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Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
DID-PTSD-EMDR Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com
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PTSD Dissociation
Neglect and PTSD
Title: Post-Traumatic Stress Disorder in Maltreated Youth: A Study of Diagnostic Comorbidity and Child Factors. Author(s): Linning, Lisa M., University of Nevada, Las Vegas, NV, US, linning@unlv.edu; Kearney, Christopher A., University of Nevada, Las Vegas, NV, US Address: Linning, Lisa M., University of Nevada, Department of Psychology, 4505 Maryland Parkway, Las Vegas, NV, US, linning@unlv.edu Source: Journal of Interpersonal Violence, Vol 19(10), Oct 2004. pp. 1087-1101. Publisher: US: Sage Publications Abstract: The study of post-traumatic stress disorder (PTSD) in maltreated youth has received increased attention, though extensive comparisons to maltreated youth without PTSD and administrations of anxiety-based structured diagnostic interviews remain needed. We examined maltreated youth with or without PTSD using structured diagnostic interviews and standardized child self-report measures. We hypothesized that maltreated youth with PTSD, compared to their peers without PTSD, would experience significantly greater duration of abuse, diagnostic comorbidity, PTSD symptomatology, dysfunctional family environment, and avoidant coping styles. Results indicated that the group with PTSD did indeed experience significantly greater duration of abuse, diagnostic comorbidity, and PTSD symptomatology, though less so dysfunctional family environment or avoidant coping styles. The presence of a mood or anxiety disorder was highly predictive of PTSD in this sample. Results are discussed within the context of evolving etiological and maintenance models of PTSD in maltreated youth. _____
Title: A validation study of the Adolescent Dissociative Experiences Scale. Author(s): Seeley, Susan M. Keck, Marion City Schools, Marion, OH, US; Perosa, Sandra L., Department of Counseling, University of Akron, Akron, OH, US; Perosa, Linda M., Department of Counseling, University of Akron, Akron, OH, US Address: Perosa, Sandra L., University of Akron, 127 Carroll Hall, Akron, OH, US Source: Child Abuse & Neglect, Vol 28(7), Jul 2004. pp. 755-769. Publisher: Netherlands: Elsevier Science Abstract: Objective: The purpose of this study was to further the validation process of the Adolescent Dissociative Experiences Scale (A-DES). In this study, a 6-item Likert response format with descriptors was used when responding to the A-DES rather than the 11-item response format used in the original A-DES. Method: The internal reliability and construct validity of the A-DES were examined by analyzing the relationships between A-DES scores, sexual abuse, and behavior. The sample consisted of 65 females ranging in age from 11 to 18 who were categorized into two groups. Thirty-four adolescents who were not in therapy and who denied a history of traumatic experiences formed the nonclinical group. Thirty-one sexually abused adolescents who were currently receiving therapy formed the clinical group. The adolescent participants completed the A-DES, their parent or guardian completed a measure of behavior (the Child Behavior Checklist--CBCL), and the therapists of the clinical adolescents completed a Trauma History Form. Results: The A-DES discriminated between the nonclinical and clinical sexually abused adolescents. However, in post hoc analyses, the A-DES did not discriminate between PTSD adolescents and those with other psychiatric diagnoses. Significant moderate correlations were found between the A-DES and the CBCL Total behavior problem scale and Internalizing and Externalizing scales. Conclusions: The A-DES items are internally consistent, and the A-DES shows promise for screening adolescents for pathological dissociation. _____
Title: Adult health status of women HMO members with posttraumatic stress disorder symptoms. Author(s): Ciechanowski, Paul S., Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, US, pavelcie@u.washington.edu; Walker, Edward A., Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, US; Russo, Joan E., Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, US; Newman, Elana, Department of Psychology, University of Tulsa, Tulsa, OK, US; Katon, Wayne J., Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, US Address: Ciechanowski, Paul S., Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA, US, pavelcie@u.washington.edu Source: General Hospital Psychiatry, Vol 26(4), Jul-Aug 2004. pp. 261-268. Publisher: Netherlands: Elsevier Science Abstract: Posttraumatic stress disorder (PTSD) is associated with high numbers of self-reported physical symptoms and functional disability in clinical samples, but little is known about the magnitude of these associations in population samples and using actual physician-coded diagnoses. We administered a 22-page survey to 1225 female HMO enrollees randomly selected from the current membership of a large, staff model HMO in Seattle, Washington. Using the PTSD Checklist (internally validated against a subset of clinical interviews) we compared women with low, moderate, and high scores with respect to differences in self-reported physical health status, functional disability (36-item short form health survey), numbers and types of self-reported health risk behaviors, common physical symptoms, and physician-coded ICD-9 diagnoses. Compared to women with low PTSD symptom severity, those with moderate or high severity reported significantly higher functional disability (P<.001), rates of abuse and neglect (P<.01 to P<.00l), health risk behavior scores (P<0.05), as well as higher mean numbers of common physical symptoms (P<.05). Compared to women with low PTSD symptom severity those with moderate or high severity had significantly higher adjusted odds ratios for aversive physical symptoms (range, 1.7-10.1). The mean number of physician-coded ICD-9 diagnoses was also significantly higher in the both the moderate and high severity groups. Among female HMO members, PTSD symptoms are associated with a wide range of both self-reported and physician-coded adverse physical health outcomes. _____
Title: Child maltreatment prevalence and mental disorders outcomes among American Indian women in primary care. Author(s): Duran, Bonnie, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, US; Malcoe, Lorraine Halinka, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, US; Sanders, Margaret, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, US; Waitzkin, Howard, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, US; Skipper, Betty, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, US; Yager, Joel, Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, NM, US Address: Malcoe, Lorraine Halinka, Department of Family and Community Medicine, University of New Mexico, MSC09 5040, Albuquerque, NM, US Source: Child Abuse & Neglect, Vol 28(2), Feb 2004. pp. 131-145. Publisher: Netherlands: Elsevier Science Abstract: Objective: To examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services. Methods: A cross-sectional study was conducted among 234 American Indian women, age 18-45 who presented for outpatient ambulatory services at a community-based Indian Health Service Hospital in Albuquerque, New Mexico. Dependent measures included mood, substance abuse, and anxiety disorders as well as posttraumatic stress disorder (PTSD) as measured by the Composite International Diagnostic Interview. CAN was assessed using the Childhood Trauma Questionnaire. Results: Approximately three-quarters of respondents (76.5%; 95% CI = 70.4, 81.7) reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a dose response manner with lifetime diagnosis of mental disorders. After adjusting for social and demographic correlates, severe child maltreatment was strongly associated with lifetime PTSD (prevalence ratio [PR] = 3.9; 95% CI = 1.9, 8.0); and was moderately associated with lifetime substance use disorders (PR = 2.3; 95% CI = 1.6, 3.3); mood disorders (PR = 2.1; 95% CI = 1.4, 3.2); and with two or more disorders (PR = 2.3: 95%CI= 1.6,3.4). _____
Title: Cross-cultural comparisons of child-reported emotional and physical abuse: Rates, risk factors and psychosocial symptoms. Author(s): Sebre, Sandra, Department of Psychology, University of Latvia, Riga, Latvia; Sprugevica, Ieva, Department of Psychology, University of Latvia, Riga, Latvia; Novotni, Antoni, Medical Faculty, St. Cyril and Methodius University, Skopje, Macedonia; Bonevski, Dimitar, Medical Faculty, St. Cyril and Methodius University, Skopje, Macedonia; Pakalniskiene, Vilmante, Department of Clinical Psychology, Vilnius University, Vilnius, Lithuania; Popescu, Daniela, National Center for Child Abuse Prevention, Chisinau, Moldova; Turchina, Tatiana, National Center for Child Abuse Prevention, Chisinau, Moldova; Friedrich, William, Mayo Clinic, Rochester, MN, US; Lewis, Owen, Columbia University College of Physicians and Surgeons, New York, NY, US Address: Sebre, Sandra, Department of Psychology, University of Latvia, Jurmalas gatve 74/76, Riga, Latvia, LV-1083 Source: Child Abuse & Neglect, Vol 28(1), Jan 2004. pp. 113-127. Publisher: Netherlands: Elsevier Science Abstract: This study was designed to assess the incidence of child emotional and physical abuse, associated risk factors and psychosocial symptoms in a cross-cultural comparison between post-communist bloc countries. One-thousand one-hundred forty-five children ages 10-14 from Latvia, Lithuania, Macedonia, and Moldova participated in the study. They completed questionnaires assessing their experience of emotional or physical abuse, and provided information about family risk-factors and psychosocial symptoms, including PTSD-related symptoms. Incidence rates of maltreatment differed by country, as did levels of reported psychosocial symptoms. Incidence of emotional and physical abuse differed by region, with higher levels of abuse reported in the rural regions. In all four countries, a similar association between emotional/physical abuse and psychosocial symptoms was found, with the uniformly largest correlation between emotional abuse and anger. In all four countries, parental overuse of alcohol was associated with emotional and/or physical abuse. Findings show differences by country in child-reported levels of emotional and physical abuse, but similar patterns of correlation with psychosocial symptoms and the risk factors of parental alcohol overuse and living in a rural area. _____
Title: Treating child abuse-related posttraumatic stress and comorbid substance abuse in adolescents. Author(s): Cohen, Judith A., Department of Psychiatry, Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, PA, US; Mannarino, Anthony P., Department of Psychiatry, Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, PA, US; Zhitova, Aren C., University of California, Berkeley, CA, US; Capone, Margery E., Private Consultant, Pittsburgh, PA, US Address: Cohen, Judith A., Department of Psychiatry, Drexel University College of Medicine, Allegheny General Hospital, Four Allegheny Center, 8th Floor, Pittsburgh, PA, US Source: Child Abuse & Neglect, Vol 27(12), Dec 2003. pp. 1345-1365. Publisher: Netherlands: Elsevier Science Abstract: Objective: Child abuse is a risk factor for developing Posttraumatic Stress Disorder (PTSD) and subsequent Substance Use Disorder (SUD). The purpose of this review is to summarize current knowledge about effective treatments for adolescent abuse-related PTSD, SUD, and the co-occurrence of these conditions. Method: The literature on empirical treatment studies for these conditions in adolescence was reviewed, summarized, and synthesized. Results: Randomized controlled studies of abuse-related PTSD and SUD in adolescents have supported the efficacy of cognitive behaviorally-based individual and family treatment components. Components overlap considerably in empirically supported treatments for each disorder. An integrated treatment approach is described for use in adolescents with abuse-related PTSD and SUD, with recommendations for optimizing services for this population and for future research. Conclusions: The available evidence on effective treatments suggests that integrated PTSD- and SUD-focused cognitive-behavioral and family treatment for adolescents with comorbid abuse-related PTSD and SUD may optimize outcomes for this population. _____
Title: Trauma, dissociation, and posttraumatic stress disorder in female borderline patients with and without substance abuse problems. Author(s): Van Den Bosch, Louisa M. C., Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands, wiesvdbosch@wxs.nl; Verheul, Roel, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Langeland, Willie, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands; Van Den Brink, Wim, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands Address: Van Den Bosch, Louisa M. C., Academic Medical Centre, University of Amsterdam, Tafelbergweg 25, 1105 BC, Amsterdam, US, wiesvdbosch@wxs.nl Source: Australian & New Zealand Journal of Psychiatry, Vol 37(5), Oct 2003. pp. 549-555. Publisher: United Kingdom: Blackwell Publishing Abstract: Objective: To examine the associations of childhood traumatic experiences and childhood neglect with dissociative experiences and posttraumatic stress disorder (PTSD) in a population of female borderline personality disorder (BPD) patients with and without substance abuse. Method: The sample included 64 female patients with BPD. Childhood traumatic experiences and childhood neglect were measured using the Structured Trauma Interview, dissociative experiences with the Dissociative Experiences Scale, and PTSD with the Structured Clinical Interview for DSM-IV. Results: In general, dissociation scores were higher among those with a history of childhood trauma and neglect, in particular among those who reported both sexual and physical abuse before age 16, more than one perpetrator and severe maternal dysfunction. The prevalence of PTSD was clearly associated with the severity of childhood sexual abuse (CSA) in terms of the occurrence of penetration during CSA, intrafamilial CSA, a duration of CSA longer than 1 year and more than one perpetrator. Comorbid substance abuse problems modified the observed associations such that the associations mentioned above were also present or even more pronounced among those without substance abuse, whereas no associations were found in those... _____
