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Abstract

Traumatic life events (TLEs) have been associated with multiple psychiatric diagnoses, including anxiety disorders, major depression, PTSD, and psychosis. To advance our understanding of the complex interactions between forms of adversity as they manifest across the lifespan, psychosis, and symptom content, we undertook a mixed-methods investigation of TLEs and psychosis. Our research explored the association between cumulative exposures, type of TLE, and proximity to the traumatic event and psychosis; the association between TLEs and clinical symptomology including specific types of delusions and/or hallucinations; and how qualitative data further inform understanding of complex relationships and patterns of past trauma and symptoms as they unfold over time. There were a total of 97 participants in the quantitative study sample, 51 participants with present state psychosis and 46 non-clinical. There were a total of 34 qualitative study participants, all of whom were experiencing psychosis. The quantitative analysis showed that when comparing persons with psychosis to the non-clinical group, there were no group differences in the overall total score of TLEs. However, there was a significant difference in cumulative TLEs that " Happened, " demonstrating that as the number of TLEs increased, the likelihood of clinical psychosis also increased. We also found a correlation between lifetime cumulative TLEs that " Happened " and PANSS five-factor analysis: positive, excitement, depression, thought disorder, activation, and paranoia scores. The qualitative analysis further built on these finding by providing rich narratives regarding the timing of trauma-related onset, relationships between trauma and both trauma-related and religious–spiritual content, and trauma and hallucinatory modality. Analysis of participant narratives suggests the central role of localized cultural and sociopolitical influences on onset, phenomenology, and coping and contributes to a growing literature calling for strengths-based, client-driven approaches to working with distressing voices and beliefs that centers the exploration of the personal and social meaning of such experiences including links to life narratives. Findings also underscore the clinical importance of trauma assessment and trauma-informed care.

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... higher rates of involuntary hospitalization (20,21) and disability (22,23). Recent studies also suggest that both the form and the content of psychotic symptoms, including auditory hallucinations, can be shaped by adverse experiences as well as by culture and race-ethnicity, sometimes in ways that render these experiences more distressing (24)(25)(26)(27). ...
... Most participants described disadvantages, cultural differences, and their intersections as major drivers of disengagement and disparities in young people's ability to equally benefit from EIP services. Although some recent studies, as noted in the introduction, have identified these variables as key predictors of engagement and functional outcomes (24)(25)(26)(27), other studies and reviews have not or have not included variables directly relevant to these topics in primary data collection (47)(48)(49)(50)(51)(52)(53)(54)(55)(56). A 2012 systematic review of studies investigating predictors of relapse in first-episode psychosis, for example, identified only a small number of variables relevant to trauma, structural disadvantages, and cultural differences included in the extant research, and even these were present in only a few studies (57). ...
Article
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Objective: Little is known about provider perspectives on programmatic responses to structural disadvantage and cultural differences within early intervention in psychosis (EIP) services, programs, and models. The primary objective of this study was to investigate providers' perspectives on the impacts of disadvantage and minority race, ethnicity, and culture and to describe current practices and perceived gaps and concerns. Methods: An online survey of specialized EIP providers was disseminated in the United Kingdom, United States, Canada, Australia, and Chile. A total of 164 providers, representing 110 unique sites, completed the survey. Closed-ended questions gathered demographic and program data, including information on formal assessment of trauma or adversity, integration of trauma-informed care, integration of formal cultural assessment tools, training focused on culture, programmatic changes to address culture-related issues, and consultation with cultural insiders. Open-ended questions addressed the demographic mix of the program's client population; the perceived role and influence of trauma, structural disadvantage, and cultural differences; and concerns and needs related to these topics. Frequencies were examined for closed-ended items; open-ended responses were systematically coded. Results: Overall, survey findings suggested low levels of implementation of a variety of assessment and support practices related to cultural diversity in EIP programs. Coding of open-ended responses revealed numerous concerns regarding the impacts of disadvantage and cultural difference on clients and perceived gaps in policy and implementation. Conclusions: An expansion of research and service development aimed at better meeting the disadvantage- and culture-related needs of young people with early psychosis and their families should be a priority for the field.
... These findings also align with prior research. For example, our previous research showed that the content of voices and delusions were often associated with cumulative lifetime exposure to adverse experiences, including childhood adversity (Rosen et al., 2017;Chase et al., 2018). Consistent with our finding that childhood adversity had a direct effect on AHVs, several prior studies have identified evidence supporting a causal relationship between trauma and the manifestation of hallucinations, with some studies reporting a five-fold increase in verbal hallucinations associated with trauma (Freeman and Fowler, 2009;Read et al., 2003). ...
... Another limitation of this study is that the small sample size increased the likelihood of Type II errors, and better powered follow-up studies are needed. The predominately African-American sample of this study were situated in a segregated urban environment, layered with complex trauma, increased exposure to childhood adversity, and community/ structural adversity that may limit generalizability of findings (Rosen et al., 2017). Additionally, there are limitations by which conventional quantitative measures can capture the deep underlying phenomenological constructs of auditory verbal hallucinations and delusions, as they typically co-exist and at times can be indistinguishable (Jones and Luhrmann, 2016;Rosen et al., 2016b). ...
Article
Adverse childhood experiences are associated with later development of psychosis, particularly auditory verbal hallucinations and delusions. Although auditory hallucinations have been proposed to be misattributed inner speech, the relation between childhood adversity and inner speech has not been previously investigated. The first aim was to test whether childhood adversity is associated with inner speech in persons with psychosis. The second aim was to test for the influence of inner speech on the association between childhood adversity and auditory hallucinations. Our final aim was to test for evidence that would falsify the null hypothesis that inner speech does not impact the relationship between childhood adversity and delusions. In persons with psychosis, we found a positive association between childhood adversity and dialogic inner speech. There was a significant total effect of childhood adversity on auditory hallucinations, including an indirect effect of childhood adversity on auditory hallucinations via dialogic inner speech. There was also a significant total effect of childhood adversity on delusions, but no evidence of any indirect effect via inner speech. These findings suggest that childhood adversities are associated with inner speech and psychosis. The relation between childhood adversity and auditory hallucination severity could be partially influenced by dialogic inner speech.
... Plenty of research has documented how material and socio-economic conditions (e.g. poverty, discrimination, crime rates, etc.) significantly decrease an individual's mental and physical well-being (Rosen et al., 2017). Social science scholarship (primarily from North America) has documented how experiences of even subtle forms of discrimination cause nontrivial harm. ...
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A range of contemporary voices argue that negative affective states like distress and anxiety can be morally productive, broaden our epistemic horizons and, under certain conditions, even contribute to social progress. But the potential benefits of stress depend on an agent’s capacity to constructively interpret their affective states. An inability to do so may be detrimental to an agent’s wellbeing and mental health. The broader political, cultural, and socio-economic context shapes the kinds of stressors agents are exposed to, but it also delineates the hermeneutic equipment they have available to interpret their stress. To explain this specific problem of conceptual deprivation, philosophical theories on wellbeing and anxiety need to move beyond individualist perspectives.
... There are other critical voices that suggest that the increase in concern is allowing a therapeutic language and culture to be inserted inappropriately into schools (Ecclestone & Hayes, 2009). There are also educational researchers, however, who are just as concerned to ensure that mental illness shakes off the stigma that has long been attached to it (Allan, 2018), while others illuminate the ways in which mental health intersects with a range of human differences, not only in our schools but also across our communities, for example, disability (Keesler, 2014;Liddiard, 2017), ethnicity (Rosen et al., 2017), gender (Bryant-Davies et al., 2010;Ussher, 2011), sexual orientation (Burton et al., 2013) and young people in public care (Luke et al., 2014). ...
Article
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There are concerns globally about the emotional wellbeing and mental health of young people and in this paper a critical orientation comprises both theoretical and empirical data sources. The case is made that 1) the medical model of mental health - that of problem identification, diagnosis and medical treatment at the level of the individual - is not appropriate for the vast majority of children and young people in schools and 2) relational approaches would be more sensitive in responding to the complexity of the ‘conditions’ in the schools, homes and communities in which young people live. Articulations of these conditions are explored from the literature while we also draw on empirical data from part of an Evaluation of a school-based teacher-training programme in which interviewees and respondents too mapped out their own conditions for emotional wellbeing and mental health. We conclude with proposals for relational approaches which 1) acknowledge the links between affect, cognition and school climate and culture; 2) foreground mental health and poverty as impacting on young people’s emotional wellbeing in their communities, families and schools; 3) attend to voice – provide spaces in which young people can develop their own ‘preferred narratives’ concerning emotional wellbeing and mental health.
