Amber A. Martinson

Perceptions of health and somatic sensations in women reporting premenstrual syndrome and premenstrual dysphoric disorder.

Abstract Focus on bodily sensations may be involved in the etiology of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). This study investigated the relationship between two types of somatic self-focus (i.e., health anxiety and anxiety sensitivity) and health-related quality of life (QOL) in women with provision diagnoses of PMS and PMDD. On the basis of responses to a screening measure, 731 college women were divided into three groups: PMDD, Moderate/Severe PMS, and Mild/No PMS. Measures included health-related QOL, health anxiety, anxiety sensitivity, and trait anxiety. Women with provisional diagnoses of PMDD and moderate/severe PMS reported higher levels of health anxiety and anxiety sensitivity. These relationships were not accounted for by trait anxiety. Furthermore, women in the PMDD and Moderate/Severe PMS groups reported lower health-related QOL. There is a significant health-related QOL burden for college women with PMDD and PMS. Health anxiety and anxiety sensitivity may contribute to the etiology of premenstrual disorders.

Premenstrual Disorders and Rumination

OBJECTIVES Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) involve emotional, behavioral, and physical symptoms; however, there is little understanding of psychological factors that contribute to these disorders. It was hypothesized that rumination, a form of depressive self-focused attention, is related to premenstrual distress. METHOD Study 1 involved women (N = 735) meeting criteria for No/Mild PMS, Moderate/Severe PMS, and PMDD using retrospective self-report. Study 2 involved women (N = 85) meeting diagnostic criteria for PMS or PMDD (i.e., PMD group) and healthy controls (i.e., No PMD group) following 60-day symptom monitoring. Participants in both studies completed questionnaires of rumination, anxiety sensitivity, and coping styles. RESULTS Rumination was strongly related to premenstrual disorders using both retrospective and prospective reports, as well as both categorical and continuous approaches to classification of premenstrual distress. CONCLUSIONS Rumination, a transdiagnostic factor in psychopathology, may contribute to the onset and maintenance of premenstrual distress.

Self-focused attention in response to laboratory stressors among women with premenstrual disorders

The etiology of premenstrual disorders, including premenstrual syndrome (PMS) and premenstrual dysphoric disorders (PMDD), is not well understood. In the current study, the relationship between self-focused attention (SFA) and premenstrual disorders was examined to explore the hypothesis that women with premenstrual disorders tend to respond to symptoms in a maladaptive manner. Based on retrospective report, clinical interview, and 30–day prospective recording of premenstrual symptoms, women (N = 52) were categorized as meeting criteria for premenstrual disorders (PMD; n = 24) or not (controls; n = 28). Key findings indicated that women with premenstrual disorders reported greater use of SFA in response to negative affect elicited by laboratory tasks than controls, despite no significant differences in change in negative affect between the two groups. Women with premenstrual disorders also reported greater trait levels of SFA and maladaptive coping styles compared to controls. Women with premenstrual disorders may tend to respond to menstrual cycle changes using increased levels of SFA. The interaction between psychological and physiological menstrual cycle-related changes may lead to increased distress and impairment. Implications for psychological contributions to premenstrual distress and disorders are discussed.

The Temporal Development of Mood, Cognitive, and Vegetative Symptoms in Recurrent SAD Episodes: A Test of the Dual Vulnerability Hypothesis

