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Barker-Collo, Suzanne L. MA, PhD, Andrew K. Moskowitz PhD (2005)
Profiles of DES Performance in Inmate and Student Samples
Journal of Trauma and Dissociation; Vol 6 nr. 1., 113 - 124 2005
ABSTRACT Despite the finding of a recent review of the literature (Moskowitz, 2004) that at least 25% of offenders demonstrated pathological levels of dissociation, very little empirical research has been conducted that examines dissociation in samples of prison inmates. This study examined the profiles of dissociative experiences reported in a sample of 42 prison inmates, when compared to 119 students on the Dissociative Experiences Scale. Profile analysis indicated that overall DES performances differed significantly for the two samples. Using Hotelling's criterion, DES items were found to deviate significantly from flatness, and using Wilks's criterion, the profiles also found to differ significantly from parallelism (p < .01). Specific items contributing to these differences were examined. It is hypothesized that some of these items may be reflective of past criminal activities rather than dissociation. As DES-taxon item content reflects less susceptibility to alternative interpretations, it is recommended that both researchers and clinicians consider using the DES-taxon, rather than DES total scores when examining dissociation in forensic samples.
Bateman A, Fonagy P. (2003)
Halliwick Day Unit, St. Ann's Hospital, St. Ann's Road, London N15 3TH, UK. anthony@abate.org.uk
Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care.
Am J Psychiatry. 2003 Jan;160(1):169-71.

ABSTRACT OBJECTIVE: The authors assessed health care costs associated with psychoanalytically oriented partial hospital treatment for borderline personality disorder compared with treatment as usual within general psychiatric services. METHOD: Health care utilization of all borderline personality disorder patients who participated in a previous trial of partial hospital treatment compared with treatment as usual was assessed by using information from case notes and service providers. Costs were compared for the 6 months before treatment, 18 months of treatment, and an 18-month follow-up period. RESULTS: There were no cost differences between the groups during pretreatment or treatment. Costs of partial hospital treatment were offset by less psychiatric inpatient care and reduced emergency room treatment. The trend for costs to decrease in the partial hospitalization group during the follow-up period was not apparent in the treatment-as-usual group. CONCLUSIONS: Specialist partial hospital treatment for borderline personality disorder is no more expensive than treatment as usual and shows considerable cost savings after treatment.

Bateman A, Fonagy P. (2001)
Halliwick Day Unit, St. Ann's Hospital, St. Ann's Road, London N15 3TH, UK. anthony@abate.org.uk
Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up.
Am J Psychiatry. 2001 Jan;158(1):36-42.

ABSTRACT OBJECTIVE: The aim of this study was to determine whether the substantial gains made by patients with borderline personality disorder following completion of a psychoanalytically oriented partial hospitalization program, in comparison to patients treated with standard psychiatric care, were maintained over an 18-month follow-up period. METHOD: Forty-four patients who participated in the original study were assessed every 3 months after completion of the treatment phase. Outcome measures included frequency of suicide attempts and acts of self-harm, number and duration of inpatient admissions, service utilization, and self-reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment. RESULTS: Patients who completed the partial hospitalization program not only maintained their substantial gains but also showed a statistically significant continued improvement on most measures in contrast to the patients treated with standard psychiatric care, who showed only limited change during the same period. CONCLUSIONS: The superiority of psychoanalytically oriented partial hospitalization over standard psychiatric treatment found in a previous randomized, controlled trial was maintained over an 18-month follow-up period. Continued improvement in social and interpersonal functioning suggests that longer-term changes were stimulated.

Bateman A, Fonagy P. (2001)
Halliwick Day Unit, St. Ann's Hospital, St. Ann's Road, London N15 3TH, UK. anthony@abate.org.uk
Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial.
Am J Psychiatry. 1999 Oct;156(10):1563-9.

ABSTRACT OBJECTIVE: This study compared the effectiveness of psychoanalytically oriented partial hospitalization with standard psychiatric care for patients with borderline personality disorder. METHOD: Thirty-eight patients with borderline personality disorder, diagnosed according to standardized criteria, were allocated either to a partially hospitalized group or to a standard psychiatric care (control) group in a randomized controlled design. Treatment, which included individual and group psychoanalytic psychotherapy, was for a maximum of 18 months. Outcome measures included the frequency of suicide attempts and acts of self-harm, the number and duration of inpatient admissions, the use of psychotropic medication, and self-report measures of depression, anxiety, general symptom distress, interpersonal function, and social adjustment. Data analysis used repeated measures analysis of covariance and nonparametric tests of trend. RESULTS: Patients who were partially hospitalized showed a statistically significant decrease on all measures in contrast to the control group, which showed limited change or deterioration over the same period. An improvement in depressive symptoms, a decrease in suicidal and self-mutilatory acts, reduced inpatient days, and better social and interpersonal function began at 6 months and continued until the end of treatment at 18 months. CONCLUSIONS: Psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. Replication is needed with larger groups, but these results suggest that partial hospitalization may offer an alternative to inpatient treatment.

