Elucidating posttraumatic stress symptom profiles and their correlates among women experiencing bidirectional intimate partner violence

Elucidating Heterogeneity of Intimate Partner Violence Among Women: Latent Class Analysis of Daily IPV, PTSD, and Substance Use Collected via Experience Sampling Methodologies

The co-occurrence of physical, psychological, and sexual intimate partner violence (IPV) is associated with heightened risk for deleterious mental and physical health outcomes, including PTSD symptoms and substance use. However, few studies have investigated the heterogeneity of experiences with respect to this co-occurrence among women who experience IPV as it unfolds naturally in women's daily lives. In this study, we developed a novel approach to classify and visualize daily patterns of IPV experiences, PTSD-related distress, and substance use among women who experience IPV. Women (N = 244, Mage = 37.1 years) who reported experiencing IPV and using substances were recruited from the community. Micro-longitudinal data were collected four times per day for 14 days using automated telephone-based data collection. Analyses included latent class analysis (LCA) and multilevel analysis (interval-, day-, and person-level), complimented by novel data visualization tool (EventFlow). We identified three classes that significantly differed in the prevalence of and patterns among IPV types, PTSD, and substance use. Based on examination of LCA results and visualization of the latent classes in EventFlow. Different patterns of associations among IPV types, PTSD symptoms, and substance use were identified within classes at the interval-, day-, and person-level. Results from this study provide greater insight into the heterogeneity of women's lived experiences than do studies solely relying on cross-sectional survey data. Findings with this type of data collection can inform the development of interventions to increase the precision in clinical practice, identify new avenues for future research, and have important policy implications.

A psychometric evaluation of the PTSD Checklist for DSM-5 among women experiencing intimate partner violence

Recent national estimates suggest that 1 in 2 women will experience intimate partner violence (IPV) in their lifetime. Given the high prevalence of posttraumatic stress disorder (PTSD) among women experiencing IPV, it is necessary to consider whether PTSD assessments function adequately for this population. Thus, the present study aimed to evaluate the psychometric properties of the past-month version of the PTSD Checklist for DSM-5 (PCL-5), one of the most widely used self-report measures of PTSD symptoms, in a sample of community women experiencing IPV. Participants were 158 women who had experienced IPV in the past 6 months (Mage = 40.14 years, 39.9% White). The PCL-5 demonstrated good internal consistency, Cronbach's α = .97, and scores were significantly positively correlated with theoretically related constructs (i.e., PTSD symptom count on the SCID-5, IPV severity, substance use, depression, anxiety, and emotion dysregulation); however, it demonstrated poor 30-day stability, r = .38, ICC = .55. The ability of the PCL-5 to discriminate with respect to a PTSD diagnosis was acceptable, AUC = .74. A cutoff score of 21 maximized sensitivity (82.5%) and specificity (55.4%); this is lower than typical cutoffs (i.e., 31-33). Although the PCL-5 has generally demonstrated adequate psychometric properties, findings suggest that it does not function optimally for women experiencing IPV relative to its functioning for other trauma-exposed populations. The lower-than-typical cutoff suggests that the PCL-5 may underestimate PTSD prevalence among women experiencing IPV.

Physical Intimate Partner Violence and Emotional Harm in Five U.S. States

The purpose of this study was to assess the relationship between physical intimate partner violence (IPV) victimization and four related aspects of emotional well-being: threat sensitivity, intolerance of uncertainty, impulse control, and access to resources for emotional regulation. We draw on a transactional model of IPV and emotional regulation to theorize how invalidation and partner threats in relationships can generate harmful emotional outcomes. We used representative data collected for residents living in five U.S. states: Colorado, Minnesota, Mississippi, New Jersey, and Texas. Our analytic sample included individuals who reported having been in a romantic relationship in the past year (N = 2,501). Data were collected using a probability-based web panel, between April 29 and May 15, 2022. Following the presentation of descriptive statistics and bivariate correlations, we developed a series of four multivariate models (ordinary least squares [OLS], negative binomial) to analyze the association between IPV victimization and each emotional outcome. All models adjusted for pertinent demographic and geographic control measures. Physical IPV victimization was associated with increased intolerance of uncertainty and heightened threat sensitivity. IPV victimization also corresponded with poorer impulse control and fewer resources for emotional regulation. Overall, our results demonstrate that experiences of physical IPV victimization are linked to poorer emotional outcomes. These outcomes can be harmful to broader mental health and potentially impact long-term well-being. The findings underscore the importance of mental health screenings that extend beyond assessments of diagnostic-level functions and allocating resources toward alleviating other clinically relevant factors that might arise from or even prompt additional exposure to physical IPV.

