Development of posttraumatic stress disorder in adult bipolar patients with histories of severe childhood abuse

Little is known about the nature and extent of posttraumatic stress disorder (PTSD) in adults with bipolar disorder, particularly in relation to the presence of past childhood or adult forms of abuse, and its impact on course of illness. The authors studied 100 consecutive DSM-IV bipolar patients who were evaluated for childhood physical, sexual and emotional abuse, traumatic events in adulthood, and lifetime PTSD. Adult comorbid PTSD was evident in 24% of subjects and was significantly associated with childhood sexual abuse, adult sexual assault, and adult survival of the suicide, homicide, or accidental death of a close friend or relative. Severe childhood abuse was reported by about half of bipolar patients, but only one-third of abused patients developed PTSD. Risk for PTSD rose in linear fashion to the number of childhood abuse subtypes present. Adult sexual assault was significantly more likely to be associated with PTSD if childhood sexual abuse was present rather than absent. The findings suggest that about one-third of bipolar patients with severe childhood abuse histories, particularly sexual abuse, manifest comorbid adult PTSD. Childhood sexual abuse, as well as severe interpersonal loss, may sensitize individuals who are predisposed to bipolar disorder also to develop eventual PTSD.     

Trauma and posttraumatic stress disorder in Japan: Results from the World Mental Health Japan Survey

The purpose of the study was to report the prevalence of trauma exposure and PTSD, conditional risk of PTSD associated with each trauma exposure in the community population in Japan. An interview survey was conducted of a random sample of adult residents in 11 communities of Japan. Among 4134 respondents (response rate, 55%), data from those who completed the part 2 interview (n = 1682) were analyzed with a weight for this subsample. Lifetime experiences of 27 trauma events and PTSD were assessed using the WHO-Composite International Diagnostic Interview version 3.0. Sixty percent of the part 2 sample reported exposure to at least one lifetime traumatic event. Lifetime and 12-month PTSD prevalences were 1.3% and 0.7%, respectively. Percentage of all months lived with PTSD in the population was predominantly accounted for by physical/sexual assaults and having a child with serious illness, and unexpected death of loved one. Ten percent of respondents reported “private events”, for which respondents did not have to describe the content, which accounted for 19% of months with PTSD. The lower prevalence of PTSD in Japan seems attributable to lower conditional risks of PTSD following these events, as well as different distributions of the events. The greater impact of events that occurred to loved ones rather than to oneself and “private events” on PTSD in Japan warrants further research of cross-cultural assessment of trauma exposure and cultural heterogeneity in the trauma-PTSD relationship.     

Victimization and PTSD in a Danish national youth probability sample

OBJECTIVE: To investigate the prevalence of traumatic events and life events in relation to posttraumatic stress disorder (PTSD). METHOD: In a Danish national representative sample of 390 eighth-grade students with a mean age of 14.5 years, 20 prevalent potential traumatizing and distressing events were described, along with the psychological impact of these events. RESULTS: Eighty-seven percent of the females and 78% of the males were exposed to at least one event. The most common events were the death of a family member, threat of violence, or serious accidents. The most distressing subjective events were rape, suicide attempts, death in the family, serious illness, and childhood abuse. Gender, parents' education, and living with a single parent were associated with specific events. The estimated lifetime prevalence of PSTD was 9.0%, whereas another 14.1% reached a subclinical level of PTSD. After exposure, females suffered from PTSD twice as often as males. Being exposed to multiple traumatic events was associated with an increase in PTSD. CONCLUSION: The findings in this study suggest substantial mental health problems in adolescents who are associated with various types of victimization.     

Gender differences in adolescents and young adults with suicidal behaviour.

