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Torturing personification of chronic pain among torture survivors
Abstract
Background
Consistent with the human tendency to anthropomorphize objects, events, and situations, individuals might ascribe human characteristics to physical symptoms and illnesses. This manuscript presents an examination of chronic pain personification in torture survivors. Specifically, it was hypothesized that torture survivors personify chronic pain as a torturing sensation. It was further hypothesized that PTSD mediates the effect of past torture on torturing pain personification.
Methods
Fifty-nine Israeli ex-prisoners of war (ex-POWs), who experienced severe torture in captivity, and 44 matched controls completed self-administered questionnaires at 18, 30, and 35 years post captivity.
Results
Whereas ex-POWs exhibit higher torturing personification than controls, no differences were found in concrete description of chronic pain. PTSD trajectories were implicated in different levels of torturing personification. Finally, sequential mediation analysis revealed that PTSD at T2 and T3 mediated the association between torture and torturing personification.
Conclusions
The findings suggest that trauma shapes the way individuals relate to and experience their bodily sensations.
... These studies inspected whether the personification of chronic conditions resonates with the experience of past violating abuse. The finding showed that, 35 years post captivity, ex-prisoners of war who were subjected to severe torture during captivity tended to ascribe torturing characteristics to their chronic pain (Tsur et al., 2017). Specifically, as compared with controls, torture survivors tended to describe their current chronic pain in a way that resonates with the experience of interpersonal violence, choosing words such as "killing," "terrifying," "evil," "beating," "penetrating," and so on (see Tsur et al., 2017, for the full word list). ...
... The finding showed that, 35 years post captivity, ex-prisoners of war who were subjected to severe torture during captivity tended to ascribe torturing characteristics to their chronic pain (Tsur et al., 2017). Specifically, as compared with controls, torture survivors tended to describe their current chronic pain in a way that resonates with the experience of interpersonal violence, choosing words such as "killing," "terrifying," "evil," "beating," "penetrating," and so on (see Tsur et al., 2017, for the full word list). Presumably, chronic pain personification may derive from the resemblance between the experience of interpersonal violence and chronic pain, with both reflecting an uncontrollable, internal experience of suffering and pain. ...
... Presumably, chronic pain personification may derive from the resemblance between the experience of interpersonal violence and chronic pain, with both reflecting an uncontrollable, internal experience of suffering and pain. The findings further indicated that PTSD mediated the association between torture and pain personification, potentially pointing to the underlying mechanism whereby pain personification evolves (Tsur et al., 2017(Tsur et al., , 2020. ...
Child abuse has been shown to increase the risk for chronic pain. The illness personification theory implies that individuals tend to ascribe humanlike characteristics to chronic pain, and that this personification is embedded in the way they cope with their chronic condition. Recent findings demonstrate that individuals who experienced interpersonal violence tend to personify chronic pain in a way that resonates with past abusive experience. Although findings prevail to the link between trauma and the experience of the body, the personification of chronic pain among individuals who experienced child abuse has not been examined before. This article includes two studies that tested whether child abuse is implicated in abusive chronic pain personification in a young adult female sample (Study 1) and among females who experienced child abuse (Study 2). In both studies, self-report measures of child abuse, posttraumatic stress (PTS) symptoms, complex posttraumatic symptoms (disturbances of self-organization [DSO]), and abusive chronic pain personification were administered. Structural equation modeling was utilized to assess the hypotheses. The findings of the two studies showed a significant association between child abuse and pain personification. Whereas PTS symptoms did not mediate this link (Study 1), DSO symptoms mediated this association (Study 2). The findings of these studies support the understanding that the experience of interpersonal violence is engraved in the experience of the body, as reflected in abusive chronic pain personification. Disturbances in self-organization seem to underlie this process, thus pertaining to the link between the experience of the body, self, and interpersonal trauma.
... Pain is a multifaceted subjective experience involving physical, mental, and interpersonal aspects (Edwards et al., 2016). Thus, although the experience of pain has no physical propensity or appearance, it may leave significant traces in the long-term experience of the self and the body (Tsur, Shahar, Defrin, Lahav, & Ginzburg, 2017). The current study provides insight into the pain experienced by physically abused children as communicated in forensic interviews while still residing with their abusive parent/s. ...
... Other findings reveal that the experience of chronic pain may resonate with the experience of pain as endured within abusive relationships. Such findings arise from research on torture survivors, revealing a significant link between the torment endured and the personification of chronic pain experienced 30 years after release from captivity (Tsur et al., 2017). Specifically, these findings show that torture survivors tended to ascribe "torturing" characteristics to current chronic pain sensations, such as "killing," "vicious," "terrifying," and "suffocating". ...
Background
Child maltreatment (CM) studies have contributed considerably to our understanding of the phenomenon epidemiology and consequences. However, the concept of children’s pain has been surprisingly understudied in CM studies.
Objective
The current study examined pain from the unique perspectives of children as conveyed in forensic interviews following parental physical abuse.
Participants and settings: The sample consisted of 35 forensic interviews with Israeli children (21 girls) aged 4-14.
Results
Thematic analysis of the interviews indicated the complex perception of pain by the children, in which while highlighted the intensive pain they endured during abuse, they also muted and minimized this pain in their descriptions. This tendency of the children to mute their pain is not surprising given their reality, which is manifested in complicated interactions with both the forensic interviewers and significant others in their lives.
Conclusions
The discussion focuses on the association between muted pain experiences and the nature of traumatic experiences. Moreover, delving into the unique family dynamic described by the children advances our understanding of the way pain is embedded in the children’s interactions with their surroundings; the family, the perpetrator, and the forensic interviewer. Potential links between peritraumatic pain in child abuse and posttraumatic chronic pain are also discussed.
... It has been established that physiological and psychological responses to pain, torture, and incarceration interact and contribute to comorbid conditions of mental health problems, stress reactions, persistent pain, and pain-related disability (Tsur, Shahar, Defrin, Lahav, & Ginzburg, 2017;Leder, 2018). Symptoms of PTSD, anxiety, and depression are associated with greater rates of physical health problems and pain-related disability (Tsang, et al., 2008;Bair at al., 2003). ...
Introduction: Survivors of torture have high rates of mental health problems and can experience a sequela of physical effects with the
most common being persistent pain. Similar to survivors of torture, persons that are incarcerated have high rates of mental health problems,
persistent pain and pain-related disability. The purpose of this study is to assess the effect of an interdisciplinary group treatment approach, involving psychotherapy and physiotherapy, with survivors of torture whom are incarcerated in a prison in Kurdistan, Iraq.
Methods: A parallel group study design was used to compare a treatment group (n=11) and a wait-list control group (n=16). The treatment group participated in an interdisciplinary treatment service for a total of 10
weekly group sessions for each discipline. The primary outcome measures were symptoms of nociplastic pain, anxiety, depression, and
PTSD. Secondary outcome measures evaluated physical functioning, sleep quality, and general self-efficacy. Results: A statistically significant reduction in outcome measure scores was seen in all symptoms
measured immediately post-treatment. Discussion and Conclusion: These findings suggest that a culturally and contextually appropriate
interdisciplinary group treatment intervention for survivors of torture in a prison
... Given its impact on their psychological status, relationships, and perception of the world, SV makes survivors particularly vulnerable in catastrophes (Herman, 2015), experiencing imminent threats such as COVID-19 as overwhelming. Like the "invasion of subjectivity" that is an inherent constituent of SV (Herman, 2015), COVID-19 may be perceived as a potential invader (Tsur, et al., 2017). Indeed, pre-pandemic maltreatment experiences such as childhood abuse and neglect have been found to exacerbate the impact of exposure to COVID-19 on mental health (Guo et al., 2020). ...
The present study is designed to improve our understanding of the impact of the COVID-19 pandemic, as collective trauma, on the wellbeing of survivors of sexual violence (SV). The data are based on an online qualitative survey about the experiences of 39 survivors and a thematic analysis of ten in-depth interviews with service providers in Israel. The findings reveal that the pandemic and restrictive measures are associated with increased risk for participants’ wellbeing, caused directly by pandemic characteristics, as well as indirectly through the denial of access to coping resources. Paradoxically, the pandemic also offers relief, given the widespread restrictions imposed on the entire population and the general crisis atmosphere. The service providers’ perspective indicates an increased demand for services as well as for their adjustment. These findings highlight the vulnerability of individuals with a history of SV and the need for accommodation of frontline SV services for health crises.
