Peritraumatic Dissociative Experiences Questionnaire Research Articles

Predisposing and Precipitating Factors for Dissociation During Labor in a Cohort Study of Posttraumatic Stress Disorder and Childbearing Outcomes.

Peritraumatic dissociation is an important predictor of posttraumatic stress disorder (PTSD), depression, and impaired bonding following childbirth. The purpose of this study was to follow up on an earlier finding that peritraumatic dissociation in labor was associated with adverse postpartum outcomes by identifying predictors of dissociation in labor. This analysis used data from a prospective cohort study of primiparous women from southeast Michigan. There were 564 women included in the analysis; the primary outcome measure was the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) score measuring dissociation during labor. The prevalence of dissociation in labor for this sample was 7.4%. Important predictors of dissociation in labor included both predisposing (eg, childhood maltreatment trauma, preexisting psychopathology) and precipitating (eg, perception of care, negative appraisal of labor) factors. Overall, these predictors explained 14.7% of variance in PDEQ score. In 3 separate, simple linear regression models, the PDEQ score explained 20% of variance in postpartum PTSD, 13% of variance in postpartum depression, and 9% of variance in impaired bonding. Women with maltreatment history and PTSD are at risk to be retraumatized or overwhelmed by birth and to dissociate. Although it would be optimal to assess for dissociative coping prenatally, assessing with the PDEQ following birth could contribute to evaluation of risk for postpartum psychopathology.

Religious Beliefs, PTSD, Depression and Resilience in Survivors of the 2010 Haiti Earthquake

BackgroundThis study examines relationships between religious beliefs regarding the origin of the 2010 earthquake in Haiti and posttraumatic symptomatology as well as depressive symptoms and resilience among its survivors. MethodWe used convenient sampling to recruit participants (n=167). They completed six scales, which had been translated into Haitian Creole, including measures such as the Earthquake Experiences Exposure (EEE), the Peritraumatic Distress Inventory (PDI), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the PTSD Checklist (PTSD-CL), the Beck Depression Inventory (BDI) and the Connor–Davidson Resilience Scale (CD- RISC) ResultsAmong our participants, 51% were male, (mean age=30.5, SD=11.03), 92% (n=155) were believers in some sort of supernatural force and 65% (n=108) endorsed the earthquake as a natural phenomenon. There was significant difference in average scores at peritraumatic distress, PTSD symptoms and Resilience measures between those perceiving a divine origin and/or a punishment through the event and those who did not. Peritraumatic responses were best predictors for PTSD (β=.366, p<.001) and Depression symptoms (β=.384, p<.001). Voodoo adherents appeared to be vulnerable to depression, but reported superior resilience factors

Hypnosis for Awake Surgery of Low-grade Gliomas: Description of the Method and Psychological Assessment.

Awake craniotomy with intraoperative electric stimulation is a reliable method for extensive removal of low-grade gliomas while preserving the functional integrity of eloquent surrounding brain structures. Although fully awake procedures have been proposed, asleep-awake-asleep remains the standard technique. Anesthetic contraindications are the only limitation of this method, which is therefore not reliable for older patients with high-grade gliomas. To describe and assess a novel method for awake craniotomy based on hypnosis. We proposed a novel hypnosedation procedure to patients undergoing awake surgery for low-grade gliomas in our institution between May 2011 and April 2015. Surgical data were retrospectively recorded. The subjective experience of hypnosis was assessed by 3 standardized questionnaires: the Cohen Perceived Stress Scale, the Posttraumatic Stress Disorder Checklist Scale, the Peritraumatic Dissociative Experience Questionnaire, and a fourth questionnaire designed specifically for this study. Twenty-eight questionnaires were retrieved from 43 procedures performed on 37 patients. The Peritraumatic Dissociative Experience Questionnaire revealed a dissociation state in 17 cases. The Perceived Stress Scale was pathological in 8 patients. Two patients in this group stated that they would not accept a second hypnosedation procedure. The Posttraumatic Stress Disorder Checklist Scale revealed 1 case of posttraumatic stress disorder. Burr hole and bone flap procedures were the most frequently reported unpleasant events during opening (15 of 52 events). The main findings of our study are the effectiveness of the technique, which in all cases allowed resection of the tumor up to functional boundaries, and the positive psychological impact of the technique in most of the patients.

