The War Experiences and Psychosocial Development of Children in Lebanon

This study examines the number and types of war traumas children face growing up in a war-torn country and the relation of such traumatic experiences to their psychosocial development. A sample of 224 Lebanese children (10–16 years old) were interviewed using measures of war exposure, mental health symptoms, adaptational outcomes, and Post-Traumatic Stress Disorder (PTSD). The number and type of children's war traumas varied meaningfully in number and type by their age, gender, father's occupational status, and mother's educational level. As predicted, the number of war traumas experienced by a child was positively related to PTSD symptoms; and various types of war traumas were differentially related to PTSD, mental health symptoms, and adaptational outcomes. For example, children who were exposed to multiple war traumas, were bereaved, became victims of violent acts, witnessed violent acts, and/or were exposed to shelling or combat exhibited more PTSD symptoms. Children who were separated from parents reported more depressive symptoms and children who experience bereavement and were not displaced reported more planful behavior. Lastly, children who were separated from parents and who witnessed violent acts reported more prosocial behavior. Implications for program interventions and directions for future research on the effects of war on the psychosocial development of children are explored.     

Modelling life satisfaction and adjustment to trauma in children exposed to ongoing military violence: An exploratory study in Palestine

Exposure to war and ongoing political violence increases mental health risks among children, especially in terms of posttraumatic stress disorder (PTSD), and depressive or somatic symptoms. However, an exclusive focus on negative functioning can lead to underestimating the coping abilities and natural potential for adjusting to trauma of war-affected children at different developmental phases. Using structural equation modelling, we tested the extent to which data gathered in a predominantly nonclinical sample of Palestinian children (N = 1276) living in refugee camps supported a conceptual model in which the relationship between subjective wellbeing and the effects of trauma is mainly top-down in direction. The cross-sectional design adopted showed that feelings of life satisfaction contributed to better affect balance in children (aged 6–11 years), which in turn, mitigated the impact of traumatic events. These findings point up the importance of dimensions of subjective well-being in children involved in traumatic events and may inspire intervention and treatment focused on the ability to activate positive emotions as a crucial resource for dealing with traumatic reactions.     

Trauma appraisals,emotion regulation difficulties,and self-compassion predict posttraumatic stress symptoms following childhood abuse

Experiencing traumatic events and abuse is unfortunately common in general, non-clinical samples. Recent research indicates that the ways in which individuals interpret traumatic experiences, as well as the ways that they manage challenging emotions in general, may statistically predict post-traumatic stress disorder (PTSD) symptoms to a greater extent than does trauma itself. Negative trauma appraisals, generalized emotion regulation (ER) difficulties, and low levels of self-compassion have each been shown to influence the connection between trauma exposure and subsequent PTSD symptoms. However, little is known regarding how these processes interact, or their relative contributions to mental health after trauma. The current study analyzed data from 466 university students who completed self-report measures of childhood abuse, PTSD symptoms, trauma appraisals, ER difficulties, and self-compassion. Childhood abuse exposure and PTSD symptoms were positively associated with negative trauma appraisals and ER difficulties, and negatively associated with self-compassion. Self-compassion was inversely associated with negative trauma appraisals and ER difficulties. Multiple mediation analyses demonstrated that negative trauma appraisals, ER difficulties, and levels of self-compassion fully explained the link between abuse exposure and PTSD symptoms via several specific pathways. These findings suggest that researchers, clinicians, and abuse survivors can benefit from addressing these interconnected domains during treatment and recovery processes.     

Prenatal Maternal Stress,Child Cortical Thickness,and Adolescent Depressive Symptoms

Prenatal maternal stress predicts subsequent elevations in youth depressive symptoms, but the neural processes associated with these links are unclear. This study evaluated whether prenatal maternal stress is associated with child brain development, and adolescent depressive symptoms using a prospective design with 74 mother child pairs (40 boys). Maternal stress was assessed during pregnancy, child cortical thickness at age 7, and depressive symptoms at age 12. Prenatal maternal stress was associated with less cortical thickness primarily in frontal and temporal regions and with elevated depressive symptoms; child cortical thickness additionally correlated with adolescent depressive symptoms. The observed associations are consistent with the possibility that cortical thickness in superior frontal regions links associations between prenatal maternal stress and adolescent depressive symptoms.     

