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Nader, Karim; Glenn E. Schafe, Joseph Le Doux (2000)
Fear memories require protein synthesis in the amygdala for reconsolidation after retrieval  
Nature 406, 722 - 726 (2000)
ABSTRACT 'New' memories are initially labile and sensitive to disruption before being consolidated into stable long-term memories. Much evidence indicates that this consolidation involves the synthesis of new proteins in neurons. The lateral and basal nuclei of the amygdala (LBA) are believed to be a site of memory storage in fear learning. Infusion of the protein synthesis inhibitor anisomycin into the LBA shortly after training prevents consolidation of fear memories. Here we show that consolidated fear memories, when reactivated during retrieval, return to a labile state in which infusion of anisomycin shortly after memory reactivation produces amnesia on later tests, regardless of whether reactivation was performed 1 or 14 days after conditioning. The same treatment with anisomycin, in the absence of memory reactivation, left memory intact. Consistent with a time-limited role for protein synthesis production in consolidation, delay of the infusion until six hours after memory reactivation produced no amnesia. Our data show that consolidated fear memories, when reactivated, return to a labile state that requires de novo protein synthesis for reconsolidation. These findings are not predicted by traditional theories of memory consolidation.
Nagata T, Kiriike N, Iketani T, Kawarada Y, Tanaka H (1999)
Department of Neuropsychiatry, Osaka City University Medical School, Osaka, Japan.
History of childhood sexual or physical abuse in Japanese patients with eating disorders: relationship with dissociation and impulsive behaviours.  
Psychol Med 1999 Jul;29(4):935-42
ABSTRACT BACKGROUND: Empirical data regarding prevalence of sexual and physical abuse histories in Japanese patients with eating disorders is lacking, in contrast to Western countries. This study investigated the prevalence of traumatic events in Japanese patients with eating disorders, and examined the relationship between such traumatic events and clinical features. METHODS: Subjects consisted of 33 patients with anorexia nervosa restricting type (RAN), 40 patients with anorexia nervosa binge eating/purging type (AN-BP), 63 patients with bulimia nervosa purging type (BN) and 99 healthy controls. All were female and diagnoses were based on DSM-IV. The Physical and Sexual Abuse Questionnaire (PSA), Eating Disorder Inventory (EDI) and Dissociation Experience Scale (DES) were administered to all of the subjects. RESULTS: Paradoxically, victims of minor sexual abuse committed by Chikan (a Japanese word indicating a person who commits minor sexual crimes) were more prevalent among controls than among patients with RAN, AN-BP or BN. However, physical punishment histories tended to be more prevalent among patients with AN-BP or BN than among RAN or controls. Only AN-BP and BN patients with physical punishment histories had twofold higher scores for DES and significantly more frequent histories of self-mutilation (67% v. 33%) compared with patients without such histories. CONCLUSION: An abuse history is not essential or a prerequisite to developing an eating disorder in Japan

Nebout-Lenes, Marie-Claude . (2001)
Service de Psychiatrie B, CHRU Saint Jacques, Clermont-Ferrand, France.
La trace sensorielle du trauma dans les dessins d*enfants victimes = Sensorial mark of trauma in children*s drawings.  
Revue Francophone du Stress et du Trauma (ISSN: v. 1, no. 2, pp. 103-108 (February 2001).

ABSTRACT Drawing, the privileged style in children's expression, usually reveals the sensorial mark of psychic trauma. We intend to start from a three-case-study to show that this assertion can be easily proved. We rely on the concept of "Image Inconsciente du Corps" through M. Sapir and F. Dolto*s research to fully understand the way this sensorial mark expresses itself in drawing. The existence of this sensorial mark, here discovered in drawings, raises the question about the implication of sensorial ingraving in committing trauma to memory and in setting up the repetition syndrome process. We propose an hypothesis about this process. Then, from case studies we derive to the usefulness and limits of using drawing in diagnosis and therapy of psychic trauma.

