Predicting PTSD symptoms in victims of violent crime: the role of shame, anger, and childhood abuse

To examine the role of cognitive-affective appraisals and childhood abuse as predictors of crime-related posttraumatic stress disorder (PTSD) symptoms, 157 victims of violent crime were interviewed within 1 month post-crime and 6 months later. Measures within 1 month post-crime included previous physical and sexual abuse in childhood and responses to the current crime, including shame and anger with self and others. When all variables were considered together, shame and anger with others were the only independent predictors of PTSD symptoms at 1 month, and shame was the only independent predictor of PTSD symptoms at 6 months when 1-month symptoms were controlled. The results suggest that both shame and anger play an important role in the phenomenology of crime-related PTSD and that shame makes a contribution to the subsequent course of symptoms. The findings are also consistent with previous evidence for the role of shame as a mediator between childhood abuse and adult psychopathology.     

Hardiness as a Moderator of Shame Associated with Childhood Sexual Abuse

An adult female sample of childhood sexual abuse survivors (n = 195) were surveyed to determine if hardiness was effective in moderating the negative effects of the perceived trauma and severity of the sexual abuse and internalized shame on relationship intimacy. The results indicated that perception of abuse, severity of abuse, and shame were significantly and negatively related to hardiness. Hardiness was found to have a significant moderating effect on the negative impact of internalized shame and severity of abuse on marital/relationship intimacy.     

儿童期受虐经历与抑郁的元分析

本研究采用元分析技术探讨儿童期虐待亚类型与抑郁的关系。通过文献搜索与检查获得了31项研究和92个独立效应量,共包含24283名被试。元分析表明儿童期虐待亚类型(心理虐待与忽视、性虐待、身体虐待与忽视)对抑郁障碍存在不同程度的影响,其中心理虐待与忽视影响程度最高;另外,被试的年龄、性别可以调节儿童期虐待与抑郁的关系。这些结果表明了在预防和治疗儿童期不良经历对抑郁影响时,尤其要关注心理虐待与忽视的消极影响,且应给予青少年群体、女性更多的关注和保护。     

Sexual Abuse and Eating Disorders: A Test of a Conceptual Model

To provide a better conceptual understanding and to stimulate further research, A. Kearney-Cooke and R. H. Striegel-Moore (1994) proposed several theoretical models concerning the relationship between sexual abuse and eating disorders. In this study, we tested the model that hypothesized an indirect relationship between sexual abuse and eating disorders, with the effects of sexual abuse being mediated through bodily shame and body disparagement. Three hundred thirty female undergraduates from a large southwestern public university participated. The women represented the social class of the university, which is predominantly middle to upper-middle class. Race/ethnicity of the participants was 69.8% Caucasian, 15.9% African American, 5.8% Latino/Mexican American, 4.9% Asian American, and 0.9% Native American; the remainder did not indicate their race/ethnicity. Of the total sample, 60% reported having been sexually abused at some point in their lives; 21% had experienced abuse prior to age 14. Almost 8% were categorized as having a diagnosable eating disorder, whereas another 72.7% were symptomatic. To test the hypothesized model, structural equation modeling with LISREL 8.3 (K. G. Joreskog & G. Sorbom, 1999) was used. Results indicated that the model fit the data well and the hypothesized relationships among the variables were in the expected directions. Sexual abuse predicted higher levels of bodily shame that, in turn, predicted increases in body disparagement. As expected, only body disparagement directly predicted eating disorder symptoms. Directions for future research are discussed.     

Cognitive-Behavioral Treatment of Depression, Part IX: Confronting Predisposing Factors

Cognitive-behavioral therapy can help many depressed clients learn more effective ways of coping with problems in their lives. However, for many clients with chronic or recurrent depression, it can be helpful to examine the biological, psychological, and social/cultural factors that may predispose a person toward depressive episodes. In order to address possible biological predispositions, it is important to assess for a positive family history of depression, evaluate family members' response to previous treatments, and refer for medications when needed. In order to address possible psychological predispositions, it is useful to evaluate long-standing personality styles, identify negative events from childhood, examine the client's relationship with his or her parents, evaluate the history of abuse, and identify early loss experiences. Cultural factors may play an influential role in the etiology of depression, and can be useful to incorporate into a broad treatment plan. However, cultural factors are difficult to modify through individual psychotherapy. Hence, they are unlikely to play a central role in cognitive-behavioral therapy for depression. Overall, therapists working with depressed clients should be prepared to confront a broad range of biological, psychological, and environmental factors that can create or perpetuate a client's risk for depression.     

