Is Rape-Related Self Blame Distinct From Other Post Traumatic Attributions of Blame? A Comparison of Severity and Implications for Treatment

The Reality of Tonic Immobility in Victims of Sexual Violence: "I was Paralyzed, I Couldn't Move"

Tonic immobility (TI) is a state of temporary, involuntary motor inhibition that occurs in states of intense fear and has been studied among victims of sexual violence. Studies on TI are scarce and mainly focus on rape victims. The present study is a literature review of research that has examined TI in women victims of sexual violence. A database search was carried out using the Preferred data elements for systematic reviews and meta-analyses (PRISMA) method. In order to be included in the analysis, the manuscripts had to deal exclusively with research involving samples of subjects and the study analyzed TI in victims of sexual violence. In all, 11 manuscripts met the above criteria and were included in the review. Research describes that TI is characterized by two factors: fear and immobility. Quantitative research was conclusive in affirming the presence of a state of paralysis and fear in TI. The immobility factor is the determining factor in explaining the victim's lack of defense or resistance and causes effects such as trembling, physical and mental paralysis, inability to vocalize, and eye closure. In addition, TI has been correlated with long-term negative clinical manifestations as victims are more likely to suffer from post-traumatic stress disorder. These findings contribute to an understanding of TI in victims of sexual violence. Therefore, legal and care practitioners must be able to recognize TI to understand the victim's behavior, differentiate it from consent, and to be able to assist in their recovery.

Women Higher Education Students' Experiences of Sexual Violence: A Scoping Review and Thematic Synthesis of Qualitative Studies

Sexual violence (SV) against women is common in higher education settings, causing serious harm to the health, well-being, and academic outcomes of victim/survivors. There have been numerous systematic reviews of the quantitative evidence on this topic, highlighting the prevalence, health impacts, and barriers and facilitators to help-seeking after SV. To date, however, qualitative research exploring the lived experience of women higher education students has not been synthesized. This scoping review and thematic synthesis of qualitative studies aims to map the global evidence on women higher education students' experiences of SV and explore how they understand and make sense of their experiences. We searched five databases (CinAHL, Academic Search Complete, Medline, PsychInfo, and SocIndex) in January 2023 for relevant articles. Eligible articles needed to be published in English and describe qualitative or mixed-methods primary research on the lived experiences of women higher education students who were victim/survivors of SV. In all, 34 articles describing 32 studies met these inclusion criteria. Thematic analysis of data extracted from the included studies suggests that, for women higher education students, the experience of SV is characterized by profound shame, with often-irreversible impacts on hopes and plans for the future. Yet, at the same time, SV is normalized and expected as a part of the "student experience." Furthermore, an imagined "specter" of "real violence" is held up as a constant comparison that serves to minimize and trivialize their experiences. These findings have important implications for higher education providers seeking to improve programs to address SV.

The impact of exposure to physical and sexual violence on opioid consequences among trauma-exposed individuals recruited from the community who use opioids

Interpersonal violence and opioid use disorder are significant and intersecting public health concerns in the USA. The current study evaluated the consequences associated with opioid use (e.g., physical, social, interpersonal, intrapersonal, and impulse control) as a function of a history of exposure to interpersonal trauma, specifically physical and sexual violence. Participants were 84 trauma-exposed individuals recruited from the community who use opioids (M age = 43.5 50% men; 55% white). Whereas no significant differences emerged in the consequences of opioid use based on a history of physical violence, individuals with a history of sexual violence demonstrated higher levels of impulsive consequences of opioid use compared to individuals without a history of sexual violence. These data highlight the importance of considering the role of exposure to sexual violence in the context of opioid use disorder treatment.

From Looking for Reason to Finding Meaning: A Spiritual Journey of Recovery From Sexual Trauma

