Peritraumatic Versus Persistent Dissociation in Acute Stress Disorder

The DSM-IV definition of acute stress disorder (ASD) regards dissociation that occurs during a trauma (peritraumatic dissociation) comparably to persistent dissociation. This study investigated the relative contributions of peritraumatic dissociation and persistent dissociation to acute posttraumatic stress reactions. Civilian trauma (N = 53) survivors with either acute stress disorder (ASD), subclinical ASD, or no ASD were administered modified versions of the Peritraumatic Dissociative Experiences Questionnaire that indexed both dissociation during the trauma and dissociation at the time of assessment. Persistent dissociation was more strongly associated with ASD severity and intrusive symptoms than peritraumatic dissociation. These results are consistent with the proposition that persistent, rather than peritraumatic, dissociation is associated with posttraumatic psychopathology.     

Effects of Litigation Settlements on Posttraumatic Stress Symptoms in Motor Vehicle Accident Victims

In order to investigate the effects of the initiation of litigation and its settlement on victims of motor vehicle accidents (MVAs), we followed up 132 MVA victims from an initial assessment 1 to 4 months post-MVA for 1 year. Of the 67 who had initiated litigation. 18 (27%) settled within the 12 months, while 49 still had litigation pending; 65 never initiated litigation. Those who initiated litigation had more severe injuries and higher initial levels of posttraumatic stress (PTS) symptoms. All three groups improved in major role function and had reduced PTS symptoms over the 1 year follow-up. Those whose suits were still pending, as well as those whose suits had been settled, showed no reduction in measures of anxiety or depression, whereas the nonlitigants did show improvement on these measures.     

Predictors of Acute Stress Following Motor Vehicle Accidents

The aim of this study was to investigate the predictors of acute stress following motor vehicle accidents (MVA). Sixty-two consecutive adult admissions to a hospital were assessed between two days and four weeks following a MVA. Participants were assessed for acute stress disorder (ASD) with a structured clinical interview and administered the Beck Depression Inventory (BDI), Coping Style Questionnaire, Dissociative Experiences Scale, and the Eysenck Personality Inventory. The prevalences of full and sub-syndromal ASD were 16.1% and 14.5%, respectively. BDI, history of psychiatric treatment, history of posttraumatic stress disorder (PTSD), and history of previous MVA accounted for 61% of the variance of acute stress severity. The findings indicate that predictors of acute stress severity are comparable to the predictors of PTSD and highlight the possibility of identifying those who may benefit from early treatment.     

Trauma‐Related Context Increases Sleep Disturbances in People with Acute Stress Disorder Symptoms

In this study, we addressed how sleep is related to acute stress disorder (ASD) symptoms, and how the presence of a trauma related‐context moderates this relationship. This study (N = 140) was carried out during the 2014 Israel–Gaza conflict, during which 70% of Israelis were exposed to missile attacks. Findings show that participants with clinical ASD symptom levels reported more sleep disturbances than participants without clinical ASD symptom levels. More critically, this effect was only evident among respondents who had a reinforced security room in their houses. While reinforced security rooms offer protection against indirect missile damage, their relevance is salient in negative traumatic situations, which individuals with a clinical level of ASD are more sensitive to. Conversely, in houses without a reinforced security room, there was no difference in subjective sleep reports between individuals with or without clinical levels of ASD symptoms. Results are discussed in reference to trauma being activated by context and the ensuing effects on sleep. Theoretical and clinical implications are discussed. Copyright © 2016 John Wiley & Sons, Ltd.     

Psychometric Properties of the Stanford Acute Stress Reaction Questionnaire (SASRQ): A Valid and Reliable Measure of Acute Stress

A reliable and valid measure is needed for assessing the psychological symptoms experienced in the aftermath of a traumatic event. Previous research suggests that trauma victims typically experience dissociative, anxiety and other symptoms, during or shortly after a traumatic event. Although some of these symptoms may protect the trauma victim from pain, they may also lead to acute stress, posttraumatic stress, or other disorders. The Stanford Acute Stress Reaction Questionnaire (SASRQ) was developed to evaluate anxiety and dissociation symptoms in the aftermath of traumatic events, following DSM-IV criteria for acute stress disorder. We present data from multiple datasets and analyses supporting the reliability and construct, convergent, discriminant, and predictive validity of the SASRQ.     

Evaluation of Initial Posttrauma Cardiovascular Levels in Association with Acute PTSD Symptoms Following a Serious Motor Vehicle Accident

The present study examined the relationship between heart rate (HR) and blood pressure (BP) levels assessed at multiple time points posttrauma and subsequent acute posttraumatic stress disorder (PTSD) symptoms present at a 1-month follow-up. HR and BP levels were measured in 65 motor vehicle accident (MVA) survivors during Emergency Medical Service transport, upon admission to the trauma unit, for the first 20 min postadmission and on the day of discharge. Hierarchical linear modeling analyses revealed no significant relationships between cardiovascular levels and acute PTSD symptoms. Given the small sample size, these results should be interpreted with caution. However, the present results question the use of initial cardiovascular levels as predictors of subsequent acute PTSD in seriously injured MVA victims.     

