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Patients with complex medical conditions may have a medical history that includes multiple negative/traumatic experiences with the health care system over the course of their diagnosis and treatment. The BITTEN (Betrayal history by health-related institutions; Indicator for health care engagement; Trauma symptoms related to health care; Trust in health care providers; Expectation of patient; Needs of patient) model posits that health care providers can recognize and respond in a way that encourages resisting patient retraumatization. We present a hypothetical case study applying the BITTEN model as a patient-centered framework to include in a standard visit. Increased awareness of the patient’s risk for institutional betrayal, trauma, and overall negative past health care experiences can help the NP better understand the patient’s current and future health care needs and expectations.

Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.

Nurse practitioners regularly treat primary care patients with trauma histories. By incorporating trauma-informed care into practice, nurse practitioners can enhance the provision of clinical care and, ultimately, improve patient health outcomes. This brief report demonstrates how to actively incorporate the principles and practices of the 4R framework of trauma-informed care into primary care to realize the prevalence of trauma, recognize patients’ trauma signs and symptoms, and respond to patients in a manner that resists retraumatization. Through early identification of trauma symptoms and referral to appropriate follow-up treatment, nurse practitioners can significantly improve the life course of their trauma survivor patients.

Background In this study, the first to examine psychometrics of a Haitian Kreyol version of the Trauma Symptom Checklist-40 (TSC-40), we investigated trauma symptoms in survivors of Haiti's 2010 earthquake who reside in Haiti's Cite Soleil slum, a violent neighborhood where non-partner sexual violence (NPSV) is rampant and whose residents are historically underrepresented in research. Methods 233 women and 280 men 18 years or older completed the TSC-40. Differential Item Function (DIF) analysis was performed on the TSC-40 responses for women and men. We examined symptom counts by gender, between NPSV victims and non-victims, and by interaction between gender and NPSV experience. Results We identified a reduced pool of 17-items that exhibited no gender bias. This 17-item index showed acceptable internal consistency reliability (α = 0.87). Employing this index, average symptom counts for women ( x ¯ = 11.3) did not differ from men ( x ¯ = 11.1). Average symptom counts for NPSV victims was greater ( x ¯ = 12.5) than for non-victims ( x ¯ = 10.7). The gender by experience of NPSV interaction indicated that women victims had the highest symptom counts ( x ¯ = 14.0). Limitations We used non-probability sampling, and data were from self-reports collected in a cross-sectional survey. Conclusions Observed differences in trauma burden are likely to be misleading if instruments are administered without regard to DIF. We contribute a Haitian Kreyol Trauma Symptom 17-item index, which offers clinicians/practitioners in Haiti the opportunity to use a valid and reliable measure of enduring trauma symptoms validated in Haiti.

Trauma exposure is pervasive among children living in foster care, and yet most resource parents (foster parents and kinship caregivers), child welfare staff, and others in the child welfare system are not adequately prepared to recognize and respond effectively when children exhibit trauma symptoms. Trauma-systems Therapy-Foster Care (TST-FC) is a systemwide model of trauma-informed care focused on meeting the emotional needs of children in foster care who have experienced traumatic events. This study evaluated the implementation of TST-FC in two state child welfare agencies that included training for staff (n = 123) and resource parents (n = 111). Study findings show training participants had positive perceptions of TST-FC and found it useful. TST-FC also was associated with significant increases in trauma-informed parenting and tolerance of children's misbehavior by resource parents, as well as more trauma-informed policies and practices in the child welfare agencies. Training participants reported that TST-FC provided useful tools and a common language about trauma that enhanced their capacity to collaborate with one another and manage children's difficult behavior. An exploratory study of resource home retention and children's placement stability revealed fewer foster home closures and placement disruptions when resource parents were trained in TST-FC compared to homes not trained in the model. The results of this study suggest that TST-FC is a promising model for increasing the capacity of child welfare agencies to provide trauma-informed care to children and families in the foster care system.

