Archives of Sexual Behavior

, Volume 48, Issue 3, pp 975–986 | Cite as

A Longitudinal Examination of Posttraumatic Stress Disorder Symptoms and Risky Sexual Behavior: Evaluating Emotion Dysregulation Dimensions as Mediators

  • Nicole H. Weiss
  • Kate Walsh
  • David D. DiLillo
  • Terri L. Messman-Moore
  • Kim L. GratzEmail author
Original Paper


Posttraumatic stress disorder (PTSD) has been linked to a wide array of risky and health-compromising behaviors, including risky sexual behavior (RSB). Cross-sectional studies reveal positive associations between emotion dysregulation and both PTSD and RSB. This study extended that work by exploring whether intermediate levels of emotion dysregulation across multiple dimensions account for the relation between baseline PTSD symptoms and RSB (i.e., number of vaginal sex partners, number of instances of condomless sex, and number of instances of risky/impulsive sex) 16 months later. Participants were 447 trauma-exposed young adult women from the community (60.0% White; M age = 21.80 years) who completed five assessments (separated by 4-month increments) over a 16-month period. Baseline PTSD symptoms were significantly positively associated with all emotion dysregulation dimensions at 8 months and the number of instances of risky/impulsive sex at 16 months. Further, results revealed significant indirect effects of baseline PTSD symptoms on (1) 16-month vaginal sex partners through both the nonacceptance of negative emotions and difficulties controlling impulsive behaviors when distressed at 8-month and (2) 16-month risky/impulsive sex through difficulties engaging in goal-directed behaviors when distressed at 8 months. Results provide support for the mediating roles of nonacceptance of negative emotions and difficulties controlling behaviors when distressed in the relation between PTSD symptoms and later RSB.


Posttraumatic stress disorder Emotion dysregulation Emotion regulation Emotional nonacceptance Risky sexual behavior 



This research was supported by National Institute of Child Health and Human Development Grant R01 HD062226, awarded to the third author (DD). Work on this paper by the first author (NHW) was supported by National Institute on Drug Abuse Grants K23 DA039327, T32 DA019426, and L30 DA038349.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev ed.). Washington, DC: Author.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Press.CrossRefGoogle Scholar
  3. Aral, S. O., & Leichliter, J. S. (2010). Non-monogamy: Risk factor for STI transmission and acquisition and determinant of STI spread in populations. Sexually Transmitted Infections, 86, 29–36.CrossRefGoogle Scholar
  4. Artime, T. M., & Peterson, Z. D. (2012). The relationships among childhood maltreatment, emotion regulation, and sexual risk taking in men from urban STD clinics. Journal of Aggression, Maltreatment and Trauma, 21, 277–299.CrossRefGoogle Scholar
  5. Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedPubMedCentralCrossRefGoogle Scholar
  6. Batten, S. V., Follette, V. M., & Aban, I. B. (2002). Experiential avoidance and high-risk sexual behavior in survivors of child sexual abuse. Journal of Child Sexual Abuse, 10, 101–120.CrossRefGoogle Scholar
  7. Benjet, C., Bromet, E., Karam, E. G., Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., & Hill, E. (2016). The epidemiology of traumatic event exposure worldwide: Results from the World Mental Health Survey Consortium. Psychological Medicine, 46, 327–343.PubMedPubMedCentralCrossRefGoogle Scholar
  8. Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D., Klauminzer, G., Charney, D. S., & Keane, T. M. (1990). The clinician administered PTSD Scale. Boston, MA: National Center for PTSD-Behavioral Science Division.Google Scholar
  9. Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behaviour Research and Therapy, 34, 669–673.PubMedPubMedCentralCrossRefGoogle Scholar
