History of past sexual abuse in married observant Jewish women.

OBJECTIVE: The authors examined instances of past sexual abuse and related demographic characteristics in the self-reports of a select group of married observant Jewish women. METHODS: Orthodox Jewish married women (N=380) ages 19 to 58 responded to advertisements asking them to complete an anonymous questionnaire about sexual experiences, including sexual abuse. RESULTS: Sexual abuse was reported by 26% of the respondents surveyed, with 16% reporting abuse occurring by the age of 13. More ultra-Orthodox Jews reported abuse than modern-Orthodox Jews. Women who were raised observant reported significantly less childhood sexual abuse than those who became observant later in life. Sexual abuse was associated with increased treatment-seeking for depression, marital counseling, or other emotional or psychological problems. CONCLUSION: While observant Jewish women live in a culture defined by a high degree of adherence to specific laws of conduct, including rules designed to regulate sexual contact, sexual abuse of various types still exists among them.

Ten-year follow-up study of cortisol levels in aging holocaust survivors with and without PTSD.

To investigate the longitudinal course of mean 24-hour urinary cortisol excretion in posttraumatic stress disorder (PTSD), the authors evaluated 24-hour cortisol excretion in 28 Holocaust survivors 10 years after obtaining an initial estimate. Cortisol levels increased in participants whose PTSD had remitted (n = 3) but declined in participants who developed PTSD (n = 3) or whose PTSD status did not change over time (PTSD+: n = 14, PTSD-: n = 8). Cortisol levels at Time 1 predicted diagnostic status change better than psychological variables, including exposure to traumatic events between assessments. The authors conclude that cortisol levels are affected by change in PTSD status and age.

Effects of parental PTSD on the cortisol response to dexamethasone administration in their adult offspring.

OBJECTIVE: The authors used a low-dose dexamethasone suppression test to examine the effect of a PTSD risk factor, parental PTSD, on cortisol negative feedback inhibition in adult offspring of Holocaust survivors with PTSD (N=13) versus without PTSD (N=12) as well as a comparison group of offspring whose parents had no Holocaust exposure (N=16). METHOD: Blood samples were obtained at 8:00 a.m. for the determination of baseline cortisol. Participants ingested 0.5 mg of dexamethasone at 11:00 p.m., and blood samples were obtained again at 8:00 a.m. the following day. RESULTS: Enhanced cortisol suppression in response to dexamethasone was associated primarily with parental PTSD status, with minimal contribution of subjects' own trauma-related symptoms. CONCLUSIONS: Enhanced cortisol negative feedback inhibition may be associated with PTSD because it is related to the PTSD risk factor of parental PTSD.

The relationship between hippocampal volume and declarative memory in a population of combat veterans with and without PTSD.

Both reduced hippocampal volume and cognitive alterations have been found in posttraumatic stress disorder (PTSD). The purpose of this article was to examine the relationship between hippocampal volume, combat exposure, symptom severity, and memory performance in a sample of combat veterans with and without a history of PTSD. Subjects were 33 male veteran volunteers (16 PTSD+, 17 PTSD-) who underwent an MRI and neuropsychological testing with the California Verbal Learning Test (CVLT), a measure of declarative memory. Relationships between hippocampal volume (i.e., right + left hippocampal volume/whole brain volume) and performance on the CVLT were determined using partial correlational analysis controlled for age and Wechsler Adult Intelligence Scale, Third Edition (WAIS-III) vocabulary scores. Percent hippocampal volume for the entire sample was positively associated with several aspects of memory performance as reflected by the CVLT. In the PTSD+ group, CVLT performance was negatively correlated with lifetime, but not current CAPS symptoms. CVLT performance appears to be strongly correlated with hippocampal volume in a group of trauma survivors with and without PTSD. Insofar as CVLT performance in the PTSD group was negatively associated with worst episode, but not to current PTSD symptoms, memory performance in combat veterans may reflect some aspect of risk related to the magnitude of the psychological response to trauma, rather than current symptoms that may be interfering with cognitive performance. It will be of interest to study cognitive abilities that may relate to the likelihood of specific PTSD symptoms and to track changes in CVLT performance and hippocampal volume over time in persons with and without a history of trauma exposure.

Longitudinal assessment of dissociation in Holocaust survivors with and without PTSD and nonexposed aged Jewish adults.

The trajectory of posttraumatic stress disorder (PTSD) and PTSD-related symptoms in relation to aging is not well understood. We previously observed higher levels of dissociation as measured by the Dissociative Experiences Scale (DES) among older Holocaust survivors with, compared to those without, PTSD, though scores on the DES in Holocaust survivors were markedly lower than those that had been reported for younger cohorts. We undertook a longitudinal evaluation of dissociation in Holocaust survivors. Twenty-six Holocaust survivors with current PTSD, 30 Holocaust survivors without current PTSD, and 19 nonexposed were evaluated at the initial evaluation and subsequently 8.11 years later. Repeated measures analysis of variance (ANOVA) on the DES scores from these times demonstrated a significant main effect for time and a significant group by time interaction, reflecting a marked decline in Holocaust survivors, particularly those with PTSD. Controlling for age obliterated the effect of time, but not the group by time interaction. A similar pattern was shown with The Clinician Administered PTSD Scale (CAPS) scores. Different symptoms related to PTSD show different trajectories of change with age, with dissociation appearing to be less prominent with age.

Are adult offspring reliable informants about parental PTSD? A validation study.

