Gender Differences in Trauma Types and Themes in Veterans with Posttraumatic Stress Disorder

Background: This study aimed to determine whether there were gender differences in trauma types and cognitive-emotional themes among veterans with deployment-related posttraumatic stress disorder (PTSD). Methods: Case notes or writing excerpts from two pilot studies were reviewed to determine types of traumas and emerging themes, with 20 women and 31 men comprising the sample. Results: Most women developed PTSD after sexual assault, with reactions emphasizing mistrust, betrayal, and anger. Men experienced more combat, with reactions including survivor guilt, moral injury, and horror. Conclusions: Both genders developed PTSD, but the causes of and reactions to their traumas differed. Emerging themes can be useful treatment foci.     

100 Years of Trauma: the Armenian Genocide and Intergenerational Cultural Trauma

The events of the Armenian Genocide of 1915, during which more than 1.5 million Armenians were massacred by the Ottoman Turkish Empire, has left a deep, painful scar on this small but prominent culture. Those who lived through the Armenian Genocide survived death marches, rapes, drownings, physical mutilation, and other such heinous crimes. As they have passed, it is being recognized that subsequent generations continue to fight for justice, manifesting their ancestral pain, sadness, and mourning for the loss of their family members. As sociocultural trauma has a multigenerational impact within families and communities and affects the feeling of membership and belonging within that community, understanding how previous traumas shape future generations of that group is important for clinicians. This article reviews the scarce research on intergenerational trauma in the Armenian community within the United States after the Armenian Genocide, using the constructivist self-development theory to provide clinical implications and suggestions.     

Overcoming a Legacy of Conflict: The Repercussive Effects of Stress and Intergenerational Transmission of Trauma Among Vietnamese Americans

The modern narrative of Vietnamese people is often strongly associated with events of the 20th century, such as the Vietnam War, but a legacy of strife in Southeast Asia spans many centuries. Enduring stress and trauma has pernicious psychological and physiological repercussions that have affected first and later generations of Vietnamese American refugees. To contextualize the present-day narrative, we review the history of Vietnam and the contemporary refugee experience in the United States. We then examine more proximal spheres of influence, including community and family. Finally, we review individual experiences of stress and trauma. We present recommendations to inform individual, group, family, and community-based counseling interventions, as well as recommendations for future research.     

Trauma Competency: An Active Ingredients Approach to Treating Posttraumatic Stress Disorder

Meta‐analytic studies have extracted 4 common elements among effective posttraumatic stress disorder treatments: cognitive restructuring and psychoeducation, a deliberate and continually improving therapeutic relationship, relaxation and self‐regulation, and exposure via narrative of traumatic experiences. The authors present a clinical treatment structure catalyzing these active ingredients into discrete therapeutic tasks that counselors can focus on to maximize treatment effectiveness. The 4 tasks represent an attempt to identify critical competencies and baseline standards for the field of trauma counseling.     

Intergenerational Transmission of Trauma-Related Distress: Maternal Betrayal Trauma,Parenting Attitudes,and Behaviors

The purpose of this study was to elucidate mechanisms involved in the intergenerational transmission of trauma-related distress. This study investigated whether betrayal trauma (BT; abuse by a person close to the victim) and specific parenting attitudes and behaviors among mothers with child abuse histories predicted internalizing and externalizing symptoms in their children. Mothers and children (ages 7–11) were recruited for a project on parenting and stress (N = 72). Maternal betrayal trauma predicted both internalizing (β = 0.33, p < .01) and externalizing symptoms (β = 0.25, p < .05) even when controlling for mothers’ trauma-related symptoms. Negative attitudes toward limit setting predicted externalizing symptoms (β = ?0.33, p < .05). Poorer communication (β = ?0.39, p < .05) but higher parenting satisfaction (β = 0.38, p < .01) predicted internalizing symptoms. These findings demonstrate the importance of assessing maternal trauma and parenting characteristics as part of interventions with symptomatic children.     

