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Sabahi Z, Hasani P, Salehi-Pourmehr H, Beheshti R, Sadeghi-Bazargani H. What Are the Predictors of Post-traumatic Stress Disorder Among Road Traffic Accident Survivors: A Systematic Review. J Nerv Ment Dis 2024; 212:104-116. [PMID: 38290103 DOI: 10.1097/nmd.0000000000001739] [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] [Indexed: 02/01/2024]
Abstract
ABSTRACT Traffic accidents put tremendous burdens on the psychosocial aspects of communities. Post-traumatic stress disorder (PTSD), after an accident, is one of the most prevalent and incapacitating psychiatric conditions worldwide. In this systematic review, we aimed to investigate the predictors of PTSD in traffic accident victims. Primary search was conducted in November 2021 and updated in 2023. Studies were excluded if they used any analysis except regression for predictors. Cumulatively, primary and update searches retrieved 10,392 articles from databases, and of these, 87 studies were systematically reviewed. The predictors were categorized into sociodemographics, pretrauma, peritrauma, and post-trauma factors. The PTSD assessment time varied between 2 weeks and 3 years. Being a woman, having depression and having a history of road traffic accidents pretraumatically, peritraumatic dissociative experiences, acute stress disorder diagnosis, rumination, higher injury severity, and involvement in litigation or compensation after the trauma were significant predictors of PTSD.
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Affiliation(s)
- Zahra Sabahi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parham Hasani
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Rasa Beheshti
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Zylberstajn C, Messina Coimbra B, Oliveira-Watanabe TT, Rangel Maciel M, Calsavara VF, Olff M, Feijo Mello M, Feijo Mello A. The Relationship between Lifetime Exposure to Potentially Traumatic Events, Peritraumatic Dissociation, and PTSD in a Sample of Sexually Assaulted Women in Sao Paulo, Brazil. J Trauma Dissociation 2023; 24:252-267. [PMID: 36271690 DOI: 10.1080/15299732.2022.2136326] [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: 02/07/2023]
Abstract
Sexually assaulted women represent a particularly high-risk group for developing post-traumatic stress disorder (PTSD). Potentially traumatic events (PTEs) and peritraumatic dissociation (PD) are known risk factors for PTSD. However, little is known about how previous trauma affects PD and how this relationship affects PTSD. We aimed to investigate whether PD acts as a mediator between PTEs and PTSD severity in a sample of recently sexually assaulted women in Sao Paulo, Brazil. Seventy-four sexually assaulted women aged 18-44 completed questionnaires and structured interviews on PTSD, PD, and PTEs. We examined direct and indirect effects of variables using causal mediation analysis. Lifetime exposure to PTEs was a risk factor for PD, but PD was not a risk factor for PTSD symptom severity. Also, PD was not a mediator between PTEs and PTSD severity. We provided recommendations on how to further explore the relationship between lifetime traumatic exposure, PTSD, and peritraumatic dissociation.
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Affiliation(s)
- Cecilia Zylberstajn
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Bruno Messina Coimbra
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Thauana T Oliveira-Watanabe
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Mariana Rangel Maciel
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Vinicius F Calsavara
- Cedars‑Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Miranda Olff
- Amsterdam UMC, location University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Marcelo Feijo Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Andrea Feijo Mello
- Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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L'amnésie dissociative dans le Trouble de Stress Post-Traumatique: analyse de la validité scientifique d'un phénomène psychologique controversé. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2023. [DOI: 10.1016/j.ejtd.2023.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Daneshvar S, Shafiei M, Basharpoor S. Compassion-Focused Therapy: Proof of Concept Trial on Suicidal Ideation and Cognitive Distortions in Female Survivors of Intimate Partner Violence With PTSD. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP9613-NP9634. [PMID: 33375899 DOI: 10.1177/0886260520984265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This proof of concept trial aimed to assess the pre-post differences in suicidal ideation and cognitive distortions in the compassion-focused therapy (CFT), and to compare the psychological improvement in the experimental group to a control group. A total of 42 women suffering from PTSD due to exposure to intimate partner violence (IPV) were randomized to the experimental and control groups (21 per group). All participants completed the questionnaires of suicidal ideation and cognitive distortions as pretest measures. Subjects of the experimental group received 8 CFT sessions, while the controls did not receive any therapy. Then, all subjects responded to the questionnaires of suicidal ideation and cognitive distortions as the posttest measures. Data were analyzed using one-way repeated measures MANOVA. Subjects of the experimental group indicated a greater reduction in post-test scores of suicidal ideation and its subscales including passive suicidal ideation, preparation for suicide, and active suicidal ideation when compared to the controls. Moreover, the subjects of the experimental group indicated a greater reduction in the post-test scores of cognitive distortions than controls. These results provide support for a larger trial focusing on the efficacy of CFT on psychological outcomes of PTSD following exposure to IPV. This intervention has the potential to be deployed at higher scales for IPV-affected women with PTSD.
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Daneshvar S, Shafiei M, Basharpoor S. Group-based Compassion-focused Therapy on Experiential Avoidance, Meaning-in-life, and Sense of Coherence in Female Survivors of Intimate Partner Violence with PTSD: A Randomized Controlled Trial. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP4187-NP4211. [PMID: 32933348 DOI: 10.1177/0886260520958660] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current study was carried out to investigate the effects of compassion-focused therapy (CFT) on experiential avoidance, meaning-in-life, and sense of coherence (SoC) in women suffering from post-traumatic stress disorder (PTSD) due to the intimate partner violence (IPV).42 women suffering from PTSD due to the IPV exposure were randomized to the two groups of experimental and control (21 per group). All participants completed the questionnaires of experiential avoidance, meaning-in-life, and SoC as pre-test measures. The experimental group received eight sessions of CFT, while the controls did not receive any treatment. After that, all subjects responded to the questionnaires of experiential avoidance, meaning-in-life, and SoC as the post-test measures. Data were analyzed using one-way repeated measures MANOVA.Subjects of the experimental group indicated a greater reduction in post-test scores of experiential avoidance, and a significant rise in the level of meaning-in-life and its subscales including the presence of meaning-in-life and search for meaning-in-life when compared to the controls. Nevertheless, there was no change in the level of SoC as a function of CFT.Applying CFT can result in reducing experiential avoidance and raising the meaning of life in women with PTSD due to IPV exposure. CFT is highly recommended to strengthen the well-being of patients with PTSD and reduce the PTSD symptoms.
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Katz C, Tsur N, Nicolet R, Carmel N, Klebanov B. Children's Responses to Maltreatment: Key Conclusions From a Systematic Literature Review. TRAUMA, VIOLENCE & ABUSE 2021; 22:1155-1168. [PMID: 32116133 DOI: 10.1177/1524838020908851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Child maltreatment (CM) has received much research attention in recent years, leading to the enormous development of services provided to children worldwide. However, although the literature in the field of trauma studies recognizes that responses to trauma are of central importance, for a variety of reasons, the research on this subject is sparse. The current systematic literature review was therefore designed to characterize and analyze the existing knowledge on children's responses to CM, while putting in focus all possible responses that will appear in the identified manuscripts. Key databases were explored using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and only six studies were identified as relevant to the focus of the current study. Utilizing thematic analysis, the results addressed four main themes: the studies' methodologies, the terminology and responses that were explored in these studies, the abuse-related factors and contexts that were taken into account, and the consequences for the children (of their responses to the maltreatment). A key conclusion from this review is that concepts in this area, as well as theory, are considerably lacking. Promoting the development of theory regarding children's responses to CM is urgently needed, as it will greatly impact clinical intervention, legal investigation, and the development of prevention programs.
