Self-reported Trauma Research Articles

Trauma memory characteristics and the development of acute stress disorder and post-traumatic stress disorder in youth

Background & objectivesThe present study addresses gaps in knowledge regarding the association between trauma memory processes and posttraumatic stress responses in youth. Our primary goal was to explore the relative contribution of perceptions of trauma memory quality versus narrative trauma memory characteristics to explain overall adjustment. MethodsChildren (N = 67) were interviewed within four weeks (T1) of an injury leading to hospital treatment and then again eight weeks later (T2). In each interview, the child told a trauma narrative (which were later coded), and answered the Trauma Memory Quality Questionnaire (Meiser-Stedman, Smith, Yule, & Dalgleish, 2007a), a self-report measure indexing the sensory, fragmented, and disorganised characteristics of trauma memory. They then completed measures of Acute Stress Disorder (ASD) symptoms and associated psychopathology at T1 and measures of Posttraumatic Stress (PTS) symptoms and associated psychopathology at T2. ResultsSelf-reported trauma memory characteristics predicted ASD symptoms cross-sectionally at T1 and PTS symptoms prospectively over time. At both time points, self-reported trauma memory characteristics accounted for all of the unique variance in symptoms initially explained by narrative characteristics. A reduction in self-report ratings, but not the hypothesised narrative features (e.g., disorganised or lexical elements of the narrative), significantly predicted a reduction in PTS symptoms over time. LimitationsThe small sample size and the absence of a within-subjects narrative control were the main limitations of the study. ConclusionsThese findings underscore the importance of self-reported trauma memory characteristics to the aetiology of PTSD.

Self-reports of trauma and dissociation: An examination of context effects.

To examine context effects in moderating the link between self-reported trauma and dissociation in undergraduate samples, we administered these measures either in the same or different experimental contexts. Trauma History Screen/THS (Carlson et al., 2011)-Dissociative Experiences Scale/DES-II (Bernstein & Putnam, 1986) correlations revealed a context effect (greater correlations in same test context), although multiple regression analyses did not confirm this finding. A context effect was supported in DES-Taxon scores using multiple regression for the THS but not the Modified Posttraumatic Stress Scale (MPSS-SR; Falsetti, Resnick, Resick, & Kilpatrick, 1993), an effect confirmed with correlation comparisons. Ethnicity influenced the association between measures of trauma and dissociation. Overall, the relation between measures of trauma and dissociation was small to medium, although high correlations were observed between the DES depersonalization/derealization subscale and the Multiscale Dissociation Inventory (Briere, Weathers, & Runtz, 2005) depersonalization and derealization subscales, supporting the construct validity of these measures.

Mindfulness-Related Traits Partially Mediate the Association Between Lifetime and Childhood Trauma Exposure and PTSD and Dissociative Symptoms in a Community Sample Assessed Online

Although theory suggests the relevance of mindfulness and mindfulness-based therapies for understanding relationships between trauma, posttraumatic stress disorder (PTSD), and dissociative experiences, little research has directly compared associations between mindfulness and trauma-related distress versus dissociation, including dissociative trauma-related altered states of consciousness (TRASC). We therefore examined whether mindfulness traits (Five Facet Mindfulness Questionnaire [FFMQ]) partially mediated the relationship between self-reported trauma exposure, whether occurring during childhood or anytime in life, and outcomes of PTSD, dissociative subtype PTSD, and TRASC in 952 trauma-exposed participants surveyed online. The relationships between increased traumatic experiences and PTSD, dissociative PTSD, and TRASC were partially mediated by the decreased capacity for mindful describing, acting with awareness, and non-judging traits, although decreased mindful non-reactivity partially mediated only the association between increased childhood trauma exposure and PTSD symptoms, while increased mindful observing partially mediated the association between increased lifetime trauma exposure and increased PTSD and dissociative symptoms. Our findings suggest that altered or decreased capacity for different facets of trait mindfulness may be one mechanism by which trauma exposure leads to the development of trauma-related distress and dissociation.