Background A Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) was added to the DSM-5, but little is known about this symptom pattern in young children exposed to trauma. Tailoring treatment to traumatized young children requires understanding the different patterns of trauma-related symptomatology and important correlates. The current study tested the hypothesis that type and number of child traumatic events, caregiver trauma exposure, and caregiver symptomatology would predict whether traumatized young children presented with PTSD, PTSD with clinical dissociation, or non-clinical trauma symptoms. Methods A multinomial regression was conducted using data collected from an ethnically and economically diverse sample of 297 trauma-exposed children between the ages of 3 and 6 and their caregivers. Based on parent-report on a well-validated measure of trauma symptoms, children were categorized into three groups: non-clinical (n = 128), PTSD only (n = 104), or PTSD with dissociation (PTSD-DISS; n = 65). Predictors included trauma exposure, parent trauma symptoms, and child sex. Results Girls were twice more likely than boys to be in the PTSD-DISS group; sexually abused children were almost three times as likely to be in the PTSD-DISS group; and, for every unit increase in parent avoidance symptoms or number of traumatic events, the odds of being in the PTSD-DISS group increased significantly. Limitations Given the cross-sectional study design, conclusions cannot be drawn regarding causality. Measures were completed by a single reporter. Conclusions Findings suggest that subgroups of children may be especially vulnerable to comorbid PTSD and dissociation. Implications for treatment are discussed.

Attrition from child trauma-focused treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is common; yet, the factors of children who prematurely terminate are unknown. The aim of the current study was to identify risk factors for attrition from TF-CBT. One hundred and twenty-two children (ages 3-18; M=9.97, SD=3.56; 67.2% females; 50.8% Caucasian) who received TF-CBT were included in the study. Demographic and family variables, characteristics of the trauma, and caregiver- and child-reported pretreatment symptoms levels were assessed in relation to two operational definitions of attrition: 1) clinician-rated dropout, and 2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Several demographic factors, number of traumatic events, and children's caregiver-rated pretreatment symptoms were related to clinician-rated dropout. Fewer factors were associated with the adequate dose definition. Child Protective Services involvement, complex trauma exposure, and child-reported pretreatment trauma symptoms were unrelated to either attrition definition. Demographics, trauma characteristics, and level of caregiver-reported symptoms may help to identify clients at risk for premature termination from TF-CBT. Clinical and research implications for different operational definitions and suggestions for future work will be presented.

Young women who had contact with child protective services (CPS) are two to three times more likely to become young mothers than their peers in the general population. Adverse life events, such as maltreatment and placement instability, are associated with an increased risk of early motherhood. Adverse events may lead to trauma symptoms, which could contribute to the circumstances that lead young women to become mothers. In this study, we explored the association between trauma symptoms and early motherhood, after controlling for the effects of maltreatment, placement instability, and risky sexual behaviors, among 112 young women who had contact with CPS. The results of a multivariate binary logistic regression analysis showed that symptoms of trauma related to sexual disturbance were associated with an increased risk of early motherhood while anger and suicidality as trauma symptoms were associated with a decrease in this risk. These results suggest that the long-term consequences of adverse events, such as trauma symptoms, should be considered in the study of early motherhood. Furthermore, a trauma-sensitive approach focused on the links between traumatic events and behavioral dysfunction could be helpful in supporting young women who had contact with CPS and are preparing for early motherhood.

There is a strong, bidirectional link between substance abuse and traumatic experiences. Teens with cooccurring substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) have significant functional and psychosocial impairment. Common neurobiological foundations point to the reinforcing cycle of trauma symptoms, substance withdrawal, and substance use. Treatment of teens with these issues should include a systemic and integrated approach to both the SUD and the PTSD.

The main goal of our study was to investigate and compare the relationship between temperament traits postulated by the Regulative Theory of Temperament (RTT) and social support dimensions with the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), in an HIV/AIDS patient sample [HIV+ (n=182) and AIDS (n=128)] and in patients suffering from chronic pain (rheumatoid arthritis; n=150). The level of trauma symptoms was assessed with the PTSD Factorial Version Inventory (PTSD-F), temperament was measured with the Formal Characteristics of Behaviour–Temperament Inventory (FCB-TI), and social support was tested with the Berlin Social Support Scales (BSSS). Significant predictors of trauma symptoms among participants were temperament traits (emotional reactivity, perseveration, and sensory sensitivity), and social support dimensions (perceived support, need for support, support seeking, and actually received support). We also noticed significant differences between the levels of trauma symptoms, temperament, and social support between HIV/AIDS and chronic pain patients. The importance of trauma symptoms, as well as temperament traits and social support, should be taken into account in planning the forms of psychological support that should accompany pharmacotherapy for HIV/AIDS and chronic pain patients.

