Measuring Trauma: Considerations for Assessing Complex and Non-PTSD Criterion A Childhood Trauma

The current definition of a traumatic event in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5; American Psychiatric Association, 2013) may be too narrow to describe the myriad of difficult childhood experiences. Furthermore, youth may develop a distinct pattern of symptoms in relation to complex or multiple childhood trauma experiences, the proposed developmental trauma disorder (DTD; B. A. van der Kolk, 2005 van der Kolk, B. A. 2005. Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35: 401–408. [Crossref], [Web of Science ®] , [Google Scholar]) We developed and utilized a new measure, the Potentially Traumatic Experiences Questionnaire (PTEQ), to assess patterns in childhood trauma exposure. We used 2 item formats (open ended vs. closed ended) in order to explore potential differences in reporting. Furthermore, we assessed for symptoms associated with DTD following exposure to complex childhood trauma in a sample of adolescents. Participants were 186 adolescents ages 18 and 19 years old who were asked to report retrospectively on their difficult childhood experiences. The results showed that participants reported multiple events that would not be considered traumatic according to DSM–5 Posttraumatic Stress Disorder Criterion A, and those who completed the PTEQ with closed-ended items reported more differentiated trauma types than participants who completed the open-ended questionnaire. Also, participants who reported multiple or chronic events were more likely to endorse symptoms associated with DTD. This study has implications for the diagnosis and treatment of complex trauma experiences in youth.     

The Symptoms of Trauma Scale (SOTS): Psychometric evaluation and gender differences with adults diagnosed with serious mental illness

A new clinician rating measure, the Symptoms of Trauma Scale (SOTS), was administered to adult psychiatric outpatients (46 men, 47 women) with severe mental illness who reported a history of trauma exposure and had recently been discharged from inpatient psychiatric treatment. SOTS composite severity scores for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, posttraumatic stress disorder (PTSD), complex PTSD (cPTSD), and total PTSD/cPTSD severity had acceptable internal consistency reliability. SOTS scores’ construct and convergent validity was supported by correlations with self-report measures of childhood and adult trauma history and PTSD, dissociation, and anger symptoms. For men, SOTS scores were associated with childhood sexual and emotional abuse and self-reported anger problems, whereas for women SOTS scores were most consistently and strongly associated with childhood family adversity and self-reported PTSD symptoms. Results provide preliminary support for the reliability and validity of the SOTS with adults with severe mental illness and suggest directions for replication, measure refinement, and research on gender differences.     

精神创伤后应激障碍与述情障碍的相关性分析

目的:研究旨在了解经历精神创伤后,创伤后应激障碍(PTSD)患者的症状特征与述情障碍的关系。方法:试验组为35名经历过精神创伤发生PTSD的患者,对照组为35名经历过精神创伤未发生PTSD的创伤暴露者,在不影响测验症状的情况下分别完成创伤后应激障碍临床筛查表平民版量表(PCL-C)及述情障碍20个条目量表(TAS-20)中文版。结果:PTSD患者述情障碍的发生率(57.14%)高于未发生PTSD的创伤幸存者(11.42%),PTSD患者的TAS-20总分(t=-5.271,P0.001)、因子1(F1:情感辩别不能)(t=-6.113,P0.001)及因子2(F2:情感描述不能)(t=-4.660,P0.001)得分高于对照组,差异有统计学意义。总分及因子分与PTSD症状的相关分析表明,PTSD患者的症状特征与TAS-20总分及F1、F2因子显著相关。结论:精神创伤暴露者中PTSD患者与未发生PTSD的创伤幸存者的述情障碍表现明显不同,TAS-20量表在临床具有较好的辅助诊断价值。     

Client Satisfaction Survey of Inpatient Trauma and Dissociative Disorders Program

Abstract

Treatment interventions from a specialized multi-disciplinary inpatient trauma and dissociative disorders program were evaluated by 43 patients through the use of a satisfaction survey questionnaire. Interventions with the highest ranking means of usefulness, as perceived by participants, included individual therapy sessions by both the psychiatrist and the psychotherapist, trauma group, psychodrama, and goals-and-closure group. Body awareness group, led by nurses, and body movement group, led by expressive therapists, were rated the lowest. These results indicate the importance for specialized trauma programs to address body distorted perceptions of the dissociative patients while maintaining frequent individual treatment interventions that address the patients' existing problems they bring to therapy.     

Early Intervention for Trauma: Current Status and Future Directions

Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.     

On Building a Science of Common Factors in Trauma Therapy

Research on therapy outcome routinely finds that common factors (e.g., warmth, genuineness, trustworthiness) account for more variance than does therapy technique. This article makes the case for more attention to training in positive common factor variables within graduate schools and internships and for research on the effectiveness of such training. Recommendations are given for a change in focus in research and training, including more discussion of taboo topics in trauma therapy; attention to therapist behaviors that enhance the experience of warmth or trustworthiness; and research on client characteristics that impede the experience of being in the presence of a warm, genuine, and trustworthy other.     

