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White WF, Burgess A, Dalgleish T, Dixon C, Halligan SL, Hiller RM, McKinnon A, Smith P, Meiser-Stedman R. Investigating the dissociative subtype of post-traumatic stress disorder in single- and multi-event trauma-exposed youth: Prevalence, course, prognosis, severity and functional impairment. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:330-346. [PMID: 38487960 DOI: 10.1111/bjc.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVES This study aimed, following both single- and multi-event trauma, to ascertain prevalence and course of the dissociative subtype of post-traumatic stress disorder (PTSD-DS) in youth; how well early PTSD-DS predicts later PTSD; and whether dissociation accounts for unique variance in post-traumatic stress symptoms (PTSS) and functional impairment over and above the effect of other post-trauma cognitive processing factors and PTSS respectively. DESIGN AND METHODS This study is a secondary analysis of data from the Acute Stress Programme for Children and Teenagers study (n = 234) and the Coping in Care After Trauma study (n = 110) in which children had experienced single- and multi-event trauma respectively. RESULTS PTSD-DS diagnosis was common in children with PTSD regardless of trauma experienced (>39.0%). PTSD-DS showed a similar trajectory of natural recovery to PTSD, and it was similarly predictive of later PTSD following single-event trauma. Finally, dissociation was a significant factor in PTSS and functional impairment. CONCLUSIONS These results should be viewed in the context of several limitations including narrow sample of participants which reduces the generalizability of results, concerns around children's ability to conceptualize challenging concepts such as dissociation and the use of self-report measures to form diagnostic groups. The PTSD-DS diagnosis may offer clinical utility to the extant PTSD diagnosis in children and adolescents, as dissociation has been shown to be a contributory factor in the maintenance of both PTSS and functional impairment. Further research is required to inform further editions of the DSM and other diagnostic systems.
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Affiliation(s)
- William F White
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Aaron Burgess
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Clare Dixon
- Sussex Partnership National Health Service Foundation Trust, Sussex, UK
| | | | - Rachel M Hiller
- Division of Psychology and Language Sciences, University College London, London, UK
- Anna Freud Centre for Children and Families, London, UK
| | - Anna McKinnon
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
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Davis LL, Urganus A, Gagnon-Sanschagrin P, Maitland J, Bedard J, Bellefleur R, Cloutier M, Guérin A, Aggarwal J. Patient journey of civilian adults diagnosed with posttraumatic stress disorder-A chart review study. Curr Med Res Opin 2024; 40:505-516. [PMID: 38258436 DOI: 10.1080/03007995.2024.2308016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To assess the journey of individuals from experiencing a traumatic event through onset of symptoms, diagnosis, and treatment of posttraumatic stress disorder (PTSD). METHODS Patient- and psychiatrist-level data was collected (02/2022-05/2022) from psychiatrists who treated ≥1 civilian adult diagnosed with PTSD. Eligible charts covered civilian adults diagnosed with PTSD (2016-2020), receiving ≥1 PTSD-related treatment (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs], atypical antipsychotics [AAs]), and having ≥1 medical visit in the last 12 months. Collected information included clinical and treatment characteristics surrounding the PTSD diagnosis. RESULTS A total of 273 psychiatrists contributed data on 687 patients with PTSD (average age 36.1; 60.4% female). On average, the traumatic event and symptom onset occurred 8.7 years and 6.5 years prior to PTSD diagnosis, respectively. In the 6 months before diagnosis, 88.9% of patients had received a PTSD-related treatment. At time of diagnosis, 87.8% of patients had intrusion symptoms and 78.9% had alterations in cognition/mood; 41.2% had depressive disorder and 38.7% had anxiety. Diagnosis prompted treatment changes for 79.3% of patients, receiving treatment within 1.9 months on average, often with a first-line SSRI as either monotherapy (52.8%) or combination (24.9%). At the end of the 24-month study period, 34.4% of patients achieved psychiatrist-recorded remission. A total of 23.0% of psychiatrists expressed dissatisfaction with approved PTSD treatments, with 88.3% at least somewhat likely to prescribe AAs despite lack of FDA approval. CONCLUSION PTSD presents heterogeneously, with an extensive journey from trauma to diagnosis with low remission rates and limited treatment options.
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Affiliation(s)
- Lori L Davis
- Research Service, Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, USA
| | | | | | | | | | | | | | | | - Jyoti Aggarwal
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
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3
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Greene T, Contractor AA, Dicker-Oren SD, Fentem A, Sznitman SR. The Effects of the Processing of Positive Memories Technique on Posttrauma Affect and Cognitions Among Survivors of Trauma: Protocol for a Daily Diary Study. JMIR Res Protoc 2024; 13:e51838. [PMID: 38214953 PMCID: PMC10818235 DOI: 10.2196/51838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The Processing of Positive Memories Technique (PPMT) is a promising new treatment approach for posttraumatic stress disorder (PTSD), which involves detailed narration and processing of specific positive autobiographical memories. Indeed, preliminary case-series studies have found reductions in PTSD symptoms, negative affect, and negative cognitions among survivors of trauma who have received PPMT. However, PPMT's effects have not been investigated at the daily level. In this study, we describe the protocol for a study that will examine the daily-level impacts of PPMT in a trauma-exposed, nonclinical community sample. OBJECTIVE This study uses an innovative research protocol that combines case-series design and daily diary approaches to examine changes in daily affect, daily cognitions, and daily PTSD symptoms pre- and post-PPMT. We hypothesize that at the daily level, in comparison to their own pre-PPMT levels, following the PPMT intervention, participants will report (1) a lower count of endorsed daily PTSD symptoms, (2) increases in daily positive affect and decreases in daily negative affect, (3) increases in positive affect reactivity to daily positive events, and (4) decreases in daily posttrauma cognitions. METHODS We are currently recruiting participants (target n=70) from a metroplex in the southwest United States. Following a screening survey, eligible participants complete a preintervention baseline survey, followed by 21 daily surveys in their natural environments. Then, they receive 4 PPMT sessions on a weekly basis. After the conclusion of the PPMT intervention, participants complete a postintervention outcome survey and 21 daily surveys. To compare daily affect, daily cognitions, and daily PTSD symptoms before and after PPMT, we will use the daily diary report data and conduct multilevel random intercepts and slopes linear regression models. RESULTS Data collection was initiated in March 2022 and is expected to end by June 2024. As of November 28, 2023, a total of 515 participants had consented to the study in the screening phase. No analyses will be conducted until data collection has been completed. CONCLUSIONS Study findings could clarify whether deficits in positive autobiographical memory processes may also characterize PTSD alongside deficits in traumatic memory processes. Furthermore, PPMT could be an additional therapeutic tool for clinicians to help clients reduce posttraumatic distress in their everyday lives. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51838.
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Affiliation(s)
- Talya Greene
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Ateka A Contractor
- Department of Psychology, University of North Texas, Denton, TX, United States
| | | | - Andrea Fentem
- Department of Psychology, University of North Texas, Denton, TX, United States
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4
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The relationship between multiple traumatic events and the severity of posttraumatic stress disorder symptoms – evidence for a cognitive link. Eur J Psychotraumatol 2023; 14:2165025. [PMID: 37052097 PMCID: PMC9879173 DOI: 10.1080/20008066.2023.2165025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Previous research has shown that multiple traumatic experiences cumulatively increase the risk for the development of severe symptoms of posttraumatic stress disorder (PTSD). Yet, little is known about the specific psychological mechanism through which this increased risk comes about.Objective: In the present study, we examined a possible cognitive link between multiple traumatic events and PTSD symptom severity through dysfunctional cognitions and expectations.Methods: A sample of patients with a diagnosed PTSD (N = 70; MAge = 42.06; 82% female) and high symptom burden (IES-R M = 79.24) was examined. On average, patients had experienced 5.31 different traumatic events. In a structural equation model, we tested the hypothesis that the relationship between multiple traumatic experiences and PTSD symptom severity is mediated through dysfunctional general cognitions and dysfunctional situation-specific expectations. General trauma-related cognitions were assessed with the Posttraumatic Cognition Inventory (PTCI) and trauma-related situational expectations were assessed with the Posttraumatic Expectations Scale (PTES).Results: The direct effect of the number of traumatic events on PTSD symptom severity was non-significant. Instead, as hypothesised, there was evidence for a significant indirect effect via dysfunctional general cognitions and situation-specific expectations.Conclusions: The current results further specify the cognitive model of PTSD by indicating that the relationship between the number of traumatic events and PTSD symptom severity is mediated through dysfunctional cognitions and expectations. These findings emphasise the importance of focused cognitive treatment approaches that seek to modify dysfunctional cognitions and expectations in people with multiple traumatic experiences.
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Impact of the Russian Invasion on Mental Health of Adolescents in Ukraine. J Am Acad Child Adolesc Psychiatry 2023; 62:335-343. [PMID: 36441074 DOI: 10.1016/j.jaac.2022.07.845] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/21/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Very limited evidence is available on the psychological impact of war on adolescents in Ukraine. This study compared war experiences and posttraumatic stress disorder (PTSD), anxiety and depression in adolescents living in war-torn and peaceful regions of Ukraine, more than 2 years after Russia first invaded in 2014. METHOD The cross-sectional study included 2,766 students aged 11 to 17 years living in the war-torn Donetsk region and in Kirovograd in central Ukraine. Self-reported PTSD, depression, and anxiety were assessed by Harvard Trauma Questionnaire, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7. Data were collected from September 2016 to January 2017. Binary and multinomial logistic regression models were used to examine the association between PTSD, anxiety, and depression and regions. RESULTS War trauma and daily stress were higher in adolescents in the Donetsk region; 881 (60.2%) adolescents had witnessed armed attacks, 204 (13.9%) were victims of violence, and 409 (27.9%) were forced to leave their homes. They also had significantly increased risks for PTSD (odds ratio [OR] 4.11, 95% CI 2.37-7.13), severe anxiety (OR 3.10, 95% CI 1.83-5.27), and moderately severe/severe depression (OR 2.65, 95% CI 1.79-3.92). CONCLUSION Traumatic events and daily stress were strongly associated with psychological distress in adolescents living in a war-torn region in Ukraine. These findings can help in understanding, measuring, and addressing the long-term impact that the current escalating war in Ukraine will have on adolescents' mental health and social functioning.