Post-traumatic stress and related symptoms among juvenile detention residents: Results from intake screening

BackgroundJuvenile justice-involved youth have high rates of trauma exposure, physical and sexual abuse and PTSD. Several factors have been found to be related to PTSD symptoms in youth including number and chronicity of traumatic events.ObjectiveTo simultaneously examine the relationships between allostatic load (defined here as number of traumatic experiences), poly-victimization (exposure to two or more forms of victimization based on 5 of the 6 categories in Ford et al.’s 2010 study), physical/sexual abuse and PTSD in justice-involved youth.Participants and SettingThe sample consisted of 1984 youth in juvenile detention in a Northeastern city. The sample was 73.4% male and the majority of youth were either African American or Hispanic.MethodsClinicians collected demographic and psychosocial information, and measured symptoms of PTSD, depression, and problematic substance use.ResultsResults showed that youth with more traumas, those who experienced poly-victimization and those who experienced physical/sexual assault/abuse were not only more likely to have PTSD, but also more likely to have depression, thoughts of suicide/self-harm, and problematic substance use (as indicated by the presence of 2 or more of 6 possible indicators). Poly-victimization was a stronger correlate of PTSD than number of traumas or physical/sexual assault/abuse. However, among youth with PTSD, number of traumas was associated with co-occurring problems while poly-victimization and physical/sexual assault/abuse were not.ConclusionsFindings can be used to help direct resources to juvenile justice-involved youth who are most in need of treatment.     

Effects of the child–perpetrator relationship on mental health outcomes of child abuse: It's (not) all relative

The present study was conducted to better understand the influence of the child–perpetrator relationship on responses to child sexual and physical trauma for a relatively large, ethnically diverse sample of children and youth presenting for clinical evaluation and treatment at child mental health centers across the United States. This referred sample includes 2,133 youth with sexual or physical trauma as their primary treatment focus. Analyses were conducted to ascertain whether outcomes were dependent on the perpetrator's status as a caregiver vs. non-caregiver. Outcome measures included psychiatric symptom and behavior problem rating scales. For sexual trauma, victimization by a non-caregiver was associated with higher posttraumatic stress, internalizing and externalizing behavior problems, depression, and dissociation compared to youth victimized by a caregiver. For physical trauma, victimization by a non-caregiver was also associated with higher posttraumatic symptoms and internalizing behavior problems. The total number of trauma types experienced and age of physical or sexual trauma onset also predicted several outcomes for both groups, although in disparate ways. These findings are consistent with other recent studies demonstrating that perpetration of abuse by caregivers results in fewer symptoms and problems than abuse perpetrated by a non-caregiving relative. Thus, clinicians should not make a priori assumptions that children and adolescents who are traumatized by a parent/caregiver would have more severe symptoms than youth who are traumatized by a non-caregiver. Further exploration of the role of the perpetrator and other trauma characteristics associated with the perpetrator role is needed to advance our understanding of these findings and their implications for clinical practice.     

Secondary Trauma and Local Mental Health Professionals in Post Conflict Sierra Leone

This pilot study explores the impact of secondary stress on the emotional well-being of local mental health professionals (N?=?44) in Sierra Leone, a country recovering from a brutal civil war, while examining the types of training and support offered to these professionals by their organizations. While age and number of different types of traumatizing life events to which a professional was exposed was significantly associated with emotional well-being (r(33)?=??.39, p?=?.02 and r(33)?=?.33, p?=?.05 respectively), traumatizing life events did not predict depression or PTSD and work-related stress was not found to predict any symptoms. The results are discussed in light of challenges faced by local mental health professionals who work with a traumatized population while dealing with their own conflict-related experiences and their professional and organizational support systems. Implications for future research and self-care strategies are also highlighted.     

Mental health correlates of victimization classes among homeless youth

Literature reports high rates of street victimization among homeless youth and recognizes psychiatric symptoms associated with such victimization. Few studies have investigated the existence of victimization classes that differ in type and frequency of victimization and how youth in such classes differ in psychiatric profiles. We used latent class analysis (LCA) to examine whether classes of homeless youth, based on both type and frequency of victimization experiences, differ in rates of meeting diagnostic criteria for major depressive episodes and posttraumatic stress disorder (PTSD) in a sample of homeless youth (N = 601) from three regions of the United States. Results suggest youth who experience high levels of direct and indirect victimization (high-victimization class) share similarly high rates of depressive episodes and PTSD as youth who experience primarily indirect victimization only (witness class). Rates of meeting criteria for depressive episodes and PTSD were nearly two and three times greater, respectively, among the high victimization and witness classes compared to youth who never or rarely experienced victimization. Findings suggest the need for screening and intervention for homeless youth who report direct and indirect victimization and youth who report indirect victimization only, while prevention efforts may be more relevant for youth who report limited victimization experience.     

