Unacknowledged versus acknowledged rape victims: situational factors and posttraumatic stress

Investigators of sexual assault have found that a substantial number of women who have been raped do not conceptualize their experiences as such. The present investigation examined differences between 40 unacknowledged rape victims and 20 women who acknowledged their experience as rape in a sample of college women, as well as a control group of 23 nonvictims. Groups were compared in terms of situational factors, postassault symptomatology, defense mechanisms, dissociative disorders, and sexual revictimization. In comparison to unacknowledged victims, acknowledged victims reported more forceful assaults and indicated more resistance and clearer refusal. Acknowledged victims exhibited more posttraumatic stress disorder symptoms than unacknowledged victims, who exhibited more symptoms than nonvictims, as measured by clinical interview. Implications of these findings are discussed.     

Psychological sequelae of hate-crime victimization among lesbian, gay, and bisexual adults.

Questionnaire data about criminal victimization experiences were collected from 2,259 Sacramento-area lesbians, gay men, and bisexuals (N?=?1,170 women and 1,089 men). Approximately 1/5 of the women and 1/4 of the men had experienced victimization because of their adult sexual orientation. Hate crimes were less likely than nonbias crimes to have been reported to police. Compared with other recent crime victims, lesbian and gay hate-crime survivors manifested significantly more symptoms of depression, anger, anxiety, and posttraumatic stress. They also displayed significantly more crime-related fears and beliefs, lower sense of mastery, and more attributions of their personal setbacks to sexual prejudice than did nonbias crime victims and nonvictims. Comparable differences were not observed among bisexuals. The findings highlight the importance of recognizing hate-crime survivors' special needs in clinical settings and in public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health correlates of criminal victimization: A random community survey.

Interviewed a representative sample of 2,004 women (aged 18 yrs and older) about victimization experiences and mental health problems. After classification of the women into victimization groups, the occurrence of 3 mental health problems was compared across type of crime. Rates of "nervous breakdowns," suicidal ideation, and suicide attempts were significantly higher for crime victims than for nonvictims. Victims of attempted rape, completed rape, and attempted sexual molestation had problems more frequently than did victims of attempted robbery, completed robbery, aggravated assault, or completed molestation. Problems were not mediated by income and were affected only marginally by age and race. Nearly 1 rape victim in 5 (19.2%) had attempted suicide, whereas only 2.2% of nonvictims had done so. Most sexual assault victims' mental health problems came after their victimization. Findings suggest that crime victims are at risk for the development of major mental health problems, some of which are life threatening in nature. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping mediates the relationship between posttraumatic stress disorder (PTSD) symptoms and alcohol use in homeless, ethnically diverse women: A preliminary study.

Homeless women are at increased risk for problematic alcohol use and posttraumatic stress disorder (PTSD). While coping motives have been shown to mediate the relationship between PTSD symptoms and alcohol problems in victims of sexual assault and domestic violence, it is unknown whether this relationship is evident in other trauma-exposed populations. The focus of this study was to examine whether drinking to cope mediated the relationship between PTSD symptoms and current alcohol use in a group of homeless, ethnically diverse women. Twenty-three women were recruited from local shelters in a southwestern community and asked to complete measures assessing their current alcohol use, drinking motives, and PTSD symptoms. Results revealed that drinking to cope mediated the relationship between PTSD symptoms and current alcohol use. This finding supports the theory that homeless women may benefit from treatment interventions that address both their substance use and trauma issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prior interpersonal trauma: The contribution to current PTSD symptoms in female rape victims.

The purpose of the current study was to disentangle the relationship of childhood sexual abuse and childhood physical abuse from prior adult sexual and physical victimization in predicting current posttraumatic stress disorder (PTSD) symptoms in recent rape victims. The participants were a community sample of 117 adult rape victims assessed within 1 month of a recent index rape for a history of child sexual abuse, child physical abuse, other adult sexual and physical victimization, and current PTSD symptoms. Results from path analyses showed that a history of child sexual abuse seems to increase vulnerability for adult sexual and physical victimization and appears to contribute to current PTSD symptoms within the cumulative context of other adult trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological distress following criminal victimization in the general population: Cross-sectional, longitudinal, and prospective analyses.

