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Salim S. The burden of trauma in the life of a refugee. Front Public Health 2024; 12:1298544. [PMID: 39086798 PMCID: PMC11288919 DOI: 10.3389/fpubh.2024.1298544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 06/19/2024] [Indexed: 08/02/2024] Open
Affiliation(s)
- Samina Salim
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX, United States
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2
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Li Piani L, Somigliana E, Micci LG, Spinelli G, Barbara G. Going Beyond Childhood and Gender-Based Violence: Epigenetic Modifications and Inheritance. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:473-484. [PMID: 39035135 PMCID: PMC11257107 DOI: 10.1089/whr.2024.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 07/23/2024]
Abstract
Being exposed to childhood or gender-based violence is associated with subsequent adverse events in individual lives. Not only can it cause psychological distress but violence survivors suffer from a range of long-term adverse health outcomes, including higher morbidity, higher mortality, and higher risk of chronic diseases. Epigenetics may be involved in the determinisms of these long-term detrimental effects. A large body of evidence supports this biological mechanism to explain violence-related health impairment in the long term. However, studies specifically focusing on violence are scant and nonunivocal. Epigenetic modifications of genes involved in stress response and in the hypothalamus-pituitary-adrenal axis regulation are the most commonly and consistently reported. Promising evidence also emerged for the use of epigenetic clocks. Finally, although very limited, there is evidence supporting the notion that long-term health impairment may be transmitted from one generation to the other. Overall, despite promising, available evidence is yet incomplete. The overlap with pure psychological mechanisms of health impairment exposes the findings to confounders and hampers strong conclusions. Based on a literature search on PubMed/Embase, our narrative review aims to illustrate the evidence concerning the potential bond between epigenetics and violence, including also possible impacts on later generations. The goal is to encourage further research to help the development of a more holistic approach for such a vulnerable and often neglected population. Further research is warranted to precisely disentangle the role of epigenetics in mediating the long-term health impairment associated with childhood or gender-based violence. Advances in this area may open new avenues of treatment. Epigenetic modifications may indeed be reversible and could be an attractive therapeutic target to minimize the long-term consequences of childhood or gender-based violence.
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Affiliation(s)
- Letizia Li Piani
- Dept of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Dept of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- SVSeD - Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laila Giorgia Micci
- SVSeD - Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaia Spinelli
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- SVSeD - Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giussy Barbara
- Dept of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- SVSeD - Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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3
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Hall H. Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat. J Trauma Dissociation 2024; 25:334-348. [PMID: 36065490 DOI: 10.1080/15299732.2022.2120154] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders.
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Rzeszutek M, Dragan M, Lis-Turlejska M, Schier K, Holas P, Pięta M, Van Hoy A, Drabarek K, Poncyliusz C, Michałowska M, Wdowczyk G, Borowska N, Szumiał S. Long-lasting effects of World War II trauma on PTSD symptoms and embodiment levels in a national sample of Poles. Sci Rep 2023; 13:17222. [PMID: 37821535 PMCID: PMC10567698 DOI: 10.1038/s41598-023-44300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023] Open
Abstract
The main aim of this study was to investigate the long-lasting influences of World War II (WWII) trauma in a national sample of Poles, based on Danieli's (1998) survivors' post-trauma adaptational styles (fighter, numb, victim) and their link with current post-traumatic stress disorder (PTSD) symptoms and embodiment level among participants. We also sought to investigate whether the level of knowledge about WWII trauma among ancestors could moderate that association. The study was conducted among a representative sample of 1598 adult Poles obtained from an external company. Participants filled out the Danieli Inventory of Multigenerational Legacies of Trauma, the knowledge about traumatic World War II experiences in the family questionnaire, the Posttraumatic Diagnostic Scale-5, and the Experience of Embodiment Scale. We observed a positive relationship between all survivors' post-trauma adaptational styles and current levels of PTSD symptoms among participants. In addition, PTSD level mediated the relationships between those adaptational styles and embodiment intensity; that mediation was additionally moderated by a lack of knowledge about WWII trauma among ancestors in our participants. Our study adds to the literature on intergenerational trauma by highlighting the importance of evaluating embodiment in understanding the mechanisms of trauma transmission. Furthermore, it highlights the moderating effect of knowledge of family history in this mechanism and the need to share family histories with subsequent generations.
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Affiliation(s)
- Marcin Rzeszutek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland.
| | - Małgorzata Dragan
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Maja Lis-Turlejska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska Street 19/31, 03-815, Warsaw, Poland
| | - Katarzyna Schier
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Paweł Holas
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Małgorzata Pięta
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Angelika Van Hoy
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Katarzyna Drabarek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Cecylia Poncyliusz
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | | | - Gabriela Wdowczyk
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Natalia Borowska
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Szymon Szumiał
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
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5
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Salberg J. Maternal envy as legacy: Search for the unknown lost maternal object. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2022; 103:726-743. [PMID: 36200359 DOI: 10.1080/00207578.2022.2043157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The impact of intergenerational transmissions of trauma and the dissociative states of mind that cross from parents to their children has become an important expansion of psychoanalytic theory. Clinical material will be discussed showing how an early death of a mother haunted the lives of many generations of mothers and daughters. Considerations of attachment rupture, trauma, envy, deadly and deadening aggression and shame are discussed as part of transgenerational transmission phenomena and how they are worked on in the analytic relationship. Envious attacks, though painful to tolerate, nonetheless need to be processed in order to transform transmissions from the past.
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Affiliation(s)
- Jill Salberg
- New York University Postdoctoral Program in Psychotherapy and Psychoanalysis, New York, NY, USA
- Institute for Psychoanalytic Training and Research, New York, USA
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6
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Chung MC, Wang Y, Wu X, Wang N, Liu F, Ye Z, Peng T. Comparison between emerging adults and adults in terms of contamination fear, post-COVID-19 PTSD and psychiatric comorbidity. CURRENT PSYCHOLOGY 2022:1-12. [PMID: 36124044 PMCID: PMC9476456 DOI: 10.1007/s12144-022-03719-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 08/13/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022]
Abstract
The present study compared Chinese emerging adults and adults regarding the association between contamination fear, posttraumatic stress disorder post-COVID-19 and psychiatric comorbidity after controlling for demographic and trauma exposure variables. 1089 Chinese civilians (M = 382; F = 707) with a mean age of 26 years (M = 26.36, SD = 8.58) were recruited from different provinces in China via an online survey posted on mainstream Chinese social networking platforms. They completed a demographic page with questions on trauma exposure, the Vancouver Obsessional Compulsive Inventory, the Posttraumatic Stress Disorder Checklist for DSM-5 and the General Health Questionnaire-28. Results showed that 12.7%, 68.7% and 18.6% met criteria for full, partial and no PTSD, respectively. Emerging adults reported significantly lower levels of symptoms of re-experiencing, avoidance, somatic problems, anxiety and fear of contamination than adults. In both emerging adults and adults, contamination fear was correlated with PTSD and psychiatric comorbidity. High educational attainment was significantly correlated with psychiatric comorbidity in emerging adults, but with PTSD in adults. Length of quarantine was correlated with psychiatric comorbidity only in adults. In conclusion, both emerging adults and adults developed varying levels of contamination fear, posttraumatic stress and general psychological symptoms following the outbreak of COVID-19. Emerging adults were more resilient than adults in coping with distress.
