Complex PTSD symptoms mediate the association between childhood trauma and physical health problems

Adverse Childhood Events, Personality Disorders, and Multimorbidity in Older Adults: Exploring the Connections

OBJECTIVES

We investigated the association between adverse childhood events, personality disorders and multimorbidity in older adults.

METHODS

This is a cross-sectional analysis in a population of older adults including 40 people with a personality disorder and 75 healthy controls. The Childhood Traumatic Events Scale was used to assess adverse childhood events. Multimorbidity was defined as the presence of 2 or more predetermined chronic somatic and psychiatric disorders. Logistic regression analysis was used to assess the association between adverse childhood events, personality disorders and multimorbidity.

RESULTS

No significant association was found between adverse childhood events and multimorbidity (OR = 1.03, 95% CI = 0.96-1.09). The presence of a personality disorder was significantly associated with multimorbidity (OR = 12.95, 95% CI = 4.28-39.14).

CONCLUSIONS

Overall, we did not find an association between adverse childhood events and multimorbidity in older adults. Multimorbidity was more prevalent in subjects with personality disorders compared to healthy controls.

CLINICAL IMPLICATIONS

The findings suggest that personality disorders are associated with both mental and physical health challenges, underscoring the importance of integrated care approaches to address both aspects in clinical practice.

Adverse childhood experiences and ICD-11 complex posttraumatic stress disorder in Poland: a population-based study

Background: Research on the prevalence of ICD-11-based complex posttraumatic stress disorder (CPTSD) in nationally representative samples is lacking, with no such studies conducted considering national Polish samples until now.Objectives: The primary aim of this study was to explore profiles of study participants in terms of either PTSD or CPTSD symptoms regarding to ICD-11 diagnosis with the aid of latent profile analysis. We also investigated the relationship between the types and cumulative number of adverse childhood experiences (ACEs) with the probability of CPTSD rate in a national sample of Poles.Methods: A representative sample of Polish adults (n = 3,557) participated in this study. ACEs were assessed using the Adverse Childhood Experiences Questionnaire, while the core features of PTSD and CPTSD were measured using the International Trauma Questionnaire.Results: The findings showed a 11% prevalence rate of probable CPTSD in the studied sample of Poles. Sexual abuse, emotional neglect, physical neglect and having the experience of a mentally ill household member were the most significant predictors of potential diagnosis. Furthermore, significant differences concerning lifestyle data were observed in the group of participants with CPTSD.Conclusions: The current rate of probable CPTSD in Poland is substantially higher than the respective data reported for other countries. We also noted that the ICD-11 diagnosis of CPTSD may not apply to all cultural environments. Finally, it was observed that the ACEs - CPTSD association may depend both on the ACEs types as well as on their overall cumulative character.

Intergenerational associations between childhood maltreatment, post-traumatic stress symptoms, and chronic pain in young adult offspring and their parents

Findings have revealed a strong link between exposure to child maltreatment (CM) and later chronic pain. Concurrently, other findings have been grounded in the understanding that CM consequences may not end with the exposed individual, rather, they extend to their offspring. However, little is known regarding the possible intergenerational transmission of chronic pain following CM. This study examines whether chronic pain among parents and their young adult offspring may be associated with parental exposure to CM. Three hundred ninety-three parent-offspring dyads (parents' mean age = 58, SD = 5.91 years; offspring's mean age = 27, SD = 3.91 years) completed self-report questionnaires, assessing CM (CTQ), posttraumatic stress (PTS) and disturbances in self-organisation (DSO) symptoms (ITQ), and chronic pain. CM was associated with chronic pain mediated by DSO symptoms among parents (indirect effect = 0.77; p = 0.007) and PTS symptoms among offspring (indirect effect = 0.285; p = 0.005). Offspring chronic pain was significantly associated with parental CM through two intergenerational paths: the mediation of parents' DSO symptoms and chronic pain (indirect effect = 0.298; p = 0.011), and through parents' PTS symptoms and offspring's PTS symptoms (indirect effect = 0.077; p = 0.004). This study's findings support the relevance of the intergenerational transmission of chronic pain following parental exposure to CM. Furthermore, the findings reveal complex PTS symptoms as a possible underlying mechanism for the intergenerational associations of chronic pain following CM.