Bidirectional Violence in Intimate Relationships: A Systematic Review

Intimate partner violence is a public health problem with significant consequences at different levels. Over the years, the literature has shown that most violence is not unidirectional and perpetrated by men against women but rather bidirectional, in which both couple elements may be victims, perpetrators, or both. In this systematic literature review, we aimed to systematize the empirical knowledge to assess the prevalence of bidirectional violence, the most reported types of violence, and the influence of sex and sexual orientation on this phenomenon. The search for this systematic review was conducted in four databases, and we included studies that showed the prevalence of bidirectional violence in samples aged over 18 years, in articles written in English or Portuguese, and published between 2012 and 2022. In the qualitative synthesis, 42 empirical studies were included. The results showed that bidirectional violence is the most common pattern of violence, with psychological violence being the most reported type of bidirectional violence; men and women reported bidirectional violence at similar rates, and homosexual couples reported higher percentages of bidirectional violence than heterosexual couples. These results contradict the patriarchalist view of violence that assigns the exclusivity role of the victim to women and of the perpetrator to men, demonstrating that violence occurs regardless of sex or sexual orientation. The practical implications and future directions at the level of public policies to give visibility to the phenomenon will be duly discussed.

Posttraumatic stress as a moderator of the association between HPA-axis functioning and alcohol use disorder among a community sample of women currently experiencing intimate partner violence

Women experiencing intimate partner violence (IPV) experience a heightened prevalence of alcohol use disorder (AUD). Hypothalamic-pituitary-adrenal (HPA)-axis functioning has been associated with increased risk for AUD in other populations, including individuals with posttraumatic stress disorder (PTSD) symptoms. The goal of the present study was to determine whether PTSD symptom severity exacerbates the relationship between HPA-axis functioning and AUD. Participants were 151 community women who had experienced physical or sexual IPV in the past 30 days by their current male partners and used any amount of alcohol or drugs. A two-phase emotion induction protocol was utilized: Neutral mood induction followed by randomly assigned negative, positive, or neutral emotion induction. Saliva cortisol samples were obtained immediately following the neutral mood induction (baseline HPA-axis functioning), 20 min following the individualized emotion induction script (HPA-axis reactivity), and 40 min post the emotionally evocative cue (HPA-axis recovery). Findings revealed that PTSD symptom severity moderated the relations between baseline HPA-axis functioning and HPA-axis recovery and log odds of meeting criteria for AUD. Specifically, baseline HPA-axis functioning was positively associated with log odds of meeting criteria for AUD at high (but not low) PTSD symptom severity, whereas HPA-axis recovery was negatively associated with log odds of meeting criteria for AUD at high (but not low) PTSD symptom severity. Results contribute to our understanding of the biological processes involved in the etiology and maintenance of AUD among women experiencing IPV-specifically the prominent role of PTSD symptom severity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Patterns and predictors of perinatal posttraumatic stress symptoms: A latent transition analysis

BACKGROUND

Pregnancy is a time of increased risk for intimate partner violence (IPV), yet there is a dearth of prospective research examining the relationship between IPV and posttraumatic stress symptoms (PTSS) in the perinatal period. Further, relationships among different types of IPV and perinatal PTSS remain understudied.

METHODS

Latent class and transition analyses were used to examine classes of PTSS in pregnancy and postpartum, the longitudinal patterns of transitions across these classes, and the role of IPV types, childhood adversity, and depressive symptoms in PTSS presentation. Participants (N = 238) were drawn from two longitudinal studies of high-risk perinatal women.

RESULTS

Four latent PTSS classes emerged: High, Avoidant, Hypervigilant, and Low. Childhood adversity (χ²(3) = 13.09, p = .004), prenatal depression (χ²(3) = 17.58, p = .001), and psychological IPV (χ²(3) = 10.51, p = .01) were associated with membership in High, Avoidant, and Hypervigilant classes. Women with low prenatal PTSS continued to have low levels at postpartum. Women in higher severity classes during pregnancy tended to transition into classes with adjacent, and often lower, levels of symptom severity postpartum. Women in the High PTSS class in pregnancy with elevated levels of depression were significantly more likely to remain in the High PTSS class or transition into the Avoidant class at postpartum, compared to the Low PTSS class, χ²(3) = 11.84, p = .008.

LIMITATIONS

Relatively modest sample size precluded examination of a broader range of symptoms consistent with PTSD.

CONCLUSIONS

Findings highlight the importance of individualized approaches to assessing, monitoring, and treating perinatal PTSS.

