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White WF, Burgess A, Dalgleish T, Dixon C, Halligan SL, Hiller RM, McKinnon A, Smith P, Meiser-Stedman R. Investigating the dissociative subtype of post-traumatic stress disorder in single- and multi-event trauma-exposed youth: Prevalence, course, prognosis, severity and functional impairment. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:330-346. [PMID: 38487960 DOI: 10.1111/bjc.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVES This study aimed, following both single- and multi-event trauma, to ascertain prevalence and course of the dissociative subtype of post-traumatic stress disorder (PTSD-DS) in youth; how well early PTSD-DS predicts later PTSD; and whether dissociation accounts for unique variance in post-traumatic stress symptoms (PTSS) and functional impairment over and above the effect of other post-trauma cognitive processing factors and PTSS respectively. DESIGN AND METHODS This study is a secondary analysis of data from the Acute Stress Programme for Children and Teenagers study (n = 234) and the Coping in Care After Trauma study (n = 110) in which children had experienced single- and multi-event trauma respectively. RESULTS PTSD-DS diagnosis was common in children with PTSD regardless of trauma experienced (>39.0%). PTSD-DS showed a similar trajectory of natural recovery to PTSD, and it was similarly predictive of later PTSD following single-event trauma. Finally, dissociation was a significant factor in PTSS and functional impairment. CONCLUSIONS These results should be viewed in the context of several limitations including narrow sample of participants which reduces the generalizability of results, concerns around children's ability to conceptualize challenging concepts such as dissociation and the use of self-report measures to form diagnostic groups. The PTSD-DS diagnosis may offer clinical utility to the extant PTSD diagnosis in children and adolescents, as dissociation has been shown to be a contributory factor in the maintenance of both PTSS and functional impairment. Further research is required to inform further editions of the DSM and other diagnostic systems.
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Affiliation(s)
- William F White
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Aaron Burgess
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Clare Dixon
- Sussex Partnership National Health Service Foundation Trust, Sussex, UK
| | | | - Rachel M Hiller
- Division of Psychology and Language Sciences, University College London, London, UK
- Anna Freud Centre for Children and Families, London, UK
| | - Anna McKinnon
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
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Miranda O, Kiehl SM, Qi X, Brannock MD, Kosten T, Ryan ND, Kirisci L, Wang Y, Wang L. Enhancing post-traumatic stress disorder patient assessment: leveraging natural language processing for research of domain criteria identification using electronic medical records. BMC Med Inform Decis Mak 2024; 24:154. [PMID: 38835009 PMCID: PMC11151516 DOI: 10.1186/s12911-024-02554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Extracting research of domain criteria (RDoC) from high-risk populations like those with post-traumatic stress disorder (PTSD) is crucial for positive mental health improvements and policy enhancements. The intricacies of collecting, integrating, and effectively leveraging clinical notes for this purpose introduce complexities. METHODS In our study, we created a natural language processing (NLP) workflow to analyze electronic medical record (EMR) data and identify and extract research of domain criteria using a pre-trained transformer-based natural language model, all-mpnet-base-v2. We subsequently built dictionaries from 100,000 clinical notes and analyzed 5.67 million clinical notes from 38,807 PTSD patients from the University of Pittsburgh Medical Center. Subsequently, we showcased the significance of our approach by extracting and visualizing RDoC information in two use cases: (i) across multiple patient populations and (ii) throughout various disease trajectories. RESULTS The sentence transformer model demonstrated high F1 macro scores across all RDoC domains, achieving the highest performance with a cosine similarity threshold value of 0.3. This ensured an F1 score of at least 80% across all RDoC domains. The study revealed consistent reductions in all six RDoC domains among PTSD patients after psychotherapy. We found that 60.6% of PTSD women have at least one abnormal instance of the six RDoC domains as compared to PTSD men (51.3%), with 45.1% of PTSD women with higher levels of sensorimotor disturbances compared to men (41.3%). We also found that 57.3% of PTSD patients have at least one abnormal instance of the six RDoC domains based on our records. Also, veterans had the higher abnormalities of negative and positive valence systems (60% and 51.9% of veterans respectively) compared to non-veterans (59.1% and 49.2% respectively). The domains following first diagnoses of PTSD were associated with heightened cue reactivity to trauma, suicide, alcohol, and substance consumption. CONCLUSIONS The findings provide initial insights into RDoC functioning in different populations and disease trajectories. Natural language processing proves valuable for capturing real-time, context dependent RDoC instances from extensive clinical notes.
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Affiliation(s)
- Oshin Miranda
- Computational Chemical Genomics Screening Center, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | | | - Xiguang Qi
- Computational Chemical Genomics Screening Center, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | | | - Thomas Kosten
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Neal David Ryan
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Levent Kirisci
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, 15213, USA
| | - Yanshan Wang
- University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, 15213, USA
| | - LiRong Wang
- Computational Chemical Genomics Screening Center, Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
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Bi Y, Cao C, Fang R, Wang N, Liu P, Luo S, Grace E, Wang L. A latent class analysis of dissociative PTSD subtype among Chinese adolescents following the COVID-19 pandemic and lockdown. J Affect Disord 2024; 349:596-603. [PMID: 38199423 DOI: 10.1016/j.jad.2023.12.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/08/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The COVID-19 pandemic and related policies have amplified the vulnerability of adolescents to the development of posttraumatic stress disorder (PTSD) and dissociation symptoms. This study sought to explore the profile patterns and psychopathological characteristics of co-occurring PTSD and dissociation symptoms in Chinese adolescents. METHODS A total of 57,984 junior and senior high school students in Deyang City, China were recruited between July 13 and July 19, 2020. PTSD and dissociation symptoms, risk factors, and functional impairment variables were assessed using the Global Psychotrauma Screen for Teenagers (GPS-T) instrument. Latent class analysis (LCA) was employed to examine the phenomenology and risk factors of co-occurring PTSD and dissociation symptoms. Analysis of Variance (ANOVA) was utilized to investigate differences in COVID-19 pandemic-related exposure and functional impairment across distinct symptom profiles. RESULTS A 4-class model was selected as the optimal solution, comprising subgroups of low symptom, predominant PTSD symptom, predominant dissociation symptom, and PTSD-dissociation symptom. Class membership could be significantly predicted by other stressful experiences, social support, childhood maltreatment and psychiatric histories. The PTSD-dissociation symptom class exhibited the most severe COVID-19 pandemic-related exposure and functional impairment among all classes. LIMITATIONS The cross-sectional design, Chinese cultural background, online survey method and oversimple measurements were the limitations. CONCLUSIONS Our findings extend existing knowledge about the coexisting patterns of PTSD and dissociation symptoms in adolescents, which could assist in identifying high-risk youths. Furthermore, our findings offer recommendations for shaping public health policies and formulating effective clinical interventions for adolescents following the COVID-19 pandemic and lockdown.
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Affiliation(s)
- Yajie Bi
- Department of Psychosomatics, People's Hospital of Deyang City, Deyang, Sichuan Province, China; School of Psychology, Guizhou Normal University, Guiyang, Guizhou Province, China; Sichuan Clinical Research Center for Neurological Disease, Deyang, Sichuan Province, China
| | - Chengqi Cao
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ruojiao Fang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Na Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Ping Liu
- Department of Psychosomatics, People's Hospital of Deyang City, Deyang, Sichuan Province, China; Sichuan Clinical Research Center for Neurological Disease, Deyang, Sichuan Province, China
| | - Shu Luo
- Department of Psychosomatics, People's Hospital of Deyang City, Deyang, Sichuan Province, China; Sichuan Clinical Research Center for Neurological Disease, Deyang, Sichuan Province, China
| | - Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Li Wang
- Laboratory for Traumatic Stress Studies, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China; School of Psychology, Guizhou Normal University, Guiyang, Guizhou Province, China.
