Traumatic Dissociation as a Predictor of Posttraumatic Stress Disorder in South African Female Rape Survivors

Women survivors of rape are at an increased risk for posttraumatic stress disorder (PTSD). Traumatic dissociation has been identified as a precursor of PTSD. This study assessed the predictive potential of traumatic dissociation in PTSD and depression development.The study followed a longitudinal, prospective design. Ninety-seven female rape survivors were recruited from 2 clinics in Cape Town, South Africa. Clinical interviews and symptom status assessments of the participants were completed to measure dissociation, childhood traumas, resilience, depression, and PTSD.Traumatic dissociation was a significant predictor of PTSD and depression. The linear combination of prior dissociation, current dissociation, and resilience significantly explained 20.7% of the variance in PTSD. Dissociation mediated the relationship between resilience and PTSD.As traumatic dissociation significantly predicts PTSD, its early identification and management may reduce the risk of developing PTSD. Interventions focused on promoting resilience may also be successful in reducing the risk of dissociation following rape.     

Somatoform dissociation and traumatic experiences in patients with rheumatoid arthritis and fibromyalgia

OBJECTIVE: Trauma and dissociation tend to be interrelated. The objective of this study was to examine the frequency of traumatic experiences and somatoform dissociation in patients with fibromyalgia syndrome (FMS) or rheumatoid arthritis (RA), two conditions that are both characterized by pain and disability. METHODS: Patients with a diagnosis of FMS (2 male, 26 female; mean age 42 +/- 11 years) or RA (5 male, 46 female; mean age 46 +/- 10 years) completed the Fibromyalgia Impact Questionnaire (FIQ), the Somatoform Dissociation Questionnaire (SDQ), and the Traumatic Experience Checklist (TEC). RESULTS: Patients with FMS reported significantly higher levels of various forms of traumatization and dissociation than patients with RA. In patients with FMS, but not in patients with RA, there was a significant correlation between traumatization and dissociative symptoms. A possible dissociative disorder was indicated in 10% of the patients with FMS and 2% of the patients with RA. CONCLUSION: Traumatization experiences are frequent in FMS, but as compared to conversion disorder or dissociative identity disorder only a small subgroup of patients with FMS or RA shows the combination of traumatization and somatoform dissociation. The observation of somatoform dissociation calls for a broad treatment approach with a special role of the psychologist or psychiatrist.     

Voxel-based analysis of MRI reveals anterior cingulate gray-matter volume reduction in posttraumatic stress disorder due to terrorism

MRI studies using the manual tracing method have shown a smaller-than-normal hippocampal volume in patients with posttraumatic stress disorder (PTSD). However, these studies have yielded inconsistent results, and brain structures other than the hippocampus have not been well investigated. A recently developed, fully automated method called voxel-based morphometry enables an exploration of structural changes throughout the brain by applying statistical parametric mapping to high-resolution MRI. Here we first used this technology in patients with PTSD. Participants were 9 victims of the Tokyo subway sarin attack with PTSD and 16 matched victims of the same traumatic event without PTSD. The voxel-based morphometry showed a significant gray-matter volume reduction in the left anterior cingulate cortex (ACC) in trauma survivors with PTSD compared with those without PTSD. The severity of the disorder was negatively correlated with the gray-matter volume of the left ACC in PTSD subjects. There were no significant differences in other gray-matter regions or any of the white-matter regions between two groups. The present study demonstrates evidence for structural abnormalities of ACC in patients with PTSD. Together with previous functional neuroimaging studies showing a dysfunction of this region, the present findings provide further support for the important role of ACC, which is pivotally involved in attention, emotional regulation, and conditioned fear, in the pathology of PTSD.     