Post traumatic stress disorder reactions in children of war: a longitudinal study

OBJECTIVE: To establish rates of posttraumatic stress disorder (PTSD) reactions and general mental health problems in children who had experienced war trauma. METHOD: A longitudinal study in the Gaza strip with 234 children aged 7 to 12 years, who had experienced war conflict, at 1 year after the initial assessment, that is, during the peace process. Children completed the Child Post Traumatic Stress Reaction Index (CPTS-RI), while the Rutter A2 and B2 Scales were completed by parents and teachers. RESULTS: The rate of children who reported moderate to severe PTSD reactions at follow-up had decreased from 40.6% (N = 102) to 10.0% (N = 74). 49 children (20.9%) were rated above the cut-off for mental health problems on the Rutter A2 (parent) Scales, and 74 children (31.8%) were above the cut-off on the Rutter B2 (teacher) Scales. The total scores on all three measures had significantly decreased during the 1-year period. The total CPTS-RI score at follow-up was best predicted by the number of traumatic experiences recalled at the first assessment. CONCLUSIONS: PTSD reactions tend to decrease in the absence of further stressors, although a substantial proportion of children still present with a range of emotional and behavioral problems. Cumulative previous experience of war trauma constitutes a risk factor for continuing PTSD symptoms.     

Childhood trauma,PTSD, and psychosis: Findings from a highly traumatized,minority sample

Trauma, especially early life trauma, is a risk factor for the development of both posttraumatic stress disorder and psychosis. The goal of the present study was to determine specific associations between exposure to childhood abuse, PTSD symptoms, and current psychotic disorder. Subjects were recruited from a public, urban hospital (N = 328, >90% African American). Psychotic disorders were measured using the MINI International Neuropsychiatric Interview, PTSD was measured using the Clinician Administered PTSD Scale, child abuse was measured with the Childhood Trauma Questionnaire, and lifetime trauma exposure was measured with the Traumatic Events Inventory. Logistic regression analyses showed that both child abuse and current PTSD were statistically significant predictors of psychotic disorder beyond the effects of lifetime trauma load. When PTSD symptom clusters were examined, avoidance and numbing symptoms showed unique association with psychotic disorder independent of demographic variables and trauma exposure. Using bootstrapping techniques, we found a full indirect effect of PTSD on the association between child abuse and, suggesting a particularly important role of PTSD symptoms in relation to psychotic disorder in the presence of early life trauma. Because this is a cross-sectional study, continued research is needed to determine causality of such models. Identifying co-occurring psychosis and PTSD, particularly in populations with high levels of trauma exposure, is critical and will likely aid in more successful treatment interventions.     

Impact of childhood maltreatment on physical health-related quality of life in U.S. active duty military personnel and combat veterans

Previous studies have found an association between childhood maltreatment (CM) and health-related quality of life (HRQoL), and to a lesser extent have considered whether psychiatric symptoms may explain the relationship. This study aimed to further our understanding of the link between CM and HRQoL by testing whether posttraumatic stress disorder (PTSD) or depressive symptoms mediate the relationship between childhood maltreatment and physical HRQoL. Mediation models were examined in a sample of male Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) active duty and combat veterans (n = 249). PTSD and depressive symptoms mediated the relationship between CM and overall physical HRQoL, as well as participation in daily activities due to physical health, bodily pain, and social functioning. Mediation of the relationship between childhood maltreatment and physical and social functioning by depression and PTSD symptoms may lend support to neurobiological hypotheses that childhood maltreatment sensitizes the nervous system and after repeated trauma may lead to the development of psychiatric symptoms, which have a major impact on morbidity and mortality.     