... The limitations of this study can be attributed to attrition overtime resulting in a reduction in the sample size of the 20 years which could increase the risk of committing a Type 1 error in the data analysis. Additionally, the follow-up assessments did not include an evaluation of trauma which is known to be associated with depersonalization, derealization and FRS (Moskowitz et al., 2008;Moskowitz et al., 2019;Rosen et al., 2017) Thus, we are not able to comment on the longitudinal effects of trauma and the associations to these symptoms. Lastly and along these lines, The Chicago Follow-up study was designed and initiated in the early 1970's, long before more detailed measures, such as the Cambridge Depersonalization Scale or the Dissociative Experiences Scale were available thus we are unable to expand our study into more specific nuances related to depersonalization and derealization outside the symptoms measured in the SADS. ...
Article
Background Depersonalization and derealization are currently considered diagnostically distinct from first-rank symptoms (FRS) seen in schizophrenia-spectrum psychoses. Nevertheless, the lived experiences of these symptoms can be very similar phenomenologically. Aims To investigate the interrelationships between depersonalization, derealization and FRS in individuals with different types of psychotic and non-psychotic diagnoses. Methods The Chicago Follow-up Study was a prospective longitudinal research program designed to study psychopathology and recovery in psychiatric disorders consisting of 555 participants, who were recruited at index hospitalization and studied over six follow-up timepoints at approximately 2, 4.5, 7.5, 10, 15, and 20 years later. The primary clinical indices were depersonalization, derealization and Schneiderian FRS that were measured at index hospitalization and at each subsequent follow-up. Results 62.8% of participants had at least four follow-ups. There were significant differences in the course and chronicity of depersonalization, derealization and first-rank symptoms across the three diagnostic groups. For the whole sample, derealization was significantly associated with FRS at 2-, 4.5- and 7.5-year follow-up timepoints whereas depersonalization was related to FRS from 10-year follow-up to 20-year follow-up. In participants with schizophrenia, overall depersonalization was more often associated with passivity phenomena whereas derealization was more often associated with overall delusions. There was also a significant effect of time on the associations between depersonalization, derealization and FRS across follow-ups. Conclusions Depersonalization and derealization should be viewed as transdiagnostic phenomena that are associated with FRS psychopathology along a continuum, although they are more closely associated with schizophrenia-spectrum psychoses.
... The relationship between R/S and psychosis has been discussed for a long time; many studies (old and recent) show that religious delusions are common in psychotic patients (voices with demonic forces, messages from God or the devil) (Rose et al. 2017). ...
Chapter
This chapter reviews the main and most robust scientific evidence on the relationship between Religiousness/Spirituality (R/S) and mental health. We discuss the proposed mechanisms involved in this relationship, such as purpose and meaning in life, optimism, gratitude, social support, self-esteem, cognitive framework (involving, for example, a sense of coherence), healthier lifestyle, etc. In general, individuals who have higher levels of religious and spiritual involvement have lower rates of depression, suicidal behaviour, and alcohol and drug use and abuse. Although less consistent, there are studies indicating R/S as useful for coping with anxiety and psychotic symptoms.
... Traumatic events are the prototype of eminently interpersonal, environmental factors that could significantly destabilize and alter subjective experience at various levels. 106 A history of neglect significantly increases the likelihood of developing schizophrenia (and other forms of clinical symptomology) 107,108 ; traumatic and other adverse events are also associated with the development of hallucinations in both clinical and nonclinical samples, and across a range of diagnoses. 109 It has been proposed that several psychological processes may be involved in the development of psychotic symptoms among trauma survivors, including patterns of emotion regulation developed to cope with trauma, unique qualities associated with memories of traumatic events (including encoding, retrieval, and processing), and changes to personal semantic memory. ...
Article
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Recent psychiatric research and treatment initiatives have tended to move away from traditional diagnostic categories and have focused instead on transdiagnostic phenomena, such as hallucinations. However, this emphasis on isolated experiences may artificially limit the definition of such phenomena and ignore the rich, complex, and dynamic changes occurring simultaneously in other domains of experience. This article reviews the literature on a range of experien-tial features associated with psychosis, with a focus on their relevance for hallucinations. Phenomenological research on changes in cognition, perception, selfhood and reality, temporality, interpersonal experience, and embodiment are discussed, along with their implications for traditional conceptualizations of hallucinations. We then discuss several phenomenological and neurocognitive theories, as well as the potential impact of trauma on these phenomena. Hallucinations are suggested to be an equifinal outcome of multiple genetic, neurocognitive, subjective, and social processes; by grouping them together under a single, opera-tionalizable definition, meaningful differences in etiology and phenomenology may be ignored. It is suggested that future research efforts strive to incorporate a broader range of experiential alterations, potentially expanding on traditional definitions of hallucinations. Relevance for clinical practice, including emphasizing phenomenologically responsive techniques and developing targeted new therapies , is discussed.
... In a recent meta-analysis Bailey et al. (2018) reported that occurrence of childhood trauma and sexual abuse are associated with the severity of positive symptoms. In keeping with previous research, our findings show that the prevalence and severity of adverse/traumatic childhood events in the total sample are associated with increased clinical symptoms of psychosis (Bebbington et al., 2004;Janssen et al., 2004;Rosen et al., 2017;Spauwen et al., 2006). ...
Article
Abstract Early childhood trauma, defined as physical or sexual abuse, neglect, emotional abuse, harm or threat of harm, has long been associated with adulthood dysregulation of the immune system. Trauma can induce chronic immune system activation and hyper-reactivity demonstrating elevated cytokine concentrations with increased psychotic symptom severity. Two of the primary intracellular signaling systems mediating immunity are the NF-κB and JAK-STAT1 pathways. This study tested the hypotheses that levels of adverse childhood experiences (ACEs) would be associated with levels of peripheral immune activity assessed by IL6, IFNG, CXCL10, IRF1, STAT1 and TLR4 mRNA expression, and that there would be an association between ACEs and psychosis along a continuum from non-clinical controls (NCC) to psychotic disorders such as schizophrenia. These hypotheses were tested in 40 participants (20schizophrenia, 20 NCC). We found evidence of associations between ACEs scores and immune markers in the overall sample. Additionally, the association between total ACEs score and peripheral IL6 mRNA levels were found in participants regardless of clinical status. We also found that in the total combined sample there was a positive association between ACEs and positive symptoms. Therefore, childhood trauma, through its effects on IL6 levels, may be a risk factor for schizophrenia in general.
... These social contexts foster distrust and erode resilience at multiple levels, affecting all members both directly and indirectly, thus echoing and reinforcing individual patterns of distress (e.g. Rosen et al., 2017). Characteristic patterns of 'symptoms' of collective trauma may be experienced at the level of the social-cultural environment (the people), the physical/ built environment (the place) and the economic environment (the availability of resources and opportunities). ...
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This article summarizes the results of a recently published project to develop a conceptual system incorporating social, psychological, and biological factors as an alternative to functional psychiatric diagnosis. The principles underlying the Power Threat Meaning Framework are briefly described, together with its major features and differences from diagnostic approaches. These include the assumptions that what may be called psychiatric symptoms are understandable responses to often very adverse environments and that these responses, both evolved and socially influenced, serve protective functions and demonstrate human capacity for meaning making and agency. We describe how the elements of the Power Threat Meaning Framework interact to restore links between environmental threats and threat responses, and to enable us to outline some probabilistic Provisional General Patterns, grouped by personal, social, and cultural meaning, describing what people do, not the “disorders” they “have.” We conclude by outlining some implications of the Framework for narrative construction and for thinking about distress across cultures.
... Research that explicitly attends to these aspects of experience is nevertheless important given how little such research has been published over the past 20 years -at least outside psychoanalytic circles -underscoring the potential value of the field engaging with such phenomena from a variety of academic and clinical perspectives. Although not focused on sex/sexuality more specifically, our work uniquely contributes to a growing body of literature concerning cultural or cross-cultural influences on the phenomenology of psychotic experiences (Luhrmann, Padmavati, Tharoor, & Osei, 2015;Powers, Kelley, & Corlett, 2016;Rosen et al., 2017) as well as the individual, agentive process of negotiating such meanings (e.g. de Jager et al., 2016;Woods, 2017). At a minimum, additional research focused on the role that subjective connections between psychotic experiences/content and salient cultural thematics (such as gender or sexual identity) play in recovery (and recovery-oriented services) seems warranted and would align with the principles of "person centered" and "meaning centered" services (Corstens, Longden, McCarthy-Jones, Waddingham, & Thomas, 2014;Corstens & Longden, 2013;Hayward, Berry, McCarthy-Jones, Strauss, & Thomas, 2014). ...
