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Circadian Rhythm and Trauma
Developmental NeuroBiology and DID
Developmental NeuroBiology and Dissociation
Developmental NeuroBiology and EMDR
Fornix and Trauma
Hippocampus Trauma and PTSD
Hypothalamus and PTSD
Developmental NeuroBiology and PTSD
Limbic System and Trauma
NeuroImaging and DID
Prefrontal Lobe and Trauma
NMRI and PTSD
NeuroImaging and Trauma
Neocortex and Trauma
MRI and Trauma
Dissociation and Affect Dysregulation
Developmental Traumatology
Developmental NeuroBiology and Trauma
Corpus Callosum and PTSD
Circadian Rhythm and Sleepwalking
Circadian Rhythm and REM Behavior Disorder
Cingulate Gyrus and Trauma
Circadiam Rhythm and PTSD
Circadian Rhythm DSM-IV
Cortisol and Dissociation
Cortisol and Trauma
Bipolar II Disorder
Bipolar I Disorder
Bipolar Disorder DSM-IV
BiPolar Disorder and Trauma
Bipolar Disorder and PTSD
Bipolar Disorder and DID
Basal Ganglia and Trauma
Basal Ganglia and PTSD
Aspergers Disorder DSM-IV
Aspergers Disorder and Infancy
Aspergers Disorder and Development
Aspergers Disorder and Childhood
Aspergers Disorder and Adolescence
Amygdala and PTSD
Amygdala and Fear
Affect Regulation-the Development of Psychopathology
Affect Regulation-Social Context on Childrens Affect Regulation
Affect Regulaqtion-Recurrent Abortiona in Bulimics
Affect Regulation-Mentalization and Development of The Self
Affect Regulation-Delayed memories of Childhood
Affect Regulation and Trauma
Affect Regulation and PTSD
Affect Dysregulation and Disorders of the Self
Affect Regulation and Attachment
ADHD and Trauma
Affect Dysregulation and Disorders of the Self
AffectDysregulation and Dissociation
Affect Regulation

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.

_______________________

 

FUNCTIONAL NEUROANATOMY

In order to best understand this atlas it is important to have a sense of the functional neuroanatomy of the brain. Over the next several pages there is a brief summary of the 5 major brain systems that relate to behavior, along with the general location seen on SPECT of these areas.


 

The Deep Limbic System


side active view


underside surface view


underside active view

Functions

  • sets the emotional tone of the mind

  • filters external events through internal states (emotional coloring)

  • tags events as internally important

  • stores highly charged emotional memories

  • modulates motivation

  • controls appetite and sleep cycles

  • promotes bonding

  • directly processes the sense of smell

  • modulates libido

Problems

  • moodiness, irritability, clinical depression

  • increased negative thinking

  • perceive events in a negative way

  • decreased motivation

  • flood of negative emotions

  • appetite and sleep problems

  • decreased or increased sexual responsiveness

  • social isolation

The Basal Ganglia System


left side active view


underside active view

Functions

  • integrates feeling and movement

  • shifts and smoothes fine motor behavior

  • suppression of unwanted motor behaviors

  • sets the body's idle or anxiety level

  • enhances motivation

  • pleasure/ecstasy

Problems

  • anxiety, nervousness

  • panic attacks

  • physical sensations of anxiety

  • tendency to predict the worst

  • conflict avoidance

  • Gilles de la Tourette's Syndrome/tics

  • muscle tension, soreness

  • tremors

  • fine motor problems

  • headaches

  • low or excessive motivation

The Prefrontal Cortex


dorsal lateral prefrontal cortex
outside view


inferior orbital prefrontal cortex
outside view


side surface view
dorsal lateral prefrontal area


inferior orbital prefrontal area
inside view


underside surface view
inferior orbital prefrontal area


top-down surface view
dorsal lateral prefrontal area

Functions

  • attention span

  • perseverance

  • judgment

  • impulse control

  • organization

  • self-monitoring and supervision

  • problem solving

  • critical thinking

  • forward thinking

  • learning from experience

  • ability to feel and express emotions

  • influences the limbic system

  • empathy

Problems

  • short attention span

  • distractibility

  • lack of perseverance

  • impulse control problems

  • hyperactivity

  • chronic lateness, poor time management

  • disorganization

  • procrastination

  • unavailability of emotions

  • misperceptions

  • poor judgement

  • trouble learning from experience

  • short term memory problems

  • social and test anxiety

The Cingulate Gyrus


inside side view


side active view


active top-down view


active front-on view

  • allows shifting of attention

  • cognitive flexibility

  • adaptability

  • helps the mind move from idea to idea

  • gives the ability to see options

  • helps you go with the flow

  • cooperation

Problems

  • worrying

  • holds onto hurts from the past

  • stuck on thoughts (obsessions)

  • stuck on behaviors (compulsions)

  • oppositional behavior, argumentative

  • uncooperative, tendency to say no

  • addictive behaviors (alcohol or drug abuse, eating disorders, chronic pain)

  • cognitive inflexibility

  • obsessive compulsive disorder

  • OCD spectrum disorders

  • eating disorders, road rage

The Temporal Lobes


side view


side surface view


underside surface view


active side view

Functions

Dominant Side (usually the left)

  • understanding and processing language

  • intermediate term memory

  • long term memory

  • auditory learning

  • retrieval of words

  • complex memories

  • visual and auditory processing

  • emotional stability

Problems

Dominant Temporal Lobe

  • aggression, internally or externally driven

  • dark or violent thoughts

  • sensitivity to slights, mild paranoia

  • word finding problems

  • auditory processing problems

  • reading difficulties

  • emotional instability

Non-dominant Side (usually the right)

  • recognizing facial expression

  • decoding vocal intonation

  • rhythm

  • music

  • visual learning

  • difficulty recognizing facial expression

  • difficulty decoding vocal intonation

  • implicated in social skill struggles


Either/Both Temporal Lobe Problems

  • memory problems, amnesia

  • headaches or abdominal pain without a clear explanation

  • anxiety or fear for no particular reason

  • abnormal sensory perceptions, visual or auditory distortions

  • feelings of déjà vu or jamais vu

  • periods of spaciness or confusion

  • religious or moral preoccupation

  • hypergraphia, excessive writing

  • seizures

 

 

Secure Attachments as a Defense Against Trauma

 “All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses.  Particularly early in life, the social context plays a critical role in fuffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses.  The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal.  Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984).  In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).”  van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds.  1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society.  New York and London: Guilford Press. .p. 185

_______________________

 

 

Sleep Disorders

 

            “The sleep disorders are organized into four major sections according to presumed etiology.  Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible.  Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors.  Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions).

            Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention.  Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation. 

            Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system.

            Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications).

            That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance.

            Five distinct sleep stages can be measured by polysomnography:  rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4).  Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults.  Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep.  Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time.  REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep.

            These sleep stages have a characteristic temporal organization across the night.  NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation.  REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes.  REM sleep periods increase in duration toward the morning.  Human sleep also varies characteristically across the life span.  After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range.  This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep.  Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual.

            Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity.  Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea.  Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep.  Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night.  However, daytime polysomnographic studies also are used to quantify daytime sleepiness.  The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day.  Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness.  The converse of the MSLT is also used:  In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day.  Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness.

            Standard terminology for polysomnographic measures is used throughout the test in this section.  Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep.  “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness.  Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity).  Sleep architecture refers to the amount and distribution of specific sleep stages.  Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency).

            The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders:  (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association.

_________________

 

Substance Dependence

Features

The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems.  There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior.  A diagnosis of Substance Dependence can be applied to every class of substances except caffeine.  The symptoms of Dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for Hallucinogenic Dependence).  Although not specifically listed as a criterion item, “craving” (a strong subjective drive to use the substance) is likely to be experienced by most (if not all) individuals with Substance Dependence.  Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time in the same 12-month-period.

Tolerance (Criterion 1) is the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance.  The degree to which tolerance develops varies greatly across substances.  Furthermore, for a specific drug, varied degrees of tolerance may develop for its different central nervous system effects.  For example, for opioids, tolerance to respiratory depression and tolerance to analgesia develop at different rates.  Individuals with heavy use of opioids and stimulants can develop substantial (e.g., 10-f0ld) levels of tolerance, often to a dosage that would be lethal to a nonuser.  Alcohol tolerance can also be pronounced, but is usually less extreme than for amphetamine.  Many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking.  Individuals with heavy use of cannabis or phencyclidine (PCP) are generally not aware of having developed tolerance (although it has been demonstrated in animal studies and in some individuals).  Tolerance may be difficult to determine by history alone when the substance used is illegal and perhaps mixed with various diluents or with other substances.  In such situations, laboratory tests may be helpful (e.g., high blood levels of the substance coupled with little evidence of intoxication suggest that tolerance is likely).  Tolerance must also be distinguished from individual variability in the initial sensitivity to the effects of particular substances.  For example, some first-time drinkers show very little evidence of intoxication with three or four drink, whereas others of similar weight and drinking histories had slurred speech and incoordination.

Withdrawal (Criterion 2a) is a maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance.  After developing unpleasant withdrawal symptoms, the persons is likely to take the substance to relieve or to avoid those symptoms (Criterion 2b), typically using the substance throughout the day beginning soon after awakening.  Withdrawal symptoms, which are generally the opposite of the acute effects of the substance, vary greatly across the calluses of substances, and separate criteria sets for Withdrawal are provided for most of the classes.  Marked and generally easily measured physiological signs of withdrawal are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics.  Withdrawal signs and symptoms are often present, but may be less apparent, with stimulants such as amphetamines and cocaine, as well as with nicotine and cannabis.  No significant withdrawal is seen even after repeated use of hallucinogens.  Withdrawal from phencyclidine and related substances has not yet been described in humans (although it has been demonstrated in animals).  Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence.  However, for most classes of substances, a past history of tolerance or withdrawals is associated with a more severe clinical course (i.e., an earlier onset of Dependence, higher levels of substance intake, and a greater number of substance-related problems).  Some individuals (e.g., those with Cannabis Dependence) show a pattern of compulsive use without obvious signs of tolerance or withdrawal.  Conversely, some general medical and postsurgical patients without Opioid Dependence may develop a tolerance to prescribed opioids and experience withdrawal symptoms without showing any signs of compulsive use.  The specifiers With Physiological Dependence and Without Physiological Dependence are provided to indicate the presence or absence of tolerance or withdrawal.