The current study aims to describe a spiritual facet of recovery processes from sexual trauma, as manifested in the transformation from the frustration and despair of looking for reasons to the traumatic event(s) to the growth and prosperity of finding meaning. A phenomenological research was conducted, interviewing individuals with a variety of affiliations to spirituality and to trauma: female survivors who turned to spirituality as part of their recovery process (n = 17), spiritually oriented therapists who treat survivors (n = 10), and spiritual leaders and teachers who are often consulted by survivors and their close ones (n = 9). Participants were asked about the nature of perceived transformation of survivors' trauma, within the meaning context, and about the perceived relevance of such a spiritual meaning-making process to recovery. Findings suggests four stances in the process:(1) doubting, describing frustrations, denials, and struggles, (2) believing, describing the acceptance of the idea that there is spiritual meaning in the trauma, (3) knowing, describing calmness, comfort, trust, and sense of freedom, and (4) doing, describing carrying the message of spiritual recovery to other survivors. This study contributes to the growing body of literature on victimology and on spirituality. It adds to the research on the spiritual meaning-making process, on the role of spirituality in survivors' perceptions of victimization and recovery, and on the importance of spiritual meaning as a recovery capital. Additionally, it directs therapists to broaden their discussions with survivors on their beliefs and values. The study lays the foundation for a theory entitled Spiritual Victimology.

Sexual Assault Labels, Compassion for Others, Self-Compassion, and Victim Blaming

Two studies examined whether label preferences (survivor, victim, neither/other/both) and past assault experience (assaulted or not assaulted) are related to compassion for others, self-compassion, rape myth acceptance, and cognitive distortions surrounding rape. Findings indicate that a preference for a victim label is related to more negative outcomes (e.g., propensity to victim-blame, less compassion for others) compared to those advocating for a survivor label or falling into a neither/other/both category. Furthermore, those who experienced sexual assault have significantly lower self-compassion compared to those who do not experience sexual assault. Implications for the impact of labels are discussed.

Tonic immobility (freezing) during sexual and physical assaults produces stronger memory effects than other characteristics of the assaults

Tonic immobility (TI) is a phylogenetically conserved, passive, obligatory defense mechanism commonly engaged during sexual and physical assaults. During TI, people become immobile while remaining conscious and later reexperience intrusive memories of both their assault and of its accompanying immobility. Here we show that this well-studied biological process has powerful effects on memory and other processes. Participants had experienced either a serious sexual (n = 234) or physical (n = 137) assault. For both the assault and its accompanying immobility, the standard measure of the peritraumatic severity of TI correlated between .40 and .65 with post-assault effects on memory, including memory of the assault and memory of the immobility, the two memory-based self-concept measures of self-blame and event centrality, and post-assault anxiety and depression. The correlations with TI were much higher than other peritraumatic characteristics commonly used to predict and describe posttraumatic effects in assaults and other traumas. The results suggest that TI should be considered for a broader, more biologically based and ecologically valid understanding of the effects of trauma on memory and memory-based reactions.

The Impact of Physical and Sexual Violence on Opioid Consequences among Trauma- exposed Individuals Recruited from the Community who Use Opioids

Interpersonal violence and opioid use disorder are significant and intersecting public health concerns in the United States. The current study evaluated the consequences associated with opioid use as a function of history of interpersonal trauma, specifically physical and sexual violence. Participants were 84 trauma-exposed individuals recruited from the community who use opioids (M age = 43.5 50% men; 55% white). Whereas no significant differences emerged in the consequences of opioid use based on a history of physical violence, individuals with a history of sexual violence demonstrated higher levels of impulsive consequences of opioid use compared to individuals without a history of sexual violence. These data highlight the importance of considering the role of sexual violence in the context of opioid use disorder treatment.

Daily reciprocal relations between emotion dysregulation and non-suicidal self-injury among individuals with a history of sexual assault: The influence of posttraumatic stress symptoms

INTRODUCTION

Non-suicidal self-injury (NSSI) is a serious public health concern that can be understood within an emotion dysregulation framework. The current study adds to the literature by utilizing a micro-longitudinal design and novel statistical modeling to test reciprocal associations between emotion dysregulation and NSSI, as well as the potential moderating effect of posttraumatic stress symptoms (PTSS).

METHODS

Participants were 81 individuals with a history of sexual assault and NSSI (M_age  = 33.80; 67.9% women; 80.2% white) recruited from the community who self-reported on symptoms of emotion dysregulation and NSSI thoughts/behaviors once daily for 7 days. Average compliance rate was 72.8% (SD = 31.3%) and 34 participants (42.0%) endorsed NSSI thoughts/behaviors over the course of the study.

RESULTS

Findings revealed a significant positive effect of NSSI thoughts/behaviors on subsequent abilities to regulate negative emotions. Furthermore, while results did not detect a moderating influence of baseline PTSS on the relation between emotion dysregulation and NSSI thoughts/behaviors over time, individuals with higher baseline PTSS were found to experience heightened levels of NSSI thoughts/behaviors and emotion dysregulation on average.

