Parental PTSD,adverse parenting and child attachment in a refugee sample

In contrast with traumatic experiences, there is a dearth of studies on the link between trauma symptoms, disconnected (frightened, threatening and dissociative) parenting behavior, extremely insensitive parenting behavior and child attachment. This study extends previous work on the impact of posttraumatic stress disorder (PTSD) on families by studying the unique contribution of disconnected and extremely insensitive parenting behavior on child attachment in a highly traumatized sample of 68 asylum seekers and refugees and their children (18–42 months). The results show that parental symptoms of PTSD are directly related to children’s insecure attachment and disorganized attachment. The greatest proportion of the risk could be attributed to factors related to the dyad and not the family. A mediation effect of adverse parenting behavior was not confirmed. On the one hand the results indicate the need for an effective treatment of PTSD symptomatology while on the other hand the results indicate the need for clinical attention to insecure attachment relationships.     

Posttraumatic stress symptoms in parents of children with acute burns

OBJECTIVE: To develop a model of risk factors for posttraumatic stress disorder (PTSD) symptoms in parents of children with burns. METHODS: Immediately following the burn and 3 months later, parents reported on their children's and their own psychological functioning and traumatic stress responses. RESULTS: Approximately 47% of the parents reported experiencing significant posttraumatic stress symptoms 3 months after the burn. Our model indicates three independent pathways to PTSD symptoms (i.e., parent-child conflict, parents' dissociation, and children's PTSD symptoms). Additionally, parents' anxiety predicted increased parent-child conflict, conflict with extended family and size of the burn predicted parents' dissociation, and size of the burn and children's dissociation predicted children's PTSD symptoms. CONCLUSIONS: This study suggests that many parents of children with burns suffer from posttraumatic stress symptoms. Interventions that target factors such as family conflict, children's symptoms, and parents' acute anxiety and dissociation may diminish the risk for PTSD.     

Brief treatment for elementary school children with disaster-related posttraumatic stress disorder: a field study.

Effective psychological intervention is needed to help children recover from disaster-related posttraumatic stress disorder (PTSD). This controlled study evaluated the effectiveness of a brief intervention for disaster-related PTSD. At one-year follow-up of a prior intervention for disaster-related symptoms, some previously treated children were still suffering significant trauma symptoms. Using a randomized lagged-groups design, we provided three sessions of Eye Movement Desensitization and Reprocessing (EMDR) treatment to 32 of these children who met clinical criteria for PTSD. The Children's Reaction Inventory (CRI) was the primary measure of the treatment's effect on PTSD symptoms. Associated symptoms were measured using the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). Treatment resulted in substantial reductions in both groups' CRI scores and in significant, though more modest, reductions in RCMAS and CDI scores. Gains were maintained at six-month follow-up. Health visits to the school nurse were significantly reduced following treatment. Psychosocial intervention appears useful for children suffering disaster-related PTSD. Conducting controlled studies of children's treatment in the postdisaster environment appears feasible.     

Posttraumatic stress symptoms are associated with the frequency and severity of delinquency among detained boys

Trauma and posttraumatic stress symptoms increasingly are recognized as risk factors for involvement with the juvenile justice system, and detained youth evidence higher rates of trauma exposure and posttraumatic stress disorder (PTSD) compared to their nondetained peers. Using a sample of 83 detained boys aged 12 to 17, we tested the hypothesis that degree of PTSD symptomatology would be positively associated with arrest frequency and delinquency severity. Results indicated that 95% of participants had experienced trauma, and 20% met criteria for Full or Partial PTSD. As predicted, severity of PTSD symptoms was associated with degree of delinquency, and this effect remained present for the past year delinquency variables after controlling for the total number of traumas reported.     