Title: Comorbidity and psychiatric diagnoses among women reporting child sexual abuse. Author(s): Owens, Gina P., Department of Educational & Counseling Psychology, University of Kentucky, Lexington, KY, US; Chard, Kathleen M., Department of Educational & Counseling Psychology, University of Kentucky, Lexington, KY, US Address: Chard, Kathleen M., University of Kentucky, 235 Dickey Hall, Lexington, KY, US Source: Child Abuse & Neglect, Vol 27(9), Sep 2003. pp. 1075-1082. Publisher: Netherlands: Elsevier Science Abstract: Prevalence rates of child sexual abuse (CSA) in the United States emphasize the importance of focusing on common symptom responses and diagnostic considerations for these individuals. The purpose of this study was to determine the frequency of certain psychiatric disorders co-occurring with posttraumatic stress disorder (PTSD). Research has suggested that mood disorders are related to a CSA history. Eighty-nine female adults reporting a history of CSA were recruited through fliers posted throughout the community and brochure mailings to service providers in a moderately sized midwestern city. The mean age of the sample was 33.06 years, with a range of 18 to 56. Eighty-two percent of the sample was Caucasian, 14% African-American, 3% Hispanic, and 1% other ethnic groups. The mean age of onset of abuse was 6.4 years, ranging from 1 to 12 years. Measures assessed the presence of depression, dysthymia, substance abuse or dependence, panic disorder, and eating disorders. Treatment focused on alleviating symptoms commonly found among CSA survivors, including PTSD, depression, and disruptive cognitions. Of this treatment-seeking sample of abuse survivors, 89% met criteria for current PTSD and were included in further regression analyses. Ten participants did not meet criteria for PTSD. _____
Title: Alleged sexual abuse at a day care center: Impact on parents. Author(s): Dyb, Grete, Department of Psychiatry and Behavioural Medicine, Faculty of Medicine, Norwegian University of Science and Technology, MTFS, Trondheim, Norway; Holen, Are, Department of Psychiatry and Behavioural Medicine, Faculty of Medicine, Norwegian University of Science and Technology, MTFS, Trondheim, Norway; Steinberg, Alan M., National Center for Child Traumatic Stress, University of California, Los Angeles, CA, US; Rodriguez, Ned, Trauma Research Consultant, Santa Monica, CA, US; Pynoos, Robert S., National Center for Child Traumatic Stress, University of California, Los Angeles, CA, US Address: Dyb, Grete, Department of Psychiatry and Behavioural Medicine, Faculty of Medicine, Norwegian University of Science and Technology, MTFS, NO-7489, Trondheim, Norway Source: Child Abuse & Neglect, Vol 27(8), Aug 2003. pp. 939-950. Publisher: Netherlands: Elsevier Science Abstract: This report describes the cascade of stressful events and secondary life changes experienced by parents in a case of alleged sexual abuse at a day care program. The study evaluated parents' Posttraumatic Stress Disorder (PTSD) symptoms and general psychological responses to the stressful events 4 years after the alleged abuse, and explored predictive factors of parental distress. A total of 39 parents were interviewed about stressful events, life changes, and social support. Current distress reactions, psychological wellbeing, and locus of control were assessed with a battery of standardized measures. Hearing about the sexual abuse, testifying in court, hearing the verdict, and being exposed in media reports were all rated by the parents as distressing events. The majority of the parents experienced secondary life changes after the alleged sexual abuse. Four years after the alleged sexual abuse, one-third of the parents reported a high level of PTSD Intrusive symptoms and one-fourth reported a high level of PTSD Avoidance symptoms. This study demonstrates that the alleged sexual abuse of children in day care and the resulting events in the legal system and the media constitute significant and chronic stressors in the lives of the children's parents. _____
Title: Posttraumatic stress disorder in adopted children from Romania. Author(s): Hoksbergen, R. A. C., Utrecht U, Faculty of Social Sciences, Utrecht, Netherlands, R.Hoksbergen@fss.uu.nl; ter Laak, J., Utrecht U, Faculty of Social Sciences, Utrecht, Netherlands; van Dijkum, C., Utrecht U, Faculty of Social Sciences, Utrecht, Netherlands; Rijk, S., Utrecht U, Faculty of Social Sciences, Utrecht, Netherlands; Rijk, K., Utrecht U, Faculty of Social Sciences, Utrecht, Netherlands; Stoutjesdijk, F., Utrecht U, Faculty of Social Sciences, Utrecht, Netherlands Address: Hoksbergen, R. A. C., Dept of Adoption/Non-Genetic Parenthood, Utrecht U, Heidelberglann 2, 3584 CS, Utrecht, Netherlands, R.Hoksbergen@fss.uu.nl Source: American Journal of Orthopsychiatry, Vol 73(3), Jul 2003. pp. 255-265. Publisher: US: Educational Publishing Foundation Abstract: This follow-up study of 80 Romanian children showed that 16 (20%) of the children exhibited posttraumatic stress disorder (PTSD). The same children got scores in the clinical range on the Child Behavior Checklist (CBCL). These PTSD children could be differentiated from the remaining children by psychosocial but not by physical health variables. Children showing characteristics of PTSD stood out from the other subjects because of their scores on the Externalization dimension and excessive attention-seeking on the CBCL. The findings indicated that these Romanian adoptees exhibited survivor behavior. A substantial number of these adopted children require aftercare by adoption specialists from the time they arrive in Dutch families. It seems plausible that the high incidence of PTSD characteristics was related to extreme physical and social neglect occurring in the orphanages. _____
Title: An investigation of trauma-centered inpatient treatment for adult survivors of abuse. Author(s): Wright, David C., Homewood Health Ctr, Guelph, ON, Canada; Woo, Wendi L., Homewood Health Ctr, Guelph, ON, Canada; Muller, Robert T., York U, La Marsh Ctr for Research on Violence & Conflict Resolution, Dept of Psychology, Toronto, ON, Canada; Fernandes, Cheryl B., York U, La Marsh Ctr for Research on Violence & Conflict Resolution, Dept of Psychology, Toronto, ON, Canada; Kraftcheck, Erin R., York U, La Marsh Ctr for Research on Violence & Conflict Resolution, Dept of Psychology, Toronto, ON, Canada Address: Wright, David C., Homewood Health Ctr, 150 Delhi St., Guelph, ON, Canada, N1E 6K9 Source: Child Abuse & Neglect, Vol 27(4), Apr 2003. pp. 393-406. Publisher: Netherlands: Elsevier Science Abstract: Objective: The purpose of this study was to examine a comprehensive inpatient treatment program in a group therapy modality designed for adult survivors of childhood abuse with posttraumatic stress disorder (PTSD). Method: One hundred and thirty-two formerly abused individuals completed clinician-administered and self-administered measures of PTSD symptomatology at admission and discharge. All participants experienced a range of physical, sexual, and/or emotional abuse as children prior to the age of 17. Approximately one-third of these individuals also completed measures at 3-months postdischarge and 1-year postdischarge. Data were collected using a clinician-administered PTSD measure and self-administered PTSD measure at admission and discharge. On admission, all participants met criteria for a diagnosis of PTSD. Results: Analyses revealed that the program was effective in reducing symptoms from admission to discharge. Additionally, treatment gains were maintained at 1-year postdischarge. Conclusion: The findings of this investigation suggest that the current intensive inpatient group treatment program appears to reduce PTSD symptoms effectively for a sample of adult survivors of abuse. _____
Title: The effects of childhood trauma on drug and alcohol abuse in college students. Author(s): Jelley, Harvey Henry, Fordham U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 63(8-B), Mar 2003. pp. 3919. Publisher: US: Univ Microfilms International Abstract: This study proposed to investigate whether childhood trauma predicted college drinking and drug use. The issue of whether specific types of maltreatment (e.g., sexual abuse and physical abuse) were related to college alcohol and substance abuse was also examined. Pathways to drug and alcohol abuse were examined using three theoretical models: the Self-Medication Model, the Diatheses-Stress Model, and the Peer Influence Model. The study's participants were 143 undergraduates comprised of 94 females and 49 males. They were administered self-report questionnaires that measured the effects of childhood trauma on drug and alcohol abuse as mediated by depression, PTSD, social skills and as moderated by stress level. The study found that emotional abuse was associated with drug abuse and that physical neglect was associated with alcohol abuse. Childhood trauma was highly associated with depression and PTSD. Emotional abuse was found to be mediated by depression and PTSD in predicting drug abuse scores. Some of the study's other findings were that emotional abuse, physical abuse, and emotional neglect were significantly associated with self-esteem, emotional abuse was significantly associated with social sensitivity and emotional neglect was significantly associated with social control. Emotional abuse was mediated by self-esteem in predicting drug abuse scores. Gender by childhood trauma interactions on the effects of drug and alcohol use were examined; there were significant effects of emotional abuse by gender, physical abuse by gender, sexual abuse by gender and physical neglect by gender. It had been hypothesized that the results of this study would confirm that childhood trauma would be associated with greater drinking and drug use in college students, this was only partially supported. However other symptomatologies such as PTSD, self-esteem and social skills may play a more important role in the development of drug and alcohol problems and thus be better indicators of individuals at risk. _____
Title: Characteristics of child maltreatment, psychological dissociation, and somatoform dissociation of Canadian inmates. Author(s): Dietrich, Anne, amdma@telus.net Address: Dietrich, Anne, 540-750 Cambie Street, Vancouver, BC, Canada, V6B 2P2, amdma@telus.net Source: Journal of Trauma & Dissociation, Vol 4(1), 2003. pp. 81-100. Publisher: US: Haworth Press Abstract: Data are presented on childhood maltreatment characteristics, psychological dissociation, somatoform dissociation, and offense types with a sample of 93 Canadian inmates (mean age 34 yrs). The present study includes findings based on the Child Maltreatment Interview Schedule-Short Form (CMIS-SF), Detailed Assessment of Posttraumatic States (DAPS), Multidimensional Dissociation Inventory (MDI), Somatoform Dissociation Questionnaire (SDQ-20), and indices of violent and sexual offending during adulthood. Results show that women reported more childhood sexual abuse (CSA) than men, and men committed more violent and sexual offenses than women. Inmates reported more trauma-related dissociation (DAPS) and more MDI dissociation compared to normative data for these instruments; however, inmates had lower somatoform dissociation scores when compared to published means of dissociative disorder, somatoform disorder, and eating-disorder patients. Inmates with CSA histories had higher SDQ-20 scores than those who did not. No differences were found between sex offenders and non-sex offenders in terms of probable PTSD, probable DID, MDI scales, or the SDQ-20. Results are discussed in terms of treatment implications for incarcerated individuals with histories of child maltreatment. Conference: Annual Meeting of the International Society for the Study of Dissociation, Dec, 2001, New Orleans, LA, US Conference Notes: Data from this paper were presented in part at the aforementioned meeting. _____
Title: Preliminary evidence of efficacy for EMDR resource development and installation in the stabilization phase of treatment of complex posttraumatic stress disorder. Author(s): Korn, Deborah L., Private Practice, Needham, MA, US, DLKorn@erols.com; Leeds, Andrew M., Private Practice, Santa Rosa, CA, US Address: Korn, Deborah L., Private Practice, 400 Hunnewell Street, Suite 3, Needham, MA, US, DLKorn@erols.com Source: Journal of Clinical Psychology, Vol 58(12), Dec 2002. pp. 1465-1487. Publisher: US: John Wiley & Sons Abstract: Reviews the complexity of adaptation and symptomatology in 2 female adult survivors (aged 39 and 31 yrs) of childhood neglect and abuse who meet criteria for the proposed diagnosis of Complex Posttraumatic Stress Disorder (Complex PTSD), also known as Disorders of Extreme Stress, Not Otherwise Specified (DESNOS). A specific EMDR protocol, Resource Development and Installation (RDI), is proposed as an effective intervention in the initial stabilization phase of treatment with Complex PTSD/DESNOS. Descriptive psychometric and behavioral outcome measures from 2 single case studies are presented which appear to support the use of RDI. Suggestions are offered for future treatment outcome research with this challenging population. _____
