Jane Stafford

Posttraumatic stress disorder and intimate relationship problems: a meta-analysis.

OBJECTIVE The authors conducted a meta-analysis of empirical studies investigating associations between indices of posttraumatic stress disorder (PTSD) and intimate relationship problems to empirically synthesize this literature. METHOD A literature search using PsycINFO, Medline, Published International Literature on Traumatic Stress (PILOTS), and Dissertation Abstracts was performed. The authors identified 31 studies meeting inclusion criteria. RESULTS True score correlations (ρ) revealed medium-sized associations between PTSD and intimate relationship discord (ρ = .38, N = 7,973, K = 21), intimate relationship physical aggression perpetration (ρ = .42, N = 4,630, K = 19), and intimate relationship psychological aggression perpetration (ρ = .36, N = 1,501, K = 10). The strength of the association between PTSD and relationship discord was higher in military (vs. civilian) samples, and when the study was conducted in the United States (vs. other country), and the study represented a doctoral dissertation (vs. published article). The strength of the association between PTSD and physical aggression was higher in military (vs. civilian) samples, males (vs. females), community (vs. clinical) samples, studies examining PTSD symptom severity (vs. diagnosis), when the physical aggression measure focused exclusively on severe violence (vs. a more inclusive measure), and the study was published (vs. dissertation). For the PTSD-psychological aggression association, 98% of the variance was accounted for by methodological artifacts such as sampling and measurement error; consequently, no moderators were examined in this relationship. CONCLUSIONS Findings highlight a need for the examination of models explaining the relationship difficulties associated with PTSD symptomatology and interventions designed to treat problems in both areas.

Relationship Between Trauma Narratives and Trauma Pathology

In this study we examined the relationship between posttrauma pathology and the level of articulation (complexity) in rape narratives recounted by victims shortly after the assault. Degree of articulation was operationalized as the reading level of the narratives as determined by a computer program. Shortly after the trauma, reading level was correlated with severity of anxiety but not with posttraumatic stress disorder (PTSD) symptoms. Degree of the narrative articulation shortly after the trauma, however, was related to severity of later PTSD. These results are consistent with the hypothesis that the less developed trauma narratives hinder recovery from trauma.

Gender differences in experiences of sexual harassment : Data from a male-dominated environment

The goal of this investigation was to examine gender differences in experiences of sexual harassment during military service and the negative mental health symptoms associated with these experiences. Female (n = 2,319) and male (n = 1,627) former reservists were surveyed about sexual harassment during their military service and current mental health symptoms. As expected, women reported a higher frequency of sexual harassment. Further, women had increased odds of experiencing all subtypes of sexual harassment. Being female conferred the greatest risk for experiencing the most serious forms of harassment. For both men and women, sexual harassment was associated with more negative current mental health. However, at higher levels of harassment, associations with some negative mental health symptoms were stronger for men than women. Although preliminary, the results of this investigation suggest that although women are harassed more frequently than men, clinicians must increase their awareness of the potential for sexual harassment among men in order to provide the best possible care to all victims of harassment.

Sexual harassment and assault experienced by reservists during military service: Prevalence and health correlates

The current investigation identified the gender-specific prevalence of sexual harassment and assault experienced during U.S. military service and the negative mental and physical health correlates of these experiences in a sample of former reservists. We surveyed a stratified random sample of 3,946 former reservists about their experiences during military service and their current health, including depression, posttraumatic stress disorder, somatic symptoms, and medical conditions. Prevalence estimates and confidence intervals of sexual harassment and assault were calculated. A series of logistic regressions identified associations with health symptoms and conditions. Both men and women had a substantial prevalence of military sexual harassment and assault. As expected, higher proportions of female reservists reported sexual harassment (60.0% vs 27.2% for males) and sexual assault (13.1% vs 1.6% for males). For both men and women, these experiences were associated with deleterious mental and physical health conditions, with sexual assault demonstrating stronger associations than other types of sexual harassment in most cases. This investigation is the first to document high instances of these experiences among reservists. These data provide further evidence that experiences of sexual harassment and assault during military service have significant implications for the healthcare needs of military veterans.

