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Results indicated both traumatic experiences and EI predicted PTS symptoms directly and indirectly, via alexithymia and dis- tress tolerance. Conversely, traumatic experiences and EI pre- dicted antisocial behaviors and both alcohol outcomes directly and indirectly. EI was indirectly related to alcohol-related problems via PTS and antisocial behaviors, regardless of alco- hol consumption. ARTICLE HISTORYReceived 7 February 2018 Accepted 28 March 2018 KEYWORDSTrauma; emotion regulation; posttraumatic stress; antisocial behaviors; alcohol Exposure to traumatic events has been identified as an important risk factor in the development and maintenance of various psychological disorders, including antisocial behaviors (Semiz, Basoglu, Ebrinc, & Cetin,2007), post- traumatic stress (PTS) symptoms (Breslau, Peterson, Poisson, Schultz, & Lucia,2004), and alcohol use and problems (Gaher et al.,2014). Likewise, low levels of emotional intelligence (EI) have also been associated with these nega- tive health outcomes (Claros & Sharma,2012). However, the mechanisms underlying these relationships remain unclear. One hypothesis is that individu- als may experience these negative outcomes due to deficits in emotion regula- tion, which results, in part, from experiencing low levels of EI or a traumatic event. Some facets of emotion regulation of interest in the current study include alexithymia, negative urgency, and distress tolerance.

Individuals with alexithymia traits may have difficulty relating with others, demonstrate little warmth within relationships, and endorse experi- encing high levels of neuroticism, all factors associated with antisocial CONTACTNicole L. Hofman, [email protected] Licensed Psychologist, Co-Director of Psychology Training, St. Cloud VA Healthcare System, St Cloud, MN 56303, USA. 2019 Taylor & Francis Group, LLC JOURNAL OF LOSS AND TRAUMA 2019, VOL. 24, NO. 3, 197–212 https://doi.org/10.1080/15325024.2018.1460528 behaviors (Mayer, DiPaolo, & Salovey,1990), PTS symptoms (Breslau & Schultz,2013), and alcohol-related problems (Littlefield, Sher, & Wood, 2010). Similarly, individuals with alexithymia are more likely to be impul- sive and act“before thinking”(Shishido, Gaher, & Simons,2013), which may in turn influence antisocial behaviors and alcohol consumption.

Therefore, alexithymia may represent an important, yet understudied, risk factor for the development of antisocial behaviors, PTS symptoms, and alcohol use and related problems following exposure to potentially trau- matic events.

A facet of impulsivity, negative urgency, is particularly relevant with regard to the development and maintenance of psychopathology. Negative urgency refers to the tendency to act impulsively as a means of regulating negative affect (Whiteside & Lynam,2001). In general, results from various studies suggest negative urgency is associated with increased engagement in antisocial behavior (Caspi et al.,1998), PTS symptoms (Weiss, Tull, Anestis, & Gratz,2013), and alcohol use. Thus, individuals may be more inclined to engage in antisocial behaviors, use alcohol, or experience PTS symptoms as a result, in part, of negative urgency.

Finally, distress tolerance refers to an individual’s ability to endure emo- tional distress (Simons & Gaher,2005). The concept of distress tolerance was first introduced to partially explain symptoms of borderline personality disorder and it was hypothesized that low distress tolerance may contribute to engagement in maladaptive and impulsive behaviors. Hence, the symp- toms of PTS, antisocial behaviors, and alcohol use and related problems, may be caused in part by difficulties associated with low tolerance of emo- tional distress, and the function of these symptoms may be to then avoid or regulate negative affect (Vujanovic et al.,2013). Thus, distress tolerance may also play an important role in the development of antisocial behaviors, PTS symptoms, and problematic alcohol use.

Current study Exposure to potentially traumatic events, subsequent emotional regulation difficulties, and the protective role of trait EI, have been examined indi- vidually with regard to antisocial behaviors, alcohol use, and PTS; however, the interrelationships among these facets of emotion regulation and symp- toms, has yet to be examined. As such, this study evaluated the mediating roles of alexithymia, negative urgency, and distress tolerance, in the rela- tionship between both traumatic experiences and EI, and four health- related outcomes: antisocial behaviors, PTS, alcohol use, and alcohol-related problems via structural equation modeling.

