Latent Profiles of Co-occurring Sexual Problems and Posttraumatic Stress Symptoms Among Young Women Exposed to Sexual Violence.

Sexual dysfunctions (SDs) have been noted to occur following exposure to sexual violence although how these conditions covary with other mental health conditions, particularly posttraumatic stress disorder symptoms (PTSS), is relatively understudied. The current study examined patterns of co-occurring SDs and PTSS in a sample of 328 college-aged, female-identified survivors of adolescent/early adulthood sexual assault (ASA). Latent profile analysis was used to examine patterns of symptom endorsement of various types of SDs and PTSS at the symptom cluster level. Four profiles were identified: asymptomatic (41.2% of sample), sexually distressed + intrusions (24.7%), co-occurring (21%), and PTSS (13.1%). Profiles were compared to one another on various characteristics of sexual assault and social reactions from others following assault disclosure. Results indicated that those in the co-occurring symptom and PTSS profiles reported more severe ASA and more unsupportive social responses relative to the sexually distressed + intrusions and asymptomatic profiles. The asymptomatic profile was significantly less likely to have experienced rape relative to the other three profiles and was less likely to report instances where a close other treated them in a negative manner following assault disclosure. Results are discussed in light of mental health needs for young women who have experienced ASA, with implications discussed for future research and clinical services for university students.

Ketamine-enhanced prolonged exposure therapy in veterans with PTSD: A randomized controlled trial protocol.

BACKGROUND: The 2023 VA/DoD Clinical Practice Guideline for the Management of PTSD recommends individual, manualized trauma-focused such as Prolonged Exposure (PE) over pharmacologic interventions for the primary treatment of PTSD. Unfortunately, clinical trials of trauma-based therapies in the military and veteran population showed that 30% to 50% of patients did not demonstrate clinically meaningful symptom change. Ketamine, an FDA-approved anesthetic with potent non-competitive glutamatergic N-methyl-d-aspartate antagonistic properties, has demonstrated to enhance the recall of extinction learning and decrease fear renewal without interference of extinction training in preclinical studies. METHODS: We plan to conduct a single site RCT comparing three ketamine treatment vs. active placebo (midazolam) adjunct to PE therapy among Veterans with PTSD. Pharmacological phase will start simultaneously with PE session 1. Infusions will be administered 24 h. prior to PE session for the first 3 weeks. After PE is completed (session 10), patients will be assessed during a 3-month follow-up period at various time points. We estimate that out of 100 veterans, 80 will reach time point for primary outcome measure and will be considered for primary analysis. Secondary outcomes include severity of depression and anxiety scores, safety and tolerability of ketamine-enhanced PE therapy, cognitive performance during treatment and early improvement during PE related to the rate of dropouts during PE therapy. DISCUSSION: Results of the proposed RCT could provide scientific foundation to distinguish the essential components of this approach, enhance the methodology, elucidate the mechanisms involved, and identify sub-PTSD populations that most likely benefit from this intervention.

Sexual Functioning and Satisfaction Among College Survivors of Sexual Violence: Examining PTSD Symptoms and Sexual Schemas.

Decreased sexual functioning is prevalent among female survivors of sexual violence yet psychological factors that contribute to sexual impairments in this population are understudied. To extend research in this area, the current study examined two psychological factors as they relate to sexual functioning concerns among 148 female survivors of sexual violence: severity of posttraumatic stress symptoms (PTSSs) and sexual self-schemas. Four domains of sexual functioning were examined: sexual desire, sexual arousal, sexual satisfaction, and orgasm functioning. It was predicted that PTSSs would be associated with a more negative sexual schema, which in turn, would be associated with decreased sexual functioning across the four domains. Using path analysis, PTSSs were found to be indirectly associated with decreased sexual satisfaction (b = -.08, SEb = .04, p = .035), sexual arousal (b = -.01, SEb = .001, p = .02), and reduced orgasm functioning (b = -.01, SEb = .001, p = .002). Results also supported significant direct paths from PTSS to all sexual functioning variables. These results support that negative sexual self-schemas may be relevant to the co-association of PTSSs and reductions in sexual functioning and satisfaction.

Using a Person-Centered Approach to Identify Patterns of Exposure to Intimate Partner Violence and Child Abuse in Women: Associations With Mental Health.

Patterns of exposure to intimate partner violence (IPV) and child abuse (CA) were explored in 467 women seeking psychological assistance following IPV. Using latent class analysis, three classes were obtained: women who had experienced physical, sexual, and psychological IPV, along with childhood physical and sexual abuse (IPV + CA; 38.5%); women who had experienced physical, sexual, and psychological IPV only (IPV/no CA; 52.9%); and women who had experienced psychological IPV only (Psych IPV only; 8.6%). Associations of class membership with severity of specific mental health conditions were examined, along with the number of diagnosed conditions. Significant between-class differences were noted on severity of IPV-related posttraumatic stress disorder, depressive disorders, alcohol and substance use disorders, and social phobia. Classes also differed significantly on the number of mental health conditions. Understanding patterns of betrayal-based trauma (e.g., IPV and CA) can inform care within agencies that serve IPV survivors by highlighting individuals at-risk for mental health conditions.

