Affective Dispositions and PTSD Symptom Clusters in Female Interpersonal Trauma Survivors

Abstract

Interpersonal trauma (IPT) against women can have dire psychological consequences including persistent maladaptive changes in the subjective experience of affect. Contemporary literature has firmly established heightened negative affect (NA) as a risk and maintenance factor for posttraumatic stress disorder (PTSD). However, the relationship between NA and PTSD symptoms is not well understood within IPT survivors, the majority of whom are female, as much of this research has focused on combat veterans. In addition, the connection between positive affect (PA) and PTSD symptoms has yet to be examined. With increased emphasis on “negative alterations in cognitions and mood . . .” as an independent symptom cluster of PTSD in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), understanding the relationship between self-reported affectivity and the classic PTSD symptom clusters may be increasingly useful in differentiating symptom presentations of trauma-related psychopathology. The current study directly compared self-reported trait NA and PA with total severity and frequency cluster scores from the Clinician-Administered PTSD Scale (CAPS) in 54 female survivors of IPT who met criteria for PTSD. Results identify NA (but not PA) as a consistent predictor of total PTSD symptoms and, specifically, re-experiencing symptoms.

Keywords

affect PTSD interpersonal trauma

Introduction

Interpersonal trauma (IPT) is a pervasive societal problem that exhibits a striking gender bias. IPT is defined as “traumatic events in which an individual is personally assaulted or violated by another human being that is either known or unknown to the trauma survivor” (Lilly & Valdez, 2012, p. 140) and may include physical or sexual assault, molestation, or domestic violence. Prior research has demonstrated that women are disproportionately affected by IPT in comparison with men (Breslau, 2001; Lilly & Valdez, 2012). Moreover, IPT can have significant psychological consequences, including emotional dysregulation and the manifestation of posttraumatic stress disorder (PTSD; Cisler et al., 2012; Courtois & Ford, 2009).

The relationship that exists between the experience of IPT and the development of PTSD is well documented. Prior research has reported that the risk of subsequent PTSD development is greater for IPT than for a non-interpersonal traumatic event (Breslau, 2001; Luthra et al., 2009). Early experiences of IPT are associated with increased rates of revictimization later in life, and individuals exposed to IPT multiple times over their life span report significantly more PTSD symptoms than individuals exposed only in childhood (Arata, 1999; Cougle, Resnick, & Kilpatrick, 2009; Lilly & Valdez, 2012).

IPT can also manifest severe emotional dysregulation, as evidenced by the significant comorbidity of PTSD and Major Depressive Disorder (MDD). Previous studies examining IPT survivors with PTSD have reported comorbidity rates with MDD ranging from 52% to 64% (Nixon, Resick, & Nishith, 2004; Taft, Resick, Watkins, & Panuzio, 2009). Some researchers have explained emotional dysregulation and high rates of comorbidity between traumatic stress and mood disorders as a function of negative affect (NA; Clark & Watson, 1991; Post, Zoellner, Youngstrom, & Feeny, 2011). NA has been defined as a stable, affective dimension of subjective distress that subsumes a variety of aversive mood states, including anger, contempt, disgust, guilt, fear, and nervousness (Watson, Clark, & Tellegen, 1988).

Until recently, NA has not traditionally been conceptualized as an integral component to PTSD. Upon the heels of research indicating that NA influences the manifestation and maintenance of PTSD (Bennett, Owen, Koutsakis, & Bisson, 2002; Christiansen & Elklit, 2008; Souza et al., 2008; Watson, 2005; Watson, Gamez, & Simms, 2005; Weems et al., 2007), the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) conceptualization of PTSD added a symptom cluster characterized by “negative alterations in cognitions and mood associated with the traumatic event(s) (p. 271).” Many of the symptoms associated with this cluster are consistent with the experience of heightened NA (i.e., “persistent negative emotional state,” “persistent and exaggerated negative beliefs or expectations about oneself, others, or the world”; APA, 2013, p. 272).

