Latest Research - 2016

MATERNAL EXPOSURE TO INTIMATE PARTNER ABUSE BEFORE BIRTH IS ASSOCIATED WITH AUTISM SPECTRUM DISORDED IN OFFSPRING

Roberts, A. L., Lyall, K., Rich-Edwards, J. W., Ascherio, A., & Weisskopf, M. G.

We sought to determine whether maternal (a) physical harm from intimate partner abuse during pregnancy or (b) sexual, emotional, or physical abuse before birth increased risk of autism spectrum disorder. We calculated risk ratios for autism spectrum disorder associated with abuse in a population-based cohort of women and their children (54,512 controls, 451 cases). Physical harm from abuse during pregnancy was not associated with autism spectrum disorder. However, autism spectrum disorder risk was increased in children of women who reported fear of partner or sexual, emotional, or physical abuse in the 2 years before the birth year (abuse in the year before the birth year: risk ratio = 1.58, 95% confidence interval = 1.04, 2.40; abuse in both of the 2 years before the birth year: risk ratio = 2.16, 95% confidence interval = 1.33, 3.50). Within-family results were similar, although did not reach statistical significance. Association of intimate partner abuse before the child’s birth year with autism spectrum disorder in the child was not accounted for by gestation length, birth weight, maternal smoking or alcohol consumption during pregnancy, gestational diabetes, preeclampsia, or history of induced abortion.

Roberts, A. L., Lyall, K., Rich-Edwards, J. W., Ascherio, A., & Weisskopf, M. G. (2016). Maternal exposure to intimate partner abuse before birth is associated with autism spectrum disorder in offspring. Autism, 20(1), 26-36. [retrieved 11/07/2016]: http://aut.sagepub.com/content/20/1/26.short

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DISSOCIATION IN PATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS : WHAT IS THE ROLE OF DIFFERENT TYPES OF CHILDHOOD ADVERSITY ?

Schroeder, K., Langeland, W., Fisher, H. L., Huber, C. G., & Schäfer, I.

Aims: Our study aimed to explore the effects of different types of adverse childhood experiences (e.g. domestic violence, early loss, parental dysfunction, sexual and physical abuse) as well as experiences of sexual and physical abuse in adulthood on dissociative symptoms in adult patients with schizophrenia-spectrum disorders.

Methods: 145 patients were examined for psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS), for dissociative symptoms with the German version of the Dissociative Experiences Scale (DES) and for adverse experiences in childhood and adulthood with the Structured Trauma Interview (STI).

Results: Childhood physical abuse was reported by 32%, childhood sexual abuse by 17% of the patients. Other forms of childhood adversity were also quite common; 18% had witnessed domestic violence, 26% reported early loss, and nearly half of patients reported at least one condition potentially related to parental dysfunction. The DES total score was significantly associated with childhood sexual abuse, witnessing of domestic violence and paternal dysfunction, as well as with physical violence in adulthood. In the final regression model, reports of paternal dysfunction and sexual abuse in childhood were independently associated with adult dissociation. Variance in dissociative symptoms was mainly explained by paternal dysfunction (18%).

Conclusion: Substantial rates of childhood adversity were found and specific associations were evident with adult dissociation amongst psychosis patients who reported sexual abuse or paternal dysfunction in childhood. Therefore, it is important that patients with schizophrenia-spectrum disorders are routinely asked about a broad range of possible adverse childhood experiences in order to provide appropriate interventions.

Schroeder, K., Langeland, W., Fisher, H. L., Huber, C. G., & Schäfer, I. (2016). Dissociation in patients with schizophrenia spectrum disorders: What is the role of different types of childhood adversity?. Comprehensive psychiatry, 68, 201-208. Online [retrieved 11/07/2016]: http://www.sciencedirect.com/ science/article/pii/S0010440X15300420

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ATTENTION-DEFICIT/HYPERACTIVITY DISORDER CASTS A LONG SHADOW : FINDINGS FROM A POPULATION-BASED STUDY OF ADULT WOMEN WITH SELF-REPORTED ADHD

Fuller Thomson, E., Lewis, D. A., & Agbeyaka, S. K.

Background: To develop a sociodemographic and health profile of women with self-reported attention deficit/hyperactivity disorder (ADHD) in comparison to women without.

Methods: Chi-square tests and logistic regression analyses were conducted on data from the nationally representative Canadian Community Health Survey-Mental Health (2012) comparing 107 women aged 20 to 39 years (inclusive) with ADHD to 3801 without ADHD. Depression, generalized anxiety disorder and substance abuse were measured using the WHO-CIDI.

Results: Women with ADHD had triple the prevalence of insomnia, chronic pain, suicidal ideation, childhood sexual abuse and generalized anxiety disorder and double the prevalence of substance abuse, current smoking, depressive disorders, severe poverty and childhood physical abuse in comparison with women without ADHD (all P < 0.001). Even after adjustments for age, race, education and income, women with ADHD had substantially higher odds of a wide range of problems.

Conclusion: Our results suggest that women with ADHD are particularly vulnerable to early adversities, health and mental health problems.

Fuller Thomson, E., Lewis, D. A., & Agbeyaka, S. K. (2016). Attention deficit/hyperactivity disorder casts a long shadow: findings from a population based study of adult women with self reported ADHD. Child: Care, Health and Development, 42(6), 918-927. Online [retrieved 11/07/2016]: http://onlinelibrary.wiley.com/ doi/10.1111/cch.12380/full

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REDUCING THE COST OF DISSOCIATIVE IDENTITY DISORDER : MEASURING THE EFFECTIVENESS OF SPECIALIZED TREATMENT BY FREQUENCY OF CONTACTS WITH MENTAL HEALTH SERVICES

Lloyd, M.

It is important to understand and record the impact of therapy on severe mental health conditions through the use of clinical assessment measures. In this article, I propose to extend out- come evaluation by measuring service use and cost prior to and during the commencement of psychological therapy over a period of 4 years for 2 people diagnosed with dissociative identity disorder. The treatment was provided within an out- patient setting in a U.K. National Health Service hospital trust following therapeutic guidelines set out by the International Society for the Study of Trauma and Dissociation. Results show that service use in both inpatient and out-of-hours crisis services reduced as the 2 people received therapy over the 4-year time period. Based on these 2 cases, it appears to be cost effective to provide specialized therapy for dissociative identity disorder in outpatient settings.

Lloyd, M. (2016). Reducing the cost of dissociative identity disorder: Measuring the effectiveness of specialized treatment by frequency of contacts with mental health services. Journal of Trauma & Dissociation, 17(3), 362-370. Online [retrieved 11/07/2016]: http://www.tandfonline.com/doi/abs/10.1080 /15299732.2015.1108947

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ASSESSMENT OF COMPLEX DISSOCIATIVE DISORDER PATIENTS AND SIMULATED DISSOCIATION IN FORENSIC CONTEXTS

Brand, B. L., Webermann, A. R., & Frankel, A. S.

Few assessors receive training in assessing dissociation and complex dissociative disorders (DDs). Potential differential diagnoses include anxiety, mood, psychotic, substance use, and personality disorders, as well as exaggeration and malingering. Individuals with DDs typically elevate on many clinical and validity scales on psychological tests, yet research indicates that they can be distinguished from DD simulators. Becoming informed about the testing profiles of DD individuals and DD simulators can improve the accuracy of differential diagnoses in forensic settings. In this paper, we first review the testing profiles of individuals with complex DDs and contrast them with DD simulators on assessment measures used in forensic contexts, including the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Personality Assessment Inventory (PAI), and the Structured Inventory of Reported Symptoms (SIRS), as well as dissociation-specific measures such as the Dissociative Experiences Scale (DES) and Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). We then provide recommendations for assessing complex trauma and dissociation through the aforementioned assessments.

Brand, B. L., Webermann, A. R., & Frankel, A. S. (2016). Assessment of complex dissociative disorder patients and simulated dissociation in forensic contexts. International Journal of Law and Psychiatry. Online [retrieved 11/07/2016]: http://www.sciencedirect.com/science/article/pii/S0160252716302278

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THE DEVELOPMENTAL ROOTS OF DISSOCIATION : A MULTIPLE MEDIATION ANALYSIS

Schimmenti, A.

The current study was aimed to test a developmental model of dissociation. This model is based on clinical observations and research findings concerning the role of childhood emotional neglect in the development and maintenance of dissociative symptoms. Seven hundred ninety-two adult volunteers completed questionnaires on parental bonding, theory of mind, alexithymia, and dissociation. Significant associations were found between the investigated variables, and a multiple mediation analysis showed that the relationship between childhood emotional neglect and dissociation was totally mediated by theory of mind and alexithymia. The findings of this study support the view that childhood experiences of emotional neglect may foster difficulties mentalizing as well as problems with affect regulation, with these two factors interacting to generate excessively activated dissociative processes. This may suggest that individuals who were exposed to emotional neglect during their childhood and who currently suffer from dissociative symptoms may greatly benefit from clinical interventions aimed to foster mentalized affectivity.

Schimmenti, A. (2016). The Developmental Roots of Dissociation: A Multiple Mediation Analysis. Online [retrieved 11/07/2016]: http://psycnet.apa.org/psycinfo/2016-21260-001/

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SYSTEMIC CASE FORMULATION, INDIVIDUALIZED PROCESS MONITORING, AND STATE DYNAMICS IN A CASE OF DISSOCIATIVE IDENTITY DISORDER

Schiepek, G. K., Stöger-Schmidinger, B., Aichhorn, W., Schöller, H., & Aas, B.

Objective: The aim of this case report is to demonstrate the feasibility of a systemic procedure (synergetic process management) including modeling of the idiographic psychological system and continuous high-frequency monitoring of change dynamics in a case of dissociative identity disorder. The psychotherapy was realized in a day treatment center with a female client diagnosed with borderline personality disorder (BPD) and dissociative identity disorder.

Methods: A three hour long co-creative session at the beginning of the treatment period allowed for modeling the systemic network of the client's dynamics of cognitions, emotions, and behavior. The components (variables) of this idiographic system model (ISM) were used to create items for an individualized process questionnaire for the client. The questionnaire was administered daily through an internet-based monitoring tool (Synergetic Navigation System, SNS), to capture the client's individual change process continuously throughout the therapy and after-care period. The resulting time series were reflected by therapist and client in therapeutic feedback sessions.

Results: For the client it was important to see how the personality states dominating her daily life were represented by her idiographic system model and how the transitions between each state could be explained and understood by the activating and inhibiting relations between the cognitive-emotional components of that system. Continuous monitoring of her cognitions, emotions, and behavior via SNS allowed for identification of important triggers, dynamic patterns, and psychological mechanisms behind seemingly erratic state fluctuations. These insights enabled a change in management of the dynamics and an intensified trauma-focused therapy.

Conclusion: By making use of the systemic case formulation technique and subsequent daily online monitoring, client and therapist continuously refer to detailed visualizations of the mental and behavioral network and its dynamics (e.g., order transitions). Effects on self-related information processing, on identity development, and toward a more pronounced autonomy in life (instead of feeling helpless against the chaoticity of state dynamics) were evident in the presented case and documented by the monitoring system.

Schiepek, G. K., Stöger-Schmidinger, B., Aichhorn, W., Schöller, H., & Aas, B. (2016). Systemic Case Formulation, Individualized Process Monitoring, and State Dynamics in a Case of Dissociative Identity Disorder. Frontiers in Psychology, 7, 1545. Online [retrieved 11/07/2016]:

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.01545/full

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IS THERE A COMPLEX RELATION BETWEEN SOCIAL ANXIETY DISORDER, CHILDHOOD TRAUMATIC EXPERIENCES AND DISSOCIATION ?