Anxiety sensitivity in relation to post-traumatic stress disorder symptom clusters among young adults with probable post-traumatic stress disorder

Despite the promise of past research on anxiety sensitivity (AS) and posttraumatic stress, extant work is limited, given (1) most studies consist of non-Hispanic White and middle-aged samples, (2) few have demonstrated incremental validity to general emotional traits and social determinants of health, and (3) limited work has characterized how AS relates to specific Posttraumatic Stress Disorder (PTSD) symptom clusters among those with (probable) PTSD. The current study evaluated the role of AS in relation to PTSD symptom clusters among a racially/ethnically diverse sample of young adults with probable PTSD. Participants included young adults who met the clinical cut-off for probable PTSD per the Posttraumatic Diagnostic Scale. Results indicated that AS was significantly related to overall posttraumatic stress symptom severity; the effect was evident after adjusting for a range of covariates including neuroticism and subjective social status. AS also was incrementally associated with arousal and hyperreactivity, changes in mood and cognition, and intrusion PTSD symptom clusters. In contrast to expectation, no effect for AS was evident for the avoidance PTSD symptom cluster. The current data uniquely add to the existing AS PTSD literature by showcasing distinct symptom cluster patterns among a racially/ethnically diverse sample of young adults with probable PTSD.

Intimate Partner Violence and Posttraumatic Stress Symptoms: Indirect Effects Through Negative and Positive Emotion Dysregulation

Women who experience intimate partner violence (IPV) are at heightened risk for developing posttraumatic stress (PTS). Emotion dysregulation has been linked to both IPV and PTS, separately, however, unknown is the role of emotion dysregulation in the relation of IPV to PTS among women who experience IPV. Moreover, existing investigations in this area have been limited in their focus on negative emotion dysregulation. Extending prior research, this study investigated whether physical, sexual, and psychological IPV were indirectly associated with PTS symptom severity through negative and positive emotion dysregulation. Participants were 354 women who reported a history of IPV recruited from Amazon's MTurk platform (M_age = 36.52, 79.9% white). Participants completed self-report measures assessing physical (Conflict Tactics Scale), sexual (Sexual Experiences Scale), and psychological (Psychological Maltreatment of Women) IPV; negative (Difficulties in Emotion Regulation Scale) and positive (Difficulties in Emotion Regulation Scale-Positive) emotion dysregulation; and PTS symptom severity (PTSD Checklist for DSM-5) via an online survey. Pearson's correlation coefficients examined intercorrelations among the primary study variables. Indirect effect analyses were conducted to determine if negative and positive emotion dysregulation explained the relations between physical, sexual, and psychological IPV and PTS symptom severity. Physical, sexual, and psychological IPV were significantly positively associated with both negative and positive emotion dysregulation as well as PTS symptom severity, with the exception that psychological IPV was not significantly associated with positive emotion dysregulation. Moreover, negative and positive emotion dysregulation accounted for the relationships between all three IPV types and PTS symptom severity, with the exception of positive emotion dysregulation and psychological IPV. Our findings provide support for the potential underlying role of both negative and positive emotion dysregulation in the associations of IPV types to PTS symptom severity. Negative and positive emotion dysregulation may be important factors to integrate into interventions for PTS among women who experience IPV.

Childhood Physical Abuse and Antisocial Traits: Mediating Role of Posttraumatic Stress Symptom Clusters

Posttraumatic stress symptoms (PTSS) are associated with both childhood physical abuse (CPA) and antisocial (AS) traits, yet their potential as mediators of the CPA-AS traits link is understudied and the specific roles of individual symptom clusters in this relation is unknown. The current study aimed to examine the mediational role of PTSS in the relation between CPA and AS traits in a sample of low-income African American women with histories of intimate partner violence (IPV). It was hypothesized that avoidance would emerge as a significant mediator, whereas reexperiencing, numbing, and hyperarousal would not. Participants (N = 150) were recruited from a level-1 trauma public hospital and evaluated as part of a randomized controlled trial of a group therapy intervention for low-income, African American women suicide attempters with histories of IPV. The Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale (PDS), and International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were used to measure variables of interest. Using bootstrapping analyses, a parallel mediation model compared PTSS clusters as potential mediators of the CPA-AS traits relation, controlling for IPV. When reexperiencing, avoidance, numbing, and hyperarousal were entered simultaneously as potential mediators, only avoidance emerged as a significant mediator of the CPA-AS traits link. Avoidance symptoms may play a unique role in the link between early experiences of CPA and later AS traits among multiply traumatized African American women. Findings have implications for understanding AS traits in the context of early life trauma and suggest that targeting specific PTSS clusters (e.g., avoidance) may improve treatment outcomes for women in this population.

