Posttraumatic Stress Disorder Severity Research Articles

Post-traumatic stress disorder among Iranian women with genital mutilation: a cross-sectional study

BackgroundThe conflicting evidence on the relationship between female genital mutilation/ cutting (FGM/C) and post-traumatic stress disorder (PTSD) may be due to the differences in the prevalence and type of FGM/C in different societies. The present study aimed to assess the prevalence and severity of PTSD and its associated factors among Iranian women with genital mutilation.MethodsThis cross-sectional study was performed on 155 women with genital mutilation aged 18–45 years referred to the health centers in Mahabad, located in west of Iran from October 2020 to April 2021. The participants were selected using convenience sampling method. After obtaining the informed consent form from the participants, the first researcher in the presence of a gynecologist determined the type of genital mutilation through the gynecological examination. The data were collected using demographic and obstetric characteristics and post-traumatic stress disorder checklist (PCL5) and analyzed using SPSS21 software. Further, independent t-test, ANOVA, Pearson correlation coefficient, and multivariate linear regression were used.ResultAll 155 women (100%) had type 1 genital mutilation. Six women (3.9%) had PTSD. The mean (SD) score of the PTSD symptoms among the women was 27.73 (6.79) in the attainable score of 0–80. The age at FGM/C, level of education, and type of residence were considered as the predictors of the severity of the symptoms of PTSD, as explaining 48.1% of the variance.Conclusion and recommendationIn the present study, the prevalence and severity of PTSD among the participants were relatively low, which may be due to convenience sampling method used in the study, the limited injury in genitalia, and the social acceptance of the practice. The results indicated that the severity of the PTSD symptoms enhanced by increasing age at FGM/C and decreasing socio-economic levels. It is recommended to conduct the similar studies among women with other types of FGM/C.

Gender Differences In Post-Traumatic Stress Disorder Severity, Pain Catastrophizing, Interference, And Intensity In Veterans: Baseline Findings From The Learning To Apply Mindfulness To Pain Study

Gender Differences In Post-Traumatic Stress Disorder Severity, Pain Catastrophizing, Interference, And Intensity In Veterans: Baseline Findings From The Learning To Apply Mindfulness To Pain Study

Latent emotion profiles of PTSD and specific emotions predicting differential therapy outcomes in a dismantling study of cognitive processing therapy.

Posttraumatic stress disorder (PTSD) is theoretically maintained by avoidance of emotions elicited from trauma-related beliefs. Whether PTSD symptom profiles and specific emotions predict treatment response is unknown. This secondary data analysis examined: a) whether individuals with PTSD can be sub-classified based on symptom clusters and specific emotions, and b) if these subgroups predict differential responses to cognitive versus exposure-based PTSD interventions. Women with physical or sexual assault-related PTSD were randomized to CPT (cognitive processing therapy elements only), CPT with written accounts (CPT+A), or written accounts (WA) only (n=150). Participants completed baseline measures of PTSD, state anxiety, internalized anger, externalized anger, shame, and guilt, and weekly PTSD measures during and 6 months after treatment. Latent profile analyses revealed four subgroups: low symptoms and emotions; moderate-high reexperiencing, low internalized emotions (i.e., moderate-high reexperiencing, moderate avoidance/hyperarousal/guilt, low shame/internalized anger/anxiety); low reexperiencing, moderate emotions (i.e., low re-experiencing, moderate avoidance/hyperarousal/guilt, moderate other emotions); and high symptoms and emotions (high symptoms and emotions except moderate externalized anger). The high symptom and emotion subgroup experienced greater PTSD symptom improvements in cognitive conditions than WA. Other groups did not exhibit differential change across conditions. Cognitive interventions may be well-suited for severe PTSD with high self-directed emotions. CLINICALTRIALS.GOV IDENTIFIER: NCT00245232.

