Research from 2014

Early experience, structural dissociation, and emotional dysregulation in borderline personality disorder: the role of insecure and disorganized attachment.

Mosquera, D., Gonzalez, A. & Leeds, A.M.

Abstract

Persistent problems in emotional regulation and interpersonal relationships in borderline patients can be understood as developing from difficulties in early dyadic regulation with primary caregivers. Early attachment patterns are a relevant causal factor in the development of Borderline Personality Disorder (BPD). Links between attachment issues, early history of neglect, and traumatic experiences, and symptoms observed in patients with BPD as per the DSM-5 classification (American Psychiatric Association: Diagnostic and statistical manual of mental disorders: DSM-5 (Fifth ed.). Washington, D.C; (2013)) are described in this article, while delineating possible pathways from attachment disruptions to the specific symptomatology of these patients. The theory of structural dissociation of the personality (TSDP) provides an essential framework for understanding the processes that may lead from insecure early attachment to the development and maintenance of BPD symptoms. Dyadic parent–child interactions and subsequent modulation of emotion in the child and future adult are considered closely related, but other factors in the development of BPD, such as genetic predisposition and traumatic experiences, should also be considered in conceptualizing and organizing clinical approaches based on a view of BPD as a heterogeneous disorder.

Mosquera, D., Gonzalez, A. & Leeds, A.M. (2014). Early experience, structural dissociation, and emotional dysregulation in borderline personality disorder: the role of insecure and disorganized attachment. Borderline Personality Disorder and Emotion Dysregulation 2014, 1:15. Online [retrieved on 11/23/2014]: http://www.bpded.com/content/pdf/2051-6673-1-15.pdf

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The Shame of Existing: An extreme form of shame

Wille, R.

Abstract

This paper presents ‘the shame of existing’ as a form of shame that is deeper and more extensive than those customarily encountered. ‘The shame of exist- ing’ is defined as shame about existing as we are and especially at the fact that we are. It is accompanied by merciless and total rejection of the subject’s self and by feelings of extreme worthlessness and inferiority coupled with the all-pervasive conviction that it would be better not to exist. On the basis of clinical material, consideration is given to the specific transference and coun- tertransference aspects of analyses in which the shame of existing constitutes an important part of the patient’s pathology. Disturbance of handling and holding by the primary objects right from birth is suggested as the earliest developmental basis of the shame of existing. This disturbance is attributed to hate and rejection of the infant by the primary objects and to the infant’s not being touched emotionally and physically and not having its right to exist acknowledged. The paper begins with an introduction to shame as an affect and as a concept in psychoanalytic theory.

Wille, R. (2014). The Shame of Existing: An extreme form of shame. International Journal of Psychoanalysis, 95:695–717. Online [retrieved on 11/23/2014]: http://www.ncbi.nlm.nih.gov/pubmed/24916725

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Childhood trauma and dissociation in tertiary care patients with migraine and tension type headache: A controlled study.

Kucukgoncu, S., Ornek, F. Y., Cabalar, M., Bestepe, E. & Yayla, V.

Abstract

The aims of this study were: i) to compare the severity of somatoform and psychoform dissociation and childhood trauma among migraine patients, tension-type headache patients (TTH), and healthy controls; and, ii) to identify any relationships between headache characteristics and dissociative symptoms and traumatic childhood experiences among tertiary care patients with headache.

The study sample consisted of 79 patients with migraine, 49 patients with TTH and 40 healthy controls. They completed the socio-demographic form, Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), and the Somatoform Dissociation Questionnaire (SDQ).

The average score for childhood emotional abuse was significantly higher in the TTH and migraine patients than in healthy controls; mean scores for emotional neglect and physical abuse were higher in TTH patients than healthy controls; and the total CTQ score was higher in TTH patients than in either migraine patients or healthy controls. Average DES scores were significantly higher in TTH patients versus migraine patients and controls; and SDQ scores were higher in both headache groups than in controls. Headache duration and severity were found to be significantly related to childhood abuse scores among migraine but not TTH patients.

Our findings support the evidence of a relationship between childhood trauma and migraines, and suggest that childhood traumatic events are common and deleteriously effect migraine characteristics. Also our study suggests that childhood trauma may have a role in TTH. Significant differences in the DES and SDQ scores between groups may be explained by the differences in childhood trauma experiences.

Kucukgoncu, S., Ornek, F. Y., Cabalar, M., Bestepe, E. & Yayla, V. (2014). Childhood trauma and dissociation in tertiary care patients with migraine and tension type headache: A controlled study. Journal of Psychosomatic Research, 77(1): 40 – 44. Online [retrieved on 11/23/2014]: http://www.sciencedirect.com/science/article/pii/S0022399914001937

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Childhood Trauma and Active Mental Processes: Dissociation and Metacognition Influence Control of Negative Thoughts

Barlow, M.R. & Goldsmith, R.E.

Abstract

Among trauma survivors, efforts to control distressing thoughts may be linked with dissociation. We examined the hypothesis that dissociation was related to metacognitive need to control thoughts (NCT); and explored dissociation and NCT as mediators between trauma and thought control techniques in a sample of college students. Dissociation was positively related to NCT and to childhood betrayal trauma (abuse by someone close to the victim). Dissociation and NCT mediated the relationship between childhood betrayal trauma and strategies used to control negative thoughts. Overall, childhood betrayal trauma was associated with NCT and with the use of active thought control methods such as reappraisal and worry, which require focusing directly on the thought; dissociation mediates this relationship. Therapeutic approaches that enhance awareness for cognitive and emotional experiences may be helpful for dissociative trauma survivors.

Barlow, M.R. & Goldsmith, R.E. (2014). Childhood Trauma and Active Mental Processes: Dissociation and Metacognition Influence Control of Negative Thoughts. Journal of Child & Adolescent Trauma,7(2): 131-140. Online [retrieved on 11/23/2014]: http://link.springer.com/article/10.1007/s40653-014-0010-3

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Fearful attachment mediates the association of childhood trauma with schizotypy and psychotic-like experiences

Kwapil, T.R.

Abstract

We examined whether insecure attachment styles mediate the association between childhood trauma and nonclinical psychotic phenomena in 546 young adults. Fearful attachment mediated the associations of physical/emotional trauma with schizotypy, suspiciousness, and psychotic-like experiences. Results support theoretical accounts implicating attachment disruptions in the pathway from childhood adversity to psychosis.

Kwapil, T.R. (2014). Fearful attachment mediates the association of childhood trauma with schizotypy and psychotic-like experiences. Psychiatry Research, 220(1-2), 691-693.  Online [retrieved on 11/23/2014]: http://libres.uncg.edu/ir/uncg/listing.aspx?id=17399

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Examining child sexual abuse in relation to complex patterns of trauma exposure: Findings from the National Child Traumatic Stress Network.

Kisiel, C., Fehrenbach, T., Liang, L.-J., Stolbach, B., McClelland, G.,  Griffin, G., Maj, N., Briggs, E.C., Vivrette, R.L., Layne, C.M. & Spinazzola, J.

Abstract

Chronic, interpersonal traumas within the caregiving system are associated with a range of symptoms, functional impairments, and trauma history profiles. This study utilized data from the National Child Traumatic Stress Network (NCTSN) Core Data Set (CDS) to examine the role of child sexual abuse in combination with other types of caregiver-related trauma (physical abuse, domestic violence, emotional abuse, neglect, and impaired caregiving). These trauma composites were assessed in relation to clinical profiles, including mental health symptoms, risk behaviors, and functional difficulties. Groups included multiply traumatized youth with a documented history of: (a) 3 or more caregiver-related traumas with co-occurring sexual abuse (CR + CSA group, N = 501); (b) 3 or more caregiver-related traumas without co-occurring sexual abuse (CR group, N = 1,108); and (c) 3 or more noncaregiver-related traumas (e.g., medical trauma, natural disaster, physical/sexual assault; non-CR group, N = 142). Youth with caregiver-related traumas had significantly earlier onset and longer duration of traumas compared to other traumatized youth. Child sexual abuse had an additive and potent predictive effect on clinical profiles, even in combination with other caregiver-related traumas. Although youth with caregiver-related traumas exhibited significant attachment problems, youth with sexual abuse in particular had higher levels of posttraumatic stress disorder (PTSD), and received higher ratings for symptoms of depression, suicidality, and sexualized behaviors in comparison with the other 2 groups. Findings suggest that careful mapping of trauma history, including age of onset, duration, and co-occurrence of trauma exposure in childhood, can provide a foundation for a more refined developmental approach to the scientific investigation, clinical assessment, and treatment of children with complex histories of trauma in childhood.

Kisiel, C., Fehrenbach, T., Liang, L.-J., Stolbach, B., McClelland, G.,  Griffin, G., Maj, N., Briggs, E.C., Vivrette, R.L., Layne, C.M. & Spinazzola, J. (2014). Examining child sexual abuse in relation to complex patterns of trauma exposure: Findings from the National Child Traumatic Stress Network. Psychological Trauma: Theory, Research, Practice, and Policy, 6(1): S29-S39. Online [retrieved on 11/23/2014]: http://psycnet.apa.org/journals/tra/6/S1/S29/

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Can social support alleviate inflammation associated with childhood adversities?