Profiles of Traumatic Stress Symptoms in Children Exposed to Intimate Partner Violence

Childhood exposure to intimate partner violence (IPV) is associated with a host of problems, including the development of posttraumatic stress symptoms (PTSS). PTSS include a wide range of unique symptomatology and as a result, clinical presentations of PTSS can vary in both distribution and overall number of symptoms. Work in child and adolescent samples has largely focused on factors predicting the total number of symptoms (i.e., symptom severity), with less work focused on both patterns of symptom number and distribution. Furthermore, few studies have examined how functional impairment varies in relation to PTSS presentation. The goal of the current study is to (a) document patterns of PTSS severity and distribution in children with histories of witnessing IPV, (b) examine the factors that predict different PTSS presentations, and (c) investigate how PTSS presentation is associated with functional impairment. Data for this study were drawn from a sample of 236 children between the ages of 4 and 12 years and their mothers who had experienced recent IPV. Families reported high levels of IPV in the past year, and children reported moderate levels of PTSS. A latent profile analysis of PTSS revealed that three profiles were the best-fitting model for the data. The three profiles were differentiated between low, moderate, and high levels of PTSS, and membership in the profiles varied by children's age and trauma history. The results of this study give important information about the potential development of PTSS as well as clinically useful information about the relationship between children's PTSS and their functioning following exposure to IPV.

Ethnic-racial identity and posttraumatic stress disorder: The role of emotional avoidance among trauma-exposed community individuals

OBJECTIVE

There are ethnic-racial differences in the prevalence of posttraumatic stress disorder (PTSD). However, the factors underlying these differences are not well studied or understood. The goal of this study was to explore the relation of strength of ethnic-racial identity to PTSD. Specifically, we examined whether strength of ethnic-racial identity was indirectly related to PTSD symptom severity through positive and negative emotional avoidance.

METHOD

Participants were 401 trauma-exposed community individuals (M_age = 43.86 years; 70.1% female; 23.4% Asian, 23.7% Black, 25.1% Hispanic, 25.4% White).

RESULTS

Within the overall sample of ethnic-racial minorities, the indirect effect of strength of ethnic-racial identity on PTSD symptom severity through the pathways of both positive and negative emotional avoidance was significant. However, these findings were not replicated within each of the specific racial-ethnic subsamples. Specifically, while strength of ethnic-racial identity was indirectly associated with PTSD symptom severity through both positive and negative emotional avoidance in the Black subsample, this indirect effect was only significant through the pathway of positive emotional avoidance in the Hispanic subsample, and was nonsignificant in the Asian and White subsamples.

CONCLUSIONS

Results underscore ethnic-racial differences in the way in which strength of ethnic-racial identity impacts PTSD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Social Reactions to IPV Disclosure and PTSD Symptom Severity: Assessing Avoidant Coping as a Mediator

Women's experiences of negative social reactions to disclosure of intimate partner violence (IPV) victimization have been linked to greater posttraumatic stress disorder (PTSD) symptom severity. However, research has not identified factors that may explain this association. The goal of the current study was to extend research in this area by elucidating the potential mediating role of avoidant coping in the relations among negative and positive social reactions to IPV disclosure and PTSD symptom severity. Participants were 173 community women currently experiencing IPV who disclosed their victimization to another individual (M age = 36.31, 65.9% African American). Findings revealed that IPV-victimized women who experienced greater negative social reactions to IPV endorsed higher levels of avoidant coping and greater PTSD symptom severity. Moreover, avoidant coping was found to mediate the negative social reactions-PTSD symptom severity association. Results highlight the relevance of avoidant coping to the link between negative social reactions to IPV disclosure and PTSD symptom severity, and suggest that prevention and intervention efforts targeting avoidant coping may be useful in reducing PTSD symptom severity among IPV-exposed women who experience negative social reactions to IPV disclosure.

Dyadic Profiles of Posttraumatic Stress Symptoms in Mothers and Children Experiencing Intimate Partner Violence

Children who witness intimate partner violence (IPV) develop posttraumatic stress disorder at alarmingly high rates. Research suggests that caregivers' symptoms of posttraumatic stress (PTSS) often co-occur alongside children's PTSS, a phenomenon termed "relational posttraumatic stress." The goal of this study is to use dyad-centered analyses to examine heterogeneity in relational PTSS presentations in mother-child dyads, and to determine factors differentiating relational PTSS profiles. Data were drawn from a sample of 231 IPV-exposed, ethno-racially diverse mother-child dyads, with children ranging from ages 4 to 12. The results of a latent profile analysis indicated that a two-profile model was the best fit with the data. Both profiles indicated similar levels of PTSS across the dyad; however, they differed in overall symptom severity. Parenting and IPV severity significantly predicted profile membership; however, age did not. Results suggest that similarities in PTSS presentation should be expected in mother-child dyads, at least in families who experience IPV.

