History of the term ‘appeasement’: a response to Bailey et al. (2023)

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The Complexity of Complex PTSD

Back to table of contents Previous article Next article Communications and UpdatesFull AccessAddressing Sleep Impairment in Treatment Guidelines for PTSDAna Nectara Ticlea, M.D., Laura A. Bajor, D.O., and David N. Osser, M.D.Ana Nectara TicleaSearch for more papers by this author, M.D., Laura A. BajorSearch for more papers by this author, D.O., and David N. OsserSearch for more papers by this author, M.D.Published Online:1 Sep 2013https://doi.org/10.1176/appi.ajp.2013.13050641AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We reviewed Dr. Germain’s article (1) in the April issue with much interest. We would like to kindly correct Dr. Germain’s statement that no treatment guidelines have proposed that the initial treatment for posttraumatic stress disorder (PTSD) should focus on sleep impairment. The PTSD algorithm of the Psychopharmacology Algorithm Project at the Harvard South Shore Program (2), published in 2011, provides treatment guidelines that support exactly the idea that sleep evaluation and treatment should be the first step in assessing and treating PTSD. Notably, the first reference in the Psychopharmacology Algorithm Project article is to previous research by Dr. Germain and colleagues (3).From a psychopharmacological perspective, the availability of prazosin (4), which has demonstrated a much larger effect size than the selective serotonin reuptake inhibitors (SSRIs), a greater tolerability profile, and a shorter time to response, makes this approach possible. Many experts continue to promote SSRIs as a first-line treatment for this disorder, but the evidence—despite U.S. Food and Drug Administration approval of two SSRIs—remains not at all impressive (5, 6). SSRIs have a small effect size in ameliorating the range of PTSD symptoms, and they frequently exacerbate insomnia and nightmares. Furthermore, they often produce disabling sexual side effects.For many patients, sleep fragmentation may exacerbate daytime PTSD symptoms (hypervigilance, avoidance, and reexperiencing), and these symptoms may improve when sleep improves (7). The importance of sleep in regulating trauma-related memories and emotions has significant clinical implications, suggesting that prioritized interventions to correct sleep disturbances may facilitate the psychotherapeutic processing of traumatic events.From Harvard Medical School at the VA Boston Healthcare System, Brockton Division, Brockton, Mass.The authors report no financial relationships with commercial interests.References1 Germain A: Sleep disturbances as the hallmark of PTSD: where are we now? Am J Psychiatry 2013; 170:372–382Link, Google Scholar2 Bajor LA, Ticlea AN, Osser DN: The Psychopharmacology Algorithm Project at the Harvard South Shore Program: an update on posttraumatic stress disorder. Harv Rev Psychiatry 2011; 19:240–258Crossref, Medline, Google Scholar3 Germain A, Buysse DJ, Nofzinger E: Sleep-specific mechanisms underlying posttraumatic stress disorder: integrative review and neurobiological hypotheses. Sleep Med Rev 2008; 12:185–195Crossref, Medline, Google Scholar4 Raskind MA, Peterson K, Williams T, Hoff DJ, Hart K, Holmes H, Homas D, Hill J, Daniels C, Calohan J, Millard SP, Rohde K, O'Connell J, Pritzl D, Feiszli K, Petrie EC, Gross C, Mayer CL, Freed MC, Engel C, Peskind ER: A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am J Psychiatry 2013; 170:1003–1010 (Epub ahead of print: Jul 12, 2013)Link, Google Scholar5 National Collaborating Centre for Mental Health: Posttraumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. London; Leicester, UK, Gaskell and the British Psychological Society, 2005Google Scholar6 Committee on Treatment of Posttraumatic Stress Disorder, Institute of Medicine: Treatment of posttraumatic stress disorder: an assessment of the evidence. Washington, DC, National Academies Press, 2008Google Scholar7 Thompson CE, Taylor FB, McFall ME, Barnes RF, Raskind MA: Nonnightmare distressed awakenings in veterans with posttraumatic stress disorder: response to prazosin. J Trauma Stress 2008; 21:417–420Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited bySleep, circadian system and traumatic stress28 September 2021 | European Journal of Psychotraumatology, Vol. 12, No. 1Traumatic stress and the circadian system: neurobiology, timing and treatment of posttraumatic chronodisruption27 November 2020 | European Journal of Psychotraumatology, Vol. 11, No. 1Multilevel Interactions of Stress and Circadian System: Implications for Traumatic Stress28 January 2020 | Frontiers in Psychiatry, Vol. 10Potential pleiotropic beneficial effects of adjuvant melatonergic treatment in posttraumatic stress disorder29 April 2016 | Journal of Pineal Research, Vol. 61, No. 1Current Opinion in Psychiatry, Vol. 27, No. 5 Volume 170Issue 9 September 2013Pages 1059-1059 Metrics PDF download History Accepted 1 June 2013 Published online 1 September 2013 Published in print 1 September 2013

