Shannon D. Chaplo

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.

America's Child Soldiers: Toward a Research Agenda for Studying Gang-Involved Youth in the United States

This article examines ways in which international research on child soldiers might serve to inform research on gang-involved youth in the United States. In particular, we discuss the importance of understanding trauma exposure and post-traumatic stress reactions as both risks for and consequences of participation in both forms of armed groups. In addition, we point to the value of expanding our view of trauma to include dimensions that have yielded important insights in the study of child soldiers, including developmental trauma disorder, perpetration-induced trauma, and the unique sequelae of sexual victimization for girls. The roles of ethnic pride and ideology, moral agency, and the processes that promote desistance and reintegration of former child soldiers and gang members are discussed. Finally, we suggest that future research on children in armed groups should give consideration not only to psychological constructs like resilience and post-traumatic growth, but to social forces that can promote prosocial behavior.

“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