  10. Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry, 55, 626–632.PubMedPubMedCentralCrossRefGoogle Scholar
  11. Briere, J. N., & Elliott, D. M. (1994). Immediate and long-term impacts of child sexual abuse. The Future of Children, 4, 54–69.PubMedPubMedCentralCrossRefGoogle Scholar
  12. Broman-Fulks, J. J., Ruggiero, K. J., Green, B. A., Kilpatrick, D. G., Danielson, C. K., Resnick, H. S., & Saunders, B. E. (2006). Taxometric investigation of PTSD: Data from two nationally representative samples. Behavior Therapy, 37, 364–380.PubMedPubMedCentralCrossRefGoogle Scholar
  13. Brown, T. A. (2006). Confirmatory factor analysis for applied research. New York: Guilford Press.Google Scholar
  14. Cavanaugh, C. E., Hansen, N. B., & Sullivan, T. P. (2010). HIV sexual risk behavior among low-income women experiencing intimate partner violence: The role of posttraumatic stress disorder. AIDS and Behavior, 14, 318–327.PubMedPubMedCentralCrossRefGoogle Scholar
  15. Chapman, A. L., Gratz, K. L., & Brown, M. Z. (2006). Solving the puzzle of deliberate self-harm: The experiential avoidance model. Behaviour Research and Therapy, 44, 371–394.PubMedPubMedCentralCrossRefGoogle Scholar
  16. Chilcoat, H. D., & Breslau, N. (1998). Investigations of causal pathways between PTSD and drug use disorders. Addictive Behaviors, 23, 827–840.PubMedPubMedCentralCrossRefGoogle Scholar
  17. Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70, 1067–1074.PubMedPubMedCentralCrossRefGoogle Scholar
  18. Cooper, M. L., Shapiro, C. M., & Powers, A. M. (1998). Motivations for sex and risky sexual behavior among adolescents and young adults: A functional perspective. Journal of Personality and Social Psychology, 75, 1528–1558.PubMedPubMedCentralCrossRefGoogle Scholar
  19. Crepaz, N., & Marks, G. (2001). Are negative affective states associated with HIV sexual risk behaviors? A meta-analytic review. Health Psychology, 20, 291–299.PubMedPubMedCentralCrossRefGoogle Scholar
  20. Crockett, L. J., Raffaelli, M., & Shen, Y. (2006). Linking self-regulation and risk proneness to risky sexual behavior: Pathways through peer pressure and early substance use. Journal of Research on Adolescence, 16, 503–525.CrossRefGoogle Scholar
  21. Deckman, T., & DeWall, C. N. (2011). Negative urgency and risky sexual behaviors: A clarification of the relationship between impulsivity and risky sexual behavior. Personality and Individual Differences, 51, 674–678.CrossRefGoogle Scholar
  22. DeLongis, A., Coyne, J. C., Dakof, G., Folkman, S., & Lazarus, R. S. (1982). Relationship of daily hassles, uplifts, and major life events to health status. Health Psychology, 1, 119–136.CrossRefGoogle Scholar
  23. Efron, B. (1987). Better bootstrap confidence intervals. Journal of the American Statistical Association, 82, 171–185.CrossRefGoogle Scholar
  24. Ehring, T., & Quack, D. (2010). Emotion regulation difficulties in trauma survivors: The role of trauma type and PTSD symptom severity. Behavior Therapy, 41, 587–598.PubMedPubMedCentralCrossRefGoogle Scholar
  25. Felner, R. D., Farber, S. S., & Primavera, J. (1983). Transitions and stressful life events: A model for primary prevention. New York: Plenum Press.Google Scholar
  26. Felner, R. D., Rowlinson, R. I., & Terre, L. (1986). Unraveling the Gordian knot in life change inquiry: A critical examination of crisis, stress and transitional frameworks of prevention. Washington, DC: Hemisphere.Google Scholar
  27. Fenton, K. A., Johnson, A. M., McManus, S., & Erens, B. (2001). Measuring sexual behaviour: Methodological challenges in survey research. Sexually Transmitted Infections, 77, 84–92.PubMedPubMedCentralCrossRefGoogle Scholar
  28. Filipas, H. H., & Ullman, S. E. (2006). Child sexual abuse, coping responses, self-blame, posttraumatic stress disorder, and adult sexual revictimization. Journal of Interpersonal Violence, 21, 652–672.PubMedPubMedCentralCrossRefGoogle Scholar