... The dialectical method was used in all parts of the work, which provided an analysis of the components of area-specific (criminal law) characteristic of illegal consequences (physical pain, physical and moral suffering). Dogmatic and hermeneutic methods ensured the content interpretation of concepts and terms to clarify the categories of national criminal, international humanitarian law and other sciences to make a comparative characteristic of the concepts (Williams et al., 2010;Tsur et al., 2017;Nyandra et al., 2018). ...
The research given is of great scientific value since the main task of any state is to protect natural human values, namely: life, health, will, honour, dignity, and other natural rights. Therefore, their defence and protection are carried out at the state level, especially by developing effective means aimed at systematic counteraction to criminal offences against the health of an individual. The doctrinal approaches on the limits of criminal law protection of person’s health, existing today, require a detailed analysis and generalization, as well as legal drawbacks in the construction of criminal law norms on liability for various types of encroachments on health and problems arising as a result of it at criminal law assessment of relevant socially dangerous acts. However, the discussion on terminology which is not only the achievement of criminal law subjects but also medicine, forensic medicine, psychology, etc., is still taking place between the researchers in various humanitarian sciences at national and international levels. First of all, these terms and categories are the determinants, and main studies in these areas are based on them.
... These theoretical explanations suggest that, for individuals exposed to trauma and especially those who suffer from PTSD, the body may become the stage for reexperiencing pain and suffering (Tsur et al., 2020;Tsur, Shahar, et al., 2017), referred to as the "somatic memory" of trauma (Levine, 1997;Van der Kolk, 2015). As a result, bodily sensations, such as heart palpitations or headaches, whether related to illness or not, might be construed as a potential danger to the self, interpreted as catastrophic and frightful sensations (Tsur, Defrin, et al., 2018). ...
Theoretical literature suggests that trauma and (PTSD) may instigate changes in the interpretation of bodily signals. Some findings support these inquiries, revealing that exposure to traumatic events and PTSD are associated with pain catastrophizing, body vigilance, fear of pain, and other manifestations of bodily perceptions and interpretations. However, these findings are not integrated into an inclusive empirically based conceptualization, thus leading to a limited comprehension of this phenomenon. This systematic literature review was conducted to synthesize the existing literature referring to orientation to bodily signals. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the review included a final of 48 manuscripts that addressed orientation to bodily signals among participants (aged 18 and above) and its potential associations with PTSD. The review revealed that most studies assessed one orientation manifestation, which was tested for its link to PTSD. The majority of the manuscripts were cross-sectional and included participants who faced combat, vehicle accidents, or various types of traumas. Only five manuscripts focused on interpersonal trauma and abuse. Most manuscripts reported significant correlations, revealing that trauma and PTSD are associated with a negative, catastrophic and frightful interpretation of bodily signals. These findings emphasize the need to encapsulate the various manifestations of orientation to bodily signals under a unified construct, as proposed by the term post-traumatic orientation to bodily signals. Further research is needed to illuminate the circumstances and processes by which trauma is implicated in post-traumatic orientation to bodily signals.
... En condiciones de estrés prolongado, como sucede con los prisioneros de guerra, secuestrados, violencia sexual o en personas con padecimientos crónicos dolorosos, el sistema cognitivo se colapsa y las personas pueden tener la ilusión de que no poseen su cuerpo, en parte o por completo [9][10][11][12][13] . Esto se conoce como «sensación de desapropiación corporal» (SDC) y se caracteriza por: -Pérdida de los recursos físicos, cognitivos, y emocionales para poder hacer frente a la situación que los ha colocado en esa desapropiación corporal. ...
... Particularly, it has been postulated that "the body keeps the score" (van der Kolk, 2015), and that trauma may result in post-traumatic orientation to bodily signals (Tsur, 2020;Tsur et al., 2018). Experiences of pain related to CSA may correspond with the essential experience of uncontrollable, invasive, interpersonal manifestations of abuse (Tsur et al., 2017). ...
The literature on child sexual abuse (CSA) has contributed significantly to the understanding of its characteristics, epidemiology, and consequences. Considerably less attention has been dedicated, however, to the subjective experiences of the abused children, and more specifically to their experiences of pain. The current study explored the way children perceive and describe pain during and shortly following incidents of sexual abuse. The sample was comprised of 35 transcripts of forensic interviews following alleged CSA. Thematic analysis of the children's narratives identified three themes: (a) pain during the abusive incidents, described using words indicating its intensity and quality; (b) pain shortly after the abusive incidents, including weeks later, and (c) pain as embedded within the complex dynamic with perpetrator. The children struggled to localize the pain, mainly using words such as "inside" and "deep." Moreover, they testified that in the course of the abusive incidents, they were often silenced when trying to communicate their pain to the perpetrators. The children's narratives provided us with a unique opportunity to learn about the pain not only during the abusive incidents but also following it. Additionally, children described suffering from pain in areas that were not directly injured during the CSA incidents, mainly referring to the head, abdomen and legs. The discussion addresses the potential intervening factors in peritraumatic CSA pain, as well as its potential links with chronic post-traumatic physical and mental morbidity. This study illuminates the necessity to address the complicated links between short- and long-term physical, emotional, cognitive, and interpersonal manifestations of CSA.
... The first path, reflecting a "negative route," reveals that CA survivors tend to experience more CPTSD symptoms, and these symptoms, in turn, are implicated in elevated levels of both fear of COVID-19, as well as COVID-19 ASD, as compared to participants who did not experience CA. These findings are in line with previous findings demonstrating that posttraumatic psychopathology, as mostly captured through the lens of PTSD, underlies the link between exposure to trauma and mental distress and physical morbidity (Asmundson & Katz, 2009;Sharp & Harvey, 2001;Tsur et al., 2017). Furthermore, the current findings unveiled that alongside PTS symptoms, DSO symptoms also show a significant mediation effect, uncovering the role of self-organization disruption for COVID-19 distress. ...
Background
The COVID-19 pandemic exposes individuals not only to health-related risks, but also to psychosocial fear and acute stress. Previous studies reveal that individuals who experienced child abuse (CA), especially those who suffer from complex posttraumatic stress disorder (CPTSD), are at a higher risk of reacting with fear and stress when faced with stressful life-events.
Objective
To test whether exposure to CA is implicated in a higher risk of COVID-19-related fear and acute stress, and whether CPTSD intervenes in such processes.
Participants and settings
A convenience sample of 837 adults participated in the study during the first peak of COVID-19 in Israel.
Methods
Participants completed self-report questionnaires, assessing child physical, sexual and emotional abuse, CPTSD (ITQ), COVID-19-related acute stress disorder (COVID-19 ASD; ASDS) and fear of COVID-19.
Results
Bivariate analyses showed that participants who experienced CA were higher than participants who did not experience CA in COVID-19 ASD (p = .032), but not in fear of COVID-19 (p = .65). Mediation analyses demonstrated two significant paths: in the first, CA was associated with elevated fear of COVID-19 (effect = .061, .059; p < 0.05) and COVID-19 ASD (effect = .14, .084; p < 0.05) through the mediation of CPTSD; in the second path, when controlling for the mediation of CPTSD, CA was associated with reduced fear of COVID-19 (effect = −.15; p = 0.001), and COVID-19 ASD (effect = −.12; p = 0.024).
Conclusions
The findings reveal a complex pattern, indicating that CPTSD may be a risk factor for elevated levels of COVID-19 distress among individuals who experienced CA. However, some CA survivors may express reduced COVID-19 distress.
... Unfortunately, trauma in general, and child maltreatment in particular, experienced by the mother, the daughter, or both, may affect this unique bond in various detrimental domains (Pickreign Stronach et al., 2011;Reijman et al., 2017). One such derivative is the subjective experience of the body, or the orientation towards bodily signals (Tsur, Defrin, Lahav, & Solomon, 2018;Tsur, Shahar, role in explaining the association between trauma and posttraumatic orientation to bodily signals. Such findings imply that PTSD is associated with a catastrophic orientation to bodily signals (e.g., Kleiman, Clarke, & Katz, 2011;López-Martínez, Ramírez-Maestre, & Esteve, 2014), and anxiety sensitivity (e.g., Bernstein, Zvolensky, Feldner, Lewis, & Leen-Feldner, 2005). ...
Background
Orientation to bodily signals reflects the ways in which individuals interpret their bodily sensations. Such orientation is formed within early interpersonal context. Findings reveal that trauma may result in catastrophic and fearful orientation towards bodily signals. However, not much is known regarding the link between trauma and orientation towards the body as manifested within a family intergenerational context.
Objective
This study examines the link between child maltreatment, complex posttraumatic stress symptoms (CPTS symptoms), and a posttraumatic orientation to bodily signals among dyads of mothers and their young adult daughters.
