The Utility of the PAI and the MMPI-2 for Discriminating PTSD, Depression, and Social Phobia in Trauma-Exposed College Students

Assessing posttraumatic stress disorder symptom clusters with the Minnesota Multiphasic Personality Inventory-3 in a forensic disability sample

OBJECTIVE

Previous evidence indicates that scales from the Minnesota Multiphasic Personality Inventory (MMPI) family of instruments can measure self-reported posttraumatic stress disorder (PTSD) symptomology and differentiate symptom clusters, including in forensic disability assessments. However, limited research has examined assessment of PTSD symptoms with the MMPI-3, the most recent MMPI instrument. The goal of the current study was to identify the strongest MMPI-3 scale predictors of individual PTSD symptom clusters, measured via self-report.

METHODS

Using a sample of 716 disability claimants (54.2% men; Mage  = 42.98, SD = 10.87; 81.8% White), correlation, regression, and dominance analyses were performed to examine associations between scores on MMPI-3 scales and latent PTSD symptom cluster factors derived using confirmatory factor analyses from items of the Detailed Assessment of Posttraumatic Stress (DAPS), and to identify the strongest predictor of each symptom cluster when MMPI-3 scales were concurrently considered.

RESULTS

Results indicate that conceptually expected MMPI-3 scale scores were meaningfully associated with PTSD symptom cluster factors, with the MMPI-3 Anxiety-Related Experiences (ARX) scale demonstrating the strongest and most consistent associations across symptom clusters.

CONCLUSIONS

Results of the current study largely converge with previous empirical studies of self-reported PTSD symptoms in disability claimant settings with the MMPI instruments. Interpretive implications for the MMPI-3, limitations, and future research directions are discussed.

Effects of bodily arousal on desire to drink alcohol among trauma-exposed college students

INTRODUCTION

Alcohol consumption on college campuses is a major public health concern. Extant literature has identified trauma exposure as a robust risk factor for problematic alcohol use in this at-risk population. However, the mechanisms underlying this association are less well-studied. Research indicates that bodily arousal is a fundamental feature of trauma exposure, and posits that internal stimuli (e.g., heart pounding) at the time of trauma may manifest into conditioned cues that can trigger posttraumatic responding and related symptomatology, including alcohol use. However, past work supporting these assertions has used paradigms purposefully designed to evoke memories of the trauma, making it difficult to ascertain whether the mechanism driving subsequent alcohol craving is the explicit memory cue or the associated bodily arousal.

METHODS

The current study examined whether an implicit, trauma-relevant cue of bodily arousal (via voluntary hyperventilation) - independent of any explicit memory cue - would elicit increased desire to drink among 104 (M_age = 20.30; 61.5% female) trauma-exposed undergraduates.

RESULTS

Results found no statistically significant difference in change in alcohol craving between the hyperventilation and control tasks. However, secondary analyses indicated that trauma type (i.e., interpersonal/non-interpersonal) may play an influential role in this relationship. More specifically, individuals reporting interpersonal trauma as their most traumatic event evidenced a significantly greater increase in desire to drink following hyperventilation compared to the non-interpersonal index trauma group.

DISCUSSION

Generally, these findings suggest that bodily arousal may only serve as an implicit, trauma-relevant interoceptive cue that increases desire to drink within a specific subset of trauma-exposed college students (i.e., individuals indexing interpersonal trauma). Replication and extension are needed to further understand the influence of bodily arousal on subsequent alcohol use behavior, which will be critical to PTSD-alcohol use modeling and, ultimately, help in informing prevention- and treatment-oriented intervention efforts aimed at reducing problematic alcohol use on college campuses.

The Personality Assessment Inventory Alcohol Scale in Veterans With PTSD: Convergent and Discriminant Relations With the Alcohol Use Disorders Identification Test

In this study, we examined the validity of the Personality Assessment Inventory Alcohol (ALC) scale in 736 male veterans presenting for formal evaluation of posttraumatic stress disorder (PTSD). The ALC scale exhibited convergence with other measures of alcohol problems, and this convergence was similar for veterans with and without formal PTSD diagnosis. When predicting alcohol consumption via the Alcohol Use Disorders Identification Test (AUDIT), the ALC scale also displayed substantial incremental validity over the effects of demographics and MMPI-2 MacAndrew Alcohol Scale. Using a standard alcohol consumption cut score on the AUDIT, the ALC scale displayed good specificity and (generally) good sensitivity across three common cut scores. PTSD severity did not significantly affect the association between the ALC composite and alcohol consumption via the AUDIT. Taken together, results suggested that the ALC can provide valid assessment of alcohol use among treatment seeking veterans.