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Shelef L, Bechor U, Ohayon O, Tatsa-Laur L, Antonovsky A. The Psychological Impact of Exposure to Battle on Medics: A Cross-Sectional Study of Ex-Soldiers Who Sought Help From the IDF Combat Reaction Unit. Mil Med 2024; 189:e781-e788. [PMID: 37721515 DOI: 10.1093/milmed/usad368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/31/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION The present study's central aim was to examine two questions: (1) Will there be differences in mental health outcomes between medics and non-medics who sought help at the Israeli Combat Reaction Unit (CRU)? (2) Will there be differences in mental health outcomes between combatants and non-combatants? MATERIALS AND METHODS This cross-sectional study included files of 1,474 Israeli Defense Forces ex-service members (89% combatants, of whom 13% were medics; 11% non-combatants, of whom 6% were medics), who filled out questionnaires on admission for evaluation at the CRU.Dependent variables were mental health measures and included two PTSD measures (Clinician-Administered PTSD Scale and PTSD Checklist for DSM-5), Beck Depression Inventory, Dissociative Experience Scale, and Brief Symptom Inventory. Military profession (medics vs. non-medics) and status (combatant vs. non-combatant) were the independent variables. Background variables were also examined. RESULTS We found no substantial differences between medics and non-medics in the mental health measures. When looking at combat and non-combat separately, the non-combat medics (CMs), in general, were in better mental health conditions than the other three groups- CMs, non-medic combatants, and non-medic non-combatants-all of whom had similar scores in the mental health measures. However, compared to the rest, non-CMs took considerably longer years before approaching the CRU. CONCLUSIONS The elapsed time to seek help for non-MCs was explained by their reluctance to seek help, not being combatants, and being medics who are portrayed as resilient. Recommendations for encouraging this subgroup to seek help were given.
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Affiliation(s)
- Leah Shelef
- The School of Social Work, Sapir Academic College, D. N. Hof Ashkelon 79165, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Uzi Bechor
- Department of Health and Well-Being, IDF Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Ofir Ohayon
- Department of Health and Well-Being, IDF Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Lucian Tatsa-Laur
- Department of Health and Well-Being, IDF Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
| | - Avishai Antonovsky
- Department of Health and Well-Being, IDF Medical Corps, Israel Defense Forces, Ramat Gan 5262000, Israel
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D’Alessandro-Lowe AM, Patel H, Easterbrook B, Ritchie K, Brown A, Xue Y, Karram M, Millman H, Sullo E, Pichtikova M, Nicholson A, Heber A, Malain A, O’Connor C, Schielke H, Rodrigues S, Hosseiny F, McCabe RE, Lanius RA, McKinnon MC. The independent and combined impact of moral injury and moral distress on post-traumatic stress disorder symptoms among healthcare workers during the COVID-19 pandemic. Eur J Psychotraumatol 2024; 15:2299661. [PMID: 38334706 PMCID: PMC10860446 DOI: 10.1080/20008066.2023.2299661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024] Open
Abstract
Background: Healthcare workers (HCWs) across the globe have reported symptoms of Post-Traumatic Stress Disorder (PTSD) during the COVID-19 pandemic. Moral Injury (MI) has been associated with PTSD in military populations, but is not well studied in healthcare contexts. Moral Distress (MD), a related concept, may enhance understandings of MI and its relation to PTSD among HCWs. This study examined the independent and combined impact of MI and MD on PTSD symptoms in Canadian HCWs during the pandemic.Methods: HCWs participated in an online survey between February and December 2021, with questions regarding sociodemographics, mental health and trauma history (e.g. MI, MD, PTSD, dissociation, depression, anxiety, stress, childhood adversity). Structural equation modelling was used to analyze the independent and combined impact of MI and MD on PTSD symptoms (including dissociation) among the sample when controlling for sex, age, depression, anxiety, stress, and childhood adversity.Results: A structural equation model independently regressing both MI and MD onto PTSD accounted for 74.4% of the variance in PTSD symptoms. Here, MI was strongly and significantly associated with PTSD symptoms (β = .412, p < .0001) to a higher degree than MD (β = .187, p < .0001), after controlling for age, sex, depression, anxiety, stress and childhood adversity. A model regressing a combined MD and MI construct onto PTSD predicted approximately 87% of the variance in PTSD symptoms (r2 = .87, p < .0001), with MD/MI strongly and significantly associated with PTSD (β = .813, p < .0001), after controlling for age, sex, depression, anxiety, stress, and childhood adversity.Conclusion: Our results support a relation between MI and PTSD among HCWs and suggest that a combined MD and MI construct is most strongly associated with PTSD symptoms. Further research is needed better understand the mechanisms through which MD/MI are associated with PTSD.
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Affiliation(s)
| | - Herry Patel
- McMaster University, Hamilton, Ontario, Canada
| | | | - Kim Ritchie
- McMaster University, Hamilton, Ontario, Canada
- Trent University, Peterborough, Ontario, Canada
| | | | - Yuanxin Xue
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Mauda Karram
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Emily Sullo
- McMaster University, Hamilton, Ontario, Canada
| | - Mina Pichtikova
- McMaster University, Hamilton, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Andrew Nicholson
- McMaster University, Hamilton, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Alex Heber
- McMaster University, Hamilton, Ontario, Canada
- Canadian Institute for Pandemic Health Education and Response, Regina, Saskatchewan, Canada
| | - Ann Malain
- Homewood Health Centre, Guelph, Ontario, Canada
| | | | | | - Sarah Rodrigues
- University of Ottawa, Ottawa, Ontario, Canada
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
| | - Fardous Hosseiny
- University of Ottawa, Ottawa, Ontario, Canada
- Atlas Institute for Veterans and Families, Ottawa, Ontario, Canada
| | - Randi E. McCabe
- McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Ruth A. Lanius
- University of Western Ontario, London, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - Margaret C. McKinnon
- McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
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6
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Messman BA, Slavish DC, Briggs M, Ruggero CJ, Luft BJ, Kotov R. Daily Sleep-Stress Reactivity and Functional Impairment in World Trade Center Responders. Ann Behav Med 2023; 57:582-592. [PMID: 37078921 DOI: 10.1093/abm/kaad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND How sleep is impacted by stress ("sleep reactivity to stress") and how stress is impacted by sleep ("stress reactivity to sleep") are trait-like characteristics of individuals that predict depression, anxiety, and insomnia. However, pathways between reactivity and functional impairment (e.g., impairment in social relationships and interpersonal functioning) have not been explored, which may be a critical pathway in understanding the link between reactivity and the development of psychological disorders. PURPOSE We examined associations between reactivity and changes in functional impairment among a cohort of 9/11 World Trade Center responders. METHODS Data from 452 responders (Mage = 55.22 years; 89.4% male) were collected between 2014 and 2016. Four baseline sleep and stress reactivity indices (i.e., sleep duration and efficiency reactivity to stress; stress reactivity to sleep duration and efficiency) were calculated from 14 days of sleep and stress data using random slopes from multilevel models. Functional impairment was assessed approximately 1 year and 2 years after baseline via semi-structured interviews. Latent change score analyses examined associations between baseline reactivity indices and changes in functional impairment. RESULTS Greater baseline sleep efficiency reactivity to stress was associated with decreases in functioning (β = -0.05, p = .039). In addition, greater stress reactivity to sleep duration (β = -0.08, p = .017) and sleep efficiency (β = -0.22, p < .001) was associated with lower functioning at timepoint one. CONCLUSION People who are more reactive to daily fluctuations in stress and sleep have poorer interpersonal relationships and social functioning. Identifying individuals with high reactivity who could benefit from preventative treatment may foster better social integration.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Madasen Briggs
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Benjamin J Luft
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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7
