1
|
Remmers MCC, Reijs RP, Hoebe CJPA. Defining and distinguishing early life stress, trauma, adversity, toxic and chronic stress and allostatic load: a descriptive review. Scand J Public Health 2024:14034948241260105. [PMID: 39087715 DOI: 10.1177/14034948241260105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
AIMS Various concepts are used to study the impact of stress on childhood development. These concepts are often used inconsistently or interchangeably. Our main objectives were to determine how selected stress concepts (chronic stress, toxic stress, allostatic load, early life stress, childhood adversity, childhood trauma and adverse childhood experiences; ACEs) are defined, operationalized and described, and to provide a theoretical context to aid the choice for a preferred concept in public health research. METHODS For this descriptive review, we systematically searched for literature published before 4 August 2021, on PubMed, Embase and PsycInfo. Two independent reviewers included studies. Exclusion criteria were: no systematic review, not peer reviewed, not published in English, selected stress concepts were no predetermined variable or a substantial topic in the discussion, full text was unobtainable or study described non-human or non-childhood populations. Data extraction forms were used. Descriptives were gathered, publication fields were identified through Journal Citation Reports categories, and verbatim descriptions were ordered in text and Venn diagrams. RESULTS Of 264 screened studies, 124 were included. ACEs, childhood adversity and childhood trauma were used most. ACEs were the main concept used most frequently (47.6%). A total of 11 of 14 public and environmental health journals used ACEs. All concepts refer to prolonged, repeated, interpersonal stress from 0 to 18 years, that can alter physiological systems. Four concepts were stressor oriented, two concepts focused on stress response and effect and one on the state of challenged homeostasis. CONCLUSIONS ACEs seem most fitting for public health setting, due to their operationalizability, large set of core experiences and widespread use.
Collapse
Affiliation(s)
- Maarten C C Remmers
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Youth Health Care, Public Health Service Limburg-North, Venlo, Netherlands
| | - Rianne P Reijs
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Youth Health Care, Living Lab Public Health Mosa, Public Health Service South Limburg, Heerlen, Netherlands
| | - Christian J P A Hoebe
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, Public Health Service South Limburg, Heerlen, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, Netherlands
| |
Collapse
|
2
|
Thomson P, Jaque SV. "I Cannot Tell Anyone:" There are Many Reasons. J Trauma Dissociation 2024:1-14. [PMID: 39041495 DOI: 10.1080/15299732.2024.2383183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024]
Abstract
Purpose: The purpose of this study was to investigate variables associated with difficulty disclosing past trauma. Across several prevalence studies, 26% of adults never disclosed childhood abuse until adulthood when they were asked in a research survey or interview question. In this Institutional Review Board approved study, group differences were examined (ability and inability to disclose a traumatic event) as well as predictors for difficulty disclosing past trauma. Method: A non-clinical population (N = 693) was examined to determine prevalence rates and group differences between participants unable to tell someone about a past traumatic event (10%) compared to those who could disclose past traumatic events (90%). Variables included pathological dissociative processing, internalized shame, coping strategies (task, emotion, avoidance), and cumulative trauma exposure. Logistic regression analyses were conducted to determine predicting variables for disclosure difficulties. Findings: The group that had difficulty disclosing a past traumatic event had more cumulative trauma, pathological dissociative processing, emotion-oriented coping, and shame. In the first logistic regression analyses, interpersonal traumatic events were predictors for the inability to disclose a traumatic event (classified 90% of group membership). In the second logistic regression, shame and cumulative traumatic exposure were predicting factors (classified 90% of group membership). Conclusion: Difficulty speaking about a traumatic event was associated with interpersonal adult and childhood traumatic events, more internalized shame, and cumulative trauma exposure. It is recommended that clinicians working with patients with substantial traumatic exposure address shame, pathological dissociative processing, and emotion-oriented coping strategies if they detect trauma disclosure difficulties.
Collapse
Affiliation(s)
- Paula Thomson
- Department of Kinesiology, California State University, Northridge, California, USA
| | - S Victoria Jaque
- Department of Kinesiology, California State University, Northridge, California, USA
| |
Collapse
|
3
|
Daniels JK, Timmerman ME, Spitzer C, Lampe A. Differential constellations of dissociative symptoms and their association with childhood trauma - a latent profile analysis. Eur J Psychotraumatol 2024; 15:2348345. [PMID: 38739008 PMCID: PMC11095287 DOI: 10.1080/20008066.2024.2348345] [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: 11/02/2023] [Accepted: 04/20/2024] [Indexed: 05/14/2024] Open
Abstract
Background: While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe.Objective: We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics.Methods: We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II (Fragebogen zu Dissoziativen Symptomen-20) in a large aggregate sample (n = 3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics.Results: Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout.Conclusions: The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment.
Collapse
Affiliation(s)
- Judith K. Daniels
- Department of Psychology, Division of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- Psychologische Hochschule Berlin, Berlin, Germany
| | - Marieke E. Timmerman
- Department of Psychology, Psychometrics and Statistics, University of Groningen, Groningen, the Netherlands
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Astrid Lampe
- Clinic for Rehabilitation Montafon, Schruns, Austria
- Ludwig Boltzmann Institute – Rehabilitation Research, Vienna, Austria
| |
Collapse
|
4
|
Fan N, Fan H, Luo R, Wang Y, Yan Y, Yang X, Wang M, Dou Y, Ni R, Wei J, Yang W, Ma X. The impact of childhood trauma on emotional distress and the moderating role of sense of coherence among college students in China. Sci Rep 2024; 14:9797. [PMID: 38684905 PMCID: PMC11058193 DOI: 10.1038/s41598-024-60537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/24/2024] [Indexed: 05/02/2024] Open
Abstract
Childhood trauma is strongly linked to emotional distress. However, few studies have explored the impact of sense of coherence (SOC) on the relationship between childhood trauma and emotional distress in college students. This study aimed to explore its impact on the relationship between childhood trauma and emotional distress. Analyzing data from 2307 Chinese college students, we found that SOC moderated the association between childhood trauma and anxiety/depression levels. Females showed higher SOC and lower anxiety/depression despite experiencing more childhood trauma. Multiple linear regression revealed that anxiety was negatively associated with SOC(P < 0.001) and grade(P = 0.027), and positively with childhood trauma(P < 0.001) and male gender(P = 0.004). Similarly, the depression exhibited similar associations. SOC moderated negatively the relationship between CTQ and anxiety, as well as between CTQ and depression. Childhood trauma is associated with increased emotional distress risk among college students, but a strong SOC can reduce this risk.
Collapse
Affiliation(s)
- Ningdan Fan
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Huanhuan Fan
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Ruiqing Luo
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
- Chongqing Mental Health Center, Chongqing, China
| | - Yu Wang
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yushun Yan
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xiao Yang
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Min Wang
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yikai Dou
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Rongjun Ni
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jinxue Wei
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Wanqiu Yang
- School of Ethnology and Sociology, Yunnan University, Kunming, China
- School of Medicine, Yunnan University, Kunming, China
| | - Xiaohong Ma
- Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
5
|
Shen ACT, Wu BCY. From adverse childhood experiences to harsh parenting: Psychological symptoms as a mediator. CHILD ABUSE & NEGLECT 2024; 149:106672. [PMID: 38325163 DOI: 10.1016/j.chiabu.2024.106672] [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: 07/10/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Research evidence has demonstrated a direct link between ACEs and harsh parenting. However, the mechanisms linking paternal ACEs to harsh parenting have remained largely unexplored among Asian populations. OBJECTIVE In the current study, we examined the relationships between parental ACEs and harsh parenting and explored the potential mediating effect of psychological symptoms on the relationship between parental ACEs and harsh parenting. PARTICIPANTS AND SETTING A total of 6195 Taiwanese parents of children aged 6 to 12 were recruited from 58 primary schools in the Taiwanese cities of Taipei and New Taipei. METHOD Using probability-proportional-to-size sampling and a self-report survey, we collected data relating to parental ACEs, psychological symptoms, and child-rearing behaviors. A hierarchical regression analysis was completed to examine the effects of parental ACEs and psychological symptoms on harsh parenting. In addition, we tested the potential mediating effects of psychological symptoms on the relationship between parental ACEs and harsh parenting by employing a simple mediation model (PROCESS) with a bootstrapping procedure. RESULTS We found that both parental ACEs and psychological symptoms were significant predictors for mothers' and fathers' adoption of harsh parenting behaviors. Moreover, after adjusting for covariates, we discovered the unique finding that psychological symptoms mediated the relationship between parental ACEs and harsh parenting among Taiwanese parents. CONCLUSIONS The study revealed a direct link between parental ACEs and harsh parenting, with psychological symptoms serving as a mediator. Our findings suggest that trauma-recovery programs should promote regular screening and interventions for parents with ACEs.
Collapse
Affiliation(s)
- April Chiung-Tao Shen
- National Taiwan University Children and Family Research Center sponsored by CTBC Charity Foundation, Taiwan; Department of Social Work, National Taiwan University, Taiwan
| | - Bethany C Y Wu
- National Taiwan University Children and Family Research Center sponsored by CTBC Charity Foundation, Taiwan.
| |
Collapse
|
6
|
Bortoletto R, Bassani L, Garzitto M, Lamberti M, Simonati A, Darra F, Bhattacharyya S, Comacchio C, Balestrieri M, Arcangeli D, Colizzi M. Risk of psychosis in autism spectrum disorder individuals exposed to psychosocial stressors: A 9-year chart review study. Autism Res 2023; 16:2139-2149. [PMID: 37929657 DOI: 10.1002/aur.3042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
Psychosocial stressors have been suggested to precipitate psychotic episodes in patients with pre-existing psychosis and otherwise healthy subjects. However, such a risk has never been formally investigated in individuals with autism spectrum disorder (ASD). Sixty-nine autistic adolescents hospitalized for psychotic/manic symptoms (PSY) and other mental health issues (NPSY) over a 9-year period were compared with reference to their previous exposure to psychosocial stressors. ASD diagnoses satisfied the International Classification of Diseases (ICD)-10 criteria. Psychotic/manic symptom assessment followed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Psychosocial stressor exposure was collected separately at each admission. Preliminarily, univariate between-group comparisons were conducted. Then, a binomial model was adopted to investigate associations with previous exposure to psychosocial stressors. Results were reported with a change in AIC (ΔAIC). PSY patients presented with higher previous exposure to adverse life events (30.43% vs. 6.52%, OR = 6.079 [1.209, 40.926], p = 0.013) and school/work difficulties (30.43% vs. 8.70%, OR = 4.478 [0.984, 23.846], p = 0.034) than NPSY ones. Admissions for psychotic/manic symptoms occurred more likely in the context of family disturbances (OR = 2.275 [1.045, 5.045], p = 0.030) and adverse life events (OR = 3.489 [1.194, 11.161], p = 0.014). The fitted binomial model was found to be significant compared to the random effects model (ΔAIC = -1.962; χ2 10 = 21.96, p = 0.015), with the risk of presenting psychotic/manic symptoms being increased by family disturbances (z = +4.118) and school/work difficulties (z = +2.455). The results suggest a potential psychosis-inducing effect of psychosocial stressors in ASD, which has clinical and policy implications.
