Substance Abuse and Posttraumatic Stress Disorder
Author(s): Kathleen T. Brady, Sudie E. Back and Scott F. Coffey
Source: Current Directions in Psychological Science, Vol. 13, No. 5 (Oct., 2004), pp. 206-209
Published by: Sage Publications, Inc. on behalf of Association for Psychological Science
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CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE
Substance Abuse and
Posttraumatic Stress Disorder
Kathleen T. Brady, Sudie E. Back, and Scott F. Coffey
Medical University of South Carolina and University at Buffalo, State University of New York
ABSTRACT?Posttraumatic stress disorder (PTSD) and substance
use disorders (SUDs) frequently co-occur. Among individuals
seeking treatment for SUDs, approximately 36% to 50% meet
criteria for lifetime PTSD. The self-medication and suscepti
bility hypotheses are two of the hypotheses that have been
proposed to help explain the etiological relationship between
PTSD and SUDs. It is also possible that common factors, such as
genetic, neurobiological, or environmental factors, contribute to
the high rate of PTSD-SUD co-occurrence. Preliminary results
from integrated psychotherapy approaches for the treatment of
patients with both disorders show promise. This article reviews
these and other advances in the study of comorbid PTSD and
SUDs, and suggests areas for future work.
KEYWORDS?posttraumatic stress disorder; trauma; substance
use disorders; addiction; comorbidity
Posttraumatic stress disorder (PTSD) is characterized by symptoms
that persist for at least 1 month following exposure to a traumatic
event. Interpersonal violence (e.g., physical and sexual abuse), com
bat, and natural disasters are examples of traumas commonly asso
ciated with PTSD. The characteristic symptoms of PTSD can be
divided into three clusters: avoidant, intrusive, and arousal symptoms.
Examples of intrusive symptoms include unwanted thoughts or
flashbacks of the event. Avoidant symptoms include, for example,
attempts to avoid any thoughts or stimuli that remind one of the event.
These symptoms are particularly relevant to this review because
substances of a ...
Horticultural Therapy as a Complementary Treatment for Post Traumatic Stress Disorder
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For more information, Please see websites below:
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Increase Food Production with Companion Planting in your School Garden =
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Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
Investigation of Horticultural Therapy as a Complementary Treatment for Post Traumatic Stress Disorder
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children
http://scribd.com/doc/239851214
`
Double Food Production from your School Garden with Organic Tech
http://scribd.com/doc/239851079
`
Free School Gardening Art Posters
http://scribd.com/doc/239851159`
`
Increase Food Production with Companion Planting in your School Garden
http://scribd.com/doc/239851159
`
Healthy Foods Dramatically Improves Student Academic Success
http://scribd.com/doc/239851348
`
City Chickens for your Organic School Garden
http://scribd.com/doc/239850440
`
Simple Square Foot Gardening for Schools - Teacher Guide
http://scribd.com/doc/239851110
Chronic Emotional Detachment, Disorders, and Treatment-Team BSarah M
This document discusses chronic emotional detachment and how it may lead to increased rates of mental health disorders like anxiety, depression, and PTSD. It hypothesizes that suppressing natural emotions to conform to societal pressures causes stress and depersonalization over time. When a distressing trigger occurs, this imbalance can lead to mental disorders. The document reviews literature linking emotional suppression to increased disorders in populations like veterans and refugees. It proposes studying the relationship between evolutionary survival mechanisms and societal norms. The methodology section describes a mixed-methods study using surveys, interviews, and archival data from a random sample to understand subjective emotional experiences and medication effectiveness.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
4. post traumatic stress disorder (ptsd) an overviewSuresh Rewar
Post-traumatic stress disorder (PTSD) is a complex mental disorder with psychological and emotional components, caused by exposure to single or repeated extreme traumatic events found in war, terrorist attacks, natural or man-caused disasters, and by violent personal assaults and accidents. In recent years, armed conflicts in the Middle East have resulted in high rates of exposure to traumatic events. Despite the increasing demand of mental health care provision, ongoing violence limits conventional approaches of mental health care provision. Internet-based interventions for posttraumatic stress disorder (PTSD) have proved feasible and effective in Western countries, but their applicability and efficacy in war and conflict regions remains unknown. Despite clinical studies and improved understanding of the mechanisms of cellular damage, prevention and treatment strategies for patients with PTSD remain unsatisfactory. Posttraumatic stress disorder is a prevalent mental health problem associated with substantial psychiatric morbidity. To develop an improved plan for treating and impeding progression of PTSD, it is important to identify underlying biochemical
changes that may play key role in the initiation and progression of these disorders.
Horticultural Therapy as a Complementary Treatment for Post Traumatic Stress Disorder
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children =
http://scribd.com/doc/239851214 ~
`
Double Food Production from your School Garden with Organic Tech =
http://scribd.com/doc/239851079 ~
`
Free School Gardening Art Posters =
http://scribd.com/doc/239851159 ~
`
Increase Food Production with Companion Planting in your School Garden =
http://scribd.com/doc/239851159 ~
`
Healthy Foods Dramatically Improves Student Academic Success =
http://scribd.com/doc/239851348 ~
`
City Chickens for your Organic School Garden =
http://scribd.com/doc/239850440 ~
`
Simple Square Foot Gardening for Schools - Teacher Guide =
http://scribd.com/doc/239851110 ~
Investigation of Horticultural Therapy as a Complementary Treatment for Post Traumatic Stress Disorder
`
For more information, Please see websites below:
`
Organic Edible Schoolyards & Gardening with Children
http://scribd.com/doc/239851214
`
Double Food Production from your School Garden with Organic Tech
http://scribd.com/doc/239851079
`
Free School Gardening Art Posters
http://scribd.com/doc/239851159`
`
Increase Food Production with Companion Planting in your School Garden
http://scribd.com/doc/239851159
`
Healthy Foods Dramatically Improves Student Academic Success
http://scribd.com/doc/239851348
`
City Chickens for your Organic School Garden
http://scribd.com/doc/239850440
`
Simple Square Foot Gardening for Schools - Teacher Guide
http://scribd.com/doc/239851110
Chronic Emotional Detachment, Disorders, and Treatment-Team BSarah M
This document discusses chronic emotional detachment and how it may lead to increased rates of mental health disorders like anxiety, depression, and PTSD. It hypothesizes that suppressing natural emotions to conform to societal pressures causes stress and depersonalization over time. When a distressing trigger occurs, this imbalance can lead to mental disorders. The document reviews literature linking emotional suppression to increased disorders in populations like veterans and refugees. It proposes studying the relationship between evolutionary survival mechanisms and societal norms. The methodology section describes a mixed-methods study using surveys, interviews, and archival data from a random sample to understand subjective emotional experiences and medication effectiveness.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
4. post traumatic stress disorder (ptsd) an overviewSuresh Rewar
Post-traumatic stress disorder (PTSD) is a complex mental disorder with psychological and emotional components, caused by exposure to single or repeated extreme traumatic events found in war, terrorist attacks, natural or man-caused disasters, and by violent personal assaults and accidents. In recent years, armed conflicts in the Middle East have resulted in high rates of exposure to traumatic events. Despite the increasing demand of mental health care provision, ongoing violence limits conventional approaches of mental health care provision. Internet-based interventions for posttraumatic stress disorder (PTSD) have proved feasible and effective in Western countries, but their applicability and efficacy in war and conflict regions remains unknown. Despite clinical studies and improved understanding of the mechanisms of cellular damage, prevention and treatment strategies for patients with PTSD remain unsatisfactory. Posttraumatic stress disorder is a prevalent mental health problem associated with substantial psychiatric morbidity. To develop an improved plan for treating and impeding progression of PTSD, it is important to identify underlying biochemical
changes that may play key role in the initiation and progression of these disorders.
Journal of Traumatic StressApril 2013, 26, 266–273Public.docxtawnyataylor528
Journal of Traumatic Stress
April 2013, 26, 266–273
Public Mental Health Clients with Severe Mental Illness and
Probable Posttraumatic Stress Disorder: Trauma Exposure and
Correlates of Symptom Severity
Weili Lu,1 Philip T. Yanos,2 Steven M. Silverstein,3 Kim T. Mueser,4 Stanley D. Rosenberg,4
Jennifer D. Gottlieb,4 Stephanie Marcello Duva,5 Thanuja Kularatne,1 Stephanie Dove-Williams,5
Danielle Paterno,5 Danielle Hawthorne,5 and Giovanna Giacobbe5
1Department of Psychiatric Rehabilitation and Counseling Professions, University of Medicine and Dentistry of New Jersey,
Scotch Plains, New Jersey, USA
2John Jay College of Criminal Justice, Department of Psychology, CUNY, New York, New York, USA
3Division of Schizophrenia Research, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New
Jersey, Piscataway, New Jersey, USA
4Department of Psychiatry, Dartmouth Medical School, Concord, New Hampshire, USA
5University Behavioral Health Care, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA
Individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure and for the development of posttraumatic
stress disorder (PTSD). This study reports findings from a large, comprehensive screening of trauma and PTSD symptoms among public
mental health clients in a statewide community mental health system. In 851 individuals with SMI and probable PTSD, childhood sexual
abuse was the most commonly endorsed index trauma, followed closely by the sudden death of a loved one. Participants had typically
experienced an average of 7 types of traumatic events in their lifetime. The number of types of traumatic events experienced and Hispanic
ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relation to events that occurred
on average 20 years earlier, suggesting the clinical need to address trauma and loss throughout the lifespan, including their prolonged
after-effects.
Over the past two decades, a growing body of research has
shown that individuals with severe mental illness (SMI) are
at greatly increased risk for trauma exposure (see Grubaugh,
Zinzow, Paul, Egede, & Frueh, 2011, for a review). Although
national surveys indicate that more than half of people in the
general population report exposure to at least one event that
according to the Diagnostic and Statistical Manual of Mental
Disorders (4th ed., DSM-IV; American Psychiatric Associa-
tion, 1994) meets criteria for trauma (Kessler, Sonnega, Bromet,
Hughes, & Nelson, 1995), studies of people with a SMI (such as
This research was supported by National Institute of Mental Health grant R01
MH064662. We wish to thank the following individuals for their assistance
with this project: Edward Kim, Lee Hyer, Rachael Fite, Kenneth Gill, Rose-
marie Rosati, Christopher Kosseff, Karen Somers, John Swanson, Avis Scott,
Rena Gitlitz, John Markey, Zygmond Gray, Marilyn Green, Alex Sh ...
Running head LITERATURE REVIEW-POST TRAUMATIC STRESS DISORDER .docxwlynn1
Running head: LITERATURE REVIEW-POST TRAUMATIC STRESS DISORDER 1
LITERATURE REVIEW-POST TRAUMATIC STRESS DISORDER 8
Literature Review-Post Traumatic Stress Disorder
Amber Hope
Argosy University
Literature Review-Post Traumatic Stress Disorder
Introduction
Using Abraham Maslow’s Hierarchy of Needs theory in this situation creates relevance towards approaches employed to manage post-traumatic stress disorder. The theory is a framework and approach that looks into satisfying needs for positive mental and physical development. The steps are met before one move to above steps. The needs include physiological, self-esteem, love & belonging, safety & security, love & belonging, and self-actualization. The above factors are considered critical for the methods employed in dealing with Post-Traumatic Stress Disorder (PTSD) (Brummelte & Galea, 2016). The model is essential in identifying the effects of PTSD on battered women, parenting of youths, the mental status of pregnant mothers, and factors that lead to future criminality among youths.
The Jungian theory is also being looked at in dealing with PTSD because of its capacity, just like the Hierarchy of Needs theory, in bridging the relationship between the mind and social developments. The situation discusses PTSD as a problem in limiting positivity in mental and physical health (Brown, 2017). The society may not work without a stable mental status. Therefore, it is essential to study the relationship between PTSD and health. This is with a focus on mood, behavioral traits, health, and another health status.
Literature Review of Post-Traumatic Stress Disorder (PTSD)
Baumeister, Vohs, Aaker, & Garbinsky (2013) argue that an organism possesses a positive life depending on its capacity to maintain an internal milieu amidst challenges in its environment. Brummelte & Galea, (2016) supports the above factor by calling it homeostasis. Stress is seen as a factor that changes the homeostasis of organisms negatively. Adamsons & Johnson (2013) presents the various stakeholders who are affected by PTSD. Among them include women, children, and male adults. However, women, children, and youths are the ones that experience the problem the most. Adamsons & Johnson (2013) shows that a stressor derived from the PTSD condition acts as a threat to the life of anyone in the world. PTSD has evolved for many decades depending on the changing nature of society and modern society. Stress response also continues to undergo evolution to acquire its adaptive processes.
Dziwota, Stepulak, Włoszczak-Szubzda, & Olajossy (2018) presents data relating to prolonged response towards stress. The situation appears as the one which influences the development of tissue damages and the occurrence of illnesses. The situation is seen to invoke coping mechanisms and responses between human and animals depending on the nature of the threats they perceive to affect their liv.
Running head RESEARCH PROPOSAL10RESEARCH PROPOSAL 8.docxtoltonkendal
Running head: RESEARCH PROPOSAL 10
RESEARCH PROPOSAL 8
Research Proposal
Jamie Bass
Argosy University
March 3, 2016
ABSTRACT
Suicide is experienced in all parts of parts of the world. Even though it has been argued that suicide is common amongst the elderly in the society, it is worth noting that even children as young as 13 years old have committed suicide. The myths and misconceptions surrounding suicidal individuals are inherently different from one culture to another. For instance, in some cultures it is believed that suicidal individuals are possessed by demons. Other cultures attribute suicide to generational curses whereas other cultures attribute suicide to such factors as depression and other mental disorders. The purpose of the proposed research is to establish the risk factors of suicide and realize possible strategies which if undertaken can help to counteract suicide and hence its adverse effects in the society. In this proposal are the points to be addressed in the course of the research. It is anticipated that there will be objections to the factors to be established and hence part of this proposal are possible objections and how each of the possible objections will be addressed. The research will use secondary sources of information and hence part of this proposal is an annotated bibliography of the sources that will be utilized in course of the research. Comment by Spencer Ellsworth: This is good, but could you state it more as a piece of argumentation? Like “This paper argues that early intervention can prevent suicide if done correctly.”
WORKING THESIS
Suicide has negatively affected the society, and unless there are mitigation strategies to curb this menace, it will continue to take the lives of many people in the society.
EXPLANATION
Suicide is the act of human beings voluntarily taking their lives. Research has shown that it has always been caused by a sense of despair or hopelessness. All these issues may be induced by mental illness which may include Bipolar disorder or even depression. Suicide has been traumatizing and shameful to the bereaved families and many people in the society have always viewed it as a cowardice way of taking one’s life. Many suicidal persons have been haunted by their thoughts in many cases this is depicted as a very personal process (Goldsmith, Pellmar, Kleinman & Bunney, 2002).
In this paper, it is very much possible to look at what suicide is and the risk factors associated with suicide. A study conducted in Sweden consisting of 271 men aged 15 years and above revealed that mental disorder is a major suicide risk factor. It is thus recommended that the research paper will dwell on mental disorder and substance abuse as risk factors that contribute to suicide as well as medical conditions and psychosocial states. Harris & Barraclough (2009) also established a causal relationship between mental disorder and suicide a factor that further makes the proposed research ...
The document summarizes research on discrimination, substance abuse, and mental health issues within the homosexual community. Several studies found high rates of discrimination and victimization reported by LGBT individuals. Contributing factors to substance abuse and mental health problems among homosexuals include biological predispositions, social and family influences, stress from discrimination, and lack of support systems. While individual experiences may vary, research suggests social acceptance and support programs could help address issues like anxiety, depression and substance abuse within the community. More research is still needed to fully understand relationships and potential ways to improve well-being.