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Affiliation(s)
| | - Yabing Wang
- Center for Linguistics and Applied Linguistics, Guangdong University of Foreign Studies, Guangzhou, China
- School of English Education, Guangdong University of Foreign Studies, Guangzhou, China
| | - Xili Wu
- School of Foreign Languages, South China University of Technology, Guangzhou, China
| | - Na Wang
- School of Foreign Languages, Huazhong University of Science and Technology, Wuhan, China
| | - Fangsong Liu
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Zilan Ye
- School of Humanities and Management, Guangdong Medical University, Guangzhou, China
| | - Ting Peng
- Shunde Wu Zhong Pei Hospital, Guangzhou, China
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7
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Harari E, Grant DC. Clinical wisdom, science and evidence: The neglected gifts of psychodynamic thinking. Aust N Z J Psychiatry 2022; 56:594-602. [PMID: 35172624 DOI: 10.1177/00048674221077622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We review five key areas of contemporary psychodynamic practice and research to highlight the contributions psychodynamic concepts can make to clinical psychiatry. These areas are as follows: (1) Contributions to understanding the development of subjectivity. (2) The psychodynamic understanding of the effects of early childhood trauma and their consequences in adult life. (3) The vital importance of the psychodynamic notion of the 'holding environment' based on an understanding of the dynamics of the development of subjectivity and trauma which, if applied, might improve the quality of psychiatric care in the public mental health system and enhance both the clinical competence and morale of clinicians in the system. (4) The emerging scientific disciplines of Neuropsychoanalysis and Affective Neuroscience, which illustrate the importance of seriously studying the mind as well as the brain. (5) A brief summary of some research into the clinical effectiveness and efficacy of psychoanalysis and its related psychodynamic therapies.
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Affiliation(s)
- Edwin Harari
- Department of Psychiatry, St Vincent's Area Mental Health Services, Fitzroy, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
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8
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Finlay S, Roth C, Zimsen T, Bridson TL, Sarnyai Z, McDermott B. Adverse childhood experiences and allostatic load: A systematic review. Neurosci Biobehav Rev 2022; 136:104605. [PMID: 35278597 DOI: 10.1016/j.neubiorev.2022.104605] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/23/2022] [Accepted: 03/06/2022] [Indexed: 12/21/2022]
Abstract
Adverse Childhood Experiences (ACEs) are stressful and/or traumatic experiences associated with an increased lifetime risk of negative health outcomes. The Allostatic Load (AL) is a measure of multisystem dysregulation, resulted by chronic stress. We systematically reviewed the English language literature on the association between ACEs and AL to identify the clinical risk profile, with the exclusion of reviews and preclinical studies. Searches covered the publication period up to the 1st of February 2022 and identified 25 studies in which ACEs such as maltreatment, abuse, poverty, psychological abuse, and discrimination were investigated in the context of AL. The selected studies used different sets of AL biomarkers resulting in substantial heterogenicity of calculating the AL index. Overall, we found that ACEs are associated with elevated AL and poorer health outcomes in adulthood. Furthermore, health risk behaviors, social support, and coping resources either moderate or mediate this association. These findings suggest that targeting individuals at risk and starting interventions early might reduce AL and its deleterious health consequences.
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Affiliation(s)
- Sabine Finlay
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia.
| | - Cody Roth
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia
| | - Tiansha Zimsen
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Tahnee Lee Bridson
- North-West Mental Health, The Royal Melbourne Hospital, Victoria, Australia; Fireside Research, Woodbridge Tasmania, Australia
| | - Zoltan Sarnyai
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Therapeutics, James Cook University, Townsville, Queensland, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Public Health, Medical & Veterinary Sciences, James Cook University, Queensland, Australia
| | - Brett McDermott
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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9
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Wilkinson SR. Diagnosis on the way out - personality on the way in? Priorities in treatment in child and adolescent psychiatry. Clin Child Psychol Psychiatry 2022; 27:504-514. [PMID: 34865505 DOI: 10.1177/13591045211048171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The scientific basis for practice in child psychiatry has developed apace. And has thrown up several quandries for an accepted paradigm for good practice anchored to the diagnostic schema developed in adult psychiatry. This paper hopes to stimulate discussion about where alternative paradigms might lead us on a path to precision medicine as applied to child psychiatry.
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Affiliation(s)
- Simon R Wilkinson
- FRC Psych, Oslo University Hospital and Akershus University Hospital, Oslo, Norway
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10
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Mannarini S, Taccini F, Rossi AA. Women and Violence: Alexithymia, Relational Competence and Styles, and Satisfaction with Life: A Comparative Profile Analysis. Behav Sci (Basel) 2021; 11:147. [PMID: 34821608 PMCID: PMC8615153 DOI: 10.3390/bs11110147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background: This research investigates the two sides of violence by profiling female interpersonal violence offenders (IVO) and female interpersonal violence victims (IVV). These groups of women have been compared on three key variables within the context of violence: satisfaction with life (SWL), alexithymia, and relational styles-defined according to the Relational Competence Theory (RCT). Regarding the latter, the experience of functional or dysfunctional relational styles in childhood and adult relationships has been evaluated and compared with both groups of women. Methods: This study involved 131 women: IVO (n = 41; enrolled in a penitentiary), IVV (n = 41; enrolled in an anti-violence center), and a control group (CG; n = 49; enrolled from the general population). Profile analysis was performed. Results: Female IVO showed low SWL, high levels of alexithymia, and a pattern of mixed relational styles with both parents and the current partner. Female IVV revealed low SWL, low levels of alexithymia and dysfunctional relational styles with both parents and current partner. Women from the CG showed high SWL, absence of alexithymia and functional relational styles with both parents and current partner. Conclusions: The profiles outlined in this study are extremely informative regarding alexithymia, relational styles, and SWL in both female IVV and IVO. Clinical interventions for both groups of women should be developed relying on these results.
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Affiliation(s)
- Stefania Mannarini
- Section of Applied Psychology, Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, 35131 Padova, Italy; (S.M.); (F.T.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
| | - Federica Taccini
- Section of Applied Psychology, Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, 35131 Padova, Italy; (S.M.); (F.T.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
| | - Alessandro Alberto Rossi
- Section of Applied Psychology, Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, 35131 Padova, Italy; (S.M.); (F.T.)
