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Trauma

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Full-Text Articles in Psychology

Nothing I Said Was Enough: Writing As Self-Validation, Michama M. Dorvile Jan 2025

Nothing I Said Was Enough: Writing As Self-Validation, Michama M. Dorvile

Electronic Theses & Dissertations (2024 - present)

This thesis explores the process of using writing as a coping mechanism to heal from trauma by portraying how personal narratives confront pain and reclaim agency. This thesis also explores how writing serves as a means of survival and sharing testimony. The thesis starts with a critical analysis essay, drawing on literary criticism and trauma theory. I explore how Roxane Gay, Kathryn Harrison, Bessel Van der Kolk, and Maya Angelou have used writing to challenge societal perceptions of trauma, and how through writing, they have resisted erasure.

The heart of this thesis is an original creative work, which involves an …


An Exploration Of Traumatic Experiences In Adults With Adhd, Anna E. Lee Jan 2025

An Exploration Of Traumatic Experiences In Adults With Adhd, Anna E. Lee

Antioch University Dissertations & Theses

This dissertation explored the lived experiences of psychological trauma in adults diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Using an Interpretative Phenomenological Analysis (IPA) methodology, seven participants exhibiting clinically significant symptoms of psychological trauma completed semi-structured interviews to share their personal narratives. Following analysis, data was consolidated into five group experiential themes: (a) patterns of negative relationships, (b) dysfunctional family dynamics, (c) recognition of role in interpersonal conflict, (d) validation through ADHD diagnosis, and (e) ADHD and trauma as intertwined. The identified themes underscore the importance of trauma-informed clinical approaches that address relational difficulties and emotional regulation among this population, while emphasizing …


Yoga As A Self-Care Practice For Mental Health Counselors Who Treat Trauma, Kari Michelle Fitzgerald Jan 2025

Yoga As A Self-Care Practice For Mental Health Counselors Who Treat Trauma, Kari Michelle Fitzgerald

Graduate Research Theses & Dissertations

Given the high rates of burnout and compassion fatigue among trauma-exposed counselors, understanding effective self-care practices is critical for sustaining clinical effectiveness and well-being. Utilizing Interpretative Phenomenological Analysis (IPA), exploration of the lived experiences of licensed mental health counselors who treat trauma and use yoga as a self-care practice was conducted. Eight participants who were regular yoga practitioners each participated in one semi-structured interview and submitted one pre- and one post-interview reflective journal entry. Thematic analysis was used to identify six major themes; 1) emotional impact and sacred responsibility of clinical work, 2) yoga as a regulating and restorative practice, …


Embodied Affliction: Somalis’ Perception Of Trauma, Ahmed M. Hassan Jan 2025

Embodied Affliction: Somalis’ Perception Of Trauma, Ahmed M. Hassan

All Graduate Theses, Dissertations, and Other Capstone Projects

Somali immigrants and refugees have a high rate of trauma, mainly because of their traumatic experiences during the Somali civil war and subsequent migration. Nevertheless, they do not readily access available psychological services in the countries to which they migrate. Research of the past two decades has revealed that different cultures conceptualize and communicate mental distress differently from one another. Those differences affect how Western mental health providers approach the treatment of clients who immigrate from an unfamiliar culture to Western countries, where the biomedical model of mental health dominates the health care system. Improved cultural awareness and communication between …


A Pedagogy Of Self: A Critical Autoethnography Evaluating The Self And The Lessons Of Exposure, Experience, Action, And Inaction, Jeremy Grisham Jan 2025

A Pedagogy Of Self: A Critical Autoethnography Evaluating The Self And The Lessons Of Exposure, Experience, Action, And Inaction, Jeremy Grisham

Antioch University Dissertations & Theses

This dissertation is a critical autoethnography, which evaluates a lifetime of experience through the lens of an educational theory in critical pedagogy, and two psychological theories in liberation psychology and feminist therapy. These theoretical frameworks will help me evaluate how the lessons of my life have acted in both oppressive ways, and ways in which I have supported and benefited from systemic oppression. This research demonstrates that the existence of my own diagnosed psychopathologies, which have provided symptomatic pressures, have ultimately stemmed from systemic pressures, even those systems of which I have inherently benefited. Through this research, I conclude that …


