Complex Trauma Research Articles

The 123s and affective, behavioral, and cognitives of unaccompanied Latinx Minors: A trauma-informed composite case study.

This article explores the stages where trauma is experienced (123s) and its physiopsychological impact (affect, behavior, and cognitions [ABCs]) in unaccompanied Latinx Minors through the analysis of a composite case study. Unaccompanied Latinx Minors represent a unique and growing population in the United States that warrants careful consideration from a trauma-informed and resilience-based framework. A detailed case study was implemented, triangulating caregiver and client therapy records to illustrate the framework of stages of trauma exposure (123s) and physiopsychological impact (ABCs). Latinx children often encounter various potentially traumatic experiences and adverse childhood experiences at the following stages (123s): (1) Preimmigration; (2) During immigration; and (3) Postimmigration. The extended traumas experienced by immigrant youth may easily constitute toxic stress. Moreover, once in the destination country, youth may lack coping resources or encounter stressful circumstances that prolong or exacerbate the impact of previous traumas. This continuous physiological hyperarousal can also result in changes in brain neurobiology, which further compounds the experience of other symptoms (Krupnik, 2021). These potentially complex trauma responses may manifest for these children through ABCs. The cumulative impact of these incidents may have significant effects on minors' A. Affective, B. Behavioral, and C. Cognitive functioning. Relevant clinical implications and policy recommendations for addressing the multifaceted needs of unaccompanied Latinx minors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The weaving of therapist responses with client storytelling to promote narrative and emotional integration of complex trauma.

The weaving of therapist responses with client storytelling to promote narrative and emotional integration of complex trauma.

Identity Reconstruction in Survivors of Complex Trauma

Survivors of complex trauma often face significant challenges in reconstructing their sense of identity, which is frequently fragmented and disrupted by their traumatic experiences. This qualitative research investigates the intricate process of identity reconstruction among trauma survivors, focusing on their perceptions, key contributing factors, and the influence of support systems. Using a phenomenological approach, the study delves into the lived experiences of 12 diverse participants through semi-structured, in-depth interviews. Data were analyzed using Colaizzi's seven-step process, facilitated by NVivo 12 software, to uncover the essence of their identity journeys. The findings reveal that survivors often perceive their identities as profoundly altered and disconnected from their pre-trauma selves, highlighting the enduring impact of trauma. Key factors aiding identity reconstruction include personal resilience, effective therapeutic interventions, and supportive social interactions. The critical role of support systems, such as family, therapy, and community, is underscored, either facilitating or hindering the reconstruction process. The research culminates in the development of the "Identity Reconstruction and Support Systems Framework" (IRSSF), a novel model that integrates essential elements of identity reconstruction with the pivotal influence of various support systems, offering comprehensive insights into the recovery pathways for complex trauma survivors. The findings of this research provide significant insights into the complex journey of identity reconstruction among trauma survivors, directly addressing the research objectives.

Supplemental Material for The Weaving of Therapist Responses With Client Storytelling to Promote Narrative and Emotional Integration of Complex Trauma

Supplemental Material for The Weaving of Therapist Responses With Client Storytelling to Promote Narrative and Emotional Integration of Complex Trauma

Infectious and Inflammatory Microenvironment Self-Adaptive Artificial Peroxisomes with Synergetic Co-Ru Pair Centers for Programmed Diabetic Ulcer Therapy.

