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Chuangchai W, Pothisiri W, Wonghempoom A. Measuring effects of height on the autonomic nervous system in middle-aged adolescents using the very low frequency band of heart rate variability. ERGONOMICS 2023; 66:569-579. [PMID: 35815817 DOI: 10.1080/00140139.2022.2100931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Previous studies have revealed the association between falling accidents and stress, measured via heart rate variability (HRV). However, none have studied this association using the very low frequency (VLF) band of HRV in adolescent populations. This study aimed to fill this gap by recruiting 90 adolescents to perform a light physical task at varying heights. Heart rates were used to calculate short-term HRV. The results showed a positive correlation between VLF bands and parasympathetic indices and a negative correlation with sympathetic indices, demonstrating the balancing effects of the autonomic modulation associated with height. The lowest VLF bands were obtained as 79.25 ms2 at 10 m (p < 0.001) and 62.87 ms2 at 9 m (p < 0.001) for the experienced and non-experienced male groups, respectively, and 28.09 ms2 at 6 m (p = 0.001) for the female group. The results also suggested the need for a relatively lower height restriction for female adolescents than for males.Practitioner summary: Increased working heights can cause stress, which leads to falling accidents. The very low frequency band was shown to be associated with parasympathetic and sympathetic indices. Furthermore, the results suggested that the height limit necessary for providing a safe working environment may be lower for female adolescents than for males.Abbreviations: HRV: heart rate variability; VLF: very low frequency; ms2: absolute power; ANS: autonomic nervous system; PNS: parasympathetic nervous system; SNS: sympathetic nervous system; RR: intervals between two successive peaks of R waves; RMSSD: root mean square of successive RR interval differences; SD1: Poincaré plot index of standard deviation 1; SD2: Poincaré plot index of standard deviation 2; HF: high frequency; LF: low frequency; BMI: body mass index; ECG: electrocardiography; HR: heart rate; FFT: fast Fourier transformation; IQR: interquartile range; r: non-parametric partial correlation coefficient; η2: eta-squared; EM: experienced males; NM: non-experienced males; NF: non-experienced females; EEG: electroencephalogram.
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Affiliation(s)
| | - Wiraporn Pothisiri
- College of Population Studies, Chulalongkorn University, Bangkok, Thailand
| | - Apiruck Wonghempoom
- School of Science, Exercise and Sport Science Program, University of Phayao, Phayao, Thailand
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2
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Chen YH, Chiou HY, Wang HY, Chung KH. Sex differences in the associations between psychological symptoms and tumor necrosis factor-alpha levels among obese and nonobese children aged 6-13 in Taiwan. J Affect Disord 2023; 320:241-246. [PMID: 36162686 DOI: 10.1016/j.jad.2022.09.073] [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: 11/09/2021] [Revised: 05/30/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Evidence of associations between psychological symptoms and tumor necrosis factor (TNF)-α level is scant, as is evidence on sex differences in associations for children and adolescents with obesity. This study examined sex differences in associations between psychological symptoms (self-concept, anxiety, depression, anger, and disruptive behavior) and TNF-α level in Taiwanese children and adolescents with healthy weight, overweight, or obesity. METHODS In 2010, 564 first, fourth, and seventh graders-comprising 250 children with overweight or obesity (44.3 %), 330 adolescents (58.5 %), and 303 males (53.7 %)-underwent a health examination and blood sampling and completed a questionnaire. RESULTS A significantly higher TNF-α level was found in children and adolescents with healthy weight than in those with overweight or obesity (median: 14.5 vs. 4.1 (pg/mL); p < 0.001). In multiple linear regression models, anxiety was significantly positively associated with TNF-α level in female participants with healthy weight (β = 0.11 per 10 increments in anxiety, 95 % confidence interval = 0.01-0.22). LIMITATIONS Given the cross-sectional nature of the study, no inferences of causal relationships among TNF-α level, obesity, and psychological symptoms could be made. CONCLUSIONS The findings enrich the literature on the TNF-α-psychological symptom association. Sex differences were found in children and adolescents without obesity rather than in those without obesity, and a higher TNF-α level was associated with increased anxiety in girls without obesity. The role of sex differences in the complex associations among psychological symptoms, TNF-α level, and overweight or obesity requires further investigation.