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Rudy JA, McKernan S, Kouri N, D'Andrea W. A meta-analysis of the association between shame and dissociation. J Trauma Stress 2022; 35:1318-1333. [PMID: 35749645 DOI: 10.1002/jts.22854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022]
Abstract
Shame and dissociation have been implicated theoretically and empirically in trauma exposure and its sequelae, with shame understood as an intense negative emotion and dissociation as a reaction to intense negative emotions. Understanding the connection between shame and dissociation is important for theory and practice; however, the strength of this association remains unclear. For example, in therapy, both shame and dissociation serve as a barrier to engaging with emotion. Theoretically, these two states should be distinct, as one (dissociation) confers low affective intensity and the other (shame) high intensity. The present meta-analysis focused on the magnitude of the association between these two phenomena and investigated the extent to which gender, trauma exposure, psychiatric comorbidities, and demographic characteristics influence this association given their independent links to shame and dissociation. An initial search of six databases identified 151,844 articles. Duplicates were removed, and additional articles were excluded based on abstract and title screening. After contacting authors for missing data, a full-text screen yielded 25 articles for the present analysis. The results indicate that shame and dissociation were moderately correlated (k = 33, n = 4,705), r = .42, 95% CI [.35, .48], p < .001, but no clear clinical moderators emerged. Despite this association, very few studies utilized experimental designs to examine the association between these constructs. Future research should focus on experimental study designs to investigate the extent to which shame induces dissociation or vice versa.
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Affiliation(s)
- Justine A Rudy
- Department of Psychology, The New School for Social Research, New York, New York, USA
| | - Scott McKernan
- Department of Psychology, The New School for Social Research, New York, New York, USA
| | - Nicole Kouri
- Department of Clinical Psychology, Wayne State University, Detroit, Michigan, USA
| | - Wendy D'Andrea
- Department of Psychology, The New School for Social Research, New York, New York, USA
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7
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Schlesselmann AJ, Huntjens RJC, Renard SB, McNally RJ, Albers CJ, De Vries VE, Pijnenborg GHM. A Network Approach to Trauma, Dissociative Symptoms, and Psychosis Symptoms in Schizophrenia Spectrum Disorders. Schizophr Bull 2022; 49:559-568. [PMID: 36124634 PMCID: PMC10154708 DOI: 10.1093/schbul/sbac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Dissociative experiences commonly occur in schizophrenia spectrum disorders (SSD). Yet little is known about how dissociative experiences in SSD are related to SSD symptoms. Accordingly, we investigated the relations between dissociative experiences and SSD symptoms, focusing on symptoms bridging these 2 symptom clusters as well as their relation to reported trauma history. STUDY DESIGN Network analyses were conducted on the responses of 248 individuals with an SSD who enrolled from multiple mental health centers in The Netherlands. Dissociative experiences were assessed via the Dissociative Experience Scale, SSD symptoms using the Positive and Negative Syndrome Scale, and trauma history through the Trauma History Questionnaire. STUDY RESULTS The results indicated that dissociative symptoms in SSD are mostly independent of other symptoms, but that emotional distress bridges between the dissociative and SSD symptom clusters. Furthermore, results revealed associations between positive and negative SSD symptoms and trauma through emotional distress, whereas dissociative symptoms remained relatively isolated. CONCLUSION Because SSD symptoms and dissociative experiences clustered relatively independent from each other, our findings promote the idea of tailored treatment approaches for individuals with an SSD with frequent dissociative experiences, specifically targeting these symptoms.
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Affiliation(s)
- Ante J Schlesselmann
- Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Rafaele J C Huntjens
- Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Selwyn B Renard
- Department of Forensic Psychiatry, GGZ Friesland, Leeuwarden, The Netherlands
| | | | - Casper J Albers
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Vera E De Vries
- Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.,Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands
| | - G H Marieke Pijnenborg
- Department of Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.,Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands
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8
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Bertele N, Talmon A, Gross JJ. Childhood Maltreatment and Narcissism: The Mediating Role of Dissociation. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP9525-NP9547. [PMID: 33356780 DOI: 10.1177/0886260520984404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Childhood maltreatment (CM) is thought to be linked to adult narcissistic traits. However, it remains unclear how CM is associated with each type of narcissism, vulnerable and grandiose, and what mechanism mediates these links. One potential candidate is dissociation. This study examines the relations among CM, dissociation, vulnerable narcissism, and grandiose narcissism. A total of 322 women completed self-reported questionnaires assessing CM, dissociation, vulnerable narcissism, and grandiose narcissism. To examine the relations among CM, dissociation, and each type of narcissism, we performed Pearson's correlations and mediation analyses. In secondary analyses, we conducted latent class analyses to classify different types of CM and to assess their relations with the study variables. We found small to moderate correlations between CM and vulnerable narcissism, (r = .35, p < .001) and CM and grandiose narcissism (r = .2, p < .001), with the former association being greater than the latter (z = -3.25, p < .001). Dissociation was found to mediate the link between CM and each type of narcissism (p < .001). Results suggest that CM may play a role in the etiology of vulnerable and grandiose narcissism, and that dissociation links CM to each type of narcissism. Findings highlight that CM may lead to different responses in terms of narcissism-through the same mediation process.
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9
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Rieder JK, Kleshchova O, Weierich MR. Trauma Characteristics Moderate the Relation Between Estradiol and Trauma-Related Symptoms. J Trauma Stress 2022; 35:246-256. [PMID: 34390027 PMCID: PMC8840997 DOI: 10.1002/jts.22725] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/10/2021] [Accepted: 06/20/2021] [Indexed: 02/03/2023]
Abstract
Women are more likely to develop posttraumatic stress disorder (PTSD) than men, and fluctuations in gonadal hormones might contribute to this vulnerability. Low-estradiol states are associated with aversive affective experiences, including trauma-related symptoms. However, the impact of trauma characteristics on the relation between estradiol and trauma-related symptoms is unknown. We used a clinical interview and 10-day ecological momentary assessment (EMA) that spanned low- and high-estradiol menstrual cycle phases to test trauma type, chronicity, and timing as moderators of the association between estradiol and trauma-related symptoms in 40 naturally cycling young women. We tested interactions between trauma characteristics and (a) estradiol on self-reported symptoms and (b) menstrual cycle-related change in estradiol on change in symptoms. Sexual, chronic, and earlier trauma was associated with more severe symptoms as reported during the interview, rs = .51-.33, but not mean symptoms across the EMA. Estradiol at the time of the interview was inversely associated with symptoms in women with sexual but not nonsexual trauma, interaction: B = -12.62 (SE = 5.28), p = .022. Menstrual cycle-related change in estradiol was inversely associated with change in symptoms in women with chronic trauma, B = -9.65 (SE = 3.49), p = .006, and earlier trauma, B = 0.71 (SE = 0.34), p = .036, but not discrete or later trauma. Sexual, chronic, or early trauma exposure might confer higher symptom vulnerability in low-estradiol states. Clinicians who work with women with particular trauma histories might anticipate menstrual cycle-related variation in symptoms.
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Affiliation(s)
- Jenna K. Rieder
- College of Humanities and Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Olena Kleshchova
- Department of Psychology, University of Nevada, Reno, Reno, Nevada, USA
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10
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Xie CS, Kim Y. Post-Traumatic Growth during COVID-19: The Role of Perceived Social Support, Personality, and Coping Strategies. Healthcare (Basel) 2022; 10:224. [PMID: 35206839 PMCID: PMC8872023 DOI: 10.3390/healthcare10020224] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 12/19/2022] Open
Abstract
Although many studies on mental health have been conducted among various populations during the COVID-19 pandemic, few studies have focused on post-traumatic growth (PTG) in the general population. The current study aimed to explore whether perceived social support, personality, and coping strategies are associated with PTG in the COVID-19 pandemic period. The study also investigated whether coping strategies mediate the relations between perceived social support, personality, and PTG. A total of 181 participants (Mage = 24) completed the self-report questionnaire online, which was distributed via various online channels, mainly in China and Sweden. The relations between the study variables were examined with correlation analyses and a multiple mediation analysis. Results showed that more than half of the participants (60.8%) reported experiences of PTG during the pandemic. Additionally, perceived social support, personality traits (extraversion, emotional stability, agreeableness, and conscientiousness) and coping strategies (problem-focused coping, emotion-focused coping, and social support coping) were positively correlated with PTG. In addition, coping strategies (problem-focused coping, emotion-focused coping, and avoidance coping) mediated the relations between perceived social support, personality traits and PTG. Theoretical and practical implications of this study are discussed, concluding that the findings of this study have the potential to guide intervention efforts to promote positive change during the pandemic.
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Affiliation(s)
- Chu-Si Xie
- Department of Psychology, Faculty of Social Science, Lund University, 22100 Lund, Sweden;
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11
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Silwal S, Chudal R, Dybdahl R, Sillanmäki L, Lien L, Sourander A. Post-traumatic Stress and Depressive Symptoms Among Adolescents After the 2015 Earthquake in Nepal: A Longitudinal Study. Child Psychiatry Hum Dev 2022; 53:430-439. [PMID: 33606131 PMCID: PMC9107405 DOI: 10.1007/s10578-021-01136-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2021] [Indexed: 12/01/2022]
Abstract
Few longitudinal studies have focused on mental health problems among adolescents after earthquakes. We investigated changes in post-traumatic stress symptoms (PTSS) and depressive symptoms from 18 to 31 months after the 2015 earthquake in Nepal and explored potential risk factors associated with the change in psychiatric symptoms. This study comprised of 515 adolescents, aged 11-17 years from two earthquake-affected areas, one severely affected than the other. The psychiatric symptoms were assessed using the standardized Child Post-traumatic Stress Disorder Scale and the Depression Self-Rating Scale. No significant change was observed in the prevalence of PTSS and depressive symptoms from 18 to 31 months after the earthquake. Living in severely affected area and exposure to trauma after the earthquake were associated with adolescents who developed chronic or delayed PTSS and depressive symptoms. The study findings highlight the need for disaster preparedness and early interventions that strengthen support at various levels.
