Child Psychiatry & Human Development

, Volume 46, Issue 6, pp 884–892 | Cite as

Exposure to Violence, Posttraumatic Stress Symptoms, and Borderline Personality Pathology Among Adolescents in Residential Psychiatric Treatment: The Influence of Emotion Dysregulation

  • Kelly E. Buckholdt
  • Nicole H. Weiss
  • John Young
  • Kim L. Gratz
Original Article


Exposure to violence during adolescence is a highly prevalent phenomenon associated with a range of deleterious outcomes. Theoretical literature suggests that emotion dysregulation is one consequence of exposure to violence associated with the manifestation of posttraumatic stress symptoms (PTSS) and borderline personality (BP) pathology. Thus, the goal of the present study was to examine the mediating role of emotion dysregulation in the relation between exposure to violence and both PTSS and BP pathology in a sample of 144 adolescents (age 10- to 17-years; 51 % male; 55 % African American) admitted to a psychiatric residential treatment center. Exposure to violence was associated with greater emotion dysregulation, which, in turn, was associated with greater PTSS and BP pathology. Furthermore, emotion dysregulation mediated the associations between exposure to violence and both PTSS and BP pathology. Findings suggest the importance of assessing and treating emotion dysregulation among violence-exposed adolescents in psychiatric residential treatment.


Exposure to violence Posttraumatic stress symptoms Borderline personality pathology Emotion dysregulation Residential treatment 



The research described here was supported, in part, by a grant from the National Institutes of Health (T32DA019426).


  1. 1.
    Finkelhor D, Turner HA, Shattuck A, Hamby SL (2013) Violence, crime, and abuse exposure in a national sample of children and youth: an update. JAMA Pediatr 167:1–8Google Scholar
  2. 2.
    Kilpatrick DG, Saunders BE, Smith DW (2003) Youth victimization: prevalence and implications. National Institute of Justice, US Department of Justice, WashingtonGoogle Scholar
  3. 3.
    Danese A, Moffitt TE, Harrington H et al (2009) Adverse childhood experiences and adult risk factors for age-related disease: depression, inflammation, and clustering of metabolic risk markers. Arch Pediatr Adolesc Med 163:1135–1143PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Widom CS, DuMont K, Czaja SJ (2007) A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up. Arch Gen Psychiatry 64:49–56CrossRefPubMedGoogle Scholar
  5. 5.
    Christiansen EJ, Evans WP (2005) Adolescent victimization testing models of resiliency by gender. J Early Adolesc 25:298–316CrossRefGoogle Scholar
  6. 6.
    Fowler PJ, Tompsett CJ, Braciszewski JM, Jacques-Tiura AJ, Baltes BB (2009) Community violence: a meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Dev Psychopathol 21:227–259CrossRefPubMedGoogle Scholar
  7. 7.
    Lynch M (2003) Consequences of children’s exposure to community violence. Clin Child Fam Psychol Rev 6:265–274CrossRefPubMedGoogle Scholar
  8. 8.
    Margolin G, Gordis EB (2000) The effects of family and community violence on children. Annu Rev Psychol 51:445–479CrossRefPubMedGoogle Scholar
  9. 9.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52:1048–1060CrossRefPubMedGoogle Scholar
  10. 10.
    Breslau N, Chilcoat HD, Kessler RC, Davis GC (1999) Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. Am J Psychiatry 156:902–907CrossRefPubMedGoogle Scholar
  11. 11.
    Linehan MM (1993) Cognitive behavioral treatment of borderline personality disorder. Guilford Press, New YorkGoogle Scholar
  12. 12.
    Sansone RA, Sansone LA (2007) Childhood trauma, borderline personality, and eating disorders: a developmental cascade. Eat Disord 15:333–346CrossRefPubMedGoogle Scholar
  13. 13.
    Zanarini MC, Dubo ED, Lewis RE, Williams AA (1997) Childhood factors associated with the development of borderline personality disorder. American Psychiatric Press, WashingtonGoogle Scholar
  14. 14.