Collapse
Affiliation(s)
- Riccardo Bortoletto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Lorenzo Bassani
- Department of Child and Adolescent Psychiatry, Hospital of Merano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Merano-Meran, Italy
| | - Marco Garzitto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Marco Lamberti
- Department of Child and Adolescent Psychiatry, Hospital of Merano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Merano-Meran, Italy
| | - Alessandro Simonati
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Francesca Darra
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carla Comacchio
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Donatella Arcangeli
- Department of Child and Adolescent Psychiatry, Hospital of Merano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medizinischen Privatuniversität (PMU), Merano-Meran, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
7
|
Dube SR, Li ET, Fiorini G, Lin C, Singh N, Khamisa K, McGowan J, Fonagy P. Childhood verbal abuse as a child maltreatment subtype: A systematic review of the current evidence. CHILD ABUSE & NEGLECT 2023; 144:106394. [PMID: 37586139 DOI: 10.1016/j.chiabu.2023.106394] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND In recent years, the prevalence of childhood emotional abuse has surpassed other forms of maltreatment. Childhood verbal abuse (CVA) is a key attribute of emotional abuse, yet CVA is not recognized as its own form of maltreatment and thus, has not received adequate attention. Clear terminology, definitions, and measures are needed to aid in assessing the occurrence and impact of CVA for its recognition and prevention. OBJECTIVE We aim to synthesize the evidence on the terms, definitions, and measurements of CVA and identify outcomes associated with CVA. PARTICIPANTS AND SETTING A systematic review focused on adult perpetration of CVA among children and adolescents using clinical, community-based, and population-based samples. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and four databases were utilized in May 2022: PsycINFO, MEDLINE, EMBASE, and ProQuest. A total of 149 quantitative and 17 qualitative studies were identified. RESULTS Across studies reviewed, the most common perpetrators of CVA were parents, mothers, and teachers. Definitional themes for CVA included negative speech volume, tone, and speech content, and their immediate impact. The most frequent measures cited were Adverse Childhood Experiences Study (ACE) Questionnaire and the Conflict Tactics Scale (CTS); 50 % used self-created measures. CVA was associated with a range of internalizing and externalizing outcomes across the lifespan. CONCLUSIONS Recognizing CVA as a form of maltreatment will be a starting point for its identification and prevention. Primary prevention of CVA using trauma-informed approaches must include adult training on the importance of safety, support, and nurturance during verbal communication with children.
Collapse
Affiliation(s)
- Shanta R Dube
- Director, Department of Public Health, Master of Public Health Program, Levine College of Health Sciences, Wingate University, Wingate, NC, United States of America.
| | - Elizabeth T Li
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Guilherme Fiorini
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Caleb Lin
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Nikita Singh
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Kumayl Khamisa
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Jennifer McGowan
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| |
Collapse
|
8
|
Saunders KRK, McGuinness E, Barnett P, Foye U, Sears J, Carlisle S, Allman F, Tzouvara V, Schlief M, Vera San Juan N, Stuart R, Griffiths J, Appleton R, McCrone P, Rowan Olive R, Nyikavaranda P, Jeynes T, K T, Mitchell L, Simpson A, Johnson S, Trevillion K. A scoping review of trauma informed approaches in acute, crisis, emergency, and residential mental health care. BMC Psychiatry 2023; 23:567. [PMID: 37550650 PMCID: PMC10405430 DOI: 10.1186/s12888-023-05016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023] Open
Abstract
Experiences of trauma in childhood and adulthood are highly prevalent among service users accessing acute, crisis, emergency, and residential mental health services. These settings, and restraint and seclusion practices used, can be extremely traumatic, leading to a growing awareness for the need for trauma informed care (TIC). The aim of TIC is to acknowledge the prevalence and impact of trauma and create a safe environment to prevent re-traumatisation. This scoping review maps the TIC approaches delivered in these settings and reports related service user and staff experiences and attitudes, staff wellbeing, and service use outcomes.We searched seven databases (EMBASE; PsycINFO; MEDLINE; Web of Science; Social Policy and Practice; Maternity and Infant Care Database; Cochrane Library Trials Register) between 24/02/2022-10/03/2022, used backwards and forwards citation tracking, and consulted academic and lived experience experts, identifying 4244 potentially relevant studies. Thirty-one studies were included.Most studies (n = 23) were conducted in the USA and were based in acute mental health services (n = 16). We identified few trials, limiting inferences that can be drawn from the findings. The Six Core Strategies (n = 7) and the Sanctuary Model (n = 6) were the most commonly reported approaches. Rates of restraint and seclusion reportedly decreased. Some service users reported feeling trusted and cared for, while staff reported feeling empathy for service users and having a greater understanding of trauma. Staff reported needing training to deliver TIC effectively.TIC principles should be at the core of all mental health service delivery. Implementing TIC approaches may integrate best practice into mental health care, although significant time and financial resources are required to implement organisational change at scale. Most evidence is preliminary in nature, and confined to acute and residential services, with little evidence on community crisis or emergency services. Clinical and research developments should prioritise lived experience expertise in addressing these gaps.
Collapse
Affiliation(s)
- Katherine R K Saunders
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK.
| | - Elizabeth McGuinness
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational, & Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Jessica Sears
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sophie Carlisle
- Section of Women's Mental Health, King's College London, London, UK
| | - Felicity Allman
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Vasiliki Tzouvara
- Care for Long Term Conditions Research Division, King's College London, London, UK
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Norha Vera San Juan
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Ruth Stuart
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Jessica Griffiths
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
- School of Health Sciences, University of Greenwich, London, UK
| | - Rachel Rowan Olive
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Patrick Nyikavaranda
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Tamar Jeynes
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - T K
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Lizzie Mitchell
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Kylee Trevillion
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Building, De Crespigny Park, SE5 8AF, London, UK
| |
Collapse
|
9
|
Liu P, Huang W, Chen S, Xiang H, Lin W, Wang H, Wang Y. The association among childhood maltreatment, sleep duration and suicide behaviors in Chinese young people. J Affect Disord 2023; 327:190-196. [PMID: 36586614 DOI: 10.1016/j.jad.2022.12.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/24/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Substantial evidence shows that childhood maltreatment and sleep duration play important roles in the development of suicide. However, the role of sleep duration in the relationship between childhood maltreatment and suicide behaviors, including suicide ideation, plan and attempt, was not fully understood. This study investigated the association among childhood maltreatment, sleep duration and suicide behaviors. METHODS 13,454 students from a polytechnic college in Shenzhen of China participated in this cross-sectional study. Multivariate logistic regression model was established to analyze the relationship among childhood maltreatment, sleep duration and suicide behaviors. RESULTS The most reported subtype of childhood maltreatment was physical neglect, which were reported by 41.57 % of males, 28.59 % of females. The positive association of physical abuse with suicide behaviors was observed. In females, emotional abuse and neglect were positively associated with suicide behaviors. In addition, almost all childhood maltreatment was significantly associated to decreased sleep duration. Moreover, compared to the sleep duration <6 h group, sleep duration was inversely associated to suicide behaviors. CONCLUSION Childhood maltreatment was positively associated with suicide ideation, plan and attempt in Chinese young adults. Meanwhile, childhood maltreatment was negatively associated with sleep duration, which were negatively associated with suicide ideation, plan and attempt.
Collapse
Affiliation(s)
- Peiyi Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - Weikang Huang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - Siqi Chen
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - Haishan Xiang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - Wei Lin
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - He Wang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China
| | - Yueyun Wang
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, No. 3012 Fuqiang Road, Futian District, Shenzhen 518028, China.
| |
Collapse
|
10
|
Xie M, Cai J, Liu Y, Wei W, Zhao Z, Dai M, Wu Y, Huang Y, Tang Y, Xiao L, Zhang G, Li C, Guo W, Ma X, Deng W, Du X, Wang Q, Li T. Association between childhood trauma and white matter deficits in first-episode schizophrenia. Psychiatry Res 2023; 323:115111. [PMID: 36924585 DOI: 10.1016/j.psychres.2023.115111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/28/2023] [Accepted: 02/14/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVE This study aimed to investigate the relationship between childhood trauma (ChT) and white matter (WM) deficits in first-episode schizophrenia (FES). METHODS A total of 103 individuals with FES and 206 healthy control individuals (HCs) were enrolled and assessed based on ChT Questionnaire (CTQ) and Positive and Negative Symptoms Scale (PANSS). Diffusion tensor imaging was acquired on a Signa 3.0 T scanner. Map of fractional anisotropy (FA) was analyzed using Tract-Based Spatial Statistics. Hierarchical logistic regression analyses were used to examine associations of sociodemographic characteristics, total CTQ scores, and WM deficits. RESULTS Compared with the HCs group, the FES group showed significantly lower FA in several WM bundles (left anterior thalamic radiation, left inferior frontal-occipital fasciculus, left cingulum, forceps major, and forceps minor), and the mean FA value in these WM bundles was inversely related to the total CTQ score. In addition, a higher CTQ score may increase the risk of schizophrenia, while higher FA values may decrease the risk of schizophrenia. CONCLUSION This study demonstrates that individuals with FES evince widespread cerebral WM abnormalities and that these abnormalities were associated with ChT. These results provide clues about the neural basis and potential biomarkers of schizophrenia.