PKCα is genetically linked to memory capacity in healthy subjects and to risk for posttraumatic stress disorder in genocide survivors

Strong memory of a traumatic event is thought to contribute to the development and symptoms of posttraumatic stress disorder (PTSD). Therefore, a genetic predisposition to build strong memories could lead to increased risk for PTSD after a traumatic event. Here we show that genetic variability of the gene encoding PKCα (PRKCA) was associated with memory capacity--including aversive memory--in nontraumatized subjects of European descent. This finding was replicated in an independent sample of nontraumatized subjects, who additionally underwent functional magnetic resonance imaging (fMRI). fMRI analysis revealed PRKCA genotype-dependent brain activation differences during successful encoding of aversive information. Further, the identified genetic variant was also related to traumatic memory and to the risk for PTSD in heavily traumatized survivors of the Rwandan genocide. Our results indicate a role for PKCα in memory and suggest a genetic link between memory and the risk for PTSD.     

Sexual and Physical Assault History and Posttraumatic Stress Disorder in Substance-Dependent Individuals

The authors explored the relationship between sexual and physical assault and posttraumatic stress disorder (PTSD) in individuals seeking treatment for substance use disorders by giving 100 substance-dependent inpatients (50 men, 50 women) a structured interview on traumatic life events and lifetime histories of sexual and physical assault. Sixty-six percent of individuals had a history of sexual or physical assault. Half of the assault victims met DSM-III-R criteria for PTSD, whereas no one in the non-assault group met criteria for PTSD. Type of assault and specific characteristics of victims were significantly associated with psychiatric disorders. Women bad higher rates of sexual assault history, serial assault, and familial assault than men. Individuals who bad experienced childhood assault bad earlier age at onset of substance dependence than those who had not experienced childhood assault. Sexual and physical assault histories and psychopathology should be assessed in all substance-dependent individuals. More accurate and specific treatment planning may improve treatment outcomes.     

Posttraumatic stress disorder in women attending human immunodeficiency virus outpatient clinics

This study examined posttraumatic stress disorder (PTSD) in human immunodeficiency virus (HIV)-positive women seeking medical care. Specifically, we examined traumatic life events, psychiatric treatment, social support, and demographic characteristics in relation to level of PTSD symptoms. We recruited and obtained informed consent from 47 ethnically diverse HIV-positive women from two HIV outpatient clinics in a county medical system. Forty-one of these women provided complete data on measures assessing demographics, traumatic life events, PTSD symptoms, social support, and psychotherapy/medical history. Analysis of the data demonstrated that a high percentage (42%) of the HIV-positive women were likely to meet criteria for full current PTSD, and an additional 22% for partial PTSD. Of the women likely with full PTSD, 59% were not receiving any psychiatric treatment, and of those likely with partial PTSD, 78% were not receiving any psychiatric treatment. Also, women reported having experienced a mean of 12 traumatic life events. As hypothesized, the level of PTSD was significantly related to the number of life events experienced (rs = 0.52, p < 0.001), and to perceived social support from friends (rs = - 0.34, p < 0.02) and family (rs = - 0.29, p < 0.05). Given the high percentages of women who were found to have experienced traumatic life events and high levels of PTSD symptoms, it seems important to assess and treat PTSD in women with HIV/acquired immune deficiency syndrome (AIDS).     

Self-harm and suicidal behavior in women with comorbid PTSD and substance dependence

This study examined the frequency, methods, and correlates of self-harm and suicidal behavior in 65 outpatient women with comorbid posttraumatic stress disorder (PTSD) and substance dependence (SD). Results showed high rates of suicide attempts, self-harm, suicidal ideation, and self-harm ideation for the prior three months. The most common methods were overdosing and cutting/scratching. Both PTSD and SD were perceived as contributing to self-harm and suicidal behavior. Women who had and had not engaged in such behavior differed in SD diagnoses and reasons for staying safe, but not in the number or type of traumatic experiences, age at first trauma, or substance abuse diagnoses.     

Prevalence of Traumatic Events and Symptoms of PTSD Among South Africans Receiving an HIV Test

We studied posttraumatic stress disorder (PTSD) among a community sample of 500 persons seeking an HIV test. The majority of participants (62.2%) indicated that they had experienced at least one index event that qualified for PTSD, even though a small proportion (5%) actually met the diagnostic criteria for the disorder. Of those who reported an index event, 25 (8.04%) met the diagnostic criteria for PTSD while 286 (91.96%) did not. On average about one-third of participants who did not meet the criteria for PTSD endorsed PTSD symptoms whereas more than three quarters of those who met the full criteria did so. No demographic factors were associated with PTSD caseness, except number of traumatic events. These results are discussed in the context of the need to address traumatic events and PTSD among persons who undergo HIV testing.     

