Showing papers in "Journal of Traumatic Stress in 2008"
TL;DR: The authors examined social causation and social selection explanations for the association between perceptions of social support and psychological distress in Mexico, finding that social selection accounted for the support-to-distress relationship at 18 to 24 months after the event.
Abstract: The authors examined social causation and social selection explanations for the association between perceptions of social support and psychological distress. Data came from a sample of 557 victims of natural disaster in Mexico. Structural equation modeling analyses indicated that social causation (more social support leading to less posttraumatic stress disorder [PTSD]) explained the support-to-distress relationship in the earlier postdisaster phase, 6 to 12 months after the impact. Both causal mechanisms emerged as significant paths in the midpoint of the study (12 and 18 months). Only social selection (more PTSD leading to less social support) accounted for the support-to-distress relationship at 18 to 24 months after the event. Interpersonal and social dynamics of disasters may explain why these two contrasting causal mechanisms emerged over time.
416 citations
TL;DR: There was a linear relationship between the number of trauma types experienced by participants before 18 and symptom complexity, suggesting a generalized effect of cumulative trauma.
Abstract: The relationship between accumulated exposure to different types of traumatic events (cumulative trauma) in childhood and the total number of different types of symptomatology reported (symptom complexity) in adulthood was examined in a sample of 2,453 female university students. There was a linear relationship between the number of trauma types experienced by participants before 18 and symptom complexity. This effect remained even when controlling for specific traumatic events, suggesting a generalized effect of cumulative trauma.
393 citations
TL;DR: Using Posttraumatic Growth Inventory data reported by participants experiencing a variety of traumatic events, five models of the underlying structure of the PTGI were tested via confirmatory factor analyses to examine whether thePTGI comprises three domains, five factors, or a unitary dimension.
Abstract: There are different views about the dimensions of the positive changes resulting from the struggle with traumatic events. Using Posttraumatic Growth Inventory (PTGI) data reported by participants (N = 926) experiencing a variety of traumatic events, five models of the underlying structure of the PTGI were tested via confirmatory factor analyses to examine whether the PTGI comprises three domains (Changed Perception of Self, Changed Interpersonal Relationships, and Changed Philosophy of Life), five factors (Relating to Others, New Possibilities, Personal Strength, Spiritual Change, and Appreciation of Life), or a unitary dimension. Results indicated an oblique 5-factor model best fit the data, thus revealing the PTGI was multidimensional. Present findings offer implications for understanding the nature of posttraumatic growth.
305 citations
TL;DR: Exposure to both hurricane-related traumatic events and to financial and social stressors influenced the duration of PTSD symptoms, and postdisaster interventions that aim to improve manipulable stressors after these events may influence the onset and course of PTSD.
Abstract: Hurricane Katrina was the most devastating natural disaster to hit the United States in the past 75 years. The authors conducted interviews of 810 persons who were representative of adult residents living in the 23 southernmost counties of Mississippi before Hurricane Katrina. The prevalence of posttraumatic stress disorder (PTSD) since Hurricane Katrina was 22.5%. The determinants of PTSD were female gender, experience of hurricane-related financial loss, postdisaster stressors, low social support, and postdisaster traumatic events. Kaplan-Meier survival curves suggest that exposure to both hurricane-related traumatic events and to financial and social stressors influenced the duration of PTSD symptoms. Postdisaster interventions that aim to improve manipulable stressors after these events may influence the onset and course of PTSD.
296 citations
TL;DR: It was concluded that growth following trauma may entail the strengthening of character and small, but positive associations among the number of potentially traumatic events experienced and a number of cognitive and interpersonal character strengths are found.
Abstract: How are strengths of character related to growth following trauma? A retrospective Web-based study of 1,739 adults found small, but positive associations among the number of potentially traumatic events experienced and a number of cognitive and interpersonal character strengths. It was concluded that growth following trauma may entail the strengthening of character.
268 citations
TL;DR: Six PTEs were found to be more traumatic, and to explain a large percentage of PTSD, as estimated by their attributable risk of PTSD: rape, undisclosed private event, having a child with serious illness, beaten by partner, stalked, beat by caregiver.