Longitudinal profiles of sleep during residential PTSD treatment

We investigated longitudinal profiles of objectively measured sleep periods (SP) over the course of residential treatment for posttraumatic stress disorder (PTSD) in a cohort of U.S. male veterans. Participants (N = 190) slept on mattress-actigraphy systems in a Veterans Affairs (VA) residential PTSD program. The final sample included 4078 sleep periods. Latent class mixed model analyses were used to identify between-subject profiles in sleep period durations, controlling for daily medication intake, over the first fifty days of residency. Logistic regression was used to determine the association of pre-treatment characteristics with identified profiles. Three longitudinal profiles of sleep period characterized most of the sample: ‘stable’ (56%), ‘decreasing’ (35%), and ‘increasing’ (8%). Less severe pre-treatment PTSD avoidance symptoms predicted membership in the 'decreasing' class and increased depression symptoms were predictive of membership in the 'increasing' class. Nearly half of the sample reported a summary change of 1 h or more over the course of the initial 50-nights in the program. Future work is needed to identify how these profiles might drive inpatient treatment decisions regarding the provision of adjunctive sleep-focused treatment such as cognitive-behavioral treatment for insomnia or hypnotic medications.

Inhibition, Attentional Control and Binding Abilities in Relation to Dissociative Symptoms Among PTSD Patients

ABSTRACT Introduction The relationship between dissociation and cognitive abilities remains controversial. Empirical studies have reported positive, negative and non-existent associations between dissociation and cognition. These inconsistent results may be due to the fact that the studies focused mainly on trait dissociation, while dissociation is not stable but transient. After validating the French version of the Clinician Administered Dissociative States Scale (CADSS), the aim of the present study was to evaluate the relationship between state dissociation and cognitive abilities. Method We recruited 83 patients suffering from post-traumatic stress disorder (PTSD) and assessed them twice. At T1, they performed a neutral Stroop task and a neutral binding task. At T2 (one to three weeks later), after a script-driven dissociative induction, they performed an emotional Stroop task and an emotional binding task. Between the two sessions, they completed questionnaires at home evaluating PTSD severity, trait dissociation and cognitive difficulties. State dissociation was assessed at T1 and T2 using the Clinician-Administered Dissociative States Scale (CADSS). Results We found good psychometric properties of the French version of the CADSS. After inducing dissociation, significantly lower attentional performance was found among patients with than without dissociative reactions. We found a significant positive correlation between state dissociation and increased attention and memory difficulties after induction. Conclusion The French version of the CADSS is a reliable and valid tool to assess state dissociation, which is correlated with attentional difficulties. Attentional training is recommended to help patients control dissociative symptoms.

Recovery and adjustment trajectories among Hurricane Florence survivors: Analysis utilizing nonlinear dynamic system modeling.

Self-regulation shift theory (SRST) argues that most individuals are able to successfully recover from trauma via engagement in self-regulation processes as well as the effective utilization of internal and environmental resources. However, a minority of individuals may instead experience a self-determination violation as a result of their self-regulatory capacity being overwhelmed. This self-determination violation is marked by chaotic and shifting adjustment, maladaptive regulation attempts, and, ultimately, a shift to an impaired self-state and the development of persistent psychopathology, such as posttraumatic stress disorder (PTSD). The current study utilized nonlinear dynamic system (NDS) analysis to identify adjustment trajectory dynamics among rural hurricane survivors in North Carolina (N = 131) who completed daily ecological momentary assessments (EMAs) regarding their distress (i.e., negative mood and PTSD symptoms), regulation efforts (e.g., coping), and appraisals (e.g., coping self-efficacy) over a 6-week period. Four adjustment trajectories were identified, including two largely adaptive trajectories (69.0% and 5.7%), a less stable adjustment trajectory (6.9%), and a fourth trajectory (18.4%) marked by shifting adjustment states and more frequent maladaptive regulation and negative appraisals, suggesting possible self-determination violation. Consistent with this possibility, this final trajectory was also associated with more severe PTSD symptoms relative to the other three trajectories at enrollment and 6-month follow-up. Future work should utilize NDS to model posttrauma adjustment dynamics from within a SRST framework to identify patterns of positive and negative adjustment dynamics at different time points in the trauma recovery process.

Comparative effectiveness of evidence-based psychotherapies for PTSD delivered in VA residential PTSD treatment.

Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are first-line treatments for posttraumatic stress disorder (PTSD). There have been few direct comparisons of CPT and PE intended to determine their comparative effectiveness, none of which have examined outcomes among military veterans receiving these treatments in a residential setting such as the Department of Veterans Affairs (VA) residential rehabilitation treatment programs (RRTPs). Such work is essential given that these veterans are among the most complex and severely symptomatic patients with PTSD treated in VA. In this study we compared changes in PTSD and depressive symptoms across admission, discharge, four months and 12 months following discharge among veterans who received CPT or PE within VA RRTPs. Using linear mixed models conducted on program evaluation data derived from the electronic medical record and follow-up surveys, we compared self-reported PTSD and depressive symptom outcomes among 1130 veterans with PTSD who were treated with individual CPT (n = 832, 73.5%) or PE (n = 297, 26.5%) in VA PTSD RRTPs in fiscal years 2018-2020. PTSD and depressive symptom severity did not significantly differ at any time points. The CPT and PE groups both showed large-sized reductions in PTSD (CPT d = 1.41, PE d = 1.51) and depression (CPT d = 1.01, PE d = 1.09) from baseline to 12-month follow-up. Outcomes for PE and CPT do not differ among a highly complex population of veterans with severe PTSD and several comorbid conditions that can make it difficult to engage in treatment.

Genetic Liability, Exposure Severity, and Post-Traumatic Stress Disorder Predict Cognitive Impairment in World Trade Center Responders.

There is a high incidence of cognitive impairment among World Trade Center (WTC) responders, comorbid with post-traumatic stress disorder (PTSD). Yet, it remains unknown whether genetic liability for Alzheimer's disease, PTSD, educational attainment, or for a combination of these phenotypes, is associated with cognitive impairment in this high-risk population. Similarly, whether the effects of genetic liability are comparable to PTSD and indicators of exposure severity remains unknown. In a study of 3,997 WTC responders, polygenic scores for Alzheimer's disease, PTSD, and educational attainment were used to test whether genome-wide risk for one or more of these phenotypes is associated with cognitive impairment, controlling for population stratification, while simultaneously estimating the effects of demographic factors and indicators of 9/11 exposure severity, including symptoms of PTSD. Polygenic scores for Alzheimer's disease and educational attainment were significantly associated with an increase and decrease, respectively, in the hazard rate of mild cognitive impairment. The polygenic score for Alzheimer's disease was marginally associated with an increase in the hazard rate of severe cognitive impairment, but only age, exposure severity, and symptoms of PTSD were statistically significant predictors. These results add to the emerging evidence that many WTC responders are suffering from mild cognitive impairments that resemble symptoms of Alzheimer's disease, as genetic liability for Alzheimer's disease predicted incidence of mild cognitive impairment. However, compared to polygenic scores, effect sizes were larger for PTSD and the type of work that responders completed during rescue and recovery efforts.

The feasibility and acceptability of Project POWER: a mindfulness-infused, cognitive-behavioral group intervention to address mental and sexual health needs of young pregnant women in Liberia

BackgroundFollowing 14 years of civil war in Liberia, war exposure, gender-based violence, and extreme poverty have been identified as key challenges affecting the mental and sexual health of young pregnant women and the health of their unborn children. Despite ongoing efforts to rebuild the country’s healthcare infrastructure, empirical and culturally tailored interventions to address the consequences of war are severely limited. To address these concerns, we developed Project POWER (Progressing Our Well-being, Emotions, and Relationships), a mindfulness-infused, cognitive-behavioral intervention for young adult pregnant women. This study sought to 1) assess the feasibility and acceptability of POWER and 2) determine the preliminary efficacy of POWER for improving mental and sexual health outcomes among Liberian war-exposed young adult pregnant women.MethodsEighty-seven women aged 18–25 were recruited from three catchment areas in Monrovia, Liberia to participate in a two-condition, pre-post design quasi-experimental pilot trial. Participants were allocated to the intervention (POWER) or the control condition (a health education program) based on where they resided relative to the catchment areas. Each condition completed a ten-session program delivered over 5-weeks. Feasibility and acceptability of POWER were examined using program logs (e.g., the number of participants screened and enrolled, facilitator satisfaction, etc.) and data from an end-of-program exit interview. The preliminary efficacy of POWER on mental and sexual health outcomes was assessed using repeated measures ANOVA with time and condition as factors.ResultsAnalyses provided preliminary support for the feasibility and acceptability of POWER. Participants attended an average of 8.99 sessions out of 10 and practiced material outside the sessions at least 2.77 times per week. Women in both conditions showed significant reductions in the level of prenatal distress (baseline, M = 16.84, 3-month assessment, M = 12.24), severity of post-traumatic stress disorder (PTSD) symptoms (baseline, M = 11.97, 3-month assessment, M = 9.79),), and the number of transactional sexual behaviors (baseline, M = 1.37, 3-month assessment, M = .94) over time. Participants who received POWER showed significant reductions in the frequency of depressive symptoms (baseline, M = 5.09, 3-month assessment, M = 2.63) over women in the control condition.ConclusionsFindings suggest that POWER may be a feasible and acceptable intervention to promote mental and sexual health for young adult pregnant women in Liberia. However, fully powered clinical trials are still needed to determine the efficacy and effectiveness of POWER before recommending its use on a larger scale in Liberia.