The document summarizes research on discrimination, substance abuse, and mental health issues within the homosexual community. Several studies found high rates of discrimination and victimization reported by LGBT individuals. Contributing factors to substance abuse and mental health problems among homosexuals include biological predispositions, social and family influences, stress from discrimination, and lack of support systems. However, factors may differ between individuals. Ongoing research is still needed to better understand these issues and find ways to reduce health risks in the gay community through social support programs and acceptance.
A minimum of 100 words each and References Response (#1 – 6) KEEP .docxevonnehoggarth79783
This document discusses schizophrenia and related theories. It provides details about the symptoms and causes of schizophrenia based on scholarly sources. Several theories are described, including the biological theory that certain genes and brain abnormalities can predispose individuals to schizophrenia. Environmental stressors are also discussed as potential triggers. The document considers the merits of different theories, with some support given to the developmental psychopathology view that both genetic and environmental factors likely play a role in the development of schizophrenia. Probing questions are provided to further discussion of the topics.
This document discusses posttraumatic stress disorder (PTSD) and proposes a research study comparing different treatments for PTSD. It provides background on PTSD, including common symptoms, prevalence among different populations, comorbidities, and societal impacts. The document discusses current recommended treatment of cognitive behavioral therapy (CBT) and its limitations. It also reviews research on intranasal oxytocin (OT) and its potential anxiolytic effects for PTSD patients. The proposed longitudinal study aims to compare the short-term and long-term effectiveness of medication-enhanced psychotherapy (MEP), CBT, and OT, and examine how treatment responses may differ based on patients' sex, stress history, and coping style.
Posttraumatic Stress Disorder Although originally considered a.docxstilliegeorgiana
Posttraumatic Stress Disorder
Although originally considered an anxiety disorder, the DSM-5 removed PTSD from the classification of anxiety disorders and included it in a new chapter, Trauma- and Stressor-Related Disorders. PTSD was once considered a psychological condition of combat veterans who were “shell shocked” by and unable to face their experience on the battlefield. Individuals with PTSD were labeled as weak, faced rejection from their military peers and society in general, and were removed from combat zones or discharged from the military. Today we know that PTSD is a psychobiological mental disorder associated with changes in brain function and structure and can affect survivors of combat experience but also survivors of terrorist attacks, natural disasters, serious accidents, assault or abuse, and even sudden and major emotional losses (National Institute of Mental Health, 2014a). Scientists are focusing on genes that play a role in creating fear memories as well as studying parts of the brain that deal with fear and stress (Clapp, 2016). The DSM-5 criterion for PTSD has been expanded to include both direct and indirect exposure to potentially traumatic experiences (Uher et al., 2014).
Prevalence
Most of the research on PTSD has been conducted with male veterans of military combat. In the cohort of Vietnam veterans (now in the “baby boomer” cohort), 3 out of 10 experience PTSD. Among Afghanistan and Iraq veterans, 11% to 20% experience PTSD (United States Department of Veterans Affairs, 2014). Only recently realized is the fact that many World War II veterans have lived most of their lives under the shadow of PTSD without realization of their disorder. PTSD occurs increasingly in women, although research is scarce. Rape, child abuse, and domestic violence are the most likely traumas that will result in PTSD in women. With more women serving in the military, combat-induced PTSD among women is expected to increase (Kaiser et al., 2014a). Prevalence rates of PTSD among older adults have not been adequately studied, but estimates are that between 3% and 5% of individuals older than age 60 experience PTSD. Many older individuals may not meet the full criteria for a PTSD diagnosis but may still exhibit symptoms (partial or subsyndromal PTSD) (Chopra et al., 2014). The percentage of older individuals with subclinical levels of PTSD symptoms ranges from 7% to 15% (Kaiser et al., 2014a). Current estimates may underrepresent the prevalence of PTSD in older adults (Clapp, 2016). In addition to military combat, seniors in our care now have also experienced the Great Depression, the Holocaust, and racism events that also may precipitate PTSD. Although they may have managed to keep symptoms under control, a person who becomes cognitively impaired may no longer be able to control thoughts, flashbacks, or images. This can be the cause of great distress that may be exhibited by aggressive or hostile behavior. Older individuals who are Holoca ...
The document summarizes research on the relationship between childhood trauma and psychosis. It finds that childhood abuse and neglect are strongly associated with psychotic symptoms later in life, with a clear dose-response relationship. Experiencing multiple types of trauma as a child increases the likelihood of developing psychosis as an adult by a factor of 18 to 193. Theories on how childhood trauma may lead to psychosis include cognitive, psychodynamic, dissociation, and attachment-related mechanisms.
Evolutionary basis of posttraumatic stress disorderBeshr Nammouz
Posttraumatic stress disorder (PTSD) is defined as a pathological anxiety that occurs after experiencing or witnessing a traumatic event that threatens one's life or physical integrity. The main symptoms include reexperiencing trauma, numbness, avoidance, and hyperarousal. Evolutionary theorists propose that PTSD may arise due to genes predisposing to psychiatric disorders also conferring ancestral benefits, environmental factors exceeding what humans evolved to handle, or result from unavoidable trait variation rather than flaws.
Post-Traumatic Stress Disorder (PTSD) is prevalent among military veterans who have witnessed severe stressors like combat. About 30% of veterans who served in war zones experience PTSD, with rates as high as 31% among Vietnam veterans and 20% among Iraqi war veterans. People with PTSD often struggle with anger, emotional problems, suicidal thoughts, and feeling disconnected from life and others. PTSD symptoms can interfere with daily life and work, making it difficult to concentrate, sleep, and maintain organization and attendance. Untreated PTSD also contributes to higher unemployment among veterans compared to those without the disorder.
Post-traumatic stress disorder (PTSD) is a psychological condition that affects many military veterans. It is characterized by flashbacks, nightmares, avoidance of trauma reminders, and hyperarousal. PTSD is linked to combat exposure and is diagnosed in 2-17% of veterans. Common symptoms include anger issues, substance abuse, and relationship problems. Treatment options with positive results include cognitive behavioral therapy and medication. However, many veterans are reluctant to seek help due to stigma. PTSD has significant negative impacts on veterans' lives and mental health.
Domestic violence psychologically affects victims and families in several ways. It can cause health issues for victims like depression, substance abuse, and chronic illness. Witnessing domestic violence can negatively impact children's development and behavior, lowering IQs and increasing aggression and emotional problems. Exposure to domestic violence has also been linked to intergenerational cycles of abuse, with children of abuse being more likely to become future victims or abusers themselves. Treatment for abusers and support for victims is important to help break these harmful cycles.
Running head PSYCHOLOGY1PSYCHOLOGY5Empirical res.docxSUBHI7
Running head: PSYCHOLOGY
1
PSYCHOLOGY
5
Empirical research on the prevalence of PTSD on servicemen and veterans from combat
Developments in combat zone medicine infer more aggrieved servicemen and veterans are surviving their injuries; though, numerous injuries are not as noticeable such as missing appendages and other bodily wounds, explicitly distressing cognitive damages and post-traumatic stress writhed by both soldiers and citizens in the way of relatives and friends. The frequency of these injuries can be, and still are, not clear-cut. Moreover, the categorizations of these injuries have transformed over the course of time, touching on the way in which the sum of the aggrieved is tallied over and above the interventions presented (Angkaw et.al, 2015). An editorial in The Economist on March 2013 centered on the upsurge in the figure of war veterans pursuing medical assistance as a result of post-traumatic stress symptoms. The rise was realized amongst the newly repatriated officers, albeit similarly among elderly veterans of prior wars, and had resulted to a surge in America`s disabled former soldiers count by nearly 45% from the year 2000. A lot of empirical research reinforces the assertion made in the Economist piece, and investigation correspondingly demonstrates the long-term overheads will be a reality for many nations involved in the cross-border wars (Beckham et.al, 2014). Internationally, a rise in number of war veterans looking for assistance for psychological signs that are every so often well-matched with PTSD disorder explicate that the number of troupers affected with PTSD in the year 2013 will grow to over 300,000 persons in the United States. A similar predisposition is noticed in other nation state, and a recent research from Europe (particularly United Kingdom) pronounces late onset indications among servicemen. Our test hypothesis will appraise the prevalence and frequency of PTSD in servicemen and veteran from the warzone. From the prevalence then apt interventions can be devised to help assist all those who served and are affected with disorder.
How is PTSD perceived in a health perspective?
PTSD is a mental disorder, which is described and defined in the ensuing two classifications; the International Classification of Diseases (ICD-10) established by the World Health Organization (WHO), together with the Diagnostic and Statistical Manual of Mental Disorders (DMMD) instigated by the American Psychiatric Association (DSM-5). The analytical measures in the two classifications are articulated somewhat differently, but overall they are seen as alike. The analytical criteria consist of the following: experiencing a traumatic situation or event, short or long lasting, in which the person is exposed to fears of loss of life, grim harm or sexual abuse. The exposure is a due to circumstances with unswervingly involves the distressing event or observes the traumatic happening personally (Angkaw et.al, 2015). The social-b ...
This document reviews literature on the impact of adverse childhood experiences (ACEs). It finds that ACEs are linked to negative health outcomes later in life through their effects on stress response systems and brain development. ACEs are common, affecting up to 67% of the population, and disproportionately impact low-income communities. The impacts of ACEs are cyclical as they increase risks for future generations. While ACEs have lasting biological and behavioral effects, perception of stress may influence outcomes. More research is needed to understand impacts, develop treatments, and engage communities to address this major public health issue.
Abnormal psychology Stress and mental healthKadine Duncan
Adjustment disorders and post-traumatic stress disorder can develop after experiencing stressful life events. Adjustment disorder involves distressing symptoms that occur within 3 months of a stressor like unemployment, divorce or bereavement. Symptoms include difficulty functioning and concentrating. Post-traumatic stress disorder can develop after traumatic events like accidents, disasters or assault. It is characterized by vivid memories of the event and disturbance in sleep and behavior. Risk factors include previous trauma, lack of support, and membership in minority groups. Without treatment, long-term problems with socializing, substance abuse, depression and anxiety can occur.
According to the NASW Code of Ethics section 6.04 (NASW, 2008), .docxaryan532920
According to the NASW Code of Ethics section 6.04 (NASW, 2008), social workers are ethically bound to work for policies that support the healthy development of individuals, guarantee equal access to services, and promote social and economic justice.
For this Discussion
, review this week’s resources, including
Working with Survivors of Sexual Abuse and Trauma: The Case of Rita
and “The Johnson Family”. Consider what change you might make to the policies that affect the client in the case you chose. Finally, think about how you might evaluate the success of the policy changes.
By Day 3
Post
an explanation of one change you might make to the policies that affect the client in the case. Be sure to reference the case you selected in your post. Finally, explain how you might evaluate the success of the policy changes.
Working With Survivors of Sexual Abuse and Trauma: The Case of Rita
Rita is a 22-year-old, heterosexual, Latina female working in the hospitality industry at a resort. She is the youngest of five children and lives at home with her parents. Rita has dated in the past but never developed a serious relationship. She is close to her immediate and extended family as well as to her female friends in the Latino community. Although her parents and three of her siblings were born in the Dominican Republic, Rita was born in the United States.
A year ago, Rita was sexually assaulted by an acquaintance of a male coworker. Rita and a female coworker met Juan and Bob after work at a local bar for a light meal and a few drinks. Because Rita had to get up early to work her shift the next day, Bob offered to drive her home. Instead of taking Rita directly home, however, he drove to a desolate spot nearby and assaulted her. Afterward, Bob threatened to harm her family if she did not remain silent and proceeded to drive her home. Although Rita did not tell her family what happened, she did call our agency hotline the next day to discuss her options. Because Rita’s assault occurred within the 5-day window for forensic evidence collection of this kind, Rita consented to activation of the county’s sexual assault response team (SART). Although she agreed to have an advocate and the sexual assault nurse examiner (SANE) meet her at the hospital, Rita tearfully stated that she did not want to file a police report at that time because she did not want to upset her family. The nurse examiner interviewed Rita, collected evidence, recorded any injuries, administered antibiotics for possible sexually transmitted infections, and gave Rita emergency contraception in case of pregnancy. The advocate stayed with Rita during the procedure, supporting her and validating her experience, and gave her a referral for individual crisis counseling at our agency.
My treatment goals for Rita included alleviation of rape trauma syndrome symptoms that included shame and self-blame, validation of self-worth and empowerment, and processing how it would feel to discl.
According to the text, crime has been part of the human condition si.docxaryan532920
The document provides instructions for a 4-6 page paper on criminal law. It asks the student to:
1) Determine if the Ex Post Facto Clause can prohibit increased federal minimum sentencing guidelines and provide a rationale.
2) Explain the distinction between criminal, tort, and moral wrongs, and support or criticize the premise that moral laws have higher standards than criminal law.
3) Identify and discuss the differences between solicitation and conspiracy to commit a crime, and support or criticize the unilateral approach to conspiracy convictions.
4) Identify the four goals of criminal law and discuss how they effectuate protecting the public and preventing innocent convictions.
According to Ronald Story and Bruce Laurie, The dozen years between.docxaryan532920
Conservatives came to dominate American politics between 1968 and 1980 by capitalizing on social unrest and challenging the New Deal coalition. They embraced ideas and policies that emphasized free markets, deregulation, and tax cuts. These policies shaped American society into the 21st century by promoting economic growth while also increasing inequality.
According to Kirk (2016), most of your time will be spent work with .docxaryan532920
According to Kirk (2016), most of your time will be spent work with your data. The four following group actions were mentioned by Kirk (2016):
Data acquisition: Gathering the raw material
Data examination: Identifying physical properties and meaning
Data transformation: Enhancing your data through modification and consolidation
Data exploration: Using exploratory analysis and research techniques to learn
Select 1 data action and elaborate on the actions performed in that action group.
Reference: Kirk, A. (2016). Data Visualisation: A Handbook for Data Driven Design (p. 50). SAGE Publications.
.
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Similar to Substance Abuse and Posttraumatic Stress DisorderAuthor(s.docx
Journal of Traumatic StressApril 2013, 26, 266–273Public.docxtawnyataylor528
Journal of Traumatic Stress
April 2013, 26, 266–273
Public Mental Health Clients with Severe Mental Illness and
Probable Posttraumatic Stress Disorder: Trauma Exposure and
Correlates of Symptom Severity
Weili Lu,1 Philip T. Yanos,2 Steven M. Silverstein,3 Kim T. Mueser,4 Stanley D. Rosenberg,4
Jennifer D. Gottlieb,4 Stephanie Marcello Duva,5 Thanuja Kularatne,1 Stephanie Dove-Williams,5
Danielle Paterno,5 Danielle Hawthorne,5 and Giovanna Giacobbe5
1Department of Psychiatric Rehabilitation and Counseling Professions, University of Medicine and Dentistry of New Jersey,
Scotch Plains, New Jersey, USA
2John Jay College of Criminal Justice, Department of Psychology, CUNY, New York, New York, USA
3Division of Schizophrenia Research, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New
Jersey, Piscataway, New Jersey, USA
4Department of Psychiatry, Dartmouth Medical School, Concord, New Hampshire, USA
5University Behavioral Health Care, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA
Individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure and for the development of posttraumatic
stress disorder (PTSD). This study reports findings from a large, comprehensive screening of trauma and PTSD symptoms among public
mental health clients in a statewide community mental health system. In 851 individuals with SMI and probable PTSD, childhood sexual
abuse was the most commonly endorsed index trauma, followed closely by the sudden death of a loved one. Participants had typically
experienced an average of 7 types of traumatic events in their lifetime. The number of types of traumatic events experienced and Hispanic
ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relation to events that occurred
on average 20 years earlier, suggesting the clinical need to address trauma and loss throughout the lifespan, including their prolonged
after-effects.
