Trauma Survivors Research Articles

Self-stigma mediates the relationships between childhood maltreatment and symptom levels of PTSD, depression, and anxiety

ABSTRACT Background: Childhood maltreatment is a risk factor for developing multiple forms of psychopathology, including depression, posttraumatic stress disorder (PTSD), and anxiety. Yet, the mechanisms linking childhood maltreatment and these psychopathologies remain less clear. Objective: Here we examined whether self-stigma, the internalization of negative stereotypes about one's experiences, mediates the relationship between childhood maltreatment and symptom severity of depression, PTSD, and anxiety. Methods: Childhood trauma survivors (N = 685, Mage = 36.8) were assessed for childhood maltreatment, self-stigma, and symptoms of depression, PTSD, and anxiety. We used mediation analyses with childhood maltreatment as the independent variable. We then repeated these mediation models separately for childhood abuse and neglect, as well as the different subtypes of childhood maltreatment. Results: Self-stigma significantly mediated the relationship between childhood maltreatment and depression, PTSD, and anxiety symptoms. For sexual abuse – but not physical or emotional abuse – a significant mediation effect of self-stigma emerged on all symptom types. For childhood neglect, self-stigma significantly mediated the relationship between both emotional and physical neglect and all symptom types. Conclusion: Our cross-sectional study suggests that different types of childhood maltreatment experiences may relate to distinct mental health problems, potentially linked to increased self-stigma. Self-stigma may serve as an important treatment target for survivors of childhood abuse and neglect.

Quality of Life and Spiritual Health in Motorcycle Accident Survivors: An Analysis Using the SF-36 Questionnaire and Spiritual Scale

Abstract Introduction Motorcycle traffic accidents rate remained high in Taiwan letting post-trauma care an imperative issue. This study investigates the spiritual, psychological, and physical impacts of motorcycle traffic accidents in Taiwan, focusing on the role of the Injury Severity Score (ISS) in influencing quality of life (QOL) and spiritual well-being outcomes, aiming to enhance holistic recovery strategies for trauma survivors. Methods A prospective study was conducted from April 2022 to March 2024 in a level I trauma center. Patients aged 20 and above with trauma from motorcycle accidents were enrolled and divided into major (ISS ≥ 16) and non-major (ISS < 16) trauma groups. QOL and spiritual health were assessed using 36-item short-form general health survey measures (SF-36) and spiritual scale before discharge and six months later. Results Of 98 patients, we observed significant post-discharge declines in both physical and mental QOL scores, regardless of ISS. However, spiritual scores improved significantly after discharge, with notable enhancements in interpersonal relationships and adversity transcendence observed in patients with ISS < 16, but not in those with ISS ≥ 16. SF-36 analysis revealed that non-religious groups experienced significant declines in mental health scores post-discharge, unlike religious groups, which remained stable. Additionally, religious individuals showed significant post-discharge improvements in interpersonal relationships and adversity transcendence, while non-religious showed no improvement. This suggests a beneficial link between religious adherence and enhanced spiritual well-being. Conclusion Motorcycle accidents reduce QOL and heighten spiritual needs for survivors, regardless of accident severity categorized by ISS score. Integrating spirituality into rehabilitation processes can positively impact overall well-being. Holistic care, addressing physical, psychological, social, and spiritual needs, is vital for optimizing long-term recovery and improving prognosis in trauma survivors, especially in regions with high rates of traffic accidents like Taiwan.

