ANNOTATED

Trauma Type and Gender Effects on PTSD, General Distress, and Peritraumatic

Dissociation

MELANIE D. HETZEL-RIGGIN and RYAN P. ROBY Department of Psychology, Western Illinois University, Macomb, Illinois, USA

This study examined the independent and interaction effects of trauma type and gender on posttraumatic stress disorder (PTSD), general psychopathology, and peritraumatic dissociation. We assessed 1,503 college students (58.3% female) who experienced a natural disaster, loss of a loved one, or interpersonal violence. Interpersonal violence survivors, those with multiple trauma histor- ies, and women reported more PTSD symptoms, general psycho- pathology, and peritraumatic dissociation than other trauma group survivors, single trauma group survivors, and men. A trauma type by gender interaction was identified for peritraumatic dissociation. The results are discussed within the context of clinical practice and assessment.

KEYWORDS dissociation, gender, mental health, PTSD, trauma

Epidemiological studies have shown that lifetime exposure to trauma is high, with 50%–69% of people (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993) experiencing at least one traumatic event during their lifetime. Costs associated with trauma exposure include medical costs, occupational and other functional impair- ment, economic costs of treating victims, and a heavy psychological burden (Kessler, 2000). Those in the trauma field have sought to develop a consen- sus on the definition of trauma and its effects on victims, but this has proved extremely difficult as traumatic events vary along many lines, such as level of life threat, duration, predictability, and controllability.

Received 18 August 2011; accepted 28 October 2011. Parts of this article were presented as part of an abstract at the annual meeting of the

Midwestern Psychological Association in April 2010. Address correspondence to Melanie D. Hetzel-Riggin, Department of Psychology,

Western Illinois University, Macomb, IL 61455, USA. E-mail: [email protected]

Journal of Loss and Trauma, 18:41–53, 2013 Copyright # Taylor & Francis Group, LLC ISSN: 1532-5024 print=1532-5032 online DOI: 10.1080/15325024.2012.679119

41

Perhaps because of the disparity in trauma characteristics, various traumatic events seem to have a different conditional risk for the develop- ment of posttraumatic stress disorder (PTSD; Norris, 1992) and other psychological problems (deRoon-Cassini, Mancini, Rusch, & Bonanno, 2010). Previous research has consistently found that survivors of interperso- nal violence (physical and sexual abuse or assault) report higher rates of PTSD, general distress, and other psychological problems than survivors of most other forms of trauma, such as motor vehicle accidents or natural dis- asters (i.e., Breslau, Chilcoat, Kessler, & Davis, 1999; Creamer, Burgess, & McFarlane, 2001; Kilpatrick, Acierno, Resnick, Saunders, & Best, 1997). Interpersonal violence may lead to higher rates of associated problems because of the victim’s sense of betrayal (Freyd, 1994), alterations in the beliefs regarding interpersonal loss and the benevolence of others (Janoff- Bulman, 1992), and a greater increase in trauma-related emotions (Creamer, McFarlane, & Burgess, 2005).

It is well documented that the experience of one trauma increases the risk of experiencing multiple traumas (Arata, 2000; Gidycz, Coble, Latham, & Layman, 1993). Multiple traumas seem to be related to increased PTSD and emotion regulation difficulties (Ehring & Quack, 2010) as well as more severe and chronic PTSD (Ford, Stockton, Kaltman, & Green, 2006). Increases in psychopathology may increase the risk for both subsequent trauma (Risser, Hetzel-Riggin, Thomsen, & McCanne, 2006) and current psy- chopathology (Breslau & Peterson, 2010). Yet little research has examined combinations of different trauma types to determine the conditional risk of PTSD and other psychopathology.

Another possible explanation is the role of gender; most research shows that women experience a lifetime prevalence rate of PTSD two times that of men (Breslau et al., 1999). Some researchers have suggested that the increased risk of PTSD and other psychopathology in women is due to an increased likelihood for women to experience interpersonal trauma (Kessler, 2000). Breslau (2009) reported that the two-fold increase in conditional probability of PTSD in females was partially due to assaultive violence exposure (35.7% vs. 6.0%); however, when assaultive violence risk was con- trolled, the risk for PTSD was still higher in women compared to men (11.5% vs. 6.2%).