Construct validation of the hybrid model of posttraumatic stress disorder: Distinctiveness of the new symptom clusters

Despite the factor analytic support for the seven-factor hybrid model (Armour et al., 2015) of posttraumatic stress disorder (PTSD), little research has examined the degree to which newly established symptom clusters (i.e., negative affect, anhedonia, dysphoric arousal, anxious arousal, externalizing behavior) functionally and meaningfully differ in their associations with other clinical phenomena. The aim of the current study was to examine the degree to which newly established PTSD symptom clusters differentially relate to co-occurring psychopathology and related clinical phenomena through Wald testing using latent variable modeling. Participants were 535 trauma-exposed undergraduates who completed the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5; Weathers et al., 2013) and Personality Assessment Inventory (PAI; Morey, 1991). As expected and in line with results from previous studies, significant heterogeneity emerged for dysphoric arousal, anxious arousal, and externalizing behavior. However, there was less evidence for the distinctiveness of negative affect and anhedonia. Results indicate that only some of the newly established symptom clusters significantly differ in their associations with related clinical phenomena and that the hybrid model might not provide a meaningful framework for understanding which PTSD symptoms relate to associated features. Limitations include a non-clinical sample and reliance on retrospective self-report assessment measures.

Peer alcohol behavior moderates within-level associations between posttraumatic stress disorder symptoms and alcohol use in college students

Self-medication theory (SMT) posits that individuals exposed to trauma and resulting posttraumatic stress symptoms (PTSD) are at risk for heavy drinking and associated negative consequences. Close peer alcohol use is also a powerful predictor of alcohol involvement in college, particularly influencing those with greater negative affect. As individuals with PTSD may rely on peers for support, peer drinking behaviors are possibly putting them at further risk for greater alcohol use and resulting consequences. To test self-medication processes, the present study examined the relationship between weekday PTSD symptoms, weekend alcohol behavior, and the influence of both emotionally supportive peer and other friend drinking behavior by investigating: (a) whether weekday PTSD symptoms predicted subsequent weekend alcohol use and consequences; and (b) whether the relationship between weekday PTSD symptoms and weekend alcohol behavior was moderated by various drinking behaviors of one's peers. Trauma-exposed heavy-drinking college students (N = 128) completed a baseline assessment and 30 daily, Web-based assessments of alcohol use and related consequences, PTSD symptoms, and peer alcohol behavior. Results directly testing SMT were not supported. However, friend alcohol behavior moderated the relationship between weekday PTSD and weekend alcohol behavior. Findings highlight the importance of peer drinking as both a buffer and risk factor for problematic drinking and provide useful information for interventions aimed at high-risk drinkers. (PsycINFO Database Record

Posttraumatic Stress and Problem Drinking at the Transition Out of College

The objective of the present study was to examine how symptoms of posttraumatic stress disorder (PTSD) may confer drinking risk as students with trauma histories complete college and move toward independent adulthood. Students (N = 283) completed assessments of trauma, posttraumatic stress, and alcohol use and consequences at four time points during the year following their fourth year of college. Some students had transitioned out of the college environment, whereas others had not. We examined how transition status moderated within-person associations between changes in PTSD and corresponding changes in alcohol outcomes over time. Using multilevel modeling, we examined differences in within-person PTSD-alcohol associations comparing students who were (1) continuing as fifth-year seniors, (2) graduated and pursuing graduate education, and (3) graduated and left the university setting. Alcohol use and consequences tended to decline on average from the fourth to fifth year post-matriculation. Yet, within-person increases in posttraumatic stress symptomatology across the fifth year were associated with greater alcohol consequences, but only for those students who had left the university setting. These data suggest that the transition out of college may be an important developmental context that is associated with increased vulnerability for negative consequences from stress-related drinking. Findings may have important implications for campus-based prevention efforts geared toward the facilitation of a successful transition into independent adulthood.

The Utility of the Personality Assessment Inventory in the Assessment of Posttraumatic Stress Disorder in OEF/OIF/OND Veterans

We examined the use of the Personality Assessment Inventory (PAI) in a small sample of 47 U.S. military veterans of the conflicts in Iraq and Afghanistan. Approximately half of the sample met criteria for posttraumatic stress disorder (PTSD) based on the Clinician-Administered PTSD Scale. PAI profiles were compared between the PTSD and non-PTSD groups. The PTSD group had clinically significant scores (≥ 70 T) on the PAI for 5 clinical scales (anxiety, anxiety-related disorders, depression, paranoia, and schizophrenia) and 10 clinical subscales consistent with the typical symptom picture for PTSD. Effect size correlations ( r) between scales and diagnosis group membership were large ( r ≥ .5) for several scales that reflect PTSD symptoms and for the PTSD LOGIT function. In a receiver operating characteristics curve analysis, the PTSD LOGIT function and the Traumatic Stress Subscale both demonstrated good diagnostic utility (areas under the curve > .80).

