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

ABSTRACT 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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    • "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.
    Psychological Injury and Law 03/2014; 7(1). DOI:10.1007/s12207-014-9185-z
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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.
    Journal of Child and Adolescent Mental Health 12/2013; 25(2). DOI:10.2989/17280583.2013.795154
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    • "Traumatic exposure seems to be more common in EDs of binge/purge subtype than in those with a restrictive ED (Brewerton, 2007). Briere and Spinazzola (2005) propose that the post-trauma strategy of so-called tension reduction behaviors, that is, strategies used to sooth, numb, or distract from the stressful reminders, may be central for explaining the relationship between mainly binge/purge EDs and trauma history. Food binging creates positive feelings and distracts the person from negative cognitions (Briere & Scott, 2007). "
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    ABSTRACT: Early experiences of traumatic events (TEs) may be associated with subsequent eating disturbance. However, few studies have investigated overall exposure and trauma-type frequency in various types of eating disorders (EDs). This study aimed to investigate the prevalence and type of TEs in a nationally representative sample of Swedish ED patients. Data from a database (Stepwise) for specialized ED care were used. Trauma history was assessed as a part of the routine, initial assessment. Participants over the age of 18 with a diagnosed DSM-IV ED were included (N=4,524). The number of patients having experienced at least one TE was 843 (18.6%), and 204 (24.2%) reported at least one additional trauma. Sexual trauma was the most common form of TE (6.3%). There was no difference in overall traumatic exposure or in type of experienced trauma between the ED diagnostic subgroups (AN, BN, EDNOS, and BED). Overall traumatic exposure was linked to self-reported severity of ED symptoms, more secondary psychosocial impairment, psychiatric comorbidity, and negative self-image. Trauma history in ED patients merits attention. Results are partly in line with and partly in contrast to previous research. Measurement of trauma history has varied substantially in research on EDs, and this study adds to the indistinct literature on trauma history in ED.
    European Journal of Psychotraumatology 11/2013; 4. DOI:10.3402/ejpt.v4i0.22482 · 2.40 Impact Factor
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