Trauma and affects

Childhood maltreatment and engaging in NSSI for automatic-negative reinforcement: The mediating role of alexithymia and moderating role of help-seeking attitudes

BACKGROUND

There is evidence indicating that childhood maltreatment is linked to the occurrence of non-suicidal self-injury (NSSI). Nevertheless, the association between childhood maltreatment and the automatic-negative reinforcement aspect of NSSI remains understudied. Chapman's (2006) experiential avoidance model posits that the main factor in sustaining NSSI is negative reinforcement, specifically through the avoidance or escape from distressful emotional experiences. The current study examines a conceptual framework based on this theory and the available literature that explores the potential mediation role of alexithymia in the relation between childhood maltreatment and the automatic-negative reinforcement of NSSI. Additionally, this study investigates how this process may be influenced by individuals' attitudes toward seeking professional help.

METHODS

3657 adolescents (1616 females) completed questionnaires regarding childhood maltreatment, alexithymia, help-seeking attitudes, the NSSI, and its functions.

RESULTS

The findings of the study exposed a positive link between childhood maltreatment and the automatic-negative reinforcement of NSSI, with the mediating role of alexithymia. Interestingly, it was unexpected to discover that individuals with high help-seeking attitudes experienced an intensification of the relationship between childhood maltreatment and both alexithymia and the automatic-negative reinforcement of NSSI.

LIMITATION

The study's cross-sectional design hindered the inference of causality.

CONCLUSION

The present study demonstrated that it is crucial to consider the impact of both alexithymia and help-seeking attitudes in adolescents who have experienced maltreatment. These findings hold implications for preventive interventions that target the reduction of NSSI behaviors driven by automatic-negative reinforcement.

A computational model for learning from repeated traumatic experiences under uncertainty

Traumatic events can lead to lifelong, inflexible adaptations in threat perception and behavior, which characterize posttraumatic stress disorder (PTSD). This process involves associations between sensory cues and internal states of threat and then generalization of the threat responses to previously neutral cues. However, most formulations neglect adaptations to threat that are not specific to those associations. To incorporate nonassociative responses to threat, we propose a computational theory of PTSD based on adaptation to the frequency of traumatic events by using a reinforcement learning momentum model. Recent threat prediction errors generate momentum that influences subsequent threat perception in novel contexts. This model fits primary data acquired from a mouse model of PTSD, in which unpredictable footshocks in one context accelerate threat learning in a novel context. The theory is consistent with epidemiological data that show that PTSD incidence increases with the number of traumatic events, as well as the disproportionate impact of early life trauma. Because the theory proposes that PTSD relates to the average of recent threat prediction errors rather than the strength of a specific association, it makes novel predictions for the treatment of PTSD.

Case Report: A Case Study Significance of the Reflective Parenting for the Child Development

There are studies that connect the “child” in the past with the “parent” in the present through the prism of high levels of stress, guilt, anxiety. This raises the question of the experiences and internal work patterns formed in childhood and developed through parenthood at a later stage. The article (case study) presents the quality of parental capacity of a family raising a child with an autism spectrum. The abilities of parents (the emphasis is on the mother) to recognize and differentiate the mental states of their non-verbal child are discussed. An analysis of the parental representations for the child and the parent–child relationship is developed. The parameters of reflective parenting are measured. The methodology provides good opportunities for identifying deficits in two aspects: parenting and the functioning of the child itself. Without their establishment, therapy could not have a clear perspective. An integrative approach for psychological support of the child and his family is presented: psychological work with the child on the main areas of functioning, in parallel with the therapy conducted with the parents and the mother, as the main caregiver. The changes for the described period are indicated, which are related to the improvement of the parental capacity in the mother and the progress in the therapy in the child. A prognosis for ongoing therapy is given, as well as topics that have arisen in the process of diagnostic procedures.

Attachment to Parents and Peers and Adolescent Mental Health: The Mediating Role of Alexithymia

The current research aims to study the mediating role of alexithymia on the relationship between attachment to parents and peers and mental health problems in a sample of 242 non-referred adolescents. Participants completed the Inventory of Parent and Peer Attachment, the Toronto Alexithymia Scale, and the Symptom Check List-90-R. Mediation analysis shows that alexithymia fully mediates the relations between attachment to peers and mental health problems in both adolescent males and females. Findings suggest the importance to identify promptly vulnerabilities and risks in order to create prevention and intervention programs aimed to foster positive attachment experiences and to support emotional regulation.

Trauma, resilience and healthy and unhealthy forms of dissociation

This paper outlines the difference between healthy and unhealthy forms of dissociation following, and in response to, traumatic experience, in particular the experience of refugees, calling on 30 years' experience in working with refugees in voluntary and public sectors, including 20 years at the Refugee Therapy Centre, London. It differentiates dissociation from repression, and looks at some of the specific traumatic experiences associated with refugees' displacement and situation, particularly relating to loss. Four key characteristics of resilience are described: 'psychic space', 'sense of self', and the use of a 'listening other' and 'healthy dissociation/resiliency'. Two vignettes are given to illustrate the difference between healthy and unhealthy dissociation.