- Interdepartmental Center for Family Research, University of Padova, 35131 Padova, Italy
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11
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Taccini F, Rossi AA, Mannarini S. Intergenerational Transmission of Relational Styles: Current Considerations. Front Psychol 2021; 12:672961. [PMID: 34658997 PMCID: PMC8514634 DOI: 10.3389/fpsyg.2021.672961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Federica Taccini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
- Interdepartmental Center for Family Research, University of Padova, Padova, Italy
| | - Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
- Interdepartmental Center for Family Research, University of Padova, Padova, Italy
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
- Interdepartmental Center for Family Research, University of Padova, Padova, Italy
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12
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Abrams B. Encountering transgenerational trauma through analytical music therapy. NORDIC JOURNAL OF MUSIC THERAPY 2021. [DOI: 10.1080/08098131.2020.1853801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Brian Abrams
- John J. Cali School of Music, Montclair State University, Montclair, NJ, USA
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13
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White LO, Schulz CC, Schoett MJS, Kungl MT, Keil J, Borelli JL, Vrtička P. Conceptual Analysis: A Social Neuroscience Approach to Interpersonal Interaction in the Context of Disruption and Disorganization of Attachment (NAMDA). Front Psychiatry 2020; 11:517372. [PMID: 33424647 PMCID: PMC7785824 DOI: 10.3389/fpsyt.2020.517372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 11/18/2020] [Indexed: 12/22/2022] Open
Abstract
Humans are strongly dependent upon social resources for allostasis and emotion regulation. This applies especially to early childhood because humans-as an altricial species-have a prolonged period of dependency on support and input from caregivers who typically act as sources of co-regulation. Accordingly, attachment theory proposes that the history and quality of early interactions with primary caregivers shape children's internal working models of attachment. In turn, these attachment models guide behavior, initially with the set goal of maintaining proximity to caregivers but eventually paving the way to more generalized mental representations of self and others. Mounting evidence in non-clinical populations suggests that these mental representations coincide with differential patterns of neural structure, function, and connectivity in a range of brain regions previously associated with emotional and cognitive capacities. What is currently lacking, however, is an evidence-based account of how early adverse attachment-related experiences and/or the emergence of attachment disorganization impact the developing brain. While work on early childhood adversities offers important insights, we propose that how these events become biologically embedded crucially hinges on the context of the child-caregiver attachment relationships in which the events take place. Our selective review distinguishes between direct social neuroscience research on disorganized attachment and indirect maltreatment-related research, converging on aberrant functioning in neurobiological systems subserving aversion, approach, emotion regulation, and mental state processing in the wake of severe attachment disruption. To account for heterogeneity of findings, we propose two distinct neurobiological phenotypes characterized by hyper- and hypo-arousal primarily deriving from the caregiver serving either as a threatening or as an insufficient source of co-regulation, respectively.
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Affiliation(s)
- Lars O. White
- Department of Child and Adolescent Psychiatry, University of Leipzig, Leipzig, Germany
| | - Charlotte C. Schulz
- Department of Child and Adolescent Psychiatry, University of Leipzig, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | - Melanie T. Kungl
- Department of Psychology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jan Keil
- Department of Child and Adolescent Psychiatry, University of Leipzig, Leipzig, Germany
| | - Jessica L. Borelli
- THRIVE Laboratory, Psychology and Social Behavior, University of California, Irvine, Irvine, CA, United States
| | - Pascal Vrtička
- Research Group “Social Stress and Family Health”, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Psychology, Centre for Brain Science, University of Essex, Colchester, United Kingdom
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14
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Repeated, Ongoing, and Systemic Incidents of Racism and their Harmful Mental Health Effects:. Dela J Public Health 2020. [DOI: 10.32481/djph.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Jacobs L. Gazing into Existence: A Discussion of “A Patient Who Does Not Look: A Collaborative Treatment with Video Feedback”. PSYCHOANALYTIC DIALOGUES 2020. [DOI: 10.1080/10481885.2020.1774338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Wallace M, Felker-Kantor E, Madkour A, Ferguson T, Welsh D, Molina P, Theall KP. Adverse Childhood Experiences, Smoking and Alcohol Use, and Allostatic Load Among People Living with HIV. AIDS Behav 2020; 24:1653-1662. [PMID: 31559525 DOI: 10.1007/s10461-019-02684-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Allostatic load is an indicator of multisystem physiologic dysregulation that may arise from prolonged or accumulated exposure to stress, including adverse childhood experiences (ACEs) and chronic stressors persisting into adulthood. People living with HIV (PLWH) may be particularly vulnerable given their high burdens of adversity across the life course. Using data from a cohort of middle aged PLWH, we examined associations between ACEs and two measures of allostatic load. In order to determine whether the negative impact of ACEs on allostatic load operates through increasing the adoption of adverse coping behaviors, we tested for mediation by smoking and alcohol use. PLWH who had experienced 4 or more ACEs had on average higher allostatic load in adulthood compared to those who experienced fewer. Neither smoking nor alcohol use mediated this relationship, however, suggesting alternative mechanisms may be at play.
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Affiliation(s)
- Maeve Wallace
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., suite 2200, New Orleans, LA, 70112, USA.
| | - Erica Felker-Kantor
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., suite 2200, New Orleans, LA, 70112, USA
| | - Aubrey Madkour
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., suite 2200, New Orleans, LA, 70112, USA
| | - Tekeda Ferguson
- Department of Epidemiology, Louisiana State University School of Public Health, 2020 Gravier St., 5th floor, New Orleans, LA, 70112, USA
| | - David Welsh
- Section of Pulmonary/Critical Care, Louisiana State University School of Medicine, 2020 Gravier St., 5th floor, New Orleans, LA, 70112, USA
| | - Patricia Molina
- Department of Physiology, Louisiana State University School of Medicine, 2020 Gravier St., 5th floor, New Orleans, LA, 70112, USA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., suite 2200, New Orleans, LA, 70112, USA
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17
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Affiliation(s)
- Jill Salberg
- New York University Postdoctoral Program in Psychotherapy and Psychoanalysis
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18
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Hoffman Y, Shrira A. Variables Connecting Parental PTSD to Offspring Successful Aging: Parent-Child Role Reversal, Secondary Traumatization, and Depressive Symptoms. Front Psychiatry 2019; 10:718. [PMID: 31681033 PMCID: PMC6803468 DOI: 10.3389/fpsyt.2019.00718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/09/2019] [Indexed: 11/13/2022] Open
Abstract
The effects of parental trauma on offspring of Holocaust survivors (OHS) are debated in the literature. Recently, scholars suggested that it may be more productive to ask when and via which mechanisms such effects are observed. Following, the current study examines if parental Holocaust-related posttraumatic stress disorder (PTSD) symptoms are linked with the aging processes of their middle-aged offspring. Beyond this association, we also suggested a putative mediation path, indicating three underlying mechanisms by which parental trauma lingers on: perceived parent-child role reversal, secondary traumatization, and depressive symptoms. Using a convenience sample of 682 community-dwelling participants, comprising 341 older adult parent-middle-aged offspring dyads (M age = 81.71 and 54.58 for parents and offspring, respectively) to address this issue. Parents reported PTSD with the valid measure of PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. OHS reported perceived parent-child role reversal, secondary traumatization, depressive symptoms, and completed indices of successful aging. Based on parents' reports, we divided the parent-offspring dyads into three groups: OHS whose parents had probable PTSD (n dyads = 43), OHS whose parents did not have PTSD (n dyads = 161), and comparison with parents who did not undergo the Holocaust (n dyads = 137). Findings reveal that OHS with parents suffering from probable PTSD aged less successfully than comparisons. Serial mediation analyses validated the aforementioned putative pathway (perceived parent-child role reversal, secondary traumatization, and depression) linking parental PTSD with offspring successful aging. Our findings are discussed through a vignette depicting a fictional OHS character. These underlying mechanisms suggest that different types of interventions, each geared towards a specific mechanism, may mitigate the lingering effect of parental PTSD on diminished OHS successful aging.