Recognizing Trauma and Posttraumatic Stress Disorder Symptoms in Individuals With Psychotic Disorders

The majority of individuals diagnosed with a psychotic episode also meet symptom criteria for posttraumatic stress disorder (PTSD; Mueser, Lu, Rosenberg, & Wolfe, 2010 ). Unfortunately, trauma from both previous life events and the experiences of a psychotic episode as well as PTSD symptoms are rarely recognized in this population. Steps to assessing trauma history and PTSD symptoms and initiating treatment in a client diagnosed with a psychotic disorder are highlighted.     

Spirituality and Trauma: The Role of Clergy in the Treatment of Posttraumatic Stress Disorder

An increased awareness of the spiritual aspects of health and illness has recently led to changes in psychiatry residency training as well as hospital accreditation requirements. The spiritual impact of trauma has been an area of particular interest, as trauma evokes certain existential questions and crises. It is estimated that from 5–11% of trauma survivors will go on to develop posttraumatic stress disorder (PTSD). Given the spiritual challenges of the experience of trauma, patients with PTSD could benefit from spiritual assessment and intervention as part of their overall treatment plan, and clergy can be utilized to perform this. The literature exploring the spiritual impact of trauma and the use of clergy in the treatment of trauma survivors is reviewed. The methods used by three chaplains in a residential treatment program for PTSD at one facility are described and discussed. Both the literature and the experiences of the clergy suggest that exploration of trauma-related existential conflicts in patients with PTSD is beneficial. However, there is a notable dearth of controlled scientific studies evaluating the effectiveness of spiritual interventions with this treatment population. The need for controlled studies to verify the usefulness of spiritual assessment and intervention in patients with PTSD is noted, and a more rigorous analysis of how clergy can best serve this treatment population is encouraged.     

Intergenerational Transmission of Violence: Shattered Subjectivity and Relational Freedom

This article considers a relational perspective regarding the intergenerational transmission of the trauma of violence. The psychoanalytic literature suggests that parents often transmit the trauma of violence to their children in the form of projected nameless dread and unmentalized states that interfere with the children's emotional needs and support. The offspring absorbs the trauma, which manifests itself in the form of disorganized attachment and in turn leads to the development of a predisposition toward cocoon-like dissociative states. This study considers two clinical cases that examine the interpersonal dynamics of dissociative processes. The therapist's reverie about his ancestors' survival of depersonalizing violence and Winnicott's concept of the survival and the use of the object help the therapist find his or her identity and gain the relational freedom needed to overcome the dissociative state, thereby becoming an alive subject who is able to help the child patient.     

Subjective Sleep Disturbances in Sexual Assault Survivors: Associations With Trauma and Posttraumatic Stress Disorder Symptom Severity

Prior work implicates sleep disturbance in the development and maintenance of posttraumatic stress disorder (PTSD). However, the majority of this literature has focused on combat veteran men, and limited work has examined links between sleep disturbance and PTSD symptoms in sexual assault survivors. This is a notable gap in the literature, as sexual trauma is disproportionately likely to result in PTSD and is more common in women. We sought to examine the relations between subjective sleep disturbance, sexual assault severity, and PTSD symptoms in a sample of sexual assault survivors with PTSD (PTSD+), without PTSD (PTSD-), and healthy controls. The sample (N = 60) completed the Insomnia Severity Index and prospectively monitored their sleep for 1 week using the Consensus Sleep Diary. The sexual assault survivors also completed the Sexual Experiences Survey and PTSD Checklist-5. Results of group comparisons found that the PTSD+ group reported significantly higher insomnia symptoms, longer sleep onset latency, more nocturnal awakenings, and lower sleep quality compared to the healthy control group and higher insomnia symptoms compared to the PTSD- group. Results of regression analyses in the sexual assault survivors found that insomnia symptoms and number of nocturnal awakenings were significantly associated with higher PTSD symptoms, and sexual assault severity was significantly associated with higher insomnia symptoms, longer sleep onset latency, and lower sleep quality. These findings highlight specific features of sleep disturbance that are linked to trauma and PTSD symptom severity among sexual assault survivors.     

