This study used data from the Interaction of Gene and Environment of Depression in PostPartum (IGEDEPP), a French multicenter prospective cohort study, including 3,252 women who completed the Childhood Trauma Questionnaire at the maternity department between November 2011 and June 2016. Depression during pregnancy was assessed retrospectively at the maternity department using DSM-5 criteria. Early- and late-onset postpartum depression were assessed at 2 months and 1 year postpartum, respectively.Results: Among the 3,252 women, 298 (9.2%) reported at least 1 CT. Women with CT had a higher risk of depression (OR = 2.2; 95% CI, 1.7-2.7), anxiety (OR = 2.3; 95% CI, 1.7-3.0), and suicide attempts (OR = 5.4; 95% CI, 3.5-8.4) than women without CT. Perinatal depression was more frequent in women with CT than in women without CT, after adjustment for sociodemographic characteristics and personal history of major depressive episode and consideration of the timing of onset (pregnancy, early or late postpartum) (P < .001). There was a dose effect between the number of CT types and the risk of perinatal depression.Conclusions: These results show that CT is associated with a depressive episode during adulthood, specifically in the perinatal period. These findings may lead to special prenatal care for women abused or neglected during childhood, to better screen and treat perinatal depression.Trial registration: ClinicalTrials.gov identifier: NCT01648816.

Prevalence, Correlates, and Treatment of Suicidal Behavior in US Military Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study.

Objective: US military veterans have high rates of suicide relative to civilians. However, little is known about the prevalence and correlates of suicidal behaviors in the general US veteran population.Methods: Data were from the National Health and Resilience in Veterans Study, a representative survey of US veterans conducted in 2019-2020 (n = 4,069). Analyses (1) estimated the prevalence of current suicidal ideation, lifetime suicide plans, and lifetime suicide attempts; (2) identified associated sociodemographic, military, DSM-5 psychiatric, and other risk correlates; and (3) examined mental health treatment utilization among veterans with suicidal ideation, suicide plans, or suicide attempts.Results: The prevalence of current suicidal ideation, lifetime suicide plans, and lifetime suicide attempts was 9.0%, 7.3%, and 3.9%, respectively. Suicidal behaviors were most prevalent among veterans aged 18-44 years, with 18.2%, 19.3%, and 11.1%, respectively, endorsing suicidal ideation, suicide plans, and suicide attempts. Major depressive disorder (MDD), age, posttraumatic stress disorder, and adverse childhood experiences (ACEs) emerged as the strongest correlates of suicidal ideation and suicide plans, while MDD, age, alcohol use disorder, and ACEs were the strongest correlates of suicide attempts. Only 35.5% of veterans with current suicidal ideation were engaged in mental health treatment, with veterans who used the US Veterans Administration (VA) as their primary source of health care more than twice as likely as VA non-users to be engaged in such treatment (54.7% vs 23.8%).Conclusions: Suicidal behaviors are highly prevalent among US veterans, particularly among young veterans. Results suggest that nearly two-thirds of veterans with current suicidal ideation are not engaged in mental health treatment, signaling the need for enhanced suicide prevention and outreach efforts.

Meanings of intrafamily violence experienced in childhood/adolescence present in the discourses of men.

OBJECTIVE: to unveil the meanings of intrafamily violence experienced in childhood and/or adolescence by men under legal proceedings due to conjugal violence. METHOD: a qualitative research, based on Thematic Oral History and supported by Symbolic Interactionism. Participants were men under legal proceedings due to domestic violence who had experienced or witnessed intrafamily violence in childhood and/or adolescence. RESULTS: the speeches revealed that the intrafamily violence experienced in childhood and/or adolescence was signified as an educational method. The aggressions committed by parents were only perceived as acts of violence in situations considered extreme, such as in cases of using a firearm, handcuffs, and rope. FINAL CONSIDERATIONS: considering that the meanings direct human conduct and that they are subject to modification depending on social interactions built throughout life, it is believed that educational strategies that encourage the redefinition of violence can be effective in facing this problem.