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Affiliation(s)
- Yaakov Hoffman
- The Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat-Gan, Israel
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Salberg J. When Trauma Tears The Fabric of Attachment: Discussion of “The Intergenerational Transmission of Holocaust Trauma: A Psychoanalytic Theory Revisited”. THE PSYCHOANALYTIC QUARTERLY 2019. [DOI: 10.1080/00332828.2019.1616500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Impact of Maternal Early Life Maltreatment and Maternal History of Depression on Child Psychopathology: Mediating Role of Maternal Sensitivity? Child Psychiatry Hum Dev 2019; 50:278-290. [PMID: 30132095 DOI: 10.1007/s10578-018-0839-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The study addresses the impact of maternal early life maltreatment (ELM) and maternal history of depression (HoD) on offspring's mental health. Maternal sensitivity was examined as a potential mediator explaining the relationship between maternal ELM, maternal HoD and child psychopathology. Participants were 194 mothers with and without HoD and/or ELM as well as their children between 5 and 12 years. Maternal sensitivity was assessed using the Emotional Availability Scales. Parent and teacher ratings were utilized to assess child psychopathology. Path analyses showed an indirect effect of maternal HoD on parents' ratings of child psychopathology with maternal sensitivity as mediating variable. In contrast, maternal ELM was directly linked to teachers' ratings of child psychopathology; this effect was not mediated by maternal sensitivity. Our results indicate that the impact of maternal HoD, maternal ELM, and maternal sensitivity on offspring psychopathology might vary depending on the context in which child psychopathology is assessed.
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Dashorst P, Mooren TM, Kleber RJ, de Jong PJ, Huntjens RJC. Intergenerational consequences of the Holocaust on offspring mental health: a systematic review of associated factors and mechanisms. Eur J Psychotraumatol 2019; 10:1654065. [PMID: 31497262 PMCID: PMC6720013 DOI: 10.1080/20008198.2019.1654065] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 07/14/2019] [Accepted: 07/28/2019] [Indexed: 11/24/2022] Open
Abstract
Exposure to war and violence has major consequences for society at large, detrimental impact on people's individual lives, and may also have intergenerational consequences. To gain more insight into these intergenerational consequences, research addressing the impact of the Holocaust on offspring is an important source of information. The aim of the current study was to systematically review the mechanisms of intergenerational consequences by summarizing characteristics in Holocaust survivors and their offspring suggested to impact the offspring's mental health. We focused on: 1) parental mental health problems, 2) (perceived) parenting and attachment quality, 3) family structure, especially parental Holocaust history, 4) additional stress and life events, and 5) psychophysiological processes of transmission. We identified 23 eligible studies published between 2000 and 2018. Only Holocaust survivor studies met the inclusion criteria. Various parent and child characteristics and their interaction were found to contribute to the development of psychological symptoms and biological and epigenetic variations. Parental mental health problems, perceived parenting, attachment quality, and parental gender appeared to be influential for the mental well-being of their offspring. In addition, having two survivor parents resulted in higher mental health problems compared to having one survivor parent. Also, there was evidence suggesting that Holocaust survivor offspring show a heightened vulnerability for stress, although this was only evident in the face of actual danger. Finally, the results also indicate intergenerational effects on offspring cortisol levels. Clinical and treatment implications are discussed.
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Affiliation(s)
| | - Trudy M Mooren
- Stichting Centrum'45/partner in Arq, Diemen, The Netherlands.,Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Rolf J Kleber
- Stichting Centrum'45/partner in Arq, Diemen, The Netherlands.,Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Rafaele J C Huntjens
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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Ullmann E, Licinio J, Perry SW, White LO, Klein AM, Barthel A, Petrowski K, Stalder T, Oratovski B, von Klitzing K, Bornstein SR, Kirschbaum C. Inherited anxiety-related parent-infant dyads alter LHPA activity. Stress 2019; 22:27-35. [PMID: 30424700 DOI: 10.1080/10253890.2018.1494151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The pathogenesis of post-traumatic stress disorder (PTSD) is incompletely understood. We hypothesize that disruptions in mother-child relations may be a key contributor to development of PTSD. A normal and healthy separation-individuation process requires adaptations of self- and interactive contingency in both the mother and her child, especially in early childhood development. Anxious mothers are prone to overprotection, which may hinder the individuation process in their children. We examined long-term stress hormones and other stress markers in subjects three generations removed from the Holocaust, to assess the long-term consequences of inherited behavioral and physiological responses to prior stress and trauma. Jewish subjects who recalled overprotective parental behavior had higher hairsteroid-concentrations and dampened limbic-hypothalamic-pituitary-adrenal (LHPA) axis reactivity compared to German and Russian-German subjects with overprotective parents. We suggest that altered LHPA axis activity in maternally overprotected Jewish subjects may indicate a transmitted pathomechanism of "frustrated individuation" resulting from cross-generational anti-Semitic experiences. Thus measurements of hairsteroid-concentrations and parenting practices may have clinical value for diagnosis of PTSD. We propose that this apparent inherited adaptivity of LHPA axis activity could promote higher individual stress resistance, albeit with risk of an allostatic overload.
