Childhood abuse experiences and combat-related PTSD

Current literature on the etiology of combat-related PTSD strongly implicates combat trauma exposure as a primary etiological factor. However, studies of premilitary variables have produced conflicting results, perhaps in part due to methodological inconsistencies and failure to employ standardized measures. The present study examines one premilitary variable, childhood physical abuse history. Using a standardized measure developed by child abuse researchers, forty-five percent of veterans with PTSD were identified as recipients of abusive physical punishment during childhood. A positive correlation between physical abuse history and severity of combat-related PTSD was found. These preliminary findings set the stage for further investigation of the child abuse variable and underscore the need for treatment of veterans with combat-related PTSD which addresses developmental traumagenic events.A version of this paper was presented at the Seventh Annual Meeting of the International Society for Traumatic Stress Studies at Washington, DC, October 26, 1991, 11:30 a.m.Correspondence concerning this paper should be addressed to the first author at 7507 18th Avenue NE, Seattle, Washington 98115.     

Nocturnal Autonomic Balance and Sleep in PTSD and Resilience

Posttraumatic stress disorder (PTSD) has been associated with heightened nocturnal autonomic nervous system (ANS) arousal and sleep disturbances. It has been suggested that relationships between sleep and nocturnal ANS activity are influenced by insomnia; however, investigation of this relationship has been limited in PTSD. This study examined nocturnal ANS activity and its relationship to sleep in PTSD and resilience. Physically healthy young adult African Americans with current PTSD (n = 20) or who had never had PTSD despite exposure to a high‐impact traumatic event (resilient, n = 18) were monitored with ambulatory electrocardiograms and actigraphy for 24‐hr periods. Frequency‐domain heart‐rate variability measures, that is, low‐frequency to high‐frequency ratios (LF/HF), which index sympathetic nervous system activity, and normalized HF (nHF), which indexes parasympathetic nervous system activity were examined. Normalized HF during the time‐in‐bed period was lower for those with PTSD than those with resilience (p = .041). Total sleep time was strongly correlated with time‐in‐bed LF/HF (r = ?.72) and nHF (r = .75) in the resilient group, but these were not correlated in the PTSD group. The results suggest elevated nocturnal ANS arousal and dissociation between ANS activity and total sleep time in PTSD.     

Sleep and Processing of Trauma Memories

Sleep has been implicated in learning processes that appear to underlie recovery from posttraumatic stress disorder (PTSD). The importance of quality and timing of sleep following exposure‐based therapies has been suggested. The present study evaluated relationships between sleep and adaptive emotional processing following written narrative exposure (WNE) to memories of traumatic events experienced by participants with clinically significant PTSD symptoms. Participants included 21 urban‐residing nontreatment‐seeking adults with full or subthreshold symptoms of PTSD who completed 4 sessions of 30‐min WNE with the first session either in the evening or the morning. There was a significant reduction of PTSD symptom severity after WNE sessions (partial η = .65), but there was no interaction between group assignment based on the initial session's proximity to sleep and initial reduction of PTSD symptom severity (partial η = .01). Polysomnography following evening WNE revealed increased duration of total sleep and N2%, reduced N3%, and increased eye movement density during REM sleep compared with baseline recordings (dz = 0.65 to 1.15). Reduced N3% and increased REM density were associated with less improvement of PTSD symptoms (r = .58 & ?.63). These findings suggest a relationship between preservation of diminished arousal during sleep and adaptive trauma memory processing.     

Childhood factors and war zone stress in chronic PTSD

This study assessed the predictive validity of combat factors and selected premilitary variables (i.e., childhood physical abuse, substance abuse in the family of origin, or being raised in a nonadaptive or noncohesive family) on posttraumatic stress disorder (PTSD) group membership. In addition, it assessed the correlation of combat exposure and selected premilitary variables with the severity of PTSD symptomology. Ninety-three male Vietnam combat veterans with PTSD were compared to 82 male Vietnam combat veterans without the disorder. The results of two hierarchical logit analyses identified combat exposure as the best predictor of PTSD group membership. However, physical punishment was also found to significantly predict group membership when entered first in the analyses. Furthermore, multiple regression analyses conducted with the PTSD group alone found that both combat exposure and physical abuse predicted greater PTSD symptomology. These findings suggest that childhood physical abuse as well as military trauma should be addressed in the assessment and treatment of chronic PTSD patients.     

Childhood Trauma Histories in Adolescent Inpatients

The authors describe the prevalence of childhood traumatic experiences among adolescent Inpatients. A Childhood Trauma Chart Review Scale (CTCRS) was developed to assess traumatic experiences during childhood and adolescence. The CTCRS was reliably applied to the medical records of 75 adolescent Inpatients who had been given structured clinical interviews for DSM-III-R diagnoses at the time of admission. Most subjects (81%) had experienced at least one traumatic event during childhood, with loss of caregiver being the most frequent type of traumatic experience. Many subjects had multiple types of traumatic experiences, during both early and late childhood. A history of childhood trauma was associated with greater functional impairment and higher likelihood of having a personality disorder, but with no difference in Axis I diagnoses.     

