ABSTRACT Three case studies of inner-city elementary school children illustrate the connection between speech-language disorders and dissociative disorders in children who have known or suspected trauma histories. The role of speech language pathologists in identifying and responding to dissociative symptoms in children is explored. Lack of adequate training concerning the impact of trauma and scarce literature on the communication profiles of dissociative children contributes and greatly impacts the diagnosis, referral, and treatment of these children. The case studies demonstrate how unusual speech and language symptoms and awareness of dissociative features may aid in identifying trauma-related problems and instituting effective treatment. Grounding techniques and specific language interventions can assist children in acquiring the vocabulary needed for communicating both their daily experiences and traumatic histories. The nature of the relationship between dissociation and communication disorders is explored, and the importance of future research, interdisciplinary collaboration, and trauma training in the speech-language curriculum is emphasized.
ABSTRACT An understanding of the biological
basis of posttraumatic stress disorder (PTSD) requires
an examination of the underlying neurobiology of fear
and the factors that might contribute to an unsuccessful
termination of the fear response in some individuals.
Several factors may lead to an inadequate termination
of a stress response, and the failure to contain the
biological alterations initiated by stress may have
long-term adverse consequences. In particular, a prolonged
continuation of biological responses following stress
may lead to an inappropriate pairing of the traumatic
memory with distress and may then initiate a cascade
of secondary biological alterations. This article
examines some of the biological alterations in PTSD
and develops a framework for understanding the development
progression of the neurobiology of this disorder.
B, Kiziltan E, Aktan M . (2000)
Department of Psychiatry, Istanbul Medical School, Turkey.
Dissociative identity disorder presenting with psychogenic
purpura. Psychosomatics 2000 May-Jun;41(3):279-81
Zatzick, Douglas MD; Peter Roy-Byrne, MD; Joan Russo, PhD; Frederick Rivara, MD, MPH; RoseAnne Droesch, MSW; Amy Wagner, PhD; Chris Dunn, PhD; Gregory Jurkovich, MD; Edwina Uehara, PhD; Wayne Katon, MD (2004) A Randomized Effectiveness Trial of Stepped Collaborative Care for Acutely Injured Trauma Survivors Arch Gen Psychiatry. 2004;61:498-506.
ABSTRACT CONTEXT Although posttraumatic stress disorder (PTSD) and alcohol abuse frequently occur among acutely injured trauma survivors, few real-world interventions have targeted these disorders.
OBJECTIVE We tested the effectiveness of a multifaceted collaborative care (CC) intervention for PTSD and alcohol abuse.
DESIGN Randomized effectiveness trial.
Participants We recruited a population-based sample of 120 male and female injured surgical inpatients 18 or older at a level I trauma center.
INTERVENTION Patients were randomly assigned to the CC intervention (n = 59) or the usual care (UC) control condition (n = 61). The CC patients received stepped care that consisted of (1) continuous postinjury case management, (2) motivational interviews targeting alcohol abuse/dependence, and (3) evidence-based pharmacotherapy and/or cognitive behavioral therapy for patients with persistent PTSD at 3 months after injury.
MAIN OUTCOME Measures We used the PTSD symptomatic criteria (PTSD Checklist) at baseline and 1, 3, 6, and 12 months after injury, and alcohol abuse/dependence (Composite International Diagnostic Interview) at baseline and 6 and 12 months after injury.
RESULTS Random-coefficient regression analyses demonstrated that over time, CC patients were significantly less symptomatic compared with UC patients with regard to PTSD (P = .01) and alcohol abuse/dependence (P = .048). The CC group demonstrated no difference (–0.07%; 95% confidence interval [CI], –4.2% to 4.3%) in the adjusted rates of change in PTSD from baseline to 12 months, whereas the UC group had a 6% increase (95% CI, 3.1%-9.3%) during the year. The CC group showed on average a decrease in the rate of alcohol abuse/dependence of –24.2% (95% CI, –19.9% to –28.6%), whereas the UC group had on average a 12.9% increase (95% CI, 8.2%-17.7%) during the year.
CONCLUSIONS Early mental health care interventions can be feasibly and effectively delivered from trauma centers. Future investigations that refine routine acute care treatment procedures may improve the quality of mental health care for Americans injured in the wake of individual and mass trauma.