Belli, H., Akbudak, M., Ural, C., Solmaz, M., Dogan, Z., & Konkan, R.

Background: A possible relationship has been suggested between social anxiety and dissociation. Traumatic experiences, especially childhood abuse, play an important role in the aetiology of dissociation.

Aim: This study assesses childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with social anxiety disorder (SAD).

Method: The 94 psychotropic drug-naive patients participating in the study had to meet DSM-IV criteria for SAD. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the Dissociation Questionnaire (DIS-Q), the Liebowitz Social Anxiety Scale (LSAS), and the Childhood Trauma Questionnaire (CTQ). Patients were divided into two groups using the DIS-Q, and the two groups were compared.

Results: The evaluation found evidence of at least one dissociative disorder in 31.91% of participating patients. The most prevalent disorders were dissociative disorder not otherwise specified (DDNOS), dissociative amnesia, and depersonalization disorders. Average scores on LSAS and fear and avoidance sub-scale averages were significantly higher among the high DIS-Q group (p < .05). In a logistic regression taking average LSAS scores as the dependent variable, the five independent variables DIS-Q, CTQ-53 total score, emotional abuse, sexual abuse, and emotional neglect were associated with average LSAS scores among patients with SAD (p < .05).

Conclusions: It is concluded that, on detecting SAD symptoms during hospitalization, the clinician should not neglect underlying dissociative processes and traumatic experiences among these patients.

Belli, H., Akbudak, M., Ural, C., Solmaz, M., Dogan, Z., & Konkan, R. (2016). Is there a complex relation between social anxiety disorder, childhood traumatic experiences and dissociation?. Nordic journal of psychiatry, 1-6. Online [retrieved 11/07/2016]: http://www.tandfonline.com/doi/abs/10.1080/08039488.2016.1218050

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 « CALL ME JOHANNA » : THE CHALLENGE OF BUILDING INTIMACY BETWEEN TWO COMPLEX TRAUMA SURVIVORS WITHIN AN ANALYTIC DYAD

Tiemann, J.

The author describes how her experience as a survivor of developmental trauma informs her work with a patient who is also a survivor of developmental trauma, citing both the assets and liabilities that this history brings to her work as an analyst. An extensive clinical interchange between the author and her patient, June, illustrates how the author’s traumatic history both impedes and enhances her work with this patient, focusing on the challenges that creating intimacy between two survivors of trauma presents.

Tiemann, J. (2016). “Call Me Johanna:” The Challenge of Building Intimacy Between Two Complex Trauma Survivors Within An Analytic Dyad. International Journal of Psychoanalytic Self Psychology, 11(1), 75-88. Online [retrieved 11/07/2016]: http://www.tandfonline.com/doi/abs/10.1080/15551024.2016.1107421

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UNIQUE AND OVERLAPPING SYMPTOMS IN SCHIZOPHRENIA SPECTRUM AND DISSOCIATIVE DISORDERS IN RELATION TO MODELS OF PSYCHOPATHOLOGY : A SYSTEMATIC REVIEW

Renard, S. B., Huntjens, R. J., Lysaker, P. H., Moskowitz, A., Aleman, A., & Pijnenborg, G. H.

Schizophrenia spectrum disorders (SSDs) and dissociative disorders (DDs) are described in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as 2 categorically distinct diagnostic categories. However, several studies indicate high levels of co-occurrence between these diagnostic groups, which might be explained by overlapping symptoms. The aim of this systematic review is to provide a comprehensive overview of the research concerning overlap and differences in symptoms between schizophrenia spectrum and DDs. For this purpose the PubMed, PsycINFO, and Web of Science databases were searched for relevant literature. The literature contained a large body of evidence showing the presence of symptoms of dissociation in SSDs. Although there are quantitative differences between diagnoses, overlapping symptoms are not limited to certain domains of dissociation, nor to nonpathological forms of dissociation. In addition, dissociation seems to be related to a history of trauma in SSDs, as is also seen in DDs. There is also evidence showing that positive and negative symptoms typically associated with schizophrenia may be present in DD. Implications of these results are discussed with regard to different models of psychopathology and clinical practice.

Renard, S. B., Huntjens, R. J., Lysaker, P. H., Moskowitz, A., Aleman, A., & Pijnenborg, G. H. (2016). Unique and Overlapping Symptoms in Schizophrenia Spectrum and Dissociative Disorders in Relation to Models of Psychopathology: A Systematic Review. Schizophrenia bulletin, sbw063. Online [retrieved 11/07/2016]: http://schizophreniabulletin.oxfordjournals.org/content/early/2016/05/21/schbul.sbw063.short

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DISSOCIATIVE COMPLEXITY : ANTECEDENTS AND CLINICAL CORRELATES OF A NEW CONSTRUCT

Briere, J., Dietrich, A., & Semple, R. J.

Objective: To the extent that dissociation is a multidimensional phenomenon, and given a growing literature on complex posttraumatic outcomes, we hypothesized a new construct: dissociative complexity (DC). DC is defined as the tendency to simultaneously endorse multiple, relatively independent dissociative dimensions into their clinical ranges, and therefore represents the overall breadth or complexity of an individual’s dissociative response. Method: DC was evaluated in general population and prison participants using the Multiscale Dissociation Inventory (MDI; Briere, 2002). Results: DC was higher among prisoners and women, and, as hypothesized, was associated with cumulative trauma and serious comorbidities (suicidality and substance abuse), even when controlling for generally elevated dissociation. Conclusions: DC appears to be a meaningful clinical construct that is phenomenologically and empirically different from a unidimensional index of dissociative severity. DC may serve as a clinical marker for multiple trauma exposures, complex dissociative outcomes, and risk of problematic comorbidities.

Briere, J., Dietrich, A., & Semple, R. J. (2016). Dissociative Complexity: Antecedents and Clinical Correlates of a New Construct. Online [retrieved 11/07/2016]: http://psycnet.apa.org/psycinfo/2016-17459-001/

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THE RELATONSHIP BETWEEN SYMPTOM SEVERITY AND LOW VITAMIN D LEVELS IN PATIENTS WITH SCHIZOPHRENIA

Bulut, S. D., Bulut, S., Atalan, D. G., Berkol, T., Gürçay, E., Türker, T., & Aydemir, Ç.

Background: In recent years, the relationship between schizophrenia and environmental factors has come into prominence. This study investigated the relationship between vitamin D levels and the positive and negative symptoms of schizophrenia by comparing vitamin D levels between patients with schizophrenia and a healthy control group.

Methods: The study included 80 patients diagnosed with schizophrenia and 74 age- and sex-matched controls. The Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) were used to evaluate symptom severity. The 25-hydroxyvitamin D (25OHD) levels of all subjects both patients and healthy controls were analyzed in relation to measurements of symptom severity.

Results: There were no significant differences between the groups in terms of age, sex, or physical activity. Their mean 25OHD levels were also similar (23.46±13.98ng/mL for the patient group and 23.69±9.61ng/ mL for the control group). But when patients with schizophrenia were grouped based on their vitamin D levels, the results indicated a statistically significant differences between their vitamin D levels and their total SANS, affective flattening, and total SAPS, bizarre behavior and positive formal thought disorder scores (p = 0.019, p = 0.004, p = 0.015, p = 0.009 and p = 0.019, respectively). There is a negative correlation between 25OHD levels and SANS total points (r = -0.232, p = 0.038); a negative correlation for attention points (r = -0.227, p = 0.044) and negative correlation with positive formal thoughts (r = -0.257, p = 0.021).

Conclusion: The results of this study show a relationship between lower levels of vitamin D and the occurrence of positive and negative symptoms, along with increased severity of symptoms at lower levels of vitamin D, suggesting that treatment for schizophrenia should include assessment of patients’ vitamin D levels. We recommend that patients with schizophrenia should be assessed with regard to their vitamin D levels.

Bulut, S. D., Bulut, S., Atalan, D. G., Berkol, T., Gürçay, E., Türker, T., & Aydemir, Ç. (2016). The Relationship between Symptom Severity and Low Vitamin D Levels in Patients with Schizophrenia. PloS one, 11(10), e0165284. Online [retrieved 11/10/2016]: http://psycnet.apa.org/psycinfo/2016-17459-001/

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WHAT FACTORS INCREASE DUTCH CHILD HEALTH CARE PROFESSIONALS’ ADHERENCE TO A NATIONAL GUIDELING ON PREVENTING CHILD ABUSE AND NEGLECT ?

Konijnendijk, A. A., Boere-Boonekamp, M. M., Fleuren, M. A., Haasnoot, M. E., & Need, A.

Guidelines to support health care professionals in early detection of, and responses to, suspected Child Abuse and Neglect (CAN) have become increasingly widely available. Yet little is known about professionals’ adherence to these guidelines or the determinants that affect their uptake. This study used a cross-sectional design to assess the adherence of Dutch Child Health Care (CHC) professionals to seven key activities described in a national guideline on preventing CAN. This study also examined the presence and strengths of determinants of guideline adherence. Online questionnaires were filled in between May and July 2013 by 164 CHC professionals. Adherence was defined as the extent to which professionals performed each of seven key activities when they suspected CAN. Thirty-three determinants were measured in relation to the guideline, the health professional, the organisational context and the socio-political context. Bivariate and multivariate regression analyses tested associations between determinants and guideline adherence. Most of the responding CHC professionals were aware of the guideline and its content (83.7%). Self-reported rates of full adherence varied between 19.5% and 42.7%. Stronger habit to use the guideline was the only determinant associated with higher adherence rates in the multivariate analysis. Understanding guideline adherence and associated determinants is essential for developing implementation strategies that can stimulate adherence. Although CHC professionals in this sample were aware of the guideline, they did not always adhere to its key recommended activities. To increase adherence, tailored interventions should primarily focus on enhancing habit strength.

Konijnendijk, A. A., Boere-Boonekamp, M. M., Fleuren, M. A., Haasnoot, M. E., & Need, A. (2016). What factors increase Dutch child health care professionals’ adherence to a national guideline on preventing child abuse and neglect?. Child abuse & neglect, 53, 118-127. Online [retrieved 11/07/2016]: http://www.sciencedirect. com/science/article/pii/S014521341500410X

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THE CHALLENGES OF NEW BIOPSYCHOSOCIALITIES : HEARING VOICES, TRAUMA, EPIGENETICS AND MEDIATED PERCEPTION

Blackman, L.

This chapter considers the promise of epigenetics in the context of the phenomenon of voice hearing and the question of how to account for the links between voice hearing, trauma and abuse. The chapter explores the epistemic spaces and controversies, which surround the calls for a more psychosocial approach to be incorporated into the more molecular focus of epigenetics. This includes the vexed question of how to invent and work with models of psychological processes, which are processual, indeterminate and contiguous with the biological, social, technical, material and immaterial. These challenges are posed for sociologists, psychosocial researchers and molecular biologists, who when theorizing psychological processes, are often trapped by an individual/social dualism or bifurcation between nature and culture.
The chapter explores evidence from the Hearing Voices Movement to draw out the issues at stake for addressing biosocial matters.

Blackman, L. (2016). The challenges of new biopsychosocialities: hearing voices, trauma, epigenetics and mediated perception. The Sociological Review Monographs, 64(1), 256-273. Online [retrieved 11/07/2016]: http://onlinelibrary.wiley.com/doi/10.1002/2059-7932.12024/full

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PARADISE LOST : THE NEUROBIOLOGICAL AND CLINICAL CONSEQUENCES OF CHILD ABUSE AND NEGLECT

Nemeroff, C. B.

