Phenomenology and psychological assessment of complex posttraumatic states

Boston University, Boston, Massachusetts, United States
Journal of Traumatic Stress (Impact Factor: 2.72). 10/2005; 18(5):401-12. DOI: 10.1002/jts.20048
Source: PubMed


The authors offer a framework for the assessment of psychological responses associated with exposure to early onset, multiple, or extended traumatic stressors. Six prominent and overlapping symptoms clusters are described: altered self-capacities, cognitive symptoms, mood disturbance, overdeveloped avoidance responses, somatoform distress, and posttraumatic stress. A strategy for the structured, psychometrically valid assessment of these outcomes is introduced, and specific recommendations for use of various generic and trauma-specific child and adult measures are provided. Implications of trauma assessment for treatment planning are discussed.

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Available from: Joseph Spinazzola, Jun 27, 2014
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    • "Research in human and nonhuman primates has demonstrated that the greater the number of traumatic events occurring in an individual's lifetime, the more severe the posttraumatic symptomatology may be (Bradshaw et al., 2008; Briere & Spinazzola, 2005; Brune et al., 2006). In humans, increased difficulties in affect regulation and self-control that are comorbid with diagnoses of CPTSD may result in increased incidents of SIB (Briere & Gil, 1998; Dyer et al., 2009). "
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    Journal of Trauma & Dissociation 04/2015; 16(4). DOI:10.1080/15299732.2014.1003673 · 1.72 Impact Factor
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    • "Psychological test results may help to identify psychological difficulties likely to be associated with significant developmental disruptions, e.g. poorly developed sense of self, problems with emotional regulation or behavioural difficulties (Briere & Spinazzola, 2005). "
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    ABSTRACT: Many adults reporting childhood or adolescent sexualized assault (CSA) seek remedies through civil proceedings, thus necessitating a forensic assessment to determine the nature and extent of any psychological injuries related to such assault. Such assessments pose challenges, as CSA often occurred years earlier and may have affected not only immediate functioning but also later psychological maturation. The present paper explains how a lifespan developmental analysis can assist such assessments. The concepts of psychological development, attachment, developmental trajectory and risk and resilience can help in evaluating whether and how CSA affected normal psychological development, in determining the influence of risk factors other than CSA and in considering resiliency factors. Risk, resilience and psychological function must be examined in the domains of individual abilities and attributes, relationships and significant life activities both pre- and post-assault. Data on pre-assault risk, resilience and function can be used to estimate a “but for the assault” developmental trajectory that can then be compared to the individual’s actual developmental trajectory. This analysis, together with analysis of the severity of CSA, can assist in determining whether and how the CSA that is the basis for civil proceedings contributed to later life psychological injuries.
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    • "Assessment and treatment of children who have experienced multiple traumas must address symptoms, dysregulation and impairment in all affected domains of functioning: emotional, behavioural, cognitive, somatic and relational (Briere and Spinazzola 2005, Cook et al. 2005, Ford and Cloitre 2009). Assessment should include holistic evaluation of trauma exposure and post-traumatic sequelae, the child's personal and family history, attachment relationships and environment (including a history of involvement of other professionals or agencies), individual and family strengths, and protective factors (Cook et al. 2005). "
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    ABSTRACT: With the anticipated publication of the DSM-5 in May 2013, much reflection and work has been done on reviewing existing psychiatric nomenclature including, but not limited to the field of traumatic exposure. Traditionally, understanding of the psychiatric and psychological effects of trauma have been developed from studies with adults and then applied to trauma-exposed children with some modifications. While this is an important step to understanding the sequelae of trauma in children and adolescents, the adverse developmental effects of traumatic exposures on the rapidly evolving neurological, physical, social and psychological capacities of children calls for a developmentally sensitive framework for understanding, assessing and treating trauma-exposed children. The importance of early attachment relationships in infancy and childhood means that severely disrupted early caregiving relationships may have far-reaching and lifelong developmental consequences and can therefore be considered traumatic. Given the high rates of violence and trauma exposure of South African children and adolescents, the need for a developmentally based understanding of the effects of trauma on child and adolescent mental health becomes even more pronounced. In this paper, we draw on theoretical perspectives to provide a practical, clinically driven approach to the management of developmental trauma.
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