Posttraumatic growth among people with serious mental illness,psychosis and posttraumatic stress symptoms

Recent research has shown high rates of exposure to trauma among people with serious mental illness (SMI). In addition, studies suggest that psychosis and mental illness-related experiences can be extremely traumatic. While some individuals develop posttraumatic symptomatology related to these experiences, some appear to experience posttraumatic growth (PTG). Little is known, however, about PTG as a possible outcome among people who experienced psychosis as well as posttraumatic stress symptoms (PTSS). For further understanding of the relationship between PTSS and PTG among people with SMI who experienced psychosis, 121 participants were recruited from community mental health rehabilitation centers and administered trauma and psychiatric questionnaires. Results revealed that while high levels of traumatic exposure were common, most participants experienced some level of PTG which was contingent upon meaning making and coping self-efficacy. In addition, posttraumatic avoidance symptoms were found to be a major obstacle to PTG. The range of effect sizes for significant results ranged from η² = 0.037 to η² = 0.144. These findings provide preliminary evidence for the potential role of meaning making and coping self-efficacy as mediators of PTG in clinical, highly traumatized populations of people with SMI and psychosis. Implications of these findings for future research and clinical practice are discussed.     

The class-dimensional structure of PTSD before and after deployment to Iraq: Evidence from direct comparison of dimensional,categorical, and hybrid models

The assumption of specific etiology in posttraumatic stress disorder (PTSD) differentiates the disorder from most other psychiatric conditions. A ‘risky test’ of the assumption of specific etiology and resultant trauma-related symptom dimensions was conducted through structural modeling of PTSD symptoms in soldiers before (N = 522) and after (n = 423) a combat deployment to Iraq. If PTSD represents a discrete diagnostic entity that emerges after trauma exposure, we hypothesized either the number of latent classes should increase from pre- to post-deployment or symptom dimensions should qualitatively distinguish affected from unaffected classes following trauma exposure. Comparison of latent structural models revealed best fitting hybrid models for PTSD and depression with strong invariance of symptom dimensions across classes both before and after deployment and only quantitative (i.e., severity) differences between classes. These findings suggest PTSD is generally well-conceptualized as a dimensional syndrome worsened but not necessarily elicited by trauma exposure.     

Preliminary study of family accommodation in youth with autism spectrum disorders and anxiety: Incidence,clinical correlates,and behavioral treatment response

Anxiety symptoms are common in youth with autism spectrum disorders (ASD) and directly associated with symptom severity and functional impairment. Family accommodation occurs frequently among individuals with obsessive-compulsive and anxiety disorders; to date, no data exist on the nature and correlates of family accommodation in youth with ASD and anxiety, as well as its relationship to cognitive-behavioral therapy outcome. Forty children with ASD and a comorbid anxiety disorder participated. Clinicians administered measures of ASD and anxiety disorder caseness, anxiety symptom severity, and family accommodation; parents completed questionnaires assessing social responsiveness, internalizing and externalizing behaviors, and functional impairment. A subsample of youth (n = 24) completed a course of cognitive-behavioral therapy. Family accommodation was common and positively correlated with anxiety symptom severity, but not functional impairment, general internalizing symptoms, externalizing behavior, or social responsiveness. Family accommodation decreased following cognitive-behavioral therapy with decreases in family accommodation being associated with decreases in anxiety levels. Treatment responders reported lower family accommodation frequency and lower parent impact relative to non-responders. Clinical implications of this study in assessing and psychotherapeutically treating youth with ASD and comorbid anxiety are discussed.     