OBJECTIVE: Gender differences in prevalence rates of suicide attempts and suicidal thoughts as well as in risk factors for suicide attempts such as traumatic events and mental disorders were investigated in a random sample of 3021 adolescents aged 14-24 years. METHOD: The M-CIDI (Composite International Diagnostic Interview) was used to survey suicidal behaviour, DSM-IV lifetime diagnoses and traumatic events. RESULTS: The female suicide attempters showed suicidal thoughts and suicide attempts significantly more often, and suicide attempts at a much younger age than the males. Furthermore, the females experienced sexual abuse much more often, and suffered significantly more often from anxiety disorders. The male suicide attempters showed higher rates of alcohol disorders and financial problems. CONCLUSION: A higher rate of anxiety in female suicide attempters results probably as a consequence of sexual abuse, which in turn makes them more vulnerable than males for attempting suicide between the age of 14-17.     

Traumatic events and posttraumatic stress disorder in an urban population of young adults

To ascertain the prevalence of posttraumatic stress disorder (PTSD) and risk factors associated with it, we studied a random sample of 1007 young adults from a large health maintenance organization in the Detroit, Mich, area. The lifetime prevalence of exposure to traumatic events was 39.1%. The rate of PTSD in those who were exposed was 23.6%, yielding a lifetime prevalence in the sample of 9.2%. Persons with PTSD were at increased risk for other psychiatric disorders; PTSD had stronger associations with anxiety and affective disorders than with substance abuse or dependence. Risk factors for exposure to traumatic events included low education, male sex, early conduct problems, extraversion, and family history of psychiatric disorder or substance problems. Risk factors for PTSD following exposure included early separation from parents, neuroticism, preexisting anxiety or depression, and family history of anxiety. Life-style differences associated with differential exposure to situations that have a high risk for traumatic events and personal predispositions to the PTSD effects of traumatic events might be responsible for a substantial part of PTSD in this population.     

Posttraumatic stress in children exposed to family violence and single-event trauma

OBJECTIVE: To examine posttraumatic stress disorder (PTSD) and other comorbid forms of psychopathology in a sample of children exposed to chronic abuse and single-event trauma. METHOD: School-age children (N = 337) were assessed for exposure to traumatic events (family violence, violent crime, death or illness of someone close to child, accidents) and posttraumatic stress symptoms. Children and mothers received structured diagnostic interviews to assess child psychopathology. RESULTS: Children from violent households were no more likely to report an extrafamilial traumatic stressor than children from nonviolent homes. Among the children reporting a traumatic event, 24.6% met the diagnostic criteria for PTSD. The leading precipitating event for PTSD symptoms was death or illness of someone close to the child (log odds = 4.3). Family violence, violent crime, but not accidents also resulted in PTSD. Children with PTSD displayed comorbidity across different symptom classes, most notably phobias and separation anxiety. CONCLUSIONS: Both type I and type II trauma can result in PTSD in about one quarter of children. Children with posttraumatic stress symptoms had many other forms of comorbid psychopathology, indicating a global and diffuse impact of trauma on children.     

Subjective Distress Associated with Sudden Loss in Clients with Severe Mental Illness

Data from interviews with 276 community mental health clients diagnosed with a severe mental illness were used to examine the association between clients’ subjective distress from sudden loss of a close friend or loved one and PTSD symptoms. Over three-quarters of these clients reported sudden losses in their lives, and regression analysis showed that distress related to sudden losses accounted for significant and unique variance in PTSD symptoms when all other sources of traumatic distress were controlled. Practitioners should routinely assess interpersonal losses among clients with SMI and offer brief interventions specifically aimed at helping clients cope with such losses.     

Incidence of post-traumatic stress disorder in adolescents: results of the Bremen Adolescent Study

The frequency and comorbidity of posttraumatic stress disorders (PTSD) were assessed together with the resultant psychosocial impairment in 1035 adolescents between the ages of 12 and 17 years. Posttraumatic stress disorder and other psychiatric disorders were coded on the basis of the DSM-IV criteria using the computerized personal interview of the Munich version of the Composite International Diagnostic Interview (CIDI). A total of 17 (1.6%) adolescents met the DSM-IV criteria for PTSD at some point in their life. Slightly more girls than boys met the criteria for the disorder, whose frequency increased with age. The lifetime prevalence of traumatic events is much higher still: 233 (22.5%) adolescents reported one or more traumatic events in their life. The types of traumatic events experienced by the greatest number of adolescents were: physical attack, injury, and serious accident. Boys experienced significantly more traumatic events than did girls. The occurrence of a traumatic event was mostly associated with hypervigilance and recurrent and intrusive psychological distress upon exposure to cues which symbolized the event itself or resembled an aspect thereof. PTSD occurred in highly frequent comorbidity with depressive disorders, somatoform disorders, and substance abuse. Over 90% of those with posttraumatic stress disorder were severely impaired in their daily life and activities. Despite the high-grade psychosocial impairment, only a small number sought professional help.     

