Examination of polytrauma typologies: A latent class analysis approach

Moving beyond vulnerability and focusing on resilience: An intersectional posttraumatic growth model for LGBTQ+ people of color

In the context of the legacy of deficit-focused research and application of theoretical models in research on minoritized groups that are underrepresented in the literature, we explored the strengths-based literature among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people of color to develop a more inclusive and relevant understanding of how posttraumatic growth (PTG) occurs in this population. Our intersectional PTG model is tailored to the experiences of LGBTQ+ people of color that builds upon previous models of PTG, intersectionality theory, and empirical findings of trauma and PTG among LGBTQ+ people of color. Our intersectional PTG model incorporates the unique intrapersonal, interpersonal, institutional, and cultural factors that are unique to this population and contribute to PTG. We challenge the limited scope of Criterion A traumatic events and emphasize empirical findings that support that LGBTQ+ people of color often experience posttraumatic stress after oppression and discrimination. Our model also recognizes the impact of intersecting risk factors, such as gendered racism, that may occur on various levels. Our model acknowledges that LGBTQ+ people of color have often demonstrated PTG in the face of adversity. Intrapersonal factors such as cognitive flexibility, interpersonal factors such as social support, and institutional and cultural factors such as identity-related activism are identified as key contributors to resilience. We discuss practice implications, highlighting that clinicians should recognize limitations of traditional trauma frameworks and adopt culturally sensitive approaches when working with LGBTQ+ people of color. Overall, our model provides a foundation for strengths-based interventions and research, emphasizing resiliency and potential for PTG in this population.

The neuropsychological presentation of women with epilepsy: Clinical considerations and future directions

Objective: Cognitive, mood, and behavioral changes are common among persons with epilepsy (PWE), resulting in a complex neuropsychological presentation. Women with epilepsy (WWE) represent a distinct cohort within the broader epilepsy population due to sex and gender-specific factors impacting epilepsy semiology and treatment. However, unique neuropsychological profiles among WWE have not been established. This narrative review aims to further define neuropsychological correlates in WWE and promote meaningful discussion related to enhancing the provision of neuropsychological care within this clinical population. Method: Current literature in PWE examining differences in cognitive function, mental health, and quality of life (QoL) between women and men was critically reviewed, emphasizing considerations for neuropsychological practice. Results: WWE demonstrate a preservation of verbal learning and memory compared to men both pre- and post-surgically, with sex-based, neurobiological mechanisms likely contributing to this association. WWE also have elevated risk for affective disorder psychopathology, suicidality, and traumatic experiences. Epidemiology related to psychotic and bipolar spectrum disorders is less clear, and findings are mixed regarding sex-specific behavioral side effects of antiseizure and psychotropic medication. Finally, hormonal and obstetric factors are highlighted as important contributors to neuropsychological symptoms in WWE, with elevated risk for low QoL and increased stigma associated with greater medical and psychiatric comorbidities compared to men. Conclusions: While emerging literature has begun to characterize the neuropsychological presentation of WWE, future research is needed to define sex and gender differences in neuropsychological sequalae among PWE to ensure consistency and quality of care for WWE.

The relationship between patterns of negative life experiences and clinical presentation in a psychiatric sample

BACKGROUND

Attempts have been made to classify the patterns of polytraumatization using a person-centered approach. However, most studies have only focused on maltreatment and interpersonal trauma and have been unable to examine various clinical symptoms.

OBJECTIVES

This study aimed to explore patterns of negative life experiences, including maltreatment, lifetime trauma, and recent stressful life events, and compare diverse dimensions of the clinical manifestations among the subtypes in a clinical sample.

METHOD

We investigated childhood maltreatment, lifetime trauma, and recent stressful events using a self-report method in 1410 psychiatric patients; we classified the patterns of lifelong negative life experiences using latent profile analysis (LPA). We used the rates of psychiatric diagnosis, the Beck Depression Inventory, the Impact of Event Scale-Revised (IES-R-K), and the Multiphasic Minnesota Personality Inventory-2-Restructured Form to compare various symptom dimensions among the derived subtypes.

