The Role of Identity in the Relationship between PTSD and Executive Functioning
  • * (Excluding Mailing and Handling)

Abstract

Introduction: The developmental period of late adolescence is when significant identity formation takes place, especially for college students (Erikson, 1968). However, traumatic experiences can affect identity development and lead to extreme identity distress. With exposure to trauma, executive functioning can also diminish, leading to a decrease in self-control and greater sensitivity.

Method: Although trauma affects both executive functioning and identity, the possible direct link between identity and executive function has not been adequately explored. Among a college sample (N = 507), those who experienced trauma reported higher levels of identity distress, ruminative identity exploration, and lower levels of executive functioning.

Result: It was hypothesized that identity variables plus PTSD would better predict executive functioning than PTSD alone. The hypothesis was supported, suggesting the incremental validity of using identity in addition to PTSD to predict executive functioning scores.

Conclusion: Implications of this study include the need to consider identity development in the treatment and prevention of PTSD, as well as trauma history, in interventions aimed at promoting positive identity development in youth.

Adams, G.R., Marshall, S.K. (1996). A developmental social psychology of identity: understanding the person-in-context. Journal of Adolescence, 19(5), 429-442.

[http://dx.doi.org/10.1006/jado.1996.0041] [PMID: 9245296]
Alexopoulos, G.S. (2003). Role of executive function in late-life depression. Journal of Clinical Psychiatry, 64 (Suppl. 14), 18-23.
[PMID: 14658931]
Diagnostic and statistical manual of mental disorders. American Psychiatric Association.

[http://dx.doi.org/10.1176/appi.books.9780890425787]
Aupperle, R.L., Melrose, A.J., Stein, M.B., Paulus, M.P. (2012). Executive function and PTSD: Disengaging from trauma. Neuropharmacology, 62(2), 686-694.

[http://dx.doi.org/10.1016/j.neuropharm.2011.02.008] [PMID: 21349277]
Bakaitytė, A., Kaniušonytė, G., Truskauskaitė-Kunevičienė, I., Žukauskienė, R. (2022). Longitudinal Investigation of Posttraumatic Growth in Female Survivors of Intimate Partner Violence: The Role of Event Centrality and Identity Exploration. Journal of Interpersonal Violence, 37(1-2), NP1058-NP1076.

[http://dx.doi.org/10.1177/0886260520920864] [PMID: 32410496]
Baumeister, R.F., Bratslavsky, E., Muraven, M., Tice, D.M. (2018). Ego depletion: Is the active self a limited resource? Self-regulation and self-control. Routledge.

[http://dx.doi.org/10.4324/9781315175775-1]
Biederman, J., Petty, C.R., Fried, R., Black, S., Faneuil, A., Doyle, A.E., Seidman, L.J., Faraone, S.V. (2008). Discordance between psychometric testing and questionnaire-based definitions of executive function deficits in individuals with ADHD. Journal of Attention Disorders, 12(1), 92-102.

[http://dx.doi.org/10.1177/1087054707305111] [PMID: 17934182]
Benjet, C., Bromet, E., Karam, E.G., Kessler, R.C., McLaughlin, K.A., Ruscio, A.M., Shahly, V., Stein, D.J., Petukhova, M., Hill, E., Alonso, J., Atwoli, L., Bunting, B., Bruffaerts, R., Caldas-de-Almeida, J.M., de Girolamo, G., Florescu, S., Gureje, O., Huang, Y., Lepine, J.P., Kawakami, N., Kovess-Masfety, V., Medina-Mora, M.E., Navarro-Mateu, F., Piazza, M., Posada-Villa, J., Scott, K.M., Shalev, A., Slade, T., ten Have, M., Torres, Y., Viana, M.C., Zarkov, Z., Koenen, K.C. (2016). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychological Medicine, 46(2), 327-343.

[http://dx.doi.org/10.1017/S0033291715001981] [PMID: 26511595]
Berman, S.L., Montgomery, M.J., Kurtines, W.M. (2004). The development and validation of a measure of identity distress. Identity, 4(1), 1-8.

[http://dx.doi.org/10.1207/S1532706XID0401_1]
Berman, S.L., Montgomery, M.J., Ratner, K. (2020). Trauma and identity: A reciprocal relationship? Journal of Adolescence, 79(1), 275-278.

[http://dx.doi.org/10.1016/j.adolescence.2020.01.018] [PMID: 32036171]
Bernard, J.D., Whittles, R.L., Kertz, S.J., Burke, P.A. (2015). Trauma and event centrality: Valence and incorporation into identity influence well-being more than exposure. Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 11-17.

