Traumatic stress in late pregnancy

Traumatic stress has traditionally been studied in the aftermath of traumatic events. In contrast, this study aimed to explore if traumatic stress can occur before an event that is perceived as threatening or feared. Traumatic stress, as related to the forthcoming delivery, was studied in 1224 women. Background data and psychological characteristics were assessed in early pregnancy and traumatic stress and fear of childbirth in late pregnancy. Of all subjects, 2.3% met all DSM-IV criteria for posttraumatic stress disorder (PTSD) and 5.8% fulfilled criteria B, C, and D in late pregnancy. Traumatic stress and fear of childbirth correlated significantly. High trait anxiety, depressive symptomatology, psychological/psychiatric counseling related to childbirth, and self-reported psychological problems, measured in early pregnancy, were risk factors for traumatic stress and fear of childbirth in late pregnancy. Results suggest the occurrence of "pre"traumatic stress (i.e., a threatening forthcoming event provoking symptoms similar to those after a traumatic event).     

Traumatic events and posttraumatic stress in childhood

CONTEXT: Traumatic events are common and are related to psychiatric impairment in childhood. Little is known about the risk for posttraumatic stress disorder (PTSD) across different types of trauma exposure in children. OBJECTIVE: To examine the developmental epidemiology of potential trauma and posttraumatic stress (PTS) in a longitudinal community sample of children. METHODS: A representative population sample of 1420 children aged 9, 11, and 13 years at intake were followed up annually through 16 years of age. Main Outcome Measure Traumatic events and PTS were assessed from child and parent reports annually to 16 years of age. Risk factors and DSM-IV disorders were also assessed. RESULTS: More than two thirds of children reported at least 1 traumatic event by 16 years of age, with 13.4% of those children developing some PTS symptoms. Few PTS symptoms or psychiatric disorders were observed for individuals experiencing their first event, and any effects were short-lived. Less than 0.5% of children met the criteria for full-blown DSM-IV PTSD. Violent or sexual trauma were associated with the highest rates of symptoms. The PTS symptoms were predicted by previous exposure to multiple traumas, anxiety disorders, and family adversity. Lifetime co-occurrence of other psychiatric disorders with traumatic events and PTS symptoms was high, with the highest rates for anxiety and depressive disorders. CONCLUSIONS: In the general population of children, potentially traumatic events are fairly common and do not often result in PTS symptoms, except after multiple traumas or a history of anxiety. The prognosis after the first lifetime trauma exposure was generally favorable. Apart from PTSD, traumatic events are related to many forms of psychopathology, with the strongest links being with anxiety and depressive disorders.     

Traumatic stress: effects on the brain

Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. Traumatic stress can be associated with lasting changes in these brain areas. Traumatic stress is associated with increased cortisol and norepinephrine responses to subsequent stressors. Antidepressants have effects on the hippocampus that counteract the effects of stress. Findings from animal studies have been extended to patients with post-traumatic stress disorder (PTSD) showing smaller hippocampal and anterior cingulate volumes, increased amygdala function, and decreased medial prefrontal/anterior cingulate function. In addition, patients with PTSD show increased cortisol and norepinephrine responses to stress. Treatments that are efficacious for PTSD show a promotion of neurogenesis in animal studies, as well as promotion of memory and increased hippocampal volume in PTSD.     

Traumatic stress in the 21st century

OBJECTIVE: The introduction to a series of articles on traumatic stress aims to examine the ambivalent relationship between traumatic stress and psychiatry. It provides an outline to the very significant contribution that this field made before the conceptualisation of posttraumatic stress disorder (PTSD) and how the research and theoretical thinking in this field can provide many insights into the relationship between environmental factors and psychological health. It focuses on the relevance of this field to general psychiatry. RESULT: Posttraumatic stress disorder has emerged as the most common anxiety disorder in women. As well, there are high rates discovered in a range of chronically ill psychiatric patient populations. In particular, strategies for dealing with the issues of childhood abuse and neglect are not often considered by adult psychiatric services for the chronically and severely mentally ill, despite there being important predictors of suicidal behaviour, hospitalisation and prolonged disability. An effective consideration of the available evidence is often complicated by concerns about the impact of financial compensation on the presentation of psychopathology. This is a complex social dialectic whose impact is important to the practise of psychiatry. Equally, this field in itself must avoid becoming excessively rigid in its clinical definitions and the particular interventions which are espoused. CONCLUSIONS: The impact of traumatic events on long-term psychological adjustment and physical health have been under estimated. Identification of those at risk is an important issue given that effective treatments are now available. This is an area in which further conceptual thinking is required. It also provides particular opportunities to explore the biological processes of, and interaction between, the environment and the underlying genetic and neurobiological processes which are critical to the modulation of psychopathology.     

