Teicher
MH, Andersen SL, Polcari A, Anderson CM, Navalta CP.
(2002) Department of Psychiatry, Harvard
Medical School, 25 Shattuck Street, Boston, MA 02115,
USA. email: martin_teicher@hms.harvard.edu Developmental neurobiology of childhood stress
and trauma. Psychiatr Clin North Am. 2002 Jun;25(2):397-426,
vii-viii.
ABSTRACT Severe early stress and maltreatment
produces a cascade of events that have the potential
to alter brain development. The first stage of the
cascade involves the stress-induced programming of
the glucocorticoid, noradrenergic, and vasopressin-oxytocin
stress response systems to augment stress responses.
These neurohumors then produce effects on neurogenesis,
synaptic overproduction and pruning, and myelination
during specific sensitive periods. Major consequences
include reduced size of the mid-portions of the corpus
callosum; attenuated development of the left neocortex,
hippocampus, and amygdala along with abnormal frontotemporal
electrical activity; and reduced functional activity
of the cerebellar vermis. These alterations, in turn,
provide the neurobiological framework through which
early abuse increases the risk of developing post-traumatic
stress disorder (PTSD), depression, symptoms of attention-deficit/hyperactivity,
borderline personality disorder, dissociative identity
disorder, and substance abuse.
Terr
Lenore C. (2003) "Wild Child": How Three Principles of Healing
Organized 12 Years of Psychotherapy Journal of the American Academy of Child & Adolescent
Psychiatry 2003; 42(12):1401-1409
ABSTRACT Methods of conducting psychotherapy
in the most severe forms of childhood posttraumatic
stress disorder (PTSD), especially in those traumas
discovered very early in life, are rarely reported.
This paper presents such a report and in the process
emphasizes three elements of treatment: abreaction
(full emotional expression of the traumatic experience),
context (understanding and gaining perspective on
the experience), and correction (finding ways personally
or through society to prevent or repair such experiences).
With traumatized children, all three elements may
be inserted into their therapeutic play, art, and/or
talk. An overarching mood of light humor helps the
transference stay positive and the child interested.
The case of "Cammie," an infant who was bitten, shaken,
and sexually abused, and whose 25-day-old sister was
discovered at home, murdered, is the subject of this
report. This little girl, upon removal at 13 months
of age from her home of origin, growled, bit, sniffed
sexual organs, rarely spoke, and behaved like the
"feral children" described in the classic psychiatric
literature. Two respected professionals diagnosed
her as mentally retarded. A year in an outstanding
foster home did little to improve her. At 29 months
of age she was brought to the author, who saw enough
imagination and pithy language to believe the child
to be intelligent but severely traumatized. The author
had begun to conceptualize three principles of PTSD
treatment after a study of normal schoolchildren's
reactions to the 1986 Challenger disaster. These three
principles were used with varying emphases at different
phases throughout the "wild child's" 12-year course
of once-monthly therapy. Improvement beyond anyone's
expectations ensued.
Thomas,
Ann. (2001) Factitious and malingered dissociative identity disorder:
clinical features observed in 18 cases Journal of Trauma and Dissociation (ISSN: 1529-9732),
v. 2, no. 4, pp. 59-77 (2001).
ABSTRACT This paper compares the clinical
features of 18 persons given a diagnosis of factitious
or malingered Dissociative Identity Disorder with
those of 18 matched persons who were given a diagnosis
of genuine Dissociative Identity Disorder, taken from
a sample of 129 second opinion consultations. Clinical
features suggesting a factitious diagnosis or malingering
included having a score above 60 on the Dissociative
Experiences Scale (DES), reporting dissociative symptoms
inconsistent with the reporting on the DES, being
able to tell a chronological life story and to sequence
temporal events, using the first person over a range
of affect, being able to express strong negative affect,
bringing "proof" of a dissociative diagnosis to the
consultation, having told persons other than close
confidants about the alleged abuse or alleged dissociative
diagnosis, reporting alleged abuse that was inconsistent
with the medical or psychiatric history or volunteering
allegations of cult or ritualized abuse, telling of
alleged abuse without accompanying shame, guilt, or
suffering, having been involved in community self-help
groups, not having symptoms of co-morbid PTSD, and
having obvious secondary gain in having a dissociative
diagnosis. Given the potential legal ramifications
of making a false positive diagnosis of Dissociative
Identity Disorder and recognizing that the treatment
for persons with valid dissociative psychopathology
differs from the treatment of factitious illness,
it is prudent to be able to separate the two groups.
