Trauma Centrality and PTSD Symptom Severity in Adult Survivors of Childhood Sexual Abuse

Theorists have posited that regarding a trauma as central to one's identity leads to greater posttraumatic stress disorder (PTSD) symptom severity. To test this hypothesis, we administered the Centrality of Events Scale (CES) to women reporting a history of childhood sexual abuse (N = 102). The CES scores were correlated with PTSD symptom severity, depression severity, and self-esteem. In addition, we conducted a principal component analysis (PCA) to evaluate factors underlying the CES. The PCA yielded 3 factors reflecting (a) the centrality and integration of the trauma, (b) whether the event is regarded as a turning point in one's life story, and (c) whether the event is a reference point for expectations about the future. Each factor was associated with PTSD symptom severity.Psycholog

Risk Factors and Posttraumatic Stress Disorder: Are They Especially Predictive Following Exposure to Less Severe Stressors?

Background: The diagnosis of posttraumatic stress disorder (PTSD) requires exposure to a traumatic stressor, as defined by Criterion A in the DSM criteria for PTSD. Yet, over the course of successive revisions of the diagnostic manual, the range of qualifying stressors has expanded considerably (e.g., watching terrorist attacks on television). Moreover, stressors that fall short of qualifying for even an expanded Criterion A can produce apparent PTSD. Taken together, these findings imply that people who do satisfy symptomatic criteria for PTSD following exposure to less severe stressors carry a heavy burden of risk factors. Method: To test this hypothesis, we examined whether the association between the risk factor of lower intelligence and more severe PTSD and depression symptoms would be greater among women reporting less severe CSA (n = 15) relative to women who reported moderate (n = 54) or high (n = 31) severity CSA. Results: The evidence was consistent with this hypothesis for subjects in the low and moderate severity groups, but less so for those in the high severity group. Conclusions: Lower intelligence was a more potent risk factor for posttraumatic distress among people exposed to less severe relative to moderately severe stressors.Psycholog

The structure of feared social situations among race-ethnic minorities and Whites with social anxiety disorder in the United States

We investigated feared social situations in individuals with social anxiety disorder from different racial and ethnic groups in the United States. The sample included 247 African Americans, 158 Latinos, and 533 non-Latino Whites diagnosed with social anxiety disorder within the past 12 months from the integrated Collaborative Psychiatric Epidemiology Studies data set. After randomly splitting the full sample, we conducted an exploratory factor analysis with half of the sample to determine the structure of feared social situations in a more diverse sample than has been used in previous studies. We found evidence for a model consisting of three feared social domains: performance/public speaking, social interaction, and observational. We then conducted a confirmatory factor analysis on the remaining half of the sample to examine whether this factor structure varied significantly between the race-ethnic groups. Analyses revealed an adequate fit of this model across all three race-ethnic groups, suggesting invariance of the factor structure between the study groups. Broader cultural contexts within which these findings are relevant are discussed, along with important implications for comprehensive, culturally sensitive assessment of social anxiety.R01 MH078308 - NIMH NIH HHS; R01 MH081116 - NIMH NIH HHS; MH-081116 - NIMH NIH HHS; K23 MH096029 - NIMH NIH HHS; MH-078308 - NIMH NIH HH

The loss of a fellow service member: Complicated grief in postâ 9/11 service members and veterans with combatâ related posttraumatic stress disorder

Bereavement is a potent and highly prevalent stressor among service members and veterans. However, the psychological consequences of bereavement, including complicated grief (CG), have been minimally examined. Loss was assessed in 204 postâ 9/11, when service members and veterans with combatâ related posttraumatic stress disorder (PTSD) took part in a multicenter treatment study. Those who reported the loss of an important person completed the inventory of complicated grief (ICG; nâ =â 160). Over three quarters (79.41%) of the sample reported an important lifetime loss, with close to half (47.06%) reporting the loss of a fellow service member (FSM). The prevalence of CG was 24.75% overall, and nearly one third (31.25%) among the bereaved. CG was more prevalent among veterans who lost a fellow service member (FSM) (41.05%, nâ =â 39) compared to those bereaved who did not (16.92%, nâ =â 11; ORâ =â 3.41, 95% CI: 1.59, 7.36). CG was associated with significantly greater PTSD severity, functional impairment, traumaâ related guilt, and lifetime suicide attempts. Complicated grief was prevalent and associated with adverse psychosocial outcomes in veterans and service members with combatâ related PTSD. Clinicians working with this population should inquire about bereavement, including loss of a FSM, and screen for CG. Additional research examining CG in this population is needed.The loss of a fellow service member occurs commonly and is associated with complicated grief (CG) amongst service members and veterans with combatâ related posttraumatic stress disorder (PTSD). The presence of CG in this study was associated with more severe PTSD, guilt, and lifetime suicide attempts, as well as poorer functioning.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139942/1/jnr24094_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139942/2/jnr24094.pd