Dissociation,Depression and Trauma in Psychiatric Inpatients in Puerto Rico

ABSTRACT

This study investigated the frequency of self-reported childhood abuse experiences of psychiatric inpatients, and the presence of dissociative and depressive symptoms. A total of 100 Puerto Rican in-patients who were hospitalized during a two month period were included in the study. The participants' dissociative and depressive symptoms were assessed using the Dissociative Experiences Scale and a subset of its items (DES-Taxon), the Questionnaire of Experiences in Dissociation and the Beck Depression Inventory. We also used a self-report instrument to assess the frequency and severity of a variety of abusive experiences. Seventy-eight percent (78%) of the participants reported some type of abusive experiences, 38% reported extreme and frequent abuse, and 40% reported being sexually abused during childhood. The findings showed a correlation between greater frequency of the abusive experiences and higher levels of dissociative and depressive symptoms. When the variable of child sexual abuse was used, only the Dissociative Experiences Scale was able to detect differences between those patients who reported such abusive experiences and those who reported none. We conclude that the level of abusive experiences reported by psychiatric in-patients in Puerto Rico is very similar to the rate in other investigations in the international literature. The data demonstrate that the participants who report frequent and intense abuse endorse a wide variety of dissociative experiences, and, to a lesser extent, depressive symptoms. As more than 95% of our inpatients had never been screened or assessed for the possibility of a dissociative disorder, we suggest that clinicians in psychiatric units in Latin America should be more sensitive and attentive to the presence of such disorders.     

Trauma and Dissociation

Abstract

The inauguration of this journal is the fruit of 20 years of modern study of trauma and dissociation that began with the publication of DSM III. Beginning with Janet and Freud, this editorial traces the growth of research, teaching and treatment in these fields and examines their close link to historic waves of social recognition and denial of child abuse in Western societies. Beginning with the women's movement of the 1960s that publicized rape and incest, followed by the undeniable traumas of American Vietnam veterans, we trace the blossoming progress of research, theory and treatment techniques in the fields of trauma and dissociation, of which this journal is one of the fruits. We note three generations of trauma treatment theory that have focused successively on abreaction, on the three-stage model of trauma treatment, and finally on integration of trauma-focused work with other theoretical models in the emerging post-memory-backlash era. As this journal is launched, our field stands at a point of unprecedented theoretical sophistication and burgeoning research on memory, trauma and dissociation to assist therapists in helping trauma survivors put their victimization in the past.     

Psychometric Utility of the Childhood Trauma Questionnaire with Female Street-Based Sex Workers

ABSTRACT

The present study examines the psychometric properties of a verbal, face-to-face administration of the Childhood Trauma Questionnaire (CTQ) with female street-based sex workers (N = 171). Confirmatory Factor Analysis (CFA) indicated a poor fit between our data and the instrument's established 5-factor structure. Exploratory Factor Analysis (EFA) yielded four stable and usable factors corresponding to the Emotional Abuse, Emotional Neglect, Physical Abuse, and Sexual Abuse subscales of the CTQ; the Physical Neglect subscale did not emerge as a stable factor. Cross loading of many CTQ items onto more than one factor most likely produced the poor CFA fit, and indicated that abuse/neglect constructs were not conceptually distinct for our sample. Mean trauma scores did not differ significantly from published scores for female substance abusers. According to the CTQ Minimization/Denial scale, 42% of participants minimized their childhood maltreatment experiences. A combination of qualitative and quantitative methods may be optimal for the acquisition of sensitive trauma information with wary and vulnerable street populations.     

Pathological Dissociative Taxon Membership,Absorption, and Reported Childhood Trauma in Women with Trauma-Related Disorders

Abstract

Employing a community sample, Irwin (1999) used the Childhood Trauma Questionnaire (CTQ; Bernstein et al, 1994) and Dissociative Experiences Scale (DES; Bernstein & Putnam, 1986) to show that trauma predicts pathological dissociation as measured by Waller, Putnam, and Carlson's (1996) DES-T (dissociative “taxon”) scale but does not predict ostensibly non-pathological DES absorption. Yet Irwin merely studied DES-T scores as a continuous variable rather than classifying participants with respect to taxon membership, as the DES-T items were designed to do. The present study hypothesized that, in a traumatized clinical sample, trauma would be associated both with dissociative taxon membership and with absorption. An inpatient sample of 235 women were administered the CTQ and DES. Even in this relatively homogeneous trauma sample, taxon membership showed good discriminant validity with respect to clinical diagnosis and reported childhood abuse. Furthermore, whereas the effect of reported childhood sexual abuse on absorption was accounted for by taxon membership, reported childhood emotional abuse related to absorption independent of taxon membership. The authors discuss the diagnostic utility of computing taxon membership as well as the clinical significance of highly elevated absorption scores in a trauma population.     

