Understanding Internalizing and Externalizing Symptoms in Trauma Exposed Community Members

Objective: Posttraumatic stress disorder (PTSD) is highly comorbid with internalizing and externalizing symptoms, but few studies have examined risk factors that can account for these comorbidities. The primary aim of this study is to investigate the role of blame attribution (i.e., self-blame and other blame) and impulsivity dimensions (i.e., negative and positive urgency) in predicting internalizing (i.e., social anxiety, depression, and worry) and externalizing symptoms (i.e., aggression, risky thrill-seeking, risky substance use, and sexual risk-taking) when statistically controlling for PTSD. Method: Participants were 63 trauma-exposed community members (47.6% diagnosed with PTSD; Mage = 27.17, 84.1% female) interviewed using the Clinician-Administered PTSD Scale-5. We hypothesized that self- and other blame would predict internalizing symptoms and that self-blame, negative urgency, and positive urgency would predict externalizing symptoms after controlling for PTSD. Results: Findings showed that self-blame was associated with all three internalizing symptoms and risky sex and that negative urgency predicted risky aggression. Conclusion: This study provides evidence that self-blame is an important risk factor for a broad range of internalizing symptoms and for at least one type of externalizing symptom and that the effects of self-blame are not fully explained by PTSD. Clinical Impact Statement This study found that those with higher self-blame are at an increased risk for experiencing internalizing symptoms and risky sexual behavior, and those with negative urgency are more likely to be aggressive. Targeting self-blame and negative urgency in therapy may benefit the mental health of those exposed to trauma.