Becker-Blease, Kathryn A. PhD, Jennifer J. Freyd PhD, Katherine C. Pears PhD (2004)
Preschoolers' Memory for Threatening Information Depends on Trauma History and Attentional Context: Implications for the Development of Dissociation
Journal of Trauma and Dissociation, vol 5 issue 1, 2004, 113 - 131 DOI: 10.1300/J229v05n01_07
ABSTRACT Although the roots of dissociative ability are thought to lie in early childhood, little is understood about how or why children dissociate or how dissociative abilities develop over time. Previous cognitive studies of adults suggest that some dissociative adults use divided attention to keep threatening information out of awareness (DePrince & Freyd, 1999, 2001). This study utilized a divided attention memory task similar to those used by DePrince and Freyd (DePrince & Freyd, 1999), but modified for fourand five-year-olds. Contrary to prediction, children with relatively high dissociation scores did not differ in their memory for charged and neutral pictures under divided attention when compared to children with low dissociation scores. Consistent with predictions, under divided attention, abused children remembered fewer charged pictures relative to non-abused children. The same pattern was found when comparing abused children with high dissociation scores to non-abused children with low dissociation scores. These results are consistent with the idea that some traumatized people use divided attention to keep threatening information out of awareness. Results are discussed in terms of a developmental theory of dissociation.
Beere, Donald B.; Simon, Melinda J.; Welch, Kenneth (2001)
Recommendations and illustrations for combining hypnosis and EMDR in the treatment of psychological trauma. (2001)
American Journal of Clinical Hypnosis. 2001 Jan-Apr Vol 43(3-4) 217-231
ABSTRACT Evaluates the combination of hypnotherapy and EMDR. Three experienced therapists, trained in hypnosis and EMDR, distilled some tentative hypotheses about the use of hypnosis in EMDR from 15 cases, 2 presented here (a 34-yr-old female with posttraumatic stress disorder (PTSD) and a 16-yr-old female diagnosed with Atypical Dissociative Disorder). Both cases focused on resolving traumatic issues using EMDR. An overview of EMDR is provided, including a discussion pertaining to its efficacy. Similarities and differences between the 2 treatment techniques are discussed.
Bender DS, Dolan RT, Skodol AE, Sanislow CA, Dyck IR, McGlashan TH, Shea MT, Zanarini MC, Oldham JM, Gunderson JG. (2001)
Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA. benderd@pi.cpmc.columbia.edu
Treatment utilization by patients with personality disorders.
Am J Psychiatry. 2001 Feb;158(2):295-302.
ABSTRACT OBJECTIVE: Utilization of mental health treatment was compared in patients with personality disorders and patients with major depressive disorder without personality disorder. METHOD: Semistructured interviews were used to assess diagnosis and treatment history of 664 patients in four representative personality disorder groups-schizotypal, borderline, avoidant, and obsessive-compulsive-and in a comparison group of patients with major depressive disorder. RESULTS: Patients with personality disorders had more extensive histories of psychiatric outpatient, inpatient, and psychopharmacologic treatment than patients with major depressive disorder. Compared to the depression group, patients with borderline personality disorder were significantly more likely to have received every type of psychosocial treatment except self-help groups, and patients with obsessive-compulsive personality disorder reported greater utilization of individual psychotherapy. Patients with borderline personality disorder were also more likely to have used antianxiety, antidepressant, and mood stabilizer medications, and those with borderline or schizotypal personality disorder had a greater likelihood of having received antipsychotic medications. Patients with borderline personality disorder had received greater amounts of treatment, except for family/couples therapy and self-help, than the depressed patients and patients with other personality disorders. CONCLUSIONS: These results underscore the importance of considering personality disorders in diagnosis and treatment of psychiatric patients. Borderline and schizotypal personality disorder are associated with extensive use of mental health resources, and other, less severe personality disorders may not be addressed sufficiently in treatment planning. More work is needed to determine whether patients with personality disorders are receiving adequate and appropriate mental health treatments.
Bethelard F, Young-Bruehl E (1999)
The wise baby as the voice of the true self.
Psychoanal Q 1999 Oct;68(4):585-610
ABSTRACT Sandor Ferenczi wrote about a typical dream of the "Wise Baby" and later used this figure to represent the child who is traumatized into precocious wisdom, who becomes "the family psychiatrist." We discuss Ferenczi's theory of traumatization and the "split self," noting how it was taken up in D. W. Winnicott's "True Self/False Self" conceptualization. We then present three patients' wise baby dreams to show how these trauma theories can be used in dream interpretation and how dream interpretation can support them
Birck, Angela (1999)
Contents of psychotherapy with asylum seeking torture victims
Torture, Quarterly journal Vol. 9 (1999), no. 4 (dec), pag. 115-118.
ABSTRACT The Behandlungszentrum für Folteropfer Berlin (BZFO, treatment centre for torture victims) treats persons with histories of persecution and torture. Most are refugees. A residence permit (granted asylum) is not a precondition for treatment. Instead, most of the patients live with an insecure residence status as asylum seekers. In a cross-case content analysis of 20 detailed psychotherapy protocols of former patients, different psychotherapy topics (course of symptoms, traumatic events, asylum seeking situation, social problems, country of origin, etc.) were assessed to describe the chronological relation between exile situation and psychotherapy contents. During psychotherapy sessions actual problems of the process of seeking asylum appeared to be a more freuqent topic than the original traumatizations. Events in the context of seeking asylum frequently lead to aggravation of symptoms and to retraumatization.
Birmes P, Brunet A, Carreras D, Ducasse JL, Charlet JP, Lauque D, Sztulman H, Schmitt L. (2003)
Service Universitaire de Psychiatrie et Psychologie Medicale, Hospital Casselardit la Grave, France. birmes.p@chu-toulouse.fr
The predictive power of peritraumatic dissociation and acute stress symptoms for posttraumatic stress symptoms: a three-month prospective study.
Am J Psychiatry. 2003 Jul;160(7):1337-9.