It has been established that heightened NA influences total PTSD symptom severity (Bradley et al., 2010; Frazier et al., 2011; Marshall-Berenz, Morrison, Schumacher, & Coffey, 2011; Rademaker, van Zuiden, Vermetten, & Geuze, 2011) and is associated with intrusive traumatic memories (Watson et al., 2005). In addition, prior research in a trauma-exposed sample has found NA to account for a significant amount of variance in both PTSD total symptom scores and each of the symptom clusters (re-experiencing, avoidance, hyperarousal; Fetzner, Collimore, Carleton, & Asmundson, 2012). Although noting that these relationships were in the positive direction, the authors also concluded that NA is a theoretically relevant construct to the relationship between anxiety sensitivity and PTSD symptoms that warrants further investigation. As such, NA may represent an underlying factor that contributes to each PTSD symptom cluster.

The relationship between Positive Affect (PA) and PTSD is less understood. PA is defined as “pleasurable engagement with the environment” and encompasses the tendency to experience positive emotions and mood states (Watson, Clark, & Carey, 1988). PA has been considered an integral component to the experience of depression since its conception, given that depressed individuals tend to report anhedonia and diminished positive mood and emotions (Watson et al., 1988). Reduced PA has also been included in the affective symptoms cluster of the DSM-5 conceptualization of PTSD (i.e., “markedly diminished interest or participation in significant activities,” “persistent inability to experience positive emotions”; APA, 2013, p. 272), despite the relative lack of research examining the relationship between PA and PTSD.

One study observed that compared with healthy women without PTSD, women with PTSD reported fewer positive trait descriptors and experienced less PA in response to viewing pictures of themselves while listening to trait adjectives (Frewen et al., 2011). Also, individuals with comorbid PTSD and MDD have exhibited lower levels of PA than individuals solely diagnosed with PTSD—a result consistent with literature regarding the compounding effects of comorbid disorders (Post et al., 2011). PA was also found to account for a significant amount of variance in both total PTSD symptoms and numbing symptoms in another study despite the fact that NA proved to be the most significant predictor in these models (Fetzner et al., 2012). It should be noted that the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; APA, 1994) conceptualization of PTSD included numbing symptoms in the avoidance symptom cluster, thus warranting further attention between PA and this specific subset of PTSD symptoms. The avoidance symptom “markedly diminished interest or participation in significant activities” (Diagnostic and Statistical Manual of Mental Disorders [4th ed., text rev.; DSM-IV-TR]; APA, 2000) also appears to be conceptually relevant to PA, as the diminished experience of positive emotions may reinforce avoidance of previously enjoyable situations. Further exploration of the relationship between PA and the PTSD symptom clusters may contribute to the empirical basis supporting the decision to alter the previous conceptualization of PTSD.

Clarification of the relationship between affectivity and PTSD symptom clusters may provide more specific information on how PA and NA are related to PTSD. For example, if affectivity is associated with all three symptom clusters, it may indicate that affectivity is a constant factor that may contribute evenly to the maintenance of symptoms across the disorder. Conversely, if PA or NA is associated with specific symptom clusters, it could suggest that a unique relationship exists and affectivity either contributes to or is a product of specific symptoms within PTSD. Understanding these relationships may also have clinical implications. Specifically, a greater understanding of these relationships may inform tailored interventions that consider when and how to address affectivity during the course of treatment.