  29. Forbes, D., Haslam, N., Williams, B. J., & Creamer, M. (2005). Testing the latent structure of posttraumatic stress disorder: A taxometric study of combat veterans. Journal of Traumatic Stress, 18, 647–656.PubMedPubMedCentralCrossRefGoogle Scholar
  30. Fortenberry, J. D., Temkit, M., Tu, W., Katz, B. P., & Orr, D. P. (2003). Mood, mood change, sexual activity and condom use among adolescent women. Journal of Adolescent Health, 32, 157.CrossRefGoogle Scholar
  31. Gebhardt, W. A., Kuyper, L., & Greunsven, G. (2003). Need for intimacy in relationships and motives for sex as determinants of adolescent condom use. Journal of Adolescent Health, 33, 154–164.PubMedPubMedCentralCrossRefGoogle Scholar
  32. Gore-Felton, C., & Koopman, C. (2002). Traumatic experiences: Harbinger of risk behavior among HIV-positive adults. Journal of Trauma and Dissociation, 3, 121–135.CrossRefGoogle Scholar
  33. Gratz, K. L., Bornovalova, M. A., Delany-Brumsey, A., Nick, B., & Lejuez, C. W. (2007). A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: The role of emotional nonacceptance. Behavior Therapy, 38, 256–268.PubMedPubMedCentralCrossRefGoogle Scholar
  34. Gratz, K. L., Dixon, L. J., Kiel, E. J., & Tull, M. T. (2018). Emotion regulation: Theoretical models, associated outcomes, and recent advances. London: Sage Publications.Google Scholar
  35. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.CrossRefGoogle Scholar
  36. Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez, C. W., & Gunderson, J. G. (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology, 115, 850–855.PubMedPubMedCentralCrossRefGoogle Scholar
  37. Gratz, K. L., & Tull, M. T. (2010). Emotion regulation as a mechanism of change in acceptance-and mindfulness-based treatments. In R. A. Baer (Ed.), Assessing mindfulness and acceptance: Illuminating the theory and practice of change (pp. 105–133). Oakland, CA: New Harbinger Publications.Google Scholar
  38. Gratz, K. L., & Tull, M. T. (2011). Extending research on the utility of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality pathology. Personality Disorders: Theory, Research, and Treatment, 2, 316–326.CrossRefGoogle Scholar
  39. Gratz, K. L., Tull, M. T., & Levy, R. (2014). Randomized controlled trial and uncontrolled 9-month follow-up of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality disorder. Psychological Medicine, 44, 2099–2112.PubMedPubMedCentralCrossRefGoogle Scholar
  40. Gratz, K. L., Tull, M. T., Matusiewicz, A. M., Breetz, A. A., & Lejuez, C. W. (2013). Multimodal examination of emotion regulation difficulties as a function of co-occurring avoidant personality disorder among women with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 4, 304–314.CrossRefGoogle Scholar
  41. Gravetter, F., & Wallnau, L. (2014). Essentials of statistics for the behavioral sciences (8th ed.). Belmont, CA: Wadsworth.Google Scholar
  42. Gray, M. J., Litz, B. T., Hsu, J. L., & Lombardo, T. W. (2004). Psychometric properties of the Life Events Checklist. Assessment, 11, 330–341.PubMedPubMedCentralCrossRefGoogle Scholar
  43. Grubaugh, A. L., Elhai, J. D., Cusack, K. J., Wells, C., & Frueh, B. C. (2007). Screening for PTSD in public-sector mental health settings: The diagnostic utility of the PTSD checklist. Depression and Anxiety, 24, 124–129.PubMedPubMedCentralCrossRefGoogle Scholar
  44. Guo, J., Chung, I., Hill, K. G., Hawkins, J. D., Catalano, R. F., & Abbott, R. D. (2002). Developmental relationships between adolescent substance use and risky sexual behavior in young adulthood. Journal of Adolescent Health, 31, 354–362.PubMedPubMedCentralCrossRefGoogle Scholar
  45. Harned, M. S., Korslund, K. E., Foa, E. B., & Linehan, M. M. (2012). Treating PTSD in suicidal and self-injuring women with borderline personality disorder: Development and preliminary evaluation of a dialectical behavior therapy prolonged exposure protocol. Behaviour Research and Therapy, 50, 381–386.PubMedPubMedCentralCrossRefGoogle Scholar
