Trauma In Adolescence Research Articles

Prehospital education in triage for pediatric and pregnant patients in a regional trauma system without collocated pediatric and adult trauma centers.

Patient triage to the appropriate destination is critical to prehospital trauma care. Triage decisions are challenging in a region without collocated pediatric and adult trauma centers. A regional survey was administered to emergency medical response units identifying variability and confusion regarding factors influencing patient disposition. A course was developed to guide the triage of pediatric and pregnant trauma patients. Pre- and posttests were administered to address course principles, including decision making and triage. A total of 445 participants completed the course at 22 sites representing 88 different prehospital provider agencies. Pre- and posttests were administered to 62% of participants with an average score improvement of 53.4% (pretest range 30% to 56.6%; posttest range 85% to 100%). Improvements were seen in all categories including major and minor trauma in pregnancy, major trauma in adolescence, and knowledge of age limits and triage protocols. Education on triage guidelines and principles of pediatric resuscitation is essential for appropriate prehospital trauma management. Pre- and posttests may be used to demonstrate short term efficacy, while ongoing evaluations of practice patterns and follow-up surveys are needed to demonstrate longevity of acquired knowledge and identify areas of persistent confusion. Level IV, Case Series without Standardized.

Affect dysregulation, adult attachment problems, and dissociation mediate the relationship between childhood trauma and borderline personality disorder symptoms in adulthood

IntroductionBoth borderline personality disorder (BPD) and childhood trauma have been shown to be associated with affect dysregulation, dissociation, and fear-based attachment schemas. However, the inter-relationships of these clinical phenomena have not been studied in unison. ObjectiveTo study the interrelations between childhood psychological trauma and adult BPD mediated by dissociation, attachment schemas, and affect dysregulation in unison while differentiating for inhibitory- and excitatory regulation symptoms. MethodAdult chronic psychiatric patients with BPD, BPD with comorbid somatoform disorder, and two psychiatric control groups with SoD-only, or chronic anxiety or affective disorders com-pleted structured interviews and self reports. Affect dysregulation, fear-based attachment schemas and dissociation were tested simultaneously -in their separate inhibitory- and excitatory form- as potential mediators in the relationship between childhood psychological trauma and BPD symptoms in adulthood. Next, two alternative models partitioning childhood trauma into more specific features as source (primary-caretaker or not), or type i.e. emotional-, physical-, or sexual abuse, while differentiating for developmental epochs, were compared to the original model. Analyses were re-run for participants who report more severe symptoms that meet criteria for a BPD diagnosis. ResultsStructured equation modeling with bootstrap 95% confidence intervals revealed that hallmark features of BPD – affect dysregulation involving extreme emotional intensity and lability (under-regulation), fragmentation of consciousness (positive psychoform dissociation; e.g., flashbacks), and core attachment fears of closeness and abandonment – partially account for the relationship between overall childhood trauma and BPD-symptom severity. The unifying theme for these mediators is excitatory dysregulation. Alternative models distinguishing types and nature of trauma did not fit the data. However, adults who report more severe symptoms that meet criteria for a BPD diagnosis were likely to have experienced sexual trauma in early childhood or adolescence, and to have an intense fear of abandonment, with the path from early childhood sexual trauma to BPD symptoms as strongest direct relationship. ConclusionRelationships between overall childhood trauma and BPD symptoms in adulthood through three mediators i.e., affect dysregulation, fear-based attachment schemas and dissociation were found, over alternative models distinguishing types of perpetrator, nature of trauma, and developmental epoch. These findings contribute to and replicate a substantial research base that highlights sexual trauma in early childhood and severe attachment insecurity (and disorganization) as contributors to adult BPD. Prospective studies are needed to elucidate the complex relationships between childhood trauma and BPD.

Concussion in adolescence and risk of multiple sclerosis.

