Background: Childhood maltreatment is associated with various psychiatric disorders, including post-traumatic stress disorder (PTSD) and personality disorders (PDs). Previous research has suggested that PTSD and PD are highly comorbid. However, the impact of different types of childhood maltreatment on the severity of PTSD and PD symptoms in a clinical population with PTSD/PD symptoms remains unclear.Objective: We aimed to clarify the role of (a) the overall severity and (b) the severity of subtypes of childhood maltreatment on the severity of (a) PTSD and (b) comorbid PD symptoms.Methods: Data was collected from participants (N = 197) seeking treatment for PTSD with comorbid PD symptoms at a trauma expertise centre in the Netherlands. We assessed childhood maltreatment using the Childhood Trauma Questionnaire-short form (CTQ-sf), PTSD severity with the Clinician-administered PTSD Scale for DSM-5 (CAPS-5), and PD severity with the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). Data were analyzed using linear and Poisson regression.Results: We found that emotional neglect was the most prevalent form of childhood maltreatment (80.7%), followed by emotional abuse (72.6%). Sexual and emotional abuse shared independent associations with the severity of PTSD. The overall maltreatment severity and emotional abuse were significantly associated with the severity of comorbid borderline PD symptoms. Sexual abuse was significantly associated with the severity of comorbid avoidant PD symptoms. None of the childhood maltreatment types were significantly associated with the severity of comorbid obsessive-compulsive PD symptoms.Conclusions: We demonstrated the relationship between childhood sexual and emotional abuse and PTSD severity in people with PTSD and comorbid PD symptoms. This has important implications since emotional abuse usually does not fulfil the A-criterion required for the diagnosis of PTSD. We recommend routinely assessing emotional abuse in trauma- and PD treatment, and investigating the effectiveness of adapting trauma treatment for emotional abuse.Trial registration: ClinicalTrials.gov identifier: NCT03833453.

The literature has consistently demonstrated that being the victim of interpersonal violence increases the risk of future interpersonal violence (i.e., revictimisation). In this context, post‐traumatic stress disorder (PTSD) is highly important since it has been investigated as a risk factor and consequence of revictimisation. The aim of the current study was to (a) compute a rate of revictimisation across types of interpersonal violence, and (b) examine which factors are associated with observed rates of revictimisation. We conducted a pre‐registered systematic search in PubMed, APA PsycInfo, PTSDpubs, Web of Science, and Scopus, that resulted in N = 1286 individual records and n = 19 inclusions (PROSPERO ID: CRD42023446788). Criteria for inclusion were: adult human sample, assessment of PTSD symptoms that precedes assessment of interpersonal revictimisation, published in a peer‐reviewed journal, longitudinal study design. Most studies focused on intimate partner revictimisation, followed by sexual revictimisation. The pooled rate of revictimisation was 39.2% for the overall group, and 53.4% for those experiencing intimate partner revictimisation. Only the proportion of females was positively associated with the observed rate of revictimisation. None of the other factors: presence of severe PTSD symptoms, mode of assessment (PTSD), type of sample, or duration of the follow‐up period, were associated with the rates of revictimisation. We recommend the use of gold‐standard assessment for PTSD, more representative and more clearly defined samples, and the development of a validated measure of revictimisation. For clinicians, we recommend paying attention to and providing psychoeducation about revictimisation and potential ways to prevent this. In sum, revictimisation is highly prevalent, but remains poorly understood. This gap may be addressed by rigorous methodological improvements (research) and psychoeducation (clinical practice).

