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Complex PTSD: A syndrome in survivors of prolonged and repeated trauma

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... 1. Marital dissatisfaction [21,59,60] 2. Divorce/Separation [61][62][63][64][65] 3. Women in an abusive spousal relationship [66][67][68][69][70] 4. Punitive responses of one spouse toward the other's An engineering analogy is useful in representing the consequence of weakened ties to larger social contexts: impact in relation to supporting surface [58]. In this analogy, supporting surface would be the social context composed of family and workplace, and impact would be the common predicament of back pain that has not become CBP, which includes flares-ups that subside as well as persistence at a mild level. ...
... 1. Major episode of childhood hospitalization [73][74][75][76] 2. Most studies that consider child abuse (but not all [77]) find that it is related to chronic pain decades afterward [17,69,[78][79][80] 3. Miscellaneous operationalization of weakened ties in childhood, including death of parent, other long-term absence of parent, divorce of parents, and childhood institutionalization [73,81,82] C. Regarding weakened ties to the social context of the workplace, studies indicate that the following increase the risk of CBP: ...
... In McCracken's words, "attention magnifies the perceived intensity of pain [91]." In cases of child or spouse abuse, post-traumatic stress may be a mediating factor in the pathway between weakened family ties and chronic pain [69,70,78]. Still another pathway is placed under the rubric of "social context" because of its precipitants, notably weakened ties to the family or workplace contexts, although they in turn produce psychological stress and attendant stress-related bio-mechanisms conducive to chronic pain. ...
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Chronic back pain (CBP) is a common symptom throughout the world, and those undergoing it often experience a profound degradation of life. Despite extensive research, it remains an elusive symptom. In most cases, CBP is "non-specific," since bio-mechanisms examined in the clinic do not account for it; another way of saying this is that it is "of obscure origins." This paper re-directs attention towards origins that are distal and usually out of sight from the vantage point of the clinic. CBP as considered here is non-specific, persists ≥ 3 months, and, additionally, interferes with activities of daily life, such as family interaction or work. A theory proposed in the paper draws upon Durkheim's Suicide to explain why exposures in the distal social contexts of family and workplace are fundamentally implicated in CBP. The theory is formed out of previously published studies on family and workplace social contexts of CBP and, in effect, provides a theoretical framework with which to review them. After treatment of CBP in the clinic, patients return to family and workplace contexts. Unless exposures in these contexts are addressed, they serve as continually renewing sources of CBP that remain unabated regardless of mechanism-based treatment in the clinic.
... disorder (PTSD) [12]. The early consideration of C-PTSD in the psychiatric field has important implications for mental health professionals to detect the presence of this disorder among child patients. ...
... Pioneers from the psychiatric field in child victimization have identified a "sibling" of the classical posttraumatic stress disorder among victims with chronic or multiple kinds of victimizations in childhood [12], [33]. Judith Herman called this psychiatric disorder "complex-posttraumatic stress disorder" because the patient suffers from PTSD plus dissociation, affective dysregulation, alterations in identity, and personality [12]. ...
... Pioneers from the psychiatric field in child victimization have identified a "sibling" of the classical posttraumatic stress disorder among victims with chronic or multiple kinds of victimizations in childhood [12], [33]. Judith Herman called this psychiatric disorder "complex-posttraumatic stress disorder" because the patient suffers from PTSD plus dissociation, affective dysregulation, alterations in identity, and personality [12]. Early clinical field trials to develop the DSM-IV found the presence of C-PTSD in patients with chronic or multiple childhood victimization histories [34]. ...
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Background: Developmental victimology research states that the child population not only suffers one victimization but also an accumulation of distinct types of victimization (polyvictimization). Several psychopathologies and brain impairments accompany polyvictimization. Recently, Complex Posttraumatic Stress Disorder (C-PTSD) is a psychiatric disorder related to the early onset of accumulative victimization in the early stages of life. The demand for its treatment has emerged. Objective: Review literature about polyvictimization focused on children related to later effects on mental health and C-PTSD onset. Methodology: A review of literature on developmental victimology examining psychopathologies associated with polyvictimization during childhood and C- PTSD onset, its treatments, and brain impairments. Results: Polyvictimization during childhood is associated with several psychopathologies such as anxiety, depression, anger/aggression, PTSD, dissociation, antisocial behavior, and suicide. In addition, C- PTSD onset is confirmed for polyvictimization during childhood but not adolescence or adulthood. There are no validated treatments for C-PTSD yet. Potential approaches like EMDR therapy and Trauma-focused cognitive behavioral therapy may improve some symptoms of C-PTSD patients. Finally, C-PTSD leads to hyperactivity in the right amygdala and bilateral insula, which are brain areas linked to emotional valence and visceral responses, respectively. Conclusion: Polyvictimization in childhood have substantial implications for the development of psychiatric disorders. Neurobiological and biological data about C-PTSD are poor. Research about biological substrates is imperative for understanding and developing pharmacological and psychotherapeutic treatments for polyvictimization survivors.
... The concept of complex PTSD was first proposed by Herman 6 and van der Kolk 7 in the early 1990's. They evidenced through their clinical work that repeated serious traumatisation could correspond to what they described as CPTSD. ...
... Herman suggested symptom clusters, in addition to the PTSD symptoms, including somatisation, dissociation, affective changes, pathological changes in relationship and pathological changes in identity. 6 These symptoms are often collectively referred to as 'disorders of self-organisation' (DSO). ...
... 26 This is consistent with the hypothesis that multiple trauma is more likely to result in CPTSD symptoms. 6 Potential gender differences were highlighted, with transgender survivors presenting more CPTSD symptom clusters than cis-women and cis-men. 26 Child populations studied had a lower prevalence of CPTSD than that of adult samples and had higher prevalence of PTSD (13%) compared to CPTSD (8%) a finding that was not reflected in the adult population. ...
Article
Background and objectives The human rights violation of human trafficking and modern slavery could be described as multiple and prolonged traumatisation. This corresponds to the type of trauma identified as most likely to be associated with ‘complex post-traumatic stress disorder’ (CPTSD) as identified in the new 11th edition of the International Classification of Diseases (ICD-11). This review aims to collate the evidence of complex post-traumatic stress disorder in populations that have been trafficked, with the intention to highlight important considerations to be made in terms of managing survivor's health care needs and minimising further traumatisation. Methods Five databases were searched using key terms related to human trafficking, modern slavery, and complex post-traumatic stress disorder. Results Five studies reporting on a total of 342 participants were included in the review. These studies indicated that an average of 41% of survivors of modern slavery and human trafficking had CPTSD. This was higher than the 14% diagnosed with PTSD. Post-trafficking stress, endured whilst living in refugee camps, was higher in individuals with CPTSD than in those living with PTSD. Healthcare was more difficult to access by populations with PTSD and CPTSD compared to those with no diagnosis. Conclusion There is a high prevalence of CPTSD in modern slavery and trafficking survivors therefore a need for identification and specialised treatment. Consideration should be given to consequent biopsychosocial needs, particularly access to healthcare and minimisation of post-trafficking stress.
... Moreover, people who are traumatized often experience somatic dissociation that separates the mind from the body, called disembodiment (Herman, 1992). Adding insult to this psychic injury, public stigma often targets people because their bodies, specifically, are perceived to be "deviant" (e.g., Pachankis et al., 2018). ...
... Furthermore, bodies help people to construct their identities through performativity, or acts and gestures, that demonstrate group memberships and social roles (Butler, 1993). All of this means that stigma-induced traumatic disembodiment can disrupt identity, self-regulation, and even a person's understanding of reality (Fredrickson & Roberts, 1997;Herman, 1992). At extremes, it may even undermine people's will to live. ...
... By not recognizing those things, people are either isolating me or putting me in danger" (as cited in Brown, 2021). Therefore, the fundamental work of recovering from a spoiled identity involves reconstructing the self within the embrace of safe and welcoming relationships, including therapeutic relationships, personal relationships, and community relationships (Duran et al., 1998;Herman, 1992). During this process, people come to terms with their experiences of stigma, mourn the losses they have experienced as a result of stigma, and create a new vision of their future. ...
... The type of stressor defining the "trauma" within the diagnostic criteria is likely to lead to different sequelae. A single event trauma is likely to evoke different responses from chronic trauma (such as interpersonal abuse) in which the individual has to develop strategies which are effective on a repeated basis (Herman, 1992). As a consequence it is important to explore the impact of these different stressors to identify the most appropriate interventions. ...
... 0 Donohue, Fanetti, & Elliott,1998). Self blame, somatization, suicidal behaviours, interpersonal difficulties, self harm, identity change, affective changes, revictimization and sexual difficulties, alongside a plethora of other psychiatric symptoms have all been identified following abuse (see Herman, 1992). This indicates that Type II trauma can lead to a greater complexity of difficulties that cannot be sufficiently explained Bullying and post-traumatic stress symptoms in adolescents 35 by the diagnosis ofPTSD. ...
... This indicates that Type II trauma can lead to a greater complexity of difficulties that cannot be sufficiently explained Bullying and post-traumatic stress symptoms in adolescents 35 by the diagnosis ofPTSD. Herman (1992) describes how much ofthe trauma experienced by the victim is associated with feeling coerced by another party. The perpetrator uses a combination of psychological trauma to instil fear "to destroy the victim's sense of self in relation to others, and to foster a pathologic attachment to the perpetrator" (p.88) alongside offering intermittent rewards to reinforce that attachment. ...
Thesis
p>The dissertation explores post-traumatic stress (PTS) symptoms in bullied adolescents. The initial part of the literature review discusses prevalence, gender differences and developmental aspects of bullying. The risk factors of being bullied are explored as well as the subsequent sequelae. The second part of the review discusses the adolescent trauma literature, particularly focusing on the developmental issues and sequelae. Because only a small proportion of individuals experience PTS symptoms, the moderating and mediating factors of developing PTS symptoms are discussed. The final section of the review brings the two bodies of literature together and argues that some bullied adolescents may actually be experiencing PTS reactions. The empirical study tests the argument proposed in the literature review that bullied adolescents experience symptoms associated with PTS symptoms, exploring the moderating role of social support and mediating role of dissociation. The participants were members of a secondary school (n = 689) who filled in four questionnaires exploring bullying experiences, levels of dissociation and support, and PTS symptoms. The results indicated that those who reported being bullied experienced significantly more PTS and dissociation symptoms that those who reported not being bullied. Over half of those bullied more than once or twice had scores for the Impact of Events Scale which fell in the clinically significant range for PTS symptoms. Dissociation was found to be a mediator between bullying and PTS symptoms but social support was not identified as a moderator. The implications for clinical practice and future research are discussed.</p
... In South Africa, institutionalised racial segregation, known as apartheid, and the violent struggle to dismantle this system in an effort to ensure South Africa is a liberated, democratic society contributes to stressful living. The high prevalence of violent crime resulting from widening socio-economic gaps also contributes to daily stress that may result in complex posttraumatic stress disorders (PTSD) [1]. Among the general population, 73.8% have lifetime exposure to at least one potentially traumatic event [1]. ...
... The high prevalence of violent crime resulting from widening socio-economic gaps also contributes to daily stress that may result in complex posttraumatic stress disorders (PTSD) [1]. Among the general population, 73.8% have lifetime exposure to at least one potentially traumatic event [1]. South Africa also has the highest global prevalence of HIV and tuberculosisinfectious diseases that are associated with increased risk for mental health disorders [2]. ...
Article
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Background The COVID-19 pandemic has created multiple mental health challenges. Many residents in South Africa face pre-existing elevated levels of stress and the pandemic may have had varying impacts on sub-populations. The aims of this study were to determine: 1) the factors associated with post-traumatic stress symptoms (PTSS) and 2) sex differences in the factors associated with PTSS in adults residing in South Africa during the COVID-19 pandemic. Methods Study participants aged 18 years and above, were recruited for this cross-sectional study through an online survey implemented from June 29, 2020 to December 31, 2020. The outcome variable was PTSS; explanatory variables were sex at birth, COVID-19 status, social isolation and access to emotional support. Confounders considered were age, education level completed and current work status. Logistic regressions were used to determine the association between the outcome and explanatory variables after adjusting for confounders. Outcomes There were 489 respondents. Among all respondents, those who were older (AOR: 0.97; 95% CI: 0.95 – 0.99) and had access to emotional support from family and relatives (AOR: 0.27; 95% CI: 0.14 – 0.53) had significantly lower odds of PTSS. Respondents who felt socially isolated had higher odds of PTSS (AOR: 1.17; 95% CI: 1.08 – 1.27). Females had higher PTSS scores and higher odds of PTSS compared to males (AOR: 2.18; 95% CI: 1.41-3.39). Females (AOR: 0.27; 95% CI: 0.08 – 0.95) and males (AOR: 0.26; 95% CI: 0.11, 0.59) who had access to emotional support had significantly lower odds of PTSS than those who had no support. Females (AOR: 1.15; 95% CI: 1.04 -1.27) and males (AOR: 1.19; 95% CI: 0.11, 0.59) who felt socially isolated had higher odds of PTSS compared to those who did not feel socially isolated. Interpretation Compared to males, females had higher scores and higher odds of reporting PTSS during the COVID-19 pandemic. Access to emotional support ameliorated the odds of having PTSS for both sexes, while feeling socially isolated worsened the odds for both sexes.