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Affiliation(s)
- E Ullmann
- a Department of Medicine , Carl Gustav Carus, Technical University of Dresden , Dresden , Germany
- b Department of Child and Adolescent Psychiatry , Psychotherapy, and Psychosomatics, University of Leipzig , Leipzig , Germany
| | - J Licinio
- c College of Medicine , SUNY Upstate Medical University , New York , NY, USA
| | - S W Perry
- c College of Medicine , SUNY Upstate Medical University , New York , NY, USA
| | - L O White
- b Department of Child and Adolescent Psychiatry , Psychotherapy, and Psychosomatics, University of Leipzig , Leipzig , Germany
| | - A M Klein
- b Department of Child and Adolescent Psychiatry , Psychotherapy, and Psychosomatics, University of Leipzig , Leipzig , Germany
- d International Psychoanalytic University Berlin , Berlin, Germany
| | - A Barthel
- a Department of Medicine , Carl Gustav Carus, Technical University of Dresden , Dresden , Germany
- e Medicover , Bochum , Germany
| | - K Petrowski
- f Department of Psychology , University of Witten/Herdecke , Witten/Herdecke , Germany
| | - T Stalder
- g Department of Psychology , Biopsychology, Technical University of Dresden , Dresden , Germany
- h Department of Developmental Psychology , University of Siegen , Siegen , Germany
| | - B Oratovski
- a Department of Medicine , Carl Gustav Carus, Technical University of Dresden , Dresden , Germany
| | - K von Klitzing
- b Department of Child and Adolescent Psychiatry , Psychotherapy, and Psychosomatics, University of Leipzig , Leipzig , Germany
| | - S R Bornstein
- a Department of Medicine , Carl Gustav Carus, Technical University of Dresden , Dresden , Germany
- i Faculty of Life Sciences & Medicine, Endocrinology and Diabetes , Kings College London , London , UK
| | - C Kirschbaum
- g Department of Psychology , Biopsychology, Technical University of Dresden , Dresden , Germany
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Aviad-Wilchek Y, Levy I, Ben-David S. Readiness to Use Psychoactive Substances Among Second-Generation Adolescent Immigrants and Perceptions of Parental Immigration-Related Trauma. Subst Use Misuse 2017; 52:1646-1655. [PMID: 28557547 DOI: 10.1080/10826084.2017.1298618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This research explores the relationship between parental immigration-related trauma and second-generation adolescent substance abuse. To examine this relationship, we focused on Ethiopian adolescents in Israel who are at risk for substance abuse. Many immigrants from Ethiopia experienced severe immigration trauma and research indicates the existence of transgenerational trauma transmission. The current research focuses on the connection between Ethiopian adolescents' perceptions of their parents' immigration trauma and their readiness to use psychoactive substances. DESIGN Five hundred and ten second-generation Ethiopian adolescents (Israeli-born children of Ethiopian immigrants) filled out questionnaires examining socio-demographic characteristics, immigration impact and readiness to consume alcoholic beverages and use illegal drugs. RESULTS Our findings show that readiness levels among Ethiopian adolescents to use psychoactive substances are relatively low, and that parental trauma only affects the readiness to consume alcohol. The levels of readiness to consume drugs were partially related to parental trauma. Conclusions/Importance: Transgenerational trauma transmission should be considered when implementing alcohol and substance abuse treatment and prevention policies among second generation immigrants. This should be done on all levels including personal, interpersonal and community levels.
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Affiliation(s)
| | - Inna Levy
- a Department of Criminology , Ariel University , Ariel , Israel.,b Department of Multidisciplinary Studies , Zefat Academic College , Zefat , Israel
| | - Sarah Ben-David
- a Department of Criminology , Ariel University , Ariel , Israel
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Ullmann E, Licinio J, Barthel A, Petrowski K, Stalder T, Bornstein SR, Kirschbaum C. Persistent LHPA Activation in German Individuals Raised in an Overprotective Parental Behavior. Sci Rep 2017; 7:2778. [PMID: 28584276 PMCID: PMC5459846 DOI: 10.1038/s41598-017-01718-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/04/2017] [Indexed: 11/24/2022] Open
Abstract
Parental upbringing may affect their offspring’s mental state across the entire lifespan. Overprotective parental child-rearing style may increase the disease burden in the offspring. Furthermore, this child-rearing style may also play a pathogenetic role by transmitting trauma- and stressor-related disorders (TSRD) across generations. Studies with animals have demonstrated that the mother’s immediate and expansive protection of the newborn decreases the limbic-hypothalamic-pituitary-adrenal (LHPA) axis activity in the offspring. However, few studies have investigated how stress impact humans raised in an overprotective manner. In a cross-sectional study with 40 healthy students recalling their overprotective upbringing, we show an increase in the dehydroepiandrostendione (DHEA) concentration and a reduction in the cortisol/DHEA-ratio in hair. Additionally, this child rearing style was associated with heightened indications of mental burden, depressiveness, and sense of coherence. Our results provide insight into the roots and consequences of psychological trauma across several generations. Further investigations focusing particularly on multigenerational transmission in extremely burdened families will augment our results.
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Affiliation(s)
- E Ullmann
- Department of Medicine, TU Dresden, Carl Gustav Carus, Dresden, Germany. .,Department for Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Leipzig, Germany.
| | - J Licinio
- Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Department of Psychiatry, Flinders University, School of Medicine, Adelaide, Australia.,South Ural State University, Biomedical School, Chelyabinsk, Russian Federation
| | - A Barthel
- Department of Medicine, TU Dresden, Carl Gustav Carus, Dresden, Germany.,Medicover, Bochum, Germany
| | | | - T Stalder
- Department of Psychology, TU Dresden, Dresden, Germany.,Clinical Psychology, University of Siegen, Siegen, Germany
| | - S R Bornstein
- Department of Medicine, TU Dresden, Carl Gustav Carus, Dresden, Germany.,Faculty of Life Sciences & Medicine, Rayne Institute, Endocrinology and Diabetes, Kings College London, London, UK
| | - C Kirschbaum
- Department of Psychology, TU Dresden, Dresden, Germany
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25
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Kaplan I, Stolk Y, Valibhoy M, Tucker A, Baker J. Cognitive assessment of refugee children: Effects of trauma and new language acquisition. Transcult Psychiatry 2016; 53:81-109. [PMID: 26563891 DOI: 10.1177/1363461515612933] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Each year, approximately 60,000 children of refugee background are resettled in Western countries. This paper reviews the effects of the refugee experience on cognitive functioning. The distinctive influences for these children include exposure to traumatic events and the need to acquire a new language, factors that need to be considered to avoid overdiagnosis of learning disorders and inappropriate educational placements. Prearrival trauma, psychological sequelae of traumatic events, developmental impact of trauma, and the quality of family functioning have been found to influence cognitive functioning, learning, and academic performance. In addition, the refugee child may be semiproficient in several languages, but proficient in none, whilst also trying to learn a new language. The influence that the child's limited English proficiency, literacy, and school experience may have on academic and test performance is demonstrated by drawing on the research on refugees' English language acquisition, as well as the more extensive literature on bilingual English language learners. Implications for interventions are drawn at the level of government policy, schools, and the individual. The paper concludes with the observation that there is a major need for longitudinal research on refugee children's learning and academic performance and on interventions that will close the academic gap, thereby enabling refugee children to reach their educational potential.