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Lebois LAM, Harnett NG, van Rooij SJH, Ely TD, Jovanovic T, Bruce SE, House SL, Ravichandran C, Dumornay NM, Finegold KE, Hill SB, Merker JB, Phillips KA, Beaudoin FL, An X, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Chang AM, Pearson C, Domeier RM, Rathlev NK, O’Neil BJ, Sergot P, Sanchez LD, Miller MW, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Luna B, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Stevens JS, Ressler KJ. Persistent Dissociation and Its Neural Correlates in Predicting Outcomes After Trauma Exposure. Am J Psychiatry 2022; 179:661-672. [PMID: 35730162 PMCID: PMC9444876 DOI: 10.1176/appi.ajp.21090911] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Dissociation, a disruption or discontinuity in psychological functioning, is often linked with worse psychiatric symptoms; however, the prognostic value of dissociation after trauma is inconsistent. Determining whether trauma-related dissociation is uniquely predictive of later outcomes would enable early identification of at-risk trauma populations. The authors conducted the largest prospective longitudinal biomarker study of persistent dissociation to date to determine its predictive capacity for adverse psychiatric outcomes following acute trauma. METHODS All data were part of the Freeze 2 data release from the Advancing Understanding of Recovery After Trauma (AURORA) study. Study participants provided self-report data about persistent derealization (N=1,464), a severe type of dissociation, and completed a functional MRI emotion reactivity task and resting-state scan 2 weeks posttrauma (N=145). Three-month follow-up reports were collected of posttraumatic stress, depression, pain, anxiety symptoms, and functional impairment. RESULTS Derealization was associated with increased ventromedial prefrontal cortex (vmPFC) activation in the emotion reactivity task and decreased resting-state vmPFC connectivity with the cerebellum and orbitofrontal cortex. In separate analyses, brain-based and self-report measures of persistent derealization at 2 weeks predicted worse 3-month posttraumatic stress symptoms, distinct from the effects of childhood maltreatment history and current posttraumatic stress symptoms. CONCLUSIONS The findings suggest that persistent derealization is both an early psychological and biological marker of worse later psychiatric outcomes. The neural correlates of trauma-related dissociation may serve as potential targets for treatment engagement to prevent posttraumatic stress disorder. These results underscore dissociation assessment as crucial following trauma exposure to identify at-risk individuals, and they highlight an unmet clinical need for tailored early interventions.
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Affiliation(s)
- Lauren A M Lebois
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Nathaniel G Harnett
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Timothy D Ely
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MA, 48202, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Caitlin Ravichandran
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA
| | - Nathalie M Dumornay
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | | | - Sarah B Hill
- Department of Psychology, Northern Illinois University, DeKalb, IL, 60115, USA
| | - Julia B Merker
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - Karlye A Phillips
- McLean Hospital, Belmont, MA, 02478, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Francesca L Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, 02930, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T Germine
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- The Many Brains Project, Belmont, MA, 02478, USA
| | - Scott L Rauch
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E Punches
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- College of Nursing, University of Cincinnati, Cincinnati, OH, 45221, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, 48309, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, 19104, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA, 19104, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA, 19141, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA, 19107, USA
| | - Anna M Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J O’Neil
- Department of Emergency Medicine, Wayne State University, Detroit, MA, 48202, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX, 77030, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Mark W Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jutta Joormann
- Department of Psychology, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - John F Sheridan
- Department of Biosciences, OSU Wexner Medical Center, Columbus, OH, 43210, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M Elliott
- Kolling Institute of Medical Research, University of Sydney, St Leonards, New South Wales, 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, 2006, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
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8
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Durham TA, Byllesby BM, Elhai JD, Wang L. Latent profile analysis of PTSD and dissociation, and relations with anger. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00693-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Umucu E, Rumrill P, Chiu CY, Ghosh A. Functional Limitations, Post-Traumatic Stress Disorder, and College Adjustment in Student Veterans: A Mediation Analysis Study. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2022. [DOI: 10.1891/re-21-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PurposeThe purpose of this study was to examine whether functional limitations mediate the relation between PTSD symptoms and college life adjustment in student veterans with PTSD symptoms.MethodsA total of 232 student veterans with PTSD symptoms were recruited for this study. Participants were predominantly male (84.5%; females = 15.5%). Participants’ ages ranged from 18 to 54 years (M = 28.43, SD = 5.42). Correlational analyses were conducted to calculate the relationships among study variables. We also conducted a mediation analysis to examine whether functional limitations mediate the relationship between PTSD symptoms and college life adjustment.ResultsThe mediation analysis indicated that the effect of PTSD symptoms on college adjustment can be partially explained by functional limitations.ConclusionOur results have potentially important implications for rehabilitation counseling researchers and clinicians in the COVID-19 era.
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10
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Patel H, O'Connor C, Andrews K, Amlung M, Lanius R, McKinnon MC. Dissociative symptomatology mediates the relation between posttraumatic stress disorder severity and alcohol-related problems. Alcohol Clin Exp Res 2022; 46:289-299. [PMID: 35179786 PMCID: PMC9307004 DOI: 10.1111/acer.14764] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/25/2021] [Accepted: 12/12/2021] [Indexed: 01/04/2023]
Abstract
Background Up to 50% of individuals with posttraumatic stress disorder (PTSD) endorse problematic alcohol use. Typically, these individuals present with more complex and often more severe PTSD symptoms than those who do not report problematic alcohol use. Emerging literature suggests that heightened symptoms of dissociation are likewise associated with greater PTSD symptom severity. Despite this knowledge, the role of dissociation in the relation between PTSD severity and alcohol‐related problems has yet to be examined. Here, we explore the mediating role of dissociative symptomatology on the association between PTSD severity and alcohol‐related problems within a PTSD treatment‐seeking sample. Methods Structural equation modeling was used to test the mediating role of dissociative symptomatology between PTSD severity and alcohol‐related problems. Participants [N = 334; mean age (SD) = 44.29 (9.77), 50% female] were drawn from a clinical intake battery database for PTSD in‐patient treatment services at Homewood Health Care, Guelph, ON, Canada. A subset of battery measures assessing PTSD severity, dissociative symptomatology, and alcohol‐related problems were submitted to analysis. Results A significant positive association emerged between PTSD severity and alcohol‐related problems (β = 0.127, p < 0.05) in the absence of dissociative symptomatology. Critically, however, when added to this model, dissociative symptomatology (six unique facets of dissociation assessed by the Multiscale Dissociation Inventory) mediated the relation between PTSD severity and alcohol‐related problems. Specifically, greater PTSD severity was associated with greater dissociative symptomatology (β = 0.566, p < 0.0001), which was in turn associated with greater alcohol‐related problems (β = 0.184, p < 0.05). Conclusions These results suggest that dissociative symptomatology plays a key role in explaining the relation between PTSD severity and alcohol‐related problems. Future studies should examine the impact of targeting dissociative symptomatology specifically in treating individuals with PTSD who endorse alcohol‐related problems.