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Affiliation(s)
- Sanju Silwal
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku, Turku, Finland. .,Department of Clinical Science, Faculty of Medicine, Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3 / Teutori (3rd. floor), 20014, Turku, Finland.
| | - Roshan Chudal
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Ragnhild Dybdahl
- Department of Social Work, Child Welfare and Social Policy, OsloMet University, Oslo, Norway ,Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Lauri Sillanmäki
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Lars Lien
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway ,Department of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Andre Sourander
- Department of Child Psychiatry, Research Centre for Child Psychiatry, University of Turku, Turku, Finland ,Department of Child Psychiatry, Turku University Hospital, Turku, Finland ,INVEST Research Flagship, University of Turku, Turku, Finland
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12
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Li L, Zhang Y, Zhao Y, Li Z, Kemp GJ, Wu M, Gong Q. Cortical thickness abnormalities in patients with post-traumatic stress disorder: A vertex-based meta-analysis. Neurosci Biobehav Rev 2022; 134:104519. [PMID: 34979190 DOI: 10.1016/j.neubiorev.2021.104519] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023]
Abstract
Neuroimaging studies report altered cortical thickness in patients with post-traumatic stress disorder (PTSD), but the results are inconsistent. Using anisotropic effect-size seed-based d mapping (AES-SDM) software with its recently-developed meta-analytic thickness mask, we conducted a meta-analysis of published studies which used whole-brain surface-based morphometry, in order to define consistent cortical thickness alterations in PTSD patients. Eleven studies with 438 patients and 396 controls were included. Compared with all controls, patients with PTSD showed increased cortical thickness in right superior temporal gyrus, and in left and right superior frontal gyrus; the former survived in subgroup analysis of adult patients, and in subgroup comparison with only non-PTSD trauma-exposed controls, the latter in subgroup comparison with only non-trauma-exposed healthy controls. Cortical thickness in right superior frontal gyrus was positively associated with percentage of female patients, and cortical thickness in left superior frontal gyrus was positively associated with symptom severity measured by the clinician-administered PTSD scale. These robust results may help to elucidate the pathophysiology of PTSD.
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Affiliation(s)
- Lei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Youjin Zhao
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Zhenlin Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Min Wu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, PR China; Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China.
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13
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Ford JD, Tennen H, Grasso DJ, Chan G. An in-Vivo Daily Self-Report Approach to the Assessment of Outcomes of Two Psychotherapies for Women With Posttraumatic Stress Disorder. Behav Ther 2022; 53:11-22. [PMID: 35027153 DOI: 10.1016/j.beth.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/23/2021] [Accepted: 05/07/2021] [Indexed: 11/02/2022]
Abstract
Emotion regulation and interpersonal psychotherapies that do not require trauma memory processing have been shown to be effective in treating posttraumatic stress disorder (PTSD). This study used a novel method to assess in vivo outcomes in a randomized clinical trial with women (N = 147; ages 18-54; 61% of color; 94% low income) with full (79%) or partial (21%) PTSD. Participants were assigned to affect regulation or interpersonal therapy, or wait-list, and completed daily self-reports for 2 to 4 weeks at baseline and up to 30 days at posttest. Mixed model regression analyses tested pre-post change on five factor analytically derived aggregated daily self-report scores. Emotion regulation-focused therapy was associated with reduced PTSD symptoms, dysregulation, and negative affect, and improvement in adaptive self-regulation and positive affect. Interpersonal-focused therapy was associated with reduced PTSD symptoms and dysregulation. Although both therapies were associated with reduced PTSD symptoms, whether this was due to nonspecific factors rather than the treatments per se could not be determined. Daily self-report data warrant further investigation in psychotherapy research with disorders such as PTSD, in order to assess affective and interpersonal dysregulation and adaptive regulation as they occur in daily life.
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Affiliation(s)
| | | | | | - Grace Chan
- University of Connecticut, School of Medicine
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14
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Nöthling J, Abrahams N, Toikumo S, Suderman M, Mhlongo S, Lombard C, Seedat S, Hemmings SMJ. Genome-wide differentially methylated genes associated with posttraumatic stress disorder and longitudinal change in methylation in rape survivors. Transl Psychiatry 2021; 11:594. [PMID: 34799556 PMCID: PMC8604994 DOI: 10.1038/s41398-021-01608-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 08/01/2021] [Accepted: 09/02/2021] [Indexed: 12/24/2022] Open
Abstract
Rape is associated with a high risk for posttraumatic stress disorder (PTSD). DNA methylation changes may confer risk or protection for PTSD following rape by regulating the expression of genes implicated in pathways affected by PTSD. We aimed to: (1) identify epigenome-wide differences in methylation profiles between rape-exposed women with and without PTSD at 3-months post-rape, in a demographically and ethnically similar group, drawn from a low-income setting; (2) validate and replicate the findings of the epigenome-wide analysis in selected genes (BRSK2 and ADCYAP1); and (3) investigate baseline and longitudinal changes in BRSK2 and ADCYAP1 methylation over six months in relation to change in PTSD symptom scores over 6 months, in the combined discovery/validation and replication samples (n = 96). Rape-exposed women (n = 852) were recruited from rape clinics in the Rape Impact Cohort Evaluation (RICE) umbrella study. Epigenome-wide differentially methylated CpG sites between rape-exposed women with (n = 24) and without (n = 24) PTSD at 3-months post-rape were investigated using the Illumina EPIC BeadChip in a discovery cohort (n = 48). Validation (n = 47) and replication (n = 49) of BRSK2 and ADCYAP1 methylation findings were investigated using EpiTYPER technology. Longitudinal change in BRSK2 and ADCYAP1 was also investigated using EpiTYPER technology in the combined sample (n = 96). In the discovery sample, after adjustment for multiple comparisons, one differentially methylated CpG site (chr10: 61385771/ cg01700569, p = 0.049) and thirty-four differentially methylated regions were associated with PTSD status at 3-months post-rape. Decreased BRSK2 and ADCYAP1 methylation at 3-months and 6-months post-rape were associated with increased PTSD scores at the same time points, but these findings did not remain significant in adjusted models. In conclusion, decreased methylation of BRSK2 may result in abnormal neuronal polarization, synaptic development, vesicle formation, and disrupted neurotransmission in individuals with PTSD. PTSD symptoms may also be mediated by differential methylation of the ADCYAP1 gene which is involved in stress regulation. Replication of these findings is required to determine whether ADCYAP1 and BRSK2 are biomarkers of PTSD and potential therapeutic targets.
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Affiliation(s)
- Jani Nöthling
- Department of Psychiatry, Faculty of Medicine and Health Sciences Stellenbosch University, Cape Town, South Africa.
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa.
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Stellenbosch University, Cape Town, South Africa.
| | - Naeemah Abrahams
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sylvanus Toikumo
- Department of Psychiatry, Faculty of Medicine and Health Sciences Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Stellenbosch University, Cape Town, South Africa
| | - Matthew Suderman
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Shibe Mhlongo
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Stellenbosch University, Cape Town, South Africa
| | - Sian Megan Joanna Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Stellenbosch University, Cape Town, South Africa
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15
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Agbaria N, Petzold S, Deckert A, Henschke N, Veronese G, Dambach P, Jaenisch T, Horstick O, Winkler V. Prevalence of post-traumatic stress disorder among Palestinian children and adolescents exposed to political violence: A systematic review and meta-analysis. PLoS One 2021; 16:e0256426. [PMID: 34437595 PMCID: PMC8389374 DOI: 10.1371/journal.pone.0256426] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
Objective We undertook a systematic review of the literature to explore the prevalence of post-traumatic stress disorder (PTSD) in Palestinian children and adolescents exposed to political violence. This is the first systematic review and meta-analysis of the prevalence of PTSD in this population. Methods PubMed, Embase, PsycInfo, Google Scholar and Cochrane library were searched until June 2020. To estimate the prevalence of PTSD, sub-group and meta-analysis were conducted. Results The search resulted in 2786 studies, of which 28 articles representing 32 samples with a total of 15,121 participants from Gaza Strip and West Bank met either the DSM-4 or DSM-5 criteria and were included. The pooled prevalence of PTSD was 36% (95% CI 30–41%; I2 98.6%) and ranged from 6% to 70%. Sub-group analysis showed that the PTSD prevalence did not differ according to region (West Bank, Gaza Strip) and tended to decrease after including only studies using a representative sample (p<0.001), and among those with low risk of bias (p<0.001). Visual inspection of the included studies revealed significant discrepancies in study design and assessment measures. Conclusion We identified high prevalence of PTSD among Palestinian children and adolescents exposed to political violence. However, the pooled results should be interpreted with caution, due to the high heterogeneity and risk of bias in the included studies. These limitations also reflect the challenge in conceptualizing and measuring PTSD in the Palestinian context with a background of continuous and cumulative trauma. Understanding the contextual factors and developing locally adapted survey measures are of relevance to future research, public health planning, and the provision of mental healthcare in Palestine.
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Affiliation(s)
- Nisreen Agbaria
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Stephanie Petzold
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Andreas Deckert
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Nicholas Henschke
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Guido Veronese
- Department of Human Sciences & Education, University of Milano-Bicocca, Milan, Italy
| | - Peter Dambach
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Thomas Jaenisch
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Centre for Global Health, Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Olaf Horstick
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Volker Winkler
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
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16
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Acar B, Acar İH, Alhiraki OA, Fahham O, Erim Y, Acarturk C. The Role of Coping Strategies in Post-Traumatic Growth among Syrian Refugees: A Structural Equation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8829. [PMID: 34444576 PMCID: PMC8394351 DOI: 10.3390/ijerph18168829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
The Syrian conflict has led to a mass migration of Syrians to other countries and exposed them to many possible traumatic events and stressors in their country of origin and in the resettlement process. The possibility of positive psychological effects of adverse life events is less documented among Syrian refugees. Thus, the current study aimed to develop preliminary evidence for the identifying factors: traumatic experiences, post-migration stressors and coping strategies that are associated with post-traumatic growth (PTG) of Syrian refugees residing in Turkey. Structural equation modeling (SEM) was used in the current study to assess the associations among these factors. Data were obtained from Syrian refugees residing in the governorates of Hatay and Mardin. A total of 528 Syrians, aged between 18-77 years (M = 35.60, SD = 11.65) participated in this cross-sectional study. Results from the SEM indicated that past traumatic experiences and post-migration stressors were indirectly related to PTG. The results from the current study provide support for that the association between refugees' traumatic experiences, post-migration stressors and PTG appear to be explained through the presence of coping strategies which could be addressed in the psychotherapies and psychosocial interventions for refugees to promote positive psychological change. Future studies should address the effects of post-migration stressors on PTG in detail.