To assess whether concussion in childhood or adolescence is associated with subsequent multiple sclerosis (MS) risk. Previous research suggests an association, but methodological limitations included retrospective data collection and small study populations. The national Swedish Patient Register (hospital diagnoses) and MS Register were used to identify all MS diagnoses up to 2012 among people born since 1964, when the Patient Register was established. The 7,292 patients with MS were matched individually with 10 people without MS by sex, year of birth, age/vital status at MS diagnosis, and region of residence (county), resulting in a study population of 80,212. Diagnoses of concussion and control diagnoses of broken limb bones were identified using the Patient Register from birth to age 10 years or from age 11 to 20 years. Conditional logistic regression was used to examine associations with MS. Concussion in adolescence was associated with a raised risk of MS, producing adjusted odds ratios (95% confidence intervals) of 1.22 (1.05-1.42, p = 0.008) and 2.33 (1.35-4.04, p = 0.002) for 1 diagnosis of concussion and >1 diagnosis of concussion, respectively, compared with none. No notable association with MS was observed for concussion in childhood, or broken limb bones in childhood and adolescence. Head trauma in adolescence, particularly if repeated, is associated with a raised risk of future MS, possibly due to initiation of an autoimmune process in the central nervous system. This further emphasizes the importance of protecting young people from head injuries. Ann Neurol 2017;82:554-561.

Problems and solutions for patients with fibromyalgia: Building new helping relationships

The aim of this study was to identify the main biological, psychological and sociological problems and potential solutions for patients diagnosed with fibromyalgia by use of Group Problem-Solving Therapy. Group Problem-Solving Therapy is a technique for identifying and solving problems, increasing assertiveness, self-esteem and eliminating negative thoughts. Qualitative phenomenological interpretive design: Group Problem-Solving Therapy sessions conducted with patients suffering fibromyalgia were studied; participants recruited via the Rheumatology Department at a general hospital and associations in Catalonia, Spain with sessions conducted in nearby university setting. The study included 44 people diagnosed with fibromyalgia (43 female, 1 male) from 6 Group Problem-Solving Therapy sessions. Data collected from March-June 2013. A total of 24 sessions were audio recorded, all with prior informed consent. Data were transcribed and then analysed in accordance with established methods of inductive thematic analysis, via a process of reduction to manage and classify data. Five themes were identified: (1) Current problems are often related to historical trauma; (2) There are no "one size fits all" solutions; (3) Fibromyalgia is life-changing; (4) Fibromyalgia is widely misunderstood; (5) Statistically Significant impacts on physical, psychological and social are described. The majority of patients' problems were associated with their previous history and the onset of fibromyalgia; which may be related to trauma in adolescence, early adulthood or later. The solutions provided during the groups appeared to be accepted by the participants. These findings can improve the self-management of fibromyalgia patients by helping to enhance adaptive behaviours and incorporating the female gender approach.

The Qualitative Study of the Process Leading to Posttraumatic Growth after Attachment Trauma in Childhood and Adolescence

The Qualitative Study of the Process Leading to Posttraumatic Growth after Attachment Trauma in Childhood and Adolescence

Sexual violence against adolescent girls: the need for shared multidisciplinary prevention strategies.

