Menstrual cycle, beta-endorphins, and pain sensitivity in premenstrual dysphoric disorder.

This study examined pain sensitivity and pain modularity mechanisms (e.g., beta-endorphin levels, blood pressure) in women with premenstrual dysphoric disorder (PMDD; n = 27) and healthy controls (n = 27) during the follicular and luteal phases of the menstrual cycle. Physiological measures were taken during rest and ischemic pain testing. In both cycle phases, PMDD women (a) displayed lower resting cortisol and beta-endorphin levels and (b) exhibited shorter pain threshold and tolerance times and greater pain unpleasantness ratings during pain. PMDD women also reported greater pain unpleasantness and intensity and had lower beta-endorphin levels in their luteal phase and tended to display higher blood pressure levels at rest and during pain testing. Results suggest that endogenous opioids may be pathophysiologically relevant to PMDD and that the hypothalamic-pituitary-gonadal axis may modulate pain sensitivity in PMDD.     

Child Maltreatment,Emotion Regulation,and Posttraumatic Stress: The Impact of Emotional Abuse

This study examined the relationship of emotion regulation to multiple forms of child abuse and subsequent posttraumatic stress. Particular consideration was given to emotional abuse, which has received less attention in the literature. Results from a survey of 912 female college students revealed that women who reported a history of sexual, physical, or emotional abuse endorsed greater emotion regulation difficulties compared to women without abuse histories. Notably, emotional abuse was the strongest predictor of emotion deregulation. Mediation analyses indicated that emotion dysregulation partially explained the relationship between physical and emotional abuse and symptoms of posttraumatic stress, suggesting that intervention efforts aimed at improving emotion regulation strategies might be beneficial in decreasing posttraumatic stress among women with child maltreatment histories.     

Validation of a brief measure of posttraumatic stress disorder: the Distressing Event Questionnaire (DEQ)

The Distressing Event Questionnaire (DEQ) is a brief instrument for assessing posttraumatic stress disorder (PTSD) according to criteria provided in Diagnostic and Statistical Manual of Mental Disorders (4th ed.). The DEQ possesses high internal consistency and exhibited satisfactory short-term temporal stability in studies with Vietnam War combat veterans and battered women. In a sample of Vietnam War veterans and 4 separate samples of abused women (with histories of incest, rape, intimate partner abuse, or prostitution and abuse), the DEQ exhibited very good discriminative validity when judged against structured interview assessment of PTSD. The DEQ exhibited strong convergent validity with other PTSD measures and other indexes of adjustment and also exhibited strong convergent validity as a measure of PTSD across ethnic groups in both the veteran sample and the combined women's sample.     

Gender differences in cardiovascular and hypothalamic-pituitary-adrenal axis responses to psychological stress in healthy older adult men and women

Gender differences in the neuroendocrine and cardiovascular response to psychological stress may contribute to the gender differences in the prevalence of diseases associated with hypothalamic-pituitary-adrenal (HPA) axis reactivity such as cardiovascular disease (CVD), diabetes and hypertension. We measured plasma ACTH, cortisol, heart rate (HR), and blood pressure (BP) responses in 8 men and 8 women (55-75 years) exposed to the Matt Stress Reactivity Protocol (MSRP), a psychological challenge. The MSRP elicited significant increases in HR, systolic-, and diastolic BP, ACTH and cortisol (all p<0.01). Men had significantly greater cortisol and diastolic BP responses compared to women (p<0.05). Additionally, a positive correlation between the ACTH and cortisol responses was only found in the males (r=0.71, p<0.05). There were no group differences in HR, systolic BP, or ACTH responses. We conclude, that among older adults, men respond to psychological stress with greater increases in cortisol, compared to women. This greater activation of the HPA axis could translate into an elevated risk for CVD, diabetes and hypertension and may be related to the higher prevalence of these diseases in males. Gender differences in brain structures and/or cognitive processes may be responsible for these sexually dimorphic stress responses.     

False memories in women with self-reported childhood sexual abuse: an empirical study

Although controversy exists about the validity of memories of childhood abuse, little is known about memory function in individuals reporting childhood abuse. This study assessed memories for previously presented words, including the capacity for false memory of critical lures not actually present in the word list, in 63 subjects, including abused women with posttraumatic stress disorder (PTSD), abused women without PTSD, and men and women without abuse or PTSD. Abused women with PTSD had a higher frequency of false recognition memory of critical lures (95%) than abused women without PTSD (78%), nonabused women without PTSD (79%), or nonabused men without PTSD (86%). PTSD women also showed poorer memory for studied words and increased insertions of non-studied words other than critical lures. These findings are consistent with a broad range of memory alterations in abused women with PTSD.     