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Affiliation(s)
- Herry Patel
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Krysta Andrews
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Amlung
- Department of Applied Behavioral Science, University of Kansas, Lawrence, Kansas, USA.,Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas, USA
| | - Ruth Lanius
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada.,Mental Health and Addictions Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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11
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Abstract
Post-traumatic Stress Disorder is a chronic condition that occurs following a traumatic experience. Information processing models of PTSD focus on integrating situationally triggered sensory-emotional memories with consciously accessible autobiographical memories. Review of the nature of implicit memory supports the view that sensory-emotional memories are implicit in nature. Dissociation was also found to be associated with the development and severity of PTSD, as well as deficits in autobiographical memory. Moreover, disorganized attachment (DA) was associated with greater degrees of dissociation and PTSD, and like the defining neural activation in PTSD, was found to be associated with basal ganglia activity. In addition, subcortical neuroception of safety promotes a neurophysiological substrate supportive of social engagement and inhibition of fear-based responses. Furthermore, activation of representations of co-created imagined scenes of safety and secure attachment are associated with increases in this neurophysiological substrate. Repeated priming of secure attachment imagery was associated with modification of internal working models of DA along with reductions in dissociation and recovery from complex PTSD. In conclusion, it is posited that adequate recovery from extensive trauma experiences requires more than conscious elaboration of traumatic autobiographical memories and that the application of implicit nonconscious memory modification strategies will facilitate more optimal recovery.
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12
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Williams M, Zare M. A Psychometric Investigation of Racial Trauma Symptoms Using a Semi-Structured Clinical Interview With a Trauma Checklist (UnRESTS). CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2022; 6:24705470221145126. [PMID: 36578698 PMCID: PMC9791291 DOI: 10.1177/24705470221145126] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
The term racial trauma is used to describe the cumulative distressing and traumatizing effects of racism in all of its forms, and it closely resembles the construct of posttraumatic stress disorder (PTSD). This investigation aims to increase our understanding of racial trauma by comparing the characteristics of those with a clinically-relevant diagnosis of racial trauma to those without, based on the findings of a clinical semi-structured interview and symptom checklist for assessing racial trauma, the University of Connecticut Racial Ethnic Stress and Trauma Survey (UnRESTS), administered to a diverse group of adults (N = 97). This paper extends prior work on racial trauma by examining the correlations between racial trauma and validated self-report measures of discriminatory distress, controlling for racialization. We examine the correlation between a clinically-relevant diagnosis of racial trauma and racial/ethnic identity. We also compare racism-related PTSD symptoms in those with and without racial trauma to inform clinical assessment. Finally, we examine the factor structure of racial trauma symptoms using the 24 items from the UnRESTS PTSD symptom checklist and compare these to current DSM-5 models. The structure of racial trauma symptoms differed from the DSM-5 4-factor model, as do other PTSD models in the research literature. Clinical and research implications are discussed.
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Affiliation(s)
| | - Manzar Zare
- School of Psychology, University of Ottawa, Ottawa, Canada
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13
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Problems with the dissociative subtype of posttraumatic stress disorder in DSM-5. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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Olivé I, Makris N, Densmore M, McKinnon MC, Lanius RA. Altered basal forebrain BOLD signal variability at rest in posttraumatic stress disorder: A potential candidate vulnerability mechanism for neurodegeneration in PTSD. Hum Brain Mapp 2021; 42:3561-3575. [PMID: 33960558 PMCID: PMC8249881 DOI: 10.1002/hbm.25454] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/15/2021] [Accepted: 04/11/2021] [Indexed: 12/11/2022] Open
Abstract
Individuals with posttraumatic stress disorder (PTSD) are at increased risk for the development of various forms of dementia. Nevertheless, the neuropathological link between PTSD and neurodegeneration remains unclear. Degeneration of the human basal forebrain constitutes a pathological hallmark of neurodegenerative diseases, such as Alzheimer's and Parkinson's disease. In this seed-based resting-state (rs-)fMRI study identifying as outcome measure the temporal BOLD signal fluctuation magnitude, a seed-to-voxel analyses assessed temporal correlations between the average BOLD signal within a bilateral whole basal forebrain region-of-interest and each whole-brain voxel among individuals with PTSD (n = 65), its dissociative subtype (PTSD+DS) (n = 38) and healthy controls (n = 46). We found that compared both with the PTSD and healthy controls groups, the PTSD+DS group exhibited increased BOLD signal variability within two nuclei of the seed region, specifically in its extended amygdaloid region: the nucleus accumbens and the sublenticular extended amygdala. This finding is provocative, because it mimics staging models of neurodegenerative diseases reporting allocation of neuropathology in early disease stages circumscribed to the basal forebrain. Here, underlying candidate etiopathogenetic mechanisms are neurovascular uncoupling, decreased connectivity in local- and large-scale neural networks, or disrupted mesolimbic dopaminergic circuitry, acting indirectly upon the basal forebrain cholinergic pathways. These abnormalities may underpin reward-related deficits representing a putative link between persistent traumatic memory in PTSD and anterograde memory deficits in neurodegeneration. Observed alterations of the basal forebrain in the dissociative subtype of PTSD point towards the urgent need for further exploration of this region as a potential candidate vulnerability mechanism for neurodegeneration in PTSD.
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Affiliation(s)
- Isadora Olivé
- Faculty of Brain Sciences, Division of PsychiatryUniversity College of LondonLondonUnited Kingdom
| | - Nikos Makris
- Departments of Psychiatry and Neurology Services, Center for Neural Systems InvestigationCenter for Morphometric Analysis, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General HospitalBostonMassachusettsUSA
- Department of Psychiatry Neuroimaging LaboratoryBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
- Department of Anatomy & NeurobiologyBoston University School of MedicineBostonMassachusettsUSA
| | - Maria Densmore
- Department of PsychiatryUniversity of Western OntarioLondonOntarioCanada
- Imaging DivisionLawson Health Research InstituteLondonOntarioCanada
| | - Margaret C. McKinnon
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonOntarioCanada
- Homewood Research InstituteGuelphOntarioCanada
- Mood Disorders ProgramSt Joseph's HealthcareHamiltonOntarioCanada
| | - Ruth A. Lanius
- Department of PsychiatryUniversity of Western OntarioLondonOntarioCanada
- Imaging DivisionLawson Health Research InstituteLondonOntarioCanada
- Department of NeurosciencesUniversity of Western OntarioLondonOntarioCanada
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15
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Post-traumatic stress disorder in train crash survivors in Italy: the role of mood spectrum dysregulations and intrusiveness. CNS Spectr 2021; 26:71-76. [PMID: 32336316 DOI: 10.1017/s1092852920001145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To explore relationships among post-traumatic stress disorder (PTSD), depressive spectrum symptoms, and intrusiveness in subjects who survived the crash of a train derailed carrying liquefied petroleum gas and exploded causing a fire. METHODS A sample of 111 subjects was enrolled in Viareggio, Italy. AMOS version 21 (IBM Corp, 2012) was utilized for a structural equation model-path analysis to model the direct and indirect links between the exposure to the traumatic event, the occurrence of depressive symptoms, and intrusiveness. Subjects were administered with the SCID-IV (Structured Clinical Interview for DSM-IV), the Questionnaire for Mood Spectrum (MOODS-SR)-Last Month version, the Trauma and Loss Spectrum Questionnaire (TALS-SR), and the Impact of Event Scale-Revised version (IES-R). RESULTS Sixty-six (66/111; 59.4%) subjects met SCID-IV criteria for PTSD. Indices of goodness of fit were as followed: χ2/df = 0.2 P = .6; comparative fit index = 1 and root mean square error of approximation = 0.0001. A significant path coefficient for direct effect of potential traumatic events on depressive symptoms (β = 0.25; P < .04) and from depressive symptoms to intrusiveness (β = 0.34; P < .003) was found. An indirect effect was also observed: standardized value of potential traumatic events on intrusiveness was 0.86. The mediating factor of this indirect effect path was represented by depressive symptoms. Potential traumatic events explained 6.2% of the variance of depressive symptoms; 11.8% of the variance of intrusiveness was accounted for traumatic event and depressive symptoms. CONCLUSIONS Path analysis led us to speculate that depression symptoms might have mediated the relationship between the exposure to potential traumatic events and intrusiveness for the onset of PTSD.