Reconsolidation of Traumatic Memories in the Treatment of Complex Post-traumatic Stress Disorder (CPTSD): A Case Study

This case study explores the memory reconsolidation-based technique of reconsolidation of traumatic memories (RTM) to address complex post-traumatic stress disorder (CPTSD). Using the framework of CPTSD and the components of International Trauma Questionnaire (ITQ), several presenting symptoms and the history of childhood trauma (adverse childhood experiences assessment) were assessed. The individual, based on the trauma-informed care approach, went through a total of eight sessions after the initial consultation that included RTM on index trauma events, reframing, and self-regulation techniques. CPTSD and several internalizing symptoms were measured before and after the intervention. The findings suggest that memory reconsolidation-based RTM protocol, coupled with the constructs of CPTSD using ITQ and index trauma, could provide benefits for individuals with symptoms from prolonged exposure to trauma during childhood.

A new framework for understanding stress and disease: the developmental model of stress as applied to multiple sclerosis

This paper proposes a new model of stress that integrates earlier models and adds insights from developmental psychology. Previous models describe the behavioral and physical effects of stress events, but have not explained the translation of experiences into stress itself. The Developmental Model of Stress shows how psychosocial developmental challenges in childhood create persistent negative beliefs and behaviors that increase threat perception and maladaptive stress responses. These developmental challenges produce early psychological and physiological predispositions for increased stress responses over time. Ongoing stress leads to dysregulation of physical stress-response systems (allostatic load), which is associated with multiple diseases. High allostatic load provides the necessary preconditions for the diathesis-stress model, which says the addition of an acute stressor to a weakened or predisposed system can lead to disease development. The paper also documents the evolving measurement of stress to better understand the stress-disease relationship, helping to resolve conflicting results between studies. The Developmental Model of Stress was combined with clinician insight and patient reports to build an integrative framework for understanding the role of stress in the development and progression of multiple sclerosis (MS). It includes the first mapping of maladaptive beliefs and behaviors arising from developmental challenges that are common to people with MS. An initial comparison shows these may be distinct from those of people with other chronic diseases. These beliefs and behaviors form the predisposing factors and contribute to the triggering factors, which are the acute stressors triggering disease onset. These often took two forms, a prolonged incident experienced as feeling trapped or stuck, and threat of a breach in a relationship. The reinforcing factors add the stress of a chronic disease with a poor prognosis and seemingly random symptom fluctuation, still managed with the same beliefs and behaviors developed in childhood, increasing physiological dysregulation and symptom severity. A pilot study is described in which these three categories of stress factors in MS were explicitly addressed. This study noted clinically important improvements in physical and mental well-being, providing preliminary support for the Developmental Model. Future research might expand on the pilot using a more robust sample and design.

Measuring interpersonal trauma: Development and validation of the German version of the victimization experience schedule (VES)

OBJECTIVE

Interpersonal victimization experiences (VEs) significantly affect mental and physical health, particularly in disorders associated with life-time adversities, like fibromyalgia syndrome (FMS) and major depressive disorder (MDD). However, assessing VEs comprehensively remains challenging due to limited tools that encompass sub-traumatic events, such as bullying or discrimination, and contextual dimensions. We aimed to address this gap by validating the Victimization Experience Schedule (VES) in German, examining its reliability, and assessing VEs in clinical populations with FMS and MDD.

METHODS

We investigated the relationship between VEs and clinical symptoms in individuals with FMS, MDD and healthy controls (N = 105) in a case-control study. We also analyzed correlations between different types of VEs and categories of early childhood abuse and posttraumatic-stress-disorder instruments. Additionally, we validated our findings in an independent sample of individuals with FMS (N = 97) from a clinical study.

RESULTS

We observed excellent inter-rater reliability (Kw = 0.90-0.99), and VEs assessed using the VES were in alignment with subcategories of early childhood abuse. The prevalence of VEs extended beyond the categories covered by traditional survey instruments and was higher in individuals with MDD (4.0 ± 2.6) and FMS (5.9 ± 3.1) compared to controls (1.5 ± 1.7). We consistently identified a significant association between the number of VEs, the associated subjective distress, and clinical scores. Furthermore, distinct correlation patterns between VEs and clinical outcomes emerged across different cohorts.