... To address this, a DSM-IV PTSD field trial was carried out in the early 1990s with the goal of better identifying disorders of extreme stress (Herman, 1992). Following a research review, the field trial workgroup proposed seven symptom categories not encompassed within the PTSD diagnosis, that are observed among people exposed to childhood trauma, women victims of domestic violence, and concentration camp survivors. ...
... These were: (a) dysregulation of affect and impulses; (b) alterations in attention or consciousness; (c) alterations in self-perception; (d) alterations in perception of the perpetrator; (e) alterations in relations with others; (f) alterations in systems of meaning; and (g) somatization . The workgroup proposed a new diagnosis for inclusion in DSM-IV -Disorders of Extreme Stress Not Otherwise Specified (DESNOS) -supported by evidence from the field trials, and informally referred to as Complex PTSD (C-PTSD) (Herman, 1992). While the proposal was not adopted, DSM-IV listed the DESNOS symptoms as associated and descriptive features (American Psychiatric Association, 1994). ...
Article
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Cluster analysis of maltreatment-related mental health symptoms manifested by adolescents in foster care suggest the absence of an underlying taxonomic structure. To test this further, we investigated alignment between mental health symptom profiles derived through cluster analysis and nominal diagnosis of Borderline Personality Disorder (BPD) and Complex Post-traumatic Stress Disorder (C-PTSD), among a sample of 230 adolescents in long-term foster care. Nominal DSM-V BPD and ICD-11 C-PTSD caseness was estimated from Child Behaviour Checklist and Assessment Checklist for Adolescents score algorithms, and alignment of case assignment with previously-derived symptom profiles was examined. Nineteen BPD and three C-PTSD nominal cases were identified. Low C-PTSD prevalence reflected low concordance between PTSD and ‘disturbances in self organization’ (DSO) case assignment. The BPD and C-PTSD cases were aligned to more complex and severe symptom profiles. While the complex and severe presentations identified in the present study included core symptoms and clinical signs of BPD, they were also characterised by clinical-level inattention/over-activity and conduct problems. The present findings provide some support for the validity of the BPD construct for describing complex and severe psychopathology manifested by adolescents in foster care, and no support for the C-PTSD construct. However, the symptom profiles point to high variability in combinations of multiple symptom types that does not conform to traditional definitions of a ‘diagnosable’ mental disorder. Further research is needed to determine if complex post-maltreatment symptomatology can be validly conceptualised as one or more complex disorders.
... The course of coping with adversity consists of (a) appraisal of the danger's potential for damage, and (b) appraisal of one's ability to flee or fight it (Zimmer-Gembeck & Skinner, 2016). Coping specifically with danger of traumatic betrayal entails appraisal of the danger's two attributes that constitute the experience of traumatization (Herman, 1992;Laddis, 2018): ...
Article
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The benefit of various psychiatric drugs for mitigation of irrational fear, anger, anxiety and impulsivity during episodes of complex traumarelated disorder is well documented. Those episodes consist of frantically making unreasonable demands, alternating with just as frantic acts of repentance and ingratiation during a crisis of trust in a current relationship. They also include flashbacks that rehearse a similar scenario retrospectively, for past experiences of traumatic betrayal. In mitigating such emotions, medication expedites psychotherapy. It restores patients’ ability to discern good will and expertise in others’ offer to jointly reappraise a patient’s reasons to cope with danger of betrayal in that manner. Psychodynamic therapists then help patients retrieve and reappraise reasons that often are latent to patients themselves. This paper notes the similarity of episodic disorder, as well as the similarity of pharmacotherapy’s outcomes among patients diagnosed variously with Complex Posttraumatic Stress Disorder, Borderline Personality Disorder or Dissociative Identity Disorder. The author proposes that these three disorders are causally related, all variants of “complex trauma-related disorder.” Therefore, it is reasonable to cite findings from the treatment of patients with all three disorders interchangeably. In summary, it is intriguing that various psychiatric drugs, i.e., antianxiety drugs, antidepressants, antipsychotics and mood stabilizers, all selectively mitigate irrational anxiety, fear, anger and impulsivity, regardless of the family name that they earned in the treatment of other disorders. In contrast, for patients with complex trauma-related disorder, the evidence for benefit strictly according to a drug’s family name (except for antianxiety drugs) has been inconsistent beyond comprehension. This paper presents an algorithm that simplifies reasoning about the order in which we test drugs by relinquishing expectations for an effect by a drug’s family name, e.g., “antidepressant,” in addition to mitigating irrational anxiety, fear, anger and impulsivity, which all four families do, more or less. This algorithm simply chooses depending on a drug’s potency, speed and duration of action, and desired or undesirable side-effects. In addition to the algorithm, this paper clarifies the logic of comparing symptom changes with and without a certain medication, in order to continue it, change the dosage or replace it. To attribute symptom changes to medication changes, we must control for symptom changes in the disorder’s natural course. Symptoms wax and wane with bad and good turns in patients’ judgment of others’ trustworthiness, which often greatly mask the true effect of medication changes
... Cumulative trauma was a significant predictor of membership in both Probable CPTSD (OR = 1.28) and Moderate Symptomatic (OR = 1.14) classes. Experiences of cumulative trauma were also more likely to result in Probable CPTSD class membership, in line with the literature suggesting that CPTSD is a disorder resulting from extreme, repeated, and/or prolonged traumatic experiences (Cloitre et al., 2009;Herman, 1992;Palic et al., 2016). It is well established that a traumatic event can result in the experience of PTSD symptomology (reexperiencing, avoidance, and sense of threat), and that the DSO symptomology is the result of the chronic nature of a prolonged stressor. ...
Article
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Background: Complex posttraumatic stress disorder (CPTSD) describes the results of complex, prolonged, and/or inescapable trauma, and is typified by avoidance, re-experiencing, sense of threat, affect dysregulation, negative self-concept, and interpersonal disturbances. Additionally, CPTSD is highly comorbid with other common psychopathologies. Objectives: A study was conducted in a trauma-exposed UK Armed Forces Veteran population resident in Northern Ireland (N = 638, NI) to determine the prevalence of CPTSD and comorbid associations. Methods: Data from the Northern Ireland Veterans Health and Wellbeing Study (NIVHWS), including self-report data describing traumatic stress, depression, anxiety, and suicidality, were used in a latent class analysis to identify distinct profiles of symptomology in the sample, and in a multinomial logistic regression to identify comorbidities associated with class membership. Results: Three distinct classes emerged: a low endorsement ‘baseline’ class (36%), a ‘Moderate Symptomatic’ class (27%), and a high endorsement ‘Probable CPTSD’ class (37%). Both the Moderate Symptomatic and CPTSD classes were predicted by cumulative trauma exposure. Depression was highly comorbid (OR = 23.06 in CPTSD), as was anxiety (OR = 22.05 in CPTSD) and suicidal ideation (OR = 4.32 in CPTSD), with suicidal attempt associated with the CPTSD class (OR = 2.51). Conclusions: Cases of probable CPTSD were more prevalent than cases of probable posttraumatic stress disorder (PTSD) without Difficulties in Self-Organisation (DSO) symptoms in a UK Armed Forces veteran sample, were associated with repeated/cumulative trauma, and were highly comorbid across a range of psychopathologies. Findings validate previous literature on CPTSD and indicate considerable distress and thus need for support in UK Armed Forces veterans resident in NI.
... PTSD has three main symptom clusters: re-experiencing of the traumatic event/s; persistent, high levels of arousal, and avoidance of internal and/or external reminders of the event/s (World Health Organisation, 2018). In recent decades, a further post-traumatic syndrome has been included in the diagnostic system: complex PTSD (CPTSD; Herman, 1992). A person with CPTSD will experience the three symptom clusters of PTSD, alongside difficulties with affect regulation; ...
Conference Paper
Overview Psychological interventions for PTSD and complex PTSD can be effective in reducing distress and improving wellbeing. The majority of the evidence base is quantitative in nature, meaning relatively little is known about clinician and service user views on the benefits and challenges of these interventions. This thesis uses qualitative methods to explore several questions about the experience of trauma-focussed therapies. Part 1 is a thematic synthesis. Twenty-one qualitative studies which explored the service user experience of evidence-based trauma therapies were reviewed and synthesised. The findings suggest that these interventions can be very beneficial, but can also be distressing and difficult. The findings also suggest a range of factors which may support initial and continued engagement with the therapies. Part 2 is a qualitative study exploring the therapist experience of the lifeline component of narrative exposure therapy (NET). In NET, a lifeline is constructed using physical materials to depict the chronology of a person’s life. Sixteen therapists were interviewed about their experience of this component of NET and their responses were analysed using thematic analysis. The findings suggest that the lifeline is a valued part of the therapy, and a range of suggested functions, challenges, and processes therapists felt were associated with the lifeline are detailed. Part 3 of this thesis is a critical appraisal of the process of the research. Through the chronology of the project from proposal to submission, a range of issues are reflected on, including the challenges of conducting research in clinical settings and the experience of adapting to qualitative methodology.
... When long lasting, these complaints can lead to a series of redundant tests and treatments that overload the public health system [29]. In the present study, we used the Health Questionnaire PHQ-15, as it includes a large variety of symptoms for which medical explanation is often missing and which is, according to the professional literature, also characteristic of recurrent trauma [35,37]. ...
Article
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Most people do not realize how common the phenomenon of neurodiverse relationships is worldwide. There does not yet exist a broad clinical and public awareness of autistic men in a long-term relationship nor enough information about the well-being of typical women in such relationships. This topic has received very little attention in the literature and in research. The authors of this paper intended to fill this gap and conducted an empirical study exploring the experiences and health condition of women in neurodiverse relationships.
... Following the classification of PTSD in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980), neither clinicians nor trauma survivors felt it captured the complex difficulties endorsed by victims of multiple or prolonged traumas. Hence, Herman (1992) introduced the concept of complex PTSD (cPTSD). This includes the above core symptoms of PTSD, as well as broader and more severe symptomatology (e.g., cognitive, affective, and relational disturbance). ...
Article
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Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, increasing symptom burden, decreasing quality of life and moderating treatment response. A range of post-traumatic sequelae have been found to mediate the relationship between trauma and psychotic experiences, including the "traditional" symptoms of post-traumatic stress disorder (PTSD). The International Classification of Diseases-11th Edition recognizes a more complex post-traumatic presentation, complex PTSD (cPTSD), which captures both the characteristic symptoms of PTSD alongside more pervasive post-traumatic sequelae known as 'disturbances in self-organization' (DSOs). The prevalence and impact of cPTSD and DSOs in psychosis remains to be explored. In the first study of this kind, 144 participants with psychosis recruited from North West United Kingdom mental health services completed measures assessing trauma, PTSD and cPTSD symptoms and symptoms of psychosis. Forty-percent of the sample met criteria for cPTSD, compared to 10% who met diagnostic criteria for PTSD. PTSD and DSOs mediated the relationship between trauma and positive symptoms, controlling for dataset membership. Both PTSD and DSOs mediated the relationship between trauma and affective symptoms but did not explain a significant proportion of variance in negative symptoms. Cognitive and excitative symptoms of psychosis did not correlate with trauma, PTSD or DSO scores. These findings indicate the possible value of adjunct therapies to manage cPTSD symptoms in people with psychosis, pending replication in larger epidemiological samples and longitudinal studies.
... Nous pouvons également évoquer le concept de « TSPT complexe » (Cloitre et al., 2013;Giourou et al., 2018;Herman, 1992;Reed et al., 2016). Ce trouble concerne les personnes ayant été exposées à une situation traumatique extrême de façon prolongée ou répétée (e.g. ...
Thesis
Le trouble de stress post-traumatique (TSPT) est associé à des anomalies structurales au niveau de plusieurs régions cérébrales, dont l’hippocampe. Un plus petit volume de cette structure pourrait favoriser le développement ainsi que la persistance des symptômes. Cette région est composée de plusieurs sous-champs (Corne d’Ammon (CA1, CA2 et CA3), Gyrus denté (DG), Subiculum), possédant chacun des caractéristiques histologiques et des fonctions différentes. Les objectifs de cette thèse étaient (1) de préciser les altérations au niveau de ces sous-champs et (2) d’étudier les liens avec la symptomatologie chez des adolescents et des adultes avec TSPT. Nos résultats montrent qu’il existerait un volume plus petit de la région CA2-3/DG chez l’adolescent avec TSPT et que cette altération pourrait favoriser l’apparition des symptômes de reviviscence. Chez l’adulte avec TSPT, il existerait une altération des régions CA2-3/DG et CA1. Un plus petit volume de CA2-3/DG serait associé aux symptômes d’évitement, d’hypervigilance et de dépression tandis qu’une altération de CA1 favoriserait les symptômes de reviviscence. Nos résultats suggèrent également qu’une augmentation de la plasticité de l’hippocampe pourrait permettre une diminution des symptômes. En effet, une augmentation des volumes CA2-3/DG et CA1 chez l’adulte TSPT, sur deux ans, était associée à une réduction des symptômes, respectivement, de dépression et de reviviscence. Ainsi, stimuler cette plasticité hippocampique pourrait être une piste d’intervention prometteuse afin de favoriser une diminution des symptômes.