The following items describe the pattern of compulsive substance use that is characteristic of Dependence.  The individual may take the substance in larger amounts or over a longer period than was originally intended (e.g., continuing to drink until severely intoxicated despite having set a limit of only one drink) (Criterion 3).  The individual may express a persistent desire to cut down or regulate substance use.  Often, there have been many unsuccessful efforts to decrease or discontinue use (Criterion 4).  The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 5).  In some instances of Substance Dependence, virtually all of the person’s daily activities revolve around the substance.  Important social, occupational, ore recreational activities may be given up or reduced because of substance use (Criterion 6).  The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with substance-using friends.  Despite recognizing the contributing role of the substance to a psychological or physical problem (e.g., sever depressive symptoms or damage to organ systems), the person continues to use the substance (Criterion 7).  The key issue in evaluating this criterion is not eh existence of the problem, but rather the individual’s failure to abstain from using the substance despite having evidence of the difficulty it is causing.

 

Specifiers

            Tolerance and withdrawal may be associated with a higher risk for immediate general medical problems and a higher relapse rate.  Specifiers are provided to note their presence or absence:

With Physiological Dependence.  This specifier should be used when Substance Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal (Criterion 2).

Without Physiological Dependence.  This specifier should be used when there is no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2).  In these individuals, Substance Dependence is characterized by a pattern of compulsive use (at least three items from Criteria 3-7).”

 

Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. P. 193-195.

 

 

 

_______________________

 

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)."

 

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.

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

__________________

Major Depressive Disorder

Diagnostic Features

The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C).  Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder.  In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B).

            The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent.  It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes.  For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months.  During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission).

            The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance.  If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features.  If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission.

            If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder.  However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted.  Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369

Course

Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s.  Epidemiological data suggest that the age at onset is decreasing for those born more recently.  The course of Major Depressive Disorder, Recurrent, is variable.  Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older.  Some evidence suggests that the periods of remission generally last longer early in the course of the disorder.  The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode.  At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode.  Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance  of having a fourth.  About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder).

            Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases).  For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery.  The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value.  A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode.  Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state.

            Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder.  The severity of the initial Major Depressive Episode appears to predict persistence.  Chronic general medical conditions are also a risk factor for more persistent episodes.

            Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce.  Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes.  Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder.

            It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder.  Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder.  A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373

 

Diagnostic and statistical manual of mental disorders. 2000. 4th ed.  Washington, D.C.: American Psychiatric Association.

 

________________

Major Depressive Disorder

 “Diagnostic Features

The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C).  Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder.  In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B).

            The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent.  It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes.  For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months.  During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission).

            The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance.  If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features.  If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission.

            If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder.  However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted.  Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369

 “Course

Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s.  Epidemiological data suggest that the age at onset is decreasing for those born more recently.  The course of Major Depressive Disorder, Recurrent, is variable.  Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older.  Some evidence suggests that the periods of remission generally last longer early in the course of the disorder.  The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode.  At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode.  Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance  of having a fourth.  About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder).

            Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases).  For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery.  The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value.  A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode.  Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state.

            Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder.  The severity of the initial Major Depressive Episode appears to predict persistence.  Chronic general medical conditions are also a risk factor for more persistent episodes.

            Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce.  Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes.  Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder.

            It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder.  Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder.  A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373

 Diagnostic and statistical manual of mental disorders. 2000. 4th ed.  Washington, D.C.: American Psychiatric Association.

________________

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

 1Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York: Guilford Press.

2Shapiro, F. (2002). EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism. Washington, DC: American Psychological Association Books.

 

 

 

 

NeuroBiology of Trauma

 

Affect Regulation and Trauma

Title: An attachment theory conceptualization of adults who have witnessed domestic violence as children:  Adult attachment styles and implications for treatment.                               

Author(s)/Editor(s): Patton, Kimberly Anne      Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 62(9-B) Apr 2002, US: Univ Microfilms International; 2002, 4231           

 Abstract/Review/Citation: This study indirectly examined the population of adults who have witnessed domestic violence as children within the context of attachment theory. Implications were drawn for treatment approaches, utilizing Bartholomew's and Horowitz's (1991) four adult attachment styles: secure, preoccupied, dismissing, and fearful. Up to the present time, there has been little research on adults who have witnessed domestic violence as children. The study expanded the research to include this population as well as derive unique treatment measures for these individuals.  Treatment recommendations were formulated from synthesizing the literature on witnessing domestic violence and attachment theory. These recommendations were delineated for the four attachment styles, including general treatment considerations and trauma-focused treatment. The interventions included several treatment parameters for each attachment style, such as goals of treatment, psychopathology, the therapeutic relationship, affect regulation, and internal working models.  Additionally, qualitative research was conducted exploring clinicians' treatment approaches with a domestic violence population. A nonrandom, national sample of 32 clinicians was recruited from domestic violence agencies. Participants completed a questionnaire requesting demographic information, perceptions of therapeutic issues with adults who have witnessed childhood domestic violence, treatment approaches with such clients, and the application of attachment concepts in therapy.  Several areas were identified by clinicians as attachment-based clinical issues and treatment interventions for adult witnesses of childhood domestic violence. Addressing issues with self-esteem, affect, trauma, interpersonal relationships, and the therapeutic relationship were seen as important for all attachment styles. Group therapy, couples therapy, psychodynamic psychotherapy, and psychoeducation were seen as useful interventions for each of the attachment styles. In addition, cognitive-behavioral therapy was recommended for clients with insecure attachment styles. Recommendations for specific attachment styles were as follows: for individuals with a secure attachment style, treatment focused on accessing these clients' strengths to help them cope with past trauma. Preoccupied clients' poorly regulated affect, low self-esteem, rejecting interpersonal relationships, and inadequate defenses were a focus. With dismissing clients, interpersonal relationships, particularly the therapeutic relationship, behavioral problems, cognitive distortions, and emotional constriction were emphasized. For individuals with a fearful attachment style, trauma resolution, safety, coping, dysregulated affect, and chaotic relationships were seen as important clinical issues. ======================================== 

Title: Ueberlebende von folter. Eine studie zu komplexen postraumatischen belastungsstoerungen./ Survivors of torture: A study of complex posttraumatic stress disorders.

Author(s)/Editor(s): Teegen, Frauke; Vogt, Silke

Author Affiliation: U Hamburg, Psychologisches Inst III, Hamburg, Germany Paper Number: 20020807

Source/Citation: Verhaltenstherapie & Verhaltensmedizin; Vol 23(1) 2002, Germany: Pabst Science Publishers; 2002, 91-106

Abstract/Review/Citation: The objective of this study was to question survivors of torture about the context and kind of the sustained torture and to administer a screening of lasting physical sequelae and symptoms of PTSD. Assuming that the experience of torture leads to very comprehensive trauma

related syndromes, the construct of complex PTSD was additionally included. As item version was constructed on the basis of the Structured Interview of Disorders for Extreme Stress, which captures changes in affect regulation, self-perception, relationship capability, systems of meaning as well as

somatic disorders. 33 survivors participated (male and female; mean age 41 yrs old). When experiencing torture for the first time, 21% were younger than 16 yrs old. 83% sustained lasting physical damage. PTSD was diagnosed in 94%. In addition to the syndrome of PTSD, two thirds exhibited the entire syndrome of

a complex PTSD.  ========================================

 

Title: Borderline-Stoerung und Verzerrungen der Aufmerksamkeit. Theoretische Modelle und empirische Befunde./ Borderline personality disorder and attentional biases. Theoretical models and empirical findings.

Author(s)/Editor(s): Ceumern-Lindenstjerna, Ina-Alexandra v.;

Brunner, R.; Parzer, P.; Fiedler, P.; Resch, F.

Author Affiliation: U Heidelberg, Psychiatrische Klinik, Abteilung Kinder- und Jugendpsychiatrie, Heidelberg, Germany U Heidelberg, Psychiatrische Klinik, Abteilung Kinder- und Jugendpsychiatrie, Heidelberg, Germany Ruprecht-Karls-U

Heidelberg, Inst fuer Psychologie, Abteilung Klinische Psychologie und Psychotherapie, Heidelberg, Germany U Heidelberg, Psychiatrische Klinik, Abteilung Kinder- und Jugendpsychiatrie, Heidelberg, Germany Paper Number: 20020828

Source/Citation: Fortschritte der Neurologie, Psychiatrie; Vol 70(6) Jun 2002, Germany: Georg Thieme Verlag; 2002, 321-330.

Abstract/Review/Citation: Comparatively describes three theoretical models of borderline personality disorder and their possible links to attentional biases. The dialectical behavior approach postulates a pronounced attentional narrowing to emotional stimuli in connection with deficits regarding affect regulation. The cognitive approach assumes that rigid dysfunctional schemata initiate a cognitive emotional circuit, which leads to a reinforcement of the symptomatology as a result of a biased perception and memory. Additionally the

present article specifies the trauma approach which emphasizes the relation between borderline pathology and childhood trauma with recourse to theories of attentional biases in patients with traumatic experiences. Preliminary empirical findings suggest that patients with borderline personality disorder demonstrate a general attentional bias for any emotional negative stimuli and

not a selective attentional bias to borderline-specific stimuli. Further studies should clarify, whether therapeutical interventions with the aim to influence attentional processes represent a useful complement to established therapies in patients with borderline personality disorder.  ========================================

 

Title: Trauma, repetition, and affect regulation: The work of Paul Russell: Book review.

Author(s)/Editor(s): Teicholz, Judith Guss; Kriegman, Daniel

Source/Citation: Psychoanalytic Psychology; Vol 19(2) Spr 2002, US: American Psychological Assn/Educational Publishing Foundation; 2002, 409-415

Abstract/Review/Citation: Review of book, Judith Guss Teicholz and Daniel Kriegman (Eds.), Trauma, Repetition, and Affect Regulation: The Work of Paul Russell. New York: Other Press, 1998, 154 pp., $22.00. Reviewed by Rafael Art. Javier.

========================================

 

Title: The tie that binds: Sadomasochism in female addicted trauma survivors.

Author(s)/Editor(s): Southern, Stephen

Source/Citation: Sexual Addiction & Compulsivity: Special Issue: Women and sexual addiction.; Vol 9(4) 2002, United Kingdom: Taylor & Francis; 2002, 209-229

Abstract/Review/Citation: Women who develop addictive disorders to survive life trauma present a wide array of variant and perverse behaviors. This overview of sadomasochism examines the life trauma syndrome and the survival functions

of addictions including self-injurious behavior, eating disorder, and sexual addiction. The etiology of sadomasochism is found in object relations damaged by neglect or abuse. Sadomasochistic dynamics function like brainwashing to oppress women in a subordinate position. Survivors turn childhood tragedy into

triumph through sadomasochistic re-enactments of life trauma. An omnibus, developmentally-based psychotherapy for treating the ego states of female addicted trauma survivors included abstinence from addictive behaviors, abreaction of unresolved trauma, information reprogramming or reprocessing of trauma-related cognitive distortions, acquisition of nonaddictive affect

regulation and self-management skills, prevention of relapse, and enhancement of capacity for intimacy, creativity, and spirituality. Case studies are presented to explore the types of sadomasochism and state-dependent treatment recommendations across five life domains.  ========================================

 

Title: Trauma recovery in female survivors:  Age, affect regulation and safe attachment.