Understanding consequences of natural disasters for family systems is of paramount importance. The aim of the current scoping review was to broadly define the content of research topics, methodological features and findings of studies published in the last 2 decades (1997–2019) examining family systems in the wake of a specific natural disaster(s) using data from more than one family member. Systematic searching of selected databases as well as handsearching were employed to identify 56 studies which met inclusion criteria for the study. All studies were about specific natural disaster events and included data from more than one family member. Studies were coded to extract several features including research questions. Study questions were then examined for methodological and topical themes. Six primary areas of topical and methodological prominence were identified including studies focused on 1) youth outcomes, 2) qualitative inquiry, 3) trauma symptoms and prevalence, 4) couples and mental health, 5) family interactions, and 6) documenting and testing of interventions for disaster affected families. Our review of these studies’ findings broadly supports the interdependence of family member experience and outcome in the wake of disaster experiences. However, further relational research is acutely needed to better establish and clarify intra-couple and family processes following disaster.

The aim of the study was to investigate whether the extent of sexual trauma symptoms was negatively associated with ‘no’ answers to misleading questions after negative feedback. The participants were 180 children aged between 7 and 17 years who were suspected victims of sexual abuse. All children completed the Gudjonsson Suggestibility Scale (GSS 2), a non-verbal IQ test, and The University of California at Los Angeles Child/Adolescent Reaction Index for post-traumatic stress (UCLA-PTSD-RI-5). The findings showed that trauma symptoms, and to a lesser extent impaired source memory recall, were significantly associated with children's inability to give ‘no’ answers after negative feedback. The more severe the trauma, the greater the vulnerability. No such findings were found for ‘don't know’ and ‘direct explanation’ answers. The type of abuser (Intrafamilial versus Extrafamilial) did not add incrementally to the variance in ‘no’ answers suggesting that the impact of type of offender in terms of family links has no independent effect on ‘no’ answers and its effects are mediated by other factors, mainly the severity of the trauma symptoms. A ‘cognitive-interpretative’ model of emotional processing best explains the current findings of a relationship between trauma symptoms and ‘no’ answers after negative feedback.

Background Current efforts to increase optimal breastfeeding rates focus on the multitude of physical benefits for both mother and child, but do not necessarily explicitly take into account the mother's mental health. Women with their own history of childhood maltreatment are especially vulnerable, yet little is known about their experience breastfeeding. A better understanding of this relationship is critical to be able to better support mothers. Objective To review current research that examines how women's personal experience of child maltreatment affects their breastfeeding outcomes and experiences. Study Design, Setting, Participants A scoping review was conducted to evaluate current literature on breastfeeding and child maltreatment. After the screening process (n = 275), 8 (n = 8) articles met the selection criteria and were included in the review. Measurable Outcome/Analysis Articles were analyzed for content on breastfeeding intention, initiation, duration, and exclusivity; medical conditions associated with breastfeeding; and mothers’ experiences related to breastfeeding. Results Mothers with a history of their own childhood maltreatment had both decreased exclusivity and duration of breastfeeding. These mothers were more likely to report pain and experience mastitis. Challenges during this period include managing touch, struggling with the power differential between providers and women, and coping with trauma symptoms, such as dissociation. Overall, mothers’ experience of breastfeeding varies: some find it empowering and others experience great distress while breastfeeding. Conclusions For some mothers, it is possible to breastfeed successfully after child maltreatment, but others find the experience distressing. There is a need for a trauma-informed approach to lactation care for women with a child maltreatment history.