... It should be noted, however, that depressed mood in PTSD is associated with a traumatic event, but it can lead to distorted and negative cognitions in relation to the event, decreased interest in activities, and feelings of alienation or inability to feel positive emotions, 1 mimicking Major Depression, turning the differential diagnosis complex and difficult to proceed. 85 We can speculate that Major Depression in OCD may occur due to the severity, chronicity or even to specific content of the obsessions, which may lead patients to low self-esteem, guilt, or shame, since some content are not moral or social accepted (e.g.: sexual, aggressive, blasphemous). Gershuny and colleagues (2008) and Huppert and collaborators (2005) hypothesized that, in addition to the intersection of psychopathological symptoms, depressive symptoms could be a mediating factor of this comorbidity, since the diagnosis of PTSD was higher in patients with OCD that also suffered from depression. ...
Article
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Introduction: Although Post-Traumatic Stress Disorder and Obsessive-Compulsive Disorder have distinct diagnostic criteria, some psychopathological phenomena seem to be shared, what may lead to misdiagnosis and to wrong therapeutical decisions. This scoping review explores the psychopathological similitudes and differences of both disorders. Methods: It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and included articles published in Portuguese, English or Spanish in the last 50 years in the PubMed database. Case-reports were excluded. Results: Fifty-three studies with different designs were included (30(56.5%) were cross-sectional; 8 (15.1%) were case control; 1 (1.9%) was cohort; 3 (5.7%) were clinical trials; 9 (17.0%) were reviews/systematic reviews; and 2 (3.8%) were meta-analysis.). The main described interfaced psychopathological aspects by the included studies were flashbacks x obsessions; avoidant behavior; depressive, anxious, and somatic symptoms; sexuality, sleep, and appetite; psychiatric comorbidities; and suicidality. The intersection of clinical features seems to be on the extrinsic psychopathological dimension. Conclusions: The psychopathological symptoms core (intrinsic characteristics) is distinctly different, since flashbacks and obsessions are consequences of predominant diverse defective mental function: the former from memory, the last from thought. In the same way, the avoidant behaviors are derived from different purposes and inner necessities.
... Women who have been raped are at great risk of developing anxiety, depression, and post-traumatic stress disorder (PTSD; Wilson & Scarpa, 2017). Those who have been sexually abused also often suffer psychosexual consequences (Perilloux et al., 2012), sexual shame (Herman, 1992), and sexual dissatisfaction (Stephenson & Meston, 2010). ...
Article
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The focus of this study was on female emergency medical personnel’s experiences of treating women who have been raped and on their own experiences of being women themselves working in this situation. We interviewed 12 female medical personnel in four focus groups of two to five participants each. The material was analysed using inductive thematic analysis. Participants’ experiences were structured under two main themes: Prerequisites for care and Effects on oneself. As women, the participants emphasized their understanding of other women and stressed the importance of offering flexible care and taking time with each patient. They described how their work affected them personally, making them increasingly aware of men’s violence against women and their need for support from their colleagues. They also discussed structural barriers to both patient care and self-care. If unaddressed, such shortcomings risk negatively affecting raped women seeking medical care and may also be detrimental to the health and well-being of the professional offering care.
... Hypothesis four findings revealed that sexual trauma index was 53.5% with female participants not significantly having sexual abuse trauma compared to males, this finding is in contrast to the findings of Herman (1992) Yuan et. al., (2006) reported that women survivors of childhood and adulthood sexual violence experience severe and chronic psychological symptoms. ...
Article
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Psychological trauma and its symptoms have been on increase considering the rise in ethnic, religious, insurgency, kidnapping, farmers and herders' conflict being experiences in Jos Plateau State, Nigeria. Trauma Symptoms Checklist-40 (TSCL-40) was the instrument used, with 297 participants (184 males and 113 females) purposefully selected among populist with mean age of 25.7, while six hypotheses were tested using Chi-square. Findings of the study showed that male participants did not significantly score high on dissociation compared with females. While male participants significantly scored high on anxiety compared with female. Furthermore, male participants significantly scored high on depression compared with female. Also, female participants did not significantly score higher on sexual abuse trauma index compared with male and male significantly scored high on sleep disturbance compared with female. Finally, females did not significantly score high on sexual problems compared with males. There is need for more studies on psychological trauma symptoms in other communities affected by conflict, as well as the establishment of community clinical interventions (community counselling, psychotherapy) which could assist in the management and treatment of such traumatic symptoms.
... Often the suppression of the direct escape responses of fight or flight can lead to the concept of learned helplessness, such that a being believes they are unable to navigate a given situation successfully to avoid aversive experiences (Maier & Seligman, 2016 Franzin, 2021a). The notion of learned helplessness is really vital to understand for those working with horses, as many humans, particularly those experiencing PTSD, also experience learned helplessness and both they and the horses may be more sensitive to noticing the familiar behaviors of trying to do the right thing to avoid negative experiences as they feel powerless to escape (Herman, 1992;Merkies & Franzin, 2021a). This is contrasted with thinking about why a person or animal is doing something, and what connection are we building. ...
Article
Attachment Theory suggests interaction with caregivers in childhood impacts relationships and health throughout our lives (Bowlby, 1965, 1969, 1971), leaving many who have experienced insecure attachment with an inability to form healthy relationships or cope with stressors throughout their lifespan (Holmberg, Lomore, Takacs, & Price, 2011). Horses have interacted with humans for over 12,000 years (Hintz, 1995), holding multiple roles in human society, most relying on observation by humans of equine behavior, and formation of a human-equine bond (Hamilton, 2011). More securely attached humans tend to more readily decipher non-verbal cues, positively affecting their felt security and internal working model of Attachment (Bachi, 2013). Interacting with horses, who provide significant non-verbal cues, may provide an opportunity to enhance this process, providing useful feedback and insight. This study aimed to evaluate if a single ground-based encounter with a horse could bring about changes in women participants’ reports of Attachment and Emotion Regulation. It was hypothesized that participants would move towards more secure dimensions of Attachment and Emotion Regulations after the encounter with the horse and that behavioral interactions with the horse would differ for those with differing dimensions of Attachment or Emotion Regulation. This study incorporated a repeated measures mixed methods design, one twenty-eight year old Standardbred mare, “Wicky” Long Wick, interacted with 22 female university students with minimal prior equine experience aged 18-30. Participants completing a demographic and screening questionnaire along with the Experiences in Close Relationships –Revised (ECR)(Brennan, Clark, & Shaver, 1998) and Emotion Regulation Questionnaires (ERQ)(Gross & John, 2003) at baseline, then the ECR and ERQ again both immediately prior to and immediately following encounter with the horse. The encounter was videotaped and included meeting, grooming, leading, and goodbye. Statistical analyses were completed using SPSS including paired t-tests and correlations. Videotape was evaluated, coded, and included in both quantitative and qualitative data analyses. Participants were recruited and participated in the study over the period of one calendar year. A significant decrease in Attachment anxiety was shown after encountering the horse (t(21)=2.915, p=.008 (M .237364, SD= .381941)), and significantly less time was spent between the horse and participant at goodbye than at meeting (t (21)=2.751, p=.021 (M 42.045, SD= 71.67)), particularly for those with insecure dimensions of Attachment (t (15)= 2.814, p=.013 (M= 45.75, SD=65.03)). Participants with insecure dimensions of Attachment showed significant increases in cognitive reappraisal after encountering the horse (t(14)= -3.732, p=.002 (M -.411, SD= .4266)), and the greatest decreases in Attachment Anxiety (t(14)=3.364, p=.005 (M .307, SD= .354)). The findings suggest interaction between horses and people differs along Attachment dimensions and show some support for positive changes in humans for both Attachment and Emotion Regulation dimensions after interaction with a horse.
... Research has proposed that the current conceptualisation of PTSD may not fully encapsulate the trauma sequelae resulting from traumatic interactions between children and caregivers during critical developmental stages, as such interactions are postulated to influence the development of the internal working model of the self (Schore, 2003). Literature regarding this experience in the general population has led to the formalisation of a distinct 'sibling' disorder in the Classification of Diseases (ICD-11) defined as Complex Post-Traumatic Stress Disorder (CPTSD; Herman, 1992). Individuals presenting with CPTSD experience the core symptoms of PTSD, alongside 'disturbances in selforganisation', involving affect dysregulation, negative self-concept, and relationship difficulties Chapter 1 54 (Maercker et al., 2013). ...
Thesis
The first chapter of this thesis is a systematic review of the literature exploring the experiences that are perceived as traumatic, and the resulting trauma-related symptomology, in autistic individuals. The narrative and thematic synthesis suggested that autistic individuals report perceiving a similar range of experiences to be traumatic, and experience similar trauma-related symptomology to the general population. Several potentially unique traumatic events and trauma-related symptoms were found. Additionally, differences were implied in the way that trauma presents in autistic adults compared with autistic children and individuals with co-occurring Intellectual disabilities. High quality research is needed to enrich understanding of trauma in autistic individuals from first- hand perspectives. This chapter concludes with clinical implications and recommendations for future research. The second chapter of this thesis is a qualitative empirical study exploring the experiences of autistic adults who have engaged in psychological support for trauma-related symptoms. Individual semi-structured interviews were completed with eight participants, aged 30-50 years old. Interview transcripts were analysed using Interpretative Phenomenological Analysis, identifying four themes: ‘Accessing support that fits my needs’, ‘Recognising trauma in autistic adults’, ‘Clinician understanding of the context of autism’ and ‘Not just doing therapy at me but working with me to do therapy’. The findings provided insight into the barriers experienced by autistic adults in accessing appropriate trauma-focused psychological support, the importance of clinician authenticity, and meaningful adaptations to therapeutic mechanisms. This chapter concludes with directions for future research and clinical implications for psychological support providers and clinicians in meeting the needs of this population.<br/
... Second, we sought to determine the point prevalence of CPTSD and PTSD, as assessed using the International Trauma Questionnaire, among this sample. Thirdly, we investigated whether refugees and asylum seekers who have experienced torture were more likely to meet the diagnostic criteria for CPTSD than PTSD, and whether any sex differences existed in probable rates of CPTSD and PTSD across the population tested due to the theorised link between SGBV in women and the development of CPTSD ( (Herman, 1992a). ...
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Introduction: Rates of torture are especially high among those seeking asylum, with global estimates of forced migrants having experienced torture exceeding 50%. Torture is the strongest predictor of PTSD amongst refugee populations. This study assesses the construct validity and diagnostic rate of the ICD-11 PTSD and Complex PTSD (CPTSD) within a population of torture survivors seeking asylum in Ireland. It further explores whether this population were more likely to meet the diagnostic criteria for CPTSD than PTSD, and whether any sex differences existed in probable rates of PTSD and CPTSD. Methods: A secondary data analysis of 264 treatment-seeking asylum seekers and refugees who experienced torture or ill-treatment was conducted. Rates of PTSD and CPTSD were assessed using the International Trauma Questionnaire. Findings: A Confirmatory Factor Analysis supported a a six-factor correlated model consisting of re-experiencing (Re), avoidance (Av), threat (Th), affective dysregulation (AD), negative self-concept (NSC), and disturbed relationships (DR), consistent with ICD-11 PTSD and CPTSD. High rates of PTSD (32.4%) and CPTSD (39.6%) were found, with the experience of torture significantly associated to the development of PTSD. No significant difference was found between the sexes. Discussion: This is the first study to investigate the validity of ICD 11 PTSD and CPTSD among torture survivors actively seeking international protection in Europe. Given the high rates of PTSD and CPTSD found among torture survivors, rehabilitation centres for victims of torture should consider CPTSD as part of their assessment and treatment programmes.
... Hypothesis four findings revealed that sexual trauma index was 53.5% with female participants not significantly having sexual abuse trauma compared to males, this finding is in contrast to the findings of Herman (1992) Yuan et. al., (2006) reported that women survivors of childhood and adulthood sexual violence experience severe and chronic psychological symptoms. ...
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Psychological trauma and its symptoms have been on increase considering the rise in ethnic, religious, insurgency, kidnapping, farmers and herders' conflict being experiences in Jos Plateau State, Nigeria. Trauma Symptoms Checklist-40 (TSCL-40) was the instrument used, with 297 participants (184 males and 113 females) purposefully selected among populist with mean age of 25.7, while six hypotheses were tested using Chi-square. Findings of the study showed that male participants did not significantly score high on dissociation compared with females. While male participants significantly scored high on anxiety compared with female. Furthermore, male participants significantly scored high on depression compared with female. Also, female participants did not significantly score higher on sexual abuse trauma index compared with male and male significantly scored high on sleep disturbance compared with female. Finally, females did not significantly score high on sexual problems compared with males. There is need for more studies on psychological trauma symptoms in other communities affected by conflict, as well as the establishment of community clinical interventions (community counselling, psychotherapy) which could assist in the management and treatment of such traumatic symptoms.