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Affiliation(s)
- Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Research Center of Health Equity, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Yi Wang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Hsuan Chung
- Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Aspiotis V, Miltiadous A, Kalafatakis K, Tzimourta KD, Giannakeas N, Tsipouras MG, Peschos D, Glavas E, Tzallas AT. Assessing Electroencephalography as a Stress Indicator: A VR High-Altitude Scenario Monitored through EEG and ECG. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22155792. [PMID: 35957348 PMCID: PMC9371026 DOI: 10.3390/s22155792] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 05/28/2023]
Abstract
Over the last decade, virtual reality (VR) has become an increasingly accessible commodity. Head-mounted display (HMD) immersive technologies allow researchers to simulate experimental scenarios that would be unfeasible or risky in real life. An example is extreme heights exposure simulations, which can be utilized in research on stress system mobilization. Until recently, electroencephalography (EEG)-related research was focused on mental stress prompted by social or mathematical challenges, with only a few studies employing HMD VR techniques to induce stress. In this study, we combine a state-of-the-art EEG wearable device and an electrocardiography (ECG) sensor with a VR headset to provoke stress in a high-altitude scenarios while monitoring EEG and ECG biomarkers in real time. A robust pipeline for signal clearing is implemented to preprocess the noise-infiltrated (due to movement) EEG data. Statistical and correlation analysis is employed to explore the relationship between these biomarkers with stress. The participant pool is divided into two groups based on their heart rate increase, where statistically important EEG biomarker differences emerged between them. Finally, the occipital-region band power changes and occipital asymmetry alterations were found to be associated with height-related stress and brain activation in beta and gamma bands, which correlates with the results of the self-reported Perceived Stress Scale questionnaire.
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Affiliation(s)
- Vasileios Aspiotis
- Human Computer Interaction Laboratory (HCILab), Department of Informatics and Telecommunications, University of Ioannina, Kostakioi, 47100 Arta, Greece; (V.A.); (A.M.); (K.K.); (K.D.T.); (N.G.); (E.G.)
- Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece;
| | - Andreas Miltiadous
- Human Computer Interaction Laboratory (HCILab), Department of Informatics and Telecommunications, University of Ioannina, Kostakioi, 47100 Arta, Greece; (V.A.); (A.M.); (K.K.); (K.D.T.); (N.G.); (E.G.)
| | - Konstantinos Kalafatakis
- Human Computer Interaction Laboratory (HCILab), Department of Informatics and Telecommunications, University of Ioannina, Kostakioi, 47100 Arta, Greece; (V.A.); (A.M.); (K.K.); (K.D.T.); (N.G.); (E.G.)
- Institute of Health Science Education, Barts and the London School of Medicine & Dentistry, Queen Mary University of London (Malta Campus), VCT 2520 Victoria, Malta
| | - Katerina D. Tzimourta
- Human Computer Interaction Laboratory (HCILab), Department of Informatics and Telecommunications, University of Ioannina, Kostakioi, 47100 Arta, Greece; (V.A.); (A.M.); (K.K.); (K.D.T.); (N.G.); (E.G.)
- Department of Electrical and Computer Engineering, Faculty of Engineering, University of Western Macedonia, 50100 Kozani, Greece;
| | - Nikolaos Giannakeas
- Human Computer Interaction Laboratory (HCILab), Department of Informatics and Telecommunications, University of Ioannina, Kostakioi, 47100 Arta, Greece; (V.A.); (A.M.); (K.K.); (K.D.T.); (N.G.); (E.G.)
| | - Markos G. Tsipouras
- Department of Electrical and Computer Engineering, Faculty of Engineering, University of Western Macedonia, 50100 Kozani, Greece;
| | - Dimitrios Peschos
- Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece;
| | - Euripidis Glavas
- Human Computer Interaction Laboratory (HCILab), Department of Informatics and Telecommunications, University of Ioannina, Kostakioi, 47100 Arta, Greece; (V.A.); (A.M.); (K.K.); (K.D.T.); (N.G.); (E.G.)
| | - Alexandros T. Tzallas
- Human Computer Interaction Laboratory (HCILab), Department of Informatics and Telecommunications, University of Ioannina, Kostakioi, 47100 Arta, Greece; (V.A.); (A.M.); (K.K.); (K.D.T.); (N.G.); (E.G.)
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Wu L, Ding F, Zhang T, He H, Wang J, Pan Y, Zhang D. Psychological suzhi moderates state anxiety and heart rate responses to acute stress in male adolescents. Stress Health 2022; 38:581-590. [PMID: 34890476 DOI: 10.1002/smi.3119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 12/16/2022]
Abstract
Psychological suzhi has increasingly been recognized to buffer chronic stress and improve mental health. However, few studies have examined the role of psychological suzhi in the response to acute stress. The current study aimed to investigate whether psychological suzhi can buffer state anxiety and heart rate responses to acute stress in adolescents. Healthy male adolescents (N = 63) were classified into high (N = 30) or low (N = 33) psychological suzhi groups based on the Chinese norm of adolescent psychological suzhi scale-simplified version. They completed both the modified Trier Social Stress Test for Groups and a specific control condition, with heart rate and state anxiety assessed. Data were analysed with mixed-design repeated measures analysis of variance. The results showed that the modified Trier Social Stress Test for Groups condition effectively induced an increase in state anxiety and heart rate. Furthermore, individuals with higher levels of psychological suzhi showed lower state anxiety and heart rate stress responses. The present study indicated that psychological suzhi is an important internal resource against acute stress, which may inform interventions for male adolescents exposed to acute stress.