Over the past two decades, a growing body of research has
shown that individuals with severe mental illness (SMI) are
at greatly increased risk for trauma exposure (see Grubaugh,
Zinzow, Paul, Egede, & Frueh, 2011, for a review). Although
national surveys indicate that more than half of people in the
general population report exposure to at least one event that
according to the Diagnostic and Statistical Manual of Mental
Disorders (4th ed., DSM-IV; American Psychiatric Associa-
tion, 1994) meets criteria for trauma (Kessler, Sonnega, Bromet,
Hughes, & Nelson, 1995), studies of people with a SMI (such as
This research was supported by National Institute of Mental Health grant R01
MH064662. We wish to thank the following individuals for their assistance
with this project: Edward Kim, Lee Hyer, Rachael Fite, Kenneth Gill, Rose-
marie Rosati, Christopher Kosseff, Karen Somers, John Swanson, Avis Scott,
Rena Gitlitz, John Markey, Zygmond Gray, Marilyn Green, Alex Sh ...
Running head LITERATURE REVIEW-POST TRAUMATIC STRESS DISORDER .docxwlynn1
Running head: LITERATURE REVIEW-POST TRAUMATIC STRESS DISORDER 1
LITERATURE REVIEW-POST TRAUMATIC STRESS DISORDER 8
Literature Review-Post Traumatic Stress Disorder
Amber Hope
Argosy University
Literature Review-Post Traumatic Stress Disorder
Introduction
Using Abraham Maslow’s Hierarchy of Needs theory in this situation creates relevance towards approaches employed to manage post-traumatic stress disorder. The theory is a framework and approach that looks into satisfying needs for positive mental and physical development. The steps are met before one move to above steps. The needs include physiological, self-esteem, love & belonging, safety & security, love & belonging, and self-actualization. The above factors are considered critical for the methods employed in dealing with Post-Traumatic Stress Disorder (PTSD) (Brummelte & Galea, 2016). The model is essential in identifying the effects of PTSD on battered women, parenting of youths, the mental status of pregnant mothers, and factors that lead to future criminality among youths.
The Jungian theory is also being looked at in dealing with PTSD because of its capacity, just like the Hierarchy of Needs theory, in bridging the relationship between the mind and social developments. The situation discusses PTSD as a problem in limiting positivity in mental and physical health (Brown, 2017). The society may not work without a stable mental status. Therefore, it is essential to study the relationship between PTSD and health. This is with a focus on mood, behavioral traits, health, and another health status.
Literature Review of Post-Traumatic Stress Disorder (PTSD)
Baumeister, Vohs, Aaker, & Garbinsky (2013) argue that an organism possesses a positive life depending on its capacity to maintain an internal milieu amidst challenges in its environment. Brummelte & Galea, (2016) supports the above factor by calling it homeostasis. Stress is seen as a factor that changes the homeostasis of organisms negatively. Adamsons & Johnson (2013) presents the various stakeholders who are affected by PTSD. Among them include women, children, and male adults. However, women, children, and youths are the ones that experience the problem the most. Adamsons & Johnson (2013) shows that a stressor derived from the PTSD condition acts as a threat to the life of anyone in the world. PTSD has evolved for many decades depending on the changing nature of society and modern society. Stress response also continues to undergo evolution to acquire its adaptive processes.
Dziwota, Stepulak, Włoszczak-Szubzda, & Olajossy (2018) presents data relating to prolonged response towards stress. The situation appears as the one which influences the development of tissue damages and the occurrence of illnesses. The situation is seen to invoke coping mechanisms and responses between human and animals depending on the nature of the threats they perceive to affect their liv.
Running head RESEARCH PROPOSAL10RESEARCH PROPOSAL 8.docxtoltonkendal
Running head: RESEARCH PROPOSAL 10
RESEARCH PROPOSAL 8
Research Proposal
Jamie Bass
Argosy University
March 3, 2016
ABSTRACT
Suicide is experienced in all parts of parts of the world. Even though it has been argued that suicide is common amongst the elderly in the society, it is worth noting that even children as young as 13 years old have committed suicide. The myths and misconceptions surrounding suicidal individuals are inherently different from one culture to another. For instance, in some cultures it is believed that suicidal individuals are possessed by demons. Other cultures attribute suicide to generational curses whereas other cultures attribute suicide to such factors as depression and other mental disorders. The purpose of the proposed research is to establish the risk factors of suicide and realize possible strategies which if undertaken can help to counteract suicide and hence its adverse effects in the society. In this proposal are the points to be addressed in the course of the research. It is anticipated that there will be objections to the factors to be established and hence part of this proposal are possible objections and how each of the possible objections will be addressed. The research will use secondary sources of information and hence part of this proposal is an annotated bibliography of the sources that will be utilized in course of the research. Comment by Spencer Ellsworth: This is good, but could you state it more as a piece of argumentation? Like “This paper argues that early intervention can prevent suicide if done correctly.”
WORKING THESIS
Suicide has negatively affected the society, and unless there are mitigation strategies to curb this menace, it will continue to take the lives of many people in the society.
EXPLANATION
Suicide is the act of human beings voluntarily taking their lives. Research has shown that it has always been caused by a sense of despair or hopelessness. All these issues may be induced by mental illness which may include Bipolar disorder or even depression. Suicide has been traumatizing and shameful to the bereaved families and many people in the society have always viewed it as a cowardice way of taking one’s life. Many suicidal persons have been haunted by their thoughts in many cases this is depicted as a very personal process (Goldsmith, Pellmar, Kleinman & Bunney, 2002).
In this paper, it is very much possible to look at what suicide is and the risk factors associated with suicide. A study conducted in Sweden consisting of 271 men aged 15 years and above revealed that mental disorder is a major suicide risk factor. It is thus recommended that the research paper will dwell on mental disorder and substance abuse as risk factors that contribute to suicide as well as medical conditions and psychosocial states. Harris & Barraclough (2009) also established a causal relationship between mental disorder and suicide a factor that further makes the proposed research ...
The document summarizes research on discrimination, substance abuse, and mental health issues within the homosexual community. Several studies found high rates of discrimination and victimization reported by LGBT individuals. Contributing factors to substance abuse and mental health problems among homosexuals include biological predispositions, social and family influences, stress from discrimination, and lack of support systems. While individual experiences may vary, research suggests social acceptance and support programs could help address issues like anxiety, depression and substance abuse within the community. More research is still needed to fully understand relationships and potential ways to improve well-being.
The document summarizes research on discrimination, substance abuse, and mental health issues within the homosexual community. Several studies found high rates of discrimination and victimization reported by LGBT individuals. Contributing factors to substance abuse and mental health problems among homosexuals include biological predispositions, social and family influences, stress from discrimination, and lack of support systems. However, factors may differ between individuals. Ongoing research is still needed to better understand these issues and find ways to reduce health risks in the gay community through social support programs and acceptance.
A minimum of 100 words each and References Response (#1 – 6) KEEP .docxevonnehoggarth79783
This document discusses schizophrenia and related theories. It provides details about the symptoms and causes of schizophrenia based on scholarly sources. Several theories are described, including the biological theory that certain genes and brain abnormalities can predispose individuals to schizophrenia. Environmental stressors are also discussed as potential triggers. The document considers the merits of different theories, with some support given to the developmental psychopathology view that both genetic and environmental factors likely play a role in the development of schizophrenia. Probing questions are provided to further discussion of the topics.
This document discusses posttraumatic stress disorder (PTSD) and proposes a research study comparing different treatments for PTSD. It provides background on PTSD, including common symptoms, prevalence among different populations, comorbidities, and societal impacts. The document discusses current recommended treatment of cognitive behavioral therapy (CBT) and its limitations. It also reviews research on intranasal oxytocin (OT) and its potential anxiolytic effects for PTSD patients. The proposed longitudinal study aims to compare the short-term and long-term effectiveness of medication-enhanced psychotherapy (MEP), CBT, and OT, and examine how treatment responses may differ based on patients' sex, stress history, and coping style.
Posttraumatic Stress Disorder Although originally considered a.docxstilliegeorgiana
Posttraumatic Stress Disorder
Although originally considered an anxiety disorder, the DSM-5 removed PTSD from the classification of anxiety disorders and included it in a new chapter, Trauma- and Stressor-Related Disorders. PTSD was once considered a psychological condition of combat veterans who were “shell shocked” by and unable to face their experience on the battlefield. Individuals with PTSD were labeled as weak, faced rejection from their military peers and society in general, and were removed from combat zones or discharged from the military. Today we know that PTSD is a psychobiological mental disorder associated with changes in brain function and structure and can affect survivors of combat experience but also survivors of terrorist attacks, natural disasters, serious accidents, assault or abuse, and even sudden and major emotional losses (National Institute of Mental Health, 2014a). Scientists are focusing on genes that play a role in creating fear memories as well as studying parts of the brain that deal with fear and stress (Clapp, 2016). The DSM-5 criterion for PTSD has been expanded to include both direct and indirect exposure to potentially traumatic experiences (Uher et al., 2014).
Prevalence
Most of the research on PTSD has been conducted with male veterans of military combat. In the cohort of Vietnam veterans (now in the “baby boomer” cohort), 3 out of 10 experience PTSD. Among Afghanistan and Iraq veterans, 11% to 20% experience PTSD (United States Department of Veterans Affairs, 2014). Only recently realized is the fact that many World War II veterans have lived most of their lives under the shadow of PTSD without realization of their disorder. PTSD occurs increasingly in women, although research is scarce. Rape, child abuse, and domestic violence are the most likely traumas that will result in PTSD in women. With more women serving in the military, combat-induced PTSD among women is expected to increase (Kaiser et al., 2014a). Prevalence rates of PTSD among older adults have not been adequately studied, but estimates are that between 3% and 5% of individuals older than age 60 experience PTSD. Many older individuals may not meet the full criteria for a PTSD diagnosis but may still exhibit symptoms (partial or subsyndromal PTSD) (Chopra et al., 2014). The percentage of older individuals with subclinical levels of PTSD symptoms ranges from 7% to 15% (Kaiser et al., 2014a). Current estimates may underrepresent the prevalence of PTSD in older adults (Clapp, 2016). In addition to military combat, seniors in our care now have also experienced the Great Depression, the Holocaust, and racism events that also may precipitate PTSD. Although they may have managed to keep symptoms under control, a person who becomes cognitively impaired may no longer be able to control thoughts, flashbacks, or images. This can be the cause of great distress that may be exhibited by aggressive or hostile behavior. Older individuals who are Holoca ...
The document summarizes research on the relationship between childhood trauma and psychosis. It finds that childhood abuse and neglect are strongly associated with psychotic symptoms later in life, with a clear dose-response relationship. Experiencing multiple types of trauma as a child increases the likelihood of developing psychosis as an adult by a factor of 18 to 193. Theories on how childhood trauma may lead to psychosis include cognitive, psychodynamic, dissociation, and attachment-related mechanisms.
Evolutionary basis of posttraumatic stress disorderBeshr Nammouz
Posttraumatic stress disorder (PTSD) is defined as a pathological anxiety that occurs after experiencing or witnessing a traumatic event that threatens one's life or physical integrity. The main symptoms include reexperiencing trauma, numbness, avoidance, and hyperarousal. Evolutionary theorists propose that PTSD may arise due to genes predisposing to psychiatric disorders also conferring ancestral benefits, environmental factors exceeding what humans evolved to handle, or result from unavoidable trait variation rather than flaws.
Post-Traumatic Stress Disorder (PTSD) is prevalent among military veterans who have witnessed severe stressors like combat. About 30% of veterans who served in war zones experience PTSD, with rates as high as 31% among Vietnam veterans and 20% among Iraqi war veterans. People with PTSD often struggle with anger, emotional problems, suicidal thoughts, and feeling disconnected from life and others. PTSD symptoms can interfere with daily life and work, making it difficult to concentrate, sleep, and maintain organization and attendance. Untreated PTSD also contributes to higher unemployment among veterans compared to those without the disorder.
Post-traumatic stress disorder (PTSD) is a psychological condition that affects many military veterans. It is characterized by flashbacks, nightmares, avoidance of trauma reminders, and hyperarousal. PTSD is linked to combat exposure and is diagnosed in 2-17% of veterans. Common symptoms include anger issues, substance abuse, and relationship problems. Treatment options with positive results include cognitive behavioral therapy and medication. However, many veterans are reluctant to seek help due to stigma. PTSD has significant negative impacts on veterans' lives and mental health.
Domestic violence psychologically affects victims and families in several ways. It can cause health issues for victims like depression, substance abuse, and chronic illness. Witnessing domestic violence can negatively impact children's development and behavior, lowering IQs and increasing aggression and emotional problems. Exposure to domestic violence has also been linked to intergenerational cycles of abuse, with children of abuse being more likely to become future victims or abusers themselves. Treatment for abusers and support for victims is important to help break these harmful cycles.
Running head PSYCHOLOGY1PSYCHOLOGY5Empirical res.docxSUBHI7
Running head: PSYCHOLOGY
1
PSYCHOLOGY
5
Empirical research on the prevalence of PTSD on servicemen and veterans from combat
Developments in combat zone medicine infer more aggrieved servicemen and veterans are surviving their injuries; though, numerous injuries are not as noticeable such as missing appendages and other bodily wounds, explicitly distressing cognitive damages and post-traumatic stress writhed by both soldiers and citizens in the way of relatives and friends. The frequency of these injuries can be, and still are, not clear-cut. Moreover, the categorizations of these injuries have transformed over the course of time, touching on the way in which the sum of the aggrieved is tallied over and above the interventions presented (Angkaw et.al, 2015). An editorial in The Economist on March 2013 centered on the upsurge in the figure of war veterans pursuing medical assistance as a result of post-traumatic stress symptoms. The rise was realized amongst the newly repatriated officers, albeit similarly among elderly veterans of prior wars, and had resulted to a surge in America`s disabled former soldiers count by nearly 45% from the year 2000. A lot of empirical research reinforces the assertion made in the Economist piece, and investigation correspondingly demonstrates the long-term overheads will be a reality for many nations involved in the cross-border wars (Beckham et.al, 2014). Internationally, a rise in number of war veterans looking for assistance for psychological signs that are every so often well-matched with PTSD disorder explicate that the number of troupers affected with PTSD in the year 2013 will grow to over 300,000 persons in the United States. A similar predisposition is noticed in other nation state, and a recent research from Europe (particularly United Kingdom) pronounces late onset indications among servicemen. Our test hypothesis will appraise the prevalence and frequency of PTSD in servicemen and veteran from the warzone. From the prevalence then apt interventions can be devised to help assist all those who served and are affected with disorder.
How is PTSD perceived in a health perspective?
PTSD is a mental disorder, which is described and defined in the ensuing two classifications; the International Classification of Diseases (ICD-10) established by the World Health Organization (WHO), together with the Diagnostic and Statistical Manual of Mental Disorders (DMMD) instigated by the American Psychiatric Association (DSM-5). The analytical measures in the two classifications are articulated somewhat differently, but overall they are seen as alike. The analytical criteria consist of the following: experiencing a traumatic situation or event, short or long lasting, in which the person is exposed to fears of loss of life, grim harm or sexual abuse. The exposure is a due to circumstances with unswervingly involves the distressing event or observes the traumatic happening personally (Angkaw et.al, 2015). The social-b ...
This document reviews literature on the impact of adverse childhood experiences (ACEs). It finds that ACEs are linked to negative health outcomes later in life through their effects on stress response systems and brain development. ACEs are common, affecting up to 67% of the population, and disproportionately impact low-income communities. The impacts of ACEs are cyclical as they increase risks for future generations. While ACEs have lasting biological and behavioral effects, perception of stress may influence outcomes. More research is needed to understand impacts, develop treatments, and engage communities to address this major public health issue.
