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Levin-Aspenson HF, Greene AL. Rethinking trauma-related psychopathology in the Hierarchical Taxonomy of Psychopathology (HiTOP). J Trauma Stress 2024; 37:361-371. [PMID: 38270594 DOI: 10.1002/jts.23014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/17/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024]
Abstract
Research on trauma exposure and its consequences has made tremendous progress in elucidating the role of traumatic life events in the development and maintenance of psychopathology as well as in evaluating interventions aimed at addressing the personal and public burden of trauma-related psychopathology. However, there is growing concern that problems with predominant definitions of posttraumatic syndrome (e.g., content coverage and scope, within-category heterogeneity, excessive diagnostic comorbidity) limit further efforts to fully conceptualize trauma-related psychopathology and deliver appropriate, personalized interventions. As demonstrated by an impressive body of research over the past several years, the Hierarchical Taxonomy of Psychopathology (HiTOP) presents a compelling alternative to traditional nosologies in terms of empirically based characterizations of psychopathology phenotypes, with evidence of strong utility for research and clinical applications. However, HiTOP's primary focus on descriptive psychopathology has resulted in an unacceptable gap regarding the conceptualization of trauma-related psychopathology from a dimensional, transdiagnostic perspective. We see an important opportunity to clarify what HiTOP can offer the field of traumatic stress research and articulate a future for trauma-related psychopathology within HiTOP. We argue for disaggregating psychopathology symptoms from their purported causes and, instead, developing a detailed taxonomy of traumatic events alongside an ever-evolving HiTOP model. Doing so will help identify empirically based phenotypes of trauma-related psychopathology that (a) go beyond the traditional PTSD criterion sets and (b) allow for the possibility that different features of traumatic experiences (e.g., type, duration, subjective meaning) may be associated with different symptom sequelae across different psychopathology spectra.
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Affiliation(s)
| | - Ashley L Greene
- VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, New York, USA
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Howard J, Lorenzo-Luaces L, Lind C, Lakhan P, Rutter LA. Is a Criterion A trauma necessary to elicit posttraumatic stress symptoms? J Psychiatr Res 2024; 170:58-64. [PMID: 38103450 DOI: 10.1016/j.jpsychires.2023.12.008] [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: 05/22/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE The posttraumatic stress disorder (PTSD) diagnosis has undergone substantial revision since its first appearance in the DSM-III. Much of the controversy surrounds the definition of trauma, or Criterion A. Our study sought to evaluate the DSM-5-TR's Criterion A and severity of PTSD symptoms in college students. METHOD Participants were 1500 college students who completed an online questionnaire about mental health symptoms. Responses to the Criterion A assessment were double coded by researchers to determine if the DSM-5-TR's Criterion A was met. Interpersonal agreement between raters was high (kappa = .81). Participants were compared across groups based on their PTSD Criterion A status: (1) DSM-Congruent, (2) DSM-Incongruent, (3) DSM-Ambiguous, and (4) Denied Trauma, using analysis of variance and multiple regression. RESULTS Participants who reported a trauma that was coded as Criterion A by researchers had the highest levels of PTSD symptoms, even after controlling for perceived stress, depression, anxiety, and gender (p < .001). Comparing across groups, the DSM-Congruent Criterion A group had significantly higher overall PTSS than those in the DSM-Incongruent Criterion A group and also significantly higher hyperarousal symptoms. However, the DSM-Congruent Criterion A group did not differ from the DSM-Ambiguous trauma group on any PTSD symptom cluster. CONCLUSIONS The lack of significant differences in scores between individuals with DSM- Congruent, DSM-Incongruent, and DSM-Ambiguous traumas provides evidence about the subjective nature of trauma and how college-age individuals interpret their symptoms of PTSD. Clinical implications are discussed.
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Affiliation(s)
- Jacqueline Howard
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA; TRAILS, a Project of Tides Center, Ann Arbor, MI, USA
| | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Colton Lind
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Prabhvir Lakhan
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Lauren A Rutter
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.
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Marx BP, Hall-Clark B, Friedman MJ, Holtzheimer P, Schnurr PP. The PTSD Criterion A debate: A brief history, current status, and recommendations for moving forward. J Trauma Stress 2024; 37:5-15. [PMID: 38123526 DOI: 10.1002/jts.23007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
Posttraumatic stress disorder (PTSD) Criterion A, also known as the "stressor criterion," has been a major source of debate ever since PTSD was added to the third edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) in 1980. Since then, the traumatic stress field has held an ongoing debate about how to best define Criterion A and the events that it covers. Because of the COVID-19 pandemic and recent race-based incidents, the Criterion A debate has been reinvigorated. In this paper, we review briefly the history of Criterion A and changes in its language across different editions of the DSM. We then describe the four main positions held by scholars involved in the Criterion A debate and carefully examine the support for those positions. We conclude by offering recommendations for moving forward.
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Affiliation(s)
- Brian P Marx
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Brittany Hall-Clark
- Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
- National Center for PTSD, Executive Division, White River Junction, Vermont, USA
| | - Matthew J Friedman
- National Center for PTSD, Executive Division, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, USA
| | - Paul Holtzheimer
- National Center for PTSD, Executive Division, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, USA
| | - Paula P Schnurr
- National Center for PTSD, Executive Division, White River Junction, Vermont, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, USA
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Muñoz Valencia JA, MuñoZuñiga JR, Rivas Nieto JC. Adolescent patient with post traumatic stress disorder due atypical stressor: Case report. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2024; 53:103-106. [PMID: 38653663 DOI: 10.1016/j.rcpeng.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/07/2021] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is characterised by intrusive, anxious, and avoidant symptoms that are triggered after a stressful experience and affect the mood. The definition of a stressor that generates PTSD has been debated in recent years, as a clinical picture compatible with the disorder can occur after exposure to stressors that do not meet the criteria A1 of the DSM V; these stressors have been defined in the literature as "of low magnitude, uncommon, unusual or atypical". CLINICAL CASE We present the clinical case of a paediatric patient who developed PTSD after being exposed to an atypical stressor. CONCLUSIONS The literature shows these stressors to be more frequently documented in the paediatric population. We therefore suggest that cases should be analysed as a complex interweaving of variables, where one of the most important is each patient's interpretation of the event according to their life history and social context, and not because of an inherent characteristic of the stressor itself.