Dissociative symptomatology in cancer patients.

Introduction: The utilization of the post-traumatic stress disorder (PTSD) diagnostic spectrum is currently being debated to categorize psychological adjustment in cancer patients.The aims of this study were to: (1) evaluate the presence of cancer-related traumatic dissociative symptomatology in a sample of cancer patients; (2) examine the correlation of cancer-related dissociation and sociodemographic and medical variables, anxiety, depression, and post-traumatic stress symptomatology; (3) investigate the predictors of cancer-related dissociation.Methods: Ninety-two mixed cancer patients (mean age: 58.94, ds = 10.13) recruited from two hospitals in northern Italy were administered a questionnaire on sociodemographic and medical characteristics, the Karnofsky Scale to measure the level of patient activity and medical care requirements, the Hospital Anxiety and Depression Scale (HADS) to evaluate the presence of anxiety and depression, the Impact of Event Scale Revised (IES-R) to assess the severity of intrusion, avoidance, and hypervigilance, and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) to quantify the traumatic dissociative symptomatology.Results: 31.5% of participants report a PDEQ score above the cutoff. The results indicated that dissociative symptomatology was positively correlated with HADS scores (HADS-Anxiety: r = 0.476, p < 0.001; HADS-Depression: r = 0.364, p < 0.001) and with IES-R scores (IES-R-Intrusion: r = 0.698, p < 0.001; IES-R-Avoidance: r = 0.619, p < 0.001; IES-R- Hypervigilance: r = 0.681, p < 0.001). A stepwise regression analysis was performed in order to find the predictors of cancer-related traumatic dissociative symptomatology. The results converged on a three predictor model revealing that IES-R-Intrusion, IES-R-Avoidance, and IES-R-Hyperarousal accounted for 53.9% of the explained variance.Conclusion: These findings allow us to hypothesize a specific psychological reaction which may be ascribed to the traumatic spectrum within the context of cancer, emphasizing the close relationship between the origin of dissociative constituents which, according to the scientific literature, compose the traumatic experience. Our results have implications for understanding dissociative symptomatology in a cancer population and can help develop clinical programs of prevention and support for patients.

Peritraumatic tonic immobility is associated with PTSD symptom severity in Brazilian police officers: a prospective study.

Peritraumatic reactions feature prominently among the main predictors for development of posttraumatic stress disorder (PTSD). Peritraumatic tonic immobility (PTI), a less investigated but equally important type of peritraumatic response, has been recently attracting the attention of researchers and clinicians for its close association with traumatic reactions and PTSD. Our objective was to investigate the role of PTI, peritraumatic panic, and dissociation as predictors of PTSD symptoms in a cohort of police recruits (n=132). Participants were asked to complete the following questionnaires during academy training and after the first year of work: Posttraumatic Stress Disorder Checklist - Civilian Version (PCL-C), Physical Reactions Subscale (PRS), Peritraumatic Dissociative Experiences Questionnaire (PDEQ), Tonic Immobility Scale (TIS), and Critical Incident History Questionnaire. Employing a zero-inflated negative binomial regression model, we found that each additional point in the TIS was associated with a 9% increment in PCL-C mean scores (RM = 1.09), whereas for PRS, the increment was 7% (RM = 1.07). As the severity of peritraumatic dissociation increased one point in the PDEQ, the chance of having at least one symptom in the PCL-C increased 22% (OR = 1.22). Our findings highlight the need to expand investigation on the incidence and impact of PTI on the mental health of police officers.