The influence of neuropeptide Y (NPY) on the relationship between emotion regulation and mood-related pathology in survivors of childhood interpersonal trauma

Neuropeptide Y (NPY) is a 36-amino acid peptide that is widely expressed throughout the limbic system. Recent evidence has highlighted NPY as a marker of resilience to posttraumatic psychopathology, which may be due to its association with neural regions involved with emotion regulation. This study examined whether plasma NPY levels moderated the relationship between emotion regulation and psychopathology in a sample of adult survivors of childhood interpersonal trauma, a population known to be at high risk for psychopathology. Adults exposed to an interpersonal criterion A trauma during childhood (N = 54) were recruited from an urban population at a midwestern medical center and completed a baseline study visit as part of a larger clinical trial. Participants gave a blood sample in order to assess circulating levels of NPY and answered questions related to emotion regulation and mood-related pathology. Results of a moderated multiple regression showed that the overall model was significant R2 = 0.26, F (5, 48) = 3.46, p < .01. Difficulties in emotion regulation was significantly predictive of psychopathology (unstandardized B = 0.032, p < .01), and this relationship was significantly moderated by levels of NPY (unstandardized B = −0.001, p < .05) such that the relationship between emotion regulation and psychopathology was weaker for those with higher levels of NPY. Results suggest that higher levels of NPY may lessen the association between emotion regulation and posttraumatic psychopathology in survivors of childhood interpersonal trauma. Further investigation of the contribution of NPY to psychopathology in this population is warranted. NCT02279290.

Living in the Aftermath: Spiritual Struggles of Hong Kong Christian Women Survivors of Sexual Violence

Spiritual trauma is one of the common outcomes for Christian women trauma survivors together with other psychological challenges (McNulty & Wardle in Child Abuse & Neglect, 18, 549–555, 1994; Rudolfsson & Tidefors in Pastoral Psychology, 64, 453–467, 2015; Yih in "Business as usual": Are Hong Kong faith communities supportive to Christian women with sexual harassment trauma? under review). Victims frequently experience much disappointment with the pastoral or congregational support they receive in the aftermath of their disclosure, which critically exacerbates their primary traumatic overwhelm and causes various faith-related challenges collectively known as spiritual struggle (Doyle in Sexual abuse in the Catholic clergy: A decade of crisis, 2002–2012 (pp. 171–182). Praegar, 2011). In this paper, I critically examine the spiritual aspect within the complex processes of Hong Kong Christian women survivors of sexual violence trauma recovering from the impacts caused by the responses of the victims’ faith communities using the qualitative research methodology of interpretative phenomenological analysis (IPA). The paper contributes to the growing efforts to develop an integrated and holistic provision of theologically robust and trauma-informed pastoral care for those struggling on the complex and challenging journey in the aftermath of trauma caused by sexual violence.

Lessons from decolonial and liberation psychologies for the field of trauma psychology.

Trauma, ranging from interpersonal to intergenerational, can create severe dysregulation and psychic suffering. Trauma may disrupt the nervous system, identity, affect regulation, and relationship schemas. Traumatic events can also disconnect survivors from the various aspects of themselves as well as their community. As a trauma survivor and trauma psychologist, I have dedicated my career to exploring ways of restoring and healing those severed connections. Exploring decolonial and liberation psychologies awakened me to conceptualizations and frameworks that center reclamation as a form of holistic healing and empowerment for trauma survivors. While much of the individually centered trauma literature focuses on skills-based psychoeducation and cognitive behavioral coping strategies, there has traditionally been less, although growing, attention paid to the diverse culturally grounded, sociopolitical pathways for survivors to reclaim themselves. In this article, I explore my scholarship and the scholarship of other underrepresented scholars as we discuss decolonial and liberation psychologies, the pathways they illuminate that can benefit the trauma recovery process, especially for marginalized survivors, and their implications for practice, training/teaching, research, and policy. The trauma and healing-informed decolonial and liberation pathways that emerge from the literature are culture as medicine, community support, spirituality and religiosity, expressive arts, and resistance. This article argues that the field would benefit from a more inclusive view of trauma and trauma recovery if it incorporates, builds on, explores, and learns from the scholarship of decolonial and liberation psychologists and traditional cultural healers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Letting ‘soft vengeance’ in when harm is ‘unforgivable’: on reading Stephen Cherry

This article draws on research in Bosnia and Rwanda and my own lived experience of ecclesiastical abuse. It reflects on, and develops, Stephen Cherry’s argument that some harms are Unforgivable (2024), and that the modern Christian Church has got ‘forgiveness’ wrong. Contra Cherry, though, it suggests that because comparatively little work has been undertaken on the contemporary spirituality of forgiveness, we have missed the potential healing power of ‘vengeance’ – but a particular kind of vengeance, as a Christian strategy to protect the future dignity, agency and flourishing of survivors of severe abuse and trauma.

