The Concept of Cumulative Trauma

Influence of Childhood Maltreatment on Schizoid Personality Pathology

Schizoid personality disorder (SPD) is among the most enduring forms of personality pathology. Research suggests that one factor associated with schizoid pathology is childhood maltreatment, although it is unclear which specific experiences of childhood maltreatment may be most impactful. In this study, we examined associations between different experiences of childhood maltreatment (e.g. physical, emotional, and sexual abuse, and physical and emotional neglect) and schizoid pathology in a sample of men and women recruited online (N = 327) using a Bayesian approach to structural equation modeling. Results suggest that emotional neglect had the strongest association with schizoid pathology over and above other forms of maltreatment and other traumatic life events. Findings further indicate that emotional and physical neglect as well as other negative life events are associated with schizoid pathology in men but only emotional abuse is associated with schizoid pathology for women. These findings provide support for the influence of childhood maltreatment on schizoid pathology and have implications for future research and clinical intervention.

The Influence of Childhood Emotional Abuse and Neglect on Love Addiction: The Indirect Effect of Vulnerable Narcissism Among Female and Male Emerging Adults

Childhood maltreatment is a key precursor to vulnerable narcissism since it likely lead to a narcissistic injury that triggers defenses against rage and abandonment. In later life, this pattern may contribute to a maladaptive model of love relationships. The present study explored the association between different types of childhood maltreatment (i.e., emotional, physical, and sexual abuse; physical and emotional neglect) and love addiction via vulnerable narcissism in a community sample of 505 cisgender emerging adults (M = 24.90, SD = 2.67; 76.6% assigned female at birth (AFAB); 68.5% heterosexual) residing in Italy. Data collection relied on self-report questionnaires administered online through the Qualtrics platform, and study hypotheses were tested using structural equation modeling. The results showed that childhood emotional abuse and emotional neglect directly influenced love addiction, while physical and sexual abuse, as well as physical neglect, showed no significant effects. Greater childhood emotional abuse and neglect were associated with increased vulnerable narcissism, leading to higher levels of love addiction. Gender differences emerged, with the indirect effect of vulnerable narcissism on the relationship between emotional neglect and love addiction significant only for AFAB. The findings emphasize the risk of love addiction in emerging adults with a history of childhood emotional abuse and neglect, highlighting the importance of addressing childhood emotional maltreatment and vulnerable narcissistic personality traits in interventions to treat this condition.

Effi Briest: The Uncanny, sexuality, and trauma

Here the author draws on Theodor Fontane's 1895 novel Effi Briest to consider the links between Freud's paper "The Uncanny" and his elaboration of the trauma of sexuality and the après-coup. Conceptualizing trauma in contemporary clinical theory inevitably draws on the theory of the après-coup: the blow that is inflicted on the psyche when the impact of the early event is retranscribed at a later date. The author considers the trauma that Effi experiences, not the catastrophic trauma of death or assault but the deceptive trauma, is disguised as an unparalleled opportunity for Effi. Her story highlights the trauma of sexuality and the incestuous Oedipal dimension. In the cruel economy of incestuous exchange across the generations Effi, in what she experiences as dreary incarceration, is left isolated with her libidinal yearnings. Arguing that Effi as a seventeen-year-old girl is drawn into the incestuous world of her parents and the mother's suitor Innstetten, the author describes how the trauma involving the denial of her sexuality leads to her being ostracized and facing psychic death. Captured in the deferred maternal desire, Effi unknowingly becomes part of a system of incestuous exchange. This is a trauma that is only known in the après-coup.

Abolishing the Captivity of a Tyrannized Woman: Evidence of Bion's Concept of the Contact-Barrier as Manifested in Dreams

Bion's notion of the contact-barrier formulates a semipermeable membrane responsible for preserving the distinction between the conscious and the unconscious. However, the question of how a newly established contact-barrier manifests itself in dreams remains unanswered. The author proposes that one such manifestation occurs when a patient sees themself asleep in a dream. A case of a severely traumatized woman who had difficulty thinking and being close to others is used to explore these clinical ideas. The author, in response to his reveries in a session, introduced a playful dream-like dialogue between a playwright and his reader. The nature of the communication, in functioning as a barrier, served to protect the patient from a tyrannizing reality: the therapist's sexuality. This intersubjective barrier helped the patient to contact dissociated and damaged parts of herself, and it also facilitated her ability to dream a sense of her own boundaries, femininity, and sexuality.