Abnormal psychology Stress and mental healthKadine Duncan
Adjustment disorders and post-traumatic stress disorder can develop after experiencing stressful life events. Adjustment disorder involves distressing symptoms that occur within 3 months of a stressor like unemployment, divorce or bereavement. Symptoms include difficulty functioning and concentrating. Post-traumatic stress disorder can develop after traumatic events like accidents, disasters or assault. It is characterized by vivid memories of the event and disturbance in sleep and behavior. Risk factors include previous trauma, lack of support, and membership in minority groups. Without treatment, long-term problems with socializing, substance abuse, depression and anxiety can occur.
Similar to Substance Abuse and Posttraumatic Stress DisorderAuthor(s.docx (18)
According to the NASW Code of Ethics section 6.04 (NASW, 2008), .docxaryan532920
According to the NASW Code of Ethics section 6.04 (NASW, 2008), social workers are ethically bound to work for policies that support the healthy development of individuals, guarantee equal access to services, and promote social and economic justice.
For this Discussion
, review this week’s resources, including
Working with Survivors of Sexual Abuse and Trauma: The Case of Rita
and “The Johnson Family”. Consider what change you might make to the policies that affect the client in the case you chose. Finally, think about how you might evaluate the success of the policy changes.
By Day 3
Post
an explanation of one change you might make to the policies that affect the client in the case. Be sure to reference the case you selected in your post. Finally, explain how you might evaluate the success of the policy changes.
Working With Survivors of Sexual Abuse and Trauma: The Case of Rita
Rita is a 22-year-old, heterosexual, Latina female working in the hospitality industry at a resort. She is the youngest of five children and lives at home with her parents. Rita has dated in the past but never developed a serious relationship. She is close to her immediate and extended family as well as to her female friends in the Latino community. Although her parents and three of her siblings were born in the Dominican Republic, Rita was born in the United States.
A year ago, Rita was sexually assaulted by an acquaintance of a male coworker. Rita and a female coworker met Juan and Bob after work at a local bar for a light meal and a few drinks. Because Rita had to get up early to work her shift the next day, Bob offered to drive her home. Instead of taking Rita directly home, however, he drove to a desolate spot nearby and assaulted her. Afterward, Bob threatened to harm her family if she did not remain silent and proceeded to drive her home. Although Rita did not tell her family what happened, she did call our agency hotline the next day to discuss her options. Because Rita’s assault occurred within the 5-day window for forensic evidence collection of this kind, Rita consented to activation of the county’s sexual assault response team (SART). Although she agreed to have an advocate and the sexual assault nurse examiner (SANE) meet her at the hospital, Rita tearfully stated that she did not want to file a police report at that time because she did not want to upset her family. The nurse examiner interviewed Rita, collected evidence, recorded any injuries, administered antibiotics for possible sexually transmitted infections, and gave Rita emergency contraception in case of pregnancy. The advocate stayed with Rita during the procedure, supporting her and validating her experience, and gave her a referral for individual crisis counseling at our agency.
My treatment goals for Rita included alleviation of rape trauma syndrome symptoms that included shame and self-blame, validation of self-worth and empowerment, and processing how it would feel to discl.
According to the text, crime has been part of the human condition si.docxaryan532920
The document provides instructions for a 4-6 page paper on criminal law. It asks the student to:
1) Determine if the Ex Post Facto Clause can prohibit increased federal minimum sentencing guidelines and provide a rationale.
2) Explain the distinction between criminal, tort, and moral wrongs, and support or criticize the premise that moral laws have higher standards than criminal law.
3) Identify and discuss the differences between solicitation and conspiracy to commit a crime, and support or criticize the unilateral approach to conspiracy convictions.
4) Identify the four goals of criminal law and discuss how they effectuate protecting the public and preventing innocent convictions.
According to Ronald Story and Bruce Laurie, The dozen years between.docxaryan532920
Conservatives came to dominate American politics between 1968 and 1980 by capitalizing on social unrest and challenging the New Deal coalition. They embraced ideas and policies that emphasized free markets, deregulation, and tax cuts. These policies shaped American society into the 21st century by promoting economic growth while also increasing inequality.
According to Kirk (2016), most of your time will be spent work with .docxaryan532920
According to Kirk (2016), most of your time will be spent work with your data. The four following group actions were mentioned by Kirk (2016):
Data acquisition: Gathering the raw material
Data examination: Identifying physical properties and meaning
Data transformation: Enhancing your data through modification and consolidation
Data exploration: Using exploratory analysis and research techniques to learn
Select 1 data action and elaborate on the actions performed in that action group.
Reference: Kirk, A. (2016). Data Visualisation: A Handbook for Data Driven Design (p. 50). SAGE Publications.
.
According to the Council on Social Work Education, Competency 5 Eng.docxaryan532920
According to the Council on Social Work Education, Competency 5: Engage in Policy Practice:
Social workers understand that human rights and social justice, as well as social welfare and services, are mediated by policy and its implementation at the federal, state, and local levels. Social workers understand the history and current structures of social policies and services, the role of policy in service delivery, and the role of practice in policy development. Social workers understand their role in policy development and implementation within their practice settings at the micro, mezzo, and macro levels and they actively engage in policy practice to effect change within those settings. Social workers recognize and understand the historical, social, cultural, economic, organizational, environmental, and global influences that affect social policy. They are also knowledgeable about policy formulation, analysis, implementation, and evaluation.
Walden’s MSW program expects students in their specialization year to be able to:
Evaluate the implication of policies and policy change in the lives of clients/constituents.
Demonstrate critical thinking skills that can be used to inform policymakers and influence policies that impact clients/constituents and services.
This assignment is intended to help students demonstrate the behavioral components of this competency in their field education.
To prepare
: Working with your field instructor, identify a social problem that is common among the organization (or its clients) and research current policies at that state and federal levels that impact the social problem. Then, from a position of advocacy, identify methods to address the social problem (i.e., how you, as a social worker, and the agency advocate to change the problem). You are expected to specifically address how both you and the agency can effectively engage policy makers to make them aware of the social problem and the impact that the policies have on the agency and clients.
The Assignment (2-3 pages): Social Problems is Ex-cons finding Jobs Opportunities in State of California. The Agency is Called "Manifest" the website is Manifest.org
Identify the social problem
Explain rational for selecting social problem
Describe state and federal policies that impact the social problem
Identify specific methods to address the social problems
Explain how the agency and student can advocate to change the social problem
You are expected to present and discuss this assignment with your agency Field Instructor. Your field instructor will be evaluating your ability to demonstrate this competency in their field evaluation. In addition, you will submit this assignment for classroom credit. The Field Liaison will grade the assignment “PASS/FAIL,” see rubric for passing criteria.
.
According to Kirk (2016), most of our time will be spent working.docxaryan532920
According to Kirk (2016), most of our time will be spent working with our data. The four following group actions were mentioned by Kirk (2016):
Book: Kirk, A. (2016). Data visualisation a handbook for data driven design. Los Angeles, CA: Sage.
Data acquisition: Gathering the raw material
Data examination: Identifying physical properties and meaning
Data transformation: Enhancing your data through modification and consolidation
Data exploration: Using exploratory analysis and research techniques to learn
Select 1 data action and elaborate on the actions preformed in that action group.
.
According to Kirk (2016), most of your time will be spent working wi.docxaryan532920
According to Kirk (2016), most of your time will be spent working with your data. The four following group actions were mentioned by Kirk (2016):
Data acquisition: Gathering the raw material
Data examination: Identifying physical properties and meaning
Data transformation: Enhancing your data through modification and consolidation
Data exploration: Using exploratory analysis and research techniques to learn
Select 1 data action and elaborate on the actions preformed in that action group.
.
According to Davenport (2014) the organizational value of healthcare.docxaryan532920
According to Davenport (2014) the organizational value of healthcare analytics, both determination and importance, provide a potential increase in annual revenue and ROI based on the value and use of analytics. To complete this assignment, research and evaluate the challenges faced in the implementation of healthcare analytics in the Health Care Organization (HCO) or health care industry using the following tools:
The paper must also address the following:
Application of PICO (problem, intervention, comparison group, and outcomes) to the challenge identified in your research.
The paper:
Must be two to four double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the
Ashford Writing Center. (Links to an external site.)
Must include a separate title page with the following:
Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
Must use at least three scholarly sources in addition to the course text.
Must document all sources in APA style as outlined in the Ashford Writing Center.
Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.
.
According to the authors, privacy and security go hand in hand; .docxaryan532920
According to the authors, privacy and security go hand in hand; and hence, privacy cannot be protected without implementing proper security controls and technologies. Today, organizations must make not only reasonable efforts to offer protection of privacy of data, but also must go much further as privacy breaches are damaging to its customers, reputation, and potentially could put the company out of business. As we continue learning from our various professional areas of practice, its no doubt that breaches have become an increasing concern to many businesses and their future operations. Taking Cyberattacks proliferation of 2011 into context, security experts at Intel/McAfee discovered huge series of cyberattacks on the networks of 72 organizations globally, including the United Nations, governments and corporations.
Q: From this research revelation in our chapter 11, briefly state and name the countries and organizations identified as the targeted victims?
.
According to Gilbert and Troitzsch (2005), Foundations of Simula.docxaryan532920
According to Gilbert and Troitzsch (2005), Foundations of Simulation Modeling, a simulation model is a computer program that captures the behavior of a real-world system and its input and possible output processes.
Briefly explain what the simulation modeling relies upon?
-500 words at least.
-No Plagiarism.
-APA Format.
.
According to Klein (2016), using ethical absolutism and ethical .docxaryan532920
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at least 250 words
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According to Franks and Smallwood (2013), information has become.docxaryan532920
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Social workers understand that human rights and social justice, as well as social welfare and services, are mediated by policy and its implementation at the federal, state, and local levels. Social workers understand the history and current structures of social policies and services, the role of policy in service delivery, and the role of practice in policy development. Social workers understand their role in policy development and implementation within their practice settings at the micro, mezzo, and macro levels and they actively engage in policy practice to effect change within those settings. Social workers recognize and understand the historical, social, cultural, economic, organizational, environmental, and global influences that affect social policy. They are also knowledgeable about policy formulation, analysis, implementation, and evaluation. Social workers:
Identify social policy at the local, state, and federal level that impacts well-being, service delivery, and access to social services;
Assess how social welfare and economic policies impact the delivery of and access to social services;
Apply critical thinking to analyze, formulate, and advocate for policies that advance human rights and social, economic, and environmental justice.
This assignment is intended to help students demonstrate the behavioral components of this competency in their field education.
To prepare: Working with your field instructor, identify, evaluate, and discuss policies established by the local, state, and federal government (within the last five years) that affect the day to day operations of the field placement agency.
The Assignment (1-2 pages): (In The States California. The Good Seed is a Drop-In center for 18-25 years!
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From this research revelation in our chapter 11, briefly state and name the countries and organizations identified as the targeted victims?
Use the APA format to include your references. Each paragraph should have different references and each para should have at least 4 sentences.
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According to recent surveys, China, India, and the Philippines are t.docxaryan532920
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According to Peskin et al. (2013) in our course reader, Studies on .docxaryan532920
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According to Franks and Smallwood (2013), information has become the.docxaryan532920
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Q: Please identify and clearly state what the difference is?
Use the APA format to include your references. Each paragraph should have different references and each para should have at least 4 sentences.
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The paper must be 1-2 pages in length (excluding title and reference page) and in APA (6th edition) format. The paper must include the Ang (2011) article in correct APA format.
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.
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Substance Abuse and Posttraumatic Stress DisorderAuthor(s.docx
1. Substance Abuse and Posttraumatic Stress Disorder
Author(s): Kathleen T. Brady, Sudie E. Back and Scott F.
Coffey
Source: Current Directions in Psychological Science, Vol. 13,
No. 5 (Oct., 2004), pp. 206-209
Published by: Sage Publications, Inc. on behalf of Association
for Psychological Science
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CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE
Substance Abuse and
Posttraumatic Stress Disorder
Kathleen T. Brady, Sudie E. Back, and Scott F. Coffey
Medical University of South Carolina and University at
Buffalo, State University of New York
ABSTRACT?Posttraumatic stress disorder (PTSD) and
substance
use disorders (SUDs) frequently co-occur. Among individuals
seeking treatment for SUDs, approximately 36% to 50% meet
criteria for lifetime PTSD. The self-medication and suscepti
bility hypotheses are two of the hypotheses that have been
proposed to help explain the etiological relationship between
PTSD and SUDs. It is also possible that common factors, such
as
genetic, neurobiological, or environmental factors, contribute
to
the high rate of PTSD-SUD co-occurrence. Preliminary results
from integrated psychotherapy approaches for the treatment of
patients with both disorders show promise. This article reviews
these and other advances in the study of comorbid PTSD and
SUDs, and suggests areas for future work.
KEYWORDS?posttraumatic stress disorder; trauma; substance
use disorders; addiction; comorbidity
3. Posttraumatic stress disorder (PTSD) is characterized by
symptoms
that persist for at least 1 month following exposure to a
traumatic
event. Interpersonal violence (e.g., physical and sexual abuse),
com
bat, and natural disasters are examples of traumas commonly
asso
ciated with PTSD. The characteristic symptoms of PTSD can be
divided into three clusters: avoidant, intrusive, and arousal
symptoms.
Examples of intrusive symptoms include unwanted thoughts or
flashbacks of the event. Avoidant symptoms include, for
example,
attempts to avoid any thoughts or stimuli that remind one of the
event.
These symptoms are particularly relevant to this review
because
substances of abuse are often used by individuals with PTSD in
an
attempt to avoid or escape memories. Arousal symptoms
generally
include exaggerated startle reflex, sleep disturbance, and
irritability,
and are generally associated with hyperactivity of the
autonomie
nervous system. These symptoms are also pertinent to our
discussion
here because the use and withdrawal of many substances of
abuse are
associated with autonomie nervous system hyperactivity.
4. A number of recent studies have emphasized the common co-oc
currence (i.e., comorbidity) of PTSD and substance use
disorders
(SUDs). The interaction between PTSD and SUDs is likely
multifac
eted and variable. Further exploration of the relationship
between
these two disorders may prove useful in explicating the
underlying
pathophysiological processes involved. In this article, we
explore the
relationship between PTSD and SUDs.
PREVALENCE
The prevalence of the co-occurrence of PTSD and SUDs has
been
examined in epidemiological studies in the general population,
as well
as in studies of individuals who seek treatment for one or both
of these
disorders.
Epidemiological Studies
Epidemiological investigations provide information about the
number
of individuals with a given disorder in the general population
or in
subgroups of the general population. Two large
epidemiological
studies focusing on psychiatric disorders have been conducted
5. fairly
recently in the United States: the Epidemiologie Catchment
Area
Study (ECA; Regier et al., 1990) and the National Comorbidity
Study
(NCS; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995).
The ECA data revealed that men with PTSD were 5 times as
likely
and women with PTSD were 1.4 times as likely to have drug
abuse or
dependence, compared with individuals without PTSD. Using
the
ECA data, Cottier, Compton, Mager, Spitznagel, and Janea
(1992)
found that cocaine and opiate users had the highest rate of
PTSD,
which was 10 times higher than the rate in other SUD groups.
In the NCS sample, approximately 7.8% of the participants
(5.0%
of men, 10.4% of women) met criteria for lifetime PTSD (i.e.,
were
diagnosed with PTSD at some point in their lifetime), and
35.4% of
men and 17.9% of women met criteria for an SUD. More than
half
(51.9%) of men and 27.9% of women with PTSD met criteria
for
lifetime alcohol abuse or dependence.
Studies of Individuals Seeking Treatment
Studies of individuals seeking treatment for SUDs indicate an
ex
6. traordinarily high prevalence of PTSD in this group. In a
number of
studies examining individuals with drug or alcohol use
disorders, the
lifetime prevalence of PTSD was found to be between 36% and
50%,
and the current prevalence of PTSD was between 25% and 42%
(Jacobsen, Southwick, & Kosten, 2001). The wide variability in
these
numbers reflects the differing populations and diagnostic
techniques
used in different studies. In general, PTSD is more common in
women
with SUDs than in men with SUDs.