CONCLUSION

Information from this study may be useful for future research and intervention development focused on the intersection of NSSI, PTSS, and emotion dysregulation.

The Deleterious Effect of Victimization on Just World Beliefs

Being a victim of a violent crime is a traumatic experience. Sexual victimization, in particular, may be powerful enough to change presumably stable worldviews like just world beliefs. Across two large samples, we examined the influence of sexual victimization on just world beliefs. Results of Study 1 (N = 727) indicated that victims of sexual aggression had significantly lower levels of just world beliefs compared to nonvictims. Other researchers have claimed that sexual aggression is a uniquely intense traumatic event. Therefore, in a second study, we examined (a) whether just world belief endorsement was associated with the frequency of victimization, and (b) whether sexual aggression was unique in its effect on just world belief endorsement compared to other crimes such as physical assault. Results of Study 2 (N = 2,011) indicated that multiple incidents of victimization did not meaningfully impact just world beliefs compared to a single instance and just world belief endorsement was not significantly different across victims of sexual aggression, robbery, physical assault, or arson. An exploratory analysis, however, indicated there was a significant difference in victims' behavior such that victims of sexual aggression were the least likely to have reported the crime. We end with a discussion of how the present research can advance our understanding of just world belief ideology and discuss the practical implications for professionals working with and studying victims of violent crimes.

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.

Risk and protective factors affecting the symptom trajectory of posttraumatic stress disorder post-rape

INTRODUCTION

The prevalence of posttraumatic stress disorder (PTSD) in rape survivors is considerably higher than the prevalence in non-sexual trauma survivors. Few studies have investigated risk and protective factors in survivors early-after-rape in a prospective longitudinal design.

METHODS

In a sample of 639 rape-exposed women who were assessed within 20 days of rape and over 6 months, baseline data were used to predict PTSD symptom severity scores up to 6 months post-rape.

RESULTS

The incidence of PTSD at 3 months was 48.5% and the cumulative incidence at 6 months post-rape was 54.8%. Baseline experience of rape stigma (guilt, shame, self-blame, social devaluation and discredit) and depression were significant predictors of PTSD symptom scores over time, in mixed linear regression models. Higher levels of depression and rape stigma were associated with higher PTSD scores. Assault-related factors were not associated with PTSD scores.

LIMITATIONS

We could not measure PTSD symptom trajectories in all rape survivors, some of who may be at greater risk for PTSD e.g. non-disclosing rape survivors, those who declined participation and those who were extremely distressed at the time of recruitment.

CONCLUSION

Addressing internalised and externalised stigma and resultant mental health effects on women who present to rape clinics may reduce the long-term adverse effects of rape on mental health outcomes, such as PTSD. Rape survivors who present with high levels of depression soon after a rape should be carefully monitored and appropriately treated in order to reduce PTSD severity.

Cognitive Coping Reduces Posttraumatic Stress Symptoms, Especially in the Context of Self-Blame

Following a traumatic event, coping strategies may affect the natural course of posttraumatic stress symptoms (PTSS). In particular, cognitive coping strategies (how one thinks about stressors) may reduce PTSS by increasing individuals' perceived control over events, appraising them as less threatening, particularly for individuals who experience self-blame after trauma. Individuals who experience a traumatic event (n =344) completed assessments at baseline (T1), one month (T2), and two months (T3). We tested whether T1 cognitive coping strategies (positive reinterpretation, acceptance, religious coping) predicted reduced T3 PTSS and whether this reduction was mediated by increased perceived control at T2. We tested whether this effect was particularly strong for individuals experiencing self-blame. Positive reinterpretation predicted decreases in, religious coping predicted increases in, and acceptance had no direct effect on PTSS. Overall, acceptance showed the greatest potential for reducing PTSS through increased perceived control over one's life. In a fully moderated mediation model, positive reinterpretation significantly interacted and acceptance marginally interacted with self-blame to predict increased perceived control and, subsequently, decreased T3 PTSS. Specifically, acceptance and positive reinterpretation were most helpful for those with higher levels of self-blame. Religious coping interacted with self-blame to predict decreased perceived control and subsequent increased PTSS. For trauma survivors experiencing self-blame, cognitive coping strategies that utilize compassionate self-talk, such as positive reinterpretation and acceptance, may be particularly helpful at increasing perceived control after trauma, while religious coping may have deleterious effects.