Complex microenvironments with bacterial infection, persistent inflammation, and impaired angiogenesis are the major challenges in chronic refractory diabetic ulcers. To address this challenge, a comprehensive strategy with highly effective and integrated antimicrobial, anti-inflammatory, and accelerated angiogenesis will offer a new pathway to the rapid healing of infected diabetic ulcers. Here, inspired by the tunable reactive oxygen species (ROS) regulation properties of natural peroxisomes, this work reports the design of infectious and inflammatory microenvironments self-adaptive artificial peroxisomes with synergetic Co-Ru pair centers (APCR) for programmed diabetic ulcer therapy. Benefiting from the synergistic Co and Ru atoms, the APCR can simultaneously achieve ROS production and metabolic inhibition for bacterial sterilization in the infectious microenvironment. After disinfection, the APCR can also eliminate ROS to alleviate oxidative stress in the inflammatory microenvironment and promote wound regeneration. The data demonstrate that the APCR combines highly effective antibacterial, anti-inflammatory, and provascular regeneration capabilities, making it an efficient and safe nanomedicine for treating infectious and inflammatory diabetic foot ulcers via a programmed microenvironment self-adaptive treatment pathway. This work expects that synthesizing artificial peroxisomes with microenvironments self-adaptive and bifunctional enzyme-like ROS regulation properties will provide a promising path to construct ROS catalytic materials for treating complex diabetic ulcers, trauma, or other infection-caused diseases.

“That weird kid without parents”: a qualitative analysis of identity following bereavement due to parental intimate partner homicide in Australia

ABSTRACT Purpose Bereavement through parental intimate partner homicide (IPH) is a unique form of complex trauma that may disrupt and destabilise identity in surviving children. This qualitative study aimed to generate a better understanding of post-homicide experiences and needs in the context of identity to improve support for these neglected victim-survivors. Methods Semi-structured interviews were conducted in Australia with 12 participants aged 16 to 55 years (10 females, one male, and one non-binary) who were younger than 18 years when one of their biological parents murdered the other. Data were analysed using reflexive thematic analysis. Results Four themes were generated: (1) non-normalcy; (2) isolation and alienation; (3) negotiating silence; and (4) understanding self through connection to parents. Participants’ bereavement seemed to catalyse a self-concept of difference that was defined relationally in opposition to “normal” peers. Isolation ensued this othering and was sometimes compounded by a lacking sense of belonging in post-homicide family environments or engagement in support that exacerbated alienation. Societal taboos saw participants mask their inner worlds, which hampered sense making and drove self-uncertainty. Connection to parents was an important vehicle for self-understanding. Participants generally rejected perpetrators and maintained an active connection with the deceased, which sometimes served as a powerful means of resolving identity-based tensions (e.g. fear of inheriting perpetrator traits). Conclusions Peer-based models of support and connection to victim parents warrant further investigation as potential intervention targets to alleviate identity-based distress following bereavement due to parental IPH.

"Estuvimos en una hielera": Migration trauma and detainment among newcomer Latinx adolescents.

Exposure to migration-related traumatic events may increase the risk for immediate distress upon arrival and complex trauma following resettlement. Record numbers of Latinx immigrant youth are being held in detainment facilities at the border and around the country. However, little research examines the psychological sequelae of trauma among detained youth. Through addressing these gaps, this article can inform policies and best practices that adhere to human rights and foster acculturative adjustment. This article describes community collaborative research with newcomer Latinx adolescents enrolled in public high schools. Study 1 (n = 127) used quantitative data to examine whether time in detention and trauma exposure were associated with psychosocial adjustment. Study 2 (n = 46) used qualitative data to explore the lived experiences of detainment and related trauma. Study 1 results found that over a third of participants had been detained for at least 4 weeks (36%) and nearly half the participants witnessed or experienced a traumatic event (46%). Although time in detainment was not related to internalizing or externalizing symptoms, exposure to trauma was associated with more internalizing and more externalizing symptoms. Study 2 results illustrated specific detainment-related stressors, including multiple relocations, inhumane conditions, legal concerns, and family separation, as well as complex psychological sequelae, both during detainment and after resettlement, as well as some satisfactory experiences. Results contribute new understanding of the unique experiences of immigration detainment and its psychological sequelae and can inform legal, policy, and educational practices that directly impact recently resettled Latinx youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Inpatient outcomes following admission to stabilization-focused complex trauma- and dissociation-specific unit.