ABSTRACT OBJECTIVE: The authors prospectively examined the power of peritraumatic dissociation and acute stress symptoms in predicting posttraumatic stress disorder (PTSD) symptoms. METHOD: Thirty-five assault victims were assessed with the Peritraumatic Dissociative Experiences Questionnaire within 24 hours of the assault. Participants were reassessed 2 weeks after the trauma with the Stanford Acute Stress Reaction Questionnaire and 3 months after the trauma with the Clinician-Administered PTSD Scale and the Impact of Event Scale. Correlational analyses and a hierarchical multiple regression were conducted. RESULTS: Peritraumatic dissociation and acute stress symptoms were correlated with later PTSD symptoms and diagnosis. Together, peritraumatic dissociation and acute stress symptoms accounted for 33% of the variance in PTSD symptoms. CONCLUSIONS: These results support earlier findings that peritraumatic dissociative experiences and acute stress are robust predictors of PTSD. Such symptoms may be of use for identifying at an early stage individuals at highest risk of remaining symptomatic. Future studies should investigate the predictive power of specific peritraumatic and acute stress disorder symptom clusters.
Blizard, Ruth A. PhD(2003)
Disorganized Attachment, Development of Dissociated Self States, and a Relational Approach to Treatment
J. of Trauma and Dissociation, Volume 4, Number 3, (27) 2003
ABSTRACT Disorganized (D) attachment, and the double-bind characteristics of the relationships that foster it, form a basis for theoretical approaches to understanding the development of alternating, dissociated self states with incompatible, idealizing/devaluing or victim/persecutor models of attachment, such as are observed in borderline personality and dissociative disorders. This model proposes that the double binds inherent in abuse by a primary caretaker are likely to generate two or more dissociated self states, with contradictory working models of attachment. In contrast, because dissociated states ensuing from extra-familial trauma can be expected to have been constructed primarily around fear, all parts of the self will operate according to the same attachment paradigm. Because relationships within the family of origin appear at least as important as trauma in the development of dissociated self states, this has important implications for treatment of child abuse survivors. D attachment may result from several parental behaviors: abuse, neglect, frightening, intrusive or insensitive manner; and disrupted affective communication. Longitudinal research demonstrates that D attachment in infancy predicts dissociation in childhood and early adulthood. Theoretical models describing the relationships among D attachment, the development of segregated internal working models of attachment, and the emergence of dissociated self states will be discussed. A relational approach to therapy calls for consideration of attachment issues in creating the frame for therapy and tailoring treatment to the individual trauma survivor. The therapist can serve as a relational bridge between dissociated self states, allowing the patient to internalize a working model of the therapeutic relationship. This interaction provides a vehicle for integrating dissociated self states and opportunity for development of more flexible, adaptive models of being with others.
Bluhm, H.O. (1999)
How did they survive? Mechanisms of defense in Nazi concentration camps.
American Journal of Psychotherapy, 53, 96-122.
ABSTRACT 2 autobiographical accounts of experiences in Nazi concentration camps were examined to determine what mechanisms of defense were developed by the ego to protect the prisoner from physical death and mental disintegration. The most typical mechanisms among those who survived included depersonalization (feelings of estrangement, emotional frigidity, and self-observation), self-expression, marked regression, attempts at sublimation, and close identification with an ego-ideal.
Bray A. (2003)
Moral responsibility and borderline personality disorder.
Aust N Z J Psychiatry. 2003 Jun;37(3):270-6.
ABSTRACT OBJECTIVE: To examine the concepts of free will and moral responsibility in a psychiatric context, and to consider whether those with borderline personality disorder (BPD) may be considered responsible for their actions. METHOD: A wide, but necessarily incomplete, range of literature was reviewed in the fields of psychiatry and philosophy. I offer a set of criteria for responsible action and examine some features of BPD in the light of these criteria. RESULTS: Impulsivity, acting out and the less severe forms of dissociation do not vitiate responsibility. Severe dissociative and psychotic symptoms may well render people with BPD less morally responsible for their actions. CONCLUSIONS: Comorbid conditions in BPD may also affect the ability to act responsibly.
Richard J. Brown, Ph.D., Clin.Psy.D., Anette Schrag, M.D., Ph.D., and Michael R. Trimble, M.D. (2005)
Dissociation, Childhood Interpersonal Trauma, and Family Functioning in Patients With Somatization Disorder
Am J Psychiatry 162:899-905, May 2005
ABSTRACT OBJECTIVE: The goals of this study were to determine 1) the occurrence of various dissociative phenomena in patients with somatization disorder, 2) the occurrence of six different types of childhood interpersonal trauma in these patients, and 3) the nature of these patientsí early family environment. METHOD: Twenty-two patients with somatization disorder and 19 medical comparison subjects completed the Structured Clinical Interview for DSM-IV Dissociative Disorders, the Childhood Trauma Interview, and the Family Functioning Scale. RESULTS: The somatization disorder patients reported significantly higher level of dissociative amnesia than the comparison subjects. The two groups reported similar levels of depersonalization, derealization, identity confusion, and identity alteration. Somatization disorder patients reported significantly greater childhood emotional abuse and more severe forms of physical abuse, relative to the comparison subjects, with chronic emotional abuse being the best predictor of unexplained symptoms. Childhood sexual abuse, separation/loss, and witnessing violence were equally common in the two groups. The somatization disorder group reported significantly more family conflict and less family cohesion. CONCLUSIONS: Only some types of dissociation are more severe in patients with somatization disorder, relative to medical comparison subjects. Many patients with somatization disorder are raised in an emotionally cold, distant, and unsupportive family environment characterized by chronic emotional and physical abuse. Sexual abuse is not a necessary prerequisite for the disorder.