Given the effects of and overlap between trauma type and gender on the development of later psychopathology, researchers have attempted to examine how these two variables interact. Epidemiological studies tend to show that for interpersonal violence, women tend to have a greater risk of PTSD than men, whereas these differences are not present for other forms of trauma (Breslau et al., 1999; Creamer et al., 2001). Buckner, Beardslee, and Bassuk (2004) reported gender specificity in PTSD development after different traumatic events, with combat experience leading to worse out- comes in men and sexual trauma leading to worse outcomes in women.

42 M. D. Hetzel-Riggin and R. P. Roby

Frans, Rimmö, Åberg, and Fredrikson (2005) found that trauma type independently explained 16.7% of the variance in PTSD symptoms, whereas gender only explained 2% of the variance. However, this relationship was better explained by perceived distress. Hapke and colleagues (Hapke, Schumann, Rumpf, John, & Meyer, 2006) reported both a higher conditional risk of PTSD in women and for sexual and physical violence; the conditional risk for PTSD was higher for women than men when they were physically threatened. However, the risk of PTSD after sexual violence did not differ between genders.

Jeon et al. (2007) reported that female gender was associated with an increased risk of the development of both partial and full PTSD. There were differences based on gender in regards to which trauma was associated with the development of partial PTSD—men were more likely to develop partial PTSD after natural disasters, fire, and military combat, whereas women were more likely to develop partial PTSD after witnessing a trauma or learning about traumas in others. Breslau and Anthony (2007) found that the con- ditional probability of PTSD for men did not differ based on type of trauma or presence of previous trauma. For women, the conditional probability of PTSD was significantly greater for assaultive than nonassaultive trauma. Naifeh and colleagues (2008) reported that military veterans evidenced higher PTSD symptoms and other posttrauma symptoms than civilian crime victims that were not due to gender. Yasan, Saka, Ozkan, and Ertem (2009) reported that men were more likely than women to develop PTSD after military trauma, whereas the reverse was true of all other trauma types. Read and colleagues (Read, Ouimette, White, Colder, & Farrow, 2011) found that in college students, female gender was associated with a higher risk of PTSD development than male gender after a sudden and unexpected death. Further analyses found that the effect due to gender was better accounted for by trauma severity exposure.

PRESENT STUDY

Most of the research examining the relationship between gender and trauma type has focused on PTSD symptoms and diagnosis (i.e., Tolin & Foa, 2006). There is a paucity of research examining the relationship between gender and trauma type on other forms of psychopathology or trauma-related dis- sociation. While women are more likely to report higher rates than men of anxiety, depression, somatization (American Psychiatric Association, 2000; Breslau et al., 1999), and peritraumatic dissociation (Irish et al., 2011; Olff, Langeland, Draijer, & Gersons, 2007), we are unaware of any research that examines the interplay of gender and trauma type on these outcomes. In addition, few studies have examined how different constellations of trauma histories are associated with PTSD and other forms of psychopathology.

Trauma Type and Gender Effects 43

Consistent with the wealth of previous research, we predict that women will report higher levels of PTSD symptoms than men. We also predict that women will report higher rates of other forms of general psychopathology and peritraumatic dissociation. Consistent with previous research (Arata, 2000), we predict that participants with multiple trauma histories will have the highest rates of PTSD, general psychopathology, and peritraumatic dis- sociation. We also predict that survivors of interpersonal violence (alone or with other forms of trauma) will report the highest rates of PTSD, general psychopathology, and peritraumatic dissociation as compared to other forms of trauma. In addition, we predict an interaction between trauma type and gender: Female victims of interpersonal violence (alone or with other forms of trauma) will report the highest rates of PTSD, general psychopathology, and peritraumatic dissociation, whereas male victims of other forms of trauma will report the lowest rates of these constructs.

METHOD

Participants and Procedure

The sample comprised 1,677 undergraduates recruited through an online human subjects pool at a medium-sized midwestern university for course credit. Participants were coded by trauma type and whether they experi- enced helplessness, fear, or horror based on DSM-IV-TR criteria. Participants were removed from the sample if they failed to meet the criteria for one of three specific trauma groups (natural disaster [ND], sudden and unexpected death of a loved one [SUD], or interpersonal violence [IPV]) or if they experi- enced more than one trauma type. Of the original sample (N ¼ 1,677), 174 participants who did not meet the criteria for any of the three trauma types were eliminated. The final group totaled 1,503 participants, sorted by trauma types: 7.1% (n ¼ 106) were in the ND only group, 21.8% (n ¼ 328) were in the SUD only group, 4.1% (n ¼ 61) experienced IPV only, 26.8% (n ¼ 403) experienced ND and SUD, 4.5% (n ¼ 67) experienced ND and IPV, 13.0% (n ¼ 196) experienced SUD and IPV, and 22.8% (n ¼ 342) experienced all three forms of trauma.

