PTSD in women is associated with a block in conversion of progesterone to the GABAergic neurosteroids allopregnanolone and pregnanolone measured in plasma

There is a need to identify new and more effective treatments for posttraumatic stress disorder (PTSD). Allopregnanolone and its stereoisomer pregnanolone (together termed ALLO) are metabolites of progesterone that positively and allosterically modulate GABA effects at GABA_A receptors, thereby reducing anxiety and depression. Previous research revealed that women with PTSD had low cerebrospinal fluid (CSF) ALLO levels and a low ratio of ALLO to the allopregnanolone precursor 5α-DHP, consistent with deficient activity of the ALLO synthetic enzyme 3α-hydroxysteroid dehydrogenase (3α-HSD). The current study examined ALLO and the ratio of ALLO to 5α-DHP in plasma at rest and in response to psychophysiological stressors in trauma-exposed, medication-free women with and without PTSD. Participants were examined twice in random order during the early follicular phase (eFP) and mid-luteal phase (mLP) of the menstrual cycle. Plasma neurosteroids were measured using gas chromatography-mass spectrometry. Results indicate that the ALLO to 5α-DHP ratio in plasma increases between the eFP and mLP. In addition, women with PTSD have a lower ratio of ALLO to 5α-DHP than trauma-exposed healthy women, as well as blunted increases in this ratio in response to a moderately stressful laboratory procedure, i.e., differential fear conditioning, across the menstrual cycle. Clinically feasible testing for 3α-HSD dysfunction is critical to translating this line of research into clinical care. Measurement of this ratio in plasma could facilitate patient stratification in clinical treatment trials, as well as precision medicine targeting of treatments that address ALLO synthesis deficits in women with PTSD.

Trauma-related sleep disturbance and self-reported physical health symptoms in treatment-seeking female rape victims

The purpose of the study was to assess the relationship between trauma-related sleep disturbance and physical health symptoms in treatment-seeking female rape victims. A total of 167 participants were assessed for PTSD symptoms, depression, sleep disturbance, and frequency of self-reported health symptoms. Results demonstrated that trauma-related sleep disturbance predicted unique variance in physical health symptoms after other PTSD and depression symptoms were controlled. The findings suggest that trauma-related sleep disturbance is one potential factor contributing to physical health symptoms in rape victims with PTSD.

Sleep difficulties and alcohol use motives in female rape victims with posttraumatic stress disorder

The purpose of this study was to assess the relationship between sleep difficulties and drinking motives in female rape victims with posttraumatic stress disorder (PTSD). Seventy-four participants were assessed for PTSD symptoms, depression, sleep difficulties, and drinking motives. Results demonstrated that neither PTSD symptoms nor depression were related to any motives for using alcohol. On the other hand, after controlling for education, sleep difficulties were significantly related to drinking motives for coping with negative affect, but not pleasure enhancement or socialization. The findings suggest that sleep difficulties may be an important factor contributing to alcohol use in rape victims with PTSD.

Prior interpersonal trauma: the contribution to current PTSD symptoms in female rape victims

The purpose of the current study was to disentangle the relationship of childhood sexual abuse and childhood physical abuse from prior adult sexual and physical victimization in predicting current posttraumatic stress disorder (PTSD) symptoms in recent rape victims. The participants were a community sample of 117 adult rape victims assessed within 1 month of a recent index rape for a history of child sexual abuse, child physical abuse, other adult sexual and physical victimization, and current PTSD symptoms. Results from path analyses showed that a history of child sexual abuse seems to increase vulnerability for adult sexual and physical victimization and appears to contribute to current PTSD symptoms within the cumulative context of other adult trauma.

Intimate partner violence and stalking behavior: exploration of patterns and correlates in a sample of acutely battered women

The aims of this study were to provide descriptive data on stalking in a sample of acutely battered women and to assess the interrelationship between constructs of emotional abuse, physical violence, and stalking in battered women. We recruited a sample of 114 battered women from shelters, agencies, and from the community at large. Results support the growing consensus that violent and harassing stalking behaviors occur with alarming frequency among physically battered women, both while they are in the relationship and after they leave their abusive partners. Emotional and psychological abuse emerged as strong predictors of within- and postrelationship stalking, and contributed a unique variance to women's fears of future serious harm or death, even after the effects of physical violence were controlled. The length of time a woman was out of the violent relationship was the strongest predictor of postseparation stalking, with increased stalking found with greater time out of the relationship. Results suggest the need to further study the heterogeneity of stalking and to clarify its relationship to constructs of emotional and physical abuse in diverse samples that include stalked but nonbattered women, as women exposed to emotional abuse, and dating violence.