Bolm T, Piegler T. (2001)
Abteilung fur Psychiatrie und Psychotherapie des AK Bergedorf, Hamburg.
Naltrexone in the Treatment of Dissociative Disorders - Reflections with Regard to a Comprehensive Therapeutic Concept of Borderline Disorders
Psychiatr Prax 2001 Jul;28(5):214-218

ABSTRACT OBJECTIVE: Not until one year ago has it become more and more known in German speaking countries, that the treatment of borderline and posttraumatic disorders benefits from the use of opiate receptor antagonists. Prerequisite is, that psychotherapeutic approaches, pharmacotherapy and brainphysiological research are integrated in an overall concept. METHODS: We report on the current standing of scientific research and moreover our own clinical experiences with opiate antagonists are explained. CONCLUSIONS: Our achieved knowledge permits our to present criteria how to combine these drugs and psychotherapy successfully.

Boon S. B (1997)
The treatment of traumatic memories in DID: Indications and contra-indications.
Dissociation: Progress in the Dissociative Disorders, 10, 65-79.

ABSTRACT A treatment model with a focus on trauma treatment and subsequent integration is widely accepted as the most successful among therapists treating dissociative identity disorder (DID). However, this model may not be the best option for all DID patients. Lower functioning patients often do not have the strength or therapeutic potential and/or opportunity to endure this kind of treatment. This article discusses indications and contra-indications for entering into the second phase in the treatment of DID patients: the treatment of traumatic memories. A checklist was developed to evaluate the treatment process and make a well-founded decision about the transition from phase I, stabilization and symptom reduction, to phase II, treatment of traumatic memories. Criteria that influence a decision to focus on phase I only, without proceeding to phase II, will be discussed. Clinical examples will demonstrate the use of the checklist.
Van Den Bosch LM, Verheul R, Langeland W, Van Den Brink W.(2003)
Academic Medical Centre, University of Amsterdam, The Netherlands. wiesvdbosch@wxs.nl
Trauma, dissociation, and posttraumatic stress disorder in female borderline patients with and without substance abuse problems.
Aust N Z J Psychiatry. 2003 Oct;37(5):549-55.
ABSTRACT OBJECTIVE: To examine the associations of childhood traumatic experiences and childhood neglect with dissociative experiences and posttraumatic stress disorder (PTSD) in a population of female borderline personality disorder (BPD) patients with and without substance abuse. METHOD: The sample included 64 female patients with BPD. Childhood traumatic experiences and childhood neglect were measured using the Structured Trauma Interview, dissociative experiences with the Dissociative Experiences Scale, and PTSD with the Structured Clinical Interview for DSM-IV. RESULTS: In general, dissociation scores were higher among those with a history of childhood trauma and neglect, in particular among those who reported both sexual and physical abuse before age 16, more than one perpetrator and severe maternal dysfunction. The prevalence of PTSD was clearly associated with the severity of childhood sexual abuse (CSA) in terms of the occurrence of penetration during CSA, intrafamilial CSA, a duration of CSA longer than 1 year and more than one perpetrator. Comorbid substance abuse problems modified the observed associations such that the associations mentioned above were also present or even more pronounced among those without substance abuse, whereas no associations were found in those with substance abuse. CONCLUSIONS: The results suggest a moderately strong association between childhood trauma and neglect with dissociation and PTSD. However, trauma-dissociation and trauma-PTSD links were only observed among BPD patients without addictive problems. The findings are largely consistent with the literature. Potential explanations for the lack of a trauma-dissociation and trauma-PTSD link in the addicted subgroup are discussed.