Anya’s Posttraumatic Growth Over Her Loss Trauma as Reflected in Natassa’s Critical Eleven

It has been commonly assumed that trauma only lead to a negative impact on its survivors. However, on another hand, trauma can bring positive changes. This situation is commonly said as post-traumatic growth (PTG). The PTG process takes a quite long time and each survivor has different capabilities and processes to achieve it. Anya, the main character in the novel of Critical Eleven, experiences the trauma of loss after her first baby dies. Since her baby left, Anya has been in a dark period. This research aims to determine the type of loss trauma experienced by Anya. As a trauma survivor, Anya's post-traumatic growth was also explained in this research. Two theories were utilized in this research. Freud's theory of mourning and melancholia was used to analyze the type of loss trauma that Anya experienced. Meanwhile, the post-traumatic growth theory (PTG) proposed by Tedeschi and Calhoun was used to determine Anya's post-traumatic growth domain. The primary data for this research were taken from the novel of Critical Eleven written by Ika Natassa. In addition, research related to traumatic loss and post-traumatic growth was used as supporting data. The research results show that the trauma of loss experienced by Anya is grief or mourning. Furthermore, the PTG domains found in Anya's personality reflected personal strength, inter-personal relationships, and spiritual change. In addition, this research also found that not all trauma survivors can achieve the five domains of post-traumatic growth due to the respective capabilities and life processes of each survivor.

Polyvictimization and emotion regulation in daily life: An ecological momentary assessment study of young adults.

Individuals who experience polyvictimization, or victimization across multiple life contexts, show particularly severe outcomes across a range of mental health diagnoses, potentially related to difficulties in regulating emotion. However, prior research has been limited by reliance on cross-sectional designs and retrospective trait measures of emotion regulation. The present study used ecological momentary assessment to test associations between polyvictimization and emotion regulation in daily life. After completing a baseline survey assessing trauma exposure, mental health symptoms, and trait emotion regulation, undergraduates (N = 122) completed smartphone surveys assessing state emotion regulation four times per day for 14 days. Low correspondence was observed between trait and state measures of emotion regulation. After accounting for baseline mental health symptoms, polyvictimization independently predicted lower scores on an aggregative measure of putatively adaptive strategies (i.e., reappraisal, acceptance, problem solving) in daily life. However, polyvictimization did not predict aggregate scores of putatively maladaptive strategies (i.e., cognitive and expressive suppression, rumination, impulsive behavior, avoidance). Baseline depression and posttraumatic stress predicted higher use of putatively maladaptive strategies. Results suggest polyvictimization may be associated with less use of adaptive emotion regulation in daily life, whereas mental health symptoms may be associated with more use of maladaptive strategies. These findings highlight the utility of experience sampling approaches for increasing insight into emotion regulation difficulties among trauma survivors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cultural psychological factors in posttraumatic symptom development and expression: a study protocol

ABSTRACT Introduction: Cultural factors were shown to be particularly relevant for the development and expression of posttraumatic stress. Recently, the concept of cultural scripts of trauma has been introduced, which proposes that trauma sequelae elements may be sequentially linked and specifically associated with cultural factors. Furthermore, a cascade model is proposed, including trauma exposure, demographic characteristics, cultural affiliation, and trauma-related value orientations as influencing factors of posttraumatic development. The purpose of this Network Project is to investigate cultural psychological factors that contribute to the expression of posttraumatic stress. Methods: The present Network Project implements a mixed methods approach and will be conducted in 5 different study sites, including Switzerland, Israel, Georgia, China, and East Africa. In sub-study I, the cultural scripts of traumatic stress inventories (CSTIs) will be developed. These scales provide a pool of trauma sequelae elements for each cultural group. For this purpose, focus groups with trauma survivors and trauma experts will be conducted and analysed using qualitative research methods. Sub-study II implements a validation analysis of the CSTIs and the empirical investigation of a cultural cascade model. This quantitative approach will include a larger sample of individuals who experienced traumatic life events. Discussion: This contribution is timely and enriches the knowledge of trauma and culture. Future publications of this Network Project will address trauma sequelae from a cultural perspective and provide diagnostic and psychotherapeutic implications.