Comorbid Substance Abuse and Posttraumatic Stress Disorder

To further explore the complex relationship between posttraumatic stress disorder (PTSD) and substance use disorders, the authors compared 30 women with PTSD in substance abuse treatment with 25 women without PTSD in substance abuse treatment on degree of addiction severity, psychopathology, and aftercare compliance. Women with PTSD were more likely to have been victims of sexual and physical abuse, particularly childhood abuse. They had significantly higher scores on the Addiction Severity Index, were more likely to have comorbid affective disorder, and less likely to comply with aftercare. These results suggest that screening for victimization and PTSD among women presenting for substance abuse treatment may have important prognostic and treatment implications.     

Childhood sexual and physical abuse histories, PTSD, depression, and HIV risk outcomes in women injection drug users: a potential mediating pathway

We explored links between childhood sexual abuse (CSA), childhood physical abuse (CPA), posttraumatic stress disorder (PTSD)/depression, and women injection drug users' (IDUs') risk in 113 women recruited from two syringe exchange sites. More than half (56%) reported CSA, 68% CPA, 23% likely were depressed-only, and 53% likely had PTSD/depression. CSA was associated with sexual (p = 0.003) and drug risk (p = 0.05); CPA was not. CSA was associated with PTSD/depression (p = 0.03); PTSD/depression was associated with sexual (p < 0.01) and drug (p < 0.03) risk. After PTSD/depression adjustment, CSA was no longer associated with sexual or drug risk. These results suggest that women IDUs' CSA-to-risk path is mediated by PTSD/depression.     

Greater Prevalence and Incidence of Dementia in Older Veterans with Posttraumatic Stress Disorder

To explore the association between posttraumatic stress disorder (PTSD) and dementia in older veterans. DESIGN: Administrative database study of individuals seen within one regional division of the Veterans Affairs healthcare network. SETTING: Veterans Integrated Service Network 16. PARTICIPANTS: Veterans aged 65 and older who had a diagnosis of PTSD or who were recipients of a Purple Heart (PH) and a comparison group of the same age with no PTSD diagnosis or PH were divided into four groups: those with PTSD and no PH (PTSD+/PH?, n=3,660), those with PH and no PTSD (PTSD?/PH+, n=1,503), those with PTSD and a PH (PTSD+/PH+, n=153), and those without PTSD or a PH (PTSD?/PH?, n=5,165). MEASUREMENTS: Incidence and prevalence of dementia after controlling for confounding factors in multivariate logistic regression. RESULTS: The PTSD+/PH? group had a significantly higher incidence and prevalence of dementia than the groups without PTSD with or without a PH. The prevalence and incidence of a dementia diagnosis remained two times as high in the PTSD+/PH? group as in the PTSD?/PH+ or PTSD?/PH? group after adjusting for the confounding factors. There were no statistically significant differences between the other groups. CONCLUSION: The incidence and prevalence of dementia is greater in veterans with PTSD. It is unclear whether this is due to a common risk factor underlying PTSD and dementia or to PTSD being a risk factor for dementia. Regardless, this study suggests that veterans with PTSD should be screened more closely for dementia. Because PTSD is so common in veterans, this association has important implications for veteran care.     

The long-term psychological effects of daily sedative interruption on critically ill patients

Critically ill patients often receive sedatives, which may delay liberation from mechanical ventilation and intensive care unit discharge. Daily interruption of sedatives alleviates these problems, but the impact of this practice on long-term psychological outcomes is unknown. We compared psychological outcomes of intensive care unit patients undergoing daily sedative interruption (intervention) with those without this protocol (control). Assessments using (1) the Revised Impact of Event Scale (evaluates signs of posttraumatic stress disorder [PTSD]), (2) the Medical Outcomes Study 36 item short-form health survey, (3) the State-Trait Anxiety Inventory, (4) the Beck Depression Inventory-2, (5) and the Psychosocial Adjustment to Illness score (overall quality of adjustment to current or residual effects of illness) were done by blinded observers. The intervention group had a better total Impact of Events score (11.2 vs. 27.3, p=0.02), a trend toward a lower incidence of PTSD (0% vs. 32%, p=0.06), and a trend toward a better total Psychosocial Adjustment to Illness score (46.8 vs. 54.3, p=0.08). We conclude that daily sedative interruption does not result in adverse psychological outcomes, reduces symptoms of PTSD, and may be associated with reductions in posttraumatic stress disorder.     