In the past two decades, much evidence has accumulated unequivocally demonstrating that child abuse and neglect is associated with a marked increase in risk for major psychiatric disorders (major depression, bipolar disorder, post-traumatic stress disorder [PTSD], substance and alcohol abuse, and others) and medical disorders (cardiovascular disease, diabetes, irritable bowel syndrome, asthma, and others). Moreover, the course of psychiatric disorders in individuals exposed to childhood maltreatment is more severe. Recently, the biological substrates underlying this diathesis to medical and psychiatric morbidity have been studied. This Review summarizes many of the persistent biological alterations associated with childhood maltreatment including changes in neuroendocrine and neurotransmitter systems and pro-inflammatory cytokines in addition to specific alterations in brain areas associated with mood regulation. Finally, I discuss several candidate gene polymorphisms that interact with childhood maltreatment to modulate vulnerability to major depression and PTSD and epigenetic mechanisms thought to transduce environmental stressors into disease vulnerability.

Nemeroff, C. B. (2016). Paradise lost: the neurobiological and clinical consequences of child abuse and neglect. Neuron, 89(5), 892-909. Online [retrieved 11/07/2016]:

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THE GENETICS AND EPIGENETIC OF PTSD OVERVIEW, RECENT ADVANCES, AND FUTURE DIRECTIONS

Sheerin, C. M., Lind, M. J., Bountress, K. E., Nugent, N. R., & Amstadter, A. B.

This paper provides a brief summary and commentary on the growing literature and current developments related to the genetic underpinnings of posttraumatic stress disorder (PTSD). We first briefly provide an overview of the behavioral genetic literature on PTSD, followed by a short synopsis of the substantial candidate gene literature with a focus on genes that have been meta-analyzed. We then discuss the genome-wide association studies (GWAS) that have been conducted, followed by an introduction to other molecular platforms used in PTSD genomic studies, such as epigenetic and expression approaches. We close with a discussion of developments in the field that include the creation of the PTSD workgroup of the Psychiatric Genomics Consortium, statistical advances that can be applied to GWAS data to answer questions of heritability and genetic overlap across phenotypes, and bioinformatics techniques such as gene pathway analyses which will further advance our understanding of the etiology of PTSD.

Sheerin, C. M., Lind, M. J., Bountress, K. E., Nugent, N. R., & Amstadter, A. B. (2017). The genetics and epigenetics of PTSD: overview, recent advances, and future directions. Current Opinion in Psychology, 14, 5-11. Online [retrieved 11/07/2016]: http://www.sciencedirect.com/science/article/pii/S2352250X16301178

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PSYCHONEUROIMMUNOLOGY OF EARLY-LIFE STRESS : THE HIDDEN WOUNDS OF CHILDHOOD TRAUMA ?

Danese, A., & Lewis, S. J.

The brain and the immune system are not fully formed at birth, but rather continue to mature in response to the postnatal environment. The two-way interaction between the brain and the immune system makes it possible for childhood psychosocial stressors to affect immune system development, which in turn can affect brain development and its long-term functioning. Drawing from experimental animal models and observational human studies, we propose that the psychoneuroimmunology of early-life stress can offer an innovative framework to understand and treat psychopathology linked to childhood trauma. Early-life stress predicts later inflammation, and there are striking analogies between the neurobiological correlates of early-life stress and of inflammation. Furthermore, there are overlapping trans-diagnostic patterns of association of childhood trauma and inflammation with clinical outcomes. These findings suggest new strategies to remediate the effect of childhood trauma before the onset of clinical symptoms, such as anti-inflammatory interventions and potentiation of adaptive immunity. Similar strategies might be used to ameliorate the unfavorable treatment response described in psychiatric patients with a history of childhood trauma.

Danese, A., & Lewis, S. J. (2016). Psychoneuroimmunology of Early-Life Stress: The Hidden Wounds of Childhood Trauma&quest. Neuropsychopharmacology. Online [retrieved 11/07/2016]:

h t t p : //www. n a t u r e . c om/n p p/ jo u r n a l / v a o p/n c u r r e n t / f u l l /n p p 20 1619 8 a . h t ml

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EARLY AND RECENT PSYCHOSOCIAL STRESS AND TELOMERE LENGTH IN OLDER ADULTS

Schaakxs, R., Wielaard, I., Verhoeven, J. E., Beekman, A. T., Penninx, B. W., & Comijs, H. C.

Psychosocial stress has been associated with an increased risk for mental and somatic health problems across the life span. Some studies in younger adults linked this to accelerated cellular aging, indexed by shortened telomere length (TL). In older adults, the impact of psychosocial stress on TL may be different due to the lifetime exposure to competing causes of TL-shortening. This study aims to assess whether early and recent psychosocial stressors (childhood abuse, childhood adverse events, recent negative life events, and loneliness) were associated with TL in older adults.

Data were from the Netherlands Study of Depression in Older Persons (NESDO) in which psychosocial stressors were measured in 496 persons aged 60 and older (mean age 70.6 (SD 7.4) years) during a face-to-face interview. Leukocyte TL was determined using fasting blood samples by performing quantitative polymerase chain reaction (qPCR) and was expressed in base pairs (bp).

Multiple regression analyses, adjusted for age, sex, and chronic diseases, showed that childhood abuse, recent negative life events and loneliness were unrelated to TL. Only having experienced any childhood adverse event was weakly but significantly negatively associated with TL.

Our findings did not consistently confirm our hypothesis that psychosocial stress is associated with shorter TL in older adults. Healthy survivorship or other TL-damaging factors such as somatic health problems seem to dominate a potential effect of psychosocial stress on TL in older adults.

Schaakxs, R., Wielaard, I., Verhoeven, J. E., Beekman, A. T., Penninx, B. W., & Comijs, H. C. (2016). Early and recent psychosocial stress and telomere length in older adults. International Psychogeriatrics, 28(03), 405-413. Online [retrieved 11/07/2016]: https://www.cambridge.org/core/journals/international-psychogeriatrics/article/early-and-recent-psychosocial-stress-and-telomere-length-in-older-adult... 2A0F38CFAFC09C5A7E13C22FC8D1F3

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PREVENTIVE ATTACHMENT DISORDER (AD) : ATTACHMENT-FOCUSED DYADIC GROUP THERAPY WITH BORDERLINE PERSONALITY DISORDER – AND FORMER AD - MOTHERS

Compés, C., Iniesta, A., Pereira, V., Martínez, C., Justo, C., & Herrero, M. E.

Children with mothers with Borderline Personality Disorder (BPD) have a high risk of developing attachment difficulties, and this risk is like to grow when their mothers experienced severe neglect and/or abuse in their childhood and early adolescence. Our objective was to clinically assess and lend support to a small group of young mothers at risk. We recruited mothers aged 18-25, with 1-12 month-old children. None was married, had a stable residence and sexual partner, and most were unemployed. All had early diagnosis of AD, had at present BPD, and had received extended global and residential psychiatric treatment in our Therapeutic Community (SIRIO Project) along their adolescence. We conducted six consecutive 4 h weekly sessions, which were attended by mothers with their babies in the familiar setting of the Community. The explicit aim proposed to them was: “to come to be listened and accompanied and to share their motherhood experiences” with members of our multidisciplinary team (nurse, social worker, therapeutic educator, psychologist and psychiatrist), who were known to them.

Fears, somatizations, more-or-less concealed rejection of her baby, apathy, sadness, suspiciousness, jealousy, relational difficulties with their couples and family figures… were common findings that were addressed in the sessions.

Main conclusion: Minor but positive changes occurred in the dyadic mother-baby relationship. This was more patent concerning breastfeeding, relationships with their couple and extended family and pediatricians, and attitudes toward job seeking. In addition, the frequent contact with these mothers elicited markedly positive reactions in the 8-9 children/adolescents currently residing in our community.

Compés, C., Iniesta, A., Pereira, V., Martínez, C., Justo, C., & Herrero, M. E. (2016). Preventing attachment disorder (AD): Attachment-focused dyadic group therapy with borderline personality disorder–and former AD–mothers. European Psychiatry, 33, S515-S516. [retrieved 11/07/2016]: http://www.sciencedirect.com/ science/article/pii/S0924933816019106

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CREATING MEMORIES FOR FALSE AUTOBIOGRAPHICAL EVENTS IN CHILDHOOD : A SYSTEMIC REVIEW

Using a framework that distinguishes autobiographical belief, recollective experience, and confidence in memory, we review three major paradigms used to suggest false childhood events to adults: imagination inflation, false feedback and memory implantation. Imagination inflation and false feedback studies increase the belief that a suggested event occurred by a small amount such that events are still thought unlikely to have happened. In memory implantation studies, some recollective experience for the suggested events is induced on average in 47% of participants, but only in 15% are these experiences likely to be rated as full memories. We conclude that susceptibility to false memories of childhood events appears more limited than has been suggested. The data emphasise the complex judgements involved in distinguishing real from imaginary recollections and caution against accepting investigator-based ratings as necessarily corresponding to participants' self-reports. Recommendations are made for presenting the results of these studies in courtroom settings.

Brewin, C. R., & Andrews, B. (2016). Creating Memories for False Autobiographical Events in Childhood: A Systematic Review. Applied Cognitive Psychology. Online [retrieved 8/22/2016]: http://onlinelibrary.wiley. com/doi/10.1002/acp.3220/full

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ATTACHMENT STYLE AND INTERPERSONAL TRAUMA IN REFUGEES

Background: Refugees can suffer many experiences that threaten their trust in others. Although models of refugee mental health have postulated that attachment securities may be damaged by refugee experiences, this has yet to be empirically tested. This study aimed to understand the relationship between the nature of traumatic experiences sustained by refugees and attachment styles.

Method: In a cross-sectional study, treatment-seeking refugees (N = 134) were assessed for traumatic exposure using the Harvard Trauma Questionnaire and Posttraumatic Diagnostic Scale. Attachment style was assessed using the Experiences in Close Relationship Scale.

Results: Whereas gender and severity of interpersonal traumatic events predicted avoidant attachment style (accounting for 11% of the variance), neither these factors nor non-interpersonal trauma predicted anxious attachment.

Conclusions: Exposure to interpersonal traumatic events, including torture, is associated with enduring avoidant attachment tendencies in refugees. This finding accords with attachment theories that prior adverse interpersonal experiences can undermine secure attachment systems, and may promote avoidance of attachment seeking. This finding may point to an important process maintaining poor psychological health in refugees affected by interpersonal trauma.

Morina, N., Schnyder, U., Schick, M., Nickerson, A., & Bryant, R. A. (2016). Attachment style and interpersonal trauma in refugees. Australian and New Zealand journal of psychiatry, 0004867416631432. Online [retrieved 8/22/2016]: http://anp.sagepub.com/content/early/2016/02/15/0004867416631432.abstract

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THE MEANING OF EVIDENCE-BASED TREATMENTS FOR VETERANS WITH POSTTRAUMATIC STRESS DISORDER

This Viewpoint suggests that the assertion that prolonged exposure or cognitive processing therapy should be the dominant evidence-based treatments for war-related PTSD is simplistic and may at times be unhelpful or contraindicated. Steenkamp’s Viewpoint reminds us that “evidence-based” psychotherapy for posttraumatic stress disorder (PTSD) encompasses clinical judgment and patient preferences as much as it does evidence from randomized clinical trials. This is a welcome perspective for clinicians working in settings such as Veterans Affairs (VA), where they are mandated by policy to provide prolonged exposure or cognitive processing therapy (CPT) as first-line treatments for veterans with PTSD.

Yehuda, R., & Hoge, C. W. (2016). The meaning of evidence-based treatments for veterans with posttraumatic stress disorder. JAMA psychiatry, 73(5), 433-434. Online [retrieved 8/22/2016]: http:// archpsyc.jamanetwork.com/article.aspx?articleID=2491946

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SEPARATING FACT FROM FICTION : AN EMPIRICAL EXAMINATION OF SIX MYTHS ABOUT DISSOCIATIVE IDENTITY DISORDER

Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside. Empirically derived knowledge about DID has replaced outdated myths. Vigorous dissemination of the knowledge base about this complex disorder is warranted.