Social connectedness and well-being among Black women who experienced adolescent sexual trauma.

Sexual violence disproportionately impacts Black girls and women in the United States. The literature documents the long-term mental health outcomes of childhood sexual trauma, but research on resilience-promoting factors for Black women survivors of such trauma is sparse. The present study tests hypotheses about the influence of Black girls' social connectedness (e.g., with mothers, peers, and racial/ethnic community) on the association between adolescent sexual trauma and early adulthood well-being. Participants included 850 Black girls from the Pittsburgh Girls Study. Girls reported prospectively and retrospectively on experiences of sexual trauma between ages 13 and 17. Annual assessments of social connectedness comprised reports of closeness with mother, peer social self-worth, and belonging/affirmation in racial/ethnic identity. In early adulthood (ages 18-21), participants reported on psychological flourishing. Approximately 10% (N = 83) of participants reported having experienced sexual trauma during adolescence. Hierarchical linear regression analyses revealed that adolescent sexual trauma predicted lower psychological flourishing, whereas peer social self-worth and belonging in racial/ethnic identity predicted higher psychological flourishing in early adulthood. Tests of moderation revealed no significant effects of social connectedness on the association between adolescent sexual trauma and later psychological flourishing. Findings suggest that Black women survivors of adolescent sexual trauma may experience lower psychological flourishing than those without histories of such trauma and support the importance of multiple domains of social connectedness for Black adolescent girls, in general. However, further research is needed on race- and gender-specific contextual factors that enable Black women survivors of sexual trauma to thrive. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Early predictors of prolonged grief among bereaved trauma survivors 8.5 years after a terrorist attack.

A better understanding of the development of prolonged grief disorder can help professionals identify bereaved in need of intervention efforts and improve the efficiency of services. We aimed to examine the prevalence of and risk factors for prolonged grief disorder in a sample of young, bereaved terrorist attack survivors almost a decade postloss. In total, 165 bereaved survivors (Mage = 27.75, SD = 4.27; 45.5% females) of the 2011 terror attack on Utøya island, Norway, participated in face-to-face, semistructured interviews. At 4-5 months after the attack, early posttraumatic reactions were measured using the Brief Grief Questionnaire, University of California at Los Angeles PTSD Reaction Index, the Hopkins Symptom Checklist-8, and the eight-item Children's Somatic Symptoms Inventory. At 8.5 years postloss, the Traumatic Grief Inventory-Self Report Plus was used to assess prolonged grief disorder. To explore the association between participants' sociodemographic characteristics, early postloss clinical characteristics, and later prolonged grief reactions, we used multiple linear regression analyses. We found that 4.8% of the participants fulfilled the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision diagnostic criteria for prolonged grief disorder 8.5 years after their traumatic loss. Lower age and high levels of early somatic complaints predicted higher prolonged grief reactions almost a decade postloss. Young, bereaved survivors may be at particularly high risk of experiencing persistent grief reactions following the traumatic loss of a peer. Pending replication of our findings, professionals should focus on identifying bereaved who experience intense somatic symptoms early after a traumatic loss. Targeting these symptoms may alleviate the exacerbation of persistent grief reactions several years after a traumatic loss. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emergency Department Thoracotomy: A National Trauma Databank analysis