Collapse
Affiliation(s)
- Min Xie
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jia Cai
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yunjia Liu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wei Wei
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang, China
| | - Zhengyang Zhao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Minhan Dai
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yulu Wu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yunqi Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yiguo Tang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Liling Xiao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Guangya Zhang
- Suzhou Psychiatry Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu, China
| | - Chuanwei Li
- Suzhou Psychiatry Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu, China
| | - Wanjun Guo
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang, China
| | - Xiaohong Ma
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wei Deng
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang, China
| | - Xiangdong Du
- Suzhou Psychiatry Hospital, Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu, China
| | - Qiang Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Tao Li
- Affiliated Mental Health Centre & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang, China.
| |
Collapse
|
11
|
Kim D, Kim D, Kim EK. Dissociation mediates association between childhood trauma and distress from trauma research participation: analysis of pooled clinical data. PSYCHOSIS 2023. [DOI: 10.1080/17522439.2023.2176536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Dongjoo Kim
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, South Korea
| | | | - Eun Kyoung Kim
- Department of Premedicine, Hanyang University, Seoul, South Korea
| |
Collapse
|
12
|
Velasco-Barbancho E, Ródenas-Perea G, Perona-Garcelán S, Senín-Calderón C, Rodríguez-Testal JF, Ruiz-Veguilla M, Crespo-Facorro B. Dissociation as a Mediator of Traumatic Childhood Experiences and Ideas of Reference. J Trauma Dissociation 2023; 24:197-213. [PMID: 36053056 DOI: 10.1080/15299732.2022.2119632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ideas of reference (IR) - self-attributions about what happens in the social environment are a frequent phenomenon present in a wide variety of people with mental health disorders as well as in the nonclinical population. The purpose of this study was to find out the relationship between traumatic childhood experiences, IR and dissociative states in the nonclinical population, emphasizing the potential mediating role of dissociation between traumatic experiences and IR. The sample was comprised of 337 participants from the general population (58.8% women) with a mean age of 33.20 years (SD = 14.08). They filled in the Juvenile Victimization Questionnaire (JVQ), the Dissociative Experiences Scale-II (DES-II) and the Referential thinking Scale (REF). The results supported the original hypotheses and showed that the participants with higher frequency of IR reported more childhood traumatic (χ2 (2) = 64.33, p < .001, f = .39, 1- β = .99) and dissociative experiences (χ2 (2) = 50,414, p < .001, f = .38, 1- β = .99), and that dissociative states (β = .12, p < .05; 95%CI [.07, .19]; c´ = .26, p < .001), specifically absorption (β = .09, p < .05; 95% CI [.03, .15]; c´ = .26, p < .001), mediated between traumatic childhood experiences and referential thinking. It was concluded that the relationship between traumatic experiences and IR is complex and may be mediated by variables such as dissociation.
Collapse
Affiliation(s)
| | | | | | | | - Juan F Rodríguez-Testal
- Personality, Evaluation and Psychological Treatment Department, University of Seville, Seville, Spain
| | - Miguel Ruiz-Veguilla
- IBiS/ CIBERSAM, Virgen Del Rocío University Hospital/ University of Sevilla/, Seville, Spain
| | | |
Collapse
|
13
|
Sölva K, Haselgruber A, Lueger-Schuster B. Resilience in the face of adversity: classes of positive adaptation in trauma-exposed children and adolescents in residential care. BMC Psychol 2023; 11:30. [PMID: 36717951 PMCID: PMC9887823 DOI: 10.1186/s40359-023-01049-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023] Open
Abstract
Children and adolescents in residential care often face multiple traumatic experiences. However, some individuals show resilient adaptation. To depict this heterogeneity, the person-centered examination of different classes of adaptation is a powerful tool. Up to date, resilience was insufficiently addressed in this population. Data from 141 children and adolescents in residential care institutions in Austria regarding trauma history, psychopathology, behavioral adjustment, and protective factors were assessed with standardized self-report questionnaires. Distinct classes of adaptation after traumatic experiences were examined with Latent Class Analysis. Class differences regarding traumatic experiences and protective factors were analyzed with χ2 testing. Three classes were identified [resilience (66.18%), mixed psychopathology (13.97%, mixed), high psychopathology (19.85%, high)]. Only males were classified into the resilient class and only females into the high class. The high class differed significantly from the resilient class regarding cumulative trauma history and protective factors. The mixed class did not differ from the resilient class regarding trauma history, however, they differed significantly regarding protective factors. The resilient class was associated with protective factors. Strong gender differences show the relevance of a differentiated evaluation of gender-specific protective factors and resilience indicators. Fostering protective factors may be a suitable approach for tailored intervention measures.
Collapse
Affiliation(s)
- Katharina Sölva
- grid.10420.370000 0001 2286 1424Unit of Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010 Vienna, Austria
| | - Alexander Haselgruber
- grid.10420.370000 0001 2286 1424Unit of Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010 Vienna, Austria
| | - Brigitte Lueger-Schuster
- grid.10420.370000 0001 2286 1424Unit of Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Wächtergasse 1, 1010 Vienna, Austria
| |
Collapse
|
14
|
Schimmenti A, Billieux J, Santoro G, Casale S, Starcevic V. A trauma model of substance use: Elaboration and preliminary validation. Addict Behav 2022; 134:107431. [PMID: 35905595 DOI: 10.1016/j.addbeh.2022.107431] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/01/2022]
Abstract
The current study expands on and integrates previous theoretical models concerning the pathways that link child maltreatment to substance use disorder. The proposed model, based on the self-medication hypothesis, suggests that experiences of neglect and abuse during childhood can lead to substance use and abuse both directly and indirectly, via dissociation resulting from failed attempts to integrate experiences of maltreatment in childhood. The model was tested on ten substances (painkillers, stimulants, sedatives, marijuana, cocaine, ecstasy, hallucinogens, heroin, inhalants, and methamphetamine) via structural equation modeling (SEM) in a sample comprising 1040 community-dwelling adults (67 % women) aged between 18 and 78 (M = 29.55, SD = 11.37). Fit indexes of the SEM were good, thus supporting the hypothesized model. Specific forms of child maltreatment were related to increased use of specific substances; however, experience of childhood neglect (both physical and emotional) was found to have a central role in predicting use of most substances. Although no single pathway can fully explain the origins of substance abuse, the current study provides evidence of a critical developmental pathway to it, with implications for theory and clinical practice.
Collapse
Affiliation(s)
- Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy.
| | - Joël Billieux
- Institute of Psychology, University of Lausanne, Géopolis CH-1015, Lausanne, Switzerland; Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), CH-1011 Lausanne, Switzerland.
| | - Gianluca Santoro
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy.
| | - Silvia Casale
- Department of Health Sciences, Psychology Unit, University of Florence, Via di San Salvi12, 50135 Florence, Italy.
| | - Vladan Starcevic
- University of Sydney, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, PO Box 63, Penrith, NSW 2751, Australia.
| |
Collapse
|
15
|
Kanders SH, Nilsson KW, Åslund C. Body mass index and bullying victimization as antecedents for depressive symptoms in a Swedish youth cohort. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01460-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Aim
The bidirectional association between obesity and depression seen in adults is not clearly established in adolescents. The aim of this study was to investigate the longitudinal association between body mass index (BMI), depressive symptoms and interactions between bullying victimization and BMI, taking gender differences into account.
Subjects and methods
In a Swedish county, self-reported bullying victimization, BMI and depressive symptoms from 1729 adolescents ($$ \overline{y} $$
y
¯
= 14.4, 56% females) were collected in 2012 (wave 1), in 2015 (wave 2) ($$ \overline{y}=17.3 $$
y
¯
=
17.3
) and in 2018 (wave 3) ($$ \overline{y} $$
y
¯
= 19.9). Longitudinal associations were assessed using binary logistic regression models controlling for confounding factors. Interaction effects between BMI and victimization on depressive symptoms were also assessed.
Results
Wave 1 obese males had approximately six times increased odds ratio compared to normal weight, for wave 2 depressive symptoms. W1 overweight was associated with an odds ratio of 1.5 in all participants for wave 3 depressive symptoms. Victimization was consistently associated with higher odds ratio for future depressive symptoms. We found interaction effects between bullying victimization and BMI for future depressive symptoms with different patterns depending on sex.
Conclusion
Given the present findings, bullying needs to be prevented, and, if it occurs, it needs to be stopped at an early stage to prevent future depressive symptoms.
Collapse
|
16
|
Strelchuk D, Hammerton G, Wiles N, Croft J, Turner K, Heron J, Zammit S. PTSD as a mediator of the relationship between trauma and psychotic experiences. Psychol Med 2022; 52:2722-2730. [PMID: 33315002 PMCID: PMC9647519 DOI: 10.1017/s0033291720004821] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/29/2020] [Accepted: 11/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Traumatic experiences are associated with a higher risk of psychotic illnesses, but little is known about potentially modifiable mechanisms underlying this relationship. This study aims to examine whether post-traumatic stress disorder (PTSD) symptoms mediate the relationship between trauma and psychotic experiences (PEs). METHODS We used data from the Avon Longitudinal Study of Parents and Children to examine whether: PTSD symptoms mediate the relationships between (a) childhood trauma and adolescent PEs (study of adolescent PEs; n = 2952), and (b) childhood/adolescent trauma and PEs in early adulthood (study of adult PEs; n = 2492). We examined associations between variables using logistic regression, and mediation using the parametric g-computation formula. RESULTS Exposure to trauma was associated with increased odds of PEs (adolescent PEs: ORadjusted 1.48, 95% CI 1.23-1.78; adult PEs: ORadjusted 1.57, 95% CI 1.25-1.98) and PTSD symptoms (adolescent PTSD: ORadjusted 1.59, 95% CI 1.31-1.93; adult PTSD: ORadjusted 1.50, 95% CI 1.36-1.65). The association between PTSD symptoms and PE was stronger in adolescence (ORadjusted 4.63, 95% CI 2.34-9.17) than in adulthood (ORadjusted 1.62, 95% CI 0.80-3.25). There was some evidence that PTSD symptoms mediated the relationship between childhood trauma and adolescent PEs (proportion mediated 14%), though evidence of mediation was weaker for adult PEs (proportion mediated 8%). CONCLUSIONS These findings are consistent with the hypothesis that PTSD symptoms partly mediate the association between trauma exposure and PEs. Targeting PTSD symptoms might help prevent the onset of psychotic outcomes.