Runsten, S., Korkeila, K., Koskenvuo, M. Rautava, P., Vainio, O. & Korkeila, J.

Abstract

Childhood adversities have been linked to elevated high-sensitivity C-reactive protein (hsCRP), which has been associated with increased morbidity. Low social support has been reported to worsen the prognosis in heart disease and cancer, and high social support has been linked to lower hsCRP. We hypothesized that social support could be a mediating factor between childhood adversities and hsCRP.

The sample was drawn from the data of the nationwide Health and Social Support Study (HeSSup Study) to which 25,898 Finns had responded in 1998. The cohort was stratified into groups of high and low social support, and the study group consisted of 100 women in both groups. Additionally, we invited a randomly drawn group of 50 subjects and a group of 62 women who had reported depressive symptoms. Of the 312 women, 116 participated in the study.

Social support score (Social Support Questionnaire, SSQ) was lower when the number of adverse experiences in childhood was high (r = − 0.251, P = 0.007). hsCRP and SSQ were inversely associated (r = − 0.188, P = 0.046). In the adjusted general linear model, the level of social support was significantly associated with hsCRP and there was a statistically significant interactive effect of small effect size of childhood adversities and the level of social support on hsCRP (ES = 0.123, P = 0.004).

This finding suggests that childhood adversity may affect social relationships and that high social support may attenuate the health risks caused by childhood adverse experience.

Runsten, S., Korkeila, K., Koskenvuo, M. Rautava, P., Vainio, O. & Korkeila, J. (2014). Can social support alleviate inflammation associated with childhood adversities? Nordic Journal of Psychiatry, 68(2): 137-144. Online [retrieved on 11/23/2014]: http://informahealthcare.com/doi/abs/10.3109/08039488.2013.786133

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Pathways Associating Childhood Trauma to the Neurobiology of Schizophrenia

Ruby, E., Malaspina, D., Corcoran, C., Polito, S. & Gorovitz, M.

Abstract

While researchers have for decades considered the role of social factors, endocrinology, neural function, hippocampal integrity, and cognition in the development of schizophrenia, there has been a relative paucity of studies considering the participation of the stress cascade in the interplay of these elements. As described in this review, stressful exposures and stress sensitivity may plausibly be argued to play a role in the etiology, neurobiology, and course of schizophrenia and related psychotic disorders. Notably, research conducted over the last decade has made it increasingly clear that childhood traumatic experiences represent a prominent risk factor for the development of psychotic disorders, including schizophrenia. Accumulating evidence suggests that this relationship is mediated by the development of a neuropathological stress response, involving HPA axis dysregulation, aberrant functioning of different neurotransmitter systems, hippocampal damage, and memory deficits. However, it remains difficult to identify exact causal pathways linking early trauma to schizophrenia, including to the individual symptoms associated with the disorder. In addition to the strong association among early trauma, stress sensitization, and positive symptoms in schizophrenia, there is also evidence indicating that the negative and cognitive symptoms are related to these factors. However, the emergence of these symptoms may lie on a distinct and non-interacting pathway in relation to the development of the positive symptoms. The natural increases in stress sensitivity and HPA axis activity during adolescence may act on already maladaptive stress circuitry resulting from early trauma and/or a genetic predisposition to produce full blown stress sensitization and cause epigenetic effects, such as the altered methylation of different genes, that lead to schizophrenia or other psychiatric illnesses.

Ruby, E., Malaspina, D., Corcoran, C., Polito, S. & Gorovitz, M. Pathways Associating Childhood Trauma to the Neurobiology of Schizophrenia. Frontiers in Psychological and Behavioral Science, 3(1):1-7. Online [retrieved on 11/23/2014]: http://www.academicpub.org/DownLoadPaper.aspx?PaperID=14873

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Effects of Psychotherapy on DNA Strand Break Accumulation Originating from Traumatic Stress

Morath, J., Moreno-Villanueva, M., Hamuni, G., Kolossa, S., Ruf-Leuschner, M., Schauer, M., Elbert, T., Bürkle, A. & Kolassa, I.T.

Abstract

Background: Previous research reveals an association be- tween traumatic stress and an increased risk for numerous diseases, including cancer. At the molecular level, stress may increase carcinogenesis via increased DNA damage and im- paired DNA repair mechanisms. We assessed DNA breakage in peripheral blood mononuclear cells from individuals with post-traumatic stress disorder (PTSD) and measured the cel- lular capacity to repair single-strand breaks after exposure to ionizing X-radiation. We also investigated the effect of psy- chotherapy on both DNA breakage and DNA repair. Methods: In a first study we investigated DNA breakage and repair in 34 individuals with PTSD and 31 controls. Controls were subdivided into 11 trauma-exposed subjects and 20 individ- uals without trauma exposure. In a second study, we anal- ysed the effect of psychotherapy (Narrative Exposure Thera- py) on DNA breakage and repair. Thirty-eight individuals with PTSD were randomly assigned to either a treatment or a waitlist control condition. Follow-up was performed 4 months and 1 year after therapy. Results: In study 1 we found higher levels of basal DNA breakage in individuals with PTSD and trauma-exposed subjects than in controls, in- dicating that traumatic stress is associated with DNA break- age. However, single-strand break repair was unimpaired in individuals with PTSD. In study 2, we found that psychother- apy reversed not only PTSD symptoms, but also DNA strand break accumulation. Conclusion: Our results show – for the first time in vivo – an association between traumatic stress and DNA breakage; they also demonstrate changes at the molecular level, i.e., the integrity of DNA, after psychothera- peutic interventions.

Morath, J., Moreno-Villanueva, M., Hamuni, G., Kolossa, S., Ruf-Leuschner, M., Schauer, M., Elbert, T., Bürkle, A. & Kolassa, I.T. (2014). Effects of Psychotherapy on DNA Strand Break Accumulation Originating from Traumatic Stress. Psychotherapy and Psychosomatics, 83:289–297. Online [retrieved on 11/23/2014]: http://cdn.bancodasaude.com/attachment/pdffddd.pdf

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Challenges to free will: transgenerational epigenetic information, unconscious processes, and vanishing twin syndrome

Bókkon, I., Pál Vas, J., Császár, N. & Lukács, T.

Abstract

Here, we present various research results and thoughts with the intention of challenging notions about free choice. Namely, we describe the concept of transgenerational transmission of epigenetic information and discuss its non-conscious effects on cognitive abilities, behavioral and emotional patterns, and responses with regard to one’s life and decisions, and the impact these have on the concept of free will. In addition, we discuss the essential role of unconscious mechanisms in human decision processes. We also show that twin loss in the womb can have a powerful lifelong impact on the surviving twin through non-conscious context-dependent epigenetic changes. Finally, we hypothesize that human explicit self-consciousness may be an active executer that intermediates between unconsciousness and the external environment by means of feedback and feed-forward interactions. This executive function makes it possible for self-consciousness to continuously develop in self-organized evolution.

Bókkon, I., Pál Vas, J., Császár, N. & Lukács, T. (2014). Challenges to free will: transgenerational epigenetic information, unconscious processes, and vanishing twin syndrome. Reviews in the Neurosciences, 25(1): 163–175. Online [retrieved on 11/23/2014]: http://www.degruyter.com/view/j/revneuro.2014.25.issue-1/revneuro-2013-0036/revneuro-2013-0036.xml

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Autobiographical Memory Specificity in Dissociative Identity Disorder

Huntjens, J.C., Wessel, I., Hermans, D. & Van Minnen, A.

Abstract

A lack of adequate access to autobiographical knowledge has been related to psychopathology. More specifically, patients suffering from depression or a history of trauma have been found to be characterized by overgeneral memory, in other words, they show a relative difficulty in retrieving a specific event from memory located in time and place. Previous studies of overgeneral memory have not included patients with dissociative disorders. These patients are interesting to consider, as they are hypothesized to have the ability to selectively compartmentalize information linked to negative emotions. This study examined avoidance and overgeneral memory in patients with dissociative identity disorder (DID; n = 12). The patients completed the autobiographical memory test (AMT). Their performance was compared with control groups of posttraumatic stress disorder (PTSD) patients (n = 26), healthy controls (n = 29), and DID simulators (n = 26). Specifically, we compared the performance of separate identity states in DID hypothesized to diverge in the use of avoidance as a coping strategy to deal with negative affect. No significant differences in memory specificity were found between the separate identities in DID. Irrespective of identity state, DID patients were characterized by a lack of memory specificity, which was similar to the lack of memory specificity found in PTSD patients. The converging results for DID and PTSD patients add empirical evidence for the role of overgeneral memory involved in the maintenance of posttraumatic psychopathology.

Huntjens, J.C., Wessel, I., Hermans, D. & Van Minnen, A. (2014). Autobiographical Memory Specificity in Dissociative Identity Disorder. Journal of Abnormal Psychology, 123(2): 419–428. Online [retrieved on 11/23/2014]: http://www.ncbi.nlm.nih.gov/pubmed/24886016

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Associations Between Early Life Stress and Gene Methylation in Children.

