Related Posttraumatic Stress Disorder Research Articles

Emotional and Cognitive Processing in Sexual Assault Survivors' Narratives

Sexual assault sequelae include posttraumatic stress disorder (PTSD), depression, and substance use. Seminal treatment models have been developed based on emotional (Foa & Kozak, 1986) and cognitive (Resick & Schnicke, 1992) theories, and determined to be efficacious. Studies also have documented the utility of Pennebaker and Beall's (1986) narrative writing paradigm for trauma- related depressive and PTSD symptoms. Recently investigations have sought to explicate its benefit, focusing on mechanisms of action. This study aimed to examine the emotional activation and cognitive processing across narrative writing sessions with undergraduate sexual assault survivors. Results revealed statistically significant reductions in depressive symptoms and alcohol use, but not PTSD symptoms. Clinically meaningful and statistically significant emotional activation and habituation occurred within and across sessions. Implications and limitations are discussed.

Traumatic Experiences and PTSD Among Adolescent Congolese Refugees in Uganda: A Preliminary Study

The study examined experienced traumatic events and the related Post-Traumatic Stress Disorder (PTSD) amongst a sample of 89 adolescent Congolese refugees (56 females and 33 males) at a refugee camp in Uganda. Data was collected using a questionnaire, and analyzed for trauma moderation by demographics and mediation by PTSD symptom scores. Findings indicate a prevalence of PTSD of 49.4% overall, with 75% of the female refugees meeting the PTSD criteria. The refugees with PTSD had high intrusive, avoidance and arousal scores, in addition to moderate to severe PTSD symptom severity scores. Trauma load was a significant predictor of PTSD among adolescent refugees. Our findings point to the high prevalence of PTSD resulting from an increased trauma load and being a female.

Childhood trauma increases the risk of post-traumatic stress disorder in response to first-episode psychosis

To investigate the relationship between childhood trauma, post-traumatic stress symptoms due to the experience of childhood trauma, and post-traumatic stress symptoms due to the experience of psychosis. The current study assessed childhood trauma and post-traumatic stress disorder (PTSD) symptoms as a result of both childhood trauma and psychosis using the Impact of Events Scale - Revised, in a group of 36 people with first-episode psychosis. Reported rates of clinical level post-psychotic PTSD symptoms, childhood trauma and childhood trauma-related clinical level PTSD symptoms were 47% (95% CI 31-64%), 64% (95% CI 48-80%) and 39% (95% CI 23-55%), respectively. Reporting childhood trauma increased the risk of developing post-psychosis PTSD 27-fold (95% CI 2.96-253.80, p = 0.01). Having childhood trauma-related PTSD increased the risk of developing post-psychosis PTSD 20-fold (95% CI 3.38-123.25, p = 0.01). These risks were not explained by illness factors such as duration of untreated psychosis, age of onset or severity of psychotic symptoms. Those without post-psychotic PTSD symptoms at clinical levels were unlikely to report childhood trauma (6%; 95% CI 3-8%). These results suggest the cognitive, social and biological consequences of childhood trauma can prevent effective recovery from the trauma of acute first-episode psychosis resulting in post-psychotic PTSD. Treatment strategies for post-psychotic PTSD must address childhood trauma and related PTSD.

AS10-02 - E-consalting: war related PTSD and the enduring personality change after catastrophic experience

This study was examination e-consalting by Telepsychiatry of war related Posttraumatic stress disorder(PTSD) and the Enduring personality change after catastrophic experiense (EPCACE). The author's objective is to analize component of symptoms in PTSD and EPCACE. The subjects were 200 male psychiatric patients by Telepsychiatry and e-consulting with war related PTSD by videoconferencing via broadband ADSL by 2 Mbps. Posttraumatic stress syndrome-PTSS-10 scale, HAMD and 20-item Zung self-rating scale was used to assess state measures of symptom severity. The study tested the equivalence of the two forms of service (clinical psychiatric consultation “face to face” and telepsychiatry with interactive videoconferencing psychiatric services) delivery with Client Satisfaction Questionnaire (CSQ-8). The symptoms of prolonged PTSS(posttraumatic stress syndrome) with duration between six moths and two years had been founded at 154 (77%) and 46 (23%) of patients had no PTSS: symptoms of depression had been found at 165 (82,5%) patients. The enduring personality exchange after catastrophic experiense (F62.0), had been found at 26(13%) patients (P < 0.01); symptoms of depression had been found at 66 (33%) patients after two years. Index of the CSQ-8 in groups Face to face 21.8±2.5(M±SD) and in telepsychiatric group 22.1 ± 2.7(M±SD). Evolution of PTSD symptoms and continued examination and follow-up by Telepsychiatry service and e-consalting may be important in predicting the eventual development of depressive symptoms and precipitation of EPCACE(F62.0) enduring personality exchange after catastrophic experience in the war related PTSD. The results demonstrated equivalent levels of satisfaction in both face-to-face and telepsychiatry groups.

