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PSYCHOLOGICAL TRAUMA
Allen, SN; Bloom, SL. Group and family treatment of post traumatic
stress disorder. Psychiatr Clin North Am. 1994 Jun; 17(2): 425-37.
A central feature of PTSD is its effect on social relationships.
Trauma affects groups of people, not just individuals. Family systems,
neighborhoods, and even whole generations may feel the results of
psychological trauma. Because of the social nature of the effects of
trauma, post-trauma treatment must address an individual's
relationship to others. Group and family psychotherapy are ideally
suited to this and are important components of a multimodal approach
to PTSD treatment. Group and family psychotherapies provide superb
opportunities for social support, social reintegration, and
interpersonal learning. As with any powerful technique, these methods
must be carefully applied. Although not all patients are appropriate
for exposure-based treatments, improved interpersonal coping skills
will likely be beneficial to many PTSD patients. Patients should be
carefully evaluated for treatment types and assessed for treatment
response. Although group and family therapies currently provide relief
and growth for PTSD patients, many considerations remain for the
future. For example, how can patients be matched with various
treatments for optimal results? How should acute and chronic PTSD
treatments be similar and different? What is the effectiveness of
group and family therapies for PTSD? What are the social and legal
implications of a prolonged course of treatment for a victim whose
children meanwhile are being traumatized by the parent's relatively
poor parenting skills secondary to their inadequacies and
disabilities? Finally, at a global level, how do we improve systems
therapy technology to enable us more radically, effectively, and
quickly to bring about total systems change? Because families and
groups are the "cells" that compose the "vital organs" we call
nations, and these nations in turn make the total body of humankind,
the answers to these questions may have a significant determining
effect on the future survival of us all.
Anderson, CT. Premedication for the pediatric patient: new and old
drugs. Nurse Anesth. 1990 Dec; 1(4): 195-205.
Over the last 15 years a rapid growth has occurred in the number of
pediatric patients that are encountered in the operating room. A
developing sophistication on the part of both children and parents,
coupled with a rapidly expanding recognition of the need to minimize
the amount of physical and psychological trauma that a child has to
experience, has led to a growing use of premedication agents for
children. A review of the premedication agents currently in use, their
various routes of administration, as well as their associated benefits
and risks, is presented.
Aspinall, CL. Family focused ethics. Cleft Palate Craniofac J. 1995
Nov; 32(6): 507-9.
It is my intent to explore the family, parent, patient, social work
relationships as a focus central to the solution of ethical dilemmas.
In today's environment, patient selection continues to reflect
persistent patterns of biased allocation of services. The ability of a
family to make a decision about medical treatment begins with an
understanding of how choices regarding that treatment are shared.
Without taking appropriate precautions, an increased risk arises of
providing surgical procedures involving real medical risk, yet
unresolved psychological trauma remains unassessed. The unrelenting
questions of, When?, How?, and Why?, a family should be involved in
the process of ethical decision-making, begs the inherent prejudice
involved.
Bachelot, A.; Fernandez, H.; Job, Spira N. [Experience of ectopic
pregnancy]. Contracept Fertil Sex. 1994 Jul-Aug; 22(7-8): 478-84.
This survey relates to the experience and the management of women who
have received a treatment for an ectopic pregnancy. It is based on 31
clinical interviews, conducted a month after the end of surgical or
medical treatment. Among these women, 42% had had previous treatment
for sterility. The main results show that 16% had never previously
heard of ectopic pregnancy, and 29% do not see any reason why they had
had one. For the patients, the diagnosis had not been made early
enough: 45% feel that the consequences could have been serious if they
had not taken the matter seriously themselves. Women clearly express
some strong feeling against the health professionals (74%) who were
responsible for their medical care, in spite of the attention they
received, which reveals the psychological trauma they suffered.
Although 55% of women felt depressed, for some of them the ectopic
pregnancy seemed to operate as an exorcism from a previous more
serious situation. They place their hope in a future pregnancy under
close medical supervision. When it appears necessary, psychological
support should be offered to these patients.
Beahrs, JO. Spontaneous hypnosis in the forensic context. Bull Am Acad
Psychiatry Law. 1989; 17(2): 171-81.
"Hypnosis" denotes either specific phenomena (altered volition,
perception, cognition, and recall) or interpersonal transactions that
often elicit them. Basic research leads to paradox: hypnosis is
validated, and shown to be dissociative in essence, at the same time
that neither its phenomena nor transactions can be separated from
those of everyday living without logical absurdity. This paradox can
be resolved by assuming that consciousness and volition are complex,
occurring simultaneously at many levels in the same waking individual.
Hypnotic-like phenomena and transactions occur spontaneously, in
either covert or overt forms. The former are pervasive, whereas the
latter are often associated with psychological trauma. Forensic
implications are twofold: for criminal responsibility, and the
reliability of eyewitness testimony. Hypnotic-like states and
transactions are rarely affirmed as an insanity defense because at
some level these subjects are aware of what they are doing and why.
Diminished capacity and mitigation of sentence are more appropriate
defense strategies. Several conflicted traditions of case law have
evolved to protect eyewitness testimony from hypnotic-like distortions
in cognition, perception, and memory that can occur either during or
outside of formal hypnotic procedures. These include the admissibility
of posthypnotic testimony, due process safeguards at eyewitness
identification procedures, and the admissibility of expert testimony
on the findings of eyewitness research. These areas are inseparable
from one another and demand a systematic coordinated approach.
Begin, S.; Gregoire, M. [Causal relations of occupational psychiatric
disability]. Can J Psychiatry. 1991 Sep; 36(7): 485-91.
This article discusses a problem that is relatively common in
psychiatric practice, but almost non existent in the literature i.e.,
an occupational disability arising from a psychological trauma. This
inquiry focuses on an area in which millions of dollars a year are at
stake. Legislative and administrative authorities are increasingly
demand that psychiatrists define objective criteria on which
legislators can base decisions in contentious cases. What is the
connection between the trauma and the current disability, and what is
the risk of reoccurrence? Will the employee be able to resume his or
her former duties? It quickly becomes clear that clinical,
administrative and legislative realities are often incompatible. This
article will therefore provide an overview of the subject in a
historical perspective, and to orient the reader, will briefly
describe the legislative context in the US and Quebec, as well as the
role of the expert in assessing causality. We will attempt, by means
of an overall conceptual model, to provide a synopsis of the usual
procedure in this type of expert assessment.
Bokey, K. Conversion disorder revisited: severe parasomnia discovered.
Aust N Z J Psychiatry. 1993 Dec; 27(4): 694-8.
In light of recently described and reviewed disorders of movement and
behaviour during sleep, the long standing diagnosis of conversion
disorder in a forty-nine year old Vietnam veteran was reappraised.
Polysomnographic studies showed that the nocturnal component of his
"pseudoseizures" was due to physical disorder, a severe mixed
parasomnia comprising the recently described REM behaviour disorder
and a non-REM parasomnia. His sleep architecture was also deranged,
featuring reduced REM latency and increased REM density. An
association between these abnormalities and psychological trauma is
recognised in the literature. Treatment with clonazepam has abolished
the nocturnal behavioural disturbance. His daytime pseudoseizures
occur less frequently and his general well being is improved. The case
is a reminder that physical disorder may underlie and act as prototype
to the psychologically-driven symptom. Before attributing behavioural
disturbance at night to psychological causes alone, polysomnographic
studies should be done to exclude a treatable parasomnia.
Briere, J.; Runtz, M. Augmenting Hopkins SCL scales to measure
dissociative symptoms: data from two nonclinical samples. J Pers
Assess. 1990 Fall; 55(1-2): 376-9.
A 13-item Dissociation scale is introduced, and preliminary data
regarding its reliability are presented. Designed to complement the
Symptom Checklist (SCL-90; Derogatis, Lipman, & Covi, 1973) and the
Hopkins Symptom Checklist (HSCL; Derogatis, Lipman, Rickels, Ulenhuth,
& Covi, 1974), this scale may be especially useful in research on the
effects of psychological trauma.