Individuals with histories of complex psychological trauma, such as those with dissociative disorders, are often high utilizers of inpatient services and thus warrant further research attention. The present study sought to examine whether treatment on a specialized inpatient trauma unit was associated with improvements in adaptive functioning, emotion regulation, and dissociation among patients experiencing complex posttraumatic and dissociative symptoms. This study used archival data collected as part of treatment provided to inpatients (N = 54), the majority of whom had a dissociative disorder, at a specialized trauma disorders unit to analyze differences in scores between intake and discharge on measures of adaptive functioning, emotion regulation, and dissociation. Adaptive functioning and emotion regulation were significantly improved at discharge compared to intake, t(299) = -11.28, p < .001; t(305) = 8.54, p < .001, respectively, with very large effect sizes (d = 1.60; d = 1.20), and there was a significant decrease, t(311) = 2.15, p = .032, d = .30, in dissociative absorption. Our findings suggest that inpatient treatment modeled after expert consensus treatment guidelines is associated with significant improvements in adaptive functioning and emotion regulation and reduced dissociative absorption in individuals experiencing severe and acute complex posttraumatic and dissociative symptoms. Appropriate screening and symptom-specific treatment of complex posttraumatic and dissociative symptoms are recommended to improve outcomes for this population during inpatient hospital admission. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Centrality of Humiliation in Complex Posttraumatic Stress Disorder

ABSTRACT Victims of traumatic events that involve repeated interpersonal aggression and low or no chance of escape frequently report intense Self-Conscious Emotions (SCEs), such as Shame, Guilt, and Humiliation. Humiliation is the reaction to a forced loss of status and is hypothesized to have unique contributions to the development and maintenance of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD). However, previous studies did not include humiliation or did not simultaneously probe the relative contribution of each SCE to posttraumatic symptoms. This study aimed to investigate the dynamics between specific SCEs and trauma-related symptomatology in the general population who suffered a form of complex trauma. Four hundred forty-nine people (77.11% women) exposed to domestic violence and sexual abuse answered an online survey. We investigated whether each emotion would accurately predict probable PTSD and CPTSD levels above the proposed cutoff. We estimated a network model to understand the dynamics of their interactions and whether the traumatic event type would moderate relationships between SCEs and posttraumatic stress symptoms, comparing networks of two types of complex trauma. No SCE predicted PTSD, but humiliation was a predictor of CPTSD while controlling for Shame and Guilt. Humiliation was also the most central SCE domain in the networks of both traumatic events. Our results stress the relevance of Humiliation to understanding posttraumatic stress symptoms and the necessity to consider humiliation when studying the emotional processing in complex trauma.

Early vs. Later Experiences of Violence and Polysubstance Use Among Adults Who Inject Drugs

Background People who inject drugs (PWID) experience high rates of violence, especially in early childhood, increasing their likelihood of engaging in risky substance use behavior in adulthood. Additionally, complex trauma has been reported among PWID due to witnessing and experiencing an overdose, further highlighting the need to examine the role of multiple experiences of trauma on their vulnerability to substance misuse. Methods Our study of 350 PWID from rural Kentucky examined differences in polysubstance use between participants who experienced violence earlier (≤15 years old) versus later (≥16 years old) in their childhood. Results Findings highlighted a direct association between experiences of early childhood violence and polysubstance use in adulthood. Additionally, our sample of PWID who experienced violence early in their childhood reported higher rates of severe substance use disorder and mental health distress. Conclusions Tailored approaches that incorporate trauma-informed care may help to address the disproportionate rates of substance use and related adverse effects among PWID.

Exploring emotion dysregulation in adolescence and its association with social immaturity, self-representation, and thought process problems.