Brand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2016). Separating fact from fiction: an empirical examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry, 24(4), 257. Online [retrieved 8/22/2016]: http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4959824/

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ADVERSE CHILDHOOD EXPERIENCES IN THE LIVES OF MALE SEX OFFENDERS IMPLICATION FOR TRAUMA-INFORMED CARE

This study explored the prevalence of childhood trauma in a sample of male sexual offenders (N = 679) using the Adverse Childhood Experience (ACE) scale. Compared with males in the general population, sex offenders had more than 3 times the odds of child sexual abuse (CSA), nearly twice the odds of physical abuse, 13 times the odds of verbal abuse, and more than 4 times the odds of emotional neglect and coming from a broken home. Less than 16% endorsed zero ACEs and nearly half endorsed four or more. Multiple maltreatments often co-occurred with other types of household dysfunction, suggesting that many sex offenders were raised within a disordered social environment. Higher ACE scores were associated with higher risk scores. By enhancing our understanding of the frequency and correlates of early adverse experiences, we can better devise trauma-informed interventions that respond to the clinical needs of sex offender clients.

Levenson, J. S., Willis, G. M., & Prescott, D. S. (2016). Adverse Childhood Experiences in the Lives of Male Sex Offenders Implications for Trauma-Informed Care. Sexual abuse: a journal of research and treatment, 28(4), 340-359. Online [retrieved 8/22/2016]: http://sax.sagepub.com/content/28/4/340.short

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MENTALIZATION AND DISSOCIATION IN THE CONTEXT OF TRAUMA : IMPLICATIONS FOR CHILD PSYCHOPATHOLOGY

Dissociation is a common reaction subsequent to childhood sexual abuse (CSA) and has been identified as a risk factor for child psychopathology. There is also evidence that mentalization contributes to resilience in the context of abuse. However, at this stage little is known regarding the relationship between mentalization and dissociation, and their respective contributions to psychopathology. The aim of this study was to examine pathways from CSA to depressive symptoms, externalizing behaviour difficulties and sexualized behaviour through mentalization and dissociation. These pathways were examined in a sample of 168 mother-child dyads, including 74 dyads where children (aged 7–12) had histories of sexual abuse. Maternal mentalization was assessed using the Parent Development Interview-Revised and children’s mentalization was assessed using the Child Reflective Functioning Scale. Children completed the Child Depression Inventory and parents completed the Child Dissociative Checklist, the Child Behavior Checklist and the Child Sexual Behavior Inventory. Direct and indirect paths from CSA to child psychopathology via children’s mentalization and dissociation were examined using Mplus. Distinct paths from abuse to psychopathology were identified. Child mentalization partially mediated the relationship between CSA and depressive symptoms. The effects of CSA on externalizing symptoms and sexualized behaviour difficulties were sequentially mediated through mentalization and dissociation.

Ensink, K., Bégin, M., Normandin, L., Godbout, N., & Fonagy, P. (2016). Mentalization and dissociation in the context of trauma: Implications for child psychopathology. Journal of Trauma & Dissociation, (just-accepted). Online [retrieved 8/22/2016]: http://www.tandfonline.com/doi/abs/10.1080/15299732.2016.1 172536

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CLINICIAN DISPARITIES IN ANXIETY AND TRAUMA SCREENING AMONG CHILDREN WITH ADHD : A PILOT STUDY

The objective of this study was to determine the rate of clinician screening for anxiety disorders or trauma when diagnosing childhood ADHD and investigate the roles of clinical setting and clinician discipline. Data were retrospectively collected in general pediatric (GP) and mental health (MH) settings. Screening rates were compared between visits in GP vs. MH setting and with a developmental–behavioral pediatrician (DBP) vs. visits without a DBP. Analysis of 200 charts revealed an overall 44% documentation rate of anxiety or trauma history screen. DBPs were responsible for 53 (26.5% of) cases; with DBP involvement, screening rates for anxiety or trauma rose to 77%, with significant variation by setting (OR = 5.27, p < 0.001) and clinician type (OR = 2.64, p < 0.001). Clinicians in the GP setting document screening for anxiety or trauma history significantly less often than clinicians in the MH setting. DBPs have an opportunity to improve the rate of anxiety and trauma screening when evaluating ADHD.

Spitzer, J., Schrager, S. M., Imagawa, K. K., & Vanderbilt, D. L. (2016). Clinician Disparities in Anxiety and Trauma Screening among Children with ADHD: A Pilot Study. Children's Health Care, (just-accepted). Online [retrieved 8/22/2016]: http://www.tandfonline.com/doi/abs/10.1080/02739615.2016.1193809

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EARLY-LIFE STRESS AND REPRODUCTIVE COST : A TWO-HIT DEVELOPMENTAL MODEL OF ACCELERATED AGING ?

Two seemingly independent bodies of research suggest a two-hit model of accelerated aging, one highlighting early-life stress and the other reproduction. The first, informed by developmental models of early-life stress, highlights reduced longevity effects of early adversity on telomere erosion, whereas the second, informed by evolutionary theories of aging, highlights such effects with regard to reproductive cost (in females). The fact that both early-life adversity and reproductive effort are associated with shorter telomeres and increased oxidative stress raises the prospect, consistent with life-history theory, that these two theoretical frameworks currently informing much research are tapping into the same evolutionary-developmental process of increased senescence and reduced longevity. Here we propose a mechanistic view of a two-hit model of accelerated aging in human females through (a) early-life adversity and (b) early reproduction, via a process of telomere erosion, while highlighting mediating biological embedding mechanisms that might link these two developmental aging processes.

Shalev, I., & Belsky, J. (2016). Early-life stress and reproductive cost: A two-hit developmental model of accelerated aging?. Medical hypotheses, 90, 41-47. Online [retrieved 8/22/2016]: http://www.ncbi.nlm.nih. gov/pubmed/27063083

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CHILDHOOD TRAUMA AND ADULTHOOD INFLAMMATION : A META-ANALYSIS OF PERIPHERAL C-REACTIVE PROTEIN, INTERLEUKIN-6 AND TUMOUR NECROSIS FACTOR-A

Childhood trauma confers higher risk of adulthood physical and mental illness; however, the biological mechanism mediating this association remains largely unknown. Recent research has suggested dysregulation of the immune system as a possible biological mediator. The present paper conducted a meta-analysis to establish whether early-life adversity contributes to potentially pathogenic pro-inflammatory phenotypes in adult individuals. A systematic search of Pubmed, PsycINFO, EMBASE, Scopus and Medline identified 25 articles for the meta-analysis, including 18 studies encompassing a sample of 16 870 individuals for C-reactive protein (CRP), 15 studies including 3751 individuals for interleukin-6 (IL- 6) and 10 studies including 881 individuals for tumour necrosis factor-α (TNF-α). Random-effects meta-analysis showed that individuals exposed to childhood trauma had significantly elevated baseline peripheral levels of CRP (Fisher’s z=0.10, 95% confidence interval (CI)=0.05–0.14), IL-6 (z=0.08, 95% CI=0.03–0.14) and TNF-α (z=0.23, 95% CI=0.14–0.32). Subgroup analyses for specific types of trauma (sexual, physical or emotional abuse) revealed that these impact differentially the single inflammatory markers. Moreover, meta-regression revealed greater effect sizes in clinical samples for the association between childhood trauma and CRP but not for IL-6 or TNF-α. Age, body mass index (BMI) and gender had no moderating effects. The analysis demonstrates that childhood trauma contributes to a pro-inflammatory state in adulthood, with specific inflammatory profiles depending on the specific type of trauma.

Baumeister, D., Akhtar, R., Ciufolini, S., Pariante, C. M., & Mondelli, V. (2016). Childhood trauma and adulthood inflammation: a meta-analysis of peripheral C-reactive protein, interleukin-6 and tumour necrosis factor-α. Molecular psychiatry, 21(5), 642-649. Online [retrieved 8/22/2016]: http://www.nature.com/mp/journal/ v21/n5/abs/mp201567a.html

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PTSD SYMPTOMS LEAD TO MODIFICATION IN THE MEMORY OF THE TRAUMA : A PROSPECTIVE STUDY OF FORMER PRISONERS OF WAR

Objective: With the growing interest in the role of trauma memory in posttraumatic stress disorder (PTSD), this prospective study examined long-term changes in memory and the bidirectional relationship between symptoms of PTSD and trauma memory.

Method: A sample of Israeli former prisoners of the 1973 Yom Kippur War (N = 103) was assessed in 1991 and in 2008. Participants’ PTSD symptom clusters, measured by the PTSD Inventory, and recollections of subjective and objective exposure during captivity, measured by a self-report questionnaire, were assessed at both times. Data on prewar and postwar negative life events and psychotherapy were also collected.

Results: Repeated-measures analysis revealed that participants’ recollections were increasingly negative over time (P < .001). Applying an autoregressive cross-lagged modeling strategy showed that the PTSD symptoms of hyperarousal facilitated subsequent amplifications in their recollections (P < .01).

Conclusions: These findings challenge the accuracy of reports of traumatic experiences and show that PTSD symptoms, in part, lead to the formation of more negative recollections over time. The findings suggest that the original memory is repeatedly updated under the influence of the individual’s emotional state. The findings are discussed in the context of the reconsolidation theory of memory.

Dekel, S., Solomon, Z., & Ein-Dor, T. (2016). PTSD symptoms lead to modification in the memory of the trauma: A prospective study of former prisoners of war. The Journal of clinical psychiatry, 77(3), 290-296. Online [retrieved 8/22/2016]: http://www.psychiatrist.com/JCP/article/Pages/2016/v77n03/v77n0303. aspx

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TRAUMA-RELATED ALTERED STATES OF CONSCIOUSNESS (TRASC) IN AN ONLINE COMMUNITY SAMPLE : FURTHER SUPPORT FOR THE 4-D MODEL OF TRAUMA-RELATED DISSOCIATION

A recent “4-D model” of trauma-related dissociation differentiates trauma-related symptoms into distressing experiences nevertheless associated with normal waking consciousness (NWC-distress) versus dissociative experiences exemplary of trauma-related altered states of consciousness (TRASC) along 4 dimensions: One’s experience of (a) time and memory, (b) thought, (c) one’s body, and (d) emotion. However, experiences of TRASC have not been assessed in large community samples in relation to the revised Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM–5) posttraumatic stress disorder (PTSD) criteria. We evaluated TRASC as well as PTSD symptoms by self-report in participants recruited online (n = 2478). We also evaluated the hypotheses of the 4-D model via measures of PTSD and related psychological symptoms, dissociative experiences, and childhood trauma history. Consistent with hypotheses, relative to symptoms of NWC-distress, experiences of TRASC were (a) endorsed less frequently, (b) coendorsed less frequently, (c) predicted incremental variance in measures of dissociative experiences, and (d) were more specific to a history of childhood traumatization. An exploratory factor analysis generated a 2-factor solution that also supports the distinction between NWC-distress and TRASC. The present results generally support differentiating between dissociative versus nondissociative experiences as outcomes of posttraumatic stress.

Frewen, P. A., Brown, M. F., & Lanius, R. A. (2016). Trauma-Related Altered States of Consciousness (TRASC) in an Online Community Sample: Further Support for the 4-D Model of Trauma-Related Dissociation. Online [retrieved 8/22/2016]: http://psycnet.apa.org/psycinfo/2016-24170-001/

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ETHICAL STANDARDS, TRUTHS AND LIES

Free Access.

