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Misitano A, Moro AS, Ferro M, Forresi B. The Dissociative Subtype of Post-Traumatic Stress Disorder: A Systematic Review of the Literature using the Latent Profile Analysis. J Trauma Dissociation 2024; 25:349-365. [PMID: 36062756 DOI: 10.1080/15299732.2022.2120155] [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: 05/19/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
A PTSD subtype with dissociative symptoms (D-PTSD) was included in the DSM-5 recognizing the existence of a more severe form of PTSD, associated to past trauma, high comorbidity, and complex clinical management. As research is rapidly growing and results are inconsistent, a better investigation of this subtype is of primary importance. We conducted a systematic review of studies using Latent Profile Analysis to investigate the existence of a D-PTSD subtype. Covariates of D-PTSD were included, to understand additional symptoms, risk factors and comorbidities. The search was performed on PubMed, EBSCOHost, and PTSDPubs according to 2020 PRISMA guidelines. Eligible articles assessed trauma exposure, PTSD symptoms and diagnosis, and dissociation, in adult samples. 13 of 165 articles met the inclusion criteria. All identified a dissociative subtype of PTSD, mainly characterized by higher levels of depersonalization and derealization. D-PTSD profile sometimes presented other dissociative symptoms, such as gaps in awareness and memory, other comorbid disorders, and a history of abuse. Despite some limitations, this review supports the existence of a dissociative subgroup of individuals among those with PTSD. More rigorous studies are needed to clarify these findings and their clinical implications.
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Affiliation(s)
- Alberto Misitano
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Andrea Stefano Moro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Ferro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Barbara Forresi
- Department of Psychology, Sigmund Freud University, Milan, Italy
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2
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Misevičė M, Gervinskaitė-Paulaitienė L, Lesinskienė S, Grauslienė I. Trust-Based Relational Intervention ® (TBRI ®) Impact for Traumatized Children-Meaningful Change on Attachment Security and Mental Health after One Year. CHILDREN (BASEL, SWITZERLAND) 2024; 11:411. [PMID: 38671627 PMCID: PMC11048912 DOI: 10.3390/children11040411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Children from vulnerable backgrounds often have insecure attachment or disorganized attachment, which are related to psychological troubles, and such children need interventions to help them heal. The attachment system reorganizes in middle childhood, and other important adults play a considerable role in children's lives. Thus, it is essential to weigh the impact of psychosocial interventions, while the main focus of the intervention is the staff member's direct work with the child through a trusting relationship. The primary purpose of this study is to investigate whether children's attachment security and mental health outcomes change after participating in a trauma-informed, attachment-based, Trust-Based Relational Intervention (TBRI) provided in a daycare center. It was a case-series study involving twelve children aged 8-11 years. The child attachment interview (CAI), CBCL/6-18, TRF/6-18, and clinical interviews for parents and children were used, measuring the change between the TBRI implementation in the daycare center and after one year. For ten participants, we noticed an improvement in mental health; for seven participants, security scales improved; for two participants, their disorganized attachment changed into insecure-dismissing. We have preliminary evidence that vulnerable children may benefit in terms of attachment security and mental health from the trusting relationship that staff build using the TBRI.
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Affiliation(s)
- Monika Misevičė
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | | | - Sigita Lesinskienė
- Clinic of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
| | - Izabelė Grauslienė
- Institute of Psychology, Faculty of Philosophy, Vilnius University, 01513 Vilnius, Lithuania; (L.G.-P.); (I.G.)
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Dialectical behaviour therapy for posttraumatic stress disorder (DBT-PTSD): transportability to everyday clinical care in a residential mental health centre. Eur J Psychotraumatol 2023; 14:2157159. [PMID: 37052092 PMCID: PMC9848310 DOI: 10.1080/20008066.2022.2157159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Dialectical Behaviour Therapy for Posttraumatic Stress Disorder (DBT-PTSD) is a phase-based treatment for PTSD. The DBT-PTSD treatment programme's efficacy has not been tested during standard operation, outside of laboratory outcome studies.Objective: The present pilot study investigated the transportability of the DBT-PTSD treatment to a real word clinical setting in a residential mental health centre.Methods: The DBT-PTSD treatment was compared to a treatment as usual (TAU) condition in a non-randomized study. Overall, 156 patients from a residential mental health centre were included. Propensity score matching was used to match participants in the two treatment arms based on baseline characteristics. Primary and secondary outcomes (PTSD and other symptoms) were assessed at the time of admission and at the time of discharge.Results: The DBT-PTSD treatment outperformed the TAU condition in the improvement of all primary outcomes, as indicated by a significant time and group interaction. There were notable differences in the effect sizes between the unmatched and matched sample as well as between the available and the intent-to-treat (ITT) data analyses. The effect sizes in the ITT data analyses were much lower. Both treatment groups showed similar improvements in secondary outcomes.Conclusions: This study provides initial evidence for the transportability of the DBT-PTSD treatment to a naturalistic clinical care setting, but with considerably lower effect sizes than in previously published laboratory RCTs. The higher efficacy of DBT-PTSD compared to TAU may largely depend on patient's adherence to treatment.
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Hudson M, Johnson MI. Hidden family rules: perspective on a dysfunctional paternalistic system and the persistence of pain. FRONTIERS IN PAIN RESEARCH 2023; 4:1303853. [PMID: 38162891 PMCID: PMC10755869 DOI: 10.3389/fpain.2023.1303853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
This article explores how paternalistic control and power reside within the family system and how this may influence pain and its persistence. Drawing upon clinical case studies and existing literature, this exploration emphasises the role of paternal dysfunction in creating emotional memory images and delves into how this may influence the chronification and treatment resistance of pain (i.e., making pain "sticky"). We argue that a dysfunctional paternalistic family system, often characterised by authoritarian dynamics, emotional neglect, and abuse, results in adverse experiences and emotional memory images that create a fertile ground for the entrenchment and propagation of psychosomatic symptoms, including pain. Further, the paper emphasizes the potential intergenerational effects of such a scenario, where inherited "Family Rules" drive maladaptive coping mechanisms, which contribute to the persistence of psychological and physiological distress across generations. Understanding these complexities offers new perspectives on treating psychological disorders and their physiological ramifications. It also highlights the urgency of addressing dysfunctional familial dynamics in psychotherapeutic interventions for both immediate and long-term psychophysiological health outcomes.
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Affiliation(s)
- Matt Hudson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
- Mind Help Limited, Durham, United Kingdom
| | - Mark I. Johnson
- Centre for Pain Research, School of Health, Leeds Beckett University, Leeds, United Kingdom
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Teculeasa F, Golu F, Gorbănescu A. The Effectiveness of Psychological Interventions on the Impact of Trauma Exposure in Foster Care: A Meta-Analysis. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:917-932. [PMID: 38045839 PMCID: PMC10689601 DOI: 10.1007/s40653-023-00563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 12/05/2023]
Abstract
Due to prevalent exposure to trauma in the biological family, children in foster care often experience post-traumatic stress symptoms, difficulties in forming secure attachments with the caregivers, and can present a complex range of symptoms and impairments across several areas of development. Therefore, there is an increased necessity for interventions on the effects of trauma exposure in foster care. This is the first meta-analysis to investigate the effectiveness of interventions on the effects of trauma exposure in foster care against control groups. Twelve randomized controlled trials on interventions for children with trauma-related diagnoses or with other mental health problems that are a result of complex trauma were included. A random-effects model was used for pooling the effect sizes, which were calculated for trauma-related outcomes at posttreatment and follow-up. Several potential moderator variables were analyzed. The results showed that participants receiving the intervention on trauma-related problems reported significantly better outcomes than those in the control conditions at posttreatment, after the exclusion of one outlier (g = 0.39; 95% CI [0.18 to 0.62]). The effect size was smaller at follow-up (g = 0.24; 95% CI [0.03 to 0.46]), but significant. Clinical diversity, methodological diversity, as well as other limitations were identified and discussed. Overall, the findings highlight the potential of interventions for trauma-related problems in foster care. These findings bring important contributions to the child welfare system in their efforts to develop and adapt suitable interventions for children with mental health problems due to trauma. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-023-00563-9.
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Affiliation(s)
- Flavia Teculeasa
- Faculty of Psychology and Educational Sciences, University of Bucharest, 90 Panduri Street, 50663 Bucharest, Romania
| | - Florinda Golu
- Faculty of Psychology and Educational Sciences, University of Bucharest, 90 Panduri Street, 50663 Bucharest, Romania
| | - Adrian Gorbănescu
- Faculty of Psychology and Educational Sciences, University of Bucharest, 90 Panduri Street, 50663 Bucharest, Romania
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Fontanil Y, Méndez MD, Postigo Á, Martín-Higarza Y, Ezama E. How are adverse childhood experiences and women's mental health associated? A latent class analysis. Acta Psychol (Amst) 2023; 241:104088. [PMID: 38000365 DOI: 10.1016/j.actpsy.2023.104088] [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] [Received: 06/10/2023] [Revised: 11/12/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have a cumulative effect on adult mental health; however, the effect of such combinations is less well known. The purpose of this study is to assess the association between specific combinations of early adversities and women's mental health. METHODS A total of 378 women (Myears = 41.4; SDyears = 13) receiving support from mental health and social services participated in this cross-sectional study. Latent class analysis was performed to classify participants based on the number of ACEs types. RESULTS Our results provided support for four latent classes which differed in ACEs types reported: class 1 range of maltreatment but no family disruption (16.40 %; n = 62), class 2 range of maltreatment with family disruption (24.87 %; n = 94), class 3 few ACEs (44.71 %; n = 169), class 4 high maltreatment/high family disruption (14.02 %; n = 53). Differences in psychological functioning (presence of psychopathology, attachment, emotion dysregulation, and coping strategies) were found between the classes, especially between few ACEs and high maltreatment/high family disruption classes. In addition, women who lived in a low-adversity home and those who lived in a home with maltreatment, but no family disruption, differed in their desire for closeness, problem-solving and emotional expression strategies. CONCLUSION This study highlights that the probability of exposure to different combinations of ACEs is associated with differences in adult psychological functioning. Deeper insight into this association may contribute to a better understanding of mental health problems and to improved prevention and intervention strategies in public support systems.