Author(s)/Editor(s): Bolduc-Hicks, Lynda Lee

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 63(5-B) Dec 2002, US: Univ Microfilms International; 2002, 2573

Abstract/Review/Citation: The purpose of this retrospective study was to examine the relationship between age, Affect Regulation and Safe Attachment in adult female survivors of interpersonal trauma and identify differences between survivor groups differing in onset of trauma and recovery status. Clinicians working with trauma survivors in outpatient mental health settings completed assessments of resilience and recovery using the Multidimensional Trauma Recovery and Resiliency Scale (MTRR) designed to assess the ways in which

survivors of trauma respond to their experiences. Pearson correlations were conducted using MTRR data for 125 female survivors of trauma to identify the relationship between age, Affect Regulation, and Safe Attachment with all survivors and the differences between survivors based on these areas of

psychological functioning. Several hypotheses were explored in this study. First, it was hypothesized that there would be a positive relationship between age, Affect Regulation, and Safe Attachment within each of these three groups as a result of the interrelationship between affect and interpersonal relationships. Findings demonstrated that both domain scores for each group of survivors showed clear trends suggesting that Safe Attachment and Affect Regulation were positively related. Differences were postulated between the three groups of survivors on onset of trauma, recovery status and by the MTRR

domains of Safe Attachment and Affect Regulation according to mean MTRR domain scores. A MANOVA was conducted to identify differences in variation in MTRR scores across recovery status and for onset of trauma. No distinctions between groups were found as a result of onset of trauma however a significant main effect was found for recovery status as it demonstrated the ability to distinguish stages of recovery based on mean scores. Significant interaction effects were revealed from mean scores on Safe Attachment concerning an expected trajectory of recovery for all survivors. Lastly, it was also hypothesized that mean scores would increase as a result of adult development or chronological age where older survivors of interpersonal violence would obtain higher MTRR mean scores independent of onset of exposure to interpersonal violence. Various findings for the Pearson Correlations and

multivariate analysis of variance are discussed following clinical implications of the results.  ========================================

 

Title: Affect management in group therapy for women with posttraumatic stress disorder and histories of childhood sexual abuse.

Author(s)/Editor(s): Wolfsdorf, Barbara A.; Zlotnick, Caron

Source/Citation: Journal of Clinical Psychology: Special Issue: Treating emotion regulation problems in psychotherapy.; Vol 57(2) Feb 2001, US: John Wiley & Sons Inc; 2001, 169-181

Abstract/Review/Citation: Affect dysregulation is pervasive among women with histories of childhood sexual abuse. It is an important aspect of the clinical presentation of posttraumatic stress disorder (PTSD), a disorder that frequently characterizes survivors of childhood abuse. Based on distinctions between approach and avoidance orientations to coping, there is controversy regarding whether initial treatment for trauma survivors should employ an exposure-based approach to increase affect or an affect-management approach to reduce it. In this article, the authors review theoretical and empirical literature regarding affect dysregulation and its relations with childhood

sexual abuse and PTSD. A new affect-management group for adult survivors of childhood sexual abuse is described that is based on a stage approach to the treatment of trauma. This group emphasizes skill acquisition, symptom reduction, and patient stabilization. Affect-management strategies such as

mindfulness, crisis planning, and challenging distorted thinking are presented to patients. Preliminary research findings support the use of this treatment.

========================================

 

Title: The effects of early relational trauma on right brain development, affect regulation, and infant mental health.

Author(s)/Editor(s): Schore, Allan N.

Source/Citation: Infant Mental Health Journal: Special Issue: Contributions from the decade of the brain to infant mental health. ; Vol 22(1-2) Jan-Apr 2001, US: John Wiley & Sons Inc; 2001, 201-269

Abstract/Review/Citation: A primary interest of the field of infant mental health is in the early conditions that place infants at risk for less than optimal development. The fundamental problem of what constitutes normal and abnormal development is now a focus of developmental psychology, infant psychiatry, and developmental neuroscience. In the 2nd part of this sequential

work, the author presents interdisciplinary data to more deeply forge the theoretical links between severe attachment failures, impairments of the early development of the right brain's stress coping systems, and maladaptive infant mental health. He

comments on topics such as the negative impact of traumatic attachments on brain development and infant mental health, the neurobiology of infant trauma, the neuropsychology of a disorganized/disoriented attachment pattern associated with abuse and neglect, the etiology of dissociation and body-mind

psychopathology, the effects of early relational trauma on enduring right hemispheric function, and some implications for models of early intervention. These findings suggest direct connections between traumatic attachment, inefficient right brain regulatory functions, and both maladaptive infant and

adult mental health.  ========================================

 

Title: Attachment status, affect regulation, and behavioral control in young adults.

Author(s)/Editor(s): Allen, Sarah Turrentine

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 61(8-B) Mar 2001, US: Univ Microfilms International; 2001, 4386

Abstract/Review/Citation: The present study evaluates predictions based on the model of development of behavioral self-control proposed by Schore (1994), which suggests that children develop the abilities to regulate affect and control self-destructive behaviors in the context of primary attachment relationships. The model proposes that insecurely attached children do not fully develop the experience-dependent neuronal control pathways necessary for behavioral inhibition, which leaves them vulnerable to potentially lifelong difficulties with impulse control. To test these predictions, 198 college

students were administered measures of sensory regulation, attachment status, and child abuse and trauma, as well as measures of hypothesized outcomes related to poor impulse control, including substance use, risky sexual behavior, bulimia, verbal aggressiveness, and Attention Deficit Hyperactivity

Disorder (ADHD) symptoms, as well as a measure of general psychological distress. Multiple regression was used to predict each hypothesized outcome as a function of sensory regulation and attachment status. The combination of attachment status and sensory regulation was significantly predictive of cigarette, alcohol, and marijuana use, bulimic symptomatology, and ADHD

symptoms, but not other drug use, risky sexual behavior, or verbal aggressiveness. Sensory regulation was a more significant contributor to prediction than was attachment status, possibly due to psychometric limitations of the measure of attachment. Additionally, attachment status and sensory regulation appear to be equally predictive of general psychopathology, rather than specific to problems of poor impulse control. The second phase of the study compared the normative sample with a clinical sample of college students (n = 21) in treatment for substance abuse disorders. The clinical substance-abusing group did not differ from the normative sample in rate of insecure attachment classification or sensory regulatory capacity. The results suggest a more general model for the role of insecure attachment and poor sensory regulation in the development of general psychological symptoms, rather than being specific to the development of impulse control problems, and a direct impact of poor regulatory capacity as well as an indirect contribution mediated by attachment status is proposed.  ========================================

 

Title: Hope when there is no hope: Discussion of Jill Scharff's case presentation.

Author(s)/Editor(s): Bromberg, Philip M.

Source/Citation: Psychoanalytic Inquiry; Vol 21(4) 2001, US: Analytic Press; 2001, 519-529

Abstract/Review/Citation: Comments on the article by J. S. Scharff concerning object relations therapy with a 35-yr-old female who is a survivor of childhood sexual trauma. The case material is viewed and discussed here from the vantage point of the 2 partners being an interpenetrating unit held in the grip of an "enactment"--an intrapsychic phenomenon that is played out interpersonally. The relationship between trauma, dissociation, shame, and affect regulation is explored in the context of impasse, repair, and psychoanalytic "technique."  ========================================

 

Title: Treating patients with symptoms--and symptoms with patience: Reflections on shame, dissociation, and eating disorders.

Author(s)/Editor(s): Bromberg, Philip M.

Source/Citation: Psychoanalytic Dialogues; Vol 11(6) 2001, US: Analytic Press; 2001, 891-912

Abstract/Review/Citation: The author offers the view that the symptom picture found in most patients with eating disorders, as well as in the symptomatology of many other so-called difficult patients, is the end result of prolonged

necessity in infancy to control traumatic dysregulation of affect. The author proposes that the central issue for an eating- disordered patient is that she is at the mercy of her own physiologic and affective states because she lacks an experience of human relatedness and its potential for reparation that mediates self-regulation. She is enslaved by her felt inability to contain desire as a regulatable affect and is thus unable to hold desire long enough to make choices without the loss of the thing not chosen leading to a dread of self-annihilation. Trauma compromises trust in the reparability of relationship, and for symptoms to be surrendered, trust and reparability must be simultaneously restored. Because felt desire is the mortal enemy of an eating-disordered patient, this fact becomes a central dynamic in the analytic field, leading analyst and patient into a struggle over who shall hold the desire and whether the issue of control over food is allowed to become a subject for negotiation.  ========================================

 

Title: Treating low-income and African American women with posttraumatic stress disorder: A case series.

Author(s)/Editor(s): Feske, Ulrike

Source/Citation: Behavior Therapy; Vol 32(3) Sum 2001, US: Assn for Advancement of Behavior Therapy; 2001, 585-601

Abstract/Review/Citation: The present uncontrolled case series was designed to examine the feasibility of prolonged exposure (PE) for posttraumatic stress disorder (PTSD) with low-income and African-American women. Five of 10 eligible women completed PE and showed significant improvements in symptoms of PTSD, general anxiety, and depression. Clinical observations suggest that the addition of interventions aimed at improving interpersonal problems might lead to a more complete recovery in this population of women with complex trauma and psychiatric histories and that a priming intervention focused on teaching affect-regulation skills might enhance the effectiveness of PE. The removal of structural barriers (e.g., lack of transportation and child care) appears to be necessary in order to boost the benefits of traditional treatment interventions in disadvantaged women. 

========================================

 

Title: Compulsive cybersex: The new tea room.

Author(s)/Editor(s): Schwartz, Mark F.; Southern, Stephen

Source/Citation: Sexual Addiction & Compulsivity: Special Issue: Cybersex: The dark side of the force; Vol 7(1-2) 2000, US: Brunner/Mazel; 2000, 127-144

Abstract/Review/Citation: Cybersex has become the new tea room for meeting anonymous partners and engaging in a fantasy world in which survivors of childhood abuse escape the demands of daily life as well as the pain and shame of past trauma. Compulsive cybersex is described as a survival mechanism

involving dissociative reenactment and affect regulation. Descriptive data from a clinical population of cybersex abusers (aged 17-66 yrs) were reviewed to construct four subtypes of cybersex addiction: male cybersex addicts, female cybersex addicts, loner cybersex addicts, and paraphiliac cybersex addicts. Treatment strategies for each of the subtypes are recommended.  ========================================

 

Title: Affect regulation and the development of psychopathology.

Author(s)/Editor(s): Bradley, Susan J.

