Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA.
J Affect Disord. 2022 Nov 15;317:329-338. doi: 10.1016/j.jad.2022.08.099. Epub 2022 Aug 31.
Prior findings suggest that psychopathology following interpersonal trauma or assaultive violence may present differently from prototypical posttraumatic stress disorder (PTSD). However, whether this is true for sexual trauma (ST) in the context of other salient lifetime traumatic experiences is yet unknown. We predicted that ST exposure may result in higher avoidance and numbing symptoms and blunted fear responses, relative to non-sexual trauma (NST), particularly if ST occurred during childhood.
Participants were n = 5163 Black women recruited in an urban public hospital. We investigated effects of ST on PTSD symptoms, fear-potentiated startle (FPS) response (n = 285), and amygdala reactivity and habituation to social threat cues with fMRI (n = 95).
ST was associated with greater PTSD symptoms (p = 2.64 × 10), but this was observed across all symptom clusters. Women who experienced repeated ST in both childhood and adulthood showed greater PTSD (p = .0009) and numbing symptoms (p = .002). In the FPS paradigm, the ST group startled more on all blocks and stimulus types than the NST group (p = .004). Developmental timing of ST did not influence startle magnitude. ST was not associated with amygdala habituation or reactivity.
Generalizability is limited to Black women with a high trauma burden. Associations are cross-sectional, limiting causal conclusions.
While survivors of ST may present with more severe PTSD symptoms, their profiles are not characteristically different from similar NST controls. Childhood sexual abuse exposure alone did not result in a unique symptom profile. ST represents a uniquely high-burden stressor with likelihood for more severe posttraumatic outcomes.
先前的研究结果表明，人际创伤或攻击暴力后的精神病理学表现可能与典型的创伤后应激障碍（PTSD）不同。然而，在其他重要的终生创伤经历背景下，性创伤（ST）是否如此尚不清楚。我们预测，与非性创伤（NST）相比，ST 暴露可能导致更高的回避和麻木症状，以及恐惧反应迟钝，特别是如果 ST 发生在儿童期。
参与者是在一家城市公立医院招募的 5163 名黑人女性。我们研究了 ST 对 PTSD 症状、恐惧增强的惊吓反应（FPS）（n=285）以及杏仁核对社会威胁线索的反应性和习惯化的 fMRI（n=95）的影响。
ST 与更大的 PTSD 症状相关（p=2.64×10），但这在所有症状群中都有观察到。在儿童期和成年期都经历过多次 ST 的女性表现出更大的 PTSD（p=0.0009）和麻木症状（p=0.002）。在 FPS 范式中，ST 组在所有块和刺激类型上的惊吓反应都大于 NST 组（p=0.004）。ST 的发展时间对惊吓幅度没有影响。ST 与杏仁核习惯化或反应性无关。
可推广性仅限于创伤负担高的黑人女性。关联是横断面的，限制了因果结论。
虽然 ST 的幸存者可能表现出更严重的 PTSD 症状，但他们的表现与类似的 NST 对照组并没有明显的不同。单独的儿童期性虐待暴露并没有导致独特的症状模式。ST 是一种独特的高压力源，有更严重的创伤后后果的可能性。
