Treating traumatized patients and victims of violence

This chapter presents a thorough exposition of treating traumatized patients and victims of violence, addressing many aspects of trauma and victimization critical to a vast proportion of the work that mental health professionals find themselves doing.     

Mental disorder and serious violence: the victims

BACKGROUND: Media representation of violence by people with mental disorder tends toward images of random, serious violence to strangers. Studies of general psychiatric patients do not support this representation, but include few cases of serious or homicidal violence. This study describes the relationship of mentally disordered offenders to victims of an attack that was serious enough to result in the offender's detention in a high-security hospital. Hypotheses tested were that perpetrators of stranger violence would be more likely than those targeting people they know to be male, nonwhite, and younger and have a violence history and less likely to have psychotic features. METHOD: A clinical register and record study of all patients with an index offense of interpersonal violence who were resident in English high-security hospitals Jan. 1, 1993, to June 30, 1993, was conducted. RESULTS: Among 887 men and 88 women, 33% had attacked strangers. After adjustment for the high proportion of men in this male-dominated population, men were still more likely than women to have attacked strangers. There was no independent association between stranger victimization and perpetrator's age, ethnic group, or violence history. Stranger victimization was, however, more likely to have been committed by those with personality disorder than those with psychosis. The most serious violence and homicide were more likely to be against intimates than strangers. CONCLUSION: Among patients selected for high risk to the public, high rates of stranger victimization would be expected. The rates appeared, however, only slightly higher than in other reported patient samples and lower than in an untreated sample. The safety of people close to such patients urgently needs improvement.     

Children of marital violence: a closer look at the unintended victims

The impact of marital violence on male children was assessed via data provided by mothers in three groups: maritally abused; nonviolent, maritally discordant; and satisfactorily married. Both marital violence and nonviolent marital discord were found to be related to behavioral and emotional problems in the witnessing children. Frequency of exposure to both discord and violence and punitive maternal parenting style were also shown to have differential negative effects.     

Erratum: Anxiety sensitivity and PTSD among female victims of intimate partner violence

The original article to which this Erratum refers was published in Depression and Anxiety (2002) 16(2) 77–83     

Narrative exposure therapy for the treatment of traumatized children and adolescents (KidNET): from neurocognitive theory to field intervention

Many children in war-affected and refugee populations have experienced multiple traumatic experiences, and high rates of psychologic disorders, especially posttraumatic stress disorder (PTSD), are found. Intervention strategies require pragmatic and effective approaches to treatment. This article describes the rationale for and the use of narrative exposure therapy in children (KidNET). KidNET is a short-term treatment for PTSD based on a neurocognitive theory of traumatic memory. Early treatment trials, including randomized controlled studies, show promising results for the treatment of children and adolescents who have PTSD living in war-affected countries and refugee communities.     

Starting an in-hospital support group for employee victims of violence in the psychiatric hospital

Violence perpetrated on the staff in our psychiatric hospitals is increasing. We believe an in-hospital support group for employee victims of violence is an effective and economical means of helping our staff, our patients, and the hospital in general. We believe that it is crucial to provide education about and to foster sensitization to issues of violence and that our staff must work together within the facility and with outside agencies, such as those in the legal system. We are just starting our support group at the Carter Center, and this paper discusses various practical points encountered thus far and some of the theoretical issues surrounding our beginning. We believe ours is an important prototype of staff support groups, which are vitally needed. I hope to publish a follow-up report on our group and the progress it has made.     

Anxiety sensitivity and PTSD among female victims of intimate partner violence

The purpose of this study was to evaluate the relationship between anxiety sensitivity (AS) and posttraumatic stress disorder (PTSD) in women. The study involved three groups: women with no history of exposure to serious trauma (n = 30), women who had been exposed to intimate partner violence (IPV) but never developed PTSD (n = 23), and women with IPV exposure and current PTSD (n = 19). As a part of a larger study, they completed measures of AS, PTSD symptomatology, and depression. Women with PTSD reported the highest levels of AS, although traumatized women with PTSD reported more AS than did women with no trauma history. AS-related psychological concerns were a statistical predictor of PTSD symptoms when the entire sample of women was considered but not among the subset with a trauma history. Nonetheless, AS may be an important factor to consider in treatment of individuals with PTSD.     

Effects of war and organized violence on children: a study of Bosnian refugees in Sweden

Data from 99 school-aged Bosnian refugee children living in Sweden were analyzed to reveal the patterns of war stress experienced and the relation between these stressors and current psychological problems. A significant pattern of associations emerged. When children had experienced much stress, talking about their experiences seemed to exacerbate their negative effects.     