RESULTS

LPA indicated a four-class solution: mild, recent stress, maltreatment, and multiple adversity group. The multiple adversity group experiencing both lifetime trauma and recent stressful life events, in addition to maltreatment, including sexual abuse, had a high rate of severe mental illness and more symptom dimensions of thought and behavior problems. However, the rates of depressive disorders and emotional/internalizing symptoms were not more than those in the other two groups (recent stress and maltreatment groups) experiencing moderate levels of lifetime trauma. There was no significant difference between the recent stress and maltreatment groups for most symptom dimensions.

CONCLUSIONS

The findings indicate that distinct symptom profiles may be associated with the pattern of negative experiences, suggesting that negative experiences need multidimensional investigation in clinical settings.

Trauma Matters: Integrating Genetic and Environmental Components of PTSD

Trauma is ubiquitous, but only a subset of those who experience trauma will develop posttraumatic stress disorder (PTSD). In this review, it is argued that to determine who is at risk of developing PTSD, it is critical to examine the genetic etiology of the disorder and individual trauma profiles of those who are susceptible. First, the state of current PTSD genetic research is described, with a particular focus on studies that present evidence for trauma type specificity, or for differential genetic etiology according to gender or race. Next, approaches that leverage non-traditional phenotyping approaches are reviewed to identify PTSD-associated variants and biology, and the relative advantages and limitations inherent in these studies are reflected on. Finally, it is discussed how trauma might influence the heritability of PTSD, through type, risk factors, genetics, and associations with PTSD symptomology.

Heterogeneity In Women's Trauma Histories: Impact On Substance Use Disorder Severity

Trauma and substance use disorders (SUDs) frequently co-occur, especially in women. Previous studies have attempted to determine if individual differences in trauma histories could be meaningfully categorized but few studies have focused solely on women, especially those reporting substance use problems. A total of 130 women (M age = 30.7, SD = 7.9) self reporting past-year substance use problems completed comprehensive measures assessing lifetime exposure to a variety of traumatic events as well as substance use patterns and severity. Using latent class analysis, three classes emerged, a Low Lifetime Interpersonal Trauma class (40%, n = 52), a Moderate Lifetime Interpersonal Trauma class (23.8%, n = 31) and a High Lifetime Interpersonal Trauma class (36.2%, n = 47). Groups did not vary on daily/almost daily use of different types of substances and polysubstance use frequency but were significantly different on SUD severity, with the Moderate and the High Lifetime Interpersonal Trauma classes reporting severe SUD severity in comparison to moderate severity for the Low Interpersonal Trauma class. The findings of the current study indicate that women experiencing substance use problems should receive SUD treatment in a trauma-informed manner but that not all may require integrated trauma and substance use interventions.

What can we learn about polytrauma typologies by comparing population-representative to trauma-exposed samples: A Nepali example

BACKGROUND

Potentially traumatic events (PTEs) are common and associated with detrimental outcomes over the life-course. Previous studies exploring the causes and consequences of PTE-exposure profiles are often from high-income settings and fail to explore the implications of sample selection (i.e., population-representative versus PTE-restricted).

METHODS

Among individuals in the Nepal Chitwan Valley Family Study, latent class analyses (LCA) were performed on 11 self-reported PTEs collected by the Nepali version of the World Mental Health Consortium's Composite International Diagnostic Interview 3.0 from 2016 to 2018, in a population-representative sample (N = 10,714), including a PTE-restricted subsample (N = 9183). Multinomial logistic regressions explored relationships between sociodemographic factors and class membership. Logistic regressions assessed relationships between class membership and psychiatric outcomes.

RESULTS

On average, individuals were exposed to 2 PTEs in their lifetime. A five-class solution showed optimal fit for both samples; however, specific classes were distinct. No single sociodemographic factor was universally associated with PTE class membership in the population-representative sample; while several factors (e.g., age, age at incident PTE, education, marital status, and migration) were consistently associated with class membership in the PTE-subsample. PTE class membership differentiated psychiatric outcomes in the population-representative sample more than the PTE-subsample.

LIMITATIONS

Primary limitations are related to the generalizability to high-income settings, debate on LCA model fit statistic usage for final class selection, and cross-sectional nature of data collection.

CONCLUSIONS

Although population-representative samples provide information applicable to large-scale, population-based programming and policy, PTE-subsample analyses may provide additional nuance in PTE profiles and their consequences, important for specialized prevention efforts.

