Journal of Traumatic Stress

April 2016, 29, 111–119

Numbing of Positive, Negative, and General Emotions: Associations

With Trauma Exposure, Posttraumatic Stress, and Depressive
Symptoms Among Justice-Involved Youth
Patricia K. Kerig, Diana C. Bennett, Shannon D. Chaplo, Crosby A. Modrowski, and Andrew B. McGee
Department of Psychology, University of Utah, Salt Lake City, Utah, USA

Increasing attention has been drawn to the symptom of emotional numbing in the phenomenology of posttraumatic stress disorder (PTSD),
particularly regarding its implications for maladaptive outcomes in adolescence such as delinquent behavior. One change in the definition
of emotional numbing according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric
Association, 2013) was the limitation to the numbing of positive emotions. Previous research with youth, however, has implicated
general numbing or numbing of negative emotions in PTSD, whereas numbing of positive emotions may overlap with other disorders,
particularly depression. Consequently, the goal of this study was to investigate whether numbing of positive emotions was associated with
PTSD symptoms above and beyond numbing of negative emotions, general emotional numbing, or depressive symptoms among at-risk
adolescents. In a sample of 221 detained youth (mean age = 15.98 years, SD = 1.25; 50.7% ethnic minority), results of hierarchical
multiple regressions indicated that only general emotional numbing and numbing of anger accounted for significant variance in PTSD
symptoms (total R2 = .37). In contrast, numbing of sadness and positive emotions were statistical correlates of depressive symptoms
(total R2 = .24). Further tests using Hayes’ Process macro showed that general numbing, 95% CI [.02, .45], and numbing of anger,
95% CI [.01, .42], demonstrated indirect effects on the association between trauma exposure and PTSD symptoms.

Emotional numbing is a specific posttraumatic symptom
that has garnered increasing empirical attention. Research on
emotional numbing helped to inform the revised criteria for
the diagnosis of posttraumatic stress disorder (PTSD) in the
Diagnostic and Statistical Manual of Mental Disorders (5th
ed.; DSM-5; American Psychiatric Association [APA], 2013)
by establishing that numbing should be considered separately
from the symptoms of avoidance with which it was combined
in the DSM-IV-TR (APA, 2000). This distinction has been con-
firmed in samples of adults (e.g., Ayer et al., 2011; King, Leskin,
King, & Weathers, 1998) as well as children and adolescents
(e.g., Kassam-Adams, Marsac, & Cirilli, 2010; Saul, Grant, &
Carter, 2008; Wang, Long, Li, & Armour, 2011). In addition,
emotional numbing has come to play a key role in theoretical
models attempting to explain the association between expo-
sure to childhood trauma and maladaptive outcomes in ado-
lescence, particularly delinquent behavior and justice system
This work was funded in part by a grant from the National Institute of Justice
(2014-90914-UT-IJ) to the first author.
Correspondence concerning this article should be addressed to Patricia K.
Kerig, Department of Psychology, University of Utah, Salt Lake City, UT
84112. E-mail: p.kerig@utah.edu
Copyright  C 2016 International Society for Traumatic Stress Studies. View
involvement (Allwood, Bell, & Horan, 2011; Becker & Kerig,
2011, 2014; Bennett, Kerig, Chaplo, McGee, & Baucom, 2014;
Gaylord-Harden, Dickson, & Pierre, 2015; Kerig & Becker,
2010; Kerig & Bennett, 2013; Kerig, Bennett, Thompson, &
Becker, 2012). Numbing of emotions in the aftermath of trauma
may serve to dampen youths’ awareness of distressing emotions
(Kalisch et al., 2005; Orsillo, Theodore-Oklota, Luterek, &
Plumb, 2007), but also might increase the likelihood that youth
will externalize that distress and act out against others (Ford,
Chapman, Connor, & Cruise, 2012; Lansford et al., 2006).
There are two mismatches, however, between the new
DSM-5 criteria regarding numbing and the extant research base.
The first mismatch is that the DSM-5 criteria limit the construct
of emotional numbing to the “persistent inability to experience
positive emotions” (p. 272; italics added) such as happiness
or love. In contrast, in keeping with the DSM-IV-TR’s more
encompassing definition of emotional numbing as involving a
“restricted range of affect” (p. 468), much of the empirical lit-
erature has investigated posttraumatic outcomes for both adults
and adolescents that are associated with the general numbing of
emotions (Bennett & Kerig, 2014; Bennett et al., 2014; Flack
Jr, Litz, Hsieh, Kaloupek, & Keane, 2000; Orsillo et al., 2007;
Roemer, Orsillo, Borkovec, & Litz, 1998). This general emotio-
nal numbing has also been termed desensitization (Gaylord-

this article online at wileyonlinelibrary.com Harden, Cunningham, & Zelencik, 2011), detachment (Kalisch
DOI: 10.1002/jts.22087 et al., 2005), or emotion suppression (Kaplow, Gipson, Horwitz,

111
112
Burch, & King, 2013). Moreover, other research has estab-
lished that there are significant associations between trauma
exposure and the numbing of negative emotions amongst ado-
lescents, such as sadness or fear (Allwood et al., 2011; Kerig
et al., 2012). Therefore, clarification is needed as to whether
emotional numbing among at-risk youth in the aftermath of
trauma is specific to, and should be limited to, that of positive
emotions.