Of the 1,503 participants, 58.3% (n ¼ 874) were women and 41.8% (n ¼ 629) were men. The mean age of the final sample was 19.3 (SD ¼ 2.8) years with a range from 17 to 57. Racial background was mostly reported as Caucasian (83.2%); 8.4% were African American, 4.3% were Hispanic, 1.8% were Asian American, and 2.3% identified as other, with an average of 1.6 (SD ¼ 0.93) years in college (range ¼ 1–4). Most subjects were unmar- ried (n ¼ 1,415; 94.1%). As compared with what would be expected, more women experienced only SUD, only IPV, and both SUD and IPV, whereas men were more likely to experience ND only and both ND and SUD, v2(6, N ¼ 1,503) ¼ 26.33, p < .001; the lowest cell size was 18 for males with

44 M. D. Hetzel-Riggin and R. P. Roby

IPV only histories. Participants experiencing all three forms of trauma were slightly older (M ¼ 20.0, SD ¼ 3.9) than participants who reported SUD only (M ¼ 18.9, SD ¼ 1.9), F(6, 1483) ¼ 5.60, p < .001. African Americans were more likely than Caucasian participants to report experiencing both ND and SUD or both SUD and IPV, v2(24, N ¼ 1,503) ¼ 49.18, p ¼ .002. Indivi- duals who reported all three forms of trauma were more likely to be married or divorced as compared to the other groups, v2(12, N ¼ 1,503) ¼ 31.45, p < .002. There were no differences between groups on years in school.

This study was conducted online using a human participant manage- ment system as part of a larger screening battery. Participants signed up for the study in exchange for course credit. They were free to sign up at any time during the semester; participants were informed that the study would take approximately 1 hour to complete. All measures were self-report and required participants to answer questions on a computer. After reading and electronically signing the informed consent document, participants com- pleted a series of questionnaires that asked about their history of stressful and traumatic events, their current levels of psychological distress (including PTSD symptoms), and peritraumatic dissociation. After completing the ass- essment, participants were provided debriefing information that explained the nature of the study and provided them with information on university and mental health resources. This study was approved by the university’s institutional review board.

Measures

DEMOGRAPHIC QUESTIONNAIRE

Each participant completed a demographics questionnaire designed to obtain information about the participant’s age, year in school, relationship and marital status, ethnicity, sexual orientation, parental education, socio- economic status, and previous therapy experience.

TRAUMATIC LIFE EVENTS QUESTIONNAIRE (TLEQ)

A modified version of the TLEQ was used to assess each participant’s level of exposure to a broad range of potentially traumatic events. The TLEQ is a self-report scale that assesses exposure to 22 different types of traumatic events. The TLEQ has exhibited adequate reliability. Test-retest reliability coefficients for the TLEQ range from .86 to .89 (Kubany et al., 2000). The TLEQ has also exhibited adequate convergent and discriminant validity in samples of undergraduate students, Vietnam veterans, and battered women (Kubany et al., 2000). In this sample, participants completed the PTSD-Q and PDEQ in regards to the traumatic event or events that had the biggest impact on their lives.

Trauma Type and Gender Effects 45

POSTTRAUMATIC STRESS DISORDER QUESTIONNAIRE (PTSD-Q)

The PTSD-Q assesses whether a participant meets qualifications for the DSM-IV definition of Criterion A for experiencing a traumatic event. It also includes a 17-item scale that measures reexperiencing, avoidance, numbing, and arousal symptoms of PTSD on a 7-point Likert-type scale (1 ¼ no=never, 7 ¼ extremely=always) completed in reference to the identified traumatic event. The PTSD-Q also inquires about when the event occurred, the parti- cipant’s age at the time of the event, and the overall duration of the symp- toms reported. The PTSD-Q has shown adequate sensitivity (.81) and specificity (.82) to PTSD symptoms using a cutoff score of 60 in nonclinical samples. The PTSD-Q has also exhibited adequate positive (.76) and negative (.86) predictive power in nonclinical samples of people not previously ident- ified as having experienced traumatic events (Cross & McCanne, 2001). Inter- nal consistency for the present sample on the PTSD-Q was .94, and 9.7% (n ¼ 146) of the sample met criteria for PTSD using 60 as a cutoff score.