[http://dx.doi.org/10.1037/a0037331] [PMID: 25793588]
Berntsen, D., Rubin, D.C. (2006). The centrality of event scale: A measure of integrating a trauma into one’s identity and its relation to post-traumatic stress disorder symptoms. Behaviour Research and Therapy, 44(2), 219-231.

[http://dx.doi.org/10.1016/j.brat.2005.01.009] [PMID: 16389062]
Blevins, C.A., Weathers, F.W., Davis, M.T., Witte, T.K., Domino, J.L. (2015). The posttraumatic stress disorder checklist for DSM‐5 (PCL‐5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489-498.

[http://dx.doi.org/10.1002/jts.22059] [PMID: 26606250]
Boykin, D.M., Anyanwu, J., Calvin, K., Orcutt, H.K. (2020). The moderating effect of psychological flexibility on event centrality in determining trauma outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 12(2), 193-199.

[http://dx.doi.org/10.1037/tra0000490] [PMID: 31282720]
Brewin, C.R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R.A., Humayun, A., Jones, L.M., Kagee, A., Rousseau, C., Somasundaram, D., Suzuki, Y., Wessely, S., van Ommeren, M., Reed, G.M. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical Psychology Review, 58, 1-15.

[http://dx.doi.org/10.1016/j.cpr.2017.09.001] [PMID: 29029837]
Briere, J.N., Scott, C. (2015). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. Sage Publications..
Channon, S., Green, P.S.S. (1999). Executive function in depression: the role of performance strategies in aiding depressed and non-depressed participants. Journal of Neurology, Neurosurgery and Psychiatry, 66(2), 162-171.

[http://dx.doi.org/10.1136/jnnp.66.2.162] [PMID: 10071094]
Dunkin, J.J., Leuchter, A.F., Cook, I.A., Kasl-Godley, J.E., Abrams, M., Rosenberg-Thompson, S. (2000). Executive dysfunction predicts nonresponse to fluoxetine in major depression. Journal of Affective Disorders, 60(1), 13-23.

[http://dx.doi.org/10.1016/S0165-0327(99)00157-3] [PMID: 10940443]
Erikson, E.H. (1963). Childhood and Society. (2nd ed.). New York: Norton.
Erikson, E.H. (1968). Identity: youth and crisis.. Oxford, England: Norton.
Ertorer, S.E. (2014). Managing identity in the face of resettlement. Identity, 14(4), 268-285.

[http://dx.doi.org/10.1080/15283488.2014.944695]
Faria, C.A., Alves, H.V.D., Charchat-Fichman, H. (2015). The most frequently used tests for assessing executive functions in aging. Dementia and Neuropsychologia, 9(2), 149-155.

[http://dx.doi.org/10.1590/1980-57642015DN92000009] [PMID: 29213956]
Fossati, P., Ergis, A.M., Allilaire, J.F. (2002). Executive functioning in unipolar depression: a review. Encephale, 28(2), 97-107.
[PMID: 11972136]
Fitzgerald, J.M., Berntsen, D., Broadbridge, C.L. (2016). The influences of event centrality in memory models of PTSD. Applied Cognitive Psychology, 30(1), 10-21.

[http://dx.doi.org/10.1002/acp.3160]
George, L.S., Park, C.L., Chaudoir, S.R. (2016). Examining the relationship between trauma centrality and posttraumatic stress disorder symptoms: A moderated mediation approach. Traumatology, 22(2), 85-93.

[http://dx.doi.org/10.1037/trm0000063] [PMID: 27458331]
Goldstein, R.B., Smith, S.M., Chou, S.P., Saha, T.D., Jung, J., Zhang, H., Pickering, R.P., Ruan, W.J., Huang, B., Grant, B.F. (2016). The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Social Psychiatry and Psychiatric Epidemiology., 51(8), 1137-1148.

[http://dx.doi.org/10.1007/s00127-016-1208-5] [PMID: 27106853]
Grissom, N.M., Reyes, T.M. (2019). Let’s call the whole thing off: evaluating gender and sex differences in executive function. Neuropsychopharmacology, 44(1), 86-96.