Posttraumatic stress symptom clusters associations with psychopathology and functional impairment

We examined posttraumatic stress symptom clusters associations with psychopathology and functional impairment in 899 Norwegian survivors of the 2004 South-East Asia tsunami six months post-disaster. Posttraumatic stress symptoms were assessed with the Impact of Event Scale-Revised (IES-R) with intrusion, avoidance, and hyper-arousal subscales. For criterion variables, we used 10 indicators of psychopathology and functional impairment, e.g. having mental health problems, seeing mental health professionals, and use of medication or sick leave. Hyper-arousal had stronger correlations than avoidance with all criterion variables (p values < 0.001) and stronger correlations than intrusion with seven of the 10 criterion variables (p values < 0.01). Also, intrusion had stronger correlations than avoidance with seven of 10 criterion variables (p values < 0.05). Thus, our findings indicate that symptoms of hyper-arousal may be more closely linked to psychopathology and functional impairment than other symptoms of posttraumatic stress following a sudden onset, short duration, natural disaster event.     

A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder

Traumatic experiences can have a powerful impact on individuals and communities but the relationship between perceptions of beneficial and pathological outcomes are not known. Therefore, this meta-analysis examined both the strength and the linearity of the relationship between symptoms of posttraumatic stress disorder (PTSD) and perceptions of posttraumatic growth (PTG) as well as identifying the potential moderating roles of trauma type and age. Literature searches of all languages were conducted using the ProQuest, Wiley Interscience, ScienceDirect, Informaworld and Web of Science databases. Linear and quadratic (curvilinear) rs as well as βs were analysed. Forty-two studies (N = 11,469) that examined both PTG and symptoms of PTSD were included in meta-analytic calculations. The combined studies yielded a significant linear relationship between PTG and PTSD symptoms (r = 0.315, CI = 0.299, 0.331), but also a significantly stronger (as tested by Fisher's transformation) curvilinear relationship (r = 0.372, CI = 0.353, 0.391). The strength and linearity of these relationships differed according to trauma type and age. The results remind those working with traumatised people that positive and negative post-trauma outcomes can co-occur. A focus only on PTSD symptoms may limit or slow recovery and mask the potential for growth.     

Parenting and the parent–child relationship in families of children with mild to borderline intellectual disabilities and externalizing behavior

This cross-sectional study examined the association between parenting behavior, the parent–child relationship, and externalizing child behavior in families of children with mild to borderline intellectual disabilities (MBID). The families of a child with MBID and accompanying externalizing behavior problems (n = 113) reported more positive discipline and physical punishment but less involvement, less positive parenting, less monitoring, a lower sense of parenting competence, less acceptance of the child, and less closeness to the child than the families of a child with MBID and no accompanying externalizing behavior problems (n = 71). The parent–child relationship was most strongly associated with externalizing child behavior, over and above parenting behaviors. In addition, the parent–child relationship was found to be associated with parenting behavior, over and above the child's externalizing behavior. Our results highlight the importance of both the parent–child relationship and parenting behavior in connection with the occurrence of externalizing behavior problems on the part of children with MBID. Parenting behavior and the parent–child relationship may thus be promising targets for interventions with this group of children.     

Does ‘fear of dying’ indicate a more severe presentation of panic disorder?

Research suggests a relationship between the presence of fearful cognitions and panic disorder (PD) severity. With little existing evidence addressing the clinical significance of individual panic-cognitions, the current study examined presentation and impairment differences among 331 outpatients with PD according to whether they experience “fear of dying” (FOD) during panic attacks. Patients reporting FOD (n = 153) were compared to patients denying FOD (n = 178) on variables indicating PD severity (e.g., number of symptoms) and psychiatric impairment (e.g., hospitalizations). PD patients with FOD reported a greater number of panic symptoms, agoraphobia diagnoses, and were more likely to be seeking treatment primarily for PD. We found no clinical impairment or comorbidity differences between groups. Results suggest that panic attacks with FOD are related to a more acute presentation of PD. Such results substantiate past research connecting cognitive distress and PD severity and further suggest that FOD may be particularly relevant to this relationship.     

