Dorte Mølgaard Christiansen

ASD and PTSD in Rape Victims

In recent years, a number of studies have investigated the prediction of posttraumatic stress disorder (PTSD) through the presence of acute stress disorder (ASD). The predictive power of ASD on PTSD was examined in a population of 148 female rape victims who visited a center for rape victims shortly after the rape or attempted rape. The PTSD diagnosis based solely on the three core symptom clusters was best identified by a subclinical ASD diagnosis based on all ASD criteria except dissociation. However, a full PTSD diagnosis including the A 2 and F criteria was best identified by classifying victims according to a full ASD diagnosis. Regardless of whether cases were classified according to full PTSD status or according to meeting the criteria for the three PTSD core symptom clusters, the classification was correct only in approximately two thirds of the cases. A regression analysis based on ASD severity and sexual problems following the rape accounted for only 28% of the PTSD severity variance. In conclusion, the ASD diagnosis is not an optimal method for identifying those most at risk for PTSD. It remains to be seen whether a better way can be found.

Predictive factors for somatization in a trauma sample

BackgroundUnexplained somatic symptoms are common among trauma survivors. The relationship between trauma and somatization appears to be mediated by posttraumatic stress disorder (PTSD). However, only few studies have focused on what other psychological risk factors may predispose a trauma victim towards developing somatoform symptoms.MethodsThe present paper examines the predictive value of PTSD severity, dissociation, negative affectivity, depression, anxiety, and feeling incompetent on somatization in a Danish sample of 169 adult men and women who were affected by a series of explosions in a firework factory settled in a residential area.ResultsNegative affectivity and feelings of incompetence significantly predicted somatization, explaining 42% of the variance. PTSD was significant until negative affectivity was controlled for.ConclusionNegative affectivity and feelings of incompetence significantly predicted somatization in the trauma sample whereas dissociation, depression, and anxiety were not associated with degree of somatization. PTSD as a risk factor was mediated by negative affectivity.

Risk factors predict post-traumatic stress disorder differently in men and women

BackgroundAbout twice as many women as men develop post-traumatic stress disorder (PTSD), even though men as a group are exposed to more traumatic events. Exposure to different trauma types does not sufficiently explain why women are more vulnerable.MethodsThe present work examines the effect of age, previous trauma, negative affectivity (NA), anxiety, depression, persistent dissociation, and social support on PTSD separately in men and women. Subjects were exposed to either a series of explosions in a firework factory near a residential area or to a high school stabbing incident.ResultsSome gender differences were found in the predictive power of well known risk factors for PTSD. Anxiety predicted PTSD in men, but not in women, whereas the opposite was found for depression. Dissociation was a better predictor for PTSD in women than in men in the explosion sample but not in the stabbing sample. Initially, NA predicted PTSD better in women than men in the explosion sample, but when compared only to other significant risk factors, it significantly predicted PTSD for both men and women in both studies. Previous traumatic events and age did not significantly predict PTSD in either gender.ConclusionGender differences in the predictive value of social support on PTSD appear to be very complex, and no clear conclusions can be made based on the two studies included in this article.

Parents bereaved by infant death: PTSD symptoms up to 18 years after the loss.

OBJECTIVE Losing an infant or fetus late in pregnancy, during birth or in the first year of life is a potentially traumatic event for parents. However, little is known about the factors contributing to chronic posttraumatic stress reactions in this population. The present study examined chronic posttraumatic stress disorder (PTSD) symptoms and potential correlates in 634 mothers and fathers up to 18 years (M=3.4 years) after the death of their infant. METHODS Members of a private national support organization for parents bereaved by infant death were contacted and asked to participate in the study. Participants filled out a questionnaire package including measures of PTSD (the Harvard Trauma Questionnaire), coping (the Coping Style Questionnaire), perceived social support (the Crisis Support Scale) and attachment (the Revised Adult Attachment Scale). Associations between variables were examined through the use of analyses of variance, correlation analyses and a regression analysis. RESULTS We found an estimated PTSD prevalence of 12.3%. Type of loss (pre-, peri- or postnatal) did not have any effect on PTSD severity, but lower gestational age was associated with more symptoms. Time since the loss, female sex, attachment avoidance, attachment anxiety, emotion-focused coping, rational coping, feeling let down and social support satisfaction accounted for 42% of the variance in PTSD severity. CONCLUSIONS The study highlights the long-term impact of infant loss and points to attachment, coping and social support as important contributors to the development and maintenance of posttraumatic stress symptoms.