Participants and setting
194 mother-daughter dyads (mothers’ mean age = 56, SD = 6.3; daughters’ mean age = 26, SD = 3.03) completed self-reported questionnaires, assessing child maltreatment (CTQ), CPTS symptoms (ITQ), and orientation to bodily signals (pain catastrophizing, anxiety sensitivity-physical, body vigilance).
Results
Orientation to bodily signals was associated with child maltreatment, through the mediation of CPTS symptoms among mothers (indirect effects between 0.13–0.28; p > 0.021) and daughters (indirect effects between 0.21–0.11; p > 0.032). Mothers’ child maltreatment was associated with daughters’ child maltreatment (effect = 0.35; p < 0.001), and mothers’ orientation to bodily signals was associated with daughters’ orientation (effects between 0.19-0.27; p < 0.016). Daughters’ orientation to bodily signals was partially associated with mothers’ child maltreatment through mothers’ CPTS symptoms and orientation to body (indirect effect = 0.064; p = 0.023).
Conclusions
Child maltreatment is implicated in posttraumatic orientation towards bodily signals. Such secondary processes may be intergenerationally transmitted.
... The experience of psychic pain (PP)-alternately referred to as psychological pain, emotional pain or suffering, and psychache (Meerwijk & Weiss, 2011;Shneidman, 1993)-is known to be associated with adverse clinical health outcomes, including increased risk for engagement in self-destructive behaviors (Hendin, Maltsberger, Haas, Szanto, & Rabinowicz, 2004;Maltsberger, 2004;Tossani, 2013;Verrocchio et al., 2016). Although certain definitions of PP contrast it from experiences of physical pain (Meerwijk & Weiss, 2011), recent studies have identified a substantial degree of biological overlap between emotional suffering and experiences of pain in the body ( DeWall et al., 2010;Tsur, Shahar, Defrin, Lahav, & Ginzburg, 2017). Psychological pain has been found to be strongly associated with suicide-related outcomes in particular ( Verrocchio et al., 2016), with many studies showing that PP is related to the frequency and lethality of suicide attempts over and above other well-known risk factors, such as depression and hopelessness (Campos & Holden, 2015;Troister & Holden, 2012). ...
Psychological pain is an important contributing factor to suicide risk. The present study examined the psychometric properties of the Psychic Pain Scale (PPS), a new measure assessing unbearable negative affect as described in Maltsberger’s theory of suicidality. The PPS was administered to n = 131 adult psychiatric patients as well as n = 953 undergraduate students. An initial factor analysis which replicated across both clinical and undergraduate samples identified two factors, affective deluge, and loss of control. These subscales were associated with risk factors including trauma history, severity of psychopathology, and decreased resilience, as well as a range of pathological personality traits. Findings support the utility of the PPS as a measure of psychological pain and point to future directions of empirical evaluation.
... Recent findings add to this inquiry, demonstrating that traumatic events are implicated in the relationship between the self and the body, namely, in pain personification. A recent study conducted with the same sample as the current, revealed that torture survivors who suffered from chronic pain at 35-years after release from captivity, tended ascribe torturing characteristics to their current chronic pain, i.e. torturing pain personification (Tsur et al., 2017b). These findings emphasize that among torture survivors, the experience of chronic pain may act as a trauma reminder, even many years after release from captivity. ...
Objective:
Individuals exposed to trauma, especially those who develop posttraumatic stress disorder (PTSD), are at a higher risk of suffering from chronic pain as well as altered pain perception and modulation. However, the underlying mechanisms of these processes are yet to be established. Recent findings have indicated that trauma survivors tend to personify chronic pain that is developed after the exposure, in a way that resonates with the traumatic experience. The aim of this study was to test whether pain personification plays a significant role in explaining the long-term links between trauma, PTSD and pain.
Methods:
This study is part of a large-scale longitudinal study on ex-prisoners of war (ex-POWs) from the 1973 Yom-Kippur war, who were followed over 35 years after the war. Fifty-nine ex-POWs who were exposed to torture and 44 matched combatants were assessed for PTSD at 18, 30, and 35 post-war. Quantitative somatosensory testing of heat-pain threshold, pain tolerance, conditioned pain modulation (CPM), and temporal summation of pain (TSP), as well as torturing personification, were assessed at 35 years after the war.
Results:
Sequential mediation analyses revealed that the associations between torture and heat pain threshold, as well as pain tolerance were mediated by PTSD at several time-points (-1.43<indirect effect < 1.47). Torturing personification significantly mediated the associations between torture, PTSD, CPM and TSP (-0.16 < indirect effect).
Conclusions:
These findings point to the effect of trauma on the subjective orientation towards bodily signals as a key factor in dysfunctional pain modulation.
... Findings indeed demonstrated that trauma may be implicated in life-long health deteriorations (Beristianos et al., 2014;O'Donovan et al., 2015) and alterations in the way physical symptoms are perceived (Tsur et al., 2018). Such alterations may occur via bodily dissociation, characterized by avoidance of internal experiences (Nijenhuis et al., 1998;Price and Thompson, 2007), or from a tendency to perceive bodily symptoms as catastrophic, frightening, and threatening (Tsur et al., 2018;Tsur et al., 2017). Therefore, as war veterans become older, thereby facing more objective health concerns and possible premature aging processes (Lohr et al., 2015;Solomon et al., 2017a,b), their perception of these physical changes may be affected by their previous traumatic experiences. ...
Rationale:
Poor subjective physical health and loneliness are among the most detrimental ramifications of trauma. Indeed, substantial research has examined the link between subjective physical health and loneliness, mainly focusing on how loneliness leads to poorer physical health. However, the effects of poor subjective physical health on loneliness, as well as the reciprocal effects of these two factors, have scarcely been examined. Even less is known regarding the course of these mutual effects among individuals who have been exposed to trauma.
Objective:
The current investigation examines the reciprocal effects of subjective physical health and loneliness among a group of war veterans over four decades.
Methods:
Two-hundred and seventy-four Israeli veterans from the 1973 Yom- Kippur War reported self-rated health (SRH), somatization and loneliness at 1991 (T1), 2003 (T2), 2008 (T3) and 2015 (T4). An autoregressive cross-lagged (ARCL) modeling strategy was employed to test the bidirectional relationship between subjective health and loneliness.
Results:
The results showed that from T1 to T2, loneliness predicted subjective physical health. However, from T2 to T3, and from T3 to T4, subjective physical health predicted loneliness. PTSD moderated the association between loneliness and subjective physical health.
Conclusion:
The findings show a novel pattern of influences, demonstrating that the reciprocal effects of subjective physical health and loneliness change over time. The findings imply that subjective health and interpersonal experiences are inherently connected.
... Later, particularly among those who develop posttraumatic stress disorder (PTSD), even normal day-today physical sensations may act as trauma reminders (Lahav et al., 2015), resembling and sometimes reactivating the traumatic experience (Rothschield, 2003). Among ex-POWs who experienced torture, somatic symptoms may be perceived as agonising and torturing (Tsur, Shahar, Defrin, Lahav, & Ginzburg, 2017). These alterations in the orientation towards the body may lead to a process of estrangement and distrust in ones' body and its experiences (Van Der Kolk, 2014). ...
Objective:
Ill-health and early mortality are amongst the most significant ramifications of trauma. Furthermore, trauma alters the subjective perception and experience of the body. The aim of this study is to examine the extent to which deteriorations in perceived health among traumatised individuals are associated with cellular health as manifested in telomere length.
Methods:
Specifically, 88 former prisoners of war (ex-POWs) evaluated their health (self-rated health; SRH) at 18 (T1), 35 (T2) and 42 (T3) years after the war, and were assessed for telomere length at T3. Health behaviour, BMI, morbidity and PTSD were also examined at T3.
Results:
The findings demonstrated that SRH was cross-sectionally correlated with telomere length. Furthermore, a significant sequential indirect effect was found, in which worse SRH in T1 was associated with shorter telomere length at T3, through worse SRH at T2 and at T3.
Conclusions:
These findings demonstrate that long-term deteriorations in the subjective evaluations of health are implicated in actual cellular health among individuals exposed to trauma.
... Torture survivors experience pain personification, and speak of a "relationship" with their physical disease (pp. 155) [31]. ...
Purpose of review:
At any point in time, there are hundreds of armed conflicts throughout the world. Neuropsychological disorders are a major cause of morbidity during and after armed conflicts. Conditions such as closed and open head injuries, acute stress disorder, post-traumatic stress disorder, depression, anxiety, and psychosis are prevalent among survivors. Herein, we summarize information on the various forms of torture, the resultant neuropsychological pathology, and treatment strategies to help survivors.