Brand, B. L., & McEwen, L. (2016). Ethical standards, truths, and lies. Journal of Trauma & Dissociation, 1-8.

Online [retrieved 5/16/2016]:

http://www.tandfonline.com/doi/full/10.1080/15299732.2016.1114357

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DIFFERENCES IN PSYCHIATRISTS’ AND PSYCHOLOGISTS’ CLASSIFICATION OF TRAUMA-RELATED CHANGES OF CONSCIOUSNESS IN PTSD

Mental trauma may precede persistent changes in a person’s mental health in the form of psychosis and dissociation. Presently, there are no subtypes to the diagnosis of PTSD. A psychotic subtype of PTSD has been proposed, and studies show that these patients differ as well in symptoms as biologically from patients with non-psychotic PTSD. Dissociation and psychosis are generally viewed as different phenomena. Where dissociation is understood as a disintegration of the mind, psychosis is viewed as a neurodegenerative disorder on a mainly biological/genetic basis. The delineation of psychotic and dissociative symptoms is not clear however.Our objective is to clarify, whether psychologists and psychiatrists describe trauma-related changes of consciousness (TCC) differently as dissociative or psychotic. Furthermore, we wish to compare scientific journals, and look for differences in how psychiatrists’ and psychologists’ make use of the terms dissociation and psychosis in relation to TCC.We aim to investigate whether TCC are interpreted differently among psychiatrists and psychologists.This study is a systematic critical review of the literature. The databases PubMed, Embase and PsychInfo will be used. Articles involving PTSD with TCC will be included. Studies will be classified as viewing TCC’s as either psychotic or dissociative, based on the terms the authors use to describe the observed phenomena. The results will be presented at the EPA in March 2016 in Madrid.The study will reveal differences in how psychiatrists and psychologists classify TCC’s in PTSD.

Schmidt, T., Uldall, S. W., Carlsson, J., Munk-Jørgensen, P., & Andersen, K. (2016). Differences in psychiatrists’ and psychologists’ classification of trauma-related changes of consciousness in PTSD. European Psychiatry, (33), S641. Online [retrieved 5/16/2016]: https://www.infona.pl/resource/bwmeta1.element. elsevier-9f6f6506-d956-3bb7-9298-ac206dae11bc

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POLYVAGAL THEORY AND EMOTIONAL TRAUMA

According to the polyvagal theory, the autonomic nervous system can, in deviation from the conventional theory, be divided in three distinct parts that are in hierarchical relationship with each other. The most-primitive autonomic control results in depression of vital functions, the more evolved one in fighting or escape and the most evolved one in social involvement. Practical application of the polyvagal theory has resulted in positive results above all in the treatment of emotional trauma. in Finland, therapy of complex trauma is founded on the theory of structural dissociation of the personality, which together with the polyvagal theory forms a practical frame of reference for psychotherapeutic work.

Leikola, A., Mäkelä, J., & Punkanen, M. (2016). Polyvagal theory and emotional trauma. Duodecim; lääketieteellinen aikakauskirja, 132(1), 55. Online [retrieved 5/16/2016]: http://www.ncbi.nlm.nih.gov/ pubmed/27044181

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INTEGRATIVE THERAPY FOCUSED ON TRAUMA FOR PEOPLE WITH INTELLECTUAL DISABILITY (TIT-ID) : A THERAPEUTIC ANSWER TO ABUSE AND INTELLECTUAL DISABILITY EXPERIENCE IN THE INDIVIDUAL AND THE FAMILY

Persons with Intellectual Disabilities (ID) have ten times more risk of suffering abuse than persons without ID. When somebody is born with ID, his/her story is printed by trauma of ID (primary trauma). If we add the trauma from disability to the trauma from abuse (secondary trauma), we find very vulnerable population with a high probability of being re-victimised. Victim Support Unit for Persons with Intellectual Disability (UAVDI) proposes an Integrative Therapy focused on Trauma for people with ID (TIT-ID). This therapy is focused on trauma, including the victim and their families and professionals, through different approaches. It intervenes from individual pathoplasty, taking into account side effects caused by abuse. It also works from a systemic perspective of the primary trauma due to ID and primary grief in the individual and his family. It includes a person-centre intervention with attachment theory and organised through phases from theory of structural dissociation. It is very important to do a rigorous analysis of variables involved in the impact of grief (primary trauma) and later in the impact of abuse experience (secondary trauma). The goals of therapy will be planned according to the individual diagnosis. The cross-cutting objectives are the establishment of consistent links to enable the person to restore their feelings of security and sense of self-worth, and also the development of a resilient personality.

Núñez-Polo, M. H., Carrasco, A. A., Muñoz, I. B., Zapata, M. R., & Cafranga, A. M. (2016). Integrative Therapy Focused on Trauma for People with Intellectual Disability (TIT-ID): A Therapeutic Answer to Abuse and Intellectual Disability Experience in the Individual and the Family. Journal of Intellectual Disability-Diagnosis and Treatment, 4(1), 29-40. Online [retrieved 5/16/2016]: http://www.lifescienceglobal.com/pms/index.php/ jiddt/article/view/3682

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ATTACHMENT THEORY AND AN EQUINE PRISON-BASED ANIMAL PROGRAM : A CASE STUDY

This counseling project examines the issue of recidivism and the need to realign the current system of retribution in favor of rehabilitative services in the United States prison system. Theoretically, this project reviews attachment theory as developed by John Bowlby and Mary Ainsworth and ties the central constructs inherent to attachment theory to equine-assisted prison-based programs. Support and evidence of animal-assisted interventions as agents of healing and psychological growth is found in connection between theory and practice in the case study involving the selected hypothetical inmate, Robert. Robert explores his traumatic past using attachment theory based personal therapy sessions in conjunction with working with the horses through the prison-based animal program. Dialogue exchanges in therapy elucidated how Robert’s attachment to the horses and with his therapist developed. The resulting progression and insight building abilities he acquires may serve as preventative measures with respect to re-offense after release.

Loeffler, M. (2016). Attachment Theory and an Equine Prison-Based Animal Program: A Case Study (Doctoral dissertation, SAINT MARY’S COLLEGE OF CALIFORNIA). Online [retrieved 5/16/2016]: http://gradworks. umi.com/10/01/10017576.html

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APPLICATION OF EMDR THERAPY TO SELF-HARMING BEHAVIORS

Self-harm is frequently a trauma-driven coping strategy that can be understood from the perspective of the adaptive information processing (AIP) model and treated with eye movement desensitization and reprocessing (EMDR) therapy (Shapiro, 1995, 2001). Self-harm is often connected with memories of adverse and traumatic life experiences. Identifying and processing these memories with EMDR therapy can put an end to the self-injurious behavior. In addition, self-harm is often based on a lack of regulation skills, and these skill deficits can be addressed in EMDR therapy as well. In this article, the authors describe strategies for treating self-harm throughout the 8 phases of EMDR. Although there is no single approach that applies to all cases, the therapist needs to take a careful history of self-harm, its historical origins, and its triggers and functions in the present to formulate a treatment plan. Often, in the authors’ experience, self-harm functions as a self-soothing strategy that redissociates traumatic affect from childhood. Treatment strategies for Phases 3–8 of EMDR therapy are illustrated through case vignettes.

Mosquera, D., & Ross, C. A. (2016). Application of EMDR Therapy to Self-Harming Behaviors. Journal of EMDR Practice and Research, 10(2), 119-128. Online [retrieved 5/16/2016]:

http://www.ingentaconnect.com/contentone/springer/emdr/2016/00000010/00000002/art00006

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PREDICTING THE PRESENCE OF CHILDHOOD TRAUMA EXPOSURE IN CHILDREN WITH ADHD SYMPTOMATOLOGY

The impact of trauma exposure during childhood is of great concern. Research has shown that trauma exposure elicits psychological and behavioral responses in children; specifically behaviors that resemble attention deficit and impulsivity. Furthermore, there has been a significant increase in the number of children referred, diagnosed, and treated with attention deficit/hyperactivity disorder (ADHD) symptoms. These overlapping conditions have prompted researchers to examine the psychological and behavioral responses to trauma exposure as well as the etiology of ADHD. Research has speculated that a co-occurrence exists between the responses to childhood trauma exposure and ADHD symptomology; specifically attention deficits and impulse control problems. Four hundred eighty (480) de-identified cases were obtained from the Child and Adolescent Needs and Strengths (CANS) assessment tool in order to examine the ability of eight psychological/behavioral responses to trauma to predict the presence of trauma exposure among children with ADHD symptomology. A logistic regression analysis found that the psychological/behavioral responses to are significantly associated with the presence of trauma exposure in children who exhibit symptoms of ADHD. Specifically, the analysis found that psychosis, depression, anxiety, attachment difficulties, and school behavior significantly predict the presence of trauma exposure in children who exhibit attention deficit/impulsive behaviors.

Cassidy, J. C. (2015). Predicting the presence of childhood trauma exposure in children with ADHD symptomology (Doctoral dissertation, CAPELLA UNIVERSITY). Online [retrieved 5/16/2016]: http:// gradworks.umi.com/37/33/3733630.html

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DREAMING THE MEMORIES OF OUR PARENTS : UNDERSTANDING NEUROBIOLOGY OF TRANSGENERATIONAL TRAUMA AND THE CAPACITIES FOR ITS HEALING

Selma Freiberg once said that “trauma demands repetition”. What if actual trauma did not happen in real life of one particular person, but he/she feels that it was real, as it is repeated every night – in every dream? Do children and grandchildren of survivors of holocaust and of the pogroms dream the memories of their parents and grandparents? Does their imagination “make them up” or do they have a transgenerational connection to the traumatic past of their parents and grandparents, even if they were protected from knowing and hearing the horrors of what actually happened to their loved ones sometime one or two generations apart? Are these people born with some specific biological markers (e.g., lower cortisol levels)? Can fear be passed along from parents to children by smell? All these questions can be answered positively (see work of Jacek Debiec, Dias and Ressler, and many others), and can be explained on the level of neurobiology and epigenetics (thanks to contributions of Moshe Szyf and Michael Meaney from McGill University, and others). This presentation will offer some neuro-psychoeducational reflections on the topic of transgenerational trauma, its epigenetic transmission and its neuro-psycho-biological constructs, as well as a very personal touch, a personal story of growing up in a very nurturing and cultured, but very small family, and not knowing of the circumstances of “why small?”

Rozentsvit, I. (2016). Dreaming the memories of our parents: Understanding neurobiology of transgenerational trauma and the capacities for its healing. European Psychiatry, (33), S498. Online [retrieved 5/16/2016]:

https://www.infona.pl/resource/bwmeta1.element.elsevier-25245734-8005-3ae3-a9df-af69ab1e1ef8

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THE ROLE OF CHILDHOOD TRAUMA IN BIPOLAR DISORDERS

This review will discuss the role of childhood trauma in bipolar disorders. Relevant studies were identified via Medline (PubMed) and PsycINFO databases published up to and including July 2015. This review contributes to a new understanding of the negative consequences of early life stress, as well as setting childhood trauma in a biological context of susceptibility and discussing novel long-term pathophysiological consequences in bipolar disorders. Childhood traumatic events are risk factors for developing bipolar disorders, in addition to a more severe clinical presentation over time (primarily an earlier age at onset and an increased risk of suicide attempt and substance misuse). Childhood trauma leads to alterations of affect regulation, impulse control, and cognitive functioning that might decrease the ability to cope with later stressors. Childhood trauma interacts with several genes belonging to several different biological pathways [Hypothalamic–pituitary–adrenal (HPA) axis, serotonergic transmission, neuroplasticity, immunity, calcium signaling, and circadian rhythms] to decrease the age at the onset of the disorder or increase the risk of suicide. Epigenetic factors may also be involved in the neurobiological consequences of childhood trauma in bipolar disorder. Biological sequelae such as chronic inflammation, sleep disturbance, or telomere shortening are potential mediators of the negative effects of childhood trauma in bipolar disorders, in particular with regard to physical health. The main clinical implication is to systematically assess childhood trauma in patients with bipolar disorders, or at least in those with a severe or instable course. The challenge for the next years will be to fill the gap between clinical and fundamental research and routine practice, since recommendations for managing this specific population are lacking. In particular, little is known on which psychotherapies should be provided or which targets therapists should focus on, as well as how childhood trauma could explain the resistance to mood stabilizers.