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Affiliation(s)
- Ida Kaplan
- Victorian Foundation for Survivors of Torture, Australia
| | | | | | - Alan Tucker
- La Trobe University, AustraliaVictoria University, Australia
| | - Judy Baker
- Victoria State Government Department of Education and Training, Australia
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26
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Nazarov A, Frewen P, Oremus C, Schellenberg EG, McKinnon MC, Lanius R. Comprehension of affective prosody in women with post-traumatic stress disorder related to childhood abuse. Acta Psychiatr Scand 2015; 131:342-9. [PMID: 25401486 DOI: 10.1111/acps.12364] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Although deficits in memory and cognitive processing are evident in post-traumatic stress disorder (PTSD), difficulties with social cognition and the impact of such difficulties on interpersonal functioning are poorly understood. Here, we examined the ability of women diagnosed with PTSD related to childhood abuse to discriminate affective prosody, a central component of social cognition. METHOD Women with PTSD and healthy controls (HCs) completed two computer-based tasks assessing affective prosody: (i) recognition (categorizing foreign-language excerpts as angry, fearful, sad, or happy) and (ii) discrimination (identifying whether two excerpts played consecutively had the 'same' or 'different' emotion). The association of performance with symptom presentation, trauma history, and interpersonal functioning was also explored. RESULTS Women with PTSD were slower than HCs at identifying happiness, sadness, and fear, but not anger in the speech excerpts. The presence of dissociative symptoms was related to reduced accuracy on the discrimination task. An increased severity of childhood trauma was associated with reduced accuracy on the discrimination task and with slower identification of emotional prosody. CONCLUSION Exposure to childhood trauma is associated with long-term, atypical development in the interpretation of prosodic cues in speech. The findings have implications for the intergenerational transmission of trauma.
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Affiliation(s)
- A Nazarov
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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27
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George C, Buchheim A. Use of the adult attachment projective picture system in psychodynamic psychotherapy with a severely traumatized patient. Front Psychol 2014; 5:865. [PMID: 25140164 PMCID: PMC4122203 DOI: 10.3389/fpsyg.2014.00865] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/20/2014] [Indexed: 11/24/2022] Open
Abstract
The following case study is presented to facilitate an understanding of how the attachment information evident from Adult Attachment Projective Picture System (AAP) assessment can be integrated into a psychodynamic perspective in making therapeutic recommendations that integrate an attachment perspective. The Adult Attachment Projective Picture System (AAP) is a valid representational measure of internal representations of attachment based on the analysis of a set of free response picture stimuli designed to systematically activate the attachment system (George and West, 2012). The AAP provides a fruitful diagnostic tool for psychodynamic-oriented clinicians to identify attachment-based deficits and resources for an individual patient in therapy. This paper considers the use of the AAP with a traumatized patient in an inpatient setting and uses a case study to illustrate the components of the AAP that are particularly relevant to a psychodynamic conceptualization. The paper discusses also attachment-based recommendations for intervention.
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Affiliation(s)
- Carol George
- Department of Psychology, Mills College Oakland, CA, USA
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck Innsbruck, Austria
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28
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Affiliation(s)
- Edwin Harari
- St Vincent's Hospital Area Mental Health Service, Fitzroy, Australia.
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29
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Kullgard N, Persson P, Möller C, Falkenström F, Holmqvist R. Reflective functioning in patients with obsessive–compulsive disorder (OCD) – preliminary findings of a comparison between reflective functioning (RF) in general and OCD-specific reflective functioning. PSYCHOANALYTIC PSYCHOTHERAPY 2013. [DOI: 10.1080/02668734.2013.795909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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Ullmann E, Barthel A, Licinio J, Petrowski K, Bornstein SR, Strauß B. Increased rate of depression and psychosomatic symptoms in Jewish migrants from the post-Soviet-Union to Germany in the 3rd generation after the Shoa. Transl Psychiatry 2013; 3:e241. [PMID: 23481628 PMCID: PMC3625916 DOI: 10.1038/tp.2013.17] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/02/2012] [Indexed: 12/17/2022] Open
Abstract
The mental health status of persons with Jewish background living in Germany is discussed with special regard to social exclusion like anti-Semitism and overprotective parental rearing behavior, as a transmissional factor of the KZ-Syndrome. These stressors are considered in the context of a higher risk for depression/fear and psychosomatic disorders and also abnormal cortisol levels. The present sample (N=89) is derived from the Jewish population currently living in the German region of Saxony aged between 17-36 years that emigrated from the post-Soviet-Union areas. The mean age was 22.9 years. Two questionnaires to detect psychosomatic symptoms (Giessen complaint list (GBB)-24, hospital anxiety and depression scale) and one questionnaire addressing parental rearing behavior (FEE) were employed. Comparisons were drawn with normative data from the literature about the German residential population. In addition, questions were asked concerning the experience of anti-Semitism in Germany and in the post-Soviet-Union areas. A higher prevalence of depression/fear (10.3% versus 18.2%) and psychosomatic symptoms (M=14.03 versus 17.8; t=2.42; P<0.05) was observed in Jewish migrants to Germany as compared with non-Jewish German residents. Furthermore, anti-Semitic experiences in Germany correlated positively with depression (r=0.293; P<0.01) and fear (r=0.254; P<0.05). The anti-Semitic experiences in the post-Soviet-Union areas also correlated positively with limb pain (r=0.41, P<0.01), fatigue symptoms (r=0.296, P<0.01) and psychocardial symptoms (r=0.219, P<0.05). It was also confirmed that the male respondents recalled a controlling and overprotecting maternal rearing behavior more frequently than the German standard random sample (M=15.39 versus 18.6; t=2.68; P<0.01). The latter also correlated significantly positive with epigastric pain (r=0.349; P<0.01). The present results show that depression, fear and psychosomatic problems are common in Jewish residents with a background of migration from the post-Soviet-Union areas to Germany. Apart from the transgenerational passing of psychological traumata and the Holocaust experiences, other stressors like anti-Semitism, control and overprotection as parental rearing measures appear to be important factors specifically contributing to the pathogenesis of the attributed symptoms.
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Affiliation(s)
- E Ullmann
- Institute of Psychosocial Medicine and Psychotherapy University Hospital, Jena, Germany.
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31
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Pickering J. Bearing the unbearable: ancestral transmission through dreams and moving metaphors in the analtyic field. THE JOURNAL OF ANALYTICAL PSYCHOLOGY 2012; 57:576-96. [PMID: 23130614 DOI: 10.1111/j.1468-5922.2012.02004.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper explores how untold and unresolved intergenerational trauma may be transmitted through unconscious channels of communication, manifesting in the dreams of descendants. Unwitting carriers for that which was too horrific for their ancestors to bear, descendants may enter analysis through an unconscious need to uncover past secrets, piece together ancestral histories before the keys to comprehending their terrible inheritance die with their forebears. They seek the relational containment of the analytic relationship to provide psychological conditions to bear the unbearable, know the unknowable, speak the unspeakable and redeem the unredeemable. In the case of 'Rachael', initial dreams gave rise to what Hobson (1984) called 'moving metaphors of self' in the analytic field. Dream imagery, projective and introjective processes in the transference-countertransference dynamics gradually revealed an unknown ancestral history. I clarify the back and forth process from dream to waking dream thoughts to moving metaphors and differentiate the moving metaphor from a living symbol. I argue that the containment of the analytic relationship nested within the security of the analytic space is a necessary precondition for such healing processes to occur.