Cognitive Strategies and the Resolution of Acute Stress Disorder

Information processing theories propose that resolution of posttraumatic stress is mediated by activation of traumatic memories and modification of threat-based beliefs. It is argued that this adaptive response is associated with reduced cognitive avoidance. Thought control strategies were assessed in civilian trauma survivors with acute stress disorder (N = 45) prior to and following either cognitive behavior therapy or supportive counseling. Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the State Trait Anxiety Inventory, the Impact of Event Scale, and the Thought Control Questionnaire within 2 weeks of their trauma and 6 months following treatment. Receiving cognitive behavior therapy was associated with reductions in the use of punishment and worry, and increases in the use of reappraisal and social control strategies. Further, reduced posttraumatic stress symptoms were associated with increased use of social control strategies and reappraisal strategies, and decreased use of worry. Findings are discussed in terms of the cognitive strategies that may mediate acute posttraumatic stress.     

Screening for Posttraumatic Stress Disorder Symptoms Among Bosnian Refugees

To assess the level of posttraumatic stress disorder (PTSD) symptoms among Bosnian war refugees, a consecutive cohort of 206 Bosnian refugees, arriving in Sweden in 1993, was screened for PTSD using a modified version of the self-report instrument PTSS-10. A comparison group of 387 visitors to seven Swedish health centers was recruited. Prevalence of possible PTSD, using two estimates, was 18 to 33% among the Bosnian refugees, and .3 to 1% in the comparison group. The PTSS-10 showed high internal consistency reliability (Cronbach's alpha = .92) and stability (test-retest reliability r = .89). Thus, Bosnian war refugees showed high levels of PTSD symptoms compared to a nonrefugee comparison group.     

Acute Psychophysiological Arousal and Posttraumatic Stress Disorder: A Two-Year Prospective Study

This study investigated the role of acute arousal in the development of posttraumatic stress disorder (PTSD). Hospitalized motor vehicle accident survivors (n = 146) were assessed for acute stress disorder (ASD) within 1 month of the trauma, 6 months later, and reassessed for PTSD 2 years posttrauma (n = 87). Heart rates (HR) were assessed on the day of hospital discharge. Participants who had PTSD 2 years posttrauma had higher HR at hospital discharge than those without PTSD. A diagnosis of ASD or a resting HR of 95 beats per minute had moderate sensitivity (74%) and specificity (91%) in predicting PTSD. These findings suggest that caution is required in using acute HR as a predictor of longer-term PTSD following trauma.     

Motor vehicle crash versus accident: a change in terminology is necessary

We assert that motor vehicle crash should replace motor vehicle accident in the clinical and research lexicon of traumatologists. Crash encompasses a wider range of potential causes for vehicular crashes than does the term accident. A majority of fatal crashes are caused by intoxicated, speeding, distracted, or careless drivers and, therefore, are not accidents. Most importantly, characterizing crashes as accidents, when a driver was intoxicated or negligent, may impede the recovery of crash victims by preventing them from assigning blame and working through the emotions related to their trauma.     

Prediction of Remission of Acute Posttraumatic Stress Disorder in Motor Vehicle Accident Victims

One hundred forty five individuals who sought medical attention as a result of a motor vehicle accident (MVA), and who were initially assessed 1 to 4 months post-MVA, were followed up prospectively for 6 months to determine how many of the 55 with posttraumatic stress disorder (PTSD) and the 43 with sub-syndromal PTSD would remit and what variables would predict remission. Thirty (55%) of those with initial PTSD had remitted at least in part by 6 months while 67% of those with sub-syndromal PTSD had remitted (and 5% had worsened). Four variables, including severity of initial symptoms, degree of initial physical injury, relative degree of physical recovery by 4 months and whether a close family member suffered a trauma during the follow-up interval, combined to classify 6-month clinical status of 84% of those with initial PTSD secondary to MVAs.     

Dissociative responses in the immediate aftermath of the Oakland/Berkeley firestorm

This study examined relationships between dissociative symptoms experienced in the immediate aftermath of the Oakland/Berkeley firestorm and contact with the fire, life events, demographic variables, and actions taken after learning about the fire. One hundred eighty-seven participants completed self-report measures about their experiences during and immediately following the fire. Dissociative symptoms were significantly related to contact with the fire, sex, and stressful life events. Also, dissociative symptoms were significantly related to engaging in certain activities, such as trying to get closer to the fire and going into blocked-off areas and crossing police barricades. These results suggest that dissociative symptoms may merit special attention in intervention focusing on the immediate aftermath of disaster.     

Are the dissociative criteria in ASD useful?