Posttraumatic stress disorder among Hispanic and African-American drug users

CONTEXT: Treating high-risk substance abusers who are members of minority groups may require varied protocols depending on differences among minority groups. OBJECTIVES: To explore cocaine abuse (CA)/ dependence with physiological dependence (CDPD) and posttraumatic stress disorder (PTSD) diagnosis differences between out-of-treatment Hispanic and African American adults, in order to identify cultural differences in how experiences and attitudes affect cocaine use behaviors. DESIGN, SETTING, AND PARTICIPANTS: This study uses data collected between February and November 2000, as part of a three-year longitudinal study. A cohort of 347 out-of-treatment, Hispanic and African American cocaine-using adults from the Houston metropolitan area were interviewed to measure differences between cocaine users who are dually diagnosed and those that are not. MAIN OUTCOME MEASURES: Meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria for dual diagnoses of CA/PTSD or CDPD/PTSD. RESULTS: For the dual diagnoses categories, 102 (29%) participants met the requirements for CA/PTSD or CDPD/PTSD. Logistic regression models were used, with CA/PTSD and CDPD/PTSD as the dependent variables. Age, race, gender, and income were used as the independent variables. Results indicate that individuals with higher income have a greater probability of developing CA/PTSD (beta = 0.919, p < 0.05). For both dual diagnoses categories of CA/PTSD and CDPD/ PTSD, results indicate that being female increases the likelihood of developing both of these dual diagnoses, (beta = 2.106, p < 0.05) or (beta = 2.510, p < 0.05). However, being an older female decreases the probability that an individual would develop these dual diagnoses (beta = -2.227, p < 0.05) (beta = -2.577, p < 0.05). CONCLUSIONS: No differences were found for race/ethnicity among the dually diagnosed Hispanics and African Americans, however, gender differences were found. Being female increases an individual's probability of developing a dual diagnosis of CA/PTSD or CDPD/PTSD. In addition to being female, being a young female further increases an individual's probability of being dually diagnosed.     

Clinical and Neuropsychological Predictors of Posttraumatic Stress Disorder

Although acute responses to traumatic stress generally resolve within a few weeks, some individuals experience severe and persistent problems, such as posttraumatic stress disorder (PTSD). While studies have identified a variety of predictors of PTSD, not all data are consistent. This longitudinal study examined the predictive power of neurocognitive deficits with regard to PTSD severity.One hundred thirty one road traffic collision (RTC) survivors were included within 2 weeks of the RTC and followed up 3 and 6 months later to determine severity of PTSD.Impairment on tests of information processing, executive functioning, verbal learning, and motor speed predicted PTSD severity when neuropsychological, clinical, and sociodemographic factors were all taken into account. Clinical variables (initial symptoms, psychiatric diagnoses, disability, trait anxiety, perceived stress, negative cognitions, and sleep) were associated with 3 and 6-month PTSD severity, but only trait anxiety was predictive of PTSD severity. Ethnicity and education were also found to be predictive.These findings suggest implementation of a holistic approach to screening for PTSD and support a need for interventions that target neurocognitive, clinical, and social variables. Early targeted profiling of this group of trauma survivors can inform early clinical interventions and policy.     