Article
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Purpose: Over the past twenty years, few empirical studies have focused on manifestations of sex, sexual identity, and gender within the phenomenology of psychosis. The goal of the present analysis was to explore themes related to gender and sexuality among individuals diagnosed with a psychotic disorder. Methods: We conducted a qualitative analysis of 25 in-depth phenomenological interviews and a secondary analysis of two focus groups with an additional 24 participants (total N = 49), all of whom reported past or current treatment for a psychotic disorder. Results: Nearly three-quarters of interview participants and one quarter of focus group participants reported some kind of sex or gender-related content. Participants’ experiences were grouped under the following four themes: “shame and persecution,” “sexual or sexualized violence,” “power, agency, sexuality & gender,” and “positive experiences of the erotic.” Some participants described sexual experiences or content as a primary facet of their experiences, while for others it occupied a more secondary place. Many participants reported some degree of shame associated with sexual aspects of their experience. Conclusions: We emphasize the clinical importance of validating and engaging with sex/sexual themes, and call for future research focused on implications vis-a-vis engagement, treatment, and social recovery.
... Corstens and Longden (2013) found that 94% of voice-hearers (the majority of whom had been diagnosed with schizophrenia) had voices whose content could be related to earlier emotionally overwhelming events. A number of other studies have also reported associations between the nature of stressors/traumas preceding AVH and the content of the ensuing AVH (Hardy et al., 2005;Thompson and Waltz, 2010;Raune et al., 2006;Rosen et al., 2017). ...
Article
A key predictor of whether or not an individual who hears voices (auditory verbal hallucinations; AVH) meets criteria for a psychiatric diagnosis is the level of negative content of the voices (e.g., threats, criticism, abuse).Yet the factors that contribute to negative voice-content are still not well understood. This study aimed to test the hypotheses that levels of childhood adversity would predict levels of negative voice-content, and that negative voice-content would partially mediate a relation between childhood adversity and voice-related distress.These hypotheses were tested in a clinical sample of 61 patients with formally diagnosed psychotic disorders(48 schizophrenia, 13 bipolar). We found evidence consistent with negative voice-content fully (not partially)mediating the relation between childhood adversity and voice-related distress. Although bivariate analyses found depression to be associated with both negative voice-content and voice-related distress, we found no evidence of an indirect effect of childhood adversity on either negative voice-content or voice-related distress via depression. Alternative study designs are now needed to test if our findings are replicable and causal. Should they be, it will be necessary for psychological therapies to devise ways to reduce negative voice-content itself,rather than just changing beliefs about voices. A number of techniques are discussed (Avatar Therapy, Compassion Focused Therapy, Voice-Dialogue) that already show promise for this.
Thesis
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Über das Medium Computerspiel findet zunehmend eine Auseinandersetzung mit psychologischen Traumata statt. Posttraumatische Belastungsstörung, Krankheit und Tod sowie Depressionen und Phobien sind hierbei vorherrschende Themen und Motive. Thomas Spies zeigt in einem historischen Überblick und in vergleichenden Analysen Tendenzen der kulturellen Repräsentation auf. Die Beschäftigung mit Titeln wie »Papers, Please«, »Hellblade: Senua's Sacrifice« und »Disco Elysium« lässt deutlich werden, wie Computerspiele zunehmend medienspezifische Möglichkeiten finden, die Vielfalt und Komplexität traumatischer Erfahrungen zu vermitteln.
Article
Psychotic disorders (e.g., schizophrenia, schizoaffective disorder) are a leading cause of morbidity and premature mortality and an overlooked health inequity in the United States. European data indicate inequities in incidence, severity, and treatment of psychotic disorders, particularly for Black communities, that appear to be primarily attributable to social adversities. The dominant US narrative is that any observed differences are primarily a result of clinician bias and misdiagnosis. We propose that employing the framework of structural racism will prompt European and US research to converge and consider the multifaceted drivers of inequities in psychotic disorders among Black Americans. In particular, we describe how historical and contemporary practices of (1) racialized policing and incarceration, and (2) economic exploitation and disinvestment, which are already linked to other psychiatric disorders, likely contribute to risks and experiences of psychotic disorders among Black Americans. This framework can inform new strategies to (1) document the role of racism in the incidence, severity, and treatment of psychotic disorders; and (2) dismantle how racism operates in the United States, including defunding the police, abolishing carceral systems, and redirecting funds to invest in neighborhoods, housing, and community-based crisis response and mental health care. (Am J Public Health. 2022;112(4):624-632. https://doi.org/10.2105/AJPH.2021.306631).
Chapter
This chapter outlines how positive psychological practices can enhance cultural competence in a clinical context. Specifically, the chapter aims to highlight how positive psychological assessments and interventions help clients offset the effects of discrimination in building a culturally informed sense of resilience and well-being. Few traditional forms of treatment offer guidelines to help clinicians acknowledge and address discrimination experiences in a manner honoring a client’s worldview, incorporating a client’s healing traditions, and restoring a client’s sense of cultural dignity. If left unaddressed or inadequately addressed, discrimination experiences may serve as a significant barrier to the therapeutic process. Given the importance of strength-building as a mechanism to encourage and maintain cultural competence, this chapter will offer a set of guidelines, informed by empirically supported positive psychological practices, to appropriately acknowledge and address discrimination experiences in treatment. Initially, we focus on defining multicultural competence with special attention to efforts aimed at reducing the effects of discrimination within a sociocultural framework. Next, we consider different positive psychological practices and how they promote strength and resilience in the face of cultural stressors. In particular, we will focus on positive psychological assessments and how they can be used early in the treatment process to set a foundation for culturally informed strength. We will supplement this discussion by highlighting how narrative and storytelling interventions empower clients to capitalize on their strengths to face cultural stress. Finally, the chapter concludes with a call to action; we encourage mental health professionals to approach challenging discrimination experiences with a mind toward sensitive, holistic, and transformative practices. Overall, the chapter offers a strength-based process whereby clinicians can demonstrate greater multicultural competence in working with the unique identities, needs, and values of their clients.
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Background: Hallucinations are a core diagnostic criterion for psychotic disorders and have been investigated with regard to its association with childhood trauma in first-episode psychosis samples. Research has largely focused on auditory hallucinations, while specific investigations of visual hallucinations in first-episode psychosis remain scarce. Objectives: The aims of this study were to describe the prevalence of visual hallucinations, and to explore the association between visual hallucination and childhood trauma in a first-episode psychosis sample. Methods: Subjects were included from TIPS-2, a first episode psychosis study in south Rogaland, Norway. Based on the medical journal descriptions of the Positive and Negative Symptoms Scale (PANSS), a separate score for visual and auditory hallucinations was created (N = 204). Patients were grouped according to hallucination severity (none, mild, and psychotic hallucinations) and multinomial logistic regression was performed to identify factors associated with visual hallucination group. Results: Visual hallucinations of a psychotic nature were reported by 26.5% of patients. The experience of childhood interpersonal trauma increased the likelihood of having psychotic visual hallucinations. Conclusion: Visual hallucinations are common in first-episode psychosis, and are related to childhood interpersonal trauma.
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Despite increasing evidence for the role of psychosocial factors in the onset and continuance of psychosis, the experiences involved are still largely considered the result of a biogenetic anomaly for which medication is the first-line treatment response. This review summarizes the extensive literature demonstrating that adverse events involving trauma, loss, stress, and disempowerment have a central etiological role in psychosis. Evidence is further presented to show that many neurological changes traditionally considered indicative of a disease process can in fact be accounted for as secondary effects to the physiology of stress or the residual of long-term neuroleptic prescription. Particular emphasis is given to the traumagenic neurodevelopmental model of psychosis, which illustrates how many of the structural and functional cerebral anomalies observed in adult patients with psychosis (including dopamine dysregulation, atrophy, hippocampal damage, and overactivity of the hypothalamic-adrenal-pituitary axis) closely correspond to those in the brains of abused children. Finally, research is discussed that demonstrates how trauma may manifest in characteristic symptoms of psychosis, particularly hallucinations and delusions. It is suggested that if social adversities are of central importance in psychosis, then psychotherapy that addresses the long term sequelae of those adversities should be considered an essential aspect of treatment.