Source/Citation: New York, NY, US: The Guilford Press; 2000, (xii, 324)

Abstract/Review/Citation: The volume presents current findings on such risk factors as loss, trauma, and abuse; temperamental or stress reactivity; brain insult; attachment difficulties; and sensitivity to expressed emotion or familial conflict. Showing that these traits and experiences have all been

linked to psychological problems, the author demonstrates that they also share a tendency to disrupt the regulation of affect. She details the development of affect regulation, with special attention to the influence of learning and experience on the physiology, chemistry, and structure of the brain. The book shows how disruptions in this aspect of development make some individuals more likely than others to experience heightened states of distress or emotional arousal. Chapters then address links to behavioral disorders, affective spectrum disorders, and the psychoses. The book will be a resource for practitioners, students, and researchers in clinical psychology, psychiatry, and related mental health disciplines; and as a text in graduate-level

courses.

Notes/Comments:  Part I: Overview The model and its rationale

Part II: The evidence An introduction to affect regulation and its development Constitutional and genetic factors The caregiving environment Stress, trauma, and abuse Coping: Learning and experience The neurobiology of affect regulation Therapeutic considerations

Part III: Clinical syndromes Internalizing disorders: Anxiety, mood, and relational disorders Externalizing disorders: The disruptive behavior disorders Psychotic disorders

Part IV: Final remarks Future directions References Index risk factors for psychological disturbance & affect development dysregulation, development of psychopathology

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Title: Peeking through the door to the 21st century.

Author(s)/Editor(s): Frank, Ellen; Kupfer, David J.

Source/Citation: Archives of General Psychiatry; Vol 57(1) Jan 2000, US: American Medical Assn; 2000, 83-85

Abstract/Review/Citation: Discusses 6 questions concerning psychiatry in the 21st century. The questions are (1) how does life experience alter gene expression in vulnerable individuals? (2) what are the neurobiological effects of psychotherapy? (3) how does trauma lead to such a wide and complex range of symptoms? (4) can we develop adverse effect-free pharmacotherapies? (5) what is the connection between various physical illnesses and mood and anxiety regulation? and (6) how does the aging process affect disorder expression and

treatment?  ========================================

 

Title: Attachment disorders in children: An integrated treatment approach.

Author(s)/Editor(s): Kelly, Victoria Jackson

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(8-B) Mar 2000, US: Univ Microfilms International; 2000, 4228

Abstract/Review/Citation: This dissertation focuses on the severe manifestations of the disorganized/disoriented attachment pattern that constitute attachment disorders in children. Attachment disorders derive from early experiences of severe maltreatment, compounded by often multiple losses of attachment relationships. Attachment disorders are evidenced by serious disturbances in both behavior and relationships. These disturbances appear intractable as the child replicates his or her dysfunctional patterns in all subsequent relationships. This dissertation utilizes the concept of internal working models to explain how these patterns evolve and are maintained. Attachment disorders are viewed from the perspective of cumulative trauma with significant insult to the developing systems of affect, cognitive and neurophysiological regulation. As the trauma precludes the effective regulation of these systems, subsequent impingement is seen on the child's developing self-system and interpersonal functioning. This dissertation seeks to explain the interrelated and mutually iterative process in the development and regulation of these systems. This perspective then enables a broader understanding of the cumulative effects of unresolved attachment-related

trauma. Recommendations for an integrated treatment approach are provided.  ========================================

 

Title: The utilization of the Rorschach Ink Blot Test to determine affect dysregulation among an inpatient population of sexual trauma survivors.

Author(s)/Editor(s): Aspenleiter, Julie Ann

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 61(6-B) Jan 2000, US: Univ Microfilms International; 2000, 3269

Abstract/Review/Citation: This study examined the ability to regulate affect among individuals who report a history of abuse. The Rorschach structural summaries of sixty subjects were selected from an archival data base of an adult inpatient unit based on subjects' self report of having been the victim of sexual abuse prior to the age of 18 years. The subjects were divided into two groups and differentiated by severity and duration of abuse, victim's relationship to the perpetrator, and victim's age of onset of abuse. Specific Rorschach structural variables and ratios were compared statistically to determine variance between the two groups and the normative population. As hypothesized, subjects who reported a more severe history of abuse demonstrated greater dysregulation in the ability to modulate their emotions as determined by the Rorschach Ink Blot Test. Contrary to prediction, subject's dysregulation manifested as mostly avoidant with surprisingly only minimal indications of unmodulated expression of emotion. The author underscores the importance of clinicians taking into consideration the role of

affect regulation in the treatment of trauma survivors.  ========================================

 

Title: Stress and health:  Research and clinical applications.

Author(s)/Editor(s): Kenny, Dianna T.; Carlson, John G.; McGuigan, F. Joseph; Sheppard, John L.

Source/Citation: Amsterdam, Netherlands: Harwood Academic Publishers; 2000, (xiii, 467)

Abstract/Review/Citation: Presents a global perspective on current developments in the field of stress divided into five broad categories. These categories include biological, physiological and psychological bases of stress; health consequences of stress; management of stress and stress-related disorders; stress, cardiovascular disease and cancer; and occupational stress.

Notes/Comments:  List of contributors Section 1:

Introduction Background and overview to stress and health: Research and clinical applications John G. Carlson

Section 2: Biological, physiological and psychological bases of stress The role of oscillations in self-regulation: Their contribution to homeostasis Nicholas Giardino, Paul Lehrer and Jonathan Feldman The physiology of stress Richard Gevirtz Psychological foundations of stress and coping: A developmental perspective Dianna T. Kenny

Section 3: Health consequences of stress Chronic pain: Neural basis and interactions with stress David J. Tracey, Judith Walker and John J. Carmody Stress, senescence and longevity: How are they connected? Paul Rosch Stress and sexual function Marita P. McCabe

Section 4: Management of stress and stress-related disorders

Why might stress management methods be effective? F. Joseph McGuigan Biofeedback and stress Michael G. McKee and Jerome F. Kiffer Stress management: What can we learn from the meditative disciplines? Johann Stoyva Behavior change following affect shift: A model for the treatment of stress disorders John L. Sheppard Stress management in health education Joe Macdonald Wallace Stress management and prevention on a European community level: Options and obstacles Lennart Levi Cognitive-behavioral treatment of insomnia: Knitting up the ravell'd sleeve of care Richard R. Bootzin Cognitive-behavioral theory, research, and treatment of trauma disorders John

G. Carlson and Claude M. Chemtob

Section 5: Stress, cardiovascular disease and cancer Personality as a risk factor in cancer and coronary heart disease Hans J. Eysenck Psychosocial aspects of cancer control Rob Sanson-Fisher and Billie Bonevski Caffeine and stress Jack E. James Implementation of relaxation therapy within a cardiac rehabilitation setting Jan van Dixhoorn

Section 6: Occupational stress Occupational stress: Reflections on theory and practice Dianna T. Kenny Measuring stress in the workplace: The Job Stress Survey Charles Spielberger, Eric Reheiser, John Reheiser and Peter R. Vagg The frustration of success: Type A behavior, occupational stress and cardiovascular disease Donald G. Byrne Stress in academe: Some recent research findings Anthony H. Winefield Index stress; health; biological; physiological; psychological; bases of stress; health consequences; management; stress related disorders; cardiovascular disease; cancer; occupational stress

Conference Proceedings/Symposia 0600 ========================================

 

Title: Transforming aggression:  Psychotherapy with the difficult-to-treat patient.

Author(s)/Editor(s): Lachmann, Frank M.

Source/Citation: Northvale, NJ, US: Jason Aronson, Inc; 2000, (xiii, 262)

Abstract/Review/Citation: Designed to avoid escalating spirals of aggression and prevent therapeutic stalemates, the process of change begins with an understanding of the nature, causes, and function of the patient's aggression. Distinguishing between reactive and eruptive aggression, the author identifies

the specific adverse developmental conditions that contribute to the latter. Some of the factors examined are experiences of abuse, deception, and neglect; early failure to establish self-soothing and affect regulation; deficiencies in the mother-infant dyad that interfere with the development of self-cohesion and increase self-fragmentation; neurological abnormalities; and an

intolerance of feelings of shame. The therapeutic process is presented with rich clinical material that highlights the effects of spontaneity, humorous exchanges, improvisational interplay, and non-interpretive comments rather than rigorous attention to technically correct interventions. The dimensions of the transference are richly elaborated, and the devaluations of the

therapist characteristic of these patients are deeply and broadly understood.

Notes/Comments:  Preface Acknowledgments Self psychology

strikes back The aggressive toddler and the angry adult The view from Motivational Systems Theory State transformations in psychoanalytic treatment State transformations and trauma State transformations through creativity The transformation of reactive aggression into eruptive aggression It's better to be feared than pitied The empathy that enrages A requiem for

countertransference A systems view Self psychology and the varieties of aggression References Credits Index  ========================================

 

Title: Applying hypnosis in pain management: Implications of alternative theoretical perspectives.

Author(s)/Editor(s): Chaves, John F.

Source/Citation: Clinical hypnosis and self-regulation:  Cognitive-behavioral perspectives., Washington, DC, US: American Psychological Association; 1999, (ix, 370), 227-247 Dissociation, trauma, memory, and hypnosis book series.

Source editor(s): Kirsch, Irving (Ed)

Abstract/Review/Citation: The author first looks at some of the historical barriers to wider acceptance of hypnosis in pain management. The author then examines the implications of approaching the hypnotic relief of pain from a cognitive-behavioral perspective rather than a traditional hypnotic-state

theory. The most important features of each phase of the hypnotic intervention are examined separately. Various features of patient selection, preparation, induction procedures, deepening procedures, therapeutic suggestions, and posthypnotic suggestions and termination all interact and affect the outcome of hypnotic intervention in pain management.

========================================

 

Title: The relationship between eating disorders and childhood trauma.

Author(s)/Editor(s): de Groot, Janet; Rodin, Gary M.

Source/Citation: Psychiatric Annals; Vol 29(4) Apr 1999, US: SLACK Incorporated; 1999, 225-229

Abstract/Review/Citation: Reviews the research regarding the relationship between childhood sexual abuse (CSA) and the development of eating disorders. Most evidence suggests that CSA is a risk factor for eating disorders, particularly bulimia nervosa. This relationship is not specific and CSA may also lead to other psychological disturbances, including depression and

borderline personality disorder, in the presence of other risk factors. The association of CSA and bulimia nervosa may occur because of common underlying psychopathology, particularly disturbed affect regulation and the tendency to dissociate. Eating disorders and other psychological disturbances are most likely to be associated with CSA when there is also a history of other physical and emotional abuse, and when the family environment is chaotic and unsupportive. It is concluded CSA and other forms of abuse reflect gross empathic failure to respond to the needs of the child.

========================================

 

Title: Image control and symptom expression in posttraumatic stress disorder.