The context of IPT provides a unique opportunity to examine self-reported affectivity following the experience of a type of trauma that manifests emotions including fear, anger, guilt, shame, and disgust. The goal of the current study was to investigate the relationship between NA, PA, and DSM-IV-TR PTSD symptoms in a sample of IPT survivors while controlling for symptoms of depression. Consistent with prior research (Fetzner et al., 2012) regarding the relationship between affective dimensions and PTSD symptom clusters, it was hypothesized that NA and PA would be significantly associated with PTSD severity. The relationship between NA and PTSD symptoms was expected to be positive, such that as NA increases, total symptom severity also increases. PA was expected to exhibit an inverse relationship with PTSD symptoms such that as PA increases, total symptom severity decreases. In addition, NA was expected to be significantly associated with the total score (i.e., frequency and intensity) of each PTSD symptom cluster. Regarding the predictions for PA, it was hypothesized that PA would only be associated with the avoidance symptom cluster score, given that two avoidance symptoms specifically reference a lack of engagement with the environment and restricted positive emotion. An increase in PA should manifest more pleasurable engagement with the environment, thus reducing avoidance behaviors.

Method

Participants

Participants were 54 females, ages 18 to 55 (M = 31.7 years, SD = 9.5 years), recruited at a specialized trauma center in the Midwest as part of a larger treatment study. All participants were compensated for their time during the assessment, and participants meeting qualifications for the treatment group received free services. All participants met DSM-IV-TR criteria for PTSD as their primary axis I diagnosis. Trauma exposure was assessed using the Life Events Checklist (LEC), and all participants endorsed IPT (i.e., physical or sexual assault, molestation, or intimate partner violence) as their Criterion A (i.e., index) event on the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995). Regarding IPT exposure, approximately 18.5% (n = 10) experienced only a sexual assault, 9.2% (n = 5) experienced only a physical assault, 70.4% (n = 38) experienced both physical and sexual assault, and 1.8% (n = 1) experienced an IPT classified as “other.” The sample was multiply traumatized with approximately 83.3% (n = 45) of the sample reporting a direct traumatic experience other than IPT. Other traumatic experiences reported by the sample include transportation accident (66.7%, n = 36), the sudden death of a loved one (33.3%, n = 18), and natural disaster (29.6%, n = 16). Only one participant reported the direct experience of combat exposure.

The study sample was relatively diverse, with 55.6% of the participants identifying as Caucasian, 35.1% as African American, 1.9% as Hispanic, and 7.4% identifying as “Other.” One-way ANOVAs were used to test for significant differences between racial identity and participant reports of NA, PA, and PTSD symptoms. Reports of NA (p = .31), PA (p = .53), and PTSD symptoms (p = .17) were not significantly different across racial groups. The sample completed, on average, 15.1 years (SD = 3.1 years) of education. Potential participants were excluded for active suicidality, Axis II conditions, current bipolar disorder, current schizophrenia, current substance use, current use of psychotropic medications, primary neurological disorders, and the inability to give informed consent or speak English. Other comorbid conditions were permitted for this analysis as long at PTSD was the primary diagnosis. Approximately 77.8% of the sample was diagnosed with at least one comorbid Axis I condition (M = 1.8, SD = 1.6). Of those diagnosed with comorbid conditions (n = 42), 76.2% reported comorbid depression (n = 32), 26.2% reported comorbid specific phobia (n = 11), 14.3% reported comorbid obsessive-compulsive disorder (n = 6), 11.9% reported comorbid social phobia (n = 5), 9.5% reported comorbid generalized anxiety disorder (n = 4), 9.5% reported comorbid panic disorder (n = 4), and 4.8% reported comorbid agoraphobia without a history of panic (n = 2).

Measures

CAPS

The CAPS (Blake et al., 1995) is a clinician-administered, 30-item scale that assesses validity, severity, and improvement over a time period of interest (e.g., past week, past month, lifetime) regarding PTSD symptoms as identified by the DSM-IV-TR. These symptoms are clustered into three groups: re-experiencing (Criterion B), avoidance/numbing (Criterion C), and arousal (Criterion D). The 1-month time period for each individual symptom was assessed in the current study. The CAPS also contains separate 5-point frequency and intensity rating scales (0-4) for each symptom. The CAPS has demonstrated high internal consistency (αs = .92-.99; Blake et al., 1995) and is a well-known, valid measure of PTSD symptoms and diagnosis.