Advancing the Measurement of Trauma-Related Shame Among Women With Histories of Interpersonal Trauma.

Shame is a predominant emotion for many interpersonal trauma (IPT) survivors and is associated with more severe posttraumatic stress disorder (PTSD) symptoms. Measurement challenges have led to difficulties in understanding the impact of trauma-related shame. The Trauma-Related Shame Inventory (TRSI) was developed to address this limitation, yet additional psychometric support is needed. The present study evaluated and provided psychometric support for the TRSI among women with IPT histories, although recommendations for improvement are discussed. The impact of trauma-related shame, relative to trait shame and trauma-related guilt, on PTSD symptoms was also studied, with results suggesting that trauma-related shame had the strongest association.

A Randomized Clinical Trial of Clinician-Supported PTSD Coach in VA Primary Care Patients.

Posttraumatic stress disorder (PTSD) is common in primary care patients; however, evidence-based treatments are typically only available in specialty mental healthcare settings and often not accessed. To test the effectiveness of a brief primary care-based treatment, Clinician-Supported PTSD Coach (CS PTSD Coach) was compared with Primary Care Mental Health Integration-Treatment as Usual (PCMHI-TAU) in (1) reducing PTSD severity, (2) engaging veterans in specialty mental health care, and (3) patient satisfaction with care. Multi-site randomized pragmatic clinical trial. A total of 234 veterans with PTSD symptoms who were not currently accessing PTSD treatment. CS PTSD Coach was designed to be implemented in Veterans Affairs PCMHI and combines mental health clinician support with the "PTSD Coach" mobile app. Four 30-min sessions encourage daily use of symptom management strategies. PTSD severity was measured by clinician-rated interviews pre- and post-treatment (8weeks). Self-report measures assessed PTSD, depression, and quality of life at pretreatment, posttreatment, and 16- and 24-week follow-ups, and patient satisfaction at post-treatment. Mental healthcare utilization was extracted from medical records. Clinician-rated PTSD severity did not differ by condition at post-treatment. CS PTSD Coach participants improved more on patient-reported PTSD severity at post-treatment than TAU participants (D = .28, p = .021). Coach participants who continued to have problematic PTSD symptoms at post-treatment were not more likely to engage in 2 sessions of specialty mental health treatment than TAU participants. Coach participants engaged in 74% more sessions in the intervention and reported higher treatment satisfaction than TAU participants (p < .001). A structured 4-session intervention designed to align with patient preferences for care resulted in more patient-reported PTSD symptom relief, greater utilization of mental health treatment, and overall treatment satisfaction than TAU, but not more clinician-rated PTSD symptom relief or engagement in specialty mental health.