Ziabreva, Gerd Poeggel, Reinhild Schnabel, and Katharina
Braun1 (2003) Department of Zoology/Developmental
Neurobiology, Otto-von-Guericke-University, 39118 Magdeburg,
Germany, and University of Leipzig, Zoological Institute,
04103 Leipzig, Germany Separation-Induced Receptor Changes in the Hippocampus
and Amygdala of Octodon degus: Influence of Maternal
Vocalizations The Journal of Neuroscience, June 15, 2003, 23(12):5329-5336
ABSTRACT Relatively little is known about
the basic mechanisms that play a role in the vulnerability
of the developing brain toward adverse environmental
influences. Our study in the South American rodent
Octodon degus revealed that repeated brief separation
from the parents and exposure to an unfamiliar environment
induces in the hippocampal formation of male and female
pups an upregulation of D1 and 5-HT1A receptor density
in the stratum radiatum and stratum lacunosum moleculare
of the CA1 region. In the CA3 region, only the 5-HT1A
receptors were upregulated; no changes were observed
for D1 receptors in this region. GABAA receptor density
in the hippocampus and amygdala was downregulated
(nonsignificant trend) after parental separation.
The acoustic presence of the mother during parental
separation suppressed the D1 and 5-HT1A receptor upregulation
in some regions of the hippocampus; no such suppressing
influence was observed for the GABAA receptors. In
the basomedial amygdala, the maternal calls enhanced
the separation-induced 5-HT1A receptor upregulation
in the male pups, whereas in the female pups the separation-induced
receptor densities were not only suppressed by the
maternal call but further downregulated, compared
with the control group. These results demonstrate
that early adverse emotional experience alters aminergic
function within the hippocampus and amygdala and that
the mother's voice, a powerful emotional signal, can
modulate these effects in the developing limbic system.
Zoellner, Lori A; Sacks, Matthew B; Foa, Edna B. (2003) Directed forgetting
following mood induction in chronic posttraumatic stress disorder patients.
Journal of Abnormal Psychology. Vol 112(3) Aug 2003, 508-514
ABSTRACT Current research of posttrauma sequelae suggests that intrusive rather than
avoidant-dissociative models more accurately represent the encoding
processes of trauma cues. However, posttraumatic stress disorder (PTSD) is
often conceptualized as a phasic phenomenon, altering between arousal and
avoidance states. The failure to support a relationship between avoidant
encoding style and PTSD may reflect this alteration. To explore this
hypothesis, participants with PTSD and controls (no PTSD) completed an
item-cued directed-forgetting task, following either a dissociative or a
serenity (control) mood induction. Results suggested that, following the
serenity induction, a standard directed-forgetting effect was observed.
However, following the dissociation induction, this effect was not
observed. The role of dissociation in impairing encoding via lack of
selective rehearsal or source discrimination is discussed.
Lori A; Sacks, Matthew B; Foa, Edna B.(2001) Stability of emotions for traumatic memories in acute
and chronic PTSD. Behaviour Research and Therapy (ISSN: 0005-7967),
v. 39, no. 6, pp. 697-711 (June 2001).
ABSTRACT While memory for central factual
information regarding an emotional event is considered
to be relatively accurate, memory for emotions seems
to be quite inaccurate. We extended this line of research
to examine memory for the emotional intensity surrounding
a traumatic event (e.g., memory for the fear and horror
of the event). We conducted a series of two studies.
In Study 1, we examined memory for the emotional intensity
of the traumatic event in recent sexual or non-sexual
assault victims with acute PTSD at 2 and 12 weeks
following the assault. In Study 2, we compared memory
for emotional intensity in sexual and non-sexual assault
victims with either acute or chronic PTSD at initial
assessment and 12 weeks Later. For both studies, participants
were asked to recall general emotional intensity,
fear intensity, and dissociative intensity of the
traumatic event. Results suggested that memory for
the fear of the traumatic event did not fluctuate
over time. However, memory for the general emotional
and dissociative intensity did fluctuate over time,
decreasing for individuals with acute PTSD and increasing
for individuals with chronic PTSD.
Lori A ; Edna B. Foa, Bartholomew D. Brigidi, Amy Przeworski
(2000) Are Trauma Victims Susceptible to False Memories?
Journal of Abnormal Psychology, 2000, Vol. 109,
No. 3, 517524,
ABSTRACT Laboratory studies using word-list
paradigms have provided evidence that nontraumatized
individuals falsely recall or recognize events that
never occurred. In the present study, H. L. Roediger
and K. B. McDermotts false-memory paradigm (1995)
was utilized to examine possible source monitoring
deficits in individuals with PTSD. Traumatized individuals
with PTSD were compared with traumatized individuals
without PTSD and with nontraumatized control participants.
