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Symptoms of Dissociation in Humans Experiencing Acute, Uncontrollable Stress: A Prospective Investigation
Abstract
Peritraumatic dissociation has been associated with subsequent development of posttraumatic stress disorder, but supporting data have been largely retrospective. The current study was designed to assess the nature and prevalence of dissociative symptoms in healthy humans experiencing acute, uncontrollable stress during U.S. Army survival training.
In study 1, 94 subjects completed the Clinician-Administered Dissociative States Scale after exposure to the stress of survival training. In study 2, 59 subjects completed the Brief Trauma Questionnaire before acute stress and the dissociative states scale before and after acute stress. A randomly selected group of subjects in study 2 completed a health problems questionnaire after acute stress.
In study 1, 96% of subjects reported dissociative symptoms in response to acute stress. Total scores, as well as individual item scores, on the dissociation scale were significantly lower in Special Forces soldiers compared to general infantry troops. In study 2, 42% of subjects reported dissociative symptoms before stress and 96% reported them after acute stress. Dissociative symptoms before and after stress were significantly higher in individuals who reported a perceived threat to life in the past. Forty-one percent of the variance in reported health problems was accounted for by poststress dissociation scores.
Symptoms of dissociation were prevalent in healthy subjects exposed to high stress. Stress-hardy individuals (Special Forces soldiers) experienced fewer symptoms of dissociation, compared to individuals who were less hardy. These data support the idea that the nature of response to previously experienced threatening events significantly determines the nature of psychological and somatic response to subsequent stress.
... It is clear that mental health difficulties can occur well before the military battlefield, especially in young personnel who have experienced childhood adversity (Pinder et al., 2012). Military training, especially the more extreme kinds, has been linked with dissociation (Eid & Morgan, 2006;Morgan et al., 2000a & b;Morgan et al., 2001Morgan et al., , 2004Morgan & Taylor, 2013;Ralph et al., 2017;Taylor & Morgan, 2014), which has been shown to occur in up to 96% of those undergoing survival exercises (Morgan et al., 2001). However, to a vulnerable younger recruit, even the basic training environment can predispose to mental disorder, including dissociation, especially if associated with emotional or physical bullying, or sexual harassment/assault (Murphy et al., 2021;Child Rights International Network, 2023). ...
... It is clear that mental health difficulties can occur well before the military battlefield, especially in young personnel who have experienced childhood adversity (Pinder et al., 2012). Military training, especially the more extreme kinds, has been linked with dissociation (Eid & Morgan, 2006;Morgan et al., 2000a & b;Morgan et al., 2001Morgan et al., , 2004Morgan & Taylor, 2013;Ralph et al., 2017;Taylor & Morgan, 2014), which has been shown to occur in up to 96% of those undergoing survival exercises (Morgan et al., 2001). However, to a vulnerable younger recruit, even the basic training environment can predispose to mental disorder, including dissociation, especially if associated with emotional or physical bullying, or sexual harassment/assault (Murphy et al., 2021;Child Rights International Network, 2023). ...
... Several studies have documented the stress induced by military training, one of which was a prospective investigation of symptoms of PD in healthy military subjects before and after exposure to intense stress as part of survival training conducted by the U.S. Army (Morgan et al., 2001). Two groups of soldiers were examined: Special Forces and general infantry soldiers. ...
Abstract
Background: Armed conflicts around the world expose members of defence forces to ever more traumatic events. However, figures for suicide after leaving the UK Armed Forces from 1996 - 2018 indicate that deployment was associated with a reduced risk of suicide, which was greatest in veterans aged under 25 years, including those who left the Armed Forces without completing their training. Similarly, in the United States, there are more attempted suicides during training than at war. Studies of military personnel have shown that dissociation is a frequent accompaniment to military training, especially of the more extreme kinds, and that dissociation is associated with an increased risk of suicide, especially among those who have experienced childhood trauma.
Objective: To examine and review the nature and extent of dissociation as a possible complication of military training and a risk factor for suicide.
Method: A brief overview is given of the figures from the UK suicide study and continues with an explanation of dissociation and its appearance during military training. Next, the connection of dissociation to self-harm and suicide is explored, as well as the influence of previous childhood adversity.
Results: The incidence of dissociation among military personnel is high at all levels of training, and even if considered as an adaptive response under stress, it does not improve military performance. It is associated with increased risk of self-harm and suicide, notably in younger age groups, and is heightened by previous trauma exposure, especially in childhood, as well as bullying and assault by training staff and peers.
Discussion and future directions: The relative contributions of training and previous childhood trauma are discussed, and directions for future research and policy are suggested.
Conclusion: It is vital that all trainees are monitored for this overlooked phenomenon. Screening for previous childhood trauma is also recommended. However, a person’s background must not be used as an excuse to evade the issue of inhumane treatment during military training.
Keywords: dissociation, military training, trauma, suicide.
... They may thus be predisposed to a higher likelihood of mental and physical health problems [5]. The majority of previous studies, however, suggested that SF personnel were less likely to exhibit symptoms or seek medical care for mental and physical health problems compared with those from other military occupational populations, including general infantry, combat artillery, and mechanized infantry soldiers [6][7][8][9][10]. ...
... Despite previous studies reporting that SF personnel were healthier than non-SF personnel, these analyses were limited by cross-sectional designs [6,7], unavailability of data on potential confounding factors such as combat history [7,8,9], and/or an inability to differentiate the roles of personnel serving in SF units (e.g., SF, support, medical) [6,8,9]. Furthermore, previous investigations have not identified the specific factors that explain why SF personnel may exhibit more positive mental and physical health outcomes than non-SF personnel. ...
... Despite previous studies reporting that SF personnel were healthier than non-SF personnel, these analyses were limited by cross-sectional designs [6,7], unavailability of data on potential confounding factors such as combat history [7,8,9], and/or an inability to differentiate the roles of personnel serving in SF units (e.g., SF, support, medical) [6,8,9]. Furthermore, previous investigations have not identified the specific factors that explain why SF personnel may exhibit more positive mental and physical health outcomes than non-SF personnel. ...
Objectives:
To prospectively examine the health and health-related behaviors of Army Special Forces personnel in comparison with two distinct, but functionally similar Army groups.
Methods:
Special Forces, Ranger Qualified, and General Purposes Forces enrolled in the Millennium Cohort Study were identified using data from the Defense Manpower Data Center. Using prospective survey data (2001-2014), we estimated the association of Army specialization with mental health, social support, physical health, and health-related behaviors with multivariable regression models.
Results:
Among the 5,392 eligible participants (84.4% General Purposes Forces, 10.0% Special Forces, 5.6% Ranger Qualified), Special Forces personnel reported the lowest prevalence of mental disorders, physical health problems, and unhealthy behaviors. In the multivariable models, Special Forces personnel were less likely to report mental health problems, multiple somatic symptoms, and unhealthy behaviors compared with General Purpose Forces infantrymen (odds ratios [OR]: 0.20-0.54, p-values < .01). Overall, Special Forces personnel were similar in terms of mental and physical health compared with Ranger Qualified infantrymen, but were less likely to sleep < 5 hours/night (OR: 0.60, 95% confidence intervals: 0.40, 0.92) and have 5 or more multiple somatic symptoms (OR: 0.69, 95% CI: 0.49, 0.98). Both Special Forces personnel and Ranger Qualified infantrymen engaged in more healthy behaviors compared with General Purpose Forces infantrymen (OR: 2.57-6.22, p-values<0.05). Engagement in more healthy behaviors reduced the odds of subsequent adverse health outcomes, regardless of specialization.
Conclusions:
Army Special Forces personnel were found to be mentally and physically healthier than General Purpose Forces infantrymen, which may in part be due to their tendency to engage in healthy behaviors. Findings indicate that engagement in a greater number of healthy behaviors may reduce odds for subsequent adverse outcomes.
... It is important that PCPs and their teams remain vigilant for signs and symptoms of dissociation which is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as a "disruption of and/or discontinuity in the normal, subjective integration of one or more aspects of psychological functioning, including -but not limited to -memory, identity, consciousness, perception, and motor control" [27]. Dissociative phenomena occur across a clinical spectrum [28]; the mildest (and most common) form is "spacing out" in which the patient would report experiencing this as a memory gap or time that cannot be accounted for [28,29]. Other presenting signs of dissociation include a glazed look, appearing "frozen," or physically withdrawn [25]. ...
... It is important that PCPs and their teams remain vigilant for signs and symptoms of dissociation which is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as a "disruption of and/or discontinuity in the normal, subjective integration of one or more aspects of psychological functioning, including -but not limited to -memory, identity, consciousness, perception, and motor control" [27]. Dissociative phenomena occur across a clinical spectrum [28]; the mildest (and most common) form is "spacing out" in which the patient would report experiencing this as a memory gap or time that cannot be accounted for [28,29]. Other presenting signs of dissociation include a glazed look, appearing "frozen," or physically withdrawn [25]. ...
... Some authors recommend screening all adults for PTSD [80], making the argument that (1) some providers may find it easier to screen for PTSD than to ask behaviorally based questions about specific traumas; (2) PTSD is an important mediator of many of the long-term health effects of trauma; (3) a number of timelimited, evidence-based treatments exist for PTSD; and (4) a large proportion of cases of PTSD remit over time [25,28] (Table 7.1). Identification of other treatable conditions that commonly result from past trauma, such as anxiety, depression, chronic pain and SUD, is another feasible approach [81]. ...
This chapter will address trauma-informed care in adult primary care settings. While a substantial body of literature exists on implementing trauma-informed care in mental health and pediatric settings, less has been written about best practices and strategies for adult primary care settings. In the United States, primary care providers manage adults with chronic pain, substance use, and comorbid mental health conditions. Patients with these conditions have a high prevalence of trauma exposure, which adversely impacts their health and complicates their care. While collaborative care, or integrated behavioral health care, is becoming more widespread, many primary care providers manage these challenging patients alone without access to adequate mental health support. Despite the prevalence of trauma and the comorbidity and complexity of adult primary care patients visit length is often short, and providers frequently carry large panels of patients. High levels of burnout have been reported among PCPs, and access to primary care is poor in many parts of the country. Trauma-informed care approaches hold promise for improving patient care and mitigating some of the challenges commonly experienced by both patients and clinicians.
... Trauma models explain that dissociation is one of several possible protective and evolutionarily beneficial responses in extremely dangerous situations, and that the dissociative reaction pattern can repeat itself after traumatic threats when associated threat networks are activated ( [51,66], see [29,42] for a discussion of the neurological basis of dissociation). Importantly, it is believed that threat networks can become detached from contextual cues related to traumatic experiences, and dissociation can occur as an automatic response to a variety of perceived threats and daily stressors, not only those that are trauma related [49]. Once threat networks have become sensitized in this way, dissociation automatically appears as affective states reach a certain quality, for example, self-reported distress accompanied by increased levels of sympathetic nervous system activity. ...
... Our literature review suggests at least three potential moderatos. First, we expect patients who report more exposure to past trauma, the single most important etiological factor linked to dissociation, to report a stronger link between distress and dissociation because with higher exposure to past trauma fear networks are more likely to become detached from contextual cues [49,66]. Second, patients who report more coping capabilities other than dissociation (e.g., emotion regulation, social support) should report a weaker link between distress and dissociation because stress and/or negative emotions should be effectively modulated more often [14]. ...
Background
Dissociation is a ubiquitous clinical phenomenon. Dissociative disorders (DD) are primarily characterized by dissociation, and dissociative states are also a criterion for borderline personality disorder (BPD) and the dissociative subtype of post-traumatic stress disorder (PTSD). Dissociative reactions (e.g., depersonalization/derealization or gaps in awareness/memory) across diagnostic categories are believed to be affect contingent and theorized to serve affect regulation functions. What is not clear, however, is how self-reported affect and physiological reactivity unfold within dissociative episodes. To address this issue, the present project aims to investigate the hypothesis (1) whether self-reported distress (as indicated by arousal, e.g., feeling tense/agitated, and/or valence, e.g., feeling discontent/unwell) and physiological reactivity increase before dissociative episodes and (2) whether self-reported distress and physiological reactivity decrease during and after dissociative episodes in a transdiagnostic sample of patients with DD, BPD, and/or PTSD.
Methods
We will use a smartphone application to assess affect and dissociation 12 times per day over the course of one week in everyday life. During this time, heart and respiratory rates will be remotely monitored. Afterwards, participants will report affect and dissociative states eight times in the laboratory before, during, and after the Trier Social Stress Test. During the laboratory task, we will continuously record heart rate, electrodermal activity, and respiratory rate, as well as measure blood pressure and take salivary samples to determine cortisol levels. Our hypotheses will be tested using multilevel structural equation models. Power analyses determined a sample size of 85.
Discussion
The project will test key predictions of a transdiagnostic model of dissociation based on the idea that dissociative reactions are affect contingent and serve affect regulation functions. This project will not include non-clinical control participants. In addition, the assessment of dissociation is limited to pathological phenomena.
... Trauma models explain that dissociation is one of several possible protective and evolutionarily beneficial responses in extremely dangerous situations, and that the dissociative reaction pattern can repeat itself after traumatic threats when associated fear networks are activated (Schauer & Elbert, 2010; see Harricharan et al., 2020;Lanius et al., 2010 for a discussion of the neurological basis of dissociation). Importantly, it is believed that fear networks can become detached from contextual cues related to traumatic experiences, and dissociation can occur as an automatic response to a variety of perceived threats and daily stressors, not only those that are trauma related (Morgan et al., 2001). Once fear networks have become sensitized in this way, dissociation automatically appears as affective states reach a certain quality, for example, self-reported distress accompanied by increased levels of sympathetic nervous system activity. ...
... Our literature review suggests at least three potential moderatos. First, we expect patients who report more exposure to past trauma, the single most important etiological factor linked to dissociation, to report a stronger link between distress and dissociation because with higher exposure to past trauma fear networks are more likely to become detached from contextual cues (Morgan et al., 2001;Schauer & Elbert, 2010). ...
Background
Dissociation is a ubiquitous clinical phenomenon. Dissociative disorders (DD) are primarily characterized by dissociation, and dissociative states are also a criterion for borderline personality disorder (BPD) and the dissociative subtype of post-traumatic stress disorder (PTSD). Dissociative reactions across diagnostic categories are believed to be affect contingent and theorized to serve affect regulation functions. What is not clear, however, is how self-reported affect and physiological reactivity unfold within dissociative episodes. To address this issue, the present project aims to investigate the hypothesis (1) whether self-reported distress (as indicated by arousal, e.g., feeling tense/agitated, and/or valence, e.g., feeling discontent/unwell) and physiological reactivity increase before dissociative episodes and (2) whether self-reported distress and physiological reactivity decrease during and after dissociative episodes in a transdiagnostic sample of patients with DD, BPD, and/or PTSD.