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Affiliation(s)
- Lili Wu
- Brain and Cognitive Neuroscience Research Center, Liaoning Normal University, Dalian, China
| | - Fangyuan Ding
- Faculty of Psychology, Southwest University, Chongqing, China
| | - Ting Zhang
- Sichuan Xinhe Yunhai Technology Co., Ltd, Chengdu, China
| | - Hua He
- Shenzhen Liannan Primary School, Shenzhen, China
| | - Juan Wang
- Sixty-sixth Middle School, Chongqing, China
| | - Yangu Pan
- Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, China
| | - Dajun Zhang
- Faculty of Psychology, Southwest University, Chongqing, China
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5
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Portnoy J, Cui N, Raine A, Frazier A, Rudo-Hutt AS, Liu J. Autonomic nervous system activity and callous-unemotional traits in physically maltreated youth. CHILD ABUSE & NEGLECT 2020; 101:104308. [PMID: 31918354 PMCID: PMC8791011 DOI: 10.1016/j.chiabu.2019.104308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Research into callous-unemotional (CU) traits often focuses exclusively on biological risk factors without integrating social factors. This gap exists despite a growing body of research showing that the social environment may actually impact physiological functioning, which could in turn affect behavior. OBJECTIVE The current study addresses this limitation by examining physical maltreatment and heart rate stress reactivity as potential risk factors for CU traits. PARTICIPANTS AND SETTING This research was conducted in a community sample of Chinese youth (mean age = 11.83 years, 44.3 % female). METHODS Each child separately reported frequency of physical maltreatment experiences by his or her mother and father over the past 12 months. Children completed a self-report measure of CU traits. RESULTS Frequency of maternal physical maltreatment was associated with uncaring traits in females, but not in males. Paternal physical maltreatment was associated with uncaring traits in both males and females and with callous traits in females only. While paternal physical maltreatment was associated with lower heart rate reactivity in females, maternal physical maltreatment was associated with higher heart rate reactivity in females. CONCLUSION Findings provide mixed support for a potential physiological pathway through which child maltreatment may impact callous traits and provide a multilevel, biosocial lens through which to understand CU traits.
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Affiliation(s)
- Jill Portnoy
- School of Criminology and Justice Studies, University of Massachusetts Lowell, United States
| | - Naixue Cui
- School of Nursing, Shandong University, China
| | - Adrian Raine
- Departments of Criminology, Psychiatry, and Psychology, University of Pennsylvania, United States
| | - Annabelle Frazier
- Department of Psychology, University of Massachusetts Lowell, United States
| | | | - Jianghong Liu
- School of Nursing, University of Pennsylvania, United States.
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6
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Cameron CA, McKay S, Susman EJ, Wynne-Edwards K, Wright JM, Weinberg J. Cortisol Stress Response Variability in Early Adolescence: Attachment, Affect and Sex. J Youth Adolesc 2017; 46:104-120. [PMID: 27468997 PMCID: PMC5518686 DOI: 10.1007/s10964-016-0548-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
Attachment, affect, and sex shape responsivity to psychosocial stress. Concurrent social contexts influence cortisol secretion, a stress hormone and biological marker of hypothalamic-pituitary-adrenal axis activity. Patterns of attachment, emotion status, and sex were hypothesized to relate to bifurcated, that is, accentuated and attenuated, cortisol reactivity. The theoretical framework for this study posits that multiple individual differences mediate a cortisol stress response. The effects of two psychosocial stress interventions, a modified Trier Social Stress Test for Teens and the Frustration Social Stressor for Adolescents were developed and investigated with early adolescents. Both of these protocols induced a significant stress reaction and evoked predicted bifurcation in cortisol responses; an increase or decrease from baseline to reactivity. In Study I, 120 predominantly middle-class, Euro-Canadian early adolescents with a mean age of 13.43 years were studied. The girls' attenuated cortisol reactivity to the public performance stressor related significantly to their self-reported lower maternal-attachment and higher trait-anger. In Study II, a community sample of 146 predominantly Euro-Canadian middle-class youth, with an average age of 14.5 years participated. Their self-reports of higher trait-anger and trait-anxiety, and lower parental attachment by both sexes related differentially to accentuated and attenuated cortisol reactivity to the frustration stressor. Thus, attachment, affect, sex, and the stressor contextual factors were associated with the adrenal-cortical responses of these adolescents through complex interactions. Further studies of individual differences in physiological responses to stress are called for in order to clarify the identities of concurrent protective and risk factors in the psychosocial stress and physiological stress responses of early adolescents.
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Affiliation(s)
- Catherine Ann Cameron
- University of British Columbia, Vancouver, BC, Canada.