The Role of Dissociation in Self-Injurious Behavior among Female Adolescents Who Were Sexually Abused

The study aimed to examine the role of dissociation (persistent versus peritraumatic) in self-injurious behavior among at-risk Israeli female adolescents. In addition, the relationship between childhood sexual abuse, depression, dissociation, and potency was investigated. A convenience sample of 93 female adolescents aged 12 years to 18 years were recruited from institutions for at-risk adolescent girls in Israel. Participants were administered an anonymous self-report questionnaire that included six measures: Demographics, Dissociative Experiences Scale, Center for Epidemiologic Studies Depression Scale, the Peritraumatic Dissociative Experiences Questionnaire, the Traumatic Events Questionnaire, and the Potency Scale. Results indicated that childhood sexual abuse increases the risk for self-injurious behavior more than threefold. Higher levels of persistent dissociation were found among girls who reported child sexual abuse compared to those who did not. Self-injurious behavior was predicted by persistent dissociation. Girls who engaged in self-injurious behavior had lower potency and higher depression levels, regardless of childhood sexual abuse history.

0065 Associations of Symptoms of Depression and Posttraumatic Stress Disorder with Peritraumatic Dissociation, and the role of Trauma Prior to Police Work

ObjectivesOur objective was to determine if symptoms of depression and posttraumatic stress disorder (PTSD) are associated with peritraumatic dissociation, and if this association is modified by trauma prior to police...

EPA-1315 - Role of peritraumatic and persistent dissociation in development of posttraumatic stress disorder

Acute stress disorder (ASD) and its predictivity in development of posttraumatic stress disorder (PTSD) has been researched extensively so far. Symptoms of peritraumatic dissociation (PD) has been proven as a predictive factor for PTSD, but recent studies have shown greater need for distinction of peritraumatic versus persistent dissociation. Symptoms of PD and of persistent dissociation in subjects diagnosed with ASD will be predictive of PTSD symptoms. To investigate the development of ASD symptoms, symptoms of PD and of persistent dissociation within the first month of traumatic event (initial) and six months later (follow-up) in victims of traffic accidents. At the moment, 25 subject were included in initial phase, and 18 at follow-up. Subject were interwieved, Mini International Neuropsychiatric Interview, Acute Stress Disorder Structured Interview, Clinician Administered PTSD Scale, The Dissociative Experience Scale, and The Peritraumatic Dissociative Experiences Questionnaire were administered. 10 subjects were diagnosed with PTSD in the follow-up. Preliminary results support for a greater risk for PTSD when dissociative symptoms are present, of PD or persistent dissociation. Greater distinction of dissociative symptoms in the acute trauma phase should be taken into account when diagnosing ASD. It could be eventually helpfull with identifying individuals at risk for PTSD.

Frequency and predictors of post-traumatic stress disorder after stroke: A pilot study

ObjectiveFew data exist about post-stroke symptoms of post-traumatic stress disorder (sPTSD) and none on DSM-IV formally diagnosed PTSD (fdPTSD). We investigated the frequency and predictors of sPTSD and fdPTSD 1–6months after a nondisabling ischemic stroke (IS) or transient ischemic attack (TIA). MethodsConsecutive patients were assessed for sPTSD (Impact of Events Scale-Revised, IES-R, significant if >30) and fdPTSD (PTSD-Interview). We recorded sociodemographic factors, stroke features (including severity of the initial deficit, persistent disability, localization), associated mood changes, peritraumatic reactions during the stroke (Peritraumatic Distress Inventory (PDI) for fear and distress, Peritraumatic Dissociative Experience Questionnaire for cognitive appraisal), and psychiatric history. Patients with sPTSD and fdPTSD were compared to patients with IES-R<30. ResultsAmong the 40 patients (65% male, mean age 52years) studied post-IS (n=30; mean initial NIHSS 4) or TIA, 25% had sPTSD, including 10% with fdPTSD. sPTSD was more frequent in women (p=0.02), patients with intense peritraumatic reactions especially on PDI (p=0.001) or identified prior depression and anxiety (p=0.007). No other demographic factors or stroke characteristics were associated with sPTSD. Forty percent of sPTSD patients were depressed versus none of the controls (p<0.002). All fdPTSD patients had ≥3 prior psychiatric co-morbidities. ConclusionsAfter nondisabling IS or TIA, sPTSD is frequent, with fdPTSD for 10%. Patients with intense peritraumatic reactions, women, and those with prior psychiatric morbidity, require particular attention to detect sPTSD.