Title: Utility of the Trauma Symptom Checklist for Children: Distinguishing between PTSD and non-PTSD youth in residential treatment. Author(s): Finnerty, Bridget Mary, Chicago School Of Professional Psychology, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 63(4-B), Oct 2002. pp. 2054. Publisher: US: Univ Microfilms International Abstract: The goal of the present study is to examine the effects of trauma on youth and the effectiveness of a particular trauma measure in distinguishing between youth who meet the DSM-IV diagnostic criteria for Posttraumatic Stress Disorder (PTSD) and youth who do not meet the same criteria for PTSD. Various assessment measures have been created to assess the presence of PTSD in youth. These measures are typically in interview format, used with single incident trauma, include only partial symptoms of PTSD and are designed for adolescent and adult populations. This study used the Trauma Symptom Checklist for Children (TSCC), an objective self-report measure of trauma which includes all diagnostic criteria of PTSD (as described in DSM-IV) and is used with youth between the ages of 8 and 17. To assess the sensitivity of this trauma measure with individuals who have experienced domestic trauma of abuse and neglect, I chose as the target population youth in the custody of the state of Illinois and who resided in a residential treatment center. The first group consisted of youth who met the diagnostic criteria for PTSD and the second group consisted of youth who did not meet the criteria for PTSD. Results showed a significant difference between the two groups in mean scores on the Trauma Symptom Checklist for Children. The youth who met the DSM-IV criteria for PTSD had significantly higher scores on the TSCC than did the youth who did not meet the diagnostic criteria for PTSD. Potential factors leading to these findings, as well as future implications of this work, are discussed. _____
Title: Trauma, trauma-related distress, and perceived parental dysfunction: Associations with severity of drinking problems in treated alcoholics. Author(s): Langeland, Willie, Amsterdam Inst for Addiction Research, Amsterdam, Netherlands; Van Den Brink, Wim, Amsterdam Inst for Addiction Research, Amsterdam, Netherlands; Draijer, Nel, Vrije U, Dept of Psychiatry, Amsterdam, Netherlands Address: Van Den Brink, Wim, U Amsterdam, Academic Medical Ctr, Div of Psychiatry, Tafelbergweg 25, 1105 BC, Amsterdam, Netherlands Source: Journal of Nervous & Mental Disease, Vol 190(5), May 2002. pp. 337-340. Publisher: US: Lippincott Williams & Wilkins Abstract: Examined the relationship between childhood abuse and alcohol problem severity in 155 treated alcoholics in an alcohol treatment program. The author examined a broad spectrum of environmental hazards (childhood abuse, perceived parental dysfunction, parental alcohol problems, early parental loss, witnessing domestic violence, and adult victimization), childhood abuse severity, and lifetime diagnosis of posttraumatic stress disorder (PTSD). Findings suggest that the severity of drinking problems in treated male alcoholics was related to neither trauma nor childhood neglect. Among women, however, both childhood dual abuse and perceived maternal dysfunction might be associated with the severity of drinking problems. _____
Title: Evaluating the effectiveness of a group treatment program: Integrating neurobiology, post-traumatic stress disorder, and childhood trauma literature. Author(s): Fujimoto, Kevin Lee, Pepperdine U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 62(8-B), Mar 2002. pp. 3799. Publisher: US: Univ Microfilms International Abstract: Research has demonstrated that childhood abuse may negatively alter cognition, affect, and behavior throughout the lifespan (Briere, 1992; van der Kolk, 1988). PTSD related to childhood abuse has been increasingly associated with impaired memory functioning and neurobiological alterations (Briggs & Joyce, 1997; van der Kolk & Fisler, 1995). A review of the trauma and child abuse literature incorporates recent research from various theoretical perspectives. In addition, the effectiveness of a treatment program is evaluated based on the literature review. Specifically, an inpatient program that utilized cathartic interventions within a supportive psycho-educational group context was examined. Catharsis was considered a critical treatment component because it is hypothesized to provide access to the implicit memory system (subcortical neural-networks) and allow traumatic experiences to reemerge (Levitt & Pinnell, 1995). Additional higher-order processing and subsequent development of explicit memory may increase impulse control, diminish PTSD symptoms, and decrease depression (Squire, 1992; Zola-Morgan & Squire, 1990). The group modality was utilized to address common issues faced by abuse victims and provide interpersonal support and validation during the expression of powerful affect. Archival data collected from treatment seeking individuals suffering from the effects of negative childhood experiences including abuse and neglect was analyzed. An experimental group (N = 68) that completed the treatment program was compared to a non-treatment group (N = 15) to determine treatment effectiveness. Specified symptoms, PTSD symptomatology (Los Angeles Symptom Checklist), anxiety (Minnesota Multiphasic Personality Inventory (MMPI) Scale 7 and A Scale), and depression (MMPI Scale 2 and the Beck Depression Inventory) were assessed. It was hypothesized that treatment subjects would report decreased levels of symptoms when contrasted with the comparison group following treatment. A MANOVA revealed no significant differences between groups for PTSD symptoms, anxiety, or depression. A clinical significance analysis also revealed that experimental subjects and no-treatment comparison subjects improved over time on all variables at the nine-month follow-up period. Possible reasons for the lack of statistical findings are given and suggestions for future research are presented. _____
Title: Differential symptom pattern of post-traumatic stress disorder (PTSD) in maltreated children with and without concurrent depression. Author(s): Runyon, Melissa K., U Medicine & Dentistry of New Jersey-School of Osteopathic Medicine, Ctr for Children's Support, Stratford, NJ, US; Faust, Jan, Nova Southeastern U, School of Psychological Studies, Ft Lauderdale, FL, US; Orvaschel, Helen, Nova Southeastern U, School of Psychological Studies, Ft Lauderdale, FL, US Address: Runyon, Melissa K., U Medicine & Dentistry of New Jersey-School of Osteopathic Medicine, Ctr for Children's Support, 42 E Laurel Rd, Suite 1100, Stratford, NJ, US Source: Child Abuse & Neglect, Vol 26(1), Jan 2002. pp. 39-53. Publisher: Netherlands: Elsevier Science Abstract: Examined specific differences in the Post-Traumatic Stress Disorder (PTSD) symptomatology among abused children with and without concurrent depression. PTSD and depressive symptoms were identified that discriminate between 98 children (aged 5-17 yrs) divided into three groups: (1) abused children with PTSD, (2) nonabused children who meet criteria for Major Depressive Disorder (MDD), and (3) abused children with both PTSD and MDD. Analyses revealed that 9 items reflecting depressive symptomatology differentiated the diagnostic groups. A discriminant analysis revealed that the sum of responses to the 9 significant items adequately predicted diagnostic classification for those with PTSD and depression, but did not correctly diagnose any in the combined group. Analyses also revealed that 3 post-trauma symptoms, including psychological amnesia, flashbacks/reenactments, and sleep difficulties, discriminated between the groups. The PTSD-only group reported more episodes of psychological amnesia while the PTSD and MDD group experienced more flashbacks. For the sample of abused children examined, these results illuminate differences with respect to PTSD symptom presentation for those children with PTSD who have a concurrent depressive disorder and their nondepressed counterparts. _____
Title: Posttraumatic somatoform dissociation in French psychiatric outpatients. Author(s): El-Hage, Wissam, Hôpital U, Clinique Psychiatrique, Tours, France, wissam.el-hage@libertysurf.fr; Darves-Bornoz, Jean-Michel, Hôpital U, Clinique Psychiatrique, Tours, France; Allilaire, Jean-François, Hôpital de la Salpêtrière, Paris, France; Gaillard, Philippe, Hôpital U, Clinique Psychiatrique, Tours, France Address: El-Hage, Wissam, Hopital U, Clinique Psychiatrique, 37044, Tours, France, wissam.el-hage@libertysurf.fr Source: Journal of Trauma & Dissociation, Vol 3(3), 2002. pp. 59-74. Publisher: US: Haworth Press Abstract: Examined the relationship between trauma and somatoform dissociation. 140 psychiatric outpatients (aged 17-76 yrs) residing in France completed: (1) the French version of the Somatoform Dissociation Questionnaire (E. R. S. Nijenhuis et al, 1996, SDQ-20); (2) the Dissociative Experiences Scale (E. B. Carlson et al, 1993, DES); and (3) the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for DSM-IV (D. D. Blake et al, 1995). Results show a strong association between the mean score of the French version of the SDQ-20 and current PTSD or past PTSD. Principal components analysis of the French version of the SDQ-20 shows the 3 factors of sensory neglect, subjective reactions to perceptive distortions, and vigilance modulation disturbance. Scores of the DES and the SDQ-20 were highly correlated. It is concluded that there is a strong association between trauma and dissociative symptoms as a whole, including somatoform dissociation. The SDQ-20 appears to be a potentially useful screening instrument for dissociative disorders. The French version of the Somatoform Dissociation Questionnaire is appended. _____
Title: Intergenerational transmission of abuse: A two-generational prospective study of an at-risk sample. Author(s): Pears, Katherine C., Oregon Social Learning Ctr, Eugene, OR, US Capaldi, Deborah M., Oregon Social Learning Ctr, Eugene, OR, US Address: Pears, Katherine C., Oregon Social Learning Ctr, 160 E. 4th Avenue, Eugene, OR, US Source: Child Abuse & Neglect, Vol 25(11), Nov 2001. pp. 1439-1461. Publisher: Netherlands: Elsevier Science Abstract: Examined a model in which the association between a parent's history of abuse and the parent's own abusive behavior toward his or her children was hypothesized to be mediated by parental psychopathology, early childbearing, and consistency of discipline, and the effect of severity of abuse on the likelihood of becoming abusive. Subjects were 109 parents (G1) and their male children (G2). The G1 parents reported on their own experiences of abuse when they were children. 10 yrs later, the G2 youths reported on the G1 parents' abusive behavior toward them. Other factors, including parental SES, antisocial behavior, depression, posttraumatic stress disorder (PTSD), consistency of discipline, and the perceived early difficulty of the G2 children were measured. As reported by their own children, parents who reported having been abused in childhood were significantly more likely to engage in abusive behaviors toward the next generation. Abuse experienced by the parents, as well as consistency of discipline and depression plus PTSD, were predictive of parental abuse of the child. Contrary to hypotheses, the effects were not fully mediated. However, there were interactions between parental history of abuse and consistency of discipline, as well as abuse history and depression and PTSD. _____
Title: The relationship between early childhood sexual abuse and the adult diagnoses of borderline personality disorder and complex posttraumatic stress disorder: Diagnostic implications. Author(s): Mclean, Linda Margaret, The Fielding Inst., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 62(4-B), Oct 2001. pp. 2069. Publisher: US: Univ Microfilms International Abstract: Over the past decade, there has been a dramatic increase in interest in the etiologic primacy of childhood sexual abuse to adult psychopathology and diagnoses. A body of empirical literature points to the association of severe childhood trauma with both Borderline Personality Disorder (BPD) and Complex PTSD (CP). The goal of this study was to determine if borderline psychopathology can be seen primarily as resulting from early onset (i.e., le;12 years of age) sexual abuse vs. late onset (i.e., ge;13 years of age) sexual abuse in a subset of women who met diagnostic criteria for both BPD and CP. The consideration of the diagnosis of CP for a subset of borderline patients informs treatment. Sixty-five women (ge;18 years) comprised a convenience sample from three mental health outpatient clinics in a large metropolitan city: Thirty-eight were selected because they presented with a history of early onset sexual abuse, while 27 were selected because they presented with a history of late onset. Each participant was administered the Revised Diagnostic Interview for Borderlines, the Traumatic Antecedent Questionnaire, the Modified PTSD Symptom Scale, and the Structured Interview for Disorders of Extreme Stress. Furthermore, five qualitative questions generated additional information regarding sexual revictimization, attachment, dissociation, and the impact of trauma. Trauma variables including chronic duration of abuse, incest, bi-parental neglect, and sexual revictimization were significantly higher in women reporting early onset of sexual abuse than women reporting late onset of sexual abuse. Moreover, the diagnoses of BPD, lifetime and current CP, and both BPD and CP were significantly higher in women reporting early onset of sexual abuse as opposed to late onset abuse. The predictor variables sexual abuse and intrafamilial (paternal incest) were found to be significant in the prediction of BPD and both BPD and CP. Discriminant analysis showed the strongest relationship with sexual abuse in the prediction of current and lifetime CP. Two other predictor variables were found to be similarly strong, namely, bi-parental neglect and emotional abuse. The results suggest that a subset of women with a history of childhood sexual abuse who meet diagnostic criteria for BPD may be subsumed under the diagnostic category of CP. _____