Personality Assessment Inventory profiles of veterans: Differential effects of mild traumatic brain injury and psychopathology

OBJECTIVE

Neuropsychiatric complaints often accompany mild traumatic brain injury (mTBI), a common condition in post-deployed Veterans. Self-report, multi-scale personality inventories may elucidate the pattern of psychiatric distress in this cohort. This study investigated valid Personality Assessment Inventory (PAI) profiles in post-deployed Veterans.

METHOD

Measures of psychopathology and mTBI were examined in a sample of 144 post-deployed Veterans divided into groups: healthy controls (n = 40), mTBI only (n = 31), any mental health diagnosis only (MH; n = 25), comorbid mTBI and Posttraumatic Stress Disorder (mTBI/PTSD; n = 23), and comorbid mTBI, PTSD, and other psychological diagnoses (mTBI/PTSD/MDD+; n = 25).

RESULTS

There were no significant differences between the mTBI and the control group on mean PAI subscale elevation, or number of subscale elevations above 60T or 70T. The other three groups had significantly higher overall mean scores, and more elevations above 60 and 70T compared to both controls and mTBI only. The mTBI/PTSD/MDD+ group showed the highest and most elevations. After entering demographics, PTSD, and number of other psychological diagnoses into hierarchical regressions using the entire sample, mTBI history did not predict mean PAI subscale score or number of elevations above 60T or 70T. PTSD was the only significant predictor. There were no interaction effects between mTBI and presence of PTSD, or between mTBI and total number of diagnoses.

CONCLUSIONS

This study suggests that mTBI alone is not uniquely related to psychiatric distress in Veterans, but that PTSD accounts for self-reported symptom distress.

Associations among Trauma, Posttraumatic Stress, and Hazardous Drinking in College Students: Considerations for Intervention

Students with trauma and posttraumatic stress are disproportionately at risk for heavy drinking and for alcohol-related consequences. Brief motivational interventions (BMIs) have been shown to reduce hazardous drinking in college students, and could serve as a first-line approach to reduce heavy drinking in students with trauma and posttraumatic stress (PTS). Yet the standard BMI format may not adequately address the factors that lead to hazardous drinking in these students. Here, we review the literature on PTS and hazardous drinking in college students, and highlight cognitive (self-efficacy, alcohol expectancies) and behavioral (coping strategies, emotion regulation skills, protective behaviors) factors that may link trauma and PTS to drinking risk. Incorporating these factors into standard BMIs in a collaborative way that enhances their personal relevance may enhance intervention efficacy and acceptability for these at-risk students.

Coping, PTSD symptoms, and alcohol involvement in trauma-exposed college students in the first three years of college

The objective of the present study was to examine prospective, bidirectional associations among posttraumatic stress disorder (PTSD) symptoms, coping style, and alcohol involvement (use, consequences) in a sample of trauma-exposed students just entering college. We also sought to test the mechanistic role that coping may play in associations between PTSD symptoms and problem alcohol involvement over time. Participants (N = 734) completed measures of trauma exposure, PTSD symptoms, coping, and alcohol use and consequences in September of their first college year and again each September for the next 2 years. We observed reciprocal associations between PTSD and negative coping strategies. In our examination of a mediated pathway through coping, we found an indirect association from alcohol consequences and PTSD symptoms via negative coping, suggesting that alcohol consequences may exacerbate posttraumatic stress over time by promoting negative coping strategies. Trauma characteristics such as type (interpersonal vs. noninterpersonal) and trauma reexposure did not moderate these pathways. Models were also invariant across gender. Findings from the present study point to risk that is conferred by both PTSD and alcohol consequences for using negative coping approaches, and through this, for posttraumatic stress. Interventions designed to decrease negative coping may help to offset this risk, leading to more positive outcomes for those students who enter college with trauma exposure.

Proximal relationships between PTSD symptoms and drinking among female college students: results from a daily monitoring study

Self-medication has been theorized to explain comorbidity between posttraumatic stress disorder (PTSD) and drinking, whereupon problem drinking develops in order to modulate negative affect and ameliorate PTSD symptoms. Daily monitoring methodologies may help refine our understanding of proximal relations between PTSD, affect, and alcohol use. One hundred thirty-six female college drinkers with a past history of sexual victimization and 38 female college drinkers with no past trauma history completed electronic monitoring of PTSD symptoms, affect, alcohol use, and alcohol cravings, daily for 4 weeks. A two-part mixed hurdle model was used to examine likelihood of drinking and amount of alcohol consumed on drinking days. We found significant relationships between daily PTSD symptoms, affect, and drinking. On days women experienced more intrusive and behavioral avoidance symptoms of PTSD, they experienced stronger urges to drink and were more likely to drink on that day. On days in which women experienced more negative affect than their average, they experienced stronger urges to drink, whereas on days in which women experienced more of the dysphoric symptoms associated with PTSD than their average, they drank less. On days with higher positive affect, women reported stronger urges to drink and were more likely to drink. Results suggest the need to examine both aspects of affect and specific PTSD symptoms as they may differentially predict drinking behavior. Differences in the ways in which PTSD symptoms and affect influence drinking suggest that interventions more specifically address the function of drinking behaviors in reducing alcohol use among college women.