Collapse
Affiliation(s)
- Daniela Strelchuk
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Gemma Hammerton
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Jazz Croft
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katrina Turner
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
- Division of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| |
Collapse
|
17
|
Rosenfield PJ, Jiang D, Pauselli L. Childhood adversity and psychotic disorders: Epidemiological evidence, theoretical models and clinical considerations. Schizophr Res 2022; 247:55-66. [PMID: 34210561 DOI: 10.1016/j.schres.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/08/2023]
Abstract
While genetic factors play a critical role in the risk for schizophrenia and other psychotic disorders, increasing evidence points to the role of childhood adversity as one of several environmental factors that can significantly impact the development, manifestations and outcome of these disorders. This paper reviews the epidemiological evidence linking childhood adversity and psychotic disorders and explores various theoretical models that seek to explain the connection. We discuss neurobiological parallels between the impact of childhood trauma and psychosis on the brain and then explore the impact of childhood adversity on different domains of clinical presentation. Finally, implications for prevention and treatment are considered, both on individual and structural levels.
Collapse
Affiliation(s)
- Paul J Rosenfield
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - David Jiang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| |
Collapse
|
18
|
Modesti MN, Rapisarda L, Capriotti G, Del Casale A. Functional Neuroimaging in Dissociative Disorders: A Systematic Review. J Pers Med 2022; 12:jpm12091405. [PMID: 36143190 PMCID: PMC9502311 DOI: 10.3390/jpm12091405] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Dissociative disorders encompass loss of integration in essential functions such as memory, consciousness, perception, motor control, and identity. Nevertheless, neuroimaging studies, albeit scarce, have suggested the existence of particular brain activation patterns in patients belonging to this diagnostic category. The aim of this review is to identify the main functional neuroimaging correlates of dissociative disorders. Methods: we searched the PubMed database to identify functional neuroimaging studies conducted on subjects with a diagnosis of a dissociative disorder, following the PRISMA guidelines. In the end, we included 13 studies in this systematic review, conducted on 51 patients with dissociative identity disorder (DID), 28 subjects affected by depersonalization disorder, 24 with dissociative amnesia, and 6 with other or not specified dissociative disorders. Results: Prefrontal cortex dysfunction seems prominent. In addition, changes in the functional neural network of the caudate are related to alterations of identity state and maintenance of an altered mental status in DID. Another role in DID seems to be played by a dysfunction of the anterior cingulate gyrus. Other regions, including parietal, temporal, and insular cortices, and subcortical areas were reported to be dysfunctional in dissociative disorders. Conclusions: Prefrontal dysfunction is frequently reported in dissociative disorders. Functional changes in other cortical and subcortical areas can be correlated with these diagnoses. Further studies are needed to clarify the neurofunctional correlations of each dissociative disorder in affected patients, in order to identify better tailored treatments.
Collapse
Affiliation(s)
- Martina Nicole Modesti
- Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Ludovica Rapisarda
- Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Gabriela Capriotti
- Unit of Nuclear Medicine, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sant’Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Antonio Del Casale
- Unit of Psychiatry, Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sant’Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
- Correspondence:
| |
Collapse
|
19
|
Mertens YL, Daniels JK. The Clinician-Administered Dissociative States Scale (CADSS): Validation of the German Version. J Trauma Dissociation 2022; 23:366-384. [PMID: 34670474 DOI: 10.1080/15299732.2021.1989111] [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: 10/20/2022]
Abstract
The Clinician-Administered Dissociative States Scale (CADSS) is a structured clinical interview to assess state dissociation rated by clinicians. The current study aimed to validate the German version of CADSS by comparing it to the established self-report measures for dissociation and exploring its underlying factor structure. Severity of within-session state dissociation was assessed directly following a standard psychotherapy session in a trauma-exposed patient sample (N= 105; 81.9% female). Internal consistency, convergent validity with other dissociation measures, and the factorial structure of the instrument were analyzed. The German version exhibited excellent internal consistency (Cronbach's α = .94) and correlated significantly with self-report measures of state dissociation (r = .86) and trait dissociation (r = .77) indicative of high convergent validity. Exploratory factor analysis revealed a three-factor solution with the factors (1) Depersonalization/Derealization, (2) Identity Confusion/Alteration, and (3) Amnesia. Results support the CADSS as a useful instrument to assess state dissociation, conceptualized as a multidimensional construct, in clinical practice.
Collapse
Affiliation(s)
- Yoki L Mertens
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands
| | - Judith K Daniels
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands
| |
Collapse
|
20
|
Wieder L, Brown RJ, Thompson T, Terhune DB. Hypnotic suggestibility in dissociative and related disorders: A meta-analysis. Neurosci Biobehav Rev 2022; 139:104751. [PMID: 35760389 DOI: 10.1016/j.neubiorev.2022.104751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/04/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022]
Abstract
Elevated responsiveness to verbal suggestions is hypothesized to represent a predisposing factor for dissociative disorders (DDs) and related conditions. However, the magnitude of this effect has not been estimated in these populations nor has the potential moderating influence of methodological limitations on effect size variability across studies. This study assessed whether patients with DDs, trauma- and stressor-related disorders (TSDs), and functional neurological disorder (FND) display elevated hypnotic suggestibility. A systematic literature search identified 20 datasets. A random-effects meta-analysis revealed that patients displayed greater hypnotic suggestibility than controls, Hedges's g=0.92 [0.66, 1.18]. This effect was observed in all subgroups but was most pronounced in the DDs. Although there was some evidence for publication bias, a bias-corrected estimate of the group effect remained significant, g=0.57 [0.30, 0.85]. Moderation analyses did not yield evidence for a link between effect sizes and methodological limitations. These results demonstrate that DDs and related conditions are characterized by elevated hypnotic suggestibility and have implications for the mechanisms, risk factors, and treatment of dissociative psychopathology.
Collapse
Affiliation(s)
- Lillian Wieder
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Richard J Brown
- School of Health Sciences, University of Manchester, Manchester, UK; Psychotherapy Services, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Sciences Centre, UK
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, UK
| | - Devin B Terhune
- Department of Psychology, Goldsmiths, University of London, London, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| |
Collapse
|
21
|
The Molecular Genetics of Dissociative Symptomatology: A Transdiagnostic Literature Review. Genes (Basel) 2022; 13:genes13050843. [PMID: 35627228 PMCID: PMC9141026 DOI: 10.3390/genes13050843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness, personality, emotion and behavior. The available evidence suggests that these disorders arise from an interaction between genetic vulnerability and stress, particularly traumatic stress, but the attention paid to the underlying genetic diatheses has been sparse. In this paper, the existing literature on the molecular genetics of dissociative disorders, as well as of clinically significant dissociative symptoms not reaching the threshold of a disorder, is reviewed comprehensively across clinical and non-clinical samples. Association studies suggest a link between dissociative symptoms and genes related to serotonergic, dopaminergic and peptidergic transmission, neural plasticity and cortisol receptor sensitivity, particularly following exposure to childhood trauma. Genome-wide association studies have identified loci of interest related to second messenger signaling and synaptic integration. Though these findings are inconsistent, they suggest biologically plausible mechanisms through which traumatic stress can lead to pathological dissociation. However, methodological concerns related to phenotype definition, study power, and correction for the confounding factors limit the value of these findings, and they require replication and extension in studies with better design.
Collapse
|
22
|
Pfaltz MC, Halligan SL, Haim-Nachum S, Sopp MR, Åhs F, Bachem R, Bartoli E, Belete H, Belete T, Berzengi A, Dukes D, Essadek A, Iqbal N, Jobson L, Langevin R, Levy-Gigi E, Lüönd AM, Martin-Soelch C, Michael T, Oe M, Olff M, Ceylan D, Raghavan V, Ramakrishnan M, Sar V, Spies G, Wadji DL, Wamser-Nanney R, Fares-Otero NE, Schnyder U, Seedat S. Social Functioning in Individuals Affected by Childhood Maltreatment: Establishing a Research Agenda to Inform Interventions. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:238-251. [PMID: 35381589 PMCID: PMC9393832 DOI: 10.1159/000523667] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/12/2022] [Indexed: 12/30/2022]
Abstract
Childhood maltreatment (CM) is linked to impairments in various domains of social functioning. Here, we argue that it is critical to identify factors that underlie impaired social functioning as well as processes that mediate the beneficial health effects of positive relationships in individuals exposed to CM. Key research recommendations are presented, focusing on: (1) identifying attachment-related alterations in specific inter- and intrapersonal processes (e.g., regulation of closeness and distance) that underlie problems in broader domains of social functioning (e.g., lack of perceived social support) in individuals affected by CM; (2) identifying internal (e.g., current emotional state) and external situational factors (e.g., cultural factors, presence of close others) that modulate alterations in specific social processes; and (3) identifying mechanisms that explain the positive health effects of intact social functioning. Methodological recommendations include: (1) assessing social processes through interactive and (close to) real-life assessments inside and outside the laboratory; (2) adopting an interdisciplinary, lifespan perspective to assess social processes, using multi-method assessments; (3) establishing global research collaborations to account for cultural influences on social processes and enable replications across laboratories and countries. The proposed line of research will contribute to globally develop and refine interventions that prevent CM and further positive relationships, which - likely through buffering the effects of chronic stress and corresponding allostatic load - foster resilience and improve mental and physical health, thereby reducing personal suffering and the societal and economic costs of CM and its consequences. Interventions targeting euthymia and psychological well-being are promising therapeutic concepts in this context.
