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Na'ama Yehuda MSc, SLP, TSHH (2005)
The language of Dissociation

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.

Yehuda Rachel, Ph.D. (2000)
Biology of Posttraumatic Stress Disorder
J Clin Psychiatry 2000;61[suppl 7]:14-21

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.

Yucel 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.

Irina 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.

Zoellner, 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.

Zoellner, 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, 517–524,

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. McDermott’s 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 individuals.

Zoellner, 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

Zoroglu 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.

de 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.

van 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) 42-5

ABSTRACT "Pseudohallucination" 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."