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Tsur N, Talmon A. Post-Traumatic Orientation to Bodily Signals: A Systematic Literature Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:174-188. [PMID: 34159853 DOI: 10.1177/15248380211025237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Theoretical literature suggests that trauma and (PTSD) may instigate changes in the interpretation of bodily signals. Some findings support these inquiries, revealing that exposure to traumatic events and PTSD are associated with pain catastrophizing, body vigilance, fear of pain, and other manifestations of bodily perceptions and interpretations. However, these findings are not integrated into an inclusive empirically based conceptualization, thus leading to a limited comprehension of this phenomenon. This systematic literature review was conducted to synthesize the existing literature referring to orientation to bodily signals. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the review included a final of 48 manuscripts that addressed orientation to bodily signals among participants (aged 18 and above) and its potential associations with PTSD. The review revealed that most studies assessed one orientation manifestation, which was tested for its link to PTSD. The majority of the manuscripts were cross-sectional and included participants who faced combat, vehicle accidents, or various types of traumas. Only five manuscripts focused on interpersonal trauma and abuse. Most manuscripts reported significant correlations, revealing that trauma and PTSD are associated with a negative, catastrophic and frightful interpretation of bodily signals. These findings emphasize the need to encapsulate the various manifestations of orientation to bodily signals under a unified construct, as proposed by the term post-traumatic orientation to bodily signals. Further research is needed to illuminate the circumstances and processes by which trauma is implicated in post-traumatic orientation to bodily signals.
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Affiliation(s)
- Noga Tsur
- Bob Shapell School of Social Work, Tel Aviv University, Israel
| | - Ada Talmon
- Bob Shapell School of Social Work, Tel Aviv University, Israel
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2
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L'amnésie dissociative dans le Trouble de Stress Post-Traumatique: analyse de la validité scientifique d'un phénomène psychologique controversé. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2023. [DOI: 10.1016/j.ejtd.2023.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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3
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Acute Stress in Health Workers during Two Consecutive Epidemic Waves of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010206. [PMID: 35010465 PMCID: PMC8751091 DOI: 10.3390/ijerph19010206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has provoked generalized uncertainty around the world, with health workers experiencing anxiety, depression, burnout, insomnia, and stress. Although the effects of the pandemic on mental health may change as it evolves, the majority of reports have been web-based, cross-sectional studies. We performed a study assessing acute stress in frontline health workers during two consecutive epidemic waves. After screening for trait anxiety/depression and dissociative experiences, we evaluated changes in acute stress, considering resilience, state anxiety, burnout, depersonalization/derealization symptoms, and quality of sleep as cofactors. During the first epidemic wave (April 2020), health workers reported acute stress related to COVID-19, which was related to state anxiety. After the first epidemic wave, acute stress decreased, with no increase during the second epidemic wave (December 2020), and further decreased when vaccination started. During the follow-up (April 2020 to February 2021), the acute stress score was related to bad quality of sleep. However, acute stress, state anxiety, and burnout were all related to trait anxiety/depression, while the resilience score was invariant through time. Overall, the results emphasize the relevance of mental health screening before, during, and after an epidemic wave of infections, in order to enable coping during successive sanitary crises.
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4
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Radell ML, Hamza EA, Moustafa AA. Depression in post-traumatic stress disorder. Rev Neurosci 2021; 31:703-722. [PMID: 32866132 DOI: 10.1515/revneuro-2020-0006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/31/2020] [Indexed: 12/12/2022]
Abstract
Major depressive disorder (MDD) symptoms commonly occur after trauma-exposure, both alone and in combination with post-traumatic stress disorder (PTSD). This article reviews recent research on comorbidity between these disorders, including its implications for symptom severity and response to treatment. Despite considerable symptom overlap, the two disorders represent distinct constructs and depend, at least in part, on separate biological mechanisms. Both, however, are also clearly related to stress psychopathology. We recommend that more research focus specifically on the study of individual differences in symptom expression in order to identify distinct subgroups of individuals and develop targeted treatments. However, a barrier to this line of inquiry is the trend of excluding particular patients from clinical trials of new interventions based on symptom severity or comorbidity. Another obstacle is the overreliance on self-report measures in human research. We argue that developing computer-based behavioral measures in order to supplement self-report can help address this challenge. Furthermore, we propose that these measures can help tie findings from human and non-human animal research. A number of paradigms have been used to model MDD-and PTSD-like behavior in animals. These models remain valuable for understanding the biological basis of these disorders in humans and for identifying potential interventions, but they have been underused for the study of comorbidity. Although the interpretation of animal behavior remains a concern, we propose that this can also be overcome through the development of close human analogs to animal paradigms.
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Affiliation(s)
- Milen L Radell
- Department of Psychology, Niagara University, Lewiston, NY, USA
| | - Eid Abo Hamza
- Department of Mental Health, Faculty of Education, Tanta University, Tanta, Egypt
| | - Ahmed A Moustafa
- School of Psychology, Western Sydney University, Sydney, NSW, Australia.,Marcs Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, NSW, Australia.,Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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5
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Miguel-Puga JA, Cooper-Bribiesca D, Avelar-Garnica FJ, Sanchez-Hurtado LA, Colin-Martínez T, Espinosa-Poblano E, Anda-Garay JC, González-Díaz JI, Segura-Santos OB, Vital-Arriaga LC, Jáuregui-Renaud K. Burnout, depersonalization, and anxiety contribute to post-traumatic stress in frontline health workers at COVID-19 patient care, a follow-up study. Brain Behav 2021; 11:e02007. [PMID: 33319496 PMCID: PMC7883101 DOI: 10.1002/brb3.2007] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/12/2020] [Accepted: 11/30/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION We designed a follow-up study of frontline health workers at COVID-19 patient care, within the same working conditions, to assess the influence of their general characteristics and pre-existing anxiety/depression/dissociative symptoms and resilience on the development of symptoms of post-traumatic stress disorder (PTSD), while monitoring their quality of sleep, depersonalization/derealization symptoms, acute stress, state anxiety, and burnout. METHODS In a Hospital reconfigured to address the surge of patients with COVID-19, 204 frontline health workers accepted to participate. They completed validated questionnaires to assess mental health: before, during, and after the peak of inpatient admissions. After each evaluation, a psychiatrist reviewed the questionnaires, using the accepted criteria for each instrument. Correlations were assessed using multivariable and multivariate analyses, with a significance level of .05. RESULTS Compared to men, women reporting pre-existing anxiety were more prone to acute stress; and younger age was related to both pre-existent common psychological symptoms and less resilience. Overall the evaluations, sleep quality was bad on the majority of participants, with an increase during the epidemic crisis, while persistent burnout had influence on state anxiety, acute stress, and symptoms of depersonalization/derealization. PTSD symptoms were related to pre-existent anxiety/depression and dissociative symptoms, as well as to acute stress and acute anxiety, and negatively related to resilience. CONCLUSIONS Pre-existent anxiety/depression, dissociative symptoms, and coexisting acute anxiety and acute stress contribute to PTSD symptoms. During an infectious outbreak, psychological screening could provide valuable information to prevent or mitigate against adverse psychological reactions by frontline healthcare workers caring for patients.