From trauma to transmission: exploring the intersection of adversity, substance use, and HIV risk in women's life histories

BACKGROUND

At increased risk for poor health outcomes, physical and/or sexual violence, and onward transmission of HIV, women who use drugs and are living with HIV (WWUDHIV) are vulnerable and in need of services. Understanding the role of trauma across their life history may offer insights into HIV and drug use prevention and opportunities for intervention. We explored trauma and drug use among WWUDHIV in Dar es Salaam, Tanzania.

METHODS

We conducted in-depth interviews with 30 WWUDHIV from January-March 2019. Interviewers used semi-structured interview guides and asked questions about the life history as related to drug use. Interviews were audio recorded, transcribed, translated, coded, and life histories charted. We utilized content analysis.

RESULTS

Participants described death of family members as traumatic catalysts for drug use. Sexual partners early in their life history were often the point of introduction to drugs and source of HIV acquisition. Death of partners was present across many life histories and was a traumatic event negatively influencing life trajectories, including start of sex work for survival or to support drug use. Sex work in-turn often led to traumatic events including sexual and/or physical violence. HIV diagnosis for many participants followed the start of drug use, frequently occurred during pregnancy or severe illness and was described by most participants as a trauma. Despite this, particularly during pregnancy, HIV diagnosis was a turning point for some participant's desire to engage in drug use treatment. Traumatic events were often cumulative and regularly described as catalysts for poor mental health that could lead to new or increased drug use for coping.

CONCLUSIONS

These findings suggest trauma is common in the life history of WWUDHIV and has negative impacts on drug use and HIV vulnerability. Our life history charting highlights the cumulative and cyclical nature of trauma and drug use in this population. This study allows for better understanding of trauma, drug use, and HIV prevention, which offers opportunities for intervention among a group with limited access to services: during adolescence for orphaned youth, following the death of a child or partner, and when vulnerable women engage with the health system (HIV diagnosis, pregnancy, illness).

Insecure adult attachment and reflective functioning as mechanisms of the relationship between traumatic life events and suicidal ideation: A path analysis

The relationship between traumatic life events and increased suicide risk has been well reported in literature. However, the complex nature of suicidality phenomena still hinders our ability to comprehend the mediation mechanism underlying this association. In this study, we examined the mediating role of adult attachment and reflective functioning in the relationship between traumatic life events and suicidal ideation. Nine hundred and fifty Italian adults completed an online survey evaluating traumatic life events, adult attachment, reflective functioning and suicidal ideation. The path analysis showed that the positive relationship between traumatic life events and suicidal ideation was partially mediated by attachment anxiety and reflective functioning. From a clinical point of view, these results support the relevance of evaluating and improving patients’ ability to mentalize as a part of psychotherapeutic intervention aimed at reducing suicidality in people with a history of traumatic experiences and attachment anxiety.

Afterwards-Forgetting, Remembering, Transmitting. Extreme Trauma and Culture in Post-National-Socialist Germany

Facing the rupture the Shoah marks in the history of humanity and in the life of survivors and their relatives, this article approaches long-term psychosocial consequences-after Auschwitz. The dimensions of "forgetting" in post-Nazi Germany are brought into focus by the remembering and passing on of extreme traumatic experiences of persecution. To gain insights into these processes, this article differentiates between traumatization and extreme traumatization. Survivors remember and pass on their experiences of persecution, especially through non-verbal communication and in the form of unconsciously shaped "scenes." This Scenic Memory of the Shoah is conveyed in relationships with descendants, to fellow human beings, to the environment and thus also in experiences of anti-Semitism in Germany today. The fact that extreme traumatization is expressed precisely in scenes of coexistence also means that it must be understood as an embedded factor in society, in culture-in forgetting and remembering "afterwards."