Older offenders, substance abuse, and treatment.

OBJECTIVE: The adoption of more stringent truth-in-sentencing laws and the aging of the United States population in general has led to an increase in the proportion of prison inmates age 55 years and older. Recent judicial rulings require prisoners to receive adequate medical and mental health care. Care for substance abuse is often included to reduce recidivism. However, little systematic research has been conducted on the mental health and substance abuse treatment needs of older prisoners. METHODS: The authors examined age differences in substance abuse history provided by 10,952 offenders as part of their orientation and evaluation on entry into prison. Trained substance abuse counselors interviewed each offender and recorded data in an institutional database. RESULTS: Seventy-one percent of older inmates reported a substance abuse problem. When compared with younger inmates, older offenders were more likely to abuse alcohol only. Those older inmates with abuse problems had used substances for over 40 years, yet more than one-third had never received treatment. CONCLUSION: Like younger inmates, most older offenders would benefit from substance abuse treatment. The treatment may need to be tailored to age and lack of previous treatment experience and should be sensitive to this high-risk group's additional medical needs.     

Trauma and dissociation among prisoners

The current study examined childhood abuse, dissociation and post-traumatic stress disorder (PTSD) among male prisoners. A sample of 101 randomly selected male prisoners was interviewed. The Dissociative Experiences Scale (DES), Childhood Abuse and Neglect Questionnaire (CANQ) and Structured Clinical Interview for DSM-IV (SCID-I)-PTSD module were applied. Probands reported high frequency of criterion A trauma (85.2%) and lifetime PTSD (66.4%). Also, dissociative experiences more frequent than that of general population and most frequent dissociative symptoms were amnesia and absorption. PTSD and childhood traumas occur at high rates in prisoners and this finding has implications for management and treatment.     

Trauma, dissociation, and posttraumatic stress disorder in female borderline patients with and without substance abuse problems

OBJECTIVE: To examine the associations of childhood traumatic experiences and childhood neglect with dissociative experiences and posttraumatic stress disorder (PTSD) in a population of female borderline personality disorder (BPD) patients with and without substance abuse. METHOD: The sample included 64 female patients with BPD. Childhood traumatic experiences and childhood neglect were measured using the Structured Trauma Interview, dissociative experiences with the Dissociative Experiences Scale, and PTSD with the Structured Clinical Interview for DSM-IV. RESULTS: In general, dissociation scores were higher among those with a history of childhood trauma and neglect, in particular among those who reported both sexual and physical abuse before age 16, more than one perpetrator and severe maternal dysfunction. The prevalence of PTSD was clearly associated with the severity of childhood sexual abuse (CSA) in terms of the occurrence of penetration during CSA, intrafamilial CSA, a duration of CSA longer than 1 year and more than one perpetrator. Comorbid substance abuse problems modified the observed associations such that the associations mentioned above were also present or even more pronounced among those without substance abuse, whereas no associations were found in those with substance abuse. CONCLUSIONS: The results suggest a moderately strong association between childhood trauma and neglect with dissociation and PTSD. However, trauma-dissociation and trauma-PTSD links were only observed among BPD patients without addictive problems. The findings are largely consistent with the literature. Potential explanations for the lack of a trauma-dissociation and trauma-PTSD link in the addicted subgroup are discussed.     