Reliability of reports of childhood trauma in bipolar disorder: A test–retest study over 18 months

ABSTRACTThis study aimed to explore the reliability of self-reported trauma histories in a population with a diagnosis of bipolar disorder using the Childhood Trauma Questionnaire. Previous studies in other populations suggest high reliability of trauma histories over time, and it was postulated that a similar high reliability would be demonstrated in this population. A total of 39 patients with a confirmed diagnosis (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria) were followed up and readministered the Childhood Trauma Questionnaire after 18 months. Cohen’s kappa scores and intraclass correlations suggested reasonable test–retest reliability over the 18-month time period of the study for all types of childhood abuse, namely, emotional, physical, and sexual abuse and physical and emotional neglect. Intraclass correlations ranged from r = .50 (sexual abuse) to r = .96 (physical abuse). Cohen’s kappas ranged from .44 (sexual abuse) to .76 (physical abuse). Retrospective reports of childhood trauma can be seen as reliable and are in keeping with results found with other mental health populations.

Enquiring about traumatic experiences in psychosis: A comparison of case notes and self-report questionnaires

Purpose: Studies have found an association between a history of trauma and the presence of psychotic symptoms. Despite the research evidence it appears to be the case that many clinicians are not routinely asking about traumatic experiences. This study aims to ascertain the level of agreement between rates of self-reported trauma and that which is recorded in case notes.Methods: The study population was drawn from all individuals with a confirmed diagnosis of psychosis, residing within a defined catchment area. Rates of childhood trauma, lifetime trauma and trauma related to the Troubles in Northern Ireland recorded in participants’ case notes were compared to their responses on self-report questionnaires: THQ, CTQ and TREQ.Results: Relatively high levels of trauma were reported by participants on the self-report measures that were administered. The rates of trauma recorded in case note records were similar to that found in other studies. Also in line with other research were poor levels of agreement between self-report and case note data.Conclusion: High levels of lifetime, childhood and trauma related to the Troubles in Northern Ireland were found when the individuals in the sample were directly assessed for the purposes of this study. In contrast much lower rates were recorded in patient notes on routine clinical assessment. The results suggest that clinicians do not routinely enquire about trauma histories with this population and as a result, case notes underestimate trauma prevalence.

Stability of trauma-related symptoms during acute substance use treatment

ABSTRACTIt is unclear whether post-traumatic stress disorder symptoms and reports of traumatic childhood experiences decline during substance withdrawal. A convenience sample of 34 inpatients of the Psychiatric University Clinics in Basel was recruited and general psychopathological and trauma-related symptoms were assessed with the Brief Symptom Checklist, Post-Traumatic Stress Diagnostic Scale, and Childhood Trauma Questionnaire in the 1st and 3rd week of substance use treatment. The average age of the sample was 41.9 (SD = 9.1) years, and 26.5% were female. Hyperarousal (Mt1 = 4.51 versus Mt2 = 3.61; z = –2.38, p = .017) and avoidance symptoms (Mt1 = 6.24 versus Mt2 = 4.27; z = –2.59, p = .010) declined significantly, but re-experiencing symptoms (Mt1 = 4.00 versus Mt2 = 3.45; z = –.50, p = .617) did not. Post-traumatic stress disorder assessment, according to the Diagnostic and Statistical Manual of Mental Disorders–4th edition criteria, remained constant for 28 of 34 patients. Likewise, self-reported childhood trauma experiences decreased, yet the number of elevated subscale scores remained stable. Post-traumatic stress disorder symptoms are not adequately treated by substance withdrawal alone. Trauma-specific diagnostics can be initiated with sufficient quality as early as the first week of withdrawal treatment.