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Memory representation of aversive social experiences in Social Anxiety Disorder. J Anxiety Disord 2023; 94:102669. [PMID: 36669276 DOI: 10.1016/j.janxdis.2023.102669] [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] [Received: 12/10/2021] [Revised: 10/04/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
Aversive social experiences are proposed to be a risk factor for developing Social Anxiety Disorder (SAD). Many patients with SAD report associated daily life symptoms, such as intrusive re-experiencing (e.g., negatively distorted images of oneself), avoidance, alterations in cognitions and mood, as well as hyperarousal, resembling symptom dimensions of Posttraumatic Stress Disorder (PTSD). These PTSD-like symptoms may result from maladaptive processing and representation of the aversive social experiences in memory. Emotional hyperreactivity during memory retrieval of aversive social experiences is another feature of SAD which was found in previous studies. This study aimed to further investigate PTSD-like symptoms and emotional reactivity associated with etiologically relevant aversive social experiences and shed more light on a potential relationship between both. Eighty-five patients with SAD and 85 healthy controls (HC) participated in this cross-sectional study. It comprised an imagination task with self-report and physiological measures to assess emotional reactivity during the cued recall of the aversive social experience and clinical interviews to assess PTSD-like symptoms. We expected increased emotional reactivity and more severe PTSD-like symptoms in response to the aversive social experience in patients with SAD compared to HC, as well as a positive correlation between emotional reactivity and PTSD-like symptoms in patients with SAD. Indeed, patients with SAD showed emotional hyperreactivity (self-report, physiology) during the cued recall of the aversive social experiences, also when compared to two control memory conditions (neutral, negative non-social) and HC. Patients with SAD furthermore reported more severe PTSD-like symptoms compared to HC and intrusive re-experiencing symptoms were positively correlated with distress during imagery of the social aversive event in patients with SAD. These results might point toward a maladaptive representation of aversive social experiences in memory. Similar to PTSD, this maladaptive memory representation might promote the development of PTSD-like symptoms such as intrusive re-experiencing (e.g., in the form of intrusive self-images in patients with SAD), which might finally lead to and maintain symptoms of SAD.
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Azoulay R, Gilboa-Schechtman E. The scarring impact of status loss in social anxiety: An evolutionary perspective. J Anxiety Disord 2022; 90:102600. [PMID: 35841783 DOI: 10.1016/j.janxdis.2022.102600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 12/01/2022]
Abstract
Evolutionary models suggest that social anxiety (SA) is associated with sensitivity to status loss. These models make several additional predictions concerning the strength as well as the specificity of the association between post-event distress (PED) following status losses and SA. First, the strength of this association is postulated to be enhanced in men, especially following status losses inflicted by other men (intra-male status losses). Second, given the evolutionary postulated relationship between social status and physical fitness, sensitivity to status loss in SA is expected to extend to physically threatening events. We examined these predictions in four online samples (total N = 1123; 59% females, 27% above the cutoff for clinically elevated SA). In all studies, participants recalled social status-loss events and rated the emotional and distressing impact of these experiences. In two samples, participants also identified and recalled physically threatening events. Our findings were consistent with evolutionary predictions. SA was associated with PED following social status-loss events (β = 0.27). This association was stronger in men than in women (β = 0.40, β = 0.16, respectively). Moreover, the SA-PED association was especially enhanced following intra-male, compared to intra-female and inter-gender, status losses (β = 0.47, β = 0.26, and β = 0.17, respectively). Furthermore, SA was uniquely associated with PED following physically threatening events, over and above PED following social status-loss events (β = 0.21). Our data highlights the significant impact of socially and physically threatening events and delineates the scarring signature of such events in SA.
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Affiliation(s)
- Roy Azoulay
- Department of Psychology and Gonda Multidisciplinary Brain Center, Bar-Ilan University, Israel.
| | - Eva Gilboa-Schechtman
- Department of Psychology and Gonda Multidisciplinary Brain Center, Bar-Ilan University, Israel
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Kotov R, Cicero DC, Conway CC, DeYoung CG, Dombrovski A, Eaton NR, First MB, Forbes MK, Hyman SE, Jonas KG, Krueger RF, Latzman RD, Li JJ, Nelson BD, Regier DA, Rodriguez-Seijas C, Ruggero CJ, Simms LJ, Skodol AE, Waldman ID, Waszczuk MA, Watson D, Widiger TA, Wilson S, Wright AGC. The Hierarchical Taxonomy of Psychopathology (HiTOP) in psychiatric practice and research. Psychol Med 2022; 52:1666-1678. [PMID: 35650658 DOI: 10.1017/s0033291722001301] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.