Brown, S. Alcoholism and trauma: a theoretical overview and
comparison. J Psychoactive Drugs. 1994 Oct-Dec; 26(4): 345-55.
This article outlines a theoretical overview of evolving conceptions
of trauma and their application to alcoholism. Traditional definitions
of trauma are reviewed and Judith Herman's theory of psychological
trauma and the process of recovery are summarized. This framework is
used to describe the experience of being alcoholic, the child of an
alcoholic (COA), the adult child of an alcoholic parent (ACA), and of
being both alcoholic and an ACA. The developmental process of recovery
within the 12-Step framework is compared to Herman's stages of trauma
resolution. It is argued that trauma theory must be expanded to
adequately described and explain the experiences of alcoholism and
that issues of power and control must be reinterpreted to fit within
the 12-Step model. This article posits that trauma theory offers an
important link between the professional worlds of chemical dependency
treatment and mental health.
Darves, Bornoz JM; Benhamou, Ayache P.; Degiovanni, A.; Lepine, JP;
Gaillard, P. [Psychological trauma and mental disorders]. Ann Med
Psychol Paris. 1995 Jan; 153(1): 77-80; discussion 80-1.
Fifty-eight female impatients consecutively hospitalized in the
University Hospital Department of Psychiatry in Tours were interviewed
with a clinician battery of instruments (among them, the SI-PTSD by
Davidson). The diagnoses leading to hospitalization were: severe
disorders of psychotic type (schizophrenic, schizophreniform,
schizo-affective, schizoid and paranoid delusional disorders as well
as bipolar disorder), borderline and narcissistic personalities for
7%, and other disorders for 53%. Among the results, we observed that
59% of these patients had experienced at least one major stressful
event (rape 26%, other sexual assault 29%, physical assault 31%,
seeing somebody dying in a violent way 8%, war scene 2%, injured in an
accident 2%). As a consequence, 61% of the victims have suffered from
PTSD and the diagnosis of PTSD was still present in 21%. In addition,
in the victims, somatoform and dissociative disorders were
significantly more frequent.
Darves, Bornoz JM; Berger, C.; Degiovanni, A.; Soutoul, JH; Gaillard,
P. [Treating psychic traumas: a psychiatric emergency]. Ann Med
Psychol Paris. 1994 Nov; 152(9): 649-52.
Interest for the psychopathological field of trauma has experienced a
revival over the last fifteen years. Early and active treatment of
victims is necessary to attenuate the psychopathological consequences
of trauma. However, emergency psychiatry still rarely places a high
value on it. This paper presents a case which contains in itself many
aspects of psychological responses to psychologically traumatizing
events. Trauma induced in this case, in particular, Dissociative
Disorders (including a Dissociative Fugue), a Post-Traumatic Stress
Disorder, Somatoform Disorders and Phobic Disorders. This case gives
us the opportunity to situate the psychiatric
emergency--"psychological trauma"--and to illustrate our talk with
regard to the principles of mid-term and emergency treatment of
victims.
De, Carmoy R. [Anxiety and reconstructive surgery in children and
adolescents]. Psychiatr Enfant. 1995; 38(1): 141-202.
Study of 133 children and adolescents hospitalized and operated in
child and adolescent reconstructive surgery. We will study the fantasy
representations of anxiety as it is expressed by this population, as
well as the psychological repercussions of surgical interventions:
behavior disorders, depression, anxiety. We will show that
pre-adolescents and adolescents represent the most vulnerable patients
in regard to the anxiety triggered by the surgical act and that some
of them experience, at the time of the operation, episodes of psychic
disorganization of psychotic appearance. We will look into the impact
of this mutilating surgery and the weight of severe orthopedic
handicaps, and have noted that the expression of anxiety isn't always
in relation to the seriousness of the handicap and/or that of the
intervention. The anxiety is linked to the psychological balance of
the child which is largely due to the relationship he has with his
parents and the feeling of self-esteem that the child has if he is
accepted as he is. The surgeon seems to us like an important element
in the dynamic of the way anxiety is dealt with since the patient and
his parents establish a truly transferential bond to him that is of
great intensity. The number of school problems, relational and
behavioral difficulties and depressive reactions noted in this
population shows that reconstructive surgery is very disorganizing for
the personality and acts as a psychological trauma.
De, Mol J. [Clinical and psychometric study of post traumatic stress
disorders following acts of violence]. Rev Med Brux. 1994 May-Jun;
15(3): 118-23.
Fifty victims of assaults and hold-ups underwent a medical and
psychological examination in order to assess the semiological and
psychometric features of post-traumatic stress disorder: 27 males and
23 females with a mean age of 41 years were examined 18 months after
the traumatic event. The following semiology was observed:
excitability, phobic avoidance, distrust, recurrent traumatic
nightmares, difficulties in concentration, impaired memory, dysphoric
mood, hyperfatigability, recurrent recollection of the traumatic
event, headache, middle and terminal sleep disturbances and
neurovegetative hyperreactivity. Testing demonstrated anxious and
depressive troubles and moderate cognitive disturbances. Statistical
study showed no correlation between type of aggression (psychological
trauma with or without concomitant physical component) and cognitive
and psycho-affective variables. Most of the cognitive disturbances
were correlated with the severity of anxiety and depression.
Post-traumatic stress disorder also perturbed the work capacity: only
8 patients resumed previous activities after a lapse of time of 1-54
months.
Duckworth, DH. Managing psychological trauma in the police service:
from the Bradford fire to the Hillsborough crush disaster [see
comments]. J Soc Occup Med. 1991 Winter; 41(4): 171-3.
Particularly since the Bradford football stadium fire of May 1985, the
UK Police Service has been developing increasingly sophisticated
procedures for managing post-traumatic stress reactions in its
officers. Coupled with the growth of dedicated occupational health
units within the Police Service, this suggests that physicians working
within police forces will have an increasingly important role to play
in the management of such problems. A brief account is given of the
confidential screening and counselling service for police officers
that was instituted after the Bradford fire, and a corresponding
description is given of the more elaborate procedures implemented
after the Hillsborough football stadium crush disaster of April 1989.
In conclusion, the possible scope for preventive management of
Post-traumatic stress disorder (PTSD) is highlighted.
El, Bassel N.; Gilbert, L.; Schilling, RF; Ivanoff, A.; Borne, D.;
Safyer, SF. Correlates of crack abuse among drug using incarcerated
women: psychological trauma, social support, and coping behavior. Am J
Drug Alcohol Abuse. 1996 Feb; 22(1): 41-56.
This investigation examines the relationship between psychological
trauma and crack abuse among 158 women with a recent history of drug
use who were incarcerated in a New York City jail facility.
Interviewers obtained data on demographics, drug use, psychological
trauma history, criminal history, social support, and coping behavior
variables. Three-fourths of the total sample had used crack three or
more times a week for a month in the past; a quarter had used other
drugs, predominantly heroin, three or more times a week for a month in
the past. Multiple logistic regression analysis was used to assess the
association between adult psychological trauma variables (loss of
custody of youngest child and lived in streets prior to arrest) and
regular crack use in three sequential models. After adjusting for
social support, coping behavior, demographics, and criminal history
variables, women who had lost custody of their youngest child were 3.3
times more likely to be regular crack uses. Women who demonstrated
more negative coping behavior and perceived themselves as having less
emotional support were also more likely to be regular crack users. The
association between childhood traumas (i.e., childhood sexual abuse,
childhood physical abuse, parental alcohol abuse) and regular crack
use was also assessed using multiple logistic regression; however, no
significant associations were found between these childhood
psychological traumas and regular crack use in both the unadjusted and
adjusted models. Study findings underscore the importance of assessing
environmental, interpersonal, and intrapersonal factors in tailoring
treatment strategies for users of crack and other drugs.
Elbedour, S.; Ten, Bensel R.; Bastien, DT. Ecological integrated model
of children of war: individual and social psychology. Child Abuse
Negl. 1993 Nov-Dec; 17(6): 805-19.
