The role of emotional functioning in military-related PTSD and its treatment

This two-part study investigated the cross-sectional and across-treatment relationships among measures of emotional functioning and posttraumatic stress disorder (PTSD) symptomatology for veterans receiving specialized treatment for military-related PTSD. Cross-sectional analyses revealed overlap among emotion regulation, affective control, depressive symptoms, and PTSD symptoms at pre-treatment. In regression analyses, fear of losing affective control was most predictive of PTSD symptoms. Bivariate analyses of residualized change scores showed that changes in emotion regulation and fear of losing affective control were associated with changes in PTSD and depressive symptoms across treatment. Regression analyses revealed that changes in fear of losing affective control most strongly predicted changes in PTSD and depressive symptoms. Theoretical and clinical implications are discussed, including an understanding of the differences between emotion regulation and affective control processes. Future research directions are offered, including improved measurement of emotional functioning and longitudinal research delineating the likely bi-directional relationship between emotional functioning and PTSD.     

Trauma and bereavement: examining the impact of sudden and violent deaths

The intersection between trauma and bereavement has only recently been explored. Prior studies of bereavement have often neglected to measure posttraumatic stress disorder (PTSD) symptoms; the few that have offer equivocal findings concerning the role of PTSD symptomatology following loss. Few studies have explored the relationship between PTSD and the other psychological sequelae more commonly associated with loss. The current investigation assessed PTSD symptoms over time following the death of a spouse, using violence and the suddenness of the loss as potential outcome predictors. In addition, the relationship between PTSD and depression symptoms was assessed. Violent death predicted PTSD symptoms and the persistence of depression over time. The suddenness of the loss was not related to PTSD symptoms. This investigation suggests that violent death results in development of PTSD symptoms over and above the normal grief response and thus, may contribute to a more severe grief response.     

IQ and Posttraumatic Stress Symptoms in Children Exposed to Interpersonal Violence

Background: The literature is mixed as to the relationship between intelligence quotient (IQ) and Posttraumatic Stress Disorder (PTSD) symptomatology in adult populations. Even less is known about the relationship in children who have been traumatized. Methods: Fifty-nine children and adolescents (mean age = 10.6) with a history of interpersonal violence were evaluated with respect to PTSD symptomatology, number of traumas, and estimated Verbal, Performance and Full scale IQ scores. PTSD symptomatology included symptom levels for cluster B (re-experiencing), cluster C (avoidance and numbing), and cluster D (Hypervigilance) and criterion F, functional impairment. Results: Results indicated that Full scale and Verbal IQ were significantly associated with the number of traumas, re-experiencing symptoms, and impairment. Performance IQ was only associated with impairment. Regression analyses suggested that together PTSD symptomatology predicted Full scale and Verbal IQ but nor Performance IQ and impairment was the single best predictor of IQ generally. Conclusions: Findings provide support for an association between PTSD symptoms and IQ, particularly verbal IQ. Two possible reasons for this relationship are that higher levels of Verbal IQ may serve as a premorbid protective factor against the development of re-experiencing symptoms, or performance on post-trauma Verbal IQ measures may be negatively impacted by expression of PTSD symptoms. Longitudinal studies are needed to clarify which of these two possibilities explains the association     

Prevalence and predictors of post-traumatic stress disorder (PTSD) in physically injured victims of non-domestic violence

BACKGROUND: Victims of violent assault experience diverse post-event emotional problems such as post-traumatic stress disorder (PTSD), and they may have multiple emotional problems. The aim of the present study was to evaluate the prevalence and predictors of PTSD in a longitudinal design. METHODS: The levels of physical injury, perceived life threat, prior experience of violence, peritraumatic dissociation (PD), acute PTSD, perceived self-efficacy and perceived social support are considered possible predictors. This study had a single group (N = 70), longitudinal design with three repeated measures over a period of 12 months. Questionnaires used were: Impact of Event Scale-15 and 22 (IES-15 and 22), Post-Traumatic Symptom Scale-10 (PTSS-10), Peritraumatic Dissociation (PD) 7-item self-report measure, Social Provisions Scale (SPS) and Generalized Self-Efficacy scale (GSE). RESULTS: Results showed a high prevalence and severity of PTSD on all outcomes, for instance 31% scored as probable PTSD-cases and 14% as risk level cases by IES-15 at T3. Either injury severity or prior experience of being a victim of violence predicted PTSD in this study. Early PTSD predicted subsequent PTSD, and perceived life threat was a predictor of PD. Furthermore, lack of perceived social support was a predictor of PTSD symptoms at T3. In addition, low perceived self-efficacy was a predictor of PTSD and influenced perceived social support at T1. CONCLUSIONS: Our results showed that experience of non-domestic violence may cause serious chronic emotional problems, and therefore it is important to be aware of early symptoms indicating needs for special follow-ups.     

