Traumas With and Without a Sense of Agency

The authors differentiate two types of traumatic experience: trauma with agency and trauma without agency. The types are different despite the fact that the symptoms of both look similar enough to fall within the diagnosis of post-traumatic stress disorder (PTSD). The differentiating factor is the sufferer's sense of agency during the circumstances surrounding the trauma. What is traumatizing is that the individual acted in some way that, however adaptive in the moment of threat and crisis, was ultimately loathed simultaneously or subsequently by the person's larger self and seen by this larger self as defining of character. Traumatized clients with a sense of agency require treatment that comes from being cared for and loved despite this hated facet of self.     

Posttraumatic Response and Children Exposed to Parental Violence

Summary

In this article some of the literature on children's responses to natural and person-created trauma are discussed. In addition, data relevant to children's posttraumatic response as a result of exposure to interparental violence are presented. Using a factor analytic procedure, the study attempted to examine how the DSM-IV symptom clusters for Posttraumatic Stress Disorder come together for this sample of children. General suggestions are made regarding possible intervention with exposed children experiencing posttraumatic symptoms.     

Attributions for Different Types of Traumatic Events and Post-Traumatic Stress Among Women

This study investigated the relationship of attributions to post-traumatic stress symptoms among women exposed to different types of traumatic events. Participants were 424 female undergraduates who previously experienced a serious accident, natural disaster, child abuse, or adult interpersonal violence. Path analysis indicated a significant indirect pathway from event type to post-traumatic stress through global attributions. Interpersonal-violence survivors exhibited the highest levels of global attributions and post-traumatic stress symptoms. Regression analyses revealed significant interactions between event type and attributions in predicting post-traumatic stress. Stable attributions were associated with increased symptoms in sexual-assault survivors and decreased symptoms in natural-disaster survivors. These findings have implications for improving cognitive interventions for survivors of different types of traumatic events.     

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.     

Toward a Public Mental Health Approach for Survivors of Terrorism

Abstract

Although most people exposed to bioterrorism or mass casualties will be extremely distressed during the immediate aftermath, only a minority (approximately 30%) will develop clinically significant psychiatric disorders. From a public mental health perspective, the challenge is to provide both preventive programs for the entire population and early detection and intervention for those at greatest risk for PTSD or other post-traumatic psychiatric disorders. Both individual and soci-etal preventive and early intervention approaches are reviewed. Utilization of the media, especially television, is presented as an example of one of many potential community/societal public mental health approaches.     

Development of the Trauma Appraisal Questionnaire

This study describes the development and psychometric properties of the Trauma Appraisal Questionnaire (TAQ). Items were generated based on interviews with 72 ethnically diverse community participants exposed to a range of trauma types. From the interviews, more than 600 items that tapped beliefs, emotions, and behaviors were generated for 9 appraisal categories (e.g., fear, betrayal, shame). Based on expert feedback, 108 items were retained for initial testing in a sample of 714 undergraduate volunteers. Using a factor analytic strategy, we arrived at a 6-scale, 54-item solution. The reliability and validity of the new measure were evaluated in community (N = 119) and undergraduate (Ns = 139 and 79) samples. The measure demonstrated excellent reliability (test–retest and internal consistency) and validity (convergent, discriminant, and concurrent).     

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.     

Unrecognized Posttraumatic Stress Disorder as a Treatment Barrier for a Gang-Involved Juvenile Offender

This study examines the case of GH, an 18-year-old Latino male participating in an employment-based delinquency intervention for gang-affiliated youth. Although postintervention measures revealed that GH showed gains on key outcomes (i.e., delinquency, employment), he experienced sporadic treatment setbacks (e.g., work absenteeism, fighting) that disrupted his progress. A comprehensive psychological assessment suggested that his aggressive, illegal behavior and difficulty maintaining employment could have been influenced by previously undiagnosed posttraumatic stress disorder (PTSD). Excerpts from counseling sessions illustrated how reactive aggression, hypervigilance, sleep disruptions, and emotional numbing could have interfered with treatment gains and ultimately contributed to GH's re-arrest. Implications for early, accurate identification of PTSD in delinquency interventions for gang youth are discussed.     

Emerging Trauma Therapies: Critical Analysis and Discussion of Three Novel Approaches

Trauma-related disorders and treatment have gained increasing attention in the last 3 decades, spurring the development of novel treatment approaches. Many of these are incorporated into clinical practice despite lacking a solid evidence base or unbiased analyses to facilitate interpretation of existing information. Although treatments might draw on elements from validated therapies, questions regarding the incremental efficacy of new approaches persist. Three novel therapies that might warrant further examination include energy psychology, yoga, and brainspotting. The emergence of novel, trauma-related therapies is examined, and the history, theory, practice, and evidence base of these 3 specific therapies are outlined. Directions for future work are discussed. Expositions such as this might serve as a helpful resource for clinicians seeking discernment regarding treatment for posttraumatic stress disorder.     

Cumulative trauma and midlife well-being in American women who served in Vietnam: effects of combat exposure and postdeployment social support

Background and Objectives: Research increasingly demonstrates that trauma exposure can have cumulative effects, yet much remains to be learned about effects of cumulative trauma, particularly regarding longer term adjustment. One such trauma, combat exposure, is insufficiently understood, especially for women, who are increasingly engaged in professional combat activities. Design: The study comprised a cross-sectional survey assessing multiple aspects of current well-being in women approximately 25 years after their service in Vietnam during the Vietnam War. Methods: Participants were 1374 women (78% military and 22% nonmilitary; mean age = 59.7). This study investigated the relations between three separate categories of trauma exposure (childhood, adulthood, and combat) and well-being and examined whether perceived social support at return from Vietnam moderated the association between combat exposure and well-being. Results: While both childhood and adulthood trauma exposure related to midlife well-being, combat exposure still uniquely predicted outcomes. Further, postdeployment perceived social support moderated the association of combat and well-being: recollected higher perceived social support at homecoming buffered participants from the links between combat exposure and well-being. Conclusions: These results may have important implications for interventions to reduce the impact of traumatic experiences, particularly in light of the increasing exposure of women to direct combat events.