The psychological trauma associated with war is a topic that has
occupied the attention of mental health researchers and practitioners
for some time. Most of their attention, though, has focused on the
traumatic stress of soldiers, and little attention has been paid to
the problems and traumatization of civilians caught in war zones,
especially the children. In this paper, the limited research on
children of war is reviewed, and themes are extracted. Children suffer
from both acute and chronic traumatic stress. The key to determining
the amount of suffering has to do with the dynamic interaction among
five processes within an ecological framework: the child's
psychobiological makeup, the disruption of the family unit, the
breakdown of community, and the ameliorating effects of culture. The
intensity, suddenness and duration of the war-like experience itself
constitute an additional component to this ecological model. In the
final section, psychotherapeutic guidelines to help children cope with
symptoms associated with war are presented for current and future
caregivers. The prevention of war should be the primary task of all.
Farberow, NL; Gallagher, Thompson D.; Gilewski, M.; Thompson, L.
Changes in grief and mental health of bereaved spouses of older
suicides. J Gerontol. 1992 Nov; 47(6): P357-66.
Comparisons are made of the impact of a suicide death on the surviving
spouse (55 years and older) with that of a natural death on spouse
survivors and a married nonbereaved control group over a bereavement
period of 2 1/2 years after death. Regardless of mode of death, the
loss of a loved one is a difficult psychological trauma, accompanied
by depression, confusion, and pervasive feelings of emptiness. Few
differences in the impact of the deaths in the early months of
bereavement were reported, but changes appeared over the course of the
2 1/2-year measurement period. Compared with natural death survivors,
the process of bereavement was found to be more difficult for the
survivors of a suicide death, whose severe depressive feelings do not
seem to lessen significantly and whose feelings of mental health do
not seem to improve until after the first year. Women, in general,
report greater feelings than men of anxiety, tension, and
apprehension, especially within the first 6 months. By the end of the
observation period, most of the differences between the two bereaved
groups have disappeared, and both report functioning adequately
despite continuing feelings of sadness and loss.
Fierman, EJ; Hunt, MF; Pratt, LA; Warshaw, MG; Yonkers, KA; Peterson,
LG; Epstein, Kaye TM; Norton, HS. Trauma and posttraumatic stress
disorder in subjects with anxiety disorders. Am J Psychiatry. 1993
Dec; 150(12): 1872-4.
Trauma histories were obtained from 711 subjects in a large study of
anxiety disorders, with the intent of determining the prevalence and
nature of psychological trauma in this group. Twenty-seven percent of
subjects reported significant trauma; 35% of these (10% of all
subjects) met DSM-II-R criteria for posttraumatic stress disorder
(PTSD). Subjects reporting sexual trauma were significantly more
likely to have PTSD. The rate of PTSD was not higher in subjects with
panic disorder than in those with other anxiety disorders.
Gauderer, MW; Lorig, JL; Eastwood, DW. Is there a place for parents in
the operating room? J Pediatr Surg. 1989 Jul; 24(7): 705-6; discussion
707.
The presence of a parent in the operating room (OR) during induction
of anesthesia is controversial. In order to assess the feasibility,
safety, and acceptance of this practice, we evaluated a near-4-year
experience with 3,086 patients less than 15 years of age, who were
operated on at a free-standing ambulatory surgical center. The age
distribution was: 1 to 23 months, 790; 2 to 5 years, 1,190; 6 to 10
years, 775; and 10 to 15 years, 331. The distribution of patients by
service was: otorhinolaryngology, 1,597; pediatric surgery, pediatric
urology, and plastic surgery, 948; ophthalmology, 443; orthopaedics,
72; and dental, 26. No premedication was employed. Anesthetic gases
were delivered via a mask while the parent held or remained close to
the child. Vascular access was established after the induction. Only
five patients (tonsillectomy, four; circumcision, one) were admitted
to the base hospital and subsequently discharged. Advantages of
parental presence in the OR during anesthesia induction are decreased
psychological trauma (child), smoother induction (child), and
decreased parental anxiety. Possible disadvantages include disruption
of OR routine, unpredictability of parental behavior, and increased
time and cost. Because of careful preoperative preparation of parents
by the nurses and anesthetists, the first three problems rarely
occurred. The cost of supplies used by each parent was minimal.
Practically all parents chose to accompany the child to the OR. The
feedback during follow-up from those parents has been excellent.
Nurses, anesthesiologists, and surgeons are enthusiastic about the
program. In the examined setting, this approach has proven safe,
simple, and effective.
Gerlock, AA. Veterans' responses to anger management intervention.
Issues Ment Health Nurs. 1994 Jul-Aug; 15(4): 393-408.
Anger management intervention is an integral part of posttraumatic
stress disorder (PTSD) treatment in the Department of Veterans Affairs
facilities across the country. However, the efficacy of such
intervention has received little scientific study. This study was
undertaken to describe the 51 male veterans who sought anger
management intervention from March 1990 to March 1992 and to measure
the efficacy of that intervention. The average participant was exposed
to combat and was diagnosed with PTSD. The majority had a past or
present substance abuse problem and described incidents of childhood
trauma. Participants were tested at the first and final classes
(State-Trait Anger Scale). Paired t-test analysis indicated a
significant drop in both state- and trait-anger. Analysis of variance
comparisons revealed that veterans with past psychological trauma had
persistently higher mean anger scores than those without past trauma.
Goodman, L.; Saxe, L.; Harvey, M. Homelessness as psychological
trauma. Broadening perspectives. Am Psychol. 1991 Nov; 46(11):
1219-25.
Most mental health literature on homelessness has focused on
characteristics that may be risk factors for homelessness. The authors
of this article argue that homelessness itself is a risk factor for
emotional disorder and use the construct of psychological
trauma--focusing on social disaffiliation and learned helplessness--to
understand the potential effects of homelessness. Psychological trauma
is likely among homeless individuals and families for three reasons.
(a) The sudden or gradual loss of one's home can be a stressor of
sufficient severity to produce symptoms of psychological trauma. (b)
The conditions of shelter life may produce trauma symptoms. (c) Many
homeless people--particularly women--become homeless after
experiencing physical and sexual abuse and consequent psychological
trauma. Research suggests that negative psychological responses to
traumatic events can be prevented or mitigated by a supportive and
empowering posttrauma environment. The implications of trauma theory
for improving the psychosocial conditions of homeless people are
discussed.
Gould, BB; Gould, JB. Young people's perception of the space shuttle
disaster: case study. Adolescence. 1991 Summer; 26(102): 295-303.
To explore how young people were affected by the space shuttle
disaster, the responses of 79 females in 5th, 8th, and 12th grades and
18 males in 5th grade who had witnessed the event on video at school
were examined. Six days after the Challenger accident, they were asked
to list and rank the three things that had affected them most over the
last seven days and to explain the reason behind their first choice.
Only 8.9% of the females ranked the space shuttle first, and only
30.4% ranked it in the top three. Competing issues were school-related
activities, grades, and family relations. Of the 5th-grade males,
88.9% mentioned the space shuttle and 38.9% saw it as their top
concern. For both males and females, this choice was based on sadness
and empathy. The youths did not relate the disaster to the fragility
of modern technology or the threat of nuclear war. The relatively low
response rate of the females who had witnessed this event was
interpreted as being indicative of repression-denial. It was concluded
that future research should address the extent to which post-crisis
denial could be masking more significant psychological trauma in
youth.
Halbreich, U.; Olympia, J.; Carson, S.; Glogowski, J.; Yeh, CM;
Axelrod, S.; Desu, MM. Hypothalamo pituitary adrenal activity in
endogenously depressed post traumatic stress disorder patients.
Psychoneuroendocrinology. 1989; 14(5): 365-70.
We studied the hypothalamo-pituitary-adrenal (HPA) system in Vietnam
veterans with post-traumatic stress disorder (PTSD) who also met
Research Diagnostic Criteria for endogenous depression (MDD-ED). Over
half also abused alcohol, and many complained of pain-confounding
factors usually associated with increased HPA activity. Nonetheless,
not even one patient had elevated basal plasma cortisol concentrations
or an abnormal dexamethasone suppression test (DST); the subjects'
post-dexamethasone cortisol values and plasma cortisol per ng plasma
dexamethasone were in the low-normal range. These results highlight
the biological heterogeneity of endogenous depression and its possible
influence by past psychological trauma, and they raise questions about
the use of current typological criteria for research purposes.