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16
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Modrowski CA, Rizzo CJ, Collibee C, Houck CD, Schneider K. Victimization profiles in girls involved in the juvenile justice system: A latent class analysis. CHILD ABUSE & NEGLECT 2021; 111:104774. [PMID: 33158582 PMCID: PMC7855520 DOI: 10.1016/j.chiabu.2020.104774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Previous research has demonstrated that youth involved in the juvenile justice system endorse diverse patterns of victimization. However, previous research investigating victimization profiles among youth involved in the juvenile justice system has primarily consisted of boys. OBJECTIVE This study investigated victimization profiles and correlates of victimization exposure, including posttraumatic stress symptoms and risk behaviors, in a sample of girls involved in the juvenile justice system. PARTICIPANTS AND SETTING Participants were 245 girls involved in the juvenile justice system (Mage = 15.57, SD = 1.13) participating in a dating violence prevention program. The sample was racially diverse, and 48 % self-identified as Hispanic/Latina. METHOD Prior to participating in the intervention, participants completed self-report measures of adversity and victimization exposure, posttraumatic stress symptoms, and risk behaviors. RESULTS Results of latent class analysis identified three distinct victimization profiles. The first class (n = 106) was characterized by low levels of victimization. The second class (n = 98) experienced predominantly emotional victimization (i.e., emotional dominant). The third class (n = 41) was characterized by exposure to polyvictimization (i.e., polyvictimization predominant). Girls categorized into the polyvictimization dominant class evidenced the greatest levels of posttraumatic stress symptoms, substance use, suicidal behaviors, and sexual risk behaviors. CONCLUSIONS Girls involved in the juvenile justice system report distinct patterns of victimization, which are differentially associated with posttraumatic stress symptoms and risk behaviors. The present study underscores the importance of implementing trauma-informed assessment and intervention practices within juvenile justice systems.
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Affiliation(s)
- Crosby A Modrowski
- Alpert Medical School of Brown University/Bradley Hasbro Children's Research Center, 1 Hoppin Street, Suite 204 Providence, RI, 02903, United States.
| | - Christie J Rizzo
- Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States.
| | - Charlene Collibee
- Alpert Medical School of Brown University/Bradley Hasbro Children's Research Center, 1 Hoppin Street, Suite 204 Providence, RI, 02903, United States.
| | - Christopher D Houck
- Alpert Medical School of Brown University/Bradley Hasbro Children's Research Center, 1 Hoppin Street, Suite 204 Providence, RI, 02903, United States.
| | - Kaitlyn Schneider
- Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States.
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17
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Park AH, Protopopescu A, Pogue ME, Boyd JE, O'Connor C, Lanius RA, McKinnon MC. Dissociative symptoms predict severe illness presentation in Canadian public safety personnel with presumptive post-traumatic stress disorder (PTSD). Eur J Psychotraumatol 2021; 12:1953789. [PMID: 34512927 PMCID: PMC8425686 DOI: 10.1080/20008198.2021.1953789] [Citation(s) in RCA: 3] [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] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder affects 9% of individuals across their lifetime and increases nearly fourfold to 35% in Canadian public safety personnel (PSP). On-the-job experiences of PSP frequently meet criteria for traumatic events, making these individuals highly vulnerable to exposures of trauma and the negative consequences of PTSD. Few studies have reported on the clinical characteristics of Canadian samples of PSP and even fewer have examined the dissociative subtype of PTSD, which is associated with more severe, chronic traumatic experiences, and worse outcomes. OBJECTIVE This study aimed to characterize dissociative symptoms, PTSD symptom severity, and other clinical variables among Canadian PSP with presumptive PTSD. METHODS We sampled current and past PSP in Canada from both inpatient and outpatient populations (N = 50) that were enrolled in a psychological intervention. Only baseline testing data (prior to any intervention) were analysed in this study, such as PTSD symptom severity, dissociative symptoms, emotion dysregulation, and functional impairment. RESULTS In our sample, 24.4% self-reported elevated levels of dissociation, specifically symptoms of depersonalization and derealization. Depersonalization and derealization symptoms were associated with more severe PTSD symptoms, greater emotion dysregulation, and functional impairment. CONCLUSIONS Nearly a quarter of this sample of Canadian PSP reported experiencing elevated levels of PTSD-related dissociation (depersonalization and derealization). These high levels of depersonalization and derealization were consistently positively associated with greater illness severity across clinical measures. It is imperative that dissociative symptoms be better recognized in patient populations that are exposed to chronic traumatic events such as PSP, so that treatment interventions can be designed to target a more severe illness presentation.
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Affiliation(s)
- Anna H Park
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada.,Homewood Research Institute, Guelph, Canada
| | - Alina Protopopescu
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada.,Homewood Research Institute, Guelph, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Michelle E Pogue
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada.,Homewood Research Institute, Guelph, Canada
| | - Jenna E Boyd
- Homewood Research Institute, Guelph, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | | | - Ruth A Lanius
- Homewood Research Institute, Guelph, Canada.,Department of Neuroscience, Robarts Research Institute, RRI 3203, Western University, London, Canada.,Department of Psychiatry, Parkwood Institute, Mental Health Care Building, F4-430, Western University, London, Canada.,Lawson Health Research Institute, London, Canada
| | - Margaret C McKinnon
- Homewood Research Institute, Guelph, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
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18
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Rabellino D, Frewen PA, McKinnon MC, Lanius RA. Peripersonal Space and Bodily Self-Consciousness: Implications for Psychological Trauma-Related Disorders. Front Neurosci 2020; 14:586605. [PMID: 33362457 PMCID: PMC7758430 DOI: 10.3389/fnins.2020.586605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
Peripersonal space (PPS) is defined as the space surrounding the body where we can reach or be reached by external entities, including objects or other individuals. PPS is an essential component of bodily self-consciousness that allows us to perform actions in the world (e.g., grasping and manipulating objects) and protect our body while interacting with the surrounding environment. Multisensory processing plays a critical role in PPS representation, facilitating not only to situate ourselves in space but also assisting in the localization of external entities at a close distance from our bodies. Such abilities appear especially crucial when an external entity (a sound, an object, or a person) is approaching us, thereby allowing the assessment of the salience of a potential incoming threat. Accordingly, PPS represents a key aspect of social cognitive processes operational when we interact with other people (for example, in a dynamic dyad). The underpinnings of PPS have been investigated largely in human models and in animals and include the operation of dedicated multimodal neurons (neurons that respond specifically to co-occurring stimuli from different perceptive modalities, e.g., auditory and tactile stimuli) within brain regions involved in sensorimotor processing (ventral intraparietal sulcus, ventral premotor cortex), interoception (insula), and visual recognition (lateral occipital cortex). Although the defensive role of the PPS has been observed in psychopathology (e.g., in phobias) the relation between PPS and altered states of bodily consciousness remains largely unexplored. Specifically, PPS representation in trauma-related disorders, where altered states of consciousness can involve dissociation from the body and its surroundings, have not been investigated. Accordingly, we review here: (1) the behavioral and neurobiological literature surrounding trauma-related disorders and its relevance to PPS; and (2) outline future research directions aimed at examining altered states of bodily self-consciousness in trauma related-disorders.
