Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) frequently co-occur. Comorbid PTSD+SUD confers heightened risk of other mental health concerns, suicidality, mortality, and functional impairment. Current treatments for comorbid PTSD+SUD show inconsistent results, highlighting the need for a more comprehensive understanding of the associations between PTSD and SUD symptoms. The current dissertation aimed to characterize the associations between PTSD and SUD using structural equation modelling among three different samples with differing clinical severity and presentation: (1) concurrent disorders sample with a high prevalence of PTSD; (2) an in-patient sample seeking treatment for PTSD; and (3) a subclinical sample of healthcare workers and public safety personnel. Data were extracted from multiple clinical databases across different studies to evaluate the associations between PTSD symptoms and alcohol/cannabis/substance use-related problems. Furthermore, the role of underlying mechanisms such as dissociation and emotion dysregulation, which are associated with both PTSD and SUD, were analyzed. All analyses used a structural equation modelling framework to represent the complex clinical presentation of comorbid PTSD+SUD analytically. A relatively consistent pattern of results was observed across the three samples. Global PTSD symptoms were significantly associated with cannabis-related problems, alcohol-related problems, and other illicit substance-related problems. Among PTSD symptoms, the reactivity symptom cluster (characterized by symptoms of hypervigilance, irritability, reckless behaviour, problems with concentration and sleep disturbances) was significantly associated with alcohol/cannabis/substance-related v problems across among the three samples. Furthermore, underlying mechanisms such as dissociation and emotion dysregulation significantly mediated the relations between PTSD symptoms and alcohol/cannabis/substance-related problems. Overall, the current results contribute to the limited literature examining the associations between PTSD and SUD symptoms. Lastly, the current results have important clinical implications for identifying efficacious treatment targets for comorbid PTSD+SUD. / Dissertation / Doctor of Philosophy (PhD) / Psychological distress following a traumatic event, known as traumatic stress, is often associated with problematic alcohol and/or substance use. The co-occurrence of these two confers a heightened risk of other mental health problems. As such, studying how these phenomena are associated with one another and what about each thing is more important to the association is important to understand. The purpose was to examine the connection between these phenomena among three different groups of people: two treatment-seeking groups and non-treatment seeking group one group. Traumatic stress was associated with problematic substance use in all three groups. In addition, other factors like mentally escaping from your body and having difficulties with regulating your emotions explained how traumatic stress and problematic substance use were connected to each other. These findings can help clinicians hone their treatment programs to better help individuals struggling with traumatic stress and problematic substance use.

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Borderline personality disorder (BPD) is a severe and debilitating mental disorder that is over-represented within the criminal legal system (CLS), with 15-29.5% of individuals in the CLS meeting criteria. However, little research has examined mechanisms leading to criminal involvement within this population. Potential mechanisms include positive/negative emotion dysregulation and internalized shame, which (aside from positive emotion dysregulation) have been linked to criminal involvement in other populations. Research has yet to examine these constructs as mechanisms explaining criminal involvement among individuals with BPD. This study examined positive/negative emotion dysregulation and internalized shame as mechanisms of the relationship between BPD and criminal involvement. Adults (N = 93) currently incarcerated in jail who are identified as having a current or prior mental health concern were invited to participate in the study. Measures include the addiction severity index (ASI) examining criminal involvement, the original and positive versions of the difficulties in emotion regulation scale (DERS; DERS-P), and the internalized shame scale (ISS). At the bivariate level, BPD symptoms were significantly correlated with negative emotion dysregulation (total score) and several subscales (clarity, goals, impulse, strategies), as well as internalized shame and criminal involvement. Negative emotion dysregulation and internalized shame were unrelated to criminal involvement, and there was no evidence of mediation through these constructs. These bivariate results are consistent with other literature, but future research is needed to examine relevant variables that could explicate the relationship between BPD symptoms and criminal involvement.