Recent findings:
Strategies to address the needs of individuals who experienced neuropsychological trauma due to armed conflicts and torture include pharmacological and psychological interventions. The former includes antidepressant, antianxiety, and antipsychotic medications. The latter includes narrative exposure therapy and trauma-focused cognitive-behavioral therapy. Neuropsychological disorders are major causes of morbidity among survivors of armed conflicts and torture. Treatment strategies must be affordable, applicable across cultures, and deliverable by individuals who understand the victims' psychosocial and ethnic background.
Objective
Illness personification theory posits that individuals suffering from chronic illness ascribe human characteristics to their illness, which impacts their adaptation. Whereas negative or malevolent personification of chronic illness derails adaptation, positive or benevolent personification yields a complex pattern with aspects of adaptation. This study aimed to examine, for the first time, the role of personification of multiple sclerosis (MS).
Method
A two-wave design was implemented with 90 people with MS (PwMS) at T1 (2019) and 60 at T2 (2020). The Ben-Gurion University Illness Personification Scale (BGU-IPS) was administered alongside a host of adaptation-related variables relating to salutogenic, psychological, psychopathological and health aspects. The intent was to replicate the 2-factor structure of the IPS and examine associations with adaptation variables.
Results
The 2-factor structure of the BGU-IPS was replicated by Principal Component Analysis and Confirmatory Factor Analysis, with good to excellent test-retest reliability.
for negative (ICC = 0.81; p < .001) as well as for positive personification scale (ICC = 0.76; p < .001). Negative personification was associated with elevated levels of psychological and psychopathological aspects, as well as low levels of heath related-adaption and salutogenic adaption. Positive personification was associated with salutogenic adaption. In addition, exploratory longitudinal analyses revealed that negative personification at T1 significantly predicted anxiety, physical problems, pain frequency and fatigue frequency at T2, while controlling for the variable's T1 measurements, while positive personification at T1 significantly predicted intolerance of uncertainty at T2.
Conclusion
The findings depict negative personification as a risk factor for adaptation in MS and call for a detailed exploration of the meaning of positive personification.
Objective: Relying on anthropomorphism research, Illness Personification Theory (ILL-PERF) posits that individuals living with a chronic illness ascribe human-like characteristics to their illness. Herein we examine the personification of chronic pain using a new measure: the Ben-Gurion University Illness Personification Scale (BGU-IPS). Method: Three samples of chronic pain patients (Sample 1 and 2 are distinct samples sharing similar characteristics, collected in the context of a cross-sectional design, Ns = 259, 263; Sample 3: a 2-waves longitudinal, N =163) completed the 12-item BGU-IPS, and measures of pain and related factors. Results: An orthogonal, two-factor structure was revealed for the BGU-IPS pertaining to negative vs. positive personifications. Negative personification was associated with pain intensity and illness-related distress (e.g., depression and low adjustment to pain). Positive personification was correlated with hope, pain-related sense of control, and low depression. However, positive personification also augmented the associations between negative personification and several risk factors. Conclusions: Pain personification, particularly as assessed via the BGU-IPS, plays a major role in (mal)adaptation to chronic pain.
Para mí esta conferencia es un reto profesional; desde que originalmente se programó para septiembre del 2017 acepte el desafío de la invitación; debido al terremoto del 19 de septiembre se tuvo que reprogramar; el terremoto nos obligó a todos a reacomodar muchas cosas y este fue uno de los reacomodos. Intento integrar el trabajo del Dr. Mario Carranza Aguilar (UAM-I y UAS) con lo que hemos venido haciendo en nuestro grupo de investigación clínica: "Mente-Cuerpo" de la Facultad de Psicología de la UNAM. Se incluyen varios niveles de trabajo: comunitario-social (del Dr. Carranza) y el trabajo clínico que hacemos nosotros; nos hemos concentrado en el trabajo con pacientes con dolor crónico (DC). En ambos niveles están incluidos problemas de salud que por su nivel de complejidad incluso han rebasado la capacidad de los especialistas médicos, ellos saben muy bien; por ejemplo, que las personas que sufren de Diabetes Mellitus tipo II no solamente tienen un problema endocrino, también un problema emocional-social; si no se encuadra adecuadamente las intervenciones resultan muy costosas y con pobres resultados. Me declaro un admirador respetuoso de la innovación, soy un "fan" de las personas que son capaces de "abrir brecha", de crear caminos donde no existían. Hace 40 años trabaje en varias cárceles de México y me impresionaba como los presos casi de la nada fabricaban bebidas embriagantes (que necesitaban para sobrevivir en la cárcel), fabricaban una bebida que ellos llamaban: "saltapatras", un fermento que preparaban con cascaras de mandarina y un poco de royal (polvo para hacer los pasteles) y lo dejaban unos dos meses que se destilara en una lata que ocultaban adentro del drenaje con una alambre, así obtenían una bebida que era el "saltapatras" se la tomaban y se iban literalmente
Different studies on the Cultural Formulation Interview, especially when administerd in refugees. Literature reviews, experimental studies, clinical experiences. next to this, a chapter on patient-clinician relationship. And two chapters on somatization in refugees: a literature review, and an experimental study.
Final chapter is a discussion about the findings.
Objective:
This study examined the relationship between leukocyte telomere length (LTL), a marker of cell aging, and psychiatric disorders in adults compared with controls using meta-analytic methods.
Methods:
Data were abstracted from studies examining the relationship between LTL and adult psychiatric disorders. In addition to an overall estimate of effect size, subgroup analyses and meta-regression were performed to examine whether covariates (including psychiatric diagnoses) moderated the estimate.
Results:
A significant overall effect size showing LTL shortening was found across all psychiatric disorders (Hedge g = -0.50, p < .001). Subgroup analyses did not demonstrate significant differences in effect size based on individual covariates (psychiatric disorder, sex, age, or assay method). The meta-regression indicated that although type of disorder and, likely, age moderate the overall effect size, the heterogeneity between studies could not be explained by a model that included these variables as well as sex and assay method. Although not significantly different, posttraumatic stress disorder, anxiety disorders, and depressive disorders had comparatively larger effect sizes (-1.27, -0.53, and -0.55), and psychotic and bipolar disorders had comparatively smaller ones (-0.23 and -0.26).
Conclusions:
We observed a robust effect size of LTL shortening for psychiatric disorders as a whole compared with controls. The results were less straightforward regarding relative differences in the strength of this association by specific disorder. Future studies should focus on mechanisms explaining accelerated cell aging with psychiatric illness, defining directions (if any) of causality and elucidating possible differences in this association between disorders.
As most research devoted to the aftermath of war captivity discusses physical and intrapersonal ramifications, the interpersonal domain is left largely underrepresented in research. Our aim in this chapter is to shed light on this realm of psychosocial deficit. Indeed, throughout this chapter we highlight the manner in which various dimensions of interpersonal pernicious and malicious conduct during captivity are weaved into a tapestry of dysfunctional interpersonal relationships in the life that is to come after repatriation. In order to accomplish this we first elaborate in some detail the ingenuity of torture and misconduct of war captivity. Next, we address multifarious dimensions of interpersonal disruption that POWs may undergo after repatriation. Throughout the chapter we provide findings from a longitudinal study that has examined such aspects in a prospective cohort of Israeli ex-POWs who fell captive in 1973 in Egypt and Syria. Concomitantly we survey various interpersonal aspects that include attachment injury, marital and familial adjustment, loneliness and betrayal following captivity. Once these dimensions of post-repatriation become evident, it is then simple to see the devastation that war captivity instills in concentric circles of interpersonal relationships: family, friend, society and state. It is from these realizations that we suggest directions for researchers, clinicians, and policy makers to work towards the mending of interpersonal bonds, the communalization of trauma, and reinstatement of trust. Hopefully with such efforts where detachment was, there attachment will once again be, and where loneliness reigned there connection will once again rule.