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Affiliation(s)
- Yolanda Fontanil
- Department of Psychology, University of Oviedo, 33003 Oviedo, Asturias, Spain.
| | - María Dolores Méndez
- Central University Hospital of Asturias, Mental Health Services of the Principality of Asturias, 33011 Oviedo, Asturias, Spain.
| | - Álvaro Postigo
- Department of Psychology, University of Oviedo, 33003 Oviedo, Asturias, Spain.
| | - Yolanda Martín-Higarza
- Institute of Legal Medicine, Government of the Principality of Asturias, 33001 Oviedo, Asturias, Spain.
| | - Esteban Ezama
- Cabueñes University Hospital, Mental Health Services of the Principality of Asturias, 33201 Gijón, Asturias, Spain
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Knefel M, Karatzias T, Spinazzola J, Shevlin M, Ford JD. The relationship of posttraumatic stress disorder and developmental trauma disorder with childhood psychopathology: A network analysis. J Anxiety Disord 2023; 99:102766. [PMID: 37690357 DOI: 10.1016/j.janxdis.2023.102766] [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: 04/12/2022] [Revised: 07/25/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Potentially traumatic experiences are a major risk factor for mental disorders in children and adolescents. Posttraumatic psychopathology includes trauma-specific disorders such as posttraumatic stress disorder (PTSD) as well as other psychiatric disorders. Developmental Trauma Disorder (DTD) has been proposed as a developmentally sensitive diagnosis. We aimed to further illuminate the co-occurrence of psychiatric conditions with DTD and PTSD. METHOD In a convenience sample of families of 507 children and adolescents (mean age = 12.11 years old, SD = 2.92; 48.5% female), we assessed DTD, PTSD, and screened for psychiatric disorders. We estimated network models including DTD, PTSD and ten psychiatric conditions. RESULTS We found that DTD and PTSD share both common and differential comorbidity features on disorder-, domain-, and symptom-level. The differential comorbidity patterns of the DTD and PTSD domains placed DTD close to both externalizing and internalizing psychopathology while PTSD was primarily linked to internalizing conditions. CONCLUSIONS Our study provides evidence for the complex clinical presentation of posttraumatic psychopathology over and above PTSD in children. DTD and PTSD provide useful and distinct diagnostic categories for children who are also experiencing internalizing conditions, and DTD may be especially relevant for children who are experiencing externalizing psychopathology.
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Affiliation(s)
- Matthias Knefel
- Faculty of Psychology, University of Vienna, Vienna, Austria; Department of Internal Medicine, Landesklinikum Baden , Baden bei Wien, Austria.
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK; Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | | | - Mark Shevlin
- Ulster University, School of Psychology, Coleraine, UK
| | - Julian D Ford
- University of Connecticut School of Medicine, Farmington, CT, USA
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Moss C, Smith SJ, Kim K, Hua N, Noronha N, Kavenagh M, Wekerle C. A global systematic scoping review of literature on the sexual exploitation of boys. CHILD ABUSE & NEGLECT 2023; 142:106244. [PMID: 37244784 DOI: 10.1016/j.chiabu.2023.106244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Sexual exploitation of children (SEC) is a widespread crime which impacts the child victim across developmental, health and well-being domains. As victims, boys have received much less clinical and research attention. While context-specific factors likely shape the SEC risk, under-recognized gender norms can deny boys' vulnerability. Professional failures to recognize and respond adequately to boys' sexual exploitation may prevent access to support. OBJECTIVE This systematic scoping review updates and broadens a previous review of literature addressing prevalence, victim/offender/facilitator characteristics, control mechanisms, as well as the health correlates and outcomes regarding sexual exploitation of boys. This review included international peer-reviewed and gray literature from 38 countries in 14 languages. PARTICIPANTS AND SETTING Studies from the years 2000 to 2022 that included samples of boys under age 18, or sex-disaggregated data for children under 18, were included. Case studies, systematic reviews, and those reporting on retrospective experiences by adults over 18 were excluded. A total of 254,744 boys were represented across 81 studies. METHODS A systematic scoping review considered qualitative and quantitative peer-reviewed publications from eight, English-language databases. English and non-English non-peer reviewed publications ('gray literature') was identified by both ECPAT International's global network of member organizations and citation chaining. RESULTS Overall, 81 peer-reviewed (n = 51) and gray literature (n = 30) documents from 38 countries were included. In total, 254,744 youth participated in peer-reviewed studies (N = 217,726) and gray literature (N = 37,018). General prevalence of sexual exploitation of boys was reported at up to 5 %, with higher rates noted in specifically vulnerable sub-populations (e.g., 10 %, trans youth; 26 %, street-connected youth). The literature indicates that sexual exploitation of boys is reported as occurring primarily between 12 and 18 years old. Multi-level factors are linked to SEC, including individual (e.g., disability status), relationship (e.g., child maltreatment, dating violence), community (e.g., community violence), and societal domains (e.g., discriminatory beliefs). SEC victimization is linked with youth mental and physical health concerns, particularly sexual health. Post-traumatic stress symptomatology or disorder was rarely evaluated. Evidence-based treatments were not available, which may be related to a lack of gender-based theoretical models for understanding SEC specifically. CONCLUSION The sexual exploitation of boys is a prevalent public health, child rights, and clinical issue. All young people experiencing sexual exploitation face sex- and gender-specific challenges, and this remains the case for boys with indications including family rejection, implicit community tolerance for abuse to service accessibility barriers. Actioning our duty to care for all children requires gender- and trauma-informed lenses. Ongoing surveillance of all forms of violence against children, with gender disaggregation, is essential for practice and policy advancement.
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Affiliation(s)
- Corinne Moss
- McMaster University, Department of Pediatrics, Hamilton, ON, Canada.
| | - Savanah Jordan Smith
- McMaster University, Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, Hamilton, ON, Canada
| | - Katherine Kim
- University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Nicholas Hua
- McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada
| | - Noella Noronha
- McMaster University, Department of Health Research Methods, Evidence and Impact, Hamilton, ON, Canada; McMaster University, School of Interdisciplinary Science, Hamilton, ON, Canada
| | | | - Christine Wekerle
- McMaster University, Department of Pediatrics, Hamilton, ON, Canada; McMaster University, Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, Hamilton, ON, Canada
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Balconi M, Angioletti L, Crivelli D. Neurofeedback as neuroempowerment technique for affective regulation and interoceptive awareness in adolescence: preliminary considerations applied to a psychogenic pseudosyncope case. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1056972. [PMID: 37456793 PMCID: PMC10347858 DOI: 10.3389/fresc.2023.1056972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Revisions of classical models of acute stress response spectrum and defence cascade process might represent a valuable background for the interpretation of the link between affective reactions, traumatic experiences, and Psychogenic pseudosyncope (PPS) events in childhood and across the lifespan. Indeed, associations between subjective emotional life, early exposure to distressing and/or traumatic events, and PPS have fuelled a debate on potential causes of occurrence and recurrence of such a peculiar clinical manifestation. At the same time, such background suggests that empowering stress management and affective regulation skills could be the target for neurorehabilitation interventions aiming at reducing the severity of symptomatology and/or improving awareness and management of pseudosyncopal spells. Specifically, neuro/biofeedback-based empowerment of self-regulation skills, associated to an increased interoceptive increased awareness, could be a promising complement to classical psychological therapies. Starting from the presentation of a paediatric PPS clinical case, the present work discusses the relevance of assessing affective appraisal and autonomic reactivity in individuals suffering from PPS episodes and introduces a novel potential neuroempowerment protocol aimed at improving self-regulation and stress management skills in adolescence based on a combined neurofeedback and embodied-awareness intervention. By capitalizing available evidence of the effects of neuromodulation and embodied practices on self-awareness/regulation across the life-span, the proposed protocol is based on neurofeedback-supported affective management training, as well as both contemplative and informal awareness exercises devised to be appealing and challenging even for younger patients.
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Affiliation(s)
- Michela Balconi
- International research center for Cognitive Applied Neuroscience (IrcCAN), Catholic University of the Sacred Heart, Milan, Italy
- Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Laura Angioletti
- International research center for Cognitive Applied Neuroscience (IrcCAN), Catholic University of the Sacred Heart, Milan, Italy
- Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Davide Crivelli
- International research center for Cognitive Applied Neuroscience (IrcCAN), Catholic University of the Sacred Heart, Milan, Italy
- Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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Weems CF, McCurdy BH, Scozzafava MD. Toward a Developmental Model of Continuity and Change in PTSD Symptoms following Exposure to Traumatic and Adverse Experiences. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:391-402. [PMID: 37234837 PMCID: PMC10205928 DOI: 10.1007/s40653-021-00398-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 05/28/2023]
Abstract
A developmental understanding of the expression of posttraumatic stress (PTS) symptoms following trauma in childhood requires identifying continuity and change in not just overall symptoms but in the individual symptoms as well. Such models of change also require understanding multiple dimensions of time. That is, longitudinal change-the passage of time-may have different effects on symptom expression depending on when in time an individual entered the study - such as what age they were when first assessed. This paper addresses these ideas with an overview of the developmental differences in the assessment of PTS from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), longitudinal research on posttraumatic stress disorder (PTSD) symptoms, and providing synthesis within a symptom network perspective. We then provide an illustration of how individual PTSD symptoms change over time at different ages (elementary versus middle school) with a secondary analysis of data from a previously reported study (n = 191 youth, aged 8-15, assessed at two time points six months apart). The reanalysis of the data suggests both continuity and change in symptoms over time (i.e., some symptoms were more stable than other symptoms) with differences in symptom rates and their longitudinal change as a function of age (i.e., some symptoms more common or more stable in younger versus older or older versus younger). We close with avenues for future research aimed at better understanding symptom cascades over time and at different ages and potential implications for future iterations of assessment/classification systems.