198 N. L. HOFMAN ET AL. Methods Participants Participants included 561 undergraduate college students from a Midwestern university. The sample ranged from 18 to 25 years of age (M¼19.74, SD¼1.50). A majority of the sample was female (69%). With regard to race, 93% identified as White, 2% as African American, 1% as Asian, 1% as Latino or Hispanic, 1% as Multiracial, 1% as another race or ethnicity, and 1% chose not to respond. In addition, this data set has been described previously (Gaher, Hofman, Simons, & Hunsaker,2013). Participants were recruited via a university subject pool and college students between the ages of 18 and 25 were eligible to participate. Participants received partial course credit in speci- fied courses as compensation for volunteering. All questionnaires were com- pleted online and were anonymous. The current study’sprocedureswere approved by the university’s institutional review board.

Measures Negative affect Negative affect was assessed using the Positive and Negative Affect Schedule (PANAS: Watson, Clark, & Tellegen,1988). Total scores were utilized within the structural model analyses. In the current sample, the Cronbach’s alpha was .88.

Trauma history Trauma history was assessed using the Trauma History Questionnaire (THQ; Green,1996). Within the structural model, the total number of events was used as the measure of exposure to traumatic events.

Emotional intelligence Emotional intelligence was assessed using the Emotional Intelligence Scale (EIS; Schutte et al.,1998). The total score was used as the measure of EI within the structural model. The Cronbach’s alpha in this sample was .92.

Alexithymia Alexithymia was assessed utilizing the Toronto Alexithymia Scale–20 (TAS-20; Bagby, Parker, & Taylor,1994). Scores for each of the subscales were utilized as latent indicators of alexithymia. The Cronbach’s alpha within this sample was .85.

Distress tolerance Distress tolerance was assessed using the Distress Tolerance Scale (DTS; Simons & Gaher,2005). Within the structural model, the latent variable JOURNAL OF LOSS AND TRAUMA 199 was composed of the four subscales. Cronbach’s alpha in this sample was .92.

Negative urgency Negative urgency was assessed using the Negative Urgency subscale of the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation-Seeking (UPPS) Impulsive Behavior Scale (Whiteside & Lynam,2001). In the meas- urement and structural model, negative urgency was composed of three item parcels as recommended by Little, Cunningham, Shahar, and Widaman (2002). The Cronbach’s alpha for this sample was .87.

PTS symptoms PTS symptoms were assessed using the Posttraumatic Stress Disorder Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane,1993). The latent construct was comprised of the hyperarousal, avoidance, and reexperienc- ing subscales; the Cronbach’s alpha was .94 in this sample.

Antisocial behaviors Antisocial behaviors were assessed via the Personality Assessment Inventory–Antisocial Scale (PAI-ANT; Morey,1991). The latent construct was comprised of items from the three subscales and the Cronbach alpha’s within this sample was .87.

Alcohol use Average weekly alcohol use was assessed via the Daily Drinking Questionnaire (DDQ; Collins, Parks, & Marlatt,1985). Within the struc- tural model, total number of drinks over the seven-day period was used as an indicator of alcohol use.

Alcohol problems Alcohol problems were assessed using the Young Adult Alcohol Consequences Questionnaire (YAACQ; Read, Kahler, Strong, & Colder, 2006). The total score was used to estimate alcohol-related problems. The Cronbach’s alpha in this sample was .95.

Results Descriptive statistics Descriptive statistics are inTable 1. Seventy-eight percent of participants (N¼440) endorsed experiencing at least one traumatic event in their 200 N. L. HOFMAN ET AL. lifetime. Fifty-six percent of participants (N¼313) experienced more than two traumatic events. The most common events included seeing dead bodies (21%), serious accidents (18%), natural disasters (18%), seeing some- one injured or killed (16%), or sexual assault (11%). With regard to anti- social behaviors, 13% of participants had a T-score higher than 65, which is one standard deviation above the mean. Twenty-five percent of partici- pants reported drinking at least 15 drinks in a typical week. Correlations among variables included in the Measurement Model can be found in Table 2.