CONCLUSION

Our study emphasizes the VES's value in understanding VEs within MDD and FMS. These experiences span from traumatic to sub-traumatic and correlate with posttraumatic-stress and clinical symptoms, underscoring the VES's importance as an assessment tool.

Folie et Société: eroding the body-mind relationship via dysfunctional paternalistic systems

This theoretical perspective examines the proposition of shared complex trauma between a parent and child, arising from blurred relational boundaries and societal oppression, leading to inequality both at home and within the larger paternalistic system of society. Specifically, the focus is on living within a paternalistic, authoritarian system where rules are unjust, demanding obedience and compliance without questioning the behaviors of the authority. Individuals growing up in these circumstances are subject to adverse and emotionally overwhelming experiences, which lead to the creation of emotional memory images (EMIs). The delusion in which the child is caught up becomes a reality for the child as time passes. This phenomenon is recognized in psychiatry as "Folie à deux" (the madness of two or more) at the micro level, and "Folie et Société" (the madness of society) on the macro level. Complex trauma, derived from a child's exposure to multiple adverse events, can erode the mind-body relationship, impacting both mental and physical health. These traumatic experiences in early childhood can manifest as body-focused disorders in adolescents, prevailing throughout adulthood if left unattended. This article provides a theoretical perspective on dealing with the dissociation and chronic stress related to oppressive and authoritarian family systems. The broader implications of this article include highlighting the psychophysiological underpinnings of complex trauma, the relationship of a highly oppressive paternalistic authoritarian system imposed on children and adolescents, and the role of Split-Second Unlearning as a therapeutic intervention to clear EMIs and improve overall health outcomes.

Responding to concerns related to the measurement of ICD-11 complex posttraumatic stress disorder using the International Trauma Questionnaire

BACKGROUND

A recent study in this journal by Frewen et al. (2023) provided a critical analysis of the most widely used measure of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD), the International Trauma Questionnaire (ITQ). The article was a thoughtful review and gave voice to several widely held concerns about the nature of CPTSD as it is represented in ICD-11 and measured by the ITQ. The primary concern expressed by Frewen et al. was that the symptom profile of ICD-11 CPTSD, as represented in the ITQ, is too simple and fails to provide adequate coverage of the construct.

OBJECTIVE

Despite its quality, the article included several misunderstandings about the nature of ICD-11 CPTSD, and the function of the ITQ, that we wish to clarify.

PARTICIPANTS

Not applicable.

SETTING

Not applicable.

RESULTS

In this article, we provide a description of what ICD-11 PTSD and CPTSD are, a review of the process that led to their inclusion in ICD-11, how the ITQ was developed and refined to measure these constructs. We then provide responses to several of the most important concerns raised by Frewen et al. CONCLUSIONS: We highlight the clinical utility of the ICD-11 descriptions of PTSD and CPTSD and discuss how the ITQ can be used as part of a suite of clinical assessments to accurately describe and understand common experiences of psychological distress that often result from exposure to traumatic life events.

Coping Styles and Defense Mechanisms Mediate Associations Between Exposure to Adverse Childhood Experiences and CPTSD Symptoms in Faroese Adolescents

Background

The experience of several adverse childhood experiences (ACEs) has been shown to be associated with Post-Traumatic Stress Disorder (PTSD) and Disturbances in Self-Organization (DSO) symptoms among adolescents. Defense mechanisms and coping styles are psychological processes involved in the association of ACEs with PTSD and DSO symptoms. However, there is a lack of research on the joint association of these variables among Faroese adolescents.

Aim

The aim of this study was to analyze the effect of exposure to ACEs on PTSD and DSO symptoms trough the indirect effect of defense mechanisms and coping styles in a sample of Faroese adolescents.

Method

Six hundred and eighty-seven Faroese adolescents were recruited from 19 schools. Participants responded to validated self-report questionnaires. A multiple step mediation and a serial mediation methodology were conducted through structural equation modeling.

Results

Exposure to ACEs was linked to PTSD and DSO symptoms through the indirect effect of immature defense mechanisms, emotional coping, and detachment coping. Exposure to ACEs was linked to PTSD symptoms through rational coping.

Conclusions

The results suggest a mutual relationship between defense mechanisms and coping styles in coping with multiple adversity among adolescents.