The Role of Ultrasound in Penetrating Trauma

A dramatic reduction of penetrating trauma is not to be expected in the near future, especially in some regions of the world. In order to identify the body structures damaged after stab or firearm wounds, complementary diagnostic studies play an essential role in assessing the severity of the case. The inclusion of ultrasound among the diagnostic tests for assessing abdominal injuries after blunt trauma because of its confident, repetitive, non-invasive, communicable, and low-cost means to obtain the relevant information is derived from rapidly widespread use of the method for other injury mechanisms, such as penetrating trauma. The excellent results in sensitivity and specificity obtained by ultrasound in the search of free fluid among patients with blunt trauma have pushed emergency physicians to try a similar implementation in the penetrating trauma setting. Ultrasonography enables experienced examiners to obtain diagnostic details from the injured patient. Regarding free fluid, it is possible to determine its presence and composition through the peritoneal aspiration after a sonoguided puncture. On the other hand, ultrasound is able to detect morphologic changes in solid organs after penetrating trauma. In order to reach these possibilities which are offered by the ultrasound technology, a planifying training and education program must be developed.     

A Relational Perspective on PTSD in Early Childhood

This paper describes the clinical and research evidence for the importance of the relational context of posttraumatic stress disorder in young children. We review 17 studies that simultaneously assessed parental and child functioning following trauma. In many studies, despite limitations, an association between undesirable parental/family variables and maladaptive child outcomes has been consistently found. We present a model of the parental/family variables as moderators and vicarious traumatic agents for symptoms in young children. Also, a Compound Model is proposed, with three distinctive patterns of the parent–child relationship that impact on posttraumatic symptomatology in young children. Implications for clinical practice and research directions are discussed.     

Trauma centrality and PTSD in veterans returning from Iraq and Afghanistan

Research has demonstrated that the extent to which an individual integrates a traumatic event into their identity (“trauma centrality”) positively correlates with posttraumatic stress disorder (PTSD) symptom severity. No research to date has examined trauma centrality in individuals exposed to combat stress. This study investigated trauma centrality using the abridged Centrality of Event Scale (Berntsen & Rubin, 2006) among Operation Enduring Freedom/Operation Iraqi Freedom combat veterans (n = 46). Multiple regression analyses demonstrated that trauma centrality predicted PTSD symptoms. Trauma centrality and PTSD symptoms remained significantly correlated when controlling for depression in subgroups of veterans with or without probable PTSD. This study replicates and extends findings that placing trauma at the center of one's identity is associated with PTSD symptomatology.     

Sleep Disturbance in Chronic Hemodialysis Patients: The Impact of Depression and Anemia

Background. Many patients with end-stage renal disease who are undergoing chronic hemodialysis suffer from sleep disturbance. This paper was designed to study the severity and prevalence of sleep disorders and the factors affecting the syndromes in this unique patient group. Methods. We conducted this study by the use of questionnaires. Included in this study were a total of 245 patients at our center who had end-stage renal disease (ESRD) and who received hemodialysis thrice weekly for more than three months. Their demographic data and biochemical and hematologic parameters were analyzed. All patients were asked to complete two questionnaires (in a Chinese version) of the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory second edition (BDI-II), either by themselves or with assistance from the medical staff. Results. One hundred and sixty-four patients completed both questionnaires with a response rate of 70.4%. Their mean age was 57.9 ± 11.8 (ranging from 23.1 to 83.7) years old. They had been receiving hemodialysis for an average of 49.1 ± 50.9 months before the study. The male to female ratio was 77:87. Seventy six (46.3%) patients had diabetes mellitus. The prevalence of sleep disturbance was 74.4% (122/164), defined as PSQI scores >5. The poor sleepers had higher BDI scores and a higher ratio of females comparing to the good sleepers. By a multivariate analysis, the BDI scores and female sex were the independent predictors of the patients being poor sleepers. In analyzing the poor sleepers, the BDI scores, durations of hemodialysis and hemoglobin levels were the independent factors for predicting the global PSQI scores. Conclusion. The questionnaire showed a high prevalence of insomnia in the dialytic population. The study also attributes a predictive role in sleep quality to gender, depression, dialytic duration, and hemoglobin levels. The data indicate that in the management of insomnia in this patient group, anemia and depression, both of which are potentially correctable, should be assessed.     

Trauma Exposure and PTSD Symptoms in International Relief and Development Personnel

International relief and development personnel may be directly or indirectly exposed to traumatic events that put them at risk for developing symptoms of Posttraumatic Stress Disorder (PTSD). In order to identify areas of risk and related reactions, surveys were administered to 113 recently returned staff from 5 humanitarian aid agencies. Respondents reported high rates of direct and indirect exposure to life-threatening events. Approximately 30% of those surveyed reported significant symptoms of PTSD. Multiple regression analysis revealed that personal and vicarious exposure to life-threatening events and an interaction between social support and exposure to life threat accounted for a significant amount of variance in PTSD severity. These results suggest the need for personnel programs; predeployment training, risk assessment, and contingency planning may better prepare personnel for service.     