Verbal learning and memory impairments in posttraumatic stress disorder: The role of encoding strategies

The present study examined mechanisms underlying verbal memory impairments in patients with posttraumatic stress disorder (PTSD). Earlier studies have reported that the verbal learning and memory alterations in PTSD are related to impaired encoding, but the use of encoding and organizational strategies in patients with PTSD has not been fully explored. This study examined organizational strategies in 21 refugees/immigrants exposed to war and political violence who fulfilled DSM-IV criteria for chronic PTSD compared with a control sample of 21 refugees/immigrants with similar exposure, but without PTSD. The California Verbal Learning Test was administered to examine differences in organizational strategies and memory. The semantic clustering score was slightly reduced in both groups, but the serial cluster score was significantly impaired in the PTSD group and they also reported more items from the recency region of the list. In addition, intrusive errors were significantly increased in the PTSD group. The data support an assumption of changed memory strategies in patients with PTSD associated with a specific impairment in executive control. However, memory impairment and the use of ineffective learning strategies may not be related to PTSD symptomatology only, but also to self-reported symptoms of depression and general distress.     

Trauma exposure, resilience, social support, and PTSD construct validity among former prisoners of war

  Background: The aim of this study was to investigate predictors of persistent symptoms of posttraumatic stress disorder (PTSD) and to examine the construct validity of PTSD in a national sample of 270 World War II and Korean Conflict prisoners of war (POWs). Method: POWs were interviewed at two points in time (1965 and 1990). Predictors included PTSD symptomatology measured in 1965 by items from the Cornell Medical Index (CMI), severity of captivity trauma, resilience factors, and post-trauma social support. The criterion, symptomatology in the early 1990s, was evaluated with the PTSD module of the Structured Clinical Interview for DSM (SCID). Results: The CMI provided only partial coverage of PTSD criteria and appeared to provide only a general index of distress. Clustering of SCID items in two-dimensional space via multidimensional scaling analysis offers some construct validation for the DSM's differentiation of PTSD symptoms into criterion groups, although there was not a perfect match. Trauma severity is best related to PTSD symptomatology experienced in 1990, mitigated in part by greater education level and age at the time of trauma exposure. Surprisingly, 1965 distress added only a modest amount to the prediction of current distress, while post-trauma social support added none. Conclusions: These findings support previous work showing the severe psychological sequelae of POW status 40–50 years after captivity, and indicate that trauma severity during captivity is the best predictor of current PTSD symptomatology. Results also add to our understanding of the conceptual differentiation of PTSD symptoms into separate and distinct symptom clusters. Accepted: 25 August 1999     

A closer look at the relationship between the subdomains of social functioning,social cognition and symptomatology in clinically stable patients with schizophrenia

Impairments in social functioning commonly seen in schizophrenia are thought to be mediated by deficits in the domains of social cognition. Some previous research has explored how social cognitive skills and psychotic symptoms are associated with social functioning, however these associations are still under debate. The main aim of this study was to investigate the relationship between different domains of social cognition and psychotic symptomatology, and also to look at the relationships with individual subdomains of social functioning within a clinically stable schizophrenia population. 45 outpatients were recruited and symptoms were assessed with the PANSS, and measures of emotion processing, affective and cognitive theory of mind (ToM), mental state reasoning attributional biases, and social functioning were taken. A correlational analysis was performed with the data. Following this, a regression analysis was used to reveal which domains of social cognition best predicted psychotic symptoms. In this stable group of patients, our results support the suggestion of a likely distinction between affective and cognitive components of ToM. The study also demonstrated that ToM and mental state reasoning were the best predictors of psychotic symptoms. Here we reveal that cognitive ToM had the most widespread relationship with social functioning, across multiple subdomains, while only some specific subdomains of social functioning correlated with other domains of social cognition and symptomatology. Further to this, positive symptoms were associated with much fewer subdomains of social functioning than negative and general symptoms. These findings imply that different aspects of social functioning may be served by different domains of social cognition and symptomatology.     