The Roles of Emotion Dysregulation and Dissociation in the Association Between Sexual Abuse and Self-Injury Among Juvenile Justice–Involved Youth

To date, scholars have established associations among nonsuicidal self-injury and sexual abuse, posttraumatic stress symptoms, and dissociation. However, leading theoretical models of the mechanisms underlying the association between trauma and negative outcomes suggest a more parsimonious explanation in that deficits in emotion regulation may underlie these various risk factors for self-injury. This study examined whether sexual abuse was differentially associated with nonsuicidal self-injury over and above other forms of traumatic experiences and whether the association between sexual abuse and self-injury was statistically mediated by emotion dysregulation and dissociation. Participants included 525 youth (392 boys, 133 girls) recruited from the U.S. juvenile justice system who completed measures of self-reported trauma exposure, posttraumatic stress symptoms, dissociation, and emotion dysregulation. Results of a hierarchical regression demonstrated that sexual abuse predicted posttraumatic stress symptoms and self-injury over and above other forms of traumatic experiences. Results of bootstrapped mediation analyses indicated that emotion dysregulation and dissociation in combination were implicated in self-injury among youth. The results suggest that youth in the juvenile justice system who experience sexual abuse may be at risk for higher rates of posttraumatic stress symptoms and that self-injury may be particularly salient for youth who experience sexual abuse. Furthermore, the results shed light on the role that dissociation and emotion dysregulation play in the relation between sexual abuse and self-injury, suggesting that a larger framework of self-regulation may have both empirical and clinical utility in helping to understand the underlying processes at play in these associations.

Self-Reported Psychopathology, Trauma Symptoms, and Emotion Coping Among Child Suicide Attempters and Ideators: An Exploratory Study of Young Children

This study examined self-reported psychopathology, trauma symptoms, and emotion coping in 7 to 12 year old children with suicidal ideation and attempts. This study compared 70 psychiatric inpatient children with current suicidal ideation to 59 psychiatric inpatient children with recent suicide attempts on measures of depression, anxiety, anger, emotional intelligence, and family/contextual factors. Results revealed greater self-reported anger as well as psychological distress associated with traumatic experiences (dissociation, anger, depression), among children who attempted suicide, in addition to increased reports of special education utilization, when compared to ideators only. These relationships were not affected by age or gender. Overall, the findings suggest self-reports of younger children who attempt suicide share similarities with older children and adolescent attempters, when compared with ideators who do not attempt. Implications for assessment and treatment are discussed.

Dual-axis hormonal covariation in adolescence and the moderating influence of prior trauma and aversive maternal parenting.

Adversity early in life can disrupt the functioning of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes and increase risk for negative health outcomes. The interplay between these axes and the environment is complex, and understanding needs to be advanced by the investigation of the multiple hormonal relationships underlying these processes. The current study examined basal hormonal associations between morning levels of cortisol, testosterone, and dehydroepiandrosterone in a cohort of adolescents (mean age 15.56 years). The moderating influence of childhood adversity was also examined, as indexed by self-reported trauma (at mean age 14.91), and observed maternal aggressive parenting (at mean age 12.41). Between-person regressions revealed significant associations between hormones that were moderated by both measures of adversity. In females, all hormones positively covaried, but also interacted with adversity, such that positive covariation was typically only present when levels of trauma and/or aggressive parenting were low. In males, hormonal associations and interactions were less evident; however, interactions were detected for cortisol-testosterone - positively covarying at high levels of aggressive parenting but negatively covarying at low levels - and DHEA-cortisol - similarly positively covarying at high levels of parental aggression. These results demonstrate associations between adrenal and gonadal hormones and the moderating role of adversity, which is likely driven by feedback mechanisms, or cross-talk, between the axes. These findings suggest that hormonal changes may be the pathway through which early life adversity alters physiology and increases health risks, but does so differentially in the sexes; however further study is necessary to establish causation.

Trauma exposure, posttraumatic stress disorder symptomatology, and aggression in male juvenile offenders.

