Traumatology最新文献

Moral injury is a trauma-related condition that may develop following exposure to events that violate one's deeply held moral beliefs and values (termed "potentially morally injurious events" [PMIEs]). Research has not examined differential roles of the many protective and iatrogenic experiences surrounding a war-zone deployment that might influence development of moral injury after the military-to-civilian transition. In total, 309 Post-9/11 combat veterans completed a cross-sectional survey including the Deployment Risk and Resilience Inventory-2 (DRRI-2), Moral Injury Events Scale, and the Expressions of Moral Injury Scale - Military version after separating from the military. Whether focusing on childhood or pre-deployment experiences or the deployment period itself, bivariate analyses revealed veterans who endorsed moral injury outcomes generally had less relational supports and a range of adverse and potentially traumatic events. Using a multivariate regression analysis with posttraumatic stress disorder symptom severity as a covariate, exposures to PMIEs (transgression and betrayal events) were uniquely linked with greater moral injury outcomes in the presence of other stressful events and possible traumas. However, perception of greater unit support was also uniquely inversely associated with moral injury outcomes in this analysis. In combination, these results affirm the probable link between varying types of PMIE exposures and moral injury outcomes while also suggesting the vital importance of having a cohesive and supportive unit during a war-zone deployment.

Posttraumatic stress disorder (PTSD) confers considerable risk for alcohol-related harms. Trauma-exposed individuals may turn to alcohol in response to intrusive trauma-related symptoms (e.g., memories, flashbacks, nightmares) or distressing trauma-related emotions, with such desires to drink shifting dynamically in-the-moment in response to PTSD symptoms. However, the in-the-moment reasons for drinking that may underlie these dynamic processes remain largely unknown. The present qualitative study aimed to identify key in-the-moment PTSD-related reasons for drinking. Focus groups of frequent drinkers with a provisional diagnosis of past-month PTSD recruited from the community (n = 39; 44% female adults) provided in-depth information on their reasons for drinking during several recent drinking episodes. Focus group data were subjected to directed content analysis. Findings revealed several novel insights regarding in-the-moment reasons for PTSD-related drinking. Participants endorsed perceptions that alcohol could numb trauma-related thoughts and emotions or distract from intrusive symptoms (i.e., negative reinforcement). Participants also described perceptions that alcohol could enhance positive emotions amid persistent negative mood and help process complex trauma-related memories as well as facilitate interpersonal connection. Results identify specific, in-the-moment reasons for drinking in response to emergent PTSD symptoms, which appear at times unique from more general drinking motivations. Findings shed light on potential risk pathways for problem drinking in response to PTSD symptoms as they occur across daily life. These specific in-the-moment reasons for drinking could represent important clinical targets for real-time, adaptive interventions for comorbid PTSD and problem alcohol use.

Trauma-related mental contamination, or a sense of dirtiness occurring without recent contact with a contaminant, is a distressing and often persistent phenomenon after sexual trauma. Following sexual trauma, cross-sectional work has demonstrated separate positive associations between mental contamination and 1) negative posttraumatic cognitions about oneself, the world, and/or self-blame and 2) disgust sensitivity - defined as the extent to which one is prone to distress when experiencing disgust. However, existing work has been primarily restricted to cross-sectional designs and has yet to consider the potential moderating role of disgust sensitivity in associations between negative posttraumatic cognitions and persistent mental contamination. The present study used a daily monitoring design to evaluate main and interactive effects of negative posttraumatic cognitions (about the self, world, and self-blame) and disgust sensitivity in predicting daily experiences of mental contamination among a sample of 39 women with a history of sexual trauma. Results revealed a significant main effect of posttraumatic cognitions about the self in predicting subsequent mental contamination. An unexpected interaction also emerged for posttraumatic cognitions about the world, wherein such cognitions only significantly predicted daily mental contamination among women high in disgust sensitivity. Findings offer preliminary understanding regarding the role of cognitions about the self in contributing to ongoing mental contamination, as well as the potential contributing role of cognitions about the world among women more vulnerable to distress when experiencing disgust. Future work should consider the potential for bidirectional relationships between negative posttraumatic cognitions and trauma-related mental contamination.

Trauma exposure and drinking motives (e.g., social, enhancement, coping) are both associated with increased alcohol use and related problems. Studies have frequently investigated this relationship by examining drinking motives, such as drinking to cope with negative affect, in isolation, yet few studies have examined motives simultaneously in trauma-exposed populations. It is also unclear whether the relationship between drinking motives and alcohol use outcomes differs as a function of population characteristics (e.g., gender, trauma type). Using latent profile analysis (LPA), we aimed to 1) identify latent profiles characterized by drinking motives, assessed with the Drinking Motives Questionnaire (DMQ), in two samples: primarily male veterans with combat trauma (N=174) and civilians with interpersonal trauma (N=152), and 2) determine whether associations with alcohol use outcomes of consumption and binge drinking would differ by sample. A 3-class solution was replicated across both samples: profiles characterized by moderate Social scores and low Enhancement and Coping scores (Low ENH/COP), moderate scores across all domains (Medium DMQ), and elevated scores across all domains (High DMQ). In both samples, profile membership was differentially associated with consumption and binge drinking. Findings suggest patterns of drinking motives may be similar across different trauma-exposed populations, but associations with alcohol outcomes likely differ in meaningful ways. Results can help inform targeted interventions at different treatment settings, such as community health centers or VA hospitals.