Bot, Hanneke and Martien Kooyman (1999)
Traumatic experiences among female refugees in the Netherlands and the consequences to their  mental health
Torture, Quarterly journal on Rehabilitation of Torture Victims and Prevention of Torture ISSN 0904-1982: Vol. 9 (1999), no. 4 (dec), pag. 110-114.

Bowman ES, Coons PM (2000)
Indiana University School of Medicine, Indianapolis, USA.
The differential diagnosis of epilepsy, pseudoseizures, dissociative identity disorder, and
dissociative disorder not otherwise specified.
    
Bull Menninger Clin 2000 Spring;64(2):164-80

ABSTRACT The authors review the co-occurrences of dissociative symptoms and disorders with epilepsy and pseudoseizures and examine newer diagnostic instruments that assist in accurate diagnosis of persons with concomitant seizure behaviors and dissociative symptoms. They also review seizure behaviors and electroencephalographic findings in persons with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) and dissociative symptoms in persons with epilepsy and with pseudoseizures. Dissociative symptoms in 15 patients with epilepsy and 15 with pseudoseizures were examined using the Dissociative Experiences Scale (DES) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). On the SCID-D, pseudoseizure patients had significantly higher dissociative symptom scores than epileptic patients, but DES scores did not reliably distinguish epileptic and pseudoseizure patients. Misdiagnosis of persons with seizures and dissociative symptoms can be avoided by careful adherence to DSM dissociative disorder criteria, the use of video-EEG monitoring, and systematic assessment of dissociative symptoms with the SCID-D.

Bowman ES, Coons PM (1992)
Department of Psychiatry, Indiana University School of Medicine, Indianapolis 46202-5109.
The use of electroconvulsive therapy in patients with dissociative disorders.     
J Nerv Ment Dis. 1992 Aug;180(8):524-8.

ABSTRACT The psychiatric literature generally discourages the use of electroconvulsive therapy (ECT) to treat depression in dissociative disorder patients, but contains little data on outcome. This prospective study of ECT in three dissociative disorder patients demonstrates that ECT is indicated for severe treatment-resistant depression in such patients. Their Hamilton Depression Scale scores fell by 50%, they were remarkably clinically improved, and they maintained their gains for at least 4 months. The ECT proved helpful when depression was felt by most of the active alters rather than just by one depressed personality. Mini-Mental State Examination scores and clinical observation revealed no unusual confusion or side effects from ECT. These patients' dissociated condition was not altered by ECT, which indicates that ECT neither treats nor impairs treatment of dissociation. Electroconvulsive therapy can be helpful in the overall treatment of dissociative disorders by alleviating severe depressions which block utilization of psychotherapy.

Bowman, Elisabeth
Delayed Memories of Child Abuse: Part I: An Overview of Research Findings on Forgetting, Remembering and Corroborating Trauma.

Dissociation, IX (4) pp. 221-231.