A second mismatch between the revised diagnosis and
the empirical base is that, despite well-replicated research
demonstrating the superior fit of models that placed numbing
on its own separate factor in DSM-IV-TR (Bennett et al., 2014;
Elhai et al., 2011), in DSM-5 numbing was placed in a cluster
involving a large array of symptoms associated with changes in
cognition and mood in the aftermath of trauma. Recent studies
have called this symptom structure into question, instead
linking the numbing of positive emotions as defined by DSM-5
to other symptoms indicative of anhedonia, such as detachment
and lack of interest, a finding that has been confirmed in
samples of adults (Armour et al., 2015; Pietrzak et al., 2015) as
well as adolescents (Wang et al., 2015). Symptoms associated
with anhedonia have considerable overlap with depression
(Armour et al., 2012); moreover, it is notable that depression
is highly comorbid with PTSD and differential diagnosis of
the two disorders is challenging (Elhai et al., 2015; Friedman,
2013). Thus, investigations are needed that help to clarify
whether emotional numbing in the aftermath of trauma
exposure is related to symptoms of posttraumatic stress in
ways that are distinguishable from symptoms of depression.
To address these questions, the present study addressed three
specific aims: (a) to investigate whether in a sample of trauma-
exposed justice-involved youth the numbing of positive emo-
tions is associated with posttraumatic stress symptoms (PTSS)
above and beyond the numbing of general emotional numb-
ing, numbing of negative emotions, or depressive symptoms;
(b) to examine whether, in contrast, the numbing of positive
emotions is associated with youth depressive symptoms above
and beyond other forms of emotional numbing; and (c) to test
whether different forms of emotional numbing have indirect
effects on the association between trauma exposure and PTSS
or depressive symptoms.
Method
Participants and Procedure
Participants included 221 youth (63 girls, 158 boys) recruited
from a short-term juvenile detention center (average length
of stay = 4 days) located in the western United States. Con-
sistent with the demographics of the larger justice-involved
population in this geographical region, youth ranged in age
from 13 to 19 years (M = 15.98, SD = 1.25) and 49.3% were
White/Caucasian, 31.2% Hispanic/Latino, 4.1% Black/African
American, 2.7% Pacific Islander/ Native Hawaiian, 4.5% Native
American, and 8.1% multiracial/other.
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
Kerig et al.
All study procedures were approved by the institutional re-
view boards of the University of Utah and the Utah Department
of Human Services. At visitations to the detention center, all le-
gal guardians were invited to provide signed informed consent
encompassing all study procedures, after which their children
were invited to provide signed assent. To eliminate any percep-
tions of coercion, no incentives were offered for participation.
Data were collected during individual interviews conducted by
a research assistant in a private room within the detention cen-
ter. Among legal guardians, 57% percent who were approached
ultimately consented to participate in the study, and 69% of
youth assented to participate.
Measures
The UCLA Posttraumatic Stress Disorder Reaction Index for
Children/Adolescents–DSM-5 (PTSD-RI; Pynoos & Steinberg,
2014) is a widely used screening tool to assess trauma exposure
and PTSS that has demonstrated good convergent validity with
other diagnostic measures, high internal consistency, and a con-
firmed factor structure that maps onto the DSM-5 criteria for
PTSD (Elhai et al., 2013; Steinberg et al., 2013). The first set
of questions establishes whether youth meet Criterion A for the
PTSD diagnosis by asking whether they have been exposed in
their lifetime to any of a series of traumatic events. The number
of events endorsed also is summed to create a Total Trauma
Exposure score.
Additional questions on the PTSD-RI ask youth to iden-
tify the “worst” stressor they have ever experienced and rate
in relation to that event the extent to which they have expe-
rienced in the past month symptoms associated with the four
symptoms clusters in the DSM-5 diagnosis of PTSD: intrusion
(Criterion B), avoidance (Criterion C), changes in cognition
and mood (Criterion D), and arousal (Criterion E). In addition,
four questions on the PTSD-RI probe for the presence of dis-
sociative symptoms involving experiences of derealization or
depersonalization. Responses to the questions are presented in
a Likert scale format ranging from 0 = none of the time to
4 = most of the time and a rating of 3 or higher is considered to
indicate symptom presence. A Total PTSS score is calculated
as a sum of all symptom ratings across the clusters. In the cur-
rent sample, Cronbach’s α was .93. In addition, the PTSD-RI
allows for an assessment of the likelihood that youth meet full
or partial criteria for a current PTSD diagnosis according to the
DSM-5. Full PTSD is defined as an endorsement of Criterion A
as well as the required number of symptoms for Criteria B, C,
D, and E, whereas partial PTSD is defined as an endorsement
of Criterion A as well the required number of symptoms for
any three of the other four symptom clusters.
The Emotional Numbing and Reactivity Scale (ENRS; Or-
sillo et al., 2007) is a self-report measure designed to assess
current experiences of numbness versus reactivity of emotional
responses to events or experiences. Subscales assess general
numbing (8 items, e.g., “I feel cut off from my emotions”),
numbing of positive emotions (26 items, e.g., “I am unable to
 Numbing of Positive, Negative, or General Emotions
feel joy”) as well as numbing of the specific negative emotions
of fear (6 items), sadness (12 items), and anger (10 items, e.g.,
“I have a hard time feeling ____ even when there are reasons for
me to feel that way”). Each item is rated on a 5-point Likert-type
scale ranging from 1 = not at all typical of me to 5 = entirely
typical of me. The developers report good internal consisten-
cies, test-retest reliability, and construct validity. Evidence of
the reliability and validity of the self-report of emotional numb-
ing using this measure is indicated by its strong psychometrics
and demonstrated utility in a large body of research on adult
samples as well as its reliability and validity in previous re-
search involving adolescents (Allwood et al., 2011; Bennett &
Kerig, 2014; Kerig et al., 2012). In the present sample, internal
consistencies of the scales were as follows: General Numbing
= .71; Positive = .86; Sadness = .83; Anger = .81; and Fear
= .80.