IntroductionEmergency Department Thoracotomy (EDT) warrants further investigation in the pediatric population due to concerns about its futility. Our study evaluates how patient demographics, injury characteristics, and physiologic status influence pediatric EDT outcomes in blunt and penetrating trauma. MethodsThis retrospective study analyzed patients ≤19 years who received EDT within 1 hour of arrival to the ED from the National Trauma Data Bank. Cases were stratified by blunt and penetrating trauma. Descriptive statistics and univariate analysis were used to identify predictors of survival post-EDT. ResultsOf the 1,075 pediatric patients who underwent Emergency Department Thoracotomy (EDT), 79.6 % experienced penetrating trauma and 20.4 % blunt trauma, with survival rates at 25.9 % and 9.1 %, respectively. Survivors of penetrating trauma typically presented with more stable vital signs, such as pulse rate, oximetry, and Glasgow Coma Scale (GCS) scores, and lower Injury Severity Scores (ISS), all correlating with survival (p < 0.05). Survivors of blunt trauma were distinguished by higher respiratory rates and temperatures (p < 0.05). Risk factor analysis indicated that age-adjusted bradycardia, age-adjusted hypotension, and pre-hospital cardiac arrest were significant predictors of mortality across trauma types (penetrating trauma: OR = 18.7, 6.2, and 20.7; blunt trauma: OR = 12, 2.69, and 6.4, all p < 0.05). Notably, pre-hospital respiratory support was associated with a reduced risk of mortality for both types of trauma (OR = 0.32 for penetrating, and OR = 0.23 for blunt, p < 0.05). ConclusionsThe study affirms the significance of pre-hospital care, showing that stable vitals and respiratory support enhance pediatric thoracotomy outcomes. Ongoing research into pediatric-specific trauma protocols are needed. Type of StudyRetrospective cohort Level of EvidenceIII

(127) TRAUMA INFORMED CARE TO REDUCE ANTEPARTUM COMPLICATIONS IN SURVIVORS OF TRAUMA

Abstract Introduction Life trauma permeates through society and across cultures. It impacts the individual, community, and society. Trauma may include but is not limited to adverse childhood experiences (ACEs), sexual assault and violence, domestic violence, and interpersonal violence (IPV). In the United States, 1 in 3 women experience physical IPV, 1 in 4 experience sexual assault, and 17% of adults have experienced 4 or more ACEs (CDC 2022, 2023). Experiencing trauma leads to a cascade of effects that infiltrate every aspect of life and causes higher levels of chronic stress. In those who are pregnant or giving birth, a history of trauma, particularly sexual assault, leads to adverse antepartum outcomes. Objective After this presentation, the learner will be able to: 1. Define trauma (ACEs, sexual assault, DV, IPV). 2. State the signs and symptoms of trauma. 3. Identify the antepartum complications associated with a history of trauma. 4. Explain the impact that a history of sexual assault has on the birth giver. 5. Define trauma informed care. 6. Identify the components of trauma informed care. 7. State the importance of using trauma informed care as a midwife and WHNP. Methods The methods used to address this topic include a literature review and podium style presentation of findings. Results Main findings include increased rates of miscarriage, preterm birth, post traumatic stress disorder, placental abruption, premature rupture of membranes, and low birth weight in pregnant survivors of past trauma. Additionally, the dynamic interplay between the Social Determinants of Health and violence experienced during pregnancy must be considered. Low household income, racism, lack of social support, as well as food and housing insecurity increased rates of intimate partner violence experienced during pregnancy. Trauma informed care has been shown to reduce psychological symptom severity and has been integrated into midwifery care to attempt to reduce these outcomes and prevent further traumatization of the client. Conclusions As pregnancy and childbirth are intimate and personal in nature, using a trauma informed model of care is crucial to identifying clients with trauma histories and caring for them in a manner that is cognizant of their lived experiences and potential antepartum outcomes. Future providers must receive adequate education and training regarding trauma informed care in an effort to prevent adverse outcomes and prevent re-traumatization of their clients. Disclosure No.