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Affiliation(s)
- Roman Kotov
- Stony Brook University, Stony Brook, New York, USA
| | | | | | | | | | | | - Michael B First
- Columbia University College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | | | - Steven E Hyman
- Stanley Center for Psychiatric Research at the Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | | | | | | | - James J Li
- University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Darrel A Regier
- Uniformed Services University, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA
| | | | | | | | - Andrew E Skodol
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | - Monika A Waszczuk
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | | | - Sylia Wilson
- University of Minnesota, Minneapolis, Minnesota, USA
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Trauma and psychosis: a qualitative study exploring the perspectives of people with psychosis on the influence of traumatic experiences on psychotic symptoms and quality of life. BMC Psychiatry 2022; 22:213. [PMID: 35331194 PMCID: PMC8944047 DOI: 10.1186/s12888-022-03808-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite experiencing high rates of trauma and trauma-related conditions, people with psychosis are seldomly asked about possible traumatic events. While there are some barriers to discussing trauma in clinical services, research has shown that disclosure is not only possible but also beneficial to both psychotic and traumatic symptoms. The current study is the first to evaluate service users' perception of the influence of trauma on the development and maintenance of their psychotic symptoms, as well as their views on how their life and mental health have been affected by traumatic events and their disclosure (or lack of). METHODS Eleven participants with experiences of psychosis and trauma took part in semi-structured interviews. RESULTS Consistently with previous literature, our participants reported high rates of interpersonal trauma, but had rarely had the opportunity to discuss any of these events. Using thematic analysis, we identified three major themes that have important implications for healthcare: factors that facilitate or hinder talking about trauma; consequences of talking or not; and relationship between trauma and psychosis. Participants generally benefited from talking about trauma and concerningly often associated the prolonged lack of opportunities to discuss traumatic events with negative feelings towards the self and with a deterioration of their mental health. Participants also recognised direct links between past traumas and the content and characteristics of their psychotic experiences. CONCLUSIONS Our findings highlight the importance, as perceived by service users, of discussing trauma and looking at psychosis through a "trauma lens". These results stress the need to systematically assess trauma history and traumatic symptoms in psychosis and might potentially help to overcome clinicians' worries about discussing trauma with service users. Our findings underscore the need to change current practice and implement trauma-informed approaches to understand clients' difficulties and provide support.
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Renner A, Kaiser J, Kersting A. [Traumatization in the Medical Profession: Initiating Events, Roles and Process Factors]. Psychother Psychosom Med Psychol 2022; 72:378-381. [PMID: 35226961 DOI: 10.1055/a-1749-6325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Physicians show an increased prevalence of post-traumatic stress disorder (PTSD). Potentially traumatic events in the medical profession include confrontation with suffering, death, violent experiences, and medical errors. The aim of the present analysis is to record traumatic events (TE) in physicians seeking help and to qualitatively analyze the roles and process factors involved. METHOD Using an online questionnaire, physicians who had experienced a traumatic event (TE) were surveyed regarding posttraumatic stress (PCL-5), depression (PHQ-9), alcohol abuse (CAGE test), and suicidality (BSIS). Reports of TEs were qualitatively analyzed using structured content analysis. RESULTS N=41 physicians described at least one TE. K=54 descriptions of TEs were qualitatively analyzed. In some cases, the physicians were victims of e. g., accidents or violence; in other cases, they were involved as witnesses or helpers. The following themes could be identified: Accompaniment of and confrontation with suffering and dying, negative courses of treatment (especially complications and medical errors), and lack of support (especially lack of error management). 53,7% of physicians had PTSD, and 36,6% showed symptoms of posttraumatic stress. Harmful alcohol use was observed in 24,4% of the sample. Psychotropic medication was taken by 31,7% of the respondents. DISCUSSION The results show a high burden of TE in the medical profession. In this context, physicians are affected by traumatization in their role as victims, witnesses, or treatment providers and confronted with the death or dying process of others. Residency presumably represents a particularly vulnerable phase. CONCLUSION Easily accessible forms of therapy (e. g., online therapy), structural changes (e. g., adequate support for residents), and programs for functional error management in hospitals could have a positive effect on the mental health of physicians.
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Affiliation(s)
- Anna Renner
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Julia Kaiser
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Anette Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
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Rameckers SA, van Emmerik AAP, Bachrach N, Lee CW, Morina N, Arntz A. The impact of childhood maltreatment on the severity of childhood-related posttraumatic stress disorder in adults. CHILD ABUSE & NEGLECT 2021; 120:105208. [PMID: 34332332 DOI: 10.1016/j.chiabu.2021.105208] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/23/2021] [Accepted: 07/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Childhood maltreatment is relatively common and is related to a range of negative consequences, such as Posttraumatic Stress Disorder (PTSD). There are indications that various maltreatment types are related to PTSD severity, although not all types, such as emotional abuse, meet the PTSD Criterion-A. OBJECTIVE The aim of the present study was to examine the relationship between 5 types of childhood maltreatment (i.e., sexual, physical, and emotional abuse, and physical and emotional neglect) and the severity of adult PTSD and PTSD symptoms. PARTICIPANTS AND SETTING Adult participants (N = 147) with Childhood-related PTSD (Ch-PTSD) recruited from clinical sites completed the Childhood Trauma Questionnaire-short form (CTQ-sf) and 2 PTSD measures: The Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5). METHODS Childhood maltreatment predictors and 2 covariates, age and gender, were analysed in multivariate multilevel models as participants were nested within sites. A model selection procedure, in which all combinations of predictors were examined, was used to select a final set of predictors. RESULTS The results indicated that emotional abuse was the only trauma type that was significantly related to severity of PTSD and to the severity of specific PTSD symptom clusters (r between 0.130 and 0.338). The final models explained between 6.5% and 16.7% of the variance in PTSD severity. CONCLUSIONS The findings suggest that emotional abuse plays a more important role in Ch-PTSD than hitherto assumed, and that treatment should not neglect processing of childhood emotional abuse.