  46. Harned, M. S., Korslund, K. E., & Linehan, M. M. (2014). A pilot randomized controlled trial of dialectical behavior therapy with and without the dialectical behavior therapy prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy, 55, 7–17.PubMedPubMedCentralCrossRefGoogle Scholar
  47. Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millenium. Communication Monographs, 76, 408–420.CrossRefGoogle Scholar
  48. Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168.PubMedPubMedCentralCrossRefGoogle Scholar
  49. Holmes, W. C., Foa, E. B., & Sammel, M. D. (2005). Men’s pathways to risky sexual behavior: Role of co-occurring childhood sexual abuse, posttraumatic stress disorder, and depression histories. Journal of Urban Health, 82, 89–99.CrossRefGoogle Scholar
  50. Hutton, H. E., Treisman, G. J., Hunt, W. R., Fishman, M., Kendig, N., Swetz, A., & Lyketsos, C. G. (2001). HIV risk behaviors and their relationship to posttraumatic stress disorder among women prisoners. Psychiatric Services, 52, 508–513.PubMedPubMedCentralCrossRefGoogle Scholar
  51. James, L. R., & Brett, J. M. (1984). Mediators, moderators, and tests for mediation. Journal of Applied Psychology, 69, 307–321.CrossRefGoogle Scholar
  52. Judd, C. M., & Kenny, D. A. (1981). Process analysis: Estimating mediation in treatment evaluations. Evaluation Review, 5, 602–619.CrossRefGoogle Scholar
  53. Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (1995a). Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Archives of General Psychiatry, 52, 1048–1060.PubMedPubMedCentralCrossRefGoogle Scholar
  54. Kessler, R. C., & Frank, R. G. (1997). The impact of psychiatric disorders on work loss days. Psychological Medicine, 27, 861–873.PubMedPubMedCentralCrossRefGoogle Scholar
  55. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995b). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048–1060.PubMedPubMedCentralCrossRefGoogle Scholar
  56. Keyes, K. M., McLaughlin, K. A., Demmer, R. T., Cerdá, M., Koenen, K. C., Uddin, M., & Galea, S. (2013). Potentially traumatic events and the risk of six physical health conditions in a population-based sample. Depression and Anxiety, 30, 451–460.PubMedPubMedCentralCrossRefGoogle Scholar
  57. Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. Journal of Traumatic Stress, 26, 537–547.PubMedPubMedCentralCrossRefGoogle Scholar
  58. Linehan, M. M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
  59. Lucenko, B. A., Malow, R. M., Sanchez-Martinez, M., Jennings, T., & Dévieux, J. G. (2003). Negative affect and HIV risk in alcohol and other drug (AOD) abusing adolescent offenders. Journal of Child and Adolescent Substance Abuse, 13, 1–17.PubMedPubMedCentralCrossRefGoogle Scholar
  60. MacKinnon, D. P., Krull, J. L., & Lockwood, C. M. (2000). Equivalence of the mediation, confounding, and suppression effect. Prevention Science, 1, 173–181.PubMedPubMedCentralCrossRefGoogle Scholar
  61. MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104.PubMedPubMedCentralCrossRefGoogle Scholar
  62. McDermott, M. J., Tull, M. T., Gratz, K. L., Daughters, S. B., & Lejuez, C. W. (2009). The role of anxiety sensitivity and difficulties in emotion regulation in posttraumatic stress disorder among crack/cocaine dependent patients in residential substance abuse treatment. Journal of Anxiety Disorders, 23, 591–599.PubMedPubMedCentralCrossRefGoogle Scholar
  63. Messman-Moore, T. L., Walsh, K. L., & DiLillo, D. (2010). Emotion dysregulation and risky sexual behavior in revictimization. Child Abuse and Neglect, 34, 967–976.PubMedPubMedCentralCrossRefGoogle Scholar
  64. Orcutt, H. K., Cooper, M. L., & Garcia, M. (2005). Use of sexual intercourse to reduce negative affect as a prospective mediator of sexual revictimization. Journal of Traumatic Stress, 18, 729–739.PubMedPubMedCentralCrossRefGoogle Scholar