Childhood adversity has frequently been related to a wide range of psychosomatic complaints in adulthood. The present study examined the relationship between different forms of childhood adversity and laboratory measures of pain. Heat pain tolerance and perceived heat pain intensity were measured in a community-based sample of 62 women (aged 20–64 years). Participants completed the Childhood Trauma Questionnaire (CTQ), which assesses five forms of childhood adversity: physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect. Somatic symptoms, depressive symptoms, and pain catastrophizing were assessed as potential mediators. Bivariate analyses indicated that emotional abuse but no other forms of childhood adversity were significantly related to decreased heat pain tolerance (r=-0.27; P,0.05). Accordingly, multiple regression analyses revealed that only emotional abuse was a significant predictor of heat pain tolerance (β=-0.62; P=0.034) when entering all CTQ subscales simultaneously. Although emotional abuse was also related to somatic symptoms, depressive symptoms, and pain catastrophizing, none of these variables mediated the relationship between childhood adversity and laboratory pain (P.0.1). No significant associations were found between any forms of childhood adversity and heat pain intensity. Our findings indicate that the severity of emotional childhood abuse is associated with decreased pain tolerance, an affective component of pain, but not with heat pain intensity, which has been described as a sensory component of pain.
SUMMARY All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. They have many health, social and welfare problems; persistent pain in the musculoskeletal system is one of the most common. There is little specific evidence on pain in survivors of torture; the guidelines on interdisciplinary specialist management are applicable. Most of the literature on refugee survivors of torture has an exclusive focus on psychological disorders, with particularly poor understanding of pain problems. This article summarizes the current status of assessment and treatment of pain problems in the torture survivor.
The current study aims to (1) assess the long-term impact of war captivity on mortality and various health aspects and (2) evaluate the potential mediating role of posttraumatic stress disorder (PTSD) and depressive symptoms. Israeli ex-prisoners of war (ex-POWs) (N = 154) and a matched control group of combat veterans (N = 161) were assessed on health conditions and self-rated health 18 years post-war (1991: T1). The whole population of ex-POWs, and the T1 sample of controls were then contacted 35 years after the war (2008: T2), and invited to participate in a second wave of measurement (ex-POWs: N = 171; controls: N = 116) Captivity was implicated in premature mortality, more health-related conditions and worse self-rated health. PTSD and depressive symptoms mediated the relationship between war captivity and self-rated health, and partially mediated the relationship between war captivity and health conditions, and these effects were amplified with age. Aging ex-POWs who develop psychiatric symptomatology should be considered a high-risk group entering a high-risk period in the life cycle. It is important to monitor ex-POWs and provide them with appropriate medical and psychological treatment as they age.
We propose the term illness personification (ILL-PERF) as an organizing theme
shedding light on the ways individuals live with, under, and outside of chronic physical
illness. Drawing from multiple theoretical sources—object relations theory, social–
cognitive theory, existential phenomenology and neuroscience—as well as from our
own research program on chronic pain and systemic lupus erothemathosis (LSE), we
argue that individual differences in the tendency to ascribe human characteristics to
physical illness play an important risk/resilience role in illness-related disability and
emotional distress. We then describe the way ILL-PERF might be incorporated into
extant—and integrative—treatments of chronic physical illness.
We examined associations between self-reported childhood maltreatment and depressive risk (sociotropy, autonomy, and self-criticism), and resilience (self-efficacy). Students (N = 203) reported childhood emotional abuse (CEA), emotional neglect (CEN), psychological distress, cognitive Vulnerability, and resilience. CEA and CEN constitute separate predictors for cognitive risk and resilience, respectively: CEA was related to heightened depressive vulnerability and CEN was related to lower levels of resilience. The presence of negative parent-child interactions might contribute to the development of rigid and dysfunctional negative self-schemas, whereas the lack of positive parent-child interactions might prevent the construction of positive beliefs about the self and thus the formation of psychological resilience (or positive self-schemas).
We propose that the tendency to anthropomorphize nonhuman agents is determined primarily by three factors (Epley, Waytz, & Cacioppo, 2007), two of which we test here: sociality motivation and effectance motivation. This theory makes unique predictions about dispositional, situational, cultural, and developmental variability in anthropomorphism, and we test two predictions about dispositional and situational influences stemming from both of these motivations. In particular, we test whether those who are dispositionally lonely (sociality motivation) are more likely to anthropomorphize well-known pets (Study 1), and whether those who have a stable need for control (effectance motivation) are more likely to anthropomorphize apparently unpredictable animals (Study 2). Both studies are consistent with our predictions. We suggest that this theory of anthropomorphism can help to explain when people are likely to attribute humanlike traits to nonhuman agents, and provides insight into the inverse process of dehumanization in which people fail to attribute human characteristics to other humans.
In Study 1, the Pain Catastrophizing Scale (PCS) was administered to 425 undergraduates. Analyses yielded a three component solution comprising (a) rumination, (b) magnification, and (c) helplessness. In Study 2, 30 undergraduate participants were classified as catastrophizers (n = 15) or noncatastrophizers (n = 15) on the basis of their PCS scores and participated in an cold pressor procedure. Catastrophizers reported significantly more negative pain-related thoughts, greater emotional distress, and greater pain intensity than noncatastrophizers. Study 3 examined the relation between PCS scores, negative pain-related thoughts, and distress in 28 individuals undergoing an aversive electrodiagnostic medical procedure. Catastrophizers reported more negative pain-related thoughts, more emotional distress, and more pain than noncatastrophizers. Study 4 examined the relation between the PCS and measures of depression, trait anxiety, negative affectivity, and fear of pain. Analyses revealed moderate correlations among these measures, but only the PCS contributed significant unique variance to the prediction of pain intensity.
In this study, we assessed the 17-year trajectories of attachment insecurities (anxiety and avoidance) and examined their relations to having been a prisoner of war and suffering from Posttraumatic Stress Disorder (PTSD). The sample included two groups of Israeli veterans from the 1973 Yom Kippur war: ex-prisoners of war and comparable control individuals who had not been held captive. They completed self-report measures of anxious and avoidant attachment and PTSD at three time points: 18, 30, and 35 years after the war. Ex-POWs were less secure with respect to attachment than the controls at the initial assessment, and although the controls experienced a decline in attachment insecurity over the 17-year period, the anxiety and avoidance scores of the ex-POWs increased over time. We also found that PTSD was associated with higher attachment insecurity scores at each time point, beyond the effect of war captivity. Implications of the findings for both attachment theory and the psychological effects of trauma are discussed.
In Study I, the Pain Catastrophizing Scale (PCS) was administered to 425 undergraduates. Analyses yielded a three component solution comprising (a) rumination, (b) magnification, and (c) helplessness. In Study 2, 30 undergraduate participants were classified as catastrophizers (
n = 15) or noncatastrophizers (
n = 15) on the basis of their PCS scores and participated in a cold pressor procedure. Catastrophizers reported significantly more negative pain-related thoughts, greater emotional distress, and greater pain intensity than noncatastrophizers. Study 3 examined the relation between PCS scores, negative pain-related thoughts, and distress in 28 individuals undergoing an aversive electrodiagnostic medical procedure. Catastrophizers reported more negative pain-related thoughts, more emotional distress, and more pain than noncatastrophizers. Study 4 examined the relation between the PCS and measures of depression, trait anxiety, negative affectivity, and fear of pain. Analyses revealed moderate correlations among these measures, but only the PCS contributed significant unique variance to the prediction of pain intensity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The formal acceptance of posttraumatic stress disorder (PTSD) as a legitimate diagnostic category in the 1980 Diagnostic and Statistical Manual of Mental Disorders stimulated a torrent of research on psychological trauma. Not surprisingly, PTSD and its treatment had dominated that research. Another common approach has been to measure the average impact of different potentially traumatic events, as well as the factors that inform that impact. In this article, we consider the limitations of these perspectives and argue for a broader theoretical approach that takes into account the natural heterogeneity of trauma reactions over time. To that end, we review recent attempts to identify prototypical patterns or trajectories of trauma reaction that include chronic dysfunction, but also delayed reactions, recovery, and psychological resilience. We consider the advantages but also the limitations and ongoing controversies associated with this approach. Finally, we introduce promising new research that uses relative sophisticated advances in latent growth mixture modeling as a means of empirically mapping the heterogeneity of trauma responses and consider some of the implications of this approach for existing trauma theories. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Although war captivity is a potent pathogen for psychiatric illness, little is known about the long-term trajectories of post-traumatic stress disorder (PTSD) among ex-prisoners of wars (ex-POWs). This study aimed to assess the long-term trajectories of PTSD and their predictors following war captivity. One hundred and sixty four Israeli ex-POWs and 185 comparable combatants from the 1973 Yom Kippur War were followed over 35 years, with three follow-ups (1991, 2003, 2008). Ex-POWs reported higher PTSD rates than controls at all three assessments. Four trajectories of PTSD were identified: chronic PTSD, delayed PTSD, recovery and resilience. The majority of POWs reported delayed PTSD, while the majority of controls were classified as resilient. While PTSD rates remained relatively stable over time among controls, a steep increase in rates was observed among POWs between 1991 and 2003, followed by stabilization in rates between 2003 and 2008. Finally, subjective experience of captivity was the variable that best distinguished between the resilience and PTSD groups of ex-POWs, followed by participation in previous wars and negative life events during childhood. War captivity carries long-lasting psychiatric implications, even decades after release. Aging processes, as well as unique stressors that exist in Israel, may account for the elevated PTSD rates found here.
The aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on parenting of young children has been examined in a few studies. Nevertheless, the toll of war captivity on parenting and the long-term relations between posttraumatic symptoms and paternal parenting of adult children remains unknown. This longitudinal study examined paternal parenting of adult children among war veterans, some of whom were held in captivity. Furthermore, we examined the mediating role of PTSD symptoms in the association between captivity and parenting. The sample included two groups of male Israeli veterans from the 1973 Yom Kippur War: ex-prisoners of war (ex-POWs) and comparable veterans who had not been held captive. Both groups were assessed via self-report measures of PTSD at three time points: Time 1 (18 after the war), Time 2 (30 after the war), and Time 3 (35 after the war) years after the war. Results shows that ex-POWs reported lower levels of positive parenting compared to comparison group veterans at Time 3. Furthermore, PTSD symptoms at Time 1, Time 2, and Time 3 mediated the association between captivity experience and parenting at Time 3. In addition, it was found that increases in the levels of PTSD symptom clusters over time were associated with lower levels of positive parenting at Time 3.
Chronic pain may be internalized and integrated into the sufferer's object-relations, thereby influencing sufferer's depression. To examine this, fifty-five women suffering from chronic pain were assessed as to their pain-personification, pain intensity, depression, anxiety, and pain related distress. The assessment protocol included an innovative self-report measure, the Pain Personification Questionnaire (PPQ), measuring pain as an internal "bad" object. Controlling for level of pain intensity, we found that the PPQ predicts depression, illness intrusiveness, and pain-related distress, but not anxiety. These findings encourage an object-relations approach to the understanding and treatment of depression in chronic illness.
Researchers often hypothesize moderated effects, in which the effect of an independent variable on an outcome variable depends on the value of a moderator variable. Such an effect reveals itself statistically as an interaction between the independent and moderator variables in a model of the outcome variable. When an interaction is found, it is important to probe the interaction, for theories and hypotheses often predict not just interaction but a specific pattern of effects of the focal independent variable as a function of the moderator. This article describes the familiar pick-a-point approach and the much less familiar Johnson-Neyman technique for probing interactions in linear models and introduces macros for SPSS and SAS to simplify the computations and facilitate the probing of interactions in ordinary least squares and logistic regression. A script version of the SPSS macro is also available for users who prefer a point-and-click user interface rather than command syntax.
This study examines the place occupied by chronic illness in the inner lives of 15 women suffering from Systemic Lupus Erythematosus (SLE). A phenomenological analysis of illness narratives demonstrates that sufferers construe their illness as a protagonist or, using an object-relations informed perspective, as an internal object. That is, with time sufferers constituted a mental representation of SLE that in itself has the power to influence the sufferers' affective states and behaviors. An insight into these "illness relations" is conducive to a better understanding of the "lived experience" of SLE for disabled, economically disadvantaged women. Through their experience, the study of risk and resilience in chronic illness may be advanced.
The PTSD Inventory, a self-report diagnostic questionnaire based on DSM-III criteria, was revised to meet the more recent DSM-III-R criteria. This study examined the validity of the revised inventory relative to a structured clinical interview (SCID) and the Impact of Events Scale (IES). Results showed a high degree of concordance between the instruments, supporting the use of the more standardized, easy to administer and economical PTSD Inventory.
Objective: This study assessed the psychopathological effects of combat in veterans with and without combat stress reaction. Method: Veterans (N=214) from the 1982 Lebanon War were assessed in a prospective longitudinal design: 131 suffered from combat stress reaction during the war, and 83 did not. They were evaluated 1, 2, 3, and 20 years after the war. Results: Combat stress reaction is an important vulnerability marker. Veterans with combat stress reaction were 6.6 times more likely to endorse posttraumatic stress disorder (PTSD) at all four measurements, their PTSD was more severe, and they were at increased risk for exacerbation/reactivation. A qualitative analysis of the profile of PTSD symptoms revealed some time-related changes in the symptom configuration of veterans who did not suffer from combat stress reaction. In both groups, the course fluctuated; PTSD rates dropped 3 years postwar and rose again 17 years later; 23% of veterans without combat stress reaction reported delayed PTSD. Conclusions: These findings suggest that the detrimental effects of combat are deep and enduring and follow a complex course, especially in combat stress reaction casualties. The implications of aging and ongoing terror in impeding recovery from the psychological wounds of war are discussed.
Posttraumatic stress disorder (PTSD) and chronic pain often co-occur and exacerbate each other. Elucidating the mechanism of this co-occurrence therefore has clinical importance. Previously, PTSD patients with chronic pain were found to demonstrate a unique, paradoxical pain profile: hyper-responsiveness together with hyposensitivity to pain. Our aim was to examine whether two seemingly paradoxical facets of PTSD - anxiety and dissociation - underlie this paradoxical profile. PTSD patients (n=32) and healthy controls (n=43) underwent psychophysical testing and completed questionnaires. PTSD patients had higher pain thresholds and higher pain ratings to suprathreshold stimuli than controls. Pain thresholds were positively associated with dissociation levels and negatively associated with anxiety sensitivity levels. Experimental pain ratings were positively associated with anxiety sensitivity and negatively related to dissociation levels. Chronic pain intensity was associated with anxiety, anxiety sensitivity and pain catastrophizing. It appears that reduced conscious attention towards incoming stimuli, resulting from dissociation, causes delayed response in pain threshold measurement while biases towards threatening stimuli and decreased inhibition, possibly due to elevated anxiety, are responsible for the intensification of experimental and chronic pain. The paradoxical facets of PTSD and their particular influences over pain perception seem to reinforce the coexistence of PTSD and chronic pain, and should be considered when treating traumatized individuals.
This article provides new information regarding the underlying mechanism of the coexistence of PTSD and chronic pain. This knowledge could potentially help to provide better management of PTSD and chronic pain among individuals in the aftermath of trauma.
Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
To investigate the relationships between sociodemographic, pre- and post-migration variables with prevalence of psychological distress and global functioning in a heterogeneous sample of torture survivors.
Clients referred from resettlement agencies via the Office of Refugee Resettlement (ORR) to a community clinic in the United States (N = 278) were interviewed with structured, translated questionnaires. Univariate and multivariate logistic regression analyses determined the associations of sociodemographic, pre-, and post-migration risk factors with posttraumatic stress disorder (PTSD), depression, anxiety, and global functioning.
Regression data indicate that length of time between arrival in US and clinical services was significantly associated with PTSD and depression; participants receiving services after 1 year of resettlement were more likely to experience PTSD (adjusted OR = 3.29) and depression (adjusted OR = 4.50) than participants receiving services within 1 year. Anxiety was predicted by female gender (adjusted OR = 3.43), age over 40 years (adjusted OR = 3.12), Muslim religion (adjusted OR = 2.64), and receiving medical services (AOR 3.1). Severely impaired global functioning was associated with female gender (adjusted OR = 2.75) and unstable housing status (adjusted OR = 2.21).
Findings highlight the importance of examining post-migration variables such as length of time in country prior to receiving services in addition to pre-migration torture history upon relocated torture survivors. Clinicians and policy-makers should be aware of the importance of early mental health screening and intervention on reducing the psychiatric burden associated with torture and forced relocation.
Tissue injury may, in some instances, induce chronic pain lasting for decades. Torture survivors suffer from high rates of chronic pain and hypersensitivity in the previously injured regions. Whether torture survivors display generalized alterations in pain perception and modulation, and whether such alterations underlie their chronic pain is unknown. We aimed at exploring the long-term alterations in pain perception and modulation in torture survivors.
In order to address these questions, a systematic quantitative somatosensory evaluation was performed in individuals (n = 60) who suffer from chronic pain, and who, decades previously, were tortured, resulting in substantial tissue damage. These individuals were compared with age- and sex-matched individuals (n = 44) of similar background. Testing included the measurement of pain threshold and pain tolerance, perceived suprathreshold stimuli, conditioned pain modulation (CPM) and temporal summation of pain (TSP) in intact body regions.