Methods
We will use a smartphone application to assess affect and dissociation 12 times per day over the course of one week in everyday life. During this time, heart and respiratory rates will be remotely monitored. Afterwards, participants will report affect and dissociative states eight times in the laboratory before, during, and after the Trier Social Stress Test. During the laboratory task, we will continuously record heart rate, blood pressure, electrodermal activity, and respiratory rate, and take salivary samples to determine cortisol levels. Our hypotheses will be tested using multilevel structural equation models. Power analyses determined a sample size of 85.
Discussion
The project will test key predictions of a transdiagnostic model of dissociation based on the idea that dissociative reactions are affect contingent and serve affect regulation functions. • This project will not include non-clinical control participants. In addition, the assessment of dissociation is limited to pathological phenomena.
... Dissociative experiences were also correlated to depression in a sample of sexually abuse survivors [7], and it was also proven in a recent study among women suffering from fibromyalgia or rheumatoid arthritis [8]. A prospective investigation found that levels of stress are positively correlated to dissociation as well [9]. Anxiety was also found to be prevalent in dissociation, as the latter is transdiagnostically present in many anxiety disorders [10]. ...
... Dissociative symptoms are very frequently observed in healthy people exposed to a lot of stress. Dissociative states can be described as an acute and/or ephemeral reaction to stressful life events as well as interpersonal issues [9]. A review about the many faces of dissociation [83] adding more depth to the previous statement, also revealed that dissociation is the eventual response of a human to a certain chronic stress. ...
Background: Dissociative experiences are psychological manifestations characterized by a loss of connection and continuity between thoughts, emotions, environment, behavior, and identity. Lebanon has been facing indescribable events in the last few years, including the COVID-19 pandemic, the Beirut explosion, a crushing economic crisis with the highest inflation rate the country has known in over three decades. The aim of this study was to evaluate the correlation between dissociative experiences and post-traumatic stress symptoms from the economic crisis, the Beirut blast, the COVID-19 pandemic, and other mental health issues in a sample of Lebanese university students.
Methods: This cross-sectional study enrolled 419 active university students (18-35 years) from all over Lebanon (May and August 2021). The respondents received the online soft copy of a survey by a snowball sampling technique through social media and messaging apps. The questionnaire included sociodemographic data, the Dissociative Experience Scale (DES-II), the PTSD Checklist Specific Version (PCL-S), the Financial Wellbeing Scale, the Beirut Distress Scale, the Lebanese Anxiety Scale, the Patient Health Questionnaire.
Results: The two-factor model of the DES fitted best according to CFI, RMSEA and χ2/df values, but modestly according to TLI. The two factors were absorption and amnesia/depersonalization. Higher stress (Beta=0.95) and more PTSD from the Beirut blast (Beta=0.29) and from the economic crisis (Beta=0.23) were significantly associated with more absorption. A personal history of depression (Beta=6.03), higher stress (Beta=0.36) and more PTSD from the Beirut blast (Beta=0.27) and from the COVID-19 pandemic (Beta=0.16) were significantly associated with more amnesia/depersonalization.
Conclusion: Significant rates of dissociative experiences and their sub-manifestations (amnesia/depersonalization and absorption) were found among Lebanese university students, with remarkable co-occurrence of a traumatic/stressful pattern, whether on an individual (history of PTSD) or a collective level (Post-traumatic manifestations from Beirut blast, COVID-19 pandemic and/or economic crisis), or whether correlated to an acute single event or to certain chronic stressors, or even to a personal history of depression. Such findings must raise the attention to serious mental and psychosocial alteration in the Lebanese national identity.
... On one hand, maladaptive effects of dissociation on attentional and perceptual functions do not allow developing a complex and integrated mental representation of emotional-eliciting situation and related personal meanings (Foa and Hearst-Ikeda, 1996). On the other hand, the defensive mode associated to dissociative mechanisms sustains automatic and rigid threat appraisals of a wide range of emotional-eliciting situations (Morgan et al., 2001). ...
... Referring to significant associations with disengagement and aversive cognitive perseveration domains, dissociation could have two main functions within emotional functioning, namely non-deliberate avoidance and over-control of emotionally relevant situations and related reactions. These nonvoluntary mechanisms cause problematic effects on emotional functioning and adaption through: a) the reinforcement of inability to process emotional information, especially negative one (e.g., Frewen and Lanius, 2006a); b) interferences on emotional learning (e.g., Ebner--Priemer et al., 2009); c) fragmented and rigid threat appraisals of a wide range of emotional-eliciting situations (e.g., Morgan et al., 2001); d) alterations of emotional feeling (e.g., numbing Frewen and Lanius, 2006b). The reciprocal relationships between dissociation and maladaptive emotional regulation strategies are particularly expressed across different clinical conditions. ...
Objective:
Clinical and neurobiological models posited that dissociative mechanisms might affect processes involved in emotional generation and regulation. However, there is a lack of a comprehensive theoretical framework that systematically includes dissociation within emotional functioning.
Methods:
The current study aims at conducting a meta-analytic review on the relationship between dissociation and emotion regulation in order to empirically estimate to what extent dissociation is related to emotion regulation processes. The meta-analysis was based on r coefficient as effect size measure, using a random-effect approach.
Results:
The meta-analysis included 57 independent studies for a total of 11596 individuals. Findings showed an overall moderate relationship between dissociation and emotion regulation (rw = .32; p < .05). The association between dissociation and emotion regulation was the same among clinical samples than non-clinical ones. Furthermore, dissociation showed moderate to large relationships with maladaptive domains of emotion regulation, namely disengagement (rw = 0.34; p < .01) (i.e., behavioral avoidance, experiential avoidance, thought and emotional suppression) and aversive cognitive perseveration (rw = 0.38; p < .001) (i.e., rumination, worry and nonacceptance). The analysis did not find significant relationship between dissociation and adaptive domain of emotional regulation (i.e., problem solving, mindfulness).
Conclusion:
Dissociation in the context of emotion regulation might be viewed as a basic neuro-mental mechanism that automatically contribute to the over-modulation of emotional states through avoidance reactions from internal and external reality. Future longitudinal studies are needed to clarify the causal relationships between dissociation and emotion regulation.
... As in previous literature, authors have found that traumatization or extreme stress, for example, a high level of perceived stress, proportionally increases the number of dissociation symptoms [24][25][26][27]. This does not necessarily mean that the increased number of dissociative symptoms are due to the stress the students are currently experiencing, but it is conceivable that the stress they have experienced in the past will add up to the situations they are currently experiencing [28]. ...
... This does not necessarily mean that the increased number of dissociative symptoms are due to the stress the students are currently experiencing, but it is conceivable that the stress they have experienced in the past will add up to the situations they are currently experiencing [28]. It can also mean that they can respond to stressful situations in a variety of ways and the way the students used in our study, is the dissociation to cope with harmful situations [25]. Where this will lead in the future, whether it will develop into a psychiatrically relevant illness, we cannot be sure. ...
Background: The findings of previous literature showed that epidemics and the associated control measures can increase the level of stress experienced by people. The phenomenon of dissociation has been investigated by many studies, and some have found that stress and trauma may play a central role in its development. In our research study, we examined the effect of COVID-19 lockdown on the mental health of students at the University of Debrecen in Hungary. We investigated whether or not the changes caused by the pandemic induced stress among students and whether or not it was accompanied by an increase in the number of dissociative experiences.
Methods: A questionnaire-based cross-sectional study was conducted at the University of Debrecen in Hungary in the period April 30 - May 15, 2020, to assess levels of perceived stress as well as dissociative experiences among students at the time of the official nationwide lockdown. Our survey has adopted the Perceived Stress Scale (PSS) and the Dissociative Experiences Scale (DES). A total of 1320 students have enrolled in our study.
Results: Our results showed a high level of perceived stress among the students during the pandemic and lockdown. This elevation was found to have a significant correlation with the emergence of dissociative experiences among both the Hungarian and the international students. Also, these changes were significant among males and females and in all subscales. Female students’ levels of dissociative experiences were higher than of male students on all subscales and in both groups (Hungarian and international).
Conclusion: According to our findings, the COVID-19 pandemic, and the quarantine situation increased the perceived stress level which has played a significant role in the development of dissociative experiences among the students. The increased frequency of dissociative experiences entails a higher risk to the appearance of dissociative disorders; thus, it is crucial to create a safety net for university students who are susceptible to high levels of stress.
... Such trauma exposure could include surviving a natural disaster, childhood physical abuse, sexual abuse, or physical assault. These types of events may exacerbate acute stress responses, 19 predict cognitive impairment 20 and poor physical health, 21 and disrupt pain processing. 22 It is, therefore, conceivable that trauma exposure may influence FM characteristics in tactical athletes. ...
... Trauma exposure was inversely associated with FM characteristics in our participants, which demonstrates that the movement competency and dynamic balance of this population were diminished with increasing exposure to traumatic experiences or events. We anticipated this in light of research linking psychological factors to movement characteristics in sport athletes and trauma exposure to acute stress reactions, 19 physical health, 21 and pain. 22 As alluded to earlier, self-reported fear predicted physical performance in participants returning to sport after surgery, 15 and psychological distress was linked to injury prevalence in adult populations. ...
Context
Tactical athletes commonly experience high levels of physical stress, which may increase their risk of musculoskeletal injury. It is critical to understand psychological predictors of functional movement (FM), which may help prevent musculoskeletal injury in this population.
Objective
To determine the associations of combat and trauma exposure with FM characteristics of male tactical athletes. Secondary objectives were to explore confounding influences of age and physical injury history as well as the mediating role of bodily pain.
Design
Cross-sectional study.
Setting
Research laboratory.
Patients or Other Participants
Eighty-two healthy, male, active-duty US Navy Explosive Ordnance Disposal personnel (age = 34.0 ± 6.7 years).
Main Outcome Measure(s)
Participants completed measures of combat exposure, trauma exposure, physical injury history, and bodily pain. We assessed FM characteristics (ie, Functional Movement Screen [FMS], Y-Balance Test), from which we derived a composite functional status (CFS) measure. Hypotheses were tested using correlational and multiple regression (causal-steps) models.
Results
In unadjusted models, trauma exposure was inversely associated with the FMS ( P = .005) and CFS ( P = .009) scores. In adjusted models, these relationships were robust to the confounding influences of age and physical injury history. Trauma exposure and bodily pain were substantive, independent predictors of FMS and CFS in causal-steps models (all P values < .05), implying additive rather than mediated effects ( R ²adj = 0.18–0.20). Combat exposure did not predict FM characteristics.
Conclusions
To our knowledge, this is the first evidence of the influence of trauma exposure on the FM characteristics of male tactical athletes, independent of age, physical injury, and bodily pain. This program of research may help to advance the prevention and treatment of musculoskeletal injuries in the tactical environment.
... To assess trauma exposure (present/absent), we used a 16-item modified version of the Brief Trauma Questionnaire (Morgan et al., 2001), in which participants reported history of lifetime traumatic exposure to each of fifteen specified events (e.g., serious accident, natural disaster) and a serious event not otherwise specified. Participants also identified which event was their first and which was their worst event, as well as their age at occurrence of first and worst events. ...
... Time-invariant covariates included race/ ethnicity (defined as White, not White; 1989 questionnaire); region of birth (Northeast, West, Midwest, South, and Puerto Rico/non-US; 1993); childhood socioeconomic status based on the highest educational attainment of parents at birth (≤3 years of college or ≥4 years of college; 2005). Time-varying covariates were updated at each questionnaire where the question was asked, including age; living arrangements (living with a spouse/partner, living with someone other than a spouse/partner, and living alone ; 1993, 2001, 2005, and 2009 questionnaire); and lifetime history of depression, considered present if women reported use of antidepressants (ascertained biennially beginning in 1993, except 1995 and 2001), physician-diagnosed depression (reported biennially beginning in 2003), or scored <60 on the 5-item Mental Health Inventory, administered in 1993, 1997, and 2001(Yamazaki et al., 2005. Information on living arrangements and depression in 1993 was carried backward to 1989 since these variables were not assessed at the earlier time point. ...
Background
Individuals with posttraumatic stress disorder (PTSD) are at increased risk of various chronic diseases. One hypothesized pathway is via changes in diet quality. This study evaluated whether PTSD was associated with deterioration in diet quality over time.
Methods
Data were from 51 965 women in the Nurses' Health Study II PTSD sub-study followed over 20 years. Diet, assessed at 4-year intervals, was characterized via the Alternative Healthy Eating Index-2010 (AHEI). Based on information from the Brief Trauma Questionnaire and Short Screening Scale for DSM-IV PTSD, trauma/PTSD status was classified as no trauma exposure, prevalent exposure (trauma/PTSD onset before study entry), or new-onset (trauma/PTSD onset during follow-up). We further categorized women with prevalent exposure as having trauma with no PTSD symptoms, trauma with low PTSD symptoms, and trauma with high PTSD symptoms, and created similar categories for women with new-onset exposure, resulting in seven comparison groups. Multivariable linear mixed-effects spline models tested differences in diet quality changes by trauma/PTSD status over follow-up.
Results
Overall, diet quality improved over time regardless of PTSD status. In age-adjusted models, compared to those with no trauma, women with prevalent high PTSD and women with new-onset high PTSD symptoms had 3.3% and 3.6% lower improvement in diet quality, respectively, during follow-up. Associations remained consistent after adjusting for health conditions, sociodemographics, and behavioral characteristics.
Conclusions
PTSD is associated with less healthy changes in overall diet quality over time. Poor diet quality may be one pathway linking PTSD with a higher risk of chronic disease development.
... The immediate effects of peritraumatic dissociation are likely adaptive, in that they protect the individual from intense negative emotional states, such as helplessness and fear. However, in the long-term, dissociation is maladaptive, increasing the risk of PTSD (Eisen & Lynn, 2001;Lensvelt-Mulders et al., 2008;Morgan et al., 2001). Much of the research on peritraumatic dissociation has considered it in relation to being the victim of violence (e.g., Schauer & Elbert, 2010), although it has also been associated with the commission of violent crimes, especially reactive violence (McLeod, Byrne, & Aitken, 2004;Moskowitz, 2004). ...
... For example, as expected, dissociation at the time of the event was associated with increased PTSD symptoms. This result is in line with literature that has shown a strong association between dissociation and PTSD symptoms (Eisen & Lynn, 2001;Morgan et al., 2001). Also as expected, committing a violent offense against someone the participant cared about (i.e., a friend or family member) resulted in stronger PTSD symptoms than violence against a stranger or acquaintance. ...