Anger in former East German political prisoners: relationship to posttraumatic stress reactions and social support

Anger is a salient symptom of traumatized victims and a major sign for posttraumatic stress disorder (PTSD). However, the causes for the increased level of anger remain almost unknown. The present study investigates the interrelationship of anger, posttraumatic stress reactions, and social support in a group of former East German political prisoners (N = 91). Assessments included the German version of the Anxiety Disorders Schedule (DIPS) as well as measures of anger (STAXI), posttraumatic stress reactions (IES-R), and social support (SSQ). As expected, participants reported a high level of anger. Most measures of anger, posttraumatic stress reactions, and social support were significantly correlated. Within structural equation modeling, trait-anger was shown to be directly activated by the experience of chronic posttraumatic intrusions. Social support appeared to lessen the level of anger. The results confirm findings from studies on other traumatic events and provide additional information on the relationship between posttraumatic anger and social support. The findings indicate that treatments for PTSD might be effectively supplemented by addressing anger and social support.     

Effects of adolescent trauma exposure on risky behavior in college women

Individuals with sexual assault or abuse histories are likely to engage in risky sexual and other self-destructive behaviors. Studies of these behaviors, however, have focused on target traumatic events without accounting for other events in the participant's history, recency of the events, and/or developmental level at time of occurrence. The present study addressed some of these confounds by creating groups with unique and non-overlapping trauma histories among adolescent participants whose first trauma occurred at age 12 or older. Sophomore women from six regional campuses were screened in a two-stage procedure, and 209 of 363 final interviewees were included in the present report. These were assigned to a no trauma group, or to one of five groups with a unique trauma history: a single traumatic loss, a single physical assault, a single sexual assault, ongoing sexual or physical abuse, or multiple single traumas. Risky sexual behavior, suicidal ideation, and elevated perpetration of violence were most prominent among those with ongoing abuse exposure, although a single exposure to interpersonal violence during adolescence was sufficient for some risky behaviors. Major depression (MDD) and posttraumatic stress disorder (PTSD) were associated with many of the behaviors, and may serve to heighten risk.     

Trauma,Post-Traumatic Stress Disorder,and Treatment Among Middle-Aged and Older Women in the Nurses’ Health Study II

ObjectiveTrauma and post-traumatic stress disorder (PTSD) are common among women and associated with negative health outcomes across the life course. Relatively few studies, however, have examined the epidemiology of trauma, PTSD, and treatment among middle-aged and older civilian women, who are at elevated risk for adverse health outcomes. We aimed to characterize trauma, PTSD, and trauma-related treatment prevalence and correlates in a large cohort of middle-aged and older women.DesignCross-sectional, nested substudy within the Nurses’ Health Study II cohort.SettingUnited States, 2018–2020.Participants33,327 current or former nurses, aged 53–74 years.Measurements16-item modified version of the Brief Trauma Questionnaire; modified PTSD Checklist for the Diagnostic and Statistical Manual, Version 5.ResultsThe majority (82.2%) of women reported one or more lifetime traumas. The most common trauma types were unexpected death of a loved one (44.9%) and interpersonal violence (43.5%). Almost 30% reported occupational (nursing-related) trauma. Among the trauma-exposed, 10.5% met criteria for lifetime PTSD and 1.5% had past-month PTSD. One-third of lifetime PTSD cases were due to interpersonal violence event types. One-third of women with lifetime PTSD—and nearly half of those with PTSD from a nursing-related trauma—reported never receiving trauma-related treatment. Women aged 65 years and older with PTSD were less likely to be in treatment than those aged less than 65 years.ConclusionHistory of trauma and PTSD is prevalent in this population, and a treatment gap persists. Addressing this treatment gap is warranted, particularly among older women and those with nursing-related trauma.     