Exploring ambivalent rape acknowledgment and posttraumatic stress symptoms among college women who have experienced rape: What's in a name?

The present study explored rape acknowledgment among 131 college women survivors of rape utilizing three subgroups: acknowledged rape, unacknowledged rape, and ambivalent acknowledgment. Posttraumatic stress disorder (PTSD) symptom clusters and parameters of victimization and were compared between the subgroups. Of the participants, 28.2 % were classified as ambivalent rape acknowledgment, 49.6 % as acknowledged rape, and 22.1 % as unacknowledged rape. Across all four PTSD symptom clusters, the ambivalent acknowledgment group had significantly higher PTSD symptoms than the unacknowledged group. With the exception of hyperarousal symptoms, PTSD symptoms did not differ between the acknowledged and ambivalent acknowledgment groups. With regard to potential group differences in exposure to various rape tactics (i.e., physical force, threat, incapacitation), the acknowledged group indicated (a) exposure to a greater number of rape tactics relative to the other groups, (b) higher likelihood of endorsing rape via threat than the ambivalent acknowledgment group, and (c) more frequent endorsement of forcible rape than the unacknowledged group. Results are discussed in light of screening methods to assess for PTSD symptoms among rape survivors, as well as the recent changes to the Title IX law regarding sexual misconduct reports on college campuses.

The role of negative cognitions in co-occurring posttraumatic stress disorder and depression: Examination of interpersonal and noninterpersonal trauma survivors.

OBJECTIVE: To examine negative cognitions underlying both posttraumatic stress disorder (PTSD) and depression following trauma. METHOD: A mixed-gender motor vehicle accident (N = 297, Mage = 43.49 years) sample and a female intimate partner violence (N = 242, Mage = 36.95 years) sample was cross-sectionally studied at research clinics of two universities. RESULTS: When diagnostic groups (PTSD+/-, depression+/-) were studied, no significant interactions were noted for any of the three forms of negative cognitions (negative thoughts about the self, negative thoughts about the world, and self-blame) in either sample. When continuous ratings of PTSD and depression were studied, the results showed that negative thoughts about the self were linked to both PTSD and depression. CONCLUSION: Findings suggest that it may be beneficial to target negative thoughts about the self when treating PTSD and depression together.

Factor Structure of the Communication Patterns Questionnaire in Violence-Exposed Women.

Understanding and addressing violence among intimate partners requires sound assessment of their communication patterns. In prior research, the 35-item, self-report Communication Patterns Questionnaire (CPQ) has been used to assess communication patterns in violent relationships. To date, psychometric analysis of the CPQ has been examined only among nonviolent couples; no studies have examined the psychometric properties of this measure in a sample of survivors of intimate partner violence (IPV). Using confirmatory factor analysis, the present study evaluated the factor structure of the CPQ in a sample of women survivors of IPV who sought mental health assessments at a university research clinic. Analyses suggested that a modified three-factor solution (constructive communication [CC], self-demand/partner withdraw [SDPW], partner demand/self-withdraw [PDSW]) provided good fit in our sample. Internal consistency estimates for each of the modified scales were acceptable and exceeded reported coefficients in prior IPV studies. Significant bivariate correlations among modified scales, and between communication patterns and aggressive behaviors, provided initial validity evidence for the CPQ scales in our sample. We found CC to be negatively associated with partner psychological aggression, PDSW to be positively associated with all forms of partner aggression and respondent psychological aggression, and SDPW to be positively associated with respondent physical and psychological aggression. The results of this study indicate that the CPQ may be an appropriate measure for assessing communication patterns in violent relationships; however, modified scoring procedures should be used. We contextualize our results within existing models of IPV and address clinical, cultural, and contextual issues in communication patterns assessment.

Can the Behavioral Model of Health Care Utilization Be Used to Predict Completion of a Mental Health Assessment Following Intimate Partner Violence?