The impact of severe stalking experienced by acutely battered women: an examination of violence, psychological symptoms and strategic responding

Stalking has been relatively understudied compared to other dimensions of intimate partner violence. The purpose of this article was to examine concurrent and subsequent intimate partner abuse, strategic responses and symptomatic consequences of severe stalking experienced by battered women. Thirty-five battered women classified as "relentlessly stalked" and 31 infrequently stalked battered women were compared. Compared to infrequently stalked battered women, relentlessly stalked battered women reported: (a) more severe concurrent physical violence, sexual assault and emotional abuse: (b) increased post-separation assault and stalking; (c) increased rates of depression and PTSD; and (d) more extensive use of strategic responses to abuse. Results underscore the scope and magnitude of stalking faced by battered women and have implications for assessment and intervention strategies.

A comparison of normal forgetting, psychopathology, and information-processing models of reported amnesia for recent sexual trauma

This study assessed memories for sexual trauma in a nontreatment-seeking sample of recent rape victims and considered competing explanations for failed recall. Participants were 92 female rape victims assessed within 2 weeks of the rape; 62 were also assessed 3 months postassault. Memory deficits for parts of the rape were common 2 weeks postassault (37%) but improved over the 3-month window studied (16% still partially amnesic). Hypotheses evaluated competing models of explanation that may account for reported recall deficits. Results are most consistent with information-processing models of traumatic memory.

A comparison of normal forgetting, psychopathology, and information-processing models of reported amnesia for recent sexual trauma

This study assessed memories for sexual trauma in a nontreatment-seeking sample of recent rape victims and considered competing explanations for failed recall. Participants were 92 female rape victims assessed within 2 weeks of the rape; 62 were also assessed 3 months postassault. Memory deficits for parts of the rape were common 2 weeks postassault (37%) but improved over the 3-month window studied (16% still partially amnesic). Hypotheses evaluated competing models of explanation that may account for reported recall deficits. Results are most consistent with information-processing models of traumatic memory.

Objective assessment of peritraumatic dissociation: psychophysiological indicators

OBJECTIVE

The aims of this study were to investigate psychophysiological changes associated with peritraumatic dissociation in female victims of recent rape and to assess the relation between these changes and symptoms of posttraumatic stress disorder (PTSD).

METHOD

Eighty-five rape victims were examined in a laboratory setting within 2 weeks after the rape, and measures of heart rate, skin conductance, and nonspecific movement were collected. Self-report indexes of reactions to the trauma and interviews to assess PTSD symptoms and peritraumatic dissociation were also completed. On the basis of their scores on the Peritraumatic Dissociation Index, the subjects were classified as having low or high levels of dissociation.

RESULTS

Items from the index exhibited good internal consistency, and scores were approximately normally distributed. Individuals in the high peritraumatic dissociation group showed a significantly different pattern of physiological responses from those of the low dissociation group. In general, there was a suppression of autonomic physiological responses in the high dissociation group. This group also contained a larger proportion of subjects (94%) identified as meeting PTSD symptom criteria. Also, among the high dissociation subjects there was a discrepancy between self-reports of distress and objective physiological indicators of distress in the laboratory setting.

CONCLUSIONS

The results provide preliminary support for the idea that there is a dissociative subtype of persons with PTSD symptoms who exhibit diminished physiological reactivity. The results also underscore the importance of assessing dissociative symptoms in trauma survivors.

Cognitive processing therapy for sexual assault victims

Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. Nineteen sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-month follow-up. CPT subjects were compared with a 20-subject comparison sample, drawn from the same pool who waited for group therapy for at least 12 weeks. CPT subjects improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 months. The comparison sample did not change from the pre- to the posttreatment assessment sessions.

Cognitive processing therapy for sexual assault victims

Cognitive processing therapy (CPT) was developed to treat the symptoms of posttraumatic stress disorder (PTSD) in rape victims. CPT is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. Nineteen sexual assault survivors received CPT, which consists of 12 weekly sessions in a group format. They were assessed at pretreatment, posttreatment, and 3- and 6-month follow-up. CPT subjects were compared with a 20-subject comparison sample, drawn from the same pool who waited for group therapy for at least 12 weeks. CPT subjects improved significantly from pre- to posttreatment on both PTSD and depression measures and maintained their improvement for 6 months. The comparison sample did not change from the pre- to the posttreatment assessment sessions.

Attitudes toward rape among mental health professionals

This study examined the attribution of blame in rape among mental health professionals from one state. Thirty-eight professionals (76% of the total population) completed the Attribution of Rape Blame Scale, a 20-item questionnaire reflecting different ways people account for rape. The responses were factor analyzed yielding four clear factors: Societal Blame, Victim Blame, Assailant Blame, and Sociological Status Blame. Analyses of variance were then performed on the participants' four factor scores to determine if there were differences in blame attribution across age or gender of respondents. The only significant finding was a gender difference on the societal blame factor. Results of the factor analysis, ANOVAs as well as implications for training of professionals are discussed.