The authors' objective was to explore aspects of trauma associated with severity of posttraumatic stress disorder (PTSD) in Vietnam veterans. Several ratings of stress exposure and symptom severity were administered to 40 patients with combat-related PTSD. A significant relationship was observed between exposure to atrocities and the impact of PTSD on veterans' lives, as measured by the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. Exposure to atrocities was also significantly correlated with current symptom severity. In contrast, combat exposure alone was not significantly associated with overall symptom severity. Both atrocity and combat exposure, however, were significantly related to reexperiencing symptoms. The data suggest that the enduring effect and severity of PTSD symptoms on an individual are associated more with exposure to brutal human death and suffering than the threat of death associated with combat.

The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire. Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire. Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events. These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.

Posttraumatic stress disorder (PTSD) is one of the few psychiatric conditions in which a subjective decrease in emotional range serves as a diagnostic criterion. In order to investigate whether veterans with chronic PTSD also experienced objective limitations in emotional perception, the authors administered the Aprosodia Battery to a group of 11 veterans with chronic PTSD, nine subjects with right hemisphere damage, seven subjects with left hemisphere damage, and 12 comparison subjects. The patients with PTSD displayed significant deficiencies in the comprehension and discriminative components of affective speech, similar in severity and performance profile on the Aprosodia Battery to the individuals with focal right hemisphere damage due to ischemic infarction.

Three years since launch It is now three years since we launched the European Journal of Psychotraumatology ( EJPT ). In December 2010, a handful of articles were published, forming volume 1. Since then, EJPT has shown a strong increase in the number of publications, citations, and downloads . As of December 2013, a total of 134 articles have been published, including clinical and basic research articles, review articles, editorials, and thematic clusters, including supplements). The rejection rate is approximately 40%. We aim to have the initial review completed within 4 weeks. Accepted manuscripts are published in their final version online approximately 4 weeks following the final editorial decision, depending on how quickly authors respond to inquiries. (Published: 20 December 2013) Citation: European Journal of Psychotraumatology 2013, 4 : 23512 - http://dx.doi.org/10.3402/ejpt.v4i0.23512

This study sought to determine whether a set of symptoms interpreted as complicated grief could be identified and distinguished from bereavement-related depression and whether the presence of complicated grief would predict enduring functional impairments. Data were derived from a study group of 82 recently widowed elderly individuals recruited for an investigation of physiological changes in bereaved persons. Baseline data were collected 3-6 months after the deaths of the subjects' spouses, and follow-up data were collected from 56 of the subjects 18 months after the baseline assessments. Candidate items for assessing complicated grief came from a variety of scales used to evaluate emotional functioning (e.g., the Hamilton Depression Rating Scale, the Brief Symptom Inventory). The outcome variables measured were global functioning, medical illness burden, sleep, mood, self-esteem, and anxiety. A principal-components analysis conducted on intake data (N = 82) revealed a complicated grief factor and a bereavement-depression factor. Seven symptoms constituted complicated grief: searching, yearning, preoccupation with thoughts of the deceased, crying, disbelief regarding the death, feeling stunned by the death, and lack of acceptance of the death. Baseline complicated grief scores were significantly associated with impairments in global functioning, mood, sleep, and self-esteem in the 56 subjects available for follow-up. The symptoms of complicated grief may be distinct from depressive symptoms and appear to be associated with enduring functional impairments. The symptoms of complicated grief, therefore, appear to define a unique disorder deserving of specialized treatment.