The Presence of Psychiatric Disorders in HIV-Infected Women

Many women of low socioeconomic status who have contracted HIV qualify for individual, dual, and multiple psychiatric diagnoses that predate their knowledge of their HIV infection. Two case studies of HIV-infected women are presented. Psychoactive substance use disorders are the most common Axis I diagnoses, followed by depression. The most frequently diagnosed Axis II disorders are borderline and antisocial personality disorders. These women reported histories that often included alcohol and other drug use, childhood sexual abuse, violent interpersonal relationships, depression, and learning disabilities. Earlier intervention addressing these problems might have prevented the onset of psychiatric disorders as well as high-risk behaviors that lead to HIV infection.     

父母早期受虐与子女对立违抗症状的关系:亲子虐待和儿童愤怒管理的作用

本研究探讨了父母的早期受虐经历与子女的对立违抗症状的关系,通过构建一个有调节的中介模型,考察了亲子虐待的中介效应和儿童愤怒管理对该效应的调节作用。采用问卷法对359名来自北京市、山东省和云南省的14所小学一至五年级的儿童及其父母进行调查,研究工具包括儿童对立违抗症状评估表、童年期创伤问卷、儿童愤怒管理量表。结果发现：（1）男孩的ODD症状得分显著高于女孩;男孩受到的躯体虐待、情感忽视和躯体忽视显著多于女孩（2）在控制了儿童性别后,父母在童年期的受虐经历仍可显著正向预测其成年期的家庭中子女的ODD症状;（3）亲子虐待在父母受虐和子女ODD症状之间起完全中介作用,即父母受虐通过亲子虐待间接影响子女ODD症状;（4）父母受虐通过亲子虐待影响子女ODD症状的中介效应后半路径受到子女个体水平愤怒失调（AD）的调节,具体来说,当AD水平较高时,亲子虐待对ODD症状的影响更大;但愤怒应对（AC）和愤怒抑制（AI）对中介效应无显著调节作用。     

Facial expression recognition ability among women with borderline personality disorder: implications for emotion regulation?

This study examined recognition of facial expressions of emotion among women diagnosed with borderline personality disorder (BPD; n = 21), compared to a group of women with histories of childhood sexual abuse with no current or prior diagnosis of BPD (n = 21) and a group of women with no history of sexual abuse or BPD (n = 20). Facial recognition was assessed by a slide set developed by Ekman and Matsumoto (Japanese and Caucasian Facial Expressions of Emotion and Neutral Faces, 1992), expanded and improved from previous slide sets, and utilized a coding system that allowed for free responses rather than the more typical fixed-response format. Results indicated that borderline individuals were primarily accurate perceivers of others' emotions and showed a tendency toward heightened sensitivity on recognition of fear, specifically. Results are discussed in terms of emotional appraisal ability and emotion dysregulation among individuals with BPD.     

Stress, Cortisol, and Externalizing Behavior in Adolescent Males: An Examination in the Context of Multisystemic Therapy

Stress and hypothalamic-pituitary-adrenal (HPA) axis dysregulation have been associated with externalizing behavior in adolescence, but few studies have examined these factors in a treatment context. This study investigated the relationship between stress, cortisol, and externalizing behavior among 120 adolescent males (mean age?=?15) receiving Multisystemic Therapy (MST). To examine the differential relationship of cortisol with various types of stressors, self-report measures assessed lifetime stress, current episodic stress, and daily hassles. Morning and afternoon cortisol samples were collected to examine whether the relationship between stress and treatment outcome depended on the youth's biological stress levels. Regression analyses indicated that awakening cortisol levels moderated the relationship between daily hassles and externalizing behaviors at post-treatment. More specifically, higher levels of daily hassles predicted worse outcomes only among adolescents with high levels of morning cortisol. In addition, lifetime stressors and afternoon measures of cortisol interacted to predict changes in caretaker reports of externalizing problems and youth arrests following treatment; lifetime stressors were positively associated with externalizing behavior when adolescents had low levels of afternoon cortisol. Implications for theory and future directions for evidence-based treatment are discussed.     