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Affiliation(s)
- Carmit Katz
- Bob Shapell School of Social Work, Tel Aviv University, Israel
| | - Noga Tsur
- Bob Shapell School of Social Work, Tel Aviv University, Israel
| | - Racheli Nicolet
- Bob Shapell School of Social Work, Tel Aviv University, Israel
| | - Nir Carmel
- Bob Shapell School of Social Work, Tel Aviv University, Israel
| | - Bella Klebanov
- Bob Shapell School of Social Work, Tel Aviv University, Israel
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Chi X, Huang L, Hall DL, Li R, Liang K, Hossain MM, Guo T. Posttraumatic Stress Symptoms Among Chinese College Students During the COVID-19 Pandemic: A Longitudinal Study. Front Public Health 2021; 9:759379. [PMID: 34900908 PMCID: PMC8655775 DOI: 10.3389/fpubh.2021.759379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/22/2021] [Indexed: 12/30/2022] Open
Abstract
A longitudinal assessment of the prevalence of posttraumatic stress symptoms (PTSS) and risk factors is indispensable for further prevention and/or treatment. The longitudinal web-based survey enrolled 1,164 college students in China. Measured at two time points (February and August 2020), PTSS, demographic information, adverse childhood experiences (ACEs), resilience and self-compassion information were collected to explicate the prevalence and predictors of PTSS concurrently and over time. Results showed that although PTSS generally declined throughout the 6 months after the outbreak of COVID-19, the prevalence remained relatively high. Resilience and self-compassion negatively predicted PTSS concurrently and longitudinally. While subjective family socioeconomic status (SES) and ACEs at Wave 1 did not predict PTSS under COVID-19 at Wave 1, but both significantly predicted PTSS at Wave 2. Findings implicate potential targets for detecting and intervening on symptoms of trauma in this vulnerable population.
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Affiliation(s)
- Xinli Chi
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Liuyue Huang
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Daniel L. Hall
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Raissa Li
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States
| | - Kaixin Liang
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Md Mahbub Hossain
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Tianyou Guo
- School of Psychology, Shenzhen University, Shenzhen, China
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Abstract
Firefighters are exposed continuously to intense stress situations and traumatic incidents, and are at high risk of developing posttraumatic stress disorder (PTSD). Coping mechanisms and behaviors have been examined as factors contributing to PTSD. The strategies that may be used to cope with stress and/or trauma differ between individuals and also between different professions and traumatic events (). Although there is a vast literature on stress and coping processes that exists, very few studies investigated the way individual firefighters cope with trauma. Among several questionnaires that have been used to examine the effects of different types of coping mechanisms after traumatic incidents is the Albert Einstein College of Medicine-Coping Style Questionnaire (AECOM-CSQ; ). In August 2007, large areas in the Peloponnese, Greece, were devastated by wildfires. One month after the event, experienced researchers visited the affected area to provide psychological support and to investigate the psychosocial consequences among the local professional firefighters. One hundred two firefighters that were on duty for the entire period of firefighting (several days) were interviewed using several questionnaires, among them the AECOM-CSQ. Our hypothesis was that firefighters who presented with PTSD would be more inclined toward engaging in avoidance coping mechanisms. A total of 18.6% of the firefighters were found to have PTSD according to ICD-10 criteria. Logistic regression showed that firefighters using the coping mechanisms of minimization and blame were associated with the greater likelihood of PTSD. It seems that specific coping mechanisms used by firefighters immediately after the traumatic event might contribute to the development of PTSD.
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Carmassi C, Bertelloni CA, Dell'Oste V, Foghi C, Diadema E, Cordone A, Pedrinelli V, Dell'Osso L. Post-traumatic stress burden in a sample of hospitalized patients with Bipolar Disorder: Which impact on clinical correlates and suicidal risk? J Affect Disord 2020; 262:267-272. [PMID: 31732278 DOI: 10.1016/j.jad.2019.10.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/05/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing evidence suggests Bipolar Disorder (BD) to be frequently associated to a history of traumatic experiences and Post-traumatic Stress Disorder (PTSD), with consequent greater symptoms severity, number of hospitalizations and worsening in quality of life. The aim of the present study was to investigate the lifetime exposure to traumatic events and PTSD rates in-patients with BD and to analyze the relationships between PTSD symptoms, clinical characteristics and severity of the mood disorder. METHODS A consecutive sample of 212 in-patients with a DSM-5 diagnosis of BD was enrolled at the psychiatric unit of a major University hospital in Italy and assessed by the SCID-5 and MOOD Spectrum-Self Report lifetime version (MOODS-SR). Socio-demographic characteristics, clinical features, substance or alcohol abuse, history of suicide related behaviors were also collected. RESULTS Lifetime trauma exposure emerged in 72.3% subjects, with a DSM-5 PTSD diagnosis reported by 35.6%. Patients with PTSD showed more frequently a (hypo)manic episode at onset, alcohol or substance abuse, psychotic features, suicide behaviors, higher scores in almost all the MOODS-SR domains, compared to those without PTSD. LIMITATIONS Cross sectional study. Lack of data about the time since trauma exposure or PTSD onset. CONCLUSIONS Our findings show a history of multiple traumatic experiences in hospitalized patients with BD besides high rates of PTSD, with the co-occurrence of these conditions appearing to be related to a more severe BD. Detailed investigation of post-traumatic stress symptoms is recommended for the relevant implications on the choice of a tailored treatment and the prognosis assessment.
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Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy.
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Claudia Foghi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Elisa Diadema
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Annalisa Cordone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100 Pisa, Italy
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McCauley HL, Campbell R, Buchanan NT, Moylan CA. Advancing Theory, Methods, and Dissemination in Sexual Violence Research to Build a More Equitable Future: An Intersectional, Community-Engaged Approach. Violence Against Women 2019; 25:1906-1931. [PMID: 31530103 DOI: 10.1177/1077801219875823] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sexual violence is a devastating trauma with long-lasting effects on survivors' health and well-being. Despite the substantial impacts of the last 25 years of research, the prevalence of sexual violence has remained stable. It will be necessary to reconceptualize our work, challenging our theories, methods, and strategies for dissemination and implementation moving forward. We outline an intersectional, community-engaged approach for sexual violence research to center the stories of survivors who face systemic oppression and inequity. Finally, we suggest applications of this approach for justice, healing, and prevention to inform our collective work to end sexual violence.
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Psarros C, Theleritis C, Kokras N, Lyrakos D, Koborozos A, Kakabakou O, Tzanoulinos G, Katsiki P, Bergiannaki JD. Personality characteristics and individual factors associated with PTSD in firefighters one month after extended wildfires. Nord J Psychiatry 2018; 72:17-23. [PMID: 28871848 DOI: 10.1080/08039488.2017.1368703] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Firefighters participate in activities with intense physical and psychological stress and are constantly at risk to develop various psychopathological reactions. AIMS To investigate psychological reactions in firefighters one month after devastating wildfires in Greece, during August 2007, which lead to the devastation of large areas and the death of 43 people among whom three were firefighters. METHODS One month after the wildfires, a joint task force of mental health clinicians was organized in order to provide psychological support and to investigate the psychological consequences of wildfires to firefighters. One hundred and two firefighters, living within the fire-devastated area, who were on duty for the whole period of wildfires were interviewed and assessed with the use of several questionnaires and inventories. RESULTS Post-traumatic stress disorder (PTSD) was detected in 18.6% of firefighters. Multiple logistic regression found that existence of fear of dying during firefighting, insomnia and increased scores in neuroticism, as well as in depression subscale of the SCL-90, were significantly associated with greater likelihood for having PTSD. Additionally those firefighters who worked permanently had 70% lower probability of having PTSD vs. those seasonally employed. CONCLUSIONS Insomnia, depressive symptoms, as well as personality characteristics as neuroticism and the perception of fear of imminent death during firefighting operations may precipitate the development of PTSD in firefighters. Within this context, mental health clinicians should be aware that the early detection of these predisposing factors may facilitate the prevention and mitigation of PTSD in firefighters particularly those who are seasonally employed.