Juvenile offenders have a high prevalence of trauma exposure and posttraumatic stress disorder (PTSD) symptoms, as well as aggressive behavior. However, relationships between exposure to different specific types of traumatic events, PTSD symptoms, and aggression have not been systematically investigated. Subgroups of male juvenile offenders were identified based on their self-reported exposure to different types of traumatic events. Male juvenile offenders who endorsed multiple types of trauma exposure or traumatic exposure involving violence endorsed higher levels of PTSD symptomatology but not self-reported aggression. In addition, meeting the DSM-IV PTSD diagnosis Criterion A for traumatic exposure was associated with more severe emotional and behavioral problems in the youth who were exposed to community violence. Implications for theory and research on violent trauma and polyvictimization, and the use of self-report trauma history and PTSD measures for screening, with youth involved in the juvenile justice system, are discussed.

Relationship of Trauma Symptoms to Amygdala‐Based Functional Brain Changes in Adolescents

In this pilot study, amygdala connectivity related to trauma symptoms was explored using resting-state functional magnetic resonance imaging (R-fMRI) in 23 healthy adolescents ages 13-17 years with no psychiatric diagnoses. Adolescents completed a self-report trauma symptom checklist and a R-fMRI scan. We examined the relationship of trauma symptoms to resting-state functional connectivity of the amygdala. Increasing self-report of trauma symptoms by adolescents was associated with increasing functional connectivity with the right amygdala and a local limbic cluster and decreasing functional connectivity with the amygdala and a long-range frontoparietal cluster to the left amygdala, which can be a hallmark of immaturity. These pilot findings in adolescents provide preliminary evidence that even mild trauma symptoms can be linked to the configuration of brain networks associated with the amygdala.

Sticks and Stones May Break My Bones but Words Relate to Adult Physiology? Child Abuse Experience and Women's Sympathetic Nervous System Response while Self-Reporting Trauma

Child abuse predicts a wide range of long-lasting deleterious outcomes, including disruptions in the biological systems central to emotion arousal and regulation. However, little is known about the specific ways in which child abuse affects adulthood sympathetic reactivity and recovery. This study investigated the association between child abuse experience and adult skin conductance level and habituation in 85 at-risk women as they completed a self-report trauma questionnaire. Childhood emotional abuse was independently associated with blunted skin conductance habituation over the course of survey completion after controlling for other abuse subtypes and current trauma symptoms. These results suggest that women emotionally abused as children experience prolonged emotional arousal and poor physiological regulation of emotion in response to reminders of traumatic experiences.

In an Idealized World: Can Discrepancies Across Self-Reported Parental Care and High Betrayal Trauma During Childhood Predict Infant Attachment Avoidance in the Next Generation?

Adult caregivers’ idealization of their parents as assessed by the Adult Attachment Interview is a risk factor for the intergenerational transmission of the insecure-avoidant attachment style. This study evaluated a briefer screening approach for identifying parental idealization, testing the utility of prenatal maternal self-report measures of recalled betrayal trauma and parental care in childhood to predict observationally assessed infant attachment avoidance with 58 mother–infant dyads 18 months postpartum. In a logistic regression that controlled for maternal demographics, prenatal psychopathology, and postnatal sensitivity, the interaction between women's self-reported childhood high betrayal trauma and the level of care provided to them by their parents was the only significant predictor of 18-month infant security versus avoidance. Results suggest that betrayal trauma and recalled parental care in childhood can provide a means of identifying caregivers whose infant children are at risk for avoidant attachment, potentially providing an efficient means for scientific studies and clinical intervention aimed at preventing the intergenerational transmission of attachment problems.

