Distinctive impacts of sexual trauma versus non-sexual trauma on PTSD profiles in highly trauma-exposed, African American women Open Access

Abstract

Prior findings suggest that posttraumatic psychopathology following assaultive and interpersonal violence like sexual assault and abuse may be more severe and present differently from prototypical PTSD. We predicted that sexual trauma (ST) exposure may result in higher symptoms of numbing and avoidance and blunted fear responses, relative to individuals who experienced non-sexual trauma (NST). We also predicted that childhood sexual abuse (CSA) would result in a more blunted affective profile than adulthood sexual assault (ASA). Participants were n=5134 African American women recruited through the Grady Trauma Project from an urban hospital serving a primarily lower-income population in Atlanta, GA. We investigated the unique effects of ST on symptoms assessed using the modified PTSD Symptom Scale, fear-potentiated startle (FPS) response in a subset of n=286, and amygdala reactivity and habituation to social threat cues using fMRI in n=95. ST was associated with greater PTSD symptoms (F(5159)=90.6, p=2.64e–21), but this was observed across all symptom clusters. Both CSA and ASA, but not CSA alone, was associated with greater PTSD symptoms (F(2,2220)=6.989, p=9.43e­–04) and greater avoidance and numbing symptoms (F(2,2220)=8.530, p=2.04e–04). In the FPS paradigm, the ST group startled more on all blocks and stimulus types than the NST group (F(1,1684)=7.19, p=0.007). Timing of sexual trauma did not have a significant effect on startle magnitude (F(2,964)=1.99, p=0.138). ST was not associated with any unique patterns of amygdala habituation or reactivity to social threat cues.  We conclude that while survivors of sexual traumas may present with more severe PTSD symptoms, their profiles are not characteristically different from similar NST controls. Experiencing CSA alone did not result in a symptom profile unique from experiencing ASA alone. The pattern of symptoms, psychophysiology and neuroimaging responses observed do not suggest an affectively-blunted subtype of PTSD in survivors of sexual trauma. Implications for treatment and suggestions for future studies are discussed.

Table of Contents

Introduction…………………………………………………..........…………………...………………1

Methods…………………………………………………….......………...…………..….……………...9

    Participants…………………………………………….........……………………..….……………..9

    Measures………………………………………………......…………………………..…..………...10

    MRI Procedures………………………………………......……………..……….….....…………..13

    MRI Acquisition and Analysis…………………………………......……..………………………14

    Fear-Potentiated Startle Paradigm………………………………...........……………………..15

    Statistical Analyses……………………………………………….......……..…………...….…….16

Results………………………………………………………………….......………...……...………….18

    Sample characteristics………………………………………….......…………………….……….18

    PTSD symptoms and diagnosis: Sexual trauma vs. non-sexual trauma survivors...…..19

    PTSD symptoms and diagnosis: Timing of sexual trauma………………………..………...20

    PTSD symptoms and diagnosis: Early family environment among CSA survivors........21

    Fear-Potentiated Startle Paradigm………..………………………………………...……....…..22

    Neuroimaging Paradigm………..……………………………………….……………….......……23

Discussion…...……………………………………………………………………………..........……..24

References…..…………………………………………………………………….........……….………32

List of Tables and Figures………………………………………………….....………………..……..44

Tables……………………………………………………………………..........………………..……….45

Figures………………………………………………………………….........……………..……...…….46

About this Honors Thesis

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School	Emory College
Department	Psychology
Subfield / Discipline	Clinical Psychology
Degree	B.A.
Submission	Honors Thesis
Language	English
Research Field	Psychology, Physiological Psychology, Clinical Psychology, Psychobiology
Keyword	Ethnic minorities PTSD Neuroimaging Psychophysiology
Committee Chair / Thesis Advisor	Kazama, Andrew, Emory University Stevens, Jennifer, Emory University
Committee Members	Kragel, Philip, Emory University

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