Examining Alcohol-Related Blackouts and Drinking Motives Over Time Among College Women.

OBJECTIVE: Excessive alcohol consumption and its consequences among college women continues despite prevention efforts. One common consequence, alcohol-related blackouts (ARBs), are periods of alcohol-activated anterograde amnesia. The purpose of the current project is to extend the ARB and drinking motive literature by examining their relationship over time. METHOD: A sample of 424 women (88.9% White) completed online surveys assessing their ARBs and drinking motives weekly for 10 weeks. A series of hierarchical generalized linear models were estimated to examine the between-person and within-person effects of each drinking motive on repeated measures of experiencing a blackout across the time points. RESULTS: Women who report higher levels of drinking motives compared with others were more likely to report having blackout experiences. College women who reported higher levels of conformity motives did not have increased odds of experiencing a blackout. In weeks when they reported elevated levels of drinking motives, they were also more likely to experience an ARB. CONCLUSIONS: In general, college women who reported higher levels of social, coping, or enhancement motives experienced more blackouts than students who reported lower levels of these motives. Women who were underage were more likely to experience a blackout compared with women who were 21 or older. In a given week, 52.6% to 70.7% of the students consumed alcohol, and among women who drank in a given week, the prevalence of blackouts ranged from 8.5% to 14.6%. The results suggest that changes in motivational levels might provide a possible intervention point for ARBs risk.

Trauma Symptoms and Deliberate Self-Harm Among Sexual Violence Survivors: Examining State Emotion Regulation and Reactivity as Dual Mechanisms.

Objective: Posttraumatic stress disorder (PTSD) symptoms have been associated with elevated rates of deliberate self-harm, including among women who have experienced sexual violence (SV); however, processes underlying this association have not been widely examined. Because a common function of deliberate self-harm is to reduce negative internal states, SV survivors may use self-harm to cope with impairments in broader affective processes associated with PTSD symptoms. To test this hypothesis, the present study examined the role of two aspects of emotional responding (i.e., state emotional reactivity and emotion dysregulation) as mechanisms between greater PTSD symptoms and risk for future deliberate self-harm among SV survivors. Method: Participants were 140 community women with a history of SV who completed two waves of data collection. At baseline, participants reported on their PTSD symptoms, as well as state emotional reactivity and state emotion dysregulation following a standardized laboratory stressor task (i.e., the Paced Auditory Serial Addition Task [PASAT-C]). Participants then completed a self-report measure of deliberate self-harm 4 months later. Results: Results from a parallel mediation analysis indicated that greater state emotion dysregulation, but not state emotional reactivity, mediated prospective associations between more severe PTSD symptoms at baseline and greater risk for deliberate self-harm 4-months later. Conclusions: Applied to the context of survivors' daily lives, these findings underscore the importance of deficits in emotion regulation during times of distress in predicting risk for later deliberate self-harm.

Trauma-Related Shame Mediates the Associations Between Self-Blame, Bisexual Minority Stress, and Rape-Related PTSD Symptoms.

Bisexual women experience higher rates of rape and post-traumatic stress disorder (PTSD) prevalence compared to heterosexual and lesbian women. In addition, bisexual women experience unique antibisexual stigma and minority stress, which are associated with post-trauma outcomes. The aim of the current study was to test trauma-related shame as a mechanism in the relations of self-blame and bisexual minority stress (i.e., antibisexual stigma and internalized binegativity) with rape-related PTSD symptom. The sample consisted of 192 cisgender bisexual women (ages 18-35 years) who reported an experience of rape since the age of 18. Results from path analysis conducted in Mplus indicated that trauma-related shame mediated the link between self-blame and rape-related PTSD severity, as well as the links from antibisexual stigma and internalized binegativity to rape-related PTSD severity. There was also an indirect serial effect from antibisexual stigma to internalized binegativity to shame to PTSD severity. Thus, findings highlight the mechanistic role of trauma-related shame in rape-related PTSD symptoms. We identified two risk pathways: (a) general/universal risk from self-blame about rape and shame to PTSD severity and (b) group-specific risk from bisexual minority stress and shame to PTSD severity. Results indicate that reducing trauma-related shame may be an important target to improve post-rape outcomes. Finally, stigma associated with rape and sexual violence as well as antibisexual stigma must be eradicated to improve post-trauma outcomes among bisexual survivors.