Race and Analytic Neutrality: Clinical and Theoretical Considerations

Neutrality remains a key concept underpinning the psychoanalytic attitude, but its operation in the clinical setting must be reconfigured if the countertransference is to be used as a source of data, conveyed by projective identification. Subjective responses thus mobilized in the analyst need to be processed before attention can return to the evenly suspended state, from which greater objectivity flows. Theory, internalized as part of the analyst's emotional learning, operates preconsciously in the session; in clinical work with racial matters this includes, crucially, familiarity with internal racism, of which a model is briefly described. These ideas are illustrated via two clinical vignettes in which these themes are traced.

Resilience, Trauma, and Coping

The study and use of resilience is of the utmost importance to psychodynamic psychiatry. It is deeply ingrained in ideas about well-being and the treatment and care of patients. However, its neurobiology is incompletely understood, its terminology and relation to trauma and coping not well defined, and its efficacy underutilized in clinical practice. This article reviews the scientific literature on resilience, especially as it relates to trauma and coping. It also attempts to point the way for its greater application in psychiatry and mental health by utilizing resilience in more informed and individualized approaches.

Psychoanalytical Considerations of Emotion Regulation Disorders in Multiple Complex-Traumatized Children—A Study Protocol of the Prospective Study MuKi

Studies in adults with mental disorders suggest that the experience of early and chronic trauma is associated with changes in reward expectancy and processing. In addition, severe childhood trauma has been shown to contribute to the development of mental disorders in general. Data on effects of early childhood trauma on reward expectancy and processing in middle childhood currently appear insufficient. The present study aims to fill this research gap by examining the effects of developmental trauma disorder (DTD) on reward expectancy and processing in children aged 8–12 years, testing the hypothesis that children with multiple complex traumas exhibit altered reward processing as a result of prior disappointing reward experiences. One main feature of developmental trauma disorder is early experiences of multiple separation from important and close relationships alongside other experiences of emotional or physical harm. In the sequel children often show affect regulation disorders. To investigate this, we have developed an adapted version of the Monetary Incentive Delay (MID) Task, which examines children’s expectation of reward or frustration. In this first study, behavioral data will be collected from N = 40 children (n = 20 experimental group and n = 20 healthy controls) using this adapted version of the MID Task. Children in the experimental group will be recruited from youth welfare centers in Frankfurt a.M., Germany. Healthy control subjects will be recruited from after-school-care facilities. A brief trauma screening will be conducted for both groups, experimental and control. If children show signs of trauma, the presence of a developmental trauma disorder will be further delineated by a German translation of the Developmental Trauma Disorder Structured Interview for Children (DTDSI-C) which was translated the first time in German by our research group. We hypothesize that children in the experimental group will be less accurate in performing the Monetary Incentive Delay Task because of their impaired emotion regulation skills due to emotional avoidance following developmental trauma. If the results of our initial behavioral study are promising, the MID task will be used in a future study to elucidate the relationship between trauma developmental disorder, reward expectancy and processing, and neurobiological processes in middle childhood.

Trauma, processo e rappresentazione

Il concetto di trauma in psicoanalisi è stato spesso usato in modo incoerente ed eccessivamente inclusivo. Una revisione degli scritti freudiani, a partire dal Progetto del 1895, mostra che dal punto di vista dell'impatto sui processi psichici Freud aveva una visione più coerente del concetto, che può contribuire a ridimensionare i dibattiti eziologici - spesso sterili - che contrappongono cause interne a cause esterne, pulsioni a realtà e così via. Da una prospettiva clinica, è più utile guardare alle diverse sfide che possono porre a un individuo circostanze potenzialmente traumati-che, considerando la modalità fortemente soggettiva di ciascuna persona di sperimentare e reagire a tali sfide e il sostegno fornito, caso per caso, dallo specifico ambiente famigliare, sociale e cultu-rale. Ogni esperienza qualificabile come "trauma" viene, in certa misura, compresa e integrata nel-la particolare soggettività dell'individuo in base alla sua peculiare organizzazione del Sé, alla sua comprensione e alla sua posizione nel mondo.