Incarcerated offenders are more likely to experience Posttraumatic Stress Disorder (PTSD) and associated symptoms than the general population. PTSD may develop from a variety of events, including being a victim of violence, witnessing violence, or from committing a violent offense. This study examined symptoms and predictors of PTSD in 150 male violent offenders. Participants recalled acts of reactive and instrumental violence, poorly recalled violence, and subjectively disturbing events (e.g., victim of violence), and rated each event for symptoms of PTSD using the Impact of Events Scale (IES). Subjectively disturbing events were associated with higher IES scores than the acts of violence. Hierarchical linear modeling showed that more recent events were associated with a greater number of trauma symptoms and peritraumatic dissociation was positively associated with trauma symptoms. As well, trauma symptoms were more likely to develop if the victim was a family member or a friend, as compared to a stranger or acquaintance. These results support the need for trauma-informed assessment and treatment for offenders. Knowing more about the predictors of trauma symptoms is a first step in effectively treating PTSD in this population.
... La redacción de los items es más sencilla y menos redundante, para disminuir la correlación entre el nivel de inteligencia y la puntuación en el DES, además de usar un formato de respuesta de 5 puntos, en lugar de los 11 que utiliza el DES. Mayer y Farmer (2003) corroboraron las buenas propiedades psicométricas de la CES, amén de diseñar un nuevo instrumento, la Scale of Dissociative Activities (SODAS). Además de demostrar su buena confiabilidad y validez, los autores correlacionaron la SODAS con la ténica de muestreo de la experiencia (Experiential Sampling Methodology) en la que usaron búsquedas electrónicas para evaluar al azar las experiencias disociativas de las personas. ...
... Un cuestionario más elaborado de estados disociativos es el Clinician-Administered Dissociative States Scale (CADSS), que consta de 19 items para que la persona conteste y 8 para que el clínico mencione sus observaciones. Este instrumento posee buenos índices de fiabilidad entre distintos evaluadores y de validez demostrada por su comparación con el DES y el SCID-D y su capacidad para diferenciar pacientes con TD de otros pacientes y de personas sin diagnóstico (Bremner et al., 1998); también muestra validez predictiva (Morgan et al., 2001). Una escala para estados de disociación que aparentemente se ha usado sólo en una publicación es la State Scale of Dissociation (SSD), con 56 items que miden el estado disociativo justo en el momento en que la persona lo contesta. ...
Este artículo está enfocado en la evaluación de trastornos disociativos en menores y adultos. La evaluación de los trastor-nos disociativos (TD)incluye objetivos clínicos y de investigación. En este último campo se in-cluyen áreas como la epidemiología de los TD en muestras clínicas y no clínicas, su presencia y manifestación en diversas eda-des, la comorbilidad de los TD con otros trastornos, y el efecto de las variables culturales. Se hace una reseña de diversos instrumentos tales como entrevistas estructuradas, cuestionarios y otras formas de evaluación más especializadas.
... A large body of literature has demonstrated that captivity survival training elicits significant but reversible increases in subjective stress, stress hormone levels, and reductions in psychological performance in trainees [21,23,29,30,31,33,34,35,46,48,49]. In contrast, little is known about the effects of the delivery of this type of training on their instructors. ...
... This suggests that the job requirements of delivering captivity survival training might generate maladaptive levels of stress in instructors, in turn, impairing their psychological function. Second, previous research demonstrates 1 The CTQ cut-offs for each subscale are based the ranges reported in the scoring that students undergoing captivity survival training experience acute and high levels of stress ( [21,23]; [29,30,31,33,34,35,46,48]). Because, as deliverers of such training, instructors must perform their duties which are stressful with high fidelity (e.g., convincing portrayal of the "enemy aggressor" role during intense mock interrogations), the possibility exists that they too might be susceptible to stress due to the unique aspects of their jobs. ...
Numerous studies have examined the effects of captivity survival training on psychological and physiological function in trainees. In the present study we shifted the focus to instructors, and measured the effects that the delivery of training exerts on their levels of stress and performance. Because instructors are called upon to perform difficult duties (e.g., mock interrogations) under extreme conditions, we hypothesized that significant increases in psychological and physiological indices of stress would occur due to training. In addition, as part of their job tasking, the instructors conducted courses in consecutive weeks. This offered a unique and ecologically valid opportunity to assess carryover of stress from one week to the next. We hypothesized stress levels would be higher in the second than the first week of training. Our first hypothesis was supported: Delivering training was associated with impairments in mood, fatigue, and sleep, as well as a reduction in the ratio of testosterone/cortisol level in blood. Our second hypothesis was largely not supported as a 3-day break separating consecutive courses appeared sufficient for restoring psychological and physiological function. Our results demonstrate that although the delivery of training exerts negative effects on instructors' levels of stress, the 3-day recovery period separating consecutive courses is sufficient to return psychological and physiological function to baseline levels.
... To ask about trauma history, coping strategies and psychosocial resources during encounters may inform clinicians how to provide more targeted interventions given links between psychosocial adaptation to uncontrollable stress and physical and mental health. 48 Yet there are unmet needs to promote environments where posttraumatic growth can occur. 49 Considerations include support for clinical care teams to recognise trauma and stressors, as well as access to experts in mental and social health services who can help address these factors and strengthen psychosocial resources for individuals with SLE. ...
Objective
Trauma history is associated with SLE onset and worse patient-reported outcomes; perceived stress is associated with greater SLE disease activity. Stress perceptions vary in response to life events and may be influenced by psychosocial factors. In an SLE cohort, we examined whether stressful events associated with perceived stress, whether psychosocial factors affected perceived stress, and whether these relationships varied by prior trauma exposure.
Methods
This is a cross-sectional analysis of data from the California Lupus Epidemiology Study, an adult SLE cohort. Multivariable linear regression analyses controlling for age, gender, educational attainment, income, SLE damage, comorbid conditions, glucocorticoids ≥7.5 mg/day and depression examined associations of recent stressful events (Life Events Inventory) and positive (resilience, self-efficacy, emotional support) and negative (social isolation) psychosocial factors with perceived stress. Analyses were stratified by lifetime trauma history (Brief Trauma Questionnaire (BTQ)) and by adverse childhood experiences (ACEs) in a subset.
Results
Among 242 individuals with SLE, a greater number of recent stressful events was associated with greater perceived stress (beta (95% CI)=0.20 (0.07 to 0.33), p=0.003). Positive psychosocial factor score representing resilience, self-efficacy and emotional support was associated with lower perceived stress when accounting for number of stressful events (−0.67 (−0.94 to –0.40), p<0.0001); social isolation was associated with higher stress (0.20 (0.14 to 0.25), p<0.0001). In analyses stratified by BTQ trauma and ACEs, associations of psychosocial factors and perceived stress were similar between groups. However, the number of recent stressful events was significantly associated with perceived stress only for people with BTQ trauma (0.17 (0.05 to 0.29), p=0.0077) and ACEs (0.37 (0.15 to 0.58), p=0.0011).
Conclusion
Enhancing positive and lessening negative psychosocial factors may mitigate deleterious perceived stress, which may improve outcomes in SLE, even among individuals with a history of prior trauma who may be more vulnerable to recent stressful events.
... Because of the design of our study, it was not possible to collect accurate ratings for the 8 observer items. Therefore, only the self-report items were administered (see also Morgan et al., 2001). A sample item is "Do you feel as if you are watching the situation as an observer or spectator?" ...
Recent research has shown that dissociative symptoms are related to self-reports of deviant sleep experiences. The present study is the 1st to explore whether sleep loss can fuel dissociative symptoms. Twenty-five healthy volunteers were deprived of sleep for 1 night. Sleepiness and dissociative symptoms were assessed every 6 hr. The authors measured both spontaneous dissociative symptoms and dissociative symptoms induced by dot-staring during sensory deprivation. Sleepiness as well as spontaneous and induced dissociative symptoms were stable throughout the day but increased during the night. These findings provide further evidence for a robust relationship between disruptions in sleep patterns and dissociative symptoms.
... In 2008, women reported lifetime exposure to 15 traumatic events and any other traumatic event not listed from a modified version of the Brief Trauma Questionnaire (Morgan et al., 2001;Schnurr, Vielhauer, Weathers, & Findler, 1999). Trauma-exposed women were asked to indicate their worst event. ...
Background:
Post-traumatic stress disorder (PTSD) is associated with cognitive impairments. It is unclear whether problems persist after PTSD symptoms remit.
Methods:
Data came from 12 270 trauma-exposed women in the Nurses' Health Study II. Trauma and PTSD symptoms were assessed using validated scales to determine PTSD status as of 2008 (trauma/no PTSD, remitted PTSD, unresolved PTSD) and symptom severity (lifetime and past-month). Starting in 2014, cognitive function was assessed using the Cogstate Brief Battery every 6 or 12 months for up to 24 months. PTSD associations with baseline cognition and longitudinal cognitive changes were estimated by covariate-adjusted linear regression and linear mixed-effects models, respectively.
Results:
Compared to women with trauma/no PTSD, women with remitted PTSD symptoms had a similar cognitive function at baseline, while women with unresolved PTSD symptoms had worse psychomotor speed/attention and learning/working memory. In women with unresolved PTSD symptoms, past-month PTSD symptom severity was inversely associated with baseline cognition. Over follow-up, both women with remitted and unresolved PTSD symptoms in 2008, especially those with high levels of symptoms, had a faster decline in learning/working memory than women with trauma/no PTSD. In women with remitted PTSD symptoms, higher lifetime PTSD symptom severity was associated with a faster decline in learning/working memory. Results were robust to the adjustment for sociodemographic, biobehavioral, and health factors and were partially attenuated when adjusted for depression.
Conclusion:
Unresolved but not remitted PTSD was associated with worse cognitive function assessed six years later. Accelerated cognitive decline was observed among women with either unresolved or remitted PTSD symptoms.
... 97 Accordingly, these neural responses might also suggest key alterations of threat appraisal of a wide range of emotional-eliciting situations, which have been associated with maladaptive effects of dissociative processes. 98 Ultimately, the current meta-analysis provides a provisional neurobiological support for growing evidence related to the distinction between complex PTSD and PTSD. 99 Dissociative disorders Meta-analytic results showed that individuals with DDs highlighted an increased neural response to emotional stimuli compared with control conditions, which was similar to individuals with PTSD-IT. ...
Aim:
Departing from existing neurobiological models of dissociation, the current study aims at conducting a quantitative meta-analytic review of neural responses to emotional stimuli among individuals ascribed to the dissociative spectrum (DS). Accordingly, the study explored common and specific brain mechanisms across borderline personality disorder, conversion/somatoform disorders, post-traumatic stress disorder [PTSD], PTSD related to repeated interpersonal traumatic experiences, dissociative disorders.
Methods:
The meta-analysis included studies that administered emotional stimuli during fMRI acquisition among individuals included in the DS. There were conducted 2 meta-analytic procedures: i) a Bayesian network meta-analysis for a region-of-interest (ROI)-based approach; ii) robust voxel-based approach.
Results:
Forty-four independent studies were included for a total of 1384 individuals (DS = 741 subjects). The network meta-analysis showed specific patterns of neural activity considering an extended brain network involved in emotion regulation for each condition ascribed to the DS. The voxel-based meta-analysis highlighted an increased activity of dorsal anterior cingulate cortex as a common neurological signature of the DS.
Conclusion:
The common neural feature of the DS captures an implicit appraisals of emotion-eliciting stimuli as threatening and/or noxious for mental and physical integrity of the individual together with painful subjective experiences associated to physiological emotional reactions. Specific brain responses across the DS suggested that the engagement in different mechanisms to address emotional stimuli - implicit avoidance reactions and attempts to over-control of affective states together with a disruption of integrative processes of emotional mind-body features. This article is protected by copyright. All rights reserved.
... If dissociative symptoms can be fueled by a labile sleep-wake cycle, then sleep loss would be expected to intensify dissociative symptoms (Morgan et al. 2001;Giesbrecht, et al., 2007). ...
The fragmented sleep, fragmented mind hypothesis has associated sleep disturbances and dissociative states in subjects with dissociative traits, as supported by neurophysiological theories of consciousness stating that altered states might result from an altered functional interaction among brain modules due to inefficient sleep processes.
Irrespective of dissociative traits, it is conceivable that a labile sleep-wake cycle might fuel dissociative states such as derealization, depersonalization, and dissociative amnesia.
To verify whether acute sleep loss can prompt dissociative states and to identify possible psychophysiological correlates, we evaluated dissociative experiences (by means of Phenomenology of Consciousness Inventory and Clinician Administered Dissociative State Scale) and resting state EEG features (band-wise spectral content and phase synchronization) after total sleep deprivation.
After deprivation, participants reported increased perception of altered state of consciousness and dissociative experiences, and a decreased perception of cognitive control. Analyzing the psychophysiological correlates of dissociative states following deprivation, we observed the following results: the higher the prefrontal theta spectral content, the higher the depersonalization state and the lower the self-awareness; the higher the intensity of the dissociative experiences, the higher the synchronization increase in alpha, beta, and gamma bands; the higher the decrease of higher-order functions, the higher the synchronization in the aforementioned bands.
Thus, acute sleep deprivation appears to fuel dissociative experiences by establishing a state of consciousness promoted by a higher large-scale synchronization at high frequencies.
... Other Trauma Experiences. Twenty-two of the 45 studies conceptualized trauma across the life course beyond interpersonal trauma, using the 16-item modified version of the Brief Trauma Questionnaire (Morgan et al., 2001;Sumner et al., 2020). In these studies, additional "very or events" that did not appear in the inventory were typically documented as well as which event happened first and which was the most distressing. ...
Objective
To synthesize research on interpersonal trauma and women’s health from the Nurses’ Health Study II (NHS II) and to analyze conceptualization of interpersonal trauma across studies.
Data Sources
A literature review was conducted in PubMed using a systematic search strategy.
Study Selection
Articles were included in the review if they used data from the NHS II and involved investigations of interpersonal trauma. Theoretical articles, methodologic articles, and other literature reviews involving the NHS II were excluded. Initially, the search returned 61 articles. After exclusions, 45 articles met the criteria for inclusion in the review and data extraction.
Data Extraction
Information was extracted and consolidated in an evidence table. Data included study time frame, sample, definition of trauma, outcomes studied, and journal of publication.
Data Synthesis
Trauma was not operationalized consistently across studies, even though the NHS II assessed trauma experiences in childhood, adolescence, and adulthood. Most investigations focused on childhood abuse, with investigations of childhood sexual abuse overrepresented in comparison to other abuse experiences. Authors conducting studies of trauma at any time in the life course consistently found a negative association with physical and mental health outcomes, which were increased by the presence of posttraumatic stress symptoms. Results from a small number of studies suggested a negative intergenerational impact of trauma on the children of women in the NHS II.