Role of blame and rape-related shame in distress among rape victims.

OBJECTIVE: Posttraumatic stress disorder (PTSD) and depression are highly prevalent among rape victims. Both blame (self-blame and victim-blaming responses to rape disclosure) and shame are frequently elevated among rape victims and contribute to PTSD and depression. However, it is unclear which type of shame is relevant. The aim of the current study was to examine the indirect effect of self-blame and victim blame on PTSD and depression via rape-related shame and general shame, in the presence of shame proneness and rape characteristics. METHOD: Online questionnaires were completed by 229 women who experienced adult rape and had disclosed to at least one person. RESULTS: Findings revealed distinct patterns for PTSD and depression. For PTSD, there was a significant indirect effect of victim blame (and self-blame) via rape-related shame but not via general shame. In contrast, for depression, there was a significant indirect effect of victim blame (and self-blame) via both rape-related shame and general shame. CONCLUSION: Results emphasized the importance of considering the type of shame (i.e., rape-related shame and general shame) when explaining PTSD and depression among women who experienced rape. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sexual Victimization Outcomes and Adjustment Among Bisexual Women: A Review of the Quantitative Literature.

Bisexual women experience worse mental health outcomes than lesbian and heterosexual women, which may be explained by greater rates of sexual violence among bisexual women. The current comprehensive literature review aimed to synthesize research on mental health and substance use outcomes related to lifetime sexual violence among bisexual women. A comprehensive literature search was conducted within the PsycINFO and Medline databases (final search conducted in August, 2021). Inclusion criteria required articles to examine a mental health or substance use correlate/outcome of lifetime sexual victimization experiences among bisexual women. Fifteen studies met inclusion criteria and were reviewed. Results indicate that there are significant gaps in this literature, including limited research on psychological distress outcomes. Most notably, there is a limited focus on the experiences of bisexual women specifically and the role of bisexual minority stress. Findings indicate that lifetime sexual victimization experiences are linked with increased posttraumatic stress, depression, and alcohol (and other substance) use and consequences. It appears that bisexual women are vulnerable to cumulative victimization, which may further exacerbate outcomes. Clinicians working with bisexual women should provide bisexual-affirmative care, help bisexual women access positive social supports, and build more effective coping strategies for managing post-trauma distress. Future research on outcomes of violence among bisexual women would benefit from contextualizing adjustment following sexual assault within a bisexual minority stress-informed approach for a more comprehensive understanding of this process.

Is the Risk for Sexual Revictimization Cumulative? A Prospective Examination.

INTRODUCTION: Sexual abuse during childhood is associated with risk for sexual assault as an adult, known as revictimization. Although multiple experiences of sexual assault in adulthood are also common, it is unclear how risk trajectories might continue to evolve in emerging adulthood, defined as ages 18-25. Clarifying risk trajectories is important to inform the development of targeted risk reduction interventions. To fill this gap, we examined cumulative risk for sexual assault in emerging adult women following multiple experiences of childhood sexual abuse (CSA) and adulthood sexual assault (ASA). METHODS: Women (n = 447; aged 18-25 years at enrollment) completed behaviorally specific assessments of unwanted sexual experiences at up to 9 time points across 3 years. Logistic regression was used to predict any sexual assault during the 3-year period as a function of victimization history at baseline. A multilevel logistic regression analysis among ASA survivors was then used to determine whether each successive ASA increased risk for further victimization. RESULTS: Extending prior research, findings revealed that the risk for sexual assault during the 3-year study was greater for women reporting more prior experiences of CSA and ASA. Unexpectedly, each ASA increased the risk for a subsequent ASA to a lesser extent among women with more experiences of CSA. CONCLUSIONS: Findings suggest that the risk for sexual revictimization can be cumulative, but that risk does not increase indefinitely. Future research should investigate the points at which survivors of multiple assaults may begin to experience a decreased risk for later assaults, as well as the factors associated with change in risk status (e.g., removal from violent environments or relationships, changes in institutional policies). Such research could inform intervention targets.