    Kessler RC (2000) Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61:4–14PubMedGoogle Scholar
  15. 15.
    Van Asselt ADI, Dirksen CD, Arntz A, Severens JL (2007) The cost of borderline personality disorder: societal cost of illness in BPD-patients. Eur Psychiatry 22:354–361CrossRefPubMedGoogle Scholar
  16. 16.
    Bornovalova MA, Hicks BM, Iacono WG, McGue M (2009) Stability, change, and heritability of borderline personality disorder traits from adolescence to adulthood: a longitudinal twin study. Dev Psychopathol 21:1335–1353PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Perkonigg A, Pfister H, Stein MB et al (2005) Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults. Am J Psychiatry 162:1320–1327CrossRefPubMedGoogle Scholar
  18. 18.
    Gratz KL, Roemer L (2004) Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 26:41–54CrossRefGoogle Scholar
  19. 19.
    Gratz KL, Tull MT (2010) Emotion regulation as a mechanism of change in acceptance-and mindfulness-based treatments. In: Baer RA (ed) Assessing mindfulness and acceptance: illuminating the theory and practice of change. New Harbinger Publications, Oakland, pp 105–133Google Scholar
  20. 20.
    Cloitre M, Miranda R, Stovall-McClough KC, Han H (2005) Beyond PTSD: emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behav Ther 36:119–124CrossRefGoogle Scholar
  21. 21.
    Kim J, Cicchetti D (2010) Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. J Child Psychol Psychiatry 51:706–716PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Calkins SD (1994) Origins and outcomes of individual differences in emotion regulation. Monogr Soc Res Child Dev 59:53–72CrossRefPubMedGoogle Scholar
  23. 23.
    Cole PM, Michel MK, Teti LO (1994) The development of emotion regulation and dysregulation: a clinical perspective. Monogr Soc Res Child Dev 59:73–102CrossRefPubMedGoogle Scholar
  24. 24.
    Thompson RA (1994) Emotion regulation: a theme in search of definition. Monogr Soc Res Child Dev 59:25–52CrossRefPubMedGoogle Scholar
  25. 25.
    Cummings EM, El-Sheikh M, Kouros CD, Buckhalt JA (2009) Children and violence: the role of children’s regulation in the marital aggression–child adjustment link. Clin Child Fam Psychol Rev 12:3–15PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Davies PT, Cummings EM (1998) Exploring children’s emotional security as a mediator of the link between marital relations and child adjustment. Child Dev 69:124–139CrossRefPubMedGoogle Scholar
  27. 27.
    Mennin DS, Heimberg RG, Turk CL, Fresco DM (2005) Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behav Res Ther 43:1281–1310CrossRefPubMedGoogle Scholar
  28. 28.
    Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K (1996) Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol 64:1152–1168CrossRefPubMedGoogle Scholar
  29. 29.
    Kooiman CG, van Rees Vellinga S, Spinhoven P, Draijer N, Trijsburg RW, Rooijmans HGM (2004) Childhood adversities as risk factors for alexithymia and other aspects of affect dysregulation in adulthood. Psychother Psychosom 3:107–116CrossRefGoogle Scholar
  30. 30.
    McLaughlin KA, Hatzenbuehler ML (2009) Mechanisms linking stressful life events and mental health problems in a prospective, community-based sample of adolescents. J Adolesc Health 44:153–160PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    McLaughlin KA, Hatzenbuehler ML, Hilt LM (2009) Emotion dysregulation as a mechanism linking peer victimization to internalizing symptoms in adolescents. J Consult Clin Psychol 77:894–904PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Schwartz D, Proctor LJ (2000) Community violence exposure and children’s social adjustment in the school peer group: the mediating roles of emotion regulation and social cognition. J Consult Clin Psychol 68:670–683CrossRefPubMedGoogle Scholar
  33. 33.
    Frewen PA, Lanius RA (2006) Toward a psychobiology of posttraumatic self-dysregulation. Ann N Y Acad Sci 1071:110–124CrossRefPubMedGoogle Scholar
  34. 34.