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Affiliation(s)
- Busra Acar
- Department of Psychology, Koç University, 34450 Istanbul, Turkey;
- Department of Psychology, Ozyegin University, 34794 Istanbul, Turkey;
| | - İbrahim H. Acar
- Department of Psychology, Ozyegin University, 34794 Istanbul, Turkey;
| | - Omar A. Alhiraki
- Department of Surgery, Bab Al-Hawa Hospital, Idlib, Syria; (O.A.A.); (O.F.)
| | - Ola Fahham
- Department of Surgery, Bab Al-Hawa Hospital, Idlib, Syria; (O.A.A.); (O.F.)
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Ceren Acarturk
- Department of Psychology, Koç University, 34450 Istanbul, Turkey;
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17
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Robin M, Douniol M, Pham-Scottez A, Gicquel L, Delvenne V, Nezelof S, Speranza M, Falissard B, Silva J, Corcos M. Specific Pathways From Adverse Experiences to BPD in Adolescence: A Criteria-Based Approach of Trauma. J Pers Disord 2021; 35:94-110. [PMID: 33999657 DOI: 10.1521/pedi_2021_35_523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the European Research Network on BPD (EURNET-BPD; n = 85 BPD adolescents, n = 84 healthy controls, aged 13-19), this study explored the combination of three types of adversity-maltreatment, stressful life events (early separation from parents, parental suicide attempt, parental chronic disease) and parental bonding-as predictors of BPD, on a criteria-based approach. Results indicated that cumulative traumatic experiences largely characterize borderline adolescent's history; and, in the multivariate regression models, all adversity experiences were likely to contribute to BPD symptoms. The role of emotional abuse, parental suicide attempt, and a decrease in paternal level of care were particularly prominent. Moreover, adversities combinations were different for each criterion, suggesting that specific sets of traumatic experiences are leading to BPD. These findings argue for a further criteria-based exploration of trauma in borderline patients, as well as a more accurate and efficient prevention.
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Affiliation(s)
- Marion Robin
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France.,Paris Descartes University, Paris, France
| | - Marie Douniol
- Medical Psychological Center, Odysseum, EPS Erasme, Sceaux, France
| | | | - Ludovic Gicquel
- Henri Laborit Hospital Center, Poitiers, URC, University of Poitiers, France
| | - Veronique Delvenne
- Queen Fabiola Children's University Hospital, Brussels, Free University of Brussels, Belgium
| | - Sylvie Nezelof
- Department of Child and Adolescent Psychiatry, Besançon University Hospital, Franche Comte University, Besançon, France
| | - Mario Speranza
- Versailles General Hospital, Le Chesnay, France.,Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Paris, France
| | - Bruno Falissard
- Paris-Saclay University, UVSQ, CESP, INSERM U1178, Team PsyDev, Paris, France.,INSERMU 669, Paris, France
| | - Jerôme Silva
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France.,Paris Descartes University, Paris, France
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Piwowarczyk P, Kaczmarska A, Kutnik P, Hap A, Chajec J, Myśliwiec U, Czuczwar M, Borys M. Association of Gender, Painkiller Use, and Experienced Pain with Pain-Related Fear and Anxiety among University Students According to the Fear of Pain Questionnaire-9. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084098. [PMID: 33924523 PMCID: PMC8068817 DOI: 10.3390/ijerph18084098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 11/30/2022]
Abstract
Anxiety and fear are determinants of acute and chronic pain. Effectively measuring fear associated with pain is critical for identifying individuals’ vulnerable to pain. This study aimed to assess fear of pain among students and evaluate factors associated with pain-related fear. We used the Fear of Pain Questionnaire-9 to measure this fear. We searched for factors associated with fear of pain: gender, size of the city where the subjects lived, subject of academic study, year of study, the greatest extent of experienced pain, frequency of painkiller use, presence of chronic or mental illness, and past hospitalization. We enrolled 717 participants. Median fear of minor pain was 5 (4–7) fear of medical pain 7 (5–9), fear of severe pain 10 (8–12), and overall fear of pain 22 (19–26). Fear of pain was associated with gender, frequency of painkiller use, and previously experienced pain intensity. We found a correlation between the greatest pain the participant can remember and fear of minor pain (r = 0.112), fear of medical pain (r = 0.116), and overall fear of pain (r = 0.133). Participants studying medicine had the lowest fear of minor pain while stomatology students had the lowest fear of medical pain. As students advanced in their studies, their fear of medical pain lowered. Addressing fear of pain according to sex of the patient, frequency of painkiller use, and greatest extent of experienced pain could ameliorate medical training and improve the quality of pain management in patients.
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Affiliation(s)
- Paweł Piwowarczyk
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
- Correspondence:
| | - Agnieszka Kaczmarska
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Paweł Kutnik
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
| | - Aleksandra Hap
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Joanna Chajec
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Urszula Myśliwiec
- Student’s Scientific Association, II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (A.K.); (A.H.); (J.C.); (U.M.)
| | - Mirosław Czuczwar
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
| | - Michał Borys
- II Department of Anesthesiology and Intensive Care, Medical University of Lublin, 20-081 Lublin, Poland; (P.K.); (M.C.); (M.B.)
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19
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Chung MC, Slanbekova GK, Kabakova MP, Kalymbetova EK, Kudaibergenova AZ. The relationship between posttraumatic stress disorder, trauma centrality, interpersonal sensitivity and psychiatric co-morbidity among students in Kazakhstan: a Latent Class Analysis. J Ment Health 2020; 30:698-705. [PMID: 32938238 DOI: 10.1080/09638237.2020.1818704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Trauma can lead to trauma centrality and affect levels of interpersonal sensitivity and psychiatric co-morbidity. Whether a coexisting relationship between posttraumatic stress disorder (PTSD) and trauma centrality can influence levels of interpersonal sensitivity and psychiatric co-morbidity among university students from Kazakhstan is unknown. AIM To investigate the impact of the aforementioned co-existing relationship on interpersonal sensitivity and psychiatric co-morbidity among Kazakh university students. METHODS 597 students (F = 428, M = 169) completed questionnaires measuring PTSD, psychiatric co-morbidity, interpersonal sensitivity, and trauma centrality. RESULTS 28%, 32% and 40% met the criteria for full, partial and no-PTSD, respectively. Latent Class Analysis revealed a three-class solution: Class 1 (the altered-self group) with a low level of PTSD but a high level of trauma centrality, Class 2 (the traumatized-self group) with high levels of PTSD and trauma centrality and Class 3 (the low symptom group) with low levels of PTSD and trauma centrality. There were significant differences in the levels of interpersonal sensitivity and psychiatric co-morbidity across three classes. CONCLUSION There are individual differences in the display of posttraumatic stress disorder symptoms, and trauma centrality. These differences can influence interaction with others and psychological distress.
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Affiliation(s)
- Man Cheung Chung
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Ho Tim Building, Shatin, Hong Kong
| | | | - Maira Pobedovna Kabakova
- Department of General and Applied Psychology, Kazakh National University Named After Al-Farabi, Almaty, Kazakhstan
| | - Elmira Kenesovna Kalymbetova
- Department of General and Applied Psychology, Kazakh National University Named After Al-Farabi, Almaty, Kazakhstan
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20
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Fitzpatrick S, Saraiya T, Lopez-Castro T, Ruglass LM, Hien D. The impact of trauma characteristics on post-traumatic stress disorder and substance use disorder outcomes across integrated and substance use treatments. J Subst Abuse Treat 2020; 113:107976. [PMID: 32059924 PMCID: PMC7198321 DOI: 10.1016/j.jsat.2020.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 02/08/2023]
Abstract
Proponents of complex post-traumatic stress disorder (PTSD) constructs suggest that specific trauma characteristics, such as earlier age of first trauma (trauma age) and higher number of traumas (trauma count), may obstruct PTSD symptom reduction in treatment. PTSD and substance use disorders (SUD) commonly co-occur, but the impact of trauma age and count on PTSD treatment responses in a comorbid PTSD and SUD sample is unclear. Further, no studies have examined the impact of trauma characteristics on SUD treatment outcomes or whether their impact on either PTSD or SUD outcomes varies if PTSD is directly addressed. A secondary analysis of a randomized controlled trial was conducted to examine: (1) whether trauma age and count influence comorbid PTSD and SUD (PTSD+SUD) responses during and following treatment; and (2) whether these effects differed across an exposure-based, integrated PTSD+SUD treatment (Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure; COPE) and a SUD-only focused treatment (Relapse Prevention Therapy; RPT). Individuals with PTSD+SUD randomized to COPE (n = 39) or RPT (n = 43) provided weekly measurements of PTSD and SUD. Across COPE and RPT, earlier trauma age predicted reduced SUD improvement (B = -0.01, standard error = 0.00). Trauma count did not predict changes in PTSD or SUD during or following treatment. These findings suggest that excluding individuals from exposure-based, integrated treatments on the basis of trauma characteristics is not empirically supported. However, individuals with earlier trauma ages may require additional or unique clinical attention to improve their SUD outcomes.
