Anger,aggression, and self‐harm in PTSD and complex PTSD

This study examined the contribution of complex posttraumatic stress disorder (PTSD) diagnosis and symptomatology to the difficulties of anger, aggression, and self‐harm in a Northern Ireland clinical community sample. A “current complex PTSD” (CCPTSD) group (n=11) was compared with a “current PTSD” group (n=31) on self‐report measures of these variables. The CCPTSD group demonstrated significantly higher levels of physical aggression and self‐harm than the PTSD group. The complex PTSD symptom of ‘alterations in self‐perception’ was a significant predictor of aggression and history of self‐harm, suggesting the potential role of posttraumatic shame and self‐loathing in PTSD theoretical models of these destructive behaviors. Social desirability was a notable confounding influence in the assessment of anger, aggression, and self‐harm in traumatised individuals. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1–16, 2009.     

Emotional reactivity and regulation in individuals with psychopathic traits: Evidence for a disconnect between neurophysiology and self‐report

Individuals with psychopathic traits often demonstrate blunted reactivity to negative emotional stimuli. However, it is not yet clear whether these individuals also have difficulty regulating their emotional responses to negative stimuli. To address this question, participants with varying levels of psychopathic traits (indexed by the Triarchic Measure of Psychopathy; Patrick, 2010) completed a task in which they passively viewed, increased, or decreased their emotions to negative picture stimuli while electrocortical activity was recorded. During passive viewing of negative images, higher boldness, but not higher disinhibition or meanness, was associated with reduced amplitude of the late positive potential (LPP), an ERP that indexes reactivity to emotionally relevant stimuli. However, all participants demonstrated expected enhancement of the LPP when asked to increase their emotional response. Participants did not show expected suppression of the LPP when asked to decrease their emotional response. Contrary to the electrophysiological data, individuals with higher boldness did not self‐report experiencing blunted emotional response during passive viewing trials, and they reported experiencing greater emotional reactivity relative to other participants when regulating (e.g., both increasing and decreasing) their emotions. Results suggest inconsistency between physiological and self‐report indices of emotion among high‐bold individuals during both affective processing and regulation.     

Trends in self‐reported sleep problems,tiredness and related school performance among Finnish adolescents from 1984 to 2011

The aim of this study was to investigate long‐term trends in insomnia symptoms, tiredness and school performance among Finnish adolescents. A time–series from 1984 to 2011 was analysed from two large‐scale survey studies, the Finnish School Health Promotion Study and the Health Behavior in School‐Aged Children study. A total of 1 136 583 adolescents aged 11–18 years answered a standardized questionnaire assessing frequency of insomnia symptoms, tiredness and school performance. A clear approximately twofold increasing trend in insomnia symptoms and tiredness was found from the mid‐1990s to the end of the 2000s. The increase was evident in all participating age groups and in both genders. After 2008, the increase seems to have stopped. Insomnia symptoms and tiredness were associated with lower school performance and they were more prevalent among girls (11.9 and 18.4%) compared to boys (6.9 and 9.0%, respectively). Unexpectedly, we also observed an increasingly widening gap in school performance between normally vigilant and chronically tired pupils. The underlying causes of these phenomena are unknown, but may concern changes in the broader society. The observed recent increasing trend in adolescents’ sleep problems is worrisome: poor sleep quality has also been suggested to associate with clinical or subclinical mood or anxiety disorders and behavioural problems and predispose to sleep and psychiatric disorders later in life. Our results justify further studies and call for serious attention to be paid to adolescent's sleep in the Finnish educational system and society at large.     

Associations between objectively measured and self‐reported sleep with academic and cognitive performance in adolescents: DADOS study

Adequate sleep has been positively related with health and school achievement outcomes during adolescence. The aim of this study was to investigate the associations of objectively measured and self‐reported sleep duration and quality with academic and cognitive performance in adolescents. This study was conducted with 257 adolescents (13.9 ± 0.3 years) from the DADOS study (Deporte, ADOlescencia y Salud). Objectively measured and self‐reported sleep duration and quality were obtained by a wrist‐worn GENEActiv accelerometer and the Spanish version of Pittsburgh Sleep Quality Index questionnaire, respectively. Academic performance was analysed through school records using four indicators: math, language, science and grade point average score. Cognitive performance was measured using the Spanish version of the “SRA Test of Educational Ability”. After Benjamini–Hochberg correction for the false discovery rate, objectively measured sleep duration was negatively associated with verbal ability (β = ?0.179, p = .004), whilst self‐reported sleep quality was positively associated with academic performance (β ranging from 0.209 to 0.273; all p < .001). These associations remained significant after further controlling for physical fitness and physical activity. Conversely, there were no associations between self‐reported sleep duration and objective sleep quality with academic and cognitive performance. Our findings fit in line with previous research showing that sleep quality may play an important role on adolescents’ academic performance. Further interventional research is needed to clarify the mechanisms by which sleep is related to academic performance in youth.     