Address correspondence to Kathleen T. Brady, Medical
University of
South Carolina, Division of Clinical Neuroscience, 67
President St.,
P.O. Box 250861, Charleston, SC 29425; e-mail:
[email protected]
206 Copyright ? 2004 American Psychological Society Volume
13?Number 5
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Kathleen T. Brady, Sudie E. Back, and Scott F. Coffey
The most common types of traumas reported among individuals
with
7. PTSD and SUDs are interpersonal, usually involving sexual
abuse
among women and physical abuse or assault among men.
Patients in
treatment for PTSD and SUDs also frequently report childhood
his
tories of emotional and physical neglect or abuse, rape or
sexual as
sault, witnessing domestic violence, robbery, death of a loved
one due
to homicide, and unhealthy environments. It is important to
note that
most individuals with both PTSD and an SUD report
experiencing
multiple traumatic events during their lifetimes.
ETIOLOGICAL RELATIONSHIPS BETWEEN PTSD AND
SUDS
Although PTSD and SUDs appear to be strongly linked, little is
known
about the nature of their relationship. The most widely held
expla
nation of their frequent co-occurrence is the self-medication
hypoth
esis. This hypothesis is based primarily on clinical observation
and
posits that traumatized individuals attempt to use substances in
order
to dampen traumatic memories, or to avoid or "escape" from
8. other
painful symptoms of PTSD. A second hypothesis, the high-risk
hy
pothesis, posits that individuals with SUDs, because of high-
risk
lifestyles, are likely to experience a trauma and are, therefore,
more
likely than the general population to develop PTSD. Finally, a
third
hypothesis, known as the susceptibility hypothesis, states that
sub
stance use increases an individual's susceptibility to developing
PTSD
following a trauma.
Chilcoat and Breslau (1998) have tested these three hypotheses
using a large longitudinal data set drawn from a health
maintenance
organization. The authors found that having PTSD greatly
increased
the risk of developing a subsequent SUD, but exposure to a
traumatic
event that did not result in PTSD did not increase the risk of
devel
oping a subsequent SUD. Thus, it appears to be the
development of
PTSD, not exposure to trauma per se, that increases the risk of
de
veloping an SUD. In addition, the study found that drug abuse
or
9. dependence did not increase, or only slightly increased, an
individ
ual's risk of developing PTSD, and did not increase an
individual's
risk of trauma exposure. The findings from Chilcoat and
Breslau's
study provide strong support for the self-medication hypothesis
and
little support for the high-risk hypothesis.
Another possible explanation for the high comorbidity of PTSD
and
SUDs is that the disorders have common susceptibility factors.
These
might be genetic, neurobiological, or environmental. To date,
studies
that have examined family patterns of the two disorders do not
support
the hypothesis that there is a genetic vulnerability common to
PTSD
and SUDs (S.H. Stewart & Conrod, 2003).
Although a full description of the commonalities in
neurobiology
between PTSD and SUDs is beyond the scope of this report,
there is
growing evidence that shared neurobiological relationships may
play a
significant role in PTSD-SUD comorbidity. In a description of
fear
conditioning, Armony and LeDoux (1997) proposed that
10. information
about a traumatic event is sent to the amygdala via the sensory
thal
amus or indirectly via the cortex or the hippocampus (a
structure
important for memory and spatial perception). The activation
of the
central nucleus of the amygdala causes a fear response,
followed by
activation causing an anxiety response. Interestingly, a number
of
abused drugs exert their anxiety-reducing effects by inhibiting
activity
in the amygdala, and this inhibition leads to an attenuated
startle
response (recall that an exaggerated startle response is one of
the
symptoms of PTSD). Alcohol may also inhibit the startle
response by
acting on the amygdala and the cortex. The areas activated by
fear and
anxiety associated with PTSD may be inhibited by drugs of
abuse, so
neurobiological evidence supports the self-medication
hypothesis.
Other investigations have focused on the hypothalamic-
pituitary
adrenal (HPA) axis, the primary neuroendocrine system
11. involved in
the stress response (J. Stewart, 2003). Abnormalities in the
function of
the HPA axis have been implicated in both PTSD and SUDs.
Animal
studies have demonstrated that exposure to stress facilitates
both the
initiation of substance use and its reinstatement after a period
of
abstinence in previously dependent animals (Kreek & Koob,
1998).
This reinstatement can be blocked by drugs that interfere with
the
activity of the HPA axis (Kreek & Koob, 1998; J. Stewart,
2003). The
"fight or flight" (noradrenergic) system is also intimately
involved in
the stress response. Increased activity in the noradrenergic
system
leads to the increase in blood pressure, heart rate, and sweating
often
seen with the fear response. This system is activated during
with
drawal from many substances of abuse, providing another
potential
neurobiological link between PTSD and SUD.
TREATMENT
The treatment of individuals with co-occurring PTSD and
SUDs has
12. only recently been explored systematically. Therefore, most of
the data
in this area are preliminary, but there are a number of
promising
approaches under development.
Psychotherapy
The psychotherapeutic treatment of comorbid PTSD and
substance
use has received much recent attention. In the past, individuals
with
PTSD and SUDs received treatment for their substance use, and
treatment of PTSD was deferred. More recently, this approach
has
been considered problematic because the symptoms of PTSD
(i.e.,
sleep disturbance and intrusive thoughts) may drive relapse to
sub
stance use. In response to this concern, integrated therapies
targeting
both disorders have been developed and are under investigation
(Ouimette & Brown, 2003). Most of these therapies combine
suc
cessful elements of existing psychotherapeutic treatments for
sub
stance abuse and trauma. For both disorders, cognitive-
behavioral
strategies, in particular, have demonstrated success. Several
prelim
inary studies support the use of the Seeking Safety (SS)
program. This
is a manual-guided group therapy designed specifically for
women
13. with PTSD and substance dependence and consists of 25
sessions
equally aimed at modifying thoughts, behaviors, and
interpersonal
issues (Najavits, Weiss, Shaw, & Muenz, 1998). In one
controlled trial,
SS and relapse prevention therapy (another cognitive-
behavioral
therapy, in this case aimed at preventing return to substance
use) were
equally efficacious, and both were superior to treatment as
usual
The amygdala and thalamus are part of the limbic system,
which plays a
critical role in processing emotional information. The thalamus
computes both
nonemotional and emotional information and then sends this
information on to
the amygdala. The amygdala is central to the expression of
negative emotions
in humans and has been associated with anger, avoidance, and
fear.
The HPA axis helps to regulate the body's stress symptoms. It
controls the
release of stress hormones and aids in reestablishing a steady
state after a
disturbance or stressful event.
Volume 13?Number 5 207
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Substance Abuse and Posttraumatic Stress Disorder
(i.e., standard treatment they would receive in a clinic if they
were not
participating in a research study).
One controversy concerning integrated psychotherapy involves
the
use of exposure-based PTSD therapy in substance-dependent
indi
viduals. There is a great deal of empirical evidence supporting
ex
posure-based treatment for PTSD, which involves helping
patients
confront memories, places, or specific situations that remind
them of
the trauma, that they have avoided, and that now evoke
unrealistic and
intense fear (Friedman, Davidson, Mellman, & Southwick,
2000). This
therapy can cause distress and discomfort and was not
recommended
for individuals with SUDs because of the concern that exposure
might
precipitate relapse in this vulnerable population. However,
several
recent studies have demonstrated successful use of exposure-
15. based
therapy in some individuals with co-morbid PTSD and SUDs,
although
the sample sizes of these studies were small and dropout rates
high
(Back, Dansky, Carroll, Foa, & Brady, 2001; Coffey, Dansky,
& Brady,
2003; Triffleman, Carroll, & Kellogg, 1999).
Although the early results from integrated treatments suggest
that
they may be helpful for many individuals with PTSD and
SUDs, the
studies of these treatments have been limited by small sample
sizes,
lack of comparison groups, and high dropout rates. To date,
only one
controlled trial using integrated psychotherapies has been
conducted.
Thus, it is not yet known whether integrated treatments are
superior to
sequential therapies (i.e., treating one disorder and then the
other) or
single-model therapies (i.e., treating only one of the disorders),
how
the various integrated treatments compare with one another,
who
benefits most from integrated treatments, and for whom
integrated
16. treatments are contraindicated.
Pharmacotherapy
One important goal of pharmacotherapy for comorbid PTSD-
SUDs is
to reduce key symptoms of PTSD so that patients do not need
to use
substances of abuse to distance themselves from the traumatic
event.
In early double-blind, placebo-controlled studies, tricyclic and
monoamine-oxidase inhibitor antidepressants (e.g., Elavil,
Pamelor,
Nardil) were shown to improve intrusive and depressive
symptoms of
PTSD. There have also been uncontrolled trials suggesting
positive
effects of other medications, including carbamazepine, beta-
blockers,
clonidine, benzodiazepines, and lithium. More recently, a
number of
placebo-controlled trials with relatively large numbers of
subjects
have demonstrated that serotonin-reuptake inhibitors,
specifically,
sertraline (i.e., Zoloft), fluoxetine (i.e., Prozac), and paroxetine
(i.e.,
Paxil), are useful in treating PTSD (Friedman et al., 2000). In
addi
tion, pharmacotherapeutic treatments for SUDs may prove
useful
among individuals with comorbid PTSD. Although there have
been no
controlled trials of such approaches, recent advances in
17. psychother
apeutic treatment for alcohol, opiate, and nicotine dependence
suggest
new possibilities. This is clearly an area that warrants
investigation.
CONCLUSIONS AND FUTURE DIRECTIONS
Although there has been a great deal of recent study focused on
the
relationships among stress, PTSD, and SUDs, much work
remains.
Further investigation of the neurobiological interface between
PTSD
and SUDs is needed to provide more information about the
mecha
nisms underlying their causal connection. The noradrenergic
system
and HPA axis are two systems that are implicated in the
pathophys
iology of both SUDs and PTSD. Does chronic use of cocaine,
alcohol,
and other substances of abuse lead to changes in the
noradrenergic,
HPA, or other systems that make an individual more
susceptible to the
development of PTSD? Conversely, does a traumatic
experience,
particularly childhood trauma, lead to changes in
neurotransmitter
and neuroendocrine systems that make an individual more
vulnerable
18. to the development of an SUD?
Additional treatment studies are also critically important. The
commonalities in the pathophysiology of PTSD and SUDs
suggest that
pharmacotherapies targeting specific neurotransmitter or
neuroendo
crine systems might be particularly beneficial, yet there has
been little
exploration of agents that act on either the noradrenergic
system or the
HPA axis in individuals with both disorders.
Although there have been promising developments in
psychother
apeutic treatments, the question of the safety and efficacy of
exposure
based treatment for PTSD in substance-using populations still
remains
unanswered. It seems likely from the data obtained thus far that
ex
posure-based treatment may be beneficial for a subset of
patients.
Further exploration of different types and timing of
psychotherapeutic
interventions will be important. Finally, how to integrate
pharmaco
therapeutic and psychotherapeutic treatments to maximize
19. outcomes
is of critical importance. In particular, would medications be
useful in
early stages of recovery to help patients engage in and comply
with
psychotherapy, or are medications better utilized for patients
who do
not respond to psychotherapeutic interventions alone?
In conclusion, further exploration of PTSD, substance use, and
the
connections between these two disorders could provide
information
that will help not only in the treatment of these disorders, but
also in
the broader understanding of the complexity of the relationship
be
tween external Stressors and the development of
psychopathology.
Recommended Reading
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Jacobsen, L.K., Southwick, S.M., & Kosten, T.R. (2001). (See
References)
Kreek, M., & Koob, G. (1998). (See References)
Ouimette, P., & Brown, P.J. (Eds.). (2003). (See References)
Stewart, J. (2003). (See References)
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Contents206207208209Issue Table of ContentsCurrent
Directions in Psychological Science, Vol. 13, No. 5 (Oct.,
2004), pp. 173-214Front MatterNeurobiological Consequences
of Long-Term Estrogen Therapy [pp. 173-176]What Can
Neuroimaging Tell Us about the Mind? Insights from Prefrontal
Cortex [pp. 177-181]Neural Foundations of Emotional Speech
Processing [pp. 182-185]Saying What You Don't Mean: Social
Influences on Sarcastic Language Processing [pp. 186-189]What
the Social Brain Sciences Can Tell Us about the Self [pp. 190-
193]Violent Children in Developmental Perspective: Risk and
Protective Factors and the Mechanisms through Which They
(May) Operate [pp. 194-197]Seasonal Patterns of Stress,
Disease, and Sickness Responses [pp. 198-201]Do Psychiatric
Patients Do Better Clinically If They Live with Certain Kinds of
Families? [pp. 202-205]Substance Abuse and Posttraumatic
Stress Disorder [pp. 206-209]Beyond Quality: Parental and
Residential Stability and Children's Adjustment [pp. 210-
24. 213]Back Matter
s anxiety sensitivity a predictor of PTSD in children and
adolescents?
· Emine Zinnur Kılıça, ,
· Cengiz Kılıçb,
· Savaş Yılmaza
Show more
http://dx.doi.org.ezproxy.fau.edu/10.1016/j.jpsychores.2008.02.
013
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Abstract
Objective
Anxiety sensitivity (AS) is the fear of the physical symptoms of
anxiety and related symptoms. Longitudinal studies support AS
as a vulnerability factor for development of anxiety disorders.
This study aimed to investigate AS as a vulnerability factor in
the development of childhood posttraumatic stress
disorder (PTSD) following traumatic experiences.
Methods
The study included 81 children 8–15 years of age who
experienced the 1999 earthquake in Bolu, Turkey. The
earthquake survivors were compared to a randomized group of
age- and sex-matched controls 5 years after the earthquake.
Both the subject and control groups were administered the
Childhood Anxiety Sensitivity Index (CASI), State and Trait
Anxiety Inventory for Children (STAI-C), and
Child Depression Inventory (CDI), while the PTSD symptoms of
the subjects were assessed using the Child Posttraumatic Stress
Reaction Index (CPTS-RI).
Results
Subjects and controls did not differ significantly in CASI,
STAI-C, or CDI scores. Multiple regression analysis showed
that both trait anxiety and CASI scores predicted CPTS-RI
scores of the subjects; the prediction by CASI scores was over
25. and above the effect of trait anxiety.
Conclusion
The results of this study support the hypothesis that AS may be
a constitutional factor, which might increase the risk of PTSD
following traumatic experiences.
Keywords
· Anxiety sensitivity;
· Child;
· Adolescent;
· PTSD
Introduction
Several factors are held responsible for the development and
chronicity of posttraumatic stress disorder (PTSD) in children
and adolescents exposed to traumas. These include within-
trauma factors such as trauma severity, and pretrauma factors
including gender and age [1]. Biological vulnerability factors,
such as anxiety sensitivity, have also been shown to play such a
role in adult samples. This study aims to show if the same
relationship holds for children and adolescents.
The concept of anxiety sensitivity
Anxiety sensitivity (AS) is a concept that was originally
developed by Reiss and McNally [2] to describe the degree of
discomfort and negative attributions to anxiety sensations
arising from the belief that these sensations are signs of
physical, psychological, or social harm. Rather than being a
sign of psychopathology itself, AS is seen as a constitutional
trait variable, acting as a risk factor for the development of
various anxiety disorders. The measurement of AS includes the
assessment of the consequences of physical, cognitive, and
social harm associated with anxiety symptoms, such as body
awareness and feared cognitions. The Anxiety Sensitivity Index
(ASI) [3] is the principal measure used to assess AS in adults.
Studies that have used ASI in adults have generally
examined panic disorder and most found a positive association
between the presence of panic disorder and high ASI
26. scores [4] and [5]. Subjects with high AS have higher rates
of comorbid anxiety disorders and tend to be susceptible to
marked anxiety reactions following biological challenge
tests [6] and [7]. Evidence from several longitudinal
investigations suggests that AS is a predictor of subsequent
panic attacks in nonclinical samples [8].