We developed a short questionnaire--Parental PTSD Questionnaire--(PPQ), designed to assess the presence of posttraumatic stress disorder (PTSD) symptoms in parents. Fifty-eight adult offspring of Holocaust survivors (23 men and 35 women) completed the questionnaire about a parent who was independently evaluated by a trained clinician using the Clinician Administered PTSD Scale (CAPS). Only 5.2% of the offspring reported, "not knowing" if their parent had experienced 10 or fewer symptoms, while 56.9% provided estimates for all 17 items. There were no significant differences between lifetime frequencies of the individual symptoms as endorsed on the PPQ compared to the CAPS when subjects with completed PPQs were compared with CAPS. Interrater reliability between offspring and clinician was highly significant for each of the items when evaluated separately so as to include data for subjects who endorsed not knowing if a certain symptom had been present. Further studies are warranted to examine the psychometric properties of this measure.

Clinical correlates of 24-h cortisol and norepinephrine excretion among subjects seeking treatment following the world trade center attacks on 9/11.

UNLABELLED: Whereas trauma-associated arousal has been linked fairly consistently with elevations in both glucocorticoids and catecholamines, neuroendocrine correlates of hyperarousal in the context of posttraumatic stress disorder (PTSD) have been more variable. Further, neuroendocrine predictors of the development of PTSD following trauma have been related to prior exposure, and data from several laboratories suggests that hyperarousal may develop in a neuroendocrine milieu of relatively diminished basal glucocorticoid secretion. METHODS: In this article we examined 24-h cortisol and norepinephrine excretion in 42 treatment-seeking survivors of the 9/11 World Trade Center (WTC) attacks, 32 of whom met criteria for PTSD, and 15 of whom met criteria for major depression, at the time of evaluation; 14 of the 15 subjects meeting criteria for major depression also suffered from PTSD. RESULTS: PTSD subjects' 24-h cortisol excretion (46.3 +/- 20.0 microL/dL) was lower than that of the non-PTSD cohort (72.2 +/- 22.4 microL/dL; t = 3.18, df = 37, P = 0.003), and 24-h urinary cortisol was negatively correlated with the experience of the WTC attacks as a Criterion-A event (r = -0.427, P = 0.007), and with self-rated avoidance (r = -0.466, P = 0.003) and total score (r = -0.398, P = 0.012) on the PTSD Symptom Scale (PSS). In contrast, 24-h norepinephrine excretion was not associated with the development of PTSD or with PTSD-related symptoms, but was negatively correlated with days since 9/11 at the time of evaluation (r = -0.393, P = 0.015). DISCUSSION: The latter finding suggests a relationship of norepinephrine to a dimension of stress-related arousal not captured by the symptom-rating scales chosen for this study to reflect symptoms related to PTSD and other neuropsychiatric disorders, but instead, of one to that of the sudden multidimensional life disruption suffered by the WTC survivors that applied for treatment. These data also confirm, in a naturalistic sample, the previously observed negative association of urinary cortisol excretion with development of PTSD in the aftermath of severe trauma exposure.

Sexual dysfunction after traumatic brain injury.

Objective: The frequency of self reported sexual difficulties was examined in a group of 322 individuals with traumatic brain injury (TBI) ($N = 193$ men; 129 women) and contrasted with reports of sexual difficulties in 264 individuals without disability (152 men; 112 women) residing in the community. Physiological, physical, and body images problems impacting sexual functioning were examined individually and then summed into a sexual dysfunction score. Mood, quality of life, health status and presence of an endocrine disorder were examined as predictors of sexual difficulties post TBI. Study design: In this retrospective study, data about sexual difficulties were analyzed separately for men and women with TBI and without disability. ANOVAs with post hoc analysis for continuous variables, chi-square analyses for categorical variables, and ANCOVAs for predictors of sexual difficulties were utilized. Results: When contrasted to individuals without disability, individuals with TBI reported more frequent: (1) physiological difficulties influencing their energy for sex, sex drive, ability to initiate sexual activities and achieve orgasm; (2) physical difficulties influencing body positioning, body movement and sensation, and (3) body image difficulties influencing feelings of attractive and comfort with having a partner view one's body during sexual activity. Additional gender specific TBI findings were observed. In comparison to gender matched groups without disability, men with TBI reported less frequent involvement in sexual activity and relationships, and more frequent difficulties in sustaining an erection; women with TBI reported more frequent difficulties in sexual arousal, pain with sex, masturbation and vaginal lubrication. While groups differed in core demographic variables, age was the only demographic variable that was related to reports of sexual difficulties in individuals with TBI and men without disability. Age at onset and severity of injury were negatively related to reports of sexual difficulties in individuals with TBI. In men with TBI and without disability, the most sensitive predictor of sexual dysfunction was level of depression. For women without disability, an endocrine disorder was the most sensitive predictor of sexual dysfunction. For women with TBI, an endocrine disorder and level depression combined were the most sensitive predictors of sexual difficulties. Conclusion: Individuals post TBI report frequent physiological, physical and body images difficulties which negatively impact sexual activity and interest. For men post TBI, predictors of sexual difficulties included age at interview, age at injury, and having milder injuries, however, depression was the most sensitive predictor of sexual dysfunctions. For women post TBI, predictors of their sexual difficulties included age at injury and having milder injuries, however, depression and an endocrine disorder combined were the most sensitive predictors of sexual dysfunction. Implications of this study include the need for broad-based assessment of sexual dysfunction, and the implementation of treatment studies to enhance sexual functioning post TBI.