Distressing and intrusive reexperiencing of the trauma is a hallmark symptom of posttraumatic stress disorder (PTSD; American Psychiatric Association, 1994). However, unwanted memories of trauma are not a sign of pathology per se. In the initial weeks after a traumatic experience, intrusive memories are common. For most trauma survivors, intrusions become less frequent and distressing over time. A central question for understanding and treating patients with PTSD is therefore what maintains distressing intrusive reexperiencing in these people. Three factors appear to be important: (1) memory processes responsible for the easy triggering of intrusive memories, (2) the individuals’ interpretations of their trauma memories, and (3) their cognitive and behavioral responses to trauma memories.

The aim of this study was to confirm and extend the authors' previous work indicating that symptoms of traumatic grief are predictors of future physical and mental health outcomes. The study group consisted of 150 future widows and widowers interviewed at the time of their spouse's hospital admission and at 6-week and 6-, 13-, and 25- month follow-ups. Traumatic grief was measured with a modified version of the Grief Measurement Scale. Mental and physical health outcomes were assessed by self-report and interviewer evaluation. Survival analysis and linear and logistic regressions were used to determine the risk for adverse mental and physical health outcomes posed by traumatic grief. Survival and regression analyses indicated that the presence of traumatic grief symptoms approximately 6 months after the death of the spouse predicted such negative health outcomes as cancer, heart trouble, high blood pressure, suicidal ideation, and changes in eating habits at 13- or 25-month follow-up. The results suggest that it may not be the stress of bereavement, per se, that puts individuals at risk for long-term mental and physical health impairments and adverse health behaviors. Rather, it appears that psychiatric sequelae such as traumatic grief are of critical importance in determining which bereaved individuals will be at risk for long-term dysfunction.

Welcome to the European Journal of Psychotraumatology ! The European Journal of Psychotraumatology (EJPT) is a new peer-reviewed Open Access journal and the official organ of the European Society for Traumatic Stress Studies (ESTSS). It aims to serve the needs of both researchers and clinicians in the field of traumatic stress. EJPT is in line with ESTSS’s mission to advance and disseminate scientific knowledge about traumatic stress within Europe and internationally, and will publish original research papers as well as papers on evidencebased clinical practice. (Published: 6 December 2010) Citation: European Journal of Psychotraumatology 2010, 1: 5768 - DOI: 10.3402/ejpt.v1i0.5768 For the full text in other languages, please see Supplementary files in the column to the right (under Reading Tools).

A recent scandal in the Netherlands painfully underscored that sexual harassment and abuse are unfortunately still happening around the world, even after decades of advocacy on this issue and five years of #MeToo. To make progress in prevention and treatment we argue that we should address sexual violence from a public health perspective. Furthermore, looking back on the past year, the COVID-19 pandemic was the dominant and potentially traumatic stressor affecting large populations around the world. Another big topic was that of the impact of climate change, we are only beginning to realize its impact on stress across the globe. The European Journal of Psychotraumatology (EJPT), with its increasing global readership and scientific and social impact, is focusing on the traumatic stress aspects of these and many other events. Relatedly, neurobiological aspects are an important and growing focus of the journal in that they help us better understand the mechanisms behind the development of trauma-related disorders and their treatment. In this editorial, we present recent trends, new Open Science developments, journal metrics, the plans and themes for next year and the ESTSS EJPT award winners for best paper of 2021. Highlights • Next years’ research focus should be on sexual violence from a public health lens, climate change, and neurobiologal aspects of trauma-related disorders. The European Journal of Psychotraumatology (EJPT) calls or papers on these issues.