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Affiliation(s)
- José Adán Miguel-Puga
- Unidad de Investigación Médica en Otoneurología, Instituto Mexicano del Seguro Social, México
| | - Davis Cooper-Bribiesca
- Departamento de Psiquiatría del Hospital de Especialidades del Centro Medico Nacional siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Francisco José Avelar-Garnica
- Departamento de Imagenología del Hospital de Especialidades del Centro Medico Nacional siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Luis Alejandro Sanchez-Hurtado
- Departamento de Terapia Intensiva del Hospital de Especialidades del Centro Medico Nacional siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Tania Colin-Martínez
- Departamento de Admisión Continua del Hospital de Especialidades del Centro Medico Nacional siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Eliseo Espinosa-Poblano
- Departamento de Inhaloterapia del Hospital de Especialidades del Centro Medico Nacional siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Juan Carlos Anda-Garay
- Departamento de Medicina Interna del Hospital de Especialidades del Centro Medico Nacional siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Jorge Iván González-Díaz
- Departamento de Imagenología del Hospital de Especialidades del Centro Medico Nacional siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Oscar Bernardo Segura-Santos
- Departamento de Psiquiatría del Hospital de Especialidades del Centro Medico Nacional siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Luz Cristina Vital-Arriaga
- Laboratorio Clínico del Hospital de Especialidades del Centro Medico Nacional siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Caputo GB. Strange-face illusions during eye-to-eye gazing in dyads: specific effects on derealization, depersonalization and dissociative identity. J Trauma Dissociation 2019; 20:420-444. [PMID: 30938658 DOI: 10.1080/15299732.2019.1597807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Experimentally induced strange-face illusions can be perceived when two individuals look at each other in the eyes under low illumination for about 10 minutes. This task of subject-other eye-to-eye gazing produces the following perceptions by the subject: (i) mild to huge deformations and color/shape changes of face and facial features; (ii) lifeless, unmoving faces and immaterial presences akin to out-of-body experiences; (iii) pseudo-hallucinations, enlightened 'idealized' faces and personalities - rather than the other's actual face. Dissociative phenomena seem to be involved, whereas the effects of non-pathological dissociation on strange-face illusions have not yet been directly investigated. In the present study, dissociative perceptions and strange-face illusions were measured through self-report questionnaires on a large sample (N = 90) of healthy young individuals. Results of correlation and factor analyses suggest that strange-face illusions can involve, respectively: (i) strange-face illusions correlated to derealization; (ii) strange-face illusions correlated to depersonalization; and (iii) strange-face illusions of identity, which are supposedly correlated to identity dissociation. The findings support the separation between detachment and compartmentalization in dissociative processes. Effects of gender show that strange-face illusions are more frequent in men with respect to women if dyads are composed of individuals of different-gender. Furthermore, drawings of strange-faces, which were perceived by portrait artists in place the others' faces, allowed a direct illustration of examples of dissociative identities. Findings are discussed in relation to the three-level model of self-referential processing.
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7
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Trauma-Related Dissociation Is No Fantasy: Addressing the Errors of Omission and Commission in Merckelbach and Patihis (2018). PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-018-9336-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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8
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Schiavone FL, McKinnon MC, Lanius RA. Psychotic-Like Symptoms and the Temporal Lobe in Trauma-Related Disorders: Diagnosis, Treatment, and Assessment of Potential Malingering. CHRONIC STRESS 2018; 2:2470547018797046. [PMID: 32440584 PMCID: PMC7219949 DOI: 10.1177/2470547018797046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/30/2018] [Indexed: 11/17/2022]
Abstract
Objective To overview the phenomenology, etiology, assessment, and treatment of psychotic-like symptoms in trauma-related disorders focusing on the proposed role of temporal lobe dysfunction. Method We describe the literature pertaining to (i) psychotic-like symptoms and temporal lobe dysfunction in trauma-related disorders and (ii) psychological testing profiles in trauma-related disorders. We define trauma-related disorders as borderline personality disorder, post-traumatic stress disorder, and the dissociative disorders. Our search terms were dissociative disorders, temporal lobe, trauma, post-traumatic stress disorder, borderline personality disorder, psychosis, and malingering. Results Trauma-related psychotic-like symptoms are common and can differ in phenomenology from primary psychotic symptoms. Hallucinations consist of auditory and nonauditory content that may or may not relate to traumatic content. Child voices are highly suggestive of complex dissociative disorders. Critically, not only do these symptoms resemble those seen in temporal lobe epilepsy, but the temporal lobe is implicated in trauma-related disorders, thus providing a plausible neurobiological explanation. Despite such evidence, these symptoms are frequently considered atypical and misdiagnosed. Indeed, common structured psychological assessment tools categorize these symptoms as possible indicators of invalid testing profiles. Conclusion Psychotic-like symptoms are common in trauma-related disorders, may be related to temporal lobe dysfunction, and are frequently misinterpreted. This may lead to ineffective treatment and inappropriate determinations of malingering in the forensic system.