Conclusion
Interpersonal trauma across the life course was strongly associated with many leading causes of morbidity and mortality among female nurses. Trauma conceptualization and operationalization varied across studies, and future investigations should leverage the full range of trauma measures available in the NHS II data set.
... Lifetime history of sexual violence was assessed in 2008 using 2 of the 16 items from the modified Brief Trauma Questionnaire. 43,44 Women indicated whether they had ever experienced workplace sexual harassment ("Ever experienced sexual harassment at work that was either physical or verbal?") and/or sexual assault in any domain ("Ever been made or pressured into having some type of unwanted sexual contact? Note: By sexual contact we mean any contact between someone else and your private parts or between you and someone else's private parts."). ...
Background
Hypertension is a prevalent condition in women and an important modifiable risk factor for cardiovascular disease. Despite women’s experiences of sexual violence being common, no prospective studies have examined lifetime sexual assault and workplace sexual harassment in relationship to hypertension in large civilian samples with extended follow‐up. Here, we examined whether these experiences were prospectively associated with greater risk of developing hypertension over 7 years.
Methods and Results
Data are from a substudy of the Nurses’ Health Study II and include women free of hypertension at the time of sexual assault and workplace sexual harassment assessment in 2008 (n=33 127). Hypertension was defined as self‐reported doctor diagnosis or initiating antihypertensive medication use, assessed biennially through 2015. We performed Cox proportional hazards regression models to predict time to developing hypertension associated with sexual violence exposure, adjusting for relevant covariates. Over follow‐up, 7096 women developed hypertension. Sexual assault and workplace sexual harassment were prevalent (23% and 12%, respectively; 6% of women experienced both). Compared with women with no exposure, women who experienced both sexual assault and workplace sexual harassment had the highest risk of developing hypertension (hazard ratio [HR], 1.21; 95% CI, 1.09–1.35), followed by women who experienced workplace sexual harassment (HR, 1.15; 95% CI, 1.05–1.25) and then by women who experienced sexual assault (HR, 1.11; 95% CI, 1.03–1.19), after adjusting for relevant covariates.
Conclusions
Sexual assault and workplace sexual harassment are prospectively associated with greater risk of hypertension. Reducing such violence is important in its own right and may also improve women’s cardiovascular health.
... Lifetime psychological trauma exposure was measured in 2018 with a 16-item modified version of the Brief Trauma Questionnaire (Morgan et al., 2001;Schnurr et al., 1999). Participants indicated whether they had experienced any traumatic event and which event they considered the worst. ...
Background
Despite evidence linking posttraumatic stress disorder (PTSD), depression, and head injury, separately, with worse cognitive performance, investigations of their combined effects on cognition are limited in civilian women.
Methods
The Cogstate Brief Battery assessment was administered in 10,681 women from the Nurses' Health Study II cohort, mean age 64.9 years (SD = 4.6). Psychological trauma, PTSD, depression, and head injury were assessed using online questionnaires. In this cross-sectional analysis, we used linear regression models to estimate mean differences in cognition by PTSD/depression status and stratified by history of head injury.
Results
History of head injury was prevalent (36%), and significantly more prevalent among women with PTSD and depression (57% of women with PTSD and depression, 21% of women with no psychological trauma or depression). Compared to having no psychological trauma or depression, having combined PTSD and depression was associated with worse performance on psychomotor speed/attention ( = −.15, p = .001) and learning/working memory ( = −.15, p < .001). The joint association of PTSD and depression on worse cognitive function was strongest among women with past head injury, particularly among those with multiple head injuries.
Conclusions
Head injury, like PTSD and depression, was highly prevalent in this sample of civilian women. In combination, these factors were associated with poorer performance on cognitive tasks, a possible marker of future cognitive health. Head injury should be further explored in future studies of PTSD, depression and cognition in women.
... Peritraumatic dissociative experiences have been widely examined in the context of acute stress (Birmes et al., 2003;Nöthling, Lammers, Martin, & Seedat, 2015). Giesbrecht, Smeets and Merckelbach (2008b) and other researchers (e.g., Leonard, Telch, & Harrington, 1999;Morgan et al., 2001;Sterlini & Bryant, 2002), suggest that peritraumatic dissociative experiences may be common, non-pathological responses to acute stress. Although it has often been proposed that dissociation functions protectively against the overwhelming experience of trauma (Schimmenti & Caretti, 2016), it has also been argued that peritraumatic dissociation may have negative, long-term consequences, either by becoming a long term strategy used in even minor stressors (Badura, Reiter, Altmaier, Rhomberg, & Elas, 1997), or by predisposing to the development of post traumatic stress disorder (PTSD; Birmes et al., 2003;Nöthling et al., 2015). ...
Acute pain can trigger reactions related to acute stress. Such reactions may also include peritraumatic dissociative symptoms. The aim of this experimental study was threefold: (a) to examine which type of dissociation symptoms (DiSym) are associated with acute pain, (b) to assess how DiSym affect pain tolerance, intensity and psychophysiological response and, (c) to evaluate the effect of prior DiSym on the development of further symptoms of dissociation and on pain. A dissociation group (DG) underwent dissociation induction through audio photic stimulation prior to exposure to a painful stimulus (cold water immersion) whereas a control group (CG) underwent exposure only to the painful stimulus. All participants were undergraduate psychology students invited through announcements (47 women, 6 men. Mean age = 21, SD = 1.4). State and peritraumatic dissociation symptoms were assessed; pain was assessed through a visual analogue scale, and tolerance through total immersion time. We found that acute pain was related to somatoform DiSym in both groups (p < .001, η² = .39). Participants in the DG reported more psychological and state DiSym and exhibited lower pain tolerance (p = .001, d = .82) than CG participants, as well as significant heart rate increase during cold water immersion (p < .001, d = .77). We conclude that certain forms of DiSym may emerge spontaneously in response to acute pain. A detrimental effect on pain intensity/ tolerance was associated to prior symptoms of dissociation. Moreover, DiSym induced prior to exposure to pain may contribute to the development of further dissociation symptoms. Thus, dissociation screening in all pain conditions may improve clinical interventions’ efficacy.
... Dissociation is the ability to disconnect from one's sensory experiences and is often employed during traumatic events. Men undergoing the same training in a separate study (Morgan et al., 2001) had a similar, albeit slightly higher, prevalence of reported symptoms of dissociation compared with women (96 versus 88 %). Women, however, experienced a stronger relationship between dissociation symptoms induced by stress and post-stress health symptoms (r = 0.76) than men (r = 0.54). ...
Combat roles are physically demanding and expose service personnel to operational stressors such as high levels of physical activity, restricted nutrient intake, sleep loss, psychological stress, and environmental extremes. Women have recently integrated into combat roles, but our knowledge of the physical, physiological, and psycho-cognitive responses to these operational stressors in women is limited. The aim of this narrative review was to evaluate the evidence for sex-specific physical, physiological, and psycho-cognitive responses to real, and simulated, military operational stress. Studies examining physical and cognitive performance, body composition, metabolism, hypothalamic-pituitary-gonadal axis, and psychological health outcomes were evaluated. These studies report that women expend less energy and lose less body mass and fat-free mass, but not fat mass, than men. Despite having similar physical performance decrements as men during operational stress, women experience greater physiological strain than men completing the same physical tasks, but this may be attributed to differences in fitness. From limited data, military operational stress suppresses hypothalamic-pituitary-gonadal, but not hypothalamic-pituitary-adrenal, axis function in both sexes. Men and women demonstrate different psychological and cognitive responses to operational stress, including disturbances in mood, with women having a higher risk of post-traumatic stress symptoms compared with men. Based on current evidence, separate strategies to maximize selection and combat training are not warranted until further data directly comparing men and women are available. However, targeted exercise training programs may be advisable to offset the physical performance gap between sexes and optimize performance prior to inevitable declines caused by intense military operations.
... Dissociation is the ability to disconnect from one's sensory experiences and is often employed during traumatic events. Men undergoing the same training in a separate study (Morgan et al., 2001) had a similar, albeit slightly higher, prevalence of reported symptoms of dissociation compared with women (96 versus 88 %). Women, however, experienced a stronger relationship between dissociation symptoms induced by stress and post-stress health symptoms (r = 0.76) than men (r = 0.54). ...
PURPOSE
To study the impact of 48 h of simulated military operational stress (SMOS) on executive function, in addition to the role of trait resilience (RES) and aerobic fitness (FIT) on executive function performance. Associations between executive function and neuropeptide-Y (NPY), brain-derived neurotropic factor (BDNF), insulin-like growth factor-I (IGF-I), oxytocin, and α-klotho (klotho) were assessed to elucidate potential biomarkers that may contribute to cognitive performance during a multi-factorial stress scenario.
METHODS
Fifty-four service members (SM) (26.4 ± 5.4 years, 178.0 ± 6.5 cm, 85.2 ± 14.0 kg) completed the 5-day protocol, including daily physical exertion and 48 h of restricted sleep and caloric intake. Each morning subjects completed a fasted blood draw followed by Cognition, a 10-part cognitive test battery assessing executive function. SMs were grouped into tertiles [low (L-), moderate (M-), high (H-)] based Connor Davidson Resilience Score (RES) and V˙O2peak (FIT). Repeated measures ANOVA were run to analyze the effect of day on cognitive performance and biomarker concentration. Separate two-way mixed ANOVAs were run to determine the interaction of group by day on cognitive function. Friedman test with Bonferroni-corrected pairwise comparisons were used if assumptions for ANOVA were not met. Associations between changes in biomarkers and cognitive performance were analyzed using parametric and non-parametric correlation coefficients.
RESULTS
SMOS reduced SM vigilance –11.3% (p < 0.001) and working memory –5.6% (p = 0.015), and increased risk propensity +9.5% (p = 0.005). H-RES and H-FIT SMs demonstrated stable vigilance across SMOS (p > 0.05). Vigilance was compromised during SMOS in L- and M-RES (p = 0.007 and p = 0.001, respectively) as well as L- and M-FIT (p = 0.001 and p = 0.031, respectively). SMOS reduced circulating concentrations of α-klotho -7.2% (p = 0.004), NPY -6.4% (p = 0.001), and IGF-I -8.1% (p < 0.001) from baseline through the end of the protocol. BDNF declined –19.2% after the onset of sleep and caloric restriction (p = 0.005) with subsequent recovery within 48 h. Oxytocin remained stable (p > 0.05). Several modest associations between neuroendocrine biomarkers and cognitive performance were identified.
CONCLUSION
This study demonstrates H-FIT and H-RES may buffer the impact of SMOS on vigilance. SMOS negatively impacted circulating neuroendocrine biomarkers. While BDNF returned to baseline concentrations by the end of the 5 d protocol, NPY, IGF-I, and α-klotho may require a longer recovery period.
... In 2008, women reported their lifetime trauma exposure and PTSD symptoms. Lifetime trauma exposure was measured with the modified Brief Trauma Questionnaire (27), which included 16 traumatic events (e.g., sexual harassment, accidents, sudden death of a loved one), along with an open-ended prompt (any other serious event). Women indicated whether they had ever experienced each event, which event(s) represented their first and worst trauma(s), and the ages these traumas occurred. ...
Background:
Posttraumatic stress disorder (PTSD) is associated with higher risk of certain chronic diseases, including ovarian cancer, but underlying mechanisms remain unclear. Although prior work has linked menopausal hormone therapy (MHT) use with elevated ovarian cancer risk, little research considers PTSD to likelihood of MHT use. We examined whether PTSD was prospectively associated with greater likelihood of initiating MHT use over 26 years.
Methods:
Using data from the Nurses' Health Study II, with trauma and PTSD (symptoms and onset date) assessed by screener in 2008 and MHT assessed via biennial survey (from 1989), we performed Cox proportional regression models with women contributing person-years from age 36 years. Relevant covariates were assessed at biennial surveys. We considered potential effect modification by race/ethnicity, age at baseline, and period (1989-2002 vs. 2003-2015).
Results:
Over follow-up, 22,352 of 43,025 women reported initiating MHT use. For example, compared with women with no trauma, the HR for initiating MHT was 1.18 for those with trauma/1-3 PTSD symptoms [95% confidence interval (CI), 1.13-1.22] and 1.31 for those with trauma/4-7 PTSD symptoms (95% CI, 1.25-1.36; P trend < 0.001), adjusting for sociodemographic factors. Associations were maintained when adjusting for reproductive factors and health conditions. We found evidence of effect modification by age at baseline.
Conclusions:
Trauma and number of PTSD symptoms were associated with greater likelihood of initiating MHT use in a dose-response manner.
Impact:
MHT may be a pathway linking PTSD to altered chronic disease risk. It is important to understand why women with PTSD initiate MHT use.
... In the first Art Therapy session, clients were observed to be very apprehensive and exhibited varied degrees of attitudinal and emotional inconsistencies due to trauma (Buchalter, 2004). Morgan et al. (2001) posited that in stressful conditions, low dissociative reactions are experienced by victims. No wonder then that they saw the researchers as intruders into their world. ...
Management of traumatized rescued victims of human trafficking has become a challenge to the personnel of AntiHuman Trafficking Unit of the Ghana Police Service who handle victims of trauma due to trafficking. Premised on the
fact that such victims do express varied trauma dispositions whiles in police facilities that required professional service
of counselling to address the emotional instability caused by trauma through trafficking. This position, constrain police
actions and cooperation needed from victims to have a conclusive investigation becomes a mirage. The study aimed at
using Art Therapy of drawing as an intervention to mitigate the trauma experienced by these victims so as to facilitate
their emotional health recovery and reintegration. Qualitative research method was used basically to gather data. Forty
rescued human trafficked victims were identified and offered sessions of Art Therapy. The results revealed that art or
drawing has the ability to offer a means of non-verbal communication, where verbal communication is hard or painful.
Besides, the art therapy sessions enhanced the release of buried emotions which are linked to their traumatic experiences
through their drawings and this quickened their emotional healing and stability.
... For example, in their 2011 study of older adults, researchers from the University of South Florida found that "perceived stress was a stronger predictor of depression in late adulthood" (Kwag, Martin, Russell, Franke, & Kohut, 2011). Another study found that the presence of stress was associated with symptoms of peritraumatic dissociation, a precursor to post-traumatic stress disorder (Morgan et al., 2001). Additional studies that have taken a public health approach to examining the relationship between stress and mental health were conducted outside of the United States (Ni et al., 2016). ...