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Affiliation(s)
- Constantin Psarros
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Christos Theleritis
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Nikolaos Kokras
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Dimitris Lyrakos
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Angelos Koborozos
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Olga Kakabakou
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Georgios Tzanoulinos
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Panagiota Katsiki
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece
| | - Joanna Despoina Bergiannaki
- a 1st Department of Psychiatry , National and Kapodistrian University of Athens, Eginition Hospital , Athens , Greece.,b University Mental Health Research Institute (UMHRI) , Athens , Greece
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Miller ML, Brock RL. The effect of trauma on the severity of obsessive-compulsive spectrum symptoms: A meta-analysis. J Anxiety Disord 2017; 47:29-44. [PMID: 28242410 DOI: 10.1016/j.janxdis.2017.02.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 01/27/2023]
Abstract
It is important to consider trauma-related sequelae in the etiology and maintenance of psychopathology, namely understudied disorders such as those belonging to the Obsessive-Compulsive Spectrum (OCS). This meta-analysis examined the association between past trauma exposure and current severity of OCS disorder symptoms. A systematic literature search was conducted with 24 (N=4557) articles meeting inclusion criteria. A significant overall effect size was obtained (r=0.20), indicating that exposure to past trauma is associated with a higher severity of OCS symptoms, with a stronger association for females (β=0.01, p<.001) but not varying as a function of relationship status. Four types of interpersonal trauma (violence, emotional abuse, sexual abuse, and neglect) were associated with OCS symptom severity (r=0.19 -0.24) and past trauma was significantly associated with more severe compulsions (r=0.17), but not obsessions. Results suggest an important link between multiple types of past trauma exposure and OCS symptoms.
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Gobin RL, Freyd J. Do Participants Detect Sexual Abuse Depicted in a Drawing? Investigating the Impact of Betrayal Trauma Exposure on State Dissociation and Betrayal Awareness. JOURNAL OF CHILD SEXUAL ABUSE 2017; 26:233-245. [PMID: 28471335 DOI: 10.1080/10538712.2017.1283650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An inability to identify betrayal may increase risk for victimization. Harm perpetrated by close others early in life may impair the ability to identify betrayal and develop trust. Dissociation may facilitate impaired betrayal awareness. The present study examined the impact of high betrayal trauma on state dissociation and betrayal awareness in a college sample (N = 216). Self-report measures were used to assess trauma history and state dissociation. Awareness for betrayal was measured using a drawing depicting an ambiguous interpersonal interaction between an adult and a child. We hypothesized that high betrayal trauma would be associated with both more state dissociation and lower awareness for betrayal. Participants with histories of high betrayal trauma reported high levels of state dissociation. Contrary to our second hypothesis, high betrayal trauma did not directly predict impaired betrayal awareness. State dissociation contributed significantly to betrayal awareness. Implications of findings for theory and practice are discussed.
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Affiliation(s)
- Robyn L Gobin
- a Department of Psychology , University of Oregon , Eugene , Oregon , USA
| | - Jennifer Freyd
- a Department of Psychology , University of Oregon , Eugene , Oregon , USA
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Thompson-Hollands J, Jun JJ, Sloan DM. The Association Between Peritraumatic Dissociation and PTSD Symptoms: The Mediating Role of Negative Beliefs About the Self. J Trauma Stress 2017; 30:190-194. [PMID: 28449364 PMCID: PMC5793871 DOI: 10.1002/jts.22179] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 01/19/2017] [Accepted: 01/25/2017] [Indexed: 11/10/2022]
Abstract
Peritraumatic dissociation, a term used to describe a complex array of reactions to trauma, including depersonalization, derealization, and emotional numbness, has been associated with posttraumatic stress disorder (PTSD) symptoms across a number of studies. Cognitive theory suggests that interpretations of traumatic events and reactions underlie the persistence of PTSD. The present study examined the associations among peritraumatic dissociation, posttraumatic cognitions, and PTSD symptoms in a group of trauma-exposed adults (N = 169). Results indicated that, after accounting for overall symptom severity and current dissociative tendencies, peritraumatic dissociation was significantly predictive of negative beliefs about the self (R2 = .06, p < .001). Other categories of maladaptive posttraumatic cognitions did not show a similar relationship (R2 = .01 to .02, nonsignificant). Negative thoughts about the self partially mediated the association between peritraumatic dissociation and PTSD severity (completely standardized indirect effect = .25). These findings lend support to cognitive theories of PTSD and point to an important area for clinical intervention.
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Affiliation(s)
- Johanna Thompson-Hollands
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Janie J. Jun
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Denise M. Sloan
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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15
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Peltonen K, Kangaslampi S, Saranpää J, Qouta S, Punamäki RL. Peritraumatic dissociation predicts posttraumatic stress disorder symptoms via dysfunctional trauma-related memory among war-affected children. Eur J Psychotraumatol 2017; 8:1375828. [PMID: 29209466 PMCID: PMC5706949 DOI: 10.1080/20008198.2017.1375828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/18/2017] [Indexed: 10/31/2022] Open
Abstract
Background: Among adults there is strong evidence about peritraumatic dissociation (PD) predicting posttraumatic stress disorder (PTSD), yet evidence among children is very limited. It has been suggested that disturbances in memory functioning might explain the association between PD and PTSD, but this has not yet been empirically tested. Objective: We aimed to test the hypotheses that greater PD would be associated with more posttraumatic stress disorder (PTSD) symptoms, and that some of this association would be mediated by disorganized and non-verbal memories about the traumatic event. Method: The sample included 197 Palestinian children (10-12-years) living in the Gaza Strip, participating in the aftermath of the 2008/9 war. Self-report questionnaires were used to measure PD (Peritraumatic Dissociative Experiences Questionnaire) three months post-war, as well as trauma-related memory (Trauma Memory Quality Questionnaire) and PTSD symptoms (Children's Revised Impact of Event Scale) six months later. Exposure to war trauma was assessed by a checklist. Structural equation modelling was used to examine direct and indirect paths from PD to posttraumatic PTSS, controlling for number of traumatic war events. Results: Structural equation modelling results showed that greater self-reported PD predicted higher levels of PTSS nine months post-war, and that a significant part, but not all, of this relationship was mediated via the quality of trauma-related memories. Conclusions: This study provided empirical evidence that, among war-affected children, greater PD during traumatic events is linked with higher levels of PTSD symptoms several months later, even when accounting for their personal exposure to war trauma. Further, the study supported the idea that the detrimental effects of dissociation during a traumatic event may be due to dysfunctional memories characterized by disorganization and lack of access to verbal and coherence. Further tests of these hypotheses with larger samples and more points of measurement are called for.
