Prior Traumatic Experiences Research Articles

Drs. Sijbrandij and Olff Reply

Back to table of contents Previous article Next article Letters to the EditorFull AccessDrs. Sijbrandij and Olff ReplyMARIT SIJBRANDIJ Ph.D.MIRANDA OLFF Ph.D.,MARIT SIJBRANDIJ Ph.D.Search for more papers by this authorMIRANDA OLFF Ph.D.Search for more papers by this author,Published Online:1 Jun 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To The Editor: Drs. Varma and Parashar comment on our randomized controlled trial in which we compared the administration of four sessions of CBT in patients with acute PTSD with a comparison group on a waiting list. Drs. Varma and Parashar argue that placing the comparison group on a waiting list did not adequately control for nonspecific factors that might have influenced outcome. We assume that they are suggesting that we should have included a treatment group that received only supportive counseling without specific CBT contents. However, we feel that an untreated comparison group on a waiting list is the best comparison group because it is the closest to studying natural recovery. Since it has been repeatedly shown that some early interventions impede natural recovery rather than promote it (1) , comparison with an untreated comparison group is essential in trials evaluating the efficacy of early interventions. Moreover, since randomized controlled trials comparing early treatment of PTSD relative to a natural recovery comparison group are somewhat scarce (e.g., 2 , 3) , studies evaluating the potential benefits or risks of any intervention relative to no intervention at all in the immediate aftermath following trauma are still necessary. Second, the authors comment that we did not perform screening for axis II disorders, specifically for borderline personality disorder. Indeed, performing extensive screening for personality disorder would have meant a significant burden for participants in our trial. We did, however, exclude patients with complex or chronic PTSD and risk for suicide. Therefore, the possibility of inclusion of many patients with borderline personality disorder influencing treatment outcome is implausible. Furthermore, we did not find an interaction effect between prior traumatic experiences—known to be present in many patients with borderline personality disorder—and treatment response in our exploratory subgroup analyses. In conclusion, we feel that any influence of the presence of borderline personality disorder on the efficacy of CBT in our study is highly unlikely.Amsterdam, the NetherlandsThe authors’ disclosures accompany the original article.

Television Watching and Mental Health in the General Population of New York City After September 11

Summary The September 11, 2001 terrorist attacks were watched on television by millions. Using data from a telephone survey of New York City residents in January 2002 (N= 2001), we examined the relations between television watching and probable posttraumatic stress disorder (PTSD) after the attacks. Among those who were directly affected by the attacks or had prior traumatic experiences, watching television was associated with probable PTSD. Experiencing a peri-event panic reaction accounted for some of the association between television watching and probable PTSD. Future research directions are suggested for better understanding the mechanisms behind observed associations between television watching and PTSD.

Mental Health Effects of Adolescent Trauma Exposure in a Female College Sample: Exploring Differential Outcomes Based on Experiences of Unique Trauma Types and Dimensions

Most studies on the psychological impact of trauma exposure focus on the response to a single type of trauma, with little or no attention paid to the contribution of prior traumatic experiences. The goal of this study was to disentangle some of the confounding effects of multiple trauma exposures by exploring the unique contribution to mental health outcomes made by specific types and dimensions of trauma. This report compares the psychological outcomes of college women who experienced different types of trauma during adolescence, including traumatic bereavement, sexual assault, and physical assault. Young women who had experienced a single event of one of these types were compared with peers who had experienced multiple single events, ongoing sexual and/or physical abuse, as well as those who had experienced no trauma. Results, based on structured clinical interviews, and self-report measures showed that there were some significant differences in mental health outcomes based on trauma type. However, trauma exposure versus no exposure and the cumulative effects of exposure versus one-time experiences played the key roles in differentiating the groups.

Vicarious Trauma in Aid Workers following the World Trade Center Attack in 2001

This study investigated the prevalence of secondary trauma in volunteers who were involved in the emergency response after the World Trade Center (WTC) attack. Secondary or vicarious trauma is defined as therapists’ emotional reactions to their clients’ traumatic material. A total of 163 caseworkers, non-clinicians involved in addressing victims’ concrete needs, participated in a semi-structured phone interview that assessed their background and volunteer experience and a mailed survey that assessed their psychological status. Outcome data were the PTSD Checklist (PCL) and the Beck Depression Inventory (BDI). Responses identified two distinct categories of volunteers: volunteers from out of town tended to be older, more experienced in disaster relief work, and had less levels of exposure to the attack than volunteers from the New York area. Most volunteers found the experience rewarding and enriching. However, 7.4% of the sample met diagnostic criteria for PTSD and a fifth had BDI scores indicating moderate to severe depression. Prior trauma, exposure to the event, self-reported unmet needs, and beginning or increasing substance use after 9/11 were significantly associated with post-traumatic stress symptoms and depression. Post-traumatic stress and depression symptoms were negatively correlated with age. Having had previous disaster experience and living with a partner appeared to have a protective effect on mental health status. In conclusion, relief agencies should pay particular attention to providing support for volunteers with prior traumatic experiences. Furthermore, they should ensure ongoing support after the end of the relief work.

The accumulative effect of trauma exposure on short-term and delayed verbal memory in a treatment-seeking sample of female rape victims.