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Affiliation(s)
- Carl F. Weems
- Department of Human Development and Family Studies, Iowa State University Ames, 4380, Palmer, IA 50011 USA
| | - Bethany H. McCurdy
- Department of Human Development and Family Studies, Iowa State University Ames, 4380, Palmer, IA 50011 USA
| | - Mikaela D. Scozzafava
- Department of Human Development and Family Studies, Iowa State University Ames, 4380, Palmer, IA 50011 USA
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Kidwell MC, Kerig PK. To Trust is to Survive: Toward a Developmental Model of Moral Injury. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:459-475. [PMID: 37234829 PMCID: PMC10205960 DOI: 10.1007/s40653-021-00399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 05/28/2023]
Abstract
Research on trauma- and stressor-related disorders has recently expanded to consider moral injury, or the harmful psychological impact of profound moral transgressions, betrayals, and acts of perpetration. Largely studied among military populations, this construct has rarely been empirically extended to children and adolescents despite its relevance in the early years, as well as youths' potentially heightened susceptibility to moral injury due to ongoing moral development and limited social resources relative to adults. Application of the construct to young persons, however, requires theoretical reconceptualization from a developmental perspective. The present paper brings together theory and research on developmentally-oriented constructs involving morally injurious events, including attachment trauma, betrayal trauma, and perpetration-induced traumatic stress, and describes how they may be integrated and extended to inform a developmentally-informed model of moral injury. Features of such a model include identification of potentially morally injurious events, maladaptive developmental meaning-making processes that underlie moral injury, as well as behavioral and emotional indicators of moral injury among youth. Thus, this review summarizes the currently available developmental literatures, identifies the major implications of each to a developmentally-informed construct of moral injury, and presents a conceptual developmental model of moral injury for children and adolescents to guide future empirical research.
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Affiliation(s)
- Mallory C. Kidwell
- Department of Psychology, University of Utah, 380 S 1530 E, Salt Lake City, UT 84112 USA
| | - Patricia K. Kerig
- Department of Psychology, University of Utah, 380 S 1530 E, Salt Lake City, UT 84112 USA
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12
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Ford JD. Why We Need a Developmentally Appropriate Trauma Diagnosis for Children: a 10-Year Update on Developmental Trauma Disorder. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:403-418. [PMID: 37234835 PMCID: PMC10205922 DOI: 10.1007/s40653-021-00415-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 05/28/2023]
Abstract
Developmental Trauma Disorder (DTD) was proposed almost two decades ago as a psychiatric diagnosis for children who have been traumatically victimized and whose attachment bonding with primary caregivers has been compromised. DTD was designed to complement and extend post-traumatic stress disorder (PTSD) by addressing forms of trauma-related biopsychosocial dysregulation not included in PTSD, many of which are attributed to other psychiatric disorders. In the past decade, evidence from clinician surveys and research field trial studies has provided evidence of DTD's validity and potential clinical utility. The growing evidence base for DTD is summarized and clinical rationales for the proposed DTD symptoms are described. DTD shows promise as a developmentally-attuned traumatic stress diagnosis for traumatized children.
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Affiliation(s)
- Julian D. Ford
- University of Connecticut School of Medicine, Farmington, USA
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13
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Ting A, McLachlan C. Dr. Smartphone, can you support my trauma? An informatics analysis study of App Store apps for trauma- and stressor-related disorders. PeerJ 2023; 11:e15366. [PMID: 37187512 PMCID: PMC10178213 DOI: 10.7717/peerj.15366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
Background Psychological trauma is prevalent in developed countries, with prevalence rates and treatment needs exceeding health system capacity. As telemedicine and out-of-patient care are promoted, there has been an expansion of digital apps to compliment therapeutic stages in psychological trauma. To date there are no reviews that have compared these apps and their clinical utility. This study aims to identify the availability of trauma- and stressor-related mhealth apps, assess their functionality, and review their therapeutic abilities. Methodology The authors conducted a systematic search using an iPhone 13 Pro in the Australian IOS App Store to extract trauma- and stressor-related apps that resulted from the search criteria. A cross-adaptation of the Mobile App Rating Scale (MARS) and the Comprehensive App Evaluation Model (CAEM) were used as a framework to produce the mTrauma App Evaluation Conceptual Model and Informatics Framework. App content descriptors were analysed based on their general characteristics, usability, therapeutic focus, clinical utility, data integration. Following an applicability in concordance with psychological trauma-informed delivery. Results A total of 234 apps resulting from the search strategy were screened, with 81 apps that met the inclusion criteria. The majority of apps were marketed to 4+ to 17+ years of age, categorised as 'health and fitness', with the highest target markets observed for adolescents, children, parents, clinicians, and clients. A total of 43 apps (53.1%) contained a trauma-informed specified section, and 37 (45.7%) incorporated a section useful to support trauma-related symptoms. A significant number of apps there was an absence of therapeutic utility (in 32 apps (39.5%)). Most apps were supporting post-traumatic stress disorder-informed, cognitive behavioural therapy and eye movement desensitisation and reprocessing. Provision of psychoeducation, courses, guided sessions, trainings, self-reflection/journaling, symptom management and progress tracking were highly present. Conclusions Trauma-informed mobile apps are available in the App Store, expanding in its target market reach and usability, with an increase of creative psychotherapies being introduced alongside conventional modalities. However, based on the app descriptors, the scarcity of evidenced-based testimonials and therapeutic applicability remains questionable for clinical validity. Although mhealth tools are marketed as trauma-related, current available apps employ a multifunctional approach to general psychological symptomatology, through to associated comorbid conditions and emphasizes on passive activity. For higher uptake on user engagement, clinical application and validity, trauma-apps require curated specification to fulfil its role as complimentary psychological treatment.
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Affiliation(s)
- Amanda Ting
- Centre for Healthy Futures, Torrens University Australia, Surry Hills, New South Wales, Australia
| | - Craig McLachlan
- Centre for Healthy Futures, Torrens University Australia, Surry Hills, New South Wales, Australia
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Klebanov B, Katz C. "Our family sleeps deeply": The Presence of Others During Intrafamilial Child Sexual Abuse as Conveyed By Girls From Diverse Communities in Israel. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6113-6137. [PMID: 36546665 DOI: 10.1177/08862605221128055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Child sexual abuse (CSA) is generally perceived as a crime perpetrated out of sight, without witnesses. Nevertheless, several researchers have explored the presence of others during incidents of abuse in regards to two main aspects: bystanders in extrafamilial CSA and bystanders' decisions whether or not to get involved. However, there is a dearth of knowledge regarding how children who experience abuse perceive and experience the presence of others during abusive incidents. The current study was designed to examine the experiences and perceptions of girls who experienced intrafamilial CSA (IFCSA) with respect to the presence of others, as conveyed during their forensic interviews. A thematic analysis of 24 forensic interviews was conducted with secular Jewish, ultra-Orthodox Jewish, and Muslim Arab girls, aged 4-14. The analysis identified four main themes: (a) the girls' perceptions of others' awareness of them being abused, (b) the girl's experiences of loneliness, (c) the girls' experiences of disclosing to the others present during the abuse, and (d) family dynamics. The discussion highlights the unique, multifaceted and elusive dynamics of IFCSA, calling into question the commonly held view that it happens only in secret. The girls' narratives highlighted their distress and pointed to the abusive and unbearable daily routine in which they live. In spotlighting their encounters with IFCSA, the girls focused on the feelings of guilt, shame, and isolation they experienced.
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Veeser J, Barkmann C, Schumacher L, Zindler A, Schön G, Barthel D. Post-traumatic stress disorder in refugee minors in an outpatient care center: prevalence and associated factors. Eur Child Adolesc Psychiatry 2023; 32:419-426. [PMID: 34524524 DOI: 10.1007/s00787-021-01866-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
Due to their likelihood for experiencing a number of traumatic events, refugee minors have an increased risk of developing post-traumatic stress disorder (PTSD). However, the prevalence of PTSD in refugee children varies widely between studies, and it remains somewhat unclear what factors increase children's risk of PTSD. This study aimed to assess the prevalence of PTSD in a clinical outpatient sample of refugee minors, and to evaluate the association of different risk factors with a PTSD diagnosis. N = 417 refugee minors were recruited from an outpatient clinical center in Hamburg, Germany. The median age was 15.4 years and 74.6% of the minors were male. As part of the standard diagnostic process, their social history and a potential PTSD diagnosis using the Module K of the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was assessed. The predictive value of age, gender, number of interpersonal traumatic events, un-/accompanied status, presence of family member in the host country, flight duration, residence status, and time since arrival in the host country were investigated using logistic regression analysis. The prevalence of PTSD among the young refugee patients was 61.6%. Significant predictors of a PTSD diagnosis were number of interpersonal traumatic life events, age, residence status, and time since arrival in the host country. The prediction model explained 33.8% of variance of the outcome with the number of interpersonal traumatic events having the largest contribution (20.8%). The high prevalence of PTSD among refugee minors in outpatient care emphasizes the need to establish appropriate care structures and train specialists in the treatment of PTSD.
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Affiliation(s)
- Jakob Veeser
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.
| | - Lea Schumacher
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Areej Zindler
- Outpatient Center GmbH, Refugee Outpatient Clinic, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Dana Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
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16
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Todorov JJ, Devine RT, De Brito SA. Association between childhood maltreatment and callous-unemotional traits in youth: A meta-analysis. Neurosci Biobehav Rev 2023; 146:105049. [PMID: 36681371 DOI: 10.1016/j.neubiorev.2023.105049] [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] [Received: 09/28/2022] [Revised: 12/15/2022] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
Callous-unemotional (CU) traits (i.e., lack of remorse or guilt, callous lack of empathy, deficient concern for the feelings of others) in youth with conduct problems confer risk for a particularly severe and persistent form of antisocial behaviour. Previous research has linked childhood maltreatment as a potential risk factor for CU traits, both primary (i.e., genetically underpinned) and secondary (i.e., environmentally influenced) variants, but findings have been inconsistent, and the association has not yet been tested in a meta-analysis. To address this gap, we conducted a meta-analysis to assess the nature and strength of the associations between childhood maltreatment and its subtypes with CU traits and potential variants (i.e., primary and secondary CU traits). A systematic search identified 29 eligible studies including 9,894 participants (42% female) between the ages of 3 and 18 years (Mage=14.22 years, SD = 1.07). Results revealed a significant moderate positive association between childhood maltreatment and CU traits. All subtypes of maltreatment bar sexual abuse were significantly associated with CU traits. However, it was not possible to compare primary and secondary CU traits directly due to inconsistencies in how they are defined. The limitations posed by current research signal the need for clinical and operational guidelines on how to define primary and secondary CU traits. Additionally, prospective longitudinal, genetically informed research is needed to clarify if maltreatment is a causal risk factor for CU traits.