Romens, S.E., McDonald, J., Svaren, J. & Pollak, S.D. (2014). Associations Between Early Life Stress and Gene Methylation in Children. Child Development, xxxx 2014, 00(0), S 1–7. Online version of record published before inclusion in an issue: DOI: 10.1111/cdev.12270 Online [retrieved 5/8/2014] PDF here: http://onlinelibrary.wiley.com/store/10.1111/cdev.12270/asset/cdev12270.pdf?v=1&t=hyhj4kih&s=e82ef1570aa870e1ae90ade0c2d7afdc63226e5d

Abstract

Children exposed to extreme stress are at heightened risk for developing mental and physical disorders. However, little is known about mechanisms underlying these associations in humans. An emerging insight is that children's social environments change gene expression, which contributes to biological vulnerabilities for behavioral problems. Epigenetic changes in the glucocorticoid receptor gene, a critical component of stress regulation, were examined in whole blood from 56 children aged 11–14 years. Children exposed to physical maltreatment had greater methylation within exon 1F in the NR3C1 promoter region of the gene compared to nonmaltreated children, including the putative NGFI-A (nerve growth factor) binding site. These results highlight molecular mechanisms linking childhood stress with biological changes that may lead to mental and physical disorders.

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Social Isolation Shortens Telomeres in African Grey Parrots (Psittacus erithacus erithacus)

Aydinonat, D., Penn, D.J., Smith, S., Moodley, Y., Hoelzl, F., Knauer, F. & Schwarzenberger, F. (2014). Social Isolation Shortens Telomeres in African Grey Parrots (Psittacus erithacus erithacus). PLOS ONE, 9(4): e93839.  Online [retrieved 5/8/2014]: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0093839

Abstract

Telomeres, the caps of eukaryotic chromosomes, control chromosome stability and cellular senescence, but aging and exposure to chronic stress are suspected to cause attrition of telomere length. We investigated the effect of social isolation on telomere length in the highly social and intelligent African Grey parrot (Psittacus erithacus erithacus). Our study population consisted of single-housed (n = 26) and pair-housed (n = 19) captive individuals between 0.75 to 45 years of age. Relative telomere length of erythrocyte DNA was measured by quantitative real-time PCR. We found that telomere length declined with age (p<0.001), and socially isolated parrots had significantly shorter telomeres compared to pair-housed birds (p<0.001) – even among birds of similar ages. Our findings provide the first evidence that social isolation affects telomere length, which supports the hypothesis that telomeres provide a biomarker indicating exposure to chronic stress.

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Dispelling Myths About Dissociative Identity Disorder Treatment:
An Empirically Based Approach

Brand, B.L., Loewenstein, R.J. & Spiegel, D. (in press). Dispelling Myths About Dissociative Identity Disorder Treatment:
An Empirically Based Approach. Psychiatry 77(2) Summer 2014. Online [retrieved 5/8/2014]: http://www.ncbi.nlm.nih.gov/pubmed/24865199

Abstract

Objective: Some claim that treatment for dissociative identity disorder (DID) is harmful. Others maintain that the available data support the view that psycho- therapy is helpful.

Method: We review the empirical support for both arguments.

Results: Current evidence supports the conclusion that phasic treatment consis- tent with expert consensus guidelines is associated with improvements in a wide range of DID patients’ symptoms and functioning, decreased rates of hospitaliza- tion, and reduced costs of treatment. Research indicates that poor outcome is associated with treatment that does not specifically involve direct engagement with DID self-states to repair identity fragmentation and to decrease dissociative amnesia.

Conclusions: The evidence demonstrates that carefully staged trauma-focused psychotherapy for DID results in improvement, whereas dissociative symptoms persist when not specifically targeted in treatment. The claims that DID treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage that are not substantiated in the scientific literature, misrepresentations of the data, and misunderstandings about DID treatment and the phenomenology of DID. Given the severe symptomatology and disability associated with DID, iatrogenic harm is far more likely to come from depriving DID patients of treatment that is consistent with expert consensus, treatment guidelines, and current research.

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Inpatient treatment for early sexually abused adults: A naturalistic 12-month follow-up study

Jepsen, E. K. K., Langeland, W., Sexton, H., & Heir, T. (2014). Inpatient treatment for early sexually abused adults: A naturalistic 12-month follow-up study. Psychological Trauma, 6(2), 142–151. Online [retrieved 5/8/2014] PDF here: https://www.duo.uio.no/bitstream/handle/10852/38224/dravhandling-jepsen.pdf?sequence=1

Abstract

To date, most of the inpatient outcome studies among early traumatized individuals lack data on dissociative disorders. More research is needed to evaluate whether severely dissociative patients can improve following specialized inpatient treatment for chronic childhood abuse. The objectives of this study were to investigate symptomatic change in patients attending a 3-month specialized inpatient treatment program for adults with a history of childhood sexual abuse (CSA) and mixed trauma-related disorders. In particular, symptomatic changes in those with and without a complex dissociative disorder I + II (CDD) were contrasted. Fifty-six patients with CSA and trauma-related disorders (including 23 patients with CDD) completed the treatment program and a test battery at precare evaluation, admission, discharge, and at 1-year follow-up. There was an overall symptom reduction in dimensional measures maintained at the 1-year follow-up. Patients with CDD consistently had significantly higher symptom levels than the patients without these disorders. Both patient subgroups showed parallel improvement from admission to follow-up, although those high in dissociation (CDD patients) needed more time to show improvement and were still clinically worse at the end of treatment and at follow-up. The findings were matched by clinically significant changes. The results suggest that adults with reported childhood sexual abuse and mixed trauma-related disorders can improve in symptom severity following a trauma-based 3-month inpatient program regardless of CDD status. The high distress level in CDD patients indicates that patients with CDD need treatment that is in part different from the more general treatment of polysymptomatic CSA survivors, addressing the pathological aspects of dissociation more vigorously.

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Therapeutic Presence: Neurophysiological mechanisms mediating feeling safe in therapeutic relationships

Geller, S.M. & Porges, S.W. (in press). Therapeutic Presence:
Neurophysiological mechanisms mediating feeling safe in therapeutic relationships. Journal of Psychotherapy Integration.

Abstract

Therapeutic presence involves therapists using their whole self to be both fully engaged and receptively attuned in the moment with and for the client. In this paper we present a bio- behavioral explanation of how therapeutic presence can facilitate a sense of safety in both therapist and client, to deepen the therapeutic relationship and promote effective therapy. The Polyvagal Theory is used as a guide to explain how specific features of therapeutic presence trigger a neurophysiological state in both client and therapist within which both perceive and experience feelings of safety. The Polyvagal Theory proposes that a state of safety is mediated by neuroception, a neural process that may occur without awareness, which constantly evaluates risk and triggers adaptive physiological responses that respond to features of safety, danger, or life threat. According to the theory, when safety is communicated via expressed markers of social engagement (e.g., facial expressions, gestures, and prosodic vocalizations), defensiveness is down regulated. Cultivating presence and engaging in present-centered relationships can therefore facilitate effective therapy by having both client and therapist enter a physiological state that supports feelings of safety, positive therapeutic relationships, and optimal conditions for growth and change.

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Standardized mirror confrontation: Body-related emotions, cognitions and level of dissociation in patients with Posttraumatic Stress Disorder after childhood sexual abuse.

Borgmann, E., Kleindienst, N, Vocks, S. & Dyer, A.S. (2014). Standardized mirror confrontation: Body-related emotions, cognitions and level of dissociation in patients with Posttraumatic Stress Disorder after childhood sexual abuse. Borderline Personality Disorder and Emotion Dysregulation 2014, 1:10. Online [retrieved 5/8/2014]: http://www.bpded.com/content/1/1/10/abstract

Abstract

Background: A criterion for Posttraumatic Stress Disorder (PTSD) is the avoidance of trauma-associated stimuli that trigger emotional suffering. First studies on body image of patients with PTSD after childhood sexual abuse (CSA) support the hypothesis that awareness of the own body triggers emotional suffering.

Methods: Body-related emotions, cognitions and level of dissociation of n = 17 patients meeting DSM-IV criteria for PTSD and n = 29 healthy controls (HCs) during a standardized mirror confrontation while wearing a standard bikini were assessed.

Results: It was shown that expecting to be and while being confronted with one’s own body, patients with PTSD showed significantly stronger negative emotionality and cognitions as well as higher dissociative states as compared to HCs.

Conclusions: Findings suggest that in patients with PTSD after CSA, one’s own body might function as a stimulus that leads to aversive emotional responses, negative cognitions and dissociative states. The elaboration of treatment for PTSD should consider these body-related aspects, e.g., by investigating the effects of body exposure.

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TITRATION OF TECHNIQUE: Clinical Exploration of the Integration of Trauma Model and Relational Psychoanalytic Approaches to the Treatment of Dissociative Identity Disorder.

