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
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 patients’ 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 19901995 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