Abstract: A potentially traumatic event (PTE) contributes to trauma through its frequency, conditional probability of posttraumatic stress disorder (PTSD), and experience of other PTEs. A cross-sectional survey was conducted, enrolling 21,425 adults nationally representative of six European countries. Using the WHO-Composite International Diagnostic Interview, 8,797 were interviewed on 28 PTEs and PTSD. Prevalence of 12-month PTSD was 1.1%. When PTSD was present, the mean number of PTEs experienced was 3.2. In a multivariate analysis on PTEs and gender, six PTEs were found to be more traumatic, and to explain a large percentage of PTSD, as estimated by their attributable risk of PTSD: rape, undisclosed private event, having a child with serious illness, beaten by partner, stalked, beaten by caregiver.
241 citations
TL;DR: Initial levels of perceived support and stressors did not predict the course of chronic PTSD symptoms, and more severe PTSD symptoms at Time 1 predicted greater erosion in perceived support from nonveteran friends, but not from relatives.
Abstract: The present study examined the temporal relationship between posttraumatic stress disorder (PTSD) and social support among 128 male veterans treated for chronic PTSD Level of perceived interpersonal support and stressors were assessed at two time points (6 months apart) for four different potential sources of support: spouse, relatives, nonveteran friends, and veteran peers Veteran peers provided relatively high perceived support and little interpersonal stress Spouses were seen as both interpersonal resources and sources of interpersonal stress More severe PTSD symptoms at Time 1 predicted greater erosion in perceived support from nonveteran friends, but not from relatives Contrary to expectations, initial levels of perceived support and stressors did not predict the course of chronic PTSD symptoms
234 citations
TL;DR: The PCL's ability to accurately estimate PTSD prevalence varied as a function of cutoff and true PTSD prevalence, and uncalibrated use of the PCL for prevalence estimation may lead to large errors.
Abstract: The PTSD Checklist (PCL) is among the most widely used self-report instruments for assessing PTSD. To determine PCL's performance on a population level, the authors combined data from published studies that compared the PCL with structured diagnostic interviews. Weighted average sensitivities and specificities were calculated for cutoff categories most often reported in the literature. Weighted average sensitivity decreased from .85 to .39 and specificity increased from .73 to .97 for cutoffs ranging from 30 to 60. The PCL's ability to accurately estimate PTSD prevalence varied as a function of cutoff and true PTSD prevalence. In populations with a true PTSD prevalence of 15% or less, cutoff values below 44 will substantially overestimate PTSD prevalence. Uncalibrated use of the PCL for prevalence estimation may lead to large errors.
227 citations
TL;DR: Findings suggest dysregulated HPA axis and immune function in women with PTSD, and that comorbid depression may contribute to these abnormalities.
Abstract: Posttraumatic stress disorder (PTSD) has been associated with hypothalamic–pituitary–adrenal (HPA) axis and immune function alterations; however, few studies have simultaneously investigated these systems in participants with PTSD. In this study, HPA axis and immune function in 26 women with PTSD with and without major depressive disorder was compared to 24 traumatized controls and to 21 nontraumatized controls. Posttraumatic stress disorder was associated with low cortisol and higher levels of DHEA and greater production of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) compared to traumatized and healthy controls. Women with PTSD and depression exhibited greater production of IL-6 and higher levels of dehydroepiandrosterone (DHEA) than those with PTSD, but without depression. These findings suggest dysregulated HPA axis and immune function in women with PTSD, and that comorbid depression may contribute to these abnormalities.
225 citations
TL;DR: Individuals high in self-compassion may engage in less avoidance strategies following trauma exposure, allowing for a natural exposure process.
Abstract: Neff's (2003a, 2003b) notion of self-compassion emphasizes kindness towards one's self, a feeling of connectedness with others, and mindful awareness of distressing experiences. Because exposure to trauma and subsequent posttraumatic stress symptoms (PSS) may be associated with self-criticism and avoidance of internal experiences, the authors examined the relationship between self-compassion and PSS. Out of a sample of 210 university students, 100 endorsed experiencing a Criterion A trauma. Avoidance symptoms significantly correlated with self-compassion, but reexperiencing and hyperarousal did not. Individuals high in self-compassion may engage in less avoidance strategies following trauma exposure, allowing for a natural exposure process.
223 citations
TL;DR: A large effect size was found associating PTSD with alexithymia, and effect sizes were higher in studies of male combat PTSD samples in comparison with studies of other PTSD samples.