[http://dx.doi.org/10.1038/s41386-018-0179-5] [PMID: 30143781]
Gur, R.C., Richard, J., Calkins, M.E., Chiavacci, R., Hansen, J.A., Bilker, W.B., Loughead, J., Connolly, J.J., Qiu, H., Mentch, F.D., Abou-Sleiman, P.M., Hakonarson, H., Gur, R.E. (2012). Age group and sex differences in performance on a computerized neurocognitive battery in children age 8−21. Neuropsychology, 26(2), 251-265.

[http://dx.doi.org/10.1037/a0026712] [PMID: 22251308]
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.

[http://dx.doi.org/10.1001/archpsyc.62.6.593] [PMID: 15939837]
Kira, I.A., Alpay, E.H., Turkeli, A., Shuwiekh, H.A.M., Ashby, J.S., Alhuwailah, A. (2021). The effects of COVID-19 traumatic stress on executive functions: The case of Syrian refugees in Turkey. Journal of Loss and Trauma, 26(7), 666-687.

[http://dx.doi.org/10.1080/15325024.2020.1869444]
Kira, I.A., Shuweikh, H., Al-Huwailiah, A., El-wakeel, S.A., Waheep, N.N., Ebada, E.E., Ibrahim, E.S.R. (2022). The direct and indirect impact of trauma types and cumulative stressors and traumas on executive functions. Applied Neuropsychology: Adult, 29(5), 1078-1094.

[http://dx.doi.org/10.1080/23279095.2020.1848835] [PMID: 33245250]
Konner, M. (2007). Trauma, Adaptation, and Resilience: A Cross-Cultural and Evolutionary Perspective. Cambridge University Press..

[http://dx.doi.org/10.1017/CBO9780511500008.021]
Kramer, L.B., Whiteman, S.E., Witte, T.K., Silverstein, M.W., Weathers, F.W. (2020). From trauma to growth: The roles of event centrality, posttraumatic stress symptoms, and deliberate rumination. Traumatology, 26(2), 152-159.

[http://dx.doi.org/10.1037/trm0000214]
Luyckx, K., Goossens, L., Soenens, B. (2006). A developmental contextual perspective on identity construction in emerging adulthood: Change dynamics in commitment formation and commitment evaluation. Developmental Psychology, 42(2), 366-380.

[http://dx.doi.org/10.1037/0012-1649.42.2.366] [PMID: 16569174]
Luyckx, K., Schwartz, S.J., Berzonsky, M.D., Soenens, B., Vansteenkiste, M., Smits, I., Goossens, L. (2008). Dimensions of identity development scale. Journal of Adolescent Health, 43, 451-458.

[http://dx.doi.org/10.1016/j.jadohealth.2008.04.005] [PMID: 18848673]
Marcia, J.E. (1966). Development and validation of ego-identity status. Journal of Personality and Social Psychology, 3(5), 551-558.

[http://dx.doi.org/10.1037/h0023281] [PMID: 5939604]
Marcia, J.E. (2001). A commentary on seth schwartz’s, review of identity theory and research. Identity, 1(1), 59-65.

[http://dx.doi.org/10.1207/S1532706XMARCIA]
Merrill, N., Waters, T.E.A., Fivush, R. (2016). Connecting the self to traumatic and positive events: links to identity and well-being. Memory, 24(10), 1321-1328.

[http://dx.doi.org/10.1080/09658211.2015.1104358] [PMID: 26512915]
Morris, B.A., Campbell, M., Dwyer, M., Dunn, J., Chambers, S.K. (2011). Survivor identity and post-traumatic growth after participating in challenge-based peer-support programmes. British Journal of Health Psychology, 16(3), 660-674.

[http://dx.doi.org/10.1348/2044-8287.002004] [PMID: 21199541]
Norvilitis, J.M., Reid, H.M. (2002). Evidence for an association between gender-role identity and a measure of executive function. Psychological Reports, 90(1), 35-45.

[http://dx.doi.org/10.2466/pr0.2002.90.1.35] [PMID: 11899009]
Polak, A.R., Witteveen, A.B., Reitsma, J.B., Olff, M. (2012). The role of executive function in posttraumatic stress disorder: A systematic review. Journal of Affective Disorders, 141(1), 11-21.

[http://dx.doi.org/10.1016/j.jad.2012.01.001] [PMID: 22310036]
Salthouse, T.A. (2005). Relations between cognitive abilities and measures of executive functioning. Neuropsychology, 19(4), 532-545.