The short form of the Children’s Depression Inventory (CDI;
Kovacs, 1992) is an 11-item self-report, symptom-oriented
scale that was designed for school-aged children and adoles-
cents. The CDI assesses emotional problems and functional
severity of symptoms including negative mood/somatic symp-
toms, low self-esteem, interpersonal problems, and perceived
ineffectiveness. For each item, there are three choices describ-
ing the frequency with which the symptom is currently experi-
enced (e.g., 0 = I am sad once in a while, 1 = I am sad many
times, 2 = I am sad all of the time). The author reports high
internal consistence, test-retest reliability, and construct valid-
ity in both normative and clinical samples. Cronbach’s α in the
current sample was .81.
Data Analysis
Data were analyzed using SPSS version 23.0. Missing data were
addressed using listwise deletion for the subset of 53 youth
who were not administered the CDI. For Aim 1, investigating
whether numbing of positive emotions explained unique vari-
ance in Total PTSS after accounting for depressive symptoms
and the numbing of general or negative emotions, we conducted
a 4-step hierarchical regression. To account for any variance re-
lated to the wide ranges of ethnicities and ages in this dataset,
and because previous research has found gender differences in
posttraumatic stress reactions in this population, ethnicity and
age were entered on the first step of the regression equation. De-
pressive symptoms was entered on the second step, followed
on the third step by scores on general numbing, numbing of
sadness, numbing of anger, and numbing of fear. In the final
step, numbing of positive emotions was added to the model. All
variables except ethnicity and gender were centered. For Aim
2, investigating whether numbing of positive emotions was a
unique correlate of depressive symptoms, we conducted a par-
allel 3-step hierarchical regression with depressive symptoms
as the dependent variable. Again, all variables were centered,
except gender and ethnicity. General numbing was entered next
in the regression, followed by numbing of sadness, numbing of
anger, and numbing of fear in the second step. In the third step,
numbing of positive emotions was added to the equation.
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
113
In addition, to test other plausible hypotheses about the in-
terrelationships of the variables measured, a number of alterna-
tive models were examined. First, to ensure that results found
were not an artifact of the order of entry of the variables into
the equation, alternative models were run for Aim 1 entering
the numbing variables and depression simultaneously against
PTSD symptoms, and for Aim 2, the numbing variables were
entered simultaneously against depression; models were then
rerun allowing positive numbing to be entered first in each
equation. Second, models were tested with and without the de-
mographic variables of ethnicity, age, and gender entered on
the first step of the model; any differences in the findings are
reported.
Finally, to examine indirect effects of numbing on the asso-
ciations between trauma exposure and the PTSS versus depres-
sion, we utilized Hayes’ (2013) PROCESS macro, which allows
for the testing of direct and indirect effects while also providing
bootstrapped estimates of the confidence interval (CI) around
the indirect effect.
Results
Descriptive statistics indicated that 92.3% of the sample
endorsed at least one lifetime traumatic event, thus meeting
Criterion A for the diagnosis of PTSD. On average, youth
endorsed experiencing 6.47 different types of traumatic events
(SD = 4.05) and the average length of time elapsed since
these events was 36.07 months (SD = 38.10). Furthermore,
113 youth (51.1%) likely met full criteria for current PTSD
based on their reports on the PTSD-RI. A significant gender
difference emerged, with girls more likely than boys to
likely meet diagnostic criteria (65.1% of girls vs. 45.6% of
boys), χ2 (1, N = 221) = 6.86, p = .015. An additional 43
youth (20.2%) met partial criteria for PTSD, with no gender
difference in the proportion of boys (5.3%) and girls (13.1%),
χ2 (1, N = 221) = 2.65, p = .10.
Descriptive statistics and intercorrelations for the full
sample are provided in Table 1. Tests for mean differences,
with equal variances not assumed, showed that in comparison
to boys, girls reported higher levels of depressive symptoms,
t(76.77) = 3.45, p = .001, d = 0.62 and PTSS, t(94.62) = 2.71,
p = .008, d = 0.43, including scores for Criterion C, t(211) =
2.58, p = .008, d = 0.40, and Criterion D, t(99.92) = 2.76,
p = .007, d = 0.42. Compared to girls, boys reported higher
levels of numbing of sadness, t(218) = −4.56, p < .001,
d = 0.68 and numbing of fear, t(218) = −4.41, p < .001,
d = 0.65. There were no significant differences between
boys and girls for Criterion B, Criterion E, trauma exposure,
general numbing of emotions, numbing of anger, or numbing
of positive emotions.
Among the youth in this sample, 9.95% endorsed the item
involving positive numbing on the PTSD-RI, and of these youth,
40.9% likely met criteria for the diagnosis of PTSD on the
measure. Examination of the concordance between this item
and youths’ endorsement of positive numbing on the ENRS
 114

Table 1
Descriptive Statistics and Intercorrelations Among Study Variables
Variable M SD 1 2 3 4 5 6 7 8 9 10 11 12 13 14
1. Age (years) 15.98 1.25 –
2. Ethnicity – – −.03 –
3. Gender – – −.10 −.04 –
4. Numb–Pos 52.51 12.71 −.05 −.09 .01 –
5. Numb–Gen 17.44 5.20 −.07 .02 −.05 .56 –
6. Numb–Sad 26.63 8.01 −.05 .01 .30 .61 .29 –
7. Numb–Anger 22.93 7.34 .00 −.02 .08 .27 −.06 .35 –
8. Numb–Fear 17.83 8.80 .03 .02 .29 .44 .23 .74 .27 –
Kerig et al.

