Avoidance Of Reminders Research Articles

Psychosocial outcomes at three and nine months after good neurological recovery from aneurysmal subarachnoid haemorrhage: predictors and prognosis

Objectives: To investigate (1) the prevalence of various aspects of cognitive and psychosocial dysfunction, including post-traumatic stress symptoms, over nine months after subarachnoid haemorrhage (SAH); (2) whether SAH is preceded...

Grand rounds: ‘I'll knock elsewhere’ – the impact of past trauma in later life

“And when life has no more meaning in old age, the will to meaning is lost; when life no longer seems to be worth living, some people who have experienced disasters and are unable to cope, may throw their lives away.” (Wilson et al, 1988) There continues to be a great deal of interest among psychiatrists, psychologists and sociologists about post traumatic stress disorder (PTSD) related to war crimes and experiences. Twentieth century studies of Holocaust victims and Far East prisoners of war, Korean and Vietnam veterans and the recent experiences of people in Bosnia have honed the diagnosis and increased awareness of the gradations of these disorders. Almost every conceivable variable has been examined in attempts to explore the motivating and resulting behaviours. Initially most studies dealt with the immediate impact of the event, but more recently articles have focused on the longer-term effects on relatives and the next generations of the earlier events (Sigal, 1998). Time has allowed this. The passage of time has also established that post-traumatic stress symptoms can be reactivated as much as half a century after the original trauma (Krasucki et al, 1995). Reactivation of events from 40 or 50 years previously may occur via current stressors such as social isolation and upheaval. Equally perceived helplessness precipitated by the somatic process of ageing could reactivate previous feelings and a delayed onset or exacerbation of clinical PTSD may emerge during the process of ageing. Institutionalisation itself could re-awaken feelings associated with incarceration or victimisation (Aarts & Op den Velde, 1996; Sadavoy, 1997). Late-life PTSD is more often associated with sleep disturbance, nightmares, intrusive ideation and avoidance of reminders of the original events (Kuch & Cox, 1992).

A "Cure" for Chronic Combat-Related Posttraumatic Stress Disorder Secondary to a Right Frontal Lobe Infarct: A Case Report

A 48-year-old combat veteran sustained a right frontal cerebral infarct at the age of 45 years. The patient's family reports that prior to the infarct he had a preoccupation with memories of combat, as well as nightmares, avoidance of reminders, and multiple arousal symptoms. Since his recovery from the infarct, the patient and his family continue to relate significant arousal symptoms but deny any continued history of preoccupation with traumatic memories, reminder avoidance, or nightmares. The resolution of a limited number of symptoms in this patient following damage to the right frontal cortex suggests that some of the symptoms of posttraumatic stress disorder may be amenable to current biological interventions.

Posttraumatic stress disorder after motor vehicle accidents

Posttraumatic stress disorder (PTSD) can occur after motor vehicle accidents (MVAs). It is an anxiety disorder characterized by intrusive reliving of the accident, avoidance of reminders of the trauma and increased arousal. Diagnostic criteria as specified in DSM-IV and in ICD-10 are discussed. A case example illustrates the features of PTSD incurred by MVA. An overview concerning the history of empirical studies on the consequences of MVAs is given. PTSD is one of the more common psychiatric disorders, with prevalence rates after MVAs ranging from 1 % to nearly 9 %. Other psychiatric and comorbid disorders that can occur as a consequence of MVAs are described. The present paper reviews the most influential etiological theories for PTSD. It describes and discusses current knowledge on risk factors for the development of PTSD after surviving an MVA. In the treatment of PTSD cognitive-behavioural approaches have proven to be the most effective interventions.

Reactions to gastrointestinal cancer--variation in mental adjustment and emotional well-being over time in patients with different prognoses.