Nicolai, N.J. (2001)   
Attachment and psychopathology: An overview
Tijdschrift voor psychotherapie 43 (2001) 5

ABSTRACT BACKGROUND: In John Bowlby's work a relation was proposed between early attachment experiences and psychpathology in adulthood. Attachment experiences in childhood become internalised as mental representations or internal working models. These can be evaluated with the Adult Attachment Overview. In recent developmental research a relation has been found between attachment, described as an internal working model of the mind and psychopathology. Attachment status is a state of mind with respect to attachment. It is evolved from attachment behaviour in childhood and is classified according discourse and attachment, not on (retrospective) life history. AIMS: This review describes the results of a recent research on attachment style and psychopathology. METHODS: Recent handbooks and overviews on internet and attachment related sites were selected. PsycLit has been consulted to search for references and also special sites on attachment in research centres (Berkeley London). RESULTS: Individuals with psychiatric problems as anxiety disorders, conduct disorders, eating disorders and some personality disorders have nearly all insecure attachment, measured with the Adult Attachment Interview (AAI). However, a clear-cut relation between attachment style and psychopathology does not exist. More than insecurity, disorganisation of attachment by loss or trauma seems to be a decisive factor in the enhancement of vulnerability. CONCLUSIONS: Disorganisation of attachment by loss or trauma is correlated with coercive behaviour in childhood and the development of dissociative disorders. In this article an overview of recent research in the area of psychopathology and attachment is given.

Nicolai, N.J. (1999)
Over de betekenis van hervonden herinneringen en de standard of care
Tijdschrift voor psychotherapie = ISSN 0165-1188: Vol. 25 (1999), no. 6 (nov), pag. 434-440.

Nijenhuis, E.R.S.  ; Van Der, Hart O., Kruger, K., & Steele, K. (2004)
Somatoform dissociation, reported abuse and animal defence-like reactions.
Australian and New Zealand Journal of Psychiatry, 38, 678-686.

ABSTRACTObjective: To test the hypotheses that among general psychiatric outpatients, somatoform dissociation is associated with posttraumatic stress symptoms and with reported potentially traumatizing events, especially with events that involve bodily threat from a person, also when reported age at onset, duration and subjectively rated impact of potentially traumatizing events are considered. Method: Administration of self-report questionnaires evaluating the severity of somatoform and psychoform dissociation, posttraumatic stress-symptoms, and reported traumatizing events, using samples of consecutive and unselected psychiatric outpatients (n = 153). Results: Somatoform dissociation was strongly correlated with posttraumatic stress symptoms and with reported cumulative traumatization as assessed with two different self-report trauma questionnaires. Among a wide range of trauma types, bodily threat from a person best predicted somatoform dissociation. Emotional neglect and age further improved the prediction, but emotional neglect and abuse did not predict somatoform dissociation when interpersonal threat to the body was not reported. Somatoform dissociation was also best predicted by bodily threat when reported age at onset, duration and subjective impact of reported traumatization were included in the analyses. Conclusion: This retrospective study suggests that recurrent interpersonal bodily threat may evoke animal defence-like psychobiological systems manifesting as somatoform dissociation and that this type of threat is often accompanied by emotional neglect. These hypotheses should now be tested in prospective studies.

Nijenhuis, E.R.S.  ; van Dyck R, ter Kuile MM, Mourits MJ, Spinhoven P, van der Hart O. (2003)
Evidence for associations among somatoform dissociation, psychological dissociation and reported trauma in patients with chronic pelvic pain.
Psychosom Obstet Gynaecol. 2003 Jun;24(2):87-98.