Intimate partner violence, which may involve sexual violence, is a widespread social problem that raises important medical, psychological, ethical, and legal concerns. As eloquently highlighted by Professor Khan in his editorial (BJOG 2016;123:1249), intimate partner violence against adult women is much more than a health-related problem, as it destroys feelings of love, self-esteem, self-efficacy, and dignity, and is a clear example of gender inequality, as in the very large majority of cases the victims are women. In this short communication we draw attention to sexual violence against adolescent girls, a particular kind of gender violence with destructive consequences on multiple levels. The World Health Organization has reported that for one-third of young girls throughout the world their first sexual experience is forced (www.who.int.violence_injury_prevention/violence/global_campain/en/chap6.pdf. August 2016). Moreover, sexual violence is often underreported by the victims – because of feelings of shame, guilt, or fear − and thus these violent events could be even more frequent than described. The estimated proportion of sexually abused girls is alarming for different reasons. First, it suggests that sexual violence may be considered as a ‘normal’ experience during adolescence. Second, exposure to trauma in adolescence can negatively affect psychological wellbeing, with an increased risk of social adjustment difficulties and impaired family functioning. Moreover, a history of maltreatment during adolescence has also been associated with the development of borderline or schizoid personality disorders (Krupnik et al. Psychiatry 2004;67:264–79). In our centre for sexual and domestic violence (SVSeD, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy), since 1996 we have adopted a holistic approach in our clinical practice with victims of violence, which entails considering health as associated with multiple factors, such as social, psychological, and legal aspects. In working with adolescents who experienced partner or sexual violence, we have to be fully aware that the physical outcomes are only a part of their life history, though important; for these reasons, we believe that the best approach is provided by a multidisciplinary team composed of different professional figures (gynaecologists, paediatric surgeons, psychologists, social workers, forensic medical doctors, sexologists, lawyers, and other professionals required for special cases). Based on our experience, in the majority of cases violence against adolescents (aged 10–19 years) is perpetrated by a relative or a friend, a neighbour or a teacher – in general by someone well known to the victim. Thus, repeated sexual abuse may be frequent and particularly alarming. The negative consequences of cumulative exposure to trauma in the young developmental age are largely acknowledged as particularly dangerous for physical and psychological growth. Prevention and timely diagnosis are fundamental to reduce the risk of sexual violence. In this regard, we believe in the importance of implementing prevention programmes targeted to the specific developmental period, and aimed at promoting sexual health education from the beginning of the school cycle. Community-based programmes should entail the active participation of young people. Moreover, training courses facilitating the prompt recognition of gender violence should be mandatory for different professionals (Romeo et al. Minerva Pediatrica 2016;68:230–36), including gynaecologists, paediatricians, and teachers. All of these strategies may help in both the timely recognition and prevention of gender violence, but still need further definition and implementation in many countries. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Relevance of Functional Emotion Regulation Processes for Sustaining Mental Health After History of Early Psychological Trauma

It is well evidenced that exposure to early psychological trauma in childhood or adolescence represents a substantial risk factor for an adult psychopathological development. In particular, so called type II trauma events, i.e. repeated or chronic interpersonal traumatic experiences like emotional, physical, sexual abuse, and physical, emotional neglect are associated with the development of a wide range of mental disorders.

Kronos Abuses His Son: A Case Study of Severe Interpersonal Trauma, Dissociation, and Survival in Adolescence

This case study presents case conceptualization, therapeutic intervention, and the subjective and objective therapeutic progress of a 14-year-old adolescent hospitalized with posttraumatic stress disorder (PTSD) following emotional, physical, and sexual abuse by his father. The adaptive information processing (AIP) model that informs eye movement desensitization and reprocessing (EMDR) therapy and the theory of structural dissociation of the personality (TSDP) were used to conceptualize and guide the treatment. Stabilization and orientation to the present were essential to integrate his traumatic memories into a life narrative, and this became a major goal and an outcome of treatment. A single-case AB design was applied in assessing the impact of intervention. The UCLA PTSD Symptom Scale, Strengths and Difficulties Questionnaire—HEL (SDQ-HEL), State-Trait Anxiety Inventory (STAI), and Dissociative Experiences Scale II were administered at 5 different time points to assess changes in the youth’s subjective emotional state and indicated substantial improvement. In addition, objective behavior change (using O’Neill’s Behavior Checklist) was recorded on a daily basis for 7 months and showed a large decrease in the frequency of targeted maladaptive behaviors. The article describes the treatment process which helped the youth to regain a sense of time; establish a coherent sense of self; and maintain adaptive perceptions, emotions, attitudes, and behaviors.