  65. Palmieri, P. A., Weathers, F. W., Difede, J., & King, D. W. (2007). Confirmatory factor analysis of the PTSD checklist and the clinician-administered PTSD Scale in disaster workers exposed to the World Trade Center Ground Zero. Journal of Abnormal Psychology, 116, 329–341.PubMedPubMedCentralCrossRefGoogle Scholar
  66. Pimlott-Kubiak, S., & Cortina, L. M. (2003). Gender, victimization, and outcomes: Reconceptualizing risk. Journal of Consulting and Clinical Psychology, 71, 528–539.PubMedPubMedCentralCrossRefGoogle Scholar
  67. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers, 36, 717–731.PubMedPubMedCentralCrossRefGoogle Scholar
  68. Reisner, S. L., Mimiaga, M. J., Safren, S. A., & Mayer, K. H. (2009). Stressful or traumatic life events, post-traumatic stress disorder (PTSD) symptoms, and HIV sexual risk taking among men who have sex with men. AIDS Care, 21, 1481–1489.PubMedCrossRefGoogle Scholar
  69. Rucker, D. D., Preacher, K. J., Tormala, Z. L., & Petty, R. E. (2011). Mediation analysis in social psychology: Current practices and new recommendations. Social and Personality Psychology Compass, 5, 359–371.CrossRefGoogle Scholar
  70. Ruscio, A. M., Ruscio, J., & Keane, T. M. (2002). The latent structure of posttraumatic stress disorder: A taxometric investigation of reactions to extreme stress. Journal of Abnormal Psychology, 111, 290–301.PubMedPubMedCentralCrossRefGoogle Scholar
  71. Saltzman, S. P., Stoddard, A. M., McCusker, J., & Moon, M. W. (1987). Reliability of self-reported sexual behavior risk factors for HIV-1 infection in homosexual men. Public Health Reports, 102, 692–697.PubMedPubMedCentralGoogle Scholar
  72. Schuster, R. M., Crane, N. A., Mermelstein, R., & Gonzalez, R. (2012). The influence of inhibitory control and episodic memory on the risky sexual behavior of young adult cannabis users. Journal of the International Neuropsychological Society, 18, 827–833.PubMedPubMedCentralCrossRefGoogle Scholar
  73. Searles, J. S., Perrine, M., Mundt, J. C., & Helzer, J. E. (1995). Self-report of drinking using touch-tone telephone: Extending the limits of reliable daily contact. Journal of Studies on Alcohol, 56, 375–382.PubMedPubMedCentralCrossRefGoogle Scholar
  74. Senn, T. E., & Carey, M. P. (2010). Child maltreatment and women’s adult sexual risk behavior: Childhood sexual abuse as a unique risk factor. Child Maltreatment, 15, 324–335.PubMedPubMedCentralCrossRefGoogle Scholar
  75. Shipherd, J. C., Stafford, J., & Tanner, L. R. (2005). Predicting alcohol and drug abuse in Persian Gulf War veterans: What role do PTSD symptoms play? Addictive Behaviors, 30, 595–599.PubMedPubMedCentralCrossRefGoogle Scholar
  76. Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422–445.PubMedPubMedCentralCrossRefGoogle Scholar
  77. Simpson, T. L., Galloway, C., Rosenthal, C. F., Bush, K. R., McBride, B., & Kivlahan, D. R. (2011). Daily telephone monitoring compared with retrospective recall of alcohol use among patients in early recovery. American Journal on Addictions, 20, 63–68.PubMedPubMedCentralCrossRefGoogle Scholar
  78. Spitzer, C., Barnow, S., Völzke, H., John, U., Freyberger, H. J., & Grabe, H. J. (2009). Trauma, posttraumatic stress disorder, and physical illness: Findings from the general population. Psychosomatic Medicine, 71, 1012–1017.PubMedPubMedCentralCrossRefGoogle Scholar
  79. Susser, E., Desvarieux, M., & Wittkowski, K. M. (1998). Reporting sexual risk behavior for HIV: A practical risk index and a method for improving risk indices. American Journal of Public Health, 88, 671–674.PubMedPubMedCentralCrossRefGoogle Scholar
  80. Tull, M. T., Barrett, H. M., McMillan, E. S., & Roemer, L. (2007). A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behavior Therapy, 38, 303–313.PubMedPubMedCentralCrossRefGoogle Scholar
