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Background Posttraumatic stress disorder (PTSD) is characterized by dysregulated arousal and altered cardiac autonomic response as evidenced by decreased high-frequency heart rate variability (HF-HRV), an indirect measure of parasympathetic modulation of the heart. Indeed, subtle threatening cues can cause autonomic dysregulation, even without explicit awareness of the triggering stimulus. Accordingly, examining the neural underpinnings associated with HF-HRV during both sub- and supraliminal exposure to trauma-related cues is critical to an enhanced understanding of autonomic nervous system dysfunction in PTSD. Methods We compared neural activity in brain regions associated with HF-HRV in PTSD (n = 18) and healthy controls (n = 18) during exposure to sub- and supraliminal processing of personalized trauma-related words. Results As compared to controls, PTSD exhibited decreased HF-HRV reactivity in response to sub- and supraliminal cues. Notably, during subliminal processing of trauma-related versus neutral words, as compared to controls, PTSD showed decreased neural response associated with HF-HRV within the left dorsal anterior insula. By contrast, during supraliminal processing of trauma-related versus neutral words, decreased neural activity associated with HF-HRV within the posterior insula/superior temporal cortex, and increased neural activity associated with HF-HRV within the left centromedial amygdala was observed in PTSD as compared to controls. Conclusions Impaired parasympathetic modulation of autonomic arousal in PTSD appears related to altered activation of cortical and subcortical regions involved in the central autonomic network. Interestingly, both sub- and supraliminal trauma-related cues appear to elicit dysregulated arousal and may contribute to the maintenance of hyperarousal in PTSD. Hum Brain Mapp 38:4898–4907, 2017. © 2017 Wiley Periodicals, Inc.

This article presents the case of a gender variant adolescent with a history of traumatic stress. Embracing a gender nonconforming identity was a source of strength and pride for this individual. However, symptoms related to relational and secondary traumatic stress significantly impinged on this client's quality of life. This case is intended to illustrate case formulation and treatment from within a traumatogenic framework that is also affirming of gender variance and exploration.

We investigated the relationship of implicit and explicit memory to a range of symptoms in a sample of 27 women with exposure to chronic interpersonal violence (IPV). Participants viewed the first 3 letters ("stems") of trauma-related, general threat, and neutral words; valenced words were matched with neutral words with the same stem. Free recall and a word-stem completion task were used to test explicit and implicit memory, respectively. Participants exhibited increased implicit memory for trauma-related words as compared with both general threat words and neutral "match" words. They also showed increased explicit memory for both general threat and trauma-related words. Finally, although neither implicit nor explicit memory was correlated with PTSD symptoms, implicit memory for trauma-related words was significantly correlated with symptoms associated with ongoing IPV. Interpersonal sensitivity, hostility, and alexithymia were significantly correlated with implicit, but not explicit, memory for trauma words. Somatization, dissociation, and alexithymia were negatively correlated with explicit, but not implicit, memory for general-threat words. These findings suggest that memory processes in survivors of IPV are closely related to the symptom profile associated with complex trauma. Exploring memory processes in survivors of IPV may lend unique insight into the development and maintenance of the symptom profile associated with IPV.

Recently, a new diagnostic construct, developmental trauma disorder (DTD), was proposed to describe the effects of chronic exposure to violence in combination with disruptions in caregiving systems. This study uses archival data to field test the consensus proposed diagnostic criteria for DTD in a sample of urban children (N = 214). Children with complex trauma histories as defined in the proposed DTD Criterion A were much more likely to meet the proposed DTD symptom criteria than children who did not meet the exposure criterion. This field trial of the proposed DTD criteria suggests that the proposed construct of DTD is useful for describing the symptoms induced by ongoing traumatic stressors and disrupted caregiving and that the proposed symptom criteria can differentiate children with histories of exposure to developmental trauma from other trauma-exposed children.

Critical race theory asserts that microaggressions, or low-level, covert acts of aggression, are commonplace in the lives of people of color. These theorists also assert a taxonomy of microaggressions, which includes “microassaults,” “microinsults,” and “microinvalidations.” The theory of microaggressions has been adopted by researchers of LGBTQ communities. This study investigated the three-factor taxonomy as it relates to a diverse sample of LGBTQ youth using the newly developed Sexual Orientation Microaggression Inventory (SOMI). Exploratory factor analysis was used to determine the number of factors that exist in SOMI in a sample of 206 LGBTQ-identifying youth. Follow up confirmatory factor analyses (CFAs) were conducted in order to compare single factor, unrestricted four factor, second order, and bi-factor models in a separate sample of 363 young men who have sex with men. The best fitting model was used to predict victimization, depressive symptoms, and depression diagnosis in order to test validity. The best fitting model was a bi-factor model utilizing 19 of the original 26 items with a general factor and four specific factors representing anti-gay attitudes (“microinsults”), denial of homosexuality, heterosexism (“microinvalidations”), and societal disapproval (“microassaults”). Reliability analyses found that the majority of reliable variance was accounted for by the general factor. The general factor was a significant predictor of victimization and depressive symptoms, as well as unrelated to social desirability, suggesting convergent, criterion-related, and discriminant validity. SOMI emerged as a scale with evidence of validity for assessing exposure to microaggressions in a diverse sample of LGBTQ youth.

Recently, a new diagnostic construct, developmental trauma disorder (DTD), was proposed to describe the effects of chronic exposure to violence in combination with disruptions in caregiving systems. This study uses archival data to field test the consensus proposed diagnostic criteria for DTD in a sample of urban children (N = 214). Children with complex trauma histories as defined in the proposed DTD Criterion A were much more likely to meet the proposed DTD symptom criteria than children who did not meet the exposure criterion. This field trial of the proposed DTD criteria suggests that the proposed construct of DTD is useful for describing the symptoms induced by ongoing traumatic stressors and disrupted caregiving and that the proposed symptom criteria can differentiate children with histories of exposure to developmental trauma from other trauma-exposed children.