European Journal of Trauma & Dissociation最新文献

The body of knowledge regarding the social work service needs of persons with complex dissociative disorders (DDs) remains seriously limited. This paper presents two case reports of young women with a complex DD to illustrate the opportunities for social work intervention to improve quality of life outcomes. This study is the first to explore the social work service needs of persons with complex DDs. It is also the second paper in the literature to present a case report of persons with complex DDs from Hong Kong. Aspects of their social work service needs are discussed, including symptom management and social and interpersonal issues. We argue that even generalist social work practitioners can play an important role in supporting persons with complex DDs, especially when there is a lack of specialized treatment providers. A series of recommendations are made to educate social work professionals about trauma and dissociation. Persons with complex DDs should receive more attention from social work practitioners and researchers given the prevalence and costs of the disorders in the community.

Despite the existence of abbreviated versions of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5), the lack of evidence regarding the validation of this measure has become a limitation in research. This study examined the Turkish validation of the PCL-5, which is a recently developed measure of an optimal short‐form of the PTSD Checklist for DSM‐5. Also, the study aimed to investigate how psychological flexibility mediates the association between PTSD and psychological adjustment problems. This cross-sectional study consisted of 568 young adults (50.5 % males) aged between 18 and 60 years (M = 27.92, SD = 9.26). The results indicated that the PCL-5-S had good internal consistency reliability and high construct validity. The findings also revealed that PTSD was negatively associated with psychological flexibility and positively associated with psychological adjustment problems. Additionally, psychological flexibility was negatively associated with psychological adjustment problems. Furthermore, mediation findings showed that psychological flexibility partially mediated the association between PTSD and psychological adjustment problems. These findings suggest that the PCL-5-S is a valid and reliable instrument for assessing the presence of PTSD symptoms in Turkish populations. Furthermore, intervention programs targeting psychological flexibility could be developed to reduce the symptoms of psychological maladjustment problems by addressing PTSD symptoms.

Background

In connection with the onset of difficult times associated with the war, Ukrainians are exposed to traumatic factors for mental health. The research is relevant in connection with the real threat to the mental state of the population in the long term, because this type of disease can be in a latent phase for a long time.

Objective

The purpose of the study is to record the specifics of the impact of the war on the psyche of Ukrainian citizens, which also includes the hypothetical post-war situation in the country.

Methods

The method of typological analysis identified six main mental disorders that can be caused by war. As an analysis of the current situation in the country, an appropriate psychodiagnostic technique was selected for each disorder. To predict the future situation in the post-war period, a comparison method was used, based on recording the experience of countries that have passed the stage of ending the conflict.

Results

It was found that approximately half of the interviewees have signs of post-traumatic stress disorder (PTSD), adjustment disorder, depression, anxiety disorders, and somatoform disorders. But signs of dependence on psychoactive substances were observed in about a quarter of those surveyed. Women were more prone to PTSD, anxiety and somatoform disorders, and men to addiction to psychoactive substances. Risk factors that may cause further complication of the situation with mental illnesses in post-war Ukraine were highlighted.

Conclusion

The results of the study are relevant for state and non-state organizations related to activities aimed at psychological or psychiatric assistance to the population.

Interpersonal trauma is associated with poorer prognoses for individuals with psychotic disorders; however, its association with symptom severity at hospital discharge is unknown. Among 57,106 individuals hospitalized for a psychotic disorder in Ontario, Canada (2009–2019), 12,805 (22.4 %) with and 44,301 (77.6 %) without a history of interpersonal trauma were compared on the positive symptom scale (PSS) score at discharge. In a subcohort of individuals with an elevated PSS score of at least 6 on admission, we calculated the relative risk of positive symptom remission (PSS<6) at discharge comparing those with and without interpersonal trauma. Interpersonal trauma was associated with a higher PSS discharge score. Effect sizes were greater for those with who experienced interpersonal trauma in the past year. Results were similar by type of trauma (physical, sexual, emotional) and specific diagnosis (schizophrenia, schizoaffective disorder, other psychotic disorder). In the subcohort, fewer inpatients with vs. without a history of interpersonal trauma had PSS<6 at discharge. Thus, individuals with psychotic disorders who have a history of interpersonal trauma are at risk for elevated symptom burden at hospital discharge. Integration of trauma-informed frameworks and trauma-focused therapies in the inpatient psychiatric setting may optimize outcomes at discharge.