THE NEED FOR POWER IN WOMEN WHO WERE SEXUALLY ABUSED AS CHILDREN An Exploratory Study

Ten women who had been sexually abused as children and a matched group of women who had not been sexually abused participated in a preliminary study to explore the hypothesis that feelings of powerlessness and a compensatory need for power continue into adulthood for survivors of childhood sexual abuse. The Picture-Story Exercise (PSE) was used as an indirect assessment technique to determine the level of the need for power (McClelland, 1985; Winter, 1973, 1988). Results indicated that the stories of women with sexual abuse histories revealed a higher need for power and greater fear of power than those of nonabused women. Further content analysis of the PSE revealed that sexual abuse survivors' stories also contained more references to Finkelhor and Browne's (1986) dynamics of powerlessness, traumatic sexualization, betrayal, and stigmatization. These findings suggest important directions for future research as well as areas for therapeutic exploration.     

Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder

A childhood history of sexual or physical abuse is highly prevalent in borderline personality disorder (BPD) and is associated with self-destructive behavior in clinical and nonclinical samples. Viewing BPD as a "high risk" disorder, we asked if childhood abuse was a risk factor for adult suicidal behavior or if it was related to other known risk factors for suicide in BPD. A semistructured Abuse History was obtained in 61 criteria-defined BPD patients, who were characterized by structured interviews and self-reports for Axis I disorders, Suicide History, BPD severity, hopelessness, impulsivity, impulsive-aggression, and antisocial traits. Occurrence and severity of childhood sexual abuse, but not physical abuse, predicted adult suicidal behavior independent of other known risk factors. The odds of a sexually abused patient attempting suicide in adulthood was over 10 times that of a patient who was never sexually abused. Given a history of childhood sexual abuse, the risk of adult suicidal behavior in BPD was increased by antisocial traits, severity of BPD, hopelessness, or comorbid major depressive episode (MDE).     

False recognition in women reporting recovered memories of sexual abuse

False recognition—the mistaken belief that one has previously encountered a novel item—was examined in four groups of subjects: women reporting recovered memories of childhood sexual abuse, women who believe that they were sexually abused as children but who cannot recall this abuse (the "repressed" group), women who were sexually abused as children and always remembered the abuse, and women with no history of childhood sexual abuse. Subjects were administered a Deese/Roediger-McDermott paradigm. The results suggest that the recovered-memory group was more prone to false recognition than the other groups. In addition, women reporting recovered and repressed memories showed greater reduction in false recognition across study trials than did other subjects, perhaps reflecting strategic changes in performance.     

Exploring Gender Differences in the Association Between Childhood Physical Abuse and Thyroid Disorders

This study used a regional subsample (n = 13,070) from the 2005 Canadian Community Health Survey to explore the independent contribution of childhood physical abuse to thyroid conditions in adulthood. Gender-specific logistic regression analyses controlled for age and race, in addition to 5 clusters of variables: childhood stressors, health behaviors, general stress levels, mental health, and socioeconomic status. No significant relationship between childhood abuse and thyroid conditions was found in men; however, childhood physical abuse was associated with higher odds of thyroid conditions among women, independent of a wide range of factors. In a fully adjusted model, abused women had 40% higher odds of thyroid conditions compared to their non abused peers, 95% CI [1.05, 1.87]. Future research on gender differences in the abuse–thyroid relationship is warranted.     

PTSD,comorbid depression,and the cortisol waking response in victims of intimate partner violence: preliminary evidence

Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV). Hypothalamic–pituitary–adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, area under the waking curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD + MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed.     

Relationships of borderline features to parental mental illness, childhood abuse, Axis I disorder, and current functioning

Although a number of studies have investigated single, putative etiological factors for borderline personality disorder (BPD), few studies have assessed the relations between multiple etiological factors and borderline features within the same study. Borderline features, parental psychopathology, childhood physical and sexual abuse, lifetime Axis I disorder, and current functioning were assessed in 65 nonclinical participants, a portion of which exhibited significant BPD features. Multivariate models were tested and results indicated that parental mental illness and lifetime Axis I disorder were significant and unique predictors of borderline scores. Borderline features accounted for significant variance in current functioning beyond what was accounted for by other predictors; borderline scores mediated the relations between lifetime Axis I disorder and current functioning.     

Perceived stress and physiological dysregulation in older adults

We use a population-based representative sample of older Taiwanese to investigate links between respondents' perceived levels of stress and a broad set of biological measures. These biomarkers were collected at a single time (2000) and reflect sympathetic nervous system (SNS)-activity, hypothalamo-pituitary-adrenal (HPA)-activity, immune function, cardiovascular function, and metabolic pathways. We model the relationship between perceived stress and (1) extreme values for each of 16 individual biological indicators; and (2) a measure of cumulative physiological dysregulation based on the full set of biomarkers. We consider two measures of perceived stress, one derived from the 2000 interview and the second based on data from three interviews (1996-2000). Age and sex-adjusted models reveal significant associations between measures of perceived stress and extreme values of cortisol, triglycerides, interleukin-6 (IL-6), dehydroepiandrosterone sulphate (DHEAS) and fasting glucose. Examined individually, numerous biomarkers, including those pertaining to blood pressure and obesity, are not significantly related to perceived stress. Jointly, however, the measure of cumulative physiological dysregulation is associated with both the level of perceived stress at a given time and to a longitudinal measure of perceived stress. Some results suggest that the relationship between level of perceived stress and physiological response is stronger for women than men.     