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Affiliation(s)
- Skye Fitzpatrick
- Department of Psychology, York University, 4700 Keele St., North York, ON M3J 1P3, Canada.
| | - Tanya Saraiya
- Derner School of Psychology, Adelphi University, One South Avenue, P.O. Box 701, Garden City, NY 11530-0701, United States of America
| | - Teresa Lopez-Castro
- Psychology Department, The City College of New York, CUNY, 160 Covent Ave., New York, NY 10031, United States of America
| | - Lesia M Ruglass
- Center of Alcohol Studies, Graduate School of Applied and Professional Psychology, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States of America
| | - Denise Hien
- Center of Alcohol Studies, Graduate School of Applied and Professional Psychology, Rutgers University, 607 Allison Road, Piscataway, NJ 08854, United States of America
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21
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Rawlins B, Brooks M, Khan R. Posttraumatic stress symptoms mediate the relationship between adverse childhood experiences, avoidant personality traits and resilience. ANXIETY STRESS AND COPING 2020; 33:590-601. [DOI: 10.1080/10615806.2020.1768532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Bethan Rawlins
- School of Psychology, University of Central Lancashire, Manchester, UK
| | - Matthew Brooks
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Roxanne Khan
- School of Psychology, University of Central Lancashire, Manchester, UK
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22
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Slanbekova GK, Chung MC, Ayupova GT, Kabakova MP, Kalymbetova EK, Korotkova-Ryckewaert NV. The Relationship between Posttraumatic Stress Disorder, Interpersonal Sensitivity and Specific Distress Symptoms: the Role of Cognitive Emotion Regulation. Psychiatr Q 2019; 90:803-814. [PMID: 31423547 DOI: 10.1007/s11126-019-09665-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examined 1) the relationship between posttraumatic stress disorder (PTSD) from past trauma, interpersonal sensitivity and psychiatric co-morbidity, and 2) whether cognitive emotion regulation strategies would mediate the impact of PTSD on specific distress outcomes. Four hundred seventy-five Kazakh students (F = 336, M = 139) participated in the study and completed a demographic page, Posttraumatic Stress Diagnostic Scale for DSM-5, General Health Questionnaire-28, Interpersonal Sensitivity Measure and Cognitive Emotion Regulation Questionnaire. The results showed that 71% reported that they had experienced at least one trauma throughout their lifespan, of whom 39% met the criteria for full-PTSD. Controlling for age and university majors, PTSD was associated with interpersonal sensitivity and psychiatric co-morbidity. Cognitive emotion regulation strategies were correlated with specific distress outcomes. Whilst positive reappraisal and refocusing on planning were associated with interpersonal sensitivity, self-blame and putting the trauma into perspective were associated with psychiatric co-morbidity. Self-blame mediated the impact of PTSD on psychiatric co-morbidity. To conclude, trauma can heighten levels of sensitivity in interpersonal interaction and psychological symptoms. Having specific thoughts about the trauma can impact on specific psychological reactions. Blaming oneself for the trauma can influence its impact on the severity of psychological symptoms.
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Affiliation(s)
| | - Man Cheung Chung
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Ho Tim Building, Shatin, NT, Hong Kong.
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23
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Slanbekova GK, Chung MC, Karipbaev BI, Sabirova RS, Alimbayeva RT. Posttraumatic Stress and Interpersonal Sensitivity: Alexithymia as Mediator and Emotional Expressivity as Moderator. Psychiatr Q 2019; 90:249-261. [PMID: 30515699 DOI: 10.1007/s11126-018-9612-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined 1) the link between PTSD from past trauma, interpersonal sensitivity and psychiatric co-morbidity, 2) mediational effects of alexithymia on 1), and 3) moderated mediational effects with emotional expressivity as the moderator. Five hundred and fifteen Kazakh students completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Toronto Alexithymia Scale-20, Berkeley Expressivity Questionnaire and Interpersonal Sensitivity Measure. The results showed that 28% met the criteria for full-PTSD. Controlling for academic year, age and university major, PTSD from past trauma was significantly correlated with interpersonal sensitivity and psychiatric co-morbidity. Alexithymia mediated the impact of PTSD on interpersonal sensitivity and psychiatric co-morbidity. Alexithymia, however, did not interact with type of emotional expressivity to influence outcomes. Moderated mediational effects were not found. To conclude, following trauma, Kazakh students can experience heightened levels of interpersonal sensitivity and psychological symptoms. These problems are particularly severe for those who have difficulty getting in touch with their emotions.
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Affiliation(s)
| | - Man Cheung Chung
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Ho Tim Building, Shatin, NT, Hong Kong.
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24
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Viard A, Mutlu J, Chanraud S, Guenolé F, Egler PJ, Gérardin P, Baleyte JM, Dayan J, Eustache F, Guillery-Girard B. Altered default mode network connectivity in adolescents with post-traumatic stress disorder. NEUROIMAGE-CLINICAL 2019; 22:101731. [PMID: 30831461 PMCID: PMC6402428 DOI: 10.1016/j.nicl.2019.101731] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/14/2019] [Accepted: 02/20/2019] [Indexed: 11/22/2022]
Abstract
Post-traumatic stress disorder (PTSD) is characterized by intrusions, re-experiencing, avoidance and hyperarousal. These symptoms might be linked to dysfunction in core neurocognitive networks subserving self-referential mental processing (default mode network, DMN), detection of salient stimuli (salience network, SN) and cognitive dysfunction (central executive network, CEN). Resting state studies in adolescent PTSD are scarce and findings are inconsistent, probably due to differences in patient symptom severity. Resting state brain activity was measured in 14 adolescents with severe PTSD and 24 age-matched controls. Seed-based connectivity analyses were used to examine connectivity between the DMN and the whole brain, including regions from other networks (SN and CEN). The relationships of network properties with symptom dimensions (severity, anxiety and depression) and episodic memory were also examined. Analyses revealed decreased within-DMN connectivity (between PCC and occipital cortex) in patients compared to controls. Furthermore, within-DMN connectivity (between PCC and hippocampus) correlated negatively with symptom dimensions (severity and anxiety), while increased connectivity (DMN-SN and DMN-CEN) correlated positively with episodic memory measures. These abnormal network properties found in adolescent PTSD corroborate those previously reported in adult PTSD. Decreased within-DMN connectivity and disrupted DMN-SN and DMN-CEN coupling could form the basis for intrusive trauma recollection and impaired episodic autobiographical recall in PTSD. Adolescent PTSD is linked to dysfunction in core neurocognitive networks. Results show decreased within-DMN connectivity in patients compared to controls. Within-DMN connectivity correlates negatively with severity and anxiety. Increased DMN-SN connectivity correlates positively with episodic memory. Disrupted connectivity may form the basis for intrusive trauma recollection in PTSD.
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Affiliation(s)
- Armelle Viard
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France.
| | - Justine Mutlu
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | - Sandra Chanraud
- INCIA CNRS UMR 5287, PSL Research University, EPHE, Université Bordeaux, Bordeaux, France
| | - Fabian Guenolé
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; CHU de Caen, Service de Psychiatrie de l'Enfant et de l'Adolescent, Caen, France
| | - Pierre-Jean Egler
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; CHU de Caen, Service de Psychiatrie de l'Enfant et de l'Adolescent, Caen, France
| | - Priscille Gérardin
- CHU de Rouen, Fédération hospitalo-universitaire de psychiatrie de l'enfant et de l'adolescent, Rouen, France
| | - Jean-Marc Baleyte
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; CHU de Caen, Service de Psychiatrie de l'Enfant et de l'Adolescent, Caen, France
| | - Jacques Dayan
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France; CHGR Rennes-I, Service de Psychiatrie de l'Enfant et de l'Adolescent, Rennes, France
| | - Francis Eustache
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | - Bérengère Guillery-Girard
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
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Mughairbi FA, Abdulaziz Alnajjar A, Hamid A. Effects of Psychoeducation and Stress Coping Techniques on Posttraumatic Stress Disorder Symptoms. Psychol Rep 2019; 123:710-724. [PMID: 30760172 DOI: 10.1177/0033294118825101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the effects of psychoeducation and stress management techniques on Posttraumatic Stress Disorder (PTSD) symptoms in Libya. The 41 Libyan patients who volunteered to take part in the study were first assessed using the PTSD Checklist. They attended workshops on PTSD symptoms, stress management techniques, and communication skills on three successive days after which they were asked to answer the Coping Inventory for Stressful Situations two weeks after they completed the workshops. Among the 39% of the participants who were diagnosed with PTSD prior to the intervention, 15% met the diagnostic criteria for PTSD after the intervention. The preintervention scores were consistently higher than the postintervention scores, and there were significant differences in the PTSD Checklist total score and the re-experiencing, avoidance, and hyperarousal symptom scores. This study concluded that in mass-trauma events such as war and natural disasters, PTSD education can reduce the PTSD symptoms of those affected. Whether the benefits of psychoeducation on the participants are long term or short term is recommended for further study due to the limitations imposed by the willingness of the participants to participate, the amount of time they are willing to stay with the program, and the duration of the psychoeducation program itself.
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Affiliation(s)
| | | | - Abdalla Hamid
- United Arab Emirates University, Abu Dhabi, United Arab Emirates
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Rokita KI, Dauvermann MR, Donohoe G. Early life experiences and social cognition in major psychiatric disorders: A systematic review. Eur Psychiatry 2018; 53:123-133. [DOI: 10.1016/j.eurpsy.2018.06.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 11/29/2022] Open
Abstract
AbstractObjective:To present a systematic review of the literature on the associations between early social environment, early life adversity, and social cognition in major psychiatric disorders, including schizophrenia, bipolar disorder, borderline personality disorder, major depressive disorder and posttraumatic stress disorder.Method:Relevant studies were identified via electronic and manual searches of the literature and included articles written in English and published in peer-reviewed journals up to May 2018. Quality assessment was performed using the quality evaluation scale employed in previous systematic reviews.Results:A total of 25 studies were included in the systematic review with the quality assessment scores ranging from 3 to 6 (out of 6). The vast majority of the studies reviewed showed a significant association between early childhood social experience, including both insecure attachment and adversity relating to neglect or abuse, and poorer social cognitive performance.Conclusion:We discuss these findings in the context of an attachment model, suggesting that childhood social adversity may result in poor internal working models, selective attention toward emotional stimuli and greater difficulties with emotional self-regulation. We outline some of the steps required to translate this understanding of social cognitive dysfunction in major psychiatric disorders into a target for interventions that mitigate the adverse effects of childhood maltreatment and poor parental attachment on social cognition.