Associations between trauma and substance use among healthcare workers and public safety personnel during the SARS-CoV-2 (COVID-19) pandemic: the mediating roles of dissociation and emotion dysregulation

ABSTRACT Background: Given the highly stressful environment surrounding the SARS-CoV-2 pandemic, healthcare workers (HCW) and public safety personnel (PSP) are at an elevated risk for adverse psychological outcomes, including posttraumatic stress disorder (PTSD) and alcohol/substance use problems. As such, the study aimed to identify associations between PTSD severity, related dissociation and emotion dysregulation symptoms, and alcohol/substance use problems among HCWs and PSP. Methods: A subset of data (N = 498; HCWs = 299; PSP = 199) was extracted from a larger study examining psychological variables among Canadian HCWs and PSP during the pandemic. Structural equation modelling assessed associations between PTSD symptoms and alcohol/substance use-related problems with dissociation and emotion dysregulation as mediators. Results: Among HCWs, dissociation fully mediated the relation between PTSD and alcohol-related problems (indirect effect β = .133, p = .03) and emotion dysregulation partially mediated the relation between PTSD and substance-related problems (indirect effect β = .151, p = .046). In PSP, emotion dysregulation fully mediated the relation between PTSD and alcohol-related problems (indirect effects β = .184, p = .005). For substance-related problems among PSP, neither emotion dysregulation nor dissociation (ps >.05) had any effects. Conclusion: To our knowledge, this is the first study examining associations between PTSD severity and alcohol/substance use-related problems via mediating impacts of emotion dysregulation and dissociation among HCWs and PSP during the SARS-CoV-2 pandemic. These findings highlight dissociation and emotion dysregulation as important therapeutic targets for structured interventions aimed at reducing the burden of PTSD and/or SUD among Canadian HCWs or PSP suffering from the adverse mental health impacts of the SARS-CoV-2 pandemic.

Changes in neural responses during affective and non-affective tasks and improvement of posttraumatic stress disorder symptoms following trauma-focused psychotherapy

At least one-third posttraumatic stress disorder (PTSD) patients do not respond to trauma-focused psychotherapy (TF-psychotherapy), which is the treatment of choice for PTSD. To clarify the change mechanisms that may be associated with treatment response, this study examined changes in neural activations during affective and non-affective processing that occur with improvement of symptoms after TF-psychotherapy. This study assessed PTSD treatment-seeking patients (n = 27) prior to and after TF-psychotherapy using functional magnetic resonance imaging when they completed three tasks: (a) passive viewing of affective faces, (b) cognitive reappraisal of negative images, and (c) non-affective response inhibition. Patients then underwent 9 sessions of TF-psychotherapy, and were assessed on the Clinician-Administered PTSD Scale following treatment. Changes in neural responses in affect and cognitive processing regions-of-interest for each task were correlated with reduction of PTSD severity from pretreatment to posttreatment in the PTSD cohort. Data from 21 healthy controls was used for comparison. Improvement of symptoms in PTSD were associated with increased activation of left anterior insula, reductions in the left hippocampus and right posterior insula during viewing of supraliminally presented affective images, and reduced connectivity between the left hippocampus with the left amygdala and rostral anterior cingulate. Treatment response was also associated with reduced activation in the left dorsolateral prefrontal cortex during reappraisal of negative images. There were no associations between response and activation change during response inhibition. This pattern of findings indicates that improvement of PTSD symptoms following TF-psychotherapy is associated with changes in affective rather than non-affective processes. These findings accord with prevailing models that TF-psychotherapy promotes engagement and mastery of affective stimuli.Clinical Trials Registration: Trial Registration: Prospectively registered at Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864 and ACTRN12609000324213. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83857

Pilot test of intranasal oxytocin as an enhancer of brief couples therapy for posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) negatively impacts military veterans and their intimate partners. Cognitive-Behavioral Conjoint Therapy (CBCT) was developed to address both PTSD and relationship satisfaction among couples. Although efficacious in improving PTSD, the effects of CBCT and the 8-session brief CBCT (bCBCT) on relationship satisfaction among veteran patients with PTSD are modest. Pharmacological augmentation with the neuropeptide oxytocin is promising for enhancing bCBCT's potency due to its effects on mechanisms of trauma recovery (e.g., extinction learning) and relationship functioning (e.g., trust, communication). The goal of this pilot uncontrolled clinical trial was to examine the feasibility and preliminary efficacy of bCBCT augmented with intranasal oxytocin for improving PTSD and relationship satisfaction among 10 U.S. veterans with PTSD and their intimate partners. Veterans self-administered 40 international units of intranasal oxytocin 30 min before each bCBCT session delivered to the couple via telehealth. Both partners completed pre-assessment, weekly, post, and 3-month follow-up assessments of PTSD symptoms and relationship satisfaction. Couples also provided qualitative feedback related to feasibility and engagement. Nine dyads completed the treatment. There were no serious adverse events. Veterans and partners reported moderate to large effect size improvements in relationship satisfaction (Hedge's g = 0.55 and 1.01, respectively). Veterans reported large effect size reductions in PTSD severity (Hedge's g = 1.87). These results suggest that virtual oxytocin-assisted bCBCT is feasible, scalable, potentially efficacious, and should be tested with a placebo-controlled randomized controlled trial.