Romantic breakups are considered ”normative” events because of their high prevalence, but they can also be stressful, and even traumatic experiences. Although there is an increasing interest in studying romantic breakups, there are few studies proposing mechanisms that turn a romantic breakup into a health problem. Based upon existing literature, we chose rumination as a mediator between trait anxiety and breakup distress. In addition, given that culture plays a significant role in both grief response and the process of rumination, we expected rumination plays a differential role in mediating the relationship between trait anxiety and breakup distress across Argentinian and North American samples, although we did not specify a moderation hypothesis due to absence of previous antecedents in the literature. To set a firm measurement foundation, we initially evaluated measurement invariance prior to testing substantive models. 415 Argentinians (78% female) and 383 USA (66% female) students who experienced a romantic breakup were recruited. Several measurement adjustments were needed to support metric invariance for the items. The indirect effect involving brooding rumination between the trait anxiety and breakup distress was significant in both countries, and not significantly different between the countries. Rumination thinking was shown as a full cross-cultural mediator of the relationship between trait anxiety and breakup distress in both countries. Our results could point at a starting point to think of rumination as a cross-culturally invariant mechanism explaining why insecure individuals (i.e., high trait anxiety) tend to suffer more during a breakup compared to less anxious individuals.

Introduction

The experience of grief and loss involves a variety of trajectories and responses, including feelings of shock or disbelief, somatic symptoms, longing for the loved one and avoidance behaviours, as well as positive reactions such as post-traumatic growth or meaning-making. Despite the large number of psychometric instruments available for assessing the pathological dimensions of grief, few tools address the different responses to bereavement.

Objective

The aim of this research was to develop and test the psychometric properties (factorial structure, reliability and validity) of an instrument based on the Integrative-Relational Model of grief and designed to address the grief responses (the Grief Response Scale (GRS)) in a clinical sample of participants who had experienced bereavement.

Method

In total, 379 participants were recruited from different clinics in Spain. Each participant completed a self-report questionnaire including the GRS and measures of complicated grief, post-traumatic stress disorder, depression, anxiety and post-traumatic growth. Twenty-eight clinical psychologists contacted each of the participants individually in order to carry out the assessment.

Results

Exploratory factor and item analysis yielded a six-factor solution for the GRS, including symptomatological distress, avoidance orientation, loss orientation, positive changes, loss integration and social support. Reliability values ranged from ω =0.88 for the symptomatological distress subscale to ω= 0.65 for the loss orientation subscale. We assessed validity evidence using Pearson's correlations, which showed significant positive and negative associations depending on the subscale. we also found statistically significant differences between participants who met the criteria for complicated grief (ICG≥30) and those who did not.

Discussion

The GRS appears to be a suitable tool for assessing the range of grief responses in a clinical population. It can measure both complicated and pathological reactions to grief, as well as positive outcomes. The GRS may also be useful for clinicians working with bereavement and end-of-life situations.

Objective

Literature reported a great occurrence of Traumatic Events (TEs) and post-traumatic symptoms in anorexia nervosa (AN). The present study aims to: a) describe the prevalence and the characteristics of TEs in AN, also comparing TEs related to Post-traumatic Stress Disorder (PTSD) to those without this link; b) compare patients with and without TEs and with and without PTSD in terms of clinical picture; c) compare patients who suffered the TE before AN onset to those with TE after AN onset.