Symptom accommodation,trichotillomania-by-proxy,and interpersonal functioning in trichotillomania (hair-pulling disorder)

ObjectiveThis study investigated relationship functioning in trichotillomania (TTM) as well as specific interpersonal behaviors that have received little attention in TTM research, including by-proxy pulling, symptom accommodation, and self-disclosure. The objective was to contribute data for future development of components of treatment that focus on interpersonal functioning.MethodsData were collected through survey about relationships and related difficulties among adults who endorsed criteria consistent with DSM-5 criteria for TTM (n = 670).ResultsConsistent with our hypotheses, TTM symptom severity was correlated negatively with relationship satisfaction and perceived social support, positively with perceived criticism, perceived risk in intimacy, and social interaction anxiety, though these correlations were small (absolute values r = .08 to .17). Approximately one-quarter of survey respondents had not told their closest friend about their trichotillomania, and one-fifth had not told their spouse or long-term romantic partner. TTM-by-proxy urges were reported by 54% of participants, and 37% of participants reported having actually pulled hair from other people, with the most common proxies specified as significant others (51%), parents (13%), friends (8%), siblings (8%), children (7%) and pets (5%). Higher levels of TTM-by-proxy urges were associated with “focused” pulling (d = .37) and perfectionistic thinking (d = .16 to .20), yet current by-proxy urges were not associated with, functional impairment. A small minority of individuals (7%) reported having asked other people to pull hair for them (78% of these requests were granted); there was increased endorsement of “focused” pulling among these individuals. The people who participants asked to pull hairs for them included significant others (66%), mothers (20%), siblings (11%), friends (9%) and one's children (9%).ConclusionMore than one-third of respondents had pulled hair from others, 7% had asked others to pull their hair, and sizable minorities kept TTM secret from their closest friends or even spouse/partners. Clinical levels of social interaction anxiety were endorsed by 51% of the sample. Understanding these interpersonal experiences more fully could improve our understanding of relationship functioning in TTM and guide efforts to individualize treatment for adults with TTM.     

Autism spectrum disorder among first-visit depressed adult patients: diagnostic clues from backgrounds and past history

ObjectiveThe present study aimed to extract discriminating indicators for diagnosis of autism spectrum disorder (ASD) from personal backgrounds and past history among depressed adult outpatients.MethodsSubjects were 430 depressed adults, consisting of patients with ASD (n= 70) and those without ASD (n= 360). Group comparison and discriminant analysis was conducted with regard to backgrounds (age, gender, education, marriage, living alone, physical diseases and family history of mood disorders) and past history (school non-attendance, bullied experience, psychotic-like experiences, conduct problems, suicide-related behaviors and interpersonal friction).ResultsSix discriminating indicators (interpersonal friction, bullied experience, psychotic-like experiences, age under 32 years, school non-attendance and university educational level) were identified by stepwise discriminant analysis (P< .001). Absence of the first 4 indicators almost excluded ASD diagnosis with the highest negative predictive value (98%) and the least negative likelihood ratio (0.11) whereas one or more out of these 4 indicators showed low positive predictive value (32%) despite high sensitivity (93%).ConclusionsThe abovementioned 4 indicators may be useful clues to cover possible ASD subjects among depressed adults although further detailed ASD focused diagnostic procedure is absolutely necessary to specify true ASD subjects. Meanwhile, absence of these 4 indicators is probably helpful to rule out ASD diagnosis.     

An examination of Anglo and Latino parenting practices: Relation to behavior problems in children with or without developmental delay

The transactional model of development has received empirical support in research on at-risk children. However, little is known about the role of ethnicity or child delay status (i.e., developmental delay [DD] or typical cognitive development [TD]) in the process of parents adapting to their child's behavior problems and special needs. We examined whether Latina (N = 44) and Anglo (N = 147) mothers of 3-year-old children with or without DD differed in their use of two parenting practices, maternal scaffolding and sensitivity. We also examined how the status and ethnic groups differed in child behavior problems at ages 3 and 5 and whether parenting predicted change in behavior problems over time in the ethnic and status groups. Analyses generally supported previous research on status group differences in behavior problems (DD higher) and parenting practices (TD higher). Parenting practices predicted a decrease in externalizing problems from child age 3 to 5 years among Latino families only. Child developmental status was not associated with change in behavior problems. Cultural perspectives on the transactional model of development and implications for intervention are discussed.     