- University of New Brunswick, Fredericton, NB, Canada.
| | - Stacey McKay
- University of New Brunswick, Fredericton, NB, Canada
| | | | | | - Joan M Wright
- University of New Brunswick, Fredericton, NB, Canada
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7
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de Zambotti M, Willoughby AR, Franzen PL, Clark DB, Baker FC, Colrain IM. K-Complexes: Interaction between the Central and Autonomic Nervous Systems during Sleep. Sleep 2016; 39:1129-37. [PMID: 26856907 DOI: 10.5665/sleep.5770] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 12/23/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To investigate the relationship between K-complexes (KCs) and cardiac functioning. METHODS Forty healthy adolescents aged 16-22 y (19 females) participated in the study. Heart rate (HR) fluctuations associated with spontaneous and evoked KCs were investigated on two nights, one with (event-related potential night) and one without auditory tones presented across the night. RESULTS There was a clear biphasic cardiac response to evoked and spontaneous KCs, with an initial acceleration in HR followed by a deceleration (P < 0.001). HR acceleration occurred immediately to KCs in response to tones presented in the first third of the interbeat interval, but was delayed a beat when the tone occurred later in the cardiac cycle (P < 0.05). Sex differences were also evident. Pretone baseline HR was higher, and the magnitude of the HR response was blunted and delayed, in female compared to male adolescents (P < 0.001). Also, pretone baseline HR was lower when a tone elicited a KC compared to when it did not (P < 0.001), suggesting that KCs are possibly more likely to be elicited by external stimuli in states of reduced cardiac activation. CONCLUSIONS The strict dependency observed between KCs and cardiac control indicates a potential role of KCs in modulating the cardiovascular system during sleep. Sex differences in the KC-cardiac response indicate the sensitivity of this measure in capturing sex differences in cardiac regulatory physiology.
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Affiliation(s)
| | | | | | - Duncan B Clark
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA.,Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
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8
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Huemer J, Nelson K, Karnik N, Völkl-Kernstock S, Seidel S, Ebner N, Ryst E, Friedrich M, Shaw RJ, Realubit C, Steiner H, Skala K. Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors. Eur J Psychotraumatol 2016; 7:29163. [PMID: 26955827 PMCID: PMC4783431 DOI: 10.3402/ejpt.v7.29163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/09/2015] [Accepted: 12/16/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine a cohort of unaccompanied refugee minors (URMs) by means of psycholinguistic methods in order to obtain a more subtle picture of their degree of traumatization. METHODS Twenty-eight participants were included in the Stress-Inducing Speech Task (SIST) consisting of a free association (FA) and a stress (STR) condition. Narratives were examined by means of (1) quantitative parameters (word count); (2) psycholinguistic variables (temporal junctures, TJs), narrative structure, referential activity (RA)-a measure of emotional expressivity; and (3) content analysis ratings. RESULTS Word count was significantly lower than in age-matched norms. In the FA condition, TJs were lower, but in the STR condition, rates were comparable. RA was significantly higher in both conditions. Content analysis ratings showed that the experiences described by these youths were potentially traumatic in nature. CONCLUSIONS This pattern of narrative shows a mixture of fulfilling the task demand, while containing an emotionally charged narrative. Narrative structure was absent in the FA condition, but preserved in the STR condition, as URMs struggled with the description of non-normative events. This indicates that these youths have not yet emotionally dealt with and fully integrated their trauma experiences.
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Affiliation(s)
- Julia Huemer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria;
| | - Kristin Nelson
- Social Sciences Division, The New School for Public Engagement, New York, USA
| | - Niranjan Karnik
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA.,Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Sabine Völkl-Kernstock
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Stefan Seidel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Nina Ebner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Erika Ryst
- Nevada Center for Excellence in Disabilities, College of Education, University of Nevada, Reno, NV, USA
| | - Max Friedrich
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Richard J Shaw
- Division of Child Psychiatry and Human Development, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Hans Steiner
- Division of Child Psychiatry and Human Development, Stanford University School of Medicine, Stanford, CA, USA
| | - Katrin Skala
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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De Los Reyes A, Augenstein TM, Aldao A, Thomas SA, Daruwala S, Kline K, Regan T. Implementing psychophysiology in clinical assessments of adolescent social anxiety: use of rater judgments based on graphical representations of psychophysiology. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 44:264-79. [PMID: 24320027 DOI: 10.1080/15374416.2013.859080] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Social stressor tasks induce adolescents' social distress as indexed by low-cost psychophysiological methods. Unknown is how to incorporate these methods within clinical assessments. Having assessors judge graphical depictions of psychophysiological data may facilitate detections of data patterns that may be difficult to identify using judgments about numerical depictions of psychophysiological data. Specifically, the Chernoff Face method involves graphically representing data using features on the human face (eyes, nose, mouth, and face shape). This method capitalizes on humans' abilities to discern subtle variations in facial features. Using adolescent heart rate norms and Chernoff Faces, we illustrated a method for implementing psychophysiology within clinical assessments of adolescent social anxiety. Twenty-two clinic-referred adolescents completed a social anxiety self-report and provided psychophysiological data using wireless heart rate monitors during a social stressor task. We graphically represented participants' psychophysiological data and normative adolescent heart rates. For each participant, two undergraduate coders made comparative judgments between the dimensions (eyes, nose, mouth, and face shape) of two Chernoff Faces. One Chernoff Face represented a participant's heart rate within a context (baseline, speech preparation, or speech-giving). The second Chernoff Face represented normative heart rate data matched to the participant's age. Using Chernoff Faces, coders reliably and accurately identified contextual variation in participants' heart rate responses to social stress. Further, adolescents' self-reported social anxiety symptoms predicted Chernoff Face judgments, and judgments could be differentiated by social stress context. Our findings have important implications for implementing psychophysiology within clinical assessments of adolescent social anxiety.
