Crosby A. Modrowski

Investigating the Dissociative Subtype of Posttraumatic Stress Disorder in a Sample of Traumatized Detained Youth

In this study, we tested the validity of a dissociative subtype in a sample of 225 detained adolescents (142 boys, 83 girls) likely meeting full or partial criteria for posttraumatic stress disorder (PTSD). Competing theories of dissociation pose controversy regarding dissociation as a taxon versus a continuum, and results of the current study contribute to this debate by providing evidence of distinct group differences between those high and low in dissociation. Mixture modeling revealed 2 groups of youth with differing levels of depersonalization/derealization dissociative symptoms. Differences between the 2 groups of youth were investigated regarding trauma exposure and several posttraumatic reactions: posttraumatic stress symptoms (PTSS), emotion dysregulation, and emotional numbing. Compared with youth classified in the low-dissociation group, youth who exhibited high levels of dissociation demonstrated higher levels of total PTSS, posttraumatic symptom clusters of emotional numbing, intrusion, and associated features, as well as reporting more difficulties with emotion dysregulation. To test theory regarding the factors that increase the likelihood of persistent dissociation, bootstrapped regression analyses were performed to examine the possibility of an indirect effect of peritraumatic dissociation. Results consistent with statistical mediation suggested that the presence of peritraumatic dissociation at the time of trauma may contribute to the continuation of dissociative symptoms as a more generalized pattern. The results of the current study have implications for clinical treatment with traumatized youth.

The Roles of Emotion Dysregulation and Dissociation in the Association Between Sexual Abuse and Self-Injury Among Juvenile Justice–Involved Youth

To date, scholars have established associations among nonsuicidal self-injury and sexual abuse, posttraumatic stress symptoms, and dissociation. However, leading theoretical models of the mechanisms underlying the association between trauma and negative outcomes suggest a more parsimonious explanation in that deficits in emotion regulation may underlie these various risk factors for self-injury. This study examined whether sexual abuse was differentially associated with nonsuicidal self-injury over and above other forms of traumatic experiences and whether the association between sexual abuse and self-injury was statistically mediated by emotion dysregulation and dissociation. Participants included 525 youth (392 boys, 133 girls) recruited from the U.S. juvenile justice system who completed measures of self-reported trauma exposure, posttraumatic stress symptoms, dissociation, and emotion dysregulation. Results of a hierarchical regression demonstrated that sexual abuse predicted posttraumatic stress symptoms and self-injury over and above other forms of traumatic experiences. Results of bootstrapped mediation analyses indicated that emotion dysregulation and dissociation in combination were implicated in self-injury among youth. The results suggest that youth in the juvenile justice system who experience sexual abuse may be at risk for higher rates of posttraumatic stress symptoms and that self-injury may be particularly salient for youth who experience sexual abuse. Furthermore, the results shed light on the role that dissociation and emotion dysregulation play in the relation between sexual abuse and self-injury, suggesting that a larger framework of self-regulation may have both empirical and clinical utility in helping to understand the underlying processes at play in these associations.

“Harm as Harm”: Gang Membership, Perpetration Trauma, and Posttraumatic Stress Symptoms Among Youth in the Juvenile Justice System

The construct of perpetration-induced trauma (PT) proposes that inflicting harm on others may constitute a traumatic event, a phenomenon which might be relevant to youth in gangs. This study investigated PT, trauma exposure, posttraumatic stress symptoms, and gang membership in a sample of 660 youth (484 boys, 176 girls) recruited from a detention center. When compared with their non-gang-member peers, youth in gangs endorsed higher levels of exposure to violence and PT, as well as higher symptoms of dissociation and emotional numbing. Girls who endorsed gang membership were those most likely to meet full or partial criteria for a posttraumatic stress disorder diagnosis. Results of regression analyses showed that PT predicted unique variance in posttraumatic stress above and beyond other variables and results of tests for bootstrapped indirect effects were consistent with the hypothesis that PT acts as a mediator of the association between gang membership and posttraumatic stress.

Screening for PTSD Among Detained Adolescents: Implications of the Changes in the DSM-5.