Traumas and Their Consequences According to Control-Mastery Theory

The aim of this article is to introduce the reader to how control-mastery theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993), an integrative relational cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapeutic process, understands traumas, their consequences, and their mastery. In the first part of this article, we will present an overview of the debate about the definition of trauma within the different editions of the Diagnostic and Statistical Manual of Mental Disorders. Then, we will focus on the concept of complex traumas and on their consequences on mental health. Finally, we will discuss how CMT conceptualizes traumas and their pathological consequences. We will stress in particular how, according to CMT, in order for a painful experience to become a trauma, its victim has to come to believe that s/he caused it in the attempt to pursue a healthy and adaptive goal. In order to master traumas and disprove the pathogenic beliefs developed from them, people attempt to reexperience situations similar to the traumatic ones in safer conditions while giving them happier endings.

Extending our understanding of the association between posttraumatic stress disorder and positive emotion dysregulation: A network analysis approach

Posttraumatic stress disorder (PTSD) has empirically-established associations with positive emotion dysregulation. Extending existing research, we utilized a network approach to examine relations between PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity [AAR]) and positive emotion dysregulation dimensions (nonacceptance, impulse control, goal-directed behavior). We identified (1) differential relations of PTSD symptom clusters with positive emotion dysregulation, and (2) central symptoms accounting for the PTSD and positive emotion dysregulation inter-group interconnections. Participants were 371 trauma-exposed community individuals (M_age = 43.68; 70.9 % females; 34.5 % white). We estimated a regularized Gaussian Graphic Model comprising four nodes representing the PTSD symptom clusters and three nodes representing positive emotion dysregulation dimensions. Study results indicated the key role of AAR and intrusions clusters in the PTSD group and impulse control difficulties in the positive emotion dysregulation group. Regarding cross-group connectivity patterns, findings indicate the pivotal role of (1) AAR in its link with positive emotion dysregulation dimensions, and (2) nonacceptance of positive emotions and impairment in goal-directed behavior in the context of positive emotions in their link to PTSD symptom clusters. Thus, the current study indicates the potentially central role of particular PTSD symptom clusters and positive emotion dysregulation dimensions, informing assessment and treatment targets.

Acute mental health symptoms among individuals receiving a sexual assault medical forensic exam: the role of previous intimate partner violence victimization

Sexual assault and intimate partner violence (IPV) are common in the USA, and they often co-occur. Individuals with multiple victimization experiences have more severe mental health outcomes compared to those with one victimization. The current study examined mental health symptoms and their association with IPV victimization history among a sample of individuals who experienced a recent sexual assault and received a sexual assault medical forensic examination. A total of 82 participants (92.70% female) completed a post-sexual assault survey as part of clinical care to coordinate follow-up services. IPV history and prior sexual assault were assessed as well as mental health symptoms including acute stress and depressive symptoms. It was found that individuals with an IPV history reported more acute stress and depressive symptoms compared to those without an IPV history. No differences were found based on prior sexual assault history. These findings highlight the importance of screening for IPV history during the sexual assault medical forensic examination to coordinate care.

Post-traumatic stress disorder symptom severity attenuates bi-directional associations between negative affect and avoidant coping: A daily diary study

INTRODUCTION

Avoidant coping plays an important role in the maintenance of post-traumatic stress disorder (PTSD). However, existing investigations have been limited in their assessment of coping as a static process - despite evidence that the coping strategies individuals use to manage stressors vary across time and contexts. Further, research has relied on cross-sectional designs, precluding determination of the directionality of the negative affect-avoidant coping association. The current study addresses these limitations by using a daily diary method to examine the moderating role of PTSD symptom severity on reciprocal relations between negative affect and avoidant coping.

METHODS

Participants were 1,188 trauma-exposed adults (M age = 19.2, 56% female, 79% White) who provided daily diary data for 30 days via online surveys. Multi-level models were tested to evaluate the moderating role of PTSD symptom severity in the daily relations between negative affect and avoidant coping during the 30-day period.

RESULTS

Levels of daytime negative affect were assoicated with use of evening avoidant coping. Use of evening avoidant coping were associated with levels of next-day daytime negative affect. PTSD symptom severity moderated these relations. For individuals with more (vs. less) severe PTSD symptoms, the association of negative affect to avoidant coping was weaker and the association of avoidant coping to negative affect was stronger.

LIMITATIONS

Findings must be interpreted in light of limitations, including self-report measures and assessment of a alcohol using sample of college students.

DISCUSSION

These findings advance our understanding of the negative affect-avoidant coping association among trauma-exposed individuals.

The role of gender in the associations among posttraumatic stress disorder symptom, severity, difficulties regulating emotions, and alcohol misuse

INTRODUCTION

The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol misuse is highly prevalent and clinically significant. Delineating mediators (i.e., emotion regulation) and moderators (i.e., gender) of this co-occurrence is critical to understanding underlying mechanisms of such comorbidity and intervention development/refinement.