9. Depressive 8.80 3.40 −.07 .07 −.30 .09 .19 −.26 −.18 −.14 –
10. Trauma Exp 6.47 4.05 .21 .13 −.13 −.04 .15 −.04 −.16 .05 .07 –
11. Criterion B 7.94 5.74 .07 .10 −.13 −.01 .15 −.21 −.21 −.14 .28 .43 –
12. Criterion C 5.68 3.79 .12 .13 −.18 −.01 .21 −.20 −.27 −.17 .30 .31 .76 –
13. Criterion D 10.31 6.15 .14 .02 −.20 .21 .41 −.13 −.27 −.03 .50 .40 .63 .60 –
14. Criterion E 10.41 5.37 .14 .07 −.12 .05 .26 −.06 −.35 .01 .27 .43 .58 .51 .65 –
15. Total PTSD 37.39 20.43 .11 .10 −.20 .10 .34 −.17 −.31 −.08 .43 .46 .87 .80 .86 .81
Note. N = 221. Coefficients ࣙ .14 are significant at p < .05, > .20 are significant at p < .01, and above .27 are significant at p < .001. Numb–Pos = numbing of positive emotions; Numb–Gen =
general numbing; Numb–Sad = numbing of sadness; Numb–Fear = numbing of fear; Numb–Anger = numbing of anger; Depressive = depressive symptoms; Trauma Exp = total trauma exposure;
PTSD = posttraumatic stress disorder.

Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
 Numbing of Positive, Negative, or General Emotions 115

Table 2
Summary of Multiple Regression Analyses of Symptoms of Posttraumatic Stress Disorder and Depression, Displaying Results at Final
Step
Variable B SE R2
PTSD symptoms
Step 1 .10**
Age 2.53 1.30
Ethnicity 1.00 1.23
Gender −10.25** 3.40
Step 2 .14***
***
Depressive symptoms 2.36 0.45
Step 3 .14***
***
General numbing 1.33 0.30
Numbing of sadness −0.46 0.27
Numbing of anger −0.40 0.20
Numbing of fear 0.40 0.35
Step 4 .00
Numbing of positive emotions 0.06 0.16
Depressive symptoms
Step 1 .10**
Age −0.32 0.22
Ethnicity 0.13 0.21
Gender −2.22*** 0.57
Step 2 .09**
*
General numbing 0.13 0.06
Numbing of sadness −0.14** 0.05
Numbing of anger −0.03 0.04
Numbing of fear 0.08 0.07
Step 3 .06**
**
Numbing of positive emotions 0.10 0.03
Note. For posttraumatic stress disorder (PTSD), N = 221. For depression, n = 152.
* p < .05. ** p < .01. *** p < .001.

showed a correlation between the variables of r = .29, p < .01,
and that youth who endorsed the positive numbing item on the
PTSD-RI reported significantly higher scores than their peers
on the ENRS positive numbing scale, t(209) = −2.39, p = .02,
d = .52.
As the results of the hierarchical regression reported in
Table 2 indicate, age and depressive symptoms were signifi-
cant correlates of Total PTSS in the 4-step regression. Specifi-
cally, the combination of age, gender, and ethnicity accounted
for 9.6% of the variance in PTSS and depressive symptoms
explained an additional 14% of the variance. The direction of
effects showed that older age and higher depressive symptoms
were associated with higher levels of PTSS. In the third step,
general numbing and numbing of anger acted as additional
correlates of Total PTSS, altogether accounting for an addi-
tional 13.5% of the variance in Total PTSS scores. Notably,
general numbing of emotions was positively associated with
increased PTSS scores, whereas numbing of anger was associ-
ated with decreased PTSS. In the fourth step, the addition of
numbing of positive emotions to the equation explained less
than 1% of additional variance in Total PTSS after accounting
for the other variables, and only age, depression, general numb-
ing of emotions, and numbing of anger remained significant.
The final model accounted for 37.2% of the variance in To-
tal PTSS. All variables had acceptable variance inflation factor
and tolerance values, indicating the absence of multicollinear-
ity among the study variables (Cohen, Cohen, West, & Aiken,
2003).
When our model was challenged by comparison to an all-
possible-subsets regression in which the numbing variables and
depression were entered simultaneously after the inclusion of
the demographic variables, results indicated no change in the
results, with age, depression, general numbing, and numbing
of anger still emerging as the only significant correlates of
PTSD scores. Similarly, when the order of entry allowed posi-
tive numbing to be entered first in the equation, followed by the
other numbing scores, and then depression, the same pattern of
results were obtained for the final model. When the regression
equations were rerun excluding the demographic variables from
the first step, results indicated only one change in the results, in

Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
116
0.20 (0.09)*
Trauma
-0.28 (0.13)*
exposure
1.81 (0.30)***
Figure 1. N = 221. Paths in the mediation model. Nonsignificant paths are displayed as dashed lines; significant paths are displayed as solid lines. Unstandardized
B coefficients (with standard errors in parentheses) are displayed for all significant paths. Indirect effects, significant for general numbing and numbing of anger,
are omitted from the figure for clarity, but are described in the text. PTSS = posttraumatic stress disorder symptoms. *p < .05. **p < .01. ***p < .001.
that numbing of sadness also emerged as a significant negative
correlate of PTSS, B = −0.64, SE = 0.31, p = .04, along with
depression, general numbing, and numbing of anger.