SYMPTOM CHECKLIST 90, REVISED (SCL-90-R)

This 90-item self-report measure assessed general psychopathology, includ- ing somatization, obsessive-compulsive disorder, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psycho- ticism. For the purposes of this study, the general symptom index (GSI) was used. The SCL-90-R lists a number of symptoms, and participants are asked to answer how much a problem has bothered them during the past week on a 5-point Likert-type scale (1 ¼ not at all, 5 ¼ extremely). Total scores for the GSI were transformed into T scores using nonclinical sample norms (Derogatis, 1994).

PERITRAUMATIC DISSOCIATIVE EXPERIENCES QUESTIONNAIRE (PDEQ)

The PDEQ (Marmar, Weiss, & Metzler, 1997) is a 10-item self-report measure that was used to assess dissociation during or shortly after a traumatic event. Participants are asked to rate the degree to which they experience each dis- sociative experience during or shortly after a traumatic event on a 5-point Likert-type scale (1 ¼ not at all true, 5 ¼ extremely true). Total scores can range from 10 to 50, and the internal consistency for this sample was good (.90).

Data Analysis

A series of 7 � 2 (Trauma Type � Gender) analyses of variance (ANOVAs) were performed on participants’ scores on the PTSD-Q, SCL-90-R, and PDEQ. Significant main effects were followed up using Student Newman-Keuls tests,

46 M. D. Hetzel-Riggin and R. P. Roby

and significant interactions were followed up with one-way ANOVAs. We also calculated the relative risk of PTSD based on gender and trauma history.

RESULTS

PTSD Scores

A 7 � 2 (Trauma Type � Gender) ANOVA was conducted on PTSD-Q scores. The ANOVA was significant for trauma type, F(6, 1498) ¼ 25.76, p < .001. Follow-up Newman-Keuls tests showed that the ND only group (M ¼ 25.6, SD ¼ 13.6) had the lowest PTSD scores, followed by the SUD only group (M ¼ 29.3, SD ¼ 14.4) and ND and SUD group (M ¼ 29.6, SD ¼ 14.7). The ND and IPV group (M ¼ 33.9, SD ¼ 16.4) had higher PTSD scores than the ND group. The IPV only group (M ¼ 35.6, SD ¼ 21.4) and SUD and IPV group (M ¼ 38.1, SD ¼ 19.0) had significantly higher PTSD scores than the ND only, SUD only, and ND and SUD groups. Participants who reported all three trauma types had PTSD scores (M ¼ 41.6, SD ¼ 18.7) that were significantly greater than all of the other groups except the SUD and IPV group. There was also a main effect for gender, F(1, 1498) ¼ 26.72, p < .001. Men (M ¼ 30.2, SD ¼ 15.1) reported fewer symptoms than women (M ¼ 35.9, SD ¼ 18.5). There was not a significant interaction of trauma type and gender on PTSD symptoms, F(6, 1498) ¼ 1.47, p ¼ .19.

We then classified participants as either meeting or not meeting criteria for PTSD based on a cutoff score of 60 (Cross & McCanne, 2001) and calcu- lated risk ratios for trauma type and gender. Those who experienced IPV (alone or with another trauma) had a relative risk for a PTSD diagnosis of 1.64, 95% CI ¼ 1.45–1.87, v2(4, N ¼ 1,499) ¼ 37.85, p < .001, as compared to those without IPV histories. Participants who experienced multiple trauma had a relative risk for a PTSD diagnosis of 1.21, 95% CI ¼ 1.10–1.32, v2(4, N ¼ 1,499) ¼ 11.04, p < .001, as compared to those with single trauma histories; participants who experienced three types of trauma had a relative risk of a PTSD diagnosis of 1.77, 95% CI ¼ 1.49–2.11, v2(4, N ¼ 835) ¼ 28.14, p < .001, as compared to those with single trauma histories. As compared to men, women had a relative risk for a PTSD diagnosis of 1.33, 95% CI ¼ 1.20–1.48, v2(4, N ¼ 1,499) ¼ 19.07, p < .001.