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Botsford J, Steinbrink M, Rimane E, Rosner R, Steil R, Renneberg B. Maladaptive Post-traumatic Cognitions in Interpersonally Traumatized Adolescents with Post-traumatic Stress Disorder: An Analysis of “Stuck-Points”. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9928-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Amone-P'Olak K, Omech B. Coping with post-war mental health problems among survivors of violence in Northern Uganda: Findings from the WAYS study. J Health Psychol 2018; 25:1857-1870. [PMID: 29781333 DOI: 10.1177/1359105318775185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cognitive emotion regulation strategies and mental health problems were assessed in a sample of war-affected youth in Northern Uganda. Univariable and multivariable regression models were fitted to assess the influence of CERS on mental health problems. Maladaptive cognitive emotion regulation strategies (e.g., rumination) were significantly associated with more mental health problems while adaptive cognitive emotion regulation strategies (e.g., putting into perspective) were associated with reporting fewer symptoms of mental health problems. The youth with significant scores on mental health problems (scores ≥ 85th percentile) reported more frequent use of maladaptive than adaptive strategies. Interventions to reduce mental health problems should focus on enhancing the use of adaptive strategies.
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Amone-P'Olak K, Elklit A. Interpersonal Sensitivity as Mediator of the Relations Between War Experiences and Mental Illness in War-Affected Youth in Northern Uganda: Findings From the WAYS Study. ACTA ACUST UNITED AC 2018; 24:200-208. [PMID: 30190654 PMCID: PMC6116889 DOI: 10.1037/trm0000145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 12/14/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
The pathways from war experiences to mental health problems are poorly understood. The current study aims to assess the role of interpersonal sensitivity in the relations between war experiences and mental health problems based on data from the War-Affected Youth Survey cohort study. The War-Affected Youth Survey is an ongoing research project of formerly abducted children in Northern Uganda assessing their war experiences and the risk and protective factors in the development of mental health problems. Mediation of the relations between war experiences and mental health problems by interpersonal sensitivity was analyzed using structural equation modeling. War experiences were related to posttraumatic stress disorder through interpersonal sensitivity accounting for 55% of the variance in their relations, to depression/anxiety through interpersonal sensitivity accounting for 89% of the variance in their relations (i.e., near complete mediation), and to psychotic symptoms through interpersonal sensitivity accounting for 53% of the variance in their relations. The direct relation between war experiences, on the one hand, and posttraumatic stress disorder and psychotic symptoms, on the other hand, attenuated but remained statistically significant. For depression/anxiety, the direct relationship ceased to be significant after including interpersonal sensitivity in the model. Interpersonal sensitivity is an important determinant of long-term mental health problems in war-affected youth. Interventions to improve mental health should target youth with high scores on interpersonal sensitivity. Cognitive–behavioral therapy to recognize and change cognitive schemas in youth prone to interpersonal sensitivity is recommended.
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Affiliation(s)
- Kennedy Amone-P'Olak
- Department of Psychology, University of Botswana, and National Center for Psychotraumatology, University of Southern Denmark
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark
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Krammer S, Grosse Holtforth M, Burri A, Soyka M, Gamma A, Liebrenz M. Interpersonal Sensitivity as a Mediator Between Cumulative Childhood Traumatic Events and Adult Sexual Disturbance. JOURNAL OF SEX & MARITAL THERAPY 2018; 44:213-220. [PMID: 28799846 DOI: 10.1080/0092623x.2017.1354343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Previous research has shown that cumulative childhood traumatic events are stronger predictors of sexual disturbances than childhood sexual abuse. Additional factors are likely to influence this relationship. Whereas socio-interpersonal factors such as interpersonal sensitivity have repeatedly been shown to be salutogenic in the aftermath of traumatic events, the specific underlying mechanisms are little understood. The aim of the present study was to examine the relationship between cumulative childhood traumatic events and adult sexual disturbances (i.e., the avoidance of sexual contacts, disruptive sexual behavior, poor sexual boundaries, decreased regulation of sexual impulses) and to investigate the role of interpersonal sensitivity as a potential mediator. The sample comprised 100 adult psychiatric in-patients. As expected, cumulative childhood traumatic events were found to be strong predictors of sexual disturbances, with interpersonal sensitivity partially mediating this relationship.
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Affiliation(s)
- Sandy Krammer
- a Forensic Psychiatric Services, Institute for Legal Medicine , University of Bern , Bern , Switzerland
| | - Martin Grosse Holtforth
- b Kompetenzzentrum Psychosomatic , Inselspital , Bern , Switzerland
- c Institute for Psychology , University of Bern , Bern , Switzerland
| | - Andrea Burri
- d Health and Rehabilitation Research Institute , Auckland University of Technology , Auckland , New Zealand
- e Waitemata Pain Service, Department of Anaesthesia and Perioperative Medicine , North Shore Hospital , Auckland , New Zealand
| | - Michael Soyka
- f Privatklinik Meiringen , Meiringen , Switzerland
- g Psychiatric Clinic , University of Munich , Germany
- h Medical Park Chiemseeblick , Bernau , Germany
| | - Alex Gamma
- a Forensic Psychiatric Services, Institute for Legal Medicine , University of Bern , Bern , Switzerland
| | - Michael Liebrenz
- a Forensic Psychiatric Services, Institute for Legal Medicine , University of Bern , Bern , Switzerland
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31
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Réponse pédopsychiatrique d’urgence à la suite de l’attentat terroriste du 14 juillet 2016 à Nice, en France. Arch Pediatr 2017; 24:1220-1227. [DOI: 10.1016/j.arcped.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/14/2017] [Accepted: 09/04/2017] [Indexed: 01/15/2023]
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32
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Lawson DM. Treating Adults With Complex Trauma: An Evidence-Based Case Study. JOURNAL OF COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1002/jcad.12143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- David M. Lawson
- Department of Counselor Education; Sam Houston State University
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33
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Tarquinio C, Houllé W, Tarquinio P. Discussion autour du traumatisme complexe : émergence du concept, étiologie et critères diagnostiques. SEXOLOGIES 2017. [DOI: 10.1016/j.sexol.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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34
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Aakvaag HF, Thoresen S, Wentzel-Larsen T, Dyb G, Røysamb E, Olff M. Broken and guilty since it happened: A population study of trauma-related shame and guilt after violence and sexual abuse. J Affect Disord 2016; 204:16-23. [PMID: 27318595 DOI: 10.1016/j.jad.2016.06.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is increasing interest in trauma-related shame and guilt. However, much remains unknown in terms of how these emotions relate to the type of event, gender and mental health. We investigated shame and guilt in men and women following various types of severe violence and their relation to mental health. METHODS Telephone interviews were conducted with a Norwegian general population sample (n=4529; age=18-75; response rate=42.9%). Measures included child sexual abuse, child and adult rape, severe physical violence from/between parents, severe violence from a partner and non-partners, less severe violence and non-violent trauma, the new Shame and Guilt After Trauma Scale, and the Hopkins Symptom Checklist. Analyses included t-tests and linear regressions. RESULTS All types of severe violence were significantly associated with trauma-related shame and guilt (coefficients from 0.11 to 0.38, p-values <0.001). The number of violence types showed a graded relationship with both emotions. Women had significantly more shame and guilt than men did (p-values <0.001 for both emotions), which was partially explained by violence exposure. Both emotions were independently associated with mental health problems (p-values <0.001). LIMITATIONS The study is cross-sectional. The shame and guilt measure requires further validation. CONCLUSIONS The more types of violence that were reported, the higher levels of shame and guilt were. Clinicians should be aware of shame and guilt after a variety of violent events, including non-sexual violence, in both men and women and should particularly be aware of whether individuals have multiple violent experiences.
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Affiliation(s)
| | - Siri Thoresen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen Røysamb
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Norway; Norwegian Institute for Public Health, Oslo, Norway
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Ashamed and Afraid: A Scoping Review of the Role of Shame in Post-Traumatic Stress Disorder (PTSD). J Clin Med 2016; 5:jcm5110094. [PMID: 27809274 PMCID: PMC5126791 DOI: 10.3390/jcm5110094] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite considerable progress in the treatment of post-traumatic stress disorder (PTSD), a large percentage of individuals remain symptomatic following gold-standard therapies. One route to improving care is examining affective disturbances that involve other emotions beyond fear and threat. A growing body of research has implicated shame in PTSD's development and course, although to date no review of this specific literature exists. This scoping review investigated the link between shame and PTSD and sought to identify research gaps. METHODS A systematic database search of PubMed, PsycInfo, Embase, Cochrane, and CINAHL was conducted to find original quantitative research related to shame and PTSD. RESULTS Forty-seven studies met inclusion criteria. Review found substantial support for an association between shame and PTSD as well as preliminary evidence suggesting its utility as a treatment target. Several design limitations and under-investigated areas were recognized, including the need for a multimodal assessment of shame and more longitudinal and treatment-focused research. CONCLUSION This review provides crucial synthesis of research to date, highlighting the prominence of shame in PTSD, and its likely relevance in successful treatment outcomes. The present review serves as a guide to future work into this critical area of study.