MacIntosh, H.B. (2014). TITRATION OF TECHNIQUE: Clinical Exploration of the Integration of Trauma Model and Relational Psychoanalytic Approaches to the Treatment of Dissociative Identity Disorder. Psychoanalytic Psychology. Online [retrieved 5/8/2014]: http://psycnet.apa.org/psycinfo/2014-21953-001/

Abstract

Psychotherapeutic work with patients presenting with severe dissociation and dissociative disorders such as dissociative identity disorder (DID) is challenging for both patient and therapist. It was the goal of this article to explore, through the chronological unfolding of the case of Emily, a woman who had previously been diagnosed with DID, the development of this writer’s process of theoretical reconciliation between a trauma model approach to treatment and relational psychoanalytic ideas about working with dissociative patients. This article reflects this writer’s process of finding balance between the containing yet sometimes confining trauma model in which I learned to be a therapist and the expansive yet sometimes nebulous psychoanalytic theories of trauma and dissociation.

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Dissociation: Adjustment or Distress? Dissociative Phenomena, Absorption and Quality of Life Among Israeli Women Who Practice Channeling Compared to Women with Similar Traumatic History

Stolovy, T., Lev-Wiesel, R. & Witztum, E. (2014). Dissociation: Adjustment or Distress? Dissociative Phenomena, Absorption and Quality of Life Among Israeli Women Who Practice Channeling Compared to Women with Similar Traumatic History. Journal of Religion and Health. Online [retrieved 5/8/2014]: http://link.springer.com/article/10.1007/s10943-014-9885-4

Abstract

This study aimed to explore the relationship between traumatic history, dissociative phenomena, absorption and quality of life among a population of channelers, in comparison with a population of non-channelers with similar traumatic history. The study sample included 150 women. The measures included Traumatic Experiences Scale, Dissociative Experience Scale, Absorption Scale, Brief Symptom Inventory and Quality of Life (QOL) Assessment. Channelers presented significantly higher levels of dissociation, absorption and psychological health compared to the other group. Dissociation and absorption were trauma-related only among the comparison group. Hence, dissociation has different qualities among different people, and spiritual practice contributes to QOL.

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Ten Reasons for Conceiving and Classifying Posttraumatic Stress Disorder as a Dissociative Disorder

Nijenhuis, E.R.S. (2014). Ten Reasons for Conceiving and Classifying Posttraumatic Stress Disorder as a Dissociative Disorder. Psichiatria e Psicoterapia, 33(1): 74-106.

Abstract

In the DSM-5 (APA 2013), posttraumatic stress disorder (PTSD) has become classified in the new chapter on trauma- and stressor-related disorders. The reclassification is an improvement over PTSD’s previous classification as an anxiety disorder given involvement of other intense trauma-related affects such as anger (Kardiner 1941), disgust (Badour et al. 2012), survivor guilt (Koranyi 1969), other types of guilt, and shame (Wilson et al. 2006).

The dissociative disorders that DSM-5 recognizes are placed next to, but are not a part of the trauma- and stressor-related disorders. This organization reflects “the close relationship between these diagnostic categories. Both acute stress disorder and posttraumatic stress disorder contain dissociative symptoms, such as amnesia, flashbacks, numbing, and depersonalization/ derealization” (p. 291). Another link is that particularly but not exclusively patients with complex dissociative disorders have, like patients with acute stress disorder (ASD) and PTSD, lived adverse events.

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DSM-5’s ‘PTSD with Dissociative Symptoms’: Challenges and Future Directions. Journal of Trauma and Dissociation

Dorahy, M. & Van der Hart, O. (2014). DSM-5’s ‘PTSD with Dissociative Symptoms’: Challenges and Future Directions. Journal of Trauma and Dissociation, [epub. ahead of print]. Online [retrieved 5/8/2014]: http://www.ncbi.nlm.nih.gov/pubmed/24983300

Abstract

The DSM-5 formally recognizes a dissociative subtype of PTSD (‘PTSD with dissociative symptoms’). This nomenclative move will boost empirical and theoretical efforts to further understand the links between dissociation, trauma and PTSD. This paper examines the empirical literature showing that patients with PTSD can be divided into two different groups based on their neurobiology, psychological symptom profile, history of exposure to early relational trauma and depersonalization/derealization symptoms. It then explores the conceptual and empirical challenges of conceiving one of these types as reflecting a ‘dissociative’ type of PTSD. First, this classification is based on the presence of a limited subset of dissociative symptoms (i.e., depersonalization, derealization). This sets aside an array of positive and negative psychoform and somatoform dissociative symptoms that may be related to PTSD. Second, empirical evidence suggests heightened dissociation in PTSD compared to many other disorders, indicating that dissociation is relevant to PTSD more broadly, rather than simply to the so-called dissociative subtype. This paper sets out important issues to be examined in the future study of dissociation in PTSD, which need to be informed by solid conceptual understandings of dissociation.

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Does Working with Child Abuse Cases Affect Professionals' Parenting and the Psychological Well-Being of Their Children? Journal of Trauma and Dissociation

Dursun, O.B., Sener, M.T., Ançi Y. & Yalin Sapmaz, S. (2014). Does Working with Child Abuse Cases Affect Professionals' Parenting and the Psychological Well-Being of Their Children? Journal of Trauma and Dissociation, [epub. ahead of print]. Online [retrieved 5/8/2014]: http://www.ncbi.nlm.nih.gov/pubmed/24983655

Abstract

Work in the field of sexual abuse is extremely stressful and may arouse negative personal reactions. Although these secondary trauma effects were well described on a personal level, there is not enough evidence to understand if these professionals carry these effects to their homes, families, and offspring. This study aims to identify the effects of working with child abuse cases on the anxiety level, parenting styles, and children's well-being of childhood trauma workers. Forty-three health and legal system workers who work with abused children in any step of their process and who have children constitute the study group, and 66 control cases, each working in the same institution and having the same occupation as one of the participants from the study group and who have children but have not been working directly with children and child abuse cases, were included in the study. Participants were asked to fill out a sociodemographic form, the Parental Attitude Research Instrument, the state portion of the State-Trait Anxiety İnventory, and an age-appropriate form of the Child Behavior Checklist for each child they have. Professionals working with child abuse cases demonstrated significantly higher democratic parenting attitudes in the study. Law enforcement workers working with child abuse cases demonstrated strict and authoritarian parenting strategies, as well as democratic attitudes, more than their colleagues. There was not a statistically significant relationship between child abuse workers' anxiety level and their children's well-being with the control subjects.

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The Trauma Model of Dissociation: Inconvenient Truths and Stubborn Fictions. Comment on Dalenberg et al. (2012)

Lynn, S.J., Lilienfeld, S.O., Merckelbach, H., Giesbrecht, T., McNally, R.J., Loftus, E.F., Bruck, M., Garry, M. & Malaktaris, A. (2014). The Trauma Model of Dissociation: Inconvenient Truths and Stubborn Fictions. Comment on Dalenberg et al. (2012). Psychological Bulletin, Vol 140(3), May 2014, 896-910. Online [retrieved 5/4/2014]: http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2014-14523-003

Katz, C. & Barnetz, Z. (2013). The behavior patterns of abused children as described in their testimonies. Child Abuse & Neglect.

Online [retrieved 1/25/2014]: http://www.sciencedirect.com/science/article/pii/S014521341300224X

Abstract

Dalenberg et al. (2012) argued that convincing evidence (a) supports the longstanding trauma model (TM), which posits that early trauma plays a key role in the genesis of dissociation; and (b) refutes the fantasy model (FM), which posits that fantasy proneness, suggestibility, cognitive failures, and other variables foster dissociation. We review evidence bearing on Dalenberg et al.’s 8 predictions and find them largely wanting in empirical support. We contend that the authors repeat errors committed by many previous proponents of the TM, such as attributing a central etiological role to trauma in the absence of sufficient evidence. Specifically, Dalenberg et al. leap too quickly from correlational data to causal conclusions, do not adequately consider the lack of corroboration of abuse in many studies, and underestimate the relation between dissociation and false memories. Nevertheless, we identify points of agreement between the TM and FM regarding potential moderators and mediators of dissociative symptoms (e.g., family environment, biological vulnerabilities) and the hypothesis that dissociative identity disorder is a disorder of self-understanding. We acknowledge that trauma may play a causal role in dissociation but that this role is less central and specific than Dalenberg et al. contend. Finally, although a key assumption of the TM is dissociative amnesia, the notion that people can encode traumatic experiences without being able to recall them lacks strong empirical support. Accordingly, we conclude that the field should now abandon the simple trauma–dissociation model and embrace multifactorial models that accommodate the diversity of causes of dissociation and dissociative disorders.