Statistical analysis of the hypothesized model Measurement model The hypothesized measurement model contained 16 observed variables as indicators of five latent variables; alexithymia, negative urgency, distress tol- erance, PTS symptoms, and antisocial behaviors. The fit of the measure- ment model was examined following the recommendations of Hu and Bentler (1999). The initial measurement model was an adequate fit to the data (x 2[94,N¼561]¼317.10,p<.001, RMSEA = .07, CFI =0.95, SRMR =0.04). The model was revised based on inspection of modification indices and factor loadings. This resulted in removal of the externally oriented sub- scale from the TAS, which had a weak loading with alexithymia and sub- stantial cross-loadings with EI. In addition, two correlated errors with modification indices of>19 were freed. Thus, the DTS Tolerance subscale was correlated with the Absorption subscale, as were the DTS Tolerance and Regulation subscales. These changes resulted in an improved fit of the model (x 2[78,N¼561]¼232.53,p<.001, RMSEA =0.06, CFI =0.97, SRMR =0.03). Structural model The structural model was tested utilizing Mplus Version 7.0 (Muthen & Muthen,2012) with maximum likelihood estimation with robust Table 1.Descriptive statistics.

Variable Mean (SD) Range Trauma History 2.30 (2.11) 0–11 Emotional Intelligence 103.39 (13.61) 44–138 Negative Affect 22.09 (7.19) 10–45 Alexithymia 52.35 (9.48) 22.9–82 Negative Urgency 28.92 (5.48) 15.9–46.2 Distress Tolerance 3.44 (.813) 1–5 PTSD Symptoms 34.31 (14.11) 17–82 Antisocial Behaviors 50.00 (10.00) 27.3–99.06 Alcohol-Related Problems 10.21 (10.00) 0–42.56 Alcohol Use 9.74 (11.59) 0–66 JOURNAL OF LOSS AND TRAUMA 201 Table 2.Correlation matrix of measurement model (N¼561). Variable1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19.

1. PTSD 2. Reexp .90 ‡ 3. Avoid .94 ‡ .77‡ 4. Arousal .89 ‡ .69‡ .76‡ 5. ASB .34 ‡ .25‡ .33‡ .34‡ 6. Beh .06 .08 .06 .02 .52 ‡ 7. Ego .34 ‡ .24‡ .35‡ .34‡ .82‡ .15‡ 8. SS .32 ‡ .22‡ .30‡ .36‡ .87‡ .18‡ .64‡ 9. Urgency .52 ‡ .47‡ .45‡ .50‡ .38‡ .16§ .30‡ .38‡ 10. Parcel 1 .48 ‡ .43‡ .42‡ .46‡ .39‡ .11§ .33‡ .39‡ .92‡ 11. Parcel 2 .50 ‡ .46‡ .45‡ .47‡ .29‡ .13§ .26‡ .30‡ .92‡ .77‡ 12. Parcel 3 .30 ‡ .28‡ .24‡ .32‡ .32‡ .19‡ .14§ .27‡ .69‡ .49‡ .48‡ 13. Alexi .51 ‡ .44‡ .50‡ .45‡ .27§ .08 .23 ‡ .19‡ .46‡ .42‡ .42‡ .27‡ 14. DI .57 ‡ .51‡ .55‡ .51‡ .22‡ .03 .24 ‡ .19‡ .50‡ .47‡ .47‡ .26‡ .86‡ 15. DD .43 ‡ .38‡ .42‡ .38‡ .20‡ .09 .18 ‡ .17‡ .35‡ .33‡ .34‡ .20‡ .81‡ .62‡ 16. DTS .59 ‡ .52 ‡ .57 ‡ .51 ‡ .21 ‡ .05 .22 ‡ .19 ‡ .55 ‡ .51 ‡ .51 ‡ .34 ‡ .52 ‡ .57 ‡ .40 ‡ 17. Reg .38 ‡ .34 ‡ .35 ‡ .34 ‡ .14 ‡ .04 .14 § .13 § .41 ‡ .37 ‡ .38 ‡ .28 ‡ .36 ‡ .34 ‡ .29 ‡ .80‡ 18. App .59 ‡ .50 ‡ .58 ‡ .51 ‡ .21 ‡ .01 .25 ‡ .20 ‡ .51 ‡ .50 ‡ .50 ‡ .29 ‡ .50 ‡ .57 ‡ .36 ‡ .92‡ .64‡ 19. Abs .61 ‡ .55 ‡ .57 ‡ .52 ‡ .21 ‡ .08 .21 ‡ .18 ‡ .54 ‡ .54 ‡ .49 ‡ .34 ‡ .51 ‡ .56 ‡ .40 ‡ .89‡ .59‡ .77‡ 20. Tol .44 ‡ .38 ‡ .43 ‡ .38 ‡ .16 ‡ .08 .14 ‡ .12 § .41 ‡ .41 ‡ .39 ‡ .28 ‡ .43 ‡ .45 ‡ .36 ‡ .84‡ .59‡ .66‡ .76‡ Note.05 PTSD: PTSD Symptoms; Reexp: Reexperiencing Symptoms; Avoid: Avoidance Symptoms; Arousal: Hyperarousal Symptoms; ASB: Antisocial Behaviors; Beh: Antisocial Behaviors Subscale; Ego: Egocentricity Subscale; SS: Stimulus Seeking Subscale; Urgency: Negative Urgency; Parcel 1: Negative Urgency Parcel 1; Parcel 2: Negative Urgency Parcel 2; Parcel 3:

Negative Urgency Parcel 3; Alexi: Alexithymia; DI: Difficulty Identifying; DD: Difficulty Describing; DTS: Distress Tolerance; Reg: Regulation;App: Appraisal; Abs: Absorption; Tol: Tolerance. ‡p<.001.§p<.01.

p<.05 202 N. L. HOFMAN ET AL. standard errors. In the full structural model, number of traumatic events, EI, negative affect, and gender served as exogenous variables.

Gender and negative affect were covariates with paths to all outcome variables. The hypothesized model was an adequate fit to the data (x 2[154,N¼561]¼442.76,p<.001, RMSEA =0.06, CFI =0.95, SRMR =0.04). Based on theoretical relationships among specific variables and modification indices, two additional paths were added to the final model, one between number of traumatic events and antisocial behaviors and the other between negative urgency and alcohol-related problems.

The final model was a good fit to the data (x 2[152, N¼561]¼427.13,p <.001, RMSEA =0.06, CFI =0.95, SRMR =0.04). SeeFigure 1. The final model accounted for approximately 63% of variance in PTS symptoms, 32% of variance in antisocial behaviors, 46% of variance in negative urgency, 48% of variance in alexithymia, 51% of variance in distress tol- erance, and 51% of variance in alcohol-related problems. Direct effects In the final model, as hypothesized, EI and exposure to traumatic events had significant direct effects on PTS symptoms and alexithymia. Although not hypothesized, exposure to traumatic events had a significant direct effect on antisocial behaviors. As predicted, alexithymia had significant dir- ect effects on negative urgency, distress tolerance, and PTS symptoms.

Distress tolerance had significant direct effects on negative urgency, but PTS symptoms, contrary to the hypothesis, had no direct effect from Figure 1.Structural model (N¼561). All values are standardized coefficients. Gender and nega- tive affect are in the model, but have been omitted from the figure for clarity. p<.05, p <.01, p<.001. JOURNAL OF LOSS AND TRAUMA 203 distress tolerance to antisocial behaviors. As predicted, negative urgency had a significant direct effect on alcohol use and antisocial behaviors.

Although not hypothesized, negative urgency was also positively associated with alcohol-related problems. In addition, negative urgency was not sig- nificantly associated with PTS symptoms, and PTS symptoms and antisocial behavior did not have significant direct effects on alcohol use. SeeTable 3 andFigure 1.

Indirect effects Indirect effects were tested by calculating the bias-corrected bootstrap con- fidence intervals (MacKinnon, Lockwood, & Williams,2004) and can be found inTable 4andFigure 1. As hypothesized, several risk and resiliency pathways emerged with regard to all outcome variables. Particularly, some notable results emerged within the structural model. For example, with regard to PTS symptoms, exposure to traumatic events and emotional intel- ligence were significant predictors via alexithymia and distress tolerance.

Table 3.Significant total and indirect effects of risk pathways.