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Racism is a multidimensional construct that impacts risk for psychosis through various complex pathways. Previous research has yet to fully explore how major racial discriminatory events contribute to risk for psychotic experiences in the general population. We examined the National Survey of American Life to analyze the effects of 9 major racial discriminatory events on lifetime psychotic experiences among Black Americans. By examining each event separately, we found that police discrimination was associated with increased risk for lifetime psychotic experiences after adjusting for demographic variables, socioeconomic status, and co-occurring psychological or social problems. Being denied a promotion, being a victim of police abuse, and being discouraged from pursuing education were associated with lifetime visual hallucinations, and being discouraged from pursuing education was also associated with lifetime delusional ideation. None of the events were associated with lifetime auditory hallucinations. As a count of events, experiencing a greater range of major racial discriminatory events was associated with higher risk, particularly for lifetime visual hallucinations. Our findings point to the need for early detection and intervention efforts in community settings and multilevel efforts to eliminate racial discrimination. (PsycINFO Database Record
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Background: Delusions are usually considered core symptoms of schizophrenia, but they are in fact associated with a wide range of psychiatric disorders. The content of a delusion is often related to stressful life experiences that preceded the delusion. Objective: The aim of this study is to detect whether there is a link—specifically, a thematic link—between past experiences and delusion content that connects the two events via thematic analogy. Method: The sample population evaluated for this study consisted of 16 consecutive patients with delusions between the ages of 9.9 and 16.5 years. All patients were experiencing their first psychotic episodes and were not taking any medications. Data were obtained from transcribed clinical sessions. Results: The data suggested the presence of a thematic link between previous experiences and the contents of delusions for 15 patients (93%). Humiliating events, including bullying, are more likely to be linked to persecutory delusions (p = .004). Conclusions: If a thematic link between past experiences and delusion content does exist, this may provide a means of greater psychotherapeutic understanding.
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Objective: Auditory verbal hallucinations (AVHs) are core features of psychotic illness and remain significant in predicting poor outcome and risk. There has been a wide range of approaches to understanding these experiences. Method: A systematic literature review summarizing different methods of investigation and their results; phenomenology, descriptive psychopathology, psychological, cognitive neurobiology, and neuroimaging. Results: A number of 764 papers and texts were screened and 113 reviewed. Phenomenological studies are comparably few in number, and psychopathology remains based on concepts defined in the early 20th century. Psychological models focus on voice content and emotional reaction, and suggest a continuum of AVHs from normal experience. Neuropsychological models include AVHs as misattribution of inner speech, whilst functional neuroimaging studies focus on the spontaneous activity and connectivity of auditory networks. Conclusion: There has been a large growth in research on AVHs in recent decades dominated by neurobiological and neuroimaging studies. Future research should include focus on phenomenological aspects and AVHs change over the course of developing illness. Integration between branches of enquiry is needed, and the risk is that without this, models are proposed and investigated that bear scant relevance to the symptom itself.
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There is a growing literature on what contemporary cultural theorists have broadly termed the ‘postsecular’: the abandonment of clear cut boundaries between the secular and non-secular in the industrialized West and an embrace of a complex understanding of what is real that neither accepts nor rejects the supernatural. We think that these new cultural currents affect not only philosophers and theologians, but also the ways in which individuals with psychosis make sense of their experiences. This paper reports on the key findings of an in-depth qualitative analysis of 19 interviews of individuals diagnosed with psychotic disorders. As we report in our analyses, the majority of participants described on going and self-conscious struggles to demarcate their experiences as the products of the real world or a ‘crazy’ mind. With equal frequency, participants weighed and debated competing secular and supernatural explanations, often juxtaposing and blending ostensibly different explanatory frameworks. We found that this syncretic process affected not only the content of psychotic experiences—what delusions or hallucinations are about--but also the type of arguments or logics used to justify particular interpretations. We discuss the implications of these observations with respect to clinical practice and the broader phenomenology of psychosis, challenging often over-simplified discourse on “insight” and suggesting that polarization(s) between the “biomedical” and “psychosocial” may be of less relevance to patients’ real world experiences than is often assumed.
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Auditory verbal hallucinations (AVH: 'hearing voices') are found in both schizophrenia and post-traumatic stress disorder (PTSD). In this paper we first demonstrate that AVH in these two diagnoses share a qualitatively similar phenomenology. We then show that the presence of AVH in schizophrenia is often associated with earlier exposure to traumatic/emotionally overwhelming events, as it is by definition in PTSD. We next argue that the content of AVH relates to earlier traumatic events in a similar way in both PTSD and schizophrenia, most commonly having direct or indirect thematic links to emotionally overwhelming events, rather than being direct re-experiencing. We then propose, following cognitive models of PTSD, that the reconstructive nature of memory may be able to account for the nature of these associations between trauma and AVH content, as may threat-hypervigilance and the individual's personal goals. We conclude that a notable subset of people diagnosed with schizophrenia with AVH are having phenomenologically and aetiologically identical experiences to PTSD patients who hear voices. As such we propose that the iron curtain between AVH in PTSD (often termed 'dissociative AVH') and AVH in schizophrenia (so-called 'psychotic AVH') needs to be torn down, as these are often the same experience. One implication of this is that these trauma-related AVH require a common trans-diagnostic treatment strategy. Whilst antipsychotics are already increasingly being used to treat AVH in PTSD, we argue for the centrality of trauma-based interventions for trauma-based AVH in both PTSD and in people diagnosed with schizophrenia.
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This study examines relationships between childhood adversity and the presence of characteristic symptoms of schizophrenia. It was hypothesised that total adversity exposures would be significantly higher in individuals exhibiting these symptoms relative to patients without. Recent proposals that differential associations exist between specific psychotic symptoms and specific adversities was also tested, namely: sexual abuse and hallucinations, physical abuse and delusions, and fostering/adoption and delusions. Data were collected through auditing 251 randomly selected medical records, drawn from adult patients in New Zealand community mental health centres. Information was extracted on presence and subtype of psychotic symptoms and exposure to ten types of childhood adversity, including five types of abuse and neglect. Adversity exposure was significantly higher in patients experiencing hallucinations in general, voice hearing, command hallucinations, visions, delusions in general, paranoid delusions and negative symptoms than in patients without these symptoms. There was no difference in adversity exposure in patients with and without tactile/olfactory hallucinations, grandiose delusions or thought disorder. Indication of a dose-response relationship was detected, in that total number of adversities significantly predicted total number of psychotic symptoms. Although fostering/adoption was associated with paranoid delusions, the hypothesised specificity between sexual abuse and hallucinations, and physical abuse and delusions, was not found. The two adversities showing the largest number of associations with psychotic symptoms were poverty and being fostered/adopted. The current data are consistent with a model of global and cumulative adversity, in which multiple exposures may intensify psychosis risk beyond the impact of single events. Implications for clinical intervention are discussed.
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Urban upbringing and childhood trauma are both associated with psychotic disorders. However, the association between childhood urbanicity and childhood trauma in psychosis is poorly understood. The urban environment could occasion a background of social adversity against which any effect of childhood trauma increases. Also, any impact of the urban environment on likelihood of exposure to childhood trauma could be stronger in children who later develop psychotic disorder. The aim of this study was twofold: (1) to investigate whether childhood urbanicity moderates the effect of childhood trauma, in a model predicting psychotic disorder; (2) to investigate whether there is an association between the urban environment and childhood trauma and whether this is moderated by genetic liability for psychotic disorder. Patients with a diagnosis of non-affective psychotic disorder (n = 1119) and 589 healthy controls from the Netherlands and Belgium were studied. Childhood trauma was assessed with the Dutch version of the Childhood Trauma Questionnaire Short Form. Urban exposure was defined at four levels, considering the population density, using data from Statistics Netherlands and the equivalent database in Belgium. There was a significant interaction between childhood urbanicity on the one hand and childhood trauma on the other, indicating that trauma was significantly associated with psychotic disorder, with increasing odds ratios for higher levels of childhood urbanicity. In addition, there was weak evidence that childhood urbanicity was associated with childhood trauma in the patient group: higher levels of childhood urbanicity were associated with higher trauma scores. The urban environment may moderate the risk-increasing effect of childhood trauma for psychotic disorder and childhood urbanicity may be a risk factor for childhood trauma in individuals who later develop psychotic disorder.
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The association between stressful childhood experiences (SCE) and psychotic symptoms is still not clearly understood and different causal pathways have been proposed. General estimating equation modeling was used to test the dose-response relationship between SCE and delusions and hallucinations, at baseline and follow-up periods, and the possible confounding effects of dissociation on this relationship. The prevalence of SCE in individuals with psychotic disorders is high with more co-occurring SCE categories being positively associated with more types of delusions and hallucinations. Each additional SCE is associated with 1.20 increase in the incidence rate ratio (IRR) (C.I. 1.09 -1.32) for hallucinations and a 1.19 (C.I. 1.09-1.29) increase for delusions supporting a dose response association. After controlling for the mediating effects of dissociative symptoms at follow up, SCE remain independently associated with delusions. We propose that cumulative SCE can result in complex trauma reactions that present with a broad range of symptomatology including dissociative, PTSD and psychotic symptoms.