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Ordaz S, Luna B. Sex differences in physiological reactivity to acute psychosocial stress in adolescence. Psychoneuroendocrinology 2012; 37:1135-57. [PMID: 22281210 PMCID: PMC3472630 DOI: 10.1016/j.psyneuen.2012.01.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 11/22/2011] [Accepted: 01/05/2012] [Indexed: 01/08/2023]
Abstract
Females begin to demonstrate greater negative affective responses to stress than males in adolescence. This may reflect the concurrent emergence of underlying differences in physiological response systems, including corticolimbic circuitries, the hypothalamic-pituitary-adrenal axis (HPAA), and the autonomic nervous system (ANS). This review examines when sex differences in physiological reactivity to acute psychosocial stress emerge and the directionality of these differences over development. Indeed, the literature indicates that sex differences emerge during adolescence and persist into adulthood for all three physiological response systems. However, the directionality of the differences varies by system. The emerging corticolimbic reactivity literature suggests greater female reactivity, particularly in limbic regions densely innervated by gonadal hormone receptors. In contrast, males generally show higher levels of HPAA and ANS reactivity. We argue that the contrasting directionality of corticolimbic and peripheral physiological responses may reflect specific effects of gonadal hormones on distinct systems and also sex differences in evolved behavioral responses that demand different levels of peripheral physiological activation. Studies that examine both subjective reports of negative affect and physiological responses indicate that beginning in adolescence, females respond to acute stressors with more intense negative affect than males despite their comparatively lower peripheral physiological responses. This dissociation is not clearly explained by sex differences in the strength of the relationship between physiological and subjective responses. We suggest that females' greater subjective responsivity may instead arise from a greater activity in brain regions that translate stress responses to subjective awareness in adolescence. Future research directions include investigations of the role of pubertal hormones in physiological reactivity across all systems, examining the relationship of corticolimbic reactivity and negative affect, and sex differences in emotion regulation processes.
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Affiliation(s)
- Sarah Ordaz
- Department of Psychology, University of Pittsburgh, 121 Meyran Avenue, Loeffler Building, Pittsburgh, PA 15213, USA.
| | - Beatriz Luna
- Department of Psychology, University of Pittsburgh, 121 Meyran Avenue, Loeffler Building, Pittsburgh, PA 15213, USA,Department of Psychiatry, University of Pittsburgh School of Medicine, 121 Meyran Avenue, Loeffler Building, Pittsburgh, PA 15213, USA
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Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res 2011; 45:1027-35. [PMID: 21439576 PMCID: PMC3135672 DOI: 10.1016/j.jpsychires.2011.03.006] [Citation(s) in RCA: 1223] [Impact Index Per Article: 94.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 03/03/2011] [Indexed: 01/21/2023]
Abstract
Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences in DSM-IV anxiety disorders were examined in a large sample of adults (N=20,013) in the United States using data from the Collaborative Psychiatric Epidemiology Studies (CPES). The lifetime and 12-month male:female prevalence ratios of any anxiety disorder were 1:1.7 and 1:1.79, respectively. Women had higher rates of lifetime diagnosis for each of the anxiety disorders examined, except for social anxiety disorder which showed no gender difference in prevalence. No gender differences were observed in the age of onset and chronicity of the illness. However, women with a lifetime diagnosis of an anxiety disorder were more likely than men to also be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder. Furthermore, anxiety disorders were associated with a greater illness burden in women than in men, particularly among European American women and to some extend also among Hispanic women. These results suggest that anxiety disorders are not only more prevalent but also more disabling in women than in men.
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12
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Nelson KL, Bein E, Huemer J, Ryst E, Steiner H. Listening for avoidance: narrative form and defensiveness in adolescent memories. Child Psychiatry Hum Dev 2009; 40:561-73. [PMID: 19452274 DOI: 10.1007/s10578-009-0144-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
Abstract
We describe a linguistic clue to speakers' states of mind that has utility for psychotherapists and counselors, and summarize the theoretical and empirical support for using this clue in clinical practice. Specifically, we posit that the degree to which people relate stressful episodes from their lives as a chronological sequence of events is negatively associated with the extent to which they self-protectively avoid experiencing negative affect. We review relevant discussions and findings from linguistics and psychology, and then present a new study that replicates previous research. In this study of the relationship between defensive avoidance and the narrative structure of stressful memories in non-clinical adolescents, 168 high school students spoke for 10 min into a tape recorder about "your most stressful life event." Transcribed interviews were analyzed for narrative immersion, the extent to which the past is retold in chronological order, using a method adopted from Labov and Waletzky. A negative association was found between narrative immersion and avoidance (as operationalized by scores on the Marlowe Crowne Social Desirability Scale). Listening for narrative immersion in the speech of clients discussing past stressful times may therefore represent a useful tool in exploring defensive avoidance of stressful episodic memories.
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Affiliation(s)
- Kristin L Nelson
- Department of Psychology, McDaniel College, Westminster, MD 21157-4390, USA.