This study aimed to explore the complex phenomenon of emotional dysregulation, particularly in adolescence, which is associated with many mental health disorders and problems. Increasing the knowledge of clinicians and researchers in this area can be helpful in guiding future treatment plans. The aim of the study was to investigate, from an exploratory perspective, which structural aspects of adolescent functioning (assessed using the Rorschach test and administered and scored according to the Comprehensive System, CS, by Exner) were associated with different dimensions of emotional dysregulation (evaluated using the Difficulties in Emotion Dysregulation Scale, DERS). Secondary data were used for the study, which included 100 adolescents, with 50 in the clinical group (patients with complex trauma histories residing in therapeutic and socio-rehabilitative communities) and 50 in the nonclinical group (recruited from a scout group and middle and high schools). The two groups were compared on terms of the mean scores obtained in the DERS scales (one-tailed t-test) and the proportions of cases that obtained pathological values for selected Rorschach CS indicators (z-test). Partial correlations were calculated between the DERS scales and the Rorschach CS variables to explore which structural dimensions of functioning were associated with different characteristics of emotional dysregulation. The results indicated that the two groups differed in their outcomes on all DERS scales, except for Awareness and Goals, and on four Rorschach CS variables (EgoIndex, a:p, Wsum6, and MOR). Some significant positive and negative correlations between the Rorschach CS variables and the DERS scales also emerged. These results suggest that the dimensions of functioning associated with emotional dysregulation are related to self-representation, relational immaturity, and thought processes character and characterize membership in a therapeutic community. The correlations described in the article warrants further consideration. Finally, the study's limitations and future research prospects are presented.

A model linking emotional dysregulation in neurodivergent people to the proprioceptive impact of joint hypermobility.

Emotional feelings are putatively ascribed to central representation of bodily states in the context of expectation and uncertainty in both internal state and external world. Neurodivergent people are more likely to experience co-occurring mental health challenges, although mechanistic insights underpinning this association are scarce. We therefore undertook a study to test whether imprecise processing of proprioceptive error signals may underlie the connection between neurodivergence and emotional dysregulation. In a cohort of people with complex chronic conditions, including chronic pain/fatigue, and complex trauma, and in a comparison group, we assessed presence of neurodivergence, variant connective tissue manifested through joint hypermobility, and emotional dysregulation. We present a data-informed conceptual model showing that variant connective tissue determines whether proprioceptive surprise is linked with emotional dysregulation in neurodivergent individuals. We suggest that future research in this area may have important clinical implications for the interaction of mental and physical wellbeing in neurodivergent people. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

Effects of Concomitant Traumatic Spinal Cord and Brain Injury on In-Hospital Mortality: A Retrospective Analysis of a Nationwide Trauma Registry in Japan.

Isolated traumatic spinal cord injury (t-SCI) and traumatic brain injury (TBI) represent significant public health concerns, resulting in long-term disabilities and necessitating sophisticated care, particularly when occurring concurrently. The impact of these combined injuries, while crucial in trauma management, on clinical, socioeconomic, and health care outcomes is largely unknown. To address this gap, our secondary retrospective cohort study used data from the Japan Trauma Data Bank, covering patients enrolled over a 13-year period (2006-2018), to elucidate the effects of concurrent t-SCI and TBI on in-hospital mortality. Data on patient demographics, injury characteristics, treatment modalities, and outcomes were analyzed. Multivariate logistic regression analysis was performed to examine prognostic variables associated with in-hospital mortality, including interaction terms between t-SCI severity and TBI presence. This study included 91,983 patients with neurotrauma, with a median age of 62 years (69.7% men). Among the patients, 9,018 (9.8%) died in the hospital. Concomitant t-SCI and TBI occurred in 2,954 (3.2%) patients. t-SCI only occurred in 9,590 (10.4%) patients, whereas TBI only occurred in the majority of these cases (79,439, 86.4%). Multivariate logistic regression analysis revealed age; sex; total number of comorbidities; systolic blood pressure at presentation; Glasgow coma scale score at presentation; and Abbreviated Injury Scale (AIS) scores for head, face, chest, abdomen, cervical-SCI, thoracic-SCI, and lumbar-SCI as significant independent factors for in-hospital mortality. The odds ratio of cervical-SCI × head AIS as an interaction term was 0.85 (95% confidence interval: 0.77-0.95), indicating a negative interaction. In conclusion, we identified 12 factors associated with in-hospital mortality in patients with t-SCI. In addition, the negative interaction between cervical t-SCI and TBI suggests that the presence of t-SCI in patients with TBI may be underestimated. This study highlights the importance of early recognition and comprehensive management of these complex trauma conditions while considering the possibility of concomitant t-SCI in patients with TBI.