Normalization of violence among inner-city youth: a formulation for research

A causal model is formulated for the thesis that in inner-city youth exposed to high levels of violence, cognitions that normalize violence mitigate affective effects of exposure while increasing risk for violent behavior, thus perpetuating violence in the very process of adapting to it psychologically. Gender differences in the cognitive normalization of violence may explain gender differences in affective and behavioral effects of exposure. Empirical studies are needed to directly test this model.     

Cognitive functioning in young people with first episode psychosis: relationship to diagnosis and clinical characteristics

OBJECTIVE: To examine the extent and nature of neuropsychological deficits in adolescents and young people with first episode psychosis (FEP), and to determine whether the pattern and extent of neuropsychological deficits varied according to diagnosis. METHOD: A total of 83 FEP subjects aged 13-25 years, and 31 healthy controls completed a comprehensive battery of neuropsychological tests, grouped into 10 cognitive domains. First episode psychosis subjects were stratified into three diagnostic groups (schizophrenia, affective disorders, substance-induced psychosis) and differences in cognitive profiles were examined. The contribution of demographic and clinical characteristics to cognitive performance was also explored. RESULTS: The schizophrenia group demonstrated significantly worse performance on tasks of verbal learning and memory than the affective disorders group. Compared to healthy controls, the schizophrenia group also demonstrated global impairment across the majority of cognitive domains. The substance-induced group's performance lay between that of the schizophrenia and affective disorders groups. Analyses of differential deficits revealed that verbal learning, verbal memory and current intellectual functioning were selectively impaired in the schizophrenia group, whereas the affective disorders group demonstrated a selective deficit in speeded processing. Premorbid intellectual functioning, negative symptomatology and medication levels were the strongest predictors of cognitive performance in FEP subjects. CONCLUSIONS: Verbal memory deficits differentiate individuals with schizophrenia from those with psychotic affective disorders. Although significant cognitive deficits are evident across all diagnostic FEP groups, individuals with schizophrenia appear to have more generalized impairment across a broad array of cognitive functions than other psychotic diagnoses. Lower premorbid intellectual functioning does not appear to contribute to greater cognitive deterioration following onset of psychosis, but severity of illness may be a more important factor than levels of mood disturbance.     

Prediction of social skill acquisition in schizophrenic and major affective disorder patients from memory and symptomatology

Memory and symptomatology were examined as predictors of social skill acquisition in psychiatric inpatients participating in a social skills training program. Poor memory was related to pretreatment social skill impairments and slower rates of skill improvement during the intervention for patients with schizophrenia or schizoaffective disorder, but not affective disorder. Symptomatology was not consistently related to pretreatment social skill or changes in skill for either schizophrenic or affective disorder patients. The results suggest that cognitive deficits in schizophrenia are associated with impairments in social skill and that such deficits may limit the rate of skill acquisition and clinical response to social skills training interventions.     

Verbal memory, negative symptomatology and prediction of psychosocial functioning in schizophrenia

Negative symptomatology and neurocognitive variables have been considered good predictors of functional outcome in schizophrenia. Specifically, secondary verbal memory has been proposed to be one of the main predictors of psychosocial functioning. In this study, negative symptoms and memory performance were analyzed for associations with psychosocial function. Linear regression methods were used to analyze the value of verbal memory and negative symptomatology as predictors of everyday life skills in a sample of 29 DSM-IV schizophrenia outpatients with predominant negative symptoms. We also took into account the role of gender in the analyses. Secondary verbal memory was found to explain 40% of the variance in psychosocial functioning, independently of gender, whereas the negative symptoms predicted 26%. When both variables were combined, the explained variance was about 49%. These results support the hypothesis that cognitive variables are better predictors than symptomatology. Finally, secondary verbal memory is a good predictor of psychosocial functioning in chronic schizophrenia with predominant negative symptomatology.     