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Affiliation(s)
- Jessica J Todorov
- Centre for Human Brain Health, School of Psychology, University of Birmingham, UK.
| | - Rory T Devine
- Centre for Developmental Science, School of Psychology, University of Birmingham, UK
| | - Stephane A De Brito
- Centre for Human Brain Health, School of Psychology, University of Birmingham, UK.
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Hagelquist JO, Jensen CH, Bloch MS, Rasmussen H. A mentalization-based approach to healing children exposed to adverse experiences: Tools for residential care. Bull Menninger Clin 2023; 87:83-103. [PMID: 36856474 DOI: 10.1521/bumc.2023.87.1.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
It is well documented how adverse childhood experiences can inhibit child development and mentalizing ability and lead to high risk of developmental psychopathology. Mentalization-based treatment (MBT) has been established as an effective approach to treatment for a long range of psychopathologies with both in- and outpatient treatment, yet the evidence base for effective clinical interventions that can help guide professionals working in residential care on how to support the development of neglected and traumatized children is underdeveloped. This article demonstrates a mentalization-based approach to understanding and working with children in residential care, and offers practical models and tools as well as considerations on implementation that are beneficial and easy to apply, demonstrated through cases. The STORM model and "Obtaining Skills" screening tool may be helpful models for professionals addressing mentalization in children while working in challenging environments such as with traumatized and neglected children.
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Affiliation(s)
| | | | - Marie Skaalum Bloch
- Psychologist, Specialist, and Supervisor at the Center for Mentalising, Gistrup, Denmark
| | - Heino Rasmussen
- Partner in management at the Center for Mentalising, Århus, Denmark
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18
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Can Developmental Trauma disorder be distinguished from posttraumatic stress disorder? A confirmatory factor Analytic Test of Four Structural Models. Res Child Adolesc Psychopathol 2022; 50:1207-1218. [DOI: 10.1007/s10802-022-00916-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
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Merritt M. Rediscovering latent trauma: An adopted adult's perspective. CHILD ABUSE & NEGLECT 2022; 130:105445. [PMID: 34953610 DOI: 10.1016/j.chiabu.2021.105445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/08/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
Though studies showing a causal relationship between adoption and trauma are scarce, there is enough cross-disciplinary research to suggest such a connection. Likewise, there are many adult adopted persons, like myself, who see their adoption narratives as traumatic in one way or another. Mental health outcomes for adopted people also indicate adoption might be a source of and not just a preventative measure against trauma. In this paper, I utilize an autoethnographic approach to highlight the relationship between infant adoption and what I refer to as "latent traumatic memories." Recounting several major life events that led to traumatic upheavals in my understanding of my own identity as an adopted person, I then relate my story to current research on trauma experienced very early in life and how it is remembered implicitly in the body. My account, I argue, highlights the need to further research adopted people's evolving views about their adoption and how and to what extent certain events in adulthood precipitate the rediscovery of latent trauma.
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Affiliation(s)
- Michele Merritt
- Arkansas State University, 2107 Aggie Road, Jonesboro, AR 72401, United States of America.
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20
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Cruz D, Lichten M, Berg K, George P. Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front Psychiatry 2022; 13:800687. [PMID: 35935425 PMCID: PMC9352895 DOI: 10.3389/fpsyt.2022.800687] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.
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Affiliation(s)
- Daniel Cruz
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | | | - Kevin Berg
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
| | - Preethi George
- Hackensack Meridian Health Mountainside Medical Center, Montclair, NJ, United States
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21
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Ford JD, Spinazzola J, van der Kolk B, Chan G. Toward an empirically based Developmental Trauma Disorder diagnosis and semi-structured interview for children: The DTD field trial replication. Acta Psychiatr Scand 2022; 145:628-639. [PMID: 35266162 DOI: 10.1111/acps.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Developmental trauma disorder (DTD) is a childhood psychiatric syndrome designed to include sequelae of trauma exposure not fully captured by PTSD. This study aimed to determine whether the assessment of DTD with an independent sample of children in mental health treatment will replicate results from an initial validation study. METHODS The DTD semi-structured interview (DTD-SI) was administered to a convenience sample in six sites in the United States (N = 271 children in mental health care, 8-18 years old, 47% female, 41% Black or Latinx) with measures of trauma history, DSM-IV PTSD, probable DSM-IV psychiatric diagnoses, emotion regulation/dysregulation, internalizing/externalizing problems, and quality of life. Confirmatory factor (CFA) and item response theory (IRT) analyses tested DTD's structure and DTD-SI's information value. Bivariate and multivariate analyses tested DTD's criterion and convergent validity. RESULTS A three-factor solution (i.e., emotion/somatic, attentional/behavioral, and self/relational dysregulation) best fit the data (CFI = 0.91; TLI = 0.89; BIC = 357.17; RMSEA = 0.06; SRMR = 0.05). DTD-SI items were informative across race/ethnicity, gender, and age with three exceptions. Emotion dysregulation was the most informative item at low levels of DTD severity. Non-suicidal self-injury was rare but discriminative in identifying children with high levels of DTD severity. Results supported the criterion and convergent validity of the DTD construct. CONCLUSION This replication provides empirical support for DTD as a construct and potential psychiatric syndrome, and the DTD-SI's validity as a clinical research tool.
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Affiliation(s)
- Julian D Ford
- University of Connecticut Medical School Psychiatry Department, Farmington, Connecticut, USA
| | | | | | - Grace Chan
- University of Connecticut Medical School Psychiatry Department, Farmington, Connecticut, USA
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22
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Thompson EL, Lever NA, Connors KM, Cloak CC, Reeves G, Chang L. Associations between potentially traumatic events and psychopathology among preadolescents in the Adolescent Brain and Cognitive Development Study ®. J Trauma Stress 2022; 35:852-867. [PMID: 35132700 PMCID: PMC9232853 DOI: 10.1002/jts.22793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/13/2021] [Accepted: 10/06/2021] [Indexed: 11/05/2022]
Abstract
The current cross-sectional study aimed to extend the literature on childhood adversity by examining the unique associations between potentially traumatic events (PTEs) and a range of mental health concerns, including domain-specific versus comorbid concerns. Participants were 11,877 preadolescents (47.8% female, 15.0% Black, 20.3% Hispanic/Latinx, Mage = 9.5 years) taking part in the Adolescent Brain and Cognitive Development (ABCD) Study® . The Kiddie Schedule for Affective Disorders and Schizophrenia was used to measure PTEs and caregiver- and child-reported mental health concerns. Adjusted odds ratios (aORs) were used for the outcomes of interest. Overall, PTEs were consistently associated with increased odds of experiencing comorbid posttraumatic stress disorder (PTSD), internalizing disorders, and externalizing disorders, significant AORs = 1.34-4.30, after accounting for children's experiences of other PTEs and polyvictimization. In contrast, PTEs were generally not associated with meeting the criteria for diagnoses within only one domain (i.e., internalizing-only or externalizing-only diagnoses). We also found PTEs to be differentially related to the various mental health outcomes. In particular, witnessing domestic violence was consistently associated with children's psychopathology. Other PTEs, such as witnessing community violence, were not associated with children's psychopathology in the final model. Associations between PTEs and mental health concerns did not differ as a function of sex. Overall, the results support the notion that PTEs are associated with comorbid concerns rather than individual disorders. These findings have important implications for the screening of PTEs, continued research on the conceptualization of traumatic stress, and the importance of accounting for comorbidities across mental health domains.
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Affiliation(s)
- Erin L. Thompson
- Center for Children and Families, Department of Psychology, Florida International University, Miami, Florida, USA
| | - Nancy A. Lever
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kay M. Connors
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christine C. Cloak
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gloria Reeves
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii, USA,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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23
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Hyland P, Karatzias T, Ford JD, Fox R, Spinazzola J. The Latent Structure of Child and Adolescent Psychopathology and its Association with Different Forms of Trauma and Suicidality and Self-Harm : LATENT STRUCTURE OF PSYCHOPATHOLOGY. Res Child Adolesc Psychopathol 2022; 50:1501-1513. [PMID: 35476235 PMCID: PMC9616783 DOI: 10.1007/s10802-022-00925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) is a multidimensional and hierarchical model of the latent structure of psychopathology. While HiTOP has received much support in child/adolescent community samples, fewer studies have assessed this model in clinical samples of children/adolescents. Here, we modelled the latent structure of 45 symptoms of psychopathology from a clinical sample of children/adolescents and assessed how dimensions of psychopathology were related to specific forms of trauma and suicidality/self-harm. Clinician-derived assessments were obtained from 507 people aged 7-18 years. Confirmatory factor analysis was used to determine the optimal fitting model, and structural equation modelling was used to estimate associations with trauma exposure and suicidality/self-harm. The best fitting model(s) included five first-order factors reflecting Fear, Distress, Externalizing, Thought Disorder, and Traumatic Stress, with a higher-order general factor (p) accounting for the covariation between these factors. Unique associations were identified between specific forms of trauma and each dimension of psychopathology. p was strongly associated with suicidality/self-harm, and of the first-order factors, Distress was most strongly associated with suicidality/self-harm. Findings support the predictions of HiTOP that the latent structure of child/adolescent psychopathology can be effectively described by a multidimensional and hierarchal model. Moreover, we found tentative evidence for a unique dimension of Traumatic Stress psychopathology. Our findings also highlight the unique associations between specific forms of early life trauma and specific dimensions of psychopathology, and the importance of Distress related psychopathology for suicidality/self-harm in children and adolescents.
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Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.
| | - Thanos Karatzias
- Department of Psychology, Edinburgh Napier University, Edinburgh, Scotland
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Robert Fox
- School of Business, National College of Ireland, Dublin, Ireland
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Ford JD, Charak R, Karatzias T, Shevlin M, Spinazzola J. Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach. Eur J Psychotraumatol 2022; 13:2133488. [PMID: 36340008 PMCID: PMC9635476 DOI: 10.1080/20008066.2022.2133488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD). OBJECTIVE To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD. METHOD Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7-18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians. RESULTS A four class solution was optimal (LMR = 398.264, p < .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X2 (3) = 16.916 and 28.016, respectively, p < .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p < .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X2(3) = 84.66, p < .001). CONCLUSION Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.