All adverse childhood experiences are not equal: The contribution of synergy to adverse childhood experience scores.

The operationalization of childhood trauma and adversity into checklists commonly known as adverse childhood experiences, or ACEs, has become the most widely adopted methodology linking traumatic childhoods to adult outcomes. As the number of self-reported ACEs increase from 0 to 4 or more (4+), most studies find a roughly stepwise progression in risk for a wide range of negative medical and mental health outcomes. A score of 4+ ACEs, has become a de facto cutpoint, increasingly used clinically to define "high risk" status for a myriad of outcomes. Comparisons across studies using a 4+ cutpoint, however, find considerable heterogeneity in the degree of risk for the same outcomes. In addition to sample and methodological differences, certain pairs of ACEs comprising the cumulative ACE score interact synergistically to significantly increase the overall risk beyond the sum (or product) of the contributions of each ACE to the outcome. This article reviews the empirical literature on synergistic ACEs including results from a general population adult and a mixed trauma, youth sample both sufficiently powered to examine over 20 different ACE pairings for possible synergy. Synergistic pairs of ACEs vary by gender and age group. About 30-40% of the variance in outcomes is accounted for by additive synergistic interactions between certain pairs of ACEs. Across studies, sexual abuse is the most synergistically reactive ACE. The article concludes with a discussion of the implications of synergistic ACE pairings for psychologists and other allied professionals across clinical practice, prevention, research, and policy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Adverse Childhood Experiences and Rate of Memory Decline From Mid to Later Life: Evidence From the English Longitudinal Study of Ageing.

Evidence on the role of early-life adversity in later-life memory decline is conflicting. We investigated the relationships between adverse childhood experiences (ACEs) and memory performance and rate of decline over a 10-year follow-up among middle-aged and older adults in England. Data were from biennial interviews with 5,223 participants aged 54 years or older in the population-representative English Longitudinal Study of Ageing from 2006/2007 to 2016/2017. We examined self-reports of 9 ACEs prior to age 16 years that related to abuse, household dysfunction, and separation from family. Memory was assessed at each time point as immediate and delayed recall of 10 words. Using linear mixed-effects models with person-specific random intercepts and slopes and adjusted for baseline age, participants' baseline age squared, sex, ethnicity, and childhood socioeconomic factors, we observed that most individual and cumulative ACE exposures had null to weakly negative associations with memory function and rate of decline over the 10-year follow-up. Having lived in residential or foster care was associated with lower baseline memory (adjusted ß = -0.124 standard deviation units; 95% confidence interval: -0.273, -0.025) but not memory decline. Our findings suggest potential long-term impacts of residential or foster care on memory and highlight the need for accurate and detailed exposure measures when studying ACEs in relation to later-life cognitive outcomes.

Prevalence of Traumas and PTSD Among Individuals Adjudicated Not Guilty by Reason of Insanity.

Trauma and posttraumatic stress disorder (PTSD) are common among psychiatric and criminal populations, yet there have been few studies among forensic psychiatric populations and no known studies have specifically examined insanity acquittees. This study aimed to identify the prevalence of trauma and to assess recognition of PTSD in forensic settings. Using a cross-sectional self-report survey methodology, we examined traumas, adverse childhood experiences (ACEs), and PTSD in insanity acquittees (n = 107). Most insanity acquittees experienced trauma (86%, averaging 11 events) and ACEs (76%, averaging 3 types). The most commonly experienced traumas were sudden death of a loved one, witnessed death or serious injury, adult physical assault, and motor vehicle accident. Women were significantly more likely to experience any ACE (especially witnessing domestic violence, household members with mental illness, emotional abuse, and emotional neglect) and adult sexual assault. PTSD prevalence was 25 percent, with 97 percent of cases being previously undiagnosed. Sexual traumas and younger age were significantly associated with PTSD. These results suggest that insanity acquittees have high levels of trauma, ACEs, and PTSD. While PTSD was about seven times more common than in previous findings in the general population, it frequently goes undiagnosed in forensic settings. Potential explanations and implications of our findings are discussed.