Supplemental Material for Early Predictors of Prolonged Grief Among Bereaved Trauma Survivors 8.5 Years After a Terrorist Attack

Supplemental Material for Early Predictors of Prolonged Grief Among Bereaved Trauma Survivors 8.5 Years After a Terrorist Attack

Cultural differences in appraisals of control and posttraumatic stress disorder symptoms

ABSTRACT Background: Appraisals are central to posttraumatic stress disorder (PTSD). Yet, few studies have examined how culture influences the associations between different types of trauma-related appraisals and PTSD symptoms. Objective: This study investigated cultural influences on appraisals of control and their associations with PTSD symptoms. Method: European Australian (n = 140, Mage = 35.80, SD = 12.44; 21 men, 97 women, 20 gender diverse/prefer not to report) and Chinese Australian (n = 129, Mage = 30.16, SD = 8.93, 21 men, 97 women, 20 gender diverse/prefer not to report) trauma survivors completed measures of appraisals, cultural values, and PTSD symptoms. Results: Findings showed that the Chinese Australian group was associated with greater Chinese cultural beliefs about adversity (i.e. emphasizing the value of adversity and people’s ability to overcome adversity) and fewer fatalism appraisals (i.e. appraising one's destiny as externally determined), which in turn were atemporally associated with fewer PTSD symptoms; these atemporal indirect associations were moderated by self-construal and holistic thinking. The Chinese Australian group also reported fewer secondary control appraisals (i.e. attempts to change aspects of the self and accept current circumstances), which were atemporally associated with greater PTSD symptoms. In contrast, the European Australian group was associated with fewer primary control appraisals (i.e. perceived ability to personally change or control a situation), which were atemporally associated with greater PTSD symptoms. Conclusion: These findings highlight the importance of considering the influence of culture on appraisals in PTSD. However, it must be noted that causal relationships cannot be inferred from cross-sectional mediation analyses and thus, future longitudinal research is needed.

Posttraumatic stress symptoms and positive autobiographical memory characteristics in everyday life.

Individuals with posttraumatic stress symptoms (PTSS) report difficulties engaging with positive autobiographical memories. Extending this line of research, we examined daily-level concurrent and lagged associations between PTSS severity and positive memory characteristics (vividness, coherence, accessibility, time perspective, sensory details, visual perspective, emotional intensity, sharing, distancing, and valence). The sample included 88 trauma survivors (Mage = 39.89 years, 59.1% female) who completed seven daily measures of PTSS and positive memory characteristics. Multilevel models examined concurrent and lagged associations between PTSS severity and positive memory characteristics. The results indicated that days with higher PTSS severity were associated with less accessibility, β = -.21, p <.001; less visual perspective, β = -0.13, p =.034; and lower positive valence of the memory, β = -.19, p =.003, as well as more emotional intensity associated with, β =.13, p =.041, and more distancing from, β =.21, p <.001, the memory. Supplemental lagged analyses indicated that higher previous-day PTSS severity was associated with more next-day distancing from, β =.15, p =.042, and sensory details of, β =.17, p =.016, the memory. Findings suggest that individuals with more severe PTSS have difficulties accessing positively valenced memories from a first-person perspective, are more distant from the recalled positive memory, and report more emotional intensity when retrieving the memory. Thus, improving access to and reducing distance from positive autobiographical memories, as well as addressing emotional intensity surrounding the retrieval of these memories, may be potential clinical targets for PTSS interventions.

Bodily Autonomy and Trauma: Understanding the Nature of the Association Between Sexual Trauma, an External Locus of Control, and Depressive Symptoms.

There is growing evidence suggesting an increased perception of control is associated with reduced psychological distress among survivors of sexual trauma. The current study advances the extant literature by investigating the association between depressive symptoms, sexual trauma, and an external locus of control or the perception life events are outside one's own control. To do so, we analyze data from the New Family Structures Study, a nationally representative survey of U.S. adults ages 18-39. Results from ordinary least square regression analyses suggest sexual trauma and an external locus of control are associated with significantly greater depressive symptoms and that external control exacerbates the association between sexual trauma and depression. Such findings suggest future research should investigate environmental control for sexual trauma survivors in areas such as prenatal care and the justice system.