Young children traumatized by organized violence together with their mothers--the critical effects of damaged internal representations

Three examples of young Kosovar children who were exposed to brutal violence together with their mothers are presented to illustrate how important it is to understand the impact of traumatic events on young children's development from the perspective of the parent-child relationship. The traumatized mothers' internal representations of self and self-being-together-with-child were damaged, and this in turn led to their care-giving system and internal representations of the children being negatively affected. No longer being able to see themselves as protective and loving parents, the mothers were unable to respond to their children with care-giving behaviour. The traumatized children's increased attachment behaviour and posttraumatic symptoms functioned as a trigger for posttraumatic symptoms in the mothers and contributed to a disengagement of the care-giving system. The on-going process disrupted the previous attachment pattern in mother-child interaction and a disorganized attachment pattern developed.     

Screening for preschool posttraumatic stress disorder with the Child Behavior Checklist

OBJECTIVE: To examine the psychometric properties and utility of a Child Behavior Checklist-Posttraumatic Stress Disorder (CBCL-PTSD) Scale to screen for posttraumatic stress disorder (PTSD) in traumatized preschool children. METHOD: Data for this study were drawn from a study of young child trauma and consisted of 62 traumatized children, 23 months through 6 years of age. The children's mothers were interviewed about PTSD symptoms and then completed the Child Behavior Checklist (CBCL). RESULTS: The modified CBCL-PTSD correlated highly with the number of PTSD symptoms from the interview (r = 0.66). The CBCL-PTSD scale predicted PTSD symptoms above and beyond the internalizing and externalizing scales of the CBCL. A cutoff score of nine on this scale possessed the best sensitivity and specificity in classifying those traumatized children who met diagnostic criteria for PTSD. CONCLUSION: The modified CBCL-PTSD scale could be a useful cost-effective tool to screen for PTSD in traumatized, preschool-age children.     

Dissociative subtype of posttraumatic stress disorder in women in partial and residential levels of psychiatric care

ABSTRACT

The dissociative subtype of posttraumatic stress disorder (PTSD) is estimated to characterize about 12-30% of those with PTSD. Some research links this subtype with increased severity of PTSD symptoms compared to samples with “classic” PTSD. However, prevalence and severity rates reported in the literature have varied. One possible explanation for these discrepancies could be related to where the populations were sampled. Therefore, we investigated whether these differences are still observed when holding level of care constant. We collected data from 104 women at a partial and residential psychiatric hospital program focused on trauma-related disorders. Participants completed self-report questionnaires assessing trauma exposure, symptoms and provisional diagnosis of PTSD, trauma-related thoughts and beliefs, and feelings of shame. All participants reported a history of childhood and/or adulthood trauma exposure. Eighty-eight (85%) met criteria for PTSD, and of those, seventy-three (83%) met criteria for the dissociative subtype as assessed by the Dissociative Subtype of PTSD Scale. A series of independent t-tests revealed no significant differences between the “classic” and dissociative PTSD groups with respect to lifetime or childhood trauma exposure, posttraumatic cognitions, shame, or overall PTSD severity. Our results suggest that samples with classic PTSD and the dissociative subtype may not differ in some types of symptom severity when holding level of care constant. Importantly, however, we found at partial/residential level of care the majority of patients with PTSD were dissociative. Given the elevated prevalence rate in this sample, these findings support the need to assess dissociative symptoms, particularly in more acute psychiatric settings.     

Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder

This study tested the proposal that negative appraisals represent a risk factor for developing posttraumatic stress disorder (PTSD) after trauma. Trainee firefighters (N = 68) were assessed during training (before trauma exposure) for PTSD, history of traumatic events, and tendency to engage in negative appraisals. Firefighters were reassessed 4 years later (N = 52), after commencing firefighter duty (after trauma exposure), for PTSD and depression using the Posttraumatic Stress Disorder Scale (E. B. Foa, L. Cashman, L. Jaycox, & K. Perry, 1997) and the Beck Depression Inventory (Version 2; A. T. Beck, R. A. Steer, & G. K. Brown, 1996). At follow-up, 12% met criteria for PTSD. Pretrauma negative appraisals about oneself accounted for 20% of variance in PTSD severity at follow-up. These data provide the first evidence that preexisting negative appraisals are a risk factor for PTSD.     