General Distress

For the SCL-90-R GSI, there was a significant main effect for trauma type, F(6, 1,502) ¼ 22.53, p < .001. Post-hoc Newman-Keuls tests showed that all of the trauma groups that did not include IPV (ND only, M ¼ 55.1, SD ¼ 10.7; ND and SUD, M ¼ 56.1, SD ¼ 12.6; and SUD only, M ¼ 56.9, SD ¼ 13.2) had significantly lower GSI scores than the groups that did include IPV (IPV only, M ¼ 62.3, SD ¼ 16.6; ND and IPV, M ¼ 63.1, SD ¼ 15.6; all three

Trauma Type and Gender Effects 47

traumas, M ¼ 65.9, SD ¼ 16.4; and SUD and IPV, M ¼ 66.0, SD ¼ 17.9). There was also a main effect for gender, F(1, 1502) ¼ 19.33, p < .001. Mean compar- isons showed that women (M ¼ 62.3, SD ¼ 16.2) scored higher than men (M ¼ 57.5, SD ¼ 13.5) on the SCL-90-R GSI. There was no interaction between trauma type and gender on the SCL-90-R GSI, F(6, 1502) ¼ 1.05, p ¼ .39.

Peritraumatic Dissociation

Gender had a main effect on PDEQ scores, F(1, 1500) ¼ 7.56, p ¼ .006, with men having lower PDEQ scores (M ¼ 16.9, SD ¼ 7.2) than women (M ¼ 18.4, SD ¼ 8.0). There was a significant effect of trauma type on PDEQ scores, F(6, 1500) ¼ 22.08, p < .001. Follow-up Newman-Keuls tests showed that the ND only group (M ¼ 14.9, SD ¼ 6.4) had the lowest PTSD scores, fol- lowed by the SUD only group (M ¼ 15.7, SD ¼ 6.2) and ND and SUD group (M ¼ 16.3, SD ¼ 6.4). The ND and IPV group (M ¼ 17.8, SD ¼ 8.0) had higher PTSD scores than the ND only group. The IPV only group (M ¼ 18.1, SD ¼ 8.54) had higher PTSD scores than the ND only group and the SUD only group. The SUD and IPV group (M ¼ 19.9, SD ¼ 8.2) had significantly higher PTSD scores than the ND only, SUD only, and ND and SUD groups. Parti- cipants who reported all three trauma types had PTSD scores (M ¼ 21.0, SD ¼ 8.8) that were significantly greater than all of the other groups except the SUD and IPV group.

However, the main effects were qualified by a significant trauma type by gender interaction on PDEQ scores, F(6, 1500) ¼ 2.26, p ¼ .04. Follow-up univariate analyses showed that for the ND group, men (M ¼ 16.3, SD ¼ 7.0) had higher PDEQ scores than women (M ¼ 13.2, SD ¼ 5.1), F(1, 105) ¼ 6.27, p ¼ .02. For the ND and SUD group, women (M ¼ 17.2, SD ¼ 5.6) had higher PDEQ scores than men, (M ¼ 15.2, SD ¼ 5.6), F(1, 402) ¼ 9.68, p ¼ .002. Women (M ¼ 20.8, SD ¼ 8.5) also had higher PDEQ scores than men (M ¼ 18.0, SD ¼ 7.4) in the SUD and IPV group, F(1, 195) ¼ 5.20, p ¼ .03.

DISCUSSION

The purpose of the present study was to examine the independent and com- bined effects of trauma type and gender on PTSD symptoms, general psycho- pathology, and peritraumatic dissociation in a sample of college students. A final sample of 1,503 participants was broken down into three single trauma groups (interpersonal violence, sudden and unexpected death of a loved one, and natural disasters) and four multiple trauma groups and split by gen- der. We predicted a main effect for gender, with women reporting more symptoms on all measures than men; we also predicted a main effect for trauma group, with participants reporting interpersonal violence and

48 M. D. Hetzel-Riggin and R. P. Roby

multiple forms of trauma reporting higher rates of psychopathology and peritraumatic dissociation than other forms of trauma. Lastly, we predicted an interaction effect, with female survivors of interpersonal violence (alone or with other trauma types) reporting the most problems and male survivors of other forms of trauma reporting the least problems.