Risk factors of post-traumatic stress disorder in tsunami survivors of Kanyakumari District, Tamil Nadu, India

Context:In this study, we assessed the relation of possible risk factors with post-traumatic stress disorder (PTSD) in the survivors of December 2004 tsunami in Kanyakumari district.Materials and Methods:We identified cases (n=158) and controls (n=141) by screening a random sample of 485 tsunami survivors from June 2005 to October 2005 using a validated tool, “Impact of events scale-revised (IES-R),” for symptoms suggestive of PTSD. Subjects whose score was equal to or above the 70th percentile (total score 48) were cases and those who had score below or equal to 30th percentile (total score 33) were controls. Analysis was done using statistical package for the social sciences to find the risk factors of PTSD among various pre-disaster, within-disaster and post-disaster factors.Results:Multivariate analysis showed that PTSD was related to female gender [odds ratio (OR) 6.35, 95% confidence interval (CI) 3.26-12.39], age 40 years and above (OR 2.38, 95% CI 1.23-4.63), injury to self (OR 2.97, 95% CI 1.55-5.67), injury to family members (OR 2.09, 95% CI 1.05-4.15), residence in urban area (area of maximum destruction) (OR 3.37, 95% CI 1.35-8.41) and death of close relatives (OR 3.83, 95% CI 1.91-7.68). Absence of fear of recurrence of tsunami (OR 0.32, 95% CI 0.17-0.60), satisfaction of services received (OR 0.57, 95% CI 0.36-0.92) and counseling services received more than three times (OR 0.45, 95% CI 0.26-0.78) had protective effect against PTSD.Conclusions:There is an association of pre-disaster, within-disaster and post-disaster factors with PTSD, which demands specific interventions at all phases of disaster, with a special focus on vulnerable groups.

Lifetime prevalence of mental health disorders and delay in treatment following initial onset: evidence from the Northern Ireland Study of Health and Stress

The current study provides the first epidemiological estimates of lifetime mental disorders across NI based on DSM-IV criteria. Risk factors, delays in treatment and the experience of conflict are also examined. Nationally representative face-to-face household survey of 4340 individuals aged > or =18 years in NI using the composite international diagnostic interview. Analyses were implemented using SAS and STATA software. Lifetime prevalence of any disorder was 39.1% while projected lifetime risk was 48.6%. Individuals who experienced conflict were more likely to have had an anxiety, mood or impulse-control disorder. Treatment delays were substantial for anxiety and substance disorders. Results from this study show that mental disorders are highly prevalent in Northern Ireland. The elevated rates of post-traumatic stress disorder in relation to other countries and the association of living 'in a region of terror' disorders suggests that civil conflict has had an additional impact on mental health. Given substantial delays in treatment, further research is required to investigate the factors associated with failure and delay in treatment seeking.

Mechanisms of Change in Cognitive Processing Therapy and Prolonged Exposure Therapy for PTSD: Preliminary Evidence for the Differential Effects of Hopelessness and Habituation

The present study examined two potential mechanisms of change, hopelessness cognitions and habituation, in a randomized controlled trial of cognitive processing therapy (CPT) and prolonged exposure therapy (PE) for posttraumatic stress disorder (PTSD). Participants were 171 adult women with a current primary diagnosis of sexual assault related PTSD. The potential mechanisms were examined by evaluating the intraindividual change in hopelessness within the course of both treatments and subjective units distress (SUDS) ratings (a proxy for habituation) within the course of PE. The effects of intraindividual change in the proposed mechanisms were then examined on within-treatment changes in PTSD symptoms. Findings indicated that the participants assigned to the CPT treatment had significantly greater pre-post reductions in hopelessness than those assigned to PE and that the changes in hopelessness predicted changes in PTSD symptoms (R2 = .24). Intraindividual changes in SUDS ratings for participants in the PE treatment condition also predicted changes in PTSD symptoms and did so independently of the effect of changes in hopelessness. Future research should examine these mechanisms using more intensive methods of data collection that would permit the demonstration of temporality of change.