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Affiliation(s)
- Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | | | - Nathan Bachrach
- GGZ Oost Brabant, RINO Zuid and Tilburg University, Helmond, the Netherlands
| | - Christopher W Lee
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Dominguez SK, Matthijssen SJMA, Lee CW. Trauma-focused treatments for depression. A systematic review and meta-analysis. PLoS One 2021; 16:e0254778. [PMID: 34292978 PMCID: PMC8297785 DOI: 10.1371/journal.pone.0254778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 07/04/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Trauma-focused treatments (TFTs) have demonstrated efficacy at decreasing depressive symptoms in individuals with PTSD. This systematic review and meta-analysis evaluated the effectiveness of TFTs for individuals with depression as their primary concern. METHODS A systematic search was conducted for RCTs published before October 2019 in Cochrane CENTRAL, Pubmed, EMBASE, PsycInfo, and additional sources. Trials examining the impact of TFTs on participants with depression were included. Trials focusing on individuals with PTSD or another mental health condition were excluded. The primary outcome was the effect size for depression diagnosis or depressive symptoms. Heterogeneity, study quality, and publication bias were also explored. RESULTS Eleven RCTs were included (n = 567) with ten of these using EMDR as the TFT and one using imagery rescripting. Analysis suggested these TFTs were effective in reducing depressive symptoms post-treatment with a large effect size [d = 1.17 (95% CI: 0.58~ 1.75)]. Removal of an outlier saw the effect size remain large [d = 0.83 (95% CI: 0.48~ 1.17)], while the heterogeneity decreased (I2 = 66%). Analysis of the 10 studies that used EMDR also showed a large effect [d = 1.30 (95% CI: 0.67~1.91)]. EMDR was superior to non trauma-focused CBT [d = 0.66 (95% CI: 0.31~1.02)] and analysis of EMDR and imagery rescripting studies suggest superiority over inactive control conditions [d = 1.19 (95% CI: 0.53~ 1.86)]. Analysis of follow-up data also supported the use of EMDR with this population [d = 0.71 (95% CI: 1.04~0.38)]. No publication bias was identified. CONCLUSIONS Current evidence suggests that EMDR can be an effective treatment for depression. There were insufficient RCTs on other trauma-focused interventions to conclude whether TFTs in general were effective for treating depression. Larger studies with robust methodology using EMDR and other trauma-focused interventions are needed to build on these findings.
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Affiliation(s)
- Sarah K. Dominguez
- School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia
| | - Suzy J. M. A. Matthijssen
- Altrecht Academic Anxiety Centre, Utrecht, The Netherlands
- Faculty of Social Sciences, Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Christopher William Lee
- School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA, Australia
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Karatzias T, Shevlin M, Hyland P, Fyvie C, Grandison G, Ben-Ezra M. ICD-11 posttraumatic stress disorder, complex PTSD and adjustment disorder: the importance of stressors and traumatic life events. ANXIETY, STRESS, AND COPING 2021; 34:191-202. [PMID: 32744873 DOI: 10.1080/10615806.2020.1803006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Although ICD-11 adjustment (AjD), posttraumatic stress (PTSD) and complex posttraumatic stress (CPTSD) are commonly diagnosed disorders following exposure to stressful or traumatic life events, their dimensional structure and co-occurrence has never been tested in a single study. The present study explored the latent structure of AjD, PTSD, and CPTSD symptoms and their relationship to stressful and traumatic life events to determine the degree of distinctiveness between these constructs.Methods: Participants were clinical patients (N = 331) who completed self-report measures of stressful and traumatic life events, AjD (The Adjustment Disorder - New Module 8 (ADNM-8)) and PTSD / CPTSD (The International Trauma Questionnaire - ITQ).Results: Using confirmatory factor analysis, a second-order model comprised of correlated latent variables of AjD, PTSD, and CPTSD provided the best fit of the data. It was also found that stressors and traumatic life events were positively associated with all of these conditions although childhood trauma was only associated with CPTSD.Conclusions: The current findings support the ICD-11 model of related-but-distinct stress-related disorders. We discuss the existence of a stress-response continuum and how the current findings impact the development of clinical interventions that may be shared across, or unique to, each stress-related disorder.
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Affiliation(s)
- Thanos Karatzias
- Edinburgh Napier University, School of Health & Social Care, Edinburgh, UK.,NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- Ulster University, School of Psychology, Derry, Northern Ireland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.,Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Claire Fyvie
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Graeme Grandison
- Edinburgh Napier University, School of Health & Social Care, Edinburgh, UK
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Sánchez-Teruel D, Robles-Bello MA, Valencia-Naranjo N. Do psychological strengths protect college students confined by COVID-19 to emotional distress? The role of gender. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021; 171:110507. [PMID: 35502314 PMCID: PMC9045810 DOI: 10.1016/j.paid.2020.110507] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/28/2020] [Accepted: 11/06/2020] [Indexed: 01/27/2023]
Abstract
The COVID-19 pandemic represents a stressful situation for the university population due to the important changes in the development of their studies and in their living conditions. However, the impact of factors related to the family unit (living with COVID-19 positive patients and living with Essential Services Workers-ESW) and other protective psychosocial factors that could produce resilient or psychopathological results (anxiety and depression) in this population has not been sufficiently assessed, differentiating them by gender. The results obtained show that both variables related to the family unit and psychosocial protective variables explain 28.6% of the variance in general distress in the total sample (R2 = 0.286; F(3,250) =34,717; p < .001). However, models of regression of distress and anxiety levels differ between men and women, but not in terms of mood alteration. Women facing circumstances reminiscent of mandatory pandemic containment have moderately higher levels of resilience than men (tCDRISC(125) = 2.218; p < .05; tGSE(125) = 2.415; p < .05; tCDRISC(125) = 0.146; p = .884; tGSE(125) = 0.315; p = .756). The results are discussed from the perspective of gender differences, taking into account the contribution of sociodemographic factors that increase remembrance of the stressor/trauma and the coping styles of the participants.