Timmerman
IG
, Emmelkamp PM. (2001) Forensic Psychiatric Clinic Veldzicht,
P.O. Box 20, 7707 ZG Balkbrug, The Netherlands. The relationship between traumatic experiences, dissociation,
and borderline personality pathology among male forensic
patients and prisoners. J Personal Disord 2001 Apr;15(2):136-
ABSTRACT In the present study the relationship
between traumatic experiences, dissociation, and borderline
personality disorder pathology is examined in a group
of 39 male forensic patients and 192 male prisoners.
Sexual and emotional abuse are significantly more
common among forensic patients than among prisoners.
Patients also report a broader range of different
kinds of traumas. Prisoners report significantly more
dissociative symptoms. Analyses of the relationship
of type of trauma on the one hand and dissociation
and borderline personality pathology on the other
show that sexual abuse is significantly associated
with borderline personality pathology but not with
dissociation among the patients. In the prison sample
these associations are found only for familial but
not extrafamilial sexual abuse. When the subjects
are grouped on account of presence or absence of a
borderline personality disorder, highly significant
differences on dissociation are found between both
groups. The results from this study lend support to
the hypothesis that sexual abuse is not related to
dissociative symptoms but merely to borderline personality
pathology. Because most subjects in this study are
not patients, these findings are not likely to be
confounded by false memories of traumatic events that
are recovered by psychotherapy. Furthermore, dissociative
symptoms are found to be related to borderline personality
pathology and not to the experience of traumatic events.
Peter M. Thomas (2005) Dissociation and Internal models of Protection: Psychotherapy with child abuse survivors Psychotherapy: Theory, Research, Practice, Training Spring 2005 Vol. 42, No. 1, 20-36
ABSTRACTThis article presents strategies for treating child abuse survivors based on a theory of interpersonal protection that integrates research in attachment, developmental psychopathology, trauma, dissociation, and experiential psychotherapy. The theory proposes that abused children do not form internal working models of an effective protector, with the result that they have difficulty defending themselves against interpersonal aggression and internal self-criticism; thus, a core psychotherapy task is to help survivors develop adequate representations of protection. The article provides case examples and describes interventions targeting the client-therapist relationship, other client relationships, client self-criticism, and traumatic memories. The author discusses dissociation as an intervention marker; client verbal and nonverbal feedback to therapist interventions; subselves and internal roles; the "inner critic"; guided imagery, role-plays, and dramatic enactment methods; and directions for future research.
Svenn
Torgersen; Sissel Lygren; Per Anders Řien; Ingunn Skre;
Sidsel Onstad; Jack Edvardsen; Kristian Tambs; Einar
Kringlen (2000) A twin study of personality disorders Comprehensive Psychiatry November/December 2000
• Volume 41 • Number 6
ABSTRACT No twin study has previously investigated
the whole range of personality disorders (PDs) recorded
by interviews. Based on twin and patient registries,
92 monozygotic (MZ) and 129 dizygotic (DZ) twin pairs
were interviewed with the Structured Clinical Interview
for DSM-III-R Personality Disorders (SCID-II). Observed
prevalence rates from a normal population study of
more than 2,000 individuals were used in combination
with data from the present study to generate statistics
assumed to be valid for a normal twin population,
and these statistics were used for structural equation
modeling. The best-fitting models had a heritability
of .60 for PDs generally, .37 for the eccentric (A)
cluster, .60 for the emotional (B) cluster, and .62
for the fearful (C) cluster. Among the specific PDs,
the heritability appeared to be .79 for narcissistic,
.78 for obsessive-compulsive, .69 for borderline,
.67 for histrionic, .61 for schizotypal, .57 for dependent,
.54 for self-defeating, .29 for schizoid, .28 for
paranoid, and .28 for avoidant PDs. The best-fitting
models never included shared-in-families environmental
effects. However, a model with only shared familial
and unique environmental effects could not be ruled
out for dependent PD. Shared familial environmental
effects may also influence the development of any
PD and borderline PD. Passive-aggressive PD did not
seem to be affected by genes or family environment
at all. The low occurrence of antisocial PD in the
twin sample precluded any model for this disorder.