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Reality Versus Fantasy: Reply to Lynn et al. (2014)

Dalenberg, C.J., Brand, B.L., Loewenstein, R.J., Gleaves, D.H., Dorahy, M.J., Cardeña, E., Frewen, P.A., Carlson, E.B. & Spiegel, D. (2014). Reality Versus Fantasy: Reply to Lynn et al. (2014). Psychological Bulletin, Vol 140(3), May 2014, 911-920.Online [retrieved 5/4/2014]: http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2014-14523-004

Abstract

We respond to Lynn et al.’s (2014) comments on our review (Dalenberg et al., 2012) demonstrating the superiority of the trauma model (TM) over the fantasy model (FM) in explaining the trauma–dissociation relationship. Lynn et al. conceded that our meta-analytic results support the TM hypothesis that trauma exposure is a causal risk factor for the development of dissociation. Although Lynn et al. suggested that our meta-analyses were selective, we respond that each omitted study failed to meet inclusion criteria; our meta-analyses thus reflect a balanced view of the predominant trauma–dissociation findings. In contrast, Lynn et al. were hypercritical of studies that supported the TM while ignoring methodological problems in studies presented as supportive of the FM. We clarify Lynn et al.’s misunderstandings of the TM and demonstrate consistent superiority in prediction of time course of dissociative symptoms, response to psychotherapy of dissociative patients, and pattern of relationships of trauma to dissociation. We defend our decision not to include studies using the Dissociative Experiences Scale—Comparison, a rarely used revision of the Dissociative Experiences Scale that shares less than 10% of the variance with the original scale. We highlight several areas of agreement: (a) Trauma plays a complex role in dissociation, involving indirect and direct paths; (b) dissociation– suggestibility relationships are small; and (c) controls and measurement issues should be addressed in future suggestibility and dissociation research. Considering the lack of evidence that dissociative individuals simply fantasize trauma, future researchers should examine more complex models of trauma and valid measures of dissociation.

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The Complex Dynamics of Wishful Thinking: The Critical Positivity Ratio

Brown, N.J.L., Sokal, A.D. & Friedman, H.L. (2014). The Complex Dynamics of Wishful Thinking: The Critical Positivity Ratio. American Psychologist, Vol 68(9), Dec 2013, 801-813.

Online [retrieved 5/4/2014]: http://psycnet.apa.org/psycinfo/2013-24609-001/

Abstract

We examine critically the claims made by Fredrickson and Losada (2005) concerning the construct known as the “positivity ratio.” We find no theoretical or empirical justification for the use of differential equations drawn from fluid dynamics, a subfield of physics, to describe changes in human emotions over time; furthermore, we demonstrate that the purported application of these equations contains numerous fundamental conceptual and mathematical errors. The lack of relevance of these equations and their incorrect application lead us to conclude that Fredrickson and Losada’s claim to have demonstrated the existence of a critical minimum positivity ratio of 2.9013 is entirely unfounded. More generally, we urge future researchers to exercise caution in the use of advanced mathematical tools such as nonlinear dynamics and in particular to verify that the elementary conditions for their valid application have been met.

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Assessment for self-blame and trauma symptoms during the medical evaluation of suspected sexual abuse

Melville, J.D., Kellogg, N.D., Perez, N. & Lukefahr, J.L. (in press). Assessment for self-blame and trauma symptoms during the medical evaluation of suspected sexual abuse. Child Abuse and Neglect.

Online [retrieved 5/4/2014]: http://www.sciencedirect.com/science/article/pii/S0145213414000386

Abstract

The purpose of this study was to describe behavioural and emotional symptoms and to examine the effect of abuse-related factors, family responses to disclosure, and child self-blame on these symptoms in children presenting for medical evaluations after disclosure of sexual abuse. A retrospective review was conducted of 501 children ages 8–17. Trauma symptoms were determined by two sets of qualitative measures. Abstracted data included gender, ethnicity, and age; severity of abuse and abuser relationship to child; child responses regarding difficulty with sleep, school, appetite/weight, sadness, or self-harm, parent belief in abuse disclosure, and abuse-specific self-blame; responses to the Trauma Symptom Checklist in Children-Alternate; and the parent's degree of belief in the child's sexual abuse disclosure. Overall, 83% of the children had at least one trauma symptom; 60% had difficulty sleeping and one-third had thoughts of self-harm. Child age and abuse severity were associated with 3 of 12 trauma symptoms, and abuse-specific self-blame was associated with 10 trauma symptoms, after controlling for other variables. The children of parents who did not completely believe the initial disclosure of abuse were twice as likely to endorse self-blame as children of parents who completely believed the initial disclosure. Screening for behavioural and emotional problems during the medical assessment of suspected sexual abuse should include assessment of self-blame and family responses to the child's disclosures. In addition, parents should be informed of the importance of believing their child during the initial disclosure of abuse and of the impact this has on the child's emotional response to the abuse.

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Overlap between dissociation and other psychological characteristics in patients with psychogenic nonepileptic seizures

Cohen, M.L., Testa, S.M., Pritchard, J.M., Zhu, J. & Hopp, J.L. (2014). Overlap between dissociation and other psychological characteristics in patients with psychogenic nonepileptic seizures. Epilepsy & Behavior, volume 34, pp 47–49. Online [retrieved 5/4/2014]: http://www.sciencedirect.com/science/article/pii/S1525505014000821

Abstract

Patients with psychogenic nonepileptic seizures (PNES) often report symptoms of dissociation. However, it is unclear how these symptoms relate to psychotherapeutic treatment, for example, with cognitive-behavioral therapy (CBT). Here, we investigated the degree of overlap between symptoms of dissociation and other psychiatric features that are more traditional targets for CBT. We used a hierarchical linear regression to measure the variance associated with dissociative symptoms (as assessed by the Dissociative Experiences Scale — DES) among 46 individuals with PNESs. The regression predictor variables are indices of participants' self-rated mood, self-efficacy, quality of life, locus of control, and life outlook (e.g., optimism). Results revealed that 70.2% of the variance associated with DES score was explained by psychological distress and locus of control. The other factors examined did not make a significant contribution to the regression model. These results suggest that traditional CBT targets – mood symptoms, mood distress, and dysfunctional beliefs about locus of control – overlap substantially with self-reported dissociative symptoms.

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Art therapy, trauma and substance misuse: Using imagery to explore a difficult past with a complex client

Skeffington, P.M. & Browne, M. (2014). Art therapy, trauma and substance misuse: Using imagery to explore a difficult past with a complex client. International Journal of Art Therapy: Formerly Inscape.

Online [retrieved 5/4/2014]: http://www.tandfonline.com/doi/abs/10.1080/17454832.2014.910816#.U2Z7MV7ckqU

Abstract

Literature regarding the efficacy of treatment programmes for post-trauma pathologies is prolific; however, often little attention is given to the treatment of resistant and complex trauma. Many psychotherapists recognise that a trauma history may need to be considered and explored, particularly when working with complex clients. Avoidance of distressing thoughts, feelings and images can manifest in a range of symptoms and behaviours other than post-traumatic stress disorder (PTSD), including substance abuse and interpersonal problems. Creative therapies, such as art therapy, utilise the potentially unfamiliar language of imagery. Imagery, as an adjunct to a sense of safety and holding, in some cases has been shown to overcome therapeutic avoidance. This paper outlines the unveiling and recognition of intra-familial childhood trauma through Art Therapy with a highly articulate Australian woman battling binge drinking behaviours.

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Hair Cortisol as a Biomarker for Chronic Stress and Its Association With Preterm Birth

Karakash, S.D., Tchankoshvili, N., Kim, S., Weedon, J., Schwartz, R.M. & Minkoff, H. (2014). Hair Cortisol as a Biomarker for Chronic Stress and Its Association With Preterm Birth. Obstetrics & Gynecology.

Online [retrieved 5/4/2014]: http://journals.lww.com/greenjournal/Abstract/2014/05001/Hair_Cortisol_as_a_Biomarker_for_ Chronic_Stress.123.aspx

Abstract

INTRODUCTION: Hair cortisol is an objective measurement of chronic hypothalamic-pituitary-adrenal activity and stress. We hypothesized that women with a preterm birth will have a higher level of chronic stress, measured by hair cortisol, and histories of greater psychological stress and trauma than those in a control group.

METHODS: In a prospective, matched, case-control study, 29 women who had a preterm birth at 24-36 weeks 5 days of gestation were compared with 29 women who delivered at term matched for maternal age, gestational age, and race. Participants completed validated questionnaires regarding general stress and childhood trauma. The Wilcoxon signed-rank test was used to compare the distribution of mean cortisol scores. Conditional logistic regression was used to predict case compared with control by cortisol score controlling for covariates. [chi]2 tests were used to assess associations between case-control and childhood trauma and analysis of variance for the perceived stress outcome.

RESULTS: Baseline characteristics of those in the case group and those in the control group did not differ. Cortisol levels were significantly lower among women in the case group in the adjusted analysis (Wald [chi]2 4.73, P=.03). Each 10-unit increase in cortisol level decreased the odds of being a case by 10%. A history of emotional neglect increased the chances of preterm birth (63.4% compared with 31.6% Pearson [chi]2=5.29; P=.021).

CONCLUSION: Contrary to our hypothesis, increased hair cortisol level was associated with term deliveries, not preterm birth. In addition, women with an emotional neglect history were more likely to have a preterm birth. Normal hypothalamic-pituitary-adrenal axis activation is a physiologic, adaptive response to stress. Women who are stressed but unable to mount an adequate stress response could be at particular risk for preterm term.