Bramsen, Inge , Ph.D.; Anja J.E. Dirkzwager, , M.A. and Henk M. van der Ploeg, , Ph.D. (2000)
Predeployment Personality Traits and Exposure to Trauma as Predictors of Posttraumatic Stress Symptoms: A Prospective Study of Former Peacekeepers  
Am J Psychiatry 157:1115-1119, July 2000
ABSTRACT OBJECTIVE: The authors’ goal was to study the contribution of predeployment personality traits and exposure to traumatic events during deployment to the development of symptoms of posttraumatic stress disorder (PTSD) in individuals involved in military peacekeeping activities.METHOD: Five hundred seventy-two male veterans who participated in the United Nations Protection Force mission in the former Yugoslavia completed a short form of the Dutch MMPI before deployment. Following deployment, they participated in a survey of all Dutch military veterans who had been deployed in the years 1990–1995 and completed the Self-Rating Inventory for PTSD.RESULTS: Exposure to traumatic events during deployment had the highest unique contribution to the prediction of PTSD symptom severity, followed by the personality traits of negativism and psychopathology, followed by age.CONCLUSIONS: Both pretrauma vulnerabilities and exposure to traumatic events were found to be important factors in the etiology of posttraumatic stress symptoms. The current study replicates in a non-American sample of peacekeepers findings obtained among American Vietnam veterans. Particularly, there is accumulating evidence for an etiological role of the personality trait of psychoneuroticism in the development of posttraumatic stress symptoms.
Brenner I (1999)
Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder  
American Journal of Psychiatry Vol. 156 (1999), no. 11 (nov), pag. 1787-1795
ABSTRACT OBJECTIVE: Childhood sexual abuse is very common in our society, but little is known about the long-term effects of abuse on brain function. The purpose of this study was to measure neural correlates of memories of childhood abuse in sexually abused women with and without the diagnosis of posttraumatic stress disorder (PTSD). METHOD: Twenty-two women with a history of childhood sexual abuse underwent injection of [15O]H2O, followed by positron emission tomography imaging of the brain while they listened to neutral and traumatic (personalized childhood sexual abuse events) scripts. Brain blood flow during exposure to traumatic and neutral scripts was compared for sexually abused women with and without PTSD. RESULTS: Memories of childhood sexual abuse were associated with greater increases in blood flow in portions of anterior prefrontal cortex (superior and middle frontal gyri-areas 6 and 9), posterior cingulate (area 31), and motor cortex in sexually abused women with PTSD than in sexually abused women without PTSD. Abuse memories were associated with alterations in blood flow in medial prefrontal cortex, with decreased blood flow in subcallosal gyrus (area 25), and a failure of activation in anterior cingulate (area 32). There was also decreasedblood flow in right hippocampus, fusiform/inferior temporal gyrus, supramarginal gyrus, and visual association cortex in women with PTSD relative to women without PTSD. CONCLUSIONS: These findings implicate dysfunction of medial prefrontal cortex (subcallosal gyrus and anterior cingulate), hippocampus, and visual association cortex in pathological memories of childhood abuse in women with PTSD. Increased activation in posterior cingulate and motor cortex was seen in women with PTSD. Dysfunction in these brain areas may underlie PTSD symptoms provoked by traumatic reminders in subjects with PTSD.
Bremner JD, Vythilingam M, Vermetten E, Adil J, Khan S, Nazeer A, Afzal N, McGlashan T, Elzinga B, Anderson GM, Heninger G, Southwick SM, Charney DS. (2003)
Department of Psychiatry and Behavioral Sciences, Emory Center for Positron Emission Tomography, Emory University School of Medicine, 1364 Briarcliff Road, Atlanta, GA 30322, USA. jdbremn@emory.edu
Cortisol response to a cognitive stress challenge in posttraumatic stress disorder (PTSD) related to childhood abuse. 
Psychoneuroendocrinology. 2003 Aug;28(6):733-50.
ABSTRACT Preclinical studies show that animals with a history of chronic stress exposure have increased hypothalamic-pituitary-adrenal (HPA) axis reactivity following reexposure to stress. Patients with posttraumatic stress disorder (PTSD) have been found to have normal or decreased function of the HPA axis, however no studies have looked at the HPA response to stress in PTSD. The purpose of this study was to assess cortisol responsivity to a stressful cognitive challenge in patients with PTSD related to childhood abuse. Salivary cortisol levels, as well as heart rate and blood pressure, were measured before and after a stressful cognitive challenge in patients with abuse-related PTSD (N=23) and healthy comparison subjects (N=18). PTSD patients had 61% higher group mean cortisol levels in the time period leading up to the cognitive challenge, and 46% higher cortisol levels during the time period of the cognitive challenge, compared to controls. Both PTSD patients and controls had a similar 66-68% increase in cortisol levels from their own baseline with the cognitive challenge. Following the cognitive challenge, cortisol levels fell in both groups and were similar in PTSD and control groups. PTSD patients appeared to have an increased cortisol response in anticipation of a cognitive challenge relative to controls. Although cortisol has been found to be low at baseline, there does not appear to be an impairment in cortisol response to stressors in PTSD.
Brenner I (1999)
Upper-extremity self-amputation in a case of dissociative identity disorder. 
J Clin Psychiatry 1999 Oct;60(10):705-6
ABSTRACT Reports the case of a profoundly traumatized 37-yr-old female with a dissociative disorder who had urges to amputate her left hand. The S had been sexually abused as a child and as a college student. Such patients may be chronically suicidal with periods of greater impulsivity and higher risk who perform self-amputation to get rid of a defective or offending body part. The S eventually severed 1 finger on her left hand during the emergence of an altered personality, and a year later severed another finger on the same hand. Following this act she made important gains in therapy, although her prognosis remains guarded.