Survivors of intimate partner violence (IPV) may experience mental health problems. Although some survivors access mental health resources to address these concerns, many discontinue prematurely. One model of health care utilization that has recently gained attention in the trauma literature is the behavioral model of health care utilization (BMHU). This model considers three groups of variables in predicting health care utilization: immutable predisposing variables (e.g., age), enabling resources (e.g., income), and measures of need (e.g., symptom severity). The current study tested the BMHU's ability to predict completion of a free, multisession mental health evaluation for female survivors of IPV (N = 214). Two models were tested, each assessing a separate need-based predictor: The first model assessed symptoms of depression and the second model assessed symptoms of posttraumatic stress disorder (PTSD). Results were consistent across both models and suggested that younger age and receiving public assistance were both associated with a lower likelihood of completing the evaluation. Contrary to the BMHU's assumed positive relation between symptom severity and health care utilization, greater severity of depression and PTSD symptoms were both associated with a lower likelihood of completing the evaluation. It is possible that following IPV, experiencing psychological distress may engender help-seeking but too much distress may serve as a barrier to continued utilization. Future research should seek to better understand the complex relation between need and access, in the context of mental health care, and develop strategies for retaining IPV survivors who access mental health resources.

The effects of shame on subsequent reactions to a trauma analog.

The current study examined the effects of experimentally-induced shame on subsequent reactions to a trauma analog. Participants were 88 college-aged women randomly assigned to a shame prime condition or to a control (neutral) condition. Participants then were presented with an analog trauma audiotape depicting dating violence. Participants reported intrusive thoughts relating to the trauma analog in the two days following the procedure. Negative (shame, guilt) and positive (pride, positive affect) emotions were monitored throughout the procedure. Results indicated that the shame prime successfully increased shame in the Shame condition alone. After the trauma analog, increases in shame were noted in both conditions. In contrast, guilt reduced in the Shame condition, while this emotion increased in the Control condition, contrary to hypothesis. Shame and guilt were somewhat volatile for participants in the Shame condition in the two days following the lab procedure, while individuals in the Control condition reported steadily decreasing levels of these emotions. No between-condition differences were noted in the frequency of intrusions in the two days following the laboratory procedure, contrary to hypothesis. Results are discussed in light of our current understanding of shame and its role in PTSD, with suggestions to guide future research.

The Association Between Posttraumatic Negative Self-Conscious Cognitions and Emotions and Maladaptive Behaviors: Does Time Since Trauma Exposure Matter?

Negative beliefs about the self, self-blame, guilt, and shame have been consistently linked to emotional problems, such as posttraumatic stress disorder and depression, following trauma exposure. To expand understanding of the potential role of negative self-conscious cognitions and emotions in other forms of posttrauma maladjustments, such as maladaptive behaviors, the current study examined the associations between these cognitions and emotions with dissociation, alcohol use, and avoidant problem-solving. As a secondary goal, the influence of time since trauma exposure was considered given recent data suggesting that some posttraumatic responses require lengthier time following trauma to become salient. Multiple-group analysis was conducted in two groups of female survivors of intimate partner violence (IPV): women whose IPV experiences occurred within 3 months prior to assessment (early posttrauma phase [EPP]; n = 67) and those whose experiences occurred 12 months or more prior to assessment (chronic posttrauma phase [CPP]; n = 145). The results suggested model invariance. Posttraumatic negative self-conscious cognitions and emotions were significantly correlated with dissociation (EPP group: ß = .61, p < .001 and CPP group: ß = .48, p < .001), alcohol use (EPP group: ß = .31, p = .014 and CPP group: ß = .30, p < .001), and avoidant problem-solving (EPP group: ß = .58, p < .001 and CPP group: ß = .56, p < .001). The findings highlight the importance of negative self-conscious cognitions and emotions in posttrauma maladjustment and support intervening in these domains shortly after trauma exposure.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) La asociación entre cogniciones y emociones negativas auto-conscientes postraumáticas y comportamientos maladaptativos: ¿Influye el Tiempo desde la Exposición al Trauma? COGNICIONES/EMOCIONES Y COMPORTAMIENTOS MALADAPTATIVOS Las creencias negativas acerca de sí mismo, la autoinculpación, la culpa y la vergüenza han sido consistentemente asociados a problemas emocionales, tales como el trastorno de estrés postraumático y la depresión, luego de la exposición a trauma. Para expandir la comprensión del rol potencial de las cogniciones y emociones negativas auto-conscientes en otras formas de inadaptación post-trauma, como comportamientos maladaptativos, el presente estudio examinó las asociaciones entre esas cogniciones y emociones con disociación, uso de alcohol, y estilo evitativo de resolución de problemas. Como un objetivo secundario, se consideró la influencia del tiempo desde la exposición al trauma dados los datos recientes que sugieren que algunas respuestas post-traumáticas requieren un mayor tiempo luego del trauma para hacerse salientes. Se realizó un análisis de grupos múltiples en dos grupos de mujeres sobrevivientes de violencia de pareja (IPV, por su sigla en inglés); aquellas cuyas experiencias de IPV ocurrieron en los últimos 3 meses (fase temprana post-trauma [FTP]; n = 67) y aquellas cuyas experiencias ocurrieron hace 12 meses o más (fase crónica post-trauma [FCP]; n = 145). Los resultados sugirieron invariancia del modelo. Las cogniciones y emociones negativas auto-conscientes se correlacionaron significativamente con disociación (grupo EPP: ß = .61, p < .001 y grupo CPP: ß = .48, p < .001), uso de alcohol (grupo EPP: ß = .31, p = .014 y grupo CPP: ß = .30, p < .001), y estilo evitativo de resolución de problemas (grupo EPP: ß = .58, p < .001 y grupo CPP: ß = .56, p < .001). Los hallazgos destacan la importancia de las emociones y cogniciones negativas auto-conscientes en la inadaptación postrauma y apoyan la intervención en esos dominios prontamente luego de la exposición a trauma.