Posttraumatic Stress Disorder and One‐Year Outcome in Methadone Maintenance Treatment

Background: Although opiate use may be associated with posttraumatic stress disorder (PTSD), it is not clear whether PTSD is associated with retention in methadone maintenance. Objectives: To evaluate among those receiving methadone maintenance at an urban methadone maintenance clinic the frequency of life‐time traumatic experiences, the predictors and prevalence of current PTSD, and whether PTSD affects retention at 1 year. Methods: Eighty‐nine people participated in the study. The Post Traumatic Diagnostic Scale was used to determine the prevalence of PTSD. The Life Stressor Checklist Revised was used to evaluate trauma history. Logistic regression analyses examined associations between demographic characteristics, substance use, trauma‐related variables, and PTSD. Similar logistic regression analyses were used to examine retention in methadone maintenance at 1 year. Results: The mean number of reported lifetime stressful events was 8.0 (SD = 3.7). Twenty‐seven percent were diagnosed with PTSD. Nearly 92% of those with PTSD had co‐occurring depressive symptoms. Female gender (adjusted odds ratio [AOR][95% CI]; 3.89 [1.07–14.01]), number of traumatic events (AOR [95% CI]; 1.34 [1.13–1.61]), and less education (AOR [95% CI]; 4.13 [1.14–14.98]) were significantly associated with PTSD. Those with a toxicology positive screen were 80% less likely to remaine in methadone maintenance at 1 year (OR [95% CI]; 0.20 [0.07–0.52]). PTSD diagnosis was not significantly associated with treatment retention at 1 year (OR [95% CI]; 0.61 [0.23–1.64]). Conclusions and Scientific Significance: Future studies are needed to determine if treatment of PTSD that is integrated into methadone maintenance programs may impact continued substance abuse use and thereby improve retention in care. (Am J Addict 2012;21:524–530)     

Cortisol production rate in posttraumatic stress disorder

CONTEXT: Several authors have reported the unsuspected finding of low cortisol levels (urinary, salivary, and serum) in patients with posttraumatic stress disorder (PTSD). Objective: Our objective was to assess concentrations of cortisol and its predominant metabolites, cortisol production rate (CPR), and glucocorticoid receptor (GR) binding characteristics in PTSD compared with normal subjects. DESIGN: Matched PTSD patients and control subjects had CPR determined by a stable isotope dilution technique after infusion of deuterated cortisol. Serum cortisol, urinary cortisol, and its metabolites were measured by gas chromatography/mass spectrometry. GR binding capacity (R(o)) and ligand binding affinity (K(d)) were measured in mononuclear leukocytes. SETTING: All subjects were tested during a 40-h admission in an inpatient clinical research center. Patients and Participants: Ten patients with PTSD were matched by age and gender with 10 controls. OUTCOME MEASURES: Statistical comparison was conducted for various measures of cortisol in PTSD patients and normal subjects. Results: No statistical difference was found in mean level or circadian pattern of cortisol secretion using serum or salivary immunoassay detection methods. Although in the normal range, urinary cortisol by immunoassay showed statistically lower values over a 24-h period in PTSD patients compared with controls. This finding was not confirmed by gas chromatography/mass spectrometry determination of cortisol or its metabolites. CPR was not statistically different between these groups. GR also showed no alteration in R(o) or K(d) between the groups. CONCLUSION: The data indicate that PTSD in the chronic and unprovoked state is not characterized by an acute biological stress response.     

Prediction of psychiatric morbidity in severely injured accident victims at one-year follow-up

The objective of this study was to assess the prevalence of posttraumatic stress disorder (PTSD) and symptoms of depression and anxiety in severely injured accident victims 1 yr posttrauma and to predict psychiatric morbidity by means of variables assessed shortly after the accident. The sample consisted of 106 consecutive patients with accidental injuries (mean Injury Severity Score = 21.9, mean Glasgow Coma Scale score = 14.4) admitted to the intensive care unit of a University Hospital. Patients with severe head injuries, suicide attempters, and victims of physical assault were excluded. At 1-yr follow-up, two patients (1.9%) had PTSD, and 13 (12.3%) had subsyndromal PTSD. Eighteen patients (17%) had clinically relevant symptoms of anxiety, and nine (8.5%) were depressed. Overall, 27 patients (25.5%) showed some form of psychiatric morbidity (full or subsyndromal PTSD and/or anxiety and/or depression). Logistic regression analysis, using 1-yr psychiatric morbidity status as the dependent variable, allowed correct classification of 83.8% of patients 12 mo postaccident (specificity 91.8%, sensitivity 61.5%). Biographical risk factors and a sense of death threat contributed significantly to the predictive model. We conclude that a substantial proportion of severely injured accident victims develop some form of psychiatric morbidity that can be predicted to some degree by mainly psychosocial variables.     