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Affiliation(s)
| | - Margaret C McKinnon
- Mood Disorders Program, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario, Canada.,Homewood Research Institute, Guelph, Ontario, Canada
| | - Ruth A Lanius
- Department of Psychiatry, University of Western Ontario, London, Ontario, Canada.,Department of Neuroscience, University of Western Ontario, London, Ontario, Canada
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9
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Fingelkurts AA, Fingelkurts AA. Alterations in the Three Components of Selfhood in Persons with Post-Traumatic Stress Disorder Symptoms: A Pilot qEEG Neuroimaging Study. Open Neuroimag J 2018; 12:42-54. [PMID: 29785227 PMCID: PMC5958296 DOI: 10.2174/1874440001812010042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/22/2018] [Accepted: 04/02/2018] [Indexed: 11/22/2022] Open
Abstract
Background and Objective: Understanding how trauma impacts the self-structure of individuals suffering from the Post-Traumatic Stress Disorder (PTSD) symptoms is a complex matter and despite several attempts to explain the relationship between trauma and the “Self”, this issue still lacks clarity. Therefore, adopting a new theoretical perspective may help understand PTSD deeper and to shed light on the underlying psychophysiological mechanisms. Methods: In this study, we employed the “three-dimensional construct model of the experiential selfhood” where three major components of selfhood (phenomenal first-person agency, embodiment, and reflection/narration) are related to three Operational Modules (OMs) of the self-referential brain network. These modules can be reliably estimated through operational synchrony analysis of the Electroencephalogram (EEG). Six individuals with PTSD symptoms and twenty-nine sex-, age- and demographic- (race, education, marital status) matched healthy controls underwent resting state EEG signal acquisition with the following estimation of the synchrony strength within every OM. Results: Our results indicate that subjects with PTSD symptoms had significantly stronger EEG operational synchrony within anterior and right posterior OMs as well as significantly weaker EEG operational synchrony within left posterior OM compared to healthy controls. Moreover, increased the functional integrity of the anterior OM was positively associated with hyperactivity symptoms, reduced synchrony of the left posterior OM was associated with greater avoidance, and increased right posterior OM integrity was positively correlated with intrusion and mood symptoms. Conclusion: The results are interpreted in light of the triad model of selfhood and its theoretical and clinical implications (including a new treatment approach) are discussed.
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10
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Sperandeo R, Monda V, Messina G, Carotenuto M, Maldonato NM, Moretto E, Leone E, De Luca V, Monda M, Messina A. Brain functional integration: an epidemiologic study on stress-producing dissociative phenomena. Neuropsychiatr Dis Treat 2018; 14:11-19. [PMID: 29296086 PMCID: PMC5741075 DOI: 10.2147/ndt.s146250] [Citation(s) in RCA: 14] [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] [Indexed: 12/25/2022] Open
Abstract
Dissociative phenomena are common among psychiatric patients; the presence of these symptoms can worsen the prognosis, increasing the severity of their clinical conditions and exposing them to increased risk of suicidal behavior. Personality disorders as long duration stressful experiences may support the development of dissociative phenomena. In 933 psychiatric outpatients consecutively recruited, presence of dissociative phenomena was identified with the Dissociative Experience Scale (DES). Dissociative phenomena were significantly more severe in the group of people with mental disorders and/or personality disorders. All psychopathologic traits detected with the symptom checklist-90-revised had a significant correlation with the total score on the DES. Using total DES score as the dependent variable, a linear regression model was constructed. Mental and personality disorders which were associated with greater severity of dissociative phenomena on analysis of variance were included as predictors; scores from the nine scales of symptom checklist-90-revised, significantly correlated to total DES score, were used as covariates. The model consisted of seven explanatory variables (four factors and three covariates) explaining 82% of variance. The four significant factors were the presence of borderline and narcissistic personality disorder, substance abuse disorders and psychotic disorders. Significant covariates were psychopathologic traits of anger, psychoticism and obsessiveness. This study, confirming Janet's theory, explains that, mental disorders and psychopathologic experiences of patients can configure the chronic stress condition that produces functional damage to the adaptive executive system. The symptoms of dissociative depersonalization/derealization and dissociative amnesia can be explained, in large part, through their current and previous psychopathologic experiences.
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Affiliation(s)
- Raffaele Sperandeo
- Department of Human Sciences, Università Della, Basilicata.,School of Integrated Gestaltic Psychotherapy, Torre Annunziata
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia
| | - Marco Carotenuto
- Department of Mental Health, Physical and Preventive Medicine, Clinic of Child and Adolescent Neuropsychiatry, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Nelson Mauro Maldonato
- Department of Human Sciences, Università Della, Basilicata.,School of Integrated Gestaltic Psychotherapy, Torre Annunziata
| | - Enrico Moretto
- Department of Human Sciences, Università Della, Basilicata.,School of Integrated Gestaltic Psychotherapy, Torre Annunziata
| | - Elena Leone
- Department of Human Sciences, Università Della, Basilicata.,School of Integrated Gestaltic Psychotherapy, Torre Annunziata
| | - Vincenzo De Luca
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples
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11
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Piccardi L, Palmiero M, Nori R, Baralla F, Cordellieri P, D’Amico S, Giannini AM. Persistence of Traumatic Symptoms After Seven Years: Evidence from Young Individuals Exposed to the L’Aquila Earthquake. JOURNAL OF LOSS & TRAUMA 2017. [DOI: 10.1080/15325024.2017.1328243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Laura Piccardi
- Life, Health and Environmental Science Department, University of L’Aquila, Coppito, AQ, Italy
- Neuropsychology Unit, I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy
| | - Massimiliano Palmiero
- Life, Health and Environmental Science Department, University of L’Aquila, Coppito, AQ, Italy
- Neuropsychology Unit, I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy
| | | | | | | | - Simonetta D’Amico
- Department of Biotechnological and Applied Clinical Science, University of L’Aquila, L’Aquila, Italy
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12
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Harricharan S, Rabellino D, Frewen PA, Densmore M, Théberge J, McKinnon MC, Schore AN, Lanius RA. fMRI functional connectivity of the periaqueductal gray in PTSD and its dissociative subtype. Brain Behav 2016; 6:e00579. [PMID: 28032002 PMCID: PMC5167004 DOI: 10.1002/brb3.579] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/09/2016] [Accepted: 08/12/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with hyperarousal and active fight or flight defensive responses. By contrast, the dissociative subtype of PTSD, characterized by depersonalization and derealization symptoms, is frequently accompanied by additional passive or submissive defensive responses associated with autonomic blunting. Here, the periaqueductal gray (PAG) plays a central role in defensive responses, where the dorsolateral (DL-PAG) and ventrolateral PAG (VL-PAG) are thought to mediate active and passive defensive responses, respectively. METHODS We examined PAG subregion (dorsolateral and ventrolateral) resting-state functional connectivity in three groups: PTSD patients without the dissociative subtype (n = 60); PTSD patients with the dissociative subtype (n = 37); and healthy controls (n = 40) using a seed-based approach via PickAtlas and SPM12. RESULTS All PTSD patients showed extensive DL- and VL-PAG functional connectivity at rest with areas associated with emotional reactivity and defensive action as compared to controls (n = 40). Although all PTSD patients demonstrated DL-PAG functional connectivity with areas associated with initiation of active coping strategies and hyperarousal (e.g., dorsal anterior cingulate; anterior insula), only dissociative PTSD patients exhibited greater VL-PAG functional connectivity with brain regions linked to passive coping strategies and increased levels of depersonalization (e.g., temporoparietal junction; rolandic operculum). CONCLUSIONS These findings suggest greater defensive posturing in PTSD patients even at rest and demonstrate that those with the dissociative subtype show unique patterns of PAG functional connectivity when compared to those without the subtype. Taken together, these findings represent an important first step toward identifying neural and behavioral targets for therapeutic interventions that address defensive strategies in trauma-related disorders.