Acute stress disorder (ASD) is a new DSM-IV diagnostic category, characterized by dissociative, intrusive, avoidance, and hyperarousal symptoms in the first month after a traumatic experience. The goal of the present study was to examine the utility of this diagnosis. In a prospective study, 79 mixed trauma victims who met DSM-IV symptom criteria for PTSD within 1 month following a traumatic event were followed through three months post-event. Dissociative symptoms in ASD only partially captured distress and dysfunction during the first month. Participants with and without ASD showed similar patterns of recovery, with only small differences that disappeared at three months post-event. Interestingly, initial PTSD avoidance but not ASD dissociative symptoms predicted PTSD severity at 3 months.     

An Affect-Management Group for Women with Posttraumatic Stress Disorder and Histories of Childhood Sexual Abuse

Systematic research on effective treatment for survivors of childhood sexual abuse with posttraumatic stress disorder (PTSD) is virtually non-existent. The aim of the present study was to compare the effectiveness of an affect-management treatment (AM) group to a wait list control condition for female survivors of childhood sexual abuse with PTSD. Forty-eight female survivors of childhood sexual abuse with PTSD were randomly assigned to either a 15-week affect-management treatment group or to a wait list control condition. All subjects received individual psychotherapy and pharmacotherapy for the duration of the study, and for at least 1-month prior to the study. Controlling for pretreatment scores, subjects who completed the affect-management treatment group (n = 17) reported significantly fewer posttreatment symptoms of PTSD and dissociation than subjects in the wait list control condition (n = 16). Our findings suggest that an affect-management group treatment is beneficial as an adjunct to individual psychotherapy and pharmacotherapy for survivors of childhood sexual abuse with PTSD.     

Degree of Somatoform and Psychological Dissociation in Dissociative Disorder Is Correlated with Reported Trauma

In this study, the prevalence and severity of traumatic experiences as reported by patients with dissociative disorders and with other DSM-IV psychiatric diagnoses were compared. Furthermore, the predictive value of emotional, physical, and sexual trauma with respect to somatoform and psychological dissociation was analyzed. In contrast with comparison patients, dissociative disorder patients reported severe and multifaceted traumatization. Physical and sexual trauma predicted somatoform dissociation, sexual trauma predicted psychological dissociation as well. According to the memories of the dissociative disorder patients, this abuse occurred in an emotionally neglectful and abusive social context. Pathological dissociation was best predicted by early onset of reported intense, chronic and multiple traumatization. Methodological limitations restricting causal inferences between reported trauma and dissociation are discussed.     

Posttraumatic Stress Disorder Symptoms and Parenting Satisfaction Among a National Sample of Male Vietnam Veterans

This study examined relationships between posttraumatic stress disorder (PTSD) symptoms and parenting satisfaction. Total PTSD severity scores and avoidance and emotional numbing symptoms were significantly associated with parenting satisfaction. These associations remained significant even after controlling for partner violence, major depression, and alcohol abuse/dependence. Results suggest that higher levels of PTSD symptoms and avoidance and emotional numbing symptoms in particular may have a deleterious effect on parent-child relationship satisfaction.     

Pilot Evaluation of Hypnotic Medication During Acute Traumatic Stress Response

Early intervention aimed at secondary prevention is a high priority for posttraumatic stress disorder (PTSD) research. Disrupted sleep may have a role in the initiation and maintenance of PTSD. Three of the participants were recruited from a surgical trauma service, and one had sought treatment in a psychiatric setting. All were within 1-3 weeks of trauma exposure and had acute PTSD symptoms that included disturbed sleep. Temazepam, a benzodiazepine hypnotic, was administered for 5 nights, tapered for 2 nights, and then discontinued. Evaluations 1-week after the medication had been discontinued revealed improved sleep and reduced PTSD severity. These observations suggest an approach that may be clinically useful and a need for more systematic trials.     

Cognitive functioning in Post-Traumatic Stress Disorder

Twelve Post-Traumatic Stress Disorder (PTSD) patients, 12 psychiatric patients matched for severity of psychopathology, and 12 normal controls were assessed for cognitive functioning by means of a comprehensive test battery. Both patient groups felt subjectively more impaired than normals. Performance on measures of intelligence, organicity, verbal fluency, memory, and attention was significantly poorer in patients than in normals. The performance of the PTSD patients and that of the psychiatric controls was, however, very similar. The premorbid intelligence of both the PTSD patients and the psychiatric controls was average and had deteriorated significantly by the time of current testing. These cognitive problems were not secondary to alcohol, drug abuse, or head injury. The results suggest a cognitive impairment in post-traumatic patients.     

Attentional Bias in Posttraumatic Stress Disorder

This study investigated preferential encoding of threat material in subjects with posttraumatic stress disorder (PTSD) with a modified dot-probe paradigm. This paradigm indexes attentional bias by measuring response latency to name neutral target words that are presented adjacent to or distant from threat words. Motor vehicle accident survivors with PTSD (n = 15), subclinical PTSD (n = 15), and low anxiety (n = 15) were required to name target words that were presented either adjacent to or distant from strong threat, mild threat, positive, and neutral words. PTSD subjects named targets faster when they were in close proximity to mild threat words. Results suggested that PTSD subjects' attention was drawn to the mild threat stimuli and are discussed in the context of network models of PTSD.