Intermittent explosive disorder: Associations with PTSD and other Axis I disorders in a US military veteran sample

This study examined the prevalence of intermittent explosive disorder (IED) and its associations with trauma exposure, posttraumatic stress disorder (PTSD), and other psychiatric diagnoses in a sample of trauma-exposed veterans (n = 232) with a high prevalence of PTSD. Structural associations between IED and latent dimensions of internalizing and externalizing psychopathology were also modeled to examine the location of IED within this influential structure. Twenty-four percent of the sample met criteria for a lifetime IED diagnosis and those with the diagnosis were more likely to meet criteria for lifetime PTSD than those without (30.3% vs. 14.3% respectively). Furthermore, regression analyses revealed lifetime PTSD severity to be a significant predictor of IED severity after controlling for combat, trauma exposure, and age. Finally, confirmatory factor analysis revealed significant cross-loadings of IED on both the externalizing and distress dimensions of psychopathology, suggesting that the association between IED and other psychiatric disorders may reflect underlying tendencies toward impulsivity and aggression and generalized distress and negative emotionality, respectively.     

Family factors contributing to emotional and behavioral problems in Korean adolescents with epilepsy

PurposeWe aimed to determine whether different aspects of family functioning are associated with emotional and behavioral problems in adolescents with epilepsy and, if not, to document any indirect associations mediated by other family factors.MethodsThis was a cross-sectional, multicenter study. A total of 297 adolescents with epilepsy and their parents participated. Adolescent psychopathology was measured using the Youth Self-Report. Family factors were classified into proximal (parent–child interaction), distal (parent characteristics), and contextual factors (family characteristics) in accordance to their level of proximity to the adolescent's everyday life. Regression analyses were used to analyze the unique and combined predictive power of family factors in relation to psychopathology.ResultsIn total, 44 (14.8%) and 51 (17.2%) adolescents with epilepsy scored above the borderline cutoff (T-score ≥ 60) of internalizing and externalizing problems, respectively. Proximal and distal factors were independently associated with both internalizing and externalizing problems. High levels of parental depressive mood and parental overcontrol were the strongest factors contributing to internalizing and externalizing problems, respectively. Contextual factors were indirectly associated with both internalizing and externalizing problems through more proximal factors.ConclusionsBoth proximal and distal family factors affect psychopathology in Korean adolescents with epilepsy. Parental feelings of depression and parental overcontrol are the strongest factors contributing to internalizing and externalizing problems, respectively.     

The relation among sleep,routines, and externalizing behavior in children with an autism spectrum disorder

The present study examined relations among sleep, routines, and externalizing behavior (based on parent report) in 115 children ages 6 to 12 years in two groups: 58 children with an autism spectrum disorder (age M = 9.0, SD = 2.09) and 57 non-ASD children (age M = 8.25, SD = 1.98). Within the ASD group, sleep hygiene and sleep quality were related to both routines and externalizing behaviors. In the combined sample, a significant interaction was found between diagnostic status and general routines in predicting externalizing behaviors. Specifically, lower levels of routines were related to higher levels of externalizing behaviors for both groups, whereas higher levels of routines were related to lower levels of externalizing behaviors for the non-ASD group. Further research among these constructs may focus on children with an ASD who experience less consistent routines or significant sleep disturbance.     