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Affiliation(s)
| | - Daniela Rabellino
- Department of Psychiatry University of Western Ontario London ON Canada
| | - Paul A Frewen
- Department of Psychiatry University of Western Ontario London ON Canada; Department of Psychology University of Western Ontario London ON Canada
| | - Maria Densmore
- Imaging Division Lawson Health Research Institute London ON Canada
| | - Jean Théberge
- Imaging Division Lawson Health Research Institute London ON Canada; Departments of Medical Imaging and Medical Biophysics Western University London ON Canada
| | - Margaret C McKinnon
- Mood Disorders Program St. Joseph's Healthcare Hamilton ON Canada; Department of Psychiatry and Behavioural Neurosciences McMaster University Hamilton ON Canada; Homewood Research Institute Guelph ON Canada
| | - Allan N Schore
- Department of Psychiatry and Biobehavioral Sciences University of California at Los Angeles Los Angeles CA USA
| | - Ruth A Lanius
- Department of Neuroscience University of Western Ontario London ON Canada; Department of Psychiatry University of Western Ontario London ON Canada; Imaging Division Lawson Health Research Institute London ON Canada
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13
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McKinnon MC, Boyd JE, Frewen PA, Lanius UF, Jetly R, Richardson JD, Lanius RA. A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions. Neuropsychologia 2016; 90:210-34. [DOI: 10.1016/j.neuropsychologia.2016.07.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/16/2016] [Accepted: 07/16/2016] [Indexed: 01/01/2023]
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14
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A novel approach to PTSD modeling in rats reveals alternating patterns of limbic activity in different types of stress reaction. Mol Psychiatry 2016; 21:630-41. [PMID: 26552592 PMCID: PMC5414084 DOI: 10.1038/mp.2015.169] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/01/2015] [Accepted: 09/14/2015] [Indexed: 11/29/2022]
Abstract
Human reactions to trauma exposure are extremely diverse, with some individuals exhibiting only time-limited distress and others qualifying for posttraumatic stress disorder diagnosis (PTSD). Furthermore, whereas most PTSD patients mainly display fear-based symptoms, a minority of patients display a co-morbid anhedonic phenotype. We employed an individual profiling approach to model these intriguing facets of the psychiatric condition in underwater-trauma exposed rats. Based on long-term assessments of anxiety-like and anhedonic behaviors, our analysis uncovered three separate phenotypes of stress response; an anxious, fear-based (38%), a co-morbid, fear-anhedonic (15%), and an exposed-unaffected group (47%). Immunohistochemical assessments for cellular activation (c-Fos) and activation of inhibition (c-Fos+GAD67) revealed a differential involvement of limbic regions and distinct co-activity patterns for each of these phenotypes, validating the behavioral categorization. In accordance with recent neurocognitive hypotheses for posttraumatic depression, we show that enhanced pretrauma anxiety predicts the progression of posttraumatic anhedonia only in the fear-anhedonic phenotype.
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15
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Meloni EG, Venkataraman A, Donahue RJ, Carlezon WA. Bi-directional effects of pituitary adenylate cyclase-activating polypeptide (PACAP) on fear-related behavior and c-Fos expression after fear conditioning in rats. Psychoneuroendocrinology 2016; 64:12-21. [PMID: 26590791 PMCID: PMC4698186 DOI: 10.1016/j.psyneuen.2015.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 01/23/2023]
Abstract
Pituitary adenylate cyclase-activating polypeptide (PACAP) is implicated in stress regulation and learning and memory. PACAP has neuromodulatory actions on brain structures within the limbic system that could contribute to its acute and persistent effects in animal models of stress and anxiety-like behavior. Here, male Sprague-Dawley rats were implanted with intracerebroventricular (ICV) cannula for infusion of PACAP-38 (0.5, 1, or 1.5 μg) or vehicle followed 30 min later by fear conditioning. Freezing was measured early (1, 4, and 7 days) or following a delay (7, 10, and 13 days) after conditioning. PACAP (1.5 μg) produced a bi-phasic response in freezing behavior across test days: relative to controls, PACAP-treated rats showed a reduction in freezing when tested 1 or 7 days after fear conditioning that evolved into a significant elevation in freezing by the third test session in the early, but not delayed, group. Corticosterone (CORT) levels were significantly elevated in PACAP-treated rats following fear conditioning, but not at the time of testing (Day 1). Brain c-Fos expression revealed PACAP-dependent alterations within, as well as outside of, areas typically implicated in fear conditioning. Our findings raise the possibility that PACAP disrupts fear memory consolidation by altering synaptic plasticity within neurocircuits normally responsible for encoding fear-related cues, producing a type of dissociation or peritraumatic amnesia often seen in people early after exposure to a traumatic event. However, fear memories are retained such that repeated testing and memory reactivation (e.g., re-experiencing) causes the freezing response to emerge and persist at elevated levels. PACAP systems may represent an axis on which stress and exposure to trauma converge to promote maladaptive behavioral responses characteristic of psychiatric illnesses such as post-traumatic stress disorder (PTSD).