Background: Mental illness affects approximately 1 in 5 Americans, making mental health an important area of study for public health. Much research has been conducted on two of the most prevalent mental health disorders, anxiety and depression. However, the association of stress with these disorders, especially specific types of stress (e.g., financial, health, relationship), has been under-studied at the local level. This study aimed to gain insight into the relationship between stress, anxiety, and depression in Athens-Clarke County, Georgia.
Methods: Data collected in the 2015 Athens-Clarke County Community Health Needs Assessment were analyzed using linear regression models to explore the association between stress and anxiety and depression.
Results:When the data were aggregated, the presence of stress in a respondent’s household was associated with a 17.8% (p
Conclusions: The results demonstrated that, in Athens-Clarke County, Georgia, stress was significantly and positively associated with both anxiety and depression. Financial, home environment, and neighborhood safety stressors were the strongest predictors of household mental health disorders. These results have implications for public health policy and clinical professionals, including the possibility of tailoring treatment strategies to the types of stress present in a patient’s life. Further research is needed to explore this relationship in other communities.
... 8 The relationship between intraoperative awareness and dissociation in surgery may be explained by perceived physical threat, as this has been found to be an important feature characterizing dissociative outcomes in PTSD literature. 59 The experience of delirium and accompanying fragmented delusions and hallucinations of life-threatening events while in a delirious state also may facilitate dissociation. A relationship between post-ICU memories of psychotic experiences or delusional states and clinically significant post-ICU PTSD is also well established. ...
Purpose
This narrative review summarizes the current literature on postoperative traumatic stress, namely post-traumatic stress disorder (PTSD), including defining features, epidemiology, identification of patient and perioperative risk factors, assessment tools, intervention recommendations, and future directions.
Principal findings
Postoperative traumatic stress occurs in approximately 20% of patients following surgery, with additionally elevated rates in specific surgical groups. Potential risk factors include the perceived uncontrollable nature of high-risk surgery, psychiatric history, intraoperative awareness, dissociation, surgical complications, medication administration, delirium, and pain. PTSD after surgery may manifest in ways that are distinct from traditional conceptualizations of PTSD. Identification of perioperative risk factors and stress symptoms in the early postoperative period may provide opportunities for intervention.
Conclusion
Research on postoperative traumatic stress, including PTSD, is in its infancy. Current evidence shows elevated incidence rates of postoperative traumatic stress, which can worsen overall physical and mental health outcomes. Future research on assessment, prevention, and treatment is warranted.
... Exposure of acute stress resulted in alterations of body perception, environment, time, problem-solving deficits and memory [1][2][3]. These facts have a direct impact in soldiers when they are exposed to combat stress in their operations areas, producing a negative stress coping many battlefield errors as friendly fire incidents, collateral damage… [4]. ...
The present research aimed to analyze the effect of experience and psychophysiological modification by combat stress in soldier’s memory in a simulated combat situation. Variables of rate of perceived exertion, blood glucose, blood lactate, lower body muscular strength manifestation, cortical arousal, specific fine motor skills, autonomic modulation, state anxiety, and memory and attention through a postmission questionnaire were analyzed before and after a combat simulation in 15 experienced soldiers of a special operation unit and 20 non-experienced soldiers of light infantry unit from the Spanish Army. The stress of combat simulation produces a significant increase (p < 0.05) in rated perceived exertion, blood glucose, blood lactate, somatic anxiety and a low frequency domain of the heart rate, and a significant decrease of rifle magazine reload time, high frequency domain of the heart rate and somatic anxiety in both groups. The variables of RPE, glucose, CFFT, RMRT, RMSSD, LF/HF, CA, SA and STAI were significantly different in experienced soldiers shown the activation of fight-flight system. The anticipatory anxiety in experienced soldiers shows a cognitive behavioral association by past experiences. The analysis of correct response in the postmission questionnaire show elements more related with the sight and that endanger the physical integrity of soldiers are more remembered, and some significant differences (p < 0.05) in the memory performance of experienced soldiers and non experienced soldiers where experienced soldiers shown a better performance. As conclusion, combat stress produce an increase in the psichophysiological response of soldiers independently of experience, but experienced ones presented a lower negative effect on memory than non experienced.
... Importantly, this coping strategy is considered to be maladaptive because it interferes with adaptive emotional processing of distressing experiences (Spiegel, 1991;Foa and Hearst-Ikeda, 1996;Schauer and Elbert, 2010). In accordance with this theory, trauma is related to dissociation (e.g., Morgan et al., 2001;Carlson et al., 2012Carlson et al., , 2016Dalenberg et al., 2012;Terock et al., 2016). Overwhelming anxiety in the form of a panic attack is also often accompanied by dissociation (Hunter et al., 2004;Mendoza et al., 2011). ...
Several short-term pathways have been implicated in relation to dissociative experiences, among them are daily stress, sleepiness, and rumination. In addition, it has been claimed that mechanisms contributing to dissociative experiences may differ, according to specific psychopathological symptoms. Accordingly, this study had two aims. The first was to sample moment-to-moment increases or decreases in current stress, sleepiness, and rumination, in order to assess their temporal relations with state dissociation. Rumination was broken down to its basic two subcomponents: the negative value of the thoughts and thinking about the past (in comparison to present or future), in order to differentiate it from other repetitive thought patterns (e.g., worry). The second goal was to explore whether depression, anxiety, and obsessive–compulsive symptoms may moderate the links between the three mechanisms and specific state dissociation scales [specifically, depersonalization-derealization (DEP-DER) and absorption (ABS)]. Ninety-nine undergraduate students completed trait questionnaires and then answered state items four times a day for 4 days. These experience sampling data were analyzed using multilevel linear modeling (MLM) with Level 1 state measurements and Level 2 demographic and trait variables of the participants. Moments of stress, sleepiness, thinking about the past and negative thoughts were all associated both with state DEP-DER and with state ABS. Dissociation, negative thinking, stress, and sleepiness were positively associated with moments of thinking about the past and the future but inversely associated with moments of thinking about the present. Finally, in accordance with our expectations, the links between DEP-DER and hypothesized mechanisms were mostly moderated by depression and anxiety symptoms, whereas the links between ABS and hypothesized mechanisms were moderated mainly by obsessive–compulsive symptoms. Our findings are in accordance with literature on the efficacy of mindfulness as well as the maladaptive correlates of mind-wandering, as they suggest that dissociative detachment from one’s present occupation is associated with decreased well-being.
... SERE trainees showed significant differences between pretest and posttest scores on the Clinician Administered Dissociative States Scale (CADSS) 36 with the greatest effects for depersonalization/derealization items. 58,59 Higher dissociation scores were associated with poorer performance and significantly correlated with lower cortisol levels. The cortisol/dissociation finding supports the model that dissociation is related to decreased activation of the sympathetic stress system. ...
Controversy about dissociation and the Dissociative Disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs about dissociation/DD often are not based on the scientific literature. Multiple lines of evidence support a powerful relationship between dissociation/DD and psychological trauma, especially cumulative and/or early life trauma. Skeptics counter that dissociation produces fantasies of trauma, and DD are artefactual conditions produced by iatrogenesis and/or socio-cultural factors. Almost no research or clinical data support this view. DD are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior. Prospective treatment outcome studies of severely ill DD patients show significant improvement in symptoms including suicidal/self-destructive behaviors, with reductions in treatment cost. A major public health effort is needed to raise awareness about dissociation/DD including educational efforts in all mental health training programs and increased funding for research.
Post-traumatic stress disorder (PTSD) is a psychiatric condition that may occur in people who have experienced or witnessed traumatic events. The microbiota–gut–brain axis has been suggested to play an important role in mental health. Here we analysed information on trauma exposure and PTSD symptoms with gut microbiome data and dietary information of 191 individuals enrolled in a substudy of an ongoing longitudinal cohort of women. We demonstrated that higher PTSD symptom levels were associated with less adherence to the Mediterranean diet pattern, and this association was also linked to specific PTSD putative protective species such as Eubacterium eligens. Moreover, the microbial pathways involved in the biosynthesis of pantothenate and coenzyme A were identified as PTSD putative protective, and these pathways were mainly contributed by PTSD putative protective species such as Akkermansia muciniphila. These findings have the potential to inform dietary- or microbiome-based interventions for PTSD prevention or amelioration.
Background:
Few modifiable risk factors for epithelial ovarian cancer have been identified. We and other investigators have found that individual psychosocial factors related to distress are associated with higher risk of ovarian cancer. The present study examined whether co-occurring distress-related factors are associated with ovarian cancer risk.
Methods:
Five distress-related factors were measured repeatedly over 21 years of follow-up: depression, anxiety, social isolation, widowhood, and, in a subset or women, posttraumatic stress disorder (PTSD). Cox proportional hazards models estimate relative risks (RR) and 95% confidence intervals (CI) of ovarian cancer for a time-updated count of distress-related factors, in age-adjusted models, then further adjusted for ovarian cancer risk factors and behavior-related health risk factors.
Results:
Across 1,193,927 person-years of follow-up, 526 incident ovarian cancers occurred. Women with ≥3 versus no distress-related psychosocial factors demonstrated increased ovarian cancer risk (HRage-adjusted = 1.71; 95% CI = 1.16, 2.52). No significant difference in ovarian cancer risk was observed in women with one or two versus no distress-related psychosocial factors. In the subsample with PTSD assessed, ≥3 versus no distress-related psychosocial factors was associated with twofold greater ovarian cancer risk (HRage-adjusted = 2.08, 95% CI = 1.01, 4.29). Further analysis suggested that women at highest ovarian cancer risk had PTSD co-occurring with any other distress-related factor (HR = 2.19, 95% CI = 1.20, 4.01). Adjusting for cancer risk factors and health behaviors minimally impacted risk estimates.
Conclusions:
Presence of multiple indicators of distress was associated with risk of ovarian cancer. When including PTSD as an indicator of distress, the association was strengthened.
Background
Prior evidence links posttraumatic stress disorder (PTSD) and depression, separately, with chronic inflammation. However, whether effects are similar across each independently or potentiated when both are present is understudied. We evaluated combined measures of PTSD and depression in relation to inflammatory biomarker concentrations.
Methods
Data are from women (n’s ranging 628-2,797) in the Nurses’ Health Study II. Trauma exposure, PTSD, and depression symptoms were ascertained using validated questionnaires. We examined (a) a continuous combined psychological distress score summing symptoms for PTSD and depression, and (b) a categorical cross-classified measure of trauma/PTSD symptoms/depressed mood status (reference group: no trauma or depressed mood). Three inflammatory biomarkers (C-reactive protein [CRP], interleukin-6 [IL-6], tumor necrosis factor alpha receptor 2 [TNFR2]) were assayed from at least one of two blood samples collected 10-16 years apart. We examined associations of our exposures with levels of each biomarker concentration (log-transformed and batch-corrected) as available across the two time points (cross-sectional analyses; CRP, IL-6 and TNFR2) and with rate of change in biomarkers across time (longitudinal analyses; CRP and IL-6) using separate linear mixed effects models.
Results
In sociodemographic-adjusted models accounting for trauma exposure, a one standard deviation increase in the continuous combined psychological distress score was associated with 10.2% (95% confidence interval (CI): 5.2-15.4%) higher CRP and 1.5% (95% CI: 0.5-2.5%) higher TNFR2 concentrations cross-sectionally. For the categorical exposure, women with trauma/PTSD symptoms/ depressed mood versus those with no trauma or depressed mood had 29.5% (95% CI: 13.3-47.9%) higher CRP and 13.1% (95% CI: 5.1-21.7%) higher IL-6 cross-sectionally. In longitudinal analysis, trauma/PTSD symptoms/depressed mood was associated with increasing CRP levels over time.
Conclusions
High psychological distress levels with trauma exposure is associated with elevated inflammation and is a potential biologic pathway by which distress can impact development of inflammatory-related chronic diseases, such as cardiovascular disease. Considering multiple forms of distress in relation to these pathways may provide greater insight into who is at risk for biologic dysregulation and later susceptibility to chronic diseases.
Background
Exposure to trauma, post-traumatic stress disorder (PTSD), and depression, have been independently associated with leukocyte telomere length (LTL), a cellular marker of aging associated with mortality and age-related diseases. However, the joint contributions of trauma and its psychological sequelae on LTL have not been examined.
Methods
We conducted an analysis of LTL in a subset of women from the Nurses’ Health Study II (NHS2; N = 1,868). Lifetime exposure to traumatic events, PTSD, and depression were assessed with validated measures. DNA was extracted from peripheral blood leukocytes and telomere repeat copy number to single gene copy number was determined by quantitative real-time PCR telomere assay. Linear regression models assessed the association of trauma, PTSD, and depression with LTL after adjustment for health behaviors and medical conditions.
Results
Trauma, PTSD, and depression were not independently associated with LTL in mutually-adjusted models. However, individuals with severe psychological distress – characterized by comorbid PTSD and depression - had shorter LTL equivalent to being 7.62 years older (95% CI: 0.02, 17.97 years) compared to participants who had never experienced a traumatic event and were not depressed. Further examination found only an association among individuals with the highest number of PTSD symptoms and comorbid depression equivalent to 9.71 additional years of aging (95% CI: 1.36, 20.49 years). No effect was found among individuals meeting the minimum threshold for probable PTSD with comorbid depression.
Conclusion
Severe psychological distress, as indicated by the presence of comorbid PTSD and depression, may be associated with shorter LTL.
Much of the author’s research has focused on psychological defense mechanisms, demonstrating how crucial they are to functioning, and how the templates of positive cognitive distortions and dissociation apply. Both templates are presented along with classical Freudian defenses, mostly subsumed by the cognitive distortion template. Additional forms of psychological defense, such as grieving, avoidance, hypomania, and personality features including resilience are described as well. It is noted that psychological defenses occur on a continuum, and while less intense variants are highly beneficial, more extreme ones tend to be less so. The way that the various psychological defenses enhance mental health are revealed.
Chapter 4 discusses and describes compelling new research in neuroscience at the forefront of understanding the physiological, psychological, emotional, and neurocognitive significance of trauma survivors in military and civilian life. This chapter examines the military neuroscience research agenda that analyzes how the military brain is mapped differently than civilians given the nature of the military as a high‐risk occupation. Chapter 4 focuses on the multiple complex mediating variables within the brain's complex neuropathways that record, transpose, replicate, and reproduce a wide range of psychological responses that underlie optimal brain health, functioning, and performance. The potential for discovering optimal brain health, neurocognitive functioning, and performance for coping and resiliency after trauma and combat operational stress is examined and appraised. Key findings in military neuroscience are interpreted for mental and behavioral health practice. The intention is to assist military clients in mood and emotional regulation, career transition, and forming healthy intimate, and social relationships.