Pathway Standardized effect Confidence interval Trauma and PTSD Symptoms Total Effect 0.23 0.17–0.28 Total Indirect Effect 0.07 0.09–0.38 Specific Indirect Effects Via Alexithymia 0.03 0.01–0.05 Via Alexithymia and Distress Tolerance0.03 0.02–0.05 Trauma and Antisocial Behaviors Total Effect 0.17 0.10–0.25 Total Indirect Effect 0.03 0.02–0.05 Specific Indirect Effects Via Alexithymia and Negative Urgency0.02 0.01–0.03 Via Alexithymia, Distress Tolerance, and Negative Urgency0.02 0.01–0.03 Trauma and Alcohol Use Total Effect 0.04 0.11–0.06 Total Indirect Effect 0.04 0.11–0.06 Specific Indirect Effects Via Alexithymia, Distress Tolerance, and Negative Urgency0.01 0.01–0.02 Trauma and Alcohol- Related Problems Total Effect 0.09 0.06–0.15 Total Indirect Effect 0.09 0.06–0.15 Specific Indirect Effects Via Antisocial Behaviors 0.03 0.01–0.06 Via Alexithymia, Distress Tolerance, Negative Urgency, and Alcohol Use0.01 0.01–0.02 Via Alexithymia, Distress Tolerance, Negative Urgency, and Antisocial Behaviors0.01 0.01–0.02 Note. N¼561. Gender is coded 0¼women, 1¼men.

204 N. L. HOFMAN ET AL. However, interestingly, negative urgency was not a significant predictor in the relationship between emotional intelligence, exposure to traumatic events, and PTS symptoms. With regard to alcohol use and antisocial behaviors, additional risk and resiliency pathways emerged. For example, both trauma history and emotional intelligence were indirectly related to these two outcomes via alexithymia and negative urgency as well as alexi- thymia, distress tolerance, and negative urgency. Emotional intelligence and alcohol-related problems were significantly associated via all mediators with the exception of distress tolerance, and these associations were significant over and above alcohol consumption.

Table 4.Significant total and indirect effects of resiliency pathways.

Pathways Standardized effect Confidence interval Emotional Intelligence and PTSD Symptoms Total Effect 0.25 0.32– 0.19 Total Indirect Effect 0.16 0.21– 0.11 Specific Indirect Effect Via Alexithymia 0.07 0.12– 0.20 Via Alexithymia and Distress Tolerance 0.07 0.10– 0.04 Emotional Intelligence and Antisocial Behaviors Total Effect 0.08 0.11– 0.05 Total Indirect Effect 0.08 0.11– 0.05 Specific Indirect Effect Via Alexithymia and Negative Urgency 0.04 0.07– 0.02 Via Alexithymia, Distress Tolerance, and Negative Urgency 0.04 0.06– 0.02 Emotional Intelligence and Alcohol Use Total Effect 0.06 0.08– 0.03 Total Indirect Effect 0.06 0.08– 0.03 Specific Indirect Effect Via Alexithymia and Negative Urgency 0.02 0.04– 0.01 Via Alexithymia, Distress Tolerance, and Negative Urgency 0.02 0.03– 0.01 Emotional Intelligence and Alcohol- Related Problems Total Effect 0.10 0.13– 0.06 Total Indirect Effect 0.10 0.13– 0.06 Specific Indirect Effect Via Alexithymia, Negative Urgency, and Alcohol Use 0.01 0.02– 0.00 Via Alexithymia, Distress Tolerance, Negative Urgency, and Alcohol Use 0.01 0.02– 0.00 Via Alexithymia, Distress Tolerance, Negative Urgency, and Antisocial Behaviors 0.01 0.01– 0.00 Via Alexithymia, Distress Tolerance, and PTSD Symptoms 0.01 0.02– 0.00 Via Alexithymia, Negative Urgency, and Antisocial Behaviors 0.01 0.02– 0.00 Note. N¼561. Gender is coded 0¼women, 1¼men. JOURNAL OF LOSS AND TRAUMA 205 Discussion The results of this study demonstrate the importance of emotional regula- tion in the development of and maintenance of various health outcomes, including PTS symptoms, antisocial behaviors, alcohol use, and related problems. Specifically, results suggest that certain aspects of emotion regu- lation may be differentially related to specific outcomes, such as the role of negative urgency in predicting antisocial behaviors, alcohol use, and related problems and, conversely, the importance of distress tolerance in predicting PTS symptoms. These, and other notable results, will be discussed in turn.

PTS symptoms For both EI and trauma history, alexithymia emerged as a significant medi- ator with regard to prediction of PTS symptoms. These results suggest indi- viduals who experience a traumatic event, or who have low levels of EI, subsequently have increased difficulty identifying and describing emotions, and are more likely to experience PTS symptoms. The results of the current study are consistent with previous research, which report significant associ- ations among trauma history, alexithymia, and PTS symptoms (Frewen, Dozois, Neufeld, & Lanius,2008). However, this is the first known study to identify alexithymia as a mediator in the relationship between EI and PTS symptoms.