Critical considerations for the positive memory-posttraumatic stress disorder model

Posttraumatic stress disorder (PTSD) includes changes in processes such as encoding and retrieval for both traumatic and positive memories. However, most work has predominantly focused on traumatic memories. Thus, Contractor and colleagues proposed a Positive Memory-PTSD model, which highlighted potential benefits associated with and mechanisms underlying positive memory retrieval/processing among individuals reporting PTSD symptoms. To enhance research on and clinical impacts of this model, the current review provides critical considerations for the Positive Memory-PTSD model. Drawing from emerging research and clinical observations, we (i) clarify that the model addresses specific versus overgeneral positive memories; (ii) underscore the importance of considering the heterogeneity in, and transitionary nature of, affect processes following positive memory retrieval; and (iii) highlight the rationale for considering trauma type/count and co-occurring conditions, as potential moderators of relations between positive memory processing and PTSD. Hereby, we provide an updated Positive Memory-PTSD model and implications for positive memory interventions drawing from this model.

Post-traumatic stress disorder's relation with positive and negative emotional avoidance: The moderating role of gender

Post-traumatic stress disorder (PTSD) is characterized by avoidance of trauma-related emotions. Research indicates that this avoidance may extend to any emotional experience that elicits distress, including those that are unrelated to the trauma. Literature in this area has been limited in its exclusive focus on negative emotions. Despite evidence of gender differences in PTSD and emotional avoidance separately, no studies to date have examined gender as a moderator of their association. The goal of the current study was to extend research by exploring the moderating role of gender in the relation between PTSD symptom severity and positive and negative emotional avoidance. Participants were 276 trauma-exposed individuals (65.9% female, 65.6% White, M_age = 19.24) from a university in the north-eastern United States. Moderation results indicated a main effect for PTSD symptom severity on both positive (b = 0.07, p < .001) and negative (b = 0.04, p = .03) emotional avoidance. The interaction of gender and PTSD symptom severity was significant for positive emotion avoidance (b = 0.97, p = .01). Analysis of simple slopes revealed that PTSD symptom severity was significantly associated with positive emotional avoidance for males (b = 0.13, p < .001) but not females (b = 0.03, p = .08). Results suggest the importance of gender-sensitive recommendations for assessment and treatment of emotional avoidance in PTSD.

Chromosomes to Social Contexts: Sex and Gender Differences in PTSD

PURPOSE OF REVIEW

This review highlights recent research on sex- and gender-related factors in the prevalence, symptom expression, and treatment of PTSD. Further discoveries about the underlying mechanisms of sex and gender effects have the potential to shape innovative directions for research.

RECENT FINDINGS

The prevalence of PTSD is substantially higher among women, but women show a modest advantage with respect to treatment response. There is evidence of greater heritability among females. Women are more likely to experience sexual and intimate violence, childhood trauma exposure, and repeated trauma exposures. Specific characteristics of social contexts act as gender-linked risks for PTSD. Among individuals diagnosed with PTSD, men and women are similar in phenotypic expression. Though research has yet to fully account for the factors that explain sex- and gender- related effects on PTSD, emerging research suggests these effects occur across multiple levels. Shared risk factors for trauma exposure and PTSD merit further investigation. Both social and biological contexts merit investigation to understand sex-linked differences in heritability.

PTSD's factor structure and measurement invariance across subgroups with differing count of trauma types

To investigate the effect of the count of traumatizing event (TE) types on post-trauma mental health, several studies have compared posttraumatic stress disorder (PTSD) severity between individuals experiencing one versus multiple TE types. However, the validity of these studies depends on the establishment of measurement invariance of the construct(s) of interest. The current study examined the stability of the most optimal PTSD Model symptom cluster constructs (assessed by the PTSD Checklist for DSM-5 [PCL-5]) across subgroups experiencing one versus multiple TE types. The sample included university students (n = 556) endorsing at least one TE (Stressful Life Events Screening Questionnaire). Using data from the entire sample, results suggest that the PCL-5-assessed Hybrid Model provided a significantly better fit compared to other models. Results also indicated invariance of factor loadings (metric), and intercepts (scalar) for the PCL-5-assessed Hybrid Model factors across subgroups endorsing one (n = 191) versus multiple TE types (n = 365). Our findings thus support the stability, applicability, and meaningful comparison of the PCL-assessed Hybrid Model factor structure (including subscale severity scores) across subgroups experiencing one versus multiple TE types.