The Associations of Intimate Partner Violence and Non-Partner Sexual Violence with Hypertension in South African Women

This study describes associations of intimate partner violence (IPV), non-partner sexual violence (NPSV) and sexual harassment (SH) exposures with hypertension in South African women aged 18–40 years. Baseline data (n = 1742) from the Rape Impact Cohort Evaluation study, including a history of sexual, physical, emotional and economic IPV, NPSV and SH were examined. Hypertension was based on blood pressure ≥140/90 mmHg or a previous diagnosis. Logistic regressions were adjusted for traditional hypertension risk factors and previous trauma (e.g., recent rape). Hypertension was more prevalent in women with a history of all forms of IPV, NPSV, and SH, all p ≤ 0.001, compared to women without. Frequent NPSV (adjusted odds ratio: 1.63; 95% CI: 1.27–2.67) any SH (2.56; 1.60–4.03), frequent physical (1.44; 1.06–1.95) and emotional IPV (1.45; 1.06–1.98), and greater severity of emotional IPV (1.05; 1.02–1.08) were associated with hypertension. Current depression, post-traumatic stress symptoms and/or alcohol binge-drinking completely or partially mediated these associations. This study shows that exposure to gender-based violence is associated with hypertension in young women. Understanding the role of psychological stress arising from abuse may enable the development of prevention and management strategies for hypertension among women with histories of abuse.

Refining Sexual Assault Treatment: Recovered Survivors and Expert Therapists Concur on Effective Therapy Components

The goal of the present study was to refine sexual assault therapy through the examination of the level of agreement between survivor and therapist assessments of key recovery-promoting therapeutic interventions. This is the first study to explore the level of agreement between those who partake in the treatment process from either position. Semistructured interviews were conducted in this qualitative study with 10 survivors and 10 experienced therapists. The results document considerable concurrence between them regarding relational and trauma processing treatment components alike. Together, these reports outline key effective interventions, both common and specific in nature, concomitantly supported by both groups.

Bounded Blame: The Effects of Victim-Perpetrator Relationship and Victimization History on Judgments of Sexual Violence

Individuals often tend to irrationally blame victims for their plight. This research incorporated a bounded rationality framework to examine first-person perspectives (rather than third-person) of both victims' and nonvictims' perceptions and judgments of acquaintance and stranger sexual violence. Upon completing individual difference measures, including a just-world belief assessment, participants (N = 296) were randomly assigned to read a scenario in which the vignette victim was either acquainted with or had no prior relationship with the perpetrator. Then, taking the perspective of the vignette victim, participants offered four judgments: the likelihood of reporting the crime, self-blame, perceived control, and sympathy expected from others. Results showed that instances of acquaintance sexual violence were judged more negatively than instances of stranger sexual violence. Moreover, participants who had previously experienced sexual violence reported more negative judgments than nonvictims (except for sympathy expected from others). An exploratory path analysis indicated that as nonvictims', but not victims', just-world beliefs became stronger, they indicated a higher willingness to report the crime, perceived more control over the situation, and expected more sympathy from others. We end with a discussion of how the present research can advance our understanding of sexual violence by using a bounded rationality framework and discuss the practical implications that the observed effects have for professionals in the legal system, outside observers, and victims themselves.

Does the attribution of responsibilities modify the relationship between coping styles and mental health? A survey of Chinese adults during the COVID-19 pandemic

The COVID-19 pandemic is associated with Posttraumatic Stress Symptoms (PTSS) and self-reported Posttraumatic Growth (PTG) in the general population. This study used linear regressions for analyses, based on an online survey conducted during the COVID-19 lockdown among 2441 Chinese adults in February 2020. The results showed negative coping and attributing responsibilities to individuals were associated with more PTSS, while both positive and negative coping, as well as attributing responsibilities to individuals were related to more PTG. Moreover, attribution of responsibilities modified the association between coping and PTSS, but not PTG. These findings shed light on mental health interventions in a pandemic context.