The Past Victim, the Future Abuser

BACKGROUND

Childhood trauma exerts a significant effect on psychological life of people. It is a ubiquitous phenomenon. We face a social epidemic with serious consequences that shatter the life of survivors. Victimization in early years of life entraps the individuals in the victim-rescuer-abuser triangle. Many perpetrators and criminals have had history of childhood abuse. The main objective of this study was the assessment of patients with a history of child abuse who behaved in abusive manner in adulthood.

METHODS

By reviewing the files of 3694 patients referred to my outpatient private clinic, I tried to gather data to answer the questions related to this study including history of abuse, victimization, substance abuse, and the percent of patients who were involved in abusive behaviors in adulthood.

RESULTS

In total, 1075 patients reported a history of some abuse during childhood (29.10%). Of them, 19.44% (total = 209, 78 men and 131 women) behaved as an abuser for most of their life. The prevalence of substance abuse in people with history of abuse was 36.6% compared to 28.36% in those without. The prevalence of acting as an abuser and perpetrator in adult life was 27.5%, 19.5%, 18.4% and 11.11% among the divorced, married, single and widowed respectively.

CONCLUSION

This preliminary study showed that a significant number of patients with history of childhood abuse involved in abusive behavior and victimization of others in adulthood. Paying attention to this issue by mental health practitioners and policy makers can prevent the intergenerational transmission of abuse and development of a more peaceful society.

Children in genocide: Extreme traumatization and the ‘affect propeller’

The author bases this paper on extensive research concerning children in genocide with a starting point in the Holocaust and in the genocide in Rwanda 1994. She demonstrates indicators for psychological phenomena concerning the child survivors' affect regulating that appeared in life histories presented in videotaped in-depth interviews. The psychological phenomena concern experiences of persecution and ways of coming to terms with recurring memory images and affects. The interviews that have been analysed in detail form a basis for an emerging conceptual model about trauma- and generational-linking processes within each individual--the 'affect propeller'. An overall conclusion from this study is that past traumatic experiences are recovered not as memories in the usual sense of the word, but as affects invading the present. Accordingly, affects seem to tell the story of the past traumatic experiences.

Association of childhood trauma and panic symptom severity in panic disorder: Exploring the mediating role of alexithymia

BACKGROUND

The aim of the present study was to examine the association between childhood trauma (CT), alexithymia, and panic symptom severity in patients with panic disorder (PD). Moreover, the effect of specific subtypes of CT on alexithymia and panic symptom severity was also investigated.

METHODS

142 patients with PD and 146 healthy age-matched and sex-matched controls were enrolled in the study. The Structured Clinical Interview for DSM-IV axis I (SCID-I), Childhood Trauma Questionnaire-28 item Short Form (CTQ-28), Toronto Alexithymia Scale (TAS-20), and Panic Disorder Severity Scale (PDSS) were administered to all subjects. The relationships among CT subtypes, alexithymia, and panic symptom severity were investigated using Pearson's correlation analysis. The types of CT that predict alexithymia and panic symptom severity were also investigated using Regression analyses.

RESULTS

PD patients showed higher scores on reporting all kinds of CT except sexual abuse. In addition, the TAS-20, DIF (difficulty identifying feelings) and DDF (difficulty describing feelings) scores were significantly higher in patients with PD than in controls. Significant positive correlations were noted among CT, alexithymia and panic symptoms severity. Results of regression analyses showed alexithymia as a mediator between the different types of CT and panic disorder severity, except sexual abuse.

LIMITATIONS

Although self-report questionnaires are reliable and widely used, the phenomenon of patients who underreport or overreport their symptoms cannot be ignored.

CONCLUSION

The present study showed that CT and alexithymia are more common in patients with PD and impact the severity of panic symptoms. Results suggest that alexithymia may be an important mediator between CT and panic disorder severity.

The Victim's Burden: Guilt, Shame and Abuse

In this article, three cases of sexual abuse are reviewed in the context of age, intensity and duration of the trauma. The questions explored concern the prognosis for positive therapeutic outcome. Crucial factors appear to include the meaning of the experience for the individual involved, the identity of the abuser and the level of autonomy exerted or regained in reworking memories or reframing the experience in the therapeutic setting. An examination of the literature on childhood trauma and sexual abuse provides a framework for the discussion of these cases. Hypnosis is found to be a valuable tool for helping the patient revivify the experience, replacing feelings of shame and guilt with a sense of efficacy and autonomy.