Objective: Screening for posttraumatic stress disorder (PTSD) is highly relevant for youth involved in the juvenile justice system given their high rates of trauma exposure and posttraumatic stress symptoms. However, to date, no studies have investigated the implications of the recent revisions to the Diagnostic and Statistical Manual for Mental Disorders (5th ed., DSM–5; American Psychiatric Association [APA], 2013) diagnostic criteria for PTSD for screening in this population. To this end, the present study compared PTSD screening rates using the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM–IV–TR; APA, 2013) versus DSM–5 criteria in a group of detained adolescents. Method: Participants included 209 youth (60 girls) aged 13–19 (M = 15.97, SD = 1.24). Youth completed measures of lifetime trauma exposure and past-month posttraumatic stress symptoms. Results: Over 95% of youth in the sample reported exposure to at least 1 type of traumatic event. Approximately 19.60% of the sample screened positive for PTSD according to the DSM–5 compared to 17.70% according to the DSM–IV–TR. Girls were more likely than boys to screen positive for PTSD according to the DSM–IV–TR compared to the DSM–5. Conclusion: The main factors accounting for the differences in screening rates across the versions of PTSD criteria involved the removal of Criterion A2 from the DSM–5, the separation of avoidance symptoms (Criterion C) into their own cluster, the addition of a cluster involving negative alterations in cognitions and mood (Criterion D), and revisions to the cluster of arousal symptoms (Criterion E). Future research should continue to investigate gender differences in PTSD symptoms in youth and consider the implications of these diagnostic changes for the accurate diagnosis and referral to treatment of adolescents who demonstrate posttraumatic stress reactions.

Validation of the factor structure of the adolescent dissociative experiences scale in a sample of trauma-exposed detained youth.

OBJECTIVE The inclusion of a dissociative subtype in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5) criteria for the diagnosis of posttraumatic stress disorder (PTSD) has highlighted the need for valid and reliable measures of dissociative symptoms across developmental periods. The Adolescent Dissociative Experiences Scale (A-DES) is 1 of the few measures validated for young persons, but previous studies have yielded inconsistent results regarding its factor structure. Further, research to date on the A-DES has been based upon nonclinical samples of youth or those without a known history of trauma. To address these gaps in the literature, the present study investigated the factor structure and construct validity of the A-DES in a sample of highly trauma-exposed youth involved in the juvenile justice system. METHOD A sample of 784 youth (73.7% boys) recruited from a detention center completed self-report measures of trauma exposure and the A-DES, a subset of whom (n = 212) also completed a measure of PTSD symptoms. RESULTS Confirmatory factor analyses revealed a best fitting 3-factor structure comprised of depersonalization or derealization, amnesia, and loss of conscious control, with configural and metric invariance across gender. Logistic regression analyses indicated that the depersonalization or derealization factor effectively distinguished between those youth who did and did not likely meet criteria for a diagnosis of PTSD as well as those with PTSD who did and did not likely meet criteria for the dissociative subtype. CONCLUSIONS These results provide support for the multidimensionality of the construct of posttraumatic dissociation and contribute to the understanding of the dissociative subtype of PTSD among adolescents. (PsycINFO Database Record

Polyvictimization, Emotion Dysregulation, Symptoms of Posttraumatic Stress Disorder, and Behavioral Health Problems among Justice-Involved Youth: a Latent Class Analysis

Among the 90% of adolescents involved in juvenile justice who have experienced traumatic victimization, a sub-group may be at highest risk due to histories of multiple types of interpersonal and non-interpersonal trauma, termed polyvictims. Latent class analyses (LCA) have identified polyvictimized subgroups in several studies of adolescents and adults, but only one study of traumatic victimization has been conducted with justice-involved youth (Ford et al. 2013). The current investigation replicates and extends that study’s findings using LCA to assess a wider range of victimization- and nonvictimization-related adversities and emotion dysregulation, DSM-5 symptom clusters of posttraumatic stress disorder (PTSD), and behavioral health problems, such as substance use, anger, depression, somatic complaints, and suicide ideation. In a sample of juvenile detainees three latent classes were identified: mixed adversity (MA; n = 327), violent environment (VE; n = 337), and polyvictimization (PV; n = 145). In contrast to MA youth, PV youth were more likely to report exposure to all forms of adversity, and in contrast to both MA and VE youth, exposure to maltreatment and family violence, and higher levels of emotion dysregulation, PTSD, and depression/anxiety symptoms, somatic complaints, and suicidality. VE youth (vs. MA youth) were more likely to report exposure to violence and non-interpersonal traumas, and were higher on some forms of emotion dysregulation, PTSD symptoms, anger and substance use. Findings suggest that most justice-involved youth have experienced substantial adversity, with almost one in five identified as a polyvictim having experienced multiple adversities, including impaired caregivers, and evidencing the most severe problems in emotion dysregulation and PTSD, internalizing, and externalizing symptoms.