A Novel Uni- and Biplanar External Fixator for Initial and Definitive Complex Foot Trauma.

Evidence concerning the complex foot trauma, especially its definitive management, is scarce. Soft tissue envelope sequalae are the primary parameters that delay or make internal fixation implausible. Stability conferred by external fixators makes them a reasonable initial treatment choice. Although AO or circular fixators can be applied around the foot, this can involve a learning curve and substantial costs, especially for the circular fixator. There is little evidence as to how well external fixators work as a definite method of fixation in patients where progression to internal fixation cannot be made. We prospectively evaluated 10 adult patients with severe and complex foot trauma who were consecutively treated at our clinic. Initial reduction and stabilization were performed with an external fixator that was initially conceived for distal radius fractures, applied during the initial procedure and mantained throughout the treatment. Fracture healing was obtained in all 10 cases, and both internal and external column length was restored. One of the patients developed chronic osteomyelitis. At the 1-year follow-up visit, these patients averaged 45.6 points in the physical and 44.8 points on the mental status sections of the 12-Item Short Form Health Survey (SF-12). The Foot Function Index findings for pain, disability, and daily activities limitations were 33.3, 39, and 41.5, respectively, which suggest moderate residual impairment. In this relatively small case series of complex foot trauma, we found that the use of simple external fixation as definitive treatment worked reasonably well. Level III, prospective cohort study.

Health and school difficulties of children in foster care in the experience of their foster parents

The period of compulsory school attendance is a mentally very challenging period for children in foster care, which can be impacted by complex developmental trauma stemming from the child's experience in foster care with cumulative and chronic traumatic events in his/her biological family. These events have taken place over a long period of time in interpersonal relationships usually related to caregivers, in the form of abandonment of the child by the caregiver, changing caregivers, lack of safe space and necessary support for the child from the family and school, and/or deficiencies in the provision of coordinated health and social care for both the child and the foster parents. The paper presents research findings supported by a statistical analysis of health and school difficulties in children in foster care related to their school attendance. The purpose of the research was to support the quality and coordination of services of non-profit organizations providing social, health and educational services to foster families and their children during school attendance to support the school success and well-being of children. The study was implemented as part of a dissertation at the University of South Bohemia in České Budějovice in the Czech Republic on the topic of promotion of the health, social and psychological well-being of school-aged children in the context of their school and family environment. The authors carried out a questionnaire survey in the Czech Republic among a selected sample of respondents, who were foster parents of children aged 6 to 15 attending primary school in the Pardubice Region. In a total sample of 102 respondents, we identified two different groups. One group – 64 respondents with healthy children and another group – 38 respondents with children with health difficulties. The aim of the research was to compare the assessments of the intensity of school difficulties of children in foster care in groups of respondents with or without a child with health difficulties or mental illness in their foster care. The hypothesis of a difference in assessments of school difficulties in children with/without health difficulties was formulated and statistically tested (H0: ratings of the intensity of difficulties are the same in both groups). Statistical testing of the hypothesis utilised the non-parametric Mann-Whitney test with the test results being significant at the level of significance p&lt;0.05. Correlation was observed for each difficulty and exploratory cluster analysis shows their interrelationships. The study results according to the foster parents' assessment show a high intensity of difficulties of school-aged children in foster care in their inclusion in the classroom in establishing relationships with classmates (p-value =0.9), in a negative attitude towards learning and lack of motivation to learn (p-value =0.7) experiencing nervousness, internal tension and staying focused when learning. In addition, when comparing the groups of respondents with healthy children and children who have health difficulties/mental illness, there was a statistically significantly higher intensity of difficulties in the group of respondents with children with health difficulties when doing prep work for the classes (p-value =0.00075).