Brenner I. (1999)
Philadelphia Psychoanalytic Institute, PA, USA.   
Deconstructing DID.
Am J Psychother 1999 Summer;53(3):344-60
ABSTRACT The author contends that a psychoanalytically informed approach to the patient with dissociative identity disorder (DID) can be very useful. However, there are difficulties in conceptualizing this condition without extending existing theory or applying in new ways what is already known. It is also difficult to put DID in a proper context relative to all the other disorders known to occur in the human mind. Depending on one's clinical experience, level of skepticism, and appreciation of history, DID may be seen as either: a) the psychological "missing link" that realizes Freud's goal of uniting the psychology of dreams with psychopathology, or b) a fraudulent condition that is wittingly or unwittingly manufactured in the therapist's office or c) a population of disturbed and disturbing patients, once the subject of great scientific interest, which, exiled like a "Lost Tribe," is now back in the fold of legitimacy. The author has had extensive clinical experience with psychic trauma, and bases his own views of DID on three assumptions: 1. that dissociation may be seen as a complex defense; 2. that DID may be thought of as a "lower level dissociative character"; and 3. that there is a unique psychic structure, the "dissociative self" whose function is to create "alter personalities" out of disowned affects, memories, fantasies, and drives. This "dissociative self" must be dissolved in order for integration of "alter personalities" to occur. A clinical vignette is offered to illustrate how he addresses some of the challenges of developing a therapeutic alliance at this end of the dissociative-character-pathology continuum, and how he grapples with the difficulty of integrating clinical phenomena, such as the appearance of "alters," with the psychoanalytic model of the mind.
Bromberg, Philip M. (2003)
One need not be a house to be haunted: On enactment, dissociation, and the dread of "not-me"
A case study. Psychoanalytic Dialogues. Vol 13(5) 2003, 689-709.
ABSTRACTThis paper examines psychic trauma as experience so shockingly strange that it exceeds the threshold for cognitive processing and begins to flood the mind with unintegratable affect that threatens to disorganize the internal template on which one's experience of self-coherence, self cohesiveness, and self-continuity depends. A detailed clinical vignette illustrates how the unprocessed "not-me" experience held by a dissociated self-state as an affective memory without an autobiographical memory of its traumatic origin "haunts" the self. It remains a ghostly horror even in an otherwise successful psychoanalysis unless a new perceptual reality is created between patient and analyst that alters the narrative structure maintaining the dissociation as though the past were still a present danger. The analyst's making optimal use of dissociative processes in an intersubjective and interpersonal context enables the patient more readily to self-regulate affect in those areas of implicit memory where trauma has left its mark; the dissociated ghosts of "notme" are thus persuaded, little-by-little, to cease their haunting and participate more and more actively and openly as self-reflective, selfexpressive parts of "me."
Brown, P., van der Hart, O., & Graafland, M. (1999).    
Trauma-induced dissociative amnesia in World War I combat soldiers. II. Treatment dimensions.
Australian & New Zealand Journal of Psychiatry, 33, 392-398.
ABSTRACT This is the 2nd part of a study of posttraumatic amnesia (PTA) in World War I (WWI) soldiers (see O. Van der Hart et al, 1999-10659-005, for the 1st part of the study). It moves beyond diagnostic validation of PTA to examine treatment findings and relates these to contemporary treatment of dissociative amnesia, including treatment of victims of civilian trauma (e.g., childhood sexual abuse). Key WWI studies were surveyed which focus on the treatment of PTA and traumatic memories. The dissociation-integration and repression-abreaction models are contrasted. Descriptive evidence is cited in support of preferring C. S. Myers' (1920-21 ) and W. McDougall's (1920-21, 1926) dissociation-integration treatment approach over W. Brown's (1920-21) repression-abreaction model. Therapeutic findings in this paper complement diagnostic data from the 1st report. Although effective treatment includes elements of both the dissociative-integrative and abreactive treatment approaches, cognitive integration of dissociated traumatic memories and personality functions is primary, while emotional release is secondary.
Brunet A, Weiss DS, Metzler TJ, Best SR, Neylan TC, Rogers C, Fagan J, Marmar CR. (2001)   
Department of Psychiatry, University of California, San Francisco, USA. brunal@douglas.mcgill.ca
The Peritraumatic Distress Inventory: a proposed measure of PTSD criterion A2.
Am J Psychiatry 2001 Sep;158(9):1480-5
ABSTRACT OBJECTIVE: Meeting criterion A2 for the diagnosis of posttraumatic stress disorder (PTSD) in DSM-IV requires that an individual have high levels of distress during or after the traumatic event. Because of the paucity of valid and reliable instruments for assessing such responses, the authors developed a 13-item self-report measure, the Peritraumatic Distress Inventory, to obtain a quantitative measure of the level of distress experienced during and immediately after a traumatic event. METHOD: The cross-sectional study group comprised 702 police officers and 301 matched nonpolice comparison subjects varying in ethnicity and gender who were exposed to a wide range of critical incidents. RESULTS: The Peritraumatic Distress Inventory was found to be internally consistent, with good test-retest reliability and good convergent and divergent validity. Even after controlling for peritraumatic dissociation and for general psychopathology, the authors found that Peritraumatic Distress Inventory scores correlated with two measures of posttraumatic stress symptoms. CONCLUSIONS: The Peritraumatic Distress Inventory holds promise as a measure of PTSD criterion A2. Future studies should prospectively examine the ability of the Peritraumatic Distress Inventory to predict PTSD and its associated biological and cognitive correlates in other trauma-exposed groups.