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Affiliation(s)
- Edward G Meloni
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA.
| | - Archana Venkataraman
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA
| | - Rachel J Donahue
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA
| | - William A Carlezon
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA
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Terock J, Van der Auwera S, Janowitz D, Spitzer C, Barnow S, Miertsch M, Freyberger HJ, Grabe HJ. From Childhood Trauma to Adult Dissociation: The Role of PTSD and Alexithymia. Psychopathology 2016; 49:374-382. [PMID: 27623153 DOI: 10.1159/000449004] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/29/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The mechanism of how childhood trauma leads to increased risk for adult dissociation is not sufficiently understood. We sought to investigate the predicting effects and the putatively mediating roles of PTSD and alexithymia on the path from childhood trauma to adult dissociation. METHODS A total of 666 day-clinic outpatients were administered the Childhood Trauma Questionnaire (CTQ), the Toronto Alexithymia Scale (TAS-20), the Posttraumatic Diagnostic Scale (PDS), and the Dissociative Experiences Scale (DES) and controlled for sex, age, and the Global Symptom Index (GSI). Linear regression analyses and mediation analyses were applied. RESULTS Independent predictive effects on dissociation were found for childhood trauma, alexithymia and PDS, even after adjusting for GSI. Effects of childhood neglect on dissociation were slightly stronger than of abuse. Alexithymia did not mediate the path from childhood trauma to dissociation. Mediation by PDS was specific for childhood abuse, with all PTSD symptom clusters being significantly involved. CONCLUSIONS Childhood abuse and neglect are important predictors of dissociation. While the effects of abuse are mediated by PTSD, the mechanism of how neglect leads to dissociation remains unclear. The results further support the predictive value of alexithymia for adult dissociation above and beyond the effects of childhood trauma, PTSD, and GSI scores.
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Affiliation(s)
- Jan Terock
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, HELIOS Klinikum Stralsund, Stralsund, Germany
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Alsawy S, Wood L, Taylor PJ, Morrison AP. Psychotic experiences and PTSD: exploring associations in a population survey. Psychol Med 2015; 45:2849-2859. [PMID: 25990802 DOI: 10.1017/s003329171500080x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extensive evidence has shown that experiencing a traumatic event and post-traumatic stress disorder (PTSD) are associated with experiences of psychosis. However, less is known about specific PTSD symptoms and their relationship with psychotic experiences. This study aimed to examine the relationship between symptoms of PTSD with paranoia and auditory hallucinations in a large-scale sample. METHOD The Adult Psychiatric Morbidity Survey (APMS) was utilized to examine the prevalence of lifetime trauma, symptoms of PTSD, and experiences of paranoia and auditory hallucinations (n = 7403). RESULTS There were significant bivariate associations between symptoms of PTSD and psychotic experiences. Multiple logistic regression analyses indicated that reliving and arousal symptoms were significant predictors for paranoia while reliving, but not arousal symptoms, also significantly predicted auditory hallucinations. A dose-response relationship was found, the greater the number of PTSD symptoms, the greater the odds were of experiencing both paranoia and hallucinations. CONCLUSIONS These findings illustrate that symptoms of PTSD are associated with increased odds of experiencing auditory hallucinations and paranoia. Overlaps appear to be present between the symptoms of PTSD and psychotic experiences. Increasing awareness of this association may advance work in clinical practice.
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Affiliation(s)
- S Alsawy
- University of Manchester,School of Psychological Sciences,Manchester,UK
| | - L Wood
- University of Manchester,School of Psychological Sciences,Manchester,UK
| | - P J Taylor
- University of Liverpool,Institute of Psychology,Health & Society,Liverpool,UK
| | - A P Morrison
- University of Manchester,School of Psychological Sciences,Manchester,UK
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Tekoah SD, Harel-Shalev A. “Living in a movie” — Israeli women combatants in conflict zones. WOMENS STUDIES INTERNATIONAL FORUM 2014. [DOI: 10.1016/j.wsif.2014.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Psychological trauma can have devastating consequences on emotion regulatory capacities and lead to dissociative processes that provide subjective detachment from overwhelming emotional experience during and in the aftermath of trauma. Dissociation is a complex phenomenon that comprises a host of symptoms and factors, including depersonalization, derealization, time distortion, dissociative flashbacks, and alterations in the perception of the self. Dissociation occurs in up to two thirds of patients with borderline personality disorder (BPD). The neurobiology of traumatic dissociation has demonstrated a heterogeneity in posttraumatic stress symptoms that, over time, can result in different types of dysregulated emotional states. This review links the concepts of trauma and dissociation to BPD by illustrating different forms of emotional dysregulation and their clinical relevance to patients with BPD.
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Affiliation(s)
- Eric Vermetten
- Department Psychiatry, Leiden University Medical Center, Utrecht, The Netherlands,
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20
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Bob P. Psychophysiology of dissociated consciousness. Curr Top Behav Neurosci 2014; 21:3-21. [PMID: 24850082 DOI: 10.1007/7854_2014_320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Recent study of consciousness provides an evidence that there is a limit of consciousness, which presents a barrier between conscious and unconscious processes. This barrier likely is specifically manifested as a disturbance of neural mechanisms of consciousness that through distributed brain processing, attentional mechanisms and memory processes enable to constitute integrative conscious experience. According to recent findings a level of conscious integration may change during certain conditions related to experimental cognitive manipulations, hypnosis, or stressful experiences that can lead to dissociation of consciousness. In psychopathological research the term dissociation was proposed by Pierre Janet for explanation of processes related to splitting of consciousness due to traumatic events or during hypnosis. According to several recent findings dissociation of consciousness likely is related to deficits in global distribution of information and may lead to heightened levels of "neural complexity" that reflects brain integration or differentiation based on numbers of independent neural processes in the brain that may be specifically related to various mental disorders.