[http://dx.doi.org/10.1037/0894-4105.19.4.532] [PMID: 16060828]
Sandole, D.H., Auerbach, C.F. (2013). Dissociation and identity transformation in female survivors of the genocide against the Tutsi in Rwanda: a qualitative research study. Journal of Trauma and Dissociation, 14(2), 127-137.

[http://dx.doi.org/10.1080/15299732.2013.724345] [PMID: 23406218]
Scott, B.G., Sanders, A.F.P., Graham, R.A., Banks, D.M., Russell, J.D., Berman, S.L., Weems, C.F. (2014). Identity distress among youth exposed to natural disasters: Associations with level of exposure, posttraumatic stress, and internalizing problems. Identity, 14(4), 255-267.

[http://dx.doi.org/10.1080/15283488.2014.944697] [PMID: 25505851]
Shanahan, M.J., Pychyl, T.A. (2007). An ego identity perspective on volitional action: Identity status, agency, and procrastination. Personality and Individual Differences, 43(4), 901-911.

[http://dx.doi.org/10.1016/j.paid.2007.02.013]
Sippel, L.M., Pietrzak, R.H., Charney, D.S., Mayes, L.C., Southwick, S.M. (2015). How does social support enhance resilience in the trauma-exposed individual? Ecology and Society, 20(4), art10.

[http://dx.doi.org/10.5751/ES-07832-200410]
Solomon, D.T., Combs, E.M., Allen, K., Roles, S., DiCarlo, S., Reed, O., Klaver, S.J. (2021). The impact of minority stress and gender identity on PTSD outcomes in sexual minority survivors of interpersonal trauma. Psychology and Sexuality, 12(1-2), 64-78.

[http://dx.doi.org/10.1080/19419899.2019.1690033]
Southwick, S.M., Bonanno, G.A., Masten, A.S., Panter-Brick, C., Yehuda, R. (2014). Resilience definitions, theory, and challenges: interdisciplinary perspectives. European Journal of Psychotraumatology, 5(1), 25338.

[http://dx.doi.org/10.3402/ejpt.v5.25338] [PMID: 25317257]
Van der Elst, W., Ouwehand, C., van der Werf, G., Kuyper, H., Lee, N., Jolles, J. (2012). The Amsterdam Executive Function Inventory (AEFI): Psychometric properties and demographically corrected normative data for adolescents aged between 15 and 18 years. Journal of Clinical and Experimental Neuropsychology, 34(2), 160-171.

[http://dx.doi.org/10.1080/13803395.2011.625353] [PMID: 22111557]
Van der Kolk, B.A. (2003). Psychological Trauma. Van Haren Publishing.
Wamser-Nanney, R., Howell, K.H., Schwartz, L.E., Hasselle, A.J. (2018). The moderating role of trauma type on the relationship between event centrality of the traumatic experience and mental health outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, , 10(5), 499-507.

[http://dx.doi.org/10.1037/tra0000344] [PMID: 29154596]
Watkins, E., Brown, R.G. (2002). Rumination and executive function in depression: an experimental study. Journal of Neurology, Neurosurgery and Psychiatry, 72(3), 400-402.

[http://dx.doi.org/10.1136/jnnp.72.3.400] [PMID: 11861707]
Welsh, M., Schmitt-Wilson, S. (2013). Executive function, identity, and career decision-making in college students. SAGE Open, 3(4)

[http://dx.doi.org/10.1177/2158244013505755]
Wild, J., Gur, R.C. (2008). Verbal memory and treatment response in posttraumatic stress disorder. British Journal of Psychiatry., 193(3), 254-255.

[http://dx.doi.org/10.1192/bjp.bp.107.045922]
Wiley, R.E., Berman, S.L., Marsee, M.A., Taylor, L.K., Cannon, M.F., Weems, C.F. (2011). Age differences and similarities in identity distress following the Katrina disaster: Theoretical and applied implications of Erikson’s theory. Journal of Adult Development., 18(4), 184-191.

[http://dx.doi.org/10.1007/s10804-011-9130-2]
Wisco, B.E., Marx, B.P., Wolf, E.J., Miller, M.W., Southwick, S.M., Pietrzak, R.H. (2014). Posttraumatic stress disorder in the US veteran population: Results from the National Health and Resilience in Veterans Study. The Journal of Clinical Psychiatry, 75(12), 14904. Zheng, Y., & Lawson, T.R. (2015). Identity reconstruction as shiduers: Narratives from Chinese older adults who lost their only child. International Journal of Social Welfare, 24(4), 399-406.

[http://dx.doi.org/10.1111/ijsw.12139]