Structured Clinical Interview for DSM-IV–Patient Version (SCID-IV-P)

The SCID-IV-P (First et al., 2002) is a clinician-administered diagnostic interview that is frequently utilized in both clinical and research settings. The interview covers all primary Axis I disorders and is often used as an essential diagnostic tool. Endorsed symptoms are rated based on a categorical system derived from the diagnostic criterion of disorders as defined by the DSM-IV-TR. The SCID-IV-P was used to assess all Axis I disorders other than PTSD and possesses fair diagnostic reliability (κ = 0.61-0.83; Lobbestael, Leurgans, & Arntz, 2011).

Hamilton Rating Scale for Depression (HAMD)

The HAMD (Hamilton, 1960, 1967) is a 17-item clinician-administered instrument designed to assess for current depressive symptoms. The HAMD includes both 3- and 5-point rating scales. Total scores are calculated by summing the item-level ratings. Internal reliability ranges from .46 to .97 and test–retest reliability ranges from .81 to .98 (Bagby, Ryder, Schuller, & Marshall, 2004).

Positive and Negative Affect Schedule–Expanded Form (PANAS-X)

All participants were administered the PANAS-X (Watson & Clark, 1994), a 60-item self-report questionnaire, to measure the two predominant dimensions of self-reported mood, PA and NA. It displays excellent convergent and discriminant validity and exhibits high internal consistency (Cronbach’s coefficient alpha) for both the PA subscale (α = .83-.90) and the NA subscale (α = .85-.90).

Procedure

Participants were recruited through online and flyer advertisements on several university campuses and within the community. After a brief phone screen, participants were scheduled for an in-person assessment. A graduate research assistant explained the project to all potential participants. During the initial assessment, informed consent was obtained and eligibility determined. This assessment began with administration of the CAPS and the SCID-IV-P to diagnose current and lifetime psychopathology. Based on prior research of childhood sexual abuse in women (Orr et al., 1997), participants must have had a total CAPS score greater than 45 and meet criteria for each PTSD symptom cluster to ensure diagnostic validity of PTSD. Participants then completed other clinician-administered and self-report assessments. All data were analyzed using SPSS Version 20.0 for Windows.

Results

Exploratory Pearson product–moment correlation analyses were conducted to examine the independent relationships among all variables of interest. The data are presented in Table 1. It appears that NA exhibited significant positive associations of moderate strength with PTSD symptom severity and all three PTSD symptom clusters, such that PTSD symptoms tend to increase as NA increases. It is important to note that the relationship between NA and PA is non-significant, further demonstrating the variables are distinct constructs. NA also demonstrates a moderate positive association with depression scores. Of additional interest are the non-significant relationships of PA with all three PTSD symptom clusters and total PTSD severity. PA, however, demonstrates a moderate inverse relationship with HAMD scores, indicating that the lack of PA is strongly associated with the experience of depression. PA also exhibits a significant inverse relationship with age, such that as age increases, PA decreases.

Table 1.

Pearson Product–Moment Correlations Between Study Variables.

	1	2	3	4	5	6	7	8	9
1. CAPS total score	—
2. Re-experiencing symptoms	.73**	—
3. Avoidance symptoms	.87**	.46**	—
4. Hyperarousal symptoms	.81**	.35*	.59**	—
5. HAMD score	.34*	.23	.31*	.28^†	—
6. Positive affect	−.18	−.12	−.13	−.19	−.54**	—
7. Negative affect	.45**	.30*	.43**	.34*	.55**	−.25^†	—
8. Age	−.10	−.34*	.10	−.06	.24	−.31*	.29*	—
9. Education	.05	−.06	.05	.12	−.07	−.25^†	−.01	−.06	—

Note. CAPS = Clinician-Administered PTSD Scale; PTSD = posttraumatic stress disorder; HAMD = Hamilton Rating Scale for Depression.

†

p < .10. *p < .01. **p < .001.