Processus psychologiques de gestion du stress et régulation neuroendocrinienne chez les adolescents délinquants en institution fermée : une étude pilote

Background

Adolescence is a stressful period where important biological, psychological and social changes occur. Adolescents are particularly vulnerable during this developmental period and can use various strategies to deal with daily stress, such as substance use or externalizing behaviors. In previous studies, stress in adolescents with externalizing behaviors was often linked to ineffective cognitive coping strategies (i.e., constructive thinking) and overlooking the biological aspects involved in stress management such as neuroendocrine regulation. Indeed, repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis in chronic stress situations may have long-term effects on subsequent cortisol regulation and lead to psychological difficulties. It was also shown that basal cortisol levels are lower in adolescents with externalizing behaviors. This study aims to assess the links between constructive thinking and neuroendocrine regulation in adolescent offenders and their association with externalizing symptoms (e.g., aggression, delinquency, psychopathic traits, substance use). Identifying particular biopsychological patterns can help to better understand stress management in youth with externalizing behaviors and to improve clinical treatments.

The role of trauma and PTSD-related symptoms for dissociation and psychopathological distress in inpatients with schizophrenia

BACKGROUND: To investigate the relationship between dissociative experiences, psychopathological distress, a history of trauma and posttraumatic symptoms in adult schizophrenia. METHODS: Eighty-seven schizophrenic inpatients returned self-questionnaires [Dissociative Experience Scale (DES); Symptom Checklist (SCL-90-R); PTSD Symptom Scale (PDS)]. Based upon this self-rating, 14 of the participants fulfilled the cut-off definition of PTSD according to DSM-IV criteria, 43 had a history of trauma without a self-rated diagnosis of PTSD. DES scores were also compared to a convenience sample of 297 non-clinical controls. RESULTS: We found no significant impact of trauma alone but a significant influence of posttraumatic symptomatology on the level of current psychopathological distress (GSI) and the DES subscale absorption. However, in logistic regression, posttraumatic symptomatology was associated with GSI but not with DES. Schizophrenic patients even without trauma or posttraumatic symptoms had significantly higher scores in all three DES subscales than non-clinical controls. CONCLUSION: Pronounced posttraumatic symptoms in schizophrenia are associated with severe additional psychopathological distress whereas the increase in dissociation (absorption) in this group of patients may be secondary to the increase in symptom load. However, schizophrenia itself seems to be associated independently from trauma and pathological posttraumatic conditions with a broad range of dissociative symptoms.     

Do communication and social interaction skills differ across youth diagnosed with autism spectrum disorder,attention-deficit/hyperactivity disorder,or dual diagnosis?

Given the well-documented symptom overlap between autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD), careful evaluation of potential differentiation and overlap is critical for accurate diagnostic decisions. Although research has considered the use of symptom checklists and parent/teacher report questionnaires for symptom differentiation, standardized observational methods, typically utilized in the context of ASD evaluation, have received less attention. The present study examined the continuum of communication and social interaction impairment for youth diagnosed with ASD and ADHD, as indexed by the Autism Diagnostic Observation Schedule (ADOS). Participants were 209 youth ages 3–18 years with ASD, ADHD, dual diagnosis (ASD + ADHD) or no diagnosis. Differences across diagnostic groups were observed for mean communication and social interaction total scores on the ADOS, with the highest scores (i.e., greater impairment) observed for the ASD group and lowest scores for the ADHD and no diagnosis groups. Results provide the first evidence for use of the ADOS for distinguishing youth who have ADHD alone versus ASD alone or co-occurring ASD + ADHD. Findings are discussed in light of implications for clinical practice and future research.     

Behavior problems among school-aged children with autism spectrum disorder: Associations with children's communication difficulties and parenting behaviors

Research has clearly demonstrated that behavior problems are common among children with ASD. These co-occurring behavior problems place children with ASD and their families at risk for a range of negative outcomes. This questionnaire study aimed to investigate whether and how age, gender, and communication difficulties at the child level and parenting behaviors at the family level are associated with externalizing and internalizing problems among children with ASD (n = 206) and without ASD (n = 187) aged 6–12 years. Results indicated that pragmatic language difficulties of the child and negative controlling parenting behaviors both made a significant and unique contribution to externalizing behavior problems for the ASD group. In the control group, chronological age and pragmatic language difficulties were the most robust concurrent predictors of externalizing problems. With regard to internalizing problems, pragmatic language difficulties and ASD adapted parenting behaviors were significant predictors for both the ASD and control group.     