Accounting for sex differences in PTSD: A multi-variable mediation model.

Background Approximately twice as many females as males are diagnosed with posttraumatic stress disorder (PTSD). However, little is known about why females report more PTSD symptoms than males. Prior studies have generally focused on few potential mediators at a time and have often used methods that were not ideally suited to test for mediation effects. Prior research has identified a number of individual risk factors that may contribute to sex differences in PTSD severity, although these cannot fully account for the increased symptom levels in females when examined individually. Objective The present study is the first to systematically test the hypothesis that a combination of pre-, peri-, and posttraumatic risk factors more prevalent in females can account for sex differences in PTSD severity. Method The study was a quasi-prospective questionnaire survey assessing PTSD and related variables in 73.3% of all Danish bank employees exposed to bank robbery during the period from April 2010 to April 2011. Participants filled out questionnaires 1 week (T1, N=450) and 6 months after the robbery (T2, N=368; 61.1% females). Mediation was examined using an analysis designed specifically to test a multiple mediator model. Results Females reported more PTSD symptoms than males and higher levels of neuroticism, depression, physical anxiety sensitivity, peritraumatic fear, horror, and helplessness (the A2 criterion), tonic immobility, panic, dissociation, negative posttraumatic cognitions about self and the world, and feeling let down. These variables were included in the model as potential mediators. The combination of risk factors significantly mediated the association between sex and PTSD severity, accounting for 83% of the association. Conclusions The findings suggest that females report more PTSD symptoms because they experience higher levels of associated risk factors. The results are relevant to other trauma populations and to other trauma-related psychiatric disorders more prevalent in females, such as depression and anxiety.

Sex Differences in PTSD

Research into the psychological sequalae of trauma originally started out by focusing on two sex-specific trauma populations: male war veterans with “soldiers heart”, “shellshock”, “battle fatigue”, or “war neurosis” and female victims of sexual assault or domestic violence with “rape trauma syndrome” or “battered woman syndrome”. It was noted how the flashbacks and nightmares reported by rape survivors were similar to the symptoms reported by war veterans, and several researchers and clinicians started pointing out that these trauma specific syndromes might be more similar than different (Ray, 2008; Van der Kolk, 2007). Finally, it was the large number of male Vietnam veterans and the activities of feminist and student organisations, which led to the inclusion of the first PTSD diagnosis into the American DSM-III in 1980 (American Psychiatric Association, 1980). With the introduction of the PTSD diagnosis, the idea that the male war neurosis and the female rape trauma syndrome were ultimately manifestations of the same disorder was widely accepted. As a result, most research on PTSD has been based on the idea that males and females are traumatised in similar ways, and studies on sex differences in PTSD have primarily focused on examining and explaining sex differences in the prevalence and severity of PTSD, whereas studies on sex differences in the manifestation of PTSD are almost completely absent from this otherwise expanding area of research. Most literature on sex differences in PTSD uses the terms sex and gender interchangeably. Traditionally, however, the term sex refers to the biological distinction between males and females, whereas gender refers to the much more complex cultural understanding of masculine and feminine gender roles as they are viewed in the context of not only sex, but also culture, subculture, age, race, class, and sexual orientation. Even though many studies on PTSD claim to examine gender differences, most studies have in fact studied sex differences and only few have looked into the effect of masculinity or femininity on PTSD. Although this chapter will focus primarily on sex, we acknowledge that gender is likely to affect the development and maintenance of PTSD in males and females as well. The contribution of sex versus gender based explanations for sex differences in PTSD will be discussed throughout the chapter, although the topic merits a more thorough discussion than is possible here.

Victimization and PTSD in a Lithuanian National Youth Probability Sample

Twenty-one potentially traumatizing and distressing events, and the impact of these events were described in a representative sample of 183 9th grade Lithuanian adolescents (M = 15.1 years). The participants had been directly exposed to a mean of 1.9 events, and indirectly exposed to a mean of 2.4 events. The estimated lifetime prevalence of PTSD was 6.1%. Subclinical levels of PTSD reached 12.2%. Results are generally comparable to other European youth studies. Variables pertaining to female gender, living with a single parent, direct and indirect exposure to traumatic events, number of traumatic events, and the temporal proximity of trauma events, predicted higher PTSD levels. Both direct and indirect exposure to traumatic events may lead to subsequent mental health problems and PTSD in adolescents.