Does a history of childhood abuse moderate the association between symptoms of posttraumatic stress disorder and borderline personality disorder in survivors of intimate partner violence?

OBJECTIVE: This study examined whether a history of childhood abuse (CA) strengthened the association between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) in the aftermath of intimate partner violence (IPV). This hypothesis arises from clinical literature but has not been examined empirically. We predicted that a history of CA would enhance associations between BPD features and PTSD symptoms. METHOD: Dimensional assessment of both PTSD and BPD was made in a sample of 211 women who sought mental health services following IPV. Two analyses were conducted using clinician-assessed DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) PTSD symptoms: (a) total score and (b) symptom clusters. RESULTS: Using path analysis, results indicated significant associations between BPD features and PTSD symptoms, but no significant interaction between BPD and CA in either analysis. CONCLUSIONS: Results are discussed given current understanding of comorbidities involving PTSD, with particular attention to potential implications for clinical practice. Areas for future research are proposed.

A Simple Method for Normalization of Aortic Contractility.

Vascular contractile function changes in proliferative vascular diseases, e.g. atherosclerosis, and is documented using isolated blood vessels; yet, many laboratories differ in their approach to quantification. Some use raw values (e.g., mg, mN); others use a "percentage of control agonist" approach; and others normalize by blood vessel characteristic, e.g. length, mass, etc. A lack of uniformity limits direct comparison of contractility outcomes. To address this limitation, we developed a simple 2-step normalization method: (1) measure blood vessel segment length (mm), area (mm2) and calculate volume (mm3); then, (2) normalize isometric contraction (mN) by segment length and volume. Normalized aortic contractions but not raw values were statistically different between normal chow and high-fat diet-fed mice, supporting the practical utility and general applicability of normalization. It is recommended that aortic contractions be normalized to segment length and/or volume to reduce variability, enhance efficiency, and to foster universal comparisons across isometric myography platforms, laboratories, and experimental settings.

Demand/withdraw communication in the context of intimate partner violence: Implications for psychological outcomes.

Intimate partner violence (IPV) is associated with symptoms of posttraumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). To clarify the influence of a dyadic conflict pattern that has previously been shown to accompany violence in romantic relationships (partner demand/self withdraw) on these mental health outcomes, we examined the associations between three forms of IPV (physical, emotional-verbal, dominance-isolation), partner demand/self withdraw, and PTSD and GAD symptoms, in a sample of 284 IPV-exposed women. Using structural equation modeling, we found significant associations between dominance-isolation IPV, partner demand/self withdraw, and clinician-assessed GAD symptoms. Associations between emotional-verbal IPV and partner demand/self withdraw were also significant. Associations for physical IPV, partner demand/self withdraw, and clinician-assessed PTSD symptoms were not statistically significant. These results underscore the need for research on the mental health outcomes associated with specific forms of IPV and the long-term psychological consequences of the conflict patterns that uniquely characterize violent relationships.

Predictors of Postdeployment Functioning in Combat-Exposed U.S. Military Veterans.

Posttraumatic stress disorder (PTSD) and sequelae of mild traumatic brain injury (mTBI) are presumed to contribute to reintegration difficulties in combat-exposed veterans. Yet their relative impacts on postdeployment functioning are not well understood. The current study used structural equation modeling (SEM) to clarify the extent to which symptoms of internalizing disorders (e.g., depression, anxiety), mTBI symptoms, and cognitive performance are associated with functional impairment in 295 combat-exposed veterans. SEM results showed that internalizing symptoms most significantly predicted functional impairment (r = 0.72). Blast mTBI and cognitive performance were associated with internalizing (r = 0.24 and -0.25, respectively), but functional impairment was only modestly related to cognition (r = -0.17) and unrelated to mTBI. These results indicate that internalizing symptoms are the strongest predictor of functioning in trauma-exposed veterans, exceeding the effects of mTBI and cognitive performance. This evidence supports prioritizing interventions that target internalizing psychopathology to improve functioning in cases of co-occurring PTSD and mTBI.