Unresolved attachment, PTSD, and dissociation in women with childhood abuse histories

The primary objective of this study was to examine unresolved trauma as assessed by the Adult Attachment Interview and current psychiatric symptoms, focusing on posttraumatic stress disorder (PTSD) and dissociation, in a group of adult female childhood abuse survivors. The authors examined psychiatric symptoms and attachment representations in a group with (n = 30) and without (n = 30) abuse-related PTSD. The findings revealed that unresolved trauma carried a 7.5-fold increase in the likelihood of being diagnosed with PTSD and was most strongly associated with PTSD avoidant symptoms rather than dissociative symptoms. The utility of a PTSD framework for understanding unresolved trauma and the role of intentional avoidance of trauma cues in the maintenance of traumatized states of mind are discussed.     

Trauma exposure,posttraumatic stress,and preventive health behaviours: a systematic review

Psychological trauma has implications for many aspects of physical health, including preventive health behaviours (PHBs). However, whether trauma exposure additionally contributes to PHBs above and beyond the effects of posttraumatic stress disorder (PTSD) symptoms remains unclear. In this systematic review, 32 studies were analysed to characterise: (1) the relationships between trauma exposure and PHBs, (2) the relationships between PTSD symptoms and PHBs, (3) the unique associations between trauma exposure and PHBs, independent of PTSD symptoms, and (4) the unique associations between PTSD symptoms and PHBs, independent of trauma exposure. Findings were variable across the three examined PHBs (physical activity, diet, medical screening) when only trauma exposure or PTSD symptoms were taken into account. Clearer relationships emerged between trauma exposure and PHBs when PTSD symptoms were taken into account, demonstrating that trauma exposure is related to PHB engagement above and beyond the effects of PTSD symptoms. Additionally, PTSD symptoms shared unique associations with physical activity and screening frequency, which were not explained by trauma exposure. Our review reveals that teasing apart the effects of trauma exposure and PTSD symptoms on PHBs brings greater clarity to the strength and direction of these associations.     

The relationship of sociotropy and autonomy to posttraumatic cognitions and PTSD symptomatology in trauma survivors

The current study examined relationships between sociotropic and autonomous personality styles and posttraumatic stress disorder (PTSD) symptomatology following trauma as well as specific posttraumatic cognitions that have been shown to characterize individuals with PTSD. Self-report data were collected in a sample of 156 college students indicating a history of traumatic experience. Significant relationships were found between symptoms of PTSD and depression and measures of sociotropy, autonomy, and negative posttraumatic beliefs about self and world. Additionally, measures of autonomy and negative posttraumatic thoughts improved prediction of PTSD symptom level after controlling for depressive symptoms.     

Trauma exposure and mental health outcomes among Central American and Mexican children held in immigration detention at the United States–Mexico border

We explored the associations between early-life adversity and migration-related stress on the mental health of Central American and Mexican migrating children held in United States immigration detention facilities. Migrating children have high rates of trauma exposure prior to and during migration. Early-life adversity increases risk for developing mental health disorders. Forced separation of migrating children from their parents at the United States–Mexico border potentially exacerbates this risk. We sought to determine whether exposure to trauma prior to immigration and specific features of immigration detention were associated with posttraumatic stress symptomatology. We interviewed parents of 84 migrating children (ages 1–17) after families were released from immigration detention facilities to assess children's migration- and detention-related experiences. A modified version of the University of California Los Angeles Posttraumatic Stress Disorder (PTSD) Reaction Index was administered to assess children's PTSD symptoms and document trauma exposure. A total of 97.4% of children experienced at least one premigration traumatic event. PTSD symptom severity was most strongly predicted by premigration trauma and duration of parent–child separation. This study contributes to a growing empirical literature documenting that early-life adversity increases risk of developing mental health disorders, particularly following additional stress exposure, and that remaining with parents during immigration detention may help mitigate children's stress response.     