The mental health and psychosocial effects of organized violence: A qualitative study in northern Haiti

Historically, organized violence has been a chronic pervasive problem in Haiti. We set out to elicit Haitians' views on its effects to guide the development of interventions. In March 2006 we studied a population in the slum area of Cap-Haitien, Haiti's second largest city, and the nearby towns of Milot and Limbe. A convenience sample of adults was asked to free list all current problems affecting victims of organized violence. Two major categories emerged: psychological problems and financial problems. The psychological problems of "feeling startled and loss of self control," "sadness/grief," "continuing to suffer from reliving/reexperiencing past events," "problems in the head/mental problems," "deep suffering in the heart," and "thinking too much" emerged as themes from key-informant interviews. These may correspond to constructs of depression, dysthymia, and anxiety disorders including posttraumatic stress disorder in psychiatric nosology. The development of effective interventions can therefore consider those known to be effective for these problems in other settings. However in selecting interventions, considerations must also include local acceptability, perceived causes of problems, and their social effects.     

Intentional social distance regulation alters affective responses towards victims of violence: an FMRI study

We used functional magnetic resonance imaging (fMRI) to investigate brain processes underlying control of emotional responses towards a person in distress by cognitive social distance modulation. fMRI and peripheral physiological responses (startle response and electrodermal activity) were recorded from 24 women while they watched victim-offender scenes and modulated their social distance to the victim by cognitive reappraisal. We found that emotional responses, including startle eyeblink and amygdala responses, can effectively be modulated by social distance modulation. Furthermore, our data provide evidence that activity in the dorsomedial prefrontal cortex (dmPFC) and the anterior paracingulate cortex (aPCC), two brain regions that have previously been associated with brain processes related to distant and close others, is differentially modulated by intentional social distance modulation: activity in the dmPFC increased with increasing disengagement from the victim and activity in the aPCC increased with increasing engagement with the victim. We suggest that these two regions play opposing roles in cognitive modulation of social distance and affective responses towards persons in distress that enable the adaptive and flexible social behavior observed in humans.     

Evaluation of psychological support for victims of sexual violence in a conflict setting: results from Brazzaville, Congo

Background  

Little is known about the impact of psychological support in war and transcultural contexts and in particular, whether there are lasting benefits. Here, we present an evaluation of the late effect of post-rape psychological support provided to women in Brazzaville, Republic of Congo.     

Plasma cortisol and neuropeptide Y in female victims of intimate partner violence

BACKGROUND: The experience of intimate partner violence (physical and sexual violence) has been linked to psychiatric disorders such as posttraumatic stress disorder, yet data on the neuroendocrine profile in this population is sparse. This study sought to examine baseline plasma cortisol and neuropeptide Y (NPY) levels in female victims of intimate partner violence (IPV). METHODS: Morning plasma samples were collected for cortisol and NPY determination in 22 women with histories of IPV (10 with current PTSD, 12 without current or lifetime PTSD) and 16 non-abused controls. RESULTS: Mean cortisol levels were significantly lower in IPV subjects compared with controls, but did not distinguish IPV subjects with and without PTSD. There were no significant differences in mean NPY levels between the groups. Neither cortisol nor NPY levels were significantly correlated with PTSD symptoms. CONCLUSIONS: These preliminary findings suggest that victims of IPV, like women traumatized by childhood abuse, may be characterized by alterations in hypothalamic-pituitary-adrenal axis functioning, however, further study is needed to identify specific stress system disturbances in this group.     

手术治疗机化型硬膜下血肿

1993～2002年我科共收治6例机化型慢性硬膜下血肿(CSDH),均经显微手术治愈,报告如下。1临床资料1.1一般资料 本组男5例,女1例,年龄46～68岁,平均56岁。病程     

Central American victims of gang violence as asylum seekers: the role of the forensic expert

Individuals fleeing persecution have the right to asylum. This most fundamental right was guaranteed by the 1951 United Nations (UN) Convention Relating to the Status of Refugees and was implemented in the 1967 UN protocol regarding refugee status. The United States codified refugee protection and the procedures for asylum in the Refugee Act of 1980, which was made part of the Immigration and Nationality Act (INA). In claiming refugee status, the burden of proof rests with the asylum seeker and is often a daunting task, given language and cultural barriers, lack of knowledge about U.S. legal procedures, and the reality that oppressive states do not document their intentions to persecute dissidents. Forensic psychiatrists may be asked to provide mental health assessment in immigration cases. In this article, an example of a Central American man with a nontraditional but increasingly common request for asylum is presented, the asylum process is described, and the role of the forensic psychiatric expert before the immigration court is explored.     

Relationship proximity to victims of witnessed community violence: associations with adolescent internalizing and externalizing behaviors

Witnessing community violence has been linked with several adverse outcomes for adolescents, including emotional and behavioral problems. Among youth who have witnessed community violence, proximity to the victim of community violence is one factor that may determine, in part, the nature of adolescents' responses to community violence exposure. The present study examines whether relationship proximity to the victim of community violence is associated with internalizing and externalizing behaviors among a sample of urban and predominantly African American adolescents (N?=?501) who have witnessed community violence. In 10th grade, participants reported whether they had witnessed 10 community violence events during the past year, and, if so, whether the victim of the violence was a family member, close friend, acquaintance, or stranger. Witnessed community violence against a family member or close friend was associated with depressive symptoms, and witnessed community violence against known individuals was associated with anxiety symptoms. Witnessing community violence against familiar persons and strangers was linked with aggressive behavior. Gender differences in these associations and implications for assessment and intervention with community violence-exposed youth are discussed.