Predicting treatment outcome on three measures for post-traumatic stress disorder

The aim of the present study was to investigate predictors of treatment outcome for Post-traumatic Stress Disorder (PTSD) after treatment completion and at 15-months follow-up (n = 48), in a trial of Eye Movement Desensitisation and Reprocessing (EMDR) versus Imaginal Exposure and Cognitive Restructuring (E+CR). Factors associated with treatment outcome were investigated using regression analyses with the mean change scores in three assessor and self-rated PTSD symptomatology measures, including the Clinician-Administered PTSD Scale (CAPS), the Impact of Events Scale (IES) and the PTSD Symptom Checklist (PCL) from pre- to post-treatment and pre-treatment to follow-up as the dependent variables and demographics, trauma, clinical and personality measures as independent variables. Irrespective to outcome measures and assessment points it was found that four variables were able to predict significantly treatment outcome. These included baseline PTSD symptomatology, number of sessions, gender and therapy type. Overall, our results showed that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome, as significant predictors were found to be sample-specific and outcome measure-specific. Clinical relevance of the present results and directions for future research are discussed.     

Risk indicators for post-traumatic stress disorder in adolescents exposed to the 5.12 Wenchuan earthquake in China

In Chinese adolescents exposed to the Wenchuan earthquake, we used the Children's Revised Impact of Event Scale (CRIES) as the screening tool, and Post-traumatic Cognitions Inventory (PTCI) and the Social Support Rating Scale (SSRS) were used to assess the cognitive status and their social supports, to evaluate the prevalence and the predictors variables of post-traumatic stress disorder (PTSD) after the Wenchuan earthquake in China, which occurred on 12 May 2008. Subjects with a CRIES score greater than 30 were interviewed and assessed using the DSM-IV criteria for PTSD diagnosis by a trained psychiatrist with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Lifetime version (Kiddie-SADS-L). We found the overall prevalence of PTSD was 2.5% in 3208 adolescents from the surrounding areas of the epicentre 6 months after the earthquake. Risk factors for post-traumatic stress symptoms are as follows: being female, being buried/injured during the earthquake, having parents who were severely injured, having classmate(s) who died, having a house destroyed, and witnessing someone buried/wounded/dying during the earthquake. Individuals with better social support had significantly lower scores on the CRIES. There were significant differences in cognitive style between individuals at low risk for PTSD (CRIES < 30) and those at high risk for PTSD (CRIES ≥ 30). Post-traumatic cognition emerged as an important factor that was associated with PTSD reactions in children. Social support can lessen the impact of a natural disaster by affecting post-traumatic cognition.     

Measuring victim empathy among mentally disordered offenders: Validating VERA-2

There are very few, if any, valid and victim-specific situation empathy measures available at present for use with mentally disordered offenders. The aim of this study was to validate a modified version (VERA-2) of the Victim Empathy Response Assessment (VERA) tool which was developed earlier (Young et al., 2008) to enable victim-specific situation empathy measurement in offenders. A total of 55 mentally disordered in-patients residing in a maximum security hospital were assessed on VERA-2 as well as on measures of antisocial personality traits, global affective empathy, violent cognitions, and reported remorse for the index offence. The VERA-2 cognitive and affective empathy scales were negatively correlated with antisocial personality traits and violent cognitions, and positively related to remorse for the index offence. Global affective empathy was positively related to VERA-2 affective empathy. Participants with a history of sexual offending had significantly higher cognitive empathy than other offenders. Acceptance of violence and remorse for the index offence were the best predictors of both cognitive and affective empathy. The findings suggest that the VERA-2 is a valid instrument for measuring victim empathy among mentally disordered offenders, and may prove useful in the context of future risk assessment and outcomes in this population.     

The adjustment of children of Australian Vietnam veterans: is there evidence for the transgenerational transmission of the effects of war-related trauma?