Several studies have attempted to show the mechanisms that
link AS to specific anxiety disorders. Avoidance has been
suggested to be a clinically significant mechanism that might
play a role in maintaining anxiety disorder and to be associated
with poorer diagnosis. Wilson and Hayward [9], in their
prospective study on adolescents with panic disorder, showed
that AS may precede and exacerbate avoidance, which, in turn,
increases anxiety. Isyanov and Calamari [10], on the other hand,
hypothesized that individuals with high levels of AS appraise
many life events as much more stressful due to their reactivity
to both the event and to the anxious arousal they experience.
They suggest that AS might lead to increased general stress
levels by altering stress appraisal. Since they appraise anxious
arousal as not just unpleasant, but as dangerous, life
experiences that lead only to a transitory increase in anxiety
will elicit greater distress in individuals with elevated AS.
While individuals with high trait anxiety will respond to
stressors with more fear and distress, individuals with high AS
may react to both the stressor and the associated anxiety
experience. Additional evidence exists that demonstrating AS is
not merely a reflection of trait anxiety, but it is shown to be
related to disorders other than anxiety, namely somatoform
disorders and substance use disorders[11], [12] and [13].
Anxiety sensitivity and childhood disorders
Children with anxiety disorders have been shown to have higher
levels of AS compared to normal controls in several
studies [14] and [15]. A number of studies have reported a
relationship between panic attacks in children and adolescents
and AS [16], [17] and [18]. Reiss et al. [5] suggested that the
level of AS at ages 7-14 years might predict the development of
27. panic disorder in adult life. According to their theory, the
development of AS is influenced by cognitive factors, in
addition to genetic ones. By the time children become 7-10
years old, they will have already developed beliefs about what
will happen to them when they become nervous or experience
stress. These beliefs are hypothesized to significantly modify
the child's inherited sensitivity to anxiety [5]. Likewise, Mattis
and Ollendick [19], in their investigation of the cognitive
responses of children to panic symptoms, concluded that AS in
children predicted catastrophic attributions, regardless of age,
and speculated that high levels of AS and elevated internal
attributions in response to negative outcomes could set the stage
for the development of panic attacks and subsequent panic
disorder.
AS has been investigated in various other problems of children
and adolescents. Although AS was found to be related
to depression[20] and worry [21], AS predicted panic attacks in
children and adolescents, even after controlling for general
negative affectivity [22]. The predictive value of high AS for
panic attacks was also shown in an adolescent African-
American sample [23]. Watt and Stewart [11] investigated this
concept further, positing that heightened AS in childhood may
lead children learn to catastrophize their bodily sensations,
leading to hypochondriacal symptoms in adolescence. The study
of Hayward et al. [18], which showed that AS develops before
panic symptoms first appear, supports the conceptualization of
AS as a risk factor for anxiety disorders, rather than being a
disorder itself. AS, therefore, seems to be a constitutional factor
creating the basis for the development of an anxiety disorder in
the presence of an external challenge.
AS and PTSD
Although AS has been widely studied in childhood anxiety
disorders, studies on AS in PTSD are scarce. In adults, the
relationship of AS and PTSD has been shown in various
studies [24]. After the Bam earthquake in Iran, Hagh-Shenas et
al. [25] found a relationship between high AS and PTSD among
28. a group of rescue workers. They reported that among the
untrained rescue workers, students with high AS scores
exhibited greater adverse psychological effects.
PTSD is common in children after disasters; many studies report
incidence rates ranging from 30–60% in children and
adolescents [26]. The notion that PTSD symptoms decrease with
time has been challenged by long-term studies. PTSD may
become chronic in a group of disaster survivors, which, in turn,
may significantly affect psychological
development [27] and [28]. In their study, after the 1999
earthquake in Turkey, Karakaya et al. [29] found very severe or
severe degrees of posttraumatic stresssymptoms in 22.2% of
adolescents 3.5 years after the disaster.
Risk factors for the occurrence and persistence of PTSD
symptoms in children after disasters are widely studied.
Proximity to the trauma scene and severity of exposure (loss of
house/relatives, injury, etc.) are commonly found to be risk
factors [30]. Research has shown that parental reactions to a
child's symptoms and parents' symptoms are also important
predictors of childhood
PTSD [31], [32], [33], [34], [35], [36] and [37]. The risk of
developing PTSD depends upon the severity of trauma,
preexisting vulnerability factors, and an interaction between the
two. The “stress vulnerability” hypothesis holds that pretrauma
characteristics make one more susceptible to the negative
effects of a traumatic experience. It is typically seen as an
interaction between the predisposing factor and the traumatic
stressor, so that the relationship between the predisposing factor
and PTSD depends on the level of trauma. In the context of
extreme trauma, host factors may diminish in importance,
whereas in milder trauma vulnerability factors may be of greater
importance. Foy et al. [38] and McCranie et
al. [39] demonstrated this form of interaction. Silva et
al. [40] have demonstrated that preexisting anxiety predicted
PTSD severity in children and adolescents, while higher IQ was
a protective factor. AS, which has been implicated as a
29. constitutional factor in the development of several other anxiety
disorders, may be the mediating factor that leads to the
development and persistence of posttraumatic stress symptoms
following psychological trauma. To our knowledge, the only
study to assess the relation of AS to PTSD symptoms in
children was conducted by Meiser-Stedman et al. In their study
on children who had had individual traumatic experiences,
although AS did not directly predict PTSD status, it mediated
the relationship between subjective distress during trauma and
the development of acute stress disorder[41]. It will be
interesting to see if a similar relationship exists between AS and
chronic PTSD. It may be hypothesized that since children with
high levels of AS are more sensitive to anxiety-related
sensations, they will have more difficulty in overcoming the
effects of traumatic experiences.
This study aimed to investigate the relationships between AS
and PTSD symptoms in a group of children that experienced a
major earthquake in Bolu, Turkey. Bolu is a small town that had
a pre-earthquake population of 87,000 and lies 30 km away
from the epicentre. The November 12, 1999 (magnitude 7.2),
earthquake killed 48 people and injured 343 in Bolu, while 2400
houses were damaged. Families had to live in tent cities for up
to 2 years after the earthquake and fear of future earthquakes
continued for several months. The rate of severe and very
severe degrees of posttraumatic stress symptoms in children
living in one tent city was 18.8%, 6 months after the
earthquake [37].
The present study was conducted 5 years after the 1999 Bolu
earthquake, at a time when life in the city had returned to
normal and issues about the earthquake were largely forgotten,
except perhaps for temporary anniversary reactions. We
hypothesized that the severity of PTSD symptoms in
earthquake-survivor children, 5 years after the earthquake,
would at least be partly explained by higher AS scores.
Methods
Subjects
30. A sample of 87 children (43 boys and 44 girls) aged between 8
and 15 years (mean: 11.2 S.D. 2.2) were recruited from the Bolu
city centre. One hundred ninety-one households were randomly
selected from a list of all households at the city centre. All
children living in those households between ages 8–15 were
invited to participate in the study. Children who did not
experience the earthquake or who were unable to complete the
study measures due to a physical or mental problem were
excluded from the study. Six children were excluded from the
study due to incomplete data on their questionnaires. The final
sample thus consisted of 81 children (40 boys and 41 girls).
Controls
The control group (n=87) was randomly selected from a larger
sample of age- and gender-matched children from Ankara
schools. This group contained 43 boys and 44 girls aged
between 8 and 15 years (mean: 11.1, S.D. 2.3) that had not
experienced the earthquake and did not report any traumatic
experience in their lifetime, nor did they report any psychiatric
problem.
Measures
Both the subject and control groups were administered the
Childhood Anxiety Sensitivity Index (CASI), State and Trait
Anxiety Inventory for Children (STAI-C),
Child DepressionInventory (CDI), and a sociodemographic
form, while the PTSD symptoms of the subjects were assessed
using the Child Posttraumatic Stress Reaction Reactions Index
(CPTS-RI).
CASI is a self-report tool developed by Silverman and
colleagues that assesses AS in children [42]; it is a modified
form of the Anxiety Sensitivity Index (ASI) [3]. CASI includes
18 items and a three-point Likert-type scale ranging from 1 (not
at all) to 3 (very much). The reliability study of the Turkish
version was conducted by Yılmaz and Kılıç with a group of
Turkish school children [43]. In that study, the scale
demonstrated reasonable reliability, with a Cronbach's alpha of
0.74 and a test–retest reliability of 0.77.
31. CPTS-RI is a 20-item self-report scale designed to assess
the posttraumatic stress reactions of school-age children and
adolescents [44]. Pynoos [27] used a revised method in
determining caseness, which we also adopted. They found that
the measure's severe and very severe categories correctly
identified 78% of subjects who met Diagnostic and Statistical
Manual of Mental Disorder (DSM), Revised Third
Editioncriteria for PTSD. The reliability and validity study of
the Turkish version was conducted with primary school children
that survived an explosion in Turkey [45]. Test–retest reliability
was .86 and internal consistency (alpha) was .75. The scale
captured 80% of DSM, Fourth Edition PTSD cases.
STAI-C is a 40-item self-report questionnaire that assesses
anxiety-related symptoms in children [46]. The scale computes
2 separate total scores: state anxiety and trait anxiety. The
validity and reliability study of the Turkish version was
conducted with a primary school sample by Özusta [47]. Test–
retest reliability of state anxiety scale was .60 and internal
consistency (alpha) was .82. Test–retest reliability of the trait
anxiety scale was .65 and, internal consistency, (alpha) .81.
STAI-C Turkish version significantly differed children with
anxiety disorders from normal controls.
CDI is a 21-item self-report questionnaire that assesses
depressive symptoms in children [48]. The validity and
reliability study of the Turkish version was carried out by Öy in
Turkish children [49]. The reliability of the scale (alpha) was
.77, and test–retest reliability was .80. The sensitivity of the
scale was 60%, whereas the specificity was 95%.
Data analysis
Statistical analyses were made using SPSS v.10.0. The two
study groups were compared using t tests. Pearson's correlation
coefficients and linear regression were used to examine the
relationship between PTSD scores and other demographic and
clinical variables. Ethical approval was obtained from Ankara
University Medical School Ethics Committee.
Results
32. No significant differences were found between the subjects and
controls in terms of age or gender. Comparing subjects to
controls, there were no significant differences in their mean
CASI, STAI-C, and CDI scores (Table 1).
Table 1.
Comparison of subjects and controls, in terms of mean CASI,
STAI-C, and CDI scores (t tests)
Subjects (Mean, S.D.)
Controls (Mean, S.D.)
t
CASI
32.4 (7.3)
31.1 (6.2)
1.68 (NS)
Trait anxiety
35.4 (7.3)
34.1 (6.4)
1.24 (NS)
State anxiety
32.7 (6.5)
31.9 (6.5)
0.8 (NS)
CDI
10.8 (7.2)
9.7 (3.9)
1.2 (NS)
NS, nonsignificant; CASI, Childhood anxiety sensitivity index;
STAI-C, State and trait anxiety inventory for children; CDI,
Child Depression Inventory.
Table options
When the subjects were grouped according to the level of
CPTS-RI PTSD symptoms as nonsymptomatic (<12 points),
mild PTSD (12–24 points), moderate PTSD (25–39 points),
severe PTSD (40–59 points), and very severe PTSD (>60 points)
in accord with the original form of the scale [44], 10% did not
33. have PTSD, 40% had mild PTSD, 33% had moderate PTSD,
16% had severe PTSD, and 2.5% had very severe PTSD. There
were 42 subjects with moderate to very severe PTSD (PTSD
subgroup), whereas nonsymptomatic subjects and subjects with
mild PTSD (non-PTSD subgroup) numbered 39. Table 2 shows
that the PTSD and non-PTSD subgroups differed significantly in
terms of depression, state and trait anxiety, and AS scores;
those with more severe PTSD symptoms had higher scores on
all measures than the non-PTSD subgroup.
Table 2.
Comparison of the PTSD and non-PTSD subgroups, in terms of
age, CDI, CASI, and trait and state anxiety mean scores (t tests)
Moderate-Very Severe PTSD (mean, S.D.) (n=42)
Non-PTSD (mean, S.D.) [n=39]
T
P
Age
11.0 (2.1)
11.4 (2.3)
1.0
.3
CDI
13.6 (8.6)
8.1 (3.7)
−3.7
.01
CASI
35.6 (7.7)
29.4 (5.6)
−4.1
.01
Trait anxiety
39.1 (7.5)
31.9 (4.6)
−5.3
34. .01
State anxiety
35.2 (6.7)
30.6 (5.8)
−3.3
.01
Table options
The correlations between CPTS-RI, CASI, STAI-C, and CDI
scores in the subject group are shown in Table 3, and Table
4 shows correlations between CASI, STAI-C, and CDI in the
control group. AS had significant positive correlations with
state and trait anxiety in both groups; correlations with trait
anxiety were higher. The correlations with CDI did not reach
significance. CPTS-RI scores had significant positive
correlations with all study measures in the subject group.
The correlations ranged between 0.38 and 0.71; the highest
correlation was with trait anxiety.
Table 3.
Correlations between CPTS-RI, CASI, state anxiety, trait
anxiety, and depression scores of the subject group (Pearson's
correlations)
CASI r(P)
State anxiety r(P)
Trait anxiety r(P)
CDI r(P)
CPTS-RI
0.38 (P<.01)
0.47 (P<.01)
0.71 (P<.01)
0. 51 (P<.01)
CASI
–
0.29 (P<.01)
0.32 (P<.01)
0.17 (P<.13)
35. State anxiety
–
–
0.58 (P<.01)
0.60 (P<.01)
Trait anxiety
–
–
–
0.65 (P<.01)
CPTS-RI, Child Post-traumatic stress reaction index; CASI,
Childhood anxiety sensitivity index; CDI, Child Depression
Inventory.
Table options
Table 4.
Correlations between the CASI, state anxiety, trait anxiety,
and depression scores of the control group (Pearson's
correlations)
State anxiety
Trait anxiety
CDI
CASI
0.22 (P<.05)
0.44 (P<.01)
0.18 (P<.10)
State anxiety
–
0.40 (P<.01)
0.38 (P<.01)
Trait anxiety
–
–
0.28 (P<.01)
Table options
Multiple regression analysis was performed within the subject
36. group in order to show if AS played a unique role in
determining CPTS-RI scores. The independent (explanatory)
variables were age, gender (1=male, 2=female), CASI score,
CDI score, state anxiety score, and trait anxiety score. The
dependent variable was CPTS-RI score. The explanatory
variables were simultaneously entered into the regression
equation (method=enter). The result of this analysis showed that
higher PTSD scores were predicted independently by both CASI
and trait anxiety scores, and the prediction by trait anxiety was
stronger (Table 5). This finding shows that the prediction of
PTSD scores by CASI scores was over and above the effect of
trait anxiety.
Table 5.
Predictors of PTDS scores (multiple linear regression)
CPTSD-RI scores
Full regression model (r=0.74; adjusted r2=0.52;
F(15,104)=15.1; P<.001)
Significant predictors
β
P
Trait anxiety
0.55
.001
Anxiety sensitivity
0.21
.05
Gender
−.011
.185
Age
−.03
.715
CDI
.09
37. .40
State anxiety
.07
.52
Entered variables: gender, age, state anxiety, trait anxiety,
depression, and AS.
Table options
Discussion
To the best of our knowledge, this is the first study to examine
the relationship of AS to chronic PTSD symptoms in children.
We compared a group of children and adolescents who had
experienced the 1999 Bolu earthquake to a control group with
no history of traumatic experiences, in terms of depression,
anxiety, and AS scores. These two groups did not differ in terms
of their mean AS, depression, or anxiety symptom scores.