Abstract: The authors present a meta-analysis investigating the prevalence of alexithymia in 12 studies encompassing 1,095 individuals with posttraumatic stress disorder (PTSD). A large effect size was found associating PTSD with alexithymia. Effect sizes were higher in studies of male combat PTSD samples in comparison with studies of other PTSD samples. Clinical and research directions are discussed.
TL;DR: Avoidant coping was found associated with PTSD symptoms at 1-year follow-up, and revictimization also had long-term consequences beyond Time 1 symptoms.
Abstract: The impact of avoidant coping on level of PTSD symptoms over 1 year was examined among 262 women exposed to intimate partner violence (IPV) within the past month. Covariates included childhood sexual abuse (CSA), IPV severity, perceived and formal social support, and revictimization. Using longitudinal hierarchical multiple regression, avoidant coping was found associated with PTSD symptoms at 1-year follow-up, controlling for initial symptoms and covariates. Revictimization also had long-term consequences beyond Time 1 symptoms. Reducing avoidant coping and increasing survivors' safety may assist in breaking a cycle of problematic coping and psychological distress.
TL;DR: Predictors of probable PTSD in a multivariate model for Jews were refusal to report income, being traditionally religious, economic and psychosocial resource loss, greater traumatic growth, and lower social support and for Arabs, predictors were low education and economic resource loss among those exposed to terrorism.
Abstract: Israel has faced ongoing terrorism since the beginning of the Al Aqsa Intifada in September 2000. The authors examined risk and resiliency factors associated with posttraumatic stress disorder (PTSD) among 1,117 Jews and 394 Arab adult citizens of Israel during August and September 2004 through telephone interviews. Probable PTSD was found among 6.6% of Jews and 18.0% of Arabs. Predictors of probable PTSD in a multivariate model for Jews were refusal to report income, being traditionally religious, economic and psychosocial resource loss, greater traumatic growth, and lower social support. For Arabs, predictors were low education and economic resource loss among those exposed to terrorism. Findings for only those directly exposed to terrorism were similar to those for the overall national sample.
TL;DR: Following brief VRE treatment, the veteran demonstrated improvement in PTSD symptoms as indicated by clinically and statistically significant changes in scores on the Clinician Administered PTSD Scale and the PTSD Symptom Scale Self-Report.
Abstract: Posttraumatic stress disorder (PTSD) has been estimated to affect up to 18% of returning Operation Iraqi Freedom (OIF) veterans. Soldiers need to maintain constant vigilance to deal with unpredictable threats, and an unprecedented number of soldiers are surviving serious wounds. These risk factors are significant for development of PTSD; therefore, early and efficient intervention options must be identified and presented in a form acceptable to military personnel. This case report presents the results of treatment utilizing virtual reality exposure (VRE) therapy (virtual Iraq) to treat an OIF veteran with PTSD. Following brief VRE treatment, the veteran demonstrated improvement in PTSD symptoms as indicated by clinically and statistically significant changes in scores on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) and the PTSD Symptom Scale Self-Report (PSS-SR; Foa, Riggs, Dancu, & Rothbaum, 1993). These results indicate preliminary promise for this treatment.
TL;DR: The results indicate that PTSD is a continued health problem in the local community and the relationship between socioeconomic status and PTSD suggests services must target marginalized populations.
Abstract: Manhattan residents living near the World Trade Center may have been particularly vulnerable to posttraumatic stress disorder (PTSD) after the September 11, 2001 (9/11) terrorist attacks. In 2003-2004, the authors administered the PTSD Checklist to 11,037 adults who lived south of Canal Street in New York City on 9/11. The prevalence of probable PTSD was 12.6% and associated with older age, female gender, Hispanic ethnicity, low education and income, and divorce. Injury, witnessing horror, and dust cloud exposure on 9/11 increased risk for chronic PTSD. Postdisaster risk factors included evacuation and rescue and recovery work. The results indicate that PTSD is a continued health problem in the local community. The relationship between socioeconomic status and PTSD suggests services must target marginalized populations. Followup is necessary on the course and long-term consequences of PTSD.
TL;DR: The program succeeded in its aim of generating many more referrals of affected individuals than came through normal referral channels, and large effect sizes for treatment comparable to those previously obtained in randomized controlled trials were revealed.