Homeostatic normalization of alpha brain rhythms within the default-mode network and reduced symptoms in post-traumatic stress disorder following a randomized controlled trial of electroencephalogram neurofeedback.

Collective research has identified a key electroencephalogram signature in patients with post-traumatic stress disorder, consisting of abnormally reduced alpha (8-12 Hz) rhythms. We conducted a 20-session, double-blind, randomized controlled trial of alpha desynchronizing neurofeedback in patients with post-traumatic stress disorder over 20 weeks. Our objective was to provide mechanistic evidence underlying potential clinical improvements by examining changes in aberrant post-traumatic stress disorder brain rhythms (namely, alpha oscillations) as a function of neurofeedback treatment. We randomly assigned participants with a primary diagnosis of post-traumatic stress disorder (n = 38) to either an experimental group (n = 20) or a sham-control group (n = 18). A multichannel electroencephalogram cap was used to record whole-scalp resting-state activity pre- and post-neurofeedback treatment, for both the experimental and sham-control post-traumatic stress disorder groups. We first observed significantly reduced relative alpha source power at baseline in patients with post-traumatic stress disorder as compared to an age/sex-matched group of neurotypical healthy controls (n = 32), primarily within regions of the anterior default mode network. Post-treatment, we found that only post-traumatic stress disorder patients in the experimental neurofeedback group demonstrated significant alpha resynchronization within areas that displayed abnormally low alpha power at baseline. In parallel, we observed significantly decreased post-traumatic stress disorder severity scores in the experimental neurofeedback group only, when comparing baseline to post-treatment (Cohen's d = 0.77) and three-month follow-up scores (Cohen's d = 0.75), with a remission rate of 60.0% at the three-month follow-up. Overall, our results indicate that neurofeedback training can rescue pathologically reduced alpha rhythmicity, a functional biomarker that has repeatedly been linked to symptoms of hyperarousal and cortical disinhibition in post-traumatic stress disorder. This randomized controlled trial provides long-term evidence suggesting that the 'alpha rebound effect' (i.e. homeostatic alpha resynchronization) occurs within key regions of the default mode network previously implicated in post-traumatic stress disorder.

The Role of Emotion Dysregulation in the Relationship Between Sleep Disturbances and PTSD Symptom Severity.

Emotion dysregulation is implicated in the development, maintenance, and treatment of sleep disturbances and posttraumatic stress disorder (PTSD) separately. However, few studies have assessed interactions among these variables. To address this gap, this study examined whether the associations of sleep quality and sleep quantity with PTSD severity were stronger at higher levels of negative and positive emotion dysregulation in a community sample of 199 trauma-exposed individuals. This study found that both poorer sleep quality and lower sleep quantity were associated with greater PTSD severity at low to average (but not high) levels of negative emotion dysregulation. Positive emotion dysregulation did not moderate the relationships between sleep quality or quantity and PTSD severity. Exploratory additive multiple moderation analyses showed significant associations between poorer sleep quality and lower sleep quantity with greater PTSD severity at low to average levels of negative emotion dysregulation, coupled with any level of positive emotion dysregulation. Findings inform theoretical perspectives on the sleep-PTSD relationship and clinical applications of targeting emotion dysregulation in the treatment of sleep disturbances and PTSD symptoms for trauma-exposed individuals.