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Childhood Trauma and Active Mental Processes: Dissociation and Metacognition Influence Control of Negative Thoughts

Barlow, M.R. & Goldsmith, R.E. (in press). Childhood Trauma and Active Mental Processes: Dissociation and Metacognition Influence Control of Negative Thoughts. Journal of Child & Adolescent Trauma.

Online [retrieved 5/4/2014]: http://link.springer.com/article/10.1007/s40653-014-0010-3

Abstract

Among trauma survivors, efforts to control distressing thoughts may be linked with dissociation. We examined the hypothesis that dissociation was related to metacognitive need to control thoughts (NCT); and explored dissociation and NCT as mediators between trauma and thought control techniques in a sample of college students. Dissociation was positively related to NCT and to childhood betrayal trauma (abuse by someone close to the victim). Dissociation and NCT mediated the relationship between childhood betrayal trauma and strategies used to control negative thoughts. Overall, childhood betrayal trauma was associated with NCT and with the use of active thought control methods such as reappraisal and worry, which require focusing directly on the thought; dissociation mediates this relationship. Therapeutic approaches that enhance awareness for cognitive and emotional experiences may be helpful for dissociative trauma survivors.

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Child Torture as a Form of Child Abuse

Knox, B.L., Starling, S.P., Feldmann, K.W., Kellogg, N.D., Frasier, L.D. & Tiapula, S.L. (2014). Child Torture as a Form of Child Abuse. Journal of Child & Adolescent Trauma, volume 7 (1), pp 37-49.

Online [retrieved 5/4/2014]: http://link.springer.com/article/10.1007/s40653-014-0009-9

Abstract

This paper describes clinical findings and case characteristics of children who are victims of severe and multiple forms of abuse; and proposes clinical criteria that indicate child abuse by torture. Medical records, investigation records, and transcripts of testimony regarding a non-consecutive case series of 28 children with evidence of physical abuse, neglect, and psychological maltreatment, such as terrorizing and isolation, were reviewed for types of injuries, duration of maltreatment, medical and physical neglect, social and family history, and history of prior Child Protective Services (CPS) involvement. The median age was 7.5 years (9 months to 14.3 years). Thirty-six percent died. Duration of abuse ranged from 3.5 months to 8 years (median 3 years). Ninety-three percent of children were beaten and exhibited cutaneous injury; 21 % had fractures. There were 25 victims of isolation (89 %), as well as 61 % who were physically restrained and 89 % who were restricted from food or water. All of the children were victims of psychological maltreatment; 75 % were terrorized through threats of harm or death to themselves or loved ones and 54 % were degraded and/or rejected by caregivers. Nearly all children were medically neglected. Half had a history of prior referrals to CPS. The children in this case series were physically abused, isolated, deprived of basic necessities, terrorized, and neglected. We define child torture as a longitudinal experience characterized by at least two physical assaults or one extended assault, two or more forms of psychological maltreatment, and neglect resulting in prolonged suffering, permanent disfigurement or dysfunction, or death.

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The Key to Resilience: A Peer Based Youth Leader Training and Support Program

Stokar, Y.N., Baum, N.L., Plischke, A. & Ziv, Y. (in press). The Key to Resilience: A Peer Based Youth Leader Training and Support Program. Journal of Child & Adolescent Trauma, volume 7 (1), pp 37-49.

Online [retrieved 5/4/2014]: http://link.springer.com/article/10.1007/s40653-014-0016-x

Abstract

The Key to Resilience, a pilot study conducted with Israeli youth leaders (N = 78), focused on resilience building in the wake of trauma. The program was designed to reach youth who do not access existing mental health services, and used peer-based intervention as a way to expand mental health resources for this population. Evaluation of workshop participants was measured through pre- and post- questionnaires, which assessed exposure to traumatic events, flexibility, perceived social support, perceived stress, and workshop impact. Significant changes were found in both measures of flexibility and social support, indicating positive changes in the direction of growing resilience. Training youth leaders in resilience building can serve to expand mental health resources for youth in post- and peri-traumatic environments.

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The Role of Dissociation in the Cycle of Violence

Daisy, N.V. & Hien, D.A. (2014). The Role of Dissociation in the Cycle of Violence. Journal of Family Violence, volume 29 (2), pp 99-107. Online [retrieved 5/4/2014]: http://link.springer.com/article/10.1007/s10896-013-9568-z

Abstract

The primary aim of this study was to examine the role of dissociation in the relationship between child maltreatment and intimate partner violence among 148 inner city women. It was proposed that dissociation would be a mediator in the relationship between child maltreatment and intimate partner perpetration. Overall, the hypothesis was supported. Findings revealed that women with a history of child maltreatment who experienced high levels of dissociation were more likely to be perpetrators of intimate partner violence than those with low levels of dissociation.

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An epigenetic way to forget those painful moments

Diegelmann, S. & Sprecher, S.G. (2014). An epigenetic way to forget those painful moments. Trend in Neuroscience, volume 37 (5), pp 245-246.

Online [retrieved 5/4/2014]: http://www.sciencedirect.com/science/article/pii/S0166223614000423

Abstract

Traumatic experience can be overwhelming, thus erasing associated memories is desirable. Although exposure-based and reconsolidation methods have been developed for recently acquired associations, treatments to modify more distant memories are rare. Focusing on HDAC2 inhibition during reconsolidation, Gräff and colleagues recently demonstrated an epigenetic means to attenuate remote fear memory.

Not every trip down memory lane is pleasant. We often feel that unpleasant moments have the strongest resistance to erasure from our memories. In the worst case, the remembrance of a traumatic event can make daily life impossible. A broad spectrum of situations can trigger acquisition of maladaptive memories, from brutal events such as war, or rape, to less severe encounters such as a stressful test. Memories formed in such unpleasant circumstances are difficult to overcome, as they are robust and persistent, and can often lead to fear and anxiety disorders. Treatments to eliminate or attenuate symptoms of such disorders are necessary and desirable to improve quality of life in a long-lasting manner.

One means of treating traumatic fear and anxiety disorders are exposure-based therapies. However, these are only effective in increasing extinction of recently encoded memories; more distant memories appear to be resistant to treatment. In a recent study, Gräff and colleagues unveil how this resistance is acquired and how an epigenetic switch may help to remove distant unpleasant recollections.

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HDAC inhibitors as cognitive enhancers in fear, anxiety and trauma therapy: where do we stand?

Whittle, N. & Singewald, N. (2014). HDAC inhibitors as cognitive enhancers in fear, anxiety and trauma therapy: where do we stand? Presentation at the Biochemical Society Transactions: Brain Disorders Across the Lifespan: Translational Neuroscience from Molecule to Man. Online [retrieved 5/4/2014]: http://www.biochemsoctrans.org/bst/042/0569/0420569.pdf

Abstract

A novel strategy to treat anxiety and fear-related disorders such as phobias, panic and PTSD (post-traumatic stress disorder) is combining CBT (cognitive behavioural therapy), including extinction-based exposure therapy, with cognitive enhancers. By targeting and boosting mechanisms underlying learning, drug development in this field aims at designing CBT-augmenting compounds that help to overcome extinction learning deficits, promote long-term fear inhibition and thus support relapse prevention. Progress in revealing the role of epigenetic regulation of specific genes associated with extinction memory generation has opened new avenues in this direction. The present review examines recent evidence from pre-clinical studies showing that increasing histone acetylation, either via genetic or pharmacological inhibition of HDACs (histone deacetylases) by e.g. vorinostat/SAHA (suberoylanilide hydroxamic acid), entinostat/MS-275, sodium butyrate, TSA (trichostatin A) or VPA (valproic acid), or by targeting HATs (histone acetyltransferases), augments fear extinction and, importantly, generates a long-term extinction memory that can protect from return of fear phenomena. The molecular mechanisms and pathways involved including BDNF (brain-derived neurotrophic factor) and NMDA (N-methyl-D-aspartate) receptor signalling are just beginning to be revealed. First studies in healthy humans are in support of extinction-facilitating effects of HDAC inhibitors. Very recent evidence that HDAC inhibitors can rescue deficits in extinction-memory-impaired rodents indicates a potential clinical utility of this approach also for exposure therapy-resistant patients. Important future work includes investigation of the long-term safety aspects of HDAC inhibitor treatment, as well as design of isotype(s)-specific inhibitors. Taken together, HDAC inhibitors display promising potential as pharmacological adjuncts to augment the efficacy of exposure-based approaches in anxiety and trauma therapy.

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Cardiac vagal tone predicts socially adaptive anger regulation

Geisler, F., Kubiak, T. & Weber, H. (2014). Cardiac vagal tone predicts socially adaptive anger regulation. Personality and Individual Differences, volume 60, supplement, p 28.

Online [retrieved 5/4/2014]: http://www.sciencedirect.com/science/article/pii/S0191886913003279

Abstract

Cardiac vagal tone (CVT; i.e., the influence of the cardioinhibitory vagal pathway on the heart) is associated with individual differences in processes related to self-regulation. The presentation focuses on the association between CVT and self-regulatory behaviour, which promotes social bonds. More specifically, we present data from an ecological momentary assessment study on the association of CVT with anger regulation. For 28 days following assessment CVT predicted making a concession as a reaction to anger caused by others. Furthermore, CVT was higher in participants who reported no anger episodes compared to those who reported at least one anger episode. Additionally, CVT was positively associated with reported episodes of anger. Results are in line with the polyvagal theory, a biobehavioural model that proposes a social engagement system, that supports dynamic changes in vagal innervations in response to situational demands, resulting in the active regulation of arousal to support adaptive social behaviour.