PTSD Symptom Severity

To test the first hypothesis that NA and PA are significantly associated with PTSD severity, a hierarchical regression was conducted with CAPS total score (M = 66.6, SD = 18.1) as the dependent variable and NA (M = 28.0, SD = 9.0) and PA (M = 23.0, SD = 7.1) as independent variables. Age, education (i.e., number of years of education), and HAMD depression score (M = 13.8, SD = 6.0) were selected as covariates to control for their effects and entered into the first block of each analysis. Previous research has identified a significant relationship between affectivity and age in both healthy and clinical samples (Cheavens, Rosenthal, Banawan, & Lynch, 2008; Mroczek & Kolarz, 1998). Another study found that controlling for years of education yielded a significant relationship between sleep disturbances and methods of coping with NA in a sample of female rape survivors with PTSD (Nishith, Resick, & Mueser, 2001). Consistent with these findings, these covariates were selected to account for their possible independent relationships with the variables of interest in this study. PA was then entered into the second block and NA into the third to examine their unique effects on the dependent variable. PA and NA were entered separately into the equation to account for the shared variance between the constructs. Outliers were absent from the sample as indicated by examination of Mahalanobis distances.

For CAPS total score, Step 1 of the model was statistically significant, F(3, 46) = 2.817 p < .05, Adj. R² =.10, with only HAMD depression score as a significant predictor (β = .39, p < .01). Multiple R for regression of the final model was statistically significant, F(5, 44) = 3.516 p < .01, Adj. R² =.20, indicating that the model was significant in predicting PTSD severity. The addition of NA (ΔR² = .13, p < .01), but not PA (ΔR² change = .00, p = .90), accounted for significantly more variance in total PTSD score in the final model. NA was found to be significantly associated with PTSD severity based on an evaluation of the standardized Beta coefficients (β = .45, p < .01). NA was also moderately correlated with the CAPS total score (r = .39), accounting for approximately 15.4% of the variance in PTSD severity scores. Age was found to be significantly associated with CAPS total score, just reaching the threshold for significance (β = −.29, p < .05). Symptoms of depression (β = .11, p = .55), PA (β = −.10, p = .58), and education (β = .02, p = .90) were not significant in the final model.

Re-Experiencing Symptoms

Following this analysis, hierarchical regressions were conducted with the scores from each individual PTSD symptom cluster (e.g., re-experiencing, avoidance, hyperarousal) as the dependent variable to examine symptom cluster relationships with NA and PA, while controlling for age, education, and symptoms of depression. Regarding re-experiencing symptoms (M = 17.5, SD = 6.8), Step 1 of the model was statistically significant, F(3, 46) = 4.36 p < .01, Adj. R² = .17, with age (β = −.42, p < .01) and HAMD depression score (β = .33, p < .05) as significant predictors. Multiple R for regression of the final model was statistically significant, F(5, 44) = 4.44, p < .01, Adj. R² = .26. The addition of NA (ΔR² = .10, p < .05), but not PA (ΔR² = .01, p = .39), accounted for significantly more variance in re-experiencing symptoms in the final model. The relationship between NA and re-experiencing symptoms was statistically significant (β = .39, p < .05, r = .36) and characterized by a moderate positive association. The relationship between age and re-experiencing symptoms was also significant (β = −.53, p < .001, r = −.51) but distinguished by a moderate negative association. Symptoms of depression (β = .01, p = .94), PA (β = −.21, p = .20), and education (β = −.14, p = .30) were not significantly associated with re-experiencing symptoms in the final model.

Avoidance Symptoms

The first step of the model in the analysis of avoidance symptoms (M = 26.6, SD = 8.3) was not statistically significant, F(3, 46) = 1.74 p = .17, Adj. R² =.04. None of the covariates were significant predictors within the first step of the model. The final model yielded a final multiple R for regression that approached significance, F(5, 44) = 2.18, p = .07, Adj. R² = .11. The addition of NA ΔR² = .09, F(1, 44) = 4.933, p < .05, but not PA (ΔR² = .01, p = .57), accounted for significantly more variance in avoidance symptoms in the final model. Only NA significantly contributed to the model (β = .37, p < .05) and demonstrated a moderate positive association with avoidance symptoms (r = .32). Age (β = −.01, p = .91), symptoms of depression (β = .14, p = .49), PA (β = .05, p = .80), and education (β = .07, p = .65) were non-significant.