The mechanisms of influence in intergenerational trauma transmission from mother to baby after the war in Bosnia-Herzegovina: what have we learned since then?

IntroductionAfter the war in Bosnia-Herzegovina that lasted from 1992 to 1995, the populations gradually rebuilt their lives haunted by the spectrum of personal and collective painful souvenirs. Regarding the children who were born after the war, some mothers would rather not talk about it to protect their children from what they might be feeling while others would definetely share what they have experienced to protect their children. Because the intergenerational transmission of war trauma from mother to baby has been poorly explored among populations who recently lived in a warzone, we seeked to highlight the particularity of the interpersonal relations between the mother and her child in connection with maternal psychotrauma, by searching the factors of influence on the functioning of the dyad.ObjectivesThe main objective of this study is to determine and conceptualize the modes of transmission of trauma from the study of mother-baby interactions in a Bosnian environment, after the war in Bosnia-Herzegovina.MethodsIn 2003, 40 mothers and their babies aged 2 to 36 months living in Sarajevo were enrolled in the study. Among these mothers, 31 lived in or near the warzone and 9 were either displaced in other areas of the country or were refugees in foreign countries. We assessed the level of severity of post-traumatic stress disorder (PTSD) using the Clinician Administered PTSD Scale (Blake et al, 1998). In order to examine the quality of the mother-child dyads of mothers who lived through the war, we videorecorded a 10-minute free play of 23 dyads in their home environment. Then the interactions were coded using the National Institute of Child Health and Human Development observation grid by two independent raters.ResultsThe results showed that all mothers who lived through the war presented post-traumatic symptoms but only half of them showed a PTSD. Videotaped observations of mother-child interactions during playtimes revealed that their interactions are less linked to the mother’s PTSD than to the influence of PTSD on maternal attitudes and thereby extending to those of their infant. They are less sensitive to their children’s signals. They are also more intrusive and detached. Overall, they are more focused on themselves than on their child when they are interacting. As a result, their children are more focused on play and less actively engaged in communicating with their mothers.ConclusionsThe interactions between the mother and her child cover a set of relatively complex processes during which the two partners influence each other. When a mother lives through the war, she will pass on to her child an often painful life story. And thus, it is not only the content but also the way she transmits it that influences how the child receives the objects of the transmission.Disclosure of InterestNone Declared

Stress and pain regulation: Parallel processes among traumatized individuals

IntroductionThe human reaction to traumatic events is often marked by a dialectic alteration of two emotional states –a state characterized by intrusion, anxiety and hyperarousal, and a state of denial marked by dissociation and numbing. These two seemingly opposite states represent attempts to modulate stress, as gradual reduction of their intensity represents an adaptation to stress. Maladaptive reactions to trauma, however, reflect disrupted regulation capacities, manifested as persistent over-modulation or under-modulation of stress.ObjectivesTo demonstrate that these manifestations of disrupted regulation, as observed among individuals with posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) are also reflected in patterns of pain modulation.MethodsThree studies using self-report questionnaires and psychophysical tests, assessing sensitivity to pain, as reflected by pain thresholds, and reactivity to suprathreshold noxious stimuli, as implicated in their ratingResultsStudy 1 Included 32 PTSD outpatients, 29 anxiety disorder outpatients, and 20 healthy controls. PTSD patients reported higher rates of chronic pain (83.3%) than anxiety patients (42.0%) and controls (5.0%). PTSD severity correlated with chronic pain severity (r = 0.61, p &lt; 0.01). PTSD patients displayed a unique paradoxical pain profile, according to which their pain thresholds were significantly higher than those of the anxiety patients and controls (p &lt; 0.01), but they perceived suprathreshold stimuli as being much more intense (p &lt; 0.01).Study 2 included 32 PTSD outpatients and 43 healthy controls. Findings replicated the paradoxical pain profile among PTSD patients. Pain thresholds were positively associated with dissociation level (b = 0.49; p &lt; 0.05) and negatively associated with anxiety level (b = -0.63, p &lt; 0.01). Pain ratings were positively associated with anxiety (b = 0.52, p &lt; 0.05) and negatively related to dissociation levels (b = -.51, p &lt; 0.05).Study 3 included 46 women diagnosed with BPD and 47 healthy controls. Women with BPD reported higher levels of childhood trauma (p &lt; 0.05) than the controls. They also demonstrated higher pain thresholds (p &lt; 0.05). Among subjects with high levels of body dissociation, implicated by reduced body awareness, those with BPD demonstrated hyposensitivity to pain, manifested in higher pain thresholds, lower suprathreshold pain ratings, and pain evoked by higher temperature, than the controls. Among those with low levels of body dissociation, BPD subjects demonstrated increased reactivity to pain as manifested in higher pain ratings and pain evoked by lower temperature.ConclusionsThese findings demonstrate the association between over-modulation and under-modulation of stress and over-modulation and under-modulation of pain, respectively, among PTSD and BPD patients. These findings point to parallel processes of disrupted regulation among traumatized individuals.Disclosure of InterestNone Declared