Alexithymia was also indirectly associated with PTS symptoms via dis- tress tolerance. Individuals high in alexithymia were more likely to endorse a low tolerance for emotional distress and, in turn, endorse more PTS symptoms. As such, exposure to traumatic events or low levels of EI may disrupt a person’s ability to cognitively process emotions, which contributes to a lack of understanding and awareness about the emotions involved in the event, or in general. The reduced ability to identify feeling states is pos- ited to undermine effective emotion regulation, leading to greater intoler- ance of negative emotions, which in turn may ultimately lead to avoidance of triggers of these emotions, a core feature of PTS. This is the first known study to identify this particular mediating role of distress tolerance and, therefore, these results extend previous research, which has focused on either examining alexithymia (Frewen et al.,2008) or distress tolerance (Vujanovic et al.,2013) separately in relation to PTS symptoms.

Interestingly, and contrary to our hypotheses, negative urgency did not have a significant effect on PTS symptoms. This finding is inconsistent with previous research, which has reported significant associations between impulsivity, and more specifically, negative urgency (Gaher et al.,2014; Hahn, Tirabassi, Simons, & Simons,2015), and PTS symptoms. A conceiv- able explanation is the possibility that certain clusters of PTS symptoms 206 N. L. HOFMAN ET AL. may be differentially related with negative urgency. For example, Baumeister (2003) suggested hyperarousal and reexperiencing symptoms of PTS might deplete self-regulatory resources, leading to increased difficulty controlling impulsive behaviors. Therefore, our results may be due to par- ticipants in our sample reporting, on average, more avoidance than reex- periencing or hyperarousal symptoms. Clinical samples may experience more significant reexperiencing and hyperarousal symptoms and therefore may be more likely to engage in impulsive behaviors.

Antisocial behaviors and alcohol use In the current study, exposure to traumatic events and EI were significant predictors of both antisocial behaviors and alcohol use via various indirect effects. For example, both traumatic experiences and emotional intelligence had indirect effects on antisocial behaviors and alcohol use via alexithymia and negative urgency. Exposure to traumatic events or low levels of EI may make it more difficult for an individual to communicate emotional experi- ences with others, leading to feeling more detached from others. As a result of this difficulty, individuals high in alexithymia may react impulsively in response to negative emotion and engage in antisocial behaviors or con- sume more alcohol as means of regulating or avoiding emotions (Gaher et al.,2014; Hahn et al.,2015).

Exposure to traumatic events and EI also predicted antisocial behaviors, indirectly, via alexithymia, negative urgency, and distress tolerance. This particular association is consistent with previous research, which suggests a person may use aggressive behaviors to regulate negative affect (Gratz, Rosenthal, Tull, Lejuez, & Gunderson,2006). However, this is the first study to demonstrate this specific pathway with regard to the relationship among exposure to traumatic events, alexithymia, negative urgency, distress tolerance, and antisocial behaviors.

Alcohol-related problems Traumatic experiences and EI predicted alcohol consumption and alcohol problems indirectly via alexithymia, distress tolerance, and negative urgency. In addition, both were indirectly related via alexithymia, distress tolerance, negative urgency, alcohol use, and antisocial behaviors. However, of interest was the finding of the identified indirect paths from trauma his- tory and EI to alcohol outcomes via antisocial behaviors and PTS symp- toms, which were only significant for alcohol problems, but not alcohol use. These findings suggest that individuals who experience PTS symptoms and engage in antisocial behaviors are more likely to experience alcohol- JOURNAL OF LOSS AND TRAUMA 207 related problems regardless of alcohol consumption. Therefore, individuals who experience trauma or have low levels of emotional intelligence may have fewer emotional regulation capabilities and experience more negative outcomes in general. These findings are consistent with previous research, in which individuals with PTS (Fetzner, Abrams, & Asmundson,2013) and antisocial personality disorder (Patock-Peckham & Morgan-Lopez,2010) report more alcohol-related problems.