Introduction: Multicultural Perspectives of Intergenerational Transmission of Trauma

Intergenerational transmission of trauma (ITT) has increasingly been a topic of interest among researchers. What still appears lacking is the thorough understanding of ITT in various marginalized cultural groups. This special issue is the second part of a 2-part series that systematically reviews the literature, synthesizes the literature, and conducts original research in ITT in marginalized groups. Due to known devastating and far-reaching effects of ITT, the authors of the 4 articles in this special issue attempt to shed light on ITT mechanisms and salient sociocultural factors that might lead to or exacerbate ITT in 4 marginalized communities. The authors also offer suggestions on culturally responsive ways of healing from ITT in these cultural groups.     

Development of a Scale to Assess Posttraumatic Stress Disorder

This study presents a newly developed self-report Posttraumatic Stress Scale (PTSS) based on the DSM-IV (American Psychiatric Association, 1994). The scale assesses the trauma experienced by people via the specific criteria of reexperiencing, numbing and avoidance, hyperarousal, and functioning. The instrument was validated on 52 Vietnam veteran subjects diagnosed with posttraumatic stress disorder (PTSD), 64 subjects who were attending professional counseling for trauma-related incidents, and 176 subjects who had never been diagnosed with PTSD or had professional counseling. The test survey comprised the PTSS, Beck's Anxiety Inventory, Beck's Depression Inventory, Impact of Events Scale, the 12-item General Health Questionnaire, Inventory of Depressive Symptomatology, and Symptoms Checklist–90R. The test-retest reliability of the scale was assessed over a four- to six-week period. The scale had a high test-retest reliability and showed high convergent and concurrent validity. Construct validity as assessed through the comparison between the three groups was high; however, factor analysis revealed only two factors instead of the three factors assumed in the DSM-IV. Overall, the scale may be used by clinicians or clients.     

Posttraumatic Stress Disorder in Children and Adolescents: A Review and Analysis

Only recently has the mental health community recognized the applicability of diagnostic criteria for posttraumatic stress disorder (PTSD) in children and adolescents, including a consideration of specific age-related features. This paper provides a current review of the literature on PTSD pertaining to children and adolescents. Following a discussion of issues on diagnostic criteria and assessment of this affective disorder in this population, there is an overview of the existing literature on prevalence, comorbidity, risk factors, parental and family factors, and issues of gender and age of onset. The remainder of the paper focuses on the range of traumatic stressors in children and adolescents that can result in PTSD, including natural or human disasters, war and violence, chronic or life-threatening medical conditions, community violence and the witnessing of traumatic events, and physical and/or sexual abuse and other forms of interpersonal violence. Throughout the paper, there is an emphasis on the importance of considering developmental factors. Finally, implications of the existing literature for future areas of research are addressed.     

Intergenerational Transmission of Conflict-Related Trauma in Northern Ireland: A Behavior Analytic Approach

Intergenerational transmission of trauma describes the impact that traumatic events experienced by one generation have for the subsequent generation. In Northern Ireland, violent conflict raged between 1969 and 1998, when a peace process begun. This study explored to what extent (if any) parents’ experiences of the conflict influenced how children perceived life in this society. Parents completed a questionnaire, and their children drew 2 pictures, depicting Northern Ireland now and before they were born. Children’s behaviors and awareness of the conflict were influenced by their parents’ experiences and narratives, their age, gender, and school. Parental narrative about the violence was influenced by individual learning history, the child’s age and gender, and present circumstances. A behavior analytic approach is offered.     

Effects of Racial Discrimination,Childhood Trauma,and Trauma Symptoms on Juvenile Delinquency in African American Incarcerated Youth

To understand racial disproportionality in juvenile delinquency, we studied relationships between 2 possible contributors: effects of manifestations of a structural factor (racism) and psychological consequences of trauma. Informed by Carter’s (2007) theory of race-based trauma, we explored the role of experiences of racial discrimination, childhood trauma, and trauma symptoms in juvenile delinquency through self-reported experiences of incarcerated African American youth. We found that childhood trauma, trauma symptoms, and racial discrimination experiences all significantly contributed to juvenile delinquency, but participants who experienced greater racial discrimination had higher posttraumatic stress symptoms and elevated delinquency rates. Considering the well-documented effects of trauma symptoms on juvenile delinquency, race-based trauma experiences might help us understand one aspect of racial disproportionality in juvenile delinquency.     