As reported in Table 2, in the 3-step hierarchical regression
with depression as the dependent variable, results indicated that
female gender was a significant correlate of depressive symp-
toms in Step 1, with gender, age, and ethnicity accounting for
10.2% of the variance in depression scores. In the second step,
female gender, higher general numbing, and lower numbing
of sadness were additional significant correlates of depressive
symptoms, accounting for an additional 8.6% of the variance in
depression. In the third step, numbing of positive emotions
explained an additional 5.7% of the variance in depressive
symptoms over and above the demographic and other emo-
tional numbing variables, and in this step, only lower numbing
of sadness and higher numbing of positive emotions remained
significant predictors of depression. Altogether, the final model
accounted for 24.4% of the variance in depressive symptoms.
Again, we examined competing models by comparing re-
sults achieved by different orders of entry of the variables into
the equation. If the demographic variables were excluded, all
numbing variables were entered simultaneously. If numbing
of positive emotions was entered in a step prior to the other
numbing variables, the same pattern emerged, with only numb-
ing of sadness and numbing of positive emotions significantly
associated with depressive symptoms.
Our third aim was to investigate whether there were indi-
rect effects of emotional numbing on the association between
trauma exposure and the dependent variables of PTSS versus
depression. In the model with PTSS as the dependent variable
(see Figure 1), bootstrapped indirect effects results were con-
sistent with a partial indirect effect of the association between
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
Kerig et al.
Positive
numbing
-0.79 (0.24)**
General
numbing
0.92 (0.27)**
Numbing
0.92 (0.17)** PTSS
of anger
Numbing
of fear
0.37 (0.14)**
Numbing
of sadness
trauma exposure and PTSS by general numbing, B = 0.19, 95%
CI [0.02, 0.45], and numbing of anger, B = 0.15, 95% CI [0.01,
0.42]. The combination of age, ethnicity, gender, and trauma
exposure accounted for 18.3% of the variance in general numb-
ing and 17.6% in numbing of anger. The total model explained
62.2% of the variance in PTSS.
A parallel model for the prediction of depression also was
conducted; results indicated that none of emotional numbing
scales emerged as having significant indirect effects on the
association between trauma exposure and depression.
Discussion
Consistent with a large body of accumulated research, the
justice-involved youth in this sample exhibited significant
levels of trauma exposure and posttraumatic stress symp-
toms, providing further confirmation that this is a cohort of
youth deserving of attention in the study of traumatic stress
(Dierkhising et al., 2013; Ford, Chapman, Mack, & Pearson,
2006; Ford, Grasso, Hawke, & Chapman, 2013; Kerig, 2012).
Further, consistent with a large body of emerging research
on youth in the justice system, gender differences emerged
with girls reporting higher levels of depression and PTSD and
being more likely than boys to likely meet criteria for a PTSD
diagnosis. Moreover, the prevalence of trauma exposure and
PTSS in this sample provided us the opportunity to investigate
an important question regarding the revised DSM-5 diagnostic
criteria for PTSD: whether the numbing of positive emotions
is associated with posttraumatic stress over and above the
numbing of other emotional states. In addition, this highly
trauma-exposed sample allowed us to examine the relative
 Numbing of Positive, Negative, or General Emotions
contributions of numbing of positive, negative, and general
emotions to PTSS versus depression.
Consistent with the lack of bivariate associations found be-
tween positive numbing and PTSS, the results of the regres-
sion analyses indicated that in this sample, numbing of positive
emotions did not explain variance in PTSS above and beyond
the presence of depressive symptoms, the numbing of nega-
tive emotions, or general emotional numbing. Instead, general
emotional numbing and the numbing of the negative emotion
of anger were the facets of numbing that were most strongly
associated with PTSS. These results suggest the possibility that
the narrowing of the definition of emotional numbing to include
only positive emotions in the DSM-5 criteria might not accu-
rately characterize the aftermath of trauma exposure in samples
such as the justice-involved youth studied here.
In contrast, in this sample, the numbing of positive emotions
did explain unique variance in depressive symptoms, above
and beyond other forms of emotional numbing. These findings
suggest the possibility that numbing of positive emotions may
be more indicative of co-occurring depressive symptoms than
PTSS specifically, in concert with other investigations that have
pointed to the overlap of dysphoric symptoms in the new DSM-
5 criteria for PTSD and depression (e.g., Armour et al., 2012;
Elhai et al., 2015; Friedman, 2013). The present study might
help to suggest a future step for research devoted to disentan-
gling depression and PTSD by pointing toward the restricted
definition of emotional numbing in DSM-5 as a potential cul-
prit in the overlap between the disorders. Although difficulty
experiencing positive emotions is a symptom that co-occurs
with depressive disorders, what may be unique to PTSD are
difficulties regarding the ability to experience a range of emo-
tions. Interestingly, among the youth in the present sample,
it was reduced numbing of anger that had indirect effects on
the association between trauma exposure and PTSS. Theoret-
ical models of the underlying mechanisms linking trauma to
delinquency have posited that the experience of victimization
in the absence of validation, support, or rescue may leave youth
with a powerful but impotent sense of anger and injustice (Ford
et al., 2006). Attempts to emotionally numb this unarticulated
rage might serve adolescents as an adaptation strategy that, al-
though perhaps associated with problem behaviors that bring
these youth to the attention of the juvenile justice system, also
serves a protective function against posttraumatic stress reac-
tions (Lansford et al., 2006).