Author(s)/Editor(s): Laor, Nathaniel; Wolmer, Leo; Wiener, Zeev; Weizman, Ronit; Toren, Paz; Ron, Samuel

Source/Citation: Journal of Nervous & Mental Disease; Vol 187(11) Nov 1999, US: Lippincott Williams & Wilkins; 1999, 673-679

Abstract/Review/Citation: Despite the devastating impact of affective dysregulation in posttraumatic stress disorder (PTSD), there has been little research on how trauma relates to affect regulation. This study examines the relationship between the cognitive capacity to control mental images and symptoms of Israeli individuals with (N = 23) and without (N = 23) PTSD after

exposure to SCUD missile attacks during the Gulf War. The capacity to control mental images, symptoms of posttrauma, anxiety, and anger were assessed. PTSD Ss with a high image control reported a higher capacity to control anger, lower levels of anger state and expression, and lower levels of intrusive symptoms compared with PTSD subjects with low image control. In individuals without PTSD, results show that the better the image control, the lower the control of anger and the higher the expression of anger. Image control seems to play different functions in the emotional regulation of normal subjects (facilitatory) and PTSD patients (protective).  ========================================

 

Title: A Jacksonian and biopsychosocial hypothesis concerning borderline and related phenomena.

Author(s)/Editor(s): Meares, Russell; Stevenson, Janine; Gordon, Evian

Source/Citation: Australian & New Zealand Journal of Psychiatry; Vol 33(6) Dec 1999, Australia: Blackwell Science Asia; 1999, 831-840

Abstract/Review/Citation: Developed an etiological model for borderline personality disorder (BPD). The postulates of neurologist J. Hughlings Jackson are used to provide a preliminary explanatory framework for borderline phenomena. The findings concerning abuse in the early history of BPD and other

conditions, notably somatization disorder and dissociative states, are briefly reviewed. Other data, including family studies, with significance in the etiology of BPD are also reviewed.  It is hypothesized that the symptoms of BPD are due to the failure of  "experience-dependent' maturation of a cascade of neural networks, with prefrontal connections, which become active

relatively late in development and which coordinate disparate elements of CNS function. These networks subserve higher psychological functions, including attentional focus and affect regulation, and underpin the reflective function necessary to the emergence of self as the stream of consciousness, which

appears at about the age of 4 yrs. Adverse developmental circumstances may produce an interrelated set of symptom clusters, with associated neural network disturbances, that are amenable to investigation with psychometric and brain imaging techniques.

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Title: Object relations, ego development, and affect regulation in severely addicted substance abusers.

Author(s)/Editor(s): Santina, Maureen Rose

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 59(11-B) Jun 1999, US: Univ. Microfilms International; 1999, 6077

Abstract/Review/Citation: Fifty severely addicted substance abusers were compared to 50 nonaddicted controls on measures of object relations, alexythymia, ego development, psychopathology, and experienced level of childhood trauma. Substance abusers were selected from residents at a

therapeutic community program, and were all diagnosed with severe chemical dependency. Controls were selected from volunteers who responded to ads placed in supermarkets, and were screened to eliminate subjects who reported substance abuse problems. Subjects were administered the Bell Object Relations and Reality Testing Inventory (BORRTI), the Sentence Completion Test for ego development, the Toronto Alexythymia Scale, the Symptom Checklist-90, and the Childhood Trauma Questionnaire. Data were analyzed using univariate ANOVAs and

discriminant analysis to evaluate differences between groups on each variable, and Pearson's r was used to determine correlations between constructs. Substance abusers displayed significant difficulties in several areas: ability to recognize, differentiate and ameliorate emotions; difficulties in forming

secure, gratifying, and supportive relationships; chronic feelings of alienation and isolation; and egocentricity. Addicts reported significantly greater levels of experienced childhood trauma and psychopathology than did controls. Alexythymia and experienced level of childhood trauma were highly correlated with object relational deficits across the whole sample. Ego development was weakly correlated with some measures and not correlated with others. It was concluded that object relations theories of addiction received empirical support, and that object relational deficits should be addressed in the treatment of addicts. The high level of experienced childhood trauma reported by addicts raised the issue of prevalence of PTSD symptoms among

addicts. It was suggested than PTSD and dissociative symptoms may cause clients to discontinue treatment if it is too confrontive.  ========================================

 

Title: Paternal contributions to the etiology of Gender Identity Disorder: A study of attachment, affect regulation, and gender conflict.

Author(s)/Editor(s): Cook, Cassandra Graham

Paper Number: 20000101

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(1-B) Jul 1999, US: Univ. Microfilms International; 1999, 0361

Abstract/Review/Citation: The goal of this study was to formulate hypotheses concerning the contribution of paternal dynamics to the etiology of Childhood Gender Identity Disorder (GID) in boys. Six fathers of sons diagnosed with GID were interviewed using the Adult Attachment Interview (AAI), the Early Memories Test, and the Fatherhood Interview, a semi-structured interview designed for this project to assess the fathers' experience of their sons' cross-gender symptoms. AAI transcripts were scored using both Main & Goldwyn's (1998) scoring system and Fonagy et al's (1998) Reflective Functioning Manual. According to Main's system, every father in this sample evidenced clinically significant levels of Unresolved Trauma, and no subject was classified as Secure. The dramatic over-representation of Insecure and Unresolved Trauma classifications

in this sample was understood as suggesting that these fathers' are very likely to have formed insecure attachment relationships with their sons, as well as to have manifested, when stressed, the kinds of frightened and frightening behaviors that may lead a sensitive and highly reactive child to feel anxious and unsafe in establishing a masculine identification. The low levels of reflective functioning obtained on this sample were seen as

suggestive of these fathers' difficulties in forming accurate and detailed inner representations of their children. Significantly, however, this sample also provided clear clinical evidence that overall reflective functioning scores may not capture certain key capacities which interact to determine the quality of parents' internal representations of their children. It was proposed that the capacity to take responsibility for one's own role in relationships is critical to the constructive use of reflective capacities, and also that the absence of well-developed reflective capacities in the specific domain of the relationship with the child may render the more general capacity for reflective functioning relatively useless in the process of

preventing the intergenerational transmission of trauma. Finally, traumatic attachment-related experiences in these fathers' histories were found to be intimately related to past and present experiences of gender. The identification of two distinct attitudes toward the child's cross-gender symptoms led to the formation of hypotheses concerning two distinct dynamic pathways for paternal reinforcement of cross-gender symptomatology.

========================================

 

Title: A narrative approach to the understanding of self-cutting in adolescent girls and women.

Author(s)/Editor(s): Scheel, Karen

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 60(2-B) Aug 1999, US: Univ. Microfilms International; 1999, 0843

Abstract/Review/Citation: Six women with histories of self-cutting participated in a study designed to explore the role self-cutting played in the participants' lives and the factors participants saw as critical to the cessation of their self-cutting. A semi-structured interview was developed for use in this study. Three of the participants started cutting themselves in

adolescence and three started in adulthood. In order to participate in the study, each of the women must have stopped self-cutting at least 6 months prior to the interview. The four primary research questions were as follows: (1) What impact did family dynamics (both past dynamics and dynamics present

during the period of self-cutting) have upon the self-cutting? (2) What mood or tension regulation function did self-cutting serve for the women? (3) Do women with trauma histories connect their self-cutting with their trauma histories? If so, how do they believe these two aspects of their lives are related? (4) What factors did the women feel were critical to the cessation of

their self-cutting? The findings included the fact that, although the impact of family dynamics upon self-cutting which began in adolescence tended to be more consistently evident, family dynamics also exerted varying degrees of influence upon self-cutting which began in adulthood. The findings also indicated that self-cutting served as a powerful means of affect management for the participants and that it was often related to dissociation. Women with trauma histories did connect their trauma histories with their self-cutting, although there was a good deal of variation in the ways participants saw these two aspects of their lives as related. Many factors were described as critical to the cessation of the participants' self-cutting, including the development of social supports, the use of safety contracts in therapy, and the use of behavioral strategies. The participants described certain aspects of their therapists' overall stance and approach to therapy as among the most helpful and significant factors in their treatment. Particular emphasis was placed upon the findings in this area. The implications for treatment were discussed.

========================================

 

Title: Disorders of narcissism:  Diagnostic, clinical, and empirical

implications.

Author(s)/Editor(s): Ronningstam, Elsa F.

Source/Citation: Washington, DC, US: American Psychiatric Press, Inc; 1998, (xxv, 483)

Abstract/Review/Citation: This book provides an overview of narcissistic pathology and narcissistic disorders. Combining the latest empirical evidence, clinical diagnostic observations, and advances in treatment, the volume addresses important subjects at the forefront of the study of narcissism.  The book is divided into 4 parts. The authors discuss relevant areas of development in the field, highlight specific theoretical rationales, pinpoint

differences in diagnostic and technical approaches to the study of narcissism, and illuminate areas for further clinical and empirical investigation.

Notes/Comments:  Contributors Foreword [by] John C. Nemiah Acknowledgments Introduction [by] Elsa F. Ronningstam

Section I: Diagnostic and theoretical considerations Normal narcissism: An etiological and ethological perspective Michael H. Stone Pathological narcissism and narcissistic personality disorder: Theoretical background and diagnostic classification Otto F. Kernberg Further developments in the clinical diagnosis

of narcissistic personality disorder Arnold M. Cooper DSM narcissistic personality disorder: Historical reflections and future directions Theodore Millon Developmental aspects of normal and pathological narcissism Paulina F.

Kernberg

Section II: Treatment implications Transference and countertransference in the treatment of narcissistic patients Glen O. Gabbard Psychoanalysis of patients with primary self-disorder: A self psychological perspective Paul H. Ornstein An object relations theory approach to psychoanalysis with narcissistic patients Lucy LaFarge Treatment of

narcissistic disorders in the intensive psychiatric milieu Ralph H. Beaumont Narcissistic patients in group psychotherapy: Containing affects in the early group Bennett E. Roth Schema-focused therapy for narcissistic patients Jeffrey Young and Catherine Flanagan Manifestations of narcissistic disorders in

couples therapy: Identification and treatment Marion F. Solomon Section III: Special clinical considerations Affect regulation and narcissism: Trauma, alexithymia, and psychosomatic illness in narcissistic patients Henry Krystal Pathological narcissism and self-regulatory processes in suicidal states John T. Maltsberger Section IV: Research Empirical studies of the construct validity of narcissistic personality disorder Leslie C. Morey and Janice K. Jones Narcissistic personality disorder and pathological narcissism: Long-term stability and presence in Axis I disorders Elsa F. Ronningstam Association between psychopathy and narcissism: Theoretical views and empirical evidence Stephen D. Hart and Robert D. Hare Narcissistic personality disorder in adolescent inpatients: A retrospective record review study of descriptive characteristics Paulina F. Kernberg, Fady Hajal and Lina Normandin Afterword [by] Elsa F. Ronningstam Index diagnostic & clinical & empirical considerations in narcissistic pathology & personality disorder

========================================

 

Title: Affect regulation and narcissism: Trauma, alexithymia, and psychosomatic illness in narcissistic patients.