Global Sleep Quality, Emotion Regulation Difficulties, And Ptsd Symptom Severity In Trauma-Exposed College Women, Grace M. Seymour Jan 2025

Global Sleep Quality, Emotion Regulation Difficulties, And Ptsd Symptom Severity In Trauma-Exposed College Women, Grace M. Seymour

Theses and Dissertations--Psychology

Sleep problems are common among college women and may contribute to PTSD symptoms. Those with emotion regulation difficulties may have increased difficulty managing distress worsened by poor sleep, though it is unclear which specific facets of emotion regulation are most relevant. This study examined interactions between sleep quality and facets of emotion regulation difficulties on PTSD symptoms among college women (N = 1,037) using self-report measures: the Pittsburgh Sleep Quality Index (PSQI), PTSD Checklist for DSM-5 (PCL-5), and Difficulties in Emotion Regulation Scale (DERS-18). Two significant interactions emerged. Sleep disturbance interacted with difficulties engaging in goal-directed behavior (b …


A Whole-Brain Voxel-Based Analysis Of Structural Abnormalities In Ptsd: An Enigma-Pgc Study, Jacklynn M. Fitzgerald Jan 2025

A Whole-Brain Voxel-Based Analysis Of Structural Abnormalities In Ptsd: An Enigma-Pgc Study, Jacklynn M. Fitzgerald

Psychology Faculty Research and Publications

Background

Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

Methods

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and …


The Lived Experiences Of Trauma In Autistic Adults: A Thematic Analysis, Briana Trageser Jan 2025

The Lived Experiences Of Trauma In Autistic Adults: A Thematic Analysis, Briana Trageser

Antioch University Dissertations & Theses

A qualitative research study focused on Autistic adults explored the lived experiences of trauma. Participants included Autistic adults who have either been professionally diagnosed with Autism Spectrum Disorder or who self-identify as Autistic. Data was collected through a survey with 12 open-ended questions. A thematic analysis revealed six themes: (a) adverse childhood experiences, (b) exposure to violence and loss, (c) difficulty relating to others, (d) complex mind and sensory experiences, (e) medical and mental health challenges, and (f) autistic identity. The themes revealed instances of Autistic people experiencing trauma in ways that differ and vary in clinical presentation from their …


The Effects Of A Spiritually Intergrated Trauma Healing Program On Ptsd Symptoms And Spiritual Well-Being In Nigeria, Emily Hervey Jan 2025

The Effects Of A Spiritually Intergrated Trauma Healing Program On Ptsd Symptoms And Spiritual Well-Being In Nigeria, Emily Hervey

Faculty Publications - Doctor of Psychology (PsyD) Program

Post-traumatic stress disorder (PTSD) has been identified as a significant concern worldwide, but very few spiritually oriented programs to address trauma have been tested in low to middle-income countries. This study evaluated the effectiveness of a faith-based, community-centered program in reducing PTSD symptoms and enhancing spiritual well-being. The program is designed for the participants’ well-being, while also equipping them to help their community in a form of task sharing. A total of 98 Nigerians participated in six five-day workshops, half in the capital city and half in areas farther north, where conflict was more common. The Posttraumatic Stress Disorder Checklist …


Natural Disasters, Psychosocial Distress, Psychological Flexibility, And Satisfaction With Life, Rodger K. Bufford, Javeen Skoubo, Kenneth Logan, Aundrea Paxton Jan 2025

Natural Disasters, Psychosocial Distress, Psychological Flexibility, And Satisfaction With Life, Rodger K. Bufford, Javeen Skoubo, Kenneth Logan, Aundrea Paxton

Faculty Publications - Doctor of Psychology (PsyD) Program

Although common, natural disasters (NDs) remain little studied, and their aggregate psychological impact is unknown. No aggregate measure of ND exposure could be located. This study reports the development and preliminary validation of the Natural Disaster Scale (NDS). In a sample of 131 US adults, disaster exposure was measured for NDs, for childhood and adult human disasters, for psychological flexibility, and for social support. Criteria included general distress, simple and complex PTSD, and life satisfaction. The NDS showed good internal consistency. Eleven of thirteen items loaded on a single factor. After controlling demographic factors, social support, and psychological flexibility, the …