The relation between mental adjustment, often referred to as coping strategies, and emotional well-being and their changes over time were studied in 139 consecutive, newly diagnosed gastrointestinal cancer patients. Sixty-six patients were potentially cured since all known disease could be removed by surgery, whereas in 73 patients, this was not possible. A more confronting reaction to the diagnosis was associated with better emotional well-being whereas avoidance of reminders of, and intrusive thoughts about the disease were associated with more distress. In agreement with other studies, we found that the coping strategy 'Fighting Spirit' was associated with better emotional well-being while the reverse was true for the strategies 'Hopeless/Helplessness' and 'Anxious Preoccupation'. There were only minor changes over time in the average values of emotional well-being and coping strategies, particularly among patients who at diagnosis were considered incurable. In analyses of each individual's changes of predominant coping style and whether they were categorized as cases/doubtful cases on the HAD anxiety and depression scale, marked changes were, however, seen in several patients. The analyses of mean values give an impression of stability, whereas analyses of the number of patients with a specific predominant coping strategy and how they change, give another. The question of whether coping strategies and emotional well-being change through the course of the disease has no simple and obvious answer. Whether some of the investigated coping strategies should be conceptualized in terms of coping, or whether they are an outcome of the coping efforts, are discussed.

Quality of life for adult leukemia survivors treated on clinical trials of Cancer and Leukemia Group B during the period 1971-1988: predictors for later psychologic distress.

To identify predictors of psychosocial adjustment for survivors of adult acute leukemia, the adaptation of 206 survivors (77% with acute myelogenous leukemia, and 23% with acute lymphocytic leukemia) treated on any of 13 Cancer and Leukemia Group B trials during the period 1971-1988 was examined. Survivors (median age, 41 years) who were at least 1 year from completion of all treatment (median, 5 years) were interviewed by telephone about psychologic symptoms; social, sexual, and vocational function; and beliefs about control over health. Standardized psychologic instruments were used to evaluate survivors' responses. Most survivors adapted well; however, 14% were 1.5 standard deviations above normal on the Global Severity Index of the Brief Symptom Inventory. Predictors of greater psychologic distress included less education, younger age, anticipatory distress during chemotherapy treatment, and the combination of more medical problems after treatment with poorer family function. Anticipatory nausea and distress during chemotherapy predicted persistent visceral distress later, which occurred with reminders of treatment. Anticipatory vomiting predicted a greater tendency toward cancer-related intrusive thoughts and avoidance of reminders. Patients experiencing anticipatory distress during treatment who are younger and less educated should be monitored for depressive syndromes later.

Veterans of a Secret War

Data from a longitudinal study of women survivors of childhood sexual trauma documents the presence, over time, of the same symptoms that characterize posttraumatic stress disorder (PTSD) in Vietnam veterans—reexperiencing, avoidance of reminders or psychic numbing, and arousal. Survivors, as well as veterans, had endured conditions of helpless terror and threats to body and life. In both cases, traumatic violence was the antecedent of PTSD, and tenacious symptoms were the result. The sexual abuse survivors differed from veterans in several ways. The women were generally abused by family members, they were far younger at the time of their trauma, and they experienced it alone rather than in a group. Their abuse typically lasted longer, it was more likely to have been repressed, and therapy was much delayed. Despite an average of three decades separating trauma from treatment, significant progress toward healing was documented during the 6-year period of this study.

A terrorist hijacking: Victims' experiences initially and 9 years later

Three victims of a terrorist attack were interviewed in order to determine the coping mechanisms they utilized during the attack, the psychopathology present after the attack and the ways they dealt with their psychopathology. Fantasy, the belief in one's ability to positively influence his environment, altruistic actions, and dissociation reportedly helped those interviewed to cope during the incident. Depressive and post-traumatic stress phenomena comprised the major psychopathology present in those interviewed. Altruistic actions, symbolic repetition and mastery of the traumatic situation, self-esteem enhancing activities, avoidance of reminders of the incident and involvement in certain types of relationships reportedly helped these victims to deal with the sequelae of the attack.