... On constate ainsi que les VSPI pourraient être associé es à un ensemble complexe de symptô mes combiné s, lié s à l'exposition chronique à des violences cumulatives dans le contexte relationnel et mettant en é vidence les difficulté s d'autoré gulation é motionnelle chez les victimes [9]. À celles-ci s'ajoutent les probables croyances né gatives sur soi nourrissant la honte et la culpabilité ainsi que les symptô mes de dissociation, é voquent la notion de trauma complexe [25]. L'inté gration ré cente du diagnostic de PTSD complexe à la CIM-11 met effectivement en exergue la dysré gulation des affects, l'image de soi abîmé e et l'alté ration des relations en tant que des symptô mes spé cifiques du PTSD complexe, par rapport au PTSD « simple » [26]. ...
Article
Résumé Introduction Les violences sexuelles entre partenaires intimes sont identifiées comme l’une des formes courantes de la violence conjugale. Elles constituent la forme de violence sexuelle la plus répandue dans le monde. La compréhension de ce phénomène d’ampleur est pourtant limitée, peu d’études spécifiques dans la littérature internationale et de très rares données en France sont disponibles. Objectifs L’objectif de cet article est de résumer l’état actuel des connaissances sur les violences sexuelles entre partenaires intimes, selon deux axes principaux : un axe descriptif, centré sur la nature, l’étendue et les expressions de la violence sexuelle dans le couple, ainsi que sur ses effets cliniques ; et un axe de réflexion, centré sur les problématiques susceptibles de contribuer aux conséquences psychologiques de la violence sexuelle entre partenaires intimes. Méthode Les articles ont été sélectionnés dans les bases de données PubMed, PsycInfo et Web of Science, à partir d’une recherche par mots-clés en anglais. Les termes "violence sexuelle entre partenaires intimes" et "viol entre partenaires intimes" ont été utilisés en première intention, puis les mots-clés "violence entre partenaires intimes ; violence conjugale; partenaire intime ; relation ; femmes battues ; conjoint(e) ; époux(se) ; marital" ont été croisés avec les termes "viol ; violence sexuelle ; abus sexuel ; coercition sexuelle ; rapport sexuel non consenti ; rapport sexuel forcé". La recherche d'articles a été effectuée entre février 2021 et mai 2021. Résultats Ces violences sont co-occurrentes des violences physiques et psychologiques du partenaire, répétitives dans la relation et aux expressions multiples : leur réalité dépasse largement les contours du viol conjugal. Elles semblent associées à des effets spécifiques pour les victimes et pourraient être un indicateur de gravité de la situation globale de violences conjugales, associées à une symptomatologie psycho traumatique et dépressive augmentée, et à un plus grand nombre de décès par suicide et par homicide. Elles restent, cependant, perçues comme moins graves que les violences sexuelles d’un non-partenaire ou d’un inconnu, du fait d’un manque de compréhension des dynamiques dysfonctionnelles liées au consentement sexuel dans les relations violentes. Les implications pratiques pour les professionnels sont discutées, de même que les futurs axes de recherche à considérer. Conclusion La réalité clinique des violences sexuelles entre partenaires intimes est à la fois inquiétante et mal comprise. Elle doit être reconnue et abordée dans la prise en charge, en raison de son potentiel traumatique et de son pouvoir en termes de confusion psychologique pour les victimes. L’état actuel des connaissances indique que le fait de poser la question des violences sexuelles aux femmes ayant subi des violences conjugales est un élément essentiel de la pratique. Les professionnels en contact avec ce public doivent être formés en ce sens afin d’être en mesure d’apporter des réponses adéquates.
... Children living in high poverty areas who frequently experience traumatic events, such as domestic and community violence often present the latter type of response. These children can experience a range of symptoms; from the traditional symptoms of posttraumatic stress disorder (PTSD), such as reliving or reexperiencing the event, presenting increased alertness and anxiety, and avoiding reminders of the event (American Psychiatric Association, 2013), to mood dysregulation, and interpersonal difficulties (Herman, 1992). Traumarelated symptoms can make public outings anxiety-provoking and unpleasant, leading to activity avoidance in public spaces (Wagenfeld et al., 2013). ...
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Early-life exposure to neighborhood violence can negatively affect children's socioemotional development and long-term health outcomes. Community-level interventions that modify the built environment to facilitate social encounters can have a positive impact on health. An example of such interventions is the building of green spaces and playgrounds. This case study describes collaboration among residents, local organizations, and a university that aimed to increase the utilization of a vacant lot by converting it into a green space with a playground. Informal conversations at volunteer gatherings and neighborhood association meetings indicated a positive impact of this project in the community. We propose a model for future program implementation and research to improve health in disinvested and disordered communities. We conclude that more research is needed on community partnerships that modify the built environment to decrease community violence. Community-based participatory research may be successful in evaluating future projects with this goal.
... A szexuális agresszió azonnali érzelmi hatásai a sokk, félelem, feldúltság, zavarodottság és szociális izoláció (Herman, 1992;Jordan és mtsai., 2010). Az erőszak közben egyéb pszichológiai mechanizmusok is közrejátszanak: disszociáció léphet fel aktus közben, és közvetlenül utána memória széttöredezettsége figyelhető meg, ami az idő múlásával és alvással konszolidálódik (Mason és Lodrick, 2013). ...
Experiment Findings
Háttér és célkitűzések: Gondolkodásunkat és értékítéletünket attitűdjeink és hiedelmeink keretezik, és ez a szexuális agresszió megítélésére és az áldozathoz való viszonyra is értelmezhető. Kutatásunkban a nemierőszak-mítoszok szexuális agressziós helyzetek megítélésére gyakorolt hatását vizsgáljuk. Vizsgáljuk, hogy ugyanaz a szituáció eltérő megítélést kap-e attól függően, hogy a szexuális agressziót elkövető személy és az áldozat közötti kapcsolat milyen távolságú (pár, ismerős, idegen). Módszer: A nemierőszak-hiedelmek vizsgálatára a Nemierőszak-mítoszok Elfogadása Skála (NEMES) magyar adaptációját, az instrumentalitás és megengedő szexuális attitűdök vizsgálatára a Rövid Szexuális Attitűdök Skála (BSAS) magyar adaptációját, valamint a helyzetek kapcsolati távolság függvényében történő megítélésre egy saját skálát alkalmaztunk online kérdőívben (N = 196). Eredmények: A kapcsolati távolság mint kognitív torzító tényező hatását igazoltuk, valamint a nemierőszak-mítoszok elfogadási mértékének helyzetmegítélésre való hatását is. A szexuális attitűdök közül kizárólag az instrumentalitás hatását igazoltuk a hiedelmekre és a helyzetmegítélésre vonatkozóan. Következtetések: Az áldozat és elkövető közti kapcsolati távolság kognitív torzító tényező, azonban ez a hatás csökken, minél erősebb a nemi erőszakkal kapcsolatos hiedelmek elutasítása. A szex mint énkielégítő eszköz attitűddel bírók hajlamosabbak a nemierőszak- hiedelmeket elfogadni, és kevésbé súlyosnak ítélik meg az egyes szexuális agressziókat. Korábbi kutatásokhoz hasonlóan igazoltuk a politikai orientáció prediktív hatását a nemierőszak-mítoszokra, viszont ezúttal az egyes helyzetmegítélésekre is. (1) Általában ugyanazt az objektív helyzetet máshogy ítéljük az elkövető személyével való kapcsolatunk tükrében. (2) A nemierőszak-mítoszokat elutasítók súlyosabban és inkább objektívebben (értsd: a kapcsolati távolság tényezőjének figyelmen kívül hagyásával) értékelik a szexuális agressziós helyzeteket. (3) A politikai orientációnak prediktív szerepe van az attitűdökre, hiedelmekre, valamint a helyzetmegítélésre. (4) A szexet mint énkielégítő eszközt használók kevésbé érzékenyek az áldozatra, relativizálják az áldozati helyzeteket, és hajlamosabbak, hogy a hiedelmeket elfogadják.
... Les personnes dont la relation avec un parent a été abusive, négligente et/ou pour qui ce parent a failli à son rôle de protection peuvent rencontrer une difficulté à développer une image positive d'elles-mêmes comme parents, puisqu'elles ont été privées de l'opportunité de développer des représentations parentales bienveillantes (Slade et al., 2009). Quand le traumatisme vécu durant l'enfance n'est pas résolu, les sentiments de peur et d'impuissance vécus en bas âge continuent à affecter les personnes à l'âge adulte (Herman, 1992). Lorsque ces personnes deviennent parents, ces sentiments de peur risquent de ré-émerger au sein des interactions avec l'enfant par le biais de comportements effrayants ou apeurés (Main & 276 Les Cahiers du CEIDEF -volume 8 -septembre 2021 Hesse, 1990). ...
... Recognizing the wide-ranging but predictable psychological sequalae of complex trauma in children and its poor characterization in the DSM, Van der Kolk (2005), building on foundational work by Herman (1992), proposed the Developmental Trauma Disorder (DTD) diagnosis. DTD requires exposure to multiple or prolonged adverse events beginning in childhood (criterion A), with impairments in affective and physiological dysregulation (criterion B), attentional and behavioral dysregulation (criterion C), self and relational dysregulation (criterion D), posttraumatic spectrum symptoms (criterion E), and functional impairment (criterion G), for a minimum of 6 months (criterion F) ( Van der Kolk et al., 2009; see Table 1 for the full list of criteria and sub-criteria). ...
Article
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Exposure to complex trauma is a prevalent and costly public health concern. Though not yet included in the formal diagnostic systems, developmental trauma disorder (DTD) was proposed to capture the consistent and predictable emotional, behavioral, and neurobiological sequelae observed in children exposed to complex trauma. This systematic review synthesizes and evaluates the existing empirical evidence for DTD as a reliable, valid, distinctive, and clinically useful construct. We identified 21 articles reporting on 17 non-overlapping samples that evaluated DTD symptom criteria using objective, empirical methods (e.g., factor analysis, associations with other diagnostic constructs, associations with trauma exposure type, clinician ratings of utility). Studies were largely supportive of the DTD construct and its clinical utility; however, it will be crucial for this work to be replicated in larger samples, by independent research groups, and with more rigorous methodological and analytic approaches before definitive conclusions can be drawn. Findings from this review, while preliminary, provide a promising empirical foundation for DTD and bring the field closer to improving diagnostic parsimony for children and adolescents affected by complex trauma.
... As arguments, the results of studies are given in which the role of traumatic stress in the etiology of borderline personality disorders is confirmed only by data from retrospective studies [9,13]. Axelrod S.R., et al. [14] tried to remove the noted limitations of the study using the example of PTSD and put forward hypotheses that boiled down to the following: 1) pre-war borderline personality disorders can be an indicator of the variability of post-war PTSD symptoms (in addition to the consequences of combat exposure) [8]; 2) combat manifestations are predictors of increasing post-war borderline personality disorders (except for those that occurred in the pre-war period); young age of combatants is a predictor of additional variability in post-war borderline personality disorders [15]; 3) Combat-related PTSD symptoms are predictors of post-war borderline personality disorders [12]. ...