Stress And Trauma-Related Concerns Among Law Enforcement, James Hughes Dec 2024

Stress And Trauma-Related Concerns Among Law Enforcement, James Hughes

Master of Arts in Human Services

Law enforcement personnel work in environments with routine exposure to high stress and trauma which can lead to increased risk for mental health conditions such as posttraumatic stress disorder (PTSD). The purpose of this study was to learn about the prevalence and effects of PTSD and related mental health issues among law enforcement (LE) officers and how psychological issues are managed within the LE system. An explanatory sequential mixed methods design strategy was used that involved collecting quantitative data first and then explaining the results with in-depth follow-up qualitative data. In the first quantitative phase of the study, data was …


The Role Of Hope In Recovery From Sexual Assault For Hispanic Women, Esmeralda Rivera Dec 2024

The Role Of Hope In Recovery From Sexual Assault For Hispanic Women, Esmeralda Rivera

Theses and Dissertations

Despite a growing amount of academic literature, there is a lack of research examining the levels of hope in Hispanic women recovering from sexual assault trauma. This quantitative survey investigates hope in Hispanic women healing from sexual assault trauma. The Miller Hope Scale (MHS) examines the variations and correlations between degrees of hope and demographic, personal, and self-advocacy factors. The research employs the Trauma Symptom Checklist—40 to investigate the correlation between levels of hope and trauma among women who have undergone sexual assault. Ninety-one Hispanic women from a crisis center in the U.S. were recruited for the study. Descriptive statistics, …


The Effects Of First Responder Stress & Trauma On Spouses And Romantic Partners, Eden Thiess Dec 2024

The Effects Of First Responder Stress & Trauma On Spouses And Romantic Partners, Eden Thiess

UNLV Theses, Dissertations, Professional Papers, and Capstones

First responder jobs pose unique difficulties due to the sheer number of traumatic events that they witness and personally experience. Research has demonstrated some effects of stress and trauma on family relationships, but the literature lacks an understanding of the ways that first responder trauma and stress affects their marriages and romantic relationships. The current study’s purpose was to investigate the experiences of first responder spouses and partners within the Las Vegas area in regards to stress, trauma, and relationship dynamics as influenced by the first responder role. In this study, 11 participants who were in a marriage or romantic …


Does Self-Care Moderate The Association Between Adverse Childhood Experiences, Trauma Symptoms, And Parental Reflective Functioning?, Vinaya Thomas Dec 2024

Does Self-Care Moderate The Association Between Adverse Childhood Experiences, Trauma Symptoms, And Parental Reflective Functioning?, Vinaya Thomas

Electronic Theses and Dissertations

Unresolved adverse and traumatic experiences in parents can amplify the risk of perpetuating intergenerational transmission of trauma. Parents’ positive and adaptive practices such as self-care might act as a protective factor against this ripple effect. This study investigated whether self-care moderated the relationship between parental ACEs, post-traumatic stress symptoms, and parental reflective functioning in mothers who are experiencing high psychosocial stress (n = 59) residing in rural Appalachia. Within our sample, there was no statistically significant linear relationship between our predictors, ACE score and PTSD symptoms, and our outcome of interest, maternal pre-mentalizing. We did not find empirical support for …


Traumatization Of In-Home Supportive Services (Ihss) Workers, Joseph Choi Nov 2024

Traumatization Of In-Home Supportive Services (Ihss) Workers, Joseph Choi

Doctoral Dissertations and Projects

The purpose of this phenomenological study is to describe Korean-speaking IHSS workers’ experiences with trauma in the Los Angeles area. The theory guiding this study is the ecological view on psychological trauma by Mary Harvey (1996). Harvey’s theory posits that each individual’s reaction to traumatizing events will be influenced by the source of one’s identity, through the combined attributes of community and a sense of belonging. As many Korean-speaking IHSS workers work exclusively with other Korean consumers, this theory can help explain the strong emotional and social ties Korean-speaking IHSS workers feel bound to in their daily operations. It is …


Destructive Plasticity, “Surplus Of Consciousness,” And The “Monster” In True Detective, Courtney Patrick-Weber Nov 2024