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Affiliation(s)
| | | | - Nieves Valencia-Naranjo
- Department of Psychology, University of Cordoba, Cordoba, Spain
- Department of Psychology, University of Jaen, Jaen, Spain
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14
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Dominguez S, Drummond P, Gouldthorp B, Janson D, Lee CW. A randomized controlled trial examining the impact of individual trauma-focused therapy for individuals receiving group treatment for depression. Psychol Psychother 2021; 94:81-100. [PMID: 31965734 DOI: 10.1111/papt.12268] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/24/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Adverse life events are associated with increased likelihood of depression and poorer prognosis. Trauma-focused treatments (TFT) appear to be effective in decreasing comorbid depressive symptoms. Accordingly, the aim of this study was to evaluate the effectiveness of a TFT on the memories of aversive events for individuals with a primary diagnosis of depression. METHODS A randomized controlled trial was conducted with 49 participants recruited from a 10-day outpatient group programme. All participants showed symptoms of depression with a subgroup (80%) meeting the DSM-5 criteria for a major depressive episode. Participants received treatment as usual (TAU); three additional individual trauma-focused sessions; or three additional individual assertiveness training sessions. Participants were assessed with regards to depression diagnosis and related symptoms. RESULTS For participants with a major depressive episode, the addition of trauma-focused sessions significantly increased the likelihood of remission when compared to TAU, or additional assertiveness training. While no significant treatment difference was noted in depressive symptom change post-treatment, six weeks after treatment those who received an adjunct treatment were more likely to maintain treatment gains than those who received TAU. Furthermore, at 12-week follow-up, participants who received a TFT reported significantly fewer depressive symptoms than those who received assertiveness training. CONCLUSIONS While differences in outcomes were minimal immediately post-treatment, differences among treatment groups increased over time. Thus, as few as three additional TFT sessions may impact positively on symptom change for people completing a group programme for the treatment of depression. PRACTITIONER POINTS Depression is the greatest cause of disability worldwide. Adverse experiences are linked with an increased likelihood of depression, more severe symptoms and poor treatment outcomes following evidence-based interventions. As few as three trauma-focused sessions can improve treatment outcomes in terms of depression diagnosis and related symptoms for individuals receiving group cognitive behavioural therapy.
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Affiliation(s)
- Sarah Dominguez
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Western Australia, Australia.,Hollywood Private Hospital, Nedlands, Western Australia, Australia
| | - Peter Drummond
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Western Australia, Australia
| | - Bethanie Gouldthorp
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Western Australia, Australia.,Hollywood Private Hospital, Nedlands, Western Australia, Australia
| | - Diana Janson
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Western Australia, Australia.,Hollywood Private Hospital, Nedlands, Western Australia, Australia
| | - Christopher William Lee
- Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Western Australia, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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15
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Fimiani R, Gazzillo F, Fiorenza E, Rodomonti M, Silberschatz G. Traumas and Their Consequences According to Control-Mastery Theory. Psychodyn Psychiatry 2020; 48:113-139. [PMID: 32628581 DOI: 10.1521/pdps.2020.48.2.113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this article is to introduce the reader to how control-mastery theory (CMT; Gazzillo, 2016; Silberschatz, 2005; Weiss, 1993), an integrative relational cognitive-dynamic theory of mental functioning, psychopathology, and psychotherapeutic process, understands traumas, their consequences, and their mastery. In the first part of this article, we will present an overview of the debate about the definition of trauma within the different editions of the Diagnostic and Statistical Manual of Mental Disorders. Then, we will focus on the concept of complex traumas and on their consequences on mental health. Finally, we will discuss how CMT conceptualizes traumas and their pathological consequences. We will stress in particular how, according to CMT, in order for a painful experience to become a trauma, its victim has to come to believe that s/he caused it in the attempt to pursue a healthy and adaptive goal. In order to master traumas and disprove the pathogenic beliefs developed from them, people attempt to reexperience situations similar to the traumatic ones in safer conditions while giving them happier endings.
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Affiliation(s)
- Ramona Fimiani
- Department of Dynamic and Clinical Psychology "Sapienza" University of Rome
| | - Francesco Gazzillo
- Department of Dynamic and Clinical Psychology "Sapienza" University of Rome
| | - Eleonora Fiorenza
- Department of Dynamic and Clinical Psychology "Sapienza" University of Rome
| | - Martina Rodomonti
- Department of Dynamic and Clinical Psychology "Sapienza" University of Rome
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17
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A plea for more attention to mental representations. J Behav Ther Exp Psychiatry 2020; 67:101510. [PMID: 31640848 DOI: 10.1016/j.jbtep.2019.101510] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 12/19/2022]
Abstract
In this invited essay I plead for a renewed attention to mental representations in research into psychopathology and its treatment. With the cognitive revolution in the second half of the previous century most psychological models of psychopathology were based on people's capacity to form mental representations of the world. However, much research effort was put into investigating cognitive biases instead of investigating mental representations, and attention shifted towards such biases, including claims that they are causal in psychopathology. Similar claims were made about emotion regulation difficulties. Moreover, in many treatment models that were developed the focus was more on cognitive biases and emotion regulation, than on underlying representations. In this essay I argue that the causal status of cognitive biases, emotion regulation, and similar phenomena is overestimated, and that in clinical reality such phenomena can be best conceptualized as output of activated mental representations. Moreover, I argue that the disappointing effectiveness and protection to relapse of many current psychological treatments are related to not addressing the underlying mental representation. Next I discuss aspects of mental representations that are important for understanding and treating psychopathology, after which I discuss the clinical implications. I sketch how better understanding the specificities of mental representations can help us to improve psychological treatments, and I make some suggestions for future research.