Collapse
Affiliation(s)
- Monique C. Pfaltz
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Zurich, Switzerland
| | - Sarah L. Halligan
- Department of Psychology, University of Bath, Bath, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Marie R. Sopp
- School of Education, Bar-Ilan University, Bar-Ilan, Israel
- Division of Clinical Psychology and Psychotherapy, Saarland University, Saarland, Germany
| | - Fredrik Åhs
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Rahel Bachem
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Eleonora Bartoli
- Faculty of Psychology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Habte Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Azi Berzengi
- University of East Anglia, Norwich, United Kingdom
| | - Daniel Dukes
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Department of Special Education, University of Fribourg, Fribourg, Switzerland
| | - Aziz Essadek
- Interpsy EA4432, University of Lorraine, Lorraine, France
| | - Naved Iqbal
- Department of Psychology, Jamia Millia islamia, New Delhi, India
| | - Laura Jobson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Monash, Australian Capital Territory, Australia
| | - Rachel Langevin
- Department of Educational and Counselling Psychology, McGill University, Montreal, Québec, Canada
| | | | - Antonia M. Lüönd
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Saarland University, Saarland, Germany
| | - Misari Oe
- Department of Neuropsychiatry, School of Medicine, Kurume University, Kurume, Japan
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience and Public Health, Amsterdam UMC, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Deniz Ceylan
- Department of Psychiatry, Koç University School of Medicine, Koç, Turkey
| | | | | | - Vedat Sar
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Georgina Spies
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- Department of Psychology, University of Yaounde 1, Yaounde, Cameroon
| | - Dany Laure Wadji
- Department of Psychological Sciences, University of Missouri St. Louis, St. Louis, Missouri, USA
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Rachel Wamser-Nanney
- CIBERSAM: Biomedical Research Networking Center for Mental Health Network, Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Ulrich Schnyder
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Zurich, Switzerland
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
23
|
Zinchuk M, Beghi M, Beghi E, Bianchi E, Avedisova A, Yakovlev A, Guekht A. Non-Suicidal Self-Injury in Russian Patients with Suicidal Ideation. Arch Suicide Res 2022; 26:776-800. [PMID: 33108991 DOI: 10.1080/13811118.2020.1833801] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nonsuicidal self-injury (NSSI) is recognized as a public health concern for its association with unfavorable outcomes, including suicidal behavior. The aim of this study is to identify factors associated with NSSI among patients with nonpsychotic mental disorders (NPMD) and suicidal ideation in Russia. METHODS A retrospective cohort study was conducted in the Moscow Research and Clinical Center for Neuropsychiatry between November 2017 and May 2019. The sample was composed of consecutive patients with lifetime suicidal ideation (from the Self-Injurious Thoughts and Behavior Interview) seen in the center's psychiatric ward for NPMD. The patients were divided into two groups: those with and without lifetime NSSI. Sociodemographic variables, psychiatric diagnosis, family history of mental disorders, history of physical or sexual abuse, sexual behavior, ad-hoc psychiatric treatments, suicidal ideation, plans, and gestures or attempts were investigated. RESULTS Six thousand, two hundred and four consecutive patients were screened for suicidal ideation. Out of a total of 361 patients (87.3% females) with suicidal ideation, 217 (60.1%) reported NSSI. Variables independently associated with NSSI included age <25 years (OR 6.0, CI 2.5-14.7), dissatisfaction with the perceived parenting style (OR 3.3, CI 1.5-7.4), bullying (OR 2.6, CI 1.0-6.5), severe body modifications (OR 11.9, CI 1.1-134.3), experience with illicit drugs (OR 4.4, CI 1.9-10.3), and eating disorders (OR 4.9, CI 2.0-11.8). LIMITATIONS Retrospective design, referral population, single center study, and exclusion of psychotic patients. CONCLUSIONS NSSI is associated with age <25 years old, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug-use, and lifetime eating disorders.HIGHLIGHTSNonsuicidal self-injury is a significant public health concern for its association with suicidal behavior.60.1% of Russian patients with non-psychotic mental disorders (NPMD) and suicidal ideation reported lifetime NSSI.NSSI in Russian patients with NPMD and suicidal ideation is associated with age less than 25 years, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug use, and lifetime eating disorders.
Collapse
|
24
|
Wang D, Deng Q, Ross B, Wang M, Liu Z, Wang H, Ouyang X. Mental health characteristics and their associations with childhood trauma among subgroups of people living with HIV in China. BMC Psychiatry 2022; 22:13. [PMID: 34986834 PMCID: PMC8729148 DOI: 10.1186/s12888-021-03658-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People living with HIV (PLWH) carry a high risk for mental health problems, which has been extensively reported in the literature. However, an understanding of mental health characteristics in different subgroups of PLWH is still limited. In the present study, we conducted a cross-sectional survey to explore mental health characteristics and their associations with childhood trauma in two major subgroups of PLWH in China. METHODS A total of 533 PLWH (213 prisoners in the prison system, and 320 outpatients) were assessed using the 8-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P8), Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Childhood Trauma Questionnaire (CTQ). RESULTS From the total sample, 22.0% PLWH frequently experienced psychotic-like experiences (PLEs), 21.8% had clinically significant anxiety syndrome, 34.0% had clinically significant depressive syndrome, and 63.6% experienced at least one type of traumatic exposure during their childhood, with physical neglect being the most common. Compared to outpatients with HIV, prisoners living with HIV reported more severe mental health problems and a higher frequency of childhood trauma, with childhood trauma in turn predicting higher risk for mental health problems. Similarly, among outpatients living with HIV, both childhood emotional and sexual abuse had predictive effects on all the three mental health problems. CONCLUSIONS The study suggests that PLWH have higher risk of anxiety, depression and PLEs, and childhood trauma could serve as predicting factors for such risks. In addition, childhood trauma may play distinct roles in predicting the risk for the mental health problems, depending on different subgroup of PLWH.
Collapse
Affiliation(s)
- Dongfang Wang
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China ,grid.263785.d0000 0004 0368 7397School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Qijian Deng
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Brendan Ross
- grid.14709.3b0000 0004 1936 8649Faculty of Medicine, McGill University, Montreal, QC Canada
| | - Min Wang
- grid.508008.50000 0004 4910 8370Institute for HIV/AIDS, the First Hospital of Changsha, Changsha, China
| | - Zhening Liu
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Honghong Wang
- grid.216417.70000 0001 0379 7164Xiangya Nursing School, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, China National Technology Institute on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, 410011, China.
| |
Collapse
|
25
|
Degnan A, Berry K, Humphrey C, Bucci S. The role of attachment and dissociation in the relationship between childhood interpersonal trauma and negative symptoms in psychosis. Clin Psychol Psychother 2022; 29:1692-1706. [PMID: 35218114 PMCID: PMC9790513 DOI: 10.1002/cpp.2731] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/17/2022] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
Abstract
Negative symptoms have an adverse impact on quality of life and functioning in psychosis. Service users with psychosis have identified negative symptoms as a priority for their recovery. Despite this, there is a lack of effective and targeted psychological interventions for negative symptoms and their underlying mechanisms remain poorly understood. Childhood trauma is a robust risk factor for positive symptoms in psychosis, but the association with negative symptoms is less well established. Our aim was to examine the association between childhood interpersonal trauma and negative symptoms and the psychological mediators of this relationship. Two hundred and forty participants experiencing psychosis completed validated self-report measures of childhood trauma, attachment, dissociation, compartmentalization, and symptoms. Mediation analyses showed that disorganized attachment and dissociative experiences mediated the association between childhood trauma and negative symptoms, when analysed individually and in a combined model. Models adjusted for age and positive and depressive symptoms. Avoidant attachment and compartmentalization were independently associated with negative symptoms but not childhood trauma and thus were not significant mediators. Childhood trauma was not independently associated with negative symptoms. This paper is the first to present empirical data to support a model implicating attachment and dissociation as important psychological processes in the link between childhood trauma and negative symptoms. These exploratory findings suggest that it may be beneficial to consider these relationships in trauma-informed formulations and interventions. Further longitudinal research is required to establish causality and test theoretical models of mechanisms in the pathway to negative symptoms.
Collapse
Affiliation(s)
- Amy Degnan
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Charlotte Humphrey
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| |
Collapse
|
26
|
Zinchuk M, Lavrishcheva A, Menshikova A, Voinova N, Artemieva M, Guekht A. Nonsuicidal self-injury in eating disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:70-78. [DOI: 10.17116/jnevro202212209170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
27
|
Beutler S, Mertens YL, Ladner L, Schellong J, Croy I, Daniels JK. Trauma-related dissociation and the autonomic nervous system: a systematic literature review of psychophysiological correlates of dissociative experiencing in PTSD patients. Eur J Psychotraumatol 2022; 13:2132599. [PMID: 36340007 PMCID: PMC9635467 DOI: 10.1080/20008066.2022.2132599] [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: Neurophysiological models link dissociation (e.g. feeling detached during or after a traumatic event) to hypoarousal. It is currently assumed that the initial passive reaction to a threat may coincide with a blunted autonomic response, which constitutes the dissociative subtype of post-traumatic stress disorder (PTSD). Objective: Within this systematic review we summarize research which evaluates autonomic nervous system activation (e.g. heart rate, blood pressure) and dissociation in PTSD patients to discern the validity of current neurophysiological models of trauma-related hypoarousal. Method: Of 553 screened articles, 28 studies (N = 1300 subjects) investigating the physiological response to stress provocation or trauma-related interventions were included in the final analysis. Results: No clear trend exists across all measured physiological markers in trauma-related dissociation. Extracted results are inconsistent, in part due to high heterogeneity in experimental methodology. Conclusion: The current review is unable to provide robust evidence that peri- and post-traumatic dissociation are associated with hypoarousal, questioning the validity of distinct psychophysiological profiles in PTSD.
Collapse
Affiliation(s)
- Sarah Beutler
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty, Technical University of Dresden, Dresden, Germany
| | - Yoki L Mertens
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Liliana Ladner
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty, Technical University of Dresden, Dresden, Germany.,Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty, Technical University of Dresden, Dresden, Germany
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, Medical Faculty, Technical University of Dresden, Dresden, Germany.,Department of Clinical Psychology, Friedrich-Schiller University Jena, Jena, Germany
| | - Judith K Daniels
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| |
Collapse
|
28
|
Winkler O, Dhaliwal R, Greenshaw A, O'Shea K, Abba-Aji A, Chima C, Purdon SE, Burback L. Web-Based Eye Movement Desensitization and Reprocessing for Adults With Suicidal Ideation: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e30711. [PMID: 34734835 PMCID: PMC8603176 DOI: 10.2196/30711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Adversity and traumatic experiences increase the likelihood of suicidal thoughts and behaviors. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based, trauma-focused psychotherapy that desensitizes painful memories, so that reminders in the present no longer provoke overwhelming emotional responses. Preliminary evidence suggests that EMDR can be used as an acute intervention in suicidal patients, including those with major depressive disorder. In addition, because of social distancing restrictions during the COVID-19 pandemic, clinicians have been using EMDR on the web and, in the absence of formal evaluations of web-based EMDR, informal reports indicate good results. OBJECTIVE The primary aim of this randomized controlled trial is to investigate whether remotely delivered EMDR (targeting experiences associated with suicidal thinking) reduces suicidal thoughts. Secondary aims include examining the impact of remotely delivered EMDR on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation. We will also report on adverse events in the EMDR group to explore whether targeting suicidal ideation with EMDR is safe. Finally, we will compare dropout rates between the treatment groups. METHODS In this randomized controlled trial, 80 adults who express suicidal ideation and meet the study criteria will receive either 12 sessions of twice weekly EMDR plus treatment as usual or treatment as usual alone. EMDR sessions will focus on the most distressing and intrusive memories associated with suicidal ideation. Data for primary and secondary objectives will be collected at baseline, 2 months, and 4 months after enrollment. A subsequent longer-term analysis, beyond the scope of this protocol, will examine differences between the groups with respect to the number of posttreatment emergency room visits, hospitalizations, and overall health care use in the year before and after therapy. RESULTS The protocol was approved by the University of Alberta Research Health Ethics Board (protocol ID Pro00090989). Funding for this study was provided by the Mental Health Foundation (grant RES0048906). Recruitment started in May 2021, with a projected completion date of March 2023. CONCLUSIONS The results of this trial will contribute to knowledge on whether web-based delivery of EMDR is a safe and effective treatment for reducing suicidal ideation and potentially reducing the incidence of suicide attempts in this patient population. TRIAL REGISTRATION ClinicalTrials.gov NCT04181047; https://clinicaltrials.gov/ct2/show/NCT04181047. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30711.