Treatment of Childhood Obstructive Sleep Apnea

An array of surgical, medical and orthodontic treatments is available for treating childhood obstructive sleep apnea. Adenotonsillectomy remains the first choice in treatment, with a need for subsequent clinical and polysomnographic reassessment in selected cases to determine residual sleep-disordered breathing. Residual obstructive sleep apnea is more likely in patients with craniofacial abnormalities or obesity. It may require the use of a positive airway pressure breathing device. Topical corticosteroids, leukotriene antagonists, weight reduction, and positional therapy also play a role in ameliorating childhood obstructive sleep apnea. The published evidence for the efficacy of various treatment modalities consists largely of case-controlled studies and case reports.     

Ataque de Nervios and History of Childhood Trauma

Objective: Ataque de nervios is a common, self-labeled Hispanic folk diagnosis. It typically describes episodic, dramatic outbursts of negative emotion in response to a stressor, sometimes involving destructive behavior. Dissociation and affective dysregulation during such episodes suggested a link to childhood trauma. We therefore assessed psychiatric diagnoses, history of ataque, and childhood trauma in treatment-seeking Hispanic outpatients (N = 70). Significantly more subjects with an anxiety or affective disorder plus ataque reported a history of physical abuse, sexual abuse, and/or or a substance-abusing caretaker than those with psychiatric disorder but no ataque. In some Hispanic individuals, ataque may represent a culturally sanctioned expression of extreme affect dysregulation associated with childhood trauma. Patients with ataque de nervios should receive a thorough traumatic history assessment.     

Dreams in the Acute Aftermath of Trauma and Their Relationship to PTSD

Dreams following trauma have been suggested to aid emotional adaptation, yet trauma-related nightmares are a diagnostic symptom of Posttraumatic Stress Disorder (PTSD). There is little published data relating dreams to PTSD soon after trauma. We assessed dreams and PTSD in 60 injured patients after life-threatening events and obtained follow-up assessments in 39 of these participants 6 weeks later. Ten of 21 dream reports from morning diaries were rated and described as similar to the recent traumatic event. The participants reporting these distressing trauma dreams had more severe concurrent PTSD symptoms than those reporting other categories of dreams and had more severe initial and follow-up PTSD than those without dream recall. These findings along with our preliminary longitudinal observations relating changes in dream patterns to outcome, suggest a relationship of dream characteristics and early adaptive versus maladaptive patterns of processing traumatic memory.     

Predicting PTSD in Women with a History of Childhood Rape

The impact of factors that predispose childhood rape victims to develop posttraumatic stress disorder (PTSD) is important in understanding both the impact of childhood rape and the development of PTSD as a psychological disorder. The present study attempted to determine which crime, perpetrator, victim, and aftermath characteristics are related to PTSD status. A national representative sample of women (N = 3,220) were interviewed about their history of rape, trauma-related variables, and PTSD status. Consistent with research on crime victims, life threat and physical injury discriminated PTSD status in a sample of childhood rape victims. In addition, two other domains were related to PTSD development: (1) testification about rape and (2) rape types. The present findings are discussed in relation to previous research.     

Trauma history characteristics and subsequent PTSD symptoms in motor vehicle accident victims

The present study examined the relationship between trauma history characteristics (number and type of traumas, age at first trauma, and subjective responses to prior traumas) and the development of posttraumatic stress disorder (PTSD) symptoms following a motor vehicle accident (MVA). One hundred eighty-eight adult MVA victims provided information about prior traumatization and were evaluated for PTSD symptoms 6 weeks and one year following the MVA. Results indicated that after controlling for demographics and depression, prior trauma history characteristics accounted for a small, but significant amount of the variance in PTSD symptoms. Distress from prior trauma and number of types of prior traumas were the most meaningful trauma history predictors. Results encourage further evaluation of trauma history as a multifaceted construct.     

The Relationship of Sleep Quality and Posttraumatic Stress to Potential Sleep Disorders in Sexual Assault Survivors with Nightmares, Insomnia, and PTSD

Sleep quality and posttraumatic stress disorder (PTSD) were examined in 151 sexual assault survivors, 77% of whom had previously reported symptoms of sleep-disordered breathing (SDB) or sleep movement disorders (SMD) or both. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Posttraumatic Stress Scale (PSS). High PSQI scores reflected extremely poor sleep quality and correlated with PSS scores. PSQI scores were greater in participants with potential SDB or SMD or both. PSQI or PSS scores coupled with body-mass index and use of antidepressants or anxiolytics predicted potential sleep disorders. The relationship between sleep and posttraumatic stress appears to be more complex than can be explained by the current PTSD paradigm; and, sleep breathing and sleep movement disorders may be associated with this complexity.