Aas, M., Henry, C., Andreassen, O. A., Bellivier, F., Melle, I., & Etain, B. (2016). The role of childhood trauma in bipolar disorders. International journal of bipolar disorders, 4(1), 1-10. Online [retrieved 5/16/2016]: http:// link.springer.com/article/10.1186/s40345-015-0042-0

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REGENERATIVE SUPERVISION : A RESTORATIVE APPROACH FOR COUNSELLORS IMPACTED BY VICARIOUS TRAUMA/SUPERVISION

Counsellors providing services for clients with traumatic material are vulnerable to vicariously experiencing emotional aspects of their clients’ experiences (Jordan, 2010). is vicarious experiencing, a phenomenon known as vicarious trauma (VT), can impact the counsellor’s functioning. e Regenerative Model is an expressive arts model of coun- selling supervision well-suited for processing the e ects of VT. is article provides an overview of VT and its related phenomenon, vicarious posttraumatic growth (VPTG). An explanation follows of how the Regenerative Model may be employed to mitigate the effects of VT while facilitating development of VPTG. Case examples are included.

Neswald-Potter, R., & Simmons, R. T. (2016). Regenerative Supervision: A Restorative Approach for Counsellors Impacted by Vicarious Trauma/Supervision régénérative: une approche rétablissante pour les conseillers affectés par traumatisme vicariant. Canadian Journal of Counselling and Psychotherapy (Online), 50(1), 75. Online [retrieved 5/16/2016]:

http://search.proquest.com/openview/1e858a4000424ca20d72cf95d2c1ccc0/1?pq-origsite=gscholar&cbl=266703

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DISSOCIATION IN PATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS : WHAT IS THE ROLE OF DIFFERENT TYPES OF CHILDHOOD ADVERSITY ?

Aims

Our study aimed to explore the effects of different types of adverse childhood experiences (e.g. domestic violence, early loss, parental dysfunction, sexual and physical abuse) as well as experiences of sexual and physical abuse in adulthood on dissociative symptoms in adult patients with schizophrenia-spectrum disorders.

Methods

145 patients were examined for psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS), for dissociative symptoms with the German version of the Dissociative Experiences Scale (DES) and for adverse experiences in childhood and adulthood with the Structured Trauma Interview (STI).

Results

Childhood physical abuse was reported by 32%, childhood sexual abuse by 17% of the patients. Other forms of childhood adversity were also quite common; 18% had witnessed domestic violence, 26% reported early loss, and nearly half of patients reported at least one condition potentially related to parental dysfunction. The DES total score was significantly associated with childhood sexual abuse, witnessing of domestic violence and paternal dysfunction, as well as with physical violence in adulthood. In the final regression model, reports of paternal dysfunction and sexual abuse in childhood were independently associated with adult dissociation. Variance in dissociative symptoms was mainly explained by paternal dysfunction (18%).

Conclusion

Substantial rates of childhood adversity were found and specific associations were evident with adult dissociation amongst psychosis patients who reported sexual abuse or paternal dysfunction in childhood. Therefore, it is important that patients with schizophrenia-spectrum disorders are routinely asked about a broad range of possible adverse childhood experiences in order to provide appropriate interventions.

Schroeder, K., Langeland, W., Fisher, H. L., Huber, C. G., & Schäfer, I. (2016). Dissociation in patients with schizophrenia spectrum disorders: What is the role of different types of childhood adversity?. Comprehensive Psychiatry. Online [retrieved 5/16/2016]:

http://www.sciencedirect.com/science/article/pii/S0010440X15300420

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A STUDY OF COMPASSION AND JOB SATISFACTION AMONG ERIE COUNTY’S CHILD PROTECTIVE SERVICES CASEWORKERS : VICARIOUS TRAUMA, COPING, SUPERVISORY STYLE, BUREAUCRATIC STRUCTURE AND SAFETY

When high profile child fatalities with previous Erie County Child Protection Services (CPS) involvement generated considerable negative media commentary questioning the competency of CPS, there was concern over the mental well-being of CPS caseworkers. Furthermore, a key problem to be resolved was the high turnover of CPS caseworkers, which is both a budgetary drain on the County due to the training costs involved with new caseworkers, but also deprives the Department of Social Services of experienced family and child welfare personnel. This study seeks to understand factors negatively affecting the CPS caseworkers. Previous research indicate that human service workers exposed to traumatic events can experience a reduction in compassion satisfaction and an increase in vicarious trauma and burnout. Government human services administration tends to be organized under the traditional public administration model of a rigid hierarchy in authority and decision making with tight supervisory structures and little opportunity (or encouragement) of opinions from front-line workers, which also can reduce CPS worker job satisfaction. Other potentially negative factors identified in the literature include perceptions of safety, the workplace environment, and supervisory styles. This study of Erie County CPS caseworkers utilized a convergent parallel mixed methods research design in order to analyze compassion satisfaction, burnout, and vicarious trauma (ProQOL instrument) and workplace safety and environment, organizational structure, and supervisory styles (focus groups). A single sample t-test conducted on the ProQOL results revealed that Compassion Satisfaction among the respondents was statistically significant (lower than the population mean) while Vicarious Trauma and Burnout were not statistically significant from the population mean. The qualitative phase (focus groups with CPS workers) uncovered significant dissatisfaction among CPS workers with respect to organizational factors, supervisory styles, and safety and environment. This study found that CPS was organized according to the traditional (hierarchical) public administration model in which CPS caseworkers were not empowered to have a voice within their agency and were not invited to participate in the policy-making process. Furthermore, it was found that CPS supervisors and front line staff were not trained in Trauma Informed Care practices. Thus, it was concluded that counterproductive organizational practices within Erie County have produced negative outcomes for the workers and may be a greater source of caseworker turnover than either the nature of the job itself or the recent negative perceptions of Erie County’s CPS division.

Rochelle, S. L. (2015). A Study of Compassion and Job Satisfaction among Erie County’s Child Protective Services Caseworkers: Vicarious Trauma, Coping, Supervisory Style, Bureaucratic Structure, and Safety. Online [retrieved 5/16/2016]:

http://digitalcommons.buffalostate.edu/mpa_projects/17/

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SWIMMING LESSONS : AGING, DISSOCIATION AND EMBODIED RESONANCE

How do bodies communicate in the analytic relationship? What is the therapeutic action of embodied communication? In this paper, I examine the effects of a form of embodied communication that I refer to as “embodied resonance.” Using a model of mind that is comprised of multiple self states that become dissociated in response to trauma and that are carried, unsymbolized, in body and mind, I suggest that “embodied resonance” enables patient and analyst to make initial contact with dissociated self-states. Consequently, the analyst helps her patient understand, verbalize, and incorporate a greater and truer sense of himself into his life story. I present a detailed clinical example of my work with Jon, an elderly patient suffering from Alzheimer’s disease, to illustrate how understanding the impact of a patient’s traumatic past can be a freeing experience that allows him to come to terms with his particularly traumatic aging experience. Changes in self understanding were reflected in changes in my patient’s body and changes in his experience of himself as an aging person. I also suggest that whether implicitly known or explicitly verbalized, embodied resonance can offer enriching, mutative attachment experiences. Finally, the analyst’s somatic attunement to her own traumatic memories and dissociated self states is discussed as a way to inform clinical impasses in the analytic treatment.

Sherman-Meyer, C. (2016). Swimming Lessons: Aging, Dissociation, and Embodied Resonance. Psychoanalytic Perspectives, 13(2), 201-213. Online [retrieved 5/16/2016]:

http://www.tandfonline.com/doi/abs/10.1080/1551806X.2016.1156434#.Vzn-pmMu3Co

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IN-THE-MOMENT DISSOCIATION, EMOTIONAL NUMBING, AND SEXUAL RISK : THE INFLUENCE OF SEXUAL TRAUMA HISTORY, TRAUMA SYMPTOMS, AND ALCOHOL INTOXICATION

From the moment conceptualizations of trauma-related suffering were introduced, questions arose about the authenticity of memories and symptoms (Herman, 1995). Even now, questions are being asked about the accuracy of traumatic memories, especially in case of borderline personality disorder, with a distinction between believers (recovered memory movement) and non-believers (false memory movement) (Verhaeghe, 2004). This instigated enormous research efforts to shed light on the nature of trauma-related memories. Starting from myriad points of view, trauma is considered as an experience that cannot be represented mentally, that floods people’s coping possibilities (Shapiro & Laliotis, 2011; Van der Kolk & Fisler, 1995). For example, recent neuroimaging studies showed a disruption between affective and linguistic processing systems supporting the suggestion of an inherently non-verbal nature of traumatic memories (Peres, McFarlane, Nasello, & Moores, 2008). Furthermore, it has been found that traumatic memories are rather re-experienced than narrated in comparison to regular auto-biographical memories (Ehlers et al., 2004), that they are more hic et nunc (Michael et al., 2005) and more affect-laden (Van der Kolk et al., 1996). Therefore, emphasis in treating trauma-related symptoms is often laid on being able to verbalize and mentalize the traumatic experience (Shapiro & Laliotis, 2011; Peres et al., 2008). Jones, Harvey and Brewin (2007) found, however, that recovery of trauma was not related to gaining more organized trauma-related memories. From a psychoanalytical point of view, emphasis should not lie on constructing a more coherent trauma-narrative. We argue that memories of every individual are coloured by the subject’s psychological architecture and that the recollections of trauma-patients are probably more accurate – i.e. a more veritable and literal print of the event - because of the fundamental breach with the Symbolic-Imaginary structure. For some, the non-verbal and affective nature of remembering trauma is a sign of “purity”, of a “truth” beyond words, because the transformation - or even distortion - of the events, which always takes place when trying to create a representation of an occurrence, remains absent. However, because people often suffer from the intrusive and repetitive features characterizing recollections of trauma, in psychoanalytic therapy emphasis is placed on the discourse of the patient, embedding the traumatic experience in an individually tailored narrative (i.e. systemic truth, Floury, 2010), in which accuracy of the facts with regard to what “really” took place in the traumatic event (i.e. specular truth, Floury, 2010) and coherency of the created narrative are of minimum concern. In this presentation we will give special attention to the phenomenon of dissociation, in which recollection is missing all together. We will argue that in the brutal confrontation with the Real, the subject defends himself by ‘splitting’ – i.e. a division between what can an cannot be consciously recollected. We will present case material to illustrate how dissociation is embedded in the subject’s psychological structure (i.e. the junction between the Real, the Imaginary and the Symbolic) and the way in which false memories within the dissociative episodes form a defensive framework for the reality of the traumatic experiences the subject encountered.

Stappenbeck, C. A., George, W. H., Staples, J. M., Nguyen, H., Davis, K. C., Kaysen, D., ... & Gilmore, A. K. (2016). In-The-Moment Dissociation, Emotional Numbing, and Sexual Risk: The Influence of Sexual Trauma History, Trauma Symptoms, and Alcohol Intoxication. Online [retrieved 5/16/2016]: http://psycnet.apa.org/ psycinfo/2016-11614-001/

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DEPRESSION AND DISSOCIATION AS PREDICTORS OF PHYSICAL HEALTH SYMPTOMS AMONG FEMALE RAPE SURVIVORS WITH POSTTRAUMATIC STRESS DISORDER

OBJECTIVE: To investigate the relative contributions of depression and dissociation, as well as posttraumatic stress disorder (PTSD), to physical health symptoms and to examine the relationships among somatic symptoms, PTSD, depression, and dissociation in relation to childhood and adult trauma exposure.