Traumatic stress: a personal view from combat

What follows is my personal account of the effects of traumatic stress disorder as it is caused by the effects of combat. I tell it in the first person because it is the most effective way to emphasize the highly personal, traumatic nature of combat stress and because it is my own story. I have endeavored to explain how combat stress occurs, what happens to the individual as a result and how a person can recover from its effects. I offer my story because I think that there are thousands of men who have been in offensive combat, who may have lived my life, but who have not had the opportunity to tell their story about why they hurt.     

Traumatic experiences,post-traumatic stress disorder and obsessive-compulsive disorder

This paper explores the links between traumatic experiences, post-traumatic stress disorder and obsessive-compulsive disorder. The development of obsessions and compulsions following trauma is noted, with case examples. The similarities in some aspects of the two disorders are also highlighted. Comments are made on the possible causal pathways, and on treatment implications.     

Traumatic stress responses in treatment-seeking earthquake survivors in Turkey

This study examined the incidence of posttraumatic stress disorder (PTSD) and depression in 1,027 earthquake survivors who were consecutively referred to a community center at a mean of 14 months after the August 1999 earthquake in Turkey. Seventy-seven percent of referrals were women. The estimated rates of PTSD and major depression were 63% and 42%, respectively. More severe PTSD symptoms related to greater fear during the earthquake, female gender, lower education, loss of friends, shorter time since the earthquake, and material loss. More severe depression symptoms related to female gender, longer time since the earthquake, lower educational level, loss of a family member, and past psychiatric illness. In conclusion, long-term public mental health policies are needed for postearthquake psychological problems. These policies need to take into account the risk factors for traumatic stress and the gender differences in referral patterns. The differential stressor-response relationship may have important implications for treatment.     

Posttraumatic stress disorder symptom severity predicts aggression after treatment

This study examined the relation between posttraumatic stress disorder (PTSD) severity and aggression (verbal, psychological, and physical aggression) in a longitudinal dataset. Participants were 175 males in PTSD residential treatment who were assessed at pre-treatment, post-treatment, and at 4-month follow-up. Post-treatment PTSD severity predicted aggression at post-treatment and 4-month follow-up, adjusting for age, pre-treatment PTSD severity, and pre-treatment aggression. When examining the relation between aggression and specific PTSD symptom clusters, post-treatment Reexperiencing, Avoidance/Numbing and Hyperarousal symptoms predicted aggression at posttreatment and 4-month follow-up. These results support the hypothesis that post-treatment PTSD severity may be an important marker of post-treatment aggression risk and may offer unique information important to clinicians and patients focused on the development and maintenance of adaptive, non-aggressive relationships after intensive PTSD treatment.     

Opioid and non-opioid stress analgesia from cold water swim: importance of stress severity

We have previously reported that stress severity plays an important role in determining the neurochemical basis of stress-induced analgesia from inescapable footshock. Increasing severity (duration or intensity of continuous footshock) causes a shift in mediation of the resultant analgesia from opioid to non-opioid. In this study, we find that stress severity plays a similar role in analgesia from cold water swim. More severe swims (longer duration or lower water temperature) produce stress analgesia insensitive to the opiate antagonist, naltrexone, whereas less severe swims produce analgesia significantly attenuated by this drug.     

Traumatic memories of childbirth relate to maternal postpartum posttraumatic stress disorder

The trauma memory is a crucial feature of PTSD etiology and maintenance. Nonetheless, the nature of memories associated with childbirth-related posttraumatic stress disorder (CB-PTSD) requires explication. The present study, as part of a larger project on psychological outcomes of childbirth, utilized a multi-method approach to characterize childbirth memories in relation to CB-PTSD symptoms. We here assessed 413 women who completed self-report measures pertaining to CB-PTSD, postpartum depression, and childbirth memories. Additionally, a subset of 209 women provided written childbirth narratives, analyzed using Linguistic Inquiry and Word Count software. Women endorsing CB-PTSD symptoms on the PTSD-Checklist (PCL)-5 reported more incoherent childbirth memories with more emotional and sensory details, and more frequent involuntary recall and reliving of the memory. They also indicated the childbirth experience was more central to their identity. Written narratives in those with probable CB-PTSD were characterized by less (positive) affective processes, and more cognitive processes. We infer that childbirth memories in women who endorse symptoms of CB-PTSD in the early postpartum period resemble those described in the general PTSD literature. This suggests that childbirth may be experienced as traumatic and evoke a traumatic memory, implicated in symptom endorsement. Opportunities for therapeutic interventions modifying traumatic memories of childbirth in women at risk for CB-PTSD need to be investigated. Future research examining characteristics of traumatic childbirth memories is needed to advance our understanding of this overlooked postpartum condition.     