Longitudinal Associations Among Negative Cognitions and Depressive and Posttraumatic Stress Symptoms in Women Recently Exposed to Stalking

Being stalked is a potentially traumatic experience associated with a threat to personal safety. Although major depression and posttraumatic stress (PTS) disorder are highly prevalent among stalking victims, little is known about factors associated with risk for the onset and maintenance of depressive and PTS symptoms in individuals with recent stalking exposure. The aim of this study was to determine the role of cognitive appraisals (negative views about the self, negative views about the world, self-blame) in the development of depressive and PTS symptoms in young adult women who had experienced stalking within 1 month of their baseline assessment. Participants (n = 82) completed self-report online surveys of posttraumatic cognitions and symptoms four times over the course of 3 months. Levels of posttraumatic cognitions among female stalking victims were comparable to those in other studies of trauma-exposed individuals. Multilevel models (MLMs) revealed that within-person changes in cognitions were differentially associated with concurrent changes in depressive and PTS symptoms over time, controlling for the influence of time, age, race, ethnicity, lifetime stalking victimization, childhood trauma exposure, and symptoms of the other disorder. Whereas more negative cognitions about the world were associated with higher levels of concurrent depressive and PTS symptoms, negative cognitions about the self were uniquely associated with higher concurrent depressive symptoms. Contrary to expectation, self-blame was not significantly associated with depressive or PTS symptoms. Results provided support for the potential utility of negative cognitions as risk markers for depressive and PTS symptoms in young adult female stalking victims. The present findings suggest that interventions targeting symptom-specific thinking patterns could help reduce risk for negative mental health outcomes associated with stalking victimization.

Child Sexual Abuse and the Moralization of Purity

Recent studies were able to associate disgust with the moral domain of purity, as well as a heightened sensitivity to disgust with sexual victimization. However, no empirical evidence has yet to document the exact relation between sexual victimization and its impact on the moralization of purity. Therefore, the present study aimed to examine the relationship between child sexual abuse (CSA) and the moral domain of purity, by means of judgments toward three different types of disgust: pathogen, sexual and moral. To test this, The Three Domains of Disgust Scale (TDDS) was given to both CSA participants (n = 29) and to a non-sexually abused population (N-SAP; n = 31). . Results have shown a statistically significant difference between the CSA and N-SAP groups on the combined dependent variables (i.e., pathogen, sexual and moral disgust). However, only the sexual disgust domain, out of the other two domains has been found to hold significance. Furthermore, consistent with previous empirical findings, similar gender patterns of moral judgments have been found between the two groups (i.e., CSA and N-SAP), though with a statistical significance only in the sexual domain. Implications of these findings are discussed.

The Effect of Prescription Drugs and Alcohol Consumption on Intimate Partner Violence Victim Blaming

Intimate Partner Violence (IPV) is a public health problem with harsh consequences for women's well-being. Social attitudes towards victims of IPV have a big impact on the perpetuation of this phenomenon. Moreover, specific problems such as the abuse of alcohol and drugs by IPV victims could have an effect on blame attributions towards them. The aim of this study was to evaluate whether the external perception (Study 1) and self-perception (Study 2) of blame were influenced by the victims' use and abuse of alcohol or by the victims' use of psychotropic prescription drugs. Results of the first study (N = 136 participants) showed a significantly higher blame attribution towards female victims with alcohol abuse compared to those without it. No significant differences were found on blame attributed to those with psychotropic prescription drugs abuse and the control group. Results of the second study (N = 195 female victims of interpersonal violence) showed that alcohol consumption is associated with higher self-blame and self-blame cognitions among IPV victims. However, results did not show significant differences on self-blame associated to the victims' use of psychotropic prescription drugs. Our findings indicate that alcohol consumption, but not prescription drugs use, plays a relevant role in the attribution of blame by general population and self-blame by victims of IPV.

Macro- and microstructural gray matter alterations in sexually assaulted women

BACKGROUND

Studies with trauma survivors documented structural alterations in brain regions involved in posttraumatic stress disorder (PTSD) neurocircuitry. Nonetheless, whether such alterations exist in women who were sexually assaulted in adulthood is not clear. We investigated the macro- and microstructure of key regions implicated in PTSD pathophysiology, namely the amygdala, hippocampus, anterior cingulate cortex (ACC), and insula, in this population.

METHODS

Thirty-eight sexually assaulted women (PTSD, n = 25; non-PTSD, n = 13) and 24 non-exposed controls (NEC) were studied with T1- and diffusion-weighted MRI. Gray matter volume, mean diffusivity (MD), and fractional anisotropy (FA) were calculated for each region. Between-group comparisons and correlations with PTSD symptom severity were performed.