PDs seem to be more strongly influenced by genetic
effects than almost any axis I disorder, and more
than most broad personality dimensions. However, we
observed a large variation in heritability among the
different PDs, probably partly because of a moderate
sample size and low prevalence of the specific disorders.
Troisi,
A. et al (2000) Affect regulation in alexithymia: an ethological
study of displacement behavior during psychiatric interviews
Journal of Nervous and Mental Disease Vol. 188 (2000),
no. 1 (jan), pag. 13-18.
ABSTRACT Displacement activities (i.e., self-directed
behaviors such as self-touching, scratching, and self-grooming)
are a reliable ethological indicator of increased
emotional and physiological arousal throughout the
phylogenetic scale. We hypothesized that, in alexithymic
individuals, the failure to regulate cognitively distressing
emotions might result in increased displacement behavior.
The nonverbal behavior of 30 patients with depressive
or anxiety disorders was video-recorded during psychiatric
interviews and analyzed using an ethological scoring
system. Before being interviewed, each patient completed
the Twenty-Item Toronto Alexithymia Scale (TAS-20),
the Beck Depression Inventory (BDI), and the state
form of the State-Trait Anxiety Index (STAI-S). Ethological
data confirmed the hypothesis of the study. The patients
with more pronounced alexithymic features showed a
significantly higher frequency of displacement activities
during interviews. At the same time, these patients
reported levels of self-rated anxiety and depression
equivalent to those reported by nonalexithymic patients.
Such a dissociation between cognitive appraisal of
emotion and nonverbal behavior reflecting increased
emotional arousal supports the view that alexithymia
implies a failure to elevate emotions from a preconceptual
level of organization to the conceptual level of mental
representations
Tsai,
Guochuan E. ,
Condie, Donald; Wu, Ming-Ting; Chang, I-Wen (1999)
Laboratory of Molecular and Psychiatric
Neuroscience, Mailman Research Center, McLean Hospital,
Belmont, MA 02478, USA. Functional magnetic resonance imaging of personality
switches in a woman with dissociative identity disorder.
Harvard Review of Psychiatry. Vol 7(2), Jul-Aug
1999, 119-122.
ABSTRACT I Investigated the neuronal substrate
involved in the personality switches of dissociative
identity disorder (DID) by conducting an functional
magnetic resonance imaging (MRI) of a 47-yr-old with
DID while she was switching personalities. It was
found that bilateral reduction of hippocampal volume
in this S with comorbid posttraumatic stress disorder
(PTSD) and DID, consistent with the reported reduction
of hippocampal volume in patients with PTSD secondary
to childhood trauma. In addition functional MRI during
volitionally induced personality switch showed changes
in hippocampal and medial temporal activity correlated
with the switch, suggesting that personality switch
may result from changes in hippocampal and temporal
function.
Tutkun H, Savas HA, Zoroglu SS, Esgi K, Herken H, Tiryaki N. (2004)
Relationship between alexithymia, dissociation and anxiety in psychiatric outpatients from Turkey. Isr J Psychiatry Relat Sci. 2004;41(2):118-24.