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Affiliation(s)
- Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center MC1410, Farmington, CT, USA
| | - Ruby Charak
- University of Texas Rio Grande Valley, Edinburg, TX, USA
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Glaus J, Moser DA, Rusconi Serpa S, Jouabli S, Turri F, Plessen KJ, Schechter DS. Families With Violence Exposure and the Intergenerational Transmission of Somatization. Front Psychiatry 2022; 13:820652. [PMID: 35280182 PMCID: PMC8904725 DOI: 10.3389/fpsyt.2022.820652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Adults who have histories of childhood trauma have been noted to display greater somatization, dissociative symptoms and affect dysregulation. What happens in the parent-child relationship when those traumatized children become parents? A potential link to somatization in the child has been suggested by several prior studies. Children who have early attachment disturbances had more physical complaints if their mothers displayed less maternal sensitivity during observed parent-child interactions. Yet, the intergenerational link between maternal and child somatization has not been sufficiently explored in a longitudinal study in order to understand the potential impact of maternal trauma history and related psychopathology on subsequent child somatization and psychopathology. METHODS This paper examined prospective, longitudinal data of 64 mother-toddler dyads (mean age = 2.4 years, SD = 0.7) who were later studied when children had a mean age of 7 years. Mothers with and without histories of interpersonal violence (IPV; physical/sexual abuse and/or family violence exposure) were included. Mothers with IPV histories were oversampled. Linear and Poisson regression models were used to test the associations between maternal IPV-related post-traumatic stress disorder (PTSD) with maternal somatization severity when children were toddlers, and between maternal somatization and maternal interactive behaviors with child somatization by maternal report and clinician-rated assessment at school-age. RESULTS Maternal PTSD severity was significantly associated with increased maternal somatization severity (p = 0.031). Maternal somatization severity during the child's early childhood predicted both maternal report of child somatization (p = 0.011) as well as child thought problems (p = 0.007) when children were school-aged. No association was found between maternal somatization and child-reported psychopathology. The study did not find that maternal alexithymia, caregiving behaviors or child exposure to violence contributed significantly to the model examining the association between maternal and child somatization. CONCLUSION The results are in line with the hypothesis of intergenerational transmission of somatization in the context of IPV and related maternal PTSD during formative early development. We interpret this as an expression of psychological distress from mother to child, as maternal trauma and pathology affect the caregiving environment and, thus, the parent-child relationship. The authors conclude with a discussion of implications for parent-infant and early childhood intervention.
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Affiliation(s)
- Jennifer Glaus
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Dominik A Moser
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | | | - Sondes Jouabli
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Fiorella Turri
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Kerstin J Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Daniel S Schechter
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, United States
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Morelli NM, Villodas MT. A Systematic Review of the Validity, Reliability, and Clinical Utility of Developmental Trauma Disorder (DTD) Symptom Criteria. Clin Child Fam Psychol Rev 2021; 25:376-394. [PMID: 34843012 DOI: 10.1007/s10567-021-00374-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/28/2022]
Abstract
Exposure to complex trauma is a prevalent and costly public health concern. Though not yet included in the formal diagnostic systems, developmental trauma disorder (DTD) was proposed to capture the consistent and predictable emotional, behavioral, and neurobiological sequelae observed in children exposed to complex trauma. This systematic review synthesizes and evaluates the existing empirical evidence for DTD as a reliable, valid, distinctive, and clinically useful construct. We identified 21 articles reporting on 17 non-overlapping samples that evaluated DTD symptom criteria using objective, empirical methods (e.g., factor analysis, associations with other diagnostic constructs, associations with trauma exposure type, clinician ratings of utility). Studies were largely supportive of the DTD construct and its clinical utility; however, it will be crucial for this work to be replicated in larger samples, by independent research groups, and with more rigorous methodological and analytic approaches before definitive conclusions can be drawn. Findings from this review, while preliminary, provide a promising empirical foundation for DTD and bring the field closer to improving diagnostic parsimony for children and adolescents affected by complex trauma.
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Affiliation(s)
- Nicholas M Morelli
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct., Suite 250, San Diego, CA, 92120, USA.
| | - Miguel T Villodas
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct., Suite 250, San Diego, CA, 92120, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Kobayashi K, Koyama N, Nagano Y, Usami I, Fujimura K, Heike T. Biopsychosocial assessment of dental neglect in a pediatric cancer patient from the perspectives of developmental trauma disorder. PEDIATRIC DENTAL JOURNAL 2021. [DOI: 10.1016/j.pdj.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lapshina N, Stewart SL. Traumatic life events, polyvictimization, and externalizing symptoms in children with IDD and mental health problems. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 116:104028. [PMID: 34339937 DOI: 10.1016/j.ridd.2021.104028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 05/22/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND AIMS This study aims to examine the rates of potentially traumatic events (PTEs) and polyvictimization, as well as interrelationships among PTE types in children and youth with intellectual developmental disorder (IDD) and co-occurring mental health issues. It also examines the association between polyvictimization (experiencing three or more PTEs) and externalizing symptoms, controlling for IDD severity, sex and age. METHOD The study utilized archival data collected from 2012 to 2020 by trained assessors (e.g., nurses, social workers, psychologists) at intake into clinical mental health services in the Province of Ontario, Canada. The sample included 502 children and youth (age range: 4-18 years) who were assessed using the interRAI Child and Youth Mental Health and Developmental Disability (ChYMH-DD) instrument. Using this standardized assessment, trained clinicians reported on children's demographics, traumatic life events, and externalizing symptoms (proactive and reactive aggression) among other physical and mental health indicators. RESULTS 64.74 % of the children had experienced at least one type of PTE, whereas 33.06 % experienced lifetime polyvictimization. Most of the PTE types were positively correlated, with the strongest associations between physical, emotional abuse, witnessing domestic violence, and parental addiction. In a multivariate model, experiences of three or more PTEs (vs. none), mild or moderate IDD (vs. severe/profound), male sex (vs. female) were associated with greater externalizing symptoms. There was a quadratic relationship between age and externalizing symptoms. CONCLUSION The project advances knowledge on trauma and polyvictimization patterns and their association with IDD severity and externalizing symptoms in this population. Trauma-informed services should be tailored to the specific needs of these children.
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Schneiderman JU, Davis JP, Negriff S. Associations Between Psychosocial Functioning and Physical Health in Youth with Maltreatment Experiences. CHILDREN AND YOUTH SERVICES REVIEW 2021; 127:106080. [PMID: 34211239 PMCID: PMC8240661 DOI: 10.1016/j.childyouth.2021.106080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Childhood maltreatment often results in long-term untoward outcomes, although some individuals demonstrate better psychosocial functioning. Maltreatment is linked with poor physical health outcomes but little is known about how psychosocial functioning is related to physical health. The aims of this study were to: 1) Identify heterogeneity of psychosocial functioning using a latent profile analysis. Positive functioning was measured by both fewer problematic symptoms (depressive, PTSD, anxiety, externalizing behavior, and substance abuse disorder) and the presence of the protective factor of social support; and 2) Explore the relationship between emergent classes of psychosocial functioning and physical health (self-reported illnesses, symptoms, and health status as well as measured overweight/obesity). Participants included a sample of youth with child welfare-documented maltreatment (n=219; mean age 18.3 years; range 15-23 years) at Time 4 (T4) of a longitudinal study. Mean differences or odds ratios were assessed across the health variables between classes. The three resulting classes were labeled: 1) higher support/lower symptoms (60.7%); 2) lower support/higher internalizing symptoms (29.2%); and 3) lower support/higher externalizing/substance abuse symptoms (10%). Youth in the lower/support/higher externalizing/substance abuse symptoms class had a similar high level of internalizing symptoms as the lower support/higher internalizing symptoms class. Youth in the lower support/high externalizing/substance abuse symptoms class had more colds and pain symptoms in the past month and gastrointestinal illnesses in the past year than the higher support/lower symptoms class, and more illnesses, respiratory problems, and gastrointestinal illnesses the last year than the lower support/higher internalizing symptoms class. Overall, functioning class was related to certain health problems which often have a stress component and were more prevalent for youth with more externalizing and substance abuse symptoms.
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Affiliation(s)
- Janet U. Schneiderman
- Corresponding Author: Nursing Department, Suzanne Dworak-Peck School of Social Work; University of Southern California; 669 West 34 Street, Los Angeles, CA, USA 90089-0411; ; 213-821-1338
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work; USC Center for Artificial Intelligence in Society; USC Center for Mindfulness Science; University of Southern California; 669 West 34 Street, Los Angeles, CA, USA 90089-0411
| | - Sonya Negriff
- Department of Research & Evaluation, Kaiser Permanente Southern California; 100 South Los Robles Avenue, Pasadena, CA USA, 91101-2453
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Schumacher L, Burger J, Zoellner F, Zindler A, Epskamp S, Barthel D. Using clinical expertise and empirical data in constructing networks of trauma symptoms in refugee youth. Eur J Psychotraumatol 2021; 12:1920200. [PMID: 34178294 PMCID: PMC8205066 DOI: 10.1080/20008198.2021.1920200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: In recent years, many adolescents have fled their home countries due to war and human rights violations, consequently experiencing various traumatic events and putting them at risk of developing mental health problems. The symptomatology of refugee youth was shown to be multifaceted and often falling outside of traditional diagnoses. Objective: The present study aimed to investigate the symptomatology of this patient group by assessing the network structure of a wide range of symptoms. Further, we assessed clinicians' perceptions of symptoms relations in order to evaluate the clinical validity of the empirical network. Methods: Empirical data on Post-Traumatic Stress Disorder (PTSD), depression and other trauma symptoms from N = 366 refugee youth were collected during the routine diagnostic process of an outpatient centre for refugee youth in Germany. Additionally, four clinicians of this outpatient centre were asked how they perceive symptom relations in their patients using a newly developed tool. Separate networks were constructed based on 1) empirical symptom data and 2) clinicians' perceived symptom relations (PSR). Results: Both the network based on empirical data and the network based on clinicians' PSR showed that symptoms of PTSD and depression related most strongly within each respective cluster (connected mainly via sleeping problems), externalizing symptoms were somewhat related to PTSD symptoms and intrusions were central. Some differences were found within the clinicians' PSR as well as between the PSR and the empirical network. Still, the general PSR-network structure showed a moderate to good fit to the empirical data. Conclusion: Our results suggest that sleeping problems and intrusions play a central role in the symptomatology of refugee children, which has tentative implications for diagnostics and treatment. Further, externalizing symptoms might be an indicator for PTSD-symptoms. Finally, using clinicians' PSR for network construction offered a promising possibility to gain information on symptom networks and their clinical validity.
