The Role of PTSD and Length of Shelter Stay in Battered Women's Severity of Reabuse after Leaving Shelter

Intimate partner violence (IPV) is associated with significant morbidity, including high rates of reabuse even after women have taken steps to achieve safety. This study evaluated the roles of posttraumatic stress disorder (PTSD) symptom severity and length of shelter stay in the severity of reabuse in 103 IPV victims over a six-month period after leaving a battered women's shelter. Results suggest that the length of shelter stay is inversely related to reabuse severity after leaving shelter. Additionally, more severe PTSD symptoms on shelter exit were associated with greater reabuse severity after leaving shelter. Furthermore, additional study findings support prior research suggesting that the emotional numbing symptoms of PTSD are a significant risk factor for reabuse among IPV victims after leaving shelter.     

Correlates of Readiness to Change in Victims of Intimate Partner Violence

Intimate partner violence (IPV) is a social problem associated with significant morbidity; however, victims do not always utilize treatment and resources. One's readiness to change might be one variable impacting his or her pursuit of treatment and other resources. This study investigated correlates of readiness to change, and readiness to change's impact on treatment utilization. Data were collected from 223 women residing in battered women's shelters. Correlational analyses find that generally victims with more psychopathology and distress, as well as more social support, were more ready to change. Posttraumatic stress disorder symptoms, overall distress, and social support were the strongest predictors of readiness to change. Finally, victims higher in readiness to change were more likely to seek mental health treatment and other IPV-related services.     

Cognitive difficulties and posttraumatic stress disorder in female victims of intimate partner violence

Subjective cognitive complaints of women exposed to intimate partner violence (IPV) and nonabused women were examined using the Cognitive Difficulties Scale (CDS). Cognitive complaints were compared among victims of IPV with a lifetime diagnosis of posttraumatic stress disorder (PTSD) (PTSD+; n=20), victims of IPV without lifetime PTSD (PTSD-; n=21), and a nonabused comparison group (n=22). The results indicated that both the PTSD+ and PTSD- groups had significantly higher levels of self-perceived cognitive difficulties than nonabused women. Furthermore, PTSD symptom severity was found to be positively correlated with self-perceived cognitive difficulties (r=.47). Further research is needed to determine whether cognitive complaints are associated with exposure to IPV, with the subsequent development of PTSD, or with other not yet understood factors. Furthermore, additional work is needed to resolve whether cognitive complaints are accompanied by objective evidence of cognitive dysfunction in victims of IPV.     

Intimate partner violence exposure predicts PTSD treatment engagement and outcome in cognitive processing therapy

Intimate partner violence (IPV) exposure was examined as a predictor of treatment engagement (i.e., starting and completing therapy) and treatment outcome in 150 women taking part in a dismantling study of cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD; Resick et al., 2008). Results indicate that women in a current intimate relationship with recent IPV (i.e., past year) were less likely to begin treatment relative to women who reported past IPV only or no history of IPV. For women who began treatment, IPV exposure was not predictive of whether or not they completed treatment. Among women who began treatment, the frequency of IPV was associated with treatment outcome such that women who experienced more frequent IPV exhibited larger reductions in PTSD and depression symptoms over the course of treatment, but experienced similar levels of PTSD and depression severity at the 6-month follow-up. Findings highlight the importance of targeting treatment engagement among women who report recent IPV and suggest that women who have experienced frequent IPV respond well to CPT treatment in spite of their IPV experiences.     

Relationships between Past Trauma Exposures and PTSD among Survivors of Intimate Partner Violence

This study examined child abuse and community violence exposure as potential risk factors in the development of posttraumatic stress disorder (PTSD) symptoms following exposure to intimate partner violence (IPV). In a community sample of 51 primarily low-income women who had experienced IPV, childhood exposure to child abuse made a unique contribution to PTSD symptom severity from subsequent IPV. Community violence also accounted for variance in PTSD symptom severity, but in the opposite direction, with individuals exposed to community violence reporting lower levels of PTSD symptoms from IPV. These findings suggest the need for further research to identify which factors related to community violence exposure might inoculate individuals against the development of PTSD following IPV exposure.     

Posttraumatic stress disorder among battered women: analysis of legal implications

The diagnosis of posttraumatic stress disorder (PTSD) has recently been applied to the psychological experiences of victims of intimate violence, including physical and sexual assault. The use of trauma theory to explain battered women's responses to violence has laid a foundation for expert testimony on PTSD, where relevant, within more general testimony concerning partner violence. This article discusses the relevance of the PTSD diagnosis within the legal context for explaining battered women's responses to violence.     