Destructive Plasticity, “Surplus Of Consciousness,” And The “Monster” In True Detective, Courtney Patrick-Weber

Dialogue: The Interdisciplinary Journal of Popular Culture and Pedagogy

The first season of HBO's cult hit True Detective introduced viewers to a southern gothic murder mystery that many will not easily forget. Since many of us focused primarily on the whodunit narrative, we may have missed the narrative of trauma simmering under the surface of the story. This narrative of trauma reveals a deeper layer to the story between Detective Rust Cohle and serial killer Errol Childress, one that also reveals our own fears regarding trauma in our lives. By applying first the nihilist philosophies of Peter Zapffe with Cohle and Catherine Malabou's concept on destructive plasticity in Childress, …


Neural Correlates Of Socially Rewarding Memories In Posttraumatic Stress Disorder, Kyle P. Blidy Oct 2024

Neural Correlates Of Socially Rewarding Memories In Posttraumatic Stress Disorder, Kyle P. Blidy

MUSC Theses and Dissertations

Significance. Memory disturbances for emotional content are central to PTSD, yet most research focuses on trauma memories. Recent evidence suggests that enhancing access to positive memories could improve mood, affect regulation, self-esteem, and integration of trauma memories. However, the neurocognitive mechanisms underlying positive memory encoding in PTSD are poorly understood. No study has examined memory for positive social items in PTSD, which is important because PTSD entails social withdrawal and reduced accessibility to positive memory. Additionally, positive memories embedded in a social context have enhanced subjective value and strengthening their accessibility may confer greater benefits to wellbeing compared to non-social …


Gsep Research Symposium Proceedings - 2024 Sep 2024

Gsep Research Symposium Proceedings - 2024

GSEP Research Symposium

The 8th Annual GSEP Research Symposium, was themed "Dismantling Barriers between Research and Practice: Shining a Light on Global Interdisciplinary Solutions," took place on July 18-19, 2024, at the picturesque Château d'Hauteville in Saint-Légier-La Chiésaz, Switzerland.

The annual symposium is hosted by the Pepperdine University Graduate School of Education and Psychology (GSEP). The symposium served as a dynamic platform for students, faculty, alums, and staff to come together and explore innovative ideas across multiple disciplines. Featuring 69 selected presentations under five distinct tracks, the proceedings showcase groundbreaking research, foster meaningful discussions, and promote professional development.

The symposium aimed to bridge …


Brain Injury And Psychosocial Trauma: Outcomes Among Justice-Involved Individuals, Mahathi D. Kosuri Sep 2024

Brain Injury And Psychosocial Trauma: Outcomes Among Justice-Involved Individuals, Mahathi D. Kosuri

Dissertations, Theses, and Capstone Projects

Justice-involved individuals experience disproportionately high rates of both traumatic brain injuries (TBI) and psychosocial traumas. However, these traumas have yet to be conceptualized together, leaving a chasm of research on how they interact and influence this population. The current study was the first to measure the effects of TBIs as well as psychosocial trauma among justice-involved men, within the context of executive functioning, history of justice involvement, and recidivism. A sample of men (N=95) from a private correctional facility were given the Ohio State University Traumatic Brain Injury Questionnaire (OSU-TBI-ID), the Lifetime Stressor Checklist- Revised (LSC-R), along with …


The Effect Of Working Memory Performance Under Stress On The Relationship Between Trauma History, Ptsd Symptoms, And Intimate Partner Violence, Gabriella Robinson Sep 2024

The Effect Of Working Memory Performance Under Stress On The Relationship Between Trauma History, Ptsd Symptoms, And Intimate Partner Violence, Gabriella Robinson

Dissertations, Theses, and Capstone Projects

Background: Over 12 million people annually experience intimate partner violence (IPV) in the United States. Emerging adulthood has the highest rates of IPV across the lifespan. While many theories attempt to explain why IPV rates are markedly increased during this age period, researchers call for more empirical studies to understand processes occurring during this period that result in increased IPV perpetration. Of the studies that assess IPV perpetration, samples generally consisted of male batterers that perpetrated severe IPV. Trauma history and PTSD symptoms have been seen as risk factors for IPV perpetration. Cognitive risk factors for IPV perpetration, such as …