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Affiliation(s)
- Lea Schumacher
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychology, Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Julian Burger
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Center Psychiatry (UCP), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Fionna Zoellner
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Areej Zindler
- Ambulanzzentrum des UKE GmbH, Flüchtlingsambulanz, Hamburg, Germany
| | - Sacha Epskamp
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychology, Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Dana Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Ambulanzzentrum des UKE GmbH, Flüchtlingsambulanz, Hamburg, Germany
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Ford JD, Courtois CA. Complex PTSD and borderline personality disorder. Borderline Personal Disord Emot Dysregul 2021; 8:16. [PMID: 33958001 PMCID: PMC8103648 DOI: 10.1186/s40479-021-00155-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD. MAIN BODY The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity; (2) clinical phenomenology; (3) traumatic antecedents; (4) psychobiology; (5) emotion dysregulation; (6) dissociation; and (7) empirically supported approaches to clinical assessment and psychotherapeutic treatment. CONCLUSION The evidence suggests that PTSD, cPTSD, and BPD are potentially comorbid but distinct syndromes. A hypothesis is advanced to stimulate scientific research and clinical innovation defining and differentiating the disorders, positing that they may represent a continuum paralleling the classic conceptualization of the stress response, with dissociation potentially involved in each disorder.
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Affiliation(s)
- Julian D Ford
- University of Connecticut Health Center MC1410, 263 Farmington Avenue, Farmington, CT, 06030-1410, USA.
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Abstract
Explosive outbursts in children and adolescents have been long identified by clinicians and have been described using many different conceptualizations and terms. The topography of explosive outbursts is complex, heterogeneous, and includes the interactions of different emotional and behavioral constructs. Included here are pre-existing central nervous system vulnerabilities including psychiatric and neurologic diagnoses, various contributing emotions that generally carry a negative valence, and aggressive behaviors that are usually overt and reactive. Emotional impulsivity and deficient emotional self-regulatory mechanisms may contribute to episode severity and duration.
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Affiliation(s)
- Daniel F Connor
- Department of Psychiatry, MC 1410, University of Connecticut Medical School, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | - Leonard A Doerfler
- Clinical Counseling Psychology Program, Assumption College, Department of Psychiatry, University of Massachusetts School of Medicine, 500 Salisbury Street, Worcester, MA 01609-1296, USA
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Abstract
Background: Polyvictimization (Gilbar & Ford, 2020) and developmental trauma (van der Kolk, Ford, & Spinazzola, 2019) have been identified in the past decade as empirically operationalized high impact forms of cumulative childhood trauma (Ford, 2015). Childhood polyvictimization (PV) is defined as experiencing multiple types of interpersonal victimization sequentially or concurrently at any point in childhood (lifetime) or in the past year (recent). Childhood developmental trauma (DT) is defined as a combination of traumatic interpersonal victimization and disruption in attachment bonds with primary caregiver(s). Objective: To present an overview of research findings to date and a systematic agenda for research on polyvictimization and developmental trauma over the next decade. Method: A systematic review of research on polyvictimization and developmental trauma in childhood was conducted in peer-reviewed publications from 2010 to 2020. Results: More than 100 empirical studies of PV or DT were reviewed. Childhood PV was associated with both the risk and severity of internalizing and externalizing disorders, specifically with PTSD when victimization is sufficiently severe to be traumatic. Childhood DT was associated with dysregulation in three domains (affective/physiological, attentional/behavioural, self/relational) that can be reliably and validly assessed with 15 symptoms that are distinct from the symptoms of ICD-11 PTSD and complex PTSD (see Table 1).Developmental trauma disorder (DTD) symptoms Emotion or somatic dysregulation | o B1: Emotion dysregulation (either B1.a. extreme negative affect states; or B1.b. impaired recovery from negative affect states) | o B2: Somatic dysregulation (either B2.a. aversion to touch; or B2.b. aversion to sounds; or B2.c. somatic distress/illness that cannot be medically explained/resolved) | o B3: Impaired access to emotion or somatic feelings (either B3.a. absence of emotion; or B3.b. physical anaesthesia that cannot be medically explained/resolved) | o B4: Impaired Emotion or Somatic Verbal Mediation/Expression (either B4.a. alexithymia; or B4.b. impaired ability to recognize/express somatic feelings/states) | Attentional or behavioural dysregulation | o C1: Attention bias towards or away from threat (either C1.a. threat-related rumination; or C1.b. hyper- or hypo-vigilance to actual or potential danger) | o C 2: Impaired self-protection (either C2.a. extreme risk-taking or recklessness; or, C2.b. intentional provocation of conflict or violence) | o C 3: Maladaptive self-soothing | o C4: Non-suicidal self-injury | o C5: Impaired ability to initiate or sustain goal-directed behaviour | Relational- or self-dysregulation | o D1: Self-loathing, including self viewed as irreparably damaged and defective | o D 2: Attachment insecurity and disorganization (either D2.a. parentified over-protection of caregivers; or D2.b. difficulty tolerating reunion following separation from primary caregiver(s)) | o D 3: Betrayal-based relational schemas (either D3.a. expectation of betrayal; or D3.b. oppositional-defiance based on expectation of coercion or exploitation) | o D4: Reactive verbal or physical aggression (including proactive instrumental aggression that is motivated primarily by preventing/responding to harm/injury) | o D5: Impaired psychological boundaries (either D.5a. promiscuous enmeshment; or D5.b. craving for reassurance) | o D6: Impaired interpersonal empathy (either D6.a. lacks empathy for, or intolerant of, others’ distress; or D6.b. excessive responsiveness to the distress of others) |
Research is needed to prospectively determine, within and across the developmental epochs of childhood and adolescence: (1) how the specific types of traumatic victimization in PV and DT differ or remain constant; (2) if and how PV and DT co-occur or diverge both on a linear and a quadratic basis; (3) the form and timing/sequencing of the separate and shared biopsychosocial sequelae of PV and DT; (4) the association of PV and DT with diagnoses of internalizing (including PTSD/cPTSD) and externalizing disorders, and severe comorbidities (e.g., self-harm, school failure, juvenile delinquency, medical illness); (5) protective factors and resilience and recovery trajectories; (6) short- and long-term response to evidence-based psychotherapies and mediators/mechanisms of symptom and impairment reduction. Conclusions: Polyvictimization and developmental trauma operationalize the broad construct of complex trauma, and parallel but are, respectively, more comprehensive and more attachment/relationally focused than the adverse childhood experiences construct.
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Stjernswärd S. Getting to Know the Inner Self. Exploratory Study of Identity Oriented Psychotrauma Therapy-Experiences and Value From Multiple Perspectives. Front Psychiatry 2021; 12:526399. [PMID: 34093249 PMCID: PMC8175788 DOI: 10.3389/fpsyt.2021.526399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/27/2021] [Indexed: 11/30/2022] Open
Abstract
Early trauma and failures in attachment attunement can affect future relational patterns, health and well-being. The processing of trauma, especially complex trauma, through adequate interventions may help integrate traumatic experiences, enhance health and quality of life. Despite years of clinical practice with Identity oriented psychotrauma therapy (IoPT), there is a lack of scientific research on the subject. Objective: The study's aim was to explore the experiences and value of IoPT for persons with experiences of IoPT, whether as a therapist, client, representative and/or observer. Methods: The study has an explorative, qualitative design. Data collection through individual in-depth interviews and focus groups with 20 participants and data analysis were inspired by grounded theory. Results: The results showed an exploratory process of self-discovery and self-development, Getting to know the inner self, to which all categories were interrelated through their contribution to the process. The findings shed light on the experiences and tangible value of IoPT for the participants from the perspectives of client, therapist, representative and observer. These perspectives were intertwined and illuminated in terms of their contribution to the process. Conclusion: IoPT seems to have transformative potential in terms of a self-exploratory journey from multiple perspectives. The need for effective treatments to enhance health and prevent further ill health in persons affected by complex trauma motivates the exploration of novel treatment approaches and formats to support clients toward health enhancing strategies. Further quantitative and qualitative research is motivated to enhance our understanding of the workings and value of IoPT for self-development, health and quality of life.
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Affiliation(s)
- Sigrid Stjernswärd
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Ford JD, Spinazzola J, van der Kolk B. Psychiatric comorbidity of developmental trauma disorder and posttraumatic Stress disorder: findings from the DTD field trial replication (DTDFT-R). Eur J Psychotraumatol 2021; 12:1929028. [PMID: 34249242 PMCID: PMC8245086 DOI: 10.1080/20008198.2021.1929028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: Developmental Trauma Disorder (DTD) has extensive comorbidity with internalizing and externalizing disorders distinct from posttraumatic stress disorder (PTSD). Objective: To replicate findings of DTD comorbidity and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable DSM-IV psychiatric disorders were identified with KSADS-PL screening modules, in a multi-site sample of 271 children (ages 8-18 years old; 47% female) in outpatient or residential mental health treatment for multiple (M = 3.5 [SD = 2.4]) psychiatric diagnoses other than PTSD or DTD. Results: DTD (N = 74, 27%) and PTSD (N = 107, 39%) were highly comorbid and shared several DSM-IV internalizing and externalizing disorder comorbidities. Children with DTD with or without PTSD had more comorbid diagnoses (M = 5.7 and 5.2 [SD = 2.4 and 1.7], respectively) than children with PTSD but not DTD (M = 3.8[SD = 2.1]) or neither PTSD nor DTD (M = 2.1[SD = 1.9]), F[3,267] = 55.49, p < .001. Further, on a multivariate basis controlling for demographics and including all potential comorbid disorders, DTD was associated with separation anxiety disorder, depression, and oppositional defiant disorder after controlling for PTSD, while PTSD was associated only with separation anxiety disorder after controlling for DTD. Both DTD and PTSD were associated with suicidality. Conclusions: DTD is associated with psychiatric comorbidity beyond that of PTSD, and DTD warrants assessment for treatment planning with children in intensive psychiatric services.