Although we did not find any difference between the subject
and control groups in terms of AS scores, the subjects with
more severe PTSD symptoms had higher AS, depression, and
anxiety scores than the subjects with less severe PTSD
symptoms. Linear regression analyses, taking CDI, CASI, and
STAI-C as independent variables, showed that AS and trait
anxiety scores, but not state anxiety or depression scores,
predicted PTSD. These results support the hypothesis that AS
might be a constitutional trait with a normal distribution among
the general population (traumatized or not), which may act as a
vulnerability factor leading to psychopathology during times of
stress.
The strong correlation we found between trait anxiety and AS
has been reported in other studies, which led some researchers
to conclude that AS is, in fact, trait anxiety. This idea has been
questioned by McNally [50], who suggests that while trait
anxiety predicts a general propensity to respond anxiously to
threatening stimuli, AS predicts a propensity specific to the
symptoms of anxiety. Reiss [51] also argued that, in trait
anxiety, the feared stimulus is regarded as dangerous, while in
AS, an uncontrollable reaction is feared. Since various studies
38. have made this distinction, Reiss et al. [5] conclude that AS is
theoretically and empirically distinct from Spielberger's
measure of trait anxiety. The fact that the two variables
independently predicted PTSD symptoms supports the above
notion that AS and trait anxiety are actually distinct constructs.
Not all individuals develop PTSD after traumas. Various factors
lead to the development and persistence of PTSD symptoms.
Individuals with high levels of AS are shown to appraise many
life events as much more stressful due to their reactivity to both
the event and to the anxious arousal they experience. They are
therefore more vulnerable to the effects of stressful life events
and to trauma reminders. Life experiences that lead only to a
transitory increase in anxiety will elicit greater distress and
catastrophic attributions in such individuals, leading to the
persistence of trauma-related stress symptoms.
Many studies demonstrate that the most persistent symptoms of
PTSD belong to the group of avoidance [52] and [53].
Avoidance is also known to relate to higher decrease in quality
of life in trauma studies. Since individuals with high AS are
more likely to respond with greater distress to stressful to life
events, it is reasonable to assume that they will tend more to
avoid events or situations that provoke anxiety. Avoidance may
also prevent improvement by removing the chance of exposure.
This avoidant attitude in children with high AS, therefore, may
be responsible for the persistence of PTSD symptoms.
The findings of our study may have implications on both
detection and management of high-risk groups. Trauma
survivors with high AS may be less motivated to volunteer for
anxiety-provoking treatments such as cognitive behavior
therapy (CBT), and they may avoid coming into contact with
treatment services or drop out of treatment prematurely.
Clinicians with an awareness of the significance of AS will,
therefore, have an advantage in engaging high AS trauma
survivors into treatment.
Some limitations of our study should be mentioned. Although
our study sample was representative of a town at the epicentre
39. of the November 1999 Bolu earthquake, the small sample size
did not allow for factor analytic studies of CASI, which would
have provided additional information contributing to an
understanding of how AS is related to PTSD. Future studies
with larger samples could overcome this limitation. A second
limitation was the cross-sectional nature of data collection.
Even if it is possible to control for the contribution of other
variables on outcome, the link of causality cannot be drawn in
cross-sectional studies. It is, therefore, possible that higher AS
may be the result of long-lasting PTSD symptoms in the
affected individuals, instead of causing it. Longitudinal
studies are therefore needed to clarify the role of AS in the
development of PTSD following psychological trauma.
Abnormalities of white matter integrity in the corpus callosum
of adolescents with PTSD after childhood sexual abuse: a DTI
study
· Authors
· Authors and affiliations
· Mirjam A. W. Rinne-AlbersEmail author
· Steven J. A. van der Werff
· Marie-José van Hoof
· Natasja D. van Lang
· Francien Lamers-Winkelman
· Serge A. Rombouts
· Robert R. J. M. Vermeiren
· Nic J. A. van der Wee
23 December 2015
DOI: 10.1007/s00787-015-0805-2
Cite this article as:
Rinne-Albers, M.A.W., van der Werff, S.J.A., van Hoof, MJ. et
al. Eur Child Adolesc Psychiatry (2016) 25: 869.
doi:10.1007/s00787-015-0805-2
Abstract
40. This study seeks to determine whether white matter integrity in
the brain differs between adolescents with post-traumatic stress
disorder (PTSD) due to childhood sexual abuse (CSA) and
matched healthy adolescents and whether there is a relationship
between white matter integrity and symptom severity in the
patient group. Using 3T diffusion tensor imaging, we examined
fractional anisotropy (FA) in a group of adolescents with CSA-
related PTSD (n = 20) and matched healthy controls (n = 20), in
a region of interest consisting of the bilateral uncinate
fasciculus (UF), the genu, splenium and body of the corpus
callosum (CC), and the bilateral cingulum. In addition, we
performed an exploratory whole brain analysis. Trauma
symptomatology was measured with the Trauma Symptom
Checklist for Children (TSCC) to enable correlational analyses
between FA differences and trauma symptomatology. The PTSD
group had significantly lower FA values in the genu, midbody
and splenium of the CC in comparison with controls (p < 0.05,
tfce corrected). Post hoc analyses of the eigenvalues of the DTI
scan showed increased radial and mean diffusivity in the patient
group. In addition, we found a significant negative correlation
between scores on the anger subscale of the TSCC and FA
values in the left body of the CC in patients (p < 0.05).
Adolescents with CSA-related PTSD show decreased FA in the
CC, with abnormalities in the integrity of the left body of the
CC being related to anger symptoms. These findings suggest
that early trauma exposure affects the development of the CC,
which may play a role in the pathophysiology of PTSD in
adolescents.
Keywords
PTSDDiffusion tensor imagingAdolescentsSexual
abuseNeuroimaging
Mirjam A.W. Rinne-Albers and Steven J.A. van der Werff share
first authorship.
Introduction
Childhood psychotrauma is a prevalent and important predictor
of both child and adult psychopathology as well as a number of
41. somatic disorders [1, 26, 31, 45]. Preclinical research in rodents
and non-human primates has shown that structure and
functioning of the developing brain are highly vulnerable to the
effects of adversity, especially in certain critical time windows.
In animal studies, childhood adversity was found to be
associated with changes in brain circuitry involved in stress and
emotion regulation, such as the hippocampus and certain
prefrontal regions, possibly underlying vulnerability to the
impact of stressors later in life [12, 25, 32, 41]. In adult
humans, a history of chronic traumatization during childhood
and adolescence was found to be associated with structural and
functional damage in key elements of emotion and stress
regulating brain circuitry, for example in the hippocampus in
adults reporting childhood abuse or in the medial prefrontal
cortex in adults reporting childhood emotional maltreatment
[5, 56]. Bearing in mind the neuroplasticity of the maturing
human brain [8], a thorough understanding of the human
neurobiology underlying the psychological sequelae of
childhood and youth psychotrauma may hold promise for
developing appropriate interventions to alter adverse
neurodevelopmental trajectories [22]. Some recent reviews and
meta-analyses have addressed structural brain alterations
following childhood trauma in both adolescents and (young)
adults with and without psychopathology [11, 40, 60]. The
studies included in these reviews and meta-analyses often used
different approaches and varied in sample size. Nevertheless,
next to findings in the cerebellum and sensory cortex, most of
the results from reviews and meta-analyses point toward
involvement of the corpus callosum (CC) and corticolimbic
circuits in the pathophysiological sequelae of psychotrauma in
children and young adults.
Diminished white matter (WM) integrity can constitute one
element of abnormalities in corticolimbic and related circuitry.
Diminished structural integrity may impede adaptive emotional
and cognitive functioning, thereby rendering an individual
vulnerable to childhood and adult psychopathology.
42. A promising tool for examining the structural integrity of WM
in children and youth who experienced psychotrauma is
diffusion tensor imaging (DTI). Fractional anisotropy (FA) is
the most commonly used DTI parameter and reflects the degree
of diffusion directionality of water, which in white matter can
be influenced by structural properties such as axonal density,
organization and myelinization. Smaller FA values are
associated with decreased white matter integrity. To further
interpret differences in FA, additional parameters such as the
mean diffusivity (MD), axial diffusivity (AD), and radial
diffusivity (RD) can be assessed as well.
So far, four studies in children and youth have employed DTI to
examine the effects of psychotrauma on white matter integrity
in the developing brain and several reported abnormalities in
the CC, but also in other areas. The first small study, in
children who had been subjected to early socioemotional
deprivation (N = 7), found decreased FA in the left UF [14].
The second study, in a group of children (N = 17) with post-
traumatic stress disorder (PTSD) following varying forms of
maltreatment, found reduced FA in the medial and posterior
subregions of the CC [24]. The third study looked at the
influence of Early Life Stress (ELS) on FA of the genu of the
CC across the life span in healthy individuals. The results
showed a lower FA in the youngest (8–12 years) and oldest (51–
72 years) ELS age groups compared to non-exposed controls,
suggesting that the effect is independent from the presence of
psychopathology [44]. This was corroborated in the fourth study
by Huang and Rao, in adolescents exposed to childhood
maltreatment but without a history of psychiatric illness, who
showed decreased FA values compared to controls in the left
and right superior longitudinal fasciculi, right cingulum bundle,
left inferior fronto-occipital fasciculus and splenium of the CC
[21]. None of these studies investigated additional DTI
parameters and only a region-of-interest (ROI) approach was
used, which may have led important alterations in WM
microstructure outside the ROI to go unobserved. Furthermore,
43. study populations were heterogeneous for type of child
adversity, which might have resulted in heterogeneous
neuroimaging findings and differences in psychopathological
sequelae.
The aim of our study was to investigate white matter integrity in
a group of adolescents with psychopathology related to
childhood sexual abuse (CSA) and matched healthy controls.
We chose CSA as this is a prevalent form of child psychotrauma
and a frequent cause of PTSD [15, 27]. This study is the first to
focus on integrity of white matter tracts in a group of
adolescents who had all experienced CSA. Based on previous
neuroanatomical studies in children and youth as well as in
adults, we hypothesized a reduced FA in the CC, the UF and the
cingulum, although findings have not been unequivocal. We
also aimed to investigate the possible relationship between FA
and clinical symptoms in the patient group. Next, we also
planned an exploratory whole brain analysis to detect aberrant
FA values in areas outside our a priori defined ROIs.
Methods
Participants
We included N = 22 adolescents with a history of CSA and
related PTSD (further described as PTSD group) and N = 30
healthy controls. The current cross-sectional study is part of the
Emotional Pathways’ Imaging Study in Clinical Adolescents
(EPISCA), a longitudinal MRI study in which adolescents are
followed over a 6-month period.
Inclusion criteria for the patient group were having experienced
sexual abuse during their lifetime more than once by one or
more perpetrators in- or outside the family and being referred to
a mental health service. Most participants came from
specialized psychotrauma centers and had experienced severe
and frequent sexual abuse. Presence of PTSD was not an
inclusion criterion, but clinical assessments (see below) showed
that all patients but one were having PTSD related to the CSA.
Exclusion criteria were: (1) primary DSM-IV diagnosis of
ADHD, pervasive developmental disorders, Tourette’s
44. syndrome, obsessive–compulsive disorder, bipolar disorder, and
psychotic disorders, (2) current use of psychotropic medication
other than stable use of SSRI’s, or amphetamine medication on
the day of scanning, and (3) current substance abuse. The
healthy control adolescents were recruited through local
advertisement, with the following inclusion criteria: no clinical
scores on validated mood and behavioral questionnaires, no
history of traumatic experiences and no current
psychotherapeutic intervention of any kind. All participants met
the following inclusion criteria: aged between 12 and 21,
estimated full scale IQ (FIQ) ≥80 as measured by Dutch
versions of the Wechsler Intelligence Scales for Children
(WISC-III) [59] or adults (WAIS) [58], being right-handed,
normal or corrected-to-normal vision, sufficient understanding
of the Dutch language, no history of neurological impairments
and no contraindications for MRI testing (e.g. braces, metal
implants or possible pregnancy). More extensive description of
the clinical group can be found in an earlier report about the
EPISCA project [57].
The medical ethics committee of the Leiden University Medical
Centre approved the study. All anatomical scans were reviewed
and cleared by a radiologist. Written informed consent was
obtained from all adolescents and their parents. Participants
received a financial compensation including travel expenses.
Clinical assessments
A standardized set of instruments was used to assess
symptomatology in both groups of adolescents.
The Anxiety Disorders Interview Schedule Child and Parent
Versions (ADIS-C/P) [46] are semi-structured interviews for the
classification of DSM-IV anxiety and depressive disorders in
children. The adolescents and at least one of their parents were
interviewed. A minimal interference score of 4, obtained by
trained examiners based on the ADIS-C and ADIS-P, is
necessary for classification. The ADIS is known to have good
reliability and validity [47] with reported strong test–retest
reliability statistics for the ADIS-C/P for combined diagnoses
45. (0.80–0.92) and individual diagnoses (0.62–0.88).
As brain development is known to be influenced by sexual
development, physical sexual development was measured with
the self-report Puberty Development Scale (PDS) [38]. The PDS
consists of five items that are measured on a five-point scale by
the examiner: 1 = pre-pubertal, 2 = early pubertal, 3 = mid-
pubertal, 4 = late pubertal, 5 = post-pubertal. The PDS is
considered a valuable instrument determining pubertal stage
[4, 19].
The Trauma Symptom Checklist for Children (TSCC) [7] which
measures trauma-related symptoms is a 54-item self-report for
children and adolescents aged 8 through 18, but is often used up
to 21 years [3, 18]. On a four-point scale (never to almost all of
the time), the adolescent indicates how often a thought, a
feeling or a behavior occurs. The items are grouped into six
clinical scales. The clinical scales are Anxiety (Anx),
Depression (Dep), Post-traumatic Stress (Pts), Sexual Concerns
(Sc), Dissociation (Dis) and Anger (Ang). The TSCC total score
is used as the main measure on post-traumatic symptomatology.
Cronbach’s alpha coefficients reported range from 0.77 to 0.89
for subscales and 0.84 for the total scale. The questionnaire has
extensively been studied, which has confirmed its good
psychometric qualities [29, 36].The internal consistency of the
TSCC subscales varied between 0.85 and 0.94, except for the
Sexual Concerns subscale that measured 0.68.
Six subscales from the Wechsler Intelligence scales scores
(picture completion, similarities, picture concepts, arithmetic,
block design and comprehension) were converted into FIQ
estimates.
Data acquisition and preprocessing
DTI data were collected using a Philips 3.0T Achieva MRI
scanner (Philips Medical Systems, Best, The Netherlands) with
an eight-channel SENSE (Sensitivity Encoding) head coil. A
single-shot echo-planar imaging sequence was used with the
following scan parameters: repetition time = 11,000 ms, echo
time = 56 ms, flip angle = 90°, b-factor = 1000 s/mm2, voxel
46. dimensions = 2.3 mm isotropic, number of slices = 73, and no
slice gap. DTI data were acquired along 32 directions, together
with a baseline image having no diffusion weighting (b = 0).
Total scanning time was ~7.5 min. Collected DTI data were
preprocessed and analyzed, using the Oxford Centre for
Functional MRI of the Brain (FMRIB) software library
(FSL; http://fsl.fmrib.ox.ac.uk.ezproxy.fau.edu/fsl/fslwiki/) [49]
version 5.0.2. First, DTI data were corrected for distortion and
motion artifacts, induced by eddy currents or by simple head
motions, using affine registration of each diffusion weighted
image to the b = 0 reference image. Next, non-brain tissue was
removed, using the Brain Extraction Tool. Finally, to generate
individual FA maps for each participant, the diffusion tensor
model was fitted to each voxel, using FMRIB’s Diffusion
Toolbox. Total brain volume, normalized for subject head size,
was estimated using SIENAX [51], part of FSL.