Methods

The sample consisted of 126 patients with AN who were interviewed with the Structured and Clinical Interview for DSM 5 (SCID-5), and completed self-reported questionnaires to investigate the general and eating-related psychopathology.

Results

The results showed that the majority of the patients with AN reported a TE, and TEs related to PTSD were more relational and sexual-related compared to TEs not leading to PTSD. Moreover, after Bonferroni correction was applied to the results, no significant differences emerged between patients with and without TEs, and between individuals with TEs before and after AN onset; differently, patients with PTSD presented a more severe global clinical picture than those without PTSD, partially independent of diagnostic AN subtype.

Conclusion

The study highlights that, despite TEs are risk factors for AN, the diagnosis of PTSD makes the difference in terms of clinical presentation and severity, impacting not only eating-related symptoms but also general psychopathology. A careful screening for PTSD in patients with AN is suggestable, especially when relational trauma and sexual violence are reported.

Background

Complex Post-Traumatic Stress Disorder (CPTSD) and Emotionally Unstable Personality Disorder (EUPD) have shared aetiology and symptomatology, and are associated with multiple comorbidities and poor clinical outcomes. Evidence from studies with clinical populations indicates high levels of morbidity between the two diagnoses. Yet, the cumulative impact of coexisting CPTSD and EUPD diagnoses on levels of general distress, risk, quality of life and resulting treatment needs have not been explored. Accordingly, our understanding of the impact of experiencing both disorders and the relationship between coexisting trauma responses, and associated treatment needs remains limited.

Methodology

Using a convenience sample of 47 women admitted to a specialised DBT inpatient service, associations between general distress, risk, quality of life and diagnostic status were explored.

Results

Women with comorbid EUPD and CPTSD reported significantly higher levels of general distress and risk to self, and significantly lower quality of life compared to women with EUPD alone. Hierarchical regression analyses revealed that, when exploring the isolated effect of each symptom cluster, only affective dysregulation remained a significant predictor of distress, risk to self, and quality of life (all p < .05).

Conclusions

Although our results require further replication, the current study indicates that the experience of comorbid EUPD and CPTSD is impactful. Affect regulation may play a critical role in explaining comorbidity between EUPD and CPTSD. Accordingly, the current findings offer novel insights into the relationship between the two diagnoses, with clinical and theoretical consequences explored.

Background

The co-occurrence of symptoms of prolonged grief (PG) and dissociation is largely unexplored. Studying heterogeneity in patterns of PG and dissociative symptoms is important to inform theorizing about, and treatment of, post-loss psychopathology. The present research aimed to examine if, among bereaved people, subgroups could be distinguished in terms of the endorsement of PG and dissociative phenomena.

Method

We performed three studies. In Study 1 (N = 476) and Study 2 (N = 141), we examined the co-occurrence of PG and peri‑loss dissociation (experienced shortly after the death) in relatively recently (≤6 months) bereaved people. In Study 3 (N = 258), we examined PG and trait-like dissociation among more remotely bereaved people. Latent profile analysis was used to identify subgroups. Our aims were to identify profiles of PG and dissociation and to examine associations of emerging profiles with loss-related emotional distress, and with socio-demographic and loss-related characteristics.

Results

In Study 1 and 3, profiles were identified characterized by low, average, and high PG and dissociation. In Study 2, profiles emerged characterized by low PG and low dissociation, average PG and low dissociation, and high PG and high dissociation. Across studies, people in the most pervasive PG and dissociation profiles reported the most severe concurrent (Studies 1, 2, and 3) and prospective (Studies 1 and 2) emotional distress. People confronted with losses of partners or children and with unexpected deaths were more likely to evidence pervasive PG and dissociation.

Conclusion

PG and dissociation appear to increase and decrease in parallel. No evidence was found that subgroups existed with severe PG and no dissociation vs. severe PG and high dissociation. This runs counter to the existence of a possible “dissociative prolonged grief disorder subtype.” Nonetheless, dissociation may be a target of treatment for more severely distressed mourners.