Objective:
Rates of behavioral health disorders and potential protective factors in U.S. Special Operations Forces (SOF) have not been well studied, including differences between Operators and Support personnel, despite very high levels of combat exposure in these military personnel. The present study examined the prevalence of endorsed behavioral health problems and protective factors within a large sample of SOF personnel.
Method:
Anonymized data from 16,284 active duty SOF Service members from the 2016 Preservation of the Force and Family (POTFF) needs survey were analyzed.
Results:
Overall, the prevalence of PTSD (7.6%), depression (8.4%), alcohol misuse (12.8%), and nicotine use (28%) were comparable or lower than reported in conventional military populations. There were significant differences between Operators and Support personnel in a number of demographic and service-related variables. Operators also endorsed more direct combat exposure and scored higher on resilience and social support, and reported better quality and quantity of sleep. There were no significant group differences in rates of PTSD and depression, except lower odds (adjusted OR = 0.81) for alcohol problems in Support personnel (11.6%) compared to Operators (14.0%), p <.001, 95% CI [0.72, 0.91].
Conclusions:
SOF personnel experience considerably higher exposure to combat deployments than conventional forces, yet the data from this study showed comparable or lower levels of behavioral health conditions. Although Operators were somewhat more likely than Support personnel to experience alcohol problems, they showed enhanced resilience, social support, and sleep health. Alcohol misuse is one potential target for preventive health efforts.
There is evidence regarding the presence of alterations in both the stress response and the endogenous pain modulation systems of people with fibromyalgia (FM). However, research on pain modulation under induced stress on FM patients is scarce and contradictory. The present study analyzes stress-induced changes in pain and intolerance thresholds among FM patients, examining the possible existence of differences linked to PTSD comorbidity and gaining insights into the role of cardiovascular reactivity. Eighteen women diagnosed with FM and comorbid PTSD (FM + PTSD), 18 women diagnosed with FM and no PTSD (FM-PTSD), and 38 healthy women (HC) were exposed to the Social Stress Test task. Pressure pain thresholds and intolerance thresholds were measured before and during stress induction, and after a recovery period, while systolic blood pressure and heart rate were simultaneously recorded. Overall, while pain thresholds decreased during stress and recovery for HC, no significant changes were observed for women with FM. The intolerance threshold decreased for HC during stress, but was maintained at basal level during recovery. FM-PTSD women exhibited a delayed response, with a drop at recovery. For FM + PTSD, tolerance levels remained unchanged. In addition, cardiovascular reactivity did not seem to explain these results. This performance of the pain modulation system seems to follow the same pattern of hypoactive responsiveness under stressors that has previously been observed in FM patients on the autonomic and neuroendocrine axes. Such a hypoactive pattern may involve a non-adaptive response that may contribute to the development and maintenance of chronic pain.
Several studies have reported a positive association between psychological stress and cardiovascular diseases; however, there is scarce evidence about various aspects of life stress, including traumatic, positive, and negative events. We aimed to evaluate the association between various stressful life events and indicators of cardiovascular risk, including the augmentation index. A total of 3276 participants from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort (Mean age: 50.9) were analyzed cross-sectionally. By using the Life Experience Questionnaire, exposures were grouped as a “positive event,” “negative event,” or “traumatic event.” The augmentation index and subclinical atherosclerosis were measured. Multivariate polytomous logistic regression was used. Overall, stressful life events did not show any significant association with any cardiovascular index; however, increased odds ratios were observed between augmentation index quartiles and those who had experienced traumatic events (quartile 4: odds ratio = 1.41, 95% confidence interval = 1.09–1.82). The association remained valid among women when stratified by sex. There was no significant result in men. Traumatic events in women were positively associated with the augmentation index. These findings suggest that more attention should be paid to trauma in the context of increased cardiovascular risk in women.
Nadel, Jacobs, and colleagues have postulated that human memory under conditions of extremely high stress is “special.” In particular, episodic memories are thought to be susceptible to impairment, and possibly fragmentation, attributable to hormonally based dysfunction occurring selectively in the hippocampal system. While memory for highly salient and self‐relevant events should be better than the memory for less central events, an overall nonmonotonic decrease in spatio/temporal episodic memory as stress approaches traumatic levels is posited. Testing human memory at extremely high levels of stress, however, is difficult and reports are rare. Firefighting is the most stressful civilian occupation in our society. In the present study, we asked New York City firefighters to recall everything that they could upon returning from fires they had just fought. Communications during all fires were recorded, allowing verification of actual events. Our results confirmed that recall was, indeed, impaired with increasing stress. A nonmonotonic relation was observed consistent with the posited inverted u‐shaped memory‐stress function. Central details about emergency situations were better recalled than were more schematic events, but both kinds of events showed the memory decrement with high stress. There was no evidence of fragmentation. Self‐relevant events were recalled nearly five times better than events that were not self‐relevant. These results provide confirmation that memories encoded under conditions of extremely high stress are, indeed, special and are impaired in a manner that is consistent with the Nadel/Jacobs hippocampal hypothesis.
Background
Posttraumatic stress disorder (PTSD) is associated with higher risk of incident hypertension, but it is unclear whether specific aspects of PTSD are particularly cardiotoxic. PTSD is a heterogeneous disorder, comprising dimensions of fear and dysphoria. Because elevated fear after trauma may promote autonomic nervous system dysregulation, we hypothesized fear would predict hypertension onset, and associations with hypertension would be stronger with fear than dysphoria.
Methods
We examined fear and dysphoria symptom dimensions in relation to incident hypertension over 24 years in 2709 trauma-exposed women in the Nurses’ Health Study II. Posttraumatic fear and dysphoria symptom scores were derived from a PTSD diagnostic interview. We used proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each symptom dimension (quintiles) with new-onset hypertension events ( N = 925), using separate models. We also considered lower-order symptom dimensions of fear and dysphoria.
Results
Higher levels of fear ( P -trend = 0.02), but not dysphoria ( P -trend = 0.22), symptoms were significantly associated with increased hypertension risk after adjusting for socio-demographics and family history of hypertension. Women in the highest v. lowest fear quintile had a 26% higher rate of developing hypertension [HR = 1.26 (95% CI 1.02–1.57)]; the increased incidence associated with greater fear was similar when further adjusted for biomedical and health behavior covariates ( P -trend = 0.04) and dysphoria symptoms ( P -trend = 0.04). Lower-order symptom dimension analyses provided preliminary evidence that the re-experiencing and avoidance components of fear were particularly associated with hypertension.
Conclusions
Fear symptoms associated with PTSD may be a critical driver of elevated cardiovascular risk in trauma-exposed individuals.
Background
Abnormal thyroid function is prevalent among women and has been linked to increased risk of chronic disease. Posttraumatic stress disorder (PTSD) has been linked to thyroid dysfunction in some studies; however, the results have been inconsistent. Thus, we evaluated trauma exposure and PTSD symptoms in relation to incident thyroid dysfunction in a large longitudinal cohort of civilian women.
Methods
We used data from 45 992 women from the ongoing Nurses’ Health Study II, a longitudinal US cohort study that began in 1989. In 2008, history of trauma and PTSD were assessed with the Short Screening Scale for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, PTSD, and incident thyroid dysfunction was determined by participants’ self-report in biennial questionnaires of physician-diagnosed hypothyroidism and Graves’ hyperthyroidism. The study period was from 1989 to 2013. Proportional hazard models were used to estimate multivariable-adjusted hazard ratios and 95% confidence intervals (CIs) for incident hypothyroidism and Graves’ hyperthyroidism.
Results
In multivariable-adjusted models, we found significant associations for PTSD only with hypothyroidism [ p -trend <0.001; trauma with no PTSD symptoms, 1.08 (95% CI 1.02–1.15); 1–3 PTSD symptoms, 1.12 (95% CI 1.04–1.21); 4–5 PTSD symptoms, 1.23 (95% CI 1.13–1.34); and 6–7 PTSD symptoms, 1.26 (95% CI 1.14–1.40)]. PTSD was not associated with risk of Graves’ hyperthyroidism ( p -trend = 0.34). Associations were similar in sensitivity analyses restricted to outcomes with onset after 2008, when PTSD was assessed.
Conclusions
PTSD was associated with higher risk of hypothyroidism in a dose-dependent fashion. Highlighted awareness for thyroid dysfunction may be especially important in women with PTSD.
2 0 t h a n n i v e r s a r y i s s u e Dissociation debates: everything you know is w r o n g Richard J. Loewenstein, MD I n t r o d u c t i o n. ihe Diagnostic and Statistical Manual of Mental Disorders, fil'lli edition (D5M-5),' defines dissociation as a disruption, interruption, and/or discontinuity of the normal, subjective integration of behavior, memory, identity, consciousness, emotion, perception, body rep r e s e n t a t i o n. a n d m o t o r c o n t r o l. The DSM-5 dissociative disorders (DD) are: 1. Dissociative Identity Disorder (DID); 2. Dissociative Amnesia (DA);* 3. Depersonalization/Derealization Disorder (DPDRD); 4. Other Specified Dissociative Disorders (OSDD); 5. Unspecified Dissociative Disorder (UDD). •In DSM-5 Dissociative Fugue (DF) is now a subtype of Dis sociative Amnesia (DA), and not a separate disorder. The DSM-5 diagnostic criteria for Posttraumatic Stress Disorder (PTSD) now include a Dissociative Subtype (PTSD-DS). Dissociative amnesia as a symp tom is a diagnostic criterion for both DID and for P T S D. C r i t e r i a f o r P T S D-D S a r e t h a t r e m i n d e r s o f t h e Controversy about dissociation and the dissociative dis orders (DO) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs about dissociation/DD often are not based on the scientific literature. Multiple lines of evidence sup port a powerful relationship between dissociation/DD and psychological trauma, especially cumulative and/ or early life trauma. Skeptics counter that dissociation produces fantasies of trauma, and that DD are arte-factual conditions produced by iatrogenesis and/or socio-cultural factors. Almost no research or clinical data support this view. DD are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior. Prospective treatment outcome studies of severely ill DD patients show significant im provement in symptoms including suicidal/self-destructive behaviors, with reductions in treatment cost. A major public health effort is needed to raise awareness about dissociation/DD, including educational efforts in all mental health training programs and increased funding for research. C 2 0 1 8 , A C H-S o v e f G r o u p D i a l o g u e s O n \ « o r o s f i. 2 0 1 8 : 2 0 : 2 2 9-2 4 2 .
While peritraumatic dissociation has been identified as a predictor of posttraumatic stress disorder, it may also have some protective aspect. The study uses experience sampling methods to assess acute dissociation reactions during conflict, and to investigate these reactions as predictors of subsequent posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG).
During the 2014 Israel-Gaza conflict, Israeli civilians (n = 96) exposed to rocket fire gave twice-daily experience sampling method (ESM) reports of dissociation symptoms for 30 days via mobile phone. PTSS and PTG were assessed two months later. A mixed effects random intercepts and slopes model estimated acute dissociation reactions. Individual slope coefficients for acute dissociative reactivity were entered as predictors of subsequent PTSS and PTG in regression analyses investigating linear and curvilinear associations.
Exposure to sirens elicited acute dissociation reactions. Dissociative reactivity gradually reduced over the conflict. Higher acute dissociative reactivity during conflict predicted PTSS in a curvilinear manner (inverted U) and PTG in a positive linear manner two months later.
The current study provides an important and novel contribution to the field by using ESM methods to assess peritraumatic dissociation, and in demonstrating that peritraumatic dissociation may be both adaptive and maladaptive, which has implications for risk assessment and clinical practice.
Objective.
—This article defines stress and related concepts and reviews their historical development. The notion of a stress system as the effector of the stress syndrome is suggested, and its physiologic and pathophysiologic manifestations are described. A new perspective on human disease states associated with dysregulation of the stress system is provided.
incidence of psychiatric casualties
battle intensity, battle stress, and psychiatric casualties
morale, cohesion, personal and family stability, and psychiatric casualties
leadership, morale, cohesion, combat effectiveness, and heroism
treatment of psychiatric casualties (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of this study was to develop an instrument for the measurement of present-state dissociative symptoms, the Clinician Administered Dissociative States Scale (CADSS). Reported here are interrater reliability and internal consistency of the CADSS, validity as assessed by comparisons with other instruments for the assessment of dissociation, and sensitivity of the CADSS to discriminate patients with dissociative disorders from patients with other psychiatric disorders and healthy subjects. Initial analyses indicated good interrater reliability and construct validity for the CADSS. Scores on the CADSS discriminated patients with dissociative disorders from the other groups.
This study compared current dissociative symptoms and dissociation at the time of specific traumatic events in Vietnam combat veterans with posttraumatic stress disorder (PTSD) and Vietnam combat veterans without PTSD.
Vietnam combat veterans who sought treatment for PTSD (N = 53) were compared to Vietnam combat veterans without PTSD (N = 32) who sought treatment for medical problems. Dissociative symptoms were evaluated with the Dissociative Experiences Scale. Dissociation at the time of a combat-related traumatic event was evaluated retrospectively with the modified Dissociative Experiences Questionnaire. The Combat Exposure Scale was used to measure level of combat exposure.
There was a significantly higher level of dissociative symptoms, as measured by the Dissociative Experiences Scale, in patients with PTSD (mean = 27.0, SD = 18.0) than in patients without PTSD (mean = 13.7, SD = 16.0). This difference persisted when the difference in level of combat exposure was controlled with analysis of covariance. PTSD patients also reported more dissociative symptoms at the time of combat trauma, as measured retrospectively by the Dissociative Experiences Questionnaire (mean = 11.5, SD = 1.6) than non-PTSD patients (mean = 1.8, SD = 2.1).
Dissociative symptoms are an important element of the long-term psychopathological response to trauma.
This article defines stress and related concepts and reviews their historical development. The notion of a stress system as the effector of the stress syndrome is suggested, and its physiologic and pathophysiologic manifestations are described. A new perspective on human disease states associated with dysregulation of the stress system is provided.
Published original articles from human and animal studies and selected reviews. Literature was surveyed utilizing MEDLINE and the Index Medicus.
Original articles from the basic science and human literature consisted entirely of controlled studies based on verified methodologies and, with the exception of the most recent studies, replicated by more than one laboratory. Many of the basic science and clinical studies had been conducted in our own laboratories and clinical research units. Reviews cited were written by acknowledged leaders in the fields of neurobiology, endocrinology, and behavior.
Independent extraction and cross-referencing by the authors.