Childhood Trauma and Illicit Drug Use in Adolescence: A Population-Based National Comorbidity Survey Replication–Adolescent Supplement Study

Although potentially traumatic events (PTEs) are established risk factors for substance use disorders among adults, little is known about associations with drug use during adolescence, an important developmental stage for drug use prevention. We examined whether childhood PTEs were associated with illicit drug use among a representative sample of US adolescents. Data were drawn from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A), which included adolescents aged 13 to 18 years (N=9,956). Weighted logistic regression models estimated risk ratios for lifetime use of marijuana, cocaine, nonmedical prescription drugs, other drugs, and multiple drugs. Exposure to any PTE before age 11 years was reported by 36% of the sample and was associated with higher risk for use of marijuana (risk ratio [RR]= 1.50), cocaine (RR= 2.78), prescription drugs (RR= 1.80), other drugs (RR= 1.90), and multiple drugs (RR= 1.74). A positive monotonic relationship was observed between number of PTEs and marijuana, other drug, and multiple drug use. Interpersonal violence was associated with all drug use outcomes. Accidents and unspecified events were associated with higher risk for marijuana, cocaine, and prescription drug use. Potentially traumatic events in childhood are associated with risk for illicit drug use among US adolescents. These findings add to the literature by illustrating a potentially modifiable health behavior that may be a target for intervention. The results also highlight that adolescents with a trauma history are a high-risk group for illicit drug use and may benefit from trauma-focused prevention efforts that specifically address traumatic memories and coping strategies for dealing with stressful life events.

Resilience and Psychological Well-Being Among Destitute Adolescents

In the present scenario, the adolescents face enormous challenges in the Indian society. Adolescents are the most vulnerable group in any population and needs the greatest social care. Adolescence as a developmental period is filled with many changes and crisis. Some of these challenges might be relatively minor, while others are disastrous on a much larger scale. Challenges faced by adolescents may deteriorate their well-being. Although family is the best place for an adolescent to grow and develop, at times, families become incapable to cater the needs of the adolescents due to family conflicts and other unavoidable circumstances. Large numbers of adolescents end up in institutional care. Though there are no official estimates of this number, Aangan India, an NGO, in its annual report of 2009-2010 puts the number at 4.5 million (2010).Institutional care is considered as an appropriate measure for providing care to orphan and destitute adolescents in India. Child welfare has become a major concern in our society with the increased number of children and adolescents ending up in institutional care. According to Childline India (2008), adolescents become destitute, for the interim or permanently of neglected parental care for many reasons including the illness, death or imprisonment of parents, parental conflict, separation due to migration or armed conflict, the removal by child welfare authorities and/or the courts based on the best interests, detention of the adolescent, or following the adolescent's own initiative to leave home. Henceforth, large populations of adolescents grow up without one or both of their parents as destitute.Adolescents undergo traumatic experiences because of parental loss and the stigmatization associated with this loss (Jain & Negi, 2001). In the case of destitute adolescents, early separation from parents, deprivation of parental care, love, affection, warmth, security, acceptance and discipline during childhood and adolescence disrupts their normal socio-emotional development (Hiremani, Khadi, Gaonkar, & Katarki 1994). They tend to feel unwanted and develop a high risk of abuse, exploitation and neglect. Institutional care in early life predisposes children to intellectual, behavioral and social problems later in life. According to Steinberg (2001) inadequate individual care in institutions, socially and emotionally weaken adolescents. Most of the destitute adolescents do not experience the warmth of love and support of parents feels that he/she is unwanted and tend to have negative attitude towards life and get depressed (Hamburg, 2006). In a crisis situation, destitute adolescents develop tunnel vision, which makes them unable to sec the positive aspects of their life. They tend to develop aggressive, non-compliant behavior, anxiety and problems with social relationships (Singh & Akbar, 1970). Caroll (1999) called the institutional life of adolescents as a state of 'chronic emotional deprivation'.Violence at home is one of the major predictors of adolescents experiencing homelessness. This makes them feel that they have no home to return due to irreconcilable familial conflicts. They run away from their houses without the parent's/guardian's permission or are moved from their families by the child welfare authorities and finally end up in institutions. Destitute adolescents often have prior experiences of violence, either eye witnessing violence or being abused physically or sexually (Dutta, Baratha, & Goswamy, 1998). Higher risks of exposure to violence or trauma in adolescence lead to behavioral and mental health problems.Mental health for adolescents is just as impoitant as their physical health. Mental health includes the ability to enjoy life, and create a balance between life activities and the efforts to achieve psychological well-being. The World Health Organization defines well-being as 'a state of mind in which an individual is able to realize his or her own abilities, cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. …

Types of trauma in adolescence and their relation to dissociation: A mixed-methods study.