Moral Injury In Police Officers Of Color, Samantha J. Thornton Aug 2024

Moral Injury In Police Officers Of Color, Samantha J. Thornton

Doctoral Dissertations and Projects

The purpose of this research is to explore the possibility of Moral Injury (MI) in police officers of color. This is a topic that is steeped in stigma and cultural dynamics, both for the community of police and communities of color. The aim is to add to the existing research on MI and how it may impact those who occupy dual special populations. The study approached targeted police advocacy organizations of color for recruitment nationwide. This study recruited 10 police officers of color from multiple states and explored their personal stories. This study used video recordings to capture qualitative data …


The Connections Among Adoption, Attachment, And Violence, Victoria M. Sanders Aug 2024

The Connections Among Adoption, Attachment, And Violence, Victoria M. Sanders

Doctoral Dissertations and Projects

Research regarding the experience and outcomes for adopted children has largely ended upon the individual turning 18 years old and has failed to provide adequate information about how adoption impacts an individual throughout the lifespan. Because of a lack of information gathering from the Department of Justice, there is little information about the incarceration rates of adopted individuals and the reasons for those incarcerations. This qualitative research study seeks to gain a better understanding of those individuals who were adopted and committed murder at some point after they were adopted. Court records, transcripts, motions, and evidence related to the murders …


Sleeping Through The Fright: Examining The Role Of Posttraumatic Symptoms On The Relationship Between Sleep Quality, Well-Being, And Health, Matthew R. Mckenzie Aug 2024

Sleeping Through The Fright: Examining The Role Of Posttraumatic Symptoms On The Relationship Between Sleep Quality, Well-Being, And Health, Matthew R. Mckenzie

Doctoral Dissertations

About one-third of our lives is spent sleeping. While sleep can be delayed to accommodate one’s lifestyle, the effects of inadequate sleep can be significant. Insufficient sleep has been linked to chronic health conditions, such as heart attacks, coronary heart disease, strokes, asthma, COPD, cancer, arthritis, depression, chronic kidney disease, and diabetes (Centers for Disease Control and Prevention, 2017). Sleep disturbances, such as insomnia and nightmares, are prevalent after a traumatic event (B. Caldwell & Redeker, 2005; Spoormaker & Montgomery, 2008) and are often seen as one of the defining characteristics of posttraumatic stress disorder (American Psychiatric Association, 2013; Maker …


Promoting Community Responsive, Trauma-Informed Consultation Practices In Rural School Communities: A Mixed Methods Exploratory Sequential Approach, Elly Q. Maras Aug 2024

Promoting Community Responsive, Trauma-Informed Consultation Practices In Rural School Communities: A Mixed Methods Exploratory Sequential Approach, Elly Q. Maras

Electronic Theses and Dissertations

Rural youth are placed at greater risk for experiencing adverse childhood experiences, developing mental health disorders, and dying by suicide when compared with the general population. Due to a widespread need for better access to mental health treatment, many are left untreated. These concerns are often exacerbated by individual and systemic risk factors that are endemic to rural communities. Rural school districts are being asked to deliver mental health services to students, with school psychologists as key stakeholders. Though school psychologists are uniquely qualified to support this need, graduate programs typically do not provide adequate coursework and training on consultation …


Healing A Broken Spirit: A Look Into Institutional Trauma And Spiritual Resilience, Christian Cederstrom Aug 2024

Healing A Broken Spirit: A Look Into Institutional Trauma And Spiritual Resilience, Christian Cederstrom

Master of Arts in Human Services

This paper focused on the relationship between spirituality, therapy, and those who are affected and traumatized by religious institutions. It sought to cover the hypothesis that exposure to positive spirituality can help those who have been affected by religious institutional trauma to recover. Studies have shown a positive correlation between religiosity and recovery from traumatic experiences and that therapy can also increase one spirituality and relationship with God or other higher powers. This article sought to highlight that this strength of a spiritual coping mechanism may be increased by a person’s education in the field of theology and spirituality meaning …


‘Catching Zzz’S And Feelings’: A Study Examining The Link Between Sleep And Emotional Intimacy Among Sexual Assault Survivors, Anna Marie Thi Thanh Nguyen Aug 2024