Collapse
Affiliation(s)
- Olga Winkler
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Raman Dhaliwal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Katie O'Shea
- Eye Movement Desensitization and Reprocessing International Association, Austin, TX, United States
| | - Adam Abba-Aji
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chidi Chima
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Scot E Purdon
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Neuropsychology, Alberta Hospital Edmonton, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
29
|
Jeong H, Kim D, Kim EK. Confirmatory factor analyses of the dissociative experiences scale in schizophrenia: Results from two psychiatric samples in South Korea. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2020.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
30
|
Varchmin L, Montag C, Treusch Y, Kaminski J, Heinz A. Traumatic Events, Social Adversity and Discrimination as Risk Factors for Psychosis - An Umbrella Review. Front Psychiatry 2021; 12:665957. [PMID: 34744806 PMCID: PMC8569921 DOI: 10.3389/fpsyt.2021.665957] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/17/2021] [Indexed: 12/17/2022] Open
Abstract
Exposure to childhood trauma is a well-known risk factor for severe mental disorders including schizophrenia and other non-affective psychoses. Beyond childhood trauma, there is increasing evidence that bullying, social exclusion, and discrimination during adolescence and adulthood may increase the risk of developing a psychotic disorder, and that such forms of traumatization may also underlie the elevated psychosis risk among migrants or persons with a visible minority status. In this umbrella review, we systematically assess meta-analyses regarding trauma and social adversity. A systematic literature review yielded 11 meta-analyses that met inclusion criteria and could be summarized quantitatively with a random effect model. Furthermore, six meta-analyses were evaluated qualitatively. Heterogeneity and publication bias were apparent in several meta-analyses. We observed that most significant social risk factors for psychosis were vulnerability for racist discrimination [OR = 3.90 (3.25-4.70)], migration [OR = 2.22 (1.75-2.80)], and childhood adversities [OR = 2.81 (2.03-3.83)]. Furthermore, social factors increasing the risk for psychosis were variation/impairment of parental communication, aversive adult life events, bullying, and factors associated with social isolation and discrimination. In spite of these environmental risk factors, there is a lack of evidence regarding treatment of trauma and psychosis, although some psychotherapeutic and art therapy approaches appear to be promising. Beyond individual interventions, stigmatization, racism, and other forms of discrimination need to be targeted to increase solidarity and communal support.
Collapse
Affiliation(s)
- Leonie Varchmin
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, University Clinic of the Charité in St. Hedwig Hospital, Charité Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Berlin, Germany
| | - Yvonne Treusch
- Hochschule Döpfer (HSD) Döpfer, University of Applied Science, Cologne, Germany
| | - Jakob Kaminski
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte (CCM), Berlin, Germany
| |
Collapse
|
31
|
Tzikos A, Arvaniti A, Kalamara E, Vorvolakos T, Kafalis G, Samakouri M, Livaditis M. Validating Dissociative Experience Scale (DES) in a Greek sample. J Trauma Dissociation 2021; 22:522-539. [PMID: 33427597 DOI: 10.1080/15299732.2020.1869648] [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: 10/22/2022]
Abstract
This study aimed to validate the Greek version of the Dissociative Experience Scale (DES). A sample of 340 psychiatric outpatients and controls was selected. Part of the sample went through a retest procedure after a two-week period. Due to the absence of equivalent tests, the Multiscale Dissociation Inventory (MDI), the Structured Clinical Interview for DSM-IV-Dissociative Disorders Revised (SCID-D-R), and the Zung Self-Rating Anxiety Scale were used. Explanatory factor analysis was performed, resulting in a 28-item scale; the analysis revealed four factors, explaining 61% of total variation: Depersonalization, Amnesia, Absorption, and Miscellaneous. Cronbach's alpha coefficient for the DES was 0.95. Intraclass correlation coefficient (ICC) of the total score between the first and second interview was 0.84. Concurrent and convergent validity, as assessed by correlations with clinical assessment used as a "gold standard," (0.77), MDI (0.96), and Zung scale (0.75) were satisfactory to excellent. The total score on the DES was significantly higher in the clinical sample than in the controls (17.8 ± 16.2 vs. 5.8 ± 7.2, p < .001), indicating high discriminant validity. After the ROC analysis was run, the best compromise between sensitivity/specificity was achieved at the value of 20. The Greek version of the DES is a reliable and valid tool suitable to assess dissociation in clinical and healthy populations.
Collapse
Affiliation(s)
- Anthimos Tzikos
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Psychiatry, Medical School, Democritus University of Thrace, Komotini, Greece
| | - Aikaterini Arvaniti
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Psychiatry, Medical School, Democritus University of Thrace, Komotini, Greece
| | | | - Theofanis Vorvolakos
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Psychiatry, Medical School, Democritus University of Thrace, Komotini, Greece
| | - Georgios Kafalis
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Maria Samakouri
- Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.,Department of Psychiatry, Medical School, Democritus University of Thrace, Komotini, Greece
| | - Miltos Livaditis
- Department of Psychiatry, Medical School, Democritus University of Thrace, Komotini, Greece
| |
Collapse
|
32
|
Individuals with Major Depressive Disorder Report High Scores of Insecure-Avoidant and Insecure-Anxious Attachment Styles, Dissociative Identity Symptoms, and Adult Traumatic Events. Healthcare (Basel) 2021; 9:healthcare9091169. [PMID: 34574943 PMCID: PMC8469763 DOI: 10.3390/healthcare9091169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023] Open
Abstract
Objective: Individuals with major depressive disorder (MDD) report more issues in social interaction compared to the general population. Moreover, dimensions of dissociation are considered dysfunctional strategies to cope with adverse life events. In this regard, current symptoms of MDD could be associated with traumatic events that occurred in childhood and in adult life. Given this background, the aim of the present study was to explore the associations between attachment styles as a proxy of quality of social interaction, dimensions of dissociation, and childhood and adult traumatic life events among individuals with MDD. Method: A total of 300 individuals with MDD (mean age: 31.31 years; 58.7% female) took part in this study. They completed a series of questionnaires on sociodemographic information, attachment styles, dimensions of dissociation, and childhood and adult traumatic life events. Results: Prevalence rates for attachment styles were as follows: anxious/ambivalent attachment style—71.7%; avoidant/dependent attachment style—13%; secure/close attachment style—15.3%. Compared to the general population, the participants reported higher prevalence rates of insecure attachment styles. Current symptoms of dissociation were associated with adult but not childhood traumatic life events. An anxious attachment style was associated with higher scores of dissociation. Conclusion: Psychotherapeutic treatment of individuals with MDD should consider the individuals’ challenging attachment styles and their risk of dissociation. While it is important to consider both adult and childhood traumatic events, in this research, more recent trauma occurring in adulthood was associated with current symptoms of dissociation.
Collapse
|
33
|
Chen X, Jiang L, Liu Y, Ran H, Yang R, Xu X, Lu J, Xiao Y. Childhood maltreatment and suicidal ideation in Chinese children and adolescents: the mediation of resilience. PeerJ 2021; 9:e11758. [PMID: 34277155 PMCID: PMC8269734 DOI: 10.7717/peerj.11758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Childhood maltreatment could increase the risk of suicidal ideation (SI) in adolescents. However, the mediation of resilience in this association remains unclear. Methods A population-based cross-sectional study has been done among 3,146 Chinese adolescents. We collected relevant information from the study participants by using self-administered questionnaire. Chinese version of the Childhood Trauma Questionnaire (CTQ), the Resilience Scale for Chinese Adolescents (RSCA), and the Beck Scale for Suicide Ideation (BSSI) were used to measure childhood maltreatment, resilience, and SI, respectively. Univariate and multivariate binary Logistic regression models were employed to estimate crude and adjusted associations between childhood maltreatment, resilience, and SI. Path analysis has subsequently been performed to measure the mediation of resilience in this association. Results Multivariate Logistic regression models revealed that compared to non-abused counterparts, adolescents who had ever experienced any type of childhood maltreatment was 1.74 times likely to report SI. Among the specific types of childhood maltreatment, emotional abuse showed the strongest association with SI (adjusted OR = 3.01, 95% CI [2.37–3.82]). Path model suggested that over one-third (39.8%) of the total association between childhood maltreatment and SI was mediated via resilience. Emotion regulation and interpersonal assistance were the most prominent mediators among all dimensions of resilience. Conclusions Resilience played as a significant mediator in the association between childhood maltreatment and SI. Resilience-oriented intervention measures could be considered for suicidal risk prevention among abused Chinese adolescents.