Measuring post-traumatic stress disorder and complex post-traumatic stress disorder using the International Trauma Questionnaire: results from a Hungarian clinical and non-clinical sample

Background: The 11th revision of the International Classification of Diseases (ICD-11) simplified the description of post-traumatic stress disorder (PTSD) and also introduced a new trauma-related diagnosis called complex post-traumatic stress disorder (CPTSD). CPTSD is linked to earlier, prolonged interpersonal trauma, and is characterized by a broader range of symptoms, in addition to the core PTSD symptoms. The International Trauma Questionnaire (ITQ) has been developed to assess the new diagnostic criteria.Objectives: The primary aim of our study was to test the factor structure of the ITQ in a clinical and a non-clinical Hungarian sample. We also examined whether the degree of traumatization or the type of trauma experienced was associated with meeting the criteria for PTSD or CPTSD, or with the severity of PTSD or disturbances in self-organization (DSO) symptoms, in both samples.Method: A trauma-exposed heterogeneous clinical sample (N = 176) and a non-clinical sample (N = 229) filled out the ITQ and a modified version of the Life Events Checklist (LEC-5). The factor structure of the ITQ was tested by examining the model fit of seven competing confirmatory factor analysis models.Results: A two-factor second-order model with a second-order PTSD factor (measured by three first-order factors) and a DSO factor (measured directly by six symptoms) had the best fit to the data in both samples if an error correlation was allowed between negative self-concept items. Those in the clinical group who reported more interpersonal and childhood trauma experienced more PTSD and DSO symptoms. Also, there were significant, positive, and weak associations between the total number of different traumas and PTSD and DSO factor scores in both samples.Conclusion: ITQ was found to be a reliable tool to differentiate between PTSD and CPTSD, two related but distinct constructs in a clinical and a non-clinical trauma-exposed sample in Hungary.

Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model

BACKGROUND

Adolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms.

METHODS

We analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008).

RESULTS

Immature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters.

CONCLUSIONS

Maladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.

Child Maltreatment, Mental Health, and Self-Reported Health Among Adolescent Girls in Child Welfare: Mediating Pathways

Child maltreatment is common in the US and has been shown to be associated with physical and psychological health problems in adolescence and adulthood. Based on the allostatic load theory, this study examined the association between different types of child maltreatment (emotional, physical, and sexual abuse, and physical neglect) and self-rated health, and the mediating roles of post-traumatic stress and depression in these relationships. Participants were 249 girls involved in the child welfare system, ages 12-19 years, the majority of whom were African American. A one item self-reported general health measure, the Child Trauma Questionnaire-Short Form (CTQ-SF), Child PTSD Symptom Scale (CPSS) and the Child Depression Inventory (CDI) measured self-reported health, child maltreatment, and posttraumatic and depression symptoms, respectively. Higher levels of emotional, physical, and sexual abuse, and physical neglect were significantly associated with poorer ratings of health. PTSD and depression were significant mediators between histories of childhood emotional, physical, and sexual abuse and physical health. In conclusion, results indicate that the pathways from child abuse to physical health problems in adolescents are through psychological distress. Trauma focused interventions to reduce symptoms of PTSD and depression among this vulnerable group of adolescents are essential to improve health.

Systematic review exploring the relationship between sexual abuse and lower urinary tract symptoms

INTRODUCTION AND HYPOTHESIS

Patients presenting with lower urinary tract symptoms (LUTS) may report a history of sexual abuse (SA), and survivors of SA may report LUTS; however, the nature of the relationship is poorly understood. The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of SA.

METHODS

A systematic literature search of six databases, Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO, was performed. The last search date was June 2021 (PROSPERO CRD42019122080). Studies reporting the prevalence and symptoms of LUTS in patients who have experienced SA were included. The literature was appraised according to the PRISMA statement. The quality of the studies was assessed.

RESULTS

Out of 272 papers retrieved, 18 publications met the inclusion criteria: studies exploring LUTS in SA survivors (n=2), SA in patients attending clinics for their LUTs (n=8), and cross-sectional studies (n=8). SA prevalence ranged between 1.3% and 49.6%. A history of SA was associated with psychosocial stressors, depression, and anxiety. LUTS included urinary storage symptoms, voiding difficulties, voluntary holding of urine and urinary tract infections. Most studies were of moderate quality. Assessment of SA and LUTS lacked standardisation.