Stress and related concepts can be traced as far back as written science and medicine. The stress system coordinates the generalized stress response, which takes place when a stressor of any kind exceeds a threshold. The main components of the stress system are the corticotropin-releasing hormone and locus ceruleus-norepinephrine/autonomic systems and their peripheral effectors, the pituitary-adrenal axis, and the limbs of the autonomic system. Activation of the stress system leads to behavioral and peripheral changes that improve the ability of the organism to adjust homeostasis and increase its chances for survival. There has been an exponential increase in knowledge regarding the interactions among the components of the stress system and between the stress system and other brain elements involved in the regulation of emotion, cognitive function, and behavior, as well as with the axes responsible for reproduction, growth, and immunity. This new knowledge has allowed association of stress system dysfunction, characterized by sustained hyperactivity and/or hypoactivity, to various pathophysiologic states that cut across the traditional boundaries of medical disciplines. These include a range of psychiatric, endocrine, and inflammatory disorders and/or susceptibility to such disorders.
We hope that knowledge from apparently disparate fields of science and medicine integrated into a working theoretical framework will allow generation and testing of new hypotheses on the pathophysiology and diagnosis of, and therapy for, a variety of human illnesses reflecting systematic alterations in the principal effectors of the generalized stress response. We predict that pharmacologic agents capable of altering the central apparatus that governs the stress response will be useful in the treatment of many of these illnesses.
SYNOPSIS
Post-traumatic stress disorder (PTSD) was studied in the Piedmont region of North Carolina. Among 2985 subjects, the lifetime and six month prevalence figures for PTSD were 1·30 and 0·44 % respectively. In comparison to non-PTSD subjects, those with PTSD had significantly greater job instability, family history of psychiatric illness, parental poverty, child abuse, and separation or divorce of parents prior to age 10. PTSD was associated with greater psychiatric co-morbidity and attempted suicide, increased frequency of bronchial asthma, hypertension, peptic ulcer and with impaired social support. Differences were noted between chronic and acute PTSD on a number of measures, with chronic PTSD being accompanied by more frequent social phobia, reduced social support and greater avoidance symptoms.
From W.B. Cannon's identification of adrenaline with "fight or flight" to modern views of stress, negative views of peripheral physiological arousal predominate. Sympathetic nervous system (SNS) arousal is associated with anxiety, neuroticism, the Type A personality, cardiovascular disease, and immune system suppression; illness susceptibility is associated with life events requiring adjustments. "Stress control" has become almost synonymous with arousal reduction. A contrary positive view of peripheral arousal follows from studies of subjects exposed to intermittent stressors. Such exposure leads to low SNS arousal base rates, but to strong and responsive challenge- or stress-induced SNS-adrenal-medullary arousal, with resistance to brain catecholamine depletion and with suppression of pituitary adrenal-cortical responses. That pattern of arousal defines physiological toughness and, in interaction with psychological coping, corresponds with positive performance in even complex tasks, with emotional stability, and with immune system enhancement. The toughness concept suggests an opposition between effective short- and long-term coping, with implications for effective therapies and stress-inoculating life-styles.
The authors compared the hypnotizability of 65 Vietnam veteran patients with posttraumatic stress disorder (PTSD) to that of a normal control group and four patient samples using the Hypnotic Induction Profile. The patients with PTSD had significantly higher hypnotizability scores than patients with diagnoses of schizophrenia (N = 23); major depression, bipolar disorder--depressed, and dysthymic disorder (N = 56); and generalized anxiety disorder (N = 18) and the control sample (N = 83). This finding supports the hypothesis that dissociative phenomena are mobilized as defenses both during and after traumatic experiences. The literature suggests that spontaneous dissociation, imagery, and hypnotizability are important components of PTSD symptoms.
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.
Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.
The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.
Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
To examine how the type and number of physical symptoms reported by primary care patients are related to psychiatric disorders and functional impairment.
Outpatient mental health survey.
Four primary care clinics.
One thousand adult clinic patients, of whom 631 were selected randomly or consecutively and 369 by convenience.
Psychiatric disorders as determined by the Primary Care Evaluation of Mental Disorders procedure; the presence or absence of 15 common physical symptoms and whether symptoms were somatoform (ie, lacked an adequate physical explanation); and functional status as determined by the Medical Outcomes Study Short-form General Health Survey.
Each of the 15 common symptoms was frequently somatoform (range, 16% to 33%). The presence of any physical symptom increased the likelihood of a diagnosis of a mood or anxiety disorder by at least twofold to three-fold, and somatoform symptoms had a particularly strong association with psychiatric disorders. The likelihood of a psychiatric disorder increased dramatically with increasing numbers of physical symptoms. The prevalence of a mood disorder in patients with 0 to 1, 2 to 3, 4 to 5, 6 to 8, and 9 or more symptoms was 2%, 12%, 23%, 44%, and 60%, respectively, and the prevalence of an anxiety disorder was 1%, 7%, 13%, 30%, and 48%, respectively. Finally, each physical symptom was associated with significant functional impairment; indeed, the number of physical symptoms was a powerful correlate of functional status.
The number of physical symptoms is highly predictive for psychiatric disorders and functional impairment. Multiple or unexplained symptoms may signify a potentially treatable mood or anxiety disorder.
This study systematically evaluated the psychological reactions of a nonclinical population to the October 1989 earthquake in the San Francisco Bay Area.
A representative group of about 100 graduate students from two different institutions in the Bay Area volunteered to participate in the study. Within 1 week of the earthquake, the authors administered a checklist of anxiety and dissociative symptoms to the subjects, and 4 months later they conducted a follow-up study with the same checklist.
The participants reported significantly greater numbers and frequency of dissociative symptoms, including derealization and depersonalization, distortions of time, and alterations in cognition, memory and somatic sensations, during or shortly after the earthquake than after 4 months. To a lesser degree they also reported significantly more nonsomatic anxiety symptoms and Schneider's first-rank symptoms at the earlier testing time.
These results suggest that among nonclinical populations, extreme distress may significantly increase the prevalence and severity of transient dissociative phenomena and anxiety. They provide further evidence of the role that dissociation plays in the response to trauma and are of considerable clinical and theoretical importance in view of the lifetime prevalence of traumatic experiences in the general population.
The aim of this study was to prospectively examine the relationship between immediate and short-term responses to a trauma and the subsequent development of posttraumatic stress disorder (PTSD).
All patients consecutively admitted to a general hospital were screened for the presence of physical injury due to a traumatic event. Fifty-one eligible subjects were assessed 1 week and 6 months after the trauma. The initial assessment included measures of event severity, peritraumatic dissociation, and symptoms of intrusion, avoidance, depression, and anxiety. The follow-up assessments added the PTSD module of the Structured Clinical Interview for DSM-III-R--Non-Patient Version and the civilian trauma version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder.
Thirteen subjects (25.5%) met PTSD diagnostic criteria at follow-up. Subjects who developed PTSD had higher levels of peritraumatic dissociation and more severe depression, anxiety, and intrusive symptoms at the 1-week assessment. Peritraumatic dissociation predicted a diagnosis of PTSD after 6 months over and above the contribution of other variables and explained 29.4% of the variance of PTSD symptom intensity. Initial scores on the Impact of Event Scale predicted PTSD status with 92.3% sensitivity and 34.2% specificity. Symptoms of avoidance that were initially very mild intensified in the subjects who developed PTSD.
Peritraumatic dissociation is strongly associated with the later development of PTSD. Early dissociation and PTSD symptoms can help the clinician identify subjects at higher risk for developing PTSD.
This study investigated the relation between history of sexual abuse, somatization, and dissociation in 53 women with a self-reported history of sexual assault in childhood and in 30 women who did not report such a history. Dissociation and reporting of chronic physical symptoms were positively correlated in subjects who had a history of sexual abuse, but this relation did not occur in subjects who reported no history of sexual abuse. The more perpetrators a subject reported, the greater the number of reported chronic physical symptoms. As the age of onset of abuse neared puberty, the more the subjects reported childbirth complications. The relation between somatization and dissociation is discussed.
Patients with complex dissociative disorders remain in alternating psychophysiological states which are discrete, discontinuous, and resistant against integrative tendencies. In this contribution, a parallel is drawn between animal defensive and recuperative states that are evoked in the face of severe threat and the characteristic responses of dissociative disorder patients as displayed in major dissociative states. Empirical data and clinical observations seem to be supportive of the idea that there are similarities between freezing, concomitant development of analgesia and anesthesia, and acute pain in threatened animals and severely traumatized human beings.
With the exception of a few reports of higher rates of childhood trauma in Vietnam veterans with posttraumatic stress disorder (PTSD), little is known about the influence of previous exposure to trauma on the PTSD effects of subsequent trauma. The authors examine interrelated questions about the effects of previous exposure to trauma.
A representative sample of 2,181 individuals in southeast Michigan were interviewed by telephone to record lifetime history of traumatic events specified in DSM-IV as potentially leading to PTSD. PTSD was assessed with respect to a randomly selected index trauma from the list of events reported by each respondent.
History of any previous exposure to traumatic events was associated with a greater risk of PTSD from the index trauma. Multiple previous events had a stronger effect than a single previous event. The effect of previous assaultive violence persisted over time with little change. When they examined several features of the previous exposure to trauma, the authors found that subjects who experienced multiple events involving assaultive violence in childhood were more likely to experience PTSD from trauma in adulthood. Furthermore, previous events involving assaultive violence--single or multiple, in childhood or later on--were associated with a higher risk of PTSD in adulthood.
Previous exposure to trauma signals a greater risk of PTSD from subsequent trauma. Although these results are consistent with a sensitization hypothesis, like the results from previous research on PTSD, they do not address the mechanism of increased responsivity to trauma. Long-term observational studies can further elucidate these observations.
Located halfway between the United Kingdom and Norway, the Ekofisk is the most highly developed of the oil fields of the North Sea. Approximately two dozen permanent and a few floating rigs are in operation there; some of them are interconnected by bridges. From the Ekofisk pipelines, crude oil is channeled to Teesside in England and gas to Emden in western Germany. The basic function of the Ekofisk fields is the supply of energy, made possible by the gigantic achievements of modern technology. Considerable attention has been given to safety issues, yet accidents and disasters have occurred.
To ascertain the prevalence of posttraumatic stress disorder (PTSD) and risk factors associated with it, we studied a random sample of 1007 young adults from a large health maintenance organization in the Detroit, Mich, area. The lifetime prevalence of exposure to traumatic events was 39.1%. The rate of PTSD in those who were exposed was 23.6%, yielding a lifetime prevalence in the sample of 9.2%. Persons with PTSD were at increased risk for other psychiatric disorders; PTSD had stronger associations with anxiety and affective disorders than with substance abuse or dependence. Risk factors for exposure to traumatic events included low education, male sex, early conduct problems, extraversion, and family history of psychiatric disorder or substance problems. Risk factors for PTSD following exposure included early separation from parents, neuroticism, preexisting anxiety or depression, and family history of anxiety. Life-style differences associated with differential exposure to situations that have a high risk for traumatic events and personal predispositions to the PTSD effects of traumatic events might be responsible for a substantial part of PTSD in this population.
The goals of this investigation were to examine the prevalence of Post-Traumatic Stress Disorder (PTSD) and victim service utilization among crime victims and family members recently involved in the criminal justice system ( N = 251). About one half of the participants met PTSD diagnostic criteria during their lifetime. Females were overrepresented in the more violent crimes (e.g., homicide and sexual assault). Victims of more violent crimes—who sustained physical injuries, who perceived that they would be seriously injured, and who perceived their lives were threatened—were more likely to suffer from PTSD than victims who did not have these characteristics. Most participants believed the criminal justice system should provide a range of victim services. However, most participants reported inadequate access to services. Also, receipt of psychological counseling and diagnostic status were significantly associated with crime type. Results imply that crime victims involved in the criminal justice system are at risk for developing PTSD, which often never is addressed by a mental health professional due to inadequate access to health care services.
[examines] some of the immediate and long-term effects of exposure to stressful events / not all individuals who are exposed to stressors suffer long-term negative consequences / provides a constructivist narrative perspective to help explain these individual differences / it is proposed that how individuals go about constructing narrative accounts influences their ability to cope with their distress
[describes a] three-phase SIT [stress inoculation training] intervention approach / focus . . . is on illustrating the various treatment phases of SIT from a constructive narrative perspective (PsycINFO Database Record (c) 2012 APA, all rights reserved)
"Trauma and the Vietnam War Generation" looks to the veterans themselves for what it means to have "survived."
In 1983, the U.S. Congress mandated that a study be conducted to examine the ongoing effects of the Vietnam war on its veterans. In response to this directive, the National Vietnam Veterans Readjustment Study (NVVRS) was undertaken.
Within these pages, the reader will find a wealth of information, sometimes difficult to take in, but ultimately essential to grasping the full magnitiude of the subject. Chapter I offers background of the study, and an overview of its design. Chapters II-XI present the actual findings of the study.
Commentaries and chapter overviews are designed to clarify the material.
Veterans, their spouses, and their families will find that they are not alone. Mental health professionals, policymakers, and even lawyers or other legal professionals will gain insight into the problems experienced by this population, which, it is hoped, will enable them to better address veterans' needs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
[focuses] on how individuals construct and control their own "minds" by creating narratives, or how individuals go about persuading themselves / illustrate this constructive narrative perspective in two areas, namely health-related behaviors and coping with stress (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The peptide messengers neuropeptide Y (NPY), growth hormone-releasing hormone (GHRH), atrial natriuretic peptide (ANP) and beta-endorphin (BEND) were tested in an animal model of anxiety, the Geller-Seifter conflict test. Rats were subjected to a multiple schedule consisting of three components: in the first component, lever-pressing produced food-reward ('unpunished responding'). The second component was a time-out period, during which lever-pressing had no consequences. During the third component, lever-pressing produced food-reward, but was also punished by an incremental foot-shock ('punished responding'). After establishing a stable baseline of both unpunished and punished responding, animals were injected with various doses of NPY, GHRH, ANP, BEND, or with saline into the lateral cerebral ventricle, and testing was repeated. While changes in unpunished responding can reflect alterations in performance factors or motivational strength, increases in punished responding have previously been shown to be highly specific for anxiety-reducing drugs, such as the benzodiazepines. NPY markedly and dose-dependently increased punished responding. A smaller increase of unpunished responding was also seen. These results add further support to the hypothesis that NPY may be an endogenous anxiolytic. GHRH, ANP and END did not affect punished responding.
The authors' goal was to determine the levels of trauma and psychiatric symptoms in a randomly selected group of Cambodian refugees and to determine the relationship between the amount of trauma experienced and subsequent psychiatric symptoms.
Data on traumatic experiences and symptoms of posttraumatic stress, dissociation, depression, and anxiety were collected on 50 randomly selected Cambodian refugees who had resettled in the United States.