The psychological effects of stillbirth on parents: A qualitative evidence synthesis of psychoanalytic literature

Objective: To review and synthesize existing psychoanalytic literature on the psychological impact of stillbirth on mothers and fathers. Method: This qualitative systematic review followed, as far as possible, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Psychoanalytic Electronic Publishing Archive, the Single Case Archive, and PsycINFO (1999-2019) were searched to identify relevant articles published between 1999-2019 that report clinical material or theoretical considerations concerning the psychological effects of stillbirth on parents, as emerging during classical analytic or psychoanalytic therapy session/journey. A thematic synthesis was performed. Results: 46 articles were identified, providing data on the parents' experiences of grief and gender differences, the detrimental effects on the parental couple's relationship, the mother's identification with the dead baby, the importance for mothers to meet and care the stillborn baby, the mothers' drive for another pregnancy and the fear of further loss, the mothers' ambivalence toward subsequent pregnancy and child, the potential negative effects of unresolved bereavement on subsequent baby, and the replacement of a stillborn child. Conclusion: Our findings reveal there is some psychoanalytic literature providing insight into the psychological dynamics of parents after a stillbirth, with observations that could be used to improve psychological health care practices. One of the main therapeutic tasks was to facilitate parents to create a psychic space where they can bring to life, psychically, their lost and never- really-known stillborn baby, and to let him or her to be part of the on-going family narrative.

Playing and virtual reality: Teleanalysis with children and adolescents during the COVID-19 pandemic

What has come into question in our analytic practice with children and adolescents during the COVID-19 pandemic? Do the new practices related to the virtual allow the creation of a therapeutic playground and the continuity of an analytic process? In the literature, the effectiveness and the perplexities raised in teleanalysis with adults are described. Conversely, no research on the use of the virtual in child analysis is available. Given the specificity of the developmental age, the three authors present their clinical experience and theoretical and technical reflections on the remote setting with children and adolescents. Particular emphasis is given to the technical changes and to the deep meaning that these changes have had in reference to the analytic relationship. Using the Winnicottian theoretical vertex, the opposition between fetishistic and transitional use, the denial of separation and recognition of otherness in the analytic virtual space will be discussed using clinical examples. The video tool may generate in children a great excitement and unleash the infantile sexual perversions. The co-creation of an intermediate virtual playground allows sufficient psychic continuity to work on the unconscious material, and even to make emerge previous traumas that then find a chance to be worked-through.

Trauma, process and representation

The concept of Trauma in psychoanalysis has suffered from overuse and inconsistent use. A review of Freud's writings beginning with the Project indicates that from the perspective of the impact upon psychic processes, Freud held a more consistent view of the concept that, if recognized, can help avoid the often fruitless etiological debates of internal vs. external cause, intrinsic (drive) vs. extrinsic (reality) factors, etc. What is more helpful from a clinical perspective, is to view the various challenges that a given set of potentially trauma-inducing circumstances might pose for an individual, consider each individual's highly subjective mode of experiencing and responding to those challenges and take into account the supports offered in any instance by the specific familial, social or cultural surround. Each set of experiences that will be qualified as 'trauma' that any of us undergoes will to some extent be understood and integrated into our particular subjectivities according to our unique, subjective organizations of self, understandings of and position in the world.

Dissociation vs Repression: A New Neuropsychoanalytic Model for Psychopathology

Recent research on trauma, attachment and neuroscience point at a clear divide in psychopathology between disorders based on repression, (as in Freud's repression model) and psychopathologies structured on dissociative mechanisms, a response to severe interpersonal trauma. Pathologies based on repression are typical of a neurotic structure, (with better developmental outcome), while pathologies based on dissociation are of more severe, often borderline nature, as in Otto Kernberg's borderline organization (1975). Neurobiology of attachment and affect regulation theory (Allan Schore), developmental psychopathology (Giovanni Liotti) and contemporary relational psychoanalysis (Philip Bromberg), all provide clinical evidence that the most severe psychopathology is of dissociative structure. This paper clarifies the after-effects of first level of traumatization of human agency (i.e., lack of attunement) and of the second level as in cases with actual abuse, maltreatment or incest (Mucci, 2013), with the internalization of a dyad victim/persecutor within the self of the survivor, as seen in borderline psychopathology (Mucci, 2018).

