Marylene Cloitre

Posttraumatic stress disorder, self‐ and interpersonal dysfunction among sexually retraumatized women

This study assessed self and interpersonal dysfunction as well as posttraumatic stress disorder (PTSD) among three groups of women: women sexually assaulted in both childhood and adulthood, women sexually assaulted only in adulthood and women who were never assaulted. Rates of PTSD were high and equivalent in the two assault groups. However, retraumatized women were more likely to be alexithymic, show dissociation scores indicating risk for dissociative disorders, and to have attempted suicide compared to the other two groups, who did not differ from each other. Additionally, only the retraumatized women experienced clinically significant levels of interpersonal problems. The findings suggest that formulations more inclusive than PTSD are required to capture the psychological difficulties experienced by this population. Treatment implications are discussed.

Childhood abuse and subsequent sexual assault among female inpatients

The relationship between a history of childhood abuse and subsequent sexual assault was assessed among 409 consecutive female inpatient admissions. A total of 45% of the sample reported a history of some form of childhood abuse and 22% reported at least one adulthood sexual assault. A hierarchical logistic regression indicated that, after controlling for sociodemographic and diagnostic variables, women with a history of childhood abuse were 3.1 times more likely to have experienced an adult sexual assault compared to those without abuse. There was a higher prevalence of adult sexual assault among women reporting only physical abuse or physical and sexual abuse than those reporting only sexual abuse, indicating the significance of physical abuse as a potential risk factor for adult sexual assault.

Peritraumatic dissociation and PTSD severity: do event-related fears about death and control mediate their relation?

Relations among peritraumatic dissociation, PTSD severity, event-related fear (i.e. fear experienced during traumatic event) about death, and event-related fear about losing control were examined in the current study. Particular emphasis was placed on testing whether or not fears about death and losing control mediate the relation between peritraumatic dissociation and PTSD severity in a sample of 146 nontreatment-seeking university women. Results indicated that event-related fears about death and losing control accounted for the relation between peritraumatic dissociation and PTSD severity; that is, the effect of peritraumatic dissociation on PTSD severity was eliminated after controlling for these fears. Speculations about findings are discussed.

Memory bias in panic disorder: An investigation of the cognitive avoidance hypothesis

Individuals with panic disorder (n = 14) and normal controls (n = 14) performed two different memory tasks: a high-speed recognition task that measured perceptual memory (memory for the sensory/perceptual features of a stimulus) and a free recall task that measured semantic memory (memory for the meaning associated with the stimulus). Subjects memory for threatening, positive, and neutral words was evaluated. In contrast to normal controls, panic disorder patients showed better perceptual memory and better semantic memory for threat words compared to positive and neutral words. These results suggest that the panic disorder individuals engaged in preferential processing of threat information at both a perceptual and semantic level of analysis. The results do not support a “cognitive avoidance” hypothesis which predicts the inhibition of more elaborate and meaningful processing of threat stimuli in anxious subjects. The conditions under which cognitive avoidance might occur are outlined.

Childhood trauma as a correlate of lifetime opiate use in psychiatric patients.

Associations have been reported between childhood sexual and/or physical abuse and adult substance abuse in general. This study investigated the relationship between childhood abuse and opiate use in particular among 763 consecutively admitted psychiatric inpatients. Patients were interviewed about demographic information, alcohol and drug use, and history of interpersonal violence. Opiate users were 2.7 times more likely to have a history of childhood sexual and/or physical abuse than nonopiate users, after controlling for diagnostic and sociodemographic variables. Opiate use was higher among those reporting physical abuse alone (24.1%) or both physical and sexual abuse (27%) than among those reporting sexual abuse alone (8.8%). Implications of these findings are discussed.

Memory performance among women with parental abuse histories: enhanced directed forgetting or directed remembering?

Performance on a directed forgetting task was assessed in 24 individuals with borderline personality disorder and early life parental abuse, 24 borderline individuals with no history of abuse, and 24 healthy nonclinical controls under conditions of explicit and implicit memory. In the explicit memory condition, individuals with abuse histories showed greater differential recall of to-be-remembered versus to-be-forgotten material compared to the 2 comparison groups. Implicit memory performance was equivalent for all 3 groups. The enhanced selective memory in the abused group was the result of better recall for remember and not poorer recall for forget information, indicating that abused individuals have an enhanced ability to sustain attention to designated remember information. Because most people with childhood abuse recall their abuse, enhanced remembering of designated events (e.g., information not associated with abuse) may be a coping strategy.