The accumulative effect of prior high-magnitude trauma exposure on memory was examined in 73 rape victims, 92% of whom had current posttraumatic stress disorder (PTSD). Participants were administered the Logical Memory component of the Wechsler Memory Scale, the Quick Test to obtain an estimate of intelligence, and were assessed for prior traumatic experiences. Prior exposure to high-magnitude stressors (e.g., child rape, being kidnapped) was significantly correlated with poorer performance on the memory tasks. Regression analyses controlling for estimated IQ and psychopathology severity demonstrated that magnitude of prior trauma exposure predicted performance on the memory task, suggesting that in the current sample, deficits in verbal memory may be related (in part) to the degree of accumulative stress experienced over the lifetime.

Lifetime panic-depression comorbidity in the National Comorbidity Survey.

The National Comorbidity Survey is a nationally representative survey of the prevalences and correlates of DSM-III-R disorders in the US household population. Retrospective age-at-onset reports were used to study predictive relationships between lifetime panic and depression. Strong associations were found between the lifetime prevalences of panic and major depressive episodes (odds ratios: for panic attacks with depression, 6.2; for panic disorder with depression, 6.8). These associations were not significantly influenced by the inclusion or exclusion of respondents with mania. Temporally primary depression predicted a first onset of subsequent panic attacks but not of panic disorder. Temporally primary panic attacks, with or without panic disorder and whether or not the panic was persistent, predicted a first onset of subsequent major depression. The associations between panic attack and depression were attenuated in models that controlled for prior traumatic life experiences and histories of other DSM-III-R disorders. Lifetime panic-depression comorbidity characterizes most community respondents with panic disorder and a substantial few of those with major depression. The absence of a dose-response relationship suggests that primary panic attack is a marker, rather than a causal risk factor, of subsequent depression. Primary depression, in comparison, appears to be a genuine risk factor for secondary panic attacks. That primary depression predicts panic attacks but not panic disorder suggests that secondary panic is a severity marker of depression rather than a comorbid condition. These results are far from definitive because they are based on retrospective reports, lay-administered diagnostic interviews, and only 1 survey. However, they raise important questions that could lead to a fundamental rethinking of panic-depression comorbidity if they are replicated in future epidemiological and clinical studies.

The black box in somatization: Unexplained physical symptoms, culture, and narratives of trauma

Stimulated by our clinical work with patients who manifest unexplained “somatoform” symptoms in the primary care setting, this article addresses a theoretical black box in our understanding of somatization: how does culture mediate severe stress to produce symptoms that cannot be explained by the presence of physical illness? Despite various problems in his explanation of hysteria, Freud broke new ground by emphasizing narratives of traumatic experiences in the development and treatment of unexplained physical symptoms. Except in anthropologically oriented cultural psychiatry, contemporary psychiatry has traveled away from a focus on narrative in the study of somatization. On the other hand, recent interest in narrative has spread across many intellectual disciplines, including the humanities and literary criticism, psychology, history, anthropology, and sociology. We operationally define narratives as attempts at storytelling that portray the interrelationships among physical symptoms and the psychologic, social, or cultural context of these symptoms. Regarding somatization and trauma, we focus on the ways that narrative integrates the cultural context with traumatic life events. In explaining the black box, we postulate that extreme stress (torture, rape, witnessing deaths of relatives, forced migration, etc.) is processed psychologically as a terrible, largely incoherent narrative of events too awful to hold in consciousness. Culture patterns the psychologic and somatic expression of the terrible narrative. Methodologically, we have developed some techniques for eliciting narratives of severe stress and somatic symptoms, which we illustrate with observations from an ongoing research project. In designing interventions to improve the care of somatizing patients, we are focusing on the creation of social situations where patients may feel empowered to express more coherent narratives of their prior traumatic experiences.

The Epidemiology of Hyperostosis of the Spine Together with Its Symptoms and Related Mortality in a General Population

The prevalence rate of hyperostosis, defined as the presence of complete bony bridges linking two vertebrae in at least two separate sites in the dorsal spine, was studied in a sample of some 9 000 persons who were 40 years of age or older and were representative of the general population of Finland. The standardized rates of hyperostosis were 3.8% for men and 2.6% for women. The prevalence rates rose sharply with age, and depending on the age group, the male-female ratio varied between 1.4 and 2.1. The adjusted rate of hyperostosis was higher in East Finland than elsewhere. There was a suggestion of hyperostosis being associated with a higher mortality rate as judged by regional variations and by analysis of matched case-controled pairs. There was no evidence that locomotor symptoms occurred in excess in subjects with hyperostosis; nor was prior traumatic experience more common.

The Epidemiology of Hyperostosis of the Spine Together with Its Symptoms and Related Mortality in a General Population

The prevalence rate of hyperostosis, defined as the presence of complete bony bridges linking two vertebrae in at least two separate sites in the dorsal spine, was studied in a sample of some 9 000 persons who were 40 years of age or older and were representative of the general population of Finland. The standardized rates of hyperostosis were 3.8 % for men and 2.6 % for women. The prevalence rates rose sharply with age, and depending on the age group, the male-female ratio varied between 1.4 and 2.1. The adjusted rate of hyperostosis was higher in East Finland than elsewhere. There was a suggestion of hyperostosis being associated with a higher mortality rate as judged by regional variations and by analysis of matched case-control pairs. There was no evidence that locomotor symptoms occurred in excess in subjects with hyperostosis; nor was prior traumatic experience more common.