  81. Tull, M. T., Weiss, N. H., Adams, C. E., & Gratz, K. L. (2012). The contribution of emotion regulation difficulties to risky sexual behavior within a sample of patients in residential substance abuse treatment. Addictive Behaviors, 37, 1084–1092.PubMedPubMedCentralCrossRefGoogle Scholar
  82. Turchik, J. A., & Garske, J. P. (2009). Measurement of sexual risk taking among college students. Archives of Sexual Behavior, 38, 936–948.PubMedPubMedCentralCrossRefGoogle Scholar
  83. Turner, R. J., & Lloyd, D. A. (1995). Lifetime traumas and mental health: The significance of cumulative adversity. Journal of Health and Social Behavior, 36, 360–376.PubMedPubMedCentralCrossRefGoogle Scholar
  84. Vasilev, C. A., Crowell, S. E., Beauchaine, T. P., Mead, H. K., & Gatzke-Kopp, L. M. (2009). Correspondence between physiological and self-report measures of emotion dysregulation: A longitudinal investigation of youth with and without psychopathology. Journal of Child Psychology and Psychiatry, 50, 1357–1364.PubMedPubMedCentralCrossRefGoogle Scholar
  85. Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar
  86. Weiss, N. H., Tull, M. T., Anestis, M. D., & Gratz, K. L. (2013a). The relative and unique contributions of emotion dysregulation and impulsivity to posttraumatic stress disorder among substance dependent inpatients. Drug and Alcohol Dependence, 128, 45–51.PubMedPubMedCentralCrossRefGoogle Scholar
  87. Weiss, N. H., Tull, M. T., Borne, M. E., & Gratz, K. L. (2013b). Posttraumatic stress disorder symptom severity and HIV-risk behaviors among substance-dependent inpatients. AIDS Care, 25, 1219–1226.PubMedPubMedCentralCrossRefGoogle Scholar
  88. Weiss, N. H., Tull, M. T., Davis, L. T., Dehon, E. E., Fulton, J. J., & Gratz, K. L. (2012a). Examining the association between emotion regulation difficulties and probable posttraumatic stress disorder within a sample of African Americans. Cognitive Behaviour Therapy, 41, 5–14.PubMedPubMedCentralCrossRefGoogle Scholar
  89. Weiss, N. H., Tull, M. T., Davis, L. T., Searcy, J., Williams, I., & Gratz, K. L. (2015a). A preliminary experimental investigation of emotion dysregulation and impulsivity in risky behaviours. Behaviour Change, 32, 127–142.PubMedPubMedCentralCrossRefGoogle Scholar
  90. Weiss, N. H., Tull, M. T., Sullivan, T. P., Dixon-Gordon, K. L., & Gratz, K. L. (2015b). Posttraumatic stress disorder symptoms and risky behaviors among trauma-exposed inpatients with substance dependence: The influence of negative and positive urgency. Drug and Alcohol Dependence, 155, 147–153.PubMedPubMedCentralCrossRefGoogle Scholar
  91. Weiss, N. H., Tull, M. T., Viana, A. G., Anestis, M. D., & Gratz, K. L. (2012b). Impulsive behaviors as an emotion regulation strategy: Examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients. Journal of Anxiety Disorders, 26, 453–458.PubMedPubMedCentralCrossRefGoogle Scholar
  92. Weiss, N. H., Williams, D. C., & Connolly, K. M. (2015c). A preliminary examination of negative affect, emotion dysregulation, and risky behaviors among military veterans in residential substance abuse treatment. Military Behavioral Health, 3, 212–218.PubMedPubMedCentralCrossRefGoogle Scholar
  93. Whiteside, S. P., & Lynam, D. R. (2001). The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669–689.CrossRefGoogle Scholar
  94. Zhao, X., Lynch, J. G., & Chen, Q. (2010). Reconsidering Baron and Kenny: Myths and truths about mediation analysis. Journal of Consumer Research, 37, 197–206.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of Rhode IslandKingstonUSA
  2. 2.Department of PsychologyYeshiva UniversityBronxUSA
  3. 3.Department of PsychologyUniversity of Nebraska-LincolnLincolnUSA
  4. 4.Department of PsychologyMiami UniversityOxfordUSA
  5. 5.Department of PsychologyUniversity of ToledoToledoUSA

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