Adverse events in emerging adulthood are associated with increases in neuroticism

Previous studies have produced mixed results when examining whether experiencing an adverse event can lead to changes in Neuroticism. We sought to examine this effect when (a) the event was relatively recent, (b) the event occurred during a relatively early development stage (i.e., emerging adulthood), and (c) the event was severely adverse. A sample of 1,108 undergraduates completed three measures of Neuroticism twice, separated by approximately 3 months, and indicated the most traumatic or adverse event they experienced during the intervening 3 months. We examined two operationalizations of adverse events: one that is more objectively defined (indicated experiencing a trauma listed on a trauma history measure) and another more subjectively defined (participant ratings of event centrality). The results revealed that high Neuroticism at Time 1 predicted future exposure to both types of adverse events. Critically, participants who experienced either type of adverse event during the semester reported significant increases in Neuroticism. Experiencing a high event centrality event was also associated with small increases in the personality traits Openness to Experience and Conscientiousness. The results are discussed in terms of the conditions necessary for adverse events to affect personality traits.

Physician-reported practice of managing childhood posttraumatic stress in pediatric primary care

OBJECTIVE

This study investigated pediatrician-reported practices in identifying, assessing, and treating traumatic exposure and posttraumatic stress disorder (PTSD) in children.

METHOD

Focus groups guided the development of a survey that was mailed to primary care pediatricians in Massachusetts in 2005. Descriptive statistics and multivariate analyses were used to describe clinical practices and perceived barriers to care.

RESULTS

A 60% (N=597) survey response-rate was obtained. On average, pediatricians reported that less than 8% of patients had psychological problems that may be related to traumatic exposure. Only 18% of pediatricians agreed that they had adequate knowledge of childhood PTSD. About 15% of pediatricians reported frequently learning about traumatic event(s) from direct inquiry in the past year. Only 10% of pediatricians reported frequent assessment and treatment of posttraumatic stress symptoms. Most pediatricians (72%) agreed that greater collaborations with mental health providers would improve pediatric assessment of PTSD. Finally, having received PTSD-specific training and believing that pediatricians should identify and manage PTSD were each significantly associated with learning about a traumatic event from direct inquiry.

CONCLUSION(S)

Providing PTSD-specific training and changing pediatricians' attitudes about childhood PTSD may be useful first steps in improving care for children.

Neurobiological characteristics of rhesus macaque abusive mothers and their relation to social and maternal behavior

Previous studies have reported hyperactivation of catecholaminergic systems and elevated concentrations of corticotropin-releasing-hormone (CRH) in the cerebrospinal fluid (CSF) of child maltreatment victims or combat veterans with post-traumatic stress disorder (PTSD). This study investigated the CSF concentrations of CRH and monoamine metabolites in rhesus macaque mothers that physically abused their infants and had themselves been abused as infants. Ten abusive mothers and 10 controls served as study subjects. All animals were sampled for CSF during pregnancy and the postpartum period. Focal observations of social and maternal behavior were also made. Abusive mothers had significantly higher CSF concentrations of CRH and 5-HIAA than controls. Across both subjects and controls, higher CRH, 5-HIAA and MHPG concentrations were associated with anti-social behavior patterns including a high frequency of maternal aggression, infant rejection, and a low frequency of contacts received from other individuals. These findings are consistent with those of previous primate and human studies and suggest that the neurobiological alterations associated with infant abuse may play an important role in the occurrence of maladaptive behavior in adulthood, including the perpetuation of infant abuse across generations.

The traumatized child at the emergency department

The emergency department child and adolescent psychiatrist is in the unique position of informing and helping emergency department providers address the traumatic impact of the cause of a child's emergency presentation and the potential iatrogenic exacerbation of the acute traumatic response. The child and adolescent psychiatrist must become a clinical traumatologist who provides the necessary consultation and education that lead to practice change in emergency department awareness and procedures and performs the optimal evaluation and interventions for children who present in psychiatric crisis.

Posttraumatische Belastungsstörung bei Kindern und Jugendlichen

Zusammenfassung. Theoretischer Hintergrund: Bislang liegen im Vergleich zur Forschung zur Posttraumatischen Belastungsstörung (PTB) bei Erwachsenen erst wenige Studien zur Epidemiologie und zur Behandlung der Störung bei Kindern und Jugendlichen vor. Ätiologische Modelle berücksichtigen bislang nur wenig entwicklungsbedingte Besonderheiten der Traumatisierung im frühen Lebensalter. Fragestellung: Überblick zum Stand der Forschung zu Häufigkeit, Entstehung, Aufrechterhaltung und Behandlung der PTB im Kindes- und Jugendalter. Methode: Analyse bislang vorliegender empirischer und theoretischer Arbeiten. Ergebnisse: Das Symptombild bei Kindern unterscheidet sich deutlich von dem der Erwachsenen, Unterschiede sowie diagnostische Instrumente werden beschrieben. Nach dem Erleben von Gewalt, besonders sexueller Art, erkranken Kinder und Jugendliche im Vergleich zu anderen Formen der Traumatisierung am häufigsten an einer PTB. Jungen sind insgesamt nach einer Traumatisierung weniger stark von posttraumatischer Symptomatik betroffen als Mädchen. Das Risiko, an PTB zu erkranken, steigt mit sinkendem Lebensalter bei Traumatisierung. Behandlungsprogramme beziehen diese besondere Vulnerabilität bislang nur wenig ein. Kontrollierte und randomisierte Studien zur Überprüfung ihrer Wirksamkeit fehlen. Schlussfolgerung: Kognitive Modelle, welche Besonderheiten der Wahrnehmung, Verarbeitung und Speicherung traumatischer Informationen in den Mittelpunkt stellen, liefern - durch die Berücksichtigung der Entwicklung kognitiver Fähigkeiten - Erklärungsmöglichkeiten für die negative Assoziation zwischen Lebensalter bei Traumatisierung und Vulnerabilität für PTB und Behandlungsansätze für die PTB im Kindes- und Jugendalter.

The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model

The current diathesis-stress model of schizophrenia proposes that a genetic deficit creates a predisposing vulnerability in the form of oversenstivity to stress. This model positions all psychosocial events on the stress side of the diathesis-stress equation. As an example of hypotheses that emerge when consideration is given to repositioning adverse life events as potential contributors to the diathesis, this article examines one possible explanation for the high prevalence of child abuse found in adults diagnosed schizophrenic. A traumagenic neurodevelopmental (TN) model of schizophrenia is presented, documenting the similarities between the effects of traumatic events on the developing brain and the biological abnormalities found in persons diagnosed with schizophrenia, including overreactivity of the hypothalamic-pituitary-adrenal (HPA) axis; dopamine, norepinephrine, and serotonin abnormalities; and structural changes to the brain such as hippocampal damage, cerebral atrophy, ventricular enlargement, and reversed cerebral asymmetry. The TN model offers potential explanations for other findings in schizophrenia research beyond oversensitivity to stress, including cognitive impairment, pathways to positive and negative symptoms, and the relationship between psychotic and dissociative symptomatology. It is recommended that clinicians and researchers explore the presence of early adverse life events in adults with psychotic symptoms in order to ensure comprehensive formulations and appropriate treatment plans, and to further investigate the hypotheses generated by the TN model.