The results showed that victims of interpersonal violence (whether alone or with other traumas) scored higher than other trauma groups on PTSD symptoms. This is consistent with previous research comparing assaul- tive and nonassaultive trauma (Breslau et al., 1999; Resnick et al., 1993). In addition, the interpersonal violence group scored higher than other trauma groups on general distress, which is somewhat consistent with previous research (Creamer et al., 2001). The results seem to confirm the idea that interpersonal violence is inherently more traumatizing, perhaps because of feelings of betrayal (Freyd, 1994), because such violence challenges one’s sense of safety and control over the world (Janoff-Bulman, 1992), or because of an increase in emotion regulation difficulties (Ehring & Quack, 2010). These findings also suggest that the higher rates of PTSD symptoms in survi- vors of interpersonal violence as compared to other groups of trauma survi- vors may reflect a general increase in level of distress that is not necessarily specific to PTSD.

Women reported significantly higher rates of PTSD as compared to men. These results are consistent with previous studies that have shown that women are two times more likely to experience PTSD symptoms (Tolin & Foa, 2006) and consistently report higher rates of general psychopathology (American Psychiatric Association, 2000; Breslau et al., 1999) than men. How- ever, in concert with the findings of Frans et al. (2005), the effect of gender on general distress was less strong than the effect of trauma type. There were also no interaction effects, suggesting that gender and trauma type have inde- pendent effects on the development of psychopathology. The results suggest that the higher levels of PTSD and general psychopathology symptoms found in survivors of interpersonal violence as compared to survivors of other types of trauma are not due to an overrepresentation of women in this group (Breslau, 2009).

The results regarding peritraumatic dissociation were somewhat unex- pected and only partially confirmed our hypotheses. Individuals in the three types of trauma groups, those who reported interpersonal violence, and women generally reported higher rates of peritraumatic dissociation than men and those in single, non-interpersonal violence trauma groups. Women reported greater symptoms than men when they experienced a sudden, unexpected death and a second trauma (i.e., interpersonal violence or natu- ral disaster). These findings are somewhat consistent with previous research showing that women and multiply traumatized people are more likely to report peritraumatic dissociation than men (Irish et al., 2011; Olff et al., 2007). However, the men in the natural disaster group reported more

Trauma Type and Gender Effects 49

symptoms of peritraumatic dissociation than the women. These findings highlight that men and women often perceive events differently (Frans et al., 2005), which may lead to differences in emotional reactivity (Bradley, Codispoti, Sabatinelli, & Lang, 2001) based on the interaction of trauma type and gender. It is possible that some of the interaction effects of trauma type and gender found in previous research (Jeon et al., 2007) may be due to dif- ferences in peritraumatic dissociation experienced after trauma, since peri- traumatic dissociation is a strong predictor of PTSD (Ozer, Best, Lipsey, & Weiss, 2003).

The current study has several limitations. The generalizability to all forms of trauma is unknown. While the posttraumatic symptoms found in the current study are consistent with the findings of others (Breslau et al., 1999; Resnick et al., 1993), further research is needed to determine whether gender will moderate general distress symptoms and peritraumatic dis- sociation in different forms of trauma (such as combat or motor vehicle acci- dent victims). We were unable to examine these trauma types in the present sample because few participants reported these traumas. Participants were recruited from a self-selected, nonclinical setting and completed a self-report measure of PTSD. Though the PTSD-Q demonstrates adequate predictive power and 9.7% of the present sample met criteria for a PTSD diagnosis, other means of determining diagnostic status are necessary for future studies, such as a diagnostic interview.

We collapsed sexual violence in with other forms of interpersonal viol- ence (physical assault, domestic violence) in the present study. This could be seen as a limitation, as sexual violence has been considered to be more traumatizing than other stressful events because of the intrusiveness to the body, the social stigma attached (Kaysen, Morris, Rizvi, & Resick, 2005), and victim blaming (Amstadter & Vernon, 2008). We also did not assess other fac- tors that may buffer the effects of trauma, such as social support, self-efficacy, perception of control, or cognitive appraisals of the event (Benight & Bandura, 2004), nor did we assess other factors that may increase the risk of posttrau- matic problems, such as physical injury and other characteristics of the person and the traumatic event (Brewin, Andrews, & Valentine, 2000). These factors could interact with both gender and trauma type to increase or decrease the risk of posttraumatic psychopathology and peritraumatic responses.