METHOD

The present study examined the potential mediating role of difficulties regulating negative and positive emotions in this association as well as the moderating role of gender using a moderated mediation analysis. Participants were 475 trauma-exposed community adults recruited from Amazon's Mechanical Turk (MTurk) platform (M_age = 35.62, 55.4% women, 77.0% White).

RESULTS

Difficulties regulating positive (but not negative) emotions significantly mediated the relation between PTSD symptom severity and alcohol misuse. Further, gender was found to significantly moderate each of the paths in this mediation model.

CONCLUSIONS

Results highlight gender-specific intervention targets for reducing alcohol misuse among trauma-exposed individuals who experience PTSD symptoms.

Fluctuations in daily PTSD symptoms are related to proximal alcohol use: a micro-longitudinal study of women victims of intimate partner violence

Background: One-third of women who experience intimate partner violence (IPV) are identified as having alcohol use problems. Yet, little research has examined factors that may increase the risk of alcohol use among this high-risk population. Objectives: This study overcomes limitations of previous research by using micro-longitudinal methods to examine how fluctuations in PTSD symptoms throughout the day are associated with proximal drinking behavior and whether these associations are related to individuals' overall PTSD severity and race/ethnicity. Methods: Using phone-based interactive voice response, 244 female victims of current IPV reported their PTSD symptoms and drinking four times daily for 14 days. Results: Results indicated positive associations between PTSD symptom cluster severity and drinking level at the person, daily and within-day levels. The effects of within-person fluctuations in daily levels of PTSD severity on levels of drinking were stronger for individuals with lower PTSD severity. No evidence was found for within-person differences on time-lagged effects of PTSD on drinking or by racial/ethnic group. Further, in time-lagged models no evidence was found for reverse causation whereby alcohol use predicts increased PTSD symptom severity. Conclusions: Findings suggest that IPV-exposed women use alcohol to alleviate their PTSD symptoms at the micro-process level and that prevention and treatment efforts targeting PTSD symptoms may be useful in reducing alcohol use in this population. Further, these efforts should consider the overall severity of PTSD symptoms experienced given the differential findings among women with higher vs. lower PTSD symptom severity.

Emotion dysregulation and posttraumatic stress disorder: a test of the incremental role of difficulties regulating positive emotions

Background and Objectives: Literature provides support for the role of emotion dysregulation in the development and course of posttraumatic stress disorder (PTSD) among women victims of intimate partner violence (IPV). However, a dearth of studies have examined the contribution of emotion dysregulation stemming from positive emotions to PTSD. Extending research, the current study examined (1) the bivariate association of difficulties regulating positive emotions to PTSD symptom severity, and (2) the incremental role of difficulties regulating positive emotions in PTSD symptom severity beyond difficulties regulating negative emotions. Design: Participants were 210 women victims of IPV involved in the criminal justice system because of their partners' arrest (M age = 36.14, 48.6% African American). Methods: Participants completed empirically-supported self-report measures assessing difficulties regulating positive and negative emotions and PTSD symptom severity. Results: Difficulties regulating positive and negative emotions (overall and across each of the specific dimensions) were significantly positively associated with PTSD symptom severity. Moreover, difficulties regulating positive emotions demonstrated an incremental relation to PTSD symptom severity beyond the variance accounted for by difficulties regulating negative emotions. Conclusions: Our findings suggest the potential utility of targeting difficulties regulating positive emotions in interventions for PTSD among women victims of IPV.

Correlates of Perinatal Post-Traumatic Stress among Culturally Diverse Women with Depressive Symptomatology

Post-traumatic stress disorder (PTSD) is an important and often neglected comorbidity of pregnancy; left untreated, it can lead to serious health complications for the mother and developing fetus. Structured interviews were conducted to identify risk factors of PTSD among culturally diverse women with depressive symptomatology receiving perinatal services at community obstetric/gynecologic clinics. Women abused as adults, with two or more instances of trauma, greater trauma severity, insomnia, and low social support were more likely to present perinatal PTSD symptoms. Perinatal PTSD is prevalent and has the potential for chronicity. It is imperative healthcare providers recognize salient risk factors and integrate culturally sensitive screening, appropriate referral, and treatment services for perinatal PTSD.

Injury and Psychiatric Disorder in Low-Income Women Experiencing Bidirectional Intimate Partner Violence

This study compared severity of physical violence, intimate partner violence (IPV)-related injury, and lifetime diagnoses of psychiatric disorders among women in relationships with bidirectional, unidirectional, or no IPV. The sample includes 763 low-income women from community-based family planning clinics. Results showed that women in relationships with bidirectional IPV were more likely to experience severe physical violence and severe IPV-related injury compared to women in the unidirectional IPV category. These women were also more likely to be diagnosed with drug abuse and depression than women in relationships without IPV. Similarly, women in the bidirectional IPV category were more likely to be diagnosed with drug abuse when compared to women in the victim-only unidirectional IPV category. Recommendations for health-care providers are discussed.