Trauma exposure and heavy drinking and drug use among college students: Identifying the roles of negative and positive affect lability in a daily diary study

Trauma exposure is linked to heavy drinking and drug use among college students. Extant research reveals positive associations between negative affect lability and both trauma exposure and alcohol use. This study aimed to extend past research by using daily diary methods to test whether (a) individuals with (versus without) trauma exposure experience greater negative and positive affect lability, (b) negative and positive affect lability are associated with heavy drinking and drug use, and (c) negative and positive affect lability mediate the relations between trauma exposure and heavy drinking and drug use. Participants were 1640 college students (M age=19.2, 54% female, 80% European American) who provided daily diary data for 30days via online surveys. Daily diaries assessed negative and positive affect and substance use (i.e., percent days of heavy drinking, percent days of drug use, total number of drugs used). Individuals with (versus without) a history of trauma exposure demonstrated higher levels of negative and positive affect lability. Negative, but not positive, affect lability was associated with percent days of heavy drinking, percent days of drug use, and total number of drugs used, and mediated the associations between trauma exposure and heavy drinking and drug use outcomes. Findings provide support for the underlying role of negative affect lability in the relations between trauma exposure and heavy drinking and drug use among college students, suggesting that treatments targeting negative affect lability may potentially serve to reduce heavy drinking and drug use among trauma-exposed college students.

Relation between lifespan polytrauma typologies and post-trauma mental health

BACKGROUND

Most individuals experience more than one trauma. Hence, it is important to consider the count and types of traumas (polytraumatization) in relation to post-trauma mental health.

METHOD

The current study examined the relation of polytraumatization patterns to PTSD clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], and alterations in arousal and reactivity [AAR]), depression, and impulsivity facets (lack of perseverance, lack of premeditation, negative urgency, sensation seeking) using a web-based sample of 346 participants. Age, gender, race, and ethnicity were covariates.

RESULTS

Results of latent class analyses indicated a three-class solution: Low Experience, Moderate Experience - Predominent Threat/Indirect PTEs (Moderate Experience), and High Experience - Predominant Interpersonal PTEs (High/Interpersonal). Multinomial logistic regression results indicated that ethnicity and gender were significant covariates in predicting Low versus High/Interpersonal Class, and Moderate Experience versus High/Interpersonal Class membership, respectively. The High/Interpersonal Class had higher scores on most PTSD clusters, depression, and the impulsivity facets of lack of perseverance and negative urgency compared to the other classes. The Low and Moderate Experience Classes differed on PTSD's avoidance and AAR clusters (lower in the former).

CONCLUSIONS

Individuals exposed to multiple PTE types, particularly interpersonal traumas, may be at risk for more severe post-trauma symptoms.

Should Posttraumatic Stress Be a Disorder or a Specifier? Towards Improved Nosology Within the DSM Categorical Classification System

PURPOSE OF REVIEW

Since 1980, posttraumatic stress (PTS) disorder has been controversial because of its origin as a social construct, its discriminating trauma definition, and the Procrustean array of symptoms/clusters chosen for inclusion/exclusion. This review summarizes the history of trauma-related nosology and proposed changes, within current categorical models (trauma definitions, symptoms/clusters, subtypes/specifiers, disorders) and new models.

RECENT FINDINGS

Considering that trauma is a risk factor for virtually all mental disorders (particularly depressive, anxiety, dissociative, personality), the multi-finality of trauma (some survivors are resilient, and some develop PTS and/or non-PTS symptoms), and the various symptoms that trauma survivors express (mood, cognitive, perceptual, somatic), it is difficult to classify PTS. Because the human mind best comprehends categories, reliable classification generally necessitates using a categorical nosology but PTS defies categories (internalizing and/or externalizing, fear-based and/or numbing symptoms), the authors conclude that PTS-like DSM-5's panic attacks specifier-is currently best conceptualized as a specifier for other mental disorders.