Cognitive Schemata and Processing Among Parents Bereaved by Infant Death

The present prospective study examined cognitive schemata and processing among 93 parents bereaved by infant death. The Trauma Constellation Identification Scale (TCIS) was used to assess maladaptive cognitive schemata associated with the loss. The impact of pre-, peri-, and post-trauma factors on the TCIS scores was assessed. Compared to parents who had not lost an infant, bereaved parents displayed significantly higher TCIS scores. High TCIS scores were significantly associated with PTSD as well as general symptomatology. Although interesting gender differences were found, the variables most strongly related to TCIS scores were posttraumatic emotional coping and cognitive processing.

Risk Factors for Posttraumatic Stress Disorder Following an Industrial Disaster in a Residential Area: A Note on the Origin of Observed Gender Differences

BACKGROUND Studies indicate that differences in trait anxiety and trauma-related distress may mediate the gender differences observed in posttraumatic stress disorder (PTSD). OBJECTIVE We examined the contributions of gender, trait anxiety, and trauma-related distress to the development of PTSD after an industrial disaster. METHODS Three months after a massive explosion in a fireworks factory in Kolding, Denmark, in November 2004, residents in the surrounding area were asked to complete the Harvard Trauma Questionnaire, the General Health Questionnaire, and a questionaire designed for the present study. Using multivariable logistic regression with PTSD as the dependent variable, we examined 4 explanatory models: (1) gender; (2) gender and trait anxiety; (3) gender, trait anxiety, and perceived danger; and (4) gender, trait anxiety, perceived danger, perceived hostility, feeling isolated, depersonalization, and behavioral self-blame. RESULTS Fifty-one percent (N = 516; 265 women and 251 men) of the area residents participated in the study. The female-to-male ratio of PTSD was 2.4:1. Women experienced significantly more trait anxiety (P < 0.001), feelings of isolation (P < 0.005), and behavioral self-blame (P = 0.018), and less perceived danger (P = 0.034) than did men. In multivariable logistic regression analysis, gender alone predicted 3.7% of the variance in PTSD status (odds ratio [OR] = 2.40; 95% CI, 1.35-4.27; P < 0.005); however, in all other models, gender was not significant. The final model comprised trait anxiety (OR = 1.20; 95% CI, 1.11-1.30; P < 0.001), perceived danger (OR = 4.62; 95% Cl, 2.24-9.50; P < 0.001), perceived hostility (OR = 5.21; 95% CI, 1.93-14.09; P < 0.001), feeling isolated (OR = 3.34; 95% CI, 1.55-7.16; P < 0.002), depersonalization (OR = 2.49; 95% CI, 1.42-4.37; P < 0.001), and behavioral self-blame (OR = 0.46; 95% CI, 0.24-0.86; P = 0.015), explaining 48.9% of the variance in PTSD severity. CONCLUSION This cross-sectional study found that gender was no longer associated with PTSD status when trait anxiety, perceived danger and hostility, feeling isolated, depersonalization, and behavioral self-blame were taken into account.

Risk factors for posttraumatic stress disorder in female help-seeking victims of sexual assault

Posttraumatic stress disorder (PTSD) is common in the aftermath of rape and other sexual assault, but the risk factors leading to PTSD following rape have been shown to differ from those related to PTSD following nonsexual assault. This prospective study examined risk factors for PTSD severity in 148 female help-seeking victims of sexual assault. Approximately 70% of the victims experienced significant levels of traumatization, with 45% reporting symptoms consistent with a probable PTSD diagnosis. Regression analyses showed that relationship with the assailant, number of assailants, the nature of the assault, perceived positive social support, support satisfaction, feeling let down by others, and prior exposure to sexual trauma did not significantly predict PTSD severity at the final level of analysis. In accordance with suggestions by Dancu, Riggs, Hearst-Ikeda, and Shoyer (1996), it is suggested that this is partly caused by a very high degree of traumatization in the sample. Instead, previous nonsexual traumatic experiences and negative affectivity accounted for 30% of the variance in PTSD severity. Although more research is needed on risk factors of assault-related PTSD, these findings suggest that although sexual assault is associated with a high degree of PTSD severity, prior nonsexual victimization and high levels of negative affectivity appear to further increase the vulnerability toward developing symptoms of assault-related PTSD.