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Affiliation(s)
- Kirsi Peltonen
- University of Tampere, Finland/Faculty of Social Sciences/Psychology, Tampere, Finland
| | - Samuli Kangaslampi
- University of Tampere, Finland/Faculty of Social Sciences/Psychology, Tampere, Finland
| | - Jenni Saranpää
- Lapua Developmental and Family Counselling, Lapua, Finland
| | - Samir Qouta
- Islamic University of Gaza, Department of Education and Psychology, Gaza
| | - Raija-Leena Punamäki
- University of Tampere, Finland/Faculty of Social Sciences/Psychology, Tampere, Finland
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Măirean C, Ceobanu CM. The relationship between suppression and subsequent intrusions: the mediating role of peritraumatic dissociation and anxiety. ANXIETY STRESS AND COPING 2016; 30:304-316. [PMID: 27873541 DOI: 10.1080/10615806.2016.1263839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Although previous studies showed that thought and emotion suppression represent risk factors for intrusions development, the mechanisms that explain these relations were less explored. This study aims to examine the relationships between thought and emotion suppression and the symptoms of intrusion following the exposure to a trauma-related event. Moreover, we explored if these relationships would be mediated by peritraumatic state dissociation and state anxiety. DESIGN AND METHODS The trauma film paradigm was used and the participants were students (N = 148) experimentally exposed to an aversive film to model a traumatic experience. Thought and emotion suppression were measured before the trauma exposure. After exposure, the participants completed scales for measuring state dissociation and state anxiety. Intrusive images and thoughts of the film were recorded in the subsequent week using an intrusion diary. RESULTS Thought suppression predicted intrusive thoughts frequency, and this effect was mediated by the peritraumatic anxiety. State anxiety predicted both intrusive images and thoughts, while state dissociation only predicted intrusive images. CONCLUSIONS Intrusive images and intrusive thoughts are different phenomena and they are predicted by different variables. The practical implications of these results for posttraumatic stress disorder treatment and secondary traumatization are discussed.
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Affiliation(s)
- Cornelia Măirean
- a Faculty of Psychology and Education Sciences, Psychology Department , Alexandru Ioan Cuza University of Iasi , Iasi , Romania
| | - Ciprian Marius Ceobanu
- a Faculty of Psychology and Education Sciences, Psychology Department , Alexandru Ioan Cuza University of Iasi , Iasi , Romania
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Zoladz PR, Diamond DM. Predator-based psychosocial stress animal model of PTSD: Preclinical assessment of traumatic stress at cognitive, hormonal, pharmacological, cardiovascular and epigenetic levels of analysis. Exp Neurol 2016; 284:211-219. [PMID: 27283115 DOI: 10.1016/j.expneurol.2016.06.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/27/2016] [Accepted: 06/03/2016] [Indexed: 01/10/2023]
Abstract
Research on post-traumatic stress disorder (PTSD) is faced with the challenge of understanding how a traumatic experience produces long-lasting detrimental effects on behavior and brain functioning, and more globally, how stress exacerbates somatic disorders, including cardiovascular disease. Moreover, the design of translational research needs to link animal models of PTSD to clinically relevant risk factors which address why only a subset of traumatized individuals develop persistent psychopathology. In this review, we have summarized our psychosocial stress rodent model of PTSD which is based on well-described PTSD-inducing risk factors, including a life-threatening experience, a sense of horror and uncontrollability, and insufficient social support. Specifically, our animal model of PTSD integrates acute episodes of inescapable exposure of immobilized rats to a predator with chronic daily social instability. This stress regimen produces PTSD-like effects in rats at behavioral, cognitive, physiological, pharmacological and epigenetic levels of analysis. We have discussed a recent extension of our animal model of PTSD in which stress exacerbated coronary pathology following an ischemic event, assessed in vitro. In addition, we have reviewed our research investigating pharmacological and non-pharmacological therapeutic strategies which may have value in clinical approaches toward the treatment of traumatized people. Overall, our translational approach bridges the gap between human and animal PTSD research to create a framework with which to enhance our understanding of the biological basis of trauma-induced pathology and to assess therapeutic approaches in the treatment of psychopathology.
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Affiliation(s)
- Phillip R Zoladz
- Department of Psychology, Sociology, & Criminal Justice, Ohio Northern University, 525 S. Main St., Ada, OH 45810, USA
| | - David M Diamond
- Department of Psychology, University of South Florida, 4202 E. Fowler Ave., Tampa, FL 33620, USA; Department of Molecular Pharmacology & Physiology, University of South Florida, 4202 E. Fowler Ave., Tampa, FL 33620, USA; Center for Preclinical & Clinical Research on PTSD, University of South Florida, 4202 E. Fowler Ave., Tampa, FL 33620, USA.
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Regambal MJ, Alden LE, Wagner SL, Harder HG, Koch WJ, Fung K, Parsons C. Characteristics of the traumatic stressors experienced by rural first responders. J Anxiety Disord 2015; 34:86-93. [PMID: 26188614 DOI: 10.1016/j.janxdis.2015.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 06/12/2015] [Accepted: 06/15/2015] [Indexed: 11/25/2022]
Abstract
First responders routinely experience work-related events that meet the definition of a traumatic stressor. Despite the high exposure to traumatic events, prevalence rates of posttraumatic stress disorder (PTSD) are relatively low. This discrepancy points to the potential value of identifying factors that distinguish those traumatic stressors that produce ongoing traumatic stress symptoms from those that do not. The present study surveyed 181 first responders from rural settings. A repeated-measures design was used to compare characteristics of traumatic stressors that were or were not associated with ongoing PTSD symptoms. A factor analysis revealed that distressing events were characterized by chaos and resource limitations. Consistent with contemporary models, two mediational analyses revealed that each event characteristic predicted peritraumatic dissociation and posttraumatic cognitions, which in turn predicted PTSD symptoms. Moreover, the effect of each event characteristic on PTSD symptoms was partially mediated by these cognitive processes.
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Affiliation(s)
- Marci J Regambal
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4
| | - Lynn E Alden
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4.
| | - Shannon L Wagner
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, Canada V2N 4Z9
| | - Henry G Harder
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, British Columbia, Canada V2N 4Z9
| | - William J Koch
- Department of Psychiatry, University of British Columbia, Detwiller Pavilion, 2255 Westbrook Mall, Vancouver, British Columbia, Canada V6T 2A1
| | - Klint Fung
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4
| | - Carly Parsons
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, Canada V6T 1Z4
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Pyszczynski T, Solomon S, Greenberg J. Thirty Years of Terror Management Theory. ADVANCES IN EXPERIMENTAL SOCIAL PSYCHOLOGY 2015. [DOI: 10.1016/bs.aesp.2015.03.001] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Soenke M, Greenberg J, Focella ES. Remembering the initial realization of one's own mortality. DEATH STUDIES 2014; 38:648-653. [PMID: 24611566 DOI: 10.1080/07481187.2013.837990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Research shows many effects of reminding people of their mortality; however, little is known about whether people recall the moment they first realized they will die, or what factors are associated with whether they do. Data from 1,552 undergraduates and a community sample of 149 adults found that about one third of participants reported remembering the moment. Individuals who recall the moment have slightly lower self-esteem, are more likely to believe in a soul, and are more prone to dissociation than those who do not. Further research into how recollection of the moment relates to psychological well-being is recommended.
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Affiliation(s)
- Melissa Soenke
- a Department of Psychology , University of Arizona , Tucson , Arizona , USA
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21
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Dell'osso L, Stratta P, Conversano C, Massimetti E, Akiskal KK, Akiskal HS, Rossi A, Carmassi C. Lifetime mania is related to post-traumatic stress symptoms in high school students exposed to the 2009 L'Aquila earthquake. Compr Psychiatry 2014; 55:357-62. [PMID: 24269194 DOI: 10.1016/j.comppsych.2013.08.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/18/2013] [Accepted: 08/04/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Bipolar patients seem to be at high risk of trauma exposure and, when exposed, of PTSD. When comorbid, PTSD has shown a negative impact on the course of the bipolar illness. Conversely, a correlation between even manic symptoms and an increased risk for suicide has also been reported in PTSD patients. The aim of this study was to investigate the relationships between lifetime mood spectrum symptoms and PTSD in a sample of earthquake survivors. METHODS A total of 475 young adults who survived the L'Aquila 2009 earthquake, 21months earlier, were assessed by the Moods Spectrum-Self Report (MOODS-SR) and the Trauma and Loss Spectrum Self Report (TALS-SR). RESULTS Significantly higher MOODS-SR and TALS-SR domain scores were found in PTSD survivors compared to those without. The mood depressive (O.R.=1.17, 95% CI: 1.10-1.25), cognition depressive (O.R.=1.07, 95% CI: 1.01-1.14) and energy manic (O.R.=1.13, 95% CI: 1.02-1.25) MOODS-SR domains were significantly associated with an increased likelihood of PTSD. CONCLUSIONS Our data corroborate the strong relationship between mood disorder and PTSD highlighting a relationship between lifetime depressive and manic symptoms and PTSD, with a particular impact of the latter on the number of traumatic exposures and maladaptive behaviors.