To study adolescent traumatization and the impact of various types of trauma on dissociative experiences in a sample of 239 Swedish youngsters, 13 to 20 years of age, with diverse socioeconomic and migration backgrounds. We also evaluated whether the type of worst lifetime trauma was associated with higher rates of dissociation. Quantitative and qualitative data on posttraumatic stress, dissociative experiences, and potentially traumatic events (PTEs), including participants' written descriptions of their worst lifetime trauma. Most (92%) of the participants had been exposed to at least 1 PTE and 51% to 4 or more, during their life. Number of PTEs correlated with symptoms of posttraumatic stress and dissociation. There were higher rates of dissociation among economically vulnerable and second-generation war refugee participants. Emotional abuse by others (mostly peers) was the only significant predictor of dissociation when controlling for gender, age, total PTEs, posttraumatic stress, and poverty. Moderation analyses showed that lifetime worst traumas categorized as primarily emotional moderated and amplified the relation between total PTEs and dissociation, but only among girls. Our findings indicate that traumatization is very common among adolescents, with greater prevalence of dissociation among vulnerable groups, and that emotional traumas are linked to higher rates of dissociation, especially among girls. Researchers, clinicians, and school personnel need to focus more on immigrant status and low SES as vulnerability factors, and address the consequences of emotional abuse, including bullying, among adolescents. (PsycINFO Database Record

Screening for Trauma in Early Adolescence: Findings from a Diverse School District

Abundant evidence demonstrates that traumatized adolescents are at increased risk of a host of negative psychoeducational and functional outcomes, but demographic disparities are often seen in access to and use of mental health services and supports. In light of this, the current study examines the prevalence of trauma experiences and traumatic stress in middle school students from a large urban school district serving a high proportion of diverse immigrant and low-income families. Descriptive statistics document the mean reported number of trauma experiences and posttraumatic stress subscale scores by participants’ sociodemographic variables. Inferential statistics report significant differences associated with race/ethnicity, gender, and type of trauma—including exposure as a victim or a witness. Results show complex and significant racial/ethnic group differences in the experience and symptomatology of trauma among the entire screened sample as well as the subset of youth with elevated distress. Furthermore, findings document the predictive value of particular trauma events related to early adolescents’ severity of self-reported traumatic stress. These in-depth findings underscore the need for routine, school-based screening to identify and bring culturally competent, trauma-informed support and interventions to middle school students experiencing traumatic stress.

Towards a person-centered approach to the developmental psychopathology of trauma.

Towards a person-centered approach to the developmental psychopathology of trauma.

Negative evaluations of self and others, and peer victimization as mediators of the relationship between childhood adversity and psychotic experiences in adolescence: the moderating role of loneliness.

Previous research has identified an association between traumatic experiences and psychotic symptoms. Few studies, however, have explored the underlying mechanisms and contingent nature of these associations in an integrated model. This study aimed to test a moderated mediation model of negative childhood experiences, associated cognitive processes, and psychotic experiences within a context of adolescent loneliness. Cross-sectional survey. A total of 785 Northern Irish secondary school adolescents completed the survey. A moderated mediation model was specified and tested. Childhood experiences of threat and subordination were directly associated with psychotic experiences. Analyses indicated that peer victimization was a mediator of this effect and that loneliness moderated this mediated effect. A new model is proposed to provide an alternative framework for assessing the association between trauma and psychotic experience in adolescence that recognizes loneliness as a significant contextual moderator that can potentially strengthen the trauma-psychosis relationship. Moderated mediation analyses poses an alternative framework to the understanding of trauma-psychosis associations Adolescent loneliness is a vulnerability factor within this association Data are based on a Northern Irish sample with relatively low levels of loneliness Cross-sectional data cannot explore the developmental course of these experiences in adolescence.

