Relation of Interpersonal Conflict Behaviors to Emotion Dysregulation and PTSD in Adolescents with a History of Betrayal Trauma

Relation of Interpersonal Conflict Behaviors to Emotion Dysregulation and PTSD in Adolescents with a History of Betrayal Trauma Vanessa M. Jacoby Posttraumatic stress disorder (PTSD) is a disorder that develops in response to exposure to a traumatic stressor. Although this is the most well known diagnosis for individuals who have difficulties after a traumatic event, research documents numerous difficulties and psychopathology that can result from traumatic events, many of which do not fit the DSM-IV criteria of PTSD. Specifically, severe, chronic, interpersonal trauma tends to have a different pattern of effects on individuals than does acute, noninterpersonal trauma. This is particularly true for children (e.g., van der Kolk, Roth, Pelcovitz, Sunday, & Spinazzola, 2005). Because of this, the construct of Developmental Trauma Disorder (DTD) was introduced, although it is not currently recognized in the DSM 5. Emotion regulation skills and interpersonal dysfunction are two core components of this disorder. Trauma perpetrator (i.e., betrayal trauma) has also been found to be an important trauma characteristic when determining the clinical trajectory following traumatic experiences. The current study examined whether adolescents who have experienced betrayal trauma exhibit more negative communication behavior during a stressful interpersonal task, and report more emotion regulation deficits, than adolescents with non-betrayal trauma histories. The study also examined whether emotion regulation mediates the relation between betrayal trauma and negative communication. Finally, analyses were conducted to determine if PTSD or betrayal trauma best predicts negative communication behavior. Adolescents with a history of betrayal trauma reported more emotion regulation difficulties, and exhibited significantly more aggressive, negative nonaggressive, and fewer positive behaviors when engaged in a stressful interpersonal task with their mothers. Although PTSD symptom severity was related to experiencing a betrayal trauma, neither PTSD severity nor PTSD diagnosis predicted interpersonal difficulties as well as betrayal trauma history or emotion regulation difficulties. Finally, emotion regulation difficulties were found to mediate the relation between betrayal trauma and negative communication behavior. These results lend support for adding DTD to the next version of the DSM, illustrating that clinically significant problems related to trauma may not look “PTSD-like. ” Conflict, Emotion Regulation, And Trauma i Acknowledgments This study would not be possible without the time and support given to me by my mentors, supervisors, fellow lab members, committee members, and my family. I would like to thank Joseph Scotti, Ph.D. for his mentorship, supervision, and feedback with the initial conceptualization and design of the study, the data collection and writing process, and also throughout my career. I would also like to thank Elisa Krackow, Ph.D. for her willingness to become my mentor, and provide me with supervision and feedback throughout the data collection and writing process. I would like to thank Jodi Arnold, Ph.D. for her overwhelming support and mentorship with my dissertation process during my internship year. I would like to thank Melanie Booth-Butterfield, Ph.D., Christina Duncan, Ph.D., and Amy Gentzler, Ph.D. for their support and feedback as Dissertation Committee members. Finally, my project would not be possible without the help of my fellow lab members, especially Sarah Nunley, M.S., and Meredith Norman, M.S., who coded much of the data. Conflict, Emotion Regulation, And Trauma ii List of Tables Table Page 1. Demographics (Number and Percentage): Race/Ethnicity of Mothers and Adolescents, Marital Status of Mothers, and Annual Household Income, Overall and by Sex of Adolescent.80 2. Number (Percentage) of Participants Reporting Each Type of Non-Interpersonal Event by Sex of Adolescent and Group.81 3. Number (Percentage) of Participants Reporting Each Type of Interpersonal Event by Sex of Adolescent and Group.82 4. Number (Percentage) of Participants in the Betrayal Trauma Group Reporting Each Type of Interpersonal Event Classifiable as Betrayal Trauma by Sex of Adolescent.83 5. Means (Standard Deviations) and Ranges for Non-Interpersonal, Interpersonal, and Betrayal Traumatic Events, Overall and by Sex of Adolescent and Group.84 6. Means (Standard Deviations) and Ranges for Adolescent and Parent Communication Behaviors during the Low-Stress and High-Stress Problem-Solving Tasks, Overall and by Sex of Adolescent and Group.85 7. Means (Standard Deviations) and Ranges for Adolescent and Parent Versions of the PTSD Reaction Index, Overall and by Sex of Adolescent and Group.88 8. Means (Standard Deviations) and Ranges for the Difficulties with Emotion Regulation Scale, Overall and by Sex of Adolescent and Group.90 9. Means (Standard Deviations) and Ranges for Adolescent and Parent Versions of the Conflict Behavior Scale, Overall and by Sex of Adolescent and Group.91 10. Means (Standard Deviations) and Ranges for Adolescent and Parent Versions of the Issues Checklist, Overall and by Sex of Adolescent and Group.92 Conflict, Emotion Regulation, And Trauma iii 11. Means (Standard Deviations) and Ranges for Adolescent and Parent Versions of the ProblemSolving Reaction Scales following the Low-Stress and High-Stress Problem-Solving Tasks, Overall and by Sex of Adolescent and Group.93 12. Correlations Among the Subscales of the UCLA PTSD Reaction Index for Adolescent (AR) and Parent (PR) Versions.96 13. Correlations Among the Subscales of Difficulties in Emotion Regulation Scale.97 14. Correlations of Among the Primary Measures (PTSD Reaction Index, Difficulties in Emotion Regulation Scale, Conflict Behavior Questionnaire, and Issues Checklist) for Adolescent (AR) and Parent (PR) Versions.98 15. Correlations among Adolescent and Parent Communication Behaviors during the Low-Stress and High-Stress Problem-Solving Tasks.99 16. Correlation of Trauma Characteristics, PTSD Scores, and Emotion Regulation scores with Negative Communication Behavior, Conflict Behavior Questionnaire-AR, and Conflict Behavior Questionnaire-PR.100 17. Best Predictors of Negative Communication Behavior, Conflict Behavior Questionnaire-AR, and Conflict Behavior Questionnaire –PR.101 Conflict, Emotion Regulation, And Trauma iv List of Figures Figure Page 1. Graph showing total percent of mother‟s communication behaviors, across groups, for the Low Stress and High Stress Problem-Solving tasks.102 2. Percent of Negative Aggressive, Negative Non-Aggressive, and Positive Communication Behaviors during Low and High Stress Tasks for Adolescents in the Non-Betrayal Trauma (NBT) and Betrayal Trauma (BT) Groups.103 3. Percent of Negative Aggressive, Negative Non-Aggressive, and Positive Communication Behaviors for Adolescents in the Non-Betrayal Trauma (NBT) and Betrayal Trauma (BT) Groups Compared with Adolescents with Low PTSD severity status vs. High PTSD severity status.104 4. Mediation model for overall Negative Communication behavior during a stressful interpersonal task, with Betrayal Trauma History as the predictor and Emotion Dysregulation as the mediator.105 Conflict, Emotion Regulation, And Trauma v Table of