Posttraumatische Belastungsstörungen in Deutschland

In a representative epidemiological study (n=2426) with a broad age range of respondents (14-93 years), prevalence rates of traumatic life events, post-traumatic stress disorder (PTSD), and partial PTSD were estimated. A standardized interview using the trauma checklist of the Composite International Diagnostic Interview and a DSM-IV PTSD symptom checklist (Modified PTSD Symptom Scale) were applied. One-month prevalence rates were 2.3% for DSM-IV PTSD and 2.7% for partial PTSD. There were no gender differences but age-group differences did appear: among persons older than 60, the prevalence of PTSD was 3.4%, whereas the prevalence was estimated at 1.3% among persons aged 14-29 years and 1.9% among those aged 30-59 years. Partial PTSD exhibited the same age distribution, with 3.8% in the elderly, 2.4% in the middle-aged, and 1.3% in young adults. The results correspond with those of other international studies taking war-related consequences for older age groups into account. Our representative study provides the first evidence of higher PTSD prevalence rates among older age groups in the German population, which is assumed to be related to consequences of World War II.     

Psychiatric comorbidity in older adults with bipolar disorder

INTRODUCTION: Comorbidity patterns and correlates among older adults with bipolar disorder (BPD) are not well understood. The aim of this analysis was to examine the prevalence of comorbid PTSD and other anxiety disorders, substance abuse and dementia in a population of 16,330 geriatric patients with BPD in a Veterans Health Administration administrative database. METHODS: Patients were identified from case registry files during Federal Fiscal Year 2001(FY01). Comorbidity groups were compared on selected clinical characteristics, inpatient and outpatient health resource use, and costs of care. RESULTS: Four thousand six hundred and sixty-eight geriatric veterans with BPD were comorbid for either substance abuse, PTSD and other anxiety disorder, or dementia (28.6% of all veterans with BPD age 60 or older). Mean age of all veterans in the four comorbidity groups was 70.0 years (+/-SD 7.2 years). Substance abuse was seen in 1,460 (8.9%) of elderly veterans with BPD, while PTSD was seen in 875 (5.4%), other anxiety disorders in 1592 (9.7%), and dementia in 741 (4.5%) of elderly veterans. Individuals with substance abuse in this elderly bipolar population are more likely to be younger, minority, unmarried and homeless compared to elderly bipolar populations with anxiety disorders or dementia. Inpatient use was greatest among geriatric veterans with BPD and dementia compared to veterans with BPD and other comorbid conditions. CONCLUSION: Clinical characteristics, health resource use and healthcare costs differ among geriatric patients with BPD and comorbid anxiety, substance abuse or dementia. Additional research is needed to better understand presentation of illness and modifiable factors that may influence outcomes.     

Posttraumatic stress disorder and the incidence of nicotine,alcohol, and other drug disorders in persons who have experienced trauma

BACKGROUND: We examine whether exposure to traumatic events increases the risk for nicotine dependence or alcohol or other drug use disorders, independent of posttraumatic stress disorder (PTSD). METHODS: Data come from a longitudinal epidemiologic study of young adults in southeast Michigan. Prospective data covering a 10-year period and retrospective lifetime data gathered at baseline were used to estimate the risk for onset of substance use disorders in persons with PTSD and in persons exposed to trauma without PTSD, compared with persons who have not been exposed to trauma. The National Institute of Mental Health Diagnostic Interview Schedule for DSM-III-R was used. Logistic regression was used to analyze the prospective data, and Cox proportional hazards survival analysis with time-dependent variables was applied to the lifetime data. RESULTS: The prospective and retrospective data show an increased risk for the onset of nicotine dependence and drug abuse or dependence in persons with PTSD, but no increased risk or a significantly (P =.004) lower risk (for nicotine dependence, in the prospective data) in persons exposed to trauma in the absence of PTSD, compared with unexposed persons. Exposure to trauma in either the presence or the absence of PTSD did not predict alcohol abuse or dependence. CONCLUSIONS: The findings do not support the hypothesis that exposure to traumatic events per se increases the risk for substance use disorders. A modestly elevated risk for nicotine dependence might be an exception. Posttraumatic stress disorder might be a causal risk factor for nicotine and drug use disorders or, alternatively, the co-occurrence of PTSD and these disorders might be influenced by shared risk factors other than traumatic exposure.     