Henry, JP. Psychological and physiological responses to stress: the
right hemisphere and the hypothalamo pituitary adrenal axis, an
inquiry into problems of human bonding. Integr Physiol Behav Sci. 1993
Oct-Dec; 28(4): 369-87; discussion 368.
In addition to repeated reexperiencing of the event, the delayed
effects of severe psychological trauma, i.e., post traumatic stress
disorder (PTSD), present a paradoxical mix of symptoms. There is
enhancement of the self-preservative catecholamine states; anger and
fear with a contrasting sense of meaninglessness and a blunting of the
emotional responses of the attachment behavior so critical for species
preservation. Hormonally, there is a striking separation of the
catecholamine response, which stays elevated and that of the
hypothalamo-pituitary-adrenal (HPA) axis, which may remain at normal
levels. Pathophysiologically, the reexperiencing of the trauma and the
arousal may be associated with dysfunction of the locus coeruleus,
amygdala and hippocampal systems. This article explores the
consequences of an additional dysfunction: a dissociation of the
hemispheres that appears to be responsible for the alexithymic
avoidance and failure of the cortisol response that so often follow
severe psychological trauma. There is neurophysiological evidence that
the left and right hemispheres subserve different emotional sets that
correspond to "control" and "appraisal," i.e., very approximately to
the self and species preservative behavioral complexes, respectively.
Several studies point to physiological dissociation of hemispheric
functions during alexithymia. This raises the question: What has been
lost if in this condition the right side no longer fully contributes
to integrated cerebral function? Right hemispheric damaged children
lose critical social skills and in adults the related sense of
familiarity critical for bonding is lost. Such losses of social
sensibilities may account for the lack of empathy and difficulties
with bonding found in sociopathy and borderline personality:
conditions now believed to result from repeated psychological trauma
during development. On the other hand, systems that promote right
hemispheric contributions provide solacing access to a "Higher Power."
They also appear to protect against socially disordered behavior,
substance abuse, the failure of the HPA axis and some aspects of the
pathophysiology of chronic disease.
Herman, JL. Crime and memory. Bull Am Acad Psychiatry Law. 1995;
23(1): 5-17.
The conflict between knowing and not knowing, speech and silence,
remembering and forgetting, is the central dialectic of psychological
trauma. This conflict is manifest in the individual disturbances of
memory, the amnesias and hypermnesias, of traumatized people. It is
manifest also on a social level, in persisting debates over the
historical reality of atrocities that have been documented beyond any
reasonable doubt. Social controversy becomes particularly acute at
moments in history when perpetrators face the prospect of being
publicly exposed or held legally accountable for crimes long hidden or
condoned. This situation obtains in many countries emerging from
dictatorship, with respect to political crimes such as murder and
torture. It obtains in this country with regard to the private crimes
of sexual and domestic violence. This article examines a current
public controversy, regarding the credibility of adult recall of
childhood abuse, as a classic example of the dialectic of trauma.
Hershberger, PJ. Information loss: the primary psychological trauma of
the loss of vision. Percept Mot Skills. 1992 Apr; 74(2): 509-10.
A psychology of blindness is proposed that contends that information
loss is the most critical trauma of the loss of vision. The magnitude
of information loss is emphasized with respect to vision as the
primary sensory modality for obtaining information. Further, the vital
role of access to information in human development and the tendency to
seek information to cope with stressful circumstances are addressed.
Implications for rehabilitation of blind persons are discussed.
Hutson, HR; Anglin, D.; Spears, K. The perspectives of violent street
gang injuries. Neurosurg Clin N Am. 1995 Oct; 6(4): 621-8.
Street gang violence has become a major public health problem in the
United States, especially in the inner city. To prevent gang violence,
one must understand the many facets of violent street gang activity
and the psychological effects of gang violence on individuals as well
as on the community. Further, one must have an understanding of the
root causes of violent street gang formation, the relationship of
firearms to gang violence, and the medical cost of these types of
injuries. Prevention should begin with alleviating the root causes of
violent street gang formation and include breaking the bonds of
violent street gang membership. Adults acknowledge a societal
obligation to protect and guide children and adolescents as an
investment in the future. Because both children and adolescents lack
judgment and experience, they cannot be expected to avoid injury and
violence on their own. Although the financial cost of preventing gang
violence would not be insignificant, the savings in terms of lives and
medical expenditure would be immense. Unless steps are taken to end
the physical and psychological trauma, regions of the United States,
such as Los Angeles County, will not be safe from the effects of gang
violence.
Jones, SM; Fiser, DH; Livingston, RL. Behavioral changes in pediatric
intensive care units. Am J Dis Child. 1992 Mar; 146(3): 375-9.
OBJECTIVE--The purposes of this study were to compare the frequency
and severity of manifestations of anxiety, depression, delirium, and
withdrawal in pediatric patients hospitalized in intensive care unit
vs ward settings and to evaluate the impact of preexisting
psychopathologic disorders on the expression of these symptoms.
RESEARCH DESIGN--Prospective patient series. SETTING--Tertiary care
pediatric center. PATIENTS--Forty-three subjects aged 6 to 17 years
hospitalized in either the pediatric or cardiovascular intensive care
unit (n = 18) or on the general wards (n = 25) were recruited to
participate. Subjects were excluded if their parents were unavailable
for diagnostic interview or if they could not answer interview
questions themselves. SELECTION PROCEDURES--Consecutive sample.
INTERVENTIONS--None. MEASUREMENTS AND RESULTS--The Hospital Observed
Behavior Scale, developed for this study, was used to describe
objectively subjects' manifestations of anxiety, depression, delirium,
and withdrawal. The Diagnostic Interview for Children and Adolescents
and Diagnostic Interview for Children and Adolescents-Parents were
used to determine the presence of preexisting psychopathologic
disorders. As measured by the Hospital Observed Behavior Scale,
subjects in the intensive care unit exhibited apprehension, anxiety,
detachment, sadness, and weeping more often than did patients in the
ward. Behavior was also significantly influenced by severity of
illness, duration of hospitalization, number of previous
hospitalizations, and presence of a preexisting anxiety or mood
disorder. We found the Hospital Observed Behavior Scale to have good
interrater reliability. CONCLUSIONS--Our data indicate that critically
ill children in the intensive care unit, children with prolonged or
repeated hospitalizations, and children with preexisting anxiety and
mood disorders are at greater risk than other hospitalized pediatric
patients for psychological trauma and/or behavior problems that may
warrant psychiatric intervention. The Hospital Observed Behavior Scale
is a reliable tool to quantitate behaviors in hospitalized children.
Kolakowski, A.; Liwska, M.; Wolanczyk, T. [Elective mutism in
children: literature review]. Psychiatr Pol. 1996 Mar-Apr; 30(2):
233-46.
This paper presents contemporary opinions about selective mutism in
children, including epidemiology, etiology, clinical features and
therapy. This is the first extensive review on this topic in Polish
literature. The essential feature of selective mutism is persistent
failure to speak in social situations, where speaking is expected
(e.g., in school), despite speaking in other situations (e.g., at
home). The authors present the diagnostic criteria according do DSM-IV
and suggested by other authors. Clinical characteristics of this
disorder were also presented, including personality traits and
behaviour of mutistic children (different at home and in unfamiliar
environment) and comorbidity of selective mutism. Etiology of this
disorder seems to be multifactorial. The important etiological factors
are: minimal brain dysfunction, somatic or psychological trauma,
particularly during the speech development and a family structure,
especially the mother-child relation. The authors emphasize that
mutism in children is a heterogeneous symptom and present several
models of mutism. The paper describes also different methods of
treatment (e.g., behavioral, psychodynamic, family therapy and some
case reports on pharmacotherapy); and long-term prognosis.