Psychiatric co-morbidity in vulnerable populations receiving primary care for HIV/AIDS

Considerable evidence suggests that people with HIV disease are significantly more distressed than the general population, yet psychiatric disorders are commonly under-detected in HIV care settings. This study examines the prevalence of three stress-related psychiatric diagnoses--depression, posttraumatic stress disorder (PTSD), and acute stress disorder (ASD), among a vulnerable population of HIV-infected patients. Among approximately 350 patients attending two county-based HIV primary care clinics, 210 participants were screened for diagnostic symptom criteria for depression, PTSD, and ASD. Standardized screening measures used to assess for these disorders included the Beck Depression Inventory, the Posttraumatic Stress Checklist, and the Stanford Acute Stress Questionnaire. High percentages of HIV-infected patients met screening criteria for depression (38 per cent), PTSD (34 per cent), and ASD (43 per cent). Thirty eight percent screened positively for two or more disorders. Women were more likely to meet symptom criteria for ASD than men (55 per cent vs. 38 per cent, OR=1.94, CI95 per cent=1.1-3.5). ASD was detected more commonly among African-American and white participants (51 per cent and 50 per cent respectively), compared with other ethnic groups. Latinos were least likely to express symptoms of ASD (OR=0.52, CI95 per cent=0.29-0.96). Of the 118 patients with at least one of these disorders, 51 (43 per cent) reported receiving no concurrent mental health treatment. Patients with HIV/AIDS who receive public healthcare are likely to have high rates of acute and posttraumatic stress disorders and depression. These data suggest that current clinical practices could be improved with the use of appropriate tools and procedures to screen and diagnose mental health disorders in populations with HIV/AIDS.     

Epigenetic and immune function profiles associated with posttraumatic stress disorder

The biologic underpinnings of posttraumatic stress disorder (PTSD) have not been fully elucidated. Previous work suggests that alterations in the immune system are characteristic of the disorder. Identifying the biologic mechanisms by which such alterations occur could provide fundamental insights into the etiology and treatment of PTSD. Here we identify specific epigenetic profiles underlying immune system changes associated with PTSD. Using blood samples (n = 100) obtained from an ongoing, prospective epidemiologic study in Detroit, the Detroit Neighborhood Health Study, we applied methylation microarrays to assay CpG sites from more than 14,000 genes among 23 PTSD-affected and 77 PTSD-unaffected individuals. We show that immune system functions are significantly overrepresented among the annotations associated with genes uniquely unmethylated among those with PTSD. We further demonstrate that genes whose methylation levels are significantly and negatively correlated with traumatic burden show a similar strong signal of immune function among the PTSD affected. The observed epigenetic variability in immune function by PTSD is corroborated using an independent biologic marker of immune response to infection, CMV—a typically latent herpesvirus whose activity was significantly higher among those with PTSD. This report of peripheral epigenomic and CMV profiles associated with mental illness suggests a biologic model of PTSD etiology in which an externally experienced traumatic event induces downstream alterations in immune function by reducing methylation levels of immune-related genes.     

Post-traumatic stress disorder treatments

A traumatic event (assault, traffic accident, bomb attack or war, disasters.) is often followed by a reaction of fear and anxiety which can evolve to a posttraumatic stress disorder (PTSD). Its severity and associated handicap justify treatment as early as possible. We present the various PTSD treatments and discuss their respective efficiency and limitations. Most of available treatments (cognitive and behavioral therapies, antidepressants.) are efficient on PTSD and co-morbid disorders. However, the efficiency of some therapies (eye movement desensitization) on the treatment of PTSD are controversial. Studies are necessary to evaluate various treatment strategies, optimal duration of antidepressant treatment and pediatric therapies.