Similarity in symptom patterns of posttraumatic stress among disaster-survivors: a three-step latent profile analysis

Background: Individuals express symptoms of posttraumatic stress in various ways, noted for example in the many symptom combinations in the diagnostic manuals. Studies aiming to examine differences of symptom presentations by extracting latent classes or profiles indicate both the presence of subtypes with differing symptomatology and subtypes distinguished by severity levels. Few studies have examined subtype associations with long-term outcomes. Objective: The current study aimed to apply latent profile analysis on posttraumatic stress (PTS) in a highly homogenous sample of Swedish tourists exposed to the 2004 Southeast Asia tsunami and to examine if classes differed in their long-term outcome. Methods: An latent profile analysis was conducted using self-report data collected one year after the disaster from 1638 highly exposed survivors that endorsed ≥ 1 symptom of PTS. Associations were examined between the classes and predictors of PTS (loss of a relative or friend, subjective life threat) and levels of PTS at a three-year follow up. Results: The latent profile analysis indicated four classes: minimal, low, moderate, and severe symptoms. The classes were distinguished mainly by their levels of PTS. Loss of a relative or friend and subjective life threat were associated with a higher likelihood of belonging to any other class than the minimal class. The severity level of the classes at one year were predictive of PTS severity at the three-year follow-up. Conclusions: Homogeneous profiles of posttraumatic stress differing mainly in symptom severity were found in this sample of disaster survivors. Profile diversity may be related to sample variation and unmeasured confounders rather than reflect qualitatively different disorders.

Strategies for coping with individual PTSD symptoms: Experiences of African American victims of intimate partner violence

OBJECTIVE

Understanding how populations at particular risk for posttraumatic stress disorder (PTSD) and its deleterious outcomes cope with individual PTSD symptoms is critical to developing interventions that promote resilience, support recovery, and ultimately empower traumatized populations. Therefore, the purpose of this study was to identify specific strategies women use to cope with individual PTSD symptoms among a population at particular risk for experiencing trauma and its negative sequelae-African American victims of intimate partner violence (IPV) who use substances.

METHOD

This 30-day study included 107 African American women who reported experiencing current IPV and using a substance. During their follow-up interviews, women participated in a structured interview to retrospectively report on the strategies they typically used to cope with various PTSD symptoms during the 30-day period.

RESULTS

Results of content analysis revealed that women used 19 different strategies to cope with symptoms (e.g., social support, substance use, electronic media, religious or spiritual coping), which varied as a function of the PTSD symptom experienced. Aggregating symptoms to the cluster level obscured the variability in strategies used to cope with individual symptoms.

CONCLUSIONS

Findings are discussed in the context of the larger literature on coping and PTSD, specifically regarding (a) coping strategies that may be adaptive or maladaptive and (b) directions for future research that attend to experiences of individual PTSD symptoms. (PsycINFO Database Record

Current Reports on Perinatal Intimate Partner Violence

PURPOSE OF REVIEW

The purpose of this study was to review the literature on perinatal intimate partner violence, focusing on recent knowledge to guide mental health professionals on the best approaches to identify and treat women exposed to perinatal intimate partner violence.

RECENT FINDINGS

Risk factors have been broadened from individual victim and perpetrator factors to include relationship, community, and societal factors which interact together. Better information is now available on how to identify, document, and treat women exposed to violence around the time of conception, pregnancy, and the postpartum period. Recent information helps psychiatrists and other mental health professionals assist women exposed to violence related to the perinatal period; however, further research is needed to provide improved evidence for optimal interventions for better patient outcomes.

Racial/ethnic differences moderate associations of coping strategies and posttraumatic stress disorder symptom clusters among women experiencing partner violence: a multigroup path analysis

BACKGROUND

Past research underscores the key role of coping strategies in the development, maintenance, and exacerbation of posttraumatic stress disorder (PTSD) symptoms. The goal of the current study was to extend existing literature by examining whether race/ethnicity moderates the relations among coping strategies (social support, problem-solving, avoidance) and PTSD symptom clusters (intrusion, avoidance, numbing, arousal).

METHODS

Participants were 369 community women (134 African Americans, 131 Latinas, 104 Whites) who reported bidirectional aggression with a current male partner. Multigroup path analysis was utilized to test the moderating role of race/ethnicity in a model linking coping strategies to PTSD symptom clusters.