METHOD: Cross-sectional data are from 132 female rape survivors with PTSD assessed before engaging in a study of trauma-focused cognitive therapy for PTSD. Measures included the Pennebaker Inventory of Limbic Languidness, Clinician Administered PTSD Scale, Beck Depression Inventory, Trauma Symptom Inventory-Dissociation Subscale, Childhood Sexual Abuse Exposure Questionnaire, and Assessing Environments-III-Physical Punishment Scale.

RESULTS: Hierarchical regression analyses revealed that only dissociative and depression symptoms contributed significantly to physical health symptoms. Similarly, among the subsample of women with either childhood sexual or physical abuse, depression and dissociation were significant predictors of somatic symptoms. However, among women without childhood abuse, only dissociation significantly predicted somatic symptoms.

CONCLUSION: Understanding the psychological and biological mechanisms that link childhood versus adult trauma exposure, PTSD, and comorbid depression or dissociation to physical health symptoms may aid development of individualized treatments for the physical and psychological consequences of trauma. (PsycINFO Database Record

Scioli-Salter, E. R., Johnides, B. D., Mitchell, K. S., Smith, B. N., Resick, P. A., & Rasmusson, A. M. (2016). Depression and dissociation as predictors of physical health symptoms among female rape survivors with posttraumatic stress disorder. Psychological trauma: theory, research, practice, and policy.

Online [retrieved 5/16/2016]: http://www.ncbi.nlm.nih.gov/pubmed/27149157

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HIDDEN IN PLAIN SIGHT : THOUGHTS ON IMAGINATION AND THE LIVED UNCONSCIOUS

The relative presence of “imagination” in human discourse overlaps to no small degree with the relative capacity for intersubjectivity that exists in any relationship. The nature of the patient–therapist relationship in analytic treatment could thus be described as a journey in which two people must each loosen the rigidity of their dissociative “truths” about self and other in order to allow “imagination” to find its shared place. As self-state permeability increases, so does openness to “state-sharing.” The co-creation of a lived, relational unconscious more and more nourishes the willingness of each person to participate in a growing sense of “we” that includes “me” and “you” as part of their individually expanded self-experiences. By living together in the enacted shadow of what is visible but not perceived, an opportunity is afforded to encounter what has been hidden in plain sight. If an analyst is emotionally and interpersonally alive as a partner while the different areas of a patient’s developmental trauma are being relived safely, but not too safely, the patient’s threshold for the potential triggering of affect-dysregulation is raised at the brain level. This allows their relationship greater interpersonal spontaneity and creative self-expression that is carried by an expanded sense of selfhood into the world “out there”. Through a clinical vignette, I hope to illustrate how both foreclosure and liberation of imagination shape clinical process and, in turn, its growing ability to allow “I” and “we” to coexist intersubjectively without compromising one or the other.

Bromberg, P. M. (2016). Hidden in Plain Sight: Thoughts on Imagination and the Lived Unconscious. Attachment, 10(1), 1-19. Revised and republished in: Attachment Journal/vol.10/1, May, 2016. Online retrieved 5/16/2016]: http://www.ingentaconnect.com/contentone/kb/att/2016/00000010/00000001/art00002

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THE CODE NOT TAKEN : THE PATH FROM GUILD ETHICS TO TORTURE AND OUR CONTINUING CHOICES

Psychology’s controversial role in torture in settings like Abu Ghraib, Bagram, and Guantánamo fractured a comforting façade and raised questions about how we can best serve the profession. The controversy confronts us with choices about what our profession is, what it means, what it does—who we are, what we mean, what we do. It asks whether our lives and organisations reflect professional ethics or guild ethics. Professional ethics protect the public against abuse of professional power, expertise, and practice, and hold members accountable to values beyond self-interest. Guild ethics place members’ interests above public interest, edge away from accountability, and tend to masquerade as professional ethics. Psychology’s path to involvement in torture began before 9/11 and the “war on terror” with a move from professional ethics to guild ethics. In sharp contrast to its previous codes, APA’s 1992 ethics code reflected guild ethics, as did the subsequent 2002 code (APA, 2002). Guild ethics are reflected in the questionable nature of APA’s, 2006, 2007a, 2008a, and 2015 policies on interrogation and torture. This article examines tactics used to maintain the façade of professional ethics despite over a decade of publicized reports of documentary evidence of psychology’s organisational involvement in what came to be called “enhanced interrogations.” It asks if we use versions of these tactics in our individual lives. If a credible identity, integrity, and professional ethics are not reflected in our individual lives, it is unlikely they will thrive in our profession and organisations.

Pope, K. S. (2016). The code not taken: The path from guild ethics to torture and our continuing choices. Canadian Psychology/Psychologie canadienne, 57(1), 51. Online [retrieved 5/16/2016]: http://psycnet.apa. org/journals/cap/57/1/51/

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IS IT TRAUMA- OR FANTASY-BASED ? COMPARING DISSOCIATIVE IDENTITY DISORDER, POST-TRAUMATIC STRESS DISORDER, SIMULATORS AND CONTROLS

Objective: The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness, and sociocultural influences. To date, these two models have not been jointly tested in individuals with DID in an empirical manner.

Method: This study included matched groups [patients (n = 33) and controls (n = 32)] that were compared on psychological Trauma and Fantasy measures: diagnosed genuine DID (DID-G, n = 17), DID- simulating healthy controls (DID-S, n = 16), individuals with post- traumatic stress disorder (PTSD, n = 16), and healthy controls (HC, n = 16). Additionally, personality-state-dependent measures were obtained for DID-G and DID-S; both neutral personality states (NPS) and trauma-related personality states (TPS) were tested.

Conclusion: For Trauma measures, the DID-G group had the highest scores, with TPS higher than NPS, followed by the PTSD, DID-S, and HC groups. The DID-G group was not more fantasy-prone or suggestible and did not generate more false memories. Malingering measures were inconclusive. Evidence consistently supported the Trauma Model of DID and challenges the core hypothesis of the Fantasy Model.

Vissia EM, Giesen ME, Chalavi S, Nijenhuis ERS, Draijer N, Brand BL, Reinders AATS. Is it Trauma- or Fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls. Acta Psychiatrica Scandinavica Early View (Online Version of Record published before inclusion in an issue). Online [retrieved 5/27/2016]:

http://onlinelibrary.wiley.com/doi/10.1111/acps.12590/abstract;jsessionid=4D7759BC591F6553FE1A52659 A4BDC2C.f04t03

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MINIMIZATION OF CHILDHOOD MALTREATMENT IS COMMON AND CONSEQUENTIAL : RESULTS FROM A LARGE, MULTINATIONAL SAMPLE USING THE CHILDHOOD TRAUMA QUESTIONNAIRE

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale—originally designed to assess a positive response bias—are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ’s MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ’s discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias—as detected by the MD subscale—has a small but significant moderating effect on the CTQ’s discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.

MacDonald, K., & Gerdner, A. (2015). Minimization of Childhood Maltreatment is Common and Consequential: Results from a Large, Multinational Sample Using the Childhood Trauma Questionnaire. PLoS ONE. Online [retrieved 2/7/2016]:

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0146058

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A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL OF STELLATE GANGLION BLOCK IN THE TREATMENT OF POST-TRAUMATIC STRESS-DISORDER

Background: Case series and popular-press reports have indicated that some individuals with Post Traumatic Stress Disorder (PTSD) undergo rapid, significant, and durable improvements after treatment with Stellate Ganglion Block (SGB). These claims have yet to be tested in a randomized, controlled trial.

Objective: Determine if SGB can reduce symptoms of PTSD in comparison to sham therapy in military service members with PTSD.

Method: In a randomized trial in which both participants and assessors were blind, participants with PTSD received either a SGB or a sham procedure. PTSD symptoms were measured using the clinician-administered PTSD scale (CAPS), and self-report measures of PTSD, depression, anxiety, and pain. Participants underwent assessment prior to the procedure, at one week, one month and 3 months post-procedure. Participants receiving sham injections were allowed to cross over to the treatment group, and participants who maintained criteria for PTSD were allowed to receive a second SGB treatment.

Results: PTSD, anxiety and depression scores all showed improvement across time, but there was no statistically or clinically relevant difference in outcomes between the active and control groups. Individuals who crossed over from sham treatment to SGB similarly showed no greater improvement with the SGB treatment. Improvement in CAPS was greater with a second SGB treatment than after the first treatment.

Conclusions: Although previous case series have suggested SGB offers an effective intervention for PTSD, this study did not demonstrate any appreciable difference between SGB and sham treatment on psychological or pain outcomes. Future studies should examine if differences in treatment methods or patient population could allow individuals with PTSD to benefit from SGB, but current evidence does not support widespread clinical use of the procedure for PTSD.

McLay R et al. (2015). A Randomized, Double-Blind, Placebo-Controlled Trial of Stellate Ganglion Block in the Treatment of Post-Traumatic Stress Disorder. Poster 126. Presented at: AAPM Annual Meeting. March 19- 22, 2015; National Harbor, Maryland. Online [retrieved 2/7/2016]: http://www.psychiatryadvisor.com/ptsd-trauma-and-stressor-related/stellate-ganglion-block-fails-as-possible-ptsd-treatment/article/406455/

http://www.painmed.org/2015posters/poster126.pdf

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THE EFFECTS OF COGNITIVE BEHAVIORAL THERAPY AS AN ANTI-DEPRESSIVE TREATMENT IS FALLING : A META-ANALYSIS

A meta-analysis examining temporal changes (time trends) in the effects of cognitive behavioral therapy (CBT) as a treatment for unipolar depression was conducted. A comprehensive search of psychotherapy trials yielded 70 eligible studies from 1977 to 2014. Effect sizes (ES) were quantified as Hedge’s g based on the Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (HRSD). Rates of remission were also registered. The publication year of each study was examined as a linear metaregression predictor of ES, and as part of a 2-way interaction with other moderators (Year × Moderator). The average ES of the BDI was 1.58 (95% CI [1.43, 1.74]), and 1.69 for the HRSD (95% CI [1.48, 1.89]). Subgroup analyses revealed that women profited more from therapy than did men (p < .05). Experienced psychologists (g = 1.55) achieved better results (p < .01) than less experienced student therapists (g = 0.98). The metaregressions examining the temporal trends indicated that the effects of CBT have declined linearly and steadily since its introduction, as measured by patients’ self-reports (the BDI, p < .001), clinicians’ ratings (the HRSD, p < .01) and rates of remission (p < .01). Subgroup analyses confirmed that the declining trend was present in both within-group (pre/post) designs (p < .01) and controlled trial designs (p = .02). Thus, modern CBT clinical trials seemingly provided less relief from depressive symptoms as compared with the seminal trials. Potential causes and possible implications for future studies are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

Johnsen, T. J., & Friborg, O. (2015). The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis. Psychological Bulletin, Vol 141(4), Jul 2015, 747-768. Online [retrieved 2/7/2016]: http://psycnet.apa.org/psycinfo/2015-20361-001/

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PRAGMATIC RANDOMIZED CONTROLLED TRIAL OF LONG-TERM PSYCHOANALYTIC PSYCHOTHERAPY FOR TREATMENT-RESISTANT DEPRESSION : THE TAVISTOCK ADULT DEPRESSION STUDY (TADS)