Social stress alters the severity of acute Theiler's virus infection

Our laboratory has previously shown that restraint stress resulted in decreased Theiler's virus-induced CNS inflammation, while exacerbating illness behaviors during the acute phase of disease. In contrast, social disruption stress (SDR) applied prior to infection led to the development of glucocorticoid (GC) resistance, and these animals developed more severe disease course, with increased inflammation. However, when SDR was applied concurrent with infection, GC resistance fails to develop, disease course is less severe and inflammation was moderate. These results suggest that the effects of SDR on Theiler's virus infection are dependent upon the timing of SDR application in relation to infection.     

Traumatic stress, brain changes, and memory deficits: a critical note

Memory deficits are frequently observed in posttraumatic stress disorder. According to some authors, these memory impairments are a result of hippocampal damage caused by traumatic stress. This article contains a critical review of studies on changes in hippocampal volume and memory performance in posttraumatic stress disorder. We conclude that most studies in this area suffer from methodological weaknesses and therefore do no allow for firm conclusions about the causal linkage among traumatic stress, hippocampal functioning, and memory. Suggestions for future research, circumventing methodological flaws, are given.     

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.     

Traumatic stress disorder: diagnostic and clinical issues in former prisoners of war

Examined are a variety of clinical issues in the diagnosis and treatment of Posttraumatic Stress Disorder (PTSD) of former prisoners of war (POWs). Difficulties and complexities in understanding and diagnosing PTSD in former POWs presenting symptomatic complaints associated with this disorder are explored. Data collected on former POWs complaining of PTSD and diagnosed by DSM-III-R criteria revealed Minnesota Multiphasic Personality Inventory (MMPI) and Millon Clinical Multiaxial Inventory (MCMI) clinical profiles appropriate for clinical application. Comparative data between German-held and Japanese-held POWs experiencing PTSD and adjustment-related stressors are discussed. Import on clinical strategies with diagnosed patients suggests both behavioral approaches to treatment and future directions in research.     

The influence of early and recent life stress on severity of depression

The influence of life stressors arising in different life stages on the severity of depression was examined in a sample of 123 depressive women, ranging from 22 to 64 years of age. In an interview, information was obtained on the incidence of certain life stressors in early and recent periods. The severity of depression was measured using the Beck Depression Inventory. The results indicate that experience of physical or sexual abuse before the age of 19 is strongly associated with severity of depression. Also, most women suffering from severe depression had previous and recent difficulties in their relationships with parents, partner or others and recent problems with self-esteem. A hypothetical model for predicting the severity of depression was evaluated. Difficulties experienced one year prior to assessment appeared to directly predict severity of depression. Difficulties with social relationships whose origin could be traced back to early periods and that had a continuing effect throughout life were found to be crucial factors for indirectly predicting the severity of depression.     

Psychotic features in chronic posttraumatic stress disorder and schizophrenia: comparative severity

Psychotic features are frequent in combat veterans with chronic posttraumatic stress disorder (PTSD), may correlate with severity of PTSD symptoms, and may reflect a distinct subtype of the disorder. These psychotic features include auditory and visual hallucinations and delusional thinking that is usually paranoid in nature. Psychotic features may be under-recognized in chronic PTSD because patients are reluctant to report these symptoms and because they may not have overt changes in affect or bizarre delusions characteristic of other psychoses, e.g., schizophrenia. To further assess these phenomena, we compared clinical ratings on the Positive and Negative Syndrome Scale (PANSS) and other assessments, including the Clinical Global Impression Scale and the Structured Clinical Interview with Psychotic Screen, in veterans meeting DSM-IV criteria for chronic PTSD with well-defined comorbid psychotic features (N = 40) or chronic schizophrenia (N = 40). The patients with schizophrenia had modestly higher composite PANSS scores and positive symptom scores although average scores in both groups were moderate to severe in intensity. Negative symptom and general psychopathology subscale scores were comparable in both groups. Regarding specific positive symptoms, hallucinations were comparable between groups in severity; however, schizophrenia patients had slightly more intense delusions and conceptual disorganization. These data further validate the occurrence of positive as well as negative symptoms of psychosis in chronic PTSD in a range of severity that may approach that of patients with schizophrenia. Although meeting DSM-IV criteria for two different major psychiatric disorders, these two patient populations were remarkably similar with respect to not only positive but also negative symptoms.