915 – Existential anxiety and posttraumatic stress disorder symptoms in a sample of psychiatric outpatients

Existential anxiety (EA) has been described as the anxiety about the meaning of life, death and the necessity to make choices (Tillich, 1953).Although recent research found EA to be associated with trauma and general psychological symptoms in community samples (Weems et al. 2004), to date, no study has investigated its relationship with trauma exposure and posttraumatic stress disorder (PTSD) symptoms in psychiatric outpatients. To examine the association between EA and self-reported trauma history and PTSD symptoms in psychiatric outpatients. Seventy-two stable psychiatric outpatients (mean(SD) age=46.1(14), 55% females) were assessed with the Existential Anxiety Questionnaire (EAQ; score ranging 0-39), the Trauma History Questionnaire which reports on criminal experiences, natural disasters, death exposure and questioning about physical and sexual experiences, and the PTSD Checklist (PCL; score ranging 17-85). Mean(SD) EAQ and PCL scores were 20.0(7.8) and 40.0(15), respectively. A majority of participants (93%) reported at least one lifetime trauma exposure. Results revealed a positive correlation between existential anxiety and lifetime trauma exposure (r=.28, p< .05).Furthermore, in patients with lifetime trauma exposure, increased EA was associated with increased PCL total score (r=.57, p< .001) as well as with all PTSD symptom clusters: re-experiencing (r=0.45, p < 0.001), hyperarousal (r=.51, p< .001) and avoidance (r=.53, p < .01). Our findings suggest that EA might be an interesting construct to examine further in the assessment and treatment of PTSD and paves the way for empirical investigations of existential therapies.

Parent–youth discordance about youth-witnessed violence: Associations with trauma symptoms and service use in an at-risk sample

ObjectiveStudies have consistently demonstrated a lack of agreement between youth and parent reports regarding youth-witnessed violence. However, little is known about whether disagreement is associated with poorer outcomes and less utilization of mental health services. The purpose of the current study was to examine disagreement among youth and parents about youth witnessed violence, and determine whether concordance predicted trauma symptoms and recognition of need and receipt of counseling services. MethodsConcordance about youth-witnessed violence was examined in 766 dyads from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Youth participants self-reported trauma symptoms, caregivers indicated youth need for and receipt of services. Both youth and parents provided information about youth-witnessed violence exposure in the last year. ResultsResults showed youth and caregivers differed significantly about youth-witnessed violence. Specifically, 42% of youth reported youth-witnessed violence, compared to only 15% of parents. For those parents who reported youth-witnessed violence, only 29% reported an identified need for services and only 17% reported the youth had received any mental health services. Concordance between parent–youth dyads was associated with greater identified need for services but was not associated with the use of counseling services or trauma symptoms. ConclusionsYouth who reported witnessing violence reported more frequent trauma symptoms regardless of concordance. Parents from dyads in which both informants reported youth-witnessed violence were more likely to endorse need for, but not receipt of counseling services. Given this association between youth-witnessed violence and mental health problems, more work is needed to identify barriers to concordance as well as service utilization.

Persecutory delusions and childhood emotional abuse in people with a diagnosis of schizophrenia

The present research assesses the frequency of self-reported childhood trauma in individuals with and without persecutory delusions. Comparisons are made between reported childhood emotional, physical and sexual trauma in adults with a diagnosis of schizophrenia, with (n = 36) and without (n = 23) persecutory delusions. Those with persecutory delusions reported significantly higher levels of emotional abuse and there was a trend towards higher levels of emotional neglect. No differences emerged on total trauma score, physical abuse, physical neglect and sexual abuse. The study suggests that over and above a general association between childhood trauma and positive symptoms of psychosis, there may exist a specific link between persecutory delusions and childhood emotional abuse.

Enquiring about traumatic experiences in bipolar disorder: A case note and self- report comparison