Adverse Childhood Experiences,Trauma Symptoms,Mindfulness, and Intimate Partner Violence: Therapeutic Implications for Marginalized Men

Adverse childhood experiences (ACEs) and trauma symptoms have been linked with intimate partner violence (IPV) perpetration and victimization among men, yet the field lacks depth in several key areas hampering progress toward violence intervention. Specifically, posttraumatic stress disorder (PTSD) dominates the field’s scope of trauma symptoms under study, limiting understanding of other manifestations of trauma especially among men. Furthermore, most research focuses exclusively on men’s physical IPV perpetration and rarely focuses on other types of IPV, severity of violence, or men’s victimization. Also, few studies examine potential protective factors grounded in the ACE framework, such as mindfulness, among clinical populations. Finally, most research has not focused on men of color, despite some racial/ethnic minority groups disproportionate rates of IPV exposure. Therefore, the relationships between IPV frequency and severity (psychological, physical, injury) and ACEs, PTSD, trauma symptomology (separate from PTSD), and mindfulness self-efficacy were examined in a sample of 67 predominantly low-income men of color in a batterer intervention program. More than half of the sample (51.5%) reported exposure to four or more ACEs, and 31.1% met the clinical cutoff for a probable PTSD diagnosis. Higher ACE scores predicted increased rates for nearly all types of self-reported IPV perpetration and victimization. PTSD symptoms and complex trauma symptom severity together explained between 13% and 40% of IPV outcomes, and each was uniquely associated with certain types of self-reported IPV victimization and perpetration frequency and severity. Mindfulness self-efficacy was associated with decreased self-report psychological IPV perpetration and victimization frequency and severity. Clinical implications relevant to marginalized men are reviewed, including screening, training, and potential therapeutic interventions.     

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.     

Coping with Intimate Partner Violence: Battered Women's Use and Perceived Helpfulness of Emotion-Focused Coping Strategies

This study investigated intimate partner violence (IPV) victims' emotion-focused coping efforts, as well as their retrospective ratings of the perceived helpfulness of these efforts, in the context of a longitudinal study of battered women's experiences over time. Four hundred and six primarily African American, low-income battered women who had experienced IPV within the previous 12 months were interviewed. Patterns of coping use and perceived helpfulness were explored. The correlation between prevalence of use of emotion-focused coping strategies and perceived helpfulness of these strategies was examined, and results showed that the strategies used by more battered women were less helpful in dealing with feelings about abuse. Implications for clinical interventions with battered women are discussed.     

A Preliminary Investigation of the Relationship Between Emotion Dysregulation and Partner Violence Perpetration Among Individuals with PTSD and Alcohol Dependence

This study examines the link between emotion dysregulation and intimate partner violence (IPV) among 77 individuals with posttraumatic stress disorder (PTSD) and alcohol dependence. Participants were recruited from a residential substance abuse treatment program as part of the eligibility screening for an institutional review board approved clinical trial examining the efficacy of an exposure-based intervention in individuals dually diagnosed with alcohol dependence and PTSD. Participants reported on PTSD symptoms, alcohol use disorder symptoms, emotion dysregulation, and physical and verbal aggression in their intimate relationships during the past year. Findings demonstrated that difficulties with emotion regulation are associated with physical and verbal IPV perpetration in a clinical sample. Although facets of emotion regulation emerged as significant predictors of IPV in the models, alcohol and PTSD symptom severity did not emerge as predictors of IPV. These findings suggest targeted emotion regulation skills training could benefit substance abusers who engage in IPV and that emotion dysregulation might be an important target for future research aimed at understanding elevated rates of IPV perpetration in mental health samples.     

Resource loss,resource gain,and emotional outcomes among inner city women

The authors examined a dynamic conceptualization of stress by investigating how economic stress, measured in terms of material loss, alters women's personal and social resources and how these changed resources impact anger and depressive mood. Resource change in women's mastery and social support over 9 months was significantly associated with changes in depressive mood and anger among 714 inner city women. Greater loss of mastery and social support was associated with increased depressive mood and anger. Loss of mastery and social support also mediated the impact of material loss on depressive mood and anger. Resource loss and worsening economic circumstances had more negative impact than resource gain and improving economic circumstances had positive impact, suggesting the greater saliency of loss than gain.     

An advocacy intervention program for women with abusive partners: Initial evaluation

Experimentally tested the hypotheses that (1) battered women are in need of numerous community resources upon exit from a domestic violence shelter, (2) working with advocates increases women's effectiveness in obtaining needed resources and social support, and (3) success in obtaining resources and social support increases women's levels of life satisfaction and decreases their risk of further abuse. The initial findings of a short-term intervention project designed to provide postshelter advocacy services to women with abusive partners are presented. One-hundred forty-one battered women were interviewed immediately upon their exit from a domestic violence shelter as well as 10 weeks thereafter. Half the sample was randomly assigned to receive the services of trained advocates who assisted them in accessing needed community resources. Women who worked with advocates reported being more effective in accessing resources and had higher levels of social support and overall quality of life postintervention. Although all women reported some decrease in postshelter abuse, there were no differences between those with and those without advocates, and abuse continued to be a problem for many women.     

Intimate Partner Violence, Welfare Receipt, and Health Status of Low-Income African American Women: A Lifecourse Analysis

Although the association among intimate partner violence (IPV), welfare receipt, and health status has been well-established, little is known about the temporal sequencing of these events. In a random sample of low-income African American women in an urban Midwestern county, lifecourse data about IPV and welfare receipt were obtained using the Life History Calendar method (D. Freedman, A. Thornton, D. Camburn, D. Alwin, & L. Young-DeMarco, 1988), along with data about mental and physical health status. Controlling for relevant factors, longitudinal analyses found that previous experience of IPV increased women's odds of receiving welfare benefits in a given year, but previous welfare receipt did not. Cumulative IPV, but not cumulative welfare receipt, was associated with current and past-year health problems. These findings are consistent with the hypothesis that IPV leads women to turn to welfare assistance, and that compromised physical and mental health due to past cumulative IPV interferes with women's gainful employment.     