Chronic pain was found highly prevalent (86.6%) among torture survivors, who exhibited higher suprathreshold pain ratings (p < 0.05), poorer CPM (p < 0.0001) and stronger TSP (p < 0.0001) than controls. Significant differences in CPM and TSP were also found between torture survivors and controls with chronic pain. Chronic pain intensity among torture survivors correlated negatively with the magnitude of CPM (r = -0.47, p < 0.01).
Torture appears to induce generalized dysfunctional pain modulation that may underlie the intense chronic pain experienced by torture survivors decades after torture. The results may be generalized to instances where chronic pain exists for decades after severe injury in non-tortured populations and emphasize the importance of preventive care.
Pain catastrophising has been broadly defined as an exaggerated negative orientation to actual or anticipated pain comprising elements of rumination, magnification, and helplessness. Hundreds of studies have documented associations between pain catastrophising and adverse pain outcomes, including heightened pain intensity, mental health problems, and disability. This article contrasts different conceptual models that have been advanced to explain how pain catastrophising might impact on pain outcomes. It is argued that traditional "intrapersonal" models of pain catastrophising are overly simplistic and lacking in explanatory power. Research is reviewed showing that interpersonal variables and social context are central determinants of the relation between pain catastrophising and pain outcomes. Discussion addresses the clinical implications of research showing that interpersonal factors underlie the relation between pain catastrophising and adverse pain outcomes. Discussion also addresses the implications of research on the interpersonal dimensions of pain catastrophising for theories of the psychology of pain.
This paper presents an in-depth, idiographic study illustrating how chronic benign low back pain may have a serious debilitating impact on the sufferer's sense of self. Semi-structured interviews were conducted with six patients and the resultant transcripts subjected to interpretative phenomenological analysis. The analysis points to the powerful ways in which chronic pain has negative impact on patients’ self and identity. This impact is made worse in the public arena. Some of the participants describe how the ensuing derogatory self image also seems to lead to their directing negative affect towards other people. The results section gives a detailed account of these processes at work. The results are then considered in relation to relevant constructs in the extant literature, including work on illness and identity, shame and acceptance.
Traditional psychotherapy addresses the cognitive and emotional elements of trauma, but lacks techniques that work directly with the physiological elements, despite the fact that trauma profoundly affects the body and many symptoms of traumatized individuals are somatically based. Altered relationships among cognitive, emotional, and sensorimotor (body) levels of information processing are also found to be implicated in trauma symptoms. Sensorimotor Psychotherapy is a method that integrates sensorimotor processing with cognitive and emotional processing in the treatment of trauma. Unassimilated somatic responses evoked in trauma involving both arousal and defensive responses are shown to contribute to many PTSD symptoms and to be critical elements in the use of Sensorimotor Psychotherapy. By using the body (rather than cognition or emotion) as a primary entry point in processing trauma, Sensorimotor Psychotherapy directly treats the effects of trauma on the body, which in turn facilitates emotional and cognitive processing. This method is especially beneficial for clinicians working with dissociation, emotional reactivity or flat affect, frozen states or hyperarousal and other PTSD symptoms. In this article, we discuss Sensorimotor Psychotherapy, emphasizing sensorimotor processing techniques which can be integrated with traditional approaches that treat these symptoms. Because the therapist’s ability to interactively regulate clients’ dysregulated states and also to cultivate clients’ self-of inner body sensations is crucial to this approach, three sessions are described illustrating the clinical application of this method.
This study aimed to investigate the interrelationship between posttraumatic stress, emotional processing difficulties, altered self-capacity, and pain catastrophising. A cross-sectional design gathered data from 249 participants completing an internet based survey. Respondents completed: The Posttraumatic Stress Diagnostic Scale; Emotional Processing Scale (EPS), the Inventory of Altered Self-Capacities (IASC), General Health Questionnaire-28 (GHQ-28) and the Pain Catastrophising Scale (PCS). Respondents were allocated to post-traumatic stress disorder (PTSD), no-PTSD (depending on whether they met the screening criteria of PTSD using the Posttraumatic Stress Diagnostic Scale), and control group. Partial least squares (PLS) analysis confirmed the hypotheses: PTSD was significantly associated with pain catastrophising and poor psychological well-being. PTSD was significantly correlated with altered self-capacity which was in turn significantly associated with emotional processing difficulties. Emotional processing was significantly associated with pain catastrophising and poor psychological well-being whilst poor psychological well-being was associated with pain catastrophising. Emotional processing difficulties mediated the association between altered self-capacity and pain catastrophising and poor psychological well-being. To conclude, people's psychological well-being and perceptions of pain are closely related to PTSD severity from past traumas as well as self-capacities. Furthermore, the way in which they process their emotions also has an important role to play.
In this chapter, we summarize the prevalence of benefit-finding and describe what is known about the related emotional and health advantages. We then briefly examine key assumptions about benefit-finding and offer several yet-to-be-tested alternatives to the dominant conceptualization of benefit-finding as a form of cognitive adaption. Finally we propose directions for future research and consider the implications of this area of inquiry for positive psychology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examined the influence of perceived pain control (PPC) and pain benefit appraisals (PBAs) on adjustment to rheumatoid arthritis (RA) in a 75-day study of 54 RA patients. After completing measures of dispositional optimism (M. Scheier and C. Carver; see record
1986-19862-001) and appraisals of control over, and benefits from, their chronic pain, Ss reported each day their pain intensity, mood, and activity limitations due to pain. Controlling for disease activity and dispositional optimism, Ss high in PPC at the outset of the study experienced less daily pain. Daily pain also moderated the relation between control beliefs and adjustment as well as the relation between PBA and adjustment. With increased pain, greater PPC was associated with less positive mood. (French abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
BACKGROUND
Pain is one of the most feared consequences of cancer and is experienced by up to 80% of patients with head and neck carcinoma (HNC). Pain in terminal HNC patients is common and often defined as severe. This study evaluated the effectiveness of the World Health Organization (WHO) analgesic ladder in the treatment of a cohort of terminal HNC patients.METHODS
The authors prospectively evaluated 62 consecutive terminal HNC patients admitted to the Chaim Sheba Medical Center Tel Hashomer Hospice or the general hospital. Data pertaining to tumor origin, spread, treatment, and results were defined. Pain was assessed with the McGill Pain Questionnaire, using a 10-point visual analogue scale (VAS) and a body map. Pain was diagnosed according to cause and type. Treatment was selected according to the guidelines provided in the WHO analgesic ladder.RESULTSOnly 10 patients suffered from pain that was not locoregional. The results of the VAS score were available in the first reading in all patients with pain (n = 48), with a mean of 4.7 (standard deviation [SD] ±2.0). A mean second VAS score obtained 72 hours after the first was 1.9 (SD ± 1.1). The difference between the two scores was statistically significant (P < 0.001). A third score was available for only 6 patients, with a mean of 1.6. Only 2 patients did not experience improvement of pain after 72 hours of treatment; both of these patients had bony involvement with tumor. Thirty-one patients (65%) were diagnosed with pain of nociceptive origin; these patients were categorized as having actual nociceptive pain (22), nociceptive nerve pain (6), or referred pain to the ear (3). Nonnociceptive pain of neuropathic origin was noted for only 6 patients (12.5%). Pain that could not be well defined but was responsive to opioid analgesic treatment was noted for 11 patients. A different form of non-cancer-related pain was noted for only one patient.CONCLUSIONS
Patients were treated for pain according to the WHO analgesic ladder. They received adequate narcotic analgesics and supportive measures that allowed significant reduction of pain in nearly all cases, with acceptable side effects. Cancer 1997; 80:1117-23. © 1997 American Cancer Society.
In this article, we reflect upon how bodies are experienced under torture. We centre this around Consuelo's personal experience, as a feminist lesbian and political activist tortured under the Chilean military government. We also draw on the training both of us received in science, which influenced our perceptions of how bodies work. Her story prompted a conversation about the gap between biomedical descriptions of bodies and the ways in which we experience our bodies and the apparent inarticulacy of pain. This conversation is both the methodology and the form of this article. We explore issues of violence and how that is built into the history of biomedicine and how this, in turn, feeds into political abuses of human rights. Another strand is power and control—built into the way scientists think about the body; yet control is deeply challenged when the body becomes uncontrollable to one/self during torture. We also talk about silence—silence both as something imposed on a prisoner and also as resistance. Biomedicine resurfaces here, too, when we speak of medical practices which silence us, as well as of the literal presence of doctors in the torture room. One purpose of this article, then, is to break that silence.