Subjects experienced multiple and severe traumas and showed high levels of all symptoms measured. Forty-three (86%) of the subjects met DSM-III-R criteria for posttraumatic stress disorder, 48 (96%) had high dissociation scores, and 40 (80%) could be classified as suffering from clinical depression. Correlations between trauma scores and symptom scores and among symptom scores were moderate to large.
These results indicate that a high proportion of Cambodian refugees who are not psychiatric patients suffer from severe psychiatric symptoms and that there is a relationship between the amount of trauma they experienced and the severity of these symptoms.
Medical patients' (75 with chronic fatigue complaints, 61 with dizziness, and 88 with disabling tinnitus; N = 224) current and past psychiatric diagnoses and personality characteristics were assessed to determine if they could independently explain the number of medically unexplained physical symptoms that the patients had experienced. Cloninger's Tridimensional Personality Questionnaire (TPQ) and the Diagnostic Interview Schedule based on DSM-III-R were used to assess the personality and psychiatric diagnoses, respectively. The results revealed that the number of lifetime medically unexplained symptoms were significantly, independently, and positively related to increasing numbers of current and past anxiety and depressive disorders and to the harm avoidance dimension of the TPQ. In a second analysis, the "worry/pessimism" and "impulsiveness" subscales were positively related to the number of medically unexplained symptoms. The results suggest that somatization is associated with current and past history of psychiatric illnesses and harm avoidance in this sample of medical patients.
The aim of this study was to determine the reliability and validity of a proposed measure of peritraumatic dissociation and, as part of that effort, to determine the relationship between dissociative experiences during disturbing combat trauma and the subsequent development of posttraumatic stress disorder (PTSD).
A total of 251 male Vietnam theater veterans from the Clinical Examination Component of the National Vietnam Veterans Readjustment Study were examined to determine the relationship of war zone stress exposure, retrospective reports of dissociation during the most disturbing combat trauma events, and general dissociative tendencies with PTSD case determination.
The total score on the Peritraumatic Dissociation Experiences Questionnaire--Rater Version was strongly associated with level of posttraumatic stress symptoms, level of stress exposure, and general dissociative tendencies and weakly associated with general psychopathology scales from the MMPI-2. Logistic regression analyses supported the incremental value of dissociation during trauma, over and above the contributions of level of war zone stress exposure and general dissociative tendencies, in accounting for PTSD case determination.
These results provide support for the reliability and validity of the Peritraumatic Dissociation Experiences Questionnaire--Rater Version and for a trauma-dissociation linkage hypothesis: the greater the dissociation during traumatic stress exposure, the greater the likelihood of meeting criteria for current PTSD.
The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire.
Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire.
Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events.
These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.
Dissociative responses to trauma have been hypothesized to be associated with long-term increases in psychopathology. The purpose of this study was to examine dissociative responses to premilitary, combat-related and postmilitary traumatic events and long-term psychopathology in Vietnam combat veterans with (n = 34) and without (n = 28) posttraumatic stress disorder (PTSD). PTSD patients reported higher levels of dissociative states at the time of combat-related traumatic events than non-PTSD patients. Higher levels of dissociative states persisted in PTSD patients in the form of higher levels of dissociative states in-response to postmilitary traumatic events. In addition, dissociative responses to combat trauma were associated with higher long-term general dissociative symptomatology as measured by scores on the Dissociative Experience Scale, as well as increases in the number of flashbacks since the time of the war. These findings are consistent with previous formulations that dissociation in the face of trauma is a marker of long-term psychopathology.
Numerous studies indicate that most mental health services are provided in the primary care medical setting and that problems exist with misdiagnoses and lack of recognition of mental health disorders. The purpose of our investigation was to determine whether patient responses on a typical medical health history form could be used to predict depression or anxiety.
New adult patients at a university community family practice clinic were surveyed during a 6-month period. Study patients completed a health history form and standardized inventories of anxiety and depression.
The study sample included 187 patients. Positive responses to mood-related symptoms reported on the health history best predicted anxiety and depression. Nonmood symptoms were also significant, although not as powerful, predictors of these disorders. A significant relation existed between total number of positive symptoms and psychiatric diagnoses, which continued when mood symptoms were removed from the analyses. Results were used to develop physical, nonmood primary care symptom profiles that could be used to screen for anxiety and depression.
Providing physicians the means to improve mental health diagnostics can help advance patient care and health care system outcomes.
This study examines the longitudinal course and predictors of stress-specific and general symptomatic distress in emergency services personnel. A three-group quasi-experimental design was used to determine the responses of 322 rescue workers to the Loma Prieta earthquake Interstate 880 Freeway collapse and to unrelated control critical incidents. Self-report questionnaires, including measures of incident exposure, peritraumatic dissociation and emotional distress, and current symptoms, were administered 1.9 years (initial) and 3.5 years (follow-up) after the freeway collapse. Despite modest symptom improvement at follow-up, rescue workers were at risk for chronic symptomatic distress after critical incident exposure. Peritraumatic dissociation accounted for significant increments in current posttraumatic stress disorder symptoms, over and above exposure, adjustment, years of experience, locus of control, social support, and general dissociative tendencies. The results suggest that rescue workers, particularly those with more catastrophic exposure and those prone to dissociate at the time of the critical incident, are at risk for chronic symptomatic distress.
The effects of burnout and perceived stress on early morning free cortisol levels after awakening were investigated in a group of teachers. Previous studies revealed that cortisol levels show a significant increase after awakening, with high intraindividual stability.
Sixty-six teachers from local public schools (42 women and 24 men, mean age 42+/-5 years) were asked to sample saliva for cortisol analysis on 3 consecutive days. On each day, cortisol levels were measured at the time of awakening and 15, 30, and 60 minutes thereafter. On the night before the third day, subjects took 0.5 mg dexamethasone orally for testing glucocorticoid feedback inhibition. Burnout and perceived stress were measured by three different questionnaires.
Perceived stress correlated with increases of cortisol levels during the first hour after awakening after dexamethasone pretreatment. In addition, teachers scoring high on burnout showed lower overall cortisol secretion on all sampling days, and a higher suppression of cortisol secretion after dexamethasone administration. In the subgroup of teachers with both high levels of perceived stress and high levels of burnout, a lower overall cortisol secretion was observed on the first 2 days, with stronger increases during the first hour after awakening after dexamethasone suppression. This subgroup also showed the lowest self-esteem, the highest external locus of control, and the highest number of somatic complaints.
These results demonstrate differential effects of burnout and perceived stress on hypothalamic-pituitary-adrenal axis regulation.
This study examines factors affecting the frequency of physician consultations by individuals with functional gastrointestinal disorders (FGD) in a group of subjects with functional dyspepsia or irritable bowel syndrome. Systematic selection of persons who were already seeing a physician for one of these problems was avoided by conducting an epidemiological field study rather than a clinical study.
A representative sample of the German population (N=2201) completed a questionnaire that included, in addition to the criterion (number of physician visits in the past 12 months), items aimed at identifying the target group and questions about physical symptoms, illness behavior, living situation, personality features, and sociodemographic status (a total of 31 predictors).
Individuals with functional gastrointestinal disorders who consulted a physician for their gastrointestinal disorders and those who did not differed significantly, especially on psychological measures. The differences between these individuals and the general population were greater for the consulters than for the nonconsulters. Multiple regression analyses yielded nine predictors that explained 40.2% of the variance of the criterion. The best predictors of frequency of physician consultations were the duration of periods with symptoms and psychological factors, such as the severity of depression and the patients' views on the cause of their illness.
The psychopathology seen in people with functional gastrointestinal disorders is of two types: one is a characteristic of the illness itself and the other leads the individual to consult a physician. When gastroenterologists see patients with such disorders, they can assume that they may be dealing with a self-selected group of individuals with psychological stress. Psychological assessment would, therefore, be useful to determine whether a given individual with FGD might benefit from psychotherapy.
We used path analysis to model the effects of combat exposure, posttraumatic stress disorder (PTSD) symptoms, and health behaviors on physical health. Participants were 921 male military veterans from the Normative Aging Study. Their mean age at time of study was 65. Measures of combat exposure, PTSD symptoms, smoking, and alcohol problems were used to predict subsequent self-reported physical health status. Both combat exposure and PTSD were correlated with poorer health. In path analysis, combat exposure had only an indirect effect on health status, through PTSD, whereas PTSD had a direct effect. Smoking had a small effect on health status but did not mediate the effects of PTSD, and alcohol was unrelated to health status. We conclude that PTSD is an important predictor of physical health and encourage further investigation of health behaviors and other possible mediators of this relationship.
Background:
Neuropeptide-Y (NPY) is present in extensive neuronal systems of the brain and is present in high concentrations in cell bodies and terminals in the amygdala. Preclinical studies have shown that injections of NPY into the central nucleus of the amygdala function as a central anxiolytic and buffer against the effects of stress. The objective of this study was to assess plasma NPY immunoreactivity in healthy soldiers participating in high intensity military training at the U.S. Army survival school. The Army survival school provides a means of observing individuals under high levels of physical, environmental, and psychological stress, and consequently is considered a reasonable analogue to stress incurred as a result of war or other catastrophic experiences.
Methods:
Plasma levels of NPY were assessed at baseline (prior to initiation of training), and 24 hours after the conclusion of survival training in 49 subjects, and at baseline and during the Prisoner of War (P.O.W.) experience (immediately after exposure to a military interrogation) in 21 additional subjects.
Results:
Plasma NPY levels were significantly increased compared to baseline following interrogations and were significantly higher in Special Forces soldiers, compared to non-Special Forces soldiers. NPY elicited by interrogation stress was significantly correlated to the subjects' behavior during interrogations and tended to be negatively correlated to symptoms of reported dissociation. Twenty-four hours after the conclusion of survival training, NPY had returned to baseline in Special Forces soldiers, but remained significantly lower than baseline values in non-Special Forces soldiers. NPY was positively correlated with both cortisol and behavioral performance under stress. NPY was negatively related to psychological symptoms of dissociation.
Conclusions:
These results provide evidence that uncontrollable stress significantly increases plasma NPY in humans, and when extended, produces a significant depletion of plasma NPY. Stress-induced alterations of plasma NPY were significantly different in Special Forces soldiers compared to non-Special Forces soldiers. These data support the idea that NPY may be involved in the enhanced stress resilience seen in humans.
Clinical models of the human response to intense, acute stress have been limited to laboratory settings or cross sectional characterizations. As a result, data about the sensitivity of the human neuroendocrine activation to realistic stressors of varying magnitudes are limited. The U.S. Army survival course offers a unique opportunity to examine, in a controlled manner, the human response to acute, realistic, military stress.
Salivary data were collected in 109 subjects at baseline during four stress exposure time points and at recovery. Serum data was collected at baseline and recovery in 72 subjects and at baseline and during stress exposure in a subgroup of subjects (n = 21).
Cortisol significantly increased during the captivity experience and was greatest after subjects' exposure to interrogations. Cortisol remained significantly elevated at recovery. Testosterone was significantly reduced within 12 hours of captivity. Reductions of both total and free T4 and of total and free T3 were observed, as were increases in thyrotropin.
The stress of military survival training produced dramatic alterations in cortisol, percent free cortisol, testosterone, and thyroid indices. Different types of stressors had varying effects on the neuroendocrine indices. The degree of neuroendocrine changes observed may have significant implications for subsequent responses to stress.
Evidence from animal studies has led to the proposal that neuropeptide Y (NPY) has anxiolytic-like effects in rats after intracerebroventricular (i.c.v.) administration. The purpose of the present study was to extend these observations by examining the behavioral effects of a series of NPY receptor agonists including NPY, peptide YY (PYY), the NPY fragment 2-36 (NPY(2-36)), the Y(1) agonist [Leu(31), Pro(34)]-NPY and the Y(2) agonist NPY fragment 13-36 (NPY(13-36)), in two established anxiety models in rats: the elevated plus-maze and the fear-potentiated startle procedures. In the elevated plus-maze procedure, i.c.v. PYY (0.07-2.3nmol), NPY (0.07-2.3nmol), NPY(2-36) (0.07-2.3nmol). [Leu(31), Pro(34)]-NPY (0.7-7nmol), but not NPY(13-36) (0.7-7nmol), increased preference for the open arms of the plus-maze in a dose-dependent manner. In an acoustic startle paradigm, NPY, PYY and NPY(2-36) inhibited fear-potentiated startle over the dose-range of 0.23-2.3nmol. [Leu(31), Pro(34)]-NPY (2.3-13.2nmol) also attenuated fear-potentiated startle, whereas NPY(13-36) (up to 13.2nmol) had no effect. Taken together, these findings demonstrate that NPY, PYY and NPY(2-36) have anxiolytic-like effects that are likely mediated by Y(1) receptors.
Health Problems Checklist. Odessa, Fla, Psychological Assessment Resources
- J A Schinka
Schinka JA: Health Problems Checklist. Odessa, Fla, Psychological Assessment Resources, 1989
The Brief Trauma Questionnaire. White River Junction, Vt, National Center for PTSD
- P P Schnurr
- M J Vieilhauer
- F Weathers
- M Findler
Schnurr PP, Vieilhauer MJ, Weathers F, Findler M: The Brief
Trauma Questionnaire. White River Junction, Vt, National Center for PTSD, 1999
Childhood physical assault as a risk factor for
- Rd Duncan
- Be Saunders
- Dg Kilpatrick
- Rf Hanson
- Hs Resnick
- Ptsd
- Depres-Morgan
- Wang Hazlett
- Et Al
Duncan RD, Saunders BE, Kilpatrick DG, Hanson RF, Resnick
HS: Childhood physical assault as a risk factor for PTSD, depres-
MORGAN, HAZLETT, WANG, ET AL.
Plasma neuropeptide-Y in humans exposed to acute uncontrollable stress
- C A Morgan
- Iii
- S Wang
- S M Southwick
- A Rasmusson
- R Hauger
- D S Charney
Morgan CA III, Wang S, Southwick SM, Rasmusson A, Hauger R,
Charney DS: Plasma neuropeptide-Y in humans exposed to
acute uncontrollable stress. Biol Psychiatry 2000; 47:902-909
Childhood physical assault as a risk factor for PTSD, depres
- Rd Duncan
- Be Saunders
- Dg Kilpatrick
- Rf Hanson
- Hs-Morgan Resnick
- Wang Hazlett
- Et Al
Duncan RD, Saunders BE, Kilpatrick DG, Hanson RF, Resnick
HS: Childhood physical assault as a risk factor for PTSD, depres-
MORGAN, HAZLETT, WANG, ET AL.
sion, and substance abuse: findings from a national survey
sion, and substance abuse: findings from a national survey. Am
J Orthopsychiatry 1996; 66:437-448