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Objective: This study examined the point prevalence of neurodevelopmental disorders among predominantly low-income, African-American psychiatric patients at Jackson Park Hospital's Family Medicine Clinic on Chicago's South Side. Methods: Using active case ascertainment methodology, the authors assessed the records of 611 psychiatric patients visiting the clinic between May 23, 2013, and January 14, 2014, to identify those with DSM-5 neurodevelopmental disorders. Results: A total of 297 patients (49%) met criteria for a neurodevelopmental disorder during childhood. Moreover, 237 (39%) had clinical profiles consistent with neurobehavioral disorder associated with prenatal alcohol exposure, and 53 (9%) had other neurodevelopmental disorders. The authors disagreed on the specific type of neurodevelopmental disorder of seven (1% of 611) of the 297 patients with neurodevelopmental disorders. Conclusions: A high prevalence of neurodevelopmental disorders was found among low-income predominantly African-American psychiatric patients on Chicago's South Side. If replicated, these findings should bring about substantial changes in medical practice with African-American patients.
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Abstract The present study sought to determine whether dissociative experiences mediated the relationship between traumatic life events and attenuated positive psychotic symptoms in a non-treatment-seeking sample of racial and ethnic minority young adults. Participants (n=549) completed a self-report inventory for psychosis risk (i.e., prodromal questionnaire (PQ; Loewy, Bearden, Johnson, Raine, & Cannon, 2005), from which a total number of attenuated positive psychotic symptoms was assessed. Participants also completed a checklist of potentially traumatic life events and a traumatic dissociation scale. Hierarchical linear regression models and bootstrapping results indicated dissociation mediated the relationship between traumatic life events and attenuated positive psychotic symptoms. Stratified analyses in Black, Asian, and Hispanic subgroups revealed that full mediation was only evident in the Black subgroup of young adults. Partial mediation was found among the Hispanic group and no mediation occurred in the Asian subgroup. For the latter, traumatic life events was not significantly associated with dissociative experiences. A dissociative response style may be particularly relevant to trauma-exposed Black young adults exhibiting subclinical psychotic experiences and less so for Asian young adults. Trauma-induced dissociative experiences should be assessed further in clinical high risk studies, especially among Black traumatized youth.
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The negative implications of living in a socially unequal society are now well documented. However, there is poor understanding of the pathways from specific environmental risk to symptoms. Here we examine the associations between social deprivation, depression, and psychotic symptoms using the 2007 Adult Psychiatric Morbidity Survey, a cross-sectional dataset including 7,353 individuals. In addition we looked at the mediating role of stress, discrimination, trust and lack of social support. We found that the participants' neighbourhood index of multiple deprivation (IMD) significantly predicted psychosis and depression. On inspection of specific psychotic symptoms, IMD predicted paranoia, but not hallucinations or hypomania. Stress and trust partially mediated the relationship between IMD and paranoid ideation. Stress, trust and a lack of social support fully mediated the relationship between IMD and depression. Future research should focus on the role deprivation and social inequalities plays in specific manifestations of psychopathology and investigate mechanisms to explain those associations that occur. Targeting the mediating mechanisms through appropriate psychological intervention may go some way to dampen the negative consequences of living in an unjust society; ameliorating economic injustice may improve population mental health.
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Traumatic experiences have been positively associated with both severity of attenuated psychotic symptoms in individuals at high risk (HR) for psychosis and transitions into psychotic disorders. Our aim was to determine what characteristics of the trauma history are more likely to be associated with individuals at HR. The Trauma History Screen was used to enable emphasis on number and perceived intensity of adverse life events and age at trauma exposure. Sixty help-seeking individuals who met HR criteria were compared to a random sample of 60 healthy volunteers. Both groups were aged 16–35 and resided in the same geographical location. HR participants experienced their first trauma at an earlier age, continued to experience trauma at younger developmental stages, especially during early/mid adolescence and were exposed to a high number of traumas. They were more depressed and anxious, but did not experience more distress in relation to trauma. Both incidences of trauma and age at which trauma occurred were the most likely predictors of becoming HR. This work emphasises the importance of assessing trauma characteristics in HR individuals to enable differentiation between psychotic-like experiences that may reflect dissociative responses to trauma and genuine prodromal psychotic presentations.
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Purpose Although there is considerable evidence that adversities in childhood such as social deprivation, sexual abuse, separation from parents, neglect and exposure to deviant parental communication are associated with psychosis in later life, most studies have considered broad diagnoses as outcomes. In this review we consider evidence for pathways between specific types of adversity and specific symptoms of psychosis. Methods We present theoretical arguments for expecting some degree of specificity (although by no means perfect specificity) between different kinds of adversity and different symptoms of psychosis. We review studies that have investigated social–environmental risk factors for thought disorder, auditory–verbal hallucinations and paranoid delusions, and consider how these risk factors may impact on specific psychological and biological mechanisms. Results Communication deviance in parents has been implicated in the development of thought disorder in offspring, childhood sexual abuse has been particularly implicated in auditory–verbal hallucinations, and attachment-disrupting events (e.g. neglect, being brought up in an institution) may have particular potency for the development of paranoid symptoms. Current research on psychological mechanisms underlying these symptoms suggests a number of symptom-specific mechanisms that may explain these associations. Conclusions Few studies have considered symptoms, underlying mechanisms and different kinds of adversity at the same time. Future research along these lines will have the potential to elucidate the mechanisms that lead to severe mental illness, and may have considerable clinical implications.
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Background Ethnic minority status and childhood trauma are established risk factors for psychotic disorders. Both are found to be associated with increased level of positive symptoms, in particular auditory hallucinations. Our main aim was to investigate the experience and effect of childhood trauma among patients with psychosis from ethnic minorities, hypothesizing that they would report more childhood trauma than the majority and that this would be associated with more current and lifetime hallucinations. Methods In this cross-sectional study we included 454 patients with a SCID-I DSM-IV diagnosis of non-affective or affective psychotic disorder. Current hallucinations were measured with the Positive and Negative Syndrome Scale (P3; Hallucinatory Behavior). Lifetime hallucinations were assessed with the SCID-I items auditory hallucinations, voices commenting and two or more voices conversing. Childhood trauma was assessed with the Childhood Trauma Questionnaire, self-report version. Results Patients from ethnic minority groups (n = 69) reported significantly more childhood trauma, specifically physical abuse/neglect, and sexual abuse. They had significantly more current hallucinatory behavior and lifetime symptoms of hearing two or more voices conversing. Regression analyses revealed that the presence of childhood trauma mediated the association between ethnic minorities and hallucinations. Conclusions More childhood trauma among ethnic minorities with psychosis may partially explain findings of more positive symptoms, especially hallucinations, in this group. The association between childhood trauma and these first rank symptoms may in part explain this group’s higher risk of being diagnosed with a schizophrenia-spectrum diagnosis. The findings show the importance of childhood trauma in symptom development in psychosis.
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Background: Different psychological models of trauma-induced psychosis have been postulated, often based on the observation of "specific" associations between particular types of childhood trauma (CT) and particular psychotic symptoms or the co-occurrence of delusions and hallucinations. However, the actual specificity of these associations remains to be tested. Methods: In 2 population-based studies with comparable methodology (Netherlands Mental Health Survey and Incidence Study-1 [NEMESIS-1] and NEMESIS-2, N = 13 722), trained interviewers assessed CT, psychotic symptoms, and other psychopathology. Specificity of associations was assessed with mixed-effects regression models with multiple outcomes, a statistical method suitable to examine specificity of associations in case of multiple correlated outcomes. Results: Associations with CT were strong and significant across the entire range of psychotic symptoms, without evidence for specificity in the relationship between particular trauma variables and particular psychotic experiences (PEs). Abuse and neglect were both associated with PEs (OR abuse: 2.12, P < .001; OR neglect: 1.96, P < .001), with no large or significant difference in effect size. Intention-to-harm experiences showed stronger associations with psychosis than CT without intent (χ(2) = 58.62, P < .001). Most trauma variables increased the likelihood of co-occurrence of delusions and hallucinations rather than either symptom in isolation. Discussion: Intention to harm is the key component linking childhood traumatic experiences to psychosis, most likely characterized by co-occurrence of hallucinations and delusions, indicating buildup of psychotic intensification, rather than specific psychotic symptoms in isolation. No evidence was found to support psychological theories regarding specific associations between particular types of CT and particular psychotic symptoms.