    Litz BT, Orsillo SM, Kaloupek D, Weathers F (2000) Emotional processing in posttraumatic stress disorder. J Abnorm Psychol 109:26–39CrossRefPubMedGoogle Scholar
  35. 35.
    Tull MT, Barrett HM, McMillan ES, Roemer L (2007) A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms. Behav Ther 38:303–313CrossRefPubMedGoogle Scholar
  36. 36.
    Gratz KL, Tull MT, Baruch DE, Bornovalova MA, Lejuez CW (2008) Factors associated with co-occurring borderline personality disorder among inner-city substance users: the roles of childhood maltreatment, negative affect intensity/reactivity, and emotion dysregulation. Compr Psychiatry 49:603–615CrossRefPubMedGoogle Scholar
  37. 37.
    Putnam KM, Silk KR (2005) Emotion dysregulation and the development of borderline personality disorder. Dev Psychopathol 17:899–925CrossRefPubMedGoogle Scholar
  38. 38.
    Weiss NH, Tull MT, Anestis MD, Gratz KL (2013) The relative and unique contributions of emotion dysregulation and impulsivity to posttraumatic stress disorder among substance dependent inpatients. Drug Alcohol Depend 128:45–51PubMedCentralCrossRefPubMedGoogle Scholar
  39. 39.
    Weiss NH, Tull MT, Viana AG, Anestis MD, Gratz KL (2012) Impulsive behaviors as an emotion regulation strategy: examining associations between PTSD, emotion dysregulation, and impulsive behaviors among substance dependent inpatients. J Anxiety Disord 26:453–458PubMedCentralCrossRefPubMedGoogle Scholar
  40. 40.
    Bornovalova MA, Gratz KL, Daughters SB et al (2008) A multimodal assessment of the relationship between emotion dysregulation and borderline personality disorder among inner-city substance users in residential treatment. J Psychiatr Res 42:717–726CrossRefPubMedGoogle Scholar
  41. 41.
    Gratz KL, Rosenthal MZ, Tull MT, Lejuez CW, Gunderson JG (2006) An experimental investigation of emotion dysregulation in borderline personality disorder. J Abnorm Psychol 115:850–855CrossRefPubMedGoogle Scholar
  42. 42.
    Glenn CR, Klonsky ED (2009) Emotion dysregulation as a core feature of borderline personality disorder. J Pers Disord 23:20–28CrossRefPubMedGoogle Scholar
  43. 43.
    Fossati A, Gratz KL, Maffei C, Borroni S (2013) Emotion dysregulation and impulsivity additively predict borderline personality disorder features in Italian nonclinical adolescents. Personal Mental Health 7:320–333CrossRefGoogle Scholar
  44. 44.
    Gratz KL, Latzman RD, Tull MT, Reynolds EK, Lejuez CW (2011) Exploring the association between emotional abuse and childhood borderline personality features: the moderating role of personality traits. Behav Ther 42:493–508PubMedCentralCrossRefPubMedGoogle Scholar
  45. 45.
    Gratz KL, Tull MT, Reynolds EK et al (2009) Extending extant models of the pathogenesis of borderline personality disorder to childhood borderline personality symptoms: the roles of affective dysfunction, disinhibition, and self- and emotion-regulation deficits. Dev Psychopathol 21:1263–1291PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Weiss NH, Tull MT, Lavender J, Gratz KL (2013) Role of emotion dysregulation in the relationship between childhood abuse and probable PTSD in a sample of substance abusers. Child Abuse Negl 37:944–954CrossRefPubMedGoogle Scholar
  47. 47.
    Gaher RM, Hofman NL, Simons JS, Hunsaker R (2013) Emotion regulation deficits as mediators between trauma exposure and borderline symptoms. Cognit Ther Res 37:1–10CrossRefGoogle Scholar
  48. 48.
    van Dijke A, Ford JD, van Son M, Frank L, van der Hart O (2013) Association of childhood-trauma-by-primary caregiver and affect dysregulation with borderline personality disorder symptoms in adulthood. Psychol Trauma Theory Res Pract Policy 5:217–224CrossRefGoogle Scholar
  49. 49.