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McLean CP, Anderson ER. Brave men and timid women? A review of the gender differences in fear and anxiety. Clin Psychol Rev 2009; 29:496-505. [PMID: 19541399 DOI: 10.1016/j.cpr.2009.05.003] [Citation(s) in RCA: 553] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 05/27/2009] [Accepted: 05/30/2009] [Indexed: 10/20/2022]
Abstract
Substantial evidence indicates that women report greater fear and are more likely to develop anxiety disorders than men. Women's greater vulnerability for anxiety disorders can be partly understood by examining gender differences in the etiological factors known to contribute to anxiety. This review examines evidence for gender differences across a broad range of relevant factors, including biological influences, temperamental factors, stress and trauma, cognitive factors, and environmental factors. Gender differences are observed with increasing consistency as the scope of analysis broadens to molar levels of functioning. Socialization processes cultivate and promote processes related to anxiety, and moderate gender differences across levels of analysis.
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Affiliation(s)
- Carmen P McLean
- National Center for PTSD, Boston VA Healthcare System, Boston, MA 02130, USA.
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14
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Habitual response to stress in recovering adolescent anorexic patients. Child Psychiatry Hum Dev 2009; 40:43-54. [PMID: 18618238 DOI: 10.1007/s10578-008-0112-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 06/23/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although previous research has investigated the stress response in acutely anorexic patients, there is currently little research addressing this response in recovering adolescent anorexic girls. Therefore, this study investigated partially and fully weight-restored anorexic adolescent girls' psychological and physiological response to a standardized stressor. METHODS We measured the heart rate and affect of 17 adolescent recovering anorexic patients and 40 healthy age-matched controls during two conditions of the Stress Induced Speech Task (SIST): Free Association and Stress Task. Recovering patients were either partially or fully weight-restored. RESULTS Compared to the controls, the recovering anorexic girls reported greater overall habitual psychological distress and higher levels of negative affect during the standardized stressor. However, recovering patients did not show a muted heart rate response during the stressor. Neither recovering anorexics nor controls demonstrated a correspondence between heart rate and positive or negative affect. DISCUSSION Although the physiological stress response of recovering adolescent anorexic patients was similar to controls, the psychological response of partially and fully weight-restored anorexic adolescents appears similar to that of acutely anorexic adolescents. Treatment implications are discussed in terms of the persistence of negative affect and treatment resistance.
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Anderson ER, Hope DA. The relationship among social phobia, objective and perceived physiological reactivity, and anxiety sensitivity in an adolescent population. J Anxiety Disord 2009; 23:18-26. [PMID: 18436426 PMCID: PMC2645715 DOI: 10.1016/j.janxdis.2008.03.011] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 03/12/2008] [Accepted: 03/12/2008] [Indexed: 11/25/2022]
Abstract
Physiological theories may be important in the development and maintenance of social phobia in youth. A limited literature base indicates that youth with social phobia experience increases in objective physiological arousal during social-evaluative situations and are more aware of such increases compared to nonanxious youth. Recent research suggests that youth with social phobia also evidence heightened levels of anxiety sensitivity, which may lead to interpretation of physiological arousal as dangerous or distressing, and, as a result, in avoidance of situations which produce increased physiological arousal. The purpose of the current study was to examine interaction among objective physiological arousal, perceived physiological arousal, and anxiety sensitivity among adolescents diagnosed with social phobia. A sample of community adolescents participated in two anxiety-provoking tasks during which objective physiological arousal was monitored, and after which perceived physiological arousal and anxiety sensitivity were evaluated. Results from this study evidenced no differences between social phobic and nonanxious adolescents with regard to objective physiological arousal during either anxiety-provoking tasks. Adolescents with social phobia, however, were more aware of measured increases in physiological arousal, as well as more afraid of the potential social implications of that arousal compared to nonanxious adolescents. Implications for theory and treatment are discussed.
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Affiliation(s)
- Emily R Anderson
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588-0308, United States.
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16
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Karnik NS, Popma A, Blair J, Khanzode L, Miller SP, Steiner H. Personality correlates of physiological response to stress among incarcerated juveniles. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2008; 36:185-90. [PMID: 18622978 PMCID: PMC3104598 DOI: 10.1024/1422-4917.36.3.185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND To examine the relationship between personality type and physiological response to stress among juvenile delinquents. METHODS Delinquent males (N = 42, mean age 16.5, SD = 1) recruited from a convenience sample at local juvenile detention facility were compared to a male control sample from a local high school (N = 79; mean age 16.1, SD = 0.8). All participants completed the Weinberger Adjustment Inventory and a Stress-Inducing Speech Task during both of which heart rate was measured. RESULTS Compared to controls, delinquent youths showed significantly lower heart rates under both free association and stress conditions (p < 0.05) and a lower rate of increase during stressful stimuli (p < 0.05). Among delinquents, those with a non-reactive personality type appeared to show consistently lower levels of physiological arousal as measured by heart rate. CONCLUSIONS Delinquents consistently had lower overall levels of arousal as measured by heart rate. In delinquent boys, we also found a persistently low arousal group with a non-reactive psychological pattern. This combination may be a forerunner of future psychopathy or a product of the developmental trajectory that leads to and results from psychopathic behavior.