OBJECTIVE: The presence of posttraumatic stress disorder (PTSD) in trauma survivors has been linked with family dysfunction and symptoms in their children, including lower self-esteem, higher disorder rates and symptoms resembling those of the traumatized parent. This study aims to examine the phenomenon of intergenerational transfer of PTSD in an Australian context. METHOD: 50 children (aged 16-30) of 50 male Vietnam veterans, subgrouped according to their fathers' PTSD status, were compared with an age-matched group of 33 civilian peers. Participants completed questionnaires with measures of self-esteem, PTSD symptomatology and family functioning. RESULTS: Contrary to expectations, no significant differences were found between the self-esteem and PTSD symptomatology scores for any offspring groups. Unhealthy family functioning is the area in which the effect of the veteran's PTSD appears to manifest itself, particularly the inability of the family both to experience appropriate emotional responses and to solve problems effectively within and outside the family unit. CONCLUSION: Methodological refinements and further focus on the role of wives/mothers in buffering the impact of veterans' PTSD symptomatology on their children are indicated. Further effort to support families of Veterans with PTSD is also indicated.     

Diagnostische und klinische Aspekte der komplexen posttraumatischen Belastungsstörung

The symptomatology of patients suffering in the aftermath of severe and prolonged traumatization is not entirely covered by the diagnostic criteria of post-traumatic stress disorder (PTSD). Consequently, the concept of complex PTSD was proposed, including symptoms of affective dysregulation, dissociation and somatization, alterations in self-perception, altered relationships with others, and altered systems of meaning. Thereby, a variety of symptoms usually classified as co-morbid disorders are combined in a single etiological model.The whole symptomatology is considered as more or less effective adaptation strategies and not primarily as deficits. This understand-ing of the underlying etiology in subjects with complex traumatization opens perspectives for new psychotherapeutic treatment strategies which have already shown effectiveness in daily practice.     

Towards a psychopathology specific to Substance Use Disorder: Should emotional responses to life events be included?

IntroductionThe severity of emotional responses to life events (PTSD spectrum) as part of Post Traumatic Stress Disorder (PTSD) in Substance Use Disorder (SUD) patients has often been considered from a unitary perspective. Light has also been shed on the possible definition of a specific psychopathology of SUD patients. This psychopathology has been proved to be independent of treatment choice, of being active in using substances, of lifetime psychiatric comorbidity and primary substance of abuse (heroin, alcohol, cocaine).MethodsTo further support this unitary perspective, in this study we have compared the severity and typology of the five psychopathological dimensions found in SUD patients, by dividing 93 HUD patients (77.4% males and 22.6% females), characterized by the lifetime absence of exposure to actual or threatened death, serious injury, or sexual violence, on the basis of the severity of their PTSD spectrum. We used the cut-off that differentiated people developing (High PTSD spectrum; H-PTSD/S) or not developing (Low PTSD spectrum; L-PTSD/S) a PTSD after the earthquake that hit L'Aquila, Italy, in April 2009.ResultsUsing a canonical correlation analysis, the significant (p < 0.001) canonical variate set-one (psychopathology) is saturated negatively by “panic anxiety” and positively by the “worthlessness-being trapped” and “violence-suicide” dimensions. Set-two (PTSD spectrum) is saturated negatively by “emotional, physical and cognitive responses to loss and traumas”, and positively by “grief reactions”, “re-experiencing numbing”, “arousal symptoms” and “personality traits”. When comparing the two groups, all five psychopathological dimensions were significantly more severe in H-PTSD/S patients, who were distinguished by higher values of worthlessness-being trapped, sensitivity-psychoticism and violence-suicide symptomatology. No differences were observed regarding the typology of psychopathology.ConclusionsThis study further supports the SUD-PTSD spectrum unitary perspective and argues in favor of the inclusion of the PTSD spectrum in the psychopathology of SUD.     