    American Psychological Association (2002) Developing adolescents: A reference for professionals. American Psychological Association, Washington, DCGoogle Scholar
  50. 50.
    World Health Organization (2014) Adolescent development.
  51. 51.
    Havens JF, Gudiño OG, Biggs EA, Diamond UN, Weis JR, Cloitre M (2012) Identification of trauma exposure and PTSD in adolescent psychiatric inpatients: an exploratory study. J Trauma Stress 25:171–178PubMedCentralCrossRefPubMedGoogle Scholar
  52. 52.
    Muller RT, Goebel-Fabbri AE, Diamond T, Dinklage D (2000) Social support and the relationship between family and community violence exposure and psychopathology among high risk adolescents. Child Abuse Negl 24:449–464CrossRefPubMedGoogle Scholar
  53. 53.
    Perez J, Venta A, Garnaat S, Sharp C (2012) The Difficulties in Emotion Regulation Scale: factor structure and association with nonsuicidal self-injury in adolescent inpatients. J Psychopathol Behav Assess 34:393–404CrossRefGoogle Scholar
  54. 54.
    Schramm AT, Venta A, Sharp C (2013) The role of experiential avoidance in the association between borderline features and emotion regulation in adolescents. Personal Disord Theory Res Treat 4:138–144CrossRefGoogle Scholar
  55. 55.
    Sharp C, Pane H, Ha C et al (2011) Theory of mind and emotion regulation difficulties in adolescents with borderline traits. J Am Acad Child Adolesc Psychiatry 50:563–573CrossRefPubMedGoogle Scholar
  56. 56.
    Lipschitz DS, Winegar RK, Hartnick E, Foote B, Southwick SM (1999) Posttraumatic stress disorder in hospitalized adolescents: psychiatric comorbidity and clinical correlates. J Am Acad Child Adolesc Psychiatry 38:385–392CrossRefPubMedGoogle Scholar
  57. 57.
    Zatzick DF, Grossman DC, Russo J et al (2006) Predicting posttraumatic stress symptoms longitudinally in a representative sample of hospitalized injured adolescents. J Am Acad Child Adolesc Psychiatry 45:1188–1195CrossRefPubMedGoogle Scholar
  58. 58.
    Venta A, Kenkel-Mikelonis R, Sharp C (2012) A preliminary study of the relation between trauma symptoms and emerging BPD in adolescent inpatients. Bull Menninger Clin 76:130–146CrossRefPubMedGoogle Scholar
  59. 59.
    Tolin DF, Foa EB (2006) Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull 132:959–992CrossRefPubMedGoogle Scholar
  60. 60.
    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  61. 61.
    Sansone RA, Sansone LA (2011) Gender patterns in borderline personality disorder. Innov Clin Neurosci 8:16–20PubMedCentralPubMedGoogle Scholar
  62. 62.
    Singer MI, Anglin TM, yu Song L, Lunghofer L (1995) Adolescents’ exposure to violence and associated symptoms of psychological trauma. J Am Med Assoc 273:477–482CrossRefGoogle Scholar
  63. 63.
    Neumann A, van Lier PA, Gratz KL, Koot HM (2010) Multidimensional assessment of emotion regulation difficulties in adolescents using the Difficulties in Emotion Regulation Scale. Assessment 17:138–149CrossRefPubMedGoogle Scholar
  64. 64.
    Walpole B, Dettmer E, Morrongiello B, McCrindle B, Hamilton J (2011) Motivational Interviewing as an intervention to increase adolescent self-efficacy and promote weight loss: methodology and design. BMC Public Health 11:459PubMedCentralCrossRefPubMedGoogle Scholar
  65. 65.