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Cronicon OPEN ACCESS EC PSYCHOLOGY AND PSYCHIATRY Short Communication Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder Samvel Hrant Sukiasyan* Center for Psychosocial Recovery, Armenian State Pedagogical University Named after Kh. Abovyan, Yerevan, Armenia *Corresponding Author: Samvel Hrant Sukiasyan, Center for Psychosocial Recovery, Armenian State Pedagogical University Named after Kh. Abovyan, Yerevan, Armenia. Received: March 22, 2022; Published: March 31, 2022 The study of the problem of personality changes in mental disorders is relevant and socially significant in modern society, since there is an urgent need to provide effective psychosocial assistance to a large number of people suffering from certain stressful effects, having certain problems. At the present stage of the development of civilization, when global social, political, economic, scientific, cultural processes (events, changes, revolutions, crises, catastrophes) are taking place that have no analogues in world history, all social groups and strata of modern society find themselves in a situation that forms a rather specific psychological state, which psychiatrists call “borderline” - a state of balancing between the norm and pathology, health and disease. These conditions are accompanied frustration bordering on prostration, various stresses reaching the level of distress, conflict leading to violence, aggression. The stressful life of modern society (information oversaturation, numerous local military conflicts, man-made disasters, terrorist attacks, material and spiritual poverty, on the one hand, and swagger and oversaturation, on the other, have produced unheard of upheavals and caused cataclysms in the social, political, eco�nomic, psychological, the spiritual life of many states and societies, have had an impact on the psychology of not only entire nations, but also individuals. The content of our existence has become immorality, lies, loss of spirituality, motivation for consumption, loss of values, perversion of ideals, isolation of the Self, which is fraught with numerous psychological problems, which, in turn, generate social and personal problems (according to the feedback mechanism), psychopathological, psychosomatic, somatic. And above all, the person suf�fers physically, spiritually and mentally. And especially with mental disorders, there are changes in the socio-psychological, emotional and moral representations of the individual. First of all, let’s try to understand what is a problem in its psychological and psychopathological manifestations, in other words, what is a “normal” problem and what is a “pathological” problem. The problem of understanding and interpreting the psychological and psychi�atric category “problem” arises before every specialist in the mental health service in the course of the treatment and diagnostic process. The problem of understanding the relationship between the psychiatric and psychological (and in some cases, social) components of this category is posed. The very formulation of such a problem is a multi-valued problem and has a number of aspects [1-4]. It is solved in its own way in psychology and psychiatry. Having a very close methodological base, psychology and psychiatry have different objects of study - a healthy and sick mind. But for some reason, the huge, intermediate between illness and health, the mass of patients, defined as borderline, is ignored. Here the prob�lems are psychological and psychiatric: from the norm to the disease, from a milder level of pathology to a more severe level, personality Citation: Samvel Hrant Sukiasyan. “Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder”. EC Psychology and Psychiatry 11.4 (2022): 98-104. Citation: Samvel Hrant Sukiasyan. “Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder”. EC Psychology and Psychiatry 11.4 (2022): 98-104. Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder 99 diseases and diseases provoked by mental traumas of varying intensity and depth. When it comes to the psychological problems of a per�son, most often they mean individual problems associated with certain personal, deep features of a person, so they can be very different - problems with self-esteem, communication, self-confidence, difficulties in making decisions and etc [5]. A psychological problem is “an actualized psychological contradiction within a person or group, which manifests itself within the framework of a mental norm, but cre�ates discomfort, tension, hinders the normal development, functioning and adaptation of a person or group” [6]. The author considers the problem as a contradiction, since any obstacle, difficulty, conflict reflects the contradiction between opposing tendencies. We can say that any problem is based on a contradiction and any problem, including psychological, can be characterized through this basis. Psychological problems are a kind of barriers to adaptation, development and normal functioning of the individual. Features of overcoming these barri�ers determine the options for personality development (progressive, regressive, pathological development) [6]. Patients often explain psychological problems not by psychological, but by objective, independent circumstances. Here an important role is played by the so-called determinative system of personality, i.e. a system of ideas on the basis of which a person explains the causes of various phenomena, including his own problems. Psychological problems lead to three forms of problem solving: adaptive response (that is, a response that leads to problem solving), partially adaptive, and non-adaptive response. Maladaptive response styles on an emotional level lead to emotional suppression, submissiveness, self-blame, and aggressiveness; at the cognitive level, there is humility, confusion, dissimulation and ignoring, and at the behavioural level, a person actively avoids the situation or retreats before solving the problem [6]. Adjustment disorder undermines the ability of the individual to manage his life and adapt to those changes that he cannot control. And the problem “Grows” into a psychiatric, that is, into a mental disorder, when a person cannot solve or adapt to his mental problems on his own. Among the most common mental disorders that can be considered as a consequence or as a result of unresolved psychological problems, one should name, first of all, stress (psychogenic) reactions, depression, all kinds of neurotic disorders (anxiety, phobic, obsessional, etc.), addiction disorders, psychotic disorders, personality disorders and some others. As noted by Alexandrovsky Yu.A. [7], “specific human qualities - work, duty and an unstated need - get a flaw”. A morally broken per�sonality loses the criterion of conscience as a socio-psychological category, which is the beginning and joy of human life, the best ally of labor. This led to a global reassessment of all the values of the physical, mental and spiritual being of the modern world, unprecedented throughout the history of mankind. The relationship of personality with the physical, mental, spiritual and social incarnations is not straightforward and one-sided. The relationships here are very deep, profound, multilateral and dynamic. In the aspect of mental disorders, we suggest that there are several possible explanations for these relationships. Firstly, personality traits and disorders that existed before the disease can act as risk factors for the development of the disease and play a certain pathogenetic role in its development. There are studies [8] confirming that individu�als with borderline personality disorders have limited resources to resolve stressful events, which makes them more vulnerable to the development of the disease. At the same time, the more significant the negative attitudes of the personality observed in the premorbid, the sharper they can be revealed in the disorder, whether it be a psychotic or neurotic disorder. Positive and negative personality traits before the disease are reflected in the patient’s pathological experiences, influencing his behavior. Positive moral and ethical attitudes of the individual to a large extent contribute to the suppression of the emerging pathological mental production with an antisocial orienta�tion, and hinder the tendency to its implementation. Secondly, stress, a pathogenic situation, psychological trauma in themselves can cause permanent changes in character. This explana�tion is supported by many researchers who have found that individuals with borderline personality disorders have a high incidence of childhood trauma [9,10]. Herman J.L. and van der Kolk B.A. [9] directly indicate that the borderline personality disorders detected in PTSD are associated with stress. However, it should be taken into account that psychological trauma is a necessary but far from sufficient Citation: Samvel Hrant Sukiasyan. “Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder”. EC Psychology and Psychiatry 11.4 (2022): 98-104. Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder 100 condition for the development of the disease [11]. It is a proven clinical fact that the causes of any mental illness are rooted in personal�ity traits that shape the cognitive processing of stressful events, but they are also influenced by early life experiences and social support. Thirdly, personality disorders and characteristics also develop as a reaction to life events, and not only to traumatic experiences [12]. For example, prolonged sleep deprivation, nightmares can lead to irritability, emotional lability, explosive outbursts, anger, which forms personality disorders over time and under certain conditions. In fairness, it should be noted that despite the obviousness of such rela�tionships, this point of view is not generally accepted. As arguments, the results of studies are given in which the role of traumatic stress in the etiology of borderline personality disorders is confirmed only by data from retrospective studies [9,13]. Axelrod S.R., et al. [14] tried to remove the noted limitations of the study using the example of PTSD and put forward hypotheses that boiled down to the fol�lowing: 1) pre-war borderline personality disorders can be an indicator of the variability of post-war PTSD symptoms (in addition to the consequences of combat exposure) [8]; 2) combat manifestations are predictors of increasing post-war borderline personality disorders (except for those that occurred in the pre-war period); young age of combatants is a predictor of additional variability in post-war bor�derline personality disorders [15]; 3) Combat-related PTSD symptoms are predictors of post-war borderline personality disorders [12]. Axelrod S.R., et al. [14] support each of the above three options and point to complex relationships between trauma, the PTSD clinic, and borderline personality disorders. Transpolating the results of these studies to a number of psychogenic, reactive diseases, we can see that, indeed, personality traits determine the clinical diversity of these disorders, reactive and psychogenic manifestations are predictors of growing personality disorders; symptoms of the disease associated with stressful experiences are predictors of subsequent personality disorders [12]. Qualitative changes underlying pathological transformations of personality and behavior are primarily detected in such areas of the personality as emotional, value-semantic, motivational, the sphere of defense mechanisms and coping strategies, as well as the sphere of social interaction [16]. It seems an indisputable fact that after a mental trauma, a chronic personality change can develop [17,18]. It is well known that difficulties harden a person. But this regularity is not always manifested with a positive sign. Under the influence of problematic life situations or unusual psychological traumas and experiences that impose unusual, non-standard requirements on the individual, both constructive and destructive changes can develop. Non-normative crises (“shocks”), as Fau E.A. notes, can have both posi�tive and negative effects on the psychological and psychosomatic status of patients [19]. Clinical practice shows that victims of extreme traumatic (combat) effects for some time after the end of exposure to stress factors experience an acute state of shock (defined by ICD-10 as “acute stress reaction”) [20]. Most victims (67%) of extreme experiences, combat veterans, acute stress reactions stop on their own, and they return to their usual state. And of course, the decisive role in resolving this problem is played by the personal characteristics of the victims of trauma. For the remaining 33% of victims, the impact of the traumatic event continues, and of course, due to certain personal characteristics, but not only personal ones. At the same time, the state of acute stress transforms into a state of post-traumatic stress, which makes it difficult to adapt to normal living conditions and leads to the emergence of various maladaptive forms of behavior. The destruction of former values, norms, ideals, worldview, ideas about oneself, about the world and one’s place in it, contribute to build�ing neurotic defense mechanisms in combat veterans [21,22]. Extreme effects of stress on the psyche lead to violations of the structure of the “self”, the cognitive model of the world, the affective sphere, and emotional ways of learning [23, 24]. All individuals with PTSD showed symptoms of this disorder, but most patients also had affective and personality disorders [25]. Most often, symptoms of “physi�ological excitability” (58.1%), “affective circle” (41.7%) and less often symptoms of “cognitive sphere” disorders (14.9%) were noted. Many researchers express the opinion that the manifestations of stress reactions largely follow from premorbid personality traits [26,27]. These ideas are clearly differentiated in the concept of character accentuations by K. Leonhard [28] and A.E. Lichko [29]. Karl Leonhard drew attention to the fact that about half of the people have fairly uniform character traits. In the other half of the people in the personality structure, one or more character traits dominate and leave an imprint on the whole appearance of the personality as a whole, determine Citation: Samvel Hrant Sukiasyan. “Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder”. EC Psychology and Psychiatry 11.4 (2022): 98-104. Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder 101 all human behavior. He called them accentuated. K. Leonhard identified several types of accentuations, which were later expanded by many researchers of this problem (for example, Lichko A.E.). Character accentuations are considered as etiopathogenic, pathoplastic and prognostic factors that determine the stress response and its subsequent course. Developing our idea expressed in the article “The role of personality in the development of combat post-traumatic stress disorder ” previously published in the journal “Psychology and Psychotechnics” [30], considering the problem of personality, on the one hand, as a pathogenetic factor in the genesis of PTSD, and on the other, - clinical phenomenon, personality, we can consider at three levels: 1) pre-traumatic personality traits or disorders (premorbid personality), 2) intra-traumatic personality disorders (personally conditioned reactions to psychological trauma, stress), 3) post-traumatic personality disorders (chronic personality changes after suffering stressful event). Pre-traumatic personality traits or disorders (premorbid personality) constitute a kind of “ground” on which the stress reaction is formed. These include, first of all, character accentuations. Psychic trauma, regardless of its nature (domestic, personal, interpersonal, professional, anthropogenic or natural, etc., etc.), does not always acquire the significance of a stressor and gives impetus to the formation of post-stress disorders. It becomes such only in those cases when it has a certain informational value in the hierarchy of value categories of the individual, the intensity of the impact on the individual, the sufficient duration of the impact, and the significance of the information. But an essential etiopathogenetic criterion is also the type of premorbid personality, character traits and temperament, as well as the biological vulnerability of a person, some features of the social situation, age factor, premorbid burden of mental trauma, etc. That is, trauma becomes a stressor only when it is aggravated by biological and gnostic content. When deciding on the boundaries of the competence of psychiatry and psychiatrists, one of the most difficult is to determine the boundaries of the mental norm and pathology. Attempts to solve it have been made by more than one generation of psychiatrists, phi�losophers, psychologists, sociologists and other specialists, but there is still no definitive answer. Apparently, it is unlikely that it will be received in the foreseeable future. The problem is that with the current level of knowledge it is impossible to consider a mental disorder in isolation from the mental norm, from the character and temperament of a person, the characteristics of his personality, from the state of his somatic health, from environmental conditions. Range of psychiatric problems Personality includes such closely interrelated cat�egories as the sphere of perception, memory, thinking, emotional-volitional sphere, personality warehouse, motivation of actions, etc. The listed parameters of the human psyche and personality are to some extent reflected in the sphere of individual, social and social function�ing of a person, and appear at the problem level. In the case of mental pathology, this and the manifestations of functioning have a tinge of individuality, originality, often extravagance, originality, giftedness, talent, and finally, the genius of the individual. Society often tends to categorize a certain part of people with these characteristics as originals, eccentrics, extravagant, and sometimes half-normal. Different subjects have different reactions to mental suffering and problems. Resistance to disorders of mental activity depends on the specific physical characteristics of individuals and the general development of their psyche. The first step leading to exhaustion of the nervous system is anxiety. It arises as a result of the tendency to draw in one’s imagination various negative developments of events that never materialize in reality, but provoke excessive unnecessary anxiety. Such anxiety gradually escalates and, as the critical situation grows, it can transform into a more serious disorder, which leads to a deviation in the mental perception of the individual and to dysfunc�tions in the functioning of various structures of internal organs. The response to prolonged exposure to traumatic situations is neuras�thenia. It is accompanied by increased fatigue and exhaustion of the psyche against the background of hyper excitability and constant irritability over trifles. At the same time, excitability and grumpiness are protective means against the final failure of the nervous system. In traumatic situations, which the subject does not try to resist, a hysterical reaction occurs. The individual simply “runs away” into such a state, forcing himself to feel all the “charm” of experiences. This condition can last from two to three minutes to several years. At Citation: Samvel Hrant Sukiasyan. “Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder”. EC Psychology and Psychiatry 11.4 (2022): 98-104. Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder 102 the same time, the longer the period of life it affects, the more pronounced the mental disorder of the personality will be. Only by changing the attitude of the individual to his own illness and attacks, it is possible to achieve a cure for this condition. In traumatic situations, as well as without them, depressive states can develop for no apparent reason. Depression is characterized by a pessimistic attitude, blues, lack of joy and desire to change anything in one’s existence. She is usually accompanied by insomnia, refusal to eat, intimacy, lack of desire to do daily activities. Often depression is expressed in apathy, melancholy. A person in depression, as it were, closes in his own reality, does not notice others. Thus, any psychological problem is based on a person who must solve it in order to achieve adaptation. Any psychological problem is solved by a person due to its characteristics, which both contribute to the achievement of adaptation and hinder this process, leading to the development of various pathological conditions and disorders. The psychological problem is solved by the personality in interaction with a number of psychobiological and psychosocial factors, which is very important depending on the intensity of the stress factor and the importance that the personality attaches to this stressful effect. The pathological process that develops in the case of a non-adaptive solution to the problem is influenced by both premorbid (pre-traumatic) personality traits and intra- and post-traumatic personality dis�orders. Both the variety of problems, their different intensity, form and content, as well as the variety of normal personality, accentuated forms of personality, as well as acquired personality disorders, create significant difficulties in creating a classification of psychological problems. Sometimes the problem seems insurmountable. The problem of searching for patterns (biological, psychological, etc.), on the basis of which the problem of classification will turn out to be real, is actualized. 1. American Psychiatric Association. “Diagnostic statistical manual of mental disorders (5th edition.)”. Arlington, VA: American Psychi�atric Publishing (2013): 947. 2. Andreasen NC “DSM and the death of phenomenology in America: An example of unintended consequence”. Schizophrenia Bulletin 33 (2007): 108-112. 3. Davtyan EN. “Psychiatry Today: The Consequences of Globalization”. Review of Psychiatry and Medical Psychology 4 (2012): 3-6. 4. S avenko YuS. “Introduction to psychiatry”. Critical Psychopathology. M (2013): 448. 5. Grishina NV. “Existential problems of a person as a life challenge”. Bulletin of St. Petersburg University: Sociology 4 (2011): 109-116. 6. Khudoyan SS. “Psychological problem: essence, characteristics, types”. Journal of Practical Psychology and Psychoanalysis (2017): 2. 7. Aleksandrovsky YuA. “Borderline psychiatry”. M.: RLS (2006): 1280. 8. Gunderson JG and Sabo AN. “The phenomenological and conceptual interface between borderline personality disorder and PTSD”. The American Journal of Psychiatry 150 (1993): 19-27. 9. Herman JL., et al. “Childhood trauma in borderline personality disorder”. The American Journal of Psychiatry 146 (1989): 490-495. 10. Paris J., et al. “Risk factors for borderline personality disorder in male outpatients”. The Journal of Nervous and Mental Disease 182 (1994): 375-380. 11. Paris J. “Predispositions, personality traits, and posttraumatic stress disorder”. Harvard Review of Psychiatry 1 (1994): 253-265. Bibliography Citation: Samvel Hrant Sukiasyan. “Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder”. EC Psychology and Psychiatry 11.4 (2022): 98-104. Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder 103 12. Southwick SM., et al. “Personality disorders in treatment-seeking combat veterans with posttraumatic stress disorder”. The American Journal of Psychiatry 15.7 (1993): 1020-1023. 13. Piekarski AM., et al. “Personality subgroups in an inpatient Vietnam veteran treatment program”. Psychological Reports 72 (1993): 667-674. 14. Axelrod SR., et al. “Symptoms of Posttraumatic Stress Disorder and Borderline Personality Disorder in Veterans of Operation Desert Storm”. The American Journal of Psychiatry 162 (2000): 270-275. 15. Herman JL. “Complex PTSD: a syndrome in survivors of prolonged and repeated trauma”. Journal of Traumatic Stress 5 (1992): 377- 391. 16. Kozhevnikova VA. “Personality traits and behavioral changes in people who have experienced extreme events”. Diss. ... cand. psychol. Science. Kharkiv (2006): 186. 17. Popov YuV. “Reactions to stress”. Practical commentary on the 5th chapter of the International Classification of Diseases 10th revi�sion. View V.D. 18. Nutt D. “Post-traumatic stress disorder: diagnosis, management and treatment”. Davidson JR, Zohar J. Martin Dunitz Ltd, London (2000): 260. 19. Fau EA. “Comparative analysis of psychological and psychosomatic characteristics of people who survived crisis situations”. Diss. ... cand. psychol. Sciences. – SPb (2004): 260. 20. World Health Organization: International Classification of Diseases (10th Revision). Classification of mental and behavioral disor�ders”. SPb: WHO (1994): 300. 21. Aleksandrovsky YuA. “Social Stress Disorders”. Russian Open Medical Journal 11 (1996): 2. 22. Kharlamova TM. “Personality determinants of post-traumatic stress disorder in combat veterans”. Modern Science-Intensive Tech�nologies 11 (2007): 67. 23. Kalshed D. “The Inner World of Trauma: Archetypal Defenses of the Personal Spirit”. Transl. from English. M.: Academic project (2001): 368. 24. Leahy R and Sample R. “Post-traumatic stress disorder: a cognitive-behavioral approach”. Moscow Psychotherapeutic Journal 1 (2002): 141-157. 25. Ostapenko AV. “Clinical and psychological characteristics of the personality of participants in local wars and their defensive and cop�ing behavior”. Diss. ... cand. psychol. Sciences. - St. Petersburg (2007): 135. 26. Boyko YuP. “Features of anti-stress medical care in emergency situations and their consequences”. Social and Clinical Psychiatrist 13.2 (2003): 60-67. 27. Ushakov GK. “Borderline neuropsychiatric disorders”. Moscow: Medicine,. 2nd editon., revised. and additional (1987): 304. 28. Leonhard K. “Accentuated Personalities”. Per. with him. V.M. Leshchinskaya. Kyiv: Vishcha shkola (1981): 390. Citation: Samvel Hrant Sukiasyan. “Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder”. EC Psychology and Psychiatry 11.4 (2022): 98-104. Psychological Problems and Personality on the Example of Posttraumatic Stress Disorder 104 29. Lichko AE. “Psychopathies and character accentuations in adolescents”. L.: Medicine,. 2nd edition. (1983): 255. 30. Sukiasyan SG and Tadevosyan MYa. “The role of personality in the development of combat post-traumatic stress disorder”. Psychology and Psychotechnics 2 (2013): 258-308. Volume 11 Issue 4 April 2022 ©All rights reserved by Samvel Hrant Sukiasyan.
... Opisują dziecko ze zdiagnozowanym ASD i niepełnosprawnością intelektualną, które padło ofiarą wiktymizacji rówieśniczej. Autorzy przedstawiają bardzo szeroki pourazowy obraz kliniczny, który w ich oczach wydaje się przypominać to, co jest znane jako złożone PTSD ( Herman, 1992). Złożony zespół stresu pourazowego odnosi się do wyjątkowego obrazu symptomatycznego, który może powstać po ekspozycji na przewlekłą, interpersonalną traumę. ...
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Po revolučnom roku 1989 zaznamenávame sociálno-ekonomickú transformáciu spoločnosti, ktorá interferovala životy mnohých rodín v súčasnosti. Príspevok objasňuje na základe kvalitatívnej analýzy dopady sociálno-ekonomických zmien v spoločnosti na život rodiny, s akcentom na vývin dieťaťa. Reštrukturalizácia hospodárskej sféry znásobila sociálne nerovnosti v rodinách, ktorých dôsledkom je chudoba, nezamestnanosť, zadlženosť. Rastúce požiadavky na trhu práce podmieňujú enormný záujem uplatniť sa v profesijnej oblasti, a tak na rodinu neostáva čas. Nedostatok emocionálneho prepojenia medzi členmi rodiny spôsobuje pocity osamelosti a disharmóniu rodinných vzťahov. Uspokojivé finančné zabezpečenie rodiny často determinuje nutnosť migrácie za pracovnými príležitosťami. Dlhotrvajúce odlúčenie rodičov od svojich detí ohrozuje fyzický vývin, psychickú pohodu a v konečnom dôsledku aj školskú úspešnosť dieťaťa.
... Con respecto al estrés postraumático complejo, Herman (1992) propone que es una respuesta frente a una serie de situaciones psicosociales adversas: vivir malos tratos, negligencia, pérdidas afectivas y separaciones. Además, puede tener lugar en interacciones repetidas en etapas tempranas con cuidadores que tienen dificultades para la regulación de su propia expresión afectiva y/o no se encuentran emocionalmente disponibles para facilitar los procesos de regulación interactiva que son necesarios para el adecuado desarrollo infantil. ...
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La institucionalización de niños, niñas y adolescentes (NNA) en Chile, corresponde a una realidad presente desde antes de la ratificación de la Convención de los Derechos del Niño en nuestro país, y está diseñada sin los estándares acordes con estos últimos. A pesar de que busca proteger a NNA vulnerados en sus derechos, genera un impacto negativo en el desarrollo de los mismos. En el contexto de los cuestionamientos y los cambios que se están generando en Chile con la emergencia del nuevo Servicio de Protección Especializada para la Niñez y Adolescencia, y a la luz de una epistemología colaborativa, se realiza una revisión narrativa que permita explorar prácticas colaborativas que pudieran ser susceptibles de implementar en el contexto del cuidado residencial de niños, niñas y adolescentes. Se revisan los aportes de los principales autores para definir las bases filosóficas, las características y los principales ejemplos de Prácticas Colaborativas, finalizando con una propuesta aplicable al contexto residencial.
... Studies of child physical abuse in the 1950s and 1960s (Dorahy et al., 2010: 6) documented the high incidence of specific psychological traits and dysfunctions among abused children (Green et al., 1981: 130), while research in the late 1980s and early 1990s associated childhood sexual abuse with long-term, diverse, negative 3 The term chreode, or chreod, was coined by Waddington Greek roots for "necessary" and "path" (Humphrey, 2019) . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 physiological and psychological effects (Trickett and Putnam, 1993). From this point forward, it was generally accepted that severe and prolonged abuse in childhood was "one of the major factors predisposing a person to become a psychiatric patient" later in life (Herman, 1992: 379; see also Lloyd and Larivée, 2020). ...
Article
What sets someone on a life trajectory? This question is at the heart of studies of 21-st century neurosciences that build on scientific models developed over the last 150 years that attempt to link psychopathology risk and human development. Historically, this research has documented persistent effects of singular, negative life experiences of people’s subsequent development. More recently, studies have documented neuromolecular effects of early life adversity on subsequent life trajectories, resulting in models that frame lives as disproportionately affected by early negative experiences. This view is dominant despite little evidence of the stability of the presumably early developed molecular traits and their potential effects on phenotypes. We argue that in the context of gaps in knowledge and the need for scientists to reason across molecular and phenotypic scales, as well as time spans that can extend beyond an individual’s life, specific interpretative frameworks shape the ways in which individual scientific findings are assessed. In the process, scientific reasoning slides between understandings of cellular homeostasis and organisms’ homeorhesis, or life trajectory. Biologist and historian François Jacob described this framework as the “attitude” that researchers bring to bear on their “objects” of study. Through an analysis of, first, historical and contemporary scientific literature and then ethnographic research with neuroscientists, we consider how early life trauma came to be associated with specific psychological and neurobiological effects grounded in understandings of life trajectories. We conclude with a consideration of the conceptual, ontological, and ethical implications of interpreting life trajectories as the result of the persistence of long-embodied biological traits, persistent life environments, or both.
... Since the early 1990 ′ s there has been recognition that the diagnostic criteria of post-traumatic stress disorder (PTSD) does not capture the extent and significance of symptoms connected to recurrent, persistent child maltreatment [14]. The World Health Organization formally recognised the distinction in the ICD-11 in 2018 when it included an additional three disturbances of self-organisation (DSO) symptom clusters for 'complex PTSD': affective/emotion dysregulation, relational disturbances and negative self-perceptions [10]. ...