青少年重复创伤暴露与创伤后应激障碍的关系:安全感与认知重评的中介作用

采用创伤暴露程度问卷、生活事件量表、安全感量表、情绪调节策略问卷和修订后的DSM-5的PTSD核查表对汶川地震8.5年后的1156名中学生进行调查,考察其重复创伤暴露、安全感和认知重评与PTSD之间的关系。结果发现,在控制初次地震暴露后,重复创伤暴露可以直接正向预测PTSD,也可以通过确定控制感和人际安全感分别间接地正向预测PTSD,还可以通过人际安全感经认知重评的多重中介作用来正向预测PTSD。不过,重复创伤暴露不能直接经过认知重评对PTSD发挥显著的预测作用,也不能通过确定控制感经认知重评来对PTSD发挥显著的多重间接预测作用。     

Management of Post-Traumatic Stress Disorder in the Military: An Intervention Model

Military Forces are involved in combat, peacekeeping operations and disaster management. The nature of such operations include violent conflict, death of women and children, child soldiers and own forces. These traumatic circumstances can contribute to the development of post traumatic stress disorder (PTSD) in members involved. This article discusses the role and function of psychological debriefing for trauma with operational military units. It also proposes a preliminary intervention model to manage PTSD in military forces.     

So You,My Children,Can Have a Better Life: A Cambodian American Perspective on the Phenomenology of Intergenerational Communication about Trauma

We address this question: How do Cambodian American young adults come to know about their family’s experiences of trauma? Using a social constructivist critical ideological approach, we developed a phenomenological model describing intergenerational communication about trauma (IGCT) in Cambodian American families. We found IGCT to be an interactional process in which younger and older generations each played a role. IGCT was influenced by the availability of multiple sources of information and opportunities for learning, interpersonal connectedness between the generations, emotional distress tolerance, and having motivation to empathically learn and share. When these factors were abundant, direct interactive IGCT was more likely. When wanting, the IGCT was more disrupted and incoherent, filled with emotionally charged silence and lead to negative attributions. IGCT was a dynamic process that could change over time to accommodate developmental change. Limitations of the findings, clinical implications, and future directions are discussed.     

Intergenerational Transmission of Trauma: The Mediating Role of Parenting Styles on Toddlers' DSM-Related Symptoms

Although the intergenerational transmission of trauma has been well documented, the pathways by which trauma symptoms are passed between parents and children remain unclear. This study examined the mediating role of parenting styles in the transmission of maternal trauma to children. Participants were a sample of 105 mothers of toddlers (18–30 months old). Mothers who had experienced interpersonal trauma were more likely to have an authoritarian parenting style, including verbal hostility, physical coercion, and low nurturance. Verbal hostility especially predicted more prevalent and increasing toddler symptoms associated with affective, hyperactive, and oppositional defiant disorders. Thus, the verbal hostility component of authoritarian parenting could serve as a major intergenerational pathway between maternal trauma and early child symptoms.     

Duty-Related Posttraumatic Stress Symptoms in 911 Telecommunicators: The Roles of Childhood Trauma Exposure and Emotion-Focused Coping

A history of childhood trauma exposure has been linked to the development of posttraumatic stress symptoms in adulthood following new exposure. Unhealthy coping behaviors that could develop or be utilized in response to early trauma could lend themselves to psychological issues in adulthood. Emotion-focused and problem-focused coping strategies in relation to stressful duty-related situations are examined as indirect pathways through which childhood trauma exposure could be associated with duty-related posttraumatic stress symptoms in 911 telecommunicators (N = 808). Multiple mediation models revealed that 3 of the 4 emotion-focused coping strategies, but not the problem-focused strategies, functioned as significant mediators in the association between childhood exposure and duty-related posttraumatic stress symptoms. Pairwise comparisons showed that self-controlling and escape-avoidance strategies were the strongest pathways of the indirect childhood trauma exposure–posttraumatic stress symptoms association. Implications of results regarding coping in response to new traumatic events in adulthood and potential research and intervention directions are discussed.