Prior Sexual Trauma Exposure Impacts Posttraumatic Dysfunction and Neural Circuitry Following a Recent Traumatic Event in the AURORA Study

BackgroundPrior sexual trauma (ST) is associated with greater risk for posttraumatic stress disorder after a subsequent traumatic event; however, the underlying neurobiological mechanisms remain opaque. We investigated longitudinal posttraumatic dysfunction and amygdala functional dynamics following admission to an emergency department for new primarily nonsexual trauma in participants with and without previous ST. MethodsParticipants (N = 2178) were recruited following acute trauma exposure (primarily motor vehicle collision). A subset (n = 242) completed magnetic resonance imaging that included a fearful faces task and a resting-state scan 2 weeks after the trauma. We investigated associations between prior ST and several dimensions of posttraumatic symptoms over 6 months. We further assessed amygdala activation and connectivity differences between groups with or without prior ST. ResultsPrior ST was associated with greater posttraumatic depression (F1,1120 = 28.35, p = 1.22 × 10−7, ηp2 = 0.06), anxiety (F1,1113 = 17.43, p = 3.21 × 10−5, ηp2 = 0.05), and posttraumatic stress disorder (F1,1027 = 11.34, p = 7.85 × 10−4, ηp2 = 0.04) severity and more maladaptive beliefs about pain (F1,1113 = 8.51, p = .004, ηp2 = 0.02) but was not related to amygdala reactivity to fearful versus neutral faces (all ps > .05). A secondary analysis revealed an interaction between ST and lifetime trauma load on the left amygdala to visual cortex connectivity (peak Z value: −4.41, corrected p < .02). ConclusionsFindings suggest that prior ST is associated with heightened posttraumatic dysfunction following a new trauma exposure but not increased amygdala activity. In addition, ST may interact with lifetime trauma load to alter neural circuitry in visual processing regions following acute trauma exposure. Further research should probe the relationship between trauma type and visual circuitry in the acute aftermath of trauma.

Differential symptom weighting in estimating empirical thresholds for underlying PTSD severity: Toward a "platinum" standard for diagnosis?

Symptom counts as the basis for Post-Traumatic Stress Disorder(PTSD) diagnoses in the DSM presume each symptom is equally reflective of underlying disorder severity. However, the "equal weight" assumption fails to fit PTSD symptom data when tested. The present study developed an enhanced PTSD diagnosis based on (a) a conventional PTSD diagnosis from a clinical interview and (b) an empirical classification of full PTSD that reflected the relative clinical weights of each symptom. Baseline structured interview data from Project Harmony (N=2658) was used. An enhanced diagnosis for full PTSD was estimated using an empirical threshold from moderated nonlinear factor analysis (MNLFA) latent PTSD scale scores, in combination with a full conventional PTSD diagnosis based on interview data. One in 4 patients in the sample had a PTSD diagnosis that was inconsistent with their empirical PTSD grouping, such that the enhanced diagnostic standard reduced the diagnostic discrepancy rate by 20%. Veterans, and in particular female Veterans, were at greatest odds for discrepancy between their underlying PTSD severity and DSM diagnosis. Psychometric methodologies that differentially weight symptoms can complement DSM criteria and may serve as a platform for symptom prioritization for diagnoses in future editions of DSM.