Recent literature on seasonal affective disorder (SAD) has begun to focus on diathesis–stress models, including Young and colleagues’ dual vulnerability hypothesis. The dual vulnerability hypothesis posits that individuals must possess both a biological vulnerability to developing vegetative symptoms and a psychological vulnerability to developing mood symptoms in order to develop SAD episodes. However, few studies have directly tested this model until very recently. Research has demonstrated a temporal relation between mood and vegetative symptoms, with vegetative symptoms having an earlier onset than mood symptoms supporting the idea that separate factors related to the two symptom clusters exist. The current study represents a longitudinal assessment of vegetative and mood symptoms, as well as cognitive factors (i.e., rumination, automatic thoughts) that may represent part of the psychological vulnerability shared by SAD sufferers. Furthermore, the present study represents only the second to assess state levels of cognitive factors that may impact recurrent SAD episode severity. Fifty-one individuals participated in the study across two groups, individuals with a history of SAD, and with no history of depression or SADs. Findings supported the dual vulnerability hypothesis, with an early vegetative symptom onset than mood symptom evident for the individuals with a history of SAD. Participants with a history of SAD also reported more ruminative responses and negative automatic thoughts about the seasons. Findings are generally supportive of Young and colleagues’ dual vulnerability hypothesis and directions for future research are suggested.

Processing of Intimacy-Related Stimuli in Survivors of Sexual Trauma The Role of PTSD

To fully understand the negative impact of sexual trauma and posttraumatic stress disorder (PTSD) upon adult intimacy-related functioning, cognitive models designed to investigate implicit processing of stimuli with emotional content are warranted. Using an emotional Stroop paradigm, the present study examined the impact of sexual trauma history (childhood sexual abuse and/or adult sexual assault) and a PTSD diagnosis on the implicit processing of 3 types of word stimuli: intimacy, sexual trauma, and neutral. Based on the results of a structured clinical interview and a behavioral-specific sexual trauma questionnaire, participants (n = 101; 74 females, 27 males) were placed in 3 groups: sexual trauma only (n = 33), sexual trauma and PTSD (n = 33), and controls (n = 35). Results indicated that men and women with a history of sexual trauma and a current PTSD diagnosis had increased latency for intimacy-related words and trauma words compared to controls, whereas individuals with only a history of sexual trauma did not differ from controls. Thus, it appears that the presence of symptoms associated with a diagnosis of PTSD is important for implicit processing of intimacy stimuli, rather than having a history of sexual trauma alone. Avoidance, a key feature of PTSD, may strengthen this relationship. More research is needed to determine the mechanisms by which individuals with a history of sexual trauma and PTSD experience intimacy difficulties.

Prevalence of Sexual Trauma History Using Behaviorally Specific Methods of Assessment in First Year College Students.

There are several challenges associated with evaluating the prevalence of sexual trauma, including child sexual abuse and adult sexual assault. The aim of this study was to assess sexual trauma prevalence rates among first year college students (N = 954) using behaviorally specific questions and a more representative recruitment sample that did not rely on self-selection. Participants completed a list of sexual trauma questions, including general questions containing labels such as “rape” or “abuse” as well as behaviorally specific questions that describe specific behaviors that qualify as sexual trauma without labels. Results indicated that 6.7% of the sample reported at least one incident of child sexual abuse, with similar rates for men and women. Women were more likely to report a history of adult sexual assault, which was reported by 12.4% of the total sample. Participants were also more likely to endorse a history of sexual trauma when answering behaviorally specific rather than general “label” questions. Women survivors in particular were more likely than men to identify their experiences as abuse/assault (66.7% versus 21.1% for child sexual abuse), which may help explain prevalence differences between men and women in prior research. Men may be less likely than women to label their experiences as abuse and may be underidentified in sexual trauma research without the use of behaviorally specific questions. Overall, the results of this study suggest that the prevalence of sexual trauma is better assessed using behaviorally specific questions and that this is an important topic of study among both men and women.

Practice in a Rural Setting

In this edited volume, Handbook of Clinical Psychology in Medical Settings, there are chapters discussing the history, growth and details of psychology practice integrated in medical care venues. For psychologists who work in rural health care there are opportunities and challenges that are unique to the rural setting. In this chapter, we discuss some of these. We first summarize epidemiological differences between rural and urban populations, health disparities and health care access problems of rural populations, and then summarize topics of ethical considerations, specialized psychology consultation (e.g., psychopharmacology) and the potential of using information technology (IT) for patient care delivery and education of patients, families and providers.