Prevalence and predictors of posttraumatic stress disorder,anxiety, depression,and burnout in Pakistani earthquake recovery workers

Past research has shown a substantial prevalence of emotional disorders in professionals involved in rescue and/or relief operations following natural disasters, including earthquakes. However, no published study to date has investigated whether disaster rehabilitation and reconstruction workers involved in later phases of the earthquake response are also affected by emotional problems. A nearly complete sample of earthquake rehabilitation and reconstruction workers (N = 267) involved in the response to the 2005 earthquake in Northern Pakistan filled in a set of self-report questionnaires assessing emotional problems and predictor variables approximately 24 months after the earthquake. Most participants had experienced the disaster themselves and suffered from a number of stressors during and shortly after the acute earthquake phase. A substantial subgroup of participants reported clinically relevant levels of emotional disorders, especially earthquake-related posttraumatic stress disorder (42.6%), as well as depression and anxiety (approx. 20%). Levels of burnout were low. Symptom levels of posttraumatic stress disorder were associated with the severity of the earthquake experience, past traumas, work-related stressors, low social support, and female gender. The results document a high prevalence of emotional problems in earthquake rehabilitation and recovery workers.     

Enacted stigma among patients with epilepsy and intellectual impairment

BackgroundThe limited research on stigma and its determinants in patients with epilepsy and intellectual impairment motivated our study in this area.PurposeWe assessed enacted stigma and its determining factors in Bulgarian patients with refractory epilepsy and intellectual impairment.MethodsWe conducted a study of 64 patients with refractory epilepsy and intellectual impairment based on a questionnaire designed for people with intellectual impairment (stigma scale) and a purposeful interview on clinical factors and real experiences of discrimination, insults and/or threats, and attacks.ResultsA real experience of discrimination was reported by 51 (91.07%) of the interviewed participants, 34 (60.71%) of whom had been insulted and/or threatened and attacked because of their health problems. The experience of insults and/or threats and attacks was more frequent in cases with moderate intellectual impairment (χ² = 5.17, P < 0.05). Discrimination was reported more rarely by older patients (F = 3.23, P < 0.05). The participants who gave a greater number of positive answers about experienced discrimination or insults and/or threats and attacks reported a more pronounced perceived stigma (F = 19.30, P < 0.001 and F = 12.91, P < 0.001, respectively). Perceived stigma and the experience of insults and/or threats and attacks proved to be predictors of discrimination on multivariate regression analysis (F = 40.54, P < 0.001).ConclusionsWe have affirmed very frequent enacted stigmatization in Bulgarian patients with refractory epilepsy and intellectual impairment and its correlation with the degree of intellectual impairment, age, and perceived stigma.     

Autistic traits in the general population: What mediates the link with depressive and anxious symptomatology?

The high prevalence of anxiety disorders and depression within the autism spectrum disorder (ASD) population is widely recognised. This study examined the role of three potential mediating variables in the relationship between autistic traits and depressive/anxious symptomatology in the general population. Participants included 231 university students (114 males, 117 females) ranging in age from 17 to 35 (M = 18.9, SD = 2.77). Participants completed five standardised questionnaires which measured: autistic traits, depressive/anxious symptomatology, social competence, social problem-solving ability, and teasing history. Two multiple mediation analyses were conducted using the bootstrapping method. Results revealed that social problem-solving ability and past teasing experiences were significant partial mediators in the relationship between autistic traits and depressive symptoms. However, contrary to expectations, social competence was not a significant mediator in the relationship between autistic traits and depressive symptoms. In addition, social problem-solving ability and past teasing experiences were significant partial mediators in the relationship between autistic traits and anxiety symptoms. This suggests that interventions to reduce anxious and depressive symptomatology in the ASD population should focus upon improving social problem-solving ability and reducing bullying experiences at school. These initial findings should be confirmed in the ASD population in future research.