Author(s)/Editor(s): Krystal, Henry

Source/Citation: Disorders of narcissism:  Diagnostic, clinical, and empirical implications., Washington, DC, US: American Psychiatric Press, Inc; 1998, (xxv, 483), 299-325

Source editor(s): Ronningstam, Elsa F. (Ed)

Abstract/Review/Citation: The purpose of this chapter is to discuss how normal affect regulation and self-esteem regulation can be influenced by the occurrence of infantile psychic trauma or massive psychic trauma later in life. The impact of affect regression on the development of narcissistic disorders is discussed, as well as alexithymia with psychosomatic disorders

and specific treatment strategies for narcissistic alexithymia patients.

========================================

 

Title: The impact of pregnancy on the psychotherapeutic process: An integrated approach to working with the self-disordered client.

Author(s)/Editor(s): Robbins, Melissa

Source/Citation: Therapeutic presence:  Bridging expression and form., Bristol, PA, US: Jessica Kingsley Publishers, Ltd; 1998, (280), 142-152

Source editor(s): Robbins, Arthur (Ed)

Abstract/Review/Citation: Examines the problems facing a pregnant therapist working with self-disordered populations, and addresses the issues raised when utilizing a 'non-regressive' treatment model. Self-disordered is defined as clients with significant self-deficits in several areas including affect regulation, self-care, and relational capacities. These clients often struggle with eating disorders, substance abuse, have experienced trauma, or may be thought of as character disordered. Due to their tendency to either flee from

therapy or regress in therapeutic relationships, and their need for structure and concrete help in managing the stresses and demands of daily life, the author utilizes 'an integrative model' of therapy. This model utilizes concepts drawn from self-psychology, ego psychology, and object relations, and incorporates them with active intervention strategies. The goal is to provide a therapeutic experience that supports the development and internalization of self-capacities through a therapeutic relationship.  This chapter provides a brief literature review on the subject of the pregnant therapist, describes

in more detail the 'integrative model', and provides clinical examples of how one might manage a pregnancy when working non- regressively with a self-disordered population.  ========================================

 

Title: Sexual revictimization: Risk factors and prevention.

Author(s)/Editor(s): Cloitre, Marylene

Source/Citation: Cognitive-behavioral therapies for trauma., New York, NY, US: The Guilford Press; 1998, (xii, 431), 278-304

Source editor(s): Follette, Victoria M. (Ed)

Abstract/Review/Citation: Research data indicate that retraumatized women make up the largest subgroup of sexually assaulted women. Given this, sexual assault research should have as a priority the identification of the psychological characteristics of women with a history of childhood sexual

abuse that put them "at risk" for adult sexual assault. It is also

important to begin developing prevention programs for at-risk women and adolescent girls that target and reduce these risk factors. This chapter reviews the available data on the potential assault risk factors among women with a history of childhood abuse. It also presents a developing model of retraumatization and a cognitive-behavioral intervention designed to reduce

risk for repeated sexual assaults. Topics discussed include theoretical orientation: a social-developmental perspective; affect regulation; interpersonal relatedness; posttraumatic stress disorder (PTSD) as a risk factor for retraumatization; a proposed treatment model: skills training in affect and interpersonal relatedness regulation/prolonged exposure;

assessment; guidelines for selection; and clinical application.

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Title: Confronting traumatic brain injury:  Devastation, hope, and healing.

Author(s)/Editor(s): Winslade, William J.

Source/Citation: New Haven, CT, US: Yale University Press; 1998, (xix, 220)

Abstract/Review/Citation: This book explains what traumatic brain injury is, how it is caused, and what can be done to treat, cope with, and prevent it. It presents facts about traumatic brain injury; information about its financial and emotional costs to individuals, families, and society; and key ethical and policy issues. The author illustrates each aspect with case studies, including his own childhood brain injury. He explains how the brain works and how severe injuries affect it, both immediately and over the the long term, pointing out how resources are often squandered on patients with poor prognoses but

adequate insurance, while underinsured patients with better prognoses often do not receive the best care. He describes the lack of regulation in the rehabilitation industry and what federal and state legislatures are doing to correct the situation. He also recommends policy changes for lowering the instances of traumatic brain injury (such as raising the minimum driving age)

as well as steps that individuals can take to protect themselves from brain trauma.

Notes/Comments: Foreword by James S. Brady Preface

Acknowledgments Introduction: It can happen to anyone Our vulnerable brains Saving lives: The golden hour Hope on the horizon The rough road to rehabilitation How families become victims Facing fatality--and worse fates Protecting the most vulnerable A better use of resources Policies and priorities Prevention: The best solution Bibliography Index causes &

prevention & treatment & coping with traumatic brain injury

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Title: Neuropsychological characteristics of self-mutilating and other subgroups of borderline women.

Author(s)/Editor(s): Schmieder, Linda Marie

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 58(8-B) Feb 1998, US: Univ. Microfilms International; 1998, 4471

Abstract/Review/Citation: Recent research has associated neuropsychological deficits with borderline personality disorder and with self-mutilation. These latest findings, along with the hypothesized early neural development, suggest that borderlines who experience preverbal trauma are more likely to act out

their distress nonverbally, such as self-mutilation. In addition, there may be subgroups, distinguishable by neuropsychological characteristics, within the borderline continuum. This research examined the relationship between borderline pathology, self-mutilation, and neuropsychological deficits. Adult borderline women (n=28), self-mutilating adult borderline women (n=24), and a control group composed of participants who had similar clinical symptoms but did not qualify, either by intensity or range of symptoms, for the diagnosis of borderline (n=21), were assessed on 11 neuropsychological measures. The hypotheses were: (1) the borderline groups would exhibit greater neuropsychological dysfunction than the control group, (2) the borderline self-mutilating group would exhibit greater neuropsychological dysfunction than borderline non-mutilating group, and (3) the degree of neuropsychological dysfunction would reflect the functioning level of the individual. Results

revealed that the self-mutilating group did not evidence more

neuropsychological dysfunction than the borderline non-mutilating group, but the combined borderline group (self-mutilators and non-mutilators) did evidence statistically significantly more neuropsychological deficits than the control group. Further analysis of the groups, redefined by high, medium, and low functioning level, revealed that the low functioning group demonstrated statistically significantly more neuropsychological deficits, followed by the medium functioning group, and then by the high functioning group. The discussion chapter addressed the clinical implications of subgroups of borderline pathology that can be identified in a clinical setting. The theoretical implications, based on an integration of developmental object relations theory and neuropsychology, suggest that the impact of neuropsychological deficits from an early age would result in difficulties in affect regulation and a predictable pattern of symptoms, the severity of which is associated with the severity in neuropsychological dysfunction, that we identify as borderline personality disorder.  ========================================

 

Title: Emotional suppression heightens autonomic response to trauma cues in posttraumatic stress disorder.

Author(s)/Editor(s): Rich, Martina Renee

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 59(4-B) Oct 1998, US: Univ. Microfilms International; 1998, 1866

Abstract/Review/Citation: Increased physiological responding to trauma-related stressor stimuli has been consistently found among patients with posttraumatic stress disorder (PTSD). Recent research on emotion regulation has demonstrated that efforts to suppress expressions of emotion when viewing evocative stimuli increase sympathetic activation. The present study tests the hypothesis that when patients with PTSD attempt to cope with trauma-related physiological changes by suppressing emotions, they increase their autonomic arousal. 32

Vietnam combat veterans with PTSD and 28 veterans with mixed psychiatric (non-PTSD) diagnoses were shown a videotape of combat scenes while physiological, affective, and behavioral responses were recorded. One-half of the subjects in each group were instructed to suppress all expression of emotion while watching the tape. As predicted, PTSD subjects who were instructed to suppress showed greater increases in skin conductance levels than nonsuppressing PTSD subjects. Experimental condition did not affect physiological responding among subjects without PTSD. The results suggest that

suppression of emotional expressiveness may interfere with habituation and prolong physiological arousal when patients with PTSD encounter evocative trauma-related stimuli.

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Title: Maltreated adolescents: Victims caught between childhood and adulthood.

Author(s)/Editor(s): Rossman, B. B. Robbie; Rosenberg, Mindy S.

Source/Citation: Journal of Aggression, Maltreatment & Trauma: Special Issue:  Vol 2(1) 1998, US: Haworth Press; 1998, 107-129

Abstract/Review/Citation: Reviews literature on the developmental tasks of adolescence and the unique problems faced by adolescent victims of maltreatment. The developmental domains addressed include cognition, identity, behavior and affect regulation, family and peer relationships, and sexuality.

Research on the co-occurrence of multiple types of victimization is discussed. The relationship between multiple victimization and violent crime, with a focus on parricide, is examined. The authors call for greater attention to the assessment and study of multiple forms of maltreatment and its outcomes in adolescence, since adolescence is one of the least researched developmental

periods in terms of single or multiple victimization.  ========================================

 

Title: Desomatization and the consequences of infantile psychic trauma.

Author(s)/Editor(s): Krystal, Henry

Source/Citation: Psychoanalytic Inquiry; Vol 17(2) 1997, US: Analytic Press; 1997, 126-150

Abstract/Review/Citation: Discusses the relationship between psychosomatic disorders, somatization, and infantile psychic trauma. Following his theory of the genetic development of affect, H. Krystal describes the transformation of emotions from their infantile to their adult form. With the affective attunement of the mothering parent, affect is differentiated and simultaneously verbalized and desomatized. The aspects of infantile psychic trauma that make affect development and desomatization impossible are described. The archaic transferences and countertransferences associated with alexithymic and somatizing patients are discussed. The author also traces the powerful resistances encountered in treatment to the terror these patients are exposed to when they experience their affects as signals and take over their self-regulation from a traumatizing parent. Specific issues addressed include infantile psychic trauma; adult (type) catastrophic trauma; alexithymia; the treatment of alexithymic patients; alexithymia, anhedonia, and the relationship to trauma; considerations about psychoanalysis of disaffected somatized patients; and operative thinking. A case illustration of a man whose affect tolerance is impaired is also presented.  ========================================

 

Title: Attachment, detachment and borderline personality disorder.

Author(s)/Editor(s): Sable, Pat

Source/Citation: Psychotherapy: Theory, Research, Practice, Training; Vol 34(2) Sum 1997, US: Division of Psychotherapy, A.P.A.; 1997, 171-181

Abstract/Review/Citation: In an attempt to expand understanding of more severe pathology, attachment theory, developed by John Bowlby, is applied to borderline personality disorder in adults. Conceptualized as a condition of profound insecure attachment, with extreme vacillations between a desire for proximity and attachment and a dread and avoidance of engagement, borderline pathology reflects traumatic attachment experiences, beginning early in life. Besides the importance of trauma, disturbances in affect regulation and cognitive distortions are emphasized. The secure base of a therapeutic bond provides consistency, reliability, and affirmation while encouraging exploration of separation and loss experiences, both current and past, in order to modify inner working models of oneself and relationships with others. Implications for prevention are discussed.  ========================================

 

Title: Failure in the mother-child dyad.