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Affiliation(s)
- Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, 1st Faculty of Medicine, Charles University, Ke Karlovu 11, 128 00, Prague, Czech Republic,
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Spiegel D, Lewis-Fernández R, Lanius R, Vermetten E, Simeon D, Friedman M. Dissociative Disorders in DSM-5. Annu Rev Clin Psychol 2013; 9:299-326. [DOI: 10.1146/annurev-clinpsy-050212-185531] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- David Spiegel
- Department of Psychiatry, School of Medicine, Stanford University, Stanford, California 94304-5718;
| | | | - Ruth Lanius
- Department of Psychiatry, London Health Sciences Center, London, N6A 5A5 ON Canada;
| | - Eric Vermetten
- Department of Psychiatry, University Medical Center Utrecht, 3584 CX Netherlands;
| | - Daphne Simeon
- Department of Psychiatry, Mt. Sinai School of Medicine, New York, New York 10025;
| | - Matthew Friedman
- Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire 03755;
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Steuwe C, Lanius RA, Frewen PA. Evidence for a dissociative subtype of PTSD by latent profile and confirmatory factor analyses in a civilian sample. Depress Anxiety 2012; 29:689-700. [PMID: 22653764 DOI: 10.1002/da.21944] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/25/2012] [Accepted: 02/25/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Dissociative symptoms are increasingly recognized in individuals with posttraumatic stress disorder (PTSD). The aim of this study was to investigate the prevalence of derealization and depersonalization symptoms via latent profile analyses (LPAs) in a civilian PTSD sample and examine the relationship between PTSD and dissociative symptoms via factor analytic methods. METHODS A civilian sample of individuals with PTSD predominantly related to childhood abuse (n = 134) completed a diagnostic interview for PTSD and comorbid psychiatric disorders. LPAs and confirmatory factor analyses (CFAs) were performed on the severity scores for PTSD, derealization, and depersonalization symptoms. RESULTS LPAs extracted three groups, one of which was uniquely characterized by high derealization and depersonalization symptoms, and accounted for 25% of the sample. Individuals in the dissociative subgroup also showed a higher number of comorbid Axis I disorders and a more significant history of childhood abuse and neglect. CFAs suggested the acceptance of a five factor solution in which dissociative symptoms are distinct from but correlate significantly with the core PTSD symptom clusters. CONCLUSIONS The results from LPAs and CFAs are concordant with the concept of a dissociative subtype in patients with PTSD and suggest that symptoms of derealization-depersonalization and the core symptoms of PTSD are positively correlated. Thought should be given to including a dissociative subtype of PTSD in the DSM-5.
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Affiliation(s)
- Carolin Steuwe
- Department of Psychiatry, The University of Western Ontario, London, Ontario, Canada
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Keuroghlian AS, Kamen CS, Neri E, Lee S, Liu R, Gore-Felton C. Trauma, dissociation, and antiretroviral adherence among persons living with HIV/AIDS. J Psychiatr Res 2011; 45:942-8. [PMID: 21636097 PMCID: PMC3118254 DOI: 10.1016/j.jpsychires.2011.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/09/2011] [Accepted: 05/06/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are approximately 1,000,000 persons living with HIV/AIDS (PLH) in the United States; to reduce rates of new infection and curb disease progression, adherence to HIV medication among PLH is critical. Despite elevated trauma rates in PLH, no studies to date have investigated the relationship between dissociation, a specific symptom of trauma, and HIV medication adherence. We hypothesized that Post-Traumatic Stress Disorder (PTSD) symptoms would be associated with lower adherence, and that dissociation would moderate this relationship. METHODS Forty-three individuals with HIV were recruited from community-based clinics to participate in a cross-sectional study. The relationship of trauma, dissociation, and their interaction to the probability of antiretroviral adherence was assessed using a hierarchical binary logistic regression analysis. RESULTS Among 38 eligible participants, greater PTSD was associated with lower odds of adherence (OR = .92, p < .05). Dissociation moderated the effect of PTSD on adherence, resulting in lower odds of adherence (OR = .95, p < .05). PTSD symptoms were significantly associated with lower odds of adherence in individuals reporting high levels of dissociation (OR = .86, p < .05) but not in those reporting low levels of dissociation (OR = 1.02, p > .05). CONCLUSIONS This is the first study to demonstrate a relationship between dissociation and medication adherence. Findings are discussed in the context of clinical management of PLH with trauma histories and the need for interventions targeting dissociative symptomatology to optimize adherence.
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Affiliation(s)
- Alex S. Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, McLean Hospital, Belmont, MA, 02478,Corresponding author. Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, WACC 812, Boston, MA, 02114, USA. Tel.: +1 650 804 6507; Fax: + 1 203 937 3481;
| | - Charles S. Kamen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, 94305
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, 94305
| | - Susanne Lee
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, 94305
| | - Rhianon Liu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, 94305
| | - Cheryl Gore-Felton
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, 94305
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Bob P, Susta M, Gregusova A, Jasova D, Raboch J, Mishara A. Traumatic Stress, Dissociation, and Limbic Irritability in Patients with Unipolar Depression Being Treated with SSRIs. Psychol Rep 2010; 107:685-96. [PMID: 21323125 DOI: 10.2466/02.15.16.pr0.107.6.685-696] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent evidence suggests that stressful experiences may be related to deficits in inhibitory functions and temporolimbic epileptic-like activity. The latter may produce psychosensory seizure-like symptoms that may also appear in nonepileptic conditions. This study assesses whether the increased presence of the seizure-like symptoms in 113 unipolar depressive patients treated with SSRIs is associated with significantly more severe symptoms of depression, traumatic stress, and dissociation in comparison with 86 healthy controls. Results indicate that seizure-like symptoms in depressive patients have significant association with depression, symptoms of dissociation, and traumatic stress. This association suggests that processess generating seizure-like symptoms may be related to symptoms of depression, traumatic stress, and dissociation.