Youth safety is an essential component of trauma-informed services (U.S. Department of Health & Human Services, 2020). Youth perception of safety should be indicative of a healthy care environment and contribute to successful outcomes. It has been shown that trauma impacts an individual’s perception of and response to perceived threat. This study examines the relationship between youth perception of safety, history of trauma, level of aggression, and outcomes in a residential care setting. Data came from the organization’s administrative database and from the care provider certification measures collected during the period of January 2016 through December 2018. Trauma exposure and symptoms, the perceived safety and aggression were used in a mediational path model analysis in predicting goal attainment, program completion, and post-discharge placement. Higher levels of youth trauma were not directly associated with poorer outcomes, and higher percentages of goals met when program supervisor perception of safety was higher. Additionally, trauma symptoms were related to lower rates of program completion when youth perception of safety was higher. Results provide insight into how trauma, perception of safety, and aggression within a residential placement intersect to impact the youth’s treatment progress.

The aim of the current study was to investigate the relationship between the intensity of pain, treated as the explained variable, and the level of trauma symptoms, as appear in posttraumatic stress disorder (PTSD), temperament traits postulated by the Regulative Theory of Temperament and aspects of social support among patients suffering from chronic pain (arthritis and low-back pain). To assess the intensity of pain among participants we used the Numerical Rating Scale (NRS-11). The level of trauma symptoms was assessed with the PTSD Factorial Version inventory (PTSD-F). Temperament was measured with the Formal Characteristics of Behaviour – Temperament Inventory (FCB-TI). Social support was tested with the Berlin Social Support Scales (BSSS). The results of our study suggest that significant predictors of pain intensity among chronic pain sufferers were trauma symptoms. We also noticed that some temperament traits (i.e., emotional reactivity) increased the level of global trauma symptoms, which, in turn, intensified the level of pain. In addition, we showed that global trauma symptoms decreased the support participants actually received.

In this study, we examined the relationships between sexting coercion, physical sex coercion, intimate partner violence, and mental health and trauma symptoms within a sample of 480 young adult undergraduates (160 men and 320 women). Approximately one fifth of the sample indicated that they had engaged in sexting when they did not want to. Those who had been coerced into sexting had usually been coerced by subtler tactics (e.g., repeated asking and being made to feel obligated) than more severe forms of coercion (e.g., physical threats). Nevertheless, the trauma related to these acts of coercion both at the time they occurred and now (looking back) were greater for sexting coercion than for physical sex coercion. Moreover, women noted significantly more trauma now (looking back) than at the time the events occurred for sexting coercion. Additionally, those who experienced more instances of sexting coercion also endorsed more symptoms of anxiety, depression, and generalized trauma. Finally, sexting coercion was related to both physical sex coercion and intimate partner violence, which suggests that sexting coercion may be a form of intimate partner violence, providing perpetrators with a new, digital route for physical and sexual covictimization.

Differences in trauma symptoms among men and women in two court-involved substance abuse treatment programs were examined using latent transition analysis (LTA). It was hypothesized that women would be more likely to report clinical-level trauma symptoms than would men, but that both groups would show reductions in symptoms over time. Symptom classifications were determined by the LTA. Scores on the Trauma Symptom Inventory (TSI) were obtained on 381 program participants, 112 men and 269 women, at intake and after 6months in treatment. Three ordered classes were obtained for men and women at each time point: non-clinical (no TSI scales elevated), moderate symptoms (1 or 2 scales elevated) and severe symptoms (all scales elevated). Men were more likely to be represented in the non-clinical class at intake, while women had higher representation in the severe symptom s classification. There was a reduction of trauma symptoms for most men and women, but some groupings had symptoms that remained the same or became worse over time. Using gender and trauma-symptoms to help determine interventions is discussed.

Estimating the prevalence of parental alienation is challenging because not all children who are exposed to parental alienating behaviors become alienated (Harman, Bernet, & Harman, 2019). The purpose of the current study was to determine whether the proportion of adults who indicate being alienated from a child will be similar to results from a previous poll of North Carolina adults (Harman, Leder-Elder, & Biringen, 2016) using three nationally representative on-line survey panels from United States and Canada, and to determine the mental health impact of parental alienating behaviors. Results from the first two polls indicate that the prevalence of parents who feel they are being alienated from their children is higher than originally estimated: 35.5% (of 273) in the U.S. and 32% (of 397) in Canada. Using another means of assessment for the third poll, 39.1% (of 594) of parents in the US are the non-reciprocating targets of parental alienating behaviors, which is over 22 million parents and confirms previous estimates that did not differentiate between reciprocating and non-reciprocating parents (Harman et al., 2016). Of these, 6.7% of the parents had children who were moderately to severely alienated, which is at least 1.3% of the US population. Alienated parents also had high levels of depression, trauma symptoms, and risk for suicide. Ramifications of these findings for researchers and practitioners are discussed.