Abstract: Following the 2005 London bombings, a novel public health program was instituted to address the mental health needs of survivors. In this article, the authors describe the rationale for the program, characteristics of individuals assessed within the program, and preliminary outcome data. In addition to validated screening instruments and routine service usage data, standardized questionnaire outcome measures were collected. Seventy-one percent of individuals screened positive for a mental disorder. Of those receiving a more detailed clinical assessment, PTSD was the predominant diagnosis. Preliminary outcome data on 82 patients revealed large effect sizes for treatment comparable to those previously obtained in randomized controlled trials. The program succeeded in its aim of generating many more referrals of affected individuals than came through normal referral channels.
TL;DR: Persisting severe PTSD symptoms were associated with worse family relationships, more smoking, less life satisfaction and happiness, more mental health service use, and more nonspecific health complaints at the 14-year follow-up.
Abstract: The authors examined the longitudinal association between persisting posttraumatic stress disorder (PTSD) symptoms and multiple domains of life functioning in a community sample of 1,377 American Legionnaire Vietnam veterans first assessed in 1984 and followed-up 14 years later. Almost 30 years after their return from Vietnam, 10% of veterans continued to experience severe PTSD symptoms. At all levels of combat exposure, persisting severe PTSD symptoms were associated with worse family relationships, more smoking, less life satisfaction and happiness, more mental health service use, and more nonspecific health complaints at the 14-year follow-up. Further investigation is needed to determine whether the PTSD-functioning relationship is causal and if successful treatment of PTSD is associated with improvement in functioning.
TL;DR: With increasing utilization of noninferiority and equivalence designs, it is critical that researchers understand the methodological issues, advantages, disadvantages, and related challenges.
Abstract: The terms noninferiority and equivalence are often used interchangeably to refer to trials in which the primary objective is to show that a novel intervention is as effective as the standard intervention. The use of these designs is becoming increasingly relevant to mental health research. Despite the fundamental importance of these designs, they are often poorly understood, improperly applied, and subsequently misinterpreted. In this article, the authors explain noninferiority and equivalence designs and key methodological and statistical considerations. Decision points in using these designs are discussed, such as choice of control condition, determination of the noninferiority margin, and calculation of sample size and power. With increasing utilization of these designs, it is critical that researchers understand the methodological issues, advantages, disadvantages, and related challenges.
TL;DR: Posttraumatic growth was significantly related to a reduction in the odds of having probable PTSD, and this latter finding is interpreted within the conceptualization of action-focused growth.
Abstract: The Israeli government's decision to remove settlers in the Gaza Strip forcibly produced a situation of traumatic stress, resulting from confrontation and conflict for settlers. The authors examined the effects of the Gaza disengagement, that occurred following prolonged terrorist exposure, on rates of probable major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) diagnosis in a representative sample of Gaza settlers (N = 190). Predictors of probable MDD in multivariate models were being female, and experiencing greater economic and psychosocial resource loss. Predictors of probable PTSD were being older and experiencing greater psychosocial resource loss. Posttraumatic growth was significantly related to a reduction in the odds of having probable PTSD. This latter finding is interpreted within our conceptualization of action-focused growth.
TL;DR: Results suggest the relevance of attachment theory in understanding the myriad psychiatric outcomes associated with childhood maltreatment and in particular, the focal roles that emotion regulation and interpersonal expectations may play.
Abstract: Despite the consistent documentation of an association between compromised attachment and clinical disorders, there are few empirical studies exploring factors that may mediate this relationship. This study evaluated the potential roles of emotion regulation and social support expectations in linking adult attachment classification and psychiatric impairment in 109 women with a history of childhood abuse and a variety of diagnosed psychiatric disorders. Path analysis confirmed that insecure attachment was associated with psychiatric impairment through the pathways of poor emotion regulation capacities and diminished expectations of support. Results suggest the relevance of attachment theory in understanding the myriad psychiatric outcomes associated with childhood maltreatment and in particular, the focal roles that emotion regulation and interpersonal expectations may play.
TL;DR: African Americans in low-income, urban communities are at high risk for exposure to traumatic events as well as for symptoms of posttraumatic stress disorder (PTSD), and data highlight the need for an awareness of the high prevalence of trauma and PTSD.