A prospective study of diurnal cortisol responses to the social experience of school transition in four-year-old children: anticipation, exposure, and adaptation

This study examined psychosocial influences on hypothalamic-pituitary-adrenal axis activity in 105 4-year-old children transitioning to primary school. Measuring before, during, and after school transition over a period of up to 12 months, salivary cortisol was assessed on awakening and early evening. Parents reported child temperament and teachers recorded adaptive behavior. Whilst cortisol at awakening and early evening increased from baseline to school transition, effects were not significant. A significant decrease occurred between transition and follow-up and from baseline to follow-up for both awakening and evening cortisol. Poorer effortful control was associated with high morning and steeper diurnal slope of cortisol at transition whilst surgency/extroversion was associated individually with greater morning and evening cortisol at transition and adaptation. Greater increase in internalizing social isolation during the first 6 months of school in more surgent/extrovert children predicted higher morning and evening cortisol at follow-up. This study is the first to explore these adaptive relationships over a 12-month period and supports social isolation over time as a key element in developmental endocrine activation.     

Brief Reports: Further evidence for an association between self‐reported health and cardiovascular as well as cortisol reactions to acute psychological stress

In a recent study, the association between cardiovascular reactions to acute psychological stress and self‐reported health was examined. Participants with excellent or good self‐reported health exhibited higher cardiovascular reactivity than those who reported fair or poor health. We investigated this association in a population‐based cohort of whom 725 men and women, aged 55–60 years, participated in a standardized psychological stress test. We measured continuous blood pressure and heart rate as well as cortisol reactivity. Good subjective health was associated with higher cardiovascular and cortisol reactions to psychological stress. Results of the present study confirm those of the previously reported study showing that greater cardiovascular reactivity may not always be associated with negative health outcomes. In addition, the same holds for cortisol reactivity.     

Derealization and self‐harm strategies are used to regulate disgust,fear, and sadness in adult survivors of childhood sexual abuse

Emotion regulation (ER) difficulties have been identified as an important target for clinical intervention in the treatment of post‐traumatic stress disorder (PTSD) symptoms in survivors of childhood sexual abuse (CSA). However, there is limited research regarding the use of specific strategies to regulate specific emotions following exposure to traumatic events. The aim of the current study was to investigate the indirect effects of four trauma‐related emotions (anger, sadness, disgust, and fear) on PTSD severity via two mediators: derealization and self‐harm. In particular, we tested that if the two hypothetical mediators operate sequentially, derealization precedes self‐harm and/or self‐harm precedes derealization. A predominate female clinical sample (N = 109) of CSA survivors completed measures of experience of emotions, ER, and post‐traumatic stress. Bivariate and serial mediation analyses were conducted to test the direct and indirect effects of trauma‐related emotions on PTSD severity. Serial mediation analyses indicated that there were significant total effects of all trauma‐related emotions on PTSD severity. Three trauma‐related emotions (sadness, disgust, and fear) were indirectly associated to PTSD severity via derealization and self‐harm and via self‐harm and derealization. Results indicate that difficulties in regulating the emotions of sadness, disgust, and fear may result in more severe derealization and self‐harm as coping strategies, which in turn lead to greater PTSD severity. The sequence of mediators does not hold great importance in these pathways. Overall, our findings suggest that therapeutically targeting derealization and self‐harm might enable the reduction of PTSD among CSA survivors.     