The Effect of Comorbid Depression and Sexual Abuse during Childhood on Glucocorticoid and Mineralocorticoid Receptor Sensitivity of Patients with Post-Traumatic Stress Disorder

Evidence shows that Posttraumatic Stress Disorder (PTSD) patients have low basal cortisol levels and Glucocorticoid-Receptor (GR) super sensitivity following a pharmacological challenge. These findings, however, are controversial, partially due to the presence of confounding factors such as comorbidity with Major Depressive Disorder (MDD) and childhood trauma. In the present study, salivary cortisol levels of victims of violence with and without PTSD were assessed following a Prednisolone Suppression Test (PST), controlling for the presence of MDD and sexual abuse during childhood. The sample was nested in an epidemiological study performed in the city of Sao Paulo. Subjects with a diagnosis of PTSD (PTSD+) and a matched control group (PTSD-) were submitted to the Structured Clinical Interview for DSM-IV, after which the Early Trauma Inventory (ETI), Clinician-Administered PTSD Scale (CAPS), Beck Depression (BDI) and Anxiety Inventory (BAI) and Peri-traumatic Dissociative Experiences Questionnaire (PDEQ) were used. A saliva sample was collected before and after 5 mg of prednisolone was administered at 10 PM. Of the 34 PTSD+ patients, 19 had MDD comorbidity (PTSD+MDD). The cortisol curve of PTSD+MDD patients was similar to that of controls, and both were higher than that of PTSD patients. Cortisol levels after awakening after prednisolone administration were negatively correlated with the CAPS, BAI, and sexual abuse score on the ETI. These findings not only reinforce the idea that PTSD patients have GR super sensitivity, they also reveal that factors such as sexual abuse during childhood and comorbid MDD should be considered when studying HPA-axis reactivity, given their significant impact on the stress response.

PERILOSS DISSOCIATION, SYMPTOM SEVERITY, AND TREATMENT RESPONSE IN COMPLICATED GRIEF

Complicated grief (CG) is a bereavement-specific syndrome characterized by traumatic and separation distress lasting over 6 months. Little is known about the role of dissociation experienced during or immediately after the loss of a loved one (i.e., periloss dissociation [PLD]) in CG. The present study aimed to examine the psychometric properties of the PLD-adapted Peritraumatic Dissociative Experiences Questionnaire and its association with symptom severity, treatment response, and drop-out rate. PLD data collected as part of a randomized controlled trial of two loss-focused psychotherapy approaches for CG were examined. Treatment-seeking individuals with primary CG (n = 193) were assessed for PLD at the initial visit, 95 of whom were randomized and completed at least one treatment session. The PLD-adapted Peritraumatic Dissociative Experiences Questionnaire was found to be internally consistent (α = 0.91) with good convergent and divergent validity. After controlling for age, gender, time since loss, and current comorbid psychiatric diagnosis, self-reported PLD was associated with greater CG symptom severity (P < .01). However, contrary to our hypotheses, after controlling for age, baseline symptoms severity, psychiatric comorbidity, and treatment arm, PLD was predictive of better treatment response (P < .05) and lower study discontinuation (P < .01). PLD may be useful in identifying individuals at risk for CG and those who might respond to psychotherapy. Additional research should investigate the relationship of PLD with treatment outcome for different treatment approaches, and whether PLD prospectively predicts the development of CG.

Negative emotions, childbirth pain, perinatal dissociation and self-efficacy as predictors of postpartum posttraumatic stress symptoms

Objective: The aim of the study was to assess the contribution of negative emotions, childbirth pain, perinatal dissociation, and feelings of self-efficacy to the development of posttraumatic stress disorder (PTSD) symptoms following childbirth. Patients and methods: A prospective longitudinal study was carried out on 98 women from the south of France area. Four questionnaires were completed at 2–3 days postpartum: the Peritraumatic Emotions List (PEL), the French version of the McGill Pain Questionnaire, the Peritraumatic Dissociative Experience Questionnaire (PDEQ) and the Childbirth Self-efficacy Inventory (CBSEI). The Impact of Event Scale-Revised (IES-R) assessing posttraumatic stress symptoms was also completed 6 weeks after delivery. Results: Pain and negative emotions were significant predictors of the intensity of posttraumatic stress symptoms at 6 weeks postpartum. Although higher levels of pain contribute to increased PSTD symptoms, and higher negative emotion also contributes to PTSD symptoms, the effect of pain on PSTD is stronger when there are high levels of negative emotion. Discussion and conclusion: Our findings highlight that pain, negative emotions and their interaction were significant predictors of posttraumatic stress symptoms and confirm the importance of developing more specific treatments focusing on support and prevention.