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18
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Bjornsson AS, Hardarson JP, Valdimarsdottir AG, Gudmundsdottir K, Tryggvadottir A, Thorarinsdottir K, Wessman I, Sigurjonsdottir Ó, Davidsdottir S, Thorisdottir AS. Social trauma and its association with posttraumatic stress disorder and social anxiety disorder. J Anxiety Disord 2020; 72:102228. [PMID: 32361167 DOI: 10.1016/j.janxdis.2020.102228] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/26/2022]
Abstract
The key characteristic of a traumatic event as defined by the Diagnostic and Mental Manual of Mental Disorders (DSM) seems to be a threat to life. However, evidence suggests that other types of threats may play a role in the development of PTSD and other disorders such as social anxiety disorder (SAD). One such threat is social trauma, which involves humiliation and rejection in social situations. In this study, we explored whether there were differences in the frequency, type and severity of social trauma endured by individuals with a primary diagnosis of SAD (n = 60) compared to a clinical control group of individuals with a primary diagnosis of obsessive compulsive disorder (OCD, n = 19) and a control group of individuals with no psychiatric disorders (n = 60). The results showed that most participants in this study had experienced social trauma. There were no clear differences in the types of experiences between the groups. However, one third of participants in the SAD group (but none in the other groups) met criteria for PTSD or suffered from clinically significant PTSD symptoms in response to their most significant social trauma. This group of SAD patients described more severe social trauma than other participants. This line of research could have implications for theoretical models of both PTSD and SAD, and for the treatment of individuals with SAD suffering from PTSD after social trauma.
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Affiliation(s)
| | | | | | | | | | | | - Inga Wessman
- Department of Psychology, University of Iceland, Iceland
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19
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Vermeulen M, Smits D, Boelen PA, Claes L, Raes F, Krans J. The Dutch Version of the Centrality of Event Scale (CES). EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2020. [DOI: 10.1027/1015-5759/a000517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract. Event centrality is defined as the extent to which the memory of a traumatic event forms a reference point for personal identity and the attribution of meaning to other experiences in a person’s life. The current study investigated the psychometric properties of the Dutch translation of the Centrality of Event Scale (CES; Berntsen & Rubin, 2006 ) and its relation with symptoms of Posttraumatic Stress Disorder (PTSD), depression, exposure to traumatic events as defined by DSM-5 trauma criterion A, and negative life events in a student sample ( N = 967). An underlying structure of one factor was found. This factor structure was replicated in two additional independent samples. High internal consistency was found for a 6-item CES. CES scores were positively related to symptoms of PTSD and depression, to the DSM-5 trauma criterion A, and the number of negative life events. The CES made a unique contribution to the explained variance in PTSD symptoms when controlling for depression. However, CES scores were unrelated to depression when controlling for PTSD symptoms, suggesting that event centrality might be more typically related to PTSD, and less to depression.
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Affiliation(s)
| | - Dirk Smits
- Behavior, Health and Psychopathology, KU Leuven, Belgium
- Odisee, University of Applied Sciences, Brussels, Belgium
| | - Paul A. Boelen
- Department of Clinical Psychology, Utrecht University, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Laurence Claes
- Behavior, Health and Psychopathology, KU Leuven, Belgium
- Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Belgium
| | - Filip Raes
- Behavior, Health and Psychopathology, KU Leuven, Belgium
| | - Julie Krans
- Behavior, Health and Psychopathology, KU Leuven, Belgium
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20
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DeLucia JA, Bitter C, Fitzgerald J, Greenberg M, Dalwari P, Buchanan P. Prevalence of Post-Traumatic Stress Disorder in Emergency Physicians in the United States. West J Emerg Med 2019; 20:740-746. [PMID: 31539331 PMCID: PMC6754196 DOI: 10.5811/westjem.2019.7.42671] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/12/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction There is increasing concern about the effects of occupational stressors on the wellness of healthcare providers. Given high patient acuity, circadian rhythm disruption, and other workplace stressors, emergency physicians (EP) would be predicted to have high rates of occupational stress. We conducted this study to assess the prevalence of post-traumatic stress disorder (PTSD) in attending EPs practicing in the United States. Methods A link to an electronic questionnaire was distributed through the emergency medicine-centric publication Emergency Medicine News. We compared the prevalence of PTSD in EPs to the general population using a chi-square goodness of fit test, and performed logistic regression to assess for significance of risk factors. Results We received survey responses from 526 persons. In this study, EPs had a PTSD point prevalence of 15.8%. Being a victim of a prior trauma or abuse is the primary predictor of PTSD (odds ratio [OR] [95% confidence interval {CI}, 2.16 (1.21 – 3.86)], p = 0.009) and PTSD severity score (OR [95% CI, 1.16 (1.07 – 1.26)], p <0.001). Conclusion Emergency physicians have a substantial burden of PTSD, potentially jeopardizing their own health and career longevity. Future studies should focus on identifying subgroups at higher risk for PTSD and modifiable risk factors. Prevention and treatment strategies should be developed and tested in healthcare providers.