‘Catching Zzz’S And Feelings’: A Study Examining The Link Between Sleep And Emotional Intimacy Among Sexual Assault Survivors, Anna Marie Thi Thanh Nguyen

Graduate Theses and Dissertations

The impact of sexual assault can be significant, including an increased likelihood of subsequent negative psychological and physical outcomes, even compared to other trauma types. Further studies indicate that individuals who have experienced sexual assault are more likely to struggle with interpersonal relationships. Sleep is a transdiagnostic process and disrupted sleep is a prominent feature of post-trauma related symptoms. Sleep is also implicated in social cognitive processes that are used to establish emotional intimacy in interpersonal relationships. The goal of the current study is therefore to examine the relations among sexual assault exposure, sleep, and emotional intimacy. A two-part study …


Under The Neon Lights: Examining The Memories Of Las Vegas' Route 91 Harvest Music Festival, William B. Ridgway Aug 2024

Under The Neon Lights: Examining The Memories Of Las Vegas' Route 91 Harvest Music Festival, William B. Ridgway

UNLV Theses, Dissertations, Professional Papers, and Capstones

The aim of the current study was to identify patterns of meaning in the trauma narratives of Route 91 Harvest survivors. We undertook a thematic analysis to examine survivors’ narratives collected shortly after the event (i.e., within one month), allowing for a more in-depth understanding of what survivors tended to emphasize or gravitate toward when recalling the episode of mass violence that resulted in the deadliest mass shooting in modern American history. From the rich thematic content emerged a dominant theme of memory for contextual details—specifically, sensory-perceptual features, time, and space. Specifically, Route 91 Harvest survivors reported vivid sensory experiences, …


Divine Retribution, Anna Payne Jul 2024

Divine Retribution, Anna Payne

Ursidae: The Undergraduate Research Journal at the University of Northern Colorado

Sexual abuse has always been an issue in all cultures throughout the world and history. Easton et al. delved into the problems of barriers to disclosing child sexual abuse with 460 male participants which showed that 61.7% of them reported CSA at the hands of a priest. As that study was conducted, Helsel and McCormack tackled the effects of CSA on the nervous system and psyche. While religion is used as a coping mechanism, it is also a tool for maltreatment from clergy sexually abusing children to parents seeking ways to rid the child of demons. There have been over …


Intense, Repeated, And Ever-Present: An Initial Investigation Of Traumatic Invalidation Among Sexual Minorities, Zane Browning Ballard Jul 2024

Intense, Repeated, And Ever-Present: An Initial Investigation Of Traumatic Invalidation Among Sexual Minorities, Zane Browning Ballard

Dissertations (1934 -)

Lesbian, gay, bisexual, and queer individuals have been shown to experience significantly more negative health outcomes than do heterosexuals, commonly attributed to sexual minority stress. Research to date has insufficiently explained the processes by which stigma exposure becomes felt, internalized stigma and has not accounted for resemblance between presentation of mental health effects of sexual minority stress and of post-traumatic responses. Researchers have posited traumatic invalidation may partially explain the development and manifestations of reactions to sexual minority stress. The current study proposed and tested a measure of traumatic invalidation, conceptualized as instances of interpersonal, identity-based invalidation among sexual minorities. …


Peritraumatic Distress And Dissociation In People With And Without Disabilities Utilizing Emergency Departments, Sydney C. Hart Jun 2024

Peritraumatic Distress And Dissociation In People With And Without Disabilities Utilizing Emergency Departments, Sydney C. Hart

USF Tampa Graduate Theses and Dissertations

To date the literature on peritraumatic distress and peritraumatic dissociation in individuals receiving emergency medical treatment has not examined people with disabilities or chronic health conditions as a specified population, despite these populations’ disproportional utilization of medical facilities and additional stressors faced in those environments. Thus, this study assessed and compared the prevalence and averages on the Peritraumatic Distress Inventory (PDI) and Peritraumatic Dissociative Experiences Questionnaire (PDEQ) in people with and without disabilities and/or chronic health conditions after Emergency Department (ED) visits. A sample of 138 participants 18 years of age or older, of which 109 reported disabilities and/or chronic …