Hyperarousal Symptoms

Last, the first step of the model for hyperarousal symptoms (M = 22.5, SD = 7.4) was not statistically significant, F(3, 46) = 1.89 p = .15, Adj. R² =.05. None of the covariates significantly contributed to the first step of the model. The final step of the model was also not statistically significant, F(5, 44) = 1.88, p = .12, Adj. R² = .08. Neither the addition of NA (ΔR² = .07, p = .07) nor PA (ΔR² = .00, p = .85) accounted for a significant amount of variance in hyperarousal symptoms when added to the model. However, it should be noted that NA (β = .32, p = .07), in comparison with age (β = −.20, p = .20), symptoms of depression (β = .11, p = .59), PA (β = −.09, p = .63), and education (β = .09, p = .53), was the only variable within this model approaching statistical significance, exhibiting a minor positive relationship with hyperarousal symptoms (r = .27).

Discussion

In accordance with the study’s first hypothesis, NA was found to be a significant predictor of PTSD symptom severity. Such a finding is consistent with previous literature that has concluded that NA is a significant predictor not only of PTSD but of psychopathology in general (Ferrier-Auerbach, Erbes, Polusny, Rath, & Sponheim, 2010; Rademaker et al., 2011; Souza et al., 2008; Weems et al., 2007). In this sample of survivors of IPT, NA accounted for 15% of the variance in PTSD severity ratings. This suggests that the experience of PTSD following IPT is indeed related to negative affective states, a relationship that may possibly be explained by the chronic nature of IPT (Breslau, 2001; Luthra et al., 2009) or the various sustained negative emotional responses often associated with IPT exposure (Lilly & Valdez, 2012). As this study did not assess trauma chronicity, further research is necessary to identify factors that contribute to the relationship between NA and PTSD symptoms. These results nevertheless strengthen the notion that self-reported affectivity is related to the experience of PTSD.

The significant relationship between NA and PTSD symptom severity was also observed in analyses that controlled for symptoms of depression, further suggesting that NA is distinct from the experience of depression and may have a differential effect on other forms of psychopathology. It should be noted that HAMD depression scores were significant predictors of both CAPS total score and re-experiencing symptoms in the first step of each regression model. However, once NA was added to the model, HAMD depression scores became non-significant. Although PTSD and MDD are often comorbid, variance in PTSD symptom scores was better accounted for by NA in this analysis. As such, NA may represent a better proxy for overall PTSD symptom severity than the presence of depression.

Certain components of the study’s second hypothesis were confirmed by the regression analyses of the PTSD symptom clusters. Only the re-experiencing model reached statistical significance, within which NA was a significant predictor. This finding was consistent with prior research demonstrating that individuals experiencing high levels of NA often exhibit the tendency to focus more on negative aspects of a situation, fueling rumination about trauma-related events and maintaining re-experiencing symptoms (Noguchi, Gohm, & Dalsky, 2006). The relationship between NA and re-experiencing symptoms is likely bi-directional, however, as the continued re-experiencing of a trauma may potentially evoke powerful negative emotions. This relationship may have implications for diagnostic comorbidity and overall distress. In an earlier study, Post and colleagues (2011) reported that individuals diagnosed with comorbid PTSD and MDD had elevated dysphoria, re-experiencing, and total PTSD symptoms, but not avoidance and hyperarousal symptoms, and higher levels of NA than participants with PTSD only. These findings corroborate the observed relationships in the current study between NA and both total PTSD symptoms and re-experiencing symptoms. In addition, our results suggest that NA is a more reliable predictor than depression of both total PTSD and re-experiencing symptoms.