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Affiliation(s)
- Daniela Rabellino
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Paul A. Frewen
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| | - Margaret C. McKinnon
- Mood Disorders Program, St. Joseph’s Healthcare, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
| | - Ruth A. Lanius
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
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19
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McCuaig Edge HJ, Lee JEC. The Mediating Role of Alexithymia in the Association Between Adverse Childhood Experiences and Postdeployment Mental Health in Canadian Armed Forces Personnel. J Trauma Stress 2020; 33:1029-1038. [PMID: 32974957 DOI: 10.1002/jts.22547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 11/09/2022]
Abstract
Recent studies showing an association between adverse childhood experiences and the development of alexithymia in military personnel have generated interest regarding the role of alexithymia in the pathway linking childhood trauma exposure to mental health disorders. Accordingly, the current study was conducted to (a) examine the associations among adverse childhood experiences, alexithymia, and symptoms of depression and posttraumatic stress disorder (PTSD) among recently deployed Canadian military personnel and (b) assess the mediating role of alexithymia in these associations. Data collected from 2,927 members of the Canadian Armed Forces at baseline and after their return from an overseas deployment were subjected to a prospective path analysis. The results of the path analysis, R2 = .35, pointed to a significant direct effect of childhood adversity on postdeployment mental health symptoms. Contrary to our expectations, the results also pointed to a negative indirect effect of childhood neglect, suggesting that childhood neglect contributed to lower levels of postdeployment depression and PTSD symptoms through the dimension of alexithymia related to difficulty in describing feelings. These patterns of associations, for the most part, persisted even when accounting for combat exposure during recent deployments, R2 = .42. The present results are discussed in light of study limitations and methodological considerations, and policy and clinical implications are noted.
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20
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Radomski MV, Giles GM, Owens J, Showers M, Rabusch S, Kreiger R, Zola J, Kath K. Can service members with mild traumatic brain injury learn to develop implementation intentions for self-identified goals? Disabil Rehabil 2020; 44:2640-2647. [PMID: 33147426 DOI: 10.1080/09638288.2020.1841309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Goal achievement relies heavily on executive functions, which may be compromised following mild traumatic brain injury (mTBI). Implementation intentions (II) have been found to help people act in accordance with their goals. II are written statements that describe a behavior that a person plans to enact when they encounter some form of anticipated trigger or stimulus. We evaluated the feasibility of teaching participants with mTBI to develop II for self-identified goals within the context of cognitive rehabilitation. METHODS Soldiers with mTBI were recruited from a traumatic brain injury clinic. During the intervention, participants were assigned to develop an II for one of three self-identified goals every day. Descriptive methods were used to examine implementability and acceptability of the II training protocol as well as the extent to which participants learned to develop II for their own goals. RESULTS The II training protocol was found to be highly implementable and acceptable to participants. Overall, participants (n = 16) were able to develop II related to their self-identified goals, which primarily focused on managing cognitive problems. For the most part, participants developed II that involved event- rather than time- or somatic/feeling-based triggers. CONCLUSION AND IMPLICATIONS Participants with mTBI were able to learn to develop II for their self-identified goals. Further study is needed to determine whether adding II to cognitive rehabilitation advances patient goal achievement.IMPLICATIONS FOR REHABILITATIONIt is feasible to incorporate training in implementation intentions (predetermined "if/when-then" plans that are intended to link specific situational triggers with actions) in metacognitive strategy instruction for patients with mild traumatic brain injury.Participants with mild traumatic brain injury in this study demonstrated that they were able to develop implementation intentions for multiple self-identified rehabilitation goals, which holds promise for also teaching patients with mild cognitive impairment from other conditions.Learning to develop implementation intentions may help patients with mild traumatic brain injury initiate a range of other cognitive strategies in their everyday lives.Implementation intentions have the potential to help patients enact goal behaviors associated with their rehabilitation goals, making cognitive rehabilitation more "customizable" and relevant to clients' specific needs.
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Affiliation(s)
| | - Gordon Muir Giles
- Occupational Therapy Programs, Samuel Merritt University, Oakland, CA, USA.,Neurobehavioral Services, Crestwood Behavioral Health, Inc, Sacramento, CA, USA
| | - Jenny Owens
- Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Mark Showers
- Fort Campbell Intrepid Spirit, Fort Campbell, KY, USA
| | - Stacey Rabusch
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
| | - Rob Kreiger
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
| | - Joette Zola
- Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN, USA
| | - Kristina Kath
- Courage Kenny Research Center, Allina Health, Minneapolis, MN, USA
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21
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Tesarz J, Baumeister D, Andersen TE, Vaegter HB. Pain perception and processing in individuals with posttraumatic stress disorder: a systematic review with meta-analysis. Pain Rep 2020; 5:e849. [PMID: 33490843 PMCID: PMC7808684 DOI: 10.1097/pr9.0000000000000849] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a known risk factor for the development of chronic pain conditions, and almost 1 in 5 individuals with chronic pain fulfills the criteria for PTSD. However, the relationship between PTSD and pain is poorly understood and studies on pain perception in patients with PTSD show inconsistent results suggesting that different sensory profiles exist among individuals with PTSD. Here, we (1) systematically summarize the current literature on experimentally evoked pain perception in patients with PTSD compared to subjects without PTSD, and (2) assess whether the nature of the traumatic event is associated with different patterns in pain perception. The main outcome measures were pain threshold, pain tolerance, and pain intensity ratings as well as measures of temporal summation of pain and conditioned pain modulation. A systematic search of MEDLINE, EMBASE, Web of Science, PsycINFO, and CINAHL identified 21 studies for the meta-analysis, including 422 individuals with PTSD and 496 PTSD-free controls. No main effect of PTSD on any outcome measure was found. However, stratification according to the nature of trauma revealed significant differences of small to medium effect sizes. Combat-related PTSD was associated with increased pain thresholds, whereas accident-related PTSD was associated with decreased pain thresholds. No clear relationship between PTSD and experimentally evoked pain perception exists. The type of trauma may affect pain thresholds differently indicating the presence of different subgroups with qualitative differences in pain processing.