Abstract: African Americans in low-income, urban communities are at high risk for exposure to traumatic events as well as for symptoms of posttraumatic stress disorder (PTSD). Approximately 22% of 220 participants recruited from urban hospital medical clinics met survey criteria for PTSD. Among the common traumas were having relatives/friends murdered (47%), being attacked with weapons (64% of men), and being sexually attacked (36% of women). Although desiring mental health services, only 13.3% of those with PTSD had prior trauma-focused treatment. Barriers to treatment included limited transportation and finances, family disapproval, and unfamiliarity with accessing treatment, among others. These data highlight the need for an awareness of the high prevalence of trauma and PTSD in this population.
TL;DR: The results imply that posttraumatic growth in adolescence is characterized by two robust components, and is greatest at moderate posttraumatic stress levels.
Abstract: To address gaps in the literature, this study examined the components of posttraumatic growth, and the relationship between growth and posttraumatic stress disorder (PTSD). Participants were from a pooled sample of 4,054 Israeli adolescents exposed to terror of whom 210 (5.5%) met criteria for PTSD. Measures included the Child Post-Traumatic Stress Reaction Index and Posttraumatic Growth Inventory. Principal components analysis showed two correlated components of outward and intrapersonal growth. Regression modeling showed that the relationship between the growth and PTSD measures was linear and curvilinear (inverted-U). These results replicated accounting for heterogeneity in PTSD, exposure and subsamples. Collectively, the results imply that posttraumatic growth in adolescence is characterized by two robust components, and is greatest at moderate posttraumatic stress levels.
TL;DR: Clinicians need to assess veterans' anger, aggression, and alcohol use, as well as their current fear of anger and elucidate the relationship between these factors to improve treatment effectiveness.
Abstract: Research has identified anger as prominent in, and an influence on, treatment outcome for military veterans with posttraumatic stress disorder (PTSD). This study examined factors influencing the relationship between anger and outcome to improve treatment effectiveness. Participants comprised 103 veterans attending PTSD treatment. Measures of PTSD and comorbidity were obtained at intake and 9-month follow-up. Measures also included potential mediators of therapeutic alliance, social support, problematic/undermining relationships and fear of emotion. Path analyses supported anger as a predictor of treatment outcome, with only fear of anger and alcohol comorbidity accounting for the variance between anger and outcome. To improve treatment effectiveness, clinicians need to assess veterans' anger, aggression, and alcohol use, as well as their current fear of anger and elucidate the relationship between these factors.
TL;DR: The Posttraumatic Growth Inventory, Revised Grief Experience Inventory, and World Assumptions Scale were administered to 111 bereaved parents and indicate that many bereavedParents report personal growth in domains outlined by L.G. Calhoun and R. G. Tedeschi (2001).
Abstract: The Posttraumatic Growth Inventory (PTGI), Revised Grief Experience Inventory, and World Assumptions Scale were administered to 111 bereaved parents. The PTGI scores indicate that many bereaved parents report personal growth in domains outlined by L.G. Calhoun and R. G. Tedeschi (2001). Grief intensity was inversely correlated with growth scores. Self-worth was a strong predictor of growth scores, whereas assumptions about the benevolence and meaningfulness of the world were not correlated with growth.
TL;DR: Findings shed new light on the structure of psychiatric comorbidity in a treatment-seeking sample characterized by high rates of PTSD.
Abstract: This study examined the latent structure of psychiatric disorders in a sample with a high prevalence of PTSD. A series of confirmatory factor analyses tested competing models for the covariation between Structured Clinical Interview for DSM-III-R diagnoses among 1,325 Vietnam veterans. The best-fitting solution was a 3-factor model that included two correlated internalizing factors: anxious-misery, defined by PTSD and major depression, and fear, defined by panic disorder/agoraphobia and obsessive-compulsive disorder. The third factor, externalizing, was defined by antisocial personality disorder, alcohol abuse/dependence, and drug abuse/dependence. Both substance-related disorders also showed significant, albeit smaller, cross-loadings on the anxious-misery factor. These findings shed new light on the structure of psychiatric comorbidity in a treatment-seeking sample characterized by high rates of PTSD.
TL;DR: The clinical importance of posttraumatic stress disorder (PTSD) symptomatology for cancer patients is unclear as discussed by the authors, and the association between the magnitude of cancer-related PTSD symptoms, comorbidity, and functioning is tested.