Posttraumatic stress disorder following assault: the role of cognitive processing,trauma memory,and appraisals

Two studies of assault victims examined the roles of (a) disorganized trauma memories in the development of posttraumatic stress disorder (PTSD), (b) peritraumatic cognitive processing in the development of problematic memories and PTSD, and (c) ongoing dissociation and negative appraisals of memories in maintaining symptomatology. In the cross-sectional study (n = 81), comparisons of current, past, and no-PTSD groups suggested that peritraumatic cognitive processing is related to the development of disorganized memories and PTSD. Ongoing dissociation and negative appraisals served to maintain PTSD symptoms. The prospective study (n = 73) replicated these findings longitudinally. Cognitive and memory assessments completed within 12-weeks postassault predicted 6-month symptoms. Assault severity measures explained 22% of symptom variance; measures of cognitive processing, memory disorganization, and appraisals increased prediction accuracy to 71%.     

Predictors of posttraumatic stress among victims of motor vehicle accidents

OBJECTIVE: This study identified factors that predict individual vulnerability to psychological trauma by examining the relationships among situation and person variables and symptoms of posttraumatic stress disorder (PTSD) 1, 6, and 12 months after a serious motor vehicle accident (MVA). METHODS: Background characteristics, exposure variables (ie, injury severity and accident characteristics), and psychosocial variables (ie, perceived loss of control, social support, and coping) were used to predict symptoms of PTSD and recovery in 115 injured MVA victims. All participants were injured during the MVA and provided data prospectively over the course of a year after their accidents. RESULTS: Along with background and exposure variables, use of wishful thinking coping distinguished between victims with and without symptoms of PTSD. CONCLUSIONS: Psychosocial variables such as wishful thinking coping can be used to identify MVA victims who are at risk of developing chronic posttraumatic stress and warrant further investigation.     

Caregiver traumatization adversely impacts young children's mental representations on the MacArthur Story Stem Battery

The aim of our study was to investigate the impact of maternal exposure to family violence, maltreatment, and related posttraumatic stress disorder (PTSD) on young children's mental representations of self and caregivers. Participant mothers (n=24) and children (n=25) were recruited from a referred sample when they were 4-7 years old. Maternal report and child story stem narratives were used. Mother's experience of domestic violence and severity of violence-related PTSD symptoms robustly predicted more dysregulated aggression, attentional bias to danger and distress, as well as more avoidance of and withdrawal from conflicts presented in the children's story stems. Less narrative coherence was also noted. Traumatized mothers experience and symptoms prior to their child's turning 4 years old adversely affected their child's mental representations from 4-7 years.     

Current measures of PTSD for children and adolescents

OBJECTIVE: To review measures of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PSS) for children and adolescents. METHODS: We reviewed broad-based child mental health journals within the disciplines of pediatrics, child psychology, and trauma, from 1995 to 2004, to identify measures of PTSD and PSS for children and adolescents. The review includes a summary of the psychometric properties and associated features of the measures and the clinical domains and types of studies using each measure. RESULTS: Seven measures of PTSD and PSS were identified, including clinician-administered interviews and self-report questionnaires. Sixty-five articles containing the measures were categorized into eight trauma domains. We found there is little consensus over measures used within each trauma domain. CONCLUSIONS: Few measures of PTSD and PSS have been designed specifically for young people. Further directions for measurement of PTSD in this age group are discussed to prevent under-diagnosis and under-treatment for youth.     