Brunner R, Parzer P, Schuld V, Resch F (2000)    
Department of Child and Adolescent Psychiatry, University of Heidelberg, Germany.
Dissociative symptomatology and traumatogenic factors in adolescent psychiatric patients.
J Nerv Ment Dis 2000 Feb;188(2):71-7
ABSTRACT This study describes the relation of different types of childhood trauma to the degree of dissociative experiences. Subjects were 198 consecutively admitted adolescent psychiatric patients, 11 to 19 years old (89 inpatients and 109 outpatients). All patients completed the Adolescent Dissociative Experiences Scale. A Checklist of Traumatic Childhood Events was filled out by clinicians. The results showed an increase in the degree of dissociative experiences in patients with a history of sexual abuse, physical abuse, neglect, and stressful life events. With the exception of life events, a moderate form of traumatic experience had the same effect on dissociative experiences as severe forms. The strongest effect was found for emotional neglect, which seems to be an important pathogenic risk factor. The results suggest that therapists and researchers should be aware that even less severe forms of abuse and neglect may have a significant impact on the development of dissociative psychopathology in adolescents.
Buchholz, Ester S PhD, and Elizabeth Helbraun, PsyD (1999)
A psychobiological developmental model for an 'alonetime' need in infancy
Bulletin of the Menninger Clinic, Vol. 63, No. 2, pp. 143-158, Spring 1999
ABSTRACT The authors make the case for a primary "alonetime" need in infancy that is both biologically based and psychologically warranted. Disengagement patterns in infancy support an aloneness need existing parallel to one for attachment. Long-held views in the psychological literature on solitude are examined. Further evidence from medical research on fetal development and from research on dyadic interaction in infancy suggests proof of the primacy of a positive experience of aloneness in infancy. The important requisite of self-regulation is discussed as well, in light of satisfactory alonetimes. The final argument stresses the equal importance of maternal sensitivity to infants' alonetime needs as well as those for attachment  
Buckner RL, Koutstaal W (1998)    
Departments of Psychology, Anatomy and Neurobiology, and Radiology, Washington University, St. Louis, MO 63130, USA.
Functional neuroimaging studies of encoding, priming, and explicit memory retrieval.
Proc Natl Acad Sci U S A 1998 Feb 3;95(3):891-8
ABSTRACT Human functional neuroimaging techniques provide a powerful means of linking neural level descriptions of brain function and cognition. The exploration of the functional anatomy underlying human memory comprises a prime example. Three highly reliable findings linking memory-related cognitive processes to brain activity are discussed. First, priming is accompanied by reductions in the amount of neural activation relative to naive or unprimed task performance. These reductions can be shown to be both anatomically and functionally specific and are found for both perceptual and conceptual task components. Second, verbal encoding, allowing subsequent conscious retrieval, is associated with activation of higher order brain regions including areas within the left inferior and dorsal prefrontal cortex. These areas also are activated by working memory and effortful word generation tasks, suggesting that these tasks, often discussed as separable, might rely on interdependent processes. Finally, explicit (intentional) retrieval shares much of the same functional anatomy as the encoding and word generation tasks but is associated with the recruitment of additional brain areas, including the anterior prefrontal cortex (right > left). These findings illustrate how neuroimaging techniques can be used to study memory processes and can both complement and extend data derived through other means. More recently developed methods, such as event-related functional MRI, will continue this progress and may provide additional new directions for research.
Burton N, Lane RC. (2001)   
The relational treatment of dissociative identity disorder.
Clin Psychol Rev 2001 Mar;21(2):301-20.
ABSTRACT The intent of this paper is to review the literature pertaining to the transference and countertransference components in the treatment of dissociative identity disorder. Aspects of transference and countertransference are presented and discussed within the relational psychoanalytic model. The functions of empathy, enactment, projective identification, and transitional objects are reviewed. Specific attitudes in the transference and countertransference are illuminated and major transference themes are discussed. Finally, a case vignette illustrates some of the central issues involved in the treatment of dissociative identity disorder.
Bull, D.L (1999)   
A verified case of recovered memories of sexual abuse
American Journal of Psychotherapy, 53(2), Spring, 1999, 221-4.
ABSTRACT A case is presented that shows verifiable evidence of repression at work. Rachel, a 40-year-old woman with no history of mental illness and ten years of exemplary professional work, recovers memories of childhood sexual abuse by her father through a call from her youth pastor in whom she had confided as an adolescent. This reminder triggered a severe depression, suicidal action, and the need for hospitalization. Rachel's older sister, herself an abuse victim, had witnessed the abuse, yet Rachel had no memory of the events. No apparent causes of false memories are present, so a different mechanism than forgetting must have been at work.
Butzel JS, Talbot NL, Duberstein PR, Houghtalen RP, Cox C, Giles DE (2000)   
Department of Psychiatry, University of Rochester School of Medicine and Dentistry, New York 14642, USA.
The relationship between traumatic events and dissociation among women with histories of childhood sexual abuse.
J Nerv Ment Dis 2000 Aug;188(8):547-9