The Management of Trauma in Childhood and Adolescence

The Management of Trauma in Childhood and Adolescence

Measuring trauma and stressful events in childhood and adolescence among patients with first-episode psychosis: Initial factor structure, reliability, and validity of the Trauma Experiences Checklist

Past trauma and stressful events, especially in childhood and adolescence, are common among individuals with serious mental illnesses like schizophrenia. Traumatic experiences are thought to be a socio-environmental risk factor not only for poorer outcomes, but also potentially for the onset of these disorders. Because improved measurement tools are needed, we developed and studied, among 205 first-episode psychosis patients, the factor structure, internal consistency reliability, and initial validity of the Trauma Experiences Checklist (TEC), our measure of trauma and stressful events during childhood/adolescence. We assessed validity of subscales using correlations with Childhood Trauma Questionnaire-Short Form, Parental Harsh Discipline, Violence Exposure, and TEC-Informant Version scores. Exploratory factor analysis resulted in two internally consistent subscales (Cronbach's α=0.79 and 0.80, respectively), interpersonal abuse and family stress, and violence, death, and legal involvement. Scores from the former subscale were substantially associated with CTQ-SF physical, emotional, and sexual abuse (r=0.42–0.57, all p<0.001) and Violence Exposure (r=0.49, p<0.001). On the other hand, violence, death, and legal involvement scores were most highly correlated with Violence Exposure (r=0.49, p<0.001), and not with most CTQ-SF subscales. The TEC is a potentially useful tool in assessing diverse traumatic life events across various social contexts during childhood and adolescence.

Une expression particulière de PTSD à l’adolescence

ObjectivesAdolescence is a developmental stage marked by the reactivation of œdipal issues and the emergence of sexual feelings, a period of separation and autonomy, overwhelming for many, traumatic for some. Adolescence is also a time for the expression of psychotic potentiality. An event on itself insignificant can have a high value and contribute to the traumatic collapse of the Self already weakened by the process of adolescence. In some circumstances, a PTSD appears which can take the shape of a psychotic decompensation. Patients/material and methodWithout being paradigmatic, the case report illustrates the appearance of this particular expression of PTSD in adolescence. Basing itself on a description of the individual and relational process, are examined the factors related to the young in question and the factors related to his social and family environment, taking part in the emergence of the psychic suffering. The paper also develops a reflection on the notion of trauma in adolescence. So some authors think that the crossing in adolescence constitutes a reality trauma so much the interior tumult hustles the references marks, certainly when the young evolves without parental support cordial and structuring. The quality of the bonds of attachment is thus of primary importance. In addition, we can wonder, in front of “delirious blaze”, about a possible beginning of schizophrenia. ResultsFrom the case report, beyond the process of adolescent transformation, it is interesting, without being exhaustive, to locate some factors supporting the particular expression of PTSD: A family operation established on a procedure defined by event-driven and the not very inclined one in the elaboration; a mother investing her parental function with pregnance, invading the interactive space intrapsychic of the child; a father, absent, distant, with the function not very operative symbolic system, not placing at the disposition of the young of the soothing answers and structuring; a quality of reception of the traumatized young marked by the indifference, the disqualification, the rejection. The psychic effraction is certainly corollary so much reactions of the entourage, the glance of the other, which it returns on the subject, influences the narcissico-object balance; a young mobilized psychic defensive mechanisms as projections and identifications. ConclusionIt proves to be important to consider some factors of the young and his environment who seems contribute to the expression of a psychotic symptomatology-like reactional method with a traumatic event. The trauma overflows the defensive mechanisms and involves a collapse of self whose symptomatic translation lets foresee a psychotic potentiality. The paper approaches some principles of the therapeutic accompaniment then: Intervene most prematurely possible by improving the axis of prevention and the recognition by the first-time professionally of the clinical signs of psychotic decompensation, by the facilitating the access to the specialized healthcare; respect the evolutionary criterion, by taking into account temporality of the psychic device, the connections between trauma and time; center on the clinical care by establishing a differential diagnosis, arresting the psychic functioning of the young, observing his state according to contact and links.