Psychodynamic Psychotherapy for Children as a Trauma-Informed Intervention

This article outlines the underpinnings of a psychodynamic approach for the treatment of childhood trauma through strengthening the implicit emotion regulation system. Childhood trauma impairs the functioning of the emotion regulation system, where deficits are common in children with post-traumatic stress disorder (PTSD). Difficulties with emotion regulation arise out of disruptions in the development of neurobiological pathways through the interaction of constitutional determinants with environmental factors, including the child's relationships with caregivers and the broader environment. We propose that a therapeutic focus on traumatized children's defenses can overcome the damaging reverberations of trauma. This approach may bypass the difficulties of high attrition rates, expense, and limited generalizability characteristic of skills training-based modalities. An illustration of an intervention to help children address unbearable emotions in traumatic experiences through defense interpretation is presented. The manualization and study of this approach within a project titled Regulation Focused Psychotherapy for Children (RFP-C) presents a unique opportunity to contribute to the evidence-based canon of treatments for children with histories of trauma.

The Collateral Impact of COVID-19 Emergency on Neonatal Intensive Care Units and Family-Centered Care: Challenges and Opportunities

The ongoing Coronavirus disease 2019 (COVID-19) pandemic is disrupting most specialized healthcare services worldwide, including those for high-risk newborns and their families. Due to the risk of contagion, critically ill infants, relatives and professionals attending neonatal intensive care units (NICUs) are undergoing a profound remodeling of the organization and quality of care. In particular, mitigation strategies adopted to combat the COVID-19 pandemic may hinder the implementation of family-centered care within the NICU. This may put newborns at risk for several adverse effects, e.g., less weight gain, more nosocomial infections, increased length of NICU stay as well as long-term worse cognitive, emotional, and social development. This article aims to contribute to deepening the knowledge on the psychological impact of COVID-19 on parents and NICU staff members based on empirical data from the literature. We also provided evidence-based indications on how to safely empower families and support NICU staff facing such a threatening emergency, while preserving the crucial role of family-centered developmental care practices.

Noah's Ark: technical and theoretical implications concerning the use of metaphor in the treatment of trauma1

In this paper, using my clinical work with a 3-year-old boy who lost his hearing when he was between 9 and 12 months old, and whose disability was only discovered when he was 22 months old, I will explore two issues of paramount technical importance when working with trauma. Firstly, it is crucial to create a boundary around the traumatic event, so that life before, during and after the trauma can be circumscribed and the traumatic event explored and hopefully understood and integrated. Secondly, it is of paramount importance to establish the level of developmental organization at the time of the trauma, especially in relation to the capacity to integrate bodily affects into mind. I will show how trauma and its vicissitudes are directly dependent on the person's capacity to resolve the splitting that trauma creates in the mind, and also the key role played by the use of metaphors in the process whereby trauma becomes thinkable and can therefore be integrated into the self.

Compassion in the Clink: When and How Human Services Workers Overcome Barriers to Care

A key assumption in past literature has been that human services workers become emotionally distant from their charges (such as clients or patients). Such distancing is said to protect workers from the emotionally draining aspects of the job but creates challenges to feeling and behaving compassionately. Because little is known about when and how compassion occurs under these circumstances, we conducted a multiphased qualitative study of 119 correctional officers in the United States using interviews and observations. Officers’ accounts and our observations of their interactions with inmates included cruel, disciplinary, unemotional, and compassionate treatment. Such treatment varied by the situations that officers faced, and compassion was surprisingly common when inmates were misbehaving—challenging current understanding of the occurrence of compassion at work. Examining officers’ accounts more closely, we uncovered a novel way that we theorize human services workers can be compassionate, even under such difficult circumstances. We find that officers describe engaging in practices in which they (a) relate to others by leveling group-based differences between themselves and their charges and (b) engage in self-protection by shielding themselves from the negative emotions triggered by their charges. We posit that the combined use of such practices offsets different emotional tensions in the work, rather than only providing emotional distance, and in doing so, can foster compassionate treatment under some of the most trying situations and organizational barriers to compassion.

