Journal of Trauma & Dissociation最新文献

Healthcare-related institutional betrayal has been used to examine how patients' previous negative healthcare experiences influence their current provider-level trust and future interactions with the healthcare system. However, healthcare-related institutional betrayal has rarely been considered among emerging independent users of the healthcare system: college students. Moreover, it is unknown whether healthcare-related institutional betrayal is associated with future healthcare expectations among this population. Using a trauma-informed framework, this study examined the relations among self-reported experiences of healthcare-related institutional betrayal, trust in healthcare providers, and subsequent expectations for healthcare among college students (n = 967). Analyses considered whether greater past healthcare-related institutional betrayal during one's worst healthcare experience predicts i) lower current trust in healthcare providers and ii) greater negative expectations for future healthcare above and beyond trauma symptoms and the perceived severity of participants' worst healthcare experiences. Sixty-nine percent of participants endorsed having experienced at least one act of institutional betrayal, the most common being the institution not taking proactive steps to prevent unpleasant healthcare experiences (28.5%). As predicted theoretically, greater experiences of institutional betrayal accounted for 16% of the variance in current trust in healthcare providers, even after accounting for trauma symptoms and the severity of the worst healthcare experience. Greater endorsement of institutional betrayal experiences were also significantly associated with negative expectations for future healthcare. Given the youthfulness of the sample, it is noteworthy that 41.4% of participants endorsed at least one negative expectation for future healthcare. Future research should examine how negative expectations are related to healthcare avoidance behaviors.

Gender differences in the prevalence, types and outcomes of traumas have consistently been reported in the literature. Other research has documented that exposure to trauma is associated with the development and maintenance of pathological personality traits. In the current study, we examined the moderating role of gender in the association between lifetime exposure to trauma and pathological personality traits. The sample included 148 clients who sought treatment at a community mental health clinic. All participants completed online questionnaires including demographic information, the Trauma History Questionnaire (THQ), and the Personality Inventory for DSM-5-Brief Form (PID-5-BF) at the entry to treatment. Our findings documented a significant association between exposure to trauma and pathological personality traits in men, but not in women. Furthermore, this pattern of results was specifically evident within two personality domains: antagonism and detachment. These findings contribute to the theoretical understanding of the interplay between trauma, gender, and the development of pathological personality traits. They expand upon the growing knowledge about the mental health crisis among boys and men by shedding light on the unique vulnerabilities that men face in response to traumatic experiences and how these experiences can have a lasting impact on their adaptive functioning. Consequently, at the clinical level, the current study emphasizes the importance of paying particular attention to men's trauma histories and explicitly exploring these during the intake session.

The Personality Assessment Inventory (PAI) is among the most commonly used broadband inventories of psychological functioning. For the purposes of assessing trauma specifically, the most relevant aspect of the PAI is the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T), which measures the degree to which a person feels wounded by something in their past. Research suggests that ARD-T is associated with exposure to a variety of different traumatic stressors. However, there is little research on the degree to which traumatic stressors that entail a component of interpersonal betrayal (i.e. betrayal trauma) are associated with higher scores on ARD-T relative to other stressors. In this study, we evaluated the relative associations between traumas with varying degrees of betrayal and scores on ARD-T in a secondary analysis of two non-clinical samples (college sample N = 494; crowdsourced sample N = 364) using a Bayesian approach to multiple regression. In both samples, traumas with both high and medium (but not low) degrees of betrayal were associated with elevated ARD-T scores. Findings suggest that ARD-T scores are associated with interpersonal trauma regardless of betrayal, which has implications for interpretation of the ARD-T scale in practice.

Previous studies showed that dissociation and dissociative disorders (DDs) are prevalent and are associated with considerable individual and social consequences. There are ongoing debates regarding whether dissociation is a response to betrayal trauma across cultures and whether dissociation can be explained by maladaptive coping. Additionally, little is known about the clinical features of individuals with DDs in the Chinese context. This study aimed to investigate the relationship between trauma, emotional regulation, coping, and dissociation. We analyzed baseline data from a randomized controlled trial (N = 101). Participants with dissociative symptoms in Hong Kong completed self-report assessments. Structured interviews were also conducted subsequently. Participants with probable DDs reported more traumatic events (p = .009 to .017) and exhibited significantly higher levels of dysfunctional coping (p < .001) compared to those who reported dissociative symptoms but did not have a DD. Dissociative symptoms were more strongly associated with betrayal trauma than with non-betrayal trauma. Among different emotion regulation and coping strategies, dysfunctional coping was the only significant factor associated with dissociative symptoms (β = .309, p = .003). Dysfunctional coping was a statistically significant mediator that may explain the relationship between betrayal trauma and dissociative symptoms. Although other mediation paths are also possible and further longitudinal studies are required, our findings highlight the strong link between dysfunctional coping and dissociative symptoms and suggest that coping skills training should be incorporated into interventions for betrayal trauma survivors with dissociative symptoms. Additionally, this study provides evidence for the cross-cultural validity of the betrayal trauma theory. Further studies, however, are required.

Previous empirical studies on the relationship between psychotic symptoms and dissociative disorders focused on auditory hallucinations only or employed limited statistical analyses. We investigated whether the frequency of Schneiderian first rank symptoms (FRS) predicts the presence or absence of a dissociative disorder (DD). Psychiatric in-patients (n = 116) completed measures of dissociation, FRS and general psychological distress (GPD). DD diagnoses were confirmed by multidisciplinary teams or administering the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). The FRS were recorded in the Multidimensional Inventory of Dissociation (MID) and a mean score obtained for 35 relevant items: Voices arguing, voices commenting, made feelings, made impulses, made actions, influences on body, thought withdrawal, and thought insertion. A global severity index (GSI) of GPD was obtained from the Symptom Checklist-90-Revised (SCL-90-R). Logistic regression models examined whether FRS predict diagnostic classification of patients under a DD (n = 16) or not (n = 100), controlling for GSI. The overall fit of the model was significant (p = .0002). DD was correctly classified using frequency of FRS, controlling for GSI. The latter was moderately associated with FRS (r = 0.56). FRS more than doubled the odds of a DD diagnosis (odds = 2.089; 95% CI = 1.409-3.098; correct classification rate 87.1%). The study provides convincing evidence that FRS are closely related to DDs. FRS should alert clinicians to consider DDs in differential diagnosis of psychiatric in-patients. Future research should analyze whether FRS also predict a diagnosis of schizophrenia or other psychiatric disorders.

Dissociative Identity Disorder (DID) is a highly disabling diagnosis, characterized by the presence of two or more personality states which impacts global functioning, with a substantial risk of suicide. The International Society for the Study of Trauma and Dissociation (ISSTD) published guidelines for treating DID in 2011 that noted individual Psychodynamically Informed Psychotherapy (PDIP) was a cornerstone of treatment. This paper systematically reviews the evidence base for PDIP in the treatment of adults with DID according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirty-five articles were located and reviewed: seven prospective longitudinal publications, 13 case series and 15 case studies. Results suggested that PDIP has been widely deployed in DID to reported good effect with a range of treatment protocols and using multiple theoretical models. Despite the positive findings observed, the evidence base remains at the level of observational-descriptive design. Creative approaches in recent years have been developed, which add empirical weight to the use of PDIP as an effective treatment. The elevation to observational-analytic designs in the Evidence-Based Medicine hierarchy has yet to take place. Bearing in mind the challenges of research in PDIP, suggestions are offered for how the evidence base might develop.