The structure of posttraumatic psychopathology in veterans attending primary care

This study attempted to extend research indicating that posttraumatic stress disorder (PTSD) factors of Re-experiencing, Avoidance and Hyperarousal are more related to Fear/phobic disorders, while PTSD Dysphoria is more related to Anxious-Misery disorders. Trauma exposure, PTSD and comorbidity data for 668 veteran patients were analysed using confirmatory factor analyses and relative strengths of the relationships between PTSD factors and the Fear and Anxious-Misery factors were assessed. Combining Simms, Watson, and Doebbeling's (2002) model of PTSD symptoms and Krueger's (1999) Fear/Anxious Misery model of mood and anxiety disorders fit the data well. Contrary to previous research, PTSD Re-experiencing, Avoidance and Hyperarousal did not correlate more with the Fear factor; nor did PTSD Dysphoria correlate more with Anxious-Misery. Hyperarousal was more closely related to Fear than was Re-experiencing; however, Avoidance was not. Dysphoria was more closely related to the Anxious-Misery factor than all other PTSD factors.

Supporting Children After Single- Incident Trauma

To strengthen trauma-informed health care by exploring parents' experiences of assisting their child after single-incident trauma (eg, violence, accidents, and sudden loss). Semistructured interviews with parents (N = 33) of 25 exposed children (8-12 years). Responsive parenting after trauma emerged as a core theme, consisting of (a) being aware of a child's needs and (b) acting on these needs. The authors identified 14 strategies, such as comparing behavior with siblings' behavior and providing opportunities to talk. Parents felt that their capacity to be responsive was influenced by their own level of distress. The authors propose a model of Relational PTSD (posttraumatic stress disorder) and Recovery to assist health care professionals working with children exposed to trauma. The results also point to the need to recognize the challenge that parents face when supporting a child after traumatic exposure and to align more with parents about procedures that may cause the child to be reminded of the event.

Trauma Exposure and Posttraumatic Stress Disorder Among Employees of New York City Companies Affected by the September 11, 2001 Attacks on the World Trade Center

Several studies have provided prevalence estimates of posttraumatic stress disorder (PTSD) related to the September 11, 2001 (9/11) attacks in broadly affected populations, although without sufficiently addressing qualifying exposures required for assessing PTSD and estimating its prevalence. A premise that people throughout the New York City area were exposed to the attacks on the World Trade Center (WTC) towers and are thus at risk for developing PTSD has important implications for both prevalence estimates and service provision. This premise has not, however, been tested with respect to DSM-IV-TR criteria for PTSD. This study examined associations between geographic distance from the 9/11 attacks on the WTC and reported 9/11 trauma exposures, and the role of specific trauma exposures in the development of PTSD. Approximately 3 years after the attacks, 379 surviving employees (102 with direct exposures, including 65 in the towers, and 277 with varied exposures) recruited from 8 affected organizations were interviewed using the Diagnostic Interview Schedule/Disaster Supplement and reassessed at 6 years. The estimated closest geographic distance from the WTC towers during the attacks and specific disaster exposures were compared with the development of 9/11-related PTSD as defined by the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. The direct exposure zone was largely concentrated within a radius of 0.1 mi and completely contained within 0.75 mi of the towers. PTSD symptom criteria at any time after the disaster were met by 35% of people directly exposed to danger, 20% of those exposed only through witnessed experiences, and 35% of those exposed only through a close associate's direct exposure. Outside these exposure groups, few possible sources of exposure were evident among the few who were symptomatic, most of whom had preexisting psychiatric illness. Exposures deserve careful consideration among widely affected populations after large terrorist attacks when conducting clinical assessments, estimating the magnitude of population PTSD burdens, and projecting needs for specific mental health interventions.