Article
Background Since colonisation, Aboriginal and Torres Strait Islander peoples have experienced violence, loss of land, ongoing discrimination and increased exposure to traumatic events. These include adverse childhood experiences which can lead to complex trauma, and are associated with increased incidence of high-risk pregnancies, birth complications and emergence of post-traumatic symptoms during the perinatal period, potentially impacting parenting and leading to intergenerational trauma. The perinatal period offers unique opportunities for processing experiences of trauma and healing yet can also be a time when parents experience complex trauma-related distress. Therefore, it is essential that trauma-aware culturally safe perinatal care is accessible to Aboriginal and Torres Strait Islander parents. Aim This study aimed to understand community perspectives of what ‘trauma-aware culturally safe perinatal care’ would look like for Aboriginal and Torres Strait Islander parents. Methods Data were collected during a workshop held with predominantly Aboriginal and Torres Strait Islander key stakeholders to co-design strategies to foster trauma-aware culturally safe perinatal care. Data were thematically analysed. Findings Four overarching themes represent proposed goals for trauma-aware culturally safe care: Authentic partnerships that are nurtured and invested in to provide the foundations of care; a skilled workforce educated in trauma awareness; empowering and compassionate care for building trust; and safe and accessible environments to facilitate parent engagement. Conclusions Provision of trauma-aware culturally safe care achieving these goals is likely to enable parents experiencing complex trauma to access appropriate support and care to foster healing in the critical perinatal period.
... Opisują dziecko ze zdiagnozowanym ASD i niepełnosprawnością intelektualną, które padło ofiarą wiktymizacji rówieśniczej. Autorzy przedstawiają bardzo szeroki pourazowy obraz kliniczny, który w ich oczach wydaje się przypominać to, co jest znane jako złożone PTSD ( Herman, 1992). Złożony zespół stresu pourazowego odnosi się do wyjątkowego obrazu symptomatycznego, który może powstać po ekspozycji na przewlekłą, interpersonalną traumę. ...
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In a narrower sense, neuropsychology is a discipline that deals with the relationship between neuroscience and psychology. Here he mainly examines the connections between the central nervous system and the human psyche. This characteristic corresponds to the narrow interdisciplinary conception of this scientific field. However, in a deeper search of current professional published literature, one can find works that document the transcendence of this discipline into other medical and some social disciplines. In the form of a literary review, this work set itself the task of examining the professional literature published on this topic and selecting representative literary sources that document the interdisciplinary nature of this scientific discipline.
... A linked appraisal is that a stabilisation phase of treatment is always needed prior to a traumafocused intervention, especially for those with multiple traumas. This misconception perhaps originates from Herman's (1992a) phased model for working with complex PTSD. She recommended that a stabilisation phase should precede a trauma-processing phase, followed by a phase of 'reintegration' with important areas of life such as relationships, socialising and work. ...
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Therapist cognitions about trauma-focused psychological therapies can affect our implementation of evidence-based therapies for post-traumatic stress disorder (PTSD), potentially reducing their effectiveness. Based on observations gleaned from teaching and supervising one of these treatments, cognitive therapy for PTSD (CT-PTSD), ten common ‘misconceptions’ were identified. These included misconceptions about the suitability of the treatment for some types of trauma and/or emotions, the need for stabilisation prior to memory work, the danger of ‘retraumatising’ patients with memory-focused work, the risks of using memory-focused techniques with patients who dissociate, the remote use of trauma-focused techniques, and the perception of trauma-focused CBT as inflexible. In this article, these misconceptions are analysed in light of existing evidence and guidance is provided on using trauma-focused CT-PTSD with a broad range of presentations. Key learning aims (1) To recognise common misconceptions about trauma-focused CBT for PTSD and the evidence against them. (2) To widen understanding of the application of cognitive therapy for PTSD (CT-PTSD) to a broad range of presentations. (3) To increase confidence in the formulation-driven, flexible, active and creative delivery of CT-PTSD.
... El maltrato psicológico puede considerarse un denominador común en las relaciones interpersonales violentas (Andersen et al., 1991) ya que las estrategias empleadas por los abusadores en relaciones de pareja violentas son similares a las de sistemas grupales de coerción, incluidas las usadas en prisioneros de guerra (Romero, 1985). También en cuanto a los efectos debilitantes de estas sobre las víctimas (Boulette y Andersen, 1985;Herman, 1992). ...
Research
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This paper aims to contribute to the delimitation of the forms of psychological abuse that occur in groups classified as coercive, abusive, or cultic. To this end, a review of the literature of the different taxonomic proposals that classify strategies meant at the submission of the individual to the group, the instruments available to evaluate their presence in practice and the effects that exposure to this type of behavior can suppose for the members is carried out. In addition, the approach to the study of psychological abuse as an inter-contextual phenomenon is proposed, which will be expressed in different ways when taking place in dissimilar relational systems, but still sharing a common core in those situations in which the submission and domination of the other is pursued. Violent relationships, workplace harassment and terrorist movements are proposed as contexts of abuse in which to study the use of strategies already delimited in coercive groups. It also raises the possibility of studying and analyzing the actions of potentially destructive communities created in the network as coercive groups that exert this type of abuse on their members.
... From this point forward, it was generally accepted that severe and prolonged abuse in childhood was "one of the major factors predisposing a person to become a psychiatric patient." (Herman, 1992: 379; see also Lloyd and Larivée, 2020) Diathesis-stress models, first developed by Charcot, gained influence as a means of understanding how sources of vulnerability (e.g., congenital traits, early experiences) and later life experiences tended to set people on stable trajectories associated with mental illness and other negative traits. These models served as a blueprint for neurobiological research on childhood trauma and its relationship with mental illness later in life (Perry, 1994), which certain researchers saw as signalling a shift "toward a psychobiology of posttraumatic stress" (van der Kolk et al., 1985). ...
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How does a trait develop, and what makes it persist? This question is at the heart of studies of 21st-century neurosciences that attempt to identify how people develop specific personality traits and how these may become permanently anchored in their neurobiological profiles and temperaments. Such studies have documented the neuromolecular effects of early life adversity and have contributed to an understanding of subsequent life trajectories as being disproportionately affected by early negative experiences. This view has arisen despite little evidence of the stability of the presumably early-developed molecular traits and their potential effects on phenotypes Moreover, the overall understanding of these trajectories raises questions as to the origin of the potential stability of molecular traits: namely, whether they simply persist or whether they are actively maintained, and potentially augmented by, ongoing life adversity. These two perspectives have potentially significant implications for the understanding of the malleability of life trajectories and commitments to support people in shaping their trajectories. Through an analysis of historical and contemporary scientific literature and ethnographic research with neuroscientists, we consider how trauma came to be associated with specific psychological and neurobiological effects grounded in understandings of homeostasis and homeorhesis (trajectories). We then consider the ways in which neuroscientific researchers conceptualize the relationships between early adversity and elevated suicide risk later in life. We conclude with a consideration of the conceptual, ontological, and ethical implications of framing persistent life traits as the result of the persistence of long-embodied biological traits, persistent life environments, or both.
... This concept may also be linked with PTSD that develops without exposure to sudden or unexpected events (Herman, 1992). There are two types of PTSD (van der Kolk, 2001a); the first stems from single exposure to traumatic events (Type I), and the second from repeated exposure to traumatic events (Type II), which is known as Disorders of Extreme Stress Not Otherwise Specified (DESNOS; also referred to as Complex PTSD). ...
Thesis
p>This thesis investigates the relationship between perceptions of social support and the narrative coherence of traumatic war memories. The aim was to understand the way in which social support impacts on the process of reconciliation of war memories, with implications for provision of therapy to currently and formerly serving veterans. In order to provide a lifespan perspective, war veterans from the Second World (WWII), Korean War, Falklands War, Gulf War and Britain’s ‘Small’ Wars participated in semi-structured one-to-one interviews based on perceptions of social support (comradeship, family support, and societal support), media representation of war, and commemoration. Analysis of narrative content was based on the perceptions of social support, and the subsequent analysis of narrative form explored the coherence of war memories as an indication of reconciliation. Coherence was operationalised as the presence of orientation and storied structure, consistency in affect, and uniting theme(s) running through the narrative. Data from the Imperial War Museum was used to provide triangulation of the social support themes, and was analysed using thematic analysis. Archival data from the Mass Observation Archive was also consulted to corroborate the findings from the interview data, providing a deeper understanding of the role of societal support using thematic analysis. In addition, a questionnaire study was conducted to probe perceptions of media representation and perceptions towards veterans. Findings suggest that veterans can reconcile their memories earlier in life, and that communicating with family members within a supportive society may aid reconciliation. This has implications for future interventions.</p
... Complex post-traumatic stress disorder (CPTSD) was introduced within the 11 th revision of the International Classification of Diseases World Health Organisation [WHO], 2019) to encapsulate the impacts of exposure to pervasive and chronic traumatic events that often begin in early life (Cook et al., 2003;Herman, 1992;Wamser-Nanney & Vandenberg, 2013). This diagnosis is characterised by a constellation of 'disturbances in self-organization' (DSO), namely dysregulation in emotional processing, interpersonal disturbances and altered core self-schemas, in addition to core PTSD criteria. ...
Article
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Background: Emotionally unstable personality disorder (EUPD) and complex post-traumatic stress disorder (CPTSD) reflect complex and highly comorbid disorders that bear significant impacts on a person’s functioning. Despite the significant treatment needs of people with EUPD and complex trauma histories, the differential effects of trauma symptomology on functioning remain unexplored in this population. Prioritizing the most impactful symptoms is critical for providing timely and efficient treatment, over a reduced intervention period. Aims: The current study sought to explore the relative associations of CPTSD symptoms with functional impairment in a clinical inpatient EUPD population. Methods: A convenience sample of 45 females with a primary diagnosis of EUPD, admitted to a specialist inpatient DBT service, completed the International Trauma Questionnaire, as a measure of CPTSD symptomology and associated functional impairment. Results: At a diagnostic level, with the exception of affective dysregulation, meeting any of the CPTSD symptom clusters was significantly associated with meeting the functional impairment criterion. At a dimensional level, the severity of all CPTSD symptoms were significantly positively associated with the severity of functional impairments. However, only sense of threat and disturbances in relationships were significant predictors of functional impairment severity, when controlling for other symptom clusters. Conclusions: Trauma symptoms bear differential impacts on a person’s ability to function in important domains of their lives. A persistent sense of threat and interpersonal difficulties stemming from traumatic experiences may reflect particularly crucial targets in interventions for individuals with EUPD and complex trauma needs. Implications for both research and clinical practice are discussed.
... [8][9][10][11][12][13][14] Trauma-related symptoms and disorders commonly experienced include posttraumatic stress symptoms (PTSS; eg, experiencing intrusive thoughts, avoidance of stimuli, or alterations in arousal or reactivity associated with the traumatic event that may or may not meet the diagnostic criteria for posttraumatic stress disorder [PTSD]), PTSD (ie, meeting all diagnostic criteria for PTSD), and complex PTSD (ie, a more severe form of PTSD that develops as a result of prolonged or severe trauma). [8][9][10][11][12][13][14][15][16] Other common mental health consequences of experiencing CSE/T include depression, anxiety, suicidality, substance abuse, and behavior problems. [8][9][10][11][12][13][14] CSE/T experiences may have a unique effect on the psychological functioning of young people beyond that of their peers who have not experienced CSE/T. ...
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Objectives The impact of posttraumatic cognitions on the development and maintenance of posttraumatic stress symptoms (PTSS) is understudied among children and adolescents who have experienced commercial sexual exploitation/trafficking (CSE/T). The objectives of this study were to (1) explore posttraumatic cognitions among help-seeking young people aged 11-19 who have experienced CSE/T; (2) determine whether experiencing direct violence, witnessing violence, polyvictimization (ie, multiple exposures to different categories of potentially traumatic events), or demographic characteristics differentially affect whether these young people meet clinical criteria for posttraumatic cognitions using established cutoffs; and (3) explore associations between posttraumatic cognitions and PTSS among young people who have experienced CSE/T. Methods This study is a secondary analysis of a baseline cross-sectional survey of 110 young people with substantiated CSE/T experiences who started trauma-focused cognitive behavioral therapy (mean [SD] age = 15.8 [1.5]) from August 1, 2013, through March 31, 2020, in a southeastern US state. We used descriptive statistics, adjusted modified Poisson regression, and adjusted linear regression to test study objectives. Results Fifty-seven of 110 (51.8%) young people aged 11-19 met clinical criteria for posttraumatic cognitions. Increased age and a greater number of trauma categories experienced were significantly associated with meeting clinical criteria for posttraumatic cognitions. On average, higher posttraumatic cognition scores were associated with higher PTSS scores, controlling for demographic characteristics (β = 0.95; 95% CI, 0.64-1.26). Conclusions These findings underscore the importance of assessing comprehensive trauma history and PTSS of young people who have experienced CSE/T, with added usefulness of measuring cognitive appraisals to inform a therapeutic treatment plan. Measuring cognitive appraisals that may influence PTSS and therapeutic success can ensure an effective public health response for this population.