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Affiliation(s)
- Liliana Dell'osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Stratta
- Section of Psychiatry, Department of Experimental Medicine, University of L'Aquila, Italy, L'Aquila, Italy
| | - Ciro Conversano
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Massimetti
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Kareen K Akiskal
- International Mood Center, University of California, San Diego, CA, USA
| | - Hagop S Akiskal
- International Mood Center, University of California, San Diego, CA, USA
| | - Alessandro Rossi
- Section of Psychiatry, Department of Experimental Medicine, University of L'Aquila, Italy, L'Aquila, Italy
| | - Claudia Carmassi
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
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Abstract
Fundamental aspects of trauma--among them dissociation during trauma, which is considered one of the strongest predictors of posttraumatic stress disorder-are not fully understood. This article argues that the application of the phenomenological structure of time and the phenomenological description of the self (minimal self, sense of ownership, sense of agency, sense of self) to dissociation during trauma can improve our understanding of this phenomenon-at its occurrence and during any possible ensuing symptoms. In addition, it is argued that the phenomenological approach, as a method that focuses on the bodily level of experience, in particular the body as it is experienced from within, enables us to penetrate the traumatic experience. Thus, by applying the phenomenological approach we may be able to improve our understanding of the traumatic experience and enable the development of better treatment.
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Affiliation(s)
- Yochai Ataria
- a Program for the History, Philosophy and Sociology of Science , The Hebrew University of Jerusalem , Jerusalem , Israel
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23
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Price CJ, Herting JR. Changes in post traumatic stress symptoms among women in substance use disorder treatment: the mediating role of bodily dissociation and emotion regulation. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2013; 7:147-53. [PMID: 24092984 PMCID: PMC3782396 DOI: 10.4137/sart.s12426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Individuals in substance use disorder (SUD) treatment have shown high levels of difficulty with emotion regulation, as well as a high prevalence of reported trauma and symptoms of post-traumatic stress (PTS). Dissociation from the body is a common clinical experience among women with a history of sexual trauma. Research has shown promising effects of mind-body approaches in SUD treatment, as well as the importance of emotional regulation in conceptual models of psychopathology. The current study examines the mediating role of bodily dissociation and emotion regulation on PTS symptoms in a sample of women enrolled in substance use disorder treatment. Results indicate that bodily dissociation and emotion regulation had significant direct effects on PTS symptoms from baseline to a 6-month follow-up, and that bodily dissociation also may indirectly operate to reduce PTS symptoms through its effect on emotion regulation difficulties. These results suggest the importance of addressing bodily dissociation and emotion regulation difficulties in women’s substance use disorder treatment.
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Affiliation(s)
- Cynthia J Price
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
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24
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Gibney S, Martens A, Kosloff S, Dorahy MJ. Examining the Impact of Obedient Killing on Peritraumatic Dissociation Using a Bug-Killing Paradigm. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2013. [DOI: 10.1521/jscp.2013.32.3.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Agorastos A, Nash WP, Nunnink S, Yurgil KA, Goldsmith A, Litz BT, Johnson H, Lohr JB, Baker DG. The Peritraumatic Behavior Questionnaire: development and initial validation of a new measure for combat-related peritraumatic reactions. BMC Psychiatry 2013; 13:9. [PMID: 23289606 PMCID: PMC3598773 DOI: 10.1186/1471-244x-13-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/02/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is one of the most commonly observed stress-related conditions following combat exposure and its effective prevention is a high health-care priority. Reports of peritraumatic reactions have been shown to be highly associated with PTSD among combat exposed service members. However, existing instruments measuring peritraumatic symptoms were not specifically developed to assess combat-related peritraumatic stress and each demonstrates a different peritraumatic focus. We therefore developed the Peritraumatic Behavior Questionnaire (PBQ), a new military-specific rating scale focused upon the wide range of symptoms suggestive of combat-related peritraumatic distress in actively deployed Service Members. This study describes the development of the PBQ and reports on the psychometric properties of its self-rated version (PBQ-SR). METHODS 688 Marine infantry service members were retrospectively assessed by the PBQ-SR within the scope of the Marine Resiliency Study after their deployment to war zone. Participants have been additionally assessed by a variety of questionnaires, as well as clinical interviews both pre and post-deployment. RESULTS The PBQ-SR demonstrated satisfactory internal consistency, convergent and discriminant validity, as well as high correlation with trait dissociation prior to deployment. Component analysis suggested a latent bi-dimensional structure separating a peritraumatic emotional distress and physical awareness factor. The PBQ-SR total score showed high correlation to general anxiety, depression, poorer general health and posttraumatic symptoms after deployment and remained a significant predictor of PTSD severity, after controlling for those measures. The suggested screening cut-off score of 12 points demonstrated satisfactory predictive power. CONCLUSIONS This study confirms the ability of the PBQ-SR to unify the underlying peritraumatic symptom dimensions and reliably assess combat-related peritraumatic reaction as a general construct. The PBQ-SR demonstrated promise as a potential standard screening measure in military clinical practice, while It's predictive power should be established in prospective studies.
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Affiliation(s)
- Agorastos Agorastos
- Veterans Affairs Center of Excellence for Stress and Mental Health, VA San Diego, CA, USA
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - William P Nash
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sarah Nunnink
- Veterans Affairs Center of Excellence for Stress and Mental Health, VA San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Abigail Goldsmith
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Brett T Litz
- Department of Psychiatry and Department of Psychology, Boston University School of Medicine, Boston, MA, USA
- National Center for Post Traumatic Stress Disorder, VA Boston Healthcare System, Boston, MA, USA
| | | | - James B Lohr
- Veterans Affairs Center of Excellence for Stress and Mental Health, VA San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Dewleen G Baker
- Veterans Affairs Center of Excellence for Stress and Mental Health, VA San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0603V), 92093-0603V, La Jolla, CA, USA
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Basu A, Levendosky AA, Lonstein JS. Trauma sequelae and cortisol levels in women exposed to intimate partner violence. Psychodyn Psychiatry 2013; 41:247-275. [PMID: 23713620 DOI: 10.1521/pdps.2013.41.2.247] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Intimate partner violence (IPV) is often a chronic form of trauma with deleterious mental health problems. Furthermore, IPV survivors have also often experienced trauma in childhood. Consequently, by examining a sample of IPV survivors, this study sought to assess typical trauma sequelae--Posttraumatic Stress Disorder (PTSD), Major Depressive Disorder (MDD), or dissociative symptoms-and trauma-related characteristics consistent with Herman's Trauma theory (1992; i.e., chronicity of trauma, age of first trauma exposure, and social support), in relation to hypothalamic-pituitary-adrenal axis function. The study compared basal and diurnal cortisol in women (n = 88) based on diagnostic status and symptom severity (PTSD [n = 14], PTSD and comorbid MDD [n = 43], subthreshold symptoms of PTSD and MDD [n = 19]), dissociative symptoms, and the aforementioned trauma-related characteristics to a matched control group (n = 12) without any lifetime history of mental health diagnoses or exposure to interpersonal trauma. Regardless of their diagnostic status and trauma-related characteristics, trauma-exposed women had higher levels of dissociative symptoms relative to women in the control group, and these dissociative symptoms were inversely related to awakening cortisol levels. Findings suggest that low cortisol levels may not be a diagnostic marker, but instead may be associated with a dissociative coping style developed in the context of trauma exposure, consistent with mechanisms posited by Trauma theory.