Mindful Awareness Promotes Resilience: Buffered Links Among Childhood Sexual Abuse Severity, Goal-Directed Emotion Dysregulation, and Psychopathology.

Objectives: Childhood sexual abuse is linked to long-term consequences, including depression and anxiety in adulthood. Although considerable progress has been made to understand mechanisms that may account for this relation, such as emotion dysregulation, less attention has been given to protective factors that may mitigate it. One such protective factor might be mindful awareness. Those who act with awareness in daily living tend to engage in healthy emotion regulation skills when faced with stressors and experience less depression and anxiety. In the current study, we aimed to replicate the positive associations among childhood sexual abuse severity, emotion dysregulation, and psychopathology across time, and also identify a personal strength-in this case, mindful awareness-that might mitigate these effects. Methods: Participants were 491 women recruited from the community who completed self-report assessments at three time points over a 32-month period. Results: A series of moderated mediation models revealed childhood sexual abuse severity predicted later reports of depression and anxiety symptoms through greater emotion dysregulation in the form of difficulties engaging in goal-directed behaviors. As expected, mindful awareness weakened the relation between goal-directed emotion dysregulation and symptoms of depression and anxiety, such that greater levels of mindful awareness fully buffered these effects. Conclusions: Through a better understanding of natural resiliency processes among survivors, we can ultimately encourage continued examination of what might be effective additions to existing treatments for the mental health consequences of trauma and adversity.

Examining the associations between PTSD symptoms and aspects of emotion dysregulation through network analysis.

Despite the clearly established link between posttraumatic stress disorder (PTSD) and emotion dysregulation, little is known about how individual symptoms of PTSD and aspects of emotion dysregulation interrelate. The network approach to mental health disorders provides a novel framework for conceptualizing the association between PTSD and emotion dysregulation as a system of interacting nodes. In this study, we estimated the structural relations among PTSD symptoms and aspects of emotion dysregulation within a large sample of women who participated in a multi-site study of sexual revictimization (N = 463). We estimated expected influence to reveal differential associations among PTSD symptoms and aspects of emotion dysregulation. Further, we estimated bridge expected influence to identify influential nodes connecting PTSD symptoms and aspects of emotion dysregulation. Results highlighted the key role of concentration difficulties in expected influence and bridge expected influence. Findings highlight several PTSD symptoms and aspects of emotion dysregulation that may be targets for future intervention.

Changes in Risk Perception After Sexual Victimization: Are We Following the Right Track?

Sexual abuse is a major public health concern with detrimental effects on both mental and physical health. Several studies have reported that victims of sexual abuse have a decreased ability to recognize risk in potentially threatening situations compared with nonvictims, although others were not able to replicate this finding. In addition, although emotion dysregulation has been linked to risk perception and sexual victimization, results have been contradictory. To strengthen the theoretical framework needed for the development of interventions to reduce women's likelihood of sexual assault, it is crucial to further examine the role of emotion dysregulation in relation to sexual victimization history and risk perception. The aim of the current study was to examine cross-sectional associations between sexual victimization, emotion regulation difficulties, and risk perception. In our sample of 276 female college students, 40% reported lifetime sexual victimization, 14% reported recent sexual victimization, and 12% reported childhood sexual abuse. In contrast to our hypothesis, we did not find risk perception to be related to lifetime sexual victimization, childhood sexual victimization, or recent sexual victimization. In addition, we did not find evidence for the expected relationship between sexual victimization, risk perception, and emotion regulation difficulties. The discussion of the current study specifically highlights the need for a clear conceptualization of risk perception and provides recommendations for future studies. More sophisticated measurement methods could lead to a higher applicability of findings to real-life situations. The potential relationships between victimization, risk perception, and emotion dysregulation need further clarification to reach the ultimate goal of contributing to the prevention of victimization.

