Elana Newman

Complex PTSD in Victims Exposed to Sexual and Physical Abuse: Results from the DSM-IV Field Trial for Posttraumatic Stress Disorder

Two hundred thirty four participants in the DSM-IV Posttraumatic Stress Disorder (PTSD) Field Trial who reported sexual and/or physical abuse were evaluated. Participants were categorized according to type of abuse (physical, sexual, both), duration of abuse (acute versus chronic), and onset of abuse (early versus late). Separate logistic regression analyses examined the relationship between age of onset, duration, abuse type, and the complex PTSD (CP) lifetime diagnosis for women and men. Sexually abused women, especially those who also experienced physical abuse, had a higher risk of developing CP, although CP symptoms occurred at a high base rate among physically abused women. The theoretical implications and incremental clinical usefulness of targeting CP symptoms with abused populations are discussed.

Validation of the PTSD checklist in an HMO sample of women

Although Post-traumatic Stress Disorder (PTSD) is common among patients seeking care at medical clinics, little is known about the performance of screening instruments for this disorder in these settings. Previous studies of acute trauma populations using the PTSD Checklist (PCL) have suggested that scores of 45-50 provide the best discrimination between cases and noncases. We gave the PCL to 1,225 randomly selected women enrolled in an HMO. After interviewing a sample of 261 of these women using a structured, clinician-administered PTSD interview, we compared the results of the PCL to the clinician interviews over a range of possible cut scores using Receiver Operating Characteristic analysis. The optimum balance of sensitivity and specificity for this population was a score of 30, yielding a sensitivity of.82 and specificity of.76. The positive and negative likelihood ratios for this cut score were 3.40 and 0.24, respectively. By comparison, the use of 45 as a cut score would result in very low sensitivity (.36) in this setting. The lower cut score found in this study may indicate that the use of previously published cut scores of 45-50 may not optimize the function of the PCL as a screening tool outside of acute trauma settings due to an unacceptably high number of false negative cases.

Report of the APSAC Task Force on Attachment Therapy, Reactive Attachment Disorder, and Attachment Problems:

Although the term attachment disorder is ambiguous, attachment therapies are increasingly used with children who are maltreated, particularly those in foster care or adoptive homes. Some children described as having attachment disorders show extreme disturbances. The needs of these children and their caretakers are real. How to meet their needs is less clear. A number of attachment-based treatment and parenting approaches purport to help children described as attachment disordered. Attachment therapy is a young and diverse field, and the benefits and risks of many treatments remain scientifically undetermined. Controversies have arisen about potentially harmful attachment therapy techniques used by a subset of attachment therapists. In this report, the Task Force reviews the controversy and makes recommendations for assessment, treatment, and practices. The report reflects American Professional Society on the Abuse of Childrens (APSAC) position and also was endorsed by the American Psychological Associations Division 37 and the Division 37 Section on Child Maltreatment.

Assessing the ethical costs and benefits of trauma-focused research

Although scientists and members of Institutional Review Boards must balance the needs of investigators and participants in research, virtually no evidence is available to inform this decision making. This study examines the frequency and correlates of adverse reactions and adequacy of informed consent among 1174 women in an HMO who completed a trauma-focused health survey, and a subset of 252 women who later completed a trauma-focused research interview. Despite the sensitive content, the majority of women participants found participation in the interview and the questionnaire study to be a positive experience. Although a small number of women, particularly those with a history of maltreatment, underestimated the level of upset they would subsequently experience, the majority still did not regret participating, indicating that informed consent procedures were adequate, with a large proportion reporting immediate perceptions of personal gain. Finally, the cost-benefit ratio appears stable 48 hours post-interview, with some minor fluctuations. Overall, these results suggest that research on childhood victimization is well tolerated by women who participate. Though a small number of women may be disturbed by these investigations, in general, adverse reactions appear less common than previously anticipated.