The results of this study also suggested that, despite its an-
nexation to a DSM-5 cluster involving a variety of other PTSD
symptoms, emotional numbing continues to warrant attention
as a specific posttraumatic reaction. For example, research has
indicated that adolescents and adults high in emotional numb-
ing are among those whose functioning is most impaired by
posttraumatic stress (Asmundson, Stapleton, & Taylor, 2004;
Saul et al., 2008) and that emotional numbing can act as a
significant impediment to the effectiveness of evidence-based
interventions for PTSD (Taylor et al., 2001). In addition, behav-
ioral expressions of emotional numbing may also overlap with
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
117
other psychological problems commonly seen among youth
in the juvenile justice system, such as callous-unemotional
traits and limited prosocial emotions, which have been newly
added as a specifier in the DSM-5 diagnosis of conduct disor-
der. Research has shown that emotional numbing in the after-
math of trauma exposure is associated with delinquent behavior
among adolescents (Allwood et al., 2011), as well as elevated
scores on measures of callous-unemotional traits (Bennett &
Kerig, 2014; Kerig et al., 2012). Consequently, further re-
search exploring the boundary between posttraumatic numbing
and youth callousness is warranted, as is care to differenti-
ate the two symptoms in screenings and assessments designed
to connect justice-involved youth to appropriate mental health
services.
The results of this study also should be considered in light
of its limitations. The present sample was drawn from a ge-
ographic region with a proportional representation of ethnic
groups that may not generalize to other areas; in particular,
there were fewer African American youth in the present sample
than are represented in the juvenile justice system in other lo-
calities in the United States. Only a subset of eligible guardians
and youth elected to participate in the study, and they may dif-
fer from other members of this population in ways we could
not assess. Another major limitation is that these data were
gathered cross-sectionally. Although the measures adminis-
tered suggest a sequential ordering in that all youth reported
on past traumatic events and current posttraumatic symptoms,
the fact that measures were taken at the same time point prevents
our drawing causal conclusions. In addition, PTSD symptoms
were assessed using the youth-report version of the PTSD-RI,
which does not include an assessment of functional impair-
ment. Although the high rates of psychiatric diagnoses among
detained youth generally (i.e., 45% of boys and 30% of girls;
Teplin et al., 2015) are suggestive of the presence of func-
tional impairment in this population, future research should
include measures that allow for the assessment of all criteria
for the diagnosis of PTSD. A further limitation is that all of
the data were gathered via youth self-report and via a single
measure for each construct. Future research would benefit from
the inclusion of reports from knowledgeable observers, such
as family members or friends, and the inclusion of multiple
measures obtained over time. Another limitation of this study
is its use of a PTSD symptom to estimate the likelihood of a
PTSD diagnosis. Finally, the sample was limited to youth in-
volved in the juvenile justice system and the results may not
generalize to other adolescent or adult populations. Although
justice-involved youth comprise a specific cohort, it is not an
insignificant one. The number of adolescents involved in the
justice system in the United States is substantial, with over
1.7 million youth processed by the courts each year (Office of
Juvenile Justice and Delinquency Prevention, 2011) and over
85,000 youth held in detention settings on any given day
(Mendel, 2011). Furthermore, the vast majority of these youth
are trauma-exposed and exhibit significant symptoms of PTSD
(see Kerig & Becker, 2012). Nonetheless, this is a group with
118 Kerig et al.
specific characteristics and risk factors that may have affected
the present findings.
In conclusion, the results of this study suggest that further
consideration of the role of emotional numbing in posttraumatic
stress reactions is warranted. In particular, at least for some pop-
ulations, such as justice-involved youth, the numbing of general
rather than positive emotions may play the more salient role in
posttraumatic stress. Given that the DSM-5 criteria limit emo-
tional numbing to experiences of positive affect, youth who en-
gage in other forms of emotional numbing might be overlooked
for services. Effective evidence-based interventions have been
developed for youth with co-occurring posttraumatic stress and
justice involvement (see Ford, Kerig, Desai, & Feierman, in
press); therefore, our accurately identifying these youth and re-
ferring them for treatment promises to have a beneficial impact
on the adolescents, their families, and their communities.
References
Allwood, M. A., Bell, D. J., & Horan, J. (2011). Posttrauma numbing of
fear, detachment, and arousal predict delinquent behaviors in early adoles-
cence. Journal of Clinical Child and Adolescent Psychology, 40, 659–667.
doi:10.1080/15374416.2011.597081
American Psychiatric Association. (2000). Diagnostic and statistical manual of
mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric
Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual
of mental disorders (5th ed.). Arlington, VA: Author.
Armour, C., Elhai, J. D., Richardson, D., Ractliffe, K., Wang, L., &
Elklit, A. (2012). Assessing a five factor model of PTSD: Is dyspho-
ric arousal a unique PTSD construct showing differential relationships
with anxiety and depression? Journal of Anxiety Disorders, 26, 368–376.
doi:10.1016/j.janxdis.2011.12.002
Armour, C., Tsai, J., Durham, T. A., Charak, R., Biehn, T. L., Elhai, J.
D., & Pietrzak, R. H. (2015). Dimensional structure of DSM-5 post-
traumatic stress symptoms: Support for a hybrid anhedonia and exter-
nalizing behaviors model. Journal of Psychiatric Research, 61, 106–113.
doi:10.1016/j.jpsychires.2014.10.012
Asmundson, G. J. G., Stapleton, J. A., & Taylor, S. (2004). Are avoidance and
numbing distinct PTSD symptom clusters?. Journal of Traumatic Stress, 17,
467–475. doi:10.1007/s10960-004-5795-7
Ayer, L. A., Cisler, J. M., Danielson, C. K., Amstadter, A. B., Saunders, B.