Lewis, CN. Psychological assessment of an artist and impostor. J Pers
Assess. 1990 Summer; 54(3-4): 656-70.
A Rorschach record and a narrative poem are examined to determine how
imagination expresses the psychological trauma of being exposed as an
impostor. The subject had been trained as a medical corpsman and
deceived people under the grandiose fantasy of being a doctor. The
role of the impostor physician is seen as an imaginative identity that
was designed with an adaptive purpose. A Jungian analysis of his
suicide attempt and the Rorschach suggest that the impostor role was a
masculine compensatory fantasy that served as a counterforce to
negative maternal imagery, linked to death, that is present in his
imagination.
Manning, SC; Casselbrant, M.; Lammers, D. Otolaryngologic
manifestations of child abuse. Int J Pediatr Otorhinolaryngol. 1990
Sep; 20(1): 7-16.
The number of reported cases of child abuse has increased dramatically
over the past several years. Maltreatment of children can take several
forms including neglect, sexual abuse, physical assault and
psychological trauma. Five cases of child abuse presenting initially
to the Otolaryngology Service are outlined: bilateral auricular
hematomas, recurrent tympanic membrane lacerations, a pharyngeal
laceration with retropharyngeal abscess and medical neglect of a
patient with a parotid malignancy and one with laryngeal
papillomatosis. Characteristic presentations and risk factors in
family background are discussed toward the goal of early recognition
and appropriate intervention.
Miller, KE. The effects of state terrorism and exile on indigenous
Guatemalan refugee children: a mental health assessment and an
analysis of children's narratives. Child Dev. 1996 Feb; 67(1): 89-106.
This study examined the mental health and psychosocial development of
58 Guatemalan Mayan Indian children living in 2 refugee camps in the
Mexican state of Chiapas. Conventional assessment instruments were
adapted for use in this unique context, and semistructured interviews
were utilized to gather phenomenological data from children regarding
various developmental, sociocultural, and political topics. Data are
presented that show minimal evidence of psychological trauma in this
sample, and various factors are suggested to account for this finding.
In addition, data are presented showing a positive relationship
between children's mental health and the health status (physical and
mental) of their mothers. In particular, a strong association was
found between depressive symptomatology in girls and poor health
status in their mothers. Qualitative data from the interviews are
presented, focusing on children's understandings of why their families
fled Guatemala, the nature and causes of the violence, and their
thoughts and feelings regarding the prospect of returning to Guatemala
at some future point.
Miller, TW; Kamenchenko, P.; Krasniasnski, A. Assessment of life
stress events: the etiology and measurement of traumatic stress
disorder. Int J Soc Psychiatry. 1992 Autumn; 38(3): 215-27.
The impact of stressful life events on health has been of considerable
interest from a cross-cultural perspective. Examined herein is the
etiology and onset of post-traumatic stress disorder with careful
review of the diagnostic criteria, current measures used and clinical
dimensions of PTSD. Also examined from a cross-cultural perspective is
how psychological trauma may be processed by victims of trauma and
subsequent approaches both pharmacological and psychotherapeutic to
the treatment of post-traumatic stress disorder.
Moscarello, R. Posttraumatic stress disorder after sexual assault: its
psychodynamics and treatment. J Am Acad Psychoanal. 1991 Summer;
19(2): 235-53.
Sexual assault as a major psychological trauma and a crime of violence
evokes immediate symptoms of posttraumatic stress and, for many
victims, long-term posttraumatic psychological sequelae. The victim,
as the recipient of the rapist's anger and need to control,
experiences terror, fear of death, and helplessness. This results in
classic posttraumatic symptoms of haunting, intrusive recollections,
numbing or constriction of feelings and focus, and increased arousal.
When this psychological trauma is not integrated, anxiety, depression,
phobias, impaired sexual and social adjustment, negative self-image,
and diminished capacity to enjoy life follow. Concepts of
posttraumatic stress are reviewed and a definition of sexual assault
is offered. The posttraumatic stress response to sexual assault is
considered under the phases of response and symptoms, followed by the
psychodynamics of this particular psychic trauma. A brief overview of
treatment is outlined.
Okasha, A.; Omar, AM; Lotaief, F.; Ghanem, M.; Seif, El Dawla A.;
Okasha, T. Comorbidity of axis I and axis II diagnoses in a sample of
Egyptian patients with neurotic disorders. Compr Psychiatry. 1996
Mar-Apr; 37(2): 95-101.
Neurosis and personality disorder (PD) are two of the most used but
least clarified and understood terms in psychiatry. The separation of
PD by the American Psychiatric Association in DSM-III and -IV as a
discrete axis of classification has been a major advance in
psychiatric nosology. Also with the advent of DSM-III and its
multiaxial system, it was recognized that both PD and clinical
syndromes can coexist, and in some cases this coexistence may have
implications on treatment response and prognosis. This study was
performed on 200 neurotic patients in an attempt to investigate
possible correlations between various neurotic subcategories and
personality types. Our results confirm that PD and personality
abnormality are significantly higher in neurotic patients than in
controls and need to be considered in diagnostic assessment. Some
comorbidity was shown between borderline PD and somatoform disorder;
compulsive PD and obsessive-compulsive disorder (OCD), and generalized
anxiety disorder (GAD); and avoidant PD and phobia. However, our data
failed to show a correlation between the presence of an additional PD
and particular neurotic symptomatology. It seems that the association
between neurotic disorders and PD should not be taken to indicate a
direct causative relationship. It is likely that personality is just
one of the predisposing factors that influence the individual response
to psychological trauma and determine the form of neurosis. The most
prevalent PD was found to be PD NOS, followed by borderline,
compulsive, avoidant, and finally histrionic PDs. The term, multiple
PD, should be given substance to characterize the diagnosis as a
disorder, rather than leaving it at its current status of what seems
to be a nondistinct clinical picture. Extensive research has to be
undertaken in an attempt to decide which specific PDs most deserve to
be included in the official nomenclature.
Rivlin, E. The psychological trauma and management of severe burns in
children and adolescents. Br J Hosp Med. 1988 Sep; 40(3): 210-5.
This paper deals specifically with the complex psychological sequelae
and management of severe burns in children and adolescents. The impact
on the families of these patients must not be ignored. Early
psychological intervention may prevent later psychological problems.
Rodewig, K. [Psychosomatic aspects of hyperthyroidism with special
reference to Basedow's disease. An overview]. Psychother Psychosom Med
Psychol. 1993 Aug; 43(8): 271-7.
The following paper deals with the current research in
hyperthyroidism, with special accent to Graves' disease. Besides
severe psychological trauma a breakdown of neurotic defense mechanism
on the ground of a special personality structure was thought to be the
trigger of the disease. The metabolic changes became the main point of
interest. The influence of thyrostatic, surgical and radioactive
therapies on psychological symptoms, was investigated. Thereby, the
previously anticipated emotional factors became less significant in
the aetiology of the disease. A recent study (Paschke 1990) suggests
that patient with hyperthyroidism have, even in an euthyrotic state,
an increased vulnerability to anxiety provoking situations. At this
point it is not clear, due to the retrospective nature of the study,
whether the vulnerability exists prior to the unset of the disease or
is a result of the metabolic disorder. Both thyroxin and TRH are being
successfully used in the treatment of major depression. TRH acts as a
neurotransmitter in the autonomic nervous system and can be
demonstrated in the peripheral lymphocytes. However, the exact
mechanisms of action of thyroxin and TRH are still unknown. Graves'
disease is an autoimmune disease, that can be caused by specific HLA
antigens. Thereby, a changed subpopulation of lymphocytes can be
demonstrated, as well as there disturbed functions. A correlation
between high scores for anxiety and depression on one hand and the
occurrence of an abnormal T4/T8 ratio on the other hand, have been
reported in a small number of cases (Paschke 1990). The psychological
symptoms in hyperthyroidism are similar to the symptomatology of
neurotic anxiety and the anxious depressive syndrome.(ABSTRACT
TRUNCATED AT 250 WORDS).