How important are Phase 1 interventions for complex interpersonal trauma? A pilot randomized control trial of a group psychoeducational intervention

Although psychoeducational interventions are recommended as Phase 1 interventions for complex trauma, there is limited evidence on their efficacy. This pilot randomized control trial (RCT) investigated the efficacy of a pure psychoeducational intervention for complex trauma. A brief 10‐session intervention was delivered to n = 44 female prisoners in a compressed format to accommodate short sentence lengths and was compared with usual care (n = 42). Results from an intent‐to‐treat (ITT) analysis indicated that there were no statistically significant differences between the two arms across the three assessment time points (including 1‐month postintervention) for the main outcomes (Behavioural Assessment Checklist‐Revised, β = 4.60, 95% CI [?1.60, 10.88], p = .148; posttraumatic stress disorder [PTSD] Checklist, β = ?1.47, 95% CI [?4.30, 1.36], p = .303). Post hoc reliable change analyses suggested twice the number of adequate dose participants made progress in addressing PTSD symptoms compared with usual care (30.3% vs. 17.6%, OR 2.03, 95% CI [.64, 6.43]). Although further work in this area is required, initial results, overall, suggest that psychoeducational group‐based treatment modalities achieve only small effect sizes in comparison with usual care.     

How Much Is Too Much? Limit Setting and Sexual Acting Out in a Digital Era

Digital media offer unique challenges to parents in terms of their efforts to shepherd their children through adolescence. Adolescents’ ready access to the Internet makes limit setting and appropriate supervision of teens much more challenging and offers teens qualitatively different dangers and opportunities for acting out than previously existed. The case of a sexually acting out adopted teen (with a history of sexual abuse) who used the Internet as a central vehicle for sexual exploration is discussed, with a particular focus on the ambiguity of appropriate limit setting in the digital era. Implications for case planning in similar situations are also discussed.     

Heterogeneity of defensive responses after exposure to trauma: Blunted autonomic reactivity in response to startling sounds

Research on threat responses, particularly among trauma-exposed individuals, has traditionally focused on increased autonomic arousal and reactivity. However, clinical features associated with trauma exposure, such as dissociation (e.g., shutting down or “spacing out”) manifest as the opposite pattern: non-reactivity and blunted arousal. These clinical features suggest that the possibility of threat responses other than fight/flight, namely, immobilization may be undergirded by hyper- or hypo-arousal. The goal of this paper is to examine autonomic responses to a stressful stimulus (acoustic startle) using analytic approaches which have been previously used to examine defensive responses before: heart rate acceleration, heart rate deceleration, and skin conductance response. We examined these responses in relation to symptoms (Posttraumatic Stress Disorder, or PTSD, and dissociation) and trauma exposure (cumulative exposure, age of onset) in a sample of trauma-exposed college students. We found evidence of blunted reactivity, with decreased acceleration and skin conductance, but with increased deceleration, particularly among individuals who had significant symptoms and early exposure to multiple types of trauma. However, individuals with sub-clinical symptoms and more attenuated exposure had large heart rate acceleration and skin conductance responses during the task. Taken together, these findings suggest that moderate symptoms and trauma exposure are related to exaggerated autonomic responses, while extreme symptoms and trauma exposure are related to blunted autonomic responses. These findings further suggest heterogeneity of stress responses within individuals with PTSD and with trauma exposure.     

Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis

Research has demonstrated that women develop postpartum PTSD. Prevalence of postpartum PTSD has ranged from 1% to 30%, and many risk factors have been identified as predictors of postpartum PTSD. While qualitative reviews have identified patterns of risk, the lack of quantitative reviews prevents the field from identifying specific risk factors and making a single estimate of the prevalence of postpartum PTSD. The current meta-analysis investigated prevalence and risk factors of postpartum PTSD, both due to childbirth and other events, among community and targeted samples. Prevalence of postpartum PTSD in community samples was estimated to be 3.1% and in at-risk samples at 15.7%. Important risk factors in community samples included current depression, labor experiences such as interactions with medical staff, as well as a history of psychopathology. In at-risk samples, impactful risk factors included current depression and infant complications. Further research should investigate how attitudes towards pregnancy and childbirth may interact with women's experiences during delivery. Additionally, studies need to begin to evaluate possible long-term effects that these symptoms may have on women and their families.     

The Mechanisms of Psychosocial Injury Following Human Rights Violations,Mass Trauma,and Torture

The pervasive negative impact of human rights violations (HRVs) on psychological functioning has been well documented. There is limited research, however, investigating the mechanisms that mediate the link between exposure to HRVs and various mental and behavioral health outcomes. We propose three theory‐ and evidence‐based pathways by which HRVs may lead to psychosocial impairment, namely, disruptions in interpersonal processes, decreased perceptions of control, and the denigration of individual and group identity. We also underscore how the post‐HRV environment moderates each of these pathways, and we describe the implications of the proposed model for clinical practice.