The Utility of the Trauma Symptom Inventory as a Primary and Secondary Assessment Instrument for Forensic Practice in Legal Settings

This paper examines the utility of the Trauma Symptom Inventory-2 (TSI-2) and its predecessor, the Trauma Symptom Inventory (TSI) in forensic psychology practice. The instrument's psychometric properties, use with special populations, legal case review and admissibility considerations are discussed. Recommendations regarding the strengths and limitations of the TSI/TSI-2 are suggested for forensic practitioners and lawyers. Considerations related to potential expert witness cross-examination are also presented. Psychological research and legal review suggest that the TSI/TSI-2 is admissible as an instrument under the Daubert Standard, especially as related to civil court disability claims. Still, lingering issues with the ATR validity scale remain and there is limited independent research establishing the predictive and discriminant validity of the TSI-2 across diverse forensic samples. In summary, this suggests the instrument is most effective as part of a comprehensive assessment battery for identifying PTSD symptomology within legal proceedings where a trauma diagnosis is relevant.

History of abuse and psychogenic nonepileptic seizures: A systematic review

Psychogenic nonepileptic seizures resemble epileptic seizures but lack the physiological basis of epileptic seizures. We conducted a systematic review to explore whether childhood abuse is a risk factor for subsequent development of PNES. We reviewed only papers with an epilepsy control group, which employed strict criteria for diagnosis of epilepsy and well-validated tools for assessing abuse history. Odds ratios (ORs) for the different categories of childhood abuse and for childhood abuse as a whole were calculated where not previously available, and pooled ORs were calculated where suitable. In papers where OR could not be calculated data are presented as p values. Most Odds Ratios fell between 1.8 and 5.2 with relatively narrow confidence intervals. In 14 out of 18 calculations, 95% confidence intervals did not cross 1. This suggests that the chance of reporting abuse is higher in people with PNES than those with epilepsy and may be a causative factor in developing PNES. Several limitations of the data and directions for future study are discussed.

Distinguishing Levels of Suicide Risk in Depressed Male Veterans: The Role of Internalizing and Externalizing Psychopathology as Measured by the MMPI-2-RF

Suicide occurs at high rates among veterans, underscoring a need for improved identification of veterans at risk of engaging in suicidal behavior. Considering dimensions of psychopathology in the context of an ideation-to-action framework, the present study examined the utility of the Minnesota Multiphasic Personality Inventory–2–Restructured Form in distinguishing depressed, psychiatrically hospitalized male veterans ( N = 430) at varying levels of suicide risk. Analysis of variance and hierarchical logistic regression analyses indicated that internalizing scales differentiated depressed ideators ( n = 147) and depressed controls ( n = 143); and in line with expectations, both broad and narrowly focused externalizing scales provided incremental validity in distinguishing depressed attempters ( n = 140) from depressed ideators. Interactions between Suicidal/Death Ideation and externalizing scale scores were found to differentiate only depressed ideators from depressed controls. Clinical implications in the areas of suicide risk assessment and therapeutic interventions with suicidal veterans are discussed.

Sexuality-related issues in borderline personality disorder: A comprehensive review

OBJECTIVE

Sexuality is somewhat neglected in clinical research on borderline personality disorder (BPD).

METHOD

We performed a systematic review from 1980 to November 2014 through PubMed and PsycINFO.

RESULTS

Empirical evidence underscores that childhood sexual trauma may be considered a non-specific risk factor for BPD. Furthermore, individuals with BPD also display higher sexual identity disturbances and homosexual relationships than non-BPD individuals. Moreover, patients with BPD also exhibit higher sexual impulsivity than non-BPD. In addition, sexual risk behaviours among individuals with BPD are related to increased rates of sexually transmitted diseases, unwanted pregnancies, rape and commercial sexual relationships, especially among drug abusers. Although psychotherapy is widely recommended for BPD, there has been little systematic research on the effect of these treatments with respect to co-morbid post-traumatic symptoms related to childhood sexual trauma.

CONCLUSIONS

Sexuality-related issues represent a major clinical topic within this population. Findings are discussed concerning their methodological limitations and clinical implications. Copyright © 2016 John Wiley & Sons, Ltd.

The dissociative subtype of PTSD: a replication and extension

BACKGROUND

The nature of the relationship between dissociation and posttraumatic stress disorder (PTSD) has clinical and nosological importance. The aim of this study was to evaluate the evidence for a dissociative subtype of PTSD in two independent samples and to examine the pattern of personality disorder (PD) comorbidity associated with the dissociative subtype of PTSD.

METHODS

Latent profile analyses were conducted on PTSD and dissociation items reflecting derealization and depersonalization in two samples of archived data: Study 1 included 360 male Vietnam War Veterans with combat-related PTSD; Study 2 included 284 female Veterans and active duty service personnel with PTSD and a high base rate of exposure to sexual trauma.

RESULTS

The latent profile analysis yielded evidence for a three-class solution in both samples: the model was defined by moderate and high PTSD classes and a class marked by high PTSD severity coupled with high levels of dissociation. Approximately 15% of the male sample and 30% of the female sample were classified into the dissociative class. Women (but not men) in the dissociative group exhibited higher levels of comorbid avoidant and borderline PD diagnoses.

CONCLUSIONS

Results provide support for a dissociative subtype of PTSD and also suggest that dissociation may play a role in the frequent co-occurrence of PTSD and borderline PD among women. These results are pertinent to the on-going revisions to the DSM and suggest that consideration should be given to incorporating a dissociative subtype into the revised PTSD criteria.