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Hueneke A. From Politics to Poetry. PSYCHOTHERAPY AND POLITICS INTERNATIONAL 2012. [DOI: 10.1002/ppi.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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34
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Carpenter L, Chung MC. Childhood trauma in obsessive compulsive disorder: the roles of alexithymia and attachment. Psychol Psychother 2011; 84:367-88. [PMID: 22903881 DOI: 10.1111/j.2044-8341.2010.02003.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the interrelationships between childhood trauma, attachment, alexithymia, and the severity of obsessive compulsive disorder (OCD) in a cohort of participants with OCD. RATIONALE There is a growing body of research linking traumatic experiences in childhood with the development of OCD. The mechanisms involved in this association are not yet clear. METHODS The sample was comprised of 82 people with OCD and 92 comparison participants. A cross-sectional design was used, utilizing internet-mediated administration of the Childhood Trauma Questionnaire - revised (CTQ-R); the Yale-Brown Obsessive Compulsive Scale - Self-Report (Y-BOCS-SR); the Experiences in Close Relationships Scale (ECR); and Toronto Alexithymia Scale (TAS-20). Partial least squares (PLS) analysis was used to determine significant paths between the constructs. RESULTS Results of PLS analysis supported all of the hypotheses made: there was a significant positive correlation between childhood trauma and attachment avoidance, which in turn was significantly positively associated with alexithymia. Alexithymia was significantly associated with the severity of OCD symptoms and the number of OCD symptoms. Mediational analysis showed that alexithymia significantly carried an influence from attachment avoidance to the severity of obsessions and the number of obsession symptoms. CONCLUSIONS There is a relationship between childhood trauma and OCD, however this relationship is not direct in nature but is influenced by peoples' past experiences with significant others and associated difficulties in emotional processing.
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Affiliation(s)
- Leanne Carpenter
- Psychological Therapies Service, Dorset Community Health Services, Dorset Primary Care Trust, UK
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35
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Scharf M, Mayseless O. Disorganizing experiences in second- and third-generation holocaust survivors. QUALITATIVE HEALTH RESEARCH 2011; 21:1539-1553. [PMID: 21189333 DOI: 10.1177/1049732310393747] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Second-generation Holocaust survivors might not show direct symptoms of posttraumatic stress disorder or attachment disorganization, but are at risk for developing high levels of psychological distress. We present themes of difficult experiences of second-generation Holocaust survivors, arguing that some of these aversive experiences might have disorganizing qualities even though they do not qualify as traumatic. Based on in-depth interviews with 196 second-generation parents and their adolescent children, three themes of disorganizing experiences carried across generations were identified: focus on survival issues, lack of emotional resources, and coercion to please the parents and satisfy their needs. These themes reflect the frustration of three basic needs: competence, relatedness, and autonomy, and this frustration becomes disorganizing when it involves stability, potency, incomprehensibility, and helplessness. The findings shed light on the effect of trauma over the generations and, as such, equip therapists with a greater understanding of the mechanisms involved.
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Affiliation(s)
- Miri Scharf
- Department of Counseling and Human Development, Faculty of Education, University of Haifa, Haifa 31905, Israel.
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36
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Doucet M, Rovers M. Generational Trauma, Attachment, and Spiritual/Religious Interventions. JOURNAL OF LOSS & TRAUMA 2010. [DOI: 10.1080/15325020903373078] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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Kaplan I. Effects of trauma and the refugee experience on psychological assessment processes and interpretation. AUSTRALIAN PSYCHOLOGIST 2009. [DOI: 10.1080/00050060802575715] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ida Kaplan
- Victorian Foundation for Survivors of Torture, Melbourne, Victoria, Australia
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Rezzoug D, Baubet T, Broder G, Taïeb O, Moro MR. Addressing the mother-infant relationship in displaced communities. Child Adolesc Psychiatr Clin N Am 2008; 17:551-68, viii. [PMID: 18558312 DOI: 10.1016/j.chc.2008.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Delivering appropriate care to refugee families requires complex care systems and models that take account of the social, cultural, and political dimensions as well as the psychologic dimension. Children born into these families are exposed to consequences of their own past experiences and also may be subject to the transmission of the traumas experienced by their parents. This exposure can lead to alterations in these children's individual creative resources. Early, tailored care should be provided for these families, so that the transmission of the trauma and its consequences can be managed or ameliorated.
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Affiliation(s)
- D Rezzoug
- Department of Child and Adolescent Psychiatry (Bobigny, France), University Paris 13, 125 Rue de Stalingrad, 93000 Bobigny, France.
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Sossin KM. Nonmentalizing states in early-childhood survivors of the Holocaust: developmental considerations regarding treatment of child survivors of genocidal atrocities. Am J Psychoanal 2007; 67:68-81. [PMID: 17510620 DOI: 10.1057/palgrave.ajp.3350014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This paper attempts to coalesce considerations of attachment processes, trauma, mentalization, and nonverbal behavior to underscore some of the developmental and therapeutic challenges demonstrated by older-adult child survivors of the Holocaust, and by implication, other child victims of similar genocidal and traumatic events. Young child survivors experienced not only their own traumatic exposure to violence, harm, and loss, but also the stress-transmission of the adult caregivers who raised them in the years that followed. For some, the horrendous losses, combined with impediments to organizing relationships, and to experiences of predictable and trusted continuities, negatively impact the development of the reflective function, and of interpretive skills basic to successful implicit relatedness and explicit exchanges. "Neutral flow" of bodily tension and shape often signals the freezing accompanying nonmentalizing states. Misalignments in individual personality structure and discordances in interpersonal exchange underscore the need to address fundamental building blocks of relatedness and mentalization in the therapeutic process.
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Affiliation(s)
- K Mark Sossin
- Department of Psychology, Pace University, New York, NY 10038, USA.
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Ringer F, Crittenden PM. Eating disorders and attachment: the effects of hidden family processes on eating disorders. EUROPEAN EATING DISORDERS REVIEW 2007; 15:119-30. [PMID: 17676680 DOI: 10.1002/erv.761] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIM This study examined pattern of attachment in cohort of women with an eating disorder to determine what types of self-protective strategies they used, and further whether there was a specific relationship between strategy and diagnosis. METHOD The participants were 62 young women with an eating disorder (19 with anorexia nervosa, 26 with bulimia nervosa and 17 with bulimic anorexia). Attachment was assessed using the Adult attachment interview (AAI), classified using Crittenden's Dynamic-Maturational Method. RESULTS The results indicated that all women with an eating disorder were anxiously attached. About half used an extreme coercive Type C strategy while most of the others combined coercion with an extreme dismissing Type A strategy. The content of the AAIs suggested lack of resolution of trauma or loss among the mothers and also of hidden family conflict between the parents. This in turn elicited extreme strategies for generating parent-child contingency from the daughters. CONCLUSIONS Central in almost all cases was the women's confusion regarding how parental behaviour was tied causally to their own behaviour. Questions are raised regarding the focus of treatment.