Confirmatory factor structure of anxiety and depression: evidence of item variance across childhood

The distinctiveness of anxiety and depressive symptoms in children has previously been questioned based on their high degree of comorbidity, shared risk factors, and treatment response. Developing children may show an unstable presentation of anxiety and depressive symptoms that would complicate interpretation of studies of comorbidity. The present study examined the measurement stability of anxiety and depressive symptoms across time and sex using a large epidemiologic sample of children. A nationally representative cohort of 1329 children (624 girls and 705 boys) aged four to seven in 1994 were drawn from the National Longitudinal Survey of Youth (NLSY). Using eight years of prospective data we examined whether a one or two factor structure of anxiety (five items) and depressive (four items) symptoms would be invariant across time and sex. Despite item variability within each factor across time, confirmatory factor analysis revealed distinct factors for anxiety and depression that were stable across time and sex. Results provide support that covariation between anxiety and depression is not likely the result of measurement overlap. However, items indicating factors of anxiety and depression in the NLSY may not be sufficient to permit developmentally-sensitive measurement of these factors.

Rates of DSM-IV-TR Trauma Exposure and Posttraumatic Stress Disorder Among Newly Matriculated College Students

The negotiation of the freedoms and responsibilities introduced as adolescents begin college may be particularly challenging for those with a trauma history and traumatic stress sequelae (posttraumatic stress disorder; PTSD). The present study examined the prevalence of and risk for trauma and PTSD in a large sample of college students. Matriculating students (N = 3,014; 1,763 female, 1,251 male) at two U.S. universities completed online and paper assessments. Sixty-six percent reported exposure to a Criterion A trauma. Nine percent met criteria for PTSD. Female gender was a risk factor for trauma exposure. Gender and socioeconomic status (SES) were associated with trauma severity. Although in bivariate models, gender and SES were associated with PTSD, multivariate analyses suggested this risk was a function of trauma severity. Thus, students enter college with significant trauma histories and PTSD symptoms. Findings highlight the potential for outreach to incoming students with trauma and point to research directions to enhance understanding of the psychological needs of entering college students.

Unique Patterns of Substance Misuse associated with PTSD, Depression, and Social Phobia

OBJECTIVES: This study investigated the relations between post-trauma psychopathology and substance abuse in a sample of trauma-exposed college students (n = 136) assigned to four groups based on primary diagnosis: posttraumatic stress disorder, depression, social phobia, or well-adjusted (participants who had low levels of distress). Groups were compared on a series of dimensions of substance use/abuse. RESULTS: Participants in the PTSD group evidenced greater substance use and abuse than those in the social phobia and well-adjusted groups on several dimensions and greater alcohol consumption than the depressed group. Correlation analyses suggested that most dimensions of substance abuse were related more strongly to avoidance and numbing (cluster C) symptoms than to reexperiencing and hyperarousal. CONCLUSIONS: The present findings suggest that trauma-related psychopathology may be associated with a more hazardous pattern of substance use than depression and social phobia.

Young Investigator Award symposium

This article highlights the research presented at the inaugural meeting of Alcoholism and Stress: A Framework for future Treatment Strategies. This meeting was held on May 6-8, 2008 in Volterra, Italy. It is an international meeting dedicated to developing preventive strategies and pharmacotherapeutic remedies for stress- and alcohol-related disorders. For the first time, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conferred a Young Investigator Award to promote the work of young researchers and highlight their outstanding achievements in the fields of addiction medicine and stress disorders. The awardees were Dr. Katie Witkiewitz (University of Washington), Dr. Andrew Holmes (NIAAA), Dr. Lara A. Ray (Brown University), Dr. James Murphy (University of Memphis), and Dr. Heather Richardson (The Scripps Research Institute). The symposium was chaired by Drs. Fulton Crews and Antonio Noronha.

Posttraumatic Stress Disorder and Substance Use Disorders in College Students

Research indicates that many college students report post-traumatic stress disorder (PTSD) or substance use disorder (SUD), yet there has been scant attention paid to the co-occurrence of these disorders in college students. This review examines the co-occurrence of PTSD and SUD in college students. Recommendations for counseling centers are provided regarding the assessment of this population, an overview of treatment issues, and three areas of clinical importance when working with this population: risk behaviors, interpersonal violence, and social isolation. Future directions for research are also suggested.