Collapse
Affiliation(s)
- Xue Chen
- School of Public Health, Kunming Medical University, Kunming, China.,The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Linling Jiang
- The First Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Yi Liu
- The First Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Hailiang Ran
- School of Public Health, Kunming Medical University, Kunming, China
| | - Runxu Yang
- The First Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Xiufeng Xu
- The First Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Jin Lu
- The First Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Yuanyuan Xiao
- School of Public Health, Kunming Medical University, Kunming, China
| |
Collapse
|
34
|
Varese F, Douglas M, Dudley R, Bowe S, Christodoulides T, Common S, Grace T, Lumley V, McCartney L, Pace S, Reeves T, Morrison AP, Turkington D. Targeting dissociation using cognitive behavioural therapy in voice hearers with psychosis and a history of interpersonal trauma: A case series. Psychol Psychother 2021; 94:247-265. [PMID: 32914542 DOI: 10.1111/papt.12304] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/27/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniques specifically targeting dissociative symptoms could improve both dissociation and auditory hallucination severity in a sample of voice hearers with psychosis and a history of interpersonal trauma (e.g., exposure to sexual, physical, and/or emotional abuse). DESIGN Case series. METHODS A total of 19 service users with psychosis were offered up to 24 therapy sessions over a 6-month intervention window. Participants were assessed four times over a 12-month period using measures of dissociation, psychotic symptoms severity, and additional secondary mental-health and recovery measures. RESULTS Sixteen participants engaged in the intervention and were included in last-observation-carried-forward analyses. Dropout rates were in line with those of other CBT for psychosis trials (26.3%). Repeated measures ANOVAs revealed large and significant improvements in dissociation (drm = 1.23) and hallucination severity (drm = 1.09) by the end of treatment; treatment gains were maintained 6 months following the end of therapy. Large and statistically significant gains were also observed on measures of post-traumatic symptoms, delusion severity, emotional distress, and perceived recovery from psychosis. CONCLUSIONS The findings of this case series suggest that the reduction of dissociation represents a valuable and acceptable treatment target for clients with auditory verbal hallucinations and a trauma history. Future clinical trials might benefit from considering targeting dissociative experiences as part of psychological interventions for distressing voices. PRACTITIONER POINTS Practitioners should consider the role of dissociation when assessing and formulating the difficulties of voice hearers with a history of trauma. Techniques to reduce dissociation can be feasibly integrated within psychological interventions for voices. Voice hearers with histories of trauma can benefit from psychological interventions aimed at reducing dissociation.
Collapse
Affiliation(s)
- Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Maggie Douglas
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Dudley
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | | | | | - Tim Grace
- Tees Esk and Wear Valley, NHS Foundation Trust, Darlington, UK
| | - Victoria Lumley
- Tees Esk and Wear Valley, NHS Foundation Trust, Darlington, UK
| | - Laura McCartney
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sonia Pace
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas Reeves
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anthony P Morrison
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Douglas Turkington
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
35
|
Mertens YL, Racioppi A, Sheinbaum T, Kwapil T, Barrantes-Vidal N. Dissociation and insecure attachment as mediators of the relation between childhood emotional abuse and nonclinical paranoid traits. Eur J Psychotraumatol 2021; 12:1888539. [PMID: 33968322 PMCID: PMC8079066 DOI: 10.1080/20008198.2021.1888539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Research suggests dissociation and insecure attachment serve as explanatory mechanisms in the pathway from childhood trauma to paranoia. However, past work has not examined these mechanisms concurrently in nonclinical populations. Objective: The current study sought to examine dissociation and insecure attachment as parallel mediators of the association between childhood emotional abuse and paranoid traits. Furthermore, a serial mediation model with insecure attachment preceding dissociation in the explanatory pathway was explored. Methods: Eighty-nine nonclinically ascertained young adults were assessed for childhood emotional abuse, dissociation, attachment styles, and paranoid traits. Parallel and serial mediation models were tested. Results: The association of childhood emotional abuse with both interview-based and self-reported paranoid traits was significantly mediated by dissociation and preoccupied attachment. Fearful attachment was a significant mediator in the model for self-reported paranoid traits. No evidence for a serial mediation effect was found. Conclusions: The present findings extend support for dissociation and attachment insecurity as mechanisms underlying the link between childhood emotional maltreatment and paranoid traits. Longitudinal research is needed to inform whether insecure attachment contributes to dissociation along the pathways to paranoid traits.
Collapse
Affiliation(s)
- Yoki Linn Mertens
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Anna Racioppi
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona (Edifici B), Barcelona, Spain
| | - Tamara Sheinbaum
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Thomas Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Department of Clinical Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona (Edifici B), Barcelona, Spain.,Departament de Salut Mental, Sant Pere Claver - Fundació Sanitària, Barcelona, Spain.,Center for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
| |
Collapse
|
36
|
Steardo L, Carbone EA, Ventura E, de Filippis R, Luciano M, Segura-Garcia C, De Fazio P. Dissociative Symptoms in Bipolar Disorder: Impact on Clinical Course and Treatment Response. Front Psychiatry 2021; 12:732843. [PMID: 34759848 PMCID: PMC8572831 DOI: 10.3389/fpsyt.2021.732843] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Dissociative symptoms are under recognized and scarcely studied by clinicians and researchers in patients with bipolar disorder (BD). We examined the relationship between dissociative symptoms and the psychotic features in patients with BD and assessed clinical and socio-demographic characteristics more frequently associated with dissociative symptoms and treatment response. Methods: Participants were 100 adult outpatients with BD. They were screened with semi-structured interview to collect socio-demographic and clinical characteristics; the Dissociative Experiences Scale-II (DES-II) and the ALDA scale were used to assess dissociative psychopathologies and response to treatment with mood stabilizers, respectively. Results: DES score (mean 31.7 ± 21.7) correlated with clinical variables, BD features, and course of illness. Psychotic symptoms, mixed features, and previous suicide attempts significantly predicted DES score [F (3, 47) = 39.880, p < 0.001, R 2 corrected = 0.713]. Dissociative symptoms were inversely correlated with poor response to treatment (r = -0.593; p < 0.001). Limitations: Cross-sectional design with a small sample and backward clinical assessment of psychotic symptoms. Conclusions: Dissociative phenomena are closely related to the presence of psychotic symptoms, mixed features, and previous suicide attempts in BD, especially in BD-I. Given the close association between dissociative and psychotic symptoms, this association could represent a diagnostic indicator of BD-I that may guide the clinician to plan the most appropriate treatment.
Collapse
Affiliation(s)
- Luca Steardo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elvira Anna Carbone
- Psychiatric Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Enrica Ventura
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Renato de Filippis
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Cristina Segura-Garcia
- Psychiatric Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| |
Collapse
|
37
|
Longden E, Branitsky A, Moskowitz A, Berry K, Bucci S, Varese F. The Relationship Between Dissociation and Symptoms of Psychosis: A Meta-analysis. Schizophr Bull 2020; 46:1104-1113. [PMID: 32251520 PMCID: PMC7505175 DOI: 10.1093/schbul/sbaa037] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Evidence suggests that dissociation is associated with psychotic experiences, particularly hallucinations, but also other symptoms. However, until now, symptom-specific relationships with dissociation have not been comprehensively synthesized. This is the first prospectively registered (CRD42017058214) meta-analysis to quantify the magnitude of association between dissociative experiences and all symptoms of psychosis. MEDLINE, PsycINFO, PubMed, and Scopus databases were searched using exhaustive terms denoting dissociation and psychotic symptoms. We included both nonclinical (58 studies; 16 557 participants) and clinical (46 studies; 3879 patient participants) samples and evaluated study quality. Ninety-three eligible articles considering 20 436 participants were retained for analysis. There was a robust association between dissociation and clinical and nonclinical positive psychotic symptoms (r = .437; 95%CI: .386 -.486), with the observed effect larger in nonclinical studies. Symptom-specific associations were also evident across clinical and nonclinical studies, and included significant summary effects for hallucinations (r = .461; 95%CI: .386 -.531), delusions (r = .418; 95%CI: .370 -.464), paranoia (r = .447; 95%CI: .393 -.499), and disorganization (r = .346; 95%CI: .249 -.436). Associations with negative symptoms were small and, in some cases, not significant. Overall, these findings confirm that dissociative phenomena are not only robustly related to hallucinations but also to multiple positive symptoms, and less robustly related to negative symptoms. Our findings are consistent with proposals that suggest certain psychotic symptoms might be better conceptualized as dissociative in nature and support the development of interventions targeting dissociation in formulating and treating psychotic experiences.
Collapse
Affiliation(s)
- Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison Branitsky
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| |
Collapse
|
38
|
Lotfinia S, Soorgi Z, Mertens Y, Daniels J. Structural and functional brain alterations in psychiatric patients with dissociative experiences: A systematic review of magnetic resonance imaging studies. J Psychiatr Res 2020; 128:5-15. [PMID: 32480060 DOI: 10.1016/j.jpsychires.2020.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/15/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION There is currently no general agreement on how to best conceptualize dissociative symptoms and whether they share similar neural underpinnings across dissociative disorders. Neuroimaging data could help elucidate these questions. OBJECTIVES The objective of this review is to summarize empirical evidence for neural aberrations observed in patients suffering from dissociative symptoms. METHODS A systematic literature review was conducted including patient cohorts diagnosed with primary dissociative disorders, post-traumatic stress disorder (PTSD), or borderline personality disorder. RESULTS Results from MRI studies reporting structural (gray matter and white matter) and functional (during resting-state and task-related activation) brain aberrations were extracted and integrated. In total, 33 articles were included of which 10 pertained to voxel-based morphology, 2 to diffusion tensor imaging, 10 to resting-state fMRI, and 11 to task-related fMRI. Overall findings indicated aberrations spread across diverse brain regions, especially in the temporal and frontal cortices. Patients with dissociative identity disorder and with dissociative PTSD showed more overlap in brain activation than each group showed with depersonalization/derealization disorder. CONCLUSION In conjunction, the results indicate that dissociative processing cannot be localized to a few distinctive brain regions but rather corresponds to differential neural signatures depending on the symptom constellation.
Collapse
Affiliation(s)
- Shahab Lotfinia
- Department of Clinical Psychology, Zahedan University of Medical Science, Zahedan, Iran
| | - Zohre Soorgi
- Department of Psychiatry, Zahedan University of Medical Science, Zahedan, Iran
| | - Yoki Mertens
- Department of Clinical Psychology, University of Groningen, the Netherlands
| | - Judith Daniels
- Department of Clinical Psychology, University of Groningen, the Netherlands.
| |
Collapse
|
39
|
The HPA axis dysregulation in severe mental illness: Can we shift the blame to gut microbiota? Prog Neuropsychopharmacol Biol Psychiatry 2020; 102:109951. [PMID: 32335265 DOI: 10.1016/j.pnpbp.2020.109951] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
Accumulating evidence indicates that patients with severe mental disorders, including major depression, bipolar disorder and schizophrenia present with various alterations of the gut microbiota and increased intestinal permeability. In addition, the hypothalamic-pituitary-adrenal (HPA) axis dysregulation and subclinical inflammation have been reported in this group of patients. Although it has been found that the HPA axis dysregulation appears as a consequence of psychosocial stress, especially traumatic life events, the exact mechanisms of this observation remain unclear. Animal model studies have unraveled several mechanisms linking the gut microbiota with the HPA axis dysfunction. Indeed, the gut microbiota can activate the HPA axis through several mediators that cross the blood-brain barrier and include microbial antigens, cytokines and prostaglandins. There is also evidence that various microbial species can affect ileal corticosterone production that may impact the activity of the HPA axis. However, some metabolites released by various microbes, e.g., short-chain fatty acids, can attenuate the HPA axis response. Moreover, several bacteria release neurotransmitters that can directly interact with vagal afferents. It has been postulated that the HPA axis activation can impact the gut microbiota and intestinal permeability. In this article, we discuss various mechanisms linking the gut microbiota with the HPA axis activity and summarize current evidence for a cross-talk between the gut-brain axis and the HPA axis from studies of patients with mood and psychotic disorders. Finally, we show potential clinical implications that can arise from future studies investigating the HPA axis activity with respect to the gut microbiota in severe mental disorders.