Perceptual processing advantages for trauma-related visual cues in post-traumatic stress disorder

BackgroundIntrusive re-experiencing in post-traumatic stress disorder (PTSD) comprises distressing sensory impressions from the trauma that seem to occur ‘out of the blue’. A key question is how intrusions are triggered. One possibility is that PTSD is characterized by a processing advantage for stimuli that resemble those that accompanied the trauma, which would lead to increased detection of such cues in the environment.MethodWe used a blurred picture identification task in a cross-sectional (n=99) and a prospective study (n=221) of trauma survivors.ResultsParticipants with acute stress disorder (ASD) or PTSD, but not trauma survivors without these disorders, identified trauma-related pictures, but not general threat pictures, better than neutral pictures. There were no group differences in the rate of trauma-related answers to other picture categories. The relative processing advantage for trauma-related pictures correlated with re-experiencing and dissociation, and predicted PTSD at follow-up.ConclusionsA perceptual processing bias for trauma-related stimuli may contribute to the involuntary triggering of intrusive trauma memories in PTSD.

Assessment, Treatment, and Vocational Implications of Combat Related PTSD in Veterans

Post Traumatic Stress Disorder (PTSD) is a potentially disabling condition among combat veterans. Often misunderstood, misdiagnosed, stigmatized, and improperly treated, veterans do not know where to seek appropriate services. The prevalence of combat related PTSD is reviewed. The symptoms of PTSD are described, common assessment measures are presented, treatment modalities are discussed, and vocational implications are described. Suggestions are made for rehabilitation counselors to be able to work within multidisciplinary teams to treat veterans with PTSD and to better accommodate veterans' readjustment to noncombatant life.

Posttraumatic Stress Disorder (Wiley Concise Guides to Mental Health)

The author is a psychologist in private practice in California, USA, and also an adjunct professor at Chapman University, Orange County. The Wiley Concise Guides to Mental Health are a series of texts covering topics such as substance use disorders, bipolar disorder and anxiety disorders. The aim of this paperback guide is to use clear language to provide an overview of the history, diagnosis, treatment, research, emerging trends and other critical information about post-traumatic stress disorder (PTSD). It describes its target audience as students, practising mental health professionals, emergency service providers, military personnel and others, who deal with traumatic situations and their aftermath. The book comprises 22 chapters organized in three sections. The first section deals with the theoretical and empirical foundations of PTSD, the second with its evaluation, assessment and treatment and the third section with more specialist areas such as PTSD in children, war, terrorism and torture. At the end of each chapter, there is a Quick Review where the content of the chapter is reiterated as a number of bullet points. The text is punctuated with case histories and boxed entries labelled as ‘alerts’ for professionals or lay people, where attention is drawn to ambiguous terminology or controversial material. The Quick Reviews provide very useful summaries and are an attractive feature of the text. The text is very readable and it fulfils the aim of the series editor to provide a condensed and comprehensive review of the topic. Although I assume that the book is targeted primarily at an American audience, it is easy to read, and there is little that is not relevant to a UK reader. I enjoyed dipping into the initial section, which explains clearly, and in depth, the theoretical basis of PTSD in terms of bio-psychosocial, cognitive and psychotherapeutic models. The most useful reference chapters for the occupational health physician are those on the assessment and treatment of PSTD. There is little mention, however, of PTSD in relation to work. Occupational health professionals who work with the emergency services or the military are likely to be disappointed if seeking practical advice on workplace management of the condition. I also doubt whether doctors in training, medical students, occupational medicine registrars or psychiatrists would choose it as a primary text on PTSD. But it covers much useful and interesting information, and it would be a good reference for the practising occupational health professional to keep in the library.