Cognitive mediation of childhood maltreatment and adult depression in recent crime victims

Childhood maltreatment has been linked to adult depressive disorders. However, few studies have examined mechanisms through which childhood maltreatment may contribute to adult depression. Thus, we examined the role of one potential mechanism of this relationship, maladaptive cognitions, in a recently traumatized sample. Participants were adult women who had been recently raped (n = 133) or physically assaulted (n = 73). We examined whether maladaptive self-and other-cognitions mediated relationships between childhood sexual, physical, and emotional abuse and current depression. Relationships between childhood sexual abuse and both current depression symptoms and diagnosis were mediated by maladaptive cognitions about self. Relationships between both childhood sexual abuse and childhood physical abuse and adult depressive symptoms were mediated by maladaptive cognitions about others.     

Additive impact of childhood emotional,physical, and sexual abuse on suicide attempts among low-income African American women

This study examines the association between exposures to multiple forms of childhood abuse (emotional, physical, sexual) and adult suicidal behavior in a sample of low-income, African American women. We hypothesized a linear relation between childhood abuse and risk for making a suicide attempt, such that the more forms of childhood abuse to which a woman was exposed, the greater her risk would be to make a suicide attempt. Logistic regression analyses revealed that, compared to women who did not report any experiences of childhood abuse, women who experienced one, two, or three forms of abuse were 1.83, 2.29, or 7.75 times more likely to attempt suicide, respectively (all statistically significant). Furthermore, compared to women who reported one or two types of abuse, women who reported all three types of abuse were statistically more likely to attempt suicide. These findings have implications for clinicians working with African American women who report either childhood abuse or exhibit suicidal behavior.     

Childhood Abuse,Nonsuicidal Self‐Injury,and Suicide Attempts: An Exploration of Gender Differences in Incarcerated Adults

The relationship between types of childhood abuse, suicide attempts, and nonsuicidal self‐injury (NSSI) was examined in a sample of 415 incarcerated adults (268 men, 147 women). Men and women were equally likely to experience childhood abuse, although women were more likely to report sexual abuse and men were more likely to report emotional neglect. Sexual abuse was the only type of abuse found to predict NSSI and suicide attempts in women. For men, physical abuse and physical neglect were significant predictors of NSSI and suicide attempts, respectively. Gender differences exist and should be examined in future research in this area.     

Autobiographical memory specificity in adults reporting repressed,recovered, or continuous memories of childhood sexual abuse

Some psychotherapists believe that adult survivors of childhood sexual abuse (CSA) are characterised by memory deficits for their childhood. Using the Autobiographical Memory Test (AMT), we asked nonabused control participants and participants who reported either continuous, recovered, or repressed memories of CSA to retrieve a specific personal memory in response to either positive or negative cue words from either childhood or adolescence/adulthood. The results indicated that participants who believed they harboured repressed memories of abuse tended to exhibit the greatest difficulty retrieving specific memories from their childhood. Neither posttraumatic stress disorder (PTSD) nor major depression was related to diminished memory specificity.     

Potentially Traumatic Experiences,Academic Performance,and Psychological Distress: The Role of Shame

The purpose of this study was to investigate the role of shame associated with previous potentially traumatic experiences, satisfaction with academic performance, and psychological distress among college students (N = 245) in Mainland China. Results indicated that previous experiences of potentially traumatic events were directly related to depressive symptoms and indirectly related through characterological shame and hopelessness. In addition, characterological shame and bodily shame were 2 distinct forms of shame that had unique associations with psychological distress.     