This study examined: (i) the prevalence of lifetime trauma, childhood trauma and trauma related to civil unrest in a Bipolar Disorder sample, and (ii) the agreement between rates of disclosure of trauma in case notes and self-report questionnaires. The case notes of sixty participants, recruited from a geographically well-defined mental health service in Northern Ireland, were examined for reports of experiences of lifetime, childhood and traumatic events related to civil conflict. The participants also completed self-report measures of trauma. Considerable differences were found between the prevalence of trauma as measured by self-report questionnaires and case notes reports. The prevalence of lifetime trauma as measured by the Trauma History Questionnaire was 61.7% (compared to case notes prevalence of 33.3%). The prevalence of moderate and severe levels of childhood trauma as measured by the Childhood Trauma Questionnaire was 65% (case notes 21.7%). Rates of trauma related to civil unrest were 35% (case notes 3.3%). Poor levels of agreement were found between all self-report trauma measures and case notes reports. Agreement on two categories of trauma (childhood emotional neglect and childhood physical neglect) reached statistical significance but kappa scores suggest this agreement was poor (κ=.14, p<.05; κ=.127, p<.05). It is probable that the increased rate of trauma disclosed in the self-report questionnaire arises because clinicians during initial assessment and subsequent treatment do not consistently enquire about trauma. The need for staff training is discussed.

Self-reported attachment style, trauma exposure and dissociative symptoms among adolescents

The aim of this study was to analyze whether self-reported attachment style (measuring avoidance and anxiety) among adolescents was associated with dissociative symptoms, in addition to self-reported potentially traumatic experiences. A group consisting of 462 adolescents completed three self-assessment questionnaires: Linkoping Youth Life Experience Scale (LYLES), Experiences in Close Relationships, modified version (ECR) and Dissociation Questionnaire Sweden (Dis-Q-Sweden). Self-reported attachment style had a stronger association with dissociative symptoms than self reported traumas. It was also found that scores on a dissociation questionnaire correlated strongly with scores on self-reported attachment style in adolescence. Discussion concerns reasons why self-reported attachment style is an important factor that may influence dissociative symptoms during adolescence.

Adaptation and validation of the Spanish-language Trauma Symptom Inventory in Puerto Rico.

This research was conducted to assess the Spanish-language Trauma Symptom Inventory's (Briere, 1995) suitability for use with a Puerto Rican sample. Minor revisions were made to the original instrument following a comprehensive appraisal involving a bilingual committee and pilot focus group. The present study outlines the review and adaptation process and examines the psychometric properties of the revised instrument, the Inventario de Síntomas de Trauma-Revisado (IST-R). A sample of 225 students (155 women, 70 men) at the University of Puerto Rico, age 20 to 59 (M = 23.24, SD = 4.69), participated in the validation study. Participants completed a demographic questionnaire; a self-report trauma exposure instrument; and measures of psychological distress, including Spanish-language versions of the Beck Depression Inventory, Symptom Checklist-36, and the Dissociative Experiences Scale. Reliability coefficients for the IST-R clinical scales ranged from .69 to .91 (mean α = .84), and correlation coefficients were strongest for scales measuring the same constructs. Factor loadings obtained were consistent with those reported in the literature. Results support the internal consistency and construct validity of the IST-R. Culturally and linguistically appropriate assessment instruments are needed to address the mental health needs of diverse populations. Results from this study provide evidence for the clinical and research promise of the IST-R as a screening tool for trauma-related symptoms.

Childhood trauma and pain medication prescription in adulthood

Objective. In this study, we examined the relationships between five types of self-reported trauma in childhood and the prescription of pain medications in adulthood. Methods. Using a cross-sectional sample of convenience, we surveyed 80 internal medicine outpatients with regard to five types of childhood trauma (i.e. sexual, physical, emotional abuses; physical neglect; the witnessing of violence). We then retrospectively examined the medical record of each participant for active prescriptions of pain medications during the preceding 4 weeks (i.e. narcotic analgesics, non-steroidal anti-inflammatory drugs or NSAIDS, “other” pain medications). Results. We found that the number of different types of abuse in childhood correlated with NSAID prescriptions, “other” pain medication prescriptions, and the total number of prescribed pain medications—but not with narcotic analgesic prescriptions. Also, no individual form of childhood trauma exceeded the others in contribution. Conclusions. While a greater number of different types of childhood trauma demonstrate an association with a greater number of different pain medications prescribed, according to findings in the medical record, there is no associated increase in the prescription of narcotic analgesics. We discuss the potential implications of these findings.