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Affiliation(s)
- Julian D Ford
- University of Connecticut School of Medicine, Farmington, CT, USA
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Lang J, Kerr DM, Petri-Romão P, McKee T, Smith H, Wilson N, Zavrou M, Shiels P, Minnis H. The hallmarks of childhood abuse and neglect: A systematic review. PLoS One 2020; 15:e0243639. [PMID: 33290423 PMCID: PMC7723263 DOI: 10.1371/journal.pone.0243639] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/25/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Studies on the impacts of child maltreatment (CM) have been conducted in diverse areas. Mechanistic understanding of the complex interplay between factors is lacking. Hallmarking is an approach which identifies common factors across studies and highlights the most robust findings. OBJECTIVES In a review of systematic reviews and meta-analyses, we addressed the following questions: 1) What are the hallmarks associated with exposure to CM across the bio-ecological spectrum? 2) What is the strength of evidence to support each hallmark? 3) What are the gaps that future research should address? METHODS A comprehensive literature search was carried out to find relevant systematic reviews or meta-analyses. 269 articles were read in full and 178 articles, encompassing more than 6000 original papers, were included in the final synthesis. All reviews were independently rated for quality by at least 2 reviewers using AMSTAR-2. RESULTS Of 178 review articles, 6 were rated as high quality (all meta-analyses) and 46 were rated as medium quality. Most were from high income countries. CONCLUSIONS Based on the most commonly reported high-quality research findings we propose that the hallmarks of exposure to child maltreatment are: Increased risk of psychopathology; Increased risk of obesity; Increased risk of high- risk sexual behaviours, Increased risk of smoking; and Increased risk of child maltreatment in children with disabilities. Research gaps include a lack of focus on complexity and resilience. Little can be concluded about directions of causality or mechanisms. Adequately powered prospective studies are required to move the field forward.
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Affiliation(s)
- Jason Lang
- University of Glasgow, Glasgow, United Kingdom
- NHS Lanarkshire, Lanarkshire, United Kingdom
| | | | | | - Tracey McKee
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Helen Smith
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Naomi Wilson
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | | | - Paul Shiels
- University of Glasgow, Glasgow, United Kingdom
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Craig SG, Bondi BC, O'Donnell KA, Pepler DJ, Weiss MD. ADHD and Exposure to Maltreatment in Children and Youth: a Systematic Review of the Past 10 Years. Curr Psychiatry Rep 2020; 22:79. [PMID: 33161561 DOI: 10.1007/s11920-020-01193-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF THE REVIEW The purpose of the current paper was to review and summarize the literature on ADHD and maltreatment over the past 10 years. RECENT FINDINGS The majority of research on ADHD and exposure to maltreatment focuses on the high rates of comorbidity, including international studies from Asia, South America, North America, and Europe. Longitudinal studies showed that early exposure to maltreatment is a risk factor for ADHD symptoms later in development; however, this finding was not consistent. There were some preliminary studies on the neurological and genetic mechanisms underlying the link between ADHD and exposure to maltreatment. Finally, ADHD and exposure to maltreatment were found to have an additive effect on clinically salient outcomes (e.g., aggression, suicide attempts). Results from the review have direct clinical and future implications, including the need to understand the effect of comorbid ADHD and exposure to maltreatment in treatment studies.
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Affiliation(s)
- Stephanie G Craig
- LaMarsh Centre for Child and Youth Research, York University, Toronto, ON, Canada.
| | - Bianca C Bondi
- LaMarsh Centre for Child and Youth Research, York University, Toronto, ON, Canada
| | | | - Debra J Pepler
- LaMarsh Centre for Child and Youth Research, York University, Toronto, ON, Canada
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Ford JD. A Developmental Trauma Perspective on Childhood Sexual Abuse. JAMA Netw Open 2020; 3:e2018272. [PMID: 32960275 DOI: 10.1001/jamanetworkopen.2020.18272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julian D Ford
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington
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Lloyd S, Larivée A. Time, trauma, and the brain: How suicide came to have no significant precipitating event. SCIENCE IN CONTEXT 2020; 33:299-327. [PMID: 34096495 DOI: 10.1017/s0269889721000065] [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] [Indexed: 06/12/2023]
Abstract
In this article, we trace shifting narratives of trauma within psychiatric, neuroscience, and environmental epigenetics research. We argue that two contemporary narratives of trauma - each of which concerns questions of time and psychopathology, of the past invading the present - had to be stabilized in order for environmental epigenetics models of suicide risk to be posited. Through an examination of these narratives, we consider how early trauma came to be understood as playing an etiologically significant role in the development of suicide risk. Suicide, in these models, has come to be seen as a behavior that has no significant precipitating event, but rather an exceptional precipitating neurochemical state, whose origins are identified in experiences of early traumatic events. We suggest that this is a part of a broader move within contemporary neurosciences and biopsychiatry to see life as post: seeing life as specific form of post-traumatic subjectivity.
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Dagan Y, Yager J. Cannabis and Complex Posttraumatic Stress Disorder: A Narrative Review With Considerations of Benefits and Harms. J Nerv Ment Dis 2020; 208:619-627. [PMID: 32433200 DOI: 10.1097/nmd.0000000000001172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite substantial controversies concerning patients' reports of benefits from cannabis for posttraumatic stress disorder (PTSD) and inconsistent research findings regarding its efficacy and adverse risks, some states have already recognized PTSD as a qualifying condition for medical cannabis. Consequently, medical cannabis can also be provided for patients with complex PTSD who experience additional posttraumatic symptoms of affective dysregulation, negative perception of the self, and difficulties in relationships due to a history of repetitive trauma. In this article, we explore cannabis use in relation to benefits versus harms that might occur relative to specific complex PTSD symptoms and comorbidities. Whereas some symptoms related to PTSD per se (e.g., anxiety, insomnia, nightmares) may be benefited, others that are more characteristic of complex PTSD (e.g., dissociation, reckless behavior, and substance abuse associated with dysregulated affect) may be aggravated. Therefore, clinicians treating patients with complex PTSD who use or seek cannabis should carefully assess patients' motivations and the impacts of particular use patterns on specific symptoms. Clinicians and patients should be aware of and fully discuss the significant number of potential adverse effects of cannabis use, several of which might impede patients' participation in beneficial psychotherapeutic, social, and medical interventions.
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Affiliation(s)
- Yael Dagan
- Jerusalem Mental Health Center, Kfar Shaul Psychiatric Hospital affiliated with The Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
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Olff M, Bakker A, Frewen P, Aakvaag H, Ajdukovic D, Brewer D, Elmore Borbon DL, Cloitre M, Hyland P, Kassam-Adams N, Knefel M, Lanza JA, Lueger-Schuster B, Nickerson A, Oe M, Pfaltz MC, Salgado C, Seedat S, Wagner A, Schnyder U. Screening for consequences of trauma - an update on the global collaboration on traumatic stress. Eur J Psychotraumatol 2020; 11:1752504. [PMID: 32489523 PMCID: PMC7241533 DOI: 10.1080/20008198.2020.1752504] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This letter provides an update on the activities of "The Global Collaboration on Traumatic Stress" (GC-TS) as first described by Schnyder et al. in 2017. It presents in further detail the projects of the first theme, in particular the development of and initial data on the Global Psychotrauma Screen (GPS), a brief instrument designed to screen for the wide range of potential outcomes of trauma. English language data and ongoing studies in several languages provide a first indication that the GPS is a feasible, reliable and valid tool, a tool that may be very useful in the current pandemic of the coronavirus disease 2019 (COVID-19). Further multi-language and cross-cultural validation is needed. Since the start of the GC-TS, new themes have been introduced to focus on in the coming years: a) Forcibly displaced persons, b) Global prevalence of stress and trauma related disorders, c) Socio-emotional development across cultures, and d) Collaborating to make traumatic stress research data "FAIR". The most recent theme added is that of Global crises, currently focusing on COVID-19-related projects.