Title: Multivariate prediction of posttraumatic symptoms in psychiatric inpatients. Author(s): Carlson, Eve B., Palo Alto Health Care System, Dept of Veterans Affairs, National Ctr for PTSD, Menlo Park, CA, US, eve.carlson@med.va.gov; Dalenberg, Constance; Armstrong, Judith; Daniels, Jill Walker; Loewenstein, Richard; Roth, David Address: Carlson, Eve B., National Ctr for PTSD 352-117 MP, 795 Willow Road, Menlo Park, CA, US, eve.carlson@med.va.gov Source: Journal of Traumatic Stress, Vol 14(3), Jul 2001. pp. 549-567. Publisher: Netherlands: Kluwer Academic Publishers Abstract: Based on a conceptual framework for the long-term effects of childhood abuse, this study examined the capacity of childhood family environment (caretaker dysfunction, neglect, perceived social support), violent abuse (physical and sexual), and individual variables (other abuse) to predict adult psychiatric symptoms of posttraumatic stress disorder (PTSD), dissociation, and depression. Complete interview data were obtained from 178 psychiatric inpatients (mean age 38 yrs) who varied greatly on abuse status and severity. Results of multiple regressions of predictor variables onto the three outcome variables showed that the predictor variables accounted for 15% (for depression) to 42% (for PTSD) of the variance in these symptoms and that violent abuse uniquely accounted for a significant proportion of the variance in outcomes for all three of the symptom groups studied. _____
Title: Childhood trauma and risk for PTSD: Relationship to intergenerational effects of trauma, parental PTSD, and cortisol excretion. Author(s): Yehuda, Rachel, Bronx Veterans Affairs, Bronx, NY, US, Rachel.yehuda@med.va.gov; Halligan, Sarah L.; Grossman, Robert Source: Development & Psychopathology, Vol 13(3), Sum 2001. Special issue: Stress and development: Biological and psychological consequences. pp. 733-753. Publisher: US: Cambridge Univ Press Abstract: Among the adverse mental health consequences of childhood trauma is the risk related to the development of posttraumatic stress disorder (PTSD) in adulthood. Other risk factors for PTSD, including parental trauma exposure and parental PTSD, can also contribute to the experience of child trauma. The authors examined associations between childhood trauma and PTSD in 51 adult children of Holocaust survivors and 41 comparison Ss, in consideration of parental trauma exposure and parental PTSD. They also examined these variables in relation to 24-hr urinary cortisol levels. Adult offspring of Holocaust survivors showed significantly higher levels of self-reported childhood trauma, particularly emotional abuse and neglect, relative to comparison Ss. The difference was largely attributable to parental PTSD. Self-reported childhood trauma was also related to severity of PTSD in Ss, and emotional abuse was significantly associated with 24-hr mean urinary cortisol secretion. It is concluded that the experience of childhood trauma may be an important factor in the transmission of PTSD from parent to child. _____
Title: Clinical features of survivors of sexual abuse with major depression. Author(s): Zlotnick, Caron, Butler Hosp, Providence, RI, US; Mattia, Jill; Zimmerman, Mark Source: Child Abuse & Neglect, Vol 25(3), Mar 2001. pp. 357-367. Publisher: Netherlands: Elsevier Science Abstract: Examined differences in rates of trauma-related disorders between patients with histories of childhood sexual abuse (CSA) and those without such histories in a sample of depressed outpatients. Another aim of this study was to determine whether CSA is associated with recent suicidal attempts, affect dysregulation and duration of index depressive episode, independent of posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). Ss were 235 treatment-seeking outpatients with major depression. Structured interviews were administered to assess for Axis I and Axis II disorders, CSA, and various clinical features. Patients with sexual abuse compared to those without sexual abuse histories had higher rates of comorbidity, primarily BPD, PTSD and multiple Axis I diagnoses. CSA status was linked to a longer duration of the index depressive episode, independent of BPD and/or PTSD. However, CSA status was not independently related to affect dysregulation and suicidal attempts. The findings suggest that patients with histories of sexual abuse represent a subgroup of depressed patients who are at especially high risk for psychiatric morbidity and a prolonged episode of depression. _____
Title: The toy theater. Author(s): Palumbo, A. J. Source: 101 more favorite play therapy techniques. Kaduson, Heidi Gerard (Ed); Schaefer, Charles E. (Ed); pp. 252-254. Northvale, NJ, US: Jason Aronson, Inc, 2001. xix, 457 pp. Abstract: (from the chapter) Puppetry is widely used by professionals who treat children. Puppetry uses "toy theaters," simple tri-part, wooden screens with crudely painted and decorated panel that can be set up on a table. Therapists, court psychologists, teachers, and nurses who work with children under stress are integrating puppet play and craft into their treatment process. Puppetry can be adapted to suit the constraints of therapy, such as limited resources and the restricted parameters. This technique can be used with children who are diagnosed with attention deficit hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), stressed by poverty, homelessness, depression, abuse and neglect, who are unable to adjust to schooling or foster care, histories of familial dysfunction and those who are isolated or aggressive. _____
Title: Treatment practices for childhood posttraumatic stress disorder. Author(s): Cohena, Judith A., MCP Hahnemann U School of Medicine, Allegheny General Hosp, Dept of Psychiatry, Pittsburgh, PA, US; Mannarino, Anthony P.; Rogal, Shari Source: Child Abuse & Neglect, Vol 25(1), Jan 2001. pp. 123-135. Publisher: Netherlands: Elsevier Science Abstract: Surveyed practices in treating childhood posttraumatic stress disorder (PTSD) among child psychiatrists and non-M.D. therapists with self-identified interest in treating traumatized children. 247 responses were received: of 77 medical and 82 nonmedical respondents who currently treat children with PTSD, a wide variety of modalities are used. Most preferred modalities among medical responders were pharmacotherapy, psychodynamic, and cognitive-behavioral therapy. Most preferred modalities among nonmedical respondents were cognitive-behavioral, family, and nondirective play therapy. 95% of medical respondents used pharmacotherapy for this disorder; most preferred medications to treat childhood PTSD were selective serotonin reuptake inhibitors and alpha-adrenergic agonists. Several significant differences between medical and nonmedical practices were identified. _____
Title: Factors predicting PTSD, depression, and dissociative severity in female treatment-seeking childhood sexual abuse survivors. Author(s): Johnson, Dawn M., U Kentucky, Dept of Educational & Counseling Psychology, Lexington, KY, US; Pike, Julie L.; Chard, Kathleen M. Source: Child Abuse & Neglect, Vol 25(1), Jan 2001. pp. 179-198. Publisher: Netherlands: Elsevier Science Abstract: Two main questions were asked: (1) what abuse characteristics relate to posttraumatic stress disorder (PTSD), depressive, and dissociative severity in adult survivors of child sexual abuse (CSA); and (2) what abuse characteristics influence the severity of dissociation during CSA. 89 female CSA survivors' (aged 18-56 yrs) current symptoms of PTSD, depression, and dissociation were assessed with standardized measures. Additionally, abuse characteristics (e.g., age of onset, peritraumatic dissociation) were assessed with a structured interview. Correlational analyses indicated that peritraumatic dissociation was most strongly related to all 3 types of symptom severity. Additional posthoc correlational analyses revealed that women who experienced penile penetration, believed someone/thing else would be killed, and/or were injured as a result of the abuse exhibited more severe peritraumatic dissociation. Regression analyses indicated that peritraumatic dissociation was the only variable to significantly predict symptom severity across symptom type or disorder. Furthermore, different abuse characteristics predicted adult symptom severity and peritraumatic dissociation. _____
Title: Commentary on PTSD discussion. Author(s): McEwen, Bruce S., Rockefeller U, Harold & Margaret Hatch Lab of Neuroendocrinology, New York, NY, US Source: Hippocampus, Vol 11(2), 2001. pp. 82-84. Publisher: US: John Wiley & Sons Abstract: Comments on articles by R. Pitman (2001), J. D. Bremner (see record 2001-17431-001), and R. Yehuda concerning the possible role of hippocampal atrophy in posttraumatic stress disorder (PTSD). There are 4 uncertainties concerning the role of hippocampal atrophy in PTSD, including: (1) the nature of neuroanatomical changes leading to a smaller hippocampus; (2) the life history of this reduced volume; (3) the importance of glucocorticoids in hippocampus atrophy processes; and (4) the hypothalamic pituitary adrenal (HPA) axis status in PTSD. Imaging technique improvements, twin studies, early childhood abuse-neglect studies, longitudinal hippocampal volume studies, and wider PTSD HPA activity sampling are needed to resolve these issues. _____
Title: The traumatization of grief? A conceptual framework for understanding the trauma-bereavement interface. Author(s): Stroebe, Margaret, Utrecht U, Dept of Psychology, Utrecht, Netherlands, M.Stroebe@fss.uu.nl; Schut, Henk; Finkenauer, Catrin Address: Stroebe, Margaret, P.O. Box 80140, 3508 TC, Utrecht, Netherlands, M.Stroebe@fss.uu.nl Source: Israel Journal of Psychiatry & Related Sciences, Vol 38(3-4), 2001. pp. 185-201. Publisher: Israel: Gefen Publishing House Abstract: Discusses the relationship between bereavement and trauma, and presents a conceptual framework. Both traumatic experiences and bereavement place individuals at high risk for developing a number of disorders independent from posttraumatic stress disorder (PTSD) or pathological grief. Relevant factors include types of events, determinants of impact intensity, psychological reactions and disturbances, life-event specific psychological disorders, and general psychological disorders. The lack of consensus about the nature of reactions and disorders of bereavement is due to concentration on different parts of the proposed framework. Furthermore, the lack of differentiation between traumatic and nontraumatic bereavement has caused neglect of the unique features of nontraumatic grief reactions. _____
Title: The relationship between posttraumatic stress disorder, childhood trauma and alexithymia in an outpatient sample. Author(s): Zlotnick, Caron, Brown U, Dept of Psychiatry & Human Behavior, Butler Hosp, Providence, RI, US, Caron.Zlotnick@Brown.edu; Mattia, Jill I.; Zimmerman, Mark Source: Journal of Traumatic Stress, Vol 14(1), Jan 2001. pp. 177-188. Publisher: Netherlands: Kluwer Academic Publishers Abstract: Examined the strength of association between posttraumatic stress disorder (PTSD) and alexithymia relative to other psychiatric disorders in 252 treatment-seeking psychiatric outpatients (mean age 40.56 yrs). The other aim of this study was to explore which type of childhood trauma was associated with a greater level of adult alexithymia. All patients completed questionnaires on alexithymia and child abuse and neglect. The results show that PTSD and borderline personality disorder were the 2 disorders among selected psychiatric disorders to contribute independently to a higher degree of alexithymia. Another finding was that a greater severity of emotional neglect and physical neglect, rather than abuse, was significantly related to higher levels of alexithymia. The findings also show that among these variables, borderline personality disorder had the strongest relationship to alexithymia. _____
Title: Treatment of persons with complex PTSD and other trauma-related disruptions of the self. Author(s): Pearlman, Laurie Anne, Ctr for Adult & Adolescent Psychotherapy, Traumatic Stress Inst, South Windsor, CT, US Source: Treating psychological trauma and PTSD. Wilson, John P. (Ed); Friedman, Matthew J. (Ed); et al; pp. 205-236. New York, NY, US: Guilford Press, 2001. xii, 467 pp. Abstract: (from the chapter) Discusses complex posttraumatic stress disorder (PTSD), the sequelae of early childhood abuse and neglect. Complex PTSD includes dissociation, relationship difficulties, revictimization, somatization, affect dysregulation, and disruptions of identity. The author provides a theoretical framework for understanding the clinical observations that are collectively termed complex PTSD. An approach to treatment has grown out of constructivist self development theory, which the author describes as it applies to the adaptations. She then applies that approach to case examples of 3 survivors of childhood trauma. In the process, she delineates some hypothetical mechanisms of change in psychotherapies with survivors of severe and early trauma. The author's intent is that the chapter will provide a clinical and theoretical basis for future research into these mechanisms and treatment approaches. _____
Title: Posttraumatic stress disorder and extent of trauma exposure as correlates of medical problems and perceived health among women with childhood abuse. Author(s): Cloitre, Marylene, New York Presbyterian Hosp-Cornell Medical Ctr, Payne Whitney Clinic, New York, NY, US, mcloitre@med.cornell.edu; Cohen, Lisa R., New York Presbyterian Hosp, Cornell Medical Ctr, New York, NY, US; Edelman, Ruth E., New York Presbyterian Hosp, Cornell Medical Ctr, New York, NY, US; Han, Hyemee, New York Presbyterian Hosp, Cornell Medical Ctr, New York, NY, US Address: Cloitre, Marylene, New York Presbyterian Hosp-Cornell Medical Ctr, Payne Whitney Clinic, Box 147, New York, NY, US, mcloitre@med.cornell.edu Source: Women & Health, Vol 34(3), 2001. pp. 1-17. Publisher: US: Haworth Press Abstract: Examined the effect of exposure to trauma and the presence of posttraumatic stress disorder (PTSD) symptoms on current health of child abuse survivors. 67 females (aged 18-69 yrs) with histories of childhood abuse completed questionnaires concerning medical history, perceived state of physical health, PTSD symptoms, and exposure to child or adult trauma in the form of sexual or physical assault, emotional abuse, or neglect. Results show that Ss with history of childhood abuse reported more medical problems and lower levels of perceived health. As well, 91% of abused Ss reported an additional trauma since their childhood abuse. Exposure to trauma significantly related to poor adult health. 70% of Ss met the criteria for PTSD diagnosis; however, there was no significant relationship between PTSD symptoms and medical problems. _____