Rogers, PD; Speraw, SR; Ozbek, I. The assessment of the identified
substance abusing adolescent. Pediatr Clin North Am. 1995 Apr; 42(2):
351-70.
When an adolescent has been identified as abusing drugs, alcohol, or
both, a complete assessment of this young person must be completed by
qualified health professionals before the level of treatment is
chosen. With our present state of knowledge of substance-abusing
adolescents, this assessment must focus on every sphere of the child's
life, not just the quantity and frequency of the drug use. Most
substance-abusing young people have experienced deep psychological
trauma that must be identified and eventually treated. A family
evaluation and psychological testing are crucial to the evaluation of
these adolescents. When choosing a treatment facility for a
substance-abusing adolescent, it is best to select a treatment program
that requires family involvement. An adolescent treatment program
should include treatment of both the family and the child, and it must
include the goal of abstinence from mood-altering substances as a
major component of recovery.
Schiffer, F. Psychotherapy of nine successfully treated cocaine
abusers: techniques and dynamics. J Subst Abuse Treat. 1988; 5(3):
131-7.
The author reviews a series of nine cocaine abusers successfully
treated with long-term, in-depth, dynamic psychotherapy begun on an
inpatient drug abuse unit and continued after hospitalization. He
finds his patients to have been victims of unrecognized psychological
trauma in childhood. He argues that the cocaine abuse, in addition to
functioning as a form of self-medication, was functioning as a
component of a repetition compulsion in which old psychological
traumas were symbolically recreated in the post-drug dysphoria. In a
retrospective assessment, the author delineates four steps he used in
the treatment process: 1) he looked for traumatic or abusive
conditions; 2) he established emotional contact; 3) he helped the
patient to appreciate how the abuse had affected him; 4) he helped the
patient to master the traumatic experiences. A clinical vignette and
the relevant literature on the psychodynamics of cocaine abuse are
discussed.
Schofferman, J.; Anderson, D.; Hines, R.; Smith, G.; Keane, G.
Childhood psychological trauma and chronic refractory low back pain.
Clin J Pain. 1993 Dec; 9(4): 260-5.
OBJECTIVE: To examine the correlation between childhood psychological
trauma(s) and refractory back pain in patients with and patients
without prior spine surgery. DESIGN: Retrospective chart review survey
of 101 consecutive patients who had undergone multidisciplinary
evaluation for refractory back pain. SETTING: Private practice,
tertiary care spine center. MAIN OUTCOME MEASURES: Each psychological
risk factor (physical abuse, sexual abuse, emotional neglect or abuse,
abandonment, and chemically dependent caregiver) was rated as present
or absent. Spinal pathology was graded as significant or not
significant. RESULTS: There were 56 patients with failed back surgery
syndrome, 28 men and 28 women, with a mean age of 43 and mean pain
duration of 45 months. There were 45 patients with no prior surgery,
26 men and 19 women, with a mean age of 43 and mean pain duration of
33 months. In the failed back surgery syndrome group, 27 (48%) had
three or more risks and 39 (70%) had two or more. When the 12 patients
with significant pathology are not considered, 24 of the remaining 44
(55%) patients had three or more risks. In the group with no prior
surgery, 26 (58%) had three or more risks and 38 (84%) had two or
more. When the five patients with significant pathology are not
considered, 24 (60%) had three or more risks. CONCLUSIONS: Multiple
childhood psychological traumas may predispose a person to chronic low
back pain. In patients in this setting with refractory low back pain
with or without prior lumbar spine surgery, three or more childhood
psychological risk factors are prevalent, especially in patients with
minimal structural pathology.
Schofferman, J.; Anderson, D.; Hines, R.; Smith, G.; White, A.
Childhood psychological trauma correlates with unsuccessful lumbar
spine surgery. Spine. 1992 Jun; 17(6 Suppl): S138-44.
In a retrospective study of 86 patients who underwent lumbar spine
surgery, patients who had three or more of a possible five serious
childhood psychological traumas (risk factors) had an 85% likelihood
of an unsuccessful surgical outcome. Conversely, in patients with a
poor surgical outcome, the incidence of these traumas was 75%. In the
group of 19 patients with no risk factors, there was only a 5%
incidence of failure. This study shows that a highly significant
correlation exists between unsuccessful lumbar spine surgery and a
history of childhood traumas. Although recognition of predictors for
unsuccessful outcome can be useful in avoiding surgery in patients
whose indications for surgery are borderline, the greater challenge is
to help the patient who, despite being at high psychological risk for
negative outcome, has severe spinal pathology that will likely require
surgery. In such cases, psychiatric treatment is critical. In the
group of 19 patients with no risk factors, single-level laminectomies
and discectomies were performed on 6 patients. The other 13 cases were
complex, involving a combination of repeat surgeries (n = 4) fusions
(n = 3), and/or multilevel laminectomies and discectomies (n = 11).
Shalev, AY; Galai, T.; Eth, S. Levels of trauma: a multidimensional
approach to the treatment of PTSD. Psychiatry. 1993 May; 56(2):
166-77.
The historical course of professional interest in psychological trauma
in the 20th century parallels the cycle of intrusion and denial
characteristic of traumatized individuals, in which periods of
recognition and concern alternate with times of forgetfulness and
neglect (Glass et al. 1966; Ingraham et al. 1986). The inclusion of
the diagnostic category of posttraumatic stress disorder (PTSD) in the
American Psychiatric Association's Diagnostic and Statistical Manual
of Mental Disorders, 3rd ed. (DSM-III-1980) inescapably confronted the
mental health community with the problem of psychic trauma and
catalyzed the quest for a deeper understanding of the disorder. This
has led to a variety of explanatory models from such distant fields as
neurobiology (Krystal et al. 1989; Pitman 1989; van der Kolk et al.
1985), psychophysiology (Kolb 1987), learning theory (Keane et al.
1985), psychoanalysis (Krystal 1978; Laufer 1988), cognitive
psychology (Janoff Bulman 1985), and existential-humanistic philosophy
(Lifton 1988).
Simon, RI. The psychological and legal aftermath of false arrest and
imprisonment. Bull Am Acad Psychiatry Law. 1993; 21(4): 523-8.
False arrest and imprisonment can be an extraordinarily stressful
psychological trauma. This is clearly demonstrated in the evaluation
of forensic cases alleging false arrest and imprisonment, a review of
the recent forensic psychiatric literature and reported legal cases. A
clinical vignette is presented that illustrates the psychological
trauma and sequelae associated with false arrest and imprisonment.
Psychiatric treatment of these individuals is discussed. A number of
these cases are litigated.
Singer, MI; Anglin, TM; Song, LY; Lunghofer, L. Adolescents' exposure
to violence and associated symptoms of psychological trauma [see
comments]. JAMA. 1995 Feb 8; 273(6): 477-82.
OBJECTIVE--To examine the extent to which adolescents are exposed to
various types of violence as either victims or witnesses, and the
association of such exposure with trauma symptoms; specifically, the
hypotheses that exposure to violence will have a positive and
significant association with depression, anger, anxiety, dissociation,
posttraumatic stress, and total trauma symptoms. DESIGN AND
SETTING--The study employed a survey design using an anonymous
self-report questionnaire administered to students (grades 9 through
12) in six public high schools during the 1992-1993 school year.
PARTICIPANTS--Sixty-eight percent of the students attending the
participating schools during the survey participated in the study (N =
3735). Ages ranged from 14 to 19 years; 52% were female; and 35% were
African American, 33% white, and 23% Hispanic. RESULTS--All hypotheses
were supported. Multiple regression analyses of the total sample
revealed that violence exposure variables (and to a lesser extent,
demographic variables) explained a significant portion of variance in
all trauma symptom scores, including depression (R2 = .31), anger (R2
= .30), dissociation (R2 = .23), posttraumatic stress (R2 = .31), and
total trauma (R2 = .37). CONCLUSIONS--A significant and consistent
association was demonstrated linking violence exposure to trauma
symptoms within a diverse sample of high school students. Our findings
give evidence of the need to identify and provide trauma-related
services for adolescents who have been exposed to violence.