Understanding the impact of complicated grief on combat related posttraumatic stress disorder, guilt, suicide, and functional impairment in a clinical trial of post‐9/11 service members and veterans

BackgroundComplicated grief (CG) is a bereavement‐specific syndrome distinct from but commonly comorbid with posttraumatic stress disorder (PTSD). While bereavement is common among military personnel (Simon et al., 2018), there is little research on the impact of CG comorbidity on PTSD treatment outcomes.MethodsTo evaluate the impact of comorbid CG on PTSD treatment outcomes we analyzed data from a randomized trial comparing prolonged exposure, sertraline, and their combination in veterans with a primary diagnosis of combat‐related PTSD (n = 194). Assessment of PTSD, trauma‐related guilt, functional impairment, and suicidal ideation and behavior occurred at baseline and weeks 6, 12, and 24 during the 24‐week trial.ResultsCG was associated with lower PTSD treatment response (odds ratio (OR) = 0.29, 95% confidence interval (CI) [0.12, 0.69], p = 0.005) and remission (OR = 0.28, 95% CI [0.11, 0.71], p = 0.007). Those with CG had greater severity of PTSD (p = 0.005) and trauma‐related guilt (<0.001) at baseline and endpoint. In addition, those with CG were more likely to experience suicidal ideation during the study (CG: 35%, 14/40 vs. no CG 15%, 20/130; OR = 3.01, 95% CI [1.29, 7.02], p = 0.011).ConclusionsComorbid CG is associated with elevated PTSD severity and independently associated with poorer endpoint treatment outcomes in veterans with combat‐related PTSD, suggesting that screening and additional intervention for CG may be needed.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153078/1/da22911_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153078/2/da22911.pd

Examining Cognitive Impairments in Bereaved Adults With and Without Complicated Grief

Grief is a syndrome of cognitions, emotions, and behaviors that commonly arise together following the death of a loved one. It includes intense pangs of emotional pain, yearning for the deceased, emotional numbness, subjective difficulty imagining the future without the deceased, and preoccupation with thoughts related to the death and the deceased. In the initial months following loss, the majority of bereaved adults will experience some or even many elements of this syndrome. For most, the frequency and severity of these elements diminishes over time. However, for some, grief persists for years after the loss; a condition known as complicated grief (CG). These distinct grief trajectories raise a critically important question for grief research: why does grief persist in some individuals, but not others? In this dissertation, I aimed to take an initial step toward answering this question. I first review recent advances in our understanding of the nature of CG and discuss the implications of these advances for research examining the etiology of CG. Most notably, I review how vulnerability factors that render bereaved adults susceptible to experiencing specific elements of the CG syndrome may contribute to the development or maintenance of CG. I then present three studies in which I examined cognitive impairments that may act as vulnerability factors for the core cognitive elements of CG and, thereby, may contribute to the broader CG syndrome. In Paper 1, I examined the ability to resist distracter information and the ability to resist proactive interference; two types of cognitive inhibition that, if impaired, may render bereaved adults vulnerable to experiencing intrusive grief-related cognitions and, thus, the broader CG syndrome. Contrary to my hypotheses, I found no evidence that bereaved adults with CG exhibit deficits in either type of cognitive inhibition for either emotional or non-emotional information relative to a bereaved comparison group without CG. In Paper 2, I examined another type of cognitive control: the ability to shift between mental representations. Contrary to my hypotheses, bereaved adults with CG did not exhibit deficits in cognitive set shifting for either emotional or non-emotional information. In Paper 3, I examined the ability to engage in episodic simulation of novel future events. Consistent with my hypotheses, bereaved adults with CG produced event simulations with fewer episodic details, less perceptual richness, less emotion/thought content, and less episodic richness than did the bereaved comparison group. Together, these studies provide a small step toward identifying cognitive vulnerabilities that may contribute to the development or maintenance of CG. Papers 1 and 2 suggest that general deficits in cognitive control are unlikely to feature prominently in the etiology of CG. Accordingly, in future studies, it will be important for researchers to examine alternative factors that may contribute to the preoccupying grief-related cognitions observed in CG, including cognitive control for more specific types of information than were assessed in this study (e.g., attachment- or grief-related information) and higher-order cognitive variables such as perceived explicability of the loss. Paper 3 providers further evidence that prospection is impaired in bereaved adults with CG and identifies impaired constructive episodic simulation of novel future events as a potential cognitive vulnerability that may contribute to the etiology of the broader CG syndrome.Psycholog