E., & Kilpatrick, D. G. (2011). Adolescent posttraumatic stress disorder: An
examination of factor structure reliability in two national samples. Journal
of Anxiety Disorders, 25, 411–421. doi:10.1016/j.janxdis.2010.11.004
Becker, S. P., & Kerig, P. K. (2011). Posttraumatic stress symptoms are
associated with the frequency and severity of delinquency among de-
tained boys. Journal of Clinical Child & Adolescent Psychology, 40, 1–7.
doi:10.1080/15374416.2011.597091
Bennett, D. C., & Kerig, P. K. (2014). Investigating the construct of
trauma-related acquired callousness among delinquent youth: Differ-
ences in emotion processing. Journal of Traumatic Stress, 27, 415–422.
doi:10.1002/jts.21931
Bennett, D. C., Kerig, P. K., Chaplo, S. D., McGee, A. B., & Baucom,
B. R. (2014). Validation of the five-factor model of PTSD symptom
structure among delinquent youth. Psychological Trauma, 6, 438–447.
doi:10.1037/a0035303
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple
regression/correlation analysis for the behavioral sciences. Mahwah, NJ:
Erlbaum.
Dierkhising, C. B., Ko, S. J., Woods-Jaeger, B., Briggs, E. C., Lee, R., &
Pynoos, R. S. (2013). Trauma histories among justice-involved youth: Find-
ings from the National Child Traumatic Stress Network. European Journal
of Psychotraumatology, 4. doi:10.3402/ejpt.v4i0.20274
Elhai, J. D., Biehn, T. L., Armour, C., Klopper, J. J., Frueh, B. C., &
Palmieri, P. A. (2011). Evidence for a unique PTSD construct represented
by PTSD’s D1–D3 symptoms. Journal of Anxiety Disorders, 25, 340–345.
doi:10.1016/j.janxdis.2010.10.007
Elhai, J. D., Contractor, A. A., Tamburrino, M., Fine, T. H., Cohen, G., Shirley,
E., & Galea, S. (2015). Structural relations between DSM-5 PTSD and major
depression symptoms in military soldiers. Journal of Affective Disorders,
175, 373–378. doi:10.1016/j.jad.2015.01.034
Elhai, J. D., Layne, C. M., Steinberg, A. M., Brymer, M. J., Briggs, E. C.,
Ostrowski, S. A., & Pynoos, R. S. (2013). Psychometric properties of
the UCLA PTSD Reaction Index. Part II: Investigating factor structure in
a national clinic-referred youth sample. Journal of Traumatic Stress, 26,
10–18. doi:10.1002/jts.21755
Flack Jr, W. F., Litz, B. T., Hsieh, F. Y., Kaloupek, D. G., & Keane, T. M.
(2000). Predictors of emotional numbing, revisited: A replication and exten-
sion. Journal of Traumatic Stress, 13, 611–618. doi:10.1023/A:100780613
2319
Ford, J. D., Chapman, J., Connor, D. F., & Cruise, K. R. (2012). Complex
trauma and aggression in secure juvenile justice settings. Criminal Justice
and Behavior, 39, 694–724. doi:10.1177/0093854812436957
Ford, J. D., Chapman, J., Mack, J. M., & Pearson, G. (2006). Pathways from
traumatic child victimization to delinquency: Implications for juvenile and
permanency court proceedings and decisions. Juvenile and Family Court
Journal, 57, 13–26. doi:10.1111/j.1755-6988.2006.tb00111.x
Ford, J. D., Grasso, D. J., Hawke, J., & Chapman, J. F. (2013). Poly-
victimization among juvenile justice-involved youths. Child Abuse & Ne-
glect, 37, 788–800. doi:10.1016/j.chiabu.2013.01.005
Ford, J. D., Kerig, P. K., Desai, N., & Feierman, J. (in press). Psychosocial
interventions for traumatized youth in the juvenile justice system: Research
evidence base and clinical/legal challenges. Journal of Juvenile Justice.
Friedman, M. J. (2013). Finalizing PTSD in DSM-5: Getting here from
there and where to go next. Journal of Traumatic Stress, 26, 548–556.
doi:10.1002/jts.21840
Gaylord-Harden, N., Cunningham, J., & Zelencik, B. (2011). Effects of expo-
sure to community violence on internalizing symptoms: Does desensitization
to violence occur in African American youth? Journal of Abnormal Child
Psychology, 39, 711–719. doi:10.1007/s10802-011-9510-x
Gaylord-Harden, N. K., Dickson, D., & Pierre, C. (in press). Profiles of com-
munity violence exposure among African American youth: An examination
of desensitization to violence using latent class analysis. Journal of Inter-
personal Violence. doi:10.1177/0886260515572474
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional
process analysis: A regression-based approach. New York: Guilford Press.
Kalisch, R., Wiech, K., Critchley, H. D., Seymour, B., O’Doherty, J. E., Oakley,
D., & Dolan, R. J. (2005). Anxiety reduction through detachment: Subjec-
tive, physiological, and neural effects. Journal of Cognitive Neuroscience,
17, 874–883. doi:10.1162/0898929054021184
Kaplow, J. B., Gipson, P. Y., Horwitz, A. G., Burch, B. N., & King, C. A. (2013).
Emotional suppression mediates the relation between adverse life events
and adolescent suicide: Implications for prevention. Prevention Science, 15,
177–185. doi:10.1007/s11121-013-0367-9
 Numbing of Positive, Negative, or General Emotions
Kassam-Adams, N., Marsac, M. L., & Cirilli, C. (2010). Posttraumatic stress
disorder symptom structure in injured children: Functional impairment
and depression symptoms in a confirmatory factor analysis. Journal of
the American Academy of Child & Adolescent Psychiatry, 49, 616–625.
doi:10.1097/00004583-201006000-00010
Kerig, P. K. (2012). Trauma and juvenile delinquency: Dynamics and devel-
opmental mechanisms. Journal of Child and Adolescent Trauma, 5, 83–87.
doi:10.1080/19361521.2012.671743
Kerig, P. K., & Becker, S. P. (2010). From internalizing to externalizing:
Theoretical models of the processes linking PTSD to juvenile delinquency.