Posttraumatic stress avoidance symptoms as mediators in the development of alcohol use disorders after exposure to childhood sexual abuse in a Swiss community sample

This study examined the role of posttraumatic stress disorder (PTSD) symptoms of re-experience, avoidance, and hyperarousal in the relationship between different types of trauma and alcohol use disorders (AUD). We used data from 731 trauma-exposed individuals who participated in the first wave of the PsyCoLaus-study. Trauma characteristics were assessed relatively to the occurrence of lifetime PTSD symptoms and AUD. The results suggest that lifetime and childhood sexual abuse as well as overall childhood trauma were directly linked to AUD and PTSD symptoms, in particular to avoidance symptoms. From single symptom clusters PTSD avoidance was found to specifically mediate the trauma-AUD pathway. Both childhood and sexual trauma strongly contribute to the comorbidity of PTSD and AUD and avoidance-type symptoms appear to play a central role in maintaining this association. Hence, the alleviation of avoidance symptoms might be an important target for therapeutic intervention among victims of sexual abuse before specific addiction treatment is initiated.     

Trauma symptoms among infants exposed to intimate partner violence

OBJECTIVE: To determine whether infants have a traumatic response to intimate partner violence (male violence toward their female partner; IPV) experienced by their mothers, two questions were explored: (1) Is the number of infant trauma symptoms related to the infant's temperament and the mother's mental health? (2) Does severity of violence moderate those relationships? METHODOLOGY: Forty-eight mothers reported whether their 1-year-old infants experienced trauma symptoms as a result of witnessing episodes of IPV during their first year of life. Mothers also reported on their own trauma symptoms that resulted from experiences of IPV. RESULTS: For those infants experiencing severe IPV and whose mothers exhibit trauma symptoms, we were able to predict whether infants exhibited trauma symptoms (b = .53, p < .01). This was not true for children who witnessed less severe IPV (b= -.14, ns). Maternal depressive symptoms and difficult infant temperament did not predict infant trauma symptoms for either group of infants. CONCLUSION: Mothers report that infants as young as 1-year-old can experience trauma symptoms as a result of hearing or witnessing IPV. The significant relationship between infant and maternal trauma symptoms, especially among those infants experiencing severe IPV, are consistent with the theory of relational PTSD. Findings suggest that interventions for mothers and families need to consider the influence of the severity of IPV on very young children.     

Comorbidity of PTSD in anxiety and depressive disorders: Prevalence and shared risk factors

The present study aims to assess comorbidity of posttraumatic stress disorder (PTSD) in anxiety and depressive disorders and to determine whether childhood trauma types and other putative independent risk factors for comorbid PTSD are unique to PTSD or shared with anxiety and depressive disorders. The sample of 2402 adults aged 18–65 included healthy controls, persons with a prior history of affective disorders, and persons with a current affective disorder. These individuals were assessed at baseline (T0) and 2 (T2) and 4 years (T4) later. At each wave, DSM-IV-TR based anxiety and depressive disorder, neuroticism, extraversion, and symptom severity were assessed. Childhood trauma was measured at T0 with an interview and at T4 with a questionnaire, and PTSD was measured with a standardized interview at T4. Prevalence of 5-year recency PTSD among anxiety and depressive disorders was 9.2%, and comorbidity, in particular with major depression, was high (84.4%). Comorbidity was associated with female gender, all types of childhood trauma, neuroticism, (low) extraversion, and symptom severity. Multivariable significant risk factors (i.e., female gender and child sexual and physical abuse) were shared among anxiety and depressive disorders. Our results support a shared vulnerability model for comorbidity of anxiety and depressive disorders with PTSD. Routine assessment of PTSD in patients with anxiety and depressive disorders seems warranted.     

The contribution of childhood emotional abuse to teen dating violence among child protective services-involved youth