Treatment choice for PTSD

The impetus for seeking help for assault-related difficulties often rests upon the victims themselves. Yet, we know very little about what factors influence a woman's decision to seek a particular kind of help after an assault. To learn more about these factors, data from 273 women with varying degrees of trauma history and subsequent PTSD symptoms were collected. All participants read a standard, "if this happened to you, what would you do" scenario describing a traumatic event and subsequent trauma-related psychiatric symptoms. Participants were given the same trauma scenario (i.e., sexual assault) and three treatment options to choose from: sertraline (SER), prolonged exposure (PE), or no treatment. Ratings of treatment credibility, personal reactions to treatment options, and treatment choice were examined. Women were more likely to choose PE than SER for the treatment of chronic PTSD. Perceived credibility of the treatment and personal reactions coincided with women's choices. By better understanding who would choose which treatments for PTSD and why, we will improve our ability to tailor how we approach discussing treatment options with these women.     

Initial examination of a multidimensional model of trauma-related guilt: Applications to combat veterans and battered women

Guilt is conceptualized as a multidimensional construct consisting of negative affect and a set of interrelated cognitions. Guilt magnitude is thought to be a function of the magnitudes of six variables posited as primary components of guilt: a negative event, distress, perceptions of responsibility, lack of justification, wrongdoing, and false beliefs about preoutcome knowledge. The model was tested with samples of Vietnam veterans and battered women. Participants rated their reactions to and perceived roles in trauma-related events. Among Vietnam veterans, distress ratings were highly correlated with guilt severity. Cognitive guilt-component variables were significantly correlated with guilt in both groups. In multiple regression, guilt components accounted for 61% of variance in veterans' guilt and 44% of variance in women's guilt. Among veterans, distress ratings were highly correlated with measures of PTSD and depression. In both groups, cognitive guilt-component variables were positively correlated with psychopathology. Results support the view that beliefs about one's role in trauma are important factors in posttrauma adjustment.     

The Ecology of Intimate Partner Violence: Theorized Impacts on Women's Use of Violence

The aim of this paper is to describe the multiple factors associated with intimate partner violence (IPV) using the social-ecological framework developed by Heise (1998). This framework is used to categorize research findings from multiple disciplines according to the level of social organization at which they operate. Evidence-based strategies are then reviewed according to the sphere of influence in the social ecological model, as well as their place on the prevention continuum. Along the way, possible effects on women's use of IPV, and battered women's use of violence in particular, will be noted.     

Partner Violence, Social Support, and Distress Among Inner-City African American Women

This study examined the role of social support in the partner violence–psychological distress relation in a sample of African American women seeking medical care at a large, urban hospital (n = 138). Results from bivariate correlational analyses revealed that partner violence was related to lower perceived social support and greater psychological distress, and lower social support was related to more distress. Furthermore, findings based on path analysis indicated that low levels of social support helped account for battered women's increased distress. Findings point to the need for service providers to screen for partner violence in nontraditional sites, such as hospital emergency rooms, and to address the role of social support resources in preventive interventions with African American battered women.     

Testing Posttraumatic Stress as a Mediator of Childhood Trauma and Adult Intimate Partner Violence Victimization

This study examined whether potential posttraumatic stress disorder (PTSD) mediated the relationships between different forms of childhood trauma (sexual abuse, physical abuse, violence between caregivers) and intimate partner violence (IPV) victimization (psychological, physical, sexual). Participants were 1,150 female nurses and nursing personnel. Path analytic findings revealed potential PTSD partially mediated the relationships between childhood sexual abuse and psychological IPV and childhood sexual abuse and sexual IPV. Potential PTSD did not mediate the relationship between other types of childhood trauma and IPV. This study adds to the literature indicating PTSD as a risk factor for revictimization in the form of adult IPV among women. Screening for and treatment of PTSD among female child sexual abuse survivors could prevent future IPV victimization.     

Examining impelling and disinhibiting factors for intimate partner violence in veterans

We examined correlates of intimate partner violence (IPV) in a military Veteran sample (N = 129) using Finkel's (2007) framework for understanding the interactions between impelling and disinhibiting risk factors. Correlates investigated included head contact events (HCEs), posttraumatic stress disorder (PTSD) symptoms, and antisocial features. Results indicated that antisocial features were significantly associated with IPV at the bivariate level. PTSD symptoms also were associated with IPV, but this association was marginally significant. Tests of moderation provided support for the expectation that HCEs would potentiate associations between antisocial features and IPV. HCEs also moderated the association between PTSD symptoms and IPV. However, contrary to expectations, the opposite pattern emerged such that PTSD symptoms were associated with a higher rate of IPV for those without a history of HCEs. Study findings have potentially important implications for furthering our understanding of the complex etiology of IPV in this population.