Self-Renewal

This article presents a model of the process of self-renewal, the creative restructuring of the self that may follow the painful and disconfirming personal crisis of illness or other extreme personal trauma. Self-renewal is a possible response to pain and struggle, and one that can be facilitated and encouraged. The article presents several examples of the complex processes that make up self-renewal, including the self-definition as a person taking an active role, the presence of a deep relationship to others, and the role of being a public witness concerning issues raised by the struggle. The article concludes by suggesting that self-renewal as a process has important social implications, beyond the personal level.

Displaced Jewish Children During World War II

Eleven people who survived World War II as Jewish children in Europe were interviewed to investigate (1) psychological resistance to emotional trauma in children, and (2) the effect on adult adjustment of a trauma experienced during the growth process. All survivors described experiences and reactions that were attempts to cope in active ways with feelings of total helpleasness during the war. As adults they continue to react to the effects of their earlier experiences by fighting helplessness and trying to integrate their feelings, thus continuing the process of active coping.

Resilience: The role of accurate appraisal, thresholds, and socioenvironmental factors

Adding to the resilience model of Kalisch and colleagues, we suggest that resilience is associated with accurate rather than excessively positive or negative appraisal or reappraisal styles; that complex systems do not always change in linear fashion; that linkages of individuals, families, and communities markedly affect individual resilience; and that resilience research focus on specific factors or mechanisms as well as more global ones.

Disrupted Moral Order: A Conceptual Framework for Differentiating Reactions to Loss and Trauma

To discern what turns a child victim of war into a patient, categories relevant to a disrupted moral dimension were applied to play sessions of two groups of children. Both groups had experienced familial loss in the context of war but differed in their clinical status: 7 children (all boys), aged 3 to 10 years, had been referred for psychological consultation and 15 community-based children (9 boys), aged 4 to 6 years, had not been so referred. Both groups exhibited vulnerability and vigilance. Whereas community-based children re-enacted scenarios of parental loss, the loss of a rule-governed universe characterised the play of referred children. Roles of perpetrator, victim, and witness shifted rapidly as moral ambiguities permeated fragmented scenes. Retaliation fantasies were intense but attribution of blame uncertain. Ambiguity and secrecy distinguished parents' narratives in the referred group. The concept of disruption in the moral order as well as the social order was useful as a framework in distinguishing children of differing clinical status.

'The child's past in the adult's present': The trauma of the Siege of Leningrad (1941-1944)

This study deals with the individual and collective memory of Leningrad Siege survivors who experienced mass and prolonged wartime trauma during childhood (1941-44). While much has been published about the Siege, there has to date been no investigation by psychologists into the effects of extreme deprivation on Siege victims apart from one pilot study (Gulina et al., 2005). This study is still underway. Interviews with 80 participants (68 female and 12 male) are analysed and discussed here. Interpretative Phenomenological Analysis (IPA) and content analysis are utilized. Unpublished archival writings by children caught in the Siege have been analysed. The principal method of interpretation is based on a psychoanalytic understanding of child development, mourning and the metabolizing of traumatic experience. The subjective meaning of the Siege experience to individual children is considered.

Mourning the body as bedrock: developmental considerations in treating transsexual patients analytically

This paper introduces the concept of massive gender trauma, a clinical syndrome arising at the onerous intersection of the misgendering of transgender patients and the subjective, anguished experience of the natal body. Analysts have become increasingly aware in recent years of the complex interactions between psyche, soma, and culture. Consequently, the field is increasingly hospitable to considering the psychic risks inherent in misgendering. However, patients' body dysphoria is often left unaddressed even by analysts who seek to work within their analysands' gendered experience. Through a detailed, in-depth account of work with a five-year-old trans girl (female-identified, male-bodied), the developmental implications of the natal body's not becoming sufficiently mentalized in the course of treatment are tracked and explored. Attention to unconscious fantasy and its transformations shows the importance of helping transgender patients whose bodies are a source of suffering to be able to psychically represent their pain as a critical step in the process of a psychologically healthy transition.

[Burden and capability of damaged parents--how refugee children can grow in exile]

In trauma, dialectical tension arises between the inner perspective of the traumatized subject and the outside perspective (objective situation), between environmental stress and the subjective attribution of meaning, as well as between experience and behaviour. The traumatic process--the subject's endeavour to comprehend the overwhelming, often inconceivable experience and integrate it into its concepts of self and world--is understood against the backdrop of these interacting dimensions. The process phases "emerge from each other, run parallel, and permeate each other" (Fischer u. Riedesser, 2003). Problems that arise in the aftermath of trauma are rarely overcome by the victims alone. Attempts to process and self-heal have a social dimension, and family members are affected by war, persecution and flight in individual, varying ways. The impacts of violence experienced by parents from different crisis regions are examined in case studies with regard to the psychological development of indirectly impacted children growing up in exile.