The structure of peritraumatic dissociation: A cross validation in clinical and nonclinical samples

Empirical data have challenged the unidimensionality of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), a widely used measure for peritraumatic dissociation. The aim of this study was to assess the factor structure of the PDEQ in 3 trauma-exposed samples: (a) trauma-exposed police officers (N = 219); (b) trauma-exposed civilians (N = 158); and (c) treatment-seeking trauma-exposed civilians (N = 185). Confirmatory factor analyses using measurement invariance testing supported a 2-factor structure (CFIs .96-.98; RMSEAs .07-.09), but excluded 2 of the original items. Factor 1 was termed Altered Awareness; Factor 2 was termed Derealization. Altered Awareness reflected disturbances in information processing during the traumatic event, whereas Derealization reflected distortions in perception. Hierarchical linear regression analysis showed that Derealization predicted posttraumatic stress severity at 26.5 weeks follow-up only in the sample of police officers (R(2) = .45). Future longitudinal research shortly following trauma is required to elucidate causality and underlying mechanisms of peritraumatic dissociation, which may contribute to the development of more accurate screening strategies, as well as more effective strategies for prevention and early intervention.

Impact of an intensive care unit diary on psychological distress in patients and relatives*

To assess the impact of an intensive care unit diary on the psychological well-being of patients and relatives 3 and 12 months after intensive care unit discharge. Prospective single-center study with an intervention period between two control periods. Medical-surgical intensive care unit in a 460-bed tertiary hospital. Consecutive patients from May 2008 to November 2009 and their relatives. Study inclusion occurred after the fourth day in the intensive care unit. A diary written by both the patient's relatives and the intensive care unit staff. Patients and relatives completed the Hospital Anxiety and Depression Scale and Peritraumatic Dissociative Experiences Questionnaire 3 months after intensive care unit discharge, and completed the Impact of Events Scale assessing posttraumatic stress-related symptoms 12 months after intensive care unit discharge. Of the 378 patients admitted during the study period, 143 were included (48 in the prediary period, 49 in the diary period, and 46 in the postdiary period). In relatives, severe posttraumatic stress-related symptoms after 12 months varied significantly across periods (prediary 80%, diary 31.7%, postdiary 67.6%; p<.0001). Similar results were obtained in the posttraumatic stress-related symptom score after 12 months in the surviving patients (prediary 34.6 ± 15.9, diary 21 ± 12.2, and postdiary 29.8 ± 15.9; p = .02). The intensive care unit diary significantly affected posttraumatic stress-related symptoms in relatives and surviving patients 12 months after intensive care unit discharge.

Peritraumatic Dissociation After Loss

This study investigated the factor-structure of retrospectively assessed peritraumatic dissociation in the moments surrounding the death of a loved one and concurrent and prospective associations of such peritraumatic dissociation with loss-related emotional distress. Data were available from 168 people, bereaved in the preceding year. They completed the Peritraumatic Dissociative Experiences Questionnaire with their loss as the index event, together with measures of prolonged grief disorder, depression, and posttraumatic stress disorder; 117 completed symptom measures again 1 year later. Confirmatory factor analysis comparing the fit of four competing models showed that the eight-item one-factor model found in the first study using the Peritraumatic Dissociative Experiences Questionnaire provided the best fit to the data. Peritraumatic dissociation predicted concurrent and prospective symptom levels even when controlling for neuroticism and demographic and loss-related variables.