Mechanisms and translational applications of regeneration in limbs: From renewable animals to humans

BackgroundThe regenerative capacity of organisms declines throughout evolution, and mammals lack the ability to regenerate limbs after injury. Past approaches to achieving successful restoration through pharmacological intervention, tissue engineering, and cell therapies have faced significant challenges. ObjectivesThis review aims to provide an overview of the current understanding of the mechanisms behind animal limb regeneration and the successful translation of these mechanisms for human tissue regeneration. ResultsParticular attention was paid to the Mexican axolotl (Ambystoma mexicanum), the only adult tetrapod capable of limb regeneration. We will explore fundamental questions surrounding limb regeneration, such as how amputation initiates regeneration, how the limb knows when to stop and which parts to regenerate, and how these findings can apply to mammalian systems. ConclusionsGiven the urgent need for regenerative therapies to treat conditions like diabetic foot ulcers and trauma survivors, this review provides valuable insights and ideas for researchers, clinicians, and biomedical engineers seeking to facilitate the regeneration process or elicit full regeneration from partial regeneration events.

Altered State Of Consciousness As A Narrative Tool İn Dennis Lehane’s Shutter Island

This article delves into Dennis Lehane’s Shutter Island(2003) and its challenge to the conventional notion of a unified humanist self, proposing instead that the post-war self is inherently fragmented. It particularly scrutinizes this fragmentation through the experiences of a traumatized character in the novel, illustrating how severe wartime and post-war events disrupt and fracture individuals. Furthermore, it examines the role of storytelling and narration as essential tools for trauma survivors to navigate and reconcile the shattered aspects of their identities. Through storytelling, the protagonist Teddy discovers a means of survival by articulating his experiences and memories. The paper emphasizes how trauma directly leads to the fragmentation of the human psyche and explores how narrative serves as a medium for the protagonist to confront his trauma. Through Teddy’s narrative, the novel provides insights into the complexities of the post-war self, the lasting wounds of trauma, and the potential for storytelling to assist in coping with trauma, offering a deeper understanding of the fragmented self in the aftermath of war.

Less-lethal weapons: ocular trauma in Chile as psychosocial trauma. Challenges from a human rights and comprehensive perspective.

In October 2019 in Chile, massive protests broke out in the so-called social uprising. The repressive response of the armed forces and Carabineros (Police) resulted in serious and mas-sive violations of human rights, with between 400 and 500 victims of ocular trauma caused mainly by shots from anti-riot shotguns, constituting the largest number of cases in the world linked to a single event. It is proposed to evaluate the different dimensions of the impact of ocular trauma due to state violence, using the concept of psychosocial trauma and a support model that integrates the medical-psychological and social dimensions. Human rights violations of the period are described, focusing on cases of ocular trauma, and state and civil society responses. The requests of a survivors' organisations regarding truth, justice and reparation is presented. A clinical case of ocular trauma treated in our centre is analyzed. Survivors of ocular trauma manifest post-traumatic reactions regardless of the severity of their ocular injuries. The impact on the mental health of survi-vors of ocular trauma due to state violence is a phenomenon where the psychic and psychosocial im-pact of trauma due to socio-political violence intersects with the short- and long-term mental health effects. The impact of sociopolitical trauma must be understood considering both the in-dividual and social subject, considering their cultural, socioeconomic and political reality. Recovery from traumatic psychological injury must be addressed in its medical, sensory rehabilitation, psycho-logical and psychosocial dimensions, including processes of social recognition, search for justice and comprehensive reparation of damage. In contexts of impunity, a model is proposed that integrates rehabilitation with psycho-legal support, promotion of agency and organisation, within the frame-work of commitment to the movement and principles of human rights.