This pragmatic randomized controlled trial tested the effectiveness of long-term psychoanalytic psychotherapy (LTPP) as an adjunct to treatment- as-usual according to UK national guidelines (TAU), compared to TAU alone, in patients with long-standing major depression who had failed at least two different treatments and were considered to have treatment-resistant depression. Patients (N5129) were recruited from primary care and randomly allocated to the two treatment conditions. They were assessed at 6-monthly intervals during the 18 months of treatment and at 24, 30 and 42 months during follow-up. The primary outcome measure was the 17-item version of the Hamilton Depression Rating Scale (HDRS-17), with complete remission defined as a HDRS-17 score 8, and partial remission defined as a HDRS-17 score 12. Secondary outcome measures included self-reported depression as assessed by the Beck Depression Inventory - II, social functioning as evaluated by the Global Assessment of Functioning, subjective wellbeing as rated by the Clinical Outcomes in Routine Evaluation - Outcome Measure, and satisfaction with general activities as assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire. Complete remission was infrequent in both groups at the end of treatment (9.4% in the LTPP group vs. 6.5% in the control group) as well as at 42-month follow-up (14.9% vs. 4.4%). Partial remission was not significantly more likely in the LTPP than in the control group at the end of treatment (32.1% vs. 23.9%, p50.37), but significant differences emerged during follow-up (24 months: 38.8% vs. 19.2%, p50.03; 30 months: 34.7% vs. 12.2%, p50.008; 42 months: 30.0% vs. 4.4%, p50.001). Both observer-based and self-reported depression scores showed steeper declines in the LTPP group, alongside greater improvements on measures of social adjustment. These data suggest that LTPP can be useful in improving the long-term outcome of treatment-resistant depression. End-of- treatment evaluations or short follow-ups may miss the emergence of delayed therapeutic benefit.

Fonagy, P., Rost, F., Carlyle, J. A., McPherson, S., Thomas, R., Pasco Fearon, R. M., ... & Taylor, D. (2015). Pragmatic randomized controlled trial of long term psychoanalytic psychotherapy for treatment resistant depression: the Tavistock Adult Depression Study (TADS). World Psychiatry, 14(3), 312-321. Online [retrieved 2/7/2016]: http://www.ncbi.nlm.nih.gov/pubmed/26407787

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CHILDHOOD TRAUMA AND PARENTAL STYLE : RELATIONSHIP WITH MARKERS OF INFLAMMATION OXIDATIVE STRESS, AND AGRESSION IN HEALTHY AND PERSONALITY DISORDERS SUBJECTS

Recent studies suggest that early life trauma is associated with elevations in circulating markers of inflammation in human subjects. History of aggression as a behavior, or aggression as a personality trait, is also associated with elevations of these inflammatory markers. Since early life trauma is associated with the development and maintenance of aggression in later life we examined the relationship of early life adversity, plasma inflammation markers (IL-6 and CRP) and oxidative stress markers (8-OH-DG and 8-ISO), and aggression in adult subjects with (n = 79) and without (n = 55) personality disorder. We used a series of mediated and moderated path models to test whether the effects of early adversity on later aggression may be mediated through markers of inflammation. Childhood abuse and parental control were associated with basal IL-6 and CRP concentrations. Path modeling suggested that childhood abuse was associated with aggression indirectly through CRP while parental control influenced aggression indirectly through IL-6 and CRP. Furthermore, these effects were independent of the effect of current depression. The results suggest that disruption of inflammatory processes represent one pathway by which early adversity influences aggression.

Fanning, J. R., Lee, R., Gozal, D., Coussons-Read, M., & Coccaro, E. F. (2015). Childhood trauma and parental style: relationship with markers of inflammation, oxidative stress, and aggression in healthy and personality disordered subjects. Biological psychology, 112, 56-65.

Online [retrieved 2/7/2016]:

http://www.sciencedirect.com/science/article/pii/S0301051115300521

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CHILDHOOD SEXUAL AND PHYSICAL ABUSE : AGE AT EXPOSURE MODULATES IMPACT ON FUNCTIONAL OUTCOME IN EARLY PSYCHOSIS PATIENTS

Background Evidence suggests a relationship between exposure to trauma during childhood and functional impairments in psychotic patients. However, the impact of age at the time of exposure has been understudied in early psychosis (EP) patients.

Method Two hundred and twenty-five patients aged 18–35 years were assessed at baseline and after 2, 6, 18, 24, 30 and 36 months of treatment. Patients exposed to sexual and/or physical abuse (SPA) were classified according to age at the time of first exposure (Early SPA: before age 11 years; Late SPA: between ages 12 and 15 years) and then compared to patients who were not exposed to such trauma (Non-SPA). The functional level in the premorbid phase was measured with the Premorbid Adjustment Scale (PAS) and with the Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS) during follow-up.

Results There were 24.8% of patients with a documented history of SPA. Late SPA patients were more likely to be female (p = 0.010). Comparison with non-SPA patients revealed that: (1) both Early and Late SPA groups showed poorer premorbid social functioning during early adolescence, and (2) while patients with Early SPA had poorer functional level at follow-up with lower GAF (p = 0.025) and lower SOFAS (p = 0.048) scores, Late SPA patients did not.

Conclusion Our results suggest a link between exposure to SPA and the later impairment of social functioning before the onset of the disease. EP patients exposed to SPA before age 12 may present long-lasting functional impairment, while patients exposed at a later age may improve in this regard and have a better functional outcome.

Alameda, L., Ferrari, C., Baumann, P. S., Gholam-Rezaee, M., Do, K. Q., & Conus, P. (2015). Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients. Psychological medicine, 45(13), 2727-2736. Online [retrieved 2/7/2016]:

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9946709&fileId =S0033291715000690

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AUSTRALIAN ABORIGINAL PERSPECTIVES OF ATTENTION DEFICIT HYPERACTIVITY DISORDER

The diagnostic methodology for ADHD is based on a western concept of health. This raises the issue of cultural sensitivity and appropriateness in identifying ADHD in a non-western culture like that of Australian Aboriginal people. Unlike their western counterparts, health to the Aboriginal people is not simply just the physical well-being of an individual but is connected to social, emotional and cultural well-being of the whole community (National Aboriginal Health Strategy Working Party, 1989). These relationships can influence how people understand illness and in turn impact on their decisions about helpseeking behaviour and accessing services.

Loh, P. R., Hayden, G., Vicary, D., Mancini, V., Martin, N., & Piek, J. P. (2016). Australian Aboriginal perspectives of attention deficit hyperactivity disorder. Australian and New Zealand Journal of Psychiatry, 0004867415624551. Online [retrieved 2/7/2016]:

http://anp.sagepub.com/content/early/2016/01/12/0004867415624551.extract

Powerpoint presentation Online [retrieved 2/7/2016]:  https://bmw.curtin.edu.au/events/2011/Pek_Ru_BMW_seminar_2011.pdf

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EMOTION AND DISSOCIATIVE SEIZURES : A PHENOMENOLOGICAL ANALYSIS OF PATIENTS’ PERSPECTIVES

Highlights

This qualitative study examined emotions in patients with dissociative seizures.  Patients showed remarkable insight into their emotional difficulties and strengths.  Over- and underregulation of affect was described (‘shutting down’, ‘explosions’).  Emotions were perceived as inconsistently related to seizure occurrence.  Traumatic experiences and stress precipitated seizure onset in many cases.

Abstract

Quantitative research has indicated that patients with dissociative seizures (DS) show altered responses to emotional stimuli, in addition to considerable emotional distress and dysregulation. The present study sought to further explore emotional processes in this population, to extend previous findings, and to provide a phenomenological insight into patients' perspectives on these issues. Semistructured interviews were carried out with 15 patients with DS, and the principles of interpretative phenomenological analysis (IPA) were adopted in data analysis. Key themes elicited included: i) general emotional functioning; ii) adverse (stressful/traumatic) life experiences; iii) the role of emotions in DS; iv) relating to others; and v) resilience, protective factors, and coping mechanisms. The clinical and theoretical implications of the findings are discussed.

Pick, S., Mellers, J. D., & Goldstein, L. H. (2016). Emotion and dissociative seizures: A phenomenological analysis of patients' perspectives. Epilepsy & Behavior, 56, 5-14. Online [retrieved 2/7/2016]: http://www. ncbi.nlm.nih.gov/pubmed/26799918

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EVALUATION OF A TAILORED TRAINING PROGRAMME TO IMPROVE THE ASSESSMENT AND TREATMENT OF TRAUMA IN AN EARLY INTERVENTION IN PSYCHOSIS (EIP) SERVICE

The correlation of psychosis and the experience of traumatic events is widely recognised in the literature and by NICE guidelines. Research suggests that around two-thirds of patients are not asked about trauma, and guidance for treatment is limited. The aim of the current study was to improve adherence to evidence-based practice by identifying, and reducing, barriers to the assessment and treatment of complex trauma in early intervention (EI) patients. The Plan Do Study Act model of service improvement was employed to guide the intervention delivered to an EI staff team. This included completing a focus group to identify staff needs and the development and delivery of a training programme which met these needs. A questionnaire was developed to assess the impact of the intervention at reducing barriers to assessing and treating trauma. The training package significantly improved staff members’ confidence and knowledge in assessing and treating trauma, and marginally reduced worries. Improvement was maintained after 6 months of implementing skills despite team restructuring. Consideration of the impact for service users, relevance of this intervention for similar services and directions for future progression are discussed.

Walters, S., Hogg, L., & Gillmore, C. (2016). Evaluation of a tailored training programme to improve the assessment and treatment of trauma in an Early Intervention in Psychosis (EIP) service. Psychosis, 1-12. Online [retrieved 2/7/2016]: http://www.tandfonline.com/doi/abs/10.1080/17522439.2015.1131324#. VreTdDYXrCo

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OXYTOCIN RECEPTOR GENETIC AND EPIGENETIC VARIATIONS : ASSOCIATION WITH CHILD ABUSE AND ADULT PSYCHIATRIC SYMPTOMS

Childhood abuse can alter biological systems and increase risk for adult psychopathology. Epigenetic mechanisms, alterations in DNA structure that regulate the gene expression, are a potential mechanism underlying this risk. While abuse associates with methylation of certain genes, particularly those in the stress response system, no study to date has evaluated abuse and methylation of the oxytocin receptor (OXTR). However, studies support a role for OXTR in the link between abuse and adverse adult outcomes, showing that abuse can confer greater risk for psychiatric symptoms in those with specific OXTR genotypes. This study therefore sought to (a) assess the role of epigenetics in the link between abuse and psychopathology and (b) begin to integrate the genetic and epigenetic literature by exploring associations between OXTR genotypes and DNA CpG methylation. Data on 18 OXTR CpG sites, 44 single nucleotide polymorphisms, childhood abuse, and adult depression and anxiety symptoms were assessed in 393 African American adults (age = 41 ± 12.8 years). Overall, 68% of genotypes were associated with methylation of nearby CpG sites, with a subset surviving multiple test correction. Child abuse associated with higher methylation of two CpG sites yet did not survive correction or serve as a mediator of psychopathology. However, abuse interacted with CpG methylation to predict psychopathology. These findings suggest a role for OXTR in understanding the influence of early environments on adult psychiatric symptoms.

Smearman, E. L., Almli, L. M., Conneely, K. N., Brody, G. H., Sales, J. M., Bradley, B., ... & Smith, A. K. (2016). Oxytocin Receptor Genetic and Epigenetic Variations: Association With Child Abuse and Adult Psychiatric Symptoms. Child Development, 87(1), 122-134.

Online [retrieved 2/7/2016]: http://www.ncbi.nlm.nih.gov/pubmed/26822448