Participants heard lists of related words (e.g., bed,
night) that were associates of a critical nonpresented
word (e.g., sleep) and were given immediate free recall
and later recognition tests. Traumatized participants
with and without PTSD generated more false recalls
of critical nonpresented words than did nontraumatized
participants. False recall was related to trait anxiety
and PTSD severity. The results are consistent with
a general source-monitoring deficit in trauma-exposed
L.A : E.B. Foa and B.D. Brigidi (1999) Interpersonal friction and PTSD in female victims
of sexual and nonsexual assault Journal of Traumatic Stress, ISSN 0894-9867: Vol.
12 (1999), no. 4 (oct), pag. 689-700.
ABSTRACT This study examines the relationship
among features of social relationships, both negative
and positive, and later posttrauma pathology. Using
a prospective design, 142 female victims of sexual
or nonsexual assault were assessed at both 2 weeks
and 3 months following the assault. We examined self-reported
perceptions of how often the participant has been
the recipient of socially supportive actions by others
and how often the participant has been engaged in
interpersonal friction with others. Degree of interpersonal
friction shortly after the assault predicted PTSD
severity 3 months later. On the contrary, positive
social support did not predict later PTSD severity.
These results are consistent with previous studies
that underscore the association between negative features
of social relationships and PTSD
SS, Sar V, Tuzun U, Tutkun H, Savas HA. (2002) Reliability and validity of the Turkish version of
the adolescent dissociative experiences scale. Psychiatry Clin Neurosci 2002 Oct;56(5):551-6
ABSTRACT The Adolescent Dissociative Experiences
Scale (A-DES) is designed to measure dissociation
in adolescents. The present study aimed to assess
the reliability, validity, and psychometric characteristics
of the Turkish version of the A-DES. The Turkish version
of the A-DES was administered to 20 patients with
a dissociative disorder, 24 patients with post-traumatic
stress disorder (PTSD), 31 patients with anxiety disorder,
31 patients with mood disorder, 24 patients with attention
deficit-hyperactivity disorder (ADHD), and 201 non-clinical
participants. The internal consistency and the test-retest
correlation of the A-DES were excellent. The mean
total score of A-DES was 6.2 in dissociative disorder,
3.9 in PTSD, 2.1 in anxiety disorder, 2.4 in mood
disorder, 2.5 in ADHD groups and 2.4 in non-clinical
participants. There was a statistically significant
difference between dissociative patients and other
diagnostic groups on the A-DES total score. The good
psychometric characteristics of the A-DES among Turkish
participants support its cross-cultural validity.
Zulueta, F. (1999) Borderline personality disorder as seen from an
attachment perspective: A review. Criminal Behaviour & Mental Health, 9, 237-253.
ABSTRACT Reviews the research on borderline
personality disorder (BPD) and discusses the importance
of attachment behavior and posttraumatic stress disorder
(PTSD) in the understanding of this disorder. Patients
with BPD often present with so many symptoms of PTSD
that many American psychiatrists now see it was a
variant of "complex PTSD" (J. Herman, 1992),
a diagnosis with far less negative connotations and
one that attends to an essential aspect of this disorder
which is often totally overlooked, that of the terror
that pervades all aspects of these peoples' lives.
There is now increasing evidence to indicate that
the syndrome of PTSD can be partly understood as resulting
from severe damage to the attachment system (F. Zulueta,
1993) and there is perhaps no disorder which highlights
the overlap between these two areas of research than
BPD. The author discusses the background of attachment
behavior, including different types of attachment
behavior in relation to the caregiver, self-perpetuating
attachment patterns and the Adult Attachment Interview,
transgenerational transmission. The author then explores
issues of PTSD, including dissociation and re-enactment,
repetition compulsion, and neurophysiological changes.
der Zwaard, Roy; Polak, Machiel A. (2001) Rijngeest Group of Mental Health,
Noordwijk, Netherlands Pseudohallucinations: A pseudoconcept? A review
of the validity of the concept, related to associate
symptomatology. Comprehensive Psychiatry. 2001 Jan-Feb Vol 42(1)
is a concept used in the classification of nonpsychotic
perceptual disorders. This report describes the history
of the concept and investigates whether pseudohallucinations
can be differentiated from related psychopathological
symptoms, such as hallucinations, re-experiencing,
and dissociative phenomena. The authors performed
a literature review, which shows that pseudohallucinations
and related symptoms have low construct validity and
are, accordingly, clinically ambiguous. Most likely,
pseudohallucinations are placed on an overlapping
continuum of symptomatology that includes perceptual
disorders, re-experiencing, (dissociative) imagery,
and normal thought and memory processes. Recommendations
are made regarding the specification of dimensions
of this continuum. The term "nonpsychotic hallucinations"
is preferred over "pseudohallucination."