RESULTS

The strength and direction of relations among coping strategies and PTSD symptom clusters varied as a function of race/ethnicity. Greater social support coping was related to more arousal symptoms for Latinas and Whites. Greater problem-solving coping was related to fewer arousal symptoms for Latinas. Greater avoidance coping was related to more symptoms across many of the PTSD clusters for African Americans, Latinas, and Whites, however, these relations were strongest for African Americans.

CONCLUSION

Results provide support for the moderating role of race/ethnicity in the relations among coping strategies and PTSD symptom clusters, and highlight potential targets for culturally informed PTSD treatments.

Comparing the effect of DSM-congruent traumas vs. DSM-incongruent stressors on PTSD symptoms: A meta-analytic review

Experts have long debated how to define the PTSD traumatic stressor criterion. Prior research demonstrates that PTSD symptoms (PTSS) sometimes stem from events that do not meet the DSM requirements for Criterion A (e.g., divorce, bereavement, illness). This meta-analysis of 22 studies examined whether PTSS differ for DSM-congruent criterion A1 traumatic events vs. DSM-incongruent events. The overall effect was significant, albeit small, suggesting that PTSS were greater for individuals who experienced a DSM-congruent event; heterogeneity analyses also indicated further exploration. Two significant moderators emerged: assessment of both A1 and A2 (vs. A1 alone) yielded a significant effect for higher PTSS following traumas vs. stressors. Likewise, self-report assessment of life threat (Criterion A1)-vs. rater or a priori assessment of A1-yielded a significant effect for higher PTSS following traumas. Our results indicate that higher levels of PTSS develop following traumas, and highlight important methodological moderators that may affect this relationship.

Patterns of DSM-5 posttraumatic stress disorder and depression symptoms in an epidemiological sample of Chinese earthquake survivors: A latent profile analysis

BACKGROUND

Posttraumatic stress disorder (PTSD) and depression are highly comorbid in association with serious clinical consequences. Nevertheless, to date, no study using latent class or latent profile analysis (LCA/LPA) has examined patterns of co-occurring PTSD and depression symptoms among natural disaster survivors, nor has the distinctiveness of DSM-5 PTSD and depression symptoms been clarified in the aftermath of trauma. This study was primarily aimed at filling these gaps.

METHODS

LPA was used to examine self-reported PTSD and depression symptoms in an epidemiological sample of 1196 Chinese earthquake survivors.

RESULTS

A 4-class solution characterized by low symptoms (53.9%), predominantly depression (18.2%), predominantly PTSD (18.9%) and combined PTSD-depression (9.0%) patterns fit the data best. Demographic characteristics and earthquake-related exposures were specifically or consistently associated with the non-parallel profiles varying in physical health impairment.

LIMITATIONS

A sample exposed to specific traumatic events was assessed by self-report measures.

CONCLUSIONS

The distinctiveness of DSM-5 PTSD and depression symptoms following an earthquake suggests that PTSD and depression may be independent sequelae of psychological trauma rather than a manifestation of a single form of psychopathology. The current findings support the distinction between PTSD and depression constructs, and highlight the need for identifications of natural disaster survivors at high risk for PTSD and/or depression, and interventions individually tailored to one's symptom presentations.

Latent profiles of PTSD symptoms in women exposed to intimate partner violence

BACKGROUND

Studies have utilized latent class analysis (LCA) and latent profile analysis (LPA) to examine posttraumatic stress disorder (PTSD) symptom profiles in a range of populations. Further study is needed to explore symptom profiles among women exposed to intimate partner violence (IPV). The current study examined latent symptom profiles in a sample of IPV-exposed women, and explored trauma-related cognitive appraisals associated with these PTSD symptom presentations.

METHODS

An LPA was conducted using cross-sectional data from a non-treatment seeking community sample of women recruited following a police-reported incident of IPV by a male perpetrator (N=229). Multinomial regression analyses determined associations between latent profile membership and trauma-related appraisals.

RESULTS

The LPA identified five PTSD symptom profiles: Low Symptom (46% of the sample); Low Symptom with High Hypervigilance (17%); Intermediate Symptom (16%); Intermediate Symptom with High Hypervigilance (11%); and High Symptom (10%). Trauma-related appraisals, including fear, alienation, and self-blame, were the strongest independent predictors of PTSD symptom profile membership.

LIMITATIONS

The study focused on female victims of IPV by a male partner, and findings may not generalize to other gender configurations (e.g. same-sex couples, male victims, etc.). The LPA is cross-sectional, and the stability of these profiles over time warrants further study.

CONCLUSIONS

These findings suggest the need for careful consideration of differences among IPV-exposed women within the larger context of PTSD research and clinical intervention. Identifying latent subgroups may provide an empirical basis for practitioners to design and implement PTSD intervention efforts that are tailored to specific symptom profiles.

Intimate partner violence during pregnancy: maternal and neonatal outcomes

The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health.