Samples of 105 violent crime victims, 227 property crime victims, and 190 nonvictims provided normative data regarding levels of psychological distress following criminal victimization. At points approximately 3, 9, and 15 mo post-crime, symptoms of depression, somatization, hostility, anxiety, phobic anxiety, fear of crime, and avoidance were assessed. Although crime victims showed substantial improvement between 3 and 9 mo, thereafter they did not. Over the course of the study, violent crime victims remained more distressed than did property crime victims who, in turn, remained more distressed than nonvictims. Regression analyses revealed that the effects of crime could not be accounted for by pre-crime differences between victims and nonvictims in either social status or psychological functioning. However, lasting effects were often contingent on the occurrence of subsequent crimes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Arousal, numbing, and intrusion: symptom structure of PTSD following assault

OBJECTIVE: This study investigated hypotheses concerning the importance of symptoms of numbing in posttraumatic stress disorder (PTSD). METHODS: Symptoms of PTSD were assessed in 72 female rape victims and 86 female victims of nonsexual assault approximately 3 months after the crimes occurred. A principal-components factor analysis of subjects' symptoms was then undertaken. RESULTS: The analysis yielded three factors: arousal/avoidance, numbing, and intrusion. These were somewhat different from the symptom clusters in DSM-III-R, since effortful avoidance and numbing symptoms did not load on the same factor. Numbing symptoms appeared to be particularly important in identifying individuals with PTSD. CONCLUSIONS: The results imply that there are two patterns of posttrauma symptoms, one characterizing PTSD and the second characterizing a phobic reaction.     

Processing of threat-related information in rape victims.

We investigated selective processing of threat information in persons with posttraumatic stress disorder (PTSD) by using a modified Stroop Color and Word Test. Ss were 15 rape victims with PTSD, 13 rape victims without the disorder, and 16 nontraumatized control Ss. They were asked to name the color of 4 types of words: specific threat (rape-related) words, general threat (related to physical harm and death) words, neutral words, and nonwords. Rape victims with PTSD evidenced a longer response latency for color naming of rape-related words than for other target-word types. Response latencies of non-PTSD victims and nonvictim control Ss did not differ across word types. Possible mechanisms underlying the selective processing of threat material are considered, and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims.

The efficacy of a brief prevention program (BP) aimed at arresting the development of chronic posttraumatic stress disorder (PTSD) was examined with 10 recent female victims of sexual and nonsexual assault who received 4 sessions of a cognitive-behavioral program shortly after the assault. Their PTSD and depression severity was compared with that of 10 matched recent female assault victims who received repeated assessments of their trauma-related psychopathology (assessment control; AC). The BP program consisted of education about common reactions to assault and cognitive-behavioral procedures. Two months postassault, victims who received the BP program had significantly less severe PTSD symptoms than victims in the control condition; 10% of the former group met criteria for PTSD versus 70% of the latter group. Five and a half months postassault, victims in the BP group were significantly less depressed than victims in the AC group and had significantly less severe reexperiencing symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Uncontrollability and unpredictability in post-traumatic stress disorder: An animal model.

The disturbances observed in animals subjected to unpredictable and uncontrollable aversive events resemble posttraumatic stress disorder (PTSD) symptoms and thus may constitute an animal model of this disorder. It is argued that the similarity between animals' symptoms and those of trauma victims may reflect common etiological factors. Relevant experiments in which animals exhibit generalized fear and arousal, discrete fear of a CS, analgesia, and avoidance are reviewed with the view that these manifestations may be analogous to the PTSD symptom clusters of persistent arousal, reexperiencing, numbing, and avoidance, respectively. Finally, animal paradigms are suggested to test the validity of the model, and specific hypotheses are derived from the animal literature regarding trauma variables that are predictive of particular PTSD symptom clusters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender and posttraumatic stress: Sexual violence as an explanation for women's increased risk.