This study compared the efficacy of 2 online expressive writing protocols for a traumatic/stressful life event in a Hispanic student sample. Participants who had reported a traumatic event were randomly assigned to either the emotion-focused group or the fact-focused group. The emotion-focused group focused their written accounts on emotions and feelings as well as facts about a stressful/traumatic experience, whereas the fact-focused group focused on facts of a stressful/traumatic event. Both groups completed 3 online writing sessions scheduled for 3 consecutive days, a 1-week online follow-up assessment, and a 5-week online follow-up assessment. Both groups statistically significantly reduced trauma symptoms over time with the emotion-focused group demonstrating statistically significantly greater trauma symptom reductions than the fact-focused group at the 5-week follow-up assessment.

Disruptive child behavior problems are common problems for parents and can be associated with serious delinquent behaviors and aggressive/violent behaviors in adolescence and adulthood. Parenting interventions to address disruptive child behavior problems has gained widespread acceptance. One of these parenting interventions is Parent-Child Interaction Therapy (PCIT). PCIT is a 14- to 20-week, founded on social learning and attachment theories, designed for children between 2 and 7 years of age with disruptive, or externalizing, behavior problems. This article will provide a brief review of the history of PCIT, a description of the basic components of PCIT, and an overview of recent developments that highlight the promise of PCIT with maltreating parent-child relationships, traumatized children, and in developing resilience in young children. In addressing the three basic treatment objectives for PCIT (i.e., reduction in child behavior problems, improving parenting skills, enhancing the quality of parent-child relationships), there is an abundance of research demonstrating very strong treatment effects and therefore, its value to the field. Recent research has also demonstrated the value of PCIT in reducing trauma symptoms in young children.

The current retrospective study examined thought control strategies, or cognitive techniques individuals use to deal with unpleasant thoughts following stressful events, as potential mediators of adjustment in young women with histories of child sexual abuse (CSA). In a sample of 76 undergraduate women who self-reported on abuse experiences, thought control strategies, and current trauma symptoms, several key findings emerged: (i) Greater severity of the CSA event was associated with greater reported use of worry and punishment strategies and less use of social control strategies; (ii) Increased use of worry and punishment strategies following the CSA event was associated with greater levels of trauma symptoms, while increased use of social control strategies following the CSA event was associated with lower levels of trauma symptoms; and (iii) Worry, punishment, and social control strategies served as mediators between CSA severity and trauma symptoms. The results suggest that thought control strategies, specifically increased worry and punishment, and decreased social control, play a vital role in understanding adjustment after CSA. Future research should examine the roles of these cognitive control strategies as possible avenues of intervention following CSA.

Research over the past decade and a half has established the efficacy of pharmacotherapy as an important adjunctive treatment for trauma in conjunction with either cognitive behavior therapy or psychoanalytic psychotherapy. Medication is often effective in reducing post-traumatic stress symptoms as well as treating a number of commonly comorbid conditions such as depressive and anxiety disorders. The current medications of choice are the selective serotonin reuptake inhibitors (SSRI), which are beneficial for posttraumatic reexperiencing, hyperarousal, and avoidant symptoms. Other medication classes including non-SSRI antidepressants, mood stabilizers, anticonvulsants, and anti-adrenergic agents have shown efficacy for some trauma symptoms. Because beneficial responses may be slow to appear, pharmacotherapy of trauma requires a medication trial of adequate length and dose to determine effectiveness. Partial responders may require the addition of a second class of medication. Positive responders should be maintained on medication for at least 6 months after remission of acute PTSD and at least 12 months after remission of chronic PTSD. The initial successes of pharmacotherapy for trauma are spurring further research and more effective medications can be anticipated in the foreseeable future.