Associations between self‐reported sleep measures and dietary behaviours in a large sample of Australian school students (n = 28,010)

This study examined the associations between self‐reported sleep timing and quality, and the frequency of breakfast and junk food consumption in 28,010 Australian school students (mean ± SD age = 13.3 ± 1.2 years, 51% male). After controlling for age, sex and socioeconomic status, regression analyses revealed that the odds of missing breakfast were significantly higher in children who reported poor sleep or later bedtimes, while the odds of junk food consumption were significantly higher in children reporting later weeknight bedtimes (p < 0.001). These findings suggest that sleep timing and quality influence the dietary choices of adolescents.     

Between a rock and a hard place: Associations between Mentzos' “dilemma”, self‐reported interpersonal problems,and psychosocial functioning in individuals with non‐affective psychoses

Primary aim of this study was to determine the extent and type of self‐reported interpersonal problems in patients with non‐affective psychoses and their impact on psychosocial functioning. Furthermore, we aimed to explore potential links with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”, which describes an insufferable inner tension caused by an individual's struggle of being torn between “self‐oriented” and “object‐oriented” tendencies. In a cross‐sectional study among 129 patients with non‐affective psychoses, measures of cognition, symptom load and social functioning as well as a tentative, psychodynamic assessment of Mentzos' “dilemma” were obtained during a clinical research visit. Self‐report data on interpersonal problems were gathered using the Inventory of Interpersonal Problems (IIP‐64D) and compared with a German representative standard sample. Second, IIP‐64D scores were compared between groups with or without Mentzos' “dilemma”. Hierarchical regression analyses were performed to test for the impact of interpersonal problems on psychosocial functioning, while controlling for cognitive deficits and psychopathology. Results showed that IIP‐64D scores differed significantly from healthy controls, except for “self‐centred” and “intrusive” interpersonal styles. Participants with a potential “psychotic dilemma” scored significantly higher on the subscales: “domineering”, “self‐centred”, “cold”, and “socially avoidant” than the group without a “psychotic dilemma”. The total amount of interpersonal problems, and particularly high scores on the IIP‐64D “socially avoidant” subscale, predicted psychosocial dysfunction, whereas a “cold” interpersonal style had an opposite effect. In conclusion, specific interpersonal problems may predict psychotherapeutic outcome measures like psychosocial functioning and are partly compatible with the psychodynamic construct of Stavros Mentzos' “psychotic dilemma”.     

What is the relationship between dissociation and self‐harming behaviour in adolescents?

Deliberate self‐harm in adolescents is an increasing clinical problem, but there is a limited understanding of the mechanisms causing or maintaining this behaviour. One proposed mechanism is that of dissociation. However, the role this mechanism may play is unclear: although some suggest that adolescents engage in self‐harm to end the aversive experience of dissociation, others propose that self‐harm is used to purposefully trigger a dissociative state to avoid emotional pain. This systematic review is the first to evaluate the available evidence regarding the relationship between dissociation and deliberate self‐harm in adolescents (aged 18 or younger). Nineteen relevant studies were identified. These studies were limited by cross‐sectional design and poor methods of measurement, but some important conclusions could be drawn. The majority of studies found a positive correlation between the severity of dissociation and the severity and frequency of deliberate self‐harm in adolescents, and a small number of results suggest that dissociation mediates the relationship between childhood trauma and adolescent self‐harm.     

No association between rs6897932 in the gene encoding interleukin‐7 receptor α and low‐grade inflammation or self‐reported health – results from the Danish Blood Donor Study

The T‐allele in the single nucleotide polymorphism rs6897932 in the gene encoding the IL‐7 receptor α (IL7RA) is associated with reduced risk of autoimmune diseases including multiple sclerosis and also affects the course of HIV infection. Low‐grade inflammation (LGI) and self‐reported, health‐related quality of life (HRQL) are often associated with chronic diseases and widely used in assessing and monitoring health status. The aim of the present study was to evaluate whether the T‐allele in rs6897932 is associated with reduced risk of LGI (hsCRP 3–10 mg/L), history of infectious mononucleosis (IM), and HRQL in healthy individuals. A total of 17, 293 healthy Danish individuals from the Danish Blood Donor Study were included in the analyses. We tested rs6897932 as a predictor of LGI, self‐reported IM, and HRQL in univariable and multivariable models stratified by sex. No associations between rs6897932 and LGI, self‐reported IM or HRQL were found in men or women. This suggests that rs6897932 is not associated with general inflammation, and the reported associations between the T‐allele in rs6897932 with several autoimmune diseases may be mediated through effects on a restricted part of the immune system.