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Bedard-Gilligan M, Zoellner LA. Dissociation and memory fragmentation in post-traumatic stress disorder: an evaluation of the dissociative encoding hypothesis. Memory 2012; 20:277-99. [PMID: 22348400 DOI: 10.1080/09658211.2012.655747] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Several prominent theories of post-traumatic stress disorder (PTSD) posit that peritraumatic dissociation results in insufficient encoding of the trauma memory and that persistent dissociation prevents memory elaboration, resulting in memory fragmentation and PTSD. In this review we summarise the empirical literature on peritraumatic and trait dissociation and trauma narrative fragmentation as measured by meta-memory and rater/objective coding. Across 16 studies to date, the association between dissociation and fragmentation was most prominent when examining peritraumatic dissociation and patient's own ratings of memory fragmentation. This relationship did not hold when examining trait dissociation or rater-coded or computer-generated measures of fragmentation. Thus initial evidence points more towards a strong self-reported association between constructs that is not supported on more objective fragmentation coding. Measurement overlap, construct ambiguity, and exclusion of potential confounds may underlie lack of a strong association between dissociation and objective-rated fragmentation.
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Affiliation(s)
- Michele Bedard-Gilligan
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA 98195, USA.
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Kesebir P, Luszczynska A, Pyszczynski T, Benight C. Posttraumatic Stress Disorder Involves Disrupted Anxiety-Buffer Mechanisms. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2011. [DOI: 10.1521/jscp.2011.30.8.819] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Factors related to posttraumatic stress symptoms in women experiencing police-involved intimate partner violence. ANS Adv Nurs Sci 2011; 34:E14-28. [PMID: 21822067 DOI: 10.1097/ans.0b013e318227241d] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Relationships among intimate partner violence (IPV), Post Traumatic Stress Disorder (PTSD) symptoms, health, and danger, using M.A. Dutton's Empowerment framework, were examined among 423 ethnically diverse women in contact with police due to IPV. Significant predictors of PTSD symptoms in multivariate analysis included Danger Assessment score, poor overall health, abuse leading to pain, victim expectations of future injury victimization, feeling unsafe, and shame. Results provide further evidence supporting routine assessment for violent trauma and PTSD as well as the need for research testing holistic interventions for women traumatized by violence.
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Pacella ML, Irish L, Ostrowski SA, Sledjeski E, Ciesla JA, Fallon W, Spoonster E, Delahanty DL. Avoidant coping as a mediator between peritraumatic dissociation and posttraumatic stress disorder symptoms. J Trauma Stress 2011; 24:317-25. [PMID: 21618289 PMCID: PMC4388133 DOI: 10.1002/jts.20641] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peritraumatic dissociation consistently predicts posttraumatic stress disorder (PTSD). Avoidant coping may serve as a mechanism through which peritraumatic dissociation contributes to PTSD symptoms. Path analysis was used to examine whether avoidant coping assessed 6 weeks following a motor vehicle accident mediated the relationship between in-hospital peritraumatic dissociation and 6-month (n = 193) and 12-month (n = 167) chronic PTSD symptoms. Results revealed that, after controlling for age, gender, depression, and 6-week PTSD symptoms, avoidant coping remained a partial mediator between peritraumatic dissociation and chronic PTSD symptoms 6- and 12-months postaccident. Post-hoc multigroup analyses suggested that at 6-months posttrauma, the mediation was significant in women, but not in men. Gender-specific results were not significant at 12-months posttrauma. Interventions targeted at reducing avoidant coping in high dissociators may aid in reducing PTSD symptoms.
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Affiliation(s)
| | - Leah Irish
- Kent State University, Department of Psychology, Kent, Ohio
| | - Sarah A. Ostrowski
- Western Kentucky University, Department of Psychology, Bowling Green, Kentucky
| | - Eve Sledjeski
- Rowan University, Department of Psychology, Glassboro, New Jersey
| | | | - William Fallon
- Summa Health System, Emergency/Trauma Services, Akron, Ohio
| | | | - Douglas L. Delahanty
- Kent State University, Department of Psychology, Kent, Ohio,Northeastern Ohio Universities College of Medicine (NEOUCOM), Department of Psychology in Psychiatry, Rootstown, Ohio
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31
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Peritraumatic dissociation mediates the relationship between acute panic and chronic posttraumatic stress disorder. Behav Res Ther 2011; 49:346-51. [DOI: 10.1016/j.brat.2011.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 01/18/2011] [Accepted: 03/08/2011] [Indexed: 11/19/2022]
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32
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Hodgson RC, Webster RA. Mediating role of peritraumatic dissociation and depression on post-MVA distress: path analysis. Depress Anxiety 2011; 28:218-26. [PMID: 21328635 DOI: 10.1002/da.20774] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/09/2010] [Accepted: 10/23/2010] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the role of pre-trauma, traumatic event, and peri-traumatic psychological characteristics on post-motor vehicle accident (MVA) Posttraumatic Stress Disorder (PTSD) and depression. METHODS The sample comprised 333 (54% female) hospital accident and emergency attendees who completed a self-report postal screening survey approximately 1-month post-accident and 128 (62% female) participants who completed a follow-up survey at 3-months. RESULTS Path analysis (Model 1) showed that dissociation partially mediated the relationship between past emotional problems and initial post-MVA distress, as well as between fear of dying and levels of distress. Level of alertness and perceived accident severity had no direct effects on post-MVA distress. However, higher levels of exposure contributed to distress predominantly in the presence of high levels of fear and subsequent dissociative experiences. When ongoing PTSD and depression symptoms were included (Model 2), feeling depressed/sad at 1-month was the strongest predictor of both PTSD and depression symptom severity at 3-months post-MVA, explaining 53% and 40% of the variance, respectively. Dissociation remained an important mediating variable at both time points. CONCLUSIONS These models show the influence of previous emotional vulnerability factors and the important mediating role of peri-traumatic experiences (in the presence of fear due to increased levels of accident severity) on post-MVA morbidity. Additionally, MVA survivors who report feeling depressed/sad 1-month after their accident are at greater risk of developing both PTSD and depression.
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Affiliation(s)
- Robert C Hodgson
- School of Psychology, University of Newcastle, Callaghan, New South Wales 2308, Australia
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Finucane AM, Dima A, Ferreira N, Halvorsen M. Basic emotion profiles in healthy, chronic pain, depressed and PTSD individuals. Clin Psychol Psychother 2011; 19:14-24. [PMID: 21243706 DOI: 10.1002/cpp.733] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To compare self-reports of five basic emotions across four samples: healthy, chronic pain, depressed and post-traumatic stress disorder (PTSD), and to investigate the extent to which basic emotion reports discriminate between individuals in healthy or clinical groups. METHODS In total, 439 participants took part in this study: healthy (n = 131), chronic pain (n = 220), depressed (n = 24) and PTSD (n = 64). The participants completed the trait version of the Basic Emotion Scale. Basic emotion profiles were compared both within each group and between the healthy group and each of the three other groups. Discriminant analysis was used to assess the extent to which basic emotions can be used to classify the participants as belonging to the healthy group or one of the clinical groups. RESULTS In the healthy group, happiness was experienced more than any other basic emotion. This was not found in the clinical groups. In comparison to the healthy participants, the chronic pain group experienced more fear, anger and sadness, the depressed group reported more sadness and the PTSD group experienced all of the negative emotions more frequently. Discriminant analysis revealed that happiness was the most important variable in determining whether an individual belonged to the healthy group or one of the clinical groups. Anger was found to further discriminate between depressed and chronic pain individuals. CONCLUSION The findings demonstrate that basic emotion profile analysis can provide a useful foundation for the exploration of emotional experience both within and between healthy and clinical groups.