Family-Witnessed Resuscitation: Bereavement Outcomes in an Urban Environment

After 20 years of debate regarding the appropriateness of family-witnessed resuscitations (FWR), little substantive data exist to suggest a benefit or harm to the family member. To compare bereavement-related depression and post-traumatic stress disorder (PTSD) symptoms among cardiopulmonary resuscitation (CPR) patients' family members who remain in the waiting room of an urban emergency department (ED) with those who are invited to witness CPR. A prospective comparison study was conducted at two large, urban, Midwestern teaching hospitals. Adult family members of nontraumatic CPR ≥18 years of age patients were eligible. In the intervention hospital, emergency physicians were trained and encouraged to invite family members to witness CPR (FWR). At the control hospital, family remained in the ED waiting room (Non-FWR). Family members from each hospital were interviewed 30 and 60 days post-event regarding bereavement-related depression and PTSD symptoms. Relevant demographic information was also collected. Comparisons between FWR and Non-FWR were conducted using independent samples t tests and χ(2) where appropriate. Sixty-five family members (24 FWR and 41 Non-FWR) were included. There were no differences between groups in relationship to the patient (35% spouse/significant other), mean age (overall, 56 years), or race (75% African American). Patients in each group did not differ in need for assistance in any activities of daily living (overall, 44% needed assistance) prior to cardiac arrest. However, more FWR were female (83% versus 59%), and had higher levels of overall social support available. There were no differences between FWR and Non-FWR on overall PTSD scores (11.7 versus 11.4; mean difference = 0.3 [95 confidence interval (CI): -5.5; 6.1]) or depression scores (16.0 versus 20.6; mean difference = -4.5 [95CI: -12.0; 3.0]). Bereavement related depression and PTSD symptoms are commonly seen in family members of cardiac arrest victims, however, the magnitude of the effect is not impacted by witnessing or not-witnessing CPR in the ED.

An examination of the structure of posttraumatic stress disorder in relation to the anxiety and depressive disorders

The nature and structure of posttraumatic stress disorder (PTSD) has been the subject of much interest in recent times. This research has been represented by two streams, the first representing a substantive body of work which focuses specifically on the factor structure of PTSD and the second exploring PTSD's relationship with other mood and anxiety disorders. The present study attempted to bring these two streams together by examining structural models of PTSD and their relationship with dimensions underlying other mood and anxiety disorders. PTSD, anxiety and mood disorder data from 989 injury survivors interviewed 3-months following their injury were analyzed using a series of confirmatory factor analyses (CFA) to identify the optimal structural model. CFA analyses indicated that the best fitting model included PTSD's re-experiencing (B1-5), active avoidance (C1-2), and hypervigilance and startle (D4-5) loading onto a Fear factor (represented by panic disorder, agoraphobia and social phobia) and the PTSD dysphoria symptoms (numbing symptoms C3-7 and hyperarousal symptoms D1-3) loading onto an Anxious Misery/Distress factor (represented by depression, generalized anxiety disorder and obsessive compulsive disorder). The findings have implications for informing potential revisions to the structure of the diagnosis of PTSD and the diagnostic algorithm to be applied, with the aim of enhancing diagnostic specificity.

Similar factors predict disability and posttraumatic stress disorder trajectories after whiplash injury

Distinct developmental trajectories for neck disability and posttraumatic stress disorder (PTSD) symptoms after whiplash injury have recently been identified. This study aimed to identify baseline predictors of membership to these trajectories and to explore their dual development. In a prospective study, 155 individuals with whiplash were assessed at <1 month, 3, 6, and 12 months postinjury. Outcomes at each time point were assessed according to the Neck Disability Index and the Posttraumatic Stress Diagnostic Scale. Baseline predictor variables were age, gender, initial pain (based on a visual analogue scale [VAS]), pressure pain thresholds (PPT), cold pain thresholds (CPT), and sympathetic vasoconstrictor responses. Group-based trajectory analytical techniques were used to parameterise the optimal trajectories and to identify baseline predictors. A dual trajectory analysis was used to explore probabilities of conditional and joint trajectory group membership. CPT ⩾ 13°C (OR = 26.320, 95% CI = 4.981–139.09), initial pain level (VAS) (OR = 4.3, 95% CI = 4.98–139.1), and age (OR = 1.109, 95% CI = 1.043–1.180) predicted a chronic/severe disability trajectory. The same baseline factors also predicted chronic moderate/severe PTSD (CPT ⩾ 13°C, OR = 9.7, 95%CI = 2.22–42.44; initial pain level [VAS]: OR = 2.13, 95% CI = 1.43–3.17; age: OR = 1.07, 95% CI = 1.01–1.14). There was good correspondence of trajectory group for both disability and PTSD. These findings support the proposal of links between the development of chronic neck related disability and PTSD after whiplash injury. Developmental trajectories of disability and posttraumatic stress disorder (PTSD) after whiplash injury are mostly in synchrony, and similar factors predict their membership. This suggests links between the development of chronic neck pain-related disability and PTSD.