Bureaucratic Structure and Impersonal Experience in Mental Hospitals

Abstract

Individuals with sexual assault or abuse histories are likely to engage in risky sexual and other self—destructive behaviors. Studies of these behaviors, however, have focused on target traumatic events without accounting for other events in the participant's history, recency of the events, and/or developmental level at time of occurrence. The present study addressed some of these confounds by creating groups with unique and non—overlapping trauma histories among adolescent participants whose first trauma occurred at age 12 or older. Sophomore women from six regional campuses were screened in a two—stage procedure, and 209 of 363 final interviewees were included in the present report. These were assigned to a no trauma group, or to one of five groups with a unique trauma history: a single traumatic loss, a single physical assault, a single sexual assault, ongoing sexual or physical abuse, or multiple single traumas. Risky sexual behavior, suicidal ideation, and elevated perpetration of violence were most prominent among those with ongoing abuse exposure, although a single exposure to interpersonal violence during adolescence was sufficient for some risky behaviors. Major depression (MDD) and posttraumatic stress disorder (PTSD) were associated with many of the behaviors, and may serve to heighten risk.     

Traumatic life events and PTSD among women with substance use disorders and schizophrenia

OBJECTIVE: The authors assessed the prevalence of traumatic life events and posttraumatic stress disorder (PTSD) among women with schizophrenia or schizoaffective disorder and co-occurring substance abuse or dependence. The association between PTSD and specific traumatic life events was also examined. METHODS: Fifty-four drug-addicted women with schizophrenia or schizoaffective disorder participated in the study. All women were psychiatric outpatients and completed a large battery of structured clinical assessments. RESULTS: High rates of trauma, particularly physical abuse (81 percent), and revictimization--being abused both as a child and as an adult--were reported. The average number of traumatic life events reported was eight, and almost three-quarters of the sample reported revictimization. Rates of current PTSD were considerably higher than those documented in previous study samples of persons with serious mental illness and of drug-addicted women in the general community. PTSD was significantly associated with childhood sexual abuse and revictimization. CONCLUSIONS: The high levels of trauma and revictimization observed in the study highlight the need for the development of evidence-based interventions to treat trauma and its aftermath among women with schizophrenia or schizoaffective disorder. Given the overlap in symptoms between PTSD and schizophrenia, a better understanding is needed of how PTSD is expressed among people with schizophrenia. Recommendations and standards for the assessment of PTSD among this population need to be articulated. Finally, the comparatively high rates of PTSD suggest that the combination of schizophrenia or schizoaffective disorder and substance use disorder makes these women particularly vulnerable to adverse outcomes.     

Trouble de stress post-traumatique en milieu pénitentiaire

PTSD is frequent in prison, with a lifetime prevalence of 17.8% among male inmates, and of 40.1% among female inmates. Despite those high rates, only a limited number of studies have been published about this disorder in the prison population, and PTSD is still widely underdiagnosed in jail. We conducted a review of the literature to identify the PTSD sociodemographic characteristics and specificities among incarcerated populations. Some epidemiological characteristics of PTSD are identical in both the general and the prison populations, with a higher prevalence among women than men, high rates of comorbidity with depression and anxiety disorders, and high suicide rates. PTSD after committing a violent crime seems to be common but is greatly underdiagnosed, mostly because of a lack of knowledge about this entity. The occurrence is especially high when the offender suffers from a severe mental illness at the time of the offence. Homicidal crimes are the most at risk to lead to PTSD. Every inmate should be screened for this diagnosis by psychiatrists practicing in prisons. Inmates are exposed to many traumatic events during their time in detention. Yet, little is known about the mental health consequences of imprisonment. PTSD after exposure to a traumatic event while in detention should be systematically explored, and future studies need to consider this matter. The high levels of PTSD among imprisoned people could be explained by the exposition of prisoners to repetitive traumatic events, especially during childhood, and by the multiple risk factors for PTSD found in this population. In France, screening for and treatment of PTSD in prison are insufficient. Strategies must be elaborated by the institutions created in 2019 (Centre National de Ressource et de Résilience et Centre Régionaux de Psychotraumatismes) to improve the health of inmates suffering from PTSD. Complex PTSD should also be studied in the prison population.