ABSTRACT This study investigates somatoform as well as psychological dissociation, somatization and reported trauma among patients with chronic pelvic pain (CPP). Women with CPP (n = 52) who were newly referred to a gynecology department, or whose pain had resisted treatment, completed standardized self-report questionnaires and received a structured interview for DSM-IV dissociative disorders. The prevalence of dissociative disorders in the sample was very low. As hypothesized, self-reported somatoform dissociation was positively correlated with self-reported psychological dissociation and features of DSM-IV dissociative disorders; women who reported more serious psychic trauma, in particular sexual and physical abuse, experienced more somatoform and psychological dissociation than women reporting less trauma, or no trauma at all; and the association of somatoform dissociation and reported trauma was stronger than the association of psychological dissociation and trauma. Physical abuse/life threat posed by a person predicted somatoform dissociation best. The results are consistent with findings among psychiatric patients, and, therefore, strengthen the thesis that somatoform dissociation, (features of) dissociative disorder, and reported trauma are strongly intercorrelated phenomena.

Nijenhuis, E.R.S.  ; Van der Hart, & Steele, K. (2002)
The emerging psychobiology of trauma-related dissociation and dissociative disorders.
In: H. D’Haenen, J.A. Den Boer, H. Westenberg, & P. Willner (Eds.), Textbook of Biological Psychiatry, pp. 1079-1098. London: Wiley.(book)

ABSTRACT Traumatic experiences may hamper the integrative functions of the mind. This chapter discusses several key neuroendocrine systems and brain structures that seem to be involved in trauma-related dissociation. Clinical, empirical, and experimental evidence suggests that this dissociation, described in this chapter as structural dissociation of the personality, reflects a lack of integration among psychobiological emotional systems, e.g., reproduction, attachment, defense. The primary form of this structural dissociation involves failed integration between systems dedicated to daily life and systems dedicated to defense in the face of severe threat. Most research has largely overlooked the fact that psychobiological reactivity to threat cues may depend on the type of dissociative psychobiological system that dominates the functioning of the patient at the time of measurement. As predicted by the theory of structural dissociation, pioneering studies have found such differences between dissociative systems dedicated to daily life and to defense.

Nijenhuis, E.R.S.  Van der Hart, O., & Kruger, K. (2002)
The psychometric characteristics of the Traumatic Experiences Questionnaire (TEC): First findings among psychiatric outpatients.
Clinical Psychology and Psychotherapy, 9(3), 200-210.

ABSTRACT The objective of the study was to assess the reliability and validity of a retrospective self-report measure of potential traumatic experiences among psychiatric outpatients. The range of evaluated experiences includes emotional neglect and abuse. Participants completed the Traumatic Experiences Checklist (TEC) (N = 153), a self-report trauma questionnaire of known psychometric qualities, i.e. the Stressful Life Experiences Questionnaire (SLESQ), and self-report measures of somatoform dissociation (SDQ-20), psychoform dissociation (DES). A majority (N = 115) completed the TEC twice, and also completed a measure of posttraumatic stress symptoms (PTSD-ss). The TEC's internal consistency and test-retest reliability were good, and the TEC strongly correlated with the SLESQ. Associations between the TEC and the PTSD-ss, DES, and SDQ-20 supported the criterion-related validity of the TEC. The internal consistency, test-retest reliability and criterion-related validity of TEC trauma area presence and severity scores were also satisfactory. Preliminary findings suggest that the psychometric characteristics of the TEC are good. Future study of the TEC should include larger samples of psychiatric patients, as well as non-clinical groups

Nijenhuis, Ellert R S ; Van Engen, Annegien; Kusters, Ine; Van der Hart, Onno(2001)
Peritraumatic somatoform and psychological dissociation in relation to recall of childhood sexual abuse.
Journal of Trauma and Dissociation (ISSN: 1529-9732), v. 2, no. 3, pp. 49-68 (2001).