Posttraumatic stress disorder and the nature of trauma

The role of psychological trauma (eg, rape, physical assaults, torture, motor vehicle accidents) as an etiological factor in mental disorders, anticipated as early as the 19th century by Janet, Freud, and Breuer, and more specifically during World War I and II by Kardiner, was “rediscovered” some 20 years ago in the wake of the psychological traumas inflicted by the Vietnam war and the discussion “in the open ” of sexual abuse and rape by the women's liberation movement, 1980 marked a major turning point, with the incorporation of the diagnostic construct of posttraumatic stress disorder (PTSD) into the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and the definition of its main diagnostic criteria (reexperiencing of the traumatic event, avoidance of stimuli associated with the trauma, and symptoms of increased arousal). Initially described as resulting from a onetime severe traumatic incident, PTSD has now been shown to be triggered by chronic multiple traumas as well. This “state-of-the-art” article discusses past and current understanding of the disorder, with particular emphasis on the recent explosive developments in neuroimaging and other fields of the neurosciences that have highlighted the complex interrelationships between the psychological, psychiatric, biological, and neuroanatomical components of the disorder, and opened up entirely new therapeutic perspectives on how to help the victims of trauma overcome their past.

The Poverty in Psychoanalysis: ‘Poverty’ of Psychoanalysis?

The article reviews psychoanalytic scholarship on the themes of poverty and deprivation available on the Psychoanalytic Electronic Publications (PEP-web). The article evaluates select definitions and explanations of poverty as illustrated in the scientific papers published in the PEP-web from 1933 to 2003 (covering 70 years) and finds that psychoanalytic scholarship has very little to say about poverty or the poor. In spite of references to the poverty of dreams, poverty of affect, poverty of intellect, there is in reality little engagement with ‘real’ poverty. The reasons and effects of this neglect are firstly traced to the attitudinal biases and beliefs held by the psychoanalytic authors which prevents them from acknowledging poor and deprived as worthy of their attention. The review also points out to great confusions, oversimplifications and neglect shown in the use of poverty and related terminologies. Absence of fuller appreciation of poverty is then traced to some philosophical quandaries in psychoanalytic epistemology such as the place of real versus psychic, culture versus individual and need versus value to cite a few. A third reason for this neglect may be attributed to the uneven spread, reception and development of psychoanalysis in different geopolit-zical locations, and the neglect in addressing these cultural differences could be behind these social inequalities remaining unaddressed in the literature.

Alexithymia in obsessive-compulsive disorder: clinical correlates and symptom dimensions

Previous studies have indicated that obsessive-compulsive disorder (OCD) is associated with alexithymic traits. The purpose of the current study was to evaluate the difference of alexithymia in OCD patients and healthy controls. This study was also designed to elucidate a specific link between certain OCD symptom dimensions and alexithymia. Forty-five patients with OCD and 45 healthy controls completed measures of the OCD symptom severity, alexithymia, anxiety, and depression. Patients with OCD had significantly higher scores of alexithymia than did the healthy controls. Multiple regression analysis revealed that age at onset and the level of anxiety were significantly associated with alexithymia. "Sexual/religious obsessions" was the only symptom dimension that showed a positive association with alexithymia in OCD patients. These findings suggest that OCD patients with a high level of anxiety and an early age of onset may have greater alexithymic tendency. We also found the first evidence for a specific link between sexual/religious obsessions and alexithymia in patients with OCD.

From hysteria and shell shock to posttraumatic stress disorder: comments on psychoanalytic and neuropsychological approaches

In this paper, we look back at some of the earliest psychoanalytic approaches to trauma. The theoretical feasibility of reconciling psychoanalytic and neurobiological accounts of the effects of severe stress is examined. First, several epistemic considerations about the concepts of falsifiability and complexity in science are discussed with regard to neuroscience and psychoanalysis. We report the decisive discussions and descriptions of shell shock and hysteria that laid the foundation for the modern notions of dissociation and posttraumatic stress disorder (PTSD). We particularly underline the differences between "traumatic memory", which merely and unconsciously repeats the past, and "narrative memory", which narrates the past as past. Then, the construction of the modern concept of PTSD is described and the classification of conversion and dissociative disorders is questioned. In the next section, several recent neurobiological findings in patients with PTSD are reviewed. We place particular emphasis on cognitive impairment and cognitive bias relative to threatening stimuli, and on a general pattern of facilitated and heightened activation of the amygdala for threat-related stimuli, which are both recognized symptoms of PTSD. A possible meeting point between Cannon's and Freud's theoretical concepts is discussed in the frame of a deregulation of the stress system which helps not only to regulate homeostasis but also to adjust behaviour to external threats. We conclude that, although psychoanalysis and neuroscience may reciprocally complement and enlighten each other, their objects and methods, and thence their concepts, are fundamentally different.