Smith, RN; Chen, CC; Feng, FF; Gomez, Gauchia H. A massively parallel
memory based story system for psychotherapy. Comput Biomed Res. 1993
Oct; 26(5): 415-23.
We describe a memory-based system for psychotherapy, Dr. Bob, built to
run on the data parallel processor Thinking Machines, Inc., CM-2a
Connection Machine. The system retrieves, in parallel, stories of
alcohol addiction and sexual abuse which can be used by psychiatrists
in working with their patients as part of their work in recovering
from addictive behavior and psychological trauma. The program is
written in *LISP (pronounced Star LISP), a version of LISP used in
programming Connection Machines.
Southwick, SM; Bremner, D.; Krystal, JH; Charney, DS. Psychobiologic
research in post traumatic stress disorder. Psychiatr Clin North Am.
1994 Jun; 17(2): 251-64.
PTSD can be a chronic, devastating disorder for which treatment is
only partially effective. For some, this disorder progressively
worsens over time and appears to affect nearly every aspect of life,
including work, interpersonal relationships, physical health, and view
of self. Although generally understood as a psychological disorder,
PTSD also may be viewed from a biologic perspective. There is now
accumulating evidence to suggest that severe psychological trauma can
cause alterations in the organism's neurobiologic response to stress
even years after the original insult. Long-standing alterations in the
biologic response to stress may contribute to a number of complaints
commonly expressed by patients with PTSD. For example, increased
sensitivity and sensitization of the noradrenergic system may leave
the individual in a hyperaroused, vigilant, sleep-deprived, and, at
times, explosive state that worsens over time. Being irritable and on
edge makes it difficult to interact with family members, friends,
coworkers, and employers. To quiet these symptoms of hyperarousal,
PTSD patients often withdraw and use substances, particularly central
nervous system depressants, that suppress peripheral and central
catecholamine function. Alterations in other neurobiologic systems may
further contribute to multiple symptoms, such as intrusive memories,
dissociation phenomena, and even numbing. Characterization of the
biologic underpinnings of PTSD relies to a large degree on available
neurobiologic technology. Much of what has been discussed in this
article has grown out of advances in physiologic, hormone, and
receptor assay methodology. With further advances in neurobiologic
technology, in areas such as brain imaging, it soon will be possible
to better delineate acute and long-term stress-induced changes in
central and peripheral nervous system functioning. Undoubtedly a far
richer, more complex understanding of neurobiologic responses and
alterations will emerge in the near future. It is believed that an
improved neurobiologic understanding will facilitate the development
of more specific, effective treatments for individuals who have been
severely traumatized.
Stanley, SR. Disclosure of sexual abuse. The secret is out what now?
J Child Adolesc Psychiatr Ment Health Nurs. 1989 Oct-Dec; 2(4): 154-60 .
The sexual abuse of a child is a well-kept secret. Disclosure creates
difficulties for the child, the family, and sometimes for the
professionals working with them. A multidisciplinary, multiagency
model is one method to facilitate care and recovery for the child
victim. Each agency and service has a different purpose and goal.
Cooperative coordination and communication are the keys to case
management with reduced psychological trauma for the child and family.
Child psychiatric nurses can be effective members of the child abuse
health team model. Advocacy roles also can be developed by nurses who
work with sexual victimization through the avenues of media, writing,
committee membership and research.
Steefel, L. The World Trade Center disaster. Healing the unseen
wounds. J Psychosoc Nurs Ment Health Serv. 1993 Jun; 31(6): 5-7.
1. After the bombing of the World Trade Center in New York on February
26, 1993, hospitals were flooded with individuals who manifested not
only medical problems, but also psychological trauma. 2. Various
coping mechanisms were used by the disaster survivors. Some people
were hysterical, while others were very quiet, almost catatonic, with
blank affect and fixated posture. Some individuals, who remained
strong during the ordeal, collapsed when they reached the hospital. 3.
In attending the victims, nurses talked with them about the traumatic
incident, the fear, and the angst--a cathartic process that helps
people get better sooner. Such therapy is the key to healing unseen
wounds.
Thearle, MJ; Gregory, H. Evolution of bereavement counselling in
sudden infant death syndrome, neonatal death and stillbirth. J
Paediatr Child Health. 1992 Jun; 28(3): 204-9.
There have been changing attitudes to death and grief in Western
society in recent centuries. During the twentieth century complex
medical and social changes have resulted in changing attitudes to and
experiences with death. Specifically, the impact of death in childhood
is reviewed. In recent decades sudden and unexpected death associated
with stillbirth, the newborn and infants appears to have a more
profound affect on the bereaved parents than in the past when the
overall death rates in childhood were higher. The evolution of parent
support groups developed since the 1960s to alleviate the
psychological trauma of unexpected and sudden death in childhood has
been traced. These groups were founded initially for support with
sudden infant death syndrome and later extended to include families
with stillbirth and neonatal death.
Tonge, BJ. The impact of television on children and clinical practice.
Aust N Z J Psychiatry. 1990 Dec; 24(4): 552-60.
The impact of television on children and child development and on the
practice of child psychiatry is reviewed. Evidence from research is
that children learn from watching television and the programs they see
can change their behaviour. Programs with violent and aggressive
themes tend to make children more aggressive and disobedient. Cultural
sex-role and social stereotypes depicted on the television can also
influence children's perceptions of society. Programs specifically
designed for different age groups of children which depict pro-social
behaviour are likely to lead children to become more friendly,
co-operative and self-controlled. The use of television in child
psychiatric clinical work supervision and research, and its potential
to reduce the psychological trauma experienced by children in the
legal proceedings of child abuse cases is discussed. More research is
needed to determine the content and intervening variables that effect
the acquisition of both positive and negative behaviour from
television and enhance its promotion of mental health.
Van, Der Hart O.; Brown, P.; Turco, RN. Hypnotherapy for traumatic
grief: janetian and modern approaches integrated. Am J Clin Hypn. 1990
Apr; 32(4): 263-71.
Traumatic grief occurs when psychological trauma obstructs mourning.
Nosologically, it is related to pathological grief and posttraumatic
stress disorder (PTSD). Therapeutic advances from both fields make it
clear that the trauma per se must be accessed before mourning can
proceed. The gamut of psychotherapies has been employed, but hypnosis
appears to be the most specific. Pierre Janet provided a remarkably
modern conceptual basis for diagnosis and treatment based on a
dissociation model. His approach is combined with contemporary
innovations to present a systematic and integrated account of
hypnotherapy for traumatic grief.
Van, Der Kolk BA. The drug treatment of post traumatic stress
disorder. J Affect Disord. 1987 Sep-Oct; 13(2): 203-13.
Many individuals with a history of psychological trauma continue to
react to current life stresses as a recurrence of the original trauma,
even though they rarely make a conscious connection between present
distress and past trauma. Their hyperreactivity, reliving experiences,
and difficulty in modulating the intensity of their anxiety,
aggression and interpersonal attachments are sources of continuing
stress to both themselves and their environment. Pharmacological
treatments are often necessary to blunt the intensity of their
response to subsequent stressors. Our knowledge about the drug
treatment of post-traumatic stress disorder (PTSD) is still very
limited. Existing reports are pretty much limited to one particular
population with chronic PTSD: Vietnam veterans. Even less is known
about effective pharmacological management of acute PTSD. While many
psychotropic agents have been proposed for the treatment of various
symptoms of PTSD, carefully controlled studies are lacking to clarify
the relative merits of particular psychotropic agents on the various
post-traumatic symptoms. Impressions in open studies have utilized
global ratings, rather than studied the effects on specific symptoms.
The animal model of inescapable shock provides a good model for
understanding the biological alterations produced by overwhelming
trauma, and suggests a variety of pharmacological treatment
interventions. Elucidation of traumatic childhood antecedents of
certain forms of adult psychopathology will provide clearer links
between existing knowledge about effective pharmacological management
and the treatment of post-traumatic states.