Attitudes Toward Women and Tolerance for Sexual Harassment Among Reservists

Women are more likely to experience sexual harassment in some work settings than others; specifically, work settings that have a large proportion of male workers, include a predominance of male supervisors, and represent traditional male occupations may be places in which there is greater tolerance for sexual harassment. The focus of the study was to document attitudes toward women among military personnel, to identify demographic and military characteristics associated with more positive attitudes toward women, and to examine associations between attitudes toward women and tolerance for sexual harassment. The study was based on data from 2,037 male and female former Reservists who reported minimal or no experiences of sexual harassment and no sexual assault in the military. Results suggest that attitudes toward women vary across content domains, are associated with several key demographic and military characteristics, and predict tolerance for sexual harassment. Implications of the findings and future directions are discussed.

Cultural scripts, memories of childhood abuse, and multiple identities: a study of role-played enactments.

Abstract This study compared the reports of Satanic, sexual, and physical abuse of persons instructed to role-play either dissociative identity disorder (DID) (n = 33), major depression (n = 33), or a college student who experienced minor adjustment problems (“normal”) (n = 33) across a number of trials that included role-played hypnosis. As hypothesized, more of the participants who were asked to role-play DID reported at least one instance of satanic ritual abuse and sexual abuse compared with those who role-played depression or a college student with minor adjustment problems. DID role-players reported more incidents of sexual abuse and more severe physical and sexual abuse than did the major depression role-players. Further, the DID role-players differed from the normal role-players on all the measures of frequency and severity of physical and sexual abuse. Participants in all groups reported more frequent and severe incidents of physical abuse after role-played hypnosis than they did prior to it.

Medical Evaluation Board Involvement, Non-Credible Cognitive Testing, and Emotional Response Bias in Concussed Service Members

Introduction Military Service Members (SMs) with post-concussive symptoms are commonly referred for further evaluation and possible treatment to Department of Defense Traumatic Brain Injury Clinics where neuropsychological screening/evaluations are being conducted. Understudied to date, the base rates of noncredible task engagement/performance validity testing (PVT) during cognitive screening/evaluations in military settings appears to be high. The current study objectives are to: (1) examine the base rates of noncredible PVTs of SMs undergoing routine clinical or Medical Evaluation Board (MEB) related workups using multiple objective performance-based indicators; (2) determine whether involvement in MEB is associated with PVT or symptom exaggeration/symptom validity testing (SVT) results; (3) elucidate which psychiatric symptoms are associated with noncredible PVT performances; and (4) determine whether MEB participation moderates the relationship between psychological symptom exaggeration and whether or not SM goes on to demonstrate PVTs failures - or vice versa. Materials and Methods Retrospective study of 71 consecutive military concussion cases drawn from a DoD TBI Clinic neuropsychology clinic database. As part of neuropsychological evaluations, patients completed several objective performance-based PVTs and SVT. Results Mean (SD) age of SMs was 36.0 (9.5), ranging from 19-59, and 93% of the sample was male. The self-identified ethnicity resulted in the following percentages: 62% Non-Hispanic White, 22.5% African American, and 15.5% Hispanic or Latino. The majority of the sample (97%) was Active Duty Army and 51% were involved in the MEB at the time of evaluation. About one-third (35.9%) of routine clinical patients demonstrated failure on one or more PVT indicators (12.8% failed 2) while PVT failure rates amongst MEB patients ranged from 15.6% to 37.5% (i.e., failed 2 or 1 PVTs, respectively). Base rates of failures on one or more PVT did not differ between routine clinical versus MEB patients (p = 0.94). MEB involvement was not associated with increased emotional symptom response bias as compared to routine clinical patients. PVT failures were positively correlated with somatization, anxiety, depressive symptoms, suspicious and hostility, atypical perceptions/alienation/subjective cognitive difficulties, borderline personality traits/features, and penchant for aggression in addition to symptom over-endorsement/exaggeration. No differences between routine clinical and MEB patients across other SVT indicators were found. MEB status did not moderate the relationship between any of the SVTs. Conclusion Study results are broadly consistent with the prior published studies that documented low to moderately high base rates of noncredible task engagement during neuropsychological evaluations in military and veteran settings. Results are in contrast to prior studies that have suggested involvement in MEB is associated with increased likelihood of poor PVT performances. This is the first to show that MEB involvement did not enhance/strengthen the association between PVT performances and evidence of SVTs. Consistent with prior studies, these results do highlight that the same SMs who fail PVTs also tend to be the ones who go on to endorse a myriad of psychiatric symptoms and proclivities. Implications of variable or poor task engagement during routine clinical and MEB neuropsychological evaluation in military settings on treatment and disposition planning cannot be overstated.