... Whereas ample research has documented greater rates of mental health diagnoses among youth in foster care as compared to similar youth not in foster care (Pecora et al., 2009;Scozzaro & Janikowski, 2014), the conceptualization of complex trauma indicates that such diagnoses may be confounded by the expression of behaviors related to traumatic experiences (National Child Traumatic Stress Network, n.d.). In fact, the concept of complex trauma emerged from research on gaps in research and practice addressing childhood trauma following the Diagnostic and Statistical Manual III (DSM-3) (American Psychological Association [APA], 1980) Post-Traumatic Stress Disorder (adult PTSD) diagnosis, which was viewed as inadequate for the symptoms and challenges manifested by children who had endured chronic trauma (Cloitre et al., 2009;Courtois, 2004;Herman, 1992;van der Kolk et al., 2005). Significant revisions to the criteria for PTSD diagnosis were made in subsequent versions of the DSM (e.g., DSM-V, APA, 2013), however the PTSD diagnosis still does not adequately address the complex trauma often experienced by youth in child welfare. ...
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Youth in the US foster care system are disproportionately prescribed antipsychotic and psychotropic medication compared to youth not involved with foster care. Research on the relationship between experiences of trauma, mental health symptoms, evidence-based treatment, and safe psychotropic prescribing practices for youth in foster care is limited. We explored stakeholders’ perspectives of the relationship between psychotropic medications and trauma informed care (TIC) for youth in foster care. We conducted semi-structured individual and group interviews with foster caregivers, caseworkers, prescribing clinicians, and alumni of the foster care system. Data were recorded and transcribed verbatim, and analyzed using a directed content analysis approach. Five themes emerged across and within stakeholder groups: (1) acknowledging trauma; (2) role of psychotropic medication; (3) psychosocial resources; (4) additional supports; and, (5) training and education. Stakeholders identified TIC as an important component of mental health services for youth in foster care. There was not consensus around the role of psychotropic medication in treating trauma; however, most stakeholders felt that it was overused. Respondents suggested including additional supportive team members to help guide youth through the mental health treatment system, and emphasized the importance of support from individuals with common lived experiences. Results demonstrate the need for a system that emphasizes trauma-sensitive clinical interactions and psychosocial supports. Improving training and education for stakeholders, and providing additional sources of support for youth in foster care, could help better identify and treat the effects of trauma and the safe pharmacotherapy for youth in foster care.
... A recent study found that complex PTSD symptoms mediate the association between childhood maltreatment and trauma and physical health problems. Complex PTSD is associated with a number of psychological sequelae, including hypervigilance, anxiety, agitation, dissociation [52], anger, aggression, self-harm [53], dysregulation in emotion processing, self-organisation (including bodily integrity), relational functioning [54], and psychological interventions that effectively treat symptoms may additionally reduce the risk of physical health problems [55]. Urological symptoms such as OAB are associated with a number of psychiatric conditions such as depression, anxiety and CSA [56]. ...
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Introduction and hypothesis Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA. Methods A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed. Results Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors ( n =2), SA in patients attending clinics for their LUTs ( n =8), and cross-sectional studies ( n =8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation. Conclusions The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of ‘moderate’ quality, the evidence suggests the need to provide a “safe space” in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment.
... The salient characteristic of the traumatic event is its power to inspire helplessness and terror." -Herman, 1992-Herman, & 1997 In general, trauma can be defined as a psychological, emotional response to an event or an experience that is deeply distressing or disturbing. Trauma refers to something upsetting such as being involved in an accident, having an illness or injury, losing a loved one, and going through a divorce or rape or torture. ...
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... The salient characteristic of the traumatic event is its power to inspire helplessness and terror." -Herman, 1992-Herman, & 1997 In general, trauma can be defined as a psychological, emotional response to an event or an experience that is deeply distressing or disturbing. Trauma refers to something upsetting such as being involved in an accident, having an illness or injury, losing a loved one, and going through a divorce or rape or torture. ...
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Cyanobacteria (blue-green algae) are photosynthetic prokaryotes which are also been used as food by humans for a long time. They are rich in a variety of bioactive compounds, proteins, vitamins, antioxidants, antimicrobials, and anti-carcinogenic biomolecules. The bioactive potential of C-phycocyanin isolated from cyanobacteria has been well established as antiviral, anti-tumor, antibacterial, antidiabetic, anti-HIV, and a food additive. This review basically presents a thorough approach to the various vital applications of cyanobacteria-derived bioactive compound C-phycocyanin together with highlights of future thrust areas in its research related to its production and potential medical applications.
... Cuando el maltrato y/o el abuso sexual infantil (ASI) se prolongan en el tiempo; cuando se da simultáneamente con otras formas de violencia; y cuando quienes ejercen esas victimizaciones son los(as) cuidadores(as) principales, nos encontramos ante una forma de trauma crónico, múltiple y de naturaleza relacional (Mitchell & Steele, 2020;Racine et al., 2020) que autores como Judith Herman (1992), Bessel van del Kolk (2005), Alexandra Cook (2005) o Julian Ford (2015), entre otros, han denominado trauma complejo del desarrollo. De acuerdo con Cook et al. (2007) las consecuencias de estas experiencias pueden ser devastadoras para niños, niñas y adolescentes (NNA), impactando áreas de su funcionamiento como el apego, los sistemas neuroendocrinos, las funciones ejecutivas, la regulación emocional, las creencias sobre el mundo, y la identidad; entre otras dimensiones de deterioro (Cloitre et al., 2013;Pérez, et al., 2020;van der Kolk et al., 2019). ...
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... From this point forward, it was generally accepted that severe and prolonged abuse in childhood was "one of the major factors predisposing a person to become a psychiatric patient." (Herman, 1992: 379; see also Lloyd and Larivée, 2020) Diathesis-stress models, first developed by Charcot, gained influence as a means of understanding how sources of vulnerability (e.g., congenital traits, early experiences) and later life experiences tended to set people on stable trajectories associated with mental illness and other negative traits. These models served as a blueprint for neurobiological research on childhood trauma and its relationship with mental illness later in life (Perry, 1994), which certain researchers saw as signalling a shift "toward a psychobiology of posttraumatic stress" (van der Kolk et al., 1985). ...
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The progressive escalation in military suicides, along with a substantial increase in post-traumatic stress diagnosis among active military personnel and veterans, has become a significant humanitarian, societal, and cultural concern. Such a defining moment illuminates the need for timely and innovative treatment approaches for combat-related post-traumatic stress. This research explored depth psychological practices within short-term, group-based treatment programs. Using a phenomenological research method, interviews were conducted with six former combat veteran alumni of these programs to gather new insights and understanding into their lived experience. Informants described meaningful reductions in post-traumatic stress, moral injury, and treatment-resistance, while treatment completion rates increased significantly. Research findings suggest depth psychological practices do exhibit compelling potential as valuable, or formidable treatment approaches, alongside current evidence-based treatments. Based on the findings of this preliminary exploration future research is warranted on depth psychological treatments and group-based programs for combat-related post-traumatic stress.
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Demystifying the puzzle of the ancient Mariner's real story and identity has been the aim of many critics. Direct analysis of the poem would always propound a crossing of boundaries between the real and the uncanny without providing a clear interpretation of the actual context of the mariner's tale. The mariner's dilemma occurs when he shoots an albatross without any distinct reason, thus resulting in the death of all the crew members who turn into eccentric creatures. Accentuating his sense of guilt, the mariner stops a guest from entering a wedding and starts narrating his story. Whereas the guest never questions the reliability of the fictitious elements of the mariner's account, the readers do. Similarly, Edgar Allan Poe's speaker posits questions to an un-welcomed guest, a raven, who visits him at night and gets infuriated at the consistent answer he receives from him: 'Nevermore'. The readers are aware that the speaker is suffering from a psychological disorder since he insists the raven would reply to his distorted inquiries. This paper reads the mariner's as well as the Raven's speaker's quandaries in association with trauma theory highlighting their traumatic experiences and underscoring the unreliability of their narration by diagnosing them as patients of post-traumatic stress disorder (PTSD). Reference will be made to the importance of the albatross and the raven as fundamental motifs that project the characters' psychological predicaments resulting in the implausible tales they both recount. | KEYWORDS
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Philosophy, Arts, Therapies: PATh! A path toward a human protective life through Philosophy, Arts and Therapies! An innovative, interdisciplinary and humanistic approach for a life with meaning and freedom. Every paper opens a new path for self-awareness, meaningful communication with significant others, solidarity and creativity as the healthiest approach to human growth. Philosophy as well as the arts contains the potential for humans to exceed the limits of physical existence and transcend self so that man rises above mundane needs to reach elevation. It is when emotional and spiritual transcendence occurs through the innate healing qualities of philosophy and arts that man can become a man. Moreover, the fathers of psychoanalysis, humanistic and existential psychotherapies, i.e. Sigmund Freud, Carl Jung, Jacques Lacan, to mention a few, supported their theories and practice through philosophical currents and some of them, i.e. Carl Jung, Rollo May etc., derived profound inspiration from the arts.
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El presente trabajo se ocupa de evaluar las propiedades psicométricas y la consistencia interna del International Trauma Questionnaire (ITQ) en Argentina. Participaron del estudio 861 adultos con edades comprendidas entre 18 y 74 años (M=40,8 DE=16.80) y de ambos sexos (Mujeres=70%, Hombres=30%). El modelo de dos factores de segundo orden, con seis factores de primer orden, presentó índices de ajuste aceptables (NNFI=.98; CFI=.99; RMSEA=.054). Los resultados indicaron una consistencia interna aceptable para el Trastorno de Estrés Postraumático (TEPT) (ω=.940) y el Trastorno de Estrés Postraumático (TEPTC) (ω=.898). La adaptación argentina del International Trauma Questionnaire (ITQ) presenta 12 ítems, similares a los propuestos por los autores originales.
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This report was prepared at the request of Dr. Dara Culhane Speck, Deputy Director of Social and Cultural Research for the Royal Commission on Aboriginal People. Our mandate was to review the scientific literature in order to identify emerging trends in research on mental health among Native peoples in Canada. In this report we do not directly address the issue of suicide as this was the topic of an earlier report for the Royal Commission prepared by our group. We do review some of the work on alcohol and substance abuse because, while these are the topic of other reports to the Commission, we feel they are closely related to mental health and we want to counter the fragmentation of research and care that seems to plague Native mental health. Published literature was searched by Medline, PsychINFO and SocLit. Unpublished research reports were solicited from research teams in Canada and the United States as noted in Appendix B. The literature was reviewed by an interdisciplinary team of clinicians and scholars from psychiatry, anthropology and sociology. It was assessed for scientific validity, assembled and integrated by the senior author. Where methodological flaws or limitations affected the data this is noted. In many areas, however, there is a paucity of research and we have had to rely on the consensus among Native peoples, researchers and scholars.
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Despite a great diagnostic overlap, complex posttraumatic stress disorder (CPTSD) has been recognised by the ICD-11 as a new, discrete entity and recent empirical evidence points towards a distinction from simple posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). The development and maintenance of these disorders is sustained by neurobiological alterations and studies using functional magnetic resonance imaging (fMRI) may further contribute to a clear differentiation of CPTSD, PTSD and BPD. However, there are no existing fMRI studies directly comparing CPTSD, PTSD and BPD. In addition to a summarization of diagnostic differences and similarities, the current review aims to provide a qualitative comparison of neuroimaging findings on affective, attentional and memory processing in CPTSD, PTSD and BPD. Our narrative review alludes to an imbalance in limbic-frontal brain networks, which may be partially trans-diagnostically linked to the degree of trauma symptoms and their expression. Thus, CPTSD, PTSD and BPD may underlie a continuum where similar brain regions are involved but the direction of activation may constitute its distinct symptom expression. The neuronal alterations across these disorders may conceivably be better understood along a symptom-based continuum underlying CPTSD, PTSD and BPD. Further research is needed to amend for the heterogeneity in experimental paradigms and sample criteria.
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Background Complex Posttraumatic Stress Disorder (CPTSD) has previously been associated with earlier trauma onset, repeated interpersonal traumatization, more dissociation and more comorbid psychopathology. However, it is still debated if the afore-mentioned risk factors are related to CPTSD diagnosis or rather indicative of a more severe form of post-traumatic distress. The aim of this study was to compare patients with a CPTSD diagnosis to those with PTSD in trauma characteristics (onset, chronicity, interpersonal nature), dissociation, and psychiatric comorbidities, while accounting for symptom severity. Methods In total, N = 81 patients with a trauma history (n = 43 with CPTSD; n = 37 with PTSD) underwent diagnostic interviews by trained clinicians and completed measures on CPTSD symptom severity, trauma characteristics, and dissociation (Screening for Complex PTSD; Dissociative Experience Scale Taxon). Results Patients with CPTSD reported earlier onset of trauma, more trauma perpetrated by acquaintances or family members, and more comorbidities than those with PTSD, also when accounting for symptom severity. No group differences in chronicity and dissociation were found. Severity of CPTSD was associated with more comorbid (affective) disorders and dissociation in both diagnostic groups. Conclusion Findings largely confirm earlier research, suggesting that CPTSD is associated with traumatic events that start earlier in life and are perpetrated by family members or acquaintances. Focusing on transdiagnostic symptoms, such as dissociation, may help to detain symptom deterioration. Further research is needed to replicate findings in larger samples and to elucidate possible working mechanisms, such as emotion dysregulation or negative self-image.
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