Faces of Shame: Implications for Self-Esteem,Emotion Regulation,Aggression, and Well-Being

There is an increasing interest in psychological research on shame experiences and their associations with other aspects of psychological functioning and well-being, as well as with possible maladaptive outcomes. In an attempt to confirm and extend previous knowledge on this topic, we investigated the nomological network of shame experiences in a large community sample (N = 380; 66.1% females), adopting a multidimensional conceptualization of shame. Females reported higher levels of shame (in particular, bodily and behavioral shame), guilt, psychological distress, emotional reappraisal, and hostility. Males had higher levels of self-esteem, emotional suppression, and physical aggression. Shame feelings were associated with low self-esteem, hostility, and psychological distress in a consistent way across gender. Associations between characterological shame and emotional suppression, as well as between bodily shame and anger occurred only among females. Moreover, characterological and bodily shame added to the prediction of low self-esteem, hostility, and psychological distress above and beyond the influence of trait shame. Finally, among females, emotional suppression mediated the influence of characterological shame on hostility and psychological distress. These findings extend current knowledge on the nomological net surrounding shame experiences in everyday life, supporting the added value of a multidimensional conceptualization of shame feelings.     

To Add Insight to Injury: Childhood Abuse,Abuse Perceptions,and the Emotional and Physical Health of Young Adults

Although childhood abuse is strongly associated with psychological difficulties, survivors may not perceive their experiences as abusive. Depression, anxiety, dissociation, and physical health complaints may decrease perceptions of abuse and may also be exacerbated by individuals' abuse perceptions. The current study examined abuse perceptions, abuse experiences, and current symptoms among 185 university students. Ninety-six participants repeated the study 1–2 years later. At Time 1, self-labeling as “abused” or “maltreated” was not related to psychological or physical health symptoms. At Time 2, self-labeling as “abused” or “maltreated” was positively related to depression, anxiety, and dissociation. Results indicate that abuse perceptions may change over time and may be connected with emotional and physical symptoms.     

The role of childhood abuse and neglect in the sensitization to stressful life events in adolescent depression

This study examined the role of childhood abuse and neglect in sensitizing adolescents to the effects of proximal stressful life events in a cross-sectional sample of 103 depressed and nondepressed adolescents. Consistent with hypotheses, adolescents with a history of childhood abuse and/or neglect reported a lower level of threat of stressful life events prior to episode onset than that reported by those without. This effect was specific to those on their 1st episode of depression and was specific to independent events (i.e., stressors outside of adolescents' control). Further, this effect was robust when controlling for level of chronic difficulties, which was higher in those with childhood abuse and/or neglect. The authors suggest that childhood abuse and/or neglect may be an important risk factor that sensitizes individuals to the effects of acute independent life events.     

Perfectionism,Shame, and Depressive Symptoms

The authors examined the relationship between depression, maladaptive perfectionism, and shame. Regression analyses were used to replicate a model in which maladaptive perfectionism was negatively associated with self‐esteem and positively associated with symptoms of depression, with self‐esteem mediating the effects of maladaptive perfectionism on depressive symptoms. Additional models showed that the path from maladaptive perfectionism to depression was partially mediated by shame, although these paths differed for men and women.     

Childhood trauma from a patient and a psychoanalyst perspective: linking chronic depression to relational multiple trauma

The relationship between multiple childhood trauma, as well as adversity, and chronic depression has been reported repeatedly. However, there is a lack of clinical differentiations of these findings. We complemented patient self-ratings, using the Childhood Trauma Questionnaire (CTQ), with psychoanalysts’ perspectives in order to provide finer grained clinical differentiations of the trauma behind chronic depression. These differentiations connect the trauma scales with early relational experiences. We developed a bespoke instrument derived from psychoanalytic trauma concepts. A subsample of 52 cases of chronically depressed patients alongside their 24 psychoanalysts was taken from the LAC depression study, in order to complement patient and psychoanalyst ratings. Our results confirm the connection between multiple childhood trauma and chronic depression. Besides relational trauma, the psychoanalysts’ perspective found separation trauma and transgenerational transmission of trauma to be significant. These traumatic relationships seem to precede and accompany adverse life events and/or traumatic experiences. They may even prevent adequate coping and/or processing of such experiences. Patient interview material from study intake and five-year follow-up further provides an insight into the changes the trauma narratives undergo throughout time. These changes emerged due to a joint reconstruction of the meaning of traumatic experiences throughout the course of the psychoanalytic process.     