Background: Victims of interpersonal violence have an increased risk to (a) develop post-traumatic stress disorder (PTSD), and (b) experience future interpersonal violence, a phenomenon called revictimization. Incidentally, PTSD is also a risk factor for revictimization, resulting in a vicious cycle for victims. To date, no interventions exist that effectively reduce the risk of revictimization in people suffering from PTSD. Furthermore, while the responsibility for preventing violence always resides with the perpetrator, we mostly see victims in clinical practice. We have chosen for a multi-dimensional approach to prevention by focusing on developing an intervention for potential victims.Objective: Our aim was to identify the skills that experts by experience would like to acquire in a novel intervention aimed at decreasing vulnerability for revictimization after trauma treatment. Secondly, this approach allowed the identification of risk factors for revictimization from a patient perspective.Methods: We conducted a qualitative study consisting of two focus groups with a total of N = 16 participants, with M_age = 49.0 (SD = 14.2) of which N = 8 were female. Participants were patients at a trauma expertise centre and had been victims of interpersonal violence in the past. The transcribed audio tapes were analyzed using iterative and reflexive thematic analysis.Results: We identified four main themes: 'emotion-focused skills', 'internal dialogue', 'communication skills', and 'managing social environment'. The results indicate that experts by experience would like to acquire skills that span emotional, cognitive, and behavioural dimensions to decrease their vulnerability for revictimization.Conclusions: Novel interventions aimed at decreasing vulnerability for revictimization after trauma treatment should incorporate the skills that experts by experience would like to acquire, such as awareness of emotions & bodily signals, coaching oneself, and managing the social environment, among others. Our results partially align with the evidence-based model of revictimization.

(1) Background: Ethnic minorities exhibit a higher prevalence of post-traumatic stress disorder (PTSD), while results for problematic substance use among ethnic groups remain mixed. PTSD and problematic substance use often co-occur; however, the impact of ethnicity on this association has not yet been investigated. (2) Methods: Self-report data on problematic alcohol/cannabis use (AUDIT/CUDIT) and presence of severe PTSD symptoms (PSS-SR) of N = 22,841 participants of Dutch (n = 4610), South-Asian Surinamese (n = 3306), African Surinamese (n = 4349), Ghanaian (n = 2389), Turkish (n = 3947), and Moroccan (n = 4240) origin were available from the HELIUS study. (3) Results: We found a positive association between the presence of severe PTSD symptoms and problematic alcohol and cannabis use. Ethnicity did not moderate the association between the presence of severe PTSD symptoms and problematic alcohol/cannabis use. (4) Conclusions: We demonstrated the relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use in a multi-ethnic sample. The relationship between the presence of severe PTSD symptoms and problematic alcohol/cannabis use was similar between ethnic groups. We recommend screening for PTSD symptoms in those exhibiting problematic substance use and vice versa, regardless of ethnic background.

Introduction: A host of cross-sectional studies have identified problematic substance use and post-traumatic stress symptoms as risk factors for repeated interpersonal violence (revictimization) in college samples. However, it remains unclear which factors are associated with revictimization for patients who meet diagnostic criteria for both substance use disorder (SUD) and post-traumatic stress disorder (PTSD). The identification of factors associated with revictimization is an important step towards preventing violence against people with psychiatric disorders and can inform treatment.Method: Data were based on the Treatment of PTSD and Addiction (TOPA) study, a randomized controlled trial including N = 209 patients that received inpatient and outpatient treatment for SUD and PTSD. We selected participants who had experienced interpersonal victimization at baseline (N = 203) and assessed revictimization across the 9-month follow-up period. Revictimization included: physical violence, violence with a gun, sexual violence, and 'other unwanted sexual experience'. The risk factors we investigated were severity of PTSD, severity of alcohol and drug use disorder, interpersonal difficulties, sex, and age. We analysed the data using logistic regression analyses with multiple imputation for missing data.Results: Physical violence was the most common type of revictimization during the study period (26.0%), closely followed by 'other unwanted sexual experience' (20.0%). The severity of PTSD and age were univariate predictors for revictimization; however, only age was robustly related to revictimization while accounting for other study variables. We conducted sensitivity analyses with complete cases and observed data.Discussion: Approximately two in five individuals experienced revictimization across the 9-month follow-up period, underscoring it as a clinically relevant issue. Since age emerged as the only risk factor for revictimization in our sample, future research should focus on identifying modifiable factors associated with age, e.g. impulsivity and novelty seeking. These factors may be addressed in interventions aimed at reducing the risk of revictimization.