Exposure to traumatic incidents and prevalence of posttraumatic stress symptomatology in urban firefighters in two countries

Urban firefighters are at risk for posttraumatic stress disorder (PTSD) due in part to their exposure to duty-related trauma. This study compared duty-related trauma exposures and the prevalences of posttraumatic stress in U.S. and Canadian firefighters. Both samples reported relatively numerous and frequent posttrauma symptoms, and the rates of self-reported PTSD prevalence did not differ significantly. However, analysis of departmental records for respondents' previous year on duty revealed significant differences in both frequencies and categories of traumatic incident exposures. Some of the vulnerability and moderating risk factors associated with PTSD caseness differed between the U.S. and Canadian samples. Potential explanations for the observed differences in risk factors for PTSD in these 2 firefighter samples are considered.     

Posttraumatic stress in children following acute physical injury.

OBJECTIVE: To prospectively assess the presence of posttraumatic stress disorder (PTSD) in children hospitalized following acute physical injury. The focus was identification of the incidence of PTSD, PTSD symptoms, and exploration of factors associated with development of PTSD symptoms and disorder. METHOD: Forty children ages 8-17 were interviewed approximately 1 month following a serious injury and assessed for PTSD, pretrauma behavior problems, levels of peritraumatic fear, and posttraumatic thought suppression. RESULTS: Twenty-two and a half percent of participants met DSM-IV diagnostic criteria for PTSD; 47.5% met criteria for at least two of the three PTSD symptom clusters. Greater thought suppression was associated with increased symptoms of PTSD, as were the child's peritraumatic fear response and pretrauma internalizing behaviors. CONCLUSIONS: Results suggest that many children who have been hospitalized for physical trauma may be experiencing clinically significant PTSD symptomatology and may benefit from psychological as well as medical intervention.     

Psychological Consequences of Human Trafficking: Complex Posttraumatic Stress Disorder in Trafficked Children

Trafficked children are frequently exposed to multiple traumatic events, including during their recruitment, transit, and exploitation. It has been hypothesized that such exposures can lead to the development of Complex Posttraumatic Stress Disorder (PTSD). Complex PTSD includes (in addition to the core PTSD symptoms of re-experiencing, avoidance, and hyperarousal) disturbances in affect regulation, dissociation, self-concept, interpersonal relationships, somatization, and systems of meaning. This historical cohort study aimed to investigate Complex PTSD in trafficked children with a diagnosis of PTSD and compare these with nontrafficked controls exposed to single or multiple trauma. Trafficked children were identified by keyword searches of the electronic health records of more than 250,000 mental health service users; a matched cohort of nontrafficked children was randomly selected. Regression models compared the number of Complex PTSD symptoms in trafficked children and non-trafficked children who had experienced multiple or single trauma. Fifty-one trafficked children were identified: eleven with a diagnosis of PTSD (22%). A high proportion of trafficked children with PTSD had Complex PTSD symptoms. Trafficked and non-trafficked children with PTSD who had been exposed to multiple trauma showed a greater number of Complex PTSD symptoms compared to nontrafficked children with PTSD exposed to single-event traumas. Somatic symptoms were noted for almost two-thirds of the trafficked children but only 10%–11% of the nontrafficked children. Child trafficking and multiple trauma exposure are associated with more complex posttraumatic presentations. A thorough clinical assessment at intake is crucial to ensure additional symptoms can be meaningfully incorporated into treatment plans.     

A Prospective Test of the Association Between Hyperarousal and Emotional Numbing in Youth With a History of Traumatic Stress

Investigated the hypothesis that emotional numbing may develop as a result of hyperarousal using a prospective design. Forty-two children between the ages of 7 and 14 with a history of trauma and posttraumatic stress disorder (PTSD) symptoms were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA; Nader et al., 1996) and were reassessed 1 year later. Results indicated that hyperarousal symptoms were concurrently positively correlated with emotional numbing at both time points. Moreover, Time 1 hyperarousal symptoms were associated with emotional numbing at Time 2 and predicted Time 2 emotional numbing even when controlling for each of the other symptom clusters of PTSD at Time 1 as well as other concurrent (i.e., Time 2) PTSD symptoms. Results are discussed in terms of the implications of the findings for enhancing the understanding of PTSD symptoms in youth.