Tract-based spatial statistics
Tract-based spatial statistics (TBSS) [48] version 1.2 was used
for voxelwise analysis of the preprocessed FA data. First,
individual FA images were aligned to the FMRIB58_FA
standard-space image, using nonlinear registration. Next, the
mean FA image was generated and thinned to create a mean FA
skeleton, which represents the centers of all tracts common to
the entire group. The mean FA skeleton was then thresholded at
a FA value of ≥0.4, to exclude peripheral tracts and minimize
partial voluming. Finally, each participant’s aligned FA images
were projected onto the mean FA skeleton and the resulting data
were fed into voxelwise permutation-based analysis.
Region-of-interest TBSS
To test for regional specific FA alterations, we implemented an
ROI-based TBSS. A binary mask, encompassing the bilateral
UF, the genu, splenium and body of the CC and the bilateral
cingulum, was created as region of interest using the Johns
Hopkins University (JHU) white matter atlas provided by FSL
[34]. The uncinate fasciculus connects subcortical subregions of
the limbic system, such as the hippocampus and the amygdala,
47. with the medial prefrontal cortex. The corpus callosum is the
largest white matter bundle in the brain and connects left and
right cerebral hemispheres. It consists of three subregions,
namely the splenium (posterior), the body (middle), and the
genu (anterior). The cingulum bundle is situated superior to the
corpus callosum, curving around the genu and splenium. It
connects prefrontal and subcortical areas, with additional
projections to the parietal lobe.
The mask was then applied to the mean FA skeleton, to include
only voxels comprised in the mean FA skeleton. This confines
the statistical analysis exclusively to voxels from the center of
the tract, thereby minimizing anatomic inter-subject variability,
registration errors, and partial voluming. The resulting study-
specific ROI mask was used for voxelwise permutation-based
ROI analysis.
Statistical analysis of demographic and clinical data
We used analysis of variance (ANOVA) to compare the two
groups on age, IQ and TSCC total score. Because not all TSCC
subscales showed normal distribution we used non-parametric
analysis (Mann–Whitney) for the comparison of the TSCC
subscales between the two groups.
MRI analysis
Using FSL’s Randomize tool, permutation-based inferences
with Threshold-Free Cluster Enhancement (TFCE) were carried
out for voxelwise analysis of FA data [50]. 5000 random
permutations were generated to build up the null distribution of
the cluster size statistic, while testing the following contrasts:
(1) controls > PTSD, (2) controls < PTSD. PDS score, total
brain volume, gender and FIQ (demeaned across groups) were
included in the analysis as nuisance regressors to correct for
between groups variances. The resulting statistical maps were
corrected for multiple comparisons across space (p < 0.05) and
the JHU White Matter and Juelich Histological atlases were
used to label clusters with significant FA alterations. This step
was first carried out using the ROI mask to test our specific
hypotheses. Next, we ran this step a second time using a whole
48. brain mask for our exploratory analysis.
Post hoc analyses
The association between FA and symptom severity in the PTSD
group was examined using a voxelwise correlation approach. A
mask was created of the voxels that were found to differ
significantly on FA based on the between-group ROI analysis.
The TSCC total and subscale scores of the PTSD group were fed
into FSL’s Randomize tool along with the mask, using
permutation-based inferences with TFCE.
Last, we examined how the between-group differences in FA
values related to the other DTI measures. Therefore,
information on each individuals’ AD (the 1st eigenvalue), RD
(the average of the 2nd and 3rd eigenvalues), and MD was fed
into FSL’s Randomize tool along with the mask based on our
ROI analysis.
Results
From the original total of 22 PTSD and 30 control adolescents,
three controls were excluded because of image artifacts in T1-
weighted anatomical scans. Further, two adolescents with PTSD
were excluded because of image artifacts in the DTI dataset,
resulting in a final sample of 20 adolescents with PTSD. From
the remaining 27 controls, 20 subjects were group-wise matched
on age and gender with the PTSD adolescents. Eventually, 40
participants (20 PTSD and 20 controls) were included. Of the 20
PTSD participants, 19 fulfilled all PTSD criteria on the ADIS,
while one had sufficient PTSD symptoms, but with limited
interference. Since earlier research showed that persons with
subthreshold PTSD in many aspects resemble PTSD patients, we
decided to include this patient [10].
The majority of participants was female (88 %, see Table 1). Of
the participants with PTSD, 15 had comorbid anxiety disorders,
most often more than one. Eight had a comorbid depressive
disorder and one an oppositional defiant disorder (ODD). All
controls and 16 adolescents with PTSD were drug and treatment
naïve. Two adolescents with PTSD were on stable SSRI
treatment and two used amphetamines (not on the day of
49. scanning).
Table 1
Demographic and clinical characteristics of participants
PTSD (N = 20)
CNTR (N = 20)
p
Mean
SD
Mean
SD
Gender (f : m)
17:3
18:2
Age (in months)
198
24
185
19
0.06
FIQ
99
9
107
9
<0.01
PDSa
Pre/mid-pubertal
1
4
51. 7.2
2.3
Dissociation
8.6
5.6
2.7
Sexual concerns
4.7
3.3
1.3
Because less than 20 % of the data in TSCC were missing,
expectation maximization as regression method was used to
calculate the scale scores
aMissing data: 2 in control group, 3 in PTSD group
bThree PTSD participants did not complete the questionnaire
The PTSD group had a significantly lower FIQ than controls
[F(1, 38) = 8,14, p < 0.01] and more subjects in the post-
pubertal phase (50 versus 25 %). As expected, there was a
significant main effect of group on the TSCC scale scores [with
and without controlling for age and
FIQ; F(7,28) = 6,48, p < 0.01]. The PTSD group had
significantly higher scores on all TSCC scales (all
with p < 0.01).
TBSS Analyses
ROI-based TBSS analysis showed that, in comparison with
controls, the PTSD group had lower FA values in the genu,
midbody and splenium of the CC (p < 0.05, TFCE corrected)
(Fig. 1). No FA differences were observed in the bilateral UF
and cingulum. The exploratory whole brain TBSS revealed no
significant lower FA values. When the threshold was lowered
we found lower FA values in the body of the CC in the left
52. hemisphere, adjacent to the splenium (p < 0.075, TFCE
corrected; Fig. 2). No white matter tracts with lower FA values
were found for controls versus PTSD.
Fig. 1
Region-of-interest analysis results. Coronal, sagittal and
transversal axial sections of the white matter skeleton (green)
superimposed on the FMRIB58_FA_1 mm standard brain (gray).
Depicted in yellow are the regions in which FA values are
significantly smaller in patients with PTSD compared to
matched healthy controls. For better visibility, the results are
thickened using the “tbss-fill” command (red). All TBSS results
are corrected for multiple comparisons (p < 0.05, TFCE
corrected), and the axial images are in radiological convention
(the right side of the image corresponds with the left
hemisphere of the brain and vice versa)
Fig. 2
Whole brain TBSS results. Coronal, sagittal and transversal
axial sections of the white matter skeleton (green) superimposed
on the FMRIB58_FA_1 mm standard brain (gray). Depicted
in yellow are the regions in which FA values are significantly
smaller in patients with PTSD compared to matched healthy
controls. For better visibility, the results are thickened using the
“tbss-fill” command (red) All TBSS results are corrected for
multiple comparisons (p < 0.075, TFCE corrected), and the
axial images are in radiological convention (the right side of the
image corresponds with the left hemisphere of the brain and
vice versa)
Using a voxelwise correlation approach, we examined the
association between the observed smaller FA values from the
ROI analysis, and the TSCC total and subscale scores in the
patients. We found a significant negative correlation between
scores on the anger subscale of the TSCC and FA values in the
left body of the CC (p < 0.05; uncorrected, Fig. 3.)
53. Fig. 3
Voxel-wise correlation between TSCC anger subscale scores
and FA values in adolescents with PTSD. Coronal, sagittal and
transversal axial sections of the white matter skeleton (green)
superimposed on the FMRIB58_FA_1 mm standard brain (gray).
FA values in the left CC correlated negatively with TSCC anger
subscale scores (p < 0.05) in the adolescents with PTSD
(yellow). For better visibility, the results are thickened using
the “tbss-fill” command (red). The axial images are in
radiological convention (the right sideof the image corresponds
with the left hemisphere of the brain and vice versa)
Post hoc analyses of the AD, RD and MD in the voxels that
showed FA differences between groups revealed a significant
increase (p < 0.05, TFCE corrected) of RD and MD in the PTSD
group compared to controls. No significant differences were
found between groups in AD. Omitting the one CSA participant
who met all PTSD criteria except for interference did not
change our findings. Excluding the two participants that were
using medication from the analyses did not change the results
either.
Discussion
We examined white matter integrity in a sample of adolescents
with CSA-related PTSD, using an ROI and an additional
exploratory whole brain approach. We hypothesized reduced FA
in a number of relevant white matter tracts: the CC, UF and
cingulum. Compared to the control group, our adolescent PTSD
group only showed decreased FA in areas of the CC, with
additional DTI parameters suggesting demyelinization and
dysmyelinization in these areas. We also found a significant
correlation (uncorrected) between FA in the CC and Anger
scores on the TSCC in the adolescents with CSA-related PTSD.
This study is the first to report on white matter integrity in a
group of adolescents with CSA-related PTSD. The results of our
study are in line with the findings of the recent DTI study by
Jackowski and colleagues, who examined the CC in a group of
children with PTSD following various forms of intrafamilial
54. maltreatment, and also found reduced FA in several subregions
of the CC [24]. Our findings are in line with recent reviews
indicating that the most consisting finding in youth with
psychotrauma is structural abnormalities of the CC, in contrast
to the reduction of hippocampal volume typically reported in
adults with PTSD [5, 40].
The CC is known to change throughout life, but most
dramatically during childhood and adolescence [2, 30]. These
developmental changes in the CC are the consequence of
varying degrees of axonal myelinization, redirection, and
pruning, reflecting a permanent adjustment and fine-tuning of
fibers connecting homologous cortical areas. The general trend
during adolescence is toward increasing FA and decreasing MD
[43]. This CC maturation parallels puberty development
suggesting gonadal hormonal influences [2]. For this reason, we
included PDS scores as regressor. However, we must
acknowledge that a simple linear regression of pubertal stage
and total brain volume may still not sufficiently account for the
results as they are known not to be linear across adolescence.
Early traumatization is likely to have a major influence on the
integrity of the CC, as the processes of myelinization and
selective pruning are typically influenced by stress hormones
[52, 54]. Of importance, the smaller FA values we found in the
CC of the PTSD group were due to increases in RD and MD,
known to reflect demyelinization (less development of the
myelin sheet) and dysmyelinization (aberrant development of
the myelin sheet), linking the abnormalities of the CC integrity
to the possible influence of stress hormones. Supporting this
possible association, a recent study found that in rhesus
monkeys exposed to early maternal abuse, cortisol levels at the
time of abuse correlated with abnormalities in white matter
connectivity in the CC, brain stem and other brain areas in
adolescence [20]. Our results are in line with the study of
Teicher et al. who, comparing abuse and neglect, found that
sexual abuse was the strongest factor influencing CC size in
girls [53].
55. Recent topographic research on the CC is beginning to map the
different regions of the CC and their connections. Apart from
frontal connections, the body of the CC also has connections
with subcortical nuclei [21]. Changes in the midbody of the CC
in children and adolescents who experienced psychological
trauma could be related to disturbances in connectivity with
limbic subcortical nuclei, resulting from or underlying the
disturbances in emotion regulation.
We found a negative association in the adolescent PTSD group
between FA in the CC and the TSCC Anger subscale. This in
contrast to the result of the small DTI study in socioemotional
deprived children with PTSD [14] in which correlations of FA
measures in the CC were found with total anxiety scores, panic
scores and separation anxiety scores. This may be due to
methodological differences as well as the populations studied. A
preclinical study in male non-human primates examined the
effects of early life stress on hippocampal volume and CC
development and found a significant inverse relationship
between CC mid-sagittal area in adult monkeys and the response
toward an intruder which typically consists of a mixture of
aggressive and anxious behavior [23]. In a recent DTI study in
male adolescents with conduct disorder, Zhang et al. report
increased structural connectivity in the genu and body of the CC
[61]. Impulsivity correlated positive with WM integrity, which
is the opposite pattern of what we found in our study. This
suggests that different pathophysiological mechanisms are
involved, which is in accordance with the putative mechanisms
described in the literature. For instance, Raine et al.
hypothesize that structural abnormalities in the CC are a
consequence of an early arrest of the normal
neurodevelopmental process of axonal pruning, while the
abnormalities in myelinization following CSA may be more
linked to detrimental stress hormone influences [39].
We believe the relatively homogeneous sample and the state-of-
the-art DTI approaches are strengths of our study, although
several potential limitations should be taken into account. While
56. we know that gender influences brain development and the
reaction to psychological trauma, we included gender as a
regressor, but could not further explore this issue because our
participants are mainly girls. Full scale IQ measures differed
significantly between the PTSD group and controls. Several
studies report a negative effect of ELS on cognitive function
[13, 37]. In this respect intellectual ability in the PTSD group
and the control group might originally have been more equal.
The New Zealand longitudinal birth cohort study [28] instead
points to IQ as a risk factor for the development of PTSD. In
the discussion about lower IQ being a consequence or a
predictor of PTSD, it is suggested that trauma severity overrules
IQ as a predictor [33] which could be the case in our study
where all included adolescents fulfilled symptom criteria for
PTSD diagnosis although this was not an inclusion criterion, but
here too results are inconclusive [6]. Navas-Sanchez et al. [35]
found a positive correlation between IQ and FA in the CC in
math gifted adolescents compared to controls matched for age
and academic level. Other studies report about correlations,
mostly positive, of cognitive function with FA in several WM
tracts [17, 42]. To decrease the potential influence of IQ on the
white matter integrity differences we included IQ as a covariate
in our analyses, but clearly further research is needed to unravel
the exact relationship between childhood adversity, IQ and WM
integrity in adolescence.
The normal increase of FA in the CC during adolescence is
related to pubertal development. Therefore, the PDS score is
chosen as nuisance regressor instead of age. The PTSD group
was older and more advanced in pubertal stage. Because of the
expected increase, the decrease in FA found in the PTSD group
cannot be a consequence of normal (pubertal) development.
Two adolescents with PTSD were on stable SSRI treatment.
Omitting these two participants from our analyses did not have
any effect on the results. To our knowledge no influence of
SSRIs on the CC is reported [9].
Patients were selected based on the presence of CSA and all
57. except one, who fulfilled PTSD criteria except interference,
showed CSA-related PTSD. Hence, we cannot differentiate
whether the neuroimaging results were a consequence of
exposure to trauma or the (development of) PTSD pathology or
reflect an underlying vulnerability. Previous research in twins
discordant for combat exposure suggests that anatomical
abnormalities may indeed represent pre-existing vulnerability
factors [16]. The ideal cross-sectional design to disentangle the
effects of exposure, psychopathology and resilience would have
incorporated a CSA group with psychopathology, a CSA group
without psychopathology and a non-exposed, healthy control
group [55]. Furthermore, we could not assess the influence of
timing and duration of the CSA in our study, which is thought
to be highly relevant in children and youth.
About one-third of the subjects also reported physical abuse,
but as we did not assess experiences of other forms of
psychotrauma we could have missed other prevalent traumatic
experiences, like emotional maltreatment, which might be
associated with the presence of DTI abnormalities in our
sample.
In conclusion, our DTI findings in this sample of adolescents
with CSA-related PTSD point at the involvement of the CC in
brain alterations associated with juvenile sexual psychotrauma,
and together with recent animal data can be taken to point at the
influence of stress hormone levels on CC integrity. Clearly,
longitudinal studies till mid-adulthood are needed to further
elucidate the role of altered CC white matter integrity in the
biopsychological consequences of early traumatization and to
examine its malleability.