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Nelson KL, Moskovitz DJ, Steiner H. Narration and Vividness as Measures of Event-Specificity in Autobiographical Memory. DISCOURSE PROCESSES 2008. [DOI: 10.1080/01638530701792891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Plattner B, Karnik N, Jo B, Hall RE, Schallauer A, Carrion V, Feucht M, Steiner H. State and trait emotions in delinquent adolescents. Child Psychiatry Hum Dev 2007; 38:155-69. [PMID: 17417724 DOI: 10.1007/s10578-007-0050-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the structure of emotions and affective dysregulation in juvenile delinquents. METHOD Fifty-six juvenile delinquents from a local juvenile hall and 169 subjects from a local high school were recruited for this study. All participants completed psychometric testing for trait emotions followed by measurements of state emotions under two conditions (free association and stress condition). Finally, delinquent participants completed a detailed assessment of past trauma using the Childhood Trauma Interview (CTI). RESULTS Delinquents exhibit significantly higher levels of negative state and trait emotions when compared to a high school sample. In the delinquent sample chronicity of physical trauma affects the longstanding variable of trait emotionality and severity of trauma, specifically emotional abuse and witnessing violence, shapes negative emotional outcomes in state emotionality. In addition, delinquents appear to experience a wider range of emotions than the comparison sample and were more likely to experience a confluence of state emotions of sadness and anger under stressed conditions. CONCLUSION Adolescent delinquents appear to have a different experience of negative emotions than comparison adolescents. The experience of emotions appears to differ in state and trait conditions. These emotions may be related to childhood experiences of trauma.
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Affiliation(s)
- Belinda Plattner
- Medizinische Universität Wien, Universitätsklinik für Neuropsychiatrie des Kindes und Jugendalters, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Steiner H, Erickson SJ, MacLean P, Medic S, Plattner B, Koopman C. Relationship between defenses, personality, and affect during a stress task in normal adolescents. Child Psychiatry Hum Dev 2007; 38:107-19. [PMID: 17356922 DOI: 10.1007/s10578-007-0046-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although there are extensive data on the relationship between personality and stress reactivity in adults, there is little comparable empirical research with adolescents. This study examines the simultaneous relationships between long term functioning (personality, defenses) and observed stress reactivity (affect) in adolescents. METHODS High school students (N = 169; mean age 16; 73 girls) were asked to participate in two conditions of the Stress Induced Speech Task (SIST): Free Association and Stressful Situation. Immature and mature defenses, distress and restraint personality dimensions, and negative and positive affect were examined. RESULTS Greater reported use of immature defenses was significantly associated with negative affect, whereas greater reported use of mature defenses was significantly associated with greater positive affect. Although personality style was also a significant predictor of negative affect across two out of three conditions, defenses were better overall predictors of affect than were personality dimensions. Gender was also a significant predictor of negative affect, wherein girls reported more negative affect than boys. DISCUSSION Defenses and personality style predict affective response during a moderately stressful task. Immature defenses and, to a lesser extent, the distress personality dimension predict mobilization of negative affect, whereas mature defenses predict the reporting of positive affect. These results relate to processes central to psychotherapy: defensive responding, personality style, and affective reactivity during the recounting of stressful events.
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Affiliation(s)
- Hans Steiner
- Center for Psychiatry and The Law, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5719, USA.
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20
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Lu Q, Zeltzer LK, Tsao JCI, Kim SC, Turk N, Naliboff BD. Heart rate mediation of sex differences in pain tolerance in children. Pain 2005; 118:185-93. [PMID: 16213093 DOI: 10.1016/j.pain.2005.08.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2005] [Revised: 06/16/2005] [Accepted: 08/08/2005] [Indexed: 11/15/2022]
Abstract
Despite evidence supporting the existence of important sex-related differences in pain, the mechanisms underpinning such differences are not well understood. The aim of this study is to examine the relationship between sex and pubertal differences in autonomic arousal and pain tolerance to laboratory pain stimuli in healthy children. We tested the following specific hypotheses: (1) females would have greater autonomic arousal and less pain tolerance than males, and (2) this sex difference in pain tolerance would be mediated by autonomic arousal. Participants were 244 healthy children (50.8% female, mean age 12.73+/-2.98 years, range 8-18 years). Separate 4-trial blocks of cutaneous pressure and thermal pain stimuli were presented in counterbalanced order. Heart rate (HR) was recorded during 2-3 min periods preceding each block and a 1-min period between trials. Results indicated lower tolerance in females for cutaneous pressure, but not thermal pain, compared to males. In addition, pre-trial HR was greater for females than males. Mediation analyses suggested that sex differences in pressure pain tolerance were accounted for by sex differences in pre-trial HR. There were also significant effects for puberty, but these did not vary by sex. Overall, early pubertal children had greater pre-trial HR and less pain tolerance than those in late puberty for both cutaneous pressure and thermal pain across sex. These results suggest that autonomic arousal may be a mediator of sex-related differences in pain responses in children.