Van, Der Kolk BA; Pelcovitz, D.; Roth, S.; Mandel, FS; McFarlane, A.;
Herman, JL. Dissociation, somatization, and affect dysregulation: the
complexity of adaptation of trauma. Am J Psychiatry. 1996 Jul; 153(7
Suppl): 83-93.
OBJECTIVE: A century of clinical research has noted a range of
trauma-related psychological problems that are not captured in the
DSM-IV framework of posttraumatic stress disorder (PTSD). This study
investigated the relationships between exposure to extreme stress, the
emergence of PTSD, and symptoms traditionally associated with
"hysteria," which can be understood as problems with stimulus
discrimination, self-regulation, and cognitive integration of
experience. METHOD: The DSM-IV field trial for PTSD studied 395
traumatized treatment-seeking subjects and 125 non-treatment-seeking
subjects who had also been exposed to traumatic experiences. Data on
age at onset, the nature of the trauma, PTSD, dissociation,
somatization, and affect dysregulation were collected. RESULTS: PTSD,
dissociation, somatization, and affect dysregulation were highly
interrelated. The subjects meeting the criteria for lifetime (but not
current) PTSD scored significantly lower on these disorders than those
with current PTSD, but significantly higher than those who never had
PTSD. Subjects who developed PTSD after interpersonal trauma as adults
had significantly fewer symptoms than those with childhood trauma, but
significantly more than victims of disasters. CONCLUSIONS: PTSD,
dissociation, somatization, and affect dysregulation represent a
spectrum of adaptations to trauma. They often occur together, but
traumatized individuals may suffer from various combinations of
symptoms over time. In treating these patients, it is critical to
attend to the relative contributions of loss of stimulus
discrimination, self-regulation, and cognitive integration of
experience to overall impairment and provide systematic treatment that
addresses both unbidden intrusive recollections and these other
symptoms associated with having been overwhelmed by exposure to
traumatic experiences.
Van, Der Kolk BA; Van, Der Hart O. Pierre Janet and the breakdown of
adaptation in psychological trauma [see comments]. Am J Psychiatry.
1989 Dec; 146(12): 1530-40.
In this reappraisal of the work of Pierre Janet at the centenary of
the publication of L'automatisme psychologique, the authors review his
investigations into the mental processes that transform traumatic
experiences into psychopathology. Janet was the first to
systematically study dissociation as the crucial psychological process
with which the organism reacts to overwhelming experiences and show
that traumatic memories may be expressed as sensory perceptions,
affect states, and behavioral reenactments. Janet provided a broad
framework that unifies into a larger perspective the various
approaches to psychological functioning which have developed along
independent lines in this century. Today his integrated approach may
help clarify the interrelationships among such diverse topics as
memory processes, state-dependent learning, dissociative reactions,
and posttraumatic psychopathology.
Vetter, TR. A comparison of midazolam, diazepam, and placebo as oral
anesthetic premedicants in younger children. J Clin Anesth. 1993
Jan-Feb; 5(1): 58-61.
STUDY OBJECTIVES: To validate the superiority of higher-dose oral
midazolam as an anesthetic premedicant in children 6 years of age and
younger, to determine whether less expensive diazepam is a viable
alternative oral premedicant in this age-group, and to assess the
preoperative oxygenation effects of both benzodiazepines. DESIGN: A
prospective, randomized, double-blind study. SETTING: Outpatient
surgery department and operating room (OR) of a freestanding
children's hospital. PATIENTS: Seventy-five ASA physical status I and
II outpatients 1 to 6 years of age. INTERVENTIONS: Patients were
randomized to receive either midazolam 0.6 mg/kg, diazepam 0.3 mg/kg,
or a placebo orally in a timely manner prior to surgery. MEASUREMENTS
AND MAIN RESULTS: Each child's subsequent reaction to separation from
his or her parents in the presurgical holding area was scored on a
three-point behavioral scale. Once in the OR, an initial room air
oxygen saturation by pulse oximeter (SpO2) was obtained. Each child's
initial acceptance of the anesthetic induction mask was then scored on
a four-point scale. No significant differences in parental separation
scores, initial room air SpO2, or postanesthesia care unit admission
time were observed among the three study groups. However, both
midazolam and diazepam were observed to be superior to the placebo in
facilitating the initial acceptance of the anesthetic induction mask.
CONCLUSIONS: Even without premedication, a majority of children did
not react negatively to an impending anesthetic. Therefore, neither
midazolam nor diazepam appears to be necessary in most children
younger than 6 years of age. Rather than implementing the routine use
of an oral preoperative sedative, the challenge appears to be the
selective identification of those children at risk for preanesthetic
difficulties and psychological trauma.
Vyner, HM. The psychological dimensions of health care for patients
exposed to radiation and the other invisible environmental
contaminants. Soc Sci Med. 1988; 27(10): 1097-103.
Invisible environmental contaminants are those contaminants that
possess environmental and/or medical invisibility. Recent studies
indicate: (1) that these contaminants can and do have traumatic
psychological effects on those individuals who have been exposed to
them and (2) that there is a remarkable uniformity to these traumatic
affects as they have been found in the various invisible exposures
that have been studied to date. The common denominators in all of
these situations is the invisibility of the involved contaminants. The
adverse psychological effects of the invisible contaminants are as
follows: (1) experienced uncertainty, (2) adaptational dilemmas, (3)
hypervigilance, (4) nonempirical belief systems about the exposure,
and (5) traumatic neuroses. This paper will: (1) review the data that
documents the occurrence of psychological effects of the invisible
environmental contaminants, (2) present an adaptational model that
explains the manner in which these psychological trauma develop, and
(3) examine the clinical and public policy implications of these
findings.
Wood, DP; Cowan, ML. Crisis intervention following disasters: are we
doing enough? (A second look). Am J Emerg Med. 1991 Nov; 9(6):
598-602.
During mass casualty events the consequences of psychological trauma
are an important cause of morbidity among survivors and rescue
personnel. Data available from military and civilian disasters over
the past 70 years has shown a fairly predictable ratio of acute and
severe emotional trauma associated with mass casualty events.
Long-term morbidity from psychological trauma can rival or exceed that
of the physical injuries of survivors. Psychological intervention
reduces this morbidity, and early psychological intervention is more
effective before adverse psychological symptoms have fully developed.
However, the widely accepted value of early psychological intervention
is not universal, with controversy over the degree of emotional trauma
expected after a large-scale catastrophic mass casualty event, as well
as the number of victims and the effectiveness of immediate
psychological intervention. Some research even suggests that there is
only a minor risk of acute emotional trauma among survivors of a major
disaster. The United States faces the possibility of mass casualties
from national disasters--particularly earthquakes--and conventional
warfare. It has been predicted that 100,000 major injuries requiring
hospitalization and 20,000 deaths would result from the maximum
plausible natural disaster incident in the United States. Pentagon
planners expect thousands of servicemen to be evacuated to the United
States for hospitalization on a daily basis during an overseas
conventional war. With these estimates of potential casualties, it is
imperative that this controversy be resolved as quickly as possible.
The National Disaster Medical System recently established plans to
provide immediate treatment for psychological trauma to disaster
survivors and rescue personnel.(ABSTRACT TRUNCATED AT 250 WORDS).
Zeanah, CH. Adaptation following perinatal loss: a critical review. J
Am Acad Child Adolesc Psychiatry. 1989 Jul; 28(4): 467-80.
Parental adaptation following perinatal loss has received increasing
attention in the past 20 years. From early anecdotal accounts to
recent more rigorous investigations, it is clear that perinatal loss
in the developed world is a significant psychological trauma for
parents. Major immediate consequences are likely for virtually all
affected families, and long-term sequelae are likely for some. Despite
widespread attention to the experience of families who lose a
stillborn or newborn infant, including major changes in hospital
practices regarding management of these families, many important
questions remain unanswered. We know little, for instance, about which
parents are at greatest risk for disordered mourning or what
additional measures might minimize their psychological morbidity. In
fact, because of a tendency to focus exclusively on affective
symptomatology following the loss, other important features of the
process of mourning have been overlooked or examined unsystematically.
Suggestions for specific and general directions for further research
are discussed.
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