Does the study of victimization revictimize the victims

Although the number of questionnaire surveys examining the sequelae of prior sexual and physical victimization has increased over the last decade, little attention has been given to understanding the impact of such studies on participants. As part of a larger study of long-term effects of prior sexual and physical victimization, 500 randomly selected women in an HMO received a comprehensive questionnaire including multiple symptomatic distress measures and several items inquiring into previous history of sexual, physical, and emotional abuse and neglect. They also completed a short rating scale asking about their reactions to completing the questionnaire. Despite the sensitive content, the women who participated generally found the experience to be a positive one. Only a small number of women were more upset than they had anticipated, but the vast majority felt they would have completed the survey even if they had known in advance how they would feel. The subset of women who did express distress was significantly different from the group that did not, with respect to other measures of symptomatic distress and trauma exposure. These data suggest that surveys that inquire into prior episodes of childhood victimization are generally well tolerated by women who participate, and that, although a small number may be disturbed by these investigations, in general, adverse reactions may be less common than previously anticipated.

Empirically supported ethical research practice: the costs and benefits of research from the participants' view.

Researchers and institutional review boards are routinely called upon to evaluate the cost‐benefit status of proposed research protocols that involve human participants. Often these assessments are based on subjective judgments in the absence of empirical data. This reliance on subjective judgments is of particular concern for studies involving clinical samples where unfounded assumptions may adversely affect research progress or clinical outcomes. The Reactions to Research Participation Questionnaire (RRPQ) was designed to address this shortcoming and to help promote ethical decision making about research practice. The present study describes development of the RRPQ and presents a series of exploratory and confirmatory analyses investigating its structure. Based on these findings, a revised version of the instrument and suggestions for future research are presented. This approach provides a foundation for scientifically informed protection of human subjects.

The relationship among cognitive schemas, job-related traumatic exposure, and posttraumatic stress disorder in journalists.

American newspaper journalists (N = 906) participated in a study examining a cognitive mediational model for explaining the relationship between exposure to work-related traumatic events and work-related posttraumatic stress disorder (PTSD). Results indicated (a) greater exposure to work-related traumatic events was associated with work-related PTSD symptoms, as well as negative cognitive schemas; (b) cognitive beliefs partially accounted for PTSD symptoms, but the full cognitive mediational model was not supported. Implications include targeting interventions for journalists who experience traumatic stress and modifying theories about PTSD symptoms in journalists.

Perceived Religious Discrimination and its Relationship to Anxiety and Paranoia Among Muslim Americans

Abstract Although the effects of discrimination and hate crimes among various minority members mental health is documented, no research to date examines the correlates of perceived discrimination among Muslim Americans. Therefore, this study examined perceived discrimination and its association with subclinical paranoia and anxiety among 152 Muslim Americans. A statistically significant relationship was found between perceived religious discrimination and subclinical paranoia, but perceived discrimination and anxiety were not related. There were also significant differences among ethnic groups and between convert, immigrant, second-generation Muslims in the perception of discrimination. Results suggest that perceived discrimination among Muslim Americans is related to the expression of increased vigilance and suspicion and that group differences affect the perception of discrimination.

Distress in Response to and Perceived Usefulness of Trauma Research Interviews

ABSTRACT Because studying trauma often involves asking about upsetting experiences, it is important for researchers to study the effects of such interviews on research participants, particularly those who may be more vulnerable. In a study of psychiatric inpatients that included a structured interviews for PTSD and childhood physical and sexual assault experiences, participants rated how upsetting and how helpful or useful they found the interview. Of the 223 participants for whom we knew level of distress, 70% experienced relatively low levels of distress, and 51% found participation to be useful in some way. Level of upset was moderately to strongly related to levels of past trauma and current symptoms, while perceived usefulness was not significantly related to any experiences or symptoms.

PTSD, Malevolent Environment, and Criminality among Criminally Involved Male Adolescents

Post-traumatic stress disorder (PTSD) is a chronic and impairing disorder that is pervasive but often overlooked in the assessment and treatment of adolescents involved in the juvenile justice system. The present study examined the occurrence of malevolent environment factors (e.g., poverty, hunger), substance use, trauma exposure, and PTSD among 51 male adolescent offenders recruited from juvenile treatment facilities representing the highest level of security in Massachusetts. Participants completed self-report instruments and semistructured interviews. Much of the information gathered was verified with records kept by the Department of Youth Services. The results of the current study suggest that among male adolescent offenders, exposure to malevolent environmental factors and traumatic life events is common and rates of PTSD are high. We conclude that PTSD and lifetime exposure to potentially traumatic events should be assessed routinely in rehabilitative settings.