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Mesquita CDS, Basto-Pereira M, da Costa Maia Â. Prevalence of Childhood Victimization Experiences in Psychiatric Patients: a Systematic Review. Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9697-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Brooks M, Lowe M, Graham-Kevan N, Robinson S. Posttraumatic growth in students, crime survivors and trauma workers exposed to adversity. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.04.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Park SC, Kim D, Jang EY. Prevalence and symptomatic correlates of interpersonal trauma in South Korean outpatients with major depressive disorder. Compr Psychiatry 2016; 66:46-52. [PMID: 26995235 DOI: 10.1016/j.comppsych.2015.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is growing evidence that exposure to severe interpersonal trauma (IPT) has a pivotal role in the development and manifestation of depression. However, it is not clearly understood whether patients with major depressive disorder (MDD) have specifically increased prevalence of IPT than other non-interpersonal traumatic events and whether those with IPT have unique symptom profile within depressed groups. In this study, we investigated the prevalence of past traumatic events and symptomatic features of treatment-seeking outpatients with MDD. METHODS A consecutive sample of 111 South Korean outpatients with MDD was recruited on their first visit to a psychiatric department of a university-affiliated hospital. Participants completed the Life Events Checklist (LEC), the Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Dissociative Experience Scale (DES) and Impact of Event Scale-Revised (IES-R). The prevalence of past traumatic events on LEC was compared to medical outpatients. RESULTS Compared to medical outpatients, MDD patients had significantly higher rates of IPT (physical and sexual) but not other traumatic events of non-interpersonal origin such as accidents or disaster. Compared to MDD patients without IPT (n=44, 40%), those with IPT (n=67, 60%) had higher subscale scores on hostility in SCL-90-R, as well as greater depressive and post-traumatic symptoms. However, multivariate analysis revealed that the best model to discriminate those with IPT was interaction of depressive and posttraumatic symptoms. LIMITATIONS Limitations include sample characteristics (treatment-seeking outpatients) and possible effects of comorbid conditions, which were not investigated. CONCLUSIONS Clinicians managing individuals with depressive disorder need to include the assessment of lifetime IPT and its impact on presenting symptoms.
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Affiliation(s)
- Seon-Cheol Park
- Department of Psychiatry, Yong-In Mental Hospital, Yongin, Republic of Korea; Institute of Mental Health, Hanyang University, Seoul, Republic of Korea
| | - Daeho Kim
- Department of Psychiatry, Hanyang University Medical School, Seoul, Republic of Korea; Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea.
| | - Eun Young Jang
- Department of Psychiatry, Hanyang University Medical School, Seoul, Republic of Korea; Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
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Xiao CL, Gavrilidis E, Lee S, Kulkarni J. Do mental health clinicians elicit a history of previous trauma in female psychiatric inpatients? J Ment Health 2016; 25:359-365. [DOI: 10.3109/09638237.2016.1139074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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40
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Wiley RE. A Case Study of Cognitive Processing Therapy for a Military Medic With Posttraumatic Stress Disorder. J Cogn Psychother 2016; 30:203-220. [PMID: 32755925 DOI: 10.1891/0889-8391.30.3.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive processing therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD) in the active duty and veteran population. This case study provides a thorough example of the use of this therapeutic modality with an active duty military service member who was exposed to several traumatic events. Over the course of 13 sessions, "Master Sergeant Smith," a middle-aged, White male, made significant progress on his treatment plan goals and reductions in PTSD symptoms. This case study describes the theoretical and research basis for treatment and course of treatment and illustrates the use of CPT in an outpatient setting while describing important areas of focus and how to overcome clinical challenges.
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41
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Duan W, Guo P, Gan P. Relationships among Trait Resilience, Virtues, Post-traumatic Stress Disorder, and Post-traumatic Growth. PLoS One 2015; 10:e0125707. [PMID: 25932954 PMCID: PMC4416702 DOI: 10.1371/journal.pone.0125707] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/17/2015] [Indexed: 11/19/2022] Open
Abstract
The present study aims to examine the relationship between trait resilience and virtues in the context of trauma. A total of 537 participants who attended the preliminary investigation and completed the Life Events Checklist were screened. Of these participants, 142 suffered from personal traumatic experiences in the past year; these individuals were qualified and invited to respond to online questionnaires to assess trait resilience, virtues (i.e., Conscientiousness, Vitality, and Relationship), post-traumatic stress disorder (PTSD) symptoms, and post-traumatic growth (PTG). The following questionnaires were used: Connor-Davidson Resilience Scale-Revised, Chinese Virtues Questionnaire, PTSD Checklist-Specific, and Post-traumatic Growth Inventory-Chinese. Only 95 participants who manifested self-reported PTSD symptoms and PTG were involved in the current analyses. Trauma was positively and significantly correlated with PTSD in the current sample. Results indicated that trait resilience was positively associated with virtues and PTG; by contrast, PTSD scores were negatively but not significantly related to most of these factors. The three virtues contributed to PTG to a greater extent than trait resilience in non-PTSD and PTSD groups. However, trait resilience remained a significant predictor in the PTSD group even when the three virtues were controlled. The relationship between trait resilience and PTG was moderated by PTSD type (non-PTSD group vs. PTSD group). Our results further suggested that trait resilience and virtues were conceptually related but functionally different constructs. Trait resilience and virtues are positively related; thus, these factors contributed variances to PTG in the context of trauma; however, trait resilience is only manifested when virtues are controlled and when individuals are diagnosed as PTSD. Furthermore, implications and limitations of this study are discussed.
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Affiliation(s)
- Wenjie Duan
- Department of Applied Social Sciences, City University of Hong Kong, Hong Kong SAR, P. R. China
| | - Pengfei Guo
- Hospital (T. C. M.) Affiliated to Luzhou Medical College, Luzhou, Sichuan, P. R. China
- * E-mail:
| | - Pei Gan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
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Stins JF, Kempe CLA, Hagenaars MA, Beek PJ, Roelofs K. Attention and postural control in patients with conversion paresis. J Psychosom Res 2015; 78:249-54. [PMID: 25466324 DOI: 10.1016/j.jpsychores.2014.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 11/08/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Current theories of conversion disorder (CD) propose that motor symptoms are related to heightened self-monitoring and excessive cognitive control of movements. We tested this hypothesis using quantification of performance on a continuous perceptuo-motor task involving quiet standing. METHODS Twelve CD patients and matched controls maintained static balance on a force platform under various attention conditions: (1) with eyes open; (2) with eyes closed (requiring enhanced attention to proprioceptive information to regulate posture); and (3) while performing an attention demanding cognitive task. RESULTS Compared to controls, CD patients displayed a greater decrease in postural stability in the 'eyes-closed' versus 'eyes-open' condition. In contrast, cognitive distraction led to a normalization of balance in CD. Moreover, sensitivity to the balance interventions correlated significantly with trauma reports and dissociative symptoms. CONCLUSION These results indicate that attention plays a crucial role in postural control in CD. More specifically, patients seem to inadvertently use deliberate control of posture (i.e., cognitive investment) of an otherwise nearly automatized perceptuo-motor task. Attentional distraction resulted in a temporary normalization of balance, which may be used to train individuals with CD to guide their attention in a more effective way.
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Affiliation(s)
- John F Stins
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands.
| | - C Lianne A Kempe
- Department of Mood Disorders, PsyQ, Parnassia Groep, The Hague, The Netherlands
| | - Muriel A Hagenaars
- Behavioural Science Institute, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, The Netherlands
| | - Peter J Beek
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; School of Sport and Education, Brunel University, London, UK
| | - Karin Roelofs
- Behavioural Science Institute, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, The Netherlands
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Stotz SJ, Elbert T, Müller V, Schauer M. The relationship between trauma, shame, and guilt: findings from a community-based study of refugee minors in Germany. Eur J Psychotraumatol 2015; 6:25863. [PMID: 26105045 PMCID: PMC4478074 DOI: 10.3402/ejpt.v6.25863] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 05/16/2015] [Accepted: 05/20/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The relationships between traumatic stress and self-conscious emotions, such as shame and guilt, remain to be fully explored, especially in refugees, who frequently are exposed to a multitude of stressors. OBJECTIVE The aim of the present study was to investigate shame and guilt in refugee minors and to assess to what extent a greater cumulative exposure to traumatic stressors would result not only in more severe posttraumatic stress disorder (PTSD) symptoms but also in higher levels of shame and guilt. METHODS Thirty-two male refugee minors, who were all below the age of 18 when they sought asylum in Germany, agreed to participate. At the time of the assessment, the age ranged from 11 to 20 years. Eighteen refugees had arrived without relatives in their host country ("unaccompanied minors"). In structured diagnostic interviews, a PTSD diagnosis was established using the UCLA PTSD Index. Posttraumatic guilt was assessed by means of the Trauma-related Guilt Inventory, and the Shame Variability Questionnaire was used to record the intensity, duration, and frequency of shame episodes. RESULTS Feelings of guilt and shame as well as trauma symptoms were all associated with the number of traumatic event types subjects had experienced. Posttraumatic guilt and shame were both correlated with PTSD symptom severity. CONCLUSIONS The findings indicate that cumulative stress such as exposure to multiple traumatic events poses a risk factor for the mental health including greater suffering and functional impairment due to shame and guilt.
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Affiliation(s)
- Sabrina J Stotz
- Department of Psychology, University of Konstanz, Konstanz, Germany;
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Veronika Müller
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Maggie Schauer
- Department of Psychology, University of Konstanz, Konstanz, Germany
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Dyer AS, Feldmann RE, Borgmann E. Body-Related Emotions in Posttraumatic Stress Disorder Following Childhood Sexual Abuse. JOURNAL OF CHILD SEXUAL ABUSE 2015; 24:627-40. [PMID: 26340071 DOI: 10.1080/10538712.2015.1057666] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/17/2015] [Indexed: 05/20/2023]
Abstract
Traumatic experiences are associated with emotions such as anxiety, shame, guilt, disgust, and anger. For patients who have experienced child sexual abuse, these emotions might be triggered by perceptions of their own body. The aim of this study was to investigate the extent of the association of the body to traumatic experiences and to discern the emotions linked to trauma-associated body areas. Ninety-seven female participants were assigned to four groups: post-traumatic stress disorder following child sexual abuse with co-occurring borderline personality disorder, post-traumatic stress disorder following child sexual abuse without co-occurring borderline personality disorder, borderline personality disorder without post-traumatic stress disorder, and healthy controls. Participants rated 26 body areas regarding their association with trauma and 7 emotions. Emotions were assessed by questionnaires. Results suggest that specific areas of the body are associated with trauma and linked to highly aversive emotions. In post-traumatic stress disorder patients, the areas associated with highly negative emotions were the pubic region and inner thighs. Thus, the patient's body may act as a trigger for traumatic memories.