Author(s)/Editor(s): Campbell, Elizabeth Flynn

Source/Citation: Mind-body problems:  Psychotherapy with psychosomatic disorders., Northvale, NJ, US: Jason Aronson, Inc; 1997, (xiv, 360), 121-131

Source editor(s): Finell, Janet Schumacher (Ed)

Abstract/Review/Citation: The advent of an object-relations framework in the 1950s provided a wider window through which we could view psychosomatic expressions. Object relations offered a broader perspective that considered the relationship between infant and caregiver as a critical determinant of the

child's ability to establish internal affect regulating and elaborating functions. Specifically, the quality of the early mother-child dyad was seen to determine whether the child could create an internalized, self-soothing "other" to help differentiate and integrate the ongoing onslaught of

affects. This chapter describes the case of a 52-yr-old female to demonstrate the critical importance of the mother's role in affect elaboration and integration, especially under traumatic circumstances.  Topics discussed include: trauma and the developing psyche, symbolization and psychosomatic illness, maternal influence on the psychic elaboration of affects, when the soma "communicates" in place of the psyche, symbolization as compensation for the failed dyad, use of the body to express the "unthought known,"  and psychoanalysis and the subway.  ========================================

 

Title: Dissociation, somatization, and affect dysregulation: The complexity of adaption to trauma.

Author(s)/Editor(s): van der Kolk, Bessel A.; Pelcovitz, David

Roth, Susan; Mandel, Francine S.; et al

Source/Citation: American Journal of Psychiatry; Vol 153(Suppl) 1996, US: American Psychiatric Assn; 1996, 83-93

Abstract/Review/Citation: Investigated the relationships between exposure to extreme stress, the emergence of PTSD, and symptoms traditionally associated with hysteria, which can be understood as problems with stimulus discrimination, self-regulation, and cognitive integration of experience. The

Mental Disorders-IV (DSM-IV) field trial for PTSD studied 395 traumatized treatment-seeking Ss and 125 non-treatment-seeking Ss (all Ss mean age 37.1 yrs) who had also been exposed to traumatic experiences. Results show PTSD,

dissociation, somatization, and affect dysregulation were highly interrelated. The Ss meeting the criteria for lifetime (but not current) PTSD scored significantly lower on these disorders than those with current PTSD, but significantly higher than those who never had PTSD. Ss who developed PTSD after interpersonal trauma as adults had significantly fewer symptoms than those with childhood trauma, but significantly more than victims of disasters. 

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Title: Trauma, inner conflict, and the vicious cycles of repetition.

Author(s)/Editor(s): Wurmser, Leon

Source/Citation: Scandinavian Psychoanalytic Review; Vol 19(1) 1996, Denmark: Munksgaard International Publishers Ltd; 1996, 17-45

Abstract/Review/Citation: Examines the concepts of trauma, narcissism, and conflict causality theoretically and clinically, exploring the recurrent sequences of compromise formations that form characteristic vicious circles of a narcissistic, masochistic, and addictive kind, and ends with some technical conclusions and a psychological and philosophical reconsideration of the

concept of repetition compulsion. The case of a 39-yr-old unmarried White woman who sought help for a severely self-destructive life pattern is used to illustrate the concepts. The repetition compulsion, reflected in the "vicious cycles," is viewed as an attempt to attain in symbolic ways affect regulation and conflict resolution which proves blocked. Narcissistic crises, loyalty conflicts, and shame-guilt dilemmas have a commanding position in the triggering of those sequences, of the ensuing impulsive actions, and of the splitting of consciousness and identity. 

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Title: The relationship between behavioral self-regulation and the combination of frontal lobe functioning and perception of parental acceptance/rejection in adolescent males.

Author(s)/Editor(s): Huslage, Susan Martha

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 56(9-B) Mar 1996, US: Univ. Microfilms International; 1996, 5195

Abstract/Review/Citation: Neuropsychological and family relationship variables independently have been associated with adolescents' difficulties in behavioral self-regulation. However, in spite of the evidence that neural maturational status and processes affect and are affected by family experiences, systematic study of the potential combination of these dual influences with regard to self-regulation has remained limited. Based upon Lewin's B = P,E model, the present study examined the association of self-regulation and the combined predictor variables of frontally-mediated cognitive skills and perception of parental acceptance/rejection. Neuropsychological measures of selective attention (Stroop Color and Word Test) and planning (Trail Making B, Porteus Maze Test), and a questionnaire

measuring perception of parental acceptance (Parental Acceptance/Rejection questionnaire) were administered to 73 male subjects, including 33 adjudicated and 32 non-adjudicated/never-in-trouble adolescents ages 14-17. In addition, Ss' parents completed a self-report measure of Ss' self-regulation (Achenbach Child Behavior Checklist). Stepwise multiple regression and DFA were used to examine the research hypotheses. Also, a univariate measure of the presence of

history of head trauma in adj. vs. non-adj. subjects was conducted. Results indicated a significant relationship between self-regulation and the predictor variables of selective attention and perception of both maternal and paternal rejection (R2 =.27), and these predictor variables, together with a planning variable, significantly discriminated between adjudicated vs. non-adjudicated group membership (83.08% hit rate). No significant relationship was found between head trauma and discipline categories (ae2 = 3.69, df = 2, p < .15). In accord with a multivariate explanation of behavior, adolescents with

self-regulation problems appear both to experience parents as rejecting of them and to exhibit deficits in frontally-mediated cognitive 

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Title: Cracks in the bell curve: The impact of chronic and complex trauma on the cognitive skills and knowledge of school-age children.

Author(s)/Editor(s): Goodman, Matthew Boyar

Source/Citation: Dissertation Abstracts International Section A: Humanities & Social Sciences; Vol 57(5-A) Nov 1996, US: University Microfilms International; 1996, 1959

Abstract/Review/Citation: The diagnostic classification of Post Traumatic Stress Disorder has emerged as a construct that characterizes a person's response to chronic and complex traumatic experiences. While current assessment approaches

and techniques have contributed to our understanding of the behavioral and emotional impact of trauma, far less is known about how traumatic life events affect the cognitive skills and functioning of children. This study explored the impact of neglect, physical or sexual abuse and multiple out-of-home

placements on the cognitive skills and knowledge of school-age children. Intelligence testing was utilized as a method to measure the effect of these complex and chronic traumatic experiences. Scale, Index and individual subtest scores of the Wechsler Intelligence Scales for Children-Third Edition

(WISC-III) were studied to determine their effectiveness in discriminating this group of traumatized children. A comparative retrospective case analysis of an outpatient clinic population was employed. WISC-III protocols of 16 children aged six to thirteen were reviewed to determine differences in the test profiles between the trauma group and the WISC-III norms. Data analysis utilized t-tests for a number of the variables. The findings suggested that the trauma group scored lower on a measure of receptive and expressive language and on subtests where efficient problem-solving requires simultaneous

processing and performance self-regulation. These particular subtests are also associated with academic performance. Findings also suggested that a subgroup within the trauma sample that had no reported history of psychotropic

medication usage demonstrated lower Full Scale IQ scores, due to poorer performance on subtests from the Perceptual Organization Index. Low scores on Coding were associated with exposure to abuse and out-of-home placements.  ========================================

 

Title: The complexity of adaptation to trauma:  Self-regulation, stimulus discrimination, and characterological development.

Author(s)/Editor(s): van der Kolk, Bessel A.

Source/Citation: Traumatic stress:  The effects of overwhelming experience on mind, body, and society., New York, NY, US: The Guilford Press; 1996, (xxv, 596), 182-213

Source editor(s): van der Kolk, Bessel A. (Ed)

Abstract/Review/Citation: [discusses] the role of secure attachments in protecting individuals against being traumatized / describes how trauma leads to a variety of problems with the regulation of affective states, such as anger, anxiety, and sexuality / how affect dysregulation makes people vulnerable to engage in a variety of pathological attempts at self-regulation

such as self-mutilation, eating disorders, and substance abuse / how extreme arousal is accompanied by (a) dissociation and (b) the loss of capacity to put feelings into words / how failure to establish a sense of safety and security leads to characterological adaptations that include problems with self-efficacy, shame, and self-hatred, as well as problems in working through interpersonal conflicts / concludes with a brief description of deliberations concerning the definition of complex trauma in Mental Disorders-IV (DSM-IV) and ICD as well as treatment implications  ========================================

 

Title: Chemically dependent lesbians and bisexual women: Recovery from many traumas.

Author(s)/Editor(s): Finnegan, Dana G.; McNally, Emily B.

Source/Citation: Chemical dependency:  Women at risk., New York, NY, US: Harrington Park Press/Haworth Press, Inc; 1996, (xix, 179), 87-107

Source editor(s): Underhill, Brenda L. (Ed)

Abstract/Review/Citation: many lesbian and bisexual women with long-term recovery are still plagued by [major disorders and other traumas that have not been resolved by being clean and sober] / [focus] on why so many lesbian and bisexual women with long-term recovery must batttle with such difficult, complex, and painful circumstances; how they do so; and what life and treatment strategies may help them win this battle / the effects of multiple traumas [totalitarian control; alterations in affect regulation, consciousness, self perception, perception of perpetrator, relations with others, and systems of meaning; physiological effects]  ========================================

 

Title: Thinking about feelings: Affect tolerance, affect regulation and response to psychological trauma.

Author(s)/Editor(s): Ansorge, Susan Beth

Source/Citation: Dissertation Abstracts International: Section B: The Sciences & Engineering; Vol 56(6-B) Dec 1995, US: Univ. Microfilms International; 1995, 3430

Abstract/Review/Citation: Current models of Post-traumatic Stress Disorder (PTSD) do not adequately address the specific processes and mechanisms underlying impairments in emotional processing and functioning within the disorder. Recently, the ways that individuals think about their feelings (i.e., evaluate, tolerate and attempt to regulate their emotional experience) have been identified as playing a central role in successful affective functioning. The present study concerns the role of these processes in psychological responses to traumatic events. Specifically, a model of emotional functioning that accounts for relationships between cognitions about emotions, responses to trauma-related stimuli and PTSD symptomatology is investigated in a sample of 61 combat-exposed Vietnam veterans (32 PTSD, 29 Well-adjusted). Key areas which have recently shown to be influential in modulating emotions are: (1) the meta-experience of emotion (i.e., reflective thoughts about feelings); (2) generalized expectancies about one's ability to regulate affect; and (3) moment-to-moment thoughts denoting 'openness' to

emotional responses. Measured after exposure to a trauma-related stimulus, openness is construed here as a correlate of the capacity to 'process' trauma-related emotions, which has been identified as a central requirement for adequate integration and adjustment to a traumatic event. These findings suggest that the ways in which individuals evaluate and attempt to regulate emotions has relevance to their cognitive and affective responses to trauma-reminders, to their ability to recover from exposure to a trauma-stimulus, and to specific PTSD symptomatology. Additionally, it appears that relative to well-adjusted combat veterans, subjects with PTSD: (1) report less acceptance of and clarity about their emotions, (2) believe that their feelings have more influence on their thoughts and judgments, (3) are less likely to attempt to repair negative emotional states and to maintain positive ones, (4) are  ========================================

 

Title: Hypnosis in the treatment of sexual trauma: A master class commentary.