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Affiliation(s)
- Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Heidelberg, Germany
| | - David Baumeister
- Department of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Heidelberg, Germany
| | | | - Henrik Bjarke Vaegter
- Pain Research Group, Pain Center, Department of Anesthesiology and Intensive Care Medicine, University Hospital Odense, University Hospital Odense, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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22
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Ellickson-Larew S, Escarfulleri S, Wolf EJ. The Dissociative Subtype of Posttraumatic Stress Disorder: Forensic Considerations and Recent Controversies. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09381-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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23
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Blades R, Jordan S, Becerra S, Eusebio B, Heatwole M, Iovine J, Mahdavi K, Mamoun M, Nicodemus N, Packham H, Spivak N, Kuhn T. Treating dissociative post-traumatic stress disorder presenting as a functional movement disorder with transcranial magnetic stimulation targeting the cingulate gyrus. Neurol Sci 2020; 41:2275-2280. [DOI: 10.1007/s10072-020-04433-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/16/2020] [Indexed: 12/01/2022]
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24
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Nicholson AA, Harricharan S, Densmore M, Neufeld RWJ, Ros T, McKinnon MC, Frewen PA, Théberge J, Jetly R, Pedlar D, Lanius RA. Classifying heterogeneous presentations of PTSD via the default mode, central executive, and salience networks with machine learning. Neuroimage Clin 2020; 27:102262. [PMID: 32446241 PMCID: PMC7240193 DOI: 10.1016/j.nicl.2020.102262] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/26/2023]
Abstract
Intrinsic connectivity networks (ICNs), including the default mode network (DMN), the central executive network (CEN), and the salience network (SN) have been shown to be aberrant in patients with posttraumatic stress disorder (PTSD). The purpose of the current study was to a) compare ICN functional connectivity between PTSD, dissociative subtype PTSD (PTSD+DS) and healthy individuals; and b) to examine the use of multivariate machine learning algorithms in classifying PTSD, PTSD+DS, and healthy individuals based on ICN functional activation. Our neuroimaging dataset consisted of resting-state fMRI scans from 186 participants [PTSD (n = 81); PTSD + DS (n = 49); and healthy controls (n = 56)]. We performed group-level independent component analyses to evaluate functional connectivity differences within each ICN. Multiclass Gaussian Process Classification algorithms within PRoNTo software were then used to predict the diagnosis of PTSD, PTSD+DS, and healthy individuals based on ICN functional activation. When comparing the functional connectivity of ICNs between PTSD, PTSD+DS and healthy controls, we found differential patterns of connectivity to brain regions involved in emotion regulation, in addition to limbic structures and areas involved in self-referential processing, interoception, bodily self-consciousness, and depersonalization/derealization. Machine learning algorithms were able to predict with high accuracy the classification of PTSD, PTSD+DS, and healthy individuals based on ICN functional activation. Our results suggest that alterations within intrinsic connectivity networks may underlie unique psychopathology and symptom presentation among PTSD subtypes. Furthermore, the current findings substantiate the use of machine learning algorithms for classifying subtypes of PTSD illness based on ICNs.
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Affiliation(s)
- Andrew A Nicholson
- Department of Cognition, Emotion and Methods in Psychology, University of Vienna, Austria; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Sherain Harricharan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Maria Densmore
- Department of Psychiatry, Western University, London, ON, Canada; Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Richard W J Neufeld
- Department of Psychiatry, Western University, London, ON, Canada; Department of Psychology, Western University, London, ON, Canada; Department of Medical Imaging, Western University, London, ON, Canada
| | - Tomas Ros
- Department of Neuroscience, University of Geneva, Switzerland
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program, St. Joseph's Healthcare, Hamilton, ON, Canada; Homewood Research Institute, Guelph, ON, Canada
| | - Paul A Frewen
- Department of Psychiatry, Western University, London, ON, Canada; Department of Neuroscience, Western University, London, ON, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, London, ON, Canada; Department of Medical Imaging, Western University, London, ON, Canada; Imaging Division, Lawson Health Research Institute, London, ON, Canada; Department of Diagnostic Imaging, St. Joseph's Health Care, London, ON, Canada
| | - Rakesh Jetly
- Canadian Forces, Health Services, Ottawa, Ontario, Canada
| | - David Pedlar
- Canadian Institute for Military and Veteran Health Research (CIMVHR), Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, ON, Canada; Department of Neuroscience, Western University, London, ON, Canada; Imaging Division, Lawson Health Research Institute, London, ON, Canada
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25
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Smith GP, Hartelius G. Resolution of Dissociated Ego States Relieves Flashback-Related Symptoms in Combat-Related PTSD: A Brief Mindfulness Based Intervention. MILITARY PSYCHOLOGY 2020; 32:135-148. [PMID: 38536266 PMCID: PMC10013259 DOI: 10.1080/08995605.2019.1654292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/07/2019] [Indexed: 10/25/2022]
Abstract
A novel understanding and therapeutic approach to the treatment of PTSD-related flashback triggers are described. Triggered responses are conceptualized as the result of latent dissociative structures of neural organization and psychodynamic functioning activated by current events. The dissociative structure - here described as a dissociated ego state (DES) - reflects a fracturing of executive functioning resulting in a delimited aspect of self that is not under cognitive control or subject to cognitive inhibition by the self of daily experience, and is the psychological construct behind intrusive PTSD symptoms. Use of a mindful attentional state permits regulated access to the DES (therapeutic engagement without risk of emotional dysregulation) so that dissociated cognitive resources can be recovered and the dissociated structure deactivated. This may relieve maladaptive responses and behaviors associated with the DES in a profound and durable way, without the need for exposure to or recovery of traumatic memories. Based on this understanding, a 9-step intervention is introduced with a case example of a Vietnam veteran suffering PTSD symptoms for 49 years with significant gains maintained at 21 months follow up. These findings demonstrate rapid and durable resolution of chronic PTSD symptoms through a mindfulness-based approach that focused on deactivation of dissociated ego states, in contrast to targeting trauma memories. If proven efficacious, this novel approach may result in reduced treatment costs and improved outcomes for veterans suffering with PTSD.
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Affiliation(s)
- Genine P. Smith
- Department of Integral and Transpersonal Psychology, California Institute of Integral Studies, San Francisco, California, USA
| | - Glenn Hartelius
- Department of Integral and Transpersonal Psychology, California Institute of Integral Studies, San Francisco, California, USA
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26
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Eidhof MB, Ter Heide FJJ, van Der Aa N, Schreckenbach M, Schmidt U, Brand BL, Lanius RA, Loewenstein RJ, Spiegel D, Vermetten E. The Dissociative Subtype of PTSD Interview (DSP-I): Development and Psychometric Properties. J Trauma Dissociation 2019; 20:564-581. [PMID: 31132959 DOI: 10.1080/15299732.2019.1597806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The inclusion of the dissociative subtype of post-traumatic stress disorder (PTSD-DS) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reflects the importance of assessing PTSD-DS. We developed the Dissociative Subtype of PTSD Interview (DSP-I). This clinician-administered instrument assesses the presence and severity of PTSD-DS (i.e., symptoms of depersonalization or derealization) and contains a supplementary checklist that enables assessment and differentiation of other trauma-related dissociative symptoms (i.e., blanking out, emotional numbing, alterations in sensory perception, amnesia, and identity confusion). The psychometric properties were tested in 131 treatment-seeking individuals with PTSD and histories of multiple trauma, 17.6 % of whom met criteria for PTSD-DS in accordance with the DSP-I. The checklist was tested in 275 treatment-seeking individuals. Results showed the DSP-I to have high internal consistency, good convergent validity with PTSD-DS items of the CAPS-5, and good divergent validity with scales of somatization, anxiety and depression. The depersonalization and derealization scales were highly associated. Moreover, the DSP-I accounted for an additional variance in PTSD severity scores of 8% over and above the CAPS-5 and number of traumatic experiences. The dissociative experiences of the checklist were more strongly associated with scales of overall distress, somatization, depression, and anxiety than scales of depersonalization and derealization. In conclusion, the DSP-I appears to be a clinically relevant and psychometrically sound instrument that is valuable for use in clinical and research settings.