Collapse
|
40
|
Sideli L, Murray RM, Schimmenti A, Corso M, La Barbera D, Trotta A, Fisher HL. Childhood adversity and psychosis: a systematic review of bio-psycho-social mediators and moderators. Psychol Med 2020; 50:1761-1782. [PMID: 32624020 DOI: 10.1017/s0033291720002172] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The association between childhood adversity (CA) and psychosis has been extensively investigated in recent years. An increasing body of research has also focused on the mediating or moderating role of biological and psychological mechanisms, as well as other risk factors that might account for the link between CA and psychosis. We conducted a systematic search of the PsychINFO, Embase, Ovid, and Web of Science databases for original articles investigating the role of genetic vulnerabilities, environmental factors, psychological and psychopathological mechanisms in the association between CA and psychosis up to August 2019. We included studies with individuals at different stages of the psychosis continuum, from subclinical psychotic experiences to diagnosed disorders. From the 28 944 records identified, a total of 121 studies were included in this review. Only 26% of the studies identified met the criteria for methodological robustness. Overall, the current evidence suggests that CA may be associated with psychosis largely independently of genetic vulnerabilities. More consistent and robust evidence supports interaction between early and recent adversities, as well as the mediating role of attachment and mood symptoms, which is suggestive of an affective pathway between CA and psychosis across the continuum from subclinical experiences to diagnosable disorder. This review highlighted numerous methodological issues with the existing literature, including selection bias, heterogeneity of measurement instruments utilised, and lack of control for potential confounders. Future research should address these limitations to more accurately estimate mediation and moderation effects on the CA-psychosis association to inform the development of preventive interventions.
Collapse
Affiliation(s)
- Lucia Sideli
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Robin M Murray
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | | | - Mariangela Corso
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Daniele La Barbera
- Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Antonella Trotta
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Tony Hillis Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| |
Collapse
|
41
|
Fernández-León S, Rodríguez-Testal JF, Gutiérrez-López ML, Senín-Calderón C. Interpersonal Violence and Psychotic-Like Experiences: The Mediation of Ideas of Reference, Childhood Memories, and Dissociation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4587. [PMID: 32630582 PMCID: PMC7345491 DOI: 10.3390/ijerph17124587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 12/18/2022]
Abstract
Previous studies have demonstrated the relationship between the accumulation of situations involving interpersonal violence (IV) and psychotic-like experiences. This study explored whether IV is related to aberrant salience (AS), using a sequential mediation model that included memories of relationship with parents (submission, devaluation, and threat; Early Life Experiences Scale (ELES)), ideas of reference (IR), and dissociative symptoms (absorption and depersonalization), and whether the patient/nonpatient condition moderated this effect. The sample was made of 401 participants (including 43 patients with psychotic disorders) aged 18 to 71 years (Mage = 30.43; SD = 11.19). Analysis of a serial multiple mediator model revealed that IR, ELES, absorption, and depersonalization fully mediated the effect of IV on AS, explaining 39% of the variance, regardless of the patient/nonpatient condition. The indirect paths, which place IR and dissociation (especially absorption, the variable to which the IR and ELES lead) in a primordial position for being related to AS, are discussed. This continuum model could be useful for understanding processes related to the onset of psychosis unmoderated by the patient/nonpatient condition.
Collapse
Affiliation(s)
- Sandra Fernández-León
- Clinical Mental Health Management Unit, Hospital Juan Ramón Jiménez, 21005 Huelva, Spain;
| | - Juan F. Rodríguez-Testal
- Personality, Evaluation and Psychological Treatment Department, University of Seville, 41018 Seville, Spain
| | | | | |
Collapse
|
42
|
Reyno SM, Simmons M, Kinley J. A meta-analytic study examining the relationship between alexithymia and dissociation in psychiatric and nonclinical populations. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:439. [PMID: 32913826 PMCID: PMC7451292 DOI: 10.4081/ripppo.2020.439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/06/2020] [Indexed: 11/23/2022]
Abstract
Alexithymia and dissociation have been consistently linked in the literature, particularly in psychiatric populations. Both arise from a disconnection between conscious aspects of self-experiences and perceptions at both the mental self and bodily levels. This results in difficulty integrating thoughts, feelings and experiences into consciousness and memory, negatively impacting emotion awareness/regulation and reflective functioning. We conducted a meta-analysis to examine the strength of the relationship between alexithymia and dissociation in both clinical and non-clinical populations. Studies using two common measures of these constructs were included (i.e., the Toronto Alexithymia Scale - TAS, and the Dissociative Experiences Scale - DES). Analyzing the effect sizes derived from 19 studies (including a total of 4664 participants) revealed moderate to strong relationships between alexithymia and dissociation. The strength of the association was higher in clinical and younger aged non clinical populations. These findings are discussed in the context of treatment recommendations..
Collapse
Affiliation(s)
| | - Maria Simmons
- Queen Elizabeth II Health Sciences Centre, Halifax NS
| | - Jackie Kinley
- Department of Psychiatry, Dalhousie University, Halifax NS, Canada
| |
Collapse
|
43
|
Allsopp K, Read J, Corcoran R, Kinderman P. Heterogeneity in psychiatric diagnostic classification. Psychiatry Res 2019; 279:15-22. [PMID: 31279246 DOI: 10.1016/j.psychres.2019.07.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 01/01/2023]
Abstract
The theory and practice of psychiatric diagnosis are central yet contentious. This paper examines the heterogeneous nature of categories within the DSM-5, how this heterogeneity is expressed across diagnostic criteria, and its consequences for clinicians, clients, and the diagnostic model. Selected chapters of the DSM-5 were thematically analysed: schizophrenia spectrum and other psychotic disorders; bipolar and related disorders; depressive disorders; anxiety disorders; and trauma- and stressor-related disorders. Themes identified heterogeneity in specific diagnostic criteria, including symptom comparators, duration of difficulties, indicators of severity, and perspective used to assess difficulties. Wider variations across diagnostic categories examined symptom overlap across categories, and the role of trauma. Pragmatic criteria and difficulties that recur across multiple diagnostic categories offer flexibility for the clinician, but undermine the model of discrete categories of disorder. This nevertheless has implications for the way cause is conceptualised, such as implying that trauma affects only a limited number of diagnoses despite increasing evidence to the contrary. Individual experiences and specific causal pathways within diagnostic categories may also be obscured. A pragmatic approach to psychiatric assessment, allowing for recognition of individual experience, may therefore be a more effective way of understanding distress than maintaining commitment to a disingenuous categorical system.
Collapse
Affiliation(s)
- Kate Allsopp
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK; Greater Manchester Mental Health NHS Foundation Trust, Complex Trauma & Resilience Research Unit, Manchester Academic Health Science Centre, Manchester, UK.
| | - John Read
- School of Psychology, University of East London, London, UK
| | - Rhiannon Corcoran
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Peter Kinderman
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| |
Collapse
|
44
|
Wang J, Sun W, Tang X, Xu L, Wei Y, Cui H, Tang Y, Hui L, Jia Q, Zhu H, Wang J, Zhang T. Transdiagnostic Dimensions towards Personality Pathology and Childhood Traumatic Experience in a Clinical Sample: Subtype Classification by a Cross-sectional Analysis. Sci Rep 2019; 9:11248. [PMID: 31375755 PMCID: PMC6677786 DOI: 10.1038/s41598-019-47754-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/23/2019] [Indexed: 12/23/2022] Open
Abstract
Psychiatric disorders are highly heterogeneous syndromes often explained by underlying and internalized personality disorder(PD) traits that are affected by externalized childhood trauma experiences(CTE). The present study investigated the differential subtype model by examining the association between PD traits and CTE in a clinical sample with transdiagnostic psychopathology. Outpatients(n = 2090) presenting for psychiatric treatment completed self-reported measures of PD traits(Personality Diagnostic Questionnaire) and the childhood adversity(Child Trauma Questionnaire). Canonical variates were generated by canonical correlation analysis(CCA) and then used for hierarchical cluster analysis to produce subtypes. A support vector machine(SVM) model was used and validated using a linear kernel to assess the utility of the extracted subtypes of outpatients in clinical diagnosis classifications. The CCA determined two linear combinations: emotional abuse related dissociality PD traits(antisocial and paranoid PD) and emotional neglect related sociality PD traits(schizoid, passive-aggressive, depressive, histrionic, and avoidant PD). A cluster analysis revealed three subtypes defined by distinct and relatively homogeneous patterns along two dimensions, and comprising 17.5%(cluster-1, n = 365), 34.8%(cluster-2, n = 727), and 47.8%(cluster-3, n = 998) of the sample, each with distinctive features of PD traits and CTE. These subtypes suggest more distinct PD trait correlates of CTE manifestations than were captured by clinical phenomenological diagnostic definitions. Our results highlight important subtypes of psychiatric patients that highlight PD traits and CTE that transcend current diagnostic boundaries. The three different subtypes reflect significant differences in PD and CTE characteristics and lend support to efforts to develop PD and childhood trauma targeted psychotherapy that extends to clinical diagnosis-based interventions.
Collapse
Affiliation(s)
- JunJie Wang
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China
| | - Wei Sun
- Department of Neurosurgery, Pu Nan Hospital, Shanghai, 200125, China
| | - XiaoChen Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - LiHua Xu
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - YanYan Wei
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - HuiRu Cui
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - YingYing Tang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China
| | - Li Hui
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China
| | - QiuFang Jia
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China
| | - Hongliang Zhu
- Institute of Mental Health, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow Unversity, Soochow Unversity, Suzhou, Jiangsu, 215137, China.
| | - JiJun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China. .,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai, P.R. China. .,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China.
| | - TianHong Zhang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, P.R. China.
| |
Collapse
|