ObjectiveFor child protective services (CPS) youth who may have experienced more than one form of maltreatment, the unique contribution of emotional abuse may be over-looked when other forms are more salient and more clearly outside of accepted social norms for parenting. This study considers the unique predictive value of childhood emotional abuse for understanding adolescent post-traumatic stress disorder (PTSD) symptomatology and dating violence. Further, PTSD symptomatology is assessed as an explanatory bridge in the emotional abuse—teen dating violence link.MethodsA random sample of 402 youth from the active caseload of a large urban CPS catchment area participated as part of a larger longitudinal study on adolescent health behaviors. Mid-adolescent youth across types of CPS status were targeted. CPS youth reported on lifetime maltreatment experiences, PTSD symptomatology, and past year dating experiences, using published scales.ResultsOver 85% of CPS youth had begun dating. For dating youth, some level of dating violence was common: over half of females (63–67%) and nearly half of males (44–49%). Taking into account other forms of maltreatment, emotional abuse emerged as a significant predictor of both PTSD symptomatology and dating violence among males and females. PTSD symptomatology was a significant mediator of the male emotional abuse-perpetration and the female emotional/physical abuse-victimization links, indicating a gendered patterning to findings.ConclusionsThese results indicate that: (1) CPS youth are a high priority group for dating violence and PTSD-linked intervention; and (2) CPS youth continue to experience the unique negative impact of childhood emotional abuse in their adolescent adjustment. All CPS children should be evaluated for emotional abuse incurred, and appropriate intervention attention be given as to how it specifically impacts on the child's approach to relating to themselves and to others.Practice implicationsThe present study directs practice implications in regards to: (1) the problem of teen dating violence, (2) the salience of childhood emotional abuse; and (3) the importance of targeting PTSD symptomatolgy among CPS youth. A substantial number of CPS youth report early engagement in violent romantic relationships and require support towards attaining the non-coercive relationship experiences of their non-CPS-involved age mates. The topic of dating, healthy dating relationships, and dating violence may need to be part of the regular casework, with a view towards supporting youths’ conceptualization of and skill set for healthy, close relationships. Further, this knowledge needs to be translated to foster parents and group home staff. With regard to the impact of childhood emotional abuse, CPS workers need to be sensitive to its potential for long-term, unique impact impairing relationship development. Emotional abuse is (a) unique among genders (i.e., for females, it clusters with physical abuse) and (b) uniquely predictive of PTSD symptoms and dating violence. Finally, as is consistent with theory and biopsychosocial evidence, PTSD symptomatology is a key causal candidate for understanding maltreatment-related impairment. Attention to targeting PTSD symptoms may be preventative for dating violence; attention to targeting emotional abuse experiences may be preventative for PTSD symptoms. CPS youth are an important population to involve in research, as their inclusion adds to the evidence-base to achieve evidence-informed practice and policy within child welfare.     

Maltreatment type,exposure characteristics,and mental health outcomes among clinic referred trauma-exposed youth

Building upon prior research documenting differential effects of psychological maltreatment, physical, and sexual abuse on youth mental health outcomes (Spinazzola et al., 2014), the present study sought to clarify the relative predictive contributions of type of maltreatment compared to salient exposure characteristics. The sample included 5058 clinic-referred youth from the Core Dataset (CDS) of the National Child Traumatic Stress Network (NCTSN) with lifetime histories of exposure to one or more of three specific types of maltreatment: psychological maltreatment (PM), physical abuse (PA), and sexual abuse (SA). First, we examined variations in salient trauma characteristics (age of onset, duration of exposure, number of co-occurring trauma types, and perpetrator type and number) by maltreatment group. Second, we examined whether type of maltreatment remained associated with mental health measures after adjusting for demographic variables and trauma characteristics. Profiles for youth with PM were more severe than youth who experienced either PA or SA only. Co-occurring PM and PA was associated with the most severe trauma exposure profile and with severity of PTSD symptoms, even after adjusting for demographic and trauma characteristics. Youth exposed to SA only had a distinct trauma profile and greater PTSD symptom severity after adjusting for demographic and trauma characteristic variables. Study findings hold important implications for trauma screening, assessment, and intervention, as well as for traumatic stress research methods that extend beyond abuse-specific or cumulative-risk approaches.     

Abnormal emotional processing in maltreated children diagnosed of Complex Posttraumatic Stress Disorder

Maltreated children usually show a specific pattern of emotional and behavioral symptoms that exceed those relating to posttraumatic stress disorder (PTSD). These symptoms have been defined as Complex PTSD (CPTSD). The underlying attentional mechanisms of abnormal emotional processing and their relation to the clinical presentation of CPTSD are not well understood. A visual dot-probe paradigm involving pre-attentive (i.e., 500 ms) and attentive (i.e., 1500 ms) presentation rates of neutral versus emotional (i.e., angry, happy or sad) facial expressions was applied. Twenty-one maltreated CPTSD children were compared with twenty-six controls. The results are as follows: an attention bias away from threatening faces and an attentional bias towards sad faces were observed in maltreated CPTSD children during pre-attentive and attentive processing. Whereas the attentional bias away from angry faces was associated with social problems, the attentional bias towards sad faces was associated with depressive and withdrawn symptoms. Therefore, CPTSD children develop maladaptive negative cognitive styles, which may underlie not only social problems (by a cognitive avoidance of threatening stimuli) but also depressive symptoms (by a cognitive approach to sad stimuli). Attention processing abnormalities should be considered as therapeutic targets for new treatment approaches in this population.     