Limitations notwithstanding, the results of this study suggest that both trauma type and gender play important roles in the development of posttraumatic symptoms. It is possible that these factors may also play a role in the relative effectiveness of different types of treatments (i.e., Fikretoglu, Brunet, Guay, & Pedlar, 2007). Mental health professionals should consider how trauma type and gender may affect symptom presen- tation after someone experiences trauma, as well as how trauma type and possibly gender may affect peritraumatic responses, when developing a treatment plan.

50 M. D. Hetzel-Riggin and R. P. Roby

REFERENCES

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision). Washington, DC: American Psychiatric Association.

Amstadter, A. B., & Vernon, L. L. (2008). Emotional reactions during and after trauma: A comparison of trauma types. Journal of Aggression, Maltreatment & Trauma, 16, 391–408.

Arata, C. M. (2000). From child victim to adult victim: A model for predicting sexual revictimization. Child Maltreatment, 5, 28–38.

Benight, C. C., & Bandura, A. (2004). Social cognitive theory of posttraumatic recov- ery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42, 1129–1148.

Bradley, M. M., Codispoti, M., Sabatinelli, D., & Lang, P. J. (2001). Emotion and motivation II: Sex differences in picture processing. Emotion, 1, 300–319.

Breslau, N. (2009). The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma, Violence, & Abuse, 10, 198–210.

Breslau, N., & Anthony, J. C. (2007). Gender differences in the sensitivity to posttrau- matic stress disorder: An epidemiological study of urban young adults. Journal of Abnormal Psychology, 116, 607–611.

Breslau, N., Chilcoat, H. D., Kessler, R. C., & Davis, G. C. (1999). Previous exposure to trauma and PTSD effects of subsequent trauma: Results from the Detroit Area Survey of Trauma. American Journal of Psychiatry, 156, 902–907.

Breslau, N., & Peterson, E. L. (2010). Assaultive violence and the risk of posttraumatic stress disorder following a subsequent trauma. Behaviour Research and Therapy, 48, 1063–1066.

Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68, 748–766.

Buckner, J. C., Beardslee, W. R., & Bassuk, E. L. (2004). Exposure to violence and low-income children’s mental health: Direct, moderated, and mediated rela- tions. American Journal of Orthopsychiatry, 74, 413–423.

Creamer, M., Burgess, P. P., & McFarlane, A. C. (2001). Post-traumatic stress disorder: Findings from the Australian National Survey of Mental Health and Well-Being. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 31, 1237–1247.

Creamer, M., McFarlane, A. C., & Burgess, P. (2005). Psychopathology following trauma: The role of subjective experience. Journal of Affective Disorders, 86, 175–182.

Cross, M. R., & McCanne, T. R. (2001). Validation of a self-report measure of posttraumatic stress disorder in a sample of college-age women. Journal of Traumatic Stress, 14, 135–147.

Derogatis, L. R. (1994). SCL–90–R: Administration, scoring and procedures manual. Minneapolis, MN: National Computer Systems.

deRoon-Cassini, T. A., Mancini, A. D., Rusch, M. D., & Bonanno, G. A. (2010). Psy- chopathology and resilience following traumatic injury: A latent growth mixture model analysis. Rehabilitation Psychology, 55, 1–11.

Trauma Type and Gender Effects 51

Ehring, T., & Quack, D. (2010). Emotion regulation difficulties in trauma survivors: The role of trauma type and PTSD symptom severity. Behavior Therapy, 4, 587–598.

Fikretoglu, D., Brunet, A., Guay, S., & Pedlar, D. (2007). Mental health treatment seeking by military members with posttraumatic stress disorders: Findings on rates, characteristics, and predictors from a nationally representative Canadian military sample. Canadian Journal of Psychiatry=La Revue canadienne de psychiatrie, 52, 103–110.

Ford, J. D., Stockton, P., Kaltman, S., & Green, B. L. (2006). Disorders of extreme stress (DESNOS) symptoms are associated with type and severity of inter- personal trauma exposure in a sample of healthy young women. Journal of Interpersonal Violence, 21, 1399–1416.

Frans, Ö., Rimmö, P. A., Åberg, L. L., & Fredrikson, M. M. (2005). Trauma exposure and post-traumatic stress disorder in the general population. Acta Psychiatrica Scandinavica, 111, 291–299.

Freyd, J. (1994). Betrayal trauma: Traumatic amnesia as an adaptive response to childhood abuse. Ethics & Behavior, 4, 307–329.