Commonality and specificity of personality disorder profiles in subjects with trauma histories.

Recently, attention has been drawn to a range of disturbances in personality functioning that commonly characterize individuals with a history of severe or prolonged trauma. Many of these features overlap with criteria for some of the Axis II personality disorders. The current study investigated the similarity of personality disorder features in different samples of patients with trauma histories, and specificity of such features compared to other psychiatric samples. Profiles of Axis II features, based on relative frequencies of individual disorder "diagnoses" derived from a common measure (Personality Diagnostic Questionnaire-Revised), were compared in three trauma samples: male Vietnam combat veterans with PTSD, female inpatients with a history of childhood sexual abuse, and female outpatients with a history of childhood sexual abuse. The PDQ-R derived profiles in each of the three trauma samples were then compared with similar PDQ-R derived profiles in published reports of psychiatric samples selected for other diagnoses. Each of the three Spearman rank correlations among the three trauma samples were significant, ranging from .72 to .94. There was a clear pattern of higher correlations within the trauma samples (average correlation of .81) than between the trauma and nontrauma samples (average correlations of .11, .36, and .25 between the nontrauma samples and the combat sample, inpatient sexual abuse sample, and outpatient sexual abuse sample, respectively). The findings suggest that a pattern of personality disorder features may be distinctly associated with individuals with trauma histories, at least of the type examined here. Future studies using more clinically valid measures of personality features and including other types of trauma samples are needed to determine the generalizability of the current findings. Also needed are studies with longitudinal designs to address questions of causal pathways that may underlie such associations.     

Treatment outcomes for female offenders: relationship to number of Axis I diagnoses

This article describes a study that examined the relationship between multiple Axis I mental health diagnoses and treatment outcomes for female offenders in prison substance abuse treatment programs. Preliminary findings of the effectiveness of therapeutic community (TC) treatment, modified for female offenders, relative to a control cognitive behavioral treatment condition, are presented. The hypothesis--that participants who fit into multiple diagnostic categories have more dysfunctional symptoms and behaviors at baseline--was confirmed; however, a hypothesized relationship between the number of Axis I diagnoses and 6 month treatment outcomes across five domains (mental health, trauma exposure, substance use, HIV needle risk behaviors, and HIV sexual risk) was not supported. Across all Axis I mental health groups, TC treatment was significantly more effective than the control condition overall, as well as on measures of mental health symptoms and HIV sexual risk. These findings suggest that this TC treatment program, as modified, is an effective model for women with varied diagnoses and diagnostic complexities.     

Antisocial personality disorder, affect dysregulation and childhood abuse among incarcerated women

The aim of this study was to examine the role of affect dysregulation and childhood abuse in antisocial personality disorder (ASPD), using a sample of incarcerated women. Subjects for this study were 85 incarcerated women who were administered structured interviews to assess for ASPD, borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), childhood trauma, and affect dysregulation. Using a series of logistic regressions, this study found that a greater degree of affect dysregulation--in particular, poor anger modulation--was significantly related to ASPD, controlling for BPD and PTSD in women prisoners. After controlling for BPD, recent self mutilation was not significantly related to ASPD. Likewise, a history of childhood abuse was not significantly associated with ASPD.     

Histories of sexual abuse in adolescent male runaways

In this study, data on sexual victimization in the histories of 89 Canadian male runaways as well as information on physical victimization, family structure, family financial stability, delinquent and criminal activities, and reasons for running away from home were evaluated. The population of male runaways evidenced dramatically higher rates of sexual and physical abuse than did randomly sampled populations. Sexually abused and nonsexually abused male runaways shared characteristics noted in the literature as common to runaways: problem families, high rates of delinquency, depression, tension, low self-image, and history of physical abuse. Sexually abused male runaways differed from nonsexually abused runaways in their reactions to their runaway event, with sexually abused male runaways responding in highly avoidant patterns coupled with extreme withdrawal from all types of interpersonal relationships. These differences are explained as consistent with known sequelae of sexual abuse, and the implications for treatment by runaway shelters and for further research are suggested.