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Lost among the trees? The autonomic nervous system and paediatrics.

Rees, C.A. (2014). Lost among the trees? The autonomic nervous system and paediatrics. Archives of Disease in Childhood. Online [retrieved 5/4/2014]: http://www.ncbi.nlm.nih.gov/pubmed/24573884

Abstract

The autonomic nervous system (ANS) has been strikingly neglected in Western medicine. Despite its profound importance for regulation, adjustment and coordination of body systems, it lacks priority in training and practice and receives scant attention in numerous major textbooks. The ANS is integral to manifestations of illness, underlying familiar physical and psychological symptoms. When ANS activity is itself dysfunctional, usual indicators of acute illness may prove deceptive. Recognising the relevance of the ANS can involve seeing the familiar through fresh eyes, challenging assumptions in clinical assessment and in approaches to practice. Its importance extends from physical and psychological well-being to parenting and safeguarding, public services and the functioning of society. Exploration of its role in conditions ranging from neurological, gastrointestinal and connective tissue disorders, diabetes and chronic fatigue syndrome, to autism, behavioural and mental health difficulties may open therapeutic avenues. The ANS offers a mechanism for so-called functional illnesses and illustrates the importance of recognising that ‘stress’ takes many forms, physical, psychological and environmental, desirable and otherwise. Evidence of intrauterine and post-natal programming of ANS reactivity suggests that neonatal care and safeguarding practice may offer preventive opportunity, as may greater understanding of epigenetic change of ANS activity through, for example, accidental or psychological trauma or infection. The aim of this article is to accelerate recognition of the importance of the ANS throughout paediatrics, and of the potential physical and psychological cost of neglecting it.

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Changes in attachment representations during psychological therapy

Taylor, P., Rietzschel, J., Danquah, A. & Berry, K. (2014). Changes in attachment representations during psychological therapy.

Research, publication ahead of print [online retrieved 5/14/2014] http://www.ncbi.nlm.nih.gov/pubmed/24559454

Abstract

This review systematically examines research that investigates changes in adult attachment representations during psychological therapy.

Method: Studies from two adult attachment approaches are reviewed (interview and self-report) with the aim of concluding whether psychotherapy can improve attachment representations. To guide the interpretation of findings, the methodological quality of studies is assessed.

Results: The results suggest that attachment security increases following therapy, whereas attachment anxiety decreases following therapy. Findings are unclear with regard to attachment avoidance. Improvements are observed across different methodologies, patient groups, therapeutic approaches, and therapy settings. Findings also appear to be consistent across different levels of study quality.

Conclusions: Overall, research supports the suggestion that attachment styles may alter during the course of psychotherapy, but further controlled trials are required to confirm this conclusion.

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The behavior patterns of abused children as described in their testimonies

Katz, C. & Barnetz, Z. (2013). The behavior patterns of abused children as described in their testimonies. Child Abuse & Neglect. Online [retrieved 1/25/2014]: http://www.sciencedirect.com/science/article/pii/S014521341300224X

Abstract

The aim of the current study is to identify how children describe their behavior during abuse and to explore their behavior further with respect to the type of the abuse (physical or sexual), frequency of abuse (single or multiple incidents), familiarity with the suspect, and children's age and gender, with the assumption that this information may have a significant effect on the children's recovery process. The study involved 224 transcripts of interviews with alleged victims aged 5–14 in Israel. The sample was randomly selected from all of the forensic investigations with children that were conducted in Israel in 2011. The results show that abuse type has a strong effect on children's behavior, with children in the sexual abuse group reporting more fight and flight behavior and children in the physical abuse group reporting more self-change behavior. This finding was interacted with the severity of abuse variable, with children in the sexual abuse group reporting less flight behavior and an increase in the self-change behavior with the highest level of severity of abuse (touch under the clothes and penetration). Investigative interviews with children can be a significant source of information for practitioners within the clinical context. The current study stresses the consequences that abuse can have on children's behavior during these incidents and the implications for the therapy process with the children.

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The integrative power of dance/movement therapy: Implications for the treatment of dissociation and developmental trauma

Pierce, L. (2014). The Arts in Psychotherapy, 41(1), pp 7-15. Online [retrieved 1/25/2014]: http://www.sciencedirect.com/science/article/pii/S0197455613001652

Abstract

Chronic and compounding exposure to traumatic events, especially within the context of early attachment relationships, can result in symptoms of dissociation commonly seen in dissociative disorders, personality disorders, and post-traumatic stress disorders. This theoretical article proposes an application of dance/movement therapy as facilitative of right brain integration in adult clients who present with trauma-related dissociative symptoms. Findings from trauma psychology, neuroscience, and dance/movement therapy literature are used to create an attachment-oriented theoretical foundation for how dance/movement therapy might support the integration of dissociated somatic, emotional, and psychological experiences. A model for case-conceptualization and treatment planning is proposed according to a trauma treatment framework consisting of three phases: safety and stabilization, integration of traumatic memory, and development of the relational self. Within this phase-oriented theoretical framework, dance/movement therapy interventions such as body-to-body attunement, kinesthetic mirroring, interactive regulation, self-awareness, symbolism and expression, and interactional movement are examined as applications that may support bottom-up integration and resolution of psychological trauma. Limitations and suggestions for future research are also discussed.

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Empirical Testing of Criteria for Dissociative Schizophrenia

Laferrière-Simard, M.-C., Lecomte, T. & Ahoundova, L. (2014). Empirical Testing of Criteria for Dissociative Schizophrenia. Journal of Trauma and Dissociation, 15(1), pp.91-107. Online [retrieved 1/25/2014]: http://www.tandfonline.com/doi/abs/10.1080/15299732.2013.834860#.UuPgkHlZBaE

Abstract

This study examined the validity of dissociative schizophrenia diagnostic criteria. In the first phase, 50 participants with a psychotic disorder were administered the Dissociative Experiences Scale and the Childhood Trauma Questionnaire to identify those with dissociative characteristics. In the second phase, we selected those who had a score of 15 or above on the Dissociative Experiences Scale. Fifteen of these participants were evaluated thoroughly with the Structured Clinical Interview for DSM–IV Axis I, Structured Clinical Interview for DSM–IV Axis II, and Structured Clinical Interview for DSM–IV Dissociative Disorders to determine whether they met the criteria for dissociative schizophrenia and to generate a clinical description. Our results indicated that 24% of the individuals we tested met these criteria. We propose making mandatory 1 of the 3 dissociative symptoms of the criteria to eliminate people with only nonspecific symptoms (e.g., extensive comorbidity). According to this modified criterion, 14% of our sample would receive a diagnosis of dissociative schizophrenia. However, a more comprehensive look at the clinical picture begs the question of whether dissociative schizophrenia is truly present in every person meeting the criteria. We discuss the relevance of creating a new schizophrenia subtype and offer recommendations for clinicians.

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Trauma Group Therapy: The Role of Attachment and Therapeutic Alliance

Zorzella, K.P.M., Muller, R.T., & Classen, C.C. (2014). Trauma Group Therapy: The Role of Attachment and Therapeutic Alliance. International Journal of Group Psychotherapy: Vol. 64, No. 1, pp. 24-47. Online [retrieved 1/25/2014]: http://guilfordjournals.com/doi/abs/10.1521/ijgp.2014.64.1.24

Abstract

Attachment has increasingly been identified as central to therapy process and outcome. Attachment theory proposes that an individual's prior interactions with attachment figures develop into templates that will guide the way they form connections and perceive their relationships with others. This study examined clients' ratings of their relationship with the therapist as well as their ratings of group climate at multiple discrete points during treatment. These variables were examined in relation to attachment classification prior to therapy. Participants were 62 women attending the Women Recovering from Abuse Program (WRAP), a primarily group-based day-treatment program for childhood interpersonal trauma, at Women's College Hospital in Toronto, Ontario, Canada. Results demonstrated that clients' perceptions of relationships in group therapy varied as a function of attachment classification.

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Institutional abuse and societal silence: An emerging global problem

Middleton, W., Stravopoulos, P., Dorahy, M.J., Krüger, C., Lewis-Fernández, R., Martínez-Taboas, A., Sar, V. & Brand, B. (2014). Institutional abuse and societal silence: An emerging global problem. Australian& New Zealand Journal of Psychiatry, 48(1), pp. 22-25. Online [retrieved 1/25/2014]: http://anp.sagepub.com/content/48/1/22.short

Abstract

The Australian Royal Commission into Institutional Responses to Child Sexual Abuse was announced by Australian Prime Minister Julia Gillard on 11 January 2013. Examining how institutions with a responsibility for children ‘have managed and responded to allegations and instances of child sex- ual abuse and related matters’ (Australian Government, 2013) argu- ably represents the most wide-ranging attempt by any national government in history to examine the institutional processes (or lack thereof) for addressing such abuse.