The authors evaluated changes in symptoms and levels of perceived distress of 21 Cambodian, 13 Hmong/Laotian, and 18 Vietnamese patients before and after a 6-month treatment period. Most of the patients improved significantly. Cambodians had the greatest and Hmong/Laotians had the least reductions in depressive symptoms. Although psychological symptoms improved, many somatic symptoms worsened. The authors conclude that refugee survivors of multiple traumata and torture can be aided by psychiatric care. They recommend investigations with larger samples and suitable control groups to further clarify the relative contributions of trauma, diagnosis, and acculturation stress to treatment outcome.

ON THE MORNING OF September 11, 2001, people the world over were riveted by breaking news of seemingly impossible events: simultaneous terrorist attacks, using three hijacked commercial airliners, on the World Trade Center in New York City and the Pentagon in Washington, D.C. As America awoke to the devastating reports on television and radio, the drama continued to unfold, until a fourth jetliner filled with passengers crashed into the earth in rural Pennsylvania, apparently falling short of its intended political target. In the subsequent hours, days, and weeks, the terrible cost of the terrorist acts continued to mount, with a death toll exceeding 3,000 people, who only hours before the attacks had begun their day’s work or travel unaware that it would be their last. Some of the losses touched Americans with particular poignancy, such as the tragic deaths of hundreds of New York City firefighters and police officers struggling in and around the damaged towers to evacuate survivors, who themselves were buried in the rubble of the collapsing structures. As the grim day ended, a nation and world community mourned the terrible loss of life. Immediate images and subsequent reports of the attacks symbolized both the personal and universal dimensions of catastrophe: scenes of individuals falling from windows 100 stories above the earth, contributing to mortality statistics tallying the deaths of citizens of more than 80 nations literally spanning the globe. And these deaths were only the most evident and anguishing of an unforeseeable range of losses—of health, livelihood, security, and much else—that would ripple through families, businesses, communities, and whole cultures in the months and years to come. The traumatic losses entailed by this attack draw attention to the frailty of human life, as well as the obvious and less than obvious impact of loss of life on survivors. This issue of Innovations focuses on the immediate and long-term effects of bereavement. Although untimely and violent deaths pose special challenges for the bereaved, even the anticipated death of a loved one can shake our emotional world, and produce surprising aftershocks. The emotional impact of such losses can be compounded by the misunderstanding, blame, or simple inattention of other people in institutional care settings, the family, workplace or community, adding a burden of private anguish, secrecy, or shame for those whose mourning is “hurried up,” disallowed, trivialized, or unrecognized by those around them.

This special issue of the European Journal of Psychotraumatology (EJPT) presents the first studies published by EJPT on COVID-19. We present 26 qualitative and quantitative studies assessing the prevalence of trauma-related symptoms and psychopathology within specific vulnerable populations such as health-care workers, students, children, and managers, or more broadly at a country level with a diverse set of outcomes including post-traumatic stress, moral injury, grief and post-traumatic growth. Intervention studies focus on whether telehealth delivery of mental health therapy in the pandemic environment was useful and effective. It is clear that the pandemic has brought with it a rise in trauma exposure and consequently impacted on trauma-related mental health. While for many individuals, COVID-19-related events met criteria for a DSM-5 Criterion A event, challenges remain in disentangling trauma exposure from stress, anxiety, and other phenomena. It is important to determine the contexts in which a trauma lens makes a useful contribution to understanding the mental health impacts of COVID-19 and the ways in which this may facilitate recovery. The papers included in this Special Issue provide an important and much-needed evidence-based foundation for developing trauma-informed understanding and responses to the pandemic.