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The cumulative effect of different childhood trauma types on self-reported symptoms of adult male depression and PTSD, substance abuse and health-related quality of life in a large active-duty military cohort. J Psychiatr Res 2014; 58:46-54. [PMID: 25139009 DOI: 10.1016/j.jpsychires.2014.07.014] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/02/2014] [Accepted: 07/17/2014] [Indexed: 12/26/2022]
Abstract
History of childhood trauma (CT) is highly prevalent and may lead to long-term consequences on physical and mental health. This study investigated the independent association of CT with symptoms of adult depression and posttraumatic stress disorder (PTSD), mental and physical health-related quality of life (HRQoL), as well as current tobacco consumption and alcohol abuse in a large homogenous cohort of 1254 never-deployed, young male Marines enrolled in the Marine Resiliency Study. Independent effects of CT history, number and type of CT on outcomes were analyzed using hierarchical multivariate logistic regression models. Our results suggested dose-dependent negative effect of an increasing number of trauma types of CT on depression, PTSD and HRQoL. Experience of single CT type demonstrated overall weak effects, while history of multiple CT types distinctively increased the likelihood of adult PTSD symptomology (OR: 3.1, 95% CI: 1.5-6.2), poor mental (OR: 2.3, 95% CI: 1.7-3.1) and physical HRQoL (OR: 1.4, 95% CI: 1.1-1.9). Risk for depression symptoms was similar for both single and multiple CT (OR: 2.2, 95% CI: 1.3-3.8 and OR: 2.1, 95% CI: 1.2-3.5 respectively). CT history had no effects on current tobacco use and alcohol abuse. Our study thus provides evidence for substantial additive effect of different CT types on adult mental and physical health with increasing levels of exposure.
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Nickerson A, Priebe S, Bryant RA, Morina N. Mechanisms of psychological distress following war in the former Yugoslavia: the role of interpersonal sensitivity. PLoS One 2014; 9:e90503. [PMID: 24658334 PMCID: PMC3962331 DOI: 10.1371/journal.pone.0090503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/02/2014] [Indexed: 11/19/2022] Open
Abstract
While high prevalence rates of psychological symptoms have been documented in civilian survivors of war, little is known about the mechanisms by which trauma exposure might lead to poor psychological outcomes in these populations. One potential mechanism that may underpin the association between war-related traumatic experiences and psychopathology is interpersonal sensitivity. In the current study, we applied structural equation modeling to investigate the impact of interpersonal sensitivity on posttraumatic stress disorder (PTSD) symptoms, depression symptoms, and anger responses following exposure to war trauma. 3313 survivors of the war in the former Yugoslavia were identified and selected using a multistage, probabilistic sampling frame and random walk technique. Participants were interviewed regarding trauma exposure, interpersonal sensitivity, and PTSD symptoms, depression symptoms, and anger responses. Structural equation modeling analyses revealed that the relationship between trauma and PTSD symptoms and depression symptoms was partly statistically mediated by interpersonal sensitivity. Further, findings indicated that the relationship between trauma and anger responses was fully statistically mediated by interpersonal sensitivity. These results suggest that interpersonal sensitivity may function as a key mechanism that contributes to psychopathology following trauma.
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Affiliation(s)
- Angela Nickerson
- School of Psychology, University of New South Wales, NSW, Sydney, Australia
- * E-mail:
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Barts' and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, NSW, Sydney, Australia
| | - Nexhmedin Morina
- Department of Clinical Psychology, University of Amsterdam, The Netherlands
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Dimova V, Horn C, Parthum A, Kunz M, Schöfer D, Carbon R, Griessinger N, Sittl R, Lautenbacher S. Does severe acute pain provoke lasting changes in attentional and emotional mechanisms of pain-related processing? A longitudinal study. Pain 2013; 154:2737-2744. [PMID: 23933182 DOI: 10.1016/j.pain.2013.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 08/05/2013] [Accepted: 08/05/2013] [Indexed: 11/15/2022]
Abstract
Pain experiences, learning, and genetic factors have been proposed to shape attentional and emotional processes related to pain. We aimed at investigating whether a singular major pain experience also changes cognitive-emotional processing. The influence of acute postoperative pain after cosmetic surgery of the thorax was tested in 80 preoperatively pain-free male individuals. Acute pain was measured as independent variable during the first week postsurgery by pain intensity ratings and the requested analgesic boluses (Patient-Controlled Epidural Analgesia (PCEA)). Pain catastrophizing (Pain Catastrophizing Scale (PCS)), pain anxiety (Pain Anxiety and Symptom Scale (PASS)), pain hypervigilance (Pain Vigilance and Awareness Questionnaire (PVAQ)), and attentional biases to emotionally loaded stimuli (including pain) in a dot-probe task were assessed 1 week, 3 months, and 6 months postsurgery as dependent variables. Hierarchical regression analyses were performed to test whether the 2 acute pain parameters can predict these cognitive-emotional variables. As a rigorous test, significant prediction was required in addition to the prediction of the dependent variables by themselves with lag-1. Acute pain (mainly the pain ratings) appeared to be a significant predictor for PCS, PASS, and PVAQ 1 week after surgery (deltaR(2) = [8.7% to 11.3%]). In contrast, the attentional biases in the dot-probe task could not be predicted by the pain ratings. The levels of pain catastrophizing and pain hypervigilance increased in the acute phase after surgery when influenced by acute pain and declined, along with pain anxiety, during the next 3 months. In conclusion, a one-time intense pain experience, such as acute postoperative pain, appeared to produce at least short-lived changes in the attentional and emotional processing of pain.
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Affiliation(s)
- Violeta Dimova
- Physiological Psychology, Otto-Friedrich University, Bamberg, Germany Pain Center, Friedrich-Alexander University, Erlangen, Germany Department of Pediatric Surgery, Friedrich-Alexander University, Erlangen, Germany
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Dissociative symptoms and sleep parameters--an all-night polysomnography study in patients with insomnia. Compr Psychiatry 2013; 54:658-64. [PMID: 23374906 DOI: 10.1016/j.comppsych.2012.12.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 12/13/2012] [Accepted: 12/31/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Dissociative disorders encompass a range of symptoms varying from severe absent-mindedness and memory problems to confusion about one's own identity. Recent studies suggest that these symptoms may be the by-products of a labile sleep-wake cycle. METHODS In the current study, we explored this issue in patients suffering from insomnia (N=46). We investigated whether these patients have raised levels of dissociative symptoms and whether these are related to objective sleep parameters. Patients stayed for at least one night in a specialized sleep clinic, while sleep EEG data were obtained. In addition, they completed self-report measures on dissociative symptoms, psychological problems, and sleep characteristics. RESULTS Dissociative symptom levels were elevated in patients suffering from insomnia, and were correlated with unusual sleep experiences and poor sleep quality. Longer REM sleep periods and less time spent awake during the night were predictive of dissociation. CONCLUSIONS This is the first study to show that insomnia patients have raised dissociative symptom levels and that their dissociative symptoms are related to objective EEG parameters. These findings are important because they may inspire sleep-related treatment methods for dissociative disorders.
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The mediator roles of trait anxiety, hostility, and impulsivity in the association between childhood trauma and dissociation in male substance-dependent inpatients. Compr Psychiatry 2013; 54:158-66. [PMID: 22901836 DOI: 10.1016/j.comppsych.2012.06.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 06/08/2012] [Accepted: 06/11/2012] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to investigate the mediator roles of negative affect, aggression, and impulsivity in the association between childhood trauma and dissociation in male substance-dependent inpatients. In addition, the effect of some variables that may be related with childhood trauma and dissociation among treatment-seeking substance dependents, such as substance of choice (alcohol/drug), mean of current age, and age at regular substance use was controlled. Participants were consecutively admitted 200 male substance-dependent inpatients. Patients were investigated with the Dissociative Experiences Scale, the Childhood Trauma Questionnaire, the Barratt Impulsiveness Scale, the Buss-Perry Aggression Questionnaire, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory. Seventy-seven patients (38.5%) with pathologic dissociation were compared with 123 nondissociative patients (61.5%) classified by dissociative taxon membership. The dissociative group had lower age, age at regular substance use, duration of education, and higher rate of drug dependency rather than alcohol dependency. Beside higher scores on anxiety, depression, childhood trauma, aggression, and impulsivity, a larger proportion of dissociative group reported suicide attempts and self-mutilation than did the nondissociative group. Results of regression analyses suggest that severity of chronic anxiety, aggression (particularly hostility), and impulsivity were found to be mediators of association between childhood trauma and dissociation. Results suggest that, to reduce the risk of dissociation and related behavior such as suicide attempt and self-mutilation among substance dependents, chronic anxiety together with the feelings of hostility and impulsivity must be the targets of evaluation and treatment among those with history of childhood trauma.
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Wabnitz P, Gast U, Catani C. Differences in trauma history and psychopathology between PTSD patients with and without co-occurring dissociative disorders. Eur J Psychotraumatol 2013; 4:21452. [PMID: 24298325 PMCID: PMC3842452 DOI: 10.3402/ejpt.v4i0.21452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The interplay between different types of potentially traumatizing events, posttraumatic symptoms, and the pathogenesis of PTSD or major dissociative disorders (DD) has been extensively studied during the last decade. However, the phenomenology and nosological classification of posttraumatic disorders is currently under debate. The current study was conducted to investigate differences between PTSD patients with and without co-occurring major DD with regard to general psychopathology, trauma history, and trauma-specific symptoms. METHODS Twenty-four inpatients were administered the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and the Mini-Structured Clinical Interview for DSM-IV Dissociative Disorders (MINI-SKID-D) to assess DD and PTSD. Additionally, participants completed questionnaires to assess general psychopathology and health status. RESULTS Symptom profiles and axis I comorbidity were similar in all patients. Traumatic experiences did not differ between the two groups, with both reporting high levels of childhood trauma. Only trauma-specific avoidance behavior and dissociative symptoms differed between groups. CONCLUSION Results support the view that PTSD and DD are affiliated disorders that could be classified within the same diagnostic category. Our results accord with a typological model of dissociation in which profound forms of dissociation are specific to DD and are accompanied with higher levels of trauma-specific avoidance in DD patients.
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Affiliation(s)
- Pascal Wabnitz
- Department of Psychology, University of Bielefeld, Bielefeld, Germany
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