ABSTRACT OBJECTIVE: Overwhelming experience can evoke psychological dissociation during or immediately after the event, including dissociative amnesia. Whereas some data suggest that such peritraumatic dissociation can also find expression in somatoform symptoms, only a limited range of such symptoms has been systematically studied. The present study hypothesized that peritraumatic psychological and somatoform dissociation are associated with each other, with delayed recall of childhood sexual abuse (CSA), and with CSA severity. Because current somatoform dissociation is most strongly associated with recalled childhood physical abuse (CPA), we also hypothesized that peritraumatic somatoform dissociation is associated with reported CPA over and above CSA. METHOD: 34 Dutch women who reported CSA were interviewed using a modified version of the Traumatic Memory Inventory (TMI) which assesses the characteristics of traumatic memories. The participants also completed the Traumatic Experiences Checklist, the Peritraumatic Dissociation Experiences Questionnaire, and the Peritraumatic Somatoform Dissociation Questionnaire. RESULTS: Peritraumatic psychological and somatoform dissociation were associated with each other, with delayed recall of trauma, and with severity of reported CSA. Reported CPA predicted peritraumatic somatoform dissociation over and above the severity of CSA in terms of the acts involved. Approximately 44 percent of the women reported independent corroboration of the abuse. Similar proportions of delayed, partial, and continuous CSA memories were corroborated. CONCLUSIONS: This retrospective study suggested that delayed recall of CSA is associated with peritraumatic dissociation and CSA severity. It also suggested that trauma -- especially that which involves serious threat to the integrity of the body -- may evoke somatoform dissociation. Based on patient report, delayed recall of some CSA memories was as accurate as continuous recall of CSA. KEYWORDS. Peritraumatic psychological dissociation, peritraumatic somatoform dissociation, child sexual abuse, continuous recall, partial recall, delayed recall

Nijenhuis, E.R.S. PhD (2000)  
Vrije Universiteit at Amsterdam, The Netherlands.
Somatoform Dissociation: Major Symptoms of Dissociative Disorders.
Journal of Trauma & Dissociation, Vol. 1(4) 2000

ABSTRACT In most of the recent scientific and clinical literature, dissociation has been equated with dissociative amnesia, depersonaliza-tion, derealization, and fragmentation of identity. However, according to Pierre Janet and several World War I psychiatrists, dissociation also pertains to a lack of integration of somatoform components of experi-ence, reactions, and functions. Some clinical observations and contem-porary studies have supported this view. Somatoform dissociation, which can be measured with the Somatoform Dissociation Questionnaire (SDQ-20), is highly characteristic of dissociative disorder patients, and a core feature in many patients with somatoform disorders and in a subgroup of patients with eating disorders. It is strongly associated with reported trauma among psychiatric patients and patients with chronic pelvic pain presenting in medical healthcare settings. Motor inhibitions and anesthesia/analgesia are somatoform dissociative symptoms that are similar to animal defensive reactions to major threat and injury. Among a wider range of somatoform dissociative symptoms, these particular symptoms are highly characteristic of patients with dissocia-tive disorders. The empirical findings reviewed in this article should have implications for the contemporary conceptualization and defini-tion of dissociation, as well as the categorization of somatoform disor-ders in a future version of the DSM..

Nijenhuis E.R.S. , van Dyck R, Spinhoven P, van der Hart O, Chatrou M, Vanderlinden J, Moene F (1999)  
Vrije Universiteit at Amsterdam, The Netherlands.
Somatoform dissociation discriminates among diagnostic categories over and above general psychopathology.
Aust N Z J Psychiatry 1999 Aug;33(4):511-20