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Affiliation(s)
- Qian Lu
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, and Veterans Administration Greater Los Angeles Healthcare System, Bldg. 115, Rm. 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA
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Back SE, Brady KT, Jackson JL, Salstrom S, Zinzow H. Gender differences in stress reactivity among cocaine-dependent individuals. Psychopharmacology (Berl) 2005; 180:169-76. [PMID: 15682303 DOI: 10.1007/s00213-004-2129-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Accepted: 11/13/2004] [Indexed: 11/28/2022]
Abstract
RATIONALE Recent investigations suggest that stress reactivity may play an important role in the relationship between stress and substance use. Important gender differences, such as reasons for using substances, have been well documented, and it is likely that men and women also differ in their stress response. OBJECTIVES In this study, gender differences in stress reactivity to two laboratory stress manipulations were examined among 18 men and 21 women with current cocaine dependence. METHODS Participants completed a psychological stress task, the Mental Arithmetic Task (MAT), and a physical stress task, the Cold Pressor Task (CPT). Subjective stress responses (i.e., feelings of stress, anxiety, nervousness, pain, mood), physiological stress responses (i.e., heart rate, skin conductance), and cocaine craving were assessed. RESULTS In response to both the MAT and the CPT, significant increases in subjective and physiological stress were observed among participants. Women, however, demonstrated greater subjective reactivity, as evidenced by significantly higher ratings of stress, nervousness, and pain as compared to men. Women also immersed their hand in the cold water bath for a significantly shorter period of time as compared to men. CONCLUSIONS The current findings are among the first to report on gender differences in stress reactivity among cocaine-dependent individuals. The findings suggest that the mechanisms linking stress and substance use may be gender-specific, and that stress reactivity may play a different role for women than for men. Future research and implications for clinical interventions are discussed.
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Affiliation(s)
- Sudie E Back
- Division of Clinical Neuroscience, Medical University of South Carolina, 67 President Street, PO Box 250861, Charleston, SC 29425, USA.
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Koopman C, Carrion V, Butler LD, Sudhakar S, Palmer L, Steiner H. Relationships of dissociation and childhood abuse and neglect with heart rate in delinquent adolescents. J Trauma Stress 2004; 17:47-54. [PMID: 15027793 DOI: 10.1023/b:jots.0000014676.83722.35] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.
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Affiliation(s)
- Cheryl Koopman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California 94305-5718, USA.
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Plattner B, Silvermann MA, Redlich AD, Carrion VG, Feucht M, Friedrich MH, Steiner H. Pathways to dissociation: intrafamilial versus extrafamilial trauma in juvenile delinquents. J Nerv Ment Dis 2003; 191:781-8. [PMID: 14671454 DOI: 10.1097/01.nmd.0000105372.88982.54] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dissociation is postulated to occur as a function of particular types of child abuse or chronic abuse. Additionally, there is an ongoing controversy examining the perpetrator's relationship to the victim in the development of dissociation. In this study, reports of traumatic events experienced both in the family environment and in the community were used to examine the relationship between dissociative disorder as defined by DSM-IV (pathological dissociation), and dissociation as a defense mechanism. The first objective was to identify whether the site of the trauma or the quantity of trauma correlated more significantly with symptoms of dissociation. The second objective was to explore a potential correlation between topics that participants choose to disclose during a standardized Stress Inducing Speech Task (SIST), and symptoms of dissociation. The third objective was to examine the relationship between the age of occurrence, the duration of trauma, and symptoms of dissociation. Fifty-two delinquent juveniles completed measures (including the SCID-D, REM-71, CTQ, CTI, SIST) assessing traumatic experiences, psychopathological dissociation, and dissociation as defense mechanism. Blind raters scored the SIST for intrafamilial and extrafamilial trauma. The perpetrator's relationship to the victim, site of the trauma, quantity of the trauma, age of occurrence, and duration of the trauma were analyzed by descriptive statistics and Pearson partial correlations. Significant correlations were found between symptoms of pathological dissociation and intrafamilial trauma. Significant correlations were not found between extrafamilial trauma and pathological dissociation and dissociation as defense mechanism. All these correlations held constant the chronicity of traumas reported. The results obtained in this study through blind and independent assessment suggest that special trauma characteristics (i.e., childhood trauma perpetrated by a family member) rather than sheer cumulative effects of trauma may have greater implications for the development of pathological dissociation. The relationships to dissociation as a defense were much weaker.
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Affiliation(s)
- Belinda Plattner
- Universitätsklinik für Neuropsychiatrie des Kindes- und Jugendalters, University Vienna, General Hospital Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria, EU
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Abstract
Patients with eating disorders have been found to have problems with Interoceptive Awareness. This study seeks to examine this issue in an experimental paradigm. In the present study, we investigated the hypothesis that, in addition to lowering a body's autonomic stress response, a state of starvation also lowers the psychological stress response. Results indicated that those with anorexia nervosa showed a muted physiology, but they did not show a complete denial of negative emotion. No relation was seen, however, between their affective and physiological responses to a stress task, which contrasted results found for the controls.
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