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Affiliation(s)
- Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, 1st Faculty of Medicine, Charles University
| | - Marek Susta
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, 1st Faculty of Medicine, Charles University
| | - Alica Gregusova
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, 1st Faculty of Medicine, Charles University
| | - Denisa Jasova
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, 1st Faculty of Medicine, Charles University
| | - Jiri Raboch
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry, 1st Faculty of Medicine, Charles University
| | - Aaron Mishara
- Department of Clinical Psychology, Chicago School of Professional Psychology, Department of Psychiatry, Yale School of Medicine
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Robinaugh DJ, McNally RJ. Autobiographical memory for shame or guilt provoking events: Association with psychological symptoms. Behav Res Ther 2010; 48:646-52. [DOI: 10.1016/j.brat.2010.03.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 03/18/2010] [Accepted: 03/22/2010] [Indexed: 10/19/2022]
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Jonsson PV. Complex trauma, impact on development and possible solutions on an adolescent intensive care unit. Clin Child Psychol Psychiatry 2009; 14:437-54. [PMID: 19515758 DOI: 10.1177/1359104509104051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In order for us to begin to understand the effect of abusive experiences in childhood on young people's personality development and symptomatology, we have to draw upon a number of theories. The most important of these relate to attachment, mentalization, dissociation, trauma, and how abusive experiences affect the development of the individual and their developing brain. In this article I will share with you my attempts to understand the young people that come to stay on our intensive care unit and consider how these theories inform our understanding of them and the treatment approach that we try to provide.
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Peace KA, Porter S, ten Brinke L. Are memories for sexually traumatic events "special"? A within-subjects investigation of trauma and memory in a clinical sample. Memory 2008; 16:10-21. [PMID: 17852726 DOI: 10.1080/09658210701363583] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
According to a long-standing clinical tradition, sexually traumatic experiences are processed and recalled differently from other experiences, often leading to memory impairment. In this study, we compared the characteristics of traumatic memories for sexual violence and two other types of emotional experiences. N=44 women recruited from a local sexual trauma agency were asked to recall and describe three autobiographical events: sexual abuse/assault, a non-sexual trauma, and a positive emotional event. The characteristics of the three memory types were compared on both subjective and objective measures. Further, the potential influences of level of traumatic impact and dissociation were assessed. Results indicated that memories for sexual trauma were not impaired or fragmented relative to other memories. Instead, memories for sexual trauma were associated with a remarkably high level of vividness, detail, and sensory components. Further, high levels of traumatic impact were not associated with memory impairment. Implications for the ongoing traumatic memory debate are discussed.
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Affiliation(s)
- Kristine A Peace
- Department of Psychology, Grant MacEwan College, Edmonton, AB, Canada.
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Porter S, Taylor K, ten Brinke L. Memory for media: Investigation of false memories for negatively and positively charged public events. Memory 2008; 16:658-66. [DOI: 10.1080/09658210802154626] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Descartes intuitively anticipated the so-called 'binding problem' of consciousness and thought that the pineal gland enables spatio-temporal integration in cognitive processing. Recent findings indicate that a major role in the process of temporal integration and binding involve neurons in suprachiasmatic nuclei, specifically targeting the pineal gland and other structures, and control the neuroendocrine rhythms. Melatonin is an endocrine output signal of the clock and provides circadian information as an endogenous synchronizer which stabilizes and reinforces circadian rhythms. This integrative process occurs at the different levels of the circadian network via gene expression in some brain regions and peripheral structures that enables integration of circadian, hormonal, and metabolic information and creating temporal order of bodily and mental experience. This specific temporal order is reflected in associative sequentiality that is necessary for cognition, behavior and all processes of memory consolidation that must preserve all information in the temporal causal order and synchrony. In this context, recent findings suggest that melatonin could be a potential regulator in the processes that contribute to memory formation, long-term potentiation, and synaptic plasticity in the hippocampus and other brain regions. There is evidence that stress disrupts normal activity and memory consolidation in the hippocampus and prefrontal cortex, and this process leads to memories that are stored without a contextual or spatiotemporal frame. These findings emphasize a specific role of melatonin in mechanisms of consciousness, memory and stress and are also consistent with reported studies that indicate melatonin alterations under stressful conditions and in mental disorders.
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Affiliation(s)
- Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress & Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic.
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Aslund C, Nilsson KW, Starrin B, Sjöberg RL. Shaming experiences and the association between adolescent depression and psychosocial risk factors. Eur Child Adolesc Psychiatry 2007; 16:298-304. [PMID: 17473948 DOI: 10.1007/s00787-006-0564-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate whether psychosocial risk factors such as parental separation, parental unemployment and experiences of sexual abuse are associated with adolescent depression, and whether shaming experiences (defined as experiences of being degraded, or ridiculed by others) may account for such an association. METHOD A total of 5048 Swedish adolescents answered the Survey of Adolescent Life in Vestmanland 2004 (SALVe-2004) during classhours. The survey included questions about depressive symptoms, parental separation, parental unemployment and experiences of sexual abuse. RESULTS The psychosocial risk factors studied were all associated with depression, but several of these associations became non-significant when a factor for shaming experiences was entered into the models. The explained variance for depression furthermore increased from approximately 4-7% to 17-20% when shame was included. CONCLUSION Shaming experiences may mediate part of the association between psychosocial risk factors and depression. These findings may have important implications for the understanding of psychotherapeutic treatment of the effects of risk factors in depressed patients.
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Affiliation(s)
- Cecilia Aslund
- Centre for Clinical Research, Uppsala University, Central Hospital of Västerås, 721 89, Västerås, Sweden
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Abstract
This paper calls for a broadening of the context within which we study responses to traumatic stress, the course of recovery, components of effective interventions, and assessments of outcome. Acute stress reactions to trauma as a spectrum include anxiety, dissociative, and depressive symptoms. The course of these symptoms may vary, with fluctuations between intrusion (positive) and avoidance/numbing/dissociative (negative) symptoms that may complicate assessment, treatment-seeking, and course of recovery. Components of effective treatments including affect management, cognitive restructuring, and social integration are discussed. Finally, a broader view of outcome assessment in such research is called for, including not just reduction in psychopathological symptoms but attention to coping styles, affect management, resilience, social reorganization, and sensitivity to subsequent trauma.