Gidycz, C. A., Coble, C. N., Latham, L., & Layman, M. J. (1993). Sexual assault experi- ence in adulthood and prior victimization experiences: A prospective analysis. Psychology of Women Quarterly, 17, 151–168.

Hapke, U., Schumann, A., Rumpf, H., John, U., & Meyer, C. (2006). Post-traumatic stress disorder: The role of trauma, pre-existing psychiatric disorders, and gen- der. European Archives of Psychiatry and Clinical Neuroscience, 256, 299–306.

Irish, L. A., Fischer, B., Fallon, W., Spoonster, E., Sledjeski, E. M., & Delahanty, D. L. (2011). Gender differences in PTSD symptoms: An exploration of peritraumatic mechanisms. Journal of Anxiety Disorders, 25, 209–216.

Janoff-Bulman, R. (1992). Shattered Assumptions: Towards a New Psychology of Trauma. New York, NY: Free Press.

Jeon, H., Suh, T., Lee, H., Hahm, B., Lee, J., Cho, S., & Cho, M. (2007). Partial versus full PTSD in the Korean community: Prevalence, duration, correlates, comorbid- ity, and dysfunctions. Depression and Anxiety, 24, 577–585.

Kaysen, D., Morris, M. K., Rizvi, S. L., & Resick, P. A. (2005). Peritraumatic responses and their relationship to perceptions of threat in female crime victims. Violence Against Women, 11, 1515–1535.

Kessler, R. C. (2000). Posttraumatic stress disorder: The burden to the individual and to society. Journal of Clinical Psychiatry, 61(Suppl. 5), 4–14.

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttrau- matic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.

Kilpatrick, D. G., Acierno, R., Resnick, H. S., Saunders, B. E., & Best, C. L. (1997). A 2-year longitudinal analysis of the relationships between violent assault and substance use in women. Journal of Consulting and Clinical Psychology, 65, 834–847.

Kubany, E. S., Leisen, M., Kaplan, A. S., Watson, S. B., Haynes, S. N., Owens, J. A., & Burns, K. (2000). Development and preliminary validation of a brief broad- spectrum measure of trauma exposure: The Traumatic Life Events Question- naire. Psychological Assessment, 12, 210–224.

52 M. D. Hetzel-Riggin and R. P. Roby

Marmar, C. R., Weiss, D. S., & Metzler, T. J. (1997). The Peritraumatic Dissociative Experiences Questionnaire. In J. Wilson, T. Keane, J. Wilson, & T. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 412–428). New York, NY: Guilford Press.

Naifeh, J. A., North, T. C., Davis, J. L., Reyes, G., Logan, C. A., & Elhai, J. D. (2008). Clinical profile differences between PTSD-diagnosed military veterans and crime victims. Journal of Trauma & Dissociation, 9, 321–334.

Norris, F. H. (1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 60, 409–418.

Olff, M., Langeland, W., Draijer, N., & Gersons, B. R. (2007). Gender differences in posttraumatic stress disorder. Psychological Bulletin, 133, 183–204.

Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52–73.

Read, J. P., Ouimette, P., White, J., Colder, C., & Farrow, S. (2011). Rates of DSM-IV- TR trauma exposure and posttraumatic stress disorder among newly matricu- lated college students. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 148–156.

Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., & Best, C. L. (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representa- tive national sample of women. Journal of Consulting and Clinical Psychology, 61, 984–991.

Risser, H. J., Hetzel-Riggin, M. D., Thomsen, C. J., & McCanne, T. R. (2006). PTSD as a mediator of sexual revictimization: The role of reexperiencing, avoidance, and arousal symptoms. Journal of Traumatic Stress, 19, 687–698.

Tolin, D. F., & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin, 132, 959–992.

Yasan, A., Saka, G., Ozkan, M., & Ertem, M. (2009). Trauma type, gender, and risk of PTSD in a region within an area of conflict. Journal of Traumatic Stress, 22, 663–666.

Melanie D. Hetzel-Riggin is an associate professor of clinical psychology at Western Illinois University. She also is a licensed clinical psychologist and works primarily with survivors of trauma. Her research interests include interpersonal violence, PTSD, prevention, and coping.

Ryan P. Roby is a graduate student at Towson University in clinical psychology. His research interests include trauma, stress, and coping.

Trauma Type and Gender Effects 53

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