Title: Sexual abuse characteristics associated with survivor psychopathology. Author(s): Ruggiero, Kenneth J., West Virginia U, Dept of Psychology, Morgantown, WV, US; McLeer, Susan V., State U New York Buffalo, Dept of Psychiatry, Buffalo, NY, US; Dixon, J. Faye, Hahnemann U, Child Psychiatry Medical Coll Pennsylvania, Philadelphia, PA, US Address: Ruggiero, Kenneth J., West Virginia U, Dept of Psychology, PO Box 6040, Morgantown, WV, US Source: Child Abuse & Neglect, Vol 24(7), Jul 2000. pp. 951-964. Publisher: Netherlands: Elsevier Science Abstract: Examined predictors of psychopathology in non-clinically referred, sexually abused (SA) children, ages 6-16 yrs, 30-60 days following abuse disclosure and termination. 80 SA children were administered a structured diagnostic interview and a variety of rating-scale instruments. Several forms of psychopathology were assessed, including posttraumatic stress, global functioning, anxiety, depression, and externalizing behavior. Abuse interviews also were used to guide the collection of demographic (victim age, gender) and abuse-related information (e.g., frequency of abuse). Abuse-related factors and demographic variables accounted for greater than half of the variance predicting global functioning, and accurately predicted posttraumatic stress disorder (PTSD) status for 86% of Ss. Also, analyses yielded significant predictors of parent-reported attention problems and sexual behavior. Of additional importance, none of the abuse-related and demographic variables predicted scores on measures of general anxiety, depression, and externalizing behavior. _____
Title: Physiological correlates of childhood abuse: Chronic hyperarousal in PTSD, depression, and irritable bowel syndrome. Author(s): Kendall-Tackett, Kathleen A., U New Hampshire, Family Research Lab, Durham, NH, US Address: Kendall-Tackett, Kathleen A., 34 Western Avenue, Henniker, NH, US Source: Child Abuse & Neglect, Vol 24(6), Jun 2000. pp. 799-810. Publisher: Netherlands: Elsevier Science Abstract: Presents a literature review examining physiological correlates of past childhood abuse, specifically focusing on 3 manifestations of chronic hyperarousal: post-traumatic stress disorder (PTSD), depression, and irritable bowel syndrome. Each is accompanied by physiological hyperarousal. In post-traumatic stress disorder, there are abnormally high levels of norepinephrine. In depression, cortisol is abnormally high. Finally, in irritable bowel syndrome, there is a heightened sensitivity to physical pain. Individual differences in the expression of symptoms are considered, especially concerning age of onset, brain maturation, appraisal of events, and severity of abuse. Implications for clinical practice are discussed. _____
Title: Developmental disabilities, trauma exposure, and post-traumatic stress disorder. Author(s): Newman, Elana, U Tulsa, Tulsa, OK, US; Christopher, Samina R.; Berry, Judy O. Source: Trauma Violence & Abuse, Vol 1(2), Apr 2000. pp. 154-170. Publisher: US: Sage Publications Abstract: It has been assumed that individuals with developmental disabilities are a group of individuals at greater risk for exposure to abuse and neglect, although there is no evidence documenting a higher prevalence or incidence of trauma exposure and post-traumatic stress disorder (PTSD) among those with developmental disabilities. The authors attempt to distinguish those biases about the relative vulnerability of individuals with developmental disabilities from facts. This article reviews the current scientific evidence with regard to the rates of trauma exposure among individuals with developmental disabilities, the probable applicability of PTSD among this group, and the scientific basis of clinical assessment. Using the lens of traumatic stress studies, the authors recommend a research agenda and the creation of an empirically formed social policy that does not reinforce stigma but provides accurate, respectful, and necessary protections. _____
Title: Availability bias in clinical formulation: The first idea that comes to mind. Author(s): Waddington, Louise, High Royds Hosp, Dept of Clinical Psychology, Ilkley, England; Morley, Stephen Source: British Journal of Medical Psychology, Vol 73(1), Mar 2000. pp. 117-127. Publisher: United Kingdom: British Psychological Society Abstract: Tested whether initial client formulations are based on the ideas that come most readily to mind, irrespective of the validity of these ideas. This phenomenon is known in decision theory literature as availability bias. The study tested the influence of 2 possible sources of availability bias in formulation: (1) theoretical orientation; and (2) a suggestion in a referral letter. 44 qualified and 20 trainee clinical psychologists (aged 23-63 yrs) read a fictional referral letter describing a client with adult attachment difficulties and posttraumatic stress disorder (PTSD) and were asked questions about it. Ss recalled information from the referral letter, described their areas of further interest and initial hypotheses. Results show no evidence of an availability bias in clinical formulation as a result of theoretical orientation. Theoretical orientation towards attachment did appear to influence the availability of attachment ideas and predicted clinicians taking a stronger attachment focus when discussing the client. In particular, a self-report measure of theoretical orientation demonstrated high predictive validity. However, orientation towards attachment did not predict bias in the sense of selective recall of attachment information or neglect of alternative psychological frameworks. _____
Title: Texture response patterns associated with sexual trauma of childhood and adult onset: Developmental and recovered memory implications. Author(s): Leavitt, Frank, Rush Medical Coll, Dept of Psychology, Chicago, IL, US Source: Child Abuse & Neglect, Vol 24(2), Feb 2000. pp. 251-257. Publisher: Netherlands: Elsevier Science Abstract: Reduced texture sensitivity on the Rorschach is proposed as a sequelae of early sexual abuse that is unlikely to be contaminated by situational variables. If this conceptualization has merit, texture attributes offer a roadmap for studying vying claims in the recovered memory debate. To explore this possibility, the author examined the extent to which intense preoccupation with sexual trauma of childhood and of adult onset related to reduced texture productivity (TP). TP was measured in 4 groups comprised of 108 female patients using the Rorschach. 27 patients with recovered memory were compared with 27 patients with continuous memory of childhood sexual trauma, 27 post trauma stress patients with sexual trauma of adult onset, and 27 non-abused patients. The study replicated previous findings of reduced TP among patients who always remembered sexual trauma of childhood-onset. The same texture deficiency pattern was observed among patients who recovered memory of childhood sexual abuse. This pattern was not observed in posttraumatic stress disorder (PTSD) patients intensely preoccupied with sexual trauma of adult onset despite the fact that they mimicked the recovered memory group in respect to enduring preoccupation with distressing thoughts of sexual abuse. _____
Title: Post traumatic stress disorder reactions in children of war: A longitudinal study. Author(s): Thabet, Abdel Aziz; Vostanis, Panos Source: Child Abuse & Neglect, Vol 24(2), Feb 2000. pp. 291-298. Publisher: Netherlands: Elsevier Science Abstract: Established rates of posttraumatic stress disorder (PTSD) reactions and general mental health problems in children who had experienced war trauma. A longitudinal study in the Gaza strip with 234 children aged 7 to 12 yrs who had experienced war conflict was conducted 1 yr after the initial assessment, that is, during the peace process. Children completed the Child Post Traumatic Stress Reaction Index (CPTS-RI), while the Rutter A2 and B2 scales were completed by parents and teachers. The rate of children who reported moderate to severe PTSD reactions at follow-up had decreased from 40.6% to 10.0% (74 Ss). 49 children (20.9%) were rated above the cut-off for mental health problems on the Rutter A2 (parent) Scales, and 74 children (31.8%) were above the cut-off on the Rutter B2 (teacher) Scales. The total scores on all 3 measures had significantly decreased during the 1-yr period. The total CPTS-RI score at follow-up was best predicted by the number of traumatic experiences recalled at the 1st assessment. PTSD reactions tend to decrease in the absence of further stressors, although a substantial proportion of children still present with a range of emotional and behavioral problems. _____
Title: Elevated picture completion scores: A possible indicator of hypervigilance in maltreated preschoolers. Author(s): Frankel, Karen A., U Colorado School of Medicine, Dept of Psychiatry, Denver, CO, US; Boetsch, Elizabeth A.; Harmon, Robert J. Source: Child Abuse & Neglect, Vol 24(1), Jan 2000. pp. 63-70. Publisher: Netherlands: Elsevier Science Abstract: Administered the Wechsler Preschool and Primary Scale of Intelligence --Revised (WPPSI--R) to 14 preschoolers (aged 4.2-5.7 yrs) who are hypervigilant as a result of maltreatment and compared their Picture Completion subtest scores with their other nonverbal scores and their overall intellectual functioning. Standardized discrepancy scores between Picture Completion scores and Performance mean scores (PC-Performance Discrepancy) and the mean of all subscale scores (PC-Overall IQ Discrepancy) were formed and then analyzed. Ss' scored significantly lower than the population mean on 4 of the 5 WPPSI-R Performance subscales; only on Picture Completion did they score significantly higher. Elevated Picture Completion score may serve as a marker for hypervigilance and/or posttraumatic stress disorder (PTSD) in children with histories of maltreatment. _____
Title: Childhood maltreatment, PTSD and suicidal behavior among African American females. Author(s): Thompson, Martie P., Ctrs for Disease Control & Prevention, Div of Violence Prevention, Atlanta, GA, US; Kaslow, Nadine J.; Lane, Danielle Bradshaw; Kingree, J. B. Source: Journal of Interpersonal Violence, Vol 15(1), Jan 2000. pp. 3-15. Publisher: US: Sage Publications Abstract: The independent and combined roles of childhood maltreatment (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect) and current post-traumatic stress disorder (PTSD) were examined in predicting nonfatal suicide attempts among 335 African American women. It was hypothesized that suicide attempters (n= _____
Title: A comparative analysis of the memory functioning of stress-exposed youth with and without posttraumatic stress disorder. Author(s): Yasik, Anastasia Elizabeth, City U New York, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 59(4-B), Oct 1998. pp. 1873. Publisher: US: Univ Microfilms International Abstract: This study compared the Wide Range Assessment of Memory and Learning (WRAML) scores of urban youth with PTSD to the WRAML scores of stress-exposed urban youth without PTSD. A total of 131 youths were referred from Bellevue Hospital clinics subsequent to exposure to a variety of traumatic events (e.g., physical assaults, sexual assaults, motor vehicle accidents, fires). Youth with a positive history for child abuse or neglect were excluded. In order to control for the potentially confounding effects of comorbidity, youth meeting criteria for ADHD, conduct disorder, major depression, substance dependence, and schizophrenia were excluded. Similarly, youth with a documented head trauma, use of psychopharmacological agents, or mental retardation were also excluded. This process led to the identification of 16 youth with PTSD and 19 youth without PTSD. Statistical analyses revealed that there were no significant differences between comparison groups with regard to gender, ethnicity, age, and SES. Separate ANOVAs for the four WRAML Index scores were performed. These analyses revealed significant group differences on the General Memory and Verbal Memory Indexes. Youth with PTSD scored significantly lower on the General Memory and Verbal Memory Indexes compared to stress-exposed youth without PTSD. Whereas statistically significant differences were not observed on the Visual Memory and Learning Indexes, clinically significant impairment of these Indexes was observed among youth with PTSD. Finally, three separate MANOVAs were performed to examine for group differences across the WRAML subtests. These analyses failed to reveal significant group differences across the nine WRAML subtests. As such, this study indicates that PTSD is associated with discrete patterns of memory impairment in youth. A discussion of the observed results with reference given to clinical and theoretical implications is presented. Finally, the potential limitations with reference given to implications for future research are addressed. _____