RESULTS

Volumetric analyses revealed lower amygdala and insula volumes in the PTSD compared with the non-PTSD group. In contrast, altered microstructure was observed in both traumatized groups compared with NEC, including higher MD and lower FA in the right amygdala, and higher FA in the ACC bilaterally. Finally, the non-PTSD group had higher FA in the right insula compared with the PTSD group. PTSD symptom severity was correlated with amygdala and insula volumes, as well as with hippocampal FA and MD.

LIMITATIONS

Sample size may have led to reduced statistical power.

CONCLUSIONS

Sexual assault and the development of PTSD in women are linked with structural alterations in key regions implicated in PTSD following other trauma types (e.g., combat), though hippocampal and ACC volumes were preserved. Further studies are needed to disentangle the unique contribution of trauma type and of sex/gender to these observations.

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

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

Exploring the mediating role of self-blame and coping in the relationships between self-compassion and distress in females following the sexual assault

OBJECTIVE

The present study investigated the associations between self-compassion, self-blame, disengagement coping, and posttraumatic stress disorder (PTSD) and depression symptom severity among females who had experienced sexual assault. We also examined whether the relationships between self-compassion and both PTSD and depression severity were mediated by self-blame and coping.

METHOD

A volunteer sample of female adults (N = 207) completed surveys online or on paper.

RESULTS

Mediational analyses showed that higher self-compassion was associated with lower behavioral self-blame, characterological self-blame (CSB), and disengagement coping which, in turn, were associated with less PTSD. Higher self-compassion was associated with less depression severity directly and indirectly via CSB.

CONCLUSIONS

These findings suggest that self-compassion may be relevant for understanding postassault mental health, partially through its associations with self-blame and coping. Clinicians working with sexual assault survivors may choose to augment treatment-as-usual with interventions designed to increase self-compassion.

Rape Disclosure and Depression Among Community Women: The Mediating Roles of Shame and Experiential Avoidance

Many women who disclose a rape encounter victim-blaming responses, which are associated with negative outcomes. The present study examined rape-related shame and experiential avoidance as mediators of the relation between victim-blaming responses to rape disclosure and depression among 103 rape survivors drawn from a community sample. Results revealed that victim-blaming responses were positively associated with depressive symptoms through rape-related shame and experiential avoidance, and shame was indirectly related to depression via avoidance. Findings suggest clinical interventions should focus on rape-related shame and experiential avoidance in targeting depression among rape survivors, and future research should continue to examine how victim-blaming responses to rape disclosure may be related to these factors.

Assault-related self-blame and its association with PTSD in sexually assaulted women: an MRI inquiry

Sexual assault is a frequent interpersonal trauma, which often leads to post-traumatic stress disorder (PTSD). Among other postassault characteristics, self-blame attributions were suggested to play an important role in sexually assaulted individuals' coping and were consistently associated with PTSD in this population. The present study aimed to elucidate the neural underpinnings that may associate self-blame and PTSD in women who experienced sexual assault at adulthood, using structural and resting-state functional MRI. Thirty-eight sexually assaulted women and 24 non-exposed matched controls were studied (mean age: 25 years). Among the sexually assaulted participants, assault-related self-blame was negatively correlated with gray matter volume (GMV) bilaterally in the lingual gyrus and adjacent intracalcarine cortex. GMV in this cluster was also predicted by intrusion symptoms and negative social reactions. Resting-state functional connectivity (rs-FC) of this cluster with the left anterior temporal fusiform cortex significantly differed between PTSD and non-PTSD sexually assaulted participants, and was inversely correlated with intrusion symptoms and with peritraumatic dissociation. Finally, lingual cluster's GMV and rs-FC with the anterior fusiform mediated the association between self-blame and intrusion symptoms across sexually assaulted participants. These findings link assault-related self-blame, disrupted postassault recovery and the neural circuitry involved in the processing of traumatic memories.

Blame, PTSD and DSM-5: an urgent need for clarification

DSM-5 substantially revised the PTSD criteria relating to exposure, redrawing symptom clusters and introducing additional symptom criteria, among them a newly defined criterion of persistent distorted blame of self or others. This commentary argues that there are fundamental problems with the current DSM-5 formulation of the blame criterion for PTSD. Most critically, there is conflation of self-blame and other-blame, which are two distinct phenomena, and there is heterogeneity in the research findings regarding the association between both kinds of blame and PTSD. Secondly, distortion of blame may be complex to determine. Finally, standard assessment tools fail to accurately represent the criteria as currently formulated. Despite the conceptual ambiguity in the diagnostic criteria and the lack of clarity regarding the assessment of this item in commonly-used measures, there is also evidence that blame is associated with other PTSD symptoms, is clinically relevant and may be an important intervention target in therapy. It is crucial, therefore, to clarify the blame criterion, differentiating aspects of self-blame and other-blame and, even more importantly, delineating the boundaries between normal and pathological blame.