ABSTRACT OBJECTIVE: The primary aim of this study was to investigate the hypothesis that somatoform dissociation would differentiate among specific diagnostic categories after controlling for general psychopathology. METHOD: The Somatoform Dissociation Questionnaire (SDQ-20), the Dissociative Experiences Scale, and the Symptom Checklist-90-R were completed by patients with DSM-IV diagnoses of dissociative disorders (n = 44), somatoform disorders (n = 47), eating disorders (n = 50), bipolar mood disorder (n = 23), and a group of consecutive psychiatric outpatients with other psychiatric disorders (n = 45), mainly including anxiety disorders, depression, and adjustment disorder. RESULTS: The SDQ-20 significantly differentiated among diagnostic groups in the hypothesised order of increasing somatoform dissociation, both before and after statistically controlling for general psychopathology. Somatoform dissociation was extreme in dissociative identity disorder, high in dissociative disorder, not otherwise specified, and increased in somatoform disorders, as well as in a subgroup of patients with eating disorders. In contrast with somatoform dissociation, psychological dissociation did not discriminate between bipolar mood disorder and somatoform disorders. CONCLUSIONS: Somatoform dissociation is a unique construct that discriminates among diagnostic categories. It is highly characteristic of dissociative disorder patients, a core feature in many patients with somatoform disorders, and an important symptom cluster in a subgroup of patients with eating disorders.

Nijenhuis, E.R.S. (1999)  
Hoe kunnen therapeuten en patiënten het beste omgaan met herinneringen aan misbruik in de kindertijd?    
PsychoPraxis= ISSN 1566-6166: Vol. 1 (1999), no. 2 (okt), pag. 53-55.

ABSTRACT In het eerste nummer van PsychoPraxis beschreef Walter Vandereycken hoe therapeuten en patiënten het beste omgaan met herinneringen aan misbruik in de kindertijd. Sommige richtlijnen zijn verstandig, maar andere missen nuancering of berusten op misvattingen en behoeven daarom aanpassing

Nijenhuis E.R.S. , Spinhoven P, van Dyck R, van der Hart O, Vanderlinden J. (1998) 
Department of Psychiatry Vrije Universiteit at Amsterdam, The Netherlands.
Psychometric characteristics of the somatoform dissociation questionnaire: a replication study.
Psychother Psychosom 1998;67(1):17-23

ABSTRACT Aimed to replicate the results of previous studies (e.g., J. Vanderlinden et al, 1993) concerning the development of 2 versions of the Somatoform Dissociation Questionnaire (SDQ). The SDQ-20 evaluates the severity of somatoform dissociative phenomena, and the SDQ-5 is a dissociative disorders screening instrument. 31 patients (aged 18-53 yrs) with dissociative disorders and 45 consecutive psychiatric outpatients (aged 19-53 yrs) with other Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnoses completed the SDQ-20 and SDQ-5 as well as the Dissociation Questionnaire (DIS-Q). Mokken scale analysis showed that the items of the SDQ-20 are strongly scalable on a latent unidimensional scale. Internal consistency was high. The SDQ-20 convergent validity was supported by high intercorrelations with the DIS-Q. Ss with dissociative identity disorder scored significantly higher than Ss with dissociative disorder nos. Sensitivity (94%) and specificity (98%) of the SDQ-5 were very satisfactory, as were positive (84%) and negative predictive value (99%). Results corroborate the conclusion that the SDQ-20 and SDQ-5 are instruments of sound psychometric quality, and that somatoform dissociative phenomena are core symptoms of complex dissociative disorders.

Nijenhuis E.R.S. , Spinhoven, Philip; Vanderlinden, Johan; van Dyck, Richard; van der Hart, Onno (1998)
Somatoform dissociative symptoms as related to animal defensive reactions to predatory imminence and injury. 
Journal of Abnormal Psychology. 1998 Feb Vol 107(1) 63-73