Title: Trauma pervasively elevates Brief Symptom Inventory profiles in inpatient women. Author(s): Allen, Jon G., Menninger Clinic, Topeka, KS, US; Coyne, Lolafaye; Huntoon, Janis Source: Psychological Reports, Vol 83(2), Oct 1998. pp. 499-513. Publisher: US: Psychological Reports Abstract: The Brief Symptom Inventory was administered to 228 women (M age: 37) consecutively admitted to specialized inpatient treatment for trauma-related disorders. Subsamples of patients were administered different posttraumatic stress disorder scales, the Impact of Events Scale-Revised, the Posttraumatic Stress Diagnostic Scale, and the PTSD scale of the Millon Clinical Multiaxial Inventory-III, as well as a measure of child abuse and neglect, the Childhood Trauma Questionnaire. In this severely traumatized group, every scale of the Brief Symptom Inventory was significantly more elevated than the inpatient female norms, with the five most highly elevated scales being Depression, Obsessive-Compulsive, Anxiety, Interpersonal Sensitivity, and Psychoticism. Different indicators of trauma (Childhood Trauma Questionnaire, PTSD scales, and PTSD diagnosis) show different patterns of relationships with the individual scales of the Brief Symptom Inventory. There is no simple relationship between trauma and BSI symptoms, but clinicians should consider severe interpersonal trauma to be one pathway to pervasively elevated profiles of the Brief Symptom Inventory. _____
Title: Prevalence of post traumatic stress disorder and other psychiatric diagnoses in three groups of abused children (sexual, physical, and both). Author(s): Ackerman, Peggy T., Arkansas Children's Hosp, Pediatrics/C.A.R.E. Unit, Little Rock, AR, US; Newton, Joseph E. O.; McPherson, W. Brian; Jones, Jerry G.; Dykman, Roscoe A. Source: Child Abuse & Neglect, Vol 22(8), Aug 1998. pp. 759-774. Publisher: Netherlands: Elsevier Science Abstract: Compared the prevalence of posttraumatic stress disorder (PTSD) and other diagnoses in 3 groups of abused children: sexual abuse (SA) only, physical abuse (PA) only, and both (BOTH). 204 children, aged 7-13 yrs, and their caregivers were separately administered the Diagnostic Interview for Children and Adolescents, Revised Version. Additionally, caregivers and classroom teachers completed the Child Behavior Checklist (CBCL). Characteristics of the abuse were obtained from an investigative questionnaire. Both victims and caregivers endorsed high rates of disorders, with caregivers generally giving higher rates than children, and boys having more externalizing diagnoses than girls. Children in the BOTH group had more diagnoses overall. PTSD was significantly comorbid with most affective disorders. On the CBCL, caregivers rated girls less disturbed than boys and the SA group less disturbed than the other groups. Teachers rated the boys more adversely than girls but did not see differences by abuse group. A younger age of onset of SA and coercion to maintain secrecy predicted a higher number of total diagnoses. Also, children had more diagnoses when PA had come from males rather than from females. _____
Title: Potential mediators of post-traumatic stress disorder in child witnesses to domestic violence. Author(s): Kilpatrick, Kym L., U of New England, Dept of Psychology, Armidale, NSW, Australia; Williams, L. M. Source: Child Abuse & Neglect, Vol 22(4), Apr 1998. pp. 319-330. Publisher: Netherlands: Elsevier Science Abstract: Examined variables that might mediate the incidence of posttraumatic stress disorder (PTSD) in child witnesses to domestic violence (DV), including age, gender, locus of control, self-blame, perception of threat, active vs palliative coping style, maternal emotional health plus aspects of the violence witnessed (intensity, frequency, age of child when first witnessing violence, and time since the last violent episode). Following screening for other PTSD inducing experiences, 20 child witnesses to DV, 15 matched control children, and their mothers were assessed with a variety of measures, including the Straus Conflict Tactics Scale; the Child Post-Traumatic Stress Reaction Index; the Nowicki-Strickland Locus of Control Scale; and the General Health Questionnaire. None of the factors under examination were found to contribute significantly to the severity levels of PTSD in relation to witness status. Findings indicate that the impact of witnessing DV, in terms of PTSD, is not mediated by factors such as maternal emotional well-being, age and gender of the child, or the child's style of coping with parental conflict. Evidence that variables specifically related to the violence witnessed did not mediate the impact suggests that all DV may have severe and long-term impact on child witnesses. _____
Title: Complex posttraumatic stress disorder in women from a psychometric perspective. Author(s): Allen, Jon G., Menninger Clinic, Trauma Recovery Program, Topeka, KS, US; Coyne, Lolafaye; Huntoon, Janis Source: Journal of Personality Assessment, Vol 70(2), Apr 1998. pp. 277-298. Publisher: US: Lawrence Erlbaum Abstract: J. L. Herman's (1992) formulation of complex posttraumatic stress disorder (PTSD) was not incorporated into the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), but finds ample confirmation in personality assessment of women in inpatient treatment for trauma-related disorders. The authors related MCMI-II and Adult Attachment Scale scores to a self-report measure of childhood abuse and neglect, the Childhood Trauma Questionnaire, in 166 female inpatients with PTSD, anxiety disorders, dissociative disorders, mood disorders, depression or dysthymia, substance abuse, eating disorders, and personality disorders. Consistent with Herman's formulation, results reveal a wide array of symptoms coupled with 2 facets of relationship disturbance: (1) enmeshment in ambivalence (depressive, dependent, and self-defeating personality and ambivalent attachment) and (2) more profound isolation (avoidant and schizoid personality and profoundly insecure attachment). The authors present a model for using such psychometric findings in patient education and diagnostic evaluations. _____
Title: PTSD as a mediator between childhood rape and alcohol use in adult women. Author(s): Epstein, Jeffery N., Duke U Medical Ctr, Durham, NC, US; Saunders, Benjamin E.; Kilpatrick, Dean G.; Resnick, Heidi S. Source: Child Abuse & Neglect, Vol 22(3), Mar 1998. pp. 223-234. Publisher: Netherlands: Elsevier Science Abstract: Though a relationship between childhood sexual abuse and later alcohol use among women has been documented, little is known about the pathways that link these 2 variables. A tension reduction hypothesis posits that emotional distress precedes substance usage. The posttraumatic stress disorder (PTSD) symptomatology resulting from childhood sexual abuse is examined as a possible source of emotional distress that may cause subsequent alcohol use. A sample of 2,994 adult women were selected and interviewed on 2 occasions 1 yr apart and childhood rape history, lifetime PTSD symptoms, and lifetime alcohol use were assessed. Path analytic techniques were used to evaluate the mediating role of PTSD symptoms on the relationship between childhood rape and subsequent alcohol use. A history of childhood rape doubled the number of alcohol abuse symptoms that women experienced in adulthood. Path analysis and cross-validation results demonstrated significant pathways connecting childhood rape to PTSD symptoms and PTSD symptoms to alcohol use. Results suggest that PTSD symptomatology which develops after childhood rape may be one of many variables that affect alcohol abuse patterns in women who were victims of childhood sexual abuse. _____
Title: Lifing the burden of shame: Using EMDR resource installation to resolve a therapeutic impasse. Author(s): Leeds, Andrew M. Source: Extending EMDR: A casebook of innovative applications. Manfield, Philip (Ed); pp. 256-281. New York, NY, US: W. W. Norton & Co, Inc, 1998. xii, 292 pp. Abstract: (from the chapter) Presents a case of a woman with depression and social isolation, a debilitating physical illness, and a history of childhood abuse and neglect. In this case, eye movement desensitization and reprocessing (EMDR) was used as a resource installation to resolve a therapeutic impasse and to help the client overcome feelings of shame. The author discusses the initiation of EMDR treatment, emotional flooding and a failed early installation, countertransference and demand characteristics, and integrating the use of imaginal resources in posttraumatic stress disorder (PTSD) EMDR protocols. The author also describes the scientific foundations for the use of imaginal resources and sources for principles used in resource installation. _____
Title: Extending EMDR: A casebook of innovative applications. Author(s): Manfield, Philip, (Ed) Source: New York, NY, US: W. W. Norton & Co, Inc, 1998. xii, 292 pp. Abstract: (from the jacket) Explores the use of eye movement sensitization and reprocessing (EMDR) in the treatment of residual psychological effects of a single-incident trauma, long-term childhood abuse,and complex posttraumatic stress disorder (PTSD). The eleven case reports provided illustrate the application of EMDR to a broad range of cases. The introduction includes basic descriptions of EMDR and the accelerated information processing model, as well as definitions of its terminology. Each of the following chapters begins with a discussion of the contributor's background, the principles of the traditional treatment approach used before incorporating EMDR, and the way he or she has integrated EMDR into that approach. The book is divided into two parts: those cases in which it was possible to target a relatively small number of distinct traumatic experiences, and those in which the clients' symptoms have resulted from ongoing childhood trauma or neglect for which they are unable to identify representative discrete trauma. The description of the client's treatment and progress is detailed enough to enable the reader to understand how the results were achieved. Finally, the duration and outcome of each case are evaluated. _____
Title: What determines post-traumatic stress disorder symptomatology for survivors of childhood sexual abuse? Author(s): Briggs, Lynne, U Dept of Psychological Medicine, Christchurch School of, Medicine, Family Health Counseling Service, Sunnyside Hosp, Healthlink South Ltd, Christchurch, New Zealand; Joyce, Peter R. Source: Child Abuse & Neglect, Vol 21(6), Jun 1997. pp. 575-582. Publisher: Netherlands: Elsevier Science Abstract: Ascertained what childhood abuse experiences were associated with symptoms of posttraumatic stress disorder (PTSD) in women survivors (CSA). 73 Ss (mean age 31.5 yrs) attending an outpatient mental health counseling service completed self-report questionnaires assessing adult abuse experiences, relationship with parents, general psychopathology, and PTSD symptomatology; and were interviewed about their childhood abuse experiences. Results showed that: (1) Ss who experienced CSA had current symptoms of PTSD, (2) the severity of PTSD symptoms correlated with the extent of general psychopathology, and (3) the severity of the PTSD symptoms correlated with the extent of CSA by sexual intercourse. Three of 5 factors (dissociation, intrusive thoughts, and hyperarousal) identified in a factor analysis of the PTSD measure were associated with CSA by sexual intercourse. It is concluded that women who report multiple abusive episodes which involve sexual intercourse have more PTSD symptoms. _____
Title: Refugee children in Sweden: Post-traumatic stress disorder in Iranian preschool children exposed to organized violence. Author(s): Almqvist, Kjerstin, Ctr for Public Health Research, Karlstad, Sweden; Brandell-Forsberg, Margareta Source: Child Abuse & Neglect, Vol 21(4), Apr 1997. pp. 351-366. Publisher: Netherlands: Elsevier Science Abstract: 50 preschool children (4-8 yrs old) from 47 Iranian families living as refugees in Sweden were assessed individually, simultaneously with parental interviews focusing on exposure to organized violence and post-traumatic stress symptomatology in the children. Information given by the children increased the prevalence of a Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) diagnosis of posttraumatic stress disorder (PTSD) from 2% to 21% in the 42 children with traumatic exposure through war and political persecution. The amount of traumatic exposure was strongly related to the prevalence of PTSD. The stability of prevalence was high in a follow-up 2 and 1/2 yrs later; 23% of the children with traumatic exposure still met the full criteria of PTSD according to DSM-III-R. _____
Title: Etiological significance of associations between childhood trauma and borderline personality disorder: Conceptual and clinical implications. Author(s): Sabo, Alex N., Berkshire Medical Ctr, Dept of Psychiatry & Behavioral Sciences, Pittsfield, MA, US Source: Journal of Personality Disorders, Vol 11(1), Spr 1997. Special issue: Trauma and personality disorders. pp. 50-70. Publisher: US: Guilford Publications Abstract: Numerous studies over the past decade have pointed to the frequent occurrence of trauma and neglect in the childhood experience of patients with Borderline Personality Disorder (BPD). Advancing research on posttraumatic stress disorder (PTSD) and Dissociative Disorders offers further insight into understanding shared clinical phenomena with BPD. Drawing on attachment theory, models of learned helplessness, and early primate deprivation, empirical, theoretical and clinical data are integrated to conceptualize the role of trauma and neglect in the etiology of BPD. _____
Title: School age children's coping with sexual abuse: Abuse stresses and symptoms associated with four coping strategies. Author(s): Chaffin, Mark, U Oklahoma, Health Sciences Ctr, Ctr on Child Abuse & Neglect, Oklahoma City, OK, US; Wherry, Jeffrey N.; Dykman, Roscoe Source: Child Abuse & Neglect, Vol 21(2), Feb 1997. pp. 227-240. Publisher: Netherlands: Elsevier Science Abstract: Strategies used by 84 sexually abused children (aged 7-12 yrs) to cope with their abuse were evaluated, along with child reported abuse-related symptoms, and parent- and teacher-reported behavioral symptoms. Four coping strategies were found (avoidant, internalized, angry, and active/social), and each was associated with a unique set of abuse characteristics, an abuse-related social environment, and symptoms. Use of avoidant coping strategies was related to fewer behavioral problems, although it was also associated with greater sexual anxieties. Internalized coping was associated with increased guilt and posttraumatic stress disorder (PTSD) hyperarousal symptoms. Angry coping was associated with a wide range of behavioral and emotional problems as rated by the child's home-room school teacher. Active/social coping was the only strategy unrelated to symptoms, but neither was it associated with measured benefits. Results are discussed in terms of a proposed mediational model. _____