Hallucinogen Persisting Perception Disorder (HPPD) and Flashback-are they Identical?

Background: Despite a multitude of etiological and therapeutic approaches, the exact pathophysiological mechanisms underlying Hallucinogen persisting perception disorder (HPPD) remain elusive. Rather, in each individual case, specific risk factors and different vulnerabilities form part of a multifactorial origin of this rare but highly debilitating psychiatric disorder. Case: The following case report describes the history of a 36 year old male who has been suffering from a visual perception disorder for the last 18 years. At the age of 17 he used LSD for the first time, having consumed cannabis and alcohol on a regular basis since a year earlier. Descriptions: After one particular LSD trip at age 18, the patient suddenly developed persistent visual disturbances including small-sized, colour-intensive, flickering, geometrical patterns; intermittent after images of objects in the visual fields, and trailing phenomena of moving objects. Results from the Early Trauma Inventory (ETI) questionnaire indicated significant mental trauma in childhood and adolescence. Brain MRI and electrophysiological investigations (median nerve SEPs) revealed a few disseminated subcortical lesions. Conclusion: Upon experimental treatment with lamotrigine, the patient experienced partial to complete remission of the various visual disturbances. With its potentially neuroprotective and mood-stabilising properties, lamotrigine may offer a promising new therapeutic approach for the treatment of HPPD.

Complex posttraumatic stress disorder and survivors of human rights violations

This article reviews recent findings on Complex Posttraumatic Stress Disorder (CPTSD) and proposes future research which would help to establish the nature of CPTSD in relation to Posttraumatic Stress Disorder (PTSD). Research on survivors of torture and war has found that CPTSD can occur when there is no history of childhood abuse. fMRI studies appear to highlight differences in neural activity in individuals exhibiting primary dissociation compared with individuals exhibiting secondary dissociation. Research has begun to show that, when symptoms of secondary dissociation are appropriately managed, exposure-based therapies are an effective treatment for individuals with CPTSD. Much research on CPTSD has emphasized its developmental basis and the disruptive effects of trauma in childhood and adolescence on subsequent emotional development. However, some studies on survivors of torture in adult life identify similar symptom patterns, despite there being no history of childhood trauma. It is argued that comparative research is required between victims of developmental trauma (such as childhood sexual abuse) and victims who experienced prolonged interpersonal trauma in adulthood (such as torture), as this could be useful in establishing the cause of CPTSD and in delineating clinically and therapeutically meaningful subtypes. It is also proposed that a focus on underlying neurobiological processes would help in developing and refining CPTSD as a construct and informing treatment.

Evaluación de psicopatología en adultos víctimas de prisión política y tortura durante su infancia y adolescencia

Objective: Evaluate the presence of psychopathology indicators in adults who were political prisoners during childhood and/or adolescence, during the Chilean military dictatorship. Materials and methods: Case studies and controls, in which indicators of mental disorders were compared in three groups: A) adults who suffered torture and have not received psychosocial treatment, B) adults who suffered torture who did receive psychosocial treatment, and C) adults whose adolescence and/or childhood took place during the dictatorship, who did not suffer torture. A nonrandom sample of 60 people was used. Indicators of depression, anxiety (state/trait), post traumatic stress syndrome (PTSD) and personality disorder were measured with specific scales. Results: There are significant differences in the indicators of mental disorder studied, between those adults who suffered torture and those that did not. Nevertheless, there are not significant differences between those that received psychosocial treatment and those that did not. Conclusions: There is an association between external trauma in childhood and/or adolescence, and psychopathology in adults, and that the possibility of disorders becoming chronic or not depends on interacting social variables.