CONCLUSIONS

The review highlights the need for a holistic assessment of patients presenting with LUTS. Although most of the studies were rated as being of 'moderate' quality, the evidence suggests the need to provide a "safe space" in clinic for patients to share sensitive information about trauma. Any such disclosure should be followed up with further assessment.

Psychological and biological mechanisms linking trauma with cardiovascular disease risk

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide, and experiences of psychological trauma have been associated with subsequent CVD onset. Identifying key pathways connecting trauma with CVD has the potential to inform more targeted screening and intervention efforts to offset elevated cardiovascular risk. In this narrative review, we summarize the evidence for key psychological and biological mechanisms linking experiences of trauma with CVD risk. Additionally, we describe various methodologies for measuring these mechanisms in an effort to inform future research related to potential pathways. With regard to mechanisms involving posttraumatic psychopathology, the vast majority of research on psychological distress after trauma and CVD has focused on posttraumatic stress disorder (PTSD), even though posttraumatic psychopathology can manifest in other ways as well. Substantial evidence suggests that PTSD predicts the onset of a range of cardiovascular outcomes in trauma-exposed men and women, yet more research is needed to better understand posttraumatic psychopathology more comprehensively and how it may relate to CVD. Further, dysregulation of numerous biological systems may occur after trauma and in the presence of posttraumatic psychopathology; these processes of immune system dysregulation and elevated inflammation, oxidative stress, mitochondrial dysfunction, renin-angiotensin system dysregulation, and accelerated biological aging may all contribute to subsequent cardiovascular risk, although more research on these pathways in the context of traumatic stress is needed. Given that many of these mechanisms are closely intertwined, future research using a systems biology approach may prove fruitful for elucidating how processes unfold to contribute to CVD after trauma.

Traumatic life events as risk factors for psychosis and ICD-11 complex PTSD: a gender-specific examination

Background

Numerous studies found robust associations between psychosis and posttraumatic stress disorder (PTSD), but few have examined the relationships between psychosis and recently formulated ICD-11 Complex PTSD (CPTSD). Further, no known study has examined the effects of different traumatic life events on CPTSD and psychotic-like symptoms in a manner that permits gender-specific effects to be identified.

Objective

Using a nationally representative sample of 1,020 Irish adults, we examined gender-differences in (a) psychotic-like symptoms, CPTSD, and exposure to 21 different traumatic life events, and (b) the unique associations between different traumas with CPTSD and Psychosis.

Method

Bivariate analyses and structural equation modelling were performed.

Results

Consistent with the literature, no gender differences were observed in psychotic-like symptoms. Females reported slightly higher levels of CPTSD and were more likely to be exposed to sexual and emotional abuse, whereas men reported greater exposure to physical violence, accidents, and disasters. Psychosis symptoms were explained by trauma exposure to a considerate degree and at a level similar to CPTSD; a moderate correlation was also found between CPTSD and Psychosis. Physical/emotional neglect was the only traumatic life event that significantly and most strongly predicted both conditions. Two gender-specific associations between different traumatic life events and CPTSD and Psychosis were identified out of the 42 possible effects modelled.

Conclusions

The present investigation provides initial evidence that psychotic-like symptoms and CPTSD are moderately correlated constructs in the general population. Results also highlight the importance of conducting a detailed assessment of trauma history for all clients presenting with symptoms of CPTSD, psychosis, or both.

Pathophysiological Bases of Comorbidity in Migraine

Despite that it is commonly accepted that migraine is a disorder of the nervous system with a prominent genetic basis, it is comorbid with a plethora of medical conditions. Several studies have found bidirectional comorbidity between migraine and different disorders including neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metaboloendocrine, and immunological conditions. Each of these has its own genetic load and shares some common characteristics with migraine. The bidirectional mechanisms that are likely to underlie this extensive comorbidity between migraine and other diseases are manifold. Comorbid pathologies can induce and promote thalamocortical network dysexcitability, multi-organ transient or persistent pro-inflammatory state, and disproportionate energetic needs in a variable combination, which in turn may be causative mechanisms of the activation of an ample defensive system with includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This strategy is designed to maintain brain homeostasis by regulating homeostatic needs, such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response. In this light, the treatment of migraine should always involves a multidisciplinary approach, aimed at identifying and, if necessary, eliminating possible risk and comorbidity factors.