Abstract: The clinical importance of posttraumatic stress disorder (PTSD) symptomatology for cancer patients is unclear. The association between the magnitude of cancer-related PTSD symptoms, comorbidity, and functioning is tested. Breast cancer patients (N = 74) were assessed at diagnosis/surgery, followed, and screened for cancer-related PTSD 18 months later. Participants then completed diagnostic interviews and PTSD (n = 12), subsyndromal PTSD (n = 5), and no symptom (n = 47) patient groups were identified. Posttraumatic stress disorder cases were distinguished by having experienced violent traumas and anxiety disorders predating cancer, whereas subsyndromal cases were not. Also, longitudinal data show that PTSD covarys with poorer functioning and lower quality of life among breast cancer survivors. Both PTSD and subsyndromal PTSD were associated with employment absenteeism and the seeking of mental health services.
TL;DR: For those soldiers reporting the highest degree of exposure to mission stressors, CISD was minimally associated with lower reports of posttraumatic stress and aggression, higher perceived organizational support, and more alcohol problems than SMC and SO.
Abstract: In a group randomized trial of critical incident stress debriefing (CISD) with platoons of 952 peacekeepers, CISD was compared with a stress management class (SMC) and survey-only (SO) condition. Multilevel growth curve modeling found that CISD did not differentially hasten recovery compared to the other two conditions. For those soldiers reporting the highest degree of exposure to mission stressors, CISD was minimally associated with lower reports of posttraumatic stress and aggression (vs. SMC), higher perceived organizational support (vs. SO), and more alcohol problems than SMC and SO. Soldiers reported that they liked CISD more than the SMC, and CISD did not cause undue distress.
TL;DR: Several differences were observed in deployment stressor exposures and results based on differential associations generally suggested more negative impacts of deployment experiences for active duty women and NG/R men.
Abstract: The increased use of National Guard and Reserve (NG/R) military personnel in current conflicts raises the question of whether deployment experiences and their associations with posttraumatic stress symptomatology differ for active duty and NG/R military personnel. To date, very few studies are available on this topic. Moreover, it is unclear whether the impact of military status differs for women and men. We addressed these research issues in a sample of 311 female and male Gulf War I veterans. Several differences were observed in deployment stressor exposures and results based on differential associations generally suggested more negative impacts of deployment experiences for active duty women and NG/R men. The potential role of unit cohesion in explaining these findings is discussed.
TL;DR: This study evaluated whether tonic immobility mediates the relations between perceived inescapability, peritraumatic fear, and posttraumatic stress disorder (PTSD) symptom severity among sexual assault survivors to suggest that tonic immersion could be one path through which trauma survivors develop PTSD symptoms.
Abstract: This study evaluated whether tonic immobility mediates the relations between perceived inescapability, peritraumatic fear, and posttraumatic stress disorder (PTSD) symptom severity among sexual assault survivors. Female undergraduates (N = 176) completed questionnaires assessing assault history, perceived inescapability, peritraumatic fear, tonic immobility, and PTSD symptoms. Results indicated that tonic immobility fully mediated relations between perceived inescapability and overall PTSD symptom severity, as well as reexperiencing and avoidance/numbing symptom clusters. Tonic immobility also fully mediated the relation between fear and reexperiencing symptoms, and partially mediated relations between fear and overall PTSD symptom severity, and avoidance/numbing symptoms. Results suggest that tonic immobility could be one path through which trauma survivors develop PTSD symptoms. Further study of tonic immobility may inform our ability to treat trauma victims.
TL;DR: Investigation of PTSD symptomatology and substance use in 212 IPV-exposed women found drug-using women reported higher PTSD severity scores compared to women who reported no substance use or alcohol use only, and the reexperiencing, avoidance and numbing, and arousal clusters demonstrated unique associations with substance use involvement.
Abstract: Women who experience intimate partner violence (IPV) have higher rates of posttraumatic stress disorder (PTSD) and substance abuse compared to women who do not experience IPV. However, the extent to which IPV-related PTSD symptoms are related to women's substance use involvement largely has been unexplored. The current study investigated PTSD symptomatology and substance use in a community sample of 212 IPV-exposed women. Drug-using women reported higher PTSD severity scores compared to women who reported no substance use or alcohol use only. Moreover, the reexperiencing, avoidance and numbing, and arousal clusters demonstrated unique associations with substance use involvement. Findings not only elucidate the associations among IPV-related PTSD symptoms and substance use, but they also can inform community-based preventive interventions.