Intimate partner aggression-related shame and posttraumatic stress disorder symptoms: The moderating role of substance use problems

Interpersonal trauma, shame, and substance use: A systematic review

BACKGROUND

Interpersonal trauma is a risk factor for a wide array of adverse mental health outcomes, including substance use. Research has begun investigating the role of shame in the intersection between substance use and interpersonal trauma. The current systematic review summarizes the existing literature documenting the relation among shame, substance use, and interpersonal trauma.

METHOD

Articles were collected using a Boolean search strategy of terms related to interpersonal trauma, substance use, and shame across six databases. Independent search and screening by three researchers led to a final review of 27 articles, 15 of which were qualitative studies.

RESULTS

Findings highlight robust associations among shame, interpersonal violence, and substance use across varied samples. Findings emphasize that increased shame is associated with greater substance use among survivors of interpersonal violence and elevated shame and greater interpersonal violence are present among individuals who use substances given the high prevalence rates. Burgeoning research suggests that shame mediates the relationship between interpersonal violence and substance use.

CONCLUSION

Results from our review suggest that shame may be an important treatment target for individuals presenting with substance use and a history of interpersonal violence. Future studies, with longitudinal designs, are needed to parse out the temporal relation among shame, substance use, and interpersonal violence.

Brain structural correlates of psychopathic traits in elite female combat-sports athletes

Psychopathy is characterized by glibness and superficial charm, as well as a lack of empathy, guilt and remorse, and is often accompanied by antisocial behaviour. The cerebral bases of this syndrome have been mostly studied in violent subjects or those with a criminal history. However, the antisocial component of psychopathy is not central to its conceptualization, and in fact, psychopathic traits are present in well-adjusted, non-criminal individuals within the general population. Interestingly, certain psychopathy characteristics appear to be particularly pronounced in some groups or professions. Importantly, as these so-called adaptive or successful psychopaths do not show antisocial tendencies or have significant psychiatric comorbidities, they may represent an ideal population to study this trait. Here, we investigated such a group, specifically elite female judo athletes, and compared them with matched non-athletes. Participants completed psychopathy, anger, perspective-taking and empathic concern questionnaires and underwent structural magnetic resonance imaging (MRI). Grey matter volume (GMV) was computed using voxel-based morphometry from the T1-weighted images. Athletes scored significantly higher in primary psychopathy and anger and lower in empathy and perspective taking. They also exhibited smaller GMV in the right temporal pole, left occipital cortex and left amygdala/hippocampus. GMV values for the latter cluster significantly correlated with primary psychopathy scores across both groups. These results confirm and extend previous findings to a little-studied population and provide support for the conceptualization of psychopathy as a dimensional personality trait which not only is not necessarily associated with antisocial behaviour but may potentially have adaptive value.

Intimate Partner Violence and HIV Prevention Among Sexual Minority Men: Protocol for a Prospective Mixed Methods Cohort Study

BACKGROUND

Sexual minority men experience intimate partner violence (IPV) at rates similar to those reported by heterosexual women in the United States. Previous studies linked both IPV victimization and perpetration to HIV risk and seroconversion; however, less is known about the impact of IPV on HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) uptake, and the persistence of PrEP use among sexual minority men experiencing IPV. Although prior work suggests that IPV may influence HIV prevention behavior, experiences of IPV are so highly varied among sexual minority men (eg, forms, frequency, and severity; steady vs casual partnerships; perpetration vs receipt; and sexual vs physical vs psychological violence) that additional research is needed to better understand the impact that IPV has on HIV risk and protective behaviors to develop more effective interventions for sexual minority men.

OBJECTIVE

This study aims to contribute to our understanding of the antecedents of IPV and the direct and indirect pathways between perpetration and receipt of IPV and HIV or STI risk behavior, STIs, and use of PrEP among sexual minority men experiencing IPV.

METHODS

This mixed methods study has 2 phases: phase 1 involved formative qualitative interviews with 23 sexual minority men experiencing IPV and 10 key stakeholders or providers of services to sexual minority men experiencing IPV to inform the content of a subsequent web-based cohort study, and phase 2 involves the recruitment of a web-based cohort study of 500 currently partnered HIV-negative sexual minority men who reside in Centers for Disease Control and Prevention-identified Ending the HIV Epidemic priority jurisdictions across the United States. Participants will be followed for 24 months. They will be assessed through a full survey and asked to self-collect and return biospecimen kits assessing HIV, STIs, and PrEP use at 0, 6, 12, 18, and 24 months. They will also be asked to complete abbreviated surveys to assess for self-reported changes in key study variables at 3, 9, 15, and 21 months.

RESULTS

Phase 1 was launched in May 2021, and the phase 1 qualitative interviews began in December 2021 and were concluded in March 2022 after a diversity of experiences and perceptions were gathered and no new ideas emerged in the interviews. Rapid analysis of the qualitative interviews took place between March 2022 and June 2022. Phase 2 recruitment of the full cohort began in August 2022 and is planned to continue through February 2024.

CONCLUSIONS

This mixed methods study will contribute valuable insights into the association that IPV has with HIV risk and protective behaviors among sexual minority men. The findings from this study will be used to inform the development or adaptation of HIV and IPV prevention interventions for sexual minority men experiencing IPV.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41453.