It is difficult to escape concluding that the single most pathogenic factor in the causation of mental illness is how we humans mistreat each other. Yet abuse of children is frequently perpetrated or overlooked by the professionals whose core roles emphasize the protection of children. These include teachers, health care professionals, police officers and judges, as well as clergymen. Despite the lasting damage of childhood mal- treatment, governments and societies have demonstrated an enduring reluctance to investigate how trauma and abuse contribute so substantially to filling our mental health centres, prisons, drug and alcohol services and medical wards. Partially and belatedly, society is attempting something that has never before been achieved – progressive exposure to public gaze of traumas that, despite earlier attempts to foster their recognition, have returned to or remained in darkness.

As the full extent of institutional complicity in the sexual abuse of children becomes uncomfortably more obvious, it does not signify that we are falling into an abyss. Rather, it suggests that for the first time in our history, such issues have reached a point at which they have attained such significance that they have become the subject of a wide-ranging national Royal Commission.

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Epigenetic Priming of Memory Updating during Reconsolidation to Attenuate Remote Fear Memories

Gräff, J., Joseph, N.F., Horn, M.E., Samiei, A., Meng, J., Seo, J., Rei, D., Bero, A.W., Phan, T.X., Wagner, F., Holson, E., Xu, J., Sun, J., Neve, R.L., Mach, R.L., Haggarty, S.J. & Tsai, L.-H.  (2014). Epigenetic Priming of Memory Updating during Reconsolidation to Attenuate Remote Fear Memories. Cell press, 156(1–2), pp. 261–276. Online [retrieved 1/25/2014]: http://www.sciencedirect.com/science/article/pii/S0092867413015894

http://news.sciencemag.org/biology/2014/01/modifying-dna-may-wipe-away-old-memories

Abstract

Traumatic events generate some of the most enduring forms of memories. Despite the elevated lifetime prevalence of anxiety disorders, effective strategies to attenuate long-term traumatic memories are scarce. The most efficacious treatments to diminish recent (i.e., day-old) traumata capitalize on memory updating mechanisms during reconsolidation that are initiated upon memory recall. Here, we show that, in mice, successful reconsolidation-updating paradigms for recent memories fail to attenuate remote (i.e., month-old) ones. We find that, whereas recent memory recall induces a limited period of hippocampal neuroplasticity mediated, in part, by S-nitrosylation of HDAC2 and histone acetylation, such plasticity is absent for remote memories. However, by using an HDAC2-targeting inhibitor (HDACi) during reconsolidation, even remote memories can be persistently attenuated. This intervention epigenetically primes the expression of neuroplasticity-related genes, which is accompanied by higher metabolic, synaptic, and structural plasticity. Thus, applying HDACis during memory reconsolidation might constitute a treatment option for remote traumata.

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Attention to eyes is present but in decline in 2–6-month-old infants later diagnosed with autism

Jones, W. & Klin, A. (2013). Attention to eyes is present but in decline in 2–6-month-old infants later diagnosed with autism. Nature, International weekly journal of science. Online [1/25/2014]: http://www.nature.com/nature/journal/vaop/ncurrent/full/nature12715.html

Abstract

Deficits in eye contact have been a hallmark of autism since the condition’s initial description3. They are cited widely as a diagnostic feature4 and figure prominently in clinical instruments; however, the early onset of these deficits has not been known. Here we show in a prospective longitudinal study that infants later diagnosed with autism spectrum disorders (ASDs) exhibit mean decline in eye fixation from 2 to 6 months of age, a pattern not observed in infants who do not develop ASD. These observations mark the earliest known indicators of social disability in infancy, but also falsify a prior hypothesis: in the first months of life, this basic mechanism of social adaptive action—eye looking—is not immediately diminished in infants later diagnosed with ASD; instead, eye looking appears to begin at normative levels prior to decline. The timing of decline highlights a narrow developmental window and reveals the early derailment of processes that would otherwise have a key role in canalizing typical social development. Finally, the observation of this decline in eye fixation—rather than outright absence—offers a promising opportunity for early intervention that could build on the apparent preservation of mechanisms subserving reflexive initial orientation towards the eyes.

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Epigenetic traces of childhood maltreatment in peripheral blood: a new strategy to explore gene-environment interactions

Uher, R. & Weaver, I.C.G. (2014). Epigenetic traces of childhood maltreatment in peripheral blood: a new strategy to explore gene-environment interactions. The British Journal of Psychiatry, 204: 3-5. Online [retrieved 1/25/2014]: http://bjp.rcpsych.org/content/204/1/3.abstract

Maltreatment in childhood affects mental health over the life course. New research shows that early life experiences alter the genome in a way that can be measured in peripheral blood samples decades later. These findings suggest a new strategy for exploring gene-environment interactions and open opportunities for translational epigenomic research.

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Childhood Trauma and Coping through the Science of Physics: An Attachment Perspective

Lucabeche, V., Haney, J., & Quinn, P. Childhood Trauma and Coping through the Science of Physics: An Attachment Perspective. Bulletin of the American Physical Society, APS Meeting 3/4/2014, 59(1). Online [1/25/2014]: http://meetings.aps.org/Meeting/MAR14/Event/211254

Abstract

Trauma can be defined as stressful life events that disrupt and/or delay successful transition during childhood developmental stages (Roberts, 2000). In this exploratory study, transitional stressors are defined as: childhood physical, sexual, or emotional abuse; loss of a caregiver or significant relative due to death or abandonment; exposure to physical violence by non-family members (e.g., bullying); or illness resulting in permanent physical disability. Trauma may produce disorganized attachments in childhood, which may lead to emotional and to social impairment in adulthood (Siegel, 1999). Consequently, traumatized individuals, who suffer from disorganized attachments, may seek to engage in activities which are emotionally predictable. An examination of the personal childhood histories from a sample of Nobel Prize winners in the field of physics provides support for the hypothesis that the study of physics may serve as an effective coping method for individuals who have experienced childhood trauma.

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The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD

Armour, C., Karstoft, K.I., Richardson, J.D. (2014). The co-occurrence of PTSD and dissociation: differentiating severe PTSD from dissociative-PTSD. Social Psychiatry and Psychiatric Epidemiology. Online [retrieved 1/25/2014]: http://link.springer.com/article/10.1007/s00127-014-0819-y

Abstract

A dissociative-posttraumatic stress disorder (PTSD) subtype has been included in the DSM-5. However, it is not yet clear whether certain socio-demographic characteristics or psychological/clinical constructs such as comorbid psychopathology differentiate between severe PTSD and dissociative-PTSD. The current study investigated the existence of a dissociative-PTSD subtype and explored whether a number of trauma and clinical covariates could differentiate between severe PTSD alone and dissociative-PTSD.

The current study utilized a sample of 432 treatment seeking Canadian military veterans. Participants were assessed with the Clinician Administered PTSD Scale (CAPS) and self-report measures of traumatic life events, depression, and anxiety. CAPS severity scores were created reflecting the sum of the frequency and intensity items from each of the 17 PTSD and 3 dissociation items. The CAPS severity scores were used as indicators in a latent profile analysis (LPA) to investigate the existence of a dissociative-PTSD subtype. Subsequently, several covariates were added to the model to explore differences between severe PTSD alone and dissociative-PTSD.

The LPA identified five classes: one of which constituted a severe PTSD group (30.5 %), and one of which constituted a dissociative-PTSD group (13.7 %). None of the included, demographic, trauma, or clinical covariates were significantly predictive of membership in the dissociative-PTSD group compared to the severe PTSD group.

In conclusion, a significant proportion of individuals report high levels of dissociation alongside their PTSD, which constitutes a dissociative-PTSD subtype. Further investigation is needed to identify which factors may increase or decrease the likelihood of membership in a dissociative-PTSD subtype group compared to a severe PTSD only group.

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Dissociation of the Personality and EMDR Therapy in Complex Trauma-Related Disorders: Applications in Phases 2 and 3 Treatment.

Van der Hart, O., Groenendijk, M., Gonzalez, A., Msquera, D. & Solomon, R. (2014). Dissociation of the Personality and EMDR Therapy in Complex Trauma-Related Disorders: Applications in Phases 2 and 3 Treatment. Journal of EMDR Practice and Research, 8(1), pp. 33 – 48.

Abstract

Eye movement desensitization and reprocessing (EMDR) psychotherapy can play a major role in phase- oriented treatment of complex trauma-related disorders. In terms of the theory of structural dissociation of the personality and its related psychology of action, a previous article described Phase 1 treatment— Stabilization, Symptom Reduction, and Skills Training—emphasizing the use of EMDR procedures in this phase. Phase 2 treatment mainly involves applications of EMDR processing in overcoming the phobia of traumatic memories and their subsequent integration. Phase 3 treatment focuses on further integration of the personality, which includes overcoming various phobias pertaining to adaptive functioning in daily life. This article emphasizes treatment approaches that assist therapists in incorporating EMDR protocols in Phases 2 and 3 of phase-oriented treatment without exceeding clients’ integrative capacity or window of tolerance.