    Weinberg A, Klonsky ED (2009) Measurement of emotion dysregulation in adolescents. Psychol Assess 21:616–621CrossRefPubMedGoogle Scholar
  66. 66.
    Gratz KL, Bornovalova MA, Delany-Brumsey A, Nick B, Lejuez CW (2007) A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: the role of emotional nonacceptance. Behav Ther 38:256–268CrossRefPubMedGoogle Scholar
  67. 67.
    Vasilev CA, Crowell SE, Beauchaine TP, Mead HK, Gatzke-Kopp LM (2009) Correspondence between physiological and self-report measures of emotion dysregulation: a longitudinal investigation of youth with and without psychopathology. J Child Psychol Psychiatry 50:1357–1364CrossRefPubMedGoogle Scholar
  68. 68.
    Foa EB, Johnson KM, Feeny NC, Treadwell KRH (2001) The Child PTSD Symptom Scale: a preliminary examination of its psychometric properties. J Clin Child Psychol 30:376–384CrossRefPubMedGoogle Scholar
  69. 69.
    Ruscio AM, Ruscio J, Keane TM (2002) The latent structure of posttraumatic stress disorder: a taxometric investigation of reactions to extreme stress. J Abnorm Psychol 111:290–301CrossRefPubMedGoogle Scholar
  70. 70.
    Forbes D, Haslam N, Williams BJ, Creamer M (2005) Testing the latent structure of posttraumatic stress disorder: a taxometric study of combat veterans. J Trauma Stress 18:647–656CrossRefPubMedGoogle Scholar
  71. 71.
    Broman-Fulks JJ, Ruggiero KJ, Green BA et al (2006) Taxometric investigation of PTSD: data from two nationally representative samples. Behav Ther 37:364–380CrossRefPubMedGoogle Scholar
  72. 72.
    Crick NR, Murray-Close D, Woods K (2005) Borderline personality features in childhood: a short-term longitudinal study. Dev Psychopathol 17:1051–1070CrossRefPubMedGoogle Scholar
  73. 73.
    Morey LC (1991) The Personality Assessment Inventory professional manual. Psychological Assessment Resources, OdessaGoogle Scholar
  74. 74.
    Muthén LK, Muthén BO (2004) Mplus Version 3.13. Muthen & Muthen, Los Angeles, CAGoogle Scholar
  75. 75.
    Linehan MM, Schmidt H, Dimeff LA, Craft JC, Kanter J, Comtois KA (1999) Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. Am J Addict 8:279–292CrossRefPubMedGoogle Scholar
  76. 76.
    Dimeff LA, Rizvi SL, Brown MZ, Linehan MM (2000) Dialectical behavior therapy for substance abuse: a pilot application to methamphetamine-dependent women with borderline personality disorder. Cogn Behav Pract 7:457–468CrossRefGoogle Scholar
  77. 77.
    Safer DL, Telch CF, Agras WS (2001) Dialectical behavior therapy for bulimia nervosa. Am J Psychiatry 158:632–634CrossRefPubMedGoogle Scholar
  78. 78.
    Telch CF, Agras WS, Linehan MM (2001) Dialectical behavior therapy for binge eating disorder. J Consult Clin Psychol 69:1061–1065CrossRefPubMedGoogle Scholar
  79. 79.
    Lynch TR (2000) Treatment of elderly depression with personality disorder comorbidity using dialectical behavior therapy. Cogn Behav Pract 7:468–477CrossRefGoogle Scholar
  80. 80.
    Lynch TR, Morse JQ, Mendelson T, Robins CJ (2003) Dialectical behavior therapy for depressed older adults: a randomized pilot study. Am J Geriatr Psychiatry 11:33–45CrossRefPubMedGoogle Scholar
  81. 81.
    Harned MS, Korslund KE, Foa EB, Linehan MM (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. Behav Res Ther 50:381–386PubMedCentralCrossRefPubMedGoogle Scholar
  82. 82.