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A data synthesis is presented from 100 clinical cases, 80% with a diagnosis of schizophrenia or other psychotic disorder, in which Romme and Escher’s “con- struct” method was used to formulate voice-hearing content and characteristics in relation to life events. Across the sample, most participants heard between two and five voices and the average duration of voice hearing was 18 years. At least one adverse childhood experience was reported by 89% of the sample, including family conflict, neglect, physical/sexual/emotional maltreatment, and bullying. In addition, a broad range of acute, precipitating stressors were associ- ated with the onset of voice hearing itself in both childhood and adulthood. In 94% of cases, it was possible to clearly formulate the underlying emotional con- flicts embodied by the voices (e.g., low self-worth, anger, shame and guilt). Representations for voice identity (e.g., disowned aspects of self, a family mem- ber, a past abuser) were formulated in 78% of cases. It is proposed that many individuals hear voices that make psychological sense in the context of life events, and that this information can be clinically applied in ways that serve personal recovery.
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General Purpose: Twenty principal component analyses of the PANSS revealed that a five-factor solution representing positive, negative, disorganization, depression/anxiety and excitability/hostility symptoms better explained the scale structure than the original three-subscale solution. Our goal was to identify to which of these five factors each of the PANSS items could be attributed based on the consistency of published factor analyses. Methodology: For each study reporting a five-factor solution, the items were assigned to any of the five factors according to the factor on which it had the strongest factor loading. Items were then rated as reaching or not our between-study stability criteria of 70% of agreement. Results: Ten items did not meet our stability criteria: Grandiosity, Stereotyped thinking, Somatic concern, Tension, Mannerism/posturing, Disorientation, Lack of judgment/insight, Disturbance of volition, Preoccupation, and Active social avoidance. Conclusions: A broad and a narrow definition of the new PANSS structure are presented according to the stability level of every item.
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Introduction: Recent models of psychosis implicate stressful events in its etiology. However, while evidence has accumulated for childhood trauma, the role of adult life events has received less attention. Therefore, a review of the existing literature on the relationship between life events and onset of psychotic disorder/experiences is timely. Methods: A search was conducted using PsychInfo, Medline, Embase, and Web of Science to identify studies of life events and the onset of psychosis or psychotic experiences within the general population. Given previous methodological concerns, this review included a novel quality assessment tool and focused on findings from the most robust studies. A meta-analysis was performed on a subgroup of 13 studies. Results: Sixteen studies published between 1968 and 2012 were included. Of these, 14 reported positive associations between exposure to adult life events and subsequent onset of psychotic disorder/experiences. The meta-analysis yielded an overall weighted OR of 3.19 (95% CI 2.15-4.75). However, many studies were limited by small sample sizes and the use of checklist measures of life events, with no consideration of contextual influences on the meaning and interpretation of events. Conclusions: Few studies have assessed the role of adult life events in the onset of psychosis. There was some evidence that reported exposure to adult life events was associated with increased risk of psychotic disorder and subclinical psychotic experiences. However, the methodological quality of the majority of studies was low, which urges caution in interpreting the results and points toward a need for more methodologically robust studies.
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Background: There is evidence that a range of socio-environmental exposures is associated with an increased risk of psychosis. However, despite the fact that such factors probably combine in complex ways to increase risk, the majority of studies have tended to consider each exposure separately. In light of this, we sought to extend previous analyses of data from the AESOP (Aetiology and Ethnicity in Schizophrenia and Other Psychoses) study on childhood and adult markers of disadvantage to examine how they combine to increase risk of psychosis, testing both mediation (path) models and synergistic effects. Method: All patients with a first episode of psychosis who made contact with psychiatric services in defined catchment areas in London and Nottingham, UK (n = 390) and a series of community controls (n = 391) were included in the AESOP study. Data relating to clinical and social variables, including parental separation and loss, education and adult disadvantage, were collected from cases and controls. Results: There was evidence that the effect of separation from, but not death of, a parent in childhood on risk of psychosis was partially mediated through subsequent poor educational attainment (no qualifications), adult social disadvantage and, to a lesser degree, low self-esteem. In addition, there was strong evidence that separation from, but not death of, a parent combined synergistically with subsequent disadvantage to increase risk. These effects held for all ethnic groups in the sample. Conclusions: Exposure to childhood and adult disadvantage may combine in complex ways to push some individuals along a predominantly sociodevelopmental pathway to psychosis.
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This article reviews recent advances in the domain of psychiatry and religion that highlight the double-edged capacity of religion to enhance or damage health and well-being, particularly among psychiatric patients. A large body of research challenges stereotyped views of religion as merely a defense or passive way of coping, and indicates that many people look to religion as a vital resource which serves a variety of adaptive functions, such as self-regulation, attachment, emotional comfort, meaning, and spirituality. There is, however, a darker side to religious life. Researchers and theorists have identified and begun to study problematic aspects of religiousness, including religiously-based violence and religious struggles within oneself, with others, and with the divine. Religious problems can be understood as a by-product of psychiatric illness (secondary), a source of psychiatric illness (primary), or both (complex). This growing body of knowledge underscores the need to attend more fully to the potentially constructive and destructive roles of religion in psychiatric diagnosis, assessment, and treatment. In fact, initial evaluative studies of the impact of spiritually integrated treatments among a range of psychiatric populations have shown promising results. The article concludes with a set of recommendations to advance future research and practice, including the need for additional psychiatric studies of people from diverse cultures and religious traditions.
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High rates of childhood abuse (CA) have been reported among people with severe mental illness, but the content of psychotic symptoms is not generally considered pertinent to diagnosis and treatment. This study explores associations between CA and the content of adult psychotic symptoms. A sample of 30 respondents was selected from a larger study of individuals interviewed using standardized and open-ended questions to assess history of CA, and to elicit content of hallucinations and delusions (HD). Interviews included detailed descriptions of psychotic symptoms and CA experiences, which were coded using qualitative techniques. Based on a review of the research, we constructed a measure comprising nine categories of symptom content found to occur among individuals reporting CA (Threat, Somatic/Tactile, Olfactory, or Kinetic sensations, Real person involved, Fear, Malevolence, Sexuality, and Memories). This “trauma-relevant content score” was used to compare abused and nonabused groups, and was found to be higher among abused than nonabused respondents. Additionally, we examined parallels between interpersonal relationships described in HD and those experienced in the context of childhood trauma, using a multiple case study approach, and drawing on the Core Conflictual Relationship Theme (CCRT) method of analysis. Congruent patterns of interaction were identified in trauma and symptom descriptions of abused respondents. Implications for research and clinical practice include identifying symptom characteristics relevant to CA history, and developing a strategy to assess correspondence between individuals' trauma and symptom reports. Identification of trauma-relevant characteristics in symptom content can provide clinicians with an effective means of recognizing trauma-related illness. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Based on a history of close conceptual link, empirical studies are beginning to accumulate that investigate the relationship between trauma and religion. A review of empirical studies that examined the relationship between religion/spirituality and PTSD showed mixed findings (n=11). Though the direction of association varied among studies, all but one study reported significant associations between the two. Factors that might have contributed to the mixed findings are discussed (e.g., measurements, research design). Overall, these results appear to be encouraging toward confirming the conceptual link between religion and trauma. Further research investigating the direction of causation and possible moderators of the association may contribute to a better understanding of the relationship between trauma and religion.
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Although violent victimization is highly prevalent among men and women with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder), future research in this area may be impeded by controversy concerning the ability of individuals with SMI to report traumatic events reliably. This article presents the results of a study exploring the temporal consistency of reports of childhood sexual abuse, adult sexual abuse, and adult physical abuse, as well as current symptoms of posttraumatic stress disorder (PTSD) among 50 people with SMI. Results show that trauma history and PTSD assessments can, for the most part, yield reliable information essential to further research in this area. The study also demonstrates the importance of using a variety of statistical methods to assess the reliability of self-reports of trauma history.
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Evidence suggests that adverse experiences in childhood are associated with psychosis. To examine the association between childhood adversity and trauma (sexual abuse, physical abuse, emotional/psychological abuse, neglect, parental death, and bullying) and psychosis outcome, MEDLINE, EMBASE, PsychINFO, and Web of Science were searched from January 1980 through November 2011. We included prospective cohort studies, large-scale cross-sectional studies investigating the association between childhood adversity and psychotic symptoms or illness, case-control studies comparing the prevalence of adverse events between psychotic patients and controls using dichotomous or continuous measures, and case-control studies comparing the prevalence of psychotic symptoms between exposed and nonexposed subjects using dichotomous or continuous measures of adversity and psychosis. The analysis included 18 case-control studies (n = 2048 psychotic patients and 1856 nonpsychiatric controls), 10 prospective and quasi-prospective studies (n = 41,803) and 8 population-based cross-sectional studies (n = 35,546). There were significant associations between adversity and psychosis across all research designs, with an overall effect of OR = 2.78 (95% CI = 2.34-3.31). The integration of the case-control studies indicated that patients with psychosis were 2.72 times more likely to have been exposed to childhood adversity than controls (95% CI = 1.90-3.88). The association between childhood adversity and psychosis was also significant in population-based cross-sectional studies (OR = 2.99 [95% CI = 2.12-4.20]) as well as in prospective and quasi-prospective studies (OR = 2.75 [95% CI = 2.17-3.47]). The estimated population attributable risk was 33% (16%-47%). These findings indicate that childhood adversity is strongly associated with increased risk for psychosis.