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Baider L, Goldzweig G, Ever-Hadani P, Peretz T. Psychological distress and coping in breast cancer patients and healthy women whose parents survived the Holocaust. Psychooncology 2006; 15:635-46. [PMID: 16363011 DOI: 10.1002/pon.1010] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychological distress levels of breast cancer patients whose parents were Holocaust survivors ('second-generation Holocaust' patients) were previously shown to be significantly higher than those of a matched group of patients with non-traumatized parents. In this study, we investigated whether this effect reflects only the generally higher distress levels of second-generation Holocaust women or whether breast cancer patients with traumatized parents also present lower adaptation abilities, which result in increased distress to the breast cancer diagnosis. We assessed psychological distress and measures of coping in 193 second-generation Holocaust patients diagnosed with breast cancer, 164 breast cancer patients with non-traumatized parents, 176 healthy second-generation Holocaust women, and 143 healthy women with non-traumatized parents. The main effect of cancer and the main effect of second-generation Holocaust survivor on psychological distress were found to be significant. These two factors (cancer x second generation) had a synergistic effect on the levels of depression and psychoticism. These results support the hypothesis that, at least on some psychological measures, the cumulative distressing effect of having traumatized parents and breast cancer diagnosis is higher than the effect of each factor alone.
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Affiliation(s)
- Lea Baider
- Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem 91120, Israel.
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Schechter DS, Coots T, Zeanah CH, Davies M, Coates SW, Trabka KA, Marshall RD, Liebowitz MR, Myers MM. Maternal mental representations of the child in an inner-city clinical sample: Violence-related posttraumatic stress and reflective functioning. Attach Hum Dev 2005; 7:313-31. [PMID: 16210242 DOI: 10.1080/14616730500246011] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Parental mental representations of the child have been described in the clinical literature as potentially useful risk-indicators for the intergenerational transmission of violent trauma. This study explored factors associated with the quality and content of maternal mental representations of her child and relationship with her child within an inner-city sample of referred, traumatized mothers. Specifically, it examined factors that have been hypothesized to support versus interfere with maternal self- and mutual-regulation of affect: posttraumatic stress disorder (PTSD) and maternal reflective functioning (RF). More severe PTSD, irrespective of level of RF, was significantly associated with the distorted classification of non-balanced mental representations on the Working Model of the Child Interview (WMCI) within this traumatized sample. Higher Levels of RF, irrespective of PTSD severity, were significantly associated with the balanced classification of maternal mental representations on the WMCI. Level of maternal reflective functioning and severity of PTSD were not significantly correlated in this sample. Clinical implications are discussed.
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Affiliation(s)
- Daniel S Schechter
- Division of Developmental Psychobiology, New York State Psychiatric Institute, Columbia College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
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Abstract
OBJECTIVE To present a critique of the ideas of Karl Popper, the philosopher of science, whose depiction of psychoanalysis as a pseudoscience is often used to justify attacks on psychoanalysis. METHOD Published sources are used to provide a brief intellectual biography of Popper, a summary of his concept of science and a summary of criticisms of Popper's view of science. His depiction of psychoanalysis and Freud's reply are presented. Clinical, experimental and neurobiological research which refutes Popper's view is summarized. RESULTS There is a vast scholarly published work critical of Popper's falsifiability criterion of science. Less recognized is Popper's misunderstanding and misrepresentation of psychoanalysis; his argument against it is logically flawed and empirically false. Even if Popper's theory of science is accepted, there is considerable clinical, experimental and neurobiological research in psychoanalysis which meets Popper's criterion of science. CONCLUSION Attacks on psychoanalysis based on Popper's theory of science are ill-founded and reflect inadequate scholarship.
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Affiliation(s)
- Don C Grant
- St. Vincents Hospital Area Mental Health Service, Melbourne, Australia.
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Laschinger B, Purnell C, Schwartz J, White K, Wingfield R. Sexuality and attachment from a clinical point of view. Attach Hum Dev 2004; 6:151-64. [PMID: 15370508 DOI: 10.1080/14616730410001688194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The clinical experience of five attachment-based psychoanalytic psychotherapists is pooled in an exploration of how issues in relation to sexuality and attachment emerge in the consulting room. Our clinical experience shows that sexuality, far from being a powerful instinctual drive that invariably needs to be explored clinically, is far more a reflection of early attachment histories. Instead of the standard pressure cooker of sexuality, which if not expressed leads to pathological emotional conflict we identify a melancholy sexuality, a cold arctic-like desert unwarmed by human relationship that barely achieves expression. We find that a broader and more fluid conception of sexuality as not just genitally focused but as erotic helps us relate to difficulties around sexuality as having to do with conflicts in relation to or associated with desire for contact and connection linked to past histories of loss, abandonment and sexual abuse. We argue theoretically that the psychological dimension of the biological system of human reproductive capacities, that is to say, the actually lived experience of human sexuality cannot be separated from the psychological dynamics of attachment within a social and cultural context. We discuss clinical issues including the sequelae of primary erotic attachments and working with sexual fantasies and working with erotic transference/countertransference re-enactments. A clinical example illustrates in some detail how we work with an adult survivor of sexual abuse troubled by intrusive sexual fantasies.
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Liotti G. Trauma, dissociation, and disorganized attachment: Three strands of a single braid. ACTA ACUST UNITED AC 2004. [DOI: 10.1037/0033-3204.41.4.472] [Citation(s) in RCA: 249] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Igreja V. The effects of traumatic experiences on the infant-mother relationship in the former war zones of central Mozambique: The case ofmadzawde in Gorongosa. Infant Ment Health J 2003. [DOI: 10.1002/imhj.10068] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Pasquini P, Liotti G, Mazzotti E, Fassone G, Picardi A. Risk factors in the early family life of patients suffering from dissociative disorders. Acta Psychiatr Scand 2002; 105:110-6. [PMID: 11939960 DOI: 10.1034/j.1600-0447.2002.01062.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To test the hypothesis that not only intrafamiliar childhood abuses inflicted to the patient, but also major losses or other severe life events suffered by the mother within 2 years of patient's birth, are risk factors for the development of dissociative disorders (DDs). METHOD A multicentric case-control study of 52 cases and 146 controls. RESULTS We estimated a crude odds ratio (OR) of 2.6 (adjusted 1.9) for mothers' losses or other severe life events experienced within 2 years of patient's birth, and a crude OR of 7.6 (adjusted 7.2) for patient's early traumatic experiences. CONCLUSION Mother's losses or other severe life events within 2 years of patient's birth and patient's traumatic experiences during childhood are risk factors for the development of dissociative disorders. A possible explanation of these findings is that disorganized or insecure attachment may increase susceptibility to traumatic experiences and propensity to dissociation in adult life.
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Affiliation(s)
- P Pasquini
- Department of Epidemiology and Clinical Psychology, Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy.
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