ABSTRACT Several studies have examined the relationship between dissociation and alexithymia. In this study, the objective was to investigate whether there was a relationship between alexithymia, dissociation and state and trait anxiety in psychiatric outpatients. The evaluations of psychiatric outpatients (n=154) were based on the Toronto Alexithymia Scale, the Dissociative Experiences Scale and the State and Trait Anxiety Index. The data were analyzed using chi2 test and multiple covariance analyses. Subjects with alexithymia (46.8%) were significantly less educated and showed higher state and trait anxiety. The mean Toronto Alexithymia Scale total score of the female and male patients was similar. The mean Dissociative Experiences Scale score of the study group was 10.8 (sd=9.8, ranged 0 to 45). A multivariate analysis of covariance showed that state and trait anxiety was a significant covariant for the Toronto Alexithymia Scale-Difficulty Identifying Feelings subscale. Only the trait anxiety was a significant covariant for the Toronto Alexithymia Scale-Difficulty Expressing Feelings subscale. The overall main effect of dissociation was not significant on the Toronto Alexithymia Scale total and subscales. These data suggest that dissociation is fundamentally a different construct from alexithymia, while state and trait anxiety are closely related to alexithymia.
Twaite JA, Rodriguez-Srednicki O. (2004)
Neurodynamics, Inc., Tenafly, New Jersey, USA.mail: jimwaite@aol.com Childhood sexual and physical abuse and adult vulnerability to PTSD: the mediating effects of attachment and dissociation. J Child Sex Abus. 2004;13(1):17-38.
ABSTRACT Two hundred and eighty-four adults from the metropolitan New York area reported on their history of childhood sexual abuse (CSA), childhood physical abuse (CPA), and on the nature of their exposure to the terrorist attack on the World Trade Center. The respondents also completed the Impact of Events Scale-Revised (IES-R), the Attachment Style Questionnaire (ASQ) and the Dissociative Experiences Scale (DES). Those reporting histories of CSA and/or CPA were found to endorse more serious symptoms of PTSD, as did those who witnessed the terrorist attack live. The presence of secure attachments and dissociative symptoms were related significantly to both CSA and CPA, and to scores on the IES-R. Adult attachment and dissociation were found to mediate the relationship between childhood abuse and severity of PTSD.
Tyrrell
CL, Dozier M, Teague GB, Fallot RD. (1999) Department of Psychology, University
of Delaware, Newark 19716-2577, USA. Effective treatment relationships for persons with
serious psychiatric disorders: the importance of attachment
states of mind. J Consult Clin Psychol 1999 Oct;67(5):725-33
ABSTRACT Participants were 54 clients with
serious psychiatric disorders and 21 clinical case
managers. Clients' serious psychiatric disorders included
Axis I diagnoses, such as schizophrenia and bipolar
disorder. This study examined how attachment states
of mind of both clients and case managers influenced
the effectiveness of therapeutic relationships and
client functioning. Client and case manager attachment
states of mind interacted in predicting the working
alliance and client functioning. Specifically, clients
who were more deactivating with respect to attachment
had better alliances and functioned better with less
deactivating case managers, whereas clients who were
less deactivating worked better with more deactivating
case managers. These findings highlight the importance
of clinicians and clients being matched in ways that
balance their interpersonal and emotional strategies.
Tyron
WW (1998) Department of Psychology, Fordham
University, Bronx, NY 10458-5198, USA. A neural network explanation of posttraumatic stress
disorder. J Anxiety Disord 1998 Jul-Aug;12(4):373-85
ABSTRACT An introduction to connectionistic
neural networks and their importance for behavior
therapists was provided by Tryon (1995a). This article
shows that the bidirectional associative memory connectionistic
neural networks model meets all four of Jones and
Barlow's (1990) requirements and all five of Brewin,
Dalgleish, and Joseph's (1996) requirements for a
theoretical explanation of posttraumatic stress disorder
(PTSD). The bidirectional associative memory model
provides a theoretical basis for explaining the clinical
symptom constellation of PTSD, with special emphasis
on why trauma is re-experienced through memory; accounts
for individual variation in symptom severity, including
why some people do not develop PTSD; explains why
persons with PTSD are comorbid with depression, generalized
anxiety, and substance abuse; explains how abnormal
behavior derives from normal memory formation processes;
and makes novel predictions.