Women are approximately twice as likely as men to develop posttraumatic stress disorder (PTSD), but the cause of this disparity remains unclear. This study evaluated 2 alternative explanations of gender differences in PTSD, one pointing to an intrinsic vulnerability in women and the other emphasizing sexual violence across the life span. To test these competing theories, the authors analyzed National Violence Against Women Survey data from 591 victims of partner aggression. Results suggested that gender, when considered alone, has a small but significant effect on PTSD symptom severity. However, once models factor in sexual victimization history, the latter replaces gender as a key determinant of PTSD symptoms. These findings argue against theories of "feminine vulnerability," instead linking PTSD risk to sexually violent situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized Trial of Cognitive-Behavioral Therapy for Chronic Posttraumatic Stress Disorder in Adult Female Survivors of Childhood Sexual Abuse.

The authors conducted a randomized clinical trial of individual psychotherapy for women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (n = 74), comparing cognitive-behavioral therapy (CBT) with a problem-solving therapy (present-centered therapy; PCT) and to a wait-list (WL). The authors hypothesized that CBT would be more effective than PCT and WL in decreasing PTSD and related symptoms. CBT participants were significantly more likely than PCT participants to no longer meet criteria for a PTSD diagnosis at follow-up assessments. CBT and PCT were superior to WL in decreasing PTSD symptoms and secondary measures. CBT had a significantly greater dropout rate than PCT and WL. Both CBT and PCT were associated with sustained symptom reduction in this sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder.

Curve estimation techniques were used to identify the pattern of therapeutic change in female rape victims with posttraumatic stress disorder (PTSD). Within-session data on the Posttraumatic Stres Disorder Symptom Scale were obtained, in alternate therapy sessions, on 171 women. The final sample of treatment completers included 54 prolonged exposure (PE) and 54 cognitive-processing therapy (CPT) completers. For both PE and CPT, a quadratic function provided the best fit for the total PTSD, reexperiencing, and arousal scores. However, a difference in the line of best fit was observed for the avoidance symptoms. Although a quadratic function still provided a better fit for the PE avoidance, a linear function was more parsimonious in explaining the CPT avoidance variance. Implications of the findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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 postcrime and 6 months later. Measures within 1 month postcrime 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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping strategies and posttraumatic stress disorder in female victims of sexual and nonsexual assault.

The coping behaviors and (posttraumatic stress disorder [PTSD]) symptoms of 215 female assault victims (103 rape victims and 112 nonsexual assault victims) were assessed within 2 weeks following the assault (Time I), and 133 of them (62%) were followed up 3 mo later (Time 2). Posttrauma symptom severity significantly decreased during the 3-mo study period, but PTSD severity levels at Times I and 2 were highly correlated. Three coping scales were constructed on the basis of exploratory factor analyses: Mobilizing Support, Positive Distancing, and Wishful Thinking. Three mo postassault, rape victims showed higher levels of wishful thinking and PTSD than nonsexual assault victims. Wishful thinking showed a positive association and positive distancing a negative association with PTSD severity, controlling for assault type, initial levels of PTSD severity, and other coping strategies. The clinical relevance of these findings is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: A mediational model of posttraumatic stress disorder and physical health outcomes.

This study examined the co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment in a predominantly African American sample of 268 female veterans, randomly sampled from an urban Veterans Affairs hospital women's clinic. A combination of hierarchical and iterative cluster analysis was used to identify 4 patterns of women's lifetime experiences of violence co-occurrence. The 1st cluster experienced relatively low levels of all 4 forms of violence; the 2nd group, high levels of all 4 forms; the 3rd, sexual revictimization across the lifespan with adult sexual harassment; and the 4th, high intimate partner violence with sexual harassment. This cluster solution was validated in a theoretically driven model that examined the role of posttraumatic stress disorder (PTSD) as a mediator of physical health symptomatology. Structural equation modeling analyses revealed that PTSD fully mediated the relationship between violence and physical health symptomatology. Consistent with a bio-psycho-immunologic theoretical model, PTSD levels more strongly predicted pain-related physical health symptoms compared to nonpain health problems. Implications for clinical interventions to prevent PTSD and to screen women for histories of violence in health care settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder.