Recent models of the relationship between posttraumatic stress and whiplash pain suggest that psychological stress relating to a motor vehicle crash may influence pain perception. The mechanisms of this relationship may be through more direct, psychological pathways, or through factors proposed by the fear-avoidance models of chronic pain. This study sought to investigate the relative contribution of fear-of-pain and trauma symptomatology to daily pain and time spent in an upright posture (uptime) in chronic whiplash-associated disorder (WAD).
Hourly electronic-diary reports were used to explore the within-day relationship of psychological trauma symptoms and fear-of-pain to same-hour and next-hour pain reports and next-hour uptime (measured by accelerometers) in 32 individuals with a chronic WAD. Within-person effects were analyzed for 329 diary entries using multilevel modeling with fixed slopes and random intercepts.
Reports of trauma-related hyperarousal were associated with greater same-hour pain, and this relationship was mediated by fear-of-pain. Fear-of-pain and uptime were independently associated with reports of increased next-hour pain (controlling for first-order serial autocorrelation). Fear-of-pain was unrelated to next-hour uptime, but trauma-related avoidance symptoms were associated with reduced uptime. This study supports the relationship between psychological trauma responses and pain, suggesting behavioral (avoidance) pathways and effects on pain perception through fear-of-pain. These findings reinforce the need to evaluate traumatic stress as a factor in recovery from WAD.
Unlabelled:
The reports on pain perception among former heroin addicts receiving methadone maintenance treatment (MMT) vary with regard to pain and intolerance threshold, and perception of suprathreshold stimuli has not been previously evaluated. Our aim was to systematically assess perception of threshold and suprathreshold noxious and innocuous stimuli with special attention to the effect of MMT dose and the presence of chronic pain. Noxious and innocuous, thermal and mechanical thresholds and ratings of suprathreshold heat-pain stimuli were measured among 31 MMT subjects receiving high and low MMT dose, with and without chronic pain, and in 17 healthy controls. The characteristics of chronic pain were also evaluated. MMT dose and chronic pain differentially affected pain perception. Whereas MMT dose did not affect thresholds, chronic pain MMT subjects exhibited increased pain threshold and pain-free MMT subjects exhibited decreased pain threshold compared with controls. MMT in general was associated with decreased perception of suprathreshold pain; however, MMT subjects with chronic pain exhibited increased suprathreshold pain ratings. It appears that subjects receiving MMT are hyperalgesic but that chronic pain in these subjects interferes with threshold measurements, inducing an apparent hypoalgesia. On the other hand, chronic pain reduces the analgesic effect of methadone seen in pain-free MMT subjects, amplifying suprathreshold pain perception. Factors such as chronic pain and MMT dose should be taken into account in future studies on pain perception in this population.
Perspective:
We show that the presence of chronic pain and methadone dose significantly affects perception of pain in former heroin addicts receiving MMT. Studying the alteration in pain perception in these subjects may contribute to understanding the high rates of chronic pain among them and may promote better treatment.
Torture is widely practiced throughout the world. Recent studies indicate that 50% of all countries, including 79% of the G-20 countries, continue to practice systematic torture despite a universal ban. It is well known that torture has numerous physical, psychological, and pain-related sequelae that can inflict a devastating and enduring burden on its victims. Health care professionals, particularly those who specialize in the treatment of chronic pain, have an obligation to better understand the physical and psychological effects of torture. This review highlights the epidemiology, classification, pain sequelae, and clinical treatment guidelines of torture victims. In addition, the role of pharmacologic and psychologic interventions is explored in the context of rehabilitation.
The aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on marital intimacy and sexual satisfaction has been examined in several studies. Nevertheless, the toll of war captivity on marital intimacy in relation to dyadic adjustment and sexual satisfaction remains unknown. In particular, the mediating role of marital intimacy in the relationship between PTSD symptoms and dyadic adjustment and between PTSD symptoms and sexual satisfaction has not yet been systematically explored thus far. Aims. This study aimed to examine the interrelationships of PTSD symptoms, dyadic adjustment, sexual satisfaction, and marital intimacy among ex-prisoners of war (ex-POWs).
A sample of Israeli veterans ex-POWs (ex-POWs: N = 105) from the 1973 Yom Kippur War and a matched comparison group of veterans who participated in the same war but were not held captive (control: N = 94) were compared in the study variables.
The PTSD inventory, dyadic adjustment scale, index of sexual satisfaction, and capacity for intimacy questionnaire. Results. Findings revealed that ex-POWs reported higher levels of PTSD symptoms and lower levels of dyadic adjustment and sexual satisfaction than comparable controls. There were also differences between the groups in the pattern of relations between PTSD symptoms, dyadic adjustment, sexual satisfaction, and marital intimacy. Finally, for ex-POWs, marital intimacy partially mediated the relationships between PTSD symptoms and dyadic adjustment and sexual satisfaction outcome measures.
PTSD symptoms are implicated in marital problems of ex-POWs. A significant relationship was found between the traumatized ex-POW's capacity for intimacy and both their sexual satisfaction and dyadic adjustment.
The purpose of this article is to describe the current state-of-the-art regarding the co-occurrence of the anxiety disorders and chronic pain. First, we describe the core characteristics of chronic pain and its co-occurrence with the anxiety disorders. Second, we review data on the prevalence of co-occurrence. Third, we describe the mutual maintenance and shared vulnerability models, both of which have been offered to explain the co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain and may have applicability to various other anxiety disorders. Fourth, we provide an integrative review of available research addressing the postulates of these models specific to the mechanisms of anxiety sensitivity, selective attention to threat, and reduced threshold for alarm. We conclude with general recommendations for improving assessment and treatment of patients who present with an anxiety disorder accompanied by clinically significant pain. Given that most of the available evidence has come from studies of PTSD and chronic pain, we provide a detailed agenda for future investigation of the co-occurrence of chronic pain and other anxiety disorders.
Hypotheses involving mediation are common in the behavioral sciences. Mediation exists when a predictor affects a dependent variable indirectly through at least one intervening variable, or mediator. Methods to assess mediation involving multiple simultaneous mediators have received little attention in the methodological literature despite a clear need. We provide an overview of simple and multiple mediation and explore three approaches that can be used to investigate indirect processes, as well as methods for contrasting two or more mediators within a single model. We present an illustrative example, assessing and contrasting potential mediators of the relationship between the helpfulness of socialization agents and job satisfaction. We also provide SAS and SPSS macros, as well as Mplus and LISREL syntax, to facilitate the use of these methods in applications.
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
The McGill Pain Questionnaire consists primarily of 3 major classes of word descriptors--sensory, affective and evaluative--that are used by patients to specify subjective pain experience. It also contains an intensity scale and other items to determine the properties of pain experience. The questionnaire was designed to provide quantitative measures of clinical pain that can be treated statistically. This paper describes the procedures for administration of the questionnaire and the various measures that can be derived from it. The 3 major measures are: (1) the pain rating index, based on two types of numerical values that can be assigned to each word descriptor, (2) the number of words chosen; and (3) the present pain intensity based on a 1-5 intensity scale. Correlation coefficients among these measures, based on data obtained with 297 patients suffering several kinds of pain, are presented. In addition, an experimental study which utilized the questionnaire is analyzed in order to describe the nature of the information that is obtained. The data, taken together, indicate that the McGill Pain Questionnaire provides quantitative information that can be treated statistically, and is sufficiently sensitive to detect differences among different methods to relieve pain.
The paper reports on the role of consultation-liaison psychiatry in a pain clinic, where posttraumatic disorders are prevalent. An original approach to consultation is described.
In multiple studies cultural affiliation has been found to have an important influence on perception of and response to experimental and acute pain. Despite that evidence little work has been directed to understanding the cultural dimensions of the chronic pain experience. We present the results of a quantitative study of reported chronic pain perception in 372 chronic pain patients in six ethnic groups, who were under treatment at a multidisciplinary pain-management center. The role of ethnic and cultural experiences in the complex array of physical, cultural, psychological and social factors which influence the chronic pain experience is identified. Ethnocultural affiliation is important to chronic pain perception and response variation. In this study population the best predictors of pain intensity variation are ethnic group affiliation and locus of control (LOC) style (ethnic group identity is also a predictor of LOC style). It appears that pain intensity variation may be affected by differences in attitudes, beliefs and emotional and psychological states associated with the different ethnic groups. This study suggests a biocultural model may be useful in conceptualizing the complex interaction of biological, cultural and psychosocial factors in the process of human pain perception. Although it is likely that intense pain affects attitudes and emotions, it is also very likely that attitudes and emotions influence reported perceptions of pain intensity. Pain intensity variation in this study population is not significantly associated with diagnosis, present medication types, or types of past treatments or surgeries for pain.