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Miller MW, Litz BT. Emotional-processing in posttraumatic stress disorder II: startle reflex modulation during picture processing. JOURNAL OF ABNORMAL PSYCHOLOGY 2004; 113:451-63. [PMID: 15311990 DOI: 10.1037/0021-843x.113.3.451] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the impact of a trauma-related stressor on subsequent emotional behavior in veterans with (n = 35) and without (n = 24) posttraumatic stress disorder (PTSD). Self-report and physiological responses, including acoustic startle, were recorded during viewing of emotionally evocative photographs at baseline and following exposure to trauma-related and non-trauma-related stressors. The 2 groups exhibited equivalent patterns of emotional response across self-report and physiological measures at baseline. In contrast, following the trauma challenge, participants with PTSD showed a pattern of startle modulation suggestive of greater defensive reactivity and reduced visual perceptual engagement. These findings, along with augmented corrugator EMG reactivity during the same interval, suggest that trauma-related reexperiencing primes subsequent negative emotional responding in individuals with PTSD.
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Affiliation(s)
- Mark W Miller
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA.
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Butler LD, Seagraves DA, Desjardins JC, Azarow J, Hastings A, Garlan RW, DiMiceli S, Winzelberg A, Spiegel D. How to launch a national Internet-based panel study quickly: lessons from studying how American are coping with the tragedy of September 11, 2001? CNS Spectr 2002; 7:597-603. [PMID: 15094696 DOI: 10.1017/s1092852900018204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article reports on the planning, development, and implementation of a large national Internet-based panel study of how Americans are coping with the terrorist attacks of September 11, 2001. The study was designed to determine predictors and correlates of risk and resilience, both cross-sectionally and longitudinally. In order to acquire timely and meaningful data, we developed/adapted an extensive set of measures, obtained human subjects approval, and posted a research Web site just 17 days after the attacks. This article describes the major hurdles we confronted and the guidelines we recommend regarding these topics, including the methodological trade-offs inherent in Internet-based research, information technology requirements and tribulations, human subjects issues, selection of measures and securing permission for their use, and the challenges of participant recruitment. We also discuss issues that we did not anticipate, including the survey intervention. We focus not on findings, but on the concrete procedural, administrative, technical, and scientific challenges we encountered and the solutions we devised under considerable time and resource pressures.
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Affiliation(s)
- Lisa D Butler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
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Leavitt F, Katz RS, Mills M, Heard AR. Cognitive and Dissociative Manifestations in Fibromyalgia. J Clin Rheumatol 2002; 8:77-84. [PMID: 17041327 DOI: 10.1097/00124743-200204000-00003] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Memory decline and mental confusion frequently complicate the clinical presentation of fibromyalgia; however, formal cognitive examination often does not support deterioration. This paradox was examined in the context of dissociation, a condition with many cognitive similarities. Dissociation refers to the separation of parts of experience from the mainstream of consciousness. A common example is highway hypnosis. Eighty-nine fibromyalgia (FM) patients and 64 other rheumatic disease patients were screened for memory decline and mental confusion using a questionnaire format. Pain, dissociation, affective distress, fatigue, sleep difficulty, and mental confusion were also assessed. Cognitive complaints (76.4%-43.8%) and dissociative symptoms (37.1%-1.9%) were overrepresented in patients with FM. Among FM patients with high dissociation, cognitive difficulties were reported by 95%; 100% of these cases reported that both memory and mental clarity were affected, a condition referred to as fibrofog. Dissociation in combination with fibrofog was associated with higher levels of FM symptom intensity and decreased mental well being. These findings suggest that dissociation may play a role in FM symptom amplification and may aid in comprehending the regularity of cognitive symptoms. Separating cases of fibrofog from cognitive conditions with actual brain damage is important. It may be prudent to add a test of dissociation as an adjunct to the evaluation of FM patients in cases of suspected fibrofog. Otherwise, test results may prove normal even in patients with disabling cognitive symptoms.
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Affiliation(s)
- Frank Leavitt
- Department of Psychology, Rush Medical College, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Lipsanen T, Lauerma H, Peltola P, Kallio S. Associations among dissociative experiences, handedness, and demographic variables in a nonclinical population. J Nerv Ment Dis 2000; 188:422-7. [PMID: 10919700 DOI: 10.1097/00005053-200007000-00005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Handedness is considered an indirect marker for bilateral language capacity in the brain. The Edinburgh Inventory for Handedness and the Dissociative Experiences Scale (DES) were administered to 297 nonclinical volunteers. Female sex, young age, and non-right handedness accounted for 24% of the total variance on the DES, including both pathological and nonpathological dissociative experiences. This is consistent with the hypothesis that cerebral lateralization indicating handedness is a predisposing factor for dissociative episodes especially in female subjects.
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Affiliation(s)
- T Lipsanen
- Department of Psychiatry, Turku University Central Hospital, Finland
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Allen JG, Console DA, Lewis L. Dissociative detachment and memory impairment: reversible amnesia or encoding failure? Compr Psychiatry 1999; 40:160-71. [PMID: 10080264 DOI: 10.1016/s0010-440x(99)90121-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The authors propose that clinicians endeavor to differentiate between reversible and irreversible memory failures in patients with dissociative symptoms who report "memory gaps" and "lost time." The classic dissociative disorders, such as dissociative amnesia and dissociative identity disorder, entail reversible memory failures associated with encoding experience in altered states. The authors propose another realm of memory failures associated with severe dissociative detachment that may preclude the level of encoding of ongoing experience needed to support durable autobiographical memories. They describe how dissociative detachment may be intertwined with neurobiological factors that impair memory, and they spell out the significance of distinguishing reversible and irreversible memory impairment for diagnosis, patient education, psychotherapy, and research.
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Affiliation(s)
- J G Allen
- Trauma Recovery Program, The Menninger Clinic, Topeka, KS 66601-0829, USA
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