The Association Between Demographic, Mental Health, and Intimate Partner Violence Victimization Variables and Undergraduate Women's Intimate Partner Violence Perpetration

Addressing women's intimate partner violence (IPV) perpetration is essential not only to their partners' safety but also to their own as, for women who are victims of IPV, their IPV perpetration may be a risk factor for their own revictimization. Although many studies have examined risk factors for women's IPV perpetration, results diverge with regard to whether demographic and mental health variables are reliable predictors. Results of several studies have demonstrated that when IPV victimization is examined concurrently with perpetration, demographic and mental health variables are no longer significant correlates. However, this research has been limited in that the type of IPV examined has been restricted to physical, psychological, and sexual abuse. In addition, some demographic variables (e.g., sexual orientation) have yet to be adequately examined. The current study extends this literature by concurrently assessing demographic, mental health, and IPV victimization variables as correlates of IPV perpetration among undergraduate women. Furthermore, the current study examined a wide range of IPV types (i.e., threats of physical abuse, physical abuse, sexual abuse, psychological maltreatment, stalking, cyberstalking). Among a final sample of 398 undergraduate women at a Midwestern public university, results demonstrated that while all variables (i.e., demographic, mental health, IPV victimization) were correlated with at least one type of IPV perpetration, only IPV victimization remained a unique significant correlate of perpetration for each of the six IPV perpetration types when variables were analyzed concurrently in hierarchical regression models. Demographic and mental health variables were nonsignificant correlates for most IPV perpetration types. These results corroborate previous studies and provide additional evidence that targeting women's own victimization, safety planning, and de-escalation may be useful at decreasing violence against women's partners as well as women's own risk for revictimization.

Shame, guilt, and posttraumatic stress symptoms: A three-level meta-analysis

Existing empirical findings are inconsistent on the correlations of shame and guilt with posttraumatic stress symptoms (PTSS). This study aimed to quantitatively summarize the strength of the associations of shame and guilt with PTSS and explore potential moderators. Based on a three-level meta-analytic method, shame was positively correlated with PTSS, no matter whether the effects of guilt were controlled; guilt also had a positive correlation with PTSS, regardless of whether the effects of shame were partialling out. Moderator analyses showed that type of shame measure (generalized vs. contextual vs. trauma-specific shame) moderated the relation between shame and PTSS, and type of guilt measure (generalized vs. contextual vs. trauma-specific guilt) moderated the relation between guilt and PTSS. In addition, culture had a marginally significant moderating effect on the relation between guilt and PTSS, with a stronger association of guilt with PTSS in Western culture than in Eastern culture. These results supported the links of shame and guilt to PTSS and implied that we should focus on the conceptual underpinnings of the manifest psychometric issue and maintain cultural sensitivity in future research. The implications for posttraumatic stress disorder treatment were also discussed.

Cognitive Reframing of Intimate Partner Aggression: Social and Contextual Influences

Intimate partner aggression violates U.S. culturally-accepted standards regarding how partners should treat each other. Victims must reconcile the dissonance associated with being in what should be a loving and supportive relationship, while being in the same relationship that is personally and deeply harmful. To manage these clashing cognitions, victims consciously and unconsciously adopt perceptions to reframe their partner’s aggression, minimizing and reinterpreting the occurrence or impact of aggressive acts, and justifying remaining in their relationship. The paper examines the multiple and nested influences that shape such perceptions, including individual, partner, relationship, and cultural factors. Each type of influence is discussed by reviewing previous research and including accounts from women who had experienced aggression. Greater awareness of such perceptions may afford greater control in changing harmful relationship patterns.

Women's Use of Aggression and Their Depressive Symptoms: The Mediating Effect of Aggression-Related Shame and Avoidance Coping Among Women Experiencing Bidirectional Intimate Partner Violence

Research is scarce on the consequences of women's use of aggression on their depressive symptoms, particularly in relationships where women use and are victimized by intimate partner violence (IPV). Further, research has yet to identify factors that may mediate the aggression-depressive symptoms link among women who experience bidirectional IPV. The present study examined the potential mediating roles of shame and avoidance coping in the relationship between women's use of intimate partner aggression and their depressive symptoms. Participants were a community sample of 369 women who used and were victimized by physical aggression with a current male partner in the previous 6 months. A serial multiple mediator model was used to examine the mediating roles of aggression-related shame and avoidance coping on the relation between women's use of aggression and depressive symptoms. Results showed a significant indirect effect of women's use of aggression on their depressive symptoms through both aggression-related shame and avoidance coping; indirect effects were not significant through each mediator separately. After controlling for women's IPV victimization, we found a positive association between women's use of aggression and aggression-related shame, which in turn was related to greater avoidance coping, and subsequently, greater depressive symptoms. These findings highlight the importance of examining shame and avoidance coping as consequences of women's use of aggression and its effects on poorer mental health outcomes among women who use and are victimized by IPV.

PTSD's risky behavior criterion: Relation with DSM-5 PTSD symptom clusters and psychopathology

A new symptom criterion of reckless and self-destructive behaviors (E2) was recently added to posttraumatic stress disorder's (PTSD) diagnostic criteria in DSM-5, which is unsurprising given the well-established relation between PTSD and risky behaviors. Researchers have questioned the significance and incremental validity of this symptom criterion within PTSD's symptomatology. Unprecedented to our knowledge, we aim to compare trauma-exposed groups differing on their endorsement status of the risky behavior symptom on several psychopathology constructs (PTSD, depression, distress tolerance, rumination, anger). The sample included 123 trauma-exposed participants seeking mental health treatment (M age=35.70; 68.30% female) who completed self-report questionnaires assessing PTSD symptoms, depression, rumination, distress tolerance, and anger. Results of independent samples t-tests indicated that participants who endorsed the E2 criterion at a clinically significant level reported significantly greater PTSD subscale severity; depression severity; rumination facets of repetitive thoughts, counterfactual thinking, and problem-focused thinking; and anger reactions; and significantly less absorption and regulation (distress tolerance facets) compared to participants who did not endorse the E2 criterion at a clinically significant level. Results indicate the utility of the E2 criterion in identifying trauma-exposed individual with greater posttraumatic distress, and emphasize the importance of targeting such behaviors in treatment.