Default mode alterations in posttraumatic stress disorder related to early-life trauma: a developmental perspective

Recently, altered default mode network (DMN) connectivity in individuals with posttraumatic stress disorder (PTSD) has been related to prolonged childhood maltreatment.1 An emerging body of literature also describes the developmental differentiation of the DMN in healthy children.2–6 Critically, developmental changes in the DMN may parallel those observed in other associated domains, including self-referential processing, autobiographical memory, prospection and theory of mind, which are thought to rely on many of the same underlying processes and neural substrates implicated in the DMN.7 Moreover, deficient DMN connectivity in adults with childhood maltreatment–related PTSD appears similar to patterns of DMN connectivity observed in healthy children aged 7 to 9 years. Here, we propose that early-life trauma may interfere with the developmental trajectory of the DMN and its associated functions.8–11

Posttraumatic intrusive symptoms across psychiatric disorders

Reexperiencing symptoms are a key feature of posttraumatic stress disorder (PTSD). This study investigated the pattern of reexperiencing symptoms in non-PTSD posttraumatic disorders. This study recruited 1084 traumatically injured patients during hospital admission and conducted follow-up assessment 12 months later (N = 817, 75%). Twelve months after injury, 22% of patients reported a psychiatric disorder they had never experienced prior to the traumatic injury. One-third of patients with a non-PTSD disorder satisfied the PTSD reexperiencing criteria. Whereas patients with a non-PTSD disorder were more likely to experience intrusive memories, nightmares, psychological distress and physiological reactivity to reminders, only patients with PTSD were likely to experience flashback memories (OR: 11.41, 95% CI: 6.17–21.09). The only other symptom that was distinctive to PTSD was dissociative amnesia (OR: 4.50, 95% CI: 2.09–9.71). Whereas intrusive memories and reactions are common across posttraumatic disorders, flashbacks and dissociative amnesia are distinctive to PTSD.

Physiological predictors of posttraumatic stress disorder

Studies have assessed relationships between posttraumatic stress disorder (PTSD) symptoms and physiological reactivity concurrently; fewer have assessed these relationships longitudinally. This study tests concurrent and prospective relationships between physiological reactivity (heart rate and skin conductance) to a monologue procedure and PTSD symptoms in female assault survivors, tested within 1 and 3 months posttrauma. After controlling for initial PTSD and peritraumatic dissociation, 3 measures of increased physiological reactivity to the trauma monologue at 1 month predicted 3-month PTSD reexperiencing severity. Additionally, increased heart rate following trauma and neutral monologues at 1 month was predictive of 3-month numbing symptoms. Implications for the prospective relationship between physiological reactivity to trauma cues and PTSD over time are discussed.

Protective factors for posttraumatic stress disorder symptoms in a prospective study of police officers

Although police officers are frequently exposed to potentially traumatic incidents, only a minority will develop chronic posttraumatic stress disorder (PTSD). Identifying and understanding protective factors could inform the development of preventive interventions; however, few studies have examined this. In the present prospective study, 233 police officers were assessed during academy training and again following 2 years of police service. Caucasian race, less previous trauma exposure, and less critical incident exposure during police service as well as greater sense of self-worth, beliefs of greater benevolence of the world, greater social support and better social adjustment, all assessed during academy training, were associated with lower PTSD symptoms after 2 years of service. Positive personality attributes assessed during training with the NEO Five-Factor Personality Inventory were not associated with lower PTSD symptoms. In a hierarchical linear regression model, only Caucasian race, lower critical incident exposure during police service, greater assumptions of benevolence of the world and better social adjustment during training remained predictive of lower PTSD symptoms after 2 years of police service. These results suggest that positive world assumptions and better social functioning during training may protect police officers from critical incident related PTSD.