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Affiliation(s)
- Anne M Finucane
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK.
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Kosloff S, Solomon S, Greenberg J, Cohen F, Gershuny B, Routledge C, Pyszczynski T. Fatal Distraction: The Impact of Mortality Salience on Dissociative Responses to 9/11 and Subsequent Anxiety Sensitivity. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2010. [DOI: 10.1207/s15324834basp2804_8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Landa H, Gimenez G. Le trauma et l’émotion : apports de la théorie janetienne et perspectives nouvelles. EVOLUTION PSYCHIATRIQUE 2009. [DOI: 10.1016/j.evopsy.2009.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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La dissociation : un concept central dans la compréhension du traumatisme. EVOLUTION PSYCHIATRIQUE 2009. [DOI: 10.1016/j.evopsy.2009.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dissociation versus posttraumatic stress: cortisol and physiological correlates in adults highly exposed to the World Trade Center attack on 9/11. Psychiatry Res 2008; 161:325-9. [PMID: 18930323 DOI: 10.1016/j.psychres.2008.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 04/07/2008] [Accepted: 04/22/2008] [Indexed: 11/24/2022]
Abstract
Nine months on average after the World Trade Center (WTC) attack, 21 highly exposed adults and 10 healthy controls without major exposure did not differ in cortisol and physiologic measures. Dissociation and posttraumatic stress symptoms were quantified in the exposed group. Dissociation was associated with greater peritraumatic dissociation and, marginally, childhood trauma, lower plasma cortisol levels at 08.00h, and blunted heart rate reactivity to psychosocial stress. Posttraumatic stress was associated with exposure, peritraumatic distress, and early posttraumatic stress, and marginally associated with peritraumatic dissociation; it was not associated with cortisol or physiologic measures. Urinary cortisol differed significantly in its relationship to dissociation versus posttraumatic stress. This small study emphasizes the importance of dissecting the neurobiology of posttraumatic stress versus dissociative traumatic responses.
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Hagenaars MA, van Minnen A, Holmes EA, Brewin CR, Hoogduin KAL. The effect of hypnotically induced somatoform dissociation on the development of intrusions after an aversive film. Cogn Emot 2008. [DOI: 10.1080/02699930701575151] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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39
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Relations among peritraumatic dissociation and posttraumatic stress: a meta-analysis. Clin Psychol Rev 2008; 28:1138-51. [PMID: 18502549 DOI: 10.1016/j.cpr.2008.03.006] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 03/19/2008] [Accepted: 03/19/2008] [Indexed: 01/11/2023]
Abstract
A meta-analysis was performed on the empirical literature which addressed the relationship of peritraumatic dissociation to posttraumatic stress (PTS). Extensive literature searches were conducted to identify as many relevant studies as possible, and revealed 59 independent eligible studies. All studies were coded using a detailed code sheet that included effect measures, variables that indicated the methodological quality of the studies, and substantial variables that might theoretically affect the relationship between peritraumatic dissociation and PTS. A significant positive relation between peritraumatic dissociation and PTS was found. Differences in the methodological rigor between studies - time elapsed since peritraumatic dissociation, design, sample type, and study type - significantly and sufficiently explained the variability in effect sizes between studies. Theoretical variables did not explain such variability. Although results underline earlier findings, due to designs of the reviewed studies no conclusions could be drawn as to causal relations between peritraumatic dissociation and PTS.
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40
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van der Hart O, van Ochten JM, van Son MJM, Steele K, Lensvelt-Mulders G. Relations among peritraumatic dissociation and posttraumatic stress: a critical review. J Trauma Dissociation 2008; 9:481-505. [PMID: 19042793 DOI: 10.1080/15299730802223362] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This paper critically reviews the empirical literature addressing the relationship of peritraumatic dissociation to posttraumatic stress. PSYCHLIT and MEDLINE literature searches were conducted to identify relevant studies. The list of articles generated was supplemented by a review of their bibliographies, which resulted in a total of 53 empirical studies. These studies were classified according to the type of potentially traumatizing event investigated and discussed. In the majority of studies, evidence was found for a positive association between peritraumatic dissociation and posttraumatic stress. However, research in this area is limited by several methodological differences and shortcomings with respect to study design, sample characteristics, measurement instruments, and control for moderating or mediating variables. In addition, research is also limited by conceptual problems and the lack of specific time parameters for the occurrence of peritraumatic dissociation. The literature is evaluated according to these methodological differences or shortcomings, and directions for future research are provided.
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Affiliation(s)
- Onno van der Hart
- Department of Clinical and Health Psychology, Utrecht University, The Netherlands.
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41
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Keane TM, Marshall AD, Taft CT. Posttraumatic stress disorder: etiology, epidemiology, and treatment outcome. Annu Rev Clin Psychol 2007; 2:161-97. [PMID: 17716068 DOI: 10.1146/annurev.clinpsy.2.022305.095305] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Posttraumatic stress disorder (PTSD) results from exposure to a traumatic event that poses actual or threatened death or injury and produces intense fear, helplessness, or horror. U.S. population surveys reveal lifetime PTSD prevalence rates of 7% to 8%. Potential reasons for varying prevalence rates across gender, cultures, and samples exposed to different traumas are discussed. Drawing upon a conditioning model of PTSD, we review risk factors for PTSD, including pre-existing individual-based factors, features of the traumatic event, and posttrauma social support. Characteristics of the trauma, particularly peritraumatic response and related cognitions, and posttrauma social support appear to confer the greatest risk for PTSD. Further work is needed to disentangle the interrelationships among these factors and elucidate the underlying mechanisms. Based upon existing treatment outcome studies, we recommend use of exposure therapies and anxiety management training as first-line treatment for PTSD. Among psychopharmacological treatments, selective serotonin reuptake inhibitors evidence the strongest treatment effects, yet these effects are modest compared with psychological treatments.
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Affiliation(s)
- Terence M Keane
- VA Boston Healthcare System, Boston University School of Medicine, Boston, Massachusetts 02130, USA.
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42
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Abstract
Dissociative symptoms and abnormalities in pain perception have been associated with a range of disorders. The authors tested whether experimentally induced increases in state dissociation would cause an analgesic response. Participants (N = 120) were randomized to a dissociation induction condition via audiophotic stimulation or a credible control condition and were compared on pre- and postchanges in subjective pain and immersion time in response to a standard cold pressor test. Unexpectedly, the dissociation induction led to small, but significant increases in subjective pain and did not lead to greater immersion time. An exploratory analysis revealed that increases in absorption and derealization significantly predicted increased subjective pain and increased immersion time, respectively.
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Affiliation(s)
- Jonathan D Horowitz
- Laboratory for Study of Anxiety Disorders, University of Texas at Austin, Austin, TX 78712-0187, USA
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43
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Abstract
Peritraumatic dissociation, and other dissociative reactions, refer to alterations in awareness in the context of a traumatic experience. This review provides an overview of the current conceptualization of dissociation, critiques methodological approaches to studying dissociation, and reviews the evidence for the purported relationship between dissociative reactions and posttraumatic stress disorder. The evidence challenges the notion that a linear relationship exists between dissociation and psychiatric morbidity. Future research should abandon the global construct of dissociation, and study the specific responses that involve altered awareness under experimental conditions.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, NSW 2052, Australia.