In S. J. Egan (Ed.), Posttraumatic stress disorder (PTSD): Causes, symptoms
and treatment (pp. 1–46). Hauppauge, NY: Nova Science.
Kerig, P. K., & Becker, S. P. (2012). Trauma and girls’ delinquency. In S. Miller,
L. D. Leve, & P. K. Kerig (Eds.), Delinquent girls: Contexts, relationships,
and adaptation (pp. 119–143). New York, NY: Springer.
Kerig, P. K., & Bennett, D. C. (2013). Beyond fear, helplessness,
and horror: Peritraumatic reactions associated with posttraumatic stress
symptoms among traumatized delinquent youth. Psychological Trauma:
Theory, Research, Practice, and Policy, 5, 431–438. doi:10.1037/a002
9609
Kerig, P. K., Bennett, D. C., Thompson, M., & Becker, S. P. (2012). “Nothing
really matters”: Emotional numbing as a link between trauma exposure and
callousness in delinquent youth. Journal of Traumatic Stress, 25, 272–279.
doi:10.1002/jts.21700
King, D. W., Leskin, G. A., King, L. A., & Weathers, F. W. (1998). Confirmatory
factor analysis of the clinician-administered PTSD Scale: Evidence for the
dimensionality of posttraumatic stress disorder. Psychological Assessment,
10, 90–96. doi:10.1037/1040-3590.10.2.90
Kovacs, M. (1992). Children’s Depression Inventory manual. Toronto, Canada:
Multi-Health Systems.
Lansford, J. E., Malone, P. S., Stevens, K. I., Dodge, K. A., Bates, J. E., & Pettit,
G. S. (2006). Developmental trajectories of externalizing and internalizing
behaviors: Factors underlying resilience in physically abused children. De-
velopment and Psychopathology, 18, 35–56. doi:10.1017/S095457940606
0032
Mendel, R. A. (2011). No place for kids: The case for reducing juvenile
incarceration. Baltimore, MD: Annie E. Casey Foundation. doi:http://
hdl.handle.net/10244/1035
Office of Juvenile Justic and Delinquency Prevention. (2011). Statistical
briefing book. Retrieved from http://www.ojjdp.gov/ojstatbb/court/qa06201.
asp?qaDate=2008.
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
119
Orsillo, S. M., Theodore-Oklota, C., Luterek, J. A., & Plumb, J. (2007). The
development and psychometric evaluation of the Emotional Reactivity and
Numbing Scale. Journal of Nervous and Mental Disease, 195, 830–836.
doi:10.1097/NMD.0b013e318156816f
Pietrzak, R. H., Tsai, J., Armour, C., Mota, N., Harpaz-Rotem, I., & South-
wick, S. M. (2015). Functional significance of a novel 7-factor model
of DSM-5 PTSD symptoms: Results from the National Health and Re-
silience in Veterans Study. Journal of Affective Disorders, 174, 522–526.
doi:10.1016/j.jad.2014.12.007
Pynoos, R. S., & Steinberg, A. M. (2014). UCLA PTSD Reaction Index for
Children/Adolescents–DSM-5. University of California at Los Angeles. Los
Angeles.
Roemer, L., Orsillo, S. M., Borkovec, T. D., & Litz, B. T. (1998). Emotional
response at the time of a potentially traumatizing event and PTSD symp-
tomatology: A preliminary retrospective analysis of the DSM-IV Criterion
A-2. Journal of Behavior Therapy and Experimental Psychiatry, 29, 123–
130. doi:10.1016/s0005-7916(98)00007-x
Saul, A. L., Grant, K. E., & Carter, J. S. (2008). Post-trumatic reactions in
adolescents: How well do the DSM-IV PTSD criteria fit the real life experi-
ence of trauma exposed youth? Journal of Abnormal Child Psychology, 36,
915–925. doi:10.1007/s10802-008-9222-z
Steinberg, A. M., Brymer, M. J., Kim, S., Briggs, E. C., Ippen, C. G, Os-
trowski, S. A., . . . Pynoos, R. S. (2013). Psychometric Properties of the
UCLA PTSD Reaction Index: Part I. Journal of Traumatic Stress, 26(1), 1–9.
doi:10.1002/jts.21780
Taylor, S., Fedoroff, I. C., Koch, W. J., Thordarson, D. S., Fecteau, G., &
Nicki, R. M. (2001). Posttraumatic stress disorder arising after road traf-
fic collisions: Patterns of response to cognitive–behavior therapy. Journal
of Consulting and Clinical Psychology, 69, 541–551. doi:10.1037/0022-
006X.69.3.541
Teplin, L., Welty, L. J., Abram, K. M., Dulcan, M. K., Washburn, J. J., McCoy,
K., & Stokes, M. L. (2015). Psychiatric disorders in youth after detention.
Washington, DC: U.S. Department of Justice, Office of Justice Programs,
Office of Juvenile Justice and Delinquency Prevention.
Wang, L., Long, D., Li, Z., & Armour, C. (2011). Posttraumatic stress disorder
symptom structure in Chinese adolescents exposed to a deadly earthquake.
Journal of Abnormal Child Psychology, 39, 749–758. doi:10.1007/s10802-
011-9508-4
Wang, L., Zhang, L., Armour, C., Cao, C., Qing, Y., Zhang, J., & Fan, G. (2015).
Assessing the underlying dimensionality of DSM-5 PTSD symptoms in
Chinese adolescents surviving the 2008 Wenchuan earthquake. Journal of
Anxiety Disorders, 31, 90–97. doi:10.1016/j.janxdis.2015.02.006
Copyright of Journal of Traumatic Stress is the property of John Wiley & Sons, Inc. and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.