This study investigated the role of acute arousal in the development of posttraumatic stress disorder (PTSD). Hospitalized motor-vehicle-accident survivors (n?=?146) were assessed for acute stress disorder (ASD) within 1 month of the trauma and were reassessed (n?=?113) for PTSD 6 months posttrauma. Heart rate (HR) and blood pressure (BP) were assessed on the day of hospital discharge. Participants with subclinical ASD had higher HR than those with ASD and no ASD. Participants who developed PTSD had higher HR in the acute posttrauma phase than those without PTSD. Diagnosis of ASD and resting HR accounted for 36% of the variance of the number of PTSD symptoms. A formula composed of a diagnosis of ASD or a resting HR of >90 beats per minute possessed strong sensitivity (88%) and specificity (85%) in predicting PTSD. These findings are discussed in terms of acute arousal and longer term adaptation to trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discriminant analysis of risk factors for sexual victimization among a national sample of college women.

Examined the accuracy with which rape and lesser sexual assaults were predicted among a representative national sample of 2,723 college women. A total of 14 risk variables operationalized three vulnerability hypotheses: (a) vulnerability-creating traumatic experiences, (b) social-psychological vulnerability, and (c) vulnerability-enhancing situations. Each hypothesis was tested individually, and a composite model was developed via discriminant analysis. Only the traumatic experiences variables clearly improved over the base rates in identifying rape victims, but risk variables from each vulnerability hypothesis met criteria for inclusion in the composite model. A risk profile emerged that characterized only 10% of the women, but among them the risk of rape was twice the rate of women without the profile. The concept of traumatic sexualization was used to explain this finding. However, the vast majority of sexually victimized women (75–91%) could not be differentiated from nonvictims. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder and anxious and fearful reactivity to bodily arousal: A test of the mediating role of nicotine withdrawal severity among daily smokers in 12-hr nicotine deprivation.

Posttraumatic stress disorder (PTSD) is associated with high rates of smoking and fear of bodily perturbation. The current study examined the role of nicotine withdrawal in the association between PTSD and responding to bodily arousal among 52 participants (27 women; Mage = 30.50 years). Compared to participants without current axis I psychopathology, persons with current PTSD responded to a 3-min voluntary hyperventilation procedure with greater increases in anxiety and more intense cognitive and physical panic symptoms, despite no group differences in physiological arousal. Nicotine withdrawal demonstrated significant mediational effects in the relations between diagnostic group and panic symptoms elicited by the hyperventilation procedure. Findings suggest nicotine withdrawal is an important factor to consider in terms of better understanding the nature of fear responding to bodily sensations among persons with PTSD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PTSD Arousal and Depression Symptoms Associated With Increased Right-Sided Parietal EEG Asymmetry.

Researchers have proposed that depression and particular types of anxiety are associated with unique patterns of regional brain activation. The authors examined the relationship among posttraumatic stress disorder (PTSD), anxiety, and depressive symptoms and frontal, temporal, and parietal EEG alpha asymmetry in female Vietnam War nurse veterans. The results indicate that PTSD arousal symptoms are associated with increased right-sided parietal activation. However, the combination of arousal, depression, and their interaction explain more than twice the variance in parietal asymmetry compared with arousal alone. The results support the contention that the association between anxiety and right-sided posterior activation is specific to the anxious arousal subtype. These findings underscore the importance of isolating, both theoretically and statistically, emotional subcomponents in studies of regional brain activation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)