Impact of traumatic and violent victimization experiences in individuals with schizophrenia and schizoaffective disorder

Individuals with schizophrenia or schizoaffective disorder (SZ) experience more violent victimization and noninterpersonal traumatic experiences than the general population. Earlier studies, however, have generally excluded one or grouped together victimization and trauma experiences into single outcome variables, which may obscure their contributory role to SZ symptoms. This issue is important because there is some evidence that intentionally induced violence produces higher rates of psychopathology than nonintentional traumatic experiences. We examined the independent contribution of both types of victimization experiences on SZ patients' symptomatology. We were also interested in determining whether SZ patients' pattern of acute symptom presentation could discriminate between SZ patients with and without posttraumatic stress disorder (PTSD) comorbidity. SZ inpatients (n = 70) were assessed for the presence of comorbid PTSD diagnosis, violent victimization, and noninterpersonal traumatic experiences. Patients were also rated on SZ symptom severity and general psychopathology measures. Past violent victimization experiences predicted severity of dysphoria and anxiety in SZ. Past traumatic experiences, however, predicted severity of psychosis. Victimization predicted severity of patients' autistic/cognitive symptoms. SZ patients with comorbid PTSD presented with significantly more anxiety and dysphoria symptoms and SZ illness chronicity than their non-PTSD counterparts. Discriminant function analysis revealed that the severity of positive, dysphoric, autistic/cognitive, and anxiety symptoms differentiated comorbid PTSD patients from their non-PTSD counterparts, with an overall 72.9% classification rate. Past traumatic and victimization experiences are significantly associated with SZ patients' symptom severity and illness course in partially overlapping domains. Use of common assessment strategies may be employed to increase detection of PTSD in SZ patients presenting for acute treatment.     

Schizotypy and patterns of lateral asymmetry on hemisphere-specific language tasks.

Following the notion that abnormalities of hemispheric asymmetry may underlie schizophrenia, patterns of cognitive hemispheric asymmetries, as assessed by left and right hemisphere language tasks, were examined in relation to schizotypal symptoms. Ninety right-handed undergraduates completed the Oxford-Liverpool Inventory of Feelings and Experiences questionnaire (O-LIFE; Mason, O., Claridge, G., Jackson, M., 1995. New scales for the assessment of schizotypy. Personality and Individual Differences, Vol. 53, pp. 727-730), which measures different aspects of schizotypy symptomatology. Low scores on right, but not left, hemisphere language tasks were significant predictors of high scores on positive schizotypal symptomatology scales (Unusual Experiences and the STA) over and above the contributions of the left hemisphere language tasks and demographic variables. Low scores on both left and right hemisphere language tasks were significant predictors of high scores on the Cognitive Disorganisation factor, over and above the contributions of tasks related to the contralateral hemisphere and demographic variables. Neither the right nor the left hemisphere language tasks resulted in a significantly good degree of prediction of introvertive anhedonia (an index of negative schizotypal symptomatology) or impulsive non-conformity. The findings provide partial support for some current theories of hemispheric differences in schizophrenia and schizotypy.     

Cognitive and Emotional Deficits in Chronic Alcoholics: a Role for the Cerebellum?

It is now widely accepted that in addition to motor coordination, the cerebellum is also involved in the modulation of cognitive and affective processes. Despite alcoholic cerebellar degeneration (ACD) being the most common form of cerebellar disorder, little systematic investigation of cerebellar-mediated cognitive and affective deficits has occurred in chronic alcoholics. Forty-nine chronic alcoholics and 29 healthy control participants underwent testing of cognitive and affective function, along with measurement of cerebellar ataxia using the International Cooperative Ataxia Rating Scale (Trouillas et al., Journal of the Neurological Sciences 145:205–11, 1997). The alcoholic group demonstrated significantly poorer performance as compared to the control group in a number of domains, including visuospatial and language skills, psychomotor speed, new learning and memory, executive functioning, and emotional regulation and affect processing. There were no differences between the alcoholic and control groups in immediate attention and working memory abilities. Years of heavy drinking and total period of abstinence were found to be the best predictors of cognitive and emotional function in the alcoholic group. After accounting for alcohol chronicity, there was still a relationship between the degree of clinical signs of ACD and some areas of cognitive and emotional functioning, including language, executive functioning, processing speed and affect processing. The results suggest that some of the cognitive and affective deficits observed in chronic alcoholics may be mediated, at least in part, by cerebellar dysfunction. These findings add support to the theory of disruption to bidirectional cerebro-cerebellar circuitry underlying cognitive and affective deficits in chronic alcoholics.