Title: The magnitude of the problem. Author(s): Blanchard, Edward B., State U New York, Ctr for Stress & Anxiety Disorders, Albany, NY, US; Hickling, Edward J. Source: After the crash: Assessment and treatment of motor vehicle accident survivors. Blanchard, Edward B.; Hickling, Edward J.; pp. 13-19. Washington, DC, US: American Psychological Association, 1997. ix, 353 pp. Abstract: (from the chapter) Motor vehicle accidents (MVAs) are widespread in the US as well as in all of the rest of the industrialized world. We have focused our own research on individuals who were injured in MVAs (driver, passenger, or pedestrian in which the vehicle was an automobile, truck, bus, or motorcycle) and who sought medical attention for those injuries within 48 hr of the accident. As we have sought to present our own research on MVA victims, a frequently raised issue has been the "seriousness of the accident." To the best of our knowledge there are no validated scales of accident severity. If by seriousness one means the extent of physical injuries to the victim (which can be scaled) or the extent of psychological distress suffered by the victim, one could use these constructs. However, it becomes tautological to attempt to determine whether serious MVAs lead to PTSD because that would mean that MVAs, which lead to great psychological distress, cause PTSD. Thus, we have a sizeable mental health problem in this country that has been all but ignored by American researchers and perhaps by the mental health treatment community. We hope this book will begin to reverse that neglect. _____
Title: Discriminant validity of the TSC-40 in an outpatient setting. Author(s): Whiffen, Valerie E., U Ottawa, School of Psychology, Ottawa, ON, Canada; Benazon, Nili R.; Bradshaw, Cathryn Source: Child Abuse & Neglect, Vol 21(1), Jan 1997. pp. 107-115. Publisher: Netherlands: Elsevier Science Abstract: Examined the discriminant validity of the Trauma Symptom Checklist (TSC-40) in a clinical sample. The TSC-40 was developed as a research instrument for assessing the impact of a history of sexual victimization. Previous validity studies used nonclinical samples of women (Elliott & Briere, 1992; Gold, Milan, Myall, & Johnson, 1994). In the present study, the TSC-40 was administered to 103 men and 79 women requesting services at 2 outpatient clinics. Information about sexual victimization was collected from the client during intake and from the therapist after the client had received 6 mo of therapy. A history of CSA was associated both with high symptom levels across symptom dimensions, and, specifically, with elevation on the trauma subscale of the TSC-40. The findings support the view that, in a clinical setting, CSA is associated both with generalized distress and with posttraumatic stress disorder (PTSD) symptoms. _____
Title: Elder abuse and neglect: Causes and consequences. Author(s): Wolf, Rosalie S., Memorial Hosp, Inst on Aging, Worcester, MA, US Source: Journal of Geriatric Psychiatry, Vol 30(1), 1997. pp. 153-174. Publisher: US: International Universities Press Abstract: Provides an overview of the more often cited theoretical models to explain elder mistreatment, reviews the research literature on risk factors and consequences, and presents some general thoughts on service delivery. The risk factors for elder abuse and neglect are caregiver stress and victim dependency, psychopathology, and abuser dependency. The consequences for victims include depression, learned helplessness and alienation, posttraumatic stress disorder (PTSD), guilt, and denial; for abusers, the consequences include depression and a web of interdependency. If elder abuse is thought to be mainly a result of caregiving stress, helping the caregiver is the treatment of choice: bringing into the home skilled nursing, personal care, meals-on-wheels, and chore services. For situations where it is advisable to remove the victim from the home temporarily, emergency shelters are used. The strong association between dependency of the abuser and physical abuse has suggested a series of services to encourage independence through housing and financial assistance, job training, and substance abuse counseling. _____
Title: The human toll: Managed care's restriction of access to mental health services. Author(s): Shapard, Barbara, Psychoanalytic Psychotherapy Program, Psychoanalytic Foundation of Washington, Washington, DC, US Source: Psychoanalytic Inquiry, 1997 Suppl, 1997. pp. 151-161. Publisher: US: Analytic Press Abstract: Presents vignettes that detail the consequences of limitations by managed care practices of both inpatient and outpatient mental health treatment. The vignettes are categorized by diagnosis: dissociation and borderline personality disorders, substance abuse, posttraumatic stress disorder (PTSD), acute suicidal crisis, spousal physical abuse, and latency and adolescent disturbances. It is concluded that the frequent managed care practice of precipitous termination of reimbursement for mental health services recreates many patients' early experiences of trauma, neglect, and abandonment (J. Rosenbaum, 1994). Compliance with managed care termination policies creates the same ethical problems for psychotherapists as withholding needed medical care creates for physicians ((N. Simon, 1994). _____
Title: Reported amnesia for childhood abuse and other traumatic events in psychiatric inpatients. Series Title: NATO ASI series: Series A: Life sciences; Vol. 291. Author(s): Carlson, Eve B., Beloit Coll, Dept of Psychology, Beloit, WA, US; Armstrong, Judith; Loewenstein, Richard Source: Recollections of trauma: Scientific evidence and clinical practice. Read, J. Don (Ed); Lindsay, D. Stephen (Ed); pp. 395-401. New York, NY, US: Plenum Press, 1997. xii, 600 pp. Abstract: (from the chapter) The study investigated the prevalence of amnesia for sexual abuse, physical abuse, and other traumatic events, and the relationships between aspects of childhood physical and sexual abuse and adult psychological symptoms among 217 psychiatric inpatients (aged 30-45 yrs). An interview was conducted to assess past sexual and physical abuse experiences and incidents of amnesia. Information about amnesia for traumatic events other than childhood abuse was obtained. Severity, duration, and age of onset of abuse experiences were measured. Childhood experiences of neglect, dysfunctional behavior in caretakers, and social support were also aspects of the abuse experience measured. Adult psychological symptoms measured included posttraumatic stress disorder (PTSD) symptoms, dissociation, depression, anxiety, self-destructiveness, somatization, and aggression. The results show that, while there are differences in the rates of different reported levels of amnesia across sexual abuse, physical abuse, and other traumas, substantial numbers of Ss reported having experienced partial or total amnesia for physical abuse and other traumatic experiences. The level of amnesia for abuse was found to be related to characteristics of the abuse experience and to trauma-related psychiatric symptoms. _____
Title: The socioemotional development of orphans in orphanages and traditional foster care in Iraqi Kurdistan. Author(s): Ahmad, Abdulbaghi, Uppsala U Hosp, Dept of Child & Adolescent Psychiatry, Uppsala, Sweden; Mohamad, Kirmanj Source: Child Abuse & Neglect, Vol 20(12), Dec 1996. pp. 1161-1173. Publisher: Netherlands: Elsevier Science Abstract: Compared the socioemotional development of 41 4-16 yr old male and female Iraqi Kurdistan orphans who were either in traditional foster care or in modern orphanages. Ss were examined at an index test and at a 1-yr followup regarding competency scores and behavioral problems at both test occasions, and posttraumatic stress reactions after 1 yr. The Achenbach Child Behavioral Check List and 2 posttraumatic stress disorder (PTSD) measures were used. While competency scores improved in both samples at the followup test, the problem scores increased in the orphanage sample and decreased among the foster care Ss. Moreover, the orphanage sample reported higher frequency of PTSD than the foster care children. The results are discussed with regard to the value of the Kurdish society's own traditions in taking care of orphans. _____
Title: Persistence of pediatric post traumatic stress disorder after 2 years. Author(s): Famularo, Richard, Boston Juvenile Court Clinic, Boston, MA, US; Fenton, Terence; Augustyn, Marilyn; Zuckerman, Barry Source: Child Abuse & Neglect, Vol 20(12), Dec 1996. pp. 1245-1248. Publisher: Netherlands: Elsevier Science Abstract: Assessed the percent of children who maintain the diagnosis of posttraumatic stress disorder (PTSD) after a 2-yr period without evidence of renewed parental abuse or neglect. 156 children were randomly evaluated at an inner-city juvenile/family court. These children were removed from their parent's custody subsequent to a finding of severe child maltreatment. Of the 156, 52 6-12 yr olds met strict criteria for PTSD and were successfully recruited and participated in the 2-yr reexamination. Each PTSD diagnosis was conferred by the Diagnostic Interview for Children and Adolescents (DICA). Of those reexamined, 17 (32.7%) retained the full PTSD diagnosis, while 67.3% did not meet criteria. The results revealed a high rate of PTSD persistence which occurs even in the presence of court-ordered supervision and treatment. _____
Title: Posttraumatic stress disorder in a clinical sample of adult survivors of childhood sexual abuse. Author(s): Rodriguez, Ned, Tufts U, School of Medicine, Boston, MA, US; Ryan, Susan W.; Rowan, Anderson B.; Foy, David W. Source: Child Abuse & Neglect, Vol 20(10), Oct 1996. pp. 943-952. Publisher: Netherlands: Elsevier Science Abstract: 117 help-seeking adult survivors of childhood sexual abuse (CSA) were assessed to investigate the relationship between the level of self-reported CSA and posttraumatic stress disorder (PTSD). CSA was measured utilizing the Sexual Abuse Exposure Questionnaire, a new research instrument. Further preliminary psychometric properties of the instrument were reported. CSA was operationalized to include severity, duration, age of onset, number of perpetrators, and use of force. PTSD diagnostic status was assessed utilizing a standardized instrument, the Structured Clinical Interview for DSM-II-R. Eighty-six percent of survivors met full DSM-III-R criteria for a PTSD diagnosis at some point during their lives. Multivariate analysis indicated that CSA severity and duration accounted for significant portions of the variance in PTSD symptoms, providing support for their role as traumagenic variables. _____
Title: Psychiatric comorbidity in childhood posttraumatic stress disorder. Author(s): Famularo, Richard, Massachusetts Dept of Mental Health, Boston Juvenile Court, Boston, MA, US; Fenton, Terence; Kinscherff, Robert; Augustyn, Marilyn Source: Child Abuse & Neglect, Vol 20(10), Oct 1996. pp. 953-961./ Publisher: Netherlands: Elsevier Science Abstract: Examined the psychiatric comorbidity between children presenting with posttraumatic stress disorder (PTSD) and traumatized children not developing this disorder. 117 severely maltreated 6-12 yr olds were examined for evidence of PTSD. Analyses probed for diagnostic relationships between PTSD and other formal diagnoses on The Diagnostic Interview for Children and Adolescents, Revised Version (DICA-C-R). This entire group of maltreated and traumatized children were dichotomized into a PTSD group and a non-PTSD group. 35% (41 of 117) of the children met strict DICA criteria for PTSD. The DICA-C-R responses provided the only determination of whether the children met formal PTSD criteria. Data gathering on the sample also included a comprehensive review of risk factors for the development of PTSD, including demographics, and type(s) of trauma suffered. Findings revealed that the PTSD diagnosis was significantly correlated with attention deficit hyperactivity disorder (ADHD), other anxiety disorders, brief psychotic disorder or psychotic disorder not otherwise specified, the presence of suicidal ideation, and a trend toward mood disorders. There were no differences between the 2 samples on measures of age, race, and family income. The results suggest that the presence of PTSD in children confers a substantial likelihood of other formal diagnoses. _____
Title: Stress and its correlates: An empirical investigation among North Dakota peace officers. Author(s): Anderson, Eric Mark, U North Dakota, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 57(3-B), Sep 1996. pp. 2194. Publisher: US: Univ Microfilms International Abstract: The mission of the present investigation was to expand the limited body of knowledge regarding stress among rural peace officers. While a number of studies have focused on large, easily sampled departments, the empirical literature evidences neglect toward officers serving rural population. The present study seeks to ascertain how North Dakota officers compare with other, more urban populations, and what differences may exist between a stratified sample of North Dakota police, sheriffs and Highway Patrol officers. A randomized sample of 311 North Dakota officers were selected to receive a 300 question anonymous survey questionnaire which assessed personal demographic information in addition to dependent measures such as the Diagnostic and Statistical Manual of Mental Disorders - Revised, post-traumatic stress disorder (PTSD) criteria; the Maslach Burnout Inventory; the State-Trait Anxiety Inventory (trait anxiety subscale); and the Police Stress Survey (modified). The 71% response rate yielded 216 usable questionnaires and represents almost 20% of the licensed peace officers in the state. Comparable response raters were obtained from each stratification. Hypotheses were put forth regarding the support systems available to the officer in both the work environment and home and the mediating effects of these factors on the negative physical and psychological consequences of job stress. Support from the officer's spouse, department and social environment were found to be strongly associated with physical health, chronic anxiety, psychological adjustment, and the perception of severity in occupational stressors. Persons who were satisfied with the support they received were more likely to report better physical health, less PTSD symptomatology, lower levels of anxiety and emotional exhaustion and less stress due to on-the-job stressors than did their counterparts who were not satisfied with their support systems. The results indicate that North Dakota officers appear ge _____