Drinking to cope as a mechanism between sleep problems and heavy episodic drinking among trauma survivors.

Objective: Women who have experienced trauma report high rates of heavy episodic drinking (HED) and sleep problems. Prior work suggests that poor sleep exacerbates heavy alcohol use; however, potential mechanisms for this association are unclear. Consistent with the self-medication model, one possibility may be that women with a history of trauma are drinking at increased rates in order to cope with the affective consequences of poor sleep. To examine this possibility, the current study tested the role of drinking to cope motives as a mediator of prospective associations between sleep problems and HED among women who have experienced trauma. Method: Community women reporting a history of trauma (N = 414, Mage = 21.8, 59.9% White, 36.2% Black) completed self-report measures at baseline and 4 month and 8 month follow-ups. Measures of trauma exposure (Life Events Checklist [LEC]) and sleep problems (Cohen-Hoberman Inventory of Physical Symptoms-Revised [CHIPS-R]) were taken from baseline, drinking motives (Revised Drinking Motives Questionnaire) at 4 months, and HED at 8 months. Results: Findings supported an indirect association between sleep problems and later HED through increased drinking to cope motives (b = .05, 95% CI [.018, .108], ß = .05). Conclusion: As hypothesized, drinking to cope accounted for associations between sleep problems and later HED. Findings underscore the potential value in addressing drinking to cope motives as a means of reducing HED, particularly among women with a history of trauma who are sleeping poorly. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Self-compassion and Shame Among Rape Survivors.

Women are at increased risk for post-traumatic stress disorder (PTSD) and depression associated with rape, and shame plays a vital role in the development and maintenance of PTSD and depression. Thus, there is a need to identify factors that may decrease shame among female survivors of adult rape. Self-compassion may be one such factor. The present study used path analysis in MPlus version 7.3 to examine the indirect effect of self-compassion on PTSD and depression via rape-related shame. We hypothesized that higher levels of self-compassion would be associated with lower levels of rape-related shame, which in turn would be associated with lower levels of PTSD and depression. College women (N = 305) who reported experiencing rape completed anonymous online surveys assessing rape, self-compassion, rape-related shame, PTSD, and depression. Consistent with our hypothesis, results indicated that self-compassion was negatively associated with assault-related shame, which in turn was positively associated with PTSD and depression. There was also a significant indirect effect of self-compassion on PTSD and depression via rape-related shame. Further, rape-related shame fully explained the relation between self-compassion and PTSD. Findings suggest that self-compassion may be an appropriate target to reduce rape-related shame and may subsequently facilitate reductions in PTSD and depression symptoms.

Binegativity Exacerbates the Effects of Sexual Victimization Disclosure on Posttraumatic Stress and Drinking Among Bisexual Women.

Bisexual women experience higher rates of sexual victimization and mental health problems compared to heterosexual and lesbian women. Bisexual women also receive more unsupportive or overtly negative reactions when they disclose experiences of sexual victimization. The current study aimed to examine the interaction of negative social reactions and binegativity (i.e., experiences of stigma due to bisexual identity) in predicting posttraumatic stress, depression, and hazardous drinking among bisexual women. The sample consisted of 161 young adult bisexual women (ages 18-35) who disclosed a sexual victimization experience to at least one person. Moderation analyses were conducted via the PROCESS macro for SPSS. "Turning against" reactions to disclosure (e.g., victim blame and avoidance of the victim) predicted increased posttraumatic stress and hazardous drinking in the presence of binegativity. In addition, reactions to disclosure that acknowledged the experience but were unsupportive predicted increased drinking in the context of binegativity. Depression was not associated with either type of negative reactions, regardless of binegativity. Thus, findings suggest that binegativity in combination with negative responses to disclosure of sexual victimization are important factors in specific types of distress related to sexual violence among bisexual women. Implications for research, clinical intervention, and policy are discussed.