Optimizing FDM 3D Printing of Medical Models

Present paper presents the results on four cases of optimization of FDM 3D printing of medical models used for training on specific medical issues (2 cases) and of personalized patient-specific models used for complex Trauma and Orthopedic surgical procedures planning (2 cases). Depending on optimization criteria (proper combination of model splitting – minimum need of supports/or no supports – minimization of printing time and material consumption, facile support removal and good surface quality), the modification of the Cura slicer recommended settings related to layer thickness and support pattern, support Z distance, support X/Y distance, support overhang angle, and minimum support area, allowed the reduction of 3D printing time with 24% and 33%, very easy support removal, and an assessment of surface accuracy and quality as very good for the purpose, made by end users.

Clinical characteristics and outcomes of COVID-19 cases admitted to adult intensive care units during the pandemic: A single center experience

BackgroundCOVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting. MethodsA retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality. ResultsA total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs. ConclusionsCOVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type.

The 3D-Printed Custom Elbow Prosthesis for Salvage Treatment of Complex Intra-Articular Distal Humerus Fracture Malunion

Intra-articular fractures of the distal humerus are complex injuries that often require surgery with the goal of restoring elbow range-of-motion and function. Open reduction and internal fixation has been the preferred surgical modality; however, restoration of the medial and/or lateral columns can be complicated in fractures involving a major loss of the articular surface and bony structure. Over the past decade, 3-dimensional (3D) printing has made significant advances in the field of orthopedic surgery, specifically in guiding surgeon preoperative planning. Recently, the incorporation of 3D-printing has proven to provide a safe and reliable construct for the restoration of anatomy in complex trauma cases. We present a 47-year-old woman who sustained a complex, intra-articular distal humerus fracture with associated shearing of the capitellum that went onto malunion. Patient was treated with a patient-specific 3D-printed custom elbow prosthesis with excellent outcomes. Our goal was to shed light on the use of 3D-printing technology as a viable salvage option in treating complex, intra-articular distal humeral fractures associated with lateral condylar damage that subsequently went onto malunion.

Testing a sequential path analysis from early complex trauma to regulation of psychological needs

Classical and contemporary theoretical approaches emphasize that significant events during childhood have important implications throughout life regarding developmental psychopathology and psychological health. Previous research has shown significant associations between early complex trauma, affective temperament, and maladaptive parenting with symptomatology. However, how trauma experiences are amplified and/or augmented and how they impact the regulation of psychological needs remains unclear. Therefore, the present study aims to explore a sequential path model from early complex trauma to psychological needs with multiple mediators. Data were collected from a convenience sample (N = 644) who responded to several questionnaires in a cross-sectional design. Early complex trauma correlated positively with early maladaptive schemas and affective temperament. A significant sequential path model showed that early complex trauma is related to difficulties in the regulation of psychological needs, with significant contributions from affective temperament, maladaptive parenting, and early maladaptive schemas. Results support the notion that several variables may mediate relationships between trauma experiences and the regulation of psychological needs. Implications for the development of an integrative early disorder determinants theory are discussed.

Developmental couple therapy for complex trauma: Results of an implementation pilot study.

This pilot study examined the process and outcome of Developmental Couple Therapy for Complex Trauma (DCTCT) with seven couples. DCTCT is a novel form of couple therapy designed to address complexposttraumatic stress disorder symptomatology and couple-level distress in trauma survivors and their partners. These couples showed statistically significant improvements in overall trauma symptoms, emotion regulation capacities, and reductions in attachment-related anxiety. These results suggest that DCTCT may be a promising approach to intervention. Future directions include the development of a sequential care model, because resource limitations may not allow for all couples to receive the full treatment model over 40 weeks; it will also be important to address measurement issues in relation to mentalizing, to allow for observational coding across the course of therapy.