Psychological Drivers of Self-Destructive Behaviors in PTSD

在退伍军人中，自我毁灭行为通常与创伤后应激障碍（PTSD）并存，

Self-destructive behaviors are frequently comorbid with posttraumatic stress disorder (PTSD) among Veterans, where they are linked to increased distress and impairment. Self-destructive behaviors encompass those with the potential for immediate injury (e.g., [suicidal and nonsuicidal] self-directed violence) and those with more distal consequences (e.g., substance use, disordered eating). The proposed research aims to apply advanced quantitative methods to model interrelations of [PTSD and depressive symptoms] and self-destructive behaviors at both the group and individual levels. In Aim 1, network models of relations of these constructs will be developed in a gender-balanced sample of Veterans from all service eras (N = 1,187). Results will identify which [symptoms bridge (i.e., connect) to suicide-related outcomes and other nonsuicidal self-destructive behaviors and whether these differ by gender.] Analyses will also test whether baseline bridge symptoms predict self-destructive behaviors [(specifically suicide-related outcomes)] at 12-month follow-up. Results will be validated in a separate gender-balanced sample of post-9/11 Veterans (N = 1,494). Aim 2 is to examine real-time, dynamic changes in network models of PTSD-related constructs and self-destructive behaviors at the intrapersonal level. A new sample of Veterans (target N = 60, 50% women) who meet criteria for subthreshold/threshold PTSD and report recent suicidal ideation and at least one other self-destructive behavior will be recruited to complete an ecological momentary assessment (EMA) protocol reporting on these constructs. Multilevel autovector regression analysis techniques will be used to model real-time changes in networks of PTSD and depressive symptoms, and self-destructive behaviors. The candidate is a postdoctoral fellow in clinical psychology at the Women’s Health Sciences Division of the National Center for PTSD, VA Boston Healthcare System. Research and training will take place within the environment of VA Boston Healthcare System and its academic affiliate, Boston University under the supervision of a distinguished mentorship team with content and methodological expertise relevant to the proposal. The training aims associated with this proposal include: 1) Gain advanced knowledge of models of traumatic stress and self- destructive behaviors; 2) acquire skills in advanced quantitative methods for analyzing complex, multivariate relations; 3) gain expertise in EMA data collection and analyses; and 4) engage in professional development to prepare the candidate for a successful career as a VA clinical investigator. The research and training associated with this CDA2 will prepare the principal investigator to achieve her immediate goal of preparing a successful VA Research Merit Award application to study the impact of trauma-focused treatments on mechanisms of self-destructive behaviors identified in this proposal. The candidate’s long-term goal is to become an expert in the dynamic processes of psychological mechanisms maintaining self-destructive behaviors secondary to trauma exposure. Through this expertise, the candidate aims to produce knowledge that can be used to enhance trauma-focused treatments and develop personalized, adaptive intervention/assessment tools for self-destructive behaviors.