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Affiliation(s)
- Joseph A DeLucia
- Saint Louis University School of Medicine, Department of Surgery/Division of Emergency Medicine, Saint Louis, Missouri
| | - Cindy Bitter
- Saint Louis University School of Medicine, Department of Surgery/Division of Emergency Medicine, Saint Louis, Missouri
| | - Jennifer Fitzgerald
- Saint Louis University School of Medicine, Department of Surgery/Division of Emergency Medicine, Saint Louis, Missouri
| | - Miggie Greenberg
- Saint Louis University School of Medicine, Department of Psychiatry, Saint Louis, Missouri
| | - Preeti Dalwari
- Saint Louis University School of Medicine, Department of Surgery/Division of Emergency Medicine, Saint Louis, Missouri
| | - Paula Buchanan
- Saint Louis University, Saint Louis University Center for Health Outcomes Research, Saint Louis, Missouri
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21
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Tirgari B, Azizzadeh Forouzi M, Ebrahimpour M. Relationship Between Posttraumatic Stress Disorder and Compassion Satisfaction, Compassion Fatigue, and Burnout in Iranian Psychiatric Nurses. J Psychosoc Nurs Ment Health Serv 2019; 57:39-47. [DOI: 10.3928/02793695-20181023-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/23/2018] [Indexed: 11/20/2022]
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22
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Tomich PL, Tolich A. Life is a balancing act: Deviation from a balanced time perspective mediates the relationship between lifetime trauma exposure and optimism. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00191-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Frewen P, Zhu J, Lanius R. Lifetime traumatic stressors and adverse childhood experiences uniquely predict concurrent PTSD, complex PTSD, and dissociative subtype of PTSD symptoms whereas recent adult non-traumatic stressors do not: results from an online survey study. Eur J Psychotraumatol 2019; 10:1606625. [PMID: 31105905 PMCID: PMC6507912 DOI: 10.1080/20008198.2019.1606625] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/29/2019] [Accepted: 04/02/2019] [Indexed: 12/19/2022] Open
Abstract
This retrospective survey study compared the differential risk of lifetime traumatic stressors, so-called "non-traumatic stressors" experienced over the past year, referring to life events that do not meet the criteria for A1 traumatic events, and adverse childhood experiences (ACE) on severity of DSM-5 versus ICD-11 PTSD, Complex PTSD (CPTSD), and dissociative subtype of PTSD (D-PTSD) symptoms among 418 participants recruited online. In pairwise analyses, all stress types were associated with all outcomes. However, multiple regression and factor analyses indicated that whereas the number of different lifetime traumatic events participants reported experiencing, together with the number of ACE participants experienced, uniquely predicted DSM-5 PTSD, D-PTSD and ICD-11 PTSD and CPTSD symptoms, the number of non-traumatic stressors they experienced during the last year did not. Moreover, ACE uniquely predicted all outcomes even after accounting for lifetime traumatic stress. These results provide further support for the particularly high risk of lifetime traumatic stressors and ACE in predicting trauma and stressor-related symptoms. Future research directions are discussed.
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Affiliation(s)
- Paul Frewen
- Department of Psychiatry, Western University, London, Canada
| | - Jenney Zhu
- Department of Psychiatry, Western University, London, Canada
| | - Ruth Lanius
- Department of Psychiatry, Western University, London, Canada
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24
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Troisi A. Psychotraumatology: What researchers and clinicians can learn from an evolutionary perspective. Semin Cell Dev Biol 2018; 77:153-160. [DOI: 10.1016/j.semcdb.2017.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/22/2017] [Accepted: 09/05/2017] [Indexed: 12/11/2022]
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25
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An empirical assessment of adjustment disorder as proposed for ICD-11 in a general population sample of Israel. J Anxiety Disord 2018; 54:65-70. [PMID: 29426030 DOI: 10.1016/j.janxdis.2018.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND A new diagnostic concept of Adjustment Disorder (AjD) was proposed for inclusion in the International Classification of Diseases, 11th version (ICD-11). However, the symptom structure of AjD is poorly understood. The aim of the present study was to investigate the dimensionality of AjD as a stress-response syndrome. METHODS A general population sample of the Israeli population (N = 1003) completed the Adjustment Disorder - New Module 20 and the WHO-5 Wellbeing Scale. We compared seven alternative models of AjD using confirmatory factor analysis (CFA). A latent profile analysis (LPA) was performed to determine if subtypes of AjD were present. The performance of the unidimensional and multidimensional models of AjD were evaluated using regression analyses. RESULTS CFA results supported a unidimensional model of AjD. The LPA identified three quantitatively distinct classes (low, medium, and high) with no evidence of any subtypes of AjD. The criterion validity of AjD was superior when treated as unidimensional. AjD was associated with lower levels of psychological wellbeing (β = -.32, p < .001). CONCLUSIONS Our results suggest that AjD is better conceptualised as a unidimensional construct. Future work should focus on a reduction of required symptoms in order to improve clinical utility and validity of the diagnosis.
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26
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Brewin CR, Cloitre M, Hyland P, Shevlin M, Maercker A, Bryant RA, Humayun A, Jones LM, Kagee A, Rousseau C, Somasundaram D, Suzuki Y, Wessely S, van Ommeren M, Reed GM. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev 2017; 58:1-15. [PMID: 29029837 DOI: 10.1016/j.cpr.2017.09.001] [Citation(s) in RCA: 323] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/18/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022]
Abstract
The World Health Organization's proposals for posttraumatic stress disorder (PTSD) in the 11th edition of the International Classification of Diseases, scheduled for release in 2018, involve a very brief set of symptoms and a distinction between two sibling disorders, PTSD and Complex PTSD. This review of studies conducted to test the validity and implications of the diagnostic proposals generally supports the proposed 3-factor structure of PTSD symptoms, the 6-factor structure of Complex PTSD symptoms, and the distinction between PTSD and Complex PTSD. Estimates derived from DSM-based items suggest the likely prevalence of ICD-11 PTSD in adults is lower than ICD-10 PTSD and lower than DSM-IV or DSM-5 PTSD, but this may change with the development of items that directly measure the ICD-11 re-experiencing requirement. Preliminary evidence suggests the prevalence of ICD-11 PTSD in community samples of children and adolescents is similar to DSM-IV and DSM-5. ICD-11 PTSD detects some individuals with significant impairment who would not receive a diagnosis under DSM-IV or DSM-5. ICD-11 CPTSD identifies a distinct group who have more often experienced multiple and sustained traumas and have greater functional impairment than those with PTSD.