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Surveys have found that otherwise well individuals report delusional experiences. Previous studies have shown an association between psychotic symptoms and exposure to trauma. To explore the association between trauma and delusional experiences in a community sample. Respondents (n=10 641) were assessed for delusional experiences, exposure to various types of traumatic experiences and the presence of post-traumatic stress disorder (PTSD). The endorsement of delusional items was examined in people exposed to traumatic events who did or did not have PTSD. Exposure to any traumatic event but without the development of PTSD was associated with increased endorsement of delusional experiences (relative risk 2.68, 95% CI 2.18-3.30) and there was a significant dose-response relationship between the number of types of traumatic events and endorsement of such experiences (chi(2) =26.74, d.f.=2, P<0.001). A diagnosis of PTSD further increased endorsement of delusional experiences (RR=9.24, 95% CI 6.95-12.27). The association between PTSD and delusional experiences remained significant after adjusting for factors associated with psychotic symptoms. Further investigation into the pathways between trauma, delusions and psychosis may provide insights into shared aetiological mechanisms underpinning these conditions.
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The Life Events Checklist (LEC), a measure of exposure to potentially traumatic events, was developed at the National Center for Posttraumatic Stress Disorder (PTSD) concurrently with the Clinician Administered PTSD Scale (CAPS) to facilitate the diagnosis of PTSD. Although the CAPS is recognized as the gold standard in PTSD symptom assessment, the psychometric soundness of the LEC has never been formally evaluated. The studies reported here describe the performance of the LEC in two samples: college undergraduates and combat veterans. The LEC exhibited adequate temporal stability, good convergence with an established measure of trauma history—the Traumatic Life Events Questionnaire (TLEQ)— and was comparable to the TLEQ in associations with variables known to be correlated with traumatic exposure in a sample of undergraduates. In a clinical sample of combat veterans, the LEC was significantly correlated, in the predicted directions, with measures of psychological distress and was strongly associated with PTSD symptoms.
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Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children’s and young adults’ receipt of mental health and substance abuse care using nationally representative data from the 2006–2012 Medical Expenditure Panel Surveys. Blacks’ and Hispanics’ visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services. Disparities were generally larger for young adults than for children. Black and white children had similar psychiatric inpatient and emergency department utilization rates, while Hispanic children had lower hospitalization rates. Multivariate control for mental health impairment, demographics, and insurance status did not attenuate racial/ethnic disparities in outpatient care. We conclude that psychiatric and behavioral problems among minority youth often result in school punishment or incarceration, but rarely mental health care.
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There is a substantial body of research reporting evidence of associations between various forms of childhood adversity and psychosis, across the spectrum from experiences to disorder. This has been extended, more recently, to include studies of cumulative effects, of interactions with other factors, of specific effects, and of putative biological and psychological mechanisms. In this paper we evaluate this research and highlight the remaining methodological issues and gaps that temper, but do not dismiss, conclusions about the causal role of childhood adversity. We also consider the emerging work on cumulative, synergistic, and specific effects and on mechanisms; and discuss the broader implications of this line of research for our understanding of psychosis. We conclude that the current balance of evidence is that childhood adversities - particularly exposure to multiple adversities involving hostility and threat - do, in some people, contribute to the onset of psychotic experiences and psychotic disorders.
Chapter
Literature from the last 15 years has found an established relationship between trauma exposure, schizophrenia, and PTSD symptoms. The reporting of trauma exposure in people with schizophrenia ranges between 33 % and 98 %, which is much higher than that found in the general population. The prevalence and severity of PTSD symptoms are also significantly higher in people with a diagnosis of schizophrenia. The trends that emerge from this literature indicate that people with schizophrenia are likely to experience exposure to more than one trauma and that there is a dose-response relationship between the number of traumas experienced and the severity of schizophrenia symptoms and PTSD symptoms. Exposure to childhood trauma, sexual assault, and violence is commonly experienced by people with schizophrenia. Evidence suggests that a bidirectional relationship exists between the severity of PTSD and schizophrenia symptoms. There are two potential causal relationships: schizophrenia symptoms and treatment cause PTSD symptoms or trauma causes the development of schizophrenia symptoms. The stress vulnerability model offers the temporal framework to further investigate the nature of the relationship between trauma exposure, schizophrenia symptoms, and PTSD. A number of biopsychosocial vulnerabilities to developing schizophrenia symptoms are associated with trauma exposure.
Article
Background: Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs. Method: General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure. Results: Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types - witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury - accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events. Conclusions: Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
Article
To ascertain the prevalence of posttraumatic stress disorder (PTSD) and risk factors associated with it, we studied a random sample of 1007 young adults from a large health maintenance organization in the Detroit, Mich, area. The lifetime prevalence of exposure to traumatic events was 39.1%. The rate of PTSD in those who were exposed was 23.6%, yielding a lifetime prevalence in the sample of 9.2%. Persons with PTSD were at increased risk for other psychiatric disorders; PTSD had stronger associations with anxiety and affective disorders than with substance abuse or dependence. Risk factors for exposure to traumatic events included low education, male sex, early conduct problems, extraversion, and family history of psychiatric disorder or substance problems. Risk factors for PTSD following exposure included early separation from parents, neuroticism, preexisting anxiety or depression, and family history of anxiety. Life-style differences associated with differential exposure to situations that have a high risk for traumatic events and personal predispositions to the PTSD effects of traumatic events might be responsible for a substantial part of PTSD in this population.
Article
There are an increasing number of studies exploring the association between voice-hearing (auditory verbal hallucinations) and dissociative experiences. The current study provides a systematic literature review and meta-analytic synthesis of quantitative studies investigating the relationship between voice-hearing and dissociation. A systematic search identified and included 19 clinical studies, comprising 1620 participants, and 12 non-clinical studies, comprising 2137 participants, published between 1986 and 2014. Nineteen of these studies provided sufficient data to be included within the meta-analysis. The narrative review findings suggested that dissociative experiences may be implicated in voice-hearing, and may potentially be a mediating factor within the well-established trauma and voice-hearing relationship. Similarly, the meta-analytic findings suggested that the majority of the identified studies showed a significant positive relationship between dissociative experiences and voice-hearing. The magnitude of the summary effect was large and significant (r=.52), indicating a robust relationship between these two phenomena. However, considerable heterogeneity within the meta-analytic results and methodological limitations of the identified studies were evident, highlighting areas for future investigation. As the majority of the studies were cross-sectional by design, we recommended future research to include longitudinal designs with a view to exploring directional effects. Additionally, future studies should control for potential confounding factors. Clinical implications of the findings were also considered. Copyright © 2015 Elsevier Ltd. All rights reserved.
Article
Background: Meta-analyses link childhood trauma to depression, mania, anxiety disorders, and psychosis. It is unclear, however, whether these outcomes truly represent distinct disorders following childhood trauma, or that childhood trauma is associated with admixtures of affective, psychotic, anxiety and manic psychopathology throughout life. Method: We used data from a representative general population sample (NEMESIS-2, n = 6646), of whom respectively 1577 and 1120 had a lifetime diagnosis of mood or anxiety disorder, as well as from a sample of patients with a diagnosis of schizophrenia (GROUP, n = 825). Multinomial logistic regression was used to assess whether childhood trauma was more strongly associated with isolated affective/psychotic/anxiety/manic symptoms than with their admixture. Results: In NEMESIS-2, largely comparable associations were found between childhood trauma and depression, mania, anxiety and psychosis. However, childhood trauma was considerably more strongly associated with their lifetime admixture. These results were confirmed in the patient samples, in which it was consistently found that patients with a history of childhood trauma were more likely to have a combination of multiple symptom domains compared to their non-traumatized counterparts. This pattern was also found in exposed individuals who did not meet criteria for a psychotic, affective or anxiety disorder and who did not seek help for subclinical psychopathology. Conclusions: Childhood trauma increases the likelihood of a specific admixture of affective, anxiety and psychotic symptoms cutting across traditional diagnostic boundaries, and this admixture may already be present in the earliest stages of psychopathology. These findings may have significant aetiological, pathophysiological, diagnostic and clinical repercussions.
