Distinctive impacts of sexual trauma versus non-sexual trauma on PTSD profiles in highly trauma-exposed, Black women

Background: Prior findings suggest that psychopathology following interpersonal trauma or assaultive violence may present differently from prototypical posttraumatic stress disorder (PTSD). However, whether this is true for sexual trauma (ST) in the context of other salient lifetime traumatic experiences is yet unknown. We predicted that ST exposure may result in higher avoidance and numbing symptoms and blunted fear responses, relative to non-sexual trauma (NST), particularly if ST occurred during childhood. Methods: Participants were n = 5163 Black women recruited in an urban public hospital. We investigated effects of ST on PTSD symptoms, fear-potentiated startle (FPS) response (n = 285), and amygdala reactivity and habituation to social threat cues with fMRI (n = 95). Results: ST was associated with greater PTSD symptoms (p = 2.64 x 10(-21)), but this was observed across all symptom clusters. Women who experienced repeated ST in both childhood and adulthood showed greater PTSD (p =.0009) and numbing symptoms (p =.002). In the FPS paradigm, the ST group startled more on all blocks and stimulus types than the NST group (p =.004). Developmental timing of ST did not influence startle magnitude. ST was not associated with amygdala habituation or reactivity. Limitations: Generalizability is limited to Black women with a high trauma burden. Associations are cross-sectional, limiting causal conclusions. Conclusion: While survivors of ST may present with more severe PTSD symptoms, their profiles are not characteristically different from similar NST controls. Childhood sexual abuse exposure alone did not result in a unique symptom profile. ST represents a uniquely high-burden stressor with likelihood for more severe posttraumatic outcomes.