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Affiliation(s)
- Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Marylène Cloitre
- Division of Dissemination and Training, National Center for PTSD, Menlo Park, CA, USA
| | - Philip Hyland
- School of Business, National College of Ireland, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, University of Ulster, Coleraine, North Ireland
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology, University of Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Lynne M Jones
- FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Cécile Rousseau
- Department of Psychiatry, McGill University Health Center, Montreal, Canada
| | | | - Yuriko Suzuki
- National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; Global Mental Health Program, Columbia University Medical Center, New York, NY, USA
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27
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Szabo YZ, Warnecke AJ, Newton TL, Valentine JC. Rumination and posttraumatic stress symptoms in trauma-exposed adults: a systematic review and meta-analysis. ANXIETY STRESS AND COPING 2017; 30:396-414. [DOI: 10.1080/10615806.2017.1313835] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Yvette Z. Szabo
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Ashlee J. Warnecke
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Tamara L. Newton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Jeffrey C. Valentine
- Department of Educational and Counseling Psychology, University of Louisville, Louisville, KY, USA
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28
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Atwoli L, Stein DJ, King A, Petukhova M, Aguilar-Gaxiola S, Alonso J, Bromet EJ, de Girolamo G, Demyttenaere K, Florescu S, Haro JM, Karam EG, Kawakami N, Lee S, Lepine JP, Navarro-Mateu F, O’Neill S, Pennell BE, Piazza M, Posada-Villa J, Sampson NA, ten Have M, Zaslavsky AM, Kessler RC. Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the world mental health surveys. Depress Anxiety 2017; 34:315-326. [PMID: 27921352 PMCID: PMC5661943 DOI: 10.1002/da.22579] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Unexpected death of a loved one (UD) is the most commonly reported traumatic experience in cross-national surveys. However, much remains to be learned about posttraumatic stress disorder (PTSD) after this experience. The WHO World Mental Health (WMH) survey initiative provides a unique opportunity to address these issues. METHODS Data from 19 WMH surveys (n = 78,023; 70.1% weighted response rate) were collated. Potential predictors of PTSD (respondent sociodemographics, characteristics of the death, history of prior trauma exposure, history of prior mental disorders) after a representative sample of UDs were examined using logistic regression. Simulation was used to estimate overall model strength in targeting individuals at highest PTSD risk. RESULTS PTSD prevalence after UD averaged 5.2% across surveys and did not differ significantly between high-income and low-middle income countries. Significant multivariate predictors included the deceased being a spouse or child, the respondent being female and believing they could have done something to prevent the death, prior trauma exposure, and history of prior mental disorders. The final model was strongly predictive of PTSD, with the 5% of respondents having highest estimated risk including 30.6% of all cases of PTSD. Positive predictive value (i.e., the proportion of high-risk individuals who actually developed PTSD) among the 5% of respondents with highest predicted risk was 25.3%. CONCLUSIONS The high prevalence and meaningful risk of PTSD make UD a major public health issue. This study provides novel insights into predictors of PTSD after this experience and suggests that screening assessments might be useful in identifying high-risk individuals for preventive interventions.
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Affiliation(s)
- Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Andrew King
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Jordi Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Giovanni de Girolamo
- IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center; and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Descartes – Paris Diderot, France
| | - Fernando Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Murcia, Spain
| | - Siobhan O’Neill
- School of Psychology, University of Ulster, Londonderry, United Kingdom
| | - Beth-Ellen Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Marina Piazza
- Universidad Peruana Cayetano Heredia; and National Institute of Health, Lima, Peru
| | | | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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29
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Abstract
The first part of the series of three articles on posttraumatic stress disorder (PTSD) in Court to appear in the journal reviews the history of the construct of PTSD and its presentation in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; American Psychiatric Association, 2013) and the ICD-11 (International Classification of Diseases, 11th Edition; World Health Organization, 2018). There are 20 symptoms of PTSD in the DSM-5. PTSD symptoms are arranged into a four-cluster model, which has received partial support in the literature. Other four-factor models have been found that fit the data even better than that of the DSM-5. There is a five-factor dysphoria model and two six-factor models that have been found to fit better the DSM-5 PTSD symptoms. Finally, research is providing support for a hybrid seven-factor model. An eighth factor on dissociation seems applicable to the minority of people who express the dissociative subtype. At the epidemiological level, individuals can expect trauma exposure to take place about 70% over one's lifetime. Also, traumatic exposure leads to traumatic reactions in about 10% of cases, with PTSD being a primary diagnosis for trauma. Once initiated, PTSD becomes prolonged in about 10% of cases. Polytrauma and comorbidities complicate these prevalence statistics. Moreover, the possibility of malingered PTSD presents confounds. However, the estimate for malingered PTSD varies extensively, from 1 to 50%, so that the estimate is too imprecise for use in court without further research. This first article in the series of three articles appearing in the journal on PTSD in Court concludes with discussion of complications related to comorbidities and heterogeneities, in particular. For example, PTSD and its comorbidities can be expressed in over one quintillion ways. This complexity in its current structure in the DSM-5 speaks to the individual differences involved in its expression.
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Affiliation(s)
- Gerald Young
- Glendon Campus, York University, Toronto, Ontario, Canada.
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