Although the final regression models for both avoidance and hyperarousal symptoms did not reach statistical significance, a finding inconsistent with the proposed hypotheses and previous literature, the relationship between NA and these symptom clusters still warrants further exploration. Within the model for avoidance symptoms, NA was a significant predictor. Within the model for hyperarousal, NA was trending toward statistical significance as a predictor. Although the relevance of such findings could easily be dismissed based on non-significance of the models, such findings are worth consideration given that the power to detect small differences in the model may have been limited by the sample size. Indeed prior research has linked NA to both avoidance behaviors (Kaysen et al., 2014) and hyperarousal symptoms (Hantsoo, Khou, White, & Ong, 2013; Zellars, Meurs, Perrewe, Kacmar, & Rossi, 2009). The former study even identified a relationship between the urge to drink alcohol and the daily occurrence of both re-experiencing symptoms and high NA. Thus, the identified relationship between NA and re-experiencing symptoms may also interact with other symptom clusters. Although the final models of avoidance and hyperarousal were non-significant, future research efforts should not rule out potential relationships between these symptoms and NA.

Results from the analyses of PA are less clear. PA was not significantly associated with PTSD symptom severity or symptom clusters within any regression model, which was inconsistent with our hypotheses. These results were somewhat surprising, given that pleasurable engagement and positive mood should theoretically decrease symptom severity or avoidance behaviors and vice versa. In addition, PTSD exhibits high rates of comorbidity with MDD, and the anhedonic qualities of MDD can largely be accounted for by diminished PA (Clark & Watson, 1991). This anhedonic quality can also be recognized within symptoms specific to PTSD, including feelings of detachment from others, a diminished engagement in pleasurable activities, and a restricted range of affect. It may be that the variance in PTSD symptom severity is already accounted for largely by another affective dimension, NA. However, prior research indicates that NA and PA are independent constructs that are not mutually exclusive (Brown, Chorpita, & Barlow, 1998). That is, an individual can simultaneously report high levels of NA and high levels of PA and the contrary. This distinction is further supported by the Pearson product–moment correlation between NA and PA from this analysis (Table 1), which was not significant.

There are two possible explanations for the role of PA within PTSD given the results of this analysis and the theoretical background of PA and psychopathology. The first is that PA plays a very minor role in the experience of PTSD symptoms. This hypothesis is supported by the fact that PTSD is often considered solely as a “distress” disorder and that amotivation and anhedonia are not considered hallmark components of the PTSD conceptualization (Watson, O’Hara, & Stuart, 2008). It is entirely possible that individuals with PTSD are able to maintain positive moods and engage in pleasurable activities despite high levels of distress caused by their symptoms. In fact, Kaysen and colleagues (2014) found that women with a history of sexual victimization experienced stronger urges to drink alcohol and were more likely to drink on days when they reported higher levels of PA.

The second explanation is that the influence of PA might be negated by another variable, such as age, chronicity of trauma, or the larger construct of depression. For example, prior research has demonstrated that PA tends to increase with age (Mroczek & Kolarz, 1998). In this sample, PA was negatively correlated with age, decreasing as age increased. This relationship may be explained by trauma chronicity. Trauma chronicity is a complex variable that considers the frequency of trauma, duration of trauma, age of onset of PTSD, and length of time an individual has been living with PTSD symptoms. As trauma chronicity lengthens, PA is expected to decrease. However, trauma chronicity as a variable was not included in the present study; thus, a more thorough exploration of this relationship was not possible. Given the results in the current study, the influence of PA on PTSD symptom severity and presentation in IPT survivors remains in question.