Biological theory proposes that autonomic nervous system (ANS) hypo-reactivity may be more specific to proactive aggression, while ANS hyper-reactivity may be specific to affective aggression. However, the literature finds mixed support, which may be because no study to date has concurrently examined emotion dysregulation, a highly related variable, as a potential moderator. The present study examined these relationships in 76 undergraduate participants (29 men, mean age = 21.49) who identified as Caucasian (51%), African-American (23%), Asian (21%), or Other (5%). Participants completed questionnaires, a resting state task, and a provocation task. Results found that blunted overall ANS reactivity was associated with proactive aggression. Emotion dysregulation moderated the relationship between parasympathetic nervous system (PNS) and sympathetic nervous system (SNS) reactivity with both proactive (at a trending level for SNS reactivity) and affective aggression. Specifically, among those slightly above average and high on emotion dysregulation, PNS augmentation and blunted SNS reactivity were associated with proactive and affective aggression, respectively. In contrast, among those low on emotion dysregulation, PNS augmentation was associated with decreased affective aggression. Thus, among those elevated on emotion dysregulation, it may be beneficial to teach counter-regulatory strategies to reduce the impact of ANS hypo-reactivity on aggression (across function). / Psychology

Although there has been a recent surge in research examining comorbidity between externalizing and internalizing disorders in childhood, relatively less work has examined relations between specific externalizing conditions (i.e., oppositional defiant disorder (ODD) symptoms) and their co-occurrence with specific internalizing conditions (i.e., depressive symptoms). Furthermore, little empirical work has evaluated potential underlying processes, such as emotion dysregulation, which may explain relations between co-occurring ODD and depressive symptoms. There is also a paucity of research examining developmental patterns of co-occurring ODD and depressive symptoms. In the present study, I used latent class and latent transition analyses to (a) identify groups of children based on ODD and depressive symptom levels, (b) determine whether emotion dysregulation predicted co-occurring ODD and depressive symptoms, and (c) examine developmental patterns of change and continuity in groups across middle childhood within a community-based sample. Children were characterized by three latent classes based on ODD and depressive symptom severity: a group with very low levels of ODD or depressive symptoms, an ODD-only group with low levels of symptoms, and a co-occurring ODD and depressive symptom group with moderate levels of ODD and low levels of depressive symptoms. Furthermore, emotion dysregulation predicted to the class with moderate levels of ODD and low levels of depressive symptoms, although prediction from emotion dysregulation to class membership depended on the methodology used to index emotion dysregulation. Results of the LTA analyses suggested that symptom severity was relatively stable across middle childhood, with little evidence of changes in developmental patterns of ODD and depressive symptoms. Overall, the results of this study provide an important foundation for more sophisticated empirical inquiry regarding co-occurring ODD and depressive symptoms in childhood and potential processes that may explain their onset and development. / Psychology

Witnessing partner violence (WPV) in childhood and adolescence can have significant impact on psychological functioning throughout development. Studies have shown that parenting factors, perceived social support, coping strategies, age at exposure, and gender can influence the relationship between WPV and outcomes. Although WPV can have serious implications towards emotion regulation abilities, empirical research on the link between WPV and emotion regulation is inadequate. The current study examined the associations between the frequency and types of WPV in childhood and adolescence and emotion dysregulation in adulthood. The study further explored the roles of parental bonds, social support, coping strategies, age at exposure, and gender as moderators in the relationship between WPV and emotion dysregulation. Data were collected using an undergraduate sample at Virginia Tech (N = 1040). Results indicated that verbal violence exposure was a significant predictor of emotion dysregulation while physical violence and total WPV were not. Parental warmth moderated the relationship between all three types of WPV and emotion dysregulation, while parental control and age of onset were moderators for total and physical WPV. Social support moderated the relationship between verbal violence exposure and emotion dysregulation. Coping strategies and gender were not found to be significant moderators. Exploratory analyses were conducted to further explore these relationships. The findings and their implications are discussed. / Ph. D.