ارتباط غیر مستقیم اختلال بدتنظیمی هیجانی بین نوعی تروما و علائم PTSD
Abstract
1- Introduction
2- Method
3- Results
4- Discussion
References
Abstract
Background: Research has explored the influence of trauma type on emotion dysregulation and the role of emotion dysregulation in posttraumatic stress disorder (PTSD). However, it remains unclear whether trauma types differentially impact emotion dysregulation, and whether this in turn contributes to elevated PTSD. The current study tested whether trauma type is related to PTSD symptoms via emotion dysregulation. Methods: Trauma-exposed community members (n = 209) completed a semi-structured clinical interview and self-reported on emotion regulation, trauma exposure, PTSD symptoms, and negative affect. Results: Interpersonal trauma, sexual assault in particular, is associated with greater emotion dysregulation. Furthermore, emotion dysregulation mediates the effects of trauma type on PTSD symptoms for sexual assault but not other trauma types, and effects remained significant after covarying for negative affectivity. More recent and chronic trauma was not associated with greater emotion dysregulation. Conclusions: This study underscores the importance of emotion dysregulation in PTSD development and maintenance. Findings may be used for the development of interventions targeting emotion regulation as a malleable risk factor for PTSD, especially for sexual assault victims.
Introduction
Posttraumatic stress disorder (PTSD) is a chronic disorder with serious individual and economic burdens (Kessler, 2000). Up to 90% of people experience a trauma; yet, a minority of individuals will develop PTSD, making it crucial to identify vulnerability factors (Kilpatrick et al., 2013). One risk factor for PTSD is the type of trauma experienced, with increased PTSD symptoms observed in individuals exposed to interpersonal trauma compared to non-interpersonal trauma (Ford, Stockton, Kaltman, & Green, 2006; LeBouthillier, McMillan, Thibodeau, & Asmundson, 2015). However, it is unclear why certain trauma types lead to the development of PTSD more often than others, in part due to limited empirical research. One promising mechanism underlying the development of PTSD, and differentially associated with trauma type, is emotion dysregulation. Gratz and Roemer (2004) broadly define emotion regulation as an ability to modulate emotional arousal, act in desired ways despite negative emotions, and understand one's emotions. Theoretical and empirical research highlight the role of difficulties with emotion regulation (i.e., emotion dysregulation) in PTSD (O'Bryan, McLeish, Kraemer, & Fleming, 2015; Seligowski, Lee, Bardeen, & Orcutt, 2015), and relevant clinical implications (Cloitre, Koenen, Cohen, & Han, 2002; Wolfsdorf & Zlotnick, 2001). Specifically, individuals who perceive themselves as unable to effectively downregulate negative emotions triggered by trauma reminders may view their emotions as uncontrollable and threatening. This may exacerbate fear of trauma cues, making individuals more likely to avoid trauma reminders that might provoke distress. Emotion regulation is especially important because individuals with difficulties are more likely to engage in maladaptive coping behaviors including avoidance, substance use, and other risky behaviors (Weiss, Tull, Viana, Anestis, & Gratz, 2012). Paradoxically, these avoidant coping strategies maintain PTSD symptoms by preventing individuals from learning accurate information about their ability to handle negative PTSD-related emotions (Naifeh, Tull, & Gratz, 2012).