Author(s)/Editor(s): Smith, William H.

Source/Citation: International Journal of Clinical & Experimental Hypnosis; Vol 43(4) Oct 1995, US: Sage Publications Inc; 1995, 366-368

Abstract/Review/Citation: Discusses the use of hypnosis in the treatment of sexual trauma. Rape victims feel helpless and emotionally overwhelmed; restoring the person's capacity for self control and calming of hyperarousal is an important step in regaining freedom from emotional stress and in restoring self respect and interpersonal trust. Affective dysregulation after

rape may be manifested by anxiety, sleep, or intrusive recollections of the trauma. Hypnosis can facilitate mastery by enhancing affect regulation. Having the memory appear on a TV screen, with the patient regulating the memory and the emotions with the remote control is also useful. The experience can be

made sensible. A coherent narrative is formed, and irrational cognitions can be corrected in the supportive therapeutic relationship. Patients treated by caring male therapists who empower them to feel safe, and in control of their minds, have a powerful corrective experience.  ========================================

 

Title: The effects of trauma on young children: A case of 2-year-old twins.

Author(s)/Editor(s): Osofsky, Joy D.; Cohen, Geraldine; Drell, Martin

Source/Citation: International Journal of Psycho-Analysis; Vol 76(3) Jun 1995, England: Institute of Psychoanalysis; 1995, 595-607

Abstract/Review/Citation: Explores effects of trauma of young children in the context of chronic community and family violence. Features of adult posttraumatic stress disorder (PTSD) have been identified in children aged <4 yrs. External events can affect intrapsychic structure and development of the self. A case is presented of 2-yr-old male twins treated with psychoanalytically-informed play psychotherapy 7 mo after witnessing the shooting death of their mother by their father. Through emotional availability and attention to affect regulation, the therapist showed sensitivity to the Ss' inner and outer worlds, helping to contain overwhelming affects as they played out conflicts and fears symbolically in fantasy play. While the

therapist facilitated working through of Ss' sense of helplessness, lack of control, and anxiety to gain a sense of mastery, systematic follow-up is needed to determine the later developmental course. (French, German & Spanish abstracts)

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Title: Traumatic memory and the intergenerational transmission of Holocaust narratives.

Author(s)/Editor(s): Adelman, Anne

Source/Citation: Psychoanalytic Study of the Child; Vol 50 1995, US: Yale Univ. Press; 1995, 343-367

Abstract/Review/Citation: This paper investigated the roles of affect regulation, narrative cohesion, and symbolic representation in the intergenerational transmission of the Holocaust experience. A study of the reminiscences of mothers who are Holocaust survivors and their daughter's reflections about the Holocaust illustrates the process of the transmission of trauma by tracing the transgenerational evolution of narrative forms, dynamic themes, and affective organization. The quality of the survivor parent's organization and integration of affect has significant bearing on how her child assimilates her knowledge of the Holocaust and develops the capacity to tolerate and express painful emotions. Through the preservation,

transformation, and transmutation of traumatic memory, children of survivors strive to assimilate, redeem, and transform their tragic historical legacy.  ========================================

 

Title: The psychodynamic treatment of women.

Author(s)/Editor(s): Bernstein, Anne E.; Lenhart, Sharyn A.

Source/Citation: Washington, DC, US: American Psychiatric Press, Inc; 1993, (xviii, 670)

Abstract/Review/Citation: Women seek psychodynamic treatment twice as frequently as men, and they manifest unique problems. In this volume, we present an overview of the general problems experienced by women and detail methods of treatment that we have utilized with positive outcomes. . . . We present and discuss patients who did respond to brief, intensive psychodynamic psychotherapy.  Our material is organized in terms of the life cycle. We discuss each issue at length at the genetic phase at which it is most prevalent, referring to each issue briefly as it occurs in other developmental

phases.

Notes/Comments:  Preface Acknowledgments Introduction Female psychology: A historical overview Adolescence Problems of self-esteem regulation Relationships, careers, and motherhood Disorders linked to reproductive functioning Abuse of women Later life issues

Appendixes A: Differences in the structure of the brain in men and women

B: Neurochemical systems that affect appetite

C: Drug use in adolescence

D: Neurochemistry of

panic disorder

E: Women who compete with women

F: Premenstrual syndrome

G: Lesions of reproductive organs

H: Medical infertility: Evaluation and treatment

I: Legal and dynamic models of sexual harassment

J: Approaches to sexual harassment

K: Subcategories of rape

L: The rape/crisis trauma syndrome

M: Theories of battering

N: Sexual exploitation in professional relationships: Legal and complaint aspects of treatment for victims

O: Biology of menopause

P: Biology of "hot flashes"

Q: Psychobiology of midlife depression

R: Estrogen and cardiovascular depression S: Menopause and sleep disorders

T: Biology and treatment of osteoporosis

U: Preparation for widowhood V: Review of the psychoanalytic literature on mourning Bibliography Supplemental readings Index examines the use of psychodynamic psychotherapy in treating

female patients & the unique problems they encounter

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Title: Trauma and affect: Applying the language of affect theory to the phenomena of traumatic stress.

Author(s)/Editor(s): Stone, Andrew M.

Source/Citation: Psychiatric Annals; Vol 23(10) Oct 1993, US: SLACK Incorporated; 1993, 567-576

Abstract/Review/Citation: Contends that the principal results of traumatic stress on humans can best be described in terms of affect. The triggering of overwhelming affect is integral to the definition of what constitutes traumatic stress. One is overwhelmed not by an external event but by the affective response to it. Much of the subsequent symptomatology is

affect-based. It also represents departures from the normal in identification, expression, and regulation of any or all of the innate affects, the emotions, and their cognitive and associative coassemblies and scripts. It is concluded that the language and concepts of affect theory offer a valuable framework for the exploration of these phenomena and further the understanding and treatment of these disorders. Three case examples are provided. 

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Title: Interface of psychoanalysis and psychology.

Author(s)/Editor(s): Barron, James W.; Eagle, Morris N.;

Wolitzky, David Leo

Source/Citation: Washington, DC, US: American Psychological Association; 1992, (xix, 647)

Abstract/Review/Citation: In the sections and chapters that follow, we have spanned a broad range of topics in basic areas relevant to psychoanalytic psychology. This book reflects serious efforts to build conceptual bridges between psychoanalysis and the relevant areas of psychological research, to identify historical and contemporary points of convergence and divergence, and to suggest directions for future research that might enrich both disciplines.

Notes/Comments:  Foreword Preface

I. Fundamental concepts and assumptions Introduction: Foundations of psychoanalysis Motivation in psychology and psychoanalysis  Jospeh D. Lichtenberg and Rosalea A. Schonbar

Psychoanalysis as a Darwinian depth psychology: Evolutionary biology and the classical-relational dialectic in psychoanalytic theory  Malcolm Owen Slavin and Daniel Kriegman Freud and cognitive psychology: The conceptual interface  Jerome C. Wakefield Telling and enacting stories in psychoanalysis  Marshall

Edelson

II. Personality development and organization Introduction: Personality development and organization Reformulations of early development and transference: Implications for psychic structure formation  Frank M. Lachmann and Beatrice Beebe Attachments, drives, and development: Conflicts and

convergences in theory  Arietta Slade and J. Lawrence Aber Object relations: Toward a relational model of the mind  Irene Fast The early organization of the psyche  E. Virginia Demos Affective development and early relationships: Clinical implications  Joy D. Osofsky The etiology of boyhood gender identity disorder: An integrative model  Susan Coates Adolescent development  Marsha H. Levy-Warren Toward a dynamic geropsychology  David L. Gutmann

III. Research approaches to cognitive processes Introduction: Psychoanalysis and cognitive psychology The Freudian unconscious and the cognitive unconscious: Identical or fraternal twins  Howard Shevrin The empirical study of defensive processes: A review  Steven H. Cooper The function of REM sleep and the meaning of dreams Jonathan Winson Psychoanalytic theory, dream formation, and REM sleep  Steven J. Ellman Social cognition and social affect in psychoanalysis and cognitive psychology: From regression analysis to analysis of regression  Drew Westen

IV. Psychopathology: Clinical and experimental research Introduction: Psychoanalysis and psychopathology Relatedness and self-definition: Two primary dimensions in personality development, psychopathology, and psychotherapy  Sidney J. Blatt and Rachel B. Blass Psychoanalysis, psychology, and the self  Bertram J. Cohler and Robert M. Galatzer-Levy The borderline concept: Crossroads of theory and research  Paul Lerner Psychosomatics and self-regulation  Graeme J. Taylor The effects of psychic trauma on mind: Structure and processing of meaning  Mardi J. Horowitz

V. Research on treatment process and outcome Introduction: The treatment process Transference in psychotherapy and daily life: Implications of current memory and social cognition research  Jefferson A. Singer and Jerome L. Singer Countertransference theory, quantitative research, and the problem of therapist-patient sexual abuse  Michael J. Tansey Interpretation: A critical perspective  Donald P. Spence Testing psychoanalytic proposition about personality change in psychotherapy  Lester Luborsky, Jacques Barber and Paul Crits-Christoph A new psychoanalytic theory and its testing in research  Harold Sampson A proposal for improving the psychoanalytic theory of technique Jeffrey L. Binder, Hans H. Strupp and Daniel L. Rock Index discusses the interface of psychoanalysis & psychological research ========================================

 

Title: On some roots of creativity.

Author(s)/Editor(s): Krystal, Henry

Source/Citation: Psychiatric Clinics of North America; Vol 11(3) Sep 1988, US: W.B. Saunders & Co.; 1988, 475-491

Abstract/Review/Citation: Suggests that clues about creativity are discovered by working with uncreative patients such as those with alexithymia. Creativity is discussed in terms of self-regulation, traumatization, posttraumatic cognitive

impairments, transitional phenomena, and the causes of affective and cognitive disturbances in alexithymia. It is argued that the origins (roots) of creativity may be ascertained by looking for evidence that the mother-infant relationship is a mutually interactive one from the start. The kind of infant psychic trauma that causes an arrest in affect development is apt to interfere with self-gratification and the process by which transitional objects become more abstract by the use of "matching symbols." The mother, by providing a secure holding environment to make possible the harmonious and timely evolution of affects and transitional processes, makes possible the development of symbolization, verbalization, and creativity.

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