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Fikretoglu D, Brunet A, Best SR, Metzler TJ, Delucchi K, Weiss DS, Fagan J, Liberman A, Marmar CR. Peritraumatic fear, helplessness and horror and peritraumatic dissociation: Do physical and cognitive symptoms of panic mediate the relationship between the two? Behav Res Ther 2007; 45:39-47. [PMID: 16516845 DOI: 10.1016/j.brat.2006.01.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 12/30/2005] [Accepted: 01/19/2006] [Indexed: 11/22/2022]
Abstract
The goal of this study was to examine whether panic mediates the relationship between fear, helplessness, and horror (PTSD criterion A2) and dissociation at the time of trauma. The study sample included 709 police officers and 317 peer-nominated civilians who had been exposed to a variety of critical incidents. Participants filled out measures of critical incident exposure, PTSD criterion A2, panic, and dissociation. Results indicate that together, physical and cognitive symptoms of panic completely mediate the relationship between criterion A2 and dissociation in civilians, and partially mediate that relationship in police. These results provide support for the idea that panic mediates the relationship between fear, helplessness, and horror (criterion A2) and dissociation at the time of trauma. The results also raise the possibility, however, that the mediational role of panic may be further moderated by additional variables.
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Affiliation(s)
- Deniz Fikretoglu
- Douglas Hospital Research Center, McGill University, Montreal, Canada.
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45
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Abstract
In the literature, peritraumatic dissociation is frequently considered to be a risk factor for Posttraumatic Stress Disorder (PTSD). In the last few years, a large number of studies have investigated the connections between PTSD and peritraumatic dissociation. A meta-analysis was conducted, including 35 empirical studies that discuss the connections between peritraumatic dissociation and PTSD. Meta-analysis makes it possible to undertake a systematic integration of findings produced by primary studies of this kind to date. The average effect size was r=0.36, indicating a significant positive correlation between the two dimensions. In this article, the authors make a distinction between correlate and risk factor. Therefore, subgroup analyses of quasi-prospective and retrospective studies were undertaken with a view to establishing whether peritraumatic dissociation represents a risk factor for the development of PTSD following a traumatic event. The average effect size in the quasi-prospective studies was r=0.34, which was significant. From a methodological viewpoint, the results show that peritraumatic dissociation is a moderate risk factor for PTSD. Nonetheless, the conceptualization of peritraumatic dissociation in the framework of psychotraumatic stress syndromes--is it a predictor, a symptom, or something else entirely?--needs to be addressed by future research.
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Affiliation(s)
- Doris C Breh
- Psychomatic University Hospital Heidelberg, Department of Psychotraumatology, Heidelberg, Germany.
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46
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Hauck S, Schestatsky S, Terra L, Kruel L, Helena Freitas Ceitlin L. Parental bonding and emotional response to trauma: A study of rape victims. Psychother Res 2007. [DOI: 10.1080/10503300500477596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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47
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Wittmann L, Moergeli H, Schnyder U. Low predictive power of peritraumatic dissociation for PTSD symptoms in accident survivors. J Trauma Stress 2006; 19:639-51. [PMID: 17075911 DOI: 10.1002/jts.20154] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To test the predictive power of peritraumatic dissociation for the development of psychopathology, the authors assessed symptoms of peritraumatic dissociation (Peritraumatic Dissociative Experiences Questionnaire; PDEQ), posttraumatic stress disorder (Clinician-Administered PTSD Scale; CAPS), anxiety and depression (Hospital Anxiety and Depression Scale; HADS) in a sample of 214 accident victims 5 days postaccident (T1). Six months later (T2), CAPS and HADS were administered again. Acute stress disorder (ASD) and PTSD symptom levels were surprisingly low. In sequential regression analyses, initial reexperiencing and hyperarousal significantly predicted PTSD symptom level (T2) over several possibly confounding variables controlled for. Peritraumatic dissociation explained less than 3% of variance. For PTSD scores, 38% overall variance explanation was obtained; the variance for HADS scores was low. Possible explanations for the low-predictive power of peritraumatic dissociation for posttraumatic psychopathology in the sample are discussed.
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Affiliation(s)
- Lutz Wittmann
- Department of Psychiatry, University Hospital, Zurich, Switzerland.
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48
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van der Velden PG, Kleber RJ, Christiaanse B, Gersons BPR, Marcelissen FGH, Drogendijk AN, Grievink L, Olff M, Meewisse ML. The independent predictive value of peritraumatic dissociation for postdisaster intrusions, avoidance reactions, and PTSD symptom severity: a 4-year prospective study. J Trauma Stress 2006; 19:493-506. [PMID: 16929504 DOI: 10.1002/jts.20140] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This 4-year prospective study (N=662) of victims of a fireworks disaster examines the independent predictive value of peritraumatic dissociation for self-reported intrusions, avoidance reactions, and posttraumatic stress disorder (PTSD) symptom severity at both 18-months (T2) and almost 4-years postdisaster (T3). Peritraumatic dissociation was measured 2-3 weeks after the disaster (T1). Hierarchical multiple regression analyses revealed that peritraumatic dissociation was not a strong independent predictor for intrusions and avoidance reactions and PTSD symptom severity at T2 or at T3 above initial intrusions, avoidance reactions, and psychological distress (T1). Results suggest that an early screening procedure for peritraumatic dissociation, which is aimed at identifying disaster victims who are at risk for long-term psychological disturbances can be omitted.
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49
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Kaysen D, Morris MK, Rizvi SL, Resick PA. Peritraumatic responses and their relationship to perceptions of threat in female crime victims. Violence Against Women 2006; 11:1515-35. [PMID: 16247114 PMCID: PMC1317308 DOI: 10.1177/1077801205280931] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Peritraumatic responses, aside from dissociation, have been understudied in acute trauma populations. Participants were 172 female rape, 68 assault, and 80 robbery victims recruited through formal reporting agencies and assessed 1 month after the crime. Despite substantial overlap across crimes, rape victims reported more emotional responses reflecting fear, detachment, shame, and more nonactive behavioral responses. Regression analysis examining the prediction of perceived threat by peritraumatic responses and crime variables indicated that increased duration of crimes; decreased calmness; increased fear; numbing; use of begging, pleading, and crying; and attempts to reason with the perpetrator(s) were all significantly associated with increased appraisal of threat.
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Affiliation(s)
- Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, University of Washington, USA
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50
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Marx BP, Sloan DM. Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behav Res Ther 2005; 43:569-83. [PMID: 15865913 DOI: 10.1016/j.brat.2004.04.004] [Citation(s) in RCA: 177] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2003] [Revised: 03/30/2004] [Accepted: 04/07/2004] [Indexed: 10/26/2022]
Abstract
This study examined whether peritraumatic dissociation serves as a proxy risk factor for experiential avoidance in its relationship with posttraumatic stress disorder (PTSD) symptomatology. One hundred eighty-five trauma survivors completed measures that assessed for peritraumatic dissociation, experiential avoidance, and PTSD symptom severity. The results indicated that peritraumatic dissociation and experiential avoidance were significantly related to PTSD symptomatology at baseline. However, after initial levels of PTSD symptomatology were taken into account, only experiential avoidance was related to PTSD symptoms both 4- and 8-weeks later. These results indicate that peritraumatic dissociation is not a proxy risk factor for experiential avoidance and contributes to the growing body of literature indicating that experiential avoidance is an important factor related to the psychological symptoms experienced by trauma survivors.
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Affiliation(s)
- Brian P Marx
- Department of Psychology, Temple University, Weiss Hall, Philadelphia, PA 19122, USA.
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