The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III

OBJECTIVES

To present current, nationally representative US findings on the past-year and lifetime prevalences, sociodemographic correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 posttraumatic stress disorder (PTSD).

METHODS

Face-to-face interviews with 36,309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. PTSD, alcohol and drug use disorders, and selected mood, anxiety, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5.

RESULTS

Past-year and lifetime prevalences were 4.7 and 6.1 %, higher for female, white, Native American, younger, and previously married respondents, those with <high school education and lower incomes, and rural residents. PTSD was significantly associated with a broad range of substance use, mood, anxiety, and personality disorders, and past-month disability. Among respondents with lifetime PTSD, 59.4 % sought treatment; an average of 4.5 years elapsed from disorder onset to first treatment.

CONCLUSIONS

DSM-5 PTSD is prevalent, highly comorbid, disabling, and associated with delayed help seeking. Additional research is needed to elucidate relationships identified herein, estimate PTSD-related costs, investigate hypotheses regarding etiology, course, and treatment, and support decisions about resource allocation to service delivery and research. Initiatives are needed to destigmatize PTSD, educate the public about its treatment, and encourage affected individuals to seek help.

Contributions of Child Sexual Abuse, Self-Blame, Posttraumatic Stress Symptoms, and Alcohol Use to Women's Risk for Forcible and Substance-Facilitated Sexual Assault

Child sexual abuse and adult sexual assault have been linked to increased self-blame, posttraumatic stress symptoms, and alcohol use. The current study aims to examine (a) whether these constructs explain women's risk for later adult sexual assault and revictimization, (b) whether such factors differentially confer risk for specific types of adult sexual assault (i.e., substance-facilitated and forcible), and (c) if self-blame confers risk indirectly through other risk factors. Multiple types of self-blame, posttraumatic stress, and alcohol use were examined among 929 female college students as serial mediators of the relationship between child sexual abuse and adult sexual assault and as risk factors for sexual revictimization among child sexual abuse survivors. In the model predicting risk for substance-facilitated adult sexual assault, child sexual abuse indirectly predicted greater risk for substance-facilitated adult sexual assault mediated through two separate paths: global blame-to-posttraumatic-stress and global blame-to-alcohol use. In the model predicting risk for forcible adult sexual assault, child sexual abuse directly predicted greater risk for forcible adult sexual assault, and this relation was mediated by the global blame-to-posttraumatic-stress path. Among child sexual abuse survivors, child sexual abuse specific characterological and behavioral self-blame directly predicted greater risk for forcible and substance-facilitated revictimization, but the pathways were not mediated by posttraumatic stress or alcohol use. Results emphasize the importance of assessing different types of self-blame in predicting posttraumatic stress symptoms as well as examining risk for sexual victimization and revictimization. Findings did not support hypotheses that increased posttraumatic stress would predict increased alcohol use but did indicate that heightened self-blame is consistently associated with heightened posttraumatic stress and that heightened global self-blame predicts increased alcohol use. Implications for future research and intervention are discussed.

Does self-blame moderate psychological adjustment following intimate partner violence?

This study explored whether self-blame moderates the relationship between exposure to specific types of abuse and both poor general psychological adjustment (i.e., self-esteem) and specific symptomatology (i.e., posttraumatic stress disorder [PTSD]) among women who had experienced intimate partner violence (IPV). Eighty female IPV survivors were involved in this study. Results indicated that self-blame was negatively associated with self-esteem for physical, psychological, and sexual abuse. Self-blame moderated physical abuse, such that high levels of physical abuse interacted with high levels of self-blame in their association with PTSD. Nonsignificant models were noted for psychological and sexual abuse in association with self-blame and PTSD. These findings support the conceptualization that self-blame is associated with both general and specific psychological outcomes in the aftermath of IPV. Future research examining different forms of blame associated with IPV might further untangle inconsistencies in the self-blame literature.