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Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Anne Bakker
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul Frewen
- Department of Psychiatry, Western University, London, Canada
| | - Helene Aakvaag
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Dean Ajdukovic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Douglas Brewer
- Ramsay Health Care, The Hollywood Clinic, Perth, Australia
| | - Diane L Elmore Borbon
- Policy Program, UCLA-Duke University National Center for Child Traumatic Stress, Washington, DC, USA
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, Department of Psychiatry and Behavioral Sciences, VA Palo Alto Health Care System, Stanford University, Menlo Park, CA, USA
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland
| | - Nancy Kassam-Adams
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Pediatric Traumatic Stress, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Juliana A Lanza
- Traumatic Stress Unit, Psychiatric Emergency Hospital, Buenos City, Argentina.,Human Factors, Emergency Medical Care System (SAME), Buenos Aires City, Argentina
| | | | | | - Misari Oe
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Carolina Salgado
- Department of Psychiatry, Medical School of Universidad Catolica Del Maule, Chile
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anne Wagner
- Department of Psychology, Ryerson University, Toronto, Canada and Remedy, Toronto, Canada
| | - Ulrich Schnyder
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands.,Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychiatry, Western University, London, Canada.,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.,Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia.,Ramsay Health Care, The Hollywood Clinic, Perth, Australia.,Policy Program, UCLA-Duke University National Center for Child Traumatic Stress, Washington, DC, USA.,National Center for PTSD Dissemination and Training Division, Department of Psychiatry and Behavioral Sciences, VA Palo Alto Health Care System, Stanford University, Menlo Park, CA, USA.,Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Pediatric Traumatic Stress, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,University of Vienna, Vienna, Austria.,Traumatic Stress Unit, Psychiatric Emergency Hospital, Buenos City, Argentina.,Human Factors, Emergency Medical Care System (SAME), Buenos Aires City, Argentina.,Faculty of Psychology, Clinical Psychology, University of Vienna, Vienna, Austria.,UNSW School of Psychology, UNSW Sydney, Australia.,Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.,Department of Psychiatry, Medical School of Universidad Catolica Del Maule, Chile.,Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Psychology, Ryerson University, Toronto, Canada and Remedy, Toronto, Canada.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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42
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Letica-Crepulja M, Stevanović A, Protuđer M, Grahovac Juretić T, Rebić J, Frančišković T. Complex PTSD among treatment-seeking veterans with PTSD. Eur J Psychotraumatol 2020; 11:1716593. [PMID: 32166005 PMCID: PMC7054953 DOI: 10.1080/20008198.2020.1716593] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 01/14/2023] Open
Abstract
Background: In the ICD-11 hierarchical classification structure, posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) are separate and distinct but also 'sibling' disorders, meaning that the diagnoses follow from the parent category of traumatic stress disorders. Objective: The aim of this study was to examine the prevalence of CPTSD in treatment-seeking war veterans with PTSD more than 20 years after the exposure to cumulative war-related trauma(s). The second aim was to examine if there was an association between demographic and psychosocial variables and CPTSD or PTSD. Method: A sample of 160 male war veterans with PTSD referred to the outpatient service of the PTSD Referral Centre at the Clinical Hospital Centre (CHC) Rijeka participated in a cross-sectional study. Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview (MINI) and participants completed validated self-report measures: The Life Events Checklist for DSM-5 (LEC-5), International Trauma Questionnaire (ITQ). Results: In total, 80.63% of the sample met criteria for a probable diagnosis of CPTSD. The study revealed that there was no significant difference in the length of deployment, in the intensity of the PTSD symptoms, types of trauma exposure and pharmacotherapeutic treatment between PTSD and CPTSD group. It was found that veterans with PTSD were more likely to be divorced and to participate in PTSD clubs. On the other hand, veterans with CPTSD were significantly more likely to have higher levels of functional impairment and comorbidity with general anxiety disorder (GAD) compared to the PTSD group. Conclusions: This study supports the proposition that a prolonged trauma of severe interpersonal intensity such as war is related to high rates of CPTSD among treatment-seeking veterans, years after the war. The distinction between PTSD and complex PTSD may help the selection of person-centred treatment interventions that would target specific mental health and functional problems in patients.
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Affiliation(s)
- Marina Letica-Crepulja
- Department for Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for Posttraumatic Stress Disorder of the Ministry of Health of the Republic of Croatia, Rijeka, Croatia
| | - Aleksandra Stevanović
- Department for Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for Posttraumatic Stress Disorder of the Ministry of Health of the Republic of Croatia, Rijeka, Croatia
| | - Marina Protuđer
- Department of Addiction Prevention and Treatment, Teaching Institute of Public Health of Primorsko-Goranska County, Rijeka, Croatia
| | - Tanja Grahovac Juretić
- Department for Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for Posttraumatic Stress Disorder of the Ministry of Health of the Republic of Croatia, Rijeka, Croatia
| | - Jelena Rebić
- Department for Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for Posttraumatic Stress Disorder of the Ministry of Health of the Republic of Croatia, Rijeka, Croatia
| | - Tanja Frančišković
- Department for Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.,Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for Posttraumatic Stress Disorder of the Ministry of Health of the Republic of Croatia, Rijeka, Croatia
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Idsoe T, Vaillancourt T, Dyregrov A, Hagen KA, Ogden T, Nærde A. Bullying Victimization and Trauma. Front Psychiatry 2020; 11:480353. [PMID: 33519533 PMCID: PMC7841334 DOI: 10.3389/fpsyt.2020.480353] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 12/16/2020] [Indexed: 12/24/2022] Open
Abstract
Bullying victimization and trauma research traditions operate quite separately. Hence, it is unclear from the literature whether bullying victimization should be considered as a form of interpersonal trauma. We review studies that connect bullying victimization with symptoms of PTSD, and in doing so, demonstrate that a conceptual understanding of the consequences of childhood bullying needs to be framed within a developmental perspective. We discuss two potential diagnoses that ought to be considered in the context of bullying victimization: (1) developmental trauma disorder, which was suggested but not accepted as a new diagnosis in the DSM-5 and (2) complex post-traumatic stress disorder, which has been included in the ICD-11. Our conclusion is that these frameworks capture the complexity of the symptoms associated with bullying victimization better than PTSD. We encourage practitioners to understand how exposure to bullying interacts with development at different ages when addressing the consequences for targets and when designing interventions that account for the duration, intensity, and sequelae of this type of interpersonal trauma.
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Affiliation(s)
- Thormod Idsoe
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | | | - Atle Dyregrov
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | | | - Terje Ogden
- Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - Ane Nærde
- Norwegian Center for Child Behavioral Development, Oslo, Norway
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Ford JD. New findings questioning the construct validity of complex posttraumatic stress disorder (cPTSD): let's take a closer look. Eur J Psychotraumatol 2020; 11:1708145. [PMID: 32082511 PMCID: PMC7006683 DOI: 10.1080/20008198.2019.1708145] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 01/19/2023] Open
Abstract
This commentary provides a broader context for interpreting evidence from Latent Class and Latent Profile analyses on complex posttraumatic stress disorder (CPTSD) that was provided in a recent contribution to the European Journal of Psychotraumatology. These data analytic strategies are not alone sufficient to test the construct validity of CPTSD. They base their conclusion on the empirical finding of substantial variation in latent models obtained with different analytic procedures and interpretations of the fit of different latent models, as well as interesting additional evidence of dispersion when individual patients' symptom counts and symptom severity scores on PTSD and CPTSD are examined. However, the results of their analyses actually do provide support for one feature of construct validity, demonstrating discriminant validity by showing a consistent differentiation between PTSD and CPTSD (with expectable variation in both PTSD and CPTSD severity level by persons). Even in a sample of patients diagnosed with PTSD, there may be a Disorders of Self Organization (DSO) sub-group with low PTSD symptom severity. More detailed examination of which DSO symptoms and sub-domains characterize the DSO sub-group and the CPTSD sub-group is needed in order to clarify the nature of the DSO/CPTSD construct. Other analyses needed to fully test construct validity also are described.
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Affiliation(s)
- Julian D Ford
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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45
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Ford JD. Commentary on the Special Section on Complex PTSD: Still Going Strong After All These Years. J Trauma Stress 2019; 32:877-880. [PMID: 31800123 DOI: 10.1002/jts.22474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 11/07/2022]
Abstract
Posttraumatic stress disorder (PTSD) is inherently complex, yet a growing evidence base indicates that a complex variant (CPTSD) can be distinguished from classic PTSD based on evidence of clinically significant affect, interpersonal, and self/identity dysregulation. This Commentary to the Journal of Traumatic Stress special section on CPTSD reviews the results of four new studies that empirically tested the structure, traumatic stressor antecedents, and construct validity of CPTSD in relation to PTSD and borderline personality disorder (BPD). Based on these and prior empirical findings, a reconceptualization of PTSD, CPTSD, and BPD as posttraumatic threat, betrayal, and rejection disorders, respectively, is proposed. Implications for treatment of trauma survivors are discussed in relation to articles in this special section, which describe a modular framework for CPTSD treatment and an innovative attachment and self-regulation focused on the redesign of a traditional outpatient mental health clinic.
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Affiliation(s)
- Julian D Ford
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Olff M, Amstadter A, Armour C, Birkeland MS, Bui E, Cloitre M, Ehlers A, Ford JD, Greene T, Hansen M, Lanius R, Roberts N, Rosner R, Thoresen S. A decennial review of psychotraumatology: what did we learn and where are we going? Eur J Psychotraumatol 2019; 10:1672948. [PMID: 31897268 PMCID: PMC6924542 DOI: 10.1080/20008198.2019.1672948] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue/collection celebrating the 10 years anniversary of the journal where we will acknowledge some of our most impactful articles of the past decade (also discussed below and marked with * in the reference list). In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline. These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience. We address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help us to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions 1. Where did we stand in 2010? 2. What did we learn in the past 10 years? 3. What are our knowledge gaps? We conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.
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Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Amsterdam
University Medical Centers (location AMC), University of Amsterdam, Amsterdam
Neuroscience, Amsterdam, The Netherlands
- ARQ National Psychotrauma
Centre, Diemen, The Netherlands
| | - Ananda Amstadter
- Departemnts of Psychiatry, Psychology, &
Human and Molecular Genetics, Virginia Commonwealth University, Richmond,
USA
| | - Cherie Armour
- School of Psychology, Queens University
Belfast, Belfast, Northern Ireland, UK
| | - Marianne S. Birkeland
- Section for implementation and treatment
research, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo
Norway
| | - Eric Bui
- Department of Psychiatry, Massachusetts
General Hospital & Harvard Medical School, Boston, MA,
USA
| | - Marylene Cloitre
- National Center for PTSD Dissemination and
Training Division, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral
Sciences, Stanford University, Palo Alto, CA, USA
| | - Anke Ehlers
- Department of Experimental Psychology,
University of Oxford, Oxford, UK
| | - Julian D. Ford
- Department of Psychiatry, University of
Connecticut Health Center, Farmington, USA
| | - Talya Greene
- Department of Community Mental Health,
University of Haifa, Haifa, Israel
| | - Maj Hansen
- Department of Psychology,
Odense, Denmark
| | - Ruth Lanius
- Posttraumatic Stress Disorder (PTSD) Research
Unit, Western University of Canada, London, ON,
Canada
| | - Neil Roberts
- Psychology and Psychological Therapies
Directorate, Cardiff & Vale University Health Board, Cardiff,
UK
- Division of Psychological Medicine &
Clinical Neurosciences, Cardiff University, Cardiff,
UK
| | - Rita Rosner
- Department of Clinical and Biological
Psychology, KU Eichstaett-Ingolstadt, Eichstaett,
Germany
| | - Siri Thoresen
- Section for trauma, catastrophes and forced
migration – children and youth, Norwegian Centre for Violence and Traumatic Stress
Studies, Oslo, Norway
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Abstract
Characterized by aggressive or violent behaviors, reactive attachment disorder (RAD) affects children who have been repeatedly exposed to traumatic experiences. This article discusses the underlying causes of RAD and provides insight on therapies and interventions.
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