As stated previously, one limitation of the current study was the exclusion of a trauma chronicity variable. Although this variable is extremely difficult to estimate because it is retrospective in nature and dependent on subcomponents like frequency, duration, and age of onset of PTSD, its inclusion would have provided insight regarding the findings with both age and PA. In addition, the generalizability of this study is limited to females who identify as White or African American; other demographic groups may show different patterns of associations between affectivity and PTSD. The inclusion of a trauma-exposed control group would have allowed a more comprehensive understanding of the impact of IPT on NA and a PTSD diagnosis versus trauma exposure alone. Last, analyses of this study may be underpowered due to the moderate sample size (N = 54). A larger sample size may produce more robust findings in future studies.

Despite these limitations, results from this study are an important first step in understanding the relationship between the dimensional construct of self-reported affectivity and the differential PTSD symptom clusters. Although the DSM-5 has formally recognized affective and emotional disturbances within a new symptom cluster to enhance understanding of complex posttraumatic symptom reactions, simply identifying and grouping affective symptoms of PTSD may be short-sighted. The results of this study suggest that the relationship between affectivity and PTSD may be better understood from a dimensional perspective, given the widespread influence of, particularly, NA across the DSM-IV-TR PTSD re-experiencing symptom cluster and total symptom severity. Moreover, assessing self-reported affectivity in individuals presenting with posttraumatic symptoms may provide useful information about the exacerbation or blunting of symptoms to inform the idiographic treatment process.

The replication of this finding within a group of IPT survivors provides us with new information on how NA is manifested and influences the unique symptom composition of PTSD as a consequence of IPT. Future research on this topic should seek to examine this relationship within other variants of trauma, such as combat-related or accident-related trauma. Analyzing the factor structure of each DSM-5 PTSD symptom cluster with the consideration of NA might also be a noble research goal, given the increased emphasis on understanding how dimensional constructs influence the manifestation and maintenance of psychopathology.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by a National Institute of Mental Health Grant K23 MH090366-01 awarded to Steven E. Bruce and 1RC1 MH089704-01 awarded to Yvette I. Sheline.

Author Biographies

Wilson J. Brown, MA, is a doctoral student in clinical psychology at the University of Missouri–St. Louis. He is currently a predoctoral intern at the Medical University of South Carolina in Charleston. His research focuses on the role of emotion regulation within comorbid anxiety and mood disorders.

Steven E. Bruce, PhD, is an associate professor in the Department of Psychology at the University of Missouri–St. Louis. His research interests and clinical specializations include the treatment of anxiety and affective disorders, particularly posttraumatic stress disorder. Specifically, he is interested in conducting translational research incorporating neuroimaging and psychophysiological assessment as predictors and outcomes of treatment response.

Katherine R. Buchholz, MA, is a doctoral student in clinical psychology at the University of Missouri–St. Louis. She is currently a predoctoral intern at the VA Ann Arbor Healthcare System. Her research interests include the investigation of neural mechanisms related to the development, maintenance, and recovery from posttraumatic stress disorder.

Tiffany M. Artime, PhD, is an assistant professor in the Department of Psychology at Saint Martin’s University. Her research and clinical interests focus on correlates and the treatment of trauma and, specifically, sexual victimization.

Emily Hu, MA, is a doctoral student in clinical psychology at the University of Missouri–St. Louis. She is currently a predoctoral intern at the Bruce W. Carter VA Medical Center in Miami. Her research interests include etiology and treatment of posttraumatic stress disorder, as well as the intersection of trauma and multicultural psychology.

Yvette I. Sheline, MD, is a professor of psychiatry, radiology, and neurology at Washington University School of Medicine and director of the Center for Depression, Stress, and Neuroimaging. Her extensive research experience has focused on neuroimaging in the diagnosis and treatment of major depression and posttraumatic stress disorders, and has conducted studies of emotional regulation in mood disorders using functional magnetic resonance imaging (fMRI) for the past decade. She maintains a productive collaboration with Dr. Steve Bruce, director of the Center for Trauma Recovery at the University of Missouri–St. Louis. Future goals are to examine populations suffering from interpersonal trauma using her expertise in resting state functional connectivity.

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