Posttraumatic stress disorder and extent of trauma exposure as correlates of medical problems and perceived health among women with childhood abuse.

ABSTRACT This study examined the relative contributions of Posttraumatic Stress Disorder (PTSD) symptoms and the extent of trauma exposure as factors contributing to the current health status of childhood abuse survivors. Sixty-seven women with a history of familial childhood abuse (sexual and/or physical) and twenty-nine women with no abuse history were assessed on two distinct aspects of health status: reported number of medical problems and perceptions of overall health. Women with abuse were found to have a greater number of medical problems and poorer perceived physical well-being than the no abuse comparison group. Regression analyses of the women with abuse histories revealed that trauma exposure was a stronger predictor than PTSD symptoms of medical problems. PTSD symptoms, however, were better predictors of the experience of physical well-being than trauma exposure. These results suggest that the nature of a traumatic exposure, especially when there is repeated, cumulative trauma may be more significant to medical problems than the psychological symptoms of PTSD. Perceived health, however, appears to be predominantly influenced by psychological factors, suggesting the importance of these variables in the quality of life of multiply traumatized women.

Memory bias does not generalize across anxiety disorders

Individuals with social phobia were compared with normal controls on their memory for socially-related threat words in contrast to positive and neutral words. A memory paradigm used in a previous study of panic disorder patients [Cloitre, M. & Liebowitz, M. R. (1991) Cognitive Therapy and Research, 15, 609-619] was applied to test the generalizability of findings of threat-biased memory in a semantic memory task (free recall) and a perceptual memory task (high-speed recognition) to social phobics. No evidence of threat-related memory bias among social phobics was obtained. Since both the social phobic and control groups showed better memory for affectively valenced (threat and positive) compared to neutral information, it is unlikely that the absence of threat-biased memory among social phobics was the result of insensitive measurement.

The impact of borderline personality disorder on process group outcome among women with posttraumatic stress disorder related to childhood abuse.

Abstract The outcome of a 12-week interpersonal process group therapy for women with postraumatic Stress Disorder (PTSD) related to childhood sexual abuse with and without borderline personality disorder (BPD) was assessed by comparing three naturally occurring treatment conditions: groups that did not have any members with borderline personality disorder (BPD-) (n = 18), groups in which at least one member carried the diagnosis (BPD+)(n = 16), and a 12-week waitlist (WL) (n = 15). PTSD, anger, depression, and other symptoms were significantly reduced in the BPD- groups. However, the BPD+ and WL conditions did not show any pre- to posttreatment improvements. Furthermore, the BPD+ condition showed a significant worsening on measures of anger. Analyses within the BPD+ condition indicated that women with and without the diagnosis experienced equal posttreatment increases in anger problems. These latter results suggest the presence of an anger “contagion” effect. That is, women without BPD did well in the BPD- groups but showed increased anger similar to the BPD+ women when treated in groups with them. Implications for client-treatment matching considerations in PTSD group therapy are discussed.

Does mood-congruence or causal search govern recall bias? a test of life event recall

Recall bias has been hypothesized to occur as a function of mood congruence or causal-search related mechanisms. This study tested whether either mechanism related to recall of stressful life events over a year. Respondents consisted of 136 cases suffering from chronic facial pain and 131 acquaintance controls. After reporting life events for 1 year at monthly intervals, respondents attempted to recall these same events at year-end. Mood and likelihood of engaging in causal search were also ascertained at year-end. Results showed no effect of mood congruence or causal search on recall of event occurrence. However, mood did influence subjective appraisal of those events that were recalled. In addition, a significant mood-related memory deficit was detected. Findings indicate that mood-related memory deficit may reduce effect sizes artifactually. Furthermore, when assessing effects of recall bias, recall of event occurrence must be considered separately from subjective appraisal of event characteristics.