ABSTRACT The authors hypothesized that there would be a similarity between animal defensive responses to variable predatory imminence and injury and certain somatoform dissociative symptoms of trauma-reporting patients who have dissociative disorder. As a first test of this hypothesis, 12 somatoform symptom clusters consisting of clinically observed somatoform dissociative phenomena were constructed. All clusters discriminated between patients with dissociative disorders (n = 50) and patients with other psychiatric diagnoses (n = 50). Those expressive of the hypothesized similarity--freezing, anesthesia-analgesia, and disturbed eating--belonged to the 5 most characteristic symptoms of dissociative disorder patients. Anesthesia-analgesia, urogenital pain, and freezing symptom clusters independently contributed to predicted presence of dissociative disorder. Using an independent sample, it appeared that anesthesia-analgesia best predicted presence of dissociative disorder after controlling for symptom severity. The results were largely consistent with the hypothesized similarity.
Nijenhuis E.R.S., Spinhoven P, van Dyck R, van der Hart O, Vanderlinden J (1998)
Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands.
Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma. .
J Trauma Stress 1998 Oct;11(4):711-30
ABSTRACT In this study, the prevalence and severity of traumatic experiences as reported by patients with dissociative disorders and with other DSM-IV psychiatric diagnoses were compared. Furthermore, the predictive value of emotional, physical, and sexual trauma with respect to somatoform and psychological dissociation was analyzed. In contrast with comparison patients, dissociative disorder patients reported severe and multifaceted traumatization. Physical and sexual trauma predicted somatoform dissociation, sexual trauma predicted psychological dissociation as well. According to the memories of the dissociative disorder patients, this abuse occurred in an emotionally neglectful and abusive social context. Pathological dissociation was best predicted by early onset of reported intense, chronic and multiple traumatization. Methodological limitations restricting causal inferences between reported trauma and dissociation are discussed.
Nijenhuis E.R.S., Vanderlinden J, Spinhoven P.   (1998)
Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands.
Animal defensive reactions as a model for trauma-induced dissociative reactions.
J Trauma Stress 1998 Apr;11(2):243-260
ABSTRACT Patients with complex dissociative disorders remain in alternating psychophysiological states which are discrete, discontinuous, and resistant against integrative tendencies. In this chapter, a parallel is drawn between animal defensive and recuperative states that are evoked in the face of severe threat and the characteristic responses of dissociative disorder patients as displayed in major dissociative states. Empirical data and clinical observations seem to be supportive of the idea that there are similarities between freezing, concomitant development of analgesia and anesthesia, and acute pain in threatened animals and severely traumatized human beings.

Nishith,  Pallavi; Mindy B. Mechanic, and Patricia A. Resick (2000)
Prior Interpersonal Trauma: The Contribution to Current PTSD Symptoms in Female Rape Victims  
Journal of Abnormal Psychology, 2000, Vol. 109, No. 1, 20–25,

ABSTRACT The purpose of the current study was to disentangle the relationship of childhood sexual abuse and childhood physical abuse from prior adult sexual and physical victimization in predicting current posttraumatic stress disorder (PTSD) symptoms in recent rape victims. The participants were a community sample of 117 adult rape victims assessed within 1 month of a recent index rape for a history of child sexual abuse, child physical abuse, other adult sexual and physical victimization, and current PTSD symptoms. Results from path analyses showed that a history of child sexual abuse seems to increase vulnerability for adult sexual and physical victimization and appears to contribute to current PTSD symptoms within the cumulative context of other adult trauma.

Nixon, Reginald D. V; Nishith, Pallavi; Resick, Patricia A. (2003)
The Accumulative Effect of Trauma Exposure on Short-Term and Delayed Verbal Memory in a Treatment-Seeking Sample of Female Rape Victims. 
Journal of Traumatic Stress. Vol 17(1) Feb 2004, 31-35.

ABSTRACTThe accumulative effect of prior high-magnitude trauma exposure on memory was examined in 73 rape victims, 92% of whom had current posttraumatic stress disorder (PTSD). Participants were administered the Logical Memory component of the Wechsler Memory Scale, the Quick Test to obtain an estimate of intelligence, and were assessed for prior traumatic experiences. Prior exposure to high-magnitude stressors (e.g., child rape, being kidnapped) was significantly correlated with poorer performance on the memory tasks. Regression analyses controlling for estimated IQ and psychopathology severity demonstrated that magnitude of prior trauma exposure predicted performance on the memory task, suggesting that in the current sample, deficits in verbal memory may be related (in part) to the degree of accumulative stress experienced over the lifetime.