Differences in emotion regulation and PTS versus antisocial behaviors, alcohol use, and problems Results of the current study suggest differential relationships among emo- tion regulation variables and PTS symptoms versus antisocial behaviors, alcohol use, and related problems. More specifically, results of the struc- tural model reveal that the emotion regulation variables of EI, alexithymia, and distress tolerance had significant direct effects to PTS symptoms.

Negative urgency did not have a significant direct effect on PTS symptoms.

The opposite effects were observed for antisocial behaviors, alcohol use, and related problems, in that negative urgency had a significant direct effect to all outcomes, however, the other emotion regulation variables only had significant indirect effects to these outcomes.

These results concerning the differential relationships among emotion regulation variables and PTS symptoms, antisocial behaviors, and alcohol use and related problems may be explained by research examining the underlying structure of these and other mental disorders. Results from this line of research reveal a three-factor structure with an externalizing factor and two internalizing factors,“anxious-misery”and“fear”(Krueger,1999).

Within Krueger’s study, depressive disorders and generalized anxiety dis- order had high loadings on the internalizing“anxious-misery”factor, whereas phobias and panic disorder had high loadings on the internalizing “fear”factor. Alcohol and drug dependence and antisocial personality dis- order had high loadings on the externalizing factor (Krueger,1999). This three-factor structure among mental disorders has been replicated with inclusion of other disorders, including PTSD and antisocial behaviors, and results from these studies suggest that PTS consistently loads on the internal- izing factor, whereas antisocial behaviors and alcohol use and related prob- lems load on the externalizing factor (Slade & Watson,2006). Given previous research, the differential relationships among emotion regulation factors identified in our study may be best explained by differences in the underlying structure of PTS, antisocial behaviors, and problematic alco- hol use.

208 N. L. HOFMAN ET AL. Limitations and conclusions There are several limitations to the study. First, the sample size limited the number of parameters included within the final model. Second, the design was cross-sectional in nature and causal relationships among variables can- not be determined. Third, the sample consisted of college students and was fairly homogenous (i.e., 95% Caucasian), therefore, generalization of results to other samples remains an empirical question. In addition, PTS symp- toms were assessed using a version of the PCL based on DSM-IV-TR diag- nostic criteria (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev.; American Psychiatric Association,2000), and no interviews were conducted to corroborate PTS symptoms. Given these limitations, results of the current study should be replicated through the utilization of a longitudinal research design and among more diverse and trauma-exposed populations.

Despite these limitations, the current study is making significant contri- butions to the literature, which has mostly focused on identifying the inde- pendent relationships among the facets of emotion regulation and negative health outcomes. The current study used structural equation modeling in order to determine not only how facets of emotion regulation are inde- pendently related to specific health outcomes, but also how they relate to one another in the development of these outcomes. As such, current find- ings support an integrated model of emotion dysregulation in the relation- ship among exposure to traumatic events, EI, and PTS, with antisocial behaviors and problematic alcohol use. In addition, these results provide valuable information concerning what variables of emotion regulation may be related to specific psychological outcomes.

Understanding the contributions of emotion dysregulation to PTS, anti- social behaviors, and alcohol use following exposure to traumatic events has important treatment and prevention implications, as enhancing emo- tion regulation capabilities may prevent the development of symptoms or represent a particular area to target within treatment. Furthermore, under- standing the specific facets of emotion regulation, and their contribution to certain maladaptive outcomes, allows for increased specificity within treat- ment. If particular components of emotion dysregulation are identified as being more influential to the maintenance of symptoms, then treatment can be designed to enhance specific emotion regulation skills.

Notes on contributors Nicole L. Hofman, PhD, is a licensed psychologist and co-director of the Psychology Internship Training Program at the St. Cloud VA Healthcare JOURNAL OF LOSS AND TRAUMA 209 System. Her research and clinical interests focus on emotion regulation, substance use disorders, and PTSD.

Raluca M. Simons, PhD, is an associate professor of psychology, director of the Disaster Mental Health Institute, and faculty member for the Center for Brain and Behavior at the University of South Dakota. Her research interests focus on traumatic stress and comorbid conditions.

Jeffrey S. Simons, PhD, is a professor of psychology at the University of South Dakota. His research focuses on regulation of affect and behavior, and associations with risk behaviors.

Austin M. Hahn, MA, is a doctoral candidate at the University of South Dakota and is currently completing his internship at Medical University of South Carolina.

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