Title: Clonidine for posttraumatic stress disorder in preschool children. Author(s): Harmon, Robert J., U Colorado, School of Medicine, Div of Child Psychiatry, Denver, CO, US; Riggs, Paula D. Source: Journal of the American Academy of Child & Adolescent Psychiatry, Vol 35(9), Sep 1996. pp. 1247-1249. Publisher: US: Lippincott Williams & Wilkins Abstract: Examined the efficacy of clonidine (CL) in the treatment of posttraumatic stress disorder (PTSD) symptoms (hyperarousal, impulsivity, aggression, and sleep difficulties) that did not lessen after individual, family, and structural/behavior treatment approaches (at least 1 mo in treatment). Seven children (aged 3-6 yrs) referred to a day hospital for severe physical abuse and/or sexual abuse and neglect were the Ss. Ss were given 0.05 mg of CL orally in the morning, and if this was tolerated, 0.05 mg at bedtime. Four of the 6 Ss given CL orally had a sedation side effect. They were then switched to a CL patch. Mild irritation was the main side effect from the patch. Aggression improved moderately to greatly in all Ss. In 5 of the 7 Ss, impulsivity, emotional outbursts and mood lability, hyperarousal, hypervigilance, generalized anxiety, oppositionality, insomnia, and nightmares improved. Relationships with staff and peers improved for all Ss. _____
Title: Traumatic stress reactions in police. Author(s): Higgins, Jeannie Nancy, U Wollongong, Australia Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 57(2-B), Aug 1996. pp. 1484. Publisher: US: Univ Microfilms International Abstract: A personal construct model of traumatic stress reactions was developed to predict the relationships between personal, trauma, and recovery factors. This model was evaluated in two studies with police. The cross-sectional study included 750 police recruits and inexperienced constables. The repeated measures study re-assessed 193 recruits after one year of policing. Data were obtained on history, personal theories, potentially traumatizing events, perceived availability of social support, and trauma symptoms. The existence of Posttraumatic Stress Disorder (PTSD) was assessed by structured interview with 20% of participants. Personal factors influenced the presence or severity of trauma symptoms. A negative personal theory, a family history of psychological assistance, a reported emotional abuse or neglect history, and Catholicism were significant explanatory variables. Some characteristics of traumatic events were significant predictors of trauma symptoms including the type of trauma, a perception of life threat, total exposure weighted by subjective impact, and personal identification with a traumatic event. Policing environments were conducive to traumatization and unfavourable to recovery from stressful life events. Constables in the cross-sectional study had PTSD prevalence rates of (6.05%) compared to recruits (3.36%). Current prevalence rates for PTSD in the repeated measures study for constables were (8.29%) compared to themselves as recruits (3.36%). Trauma symptoms were associated with being a constable with one year of operational experience. Exposure to, or the perceived relevance of, the current sources of information and advice predicted the presence of trauma symptoms in both studies. Participants who perceived emotional support as relevant had more severe trauma symptoms, irrespective of perceived availability, in the cross-sectional study. A perceived lack of availability of practical assistance following a traumatic event predicted the presence of tra _____
Title: Elder maltreatment and posttraumatic stress disorder. Author(s): Goldstein, Marion Zucker, State U New York, Dept of Psychiatry, Buffalo, NY, US Source: Aging and posttraumatic stress disorder. Ruskin, Paul E. (Ed); Talbott, John A. (Ed); pp. 127-135. Washington, DC, US: American Psychiatric Association, 1996. xi, 268 pp. Abstract: (from the chapter) victimization by physical, emotional, and material abuse during each phase of the life cycle has been underdetected and underreported, leading to underrecognition and misdiagnosis of manifestations of posttraumatic stress disorder (PTSD) at various times in the course of, or following, vicitimization / to focus attention on mistreatment experienced in late life, [the author considers] the definitions, incidence, prevalence, and research findings of 1) elder abuse, neglect, and exploitation; 2) sequelae of victimization on mental status; 3) common defenses used by victimizer and provider of formal care that contribute to the high prevalence of underdetection; and 4) common profiles of elderly victims and those they depend on / [examines how] the frail dependent elderly are a population at high risk for abuse, neglect, and exploitation _____
Title: Adult survivors of child abuse and neglect. Author(s): Goodwin, Jean M., U Texas, Medical Ctr, Galveston, TX, US Source: Family violence: A clinical and legal guide. Kaplan, Sandra J. (Ed); pp. 209-240. Washington, DC, US: American Psychiatric Association, 1996. xxi, 332 pp. Abstract: (from the chapter) review, with case illustrations, 3 presentations of adult psychopathology associated with different types of child maltreatment, as well as techniques of recognizing and treating these conditions / 3 syndromes of maltreatment sequelae [posttraumatic stress disorder (PTSD), borderline conditions, dissociative disorders] / legal commentary [issues related to victims, other family members, and offenders; guidance for mental health professionals and practitioners] _____
Title: Prior victimization: A risk factor for child sexual abuse and for PTSD-related symptomatology among sexually abused youth. Author(s): Boney-McCoy, Sue, U New Hampshire, Family Research Lab, Durham, US; Finkelhor, David Source: Child Abuse & Neglect, Vol 19(12), Dec 1995. pp. 1401-1421. Publisher: Netherlands: Elsevier Science Abstract: Studied the influence of prior victimization on posttraumatic stress disorder (PTSD) related symptomatology over and above the contribution made by the child sexual abuse episode, demographic factors, and quality of parent-child relation. 2,000 Ss (aged 10-16 yrs) were questioned about victimizations they might have experienced, including its sexual and non sexual forms. Trauma symptoms related to PTSD, 9 child sexual abuse episode characteristics, and quality of parent-child relationship were assessed using various scales. Parents of all Ss were interviewed regarding their demographic characteristics. Results indicate that a prior victimization acted as a risk factor for later child sexual abuse even when background variables were controlled for. It exacerbated the symptoms associated with PTSD. Prior victimization of a family member also predicted later child sexual abuse. (French & Spanish abstracts) _____
Title: Clinical characteristics related to severity of sexual abuse: A study of seriously mentally ill youth. Author(s): McClellan, Jon, Child Study & Treatment Ctr, Tacoma, WA, US; Adams, Julie; Douglas, Donna; McCurry, Chris; et al. Source: Child Abuse & Neglect, Vol 19(10), Oct 1995. pp. 1245-1254. Publisher: Netherlands: Elsevier Science Abstract: Examined demographic, social, and clinical variables related to sexual abuse histories (SA) in mentally ill youth (aged 5-18 yrs). A retrospective chart review of patients treated over a 5-year period (1987-92) at a tertiary care public sector psychiatric hospital was used to divide Ss into 4 groups: 226 with no SA, 62 with isolated events of SA, 61 with intermittent abuse, and 150 with chronic SA. Ss with SA history were usually female and had higher rates of social chaos, associated physical abuse, neglect, posttraumatic stress disorder (PTSD), and substance abuse disorders. Chronic SA Ss usually came from chaotic and abusive backgrounds, were younger when 1st abused, had the highest number of abusers (most often a close family member), and were most likely to have been molested. (Spanish abstract) _____
Title: Incest revisited: Delayed post-traumatic stress disorder in mothers following the sexual abuse of their children. Author(s): Green, Arthur H., Presbyterian Hosp, Family Ctr, New York, NY, US; Coupe, Pat; Fernandex, Rosemary; Stevens, Brooks Source: Child Abuse & Neglect, Vol 19(10), Oct 1995. pp. 1275-1282. Publisher: Netherlands: Elsevier Science Abstract: Presents 4 case histories of mothers who developed symptoms of posttraumatic stress disorder (PTSD) following the disclosure of sexual abuse (SA) of their daughters. All Ss had been incest victims during childhood. They manifested a variety of psychological symptoms including acute schizophrenic reaction, depression, insomnia, anorexia, and panic attacks. Awareness of SA of their daughters appeared to provoke a reliving of their own childhood victimization. None of the Ss had been able to disclose or discuss their victimization in the past. Intervention involved recognizing the possibility of a delayed PTSD, and using individual and group therapy, parenting education, social service support and crisis intervention, and psychotropic medication. Followup revealed that multidisciplinary intervention helped Ss in re-integrating their traumatic experiences into their personality. (French & Spanish abstracts) _____
Title: Commentary on "Incest revisited: Delayed Post-Traumatic Stress Disorder in mothers following the sexual abuse of their children." Author(s): Berliner, Lucy, Harborview Medical Ctr, Sexual Assault Ctr, Seattle, WA, US Source: Child Abuse & Neglect, Vol 19(10), Oct 1995. pp. 1311-1312. Publisher: Netherlands: Elsevier Science Abstract: Comments on 4 case studies of mothers, who developed symptoms of posttraumatic stress disorder (PTSD) following the disclosure of sexual abuse of their daughters. Though the cases provide clues to the conditions under which delayed onset of PTSD may occur, there is a need to identify the factors that led to the onset of unusually disturbed response in these mothers. Mothers' memories of incest victimization in childhood and preoccupation with their own distress might have posed a hindrance in their response to the needs of children, which might have depicted as PTSD. _____
Title: Psychological sequelae in adult females reporting childhood ritualistic abuse. Author(s): Lawrence, Kathy J., Grand River Hosp, Kitchener-Waterloo Health Ctr, ON, Canada; Cozolino, Louis; Foy, David W. Source: Child Abuse & Neglect, Vol 19(8), Aug 1995. pp. 975-984. Publisher: Netherlands: Elsevier Science Abstract: Explored the possibility that women reporting ritualistic sexual abuse may be characterized primarily by the severity of their abuse histories or the severity of their present psychological symptoms, rather than the veridicality of the ritualistic events. 19 female outpatients (mean age 38.7 yrs) reporting childhood sexual abuse with ritualistic features (CRA) were compared with 27 women (mean age 38.4 yrs) who reported childhood sexual abuse without ritualism (CSA) on characteristics of childhood sexual and physical abuse, current posttraumatic stress disorder (PTSD) diagnostic status and symptom severity, and severity of current dissociative experiences. Ss reporting CRA scored significantly higher on measures of childhood sexual and physical abuse. Neither PTSD diagnostic status nor severity of PTSD or dissociative experiences were significantly different between the 2 groups. (French & Spanish abstracts) _____
Title: Sexually inappropriate behaviors in seriously mentally ill children and adolescents. Author(s): Adams, Julie, U Washington, Dept of Psychiatry, Seattle, US; McClellan, Jon; Douglass, Donna; McCurry, Chris; et al. Source: Child Abuse & Neglect, Vol 19(5), May 1995. pp. 555-568. Publisher: Netherlands: Elsevier Science Abstract: Reviewed charts of seriously mentally ill 5-18 yr olds (334 boys and 165 girls) regarding sexually inappropriate behavior (SIB). Ss were grouped into 4 categories: no SIB (n=296), hypersexual (n=82), exposing (n=39) and victimizing (n= _____
Title: Post-traumatic stress disorders in women who experienced childhood incest. Author(s): Lindberg, Frederick H., Casper Psychological Services, WY; Distad, Lois J. Source: Child Abuse & Neglect, Vol 9(3), 1985. pp. 329-334. Publisher: Netherlands: Elsevier Science Abstract: Discusses symptoms exhibited in a clinical population of 17 women (aged 24-70 yrs) who had experienced childhood or adolescent incest that appear to fit the features of a chronic and/or delayed posttraumatic stress disorder (PTSD). All Ss entered individual therapy an average of 17 yrs after the abuse was terminated. Ss regarded their incest experience as the most damaging event of their lives and manifested, in adulthood, such symptoms as intrusive imagery of the incest, feelings of detachment or constricted affect, sleep disturbance, guilt, and intensification of symptoms when exposed to events resembling the incest trauma. It is noted that such maladaptive and self-destructive behaviors were often delayed or unrecognized by Ss for several years following the period of abuse. Treatment guidelines for alleviating PTSD include the establishment of trust, expression of feelings, guilt reduction through an understanding of family dynamics, and acquisition of adaptive behaviors. (French abstract) (23 ref)
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