Trauma and PTSD Overlooked in Severely Mentally III

High‐risk behaviors and drinking‐to‐cope as mediators of lifetime abuse and PTSD symptoms in clients with severe mental illness

“…Although the high risk/drink-to-cope mediator model showed the best fit to the data, PTSD symptoms showed a somewhat higher mediating effect between abuse and drink-to-cope motives suggesting that substance abuse might be more acutely affected by PTSD symptoms than by other problems associated with trauma. Post hoc correlation analysis with the original PSS subscales (i.e., before factor analysis) showed drink-to-cope motives to have the highest association with hyperarousal symptoms (.31) suggesting a moderate tension-reduction motive (Ouimette, Coolhart, Funderburk, Wade, & Brown, 2007;Stewart, 1996), thus, lending support to Mueser et al's (2002) model. Interpretation of these findings should also consider the role of ongoing environmental stressors in this sample.…”

“…Other investigators demonstrated that PTSD mediated abuse and adult sexual assault (Risser, Hetzel-Riggin, Thomsen, & McCanne, 2006) and nonsuicidal self-injury (Weaver, Chard, Mechanic, & Etzel, 2004;Weierich & Nock, 2008). In a test of Mueser et al's (2002) PTSD mediation theory, Van Dorn and colleagues (2005) showed that PTSD symptoms in SMI clients mediated the relationship between abuse and high risk sexual behavior in women (but not men).…”

“…Currently, there remains a lack of research explicating the trajectory and variability of PTSD symptoms over time (Kessler et al, 1997). Mueser et al (2002) suggest, for example, that sexual and physical abuse might cause problems other than PTSD in SMI clients including depression, substance abuse, and high risk behaviors, thus, opening the possibility of alternative relationships among these factors. Traumatic events that do not initially result in PTSD might increase vulnerability to retraumatization (often associated with high risk behaviors and drinking), or increase vulnerability to the development of PTSD through the cumulative impact of trauma on subclinical PTSD symptoms.…”

A cognitive behavioural perspective on the relationship between childhood trauma and psychosis

“…However, it is also important to remember that there are multiple pathways to psychosis, and while childhood trauma is clearly involved for some people with psychosis, there are many others with no history of trauma. Even is such instances, it is possible that these are prone to exacerbation and maintenance of their psychotic experiences through being traumatised by the subjective experience of psychosis or through subsequent victimisation in the community (Mueser et al, 2002;Walsh et al, 2003).…”

“…For example, unhelpful thought control strategies, such as punishment and distraction, have been linked to trauma (Reynolds & Wells, 1999) and are utilised by patients meeting criteria for schizophrenia (Morrison & Wells, 2000). Similarly, reliance on avoidance, dissociation and substance use are common in victims of abuse, and clearly contribute to the maintenance of psychotic experiences (Mueser et al, 2002). It has also been shown that psychiatric voice hearers with predominantly negative beliefs about voices had higher levels of childhood sexual abuse in comparison with non-psychiatric voice hearers with predominantly positive beliefs about voices, and that the psychiatric voice hearers were more likely to resist their voices and less likely to engage with them (Andrew et al, 2008), which is consistent with predictions of trauma-related psychological models of psychosis (Morrison et al, 2003a).…”