Psychoanalytic Perspectives on the Psychological Effects of Stillbirth on Parents: A Protocol for Systematic Review and Qualitative Synthesis

Introduction: Despite the fact that stillbirth has a broad economic impact on health systems and society and despite the fact that the importance of appropriate psychological and social support for parents has been highlighted, there is still a lack of research exploring the intrapsychic and interpersonal dynamics and issues triggered by the experience of stillbirth. Healthcare professionals attempting to provide effective psychological support to bereaved parents who have suffered perinatal loss continue to struggle to achieve better and deeper understanding of their psychological states and processes. Psychoanalysis could play a key role in improving this situation, but the studies available are confined to journals of psychoanalysis, and there is a lack of synthesis, leaving this knowledge beyond the reach of scientists from other theoretical approaches or disciplines. This protocol proposes the systematic review and qualitative synthesis of articles from journals of psychoanalysis on the psychological effects on parents of stillbirth.

Methods and Analysis: This systematic review will follow, as far as possible, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Psychoanalytic Electronic Publishing Archive (1999–2019), the Single Case Archive (1999–2019), and PsycINFO (1999–2019) will be used to identify relevant articles. The review will include articles reporting clinical material and/or theoretical considerations concerning parent psychological states and processes triggered by the experience of stillbirth, and a meta-synthesis will be performed.

Ethics and Dissemination: Formal ethical approval is not required for this study, as no primary data will be collected. The findings will be published in an international peer-reviewed journal.

Bound Together: How Psychoanalysis Diminishes Inter-generational DNA Trauma

The concept of intergenerational transmission of trauma plays a fundamental role in psychoanalysis. While it is known that intergenerational trauma can be transmitted through attachment relationships, a new branch of genetics (epigenetics) has emerged to study the interaction between human behavior and changes in DNA expression. Therefore, psychoanalysis, which has proven to reduce the intergenerational transmission of trauma from a behavioral perspective, can play a positive role in regulating DNA changes caused by environmental stress. The present paper focuses on recent research suggesting a direct correlation between psychological trauma and DNA modifications. In particular, DNA changes caused by psychological trauma can be transmitted from generation to generation, validating the psychoanalytic concept of intergenerational transmission of trauma. This evidence not only supports the essential role psychoanalysis has in influencing human behavior, but also suggests that it affects not only the individuals who undergo it but their offspring, as well, via the epigenetic passage of DNA.

Resilience, Trauma, and Coping

The study and use of resilience is of the utmost importance to psychodynamic psychiatry. It is deeply ingrained in ideas about well-being and the treatment and care of patients. However, its neurobiology is incompletely understood, its terminology and relation to trauma and coping not well defined, and its efficacy underutilized in clinical practice. This article reviews the scientific literature on resilience, especially as it relates to trauma and coping. It also attempts to point the way for its greater application in psychiatry and mental health by utilizing resilience in more informed and individualized approaches.

Vicissitudes in adult life resulting from traumatic experiences in adolescence

The author deals with the difficulties in combining the concepts of trauma and phantasy. He evaluates Freudian observations relating to chance and trauma. He considers traumatic effects of chance in relation to the rupture of a narcissistic phantasy of invulnerability. The narrating of traumatic events may awaken in the analyst tendencies to repeat the aggression of these traumatic events towards the subject. The accusatory interpretation can be one of the means by which this repetition is established. The author explores a type of trauma which is essentially related to the disturbance of the structure which contains the ideals of the subject. This disturbance is a consequence of disillusionment resulting from the loss of an object who was the depository of these ideals. Trauma generates a state of mourning for lost ideals. The author describes traumatic events which occurred in a patient's life at puberty; paradoxical behaviours in the patient's parents caused the patient to have new traumas. The reluctance to explore the derivatives of the unconscious, and to investigate possible meaning in symbols, was a central problem in this patient's analysis. The author discusses disturbances in symbolization, and he examines the subject of projective identifications that were received by patients from their primary objects.