Anxiety and depression as correlates of self-reported behavioural inhibition in normal adolescents

In a previous study, Muris, Merckelbach, Wessel, and Van de Ven [Psychopathological correlates of self-reported behavioural inhibition in normal children. Behav. Res. Ther. 37 (1999) 575-584] found that children who defined themselves as high on behavioural inhibition displayed elevated levels of psychopathological symptoms compared to children who defined themselves as low or middle on behavioural inhibition. The present study further examined the relationship between self-reported behavioural inhibition and anxiety disorders and depression symptoms in a large sample of adolescents aged 12-18 years (N=968). Adolescents completed a measure of behavioural inhibition and questionnaires of anxiety and depression. Results indicated that adolescents who classified themselves as high on behavioural inhibition had higher scores of anxiety and depression than adolescents who classified themselves as low or middle on behavioural inhibition. Structural equations modelling was employed to test hypothetical models on the role of behavioural inhibition in childhood anxiety and depression. It was found that a pathway in which behavioural inhibition results in anxiety, which in turn leads to depression, provided the best fit for the data.     

The Severity of Childhood Abuse and Neglect in Relationship to Post-Traumatic Stress Disorder Among Female Sex Workers in the Netherlands

In this article, the relationship between childhood abuse and neglect and post-traumatic stress disorder (PTSD) in adulthood is examined in a sample of 123 female indoor sex workers in the Netherlands. It was hypothesized that the severity of childhood abuse and neglect is associated with the severity of PTSD. In this study, a substantial number of sex workers had experienced abuse, neglect, or both during childhood. Furthermore, a substantial number suffered from PTSD. Results show significant differences between sex workers suffering from PTSD and sex workers not suffering from PTSD, in the extent to which they have experienced abuse or neglect. Logistic regression analysis shows emotional abuse contributes significantly to the prediction of PTSD. Our findings suggest that the high rate of PTSD among sex workers might be partially related to childhood experiences, indicating that a number of sex workers might be traumatized before entering sex work.     

The effectiveness of family therapy and systemic interventions for child-focused problems

This review updates a similar paper published in the Journal of Family Therapy in 2001. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family-based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, ADHD, delinquency and drug abuse); emotional problems (including anxiety, depression, grief, bipolar disorder and suicidality); eating disorders (including anorexia, bulimia and obesity); and somatic problems (including enuresis, encopresis, recurrent abdominal pain, and poorly controlled asthma and diabetes).     

Childhood Abuse,the Interpersonal–Psychological Theory of Suicide,and the Mediating Role of Depression

Although childhood abuse is a well‐known risk factor for suicide, no studies have investigated the role of interpersonal–psychological (Joiner, 2005), constructs in this association. This study examined whether childhood physical, sexual, and emotional abuse were associated with IPTS constructs, and whether depressive symptoms mediated these associations. Ninety‐one participants completed self‐report measures. Emotional abuse predicted perceived burdensomeness and thwarted belongingness, and depressive symptoms mediated these associations. Physical abuse predicted the acquired capability for suicide, although depression did not mediate this association. These findings suggest that specific types of abuse differentially predict IPTS components and underscore depression as a potential mechanism.     

Effects of Incest in Aging Survivors: Psychopathology and Treatment Issues

Most older people who have been sexually abused in childhood have probably never been treated for the consequences of their destructive experiences. The character pathology and long-term effects of child sexual abuse are described. Parallels were drawn between delayed Posttraumatic Stress Disorder seen in older veterans and World War II victims and later-life onset of posttraumatic psychopathology in aging incest survivors. Special geropsychological treatment issues, such as the appropriateness of explicit inquiry regarding a history of abuse and the role of power, gender, and shame in the psychotherapeutic relationship, are presented. The dilemma of uncovering repressed malignant childhood trauma in aging individuals is discussed. With proper medical and psychological preparation, demanding curative interventions with older survivors may be considered.