Posttraumatic Stress Disorder and psychological distress following medical and surgical abortion

Objective: Abortion can be a difficult event to cope with and can lead to the development of psychological disturbance. The aim of this prospective and longitudinal study was to assess and to predict Posttraumatic Stress Disorder (PTSD) symptoms following abortion. Moreover, this study aimed to assess whether the type of abortion had an impact on women’s experience. Method: Eighty-six women were approached a few hours after the abortion and then 6 weeks later. Several questionnaires were completed: the Impact of Event Scale Revised (IES-R), the Multidimensional Scale of Social Support (MSPSS), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the Peritraumatic Emotions List (PEL), the Hospital Anxiety and Depression Scale (HADS), the Perinatal Grief Scale (PGS) and the Texas Grief Inventory (TGI). Results: Six weeks after the abortion, 38% of women reported a potential PTSD and a significant decrease of the anxious symptomatology was also highlighted. Peritraumatic dissociation and peritraumatic emotions were the main predictors of the intensity of post-abortum PTSD symptoms. Compared to surgical abortion, medical abortion was associated with increasing the risk of developing a possible PTSD. Conclusion: By providing evidence on some of the main risk factors, this study highlights the need for psychological support for women and strategies of prevention to be developed.

Dissociative experience during childbirth

Objective: A dissociative experience refers to phenomena such as depersonalization, derealization, amnesia, out of body experience, altered time perception and body image. The aim of this study was to assess dissociative experience during childbirth and the possible related variables. Method: A total of 328 women, up to 72 hours postpartum, completed the peritraumatic dissociative experience questionnaire (PDEQ), the socio-demographic and obstetrical questionnaire, the pain numeric rating scale, the Trauma History Questionnaire and an SCID-I for traumatic events. Results: A total of 11.3% of the sample experienced significant dissociation. In particular, symptoms like a sensation of time changes during the event/things seemed to be happening in slow motion, not being aware of things that happened, and disorientation. A traumatic childbirth, previous trauma, obstetrical complications, forceps, prematurity, complications with the baby, dissatisfaction with the maternity care, unemployment, high score pain during labor and years of schooling were the factors considered. Conclusion: Dissociative experiences can occur during childbirth.

EEG Complexity and Attentional Processes Related to Dissociative States

Reported findings indicate that attentional narrowing is related to decreased complexity and increased inhibition of neural assemblies. These findings suggest that analysis of electroencephalogram (EEG) complexity could present a useful method for research of attentional changes related to dissociation. To examine this model we used a case study to test the two hypotheses: (1) that successful anticonvulsant medication would result in dissociative symptom alleviation, improvement of inhibitory neural functions, and decreased EEG complexity, and (2) that cognitive conflict, related to aversive events in the patient's past experience, during reliving of a dissociative state would lead to greater allocation of attention and decreased EEG complexity. Three EEG studies recorded in the eyes closed non-drowsy state were performed: (1) at baseline, (2) post-induction of dissociative state, and (3) post-anticonvulsant medication following induction of dissociative state. A dissociative state was achieved following an interview regarding the patient's aversive past experiences through use of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). The patient's level of dissociation was measured using the Dissociative Experiences Scale-II (DES-II). The PDEQ interview and DES-II assessment were also used one hour following the oral consumption of an anticonvulsant medication (clonazepam 2mg). Analysis of the data revealed that complexity values (PD2) are significantly lower following the oral consumption of clonazepam (2mg) in the majority of EEG channels. Additionally, complexity during the reliving of a dissociative state was statistically significantly lower than both the baseline and post-medication conditions in all but two EEG channels. Results of the case study suggest that changes in attentional processes linked to dissociation are related to: (1) decreased complexity when attention is extremely focused because of attentional narrowing to the disturbing past experience, and (2) increased complexity during ordinary experiences when attention is less narrowly focused.