Article
Background Several studies have found an association between area deprivation and incidence of schizophrenia. However, not all studies have concurred and definitions of deprivation have varied between studies. Relative deprivation and inequality seem to be particularly important, but which aspects of deprivation or how this effect might operate is not known. Methods The Lambeth Early Onset case register is a database of all cases of first episode psychosis aged 16 to 35 years from the London Borough of Lambeth, a highly urban area. We identified 405 people with first onset schizophrenia who presented between 2000 and 2007. We calculated the overall incidence of first onset schizophrenia and tested for an association with area-level deprivation, using a multi-domain index of deprivation (IMD 2004). Specific analyses into associations with individual sub-domains of deprivation were then undertaken. Results Incidence rates, directly standardized for age and gender, were calculated for Lambeth at two geographical levels (small and large neighbourhood level). The Poisson regression model predicting incidence rate ratios for schizophrenia using overall deprivation score was statistically significant at both levels after adjusting for ethnicity, ethnic density, population density and population turnover. The incidence rate ratio for electoral ward deprivation was 1.03 (95% CI = 1.004–1.04) and for the super output area deprivation was 1.04 (95% CI = 1.02–1.06). The individual domains of crime, employment deprivation and educational deprivation were statistically significant predictors of incidence but, after adjusting for the other domains as well as age, gender, ethnicity and population density, only crime and educational deprivation, remained statistically significant. Low income, poor housing and deprived living environment did not predict incidence. Conclusions In a highly urban area, an association was found between area-level deprivation and incidence of schizophrenia, after controlling for age, gender, ethnicity and population density; high crime and low levels of education accounted for this. As both of these are potentially modifiable, this suggests a possible means to reduce the incidence of schizophrenia.
Article
Most of the research on elderly victimization has focused primarily on the Federal Bureau of Investigation's (FBI)'s major index crimes of murder, rape, and robbery; however, this restricted approach to the study of crime only depicts a portion of the actual crime against the elderly. This research was conducted to capture a more encompassing view of elderly victimization. The data were obtained from the FBI's National Incident Based Reporting System (NIBRS) in the state of South Carolina. ResUlts of the study suggest that the elderly (age 65 and older) are more at risk than are younger segments of the population for crimes of robbery, intimidation, vandalism, and forgery/fraud, with the sex and race of the elderly victim also associated with specific types of criminal victimization.
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In a study of 115 combat veterans with post-traumatic stress disorder, the majority (65%) reported hearing voices. These dissociative voices included command hallucinations to which the individuals responded with a feeling of automatic obedience. We describe an evolving series of psychological interventions that appear to diminish dissociation. These techniques teach the patient to objectively clarify, to conduct a dialogue with, and to negotiate with their voices.[1882 words]
Book
An Introduction to the Psychology of Religion and Coping. Part I: A Perspective on Religion. The Sacred and the Search for Significance. Religious Pathways and Religious Destinations. Part II: A Perspective on Coping. An Introduction to the Concept of Coping. The Flow of Coping. Part III: The Religion and Coping Connection. When People Turn to Religion. When They Turn Away. The Many Faces of Religion in Coping. Religion and the Mechanisms of Coping - The Transformation of Significance. Part IV: Evaluative and Practical Implications. Does it Work? Religion and the Outcomes of Coping. When Religion Fails - Problems of Integration in the Process of Coping. Putting Religion into Practice.
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Individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure and for the development of posttraumatic stress disorder (PTSD). This study reports findings from a large, comprehensive screening of trauma and PTSD symptoms among public mental health clients in a statewide community mental health system. In 851 individuals with SMI and probable PTSD, childhood sexual abuse was the most commonly endorsed index trauma, followed closely by the sudden death of a loved one. Participants had typically experienced an average of 7 types of traumatic events in their lifetime. The number of types of traumatic events experienced and Hispanic ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relation to events that occurred on average 20 years earlier, suggesting the clinical need to address trauma and loss throughout the lifespan, including their prolonged after-effects. 標題:孩童面對家長離世的HPA軸功能與心理及環境因素的關鍵:初步研究結果 撮要:本文檢視孩童喪親後HPA軸功能(包括皮質醇睡醒反應;CAR) 與心理困擾、應對、和另一尚存家長的悲傷反應之間的關係。樣本包括38名孩童(20名女童曾在過去6個月有家長離世)和28名尚存的孩童家長(23名女性),他們會接受自我答問工具和半結構面談,而面談包括討論孩童對喪親的想法及感受,面談後連續三日,受訪者會提供3個在家唾液樣本(睡醒時,30分鐘後和黃昏時)。結果顯示孩童第1天CAR減退與更多焦慮症狀(r= -.45) 、 抑鬱症狀(r= -.40) 、 創傷後壓力症狀(r= -.45) 、不適應哀悼症狀(r= -.43) 和迴避性應對水平(r= -.53)有顯著關連。家長的更高不適應哀悼水平(r= -.47) 亦與孩童第1天CAR減退有關連。這些數據突出了減弱的CAR可能是累積穩態負荷和(又或)情緒上刺激的事件(與死者相關的討論),及在家庭中相關的後續處理(或缺少處理)而導致的。這些可能對喪親兒童(已經歷高度心理困擾、迴避應對和家長的不適應哀悼)來說已是特別壓力。 标题:孩童面对家长离世的HPA轴功能与心理及环境因素的关键:初步研究结果 撮要:本文检视孩童丧亲后HPA轴功能(包括皮质醇睡醒反应;CAR) 与心理困扰、应对、和另一尚存家长的悲伤反应之间的关系。样本包括38名孩童(20名女童曾在过去6个月有家长离世)和28名尚存的孩童家长(23名女性),他们会接受自我答问工具和半结构面谈,而面谈包括讨论孩童对丧亲的想法及感受,面谈后连续三日,受访者会提供3个在家唾液样本(睡醒时,30分钟后和黄昏时)。结果显示孩童第1天CAR减退与更多焦虑症状(r= -.45) 、 抑郁症状(r= -.40) 、 创伤后压力症状(r= -.45) 、不适应哀悼症状(r= -.43) 和回避性应对水平(r= -.53)有显著关连。家长的更高不适应哀悼水平(r= -.47) 亦与孩童第1天CAR减退有关连。这些数据突出了减弱的CAR可能是累积稳态负荷和(又或)情绪上刺激的事件(与死者相关的讨论),及在家庭中相关的后续处理(或缺少处理)而导致的。这些可能对丧亲儿童(已经历高度心理困扰、回避应对和家长的不适应哀悼)来说已是特别压力。
Article
This paper presents a comparative analysis of the prevalence of stressful life events and of the relationships between stressful life events and alcohol, illicit drug, and cigarette use among a multi-ethnic community sample (N = 2,446) of early adolescent boys. The data were derived from a longitudinal study of substance use behaviors and their psychosocial correlates among Hispanic, African-American, and White non-Hispanic adolescent boys residing in Dade County, Florida. Similar levels of event exposure were found among the subgroups, with one exception. African Americans were significantly more likely to experience a death-related event in the past year. Stressful life events were not significantly related with substance use among African-American students. Among Hispanics and White non-Hispanics, however, a number of significant positive relationships were found. A number of bidirectional events (i.e., those events that could be either an antecedent to and/or the result of substance use) were significantly related with stressful events, highlighting the importance of longitudinal research in delineating the temporal ordering of events and outcomes. The authors conclude that future stress research with adolescents should pay particular attention to the important moderating influences of culture and ethnicity as well as to the bidirectional nature of life events and substance use.
Article
Previous studies have reported associations between childhood adversities, eg, loss of a parent, being raised in institutional care, sexual and other kinds of abuse by adults and bullying by peers, and psychosis in adulthood. However, the mechanisms by which these adversities lead to psychotic experiences are poorly understood. From models of the psychological processes involved in positive symptoms, it was predicted that childhood sexual abuse would be specifically associated with auditory hallucinations in adulthood, and that disruption of early attachment relations and more chronic forms of victimization such as bullying would be specifically associated with paranoid ideation. We therefore examined the associations between sexual trauma, physical abuse, bullying, and being brought up in institutional or local authority care and reports of auditory hallucinations and paranoid beliefs in the 2007 Adult Psychiatric Morbidity Survey. All simple associations between childhood adversities and the two symptom types were significant. Childhood rape was associated only with hallucinations (OR 8.9, CI = 1.86-42.44) once co-occurring paranoia was controlled for. Being brought up in institutional care (OR = 11.08, CI = 3.26-37.62) was specifically associated with paranoia once comorbid hallucinations had been controlled for. For each symptom, dose-response relationships were observed between the number of childhood traumas and the risk of the symptom. The specific associations observed are consistent with current psychological theories about the origins of hallucinations and paranoia. Further research is required to study the psychological and biological mediators of these associations.