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Affiliation(s)
- Marloes B Eidhof
- Psychotraumacentrum Zuid Nederland, Reinier van Arkel , 's Hertogenbosch , The Netherlands.,Psychotrauma Expert Group, Arq , Diemen , The Netherlands
| | | | | | | | - Ulrike Schmidt
- Max Planck Institute of Psychiatry , München , Germany.,Clinic of Psychiatry and Psychotherapy, Psychotrauma Unit & RG Stress Modulation of Neurodegeneration, University Medical Center Göttingen (UMG) , Göttingen , Germany.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Bethany L Brand
- Department of Psychology, Towson University , Towson , MD , USA
| | - Ruth A Lanius
- Department of Psychiatry, University of Western Ontario , London , Ontario , Canada
| | - Richard J Loewenstein
- Sheppard Pratt Health System , Baltimore , MD , USA.,Department of Psychiatry, University of Maryland School of Medicine , Baltimore , MD , USA
| | - David Spiegel
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine , Stanford , CA , USA
| | - Eric Vermetten
- Psychotrauma Expert Group, Arq , Diemen , The Netherlands.,Department of Psychiatry, Leiden University Medical Center , Leiden , The Netherlands.,Military Mental Health Care - Research, Ministry of Defense , Utrecht , The Netherlands
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27
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Abstract
PURPOSE OF REVIEW Combat-related posttraumatic stress disorder is increasingly recognized as having a variable course in returning veterans. Relatively few studies have identified predictors of illness duration or severity in this population. This review sought to synthesize the existing literature. RECENT FINDINGS The existing literature remains limited and heterogeneous. However, several studies identified hyperarousal and pre-deployment dissociation as predictive of disease severity, and re-experiencing as predictive of suicidality in veterans with combat-related PTSD. No other pre-, peri-, or posttraumatic psychosocial predictors of individual symptoms or overall disease severity have been identified in replicated studies. Important clinical factors to explore in the assessment of PTSD in combat veterans may now include hyperarousal and a history of dissociation as these may predict disease severity, and re-experiencing as this has been identified as a significant predictor of suicidality. Further study into this topic may reveal biological or more sensitive psychosocial markers predicting illness severity and prognosis.
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Affiliation(s)
- Michael L Able
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA. .,, North Bethesda, USA.
| | - David M Benedek
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
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28
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Bravo AJ, Kelley ML, Mason R, Ehlke S, Vinci C, Redman Ret LJC. Rumination as a Mediator of the Associations Between Moral Injury and Mental Health Problems in Combat-Wounded Veterans. ACTA ACUST UNITED AC 2019; 26:52-60. [PMID: 32863781 DOI: 10.1037/trm0000198] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Moral injury is hypothesized to develop from witnessing or engaging in events that violate one's beliefs about themselves and has been shown to be associated with negative mental health symptoms. Although there has been an increase in research examining moral injury among military veterans, mechanisms that link moral injury to mental health outcomes are not well understood. The present study examined rumination subcomponents (problem-focused thoughts, counterfactual thinking, repetitive thoughts, and anticipatory thoughts) as possible mediators of the associations between moral injury (both self-directed and other-directed symptoms) and negative mental health symptoms (i.e., depression, anxiety, suicidality, sleep disturbance, memory problems, and posttraumatic stress disorder symptoms). Participants were 189 combat wounded veterans (180 men; Mean age = 43.14 years) who had experienced one or more deployments (defined as 90 days or more). Nearly all participants reported a service-connected disability (n = 176, 93.1%), with the average participant reporting a 90% total VA disability ranking, and most participants had received a purple heart (n = 163, 86.2%). Within our comprehensive mediation model, we found eight significant mediation effects with the most consistent mediator being problem-focused thoughts. Specifically, both self-directed and other- directed moral injury were associated with increased problem-focused thoughts, which in turn was associated with higher reported symptoms of depression, anxiety, and posttraumatic stress disorder. Taken together, rumination, and in particular, problem-focused thoughts, is relevant to understand the increased vulnerability of military veterans to exhibit poor mental health outcomes when experiencing moral injury.
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Affiliation(s)
- Adrian J Bravo
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | - Michelle L Kelley
- Old Dominion University, Virginia Consortium Program in Clinical Psychology
| | | | - Sarah Ehlke
- Department of Psychology, Old Dominion University
| | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center
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29
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Battaglia AM, Protopopescu A, Boyd JE, Lloyd C, Jetly R, O'Connor C, Hood HK, Nazarov A, Rhind SG, Lanius RA, McKinnon MC. The relation between adverse childhood experiences and moral injury in the Canadian Armed Forces. Eur J Psychotraumatol 2019; 10:1546084. [PMID: 30693070 PMCID: PMC6338272 DOI: 10.1080/20008198.2018.1546084] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/27/2018] [Accepted: 10/20/2018] [Indexed: 11/27/2022] Open
Abstract
Background: There is increasing evidence that moral injuries (MIs) may affect the mental health of Canadian Armed Forces (CAF) members and veterans. Despite knowledge suggesting that MIs are related to multiple negative mental health outcomes, including the onset of post-traumatic stress disorder (PTSD), it is unknown whether pre-traumatic variables, including the presence of childhood abuse, are related to MIs. Objective: This study seeks to investigate the potential relationship between adverse childhood experiences and later onset MI in military members. Methods: Thirty-three patients newly admitted to an inpatient unit for treatment of trauma-related disorders received a standardized self-assessment package, including the PTSD Checklist for DSM-5 (PCL-5), the Moral Injury Events Scale (MIES; adapted for the Canadian context), and the Adverse Childhood Experiences Questionnaire (ACE-Q), which is a retrospective measure of childhood abuse. Results: Analyses revealed a significant relation between childhood emotional abuse and the presence of MI in adulthood. Specifically, emotional abuse during childhood was correlated with total score on the MIES (p = 0.006) and with its two subscales, perceived betrayals (p = 0.022) and perceived transgressions (p = 0.016). These correlations remained significant when controlling for age and gender. Conclusions: Among CAF members and veterans, childhood events are related to the presence of MI during adulthood. These preliminary data are provocative in suggesting that emotional abuse during childhood may increase the likelihood of endorsing MI during adult military service. Further work is needed to identify pre-traumatic variables that may serve to increase risk or enhance resilience to the development of MI in military members.
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Affiliation(s)
- Anthony M Battaglia
- Departments of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Alina Protopopescu
- Departments of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
| | - Jenna E Boyd
- Departments of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
| | - Chantelle Lloyd
- Departments of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Rakesh Jetly
- Department of National Defence, Government of Canada, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Charlene O'Connor
- Homewood Research Institute, Guelph, ON, Canada.,Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, ON, Canada
| | - Heather K Hood
- Program for Traumatic Stress Recovery, Homewood Health Centre, Guelph, ON, Canada.,Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Anthony Nazarov
- Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Shawn G Rhind
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Ruth A Lanius
- Homewood Research Institute, Guelph, ON, Canada.,Departments of Psychiatry, Western University, London, ON, Canada.,Departments of Neuroscience, Western University, London, ON, Canada.,Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Homewood Research Institute, Guelph, ON, Canada.,Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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