Co-morbid depression and sexual abuse during childhood as confounding factors in the analysis of glucocorticoid-receptor supersensitivity in patients with posttraumatic stress disorder

INTRODUCTION Evidence shows that posttraumatic stress disorder (PTSD) patients have low basal cortisol levels and glucocorticoid-receptor (GR) supersensitivity following a pharmacological challenge. These findings, however, are controversial, partially due to the presence of confounding factors, such as co-morbidity with major depressive disorder (MDD) and childhood trauma. In the present study, salivary cortisol levels of victims of violence with and without PTSD were assessed following a prednisolone suppression test (PST), controlling for the presence of MDD and sexual abuse during childhood. METHOD The sample was nested in an epidemiological study performed in Sao Paulo City. The subjects with a diagnosis of PTSD (PTSD+) and a matched control group (PTSD-) were submitted to SCID-I; after which Early Trauma Inventory (ETI), Clinician-Administered PTSD Scale (CAPS), Beck Depression (BDI) and Anxiety Inventory (BAI) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) were used. Saliva samples were collected before and after 1,5 mg of prednisolone, administered at 10 PM. Discussion These results confirm previous findings that PTSD patients have lower cortisol levels by showing a blunted response to exogenous GC), which is likely due to increased GR responsiveness. Separating the patients with PTSD alone from those with co-morbid MDD showed that hypocortisolism is specific to PTSD, and the presence of MDD counterbalances PTSD-related dysfunction to “normalize” the curve of patients with both diagnoses. The presence of sexual abuse during childhood correlated negatively with lower the salivary cortisol concentrations. Early sexual abuse, but not other types of trauma such as general, physical, and psychological traumas, was correlated with cortisol dysfunction. The presence of sexual abuse during childhood is a potent risk factor for developing an Axis I diagnosis during adulthood [1]. Some authors find a correlation between early abuse and lower cortisol concentrations after a psychosocial stressor test and pharmacological challenge, an effect that is independent of the presence of an Axis I diagnostics [2-3]. The question raised here is whether the presence of severe sexual abuse during childhood and HPA axis response to stress is an endophenotype. Another aspect to consider is whether subjects with a particular type of HPA axis response are at a greater risk for PTSD development after a severe adulthood stressor. PTSD related to increased GR supersensitivity should be investigated further. Research also should address whether the presence of different endophenotypes depends on the timing of the trauma (considering epigenetic phenomenon). Interestingly, we did not find differences between controls and PTSD patients. Despite the fact that 40% of our sample had PTSD+MDD, the presence of PTSD symptoms had a predominant effect on HPA axis by lowering cortisol concentrations, as demonstrated by our comparison of PTSD+ (either with or without MDD) with controls.

Gravidade psicopatológica em mulheres vítimas de violência doméstica

OBJETIVO: Avaliar a presença de sintomas psicopatológicos em mulheres vítimas de violência doméstica (VD) que procuraram uma delegacia de defesa da mulher. MÉTODO: Foram avaliadas mulheres com idade entre 20 e 50 anos que deram entrada em uma delegacia da mulher com queixa de VD. Durante a entrevista, todas foram submetidas ao Relatório de Indicadores Sociais e preencheram os seguintes instrumentos de autoaplicação: Inventário de Depressão de Beck, Inventário de Ansiedade de Beck, Post-Traumatic Stress Disorder Checklist - Civilian Version e o Questionário de Experiências Dissociativas Peritraumáticas (todos em língua portuguesa). Foram usadas notas de corte a partir dos estudos de validação desses instrumentos para categorizar indivíduos com alta probabilidade de apresentar transtorno depressivo maior, transtorno de ansiedade, transtorno de estresse pós-traumático, ou alta/baixa dissociação peritraumática. RESULTADOS: Foram avaliadas 17 mulheres com idade média de 34,7±7,7 anos. O tempo médio de duração da violência foi de 9,1±8,7 anos. Do total de mulheres, 53% eram vítimas de agressão excessiva e 84% eram ameaçadas de morte pelo companheiro; em 71% dos casos, os companheiros eram usuários de drogas. Além disso, 53% das mulheres afirmaram ter sofrido VD na infância. Do total da amostra, 89% tiveram grande probabilidade de apresentar transtorno depressivo maior, 94% transtorno de ansiedade, 76% transtorno de estresse pós-traumático e 88% apresentaram elevados níveis de experiências dissociativas peritraumáticas. CONCLUSÃO: As vítimas de VD que dão entrada em delegacias de defesa da mulher têm alta probabilidade de apresentar morbidade psiquiátrica, assim como alterações cognitivas que as impossibilitam de sair do ciclo da violência.