    Miller AL, Rathus JH, DuBose AP, Dexter-Mazza ET, Goldklang AR (2007) Dialectical behavior therapy for adolescents. Guilford Press, New YorkGoogle Scholar
  83. 83.
    Fleischhaker C, Böhme R, Sixt B, Brück C, Schneider C, Schulz E (2011) Dialectical Behavioral Therapy for Adolescents (DBT-A): a clinical trial for patients with suicidal and self-injurious behavior and borderline symptoms with a one-year follow-up. Child Adolesc Psychiatry Ment Health 5:3PubMedCentralCrossRefPubMedGoogle Scholar
  84. 84.
    Miller AL, Wyman SE, Huppert JD, Glassman SL, Rathus JH (2000) Analysis of behavioral skills utilized by suicidal adolescents receiving dialectical behavior therapy. Cogn Behav Pract 7:183–187CrossRefGoogle Scholar
  85. 85.
    James AC, Taylor A, Winmill L, Alfoadari K (2008) A preliminary community study of Dialectical Behaviour Therapy (DBT) with adolescent females demonstrating persistent, deliberate self-harm (DSH). Child Adolesc Mental Health 13:148–152CrossRefGoogle Scholar
  86. 86.
    James AC, Winmill L, Anderson C, Alfoadari K (2011) A preliminary study of an extension of a community dialectic behaviour therapy (DBT) programme to adolescents in the looked after care system. Child Adolesc Mental Health 16:9–13CrossRefGoogle Scholar
  87. 87.
    Woodberry KA, Popenoe EJ (2008) Implementing dialectical behavior therapy with adolescents and their families in a community outpatient clinic. Cogn Behav Pract 15:277–286CrossRefGoogle Scholar
  88. 88.
    Gratz KL, Gunderson JG (2006) Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behav Ther 37:25–35CrossRefPubMedGoogle Scholar
  89. 89.
    Gratz KL, Tull MT (2011) Extending research on the utility of an adjunctive emotion regulation group therapy for deliberate self-harm among women with borderline personality pathology. Personal Disord Theory Res Treat 2:316–326CrossRefGoogle Scholar
  90. 90.
    Breslau N, Davis GC, Andreski P, Peterson EL, Schultz LR (1997) Sex differences in posttraumatic stress disorder. Arch Gen Psychiatry 54:1044–1048CrossRefPubMedGoogle Scholar
  91. 91.
    Breslau N (2001) Gender differences in trauma and posttraumatic stress disorder. J Gend Specif Med 5:34–40Google Scholar
  92. 92.
    Zanarini MC, Frankenburg FR, Reich DB, Marino MF, Haynes MC, Gunderson JG (1999) Violence in the lives of adult borderline patients. J Nerv Ment Dis 187:65–71CrossRefPubMedGoogle Scholar
  93. 93.
    Bornovalova MA, Lejuez CW, Daughters SB, Rosenthal MZ, Lynch TR (2005) Impulsivity as a common process across borderline personality and substance use disorders. Clin Psychol Rev 25:790–812CrossRefPubMedGoogle Scholar
  94. 94.
    Lemos-Miller A, Kearney CA (2006) Depression and ethnicity as intermediary variables among dissociation, trauma-related cognitions, and PTSD symptomatology in youths. J Nerv Ment Dis 194:584–590CrossRefPubMedGoogle Scholar
  95. 95.
    Carlson EA, Egeland B, Sroufe LA (2009) A prospective investigation of the development of borderline personality symptoms. Dev Psychopathol 21:1311–1334CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Kelly E. Buckholdt
    • 1
    • 2
  • Nicole H. Weiss
    • 3
  • John Young
    • 4
  • Kim L. Gratz
    • 1
  1. 1.Department of PsychiatryUniversity of Mississippi Medical CenterJacksonUSA
  2. 2.Psychology DivisionG.V. (Sonny) Montgomery VAMCJacksonUSA
  3. 3.Department of PsychiatryYale University School of MedicineNew HavenUSA
  4. 4.Department of PsychologyUniversity of MississippiOxfordUSA

Personalised recommendations