Testing gender-differentiated models of the mechanisms linking polyvictimization and youth offending: Numbing and callousness versus dissociation and borderline traits

ABSTRACT The increasing prevalence of girls in the juvenile justice system suggests the importance of examining whether models of adolescent offending are differentiated by gender. Polyvictimization has emerged as a robust predictor of youth justice involvement, especially for girls, and research exploring mechanisms underlying the link between polyvictimization and offending suggests further gender differences in that callous-unemotional (CU) traits have been implicated in samples of boys whereas borderline personality (BP) traits have been implicated amongst girls. However, a limitation of these studies is that most have included all-male or all-female samples, thus not allowing for comparisons across gender. Further, few studies have used a trauma-informed lens to investigate posttraumatic symptoms, particularly dissociation and emotional numbing, that might account for these associations. To address this gap, this study investigated associations among polyvictimization, dissociation, numbing, CU, BP, and offending in a sample of 782 youth (579 boys and 203 girls) recruited from a detention center. As hypothesized, for both genders, polyvictimization was related to BP through the indirect effect of dissociation and to CU through the indirect effect of emotional numbing. Further, for both genders, path models indicated indirect effects on the association between polyvictimization and offending through dissociation and BP. These results suggest the value of using a trauma-informed approach to understanding youth justice involvement and continuing to fine-tune models of gender differences in traumatized girls’ and boys’ offending.

PTSD and dissociation symptoms as mediators of the relationship between polyvictimization and psychosocial and behavioral problems among justice-involved adolescents

ABSTRACT Polyvictimization (PV) has been shown to be associated with psychosocial and behavioral impairment in community and high risk populations, including youth involved in juvenile justice. However, the mechanisms accounting for these adverse outcomes have not been empirically delineated. Symptoms of posttraumatic stress disorder (PTSD) and dissociation are documented sequelae of PV and are associated with a wide range of behavioral/emotional problems. This study used a cross-sectional research design and bootstrapped multiple mediation analyses with self-report measures completed by a large sample of justice-involved youth (N = 809, ages 12–19 years old, 27% female, 46.5% youth of color) to test the hypothesis that PTSD and dissociation symptoms mediate the relationship between PV and problems with anger, depression/anxiety, alcohol/drug use, and somatic complaints after controlling for the effects of exposure to violence and adversities related to juvenile justice involvement. As hypothesized, PTSD symptoms mediated the relationship of PV with all outcomes except alcohol/drug use problems (which had an unmediated direct association with PV). Partially supporting study hypotheses, dissociation symptoms mediated the relationship between PV and internalizing problems (i.e., depression anxiety; suicide ideation). Implications are discussed for prospective research demarcating the mechanisms linking PV and adverse outcomes in juvenile justice and other high risk populations.

The roles of trauma exposure, rejection sensitivity, and callous-unemotional traits in the aggressive behavior of justice-involved youth: A moderated mediation model

Research has demonstrated an association between childhood trauma exposure and adolescent aggression. This association may be explained by rejection sensitivity, defined as anger, or anxiety in the anticipation of rejection, which can be a consequence of trauma exposure. Callous-unemotional (CU) traits also are associated with trauma exposure and aggressive behavior; however, research has not yet investigated the interactive roles that rejection sensitivity and CU traits play in the relation between trauma exposure and aggression. Therefore, this study sought to investigate the role of rejection sensitivity in the association between trauma exposure and aggression, and whether this indirect effect was moderated by CU traits. Participants included 380 detained youth (98 girls, 282 boys) who completed self-report measures of trauma exposure, angry, and anxious rejection sensitivity, CU traits, and aggression. Results of moderated mediation demonstrated that the relation between trauma exposure and aggression exhibited an indirect effect through angry rejection sensitivity, but only at moderate or high levels of CU traits. This pattern was not found for anxious rejection sensitivity. Results suggest that interventions aimed to decrease aggressive behavior in traumatized adolescents may benefit from considering how youth respond to rejection, as well as whether youth endorse CU traits, as this may help to limit further involvement in the juvenile justice system after release.