Differential symptom pattern of post-traumatic stress disorder (PTSD) in maltreated children with and without concurrent depression

OBJECTIVE: The present study attempted to examine specific differences in the Post-Traumatic Stress Disorder (PTSD) symptomatology among abused children with and without concurrent depression. METHOD: PTSD and depressive symptoms were identified that discriminate between 98 children divided into three groups: (1) abused children with PTSD, (2) nonabused children who meet criteria for Major Depressive Disorder (MDD), and (3) abused children with both PTSD and MDD. RESULTS: Analyses revealed that nine items reflecting depressive symptomatology, primarily vegetative symptoms, differentiated the diagnostic groups (PTSD-only, MDD-only, and the combined group). A discriminant analysis revealed that the sum of responses to the nine significant items adequately predicted diagnostic classification for those with PTSD and depression, but did not correctly diagnose any in the combined group. Analyses also revealed that three post-trauma symptoms, including psychological amnesia, flashbacks/reenactments, and sleep difficulties, discriminated between the groups. The PTSD-only group reported more episodes of psychological amnesia while the PTSD and MDD group experienced more flashbacks. CONCLUSIONS: For the sample of abused children examined, these results illuminate differences with respect to PTSD symptom presentation for those children with PTSD who have a concurrent depressive disorder and their nondepressed counterparts. Children with PTSD who have a concurrent depression report greater levels of intrusive PTSD-related symptoms.     

Posttraumatic symptoms among maltreated youth using classification and regression tree analysis

Individual psychological factors have been shown to exacerbate risk for posttraumatic stress disorder (PTSD) symptoms in youth following maltreatment, but the novel contribution of the present study includes a focus on interactive relationships between these factors on specific PTSD symptom clusters. This study identified maltreated youth at highest risk for re-experiencing, avoidance, and hyperarousal symptom clusters via cognitive, affective, and demographic variables. Participants (n = 400) included ethnically diverse maltreated youth. Classification and regression tree (CART) analysis, a form of binary recursive partitioning (BRP), identified subgroups of maltreated youth at highest risk for three core PTSD symptom clusters. Posttraumatic cognitions, anhedonia, negative mood, processing speed, and ethnicity best predicted re-experiencing symptoms. Depersonalization/derealization, verbal comprehension, sexual maltreatment, and age best predicted avoidance symptoms. Negative cognitions about self, IQ, dissociation, working memory, and posttraumatic cognitions best predicted hyperarousal symptoms. Core PTSD symptom clusters may thus be associated with unique collections of risk factors for maltreated youth. Clinical protocols for this population could be recalibrated to be more sensitive to specific profiles that more accurately identify highest risk maltreated youth and better inform evidence-based treatment practices.     

Mediational significance of PTSD in the relationship of sexual trauma and eating disorders

OBJECTIVE: To examine the mediational significance of posttraumatic stress disorder (PTSD) and the development of eating disorder symptomatology following sexually traumatic experiences. METHOD: Seventy-one victims of sexual trauma and 25 control subjects completed interviews and questionnaires assessing eating disorder psychopathology and posttraumatic stress disorder symptomatology. Mediational analyses were conducted examining the relationships among trauma, posttraumatic stress, and eating disorder symptoms. Mediational significance was assessed by the drop in the overall correlation between trauma and eating disorder symptoms when PTSD symptoms were included in the regression model. RESULTS: There is a significant association between a history of trauma and eating disorder symptoms. Also, there was a significant association between a history of trauma and posttraumatic stress disorder symptoms. Importantly, the relationship between trauma and eating disorder symptoms was significantly reduced when posttraumatic stress disorder symptoms were included in the regression analyses, indicating mediational significance of the posttraumatic stress construct. These findings were most pronounced for the physiological arousal and avoidance components of posttraumatic stress disorder. DISCUSSION: The present findings support the idea that individuals who develop eating disorders after sexual trauma are likely to have experienced posttraumatic stress disorder symptomatology. These findings have significant implications for causal models of eating disorder onset in trauma victims. Furthermore, clinical interventions for traumatized eating disordered individuals may benefit from a focus on posttraumatic stress symptomatology.